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The study of distant galaxy groups and clusters at the peak epoch of star formation is limited by the lack of a statistically and homogeneously selected and spectroscopically confirmed sample. Recent discoveries of concentrated starburst activities in cluster cores have opened a new window to hunt for these structures based on their integrated IR luminosities. Here, we carry out a large NOEMA (NOrthern Extended Millimeter Array) program targeting a statistical sample of infrared-luminous sources associated with overdensities of massive galaxies at z > 2, the Noema formIng Cluster survEy (NICE). We present the first result from the ongoing NICE survey, a compact group at z = 3.95 in the Lockman Hole field (LH-SBC3), confirmed via four massive (M∗ ≳ 1010.5 M⊙) galaxies detected in the CO(4-3) and [CI](1-0) lines. The four CO-detected members of LH-SBC3 are distributed over a 180 kpc physical scale and the entire structure has an estimated halo mass of ~1013 M⊙ and total star formation rate of ~4000 M⊙ yr-1. In addition, the most massive galaxy hosts a radio-loud active galactic nucleus with L1.4 GHz, rest = 3.0 × 1025 W Hz-1. The discovery of LH-SBC3 demonstrates the feasibility of our method to efficiently identify high-z compact groups or cluster cores undergoing formation. The existence of these starbursting cluster cores up to z ~ 4 provides critical insights into the mass assembly history of the central massive galaxies in clusters.

Yun Xiang,1,2,* Dini Lin,1,* Qiang Zhou,1 Hongyu Luo,1 Zixin Zhou,1 Shuyi Wu,2 Keyuan Xu,2 Xiaoting Tang,1 Pingping Ma,2 Chunyuan Cai,1 Xinkun Shen1 1Wenzhou Key Laboratory for the Diagnosis and Prevention of Diabetic Complications, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People’s Hospital), Wenzhou, 325016, People’s Republic of China; 2School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China*These authors contributed equally to this work and share first authorshipCorrespondence: Xinkun Shen; Chunyuan Cai, Wenzhou Key Laboratory for the Diagnosis and Prevention of Diabetic Complications, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People’s Hospital), Wenzhou, Zhejiang Province, 325016, People’s Republic of China, 108# Wansong Road, Email shenxinkun123@wmu.edu.cn; caichunyuan123@wmu.edu.cnBackground: Large-diameter titanium dioxide nanotubes (TNTs) have shown promise in preserving osteoblast function under oxidative stress (OS) in vitro. However, their ability to enhance osteogenesis in vivo under OS conditions and the underlying mechanisms remain unclear.Purpose: This study aimed to evaluate the osteogenic potential of 110 nm TNTs (TNT110) compared to 30 nm TNTs (TNT30) in an aging rat model exhibiting OS, and to investigate the mechanisms involved.Methods: Surface properties of TNTs were characterized, and in vitro and in vivo experiments were conducted to assess their osteoinductive effects under OS. Transcriptomic, proteomic analyses, and Western blotting were performed to investigate the protective mechanisms of TNT110 on osteoblasts. Protein adsorption studies focused on the roles of fibronectin (FN) and albumin (BSA) in modulating osteoblast behavior on TNT110.Results: In both in vitro and in vivo experiments, TNT110 significantly improved new bone formation and supported osteoblast survival under OS conditions. Subsequent ribonucleic acid sequencing results indicated that TNT110 tended to attenuate inflammatory responses and reactive oxygen species (ROS) expression while promoting endoplasmic reticulum (ER) stress and extracellular matrix receptor interactions, all of which are crucial for osteoblast survival and functionality. Further confirmation indicated that the cellular behavior changes of osteoblasts in the TNT110 group could only occur in the presence of serum. Moreover, proteomic analysis under OS conditions revealed the pivotal roles of FN and BSA in augmenting TNT110’s resistance to OS. Surface pretreatment of TNT110 with FN/BSA alone could beneficially influence the early adhesion, spreading, ER activity, and ROS expression of osteoblasts, a trend not observed with TNT30.Conclusion: TNT110 effectively protects osteoblast function in the OS microenvironment by modulating protein adsorption, with FN and BSA synergistically enhancing osteogenesis. These findings suggest TNT110’s potential for use in implants for elderly patients.Keywords: osteoporosis, oxidative stress, titania nanotube, protein adsorption, osteogenesis

Zhongkang Ji,1,* Sheng Bi,1,* Bin Lu,1,2 Lin Zheng,1 Xiuyuan Jin,1 Shujuan Huang,1 Liangxiu Jiang,1 Yuping Wang,1 Cheng Ding,1 Kaijin Xu1 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Infectious Diseases, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Kaijin Xu; Cheng Ding, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13750870030, Email zdyxyxkj@zju.edu.cn; dingchengzju@zju.edu.cnObjective: To assess the diagnostic performance of the blood-based Cepheid 3-gene Host Response test (MTB-HR), urine-based Lipoarabinomannan (LAM), and a combination of MTB-HR and LAM (MTB-HR & LAM) for detecting active tuberculosis (ATB).Methods: All participants were recruited from the First Affiliated Hospital, Zhejiang University School of Medicine, between June 8, 2023 and September 13, 2023. Subsequently, the participants were classified into the ATB group or non-active tuberculosis (non-ATB) group based on microbiological evidence. MTB-HR and LAM tests were performed using fingerstick blood and urine samples from each participant, respectively. The diagnostic performance of the tests was evaluated based on the sensitivity, specificity, Youden index, and Kappa value. Pairwise comparisons of the areas under the receiver operating characteristic curves (AUROCs) between different tests were conducted using nonparametric methods.Results: A total of 297 participants were included. The MTB-HR test demonstrated diagnostic efficacy with a sensitivity of 77.37% (95% CI: 70.37– 84.38) and a specificity of 85.63% (95% CI: 80.19– 91.06). The LAM test demonstrated a high specificity of 97.50% (95% CI: 95.08– 99.92), albeit with a lower sensitivity of 54.74% (95% CI: 46.41– 63.082). The sensitivity and specificity of the MTB-HR & LAM were 83.21% (95% CI: 76.95– 89.47) and 83.13% (95% CI: 77.32– 88.93), respectively. Only MTB-HR & LAM exhibited higher values of area under the receiver operating characteristic curve than the LAM test (MTB-HR & LAM vs LAM: 0.83 vs 0.76, P=0.0031).Conclusion: In this study, although both non-sputum-based triage MTB-HR and LAM do not meet the WHO diagnostic target currently, they show possible values for triage and diagnosis in ATB. Compared to single MTB-HR or LAM test, the combined MTB-HR & LAM does not demonstrate advantages.Keywords: active tuberculosis, diagnostic, three-gene host response, Lipoarabinomannan, AUROC

Kun Xu,1,2 Jiefan Zhang,1,2 Wei Ma,1,2 Yongyu Wang,1,2 Bo Chen,1,2 Ningyang Gao,1,2 Jian Pang,1,2 Hongsheng Zhan1,2 1Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Hongsheng Zhan; Jian Pang, Email shgsyjs@139.com; pangjian2004@gmail.comObjective: Shi’s Knee Daoyin (SKD) exercise is a treatment derived from Traditional Chinese exercise (TCE) specifically designed for lower limb health care. This study aimed to assess the feasibility of conducting a randomized controlled trial to explore the effectiveness of SKD exercise in treating knee osteoarthritis (KOA).Methods: Participants were randomized to receive Health Education (HE) or SKD exercise. The primary outcomes were feasibility and safety outcomes, including participant recruitment rate, retention rate, as well as adherence to intervention. The secondary outcomes included Visual Analogue Scale (VAS) scores for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the 20-Meter Walk Test (20-MWT) and the 5-times Chair-Stand Test (5-CST).Results: The results indicate that out of 89 individuals invited to participate in the study, 72 were eligible and agreed to participate, resulting in a recruitment rate of 80.9%. All participating patients completed the follow-up and were included in the analysis; no patients dropped out of the study due to adverse events. The secondary outcome measures showed that after twelve weeks of treatment, the VAS score, WOMAC total score, WOMAC pain score, WOMAC stiffness score, and WOMAC function score of patients in the HE group and SKD group all improved, but the improvement was more significant in the SKD group. The 20-MWT of SKD group after treatment was significantly shorter than before treatment (P< 0.001); There was no significant difference in 20-MWT between the HE group and baseline after treatment. The performance of the two groups of patients improved in 5-CST, but there was no statistical difference between the two groups after treatment (P=2.439).Conclusion: This study evaluated the feasibility and effectiveness of home-based SKD exercise intervention in alleviating symptoms in patients with symptomatic KOA, providing valuable information for designing an appropriate randomized controlled study.Keywords: knee osteoarthritis, pilot, exercise, randomized controlled trial

Yang Liu,1 Lanxi Zhang,2 Jie Zhao,1,3 Ruilong Lu,1 Xuejie Shao,1 Kexin Xu,1 Jiansheng Li,1,3,4,&ast; Yange Tian1,3,&ast; 1Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province and Education Ministry of People’s Republic of China, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China; 2School of Basic Medicine (Zhongjing School), Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China; 3Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China; 4First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiansheng Li; Yange Tian, Email li_js8@163.com; yange0910@126.comPurpose: The main objective of this study was to explore the mechanism of effective component compatibility of Bufei Yishen formula III (ECC-BYF III) in inhibiting mitochondrial oxidative stress in a rat model of chronic obstructive pulmonary disease (COPD).Methods: A549 cells exposed to cigarette smoke extract (CSE) were used to establish a model of mitochondrial oxidative damage. The cells were treated with the plasmid encoding Pkm2 and the enzymes and proteins involved in oxidative stress and mitochondrial function were measured. A rat model of COPD was established using CS and bacteria. Two different treatments were established, ECC-BYF III (5.5 mg/kg/d) and N-acetylcysteine (54 mg/kg/day). Animals were tested for pulmonary function (Vt, PEF, FVC, FEV0.1s and Cdyn) after eight weeks of therapy and were sacrificed. Pulmonary H&E staining was performed, and the total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), and malondialdehyde (MDA) content were measured. The mitochondrial function was also examined. Furthermore, the Pkm2/Nrf2 signaling pathway was evaluated.Results: Overexpression of Pkm2 dramatically ameliorated the CS-induced mitochondrial oxidative damage. Further studies indicated that ECC-BYF III significantly improved mitochondrial function and inhibited oxidative stress in the lung tissues of COPD rats. Moreover, it can upregulate mitochondrial respiratory chain enzyme activity. ECC-BYF III also decreased the MDA content and increased T-SOD, GSH-Px, and T-AOC expression to facilitate oxidative homeostasis. Finally, our results indicated that the Pkm2/Nrf2 pathway is regulated by ECC-BYF III in A549 cells and lung tissue.Conclusion: These results indicate that ECC-BYF III exerts a strong effective therapeutic effect against cigarette smoke combined with bacteria-induced COPD in rats by activating the Pkm2/Nrf2 signaling pathway and restoring mitochondrial oxidative stress. Although more in vivo animal model research is needed to confirm these findings, this study contributes new data to support the conventional usage of ECC-BYF III.Keywords: chronic obstructive pulmonary disease, oxidative stress, ECC-BYF III, Pkm2, Nrf2

Kaiwu Xu,1 Cailing Xiang,1 Zhige Yu,1 Jia Li,2 Changjun Liu2 1Department of Gastrointestinal Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, 410005, People’s Republic of China; 2Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, 410005, People’s Republic of ChinaCorrespondence: Changjun Liu, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), 61 Jiefang West Road, Changsha, Hunan Province, 410005, People’s Republic of China, Tel +86-0731-83928052, Email liuchangjun712@163.comPurpose: Strategies therapy for hepatocellular carcinoma (HCC) beyond oligometastasis are limited. The optimal sequence of systemic treatment for advanced HCC is not yet clear. Our study aims to evaluate the effectiveness of simultaneous lenvatinib combined PD-1 inhibitor on advanced HCC beyond oligometastasis.Patients and Methods: A total of 232 patients were enrolled in our retrospective study. Patients divided into three groups. (a) Lenvatinib plus simultaneous PD-1 inhibitor (Simultaneous group, n=58); (b) patients received PD-1 inhibitor before the tumor progression with continued lenvatinib administration (Before PD group, n=77); (c) patients received PD-1 inhibitor after the tumor progression (After PD group, n=97). To analyze overall survival (OS) and progression-free survival (PFS) among the three groups.Results: The estimated 6-, 12-, 18- and 24-mon OS for Simultaneous group patients were 100%, 93.1%, 63.4%, 48.3%, whereas the OS rates were 100%, 78%, 36.3%, 23.6% in Before PD group, and 99%, 61.2%, 22.1%, 7.5% in After PD group. The OS rates were obviously improved with the use of simultaneous PD-1 inhibitor among the three groups (P < 0.001). The estimated 3-, 6-, 9- and 12-month PFS rates for patients were 89.6%, 44.8%, 24.6%, 6% in After PD group, 90.9%, 59.7%, 27.3%, 12.4% in Before PD group and 98.3%, 81%, 51.7%, 39.7% in Simultaneous group, respectively. PFS rate was significantly different among the three groups (P < 0.001).Conclusion: Synchronous administration of lenvatinib and PD-1 inhibitors improved survival rate significantly. The synchronous combination could represent a promising strategy in HCC beyond oligometastasis.Keywords: lenvatinib, PD-1 inhibitor, hepatocellular carcinoma beyond oligometastasis, simultaneous, prognosis

Shenjiao Wang,1,2,&ast; Xin Zou,3– 5,&ast; Jianguang Fu,1 Fei Deng,1 Huiyan Yu,1 Huan Fan,1 Qigang Dai,1 Qingxiang Shang,5 Ke Xu,1 Changjun Bao1,5 1Acute Infectious Disease Control and Prevention Institute, Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial Academy of Preventive Medicine), Nanjing, Jiangsu Province, People’s Republic of China; 2Ili Kazakh Autonomous Prefecture Center for Disease Control and Prevention, Ili, Xinjiang, People’s Republic of China; 3Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China; 4Chongqing Key Laboratory of Viral Infectious Diseases, Chongqing, People’s Republic of China; 5School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ke Xu; Changjun Bao, Acute Infectious Disease Control and Prevention Institute, Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial Academy of Preventive Medicine), No. 172, Jiangsu Road, Gulou District, Nanjing, Jiangsu Province, 210009, People’s Republic of China, Tel +86-18915999237, +86-18118996911, Email xuke923@163.com; bao2000_cn@163.comBackground: Human adenovirus (HAdV) is common pathogens that cause various respiratory diseases. The genetic diversity of viruses caused by recombination is considered to be the main source of emerging outbreaks. The aim of this study is to explore the evolutionary relationship and recombination events of HAdV genome in respiratory tract infections in Jiangsu Province.Methods: Whole-genome sequencing (WGS) technology was used to sequence 66 patients with HAdV infection (37 patients with influenza-like illness (ILI) and 29 hospitalized patients with pneumonia) from Jiangsu Province. Epidemiological analysis was performed on hospitalized pneumonia and ILI patients infected with HAdV. Subsequently, phylogenetic, recombination, and nucleotide and amino acid identity analyses were performed.Results: Epidemiological analysis of patients undergoing WGS showed that 75.7% of ILI patients were infected with the HAdVB strain and 69.0% of hospitalized pneumonia patients were infected with the HAdVC strain. Moreover, the hospitalized pneumonia and ILI patients infected with HAdV were different in region and time. The strains of HAdVB3 and HAdVB7 genotypes were mainly infected in 2015 and 2017, and the strains of HAdVC1 and HAdVC2 genotypes were mainly infected in 2020. The results of histogram analysis showed that the HAdV strain mainly infected children under 5 years old. In addition, 36 novel recombinant strains were identified. The discovery of these recombinant strains may contribute to understanding the epidemiology of HAdV and research on related vaccines. Furthermore, the percentage of nucleotide and amino acid identities revealed a high level of genetic conservation within isolates from HAdVB3, HAdVB7, HAdVC1, HAdVC2 and HAdVC5 genotypes.Conclusion: The WGS analysis reveals the evolutionary relationships and recombination events of HAdV strains in Jiangsu Province, which is helpful to deepen the understanding of HAdV epidemiology and evolution. In addition, it provides a basis for the formulation of public health strategies in Jiangsu Province.Keywords: human adenovirus, whole genome sequencing, phylogenetic analysis, recombination

Jiongfeng Zhang,1,&ast; Xiaohui Luo,1,&ast; Ruiling Zhou,2,&ast; Chong Guo,1 Kai Xu,1 Gaoyang Qu,1 Le Zou,1 Wenye Yao,1 Shifan Lin,1 Zhiping Zhang1 1Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China; 2Department of Dermatology, Jiangxi Provincial Dermatology Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shifan Lin, Email 66031226@qq.com; Zhiping Zhang, Tel +86 791-88862249, Email ndsfy001425@ncu.edu.cnObjective: To explore the suitable population of CT value for predicting low bone mineral density (low-BMD).Methods: A total of 1268 patients who underwent chest CT examination and DXA within one-month period retrospectively analyzed. The CT attenuation values of trabecular bone were measured in mid-sagittal plane from thoracic vertebra 7 (T7). Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose low-BMD.Results: The AUC for diagnosing low BMD was larger in women than in men (0.894 vs 0.744, p < 0.05). The AUC increased gradually with the increase of age but decreased gradually with the increase in height and weight (p < 0.05). In females, when specificity was adjusted to approximately 90%, a threshold of 140.25 HU has a sensitivity of 69.3%, which is higher than the sensitivity of 36.5% in males for distinguishing low-BMD from normal. At the age of 70 or more, when specificity was adjusted to approximately 90%, a threshold of 126.31 HU has a sensitivity of 76.1%, which was higher than that of other age groups.Conclusion: For patients who had completed chest CTs, the CT values were more effective in predicting low-BMD in female, elderly, lower height, and lower weight patients.Keywords: bone mineral density, chest computed tomography, dual-energy X-ray absorptiometry, attenuation value

Yuli Ji,1,2,&ast; Liangyu Mi,1,2,&ast; Miaomiao Zhao,1,2 Xiaoyao He,1,2 Yuting Hu,1,2 Yanan Gao,1,2 Chengliang Yin,3 Ke Xu1,2 1Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China; 2Department of Rheumatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 3Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ke Xu, Department of Rheumatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99 Longcheng Street, Taiyuan, Shanxi Province, People’s Republic of China, Email xukesxbqeh@hotmail.comAbstract: Autoimmune diseases refer to a group of conditions where the immune system produces an immune response against self-antigens, resulting in tissue damage. These diseases have profound impacts on the health of patients. In recent years, with the rapid development in the field of biomedicine, engineered exosomes have emerged as a noteworthy class of biogenic nanoparticles. By precisely manipulating the cargo and surface markers of exosomes, engineered exosomes have gained enhanced anti-inflammatory, immunomodulatory, and tissue reparative abilities, providing new prospects for the treatment of autoimmune diseases. Engineered exosomes not only facilitate the efficient delivery of bioactive molecules including nucleic acids, proteins, and cytokines, but also possess the capability to modulate immune cell functions, suppress inflammation, and restore immune homeostasis. This review mainly focuses on the applications of engineered exosomes in several typical autoimmune diseases. Additionally, this article comprehensively summarizes the current approaches for modification and engineering of exosomes and outlines their prospects in clinical applications. In conclusion, engineered exosomes, as an innovative therapeutic approach, hold promise for the management of autoimmune diseases. However, while significant progress has been made, further rigorous research is still needed to address the challenges that engineered exosomes may encounter in the therapeutic intervention process, in order to facilitate their successful translation into clinical practice and ultimately benefit a broader population of patients.Keywords: engineered exosomes, autoimmune diseases, genetic engineering, anti-inflammatory applications

Yushan Shi,1,&ast; Zhangmeng Xu,2,&ast; Shuangshuang Pu,1 Kanghong Xu,1 Yanan Wang,1 Chunlai Zhang1 1Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China; 2School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610075, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chunlai Zhang, Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road, Lixia, Jinan, Shandong, 25000, People’s Republic of China, Tel +86+15863139900, Email qd07@163.comPurpose: This study sought to examine the potential association between serum Klotho levels and the prevalence of COPD in the United States.Patients and Methods: This study was a cross-sectional analysis involving 4361 adults aged 40– 79 years participating in the US National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2016. Our investigation utilized multivariate logistic regression and restricted cubic spline (RCS) regression to explore the potential correlation between serum Klotho concentrations and the prevalence of COPD. Additionally, we conducted stratified and interaction analyses to evaluate the consistency and potential modifiers of this relationship.Results: In this study encompassing 4631 patients (with an average age of 57.6 years, 47.5% of whom were male), 445 individuals (10.2%) were identified as having COPD. In the fully adjusted model, ln-transformed serum Klotho was negatively associated with COPD (OR = 0.71; 95% CI: 0.51– 0.99; p = 0.043). Meanwhile, compared with quartile 1, serum Klotho levels in quartiles 2– 4 yielded odds ratios (ORs) (95% CI) for COPD were 0.84 (0.63~1.11), 0.76 (0.56~1.02), 0.84 (0.62~1.13), respectively. A negative relationship was observed between the ln-transformed serum Klotho and occurrence of COPD (nonlinear: p = 0.140). the association between ln-transformed serum Klotho and COPD were stable in stratified analyses.Conclusion: Serum Klotho was negatively associated with the incidence of COPD, when ln-transformed Klotho concentration increased by 1 unit, the risk of COPD was 29% lower.Keywords: α-Klotho (Klotho), chronic obstructive pulmonary disease, cross-sectional study, National Health and Nutrition Survey, NHANES

Interfacially asymmetric magnetic multilayers made of heavy metal/ferromagnet have attracted considerable attention in the spintronics community for accommodating spin-orbit torques (SOTs) and meanwhile for hosting chiral spin textures. In these multilayers, the accompanied interfacial Dzyaloshinskii–Moriya interaction (iDMI) permits the formation of Néel-type spin textures. While significant progresses have been made in Co, CoFeB, Co2FeAl, CoFeGd based multilayers, it would be intriguing to identify new magnetic multilayers that could enable spin-torque controllability and meanwhile host nanoscale skyrmions. In this report, first, thin films made of permanent magnet SmCo5 with perpendicular magnetic anisotropy are synthesized, in which the deterministic SOT switching, enabled by the spin Hall effect, in Pt/SmCo5/Ta trilayer is demonstrated. Further, the stabilization of room-temperature skyrmions with diameters ≈100 nm in [Pt/SmCo5/Ta]15, together with a skyrmionium-like spin texture in [Pt/SmCo5/Ir]15 multilayers is shown. Based on the material specific parameters, micromagnetic simulations are also carried out. The results confirm the presence of chiral spin textures in this new material family. Through interfacial engineering, the results thus demonstrate that rare earth permanent magnets could be a new platform for studying interfacial chiral spintronics.

Calcium silicate hydrate (C-S-H), is the principal hydration product of Portland cement that mainly contributes to the physical and mechanical properties of concrete. This paper aims to investigate the three-dimensional structure of C-S-H with Ca/Si ratios of 1.0 and 1.6 at the nanoscale using electron tomography. The 3D reconstructions and selected region of interest analysis confirm that the morphology of both C-S-H materials are foil-like structures. The difference between the two materials is the density of elongated structures. C-S-H with Ca/Si ratio 1.6 is clearly composed of denser particles compared to the other C-S-H material due to overlapping of the foil-like structure. Pore analysis shows that C-S-H 1.0 and C-S-H 1.6 have porosities 69.2% and 49.8% respectively. Pore size distribution also reveals that C-S-H 1.0 has pore size range between 0-250 nm and C-S-H 1.6 between 0-100 nm. The pore network's size of C-S-H 1.0 is significantly larger than 1.6. This study illustrates the capability of using electron tomography to determine the 3D nanoscale structure of cementitious products and to distinguish between C-S-H 1.0 and 1.6.

The advent of lidar has revolutionized the way we observe and measure vegetation structure from the ground and from above and represents a major advance toward the quantification of 3D ecological observations. Developments in lidar hardware systems and data processing algorithms have greatly improved the accessibility and ease of use of lidar observations in ecological studies. A wide range of studies has been devoted to accurately measuring and modeling vegetation structural and functional attributes from lidar data across a range of spatial scales (from individual organs to global scales) and ecosystem types (e.g., forest, agricultural, grassland, and urban ecosystems).

There is renewed interest in using advanced techniques to characterize ancient Roman concrete due to its exceptional durability and low-carbon footprint. In the present work, samples were drilled from the “Hospitium” in Pompeii and were analyzed by synchrotron microtomography (μCT) and neutron radiography to study how the microstructure, including the presence of induced cracks, affects their water adsorption. The water distribution and absorptivity were quantified by neutron radiography. The 3D crack propagation, pore size distribution and orientation, tortuosity, and connectivity were analyzed from μCT results using advanced imaging methods. Porosity was also measured by mercury intrusion porosimetry (MIP) as a reference. Ductile fracture patterns were observed once cracks were introduced. Compared to Portland cement mortar/concrete, the Pompeii samples had relatively high porosity, low connectivity, and a similar coefficient of capillary penetration. In addition, permeability was predicted from models based on percolation theory and pore structure data to evaluate the fluid transport properties. Understanding the microstructure of ancient Pompeii concrete is important because it could inspire the development of modern concrete with high durability.

Introduction: We sought to examine the utility of self-reported pain scale by comparing emergency department (ED) triage pain scores of self-reported but non-verifiable painful conditions with those of verifiable painful conditions using a large, nationally representative sample. Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2015. Verifiable painful conditions were identified based on the final diagnoses in the five included International Classification of Diseases 9th revision codes. Non-verifiable painful conditions were identified by the five main reasons for visit. Only adults 18 years of age or older were included. The primary outcome variable was the pain scale from 0 to 10 at triage. We performed descriptive and multivariate analyses to investigate the relationships between the pain scale and whether the painful condition was verifiable, controlling for patient characteristics. Results: There were 55 million pain-related adult ED visits in 2015. The average pain scale was 6.49. For verifiable painful diagnoses, which were about 24% of the total visits, the average was 6.27, statistically significantly lower than that for non-verifiable painful conditions, 6.56. Even after controlling for the confounding of patient characteristics and comorbidities, verifiable painful diagnoses still presented less pain than those with non-verifiable painful complaints. Older age, female gender, and urban residents had significantly higher pain scores than their respective counterparts, controlling for other confounding factors. Psychiatric disorders were independently associated with higher pain scores by about a half point.  Conclusion: Self-reported pain scales obtained at ED triage likely have a larger psychological component than a physiological one. Close attention to clinical appropriateness and overall patient comfort are more likely to lead to better health outcomes and patient experiences than focusing on self-reported pain alone.

An unexploited property of graphene-based heterojunctions is the tunable doping of the junction via electrostatic gating. This unique property may be key in advancing electronic transport across interfaces with semiconductors. Here, we engineer transport in semiconducting TMDs by constructing a lateral heterostructure with epitaxial graphene and tuning its intrinsic doping to form a p–n junction between the graphene and the semiconducting TMDs. Graphene grown on SiC (epitaxial graphene) is intrinsically doped via substrate polarization without the introduction of an external dopant, thus enabling a platform for pristine heterostructures with a target band alignment. We demonstrate an electrostatically tunable graphene/MoS2p–n junction with >20× reduction and >10× increased tunability in contact resistance (Rc) compared with metal/TMD junctions, attributed to band alignment engineering and the tunable density of states in graphene. This unique concept provides improved control over transport across 2D p–n junctions.

Exploitation of novel faradic materials is an alternative implementation for solving the problem of poor specific electrosorption capacity that conventional carbon materials are encountered in capacitive deionization. Particularly, composite electrode is just a suitable choice because of its potentially high ion-storage ability. Herein, a cyclic voltammetric treatment method with different low limit of potential window was used to manipulate the polymeric conformation and doping level of graphene oxide/polypyrrole (GO/PPy) composite electrode. Based on it, the effect of polymeric structure on the electrosorption performance was systematically studied. When the low limit of potential window is shifted negatively enough, the irreversible polymeric conformational shrinks of GO/PPy are promoted, which not only hinders the insertion process of ions, but also decreases the doping level of polymer due to the intensive interchain-action produced by more entangled polymeric chain. Thus, the number of intercalated ions should decrease, which is expressed by electrochemical impedance spectroscopy (EIS) results and is proportional to the electrosorption capacity of GO/PPy composite electrode in membrane capacitive deionization (MCDI) process. Our work suggests that the less packing density, higher doping level and more charge delocalization on PPy backbone in electrode are beneficial to enhance its capacitive deionization performance.

Borodin et al. review advances in designing electrolytes for aqueous and non-aqueous batteries with a focus on going beyond the conventional “1 M” salt concentration to super-concentration that brings about multitudes of unexpected electrolyte properties from novel interfaces, interphases, ion transport mechanisms, and thermal stability.

One of the major challenges in the van der Waals (vdW) integration of two-dimensional (2D) materials is achieving high-yield and high-throughput assembly of predefined sequences of monolayers into heterostructure arrays. Mechanical exfoliation has recently been studied as a promising technique to transfer monolayers from a multilayer source synthesized by other techniques, allowing the deposition of a wide variety of 2D materials without exposing the target substrate to harsh synthesis conditions. Although a variety of processes have been developed to exfoliate the 2D materials mechanically from the source and place them deterministically onto a target substrate, they can typically transfer only either a wafer-scale blanket or one small flake at a time with uncontrolled size and shape. Here, we present a method to assemble arrays of lithographically defined monolayer WS2 and MoS2 features from multilayer sources and directly transfer them in a deterministic manner onto target substrates. This exfoliate-align-release process - without the need of an intermediate carrier substrate - is enabled by combining a patterned, gold-mediated exfoliation technique with a new optically transparent, heat-releasable adhesive. WS2/MoS2 vdW heterostructure arrays produced by this method show the expected interlayer exciton between the monolayers. Light-emitting devices using WS2 monolayers were also demonstrated, proving the functionality of the fabricated materials. Our work demonstrates a significant step toward developing mechanical exfoliation as a scalable dry transfer technique for the manufacturing of functional, atomically thin materials.

Xiaoqun Xu1,2 &ast;, Houyong Zhu3 &ast;, Long Cai1,2 &ast;, Xinyu Zhu,4 Hanxin Wang,5 Libin Liu,1,2 Fengwei Zhang,1,2 Hongjuan Zhou,1,2 Jing Wang,1,2 Tielong Chen,3 Kan Xu1,2 1Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 4Department of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Kan Xu, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, No. 208 East Huancheng Road, Hangzhou, 310003, People’s Republic of China, Email xukan3787@qq.com Tielong Chen, Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Stadium Road, Hangzhou, 310007, People’s Republic of China, Email ctlppp@foxmail.comBackground: This study aimed to investigate whether nutrition levels in patients with active pulmonary tuberculosis (TB) affect their risk of all-cause mortality during hospitalization and to further evaluate the predictive ability of Geriatric Nutritional Risk Index (GNRI) and Body Mass Index (BMI) for risk of all-cause mortality.Methods: Patients from January 1, 2020 to December 31, 2021 were retrieved, and a total of 1847 were included. The primary outcome was all-cause mortality. Propensity score matching (PSM) was performed for risk adjustment, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive ability of GNRI and BMI for all-cause mortality.Results: Malnourished TB patients were older, had more congestive heart failure, and had more chronic obstructive pulmonary disease or asthma. Under the nutrition level grouping defined by GNRI, the all-cause mortality in the malnourished group did not appear to reach a statistical difference compared with the nonmalnourished group (P = 0.078). When grouped by level of nutrition as defined by BMI, the all-cause mortality was higher in the malnourished group (P = 0.009), and multivariate logistic regression analysis revealed that malnutrition was an independent risk factor for all-cause mortality. After propensity score matching, the results showed that the all-cause mortality was higher in the malnutrition group, regardless of BMI or GNRI defined nutrition level grouping, compared with the control group (both P < 0.001). The ROC curve analysis revealed that the area under the curve (AUC) was 0.811 ([95% confidence interval (CI) 0.701– 0.922], P < 0.001) for GNRI and 0.728 ([95% CI 0.588– 0.869], P = 0.001) for BMI.Conclusion: In the clinical treatment of patients with active TB, more attention should be paid to the management of nutritional risk. GNRI may be a highly effective and easy method for predicting short-term outcomes in patients with active pulmonary TB.Keywords: tuberculosis, malnutrition, Geriatric Nutritional Risk Index, body mass index

Yanwan Shangguan,&ast; Zhongkang Ji,&ast; Wanru Guo, Wenjuan Hu, Xiaomeng Li, Kaijin Xu State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Kaijin Xu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China, Tel/Fax +86-0571-87236440, Email zdyxyxkj@zju.edu.cnAbstract: Linezolid-induced black hairy tongue is a self-limiting benign disease that is rare. Here, we report three patients who developed black hairy tongue after linezolid treatment. The severe dysbiosis of oral bacterial communities was observed in all these patients. Proteobacteria was the most prevalent phylum (over 90%) at the black tongue stage. Furthermore, the dramatic oral bacterial alteration took a long time to reverse after the BHT resolved.Keywords: tuberculosis infection, linezolid, treatment, side-effect, black-hairy tongue, microorganism metabolism

Zihao Qin, Ke Xu, Wen Mo, Jie Ye, Jinhai Xu Orthopedics Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Jinhai Xu; Jie Ye, Longhua Hospital Shanghai University of Traditional Chinese Medicine, 725, South Wanping Road, Xuhui District, Shanghai, 200030, People’s Republic of China, Tel +86 18016006692 ; +86 3301880301, Email jinhaixu@126.com; yejie1977@126.comPurpose: This randomized controlled trial aimed to evaluate the clinical efficacy of Jianyao Migu granules (JYMGG) in the treatment of primary osteopenic low back pain (LBP).Patients and Methods: A total of 108 patients with primary osteopenic LBP were randomly divided into the JYMGG group and placebo group. Both groups took 600 mg of oral Caltrate D daily; in addition, the JYMGG group was given oral JYMGG, while the placebo group was given placebo granules. The treatment period was 6 months for both groups. The pre- to post-treatment changes in the bone mineral density (BMD), visual analogue scale (VAS) score, Oswestry disability index (ODI), and bone turnover markers were compared between the two groups.Results: The post-treatment VAS score and ODI were significantly lower than baseline in both groups (P< 0.05). In the JYMGG group, the lumbar BMD increased from 0.88± 0.07 g/cm2 to 0.90± 0.13 g/cm2 and the hip BMD increased from 0.77± 0.08 g/cm2 to 0.78± 0.10 g/cm2, giving increases of 2.70% and 1.96% respectively, but the differences were not statistically significant. The post-treatment levels of ALP, osteocalcin, P1NP, and β-CTX were increased compared with baseline in both groups, but the differences were not statistically significant. The thyrotropin level was significantly increased after treatment in the placebo group (P< 0.05). There were no abnormalities detected in routine blood and kidney function tests performed during the observation period. Some patients showed elevated liver enzymes and gastrointestinal reactions.Conclusion: JYMGG effectively relieved the bone pain, and improved the quality of life of patients with primary osteopenic LBP.Keywords: chinese herb, clinical trial, Jianyao Migu granules, osteoporosis