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Abstract Ethylene glycol, a widely used chemical, has a large global capacity exceeding 40 million tons per year. Nevertheless, its production is heavily reliant on fossil fuels, resulting in substantial CO2 emissions. Herein, we report an approach for electrochemically producing ethylene glycol from biomass glycerol. This process involves glycerol electrooxidation to glycolaldehyde at anode, which is subsequently electro-reduced to ethylene glycol at cathode. While the anode reaction has been reported, the cathode reaction remains a challenge. An electrodeposited electrode with metallic Cu catalyst enables us to achieve glycolaldehyde-to-ethylene glycol conversion with an exceptional faradaic efficiency of about 80%. Experimental and theoretical studies reveal that metallic Cu catalyst facilitates the C=O activation, promoting glycolaldehyde hydrogenation into ethylene glycol. We further assemble a zero-gap electrolyzer and demonstrate ethylene glycol electrosynthesis from glycerol to give a decent production rate of 1.32 mmol cm–2 h–1 under a 3.48 V cell voltage. The carbon intensity assessment based on a valid assumption reveals that our strategy may reduce CO2 emissions by over 80 million tons annually compared to conventional fossil fuel routes.

Abstract Intervertebral disc degeneration (IDD), osteoarthritis (OA), and osteoporosis (OP) are common musculoskeletal disorders (MSDs) with similar age-related risk factors, representing the leading causes of disability. However, successful therapeutic development and translation have been hampered by the lack of clinically-relevant animal models. In this study, we investigated the potential suitability of the tree shrew, a small mammal with a close genetic relationship to primates, as a new animal model for MSDs. Age-related spontaneous IDD in parallel with a gradual disappearance of notochordal cells were commonly observed in tree shrews upon skeletal maturity with no sex differences, while age-related osteoporotic changes including bone loss in the metaphyses were primarily presented in aged females, similar to observations in humans. Moreover, in the osteochondral defect model, tree shrew cartilage exhibited behavior similar to that of humans, characterized by a more restricted self-healing capacity compared to the rapid spontaneous healing of joint surfaces observed in rats. The induced OA model in tree shrews was highly efficient and reproducible, characterized by gradual deterioration of articular cartilage, recapitulating the human OA phenotype to some degree. Surgery-induced IDD models were successfully established in tree shrews, in which the lumbar spine instability model developed slow progressive disc degeneration with more similarity to the clinical state, whereas the needle puncture model led to the rapid development of IDD with more severe symptoms. Taken together, our findings pave the way for the development of the tree shrew as a new animal model for the study of MSDs and aging.

Parameters of peripheral blood cell have been shown as the potential predictors of erectile dysfunction (ED). To investigate the clinical significance of hematological parameters for predicting the risk of rapid ejaculation, we established a rat copulatory model on the basis of ejaculation distribution theory. Blood samples from different ejaculatory groups were collected for peripheral blood cell counts and serum serotonin (5-HT) tests. Meanwhile, the relationship between hematological parameters and ejaculatory behaviors was assessed. Final analysis included 11 rapid ejaculators, 10 normal ejaculators, and 10 sluggish ejaculators whose complete data were available. The platelet (PLT) count in rapid ejaculators was significantly lower than that in normal and sluggish ejaculators, whereas the platelet distribution width (PDW) and mean platelet volume (MPV) were significantly greater in rapid ejaculators. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis showed that the PLT was an independent protective factor for rapid ejaculation. Meanwhile, rapid ejaculators were found to have the lowest serum 5-HT compared to normal and sluggish ejaculators (P < 0.001). Furthermore, there was a positive correlation between the PLT and serum 5-HT (r = 0.662, P < 0.001), indicating that the PLT could indirectly reflect the serum 5-HT concentration. In addition, we assessed the association between the PLT and ejaculatory parameters. There was a negative correlation between ejaculation frequency (EF) and the PLT (r = −0.595, P < 0.001), whereas there was a positive correlation between ejaculation latency (EL) and the PLT (r = 0.740, P < 0.001). This study indicated that the PLT might be a useful and convenient diagnostic marker for predicting the risk of rapid ejaculation.

Abstract Background To investigate the optimization of leadless pacemaker placement and to assess its impact on heart synchronization and tricuspid regurgitation. Results A clinical trial was conducted involving 53 patients who underwent leadless pacemaker implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine and Hangzhou First People’s Hospital between March 2022 and February 2023. Implantation site localization was determined using the 18-segment method under RAO 30° imaging. Intraoperative and 1-month post-operative echocardiography was performed to assess cardiac electromechanical synchronization and tricuspid regurgitation; parameters of interest included interventricular mechanical delay (IVMD), pre-ejection period of the aorta (L-PEI), and septal-to-posterior wall motion delay (SPWMD). Pacing thresholds, sensing, and impedance exhibited no significant differences between the 8/9 zone and other sites (P > 0.05). In contrast, the 8/9 zone group manifested a significant reduction in L-PEI (128.24 ± 12.27 vs. 146.50 ± 18.17 ms, P

Abstract Antivortices have potential applications in future nano-functional devices, yet the formation of isolated antivortices traditionally requires nanoscale dimensions and near-zero magnetocrystalline anisotropy, limiting their broader application. Here, we propose an approach to forming antivortices in multiferroic ε-Fe2O3 with the coalescence of misaligned grains. By leveraging misaligned crystal domains, the large magnetocrystalline anisotropy energy is counterbalanced, thereby stabilizing the ground state of the antivortex. This method overcomes the traditional difficulty of observing isolated antivortices in micron-sized samples. Stable isolated antivortices were observed in truncated triangular multiferroic ε-Fe2O3 polycrystals ranging from 2.9 to 16.7 µm. Furthermore, the unpredictability of the polarity of the core was utilized as a source of entropy for designing physically unclonable functions. Our findings expand the range of antivortex materials into the multiferroic perovskite oxides and provide a potential opportunity for ferroelectric polarization control of antivortices.

Abstract Introduction Cardiac arrest (CA), characterized by its heterogeneity, poses challenges in patient management. This study aimed to identify clinical subphenotypes in CA patients to aid in patient classification, prognosis assessment, and treatment decision-making. Methods For this study, comprehensive data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) 2.0 database. We excluded patients under 18 years old, those not initially admitted to the intensive care unit (ICU), or treated in the ICU for less than 72 h. A total of 57 clinical parameters relevant to CA patients were selected for analysis. These included demographic data, vital signs, and laboratory parameters. After an extensive literature review and expert consultations, key factors such as temperature (T), sodium (Na), creatinine (CR), glucose (GLU), heart rate (HR), PaO2/FiO2 ratio (P/F), hemoglobin (HB), mean arterial pressure (MAP), platelets (PLT), and white blood cell count (WBC) were identified as the most significant for cluster analysis. Consensus cluster analysis was utilized to examine the mean values of these routine clinical parameters within the first 24 h post-ICU admission to categorize patient classes. Furthermore, in-hospital and 28-day mortality rates of patients across different CA subphenotypes were assessed using multivariate logistic and Cox regression analysis. Results After applying exclusion criteria, 719 CA patients were included in the study, with a median age of 67.22 years (IQR: 55.50-79.34), of whom 63.28% were male. The analysis delineated two distinct subphenotypes: Subphenotype 1 (SP1) and Subphenotype 2 (SP2). Compared to SP1, patients in SP2 exhibited significantly higher levels of P/F, HB, MAP, PLT, and Na, but lower levels of T, HR, GLU, WBC, and CR. SP2 patients had a notably higher in-hospital mortality rate compared to SP1 (53.01% for SP2 vs. 39.36% for SP1, P

Abstract Objective In this study, we aimed to screen the risk factors for delayed extubation after surgery for Ebstein’s anomaly (EA), determine the diagnostic cut-off values, and develop a prediction equation to accurately encourage rapid recovery after surgery. Methods The perioperative data of 76 pediatric patients undergoing EA surgery in the Surgical Department of the Pediatric Heart Center of Anzhen Hospital from September 2013 to September 2021 were retrospectively analyzed. Results Among these cases, 37 (48.6%) were male, with an average age of 4.67 (2, 11.19) years and an average weight of 18 (12.4, 37) kg. The median postoperative duration of mechanical ventilation was 18 (10, 24) h, and the duration of mechanical ventilation ≥ 24 h (75th percentile) was defined as delayed extubation. Body weight (11.25 kg) and preoperative oxygen saturation (SpO2) (95.5%) were protective factors, while the simplified Great Ormond Street Echocardiogram (GOSE) value (0.995) and the intraoperative cardiopulmonary bypass (CPB) time (135 min) were the risk factors. The prediction model was developed based on these indexes: logit (P) = 8.9 + (0.02 × CPB time) + (2.2 × simplified GOSE) – (0.14 × preoperative SpO2) − (0.06 × body weight), and the area under the receiver operator characteristic (ROC) curve was 83.4% (P

This paper proposes a method for floor plan designs that combines shape grammar with Building Information Modeling (BIM) technology to create plan module libraries by using the mass modular housing project in ShanLiChenJia village as an example. The modular building is composed of several component modules, and shape grammar can manipulate their graphics and functions to enrich the combination relationship between component modules. The rule-making of the combination process can code the size relationship that affects the module form by adding space and size constraints. In the rule system of shape grammar, geometric dimensions, and functional attributes are first embedded in the shape graph. Then, the mapping relationship is established between the shape graph and the attributes of the modules. Finally, the BIM platform can establish the module library using Autodesk Revit. In addition, a spatial relationship in the scheme is selected in Revit software for generative experiments, which confirms the feasibility of shape grammar in generative design and spatial diversity of modular buildings.

Consumers who post negative reviews of products on social media often face defamation claims by business entities. Such lawsuits have had a chilling effect on the right to freedom of expression, which is protected by law. In adjudicating consumer cases, judges have generally failed to apply the concept of common interest as a consideration, despite the potential benefits and awareness such reviews provide to prospective consumers. The common interest concept, as stipulated in defamation laws, can serve as a form of legal protection for consumers who post reviews on social media, provided the reviews are truthful, reflect actual conditions, and are made in good faith. By implementing the common interest concept and conducting its proper assessment, legal protection can be ensured for both consumers and businesses. Consumers would be shielded from unwarranted defamation claims, while businesses would be protected from malicious reviews by bad-faith consumers that result in financial or reputational harm. This study aims to dissect the legal safeguard afforded to consumers through the prism of common interest when confronting social media-based complaints or reviews ensnared in defamation litigations instigated by corporate entities. Employing a normative juridical methodology, the research amalgamates legislative analysis with conceptual frameworks. The research findings accentuate the significance of invoking the public interest doctrine in consumer-related litigation, thereby fortifying legal defenses against defamation allegations.

Growing evidence has linked extreme temperature with neuropsychiatric disorders under climate warming with frequent extreme heat events over the past decades, while cognitive performance in relation to heat exposure remains largely unstudied, particularly in populations at high vulnerability to climate risks (e.g., China). Based on five survey waves of a nationwide dynamic cohort (2011–2020), we analyzed 47,825 cognitive test records from 14,729 respondents aged 45+ years across 126 Chinese cities. Global cognitive performance and its two dimensions (episodic memory and mental status) was measured using standardized questionnaires. Temperature exposure prior to cognitive tests was assessed using both average temperatures and heat days exceeding predefined temperature thresholds. Linear mixed-effects models were utilized to examine the relationship between high temperature exposure and cognitive function. This study revealed consistent evidence for heat-related declines in global cognitive performance and episodic memory across multiple exposure-window analyses, while robust associations were observed solely during prolonged exposure periods (more than 90 d) for mental status. For each 1-°C rise in annual mean temperature within 1 year prior to investigation, cognitive scores declined by 0.058 (95% CI: −0.079, −0.037) points for global performance, 0.033 (95% CI: −0.048, −0.018) points for episodic memory, and 0.025 (95% CI: −0.038, −0.013) points for mental status, respectively. Similar findings were seen in analyses using heat exposure days defined by multiple temperature percentiles, linking per 10-d increase in heat duration to reduced global cognitive scores ranging from −0.142 (95% CI: −0.214, −0.070) to −0.168 (95% CI: −0.254, −0.082). Despite varied evidence by heat exposure metrics and cognitive dimensions, stratified analyses suggested possibly higher susceptibility among females, less-educated, and urban-dwelling residents to heat-related cognitive impairment. These results provided suggestive evidence for the role of exposure to heat in triggering cognitive impairment in middle-aged and older individuals. This finding may be crucial in developing public health strategies for managing climate change risks of neurobehavioral disorders in a healthy aging society.

Abstract Background Alzheimer’s disease (AD) is the most common form of neurodegenerative disorder, which is characterized by a decline in cognitive abilities. Genome-wide association and clinicopathological studies have demonstrated that the CD2-associated protein (CD2AP) gene is one of the most important genetic risk factors for AD. However, the precise mechanisms by which CD2AP is linked to AD pathogenesis remain unclear. Methods The spatiotemporal expression pattern of CD2AP was determined. Then, we generated and characterized an APP/PS1 mouse model with neuron-specific Cd2ap deletion, using immunoblotting, immunofluorescence, enzyme-linked immunosorbent assay, electrophysiology and behavioral tests. Additionally, we established a stable CD2AP-knockdown SH-SY5Y cell line to further elucidate the specific molecular mechanisms by which CD2AP contributes to AD pathogenesis. Finally, the APP/PS1 mice with neuron-specific Cd2ap deletion were treated with an inhibitor targeting the pathway identified above to further validate our findings. Results CD2AP is widely expressed in various regions of the mouse brain, with predominant expression in neurons and vascular endothelial cells. In APP/PS1 mice, neuronal knockout of Cd2ap significantly aggravated tau pathology, synaptic impairments and cognitive deficits. Mechanistically, the knockout of Cd2ap activated p38 mitogen-activated protein kinase (MAPK) signaling, which contributed to increased tau phosphorylation, synaptic injury, neuronal apoptosis and cognitive impairment. Furthermore, the phenotypes of neuronal Cd2ap knockout were ameliorated by a p38 MAPK inhibitor. Conclusion Our study presents the first in vivo evidence that CD2AP deficiency exacerbates the phenotypes and pathology of AD through the p38 MAPK pathway, identifying CD2AP/p38 MAPK as promising therapeutic targets for AD.

Abstract Hyaluronan (HA), a natural high molecular weight polysaccharide, has extensive applications in cosmetology and medical treatment. Hyaluronan-degrading enzymes (Hyals) act as molecular scissors that cleave HA by breaking the glucosidic linkage. Hyals are present in diverse organisms, including vertebrates, invertebrates and microorganisms, and play momentous roles in biological processes. In recent years, microbial Hyals (mHyals) have gained considerable attention for their exceptional performance in the production and processing of HA. Moreover, the applications of mHyals have been greatly extended to various biomedical fields. To explore the potential applications of mHyals, a thorough comprehension is imperative. In this context, this review systematically summarizes the sources, structures, mechanisms and enzymatic properties of mHyals and discusses their biological functions in host invasion, disease development, and regulation of intestinal flora. Furthermore, versatile applications inspired by their biological functions in medicine development, molecular biology, and industrial biotechnology are comprehensively reviewed. Finally, prospects are presented to emphasize the importance of exploration, expression and characterization of mHyals and the necessity of excavating their potential in biotechnological fields. Graphical abstract

Abstract Objective This study aimed to examine the levels of physical activity (PA), sleep, and mental health (MH), specifically depression, anxiety, and stress, among Chinese university students. It also aimed to analyze the influencing factors of MH, providing a theoretical foundation for developing intervention programs to improve college students’ mental health. Methods A stratified, clustered, and phased sampling method was employed. In September 2022, a survey was conducted among 36,756 university students from 104 higher education institutions across 31 provinces, autonomous regions, and municipalities in China. The participants’ PA behaviors, sleep patterns, depressive symptoms (use the CES-D), anxiety symptoms (use the GAD-7), smoking and drinking behaviors, and demographic information were assessed through an online questionnaire using Questionnaire Star software. Results A total of 30,475 valid questionnaires were completed. The proportion of university students engaging in light-intensity PA was 77.6%. The prevalence of insufficient sleep was 39.5%, whereas the prevalence of poor sleep quality was 16.7%. The prevalence of depressive symptoms was 10%, and the prevalence of anxiety symptoms was 23.3%. Binary logistic regression analysis revealed that engaging in moderate to high-intensity PA and having sufficient and high-quality sleep were associated with a lower likelihood of depressive symptoms (OR = 0.207–0.800, P

Abstract Background Coronary artery disease (CAD) has become a dominant economic and health burden worldwide, and the role of autophagy in CAD requires further clarification. In this study, we comprehensively revealed the association between autophagy flux and CAD from multiple hierarchies. We explored autophagy-associated long noncoding RNA (lncRNA) and the mechanisms underlying oxidative stress-induced human coronary artery endothelial cells (HCAECs) injury. Methods (1) Autophagy-related proteins including LC3, p62, Beclin1, ATG5, and ATG7 were immunohistochemical stained in coronary specimens; (2) The levels and function of autophagy in the HCAEC oxidative stress model were evaluated using western blot (WB), transmission electron microscopy (TEM), and mRFP-GFP-LC3 adenovirus transfection experiments; (3) The competing endogenous RNA (ceRNA) network of lncRNA LUCAT1/hsa-miR-6776-5p/LRRC25 axis was constructed and validated; (4) The expression levels of above autophagy-related RNAs in peripheral blood mononuclear cells (PBMCs) were verified by qPCR, and their diagnostic performance was subsequently analyzed using receiver operating characteristic (ROC) analysis. Results (1) The expression of LC3, Beclin1, ATG5, and ATG7 demonstrated a consistent decline whereas p62 expression exhibited an opposite increase as atherosclerosis progressed; (2) Autophagy levels was significantly elevated in HCAECs under oxidative stress, while inhibition of the initial stage of autophagy with 3-MA exacerbated cellular damage; (3) The lncRNA LUCAT1/hsa-miR-6776-5p/LRRC25 axis was established through bioinformatic prediction and validated by dual-luciferase reporter assay, which resulted in a significant decrease in autophagy levels in HCAECs; (4) In total, p62, ATG7, lncRNA LUCAT1 and LRRC25 were validated as robust diagnostic biomarkers for CAD. Conclusions Our results delineated the dynamic disruption of the autophagy landscape during the progression of human coronary atherosclerosis and identified the lncRNA LUCAT1/hsa-miR-6776-5p/LRRC25 axis, uncovered through transcriptomic profiling, as a protective mechanism against endothelial cell injury through autophagy activation. Furthermore, we recognized p62, ATG7, lncRNA LUCAT1, and LRRC25 as dependable autophagy-related diagnostic biomarkers in circulating PBMCs, correlating with CAD severity. Collectively, Our findings furnish novel insights into the intricate autophagy landscape at various levels of coronary atherosclerosis and propose potential diagnostic biomarkers, and a theoretical foundation for managing CAD patients.

Background and Aim: Machine learning based on clinical data and treatment protocols for better clinical decision-making is a current research hotspot. This study aimed to build a machine learning model on washed microbiota transplantation (WMT) for ulcerative colitis (UC), providing patients and clinicians with a new evaluation system to optimize clinical decision-making.MethodsPatients with UC who underwent WMT via mid-gut or colonic delivery route at an affiliated hospital of Nanjing Medical University from April 2013 to June 2022 were recruited. Model ensembles based on the clinical indicators were constructed by machine-learning to predict the clinical response of WMT after one month.ResultsA total of 366 patients were enrolled in this study, with 210 patients allocated for training and internal validation, and 156 patients for external validation. The low level of indirect bilirubin, activated antithrombin III, defecation frequency and cholinesterase and the elderly and high level of creatine kinase, HCO3- and thrombin time were related to the clinical response of WMT at one month. Besides, the voting ensembles exhibited an area under curve (AUC) of 0.769 ± 0.019 [accuracy, 0.754; F1-score, 0.845] in the internal validation; the AUC of the external validation was 0.614 ± 0.017 [accuracy, 0.801; F1-score, 0.887]. Additionally, the model was available at https://wmtpredict.streamlit.app.ConclusionsThis study pioneered the development of a machine learning model to predict the one-month clinical response of WMT on UC. The findings demonstrate the potential value of machine learning applications in the field of WMT, opening new avenues for personalized treatment strategies in gastrointestinal disorders.Trial registrationclinical trials, NCT01790061. Registered 09 February 2013 - Retrospectively registered, https://clinicaltrials.gov/study/NCT01790061

Abstract Distributing quantum entanglement between distant parties is a significant but difficult task in quantum information science, as it can enable numerous applications but suffers from exponential decay in the quantum channel. Quantum repeaters are one of the most promising approaches towards this goal. In a quantum repeater protocol, it is essential that the entanglement generation speed within each elementary link is faster than the memory decoherence rate, and this stringent requirement has not been implemented over a fiber of metropolitan scale so far. As a step towards this challenging goal, in this work we experimentally realize multiplexing-enhanced generation of heralded atom-photon quantum correlation over a 12 km fiber. We successively generate 280 pairs of atom-photon quantum correlations with a train of photonic time-bin pulses filling the long fiber, and read out the excited memory modes on demand with either fixed or variable storage time after successful heralding. With the multiplexing enhancement, the heralding rate of atom-photon correlation can reach 1.95 kHz, and the ratio between the quantum correlation generation rate to memory decoherence rate can be improved to 0.46 for a fiber length of 12 km. This work therefore constitutes an important step towards the realization of a large-scale quantum repeater network.

Abstract Multifunctional integration and heterogeneous surface integration are two crucial challenges in the in-depth use and development of triboelectric nanogenerators (TENGs) in the wearable electronic field. A promising solution is to develop stretchable TENGs (STENG), which have the potential for microenergy supply and self-powered sensing. The key challenge is to endow its functional components with good deformability and realize heterogeneous surface integration. Herein, we proposed a fully stretchable, surface adaptable TENG using stretchable micro-nano hierarchical friction interfaces. It integrated microenenrgy supply and multifunctional self-powered sensing (i.e., bend, force, and frequency sensing) abilities successfully. The highly-linear sensing abilities endows the STENG with a good biometric ability. As an application, a STENG array based-stretchable wearable keyboard was proposed. It identified dynamic keystroke motions of all users with a Support Vector Machine, with a high accuracy of 93.21%. Besides, the intruders who were not sampled were distinguished from users, with an accuracy of 81.50%.

Three new species of the genus Cicurina Menge, 1871 are described from Daba Mountain National Nature Reserve, Chongqing, China: C. chengkou sp. nov. (♂♀), C. dabashan sp. nov. (♂♀) and C. longihamata sp. nov. (♂♀). Morphological descriptions, photos and illustrations of copulatory organs are provided.

The wolf spider genus Halocosa Azarkina & Trilikauskas, 2019 from China is reviewed, including two species: H. cereipes (L. Koch, 1878) (♂♀) and H. hatanensis (Urita, Tang & Song, 1993) (♂♀). Both species are restricted to northern China, with H. cereipes recorded from China for the first time. Halocosa jartica (Urita, Tang & Song, 1993), syn. nov. is synonymized with H. hatanensis (Urita, Tang & Song, 1993). Detailed species descriptions, along with morphological photos, genitalia illustrations, SEM photos of the bulbs and photos of live specimens are also presented.

Seven species of the crab-spider family Thomisidae from Medog, Xizang, China are described here, including six new species: Camaricus medog Wang, Lu & Zhang, sp. nov. (♂♀), Monaeses xizang Wang, Lu & Zhang, sp. nov. (♂♀), Sinothomisus beibeng Wang, Lu & Zhang, sp. nov. (♂♀), Sinothomisus dawai Wang, Lu & Zhang, sp. nov. (♂♀), Spilosynema motuo Wang, Lu & Zhang, sp. nov. (♂♀), and Thomisus yarang Wang, Lu & Zhang, sp. nov. (♂♀). The male of Pharta xizang Liu & Yao, 2023 is described here for the first time. Descriptions and photographs of all the species are provided.

Abstract To investigate the diagnostic value of intraoperative cytology and rapid immunocytochemistry in primary central nervous system lymphoma. 254 cases of lymphoma and 82 cases of non-lymphoma were collected from 2010 to 2023. Frozen section(FS) was using alone in 44 cases during 2010–2014, FS and intraoperative cytology(IC) were using in 251 cases during 2015 to 2022. Rapid immunocytochemical(RICC, CD20, GFAP) were using with FS + IC in 41 cases during 2021 to 2023. Method One: According to the results of archives, statistic the diagnostic accuracy of lymphoma during three time periods. Method Two: All cases were randomly renumbered, 4 neuropathologists compared the accuracy of independent histology and that of combining cytology. The archives showed the diagnostic accuracy of FS in PCNSL was 77.27%, FS + IC was 86.06%, FS + IC + RICC was 92.68%. The retrospective study demonstrated the diagnostic accuracy of FS was 79.76%, FS + IC was 87.33% and FS + IC + RICC was 92.68%. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of CD20 were 100%, 76.92%, 90.32%, 100% and 92.68%, respectively. The results of the paired χ2 test was no statistically significant difference (0.05

Abstract Ligand-protected metal nanoclusters provide an ideal platform for investigating photoredox catalysis. The central challenge is balancing their stability and catalytic activity. Here we show a photochemical reduction–oxidation cascade method for synthesizing an Au8Cu6 nanocluster, which features a robust structure and active surface. Photoredox catalytic activity of Au8Cu6 is developed for the functionalization of alkynes under oxidative conditions. Mechanism studies based on the precise structure reveal the catalytic process of the Au8Cu6 nanocluster. Oxidant-dependent selectivity of Au8Cu6 catalysis is developed for chemodivergent synthesis of mono- and di-functionalized products in high efficiency. The results will stimulate more research on metal nanocluster synthesis and catalysis.

This study aims to elucidate the practical approaches and experiences of comorbidity management in Shanghai city, providing a reference for the Yangtze River Delta and other regions in China. Shanghai city has developed a comprehensive and closed-loop chronic disease health management system, which includes pre-diagnosis risk assessment and identification with tagged classification, intra-diagnosis standardized monitoring, data sharing integration, multidisciplinary collaboration, decision support, and post-diagnosis complication screening, intelligent follow-up, patient self-management, standardized health education, and re-evaluation. This system provides continuous medical care for patients with chronic comorbidities. Future potential directions and pathways for chronic comorbidity management include optimizing the social collaborative governance mechanism, further improving the network of community and social resource provision, refining the standards and mechanisms for referral of chronic disease patients, formulating shared decision-making and dynamic, continuous, and personalized care plans, and establishing a multidisciplinary collaboration mechanism for comorbidity patients in primary healthcare institutions.

This study compared different doublet and triplet therapies for efficacy and safety in metastatic hormone-sensitive prostate cancer (mHSPC). PubMed, EMBASE, and the Cochrane Library were comprehensively searched for eligible randomized controlled trials (RCTs) published from inception to October 2023. Interventions included abiraterone, apalutamide, enzalutamide, docetaxel, darolutamide, and androgen deprivation therapy (ADT), either as doublet or triplet therapies. The outcomes examined were overall survival (OS), progression-free survival (PFS), castration-resistant prostate cancer (CRPC)-free survival, time to symptomatic skeletal event (SSE), and toxicity. The surface under the cumulative ranking curve (SUCRA) was determined to identify the preferred treatments. Ten RCTs were included. The combination of darolutamide, docetaxel, and ADT had the highest SUCRA of 84.3 for OS, followed by combined abiraterone, docetaxel, and ADT (SUCRA = 71.6). The highest SUCRAs for PFS were observed for triplet therapies (abiraterone, docetaxel, and ADT [SUCRA = 74.9], followed by enzalutamide, docetaxel, and ADT [SUCRA = 74.3]) and other androgen receptor axis-targeted therapy-based doublet therapies (SUCRAs: 26.5–59.3). Darolutamide, docetaxel, and ADT had the highest SUCRAs, i.e., 80.8 and 84.0 regarding CRPC-free survival and time to SSE, respectively. Regarding Grade >3 adverse events (AEs), the SUCRAs of triplet therapies (SUCRAs: 14.8–31.5) were similar to that of docetaxel and ADT (SUCRA = 39.5). Three studies had a low risk of bias in all categories; the remaining studies had at least an unclear risk of bias in at least one category. Triplet therapy demonstrated potentially enhanced effectiveness than doublet therapy in mHSPC, with acceptable safety concerns. Darolutamide might be the optimal option for triplet therapy in combination with docetaxel and ADT.

The prediction of slope stability is considered as one of the critical concerns in geotechnical engineering. Conventional stochastic analysis with spatially variable slopes is time-consuming and highly computation-demanding. To assess the slope stability problems with a more desirable computational effort, many machine learning (ML) algorithms have been proposed. However, most ML-based techniques require that the training data must be in the same feature space and have the same distribution, and the model may need to be rebuilt when the spatial distribution changes. This paper presents a new ML-based algorithm, which combines the principal component analysis (PCA)-based neural network (NN) and transfer learning (TL) techniques (i.e. PCA–NN–TL) to conduct the stability analysis of slopes with different spatial distributions. The Monte Carlo coupled with finite element simulation is first conducted for data acquisition considering the spatial variability of cohesive strength or friction angle of soils from eight slopes with the same geometry. The PCA method is incorporated into the neural network algorithm (i.e. PCA-NN) to increase the computational efficiency by reducing the input variables. It is found that the PCA-NN algorithm performs well in improving the prediction of slope stability for a given slope in terms of the computational accuracy and computational effort when compared with the other two algorithms (i.e. NN and decision trees, DT). Furthermore, the PCA–NN–TL algorithm shows great potential in assessing the stability of slope even with fewer training data.

Abstract Background The aim of this study was to elucidate the critical role of autophagy-related gene aggregation in gastric cancer tumor microenvironment cells and to investigate their major roles in cellular functions. In particular, the expression of these genes in tumor-associated fibroblast subtypes was scrutinized in an attempt to explain their cell-subpopulation-specific roles in cell–cell communication and regulation of cellular functions. Methods In this study, single-cell RNA sequencing data were first analyzed in multiple steps, including data preprocessing, cell clustering, and cell classification. Cell subpopulations and gene expression patterns were identified and analyzed using unsupervised non-negative matrix factorization (NMF) techniques. The dynamic expression of autophagy-related gene aggregates in various cell types was deciphered by pseudotime trajectory analysis (PTA). Intercellular communication analysis was performed using the CellChat R software package, revealing the intricate communication patterns and exchange of key signaling molecules between cell subpopulations, and SCENIC analysis was used to identify gene regulatory networks and reveal the mechanisms behind cellular heterogeneity. Result Cell subpopulations associated with pan-apoptosis were identified by NMF decomposition and SCENIC analysis. Cell–cell communication analysis revealed intricate communication patterns and exchange of key signaling molecules between cell subpopulations. Dynamic expression of autophagy-related genes aggregated in the pseudotemporal trajectory of STAD was observed by PTA. In the fibroblast subtype, different ligand-receptor interactions and their key roles in immunomodulation were observed. Conclusion By deeply analyzing and comparing gene expression patterns within cellular subpopulations and intercellular communication, this study provides new insights into the role of pan-apoptosis-related genes in regulating immune responses and cellular functions in gastric cancer. These findings pave the way for further exploration of the role of these genes in tumorigenesis and immune regulation, as well as laying the foundation for potential therapeutic strategies.

Abstract Accurate detection of asphalt pavement distress is crucial for road maintenance and traffic safety. However, traditional convolutional neural networks usually struggle with this task due to the varied distress patterns and complex background in the images. To enhance the accuracy of asphalt pavement distress identification across various scenarios, this paper introduces an improved model named SMG-YOLOv8, based on the YOLOv8s framework. This model integrates the space-to-depth module and the multi-scale convolutional attention mechanism, while optimizing the backbone’s C2f structure with a more efficient G-GhostC2f structure. Experimental results demonstrate that SMG-YOLOv8 outperforms the YOLOv8s baseline model, achieving P macro and mAP50 scores of 81.1% and 79.4% respectively, marking an increase of 8.2% and 12.5% over the baseline. Furthermore, SMG-YOLOv8 exhibits clear advantages in identifying various types of pavement distresses, including longitudinal cracks, transverse cracks, mesh cracks, and potholes, when compared to YOLOv5n, YOLOv5s, YOLOv6s, YOLOv8n, and SSD models. This enhancement optimizes the network structure, reducing the number of parameters while maintaining excellent detection performance. In real-world scenarios, the SMG-YOLOv8 model, when applied to image data collected from projects, achieves a P macro of 80.5% and an R macro of 86.2%. This result demonstrates its excellent generalization capability and practicality. The model provides significant technical support for the intelligent detection of pavement distress.

Abstract Phytochrome interacting factors (PIFs) serve as crucial regulators in the light signal transduction pathway and also mediate light signals to regulate secondary metabolite synthesis in plants. However, the regulator role of PIFs in secondary metabolites often varies among different plants. Isorhynchophylline (IRN), an iconic secondary metabolite of Uncaria rhynchophylla, holds significant medicinal value. Low light induces the synthesis of IRN in previous research, but PIFs in U. rhynchophylla have not been studied to date. Building on this, we identified a PIF protein, UrPIF3, which possesses the typical conserved domains of the PIFs and is localized in the nucleus. Moreover, the expression level of UrPIF3 is consistently positively correlated with the expression of two key enzyme genes (UrSGD and UrSTR) in the IRN biosynthesis pathway, regardless of whether under low light or restoring light conditions. Yeast one-hybrid and dual-luciferase assays further demonstrated that UrPIF3 can directly upregulate UrSGD. Conversely, silencing UrPIF3 inhibits IRN synthesis, and significantly reduces the expression levels of UrSGD and UrSTR. In summary, our results suggest that under low light conditions, UrPIF3 can directly upregulate UrSGD and indirectly upregulate UrSTR, thereby promoting the synthesis of IRN.

Immunotherapy is an important cancer treatment method that offers hope for curing cancer patients. While immunotherapy has achieved initial success, a major obstacle to its widespread adoption is the inability to benefit the majority of patients. The success or failure of immunotherapy is closely linked to the tumor's immune microenvironment. Recently, there has been significant attention on strategies to regulate the tumor immune microenvironment in order to stimulate anti-tumor immune responses in cancer immunotherapy. The distinctive physical properties and design flexibility of nanomedicines have been extensively utilized to target immune cells (including tumor-associated macrophages (TAMs), T cells, myeloid-derived suppressor cells (MDSCs), and tumor-associated fibroblasts (TAFs)), offering promising advancements in cancer immunotherapy. In this article, we have reviewed treatment strategies aimed at targeting various immune cells to regulate the tumor immune microenvironment. The focus is on cancer immunotherapy models that are based on nanomedicines, with the goal of inducing or enhancing anti-tumor immune responses to improve immunotherapy. It is worth noting that combining cancer immunotherapy with other treatments, such as chemotherapy, radiotherapy, and photodynamic therapy, can maximize the therapeutic effects. Finally, we have identified the challenges that nanotechnology-mediated immunotherapy needs to overcome in order to design more effective nanosystems.

Abstract Background Sepsis remains a leading cause of mortality in intensive care units, and rapid and accurate pathogen detection is crucial for effective treatment. This study evaluated the clinical application of multi-site metagenomic next-generation sequencing (mNGS) for the diagnosis of sepsis, comparing its performance against conventional methods. Methods A retrospective analysis was conducted on 69 patients with sepsis consecutively admitted to the Department of Intensive Care Medicine, Meizhou People’s Hospital. Samples of peripheral blood and infection sites were collected for mNGS and conventional method tests to compare the positive rate of mNGS and traditional pathogen detection methods and the distribution of pathogens. The methods used in this study included a comprehensive analysis of pathogen consistency between peripheral blood and infection site samples. Additionally, the correlation between the pathogens detected and clinical outcomes was investigated. Results Of the patients with sepsis, 57.97% experienced dyspnea, and 65.2% had underlying diseases, with hypertension being the most common. mNGS demonstrated a significantly higher pathogen detection rate (88%) compared to the conventional method tests (26%). The pathogen consistency rate was 60% between plasma and bronchoalveolar lavage fluid samples, and that of plasma and local body fluid samples was 63%. The most frequently detected pathogens were gram-negative bacteria, and Klebsiella pneumonia. There were no significant differences in the clinical features between the pathogens. Conclusion mNGS is significantly superior to conventional methods in pathogen detection. There was a notable high pathogen consistency detection between blood and local body fluid samples, supporting the clinical relevance of mNGS. This study highlights the superiority of mNGS in detecting a broad spectrum of pathogens quickly and accurately. Trial registration Not applicable.

Abstract Primary central nervous system lymphoma (PCNSL) is a rare and frequently fatal lymphoma subtype. The programmed death-1 (PD-1) pathway has emerged as a potential therapeutic target, but the effectiveness of PD-1 antibody sintilimab in combination with immunochemotherapy as a frontline treatment for PCNSL remains to be determined. In this phase 2 trial (ChiCTR1900027433) with a safety run-in, we included patients aged 18–70 with newly diagnosed PCNSL. Participants underwent six 21-day cycles of a SMTR regimen, which includes sintilimab (200 mg, Day 0), rituximab (375 mg/m2, Day 0), methotrexate (3.0 g/m2, Day 1 or 1.0 g/m2 for patients aged ≥65 years), and temozolomide (150 mg/m2/d, Days 1–5). Among 27 evaluable patients, the overall response rate (ORR) was 96.3% (95% confidence interval: 81–99.9%), with 25 complete responses. At a median follow-up of 24.4 months, the medians for duration of response, progression-free survival (PFS), and overall survival were not reached. The most common grade 3–4 treatment-related toxicities were increased levels of alanine aminotransferase (17.9%) and aspartate aminotransferase (14.3%). Additionally, baseline levels of interferon-α and the IL10/IL6 ratio in cerebrospinal fluid emerged as potential predictors of PFS, achieving areas under the curve of 0.88 and 0.84, respectively, at 2 years. Whole-exome sequencing revealed a higher prevalence of RTK-RAS and PI3K pathway mutations in the durable clinical benefit group, while a greater frequency of Notch and Hippo pathway mutations in the no durable benefit group. These findings suggest the SMTR regimen is highly efficacious and tolerable for newly diagnosed PCNSL, warranting further investigation.

Abstract A large-scale, high-speed, long-runout landslide occurred in Xinmo Village, Maoxian, Sichuan Province, China, on June 24, 2017. It was characterized by fast sliding speed, rapid volume growth, and large impact area. The dynamic process of such landslides and the influence of erosion on the dynamic process are studied by field investigation, numerical inversion and simulation. The results showed that entrainment erosion was a major factor of landslide volumetric change and a salient feature of the landslide process. An exponential equation relating the erosion rate and the deposition volume was established. Moreover, the study found that a slight change of the erosion rate (1e-4) also had a significant impact on the lateral spreading, longitudinal runout, and vertical erosion. As the erosion rate increased, the lateral spreading, longitudinal runout, and vertical erosion of this type of landslide became more obvious. By using the coefficient of variation method, it was obtained that the erosion rate had a greater influence on the vertical erosion than on the lateral spreading and longitudinal runout. In the study of the velocity of the rock avalanche under different erosion conditions, it was found that the erosion amount and the landslide velocity were not strictly linearly related. This study has important significance for understanding the dynamic process and erosion effect of rock avalanche, and provides useful references and insights for future research in related fields.

Abstract Skeletal muscle is a highly heterogeneous tissue, and its contractile proteins are composed of different isoforms, forming various types of muscle fiber, each of which has its own metabolic characteristics. It has been demonstrated that endurance exercise induces the transition of muscle fibers from fast-twitch to slow-twitch muscle fiber type. Herein, we discover a novel epigenetic mechanism for muscle contractile property tightly coupled to its metabolic capacity during muscle fiber type transition with exercise training. Our results show that an 8-week endurance exercise induces histone methylation remodeling of PGC-1α and myosin heavy chain (MHC) isoforms in the rat gastrocnemius muscle, accompanied by increased mitochondrial biogenesis and an elevated ratio of slow-twitch to fast-twitch fibers. Furthermore, to verify the roles of reactive oxygen species (ROS) and AMPK in exercise-regulated epigenetic modifications and muscle fiber type transitions, mouse C2C12 myotubes were used. It was shown that rotenone activates ROS/AMPK pathway and histone methylation enzymes, which then promote mitochondrial biogenesis and MHC slow isoform expression. Mitoquinone (MitoQ) partially blocking rotenone-treated model confirms the role of ROS in coupling mitochondrial biogenesis with muscle fiber type. In conclusion, endurance exercise couples mitochondrial biogenesis with MHC slow isoform by remodeling histone methylation, which in turn promotes the transition of fast-twitch to slow-twitch muscle fibers. The ROS/AMPK pathway may be involved in the regulation of histone methylation enzymes by endurance exercise.

Abstract Background The intricate interplay between genetics and immunology often dictates the host’s susceptibility to various diseases. This study explored the genetic causal relationship between natural killer (NK) cell-related traits and the risk of infection. Methods Single-nucleotide polymorphisms (SNPs) significantly associated with NK cell-related traits were selected as instrumental variables to estimate their genetic causal effects on infection. SNPs from a genome-wide association study (GWAS) on NK cell-related traits, including absolute cell counts, median fluorescence intensities reflecting surface antigen levels, and relative cell counts, were used as exposure instruments. Summary-level GWAS statistics of four phenotypes of infection were used as the outcome data. The exposure and outcome data were analyzed via the two-sample Mendelian randomization method. Results Each one standard deviation increase in the expression level of human leukocyte antigen (HLA)-DR on HLA-DR+ NK cells was associated with a lower risk of pneumonia (P

The therapeutic effect of immune checkpoint inhibitors (ICIs) in triple-negative breast cancer (TNBC) is unsatisfactory. The immune ''cold'' microenvironment caused by tumor-associated fibroblasts (TAFs) has an adverse effect on the antitumor response. Therefore, in this study, mixed cell membrane-coated porous magnetic nanoparticles (PMNPs) were constructed to deliver salvianolic acid B (SAB) to induce an antitumor immune response, facilitating the transition from a ''cold'' to a ''hot'' tumor and ultimately enhancing the therapeutic efficacy of immune checkpoint inhibitors. PMNP-SAB, which is based on a mixed coating of red blood cell membrane and TAF membrane (named PMNP-SAB@RTM), can simultaneously achieve the dual effects of ''immune escape'' and ''homologous targeting''. Under the influence of an external magnetic field (MF), SAB can be targeted and concentrated at the tumor site. The SAB released in tumors can effectively inhibit the production of extracellular matrix (ECM) by TAFs, promote T-cell infiltration, and induce antitumor immune responses. Ultimately, the combination of PMNP-SAB@RTM and BMS-1 (PD-1/PD-L1 inhibitor 1) effectively inhibited tumor growth. Finally, this study presents a precise and effective new strategy for TNBC immunotherapy on the basis of the differentiation of ''cold'' and ''hot'' microenvironments.

ABSTRACT Background The mycobiome in the tumor microenvironment of non‐smokers with early‐stage lung adenocarcinoma (ES‐LUAD) has been minimally investigated. Methods In this study, we conducted ultra‐deep metagenomic and transcriptomic sequencing on 128 samples collected from 46 nonsmoking ES‐LUAD patients and 41 healthy controls (HC), aiming to characterize the tumor‐resident mycobiome and its interactions with the host. Results The results revealed that ES‐LUAD patients exhibited fungal dysbiosis characterized by reduced species diversity and significant imbalances in specific fungal abundances. Concurrently, microbial functional analysis revealed significant alterations associated with genes such as ribosomal proteins and histones. We observed correlations between Yarrowia lipolytica, Saccharomyces paradoxus, and tumor‐infiltrating immune cells (TIICs), and identified a strong association (|rho| > 0.7) between S. paradoxus and 14 transcription factors. A signature of three prognostic genes (GRIA1, CDO1, FHL1) closely associated with S. paradoxus was identified and they suggest that the interaction between the mycobiome and the host may contribute to prolonged overall survival (OS). Finally, a predictive model based on six fungi demonstrated decent classification performance in distinguishing ES‐LUAD cases from HCs (AUC = 0.724). Conclusions Our study demonstrates that the interactions between the mycobiome and transcriptome within tumors may help elucidate the pathogenic mechanisms of ES‐LUAD. Fungi, as a potential predictive tool, can be used as an additional resource for accurately detecting and discriminating individuals with ES‐LUAD.

BackgroundThe escalating incidence of ischemic stroke (IS) exerts a heavy toll on global health. Aging, a prominent risk factor, implicates the senescence-associated secretory phenotype (SASP) in IS pathogenesis. We postulated that alterations in SASP-related factor expression during IS correlate with remodeling of intercellular interaction networks and disease advancement. The present study endeavored to preliminarily dissect the SASP-IS nexus via combined bulk and single-cell transcriptome analysis.MethodsAggregated expression profiles from human peripheral blood bulk chips and MCAO mouse single-cell sequencing data, followed by SASP gene analysis. Executed protein interaction network and enrichment assays. Investigated immune infiltration in stroke patients, managed quality control and annotation of single-cell data, cherry-picked central cells based on SASP scores, unearthed essential genes via enrichment analysis, conducted pseudo-time and intercellular communication studies, and prognosticated drugs for hub genes. Finally, authenticated core gene expression in serum of MCAO and Sham rats using real-time fluorescent polymerase chain reaction (RT-qPCR).ResultsFourteen hub genes were discerned. Seven cell types were annotated in MCAO mouse peripheral blood single-cell data. Basophils exhibited the highest SASP scores, with Lcp1 upregulated and Ccl3 downregulated in basophils of the MCAO group. Enrichment analysis divulged a significant association of Ccl3 with the cell apoptosis pathway and Lcp1 with immune responses. The Ccl3 gene is pivotal in basophils and basophil-neutrophil crosstalk. Additionally, we forecasted nagrestipen’s regulatory function on Ccl3. RT-qPCR demonstrated a marked elevation in Lcp1 mRNA and a pronounced reduction in Ccl3 in the MCAO group relative to the Sham group.ConclusionThe Ccl3 gene in basophils and its immune cell interaction is a linchpin in the IS immune microenvironment. Ccl3 and Lcp1 might potentially modulate IS progression by influencing SASP, proffering novel prospects for IS clinical diagnosis and treatment.

BackgroundAcute myocardial infarction (AMI) is prevalent and perilous, leading to mortality and disability in the coronary care unit (CCU). This paper was to verify the correlation of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI) with all-cause mortality for AMI patients in the CCU.MethodsAdult patients diagnosed with AMI and admitted to CCU were selected from the MIMIC-IV database. Various clinical and laboratory data were extracted. Logistic regression models were employed to determine the correlation between NLR and in-hospital mortality, 30-day mortality, and 90-day mortality. Confounding factors were adjusted to validate the result robustness. Restricted cubic spline (RCS) curves were adopted to analyze the potential correlation between NLR and all-cause mortality. Meanwhile, the area under the receiver operating characteristic (ROC) curve (AUC) was utilized to compare the prediction ability of NLR, SII, PLR, and SIRI in all-cause mortality. Subsequently, subgroup analyses of gender and comorbidities were performed.Results1,386 AMI patients in the CCU were enrolled. The NLR was non-linearly and positively associated with in-hospital mortality [Q4: OR (95%CI) 2.61; (1.261–5.626), p = 0.012], 30-day mortality [Q4: OR (95%CI) 2.005; (1.048–3.925); p = 0.038], 90-day mortality [Q4: OR (95%CI) 2.191; (1.235–3.948); p = 0.008] with Q1 as the reference group. The NLR had the highest AUC for in-hospital mortality, 30-day mortality, and 90-day mortality among four inflammatory markers (NLR, SII, PLR, SIRI). Stratified analyses based on gender and comorbidities showed that the risk of death was significantly increased in male and female patients, with or without diabetes, without cerebral infarction, chronic obstructive pulmonary disease, liver disease, and renal disease in the Q4 group when compared to the Q1 group.ConclusionsNLR is nonlinearly and positively associated with all-cause mortality of AMI patients in the CCU. The predictive ability of NLR in in-hospital mortality, 30-day mortality, and 90-day mortality is superior to that of SII, PLR, and SIRI.

BackgroundSepsis-associated acute kidney injury (S-AKI) has a significant impact on patient survival, with continuous renal replacement therapy (CRRT) being a crucial intervention. However, the optimal timing for CRRT initiation remains controversial.MethodsUsing the MIMIC-IV database for model development and the eICU database for external validation, we analyzed patients with S-AKI to compare survival rates between early and late CRRT initiation groups. Propensity score matching was performed to address potential selection bias. Subgroup analyses stratified patients by disease severity using SOFA scores (low ≤10, medium 11–15, high >15) and creatinine levels (low ≤3 mg/dL, medium 3–5 mg/dL, high >5 mg/dL). Multiple machine learning models were developed and evaluated to predict patient prognosis, with Shapley Additive exPlanations (SHAP) analysis identifying key prognostic factors.ResultsAfter propensity score matching, late CRRT initiation was associated with improved survival probability, but led to increased hospital and ICU stays. Subgroup analyses showed consistent trends favoring late CRRT across all SOFA categories, with the most pronounced effect in high SOFA scores (>15, p = 0.058). The GBM model demonstrated robust predictive performance (average C-index 0.694 in validation and test sets). SHAP analysis identified maximum lactate levels, age, and minimum SpO2 as the strongest predictors of mortality, while CRRT timing showed relatively lower impact on outcome prediction.ConclusionWhile later initiation of CRRT in S-AKI patients was associated with improved survival, this benefit comes with increased healthcare resource utilization. The clinical parameters, rather than CRRT timing, are the primary determinants of patient outcomes, suggesting the need for a more personalized approach to CRRT initiation based on overall illness severity.

IntroductionAlisma starch (AS) from Alismatis Rhizoma has potential applications but has been less studied compared to common starches like corn starch (CS) and potato starch (PS).MethodsWe used scanning electron microscopy, X-ray diffraction, and rapid visco analysis to study the granule morphology, crystal structure, pasting properties, freeze -thaw stability, solubility, swelling degree, and gel strength of AS, CS, and PS.ResultsAS has a lower starch content but higher amylose content than CS and PS. It has a smaller particle size and is A-type starch. Its pasting temperature and trough viscosity are higher, and its freeze -thaw stability is intermediate. Gel strength increases with concentration and shows no significant difference between 10% AS and 12% PS.DiscussionAS has good heat resistance, shear resistance, and gel strength, indicating potential for high-temperature processed foods. Future research should focus on its heat resistance mechanism and broader applications.