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Abstract Background Anaplastic lymphoma kinase (ALK)-positive histiocytosis, a novel rare histiocytic proliferation, was first described in 2008; it occurs in early infancy with liver and hematopoietic involvement. The spectrum was subsequently broadened to include localized diseases in older children and young adults. However, its full clinicopathological features and molecular lineage have not been fully elucidated. Results Here, we report four cases of multisystem ALK-positive histiocytosis without hematopoietic involvement. Clinically, three patients were adults aged between 32 and 51 years. Two patients’, whose main manifestations were intracranial mass and numerous micronodules in the thoracoabdominal cavity organs and skin papules respectively, had a partial response to ALK inhibitors after surgery. One patient presented with mediastinal neoplasm without surgical treatment, and progressive disease occurred after two years of ALK inhibitor therapy. The fourth patient was a 17-month-old male with a large intracranial mass and presented with a poor response to ALK inhibitor and chemoradiotherapy; he died eight months after surgery. Pathologically, the histiocytes were large, with abundant eosinophilic cytoplasm, and mixed with variable numbers of foamy cells and Touton giant cells. Interstitial fibrosis was also observed. Histiocytes were positive for macrophage markers (CD68 and CD163) and ALK. KIF5B-ALK fusions were detected in two cases, EML4-ALK in one, and both DCTN1-ALK and VRK2-ALK fusions were detected in one case. Conclusions We observed that ALK inhibitors present robust and durable responses in adult patients but a poor response in young children with central nervous system involvement. There is no consensus on the optimal treatment regimen and long-term prognosis requires further observation. Moreover, every unusual histiocytic proliferative lesion, especially unresectable and multisystem involvement, should be routinely tested for ALK immunohistochemical staining to identify this rare disease.

Abstract Context A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. Objective This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age. Methods An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18–64 years) and an older group (≥ 65 years), further stratified into young-old (65–79 years) and oldest-old (≥ 80 years) groups. Results The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups. Conclusion Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.

The aim of this meta-analysis was to comprehensively evaluate the effectiveness of Diagnosis-related group (DRG) based payment on inpatient quality of care. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science from their inception to December 30, 2022. Included studies reported associations between DRGs-based payment and length of stay (LOS), re-admission within 30 days and mortality. Two reviewers screened the studies independently, extracted data of interest and assessed the risk of bias of eligible studies. Stata 13.0 was used in the meta-analysis. A total of 29 studies with 36 214 219 enrolled patients were analyzed. Meta-analysis showed that DRG-based payment was effective in LOS decrease (pooled effect: SMD = −0.25, 95% CI = −0.37 to −0.12, Z = 3.81, P

To analyze the performance of the Prostate Health Index (phi) and its derivatives for predicting Gleason score (GS) upgrading between prostate biopsy and radical prostatectomy (RP) in the Chinese population, an observational, prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020. Pathological reclassification was determined by the Gleason Grade Group (GG). The area under the receiver operating characteristic curve (AUC) and logistic regression (LR) models were used to evaluate the predictive performance of predictors. In clinically low-risk patients with biopsy GG ≤2, phi (odds ratio [OR] = 1.80, 95% confidence interval [95% CI]: 1.14–2.82, P = 0.01) and its derivative phi density (PHID; OR = 2.34, 95% CI: 1.30–4.20, P = 0.005) were significantly associated with upgrading to GG ≥3 after RP, and the results were confirmed by multivariable analysis. Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG ≥2. Compared to the base model (AUC = 0.59), addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients (AUC = 0.69 and 0.71, respectively, both P < 0.05). In conclusion, phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

Abstract Background Cryptosporidium viatorum is a minor Cryptosporidium pathogen in humans. Currently, there is limited information regarding the prevalence and genotypes of C. viatorum in animals in China. Methods In this study, 228 faecal samples were collected from two wild rat species (Leopoldamys edwardsi and Berylmys bowersi) in Chongqing Municipality and Guangdong Province, China. These specimens were analyzed for C. viatorum and then subtyped it using PCR and sequence analysis of the small subunit ribosomal RNA (SSU rRNA) and 60-kilodalton glycoprotein (gp60) genes, respectively. Results A total of 25 (11.0%) faecal samples were tested positive for C. viatorum by SSU rRNA assay. Of these samples, 4 (3.6%) came from L. edwardsi and 21 (18.0%) from B. bowersi. Of the 25 C. viatorum-positive samples, 17 were successfully amplified at the gp60 gene locus, which represented four subtypes belonging to two subtype families, including XVa (XVaA6, XVaA3g, XVaA3h) and XVc (XVcA2G1). Phylogenetic analysis based on the gp60 amino acid sequences indicated that all of the C. viatorum isolates grouped together, supporting the conclusion that C. viatorum from the wild rats represent two subtype families. Conclusions These results indicate an occurrence of C. viatorum XVa subtype family from rats which is genetically identical to those found in humans. Our findings suggest that wild rats may be a potential source of human cryptosporidiosis.

Preplaced aggregate concrete (PAC) has up to 60 % aggregate volume content, making mesoscale modelling difficult. A novel mesoscale simulation method based on physics engine was proposed in this study to accurately simulate the coarse aggregate skeleton of PAC. Unlike in conventional mesoscale simulations, point-to-point contacts between aggregates were formed due to virtual gravity in the physics engine. To verify this novel method, mechanical property and shrinkage behavior tests of PAC were conducted under different aggregate gradings and with different expansive agents. For the mechanical property test, the simulation results were compared with the test results in terms of the aggregate stacking state, failure mode, stress–strain curve, and mechanical property parameters. Repeatability and aggregate shape analyses were performed using finite element (FE) model. A similar comparison between the simulation and test results was also performed for the shrinkage behavior. A shrinkage coefficient reflecting the relationship between grout and PAC shrinkage was proposed. This novel mesoscale simulation method based on physics engine is particularly suitable for PAC. However, it is not limited to PAC and can be applied to the simulation of conventional concrete, thus solving the problem of traditional simulation methods that struggle to achieve a high aggregate fraction.

Abstract Emerging reconfigurable metasurfaces offer various possibilities for programmatically manipulating electromagnetic waves across spatial, spectral, and temporal domains, showcasing great potential for enhancing terahertz applications. However, they are hindered by limited tunability, particularly evident in relatively small phase tuning over 270°, due to the design constraints with time‐intensive forward design methodologies. Here, a multi‐bit programmable metasurface is demonstrated capable of terahertz beam steering facilitated by a developed physics‐informed inverse design (PIID) approach. Through integrating a modified coupled mode theory (MCMT) into residual neural networks, the PIID algorithm not only significantly increases the design accuracy compared to conventional neural networks but also elucidates the intricate physical relations between the geometry and the modes. Without decreasing the reflection intensity, the method achieves the enhanced phase tuning as large as 300°. Additionally, the inverse‐designed programmable beam steering metasurface is experimentally validated, which is adaptable across 1‐bit, 2‐bit, and tri‐state coding schemes, yielding a deflection angle up to 68° and broadened steering coverage. The demonstration provides a promising pathway for rapidly exploring advanced metasurface devices, with potentially great impact on communication and imaging technologies.

Abstract Background Recent research suggests that periodontitis can increase the risk of chronic obstructive pulmonary disease (COPD). In this study, we performed two-sample Mendelian randomization (MR) and investigated the causal effect of periodontitis (PD) on the genetic prediction of COPD. The study aimed to estimate how exposures affected outcomes. Methods Published data from the Gene-Lifestyle Interaction in the Dental Endpoints (GLIDE) Consortium’s genome-wide association studies (GWAS) for periodontitis (17,353 cases and 28,210 controls) and COPD (16,488 cases and 169,688 controls) from European ancestry were utilized. This study employed a two-sample MR analysis approach and applied several complementary methods, including weighted median, inverse variance weighted (IVW), and MR-Egger regression. Multivariable Mendelian randomization (MVMR) analysis was further conducted to mitigate the influence of smoking on COPD. Results We chose five single-nucleotide polymorphisms (SNPs) as instrumental variables for periodontitis. A strong genetically predicted causal link between periodontitis and COPD, that is, periodontitis as an independent risk factor for COPD was detected. PD (OR = 1.102951, 95% CI: 1.005–1.211, p = 0.039) MR-Egger regression and weighted median analysis results were coincident with those of the IVW method. According to the sensitivity analysis, horizontal pleiotropy’s effect on causal estimations seemed unlikely. However, reverse MR analysis revealed no significant genetic causal association between COPD and periodontitis. IVW (OR = 1.048 > 1, 95%CI: 0.973–1.128, p = 0.2082) MR Egger (OR = 0.826, 95%CI:0.658–1.037, p = 0.1104) and weighted median (OR = 1.043, 95%CI: 0.941–1.156, p = 0.4239). The results of multivariable Mendelian randomization (MVMR) analysis, after adjusting for the confounding effect of smoking, suggest a potential causal relationship between periodontitis and COPD (P = 0.035). Conclusion In this study, periodontitis was found to be independent of COPD and a significant risk factor, providing new insights into periodontitis-mediated mechanisms underlying COPD development.

Abstract Heart injury such as myocardial infarction leads to cardiomyocyte loss, fibrotic tissue deposition, and scar formation. These changes reduce cardiac contractility, resulting in heart failure, which causes a huge public health burden. Military personnel, compared with civilians, is exposed to more stress, a risk factor for heart diseases, making cardiovascular health management and treatment innovation an important topic for military medicine. So far, medical intervention can slow down cardiovascular disease progression, but not yet induce heart regeneration. In the past decades, studies have focused on mechanisms underlying the regenerative capability of the heart and applicable approaches to reverse heart injury. Insights have emerged from studies in animal models and early clinical trials. Clinical interventions show the potential to reduce scar formation and enhance cardiomyocyte proliferation that counteracts the pathogenesis of heart disease. In this review, we discuss the signaling events controlling the regeneration of heart tissue and summarize current therapeutic approaches to promote heart regeneration after injury.

The field synergy principle is widely used in the analyses and optimizations of convective heat transfer, but its original derivations are based on fluids with constant thermal properties. The applicability of the principle for fluids with temperature-dependent properties needs clarification. A theoretical analysis of the problem is conducted. It is found that a synergy principle of mass flux vector and specific enthalpy gradient is more fundamental. Because temperature gradients are parallel to specific enthalpy gradients, the original field synergy principle of velocity and temperature fields is still valid. Heat transfer of supercritical CO2 and molten salt in different finned channels is numerically studied, and different mean synergy angles are compared. It is found that the domain integration mean synergy angles calculated with specific enthalpy gradient or temperature gradient have the same trends. For the volume-weighted mean angles, the absolute value of dot product of velocity and temperature gradient should be used in calculating the local synergy angles. Otherwise, the trend of the volume-weighted mean angles can be contrary to the field synergy principle. Meanwhile, the accuracy of the mesh and the temperature gradient near the heat transfer surfaces is important for the numerical applications of the field synergy principle.

This paper aims to study the low-cycle fatigue property and recovery properties of viscous material. The authors designed a Self-Stabilization Dynamic Sandwich-Type Shear (S-DSTS) test device, which allows the static recovery of semisolid materials that can not be achieved in the traditional rheometer. A series of recovery tests with different static recovery times and low-cycle fatigue tests with different strain amplitudes and loading frequencies were conducted on the polyisobutylene-B12 (PIB–B12) by this device. The test data on low-cycle fatigue and recovery properties of PIB-B12 were evaluated by the storage modulus, loss modulus, loss factor, velocity exponent, parameter decay ratio, and recovery coefficient. The results show that each parameter's degradation rate and degradation degree increase significantly with the rise of strain amplitude. The low-cycle fatigue property of PIB-B12 is less affected by the loading frequency, and the degradation rate and degradation degree of all parameters are similar under different loading frequencies. The PIB-B12 has excellent recoverability and static recovery showing that the mechanical parameters of PIB-B12 could restore to more than 65% and 92% of the original magnitude after short-term and long-term intervals, which ensures a reliable energy absorption property during aftershocks. The velocity exponent of PIB-B12 shows minor variations under different strain amplitudes and loading frequencies.

Embryo implantation and decidualization are key steps for successful reproduction. Although numerous factors have been identified to be involved in embryo implantation and decidualization, the mechanisms underlying these processes are still unclear. Based on our preliminary data, Prss56, a trypsin-like serine protease, is strongly expressed at implantation site in mouse uterus. However, the expression, regulation and function of Prss56 during early pregnancy are still unknown. In mouse uterus, Prss56 is strongly expressed in the subluminal stromal cells at implantation site on day 5 of pregnancy compared to inter-implantation site. Under delayed implantation, Prss56 expression is undetected. After delayed implantation is activated by estrogen, Prss56 is obviously induced at implantation site. Under artificial decidualization, Prss56 signal is seen at the primary decidual zone at the initial stage of artificial decidualization. When stromal cells are induced for in vitro decidualization, Prss56 expression is significantly elevated. Dtprp expression under in vitro decidualization is suppressed by Prss56 siRNA. In cultured stromal cells, HB-EGF markedly stimulates Prss56 expression through EGFR/ERK pathway. Based on promoter analysis, we also showed that Egr2 is involved in Prss56 regulation by HB-EGF. Collectively, Prss56 expression at implantation site is modulated by HB-EGF/ EGFR/ERK signaling pathway and involved in mouse decidualization. [ABSTRACT FROM AUTHOR]

Abstract Background The relationship between triglyceride-glucose index (TyG index) and the prevalence and prognosis of cardiovascular disease has been confirmed by former studies. However, it remains uncertain whether TyG index has a prognostic impact in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Methods The study retrospectively enrolled 798 patients (mean age: 60.9 ± 8.3 years; 68.3% men) with T2DM and NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. TyG index was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. The primary endpoint was a composite of adverse events as follows: all-cause death, non-fatal myocardial infarction (MI) and ischemia-driven revascularization. Results TyG index was significantly higher in patients with a primary endpoint event compared with those without. Multivariate Cox proportional hazards analysis showed that 1-unit increase of TyG index was independently associated with higher risk of primary endpoint, independent of other risk factors [hazard ratio (HR) 3.208 per 1-unit increase, 95% confidence interval (CI) 2.400–4.289, P

Abstract Background It is uncertain whether estimated remnant-like particle cholesterol (RLP-C) could predict residual risk in patients with different glycometabolic status. This study aimed to evaluate the relationship between estimated RLP-C and adverse prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with percutaneous coronary intervention (PCI) and to identify the potential impact of glycometabolism on the predictive value of estimated RLP-C. Methods The study assessed 2419 participants with NSTE-ACS undergoing PCI at Beijing Anzhen Hospital from January to December 2015. Estimated RLP-C was calculated as follows: total cholesterol (TC) minus low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The adverse events included all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization. Results Estimated RLP-C was prominently associated with adverse prognosis in the total population [hazard ratio (HR) 1.291 per 1-SD increase, 95% confidence interval (CI) 1.119–1.490, P

In order to obtain the shockwave load simplified algorithm model for the semiarmored projectile internal explosion in the cabin, this research made use of AUTODYN to provide a numerical modeling method for explosion in the cabin and verified the accuracy of the method via the experiment. Internal explosion simulation calculation was conducted on the operating condition numerical model with different cabin structural dimensions and different explosive loads. The cabin internal explosion space was divided into the noncorner central area, near-wall area, two-sided corner area, and three-sided corner area. Through regression of the abovementioned calculation results, an engineering model to calculate the shockwave load was obtained. It is hoped that the model can offer some references to the antiexplosion design for the ship cabin and for damage assessment of the internal explosion.

A three-level (provincial, municipal and county levels) schistosomiasis diagnosis network platform had been created in Yunnan Province, and assessment of laboratory quality-control samples and field evaluation of nucleic acid diagnostic techniques and immunodiagnostic reagents had been performed. This paper described the review process of the schistosomiasis diagnosis network laboratory and the operation of schistosomiasis diagnosis network laboratory and analyzed the problems of the schistosomiasis diagnosis network laboratory in Yunnan Province. The establishment of the schistosomiasis diagnosis reference (network) laboratory will provide a strong support for schistosomiasis control in Yunnan Province in the new era.

HIV-1 fusion inhibitors are a new class of anti-HIV compounds, which block the entry of HIV into target cells through preventing the fusion between viral and cell plasma membrane and thus interrupt the initial steps of viral replication. T-20 (enfuvirtide), which has been clinically approved as the first fusion inhibitor of HIV-1 by U.S. FDA in 2003, can suppress replication of HIV variants with multi-drug resistance to reverse transcriptase and protease inhibitors. Peptides and small molecules display potent anti-HIV fusion activities by targeting gp41 thus inhibit its fusogenic function. In recent years, with the development of studies on the molecular mechanism of HIV membrane fusion process and the function of gp41, many new fusion inhibitors are found and some have been in advanced clinical trials. This review discusses recent progress in the development of HIV-1 fusion inhibitors targeting the gp41.