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BackgroundWhen compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission. ObjectiveThe ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety. MethodsThe cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort. ResultsPatients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P

To understand the latent categories of perceived stress in colorectal cancer patients and analyze the characteristics of different categories of patients.

Abstract Objective To understand the prevalence rate of obstructive pulmonary dysfunction in workers exposed to silica dust and analyze its risk factors, so as to provide reference for the formulation of diagnostic criteria for chronic obstructive pulmonary disease caused by occupational dust. Methods Data collection and structured questionnaire were used to collect the data of 2064 workers exposed to silica dust who underwent health examination in Hunan Occupational Disease Prevention and Control Hospital and Yuanling Second People’s Hospital from January 1, 2021 to June 30, 2022. The prevalence rate of obstructive pulmonary ventilation dysfunction was analyzed and the risk factors were analyzed. Results The prevalence rate of obstructive pulmonary ventilation dysfunction (FEV1/FVC

Abstract Comprehending the phylogeography of invasive organisms enhances our insight into their distribution dynamics, which is instrumental for the development of effective prevention and management strategies. In China, Pomacea canaliculata and Pomacea maculata are the two most widespread and damaging species of the non-native Pomacea spp.. Given this species’ rapid spread throughout country, it is urgent to investigate the genetic diversity and structure of its different geographic populations, a task undertaken in the current study using the COI and ITS1 mitochondrial and ribosomal DNA genes, respectively. The result of this study, based on a nationwide systematic survey, a collection of Pomacea spp., and the identification of cryptic species, showed that there is a degree of genetic diversity and differentiation in P. canaliculata, and that all of its variations are mainly due to differences between individuals within different geographical populations. Indeed, this species contains multiple haplotypes, but none of them form a systematic geographical population structure. Furthermore, the COI gene exhibits higher genetic diversity than the ITS1 gene. Our study further clarifies the invasive pathways and dispersal patterns of P. canaliculata in China to provide a theoretical basis.

Natriuretic peptide receptor-C (NPR-C) is highly expressed in adipose tissues and regulates obesity-related diseases; however, the detailed mechanism remains unknown. In this research, we aimed to explore the potential role of NPR-C in cold exposure and high-fat/high-sugar (HF/HS) diet-induced metabolic changes, especially in regulating white adipose tissue (WAT) mitochondrial function. Our findings showed that NPR-C expression, especially in epididymal WAT (eWAT), was reduced after cold exposure. Global Npr3 (gene encoding NPR-C protein) deficiency led to reduced body weight, increased WAT browning, thermogenesis, and enhanced expression of genes related to mitochondrial biogenesis. RNA-sequencing of eWAT showed that Npr3 deficiency enhanced the expression of mitochondrial respiratory chain complex genes and promoted mitochondrial oxidative phosphorylation in response to cold exposure. In addition, Npr3 KO mice were able to resist obesity induced by HF/HS diet. Npr3 knockdown in stromal vascular fraction (SVF)-induced white adipocytes promoted the expression of proliferator-activated receptor gamma coactivator 1α (PGC1α), uncoupling protein one (UCP1), and mitochondrial respiratory chain complexes. Mechanistically, NPR-C inhibited cGMP and calcium signaling in an NPR-B-dependent manner but suppressed cAMP signaling in an NPR-B-independent manner. Moreover, Npr3 knockdown induced browning via AKT and p38 pathway activation, which were attenuated by Npr2 knockdown. Importantly, treatment with the NPR-C-specific antagonist, AP-811, decreased WAT mass and increased PGC-1α, UCP1, and mitochondrial complex expression. Our findings reveal that NPR-C deficiency enhances mitochondrial function and energy expenditure in white adipose tissue, contributing to improved metabolic health and resistance to obesity.

Abstract Objective To improve our understanding of systemic lupus erythematosus (SLE)‐macrophage activation syndrome (MAS). Methods A systematic review was performed, to retrieve all those papers on patients with SLE‐MAS, in individual or aggregated form. The data in each of these medical records were extracted and analyzed to identify the characteristics of SLE‐MAS. Results A total of 86 SLE‐MAS patients were included (25 males and 61 females. The mean (±standard error of the mean) age was 31.21 ± 1.694 years. MAS occurred as the initial presentation of SLE in 47 people (54.65%) and during the course of SLE in 39 (45.35%). A coinfection was reported in 23 (26.74%) patients. The mean Lupus Erythematosus Disease Activity Index 2000 (SLEDAI‐2K) score was 16.54 ± 0.9462. Overall, 10 patients (11.63%) died. The SLEDAI‐2K score was higher in patients with MAS as an initial manifestation of SLE than in those where MAS occurred during the course of SLE. The proportion of patients receiving steroid pulse therapy was lower in patients with coinfections. The deceased group demonstrated lower platelet and ferritin levels. Multiple regression analysis revealed that age and thrombocytopenia were independent factors associated with poor prognosis. In receiver operating characteristic analysis, a platelet count cutoff value of ≤47 × 109/L was a predictor of poor outcome. Conclusions SLE‐MAS patients demonstrated high lupus activity, and lupus activity was especially higher in patients with MAS as an initial manifestation. Lupus activity was the predominant trigger of lupus MAS. Thrombocytopenia was an independent factor for poor prognosis.

Objective Explainable machine learning (XAI) was introduced in this study to improve the interpretability, explainability and transparency of the modelling results. The survex package in R was used to interpret and compare two survival models – the Cox proportional hazards regression (coxph) model and the random survival forest (rfsrc) model – and to estimate overall survival (OS) and its determinants in heart failure (HF) patients using these models. Methods We selected 1159 HF patients hospitalised at the First Affiliated Hospital of Kunming Medical University. First, the performance of the two models was investigated using the C-index, the integrated C/D AUC, and the integrated Brier score. Second, a global explanation of the whole cohort was carried out using the time-dependent variable importance and the partial dependence survival profile. Finally, the SurvSHAP(t) and SurvLIME plots and the ceteris paribus survival profile were used to obtain a local explanation for each patient. Results By comparing the C-index, the C/D AUC, and the Brier score, this study showed that the model performance of rfsrc was better than coxph. The global explanation of the whole cohort suggests that the C-reactive protein, lg BNP (brain natriuretic peptide), estimated glomerular filtration rate, albumin, age and blood chloride were significant unfavourable predictors of OS in HF patients in both the cxoph and the rfsrc models. By including individual patients in the model, we can provide a local explanation for each patient, which guides the clinician in individualising the patient's treatment. Conclusion By comparison, we conclude that the model performance of rfsrc is better than that of coxph. These two predictive models, which address not only the whole population but also selected patients, can help clinicians personalise the treatment of each HF patient according to his or her specific situation.

Abstract Integrating CYP2D6 genotyping and therapeutic drug monitoring (TDM) is crucial for guiding individualized atomoxetine therapy in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this retrospective study was (1) to investigate the link between the efficacy and tolerability of atomoxetine in children with ADHD and plasma atomoxetine concentrations based on their CYP2D6 genotypes; (2) to offer TDM reference range recommendations for atomoxetine based on the CYP2D6 genotypes of children receiving different dosage regimens. This retrospective study covered children and adolescents with ADHD between the ages of 6 and 60% of enrolled children belonged to the CYP2D6 extensive metabolizer (EM), while

Background Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, marked by hormonal imbalances and disruptions in glucose and lipid metabolism. Emerging research has indicated a correlation between lipids and PCOS, yet the specific lipid profiles or associated genes identified in various studies vary, and observational data alone cannot establish causation. Therefore, our study seeks to establish a causal association between lipidome and PCOS.Methods Data from genome-wide association studies, liposomes, metabolites, and PCOS-related information were collected. Four rounds of double-sample bidirectional intermediate Mendelian Randomization analyses including liposomes to disease, liposomes to metabolites, metabolites to disease, and reverse Mendelian Randomization analysis of lipids, total effect values and intermediary effect values were calculated. The proportion mediated by the intermediary effect was determined by dividing the intermediary effect value by the total effect value.Results The analyses revealed that three liposomes and nine metabolites were causally associated with PCOS. Specifically, phosphatidylcholine and 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol were identified as independent risk factors for PCOS through further Mendelian Randomization analysis. The risk of developing PCOS increased by 32% for every one standard deviation increase in phosphatidylcholine and by 17% for every one standard deviation increase in 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol. Furthermore, the study revealed that phosphatidylcholine can influence the development of PCOS with 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol acting as a mediator, explaining 4.97% of the effect.Conclusions This study confirmed a causal relationship between phosphatidylcholine and 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol with PCOS, where phosphatidylcholine can influence the occurrence of PCOS with 1-Stearoyl-2-Oleoyl-Glycosylphosphatidylinositol as a mediator.

Abstract Background Intraductal papillary mucinous neoplasm (IPMN) is a cystic tumor of the pancreas arising from abnormal papillary proliferation of ductal epithelial cells, and is a precancerous lesion of pancreatic malignancy. This study aimed to evaluate associations between acute pancreatitis (AP) and histologic subtypes of IPMN. Methods In the clinical study, patients with IPMN confirmed by surgical resection specimens at our institute between 2009 and 2021 were eligible for inclusion. Associations and predictive accuracy of AP on the presence of HGD were determined by logistic regressions. In addition, a systematic review and meta-analysis was conducted through literatures upon search in PubMed, Embase, CENTRAL, China National Knowledge Infrastructure (CKNI), and Wanfang database, up to June, 2023. Pooled effects of the associations between AP and HGD and intestinal epithelial subtype subtype, shown as odds ratios (ORs) with 95% confidence intervals (CIs), were calculated using random effects model. Results The retrospective cohort study included 47 patients (32 males, 15 females) diagnosed with IPMN at our center between 2009 and 2021, including 11 cases with AP (median 62 years) and 36 cases (median 64.5 years) without. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AP in predicting HGD were 78.7%, 57.1%, 82.5%, 36.4%, and 91.7%, respectively. Univariate logistic regression analysis showed that AP group had greater odds of presence of HGD (OR: 6.29,95% CI: 1.14–34.57) than non-AP group. Meta-analysis of five case-control studies in the literature included 930 patients and showed that AP-IPMN patients had higher odds for HGD (OR: 2.13, 95% CI 1.38–3.29) and intestinal epithelial subtype (OR: 5.38, 95% CI: 3.50–8.27) compared to non-AP IPMN. Conclusions AP is predictive of malignancy in patients with IPMN.

Objective: To select and use aptamers as molecular recognition elements to construct a biosensor based on the salt effect of gold nanoparticles for the rapid quantitative detection of staphylococcal enterotoxin A (SEA). Methods: Molecular docking and molecular dynamics simulation were used to truncate the SEA aptamer and predict the results. The simulation results were verified colorimetrically using gold nanoparticles. The optimal SEA aptamer was used as the molecular recognition element. The reaction system was optimized, the relationship between SEA mass concentration and absorbance ratio was explored, and the accuracy, precision and specificity of the developed method were evaluated. Results: An SEA aptamer with short sequence, high affinity, strong specificity and stability was selected. This method was characterized by low limit of detection (LOD) and satisfactory recoveries for spiked samples. Conclusion: Molecular simulation can effectively improve the screening efficiency of aptamers, and the proposed method can be used for rapid detection of SEA.

BackgroundIn the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change.MethodsWe examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I.ResultsWe observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: -0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications.DiscussionIncreasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).

Summary: When designing new conjugated microporous polymers (CMPs), major efforts are typically focused on selecting specific linkages and variations of building blocks to control their terminal structure and function. However, the constitutional isomerism of CMPs has seldom been considered so far as a crucial aspect. Herein, we successfully synthesize a pair of isomeric CMPs, named DBP-TEP (with phenanthrenequinone units) and DBQ-TEP (with anthraquinone units). Benefiting from the construction of the extended D-π-A conjugated skeleton, our isomeric CMPs are characterized by low band gaps and high charge transport efficiency, thus remarkably enhancing uranium photoreduction performance. Interestingly, the experiment results show that the adsorption capacity of DBP-TEP is 1.5 times that of DBQ-TEP under light irradiation. Additionally, both experiments in real-life and theoretical calculations prove that the phenanthrenonequinone unit does have a profound effect on the photocatalytic activity, which is predominantly attributed to the stronger electronic push-pull system and higher π-conjugated system in DBP-TEP. Science for society: Rare earth elements are a key component of modern technology. However, the mining of rare earth elements can lead to polluted waters entering the environment. Rare earth mine tailwater discharged from mining and leaching wastewater from improper mine disposal can result in a large amount of residual radionuclide uranium mainly in the form of UVI. To combat this, the reduction of highly environmentally mobile UVI to relatively immobile and low-solubility UIV has recently been recognized as one of the most promising technologies. Our study presents a green and efficient photocatalyst—a material that can absorb light influencing the rate of a chemical reaction—named 2,7-dibromo-9,10-phenanthrenedione (DBP) tetrakis(4-ethynylphenyl)methane (TEP), to extract uranium from rare earth wastewater. This study demonstrates that isomer pairs are key to efficiency: DBP-TEP (with phenanthrenequinone units) has much better photocatalytic performance in extracting uranium than 2,6-dibromoanthraquinone DBQ-TEP (with anthraquinone units).

At present, the key technical researches are carried out for the future exploration missions to dense atmosphere planets such as Jupiter. As a necessary aerodynamic decelerator for planetary exploration missions with dense atmosphere, parachutes face several big challenges, such as complex transonic/supersonic unsteady aerodynamic characteristics. Thus, it is necessary to study deeply and make clear the transonic/supersonic unsteady flow mechanisms around the parachute systems and its aerodynamic characteristics; however, these are still unknown to date. In this study, parachute structure systems are designed based on the Galileo exploration mission. Using the parachute models, the numerical simulations were conducted to investigate the complex flow phenomena and unsteady aerodynamics of parachute systems with different diameter ratios of capsule to canopy, under different freestream Mach numbers. As a result, it is found that when a parachute 2-body model with a bigger diameter ratio of capsule to canopy is placed in transonic flows, the wake of the forebody (capsule) is strong, and the shock wave in front of the canopy is weak. When the canopy shock moves upstream, the pressure fluctuation inside the canopy surface exhibits 3 stages of changes: high-frequency large-amplitude, low-frequency small-amplitude, and high-frequency small-amplitude. It is also found that in the supersonic flow cases, the amplitude and frequency of pressure fluctuations inside the canopy increase significantly, especially at Mach 2.0. This is due to the strong interactions between the shedding vortex of the wake and the shock wave in front of the canopy. However, for the parachute model with a small diameter ratio, the important shock waves in front of the canopy is not observed, and high-frequency and small-amplitude pressure variations remain, which is affected directly by the frequency and intensity of wake vortex shedding. In summary, as the Mach number increases, the amplitude and frequency of pressure fluctuations increase, and the average pressure distribution also increases, and the law of its influence becomes more complex.

Background: Trigger finger is a common hand condition in which a finger is unable to fully extend owing to a thickening of the tendon and its sheath, causing the finger to lock in a bent position. Aim: To assess the viability of carrying out trigger finger surgeries in NHS primary care in terms of clinician and patient acceptance, experience, and outcomes; and operational requirements of this service for wider application. Design & setting: A pilot study for a new service in primary care in Leicestershire, UK. Method: A total of 214 trigger finger release surgery procedures were carried out between 22 August 2019 and 25 October 2022 by a single hand surgeon in a single primary care surgery. Data were analysed using information from SystmOne, which is a patient database linked with the NHS. Results: Thirty-two cases out of 214 (15.0%) experienced a wait time of

BackgroundUrinary tract infection (UTI) accounts for a substantial portion of outpatient visits and antibiotic prescriptions in the United States. Few studies have considered sociodemographic factors including low socioeconomic status (SES)-which may increase residential crowding, inappropriate antibiotic prescribing, or comorbidities-as UTI or multidrug-resistant (MDR) UTI risk factors.MethodsWe used 2015-2017 electronic health record data from 2 California health care systems to assess whether 3 sociodemographic factors-use of Medicaid, use of an interpreter, and census tract-level deprivation-were associated with overall UTI or MDR UTI. UTIs resistant to ≥3 antibiotic classes were considered MDR.ResultsAnalyses included 601 352 UTI cases, 1 303 455 controls, and 424 977 urinary Escherichia coli isolates from Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. The MDR prevalence was 10.4% at KPSC and 12.8% at Sutter Health. All 3 sociodemographic factors (ie, use of Medicaid, using an interpreter, and community deprivation) were associated increased risk of MDR UTI. For example, using an interpreter was associated with a 36% (relative risk [RR], 1.36; 95% CI, 1.31 to 1.40) and 28% (RR, 1.28; 95% CI, 1.22 to 1.34) increased risk of MDR UTI at KPSC and Sutter Health, respectively, adjusted for SES and other potential confounding variables. The 3 sociodemographic factors were only weakly associated with UTI overall.ConclusionsWe found low SES and use of an interpreter to be novel risk factors for MDR UTI in the United States.

BackgroundUrinary tract infection (UTI) accounts for a substantial portion of outpatient visits and antibiotic prescriptions in the United States. Few studies have considered sociodemographic factors including low socioeconomic status (SES)-which may increase residential crowding, inappropriate antibiotic prescribing, or comorbidities-as UTI or multidrug-resistant (MDR) UTI risk factors.MethodsWe used 2015-2017 electronic health record data from 2 California health care systems to assess whether 3 sociodemographic factors-use of Medicaid, use of an interpreter, and census tract-level deprivation-were associated with overall UTI or MDR UTI. UTIs resistant to ≥3 antibiotic classes were considered MDR.ResultsAnalyses included 601 352 UTI cases, 1 303 455 controls, and 424 977 urinary Escherichia coli isolates from Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. The MDR prevalence was 10.4% at KPSC and 12.8% at Sutter Health. All 3 sociodemographic factors (ie, use of Medicaid, using an interpreter, and community deprivation) were associated increased risk of MDR UTI. For example, using an interpreter was associated with a 36% (relative risk [RR], 1.36; 95% CI, 1.31 to 1.40) and 28% (RR, 1.28; 95% CI, 1.22 to 1.34) increased risk of MDR UTI at KPSC and Sutter Health, respectively, adjusted for SES and other potential confounding variables. The 3 sociodemographic factors were only weakly associated with UTI overall.ConclusionsWe found low SES and use of an interpreter to be novel risk factors for MDR UTI in the United States.