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ABSTRACT Sugarcane smut, caused by the basidiomycetous fungus Sporisorium scitamineum, is a global fungal disease resulting in substantial economic losses. Our previous research has highlighted the significant role of reactive oxide species (ROS) in the sexual reproduction of S. scitamineum, yet the underlying mechanisms remain unclear. In this study, we identified the cytochrome c-peroxidase encoding gene, SsCCP1, as crucial for oxidative stress resistance. We further found that absence of SsCcp1 leads to defects in mating/filamentation and disrupts intracellular ROS homeostasis. However, restoration of mating/filamentation of SsCCP1 deletion mutants was partially achieved with exogenous antioxidants (vitamin C or vitamin E). Notably, transcription of the pheromone response factor SsPRF1, pivotal for mating/filamentation of S. scitamineum, is significantly reduced in the SsCCP1 deletion mutants or under exogenous hydrogen peroxide (H2O2) conditions. Nevertheless, the addition of exogenous vitamin C for 60 min significantly up-regulated the SsPRF1 gene in the SsCCP1 deletion mutants. Moreover, the constitutive expression of SsPRF1 essentially reinstated the mating/filamentation of SsCCP1 deletion mutants, suggesting that SsCcp1 mediates the transcriptional activity of SsPRF1 by maintaining ROS homeostasis to regulate the mating/filamentation of S. scitamineum. Further investigations revealed that SsCcp1 is necessary for ROS detoxification and full pathogenicity in planta. Overall, this study not only unveils the importance of SsCcp1 in S. scitamineum mating/filamentation, ROS detoxification, and virulence but also provides insights into the role of SsCcp1-regulated ROS homeostasis in sexual reproduction of S. scitamineum. IMPORTANCE Reactive oxygen species play an important role in pathogen-plant interactions. In fungi, cytochrome c-peroxidase maintains intracellular ROS homeostasis by utilizing H2O2 as an electron acceptor to oxidize ferrocytochrome c, thereby contributing to disease pathogenesis. In this study, our investigation reveals that the cytochrome c-peroxidase encoding gene, SsCCP1, not only plays a key role in resisting H2O2 toxicity but is also essential for the mating/filamentation and pathogenicity of S. scitamineum. We further uncover that SsCcp1 mediates the expression of SsPrf1 by maintaining intracellular ROS homeostasis to regulate S. scitamineum mating/filamentation. Our findings provide novel insights into how cytochrome c-peroxidase regulates sexual reproduction in phytopathogenic fungi, presenting a theoretical foundation for designing new disease control strategies.

A high-intensity muon source driven by a continuous-wave superconducting linac holds the potential to significantly advance the intensity frontier of muon sources. Alongside advancements in accelerator technologies, breakthroughs in muon production target and collection schemes are essential. After a brief introduction to the development of the accelerator-driven system superconducting linac, a novel muon production target is proposed, utilizing a free-surface liquid lithium jet capable of handling the heat power generated by a proton beam with an energy of 600 MeV and a current of 5 mA. It is predicted by our simulation studies that the lithium target is more efficient in surface muon production compared to the rotating graphite target. The parameter space of the front end consisting of a lithium target and a large-aperture capture solenoid is explored, from the perspective of production efficiency, capture efficiency, and characteristics of the surface muon beam.

The concept of dense granular-flow target (DGT) for the China Initiative Accelerator Driven Subcritical system (CiADS) is an attractive choice for high heat removal ability, low chemical toxicity, and radiotoxicity. A wobbling hollow beam is proposed to enhance the homogeneity of temperature rise of flowing particles in beam-target coupling zone. In this paper, the design procedure of target and beam parameters was discussed firstly. Then we simulated the heat deposition and transfer of the scanning beam in DGT to study the effect of beam parameters. The results show the flux density of proton beam plays a crucial role in the distribution of temperature rise while the contributions from scanning frequency heat transfer are also obvious. Moreover, heat transfer in transversal directions is insignificant, resulting in a low heat flux towards the sidewalls of DGT. This work not only contributes to the design of DGT, but also beneficial for understanding the beam-target coupling in porous materials.

The dense granular flow spallation target is a new target concept proposed for an Accelerator-Driven Sub-critical (ADS) system. In this paper, the beam-target configurations of a tungsten granular flow target for the ADS with a thermal power of 1 GW is explored. The beam profile options using different scanning methods are discussed. The critical geometry parameters are adjusted to investigate the performance of the granular target from the aspects of neutron efficiency, stability and temperature distribution in target medium. To figure out how the target under accident conditions would behave, different clogging conditions are induced in the simulation. The dynamic processes are analyzed and some important parameters such as abnormal temperature rise and beam cutoff time window are obtained. The response of the sub-critical reactor to a clogging accident is also investigated. It is indicated that the monitoring of the granular flow by the neutron detectors in the sub-critical core will be effective.

Abstract Background POU3F4 is the causative gene for X-linked deafness-2 (DFNX2), characterized by incomplete partition type III (IP-III) malformation of the inner ear. The purpose of this study was to investigate the clinical characteristics and molecular findings in IP-III patients by Sanger or nanopore single-molecule sequencing. Methods Diagnosis of IP-III was mainly based on clinical characteristics including radiological and audiological findings. Sanger sequencing of POU3F4 was carried out for these IP-III patients. For those patients with negative results for POU3F4 Sanger sequencing, nanopore long-read single-molecule sequencing was used to identify the possible pathogenic variants. Hearing intervention outcomes of hearing aids (HAs) fitting and cochlear implantation (CI) were also analyzed. Aided pure tone average (PTA) was further compared between two groups of patients according to their different locations of POU3F4 variants: in the exon region or in the upstream region. Results In total, 18 male patients from 14 unrelated families were diagnosed with IP-III. 10 variants were identified in POU3F4 by Sanger sequencing and 6 of these were reported for the first time (p.Gln181*, p.Val215Gly, p.Arg282Gln, p.Gln316*, c.903_912 delins TGCCA and p.Arg205del). Four different deletions that varied from 80 to 486 kb were identified 876–1503 kb upstream of POU3F4 by nanopore long-read single-molecule sequencing. De novo genetic mutations occurred in 21.4% (3/14) of patients with POU3F4 mutations. Among these 18 patients, 7 had bilateral HAs and 10 patients received unilateral CI. The mean aided PTA for HAs and CI users were 41.1 ± 5.18 and 40.3 ± 7.59 dB HL respectively. The mean PTAs for patients with the variants located in the exon and upstream regions were 39.6 ± 6.31 versus 43.0 ± 7.10 dB HL, which presented no significant difference (p = 0.342). Conclusions Among 14 unrelated IP-III patients, 28.6% (4/14) had no definite mutation in exon region of POU3F4. However, possible pathogenic deletions were identified in upstream region of this gene. De novo genetic mutations occurred in 21.4% (3/14) of patients with POU3F4 mutation. There was no significant difference of hearing intervention outcomes between the IP-III patients with variants located in the exon region and in the upstream region.

Lost circulation is a world-class problem, and the contradiction between plugging and unplugging in reservoirs is a problem that needs to be solved urgently. The traditional LCM is not suitable for reservoirs and the complex subsequent operations. Currently, a self-degrading plugging material is proposed. In this paper, a new self-degradation plugging material, CKS-DPPG, was prepared by AM, GG, nano silica, and PEGDA. The effects of reactant concentration, pH, mineralization, etc., on the swelling and degradation performance of CKS-DPPG were investigated. The plugging capacity was tested by fracture plugging equipment, and the mechanism of self-degradation was revealed. The results show that the CKS-DPPG reached a 50% degradation rate in 54 h and complete degradation in 106 h at 80 °C and pH = 8. Low temperatures, high mineralization, and weak alkaline conditions prolong the complete degradation time of CKS-DPPG, which facilitates subsequent operations. The simulation of the 3 mm opening fracture plugging experiment showed that the pressure-bearing capacity reached 6.85 MPa and that a 0.16 MPa pressure difference could unplug after degradation. The ester bond of PEGDA is hydrolyzed under high-temperature conditions, and the spatial three-dimensional structure of CKS-DPPG becomes linear. The CKS-DPPG can effectively reduce subsequent unplugging operations and lower production costs.

Kongsuphol et al. develop a paper-based, vertical flow assay to detect SARS-CoV-2 neutralizing antibodies. The point-of-care assay has comparable performance to lab-based tests and provides results in 10 min.

ABSTRACT As the COVID-19 pandemic continues, countries around the world are switching toward vaccinations and boosters to combat the pandemic. However, waning immunity against SARS-CoV-2 wild-type (WT) and variants have been widely reported. Booster vaccinations have shown to be able to increase immunological protection against new variants; however, the protection observed appears to decrease quickly over time suggesting a second booster shot may be appropriate. Moreover, heterogeneity and waning of the immune response at the individual level was observed suggesting a more personalized vaccination approach should be considered. To evaluate such a personalized strategy, it is important to have the ability to rapidly evaluate the level of neutralizing antibody (nAbs) response against variants at the individual level and ideally at a point of care setting. Here, we applied the recently developed cellulose pulled-down virus neutralization test (cpVNT) to rapidly assess individual nAb levels to WT and variants of concerns in response to booster vaccination. Our findings confirmed significant heterogeneity of nAb responses against a panel of SARS-CoV-2 variants, and indicated a strong increase in nAb response against variants of concern (VOCs) upon booster vaccination. For instance, the nAb response against current predominant omicron variant was observed with medians of 88.1% (n = 6, 95% CI = 73.2% to 96.2%) within 1-month postbooster and 70.7% (n = 22, 95% CI = 66.4% to 81.8%) 3 months postbooster. Our data show a point of care (POC) test focusing on nAb response levels against VOCs can guide decisions on the potential need for booster vaccinations at individual level. Importantly, it also suggests the current booster vaccines only give a transient protective response against some VOC and new more targeted formulations of a booster vaccine against specific VOC may need to be developed in the future. IMPORTANCE Vaccination against SARS-CoV-2 induces protection through production of neutralization antibodies (nAb). The level of nAb is a major indicator of immunity against SARS-CoV-2 infection. We developed a rapid point-of-care test that can monitor the nAb level from a drop of finger stick blood. Here, we have implemented the test to monitor individual nAb level against wild-type and variants of SARS-CoV-2 at various time points of vaccination, including post-second-dose vaccination and postbooster vaccination. Huge diversity of nAb levels were observed among individuals as well as increment in nAb levels especially against Omicron variant after booster vaccination. This study evaluated the performance of this point-of-care test for personalized nAb response tracking. It verifies the potential of using a rapid nAb test to guide future vaccination regimens at both the individual and population level.

Abstract There is clinical need for a quantifiable point‐of‐care (PoC) SARS‐CoV‐2 neutralizing antibody (nAb) test that is adaptable with the pandemic's changing landscape. Here, we present a rapid and semi‐quantitative nAb test that uses finger stick or venous blood to assess the nAb response of vaccinated population against wild‐type (WT), alpha, beta, gamma, and delta variant RBDs. It captures a clinically relevant range of nAb levels, and effectively differentiates prevaccination, post first dose, and post second dose vaccination samples within 10 min. The data observed against alpha, beta, gamma, and delta variants agrees with published results evaluated in established serology tests. Finally, our test revealed a substantial reduction in nAb level for beta, gamma, and delta variants between early BNT162b2 vaccination group (within 3 months) and later vaccination group (post 3 months). This test is highly suited for PoC settings and provides an insightful nAb response in a postvaccinated population.

In response to the worldwide shortage of 99mTc supply caused by the combined consequence from both decommissioning and maintenance of research reactors worldwide, the Institute of Modern Physics (IMP) of the Chinese Academy of Science and Lanzhou University have launched a collaboration to research and develop a 99mTc production solution based on the 25 MeV high-intensity superconducting proton linear accelerator. Radiation from high-current proton bombardment must be evaluated and considered carefully at the design stage to meet radiation protection (RP) policy and requirements of the shielding for the key device. This work employed FLUKA to conduct the shielding assessment of both prompt and residual radiation fields in several iterations, based on a prototype of the high-power target system. The prompt dose rates outside the target station are lower than the institution’s limit. The residual dose rates inside the station fall below 100 μSv/h at 64 h after the end of beam (EOB); the dominant source term is then the target chamber. The service life of the main actuator is expected to be extended by 2.7 times with the current partial shielding design. The simulation accelerating techniques are applied to balance the accuracy of results and the progress of the project at the same time, which is referential to the shielding assessment of large-scale nuclear facilities. The results can also be used in further study and construction of the target station.

Objectives. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR). Methods. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. Results. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR. Conclusion. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

Background: As an advanced surgical technique to reduce trauma to the inner ear, robot-assisted electrode array (EA) insertion has been applied in adult cochlear implantation (CI) and was approved as a safe surgical procedure that could result in better outcomes. As the mastoid and temporal bones are generally smaller in children, which would increase the difficulty for robot-assisted manipulation, the clinical application of these systems for CI in children has not been reported. Given that the pediatric candidate is the main population, we aim to investigate the safety and reliability of robot-assisted techniques in pediatric cochlear implantation.Methods: Retrospective cohort study at a referral center in Shanghai including all patients of simultaneous bilateral CI with robotic assistance on one side (RobOtol® system, Collin ORL, Bagneux, France), and manual insertion on the other (same brand of EA and CI in both side), from December 2019 to June 2020. The surgical outcomes, radiological measurements (EA positioning, EA insertion depth, mastoidectomy size), and audiological outcomes (Behavior pure-tone audiometry) were evaluated.Results: Five infants (17.8 ± 13.5 months, ranging from 10 to 42 months) and an adult (39 years old) were enrolled in this study. Both perimodiolar and lateral wall EAs were included. The robot-assisted EA insertion was successfully performed in all cases, although the surgical zone in infants was about half the size in adults, and no difference was observed in mastoidectomy size between robot-assisted and manual insertion sides (p = 0.219). The insertion depths of EA with two techniques were similar (P = 0.583). The robot-assisted technique showed no scalar deviation, but scalar deviation occurred for one manually inserted pre-curved EA (16%). Early auditory performance was similar to both techniques.Conclusion: Robot-assisted technique for EA insertion is approved to be used safely and reliably in children, which is possible and potential for better scalar positioning and might improve long-term auditory outcome. Standard mastoidectomy size was enough for robot-assisted technique. This first study marks the arrival of the era of robotic CI for all ages.

Objectives: The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol® (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called “neuro-endoscopes,” have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called “oto-endoscopes,” and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES.Methods: Two neuro-endoscopes (3.3 mm, 25 cm, 0°/30°) were studied using two routine light sources (LED/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0°/30°) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied.Results: Light intensity was correlated with stabilized tip temperatures (P < 0.01, R2 = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0°, 30° neuro-endoscopes, and 0°, 30° oto-endoscopes were 96.1, 60.1, 67.8, and 56.4°C, respectively. With 100% LED power, the temperatures decreased by about 10°C, respectively. For the 0° neuro-endoscope, the illuminated area far away 1cm from the tip was below 37°C when using more than 50% both power, while this distance for 30° neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3°C with the 0° neuro-endoscope under 100% xenon power. Suction resulted in a ~1–2°C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min.Conclusion: Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.

A buncher is one of the main pieces of equipment in the medium energy beam transport line (MEBT) for China accelerator driven sub-critical system (C-ADS) Injector II. To focus the beam longitudinally and match the beam for the acceptance of the superconducting linac section, two room temperature quarter wave resonator (QWR) bunchers with frequency of 162.5 MHz have been designed as parts of the MEBT. According to the beam transmission matching of the MEBT and the geometric parameters requirements of bunchers, the unique mechanical structure and the main processing technology of buncher cavities and their couplers and tuners are described in this paper. The fabrication of bunchers and their parts have been completed and tested at high power, the test results agree well with the design requirements. These bunchers work well for about two years in Institute of Modern Physics, Chinese Academy of Sciences.

Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this disease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform standard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lacking of long-term follow-up large data after radiotherapy, and with the development of microsurgery, radiotherapy is now less recommended except for recurrent cases or elderly patients. Keywords: Sporadic acoustic neuroma, Vestibular schwannoma, Management, Symptoms grading, Tumor stage, Microsurgery, Radiotherapy

As the highest power proton linear accelerator in continuous wave mode, China initiative Accelerator Driven sub-critical System linear accelerator will deliver 2.5 MW proton beam to the target inside the reactor. Vacuum transition from 5×10^{4} Pa to several 10^{-6} Pa is required at the accelerator to target section. A vacuum differential system located at the transfer line is designed to meet the requirement of the windowless target and upstream collimators are considered for power loss control in this paper. A vacuum test based on vacuum transition verifies that about 10 orders of magnitude vacuum transition could be achieved as required, and gas scattering simulation shows that the power loss and beam size increase are at an acceptable level before the last magnet.

Salt stress limits plant growth and crop productivity and is an increasing threat to agriculture worldwide. In this study, proteomic and physiological responses of Brassica napus leaves under salt stress were investigated. Seedlings under salt treatment showed growth inhibition and photosynthesis reduction. A comparative proteomic analysis of seedling leaves exposed to 200 mM NaCl for 24 h, 48 h and 72 h was conducted. Forty-four protein spots were differentially accumulated upon NaCl treatment and 42 of them were identified, including several novel salt-responsive proteins. To determine the functional roles of these proteins in salt adaptation, their dynamic changes in abundance were analyzed. The results suggested that the up-accumulated proteins, which were associated with protein metabolism, damage repair and defense response, might contribute to the alleviation of the deleterious effect of salt stress on chlorophyll biosynthesis, photosynthesis, energy synthesis and respiration in Brassica napus leaves. This study will lead to a better understanding of the molecular basis of salt stress adaptation in Brassica napus and provides a basis for genetic engineering of plants with improved salt tolerance in the future.

To develop the next generation of safe and cleaner nuclear energy, the accelerator-driven subcritical (ADS) system emerges as one of the most attractive technologies. It will be able to transmute the long-lived transuranic radionuclides produced in the reactors of today’s nuclear power plants into shorter-lived ones, and also it will provide positive energy output at the same time. The prototype of the Chinese ADS (C-ADS) proton accelerator comprises two injectors and a 1.5 GeV, 10 mA continuous wave (CW) superconducting main linac. The injector scheme II at the C-ADS demo facility inside the Institute of Modern Physics is a 10 MeV CW superconducting linac with a designed beam current of 10 mA, which includes an ECR ion source, a low-energy beam transport line, a 162.5 MHz radio frequency quadrupole accelerator, a medium-energy beam transport line, and a superconducting half wave resonator accelerator section. This demo facility has been successfully operating with an 11 mA, 2.7 MeV CW beam and a 3.9 mA, 4.3 MeV CW beam at different times and conditions since June 2014. The beam power has reached 28 kW, which is the highest record for the same type of linear accelerators. In this paper, the parameters of the test injector II and the progress of the beam commissioning are reported.

Background and methodsTo understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials.ResultsBetween 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.

Abstract Background The current review aims to explore the evidence regarding the effectiveness of mandibular advancement orthodontic appliances with maxillary expansion device in treating pediatric Obstructive Sleep Apnea (OSA). Materials and methods A systematic literature search was conducted across PubMed, Cochrane Central, Web of Science, Embase, Scopus databases, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, and Wanfang. The research involved children and adolescents (under 16 years old) who received mandibular advancement and maxillary expansion functional orthopedic appliances for OSA treatment. We performed narrative reviews and subsequently amalgamated the findings from the studies. Results Six articles were included for review. Although a small number of studies were included, the research suggested the potential advantages of mandibular advancement for children with OSA. Following treatment, there was a decrease in AHI/RDI, an improvement in sleep quality, and the increase in oxygen saturation. Conclusions The limited quantity and quality of existing studies necessitate caution when drawing conclusions about the effectiveness of mandibular advancement and maxillary expansion for OSA. In the future, larger and well-designed randomized controlled trials (RCTs) are needed to provide more robust evidence. Patients should be carefully selected, and their orthodontic indications should be thoroughly evaluated before inclusion in such trials.We encourage researchers to design studies that monitor patients over several years to provide a comprehensive understanding of the long-term effectiveness. Trial registration This study was registered in PROSPERO(CRD42023480407) on November 20, 2023.

Abstract Multifunctional composites have been continuously developed for a myriad of applications with remarkable adaptability to external stimuli and dynamic responsiveness. This study introduces a 4D printing method for liquid crystal elastomer (LCE) composites with continuous fibers and unveils their multifunctional actuation and exciting mechanical responses. During the printing process, the relative motion between the continuous fiber and LCE resin generates shear force to align mesogens and enable the monodomain state of the matrix materials. The printed composite lamina exhibits reversible folding deformations that are programmable by controlling printing parameters. With the incorporation of fiber reinforcement, the LCE composites not only demonstrate high actuation forces but also improved energy absorption and protection capabilities. Diverse shape-changing configurations of 4D composite structures can be achieved by tuning the printing pathway. Moreover, the incorporation of conductive fibers into the LCE matrix enables electrically induced shape morphing in the printed composites. Overall, this cost-effective 4D printing method is poised to serve as an accessible and influential approach when designing diverse applications of LCE composites, particularly in the realms of soft robotics, wearable electronics, artificial muscles, and beyond.

Abstract Background Postoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation. Methods Data from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People’s Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan–Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed. Results After propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P

Abstract Objective To evaluate the trend of alcohol use disorder (AUD) mortality as a percentage of all-cause mortality in Canada and the United States (US) between 2000 and 2019, by age group. Results Joinpoint regression showed that AUD mortality as a percentage of all-cause mortality significantly increased between 2000 and 2019 in both countries, and across all age groups (i.e., young adults (20–34 years), middle-aged adults (35–49 years), and older adults (50 + years)). The trend has been levelling off, and even reversing in some cases, in recent years. The average annual percentage change differed across countries and between age groups, with a greater increase among Canadian adults aged 35–49 years and among adults aged 50 + years in the US. Over the past two decades, AUD mortality as a percentage of all-cause mortality has been increasing among all adults in both Canada and the US.