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ABSTRACTPreviously, we reported a cohort of Japanese encephalitis (JE) patients with Guillain–Barré syndrome. However, the evidence linking Japanese encephalitis virus (JEV) infection and peripheral nerve injury (PNI) remains limited, especially the epidemiology, clinical presentation, diagnosis, treatment, and outcome significantly differ from traditional JE. We performed a retrospective and multicenter study of 1626 patients with JE recorded in the surveillance system of the Chinese Center for Disease Control and Prevention, spanning the years 2016–2020. Cases were classified into type 1 and type 2 JE based on whether the JE was combined with PNI or not. A comparative analysis was conducted on demographic characteristics, clinical manifestations, imaging findings, electromyography data, laboratory results, and treatment outcomes. Among 1626 laboratory confirmed JE patients, 230 (14%) were type 2 mainly located along the Yellow River in northwest China. In addition to fever, headache, and disturbance of consciousness, type 2 patients experienced acute flaccid paralysis of the limbs, as well as severe respiratory muscle paralysis. These patients presented a greater mean length of stay in hospital (children, 22 years [range, 1–34]; adults, 25 years [range, 0–183]) and intensive care unit (children, 16 years [range, 1–30]; adults, 17 years [range, 0–102]). The mortality rate was higher in type 2 patients (36/230 [16%]) compared to type 1 (67/1396 [5%]). The clinical classification of the diagnosis of JE may play a crucial role in developing a rational treatment strategy, thereby mitigating the severity of the disease and potentially reducing disability and mortality rates among patients.

The death of cells can occur through various pathways, including apoptosis, necroptosis, mitophagy, pyroptosis, endoplasmic reticulum stress, oxidative stress, ferroptosis, cuproptosis, and disulfide-driven necrosis. Increasing evidence suggests that mitophagy and ferroptosis play crucial regulatory roles in the development of stroke. In recent years, the incidence of stroke has been gradually increasing, posing a significant threat to human health. Hemorrhagic stroke accounts for only 15% of all strokes, while ischemic stroke is the predominant type, representing 85% of all stroke cases. Ischemic stroke refers to a clinical syndrome characterized by local ischemic-hypoxic necrosis of brain tissue due to various cerebrovascular disorders, leading to rapid onset of corresponding neurological deficits. Currently, specific therapeutic approaches targeting the pathophysiological mechanisms of ischemic brain tissue injury mainly include intravenous thrombolysis and endovascular intervention. Despite some clinical efficacy, these approaches inevitably lead to ischemia-reperfusion injury. Therefore, exploration of treatment options for ischemic stroke remains a challenging task. In light of this background, advancements in targeted therapy for cerebrovascular diseases through mitophagy and ferroptosis offer a new direction for the treatment of such diseases. In this review, we summarize the progress of mitophagy and ferroptosis in regulating ischemia-reperfusion injury in stroke and emphasize their potential molecular mechanisms in the pathogenesis. Importantly, we systematically elucidate the role of medicinal plants and their active metabolites in targeting mitophagy and ferroptosis in ischemia-reperfusion injury in stroke, providing new insights and perspectives for the clinical development of therapeutic drugs for these diseases.

Abstract Background Although headache disorders are common, the current diagnostic approach is unsatisfactory. Previously, we designed a guideline-based clinical decision support system (CDSS 1.0) for diagnosing headache disorders. However, the system requires doctors to enter electronic information, which may limit widespread use. Methods In this study, we developed the updated CDSS 2.0, which handles clinical information acquisition via human–computer conversations conducted on personal mobile devices in an outpatient setting. We tested CDSS 2.0 at headache clinics in 16 hospitals in 14 provinces of China. Results Of the 653 patients recruited, 18.68% (122/652) were suspected by specialists to have secondary headaches. According to “red-flag” responses, all these participants were warned of potential secondary risks by CDSS 2.0. For the remaining 531 patients, we compared the diagnostic accuracy of assessments made using only electronic data firstly. In Comparison A, the system correctly recognized 115/129 (89.15%) cases of migraine without aura (MO), 32/32 (100%) cases of migraine with aura (MA), 10/10 (100%) cases of chronic migraine (CM), 77/95 (81.05%) cases of probable migraine (PM), 11/11 (100%) cases of infrequent episodic tension-type headache (iETTH), 36/45 (80.00%) cases of frequent episodic tension-type headache (fETTH), 23/25 (92.00%) cases of chronic tension-type headache (CTTH), 53/60 (88.33%) cases of probable tension-type headache (PTTH), 8/9 (88.89%) cases of cluster headache (CH), 5/5 (100%) cases of new daily persistent headache (NDPH), and 28/29 (96.55%) cases of medication overuse headache (MOH). In Comparison B, after combining outpatient medical records, the correct recognition rates of MO (76.03%), MA (96.15%), CM (90%), PM (75.29%), iETTH (88.89%), fETTH (72.73%), CTTH (95.65%), PTTH (79.66%), CH (77.78%), NDPH (80%), and MOH (84.85%) were still satisfactory. A patient satisfaction survey indicated that the conversational questionnaire was very well accepted, with high levels of satisfaction reported by 852 patients. Conclusions The CDSS 2.0 achieved high diagnostic accuracy for most primary and some secondary headaches. Human–computer conversation data were well integrated into the diagnostic process, and the system was well accepted by patients. The follow-up process and doctor–client interactions will be future areas of research for the development of CDSS for headaches.

Abstract The coexistence of hemicrania‐continua and trigeminal neuralgia is called HC‐tic syndrome. We describe a case of an elderly man who suffered both types of headache related to fungal sphenoiditis. This is the first case to be reported, to the best of our knowledge.

BIM maturity models have become a significant method used to show the development stage of building information modeling (BIM) and to assist in measuring BIM capability. However, most of the existing maturity models focus on the evaluation technology, but the effect of BIM is not only related to technology, and most of them are mostly used for a comprehensive evaluation of BIM capability after the event. In this paper, for the purpose of comprehensive preevaluation of BIM application maturity of the project, considering the temporary characteristics of the project, based on Nolan’s growth stage model, from the perspective of technology, social environment, and project participants, a BIM application maturity model (BIM-AMM) including 10 measurement indicators is proposed. The model integrates the Barrel Principle in accordance with the characteristics of a single project. The conditions of BIM implementation are evaluated in advance, and specific deficiencies of BIM implementation are identified; then, BIM decision-making is determined for the project. Finally, an actual project is taken as the application demonstration case of BIM-AMM, and according to the results, the obstacles faced by the project organization in adopting BIM technology and the improvement strategies are put forward. The research results further expand the BIM maturity research to the early stage of the project and provide new ideas for BIM maturity research.

Abstract Background Cluster headache (CH), a rare primary headache disorder, is currently thought to be a genetic susceptibility which play a role in CH susceptibility. A large numbers of genetic association studies have confirmed that the HCRTR2 (Hypocretin Receptor 2) SNP rs2653349, and the ADH4 (Alcohol Dehydrogenase 4) SNP rs1126671 and rs1800759 polymorphisms are linked to CH. In addition, the CLOCK (Circadian Locomotor Output Cycles Kaput) gene is becoming a research hotspot for CH due to encoding a transcription factor that serves as a basic driving force for circadian rhythm in humans. The purpose of this study was to evaluate the association between CH and the HCRTR2, ADH4 and CLOCK genes in a Chinese CH case–control sample. Methods We genotyped polymorphisms of nine single nucleotide polymorphisms (SNPs) in the HCRTR2, ADH4 and CLOCK genes to perform an association study on a Chinese Han CH case-control sample (112 patients and 192 controls),using Sequenom MALDI-TOF mass spectrometry iPLEX platform. The frequencies and distributions of genotypes and haplotypes were statistically compared between the case and control groups to identify associations with CH. The effects of SNPs on CH were further investigated by multiple logistic regression. Results The frequency of the HCRTR2 SNP rs3800539 GA genotype was significantly higher in cases than in controls (48.2% vs.37.0%). The GA genotypes was associated with a higher CH risk (OR = 1.483, 95% CI: 0.564-3.387, p = 0.038), however, after Bonferroni correction, the association lost statistical significance. Haplotype analysis of the HCRTR2 SNPs showed that among eight haplotypes, only H1-GTGGGG was linked to a reduced CH risk (44.7% vs. 53.1%, OR = 0.689, 95% CI =0.491~0.966, p = 0.030). No significant association of ADH4, CLOCK SNPs with CH was statistically detected in the present study. Conclusions Association between HCRTR2, ADH4,CLOCK gene polymorphisms and CH was not significant in the present study, however, haplotype analysis indicated H1-GTGGGG was linked to a reduced CH risk.

Conflicting data have been reported on the association between tumor necrosis factor (TNF) -308G>A and nitric oxide synthase 3 (NOS3) +894G>T polymorphisms and migraine. We performed a meta-analysis of case-control studies to evaluate whether the TNF -308G>A and NOS3 +894G>T polymorphisms confer genetic susceptibility to migraine.We performed an updated meta-analysis for TNF -308G>A and a meta-analysis for NOS3 +894G>T based on studies published up to July 2014. We calculated study specific odds ratios (OR) and 95% confidence intervals (95% CI) assuming allele contrast, dominant model, recessive model, and co-dominant model as pooled effect estimates.Eleven studies in 6682 migraineurs and 22591 controls for TNF -308G>A and six studies in 1055 migraineurs and 877 controls for NOS3 +894G>T were included in the analysis. Neither indicated overall associations between gene polymorphisms and migraine risk. Subgroup analyses suggested that the "A" allele of the TNF -308G>A variant increases the risk of migraine among non-Caucasians (dominant model: pooled OR = 1.82; 95% CI 1.15 - 2.87). The risk of migraine with aura (MA) was increased among both Caucasians and non-Caucasians. Subgroup analyses suggested that the "T" allele of the NOS3 +894G>T variant increases the risk of migraine among non-Caucasians (co-dominant model: pooled OR = 2.10; 95% CI 1.14 - 3.88).Our findings appear to support the hypothesis that the TNF -308G>A polymorphism may act as a genetic susceptibility factor for migraine among non-Caucasians and that the NOS3 +894G>T polymorphism may modulate the risk of migraine among non-Caucasians.

AimsBased on the quantitative and qualitative fusion data of traditional Chinese medicine (TCM) and Western medicine, a diabetic foot (DF) prediction model was established through combining the objectified parameters of TCM and Western medicine.MethodsThe ResNet-50 deep neural network (DNN) was used to extract depth features of tongue demonstration, and then a fully connected layer (FCL) was used for feature extraction to obtain aggregate features. Finally, a non-invasive DF prediction model based on tongue features was realized.ResultsAmong the 391 patients included, there were 267 DF patients, with their BMI (25.2 vs. 24.2) and waist-to-hip ratio (0.953 vs. 0.941) higher than those of type 2 diabetes mellitus (T2DM) group. The diabetes (15 years vs. 8 years) and hypertension durations (10 years vs. 7.5 years) in DF patients were significantly higher than those in T2DM group. Moreover, the plantar hardness in DF patients was higher than that in T2DM patients. The accuracy and sensitivity of the multi-mode DF prediction model reached 0.95 and 0.9286, respectively.ConclusionWe established a DF prediction model based on clinical features and objectified tongue color, which showed the unique advantages and important role of objectified tongue demonstration in the DF risk prediction, thus further proving the scientific nature of TCM tongue diagnosis. Based on the qualitative and quantitative fusion data, we combined tongue images with DF indicators to establish a multi-mode DF prediction model, in which tongue demonstration and objectified foot data can correct the subjectivity of prior knowledge. The successful establishment of the feature fusion diagnosis model can demonstrate the clinical practical value of objectified tongue demonstration. According to the results, the model had better performance to distinguish between T2DM and DF, and by comparing the performance of the model with and without tongue images, it was found that the model with tongue images performed better.

The NiAl intermetallic compounds have higher service temperature and lower density than traditional Ni-based super-alloy. In this work, for overcoming the fabricating bottleneck of NiAl alloy hollow thin-walled component, a typical NiAl alloy square-section component was obtained by hot gas forming of NiAl laminated tube and conversion. Firstly, the Ni/Al laminated tubes with tight interfacial bonding between layers and considerable plasticity was prepared by controlling the thickness and distribution of intermediate layer (NiAl3 and Ni2Al3). Then, the hot gas forming behavior and micro-damage control method of the Ni/Al laminated square-section component were studied under different process parameters. Finally, the Ni/Al laminated square-section components were converted into NiAl alloy components at 1200 °C/1 h. The results show that the forming temperature and gas pressure loading rate are the key parameters for hot gas forming of Ni/Al laminated materials. At an optimal temperature, the micro-damage can be avoided and the fillet accuracy can be controlled by adjusting the strain rate through using different gas pressure loading rates.

Aims: The objectives of this study were to identify clinical predictors of the Traditional Chinese medicine (TCM) clinical index for diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, develop a clinical prediction model, and construct a nomogram. Methods: We collected the TCM clinical index from 3590 T2DM recruited at the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to October 2020. The participants were randomly assigned to either the training group (n = 3297) or the validation group (n = 1426). TCM symptoms and tongue characteristics were used to assess the risk of developing DPN in T2DM patients. Through 5-fold cross-validation in the training group, the least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection. In addition, using multifactor logistic regression analysis, a predictive model and nomogram were developed. Results: A total of eight independent predictors were found to be associated with the DPN in multivariate logistic regression analyses: advanced age of grading (odds ratio/OR 1.575), smoke (OR 2.815), insomnia (OR 0.557), sweating (OR 0.535), loose teeth (OR 1.713), dry skin (OR 1.831), purple tongue (OR 2.278). And dark red tongue (OR 0.139). The model was constructed using these eight predictor's medium discriminative capabilities. The area under the curve (AUC) of the training set is 0.727, and the AUC of the validation set is 0.744 on the ROC curve. The calibration plot revealed that the model's goodness-of-fit is satisfactory. Conclusions: We established a TCM prediction model for DPN in patients with T2DM based on the TCM clinical index.

Background: Pituitary adenylate cyclase-activating polypeptide (PACAP) plays several important roles in vasodilation, neurotransmission, neuromodulation and neurotrophy, as well as activation of the trigeminovascular system. The aim of the present study was to explore the relationship between altered PACAP levels in peripheral blood and different types of headache. Methods: The present study enrolled 101 outpatients with headache and 35 healthy control volunteers. Blood samples were collected from the cubital vein and peripheral blood mononuclear cells (PBMCs) were separated. Total mRNA in the PBMCs was extracted and the expression of PACAP mRNA was analyzed by quantitative-polymerase chain reaction (Q-PCR). Results: There was a significant decrease in PACAP mRNA expression in the PBMCs of the migraine (M) group relative to the healthy control group. However, there were no significant differences in PACAP mRNA expression between the control group and tension-type headache (TTH), cluster headache (CH), or medication overuse headache (MOH) groups. Conclusion: The PBMC levels of patients with migraine, but not other commonly seen headache types, exhibited a significant reduction in PACAP mRNA expression compared with healthy control subjects. [ABSTRACT FROM AUTHOR]

Objective. Metformin is an important component of PCOS treatment. At present, the effect of metformin in overweight women with PCOS has not been evaluated. Therefore, we conducted a systematic review to assess the effects of metformin in overweight women with PCOS and to analyze the effects of metformin in overweight women with PCOS. Methods. We searched the PubMed, Cochrane Library, Embase, CNKI, VIP, and Wanfang databases for studies published before March 2020. Randomized controlled trials were identified to study the effects of metformin in overweight women with PCOS. Data from studies including body mass index (BMI), waist circumference (WC), follicle-stimulating hormone (FSH), homeostasis model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), triglycerides (TG), fasting blood glucose (FBG), fasting insulin, testosterone, and androstenedione were pooled. Qualified trials were selected, and methodological quality was strictly assessed. Two reviewers chose the studies independently of each other. Results. Twelve trials were included. The intervention group and the control group had significant differences in the changes in body mass index (BMI) (WMD = −1.25, 95% CI (−1.60, −0.91), p

Small cell network is a multi-layer cell network formed by low-power nodes whose base stations transmit power is lower than conventional macrocell base stations. More and more industry attention is pained to the development of small cell which is considered as an important part of LTE-Advanced technology study. The performance of a variety of mobile state estimation scheme in mobility management was analyzed and evaluated and the same work was done on the protection scheme of the switching instruction involved in a cellular switch. A summary was made about challenge and future research directions of small cell mobility management finally.

TiBw/TA15 (TA15 alloy reinforced by TiB whiskers) composites with network microstructures were successfully prepared by current-assisted sintering at 1100 °C for 10 min. The influence of the sintering parameters on the microstructures of obtained composites was investigated. The sintering temperature was the main factor affecting the average aspect ratio of TiBw, and the average diameter of TiBw could be controlled for various sintering conditions. Yield strength, ultimate compressive strength, and plastic strain at ambient temperature are 1172.5 MPa, 1818.4 MPa, and 22.4% for the TiBw/TA15 composites, respectively. Moreover, yield strength of the composites at 600 °C is 616.3 MPa, which is 26.1% higher than that of the TA15 titanium alloy. The effect of the TiBw on the microstructure evolution for the alloy matrix was discussed in detail. The strengthening mechanism of the TiBw/TA15 composites with network microstructure was attributed to the microstructure modification induced by TiBw, load bearing effect, and dislocation strengthening effect of the TiBw.