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Yuanhang Pan,1,* Di Zhao,1,* Xinbo Zhang,1,* Na Yuan,1 Lei Yang,1 Yuanyuan Jia,2 Yanzhao Guo,3 Ze Chen,1 Zezhi Wang,1 Shuyi Qu,1 Junxiang Bao,4 Yonghong Liu1 1Department of Neurology, Xijing Air Force Medical University, Xi’an, People’s Republic of China; 2Encephalopathy Department No.2, Baoji Hospital of Traditional Chinese Medicine, Baoji, People’s Republic of China; 3Encephalopathy Department No.10, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, People’s Republic of China; 4Department of Aerospace Hygiene, Air Force Medical University, Xi’an, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yonghong Liu, Department of Neurology, Xijing hospital, Air Force Medical University, Xi’an, People’s Republic of China, Tel +86 13991236602, Email liuyhong@fmmu.edu.cn Junxiang Bao, Department of Aerospace Hygiene, Air Force Medical University, Xi’an, People’s Republic of China, Tel +86 02984711241, Email baojunx@fmmu.edu.cnBackground: Excessive daytime sleepiness (EDS) forms a prevalent symptom of obstructive sleep apnea (OSA) and narcolepsy type 1 (NT1), while the latter might always be overlooked. Machine learning (ML) models can enable the early detection of these conditions, which has never been applied for diagnosis of NT1.Objective: The study aimed to develop ML prediction models to help non-sleep specialist clinicians identify high probability of comorbid NT1 in patients with OSA early.Methods: Totally, clinical features of 246 patients with OSA in three sleep centers were collected and analyzed for the development of nine ML models. LASSO regression was used for feature selection. Various metrics such as the area under the receiver operating curve (AUC), calibration curve, and decision curve analysis (DCA) were employed to evaluate and compare the performance of these ML models. Model interpretability was demonstrated by Shapley Additive explanations (SHAP).Results: Based on the analysis of AUC, DCA, and calibration curves, the Gradient Boosting Machine (GBM) model demonstrated superior performance compared to other machine learning (ML) models. The top five features used in the GBM model, ranked by feature importance, were age of onset, total limb movements index, sleep latency, non-REM (Rapid Eye Movement) sleep stage 2 and severity of OSA.Conclusion: The study yielded a simple and feasible screening ML-based model for the early identification of NT1 in patients with OSA, which warrants further verification in more extensive clinical practices.Keywords: obstructive sleep apnea, narcolepsy, machine learning, prediction model, sleep disorder

Gengyao Hu,1,* Yuanhang Pan,1,* Na Yuan,1,* Zhixian Yang,2 Xiuyu Shi,3 Sha Ma,4 Shan Li,4 Xiaohua Hou,5 Fei Liu,5 Dongmei Li,6 Junxiang Bao,7 Yonghong Liu1 1Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China; 2Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China; 3Department of Pediatrics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; 4Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 6Department of Dentistry for Special Services, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China; 7Department of Aerospace Hygiene, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yonghong Liu, Email liuyhong@fmmu.edu.cnBackground: Sleep-related facial mandibular myoclonus (SRFMM) remains rare in clinical practice. The aim of this study was to provide a comprehensive understanding of the electroclinical manner, therapeutic regimen, and prognosis of SRFMM.Methods: Twenty-three patients who were diagnosed with SRFMM by clinical manifestation, video-electroencephalography (EEG) and electromyography over bilateral masseter and temporalis muscles were enrolled. Clinical and electrophysiological evaluation as well as follow-up information were recorded and analyzed.Results: The cohort involved 4 infants and 19 adults with a mean onset age of 43.5 years for SRFMM, among whom 19 were male. Twenty-one patients complained of tongue injuries and disturbed night-time sleep. SRFMM in 4 patients were ascribed to oral aripiprazole, brainstem ischemia and brain trauma. In 62 SRFMM episodes, 93.5% occurred in NREM sleep and 6.5% in REM sleep, and all events were associated with EEG arousals. In 13 patients with or without clonazepam, the motor events gradually disappeared, and the rest turned to be sporadic.Conclusion: SRFMM is a characteristic parasomnia manifested by tongue biting and accompanying facial mandibular myoclonus, leading to disrupted sleep. Besides adults, infants can also experience SRFMM with spontaneous remission. Most patients respond well to clonazepam, eventually with favorable prognosis.Keywords: sleep-related facial mandibular myoclonus, tongue biting, movement disorder, SRFMM

Jing Tian,1,2 Fengqin Ding,3 Ruoya Wang,3 Gangfei Han,1 Jingjing Yan,3 Na Yuan,3 Yutao Du,3 Qinghua Han,1 Yanbo Zhang2– 4 1Department of Cardiology, the 1st Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China; 3Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China; 4Shanxi University of Chinese Medicine, Jinzhong, People’s Republic of ChinaCorrespondence: Yanbo Zhang, Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China, Tel +86 3327518812, Email sxmuzyb@126.com Correspondence: Qinghua Han, Department of Cardiology, the 1st Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China, Tel +86 3100113031, Email syhqh@sohu.comPurpose: This study aimed to identify subgroups of chronic heart failure (CHF) patients with distinct trajectories of quality of life (QOL) and to identify baseline characteristics associated with the trajectories.Patients and methods: Two-year, prospective, cohort study including 315 patients with CHF was conducted from July 2017. Information on QOL assessed by CHF-patient-reported outcomes measure (CHF-PROM) was collected at baseline, 6, 12, 18, and 24 months. Demographic and clinical variables were recorded at baseline. Growth mixture model was used to identify distinct trajectories of CHF-PROM and its physical, psychological, social, and therapeutic domains. Single factor analysis was employed to assess the factors associated with development of CHF-PROM over time.Results: Two classes of overall score of CHF-PROM were identified: poorer (14.0%) and better (86.0%). Poorer class tended to be aged, have low diastolic blood pressure, have concomitant atrial fibrillation, diabetes, chronic obstructive pulmonary disease, cancers, and central nervous system diseases, and used nitrates. Three classes of physical scores were identified: unstable-poorer (5.2%), stable-poorer (29.4%) and better (65.4%). Age, NYHA grade, chronic obstructive pulmonary disease, combined with cancers and central nervous system diseases were related to the grouping. Poorer (8.6%) and better (91.4%) classes of psychological scores were identified. Poorer class tended to be female and had concomitant atrial fibrillation. Degenerate class (34.6%) and meliorate class (65.4%) of therapeutic scores were identified. Degenerate class tended to have concomitant chronic obstructive pulmonary disease and use less angiotensin converting enzyme inhibitors.Conclusion: We identified different classes with distinct trajectories of QOL that may help proper evaluate QOL and further improve its status for patients CHF.Keywords: patient-reported outcome, chronic heart failure, growth mixture model, dynamic trajectory

Gengyao Hu,1,2,* Na Yuan,1,* Yuanhang Pan,1,* Bi Wang,1 Xiaoli Wang,1 Zezhi Wang,1 Ze Chen,1 Yonghong Liu1 1Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, 710032, People’s Republic of China; 2Department of Neurology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, 710061, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yonghong LiuDepartment of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of ChinaTel +86 13991236602Email liuyhong@fmmu.edu.cnStudy Objectives: To evaluate clinical and electrophysiological features of sleep-related head jerk (SRHJ) and electromyographic activity of superficial neck muscles during head jerk.Methods: Totally, 850 cases with video-polysomnography recording were collected, among which 50 presented with SRHJ. In these 50 patients, 15 underwent electromyography (EMG) check on bilateral sternocleidomastoid (SCM) and trapezius muscles as well as chin, while 35 had only chin EMG check. Further, the sensitivity and specificity of the both EMGs were calculated and compared.Results: Six among the 50 SRHJ patients had a primary complaint of involuntary head jerks associated with impaired sleep. Approximately 76.1% of head jerks occurred during REM sleep with the median head jerk index of 5.9/h, 64.5% of which were associated with electroencephalogram arousals and 66.4% with body movements. One patient showed SRHJ predominantly in NREM sleep but also in wakefulness. Surface EMG of SCM/trapezius muscles showed a sensitivity of 92% and a specificity of 97.8%, whereas chin EMG had a sensitivity of 14.5% and a specificity of 98.8%.Conclusion: SRHJ was associated with electroencephalogram arousals and might interfere with sleep. Surface EMG of SCM/trapezius muscles exhibited a good accuracy in the revelation of SRHJ.Keywords: sleep-related head jerk, neck myoclonus, movement disorder, video-polysomnography, electromyography

Fang Liu,1 Yingmei Liu,2 Na Yuan,1 Xiuying Zhang,1 Mei Cao,1 Jie Dong,1 Jinqing Zhang1 1Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People’s Republic of China; 2Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, People’s Republic of ChinaCorrespondence: Fang LiuDepartment of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti South Road, Beijing 100020, People’s Republic of ChinaTel +86-18611369216Email roseliufang@qq.comPurpose: This report describes a case of a skin sporotrichosis infection and the steps taken to identify an effective antifungal treatment.Patients and Methods: A 50-year-old woman from Jilin province, China, presented complaining of a small mass that had been on her right upper eyelid for two years. A skin biopsy was taken and submitted for bacterial and mycological assessment. Bacterial culture from the lesion was negative, but a fungal culture was positive. In vitro susceptibility test was performed to assess its susceptibility to antifungal drugs.Results: The skin biopsy showed infectious granuloma. Fungal culture was identified as Sporothrix globosa based on both the morphological features and confirmation by the molecular method; it was resistant to many kinds of antifungal drugs, including amphotericin B, voriconazole, fluconazole, and caspofungin. However, it was relatively sensitive to itraconazole. The patient was prescribed 0.2 g itraconazole to be taken twice per day. One month later, she had almost completely recovered from her symptoms. The treatment lasted for 3 months and her liver function and renal function were normal at the endpoint.Conclusion: Itraconazole was an effective treatment in this case of a multidrug-resistant sporotrichosis caused by S. globosa.Keywords: fixed cutaneous sporotrichosis, Sporothrix globosa

Neal Yuan,1 Christy Boscardin,2 Nadra E Lisha,2 R Adams Dudley,3,4 Grace A Lin2 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 4School of Public Health, University of Minnesota, Minneapolis, MN, USACorrespondence: Neal YuanSmidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Davis 1015, Los Angeles, CA 90048, USAEmail Neal.Yuan@cshs.orgBackground: In stable coronary artery disease (CAD), shared decision-making (SDM) is encouraged when deciding whether to pursue percutaneous coronary intervention (PCI) given similar cardiovascular outcomes between PCI and medical therapy. However, it remains unclear whether improving patient-provider communication and patient knowledge, the main tenets of SDM, changes patient preferences or the treatment chosen. We explored the relationships between patient-provider communication, patient knowledge, patient preferences, and the treatment received.Methods: We surveyed stable CAD patients referred for elective cardiac catheterization at seven hospitals from 6/2016 to 9/2018. Surveys assessed patient-provider communication, medical knowledge, and preferences for treatment and decision-making. We verified treatments received by chart review. We used linear and logistic regression to examine relationships between patient-provider communication and knowledge, knowledge and preference, and preference and treatment received.Results: Eighty-seven patients completed the survey. More discussion of the benefits and risks of both medical therapy and PCI associated with higher patient knowledge scores (β=0.28, p< 0.01). Patient knowledge level was not associated with preference for PCI (OR=0.78, 95% CI 0.57– 1.03, p=0.09). Black patients had more than four times the odds of preferring medical therapy to PCI (OR=4.49, 1.22– 18.45, p=0.03). Patients preferring medical therapy were not significantly less likely to receive PCI (OR=0.67, 0.16– 2.52, p=0.57).Conclusions: While communicating the risks of PCI may improve patient knowledge, this knowledge may not affect patient treatment preferences. Rather, other factors such as race may be significantly more influential on a patient’s treatment preferences. Furthermore, patient preferences are still not well reflected in the treatment received. Improving shared decision-making in stable CAD therefore may require not only increasing patient education but also better understanding and including a patient’s background and pre-existing beliefs.Keywords: stable coronary artery disease, stable angina, shared decision-making, percutaneous coronary intervention, stent, optimal medical therapy

Xuefeng Jiang,1,* Yusheng Liu,1,* Guijuan Zhang,2,* Shujun Lin,1 Naijun Yuan,1 Jieyan Wu,1 Xianxin Yan,1 Yi Ma,3 Min Ma1,2 1College of Traditional Chinese Medicine of Jinan University, Guangzhou, People’s Republic of China; 2The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 3Institute of Biomedicine and Department of Cellular Biology, Jinan University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Min MaCollege of Traditional Chinese Medicine of Jinan University, 601 Huangpu Avenue West, Guangzhou, Guangdong 510632, People’s Republic of ChinaTel +86 15876583624Fax +86 20-85227173Email 2246809300@qq.comPurpose: Acetyl-11-keto-β-boswellic acid (AKBA) has therapeutic effects on a range of diseases, including tumours. lncRNAs, as competing endogenous RNAs (ceRNAs), can interact with miRNAs to regulate the expression of target genes, which can affect the development of tumors. Here, we examined the effects of AKBA on breast precancerous lesions MCF-10AT cells.Methods: The expression profiles of breast cancer (BC) tissue were collated from The Cancer Genome Atlas (TCGA), and the lncRNA-miRNA-mRNA ceRNA network was constructed. AKBA targets were predicted by network pharmacology. The expression of long intergenic nonprotein-coding RNA 707 (LINC00707), miR-206 and ER-α was determined by qRT-PCR. Cell viability, apoptosis and cycle were assessed by CCK-8 and flow cytometry. Protein levels were measured by Western blotting.Results: A total of 3205 differentially expressed mRNAs, 104 miRNAs, and 605 lncRNAs were identified. The ceRNA network consisting of 9 lncRNAs, 15 miRNAs and 82 mRNAs was constructed. We found that LINC00707 was up-regulated and miR-206 was down-regulated in MCF-10AT cells. Transfected si-LINC00707 could inhibit cell proliferation, induce cell apoptosis and cycle arrest of MCF-10AT cells. In addition, network pharmacology predicted that AKBA may regulate the ESR1 in the treatment of BC. Our research demonstrated that AKBA could induce cell apoptosis and G1-phase arrest and inhibit ER-α expression via LINC00707/miR-206 in MCF-10AT cells.Conclusion: AKBA inhibited MCF-10AT cells via regulation of LINC00707/miR-206 that reduces ER-α.Keywords: breast precancerous lesion, acetyl-11-keto-β-boswellic acid, ceRNA, LINC00707, miR-206, ESR1

Maintaining balance involves the combination of sensory signals from the visual, vestibular, proprioceptive, and auditory systems. However, physical and biological constraints ensure that these signals are perceived slightly asynchronously. The brain only recognizes them as simultaneous when they occur within a period of time called the temporal binding window (TBW). Aging can prolong the TBW, leading to temporal uncertainty during multisensory integration. This effect might contribute to imbalance in the elderly but has not been examined with respect to vestibular inputs. Here, we compared the vestibular-related TBW in 13 younger and 12 older subjects undergoing 0.5 Hz sinusoidal rotations about the earth-vertical axis. An alternating dichotic auditory stimulus was presented at the same frequency but with the phase varied to determine the temporal range over which the two stimuli were perceived as simultaneous at least 75% of the time, defined as the TBW. The mean TBW among younger subjects was 286 ms (SEM ± 56 ms) and among older subjects was 560 ms (SEM ± 52 ms). TBW was related to vestibular sensitivity among younger but not older subjects, suggesting that a prolonged TBW could be a mechanism for imbalance in the elderly person independent of changes in peripheral vestibular function. [ABSTRACT FROM AUTHOR]

Abstract We aimed to implement a fully automatic computed tomography (CT) image-detection programming algorithm as a pectus excavatum (PE) diagnostic tool, facilitating comprehensive chest wall deformity evaluation. We developed our algorithm using MATLAB, leveraging the Hounsfield unit threshold and region growing methods. The MATLAB graphical user interface enables the direct use of our program. We validated the model using CT images of anthropomorphic phantoms and one normal individual. The measurement values obtained by our algorithm demonstrated very small differences compared to the known anthropomorphic phantom model data and manual measurement. For algorithm testing, 17,214 chest CT scans obtained from 57 PE patients were processed by the algorithm and independently reviewed by a radiologist and a thoracic surgeon. The measurements of transverse, anteroposterior, and sternum-to-vertebral distance of the thoracic cavity, along with the calculated data of four indices, exhibited high positive correlations (0.94–0.99). The asymmetry index and maximum anteroposterior hemithorax distance exhibited moderate correlation (0.40–0.83). Our automatic PE diagnostic tool demonstrated high accuracy; four chest wall deformity indices were obtained simultaneously without any initial manual marking, correlating well with manual measurements.

The management of patients undergoing bilateral nephrectomy for renal cancer presents significant challenges, particularly in addressing hypotension, anemia, and tumor recurrence during hemodialysis.

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by a systemic inflammatory response, predominantly associated with hepatitis B virus in the Asia-Pacific region, with a high short-term mortality rate. The platelet to high-density lipoprotein ratio (PHR) has been used to predict the prognosis of patients with various inflammatory diseases. We aim to is to use the PHR to predict the short-term prognosis of patients with HBV-ACLF. Method In this study, we retrospectively analyzed clinical data from 270 HBV-ACLF patients. Using logistic regression, we identified independent risk factors for short-term mortality and developed a prognostic model. This model was then validated, compared, and its clinical utility assessed via decision curve analysis (DCA). Results Among the 270 HBV-ACLF patients, 98 patients died within 28 days. The deceased group exhibited a higher proportion of severe hepatic encephalopathy and ascites. Additionally, there was a statistically significant difference (P = 0.046) in the novel inflammation scoring system, PHR, between the two groups. Following stringent variable selection, PHR was identified as a predictive factor for short-term mortality in HBV-ACLF patients using logistic regression analysis (OR: 0.835 (0.756–0.999), P = 0.009), and it exhibited a synergistic effect with certain traditional scores. The prognostic model constructed based on PHR demonstrated a superior ability to predict short-term mortality compared to traditional scores such as Child-Turcotte-Pugh (AUC: 0.889). Evaluation using calibration curves and decision curve analysis (DCA) suggested its practical utility. Conclusion PHR can predict short-term mortality in patients, with a low PHR upon admission being associated with an increased risk of death.

Abstract Cervical softening and dilation are critical for the successful term delivery of a fetus, with premature changes associated with preterm birth. Traditional clinical measures like transvaginal ultrasound and Bishop scores fall short in predicting preterm births and elucidating the cervix’s complex microstructural changes. Here, we introduce a magnetic resonance diffusion basis spectrum imaging (DBSI) technique for non-invasive, comprehensive imaging of cervical cellularity, collagen, and muscle fibers. This method is validated through ex vivo DBSI and histological analyses of specimens from total hysterectomies. Subsequently, retrospective in vivo DBSI analysis at 32 weeks of gestation in ten term deliveries and seven preterm deliveries with inflammation-related conditions shows distinct microstructural differences between the groups, alongside significant correlations with delivery timing. These results highlight DBSI’s potential to improve understanding of premature cervical remodeling and aid in the evaluation of therapeutic interventions for at-risk pregnancies. Future studies will further assess DBSI’s clinical applicability.

Background: Both multi‐morbidity (MM) and polypharmacy (PP) are common in the elderly and pose a challenge for health and social care systems. However, high‐quality patient‐centred care requires context‐bound understanding of the patterns and use of medications in those with MM. Therefore, the aim of this study was to investigate the prevalence of PP in community‐dwelling elderly, and the factors associated with MM, PP, excessive polypharmacy (EPP), and the types of drugs used. Methods: We analysed data of 164 community‐dwelling subjects aged ≥60 years from January to December 2020 at a general hospital in a rural area of Taiwan. MM was defined as >4 diagnoses of chronic health conditions. Non‐polypharmacy (NP), PP, and EPP were defined as <5, 5–8, and >8 prescriptions, respectively. Other variables including basic activities of daily living (BADL), severity of frailty, depressive mood, screening for intellectual impairment, and nutritional status were also analysed. Results: Of the 164 participants, 34.8% had >4 diagnoses, 66.5% had PP, and 26.2% had EPP. The patients with >4 diagnoses had worse performance in BADL, higher levels of frailty, and more prescriptions than those with fewer diagnoses. The EPP group had worse performance in BADL, a higher level of frailty, more comorbidities, and higher prevalences of diabetes mellitus and chronic kidney disease compared to the NP and PP groups. After adjusting for covariates, we further found a higher number of medications associated with having more comorbidities, and a higher level of frailty associated with having a greater number of medications. Conclusion: We found relationships between frailty and PP, and between PP and MM, but frailty did not associate with MM. Since frailty, PP, and MM may be viewed as an inevitable trinity of ageing, reducing PP could be a method to both prevent frailty and disentangle this trinity in the elderly. [ABSTRACT FROM AUTHOR]

A novel heterotrophic, cold-tolerant bacterium, designated Pseudomonas zhanjiangensis 25A3ET, was isolated from mangrove sediment and demonstrated excellent efficiency in cold wastewater treatment. Phylogenetic analysis based on 16S rRNA gene sequences positioned strain 25A3ET within the genus Pseudomonas, showing the highest similarity (98.7%) with Pseudomonas kurunegalensis LMG 32023T. Digital DNA–DNA hybridization (dDDH) and average nucleotide identity (ANI) values were below the species delineation thresholds (70% for dDDH, 95% for ANI), indicating that strain 25A3ET represents a novel species. This strain demonstrated high efficiency in removing nitrogen (N) and organic pollutants under low-temperature conditions. Specifically, it achieved 72.9% removal of chemical oxygen demand (COD), 70.6% removal of ammoniacal nitrogen (NH4+-N), and 69.1% removal of total nitrogen (TN) after 96 h at 10°C. Genomic analysis identified key genes associated with cold adaptation, nitrogen removal and organic matter degradation. These findings indicate that Pseudomonas zhanjiangensis 25A3ET holds significant potential for application in cold temperature wastewater treatment, offering a promising solution for environmental remediation in regions with low ambient temperatures.

Abstract Argininosuccinate synthase (ASS1), a critical enzyme in the urea cycle, acts as a tumor suppressor in many cancers. To date, the anticancer mechanism of ASS1 has not been fully elucidated. Here, we found that phosphoglycerate dehydrogenase (PHGDH), a key rate-limiting enzyme in serine synthesis, is a pivotal protein that interacts with ASS1. Our results showed that ASS1 directly binds to PHGDH and promotes its ubiquitination-mediated degradation to inhibit serine synthesis, consequently suppressing tumorigenesis. Importantly, the tumor suppressive effects of ASS1 were strongly abrogated by PHGDH knockout. In addition, ASS1 knockout and knockdown partially rescued cell proliferation when serine and glycine were depleted, while the inhibitory effect of ASS1 overexpression on cell proliferation was restored by the addition of serine and glycine. These findings unveil a novel role of ASS1 and suggest that the ASS1/PHGDH serine synthesis pathway is a promising target for cancer therapy.

Objective: To find the optimal quantitative index of emphysema by comparing and analyzing the quantitative indexes of emphysema in patients with mild to moderate chronic obstruction pulmonary disease (COPD) via registered biphasic quantitative computed tomography (QCT). Methods: We retrospectively collected 55 healthy controls, 21 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 1 case, and 31 GOLD 2 cases in our hospital. We imported the CT raw DICOM data into the "Digital Lung" analysis platform and measured the LAA-950% at the end of deep inspiration and the LAA-910% at the end of deep expiration. The expiratory and inspiratory CT images were registered. Then, the percentage of emphysema area (PRMEmph%), the percentage of functional small airway disease area (PRMfSAD%), and the percentage of the normal area (PRMNormal%) were calculated according to the threshold method. Pulmonary function indicators included FVC, FEV1%, and FEV1/FVC. Differences in general data, CT quantitative indexes, and pulmonary function between groups were assessed using the independent sample t-test, Mann–Whitney U test, or chi-square test, and the correlation was analyzed using Spearman correlation. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of CT quantitative parameters for emphysema in patients with mild to moderate COPD. Results: There were significant differences in sex, smoking index, FEV1%, FEV1/FVC, inspiratory phase LAA%-950, expiratory phase LAA%-910, PRMEmph%, PRMfSAD%, and PRMNormal% between the mild to moderate COPD patients and normal control groups. The inspiratory phase LAA%-950 was negatively correlated with FEV1/FVC, the expiratory phase LAA%-910 and PRMEmph% were negatively correlated with FVC, FEV1%, and FEV1/FVC. ROC curve analysis results showed that the areas under the curve of inspiration phase LAA%-950, expiratory phase LAA%-910, and PRMEmph% were 0.742, 0.861, and 0.876, respectively. Among them, the area under the curve of the PRMEmph% index was the largest, with a corresponding critical value of 9.84%, a sensitivity of 76.90%, and a specificity of 94.50%. Conclusion: Quantitative CT emphysema index LAA%-950 in the inspiratory phase, LAA%-910 in the expiratory phase, and PRMEmph% in biphasic can objectively evaluate emphysema in patients with mild to moderate COPD, among which PRMEmph% is the best evaluation index.

Background The analytical renal pathology system (ARPS) based on convolutional neural networks has been used successfully in native IgA nephropathy (IgAN) patients. Considering the similarity of pathologic features, we aim to evaluate the performance of the ARPS in allograft IgAN patients and broaden its implementation.Methods Biopsy-proven allograft IgAN patients from two different centers were enrolled for internal and external validation. We implemented the ARPS to identify glomerular lesions and intrinsic glomerular cells, and then evaluated its performance. Consistency between the ARPS and pathologists was assessed using intraclass correlation coefficients. The association of digital pathological features with clinical and pathological data was measured. Kaplan-Meier survival curve and cox proportional hazards model were applied to investigate prognosis prediction.Results A total of 56 biopsy-proven allograft IgAN patients from the internal center and 17 biopsy-proven allograft IgAN patients from the external center were enrolled in this study. The ARPS was successfully applied to identify the glomerular lesions (F1-score, 0.696–0.959) and quantify intrinsic glomerular cells (F1-score, 0.888–0.968) in allograft IgAN patients rapidly and precisely. Furthermore, the mesangial hypercellularity score was positively correlated with all mesangial metrics provided by ARPS [Spearman’s correlation coefficient (r), 0.439–0.472, and all p values < 0.001]. Besides, a higher allograft survival was noticed among patients in the high-level groups of the maximum and ratio of endothelial cells, as well as the maximum and density of podocytes.Conclusion We propose that the ARPS could be implemented in future clinical practice with outstanding capability.

Purpose: To develop and validate deep learning algorithms that can identify and classify angle-closure (AC) mechanisms using anterior segment optical coherence tomography (AS-OCT) images. Methods: This cross-sectional study included participants of the Handan Eye Study aged ≥35 years with AC detected via gonioscopy or on the AS-OCT images. These images were classified by human experts into the following to indicate the predominant AC mechanism (ground truth): pupillary block, plateau iris configuration, or thick peripheral iris roll. A deep learning architecture, known as comprehensive mechanism decision net (CMD-Net), was developed to simulate the identification of image-level AC mechanisms by human experts. Cross-validation was performed to optimize and evaluate the model. Human-machine comparisons were conducted using a held-out and separate test sets to establish generalizability. Results: In total, 11,035 AS-OCT images of 1455 participants (2833 eyes) were included. Among these, 8828 and 2.207 images were included in the cross-validation and held-out test sets, respectively. A separate test was formed comprising 228 images of 35 consecutive patients with AC detected via gonioscopy at our eye center. In the classification of AC mechanisms, CMD-Net achieved a mean area under the receiver operating characteristic curve (AUC) of 0.980, 0.977, and 0.988 in the cross-validation, held-out, and separate test sets, respectively. The best-performing ophthalmologist achieved an AUC of 0.903 and 0.891 in the held-out and separate test sets, respectively. And CMD-Net outperformed glaucoma specialists, achieving an accuracy of 89.9 % and 93.0 % compared to 87.0 % and 86.8 % for the best-performing ophthalmologist in the held-out and separate test sets, respectively. Conclusions: Our study suggests that CMD-Net has the potential to classify AC mechanisms using AS-OCT images, though further validation is needed.

The Shunbei 5 (SB5) strike-slip fault, situated in the central Tarim basin, is distinguished by its considerable length, significant variations in planar orientation, and intricate multi-stage tectonic evolution. This study delves into the geometric, kinematic, and dynamic features of both the southern and northern parts of the SB5 fault, utilizing the latest seismic data from the Fuman Oilfield, and examines the factors influencing the fault’s planar deflection. The fault can be categorized into three structural deformation layers based on lithological features and fault features: the deep structural deformation layer (below TЄ3), characterized by basement rifting and limited strike-slip activity; the middle structural deformation layer (TЄ3-TO3), marked by vigorous strike-slip movements and the dominance of flower structures; and the shallow structural deformation layer (TO3-TP), featuring echelon-type normal faults and boundary graben faults, specifically in the southern SB5 fault. The fault activity is more pronounced in its southern SB5 fault compared to the northern, with the weakest activity at the TЄ3 interface and the peak at the TO3 interface. The southern SB5 fault transitions to sinistral slip at the TO3 interface, while the northern SB5 fault shifts from dextral to sinistral slip at the TC interface, highlighting variable slip directions across different interfaces. Rifts are extensively distributed within the Precambrian basement along the SB5 fault. The initial strike-slip fault rupture, which is primarily localized in these areas, exerts a significant influence on the formation of the S-shaped fault plane. This process involves four distinct evolution stages: the embryonic stage of strike-slip activity during the Middle-Late Cambrian; the intense strike-slip fault activity stage during the Middle-Late Ordovician; the reactivation stage of deep strike-slip fault in the Silurian; and the connection and reactivation stage during the Devonian-Carboniferous.

IntroductionAge-related macular degeneration (AMD) is an ophthalmic disease that causes visual impairment and is one of the leading causes of blindness in the elderly. Fatty acids are essential nutrients required by the body and play a cornerstone role in the life activities of the body. Many studies have reported that fatty acids are involved in the development of AMD. To confirm this association, we conducted the present study.MethodsWe analyzed the association between all fatty acid intake and AMD using National Health and Nutrition Examination Survey (NHANES) data from 2005–2008. Quantile regression was performed to assess the effect of fatty acids on AMD at different intake levels.ResultsAfter adjusting for covariates, only saturated fatty acids showed no significant difference between AMD patients and non-AMD patients (23.64 g vs. 26.03 g, p = 0.052). Total fat (70.88 g vs. 78.86 g, p = 0.024), monounsaturated fatty acids (25.87 g vs. 28.95 g, p = 0.019), polyunsaturated fatty acids (15.10 g vs. 17.07 g, p = 0.017) showed significant differences between the two groups. When AMD was considered as an outcome, the association between AMD and docosaentaenoic acid (DPA) was negative in the multivariate logic model (model 1: OR =

Persistent organic pollutants seriously affect the growth and development of crops. 1,2,4-Trichlorobenzene (TCB), as one of the most widely used chlorobenzenes, can affect the yield of japonica rice. However, existing research on the effect of TCB on japonica rice yield is not in-depth, and a basic understanding of commonality has not yet been formed. In this study, 28 conventional japonica rice varieties were selected to investigate the effects of TCB stress on their yield, yield composition, and TCB accumulation. This study also evaluated the efficiency of conventional tolerance indices in evaluating the TCB stress tolerance of japonica rice. The results showed that TCB caused sustained inhibition of the growth of japonica rice, which was considerably manifested in plant height, root length, soil plant analysis development (SPAD), and dry weight at different growth stages. Under TCB stress, TCB accumulation in various tissues of japonica rice increased sharply. TCB stress reduces the yield of japonica rice by reducing the number of panicles per hill, the number of spikelets per panicle, the grain filling percentage, and the grain weight. Overall, the results of this study indicate that TCB stress can cause a decrease in the yield of japonica rice, and the decrease in panicle number is the main reason. The conventional tolerance index can effectively evaluate the tolerance of japonica rice to TCB. The results of this study are substantial for the breeding and cultivation of japonica rice.

Microwave dielectric ceramics should be improved to advance mobile communication technologies further. In this study, we prepared Sr1+xY2O4+x (x = 0–0.04) ceramics with nonstoichiometric Sr2+ ratios based on our previously reported SrY2O4 microwave dielectric ceramic, which has a low dielectric constant and an ultrahigh quality factor (Q value). The ceramic exhibited a 33.6% higher Q-by-frequency (Q×f) value (Q ≈ 12,500) at x = 0.02 than SrY2O4. All Sr1+xY2O4+x (x = 0–0.04) ceramics exhibited pure phase structures, although variations in crystal-plane spacings were observed. The ceramics are mainly composed of Sr–O, Y1–O, and Y2–O octahedra, with the temperature coefficient of the resonant frequency (τf) of the ceramic increasing with Y2–O octahedral distortion. The ceramic comprises uniform grains with a homogeneous elemental distribution, clear grain boundaries, and no obvious cavities at x = 0.02. The Sr1+xY2O4+x (x = 0–0.04) ceramics exhibited good microwave dielectric properties, with optimal performance observed at x = 0.02 (dielectric constant (εr) = 15.41, Q×f = 112,375 GHz, and τf = −17.44 ppm/℃). The τf value was reduced to meet the temperature-stability requirements of 5G/6G communication systems by adding CaTiO3, with Sr1.02Y2O4.02+2wt%CaTiO3 exhibiting εr = 16.14, Q×f = 51,004 GHz, and τf = 0 ppm/℃. A dielectric resonator antenna prepared using Sr1.02Y2O4.02+2wt%CaTiO3 exhibited a central frequency of 26.6 GHz, with a corresponding gain and efficiency of 3.66 dBi and 83.14%, respectively. Consequently, Sr1.02Y2O4.02-based dielectric resonator antennas are suitable for use in 5G millimeter-wave band (24.5–27.5 GHz) applications.

Abstract Background The current literature shows a strong relationship between retinal neuronal and vascular alterations in dementia. The purpose of the study was to use NFN+ deep learning models to analyze retinal vessel characteristics for cognitive impairment (CI) recognition. Methods We included 908 participants from a community-based cohort followed for over 15 years (the prospective KaiLuan Study) who underwent brain magnetic resonance imaging (MRI) and fundus photography between 2021 and 2022. The cohort consisted of both cognitively healthy individuals (N = 417) and those with cognitive impairment (N = 491). We employed the NFN+ deep learning framework for retinal vessel segmentation and measurement. Associations between Retinal microvascular parameters (RMPs: central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension) and CI were assessed by Pearson correlation. P

Abstract Background Nonalcoholic steatohepatitis (NASH) is a progressive manifestation of nonalcoholic fatty liver disease (NAFLD) that can lead to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Despite the growing knowledge of NASH and HCC, the association between the two conditions remains to be fully explored. Bioinformatics has emerged as a valuable approach for identifying disease-specific feature genes, enabling advancements in disease prediction, prevention, and personalized treatment strategies. Materials and methods In this study, we utilized CellChat, copy number karyotyping of aneuploid tumors (CopyKAT), consensus Non-negative Matrix factorization (cNMF), Gene set enrichment analysis (GSEA), Gene set variation analysis (GSVA), Monocle, spatial co-localization, single sample gene set enrichment analysis (ssGSEA), Slingshot, and the Scissor algorithm to analyze the cellular and immune landscape of NASH and HCC. Through the Scissor algorithm, we identified three cell types correlating with disease phenotypic features and subsequently developed a novel clinical prediction model using univariate, LASSO, and multifactor Cox regression. Results Our results revealed that macrophages are a significant pathological factor in the development of NASH and HCC and that the macrophage migration inhibitory factor (MIF) signaling pathway plays a crucial role in cellular crosstalk at the molecular level. We deduced three prognostic genes (YBX1, MED8, and KPNA2), demonstrating a strong diagnostic capability in both NASH and HCC. Conclusion These findings shed light on the pathological mechanisms shared between NASH and HCC, providing valuable insights for the development of novel clinical strategies.

In the post-epidemic era, public panic has emerged as a highly significant secondary disaster, necessitating an urgent enhancement of emergency management capabilities by governments at all levels. In order to ensure a robust assessment of the government's ability to manage public panic, it is crucial to effectively address the influence of uncertain and ambiguous factors associated with such scenarios. This paper proposes a governmental public panic emergency management capability assessment method based on fuzzy Petri nets. By analyzing the factors influencing public panic across the four evolutionary stages, namely gestation, outbreak, diffusion, and fading, we establish a hierarchical evaluation index system for assessing emergency management capabilities. Additionally, we develop a range of multi-scenario emergency management strategies. To address the challenges posed by uncertainty, randomness, fuzziness, and insufficient statistical data within the assessment index system, we introduce fuzzy Petri nets and fuzzy reasoning rules to evaluate the emergency management capability of the assessment system and derive the optimal emergency management strategy. According to example simulations, the effectiveness and practicality of models and rules constructed using fuzzy Petri nets are demonstrated, highlighting their superiority over traditional assessment methods. This comprehensive approach equips the government with a versatile toolkit for effectively managing public panic emergencies.

Objective: To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction. Design: A multicentre cross‐sectional study. Setting: A total of 94 hospitals across 23 provinces in China. Population: A total of 73 977 randomly selected deliveries. Methods: We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates. Main outcome measures: CD rates in China. Results: In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs. Conclusions: Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD. The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953. [ABSTRACT FROM AUTHOR]

With the aim of investigating the assessment methodology for the overall damage effects on an unmanned aerial vehicle (UAV) subjected to a blast wave, the failure criteria for the typical UAV was formulated through an analysis of the structural strength design standards. Specifically, the shear force associated with wing failure can serve as a critical parameter for assessing the overall damage inflicted on the UAV by blast waves. According to the design load criterion of the aircraft, the shear force value corresponding to the overall failure of the typical UAV was calculated. Numerical simulations were conducted to investigate the mechanical response of UAV structures under blast wave loading generated by a 500 g explosive. Combining the critical shear force values obtained from theoretical calculations with the numerical simulation results, two distances between the explosives and the UAV that could produce different damage effects were estimated, namely 1 m and 2.5 m. Subsequently, static explosion experiments with equivalent explosive charges were performed, revealing different damage effects on a typical UAV at two specific distances. The numerical simulation results were highly consistent with the experimental observations, further validating the scientific and rational basis for using shear force as a primary parameter in assessing overall structural damage to fixed-wing UAVs.

DC voltage is one of the important parameters of active power filters. Since the series hybrid active power filter does not withstand the fundamental voltage, it cannot absorb energy from the power grid, making it too difficult to control its DC voltage. In order to solve the DC voltage control problem, an improved control method for the series hybrid active power filter with magnetic flux compensation is proposed in this paper. In this improved method, the fundamental magnetic flux compensation coefficient is equal to 1, meeting the condition of fundamental magnetic flux compensation. This improved method does not rely on the precise detection and phase-locking of the fundamental voltage at the port of the series transformer. A phase-fixed active current component is generated directly by the inverter, enabling the active power filter (APF) to absorb active power from the power grid. Consequently, the active power absorbed by the APF from the power grid has a linear relationship with the active current component. Both simulation and experimentation verified the correctness and effectiveness of this proposed method.

This paper presents several new results in the studies of the fictitious-crack model. First, an engineering version of the stability theory of the fictitious-crack model is presented in the framework of the finite element method. Then, the rupture condition of the fictitious-crack model is extended to the case of multiple loads for the linear softening materials, which leads to a new formula to predict tensile strength. In addition, a new semianalytic model is proposed to study beams without notch, from which a very simple size-effect formula is derived. This new formula currently has been adopted in a German code to predict the concrete response under multiple loads. Extensive experimental results are collected and compared with our theoretical predictions. In view of the comparison, it appears that, for normal concrete, a linear softening relation is sufficient for the purpose of describing its modulus of rupture.