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Abstract Background Myopia and obesity in children and adolescents have become serious public health problems that endanger public health, especially in China. Unhealthy lifestyle behaviors are environmental drivers of both myopia and obesity. This protocol describes a study to evaluate the effectiveness of “22510SS”, that is 2 h of daytime outdoor activities (‘2’); Limit screen time to no more than 2 h per day (‘2’); Consume at least 5 servings of fruits and vegetables daily (‘5’); Attain 1 h of physical activity daily (‘1’); Consume 0 sugar-sweetened beverages (‘0’); Reasonable sleep duration (‘S’); Regular supervision (‘S’). A school-based, multifaceted intervention strategy for myopia and obesity prevention, and to assess and explore the implementation of “22510SS” with regards to acceptability, feasibility, adoption, usage and maintenance. Methods and analysis This study aims to develop a comprehensive intervention strategy "22510SS" based on the socio-ecological model, and A two-arm cluster randomized trial with a parallel-group of a 1:1 allocation ratio in 36 primary and secondary schools to test its evidence-based intervention programs on the effects and implementation of myopia and obesity epidemics in children and adolescents in grades 4 and 7. The primary outcomes will include differences in visual acuity, body mass index, outdoor activity indicators, screen time, fruit and vegetable intake, high-quality protein intake, sugar-sweetened beverage intake, sleep duration, and level of monitoring among children and adolescents. Secondary outcomes will assess the acceptability, feasibility, uptake, use, and maintenance of the intervention. Effects on the primary and secondary outcomes will be analyzed using linear and logistic regression analyses, as well as difference-in-difference analysis, taking into account cluster effects and possible confounding factors. Process assessments will also be conducted through quantitative and qualitative analyses, including acceptability, feasibility, gender, adoption, implementation, and sustainability. Discussion This study will evaluate the effectiveness of “22510SS” and examine its implementation in the school-based network nesting family and clinic. Following this intervention study, the integrated intervention program focused on myopia and obesity among children and adolescents have great potential to be implemented in China to promote and support healthy lifestyle behavior change and reduce the risk of myopia and obesity in children and adolescents. Trial registration NCT05275959. Registered 23 Mach 2022.

Inspired by mobile edge computing (MEC), edge learning has gained a momentum by directly performing model training at network edge without sending massive data to a centralized data center. However, the quality of model training will be affected by the limited communication and computing resources of network edge. In this paper, how to improve the training performance of a federated learning system aided by intelligent reflecting surface (IRS) over vehicle platooning networks is studied, where multiple platoons train a shared federated learning model. Multi-platoon cooperation can alleviate the pressure of data processing caused by the limited computing resources of single platoon. Meanwhile, IRS can enhance the inter-platoon communication in a cost-effective and energy-efficient manner. Firstly, the federated learning optimization problem of maximizing the learning accuracy is formulated by jointing platoon scheduling, bandwidth allocation and phase shifts at the IRS to maximize the number of scheduled platoon. Specifically, in the proposed learning architecture each platoon updates the learning model with its own data and uploads it to the global model through IRS-based wireless networks. Then, a method based on sequential optimization algorithm (SOA) and a group-based optimization method are analyzed for single IRS aided and large-scale IRS aided communication, respectively. Finally, a platoon scheduling scheme is designed based on the communication reliability and computing reliability of platoons. Simulation results demonstrate that large-scale IRS assisted communication can effectively improve the reliability of multi-user communication networks. The scheduling scheme based on learning reliability balances the communication performance and computing performance of platoons.

Abstract Background Infectious diseases pose a significant risk to the health and well-being of children and adolescents, and can even be life-threatening. Thus, our study aimed to explore the effectiveness of health education based on the social-ecological model in improving the knowledge of infectious diseases among this vulnerable population. Methods This study was a school-based intervention conducted in seven Chinese provinces in 2013, involving a total of 26,591 children and adolescents in the intervention group and 24,327 in the control group. The intervention group received a comprehensive health intervention based on the social-ecological model (SEM) over six months, which included a supportive environment, health education on infectious diseases, guidance on self-monitoring infectious disease-related behaviors, and other measures. Data on infectious disease-related knowledge and other characteristics were collected through questionnaires. The main outcome measure will be the difference in the effectiveness of health education regarding infectious diseases in children and adolescents between baseline and post-intervention. A mixed-effects regression model was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) to assess the impact of infectious disease-related interventions on the participants. Results We utilized a socioecological model as the foundation for a six-month health education program on infectious diseases targeting children and adolescents in the intervention group. At the individual and community levels, the correct rate of health behavior related to infectious diseases in the intervention group was higher than that in the control group (P

Acute myocardial infarction (AMI) is the leading cause of death worldwide. Ischemia-reperfusion (I/R) injury is considered the most common contributor to AMI. Hirsutine has been shown to protect cardiomyocytes against hypoxic injury. The present study investigated whether hirsutine improved AMI induced by I/R injury and the underlying mechanisms. In our study, we used a rat model of myocardial I/R injury. The rats were given hirsutine daily (5, 10, 20 mg/kg) by gavage for 15 days before the myocardial I/R injury. Detectable changes were observed in myocardial infarct size, mitochondrial function, histological damage, and cardiac cell apoptosis. According to our findings, hirsutine pre-treatment reduced the myocardial infarct size, enhanced cardiac function, inhibited cell apoptosis, reduced the tissue lactate dehydrogenase (LDH) and reactive oxygen species (ROS) content, as well as enhanced myocardial ATP content and mitochondrial complex activity. In addition, hirsutine balanced mitochondrial dynamics by increasing Mitofusin2 (Mfn2) expression while decreasing dynamin-related protein 1 phosphorylation (p-Drp1), which was partially regulated by ROS and calmodulin-dependent protein kinase II phosphorylation (p-CaMKII). Mechanistically, hirsutine inhibited mitochondrial-mediated apoptosis during I/R injury by blocking the AKT/ASK-1/p38 MAPK pathway. This present study provides a promising therapeutic intervention for myocardial I/R injury.

Abstract Background Endoplasmic reticulum stress (ER stress) may destroy endoplasmic reticulum homeostasis (ER homeostasis) and leads to programmable cell death. Unfolded protein response (UPR) originally stimulated by ER stress is critical for the survival of tumor cells through trying to re-establish ER homeostasis as an adaption to harsh microenvironment. However, mechanisms involving key regulators in modulating UPR remain underexplored. Methods The expression of LINP1 in cutaneous squamous cell carcinoma (cSCC) tissues and cell lines was assessed. Subsequently, LINP1 was knocked out, knocked down or overexpressed in cSCC cells. CCK-8 assays, colony forming assays, transwell migration assays and invasiveness measurement by matrigel-coated transwell were performed to examine the role of LINP1 in cSCC development through gain-of-function and loss-of-function experiments. Transcriptomic sequencing (RNA-Seq) was conducted and indicated the key downstream signaling events regulated by LINP1 including UPR and apoptosis signaling. Furthermore, the direct interaction between LINP1 and eIF2α to modulate UPR and apoptosis was confirmed by RNA pulldown, RNA immunoprecipitation (RIP), ChIP-qPCR and in vitro phosphorylation assays. Results In this study, LncRNA in non-homologous end joining pathway 1 (LINP1) was identified to be one of the top ten highest-expressed LncRNAs in cSCC, the second most common cancer in the world. Functional studies using in vitro and in vivo models revealed that LINP1 functions as an oncogene to promote cell proliferation, colony formation, migration and invasiveness while inhibiting cell apoptosis in cSCC. Transcriptomic sequencing after knockdown of LINP1 indicated LINP1 negatively regulates UPR-related pathways involving key effectors for activating UPR and the apoptosis following the prolonged UPR. Mechanistic study showed LINP1 physically interacts with eIF2α to inhibit its phosphorylation for avoiding unmitigated UPR. Loss of LINP1 followed by enhanced eIF2α phosphorylation led to overactivated UPR and induced DDIT3 expression, contributing to ER stress-induced apoptosis and suppression of cSCC development. Conclusions Our findings demonstrate a novel regulatory hierarchy of UPR by demonstrating LINP1 as a critical modulator for eIF2α phosphorylation and a suppressor of UPR-mediated apoptosis, which suggests a novel therapeutic target for cSCC treatment.

Currently, many fault diagnosis methods for rolling bearings based on deep learning are facing two main challenges. Firstly, the deep learning model exhibits poor diagnostic performance and limited generalization ability in the presence of noise signals and varying loads. Secondly, there is incomplete utilization of fault information and inadequate extraction of fault features, leading to the low diagnostic accuracy of the model. To address these problems, this paper proposes an improved dual-branch convolutional capsule neural network for rolling bearing fault diagnosis. This method converts the collected bearing vibration signals into grayscale images to construct a grayscale image dataset. By fully considering the types of bearing faults and damage diameters, the data are labeled using a dual-label format. A multi-scale convolution module is introduced to extract features from the data and maximize feature information extraction. Additionally, a coordinate attention mechanism is incorporated into this module to better extract useful channel features and enhance feature extraction capability. Based on adaptive fusion between fault type (damage diameter) features and labels, a dual-branch convolutional capsule neural network model for rolling bearing fault diagnosis is established. The model was experimentally validated using both Case Western Reserve University’s bearing dataset and self-made datasets. The experimental results demonstrate that the fault type branch of the model achieves an accuracy rate of 99.88%, while the damage diameter branch attains an accuracy rate of 99.72%. Both branches exhibit excellent classification performance and display robustness against noise interference and variable working conditions. In comparison with other algorithm models cited in the reference literature, the diagnostic capability of the model proposed in this study surpasses them. Furthermore, the generalization ability of the model is validated using a self-constructed laboratory dataset, yielding an average accuracy rate of 94.25% for both branches.

Droughts have a severe impact on the environment and social economy, and predicting their future changes is challenging due to significant uncertainties in climate change and human activities. Many countries have pledged to achieve carbon neutrality to limit global warming; however, few studies have focused on drought changes during the carbon-neutral period. Here, we analyzed the variations in drought characteristics across the Yellow River Basin (YRB) during the carbon-neutral period under two low-emission scenarios from 7 CMIP6 model outputs. The results show that the temperature and precipitation will increase significantly during the 2015–2100 period under both SSP1-1.9 and SSP1-2.6 scenarios. Compared to the historical period (1979–2014), the hydrological drought frequency is projected to decrease by 15.5% (13.0–18.1%), while drought severity is expected to increase by 14.4% (13.2–15.7%) during the carbon-neutral period. Meteorological droughts exhibit a similar changing trend, although the results vary between different regions. In general, more severe hydrological droughts may occur in the southern YRB in the carbon-neutral period under low-emission scenarios. This study has implications for future drought mitigation within the Yellow River Basin.

The effects of Helicobacter pylori eradication on gastric mucosa-colonizing microbes in patients with functional dyspepsia (FD) remain unclear. Here, we explored microbial variation induced by H. pylori infection and eradication treatment in FD patients. Gastric microbial abundance and diversity were significantly reduced in the H. pylori-infected FD patients. Eradication treatment increased alpha and beta diversity of gastric mucosa-colonizing microbes, and promoted the expansion of several probiotic microbes, such as Leuconostoc mesenteroides, which exhibited a matched antagonistic performance against H. pylori. Significant variation was observed in gastric mucosa-colonizing microbes between H. pylori-positive and H. pylori-negative FD patients. Eradication treatment induced microbial diversity recovery and may provide sufficient nutrition and space for probiotic microbes, such as Leuconostoc mesenteroides.

AimsWe aimed to explore the associations of the early PVR in four cortices with Healing Index (HI), Lengthening Index (LI), and External Fixator Index (EFI) in the bone union and non-union groups.MethodsA total of 52 patients, including 39 bone union and 13 bone non-union subjects, were recruited in this study. The general characteristics and PVR in four cortices in each group were explored. Afterward, the early PVR in four cortices, including medial, lateral, anterior, and posterior sides, were compared. Finally, the associations of the early PVR in four cortices with HI, LI, and EFI were also investigated.ResultsThe general characteristics of these patients were consistent, except for HI (31.54 ± 12.24 vs. 45.08 ± 27.10, P = 0.018) and EFI (57.63 ± 18.15 vs. 71.29 ± 24.60, P = 0.046). The growth of regenerated callus was asymmetrical in the bone union group (the posterior PVR seems to grow faster), whereas no statistical difference was obtained in the bone non-union group. Furthermore, the posterior PVR in the bone union group was significantly higher than that in the bone non-union group (the first month: 0.96 ± 0.17 vs. 0.86 ± 0.06, p = 0.047; the second month: 0.98 ± 0.14 vs. 0.89 ± 0.09, p = 0.041; the third month: 1.00 ± 0.12 vs. 0.92 ± 0.09, p = 0.039). Most importantly, the posterior PVR was inversely associated with HI, LI, and EFI (the first month: r = −0.343, p = 0.041; r = −0.346, p = 0.042; r = −0.352, p = 0.041; the second month: r = −0.459, p = 0.004; r = −0.277, p = 0.101; r = −0.511, p = 0.002; the third month: r = −0.479, p = 0.003; r = −0.398, p = 0.018; r = −0.551, p = 0.001) in the bone union group, respectively. However, this finding was lost in the bone non-union group.ConclusionThe early posterior cortex PVR seems to grow faster than the medial, lateral, and anterior sides in the bone union group, which represents an asymmetrical development pattern. Moreover, the posterior cortex PVR was negatively associated with HI, LI, and EFI, respectively. The posterior cortex PVR may be a novel and reliable detection index in the process of DO.

Background: Early onset of puberty could have significant impacts on childhood health, but the extent to which it was affected by phthalate esters (PAEs) and sex hormone disruption was not understood. The aim of this study is to investigate the associations between exposure to PAEs and sex hormone disruption and early onset of puberty in children. Methods: A longitudinal cohort study was conducted in China from May 2017 to Oct 2020, involving 740 children during consecutive visits. The onset of puberty was evaluated using Tanner definition, and early puberty was defined as an onset age less than the first 25 %, with cut-offs of 10.33 and 8.97 years for boys and girls, respectively. Serum testosterone (TT), estradiol (E2) and urinary PAE metabolites were measured during three visits. Generalized linear models were used to explore the associations between PAE and sex hormones with the age of puberty onset, while log-binomial regressions were applied to assess the associations of persistent exposure to PAEs and sex hormones with early pubertal onset. Results: Approximately 86.0 % of boys and 90.2 % of girls completed puberty onset from pre-puberty, and more than 95 % of participants had PAE concentrations higher than the limit of detection. Boys showed higher exposure to PAE pollutants and higher TT levels. Persistent exposure to PAEs was positively associated with early pubertal onset in girls (ARR = 1.97, 95 %CI = 1.12, 3.46). Moreover, persistent exposure to PAEs and E2 had synergistic associations with early pubertal onset in both boys (ARR = 4.77, 95 %CI = 1.06, 21.54) and girls (ARR = 7.07, 95 %CI = 1.51, 33.10). However, PAEs and TT had antagonistic associations only in boys (ARR = 0.44, 95 %CI = 0.07, 2.58). Conclusion: Long-term exposure to PAEs might increase the risk of early pubertal onset, and it appears to work in synergy with E2, while in antagonism with TT in boys’ early pubertal onset. Reducing PAEs exposure might promote pubertal health.

Abstract Cutaneous radiation injury (CRI) interrupts the scheduled process of radiotherapy and even compromises the life quality of patients. However, the current clinical options for alleviating CRI are relatively limited. Resveratrol (RSV) has been shown to be a promising protective agent against CRI; yet the mechanisms of RSV enhancing radioresistance were not fully elucidated and limited its clinical application. In this study, we demonstrate RSV promotes cutaneous radioresistance mainly through SIRT7. During ionizing radiation (IR) treatment, RSV indirectly phosphorylates and activates SIRT7 through AMPK, which is critical for maintaining the genome stability of keratinocytes. Immunoprecipitation and mass spectrometry identified HMGB1 to be the key interacting partner of SIRT7 to mediate the radioprotective function of RSV. Mechanistic study elucidated that SIRT7 interacts with and deacetylates HMGB1 to redistribute it into nucleus and “switch on” its function for DNA damage repair. Our findings establish a novel AMPK/SIRT7/HMGB1 regulatory axis that mediates the radioprotective function of RSV to alleviate IR-induced cutaneous DNA injury, providing an efficiently-curative option for patients with CRI during radiotherapy.

Abstract Hypertension is an important global public health issue because of its high morbidity as well as the increased risk of other diseases. Recent studies have indicated that the development of hypertension is related to the dysbiosis of the gut microbiota in both animals and humans. In this review, we outline the interaction between gut microbiota and hypertension, including gut microbial changes in hypertension, the effect of microbial dysbiosis on blood pressure (BP), indicators of gut microbial dysbiosis in hypertension, and the microbial genera that affect BP at the taxonomic level. For example, increases in Lactobacillus, Roseburia, Coprococcus, Akkermansia, and Bifidobacterium are associated with reduced BP, while increases in Streptococcus, Blautia, and Prevotella are associated with elevated BP. Furthermore, we describe the potential mechanisms involved in the regulation between gut microbiota and hypertension. Finally, we summarize the commonly used treatments of hypertension that are based on gut microbes, including fecal microbiota transfer, probiotics and prebiotics, antibiotics, and dietary supplements. This review aims to find novel potential genera for improving hypertension and give a direction for future studies on gut microbiota in hypertension.

Abstract Background The clinical characteristics of bone nonunion during distraction osteogenesis (DO) were rarely discussed. This study was employed to specify the difference between bone union and nonunion during DO. Methods The patients with bone lengthening were recruited in our study. The bone union cases indicated the ones that remove the external fixator successfully, whereas the bone nonunion represented the bridging callus did not appear even after 9 months (an absence of bridging callus for at least three out of four cortices on plain radiographs) that needs autogenous bone transplantation. The differences in the pixel value ratio (PVR) growth of regenerated callus, lengthening index (LI), healing index (HI), external fixation index (EFI) and blood biochemical indexes between bone union and nonunion were analyzed. Results A total of 8 bone nonunion and 27 bone union subjects were included in this study. The PVR growth in bone nonunion was significantly lower than that in bone union (0.19 ± 0.06 vs. 0.32 ± 0.16, P = 0.048). Interestingly, the HI and EFI in bone nonunion was significantly higher than that in bone union (62.0 ± 31.4 vs. 37.0 ± 27.4, P = 0.036; 75.0 ± 30.9 vs. 49.9 ± 16.1, P = 0.006). However, no significant difference with regard to LI was identified (0.76 ± 0.52 vs. 0.77 ± 0.32, P = 0.976). Moreover, the circulating level of urea and lymphocyte count in bone union was significantly lower than that in bone nonunion (4.31 ± 1.05 vs. 5.17 ± 1.06, P = 0.049; 2.08 ± 0.67 vs. 2.73 ± 0.54, P = 0.018). On the contrary, the circulating level of magnesium in bone union was significantly higher than that in bone nonunion (0.87 ± 0.07 vs. 0.80 ± 0.07, P = 0.014). Conclusion Compared to the bone union, the PVR growth was significantly lower, whereas the HI and EFI was significantly higher in the bone nonunion. Moreover, the circulating level of urea, magnesium and lymphocyte count was also different between these two. Therefore, the PVR, HI and EFI seems to be reliable and sensitive indicators to reflect the bone nonunion during DO, which might be considered in bone lengthening. Further prospective studies are still needed to elaborate the concerned issues.

ObjectivesTo conduct a bibliometric analysis to quantify and identify the current status and trends of acromegaly research in the past two decades.Materials and methodsArticles related to acromegaly that were published from 1999 to 2022 were retrieved through the Web of Science core collection (WoSCC) database. Then, they were imported into VOSviewer and CiteSpace to conduct a visualization analysis of authors, countries, institutions, citation numbers, cocitations, keywords, and references.ResultsA total of 3,909 articles were identified in the study. Among them, the United States made the largest contribution to the field. Moreover, Colao A. was the most prolific author, and the University of Naples Federico II was the institution with the most publications. In addition, the Journal of Clinical Endocrinology and Metabolism was the core journal in the field. High-frequency keywords mainly included “acromegaly,” “GH (Growth Hormone),” “IGH-I (Insulin-Like Growth Factor I),” “pituitary adenomas,” and “octreotide.”ConclusionStudies related to acromegaly have shown stable stepwise growth over the past two decades. Interestingly, the research focus after 2016 gradually shifted from the etiology, mechanism, medications for treatment, and complications to improving prognosis and quality of life of patients with acromegaly. The current findings may provide guidance for further research in the field of acromegaly.

Tuberculosis, caused by Mycobacterium tuberculosis (Mtb), remains a global health crisis with substantial morbidity and mortality rates. Type II alveolar epithelial cells (AEC-II) play a critical role in the pulmonary immune response against Mtb infection by secreting effector molecules such as antimicrobial peptides (AMPs). Here, human β-defensin 1 (hBD1), an important AMP produced by AEC-II, has been demonstrated to exert potent anti-tuberculosis activity. HBD1 overexpression effectively inhibited Mtb proliferation in AEC-II, while mice lacking hBD1 exhibited susceptibility to Mtb and increased lung tissue inflammation. Mechanistically, in A549 cells infected with Mtb, STAT1 negatively regulated hBD1 transcription, while CEBPB was the primary transcription factor upregulating hBD1 expression. Furthermore, we revealed that the ERK1/2 signaling pathway activated by Mtb infection led to CEBPB phosphorylation and nuclear translocation, which subsequently promoted hBD1 expression. Our findings suggest that the ERK1/2-CEBPB-hBD1 regulatory axis can be a potential therapeutic target for anti-tuberculosis therapy aimed at enhancing the immune response of AEC-II cells.

Sugarcane is a major crop for sugar and biofuel production. Historically, mapping large sugarcane fields meticulously depended heavily on gathering comprehensive and representative training samples. This process was time-consuming and inefficient. Addressing this drawback, this study proposed a novel index, the Normalized Difference Vegetation Index (NDVI)-Based Sugarcane Index (NBSI). NBSI analyzed the temporal variation of sugarcane’s NDVI over a year. Leveraging the distinct growth phases of sugarcane (transplantation, tillering, rapid growth and maturity) four measurement methodologies, f(W1), f(W2), f(V) and f(D), were developed to characterize the features of the sugarcane growth period. Utilizing imagery from Landsat-8, Sentinel-2, and MODIS, this study employed the enhanced gap-filling (EGF) method to reconstruct NDVI time-series data for seven counties in Chongzuo, Guangxi Zhuang Autonomous Region, during 2021, subsequently testing NBSI’s ability to extract sugarcane. The results demonstrate the efficiency of NBSI with simple threshold settings: it was able to map sugarcane cultivation areas, exhibiting higher accuracy when compared to traditional classifiers like support vector machines (SVM) and random forests (RF), with an overall accuracy (OA) of 95.24% and a Kappa coefficient of 0.93, significantly surpassing RF (OA = 85.31%, Kappa = 0.84) and SVM (OA = 85.87%, Kappa = 0.86). This confirms the outstanding generalizability and robustness of the proposed method in Chongzuo. Therefore, the NBSI methodology, recognized for its flexibility and practicality, shows potential in enabling the extensive mapping of sugarcane cultivation. This heralds a new paradigm of thought in this field.

Abstract Hepatocellular carcinoma (HCC) is the most common subtype of liver cancer and the second most fatal cancer in the world despite the great therapeutic advances in the past two decades, which reminds us of the gap in fully understanding the oncogenic mechanism of HCC. To explore the key factors contributing to the progression of HCC, we identified a LncRNA, termed SALIS (Suppression of Apoptosis by LINC01186 Interacting with STAT5A), functions in promoting the proliferation, colony formation, migration and invasion while suppressing apoptosis in HCC cells. Mechanistic study indicated SALIS physically associates with transcription factor STAT5A and binds to the promoter regions of IGFBP3 and Caspase-7 to transcriptionally repress their expression and further inhibit apoptosis. Our findings identified SALIS as an oncogene to promote HCC by physically binding with STAT5A to inhibit the expression of pro-apoptotic IGFBP3 and Caspase-7, which suggests novel therapeutic targets for HCC treatments.

Purpose This study compared the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the Risk of Malignancy Index 4 (RMI4), the International Ovarian of Tumor Analysis Logistic Regression Model 2 (IOTA LR2), and the IOTA Simple Rules (IOTA SR) in predicting the malignancy of adnexal masses (AMs). Methods This retrospective study included 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (group I) and two junior doctors (group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. A receiver operating characteristic curve was used to test the diagnostic performance. The interrater agreement between the two groups was tested using kappa values. Results Of all 592 AMs, 447 (75.5%) were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68, and 0.77 for the O-RADS, RMI4, IOTA LR2, and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems were 0.90, 0.89, 0.90, and 0.86 for group I and 0.89, 0.87, 0.88, and 0.84 for group II, respectively. The O-RADS had the highest sensitivity (91.0% in group I and 84.8% in group II). Conclusion The four diagnostic systems could compensate for junior doctors’ inexperience in predicting malignant adnexal lesions. The O-RADS performed best and showed the highest sensitivity.

Abstract Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool.

IntroductionWe aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO2 and CO), and blood pressure in children and adolescents.MethodsFrom 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7–17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO2 and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects.ResultsAmong all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO2 and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO2 and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%).DiscussionGreenness could alleviate the damage effects of SO2/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.

Acoustic neuroma is one of the most common tumors in the cerebellopontine angle area. Patients with acoustic neuroma have clinical manifestations of the cerebellopontine angle occupying syndrome, such as tinnitus, hearing impairment and even hearing loss. Acoustic neuromas often grow in the internal auditory canal. Neurosurgeons need to observe the lesion contour with the help of MRI images, which not only takes a lot of time, but also is easily affected by subjective factors. Therefore, the automatic and accurate segmentation of acoustic neuroma in cerebellopontine angle on MRI is of great significance for surgical treatment and expected rehabilitation. In this paper, an automatic segmentation method based on Transformer is proposed, using TransUNet as the core model. As some acoustic neuromas are irregular in shape and grow into the internal auditory canal, larger receptive fields are thus needed to synthesize the features. Therefore, we added Atrous Spatial Pyramid Pooling to CNN, which can obtain a larger receptive field without losing too much resolution. Since acoustic neuromas often occur in the cerebellopontine angle area with relatively fixed position, we combined channel attention with pixel attention in the up-sampling stage so as to make our model automatically learn different weights by adding the attention mechanism. In addition, we collected 300 MRI sequence nuclear resonance images of patients with acoustic neuromas in Tianjin Huanhu hospital for training and verification. The ablation experimental results show that the proposed method is reasonable and effective. The comparative experimental results show that the Dice and Hausdorff 95 metrics of the proposed method reach 95.74% and 1.9476 mm respectively, indicating that it is not only superior to the classical models such as UNet, PANet, PSPNet, UNet++, and DeepLabv3, but also show better performance than the newly-proposed SOTA (state-of-the-art) models such as CCNet, MANet, BiseNetv2, Swin-Unet, MedT, TransUNet, and UCTransNet.

BackgroundLAMA2-related limb girdle muscular dystrophy (LGMD R23) is rare. The detailed clinical phenotypes and genetic information associated with LGMD R23 are unknown.MethodsWe conducted a retrospective cross-sectional and longitudinal study on 19 LGMD R23 patients.ResultsNormal early motor development was observed in 84.2% patients. Mild orthopedic complications were observed in 42.1% patients. 36.8% patients had seizures, which is unusually frequent in LGMD. Epilepsy was eventually diagnosed in 26.3% patients. 46.7% patients presented with motor neuropathy. Genetic analysis identified 29 pathogenic variants, with missense and frameshift variants being the most common. The mutant sites were mainly distributed in the N-terminal and G-like domains of laminin. The missense variants are distributed near the N-terminus (exons 3–11), whereas frameshift variants are distributed in exons 12–65. Five patients were diagnosed with epilepsy and all of them harbor at least one missense variants in exon 4. 71.4% variants of patients with motor neuropathy located in the LN domain.ConclusionsMissense variants in exon 4 maybe correlated with epilepsy and variants in the LN domain maybe correlated with motor neuropathy in Chinese patients. Our study expands the clinical and genetic spectrum caused by LAMA2 variations and provides novel genotype-phenotype correlations of LGMD R23.

BackgroundHealth literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs).MethodsFrom 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases – diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.ResultsA total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772–4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236–0.600, p

Abstract The manual monitoring of callus with digital radiography (X-ray) is the primary bone healing evaluation, assessing the number of bridged callus formations. However, this method is subjective and nonquantitative. Recently, several quantitative monitoring methods, which could assess the recovery of the structure and biomechanical properties of the callus at different stages and the process of bone healing, have been extensively investigated. These methods could reflect the bone mineral content (BMC), bone mineral density (BMD), stiffness, callus and bone metabolism at the site of bone lengthening. In this review, we comprehensively summarized the latest techniques for evaluating bone healing during distraction osteogenesis (DO): 1) digital radiography; 2) dual-energy X-ray scanning; 3) ultrasound; 4) quantitative computed tomography; 5) biomechanical evaluation; and 6) biochemical markers. This evidence will provide novel and significant information for evaluating bone healing during DO in the future.

An accurate and efficient estimation of eucalyptus plantation areas is of paramount significance for forestry resource management and ecological environment monitoring. Currently, combining multidimensional optical and SAR images with machine learning has become an important method for eucalyptus plantation classification, but there are still some challenges in feature selection. This study proposes a feature selection method that combines multi-temporal Sentinel-1 and Sentinel-2 data with SLPSO (social learning particle swarm optimization) and RFE (Recursive Feature Elimination), which reduces the impact of information redundancy and improves classification accuracy. Specifically, this paper first fuses multi-temporal Sentinel-1 and Sentinel-2 data, and then carries out feature selection by combining SLPSO and RFE to mitigate the effects of information redundancy. Next, based on features such as the spectrum, red-edge indices, texture characteristics, vegetation indices, and backscatter coefficients, the study employs the Simple Non-Iterative Clustering (SNIC) object-oriented method and three different types of machine-learning models: Random Forest (RF), Classification and Regression Trees (CART), and Support Vector Machines (SVM) for the extraction of eucalyptus plantation areas. Each model uses a supervised-learning method, with labeled training data guiding the classification of eucalyptus plantation regions. Lastly, to validate the efficacy of selecting multi-temporal data and the performance of the SLPSO–RFE model in classification, a comparative analysis is undertaken against the classification results derived from single-temporal data and the ReliefF–RFE feature selection scheme. The findings reveal that employing SLPSO–RFE for feature selection significantly elevates the classification precision of eucalyptus plantations across all three classifiers. The overall accuracy rates were noted at 95.48% for SVM, 96% for CART, and 97.97% for RF. When contrasted with classification outcomes from multi-temporal data and ReliefF–RFE, the overall accuracy for the trio of models saw an increase of 10%, 8%, and 8.54%, respectively. The accuracy enhancement was even more pronounced when juxtaposed with results from single-temporal data and ReliefF-RFE, at increments of 15.25%, 13.58%, and 14.54% respectively. The insights from this research carry profound theoretical implications and practical applications, particularly in identifying and extracting eucalyptus plantations leveraging multi-temporal data and feature selection.

Soil moisture (SM), as one of the crucial environmental factors, has traditionally been estimated using global navigation satellite system interferometric reflectometry (GNSS-IR) microwave remote sensing technology. This approach relies on the signal-to-noise ratio (SNR) reflection component, and its accuracy hinges on the successful separation of the reflection component from the direct component. In contrast, the presence of carrier phase and pseudorange multipath errors enables soil moisture retrieval without the requirement for separating the direct component of the signal. To acquire high-quality combined multipath errors and diversify GNSS-IR data sources, this study establishes the dual-frequency pseudorange combination (DFPC) and dual-frequency carrier phase combination (L4) that exclude geometrical factors, ionospheric delay, and tropospheric delay. Simultaneously, we propose two methods for estimating soil moisture: the DFPC method and the L4 method. Initially, the equal-weight least squares method is employed to calculate the initial delay phase. Subsequently, anomalous delay phases are detected and corrected through a combination of the minimum covariance determinant robust estimation (MCD) and the moving average filter (MAF). Finally, we utilize the multivariate linear regression (MLR) and extreme learning machine (ELM) to construct multi-satellite linear regression models (MSLRs) and multi-satellite nonlinear regression models (MSNRs) for soil moisture prediction, and compare the accuracy of each model. To validate the feasibility of these methods, data from site P031 of the Plate Boundary Observatory (PBO) H2O project are utilized. Experimental results demonstrate that combining MCD and MAF can effectively detect and correct outliers, yielding single-satellite delay phase sequences with a high quality. This improvement contributes to varying degrees of enhanced correlation between the single-satellite delay phase and soil moisture. When fusing the corrected delay phases from multiple satellite orbits using the DFPC method for soil moisture estimation, the correlations between the true soil moisture values and the predicted values obtained through MLR and ELM reach 0.81 and 0.88, respectively, while the correlations of the L4 method can reach 0.84 and 0.90, respectively. These findings indicate a substantial achievement in high-precision soil moisture estimation within a small satellite-elevation angle range.

Abstract Background Congenital myopathies are a group of rare neuromuscular diseases characterized by specific histopathological features. The relationship between the pathologies and the genetic causes is complex, and the prevalence of myopathy-causing genes varies among patients from different ethnic groups. The aim of the present study was to characterize congenital myopathies with infancy onset among patients registered at our institution. Method This retrospective study enrolled 56 patients based on the pathological and/or genetic diagnosis. Clinical, histopathological and genetic features of the patients were analysed with long-term follow-up. Results Twenty-six out of 43 patients who received next-generation sequencing had genetic confirmation, and RYR1 variations (12/26) were the most prevalent. Eighteen novel variations were identified in 6 disease-causing genes, including RYR1, NEB, TTN, TNNT1, DNM2 and ACTA1. Nemaline myopathy (17/55) was the most common histopathology. The onset ages ranged from birth to 1 year. Thirty-one patients were followed for 3.83 ± 3.05 years (ranging from 3 months to 11 years). No patient died before 1 year. Two patients died at 5 years and 8 years respectively. The motor abilities were stable or improved in 23 patients and deteriorated in 6 patients. Ten (10/31) patients developed respiratory involvement, and 9 patients (9/31) had mildly abnormal electrocardiograms and/or echocardiograms. Conclusion The severity of congenital myopathies in the neonatal/infantile period may vary in patients from different ethnic groups. More concern should be given to cardiac monitoring in patients with congenital myopathies even in those with static courses.

Poliomyelitis is an acute infectious disease caused by poliovirus. This bibliometric analysis aims to examine the status of poliomyelitis research in the past 20 years. Information regarding polio research was obtained from the Web of Science Core Collection database. CiteSpace, VOSviewer, and Excel were used to perform visual and bibliometric analysis with respect to countries/regions, institutions, authors, journals and keywords. A total of 5,335 publications on poliomyelitis were published from 2002 to 2021. The USA was the county with the majority of publications. Additionally, the most productive institution was the Centers for Disease Control and Prevention. Sutter, RW produced the most papers and had the most co-citations. Vaccine was the journal with the most polio-related publications and citations. The most common keywords were mainly about polio immunology research (“polio,” “immunization,” “children,” “eradication” and “vaccine”). Our study is helpful for identifying research hotspots and providing direction for future research on poliomyelitis.

BackgroundThe number of empty nest elderly in China has gradually increased in recent years. There is growing concern about the physical and mental health of this population as empty nest elderly are commonly at the risk of compromising health, home safety and quality of life. This study reported the health and well-being of empty nest elderly with regards to their health status, depression and satisfaction, lifestyle as compared to non-empty nest elderly in China.MethodsData was collected from the 2018 follow-up interviews of China Health and Retirement Longitudinal Survey. We included 4,630 empty nest elderly and 6,188 non-empty nest elderly. Chi-square Test and Logistic Regression were used to compare the differences between these two groups.ResultsAs compared to the non-empty nest elderly, there was higher proportion of empty nest elderly who suffered from dyslipidemia, diabetes, chronic lung diseases, heart attack (27.0% vs. 25.0%; 16.6% vs. 15.1%; 19.4% vs. 16.4%; 26.3% vs. 23.4%, P < 0.05). The empty nest elderly had higher proportion of participants who drank more than once a month (25.3% vs. 23.9%, P < 0.05), who felt satisfied with their marriage (71.6% vs. 66.2%, P < 0.001), who were satisfied with their children's relationship (85.2% vs. 83.2%, P < 0.001). However, these significances disappeared in the Logistic Regression analysis (P > 0.05).ConclusionOur study showed that significant between-group difference was found between empty nest elderly and non-empty nest elderly in their health and wellbeing. However, disappearance of such difference in the multivariable analysis may indicate improved health and wellbeing among the empty nest elderly. Even though our study still suggested the importance of improving the health, lifestyles and family dynamics of the elderly and promoting the integration of health and social care for the elderly, especially among the empty nest elderly.

BackgroundCardiovascular health (CVH) in children and adolescents, which might be largely influenced by parental behaviors, may affect the incidence of cardiovascular diseases in adulthood. However, few studies have been conducted to explore the associations between parental behaviors and CVH status of offspring in China.MethodsData were obtained from a cross-sectional survey conducted in Chinese children and adolescents aged 7–18 years old, with a total of 10,043 parent–offspring pairs included. Parental behaviors included moderate to vigorous physical activity (MVPA), dietary behaviors, and weight status. The CVH status of offspring was consulted by The American Heart Association, including seven factors. The associations between parental behaviors and CVH status of offspring were evaluated by multilevel logistic regression. Stratified analyses were conducted to explore the potential modifying influence of sociodemographic factors.ResultsMost of the offspring had five ideal CVH factors; only 21.04% had six to seven ideal CVH factors. Parental unhealthy behaviors were associated with high odds of nonideal CVH status of offspring. Parental overweight/obesity, insufficient MVPA, and unhealthy dietary behaviors could increase the odds of owning one to three ideal CVH factors in offspring, with corresponding odds ratios (ORs) (95% confidence interval) of 1.61 (1.32–1.96), 1.31 (1.10–1.56), and 2.05 (1.43–2.94), respectively. There was a dose–response relationship between parental single unhealthy behavior and the odds of nonideal CVH status in offspring (P-trend