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Abstract Traditional aluminum–silicon alloy pistons are gradually replaced by steel pistons, which has become the trend of future diesel engine development. However, the efficient design and broad application of steel pistons are limited by the higher density of steel. For this reason, a new lightweight design method for steel pistons in diesel engines was proposed in this paper. The progressive design of the cooling gallery cross-section and the topology optimization of the window region were carried out to meet the strength and deformation requirements. Ultimately, a lightweight steel piston (LSP) was obtained. The results of the study showed that the total mass of LSP could be reduced by 8.86% compared to the original steel piston (OSP). The thermal states of LSP are all superior to those of OSP. The highest temperature, maximum thermal stress, maximum longitudinal thermal deformation, and maximum transverse thermal deformation can be reduced by 0.96 °C, 3.03%, 11.65%, and 8.99%, respectively. LSP has a larger thermo-mechanical coupling stress manifestation compared to OSP. However, the maximum longitudinal and transverse thermo-mechanical coupling deformations can be obtained with a significant reduction of 8.33% and 42.19%, respectively.

Abstract Objective To identify factors that influence the severity of tinnitus via a hierarchical multiple linear regression model. Methods The study was a retrospective cross‐sectional analysis. The study included 331 patients experiencing tinnitus as their primary concern, who visited Shanghai Changzheng Hospital of the Navy Medical University between 2019 and 2021. Data on general health status and disease characteristics were collected from all patients. With their consent, participants underwent audiological evaluatons and completed questionnaires to analyze the characteristics of their tinnitus and the factors influencing its severity. Results The correlation analysis showed a positive relationship between tinnitus frequency, tinnitus loudness, SAS scores, and PSQI scores with THI scores (P

Abstract Background Eosinophilic extracellular traps (EETs) are reticular complexes comprising deoxyribonucleic‐Acid (DNA) fibers and granule proteins. Aims EETs play a crucial role in antimicrobial host responses and are pathogenic when overproduced or under degraded. EETs created by eosinophils appear to enable vital immune responses against extra‐cellular pathogens, nevertheless, trap overproduction is evident in pathology. Materials & Methods As considerably research is performed, new data affirmed that EETs can alter the outcome of respiratory ailment. Results We probe into the disclosure and specificity of EETs produced in reaction to various stimuli and propose a role for those frameworks in ailment pathogenesis and the establishment of chronic, unresolved inflammation. Discussion Whether EETs can be used as a prospective brand‐new target for the diagnosis, treatment and prognosis of respiratory ailments is a scientific theme worth studying. Conclusion We probe into the disclosure and specificity of EETs produced in reaction to various stimuli and propose a role for those frameworks in ailment pathogenesis and the establishment of chronic, unresolved inflammation.

Abstract Background Due to the unique working environment and nature of work in emergency departments, nurses are prone to experiencing compassion fatigue (CF), leading to job burnout and attrition. As more Generation Z (Gen Z) nurses enter the emergency department with distinct personality traits compared to previous generations, studying their experiences with CF will inform future management strategies. Methods The qualitative phenomenological research method was utilised to investigate CF among Gen Z emergency nurses at a hospital in Shanghai, China. Data were collected through face-to-face semi-structured interviews and analyzed using Colaizzi’s seven-step phenomenological analysis method. Study participants were purposively selected. Results Three main themes and nine sub-themes emerged from the study: secondary traumatic stress, including physiological symptoms, psychological symptoms, and behavioral changes; cumulative effects, including impaired empathy, interference with family life, and post-traumatic growth (PTG); coping strategies, including cognitive reconstruction, seeking support, and facilitating action. Conclusions The aim of this study is to investigate the experience of CF among Gen Z emergency nurses, providing managers with a reference for future management strategies. The significance of multi-dimensional support for Gen Z emergency nurses is underscored by our findings. Additionally, interventions that enhance resilience and competency can facilitate their psychological transformation after experiencing CF and promote accelerated personal growth.

Abstract Research on the severity and prognosis of sepsis with or without progressive delirium is relatively insufficient. We constructed a prediction model of the risk factors for 28-day mortality in patients who developed sepsis or sepsis-associated delirium. The modeling group of patients diagnosed with Sepsis-3 and patients with progressive delirium of related indicators were selected from the MIMIC-IV database. Relevant independent risk factors were determined and integrated into the prediction model. Receiver operating characteristic (ROC) curves and the Hosmer–Lemeshow (HL) test were used to evaluate the prediction accuracy and goodness-of-fit of the model. Relevant indicators of patients with sepsis or progressive delirium admitted to the intensive care unit (ICU) of a 3A hospital in Xinjiang were collected and included in the verification group for comparative analysis and clinical validation of the prediction model. The total length of stay in the ICU, hemoglobin levels, albumin levels, activated partial thrombin time, and total bilirubin level were the five independent risk factors in constructing a prediction model. The area under the ROC curve of the predictive model (0.904) and the HL test result (χ2 = 8.518) indicate a good fit. This model is valuable for clinical diagnosis and treatment and auxiliary clinical decision-making.

[Objective] By studying the relationship between the operating parameters of the polishing machine, the motion patterns of rice grains, and the generation of broken rice rates, to seek the basis for optimal parameter control of the polishing machine. [Methods] By analyzing the motion process of rice grains in the polishing chamber, conducting full-factorial experiments, and applying Particle Image Velocimetry (PIV) to analyze the trajectory of rice grain movement, clarifiied the relationship between the motion status of rice grains, the rate of broken rice, and the rotational speed of the polishing machine as well as the opening degree of the pressure gate. [Results] When the pressure gate aperture was set to 20 mm, no coherent motion pattern wwas observed within the experimental range of machine speeds, rendering the rice polishing ineffective. In contrast, with a pressure gate aperture of 4 mm and machine speeds ranging from 600 to 1 400 revolutions per minute, the rice grains exhibited an alternating motion pattern characterized by a relatively small spiral angle and the occurrence of regions with varying velocities. Furthermore, under the condition of a pressure gate aperture of 8 mm and a machine speed of 1 400 r/min, the rice grains demonstrated an alternating motion pattern in regions of high and low velocities (with a velocity difference exceeding 3 m/s). In both of these scenarios, excessive friction and pressure leaded to a high rate of broken rice (exceeding 4%). In the remaining experimental conditions, characterized by appropriate pressure gate apertures and machine speeds, the rice grains exhibited a moderately sized spiral angle in alternating regions of high and low velocities (with a velocity difference of 2～3 m/s). This configuration resulted in a broken rice rate ranging from 2% to 4%, indicative of favorable polishing effects. [Conclusion] The motion patterns formed by rice grains and the resulting broken rice rates vary under different operating conditions. Under suitable opening degree of the pressure gate and rotational speed, rice grains exhibit appropriate motion patterns and achieve better polishing effects.

The Western Route of the South-to-North Water Diversion Project is the final link to be constructed for the four-horizontal three-vertical framework of China’s national water network. The adjustable water volume in the water source areas is a focal and challenging issue in the planning and demonstration of the Western Route. This study raised ten questions related to the adjustable water volume in the water source areas of the Western Route from the aspects of water resource background conditions and evolution trends, ecological and socio-economic water demands, scales of reservoirs and water conveyance projects, as well as impacts of water diversion on water resource development and utilization, aquatic ecological environment, hydropower, and navigation in the water source areas and their lower reaches. Based on a distributed hydrological model of the upper reaches of the Yangtze River, a simulation and analysis model for calculating the adjustable water volume in water source areas of the Western Route is established to quantitatively answer the ten questions raised. The main conclusions are as follows. First, under the premise of solely satisfying ecological and socio-economic water demands within and outside the river channels of the water source areas, a plan that combines upper and lower routes presents an average adjustable water volume of 1.59×1010 m³ over multiple years, while a plan for solely constructing a lower route can reach an average adjustable water volume of 1.74×1010 m³ by constructing the Gangtuo Reservoir for coordinated operation. Second, comprehensively considering the impacts of water diversion on water balance, hydropower, and navigation, as well as their acceptability in the water source areas, the adjustable water volume is between 1.22×1010 and 1.26×1010 m³. Third, in the long term, the plan should focus on connecting and integrating the water network in the southwestern region with the main framework and major streams of the national water network of China. This will reduce the impacts of water diversion by the Western Route Project, increase the overall water supply capacity of the project, and promote its adaptability to external conditions such as climate change.

Abstract In this study, to improve the compaction quality and parameters of slag, discrete element models of irregular rock particles (10–60 mm) and circular soil particles (5 mm) were established based on on-site slag screening results. The motion of the vibratory roller was captured by coupling the roadbed model with the roller model in a simulation in which the roller vibrated and compacted the slag subgrade. The results indicated that (1) the best compaction was achieved when the small particle content was 40%, the medium particle content was 20%, and the large particle content was 40%. (2) When the slag was dominated by small rock particles, the optimum compaction frequency was 28 Hz, and when large rock particles dominated, the optimum compaction frequency was 33 Hz. (3) Rock particles were the primary particles that experienced stress in the vibration compaction, and the compressive force and displacement depended on the particle size. (4) The longitudinal and vertical displacements and rotation angles of the soil and rock particles were examined. The results of this study are conducive for advancing the understanding of slag compaction and improving the working efficiency and compaction quality of rollers.

Introduction: Liver fibrosis is a life-threatening pathological anomaly which usually evolves into advanced liver cirrhosis and hepatocellular carcinoma although limited therapeutic option is readily available. FUN14 domain containing 1 (FUNDC1) is a mitophagy receptor with little information in liver fibrosis. Objective: This study was designed to examine the role for FUNDC1 in carbon tetrachloride (CCl4)-induced liver injury. Methods: GEO database analysis and subsequent validation of biological processes including western blot, immunofluorescence, and co-immunoprecipitation were applied to clarify the regulatory role of FUNDC1 on mitophagy and ferroptosis. Results: Our data revealed elevated FUNDC1 levels in liver tissues of patients with liver fibrotic injury and CCl4-challenged mice. FUNDC1 deletion protected against CCl4-induced hepatic anomalies in mice. Moreover, FUNDC1 deletion ameliorated CCl4-induced ferroptosis in vivo and in vitro. Mechanically, FUNDC1 interacted with glutathione peroxidase (GPx4), a selenoenzyme to neutralize lipid hydroperoxides and ferroptosis, via its 96–133 amino acid domain to facilitate GPx4 recruitment into mitochondria from cytoplasm. GPx4 entered mitochondria through mitochondrial protein import system-the translocase of outer membrane/translocase of inner membrane (TOM/TIM) complex, prior to degradation of GPx4 mainly through mitophagy along with ROS-induced damaged mitochondria, resulting in hepatocyte ferroptosis. Conclusion: Taken together, our data favored that FUNDC1 promoted hepatocyte injury through GPx4 binding to facilitate its mitochondrial translocation through TOM/TIM complex, where GPx4 was degraded by mitophagy to trigger ferroptosis. Targeting FUNDC1 may be a promising therapeutic approach for liver fibrosis.

Abstract Purpose The choice of continuous renal replacement therapy (CRRT) anticoagulation program for patients at high risk of bleeding has always been a complex problem in clinical practice. Clinical regimens include regional citrate anticoagulation (RCA) and nafamostat mesylate (NM). This study aimed to evaluate the efficacy and safety of these two anticoagulants for CRRT in patients at high risk of bleeding to guide their clinical use better. Patients and methods Between January 2021 and December 2022, 307 patients were screened for this study. Forty-six patients were finally enrolled: 22 in the regional citrate anticoagulation group and 24 in the nafamostat mesylate group. We collected patients’ baseline characteristics, laboratory indicators before CRRT, and CRRT-related data. We then performed a statistical analysis of the data from both groups of patients. Results In our study, the baseline characteristics did not differ significantly between the two groups; the baseline laboratory indicators before CRRT of patients in the two groups were not significantly different. The duration of CRRT was 600 min in the regional citrate anticoagulation (RCA) group, 615 min in the nafamostat mesylate (NM) group; the success rate was 90.7% in the RCA group, and 85.6% in the NM group, the anticoagulant efficacy between the two groups was comparable. There was no significant difference in the safety of anticoagulation between the two groups. We used Generalized Estimating Equations (GEE) to test whether different anticoagulation methods significantly affected the success rate of CRRT and found no statistical difference between RCA and NM. Conclusion Our study suggests that nafamostat mesylate's anticoagulant efficacy and safety are not inferior to regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding.

Rotated object detection in remote sensing images presents a highly challenging task due to the extensive fields of view and complex backgrounds. While Convolutional Neural Networks (CNNs) and Transformer networks have made progress in this area, there is still a lack of research on extracting and fusing features for small targets in complex backgrounds. To address this gap, we have extended the RTMDet framework by introducing three modules: the Focused Feature Context Aggregation Module, the Feature Context Information Enhancement Module, and the Multi-scale Feature Fusion Module. In the Focused Feature Context Aggregation Module, we replaced the Spatial Pyramid Pooling Bottleneck (SPPFBottleneck) to better extract small target features by focusing on contextual information. The Feature Context Information Enhancement Module enhances the model’s perception of multi-dimensional temporal and spatial information. Finally, we combined the original features with the fused ones to prevent the loss of specific features during the fusion process. Our proposed model, named the Multi-scale Feature Context Aggregation Network (MFCANet), was evaluated on four challenging remote sensing datasets (MAR20, SRSDD, HRSC, and DIOR-R). The experimental results demonstrate that our method outperforms baseline models, achieving improvements of 2.13%, 10.28%, 1.46%, and 1.13% in mAP for the MAR20, SRSDD, HRSC, and DIOR-R datasets, respectively.

The open-cathode proton exchange membrane fuel cell (OC-PEMFC) is a promising power supply for mobile equipment and the design of the cathode channel structure has a significant effect on its water and thermal management. In this study, a three-dimensional multifield coupled OC-PEMFC single-cell model based on a graphite bipolar plate was used to investigate the performance of three types of cathode channel designs, namely, straight, divergent, and convergent channels, under dry ambient conditions. Under ambient conditions of 10 °C and 35% relative humidity, the divergent channel design exhibits the best performance, with the highest membrane water content and uniformity, even when the ambient temperature is increased. The performance of OC-PEMFCs can be improved by increasing the cathode stoichiometric ratio (CSR) under high-temperature and dry conditions. The divergent channel design has the best output performance under various CSRs. The growth percentage of the water content in the membrane ranges from 5.3 to 8.0%, and the average temperature in the membrane is reduced by 2.78–3.47 °C. Although the performance of the convergent channel design is improved, the uniformity of the water and electricity is significantly reduced. This study also provides guidance for the design of OC-PEMFC graphite bipolar plates.

Electrochemical water splitting by electrocatalyst is one of the most promising ways for generating and utilizing hydrogen energy, and it is critical to effectively mitigate the serious energy crisis and environmental pollution. However, the widely application of electrocatalysis technology is still limited by its low conversion efficiency and high cost. For this purpose, developing electrocatalyst materials with high activity, low cost and well stability are critical to solve the above limitions. As an inexpensive and readily available two-dimensional material, molybdenum disulfide is considered as a promising candidate to replace noble metal catalysts due to its good catalytic activity for electrocatalytic hydrogen evolution, which realize the industrial application. However, the inert basal plane and low electrical conductivity of pristine MoS2 limit the further improvement of its electrocatalytic performance. In this review, starting from the mechanism of water electrolysis and the inherent feature of molybdenum disulfide electrocatalysts, the latest research progress of various modification strategies to improve the catalytic performance of MoS2 was summarized. Moreover, the intrinsic mechanism of different modification strategies in the catalytic reaction process was highlighted and their respective drawbacks were indicated. Finally, it was pointed out that the current molybdenum disulfide catalyst should be further developed towards a combination of multiple modification measures, theoretical guidance for experiments, and rapid and effective synthesis.

Abstract Isoforms of a gene may contribute to diverse biological functions. In the cochlea, the repertoire of alternative isoforms remains unexplored. We integrated single-cell short-read and long-read RNA sequencing techniques and identified 236,012 transcripts, 126,612 of which were unannotated in the GENCODE database. Then we analyzed and verified the unannotated transcripts using RNA-seq, RT-PCR, Sanger sequencing, and MS-based proteomics approaches. To illustrate the importance of identifying spliced isoforms, we investigated otoferlin, a key protein involved in synaptic transmission in inner hair cells (IHCs). Upon deletion of the canonical otoferlin isoform, the identified short isoform is able to support normal hearing thresholds but with reduced sustained exocytosis of IHCs, and further revealed otoferlin functions in endocytic membrane retrieval that was not well-addressed previously. Furthermore, we found that otoferlin isoforms are associated with IHC functions and auditory phenotypes. This work expands our mechanistic understanding of auditory functions at the level of isoform resolution.

With the improvement of quality of life, people are more and more concerned about the quality of sleep. The electroencephalogram (EEG)-based sleep stage classification is a good guide for sleep quality and sleep disorders. At this stage, most automatic staging neural networks are designed by human experts, and this process is time-consuming and laborious. In this paper, we propose a novel neural architecture search (NAS) framework based on bilevel optimization approximation for EEG-based sleep stage classification. The proposed NAS architecture mainly performs the architectural search through a bilevel optimization approximation, and the model is optimized by search space approximation and search space regularization with parameters shared among cells. Finally, we evaluated the performance of the model searched by NAS on the Sleep-EDF-20, Sleep-EDF-78 and SHHS datasets with an average accuracy of 82.7%, 80.0% and 81.9%, respectively. The experimental results show that the proposed NAS algorithm provides some reference for the subsequent automatic design of networks for sleep classification.

High-resolution multi-spectral (HRMS) images have been widely used in various fields, however, they can not be directly obtained due to the physical hardware limits of existing remote sensing satellites. Therefore, the pansharpening technique has been widely explored as an effective tool to generate HRMS images by fusing the complementary information of low-resolution multi-spectral (LRMS) images and high-resolution panchromatic (PAN) images. Existing deep learning-based pansharpening methods mainly focus on enhancing the spatial representation ability of the network, while paying little attention to modeling spectral dependencies in spite of its significance for remote sensing data. In this paper, we propose a simple yet effective channel group shuffling (CGS) module to explore the implicit relationships with regard to the adjacent and cross-channels while considering spatial information. To be specific, the proposed CGS module consists of two components: the channel group module and the feature shuffle fusion module. The former enhances the diversity of spectral information and cross-channel information communications while ensuring the spectral order of the input feature. The latter integrates the cross-group feature maps with rich spatial-spectral information. Equipped with the proposed functional module, our image fusion network, dubbed CGSNet, produces favorable results against existing state-of-the-art counterparts over various satellite datasets. Ablation studies further verify the flexibility and effectiveness of our core design.

Abstract An increasing demand for bioelectronics that interface with living systems has driven the development of materials to resolve mismatches between electronic devices and biological tissues. So far, a variety of different polymers have been used as substrates for bioelectronics. Especially, biopolymers have been investigated as next-generation materials for bioelectronics because they possess interesting characteristics such as high biocompatibility, biodegradability, and sustainability. However, their range of applications has been restricted due to the limited compatibility of classical fabrication methods with such biopolymers. Here, we introduce a fabrication process for thin and large-area films of chitosan nanofibers (CSNFs) integrated with conductive materials. To this end, we pattern carbon nanotubes (CNTs), silver nanowires, and poly (3,4-ethylenedioxythiophene):poly (styrenesulfonate) (PEDOT:PSS) by a facile filtration process that uses polyimide masks fabricated via laser ablation. This method yields feedlines of conductive material on nanofiber paper and demonstrates compatibility with conjugated and high-aspect-ratio materials. Furthermore, we fabricate a CNT neural interface electrode by taking advantage of this fabrication process and demonstrate peripheral nerve stimulation to the rapid extensor nerve of a live locust. The presented method might pave the way for future bioelectronic devices based on biopolymer nanofibers.

Abstract Thin film electronic devices based on flexible biocompatible substrates are desired in various fields such as implants, soft robotics, and wearables, where stretchability is often necessary. Structure‐enabled stretchability in flexible thin films can be achieved by introducing origami‐inspired folds, thereby storing excess material in the out‐of‐plane direction to unfold upon stress. When using vapor‐deposited substrates such as parylene‐C, folds can be introduced prefabrication using molds patterned in repeated grooves and ridges. Here, this work reports the fabrication and parametrization of 10‐µm‐thick stretchable origami parylene‐C electrodes using 3D printed molds. The molds are printed with a sinusoidal pattern and tunable amplitude and slope, with accurate printing results up to 60° steepness. A 160‐nm‐thick gold layer on top of the folded parylene is patterned via laser ablation following the 3D mold shape. Depending on the design parameters, the resulting electrodes maintain functionality until 40%–100% strain. By 3D printing the molds, this technique can fabricate electrodes with complete control of the designed directions of stretchability in a rapid prototyping approach.

BackgroundSepsis stands as a dire medical condition, arising when the body’s immune response to infection spirals into overdrive, paving the way for potential organ damage and potential mortality. With intestinal flora’s known impact on sepsis but a dearth of comprehensive data, our study embarked on a two-sample Mendelian randomization analysis to probe the causal link between gut microbiota and their metabolites with severe sepsis patients who succumbed within a 28-day span.MethodsLeveraging data from Genome-wide association study (GWAS) and combining it with data from 2,076 European descendants in the Framingham Heart Study, single-nucleotide polymorphisms (SNPs) were employed as Instrumental Variables (IVs) to discern gene loci affiliated with metabolites. GWAS summary statistics for sepsis were extracted from the UK Biobank consortium.ResultsIn this extensive exploration, 93 distinct genome-wide significant SNPs correlated with gut microbial metabolites and specific bacterial traits were identified for IVs construction. Notably, a substantial link between Coprococcus2 and both the incidence (OR of 0.80, 95% CI: 0.68-0.94, P=0.007) and the 28-day mortality rate (OR 0.48, 95% CI: 0.27-0.85, P=0.013) of sepsis was observed. The metabolite α-hydroxybutyrate displayed a marked association with sepsis onset (OR=1.08, 95% CI: 1.02-1.15, P=0.006) and its 28-day mortality rate (OR=1.17, 95% CI: 1.01-1.36, P=0.029).ConclusionThis research unveils the intricate interplay between the gut microbial consortium, especially the genus Coprococcus, and the metabolite α-hydroxybutyrate in the milieu of sepsis. The findings illuminate the pivotal role of intestinal microbiota and their metabolites in sepsis’ pathogenesis, offering fresh insights for future research and hinting at novel strategies for sepsis’ diagnosis, therapeutic interventions, and prognostic assessments.

The maximum electromagnetic field formed in the electrically large enclosures for a given input power has always been the focus of electromagnetic compatibility issues such as radiation sensitivity and shielding effectiveness. To model the maximums in a simple manner, the electrically large enclosure can be regarded as a reverberation chamber (RC), thus the generalized extreme value (GEV) theory based framework is used for both undermoded and overmoded frequencies. Since the mechanical stirrer is not easy to be installed like that for RC, frequency stirring and mechanical stirring related configurations are discussed, and the corresponding results have confirmed the validity of frequency stirring with the estimate of the parameters in GEV distribution. As for the maximum field, a comparison has been made between GEV distribution and IEC 61000-4-21, and the corresponding results have also highlighted that the maximum field can be assessed by frequency stirring configuration, and by GEV distribution with a desired confidence.

Abstract Background The minimum variance (MV) beamformer can significantly improve the image resolution in ultrasound imaging, but it has limited performance in noise reduction. We recently proposed the covariance matrix-based statistical beamforming (CMSB) for medical ultrasound imaging to reduce sidelobes and incoherent clutter. Methods In this paper, we aim to improve the imaging performance of the MV beamformer by introducing a new pixel-based adaptive weighting approach based on CMSB, which is named as covariance matrix-based adaptive weighting (CMSAW). The proposed CMSAW estimates the mean-to-standard-deviation ratio (MSR) of a modified covariance matrix reconstructed by adaptive spatial smoothing, rotary averaging, and diagonal reducing. Moreover, adaptive diagonal reducing based on the aperture coherence is introduced in CMSAW to enhance the performance in speckle preservation. Results The proposed CMSAW-weighted MV (CMSAW-MV) was validated through simulation, phantom experiments, and in vivo studies. The phantom experimental results show that CMSAW-MV obtains resolution improvement of 21.3% and simultaneously achieves average improvements of 96.4% and 71.8% in average contrast and generalized contrast-to-noise ratio (gCNR) for anechoic cyst, respectively, compared with MV. in vivo studies indicate that CMSAW-MV improves the noise reduction performance of MV beamformer. Conclusion Simulation, experimental, and in vivo results all show that CMSAW-MV can improve resolution and suppress sidelobes and incoherent clutter and noise. These results demonstrate the effectiveness of CMSAW in improving the imaging performance of MV beamformer. Moreover, the proposed CMSAW with a computational complexity of $$O(N^2)$$ O ( N 2 ) has the potential to be implemented in real time using the graphics processing unit.

Objective To analyze the clinical features of HBeAg and HBeAb double-positive patients with chronic hepatitis B, and explore the efficacy and outcomes of different antiviral regimens. Methods A total of 158 HBeAg and HBeAb double-positive patients with chronic hepatitis B who met the antiviral treatment criteria were selected from Chongqing Three Gorges Hospital from 2014 to 2018. They were divided into entecavir treatment group (n=52), interferon treatment group (n=49), and control group (without antiviral treatment, n=57) according to the actual treatment regimen, and were followed up for 48 weeks. The efficacy and outcomes of patients were observed and compared among different groups. Results Baseline distribution of HBeAg and HBeAb: among 158 HBeAg/HBeAb double positive chronic hepatitrs B patients, 79 patients had HBeAg≥10, and 79 patieats had HBeAg < 10, each accounting for 50%; HBV DNA level was 4.77±1.23 Lg. Antiviral efficacy: the decrease of HBV DNA level, the HBV DNA negative conversion rate, and the normalization rate of ALT were all better in the entecavir group than the interferon group (P < 0.05), while the decline of HBeAg and HBeAb levels, as well as the HBeAg negative conversion rate were greater in the interferon group (P < 0.05). Clinical outcomes: the proportion of patients who became HBeAg negative or only presented HBsAg and HBcAb positive was significantly larger in the antiviral groups as compared with the control group (P < 0.05), while the control group showed higher proportion of continuous "double-positive" (P < 0.05). In addition, the decrease range of HBeAg-Lg/HBeAb ratio before and after treatment had the greatest value in predicting HBeAg negative conversion. Conclusion For HBeAg and HBeAb double-positive patients with chronic hepatitis B, interferon treatment shows greater advantage in HBeAg negative conversion. Monitoring the decline of HBeAg-Lg/HBeAb is helpful to predict clinical outcome in the double-positive patients.

Background & Aims: Hepatic fibrosis is characterized by hepatic stellate cell (HSC) activation and transdifferentiation-mediated extracellular matrix (ECM) deposition, which both contribute to cirrhosis. However, no antifibrotic regimen is available in the clinic. microRNA-23b/27b/24-1 cluster inhibition of transforming growth factor-β (TGF-β) signaling during hepatic development prompted us to explore whether this cluster inhibits HSC activation and hepatic fibrosis. Methods: Experimental fibrosis was studied in carbon tetrachloride (CCl4)-treated C57BL/6 mice. After administration of miR-23b/27b/24-1 lentivirus or vehicle, animals were euthanized for liver histology. In primary rat HSC and HSC-T6, the anti-fibrotic effect of miR-23b/27b/24-1 cluster was furtherly investigated by RNA-sequencing, luciferase reporter assay, western blotting and bioinformatic means. Results: In this study, we showed that increasing the miR-23b/27b/24-1 level through intravenous delivery of miR-23b/27b/24-1 lentivirus ameliorated mouse hepatic fibrosis. Mechanistically, the miR-23b/27b/24-1 cluster directly targeted messenger RNAs, which reduced the protein expression of 5 secretory profibrotic genes (TGF-β2, Gremlin1, LOX, Itgα2, and Itgα5) in HSCs. Suppression of the TGF-β signaling pathway by down-regulation of TGF-β2, Itgα2, and Itgα5, and activation of the bone morphogenetic protein signaling pathway by inhibition of Gremlin1, decreased extracellular matrix secretion of HSCs. Furthermore, down-regulation of LOX expression softened the ECM. Moreover, a reduction in tissue inhibitors of metalloproteinase 1 expression owing to weakened TGF-β signaling increased ECM degradation. Conclusions: Hepatic overexpression of the miR-23b/27b/24-1 cluster blocked hepatic fibrosis and may be a novel therapeutic regimen for patients with hepatic fibrosis.

Medium-chain fatty acids (MCFAs) are important components for food, pharmaceutical and fuel industries. Nevertheless, engineering microorganisms to produce MCFAs often induces toxicity and stresses towards host strains, which could be alleviated via accelerating the export of MCFAs from cells. However, current secretory systems are inefficient and require inducible promoters. Here, a multi-layer genome mining and phylogenomic analysis was developed to identify efficient efflux transporters. Firstly, based on the genomic mining of 397 strains throughout various representative species, the evolutionary history of efflux transporters was recapitulated, and further experimental analysis revealed that acrE from Citrobacter exhibited the best performance. Secondly, according to the further mining of 797 Citrobacter genomes and 1084 Escherichia genomes, a detailed phylogenomic analysis of efflux transporter-centric genomic vicinities was performed. This led to the identification of efficient efflux pump combination acrE and acrF. These efflux pumps were then combined with the quorum-sensing circuit from Enterococcus faecalis to regulate MCFA efflux in an autonomous manner, which achieved a 4.9-fold boost in MCFA production and firstly demonstrated the efficient and autonomous efflux pump specially for MCFAs. The integrative omics technologies described here are enabling the utilization of the increasingly large database and the effective mining of target gene diversities.

Given the opposing effects of Akt and AMP-activated protein kinase (AMPK) on metabolic homeostasis, this study examined the effects of deletion of Akt2 and AMPKα2 on fat diet-induced hepatic steatosis. Akt2–Ampkα2 double knockout (DKO) mice were placed on high fat diet for 5 months. Glucose metabolism, energy homeostasis, cardiac function, lipid accumulation, and hepatic steatosis were examined. DKO mice were lean without anthropometric defects. High fat intake led to adiposity and decreased respiratory exchange ratio (RER) in wild-type (WT) mice, which were ablated in DKO but not Akt2−/− and Ampkα2−/− mice. High fat intake increased blood and hepatic triglycerides and cholesterol, promoted hepatic steatosis and injury in WT mice. These effects were eliminated in DKO but not Akt2−/− and Ampkα2−/− mice. Fat diet promoted fat accumulation, and enlarged adipocyte size, the effect was negated in DKO mice. Fat intake elevated fatty acid synthase (FAS), carbohydrate-responsive element-binding protein (CHREBP), sterol regulatory element-binding protein 1 (SREBP1), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), peroxisome proliferator-activated receptor-α (PPARα), PPARγ, stearoyl-CoA desaturase 1 (SCD-1), phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6Pase), and diglyceride O-acyltransferase 1 (DGAT1), the effect was absent in DKO but not Akt2−/− and Ampkα2−/− mice. Fat diet dampened mitophagy, promoted inflammation and phosphorylation of forkhead box protein O1 (FoxO1) and AMPKα1 (Ser485), the effects were eradicated by DKO. Deletion of Parkin effectively nullified DKO-induced metabolic benefits against high fat intake. Liver samples from obese humans displayed lowered microtubule-associated proteins 1A/1B light chain 3B (LC3B), Pink1, Parkin, as well as enhanced phosphorylation of Akt, AMPK (Ser485), and FoxO1, which were consolidated by RNA sequencing (RNAseq) and mass spectrometry analyses from rodent and human livers. These data suggest that concurrent deletion of Akt2 and AMPKα2 offers resilience to fat diet-induced obesity and hepatic steatosis, possibly through preservation of Parkin-mediated mitophagy and lipid metabolism.

BackgroundIn early 2022, an outbreak of Coronavirus Disease 2019 (COVID-19) occurred in Shanghai, China. The spread of the epidemic put a large amount of stress on the local healthcare system, especially emergency nurses (ENs), which may affect their well-being and performance. Enhancing the psychological resilience of ENs during COVID-19 pandemic may improve job satisfaction, retention, and public health emergency response. However, few studies have researched the perception and psychological resilience of ENs during COVID-19 pandemic.ObjectiveTo understand ENs' perception and psychological resilience and their coping strategies with adversity during COVID-19 in Shanghai, as well as factors associated with psychological resilience.MethodsThis qualitative study was conducted using a phenomenological approach. A total of 17 ENs from a 3rd level hospital in Shanghai were selected using a method of purposive sampling. Between April and May 2022, in-depth semi-structured interviews and Colaizzi seven-step method were performed for data collection and analysis.ResultsThe investigation discovered three themes and nine subthemes. The first theme is “risk factors.” Risk factors for ENs to remain resilience are sudden multiplication of workload, stressful of screening of infected patients, and the support nurses being unfamiliar with the procedure. The second theme is “promoting factors.” ENs emphasized the importance of management assurance and humanistic care, as well as social support. They recognized adversity and resilience, and used self-management strategies to cope with the situation. The third theme is “motivated by altruism.” ENs were driven by altruism to respond to adversity with a positive attitude. They realized their self-worth by helping patients with a sense of sacred mission.ConclusionsPsychological resilience is not a stable psychological characteristic but a constantly changing process that is affected by internal and external factors. Enhancing resilience of ENs during the COVID-19 pandemic may improve work satisfaction, retention, and public health emergency response. Adequate preparation before a pandemic, reasonable arrangement, a trustworthy working atmosphere, encouragement and improvement of individual and collective strategies for nurses to cope with adversity, timely rewards, and nurse empowerment, as well as counseling and training, can be used to enhance psychological resilience of ENs.

Tungsten powders without and with Fe doping (0.1% and 1.0% in mass fraction) were prepared by liquid‒solid doping and two-step hydrogen reduction method, respectively. The influences of trace Fe on the reduction behaviors of WO3 powders and the microstructure characteristic of W powders were systematically studied. The results indicate that the Fe-containing solid solution is formed in the surface crystal lattice of WO3 particles after doping and calcination. In the process of hydrogen reduction, Fe solution can reduce the reaction temperatures of WO2.9→WO2 and WO2→W, promote the formation of micro-cracks and holes in the WO3, and refine the particle size of tungsten powders. After reduction, Fe migrates from the surface of WO3 particles to the interior of tungsten particles, and the Fe distribution changes obviously.

Objective To explore the alteration profile of lysophosphatidylcholine (LPC) content in donor liver with the elapse of total ischemic time and investigate its application value in the evaluation of donor liver quality. Methods A total of 100 patients who underwent liver transplantation in our hospital from June 2018 to August 2020 were enrolled in this study. Donor liver samples were collected respectively at the moment of donor liver acquisition (group A) and after reperfusion (group B). Pathomorphological scoring was performed and the tissue content of LPC was detected. The incidence of early allograft dysfunction (EAD) was used as a grouping variable. The efficacy of LPC in the evaluation of the quality of donor liver was analyzed. Results The tissue concentration of LPC in the liver samples of both group A and B was significantly higher in EAD group than non-EAD group (P < 0.05), and the concentration was higher in group B than group A. The LPC concentration in group B showed a good value in prediction for EAD (AUC=0.909, 95%CI: 0.849~ 0.969) when the cut-off value was 15 258 fg/mg. The best regression equation was Y=-7554+22.64×t-0.169 2×X0+0.000345×t× X0(Y: LPC concentration after reperfusion; t: total ischemic time; X0: LPC concentration at the moment of donor liver acquisition). The adjusted determination coefficients R2 in the modeling set and validation set were 0.944 7 and 0.915 4, respectively, which could well explain the changes of LPC and had a good prediction accuracy for LPC concentration after perfusion. Conclusion Our established prediction model well shows the changes of LPC concentration in donor liver tissue, indicates the severity of donor liver damage, and has clinical value in prediction of the occurrence of EAD.

Objective: This experiment is to judge the comprehensive quality of Hunan bacon. Methods: The contents of 8 biogenic amines in Hunan bacon were determined by HPLC-UV. The contents of moisture content, peroxide value and nitrite were measured. Results: The facts showed the total amount of biogenic amines was 127.22~166.24 mg/kg, which were mainly composed of cadaverine, putrescine, spermine and tyramine. The content of histamine was 0.43~10.24 mg/kg while the content of tyramine was 2.11~57.60 mg/kg. As for the physical and chemical indicators, the moisture content in the sample ranged from 13%~23%, the detection range of peroxide value was 0.014 2~0.035 0 g/100 g, with the nitrite content ranging from 2.15 to 7.50 mg/kg. Conclusion: The content of biogenic amines in Hunan bacon products is lower than the European Union and US FDA standard. All physical and chemical indexes meet the national standard.

Introduction Psychotherapy is considered part of the standard treatment of cancer in Western countries. However, there is no literature on the attitudes of Chinese cancer patients toward psychotherapy. Methods: In a multicenter, cross-sectional study in China, a homemade questionnaire was delivered to cancer patients. The targeted population was Chinese hospitalized cancer patients who were informed of their state of illness. Results Five hundred and fifty cancer patients received our questionnaire, and 83.3% completed the questionnaire. Among the 458 patients, 43.2% indicated that they had never heard of psychotherapy before the survey. However, after a brief introduction of psychotherapy, most (92.1%) cancer patients indicated that psychotherapy is essential for cancer patients, and over half of patients (57.4%) were willing to take psychotherapy on the advice of the oncologist in charge. Participants aged 45 years or younger, had a family income > 10000 yuan per month, and had an ECOG PS (Eastern Cooperative Oncology Group Performance Status) of 2-4 were more willing to receive psychotherapy. Of all patients, 59.2% and 57.6% were willing to participate in individual and group psychotherapy clinical trials, respectively. Participants who had a bachelor’s degree or higher (odds ratio, OR = 2.09) and were aged 45 years or younger (OR = 1.67) were more willing to participate in individual and group psychotherapy clinical trials, respectively. Conclusion The unmet psychological needs of cancer patients in China remain high, and doctors’ advice is likely to positively impact the patients’ acceptance of psychotherapy. Psychological education for Chinese cancer patients should be strengthened. More high-quality clinical trials of psychotherapy should be conducted in China to achieve greater benefits for cancer patients and their families.

Although various measurement techniques have been applied to both qualitative and quantitative evaluation for the electromagnetic shielding performance of braided-shield power cables, the existing measurements cannot directly assess the low-frequency shielding performance (typically below 100 kHz) due to factors such as ground-loop effects and dynamic range problem in measurement. To solve these, an improved shield reduction factor method, based on gain (T/R) rather than scattering parameters, is proposed to evaluate the shielding performance of braided-shield power cables from 25 Hz to 1 MHz. In this work, we highlight the implementation of measurement setup to avoid the effects of ground-loop and stray electromagnetic field. Meanwhile, the test cell is simplified according to the definition of the shield reduction factor in order to obtain the gain (T/R) parameters, which can be used to calculate transfer impedance as well. From the measurements we present more intuitive evaluation of shielding behavior of braided-shield power cables at low frequency regimes, and showcase a detailed comparative discussion between transfer impedance and shield reduction factor. The proposed shield reduction factor method is expected to be a useful way for the evaluation of the low frequency shielding performance of braided-shield cables.

Objective To develop nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with small hepatocellular carcinoma (HCC). Methods We retrieved the data of patients with small HCC diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database, and then randomized the eligible patients into training group (n=958) and validation group (n=958). The prognosis-related risk factors were selected using univariate Cox regression analysis, and the independent prognostic factors of OS and CSS were identified using a lasso Cox regression model. Akaike's information criterion (AIC) was used to evaluate the quality of fit of the models. The nomograms for predicting 1-, 3- and 5-year OS and CSS of the patients were constructed based on the identified prognostic factors, and their prediction ability was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve in both the training and validation cohorts. Results In the overall cohort, the 1-, 3-, and 5-year probabilities of OS rates were 81.3%, 60.7% and 49.2%, and the 1-, 3- and 5-year CSS rates were 85.2%, 66.9% and 56.9%, respectively. Six independent prognostic factors related to OS were selected to develop the OS nomogram, and 6 independent prognostic factors and 1 CSS-related factor were selected to develop the CSS nomogram. In the training group, the C-index for OS nomogram was 0.727 (95%CI: 0.705-0.750) and the areas under the ROC curve (AUCs) for 1-, 3- and 5-year OS were 0.754, 0.783 and 0.795 respectively. For the CSS nomogram, the C-index was 0.753 (95%CI: 0.729-0.777) and the AUCs for 1-, 3- and 5-year CSS were 0.801, 0.806 and 0.818, respectively. In the validation group, the C-index for OS nomogram was 0.725 (95%CI: 0.702-0.749) with AUCs for 1-, 3- and 5- year OS of 0.752, 0.770 and 0.799 respectively; The C-index for CSS nomogram was 0.772 (95%CI: 0.748-0.795) with AUCs for 1-, 3- and 5-year CSS of 0.806, 0.815 and 0.837 respectively. The calibration curves for the probabilities of 1-, 3-, and 5-year OS and CSS showed a good agreement between the nomogram-predicted survival and the actual survival outcomes in both the training and validation cohorts. We calculated the risk score for every patient according to the nomograms and accurately stratified the patients into high- and low-risk groups based on the median risk score. Conclusion The nomogram we established can accurately predict the OS and CSS of the patients with small HCC to assist the surgeons for clinical decision-making.

Abstract Background Systemic inflammation is an important feature of post-cardiac arrest syndrome (PCAS). This study was designed to determine whether the plasma concentrations of some circulating pro-inflammatory cytokines (interleukin-17 [IL-8], IL-22, IL-23 and IL-33) are of value in predicting the outcome of patients after return of spontaneous circulation (ROSC) during the post–cardiac arrest period. Methods This was a prospective observational clinical study. In total, 21 patients (survivors, n = 10; non-survivors, n = 11) who experienced cardiac arrest and successful ROSC with expected survival of at least 7 days were consecutively enrolled from January 2016 to December 2017. Of the 21 enrolled patients, ten survived were designated “survivors”. The other eleven patients died between 2 days and 1 months post ROSC. Venous blood was drawn at three time-points: baseline (

IntroductionAF4/FMR2 family member 4 (AFF4) is a core component of super elongation complex (SEC) and regulates the transcription elongation of many genes. AFF4 depletion or amplification is associated with multiple cancers, but its role in colorectal cancer (CRC) has not been investigated so far.MethodsqRT-PCR and Western blot analyzed AFF4 expression in the paired clinical CRC tissues. The patients’ overall survival curve was determined using the Kaplan-Meier plotter. In vitro experiments, such as cell proliferation, migration, and invasion, were used to preliminarily ascertain the role of AFF4 in CRC. A CRC cell liver metastasis animal model was well established. Livers were harvested and examined histologically by a series of indicators, such as tumor nodules, liver weight, ALT/AST activity, and tumor cell identification by hematoxylin-eosin (HE) staining.ResultsWe firstly examined the expression of AFF4 in colorectal cancer and normal tissues by collecting paired CRC tissues and adjacent normal tissues, revealing that AFF4 was significantly downregulated in CRC patients and lower expression of AFF4 was correlated with poor prognosis. Next, we observed that presence or absence of AFF4 in CRC cells had no effect on cancer cell proliferation, while AFF4 depletion significantly promoted the migration or invasion of CRC cells in vitro. Furthermore, we confirmed that AFF4 deficiency enhanced the metastatic capacity of CRC cells in vivo. Mechanistically, we found that AFF4 upregulated the transcription of CDH1 gene, which encodes E-cadherin and suppresses the epithelial-mesenchymal transition (EMT). Knockdown of AFF4 interfered with CDH1 transcription, resulting in downregulation of E-cadherin expression and the progression of CRC. Moreover, restored CDH1 expression could rescue the phenotype of CRC cells without AFF4.ConclusionsCollectively, our data demonstrated that AFF4 served as a significant novel regulator of CRC via CDH1 transcriptional regulation and a potential effective therapy target for patients with CRC.

Mutations in a number of genes encoding mitochondrial aminoacyl-tRNA synthetases lead to non-syndromic and/or syndromic sensorineural hearing loss in humans, while their cellular and physiological pathology in cochlea has rarely been investigated in vivo. In this study, we showed that histidyl-tRNA synthetase HARS2, whose deficiency is associated with Perrault syndrome 2 (PRLTS2), is robustly expressed in postnatal mouse cochlea including the outer and inner hair cells. Targeted knockout of Hars2 in mouse hair cells resulted in delayed onset (P30), rapidly progressive hearing loss similar to the PRLTS2 hearing phenotype. Significant hair cell loss was observed starting from P45 following elevated reactive oxygen species (ROS) level and activated mitochondrial apoptotic pathway. Despite of normal ribbon synapse formation, whole-cell patch clamp of the inner hair cells revealed reduced calcium influx and compromised sustained synaptic exocytosis prior to the hair cell loss at P30, consistent with the decreased supra-threshold wave I amplitudes of the auditory brainstem response. Starting from P14, increasing proportion of morphologically abnormal mitochondria was observed by transmission electron microscope, exhibiting swelling, deformation, loss of cristae and emergence of large intrinsic vacuoles that are associated with mitochondrial dysfunction. Though the mitochondrial abnormalities are more prominent in inner hair cells, it is the outer hair cells suffering more severe cell loss. Taken together, our results suggest that conditional knockout of Hars2 in mouse cochlear hair cells leads to accumulating mitochondrial dysfunction and ROS stress, triggers progressive hearing loss highlighted by hair cell synaptopathy and apoptosis, and is differentially perceived by inner and outer hair cells.

Background: Resistance to platinum-based chemotherapy is a major cause of therapeutic failure during the treatment of epithelial ovarian cancer (EOC) patients. Our study aims to elucidate the molecular mechanisms by which ZNF711 down regulation promotes CISPLATIN resistance in EOC. Methods: ZNF711 expression in 150 EOC specimens was examined using immunohistochemistry. ZNF711 expression and the survival of EOC patients were assessed with a Kaplan-Meier analysis. The effects of ZNF711 expression on CDDP resistance were studied by IC50, Annexin V, and colony formation in vitro, and in an in vivo intra-peritoneal tumor model. The molecular mechanism was determined using a luciferase reporter assay, ChIP assay, CAPTURE approach, and co-IP assay. Findings: ZNF711 down-regulation exerts a great impact on CDDP resistance for EOC patients by suppressing SLC31A1 and inhibiting CDDP influx. ZNF711 down-regulation promoted, while ZNF711 overexpression drastically inhibited CDDP resistance, both in vivo and in vitro. Mechanistically, the histone demethylase JHDM2A was recruited to the SLC31A1 promoter by ZNF711 and decreased the H3K9me2 level, resulting in the activation of SLC31A1 transcription and enhancement of CDDP uptake. Importantly, co-treatment with the histone methylation inhibitor, BIX-01294, increased the therapeutic efficacy of CDDP treatment in ZNF711-suppressed EOC cells. Interpretation: These findings both verified the clinical importance of ZNF711 in CDDP resistance and provide novel therapeutic regimens for EOC treatment. Funding: This work was supported by the Natural Science Foundation of China; Guangzhou Science and Technology Plan Projects; Natural Science Foundation of Guangdong Province; The Fundamental Research Funds for the Central Universities; and China Postdoctoral Science Foundation.

More and more EMC tests have shown that the radiated emission problems of the equipment under test mainly concentrate on the intercon- nected power cables and cable connectors. Measurement of shielding performance is a prerequisite for quantitative and qualitative evaluation of the frequency-dependent characteristic of braided-shield power cables and cable connectors. Due to the asymmetric geometric structures of these cable assemblies, compared with the coaxial and symmetrical communication cables, the commonly used transfer impedance testing methods may not be suitable. In view of this, several improved simple and effective measurement methods, including transfer impedance and shield reduction factor testing methods, were proposed in recent years. These methods, based on the equivalent circuit model of the characteristic parameters, provide good repeatability for the measurement of shielding performance. This paper presents an overview analysis of various measurement techniques for shielding performance of power cables and cable connectors, highlights some of its equivalence principle in measurement setups, and showcases a brief comparison between transfer impedance and shield reduction factor.

Coherent plane-wave compounding (CPWC) enables high-frame-rate ultrasound imaging, but the imaging quality is mainly determined by the beamforming method. Covariance-matrix-based statistical beamforming (CMSB) was previously proposed for synthetic aperture ultrasound imaging, which provides notable improvements in resolution and contrast over conventional delay-and-sum (DAS). However, the speckle quality is inadequate in the phantom experiment, and there exists a tradeoff between the contrast and speckle preservation of CMSB due to the constant diagonal reducing factor. In this paper, we applied CMSB in CPWC ultrasound imaging and propose an enhanced CMSB approach for CPWC to enhance the image quality. First, we introduced lag-one coherence (LOC) as an adaptive weighting factor for CMSB to suppress incoherent noise. Then, we propose adaptive diagonal reducing for CMSB using the coherence factor and amplitude standard deviation, with the aim to further improve the speckle quality. Finally, the combination of LOC weighting and adaptive diagonal reducing is proposed for CMSB to simultaneously improve the contrast and speckle quality. A simulation, experiments, and carotid studies were used to validate the imaging performance of the proposed methods. Results from the experiments show that LOC-weighted CMSB (LOCw-CMSB) with adaptive diagonal reducing improves the average contrast, generalized contrast-to-noise ratio (gCNR), and speckle signal-to-noise ratio (sSNR) by 59.9%, 53.6%, and 77.7%, respectively, in comparison with DMAS. The contrast and sSNR of the LOCw-CMSB with adaptive diagonal reducing were improved by 32.3% and 33.1%, respectively, compared to CMSB. In addition, LOCw-CMSB with adaptive diagonal reducing improves the contrast by 176.6% compared with SLSC in the in vivo carotid study, while it obtains a comparable gCNR. These results demonstrate that the proposed methods are effective in improving the image quality of CPWC imaging.