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Abstract Although the relationship between hypertension and hyperuricemia is widely recognized, there is still a relative lack of research on prehypertensive individuals and the individual associations of systolic and diastolic blood pressure with the risk of hyperuricemia. From 2011 to 2016, we conducted a study on 53,323 individuals at Wuhu City Hospital in China. Based on initial blood pressure readings, participants were categorized into normal, prehypertension, or hypertension groups. We used Cox regression to analyze the associations with baseline factors. In subgroup analyses, systolic and diastolic pressures were treated as continuous variables, and their relationship with the risk of hyperuricemia was examined using restricted cubic spline analysis. The risk increased in the prehypertension and hypertension groups compared to the normal blood pressure group, with hazard ratios of 1.192 and 1.350, respectively. For each unit increase in blood pressure, the risk of hyperuricemia rose by 0.8% (systolic) and 0.9% (diastolic), especially when blood pressure levels exceeded 115/78 mmHg. Additionally, we observed that factors such as gender, alcohol consumption habits, obesity, and dyslipidemia might further influence this association. These findings emphasize the importance of early risk assessment and intervention in these patient populations in clinical practice.

Wide-band gap semiconductor devices based on GaN materials, such as high electron mobility transistors (HEMT), are gradually replacing traditional Si devices in industrial applications owing to their excellent electrothermal properties. Nonetheless, reliability concerns and accurate junction temperature estimation remain critical in the deployment of these devices. This paper proposes an enhanced Cauer thermal network model accounting for bidirectional heat transfer. The improved model takes into account the path from the junction via the top case to the ambient. Additionally, it utilizes the top case temperature rise to identify thermal parameters and establishes the relationship between the top case temperature time constant and the Cauer model’s thermal parameters. This method eliminates the need for measuring power losses or invasively modifying the original devices, nor does it require detailed structural and material parameters of the packaged device. The feasibility and reliability of the obtained thermal network parameters are verified through simulation and validated through experimentation.

Combining first-principles calculations and classical nucleation theory, the results of elemental doping on the structure, electrons and stability of niobium carbides are investigated. Ti, Cr and Mn doping altered the physical characteristics of the carbides, resulting in lower mismatch strains and interfacial energies between the carbide and the substrate. Elemental doping reduced the critical nucleation size of carbides and contributed to the promotion of carbide nucleation. However, excessive doping with Cr and Mn increases the formation energy of carbides and unfavorable to carbide stabilization. Therefore, Cr and Mn are involved in the early elemental aggregation of carbides, while Ti and Nb are the main carbide-forming elements. The nano-precipitated phases of various compositions produced in niobium microalloyed steel were experimentally validated utilizing transmission electron microscopy (TEM) and three-dimensional atom probe tomography (3D-APT). The carbides primarily composed of Nb, Ti and C elements, with the presence of Cr and Mn in the core region leading to the formation of a core-shell structure, which is consistent with theoretical calculations.

The stochastic search algorithms are an important optimization technique used to solve complex global optimization problems. The Slime Mould Algorithm (SMA) is one of stochastic search algorithm inspired by the observed behaviors and morphological changes in the foraging process of slime moulds. SMA has the advantage of having few parameters and a simple structure, making it applicable to various real-world optimization problems. However, it also has some drawbacks, such as high randomness during the search process and a tendency to converge to local optima, resulting in decreased accuracy. Therefore, we propose an effective method for global optimization - improved slime mould algorithm combine multiple strategy, called EISMA. In EISMA, we introduce a method of exploration that combines the average position of the population with Levy flights to enhance the algorithm's search capability in the previous phase. Then, a novel information-exchange hybrid elite learning operator is proposed to improve the guidance ability of the best search agent. Finally, a dual differential mutation search method that combines global and local optimization is introduced to maintain the diversity of the population by updating the search agents obtained in each iteration. These operations facilitate the algorithm's ability to escape local optima and ensure continuous optimization. To validate the applicability of EISMA, we numerically test it on 39 benchmark functions from CEC2013 and CEC2017 and compare its performance with SMA, as well as 7 modified, 5 standard and 4 classic stochastic search algorithms. Experimental results demonstrate that EISMA outperforms other versions in terms of optimization search performance. Furthermore, EISMA has achieved promising outcomes in testing problems related to path planning for three-dimensional unmanned aerial vehicles, pressure vessel design and robot gripper problem.

IntroductionPrevious coronavirus, 2019 (COVID-19) research has applied network analysis to examine relationships between psychopathological symptoms but rarely extended to potential risk and protective factors or the influence of COVID-19 infection history. This study examined complex inter-relationships between psychopathological symptoms, COVID-19–related stressors, perceived social support, and COVID-19 infection history among Chinese university/college students during the peak of fifth pandemic wave using a network analysis approach.MethodsA Least Absolute Shrinkage and Selection Operator–regularized partial correlation network using Gaussian graphical model was constructed in 1,395 Chinese university/college students in Hong Kong who completed a survey between 15 March and 3 April, 2022. Depressive, anxiety, and acute/traumatic stress symptoms were measured by Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Impact of Event Scale-6, respectively. COVID-19–related stressors and perceived social support were measured. Network differences by COVID-19 infection history (COVID-network vs. no_COVID-network) and network communities were examined.ResultsOur results showed that the most influential nodes were depressed mood, uncontrollable worries, and uncontrollable thoughts about COVID-19. The main bridging symptoms were concentration problems and psychomotor problems. The COVID-network, comprising participants with a history of COVID-19 infection only, was significantly stronger than the no_COVID-network. Perceived social support and stress from conflicts with family/friends formed a unique community with negative cognition and suicidal idea in the COVID-network only.ConclusionOur findings indicate that specific interventions targeting interpersonal conflicts and concentration problems as well as facilitating stress buffering effects of social support may represent effective strategies to reduce psychological distress in university/college students during COVID-19 and should be considered for future pandemic preparedness.

Constructing a resilient ecological network (EN) and identifying critical strategic nodes and corridors within the EN, stands as a pivotal approach toward achieving a harmonious equilibrium between regional development and ecological conservation. It is imperative to expand the perspective to encompass the holistic resilience of the EN, thus identifying and safeguarding ecologically strategic nodes and corridors that play pivotal roles throughout the entire network. Therefore, this study takes Nanjing City as a case study and establishes a comprehensive EN resilience assessment framework based on resilience theory and complex network theory, grounded in a foundation of multidimensional indicators. Building upon this, the research develops the ‘regional network simulation - ecological spatial analysis - strategic spatial identification’ investigative framework. The results show that a core EN structure centered around green spaces, rivers, lakes, and similar features has taken shape, encompassing a total of 39 ecological nodes and 69 ecological corridors. Examining from six perspectives, connectivity, integration, complexity, centrality, efficiency, and substitutability, and their integrated assessment, this study analyzed the impact of single and sequential failures in different EN component spaces on the overall resilience of the EN. The study aimed to identify the component space that significantly contributes to the network's resilience. As a result, the strategic space of the EN was divided into three levels. The ecological source areas 1, 2, 7, and 34, along with ecological corridors 1–34, 1–4, 4–11, 19–34, 18–19, and 27–39, emerge as the primary strategic spaces within the study region. Previous research primarily emphasized the individual characteristics of ecological spaces. However, this study adopts a systemic perspective rooted in resilience theory and complex network theory to meticulously explore the pivotal impact of specific ecological spaces on the overall resilience of the ecological system network. Moreover, it amalgamates considerations of both the significance and scale of ecological spaces, conducting a comprehensive assessment of their combined influence on the overall EN resilience. This approach not only aids in identifying and preserving strategic ecological nodes and corridors but also contributes to evaluating, planning, and restoring regional EN resilience. This progression plays a crucial role in establishing an equilibrium between regional advancement and ecological conservation.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease with sporadic occurrence and high mortality. Herein, we report an example of the in-hospital transmission of SFTS virus (SFTSV) infections with familial and nosocomial clustering in Zhejiang Province, eastern China, from March to April 2023. The epidemiological investigation and genomic analysis revealed that at least eight suspected cases of SFTS occurred in this cluster, including one death and one asymptomatic case. Our report reemphasizes the risk of familial and nosocomial SFTSV infections in healthcare settings and the urgent need for the long-term systematic surveillance of SFTSV evolution in humans and animals in the eastern coastal regions of China.

Abstract Background Radical resection is still the most cost-effectiveness curative strategy for intrahepatic cholangiocarcinoma (ICC), but it remains controversial on the survival benefit of anatomic resection (AR). In this study, we sought to compare the oncologic outcomes between AR versus non-AR (NAR) as the primary treatment for early-stage ICC patients. Methods Data of ICC patients who underwent hepatectomy and staged at AJCC I were retrospectively collected from 12 hepatobiliary centers in China between Dec 2012 and Dec 2015. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) analysis were performed to minimize the effect of potential confounders, and the perioperative and long-term outcomes between AR and NAR groups were compared. Results Two hundred seventy-eight ICC patients staged at AJCC I were eligible for this study, including 126 patients receiving AR and 152 patients receiving NAR. Compared to the NAR group, the AR group experienced more intraoperative blood loss before and after PSM or stabilized IPTW (all P > 0.05); AR group also experienced more intraoperative transfusion after stabilized IPTW (P > 0.05). In terms of disease-free survival (DFS) and overall survival (OS), no significant differences were observed between the two groups before and after PSM or stabilized IPTW (all P > 0.05). Multivariable Cox regression analyses found that AR was not an independent prognostic factor for either DFS or OS (all P > 0.05). Further analysis also showed that the survival benefit of AR was not found in any subgroup stratified by Child–Pugh grade (A or B), cirrhosis (presence or absence), tumor diameter (≤ 5 cm or > 5 cm) and pathological type (mass-forming or non-mass-forming) with all P > 0.05. Conclusion Surgical approach does not influence the prognosis of patients with stage I primary ICC, and NAR might be acceptable and oncological safety.

Abstract Recently, a large class of 3d 𝒩 = 2 gauge theories with mixed Chern-Simons levels, corresponding to plumbing 3-manifolds, has been identified. In this paper we generalize these theories by including in their content chiral multiples, and analyze their properties. We find that the content of such theories can be encoded in graphs, which generalize plumbing graphs, and various operations in these theories can be represented in terms of transformations of such graphs. The operations in question include gauging global symmetries, integrating out gauge nodes, which for theories without chiral multiplets corresponds to Kirby moves, and ST-transformations that involve chiral multiplets. The dualities such as mirror triality and SQED-XYZ duality can be also represented in terms of graphs, and enable us to find many new dual theories by gauging global symmetries. In particular, we find that gauged SQED-XYZ duality leads to other dualities, which take the same form as operations of linking and unlinking discussed in the context of knots-quivers correspondence. We also find that the superpotential can be encoded in an interesting class of triangle graphs that satisfy certain consistency conditions, we discuss decoupling and Higgsing of chiral multiplets, as well as interpretation of various phenomena in terms of brane webs.

As satellite capabilities have evolved and new observation requirements have emerged, satellites have become essential tools in disaster relief, emergency monitoring, and other fields. However, the efficiency of satellite scheduling still needs to be enhanced. Learning and optimization are symmetrical processes of solving problems. Learning problem knowledge could provide efficient optimization strategies for solving problems. A knowledge-guided parallel hybrid local search algorithm (KG-PHLS) is proposed in this paper to solve time-dependent agile Earth observation satellite (AEOS) scheduling problems more efficiently. Firstly, the algorithm uses heuristic algorithms to generate initial solutions. Secondly, a knowledge-based parallel hybrid local search algorithm is employed to solve the problem in parallel. Meanwhile, data mining techniques are used to extract knowledge to guide the construction of new solutions. Finally, the proposed algorithm has demonstrated superior efficiency and computation time through simulations across multiple scenarios. Notably, compared to benchmark algorithms, the algorithm improves overall efficiency by approximately 7.4% and 8.9% in large-scale data scenarios while requiring only about 60.66% and 31.89% of the computation time of classic algorithms. Moreover, the proposed algorithm exhibits scalability to larger problem sizes.

The quality of urban green space has an impact on the health and well-being of populations. Previous studies have shown that consideration of crowd activity characteristics is the key premise of landscape space design and planning. However, there is limited research on the correlation between features of the spatial layout of Mini Urban Green Spaces (MUGS) and the behavior of people, and it is difficult to take into account the possible distribution of people and their activity characteristics during the design phase of MUGS. This study aims to construct a technical workflow utilizing the AnyLogic platform and agent-based simulation methods for analyzing the characteristics of landscape spatial layouts considering dynamic human behavior. One MUGS, named 511 Park in Nanjing, China, was selected as the case for the application of the method and exploration of the impacts of spatial elements and layout on crowd activity types and density. We investigated the impact of four types of spatial elements—paths, facilities, nodes, and entrances—on human activities in MUGS. The results showed that path layout emerged as the most significant influencing factor. Changes in nodes and the number of facilities have a relatively minor impact on people’s activities. There was an apparent impact of changes in path orientation around nodes on the dynamics of the flow of people. This study could provide valuable insights for landscape designers, aiding informed decision-making during the construction, renovation, and management of MUGS.

The visual attributes of urban green spaces influence people’s perceptions, preferences, and behavioural activities. While many studies have established correlations between landscape perception and visual attributes, they often focus on specific timeframes and overlook dynamic changes in the spatial form of urban green spaces. This study aims to explore the long-term changes in the visual attributes of urban green spaces. We propose a method to quantitatively analyse changes in visual attributes using point clouds to simulate visual interfaces. Using an unmanned aerial vehicle, we conducted a five-axis tilt photography survey of Qinglvyuan Park in Nanjing, China, in August 2018 and September 2023. Point cloud models were generated for the two periods, and five visual attribute indicators, openness (OP), depth variance (DV), green view ratio (GVR), sky view ratio (SVR), and skyline complexity (SC), were analysed for long-term changes. The results indicate that OP, DV, and SVR decreased after five years, while GVR increased. The maximum increase in GVR was 26.6%, and the maximum decrease in OP was 12.8%. There is a positive correlation between GVR and its change (d_GVR). Conversely, there are negative correlations between SC and its change (d_SC), as well as between SVR and d_GVR. Tree growth emerged as a primary factor influencing changes in the visual attributes of urban green spaces. This study highlights the importance of adopting a long-term and dynamic perspective in visual landscape studies, as well as in landscape design and maintenance practices. Future research on predicting long-term changes in the visual attributes of urban green spaces should focus on understanding the relationships between tree properties and environmental conditions.

(1) Background: Sequential landscape changes give people experiences of dynamic beauty, and the key to creating spatial sequences lies in the organization of spatial changes. The purpose of this study is to use a 3D point cloud model to achieve a refined description of spatial sequences’ organizational characteristics from information acquisition to description and explore the quantitative interpretation methods of typical sequence organizational characteristics. (2) Methods: The proposed model contains three main steps: data acquisition and extraction, characteristic index system construction and data processing, and quantitative characterization analysis. A typology research method that combines quantitative induction with qualitative statistical verification is proposed. (3) Results: Seventy-two spatial sequence point cloud models of study cases are obtained; 4 indicators are established; 3 typical organization types are summarized, namely fluctuating, reversal and moderate type; and the characterization factors and threshold intervals for each sequence organization type are analyzed to validate the type classification result. (4) Conclusions: This research improves the accuracy of spatial data, the comprehensiveness of sequence organization characterization factors, and the reliability of classification results. It supplements the existing spatial sequence theoretical knowledge system and provides parameters that can be referred to in practical design.

The present investigation endeavors to explore the influence of rare earth elements on the strength and plasticity characteristics of low-carbon microalloyed steel under tensile loading conditions. The findings from the conducted tensile tests indicate that the incorporation of rare earths leads to a notable enhancement in the yield strength, ultimate tensile strength, and ductility properties of the steel. A comparative analysis of the microstructures reveals that the presence of rare earths significantly refines and optimizes the microstructure of the microalloyed steel. This optimization is manifested through a reduction in grain size, diminution of inclusion sizes, and a concomitant rise in their number density. Moreover, the addition of rare earths is observed to foster an increase in the volumetric fraction of carbides within the steel matrix. These multifaceted microstructural alterations collectively contribute to a substantial strengthening of the microalloyed steel. Furthermore, it is elucidated that the synergistic interaction between rare earth elements and both carbon (C) and niobium (Nb) in the steel matrix augments the extent of the Lüders strain region during the tensile deformation of specimens. This phenomenon is accompanied by the effective modification of inclusions by the rare earths, which serves to mitigate stress concentrations at the interfaces between the inclusions and the surrounding matrix. This article systematically evaluates the modification mechanism of rare earth microalloying, which provides a basis for broadening the application of rare earth microalloying in microalloyed steel.

The development of the recommendation system (RS) has been focused on improving the accuracy of algorithms. As the number of new users grows, RS suffers from the cold start problem, data sparsity and long-tail problem. In this paper, we proposed a many objective commercial recommendation algorithm that extracts the core node through the pay-off function of game theory and makes it guide the evolutionary computation. Firstly, the core aim of commercial recommendations is to maximize total profit. Profits can vary wildly with the same accuracy. Thus, the profit value as one of the goals is considered in attention to accuracy, coverage, and novelty. Besides, the current user state value is updated according to user features and rating scores matrix with the attention mechanism at different time stamps. The nodes are divided into different communities, forming a dynamic community, and recommendations are made within each community. Meanwhile, to reduce the computational complexity and runtime, the pay-off function of game theory is used to extract the core user in each community. Each contribution value and user interaction as criteria to guide the current community of users. Experiments on real datasets show that selecting core nodes can improve the performance of business RS. Compared with other existing algorithms in many experiments, our algorithm performs better.

Abstract Background: Rowell syndrome (RS) is an uncommon condition characterized by erythema multiforme (EM)‐like lesions and lupus erythematosus. It is more common in females, and EM may be the first manifestation of the disease with positive autoantibodies, such as antinuclear antibody (ANA), SSA, SSB and rheumatoid factor. The pathogenesis of RS is unknown and is likely caused by drug induction, ultraviolet exposure and infection. Method: We describe a case of RS from China which presented as characteristic targetoid‐like lesions and chilblain‐like erythema on hands and feet. This is a case of RS in a female patient from the inpatient department of dermatology. Results: A 41‐year‐old female with systemic lupus erythematosus exhibited chilblain‐like erythema and characteristic EM lesions on her extremities. She tested positive for serum ANA (1:320) and anti‐double‐stranded DNA, as well as other autoantibodies. Systemic glucocorticoids and hydroxychloroquine worked effectively for her. Conclusion: The present case met diagnostic criteria of RS. Notably, there was a co‑occurrence of facial butterfly erythema, chilblain‐like erythema and EM lesions distributed on the limbs in this case.

BackgroundInflammation has been recognized to be a factor that substantially influences tumorigenesis and tumor prognosis. Hence, this study was aimed to investigate an inflammatory marker with the most potent prognostic ability and to evaluate the survival estimation capability of dynamic change in this marker for patients suffered from oral squamous cell carcinoma (OSCC).Methods469 patients’ inflammatory indicators including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory response index (SIRI), were calculated. Their predictive abilities for overall survival (OS) were evaluated by Kaplan-Meier curves to screen for the one with the most potent prognostic value. The predictive ability of dynamic changes in this marker was verified and a predictive nomogram incorporating inflammatory indicators was developed.ResultsA high LMR was identified to be an indicator of a satisfactory survival rate. Compared with that of other inflammatory markers, area under the receiver operating characteristics (ROC) curve (AUC) of LMR for 1-year and 3-year OS was significantly larger (P

Exposure to poultry in live poultry markets is strongly associated with human infection with avian influenza virus. To effectively prevent the transmission of viruses from live poultry to humans, people have been forced to change their living habits from purchasing live poultry for consumption to purchasing freshly slaughtered poultry after the permanent closure of live poultry markets in China. In this study, we reported a case of human infection by the H5N6 virus in Hangzhou after exposure to a freshly slaughtered chicken, defying the traditional hypothesis that human infection requires a history of exposure to live poultry and indicating a novel route of infection. Rapid genomic characterization of H5N6 influenza A variants from the patient and the associated environment suggested that these viral variants were of avian origin, belonged to clade 2.3.4.4b H5 and were adapting to the human host after infection. Comparative analysis of the local H5N6 genomes showed that viral contamination in the associated environment and the poultry market was complex. Considering this case of H5N6 infection, conducting surveillance for any possible new avian influenza virus reassortment spillover to humans or other animal species is critical, and awareness of the risk of exposure to possible viral variants from infected slaughtered poultry or the associated environment must be seriously improved.Highlights We reported the first case of human infection with avian-origin influenza A (H5N6) virus in Zhejiang Province, southeastern China.Rapid genomic characterization of H5N6 influenza A variants from a patient and the associated environment suggested that these viral variants were of avian origin and were adapting to the human host after infection.Comparative analysis of the H5N6 genomes showed that viral contamination in the associated environment and poultry market was complex.Considering this case of H5N6 infection, the risk of exposure to possible viral variants from infected slaughtered poultry or the associated environment must be seriously considered.

Osteosarcoma (OS) tissue resection with distinctive bactericidal activity, followed by regeneration of bone defects, is a highly demanded clinical treatment. Biodegradable Mg-based implants with desirable osteopromotive and superior mechanical properties to polymers and ceramics are promising new platforms for treating bone-related diseases. Integration of biodegradation control, osteosarcoma destruction, anti-bacteria, and bone defect regeneration abilities on Mg-based implants by applying biosafe and facile strategy is a promising and challenging topic. Here, a black Mn-containing layered double hydroxide (LDH) nanosheet-modified Mg-based implants was developed. Benefiting from the distinctive capabilities of the constructed black LDH film, including near-infrared optical absorption and reactive oxygen species (ROS) generation in a tumor-specific microenvironment, the tumor cells and tissue could be effectively eliminated. Concomitant bacteria could be killed by localized hyperthermia. Furthermore, the enhanced corrosion resistance and synergistic biofunctions of Mn and Mg ions of the constructed black LDH-modified Mg implants significantly facilitated cell adhesion, spreading and proliferation and osteogenic differentiation in vitro, and accelerated bone regeneration in vivo. This work offers a new platform and feasible strategy for OS therapeutics and bone defect regeneration, which broadens the biomedical application of Mg-based alloys.

Different scale microstructures at different scales were obtained by one and two-step isothermal transformation. The deformation behavior and stability of retained austenite under the action of nanoindentation stress was investigated in these different microstructures. The results demonstrate that the boundary fraction and density of the K–S relationship increase significantly after two-step isothermal transformation, promoting the nucleation of bainite and resulting in a refined microstructure. Changes in the nano-hardness as a function of indentation depth and morphology confirmed the quantity of RA transformation and the composite deformation/transformation behavior of blocky martensite/retained austenite (M/RA). A higher dislocation density is enriched in RA with higher KAM with the two-step isothermal process. This resulted in higher stability to delay the occurrence of the pop-in phenomenon. The stability of RA is highly dependent on the crystal orientation, with (001) oriented RA having an increased propensity to undergo mechanical transformation to martensite, with additional pop-ins generated during loading.

The shield tunnel is typically simplified as an infinite beam with two free ends in existing analytical models, which are used to calculate the longitudinal deformation of the underlying shield tunnel induced by the excavation of a foundation pit. However, the applicability of those analytical models is limited due to the simplification. The current study is aimed at estimating analytically the longitudinal deformation of the underlying shield tunnel induced by the excavation of a foundation pit adjacent to the station (working shaft). The constraint on the shield tunnel generated by the joint between the station (working shaft) and the tunnel is treated as a rotation spring with the rotation stiffness of K and a vertical rod support. The Winkler foundation–Timoshenko beam model for calculating the longitudinal deformation of the shield tunnel adjacent to the station (working shaft) induced by the foundation pit excavation is proposed. The finite difference solution of the proposed model is strictly derived based on the basic principles of the force method. The reliability and applicability of the proposed analytical model are verified via the comparison with the finite element numerical solution of one-dimensional elastic foundation beam model and the global finite element simulation results of the longitudinal deformation of the underlying tunnel induced by the excavation of a foundation pit adjacent to the station. The parametric studies indicate the following conclusions. (i) The longitudinal deformation and internal forces of the shield tunnel are significantly influenced by the rotation stiffness, K, of the joint between the station (working shaft) and the tunnel. The internal forces and the longitudinal deformation (i.e. rotation angle) at the end of the tunnel increase and decreases nonlinearly with a increasing K, respectively. In addition, when the flexible connection is adopted at the joint between the station (working well) and tunnel, the working performance of the shield tunnel at the joint can be better guaranteed. (ii) The constraint effect of the joint on the end of the tunnel is non-negligible, when the distance from the center of the foundation pit to the station-tunnel joint ranges from 4 to 5 times the width of the pit along the tunnel axis. In this condition, the proposed analytical model should be adopted to evaluate the longitudinal working performance of the tunnel. (iii) The influence of the overlying foundation pit excavation on the underlying tunnel mainly exerts within 2 times the length of the pit perpendicular to the tunnel axis away from the center of the pit.

Abstract We discuss 3d brane webs and effective Chern-Simons levels for 3d N $$ \mathcal{N} $$ = 2 gauge theories. We find that turning on real masses for chiral multiplets leads to various equivalent brane webs that are related by flipping positions of D5-branes. We interpret flips as ST-transformations for chiral multiplets. ST-transformations could turn abelian theories into dual theories with mixed Chern-Simons levels that are interpreted as quiver matrices C ij encoding DT-invariants. We notice that each brane web corresponds to a quiver matrix. ST-transformations of holomorphic blocks are discussed to verify results. We also discuss the movement of flavor D5-branes, which leads to double-layer brane webs and manifests fiber-base duality. In the second part, we compute refined vortex partition functions of nonabelian theories with the gauge group U(N) and find corresponding quiver matrices. The computation shows that on Higgs branch nonabelian groups are broken to abelian groups.

Objective To investigate the clinical effects of microwave ablation (MWA) in addition to open surgery for the treatment of lung cancer‐derived thoracolumbar metastases. Methods This was a single‐institution, retrospective, cohort study. From January 2019 to December 2020, a total of 47 patients with lung cancer‐derived thoracolumbar metastases underwent posterior spinal canal decompression and fixation surgery in our hospital. Two independent surgical teams treated these patients. One group underwent open surgery combined with MWA therapy, while the other had open surgery only (control). The pre‐ and post‐operative visual analog scale (VAS) scores and the overall survival (OS) were compared between the MWA and control groups. The Frankel Grade classification was applied for the evaluation of the post‐surgical spinal cord function. Improvement was defined as an increase of at least one rank from the pre‐operative scores. Each patient was evaluated pre‐ and post‐operatively at 48 h, 1 month, and 3‐month intervals. Data on surgical‐related complications were recorded. Results Thirty men and 17 women were included, with an average age of 57.9 ± 11.4 years (range, 26–81 years). Twenty‐eight patients underwent MWA and were in the MWA group, and 19 patients were included in the control group. Post‐operatively all patients were followed up regularly; the median follow‐up time was 12 months (range, 3–24 months), and their median OS was 14 months. Patients in the MWA group had a lower VAS score than those in the control group at the 48‐h (1.75 ± 1.01 vs 2.47 ± 0.96, P = 0.01) and 1‐month (1.79 ± 0.92 vs 2.53 ± 1.35, P = 0.048) check‐ups. At the 3‐month evaluation, the VAS score differences between the two groups were not significant (P = 0.133). After surgery, spinal cord function improvement was not significantly different between the MWA and control groups (P = 0.515). MWA therapy combined with open surgery was not associated with increased OS compared with the control group (P = 0.492). Conclusion MWA can be an effective and safe pain‐relief method but may not extend the OS of patients with lung cancer.

Bacterial infection is a series of pathological changes caused by bacteria invading the host and interacting with the body. Nowadays, bacterial infection remains a major public health issue and a severe threat to human life and health. Traditional antibiotic therapy is less effective against biofilms and easily causes bacterial resistance, which has urged the development of a substitute antibacterial strategy. Recently, antibacterial nanomaterials have attracted much attention. However, traditional nanomaterials face some problems of insufficient drug concentration at infectious sites and the toxicity of extravasated drug causes damage to healthy tissues. On the contrary, nanomaterials based on advanced on-demand and precise strategies reduce biological toxicity effectively while improving germicidal efficacy, since these type of nanodrugs have higher spatiotemporal controllability. Currently, some smart stimuli-responsive nanomaterials and targeting nanomaterials have been successfully constructed to achieve on-demand and precise antibacterial therapies. This review focuses on the mechanisms, working principles and antimicrobial properties of diverse nanoparticles based on on-demand and precise strategies. Meanwhile, the strengths and inferiorities of different on-demand and precise strategies have been discussed. Finally, this review concludes with our opinions on the future development directions for exploiting next-generation on-demand and precise antibacterial therapies.

Background: Helicobacter pylori infection is related to the occurrence of various diseases, and its influencing factors have been studied worldwide. Research on the current status of H. pylori infection in underdeveloped rural areas in China is limited. Aim: This research aimed to understand the status of H. pylori infection and its risk factors in rural Yan'an city, Northwest China. Methods: This cross-sectional study was implemented in two villages in Yan'an city in 2018, and 226 individuals underwent the Carbon-14 urea breath test to detect H. pylori infection. Participants' demographic characteristics, socioeconomic status, dietary habits, and lifestyle were collected through structured questionnaires. Results: In this research, the overall infection rate of H. pylori was 32.7% (74/226). Multivariate logistic regression analysis showed that people with a body mass index (BMI)≥24 kg/m2 (OR = 3.03; 95% CI = 1.65–5.57) and people who frequently dined out (OR = 8.87; 95% CI = 1.43–54.97) were more likely to be infected H. pylori. Conversely, the H. pylori infection risk was reduced among people over 60 years of age (OR = 0.32; 95% CI = 0.17–0.62) as well as among those who ate sweet potatoes more than 7 times a week (OR = 0.23; 95% CI = 0.07–0.75). Conclusion: A BMI≥24 kg/m2 and frequent eating out were risk factors for H. pylori infection among the village inhabitants of Yan'an city. The consumption of sweet potatoes was related to a low risk of H. pylori infection.

The infection countermeasure, in which the main idea is to prevent adversaries from exploiting faulty ciphertexts to break the key by spreading the induced fault, is a very effective countermeasure against fault attacks. However, most existing infection countermeasures struggle to defend against double-fault attacks effectively due to the single-fault assumption. By analyzing the principle of infection mechanism and adding different random Boolean masks in the two encryption paths, this paper proposes a measure called a random mask infection countermeasure to defend against double-fault attacks. In addition, the multiplication mask is used to randomize the fault diffusion to further resist single-byte fault attacks. The experimental results indicate that the random mask infection countermeasure proposed can perform fault diffusion effectively when the cryptographic circuit suffers double-fault attacks, and the fault diffusion shows randomness, and can effectively defend against these fault attacks.

Urban forests by the riverside are important habitats for various animals and contribute various soundscapes for citizens. Unfortunately, urban forests are exposed to the influence of riverside traffic noises from freeways. This study aims to explore the spatial and temporal variation of soundscape, conduct soundscape optimization for multiple parameters, and find a balance and its interval of soundscape elements through optimizing a soundscape map. Questionnaires and measuring equipment were used to gather soundscape information in an urban forested area in Fuzhou, China. Diurnal variations and soundscape mapping were used to analyze spatial and psychophysical relationships between soundscape drivers. We then conducted optimization for a soundscape map, which included normalization, critical value determination, target interval of optimal SPL determination, and modification of SPL and mapping. Our findings suggest that biological activities and natural phenomena are potential drivers for diurnal variation of soundscapes, especially tidal phenomena contributing water and shipping soundscapes. Our results also suggest that all the high values of perceived soundscapes were found at the southwest corner of the study area, which includes both riverside and urban forest elements. Furthermore, we suggest combining both optimal soundscape and SPL correction maps to aid in sustainable design in urban forests. This can contribute to the understanding and methodology of soundscape map optimization in urban forests when proposing suitable design plans and conservation of territorial sound.

Abstract Background Osteochondral lesion of the talus (OLT) is one of the most common ankle injuries, which will lead to biomechanical changes in the ankle joint and ultimately affect ankle function. Finite element analysis (FEA) is used to clarify the effect of talus osteochondral defects on the stability of the ankle joint at different depths. However, no research has been conducted on talus osteochondral defect areas that require prompt intervention. In this research, FEA was used to simulate the effect of the area size of talus osteochondral defect on the stress and stability of the ankle joint under a specific depth defect. Methods Different area sizes (normal, 2 mm* 2 mm, 4 mm* 4 mm, 6 mm* 6 mm, 8 mm* 8 mm, 10 mm* 10 mm, and 12 mm* 12 mm) of the three-dimensional finite element model of osteochondral defects were established. The model was used to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus when the ankle joint was in the heel-strike, midstance, and push-off phases. Results When OLT occurred, the contact pressure of the articular surface, the equivalent stress of the proximal talus, the tibial cartilage, and the talus cartilage did not change significantly with an increase in the size of the osteochondral defect area when the heel-strike phase was below 6 mm * 6 mm. Gradual increases started at 6 mm * 6 mm in the midstance and push-off phases. Maximum changes were reached when the defect area size was 12 mm * 12 mm. The same patterns were observed in the talus displacement. Conclusions The effect of the defect area of the ankle talus cartilage on the ankle biomechanics is evident in the midstance and push-off phases. When the size of the defect reaches 6 mm * 6 mm, the most apparent change in the stability of the ankle joint occurs, and the effect does not increase linearly with the increase in the size of the defect.

Abstract There was very limited evidence linking high-sensitivity C-reactive protein (HS-CRP) and total bone mineral density (BMD) in adolescents. The aim of this population-based study was to investigate the relationship between HS-CRP and total BMD in adolescents aged 10–20 years. A cross-sectional study was performed in the normal U.S. population from the data of the National Health and Nutrition Examination Survey (NHANES). The correlation between HS-CRP and total BMD was evaluated by using weighted multivariate linear regression models. And further subgroup analysis was conducted. There were 1747 participants in this study, 47.1% were female, 29.4% were white, 19.5% were black, and 22.3% were Mexican–American. In the multi-regression model that after the potential confounders had been adjusted, HS-CRP was negatively associated with total BMD. The negative association was also observed in the subgroup analyses stratified by gender and age. Our results demonstrated that higher HS-CRP was negatively correlated with total BMD in 10–20 years old adolescents.

Infection, inflammation, tumors, and other illnesses have for a long time posed a major danger to human health and have developed into a global public health issue. However, the existing treatment methods are sometimes not effective, leading to high mortality. Therefore, it is urgent to seek new alternative therapies. Gallium and related derivatives have received a lot of interest recently because of their exceptional biological safety and distinctive pharmacological properties. More crucially, gallium and its compounds have the potential to specifically destroy iron metabolism, called the “Trojan Horse” strategy, which provides unparalleled opportunities in antibacterial, anti-tumor, and bone regeneration. In this review, gallium and its compounds-based biomedical applications in antibacterial, anti-tumor, anti-inflammatory, and bone regeneration are focused upon and the relevant therapeutic mechanisms are discussed. Then, the latest gallium-based drug design and drug delivery system are summarized. Finally, we put forward the limitations of current gallium materials and the development trend of future materials. This review is anticipated to offer new insights into the treatment of gallium and its compounds, and provide new inspiration for application and design in the future.

Prosthesis loosening after THA is a rather common complication. For DDH patients with Crowe IV, the surgical risk and complexity is significant. THA with S-ROM prosthesis combined with subtrochanteric osteotomy is a common treatment. However, loosening of a modular femoral prosthesis (S-rom) is uncommon in THA and has a very low incidence. With modular prostheses distal prosthesis looseness are rarely reported. Non-union osteotomy is a common complication of subtrochanteric osteotomy. We report three patients with Crowe IV DDH who developed prosthesis loosening following THA with an S-ROM prosthesis and subtrochanteric osteotomy. We addressed the management of these patients and prosthesis loosening as likely underlying causes.

Differential fault attack (DFA) is a distinctive methodology for acquiring the key to block ciphers, which comprises two distinct strategies: DFA on the state and DFA on the key schedule. Given the widespread adoption of the Advanced Encryption Standard (AES), it has emerged as a prominent target for DFA. This paper presents an efficient DFA on the AES, utilizing a two−byte fault model that induces faults at the state with discontiguous rows. The experiment demonstrates that, based on the proposed fault model, the key for AES–128, AES–192, and AES–256 can be successfully recovered by exploiting two, two, and four faults, respectively, without the need for exhaustive research. Notably, in the case of AES–256, when considering exhaustive research, two (or three) faults are needed with 232 (or 216) exhaustive searches. In comparison to the currently available DFA on the AES state, the proposed attack method shows a higher efficiency due to the reduced induced faults.

Abstract Background At present, hepatectomy is still the most common and effective treatment method for intrahepatic cholangiocarcinoma (ICC) patients. However, the postoperative prognosis is poor. Therefore, the prognostic factors for these patients require further exploration. Whether microvascular invasion (MVI) plays a crucial role in the prognosis of ICC patients is still unclear. Moreover, few studies have focused on preoperative predictions of MVI in ICC patients. Methods Clinicopathological data of 704 ICC patients after curative resection were retrospectively collected from 13 hospitals. Independent risk factors were identified by the Cox or logistic proportional hazards model. In addition, the survival curves of the MVI-positive and MVI-negative groups before and after matching were analyzed. Subsequently, 341 patients from a single center (Eastern Hepatobiliary Hospital) in the above multicenter retrospective cohort were used to construct a nomogram prediction model. Then, the model was evaluated by the index of concordance (C-Index) and the calibration curve. Results After propensity score matching (PSM), Child-Pugh grade and MVI were independent risk factors for overall survival (OS) in ICC patients after curative resection. Major hepatectomy and MVI were independent risk factors for recurrence-free survival (RFS). The survival curves of OS and RFS before and after PSM in the MVI-positive groups were significantly different compared with those in the MVI-negative groups. Multivariate logistic regression results demonstrated that age, gamma-glutamyl transpeptidase (GGT), and preoperative image tumor number were independent risk factors for the occurrence of MVI. Furthermore, the prediction model in the form of a nomogram was constructed, which showed good prediction ability for both the training (C-index = 0.7622) and validation (C-index = 0.7591) groups, and the calibration curve showed good consistency with reality. Conclusion MVI is an independent risk factor for the prognosis of ICC patients after curative resection. Age, GGT, and preoperative image tumor number were independent risk factors for the occurrence of MVI in ICC patients. The prediction model constructed further showed good predictive ability in both the training and validation groups with good consistency with reality.

Gene therapy in its current design is an irreversible process. It cannot be stopped in case of unwanted side effects, nor can expression levels of therapeutics be adjusted to individual patient’s needs. Thus, the Gene-Switch (GS) system for pharmacologically regulable neurotrophic factor expression was established for treatment of parkinsonian patients. Mifepristone, the synthetic steroid used to control transgene expression of the GS vector, is an approved clinical drug. However, pharmacokinetics and -dynamics of mifepristone vary considerably between different experimental animal species and depend on age and gender. In humans, but not in any other species, mifepristone binds to a high-affinity plasma carrier protein. We now demonstrate that the formulation of mifepristone can have robust impact on its ability to activate the GS system. Furthermore, we show that a pharmacological booster, ritonavir (Rtv), robustly enhances the pharmacological effect of mifepristone, and allows it to overcome gender- and species-specific pharmacokinetic and -dynamic issues. Most importantly, we demonstrate that the GS vector can be efficiently controlled by mifepristone in the presence of its human plasma carrier protein, α1-acid glycoprotein, in a “humanized” rat model. Thus, we have substantially improved the applicability of the GS vector toward therapeutic use in patients.

Titanium-based scaffolds are widely used implant materials for bone defect treatment. However, the unmatched biomechanics and poor bioactivities of conventional titanium-based implants usually lead to insufficient bone integration. To tackle these challenges, it is critical to develop novel titanium-based scaffolds that meet the bioadaptive requirements for load-bearing critical bone defects. Herein, inspired by the microstructure and mechanical properties of natural bone tissue, we developed a Ti–6Al–4V alloy (TC4)/gelatin methacrylate (GelMA) hybrid scaffold with dual bionic features (GMPT) for bone defect repair. GMPT is composed of a hard 3D-printed porous TC4 metal scaffold (PT) backbone, which mimics the microstructure and mechanical properties of natural cancellous bone, and a soft GelMA hydrogel matrix infiltrated into the pores of PT that mimics the microenvironment of the extracellular matrix. Ascribed to the unique dual bionic design, the resultant GMPT demonstrates better osteogenic and angiogenic capabilities than PT, as confirmed by the in vitro and rabbit radius bone defect experimental results. Moreover, controlling the concentration of GelMA (10%) in GMPT can further improve the osteogenesis and angiogenesis of GMPT. The fundamental mechanisms were revealed by RNA-Seq analysis, which showed that the concentration of GelMA significantly influenced the expression of osteogenesis- and angiogenesis-related genes via the Pi3K/Akt/mTOR pathway. The results of this work indicate that our dual bionic implant design represents a promising strategy for the restoration of large bone defects.

When shield is driving along a curve alignment or during deviation correction, the asymmetrical thrust will generate an additional bending moment at the head of the tunnel, which will cause construction problems such as longitudinal deformation of the tunnel and dislocation between rings. Based on the theory of elastic foundation beam, the shield tunnel is simplified as a Timoshenko beam in Winkler foundation, an analytical model for evaluating the additional response of the shield tunnel induced the asymmetric thrust is established, and the analytical solutions of longitudinal deformation and internal force of shield tunnel are deduced. Then the correctness and applicability of the analytical solutions are verified based on the finite element method, and the sensitivity of key parameters in the analytical model is further analyzed. Finally, the influence range of additional bending moment and the second order effect of shield thrust are discussed. The research results show that the proposed analytical model is reliable and has good applicability for evaluating the additional response of shield tunnel under asymmetric thrust. The influences of foundation stiffness and tunnel stiffness on the longitudinal deformation of the tunnel are more significant than the internal force. The influence range of the additional bending moment is more sensitive to the changes of the foundation stiffness, and an exponential attenuation relationship is found to exist between the two. The shield thrust improves the longitudinal bending stiffness of the tunnel, and the second-order effect produced is relatively low. Under the condition of lower bending stiffness of tunnel and foundation stiffness, the second-order effect of axial force is enhanced.

Titanium (Ti) has been the most widely used orthopedic implant in the past decades. However, their inert surface often leads to insufficient osteointegration of Ti implant. To solve this issue, two bioactive Mg(OH)2 films were developed on Ti surfaces using hydrothermal treatment (Ti-M1# and Ti-M2#). The Mg(OH)2 films showed nano-flake structures: sheets on Ti-M1# with a thickness of 14.7 ± 0.7 nm and a length of 131.5 ± 2.9 nm, and on Ti-M2# with a thickness of 13.4 ± 2.2 nm and a length of 56.9 ± 5.6 nm. Both films worked as Mg ions releasing platforms. With the gradual degradation of Mg(OH)2 films, weakly alkaline microenvironments will be established surrounding the modified implants. Benefiting from the sustained release of Mg ions, nanostructures, and weakly alkaline microenvironments, the as-prepared nano-Mg(OH)2 coated Ti showed better in vitro and in vivo osteogenesis. Notably, Ti-M2# showed better osteogenesis than Ti-M1#, which can be ascribed to its smaller nanostructure. Moreover, whole genome expression analysis was applied to study the osteogenic mechanism of nano-Mg(OH)2 films. For both coated samples, most of the genes related to ECM-receptor interaction, focal adhesion, and TGF-β pathways were upregulated, indicating that these signaling pathways were activated, leading to better osteogenesis. Furthermore, cells cultured on Ti-M2# showed markedly upregulated BMP-4 gene expression, suggesting that the nanostructure with Mg ion release ability can better activate BMP-4 related signaling pathways, resulting in better osteogenesis. Nano-Mg(OH)2 films demonstrated a superior osteogenesis and are promising surface modification strategy for orthopedic applications.

Abstract Background The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC). Methods Between November 2011 and August 2017, patients who underwent hepatectomy for ICC were collected from 13 major hepatopancreatobiliary centers in China. The survival outcomes for patients who underwent wide margin hepatectomy (WMH) were compared with those who underwent narrow margin hepatectomy (NMH) using the 1:1 propensity score matching (PSM). Results Among 478 included patients, 195 (40.8%) underwent WMH whereas 283 (59.2%) underwent NMH. PSM yielded 79 matched patients with similar baseline characteristics. Patients underwent WMH had a significant better OS and DFS compared with those underwent NMH (before PSM: median OS 27 vs 17 months, P

Background: Two cannulated screws were proposed for prophylactic fixation in adult patients with an aggressive benign femoral neck lesion in recent literature. However, the biomechanical properties of this intervention have not yet been investigated.Methods: After the evaluation of the heterogeneity of bone mineral density and geometry via quantitative computed tomography, 24 embalmed adult human cadaver femurs were randomized into the control, inferior half of the anterior cortical (25%) bone defect, entire anterior cortical (50%) bone defect, and the 50% bone defect and two cannulated screw group. Biomechanical analysis was conducted to compare the stiffness and failure load among the four groups when mimicking a one-legged stance. A CT-based finite element analysis (FEA) was performed to mimic the cortical and cancellous bone defect and the implantation of two cannulated screws of the four groups. Measurements of the maximal displacement and von Mises stress were conducted with the longitudinal load force and boundary conditions being established for a one-leg-standing status.Results: We noted a significant improvement in the failure load after the insertion of two 6.5 mm cannulated screws in femurs with 50% bone defect (+95%, p = 0.048), and no significant difference was found between the screw group and the intact femur. Similar trends were also found in the measurements of stiffness (+23%, p > 0.05) via biomechanical testing and the von Mises stresses (−71%, p = 0.043) by FEA when comparing the screw group and the 50% bone defect group.Conclusion: Our findings suggest that two cannulated screws provided sufficient biomechanical strength for prophylactic fixation in adult patients with an aggressive benign femoral neck lesion even when the entire anterior cortical bone is involved.

The transverse vibration equation is obtained by establishing the balance equation of poly-V belt and tensioner and coupling vibration model of pulley and poly-V belt. The influence of different extreme deviations on the dynamic performance of EFEADS is analyzed by calibrating and modifying the simulation model. Result shows that the maximum swing of tensioning arm reduced under the increasing of extreme deviation. At medium and high speed，the larger extreme deviation caused EFEADS instability and the swing of tensioning arm increasing. In addition，it caused the entire increasing of transverse vibration. But，the changing tension force lead to variation of resonance frequency and caused corresponding rotary speed by transverse vibration peak drifted at different speed. The smaller the extreme deviation caused the greater the belt tension and the lesser transverse vibration.

For a multi-robot system, the accurate global map building based on a local map obtained by a single robot is an essential issue. The map building process is always divided into three stages: single-robot map acquisition, multi-robot map transmission, and multi-robot map merging. Based on the different stages of map building, this paper proposes a multi-stage optimization (MSO) method to improve the accuracy of the global map. In the map acquisition stage, we windowed the map based on the position of the robot to obtain the local map. Furthermore, we adopted the extended Kalman filter (EKF) to improve the positioning accuracy, thereby enhancing the accuracy of the map acquisition by the single robot. In the map transmission stage, considering the robustness of the multi-robot system in the real environment, we designed a dynamic self-organized communication topology (DSCT) based on the master and slave sketch to ensure the efficiency and accuracy of map transferring. In the map merging stage, multi-layer information filtering (MLIF) was investigated to increase the accuracy of the global map. We performed simulation experiments on the Gazebo platform and compared the result of the proposed method with that of classic map building methods. In addition, the practicability of this method has been verified on the Turtlebot3 burger robot. Experimental results proved that the MSO method improves the accuracy of the global map built by the multi-robot system.

Summary: Assemblies of tau can transit between neurons, seeding aggregation in a prion-like manner. To accomplish this, tau must cross cell-limiting membranes, a process that is poorly understood. Here, we establish assays for the study of tau entry into the cytosol as a phenomenon distinct from uptake, in real time, and at physiological concentrations. The entry pathway of tau is cell type specific and, in neurons, highly sensitive to cholesterol. Depletion of the cholesterol transporter Niemann-Pick type C1 or extraction of membrane cholesterol renders neurons highly permissive to tau entry and potentiates seeding even at low levels of exogenous tau assemblies. Conversely, cholesterol supplementation reduces entry and almost completely blocks seeded aggregation. Our findings establish entry as a rate-limiting step to seeded aggregation and demonstrate that dysregulated cholesterol, a feature of several neurodegenerative diseases, potentiates tau aggregation by promoting entry of tau assemblies into the cell interior.

BackgroundFrailty is an aggregate expression of susceptibility to adverse health outcomes because of age- and disease-related deficits that accumulate across multiple domains. Previous studies have found the presence of preoperative frailty is associated with an increased risk of adverse outcomes. The number of older adults undergoing orthopedic surgery is rapidly increasing. However, there has been no evidence-based study on the relationship between frailty and outcomes in patients undergoing orthopedic surgery. ObjectiveThe aims of this study are to investigate the association between frailty and outcomes in patients who underwent orthopedic surgery as well as patient factors associated with frailty. MethodsThe methods to be used for this systematic review are reported according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) 2015 checklist. An extensive search will be conducted in PubMed, Embase, the Cochrane Library, and other mainstream databases. Any study where patients undergoing orthopedic surgery were assessed using a defined or validated measure of frailty and the association of frailty with patient factors and/or outcomes was reported will be included. A total of 2 researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. We will perform a narrative synthesis of the factors associated with frailty, prevalence of frailty, effect of frailty on patient outcomes, and interventions for patients who are frail. A meta-analysis focusing on individual factors associated with frailty and the effect of frailty on patient outcomes will be performed, if applicable. The risk of bias will be evaluated. A subgroup analysis and sensitivity analysis will be performed. ResultsLiterature searches were conducted in September 2021 and the review is anticipated to be completed by the end of July 2022. ConclusionsThis systematic review and meta-analysis will provide an overview of frailty and investigate the relationship between frailty and patient outcomes as well as the relationship between patient factors and frailty in patients undergoing orthopedic surgery. This study could potentially increase patients’ awareness of the outcomes associated with frailty, compel clinical specialties to further acknowledge the concept of frailty, and enhance the development of assessment instruments and tools for frailty. Trial RegistrationPROSPERO CRD42020181846; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181846 International Registered Report Identifier (IRRID)DERR1-10.2196/28338