Search

ObjectiveTo verify the reliability and validity of a portable Right Gait & Posture® gait detection system based on wearable sensors.MethodsA total of 36 healthy volunteers were recruited in the Jiangsu Zhongshan Geriatric Rehabilitation Hospital from August to November 2023. Right Gait & Posture® system was used to detect the gait of each subject for three times by two trained assessors. The assessor 1 completed the first and second tests, and the assessor 2 completed the third test. All tests were completed on the same day. Gait parameters such as gait cycle, swing phase proportion, stance phase proportion, walking speed, stride frequency, stride length, foot deviation angle, ground contact angle, ground contact inward rotation angle and propulsion angle were recorded. The intragroup correlation coefficient (ICC) was used to calculate the inter-tester reliability and the relative reliability of the repeated tests, and the standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated as the absolute reliability of the repeated tests. With video gait analysis as a control, Bland-Altman method was used to calculate the 95% consistency limit, and the validity of the Right Gait & Posture® gait detection system in detecting gait cycle, swing phase ratio, stance phase proportion and walking speed was analyzed.Results(1) Inter-tester reliability: the ICC values of gait cycle, swing phase proportion, stance phase proportion, walking speed, stride frequency, stride length, foot deviation angle, ground contact angle, ground contact inward rotation angle, forward propulsion angle and foot deviation angle between two assessors were 0.901 to 0.981. (2) Test-retest reliability: the ICC values of gait cycle, swing phase proportion, stance phase proportion, walking speed, stride frequency, stride length, ground contact angle, ground contact inward rotation angle and forward propulsion angle and foot deviation angle between the two tests of the same assessor were 0.822 to 0.983. The SEM and SEM% values of gait parameters were 0.02 to 2.17 and 0.49% to 13.83%, respectively. The MDC and MDC% values were 0.06 to 6.02 and 1.37% to 38.34%, respectively. (3) Validity analysis: Bland-Altman plot showed that the mean absolute errors and 95% CI of gait cycle, swing phase proportion, stance phase proportion and walking speed were 0.003 s, (-0.059, 0.064); 0.756%, (-3.048, 4.560); -0.756%, (-4.560, 3.048); -0.001 m/s, (-0.155, 0.152), respectively.ConclusionRight Gait & Posture® gait detection system shows good reliability in spatio-temporal parameters and ankle kinematics parameters, and has high validity in gait cycle, swing phase proportion, stance phase proportion and walking speed, which is recommended for clinical application.

Abstract Alzheimer’s disease (AD) is an important geriatric disease that creates challenges in health policy planning. There is no previous attempt to quantify the actual direct healthcare cost of AD among older adults in Malaysia. This retrospective observational study with bottom-up micro-costing approach aimed to evaluate the direct healthcare expenditure on AD along with its potential predictors from healthcare providers’ perspective, conducted across six tertiary hospitals in Malaysia. AD patients aged 65 and above who received AD treatment between 1 January 2016 and 31 December 2021 were included. Direct healthcare cost (DHC) of AD was estimated by extracting one-year follow-up information from patient medical records. As a result, 333 AD patients were included in the study. The mean DHC of AD was estimated RM2641.30 (USD 572.45) per patient per year (PPPY) from the healthcare payer’s perspective. Laboratory investigations accounted for 37.2% of total DHC, followed by clinic care (31.5%) and prescription medicine (24.9%). As disease severity increases, annual DHC increases from RM2459.04 (mild), RM 2642.27 (moderate), to RM3087.61 (severe) PPPY. Patients aged 81 and above recorded significantly higher annual DHC (p = 0.003). Such real-world estimates are important in assisting the process of formulating healthcare policies in geriatric care.

Objective To explore the influence of gender on the prognosis of patients with atrial fibrillation (AF) undergoing left atrial appendage occlusion (LAAO). Methods All non-valvular AF patients who were admitted in our hospital and underwent LAAO from August 2014 to August 2021 were enrolled and grouped according to gender. Their general information, including gender, age, comorbid underlying diseases, and results of transthoracic echocardiography and transesophageal echocardiography (TEE) were collected. The incidences of device-related thrombosis (DRT), pericardial tamponade, stroke, bleeding, hospitalization for heart failure, and cardiac death were recorded during follow-up. The influence of gender on the prognosis of these patients was analyzed. Results There were totally 673 patients with non-valvular AF were enrolled, including 366 males and 307 females, at a mean age of 68.2±9.4 years. When compared with the male patients, the female ones had a higher CHA2DS2-VASc score (P < 0.01), but smaller proportions of history of stroke, average compression ratio of occluders, and incidence of residual shunt (< 3 mm) after occlusion (P < 0.05). In 45~60 d after surgery, TEE revealed that there were 17 cases of DRT, including 8 males (2.2%) and 9 females (2.9%), though without statistical difference between the groups. Among the 17 DRT cases, 1 experienced stroke, and the incidence of stroke was 5.9% in those with DRT and 0.5% without. There were 4 cases of postoperative pericardial tamponade, including 1 in the male group and 3 in the female group (no significant difference), and all of them were improved after pericardial puncture and fluid extraction. During the follow-up period of 40.2±20.5 months, no obvious differences were observed between the 2 groups in terms of stroke, bleeding, hospitalization for heart failure, and cardiogenic death. Conclusion Gender shows no significant effect on the prognosis of patients with non-valvular AF after LAAO.

A 38-year-old lady was diagnosed with systemic lupus erythematosus (SLE) and alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) autoimmune encephalitis, fulfilling both classification criteria during her index admission. She was subsequently diagnosed with seropositive myasthenia gravis (MG) with a typical clinical presentation. Her SLE and AMPAR encephalitis were successfully treated with immunosuppressive therapy. Her MG responded well to anti-cholinesterase inhibitors. We report a distinctive case with the association of three rare autoimmune diseases in an individual.

Abstract Mild sleep deprivation is widespread in many societies worldwide. Electroencephalography (EEG) microstate analysis provides information on spatial and temporal characteristics of resting brain network, serving as an indicator of neurophysiological activities at rest. This study seeks to investigate potential neural markers in EEG following mild sleep deprivation of a single night using EEG microstate analysis. Six-minute resting EEG was conducted on thirty healthy adults within 6 hours of waking in the morning and after at least 18 h of sleep deprivation. Translated and validated Malay language Karolinska Sleepiness Scale was used to assess the participants’ degree of sleepiness. Microstate characteristics analysis was conducted on the final 24 subjects based on four standard microstate maps. Microstate C shows a significant increase in mean duration, coverage and occurrence, while microstate D has significantly higher occurrence after sleep deprivation. This study demonstrates notable changes in resting state EEG microstates following mild sleep deprivation. Present findings deepen our understanding of the brain's spatiotemporal dynamics under this condition and suggest the potential utility of neural markers in this domain as components of composite markers for sleep deprivation.

Objective To analyze the accuracy of the new generation intraocular lens (IOL) formula and the Wang-Koch (WK) adjustment in individuals with severe myopia undergoing combined anterior-posterior surgery. Methods A total of 100 patients (100 eyes) with axial length (AL) >26 mm undergoing combined anterior and posterior segment surgery in our department from June 2015 to June 2021 were enrolled in this study. Totally 13 IOL calculation formulas, such as Barrett Universal Ⅱ (BUⅡ), Emmetropia Verifying Optical (EVO), Kane, Haigis, Hoffer Q, Holladay, and SRK/T as well as the first generation linear WK eye axis optimization formula (Haigis-WK1, SRK/T-WK1, Hoffer Q-WK1, Holladay 1-WK1) and the second generation linear WK eye axis optimization formula (SRK/T-WK2, Holladay 1-WK2), were utilized to determine IOL diopter. The mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE), and percentage of prediction error within different refractive thresholds were calculated to assess the accuracy of each formula. In order to investigate the impact of AL on accuracy of IOL calculation, the patients were categorized into group A (38 eyes, 26.00 mm < AL≤28.00 mm), group B (28 eyes, 28.00 mm < AL≤30.00 mm), and group C (34 eyes, AL >30.00 mm). Additionally, the patients were also divided into silicone oil (63 eyes) and non-silicone oil (37 eyes) groups based on preoperative intraocular filling to determine the effect of intraocular filling on IOL calculation. Results The MedAE values of the new-generation IOL formulas (BUⅡ, EVO, and Kane) were significantly lower (0.34D, 0.31D, 0.35D) than those of traditional formulas (P < 0.05). Additionally, the percentage of prediction errors within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D were significantly higher with the new formulas when compared to traditional ones (P < 0.05). Traditional formulas exhibited a hyperopic deviation (0.35D~0.65 D), which could be corrected using the WK eye axis adjustment. WK2 was effective in improving the accuracy of calculation in SRK/T and Holladay 1 formulas, and there was no statistical difference in the MedAE values of SRK/T-WK2 and Holladay 1-WK2 formulas with the new-generation IOL formulas. When comparing the formulas across different axial eye length groups in terms of MedAE, the new IOL formulas (BUⅡ, kane and EVO) and WK-corrected formulas (Haigis-WK1, SRK/T-WK1, SRK/T-WK2, Hoffer Q-WK1, Holladay 1-WK1, Holladay 1-WK2) showed no significant differences among the different AL groups. However, there were significant differences in the MedAE values of traditional formulas among the different AL groups (P < 0.01), with group C displaying the largest MedAE values (Haigis: 0.84D, SRK/T: 1.10D, Hoffer Q: 1.23D, Holladay 1: 1.20D). Comparing the MedAE values of different formulas in various preoperative intraocular filling groups, it was observed that the MedAE values of the new-generation IOL formulas (BUⅡ, kane and EVO), Haigis, and SRK/T formulas were significantly higher in the silicone oil-filled eye group than the non-silicone oil-filled eye group (P < 0.05). Conclusion In patients with high myopia undergoing combined anterior and posterior segment surgery, the precision and consistency of the new-generation IOL formulas and the second-generation linear WK axis correction formula exhibit significant improvements when compared to traditional formulas.

Background: This study aims to analyze the safety and clinical efficacy of using double posterolateral coaxial portals for endoscopic treatment of posterior ankle impingement syndrome (PAIS), a procedure that has gained popularity in recent times. Methods: Six fresh foot samples were randomly selected to measure the distances of two posterolateral portals to the sural nerve in different positions (plantar flexion 10°, dorsiflexion 30°, and plantar flexion 30°) for safety evaluation. A prospective analysis was conducted on the clinical efficacy of the operative approach for endoscopic management of posterior ankle impingement syndrome, including evaluation of effectiveness and complications. Results: In this study, the mean distances of the first and second portals to the sural nerve were measured in different ankle positions. The distances were found to be 2.26 ± 0.22 cm and 1.59 ± 0.12 cm in the plantar flexion 10° position, 2.21 ± 0.21 cm and 1.55 ± 0.12 cm in the dorsiflexion 30° position, and 2.46 ± 0.29 cm and 1.73 ± 0.19 cm in the plantar flexion 30° position, demonstrating a significant safety margin from the nerve. A total of 38 patients underwent endoscopic treatment for posterior ankle impingement syndrome using double posterolateral coaxial portals between January 2012 and December 2017. This surgical approach provided access to the subtalar joint and posterior ankle region. The patients were followed up for an average of 38.2 months (24–72 months), with a satisfaction rate of 94.7%. There were no reported complications, and significant improvements were observed in both visual analogue scale (VAS) and The American Orthopedic Foot and Ankle Society Score (AOFAS) scores postoperatively. The VAS score decreased from 5.68 to 0.51 (P

IntroductionSpeckle tracking ultrasound is a novel technique for evaluating diaphragm movement, yet its guidance in weaning mechanically ventilated patients remains unclear. In this study, we assessed diaphragmatic function using speckle tracking ultrasound and guided the weaning process.MethodsA total of 86 mechanically ventilated patients were included and divided into successful or failed weaning groups. Diaphragmatic function was assessed using speckle tracking ultrasound, M-ultrasound diaphragm excursion (DE), and diaphragmatic twitch force (DTF) after 30 min spontaneous breathing trial (SBT). The diagnostic performance of these indicator in predicting weaning outcomes was also evaluated.ResultsIn this study, a total of 86 patients completed the follow-up for weaning outcomes, with 35 cases of weaning failure and 51 cases of successful weaning. Logistic regression analysis identified whole strain (p = 0.037) and DE (p = 0.004) as independent predictors of weaning outcome. Receiver operating characteristic (ROC) curve showed that the strain threshold for Costal Diaphragm (Dlcos) was −9.836, Area Under the Curve (AUC) value was 0.760, the predictive specificity for weaning failure was 72.5%, and the sensitivity was 80%. DE value exceeding 1.015 cm had an AUC value of 0.785, noting that DE value had a high specificity (90.2%) for predicting successful weaning, but a lower sensitivity (60%). After merging, the AUC of whole strain and DE was 0.856, and the sensitivity (80%) and specificity (80.4%) were more balanced compared to using DE alone.ConclusionThe findings of this study demonstrate the feasibility of using speckle tracking ultrasound to assess diaphragmatic function in mechanically ventilated patients. The combined utilization of whole strain and DE provides a more precise evaluation of diaphragmatic function in ICU patient, which may improve patient outcome.

An early and accurate diagnosis of septic cardiomyopathy is vital for improving the overall prognosis of sepsis. In our research, we aimed to identify signature genes and their immune connections in septic cardiomyopathy. By analyzing the mouse myocardial transcriptome from sepsis induced by cecum ligation and puncture (CLP), we identified four distinct k-means clusters. Further analysis of human myocardial datasets using Weighted Gene Co-expression Network Analysis (WGCNA) revealed a strong correlation between the MEturquoise module and septic cardiomyopathy (cor = 0.79, p

Sustainable energy planning and development are necessary to move towards net zero emissions. Cross-border electricity trading and green hydrogen trading are sustainable options to increase renewable energy capacity growth. Using the solar energy potential in Peninsular Malaysia, the hydropower potential in East Malaysia as an energy supply source, and the electricity demand of Singapore as the demand side, this study aimed to reveal the potential electricity and hydrogen trading activities within these two countries. A mixed integer non-linear programming mathematical model with an objective function to minimize the overall cost was developed using the General Algebraic Modeling System. The results shows that hydropower-generated electricity from East Malaysia is most cost-effective in satisfying Singapore's electricity demand, with a total cost of 1.15 × 1011 USD, resulting in an LCOE of 0.1203 USD/kWh. The deployment of a new hydropower plant capacity was found to be 6.54 GW, with annual electricity production of 36.6 TWh to satisfy the electricity demand of Singapore. This study also found that energy trading in the form of electricity transmission via submarine power cable from East Malaysia results in the lowest cost, followed by electricity transmission via power cable from Johor, and hydrogen pipeline transportation from Johor. Hydrogen shipping from East Malaysia is infeasible due to limited hydropower resource available. The model developed from this study can provide insight for policymakers, investors, and developers in the early stages of project development.

ABSTRACT Introduction Patients with terminal‐stage cancer frequently experience multiple symptoms simultaneously. Little is known about how core symptom clusters differ in advanced‐cancer patients with different survival expectancies receiving hospice care. To identify the core symptom clusters of hospice‐care cancer patients with different survival expectancies and compare the features of their symptom networks. Methods In this retrospective study, secondary data analysis was conducted. Records of 6946 patients with advanced cancer who received home‐based hospice care service in a hospice center from April 2001 to December 2020 were collected and analyzed using network analysis. Results This analysis included 6946 patients with advanced cancer receiving hospice care. In patients with survival expectancies of 0–6 months, loss of appetite was identified as the core symptom (rs = 4.03, rb = 5.21, rc = 2.63), and five symptom clusters were identified. Malnutrition was the core symptom in patients with survival expectancies of 6–12 months (rs = 2.83, rb = 2.43, rc = 0.93), and nine symptom clusters were identified. Wasting syndrome was the core symptom cluster in two groups. The network density of symptoms in patients with

Background: Existing studies have shown that the brain network of major depression disorder (MDD) has abnormal topologies. However, constructing reliable MDD brain networks is still an open problem. New method: This paper proposed a reliable MDD brain network construction method. First, seven connectivity methods are used to calculate the correlation between channels and obtain the functional connectivity matrix. Then, the matrix is binarized using four binarization methods to obtain the EEG brain network. Besides, we proposed an improved binarization method based on the criterion of maximizing differences between groups: the adaptive threshold (AT) method. The AT can automatically set the optimal binarization threshold and overcome the artificial influence of traditional methods. After that, several network metrics are extracted from the brain network to analyze inter-group differences. Finally, we used statistical analysis and Fscore values to compare the performance of different methods and establish the most reliable method for brain network construction. Results: In theta, alpha, and total frequency bands, the clustering coefficient, global efficiency, local efficiency, and degree of the MDD brain network decrease, and the path length of the MDD brain network increases. Comparison with existing methods: The results show that AT outperforms the existing binarization methods. Compared with other methods, the brain network construction method based on phase-locked value (PLV) and AT has better reliability. Conclusions: MDD has brain dysfunction, particularly in the frontal and temporal lobes.

BackgroundRenal ischemia reperfusion injury (IRI) is one of the pivotal event of acute kidney injury (AKI), and they are unavoidable in the process of kidney transplantation, which eventually leads to the loss of renal allograft. Ferroptosis is a newly identified programmed cell death. Recent studies have suggested that ferroptosis may participate in the pathophysiological process of renal IRI. Therefore, we aimed to determine biomarkers associated with ferroptosis during renal IRI and their impact on renal allografts.MethodsWe conducted a comprehensive bioinformatics analysis and established an IRI-AKI animal model to illustrate the critical role of ferroptosis-related hub genes (FRHGs) in IRI-AKI and their potential impact on kidney transplantation.ResultsIn this study, we identified 60 ferroptosis-related genes (FRGs) in renal IRI based on the GSE148420 dataset and FerrDb database. And then we performed functional annotation analysis using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Protein-protein interaction (PPI) network was constructed by online tool String. EZH2, CDKN1A, PPARA, EGR1, ATF3, and CD44 were identited as six ferroptosis-related hubgenes (FRHGs) using four methods, including MMC, Degree, DMNC, and EPC. FRHGs expression level were verified by the validation sets GSE58438 and GSE126805. Protein expression level of FRHGs verified by Proteomics and Western blot. Cibersort was utilized to analyze immune cell infiltration during renal IRI as well as the correlation between FRHGs and immune cells. The GSE21374 dataset was used for renal allografts survival analysis. Finally, We induced the IRI-AKI animal model and illustrated the importance of FRGHs CD44 in ferroptosis and the accumulation of macrophages.ConclusionWe identified 6 FRHGs. We found that FRHGs not only exhibited significant correlation with immune cells but also directly influenced the survival of transplanted kidneys in the human population. Among six FRHGs, only CD44 was overexpressed at both the gene and protein levels. Anti-CD44 exerts a protective effect by inhibiting ferroptosis and the accumulation of M1 macrophages during renal IRI. This study provided new insights into the pathogenesis of renal IRI and provided new evidence for its treatment.

Introduction Reduced thrombin generation is an important component of post cardiopulmonary bypass (CPB) coagulopathy. To replenish coagulation factors and enhance thrombin generation in bleeding surgical patients, frozen plasma (FP) and four-factor prothrombin complex concentrate (4F-PCC) are used. However, the efficacy–safety balance of 4F-PCC relative to FP in cardiac surgery is unconfirmed.Methods and analysis LEX-211 (FARES-II) is an active-control, randomised, phase 3 study comparing two coagulation factor replacement therapies in bleeding adult cardiac surgical patients at 12 hospitals in Canada and the USA. The primary objective is to determine whether 4F-PCC (Octaplex/Balfaxar, Octapharma) is clinically non-inferior to FP for haemostatic effectiveness. Inclusion criteria are any index (elective or non-elective) cardiac surgery employing CPB and coagulation factor replacement with 4F-PCC or FP ordered in the operating room for bleeding management. Patients will be randomised to receive 1500 or 2000 international units of 4F-PCC or 3 or 4 units of FP, depending on body weight. The primary endpoint of haemostatic treatment response is ‘effective’ if no additional haemostatic intervention is required from 60 min to 24 hours after the first initiation of 4F-PCC or FP; or ‘ineffective’ if any other haemostatic intervention (including a second dose of study drug) is required. An estimated 410 evaluable patients will be required to demonstrate non-inferiority (one-sided α of 0.025, power ≥90%, non-inferiority margin 0.10). Secondary outcomes include transfusions, bleeding-related clinical endpoints, coagulation parameters and safety.Ethics and dissemination The trial has been approved by the institutional review boards of all participating centres. Trial completion is anticipated at the end of 2024, and results will be disseminated via publications in peer-reviewed journals and conference presentations in 2025. The results will advance our understanding of coagulation management in bleeding surgical patients, potentially reducing the need for allogeneic blood products and improving outcomes in surgical patients.Trial registration number NCT05523297.

Summary: Caspase recruitment domain family member 14 (CARD14) and its variants are associated with both atopic dermatitis (AD) and psoriasis, but their mechanistic impact on skin barrier homeostasis is largely unknown. CARD14 is known to signal via NF-κB; however, CARD14-NF-κB signaling does not fully explain the heterogeneity of CARD14-driven disease. Here, we describe a direct interaction between CARD14 and MYC and show that CARD14 signals through MYC in keratinocytes to coordinate skin barrier homeostasis. CARD14 directly binds MYC and influences barrier formation in an MYC-dependent fashion, and this mechanism is undermined by disease-associated CARD14 variants. These studies establish a paradigm that CARD14 activation regulates skin barrier function by two distinct mechanisms, including activating NF-κB to bolster the antimicrobial (chemical) barrier and stimulating MYC to bolster the physical barrier. Finally, we show that CARD14-dependent MYC signaling occurs in other epithelia, expanding the impact of our findings beyond the skin.

Snakebite envenomation remains an important, yet a neglected public health issue in most tropical and subtropical countries. Underdeveloped medical infrastructure, suboptimal medical services, poor documentation and failure to make snake-related injury a mandatory notifiable disease are important contributing factors. The King Cobra (Ophiophagus hannah) is a medically significant species encountered in Malaysia however, there have been few publications from the clinical perspective. The objectives of this study were to determine the frequency of King Cobra related injuries, geographical distribution, clinical presentation, type and frequency of antivenom utilization and the management outcome. This is a cross-sectional study of confirmed King Cobra related injuries consulted to Remote Envenomation Consultation Services (RECS) from 2015 to 2020. Data were extracted from the RECS database and descriptively analyzed. A total of 32 cases of King Cobra bite were identified. Most cases were from Peninsular Malaysia with the most frequent from the state of Pahang (n = 9, 28.1%). Most patients got bitten while attempting to catch or play with the snake (68.8%). Signs and symptoms of envenomation were documented in 24 (75.0%) cases and the most frequent systemic manifestation was ptosis (n = 13, 40.6%). Tracheal intubation and ventilatory support were required in 13 (40.6%) patients. Antivenom was administered to 22 (68.8%) patients with most (25.0%) receiving 10 vials (1 dose). The commonest antivenom used was monospecific King Cobra antivenom (50.0%) from Thai Red Cross. There was one death documented due to complications from necrotizing fasciitis and septicemia. Public awareness of the dangers and proper handling of King Cobras needs to be emphasised. Timely administration of the appropriate antivenom is the definitive treatment and leads to favorable outcomes.

Our previous studies have shown that early exercise intervention after stroke increases neural activity and synaptic plasticity and promotes the recovery of nerve fiber bundle integrity in the brain. However, the effect of exercise on the repair of myelin in the brain and the related mechanism are still unclear. In this study, we randomly divided the rats into three groups. Before and after 28 days of intervention, body weight, nerve function, the infarct size, white matter fiber bundle integrity, and nerve myelin structure and function were observed by measuring body weight, analysis of modified neurological severity score, CatWalk gait analysis, MRI, luxol fast blue staining, immunofluorescence, and transmission electron microscopy. Changes in the expression of proteins in the MEK/ERK pathway were assessed. The results showed that early exercise intervention resulted in neurological recovery, decreased the infarct volume and increased nerve fiber integrity, the myelin coverage area, myelin basic protein (MBP) fluorescence intensity expression, and myelin thickness. Furthermore, the expression level of MBP was significantly increased after early exercise intervention, while the expression levels of p-MEK1/2 and p-ERK1/2 were significantly reduced. In the cell study, MBP expression levels were significantly higher in the oxygen and glucose deprivation and administration group.In summary, early exercise intervention after stroke can promote myelin repair by inhibiting the MEK/ERK signaling pathway.

Background: The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates. Methods: A single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI. Results: The median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome. Conclusions: Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population. Résumé: Contexte: L’étude visait à évaluer l’issue des patients ayant subi une intervention coronarienne percutanée (ICP) sur un greffon coronarien, en mettant l’accent sur le taux de mortalité toutes causes confondues et le taux d’échecs de revascularisation du vaisseau cible (EVC). Méthodologie: Une analyse du registre d’un seul établissement a porté sur 364 patients ayant subi une ICP sur un greffon coronarien de 2008 à 2019. L’étude a analysé la mortalité toutes causes confondues et les EVC, qui comprenaient la revascularisation de la lésion cible, la revascularisation du vaisseau cible et le traitement médical de l’occlusion du greffon coronarien cible après l’ICP. Résultats: L’âge médian des patients était de 71 ans (intervalle interquartile [IIQ] de 65 à 78) et 82,1 % d’entre eux étaient de sexe masculin. La plupart des patients (94,8 %) avaient subi une ICP sur un greffon de veine saphène; l’âge médian des greffons était de 13,0 ans (IIQ de 8,4 à 17,6). Les endoprothèses médicamentées avaient été utilisées plus fréquemment (54,4 %) que les endoprothèses non médicamentées (45,6 %), le diamètre médian de l’endoprothèse étant de 3,5 mm (IIQ de 3 à 4) et sa longueur, de 19 mm (IIQ de 18 à 28). Les différences pour ce qui est de l’issue clinique n’étaient pas significatives à l’égard des sites d’ICP (aorto-ostial, corps du greffon, anastomose), de l’utilisation d’une endoprothèse médicamentée, ou encore de l’utilisation de dispositifs de protection. Le taux de mortalité à 1 an était de 3,3 %, alors que le taux combiné d’EVC ou de décès était de 20,3 %. Après 5 ans, le taux de mortalité avait augmenté à 14,9 %, alors que le taux combiné d’EVC ou de décès s’élevait à 40,3 %. Les analyses multivariables ont révélé que la néphropathie chronique était indépendamment associée au décès (rapport des risques instantanés [RRI] de 1,74, intervalle de confiance [IC] à 95 % de 1,16 à 2,61, p = 0,007), alors que l’hypertension (RRI de 2,42, IC à 95 % de 1,32 à 4,42, p = 0,004) et une longueur accrue de l’endoprothèse (RRI de 1,01, IC à 95 % de 1,00 à 1,02, p = 0,007) étaient indépendamment associées à une issue d’EVC ou de décès. Conclusions: Les patients qui ont subi une ICP sur un greffon coronarien présentent des complications considérables sur une période de 5 ans, ce qui souligne le besoin de mettre en place davantage de stratégies de prise en charge pour cette population à risque élevé.

Abstract Activatable afterglow luminescence nanoprobes enabling switched “off-on” signals in response to biomarkers have recently emerged to achieve reduced unspecific signals and improved imaging fidelity. However, such nanoprobes always use a biomarker-interrupted energy transfer to obtain an activatable signal, which necessitates a strict distance requisition between a donor and an acceptor moiety (

Abstract Backgrounds Ampullary adenocarcinoma (AMPAC) is a rare malignancy, treated as pancreatic or intestinal cancer based on its histologic subtype. Little is known about the genomic features of Chinese patients with AMPAC. Materials and methods We enrolled 145 Chinese AMPAC patients in our local cohort and performed a compressive somatic and germline genetic testing using a 156 gene panel. Expression of PD-L1 (clone 28 − 8) was also assessed in tumor specimens from 64 patients. Results The frequency of genetic alterations (GAs) in Chinese patients with AMPAC was found to be distinctive, with TP53, KRAS, SMAD4, APC, CTNNB1, ARID1A, and CDKN2A emerged as the most frequently mutated genes. Comparing with Western patients, significant differences were observed in the prevalence of PIK3CA and ARID2. Furthermore, the incidence of MSI-H was lower in the Chinese cohort, with only two patients identified as MSI-H. Conversely, 11 patients (8.27%) had pathogenic/likely pathogenic germline alterations, all of which were in the DNA damage response (DDR) pathway. In our cohort, 34.48% (22/64) of patients exhibited positive PD-L1 expression in tumor cells, and this expression was associated with GAs in CTNNB1 and BLM. Importantly, over three-fourths of Chinese AMPAC patients in our study had at least one actionable GA, with more than one-fifth of them having actionable GAs classified as Level 3. These actionable GAs were primarily involved in the DDR and PI3K pathways. Notably, GAs in the DDR pathway were detected in both Chinese and Western patients, and regardless of their functional impact, these alterations demonstrated enhanced overall survival rates and higher tumor mutational burden (TMB) levels. Conclusion These findings underscore the distinct genomic landscape of Chinese AMPAC patients and highlight the potential for targeted therapies based on the identified GAs.

This paper provides a comprehensive analysis of the current state of intelligent ophthalmology in China, including technological advancements, academic exchange platforms, policy support, future challenges, and potential solutions. Technologically, remarkable progress have been made in various areas of intelligent ophthalmology in China, including diabetic retinopathy, fundus image analysis, and crucial aspects such as quality assessment of medical artificial intelligence products, clinical research methods, technological evaluation, and industrial standards. Researchers are constantly improving the safety and standardization of intelligent ophthalmology technology by formulating clinical application guidelines and standards. Academic exchange platforms have been established to provide extensive collaboration opportunities for professionals across diverse fields, and various academic journals serve as publication platforms for intelligent ophthalmology research. Regarding public policy, the Chinese government has not only established a supportive policy environment for the advancement of intelligent ophthalmology through various documents and regulations, but provided a legal basis and management framework. However, there are still challenges to overcome, such as technological innovation, data privacy and security, outdated regulations, and talent shortages. To tackle these issues, there is a requirement for increased technological research and development, the establishment of regulatory frameworks, talent cultivation, and greater awareness and acceptance of new technologies among patients. By comprehensively addressing these challenges, intelligent ophthalmology in China is expected to continue leading the industry's global development, bringing more innovation and convenience to the field of ophthalmic healthcare.

Cereals are enriched with many nutrients that are good for human health. Cereal meal replacement powder interventions can reduce weight, improve blood lipids, regulate postprandial glucose, adjuvant treatment and prevention of diabetes, and have a wide range of applications and development prospects. In this review, the processing materials, efficacy, formulation optimization methods, digestive properties, processing techniques, and related implementation standards for meal replacements are summarized, and the development of meal replacements is prospected.

Abstract Background Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia. Methods A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings. Results Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation. Conclusions In addition to the global effort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.

Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common developmental spine disorder among children. It is characterized by a lateral deviation of the spine that gives rise to the distinctive “S” or “C” shaped bending of the spine. The Lin School of Lingnan Region (LSLR), one of the prominent schools for bare-handed orthopaedic manipulation in southern China, provides preliminary evidences that the orthopaedic manipulation techniques help to correct deviations of the spine. Previous research found that Orthopaedic Manipulation Techniques of LSLR (OMT-LSLR) could reduce the Cobb’s angles in patients with AIS. Therefore, the current study aims to investigate the effectiveness and safety of the OMT-LSLR in treating teenagers with AIS. Methods In this participant-and-assessor-blinded randomized controlled clinical trial, 50 participants identified AIS without surgical indications will be recruited and randomized into two groups to receive physiotherapy scoliosis-specific exercises training with either orthopaedic manipulation or sham manipulation treatment for 16 weeks, followed by post-treatment visits at week 24. Primary outcome measure is the change of Scoliosis Research Society-22 (SRS-22) questionnaire score. Secondary outcome measures include Traditional Chinese version of Spinal Appearance Questionnaire (TC-SAQ) score, Italian Spine Youth Quality of Life (ISYQOL) score, the change of Cobb’s angle measured by Xray, and the change of Cobb’s angle, spinal rotation and muscle volume measured by three-dimensional (3D) ultrasound. The trial will be conducted at the Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre in Hong Kong (CUHK-CMSCTRC). Discussion The results of this study will establish comprehensive clinical evidence about the efficacy and safety of the Orthopaedic Manipulation Techniques of the Lin School of Lingnan Region in the Treatment of Adolescent Idiopathic Scoliosis. One of the characteristics of this trial is that it is a participant-and-assessor-blinded randomized controlled clinical trial with sham manipulation. The study would also apply three-dimensional (3D) ultrasound technology to investigate the relationship between the change of the muscle volume and the spinal curve. Trial registration The trial is registered on ClinicalTrials.gov (Identifier: NCT05639023 ) on December 6, 2022.

Abstract Background Tendon-to-bone healing is a critical challenge in sports medicine, with its cellular and molecular mechanisms yet to be explored. An efficient murine model could significantly advance our understanding of this process. However, most existing murine animal models face limitations, including a propensity for bleeding, restricted operational space, and a steep learning curve. Thus, the need for a novel and efficient murine animal model to investigate the cellular and molecular mechanisms of tendon-to-bone healing is becoming increasingly evident. Methods In our study, forty-four 9-week-old male C57/BL6 mice underwent transection and reattachment of the Achilles tendon insertion to investigate tendon-to-bone healing. At 2 and 4 weeks postoperatively, mice were killed for histological, Micro-CT, biomechanical, and real-time polymerase chain reaction tests. Results Histological staining revealed that the original tissue structure was disrupted and replaced by a fibrovascular scar. Although glycosaminoglycan deposition was present in the cartilage area, the native structure had been destroyed. Biomechanical tests showed that the failure force constituted approximately 44.2% and 77.5% of that in intact tissues, and the ultimate tensile strength increased from 2 to 4 weeks postoperatively. Micro-CT imaging demonstrated a gradual healing process in the bone tunnel from 2 to 4 weeks postoperatively. The expression levels of ACAN, SOX9, Collagen I, and MMPs were detected, with all genes being overexpressed compared to the control group and maintaining high levels at 2 and 4 weeks postoperatively. Conclusions Our results demonstrate that the healing process in our model is aligned with the natural healing process, suggesting the potential for creating a new, efficient, and reproducible mouse animal model to investigate the cellular and molecular mechanisms of tendon-to-bone healing. Graphical abstract

Abstract Background The prognostic value of triglyceride-glucose (TyG) index in general type 2 diabetes mellitus (T2DM) patients is still unclear. Therefore, we aimed to determine the associations between TyG and all-cause/cause-specific death in a T2DM cohort and explore whether such associations would be modified by age. Methods A total of 3,376 patients with T2DM from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were selected and divided into the younger group (

This study introduces a sophisticated methodology that integrates 3D assessment technology for the reorganization and recycling of retired lithium-ion battery packs, aiming to mitigate environmental challenges and enhance sustainability in the electric vehicle sector. By deploying a kernel extreme learning machine (KELM), variational mode decomposition (VMD), and an advanced sparrow search algorithm (SSA), the research achieves a marked increase in the precision of battery classification and performance forecasting. Implementing a three-dimensional dynamic evaluation model, the study optimizes battery pack grouping strategies, culminating in superior secondary utilization rates, extended operational lifespans, and minimized ecological footprints. The research demonstrates that balanced weight distribution strategies, which maximize energy density to 61.37571 Wh/L and cycle counts up to 947 cycles, are pivotal for the efficient reorganization of battery packs, substantiating the economic feasibility and environmental sustainability of recycling initiatives. Future endeavors will extend this research to investigate the influence of diverse battery materials and morphologies on reorganization efficacy, with the aim of broadening the application horizons to include real-world scenarios, thereby refining battery performance and lifespan predictions and propelling forward the frontiers of recycling technology and policy development.

Background: The single-channel sleep EEG has the advantages of convenient collection, high-cost performance, and easy daily use, and it has been widely used in the classification of sleep stages. Methods: This paper proposes a single-channel sleep EEG classification method based on long short-term memory and a hidden Markov model (LSTM-HMM). First, the single-channel EEG is decomposed using wavelet transform (WT), and multi-domain features are extracted from the component signals to characterize the EEG characteristics fully. Considering the temporal nature of sleep stage changes, this paper uses a multi-step time series as the input for the model. After that, the multi-step time series features are input into the LSTM. Finally, the HMM improves the classification results, and the final prediction results are obtained. Results: A complete experiment was conducted on the Sleep-EDFx dataset. The results show that the proposed method can extract deep information from EEG and make full use of the sleep stage transition rule. The proposed method shows the best performance in single-channel sleep EEG classification; the accuracy, macro average F1 score, and kappa are 82.71%, 0.75, and 0.76, respectively. Conclusions: The proposed method can realize single-channel sleep EEG classification and provide a reference for other EEG classifications.

Inflammasome is linked to many inflammatory diseases, including COVID-19 and autoimmune liver diseases. While severe COVID-19 was reported to exacerbate liver failure, we report a fatal acute-on-chronic liver failure (ACLF) in a stable primary biliary cholangitis-autoimmune hepatitis overlap syndrome patient triggered by a mild COVID-19 infection. Postmortem liver biopsy showed sparse SARS-CoV-2-infected macrophages with extensive ASC (apoptosis-associated speck-like protein containing a CARD) speck-positive hepatocytes, correlating with elevated circulating ASC specks and inflammatory cytokines, and depleted blood monocyte subsets, indicating widespread liver inflammasome activation. This first report of a fatal inflammatory cascade in an autoimmune liver disease triggered by a mild remote viral infection hopes to elucidate a less-described pathophysiology of ACLF that could prompt consideration of new diagnostic and therapeutic options.

Abstract In recent years, increased species extinction and habitat loss have significantly reduced biodiversity, posing a serious threat to both nature and human survival. Environmental factors strongly influence bird distribution and diversity. The potential distribution patterns and species richness offer a conservation modeling framework for policymakers to assess the effectiveness of natural protected areas (PAs) and optimize their existing ones. Very few such studies have been published that cover a large and complete taxonomic group with fine resolution at regional scale. Here, using birds as a study group, the maximum entropy model (MaxEnt) was used to analyze the pattern of bird species richness in Jiangsu Province. Using an unparalleled amount of occurrence data, we created species distribution models (SDMs) for 312 bird species to explore emerging diversity patterns at a resolution of 1 km2. The gradient of species richness is steep, decreasing sharply away from water bodies, particularly in the northern part of Jiangsu Province. The migratory status and feeding habits of birds also significantly influence the spatial distribution of avian species richness. This study reveals that the regions with high potential bird species richness are primarily distributed in three areas: the eastern coastal region, the surrounding area of the lower reaches of the Yangtze River, and the surrounding area of Taihu Lake. Compared with species richness hotspots and existing PAs, we found that the majority of hotspots are well‐protected. However, only a small portion of the regions, such as coastal areas of Sheyang County in Yancheng City, as well as some regions along the Yangtze River in Nanjing and Zhenjiang, currently have relatively weak protection. Using stacked SDMs, our study reveals effective insights into diversity patterns, directly informing conservation policies and contributing to macroecological research advancements.

Introduction Health literacy refers to acquiring and utilizing health information to make health-related actions and decisions. Filipino domestic workers with low health literacy are often vulnerable to health problems due to poor living and working conditions. Objective This study examined the effect of an online health literacy promotion program on health literacy and health knowledge of Filipino domestic workers in Macao. Methods The mixed method combined quantitative findings of a quasi-experimental study with qualitative results applied. The quasi-experiment included three parallel groups: a synchronous online education group (videoconference group), an asynchronous online education group (video group), and a control group. A total of 88 Filipino domestic workers were assigned to one of these groups, and eight respondents participated in two focus-group interviews respectively after the intervention. Results For quantitative data, both synchronous and asynchronous online education interventions had positive effects. While comparing with the control group, participants in the videoconference group were more likely to have better health promotion health literacy after the intervention (β = 5.36, p = .02), and participants in the video group were more likely to have better general health literacy (β = 5.17, p = .01), disease prevention health literacy (β = 5.31, p = .04), health promotion health literacy (β = 5.97, p = .01). For qualitative data, three themes and eight subthemes were extracted after the online health literacy promotion program. After integrating the findings of this study, the study found that this program was essential and beneficial for Filipino domestic workers’ health knowledge and health literacy. Conclusion Overall, online health literacy promotion programe had positive impacts on participants revealed in this study. Asynchronous online education has made significant progress in overall health literacy, which may be more suitable as a widely promoted education method because of the characteristics and working conditions of this population.

BackgroundThis study aimed to explore the postoperative myopic shift and its relationship to visual acuity rehabilitation in patients with bilateral congenital cataracts (CCs).MethodsBilateral CC patients who underwent cataract extraction and primary intraocular lens implantations before 6 years old were included and divided into five groups according to surgical ages (

Biosensing platforms have become increasingly important in our daily lives due to their ability to provide real-time monitoring with low cost, high sensitivity, and specificity. Carbon nanotubes possess unique optical, electrical, and physical/chemical characteristics that can significantly enhance the electron transfer rate in biosensors, thereby improving sensing performance and enabling rapid detection of biochemical molecules and electrophysiological signals. Additionally, carbon nanotubes facilitate high-resolution imaging detection of cells and tissues. The bio-nano platform based on carbon nanotubes holds excellent potential for integrating diagnosis and treatment to achieve precision medicine goals. As a result, carbon nanotube-based biosensors are emerging as the most promising candidate for medical diagnostics. This paper reviews the synthesis of carbon nanotubes, their application in sensors for medical diagnosis, and their potential use in remediation therapy. Furthermore, it explores the existing limitations and future development trends of carbon nanotubes in the medical field. This interdisciplinary research offers abundant opportunities for researchers interested in carbon nanotube synthesis, medical diagnostics, and regenerative therapy.

Neurologists have a difficult time identifying sporadic cerebellar ataxia. Multiple system atrophy of the cerebellar type (MSA-C), spontaneous late cortical cerebellar atrophy, and prolonged alcohol use are a few possible causes. In a group of people with sporadic cerebellar ataxia that was not MSA-C, an autosomal-dominant spinocerebellar ataxia (SCA) mutation was recently discovered. Chinese single-hospital cohort will be used in this study to genetic screen for SCA-related genes. One hundred forty individuals with CA were monitored over 8 years. Thirty-one individuals had familial CA, 109 patients had sporadic CA, 73 had MSA-C, and 36 had non-MSA-C sporadic CA. In 28 of the 31 non-MSA-C sporadic patients who requested the test, we carried out gene analysis, including SCA1, SCA2, SCA3, SCA6, SCA7, SCA8, SCA12, SCA17, SCA31, and dentatorubro-pallidoluysian atrophy (DRPLA). The control group consisted of family members of the patients. In 57% of the instances with spontaneous CA that were not MSA-C, gene abnormalities were discovered. The most frequent exception among individuals with sporadic CA was SCA6 (36%), followed by monsters in SCA1, 2, 3, 8, and DRPLA. In contrast, 75% of the patients with familial CA had gene abnormalities, the most frequent of which was SCA6 abnormality. The age of 69 vs 59 was higher, and the CAG repeat length was a minor age of 23 vs 25 in the former instances compared to the last one among individuals with SCA6 anomalies that were sporadic as opposed to familial cases. In sporadic CA, autosomal-dominant mutations in SCA genes, notably in SCA6, are common. Although the cause of the increased incidence of SCA6 mutations is unknown, it may be related to a greater age of onset and varied penetrance of SCA6 mutations.

Abstract Gas hydrates provide alternative solutions for gas storage & transportation and gas separation. However, slow formation rate of clathrate hydrate has hindered their commercial development. Here we report a form of porous ice containing an unfrozen solution layer of sodium dodecyl sulfate, here named active ice, which can significantly accelerate gas hydrate formation while generating little heat. It can be readily produced via forming gas hydrates with water containing very low dosage (0.06 wt% or 600 ppm) of surfactant like sodium dodecyl sulfate and dissociating it below the ice point, or by simply mixing ice powder or natural snow with the surfactant. We prove that the active ice can rapidly store gas with high storage capacity up to 185 V g V w −1 with heat release of ~18 kJ mol−1 CH4 and the active ice can be easily regenerated by depressurization below the ice point. The active ice undergoes cyclic ice−hydrate−ice phase changes during gas uptake/release, thus removing most critical drawbacks of hydrate-based technologies. Our work provides a green and economic approach to gas storage and gas separation and paves the way to industrial application of hydrate-based technologies.

Abstract Active noise control (ANC) is gaining ever-increasing attention owing to its powerful ability to attenuate low-frequency noise. The computational complexity of an ANC system may directly affect its computational efficiency, control performance, and hardware costs. Therefore, the focus of this paper is mainly on discussing the development of ANC systems with emphasis on reducing computational complexity. The ANC systems are classified into two groups of narrowband and broadband systems. The computational complexity analysis is provided to show the computational merit of each system with respect to the conventional ANC systems. In addition, numerical simulations are performed to evaluate the convergence speed and noise reduction performance of the considered systems. The results show that, in the narrowband ANC systems, the LFE-NANC, CFX-NANC and BFX-NANC systems enjoy better overall performance in terms of the computational complexity, convergence speed and steady-state error, and in the broadband ANC systems, the DF-BANC system has the lowest computational complexity but cannot effectively attenuate the broadband noise with high spectral dynamics, whereas the DS-BANC and MDS-BANC systems can. This study provides in-depth insight into current typical low-complexity ANC systems.

AIM: To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device (OVD). METHODS: Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane (PPM) removal surgery were presented and followed up. This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) exposure. Then, to provide the pathological basis for our speculation, another four cataract patients were randomly exposed to different OVDs, and their anterior lens capsules were investigated with transmission electron microscopy (TEM). RESULTS: After months, the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration. For the cataract patients, similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ (sodium hyaluronate gel 1.0%). In addition, marked ultrastructural changes, including chromatin condensation, extensive cytoplasmic vacuoles, and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc, were observed by TEM. CONCLUSION: The lens vacuolar changes may be associated with a dispersive OVD exposure. Therefore, it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction. In addition, close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.

The stability issue of perovskite solar cells (PSCs) has long been of concern to researchers. Poly (3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) is commonly used as a hole transport layer (HTL) in the inverted PSCs to achieve efficient and stable performance. However, PEDOT:PSS can corrode ITO, affecting device efficiency. Moreover, the hydrophilic nature of PEDOT:PSS compromises device stability. In this work, Poly (3-hexylthiophene-2,5-diyl) (P3HT), known for its good hydrophobicity, was used to modify the surface of PEDOT:PSS, reducing its water absorption and thereby enhancing the efficiency and stability of PSCs. The results reveal that incorporating P3HT effectively enhances the hydrophobicity of PEDOT:PSS. Furthermore, it fosters the development of large-grain perovskite film on the PEDOT:PSS/P3HT bilayer. This enhancement leads to a power conversion efficiency (PCE) of 19.78% for PSCs, with an increase by 16% than that of reference cells (17.04% of PCE). Following a duration of 1000 h, the PCE for the device modified with P3HT remains above 90%, while the PCE of the reference device is below 70%. These findings suggest that using P3HT in conjunction with PEDOT:PSS as a bilayer HTL can concurrently and proficiently improve the efficiency and stability of PSCs.

Climate change has led to significant fluctuations in marine ecosystems. As a component of the food web, the trophic diversity and spatiotemporal changes of fish communities are crucial for understanding ecosystems. In recent years, stable isotope analysis has been increasingly used as a comprehensive tool for quantitative assessment of trophic diversity to explore spatiotemporal variations in fish community diversity. This study is based on carbon (δ13C) and nitrogen (δ15N) stable isotope analysis using different biomass-weighted isotope diversity indices, including isotopic divergence index (IDiv), isotopic dispersion index (IDis), isotopic evenness index (IEve), and isotopic uniqueness index (IUni). The overall results indicate that IDis, IEve, and IUni values of fish communities were relatively low, while IDiv was relatively high in the Haizhou Bay ecosystem. IDiv, IDis, IEve, and IUni were lower in autumn than in spring; IDiv and IDis were relatively higher in offshore waters, while IEve and IUni were relatively higher in inshore waters. The changes in species composition and intensive pelagic–benthic coupling in Haizhou Bay may lead to significant spatiotemporal variations in the trophic diversity of fish communities in the area. These findings highlight the importance of incorporating trophic relationships into ecosystem models, which will help to enhance our understanding of the complexity of the trophic structure of fish communities.

Abstract Pediatric patients with recurrent and refractory cancers are in most need for new treatments. This study developed patient-derived-xenograft (PDX) models within the European MAPPYACTS cancer precision medicine trial (NCT02613962). To date, 131 PDX models were established following heterotopical and/or orthotopical implantation in immunocompromised mice: 76 sarcomas, 25 other solid tumors, 12 central nervous system tumors, 15 acute leukemias, and 3 lymphomas. PDX establishment rate was 43%. Histology, whole exome and RNA sequencing revealed a high concordance with the primary patient’s tumor profile, human leukocyte-antigen characteristics and specific metabolic pathway signatures. A detailed patient molecular characterization, including specific mutations prioritized in the clinical molecular tumor boards are provided. Ninety models were shared with the IMI2 ITCC Pediatric Preclinical Proof-of-concept Platform (IMI2 ITCC-P4) for further exploitation. This PDX biobank of unique recurrent childhood cancers provides an essential support for basic and translational research and treatments development in advanced pediatric malignancies.

Abstract To reduce the dimensionality of EEG features and improve classification accuracy, we propose an improved hybrid feature selection method for EEG feature selection. First, MIC is used to remove irrelevant features and redundant features to reduce the search space of the second stage. QPSO is then used to optimize the feature in the second stage to obtain the optimal feature subset. Considering that both dimensionality and classification accuracy affect the performance of feature subsets, we design a new fitness function. Moreover, we optimize the parameters of the classifier while optimizing the feature subset to improve the classification accuracy and reduce the running time of the algorithm. Finally, experiments were performed on EEG and UCI datasets and compared with five existing feature selection methods. The results show that the feature subsets obtained by the proposed method have low dimensionality, high classification accuracy, and low computational complexity, which validates the effectiveness of the proposed method.

The detection of pain in persons with advanced dementia is challenging due to their inability to verbally articulate the pain they are experiencing. Pain Assessment in Advanced Dementia (PAINAD) is an observer-rated pain assessment tool developed based on non-verbal expressions of pain for persons with severe dementia. This study aimed to perform construct validation of PAINAD for pain assessment in persons with severe dementia in Malaysia. This was a prospective cross-sectional study conducted from 27 April 2022 to 28 October 2022 in eight public hospitals in Malaysia. The PAINAD scale was the index test, and the Discomfort Scale—Dementia of the Alzheimer Type (DS-DAT) and Nurse-Reported Pain Scale (NRPS) were the reference tests for construct and concurrent validity assessment. Pain assessment for the study subjects was performed by two raters concurrently at rest and during activity. The PAINAD score was determined by the first rater, whereas the DS-DAT and NRPS were assessed by the second rater, and they were blinded to each other’s findings to prevent bias. PAINAD showed good positive correlations ranging from 0.325 to 0.715 with DS-DAT and NRPS at rest and during activity, with a p-value of

The expression status of proinflammatory cytokines in high-altitude pulmonary arterial hypertension (PAH) has been well studied. However, the changes in interleukin (IL)-8 and tumor necrosis factor α (TNF-α) during the reversible changes in pulmonary vascular remodeling (PVR) in PAH after detaching from a hypobaric hypoxic environment have not been elucidated. This investigation elucidated a high-altitude PAH rat model. Then, PAH rats in the high-altitude group were maintained in the high-altitude area, and rats in the low-altitude group returned to the low-altitude area. After 0, 10, 20, and 30 days of PAH modeling, right ventricular systolic pressure (RVSP) and the mean pulmonary arterial pressure (mPAP) were assessed. Right ventricular (RV) hypertrophy was reflected by the ratio of RV/[left ventricle + interventricular septum (S)]. Pathological changes in PVR were accessed by hematoxylin-eosin staining, and medial wall thickness (WT%) and medial wall area (WA%) were measured. TNF-α and IL-8 levels in pulmonary artery tissues and blood were measured with Western blot assay and enzyme-linked immunosorbent assay, respectively. Our results showed that PAH rats exhibited a substantial increase in RVSP and mPAP, RV hypertrophy, PVR, and enhanced generation of TNF-α and IL-8. Then, we found that these pathological changes were gradually aggravated and TNF-α and IL-8 levels were increased in rats in the high-altitude group after 10, 20, and 30 days of PAH modeling. In contrast, the mPAP was decreased and PVR was alleviated in rats in the low-altitude group, accompanying with reduced TNF-α and IL-8 production. In conclusion, our study demonstrated that the generation of TNF-α and IL-8 was also reversible during the reversible changes in PVR after detaching from a hypobaric hypoxic environment. Thus, proinflammatory cytokine TNF-α and IL-8 levels are positively correlated with PVR severity.

With the continuous promotion of the unified electricity spot market in the southern region, the formation mechanism of spot market price and its forecast will become one of the core elements for the healthy development of the market. Effective spot market price prediction, on one hand, can respond to the spot power market supply and demand relationship; on the other hand, market players can develop reasonable trading strategies based on the results of the power market price prediction. The methods adopted in this paper include: Analyzing the principle and mechanism of spot market price formation. Identifying relevant factors for electricity price prediction in the spot market. Utilizing a clustering model and Spearman’s correlation to classify diverse information on electricity prices and extracting data that aligns with the demand for electricity price prediction. Leveraging complementary ensemble empirical mode decomposition with adaptive noise (CEEMDAN) to disassemble the electricity price curve, forming a multilevel electricity price sequence. Using an XGT model to match information across different levels of the electricity price sequence. Employing the ocean trapping algorithm-optimized Bidirectional Long Short-Term Memory (MPA-CNN-BiLSTM) to forecast spot market electricity prices. Through a comparative analysis of different models, this study validates the effectiveness of the proposed MPA-CNN-BiLSTM model. The model provides valuable insights for market players, aiding in the formulation of reasonable strategies based on the market's supply and demand dynamics. The findings underscore the importance of accurate spot market price prediction in navigating the complexities of the electricity market. This research contributes to the discourse on intelligent forecasting models in electricity markets, supporting the sustainable development of the unified spot market in the southern region.

The human leukocyte antigen (HLA) system is a major factor controlling cancer immunosurveillance and response to immunotherapy, yet its status in pediatric cancers remains fragmentary. We determined high-confidence HLA genotypes in 576 children, adolescents and young adults with recurrent/refractory solid tumors from the MOSCATO-01 and MAPPYACTS trials, using normal and tumor whole exome and RNA sequencing data and benchmarked algorithms. There was no evidence for narrowed HLA allelic diversity but discordant homozygosity and allele frequencies across tumor types and subtypes, such as in embryonal and alveolar rhabdomyosarcoma, neuroblastoma MYCN and 11q subtypes, and high-grade glioma, and several alleles may represent protective or susceptibility factors to specific pediatric solid cancers. There was a paucity of somatic mutations in HLA and antigen processing and presentation (APP) genes in most tumors, except in cases with mismatch repair deficiency or genetic instability. The prevalence of loss-of-heterozygosity (LOH) ranged from 5.9 to 7.7% in HLA class I and 8.0 to 16.7% in HLA class II genes, but was widely increased in osteosarcoma and glioblastoma (~15-25%), and for DRB1-DQA1-DQB1 in Ewing sarcoma (~23-28%) and low-grade glioma (~33-50%). HLA class I and HLA-DR antigen expression was assessed in 194 tumors and 44 patient-derived xenografts (PDXs) by immunochemistry, and class I and APP transcript levels quantified in PDXs by RT-qPCR. We confirmed that HLA class I antigen expression is heterogeneous in advanced pediatric solid tumors, with class I loss commonly associated with the transcriptional downregulation of HLA-B and transporter associated with antigen processing (TAP) genes, whereas class II antigen expression is scarce on tumor cells and occurs on immune infiltrating cells. Patients with tumors expressing sufficient HLA class I and TAP levels such as some glioma, osteosarcoma, Ewing sarcoma and non-rhabdomyosarcoma soft-tissue sarcoma cases may more likely benefit from T cell-based approaches, whereas strategies to upregulate HLA expression, to expand the immunopeptidome, and to target TAP-independent epitopes or possibly LOH might provide novel therapeutic opportunities in others. The consequences of HLA class II expression by immune cells remain to be established. Immunogenetic profiling should be implemented in routine to inform immunotherapy trials for precision medicine of pediatric cancers.

Taiwan learned from its 2003 SARS experience and established multiple surveillance systems to be able to detect and respond to COVID-19. With the find, test, trace, isolate, and support (FTTIS) strategy, Taiwan was successful in containing SARS-CoV-2 from spreading for two years. During the surge of the Omicron variant in the community, COVID-19 control strategy shifted from containment to mitigation in April 2022, to reduce morbidity and mortality. Lessons learned from COVID-19 response re-emphasizes the importance of having sensitive public health surveillance and linking surveillance with public health actions.