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Abstract Privacy and security concerns restrict access to original training datasets, posing significant challenges for model compression. Data-Free Knowledge Distillation (DFKD) emerges as a solution, aiming to transfer knowledge from teacher to student networks without accessing original data. Existing DFKD methods struggle to generate high-quality synthetic samples that capture the complexities of real-world data, leading to suboptimal knowledge transfer. Moreover, these approaches often fail to preserve the spatial attributes of the teacher network, resulting in shortcut learning and limited generalization.To address these issues, a novel DFKD strategy is proposed with three innovations: (1) an enhanced DCGAN generator with an attention module for synthesizing samples with improved micro-discriminative features; (2) a Multi-Scale Spatial Activation Region Consistency (MSARC) mechanism to accurately replicate the teacher’s spatial attributes; and (3) an adversarial learning framework that creates a dynamic competitive environment between the generative and distillation phases. Rigorous evaluation of the method on several benchmark datasets, including CIFAR-10, CIFAR-100, Tiny-ImageNet, and medical imaging datasets such as PathMNIST, BloodMNIST, and PneumoniaMNIST, demonstrates superior performance compared to existing DFKD methods. Specifically, on CIFAR-100, the student network attains an accuracy of 77.85%, surpassing previous methods like CMI and SpaceshipNet. On BloodMNIST, the method achieves an accuracy of 80.50%, outperforming the next best method by over 5%.

Abstract Background In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging. Case presentation With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022. Conclusions Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.

In order to identify biomarkers of lipid deterioration in grass carp (Ctenopharyngodon idella) muscle during cold storage, the lipid profile change of the grass carp muscle stored at 4 ℃ for different periods (3, 6, and 9 d) was investigated by UPLC-Q Exactive HF-X. Multivariate statistical analysis and one-way ANOVA were used to screen the differential lipids during the cold storage, and then to enrich the metabolic pathways involved in the differential lipids through the KEGG database. The results showed that the pH in grass carp muscle decreased gradually, while the thiobarbituric acid reactive substance, total free fatty acid content, and volatile base total nitrogen increased gradually, reaching 0.82 µg/kg, 168.22 µg/10 g and 23.63 mg/100 g, respectively, on the 9 d of cold storage. A total of 1265 lipid molecules belonging to 5 categories and 35 subclasses were identified in the chilled grass carp muscle. Glycerol phospholipids (GP) and glycerol esters (GL) were the main components of lipids in grass carp muscle. There was no significant difference in lipid profile between grass carp muscle refrigerated for 3~6 days (P>0.05), but there were significant changes in lipid composition when refrigerated for 9 days. Fatty acyl (FA) and sphingolipids (SP) were the major different lipids in the early stage of refrigeration (3~6 days), and GP was the main lipids with significant changes in the late stage of refrigeration (6~9 days). A total of 20 different lipid molecules were screened from multivariate statistical difference analysis, and they were mainly glycerol ester and glycerol phospholipid, among which PE (16:1e/22:6) showed significant differences (P

Objectives Recent studies have indicated that radiomics may have excellent performance and clinical application prospects in the differential diagnosis of benign and malignant vertebral compression fractures (VCFs). However, multimodal magnetic resonance imaging (MRI)‐based radiomics model is rarely used in the differential diagnosis of benign and malignant VCFs, and is limited to lumbar. Herein, this study intends to develop and validate MRI radiomics models for differential diagnoses of benign and malignant VCFs in patients. Methods This cross‐sectional study involved 151 adult patients diagnosed with VCF in The First Affiliated Hospital of Soochow University in 2016–2021. The study was conducted in three steps: (i) the original MRI images were segmented, and the region of interest (ROI) was marked out; (ii) among the extracted features, those features with Pearson's correlation coefficient lower than 0.9 and the top 15 with the highest variance and Lasso regression coefficient less than and more than 0 were selected; (iii) MRI images and combined data were studied by logistic regression, decision tree, random forest and extreme gradient boosting (XGBoost) models in training set and the test set (ratio of 8:2), respectively; and the models were further verified and evaluated for the differential diagnosis performance. The evaluated indexes included area under receiver (AUC) of operating characteristic curve, accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and 95% confidence intervals (CIs). The AUCs were used to assess the predictive performance of different machine learning modes for benign and malignant VCFs. Results A total of 1144 radiomics features, and 14 clinical features were extracted. Finally, 12 radiomics features were included in the radiomics model, and 12 radiomics features with 14 clinical features were included in the combined model. In the radiomics model, the differential diagnosis performance in the logistic regression model with the AUC of 0.905 ± 0.026, accuracy of 0.817 ± 0.057, sensitivity of 0.831 ± 0.065, and negative predictive value of 0.813 ± 0.042, was superior to the other three. In the combined model, XGBoost model had the superior differential diagnosis performance with specificity (0.979 ± 0.026) and positive predictive value (0.971 ± 0.035). Conclusion The multimodal MRI‐based radiomics model performed well in the differential diagnosis of benign and malignant VCFs, which may provide a tool for clinicians to differentially diagnose VCFs.

Abstract Acute ischemic stroke (AIS) is a major global health concern due to its high mortality and disability rates. Hemorrhagic transformation, a common complication of AIS, leads to poor prognosis yet lacks effective treatments. Preclinical studies indicate that hyperbaric oxygen (HBO) treatment within 12 h of AIS onset alleviates ischemia/reperfusion injuries, including hemorrhagic transformation. However, clinical trials have yielded conflicting results, suggesting some underlying mechanisms remain unclear. In this study, we confirmed that HBO treatments beginning within 1 h post reperfusion significantly alleviated the haemorrhage and neurological deficits in hyperglycemic transient middle cerebral arterial occlusion (tMCAO) mice, partly due to the inhibition of the NLRP3 inflammasome-mediated pro-inflammatory response in microglia. Notably, reactive oxygen species (ROS) mediate the anti-inflammatory and protective effect of early HBO treatment, as edaravone and N-Acetyl-l-Cysteine (NAC), two commonly used antioxidants, reversed the suppressive effect of HBO treatment on NLRP3 inflammasome-mediated inflammation in microglia. Furthermore, NAC countered the protective effect of early HBO treatment in tMCAO mice with hyperglycemia. These findings support that early HBO treatment is a promising intervention for AIS, however, caution is warranted when combining antioxidants with HBO treatment. Further assessments are needed to clarify the role of antioxidants in HBO therapy for AIS.

To explore the different extraction methods and traditional refining process of squid visceral fish oil and its quality changes, the deep-sea squid viscera from the Equator, Argentina, and the North Pacific were used as raw materials in this study. Firstly, different organic reagent extraction methods and compound methods were used to extract fish oil from Argentine squid viscera. The method with the highest oil yield and best quality was selected for refining three types of crude squid visceral oil. The sensory morphology, physicochemical indicators, fatty acid composition and volatile flavor compounds of three types of crude and refined squid visceral oils were analyzed. The results showed that the oil extraction method of the No.6 solvent assisted freeze-thaw was the best, with a yield of 12.90%, and the physical and chemical indexes of squid visceral oil after refining were significantly improved. The peroxide value, insoluble impurities, color difference value, acid value, moisture and volatiles, and anisidine values were significantly reduced (P

Objective With increasing difficulty in phosphate ore prospecting, there are an increasing number of geological exploration reports. The manual recognition of geological information related to phosphate rock mineralization in massive documents is time-consuming and inefficient. It cannot meet the needs of knowledge sharing, dissemination and intelligent management of geological reports. Methods To quickly obtain the ore-forming geological knowledge hidden in the phosphate ore reports, this work intends to establish an automatic recognition method for ore-forming geological entities based on the extreme learning machine network(XLNET) model. First, BIO labelling of entities was carried out to establish a geological entity dictionary, and XLNET was used as the underlying preprocessing model to learn the bidirectional semantics of sentences. Then, the BILSTM-Attention-CRF(bidirectional long short term memory(BILSTM)-self attention layer(Attention)-conditional random field(CRF)) model was used to realize intelligent classification of multiple text labels. Finally, the ore-forming conditions and ore-forming model of phosphate ore in the reports were roughly predicted by locating the distribution position of phosphate ore entities in the report. Results Comparing this model with the other three models, these results show that the accuracy rate, recall rate and F1 value of this model are close to 90%, which are 2%, 5% and 6% higher than those of the previous three models, respectively. Conclusion This study provides a more efficient method for automatic geological entity recognition for geological researchers in the Kaiyang phosphate mine.

Ischemic stroke is a major global public health concern that lacks effective treatment options. A significant challenge lies in delivering therapeutic agents to the brain due to the restrictive nature of the blood-brain barrier (BBB). The BBB's selectivity hampers the delivery of therapeutically relevant quantities of agents to the brain, resulting in a lack of FDA-approved pharmacotherapies for stroke. In this article, we review therapeutic agents that have been evaluated in clinical trials or are currently undergoing clinical trials. Subsequently, we survey strategies for synthesizing and engineering nanoparticles (NPs) for drug delivery to the ischemic brain. We then provide insights into the potential clinical translation of nanomedicine, offering a perspective on its transformative role in advancing stroke treatment strategies. In summary, existing literature suggests that drug delivery represents a major barrier for clinical translation of stroke pharmacotherapies. While nanotechnology has shown significant promise in addressing this challenge, further advancements aimed at improving delivery efficiency and simplifying formulations are necessary for successful clinical translation.

Abstract Halophyte shrubs, prevalent in arid regions globally, create saline fertile islands under their canopy. This study investigates the soil microbial communities and their energy utilization strategies associated with tamarisk shrubs in arid ecosystems. Shotgun sequencing revealed that high salinity in tamarisk islands reduces functional gene alpha-diversity and relative abundance compared to bare soils. However, organic matter accumulation within islands fosters key halophilic archaea taxa such as Halalkalicoccus, Halogeometricum, and Natronorubrum, linked to processes like organic carbon oxidation, nitrous oxide reduction, and sulfur oxidation, potentially strengthening the coupling of nutrient cycles. In contrast, bare soils harbor salt-tolerant microbes with genes for autotrophic energy acquisition, including carbon fixation, H2 or CH4 consumption, and anammox. Additionally, isotope analysis shows higher microbial carbon use efficiency, N mineralization, and denitrification activity in tamarisk islands. Our findings demonstrate that halophyte shrubs serve as hotspots for halophilic microbes, enhancing microbial nutrient transformation in saline soils.

Abstract The epigenetic regulation of N6-methyladenosine (m6A) has attracted considerable interest in tumor research, but the potential roles of m6A regulator-related genes, remain largely unknown within the context of gastric cancer (GC) and tumor microenvironment (TME). Here, a comprehensive strategy of data mining and computational biology utilizing multiple datasets based on 28 m6A regulators (including novel anti-readers) was employed to identify m6A regulator-related genes and patterns and elucidate their underlying mechanisms in GC. Subsequently, a scoring system was constructed to evaluate individual prognosis and immunotherapy response. Three distinct m6A regulator-related patterns were identified through the unsupervised clustering of 56 m6A regulator-related genes (all significantly associated with GC prognosis). TME characterization revealed that these patterns highly corresponded to immune-inflamed, immune-excluded, and immune-desert phenotypes, and their TME characteristics were highly consistent with different clinical outcomes and biological processes. Additionally, an m6A-related scoring system was developed to quantify the m6A modification pattern of individual samples. Low scores indicated high survival rates and high levels of immune activation, whereas high scores indicated stromal activation and tumor malignancy. Furthermore, the m6A-related scores were correlated with tumor mutation loads and various clinical traits, including molecular or histological subtypes and clinical stage or grade, and the score had predictive values across all digestive system tumors and even in all tumor types. Notably, a low score was linked to improved responses to anti-PD-1/L1 and anti-CTLA4 immunotherapy in three independent cohorts. This study has expanded the important role of m6A regulator-related genes in shaping TME diversity and clinical/biological traits of GC. The developed scoring system could help develop more effective immunotherapy strategies and personalized treatment guidance.

Abstract Background About 13–25% of cerebral venous thrombosis (CVT) cases lack clear etiology, which may be associated with underlying genetic factors. This study aims to investigate genetic factors in CVT patients using whole exome sequencing (WES). Methods Thirty-eight CVT patients hospitalized underwent WES. 977 subjects with WES data from a community cohort study --the Shunyi cohort were as the control group. Using bioinformatics analysis, differential genes with rare damaging variants between two groups were filtered (P A, CBS c.949 A > G; F2 c.1787G > A; SERPINC1 c.409-11G > T. Comparing the WES data of two groups, a total of 179 different genes with rare damaging variants were screened (P

At present, suture bridge is a feasible choice in the treatment of massive rotator cuff tears (MRCTs). However, high tension on the repair site and medial tension during suture tightening and after medial knotting are unavoidable problems in MRCT repair with a suture bridge. Arthroscopic V-shaped double-pulley suture-bridge repair is a pragmatic surgical technique for the repair of MRCTs. The unique parallel design of medial- and lateral-row anchors can minimize tendon tension on the apex portion; 6 sets of double-pulley suture bridges can not only provide sufficient tendon-bone contact area but also reduce the tendon retear rate. Moreover, medial knotless techniques can reduce tendon tension.

Abstract Prussian blue (PB) is regarded as a promising cathode for sodium‐ion batteries because of its sustainable precursor elements (e.g., Mn, Fe), easy preparation, and unique framework structure. However, the unstable structure and inherent crystal H2O restrain its practical application. For this purpose, a self‐constructed trace Mg2+/K+ co‐doped PB prepared via a sea‐water‐mediated method is proposed to address this problem. The Mg2+/K+ co‐doping in the Na sites of PB is permitted by both thermodynamics and kinetics factors when synthesized in sea water. The results reveal that the introduced Mg2+ and K+ are immovable in the PB lattices and can form stronger K‒N and Mg‒N Coulombic attraction to relieve phase transition and element dissolution. Besides, the Mg2+/K+ co‐doping can reduce defect and H2O contents. As a result, the PB prepared in sea water exhibits an extremely long cycle life (80.1% retention after 2400 cycles) and superior rate capability (90.4% capacity retention at 20 C relative to that at 0.1 C). To address its practical applications, a sodium salts recycling strategy is proposed to greatly reduce the PB production cost. This work provides a self‐constructed Mg2+/K+ co‐doped high‐performance PB at a low preparation cost for sustainable, large‐scale energy storage.

Transtendon repair is increasingly applied in the treatment of PASTA (partial articular supraspinatus tendon avulsion) lesions, but a “tendon hole” from anchor insertion, which will break the intact bursal layer and potentially result in tear completion, is an unavoidable problem. The “mini-incision” transtendon double-pulley suture bridge presented in the study is a pragmatic technique in treatment of PASTA lesion. The 4 suture strands on the medial-row anchor provide enough biomechanical strength on the reattached articular layer, the “mini-incision” minimizes iatrogenic trauma on the bursal layer, and double-pulley suture-bridge smoothly covers the “mini-incision” so as to achieve anatomical reduction of articular and bursa side of supraspinatus tendon. The surgical technique is described, as well as pearls, pitfalls, advantages, and disadvantages.

BackgroundWhile Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in managing diabetes and reducing cardiovascular risk, concerns about their association with lower limb complications, including, osteomyelitis, ulcers, and peripheral artery disease (PAD), persist. This study employs Mendelian Randomization (MR) to assess the causal relationship between SGLT2 inhibitors and these lower limb safety outcomes.MethodsA two-sample drug-target MR approach was used, complemented by a one-sample MR and genetic association analysis. Six SNPs were selected as instrumental variables to proxy the effect of SGLT2 inhibition. Primary outcomes were major limb safety outcomes, including osteomyelitis, lower limb ulcers, PAD, and cellulitis. The primary analytical method was the generalized inverse variance-weighted (IVW) approach, along with several sensitivity analyses.ResultsThe MR analysis indicated no significant causal association between genetically proxied SGLT2 inhibition and most of the studied lower limb safety outcomes. However, a significant association with PAD was observed, necessitating careful interpretation due to discrepancies between IVW and MR-Egger results. Sensitivity analyses supported these findings, showing little evidence of heterogeneity or directional pleiotropy.ConclusionThis study suggests that SGLT2 inhibitors may not be significantly associated with an increased risk of most lower limb safety outcomes, including osteomyelitis, lower limb ulcers, and cellulitis, in patients with type 2 diabetes. However, the complex relationship with PAD highlights the need for further research. These findings contribute to the understanding of the safety profile of SGLT2 inhibitors, supporting their continued use in diabetes management while underlining the importance of continuous safety monitoring.

Significal challenges exist to bacterial infection wound healing. The bacterial infection and inflammation generated by oxidative stress inevitably hinder the process of wound healing. Ag6Cu2 nanoclusters in this study were successfully prepared and displayed excellent physiological stability. Noticeably, Ag6Cu2 nanoclusters exhibited efficient therapeutic potentials for accelerating the process of wound healing, which had good biosafety under the appropriate concentration. The treatment of Ag6Cu2 was able to suppress the bacterial proliferation by destructing the bacterial, resulting in the secondary release of bacterial contents and to exert anti-inflammatory properties via scavenging the overproduction of reactive oxygen species and upregulating the expression of Nrf2 as well as its downstream genes including HO-1 and NQO1. In-vivo studies further validated the efficient therapeutic effects of Ag6Cu2 nanoclusters by inhibiting the activation of the cascade of inflammatory factors and the proliferation of bacteria as a novel agent in a nano scale for accelerating the process of wound healing.

It has been well acknowledged that maternal exposure to fine particulate matters (PM2.5) might lead to poor pregnancy outcomes including the intrauterine growth restriction (IUGR) by interfering with the placental development. Our previous studies have demonstrated that maternal PM2.5 exposure induces IUGR, accompanied with increased maternal circulating TNFα level and impaired extravillous trophoblast cells (EVTs) invasion in mice. In this study, HTR8/SVneo cells, the immortalized human EVTs line, were used to assess effects and the underlying molecular mechanisms of nicotinamide on the impaired EVTs invasion. Our results showed that, the placental FLT1 protein level was significantly increased whereas maternal serum nicotinamide concentration was remarkably decreased in PM2.5-exposured pregnant mice at GD17.5 (vaginal plug day=GD0.5), compared to that in normal GD17.5 pregnant mice. FLT1 expression in HTR8/SVneo cells was significantly up-regulated by TNFα treatment, and the down-regulated FLT1 expression effectively abated the inhibitory effects of TNFα on HTR8/SVneo cells migration and invasion. Meanwhile, TNFα promoted reactive oxygen species (ROS) production and NF-κB signaling pathway activation in HTR8/SVneo cells in a dose-dependent manner. Nicotinamide treatment significantly reversed the effects of TNFα on cell migration and invasion, as well as the FLT1 expression, ROS production and NF-κB pathway activation. In summary, increased TNFα induced by PM2.5 exposure inhibits EVTs invasion by activating the ROS/NF-κB/FLT1 signaling pathway, and this adverse effect could be attenuated by nicotinamide treatment, suggesting a potential application in the clinical intervention of PM2.5-induced IUGR.

Abstract Background Inadequate DNA damage repair promotes aberrant differentiation of mammary epithelial cells. Mammary luminal cell fate is mainly determined by a few transcription factors including GATA3. We previously reported that GATA3 functions downstream of BRCA1 to suppress aberrant differentiation in breast cancer. How GATA3 impacts DNA damage repair preventing aberrant cell differentiation in breast cancer remains elusive. We previously demonstrated that loss of p18, a cell cycle inhibitor, in mice induces luminal-type mammary tumors, whereas depletion of either Brca1 or Gata3 in p18 null mice leads to basal-like breast cancers (BLBCs) with activation of epithelial-mesenchymal transition (EMT). We took advantage of these mutant mice to examine the role of Gata3 as well as the interaction of Gata3 and Brca1 in DNA damage repair in mammary tumorigenesis. Results Depletion of Gata3, like that of Brca1, promoted DNA damage accumulation in breast cancer cells in vitro and in basal-like breast cancers in vivo. Reconstitution of Gata3 improved DNA damage repair in Brca1-deficient mammary tumorigenesis. Overexpression of GATA3 promoted homologous recombination (HR)-mediated DNA damage repair and restored HR efficiency of BRCA1-deficient cells. Depletion of Gata3 sensitized tumor cells to PARP inhibitor (PARPi), and reconstitution of Gata3 enhanced resistance of Brca1-deficient tumor cells to PARP inhibitor. Conclusions These results demonstrate that Gata3 functions downstream of BRCA1 to promote DNA damage repair and suppress dedifferentiation in mammary tumorigenesis and progression. Our findings suggest that PARP inhibitors are effective for the treatment of GATA3-deficient BLBCs.

Abstract Objectives To investigate the risk factors and underlying causes of pregnancy-related cerebral venous thrombosis (PCVT). Methods A retrospective cohort of 16 patients diagnosed with CVT during pregnancy and postpartum (within six weeks after delivery) in a comprehensive hospital in China between 2009 and 2022 were carefully reviewed, focusing on demographic, clinical, and etiological characteristics, especially underlying causes. We matched 16 PCVT patients with 64 pregnant and puerperal women without PCVT to explore risk factors and clinical susceptibility to PCVT. Results PCVT occurred commonly during the first trimester (43.75%) and the puerperium (37.5%). The frequency of anemia, thrombocytosis and thrombocytopenia during pregnancy, dehydration, and pre-pregnancy anemia was significantly higher in women with PCVT than in those without PCVT (P A (p. Met406Ile), heterozygous PROS1 c.301C > T (p. Arg101Cys), composite heterozygous mutation in the F8 gene (c.144-1259C > T; c.6724G > A (p. Val2242Met)) and homozygous MTHFR c.677C > T (p. Ala222Val). Conclusions The occurrence of anemia, thrombocytopenia and thrombocytosis during pregnancy, dehydration and pre-pregnancy anemia suggested a greater susceptibility to PCVT. For confirmed PCVT patients, autoimmune diseases, hereditary thrombophilia, and hematological disorders were common causes. Screening for potential etiologies should be paid more attention, as it has implications for treatment and long-term management.

Abstract Background The left-behind children (LBC), children and adolescents aged 0–18 whose parents have migrated for economic purposes for extended periods exceeding three months, present a unique social concern. These children remain in their place of household registration, often under the guardianship of relatives, while receiving compulsory education. LBC with growing Internet addiction (IA) have made it urgent to take a close look at the mechanisms and effective interventions for them. Anxiety has been proven to be correlated with IA in adolescents; however, the mechanisms of addiction in this population are less well-fully grasped. Based on the current theories and empirical results, the study examined whether and how social support (SS) and family types moderated the associations between anxiety and IA among left-behind secondary students. Methods Stratified cluster sampling survey. A questionnaire was administered to 5290 secondary school children (2553 classified as left-behind) to explore the relationships between anxiety, IA, left-behind types, family types, and social support. This cross-sectional study employed a stratified cluster sampling survey of students in the ethnic areas of southeast Chongqing. The study sought to appraise the relationships between anxiety and IA in different types of left-behind children and to assess the potential moderating effect of SS on the relationship among the population and its family types differences. Results The relationship between anxiety and IA was moderated significantly by social support and family types. Notably, the impact of social support on the moderating effect between IA and anxiety varied among students from both family types. For students from families where both parents had migrated, social support weakened the association between IA and anxiety. Conversely, for students from single-parent families where the parent had migrated, social support seemed to strengthen the relationships between these two issues. Conclusions The moderating effects of SS on the relationship between anxiety and IA differs based on family type among various groups of left-behind secondary students. Gaining insights into the IA mechanisms can guide the development of targeted intervention strategies aimed at minimizing IA among diverse groups of left-behind students.

Abstract The ultrahigh flexibility and elasticity achieved in freestanding single-crystalline ferroelectric oxide membranes have attracted much attention recently. However, for antiferroelectric oxides, the flexibility limit and fundamental mechanism in their freestanding membranes are still not explored clearly. Here, we successfully fabricate freestanding single-crystalline PbZrO3 membranes by a water-soluble sacrificial layer technique. They exhibit good antiferroelectricity and have a commensurate/incommensurate modulated microstructure. Moreover, they also have good shape recoverability when bending with a small radius of curvature (about 2.4 μm for the thickness of 120 nm), corresponding to a bending strain of 2.5%. They could tolerate a maximum bending strain as large as 3.5%, far beyond their bulk counterpart. Our atomistic simulations reveal that this remarkable flexibility originates from the antiferroelectric-ferroelectric phase transition with the aid of polarization rotation. This study not only suggests the mechanism of antiferroelectric oxides to achieve high flexibility but also paves the way for potential applications in flexible electronics.

Abstract Background To analyse the causal associations of different physical measures with osteoarthritis knee (KOA). Methods Exposure factors (weight, body mass index (BMI), body fat percentage, waist circumference, hip circumference, waist–hip ratio (WHR), and basal metabolic rate (BMR)), and outcome factor KOA were analyzed by inverse-variance weighted (IVW) method, along with heterogeneity test, sensitivity and pleiotropy analyses. Meta-analysis was used to combine the effect values of IVW methods in different data sources. Results Weight, BMI, body fat percentage, waist circumference, hip circumference and BMR analyses showed causal association with increased KOA risk, while WHR analysis indicated a reduction of the incidence of KOA. P-value for all the results was less than 0.05 and F-value large than 20. All results were negative for heterogeneity tests and sensitivity analyses, and there was pleiotropy in weight and BMR. Meta-analysis results showed that the results of Odds Ratios (95% Confidence Intervals) for Weight (1.43(1.35–1.51)), BMI (1.40(1.10–1.78)), body fat percentage (1.56(1.44–1.68)), waist circumference (1.40(1.10–1.78)), hip circumference (1.37(1.30–1.44)), WHR (0.86(0.71–1.04)) and BMR (1.36(1.27–1.46) were consistent with the ones by Mendelian randomization analyses. Conclusions Body fat percentage may be a better indicator of KOA than BMI. In addition, weight and BMR may have a causal effect in KOA, but WHR does not have a causal relationship. BMI, body fat percentage, waist circumference, and hip circumference has a causal effect on KOA.

Abstract. Background:. In the clinic, practitioners encounter many patients with an abnormal pattern of dense punctate magnetic resonance imaging (MRI) signal in the basal ganglia, a phenomenon known as "cheese sign". This sign is reported as common in cerebrovascular diseases, dementia, and old age. Recently, cheese sign has been speculated to consist of dense perivascular space (PVS). This study aimed to assess the lesion types of cheese sign and analyze the correlation between this sign and vascular disease risk factors. Methods:. A total of 812 patients from Peking Union Medical College Hospital (PUMCH) dementia cohort were enrolled. We analyzed the relationship between cheese sign and vascular risk. For assessing cheese sign and defining its degree, the abnormal punctate signals were classified into basal ganglia hyperintensity (BGH), PVS, lacunae/infarctions and microbleeds, and counted separately. Each type of lesion was rated on a four-level scale, and then the sum was calculated; this total was defined as the cheese sign score. Fazekas and Age-Related White Matter Changes (ARWMC) scores were used to evaluate the paraventricular, deep, and subcortical gray/white matter hyperintensities. Results:. A total of 118 patients (14.5%) in this dementia cohort were found to have cheese sign. Age (odds ratio [OR]: 1.090, 95% confidence interval [CI]: 1.064–1.120, P

Existing literature suggests a potential link between private self-awareness and purchase decisions, though the evidence supporting this claim remains limited. Moreover, the role of private self-awareness as a predictor of overall purchase desire has been largely underexplored, particularly in the context of negative emotions and self-control in contemporary consumer behavior. This study investigates the moderated mediation effects of self-control, via state boredom, on the relationship between private self-awareness and snack purchase desire. Participants were recruited from a university in Shanghai through online platforms, and data were analyzed to explore these relationships. Those in the self-awareness priming group completed a task designed to enhance self-awareness before responding to state boredom and self-control scales, while the control group completed only the state boredom and self-control scales. Subsequently, participants rated their likelihood of purchasing snacks depicted in images of four snack options. The findings reveal that private self-awareness positively influences snack purchase desire, with state boredom mediating this relationship and self-control acting as a moderator. These results have significant implications for emotional marketing strategies, particularly in understanding how self-control and emotional states impact consumer behavior. This research contributes to existing literature by elucidating the complex dynamics between self-awareness, emotional states, and purchasing behavior, offering both theoretical insights and practical applications for marketers.

Abnormal serum Na (SNa) levels are common in patients with chronic kidney disease (CKD) which is associated with increased morbidity and mortality. There are relatively few studies on the effect of SNa indicators on the prognosis of patients undergoing maintenance hemodialysis (MHD). We aim to investigate the effect of long-term SNa levels on the survival and prognosis of patients undergoing hemodialysis (HD). Newly entered HD patients in the registration system of Zhejiang Provincial Dialysis Quality Control Center between January 1, 2010 and December 31, 2019 were included and followed up until December 31, 2020. Multiple sodium levels were collected from patients, defining long-term SNa as the mean of multiple SNa, according to which patients were grouped, with the prognostic differences between subgroups compared by Kaplan-Meier modeling and multifactorial Cox regression modeling. Finally, a total of 21,701 patients were included in this study and Cox regression showed that decreased SNa levels (Na < 135 mmol/L, HR = 1.704, 95% CI 1.408–2.063, p 145mmol/L, HR = 2.150, 95% CI 1.615–2.863, p

Glioblastoma multiforme (GBM) is a formidable cancer to treat due to the lack of effective drugs that can also efficiently cross the blood–brain barrier (BBB). Herein, a novel strategy involving the synthesis of p28 peptide‐conjugated, lexiscan (LEX)‐loaded, bardoxolone methyl (BM) self‐assembled nanoparticles, designated as p28‐LBM NPs, is introduced. These NPs are designed to overcome the dual challenges of effectively killing GBM cells and efficiently penetrating the brain. The p28 peptide is chosen for targeted delivery to brain tumors, and LEX is employed to enhance drug penetration across the BBB. The successful penetration of brain tumors by the p28‐LBM NPs after intravenous administration is demonstrated, with BM delivered as part of the NPs significantly inhibiting GBM tumor growth and extending the survival of mice with tumors. In conclusion, the p28‐LBM NPs present a promising approach for GBM treatment, with potential for effective and safe clinical applications in the future.

The Organic Rankine Cycle (ORC) plays a pivotal role in the domain of renewable energy, adeptly harnessing thermal energy from sources such as solar and geothermal to generate electrical power. Central to this system is the scroll expander, whose operational efficacy directly influences the ORC's overall efficiency. This study initiates with a detailed numerical analysis of the impact of various operational parameters on both the steady and transient output performance of the scroll expander. Following this, a sophisticated performance prediction model is developed employing the response surface methodology. The model boasts high coefficients of determination, R2,values of 0.9967 and 0.9916, respectively, underscoring its superior predictive accuracy. Further, this model delves into the complex interactions among operational parameters and their consequent effects on the expander's performance. Validation of this predictive model is achieved through rigorous testing on an experimental platform designed for the ORC low-temperature waste heat power generation system. The discrepancies between predicted and actual performance measurements fall within a commendable margin of 15 %, affirming the model's robustness in forecasting scroll expander performance. The culmination of this research furnishes a novel and efficacious optimization strategy, establishing a robust theoretical foundation and offering fresh insights for the enhancement and prediction of scroll expander performance. This not only underscores the innovation of the approach but also its practical applicability in advancing the efficiency of renewable energy systems.

BackgroundVitamins A and D are essential for the health of pregnant women and infants. Nevertheless, the relationship between umbilical cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants remains uncertain.ObjectiveThis cohort study aims to examine the relationship between cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants aged 0–6 months.Methods140 singleton mother–infant pairs were recruited in total. Questionnaires were used to collect maternal and infant information, and liquid chromatography was utilized to quantify the levels of vitamins A and D in the umbilical cord blood. Anthropometric measurements were conducted at birth, at 3 and 6 months of age, and the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HAZ), and BMI-for-age z-score (BMIZ) were calculated. Univariate and multivariate linear regression models were used for the analysis.ResultsThe average concentration of vitamins A and D in cord blood was 0.58 ± 0.20 μmol/L and 34.07 ± 13.35 nmol/L, both below the normal range for children. After adjusting for confounding factors, vitamin A levels in cord blood positively correlated with HAZ growth in infants aged 3–6 months (β= 0.75, P < 0.01) while vitamin D levels negatively correlated with LAZ growth (β= −0.01, P = 0.01) and positively correlated with BMIZ growth (β= 0.02, P < 0.01).ConclusionHigher Vitamin A levels at birth promote HAZ growth in infants aged 3–6 months while higher vitamin D levels at birth promote BMIZ growth in infants aged 3–6 months.Clinical trial registrationhttps://register.clinicaltrials.gov, identifier NCT04017286.

Abstract Understanding soil moisture variability and estimating high‐resolution soil moisture at subfield to field scales is critical for agricultural research and applications. However, systematic investigation of subfield scale soil moisture variability over cropland is still lacking from both measurement and satellite remote sensing. In this study, we aim to investigate (1) the characteristics of within‐field soil moisture distribution over typical cropland in the US Midwest and (2) the capabilities of satellite remote sensing in capturing the spatiotemporal variabilities of soil moisture at subfield scale. Specifically, we conducted soil moisture field experiments in three typical commercial agricultural fields (∼85 acres per field) in central Illinois, representing typical commercial farmlands in the US Midwest, and compared the soil moisture measurements with satellite remote sensing data from optical and active microwave sensors. In each field, dense soil moisture samples (spaced at 50–60 m) were obtained for two dry down events in May and July 2021, and multiple long‐term soil moisture stations were installed. We found prominent time‐invariant spatial structures of soil moisture at within‐field scales both during the dry down period and over longer time scales, and the stability is minimally affected by plant water use during the growing season. Comparing the field campaign measurements with satellite remote sensing data, we found that surface reflectance of shortwave infrared bands, such as SWIR1 (1610 nm) from Sentinel‐2, can capture relative surface soil moisture patterns at within‐field scales, but their relationships with soil moisture are field specific. These findings and the improved understanding of within‐field soil moisture dynamics could potentially help future research on high‐resolution soil moisture estimation with multi‐source remote sensing data.

ABSTRACT: Relationships between texture measurements and meat water properties were investigated in raw intact broiler breast fillets with the wooden breast (WB) condition. Texture measurements included subjective WB scores and blunt Meullenet-Owens Razor Shear (BMORS). Water properties were determined with low-field nuclear magnetic resonance (LF-NMR). Spearman correlation was used to estimate relationships between WB scores and water properties, while Pearson correlation was used for relationships between BMORS force and water properties. LF-NMR measurements exhibited 3 water components: protein-associated or hydration water T2b, intra-myofibrillar water or immobilized water T21, and extra-myofibrillar water or free water T22 in chicken breast meat. Significant and strong Spearman correlations were found between the WB scores and T21 time constant, the abundance (normalized areas) of T22, and the proportion of T21 and T22 (rs > 0.60, P < 0.001). Strong Pearson correlations (r = 0.72) were noted only between the T21 time constant and BMORS force. These results demonstrate that water may contribute to the specific texture characteristics measured with subjective WB scoring (palpable hardness and rigidity) and BMORS (hardness and share force) in raw broiler breast fillets with the WB condition.

In a jujube orchard, cropping withgrass may influence bacterial diversity and ecological networks due to changes of physicochemical properties in soil, which has a serious effect on the stability of soil ecosystems. The aim of this study was to analyze the effects of different cultivation methods (CK: cleaning tillage; NG: cropping with native grass; VV: cropping with Vicia villosa) on the soil’s bacterial structure and its co-occurrence network in a jujube orchard. The results showed that the highest moisture content, total nitrogen, and organic matter in the rhizosphere soil of a jujube orchard was found in the VV group. The soil’s moisture content, total nitrogen, and organic matter in the VV group were 2.66%, 0.87 g kg−1, and 5.55 mg kg−1 higher than that found in the CK group. Compared to the CK group, the number of unique species in the rhizosphere soil in the NG and the VV groups increased by 7.33% and 21.44%. The PICRUSt and FAPROTAX analysis showed that sown grass had a greater influence on the ecological function of the soil’s bacteria. Cropping with Vicia villosa and native grass significantly increased aerobic chemoheterotrophy, nitrogen respiration, nitrate reduction related to biochemical cycles, and the relative abundance of genes related to carbohydrate metabolism and the biodegradation of xenobiotics. The bacterial network complexity in the NG group was higher than that in the CK and VV groups and was greatest in the hub nodes (OTU42, Bacteroidota; OTU541, Nitrospiraceae). In this study, the ecological benefit seen in the soil’s microbial function provides support to the theory that cropping with grass (Vicia villosa) increases the sustainable development of a jujube orchard.

BackgroundThe study aimed to examine the association between the systemic immune-inflammation index (SII), a contemporary metric of systemic inflammatory response, and biological aging, which are closely interconnected processes.MethodsThis cross-sectional study utilized 10 cycles of data from the NHANES database spanning from 1990 to 2018. The study examined the relationship between the SII index, calculated as P * N/L, where P represents preoperative peripheral platelet count, N represents neutrophil count, and L represents lymphocyte count, and biological aging. Biological aging was assessed through various methods, such as phenotypic age, phenotypic age acceleration (PhenoAgeAccel), biological age, and biological age acceleration (BioAgeAccel). Correlations were analyzed using weighted linear regression and subgroup analysis.ResultsAmong the 7,491 participants analyzed, the average age was 45.26 ± 0.34 years, with 52.16% being female. The average phenotypic and biological ages were 40.06 ± 0.36 and 45.89 ± 0.32 years, respectively. Following adjustment for potential confounders, elevated SII scores were linked to increased phenotypic age, biological age, Phenotypic age acceleration, and Biological age acceleration. Positive correlations were observed between health behavior and health factor scores and biological aging, with stronger associations seen for health factors. In health factor-specific analyses, the β coefficient was notably higher for high BMI. The robust positive associations between SII scores and both phenotypic age and biological age in the stratified analyses were consistently observed across all strata.ConclusionThe evidence from the NHANES data indicate that SII may serve as a valuable marker for assessing different facets of aging and health outcomes, such as mortality and the aging process. Additional research is warranted to comprehensively elucidate the implications of SII in the aging process and its utility as a clinical instrument for evaluating and addressing age-related ailments.

At present, the repair patterns for medium-sized supraspinatus tendon tears are double- and single-row repairs. However, the limitations of double-row repair include excessive anchor implantation and incremental surgical cost and time, whereas a deficient tendon-bone contact area exists with single-row repair. The modified double-pulley suture-bridge repair presented in this study is an arthroscopic technique using 3 double-loaded suture anchors combined with a double-pulley technique to form a hybrid repair pattern with a double row as the mainstay and a single row as the supplement. In the treatment of medium-sized tendon tears, the modified double-pulley suture-bridge repair can not only maximize the tendon-bone contact area but also lower the surgical cost and shorten the operative time. The surgical technique is described, including pearls and pitfalls, as well as advantages and disadvantages.

Introduction Branch atheromatous disease (BAD)-related stroke is increasingly becoming a clinical entity and prone to early neurological deterioration (END) and poor prognosis. There are no effective regimens to reduce the disability caused by BAD-related stroke in acute phase. Recent studies have indicated the efficacy of tirofiban in acute ischaemic stroke; however, its efficacy has not been validated in patients with BAD-related stroke. Thus, we aim to test whether intravenous tirofiban initiated within 48 hours after the onset would improve the functional outcome in patients with acute BAD-related stroke, in comparison with the standard antiplatelet therapy based on the current guideline.Methods and analysis BRANT is a multicentre, randomised, open-label, blinded endpoint, parallel-controlled, phase III trial conducted in 21 hospitals in China. Participants aged 18–75 years with acute BAD-related stroke within 48 hours after the stroke onset are randomised in a 1:1 ratio to the tirofiban or control group. The treatment period is 48 hours in both groups. The primary outcome is the excellent functional outcome (modified Rankin Scale Score: 0–1) at 90 days. The secondary outcomes include END, major bleeding, stroke, death, functional status, serious adverse events and change in bleeding-related markers. Assuming the rates of the primary outcome to be 74% in the tirofiban group and 62% in the control group, a total of 516 participants are needed for 0.8 power (two-sided 0.05 alpha).Ethics and dissemination BRANT study has been approved by the Ethics Committee of the Peking Union Medical College Hospital (I-23PJ1242). Written informed consent is required for all the patients before enrolment. The results of the study will be published in a peer-reviewed journal.Trial registration number ClinicalTrials.gov (NCT06037889).

ObjectiveThere are various detrimental effects of excessive added sugar consumption on health, but the association of added sugars with frailty remains elusive. We aimed to examine the association between added sugar intake and frailty among American adults in the present cross-sectional study.MethodsThis cross-sectional study is based on the National Health and Nutrition Examination Survey (NHANES) database. Data from NHANES spanning from 2007 to 2018 on frailty, added sugars, and covariates were collected. Added sugars were categorized into quartiles according to the recommended percentages by institutions. Weighted multivariable logistic regression was used to analyze the relationship between frailty and added sugars. Subgroup analysis was conducted based on sex, age, body mass index (BMI), smoking, alcohol consumption, hypertension, and diabetes status.ResultsThis study included 16,381 participants, with 13,352 (81.51%) in the non-frailty group and 3,029 (18.49%) in the frailty group. We found that added sugars were positively associated with frailty, and subgroup analysis showed that participants who were male, over the age of 60, had a low BMI, had previously smoked and consumed alcohol, had no hypertension, or had diabetes mellitus (DM) were more likely to be frail. Added sugar intake was positively associated with frailty. Subgroup analysis showed that the association was strongest in males, those aged >60, those with a low BMI, former smokers, former alcohol consumers, and people with no hypertension or DM. When added sugars are classified by energy percentage, populations with more than 25% of their energy coming from added sugars have similar results, with a higher prevalence of frailty.ConclusionAdded sugars are positively associated with a higher risk of frailty, and the association is stable among different populations.

Abstract Background The shortage of nurses has been a global human resources problem. A good professional growth environment is essential to developing potential nursing students and attracting nurses to join, and it has great significance in reducing nurse turnover. However, nurses’ comprehensive perceptions of professional growth have not yet been examined. Methods A cluster sampling method was used to conduct a professional growth questionnaire survey on young nursing talents from a large Chinese public tertiary A hospital in March 2022. Results The score of professional growth among 243 young nursing talents was 57.92 ± 9.607, with a scoring rate of 77.23%. The scores for dimensions of professional growth, from lowest to highest, were rehabilitation growth, promotion speed, professional goal progress, and professional ability development. Attitudes towards participating in training, service as the quality manager or clinical teacher, self-efficacy, professional title, work-family support, education, and organizational commitment of young nursing talents were significantly associated with professional growth. Conclusion The professional growth of young nursing talents was at a moderate level and needed to be strengthened. Nursing leaders and managers are expected to develop management practices to enhance young nursing talents’ professional growth in combination with the related factors.

Abstract Background Although prior observational studies indicate an association between cardiovascular diseases (CVDs) and frozen shoulder (FS), the potential causal relationship between them remains uncertain. This study aims to explore the genetic causal relationship between CVDs and FS using Mendelian randomization (MR). Methods Genetic variations closely associated with FS were obtained from the FinnGen Consortium. Summary data for CVD, including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), stroke, and ischemic stroke (IS), were sourced from several large-scale genome-wide association studies (GWAS). MR analysis was performed using inverse variance weighting (IVW), MR Egger, and weighted median methods. IVW, as the primary MR analysis method, complemented by other sensitivity analyses, was utilized to validate the robustness of the results. Further reverse MR analysis was conducted to explore the presence of reverse causal relationships. Results In the forward MR analysis, genetically determined risk of stroke and IS was positively associated with FS (OR [95% CI] = 1.58 (1.23–2.03), P

Abstract Background Triosephosphate isomerase 1 (TPI1), as a widely involved glycolytic enzyme, plays a significant role in glucose metabolism and is highly expressed in various tumors. However, its role in lung adenocarcinoma (LUAD) remains incompletely understood. Methods Through bioinformatic analysis, we identified a positive association between high expression of TPI1 and metastasis in LUAD. Western blot, RT‐qPCR, wound healing assays and transwell experiments, were employed to investigate potential mechanisms. Results In this study, bioinformatic analysis showed that high expression of TPI1 was associated with poor prognosis in LUAD patients. We examined the expression of TPI1 in 29 paired LUAD tissues and found that TPI1 expression was higher in LUAD tissues than in paired adjacent noncancerous tissues. Meanwhile, overexpression of TPI1 promoted the epithelial‐mesenchymal transition (EMT) process in LUAD cells, while silencing TPI1 weakened the EMT process. Furthermore, TPI1 was shown to regulate EMT through the MAPK/ERK signaling pathway. Conclusion TPI1 promotes LUAD metastasis by activating the MAPK/ERK signaling pathway.

In this study, we introduce Light-ESRGAN, a novel cellular image super-resolution reconstruction model utilizing Generative Adversarial Networks (GANs). High-resolution (HR) cellular images are pivotal in pathological research; however, how to caputer critical features such as cell edges during microscopic imaging presents challenges due to hardware limitations and environmental factors. These factors frequently introduce noise and interference. Rapid advancements in deep learning have significantly enhanced the field of image super-resolution reconstruction, demonstrating substantial potential in cellular image processing. Our Light-ESRGAN employs a random degradation modeling process to leverage the GAN architecture for more accurate simulations of real-world degradation. We have also incorporated the Convolutional Block Attention Module (CBAM) into the residual blocks of the generator, thereby enhancing its ability to reconstruct image edges and textures through the fusion of channel and spatial attentions. For the discriminator, a lightweight U-Net structure is adopted, which not only reduces the model’s parameter size but also improves its discriminative capacity. Compared to Real-ESRGAN and A-ESRGAN, Light-ESRGAN has reduced model parameters by 34.7% and 66.4%, respectively. It has demonstrated improved performance on publicly available cellular images, increasing the average Peak Signal-to-Noise Ratio (PSNR) by 1.174 dB and 1.992 dB, the Structural Similarity Index (SSIM) by an average of 1.5% and 9.1%, and reducing the Normalized Root Mean Square Error (NRMSE) by an average of 0.005 and 0.009.

Fluid flow at nanoscale is closely related to many areas in nature and technology (e.g., unconventional hydrocarbon recovery, carbon dioxide geo-storage, underground hydrocarbon storage, fuel cells, ocean desalination, and biomedicine). At nanoscale, interfacial forces dominate over bulk forces, and nonlinear effects are important, which significantly deviate from conventional theory. During the past decades, a series of experiments, theories, and simulations have been performed to investigate fluid flow at nanoscale, which has advanced our fundamental knowledge of this topic. However, a critical review is still lacking, which has seriously limited the basic understanding of this area. Therefore herein, we systematically review experimental, theoretical, and simulation works on single- and multi-phases fluid flow at nanoscale. We also clearly point out the current research gaps and future outlook. These insights will promote the significant development of nonlinear flow physics at nanoscale and will provide crucial guidance on the relevant areas.

The inadequate automation level in the transit of oil drilling tubular columns has led to significant inefficiencies and safety issues. To address these challenges, a real-time detection algorithm, ECS-YOLOv5s, has been proposed. This algorithm aims to improve the accuracy of drill pipe identification during operational processes, facilitating the automation of tubular column handling It has the potential to reduce drilling cycles and overall drilling costs. ECS-YOLOv5s enhance the detection accuracy of drill pipes by incorporating a Bidirectional Feature Pyramid Network (BiFPN) architecture with an improved multi-scale feature fusion network. The use of EfficientNet as the backbone network reduces the number of parameters and computations while effectively merging features from different layers. Additionally, the Spatial Pyramid Pooling (SPP) structure in the Neck is replaced with SPPF, and a Convolutional Block Attention Module (CBAM) is introduced to improve model robustness, reduce parameters and computations, and enhance the model’s ability to detect dense targets. The ECS-YOLOv5s algorithm exhibits superior performance in drill pipe inspection, achieving a mean Average Precision (mAP) of 90.2%, a frame rate of 125 FPS, and a parameter count of only 37%. It achieves an accuracy of 98.6%, outperforming the original model by 9.2%. The comparative analysis demonstrates that the improved algorithm surpasses traditional models such as YOLOv5s, SSD, Faster-RCNN, and YOLOv7-tiny in both performance and accuracy. These findings provide valuable insights for the research on automated processing of tubular columns in intelligent oil drilling platforms.

Objective: In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method: Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies’ quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results: Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion: Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.

Abstract To explore the association between lipid markers and osteoarthritis (OA). First, the National Health and Nutrition Examination Survey (NHANES) database was used to screen participants with lipid markers, OA and relevant covariates, and logistic regression was used to analyze the association between lipid markers and OA; Then, under the theoretical framework of Mendelian randomization (MR), two-sample MR was performed using GWAS data of lipid markers and OA to explore the causal association between the two, which was analyzed by inverse variance weighting (IVW) method. Heterogeneity test, sensitivity analysis and pleiotropy analysis were also performed. The NHANES database screened a total of 3706 participants, of whom 836 had OA and 2870 did not have OA. When lipid markers were used as continuous variables, multivariate logistic results showed an association between HDL, LDL and OA (HDL, OR (95%):1.01 (1.00, 1.01); LDL, OR (95%):1.00 (0.99, 1.00)). When lipid markers were used as categorical variables, multivariate logistic results showed the fourth quartile result of 0.713 (0.513, 0.992) for LDL relative to the first quartile. In MR study, the results of the IVW method for TG, TL, HDL and LDL showed OR (95% CI) of 1.06 (0.97–1.16), 0.95 (0.85–1.06), 0.94 (0.86–1.02) and 0.89 (0.80–0.998) with P-values of 0.21, 0.37. 013, 0.046. The heterogeneity tests and multiplicity analyses showed P-values greater than 0.05, and sensitivity analyses showed no abnormal single nucleotide polymorphisms. Through NHANES database and MR analyses, LDL was found to be a protective factor for OA, while HDL still needs further study. Our results provide new biomarkers for preventive and therapeutic strategies for OA.

Abstract Accurate and cost-effective quantification of the carbon cycle for agroecosystems at decision-relevant scales is critical to mitigating climate change and ensuring sustainable food production. However, conventional process-based or data-driven modeling approaches alone have large prediction uncertainties due to the complex biogeochemical processes to model and the lack of observations to constrain many key state and flux variables. Here we propose a Knowledge-Guided Machine Learning (KGML) framework that addresses the above challenges by integrating knowledge embedded in a process-based model, high-resolution remote sensing observations, and machine learning (ML) techniques. Using the U.S. Corn Belt as a testbed, we demonstrate that KGML can outperform conventional process-based and black-box ML models in quantifying carbon cycle dynamics. Our high-resolution approach quantitatively reveals 86% more spatial detail of soil organic carbon changes than conventional coarse-resolution approaches. Moreover, we outline a protocol for improving KGML via various paths, which can be generalized to develop hybrid models to better predict complex earth system dynamics.

Abstract Background Cornichon homolog 4 (CNIH4) belongs to the CNIH family. It functions as an oncogene in many tumors. However, CNIH4's significance in the immune landscape and its predictive potential in cervical cancer (CESC) is unexplored. Methods CNIH4 levels and its effect on the survival of patients with CESC were evaluated using data retrieved from The Cancer Genome Atlas (TCGA). The oncogenic effect of CNIH4 in CESC was determined using small interfering RNA‐mediated transfected cell lines and tumorigenesis experiments in animal models. Results Higher expression of CNIH4 was found in advanced tumor and pathological stages, as well as lymph node metastasis. CNIH4 expression correlated positively with the infiltration of macrophages M2 and resting dendritic cells into the affected tissue. Additionally, functional enrichment of RNA‐sequencing of CNIH4‐knocked down CESC cell lines showed the association of CNIH4 to the PI3K‐Akt signaling pathway. Single‐sample gene set enrichment analysis highlighted several immune pathways that were elevated in the CESC samples with enhanced levels of CNIH4, including Type‐I and Type‐II IFN‐response pathways. The impact of CNIH4 on drug sensitivity was further assessed using the GDSC database. As CNIH4 is linked to the immune landscape in CESC, this study determined a four‐gene risk prediction signature utilizing CNIH4‐related immunomodulators. The risk score quantified from the prediction signature was an independent predictive indicator in CESC. Receiver operating characteristic curve analysis verified the good predictive ability of the four‐gene signature in TCGA‐CESC cohort. Thus, the CNIH4‐related model showed potential as an auxiliary TNM staging system tool. Conclusion CNIH4 may be an effective predictive biomarker for patients with cervical cancer, thus providing new ideas and research directions for CESC.

The inhomogeneity between cells is the main cause of failure and thermal runaway in Lithium-ion battery packs. Electrochemical Impedance Spectroscopy (EIS) is a non-destructive testing technique that can map the complex reaction processes inside the battery. It can detect and characterise battery anomalies and inconsistencies. This study proposes a method for detecting impedance inconsistencies in Lithium-ion batteries. The method involves conducting a battery EIS test and Distribution of Relaxation Times (DRT) analysis to extract characteristic frequency points in the full frequency band. These points are less affected by the State of Charge (SOC) and have a strong correlation with temperature, charge/discharge rate, and cycles. An anomaly detection characteristic impedance frequency of 136.2644 Hz was determined for a cell in a Lithium-ion battery pack. Single-frequency point impedance acquisition solves the problem of lengthy measurements and identification of anomalies throughout the frequency band. The experiment demonstrates a significant reduction in impedance measurement time, from 1.05 h to just 54 s. The LOF was used to identify anomalies in the EIS data at this characteristic frequency. The detection results were consistent with the actual conditions of the battery pack in the laboratory, which verifies the feasibility of this detection method. The LOF algorithm was chosen due to its superior performance in terms of FAR (False Alarm Rate), MAR (Missing Alarm Rate), and its fast anomaly identification time of only 0.1518 ms. The method does not involve complex mathematical models or parameter identification. This helps to achieve efficient anomaly identification and timely warning of single cells in the battery pack.

Abstract The dental operative microscope has been widely employed in the field of dentistry, particularly in endodontics and operative dentistry, resulting in significant advancements in the effectiveness of root canal therapy, endodontic surgery, and dental restoration. However, the improper use of this microscope continues to be common in clinical settings, primarily due to operators’ insufficient understanding and proficiency in both the features and established operating procedures of this equipment. In October 2019, Professor Jingping Liang, Vice Chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, organized a consensus meeting with Chinese experts in endodontics and operative dentistry. The objective of this meeting was to establish a standard operation procedure for the dental operative microscope. Subsequently, a consensus was reached and officially issued. Over the span of about four years, the content of this consensus has been further developed and improved through practical experience.

Sugar is a primary determinant of citrus fruit flavour, but undergoes varied accumulation processes across different citrus varieties owing to high genetic variability. Sucrose phosphate synthase (SPS), a key enzyme in glucose metabolism, plays a crucial role in this context. Despite its significance, there is limited research on sugar component quality and the expression and regulatory prediction of SPS genes during citrus fruit development. Therefore, we analysed the sugar quality formation process in ‘Kiyomi’ and ‘Succosa’, two citrus varieties, and performed a comprehensive genome-wide analysis of citrus CsSPSs. We observed that the accumulation of sugar components significantly differs between the two varieties, with the identification of four CsSPSs in citrus. CsSPS sequences were highly conserved, featuring typical SPS protein domains. Expression analysis revealed a positive correlation between CsSPS expression and sugar accumulation in citrus fruits. However, CsSPS expression displays specificity to different citrus tissues and varieties. Transcriptome co-expression network analysis suggests the involvement of multiple transcription factors in shaping citrus fruit sugar quality through the regulation of CsSPSs. Notably, the expression levels of four CsWRKYs (CsWRKY2, CsWRKY20, CsWRKY28, CsWRKY32), were significantly positively correlated with CsSPSs and CsWRKY20 might can activate sugar accumulation in citrus fruit through CsSPS2. Collectively, we further emphasize the potential importance of CsWRKYs in citrus sugar metabolism, our findings serve as a reference for understanding sugar component formation and predicting CsSPS expression and regulation during citrus fruit development.

Abstract Flexible electronics strongly demand the integration of flexible and large‐scale multifunctional oxides. BiFeO3 is one of the most essential multifunctional oxides that could be used in memories, logics, sensors, and actuators. Recently, freestanding single‐crystalline BiFeO3 membranes exhibited superior elasticity and flexibility. However, fabrication and integration of large‐scale freestanding BiFeO3 membranes into flexible electronics remain elusive. In this study, inch‐scale freestanding single‐crystalline BiFeO3 membranes are fabricated with assistance from a water‐soluble sacrificial layer. To transfer flat and crack‐free membranes, all the existing methods are first followed but fail. Then the study introduces a temporary supporting Cu layer on the surface of the as‐grown SiTiO3/Sr3Al2O6/(SrRuO3/)BiFeO3 heterostructure and successfully obtains full and crack‐free 5 mm × 5 mm freestanding membranes on various substrates. The residual strain within the heterostructure releases gradually under the protection of the Cu layer. The freestanding BiFeO3 membranes are relatively uniform among different regions and exhibit good dielectric, ferroelectric, and ferromagnetic properties. Finally, flexible ferroelectric photovoltaic devices are patterned based on those BiFeO3 membranes, and they have open circuit voltage and short circuit current density up to −0.25 ± 0.03 V and 0.82 ± 0.09 µA cm−2, respectively.