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The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers. Patient-centered predictors of healthcare utilization after elective spine surgery may identify targets for cost reduction and value creation. Therefore, our study aims to quantify patterns of healthcare utilization and identify risk factors that predict high healthcare utilization after elective spine surgery.A total of 623 patients who underwent elective spine surgery at a tertiary academic medical center by one of three fellowship-trained orthopedic spine surgeons between 2013 and 2018 were identified in this retrospective cohort study. Healthcare utilization was quantified including advanced spine imaging, emergency and urgent care visits, hospital readmission, reoperation, PT/OT referrals, opioid prescriptions, epidural steroid injections, and pain management referrals. Patient variables, namely, the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification system, were assessed as potential predictors for healthcare utilization.Among all patients, a wide range of health utilization was identified. Age, body mass index, Charlson Comorbidity Index, and American Society of Anesthesiology class were identified as positive predictors of postoperative healthcare utilization including emergency department visits, spine imaging studies, opioid and nerve blocker prescriptions, inpatient rehabilitation, any referrals, and pain management referrals.Markers of patient health-such as CCI and ASA class-may be used to predict healthcare utilization following elective spine surgery. Identifying at-risk patients and addressing these challenges prior to surgery is an important step to deliver efficient postoperative care.3.

This study aimed to investigate the association between depressive symptoms and diet- and lifestyle-related behaviors among adolescents.Cross-sectional study.Our study used stratified random cluster sampling method to recruit 6,251 adolescents aged 11-19 years as samples for research and analysis. The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms. Chi-squared test, t test, and logistic regression were used to explore the diet and lifestyle factors of depressive symptoms. Backpropagation (BP) neural network model was used to investigate the ranking of diet and lifestyle behaviors factors of depressive symptoms.The prevalence of depressive symptoms among adolescents was 32.1%. Multivariable logistic regression was used to determine 10 important variables of depressive symptoms. After ranking the importance by BP neural network, the top three important variables were found, which were sleep duration (100%), screen time (49.1%), and breakfast (23.6%).Sleep duration, screen time, and breakfast were associated factors with the most significant impacts on depressive symptoms.

Assessing the prognostic utility of lymph node status in pediatric rhabdomyosarcoma (RMS) patients and identifying demographic and clinical predictors of positive lymph node status among pediatric rhabdomyosarcoma patients.Retrospective cohort study of head and neck RMS in patients with and without positive lymph node metastasis.National Cancer Database (NCDB) was queried for patients of young (0-11 years) and adolescent (12-21 years) ages with head and neck RMS and confirmed positive or negative lymph node metastasis status. Descriptive analyses, Kaplan-Meier survival analyses, and multivariate logistic regressions were performed on extracted demographic and clinical characteristics.Among 272 head and neck RMS patients, 146 (54%) were found to have positive lymph node metastasis. Alveolar RMS (n = 147, 54%) followed by embryonal RMS (n = 74, 27%) were the most represented histology types. Positive lymph node metastasis conferred significantly decreased survivability (p 0.001) with a median survival period of 36.42 months compared to negative lymph node metastasis with a period of 53.47 months. Older age showed markedly increased odds (OR-2.02; 95%CI 1.22-3.38) of having lymph node metastasis when controlling for sex, race, insurance status, and Charlson-Comorbidity score. Alveolar histologies showed markedly increased odds of having lymph node metastasis (OR-3.21; 95%CI 1.96-5.31); embryonal histologies showed markedly decreased odds of having lymph node metastasis (OR-0.32; 95%CI 0.18-0.56) CONCLUSIONS: This study highlights the significant prognostic value of lymph node status among pediatric head and neck rhabdomyosarcoma patients while showcasing crucial demographic and pathological predictors of lymph node metastasis in said patients. Use of lymph node status in pediatric head and neck rhabdomyosarcoma will present future steps towards improving its clinical course.

Time-series and case-crossover are two main study designs in environmental epidemiology. However, due to the differences in design principles and model construction between the two analyses, the results of the two analyses may not be consistent. Herein, we examined the short-term effect of cold spells on cardiovascular mortality in Nanjing using both time series and case-crossover analyses, aiming to provide a basis for the selection of appropriate research design in environmental epidemiology.时间序列和病例交叉是环境流行病学研究常用的两种方法，由于两种方法在设计原理和模型构建等方面存在差异，所得出的结论可能并不完全一致。本文以南京市气象和人群心血管病死亡数据为基础资料，分别应用时间序列和病例交叉方法分析寒潮对心血管病死亡的短期效应，为今后在环境与健康研究中选择合适的研究方法提供参考。.

原发性醛固酮增多症（primary aldosteronism，PA）根据肾上腺病变部位不同分为单侧和双侧PA，前者可手术治疗，后者应药物控制。单侧PA影像学上常表现为肾上腺低密度结节或增粗。肾上腺CT显像“无异常”的单侧PA既往国内未见报道。本文通过对1例肾上腺CT显像“无异常”的单侧PA患者的临床特点及诊治过程进行分析，总结诊治要点并结合文献复习进行讨论，以期为影像学阴性的单侧PA的临床诊治提供一些借鉴和思路。.

ImportancePrior investigations in social determinants of health (SDoH) in pediatric head and neck cancer (HNC) have only considered a narrow scope of HNCs, SDoH, and geography while lacking inquiry into the interrelational association of SDoH with disparities in clinical pediatric HNC.ObjectivesTo evaluate the association of SDoH with disparities in HNC among children and adolescents and to assess which specific aspects of SDoH are most associated with disparities in dynamic and regional sociodemographic contexts.Design, Setting, and ParticipantsThis retrospective cohort study included data about patients (aged ≤19 years) with pediatric HNC who were diagnosed from 1975 to 2017 from the Surveillance, Epidemiology, and End Results Program (SEER) database. Data were analyzed from October 2021 to October 2022.ExposuresOverall social vulnerability and its subcomponent contributions from 15 SDoH variables, grouped into socioeconomic status (SES; poverty, unemployment, income level, and high school diploma status), minority and language status (ML; minoritized racial and ethnic group and proficiency with English), household composition (HH; household members aged ≥65 and ≤17 years, disability status, single-parent status), and housing and transportation (HT; multiunit structure, mobile homes, crowding, no vehicle, group quarters). These were ranked and scored across all US counties.Main Outcomes and MeasuresRegression trends were performed in continuous measures of surveillance and survival period and in discrete measures of advanced staging and surgery receipt.ResultsA total of 37 043 patients (20 729 [55.9%] aged 10-19 years; 18 603 [50.2%] male patients; 22 430 [60.6%] White patients) with 30 different HNCs in SEER had significant relative decreases in the surveillance period, ranging from 23.9% for malignant melanomas (mean [SD] duration, lowest vs highest vulnerability: 170 [128] months to 129 [88] months) to 41.9% for non-Hodgkin lymphomas (mean [SD] duration, lowest vs highest vulnerability: 216 [142] months vs 127 [94] months). SES followed by ML and HT vulnerabilities were associated with these overall trends per relative-difference magnitudes (eg, SES for ependymomas and choroid plexus tumors: mean [SD] duration, lowest vs highest vulnerability: 114 [113] months vs 86 [84] months; P P = .43) to 61.4% for gliomas not otherwise specified (NOS) (mean [SD] survival, lowest vs highest vulnerability: 44 [84] months to 17 [28] months; P P Conclusions and RelevanceIn this cohort study of patients with pediatric HNC, significant decreases in receipt of care and survival time were observed with increasing SDoH vulnerability.

To summarize the main findings from research on measuring the value in spine surgery.Determining the value of surgical interventions, which is defined by the quality and efficacy of care received divided by the cost to deliver healthcare, is inherently complex. The two most fundamental components of value-quality and total cost-are multifactorial and difficult to quantify.A narrative review of all the relevant papers known to the author was conducted.It is straightforward to calculate the aggregate hospital cost following a surgical procedure, but it is not simple to estimate the total cost of a procedure-including the direct and indirect costs. These individual metrics can help providers make more educated decisions with regards to improving patient quality of life and minimizing unnecessary costs. A consensus of the appropriate cost-per-quality-adjusted life-year threshold of different spine surgeries needs to be established. As these metrics become more commonplace in spine surgery, the potential for personalized health care will continue to be developed.As the healthcare system shifts toward value-based care, there is a substantial need for research assessing the value as defined by the quality and efficacy of care received divided by the cost to deliver healthcare of specific spine surgery procedures. Studies on different predictors-both patient-specific and surgical-that may influence outcomes, cost, and value are required.

This study investigates the relationship between rice yields, climate change, and carbon dioxide (CO2). We integrate gridded climate data in the growing seasons and Asian rice yield data reported by the Food and Agriculture Organization with free air carbon dioxide enrichment (FACE) experimental data. Using those data, we estimate prediction models of rice yields that evolve over time and decompose effects of climate, CO2, and technological progress. The results show that atmospheric CO2 has significantly increased rice yields, with the contribution accounting for 29% to 33% of the observed yield growth. The results also reveal that increases in temperature decrease rice yields in parts of Asia, implying that both CO2 mitigation and climate change are yield growth depressing factors. The finding suggests a potential need for more agricultural research and development investment to offset CO2 mitigation and climate change effects.

SUMMARYBrain regeneration requires a precise coordination of complex responses in a time- and region-specific manner. Identifying key cell types and molecules that direct brain regeneration would provide potential targets for the advance of regenerative medicine. However, progress in the field has been hampered largely due to limited regeneration capacity of the mammalian brain and understanding of the regeneration process at both cellular and molecular level. Here, using axolotl brain with extrodinary regeneration ability upon injury, and the SpaTial Enhanced REsolution Omics-sequencing (Stereo-seq), we reconstructed the first architecture of axolotl telencephalon with gene expression profiling at single-cell resolution, and fine cell dynamics maps throughout development and regeneration. Intriguingly, we discovered a marked heterogeneity of radial glial cell (RGC) types with distinct behaviors. Of note, one subtype of RGCs is activated since early regeneration stages and proliferates while other RGCs remain dormant. Such RGC subtype appears to be the major cell population involved in early wound healing response and gradually covers the injured area before presumably transformed into the lost neurons. Altogether, our work systematically decoded the complex cellular and molecular dynamics of axolotl telencephalon in development and regeneration, laying the foundation for studying the regulatory mechanism of brain regeneration in the future.

A 57-year-old man was admitted to hospital with diarrhea for 10 months and dizziness for 4 months. The patient had 1-2 liters watery stool per day, without pyogenic blood or abnormality in gastroenteroscopy examination. The level of hemoglobin and albumin was generally normal, and fasting test was positive. At the same time, he was accompanied with hyperalgesia of lower limbs and orthostatic hypotension. After the discussion of multiple disciplinary teams, the patient was diagnosed with amyloidosis by sural nerve biopsy, myocardial MRI, and the assays of urine immunoelectrophoresis and serum free light chain. Light chain amyloidosis was confirmed after excluded the diagnosis of familial amyloidosis. The patient was improved after courses of chemotherapy with melphalan and dexamethasone.患者男，57岁，因腹泻10个月，头晕4个月入院。患者每天1~2 L水样便，不含脓血，禁食试验阳性，胃肠镜检查无异常发现，血红蛋白及白蛋白大致正常；同时伴有双下肢感觉异常以及显著的直立性低血压症状。既往有多年的血糖异常及长期大量饮酒史。入院后经多科讨论，通过腓肠神经活检找到了淀粉样变的证据，并结合尿免疫固定电泳、血清游离轻链及心肌核磁检查，确诊为轻链型淀粉样变。予马法兰联合地塞米松化疗后病情缓解。.

Background The incidence of end-stage renal disease (ESRD) after liver transplant (LT) has increased. The actual benefit of kidney transplantation (KT) is not completely understood in LT recipients with ESRD. Methods We analyzed Scientific Registry of Transplant Recipients data for all KT candidates with prior LT from 1998 to 2014; the benefits of KT relative to remaining on dialysis were compared by means of multivariate Cox proportional hazards regression analysis. Results The number of these KT candidates with prior LT has tripled from 98 in 1998 to 323 in 2015; LT recipients with ESRD remaining on dialysis have a 2.5-times increase in the risk of liver graft failure and a 3.6-times increase in the risk of patient death compared with these patients receiving KT. The adjusted liver graft and patient survival rates after donors from donation after cardiac death or expanded-criteria donor kidney transplantation were significantly higher than in patients remaining on dialysis in LT recipients with ESRD. Conclusions The number of referrals to KT with prior LT is increasing at a rapid rate. Remaining on dialysis in LT recipients with ESRD has profound increased risks of liver graft failure and patient death in comparison to receiving a KT. LT recipients with ESRD can benefit from expanded-criteria donor and donation after cardiac death kidney transplantation.

功能性便秘的治疗中推荐增加膳食纤维摄入，有助于改善粪便性状、增加排便次数。膳食纤维在促进肠道动力、保护肠黏膜屏障、调节肠道菌群等方面均有积极作用，这主要与膳食纤维的理化特性及其分解产物短链脂肪酸的相关生理作用有关。但膳食纤维可能也存在一些副作用，如腹胀、胃肠胀气，这主要由膳食纤维在代谢过程中产生气体导致。伴明显腹胀的功能性便秘患者和有结肠扭转风险或病史的患者应慎重增加膳食纤维摄入。.

Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5 GeV/c2, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85 MeV/c2 by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.

The XENON1T liquid xenon time projection chamber is the most sensitive detector built to date for the measurement of direct interactions of weakly interacting massive particles with normal matter. The data acquisition system (DAQ) is constructed from commercial, open source, and custom components to digitize signals from the detector and store them for later analysis. The system achieves an extremely low signal threshold below a tenth of a photoelectron using a parallelized readout with the global trigger deferred to a later, software stage. The event identification is based on MongoDB database queries and has over 97% efficiency at recognizing interactions at the analysis energy threshold. A readout bandwidth over 300 MB/s is reached in calibration modes and is further expandable via parallelization. This DAQ system was successfully used during three years of operation of XENON1T., 14 pages, 6 figures, submitted to JINST; Version 2 with minor updates to text

The low survival rate of patients with ovarian cancer largely results from the advanced ovarian tumors as well as tumor resistance to chemotherapy, leading to metastasis and recurrence. However, it is missing as to an effective therapeutic approach that focuses on these aspects to prolong progression-free survival and to decrease mortality in ovarian cancer patients. Here, based on our cancer drug discovery studies, we provide prospective insights into the development of a future line of drugs to effectively reduce ovarian cancer deaths. Pathways that increase the probability of cancer, such as the defective Fanconi anemia (FA) pathway, may render cancer cells more sensitive to new drug targeting.

Purpose – The purpose of this paper is to understand the nature and extent of current practice of construction supply chain management (CSCM) in the New Zealand (NZ) construction industry; consequently, to examine the challenges and issues that the industry is confronted in implementing an efficient CSCM. The construction industry, which contributes around 5 per cent to gross domestic product, is a vitally important industry in NZ. With over 50,000 businesses, the construction industry is the third largest industry by business count in NZ’s economy (Statistics New Zealand, 2009). Although it is widely accepted that productivity can be improved by adoption of effective supply chain management (SCM), no studies have investigated this at the tactical level in the NZ context. Design/methodology/approach – A case study approach is used for probing SCM practice on a NZ$75-million commercial project located in Auckland Central Business District. The supply chain network of the principal ground works and superstructure construction stages was studied. Findings – The key findings of the case study suggest that the flow of materials remains the main focus of CSCM practice. It was found that essential skills training for CSCM was extremely limited and largely ill-defined in terms of its nature and content. Finally, it was identified that as the NZ construction industry moves towards a significantly more collaborative framework, the efficacy of CSCM operations is expected to substantially improve. However, this last point did not negate the requirement to expand and improve skills training in CSCM. Originality/value – The results of the case study present that our best industry proponents are inadequate in their knowledge of CSCM as a result of education and training. This is a key issue that needs to be addressed through education at all levels. Similarly, they have virtually nil capability with logistics and the efficiency of transportation as a result of standard contractual costing procedures. Until the SCM/logistics knowledge gap is recognised and addressed, the improvements in logistics and, therefore, SCM will not occur in the NZ construction industry. That said, the findings related to partnering and collaborative thinking in NZ are encouraging. NZ has these elements largely in place already and a willingness to engage, particularly in alliances, in the future. It remains to be seen whether there will be sufficient energy expended in NZ by the leading players to create effective partnering and alliancing through improving SCM and logistics competencies.

ZnO–reduced graphene oxide (rGO) nanocomposites with rGO/ZnO mass ratio of 0–0.20 were synthesised by a hydrothermal method. The photodegradation experiments of malachite green in water on the nanocomposites indicated that the photodegradation rate increased with increasing rGO content and initial solution pH. Significantly, the Fenton-like photodegradation of the malachite green in water was observed in the presence of H2O2. This Fenton-like reaction speeds up as the rGO/ZnO ratio increases. The quasi-kinetic rate constants of the photocatalysis systems are in the range of ∼0.0064–0.0247 min−1 and increase about one magnitude to ∼0.0868–0.2120 min−1 by the Fenton-like reaction.

We describe the purification of xenon from traces of the radioactive noble gas radon using a cryogenic distillation column. The distillation column is integrated into the gas purification loop of the XENON100 detector for online radon removal. This enabled us to significantly reduce the constant $^{222}$Rn background originating from radon emanation. After inserting an auxiliary $^{222}$Rn emanation source in the gas loop, we determined a radon reduction factor of R > 27 (95% C.L.) for the distillation column by monitoring the $^{222}$Rn activity concentration inside the XENON100 detector.

International audience; We report on weakly interacting massive particles (WIMPs) search results in the XENON100 detector using a nonrelativistic effective field theory approach. The data from science run II (34 kg×224.6 live days) were reanalyzed, with an increased recoil energy interval compared to previous analyses, ranging from (6.6–240) keVnr. The data are found to be compatible with the background-only hypothesis. We present 90% confidence level exclusion limits on the coupling constants of WIMP-nucleon effective operators using a binned profile likelihood method. We also consider the case of inelastic WIMP scattering, where incident WIMPs may up-scatter to a higher mass state, and set exclusion limits on this model as well.

Colitis is still a significant disease challenge in humans, but its underlying mechanism remains to be fully elucidated. The transient receptor potential vanilloid (TRPV) ion channel plays an important pathological role in host immunity, as deficiency of TRPV compromises host defence in vivo and in vitro. Using a DSS-induced colitis mouse model, the function of TRPV2 in the development of colitis was investigated, utilizing TRPV2(-/-) and Wt mice. Less severe colitis was observed in TRPV2(-/-) , compared to that of Wt mice, at the clinical, histopathological and immunohistochemical levels. Compared to Wt mice, reduced severity of colitis in TRPV2(-/-) mice may be due to less intestinal inflammation via reduced recruitment of macrophages. The TRPV2 pathway contributes to the development of colitis. These data provide useful information for potential therapeutic intervention in colitis patients.

Pure and Sn4+-doped SnS films with different S/Sn molar ratio were fabricated by chemical bath deposition from the solution of tin dichloride, thiacetamide, and triammonium citrate. The deposited films were characterized by X-ray diffraction, scanning electron microscopy, ultraviolet-visible spectrophotometry, photoluminescence spectrophotometry, and electrical conduction measurement. The effect of S/Sn molar ratios and Sn4+-doping on the properties of the films was investigated. When S/Sn molar ratio in bath solution was designed as 0.55–0.85, the S/Sn ratios in the films were ~0.54–0.83. The pure films showed electrical resistivity of ~26.2–71.3 k Ω cm, decreasing as decreasing S/Sn ratio. The Sn4+-doping further obviously decreased the resistivity of the films to ~1.5–9.6 kΩ cm. The films had thicknesses of ~470−650 nm and average transmittances of ~48.9−71.4% in the wavelength range of 290−1000 nm. The direct and indirect optical band gaps estimated from the transmittance and reflectance spectra equaled to ~1.25−1.83 eV and ~1.1−1.65 eV, respectively. The average transmittances and band gap values increased as decreasing S/Sn ratio and doping Sn4+-cation.