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AIM: To quantify the severity and frequency of ocular pain in Tibetan plateau patients with dry eye, and to evaluate the related factors affecting ocular pain. METHODS: A retrospective study included 160 cases of dry eye disease (DED) patients who were treated from July 2022 to June 2023. Age, gender, occupation, illness course, anxiety, plateau duration, plateau protection, ocular surface disease index scale (OSDI), break-up time (BUT), Schirmer I test (SIT), conjunctivitis, history of ophthalmic medication, autoimmune disease, the workload of daily near vision range, smoking and overnight stay were obtained via comprehensive ophthalmic assessment, and their duration was followed up. Logistic regression analysis was used to determine the related factors affecting ocular pain. RESULTS: Totally 77.5% (124/160) of DED patients had ocular pain, of which the severity of ocular pain was mild, moderate, and severe in 30.0%, 36.3%, and 11.3% of patients, respectively. Frequency of ocular pain was reported occasional, half the time, frequent, and persistent pain in 19.4%, 36.9%, 16.9%, and 4.4%. OSDI score was 19.67±5.70 (13 to 36), and the level of pain was lowly correlated with OSDI (rs=0.316, P0.05). CONCLUSION: Ocular pain is a common complaint in high-altitude DED patients during the pandemic. Anxiety, eye protection, and adequate sleep during the epidemic period are significantly associated with the severity and frequency of ocular pain in patients with plateau DED, while symptoms of DED have relatively little influence on them.

Abstract Realizing the immense clinical potential of mRNA-based drugs will require continued development of methods to safely deliver the bioactive agents with high efficiency and without triggering side effects. In this regard, lipid nanoparticles have been successfully utilized to improve mRNA delivery and protect the cargo from extracellular degradation. Encapsulation in lipid nanoparticles was an essential factor in the successful clinical application of mRNA vaccines, which conclusively demonstrated the technology's potential to yield approved medicines. In this review, we begin by describing current advances in mRNA modifications, design of novel lipids and development of lipid nanoparticle components for mRNA-based drugs. Then, we summarize key points pertaining to preclinical and clinical development of mRNA therapeutics. Finally, we cover topics related to targeted delivery systems, including endosomal escape and targeting of immune cells, tumors and organs for use with mRNA vaccines and new treatment modalities for human diseases.

The sea level in coastal areas of China reached the second highest in 2021, just after that recorded in 2022. External force and dynamic analyses based on tide gauges, satellite observations, reanalysis data and regional numerical outputs were conducted to understand these abnormally high sea levels and determine their possible causes. Results show that the coastal sea level of China had increased at an annual rate of 3.4 ± 0.3 mm during 1980–2021, with an acceleration of 0.06 ± 0.02 mm per year2. The superposition of significant oscillations of quasi-2, 3–7, quasi-9, quasi-11, quasi-19 and 20–30 years contributed to the anomalously high sea levels. The negative-phased El Niño/Southern Oscillation was correlated with the anomalously high sea level and the north‒south anti-phase pattern of the coastal sea level in 2021. Meanwhile, phase lags of 1–4 months occurred with the sea-level response. On a decadal timescale, the Pacific Decadal Oscillation (PDO) was negatively correlated with the anomalous mean sea level (MSL), and the negative-phased PDO contributed to the anomalous sea-level change in 2021. Particularly, the monthly MSL peaked in April and July, and the contribution of wind stress to the anomalously high sea level was 38.5% in the south of the Taiwan Strait in April and 30% along the coast of China in July. These results were consistent with the tide gauge and satellite data. Close agreement was also observed between the coastal sea-level fingerprint and the air and sea surface temperatures.

Abstract This study presents a pioneering investigation into the complex Holocene paleo-morphologies of the Yilan Plain, located at the southwestern edge of the Okinawa Trough. We employed a novel approach that synergized resistivity measurements with machine learning techniques to unlock valuable insights into the geological history, sedimentary patterns, and seismic activity of this dynamic region. Our methodology involved the creation of an Apparent Geological Model (AGM) through the interpolation of inverted resistivity data and the application of supervised machine learning algorithms. Classification criteria, derived from the relationship between resistivity values and sediment types found in nearby boreholes, were developed using the random forest machine-learning method. The resultant 3D resistivity model was transformed into a clay-sand-gravel model, offering a comprehensive depiction of sediment distribution within the Yilan Plain. Notably, our findings revealed distinct sedimentary patterns. Gravel-dominated regions, characterized by resistivity values above 140 Ohm-m, were identified alongside areas dominated by sand and clay sediments. The Carbon-14 dating ages in the sand sediments exhibited remarkable consistency, shedding light on the depositional history of the region. Furthermore, our research unveiled a previously unknown phenomenon of rapid subsidence in the Yilan Plain. Through meticulous analysis and correction for sea-level changes, we estimated an average subsidence rate of approximately 8.5 mm/year. This subsidence was punctuated by abrupt events around 6000–7000 years BP and 2000–3000 years BP, associated with a sudden increase. These events suggested a potential link to prehistoric seismic activity, with variable subsidence rates between episodes hinting at recurrent active seismic periods every 4000–5000 years. In conclusion, our multidisciplinary approach has provided unprecedented insights into the Holocene paleo-morphologies of the Yilan Plain. By combining resistivity measurements, machine learning, and geological analysis, we have enriched our understanding of the region's geological history, sedimentary dynamics, and seismic behavior. These findings not only contribute to the knowledge of Yilan’s past but also offer vital data for future environmental and geological studies in similarly dynamic regions.

Abstract Background Galactosemia is an autosomal recessive disorder resulting from an enzyme defect in the galactose metabolic pathway. The most severe manifestation of classic galactosemia is caused by galactose-1-phosphate uridylyltransferase (GALT) deficiency, and this condition can be fatal during infancy if left untreated. It also may result in long-term complications in affected individuals. Case presentation This report describes a patient whose initial clinical symptoms were jaundice and liver dysfunction. The patient’s liver and coagulation functions did not improve after multiple admissions and treatment with antibiotics, hepatoprotective and choleretic agents and blood transfusion. Genetic analysis revealed the presence of two variants in the GALT gene in the compound heterozygous state: c.377 + 2dup and c.368G > C (p.Arg123Pro). Currently, the variant locus (c.377 + 2dup) in the GALT gene has not been reported in the Human Gene Mutation Database (HGMD), while c.368G > C (p.Arg123Pro) has not been reported in the Genome Aggregation Database (GnomAD) nor the HGMD in East Asian population. We postulated that the two variants may contribute to the development of classical galactosemia. Conclusions Applications of whole-exome sequencing to detect the two variants can improve the detection and early diagnosis of classical galactosemia and, more specifically, may identify individuals who are compound heterozygous with variants in the GALT gene. Variants in the GALT gene have a potential therapeutic significance for classical galactosemia.

Abstract Background The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being. Methods A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants’ experiences. Results A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability. Conclusions The participants have mixed perceptions of the program’s acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education.

This study investigates the propagation of dark Alfvén solitons in low-β magnetized plasma using Hall-magnetohydrodynamic (Hall-MHD) numerical simulations. The rational solution of the nonlinear Schrödinger equation (NLSE) is presented, which is proposed as an effective tool for studying dark envelope solitons in plasma. Our results show a high degree of agreement between numerical simulations and analytical solutions derived from the NLSE via the reductive perturbation method. This agreement validates our modeling and computational approach. In addition, the simulations confirm the existence of dark Alfvén solitons in magnetized plasma. This work demonstrates the effectiveness of Hall-MHD simulations in studying complex plasma phenomena, contributing to the broader understanding of soliton propagation in plasma environments.

ObjectiveTo study the effectiveness of liver transplantation (LT) in treating mitochondrial DNA depletion syndrome (MDS) caused by the MPV17 gene variant.Case presentationA boy aged 2.8 years presented with edema of the lower limbs and abdomen, which persisted for over 10 days and was of unknown origin; this was accompanied by abnormal liver function, intractable hypoglycemia, and hyperlactatemia. During the second week of onset, he developed acute-on-chronic liver failure and was diagnosed with MDS due to homozygous variant c.293C>T in the MPV17 gene. Subsequently, he underwent LT from a cadaveric donor. At follow-up after 15 months, his liver function was found to be normal, without any symptoms. Additionally, a literature review was performed that included MDS patients with the MPV17 variant who underwent LT. The results demonstrated that the survival rates for MDS patients who underwent LT were 69.5%, 38.6%, 38.6%, and 38.6% at 1-year, 5-year, 10-year, and 20-year intervals, respectively. Sub-group analyses revealed the survival rate of MDS patients with isolated liver disease (83.33%, 5/6) was higher than that of hepatocerebral MDS patients (44.44%, 8/18). Fifteen variants were identified in the MPV17 gene, and patients with the c.293C>T (p.P98l) variant exhibited the highest survival rate.ConclusionHepatocerebral MDS patients without neurological symptoms may benefit from LT.

Abstract Background Citrus is one of the most valuable fruits worldwide and an economic pillar industry in southern China. Nevertheless, it frequently suffers from undesirable environmental stresses during the growth cycle, which severely restricts the growth, development and yield of citrus. In plants, the growth-regulating factor (GRF) family of transcription factors (TF) is extensively distributed and plays an vital part in plant growth and development, hormone response, as well as stress adaptation. However, the systematic identification and functional analysis of GRF TFs in citrus have not been reported. Results Here, a genome-wide identification of GRF TFs was performed in Citrus sinensis, 9 members of CsGRFs were systematically identified and discovered to be scattered throughout 5 chromosomes. Subsequently, physical and chemical properties, phylogenetic relationships, structural characteristics, gene duplication events, collinearity and cis-elements of promoter were elaborately analyzed. In particular, the expression patterns of the CsGRF genes in response to multiple phytohormone and abiotic stress treatments were investigated. Predicated on this result, CsGRF04, which exhibited the most differential expression pattern under multiple phytohormone and abiotic stress treatments was screened out. Virus-induced gene silencing (VIGS) technology was utilized to obtain gene silenced plants for CsGRF04 successfully. After the three stress treatments of high salinity, low temperature and drought, the CsGRF04-VIGS lines showed significantly reduced resistance to high salinity and low temperature stresses, but extremely increased resistance to drought stress. Conclusions Taken together, our findings systematically analyzed the genomic characterization of GRF family in Citrus sinensis, and excavated a CsGRF04 with potential functions under multiple abiotic stresses. Our study lay a foundation for further study on the function of CsGRFs in abiotic stress and hormone signaling response.

Abstract Introduction Limited studies have evaluated the association between Clostridium difficile infection (CDI) and the duration of proton pump inhibitor (PPI) or histamine H2-receptor blocker (H2RA) use and provided a cutoff duration for PPI or H2RA use to mitigate a substantially increased risk of CDI. We aimed to evaluate these associations in hospitalized patients using a nationwide insurance claims database. Methods We conducted a nested case–control study to identify cases with a first ever record of CDI in a study cohort undergoing PPI or H2RA therapy from the National Health Insurance Database from 2012 to 2018. Each case was matched with one control by age, sex, and calendar year. We used conditional logistic regression to estimate the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC ROC). Youden’s J statistic was used to identify the optimal cutoff duration in days for PPI or H2RA use. Results In the main analysis, the AUC ROC was 0.64 (95% CI 0.63–0.66) and optimal cutoff duration was 15 days for PPI users. The AUC ROC was 0.63 (95% CI 0.62–0.64) and optimal cutoff duration was 16 days for H2RA users. In the sensitivity analyses, the results were similar to those of the main analysis, and the optimal cutoff duration was in the range of 14–15 days. Conclusions The optimal cutoff duration for PPI and H2RA use was about 2 weeks. It is necessary to be cautious regarding the risk of CDI in patients taking PPIs or H2RAs for longer than 2 weeks.

Research on the use of augmented reality technology in museums is mostly limited to scientific knowledge. The use of wearable device technology learning materials to benefit students in the process of English learning has been somewhat explored, along with differences in students' learning styles and their influence on students' learning motivation, but there remains much to be done in this field. This study explored the learning effect of smart glasses integration into the English language dinosaur exhibition at the Museum of Natural Science and investigated their impact on motivation. The experimental group used smart glasses learning strategy to facilitate their learning experience, whereas the control group used a tablet learning strategy. The research results show that: 1) Learning effectiveness and motivation were significantly superior when using smart glasses learning strategy, as compared to using a tablet learning strategy when learning through the English language situated exploration game. 2) The interaction between different learning strategies and learning styles had a significant impact on learning effectiveness. In the smart glasses learning strategy group and the tablet learning strategy group, the learning effectiveness of the kinesthetic students was significantly higher than those of the auditory students. The learning effectiveness of the visual students using the tablet learning strategy was higher than auditory students. 3) The interaction between different learning strategies and learning styles had no significant effect on learning motivation. In terms of learning motivation, visual students were more affected than auditory and kinesthetic students.

This paper aims to investigate the antecedents of how crowdfunded projects succeed over crowdsourcing platforms (CFPs) on the Internet. As CFPs make quite a large number of open innovations feasible, little is known about knowledge sharing and cross-project learning (CPL) in association with the success of crowdfunded projects. No study has considered the success of CFP projects in terms of gaining crowd capital with respect to generating ideas, achieving innovation or meeting the budget plan. However, the notion of project learning occurring on CFPs is essential. Therefore, this paper first adopted theories of project management and social exchange in one study. A developing region in the Asia-Pacific area is selected for examination as a case study. By doing so, it fills the gap in terms of the scarce research on this type of market, which is full of potential and possibilities. An empirical study was conducted on 43 project teams that had successfully won crowdsourcing projects. The results reveal that CPL in relation to project learning and esteem support in relation to social support are both positively associated with the success of crowd-funded projects. The discussion, implications and contributions of the study are presented at the end of the paper.

Abstract Background Epidural anesthesia (EA) is the regional anesthesia technique preferred over spinal anesthesia for pregnant women requiring cesarean section and post-operative pain control. EA failure requires additional sedation or conversion to general anesthesia (GA). This may be hazardous during sedation or GA conversion because of potentially difficult airways. Therefore, this retrospective study aimed to determine the risk factors for epidural failure during cesarean section anesthesia. Methods We retrospectively analyzed parturients who underwent cesarean section under EA and catheterization at the Chang Gung Memorial Hospital in Taiwan between January 1 and December 31, 2018. Patient data were collected from the medical records. EA failure was defined as the administration of any intravenous anesthetic at any time during a cesarean section, converting it into GA. Results A total of 534 parturients who underwent cesarean section were recruited for this study. Of them, 94 (17.6%) experienced EA failure during cesarean section. Compared to the patients with successful EA, those with EA failure were younger (33.0 years vs. 34.7 years), had received EA previously (60.6% vs. 37%), were parous (72.3% vs. 55%), and had a shorter waiting time (14.9 min vs. 16.5 min) (p