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This study explores the trend of urban spatial networking driven by information technology transformation and regional economic rise, with a particular focus on the role of resilience in urban network structures in responding to risk disturbances. Scholars worldwide have developed a framework for urban network analysis based on transportation, enterprise, and population flow networks. Building on this framework, research has begun to focus on network resilience, emphasizing how networks maintain functional stability through self-adjustment and continuous development when faced with external shocks. The COVID-19 pandemic, as a global event, has profoundly affected societies and economies, particularly in terms of population mobility. Studies conducted during the pandemic have noted significant changes in population flows between Chinese cities, with residents opting for shorter, dispersed travel. However, the resilience of intraregional population flow networks during the post-pandemic period remains underexplored, providing a vital opportunity for supplementary research. Specifically, it is crucial to identify and understand the core nodes essential for supporting network resilience to guide safer urban development. Metropolitan areas are key hubs for regional resource coordination, and interactions among towns within these areas are crucial for coordinated regional development. Towns should form resilient connections and interaction paths, notably by harnessing the capacities of small towns to handle diverse risks. Dynamic changes within metropolitan areas are particularly noteworthy because urban functions are complex and exchanges are stable, enabling a certain level of recovery after risk disturbances. In contrast, townships may exacerbate the "siphon effect" due to their agricultural roles and population structures. This study examines the Nanjing Metropolitan Area as a typical case, leveraging mobile signaling data to quantitatively analyze the structural resilience of population flow networks before and during the pandemic in 2019 and 2021, respectively. The findings indicate that although the pandemic did not directly reduce overall population movement, it altered network hierarchy and spatial distribution, concentrating flows toward urban centers and reducing cross-boundary and long-distance connections. The leisure flow network exhibits greater volatility than the employment flow network, with the latter exhibiting stronger periodicity and stability. High-centrality cross-boundary nodes play a critical role in maintaining safe network operations. If these nodes fail, network density and stability decrease significantly, highlighting their importance for resilient urban construction.

Abstract Transcription Factors (TFs) are key regulators of how plants grow and develop. Among the diverse TF families, the Glabrous-enhancer binding protein (GeBP) family plays a key role in trichome initiation and leaf development. The specific roles of GeBP TFs in plants remain largely unexplored, although GeBP transcription factors play important roles in plants. This study identified 16 GhGeBP genes in Gossypium hirsutum, ranging from 534 bp (GhGeBP14) to 1560 bp (GhGeBP2). Phylogenetic analysis grouped 16 GhGeBP genes clustered into three subgroups, unevenly distributed across 14 chromosomes. Analysis of the cis-acting elements revealed 408 motifs in the 2 kb upstream regions of the promoters, including stress-responsive, phytohormone-responsive, and light-responsive elements. Tissue-specific expression analysis showed 8 GhGeBP genes were highly expressed across all tissues, while GhGeBP4 and GhGeBP12 were down-regulated under conditions of drought, salt, cold, and heat stress. A genome-wide association study (GWAS) identified GhGeBP4 was associated with fiber micronaire (FM) and fiber strength (FS), while GhGeBP9 was linked to the node of the first fruiting branch (NFFB) and flowering time (FT). Haplotype analysis revealed that GhGeBP4-HAP2 exhibited higher fiber quality traits, while GhGeBP9-HAP2 was associated with early maturity. The results of this study offer significant insights that are worthy of further investigation into the role of the GhGeBP gene family in G. hirsutum and promising targets for marker-assisted selection strategies in cotton breeding programs, particularly for improving fiber quality and early maturity traits.

Abstract Background Cotton serves as a primary source of natural fibers crucial for the textile industry. However, environmental elements such as drought have posed challenges to cotton cultivation, resulting in adverse impacts on both production and fiber quality. Improving cotton’s resilience to drought could mitigate yield losses and foster the expansion of cotton farming. Rab7 protein, widely present in organisms, controls the degradation and recycling of cargo, and has a potential role in biotic and abiotic tolerance. However, comprehensive exploration of the Rab7 gene family in Gossypium remains scarce. Results Herein, we identified a total of 10, 10, 20, and 20 Rab7 genes through genome-wide analysis in Gossypium arboreum, Gossypium raimondii, Gossypium hirsutum, and Gossypium barbadense, respectively. Collinearity analysis unveiled the pivotal role of whole genome or segmental duplication events in the expansion of GhRab7s. Study of gene architecture, conserved protein motifs, and domains suggested the conservation of structure and function throughout evolution. Exploration of cis-regulatory elements revealed the responsiveness of GhRab7 genes to abiotic stress, corroborated by transcriptome analysis under diverse environmental stresses. Notably, the greatly induced expression of GhRab7B3-A under drought treatment prompted us to investigate its function through virus-induced gene silencing (VIGS) assays. Silencing GhRab7B3-A led to exacerbated dehydration and wilting compared with the control. Additionally, inhibition of stomatal closure, antioxidant enzyme activities and expression patterns of genes responsive to abiotic stress were observed in GhRab7B3-A silenced plants. Conclusions This study sheds light on Rab7 members in cotton, identifies a gene linked to drought stress, and paves the way for additional investigation of Rab7 genes associated with drought stress tolerance.

Abstract Background The cotton whitefly (Bemisia tabaci) is a major global pest, causing significant crop damage through viral infestation and feeding. Traditional B. tabaci recognition relies on human eyes, which requires a large amount of work and high labor costs. The pests overlapping generations, high reproductive capacity, small size, and migratory behavior present challenges for the real-time monitoring and early warning systems. This study aims to develop an efficient, high-throughput automated system for detection of the cotton whiteflies. In this work, a novel tool for cotton whitefly fast identification and quantification was developed based on deep learning-based model. This approach enhances the effectiveness of B. tabaci control by facilitating earlier detection of its establishment in cotton, thereby allowing for a quicker implementation of management strategies. Results We compiled a dataset of 1200 annotated images of whiteflies on cotton leaves, augmented using techniques like flipping and rotation. We modified the YOLO v8s model by replacing the C2f module with the Swin-Transformer and introducing a P2 structure in the Head, achieving a precision of 0.87, mAP50 of 0.92, and F1 score of 0.88 through ablation studies. Additionally, we employed SAHI for image preprocessing and integrated the whitefly detection algorithm on a Raspberry Pi, and developed a GUI-based visual interface. Our preliminary analysis revealed a higher density of whiteflies on cotton leaves in the afternoon and the middle-top, middle, and middle-down plant sections. Conclusion Utilizing the enhanced YOLO v8s deep learning model, we have achieved precise detection and counting of whiteflies, enabling its application on hardware devices like the Raspberry Pi. This approach is highly suitable for research requiring accurate quantification of cotton whiteflies, including phenotypic analyses. Future work will focus on deploying such equipment in large fields to manage whitefly infestations.

Abstract Background Begomoviruses are major constraint in the production of many crops. Upon infection, begomoviruses may substantially modulate plant biological processes. While how monopartite begomoviruses interact with their plant hosts has been investigated extensively, bipartite begomoviruses-plant interactions are understudied. Moreover, as one of the major groups of hosts, cucurbitaceous plants have been seldom examined in the interaction with begomoviruses. Results We profiled the zucchini transcriptomic changes induced by a bipartite begomovirus squash leaf curl China virus (SLCCNV). We identified 2275 differentially-expressed genes (DEGs), of which 1310 were upregulated and 965 were downregulated. KEGG enrichment analysis of the DEGs revealed that many pathways related to primary and secondary metabolisms were enriched. qRT-PCR verified the transcriptional changes of twelve selected DEGs induced by SLCCNV infection. Close examination revealed that the expression levels of all the DEGs of the pathway Photosynthesis were downregulated upon SLCCNV infection. Most DEGs in the pathway Plant-pathogen interaction were upregulated, including some positive regulators of plant defenses. Moreover, the majority of DEGs in the MAPK signaling pathway-plant were upregulated. Conclusion Our findings indicates that SLCCNV actively interact with its cucurbitaceous plant host by suppressing the conversion of light energy to chemical energy and inducing immune responses. Our study not only provides new insights into the interactions between begomoviruses and host plants, but also adds to our knowledge on virus-plant interactions in general.

On December 18, 2023, an Ms 6.2earthquake occurred in Jishishan County, Linxia Prefecture, Gansu Province, causing a large number of geological disasters and threatening people's lives and the safety of infrastructure. After the earthquake, Gansu and Qinghai provincial governments quickly deployed hundreds of geology professionals to carried out the investigation and verification geological disasters in the earthquake area. Based on the results of the earthquake geohazard investigation and verification, this paper analyses the characteristics, control factors and development trend of the earthquake-induced geohazards, and puts forward suggestions on disaster prevention and risk mitigation measures. Till December 23, a total of 2044 geohazards have been checked, including 78 new geohazards, 88 existing geohazards with intensified deformation due to earthquake, and 1 878 existing geohazards without obvious different from before. Most of new and intensified deforming geohazards are collapse, accounting for 67.5%, followed by landslide, accounting for 31.9%. Most of new and intensified deforming geohazards are small in scale, accounting for 84.9%, followed by medium, accounting for 10.8%. Disaster mode of new and intensified deforming geohazards are mostly small collapse threatening houses and roads. The co-seismic geohazards are densely distributed along the seismic fault, and the spatial density increases with the enhancement of earthquake intensity. Data from 206 groups of accelerate-meters within 50 km from the epicenter of the National Geological Safety Monitoring Network showed that the peak acceleration of the earthquake area was 30.4～1969.7 mg. and decayed logarithm with the increase of the distance from the epicenter. In addition, the surface deformation monitoring equipment also recorded the co-seismic displacement curve of a typical landslide. Analysis shows, earthquake put a deteriorate effect to rock and soil, which decreased their integration and strength. There is a magnificent geohazard after-effect of earthquake; collapse, landslide and debris flow will be much often than before. So the authors suggest: (1) update earthquake geohazard database as soon as possible, (2) work out targeted prevention and control measures for the geohazards with large potential danger, (3) conduct comprehensive remote sensing monitoring and research of earthquake-induced geohazard mechanism, (4) improve the meteorological early warning model and threshold. By all this efforts the risk of geohazards after earthquake will be reduced and controlled.

Abstract Background Monoacylglycerol lipase (MAGL) genes belong to the alpha/beta hydrolase superfamily, catalyze the terminal step of triglyceride (TAG) hydrolysis, converting monoacylglycerol (MAG) into free fatty acids and glycerol. Results In this study, 30 MAGL genes in upland cotton have been identified, which have been classified into eight subgroups. The duplication of GhMAGL genes in upland cotton was predominantly influenced by segmental duplication events, as revealed through synteny analysis. Furthermore, all GhMAGL genes were found to contain light-responsive elements. Through comprehensive association and haplotype analyses using resequencing data from 355 cotton accessions, GhMAGL3 and GhMAGL6 were detected as key genes related to lipid hydrolysis processes, suggesting a negative regulatory effect. Conclusions In summary, MAGL has never been studied in upland cotton previously. This study provides the genetic mechanism foundation for the discover of new genes involved in lipid metabolism to improve cottonseed oil content, which will provide a strategic avenue for marker-assisted breeding aimed at incorporating desirable traits into cultivated cotton varieties.

Objectives: Efforts to shorten rifampicin-resistant tuberculosis (RR-TB) treatment have led to concerns about hepatotoxicity in shorter regimens. We evaluated hepatotoxicity in two novel regimens against the standard shorter regimen recommended by the World Health Organization (WHO). Methods: Participants from the TB-TRUST and TB-TRUST plus trials were assigned to the WHO shorter regimen, a levofloxacin (Lfx)-based regimen, or a bedaquiline (Bdq)-based regimen. Liver function was tested bi-weekly in the first month, then monthly until treatment ended. Eligibility required receiving at least one drug dose and undergoing at least two liver function tests. Results: Of 429 patients, hepatotoxicity was most prevalent in the WHO shorter group (26.7% of 169), compared to 4.7% in the Lfx group (172 patients), and 5.7% in the Bdq group (88 patients). The median peak alanine aminotransferase levels were 1.67 × upper limit of normal (ULN) for WHO, 0.82 × ULN for Lfx, and 0.88 × ULN for Bdq groups. The incidence of drug-induced liver injury was significantly higher in the WHO group (18.3%) than in the Lfx (3.5%) and Bdq (4.6%) groups. The time to significant alanine aminotransferase elevation was about 2.8 months, with no differences between groups. Conclusions: Two novel regimens demonstrated lower hepatotoxicity compared to the WHO's shorter regimen. Entire course management monitoring is recommended in RR-TB treatment.

Objective: Ferroptosis represents a form of regulated cellular death dependent upon iron and lipid peroxidation derivatives, holding considerable implications for cerebral and neurologic pathologies. In the present study, we endeavored to elucidate the molecular mechanisms governing ferroptosis and appraise the therapeutic value of electrical stimulation of median nerve in addressing cognitive impairments following traumatic brain injury (TBI), employing a rodent model. Methods: In this study, we established a rat model to investigate the cognitive impairments resulting from TBI, followed by the application of median nerve stimulation (MNS). Initially, rats received an intraperitoneal injection of Erastin (2 mg/kg) prior to undergoing MNS. After 24 h of MNS treatment, the rats were subjected to an open field test to evaluate their cognitive and motor functions. Subsequently, we conducted biochemical assays to measure the serum levels of GSH, MDA and SOD. The structural integrity and cellular morphology of hippocampal tissue were examined through H&E staining, Nissl staining and transmission electron microscopy. Additionally, we assessed the expression levels of proteins crucial for neuronal health and function in the hippocampus, including VEGF, SLC7A11, GPX4, Nrf2, α-syn, NEUN and PSD95. Results: Compared to the control group, rats in the stimulation group demonstrated enhanced mobility, reduced levels of tissue damage, a decrease in MDA concentration, and increased levels of GSH and SOD. Additionally, there was a significant upregulation in the expression of proteins critical for cellular defense and neuronal health, including GPX4, SLC7A11, Nrf2, VEGF, α-syn, NEUN, and PSD95 proteins. Conversely, rats in the Erastin group demonstrated decreased mobility, exacerbated pathological tissue damage, elevated MDA concentration, and decreased levels of GSH and SOD. There was also a notable decrease in the expression of GPX4, SLC7CA11, Nrf2, and VEGF proteins. The expression levels of α-syn, NEUN, and PSD95 were similarly diminished in the Erastin group. Each of these findings was statistically significant, indicating that MNS exerts neuroprotective effect in the hippocampal tissue of rats with TBI by inhibiting the ferroptosis pathway. Conclusion: (1) MNS may enhance the cognitive and behavioral performance of rats after TBI; (2) MNS can play a neuroprotective role by promoting the expression of nerve injury-related proteins, alleviating oxidative stress and ferroptosis process; (3) MNS may inhibit ferroptosis of neuronal cells by activating Nrf2/ GPX4 signaling pathway, thereby improving cognitive impairment in TBI rats.

Background: The complexity of the neurophysiological mechanisms underlying human consciousness is widely acknowledged, with information processing and flow originating in cortex conceived as a core mechanism of consciousness emergence. Combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) is considered as a promising technique to understand the effective information flow associated with consciousness. Objectives: To investigate information flow with TMS-EEG and its relationship to different consciousness states. Methods: We applied an effective information flow analysis by combining time-varying multivariate adaptive autoregressive model and adaptive directed transfer function on TMS-EEG data of frontal, motor and parietal cortex in patients with disorder of consciousness (DOC), including 14 vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients, 21 minimally conscious state (MCS) patients, and 22 healthy subjects. Results: TMS in DOC patients, particularly VS/UWS, induced a significantly weaker effective information flow compared to healthy subjects. The bidirectional directed information flow was lost in DOC patients with TMS of frontal, motor and parietal cortex. The interactive ROI rate of the information flow network induced by TMS of frontal and parietal cortex was significantly lower in VS/UWS than in MCS. The interactive ROI rate correlated with DOC clinical scales. Conclusions: TMS-EEG revealed a physiologically relevant correlation between TMS-induced information flow and levels of consciousness. This suggests that breakdown of effective cortical information flow serves as a viable marker of human consciousness. Significance: Findings offer a unique perspective on the relevance of information flow in DOC, thus providing a novel way of understanding the physiological basis of human consciousness.

Abstract Background Schizophrenia (SCZ) is a profound mental disorder with a multifactorial etiology, including genetics, environmental factors, and demographic influences such as ethnicity and geography. Among these, the studies of SCZ also shows racial and regional differences. Methods We first established a database of biological samples for SCZ in China’s ethnic minorities, followed by a serum metabolomic analysis of SCZ patients from various ethnic groups within the same region using the LC-HRMS platform. Results Analysis identified 47 metabolites associated with SCZ, with 46 showing significant differences between Miao and Han SCZ patients. These metabolites, primarily fatty acids, amino acids, benzene, and derivatives, are involved in fatty acid metabolism pathways. Notably, L-Carnitine, L-Cystine, Aspartylphenylalanine, and Methionine sulfoxide demonstrated greater diagnostic efficacy in Miao SCZ patients compared to Han SCZ patients. Conclusion Preliminary findings suggest that there are differences in metabolic levels among SCZ patients of different ethnicities in the same region, offering insights for developing objective diagnostic or therapeutic monitoring strategies that incorporate ethnic considerations of SCZ.

Abstract Background This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. Methods This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. Results The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. Conclusion Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.

Abstract Quantum effects in photosynthetic energy transport in nature, especially for the typical Fenna-Matthews-Olson (FMO) complexes, are extensively studied in quantum biology. Such energy transport processes can be investigated as open quantum systems that blend the quantum coherence and environmental noise, and have been experimentally simulated on a few quantum devices. However, the existing experiments always lack a solid quantum simulation for the FMO energy transport due to their constraints to map a variety of issues in actual FMO complexes that have rich biological meanings. Here we successfully map the full coupling profile of the seven-site FMO structure by comprehensive characterisation and precise control of the evanescent coupling of the three-dimensional waveguide array. By applying a stochastic dynamical modulation on each waveguide, we introduce the base site energy and the dephasing term in coloured noise to faithfully simulate the power spectral density of the FMO complexes. We show our photonic model well interprets the phenomena including reorganisation energy, vibrational assistance, exciton transfer and energy localisation. We further experimentally demonstrate the existence of an optimal transport efficiency at certain dephasing strength, providing a window to closely investigate environment-assisted quantum transport.

Pandanus amaryllifolius, known as Pandan, serves as a coloring agent and spice in food. The effects of lactic acid bacteria (LAB) on Pandan are underexplored. This study aimed to investigate changes in physicochemical properties, antioxidant activity, volatile compounds and metabolites of Pandan fermented with Lactobacillus acidophilus, Levilactobacillus brevis and Lacticaseibacillus rhamnosus. Fermented Pandan showed increased total phenol (13 %–21 %) and flavonoid (33 %–53 %) content. Pandan fermented with L. rhamnosus exhibited significantly higher antioxidant activity, followed by those fermented with L. brevis and L. acidophilus. Key components like naringenin and volatile compounds such as α-ionone significantly increased after fermentation, with the production of new compounds, including damascenone and linalool. These compounds enhance the flavor and functional properties of fermented Pandan. This research lays a foundation for developing novel LAB-fermented Pandan products.

Background: Simulation-based medical education (SBME) is a widely used method in medical education. This study aims to analyze publications on SBME in terms of countries, institutions, journals, authors, and keyword co-occurrence, as well as to identify trends in SBME research. Methods: We retrieved the Publications on SBME from the Web of Science Core Collection (WoSCC) database from its inception to January 27, 2024. Microsoft Excel 2019, CiteSpace, and VOSviewer were used to identify the distribution of countries, journals, and authors, as well as to determine the research hotspots. Results: We retrieved a total of 11272 publications from WoSCC. The number of documents published in 2022 was the highest in the last few decades. The USA, the UK, and Canada were three key contributors to this field. The University of Toronto, Stanford University, and Harvard Medical School were the top major institutions with a larger number of publications. Konge, Lars was the most productive author, while McGaghie, William C was the highest cited author. BMC Medical Education has the highest number of publications among journals. The foundational themes of SBME are “Patient simulation,” “extending reality,” and “surgical skills.” Conclusions: SBME has attracted considerable attention in medical education. The research hotspot is gradually shifting from traditional simulations with real people or mannequins to virtual, digitally-based simulations and online education. Further studies will be conducted to elucidate the mechanisms of SBME. The utilization of SBME will be more rationalized.

BackgroundThe increasing influence of overactive bladder (OAB) on physical as well as mental health of individuals is becoming more pronounced annually, as evidenced by the urge urinary incontinence and nocturia. Symptoms in OAB patients may be influenced by inflammation and oxidative stress. Flavonoids are recognized as significant anti-inflammatory and antioxidant agents, which are commonly available in fruits, tea, vegetables, etc. Previous research has demonstrated the therapeutic potential of flavonoids and their subclasses in treating inflammation, and oxidative stress. Despite this, there remains a paucity of research exploring the potential correlation between flavonoid consumption, specifically within distinct subclasses, and OAB. Thus, our study aims to investigate the relationship between flavonoid intake and OAB to identify possible dietary interventions for OAB management.MethodsWe utilized the survey data from the National Health and Nutrition Examination Survey (NHANES) and the USDA Food and Nutrient Database for Dietary Studies (FNDDS) to investigate the relationship between dietary intake of total and subclass flavonoids and the risk of OAB based on 13,063 qualified American adults. The dietary flavonoid intake was estimated from two 24-h dietary recalls. Weighted multivariate logistic regression model, quantile-based g-computation, restricted cubic spline model, and stratified analysis were used to explore the association between flavonoid intake and OAB, respectively.ResultsThe participants diagnosed with OAB exhibited a higher percentage of being female, older, Non-Hispanic Black, unmarried, former drinkers, having a lower annual household income, lower poverty to income ratio, lower educational attainment, and a higher likelihood of being obese and smokers. Upon adjusting for confounding factors, the weighted logistic regression models revealed that the third quartile of consumption of anthocyanidin and the second quartile of consumption of flavone were significantly associated with the reduced odds of OAB, while total flavonoid consumption did not show a significant correlation with the risk of OAB. The quantile-based g-computation model indicated that flavone, anthocyanidin and flavonol were the primary contributors to the observed negative correlation. Furthermore, the restricted cubic spline models demonstrated a J-shaped non-linear exposure-response association between anthocyanidin intake and the risk of OAB (Pnonlinear = 0.00164). The stratified and interaction analyses revealed that the relationship between anthocyanidin intake and the risk of OAB was significantly influenced by age (Pinteraction = 0.01) and education level (Pinteraction = 0.01), while the relationship between flavone intake and the risk of OAB was found to vary by race (Pinteraction = 0.02) and duration of physical activity (Pinteraction = 0.05).ConclusionOur research suggests that consuming a diet rich in flavonoid subclass anthocyanidin and flavone is associated with a reduced risk of OAB, potentially offering clinical significance in the prevention of OAB development. This underscores the importance of dietary adjustments in the management of OAB symptoms.

MicroRNAs (miRNAs) are small noncoding RNAs of 18–25 bases. miRNAs are also important new biomarkers that can be used for disease diagnosis in the future. Studies have shown that miR-124 levels are significantly elevated during acute myocardial infarction (AMI) and play a key role in the cardiovascular system. A variety of methods have been established to detect myocardial infarction-related miRNAs. However, most require complex miRNA extraction and isolation, and these methods are virtually undetectable when RNA levels are low in the sample. It may lead to biased results. Thus, it is necessary to develop a technique that can detect miRNA without extracting it, which means that intracellular detection is of great significance. Here, we improved the traditional silicon spheres and obtained a biosensor that could effectively capture and detect specific noncoding nucleic acids through the layer-by-layer assembly method. The sensor is protected by hyaluronic acid so it can successfully escape the lysosome into the cell and achieve detection. With the help of a full-featured microplate reader, we determined that the detection limit of the biosensor could reach 1 fM, meeting the needs of intracellular detection. At the same time, we prepared an oxidative stress cardiomyocyte infarction model and successfully captured the overexpressed miR-124 in the infarcted cells to achieve in situ detection. This study could provide a new potential tool to develop miRNAs for sensitive diagnosis in AMI, and the proposed strategy implies its potential for biomedical research.

The Joint Video Experts Team (JVET) has explored neural network-based video coding (NNVC) and is trying to introduce NNVC into the versatile video coding (VVC). In NNVC, the NN-based in-loop filter is the most active area, which is very close to deployment of software. Recent NN-based in-loop filters start adopting Transformer to capture context information, but it causes a remarkable increase of complexity to about 1000 kMAC/Pixel. In this paper, we propose a low complexity NN-based in-loop filter for VVC based on convolution and Transformer, named ConvTransNet. ConvTransNet adopts a pyramid structure in feature extraction to capture both global contextual information and local details at multiple scales. Moreover, ConvTransNet combines convolutional neural network (CNN) and Transformer into the in-loop filter. CNN captures local features and reduces compression artifacts in an image, while Transformer captures long-range spatial dependency and enhances global structures in an image. Thus, ConvTransNet enables the NN-based in-loop filter to reduce compression artifacts and enhance visual quality in an image. In ConvTransNet, we use grouped convolutions in CNN and depthwise convolutions in Transformer to reduce the network complexity. Therefore, ConvTransNet successfully captures both local spatial structure and global contextual information in an image and achieves outstanding performance in terms of BD-rate and complexity. Experimental results show that the proposed NN-based in-loop filter based on ConvTransNet achieves average {6.58%, 23.02%, 23.04%} and {8.18%, 22.67%, 22.00%} BD-rate reductions for {Y, U, V} channels over VTM_11.0-NNVC_2.0 anchor under AI and RA configurations, respectively.

In this study, the age hardening behavior of hot extruded Mg-8Gd-4Y-1Sm-0.5Zr (GWS841) alloy, mechanical properties and microstructural evolution of hot extruded GWS841 alloy during elevated temperature tensile processes were mainly investigated. The results show that the hot extrusion aged GWS841 alloy possess excellent mechanical properties at room and high temperature, which are 397 MPa, 386 MPa, 376 MPa, and 312 MPa at 25 °C, 200 °C, 250 °C, and 300 °C, respectively. After aging for 200 °C × 96 h, the hot extruded GWS841 alloy reaches its maximum hardness and room temperature tensile strength, and strengthening precipitation phase, being nano β′ phase, approximately 12 nm × 20 nm in size, precipitates simultaneously in three prismatic planes, (1‾21‾0)α、 (1‾1‾20)α and (21‾1‾0)α planes, which present precipitation strengthening behavior. During tensile testing at 200 °C, the strengthening precipitate remains β′ phase. During elevated tensile processes at 250 °C and 300 °C, strengthening precipitation phase undergoes significant transformation at grain boundary, β′ phase → β phase, and additionally, nano precipitation zone formed by rare earth atoms aggregation along grain boundary, which strengthen the grain boundary. During elevated tensile deformation at 300 °C, β′ phase completely disappeared and transformed into nano rare earth atom cluster region uniformly distributing inner grain.

Abstract Background The aim of this study was to investigate the imaging features, lymph node metastasis, and genetic mutations in micropapillary lung adenocarcinoma (imaging with mixed ground‐glass nodules) ≤2 cm, to provide a more precise and refined basis for the selection of lung segment resection. Methods A retrospective analysis of 162 patients with surgically resected pathologically confirmed cancers ≤2.0 cm in diameter (50 cases of micropapillary mixed ground‐glass nodules [mGGNs], 50 cases of nonmicropapillary mGGNs, and 62 cases of micropapillary SNs [solid nodules]) was performed. mGGNs were classified into five categories according to imaging features. The distribution of these five morphologies in micropapillary with mGGN and nonmicropapillary with mGGN was analyzed. The postoperative pathology and prognosis of lymph node metastasis were also compared between micropapillary mGGNs and micropapillary with SNs. After searching the TCGA database, we demonstrated heterogeneity, high malignancy and high risk of microcapillary lung cancer cancers. Results Different pathological subtypes of mGGN differed in morphological features (p

This study aimed to evaluate the nutritional requirements of Saccharomyces cerevisiae to improve low ethanol production in some fruit wines. The growth kinetics, ethanol production and nutrient requirements of S. cerevisiae were analyzed in chemically defined media. The results revealed that Ca2+, Fe2+, Co2+, Mo2+, Cu2+ and BO33− were predominantly utilized during the late lag phase, whereas free amino acids, nicotinic acid, calcium pantothenate, Na+ and Mg2+ were mainly consumed during the logarithmic phase. Compared with the control medium, supplementation with threonine, inositol, calcium pantothenate, thiamine hydrochloride, riboflavin, biotin, MgSO4 or KH2PO4 significantly increased the ethanol content by 1.10-fold (p < 0.05). Furthermore, adding key nutrients to noni-, guava- and mango juice significantly shortened the fermentation time and increased the final alcohol content of the fruit wines (p < 0.05). This study provides scientific insights and effective methods for shortening fermentation time and increasing alcohol content with S. cerevisiae in some fruit wines.

Pandan pigment (Pandanus amaryllifolius) is widely used as a natural food coloring and flavoring agent. However, its application in food is limited because of its susceptibility to thermal degradation during food processing, which affects both pigment stability and color. Despite its growing use, there is limited research on how common food ingredients can mitigate this degradation. This study addresses this gap by exploring the effects of sucrose, lactose, rice starch, whey protein, and soy protein isolate on the thermal and color stability of pandan pigment under various heating conditions (65 °C, 95 °C, 115 °C, and 121 °C for 15 min). Spectroscopic techniques (UV–visible, infrared, and fluorescence) and laser confocal microscopy were used to elucidate the molecular interactions. The results revealed that rice starch provided the strongest protection, followed by whey protein, soy protein isolate, lactose, and sucrose, although the protective effects decreased at higher temperatures. These findings offer new insights into the use of sugars and proteins to increase the thermal stability of natural pigments in food applications.

BackgroundTreatment of disorders of consciousness (DOC) poses a huge challenge for clinical medicine. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation method, which shows potential in improving recovery of DOC. However, the evidence came from single-center, small-sample randomized controlled trial, which is insufficient to form a conclusion. Thereby, we propose a prospective, multicenter, double-blind, stratified, two-arm randomized controlled trial protocol to investigate the efficacy and safety of bilateral synchronous taVNS for treatment of DOC.MethodsWe aim to recruit 382 patients with prolonged DOC, and divide them into an active stimulation group and a sham stimulation group. The patients in the active stimulation group will receive bilateral synchronous taVNS with a 200 μs pulse width, 20 Hz frequency, and personal adjusted intensity. The sham stimulation group will wear the same stimulator but without current output. Both groups will receive treatment for 30 min per session, twice per day, 6 days per week lasting for 4 weeks. The clinical assessment including Coma Recovery Scale-Revised (CRS-R), Full Outline of Unresponsiveness (FOUR), Glasgow Coma Scale (GCS), and Extended Glasgow Outcome Scale (GOS-E) will be conducted to evaluate its efficacy. Heart rate variability (HRV), blood pressure, and adverse events will be recorded to evaluate its safety.DiscussionThese results will enable us to investigate the efficacy and safety of taVNS for DOC. This protocol will provide multicenter, large-sample, high-quality Class II evidence to support bilateral synchronous taVNS for DOC, and will advance the field of treatment options for DOC.Clinical trial registration:https://www.chictr.org.cn/showproj.html?proj=221851, ChiCTR2400081978.

Background: Dysphagia, or difficulty swallowing, is a prevalent complication of Parkinson's disease (PD), which can significantly impair quality of life. Despite the numerous studies on dysphagia in PD published in various journals, there remains a dearth of bibliometric analysis within this domain. This study thus aims to examine the global patterns of research on dysphagia after PD over the past 20 years, employing a visual analysis. Material and methods: This investigation aimed to gather pertinent publications concerning dysphagia in PD from the SCI-Expanded database of the Web of Science Core Collection (WoSCC), covering the period from 2002 to 2022. To dissect and visually represent the collated corpus, we harnessed the capacities of CiteSpace, VOSviewer and R software for meticulous bibliometric scrutiny. Results: The bibliometric study encompassed a total of 692 publications. Within the scope of autocratic nations, the USA emerged as the leading country in the quantity of research outputs. The University of Florida stood out as the most prolific academic entity, with Troche MS being the foremost author, contributing to 21 publications. The journal ''Dysphagia'' featured as the prime venue for publication. Key trending terms identified over the last 20 years include ''Parkinson's disease,'' ''dysphagia,'' ''oropharyngeal dysphagia,'' and ''prevalence.'' Conclusion: Bibliometric analysis on dysphagia in PD offers a detailed overview of the development of scholarly publications, enabling scholars to grasp the current state of research within their field. It also serves as a benchmark for shaping future research directions.

Doxorubicin-induced cardiotoxicity (DIC) adversely impacts patients' long-term health and quality of life. Its underlying mechanism is complex, involving regulatory cell death mechanisms, such as ferroptosis and autophagy. Moreover, it is a challenge faced by patients undergoing cardiac rehabilitation. Endurance exercise (E-Exe) preconditioning effectively counters DIC injury, potentially through the adenosine monophosphate-activated protein kinase (AMPK) pathway. However, detailed studies on this process's mechanisms are scarce. Here, E-Exe preconditioning and DIC models were established using mice and primary cultured adult mouse cardiomyocytes (PAMCs). Akin to ferrostatin-1 (ferroptosis inhibitor), rapamycin (autophagic inducer), and MitoTEMPO (mitochondrial free-radical scavenger), E-Exe preconditioning effectively alleviated Fe2+ accumulation and oxidative stress and improved energy metabolism and mitochondrial dysfunction in DIC injury, as demonstrated by multifunctional, enzymatic, and morphological indices. However, erastin (ferroptosis inducer), 3-methyladenine (autophagic inhibitor), adenovirus-mediated AMPKα2 downregulation, and AMPKα2 inhibition by compound C significantly diminished these effects, both in vivo and in vitro. The results suggest a non-traditional mechanism where E-Exe preconditioning, under mild mitochondrial reactive oxygen species generation, upregulates and phosphorylates AMPKα2, thereby enhancing mitochondrial complex I activity, activating adaptive autophagy, and improving myocardial tolerance to DIC injury. Overall, this study highlighted the pivotal role of mitochondria in myocardial DIC-induced ferroptosis and shows how E-Exe preconditioning activated AMPKα2 against myocardial DIC injury. This suggests that E-Exe preconditioning could be a viable strategy for patients undergoing cardiac rehabilitation.

ObjectiveWhile observational studies link immune cells with post-stroke functional outcome, the underlying immune mechanisms are not well understood. Immune cell surface antigens are actively involved in the biological behavior of immune cells, investigating immune cell surface antigens could deepen our comprehension of their role and biological processes in stroke recovery. Therefore, we aimed to investigate the immunological basis of stroke outcome by exploring the causal relationship between immune cell surface antigens and functional outcome after ischemic stroke in a Mendelian randomization study.MethodsGenetic variants related to immune cell surface antigens and post-stroke functional outcome were selected for two-sample Mendelian randomization (MR) analysis. 389 fluorescence intensities (MFIs) with surface antigens were included. Inverse variance weighted (IVW) modeling was used as the primary MR method to estimate the causal effect of exposure on the outcome, followed by several alternative methods and sensitivity analyses. Additional analysis of the association between immune cell surface antigens and risk of ischemic stroke for assessment of collider bias.ResultsWe found that suggestive associations between CD20 on switched memory B cell (OR = 1.16, 95% CI: 1.01-1.34, p = 0.036) and PDL-1 on monocyte (OR = 1.32, 95% CI: 1.04-1.66, p = 0.022) and poor post-stroke functional outcome, whereas CD25 on CD39+ resting Treg (OR = 0.77, 95% CI: 0.62-0.96, p = 0.017) was suggestively associated with good post-stroke functional outcome.ConclusionThe elevated CD20 on switched memory B cell, PDL-1 on monocyte, and CD25 on CD39+ resting Treg may be novel biomarkers and potential causal factors influencing post-stroke functional outcome.

Noni (Morinda citrifolia L.) is a tropical fruit rich in bioactive compounds. Little is known about its polyphenol composition at different ripeness levels and digestive characteristics. Here, we studied changes in polyphenols and antioxidant activity as noni ripened. Rutin and kaempferol-3-O-rutinoside were found in high amounts in noni, with antioxidant capacity increasing as it ripened. Under simulated digestion, polyphenols were gradually released from the oral to gastrointestinal phases, partially decomposing in the small intestine due to their instability. Conversely, fiber-bound phenols were released during colonic fermentation, leading to high bioaccessible antioxidant activity. Additionally, noni consumption affected the intestinal microbiome by reducing the Firmicutes/Bacteroidetes ratio and increasing bacteria with prebiotic properties like Prevotella and Ruminococcus. These findings demonstrate that polyphenols significantly contribute to the health benefits of noni fruit by providing absorbable antioxidants and improving the structure of the intestinal microbiome.

Abstract Graphical user interfaces (GUIs) are widely used in human–computer interaction, providing a convenient interface for operation. Automating the conversion of GUI design images into source code can significantly reduce the coding workload for front-end developers. Detecting elements in GUI images is a key challenge in achieving automatic GUI code generation and is crucial for tasks such as GUI automation and testing. However, current state-of-the-art methods do not fully consider the unique characteristics of GUI images and elements, and they lack the required high localization accuracy, resulting in low detection accuracy for GUI element boxes. In this paper, we propose GUICG, an automatic GUI code generator that combines deep neural networks with image processing techniques to efficiently detect GUI elements from GUI images and generate front-end code. We empirically investigate various deep learning approaches and image processing methods for GUI component detection. Based on a comprehensive understanding of their performance and characteristics, we design GUICG by fusing image processing with a deep learning-based target detection model, achieving state-of-the-art performance. GUICG outperforms existing methods in accuracy and F1 score for component detection tasks, while producing human-readable code with a logical structure. Furthermore, we conduct an ablation study to quantitatively assess the impact of each key element in GUICG.

Abstract Background The aim of this study was to analyze the effect of paclitaxel on the apoptosis of esophageal cancer cells in relation to MUC20. Methods RT‐qPCR analysis, a CCK‐8 assay, western blotting, and flow cytometry were used to analyze the anticancer effects of paclitaxel treatment or OE‐MUC20 in vitro and in vivo. Results The in vitro results showed that paclitaxel significantly induced MUC20 upregulation and that paclitaxel treatment or OE‐MUC20 significantly decreased esophageal cancer cell viability and increased mTOR signaling activation and apoptosis. In addition, PKM2, a key downstream molecule of mTOR signaling, similarly showed significant upregulation after paclitaxel treatment in cells with OE‐MUC20, and its expression was attenuated after treatment with mTOR inhibitors. In a nude mouse model, tumor growth was slow in the OE‐MUC20 group and accelerated after inhibition of mTOR signaling. Conclusion These data suggest that MUC20 is an important target of paclitaxel in esophageal cancer and promotes apoptosis through activation of mTOR signaling.

Abstract Purpose The study aimed to analyze the clinical efficacy and safety of hand-sewn anastomosis for the digestive tract with Da Vinci robot in rectal cancer surgery. Methods A retrospective study was conducted to collect the clinical data from 27 patients who underwent Da Vinci robotic rectal cancer radical surgery in the department of gastrointestinal surgery at the Second Affiliated Hospital of Dalian Medical University from August 2019 to February 2022. All patients received a manual suture for digestive tract reconstruction. After the posterior wall was sutured, the anterior wall was sutured continuously. Finally, a prilling thread was used to sew the junction of the front and rear walls. Perioperative indexes and complications were recorded. Results All 27 patients successfully underwent the operation. Neither conversion to laparotomy nor perioperative death occurred. The operation time and intraoperative blood loss were 183.6 ± 44.8 min and 54.8 ± 34.4 ml, respectively. A total of 15.3 ± 7.8 lymph nodes were harvested. The pain score 24 h after operation was 1.3 ± 1.3. The time out of bed, the time to exhaust, and the time to eat were 15.6 ± 2.9 h, 2.2 ± 0.8 days, and 2.1 ± 0.6 days, respectively. A total of 4 patients (14.8%) developed complications after the operation. Grade B anastomotic leakage gradually resolved after drainage and antibiotic therapy in 1 case. A patient with grade C anastomotic leakage received a second operation for ileostomy. One patient with postoperative pneumonia recovered after anti-infective treatment. Another patient with intraperitoneal hemorrhage improved after symptomatic treatment with blood transfusion and hemostasis. The postoperative hospitalization time and total hospitalization costs were 8.9 ± 4.4 days and 89,236.1 ± 13,527.9 yuan, respectively. Conclusions Manual suture with Da Vinci robotic surgery system is safe and feasible for reconstructing the digestive tract in rectal cancer surgery.

The creep characteristics of rock are closely related to the long-term stability of rock mass. With the excavation of deep buried tunnels in west China, in order to ensure the safety of engineering and the long-term stability of underground buildings, it is particularly important to study the creep characteristics of rock under complex stress conditions. The traditional creep constitutive model is difficult to accurately describe the accelerated creep stage of rock, and the existing creep model is difficult to fit the creep characteristics of the Pocigou Formation slate. This study takes the Bocigou Formation slate in the Kangding-Xinduqiao section of west Sichuan as the research object. Based on the identification of geological environment background and rock mineral composition, the unloading creep test is carried out. The deformation characteristics of the Bocigou Formation slate under unloading conditions are analyzed, and the creep characteristics of the slate and the damage evolution law during unloading are revealed. Considering the cumulative damage effect in the unloading creep process, the damage variable is introduced to improve the Newtonian element in the traditional Nishihara model, and a creep damage model which can describe the accelerated creep stage is established. The results show that under unloading conditions, the deformation of slate is dominated by instantaneous elastic strain, and the creep phenomenon is significantly enhanced with the increasing deviatoric stress level. The long-term strength of slate is reduced by 20.2%–27.1%. The 1-stOpt is used to identify the parameters of the nonlinear creep damage model. The fitting theoretical curve is in good agreement with the experimental value, and the correlation coefficient reaches 0.945. The improved nonlinear creep damage model after the introduction of damage variable is more reasonable for description of the unloading creep characteristics of slate in the study area, which provides a theoretical basis for the stability analysis of surrounding rock under relevant working conditions.

Abstract Objective To investigate the relationship between dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) measurements and the potential composition of rectal carcinoma. Methods Twenty-four patients provided informed consent for this study. DCE-MRI was performed before total mesorectal excision. Quantitative parameters were calculated based on a modified Tofts model. Whole-mount immunohistochemistry and Masson staining sections were generated and digitized at histological resolution. The percentage of tissue components area was measured. Pearson correlation analysis was used to evaluate the correlations between pathological parameters and DCE-MRI parameters. Results On the World Health Organization (WHO) grading scale, there were significant differences in extracellular extravascular space (Ktrans) (F = 9.890, P = 0.001), mean transit time (MTT) (F = 9.890, P = 0.038), CDX-2 (F = 4.935, P = 0.018), and Ki-67 (F = 4.131, P = 0.031) among G1, G2, and G3. ECV showed significant differences in extramural venous invasion (t = − 2.113, P = 0.046). K trans was strongly positively correlated with CD34 (r = 0.708, P = 0.000) and moderately positively correlated with vimentin (r = 0.450, P = 0.027). Interstitial volume (Ve) was moderately positively correlated with Masson’s (r = 0.548, P = 0.006) and vimentin (r = 0.417, P = 0.043). There was a moderate negative correlation between Ve and CDX-2 (r = − 0.441, P = 0.031). The rate constant from extracellular extravascular space to blood plasma (Kep) showed a strong positive correlation with CD34 expression (r = 0.622, P = 0.001). ECV showed a moderate negative correlation with CDX-2 (r = − 0.472, P = 0.020) and a moderate positive correlation with collagen fibers (r = 0.558, P = 0.005). Conclusion The dynamic contrast-enhanced MRI-derived parameters measured in rectal cancer were significantly correlated with the proportion of histological components. This may serve as an optimal imaging biomarker to identify tumor tissue components.

Abstract Background Individuals with diabetes have increased risk of depression, but there are limited nationally representative studies on this topic. We aimed to investigate the prevalence and predictors of depression, as well as its impact on all-cause and cardiovascular mortality in adults with type 2 diabetes (T2DM) using a prospective cohort study and a representative sample of the U.S. population. Methods We analyzed National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 and linked it with the most recent publicly available National Death Index (NDI) data. Individuals aged 20 years or old who had depression measurements were included. Depression was defined as a Patient Health Questionnaire (PHQ-9) score ≥ 10, and categorized into moderate (10–14 points) and moderately severe to severe (≥ 15 points). Cox proportional hazard models were used to estimate the association between depression and mortality. Results Among 5695 participants with T2DM, 11.6% had depression. Depression was associated with female gender, younger age, overweight, lower education, being unmarried, smoking, and a history of coronary heart disease and stroke. During a mean follow-up period of 78.2 months, 1161 all-cause deaths occurred. Total depression and moderately severe to severe depression significantly increased all-cause mortality (adjusted hazard ratio [aHR] 1.36, 95% CI [1.09–1.70]; 1.67 [1.19–2.34]) and non-cardiovascular mortality (aHR 1.36, 95% CI [1.04–1.78]; 1.78, 95% CI [1.20–2.64]), but not cardiovascular mortality. Subgroup analysis showed a significant association between total depression and all-cause mortality in males (aHR 1.46, 95% CI [1.08–1.98]) and those aged 60 years or older (aHR 1.35, 95% CI [1.02–1.78]). Any severity of depression was not significantly associated with cardiovascular mortality in age- or gender- stratified subgroups. Conclusions In a nationally representative sample of U.S. adults with T2DM, approximately 10% experienced depression. Depression did not significantly associate with cardiovascular mortality. However, comorbid depression in T2DM patients increased the risk of all-cause and non-cardiovascular mortality. The impact of depression on mortality varied across subgroups. Therefore, healthcare providers should consider incorporating depression screening and management into routine care, especially for subgroups with specific risk factors, due to the increased risk of all-cause mortality in T2DM patients with depression.

Overlapping syndrome is a syndrome that meets the criteria for at least two connective tissue diseases. When systemic lupus erythematosus (SLE) overlaps with systemic sclerosis (SSc), dermatomyositis/polymyositis, Sjogren's syndrome (SS), rheumatoid arthritis (RA), and other diseases, the lack of specific serological indicators and clinical manifestations can result in missed diagnosis and/or misdiagnosis, leading to life-threatening in severe cases. Early diagnosis and treatment of overlap syndrome can help alleviate the impact on patients′ quality of life and improve the prognosis. This article reviews the research progress in this disorder and its management strategies. Although there is currently limited research on SLE related overlap syndrome, its clinical manifestations and immunological characteristics are strongly related to the overlapping diseases. Specific tests and examinations in time can facilitate the diagnosis and treatment of overlap syndrome.

BackgroundTranscutaneous auricular vagus nerve stimulation (taVNS) has emerged as a potentially effective neuromodulation technique for addressing neurological disorders, including disorders of consciousness. Expanding upon our prior clinical study, which demonstrated the superior effectiveness of a 4-week taVNS treatment in patients with minimally conscious state (MCS) compared to those in a vegetative state/unresponsive wakefulness state, the aim of this investigation was to evaluate the safety and therapeutic efficacy of taVNS in individuals with MCS through a sham-controlled randomized double-blind clinical trial.MethodsA cohort of 50 adult patients (male = 33, female = 17) diagnosed with a MCS were randomly assigned to either the active taVNS (N = 25) or sham taVNS (N = 25) groups. The treatment period lasted for 4 weeks, followed by an 8-week follow-up period. The Coma Recovery Scale-Revised (CRS-R) and Glasgow Coma Scale (GCS) were administered at baseline and weekly during the initial 4 weeks. Additionally, the Disability Rating Scale (DRS) was used to assess the patients’ functional abilities via telephone at week 12. Furthermore, various neurophysiological measures, including electroencephalogram (EEG), upper-limb somatosensory evoked potentials (USEP), brainstem auditory evoked potentials (BAEP), and P300 event-related potentials (P300), were employed to monitor changes in brain activity and neural conduction pathways.ResultsThe scores for the active taVNS group in the CRS-R and GCS showed greater improvement over time compared to the sham taVNS group (CRS-R: 1-week, Z = −1.248, p = 0.212; 2-week, Z = −1.090, p = 0.276; 3-week, Z = −2.017, p = 0.044; 4-week, Z = −2.267, p = 0.023. GCS: 1-week, Z = −1.325, p = 0.185; 2-week, Z = −1.245, p = 0.213; 3-week, Z = −1.848, p = 0.065; 4-week, Z = −1.990, p = 0.047). Additionally, the EEG, USEP, BAEP, and P300 also demonstrated significant improvement in the active taVNS group compared to the sham taVNS group at week 4 (EEG, Z = −2.086, p = 0.037; USEP, Z = −2.014, p = 0.044; BAEP, Z = −2.298, p = 0.022; P300 amplitude, Z = −1.974, p = 0.049; P300 latency, t = 2.275, p = 0.027). Subgroup analysis revealed that patients with MCS derived greater benefits from receiving taVNS treatment earlier (CRS-R, Disease duration ≤ 1-month, mean difference = 8.50, 95% CI = [2.22, 14.78], p = 0.027; GCS, Disease duration ≤ 1-month, mean difference = 3.58, 95% CI = [0.14, 7.03], p = 0.044). By week 12, the active taVNS group exhibited lower Disability Rating Scale (DRS) scores compared to the sham taVNS group (Z = −2.105, p = 0.035), indicating a more favorable prognosis for MCS patients who underwent taVNS. Furthermore, no significant adverse events related to taVNS were observed during treatment.ConclusionThe findings of this study suggest that taVNS may serve as a potentially effective and safe intervention for facilitating the restoration of consciousness in individuals diagnosed with MCS. This therapeutic approach appears to enhance cerebral functioning and optimize neural conduction pathways.Clinical trial registrationhttp://www.chictr.org.cn, Identifier ChiCTR2200066629.

Abstract Background Standard treatment for drug-susceptible tuberculosis (DS-TB) includes a multidrug regimen requiring at least 6 months of treatment, and this lengthy treatment easily leads to poor adherence. There is an urgent need to simplify and shorten treatment regimens to reduce interruption and adverse event rates, improve compliance, and reduce costs. Methods ORIENT is a multicenter, randomized controlled, open-label, phase II/III, non-inferiority trial involving DS-TB patients to evaluate the safety and efficacy of short-term regimens compared with the standardized six-month treatment regimen. In stage 1, corresponding to a phase II trial, a total of 400 patients are randomly divided into four arms, stratified by site and the presence of lung cavitation. Investigational arms include 3 short-term regimens with rifapentine 10 mg/kg, 15 mg/kg, and 20 mg/kg, while the control arm uses the standardized six-month treatment regimen. A combination of rifapentine, isoniazid, pyrazinamide, and moxifloxacin is administered for 17 or 26 weeks in rifapentine arms, while a 26-week regimen containing rifampicin, isoniazid, pyrazinamide, and ethambutol is applied in the control arm. After the safety and preliminary effectiveness analysis of patients in stage 1, the control arm and the investigational arm meeting the conditions will enter into stage 2, which is equivalent to a phase III trial and will be expanded to recruit DS-TB patients. If all investigational arms do not meet the safety conditions, stage 2 will be canceled. In stage 1, the primary safety endpoint is permanent regimen discontinuation at 8 weeks after the first dose. The primary efficacy endpoint is the proportion of favorable outcomes at 78 weeks after the first dose for both two stages. Discussion This trial will contribute to the optimal dose of rifapentine in the Chinese population and suggest the feasibility of the short-course treatment regimen containing high-dose rifapentine and moxifloxacin for DS-TB. Trial registration The trial has been registered on ClinicalTrials.gov on 28 May 2022 with the identifier NCT05401071.

Against the backdrop of digital technology integration and digital transformation, the digital economy has become an important new economic development in China. The digital economy changes and subverts the traditional production and organization modes of industries, breaks regional and spatial barriers, and realizes a highly interconnected network structure. Therefore, it is critical to study the digital economy from a network analysis perspective. In previous studies, the interlocking network model and the headquarters-branch model have been adopted to construct enterprise networks; however, the networks based on these models have some deficiencies in comprehensiveness and authenticity. An enterprise equity network built based on the investment relationships between enterprises can reflect the actual contact network status of the enterprise. Based on the above background, this study analyzed the evolutionary characteristics of the digital economy network in the Yangtze River Delta area through an enterprise equity network and explored its influencing factors and mechanisms. First, we constructed the digital economy networks of the Yangtze River Delta area for 2010, 2015, and 2020 using equity investment data between enterprises and a directed correlation network model. Second, with the indicators of degree centrality, degree centralization, an investment source, and others, the spatial and temporal evolution characteristics of digital economy networks were described from two aspects: network patterns and investment relationships. Furthermore, this study explored the possible factors affecting digital economy networks in the Yangtze River Delta area through a Quadratic Assignment Procedure. This study has three main findings: 1) From 2010 to 2020, various types of digital economy networks in the Yangtze River Delta area showed the characteristics of hierarchical diffusion and node agglomeration. Each industry forms an expansion of the network framework around the core node in the initial stage and then expands to the surrounding areas through secondary nodes. Shanghai and Hangzhou were the most important network nodes in the digital economy. 2) The number of net inflow areas for digital economy investment in the Yangtze River Delta was increasing, whereas the number of net outflow areas was decreasing. Hangzhou was the main net inflow city, while Shanghai and Ningbo were the main net outflow cities. Simultaneously, the source of investment in research units has changed from inside the province to outside, and there are clear interprovincial differences. 3) Cognitive proximity, the difference in the number of digital economy enterprises, the difference in the proportion of secondary industries, the difference in information facilities, and the early network foundation all have significant positive effects on the establishment of digital economy networks. System proximity, the difference in the proportion of tertiary industries, the time difference in the establishment of digital economy enterprises, and the gap in innovation ability restrict the formation and development of digital economy networks. Geographical distance is no longer the main factor influencing the formation of digital economic networks. Based on the above conclusions, this study proposes some suggestions for promoting the development of the digital economy from the perspectives of industrial agglomeration, facility and policy allocation, and path dependence.

BackgroundThe correlation between gut microbiota and infections has garnered significant attention in previous studies; nevertheless, our understanding of the causal relationships and mechanisms between specific microbial species and infections remains limited.MethodsThis study aimed to employ Mendelian randomization (MR) using single-nucleotide polymorphisms (SNPs) and genome-wide association study (GWAS) data of European ancestry to explore the genetic-level relationships between distinct types of gut microbiota and susceptibility to infections. Our analysis encompassed three prevalent infections: intestinal infections, pneumonia, and urinary tract infections, while concurrently examining various types of gut microbiota.ResultsWe identified 18 protective gut microbiotas alongside 13 associated with increased infection risk. Particularly noteworthy are certain microbial communities capable of producing butyrate, such as the Ruminococcaceae and Lachnospiraceae families, which exhibited both favorable and unfavorable effects. Additionally, we observed a few certain communities linked to infection susceptibility, including ErysipelotrichaceaeUCG003 (OR = 0.13, 95% CI: 0.054–0.33, p = 1.24E-05), Collinsella (OR = 3.25, 95% CI: 2.00–5.27, p = 1.87E-06), and NB1n (OR = 1.24, 95% CI: 1.09–1.40, p = 1.12E-03).ConclusionThis study reveals complex relationships between gut microbiota and various infections. Our findings could potentially offer new avenues for exploring prevention and treatment strategies for infectious diseases.

PurposeThe purpose of this study is to evaluate the efficacy and safety of stimulating the vagus nerve in patients with disorders of consciousness (DOCs).MethodsA comprehensive systematic review was conducted, encompassing the search of databases such as PubMed, CENTRAL, EMBASE and PEDro from their inception until July 2023. Additionally, manual searches and exploration of grey literature were performed. The literature review was conducted independently by two reviewers for search strategy, selection of studies, data extraction, and judgment of evidence quality according to the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) Study Quality Scale.ResultsA total of 1,269 articles were retrieved, and 10 studies met the inclusion criteria. Among these, there were three case reports, five case series, and only two randomized controlled trials (RCTs). Preliminary studies have suggested that stimulation of vagus nerve can enhance the levels of DOCs in both vegetative state/unresponsive wakefulness state (VS/UWS) and minimally conscious state (MCS). However, due to a lack of high-quality RCTs research and evidence-based medical evidence, no definitive conclusion can be drawn regarding the intervention’s effectiveness on consciousness level. Additionally, there were no significant adverse effects observed following stimulation of vagus nerve.ConclusionA definitive conclusion cannot be drawn from this systematic review as there was a limited number of eligible studies and low-quality evidence. The findings of this systematic review can serve as a roadmap for future research on the use of stimulation of vagus nerve to facilitate recovery from DOCs.

Time series Autoregressive Integrated Moving Average (ARIMA) model is often used in landslide prediction and forecasting. However, few conditions have been suggested for the application of ARIMA models in landslide displacement prediction. This paper summarizes the distribution law of the tangential angle in different time periods and analyzes the landslide displacement data by combining wavelet transform. It proposes an applicable condition for the ARIMA model in the field of landslide prediction: when the landslide deformation is in the initial deformation to initial acceleration stage, i.e., the tangential angle of landslide displacement is less than 80°, the ARIMA model has higher prediction accuracy for 24-h landslide displacement data. The prediction results are RMSE = 4.52 mm and MAPE = 2.39%, and the prediction error increases gradually with time. Meanwhile, the ARIMA model was used to predict the 24-h displacements from initial deformation to initial acceleration deformation for the landslide in Guangna Township and the landslide in Libian Gully, and the prediction results were RMSE = 1.24 mm, MAPE = 1.34% and RMSE = 5.43 mm, MAPE = 1.67%, which still maintained high accuracy and thus verified this applicable condition. At the same time, taking the landslide of Libian Gully as an example, the ARIMA model was used to test the displacement prediction effect of the landslide in the Medium-term acceleration stage and the Imminent sliding stage (the tangential angle of landslide displacement is 80° and 85°, respectively). The relative error of displacement data prediction in the Medium-term acceleration stage is within 3%, while the relative error of the prediction value in the Imminent sliding stage is more than 3%, and the error gradually increases with time. This demonstrates that the relative error of the ARIMA model in landslide prediction and forecasting is within 3%. The relative error of the prediction value in the Imminent sliding stage is above 3%, and the error increases gradually with time. Meanwhile, the prediction results are analyzed and it is concluded that the increase in prediction time and tangential angles are the main reasons for the increase in error. The applicable conditions proposed in this study can provide a reference for the application of ARIMA model in landslide prediction and forecast.

Seed vigor (SV) is a crucial trait determining the quality of crop seeds. Currently, over 80% of China’s cotton-planting area is in Xinjiang Province, where a fully mechanized planting model is adopted, accounting for more than 90% of the total fiber production. Therefore, identifying SV-related loci and genes is crucial for improving cotton yield in Xinjiang. In this study, three seed vigor-related traits, including germination potential, germination rate, and germination index, were investigated across three environments in a panel of 355 diverse accessions based on 2,261,854 high-quality single-nucleotide polymorphisms (SNPs). A total of 26 significant SNPs were detected and divided into six quantitative trait locus regions, including 121 predicted candidate genes. By combining gene expression, gene annotation, and haplotype analysis, two novel candidate genes (Ghir_A09G002730 and Ghir_D03G009280) within qGR-A09-1 and qGI/GP/GR-D03-3 were associated with vigor-related traits, and Ghir_A09G002730 was found to be involved in artificial selection during cotton breeding by population genetic analysis. Thus, understanding the genetic mechanisms underlying seed vigor-related traits in cotton could help increase the efficiency of direct seeding by molecular marker-assisted selection breeding.

This article explored the effect of insoluble okara fiber (IOF) on the properties of okara protein (SOP) emulsion. The effects of different concentrations of IOF (0.25 wt%, 0.50 wt%, 0.75 wt% and 1.00 wt%) on the microstructure, interfacial activity, emulsifying activity and stability of SOP emulsion were studied with sunflower oil as oil phase. The results showed that with the increase of the IOF concentration, the particle size of the SOP/IOF emulsion showed a trend of gradual increase. The laser confocal microscope observation experiment showed that the emulsion droplets change in the same trend, and the absolute value of the zeta potential presents an increasing trend. The content and concentration of interfacial protein showed an increasing trend, and the change of rheological index showed that the trend of shear thinning was increasing, and high concentration of IOF could significantly enhance the long-term storage stability, acid resistance stability and salt resistance stability of SOP emulsion. This provides a theoretical basis for the further application of IOF in the protein emulsion gel system.

Abstract Background The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the “modified hand‐tearing method” (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video‐assisted thoracoscopic surgery (VATS) and robot‐assisted thoracoscopic surgery (RATS) using the MHT method. Methods From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well‐matched pairs of 276 cases in the MHT method and non‐MHT method groups, and two well‐matched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. Results Compared with the non‐MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between‐group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. Conclusion Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.

Introduction: Oral semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that improves glycated hemoglobin levels and body weight in patients with type 2 diabetes (T2DM). We aim to evaluate the cost-effectiveness of once-daily oral semaglutide in comparison to placebo and injectable GLP-1 RAs in Chinese patients with T2DM inadequately controlled on basal insulin.Methods: The United Kingdom Prospective Diabetes Study Outcomes Model (UKPDS OM2.1) was used to estimate the cost-effectiveness by calculating the incremental cost-effectiveness ratio (ICER). Baseline characteristics of the simulation cohort were obtained from the PIONEER 8 trial. Utility and safety inputs were derived from a network meta-analysis of 12 trials. Direct medical costs were retrieved from published literature and discounted at an annual rate of 5%. We used a willingness-to-pay (WTP) threshold of $36,528.3 per quality-adjusted life-year (QALY) gained. Scenario analysis, and one-way and probabilistic sensitivity analysis were performed.Results: The effectiveness of oral semaglutide was 10.39 QALYs with a total cost of $30,223.10, while placebo provided 10.13 QALYs at a lower total cost of $20,039.19. Oral semaglutide was not cost-effective at an ICER of $39,853.22 and $88,776.61 per QALY compared to placebo and exenatide at the WTP. However, at an annual price of $1,871.9, it was cost-effective compared with dulaglutide, liraglutide, and lixisenatide. The model was most sensitive to the discount rate and annual cost of oral semaglutide. The price of oral semaglutide needed to be reduced to $1,711.03 per year to be cost-effective compared to placebo and other injectable GLP-1 RAs except for exenatide and semaglutide injection.Conclusion: We found that once-daily oral semaglutide, at a comparable price of semaglutide injection, proves to be a cost-effective add-on therapy to insulin for Chinese patients with T2DM, especially when compared to subcutaneous GLP-1 RAs other than injectable semaglutide and exenatide. However, to achieve cost-effectiveness in comparison to placebo, further cost reduction of oral semaglutide is necessary. The estimated annual cost of $1,711.03 for oral semaglutide demonstrates a more cost-effective option than placebo, highlighting its potential value in the management of T2DM.

IntroductionSingle-cell RNA sequencing (scRNA-seq) is a powerful tool for understanding cellular heterogeneity and identifying cell types in virus-related research. However, direct identification of SARS-CoV-2-infected cells at the single-cell level remains challenging, hindering the understanding of viral pathogenesis and the development of effective treatments.MethodsIn this study, we propose a deep learning framework, the single-cell virus detection network (scVDN), to predict the infection status of single cells. The scVDN is trained on scRNA-seq data from multiple nasal swab samples obtained from several contributors with varying cell types. To objectively evaluate scVDN’s performance, we establish a model evaluation framework suitable for real experimental data.Results and DiscussionOur results demonstrate that scVDN outperforms four state-of-the-art machine learning models in identifying SARS-CoV-2-infected cells, even with extremely imbalanced labels in real data. Specifically, scVDN achieves a perfect AUC score of 1 in four cell types. Our findings have important implications for advancing virus research and improving public health by enabling the identification of virus-infected cells at the single-cell level, which is critical for diagnosing and treating viral infections. The scVDN framework can be applied to other single-cell virus-related studies, and we make all source code and datasets publicly available on GitHub at https://github.com/studentiz/scvdn.

ABSTRACT Prediction of susceptibility to pyrazinamide (PZA) directly from sputum has been challenging. The MeltPro MTB/PZA assay, based on melting curve analysis, can simultaneously detect Mycobacterium tuberculosis and the resistance to PZA from sputum. We aimed to evaluate the MeltPro MTB/PZA assay to predict PZA resistance among rifampin-resistant tuberculosis (RR-TB) patients. We prospectively enrolled RR-TB patients in the registered trials, and their baseline sputum samples were obtained to perform the assay and culture. DNA sequencing of culture isolates was analyzed and used as the reference standard. Sanger sequencing was performed for samples with discrepant results between next-generation sequencing (NGS) and the investigational assay. The main analysis was conducted in the population of patients with interpretable results by both NGS and the assay. A total of 239 patients with RR-TB were screened, and 220 underwent the MeltPro MTB/PZA assay. The assay provided no information for 25 of 220 patients (11.4%). Among the remaining 195 patients, 13 had negative culture or insufficient raw NGS sequencing data, and 15 had indeterminate assay results. A total of 167 patients were included in the main analysis. Against DNA sequencing, the sensitivity, specificity, and negative predictive value of the assay for detecting resistance to PZA were 91.4% (95% confidence interval [CI], 87.1% to 95.6%), 89.9% (95% CI, 85.3% to 94.5%), and 95.2% (95% CI, 91.9% to 98.4%), respectively. In conclusion, the MeltPro MTB/PZA assay is a fast semiautomatic molecular platform to rapidly predict resistance to PZA from sputum and holds promise as a screening tool with satisfactory sensitivity. IMPORTANCE This study evaluated the accuracy of the MeltPro MTB/PZA assay at detecting the presence of PZA resistance through registered clinical trials. Compared to DNA sequencing, the assay had high sensitivity and negative predictive value, suggesting its potential utility as a screening tool in clinical practice. The assay could serve as an ideal primary screening tool in low PZA-resistant M. tuberculosis prevalence settings and could be used as an additional test to identify PZA resistance rapidly and initially in the RR-TB population.

Achieving omnidirectional walking for bipedal robots is considered one of the most challenging tasks in robotics technology. Reinforcement learning (RL) methods have proved effective in bipedal walking tasks. However, most existing methods use state machines to switch between multiple policies and achieve omnidirectional gait, which results in shaking during the policy switching process for bipedal robots. To achieve a seamless transition between omnidirectional gait and transient motion for full-size bipedal robots, we propose a novel multi-agent RL method. Firstly, a multi-agent RL algorithm based on the actor–critic framework is designed, and policy entropy is introduced to improve exploration efficiency. By learning agents with parallel initial state distributions, we minimize reliance on gait planner effectiveness in the Robot Operating System (ROS). Additionally, we design a novel heterogeneous policy experience replay mechanism based on Euclidean distance. Secondly, considering the periodicity of bipedal robot walking, we develop a new periodic gait function. Including periodic objectives in the policy can accelerate the convergence speed of training periodic gait functions. Finally, to enhance the robustness of the policy, we construct a novel curriculum learning method by discretizing Gaussian distribution and incorporate it into the robot’s training task. Our method is validated in a simulation environment, and the results show that our method can achieve multiple gaits through a policy network and achieve smooth transitions between different gaits.

Storage proteins are essential for seed germination and seedling growth, as they provide an indispensable nitrogen source and energy. Our previous report highlighted the defective endosperm development in the serine hydroxymethyltransferase 4 (OsSHMT4) gene mutant, floury endosperm20-1 (flo20-1). However, the alterations in storage protein content and distribution within the flo20-1 endosperm remained unclear. Here, the immunocytochemistry analyses revealed a deficiency in storage protein accumulation in flo20-1. Electron microscopic observation uncovered abnormal morphological structures in protein bodies (PBI and PBII) in flo20-1. Immunofluorescence labeling demonstrated that aberrant prolamin composition could lead to the subsequent formation and deposition of atypical structures in protein body I (PBI), and decreased levels of glutelins and globulin resulted in protein body II (PBII) malformation. Further RNA-seq data combined with qRT-PCR results indicated that altered transcription levels of storage protein structural genes were responsible for the abnormal synthesis and accumulation of storage protein, which further led to non-concentric ring structural PBIs and amorphous PBIIs. Collectively, our findings further underscored that OsSHMT4 is required for the synthesis and accumulation of storage proteins and storage organelle formation in endosperm cells.

Abstract Liver and lymph node sinusoidal endothelial cell C-type lectin (LSECtin) plays an important regulatory role in a variety of diseases, including tumors. However, the underlying mechanism of LSECtin in gastric cancer (GC) remains largely unknown. In our research, LSECtin promoted the adhesion and invasion of GC cells, and was involved in lymphatic metastasis of GC cells. Mechanistically, LSECtin promoted the adhesion, proliferation and migration of GC cells by downregulating STAT1 expression. The circular RNA circFBXL4, which is regulated by LSECtin, sponges the microRNA miR-146a-5p to regulate STAT1 expression. The promotion of GC cell proliferation, migration and invasion mediated by LSECtin was largely inhibited by circFBXL4 overexpression or miR-146a-5p silencing. Moreover, in its role as a transcription factor, STAT1 modulated the expression of FN1 and CHD4. In conclusion, LSECtin might be involved in the lymphatic metastasis of GC by upregulating the expression of FN1 and CHD4 via the circFBXL4/miR-146a-5p/STAT1 axis, possibly indicating a newly discovered pathogenic mechanism.

ObjectiveTo investigate the efficacy of median nerve stimulation (MNS) combined with repetitive transcranial magnetic stimulation (rTMS), MNS alone, and rTMS alone in elevating the level of consciousness in patients with prolonged disorders of consciousness (pDOC).Participants and methodsWe enrolled 75 eligible inpatients suffering from pDOC as a result of traumatic or non-traumatic brain injury. Participants were randomly assigned to one of the following three treatment groups: (1) rTMS+sham-MNS; (2) MNS + sham-rTMS; or (3) MNS + rTMS. The rTMS protocol involved stimulation above the left dorsolateral prefrontal cortex at a 10 Hz frequency and 90% resting motor threshold. The MNS protocol involved the delivery of a 15–20 mA current at the median nerve point 2 cm from the wrist crease of the right distal forearm. The primary outcome was the change from baseline of the Coma Recovery Scale-Revised (CRS-R) score after treatment. Secondary outcomes included post-treatment changes from baseline of the Glasgow Coma Scale (GCS) score, awaken ratio, electroencephalography (EEG) scores, and the latency and amplitude of N20 on somatosensory evoked potentials.ResultsBefore the intervention, there were no significant differences between groups in the CRS-R, GCS scores, age, duration of pDOC, clinical diagnosis, EEG scores, latency and amplitude of N20, sex, job, marital status, education level, or disease etiology. Within the three groups, the total CRS-R, GCS scores and amplitude of N20 on both side significantly increased and latency of N20 on poor side significantly decreased post-intervention. Significantly greater improvement in CRS-R, GCS total scores, amplitude of N20 on both side and latency of N20 on the poor side were observed in the MNS + TMS group compared to those of the groups receiving rTMS alone or MNS alone. The patients receiving TMS and MNS intervention showed a greater EEG activity improvement, and the EEG activity improved ratio significantly differ between groups, while there were no significant differences in the awakening ratios between the three groups.ConclusionThe combination of MNS + rTMS was more efficacious in improving the level of consciousness than MNS alone or rTMS alone in patients with pDOC.