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Abstract Bone is a common organ affected by metastasis in various advanced cancers, including lung, breast, prostate, colorectal, and melanoma. Once a patient is diagnosed with bone metastasis, the patient's quality of life and overall survival are significantly reduced owing to a wide range of morbidities and the increasing difficulty of treatment. Many studies have shown that bone metastasis is closely related to bone microenvironment, especially bone immune microenvironment. However, the effects of various immune cells in the bone microenvironment on bone metastasis remain unclear. Here, we described the changes in various immune cells during bone metastasis and discussed their related mechanisms. Osteoblasts, adipocytes, and other non‐immune cells closely related to bone metastasis were also included. This review also summarized the existing treatment methods and potential therapeutic targets, and provided insights for future studies of cancer bone metastasis.

Abstract Background Interprofessional education (IPE) has the potential to shape students’ collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students. Methods Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students (N = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson’s correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted. Results Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p = .02) and interprofessional identity (M = 3.97, t = 4.86; p

Abstract Background The age-related loss of skeletal muscle mass is an important characteristic of sarcopenia, an increasingly recognized condition with systemic implications. However, its association with shoulder function in elderly patients with rotator cuff tears (RCT) remains unknown. This study aimed to investigate the relationship between low skeletal muscle mass and shoulder function in elderly RCT patients. Methods A retrospective analysis was conducted on RCT patients who underwent chest computed tomography (CT) scans for clinical evaluation. Preoperative CT scan images of the chest were used to calculate the cross-sectional area (CSA) of thoracic muscle at the T4 level. The medical records were reviewed. Shoulder function was assessed using the ASES score and CMS score both preoperatively and at the final follow-up. Data on the preoperative range of motion (ROM) for the affected shoulder, were collected for analysis. Subgroup analyses by sex were also performed. Results A total of 283 RCT patients, consisting of 95 males and 188 females, with a mean age of 66.22 ± 4.89(range, 60–95 years) years were included in this retrospective study. The low muscle mass group showed significantly higher level of c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to the normal group(3.75 ± 6.64 mg/L vs. 2.17 ± 2.30 mg/L, p = 0.021; 19.08 ± 12.86 mm/H vs.15.95 ± 10.76 mm/H, p = 0.038; respectively). In the normal group, pre-operative passive ROM, including forward elevation, abduction, lateral rotation, and abductive external rotation, was significantly better than that in the low muscle mass group (127.18 ± 34.87° vs. 89.76 ± 50.61°; 119.83 ± 45.76° vs. 87.16 ± 53.32°; 37.96 ± 28.33° vs. 25.82 ± 27.82°; 47.71 ± 23.56° vs. 30.87 ± 27.76°, all p

Background Self-assessment (SA) is increasingly recognized not only as an assessment method but also as a vital learning activity that enables learners to identify their strengths and limitations, fostering a crucial skill for lifelong learning. Despite its acknowledged significance, there remains a gap in understanding SA for and as learning, rather than merely of learning. This review, therefore, explores two primary questions: (1) What factors inform the implementation of medical students’ SA practices? (2) How does SA practices contribute to various educational outcomes?Methods A systematic review was conducted across five databases, employing a combination of keywords pertinent to SA and medical education. Our selection criteria deliberately excluded articles that solely focused on the accuracy of SA or used SA exclusively as a measure for other outcome variables. As a result, 39 studies met our inclusion criteria and were analyzed for this review. Qualitative narrative synthesis was used to summarize the informing factors. Furthermore, Kirkpatrick’s model was employed to categorize and summarize the effects of SA activities across various educational outcome levels, including reactions, learning, and behavioral changes.Results Our review reveals that key factors influencing students’ SA includes feedback from various stakeholders, peer assessment, the format of SA, and both learner and teacher training. Among the 39 studies examined, the majority demonstrated positive effects of SA on aspects such as attitudes and skills. However, a minority found no significant associations, with these outcomes frequently linked to contextual variables and how SA was implemented.Conclusions Our review does not focus on SA accuracy or its role as an assessment method; instead it delves into the role of SA as an integral learning practice. We explored its influencing factors and its impact across various outcomes. The findings indicate that for SA to effectively enhance student learning outcomes, it must be implemented with ample support, clear guidelines, and within contexts that encourage feedback and reflection.

Yield stress of thickened tailings is a basic parameter in the design of tailings pipeline transport and discharge systems. To accurately determine the yield stress of thickened tailings, it is essential to develop a rapid determination method suitable for engineering applications and explore the relationship among various factors. In this paper, a high-precision velocity-controlled slump test system was designed to investigate the effects of thickened tailings temperature, lifting speed, slump cylinder shape, and tailings slurry mass concentration on the slump value. The test results indicate that the slump value decreases with the increases in thickened tailings temperature, resulting in a higher yield stress. Lifting speed significantly affects the yield stress, a faster lifting speed produces a larger slump value, which in turn leads to a smaller calculated yield stress. The lifting speed of 0.01 m/s provides a yield stress calculation that is close to the actual value. Moreover, among the tested slump cylinder shapes, the results obtained from the cylinder with dimensions of 100 mm (height) × 100 mm (diameter) are the closest to the actual values. These findings offer technical support for rapid and accurate on-site testing of the rheological parameters of thickened tailings and provide theoretical support for developing disposal methods for tailings.

Vegetation, being a core component of ecosystems, is known to be influenced by natural and anthropogenic factors. This study used the annual mean Normalized Difference Vegetation Index (NDVI) as the vegetation greenness indicator. The variation in NDVI on Hainan Island was analyzed using the Theil–Sen median trend analysis and Mann–Kendall test during 2000–2019. The influence of natural and anthropogenic factors on the driving mechanism of the spatial pattern of NDVI was explored by the Multiscale Weighted Regression (MGWR) model. Additionally, we employed the Boosted Regression Tree (BRT) model to explore their contribution to NDVI. Then, the MGWR model was utilized to predict future greenness patterns based on precipitation and temperature data from different Shared Socioeconomic Pathway (SSP) scenarios for the period 2021–2100. The results showed that: (1) the NDVI of Hainan Island forests significantly increased from 2000 to 2019, with an average increase rate of 0.0026/year. (2) the R2 of the MGWR model was 0.93, which is more effective than the OLS model (R2 = 0.42) in explaining the spatial relationship. The spatial regression coefficients of the NDVI with temperature ranged from −10.05 to 0.8 (p < 0.05). Similarly, the coefficients of Gross Domestic Product (GDP) with the NDVI varied between −5.98 and 3.28 (p < 0.05); (3) The natural factors played the most dominant role in influencing vegetation activities as a result of the relative contributions of 83.2% of forest NDVI changes (16.8% contributed by anthropogenic activities). (4) under SSP119, SSP245, and SSP585 from 2021 to 2100, the NDVI is projected to have an overall decreasing pattern under all scenarios. This study reveals the trend of greenness change and the spatial relationship with natural and anthropogenic factors, which can guide the medium and long-term dynamic monitoring and evaluation of tropical forests on Hainan Island.

Abstract Objectives A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. Methods This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students’ data. Results We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest–posttest differences in students’ readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students’ social interaction anxiety after the IPE simulation. Conclusions The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education.

Colorectal cancer is a leading cause of cancer-related mortality worldwide. Approximately 3–5% of colorectal tumors harbor human epidermal growth factor receptor ( HER2 ) amplification which is associated with a higher incidence of intracranial metastasis and overall worse outcomes. In the setting of refractory metastatic RAS wild-type tumors, evidence supports the use of various HER2-blocking agents, including monoclonal antibodies, tyrosine kinase inhibitors, and novel antibody–drug conjugates. With a number of relatively active agents clinically available and even more in development, it is crucial for clinicians to familiarize themselves with the mechanisms of action, efficacy data, and safety profiles of these treatments. In this review, we aim to summarize key findings from past and ongoing trials with anti-HER2 agents in metastatic colorectal cancer.

ABSTRACTBackground Achievement emotions have been proven as important indicators of students’ academic performance in traditional classrooms and beyond. In the online learning contexts, previous studies have indicated that achievement emotions would affect students’ adoption of self-regulated learning strategies and further predict their learning outcomes. However, the pathway regarding how different positive and negative achievement emotions might affect students’ burnout through self-regulated learning among medical students in online learning environments remains unclear. In this study, the aim is to investigate how achievement emotions and self-regulated learning predict burnout among medical students in online education.Methods This study involved 282 medical students who had attended online courses due to the sudden shift of learning mode caused by the COVID-19 pandemic in 2022. Confirmatory factor analysis was performed to examine the hypothesized factor structure, and structural equation modelling was conducted to test the hypothesized relationships among factors.Results The results of structural equation modelling revealed that medical students’ self-efficacy positively predicted their enjoyment (β = .57) and online self-regulated learning (β = .54). Learning-related boredom inhibited students’ adoption of online self-regulated learning strategies (β = −.24), and it was positively associated with their burnout (β = .54). Learning-related anxiety was a positive predictor of online self-regulated learning (β = .38).Discussions The results of this study suggest that achievement emotions experienced by medical students had a significant impact on their online self-regulated learning and burnout. Specifically, the experience of learning-related boredom was detrimental to the adoption of self-regulated learning strategies and increased the likelihood of burnout. However, learning-related anxiety, despite being a negative achievement emotion, was positively associated with students’ online self-regulated learning. These findings have important implications for online teaching and learning, particularly in the post-pandemic era.

ABSTRACTIntroduction Online interprofessional education is a collaborative process that emphasizes both individual reflection and shared discourses. A useful analytical tool for understanding the complex dynamics of online collaborative learning is the community of inquiry (CoI) framework, which originally held that there are three types of presence in such learning: teaching, cognitive, and social. However, it was later revised to include learning presence, which is characterized by self-regulated learning. Our study aims to refine the construct of learning presence through a clearer understanding of how self- and co-regulation jointly influence learning outcomes.Methods We surveyed 110 people involved with an online interprofessional medical-education curriculum at a university in Hong Kong. Path analysis was adopted to explore the relationships among 1) the three original presences of CoI; 2) learning presence (i.e., for this purpose, a combination of self-regulation and co-regulation); and 3) two learning outcomes: perceived progress and learner satisfaction.Results The results of path analysis indicated that teaching presence had a significant indirect effect, through co-regulation, on perceived progress. In terms of direct relationships, co-regulation significantly and positively influenced both self-regulation and cognitive presence; and social presence had both positive influence on learners’ satisfaction and perceived progress.Discussion This study’s findings suggest the important role of co-regulation in supporting self-regulation, especially in online collaborative-learning environments. Learners’ self-regulation skills are shaped by their social interactions and regulatory activities with others. This further implies that health-professions educators and instructional designers should create learning activities that facilitate the development of co-regulatory skills, as a means of improving learning outcomes. As self-regulation is an important skill for health professions learners’ lifelong learning, and because their future workplaces will be interdisciplinary in nature, it is critical to provide interactive and collaborative learning environments that will promote co-regulation and self-regulation.

AbstractBackground Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE.Method This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis.Results CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p

IntroductionThe global spread of the COVID-19 has brought about global changes, especially in terms of economic growth. Therefore, it has become a global issue to explore the impact of public health security on the economy.MethodsEmploying a dynamic spatial Durbin model, this study analyzes the spatial linkage mechanism of medical level, public health security, and economic climate in 19 countries as well as investigates the relationship between economic climate and COVID-19 by the panel data of 19 OECD European Union countries from March 2020 to September 2022.ResultsResults show that an improvement in the medical level can reduce the negative impact of public health security on the economy. Specifically, there is a significant spatial spillover effect. The degree of economic prosperity hurts the reproduction rate of COVID-19.DiscussionPolicymakers should consider both the severity of the public health security issues and the economic level when developing prevention and control policies. Given this, corresponding suggestions provide theoretical support for formulating policies to reduce the economic impact of public health security issues.

Abstract Background Twitter has gained increasing popularity and attention as a professional learning environment to share knowledge, exchange information, make connections, and build networks. To evaluate the effectiveness of Twitter-facilitated online discussions, a community of inquiry framework could be used with the three key elements of online environments: cognitive presence, social presence, and teaching presence. This study aims to explore how medical educators participate in synchronous online discussions on Twitter using #MedEdChat, and how participants’ perceptions toward the three presences, sense of connectedness and interactions influenced their online satisfaction. Methods A survey invitation was emailed using the medical education email list DR-ED and was posted during the weekly Twitter conversations in December 2020, to solicit participants who have been involved in any kind of #MedEdChat activities (i.e., read transcripts or directly participate in discussions). Results A total of 68 people responded. Through descriptive analysis and path analysis, we found that almost half of the survey respondents were lurkers on #MedEdChat who read others’ tweets or transcripts. In addition, participants mainly used Twitter for resource sharing, collaborating with others, and networking. Participants rated teaching (i.e., moderator) presence the highest, followed by overall satisfaction, cognitive presence, sense of connectedness, social presence, and interactions. Among them, sense of connectedness and cognitive presence were significantly associated with participants’ overall satisfaction. Conclusions This study provided significant implications for using Twitter as a professional learning community to conduct online discussion activities. Facilitators could think of ways to improve participation by providing tutorials on how to participate on Twitter discussions, introduce or ask new participants to introduce themselves, facilitate discussion with intriguing questions, and invite medical educators of different roles as well as medical students and residents to join to bring in diverse perspectives.

Abstract Thermal stress impacts various engineering fields significantly, such as aerospace and precision instruments. This adverse effect can be greatly reduced, if not eliminated, by the application of micro-thermal expansion materials, and bi-material beams are widely utilized in the design of micro-thermal expansion structures, thereby exhibiting great application potentials. The elasticity solution of bi-material curved beam under free thermal expansion has been proposed by scholars. Based on this solution, the simplified form is proposed in this paper, and extended to the case where the rotation angles at both ends of the circular arc are constrained under thermal loads. Besides, the geometric parameters and the nonlinear problems of the thermal expansion of bi-material curved beam are analyzed. In addition, a novel type of negative thermal expansion material has been designed by applying the bi-material curved beam to the tetra chiral and anti-tetra chiral materials. The proposed material has greater negative thermal expansion effect than the traditional tetra and anti-tetra chiral materials that are with straight beams.

Abstract Background To investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) was used to correct rigid thoracolumbar kyphotic deformities in patients with ankylosing spondylitis (AS). Methods Eighteen AS patients underwent TOWO to correct rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at the last follow-up. The SRS-22 questionnaire was given before surgery and at the last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. Results The mean operating time and estimated blood loss were 236 min and 595 ml, respectively. The mean preoperative sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT) and thoracolumbar kyphosis (TLK) were 158.97 mm, 51.24 mm, 43.63 mm and 41.74 mm, respectively, and decreased to 66.72 mm, 35.96 mm, 27.21 mm and 8.67 mm at the last follow-up. The mean preoperative lumbar lordosis (LL) and sacral slope (SS) were 8.30 ± 24.43 mm and 19.67 ± 9.40 mm, respectively, which increased to 38.23 mm and 28.13 mm at the last follow-up. The mean height of the anterior column of osteotomized vertebrae increased significantly from 25.17 mm preoperatively to 37.59 mm at the last follow, but the height of the middle column did not change significantly. SRS-22 scores were improved significantly at the last follow-up compared with preoperatively. Solid bone union was achieved in all patients after 12 months of follow-up, and no screw loosening, screw removal or rod breakage was noticed at the last follow-up. Conclusions TOWO could achieve satisfactory kyphosis correction by opening the anterior column instead of vertebral body decancellation and posterior column closing, thus simplifying the osteotomy procedure and improving surgical efficacy.

Under the background of economic globalization and COVID-19, online shopping has gradually replaced offline shopping as the main shopping mode. In this paper, consumers’ perceptions are introduced into the traditional BCG matrix to form a new BCG matrix, and according to it, the small gifts of a gift e-commerce platform are classified. We then performed a robustness test comparing the BCG matrix with K-means clustering. We found that new BCG matrix can objectively reflect the value of small gifts and provide suggestions for the e-commerce platform to make subsequent product decisions. Then we judge the customer value of the platform based on the improved RFM model and K-means++ clustering, and provide a reasonable customer value classification method for the e-commerce platform. Finally, we comprehensively consider the relationship between the commodity value and customer value, and analyze the preferences of different types of customer groups for different types of small gifts. Our research result shows that small gifts can be divided into 4 categories according to commodity value, namely “stars,” “cash cows,” “questions marks,” and “dogs.” These four categories of small gifts can be converted into each other through marketing ploys. Customers can be divided into important retention customers, key loyal customers and general development customers according to their values. Faced with different types of customers, managers can adopt different strategies to extract customer value. However, consumer psychology will affect consumer cognition, and different types of consumers prefer different types of small gifts, so the precise implementation of marketing strategies will effectively improve the profitability of the gift e-commerce platform. Compared with the traditional classification method, the commodity business value classification method proposed in this paper uses management analysis and planning methods, and introduces consumer psychological factors into the commodity and customer classification, so that the classification results are more credible. In addition, we jointly analyze the results of commodity value classification and customer value classification, and analyze in detail the preferences of different valued customer groups for different types of commodities, so as to provide directions for subsequent research on customer preference.

Chromothripsis is associated with unfavourable outcomes in multiple myeloma (MM), but its detection usually requires whole genome sequencing. Here the authors develop an approach to detect chromothripsis in MM based on copy-number signatures that also works with whole exome sequencing data.

The factors that are associated with myeloma precursor condition progression are not well understood. Here the authors find that monoclonal gammopathies of undetermined significance and smoldering myelomas that did not progress to multiple myelomas have a distinct genomic profile and emerge later in the patient’s life.

Tailings pond engineering is a complex and extensive system with many risk factors that can trigger a dam failure. It is important to clarify the evolutionary relationships among the factors and to enhance effective management to reduce the risk of dam failure. In this paper, an effective and reliable method for analyzing the evolution of tailings pond dam failure risk by combining DEMATEL and MISM is proposed. Firstly, 35 risk factors affecting tailings pond failure were summarized. An index system for evaluating the imfluence factors of dam failure was constructed from four aspects: personnel, management, environment, and system. Secondly, the Decision-making Trial and Evaluation Laboratory (DEMATEL) was used to study the influence relationships among the factors, for analyzing and identifying the key causal factors. Subsequently, the Modified Interpretative Structural Model Method (MISM) was used to classify the cause factors into five levels of influence as well as to determine the degree of integrated influence between the risk factors. Finally, an evolutionary model of tailings pond dam failure risk was constructed based on the results of the analysis. The results of the study indicated the followings: 1) System risk accounted for 58.58% of the total weight, while personnel risk accounts for 15.51%. To maintain the stability of the tailings pond system, personnel risk should not be neglected in addition to focusing on systemic factors. 2) Rainfall intensity was an essential causal factor. Focusing on rainfall intensity and taking appropriate measures effectively reduced the risk of dam failure. The height of the dam and the depth of the seepage line accounted for a large proportion of the causal factors, making it possible to control the height of the dam and accurately monitor the depth of the seepage line to improve the stability of the dam. 3) In the tailings pond dam risk evolution model, there were 30 factors with higher mutability and correlation, which played a transitional role in risk transfer. A risk factor transfer network diagram was established for this purpose as a diagnostic map. The research results can provide new methods and ideas for tailings dam failure risk analysis research and practice.

Doxorubicin induces severe cardiotoxicity, accompanied by the high level of bilirubin in the blood. The conventional wisdom is that bilirubin is considered as a marker of liver damage. By contrast, here we aim to explore the potential protective effect of bilirubin on doxorubicin-induced cardiotoxicity, and investigate the mechanism for drug development. Doxorubicin was used to establish cardiotoxicity model in vitro and in vivo. The electrocardiogram (ECG), echocardiography and molecular biological methods were used to detect the effects of bilirubin on doxorubicin-induced cardiotoxicity. Consecutive intraperitoneal injection of bilirubin for 7 days significantly attenuated doxorubicin-induced arrhythmia, prolonged survival time and reduced the levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase MB (CK-MB) and α-hydroxybutyrate dehydrogenase (α-HBDH) in mice. Bilirubin also markedly inhibited doxorubicin-induced phosphorylation of c-Jun N-terminal kinase (JNK) and connexin 43 (Cx43), and improved gap junction function in vitro and in vivo. In addition, bilirubin activated adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK) and induced suppressor of cytokine signaling 3 (SOCS3) expression, which was abolished by Axl inhibition. Moreover, pretreatment with AMPK agonist or AMPK inhibitor could mimic or abolish the cardioprotective effect of bilirubin on H9C2 cells in vitro, respectively. Altogether, bilirubin upregulates gap junctions’ function to protect against doxorubicin-induced cardiotoxicity by activating AMPK-Axl-SOCS3 signaling axis. We enrich the physiological function of bilirubin, and provide theoretical support for drug development.

The construction period of most tailing ponds generally lasts for more than 10 years or even decades. During this period, it may be affected by more than one earthquake and is often subjected to vibrations generated by mining activities. The tailings liquefied by earthquakes or vibrations may experience dynamic loads again. Due to the low permeability of tailings, the reconsolidation process of tailings after liquefaction is prolonged. Therefore, changes in the nature of the tailings caused by previous earthquakes will affect the performance of the tailing dam in the subsequent earthquakes. Dynamic triaxial tests and bending element tests were conducted on two kinds of tailings from a copper mine in Southwest China to study this process. The tailing specimens will undergo two consolidation processes and subsequent cyclic loads during the test. The influence of reconsolidation degree, confining pressure, and particle size on the dynamic characteristics and wave velocity of the tailings after liquefaction under cyclic loading was measured. The results show that the reconsolidation degree significantly affects the trend of the excess pore water pressure ratio changing with the increase in the cycle number of loads. The reconsolidation process after liquefaction of tailings will improve its liquefaction resistance. The relationship between the ratio of the cycle number of liquefaction after reconsolidation to the cycle number of first liquefaction and the reconsolidation degree is proposed. In the entire experimental process, the shear wave velocity of the tailings gradually decreases when applying the cyclic load and gradually increases during the consolidation process, including the first consolidation before cyclic loading and reconsolidation after liquefaction. The research results are of great significance to the safe disposal of tailings, especially those in earthquake-prone areas.

Abstract Background Mounting evidence has demonstrated the vital importance of tumor-associated macrophages (TAMs) and exosomes in the formation of the premetastatic niche. However, the molecular mechanisms by which tumor-derived exosomal miRNAs interact with TAMs underlying premetastatic niche formation and colorectal cancer liver metastasis (CRLM) remain largely unknown. Methods Transmission electron microscopy and differential ultracentrifugation were used to verify the existence of exosomes. In vivo and in vitro assays were used to identify roles of exosomal miR-934. RNA pull-down assay, dual-luciferase reporter assay, etc. were applied to clarify the mechanism of exosomal miR-934 regulated the crosstalk between CRC cells and M2 macrophages. Results In the present study, we first demonstrated the aberrant overexpression of miR-934 in colorectal cancer (CRC), especially in CRLM, and its correlation with the poor prognosis of CRC patients. Then, we verified that CRC cell-derived exosomal miR-934 induced M2 macrophage polarization by downregulating PTEN expression and activating the PI3K/AKT signaling pathway. Moreover, we revealed that hnRNPA2B1 mediated miR-934 packaging into exosomes of CRC cells and then transferred exosomal miR-934 into macrophages. Interestingly, polarized M2 macrophages could induce premetastatic niche formation and promote CRLM by secreting CXCL13, which activated a CXCL13/CXCR5/NFκB/p65/miR-934 positive feedback loop in CRC cells. Conclusions These findings indicate that tumor-derived exosomal miR-934 can promote CRLM by regulating the crosstalk between CRC cells and TAMs. These findings reveal a tumor and TAM interaction in the metastatic microenvironment mediated by tumor-derived exosomes that affects CRLM. The present study also provides a theoretical basis for secondary liver cancer.

Abstract Background The flipped-classroom model is increasingly being adopted in competency-based medical education. However, it poses a major challenge to students who have not mastered self-regulated learning strategies. This study explores which self-regulated learning skills affect student learning performance in the first 2 years of medical school at a university in the midwestern United States. Methods Survey data were used to assess how 146 first- and second-year medical students’ use of self-regulated learning strategies affected their performance on standardized tests. Results Based on the results of regression analysis and content analysis, it was found that the use of peer learning and help-seeking positively affected the performance of first- and second-year students, respectively; whereas the use of rehearsal had a negative effect on student learning outcomes. Conclusions The study findings imply that during the transition period from traditional lecture-intensive learning to flipped-classroom learning, promoting peer learning and help-seeking could significantly improve students’ academic achievement.

BACKGROUND Twitter offers opportunities to share resources, engage in online discussions, and network with other professionals. In medical education, Twitter is also being used for professional development. Little is known about the level of engagement in topical chats related to medical education. This study explores how medical educators participated and engaged in Twitter-facilitated discussion activity using #MedEdChat. METHODS All twitter chat transcripts using the hashtag #MedEdChat from Thursday night synchronous discussions were collected between January and December 2019. A total of 37 discussion topics were included. To answer the first research question about the overall participation, descriptive statistics were used to analyze the number of participants, posts, retweets, and interactions for each week's discussion. To answer the second question about types of discussion participants engaged in during weekly chats, a combination of top-down and bottom-up coding strategy was adopted with three categories: functional, social, and content. RESULTS This study identified five themes from #MedEdChat discussions: curriculum, faculty development, scholarship, assessment, and general medical education topics. All discussions had an average of 26 participants, with an average of 145 total posts, including 37 original posts, 52 retweets, and 56 interactions (mentions or replies using @). In terms of types of discussion, content-related tweets were most frequently posted, followed by functional and social tweets. CONCLUSION By identifying the patterns of participation and content of discussions, preliminary findings suggest implications for future study to further explore the social interactions and knowledge building processes among online participants in the Twitter-facilitated medical education online community.

IntroductionThis study explores how tutors and tutees perceived their teaching and learning experience in a near-peer teaching programme within a formal undergraduate medical-education curriculum.MethodsThis mixed-methods study was conducted in an Asian medical school. First, a survey was administered to two groups of students, one that had been tutored by near-peers, and another with faculty tutors. Then, the near-peer tutors were interviewed and wrote reflection essays that the researchers collected. Quantitative analysis was used to analyse the survey responses, and qualitative analysis to analyse the interview and reflection data.ResultsOur study found no difference between near-peer tutees' and faculty tutees' perceptions of either tutor facilitation or tutor behaviours. Also, when near-peer tutors explained how their experience of delivering tutoring had influenced their professional-identity formation, they highlighted that they had gained skills important to their future careers as medical educators.ConclusionIntegrating near-peer teaching into undergraduate medical curricula could be beneficial to both tutors and tutees because of the social, cognitive, and professional congruence between these two groups, and due to its likely positive influence on their professional-identity formation.

Abstract Liver metastasis of colorectal cancer (CRLM) is the most common cause of CRC‐related mortality, and is typically caused by interactions between CRC cells and the tumour microenvironment (TME) in the liver. However, the molecular mechanisms underlying the crosstalk between tumour‐derived extracellular vesicle (EV) miRNAs and the TME in CRLM have yet to be fully elucidated. The present study demonstrated that highly metastatic CRC cells released more miR‐181a‐5p‐rich EVs than cells which exhibit a low metastatic potential, in‐turn promoting CRLM. Additionally, we verified that FUS mediated packaging of miR‐181a‐5p into CRC EVs, which in‐turn persistently activated hepatic stellate cells (HSCs) by targeting SOCS3 and activating the IL6/STAT3 signalling pathway. Activated HSCs could secrete the chemokine CCL20 and further activate a CCL20/CCR6/ERK1/2/Elk‐1/miR‐181a‐5p positive feedback loop, resulting in reprogramming of the TME and the formation of pre‐metastatic niches in CRLM. Clinically, high levels of serum EV containing miR‐181a‐5p was positively correlated with liver metastasis in CRC patients. Taken together, highly metastatic CRC cells‐derived EVs rich in miR‐181a‐5p could activate HSCs and remodel the TME, thereby facilitating liver metastasis in CRC patients. These results provide novel insight into the mechanism underlying liver metastasis in CRC.

Tailings dam is a man-made hazard with high potential energy; dam failure would cause great losses to human lives and properties. However, the limitations of conventional reinforcement methods like geosynthetic make it easy to slide along the weak structural plane. In this paper, we innovatively added basalt fibre (BF) with different lengths (l) and contents (ω) into tailings to study its mechanical and permeation characteristics. The results indicate that BF can improve the shear strength (τ), cohesion (c) and compression index (Cc) of tailings, but it has little effect on internal friction angle (φ). When l is constant, τ, c and Cc are positively correlated with ω. One notable phenomenon is that τ and c do not constantly increase with l when ω is constant, but obtain the maximum under the optimal length of 6 mm. Moreover, when ω > 0.6%, permeability coefficient (k) is greater than that of the original tailings and the sensitivity of c, φ, τ, Cc, k to fibre content is greater than that of length. The research results facilitate the understanding of BF reinforced tailings, and could serve as references for improving the safety of tailings dam and other artificial soil slopes or soil structures.

An amendment to this paper has been published and can be accessed via the original article.

Background: Dermatomyositis (DM) is an idiopathic inflammatory myopathy with various cutaneous manifestations. There is a strong association between DM and malignancy with an estimated 5–7 fold increase in cancer incidence in DM patients compared to the general population. Dermatomyositis as a paraneoplastic manifestation has been reported in several malignancies notably ovarian, gastric, colon, cervical, pancreatic, and lung cancer but rarely in prostate cancer ('Table 1'). Case Presentation: A 64-year-old male with a past medical history of hypertension, gout, and type II diabetes was admitted to the hospital following a mechanical fall after which he sustained shoulder and facial trauma. On further evaluation, the patient was found to have dysphagia, dysphonia, proximal upper extremity and lower extremity weakness, and rashes. The dysphagia began one month prior to presentation and the rashes appeared two months prior. Physical exam was notable for erythematous and scaly-dry skin in V-neck pattern, gottron papules, facial and periorbital erythema with scaly skin, periungual erythema, oropharyngeal salivary pooling, proximal bilateral upper and lower extremity weakness with intact distal extremity strength, and wasting of the bilateral quadriceps and hamstrings. Labs were notable for elevated creatine kinase (CPK) 296, positive Anti-p155/140 antibodies which are directed against transcription intermediate family-1 (TIF-1). Further workup with a computed tomography scan (CT) of the abdomen and pelvis revealed extensive pelvic and abdominal lymphadenopathy, centered in the pelvis, and therefore suspicious for either nodal metastasis from prostate adenocarcinoma versus lymphoma. A right inguinal lymph node biopsy was done and confirmed the diagnosis of metastatic adenocarcinoma of the prostatic primary. Staging workup via bone scan and MRI showed diffuse osseous metastases in the thoracolumbar spine ('Figure 1'). Consequently, the patient was started on Bicalutamide and Leuprolide as therapy for the underlying prostate cancer by the inpatient oncology team. The neurology service was consulted for the muscle weakness and were immediately concerned for dermatomyositis. Hence, they recommended empiric treatment with steroids whish were initiated and a biopsy of the left deltoid muscle was obtained. Biopsy results revealed skeletal muscle with perifascicular atrophy and mild mixed inflammatory infiltrate, suggestive of DM ('Figure 2'). Hence, in the setting of the patient’s clinical presentation confirmed the diagnosis of DM likely paraneoplastic. The patient was started on intravenous immunoglobulins (IVIG) in addition to steroids for treatment of DM. The patient’s hospital course was complicated by worsening dysphagia necessitating percutaneous gastric tube placement (PEG), worsening dysphonia, as well as hypoxic respiratory failure requiring a brief intensive care unit admission and non-invasive positive pressure ventilation. The patient slowly regained his speech and his respiratory status improved. He was able to be discharged to a subacute rehab after 37 days of inpatient stay. The patient is still requiring a PEG tube for feeding but his dysphagia has significantly improved, and his rashes have almost resolved. His muscle strength is slowly recovering. He continues to get IVIG sessions and steroids as well as Leuprolide injections every three months for treatment of his metastatic prostate cancer. His prostate-specific antigen (PSA) a marker that is usually elevated in prostate cancer and was markedly elevated in this patient began to downtrend significantly which usually indicates a positive response to therapy. Conclusion: This case illustrates the importance of screening for an underlying malignancy in any patient presenting with DM. Because of the rarity of DM physicians should maintain a high index of suspicion and screen for more cancers than only those reported to be commonly associated with DM. Cases have shown that systemic manifestations of paraneoplastic DM tend to improve following treatment of the underlying malignancy.

There is a balance between the fluorescence and photothermal properties of fluorescent molecules. Here, the authors report on an NIR-II fluorophore which binds with human serum albumin changing the equilibrium, increasing the photothermal efficiency, and demonstrate application of this for tumour ablation.

Rock-like materials can be used as a filling material to improve the stability of underground engineering substantially. And the optimization of the rock-like material is an effective way to improve the performance of the filling material. Firstly, the AHP-FUZZY comprehensive optimization model was constructed for the complexity and fuzziness of the rock-like filling material ratio optimization. Secondly, according to the mechanical properties of rock-like filling materials under special environment (such as high temperature, high humidity, high stress, and high airtight) in old goaf, mechanical properties of rock-like filling materials were studied with the method of field core and laboratory test, which revealed the variation law of mechanical properties with time, and the regression equation between mechanical parameters and time was established with the method of least squares. Finally, the strength and deformation characteristics of rock-like filling materials were monitored by the monitoring and early warning technology. The results show that the optimal ratio of the rock-like filling materials is “E3”; that is, the cement content is 9%, the ash ratio is 2 : 5, and the mass concentration is 74%. The mass concentration is the main factor that affects the slump of the slurry, and the proportion of fly ash and coal gangue content directly affects the stratification and bleeding rate of the slurry. Reasonably increasing the ash and gangue ratio can significantly improve the workability and water retention of the rock-like filling materials. Also, the amount of composite cementitious material is the main factor that affects the setting time and the strength of the rock-like material. What is more, the special environment in gob is good for each chemical reaction fully in rock-like filling materials and strengthens the gelling property of deformation resisting capability, which can be a benefit for disaster prevention of underground engineering.

Basalt fiber is a new environmentally-friendly material with excellent potential for soil reinforcement in geotechnical engineering construction. This study explores the effects of freeze–thaw cycles on the unconfined compressive strength (UCS) and P-wave velocity (Vp) of lime-stabilized basalt fiber-reinforced loess. Reinforced loess samples with different proportions of basalt fiber and lime were subjected to 0, 1, 5, and 10 freeze–thaw cycles, and their UCS and Vp were subsequently measured. The test results showed that the addition of basalt fiber and lime to loess could enhance strength and improve resistance against freeze–thaw damage, and the freeze–thaw damage of reinforced loess decreases with the increase of basalt fiber content and length. A relationship between UCS and Vp of the reinforced samples was obtained for the same number of freeze–thaw cycles, and this relationship exhibited linear characteristics. The fitting results indicate that the Vp can be used to estimate the UCS after freeze–thaw damage. The research results not only have important practical significance in the application of basalt fiber in geotechnical engineering but also provide a reference for the non-destructive testing of the strength of loess after freeze–thaw cycles.

To identify the water softening mechanisms that caused landslides in Panzhihua Airport, China, property and saturation tests of the mudstones extracted from a representative landslide were proposed. In this paper, water saturation tests were carried out on samples of carbonaceous mudstone collected from the east side of the No. 12 landslide at the airport. A number of different analytical techniques and mechanical tests were used to determine changes in chemical composition, mineral assemblages, and mudstone structural characteristics, including shear strength, after the mudstone had been softened. Three kinds of changes caused by water and three mudstone softening stages are proposed. The results show that the water has a significant influence on the properties of the mudstone, so the stability of the mudstone in the watery period is a big threat to the upper structure. A model for water immersion mudstone strength softening is developed. The model incorporates a permeability coefficient, the hydraulic gradient, and time; the model can be used to determine the mudstone’s shear strength and internal friction angle. This study provides a reference for the study of rock softened by water immersion.

Background: The transition from a traditional lecture-based curriculum to a competency-based curriculum poses significant challenges to both students and faculty in medical schools, especially when the curriculum is implemented in a flipped learning environment. Self-regulated learning (SRL) has been proven to be beneficial for competency-based learning and flipped classroom learning, but medical educators cannot expect our entering medical students to bring in these learning skills automatically. Methods: This study took place in the Michigan State University College of Human Medicine. A new competency-based curriculum was implemented in the fall 2016, focusing on the integration of basic science and clinical experience. Participants in this study were 26 first- and second-year students. By interviewing each student about the learning strategies they use in independent learning before class, we investigated how students use SRL strategies in different phases of learning, and how their adoption of SRL strategies differ across self-perceived achievement groups and years. Results: We found that students frequently use strategies in the stages of planning and reflection, but less frequently during the learning or monitoring phase. Students who perceive themselves as high achieving, and students in their second year of medical school do use more learning strategies during the monitoring stage than their counterparts. Conclusions: Students who lack self-regulation strategies may fail to comprehend or connect ideas in their pre-class learning, which could lead to ineffective learning outcomes during in-class activities. Our study indicated that while medical students, who tend to be successful learners in their undergraduate study, were able to use learning strategies to plan and reflect on their learning, they need more explicit instruction in how to monitor their own learning.

Tibial plateau fractures are multiple fracture patterns associated with soft-tissue injuries. Among which, the combined existence of posterolateral tibial plateau depression fracture with anterior cruciate ligament (ACL) rupture has been reported rarely. Meanwhile, surgical method for the treatment of depression fracture is fairly complex. The aim of this article is to show a case series of this unusual injury pattern and the therapy of posterolateral tibial plateau depression fracture accompanying ACL rupture. In our treatment, arthroscopy assisted reduction of depression fracture and ACL reconstruction reduces surgical trauma and leads to good functional recovery. We also review the current literature.

The use of text chat in synchronous computer-mediated communication (SCMC) could help remedy the widely reported lack of active involvement in online language learning. However, the nuances and complexities of learners' text-chat actions warrant further examination. This exploratory study used observational data collected from 40 students in a graduate-level Academic English course at eight time points across a semester to analyze the functions of text-chat interaction in an SCMC setting and to capture how their text chat changed over time. This led to the identification of five functions of text-chat interaction (i.e. cognition, metacognition, socio-affect, organization, and technology), suggesting that cognitively meaningful learning occurred immediately through such interaction. Over time, there was a decline in the quantity of text-chat interactions. In addition, the patterns of chat between students and the teacher were somewhat different from those observed among students. In the former case, text quantity diminished, especially in the category of cognition; but in the latter, students engaged in more text chat with their peers to show affect, cognitive agreement, and disagreement over time. The study's findings regarding the complex dynamics of an authentic process in SCMC language classrooms have considerable practical value in facilitating interaction in similar language-learning contexts.

Improving the accuracy of material feeding for printed circuit board (PCB) template orders can reduce the overall cost for factories. In this paper, a data mining approach based on multivariate boxplot, multiple structural change model (MSCM), neighborhood component feature selection (NCFS), and artificial neural networks (ANN) was developed for the prediction of scrap rate and material feeding optimization. Scrap rate related variables were specified and 30,117 samples of the orders were exported from a PCB template production company. Multivariate boxplot was developed for outlier detection. MSCM was employed to explore the structural change of the samples that were finally partitioned into six groups. NCFS and ANN were utilized to select scrap rate related features and construct prediction models for each group of the samples, respectively. Performances of the proposed model were compared to manual feeding, ANN, and the results indicate that the approach exhibits obvious superiority to the other two methods by reducing surplus rate and supplemental feeding rate simultaneously and thereby reduces the comprehensive cost of raw material, production, logistics, inventory, disposal, and delivery tardiness compensation.

Accurate prediction of material feeding before production for a printed circuit board (PCB) template can reduce the comprehensive cost caused by surplus and supplemental feeding. In this study, a novel hybrid approach combining fuzzy c-means (FCM), feature selection algorithm, and genetic algorithm (GA) with back-propagation networks (BPN) was developed for the prediction of material feeding of a PCB template. In the proposed FCM−GABPN, input templates were firstly clustered by FCM, and seven feature selection mechanisms were utilized to select critical attributes related to scrap rate for each category of templates before they are fed into the GABPN. Then, templates belonging to different categories were trained with different GABPNs, in which the separately selected attributes were taken as their inputs and the initial parameter for BPNs were optimized by GA. After training, an ensemble predictor formed with all GABPNs can be taken to predict the scrap rate. Finally, another BPN was adopted to conduct nonlinear aggregation of the outputs from the component BPNs and determine the predicted feeding panel of the PCB template with a transformation. To validate the effectiveness and superiority of the proposed approach, the experiment and comparison with other approaches were conducted based on the actual records collected from a PCB template production company. The results indicated that the prediction accuracy of the proposed approach was better than those of the other methods. Besides, the proposed FCM−GABPN exhibited superiority to reduce the surplus and/or supplemental feeding in most of the case in simulation, as compared to other methods. Both contributed to the superiority of the proposed approach.

As one of the largest artificial geotechnical structures on earth, the tailings dams are classified as one of the high-risk sources in China’s industry. How to improve the stability and safety of tailings dams remains a challenge for mine operators currently. In this paper, an innovative method is presented for improving the stability of tailings dams, in which the basalt fiber is used to reinforce tailings. The mechanical properties of tailings used for dam-construction have a great influence on the stability of tailings dam. In order to investigate the mechanical performance of basalt fiber-reinforced tailings (BFRT), a series of laboratory triaxial tests were conducted. The effects of five parameters (fiber length, fiber content, particle size, dry density and confining pressure) on the mechanical properties of BFRT were studied. The microstructure and the behavior of interfaces between basalt fibers and tailings particles were analyzed by using scanning electron microscopy (SEM). The triaxial experimental test results show that the mechanical properties of BFRT increase with the increases of fiber length and content, particle size, dry density and confining pressure. The SEM results indicate that the interfacial interaction between fibers and tailings particles is mainly affected by particle shape.

Identifying the printed circuit board (PCB) orders with high reorder frequency for batch production can facilitate production capacity balance and reduce cost. In this paper, the repeated orders identification problem is transformed to a reorder level prediction problem. A prediction model based on a modified Bayesian network (BN) with Monte Carlo simulations is presented to identify related variables and evaluate their effects on the reorder level. From the historically accumulated data, different characteristic variables are extracted and specified for the model. Normalization and principal component analysis (PCA) are employed to reduce differences and the redundancy of the datasets, respectively. Entropy minimization based binning is presented to discretize model variables and, therefore, reduce input type and capture better prediction performance. Subsequently, conditional mutual information and link strength percentage are combined for the establishment of BN structure to avoid the defect of tree augmented naïve BN that easily misses strong links between nodes and generates redundant weak links. Monte Carlo simulation is conducted to weaken the influence of uncertainty factors. The model’s performance is compared to three advanced approaches by using the data from a PCB manufacturer and results demonstrate that the proposed method has high prediction accuracy.

Data mining (DM) with Big Data has been widely used in the lifecycle of electronic products that range from the design and production stages to the service stage. A comprehensive analysis of DM with Big Data and a review of its application in the stages of its lifecycle will not only benefit researchers to develop strong research themes and identify gaps in the field but also help practitioners for DM application system development. In this paper, a brief clarification of DM-related topics is presented first. A flowchart of DM and the main content of the flowchart steps are given in which commonly used data preparation and preprocessing approaches, DM functions and techniques, and performances indicators are summarized. Then, a comprehensive review covering 105 articles from 2007 to 2017 on DM or Big Data applications in the electronics industry is provided according to the flowchart from various points of view such as data handling, applications of DM, or Big Data at different lifecycle stages, and the software used in the applications. On this basis, a diagram of data content for different knowledge areas and a framework for DM and Big Data applications in the electronics industry are established. Finally, conclusions and future research directions are given.