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Recent research has unveiled the critical roles of self-efficacy and buoyancy in teachers' work engagement. However, there has been limited research on the intricate links between teacher self-efficacy, buoyancy and engagement in the online English as a foreign language (EFL) teaching context. To address the underexplored relationships among these variables, the current study adopted a quantitative approach to verify the direct and indirect paths from online EFL teacher self-efficacy to engagement via the mediating effect of teacher buoyancy. We invited 978 Chinese high school EFL teachers to take part in the current study and answer questions about their self-efficacy, buoyancy and work engagement. The results of the structural equation modelling indicate that teacher self-efficacy could directly and indirectly predict online EFL teacher work engagement via the mediation of teacher buoyancy. The results of this study shed light on ways of improving EFL teachers' online teaching experience and educational outcomes.

We explore the feasibility of surgical video combined with a multidisciplinary treatment (MDT) integrated teaching method in the clinical teaching of thyroid surgery and its impact on medical students' autonomous learning ability. Eighty-four clinical interns who studied surgical work in our hospital were randomly divided into two groups with 42 in each group. Among them, the observation group was given surgical operation video combined with the MDT integrated teaching method; the control group was given the traditional conventional teaching method. The feasibility of the two teaching methods in the clinical teaching of thyroid surgery and their influence on students' autonomous learning ability were analyzed by means of questionnaires and examination tests. In terms of the examination results (including theoretical knowledge and practical results), the observation group was significantly better than the control group (P < 0.05). In terms of teaching evaluation (including the improvement in self-study ability, the cultivation of clinical thinking, the improvement in expression level, and the enhancement of teamwork spirit), the observation group was significantly better than that of the control group (P < 0.05). In terms of teaching satisfaction, the observation group was significantly better than that of the control group (P < 0.01). In conclusion, surgical operation video combined with the MDT integrated teaching method can effectively improve students' learning efficiency in the clinical teaching of thyroid surgery. At the same time, students' comprehensive abilities, such as autonomous learning ability, teamwork, and the ability to analyze and solve problems, have been improved.

This study aims to explore the impact of perceived transformational leadership on knowledge sharing behavior among university teachers in Anhui Province, China. Using a questionnaire survey method, convenient sampling was conducted among college teachers in Anhui Province. With 326 teachers as the research subjects, SPSS software was used to analyze the relationship between teachers' perception of transformational leadership and knowledge sharing behavior in the context of colleges and universities. Additionally, this study compared the impact of demographic variables such as age, teaching experience, and professional title on teachers' knowledge sharing behavior. The research results indicate that Anhui university teachers' perception of transformational leadership has a significant positive impact on knowledge sharing behavior. Moreover, there are significant differences in teachers' knowledge sharing behavior based on their age, teaching experience, and professional titles.

Abstract Background Many studies have investigated the association between hypothyroidism and frozen shoulder, but their findings have been inconsistent. Furthermore, earlier research has been primarily observational, which may introduce bias and does not establish a cause-and-effect relationship. To ascertain the causal association, we performed a two-sample bidirectional Mendelian randomization (MR) analysis. Methods We obtained data on “Hypothyroidism” and “Frozen Shoulder” from Summary-level Genome-Wide Association Studies (GWAS) datasets that have been published. The information came from European population samples. The primary analysis utilized the inverse-variance weighted (IVW) method. Additionally, a sensitivity analysis was conducted to assess the robustness of the results. Results We ultimately chose 39 SNPs as IVs for the final analysis. The results of the two MR methods we utilized in the investigation indicated that a possible causal relationship between hypothyroidism and frozen shoulder. The most significant analytical outcome demonstrated an odds ratio (OR) of 1.0577 (95% Confidence Interval (CI):1.0057–1.1123), P = 0.029, using the IVW approach. Furthermore, using the MR Egger method as a supplementary analytical outcome showed an OR of 1.1608 (95% CI:1.0318–1.3060), P = 0.017. Furthermore, the results of our sensitivity analysis indicate that there is no heterogeneity or pleiotropy in our MR analysis. In the reverse Mendelian analysis, no causal relationship was found between frozen shoulders and hypothyroidism. Conclusion Our MR analysis suggests that there may be a causal relationship between hypothyroidism and frozen shoulder.

Abstract We present the analytic total cross section of top quark pair production in electron-positron annihilation at next-to-next-to-leading order (NNLO) in Quantum Chromodynamics (QCD). By utilizing the optical theorem, the NNLO corrections are related to the imaginary parts of three-loop self-energy Feynman diagrams, of which the master integrals are calculated with canonical differential equations. The analytic results for the NNLO corrections are expressed in terms of multiple polylogarithms as well as elliptic functions. We discuss the asymptotic expansions near the threshold and in the high energy limit in detail. Numerical results are provided for the total cross section of top quark pair production at future lepton colliders.

Abstract Deep vein thrombosis (DVT) is a leading cause of morbidity and mortality after trauma. Here, we integrate plasma metabolomics and proteomics to evaluate the metabolic alterations and their function in up to 680 individuals with and without DVT after trauma (pt-DVT). We identify 28 metabolites and 2 clinical parameter clusters associated with pt-DVT. Then, we develop a panel of 9 metabolites (hexadecanedioic acid, pyruvic acid, L-Carnitine, serotonin, PE(P-18:1(11Z)/18:2(9Z,12Z)), 3-Hydroxycapric acid, 5,6-DHET, 3-Methoxybenzenepropanoic acid and pentanenitrile) that can predict pt-DVT with high performance, which can be verified in an independent cohort. Furthermore, the integration analysis of metabolomics and proteomics data indicates that the upregulation of glycolysis/gluconeogenesis-TCA cycle may promote thrombosis by regulating ROS levels in red blood cells, suggesting that interfering with this process might be potential therapeutic strategies for pt-DVT. Together, our study comprehensively delineates the metabolic and hematological dysregulations for pt-DVT, and provides potential biomarkers for early detection.

Abstract Endo-periodontal lesions (EPLs) involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms, including unique anatomical and microbiological characteristics and multiple contributing factors. This etiological complexity leads to difficulties in determining patient prognosis, posing great challenges in clinical practice. Furthermore, EPL-affected teeth require multidisciplinary therapy, including periodontal therapy, endodontic therapy and others, but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy. By compiling the most recent findings on the etiology, pathogenesis, clinical characteristics, diagnosis, therapy, and prognosis of EPL-affected teeth, this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

AIM: To develop a deep learning-based model for automatic retinal vascular segmentation, analyzing and comparing parameters under diverse glucose metabolic status (normal, prediabetes, diabetes) and to assess the potential of artificial intelligence (AI) in image segmentation and retinal vascular parameters for predicting prediabetes and diabetes. METHODS: Retinal fundus photos from 200 normal individuals, 200 prediabetic patients, and 200 diabetic patients (600 eyes in total) were used. The U-Net network served as the foundational architecture for retinal artery-vein segmentation. An automatic segmentation and evaluation system for retinal vascular parameters was trained, encompassing 26 parameters. RESULTS: Significant differences were found in retinal vascular parameters across normal, prediabetes, and diabetes groups, including artery diameter (P=0.008), fractal dimension (P=0.000), vein curvature (P=0.003), C-zone artery branching vessel count (P=0.049), C-zone vein branching vessel count (P=0.041), artery branching angle (P=0.005), vein branching angle (P=0.001), artery angle asymmetry degree (P=0.003), vessel length density (P=0.000), and vessel area density (P=0.000), totaling 10 parameters. CONCLUSION: The deep learning-based model facilitates retinal vascular parameter identification and quantification, revealing significant differences. These parameters exhibit potential as biomarkers for prediabetes and diabetes.

Biometal ions are crucial in the structure and function of living organisms and have extensively been employed to promote bone tissue regeneration. Nevertheless, the biological functions of biometal ions and the underlying mechanisms responsible for their pro-regenerative effects remain incompletely understood, since bone repair is an intricate physiological process involving multiple cell types and signals. Recent accomplishments in the osteoimmunological field have revealed the momentous involvement of the immune system in mediating the therapeutic effects of biometal ions. The inflammatory factors secreted by immune cells contribute to bone cell migration, activation, and proliferation. This review summarizes the immune system and its constituent cells, followed by the current perspective on immunomodulation during bone healing. Next, the physicochemical and physiological properties of various biometal ions, including lithium, sodium, potassium, magnesium, calcium, strontium, vanadium, iron, cobalt, copper, and zinc, are thoroughly reviewed. In addition, the interactions between biometal ions, immune cells, and bone tissue are discussed, aiming to provide insights into the prospective development of novel approaches to bone tissue regeneration by harnessing the therapeutic potential of these biometal ions.

Abstract The spatial delays of pulmonary tuberculosis (PTB) have been less explored. In this study, a total of 151,799 notified PTB cases were included, with median patient and diagnostic delays of 15 [interquartile range (IOR), 4–35] and 2 (IOR, 0–8) days, respectively. The spatial autocorrelation analysis and spatial–temporal scan statistics were used to determine the clusters, indicating that the regions in the southwestern and northeastern parts of Zhejiang Province exhibited high rates of long-term patient delay (LPD, delay ≥ 15 days) and long-term diagnostic delay (LDD, delay ≥ 2 days). Besides, the Mantel test indicated a moderately positive correlation between public awareness of suspicious symptoms and the LPD rate in 2018 (Mantel's r = 0.4, P

Abstract In this work, we study the duality symmetry group of Carrollian (nonlinear) electrodynamics and propose a family of Carrollian ModMax theories, which are invariant under Carrollian SO(2) electromagnetic (EM) duality transformations and conformal transformation. We define the Carrollian SO(2) EM transformations, with the help of Hodge duality in Carrollian geometry, then we rederive the Gaillard-Zumino consistency condition for EM duality of Carrollian nonlinear electrodynamics. Together with the traceless condition for the energy-momentum tensor, we are able to determine the Lagrangian of the Carrollian ModMax theories among pure electrodynamics. We furthermore study their behaviors under the T T ¯ $$ \sqrt{T\overline{T}} $$ deformation flow, and show that these theories deform to each other and may reach two endpoints under the flow, with one of the endpoint being the Carrollian Maxwell theory. As a byproduct, we construct a family of two-dimensional Carrollian ModMax-like multiple scalar theories, which are closed under the T T ¯ $$ \sqrt{T\overline{T}} $$ flow and may flow to a BMS free multi-scalar model.

Abstract Greenspace, offering multifaceted ecological and socioeconomic benefits to the nature system and human society, is integral to the 11th Sustainable Development Goal pertaining to cities and communities. Spatially and temporally explicit information on greenspace is a premise to gauge the balance between its supply and demand. However, existing efforts on urban greenspace mapping primarily focus on specific time points or baseline years without well considering seasonal fluctuations, which obscures our knowledge of greenspace’s spatiotemporal dynamics in urban settings. Here, we combined spectral unmixing approach, time-series phenology modeling, and Sentinel-2 satellite images with a 10-m resolution and nearly 5-day revisit cycle to generate a four-year (2019–2022) 10-m and 10-day resolution greenspace dynamic data cube over 1028 global major cities (with an urbanized area >100 km2). This data cube can effectively capture greenspace seasonal dynamics across greenspace types, cities, and climate zones. It also can reflect the spatiotemporal dynamics of the cooling effect of greenspace with Landsat land surface temperature data. The developed data cube provides informative data support to investigate the spatiotemporal interactions between greenspace and human society.

Objective To explore the effects of prophylactic analgesia with esketamine on pain, hemodynamics, and stress response in patients with single-segment thoracolumbar fracture after percutaneous pedicle screw fixation (PPSF). Methods From April 2021 to April 2023, 85 patients with single-segment thoracolumbar fracture undergoing PPSF at The Sixth People's Hospital of Nantong were enrolled as the research objects. All patients underwent PPSF under tracheal intubation and general anesthesia, routine anesthesia induction, maintenance and patient controlled intravenous analgesia. Among all the patients, 42 cases in obeservation group were given intravenous injection of esketamine (10 mg) at 20 min before the end of the surgery, 43 cases in control group did not receive any other treatment. The postoperative pain ［visual analogue scale (VAS)］, hemodynamics ［heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), respiratory rate］, stress response ［eosinophils (EOS), platelet count (PLT)］ and adverse reactions were compared between the two groups. Results Compared with control group, obeservation group had higher HR and lower MAP immediately after surgery(T1), lower VAS scores at 2 h (T2) and 6 h (T3) after surgery, and lower frequency of analgesic pump compression at 48h after surgery (P＜0.05). There was no significant difference in SpO2, respiratory rate between two groups (P＞0.05). At T1 and T3, EOS was higher, while PLT was lower in observation group than control group (P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group (9.52% vs4.65%, χ2=0.206, P=0.433). Conclusion Prophylactic analgesia with esketamine is beneficial to relieve short-term pain, stress response and stabilize hemodynamics in patients with single-segment thoracolumbar fracture after PPSF, which has few effects on postoperative cognitive function and good safety.

Abstract Objective Radiofrequency thermocoagulation (RFTC) has emerged as an effective and safe treatment method for patients with refractory focal epilepsy, when stereo‐electroencephalography (SEEG) is implanted. Although real‐world research results are still limited, a considerable number of patients have shown favorable outcomes with this less invasive method. This study aims to describe the outcomes and predictive factors of SEEG‐RFTC in real‐world research. Methods A retrospective observational study was conducted on patients in the authors' epilepsy center. In total, 121 patients who underwent RFTC were included in the study. Post‐RFTC outcomes were evaluated using the seizure‐free rate and response rate (seizure frequency reduction more than 50%). Predictive factors influencing post‐RFTC outcome were considered by comparing different variables. Results The mean follow‐up period was 18.3 months. Eighty‐two patients (67.8%) were responders and 54 (44.6%) were seizure free. In 36 patients with malformation of cortical development, the seizure‐free rate and the response rate were 69.44% and 83.33%, respectively. In 20 patients with hippocampal sclerosis, 19 patients were responders and 14 (70%) patients were seizure free at the last follow‐up. The MRI feature and etiology of epilepsy are correlated with the outcome. MR‐positive is a predictive factor for seizure freedom (p

Abstract In this study, we explore the correlation functions of thin-shell operators, represented semiclassically by a homogeneous, thin interface of dust particles. Employing the monodromy method, we successfully compute the contribution from the Virasoro vacuum block and present the monodromy equation in a closed form without assuming the probe limit. Although an analytical solution to the monodromy equation remains difficult, we demonstrate that it is perturbatively solvable within specific limits, including the probe limit, the heavy-shell limit, and the early-time limit. Moreover, we compare our results with gravitational calculations and find precise agreement. We strengthen our findings by proving that the thermal correlation functions in gravity, after an inverse Laplace transformation, satisfy the field theory’s monodromy equation. Additionally, we identify an infinite series of unphysical solutions to the monodromy equation and discuss their potential geometrical duals.

Abstract Background Heart failure (HF), which is caused by cardiac overload and injury, is linked to significant mortality. Writers of RNA modification (WRMs) play a crucial role in the regulation of epigenetic processes involved in immune response and cardiovascular disease. However, the potential roles of these writers in the immunological milieu of HF remain unknown. Methods We comprehensively characterized the expressions of 28 WRMs using datasets GSE145154 and GSE141910 to map the cardiac immunological microenvironment in HF patients. Based on the expression of WRMs, the immunological cells in the datasets were scored. Results Single-cell transcriptomics analysis (GSE145154) revealed immunological dysregulation in HF as well as differential expression of WRMs in immunological cells from HF and non-HF (NHF) samples. WRM-scored immunological cells were positively correlated with the immunological response, and the high WRM score group exhibited elevated immunological cell infiltration. WRMs are involved in the differentiation of T cells and myeloid cells. WRM scores of T cell and myeloid cell subtypes were significantly reduced in the HF group compared to the NHF group. We identified a myogenesis-related resident macrophage population in the heart, Macro-MYL2, that was characterized by an increased expression of cardiomyocyte structural genes (MYL2, TNNI3, TNNC1, TCAP, and TNNT2) and was regulated by TRMT10C. Based on the WRM expression pattern, the transcriptomics data (GSE141910) identified two distinct clusters of HF samples, each with distinct functional enrichments and immunological characteristics. Conclusion Our study demonstrated a significant relationship between the WRMs and immunological microenvironment in HF, as well as a novel resident macrophage population, Macro-MYL2, characterized by myogenesis. These results provide a novel perspective on the underlying mechanisms and therapeutic targets for HF. Further experiments are required to validate the regulation of WRMs and Macro-MYL2 macrophage subtype in the cardiac immunological milieu.

Abstract Objective In this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia. Methods We enrolled 90 children (aged 1–8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications. Results There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P

Abstract Objectives Metabolic dysfunction-associated fatty liver disease (MAFLD), a globally prevalent disease, is closely linked to insulin resistance (IR). Physical activity (PA) is closely linked to both MAFLD and IR. We aim to explore the dose–response relationship between metabolic score for IR (METS-IR)/homeostasis model assessment of IR (HOMA-IR) and MAFLD, and investigate the relationship between PA, IR and MAFLD. Methods Participants from the NHANES study were included in this cross-section study. Logistic regression and the receiver operating characteristic were used to assess the predictive performance of METS-IR/HOMA-IR for MAFLD. Restrictive cubic splines were performed to visualize their dose–response relationship. Decision tree analysis was used to identify high-risk populations of MAFLD. PA’s mediating effect in the association between METS-IR/HOMA-IR and MAFLD was also examined. Results Of all 1,313 participants, 693 had MAFLD (52.78%). There were a positive association between METS-IR (OR = 1.162, 95% CI = 1.126–1.199) and HOMA-IR (OR = 1.630, 95% CI = 1.431–1.856) and MAFLD risk. The AUCs of the METS-IR and HOMA-IR were 0.831 (0.809, 0.853) and 0.767 (0.741, 0.791), respectively, with significantly different predictive performance (P

Background The reaserch of artificial intelligence (AI) model for predicting spinal refracture is limited to bone mineral density, X‐ray and some conventional laboratory indicators, which has its own limitations. Besides, it lacks specific indicators related to osteoporosis and imaging factors that can better reflect bone quality, such as computed tomography (CT). Objective To construct a novel predicting model based on bone turn‐over markers and CT to identify patients who were more inclined to suffer spine refracture. Methods CT images and clinical information of 383 patients (training set = 240 cases of osteoporotic vertebral compression fractures (OVCF), validation set = 63, test set = 80) were retrospectively collected from January 2015 to October 2022 at three medical centers. The U‐net model was adopted to automatically segment ROI. Three‐dimensional (3D) cropping of all spine regions was used to achieve the final ROI regions including 3D_Full and 3D_RoiOnly. We used the Densenet 121‐3D model to model the cropped region and simultaneously build a T‐NIPT prediction model. Diagnostics of deep learning models were assessed by constructing ROC curves. We generated calibration curves to assess the calibration performance. Additionally, decision curve analysis (DCA) was used to assess the clinical utility of the predictive models. Results The performance of the test model is comparable to its performance on the training set (dice coefficients of 0.798, an mIOU of 0.755, an SA of 0.767, and an OS of 0.017). Univariable and multivariable analysis indicate that T_P1NT was an independent risk factor for refracture. The performance of predicting refractures in different ROI regions showed that 3D_Full model exhibits the highest calibration performance, with a Hosmer–Lemeshow goodness‐of‐fit (HL) test statistic exceeding 0.05. The analysis of the training and test sets showed that the 3D_Full model, which integrates clinical and deep learning results, demonstrated superior performance with significant improvement (p‐value

Abstract Female urethral caruncle is the most common urethral mass in postmenopausal women, yet there is a lack of studies on its imaging. The aim of this study was to provide a summary of the clinical and ultrasound features as well as the precise location of female urethral caruncle. This study reviewed the clinical and ultrasonographic records of 20 consecutive women with pathologically confirmed urethral caruncle. Data on patient demographics, symptoms, and transperineal and transrectal ultrasound imaging features, including location, shape, margin, size, blood flow, and inner echo of the caruncle, were extracted. Each patient presented with only one mass at the urethral meatus. Most caruncles were located on the posterior lip (75%) of the urethra, presenting as oval (80%), mixed-echoic (50%), or hypo-echoic (40%) nodules with abundant linear (40%) or dendritic (60%) blood flow. The average distance between the bladder neck and the cranial end of the masses was 28 mm. Hyper-echogenic spots, cystic echo areas, and macrocalcifications were detected in thirteen caruncles (70%). This study shows that transperineal combined with transrectal ultrasound can be used to assess female urethral caruncle, and its relative location to the urethra can be accurately described, which is helpful for surgeons making preoperative localization and conversations.

Abstract Purpose Using data from the National Health and Nutrition Examination Survey (NHANES) and employing Controlled Attenuation Parameter (CAP) measures, this study explores the correlation between vitamin E (VE) intake and hepatic steatosis and its impact on different subsets. Materials and methods We selected 5757 participants with CAP data from the 2017–2020 NHANES dataset. Daily VE intake was assessed by a 24-hour dietary recall. Hepatic fat content was quantified using transient elastography to measure CAP. Stratified multivariable regression analysis investigated relationships in different subsets, and a generalized additive model identified nonlinear relationships and thresholds. Results After adjusting for confounders, higher VE intake correlated with lower CAP levels. Subgroup analyses and tests for interaction revealed a significantly stronger negative correlation between VE intake and CAP in obese individuals. Further analysis indicated a curvilinear relationship between VE intake and the severity of liver fat degeneration in both the general study population and the obese subgroup, demonstrating a threshold effect. In the general population, VE intake below the threshold (6.58 mg/day) is positively correlated with CAP levels, whereas intake above this threshold shows a negative correlation. For obese individuals, the threshold is set at 7.37 mg/day, above which the negative correlation with CAP is even more pronounced. Conclusion Our study revealed a negative correlation between VE intake and hepatic fat content, highlighting the potentially crucial role VE plays in obese fatty liver patients. Importantly, we identified threshold effects of VE intake in both general and obese populations. Our results support clinical nutritional interventions, personalized dietary guidance, and the development of drugs to combat fatty liver.

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a growing health crisis in the general population of the United States (U.S.), but the relationship between systemic immune-inflammation (SII) index and NAFLD is not known. Methods We collected data from the National Health and Nutrition Examination Survey 2017–2018. Next, propensity score matching (PSM), collinearity analysis, restricted cubic spline (RCS) plot, logistic regression, quantile regression analysis, subgroup analysis, mediation analysis, and population attributable fraction were used to explore the association of the SII with risk of NAFLD. Results A total of 665 participants including the 532 Non-NAFLD and 133 NAFLD were enrolled for further analysis after PSM analysis. The RCS results indicated that there was a linear relationship between the SII and controlled attenuation parameter (p for nonlinear = 0.468), the relationship also existed after adjustment for covariates (p for nonlinear = 0.769). The logistic regression results indicated that a high SII level was an independent risk factor for NAFLD (OR = 3.505, 95% CI: 1.092–11.249, P

Abstract We conducted a retrospective study to investigate risk factors for tuberculosis care-seeking delay and diagnostic delays among pediatric pulmonary tuberculosis cases in Zhejiang Province from 2013 to 2022. Among 1274 cases, 49.61% experienced tuberculosis care-seeking delays (> 14 days from symptom onset to first hospital visit) and 14.91% faced diagnostic delays (> 14 days from initial consultation to diagnosis). The proportion of care-seeking delays ranged from 37.42 to 64.89%, while diagnostic delay fluctuated from 6.11 to 21.02%. Urban residence (OR = 0.78, 95% CI 0.62–0.98, P = 0.030), first visiting a municipal-level hospital (OR = 0.57, 95% CI 0.45–0.72, P

Abstract We consider the light emitters moving freely along the geodesics on the equatorial plane near a Kerr black hole and study the observability of these emitters. To do so, we assume these emitters emit photons isotropically and monochromatically, and we compute the photon escaping probability (PEP) and the maximum observable blueshift (MOB) of the photons that reach infinity. We obtain numerical results of PEP and MOB for the emitters along various geodesic orbits, which exhibit distinct features for the trajectories of different classes. In particular, we find that the plunging emitters could have considerable observability even in the near-horizon region. This interesting observational feature becomes more significant for the high-energy emitters near a high-spin black hole. As the radiatively-inefficient accretion flow may consist of plunging emitters, the present work could be of great relevance to the astrophysical observations.

Abstract Objective The objective of this study was to investigate the initial stability of different screw placements in arthroscopic anterior cruciate ligament (ACL) tibial avulsion fracture fixation. Methods A three-dimensional knee model at 90° flexion was utilized to simulate type III ACL tibial avulsion fracture and arthroscopic screw fixation through different portals, namely the central transpatellar tendon portal (CTP), anterolateral portal (ALP), anteromedial portal (AMP), lateral parapatellar portal (LPP), medial parapatellar portal (MPP), lateral suprapatellar portal (LSP), medial suprapatellar portal (MSP). A shear force of 450 N was applied to the finite element models at 30° flexion to simulate the failure condition. The displacement of the bony fragment and the volume of the bone above 25,000 µ-strain (damaged bone volume) were calculated around the screw path. Results When the screw was implanted through CTP, the displacement of the bony fragment reached the maximum displacement which was 1.10 mm and the maximum damaged bone volume around the screw path was 148.70 mm3. On the other hand, the minimum displacement of the bony fragment was 0.45 mm when the screw was implanted through LSP and MSP. The minimum damaged bone volume was 14.54 mm3 around the screw path when the screw was implanted through MSP. Conclusion Screws implanted through a higher medial portal generated less displacement of the bony fragment and a minimum detrimental strain around the screw path. The findings are clinically relevant as they provide biomechanical evidence on optimizing screw placement in arthroscopic ACL tibial avulsion fracture fixation.

Abstract Purpose Our study aimed to develop and validate a homologous recombination deficiency (HRD) scoring algorithm in the Chinese breast cancer population. Methods and materials Ninety-six in-house breast cancer (BC) samples and 6 HRD-positive standard cells were analyzed by whole-genome sequencing (WGS). Besides, 122 BCs from the TCGA database were down-sampled to ~ 1X WGS. We constructed an algorithm named AcornHRD for HRD score calculated based on WGS at low coverage as input data to estimate large-scale copy number alteration (LCNA) events on the genome. A clinical cohort of 50 BCs (15 cases carrying BRCA mutation) was used to assess the association between HRD status and anthracyclines-based neoadjuvant treatment outcomes. Results A 100-kb window was defined as the optimal size using 41 in-house cases and the TCGA dataset. HRD score high threshold was determined as HRD score ≥ 10 using 55 in-house BCs with BRCA mutation to achieve a 95% BRCA-positive agreement rate. Furthermore, the HRD status agreement rate of AcornHRD is 100%, while the ShallowHRD is 60% in standard cells. BRCA mutation was significantly associated with a high HRD score evaluated by AcornHRD and ShallowHRD (p = 0.008 and p = 0.003, respectively) in the TCGA dataset. However, AcornHRD showed a higher positive agreement rate than did the ShallowHRD algorithm (70% vs 60%). In addition, the BRCA-positive agreement rate of AcornHRD was superior to that of ShallowHRD (87% vs 13%) in the clinical cohort. Importantly, the high HRD score assessed by AcornHRD was significantly correlated with a residual cancer burden score of 0 or 1 (RCB0/1). Besides, the HRD-positive group was more likely to respond to anthracycline-based chemotherapy than the HRD-negative group (pCR [OR = 9.5, 95% CI 1.11–81.5, p = 0.040] and RCB0/1 [OR = 10.29, 95% CI 2.02–52.36, p = 0.005]). Conclusion Using the AcornHRD algorithm evaluation, our analysis demonstrated the high performance of the LCNA genomic signature for HRD detection in breast cancers.

Abstract Background Keloid is a disease characterized by proliferation of fibrous tissue after the healing of skin tissue, which seriously affects the daily life of patients. However, the clinical treatment of keloids still has limitations, that is, it is not effective in controlling keloids, resulting in a high recurrence rate. Thus, it is urgent to identify new signatures to improve the diagnosis and treatment of keloids. Method Bulk RNA seq and scRNA seq data were downloaded from the GEO database. First, we used WGCNA and MEGENA to co-identify keloid/immune-related DEGs. Subsequently, we used three machine learning algorithms (Randomforest, SVM-RFE, and LASSO) to identify hub immune-related genes of keloid (KHIGs) and investigated the heterogeneous expression of KHIGs during fibroblast subpopulation differentiation using scRNA-seq. Finally, we used HE and Masson staining, quantitative reverse transcription-PCR, western blotting, immunohistochemical, and Immunofluorescent assay to investigate the dysregulated expression and the mechanism of retinoic acid in keloids. Results In the present study, we identified PTGFR, RBP5, and LIF as KHIGs and validated their diagnostic performance. Subsequently, we constructed a novel artificial neural network molecular diagnostic model based on the transcriptome pattern of KHIGs, which is expected to break through the current dilemma faced by molecular diagnosis of keloids in the clinic. Meanwhile, the constructed IG score can also effectively predict keloid risk, which provides a new strategy for keloid prevention. Additionally, we observed that KHIGs were also heterogeneously expressed in the constructed differentiation trajectories of fibroblast subtypes, which may affect the differentiation of fibroblast subtypes and thus lead to dysregulation of the immune microenvironment in keloids. Finally, we found that retinoic acid may treat or alleviate keloids by inhibiting RBP5 to differentiate pro-inflammatory fibroblasts (PIF) to mesenchymal fibroblasts (MF), which further reduces collagen secretion. Conclusion In summary, the present study provides novel immune signatures (PTGFR, RBP5, and LIF) for keloid diagnosis and treatment, and identifies retinoic acid as potential anti-keloid drugs. More importantly, we provide a new perspective for understanding the interactions between different fibroblast subtypes in keloids and the remodeling of their immune microenvironment.

Four new species of Russula subsect. Cyanoxanthinae, viz. Russula atrochermesina Y.L. Chen & J.F. Liang, R. lavandula Y.L. Chen, B. Chen & J.F. Liang, R. lilaceofusca Y.L. Chen & J.F. Liang and R. perviridis Y.L. Chen, B. Chen & J.F. Liang, from China are proposed, based on morphological and molecular evidence. Russula atrochermesina can be distinguished by its violet pileus with tuberculate-striate margin, distant lamellae that stain greyish-yellow when bruised, basidiospores ornamented by isolated warts, wide hymenial cystidia on lamellae edges, cystidia content negative reaction in sulphovanillin and branched subterminal cells in pileipellis. Russula lavandula has a purplish-white to violet red pileus with a yellow centre, frequently present lamellulae and furcations, stipe often with pale yellow near the base, isolated basidiospores ornamentation and unbranched cuticular hyphal terminations, while R. lilaceofusca is characterised by its lilac brown to dark brown pileus, crowded lamellae with lamellulae and furcations, stipe often turning reddish-yellow when bruised, subreticulate basidiospores ornamentation and clavate hymenial cystidia often with capitate appendage whose contents that change to reddish-black in sulphovanillin. Russula perviridis is characterised by its large basidiomata, smooth pileus surface, frequently present lamellulae and furcations, stipe with yellow-brown tinge, globose to broadly ellipsoid basidiospores with subreticulate ornamentation, long hymenial cystidia that turn greyish-black in sulphovanillin and symbiotic with Quercus semecarpifolia. Phylogenetic analyses, based on multi-gene ITS+LSU+mtSSU+rpb2, indicate that R. atrochermesina, R. lavandula, R. lilaceofusca and R. perviridis are closely related to R. pallidirosea and R. purpureorosea, R. banwatchanensis, R. lakhanpalii and R. nigrovirens, respectively.

Abstract Background The level of tumor abnormal protein (TAP) level has a significant impact on tumor growth, recurrence, and metastasis. Previous studies have highlighted the influence of the mutations in exons 19 and 21 of the epidermal growth factor receptor (EGFR), particularly the sensitivity displayed by tumor cells to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy. Our study is centered on exploring the clinical relevance of TAP and EGFR mutations in patients with non-small cell lung cancer (NSCLC). Material and methods In this study, tissue samples were collected from a total of 176 patients diagnosed with non-small cell lung cancer (NSCLC). Real-time PCR technology was utilized to detect mutations within exons 19 and 21 of the epidermal growth factor receptor (EGFR) gene in these samples. This approach enables precise identification of EGFR mutations associated with NSCLC. Furthermore, the study investigated the impact of various tumor markers, including tumor abnormal protein (TAP) and carcinoembryonic antigen (CEA), on EGFR mutation status. Established assays were employed to evaluate TAP and CEA levels, aiming to ascertain their potential correlation with EGFR mutation in NSCLC patients. Results EGFR exhibited mutation rates of 23.86% and 12.50% in exons 19 and 21, respectively. EGFR mutations were more prevalent in younger women ( 6.5 ng/mL, and TAP > 228 µm2 for both genders. Increased TAP levels independently predicted EGFR mutations (P = 0.001 for males; P = 0.000 for females). An area under the curve (AUC) of 0.833 indecated EGFR mutation prediction with sensitivity and specificity of 79.7% and 87.0%, respectively. For females, the sensitivity increased to 89.7% and specificity increased to 93.8%. Conclusions TAP effectively predicts EGFR mutations in NSCLC patients with moderate accuracy, particularly benefiting diagnosis in females with high sensitivity and specificity. Integrating TAP assessment into EGFR mutation testing can significantly enhance diagnostic precision, especially in female NSCLC cases.

Abstract Exploring chemical doping method to improve the electrical conductivity of polymers is still very attractive for researchers. In this work, we report a developed method of doping a polymer semiconductor aided by the coupled reaction that commonly exists in biological systems where a non-spontaneous reaction is driven by a spontaneous reaction. During the doping process, the chemical reaction between the dopant and the polymer is promoted by introducing a thermodynamically favorable reaction via adding additives that are highly reactive to the reduction product of the dopant to form a coupled reaction, thus significantly improving the electrical conductivity of polymers by 3–7 orders. This coupled reaction doping process shows the potential of wide applications in exploring efficient doping systems to prepare functional conducting polymers, which could be a powerful tool for modern organic electronics.

Abstract For patients presenting with prostate imaging reporting and data system (PI-RADS) 3/4 findings on magnetic resonance imaging (MRI) examinations, the standard recommendation typically involves undergoing a biopsy for pathological assessment to ascertain the nature of the lesion. This course of action, though essential for accurate diagnosis, invariably amplifies the psychological distress experienced by patients and introduces a host of potential complications associated with the biopsy procedure. However, [18F]DCFPyL PET/CT imaging emerges as a promising alternative, demonstrating considerable diagnostic efficacy in discerning benign prostate lesions from malignant ones. This study aims to explore the diagnostic value of [18F]DCFPyL PET/CT imaging for prostate cancer in patients with PI-RADS 3/4 lesions, assisting in clinical decision-making to avoid unnecessary biopsies. 30 patients diagnosed with PI-RADS 3/4 lesions through mpMRI underwent [18F]DCFPyL PET/CT imaging, with final biopsy pathology results as the “reference standard”. Diagnostic performance was assessed through receiver operating characteristic (ROC) analysis, evaluating the diagnostic efficacy of molecular imaging PSMA (miPSMA) visual analysis and semi-quantitative analysis in [18F]DCFPyL PET/CT imaging. Lesions were assigned miPSMA scores according to the prostate cancer molecular imaging standardized evaluation criteria. Among the 30 patients, 13 were pathologically confirmed to have prostate cancer. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual analysis in [18F]DCFPyL PET/CT imaging for diagnosing PI-RADS 3/4 lesions were 61.5%, 88.2%, 80.0%, 75.0%, and 76.5%, respectively. Using SUVmax 4.17 as the optimal threshold, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis were 92.3%, 88.2%, 85.7%, 93.8%, and 90.0%, respectively. The area under the ROC curve (AUC) for semi-quantitative analysis was 0.94, significantly higher than visual analysis at 0.80. [18F]DCFPyL PET/CT imaging accurately diagnosed benign lesions in 15 (50%) of the PI-RADS 3/4 patients. For patients with PI-RADS 4 lesions, the positive predictive value of [18F]DCFPyL PET/CT imaging reached 100%. [18F]DCFPyL PET/CT imaging provides potential preoperative prediction of lesion nature in mpMRI PI-RADS 3/4 patients, which may aid in treatment decision-making and reducing unnecessary biopsies.

Abstract One-dimensional carbon nanotubes are promising candidates for thermoelectrics because of their excellent electrical and mechanical properties. However, the large n-type power factor remains elusive in macroscopic carbon nanotubes films. Herein, we report an outstanding n-type power factor of 6.75 mW m−1 K−2 for macroscopic carbon nanotubes films with high electrical and thermal conductivity. A high-power density curl-able thermoelectric generator is fabricated with the obtained carbon nanotubes films, which exhibits a high normalized power output density of 2.75 W m−1 at a temperature difference of 85 K. The value is higher than that of previously reported flexible all-inorganic thermoelectric generators (

Abstract Background Non‐small‐cell lung cancer (NSCLC) is a common malignancy with high morbidity and mortality. Circular RNAs are widely involved in NSCLC progression. However, the mechanism of circSLC25A16 in NSCLC has not been reported. Methods The expressions of circSLC25A16, microRNA‐335‐5p (miR‐335‐5p), and CDGSH iron–sulfur domain‐containing protein 2 (CISD2) were monitored by quantitative real‐time fluorescence polymerase chain reaction. Western blot was also carried out to measure the protein levels of CISD2, hexokinase 2 (HK2), and lactate dehydrogenase A (LDHA). For functional analysis, cell counting kit‐8 assay, 5‐ethynyl‐2′‐deoxyuridine, flow cytometry, transwell, and wound healing assays were utilized to examine cell proliferation, apoptosis, and migration. Glucose uptake and lactate production were detected using commercial kits. The relationship between miR‐335‐5p and circSLC25A16 or CISD2 was verified by dual‐luciferase reporter and RNA immunoprecipitation assays. Furthermore, tumor xenograft was established to explore the function of circSLC25A16 in vivo. Results CircSLC25A16 and CISD2 were overexpressed in NSCLC, but miR‐335‐5p was downregulated. CircSLC25A16 acted as a miR‐335‐5p sponge, and silencing of circSLC25A16 arrested cell proliferation, migration, and glycolysis, and promoted apoptosis, but these impacts were resumed by miR‐335‐5p inhibition. CISD2 was a miR‐335‐5p target, and overexpression of CISD2 abolished the suppressive function of miR‐335‐5p mimic on the malignant behavior of NSCLC cells. CircSLC25A16 could adsorb miR‐335‐5p to mediate CISD2 expression. Additionally, silencing circSLC25A16 restrained the growth of NSCLC tumor xenograft in vivo. Conclusion CircSLC25A16 facilitated NSCLC progression via the miR‐335‐5p/CISD2 axis, implying that circSLC25A16 may serve as a novel biomarker for NSCLC treatment.