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Abstract Background The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient’s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA). Methods We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event. Results A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group. Conclusion We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.

Grain temperature is one of the most important factors that affect the safety of grain storage. In order to reveal the distribution rule of grain storage temperature field in semi-underground double-storey squat silos(SUDSSS), the mathematical analysis models of the grain piles of the ground squat silo and the underground silo are established respectively in this paper, and the validity of the models is verified by the field test results. A numerical model of the SUDSSS was established. Through numerical analysis, the temperature field variation rule of the grain pile during the 1-year static storage of the SUDSSS after low-temperature grain storage was acquired by numerical analysis. The research demonstrates that the grain temperature within 2 m of the above-ground part of the SUDSSS close to the silo wall varies significantly because of the influence of the outside air temperature, and the temperature from 10.62 to 27.37 ℃. The grain temperature in the underground part is in a quasi-low temperature state all the year round, and the average temperature does not exceed 17 ℃ of the temperature in the underground constant temperature zone. At the beginning of the winter, a heat accumulation area will be formed in the upper storey of the ground between 1 ~ 3 m from the warehouse wall in a short period of time, leading to a large temperature difference in the grain pile near the warehouse wall, and then the temperature in the peripheral area will slowly decrease, forming a ‘hot core and cold skin’, and the thermal insulation measures of the silo wall can effectively reduce the influence of temperature on the grain temperature. The highest grain temperature in the upper storey in summer is about 3.86 ℃, lower than that of the shallow silo without thermal insulation. The research results can provide technical support for the popularization and application of the SUDSSS.

Background: The occurrence of acne in patients treated with Janus kinase (JAK) inhibitors for skin diseases is a potential issue, which may reduce treatment adherence.Purpose: To systematically analyzes randomized clinical trials (RCTs) of JAK inhibitors in dermatological indications for the risk of acne as an adverse event.Methods: A meta-analysis of odds ratios (ORs) for acne incidence was conducted. Data were quantitatively synthesized using random-effects meta-analysis. Surface under the cumulative ranking curve (SUCRA) values representing the relative ranking probabilities of treatments were obtained. Analyses were performed using R statistical software version 4.4.0.Results: A total of 11,396 patients were included from 24 studies. The incidence of acne for JAK inhibitors was ranked according to the SUCRA as follows: JAK1 inhibitors > TYK2 inhibitors > combined JAK1 and JAK2 inhibitors > combined JAK1 and TYK2 inhibitors > JAK3 + TEC inhibitors > pan-JAK inhibitors. ORs were higher for longer durations of drug use and larger dosages. Subgroup analyses by disease indication revealed increased ORs for psoriasis (5.52 [95% CI, 1.39–21.88]), vitiligo (4.15 [95% CI, 1.27–13.58]), alopecia areata (3.86 [95% CI, 1.58–9.42]), and atopic dermatitis (2.82 [95% CI, 1.75–4.54]). The use of JAK inhibitors in patients with systemic lupus erythematosus (SLE) may not significantly increase the incidence of acne.Conclusions: There are higher rates of acne following treatment with JAK inhibitors for dermatologic indications, particularly with longer durations and larger dosages. Pan-JAK inhibitors exhibit the lowest incidence of acne.

Entomopathogenic fungi (EPF) are economical and environmentally friendly, forming an essential part of integrated pest management strategies. We screened six strains of Beauveria bassiana (B1–B6) (Hypocreales: Cordycipitaceae), of which B4 was the most virulent to Bactrocera dorsalis (Hendel) (Diptera: Tephritidae). We further assessed the biological characteristics of strain B4 and the environmental factors influencing its ability to infect B. dorsalis. We also evaluated the effects of B4 on two of the natural predators of B. dorsalis. We found that strain B4 was the most virulent to 3rd instar larvae, pupae, and adult B. dorsalis, causing mortality rates of 52.67, 61.33, and 90.67%, respectively. B4 was not toxic to B. dorsalis eggs. The optimum B4 effects on B. dorsalis were achieved at a relative humidity of 91–100% and a temperature of 25°C. Among the six insecticides commonly used for B. dorsalis control, 1.8% abamectin emulsifiable concentrate had the strongest inhibitory effect on B4 strain germination. B4 spraying affected both natural enemies (Amblyseius cucumeris and Anastatus japonicus), reducing the number of A. cucumeris and killing A. japonicus adults. We found a valuable strain of EPF (B4) that is virulent against many life stages of B. dorsalis and has great potential for the biological control of B. dorsalis. We also provide an important theoretical and practical base for developing a potential fungicide to control B. dorsalis.

Abstract Background Tetralogy of Fallot (TOF) is a common cyanotic congenital heart malformation that carries a high risk of right-to-left shunting. Anemia is characterized by decreased hemoglobin (Hb) levels that can affect tissue oxygen delivery and impact postoperative recovery in patients. Chronic hypoxia caused by right-to-left shunting of TOF could lead to compensatory increases in Hb to maintain systemic oxygen balance. This study aims to investigate whether preoperative Hb and blood oxygen saturation (SpO2) can predict adverse outcomes in children undergoing corrective surgery for TOF. Methods This retrospective study included patients under 18 years of age who underwent corrective surgery for TOF at Fuwai Hospital between January 2016 and December 2018. Adverse outcomes, including in-hospital death, extracorporeal membrane oxygenation implantation, ICU stay > 30 days, and severe complications, were considered as the primary outcome. Univariable and multivariable logistic analyses were performed to identify independent risk factors for adverse outcomes. Propensity score-matched (PSM) analysis was also conducted to minimize the confounding factors. Results A total of 596 children were included in the study, of which 64 (10.7%) experienced adverse outcomes. Hb*SpO2

Abstract Studies have shown that high humidity is a condition that aggravates the pain of rheumatoid arthritis (RA), but the relevant mechanism is controversial. Currently, there is a lack of experimental animal studies on high humidity as an adverse factor related to the pathogenesis of RA. We used healthy SD rats and collagen-induced arthritis (CIA) rats to investigate the effects of high humidity on arthritis. Integrated metabolomics analyses of faeces and 16S rRNA sequencing of the faecal microbiota were performed to comprehensively assess the diversity of the faecal microbiota and metabolites in healthy and CIA rats. In this study, high humidity aggravated arthritis in CIA rats, which manifested as articular cartilage lesions, increased arthritis scores, and an increase in proinflammatory cytokines. High humidity had a certain effect on the articular cartilage extent, arthritis score and proinflammatory cytokines of healthy rats as well. Furthermore, high humidity caused significant changes in faecal microbes and metabolites in both healthy and CIA rats. 16S rRNA sequencing of faecal samples showed that high humidity increased the amount of inflammation-related bacteria in healthy and CIA rats. Faecal metabolomics results showed that high humidity significantly altered the level of faecal metabolites in healthy rats and CIA rats, and the changes in biological functions were mainly related to the inflammatory response and oxidative stress. Combined analysis showed that there was a strong correlation between the faecal microbiota and faecal metabolites. High humidity is an adverse factor for the onset and development of RA, and its mechanism is related to the inflammatory response and oxidative stress. However, the question of how high humidity impacts RA pathogenesis needs to be further investigated.

HIV-1 envelope glycoprotein gp41 mediates fusion between HIV-1 and host cell membranes, making inhibitors of gp41 attractive anti-HIV drugs. We previously reported an efficient HIV-1 fusion inhibitor, ADS-J1, with a Y-shaped structure. Here, we discovered a new compound, ADS-J21, with a Y-shaped structure similar to that of ADS-J1 but with a lower molecular weight. Moreover, ADS-J21 exhibited effective anti-HIV-1 activity against divergent HIV-1 strains in vitro, including several HIV-1 laboratory-adapted strains and primary isolates with different subtypes (clades A to F) and tropisms (X4 or R5). Mechanistic studies have demonstrated that ADS-J21 blocks the formation of the gp41 six-helix bundle (6-HB) by targeting conserved amino acids Lys35 and Trp32. These findings suggest that ADS-J21 can be used as a new lead compound for further optimization in the development of a small-molecule fusion inhibitor.

To determine a vertical cooperation strategy and address the optimal pricing problem of the electric vehicle (EV) supply chain, a supply chain system consisting of two competing EV manufacturers (M1 and M2) and a battery supplier is studied. Firstly, three cooperation strategy models were constructed for the battery supplier and the EV manufacturers, namely: Strategy N (neither the battery supplier nor the two manufacturers cooperate with each other); Strategy I (M1 cooperates with the battery supplier); and Strategy II (M2 cooperates with the battery supplier). Then, the Stackelberg solution method was used to obtain the optimal equilibrium decisions under the three strategic models. Finally, the effect of the preference coefficient of consumers for leasing EVs per unit on the optimal equilibrium decision was analyzed. We found that: (1) The wholesale price of batteries provided by the battery supplier to M1 is always greater than to M2. (2) Strategies I and II prompt M1 and M2 to reduce the unit and fixed rental prices of EVs to some extent, while intensifying the competition between the two manufacturers in terms of EV lease prices. (3) When the consumer preference coefficient (θ) for leasing EVs per unit provided by manufacturer M1 is relatively small, the cooperation alliance S2 and the supply chain achieve the maximum profit under Strategy II; however, while θ is large, M1, cooperative alliance S1, and the entire supply chain could benefit the most under Strategy I.

Abstract Background This study aimed to evaluate the predictive accuracy of the superior vena cava collapsibility index measured by transesophageal echocardiography and compare the index with stroke volume variation measured by FloTrac™/Vigileo™ in mechanically ventilated patients. Methods In the prospective study, a total of 60 patients were enrolled for elective general surgery under mechanical ventilation, where all patients received 10 ml/kg of Ringer’s lactate. Five kinds of related data were recorded before and after the fluid challenge, including the superior vena cava collapsibility index (SVC-CI), the ratio of E/e’, cardiac index (CI), stroke volume variation (SVV), and central venous pressure (CVP). Based on the collected data after the fluid challenge, we classified the patients as responders (FR group) if their CI increased by at least 15% and the rest were non-responders (NR). Results Twenty-five of 52 (48%) of the patients were responders, and 27 were non-responders (52%). The SVC-CI was higher in the responders (41.90 ± 11.48 vs 28.92 ± 9.05%, P 0.05). The best cutoff value for SVV was 12.5% (sensitivity 40%, specificity 89%) with the AUROC of 0.68 (95% CI 0.53 ~ 0.826, P

Different hydraulic retention times (HRTs) were tested in a mixed anoxic/oxic (A/O) system at 5°C and 10°C to investigate the effects of HRT and carrier on nitrogen removal in wastewater at low temperatures. The results showed that the addition of the fillers improved the treatment effect of each index in the system. With an optimal HRT of 7.5 h at 5°C, the removal efficiencies of NH4+-N and total nitrogen (TN) reached 91.2% and 75.6%, respectively. With an HRT of 6 h at 10°C, the removal efficiencies of NH4+-N and TN were 96.7% and 82.9%, respectively. The results of high-throughput sequencing showed that the addition of the suspended carriers in the aerobic zone could improve the treatment efficiency of nitrogen at low temperatures. The microbial analysis indicated that the addition of the suspended carriers enhanced the enrichment of nitrogen removal bacteria. Nitrospira, Nitrotoga, and Nitrosomonas were found to be the bacteria responsible for nitrification, and their relative concentrations on the biofilm at 5°C and 10°C accounted for 98.11%, 92.79%, and 69.98% of all biological samples, respectively.

Advanced paternal age has been overlooked, and its effect on fertility remains controversial. Previous studies have focused mainly on intracytoplasmic sperm injection (ICSI) cycles in men with oligozoospermia. However, few studies have reported on men with semen parameters within reference ranges. Therefore, we conducted a retrospective cohort study analyzing the reproductive outcomes of couples with non-male-factor infertility undergoing in vitro fertilization (IVF) cycles. In total, 381 cycles included were subgrouped according to paternal age ( 0.05). The pregnancy rate was not significantly different in the 35–39-year-old group (42.0%; P > 0.05), but was significantly lower in the ≥40-year-old group (26.1%; P < 0.05) than that in the 0.05), but showed a declining trend. The miscarriage rate significantly increased in the 35–39-year-old group (44.8%) compared with that in the

This is the first pilot meta-analysis on the association of prenatal phthalate exposure with childhood cardiometabolic risks. A systematic literature search was performed in MEDLINE, Web of Science and CNKI (Chinese National Knowledge Infrastructure) until June 5, 2023. A total of seven studies with 5746 children (2646 girls and 3100 boys) were finally included. Four, three and two studies investigated the effects of maternal phthalate exposure on childhood blood pressure (BP), blood lipids and blood glucose profiles, respectively. The pilot meta-analysis suggested that di-2-ethylhexyl phthalate (DEHP) metabolite exposure was associated with a decrease in childhood z-systolic BP (SBP, β = −0.169, 95% CI = −0.338–0.001). Furthermore, the pooled results showed negative relationships of prenatal ∑DEHP exposure with z-SBP (β = −0.109, 95% CI = −0.163 to −0.055) and z-diastolic BP (DBP, β = −0.126, 95% CI = −0.182 to −0.069) in girls. In addition, MEP exposure was associated with z-SBP in girls (β = −0.227, 95% CI = −0.387 to −0.066). The pooled result showed a positive relationship between prenatal ∑DEHP exposure and triglycerides (β = 0.103, 95% CI = 0.028–0.178). The overall results revealed that exposure to ∑DEHP throughout gestation was associated with a decrease in insulin (β = −0.074, 95% CI = −0.144 to −0.004) and glucose (β = −0.129, 95% CI = −0.199 to −0.058) in boys. Interestingly, there was an inverse relationship of prenatal mono− 3 −carboxypropyl phthalate (MCPP) exposure with glucose in pubertal boys (β = −3.749, 95% CIs = −6.758 to −0.741) but not found in postpubertal children. In conclusion, prenatal phthalate exposure interfered with cardiovascular risk in children with gender-specific differences and was influenced by puberty. Overall, prenatal ∑DEHP was negatively associated with systolic blood pressure in girls and with insulin and glucose in boys but increased the level of triglycerides.

AIM: To evaluate the therapeutic effect of pupilloplasty combined with phacomulsification and intraocular lens implantation (PPI) in uveitis-induced cataract. METHODS: Total 28 patients with uveitis-induced cataract were enrolled. Within 3mo before the PPI, 7 cases accompanied with glaucoma maintained carteolol hydrochloride for lowering intraocular pressure, and 1 case maintained glucocorticoid for anti-inflammation. The baseline characteristics, treatment processes, and outcomes of enrolled cases were retrospectively analyzed. Hematoxylin and eosin (HE) staining was performed to reveal the histopathological changes of iris tissues. RESULTS: Iris hemorrhage was the only intraoperative complication observed in 2 cases. After the surgery, normal intraocular pressure, right position of intraocular lens, and improved visual gain [best corrected visual acuity (BCVA)>0.5] were achieved. Postoperative keratic precipitates was observed in 2 cases, which was recovered within 1wk. During the follow-up of 5-10y, no recurrence of uveitis was found in 27 cases (96.43%). Uveitis only recurred in one case with the onset of ankylosing spondylitis. HE staining showed iris stroma (all samples), pigment cell hyperplasia in pigment epithelium (n=9) and stroma (n=19), inflammatory cell infiltration in iris (n=7), and neovascularization in iris surface (n=2). CONCLUSION: PPI improves the visual gain and prevents the long-term recurrence of uveitis in patients with uveitis-induced cataract, including those with preoperative intraocular pressure abnormality (glaucoma) and inflammation (active uveitis). Uveitis presents stroma atrophy, pigment cell hyperplasia, and inflammatory cell infiltration, even in a quiet state.

Abstract While therapies such as chemotherapy combined with immunotherapy, sacituzumab govitecan, and PARP inhibitors are available for metastatic TNBC, on disease progression after these therapies, the mainstay of therapy is chemotherapy. Apatinib is a small-molecule tyrosine kinase inhibitor that has promising anti-angiogenesis and antitumor activity for TNBC. We aimed to evaluate the safety and efficacy of adding apatinib to chemotherapy in patients with advanced TNBC with failed first/second-line treatment. A total of 66 patients were randomly assigned, in a 1:1 ratio, to receive vinorelbine or vinorelbine with apatinib in 28-day cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. 33 received apatinib plus vinorelbine and 32 received vinorelbine (1 was withdrawal). Median PFS was significantly longer in the apatinib plus vinorelbine group than in the vinorelbine group (3.9 months vs. 2.0 months; hazard ratio, 1.82; 95% confidence interval [CI], 1.06 to 3.11; P = 0.026). Median OS was 11.5 months with apatinib plus vinorelbine and 9.9 months with vinorelbine (HR,1.01; 95% CI, 0.51 to 1.97; P = 0.985). The ORR was 9.1% in the apatinib plus vinorelbine group and 6.3% in the vinorelbine group (P = 0.667). The most common treatment-related hematologic grade 3–4 adverse events in apatinib plus vinorelbine group, were leukopenia, granulocytopenia, anemia, and thrombocytopenia. no treatment-related nonhematologic grade 4 adverse events or treatment-related deaths were observed. Collectively, adding apatinib to vinorelbine shows a promising benefit in PFS compared to vinorelbine monotherapy, with an excellent toxicity profile, warranting further exploration.

BackgroundMultiple systematic reviews and meta-analyses have examined the association between neonatal jaundice and autism spectrum disorder (ASD) risk, but their results have been inconsistent. This may be because the included observational studies could not adjust for all potential confounders. Mendelian randomization study can overcome this drawback and explore the causal relationship between the both.MethodsWe used the data of neonatal jaundice, direct bilirubin (DBIL), indirect bilirubin (IBIL), and ASD collected by genome-wide association study (GWAS) to evaluate the effects of neonatal jaundice, DBIL and IBIL on ASD by using a two-sample Mendelian randomized (MR). The inverse variance-weighted method (IVW) was the main method of MR analysis in this study. Weighted median method, MR-Egger regression and mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analysis.ResultsThere was no evidence of an effect of neonatal jaundice (OR, 1.002, 95% CI, 0.977–1.027), DBIL (OR, 0.970, 95% CI, 0.884–1.064) and IBIL (OR, 1.074, 95% CI, 0.882–1.308) on ASD risk by IVW test. In the weighted median method, MR-Egger regression and leave-one-out analysis, the results were robust and no heterogeneity or pleiotropy was observed.ConclusionsWe found that neonatal jaundice, DBIL and IBIL were not associated with ASD in this study. However, this paper did not explore the effect of severity and duration of jaundice on ASD in different ethnic populations, which may require further research.

Objective: The optimal dose of epidural morphine after cesarean section (CS) still remains unknown when combined with low-concentration ropivacaine based on a continuous basal infusion (CBI) mode. The aim of this study was to assess the impact of different dose of epidural morphine plus ropivacaine on maternal outcomes.Materials and methods: Data of parturients who received epidural analgesia for CS at a teaching hospital from March 2021 to June 2022 were retrospectively collected. Parturients were divided into two groups (RM3 group and RM6 group) according to different medication regimens of morphine. The implementation of epidural analgesia was performed with 3 mg morphine in RM3 group and 6 mg morphine in RM6 group in combination with 0.1% ropivacaine via a CBI pump. The primary outcomes included pain intensity at rest and movement and the incidence of urinary retention and pruritus within postoperative 48 h. The secondary outcomes included the incidence and severity of postoperative nausea and vomiting (PONV) and pruritus, the rate of rescue analgesia and grading of motor Block.Results: Totally, 531 parturients were eligible for the final analysis, with 428 and 103 parturients in the RM3 group and RM6 group, respectively. There were no statistically significant differences in the visual analogue scores (VAS) at rest and movement within postoperative 48 h between the two groups (all p > 0.05). Compared with the RM6 group, the incidence of urinary retention was lower in the RM3 group within 48 h after CS (4.0% vs. 8.7%, p = 0.044). No significant difference was found in the incidence and severity of PONV and pruritus, the rate of rescue analgesia and grading of motor block between RM3 and RM6 groups.Conclusion: Epidural 3 mg morphine plus 0.1% ropivacaine in a CBI mode can provide equal efficacy and have lower incidence of urinary retention compared with 6 mg morphine after CS.

The study aimed to investigate the effects of Reader's Theater on EFL learners' English reading comprehension. The roles of English learning anxiety and learning styles in the RT instruction were also explored. Mixed methods research was conducted to collect and analyze quantitative and qualitative data. The subjects were 11 graders in a senior high school in New Taipei City. There were 25 students in the experimental group and 26 in the control group, and the total number of students was 51. Experiment group received RT instruction for 16 periods in 16 weeks, while the control group was distributed with the same scripts without RT instruction as outside reading. Reading tests based on scripts were adopted to examine the difference of learners' reading comprehension with RT instruction intervention. Questionnaires of Foreign Language Classroom Anxiety and learning styles were conducted to realize the correlations among learners. To understand students' views on RT instruction, 24 subjects from the experimental group received an interview. The results of the study indicated that most students thought RT helped improve their reading comprehension. In addition, most students regarded that RT decreased English learning anxiety. However, among the six stages of RT, Instant Reading was the stage that students felt most anxious because they were worried about others' opinions. Finally, the study found that RT was a suitable platform for students with different learning styles. However, RT provided less time for students with visual modality to practice and learn best. It was suggested that instructors adopting RT instruction could use more pictures or graphic organizers.