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Background: The aim of this study is to investigate the association between intravenous tirofiban and symptomatic intracranial hemorrhage (SICH) in patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) receiving endovascular thrombectomy (EVT) within 24 h of time last known well (LKW). Methods: Patients with AIS-LVO who were randomly assigned to receive intravenous tirofiban or placebo before EVT within 24 h of time LKW and had follow-up brain non-contrast computed tomography within 24 h after stopping tirofiban treatment were derived from "RESCUE BT": a multicenter, randomized, placebo-controlled, double-blind trial. All eligible patients were divided into SICH and NO-SICH groups. Subgroup analyses were performed to explore for heterogeneity. Results: Of 945 patients included in this cohort, there were 76 (8.0%) in the SICH group and 869 (92.0%) in the NO-SICH group. The incidence of SICH was not higher in patients receiving intravenous tirofiban compared with placebo (adjusted risk ratio (RR), 1.51; 95% confidence interval (CI), 0.97–2.36; P = 0.07). Subgroup analyses showed that age greater than 67-year-old (adjusted RR, 2.18; 95% CI 1.18–4.00), NIHSS greater than 16 (adjusted RR, 1.88; 95% CI 1.06–3.34), and cardioembolism (adjusted RR, 3.73; 95% CI 1.66–8.35) were associated with increased SICH risk. Conclusions: In patients with acute large vessel occlusion stroke, intravenous tirofiban before EVT within 24 h of time from last known well is not associated with increased risk of SICH. Patients who are older, have more severe neurological deficits, or with cardioembolism are at higher risk of SICH with intravenous tirofiban. Trial registration number: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR-INR-17014167. [ABSTRACT FROM AUTHOR]

Background: Length of stay (LOS) is an important metric for evaluating the management of inpatients. This study aimed to explore the factors impacting the LOS of inpatients with type-2 diabetes mellitus (T2DM) and develop a predictive model for the early identification of inpatients with prolonged LOS. Methods: A 13-year multicenter retrospective study was conducted on 83,776 patients with T2DM to develop and validate a clinical predictive tool for prolonged LOS. Least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis were adopted to build the risk model for prolonged LOS, and a nomogram was taken to visualize the model. Furthermore, receiver operating characteristic curves, calibration curves, and decision curve analysis and clinical impact curves were used to respectively validate the discrimination, calibration, and clinical applicability of the model. Results: The result showed that age, cerebral infarction, antihypertensive drug use, antiplatelet and anticoagulant use, past surgical history, past medical history, smoking, drinking, and neutrophil percentage-to-albumin ratio were closely related to the prolonged LOS. Area under the curve values of the nomogram in the training, internal validation, external validation set 1, and external validation set 2 were 0.803 (95% CI [confidence interval] 0.799–0.808), 0.794 (95% CI 0.788–0.800), 0.754 (95% CI 0.739–0.770), and 0.743 (95% CI 0.722–0.763), respectively. The calibration curves indicated that the nomogram had a strong calibration. Besides, decision curve analysis, and clinical impact curves exhibited that the nomogram had favorable clinical practical value. Besides, an online interface (https://cytjt007.shinyapps.io/prolonged%5flos/) was developed to provide convenient access for users. Conclusion: In sum, the proposed model could predict the possible prolonged LOS of inpatients with T2DM and help the clinicians to improve efficiency in bed management. [ABSTRACT FROM AUTHOR]

[Display omitted] • The prepared SnO 2 sensor has higher response than the commercial sensors. • SnO 2 sensors have superior gas sensing performance, including selectivity, response, etc. • The dataset with 20 concentrations was collected using SnO 2 and commercial sensors. • The dataset was processed by the FPNet and high evaluation metrics were obtained. The leakage of HCHO gas has direct and irreversible damage on both human health and the environment. However, the current commercial electronic nose (E-nose) has low accuracy in predicting the concentration of HCHO. In this work, a sensor array consisting of 6 gas sensors was fabricated and combined with advanced deep learning algorithms to achieve accurate prediction of HCHO concentration. High-performance SnO 2 sensing material with high specific surface area was synthesized by applying the Metal-Organic Frameworks (MOFs) sacrificial template, and the response of the SnO 2 gas sensor was as high as 15.098, which is much higher than that of commonly used commercial sensors. In addition, the sensing performance of the SnO 2 sensor, including response, selectivity and repeatability etc., were investigated. Afterward, a Formaldehyde Prediction Network (FPNet) model was proposed for processing the HCHO gas dataset and cosine annealing was added to gradually reduce the learning rate during training to help the model converge to the optimal solution. Furthermore, the residual structures with different number of layers were compared, and the 3-layer residual structure expressed the most accurate results of concentration prediction of the HCHO gas, with an MSE of 9.003, MAPE of 0.015, and R2 of 0.998. This study provides a new idea from sensor preparation to pattern recognition algorithm research, effectively solving the problems of the low response of commercial sensors to HCHO and the low accuracy of pattern recognition algorithms for E-nose datasets. [ABSTRACT FROM AUTHOR]

• A general spatial dynamics model is developed to support system dynamics analysis and controller design. • A composite control strategy is proposed to reduce residual vibration and improve trajectory tracking accuracy. • A hybrid PSO algorithm is proposed to improve particle diversity and the ability to jump out of local solutions. Residual vibrations caused by point-to-point motions reduce the positioning accuracy and dynamic performance of flexible link manipulators, and the trajectory planning method, a well-known open-loop control strategy, has been proven to effectively suppress the residual vibration in point-to-point motion. However, this open-loop control method has limitations in dealing with model uncertainty and disturbance problems. In this paper, a control strategy based on dynamics-based trajectory planning and fuzzy self-tuning PD (FST PD) controller is proposed, and applied to achieve residual vibration suppression and trajectory tracking of a flexible link manipulator. To improve the trajectory tracking performance under external disturbances, this control strategy is combined with a linear extended state observer (LESO). Firstly, the dynamic model of the system is deduced using the floating reference frame and Lagrange equation. On this basis, the objective function to minimize the lateral deformation of the tip is constructed, and then the optimal trajectory is obtained by using the Crossbreeding PSO (CBPSO) algorithm. Secondly, the optimal trajectory is used as the desired trajectory to suppress residual vibration, and the FST PD controller combined with the LESO is used to achieve high-precision trajectory tracking control of the flexible link manipulator. Finally, the effectiveness and feasibility of the composite control strategy is verified through multiple simulations. The proposed method can provide support for vibration suppression of flexible link manipulators; meanwhile, the controller structure of this method is simple and easy to implement, and the use of sensors/actuators and other equipment in the system is reduced, which effectively reduces the economic cost. [ABSTRACT FROM AUTHOR]

• An under-actuated snake robot is designed based on cable traction. • The motion of the under-actuated snake robot is controlled based on iterative tractrix. • Realize the whole process trajectory control for the under-actuated snake robot. • The algorithm can satisfy the online or offline control of snake robots. This article proposes an adaptive trajectory control method for under-actuated snake robots by simplifying the control and actuation systems of hyper-redundant robots. The under-actuated joints are formed by controlling the spatial rotation angles of multiple rigid joints in the joint group in order for them to synchronize. Based on the under-actuated configuration, a trajectory control algorithm is proposed and includes the following parts: (i) A control principle based on variable rod length is adopted so that the snake robot can track into a small working space; (ii) a trajectory planning of the snake robot in a fixed state at one end is realized by an iterative tractrix principle minimizing the joint displacement; and (iii) a fast return tracking control of the snake robot in any posture is realized by adopting the principles of the variable rod-length tractrix and the forced return iteration. A snake robot with an arm 2300 mm in length is designed and fabricated. The trajectory control simulation and experiments validate the correctness of the trajectory control algorithm and the rationality of the structural design. [ABSTRACT FROM AUTHOR]

Ischemic stroke, accounting for 80 % of all strokes, is a major cause of morbidity and mortality worldwide. However, effective and safe pharmacotherapy options for ischemic injury are limited. This study investigated the therapeutic effects of wogonoside, a compound derived from Radix Scutellariae , on ischemia/reperfusion (I/R) injury. The results showed that wogonoside treatment had significant therapeutic effects in rats with middle cerebral artery occlusion. It effectively reduced mortality rates, neurological deficits, cerebral infarct size, and brain water content. In an in vitro model using PC12 cells, wogonoside activated the Nrf2/Sirt3 signaling pathway. This activation contributed to the attenuation of oxidative damage and inflammation. Metabolomics analysis revealed increased levels of γ-aminobutyric acid (GABA) and glutathione in response to wogonoside treatment, suggesting their potential as therapeutic biomarkers for ischemic stroke. Additionally, wogonoside restored perturbed energy metabolism, including the tricarboxylic acid cycle. Wogonoside has the potential to ameliorate cerebral ischemic injury by targeting GABA-related amino acid metabolism, energy metabolism, and glutathione metabolism, maintaining redox homeostasis, and attenuating oxidative stress. These findings provide valuable insights into the protective mechanisms of wogonoside in cerebral I/R injury and highlight the promising therapeutic approach of wogonoside in the treatment of ischemic stroke. [Display omitted] • Wogonoside treatment has significant therapeutic effects in MCAO rats. • Wogonoside activates the Nrf2/Sirt3 pathway, exerting neuroprotective effects. • Wogonoside ameliorates cerebral I/R injury by targeting GABA-related amino acid metabolism, etc. [ABSTRACT FROM AUTHOR]

Microplastics (MPs), particles with a size <5 mm, are ubiquitous in water, soil, and atmosphere, and have become a highly discussed environmental issue. Although atmospheric MPs have received less attention than MPs in soil and water, their possible environmental consequences are being examined in more depth. This study systematically reviews the sources, transport, distribution, and variations of atmospheric MPs, their interactions with other pollutants in the environment and impact on human health based on the literature. The results show that MPs have been identified in diverse atmospheric settings such as urban, sub-urban, and remote areas as well as in indoor air. These airborne MPs can originate from terrestrial sources like landfills, synthetic clothing, and plastic manufacturing, use and recycling activities, as well as from aquatic sources like MPs resulting from bubble bursting. The outdoor MP abundance was detected in a range of 2 to 1159 MP/m2/day in depositions and 0 to 224 MP/m3 in suspended samples, while significantly higher abundance was observed indoors with depositions ranging from 22 to 760,000 MP/m2/day and suspended from 0.4 to 1583 MP/m3. The distribution characteristics of atmospheric MPs are affected by several factors such as urbanization, anthropogenic activities, indoor and outdoor environments and seasons. Atmospheric transport of MPs occurs through suspension, horizontal transport and deposition processes that are greatly influenced by the morphology of the MP, wind speed and direction, precipitation and other atmospheric factors. The transport path of MPs in the atmosphere is studied by Lagrangian atmospheric models by conducting backward trajectory simulations to estimate linear trajectories of MPs at sampling locations to discern their potential origin and travel distance. MPs can also interact with a variety of chemical pollutants and microorganisms in the environment and thus act as a vector for pollutant transport. The toxicity of MPs may be increased by the release of pathogens and chemical contaminants into the environment, thereby increasing the health risk to humans. Based on the study, it is suggested that further scientific research on atmospheric MPs should focus on the standardization of research methods, atmospheric transport mechanisms, interactions of MPs with atmospheric pollutants and ecological impacts. As MPs could enter the human body through various mechanisms, it is urgent to study their physiological effects on the human body when exposed to atmospheric MP pollution. [Display omitted] • Atmospheric Microplastics (MPs) could originate from terrestrial and aquatic sources. • Suspension, horizontal transport and deposition are main stages in atmospheric MP transport. • Local anthropogenic activities play a major role in determining local airborne MP abundances. • MP act as a pollutant transport vector in the environment. [ABSTRACT FROM AUTHOR]

• The general mathematical model of mover was established by using physics-based method. • A state error feedback-based state observer was established. • Controller based on model predictive control (MPC) was designed. The control matrix was solved based on the primal-dual method and Hildreth iterative method to improve the calculation efficiency and the stability of the actual operation. • The results showed that the control error of the MPC controller was reduced by 70 % compared to the PI controller. Motion control of Blanket Remote Maintenance Mover (BRMM) is studied in the maintenance and transportation process of blanket in the China Fusion Engineering Test Reactor (CFETR). Firstly, the mathematical model of mover is established in state space function type to provide model basement of model predictive control (MPC) controller. Secondly, system state observer was designed to provide system states to controller. Thirdly, to realize high accuracy motion control of BRMM, MPC controller was solved by using innovative primal-dual method and Hildreth iterative method. Finally, simulation and experiment were conducted to verify the control effectiveness of proposed controller. The results showed that control error was reduced by 70 % by using proposed controller. This work also provides application experience for blanket maintenance in the future. [ABSTRACT FROM AUTHOR]

The rapid development of computer simulation technology has provided theoretical and technical support for the performance prediction of ceramic materials. A two-dimensional simulation model was established to investigate the effect of the graphene (G) and gradient structure on the mechanical properties of (HfNbTaTiZr)C. Voronoi mosaics were applied in Abaqus to characterize the particle distribution of high entropy ceramics (HECs). The G/(HfNbTaTiZr)C–Al 2 O 3 gradient ceramics were characterized through the formation of cohesive elements within grain boundaries and grains of each element using Python language. The fracture toughness, flexural strength and hardness of G/(HfNbTaTiZr)C–Al 2 O 3 gradient ceramics were investigated through simulation model. The toughening mechanisms of G/(HfNbTaTiZr)C–Al 2 O 3 gradient composites were investigated by establishing crack growth model. The simulation consequences are consistent with the experimental results in the literature, which verifies the accuracy of the simulation consequences. The toughening mechanism is validated through crack propagation experiments and its correctness is testified. Therefore, the simulation consequences are conducive to improving the design efficiency of HECs. • The graphene gradient toughening performed more effective than most reported toughening methods. • Excellent mechanical properties were achieved for the graphene reinforced gradient HEC, enhanced by 41.9%, 112.9%, and 57.2% than pure HEC. • The toughening mechanisms of were investigated by establishing crack growth model and validated through crack propagation experiments. [ABSTRACT FROM AUTHOR]

In this study, the location of air vessels in long-distance water supply systems was investigated. The relation between location and pressure amplitude of the air vessel was established, and a new formula for air vessel location—that is, a middle-reach location—was presented and verified using a numerical simulation based on a practical project. Moreover, the water hammer protection performance of air vessels in normal and middle-reach locations was compared. The results showed that the location formula agrees well with the numerical results: The middle-reach location effectively reduced the total air vessel volume under the same protection requirements, and the maximum gas pressure was much lower. Furthermore, based on a fixed air vessel volume, the middle-reach location exhibited better protection performance compared to the normal location. [ABSTRACT FROM AUTHOR]

Formaldehyde (HCHO) is one of the most abundant carbonyls in the troposphere, which plays a significant role in atmospheric chemistry. Limited knowledge is available on the spatial fingerprints and long-term trends of ground-based HCHO in megacity clusters of China. Here we performed a concurrent multi-site observation during a photochemical episode in autumn 2021 and conducted a temporal trend analysis of HCHO in the Pearl River Delta (PRD) region, southern China. The HCHO concentrations were found to be sensitive to the land-use types in the order of urban > suburban > rural. The predominant sources of HCHO in the morning and afternoon were primary emissions and secondary formations, respectively. Extremely high concentrations of HCHO were captured in the Pearl River Estuary (PRE) area, and shipping emissions might be a plausible explanation for this unexpected phenomenon. O 3 sensitivity analysis showed that the PRE area was in a VOC-limited regime during the episode. Meta-analysis demonstrated a U-shaped trend of HCHO in the PRD over the past two decades, exhibiting a "Seesaw effect" between particulate and photochemical pollutants after 2013. The snapshot and meta-analysis of ground-based HCHO in this study highlight the importance of ship-related HCHO in the PRE and in-depth investigation of reactive carbonyls from ship emissions will be in demand. Our results would be helpful for the assessment of past and future implementations of photochemical pollution control policy in the PRD region. [Display omitted] • Concurrent multi-site observation of HCHO during a photochemical episode in the PRD. • HCHO concentrations were sensitive to the land-use types. • Unexpected high levels of HCHO in the Pearl River Estuary were likely related to ship emissions. • U-shaped trend was found for ground-based HCHO in the PRD over the past two decades. • "Seesaw effect" between particulate and photochemical pollutants after 2013 was revealed. [ABSTRACT FROM AUTHOR]

Computation of shale permeability is challenging owing to the complicated physics of gas flow and the small-scale heterogeneity in nanometer pores. In this study, a statistical-coupled model (SCM), based on the combination of FIB/SEM and SEM imaging measurements and statistical analysis is proposed to bridge the nanopore-scale with the organic representative elementary volume (oREV)-scale. FIB/SEM imaging is adopted to get the nanometer pores properties in organic matter (OM), and SEM imaging is used to get the OM content distribution. With the analysis of nanopores of a Longmaxi shale sample from the Chongqing Province, China, it is demonstrated that the pore size distribution obtained from FIB/SEM images of typical samples is representative considering the principal parts of the pore radii are similar comparing with 2D SEM image. Then, the SCM is constructed based on the combination of the statistical method, the series-parallel model and the equivalent model for microstructures, and the rationality of SCM are also investigated. The obtained characteristic parameters show an excellent performance in calculating the SCM element permeability with a small deviation of less than 3% and a significantly faster computation speed comparing with the previous literature by approximately 400 times. Using the SCM, a method for the construction of oREV and the determination of oREV-scale permeability for the organic-rich shale is presented. Finally, the sensitivity analyses of oREV-scale permeability are conducted and the results show that the permeability is sensitive to the OM content distribution, the district of shale sample and the permeability of IOM. The influence of OM permeability on macroscale is also analyzed. The new model can advance the understanding of the multiscale phenomena and establish a relationship between microscale properties and macroscale behavior. [ABSTRACT FROM AUTHOR]

• A CNN (Convolutional Neural Networks)-LSTM (Long Short-Term Memory) model is proposed and developed to diagnose faults of the Mover's hydraulic system. • The proposed model combines the advantages of both the CNN model and the LSTM model, with the ability to extract both spatial and temporal features of the data. • Fault diagnosis experiment is conducted to validate the effectiveness and efficiency of the proposed CNN-LSTM based fault diagnosis method. • Providing some insights for subsequent research on the Prognostics and Health Management (PHM) of the Mover's hydraulic system and the CFETR's remote handling intelligent operational decision system. Conducting fault diagnosis on the hydraulic system of the blanket transfer device Mover in the Chinese Fusion Engineering Test Reactor (CFETR) is a key technical issue that needs to be addressed urgently. In this article, a CNN (Convolutional Neural Networks)-LSTM (Long Short-Term Memory) deep learning model-based method is proposed for fault diagnosis, combining the advantages of feature extraction of the CNN model with the advantages of the LSTM model for time series data processing. Therefore, this model shows a " multi-perspective" property, greatly improving its ability to extract features from data. In the fault diagnosis experiment under the condition of four typical faults, the proposed model has the highest accuracy of 98.56% on the test set and good efficiency in computation time compared to the other three models. This method provides some insights for future research on the Prognostics and Health Management (PHM) of the Mover's hydraulic system and the CFETR's remote handling intelligent operational decision system. [ABSTRACT FROM AUTHOR]

• Overview of the remote maintenance system for the Chinese Fusion Engineering Test Reactor is presented. • The CAD design of the blanket, divertor, heavy-load manipulator remote handling system are discussed. • The modular and distributed control system architecture for CFETR remote handling system is investigated. Due to the extreme environment inside the vacuum vessel of Chinese Fusion Engineering Test Reactor (CFETR), the maintenance of core components after shutdown cannot be carried out by human operator or general equipment at the maintenance site. A remote handling (RH) system, which uses the radiation-enhanced automation equipment and is controlled remotely by operators, is adopted. The engineering design of the CFETR RH system has been conducted in the past few years with a novel maintenance strategy of transferring the blanket and divertor components through the vertical upper port. A heavy-load robotic manipulator is illustrated, entering the CFETR vessel through an equatorial port to implement in-vessel maintenance tasks with exchangeable end-effectors and support blanket and divertor RH system. An integrated supervisory control system is being developed to provide a safe, reliable, and user-friendly control interface. Finally, despite all the progress that the CFETR RH team has made, it can be said that the CFETR RH system still faces challenges considering the hostile environment as well as the complex and heavy load maintenance process. [ABSTRACT FROM AUTHOR]

• Design method of snake arm maintainer suitable for nuclear industry. • Worm folding mechanism realizes reverse folding of snake arm. • Designed the trajectory planning and trajectory tracking algorithm of a snake arm. • Mechatronics simulation model verifies the feasibility. This paper develops a remote handling system with a Snake Arm Maintainer (SAM) as the end effector, which aims to meet the maintenance needs of various narrow working spaces of the Chinese Fusion Engineering Test Reactor (CFETR). The multi-joint snake-arm is designed with the principle of layered drive to realie the angle synchronisation of adjacent joints, which reduces the complexity of the drive control system, and reduces the volume and weight while ensuring a high spatial curvature. The drive box is connected to the Multi-Purpose Overload Robot (CMOR) through a quick-change connector. The worm gear mechanism realies the reverse folding of the SAM and close to the CMOR, enabling access to the narrow vacuum chamber. Two working methods of SAM are designed based on trajectory planning and trajectory tracking. Finally, based on the actual environment of the CFETR vacuum chamber, simulation experiments were carried out on the rationality of the structural design of the SAM and the correctness of the working methods, which verified the feasibility of working in a narrow vacuum chamber. [ABSTRACT FROM AUTHOR]

• A zinc-based coordination polymer, [Zn 2 (DABA) 3 (CH 3 OH)] (ZCP), was synthesized. • ZCP showed high antibacterial activity towards E. coli and S. aureus. • The antibacterial mechanism might be related to the ROS production. • ZCP showed remarkable prospect in application of bacterial infection. Zn coordination polymer, [Zn 2 (DABA) 3 (CH 3 OH)] (DABA= 4-Dimethylaminobenzoic acid) (ZCP), was successfully synthesized with DABA and Zn(NO 3) 2 •6H 2 O in a manner of solvothermal synthesis. The exact structure of ZCP was confirmed by thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR) and single crystal X-ray diffraction. In addition, experiments showed that ZCP possessed antibacterial activity against Escherichia coli in vitro. The antibacterial mechanism of ZCP was discussed in this study, which was associated with the generation of reactive oxygen species (ROS) in bacteria. Our findings could be helpful for a better understanding of the potential of ZCP as antibacterial agents, which had prospective applications for microbial infection in patients. [Display omitted] [ABSTRACT FROM AUTHOR]

• A hydraulic system suitable for a divertor transfer platform is designed. • A mechatronics–hydraulic simulation model is designed. • A single closed-loop control double-parameter system is designed. • An additional parallel oil circuit can drive the blanket transport platform. In this study, a single-pump closed-loop hydraulic system with multiple actuators and load sensitivity is designed for a circular transfer platform, which remotely handles the divertor of the China Fusion Engineering Test Reactor by rotating the divertor module in the non-maintenance window to the designated position along the circular track. The proposed system controls the position and force of the pushing and locking cylinders. The designed closed-loop system synchronizes the movements of the internal and external cylinders. It also controls the displacement and force of the locking cylinder, ensuring the stability of the clamping force and the controllable position of the cylinder. Furthermore, the dynamic performance of the hydraulic control system is verified via the Adams–AMESim software co-simulation. [ABSTRACT FROM AUTHOR]

• NSGA-II was coupled with the 1-D General Lake Model (GLM) for reservoir re-operation. • Trade-off relations between three objectives were estimated as Pareto frontiers. • Outflow-temperature condition can be improved at the expense of power generation. • Slope of the outflow discharge curve is a useful parameter for re-operation. • The results are applied for other reservoirs with outflow temperature problems. Thermal stratification occurs in deep reservoirs and causes an outflow temperature that is significantly different from the inflow temperature, which is harmful to the ecology of downstream reaches. Optimal operation of reservoirs using the multi-objective evolutionary algorithm (MOEA), which focuses on power generation, flood control, agricultural irrigation, navigation, etc., has been performed. However, the outflow temperature has not been considered. Focusing on this deficiency, we considered Sanbanxi Reservoir as a case study and used the non-dominated sorting genetic algorithm II (NSGA-II) by combining it with the calibrated 1-D General Lake Model. The trade-off relationships among three objectives, namely, total power generation (TPG), root-mean-square deviation between the inflow and outflow temperatures (RMSD tem) and weighted aggregate eco-index (EI) based on indicators of hydrologic alteration (IHAs) parameters, were estimated as Pareto frontiers during the storage period from March 15 to July 15. The results demonstrated the following. 1) Through reservoir re-operation, RMSD tem could be reduced by 1.60 °C from 5.99 to 4.39 °C at the expense of reducing TPG from 7.43 × 108 to 6.56 × 108 kW·h (–11.8%) during a normal year. 2) The optimized operating schemes were extracted as Pareto frontiers, and the slope of the outflow discharge curve (SODC) could be a useful parameter for determining the operating scheme in practice. A large SODC yielded high TPG, a small SODC resulted in low RMSD tem , and a medium SODC yielded minimum EI. The medium SODCs ranged from –0.1 to 0.4 m3/(s·d), –0.4 to 0.6 m3/(s·d), and –0.6 to 1.2 m3/(s·d) for dry, normal, and wet years, respectively. 3) As the yearly inflow increased, the absolute value of the SODC for the best individuals for a single objective became larger. The range of TPG and RMSD tem in the Pareto frontier expanded, and that of EI remained basically unchanged. The results of the Sanbanxi Reservoir can be applied to other reservoirs to support reservoir re-operation, especially for the deep reservoirs in southwest China that suffer from outflow-temperature problems. [ABSTRACT FROM AUTHOR]

• MPD's rigid–flexible coupled dynamic system was modeled. • Dynamic MPD model-based NNASMC was derived. • MPD tracking accuracy under the action of the flexible body and NNASMC was analyzed. Multi-purpose deployer (MPD), an articulated heavy load handling remote handling system, is considered as a potential RH system that can be used for a fusion reactor. In this study, dynamic equations of rigid–flexible coupling of the MPD were derived. A neural network adaptive sliding mode controller (NNASMC) was subsequently designed based on the complex nonlinearity and uncertainty of the dynamic MPD model to ensure accurate trajectory tracking of the MPD. The stability and robustness of the proposed method were analyzed based on the Lyapunov stability theory. The control performance of the NNASMC was simulated using ADAMS-MATLAB/Simulink. The position tracking accuracy of the MPD under the combined action of NNASMC, MPD's rigid–flexible coupling model, model uncertainty, and flexible deformation errors was analyzed. Results show that the MPD tracking error occurs mainly due to the deformation of the connecting rods and joints. This finding provides a reference for the MPD controller design and improvement in its tracking accuracy. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the prevalence of antibiotic resistance genes (ARGs) within the ecosystem of natural plague foci, assessing their potential impact on the efficacy of plague treatments. Employing 16S rRNA gene sequencing and high-throughput quantitative PCR, microbial communities and ARGs were detected, with subsequent analysis of interactions among ARGs, mobile genetic elements (MGEs), environmental factors, and microbial species. Tetracycline resistance genes were found to be dominant, with multidrug and tetracycline resistance ARGs primarily associated with marmots and ecological soil, while pikas predominantly harbored β-lactam resistance ARGs. High detection rates were observed for resistance genes rpsl and sul1, which are relevant to streptomycin and sulfonamides, antibiotics commonly used in plague treatment. The total dissolved solids (TDS) in soil significantly promoted the presence of tetR-02, and Ni was found to inhibit vanHB. The tnpA-03 MGE was identified as a significant contributor to the dissemination of the aadE gene. The high prevalence of ARGs, particularly rpsl and sul1, poses a potential risk to the efficacy of main antibiotic treatments for plague. The study suggests that environmental microbiomes may be the greatest risk factor for the emergence of drug-resistant Yersinia pestis, given the low misuse of antibiotics in animals within natural plague foci. Monitoring the risk of drug-resistant strain emergence and preparing alternative antibiotic or combination therapy strategies based on ARG pollution levels in plague-affected areas is deemed necessary., Competing Interests: Declaration of Competing Interest The authors declare that they have no potential conflicts of interest to report regarding the content of this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Cardiac rupture (CR) is fatal mechanical complication of ST-segment elevation myocardial infarction (STEMI). We systematically analyzed the clinical features of STEMI patients with CR, as well as predictors and treatments associated with risk of CR in contemporary era. In this nationwide database, 49,284 patients admitted within 48 h after STEMI were enrolled, and were stratified according to CR status. We analyzed patients' clinical characteristics, case fatality rate, and independent correlates of CR. A total of 188 (0.38%) patients had CR, of which 42.6% died during hospitalization. Older age, female gender, higher heart rate, history of diabetes, and worse cardiac function were risk factors of CR in patients with STEMI, while a previous history of myocardial infarction was associated with a reduced risk of CR. CR patients were less likely to undergo primary percutaneous coronary intervention (PCI). After adjustment, primary PCI was associated with 56% decreased risk of CR (OR 0.44, 95% CI 0.29-0.67). This result was consistent in the propensity-score matching analysis and inverse probability of treatment weighting analysis. CR was associated with high in-hospital mortality among STEMI patients. Multiple factors were associated with CR occurrence, primary PCI was associated with lower risk of CR, indicating that early intervention targeting the risk factors and implementation of primary PCI may improve its prognosis. Clinical trial registration ClinicalTrials.gov; Number: NCT02306616; URL: www.clinicaltrials.gov., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Introduction: Marmots are recognized as host animals for plague caused by Yersinia pestis infection. It is unclear that why plague prevalent in marmot rather than other rodents like pikas in the same habitats. This study aims to analyze the differences of the soil characteristics around marmots and pikas burrows to explore the soils factors impacting on different epidemic intensities of Yersinia pestis in these two rodents., Methods: Soil samples were collected from within and around marmot and pika burrows, as well as from the nearby areas not inhabited by them and Chinese baseline soil properties as control groups, in the Qilian Mountains of Gansu Province, China. The physicochemical properties and the bacterial 16S rRNA were measured to analyze the characteristics of soils from different groups. Subsequently, the data were analyzed using R studio., Results: The analysis revealed that marmot habitats exhibited distinct soil characteristics, including lower organic matter and alkaline hydrolyzed nitrogen, but higher electrical conductivity and total soluble salts. And soil in marmot areas tended to have higher concentrations of nickel, chromium, and iron, also lower levels of zinc and selenium. Additionally, the alpha diversity of soil microorganisms in marmot habitats was significantly low. Simultaneously, redundancy analysis was conducted, which showed that the low alpha diversity of marmot-soil was influenced by its physicochemical properties. The alpha diversity of the soil was positively correlated with EC, TSS, Na, and Cr, etc., while it was negatively correlated with AHN, OM, Se, Zn, and Fe, etc., Conclusion: These characteristics in marmot habitats, including low levels of organic matter, alkaline hydrolyzed nitrogen, zinc, selenium, and bacterial alpha diversity, as well as high levels of electrical conductivity, total soluble salts, iron, and nickel, played a crucial role in the spread of plague. It was discovered that the unique characteristics of marmot-soils provided essential elements necessary for the survival of Yersinia pestis , including high levels of Fe and Ca, or facilitated the spread of plague. Thus, the transmission of the plague was facilitated., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhao, Li, Sun, Liu, Ma and Qi.)

To observe the long-term variations in halocarbons in the Yangtze River Delta (YRD) region, this study analyzes halocarbon concentrations and composition characteristics in Shanxi from 2018 to 2020, exploring their origins and the health effects. The total concentration of halocarbons has shown an overall increasing trend, which is driven by both regulated substances (CFC-11 and CFC-113) and unregulated substances, such as dichloromethane, chloromethane and chloroform. The results of the study also reveal that dichloromethane (1.194 ± 1.003 to 1.424 ± 1.004 ppbv) and chloromethane (0.205 ± 0.185 to 0.666 ± 0.323 ppbv) are the predominant halocarbons in Shanxi, influenced by local and northwestern emissions. Next, this study identifies that neighboring cities in Zhejiang Province and other YRD areas are potentially affected by backward trajectory models. Notably, chloroform and 1,2-dichloroethane have consistently surpassed acceptable thresholds, indicating a significant carcinogenic risk associated with solvent usage. This research sheds light on the evolution of halocarbons in the YRD region, offering valuable data for the control and reduction in halocarbon emissions.

Background: The prognostic significance of obstructive sleep apnea (OSA) in patients with unstable angina (UA) based on remnant cholesterol (RC) or triglyceride (TG) levels remains unclear. This study aims to evaluate the effects of the interaction between RC, TG, and OSA on cardiovascular outcomes in UA patients., Methods: In this prospective cohort study, OSA was diagnosed when apnea-hypopnea index of ≥ 15 events/h. Patients with high RC (HRC, n = 370) or high TG (HTG, n = 362) included RC or TG in the highest tertile, and those in the middle and lowest tertiles were defined as normal RC (NRC, n = 736) or normal TG (NTG, n = 744). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, ischemia stroke, ischemia-driven revascularization, or hospitalization for UA., Results: A total of 1,106 eligible UA patients were enrolled, among which 560 (50.6%) had OSA. RC and TG levels were increased in OSA patients, but there was no difference in the prevalence of OSA between the NRC and HRC or NTG and HTG groups. During a median follow-up of 1.9 (1.1, 3.0) years, OSA was associated with an increased risk of MACCE occurrence compared to non-OSA in UA patients with HRC (adjusted HR 2.06; 95% CI 1.20-3.51, P = 0.008), but not in those with NRC (adjusted HR 1.21; 95% CI 0.84-1.75, P = 0.297). The incremental risk in HRC was attributable to higher rates of hospitalization for UA and ischemia-driven revascularization. Results for HTG and NTG were similar., Conclusion: OSA was associated with a worse prognosis in UA patients with HRC or HTG, emphasizing the necessity of identifying OSA presence in this population., Trial Registration: Clinicaltrials.gov; No: NCT03362385., (© 2024. The Author(s).)

Designing robust, efficient and inexpensive trifunctional electrocatalysts for the oxygen reduction reaction (ORR), oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) is significant for rechargeable zinc-air batteries and water-splitting devices. To this end, constructing heterogenous structures based on transition metals stands out as an effective strategy. Herein, a dual-phase Co 9 S 8 -CoMo 2 S 4 heterostructure grown on porous N, S-codoped carbon substrate (Co 9 S 8 -CoMo 2 S 4 /NSC) via a one-pot synthesis is investigated as the trifunctional ORR/OER/HER electrocatalyst. The optimized Co 9 S 8 -CoMo 2 S 4 /NSC2 exhibits that ORR has a half-wave potential of 0.86 V (vs. RHE) and the overpotentials at 10 mA cm -2 for OER and HER are 280 and 89 mV, respectively, superior to most transition-metal based trifunctional electrocatalysts reported to date. The Co 9 S 8 -CoMo 2 S 4 /NSC2-based zinc-air battery (ZAB) has a high open-circuit voltage (1.41 V), large capacity (804 mAh g -1 ) and highly stable cyclability (97 h at 10 mA cm -2 ). In addition, the prepared Co 9 S 8 -CoMo 2 S 4 /NSC2-based ZAB in series can self-drive the corresponding water-splitting device. The dual-phase Co 9 S 8 -CoMo 2 S 4 heterostructure provides not only multi-type active sites to drive the ORR, OER and HER, but also high-speed charge transfer channels between two phases to improve the synergistic effect and reaction kinetics., (© 2024 Wiley-VCH GmbH.)

Background: Lumbar spine surgery is a crucial intervention for addressing spinal injuries or conditions affecting the spine, often involving lumbar fusion through pedicle screw (PS) insertion. The precision of PS placement is pivotal in orthopedic surgery. This systematic review compares the accuracy of robot-guided (RG) surgery with free-hand fluoroscopy-guided (FFG), free-hand without fluoroscopy-guided (FHG), and computed tomography image-guided (CTG) techniques for PS insertion., Methods: A systematic search of various databases from 1 January 2013 to 30 December 2023 was conducted following PRISMA guidelines. Primary outcomes, including PS insertion accuracy and breach rate, were analyzed using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Scale., Results: The overall accuracy of PS insertion using RG, based on 37 studies involving 3,837 patients and 22,117 PS, is 97.9%, with a breach rate of 0.021. RG demonstrated superior accuracy compared to FHG and CTG, with breach rates of 3.4 and 0.015 respectively for RG versus FHG, and 3.8 and 0.026 for RG versus CTG. Additionally, RG was associated with reduced mean estimated blood loss compared to CTG, indicating improved safety., Conclusions: The RG is associated with enhanced accuracy of PS insertion and reduced breach rates over other methods. However, additional randomized controlled trials comparing these modalities are needed for further validation., Prospero Registration: CRD42023483997.

Rapid elongation of coleoptiles from rice seeds to reach the water surface enables plants to survive submergence stress and therefore plays a crucial role in allowing direct seeding in rice cultivation. Gibberellin (GA) positively influences growth in rice, but the molecular mechanisms underlying its regulation of coleoptile elongation under submerged conditions remain unclear. In this study, we performed a weighted gene co-expression network analysis to conduct a preliminarily examination of the mechanisms. Four key modules were identified with high correlations to the GA regulation of submergence tolerance. The genes within these modules were mainly involved in the Golgi apparatus and carbohydrate metabolic pathways, suggesting their involvement in enhancing submergence tolerance. Further analysis of natural variation revealed that the specific hub genes Os03g0337900, Os03g0355600, and Os07g0638400 exhibited strong correlations with subspecies divergence of the coleoptile elongation phenotype. Consistent with this analysis, mutation of Os07g0638400 resulted in a lower germination potential and a stronger inhibition of coleoptile elongation under submerged conditions. The hub genes identified in this study provide new insights into the molecular mechanisms underlying GA-dependent tolerance to submergence stress in rice, and a potential basis for future modification of rice germplasm to allow for direct seeding., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Ionic liquid electrolytes (ILEs) are promising to develop high-safety and high-energy-density lithium-metal batteries (LMBs). Unfortunately, ILEs normally face the challenge of sluggish Li + transport due to increased ions' clustering caused by Coulombic interactions. Here a type of anion-reinforced solvating ILEs (ASILEs) is discovered, which reduce ions' clustering by enhancing the anion-cation coordination and promoting more anions to enter the internal solvation sheath of Li + to address this concern. The designed ASILEs, incorporating chlorinated hydrocarbons and two anions, bis(fluorosulfonyl) imide (FSI - ) and bis(trifluoromethanesulfonyl) imide (TFSI - ), aim to enhance Li + transport ability, stabilize the interface of the high-nickel cathode material (LiNi 0.8 Co 0.1 Mn 0.1 O 2 , NCM811), and retain fire-retardant properties. With these ASILEs, the Li/NCM811 cell exhibits high initial specific capacity (203 mAh g -1 at 0.1 C), outstanding capacity retention (81.6% over 500 cycles at 1.0 C), and excellent average Coulombic efficiency (99.9% over 500 cycles at 1.0 C). Furthermore, an Ah-level Li/NCM811 pouch cell achieves a notable energy density of 386 Wh kg -1 , indicating the practical feasibility of this electrolyte. This research offers a practical solution and fundamental guidance for the rational design of advanced ILEs, enabling the development of high-safety and high-energy-density LMBs., (© 2024 Wiley‐VCH GmbH.)

Background: Ankylosing Spondylitis (AS) is a chronic inflammatory disorder which can lead to considerable pain and disability. Mendelian randomization (MR) has been extensively applied for repurposing licensed drugs and uncovering new therapeutic targets. Our objective is to pinpoint innovative therapeutic protein targets for AS and assess the potential adverse effects of druggable proteins., Methods: We conducted a comprehensive proteome-wide MR study to assess the causal relationships between plasma proteins and the risk of AS. The plasma proteins were sourced from the UK Biobank Pharma Proteomics Project (UKB-PPP) database, encompassing GWAS data for 2,940 plasma proteins. Additionally, GWAS data for AS were extracted from the R9 version of the Finnish database, including 2,860 patients and 270,964 controls. The colocalization analysis was executed to identify shared causal variants between plasma proteins and AS. Finally, we examined the potential adverse effects of druggable proteins for AS therapy by conducting a phenome-wide association study (PheWAS) utilizing the extensive Finnish database in version R9, encompassing 2,272 phenotypes categorized into 46 groups., Results: The findings revealed a positive genetic association between the predicted plasma levels of six proteins and an elevated risk of AS, while two proteins exhibited an inverse association with AS risk ( P fdr < 0.05). Among these eight plasma proteins, colocalization analysis identified AIF1, TNF, FKBPL, AGER, ALDH5A1, and ACOT13 as shared variation with AS(PPH3+PPH4>0.8), suggesting that they represent potential direct targets for AS intervention. Further phenotype-wide association studies have shown some potential side effects of these six targets ( P fdr < 0.05)., Conclusion: Our investigation examined the causal connections between six plasma proteins and AS, providing a comprehensive understanding of potential therapeutic targets., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhao, Fang, Lai, Xu, Wang, Liu, Jiang, Liu and Liu.)

Diabetic mellitus management extends beyond blood glucose monitoring to the essential task of mitigating the overexpression of reactive oxygen species (ROS), particularly vital for cellular repair, especially within the nervous system. Herein, antioxidant carbon dots (Arg-CDs) were designed and prepared using anhydrous citric acid, L-arginine, and ethylenediamine as sources through a hydrothermal method. Arg-CDs exhibited excellent scavenging ability to 2,2-Diphenyl-1-picrylhydrazyl (DPPH∙), and fluorescence response to hydroxyl radicals (∙OH), a characteristic representative of reactive oxygen species (ROS). Assisted by glucose oxidase and Fe 2+ , Arg-CDs showed a sensitive and selective response to glucose. The quenching mechanism of Arg-CDs by formed ∙OH was based on the static quenching effect (SQE). The analytical performance of this method for glucose detection encompassed a wide linear range (0.3-15 μM), a low practical limit of detection (0.1 μM) and practical applicability for blood glucose monitoring. In an in vitro model employing glial cells (BV2 cells), it was observed that high glucose medium led to notable cellular damage ascribed to the excessive ROS production from hyperglycemia. The diminished and apoptotic glial cells were gradually recovered by adding increased contents of Arg-CDs. This work illustrates a promising area that designs effective carbon dots with antioxidant capacity for the dual applications of detection and cell repairing based on the utilization of antioxidant activity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Chiral B/N embedded multi-resonance (MR) emitters open a new paradigm of circularly polarized (CP) organic light-emitting diodes (OLEDs) owing to their unique narrowband spectra. However, pure-red CP-MR emitters and devices remain exclusive in literature. Herein, by introducing a B-N covalent bond to lower the electron-withdrawing ability of the para-positioned B-π-B motif, the first pair of pure-red double hetero-[n]helicenes (n = 6 and 7) CP-MR emitter peaking 617 nm with a small full-width at half-maximum of 38 nm and a high photoluminescence quantum yield of ≈100% in toluene is developed. The intense mirror-image CP light produced by the enantiomers is characterized by high photoluminescence dissymmetry factors (g PL ) of +1.40/-1.41 × 10 -3 from their stable helicenes configuration. The corresponding devices using these enantiomers afford impressive CP electroluminescence dissymmetry factors (g EL ) of +1.91/-1.77 × 10 -3 , maximum external quantum efficiencies of 36.6%/34.4% and Commission Internationale de I'Éclairage coordinates of (0.67, 0.33), exactly satisfying the red-color requirement specified by National Television Standards Committee (NTSC) standard. Notably a remarkable long LT95 (operational time to 95% of the initial luminance) of ≈400 h at an initial brightness of 10,000 cd m -2 is also observed for the same device, representing the most stable CP-OLED up to date., (© 2023 Wiley-VCH GmbH.)

Global incidence rate of non-tuberculous mycobacteria (NTM) pulmonary disease has been increasing rapidly. In some countries and regions, its incidence rate is higher than that of tuberculosis. It is easily confused with tuberculosis. The topic of this study is to identify two diseases using CT radioomics. The aim in the present study was to investigate the value of CT-based radiomics to analyze consolidation features in differentiation of non-tuberculous mycobacteria (NTM) from pulmonary tuberculosis (TB). A total of 156 patients (75 with NTM pulmonary disease and 81 with TB) exhibiting consolidation characteristics in Shandong Public Health Clinical Center were retrospectively analyzed. Subsequently, 305 regions of interest of CT consolidation were outlined. Using a random number generated via a computer, 70 and 30% of consolidations were allocated to the training and the validation cohort, respectively. By means of variance threshold, when investigating the effective radiomics features, SelectKBest and the least absolute shrinkage and selection operator regression method were employed for feature selection and combined to calculate the radiomics score. K-nearest neighbor (KNN), support vector machine (SVM) and logistic regression (LR) were used to analyze effective radiomics features. A total of 18 patients with NTM pulmonary disease and 18 with TB possessing consolidation characteristics in Jinan Infectious Disease Hospital were collected for external validation of the model. A total of three methods was used in the selection of 52 optimal features. For KNN, the area under the curve (AUC; sensitivity, specificity) for the training and validation cohorts were 0.98 (0.93, 0.94) and 0.90 (0.88, 083), respectively; for SVM, AUC was 0.99 (0.96, 0.96) and 0.92 (0.86, 0.85) and for LR, AUC was 0.99 (0.97, 0.97) and 0.89 (0.88, 0.85). In the external validation cohort, AUC values of models were all >0.84 and LR classifier exhibited the most significant precision, recall and F1 score (0.87, 0.94 and 0.88, respectively). LR classifier possessed the best performance in differentiating diseases. Therefore, CT-based radiomics analysis of consolidation features may distinguish NTM pulmonary disease from TB., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Yan et al.)

Abstract: A 44-year-old man who presented with progressive right limb weakness was diagnosed with ischemic stroke. He was referred for 18F-DPA-714 PET/CT for evaluation of the disease. 18F-DPA-714 PET/CT showed increased uptake of the intracranial thrombus. This DPA-714-avid thrombus highly suggested the involvement of immune cells in the extension of the clot resulting in neurological deterioration. This present case suggested that 18F-DPA-714 PET might be a promising tracer in visualizing thromboinflammation in vivo., Competing Interests: Conflicts of interest and sources of funding: none declared. This study was funded in part by National Natural Science Foundation of China (82171982), Natural Science Foundation of Fujian Province (2023J06031), and Natural Science Foundation of Fujian Province (2021J05153)., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Preeclampsia (PE) is a risk factor for autism spectrum disorder (ASD) in offspring. However, the exact mechanisms underlying the impact of PE on progeny ASD are not fully understood, which hinders the development of effective therapeutic approaches. This study shows the offspring born to a PE mouse model treated by N ω -nitro-L-arginine methyl ester (L-NAME) exhibit ASD-like phenotypes, including neurodevelopment deficiency and behavioral abnormalities. Transcriptomic analysis of the embryonic cortex and adult offspring hippocampus suggested the expression of ASD-related genes was dramatically changed. Furthermore, the level of inflammatory cytokines TNFα in maternal serum and nuclear factor kappa B (NFκB) signaling in the fetal cortex were elevated. Importantly, TNFα neutralization during pregnancy enabled to ameliorate ASD-like phenotypes and restore the NFκB activation level in the offspring exposed to PE. Furthermore, TNFα/NFκB signaling axis, but not L-NAME, caused deficits in neuroprogenitor cell proliferation and synaptic development. These experiments demonstrate that offspring exposed to PE phenocopies ASD signatures reported in humans and indicate therapeutic targeting of TNFα decreases the likelihood of bearing children with ASD phenotypes from PE mothers., (© 2023 Liu et al.)

Background: Bone age is the age of skeletal development and is a direct indicator of physical growth and development in children. Most bone age assessment (BAA) systems use direct regression with the entire hand bone map or first segmenting the region of interest (ROI) using the clinical a priori method and then deriving the bone age based on the characteristics of the ROI, which takes more time and requires more computation., Materials and Methods: Key bone grades and locations were determined using three real-time target detection models and Key Bone Search (KBS) post-processing using the RUS-CHN approach, and then the age of the bones was predicted using a Lightgbm regression model. Intersection over Union (IOU) was used to evaluate the precision of the key bone locations, while the mean absolute error (MAE), the root mean square error (RMSE), and the root mean squared percentage error (RMSPE) were used to evaluate the discrepancy between predicted and true bone age. The model was finally transformed into an Open Neural Network Exchange (ONNX) model and tested for inference speed on the GPU (RTX 3060)., Results: The three real-time models achieved good results with an average (IOU) of no less than 0.9 in all key bones. The most accurate outcomes for the inference results utilizing KBS were a MAE of 0.35 years, a RMSE of 0.46 years, and a RMSPE of 0.11. Using the GPU RTX3060 for inference, the critical bone level and position inference time was 26 ms. The bone age inference time was 2 ms., Conclusions: We developed an automated end-to-end BAA system that is based on real-time target detection, obtaining key bone developmental grade and location in a single pass with the aid of KBS, and using Lightgbm to obtain bone age, capable of outputting results in real-time with good accuracy and stability, and able to be used without hand-shaped segmentation. The BAA system automatically implements the entire process of the RUS-CHN method and outputs information on the location and developmental grade of the 13 key bones of the RUS-CHN method along with the bone age to assist the physician in making judgments, making full use of clinical a priori knowledge., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yang, Dai, Qin, He and Zhao.)

In 2013, the Chinese government implemented a two-child policy to increase the country's fertility rate. However, the persistently low rates necessitated other measures to boost fertility. This study empirically investigated the association between intergenerational support and second-child fertility intention in the Chinese sandwich generation and demonstrated the mediating role of parental burnout and burnout in caring for grandparents. Survey data collected at Time 1, Time 2, and Time 3 included 2939 participants from different regions of China. Before analyzing the data, coarsened exact matching and propensity score matching was conducted to reduce sampling bias. Regression analysis results indicated that intergenerational support has a significant total positive effect on second-child fertility intention. Furthermore, mediation path analysis revealed that parental burnout and burnout in caring for grandparents play significant but opposite directional mediating roles in the association between intergenerational support and second-child fertility intention. Sensitivity analysis using different calipers yielded similar results. These results indicated that second-child fertility intention can be increased among the Chinese sandwich generation with intergenerational support, by mitigating parental burnout. However, intergenerational support did not alleviate burnout in caring for grandparents in the sandwich generation; therefore, formal older adult care policies are required to help the sandwich generation experience lower burnout, while receiving intergenerational support.

Purpose: To analyze the clinical data and prognosis of patients with World Health Organization (WHO) functional class I pulmonary arterial hypertension (PAH)., Methods: This research retrospectively analyzed the clinical data (baseline, laboratory as well as echocardiography and right heart catheterization data) of 63 class I PAH patients diagnosed and treated in the Department of Cardiology, First Affiliated Hospital of Zhengzhou University, between January 2021 and June 2022. The mean follow-up time was 10.7±6.5 months. The treatment and prognosis of the patients were analyzed., Results: Among the class I PAH patients, the average age at diagnosis was 39.7±12.7 years, with females accounting for 92.1%; 44.4% of patients were at grade III or IV; 55.6% were at medium-high risk. In the subgroup analysis, there were more cases with grade III/IV cardiac function ( P =0.03) and high risk in idiopathic PAH (IPAH) group than those in congenital heart disease-associated (CHD-PAH) and connective tissue disease-associated PAH (CTD-PAH) groups ( P =0.04). CHD-PAH patients tended to present with higher pulmonary systolic blood pressure, mean pulmonary artery pressure and pulmonary vascular resistance than CTD-PAH patients ( P <0.01), while IPAH patients had worse right ventricular end-systolic and end-diastolic volumes ( P <0.05). The three subgroups showed no obvious differences in echocardiographic indexes (right atrial size, right ventricular size and pulmonary artery systolic pressure) and related laboratory indexes (blood routines and hepatorenal function). In terms of the targeted drug therapy for PAH, the proportion of dual-drug combination therapy was the highest (48.1%), followed by monotherapy (35%) and triple combination therapy (15.9%). Nearly half (48.7%) of CTD-PAH cases were first diagnosed in the Rheumatology and Immunology Department, and all of them were given targeted drug therapy for PAH. After a mean follow-up of 10.7±6.5 months, a total of 8 endpoint events occurred, including 3 deaths due to CTD-PAH complicated with serious complications of other organs. The 1-year survival rate for all the included PAH patients was 95.2%., Conclusions: In the era of targeted therapy, class I PAH patients in China have a high early survival rate, a high proportion of combined therapy and strong multidisciplinary attention., Competing Interests: None., (AJTR Copyright © 2023.)

Background: Globally, blood pressure management strategies were ineffective, and a low percentage of patients receiving hypertension treatment had their blood pressure controlled. In this study, we aimed to build a medication prediction model by correlating patient attributes with medications to help physicians quickly and rationally match appropriate medications., Methods: We collected clinical data from elderly hypertensive patients during hospitalization and combined statistical methods and machine learning (ML) algorithms to filter out typical indicators. We constructed five ML models to evaluate all datasets using 5-fold cross-validation. Include random forest (RF), support vector machine (SVM), light gradient boosting machine (LightGBM), artificial neural network (ANN), and naive Bayes (NB) models. And the performance of the models was evaluated using the micro-F1 score., Results: Our experiments showed that by statistical methods and ML algorithms for feature selection, we finally selected Age, SBP, DBP, Lymph, RBC, HCT, MCHC, PLT, AST, TBIL, Cr, UA, Urea, K, Na, Ga, TP, GLU, TC, TG, γ-GT, Gender, HTN CAD, and RI as feature metrics of the models. LightGBM had the best prediction performance with the micro-F1 of 78.45%, which was higher than the other four models., Conclusion: LightGBM model has good results in predicting antihypertensive medication regimens, and the model can be beneficial in improving the personalization of hypertension treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Yan, Xiang, Tan, Yang and Zhao.)

Legumes in the inverted repeat-lacking clade (IRLC) each produce a unique set of nodule-specific cysteine-rich (NCR) peptides, which act in concert to determine the terminal differentiation of nitrogen-fixing bacteroid. IRLC legumes differ greatly in their numbers of NCR and sequence diversity. This raises the significant question how bacteroid differentiation is collectively controlled by the specific NCR repertoire of an IRLC legume. Astragalus sinicus is an IRLC legume that forms indeterminate nodules with its microsymbiont Mesorhizobium huakuii 7653R. Here, we performed transcriptome analysis of root and nodule samples at 3, 7, 14, 28 days postinoculation with M. huakuii 7653R and its isogenic ∆ bacA mutant. BacA is a broad-specificity peptide transporter required for the host-derived NCRs to target rhizobial cells. A total of 167 NCRs were identified in the RNA transcripts. Comparative sequence and electrochemical analysis revealed that A. sinicus NCRs (AsNCRs) are dominated by a unique cationic group (termed subgroup C), whose mature portion is relatively long (>60 amino acids) and phylogenetically distinct and possessing six highly conserved cysteine residues. Subsequent functional characterization showed that a 7653R variant harboring AsNCR083 (a representative of subgroup C AsNCR) displayed significant growth inhibition in laboratory media and formed ineffective white nodules on A. sinicus with irregular symbiosomes. Finally, bacterial two-hybrid analysis led to the identification of GroEL1 and GroEL3 as the molecular targets of AsNCR067 and AsNCR076. Together, our data contribute to a systematic understanding of the NCR repertoire associated with the A. sinicus and M. huakuii symbiosis. [Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

The current study uses a two-wave longitudinal survey to explores the influence mechanism of the family environment on adolescents' academic achievement. The family environment is measured by parents and children's reports, including family atmosphere, parent-child interaction, and family rules, to reveal the mediating effect of adolescents' positive or negative peers between the family environment and academic achievement, and whether the gap between self- and parental educational expectation plays a moderating effect. This study uses the data of the China Education Panel Study (CEPS); the survey samples include 9,449 eighth-grade students (M age = 13.55 years, SD = 0.70), establishing a multilevel moderated mediating effect model. The results showed (1) the family environment and peer interaction quality can positively predict adolescents' academic achievement. (2) Using the KHB test, peer interaction quality plays a partial mediating role in the process of family environment positively affecting academic achievement, and the mediating ratio is 27.5%. (3) The educational expectation gap moderates the effect of the family environment on academic achievement and also on peer interaction quality. Therefore, from the perspective of environment and important others, to correctly grasp the academic achievement of junior high school students in the process of socialization, it is necessary to recognize that the family environment, peer interaction quality, and educational expectation gap play an important role., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhao and Zhao.)

Study Objectives: There is no consensus information on infections associated with nonbenzodiazepines. Knowledge about infections related to newly marketed hypnotics (orexin receptor antagonists and melatonin receptor agonists) is scarce. The study aimed to detect infection signals for nonbenzodiazepines, orexin receptor antagonists, and melatonin receptor agonists by analyzing data from the U.S. Food & Drug Administration adverse event reporting system., Methods: A disproportionality analysis was performed to quantitatively detect infection signals for hypnotics by calculating the reporting odds ratio and the 95% confidence interval. Data registered in the U.S. Food & Drug Administration adverse event reporting system from 2010-2020 were retrieved., Results: A total of 3,092 patients with infection were extracted for the 3 classes of hypnotic drugs. Nonbenzodiazepines were associated with a higher disproportionality of infections (reporting odds ratio: 1.10; 95% confidence interval, 1.06-1.14). The association of infections was not present for melatonin receptor agonists (reporting odds ratio: 0.86; 95% confidence interval, 0.74-1.00) and orexin receptor antagonists (reporting odds ratio: 0.19; 95% confidence interval, 0.15-0.25). Significant reporting associations were identified for nonbenzodiazepines concerning the categories of bone and joint infections, dental and oral soft tissue infections, upper respiratory tract infections, and urinary tract infections., Conclusions: Nonbenzodiazepines had a positive signal for infections, while orexin receptor antagonists and melatonin receptor agonists had a negative signal. More research needs to be conducted to confirm this relationship., Citation: Meng L, Huang J, He Q, et al. Hypnotics and infections: disproportionality analysis of the U.S. Food & Drug Administration adverse event reporting system database. J Clin Sleep Med. 2022;18(9):2229-2235., (© 2022 American Academy of Sleep Medicine.)

Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy., Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion., Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022., Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy., Main Outcomes and Measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours., Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%])., Conclusions and Relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke., Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.

Objective: To differentiate nontuberculous mycobacteria (NTM) pulmonary diseases from pulmonary tuberculosis (PTB) by analyzing the CT radiomics features of their cavity., Methods: 73 patients of NTM pulmonary diseases and 69 patients of PTB with the cavity in Shandong Province Chest Hospital and Qilu Hospital of Shandong University were retrospectively analyzed. 20 patients of NTM pulmonary diseases and 20 patients of PTB with the cavity in Jinan Infectious Disease Hospitall were collected for external validation of the model. 379 cavities as the region of interesting (ROI) from chest CT images were performed by 2 experienced radiologists. 80% of cavities were allocated to the training set and 20% to the validation set using a random number generated by a computer. 1409 radiomics features extracted from the Huiying Radcloud platform were used to analyze the two kinds of diseases' CT cavity characteristics. Feature selection was performed using analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO) methods, and six supervised learning classifiers (KNN, SVM, XGBoost, RF, LR, and DT models) were used to analyze the features., Results: 29 optimal features were selected by the variance threshold method, K best method, and Lasso algorithm.and the ROC curve values are obtained. In the training set, the AUC values of the six models were all greater than 0.97, 95% CI were 0.95-1.00, the sensitivity was greater than 0.92, and the specificity was greater than 0.92. In the validation set, the AUC values of the six models were all greater than 0.84, 95% CI were 0.76-1.00, the sensitivity was greater than 0.79, and the specificity was greater than 0.79. In the external validation set, The AUC values of the six models were all greater than 0.84, LR classifier has the highest precision, recall and F1-score, which were 0.92, 0.94, 0.93., Conclusion: The radiomics features extracted from cavity on CT images can provide effective proof in distinguishing the NTM pulmonary disease from PTB, and the radiomics analysis shows a more accurate diagnosis than the radiologists. Among the six classifiers, LR classifier has the best performance in identifying two diseases., (© 2021. The Author(s).)

In vivo induction of non-neuronal cells into neurons by transcription factors offers potential therapeutic approaches for neural regeneration. Although generation of induced neuronal (iN) cells in vitro and in vivo has been reported, whether iN cells can be fully integrated into existing circuits remains unclear. Here we show that expression of achaete-scute complex homolog-like 1 (Ascl1) alone is sufficient to convert dorsal midbrain astrocytes of mice into functional iN cells in vitro and in vivo. Specific expression of Ascl1 in astrocytes by infection with GFAP-adeno-associated virus (AAV) vector converts astrocytes in dorsal midbrain, striatum, and somatosensory cortex of postnatal and adult mice into functional neurons in vivo. These iN cells mature progressively, exhibiting neuronal morphology and markers, action potentials, and synaptic inputs from and output to existing neurons. Thus, a single transcription factor, Ascl1, is sufficient to convert brain astrocytes into functional neurons, and GFAP-AAV is an efficient vector for generating iN cells from astrocytes in vivo., (Copyright © 2015 the authors 0270-6474/15/359336-20$15.00/0.)