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Abstract In China, natural snowfall is insufficient, and ski resorts often require artificial snowmaking in winter and turf management in summer, which results in high overall water consumption and considered as one of the high water-consuming service industries, with an urgent need for theoretical foundations related to water management. Based on life cycle theory, we examined the characteristics of the water systems of ski resorts in winter and summer. A Monte Carlo simulation was used to construct a stochastic model to quantify the theoretical water consumption for snowmaking at ski resorts and to investigate the mechanisms by which various factors influence this consumption. We summarize the necessity of summer turf management and irrigation requirements at ski resorts, explore the interaction between ski resorts and agricultural irrigation. The results show that the theoretical water demand of ski resorts is basically consistent with the actual water consumption of ski resorts, that the constructed model is feasible, and that snowmaking water is the most important water use of ski resorts. Exploring the collection and reuse of meltwater or rainwater from ski resorts for agricultural irrigation in the spring and summer could provide more possibilities for the sustainable management of regional water resources. The research findings can provide a theoretical basis for scientifically and reasonably setting the norm of water intake for ski resorts and for developing comprehensive water resource management plans for ski resorts and agricultural irrigation.

Background: To evaluate the effectiveness and safety of the Shenfu injection (SFI) combined with standard bundle treatment in septic patients with hypoperfusion. Method: This study was a multi-center, randomized, open-label, controlled trial conducted in four teaching hospitals in China. The septic patients with hypoperfusion and traditional Chinese medicine (TCM) syndrome with Yang-Qi deficiency were enrolled from January 2019, through September 2020. Eligible patients were randomly allocated in a 1:1 ratio to either receive 60 mL of SFI infusion per day plus standard treatment (SFI group) or standard bundle treatment alone (control group). The primary outcome was 28-day all-cause mortality. Secondary outcomes were 90-day all-cause mortality time to weaning from mechanical ventilation, time to weaning from vasopressors, time to discharge from the ICU and hospital, and laboratory results after randomization. Results: A total of 188 patients completed the trail. This study revealed that the results of the SFI group and the control groups were not statistically significant in 28-day all-cause mortality (10.6% vs. 20.2%, respectively; P=0.106). The infusion of SFI was associated with a significant reduction in the duration of vasopressor use (median=4.0 days, interquartile range [IQR]: 2.0 days–6.0 days vs. median=5.0 days, IQR: 3.0 days–8.0 days, respectively; P=0.043). Patients in the SFI group had statistically greater reductions in plasma lactate levels compared with those in the control group at the first 12 h (median=1.1 mmol/L, IQR: 0.3–2.0 mmol/L vs. median=0.0 mmol/L, IQR: −0.2 to 0.8 mmol/L, respectively; P

Abstract Background Radiation-induced brain injury (RIBI) is a debilitating sequela after cranial radiotherapy. Research on the topic of RIBI has gradually entered the public eye, with more innovations and applications of evidence-based research and biological mechanism research in the field of that. This was the first bibliometric analysis on RIBI, assessing brain injury related to radiation articles that were published during 1998–2023, to provide an emerging theoretical basis for the future development of RIBI. Methods Literature were obtained from the Web of Science Core Collection (WOSCC) from its inception to December 31, 2023. The column of publications, author details, affiliated institutions and countries, publication year, and keywords were also recorded. Results A total of 2543 journal articles were selected. The annual publications on RIBI fluctuated within a certain range. Journal of Neuro-oncology was the most published journal and Radiation Oncology was the most impactful one. LIMOLI CL was the most prolific author with 37 articles and shared the highest h-index with BARNETT GH. The top one country and institutions were the USA and the University of California System, respectively. Clusters analysis of co-keywords demonstrated that the temporal research trends in this field primarily focused on imaging examination and therapy for RIBI. Conclusion This study collects, visualizes, and analyzes the literature within the field of RIBI over the last 25 years to map the development process, research frontiers and hotspots, and cutting-edge directions in clinical practice and mechanisms related to RIBI.

BackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder posing challenges to patients, caregivers, and society. Accessible and accurate information is crucial for effective AD management. ObjectiveThis study aimed to evaluate the accuracy, comprehensibility, clarity, and usefulness of the Generative Pretrained Transformer’s (GPT) answers concerning the management and caregiving of patients with AD. MethodsIn total, 14 questions related to the prevention, treatment, and care of AD were identified and posed to GPT-3.5 and GPT-4 in Chinese and English, respectively, and 4 respondent neurologists were asked to answer them. We generated 8 sets of responses (total 112) and randomly coded them in answer sheets. Next, 5 evaluator neurologists and 5 family members of patients were asked to rate the 112 responses using separate 5-point Likert scales. We evaluated the quality of the responses using a set of 8 questions rated on a 5-point Likert scale. To gauge comprehensibility and participant satisfaction, we included 3 questions dedicated to each aspect within the same set of 8 questions. ResultsAs of April 10, 2023, the 5 evaluator neurologists and 5 family members of patients with AD rated the 112 responses: GPT-3.5: n=28, 25%, responses; GPT-4: n=28, 25%, responses; respondent neurologists: 56 (50%) responses. The top 5 (4.5%) responses rated by evaluator neurologists had 4 (80%) GPT (GPT-3.5+GPT-4) responses and 1 (20%) respondent neurologist’s response. For the top 5 (4.5%) responses rated by patients’ family members, all but the third response were GPT responses. Based on the evaluation by neurologists, the neurologist-generated responses achieved a mean score of 3.9 (SD 0.7), while the GPT-generated responses scored significantly higher (mean 4.4, SD 0.6; P

Background: Ginsenosides (GS), including total GS, Rh2, Rg3 and compound K (CK), have been utilized as adjuvants in transarterial chemoembolization (TACE), surgery, and chemotherapy for hepatocellular carcinoma (HCC) therapy. However, the safety and efficacy of such combination treatments have been contradictory across different studies. This study aims to systematically evaluate the efficacy and safety of GS as adjuvant therapy for HCC. Methods : A literature search of PubMed, CNKI, Wanfang Data, Cochrane Library, Embase, and Web of Science was conducted up to May 2024 for clinical randomized controlled trials (RCTs) on GS-based adjuvant treatments for HCC. Two researchers independently screened the literature, extracted relevant data, and assessed study quality. Meta-analysis was conducted using RevMan 5.4. Results : Nineteen articles involving 1448 patients were included. Meta-analysis showed that GS as an adjuvant therapy for HCC improved disease control rate (risk ratio (RR) = 1.42, 95% CI [1.26, 1.60]), objective response rate (RR = 1.20, 95% CI [1.09, 1.32]), life quality (RR = 1.49, 95% CI [1.23, 1.79]), 1-year overall survival rate (RR = 1.27, 95% CI [1.06, 1.52]), 2-year overall survival rate (RR = 1.43, 95% CI [1.06, 1.95]), ehanced Child-Pugh in A level (RR = 1.59, 95% CI [1.08, 2.34]), Child-Pugh in B level (RR = 1.28, 95% CI [1.08, 1.52]); increased CD3 + (MD = 8.81, 95% CI [3.91, 13.71]), NKC (MD = 8.00, 95% CI [6.76, 9.24]) and CD4 + (MD = 9.38, 95% CI [8.04, 10.72]), and reduced incidence of adverse reactions including nausea and vomiting (RR = 0.66, 95% CI [0.57, 0.77]), anorexia (RR = 0.33, 95% CI [0.21, 0.50]), leukopenia (RR = 0.55, 95% CI [0.46, 0.67]) and myelosuppression (RR = 0.54, 95% CI [0.40, 0.74]); decreased Child-Pugh in C level (RR = 0.43, 95% CI [0.27, 0.68]) and CD4 + /CD8 + ratio (MD = 0.50, 95% CI [0.47, 0.57]). Conclusions : In summary, GS combined with Western medical approaches (TACE, surgery, chemotherapy) for the treatment of HCC can improve clinical efficacy, increase overall survival rates, enhance patient life quality, and reduce the occurrence of adverse reactions. However, due to the generally low quality of the included studies, more large-sample, multi-center, high-quality, RCTs are warranted to further consolidate these findings.

In response to local sudden disasters, e.g., high-rise office or residential building fire disasters, road occupation can cause conflicts, and traffic directions may be opposite between evacuation vehicles and rescue vehicles; moreover, lane contraflow can be adopted to meet these surge traffic demands. However, lane contraflow that provides more roads for rescue vehicles reduces the traffic supply in the evacuation direction. It is unclear how to control the number of contraflow roads used by rescue vehicles to coordinate evacuation and rescue traffic operations. Here, we adjust the critical rescue traffic volume of reversing the normal road traffic direction to control rescue contraflow. Additionally, we propose a multiobjective mixed integer linear programming formulation for evacuation and rescue traffic optimization. Additionally, considering that the upper limit of the critical rescue traffic volume is unknown and that the proposed formulation includes multiple objectives and multi-priority vehicle classes, a three-stage solving algorithm is developed. Next, a large-scale evacuation and rescue traffic optimization result dataset is obtained for the Nguyen–Dupuis road network, and the impact of different rescue contraflow control plans on evacuation and rescue traffic is studied based on data-driven statistical analysis. The results show that by adjusting the optimal rescue traffic route, the critical rescue traffic volume for reversing the normal road traffic direction can reduce the interference of rescue traffic to evacuation traffic operation performance without reducing rescue traffic operation performance, and can be used to coordinate evacuation and rescue traffic operation under rescue contraflow.

BackgroundThis study aims to explore the analgesic effect of lidocaine administered through the hepatic artery during hepatic artery infusion chemotherapy (HAIC) for hepatocellular carcinoma (HCC).MethodsA total of 45 HCC patients were randomly divided into a study group and a control group. Both groups received oxaliplatin (OXA) based FOLFOX protocol via electronic infusion pump. The study group was continuously infused with 100 mg of lidocaine during HAIC, while 5% glucose solution was infused in the same way as described above. Changes in vital signs, visual analogue score (VAS) and general comfort score (GCQ scale) were recorded before surgery (Time point 0), at the end of infusion (Time point 01), 1 h after HAIC (Time point 02), 3 h after HAIC (Time point 03) and 6 h after HAIC (Time point 04).ResultsAt each point of time from Time point 0 through Time point 04, the differences in MAP, RR and SPO2 between the two groups were not statistically significant (P > 0.05). At each point of time from Time point 01 through Time point 04, the mean VAS scores in the study group were smaller and GCQ scores were higher than those in the control group, and the differences were both statistically significant (P

BackgroundTo investigate the effectiveness and safety of maintenance regimens based on cetuximab, we conducted a real-world, single-arm, retrospective study at a single center.MethodsIn Fujian Medical University Union Hospital, patients with unresectable metastatic colorectal cancer (mCRC) who received cetuximab-based maintenance therapy between December 2020 and December 2021 were included. All patients had RAS and BRAF wild-type. The maintenance regimen consisted of 6–12 cycles of cetuximab plus irinotecan (Phase 1) and cetuximab (Phase 2). Patients could receive reintroduction therapy in case of disease progression during Phase 2. Progression-free survival (PFS), overall survival (OS), and safety data were collected.ResultsAccording to the inclusion and exclusion criteria of the study, a total of 108 subjects who received maintenance therapy were included— 51 experienced disease progression during Phase 1, with PFS (1) of 7.3 months. Among the 52 patients who entered Phase 2, 17 were still in this phase at the end of follow-up, with PFS (2) of 10.1 months. In Phase 2, 35 patients experienced disease progression, of whom 24 received reintroduction therapy, with PFS (3) of 6.7 months. The overall PFS (total) during the maintenance period was 11.9 months, and the OS was 39.2 months. Grade III or higher adverse events were 4.6% during Phase 1 and 0% during Phase 2.ConclusionInnovative cetuximab-based maintenance therapy showed a trend toward improving the prognosis of mCRC patients with RAS and BRAF wild-type, while the toxic side effects of maintenance therapy were manageable.Clinical trial registrationhttps://www.chictr.org.cn, identifier ChiCTR2000040940.

Summary: The rhizosphere microbiome is important for plant health, yet their contributions to disease resistance and assembly dynamics remain unclear. This study employed rhizosphere microbiome transplantation (RMT) to delineate the impact of the rhizosphere microbiome and the immune response of eggplant (Solanum melongena) on resistance to bacterial wilt caused by Ralstonia solanacearum. We first identified disease-suppressive and disease-conducive rhizosphere microbiome in a susceptible tomato recipient. Using a non-destructive rhizobox and 16S rRNA amplicon sequencing, we monitored the dynamics of both microbiome types during the eggplant development. Most differences were observed at the early stage and then diminished over time. The suppressive microbiome maintained a higher proportion of initial community members throughout eggplant development and exhibited stronger deterministic processes in the early stage, underscoring the importance of plant selection in recruiting protective microbes for rhizosphere immunity. Our study sheds light on the development of microbiome-based strategies for plant disease management and resistance breeding.

Using seawater to make concrete structures saves freshwater resources and reduces transport costs in offshore construction. However, the presence of chloride ions in mortar causes the formation of Friedel’s salt, which changes the microstructure of cement hydration products. As a result, the compressive strength of the mortar significantly deteriorates due to excessive chloride ions. Graphene oxide (GO) is used to overcome chloride ions-induced deterioration in the compressive strength of mortar in this study. The compressive strength of mortar mixed with chloride ions is increased from 38±5.2 MPa to 44.5±0.2 MPa with the addition of GO. Scanning electron microscopy and energy-dispersive X-ray spectroscopy analysis show the decrease of porosity in mortar with GO and adsorption of chloride ions on GO. Molecular dynamics simulations show that GO yields constraints on the mobility of chloride ions and the improvement of interfacial strength between calcium silicate hydrates.

BackgroundBurnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. ObjectiveThis systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. MethodsWe conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. ResultsThe review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). ConclusionsThe findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173

Abstract Osteoarthritis (OA) is a degenerative disease that significantly impairs quality of life. There is a pressing need for innovative OA therapies. While small extracellular vesicles (sEVs) show promising therapeutic effects against OA, their limited yield restricts clinical translation. Here, we devised a novel production system for sEVs that enhances both their yield and therapeutic properties. By stimulating mesenchymal stem cells (MSCs) using electromagnetic field (EMF) combined with ultrasmall superparamagnetic iron oxide (USPIO) particles, we procured an augmented yield of EMF-USPIO-sEVs. These vesicles not only activate anabolic pathways but also inhibit catabolic activities, and crucially, they promote M2 macrophage polarization, aiding cartilage regeneration. In an OA mouse model triggered by anterior cruciate ligament transection surgery, EMF-USPIO-sEVs reduced OA severity, and augmented matrix synthesis. Moreover, they decelerated OA progression through the microRNA-99b/MFG-E8/NF-κB signaling axis. Consequently, EMF-USPIO-sEVs present a potential therapeutic option for OA, acting by modulating matrix homeostasis and macrophage polarization.

Treatment of industrial brine wastewater, which is characterized by multiple sources and complex water quality, poses significant challenges. Brine separation technology can effectively address the difficulties in brine wastewater treatment while facilitating water reuse and the separation and resource utilization of crystalline salts, thus providing important development opportunities in wastewater treatment. This study comprehensively and systematically reviews and summarizes the treatment processes and reuse pathways of brine wastewater based on practical investigations in different industries, providing technical guidance and experience for relevant brine wastewater treatment and reuse cases. This study is of great significance for promoting the standardization and management of wastewater treatment and reuse worldwide. Finally, suggestions and prospects for further promoting the standardized management of brine wastewater reuse are proposed.

Acupuncture is an important therapeutic method of traditional Chinese medicine and can effectively modulate brain disorders. The therapeutic efficacy of acupuncture is hard to evaluate due to lacking of effective measurements of brain activity. In this work, we design an EEG-based monitoring system to evaluate therapeutic effect of acupuncture on human brain by extracting periodic-aperiodic features. Power spectral density is estimated to compute the adjusted power of periodic oscillatory rhythm in EEG under acupuncture stimulation. It is exhibited that the brain activity in alpha band (8–12 Hz) is significantly enhanced during acupuncture, especially in parietal and occipital lobe regions. To probe the modulatory effect of acupuncture on aperiodic brain activity, we calculate the aperiodic exponent based on the parameterization of EEG power spectra. The aperiodic exponent decreases along with acupuncture process, which is more significant in central and frontal lobe regions. Furthermore, sensitivity of different brain regions to acupuncture is assessed by the integration of adjusted power and aperiodic exponent. Experimental results demonstrate the effectiveness of proposed periodic-aperiodic measurements of EEG signals, by which different effects of four acupuncture manipulations are precisely evaluated and a knowledge graph is established. The monitoring system provides a new perspective to quantitatively evaluate acupuncture effect on human brain and improve its therapeutic efficacy in clinical applications for neural disorders.

To meet the practical needs of classified collection, graded treatment, and quality recycling of coal chemical wastewater, and in accordance with the standardization requirements of wastewater resource utilization, the Standardization Administration of China released the national standard GB/T 42,866-2023 ″Guidelines for Coal Chemical Wastewater Treatment and Recycling Technology” on August 6, 2023, for the first time. Based on the standard, this paper comprehensively and systematically sorts out and analyzes the characteristics, processes, water circulation systems, and standardization paths of units such as coal chemical wastewater collection and treatment, recycling, and the treatment of concentrated brine water, through extensive industry research. Furthermore, by integrating typical engineering case practices, this paper explains the feasibility of the paths, which provides technical guidance and experience for relevant cases of coal chemical wastewater treatment and recycling. It is also of great importance for promoting the standardized management and development of coal chemical wastewater treatment and recycling worldwide.

Abstract Hepatoid adenocarcinoma of the lung is a special type of primary origin in the lung with obvious pathological features and short survival time. However, standard treatment guidelines have not yet been established. Herein, we report a case of hepatoid adenocarcinoma with the primary lesion located in the left upper lung. The tumour size was reduced after four cycles of combined therapy. Subsequent postoperative pathology confirmed complete remission.

Abstract Metabolic oligosaccharide engineering (MOE) is a classical chemical approach to perturb, profile and perceive glycans in physiological systems, but probes upon bioorthogonal reaction require accessibility and the background signal readout makes it challenging to achieve glycan quantification. Here we develop SeMOE, a selenium-based metabolic oligosaccharide engineering strategy that concisely combines elemental analysis and MOE,enabling the mass spectrometric imaging of glycome. We also demonstrate that the new-to-nature SeMOE probes allow for detection, quantitative measurement and visualization of glycans in diverse biological contexts. We also show that chemical reporters on conventional MOE can be integrated into a bifunctional SeMOE probe to provide multimodality signal readouts. SeMOE thus provides a convenient and simplified method to explore the glyco-world.

Determining the navigation line is critical for the automatic navigation of agricultural robots in the farmland. In this research, considering a wheat field as the typical scenario, a novel navigation line extraction algorithm based on semantic segmentation is proposed. The data containing horizontal parallax, height, and grayscale information (HHG) is constructed by combining re-encoded depth data and red–green–blue (RGB) data. The HHG, RGB, and depth data are used to achieve scene recognition and navigation line extraction for a wheat field. The method includes two main steps. First, the semantic segmentation of the wheat, ground, and background are performed using a fully convolutional network (FCN). Second, the navigation line is fitted in the camera coordinate system on the basis of the semantic segmentation result and the principle of camera pinhole imaging. Our segmentation model is trained using 508 randomly selected images from a data set, and the model is tested on 199 images. When labelled data are used as the reference benchmark, the mean intersection over union (mIoU) of the HHG data is greater than 95%, which is the highest among the three types of data. The semantic segmentation methods based on the RGB and HHG data show higher navigation line extraction accuracy rates (with the absolute value of the angle deviation less than 5°) than the compared methods. The mean and standard deviation of the angle deviation of the two methods are within 0.1° and 2.0°, while the mean and standard deviation of the distance deviation are less than 30 mm and 60 mm, respectively. These values meet the basic requirements of agricultural machinery field navigation. The novelty of this work is the proposal of a navigation line extraction algorithm based on semantic segmentation in wheat fields. This method is high in accuracy and robustness to interference from crop occlusion.

Environmental and design factors determine the stormwater management capacity of green roofs; however, the design and environmental factors that impact their hydrological performance in subtropical humid regions are poorly understood. In particular, meteorological factors have received little attention. Meteorological factors vary greatly at different stages of a rainfall event (e.g., during the rainfall and outflow). Therefore, the impact of meteorological factors at different stages on hydrological performance should be considered separately to obtain a more accurate picture of their effects on hydrological performance. In this study, experimental green roofs were established based on four substrate types and two depths. For the first time, this study systematically explored the effects of design factors for the substrate (type and depth) and multi-stage environmental factors on the hydrological performance of green roofs. Environmental factors, including meteorological factors, from three critical stages (before and during a rainfall event and during the outflow), and rainfall characteristics (e.g., rainfall depth and rainfall duration) were incorporated to determine the variation in hydrological performance. The effects of multi-stage environmental factors on retention and peak reduction were analyzed, with a ranking of each factor’s relative importance. Environmental factors played a leading role in determining hydrological performance. However, the impact of multi-stage environmental factors was not as important as that of rainfall depth and antecedent volumetric water content. Differences in hydrological performance were compared across combinations of design factors. No significant differences were observed across substrate types and depths. However, potential interactive effects might exist, though these were not significant compared to environmental factors (e.g., rainfall depth and rainfall duration). These results confirmed that the meteorological factors in the different event-related stages significantly impacted the hydrological performance. Quantifying the effects of design and environmental factors is critical for hydrological performance evaluation. The results provided a broader perspective on understanding influence mechanisms of hydrological performance and highlighted the impact of microclimates on hydrological performance.

Abstract Background Deoxynivalenol (DON), one of the most prevalent mycotoxins, has been found to cause fetal growth retardation in animals. However, limited evidence exists regarding its effects on pregnant women. Methods Maternal urinary concentration of total DON (tDON) and free DON (fDON) in the second trimester was measured using liquid chromatography with tandem mass spectrometry. Provisional daily intake (PDI) of DON was calculated based on tDON concentration. Linear and logistic regression models were used to evaluate the association between DON exposure levels and birth weight, birth length, and the risk of small for gestational age (SGA). Results Among 1538 subjects, the median concentrations of tDON and fDON were 12.1 ng/mL and 5.1 ng/mL, respectively. The PDI values revealed that the median DON intake was 0.7 µg/kg bw, and 35.9% of the total population exceeded the provisional maximum tolerable daily intake (PMTDI) of 1 µg/kg bw. Compared with the lowest tertile, birth weight decreased by 81.11 g (95% CI: -127.00, -35.23) for tDON (P-trend

Abstract Ethanol solution as a disinfectant has been widely used in various fields. However, it has a significant bactericidal capability only when the volume fraction of ethanol is around 70%–75%. For such high concentration of ethanol solution, it has an irritating smell. When it is used for applications such as wound disinfection, it causes a stinging sensation. Low concentrations of ethanol solution are less irritating, but it is also less effective at killing bacteria. In this study, an idea for producing a green, efficient and less irritating disinfectant is proposed. It is based on a plasma‐activated low‐concentration ethanol solution (PAES). It is found that the plasma‐activated 10% volume fraction of ethanol solution can kill more than seven orders of magnitude of Escherichia coli, while the untreated 10% volume fraction of ethanol solution has no bactericidal effect. Besides, the PAES's activity remains unchanged after being stored at −20°C for three days. Further investigation shows that new compositions including peracetic acid, peroxynitrite, hydrogen peroxide and acetic acid are detected in the PAES, which together are playing the main role of the excellent and prolonged bactericidal effect.

Herein, cryo-grinding technique was introduced into the extraction process of silk fibroin, aiming to achieve efficient preparation and controllable performance of silk fibroin. More specifically, the cocoon was pre-frozen in liquid nitrogen for 12 h before being ground, and the physical and chemical properties of the obtained sample (GSF322) were compared with the control one (SF). Results revealed that, compared with SF, the degumming duration for GSF322 dwindled from 90 min to 40 min with a close yield. Circular dichroism analysis demonstrated that the pretreatment process would not destroy the steric structure of the macromolecule. Turbidity assay implied that the assembly activity of the polymer in vitro could also be manipulated via assorted grinding periods, among which the sample ground for 3 min had the best assembly capacity. Dissection of the Zeta potential displayed that, after grinding, the positively-charged groups on the molecular chain of GSF322 might multiply, resulting in the exposure of more -NH2 groups in the surroundings and enhanced hydrophilicity of the material, which was in accordance with the trend from the water solubility experiment. Moreover, in the thermostability test, the dehydration peak for GSF322 was higher than that of SF, showing better thermal stability. To conclude, concerning the extraction process for silk fibroin, the cryogrinding approach sheds light on both the strengthening of the extraction efficiency as well as the tuning of the physiochemical aptitudes of the polymer.

Development of wound dressings with antimicrobial activity and promotion of sustained wound healing to reduce the use of antibiotics in infected wounds is important. In this study, we developed a thermosensitive ABA triblock copolymer poly {(N-isopropyl acrylamide)–co-[(6-((3-(6-amino-purin-9-yl)propanoyl)oxy)hexyl acrylates)]-b-PEO-b-Poly (N-isopropyl acrylamide)–co-{[(6-((3-(6-amino-purin-9-yl)propanoyl)oxy)hexyl acrylates)]} as matrix and participating nitric oxide (NO) donor (N,N'-dis-sec-butyl-N,N'-dinitroso-1,4-phenylenediamine, BNN6) loaded SiO2@PDA nanoparticles composed of hydrogel dressings (Gel-APB) for efficient antimicrobial and sustainable treatment of wounds. Thanks to the presence of poly (N-isopropyl acrylamide) (PNIPAM) and unique ABA triblock structure, the NAONA copolymer would self-assemble into temperature-sensitive injectable hydrogel with excellent dermal adaptation to dynamic wounds. Meanwhile, the biobase adenine endowed the hydrogel dressing with self-healing ability. Under 808 nm wavelength irradiation, the hydrogel was able to elevate to a mild temperature (∼48 °C) and release NO on demand, which efficiently kills E. coli and S. aureus, realizing highly efficient and mild photothermal antimicrobial therapy (PTAT). In addition, full-thickness skin wound modeling demonstrated that Gel-APB hydrogel dressing accelerated tissue regeneration, angiogenesis, and collagen deposition in S. aureus infected wounds in vivo, achieving rapid wound healing. Thus, Gel-APB is a multifunctional hydrogel dressing with excellent antimicrobial activity and has considerable potential for application in infected skin wound healing.

Chronic diabetic wounds seriously threaten human health due to their intractable nature in a complex pathological microenvironment that contains oxidative stress, persistent inflammatory status, hypoxia and bacterial infections, of which oxidative damage contributing the most. Applied materials that can mimic the natural intracellular antioxidant defense system are perceived to have huge therapeutic potential. Herein, we present a novel strategy to prepare a versatile nanocomposite hydrogel by incorporating the nanoenzyme (manganese dioxide (MnO2)) and nonenzymatic antioxidant components (polydopamine (PDA)) in a dynamic hydrogel network composed of thioctic acid and tannic acid (TA). The prepared hydrogel exhibited outstanding adhesive and injectable properties, making it adapt perfectly to wounds with different shapes and depths. More importantly, encapsulation of PDA@MnO2 nanoparticles (NPs) conferred the hydrogel with superior antioxidant performance to effectively scavenge multiple types of reactive nitrogen and oxygen species (RNOS) and reduce the inflammatory response by regulating macrophage polarization. Meanwhile, the hydrogel showed high-performance catalyzing ability to transfer hydrogen peroxide (H2O2) into oxygen (O2), which could further alleviate hypoxic wound environment. Moreover, the nanocomposite hydrogel exhibited excellent near-infrared (NIR) photothermal antibacterial effect. Collectively, our findings indicate that the synthesized nanocomposite hydrogel shows potential for use in a clinical setting to treat diabetic wounds.

BackgroundArtificial intelligence models tailored to diagnose cognitive impairment have shown excellent results. However, it is unclear whether large linguistic models can rival specialized models by text alone. ObjectiveIn this study, we explored the performance of ChatGPT for primary screening of mild cognitive impairment (MCI) and standardized the design steps and components of the prompts. MethodsWe gathered a total of 174 participants from the DementiaBank screening and classified 70% of them into the training set and 30% of them into the test set. Only text dialogues were kept. Sentences were cleaned using a macro code, followed by a manual check. The prompt consisted of 5 main parts, including character setting, scoring system setting, indicator setting, output setting, and explanatory information setting. Three dimensions of variables from published studies were included: vocabulary (ie, word frequency and word ratio, phrase frequency and phrase ratio, and lexical complexity), syntax and grammar (ie, syntactic complexity and grammatical components), and semantics (ie, semantic density and semantic coherence). We used R 4.3.0. for the analysis of variables and diagnostic indicators. ResultsThree additional indicators related to the severity of MCI were incorporated into the final prompt for the model. These indicators were effective in discriminating between MCI and cognitively normal participants: tip-of-the-tongue phenomenon (P

Background: Selenium (Se) has been reported to have an antagonistic effect on heavy metals in animals. Nevertheless, there is a lack of epidemiological research examining whether Se can mitigate the adverse effects of cadmium (Cd) and lead (Pb) on hand grip strength (HGS) in middle-aged and elderly individuals.Methods: This study used data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). HGS measurements were conducted by trained examiners with a dynamometer. Concentrations of Se, Cd, and Pb in blood were determined via inductively coupled plasma mass spectrometry. We employed linear regression, restricted cubic splines, and quantile g-computation (qgcomp) to assess individual and combined associations between heavy metals and HGS. The study also explored the potential influence of Se on these associations.Results: In both individual metal and multi-metal models adjusted for confounders, general linear regression showed Se’s positive association with HGS, while Cd and Pb inversely related to it. At varying Se-Cd and Se-Pb concentrations, high Se relative to low Se can attenuate Cd and Pb’s HGS impact. An inverted U-shaped correlation exists between Se and both maximum and combined HGS, with Se’s benefit plateauing beyond approximately 200 μg/L. Stratified analysis by Se quartiles reveals Cd and Pb’s adverse HGS effects diminishing as Se levels increase. Qgcomp regression analysis detected Se alleviating HGS damage from combined Cd and Pb exposure. Subsequent subgroup analyses identified the sensitivity of women, the elderly, and those at risk of diabetes to HGS impairment caused by heavy metals, with moderate Se supplementation beneficial in mitigating this effect. In the population at risk for diabetes, the protective role of Se against heavy metal toxicity-induced HGS reduction is inhibited, suggesting that diabetic individuals should particularly avoid heavy metal-induced handgrip impairment.Conclusion: Blood Cd and Pb levels are negatively correlated with HGS. Se can mitigate this negative impact, but its effectiveness plateaus beyond 200 μg/L. Women, the elderly, and those at risk of diabetes are more vulnerable to HGS damage from heavy metals. While Se supplementation can help, its protective effect is limited in high diabetes risk groups.

BackgroundHypertension has now developed into a major public health problem worldwide. Under the existing antihypertensive drug treatment paradigm, problems such as decreasing drug resistance and increasing drug side effects can occur for elderly patients. Acupuncture, a core technique in the non-pharmacological treatment of Chinese medicine, plays an important role in the treatment of elevated blood pressure.ObjectiveThis study aimed to systematically evaluate the effect of acupuncture alone or in combination with antihypertensive drugs on the efficiency of reducing blood pressure and controlling blood pressure in elderly patients with hypertension.MethodsArticles of randomized controlled trials of acupuncture for hypertension in the elderly published before November 2022 were searched in 7 databases. The methodological quality of the literature was evaluated using the Cochrane Risk of Bias Assessment Tool. The primary outcome was the efficiency rate of blood pressure reduction, and the secondary outcome was the change in blood pressure after treatment.ResultsThis study conducted a systematic review and meta-analysis of 12 randomized controlled trials with a total of 1,466 subjects. Among the primary outcome—efficiency rate, acupuncture-only treatment (RR = 1.11, 95% CI: 1.03–1.20, P

Abstract Background The COVID-19 pandemic increases the risk of psychological problems, especially for the infected population. Sleep disturbance and feelings of defeat and entrapment are well-documented risk factors of anxiety symptoms. Exploring the psychological mechanism of the development of anxiety symptoms is essential for effective prevention. This study aimed to examine the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China. Methods A cross-sectional study was conducted from March to April, 2022. Participants were 1,283 asymptomatic COVID-19 carriers enrolled from the Ruijin Jiahe Fangcang Shelter Hospital, Shanghai (59.6% male; mean age = 39.6 years). Questionnaire measures of sleep disturbance, entrapment, defeat, anxiety symptoms, and background characteristics were obtained. A mediation model was constructed to test the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms. Results The prevalence rates of sleep disturbance and anxiety symptoms were 34.3% and 18.8%. Sleep disturbance was positively associated with anxiety symptoms (OR [95%CI] = 5.013 [3.721–6.753]). The relationship between sleep disturbance and anxiety symptoms (total effect: Std. Estimate = 0.509) was partially mediated by entrapment (indirect effect: Std. Estimate = 0.129) and defeat (indirect effect: Std. Estimate = 0.126). The mediating effect of entrapment and defeat accounted for 50.3% of the association between sleep disturbance and anxiety symptoms. Conclusion Sleep disturbance and anxiety symptoms were prevalent among asymptomatic COVID-19 carriers. Entrapment and defeat mediate the association between sleep disturbance and anxiety symptoms. More attention is needed to monitoring sleep conditions and feelings of defeat and entrapment to reduce the risk of anxiety.

Abstract The bone marrow contains various populations of skeletal stem cells (SSCs) in the stromal compartment, which are important regulators of bone formation. It is well-described that leptin receptor (LepR)+ perivascular stromal cells provide a major source of bone-forming osteoblasts in adult and aged bone marrow. However, the identity of SSCs in young bone marrow and how they coordinate active bone formation remains unclear. Here we show that bone marrow endosteal SSCs are defined by fibroblast growth factor receptor 3 (Fgfr3) and osteoblast-chondrocyte transitional (OCT) identities with some characteristics of bone osteoblasts and chondrocytes. These Fgfr3-creER-marked endosteal stromal cells contribute to a stem cell fraction in young stages, which is later replaced by Lepr-cre-marked stromal cells in adult stages. Further, Fgfr3+ endosteal stromal cells give rise to aggressive osteosarcoma-like lesions upon loss of p53 tumor suppressor through unregulated self-renewal and aberrant osteogenic fates. Therefore, Fgfr3+ endosteal SSCs are abundant in young bone marrow and provide a robust source of osteoblasts, contributing to both normal and aberrant osteogenesis.

Abstract Purpose The purpose of this study was to analyze and compare the clinical characteristics of patients with 30-day planned and unplanned readmissions and to identify patients at high risk for unplanned readmissions. This will facilitate a better understanding of these readmissions and improve and optimize resource utilization for this patient population. Methods A retrospective cohort descriptive study was conducted at the West China Hospital (WCH), Sichuan University from January 1, 2015, to December 31, 2020. Discharged patients (≥ 18 years old) were divided into unplanned readmission and planned readmission groups according to 30-day readmission status. Demographic and related information was collected for each patient. Logistic regression analysis was used to assess the association between unplanned patient characteristics and the risk of readmission. Results We identified 1,118,437 patients from 1,242,496 discharged patients, including 74,494 (6.7%) 30-day planned readmissions and 9,895 (0.9%) unplanned readmissions. The most common diseases of planned readmissions were antineoplastic chemotherapy (62,756/177,749; 35.3%), radiotherapy sessions for malignancy (919/8,229; 11.2%), and systemic lupus erythematosus (607/4,620; 13.1%). The most common diseases of unplanned readmissions were antineoplastic chemotherapy (2038/177,747; 1.1%), age-related cataract (1061/21,255; 5.0%), and unspecified disorder of refraction (544/5,134; 10.6%). There were statistically significant differences between planned and unplanned readmissions in terms of patient sex, marital status, age, length of initial stay, the time between discharge, ICU stay, surgery, and health insurance. Conclusion Accurate information on 30-day planned and unplanned readmissions facilitates effective planning of healthcare resource allocation. Identifying risk factors for 30-day unplanned readmissions can help develop interventions to reduce readmission rates.

Abstract Constitutive activation of RAS-RAF-MEK-ERK signaling pathway (MAPK pathway) frequently occurs in many cancers harboring RAS or RAF oncogenic mutations. Because of the paradoxical activation induced by a single use of BRAF or MEK inhibitors, dual-target RAF and MEK treatment is thought to be a promising strategy. In this work, we evaluated erianin is a novel inhibitor of CRAF and MEK1/2 kinases, thus suppressing constitutive activation of the MAPK signaling pathway induced by BRAF V600E or RAS mutations. KinaseProfiler enzyme profiling, surface plasmon resonance (SPR), isothermal titration calorimetry (ITC), cellular thermal shift assay, computational docking, and molecular dynamics simulations were utilized to screen and identify erianin binding to CRAF and MEK1/2. Kinase assay, luminescent ADP detection assay, and enzyme kinetics assay were investigated to identify the efficiency of erianin in CRAF and MEK1/2 kinase activity. Notably, erianin suppressed BRAF V600E or RAS mutant melanoma and colorectal cancer cell by inhibiting MEK1/2 and CRAF but not BRAF kinase activity. Moreover, erianin attenuated melanoma and colorectal cancer in vivo. Overall, we provide a promising leading compound for BRAF V600E or RAS mutant melanoma and colorectal cancer through dual targeting of CRAF and MEK1/2.

Online consumer credit services play a vital role in the contemporary consumer market. To foster their sustainable development, it is essential to establish and strengthen the relevant risk management mechanism. This study proposes an intelligent management framework called the consumer default risk portrait (CDRP) to mitigate the default risks associated with online consumer loans. The CDRP framework combines traditional credit information and Internet platform data to depict the portrait of consumer default risks. It consists of four modules: addressing data imbalances, establishing relationships between user characteristics and the default risk, analyzing the influence of different variables on default, and ultimately presenting personalized consumer profiles. Empirical findings reveal that “Repayment Periods”, “Loan Amount”, and “Debt to Income Type” emerge as the three variables with the most significant impact on default. “Re-payment Periods” and “Debt to Income Type” demonstrate a positive correlation with default probability, while a lower “Loan Amount” corresponds to a higher likelihood of default. Additionally, our verification highlights that the significance of variables varies across different samples, thereby presenting a personalized portrait from a single sample. In conclusion, the proposed framework provides valuable suggestions and insights for financial institutions and Internet platform managers to improve the market environment of online consumer credit services.

As the Internet of Things (IoT) becomes more widespread, wearable smart systems will begin to be used in a variety of applications in people’s daily lives, not only requiring the devices to have excellent flexibility and biocompatibility, but also taking into account redundant data and communication delays due to the use of a large number of sensors. Fortunately, the emerging paradigms of near-sensor and in-sensor computing, together with the proposal of flexible neuromorphic devices, provides a viable solution for the application of intelligent low-power wearable devices. Therefore, wearable smart systems based on new computing paradigms are of great research value. This review discusses the research status of a flexible five-sense sensing system based on near-sensor and in-sensor architectures, considering material design, structural design and circuit design. Furthermore, we summarize challenging problems that need to be solved and provide an outlook on the potential applications of intelligent wearable devices.

Boron nitride nanosheet (BNNS) is an attractive nanomaterial to improve polymeric materials in hydrogels due to their high mechanical properties, robust interfacial properties with polymer, and non-toxicity. However, the mismatching deformation capacity between BNNS and hydrogels results in damage to the BNNS-hydrogels interface and deteriorates the tensile properties of BNNS reinforced hydrogels. By adopting nanotechnology, the brittle nature of BNNSs can be modified. A novel penta-BNNS exhibits pentagonal rings, presenting ductile behavior under tensile deformation. The tensile test is performed by molecular dynamics simulations. The simulation results show that the ultimate failure strain of the penta-BNNS is significantly increased, which is attributed to the structure transition of the pentagonal rings in the penta-BNNS under tensile deformation. Due to the structure transition, the deformation capacity of the penta-BNNS is significantly improved with respect to the hexa-BNNS. This study links the structure to ductile behavior, which helps to devise advanced two-dimensional nanomaterials for improving hydrogels.

Abstract N‐Glycosylation, a main post‐translational modification of Immunoglobulin G (IgG), plays a significant role in modulating the immune functions of IgG. However, the precise function elucidation of IgG N‐glycosylation remains impeded due to the obstacles in obtaining comprehensive and well‐defined N‐glycans. Here, an easy‐to‐implement divergent approach is described to synthesize a 64‐membered IgG N‐glycan library covering all possible biantennary and bisected N‐glycans by reprogramming biosynthetic assembly lines based on the inherent branch selectivity and substrate specificity of enzymes. The unique binding specificities of 64 N‐glycans with different proteins are deciphered by glycan microarray technology. This unprecedented collection of synthetic IgG N‐glycans can serve as standards for N‐glycan structure identification in complex biological samples and the microarray data enrich N‐glycan glycomics to facilitate biomedical applications.

Objectives: We aimed to analyze the secular trends in mesothelioma burden, the effect of age, period, and birth cohort, and project the global burden over time. Material and methods: Based on the mesothelioma incidence, mortality, and Disability-Adjusted Life Years (DALYs) data from 1990 to 2019 in Global Burden of Diseases (GBD) database, the annual percentage change (APC) and average annual percent change (AAPC), calculated from joinpoint regression model, was used to describe the burden trends. An age-period-cohort model was utilized to disentangle age, period, and birth cohort effects on mesothelioma incidence and mortality trends. The mesothelioma burden was projected by the Bayesian age-period-cohort (BAPC) model. Results: Globally, there were the significant declines in age-standardized incidence rate (ASIR) (AAPC = −0.4, 95%CI: −0.6,−0.3, P

Cr/Al/B/diamond powder was used as raw material, and a small amount of Cr2O3 or B2O3 was added to induce thermal explosion reaction. The results show that under the protection of high-purity Ar, the sample after thermal explosion reaction is seriously powdered, and it is easy to separate the binder from the diamond particles. After the thermal explosion reaction of the raw material system added with Cr2O3, the main phase in the binder is Cr2AlB2, and the composite coating containing Cr3C2 and Al will be formed on the diamond surface. The grain size of the composite coating is 0.5～7.0 µm. When the mass fractions of diamond are 10% and 20%, the surface of diamond particles in the samples are well coated, and the initial and the final oxidation temperatures of coated diamond are significantly higher than that of uncoated diamond. However, when the mass fraction of diamond is high, the coating effect on the diamond surface is slightly poor. After the thermal explosion reaction of the raw material system added with B2O3, the coating effect on the diamond surface is poor, and only half or less of the diamond particles are coated.

The bubble breakup mechanism in a venturi-type bubble generator is a hot research topic, and the bubble breakup mechanisms induced by the axial regional flow field characteristics has long been studied and debated. A coupled volume of fluid and large eddy simulation numerical simulation method was conducted within the OpenFOAM® framework to track the two-phase interfaces and transient turbulence characteristics of the flow field in a venturi-type bubble generator. A turbulence inlet database was established to ensure the reliability of the numerical solution and the economy of the calculation. The results indicated that the bubble breakup induced by the axial regional flow field characteristics of the divergent section can be divided into a steady-state disturbed breakup pattern and an unsteady-state disturbed breakup pattern macroscopically, the latter playing a dominant role in generating fine bubbles. Furthermore, a series of typical bubble breakup processes were captured via a Lagrangian approach that showed that interfacial instability played an important role at each stage of bubble transport: Kelvin–Helmholtz instability caused bubbles to detach from the gas film during the steady-state disturbed breakup pattern, and Rayleigh–Taylor instability induced the deformation of detached bubbles in the unsteady-state disturbed region. Additionally, viscous shear force strengthened the interfacial instability in the binary breakup process, and turbulent fluctuations and collisions contributed to the shattering of defective bubbles. Moreover, a shearing-off process tended to occur in regions with small vorticity fluctuations, therefore playing a small role in creating large clusters of bubbles.

Abstract Disseminated intravascular coagulation (DIC) is a complex, life-threatening syndrome associated with the end-stage of different coagulation disorders. Early prediction of the risk of DIC development is an urgent clinical need to reduce adverse outcomes. However, effective approaches and models to identify early DIC are still lacking. In this study, a novel interpretable deep learning based time series is used to predict the risk of DIC. The study cohort included ICU patients from a 4300-bed academic hospital between January 1, 2019, and January 1, 2022. Experimental results show that our model achieves excellent performance (AUC: 0.986, Accuracy: 95.7%, and F1:0.935). Gradient-weighted Class Activation Mapping (Grad-CAM) was used to explain how predictive models identified patients with DIC. The decision basis of the model was displayed in the form of a heat map. The model can be used to identify high-risk patients with DIC early, which will help in the early intervention of DIC patients and improve the treatment effect.

Abstract Although titanium (Ti) and Ti-based alloy have been widely used as dental and orthopedic implant materials, its bioinertness hindered the rapid osseointegration. Therefore, it is recommended to acquire ideal topographic and chemical characteristics through surface modification methods. 3D printing is a delicate manufacture technique which possesses superior controllability and reproducibility. While aspirin serve as a well-established non-steroidal anti-inflammatory agent. Recently, the importance of immune system in regulating bone dynamics has attracted increasing attention. We herein superimposed the aspirin/poly (lactic–co–glycolic acid) (ASP/PLGA) coating on the 3D-printed Ti-6Al-4V surface with uniform micro-structure to establish the Ti64-M-ASP/PLGA substrate. Scanning electron microscopy (SEM), x-ray photoelectron spectroscopy (XPS) and contact angle test confirmed the successful fabrication of the Ti64-M-ASP/PLGA substrate, with increased wettability and sustained release pattern of ASP. Compared with the Ti64 base material, the Ti64-M-ASP/PLGA substrate showed enhanced M2 and depressed M1 genes and proteins expressions in macrophages. The novel Ti64-M-ASP/PLGA substrate also displayed enhanced osteoblast proliferation, adhesion, extracellular mineralization ability and osteogenic gene expressions when cultured with macrophage conditioned medium in vitro. Furthermore, rat femora implantation model was used for in vivo evaluation. After 4 weeks of implantation, push out test, micro-computed tomography (micro-CT) and histological analyses all confirmed the superior osseointegration capabilities of the Ti64-M-ASP/PLGA implant than the other groups. Our study revealed the synergistic role played by 3D-printed micro topography and immunoregulatory drug aspirin in promoting osteogenesis in vitro and accelerating osseointegration in vivo, thus providing a promising method for better modifying the implant surface. Graphical abstract

Objective(s): Esophageal cancer is one of the most common cancers with high incidence and mortality rates, especially in China. MicroRNA (miRNA) can be used as a prognostic marker for various human cancers. This study aims to detect suitable miRNA markers for esophageal squamous cell carcinoma (ESCC). Materials and Methods: Our previous gene expression data of ESCC cells and the data from GSE43732 and GSE112840 were analyzed. The expression of miR-574-5p in ESCC patients and controls was analyzed by real-time quantitative PCR. The effect of miR-574-5p on proliferation was detected by real-time cell analysis (RTCA) and EdU proliferation assay after cell transfections. The target gene small C-terminal domain phosphatase 1 (CTDSP1) of miR-574-5p was validated by luciferase reporter assay and western blotting.Results: In the current study, the bioinformatics analysis found miR-574-5p up-regulated in ESCC. The qPCR assay of 26 ESCC and 13 adjacent/ normal tissues confirmed these results. We further demonstrated that miR-574-5p overexpression promoted cell proliferation. Then the dual-luciferase reporter assay and the rescue experiment suggested that CTDSP1 was a direct target of miR-574-5p.Conclusion: MiR-574-5p played an oncological role in ESCC by interacting and negatively regulating CTDSP1. These results provided a deeper understanding of the effect of miR-574-5p on ESCC.

Background: Degenerative diseases in orthopaedics have become a significant global public health issue with the aging of the population worldwide. The traditional medical interventions, including physical therapy, pharmacological therapy and even surgery, hardly work to modify degenerative progression. Stem cell–based therapy is widely accepted to treat degenerative orthopaedic disease effectively but possesses several limitations, such as the need for strict monitoring of production and storage and the potential risks of tumorigenicity and immune rejection in clinical translation. Furthermore, the ethical issues surrounding the acquisition of embryonic stem cells are also broadly concerned. Exosome-based therapy has rapidly grown in popularity in recent years and is regarded as an ideal alternative to stem cell–based therapy, offering a promise to achieve ‘cell-free’ tissue regeneration. Methods: Traditionally, the native exosomes extracted from stem cells are directly injected into the injured site to promote tissue regeneration. Recently, several modified exosome–based strategies were developed to overcome the limitations of native exosomes, which include mainly exogenous molecule loading and exosome delivery through scaffolds. In this paper, a systematic review of the exosome-based strategy for degenerative disease in orthopaedics is presented. Results: Treatment strategies based on the native exosomes are effective but with several disadvantages such as rapid diffusion and insufficient and fluctuating functional contents. The modified exosome–based strategies can better match the requirements of the regeneration in some complex healing processes. Conclusion: Exosome-based strategies hold promise to manage degenerative disease in orthopaedics prior to patients reaching the advanced stage of disease in the future. The timely summary and highlights offered herein could provide a research perspective to promote the development of exosome-based therapy, facilitating the clinical translation of exosomes in orthopaedics. Translational potential of this article: Exosome-based therapy is superior in anti-senescence and anti-inflammatory effects and possesses lower risks of tumorigenicity and immune rejection relative to stem cell–based therapy. Exosome-based therapy is regarded as an ideal alternative to stem cell–based therapy, offering a promise to achieve ‘cell-free’ tissue regeneration.

ChatGPT has promising applications in health care, but potential ethical issues need to be addressed proactively to prevent harm. ChatGPT presents potential ethical challenges from legal, humanistic, algorithmic, and informational perspectives. Legal ethics concerns arise from the unclear allocation of responsibility when patient harm occurs and from potential breaches of patient privacy due to data collection. Clear rules and legal boundaries are needed to properly allocate liability and protect users. Humanistic ethics concerns arise from the potential disruption of the physician-patient relationship, humanistic care, and issues of integrity. Overreliance on artificial intelligence (AI) can undermine compassion and erode trust. Transparency and disclosure of AI-generated content are critical to maintaining integrity. Algorithmic ethics raise concerns about algorithmic bias, responsibility, transparency and explainability, as well as validation and evaluation. Information ethics include data bias, validity, and effectiveness. Biased training data can lead to biased output, and overreliance on ChatGPT can reduce patient adherence and encourage self-diagnosis. Ensuring the accuracy, reliability, and validity of ChatGPT-generated content requires rigorous validation and ongoing updates based on clinical practice. To navigate the evolving ethical landscape of AI, AI in health care must adhere to the strictest ethical standards. Through comprehensive ethical guidelines, health care professionals can ensure the responsible use of ChatGPT, promote accurate and reliable information exchange, protect patient privacy, and empower patients to make informed decisions about their health care.

BackgroundDeep learning (DL) prediction models hold great promise in the triage of COVID-19. ObjectiveWe aimed to evaluate the diagnostic test accuracy of DL prediction models for assessing and predicting the severity of COVID-19. MethodsWe searched PubMed, Scopus, LitCovid, Embase, Ovid, and the Cochrane Library for studies published from December 1, 2019, to April 30, 2022. Studies that used DL prediction models to assess or predict COVID-19 severity were included, while those without diagnostic test accuracy analysis or severity dichotomies were excluded. QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2), PROBAST (Prediction Model Risk of Bias Assessment Tool), and funnel plots were used to estimate the bias and applicability. ResultsA total of 12 retrospective studies involving 2006 patients reported the cross-sectionally assessed value of DL on COVID-19 severity. The pooled sensitivity and area under the curve were 0.92 (95% CI 0.89-0.94; I2=0.00%) and 0.95 (95% CI 0.92-0.96), respectively. A total of 13 retrospective studies involving 3951 patients reported the longitudinal predictive value of DL for disease severity. The pooled sensitivity and area under the curve were 0.76 (95% CI 0.74-0.79; I2=0.00%) and 0.80 (95% CI 0.76-0.83), respectively. ConclusionsDL prediction models can help clinicians identify potentially severe cases for early triage. However, high-quality research is lacking. Trial RegistrationPROSPERO CRD42022329252; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42022329252

ChatGPT is receiving increasing attention and has a variety of application scenarios in clinical practice. In clinical decision support, ChatGPT has been used to generate accurate differential diagnosis lists, support clinical decision-making, optimize clinical decision support, and provide insights for cancer screening decisions. In addition, ChatGPT has been used for intelligent question-answering to provide reliable information about diseases and medical queries. In terms of medical documentation, ChatGPT has proven effective in generating patient clinical letters, radiology reports, medical notes, and discharge summaries, improving efficiency and accuracy for health care providers. Future research directions include real-time monitoring and predictive analytics, precision medicine and personalized treatment, the role of ChatGPT in telemedicine and remote health care, and integration with existing health care systems. Overall, ChatGPT is a valuable tool that complements the expertise of health care providers and improves clinical decision-making and patient care. However, ChatGPT is a double-edged sword. We need to carefully consider and study the benefits and potential dangers of ChatGPT. In this viewpoint, we discuss recent advances in ChatGPT research in clinical practice and suggest possible risks and challenges of using ChatGPT in clinical practice. It will help guide and support future artificial intelligence research similar to ChatGPT in health.

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates in patients admitted to the intensive care unit (ICU) patients with overwhelming inflammation considered to be an internal cause. The authors’ previous study indicated a potential correlation between phenylalanine levels and lung injury. Phenylalanine induces inflammation by enhancing the innate immune response and the release of pro-inflammatory cytokines. Alveolar macrophages (AMs) can respond to stimuli via synthesis and release of inflammatory mediators through pyroptosis, one form of programmed cell death acting through the nucleotide-binging oligomerization domain-like receptors protein 3 (NLRP3) signaling pathway, resulting in the cleavage of caspase-1 and gasdermin D (GSDMD) and the release of interleukin (IL) -1β and IL-18, aggravating lung inflammation and injury in ARDS. In this study, phenylalanine promoted pyroptosis of AMs, which exacerbated lung inflammation and ARDS lethality in mice. Furthermore, phenylalanine initiated the NLRP3 pathway by activating the calcium-sensing receptor (CaSR). These findings uncovered a critical mechanism of action of phenylalanine in the context of ARDS and may be a new treatment target for ARDS.

The DL deposit is a typical tabular-shaped U deposit hosted in sandstones of the Upper Cretaceous Yaojia Formation in the southwestern Songliao Basin, northeast China. Owing to its recent discovery, the origin of the deposit remains unclear. In this study, mineralogical and geochemical data were used to constrain the genesis of the DL deposit. Two sources of U were recognized: (1) pre-ore U enrichment in the Yaojia Formation during diagenesis; and (2) the provenance of the Yaojia Formation, which comprises late Permian–Early Cretaceous granitic rocks from the southern Great Xing’an Range and northern margin of the North China Craton, rather than the oils and diabase dikes in the study area. Mineralogical and geochemical characteristics indicate that organic matter (OM) in the Yaojia Formation was derived mainly from plant debris and hydrocarbons. In situ S isotope data for pyrite from the ore-bearing sandstones show that most of the pyrite has similar δ34S values (−43.8‰ to −20.6‰) to those of pyrite associated with bacterial sulfate reduction (BSR). The pyrite is often typically replaced and/or overgrown by pitchblende, which has a high P2O5 content (0.07–1.64 wt.%), indicative of a genetic relationship between BSR and U mineralization. The geological, mineralogical, and geochemical features suggest that the U mineralization in the DL deposit was mainly associated with BSR.

In the post-pandemic era, the need for accessible urban green open spaces has increased. There is an urgent need to accurately identify large-scale unit-affiliated green spaces and focus on the potential for open sharing. Therefore, using POI data from the Gaode map of Shanghai obtained via web crawler, combined with remote sensing image data and the current green space data, the subjects of unit-affiliated green spaces in the main urban area and five new towns of Shanghai were identified in 2021. On this basis, in-depth explorations were carried out in terms of the type and number of subjects, the overall layout, and the grading of potential open sharing. A new application path for identifying subjects of unit-affiliated green spaces based on the POI data was established. The analysis of the potential openness of the subjects strongly supports the open sharing of unit-affiliated green spaces; the open sharing of unit-affiliated green spaces can compensate for the deficiencies in the fairness and efficiency of urban green spaces.