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Abstract In complicated urban environments, Global Navigation Satellite System (GNSS) signals are frequently affected by building reflection or refraction, resulting in Non-Line-of-Sight (NLOS) errors. In severe cases, NLOS errors can cause a ranging error of hundreds of meters, which has a substantial impact on the precision and dependability of GNSS positioning. To address this problem, we propose a reliable NLOS error identification method based on the Light Gradient Boosting Machine (LightGBM), which is driven by multiple features of GNSS signals. The sample data are first labeled using a fisheye camera to classify the signals from visible satellites as Line-of-Sight (LOS) or NLOS signals. We then analyzed the sample data to determine the correlation among multiple features, such as the signal-to-noise ratio, elevation angle, pseudorange consistency, phase consistency, Code Minus Carrier, and Multi-Path combined observations. Finally, we introduce the LightGBM model to establish an effective correlation between signal features and satellite visibility and adopt a multifeature-driven scheme to achieve reliable identification of NLOSs. The test results show that the proposed method is superior to other methods such as Extreme Gradient Boosting (XGBoost), in terms of accuracy and usability. The model demonstrates a potential classification accuracy of approximately 90% with minimal time consumption. Furthermore, the Standard Point Positioning results after excluding NLOSs show the Root Mean Squares are improved by 47.82%, 56.68%, and 36.68% in the east, north, and up directions, respectively, and the overall positioning performance is significantly improved.

Abstract Background Patient safety incidents are unavoidable and nurses, as parties involved, become second victims due to the incident itself and the way it is handled. In China, reconstructing the course of events is a crucial step in the aftermath of the incident; however, its impact on the emotional well-being of the second victim remains unclear. Purpose The purpose of this study is to gain insight into the psychological experiences and current conditions of nurses who act as second victims during the process of reconstructing the sequence of events. Additionally, the study aims to provide justifications for supporting these individuals. Methods An exploratory mixed research method was adopted to understand the emotional experience of the second victim when reconstructing the passage of the incident through qualitative research. Fourteen nurses with experience as second victims were selected for semi-structured interviews using purposive sampling according to the maximum difference sampling strategy. Through quantitative research, we explored the negative psychology and support needs of the second victims when they reverted to the incident, and a self-developed questionnaire (the Cronbach’s alpha coefficient was 0.895) was used to survey 3,394 nurses with experiences as second victims in 11 tertiary hospitals in Shanxi Province. Results In the qualitative part of the study, the emotional experience of the second victim’s reconstruction of the course of events after a patient safety incident could be categorized into 3 themes: negative views as initial psychological impact, avoidance as part of psychological impact, and expectations and growth in overcoming negative psychological impact. The quantitative part of the study revealed that the emotions of guilt and self-blame accounted for the highest percentage after a patient safety incident. The second victim presented a high score of 39.58 ± 5.45 for support requirements. Conclusion This study provides a better understanding of the true emotional experiences and the need for support of the second victim in the process of reconstructing the course of events. Following a patient safety incident, nursing administrators and healthcare institutions should consider the adverse psychological effects on the second victim, prioritize their support needs during the incident’s reconstruction, create a positive safety culture, and reduce the risk of secondary victimization for these individuals.

Abstract Background This study aimed to investigate the clinical and molecular genetic characteristics of ten children with ornithine carbamoyltransferase deficiency (OTCD) in southeastern China, as well as the correlation between the genotype and phenotype of OTCD. Methods A retrospective analysis was performed on the clinical manifestations, laboratory testing, and genetic test findings of ten children with OTCD admitted between August 2015 and October 2021 at Quanzhou Maternity and Children’s Hospital of Fujian Province in China. Results Five boys presented with early-onset symptoms, including poor appetite, drowsiness, groaning, seizures, and liver failure. In contrast, five patients (one boy and four girls) had late-onset gastrointestinal symptoms as the primary clinical manifestation, all presenting with hepatic impairment, and four with hepatic failure.Nine distinct variants of the OTC gene were identified, including two novel mutations: c.1033del(p.Y345Tfs*50) and c.167T > A(p.M56K). Of seven patients who died, five had early-onset disease despite active treatment. Three patients survived, and two of them underwent liver transplantation. Conclusions The clinical manifestations of OTCD lack specificity. However, elevated blood ammonia levels serve as a crucial diagnostic clue for OTCD. Genetic testing aids in more accurate diagnosis and prognosis assessment by clinicians. In addition, we identified two novel pathogenic variants and expand the mutational spectrum of the gene OTC, which may contribute to a better understanding of the clinical and genetic characteristics of OTCD patients.

Abstract Background In patient safety accidents, nurse managers are indirectly victimized by the pressures from many aspects and become the second victim. This study delves into the experiences of nurse managers in China, aiming to uncover their cognition and provide reference for relevant managers. Methods A descriptive phenomenological approach was used to gain insight into the inner reality of nurse leaders’ experiences and management perceptions of experiencing patient safety incidents. The data of 15 nurse leaders who experienced patient safety incidents in Bethune Hospital, Shanxi Province, China, were collected via face‒to‒face semi-structured interviews, and the data were analyzed via the 7-step analysis method of Colaizzi. Results On the basis of the content of the interviews, three themes were identified, the emotional experience of experiencing patient safety events, role dilemmas, the obstruction and conceptual reshaping of nursing management. Eight subthemes as follows: physical and mental health-related symptoms due to passive coping and life and work disorder, self-relief, playing multiple roles with lack of role adjustment ability, blurred role positioning and initial signs of job burnout, event replay is impeded, Inaccurate analysis of safety incidents, subversion and remolding of the nursing management concept. Finally, it can be abstracted as “forced growth in patient safety events”. Conclusion Patient safety incidents can lead to negative impacts, role dilemmas, and management confusion for head nurses, but they also promote purposeful rumination, meditation, and growth. Medical institutions should pay attention to special groups that are second victims of head nurses and construct a safety event support system for nurse leaders to improve the post-training and education system for nurse leaders, help them better adapt to their roles, break through their role dilemmas, improve their post-competence, and construct an effective safety event management system.

Abstract Introduction Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is a common and potentially fatal post-surgery complication. Research has shown that 50% of VTE causes are intraoperative, with the risk of occurrence highest during and immediately post-surgery. Therefore, strategies for early assessment and prevention should be established. Objective To identify optimal equipment selection, compression protocols, and strategies for complication prevention and management during intraoperative intermittent pneumatic compression (IPC), this study aims to synthesize the best available evidence. The objective is to inform accurate risk assessment and facilitate early mechanical prophylaxis against venous thrombosis. Methods The Practical Application to Clinical Evidence model proposed by the Joanna Briggs Institute was utilized. Indicators were identified using the available best evidence from January 2023 to October 2023, and a baseline review was conducted. Negative factors were identified based on clinical evidence-based practice. The implementation rates of different indicators before (n = 372) and after (n = 405) evidence-based practice, the incidence rates of intraoperative IPC-related adverse events and VTE, and the risk of venous thrombosis before (n = 50) and after (n = 50) practice were identified and compared. Furthermore, medical staff’s knowledge of best practices for intraoperative IPC was assessed through pre- and post-intervention surveys involving 109 operating room personnel. Results All review indicators significantly improved (P 0.05). However, there were significant differences in intraoperative venous blood hemodynamics before and after the practice (P

The uncertainties in microwave land surface emissivity (MLSE) measurements have long limited the use of spaceborne microwave radiometer data. As an emerging observation method, Global Navigation Satellite System Reflectometry (GNSS-R) has demonstrated great potential in several land and ocean applications. In this study, a method for obtaining daily MLSE dataset in the pan-tropical region from Cyclone GNSS (CYGNSS) observations is presented and evaluated. The CYGNSS observations are first aggregated into the Equal-Area-Scalable-Earth (EASE) 2.0 36 km grid by a combined weight function of distance, time, and signal-to-noise ratio variance. Then, the method employs a pixel-by-pixel regression algorithm to conduct the daily MLSE retrieval using reference emissivity derived from the Soil Moisture Active Passive (SMAP) brightness temperature. The CYGNSS MLSE shows good agreement with SMAP MLSE, delivering an overall root-mean-square error (RMSE) of 0.022 and 0.017 for horizontal and vertical polarization, respectively, during the training set spanning the whole year of 2018. Furthermore, on the test set from January 2019 to May 2019, the RMSE values amounted to 0.030 and 0.023 for horizontal and vertical polarization, respectively. Temperature records from the International Soil Moisture Network are employed to calculate the emissivity and for in-situ validation, which yield an RMSE of 0.034 and 0.026 for the two polarizations, respectively. The proposed algorithm provides an encouraging approach to obtain accurate daily MLSE dataset for microwave remote sensing. Compared to the SMAP MLSE, the CYGNSS MLSE has a remarkable improvement of 86% in temporal resolution, greatly complementing the existing microwave emissivity datasets.

The MYH6 gene encodes α-myosin heavy chain in the adult human heart. MYH6 c.4034T > C (p.Leu1345Pro) mutation in MYH6 gene have been reported in patients with hypertrophic cardiomyopathy (HCM), but its causal role in HCM is less certain and has not been established unambiguously. Here, we generated a MYH6 (c.4034T > C) mutant human embryonic stem cell line (WAe009-A-1D) based on the CRISPR adenine base editing system that converts base A/T to G/C. The WAe009-A-1D cell maintains the morphology, pluripotency, and normal karyotype of the stem cells and is capable of differentiating into all three germ layers in vivo.

This article embarks on a comparative analysis to uncover the role of the island as a liminal space in William Shakespeare's *The Tempest* and the television series *Lost*, exploring its function in facilitating redemption, fantasy, and transformation. The study elucidates how both narratives utilize the island not merely as a setting but as a crucial catalyst for character evolution and thematic depth. Through an examination of geographical, temporal, and psychological dimensions of liminality, the article demonstrates the island's pivotal role as a space where human complexity, the quest for identity, and aspirations towards redemption unfold. The comparative inquiry highlights narrative and thematic correspondences, underlining the interpretive richness offered by the concept of liminality within literary and media studies. This analysis accentuates the enduring significance of liminal spaces in fostering significant personal and collective transformations, despite disparities in medium and historical context.

Purpose Systemic immune-inflammation index (SII) was an indicator which could reflect immune response and systemic inflammation. We aim to explore the relationship between SII and diabetic nephropathy (DN). Methods SII was calculated as neutrophil count × platelet count/lymphocyte count. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnosis power of SII. Univariate and multivariate logistic analysis were conducted to assess SII as the risk factor for DN. A restricted cubic spline model was carried out to show the nonlinear association between SII and DN. Results Two hundred participants were enrolled, with an average age of 56.6 ± 13.4 years; 54% participants were categorized as DN. Spearman association analysis showed SII was positive associated with increased urinary albumin to creatinine ratio and serum creatinine, while negative associated with eGFR and serum albumin. The ROC curve revealed that the maximum area under the curve (AUC) was 0.761 (95% CI, 0.694-0.828, P

BackgroundForsythia suspensa (F. suspensa) is a plant of the Oleaceae family that is used as a medicinal plant. It is a traditional Chinese medicine that functions in clearing heat and detoxification. F. suspensa contains various phytochemicals, such as lignans, flavonoids, triterpenoids, and phenylethanolic glycosides; however, the main active phytochemical in F. suspensa is phillygenin, which has lipid-lowering, antioxidant, antihypertensive, and tyrosinase inhibitory effects. However, the content of phillygenin in F. suspensa is very low, limiting its application.MethodsThis study used wild F. suspensa leaves (FSL) from Lingchuan County (LC), Anze County (AC), Pingshun County (PS), and Pingding County (PD) in Shanxi Province as experimental materials. Through a single factor and orthogonal experimental design, the fermentation time, temperature, and humidity of F. suspensa leaf fermented tea (FSLFT) were optimized using a black tea fermentation machine. By comparing the differences in phillygrin and phillygenin content in FSL and FSLFT, the optimal production process for increasing phillygenin content in FSLFT was sought. This study also compared the differences in bioactive substance content and in vitro antioxidant and antibacterial functions of wild FSLFT from the four counties to evaluate the quality of wild FSLFT from the four counties.ResultsThe optimal technological parameters of Forsythia suspensa leaf fermented tea (FSLFT): fermentation time of 2 h, fermentation humidity of 80%, fermentation temperature of 35°C, the experimental results showed that the order of influence of each factor on phillygenin content was C (fermentation temperature) > A (fermentation time) > B (fermentation humidity). The cellulase activity of FSLFT was significantly higher than that of FSL (P < 0.05). The total volatile compounds of the wild FSLFT from the four counties were 87 volatile aroma components, 13 of which were common aroma components, and the PCA scores ranged from high to low as follows: AZ-FSLFT > LC-FSLFT > PS-FSLFT > PD-FSLFT. The antioxidant effects of the FSLFT were as follows: AZ-FSLFT > LC-FSLFT > PS-FSLFT > PD-FSLFT. PD-FSLFT had the least inhibitory effect on both Gram-positive and Gram-negative bacteria, whereas AZ-FSLFT had the greatest inhibitory effect.ConclusionFermentation promoted the conversion of phillygrin to phillygenin in FSL, which might be related to the increased cellulase activity in FSL during fermentation. The AZ-FSLFT had the best quality and functional activity, which made sense given its active ingredient content. The AZ-FSLFT had the best quality and functional activity, which made sense given its active ingredient content. This study contributes to the comprehensive development and utilization of F. suspensa leaves for economic and healthcare purposes.

BackgroundAccording to recent research, there is a considerable correlation between the severity of coronary artery disease and the platelet-to-high-density lipoprotein cholesterol ratio (PHR), which suggests that PHR is a potentially valuable inflammatory biomarker. However, the body of current research offers insufficiently strong evidence to clarify the connection between PHR and the incidence of stroke. Therefore, this study aims to elucidate any potential associations between PHR and stroke risk.MethodsThis study employed data from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2011 to 2018. It included 5,872 participants who did not have a history of stroke in 2011. These patients were separated into four groups according to their baseline PHR quartiles. The main goal of the study was to focus on stroke outcomes. Stroke was defined as an occurrence of a cerebrovascular accident confirmed by a physician. We employed Cox proportional hazards regression models to investigate the association between PHR and the likelihood of experiencing a stroke. Furthermore, we conducted restricted cubic spline regression analysis and subgroup analysis.ResultsThe average follow-up period was 77.5 months, during which 390 participants experienced a stroke. In comparison to the lowest quartile group, participants in the highest quartile of PHR had a 49% increased risk of stroke (HR 1.49, 95% CI 1.13–1.96, p = 0.004). The adjusted multivariable Cox regression analysis maintained the statistical significance of this association (aHR 1.42, 95% CI 1.06–1.90, p = 0.019). After adjustment, a positive linear relationship between stroke risk and PHR was identified through restricted cubic spline regression analysis (nonlinear p > 0.05). Additionally, the impact of stroke was consistent across a variety of subgroups, as evidenced by subgroup analysis.ConclusionOur study indicates that higher PHR levels are significantly associated with an increased risk of stroke and that these levels can be used to identify groups that are at high risk of stroke.

Background In patients with untreated CD20-positive diffuse large B-cell lymphoma (DLBCL), a phase 3 trial was carried out to evaluate the efficacy and safety of zuberitamab plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone; Hi-CHOP) versus rituximab plus CHOP (R-CHOP) treatment regimens.Methods In a 2:1 ratio, eligible patients were assigned randomly to receive treatment of six cycles of either 375 mg/m2 zuberitamab or rituximab together with conventional CHOP chemotherapy. The objective response rate (ORR) at C6D50 served as the primary endpoint, and a non-inferiority margin of 10% was established. The secondary endpoints included the complete response (CR) rate at C6D50, duration of response (DOR), progression-free survival (PFS) and event-free survival (EFS) judged by blinded-independent review committee (BIRC), overall survival (OS) and safety outcomes.Results Of the 487 randomized patients, 423 patients including 287 in the Hi-CHOP and 136 in the R-CHOP groups completed the C6D50 assessment. For the full analysis set (FAS) and per-protocol set (PPS), BIRC-assessed ORR at C6D50 for the Hi-CHOP and R-CHOP groups were 83.5% versus 81.4% and 95.3% versus 93.7%, respectively. The non-inferiority was confirmed as the lower limit of the two-sided 95% CI for the intergroup differences of −5.2% and −3.3%; both were >−10% in the FAS and PPS. The BIRC-assessed CR rate of Hi-CHOP was significantly higher in PPS (85.7% vs 77.3%, p=0.038), but comparable in FAS (75.2% vs 67.9%, p=0.092). After a median follow-up of 29.6 months, patients in the Hi-CHOP group had a slight advantage with regard to the DOR (HR 0.74, p=0.173), PFS (HR 0.67, p=0.057), EFS (HR 0.90, p=0.517) and OS (HR 0.60, p=0.059). Patients with the germinal-center B cell-like subtype who received Hi-CHOP exhibited statistically significant improvements in ORR (p=0.034) and CR rate (p=0.038) at C6D50, EFS (p=0.046) and OS (p=0.014). Treatment-emergent adverse event occurrence rates were comparable across groups (all p>0.05). Infusion-related responses occurred more often in the Hi-CHOP group (32.1% vs 19.9%, p=0.006), all of grade 1–3 severity.Conclusions Zuberitamab (375 mg/m2) plus CHOP was non-inferior to R-CHOP regarding ORR but exhibited a higher CR rate and was well tolerated in CD20-positive, previously untreated Chinese patients with DLBCL.Trial registration number Chinese Clinical Trial Registry, ChiCTR2000040602, retrospectively registered.

Abstract The inefficient delivery of herbicides causes unpleasant side effects on the ecological environment. Protoporphyrinogen oxidase (PPO)‐inhibiting herbicides rely on the presence of external light to exert the activities and thus their performance in the field is extremely susceptible to the light environment. Here, taking acifluorfen (ACI) as a model PPO‐inhibiting herbicide to enhance efficacy by boosting the utilization rate of sunlight, amphiphilic cationic CDs (CPC‐CDs) from cetylpyridinium chloride (CPC) as a precursor, is first prepared as a supplementary light source generator, and subsequently co‐assembled with ACI through non‐covalent bond interactions to obtain the stable fluorescent nanoparticles (ACI@CPC‐CDs). ACI@CPC‐CDs with fascinating physicochemical properties can penetrate the leaves of weeds through the stomata and undergo a long‐distance transport in the cell intervals. Under low light intensity, CPC‐CDs can be applied as the internal light source to promote the formation of more singlet oxygen to damage the leaf cell membrane, consequently improving the herbicidal activity of ACI. Moreover, the safety evaluation of ACI@CPC‐CDs demonstrates no risk to non‐target organisms and the environment. Therefore, this work offers a promising strategy for the efficient delivery of light‐dependent PPO‐inhibiting herbicides and opens new insights into the application of CDs in the development of sustainable agriculture.

To address the challenges of high grinding force and poor processing quality in grinding zirconia ceramics with traditional grinding wheels, this study explores the use of leaf vein bionic fractal textured diamond grinding wheels. These wheels, designed with fractal angles of 30.0°, 45.0°, and 60.0°, leverage the leaf vein bionic fractal texture's capabilities in reducing drag, guiding flow, heat dissipation, and mass transfer. The effects of the original grinding wheel and the three types of bionic fractal grinding wheels on the surface roughness (Ra), grinding force, and grinding force ratio of zirconia ceramics were compared and analyzed. The results show that the bionic fractal grinding wheels outperform the original grinding wheel. Specifically, compared to the original grinding wheel, the normal grinding force of the bionic fractal grinding wheel is reduced by 12.7% to 55.8%, and the tangential grinding force is reduced by 8.1% to 40.3%. The bionic fractal grinding wheels have not obvious effects on the surface roughness Ra. When the fractal angle is 30.0°, the minimum grinding force ratio is 1.4 to 3.0, and the minimum surface roughness Ra is 1.824 μm.

Abstract BeiDou global navigation satellite system (BDS-3), a developed GNSS by China, has the ability to support five different signals, including B1I, B3I, B1C, B2a, and B2b. Meanwhile, BDS-3 has officially provided the satellite-based precise point positioning (PPP) service through the B2b signal (PPP-B2b) since 2021. It’s necessary to conduct a comprehensive analysis on multi-frequency PPP with PPP-B2b corrections. In this study, a multi-frequency undifferenced and uncombined PPP model (UDUC) using PPP-B2b corrections was employed to investigate dual-frequency to five-frequency real-time PPP performance. The results show that compared with the conventional dual-frequency solutions, multi-frequency solutions can improve both the convergence performances and positioning accuracy of PPP-B2b service, especially during the convergence stage. The quad-frequency and five-frequency solutions can achieve the best positioning performance. The static solutions of multi-frequency PPP models reach the centimeter-level accuracy after convergence. In kinematic mode, the convergence time of the five-frequency PPP results is reduced by 23.5% compared with the dual-frequency results. The root mean square (RMS) errors of the five-frequency PPP in the E, N, and U components are 7.1 cm, 4.8 cm, and 12.4 cm, which are improved by 6.8%, 11.5%, and 5.5%, respectively. Graphical Abstract

Abstract The integer least squares (ILS) estimation is commonly used for carrier phase ambiguity resolution (AR). More recently, the best integer equivariant (BIE) estimation has also attracted an attention for complex application scenarios, which exhibits higher reliability by a weighted fusion of integer candidates. However, traditional BIE estimation with Gaussian distribution (GBIE) faces challenges in fully utilizing the advantages of BIE for urban low-cost positioning, mainly due to the presence of outliers and unmodeled errors. To this end, an improved BIE estimation method with Laplacian distribution (LBIE) is proposed, and several key issues are discussed, including the weight function of LBIE, determination of the candidates included based on the OIA test, and derivation of the variance of LBIE solutions for reliability evaluation. The results show that the proposed LBIE method has the positioning accuracy similar to the BIE using multivariate t-distribution (TBIE), and significantly outperforms the ILS-PAR and GBIE methods. In an urban expressway test with a Huawei Mate40 smartphone, the LBIE method has positioning errors of less than 0.5 m in three directions and obtains over 50% improvements compared to the ILS-PAR and GBIE methods. In an urban canyon test with a low-cost receiver STA8100 produced by STMicroelectronics, the positioning accuracy of LBIE in three directions is 0.112 m, 0.107 m, and 0.252 m, respectively, with improvements of 17.6%, 27.2%, and 26.1% compared to GBIE, and 23.3%, 28.2%, and 30.6% compared to ILS-PAR. Moreover, its computational time increases by 30–40% compared to ILS-PAR and is approximately half of that using TBIE.

Abstract Colorectal cancer (CRC) often necessitates cetuximab (an EGFR-targeting monoclonal antibody) for treatment. Despite its clinical utility, the specific operative mechanism of cetuximab remains elusive. This research investigated the influence of PLCB3, a potential CRC oncogene, on cetuximab treatment. We extracted differentially expressed genes from the GSE140973, the overlapping genes combined with 151 Wnt/β-Catenin signaling pathway-related genes were identified. Then, we conducted bioinformatics analysis to pinpoint the hub gene. Subsequently, we investigated the clinical expression characteristics of this hub gene, through cell experimental, scrutinized the impact of cetuximab and PLCB3 on CRC cellular progression. The study identified 26 overlapping genes. High expression of PLCB3, correlated with poorer prognosis. PLCB3 emerged as a significant oncogene associated with patient prognosis. In vitro tests revealed that cetuximab exerted a cytotoxic effect on CRC cells, with PLCB3 knockdown inhibiting CRC cell progression. Furthermore, cetuximab treatment led to a reduction in both β-catenin and PLCB3 expression, while simultaneously augmenting E-cadherin expression. These findings revealed PLCB3 promoted cetuximab inhibition on Wnt/β-catenin signaling. Finally, simultaneous application of cetuximab with a Wnt activator (IM12) and PLCB3 demonstrated inhibited CRC proliferation, migration, and invasion. The study emphasized the pivotal role of PLCB3 in CRC and its potential to enhance the efficacy of cetuximab treatment. Furthermore, cetuximab suppressed Wnt/β-catenin pathway to modulate PLCB3 expression, thus inhibiting colorectal cancer progression. This study offered fresh perspectives on cetuximab mechanism in CRC.

Abstract Background Untargeted metabolomics and proteomics were employed to investigate the intracellular response of yak rumen epithelial cells (YRECs) to conditions mimicking subacute rumen acidosis (SARA) etiology, including exposure to short-chain fatty acids (SCFA), low pH5.5 (Acid), and lipopolysaccharide (LPS) exposure for 24 h. Results These treatments significantly altered the cellular morphology of YRECs. Metabolomic analysis identified significant perturbations with SCFA, Acid and LPS treatment affecting 259, 245 and 196 metabolites (VIP > 1, P

BackgroundIntrahepatic cholestasis of pregnancy (ICP) and gestational diabetes mellitus (GDM) are two common pregnancy complications that pose considerable health challenges. The interplay between these conditions is believed to significantly influence pregnancy outcomes, yet the nature of this relationship remains elusive. This study was designed to elucidate the connection between ICP and GDM.MethodsThis retrospective cohort study included 742 singleton pregnancies delivered at the Shanghai Public Health Clinical Center from January 2015 to December 2023. We compared the incidence of GDM and pregnancy outcomes between multiple ICP subgroups and a control group of healthy pregnancies. A multivariate regression model was used to measure the independent association between ICP and propensity for GDM development, as well as to assess the impact of potential bidirectional effects between ICP and GDM.ResultsThe results indicate that the incidence of GDM is highest in the early-onset ICP (diagnosed before the 24th week of gestation) group compared to the control group and other ICP subgroups. Early-onset ICP is an independent risk factor for the development of GDM, with other risk factors including age, history of abortion, family history of diabetes, and elevated ALT levels. Subgroup interaction analysis did not reveal heterogeneity in the influence of early-onset ICP on the development of GDM across different subgroups. Further analysis showed that GDM itself does not increase the risk of late-onset ICP. Additionally, when comparing pregnancy outcomes between GDM patients with or without ICP, those with both GDM and ICP had significantly higher rates of preterm birth, cesarean section, and small for gestational age (SGA) compared to patients with GDM alone. Furthermore, elevated TBA levels (first diagnosed) of early-onset ICP patients were associated with an increased risk of GDM in a nonlinear fashion.ConclusionOur study indicated that early-onset ICP is significantly linked to an increased risk of GDM. Further research is warranted to explore the mechanisms behind this association and to develop strategies for early identification and intervention to mitigate GDM risk.

IntroductionThe protective effect of sodium–glucose cotransporter-2 (SGLT-2) inhibitors on the kidneys has been widely recognized. However, limited research has reported the changes in estimated glomerular filtration rate (eGFR) of real-world patients with type 2 diabetes mellitus (T2DM) over time after administration of SGLT-2 inhibitors. This study aimed to reflect the trend of eGFR changes over time in T2DM patients having different baseline eGFR after SGLT-2 inhibitors administration in the real world.MethodsA single-center retrospective study was performed in a tertiary public hospital in Beijing, China. In total, 998 outpatients with T2DM who initiated SGLT-2 inhibitors treatment were included in the study. The changes in eGFR, urinary albumin/creatinine ratio (UACR), and glycolipid metabolism indicators were analyzed during the 18-month follow-up period.ResultsThe eGFR levels significantly decreased to their lowest point (−3.04 mL/min/1.73 m2) in the first 3 months after initiation of SGLT-2 inhibitors treatment, however, gradually returned to the baseline level after 1 year. Compared to the subgroup with eGFR >90 mL/min/1.73 m2, improvements in renal function were more significant in patients with T2DM from the 60 < eGFR ≤90 mL/min/1.73 m2 and eGFR ≤60 mL/min/1.73 m2 subgroups after treatment with SGLT-2 inhibitors. Similarly, SGLT-2 inhibitors reduced the UACR in patients with diabetic nephropathy.ConclusionThis study further confirmed the real-world long-term protective effect of SGLT-2 inhibitors on the kidneys of patients with T2DM, which is not related to baseline renal function and blood glucose.

Stress-associated proteins (SAPs) are known to play an important role in plant responses to abiotic stresses. This study systematically identified members of the sunflower SAP gene family using sunflower genome data. The genes of the sunflower SAP gene family were analyzed using bioinformatic methods, and gene expression was assessed through fluorescence quantification (qRT-PCR) under salt and drought stress. A comprehensive analysis was also performed on the number, structure, collinearity, and phylogeny of seven Compositae species and eight other plant SAP gene families. The sunflower genome was found to have 27 SAP genes, distributed across 14 chromosomes. The evolutionary analysis revealed that the SAP family genes could be divided into three subgroups. Notably, the annuus variety exhibited amplification of the SAP gene for Group 3. Among the Compositae species, C. morifolium demonstrated the highest number of collinearity gene pairs and the closest distance on the phylogenetic tree, suggesting relative conservation in the evolutionary process. An analysis of gene structure revealed that Group 1 exhibited the most complex gene structure, while the majority of HaSAP genes in Group 2 and Group 3 lacked introns. The promoter analysis revealed the presence of cis-acting elements related to ABA, indicating their involvement in stress responses. The expression analysis indicated the potential involvement of 10 genes (HaSAP1, HaSAP3, HaSAP8, HaSAP10, HaSAP15, HaSAP16, HaSAP21, HaSAP22, HaSAP23, and HaSAP26) in sunflower salt tolerance. The expression of these 10 genes were then examined under salt and drought stress using qRT-PCR, and the tissue-specific expression patterns of these 10 genes were also analyzed. HaSAP1, HaSAP21, and HaSAP23 exhibited consistent expression patterns under both salt and drought stress, indicating these genes play a role in both salt tolerance and drought resistance in sunflower. The findings of this study highlight the significant contribution of the SAP gene family to salt tolerance and drought resistance in sunflower.

Objectives To assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation.Design Prospective randomised controlled trial.Setting Single-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central Hospital, China.Participants Eligible were adult patients undergoing elective gynaecologic oncologic surgery.Interventions The intervention group utilised a modified Borg Rating of Perceived Experience (RPE) scale for self-assessment of fatigue levels. The control group followed fixed-activity distance guidelines postoperatively.Primary and secondary outcome measures The primary outcome was the self-reported the time to first flatus postoperatively. Secondary outcomes encompassed the time to first defecation, incidence of moderate-to-severe abdominal distention, ileus, postambulation adverse events (nausea, vomiting and dizziness), patient satisfaction with early ambulation instructions, compliance with early ambulation and average hospital costs and length of stay.Results Between June 2021 and October 2022, 552 patients were enrolled. The self-assessed fatigue intervention group demonstrated non-inferior the time to first flatus compared with the fixed-activity distance assessment group (25.59±14.59 hours vs 26.10±14.19 hours, pnon-inferiority

BackgroundHigh-intensity chemotherapy can cause life-threatening complications in pediatric patients. Therefore, this study investigated safety and efficacy of long-acting pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF; Jinyouli®) in children undergoing high-intensity chemotherapy.MethodsTreatment-naive patients received post-chemotherapy PEG-rhG-CSF as primary prophylaxis for two cycles. The primary endpoints were drug-related adverse events (AEs) and bone pain scores. Secondary endpoints included grade 3–4 neutropenia, duration of neutropenia recovery, absolute neutrophil count changes, febrile neutropenia (FN), reduced chemotherapy intensity, antibiotic usage, and AE severity. The cost-effectiveness of PEG-rhG-CSF was compared with that of rhG-CSF (Ruibai®).ResultsHere, 307 and 288 patients underwent one and two PEG-rhG-CSF cycles, respectively. Ninety-one patients experienced drug-related AEs, primarily bone pain (12.7%). Moreover, Grade 3–4 neutropenia and FN were observed. Median FN durations were 3.0 days in both cycles. No drug-related delays were observed during chemotherapy. One patient experienced grade 4 neutropenia-induced reduction in chemotherapy intensity during cycle 2. In total, 138 patients received antibiotics. PEG-rhG-CSF exhibited superior cost-effectiveness compared to rhG-CSF.ConclusionOur findings indicate that PEG-rhG-CSF is safe, efficient, and cost-effective in pediatric patients undergoing high-intensity chemotherapy, providing preliminary evidence warranting further randomized controlled trials.

Background: Efficient diagnosis of patients at high risk for invasive aspergillosis (IA) improves the outcome of the disease. Lateral flow assay (LFA) is a novel technology and assessing its diagnostic accuracy is of great significance in the clinical management of IA. Methods: A meta-analysis using case-control studies was performed to assess the diagnostic performance of LFA alone or galactomannan (GM) combined with LFA (GM-LFA) as screening tests for IA. The sensitivity, specificity, and summary receiver operating characteristic curves were constructed. Results: Nineteen studies with 2838 patients were included. The pooled effect sizes for different indicators included: sensitivity (77 % for LFA and 75 % for GM-LFA), specificity (88 % for LFA and 87 % for GM-LFA), positive likelihood ratio (6.65 for LFA and 12.02 for GM-LFA), negative likelihood ratio (0.26 for LFA and 0.27 for GM-LFA), and the diagnostic odds ratio (25.81 for LFA and 44.87 for GM-LFA). The area under the curve was 0.91 for LFA and 0.94 for GM-LFA with a cut-off value ≥ 0.5. Conclusion: The present meta-analysis suggested that LFA or GM-LFA at an optical density index (ODI) cutoff of ≥0.5 was a useful diagnostic tool for IA in patients. The results showed no significant differences in the accuracy of LFA alone and GM-LFA in diagnosing IA. In the clinical diagnosis and treatment of IA, LFA can be recommended if timely results are needed.

Abstract Quantitative understanding of the land water loading is a prerequisite to the construction of reliable tectonic deformation velocity field in the Tibetan Plateau (TP). Here, for the first time, we image the three‐dimensional crustal loading deformation velocity field of each land water component in the TP. Our results reveal that the loading signal strength of the six land water components ranks from largest to smallest as groundwater, glacier, lake, soil water, permafrost, and snow, with the maximum vertical velocity close to ±1.60 mm/yr and the maximum horizontal velocity exceeding 0.40 mm/yr. All land water components can achieve a strong enough vertical loading velocity exceeding the present‐day Global Positioning System (GPS) velocity at some sites. But for horizontal loading, apparent impacts are only from glacier, lake and groundwater, however, are very limited, with the absolute ratio of loading velocity to GPS velocity being smaller than 5% at almost all the sites.

The success of vision Transformers (ViTs) relies heavily on the self-attention mechanism, which requires support from appropriate patch tokenization. However, hyperspectral image (HSI) often suffer from significant noise distortions and spectral uncertainty, which result in unstable attention patterns and overfitting due to equivocal tokenization. In this paper, we propose a neighborhood contrastive tokenization task (NeiCoT) to learn compact, semantically meaningful, and context-sensitive tokens for efficient Transformer encoding. Specifically, we employ a predictor on patch embedding to maximize the mutual information between local individuals and their global average anchor. This encourages neighboring tokens’ relevance and active participation in feature learning. Next, we revise a token-level contrastive loss to align predictions with local individuals and distinguish them from other samples in a mini-batch to enhance tokens rich in contextual semantics. Furthermore, we apply a Gaussian weighting to the tokens’ contrastive loss to balance the neighborhood contribution. Finally, we propose a sequence-specific MAE framework with NeiCoT to achieve HSI representation, and additionally validate NeiCoT on a supervised Transformer backbone. The results demonstrate that NeiCoT consistently enhances the robustness and generalization of the Transformer, achieving accurate object recognition and boundary localization even with limited training samples. Our code will be available at https://github.com/zoegnov07/NeiCoT.

In the context of ongoing global climate warming, researchers have observed an intricate relationship between the variability of Terrestrial Water Storage (TWS) on the Tibetan Plateau (TP) and climate anomalies. In this study, we utilize a combination of Global Navigation Satellite System (GNSS), Gravity Recovery and Climate Experiment (GRACE), and precipitation data to investigate the response of TWS on the TP to extreme climate changes, with a focus on seasonal and interannual variations. Our findings reveal that the first Common Mode Component (1st CMC) extracted from GNSS coordinate time series exhibits strong interannual fluctuations. Additionally, both GNSS and GRACE-inferred TWS demonstrate noticeable anomalous changes during the 2015/2016 period. The estimated periods of the 1st CMC of GNSS and GRACE-inferred TWS are approximately 5 and 7 years, respectively. Both reach a minimum during the extreme climate event in 2015/2016. Furthermore, we investigate the spatial variation of summer precipitation before and after the extreme drought event on the TP. It reveals that the inflection point of TWS occurs approximately 1 year prior to the drought event, suggesting a consistent spatial propagation process between precipitation and TWS. This indicates that the changes of TWS during this drought event were primarily influenced by precipitation. Finally, we evaluate the response of 12 sub-basins on the TP to the drought event that occurred in 2015/2016. The regions experiencing significant abnormal fluctuations in TWS are mainly located in inner and northeastern plateau. These regions show rapid upward changes in the TWS and demonstrate a strong spatial consistency with summer precipitation.