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Renal recovery following dialysis-requiring acute kidney injury (AKI-D) is a vital clinical outcome in critical care, yet it remains an understudied area. This retrospective cohort study, conducted in a medical center in Taiwan from 2015 to 2020, enrolled patients with AKI-D during intensive care unit stays. We aimed to develop and temporally test models for predicting dialysis liberation before hospital discharge using machine learning algorithms and explore early predictors. The dataset comprised 90 routinely collected variables within the first three days of dialysis initiation. Out of 1,381 patients who received acute dialysis, 27.3% experienced renal recovery. The cohort was divided into the training group (N = 1135) and temporal testing group (N = 251). The models demonstrated good performance, with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81–0.88) and an area under the precision-recall curve of 0.69 (95% CI, 0.62–0.76) for the XGBoost model. Key predictors included urine volume, Charlson comorbidity index, vital sign derivatives (trend of respiratory rate and SpO2), and lactate levels. We successfully developed early prediction models for renal recovery by integrating early changes in vital signs and inputs/outputs, which have the potential to aid clinical decision-making in the ICU. [ABSTRACT FROM AUTHOR]

This study investigated the healthcare utilization and medical expenditure of type 2 diabetes mellitus (T2DM) patients with generalized anxiety disorder (GAD) and identified the associated factors. The healthcare utilization and expenditure of T2DM patients with (case group) and without (control group) GAD between 2002 and 2013 were examined using the population-based Taiwan National Health Insurance Research Database. Healthcare utilization included outpatient visits and hospitalization; health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, nonpsychiatric healthcare utilization and medical expenditure were distinguished from total healthcare utilization and medical expenditure. The average healthcare utilization, including outpatient visits and hospitalization, was significantly higher for the case group than for the control group (total and nonpsychiatric). The results regarding differences in average outpatient expenditure (total and nonpsychiatric), inpatient expenditure (total and nonpsychiatric), and total expenditure (total and nonpsychiatric) between the case and control groups are inconsistent. Sex, age, income, comorbidities/complications, and the diabetes mellitus complication severity index were significantly associated with outpatient visits, medical expenditure, and hospitalization in the case group (total and nonpsychiatric). Greater knowledge of factors affecting healthcare utilization and expenditure in comorbid individuals may help healthcare providers intervene to improve patient management and possibly reduce the healthcare burden in the future. [ABSTRACT FROM AUTHOR]

Circadian rhythms are essential regulators of a multitude of physiological and behavioral processes, such as the metabolism and function of the liver. Circadian rhythms are crucial to liver homeostasis, as the liver is a key metabolic organ accountable for the systemic equilibrium of the body. Circadian rhythm disruption alone is sufficient to cause liver cancer through the maintenance of hepatic metabolic disorder. Although there is evidence linking CRD to hepatocarcinogenesis, the precise cellular and molecular mechanisms that underlie the circadian crosstalk that leads to hepatocellular carcinoma remain unknown. The expression of CRD-related genes in HCC was investigated in this study via bulk RNA transcriptomic analysis and single-cell sequencing. Dysregulated CRD-related genes are predominantly found in hepatocytes and fibroblasts, according to the findings. By using a combination of single-cell RNA sequencing and bulk RNA sequencing analyses, the dysregulated CRD-related genes ADAMTS13, BIRC5, IGFBP3, MARCO, MT2A, NNMT, and PGLYRP2 were identified. The survival analysis using the Kaplan–Meier method revealed a significant correlation between the expression levels of BIRC5 and IGFBP3 and the survival of patients diagnosed with HCC. [ABSTRACT FROM AUTHOR]

Simple Summary: The synchronization process of yak estrus plays a crucial role in enhancing the reproductive success rate of yaks and safeguarding the continuation of the species. Metabolomics, a branch of bio-chemistry, primarily focuses on the quantitative analysis of all metabolites within an organism, aiming to identify the relative relationships between metabolites and physiological changes. It serves as a valuable tool for delving into the molecular mechanisms and responses of metabolic pathways under various perturbations. In this study, metabolomics methods were utilized to analyze blood samples collected from non-estrus yaks as well as those that underwent hormonally induced synchronized estrus to identify differential metabolites. The research results provide a theoretical basis for the optimization and application of synchronized estrus technology in yaks, promoting the healthy development of the yak industry. The yak is a unique species of livestock found in the Qinghai-Tibet Plateau and its surrounding areas. Due to factors such as late sexual maturity and a low rate of estrus, its reproductive efficiency is relatively low. The process of estrus synchronization in yaks plays a crucial role in enhancing their reproductive success and ensuring the continuation of their species. In order to clarify the characteristics of the serum metabolites of yak estrus synchronization, the yaks with inactive ovaries were compared with the estrus synchronization yaks. In this study, yaks were divided into the inactive ovaries group (IO), gonarelin-induced yak estrus group (GnRH), and chloprostenol sodium-induced yak estrus group (PGF). After the completion of the estrus synchronization treatment, blood samples were collected from the jugular veins of the non-estrus yaks in the control group and the yaks with obvious estrus characteristics in the GnRH and PGF groups. Metabolites were detected by ultra-high performance liquid chromatography-mass spectrometry, and differential metabolites were screened by multivariate statistical analysis. The results showed that a total of 70 significant differential metabolites were screened and identified in the GnRH vs. IO group, and 77 significant differential metabolites were screened and identified in the PGF vs. IO group. Compared with non-estrus yaks, 36 common significant differential metabolites were screened out after the induction of yak estrus by gonarelin (GnRH) and cloprostenol sodium (PGF), which were significantly enriched in signaling pathways such as the beta oxidation of very long chain fatty acids, bile acid biosynthesis, oxidation of branched chain fatty acids, steroidogenesis, steroid biosynthesis, and arginine and proline metabolism. This study analyzed the effects of gonadotropin releasing hormone (GnRH) and prostaglandin F (PGF) on the reproductive performance of yaks treated with estrus synchronization, which provides a theoretical basis for the optimization and application of yak estrus synchronization technology and promotes the healthy development of the yak industry. [ABSTRACT FROM AUTHOR]

This paper studies the sharing mode selection and optimal pricing for an electric vehicle manufacturer (EVM). We evaluate three sharing modes, i.e. Mode N, car sales business only, Mode S, car sales business and car-sharing service provided by a self-built sharing platform, and Mode T, car sales business and car-sharing service provided by a third-party sharing platform. Further, we consider two types of government subsidy policies: purchase and production subsidies. We find that for purchase subsidies, the EVM should select Mode S if the transaction cost per sharing service is low, and select Mode T otherwise; for production subsidies, the EVM should select Mode S. Regardless of the subsidy policy, the optimal sales prices of EVs under Mode N and Mode S are the same, but both are lower than that under Mode T. The optimal rental price of EVs under Mode S is lower than that under Mode T. [ABSTRACT FROM AUTHOR]

Aim: To investigate the continuing education requirements and factors influencing school nurses' needs in relation to medication administration on school campuses. Design: A total of 391 school nurses working in K‐12 schools in Taiwan were invited to participate in an online questionnaire survey. Methods: This cross‐sectional study employed a probability proportionate to size technique along with a random sampling method. Data were collected from February to April 2023. Results: School nurses reported a significant demand for continuing education and perceived moderate levels of stress and government support related to medication administration. Among the various dimensions, the highest demand was observed for 'definition of campus medication errors' and 'regulations for campus medical orders.' Moreover, the 'identifying drug interactions' and 'adverse drug effects and referrals' dimensions were identified as the most stressful aspects. Notably, perceived stress emerged as the sole predictive factor for continuing education demand, accounting for 16.1% of the variance. Conclusions: The study found that there was a significant demand for and moderate stress related to continuing education among school nurses. Therefore, it is crucial for the government and school nursing organizations to develop targeted programs focusing on medication administration. These initiatives should be designed to enhance nurses' capabilities and reduce their stress, thereby ensuring safe medication administration on campuses. Impact: Continuing education enables school nurses to acquire up‐to‐date knowledge and improve the workflow in their practice. This study highlights a strong need for education in medication administration with a focus on 'campus medication error definitions' and 'campus medical order regulations.' The government and relevant school nursing organizations should prioritize the development and implementation of continuing education programs to decrease the school nurses' stress related to medication administration. Patient or Public Contribution: No patient or public contribution. Reporting Method: This study adhered to the relevant cross‐sectional EQUATOR STROBE guidelines. [ABSTRACT FROM AUTHOR]

Measurements of neutron star mass and radius or tidal deformability deliver unique insight into the equation of state (EOS) of cold dense matter. EOS inference is very often done using generalized parametric or non-parametric models, which deliver no information on composition. In this paper, we consider a microscopic nuclear EOS model based on a field theoretical approach. We show that current measurements from NICER and gravitational wave observations constrain primarily the symmetric nuclear matter EOS. We then explore what could be delivered by measurements of mass and radius at the level anticipated for future large-area X-ray timing telescopes. These should be able to place very strong limits on the symmetric nuclear matter EOS, in addition to constraining the nuclear symmetry energy that determines the proton fraction inside the neutron star. [ABSTRACT FROM AUTHOR]

Summary At present, many DNA logic circuits have been successfully constructed. However, advanced complex DNA computing tasks with simple structure, fast response, and modularization still remain a huge challenge. In this paper, molecular switch circuits (MSCs) are constructed based on DNA strand displacement to improve above problems. At first, molecular switch is constructed, which is the basic element for building logic circuits. Next, the functions of AND, OR, Fan‐in, and Fan‐out are realized through switches cascading in series or parallel. Furthermore, switch canvas strategy is explored to obtain the shortest reaction path and highest output concentration for circuits. Finally, a novel strategy of integrating computing module using molecular switches is proposed. Here, we construct a half‐adder, half‐subtractor, and a 9‐bit parity checking circuits to verify its feasibility. Compared with the classical monorail and dual‐track logic circuits, the structure scale is reduced by more than two times, and the DNA strands are decreased by more than four times, which effectively reduces the circuit complexity and raises the reaction speed. The above results show that MSC strategy has a great potential to construct large‐scale DNA circuits and provides a development model for the scalability and modularity of biological computing. [ABSTRACT FROM AUTHOR]

Determining background aerosol optical depth threshold value (BAOD) is critical to aerosol type identification and air pollution control. This study presents a statistical method to select the best BAOD threshold value using the VIIRS DB AOD products at 1 × 1 degree resolution from 2012 to 2019 as a major testbed. A series of multiple lognormal distributions with 1 to 5 peaks are firstly applied to fit the AOD histogram at each grid point, and the distribution with the highest correlation coefficient (R) gives preliminary estimations of BAOD, which is defined as either the intersection point of the first two normal distribution curves when having multiple peaks, or the midpoint between the peak AOD and the first AOD with non-zero probability when the mono peak is the best fit. Then, the lowest 1st to 100th percentile AOD distributions are compared with the preliminary BAOD distribution on a global scale. The final BAOD is obtained from the best cutoff percentile AOD distributions with the lowest bias compared with preliminary BAOD. Results show that the lowest 30th percentile AOD is the best estimation of BAOD for different AOD datasets and different seasons. Analysis of aerosol chemical information from MERRA-2 further supports this selection. Based on the BAOD, we updated the VIIRS aerosol type classification scheme, and the results show that the updated scheme is able to achieve reliable detection of aerosol type change in low aerosol loading conditions. [ABSTRACT FROM AUTHOR]

This study aimed to explore the diagnostic significance of high-frequency ultrasound combined with visual touch tissue imaging quantification (VTIQ) in the diagnosis and management of systemic sclerosis (SSc). Patients diagnosed with SSc and normal volunteers were recruited and divided into an experimental group and a control group, with 30 cases in each group, respectively. The skin thickness at six sites was assessed using high-frequency ultrasound, and the shear wave velocity (SWV) was determined using the VTIQ method. The differences in skin thickness and SWV between the experimental group and the control group were compared and a receiver operating characteristic (ROC) curve was plotted. The value of high-frequency ultrasound, VTIQ, and high-frequency ultrasound combined with VTIQ for evaluating skin involvement in SSc was determined. The difference in SWV sum at six sites and the thickness sum was statistically significant (all p = 0.000 < 0.05) from that of the control group, and there was a strong association between the SWV sum, thickness sum, and Rodnan skin score at the six sites in the experimental group (p = 0.000, r = 0.726; p = 0.000, r = 0.679). Based on the ROC curve, the area under the curve (AUC) for high-frequency ultrasound examination was 0.789. The AUC for VTIQ examination was 0.893, while the AUC for high-frequency ultrasound combined with VTIQ examination was 0.923. The combined examination method showed the highest AUC, indicating the best diagnostic performance. The integration of high-frequency ultrasound and VTIQ provides a quantitative approach for assessing the extent of skin involvement in SSc patients, offering valuable insights for clinical diagnosis and treatment purposes. [ABSTRACT FROM AUTHOR]

Implementation of the Sensory Organization Test (SOT) under the rambling-trembling (RM-TR) framework allows for an examination of both individual sensory contributions and compensatory mechanisms, a valuable insight in research and clinical settings. Such investigation could substantially improve our ability to assess and treat fall risk in older adults and people living with neurological disorders. How are RM and TR components of sway influenced by SOT-induced challenges in healthy adults? Twenty-three healthy adults (27.4±8 years; 10 male) volunteered to participate in this cross-sectional study. Each participant completed a VR-based SOT program, which included six conditions with varied visual environments (normal, blacked-out, conflict) and support surfaces (stable, unstable foam), while a force plate captured forces at the plantar surface. Center of pressure (COP) was calculated and decomposed into RM-TR components. For each time series, range, root-mean-square (RMS) and sample entropy (SampEn) were extracted. Individual contributions of somatosensation, vision, and vestibular sense, as well as the preference ratio, were calculated. Repeated measures ANOVA were used to compare the effects of time series type (COP, RM, TR) and SOT condition. Paired t-tests were used to assess the difference in preference ratio between RM and TR components. TR sway behavior was impacted significantly by the sensory challenges induced by the SOT procedure, while RM was largely unaffected. Such findings are characteristic of healthy individuals, capable of competently re-weighting sensory input, but still facing challenge-based adaptations. Additionally, the mediolateral SampEn preference ratio was higher in TR compared to RM, indicating potential differences in compensation strategies between supraspinal and spinal/peripheral control mechanisms. These findings serve as a foundation for future RM-TR analyses using SOT procedures, aiding in our ability to implement targeted diagnostic and treatment methods, ultimately reducing the incidence of falls in aging and individuals with neurological conditions. • Sensory re-weighting requires distinct rambling and trembling sway adaptations. • Spinal postural control mechanisms are greatly influenced by sensory conflict. • Rambling-trembling decomposition may be able to differentiate balance deficits by their sources. [ABSTRACT FROM AUTHOR]

We have found recently that two-step intrinsic hydroxyl radical (·OH)-dependent chemiluminescence (CL) could be produced by carcinogenic tetrahaloquinone and H 2 O 2. However, the first-step CL was too fast to clearly detect the stepwise generation of ·OH and CL, and to distinguish the exact dividing point between the first-step and second-step CL. Here we found that, extremely clear two-step intrinsic CL could be produced by the relative slow reaction of tetrabromohydroquinone (TBHQ) with H 2 O 2 , which was directly dependent on the two-step ·OH generation. Interestingly, the second-step, but not the first-step CL production of TBHQ/H 2 O 2 (CRET donor) was markedly enhanced by fluorescein (a typical xanthene dye, CRET acceptor) through a unique chemiluminescence resonance energy transfer (CRET) process. The novel CRET system of TBHQ/H 2 O 2 /fluorescein was successfully applied for the sensitive detection of TBHQ with the detection limit as low as 2.5 µmol/L. These findings will help to develop more sensitive and highly efficient CL or CRET systems and specific CL sensor to detect the carcinogenic haloquinones, which may have broad environmental applications. [Display omitted] [ABSTRACT FROM AUTHOR]

As a type of heavy metal ion, lead ions can pollute the environment and endanger human health, and thus, research on the detection of lead ions is crucial. In this study, a simple fluorescent biosensor based on lead ion-DNAzyme (Pb-enzyme) cleavage and a hemin/carbon quantum dot complex for the detection of lead ions was fabricated. Magnetic beads were linked to a substrate chain modified by adenosine ribonucleotide (Pb-substrate) via avidin-biotin interaction, Pb-enzyme bound Pb-substrate, and multifunctional magnetic beads were prepared. Carbon quantum dots were prepared from grapefruit peel (G-CQDs) and were characterized using transmission electron microscopy, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, ultraviolet and visible absorption spectroscopy, and fluorescence spectroscopy analyses. The results indicated that the average particle size of G-CQDs was 2.41 nm, and G-CQDs emitted a bright blue color under ultraviolet irradiation at a wavelength of 350 nm. However, the fluorescence of G-CQDs could be quenched by hemin. When a G-quadruplex was combined with hemin, the fluorescence of hemin/G-CQDs was recovered. In the presence of lead ions, the cleavage activity of the Pb-enzyme was induced, the Pb-substrate strand was cleaved at the modification site, and a single-stranded DNA was released. The single-stranded DNA bound to a hairpin probe, and G-rich sequences of the hairpin probe formed a G-quadruplex, which could restore the fluorescence of hemin/G-CQDs. This fluorescent biosensor exhibits excellent selectivity and sensitivity, with a limit of detection (LOD) value of 5 nM, for lead ions. Moreover, the fluorescent biosensor can be further used to test water samples. [ABSTRACT FROM AUTHOR]

The widespread adoption of genetically modified (GM) crops has escalated concerns about their safety and ethical implications, underscoring the need for efficient GM crop detection methods. Conventional detection methods, such as polymerase chain reaction, can be costly, lab-bound, and time-consuming. To overcome these challenges, we have developed RapiSense, a cost-effective, portable, and sensitive biosensor platform. This sensor generates a measurable voltage shift (0.1–1 V) in the system's current-voltage characteristics, triggered by an increase in membrane's negative charge upon hybridization of DNA/RNA targets with a specific DNA probe. Probes designed to identify the herbicide resistance gene hygromycin phosphotransferase show a detection range from ∼1 nM to ∼10 μM and can discriminate between complementary, non-specific, and mismatched nucleotide targets. The incorporation of a small membrane sensor to detect fragmented RNA samples substantially improve the platform's sensitivity. In this study, RapiSense has been effectively used to detect specific DNA and fragmented RNA in transgenic variants of Arabidopsis, sweet potato, and rice, showcasing its potential for rapid, on-site GM crop screening. • Accelerated GM plant detection with anion exchange membrane-based nucleic acid sensor. • Improved sensitivity with small membrane sensor integration to detect fragmented RNA. • The RapiSense prototype device is easy-to-operate, portable, and time-efficient. [ABSTRACT FROM AUTHOR]

Every once in a while, a revolutionary technological development arises, which leads to a significant change in the way to approach research and push development efforts. The appetite for new technology compels society to look for game‐changing materials, that can transform the industry and make advances. Sustainable energy production is paramount to addressing the climate crisis, and energy generation and storage play an important role in the development of self‐powered microelectronic devices. The 2D materials, MXenes have emerged as promising candidates for energy and other applications owing to their inherent electrical merits, high specific surface area, and tunable properties. Particularly, in the context of additive and interfacial materials for perovskite solar cell fabrication and utilization as additives in secondary batteries, this review delves into the application of MXenes in such devices. The protocols of MXenes and their nanostructures tailoring toward such applications and, the underlying mechanism is uncovered. Further, the existing challenges and direction for future in MXene‐based energy harvesters are discussed. [ABSTRACT FROM AUTHOR]

Background: Lung cancer significantly impairs exercise capacity and health-related quality of life (HRQL). Pulmonary rehabilitation (PR) has demonstrated positive effects on exercise capacity and HRQL in lung cancer patients. However, its impact on cardiopulmonary function needs further exploration. The aim of this study was to explore the effects of PR on cardiopulmonary function, exercise capacity and HRQL in patients with lung cancer. Methods: Patients with lung cancer were enrolled in a 12-week PR program. Each participant underwent a thorough evaluation, which included spirometry, cardiopulmonary exercise testing, respiratory muscle strength test, and evaluation of HRQL using the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). Results: Fifty-six patients completed the PR program. Following PR, exercise capacity significantly improved, as evidenced by increased peak oxygen uptake and work rate (both p < 0.05). Exertional symptoms were notably reduced, including leg soreness and dyspnea at peak exercise, accompanied by a decrease in the CAT score (all p < 0.05). Furthermore, improvements in cardiopulmonary function were observed, encompassing respiratory muscle strength, ventilatory equivalent, tidal volume, stroke volume index, and cardiac index at peak exercise (all p < 0.05). Conclusions: PR demonstrated notable enhancements in cardiopulmonary function, exertional symptoms, exercise capacity, and HRQL in patients with lung cancer. [ABSTRACT FROM AUTHOR]

AbstractScar tissue is connective tissue formed on the wound during the wound-healing process. The most significant distinction between scar tissue and normal tissue is the appearance of covalent cross-linking and the amount of collagen fibers in the tissue. This study investigates the efficacy of four types of collagen scaffolds in promoting wound healing and regeneration in a Sprague-Dawley murine model—the histomorphology analysis of collagen scaffolds and developing a deep learning model for accurate tissue classification. Four female rats (n = 24) groups received collagen scaffolds prepared through physical and chemical crosslinking. Wound healing progress was evaluated by monitoring granulation tissue formation, collagen matrix organization, and collagen fiber deposition, with histological scoring for quantification—the EDC and HA groups demonstrated enhanced tissue regeneration. The EDC and HA groups observed significant differences in wound regeneration outcomes. Deep-learning CNN models with data augmentation techniques were used for image analysis to enhance objectivity. The CNN architecture featured pre-trained VGG16 layers and global average pooling (GAP) layers. Feature visualization using Grad-CAM heatmaps provided insights into the neural network’s focus on specific wound features. The model’s AUC score of 0.982 attests to its precision. In summary, collagen scaffolds can promote wound healing in mice, and the deep learning image analysis method we proposed may be a new method for wound healing assessment. [ABSTRACT FROM AUTHOR]

Orthotopic allograft transplantation (OAT) is a significant approach to addressing organ failure. However, persistent immune responses to the allograft affect chronic rejection, which induces OAT vasculopathy (OATV) and organ failure. Porphyromonas gingivalis can infiltrate remote organs via the bloodstream, thereby intensifying the severity of cardiovascular, respiratory, and neurodegenerative diseases and cancer. GroEL, a virulence factor of P. gingivalis promotes pro‐inflammatory cytokine production in host cells, which assumes to play a pivotal role in the pathogenesis of cardiovascular diseases. Although the aggravation of OATV is attributable to numerous factors, the role of GroEL remains ambiguous. Therefore, this study aimed to investigate the impact of GroEL on OATV. Aortic grafts extracted from PVG/Seac rats were transplanted into ACI/NKyo rats and in vitro human endothelial progenitor cell (EPC) and coronary artery endothelial cell (HCAEC) models. The experimental findings revealed that GroEL exacerbates OATV in ACI/NKyo rats by affecting EPC and smooth muscle progenitor cell (SMPC) function and enabling the anomalous accumulation of collagen. In vitro, GroEL spurs endothelial‐mesenchymal transition in EPCs, reduces HCAEC tube formation and barrier function by downregulating junction proteins, accelerates HCAEC aging by lowering mitochondrial membrane potential and respiratory function, and impedes HCAEC migration by modulating cytoskeleton‐associated molecules. This study suggests that P. gingivalis GroEL could potentially augment OATV by impacting vascular progenitor and endothelial cell functions. [ABSTRACT FROM AUTHOR]

Background: Several studies have demonstrated that iDAScore is more accurate in predicting pregnancy outcomes in cycles without preimplantation genetic testing for aneuploidy (PGT-A) compared to KIDScore and the Gardner criteria. However, the effectiveness of iDAScore in cycles with PGT-A has not been thoroughly investigated. Therefore, this study aims to assess the association between artificial intelligence (AI)-based iDAScore (version 1.0) and pregnancy outcomes in single-embryo transfer (SET) cycles with PGT-A. Methods: This retrospective study was approved by the Institutional Review Board of Chung Sun Medical University, Taichung, Taiwan. Patients undergoing SET cycles (n = 482) following PGT-A at a single reproductive center between January 2017 and June 2021. The blastocyst morphology and morphokinetics of all embryos were evaluated using a time-lapse system. The blastocysts were ranked based on the scores generated by iDAScore, which were defined as AI scores, or by KIDScore D5 (version 3.2) following the manufacturer's protocols. A single blastocyst without aneuploidy was transferred after examining the embryonic ploidy status using a next-generation sequencing-based PGT-A platform. Logistic regression analysis with generalized estimating equations was conducted to assess whether AI scores are associated with the probability of live birth (LB) while considering confounding factors. Results: Logistic regression analysis revealed that AI score was significantly associated with LB probability (adjusted odds ratio [OR] = 2.037, 95% confidence interval [CI]: 1.632–2.542) when pulsatility index (PI) level and types of chromosomal abnormalities were controlled. Blastocysts were divided into quartiles in accordance with their AI score (group 1: 3.0–7.8; group 2: 7.9–8.6; group 3: 8.7–8.9; and group 4: 9.0–9.5). Group 1 had a lower LB rate (34.6% vs. 59.8–72.3%) and a higher rate of pregnancy loss (26% vs. 4.7–8.9%) compared with the other groups (p < 0.05). The receiver operating characteristic curve analysis verified that the iDAScore had a significant but limited ability to predict LB (area under the curve [AUC] = 0.64); this ability was significantly weaker than that of the combination of iDAScore, type of chromosomal abnormalities, and PI level (AUC = 0.67). In the comparison of the LB groups with the non-LB groups, the AI scores were significantly lower in the non-LB groups, both for euploid (median: 8.6 vs. 8.8) and mosaic (median: 8.0 vs. 8.6) SETs. Conclusions: Although its predictive ability can be further enhanced, the AI score was significantly associated with LB probability in SET cycles. Euploid or mosaic blastocysts with low AI scores (≤ 7.8) were associated with a lower LB rate, indicating the potential of this annotation-free AI system as a decision-support tool for deselecting embryos with poor pregnancy outcomes following PGT-A. [ABSTRACT FROM AUTHOR]

Objective: To explore the neuroimage change in Parkinson's disease (PD) patients with cognitive impairments, this study investigated the correlation between plasma biomarkers and morphological brain changes in patients with normal cognition and mild cognitive impairment. The objective was to identify the potential target deposition regions of the plasma biomarkers and to search for the relevant early neuroimaging biomarkers on the basis of different cognitive domains. Methods: Structural brain MRI and diffusion weighted images were analyzed from 49 eligible PD participants (male/female: 27/22; mean age: 73.4 ± 8.5 years) from a retrospective analysis. Plasma levels of α-synuclein, amyloid beta peptide, and total tau were collected. A comprehensive neuropsychological assessment of the general and specific cognitive domains was performed. Difference between PD patients with normal cognition and impairment was examined. Regression analysis was performed to evaluate the correlation between image-derived index and plasma biomarkers or neuropsychological assessments. Results: Significant correlation was found between plasma Aβ-42 level and fractional anisotropy of the middle occipital, angular, and middle temporal gyri of the left brain, as well as plasma T-tau level and the surface area of the isthmus or the average thickness of the posterior part of right cingulate gyrus. Visuospatial and executive function is positively correlated with axial diffusivity in bilateral cingulate gyri. Conclusion: In nondemented PD patients, the target regions for plasma deposition might be located in the cingulate, middle occipital, angular, and middle temporal gyri. Changes from multiple brain regions can be correlated to the performance of different cognitive domains. Clinical relevance statement: Cognitive impairment in Parkinson's disease is primarily linked to biomarkers associated with Alzheimer's disease rather than those related to Parkinson's disease and resembles the frontal variant of Alzheimer's disease, which may guide management strategies for cognitive impairment in Parkinson's disease. Key Points: • Fractional anisotropy, surface area, and thickness in the cingulate, middle occipital, angular, and middle temporal gyri can be significantly correlated with plasma Aβ-42 and T-tau level. • Axial diffusivity in the cingulate gyri was correlated with visuospatial and executive function. • The pattern of cognitive impairment in Parkinson's disease can be similar to the frontal variant than typical Alzheimer's disease. [ABSTRACT FROM AUTHOR]

The current fabrication methods of surface-enhanced Raman scattering (SERS) chips used for biological detection mostly require antibodies conjugated on nanostructured metals or additionally connected to a reporter, which leads to complicated fabrication processes and increases the cost of these chips. More importantly, only a single-layer (2D) signal source is generated on the substrate of the chip, resulting in poor sensitivity. Herein, we constructed a single-component, multiscale, three-dimensional SERS (M3D-SERS) substrate from silver nanowires (AgNWs) packing. According to our results, the Raman enhancement effect of the M3D-SERS substrate was related to the degree of AgNWs stacking along the z axis. In addition, the light source-dependent plasmonic partition and hotspot formation of the M3D-SERS substrate were evaluated by the finite integration technique to prove that M3D-SERS offers advantages, with isotropic localized surface plasmon resonance as well as homogeneous hotspot distribution, for SERS over its 1D and 2D counterparts. Experimentally, the optimal construction of the M3D-SERS chip was explored and established based on the Raman signal enhancement of bovine serum albumin, and consequently, the efficiency of the M3D-SERS chip in detecting SARS-CoV-2-related biomolecules was investigated based on the detection superiority to biomolecules. This study demonstrates a simple, label-free, pre-treatment-free potential biosensor technology that can be used in healthcare units. Furthermore, in combination with a suitable laser light source, this technology can be applied for efficient detection in point-of-care tests with a handheld spectrometer. [ABSTRACT FROM AUTHOR]

Identifying potential contributing factors for physical inactivity in people with knee osteoarthritis is vital for designing practical activity promoting interventions. Walking is a common activity, but it is unknown how gait characteristics may influence physical activity and if psychological factors, specifically fear of movement (kinesiophobia), contribute to this relationship. The aim of our study was to investigate the contributions of select gait parameters and kinesiophobia to activity levels. Cross‐sectional data from 40 participants (F 24|M 16; age 57.6 ± 8.9 years; BMI 34.7 ± 7.0 kg/m2) with uni‐ or bilateral knee osteoarthritis were included. Physical activity and kinesiophobia were assessed by self‐report using the University of California, Los Angeles activity rating scale, and Tampa scale for kinesiophobia, respectively. Gait parameters were collected with three‐dimensional gait analysis while participants walked on an instrumented split‐belt treadmill at a self‐selected speed. Higher peak sagittal plane joint moments at the ankle (ρ = 0.418, p = 0.007), and hip (ρ = 0.348, p = 0.028), faster self‐selected gait speed (ρ = 0.553, p < 0.001), and less kinesiophobia or fear of movement (ρ = −0.695, p < 0.001) were independently related to higher physical activity level in adults with knee osteoarthritis. In hierarchical regression models, after accounting for covariates, only self‐selected gait speed, and kinesiophobia significantly contributed to explaining the variation in physical activity level. Statement of clinical significance: Interventions aimed at improving physical activity participation in those with lower limb osteoarthritis should consider assessing the contribution of pain‐related fear of movement. [ABSTRACT FROM AUTHOR]

As the lower extremity is a linked‐joint system, the contribution of movements at the hip and ankle, in addition to the knee, to gait patterns should be considered for persons with knee osteoarthritis (OA). However, the relationships of joint coordination variability to OA symptoms, particularly knee pain, and joint loading is unknown. The purpose of this study was to determine the relationship of joint coordination variability to knee pain severity and joint loading in persons with knee OA. Thirty‐four participants with knee OA underwent gait analysis. Vector coding was used to assess coordination variability during the early, mid, and late stance phase. Hip–knee coupling angle variability (CAV) during midstance was associated with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain (r = −0.50, p = 0.002) and Visual Analog Scale pain (r = 0.36, p = 0.04). Knee–ankle CAV during midstance was associated with KOOS pain (r = −0.34, p = 0.05). Hip–knee CAV during early and midstance were associated with knee flexion moment (KFM) impulses (r = −0.46, p = 0.01). Knee–ankle CAV during early and midstance were associated with peak KFM (r = −0.51, p < 0.01; r = −0.70, p < 0.01). Moreover, knee–ankle CAV during early, mid, and late stance phase were associated with KFM impulses (r = −0.53, p < 0.01; r = −0.70, p < 0.01; r = −0.54, p < 0.01). These findings suggest that joint coordination variability may be a factor that influences pain and knee joint loading in persons with knee OA. Statement of Clinical Significance: Movement coordination of the hip, knee, and ankle should be considered in the clinical management and future research related to knee OA. [ABSTRACT FROM AUTHOR]

Understanding how the spatial arrangement of remnant green spaces in cities complements biodiversity provides an opportunity for synergy between urban development and biological conservation. However, the geography of urbanization is shifting from Europe and North America to Asia and Africa, and more research is needed for fast-growing regions. To understand how shifting urbanization shapes biodiversity patterns, we analyzed the contribution of landscape factors in explaining vertebrate species richness in urban areas across biogeographic realms. We used variation partitioning to quantify and compare the relative importance of landscape factors (composition and configuration) and environmental factors (climate, elevation, and latitude) in explaining vertebrate species richness in landscapes with at least a million inhabitants across biogeographic realms. Our results pointed out that in the Indo-Malayan, the Afrotropical, and the Neotropical realm (on average of 16.46%) and China and India (11.88%), the influence of landscape factors on vertebrate species richness are significantly higher than that of the Palearctic and Nearctic realms (6.48%). Our findings outline the importance of landscape composition and configuration in shaping biodiversity patterns in regions with fast urban growth during the next two decades, such as Africa, Latin America, and Southeastern Asia. We suggest improving land governance and urban planning to construct eco-friendly landscape structures to mitigate biodiversity loss due to urbanization. [ABSTRACT FROM AUTHOR]

International airports are responding to the threat of climate change and various man-made hazards by proposing impact protection measures. Airport managers and risk controllers should develop a comprehensive risk assessment model to measure the mutual influence relationships of resilience factors. In this paper, the problem of treating resilience factors as independent ones in previous studies is overcome. In this study, we not only develop a framework for assessing resilience factors in international airports based on an aviation safety perspective, but also develop the Fermatean fuzzy decision-making trial and evaluation laboratory (FF-DEMATEL) to identify the mutual influence relationships of resilience factors. Fermatean fuzzy sets are incorporated in DEMATEL to reflect information incompleteness and uncertainty. The critical resilience factors of international airports were identified through real-case analysis. In terms of importance, the results show that rescue capability is a core capability that is important for airport resilience. In addition, "security management system (SeMS) integrity", "education and training of ground staff on airport safety awareness", "first aid mechanism for the injured", and "adequate maintenance equipment for rapid restoration tasks" are identified as key factors that are given more weights. On the other hand, in terms of influence strength, the detection capability has the highest total influence and significantly influenced the other resilience capabilities. Finally, the influential network relation map (INRM) is utilized to assist decisionmakers in swiftly comprehending the impact of factors and formulating viable strategies to enhance airport resilience. This enables airport managers and risk controllers to make informed decisions and allocate resources efficiently. [ABSTRACT FROM AUTHOR]

Several studies have explored the biological activities of Citrus aurantium flowers, fruits, and seeds, but the bioactivity of C. aurantium leaves, which are treated as waste, remains unclear. Thus, this study developed a pilot-scale ultrasonic-assisted extraction process using the Box–Behnken design (BBD) for the optimized extraction of active compounds from C. aurantium leaves, and their antityrosinase, antioxidant, antiaging, and antimicrobial activities were evaluated. Under optimal conditions in a 150× scaleup configuration (a 30 L ultrasonic machine) of a pilot plant, the total phenolic content was 69.09 mg gallic acid equivalent/g dry weight, which was slightly lower (3.17%) than the theoretical value. The half maximal inhibitory concentration of C. aurantium leaf extract (CALE) for 2,2-diphenyl-1-picrylhydrazyl–scavenging, 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid)–scavenging, antityrosinase, anticollagenase, antielastase and anti-matrix metalloprotein-1 activities were 123.5, 58.5, 181.3, 196.4, 216.3, and 326.4 mg/L, respectively. Moreover, the minimal inhibitory concentrations for bacteria and fungi were 150–350 and 500 mg/L, respectively. In total, 17 active compounds were detected in CALE—with linalool, linalyl acetate, limonene, and α-terpineol having the highest concentrations. Finally, the overall transdermal absorption and permeation efficiency of CALE was 95.9%. In conclusion, our CALE demonstrated potential whitening, antioxidant, antiaging, and antimicrobial activities; it was also nontoxic and easily absorbed into the skin as well as inexpensive to produce. Therefore, it has potential applications in various industries. [ABSTRACT FROM AUTHOR]

This study aimed to identify the influence factors for snacking-avoidance behavior among elementary schoolchildren. We recruited 940 Taipei schoolchildren and used five validated questionnaires to assess family affluence, snacking nutrition knowledge, attitude, and motivation to avoid unhealthy snacks. Social support from parents and peers for refusing unhealthy snacks, and adolescents' willingness to comply were also examined. Motivation to avoid unhealthy snacks or drinks was enhanced when support was given by parents, teachers, and peers. Participants who reported higher levels of social support were more likely to have a positive attitude towards healthy snacking and were more motivated to avoid unhealthy snack options. In conclusion, social support from significant others, attitudes, and nutrition knowledge all help schoolchildren to avoid unhealthy snacks. [ABSTRACT FROM AUTHOR]

Understanding how the spatial arrangement of remnant green spaces in cities complements biodiversity provides an opportunity for synergy between urban development and biological conservation. However, the geography of urbanization is shifting from Europe and North America to Asia and Africa, and more research is needed for fast-growing regions. To understand how shifting urbanization shapes biodiversity patterns, we analyzed the contribution of landscape factors in explaining vertebrate species richness in urban areas across biogeographic realms. We used variation partitioning to quantify and compare the relative importance of landscape factors (composition and configuration) and environmental factors (climate, elevation, and latitude) in explaining vertebrate species richness in landscapes with at least a million inhabitants across biogeographic realms. Our results pointed out that in the Indo-Malayan, the Afrotropical, and the Neotropical realm (on average of 16.46%) and China and India (11.88%), the influence of landscape factors on vertebrate species richness are significantly higher than that of the Palearctic and Nearctic realms (6.48%). Our findings outline the importance of landscape composition and configuration in shaping biodiversity patterns in regions with fast urban growth during the next two decades, such as Africa, Latin America, and Southeastern Asia. We suggest improving land governance and urban planning to construct eco-friendly landscape structures to mitigate biodiversity loss due to urbanization. [ABSTRACT FROM AUTHOR]

Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare spectrum of acute, mucocutaneous drug reactions characterized by epidermal necrosis of the skin and mucous membranes with progressive multiorgan failure. Cutaneous presentation of SJS/TEN is similar to that of acute graft-versus-host disease, creating a diagnostic dilemma in solid-organ transplant recipients presenting with diffuse, erythematous eruptions, skin sloughing, and systemic sequelae, reflective of both diseases. This case report details a 48-year-old woman post-orthotopic liver transplantation (OLT) who developed a diffuse, painful, morbilliform rash with progressive desquamation, along with corresponding pathological analysis indicative of SJS/TEN. There are few documented reports of SJS/TEN in solid-organ transplant recipients, and this case illustrates successful intervention and resolution of SJS/TEN in an OLT recipient while managing intraabdominal sepsis and an episode of acute rejection. Despite its rarity, prompt diagnosis of SJS/TEN and the implementation of tailored therapeutic strategies are crucial in the care of solid-organ transplant recipients. [ABSTRACT FROM AUTHOR]

Rough Set (RS) theory is used for data analysis and decision making where decision-making rules can be derived through attribute reduction and feature selection. Energy shortage is an issue for governments, and solar energy systems have become an important source of renewable energy. Rough sets may be used to summarize and compare rule sets for different periods. In this study, the analysis of rules is an element of decision support that allows organizations to make better informed decisions. However, changes to decision rules require adjustment and analysis, and analysis is inhibited by changes in rules. With this consideration, a solution approach is proposed. The results show that not only can decision costs be reduced, but policymakers can also make it easier for the public to understand the incentives of green energy programs and the use of solar panels. The application process is simplified for the implementation of sustainable energy policies. [ABSTRACT FROM AUTHOR]

Photon plays a dominant role as the information carrier in telecom, thanks to the merits of large bandwidth and low energy consumption. Optical encryption has kept attracting intensive attention in the era of frequent information exchange. Multidegrees of light facilitate enhancing the security of data transmission. Here, following the Malus law and the phase encoding rule of the geometric phase, dual-channel intensities and a far-field hologram of the transmitted light are separately programmed. Different quick response codes that link to plaintexts are recorded into two intensity channels. They are further transformed according to the predetermined rule as revealed by the hologram to form the key. The key converts the protected information in a single-pixel imaging process, and generated ciphertexts are inserted into the plaintexts to perform the encryption. The tri-channel liquid crystal device enables simultaneous encryption in two separate routes and significantly improves information security. The design supplies a universal key for data encryption. [ABSTRACT FROM AUTHOR]

The carcinogenicity of aristolochic acids (AAs) has been attributed mainly to the formation of stable DNA-aristolactam (DNA-AL) adducts by its reactive N -sulfonated metabolite N-sulfonatooxyaristolactam (N–OSO 3 --AL). The most accepted mechanism for such DNA-AL adduct formation is via the postulated but never unequivocally-confirmed aristolactam nitrenium ion. Here we found that both sulfate radical and two ALI-derived radicals (N-centered and C-centered spin isomers) were produced by N–OSO 3 --ALI, which were detected and unequivocally identified by complementary applications of ESR spin-trapping, HPLC-MS coupled with deuterium-exchange methods. Both the formation of the three radical species and DNA-ALI adducts can be significantly inhibited (up to 90%) by several well-known antioxidants, typical radical scavengers, and spin-trapping agents. Taken together, we propose that N–OSO 3 --ALI decomposes mainly via a new N–O bond homolysis rather than the previously proposed heterolysis pathway, yielding reactive sulfate and ALI-derived radicals, which are together and in concert responsible for forming DNA-ALI adducts. This study presents strong and direct evidence for the production of free radical intermediates during N–OSO 3 --ALI decomposition, providing an unprecedented free radical perspective and conceptual breakthrough, which can better explain and understand the molecular mechanism for the formation of DNA-AA adducts, the carcinogenicity of AAs and their potential prevention. [Display omitted] • First direct ESR evidence of aristolochic acid-related aristolactam radical. • Identification of two isomers of aristolactam radical by ESR and HPLC-MS. • First evidence for sulfate radical formation under physiological conditions. • Synergistic free radical mechanism for forming DNA-aristolactam adducts. • First radical mechanism for DNA damage & carcinogenicity by aristolochic acid. [ABSTRACT FROM AUTHOR]

A novel binuclear Cu(I) halide complex, Cu2I2(DPPCz)2, which emits efficient thermally activated delayed fluorescence (TADF), is reported. The crystal of this complex spontaneously undergoes ligand rotation and coordination-configuration transformation, converting to its isomer without any external stimulation. [ABSTRACT FROM AUTHOR]

Multiple tower crane layout planning (MTCLP) refers to the selection of the types, quantities, and positions of tower cranes and material storage positions. In a construction project, choosing tower cranes with a larger covering radius and lifting capacity can reduce the transportation time of materials. However, it can also simultaneously raise the rental cost and the risk of crane crashes. Determining an optimal multiple tower crane layout plan to achieve high construction efficiency with low cost is still a challenge. Mathematically, MTCLP is a complex combinatorial problem controlled by a number of variables, such as site configuration, building layout, material storage positions, and workload. To precisely describe irregular shaped sites and buildings, this research partitioned the site into unit cells and proposed a cell-based optimization model. For the optimal crane layout plan, the problem was formulated as a mixed integer linear problem (MILP). The model's mathematical constraints comprised coverage of the given positions, the crane's safety distance, sufficient crane capacity, and the utilization ratio. The objectives were to increase the crane coverage ratio while reducing the cost and the working areas overlapped by more than two cranes. Two case studies are presented to demonstrate the effectiveness of the model. The first construction project consisted of seven buildings with irregular shapes. By strictly forbidding the areas to be overlapped by more than three tower cranes, the model successfully obtained the optimal crane layout plan using the Gurobi Optimizer. Compared with the contractor's layout plan, the optimal plan reduced the rental cost by 10.7% and the area overlapped by more than three tower cranes by 4.56%. In the second project, alternative plans were identified by the Gurobi Optimizer and ε -constraint method to enhance confidence in selecting the ultimate crane layout plan. The optimization procedure involved (1) optimizing the layout plan with minimum crane cost and maximum coverage ratio, (2) identifying all possible layouts as the Pareto fronts when the coverage ratio could not be raised without increasing the crane cost, and (3) minimizing the areas of crane overlap covered by more than three tower cranes. The effectiveness of the proposed model is also proved by comparing the differences in layout plans caused by "regular" and "urgent" lifting demands. [ABSTRACT FROM AUTHOR]

Acetylhydrazine (AcHZ), a major human metabolite of the widely-used anti-tuberculosis drug isoniazid (INH), was considered to be responsible for its serious hepatotoxicity and potentially fatal liver injury. It has been proposed that reactive radical species produced from further metabolic activation of AcHZ might be responsible for its hepatotoxicity. However, the exact nature of such radical species remains not clear. Through complementary applications of ESR spin-trapping and HPLC/MS methods, here we show that the initial N-centered radical intermediate can be detected and identified from AcHZ activated by transition metal ions (Mn(III)Acetate and Mn(III) pyrophosphate) and myeloperoxidase. The exact location of the radical was found to be at the distal-nitrogen of the hydrazine group by 15N-isotope-labeling techniques via using 15N-labeled AcHZ we synthesized. Additionally, the secondary C-centered radical was identified unequivocally as the reactive acetyl radical by complementary applications of ESR spin-trapping and persistent radical TEMPO trapping coupled with HPLC/MS analysis. This study represents the first detection and unequivocal identification of the initial N-centered radical and its exact location, as well as the reactive secondary acetyl radical. These findings should provide new perspectives on the molecular mechanism of AcHZ activation, which may have potential biomedical and toxicological significance for future research on the mechanism of INH-induced hepatotoxicity. [Display omitted] • N-centered radical of AcHZ was identified by both ESR and HPLC/MS methods. • N-centered radical was identified on the distal-N by 15N-labeled technique. • The adduct of acetyl radical with biomolecules was identified by HPLC/MS. [ABSTRACT FROM AUTHOR]

Background: The upgrading of atmospheric‐pressure plasma polymerization process, the detailed investigation of atmospheric‐pressure plasma polymerization deposited organic carbon‐silicon film features is essential to obtain the further understandings into the optimizing coating techniques. Aim: This investigation demonstrates plasma cyclone deposited film features with adjusting argon gas flow rate and HMDSN monomer flow rate. Method: This study utilized the plasma cyclone system to polymerize a carbon‐silicon film. In this study, Optical Emission Spectroscopy (OES) was employed as a diagnostic tool to indirectly inspect the chemical composition of the atmospheric‐pressure plasma polymerization's glow discharge by detecting the photo‐emitting species. The Contact Angle Goniometer, ATR‐FTIR, AFM, and XPS were used to measure the surface properties of the films deposited by plasma cyclone. Results: The static contact angle results show that most of the deposited films obtain the divergent contact angle values with adjusting argon gas flow rate and HMDSN monomer flow rate. ATR‐FTIR results show that argon gas flow rate and HMDSN monomer flow rate dominate the porosity of plasma cyclone deposited film surface. XPS and AFM analyses also detect the comparable trend of physicochemical characteristics of organic carbon‐silicon film with adjusting argon gas flow rate and HMDSN monomer flow rate. In summary, the organic carbon‐silicon films can be successfully polymerized by plasma cyclone. Conclusions: The results refer that the organic carbon‐silicon film deposition on vanadium redox flow battery separator surface improved the electrolyte uptake of the cyclonic‐plasma‐coated separators was larger than that of a commercial separator. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with severe diseases at the end-of-life stage are mostly hospitalized and may receive care from a hospitalist in the current healthcare system. In this study, we found that hospitalist care may enhance palliative care and reduce unnecessary aggressive life-sustaining treatment, such as mechanical ventilation, tracheostomy, surgery, and intensive care unit transfer before death. Although the benefit of hospitalist care at the end-of-life stage requires further validation, it potentially improves care for terminally ill patients in the hospital, especially when palliative care services are scarce. Background: Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. Methods: This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. Results: Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63–4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10–0.17), tracheostomy (OR = 0.14, 95% CI: 0.06–0.31), hemodialysis (OR = 0.70, 95% CI: 0.55–0.89), surgery (OR = 0.25, 95% CI: 0.19–0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08–0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = −0.54, 95% CI: −0.62–−0.46) and daily medical costs. Conclusions: Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (PoCUS) has high sensitivity and specificity in diagnosing uncomplicated colonic diverticulitis in Western patients. Evidence regarding the accuracy of PoCUS in Asian patients in which diverticulitis frequently occurs in the right-side colon is lacking. This multicenter, 10-y study was aimed at evaluating the diagnostic accuracy of PoCUS in various locations of uncomplicated diverticulitis among Asians. A convenience sample of patients with suspected colonic diverticulitis who had undergone computed tomography (CT) were eligible. Patients undergoing PoCUS before CT were included. The primary outcome was the diagnostic accuracy of PoCUS in the various locations, compared with the final diagnosis made by the expert physicians. The sensitivity, specificity, positive predictive value and negative predictive value were computed. The logistic regression model was used to investigate the possible factors related to the accuracy of PoCUS. A total of 326 patients were included. The overall accuracy of PoCUS was 92% (95% confidence interval [CI]: 89.1%–95.0%) and was lower in the cecum (84.3%, 95% CI: 77.8%–90.8%), compared with other locations (p < 0.0001). Nine of 10 false positives had the final diagnosis of appendicitis: 5 had an outpouching structure whose origin in the cecum could not be traced and 4 had elongated "diverticula." Moreover, body mass index was negatively associated with the accuracy of PoCUS in cecal diverticulitis (odds ratio: 0.79, 95% CI: 0.64–0.97) after adjusting for other covariates. Point-of-care ultrasound exhibits high diagnostic accuracy in diagnosing uncomplicated diverticulitis in the Asian population. However, the accuracy varies according to location, and was relatively low in the cecum. [ABSTRACT FROM AUTHOR]

Geoid undulation model is typically used for the conversion between GNSS obtained ellipsoidal heights and their orthometric counterparts. In this study, an adaptive approach for optimizing regional geoid model based on global geoid model and local GNSS/leveling measurements is presented. A rigorous sequential least squares approach coupled with an adjustable criterion is used for identifying appropriate observables so that an optimized model that fulfills a predefined quality level can be automatically produced. It has been demonstrated that a city scale geoid undulation model with a quality level around ± 14 mm km can be obtained by applying the proposed approach. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to investigate the surgical volume shifts for primary female stress urinary incontinence (SUI) over a 20-year period (1999−2018) in Taiwan. Methods: This was a retrospective cohort study based on Taiwan's National Health Insurance Research Database. We divided the time-frame into four periods: first period (1999−2003), second period (2004−2008), third period (2009−2013), and fourth period (2014−2018). The variables included major surgical types for SUI (retropubic urethropexy, pubovaginal sling, midurethral sling, etc.), surgeon gender, specialty, surgical volume (high ≥30, median 5–29, low <5), and hospital accreditation level. Reoperation rates within 1 year were analyzed as an outcome measurement. Results: A total of 51,018 patients were identified. Major surgical types increased significantly during the first three periods and slightly decreased during the fourth period. The proportion of surgical volume shifted from high- to medium-, and low-volume, but it reversed during the fourth period. The proportion of SUI surgeries decreased in medical centers, whereas it increased in regional and local hospitals. The proportion of SUI surgeries by female surgeons increased. Similar phenomena occurred in MUS. As for surgeon specialty, major surgical types were performed by gynecologists and urologists equally, whereas MUS were performed more by gynecologists than by urologists. Unexpectedly, 1-year reoperation rates were higher in high-volume surgeons. Conclusions: The surgical trend of SUI surgeries shifted from high- to medium-, and low-volume surgeons, medical centers to regional and local hospitals during the study periods. This implied surgical skills and performance spreading, which may have a great influence on patient and healthcare provider choice of treatment. [ABSTRACT FROM AUTHOR]

We demonstrate in-plane gate transistors based on the molybdenum disulfide (MoS2)/graphene hetero-structure. The graphene works as channels while MoS2 functions as passivation layers. The weak hysteresis of the device suggests that the MoS2 layer can effectively passivate the graphene channel. The characteristics of devices with and without removal of MoS2 between electrodes and graphene are also compared. The device with direct electrode/graphene contact shows a reduced contact resistance, increased drain current, and enhanced field-effect mobility. The higher field-effect mobility than that obtained through Hall measurement indicates that more carriers are present in the channel, rendering it more conductive. [ABSTRACT FROM AUTHOR]

We have shown that step length asymmetry seen in hip osteoarthritis (OA) is associated with poorer mechanical energy exchange and higher metabolic cost. Thus, we conducted this proof-of-concept study to investigate whether modifying step length through split-belt treadmill training can improve walking energetics. We conducted split-belt treadmill training in four periods with simultaneous motion and metabolic analyses in 10 women with unilateral hip OA. Using repeated measures ANOVA, we evaluated changes across each period, in step length asymmetry, mechanical energy exchange, and O2 rate. We also examined changes in hip range of motion and peak plantarflexor moment. We used Spearman correlations (rho) to assess the strength of associations between variables at baseline and after adaptation. We found that step length asymmetry and O2 rate decreased (p = 0.007, p < 0.001) and mechanical energy exchange increased (p < 0.001). Reduced step length asymmetry was associated with reduced O2 rate (rho = 0.732, p = 0.016). Hip range of motion increased (p < 0.001) and was associated with decreased step length asymmetry (rho = 0.818, p = 0.004), indicating a potential mechanism. These findings suggest that reducing step length asymmetry by split-belt treadmill training could improve walking energetics in hip OA people. [ABSTRACT FROM AUTHOR]

Fracture healing is a complicated process containing the regulation of cellular process. It has been reported that circRNAs are involved in fracture healing. Our study aims to explore the role and mechanism of circ_C4orf36 in fracture healing. Here, we found that the expressions of Circ_C4orf36 and VEGFA were increased during osteoblast differentiation in MC3T3-E1 cells. Circ_C4orf36 overexpression could accelerate the proliferation and migration, as well as osteoblast differentiation in MC3T3-E1 cells, as well as increased ALP activity and osteogenic markers (Runx2, OCN) via upregulating VEGFA expression. Mechanistically, circ_C4orf36 facilitated the expression of VEGFA by recruiting EIF4A3. Taken together, our results elucidated that circ_C4orf6 promoted the migration, proliferation and osteoblast differentiation in BMSCs by upregulating VEGFA, which indicated that circ_C4orf36 might be a potential target in fracture healing treatment. [ABSTRACT FROM AUTHOR]

Background: Recent reports suggested combining ramucirumab with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) to overcome EGFR resistance in non–small cell lung cancer (NSCLC). Nonetheless, evidence supporting the activity of afatinib and ramucirumab is lacking. This study investigated the survival benefits and safety profile of afatinib plus ramucirumab in patients with treatment-naïve, EGFR-mutated, metastatic NSCLC. Materials and methods: The medical records of patients with EGFR-mutated NSCLC were retrospectively retrieved. Patients who received first-line sequential afatinib followed by ramucirumab and the first-line combination of afatinib plus ramucirumab were included. The Kaplan-Meier was used to estimate the progression-free survival (PFS) of all included patients, patients on sequential afatinib followed by ramucirumab (PFS1), and patients on the up-front combination of afatinib and ramucirumab (PFS2). Results: Thirty-three patients were included (25 women; median age: 63 [45–82] years). The median follow-up of the included patients was 17 months (range 6–89 months). the median PFS for the whole cohort was 71 months (95% CI 67.2–74.8) with eight events during the follow-up. The median PFS1 and PFS2 were 71 months (95 CI not defined) and 26 months (95% CI 18.6–33.4), respectively. In terms of OS, the median OS for all patients and patients on sequential treatment was not defined, while the median OS for patients on upfront combination was 30 months (95% CI 20.9–39.1). There was no significant association between EGFR mutation type and PFS1 or PFS2. Conclusions: Afatinib plus ramucirumab could improve the PFS of patients with EGFR-positive NSCLC at a predictable safety profile. Our data also suggest a survival benefit of adding ramucirumab to afatinib in patients with uncommon mutations, which should be investigated further. [ABSTRACT FROM AUTHOR]

Tumor necrosis factor superfamily 14 (TNFSF14) is also known as the LT-related inducible ligand (LIGHT). It can bind to the herpesvirus invasion mediator and lymphotoxin-β receptor to perform its biological activity. LIGHT has multiple physiological functions, including strengthening the synthesis of nitric oxide, reactive oxygen species, and cytokines. LIGHT also stimulates angiogenesis in tumors and induces the synthesis of high endothelial venules; degrades the extracellular matrix in thoracic aortic dissection, and induces the expression of interleukin-8, cyclooxygenase-2, and cell adhesion molecules in endothelial cells. While LIGHT induces tissue inflammation, its effects on angiogenesis after tissue ischemia are unclear. Thus, we analyzed these effects in the current study. In this study, the animal model of hind limb ischemia surgery in C57BL/6 mice was performed. Doppler ultrasound, immunohistochemical staining, and Western blotting were employed to analyze the situation of angiogenesis. In addition, human endothelial progenitor cells (EPCs) were used for in vitro studies to analyze the possible mechanisms. The results in the animal study showed that LIGHT injection inhibited angiogenesis in ischemic limbs. For the in vitro studies, LIGHT inhibited the expression of integrins and E-selectin; decreased migration and tube formation capabilities, mitochondrial respiration, and succinate dehydrogenase activity; and promoted senescence in EPCs. Western blotting revealed that the impairment of EPC function by LIGHT may be due to its effects on the proper functioning of the intracellular Akt signaling pathway, endothelial nitrite oxide synthase (eNOS), and mitochondrial respiration. In conclusion, LIGHT inhibits angiogenesis after tissue ischemia. This may be related to the clamped EPC function. [ABSTRACT FROM AUTHOR]

Biosynthesis of gamma-aminobutyric acid (GABA) can be achieved by naturally occurring microorganisms with the advantages of cost-effectiveness and safety. In this study, Bacillus amyloliquefaciens EH-9 strain (B. amyloliquefaciens EH-9), a soil bacterium, was used to promote the accumulation of GABA in germinated rice seed. Further, the topical application of supernatant from rice seed co-cultivated with soil B. amyloliquefaciens EH-9 can significantly increase the production of type I collagen (COL1) in the dorsal skin of mice. The knocking down of the GABA-A receptor (GABAA) significantly reduced the production of COL1 in the NIH/3T3 cells and in the dorsal skin of mice. This result suggests that topical application of GABA can promote the biosynthesis of COL1 via its interaction with the GABAA receptor in the dorsal skin of mice. In summary, our findings illustrate for the first time that soil B. amyloliquefaciens EH-9 elicits GABA production in germinated rice seed to upregulate the formation of COL1 in the dorsal skin of mice. This study is translational because the result shows a potential remedy for skin aging by stimulating COL1 synthesis using biosynthetic GABA associated with B. amyloliquefaciens EH-9. [ABSTRACT FROM AUTHOR]

Background: The T790M mutation is the major resistance mechanism to first- and second-generation TKIs in EGFR-mutant NSCLC. This study aimed to investigate the utility of droplet digital PCR (ddPCR) for detection of T790M in plasma circulating tumor DNA (ctDNA), and explore its impact on prognosis. Methods: This prospective study enrolled 80 advanced lung adenocarcinoma patients treated with gefitinib, erlotinib, or afatinib for TKI-sensitizing mutations between 2015 and 2019. Plasma samples were collected before TKI therapy and at tri-monthly intervals thereafter. Genotyping of ctDNA for T790M was performed using a ddPCR EGFR Mutation Assay. Patients were followed up until the date of death or to the end of 2021. Results: Seventy-five of 80 patients experienced progressive disease. Fifty-three (71%) of 75 patients underwent rebiopsy, and T790M mutation was identified in 53% (28/53) of samples. Meanwhile, plasma ddPCR detected T790M mutation in 23 (43%) of 53 patients. The concordance rate of T790M between ddPCR and rebiopsy was 76%, and ddPCR identified 4 additional T790M-positive patients. Ten (45%) of 22 patients who did not receive rebiopsy tested positive for T790M by ddPCR. Serial ddPCR analysis showed the time interval from detection of plasma T790M to objective progression was 1.1 (0–4.1) months. Compared to 28 patients with rebiopsy showing T790M, the overall survival of 14 patients with T790M detected solely by ddPCR was shorter(41.3 [95% CI, 36.6–46.0] vs. 26.6 months [95% CI, 9.9–43.3], respectively). Conclusion: Plasma ddPCR-based genotyping is a useful technology for detection and monitoring of the key actionable genomic alteration, namely, T790M, in patients treated with gefitinib, erlotinib, or afatinib for activating mutations, to achieve better patient care and outcome. [ABSTRACT FROM AUTHOR]

Loss of sagittal plane hip range of motion (ROM) is a commonly reported walking gait impairment in people with hip osteoarthritis (OA). The purpose of this study was to evaluate whether sagittal plane hip ROM reduction and the resulting altered sagittal plane ankle kinetics during gait influence the energy cost of walking in people with hip OA. We evaluated 24 women with unilateral hip OA (60 ± 9.1 years; 29.4 ± 6.1 kg/m2). Sagittal plane hip ROM and peak ankle dorsiflexion moment were assessed by instrumented gait analysis. We also used a portable metabolic system to measure the energy cost of walking. Pearson correlations and regression analyses were performed to test our hypotheses. We found that greater involved limb sagittal plane hip ROM was associated with a larger ankle peak dorsiflexion moment at push‐off during gait (R = 0.50, p = 0.01). Greater involved limb peak ankle dorsiflexion moment at push‐off was associated with a lower oxygen consumption during gait (R = −0.51, p = 0.01). Involved limb peak ankle dorsiflexion moment at push‐off predicted 26% of the variance in O2 cost. Statement of Clinical Significance: Sagittal plane hip ROM was associated with peak ankle dorsiflexion moment at push‐off during gait in women with hip OA. Moreover, peak ankle dorsiflexion moment at push‐off was associated with the energy cost of walking. Therefore, modifying sagittal plane hip ROM and peak ankle dorsiflexion moment could be a possible rehabilitation strategy to improve gait efficiency in women with hip OA. [ABSTRACT FROM AUTHOR]

Patients with oral cavity squamous cell carcinoma (OSCC) undergoing curative-intent treatment may become immunocompromised. This study aimed to investigate the association of pretreatment sarcopenia, nutritional status, comorbidities, and blood-based inflammation prognostic biomarkers in bloodstream infection (BSI) with survival status in elderly patients with OSCC. Retrospective data were collected from 235 patients who were newly diagnosed with OSCC, were aged ≥ 65 years, had undergone curative-intent treatment, and were classified into either the BSI group or the no-BSI group within 6 months after surgery and/or adjuvant therapy initiation. Of the 235 elderly patients, 27 presented with BSI episodes. A preoperative high neutrophil-to-lymphocyte ratio (NLR) was a significant independent risk factor for BSI. BSI was not significantly associated with survival status. Ever betel nut chewing, hypoalbuminemia, and advanced tumor stage were associated with shorter overall survival. Moreover, a high NLR was an independent risk factor associated with disease-free survival. A high NLR was associated with BSI and resistance to curative-intent treatment. Pretreatment of NLR could act as an independent prognostic indicator and help inform treatment strategies for older patients with OSCC. [ABSTRACT FROM AUTHOR]

Background: We aimed to analyze the radiation dose and compare survival among combined modality therapy using modern radiation techniques for patients with esophageal squamous cell carcinoma (ESCC). Methods: This retrospective study included patients with clinically staged T1‐4N0‐3M0 ESCC from 2014 to 2018. Patients who received combined modality therapies with curative intent were enrolled. The overall survival (OS) rates among combined modality therapy were compared. The clinical variables and impacts of radiation dose on survival were analyzed by the Kaplan–Meier method and Cox regression model. Results: Of the 259 patients, 141 (54.4%) received definitive concurrent chemoradiotherapy (DCCRT); 67 (25.9%) underwent neoadjuvant chemoradiotherapy followed by surgery (NCRT+S); 51 (19.7%) obtained surgery followed by adjuvant chemoradiotherapy (S+ACRT). Two‐year OS rates of the DCCRT, NCRT+S and S+ACRT group were 48.9, 61.5 and 51.2%. In the subgroup analysis of DCCRT group, the 2‐year OS of patients receiving radiation dose 55–60 Gy was 57.1%. Multivariate analyses showed that clinical stage (p = 0.004), DCCRT with 55–60 Gy (p = 0.043) and NCRT+S with pathological complete response (pCR) (p = 0.014) were significant prognostic factors for better OS. The radiation dose–survival curve demonstrated a highly positive correlation between higher radiation dose and better survival. Conclusion: Our results suggest that NCRT+S can provide a favorable survival for patients with ESCC, especially in patients who achieved pCR. The optimal radiation dose might be 55–60 Gy for patients receiving DCCRT via modern radiation techniques. Further randomized clinical studies are required to confirm the survival benefits between NCRT+S and DCCRT with escalated dose. [ABSTRACT FROM AUTHOR]