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Abstract Background Preventive treatment of tuberculosis infection (TBI) is considered a crucial strategy to prevent and control tuberculosis (TB). However, the acceptance and completion rates of preventive therapy for TBI are still far from optimistic. Evidence is mounting that TB knowledge and stigma may have a substantial effect on acceptance of TBI treatment. This study aimed to explore the effect of stigma on the relationship between the level of TB knowledge and acceptance of TBI treatment. Methods 7017 general population were included in the study. We adjusted for the covariates at the individual. Stepwise logistic regression was used to examine the moderating role of TB stigma and also explore the association between TB knowledge and acceptance of TBI treatment. Results The acceptance rate of TBI treatment among the respondents was 84.38% (n = 5921). Among respondents, a significant positive correlation between acceptance of TBI treatment and TB knowledge (OR = 1.096,95%CI = 1.073,1.118). Additionally, the association between TB knowledge and acceptance of TBI treatment was found to be moderated by TB stigma. In other words, TB stigma was found to weaken the impact of TB knowledge on acceptance of TBI treatment (OR = 0.994,95%CI = 0.991,0.996). Conclusion The findings of the study indicated that having a high level of awareness about TB can enhance the general population’s acceptability of TBI treatment. TB stigma moderated this association; it weakened the relationship between TB knowledge and individuals’ willingness to accept TBI treatment. To mitigate TB stigma and enhance the intention of individuals with TBI to accept preventive therapy, it is imperative to enhance TB-related health education.

Abstract Objective We performed a post hoc exploratory analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to determine whether hypertension history and baseline systolic blood pressure (SBP) affect the efficacy of remote ischemic conditioning (RIC). Methods Based on the full analysis set of RICAMIS, patients were divided into hypertension versus non‐hypertension group, or

Abstract Systolic blood pressure variability (SBPV) is associated with outcome in acute ischemic stroke. Remote ischemic conditioning (RIC) has been demonstrated to be effective in stroke and may affect blood pressure. Relationship between SBPV and RIC treatment after stroke warrants investigation. A total of 1707 patients from per-protocol analysis set of RICAMIS study were included. The SBPV was calculated based on blood pressure measured at admission, Day 7, and Day 12. (I) To investigate the effect of SBPV on efficacy of RIC in stroke, patients were divided into High and Low categories in each SBPV parameter. Primary outcome was excellent functional outcome at 90 days. Compared with Control, efficacy of RIC in each category and interaction between categories were investigated. (II) To investigate the effect of RIC treatment on SBPV, SBPV parameters were compared between RIC and Control groups. Compared with Control, a higher likelihood of primary outcome in RIC was found in high category (max–min: adjusted risk difference [RD] = 7.2, 95% CI 1.2–13.1, P = 0.02; standard deviation: adjusted RD = 11.5, 95% CI 1.6–21.4, P = 0.02; coefficient of variation: adjusted RD = 11.2, 95% CI 1.4–21.0, P = 0.03). Significant interaction of RIC on outcomes were found between High and Low standard deviations (adjusted P

Corrosion failure of sacrificial anodes in extreme deep-sea environment is a key problem in metal protection technology. This study investigated the failure mechanism of the Al-Zn-In sacrificial anode under the synergic action of water pressure and fluid flow, by microstructure characterization and finite element analysis. The results exhibit that water pressure promotes the dissolution of Al-Zn-In alloy near the precipitates that are enriched at the grain boundaries. The flow amplifies the promoting effect of the pressure on anodic dissolution by inhibiting the formation of corrosion layers, and it accelerates the mass loss by mechanically aggressing the aluminum matrix. The synergic effect of water pressure and fluid flow results in a rapid degradation in the extreme deep-sea environment.

Abstract Background Anorectal malformation is a common congenital problem occurring in 1 in 5,000 births and has a spectrum of anatomical presentations, requiring individualized surgical treatments for normal growth. Delayed extubation or reintubation may result in a longer intensive care unit (ICU) stay and hospital stay, increased mortality, prolonged duration of mechanical ventilation, increased tracheostomy rate, and higher hospital costs. Extensive studies have focused on the role of risk factors in early extubation during major infant surgery such as Cardiac surgery, neurosurgery, and liver surgery. However, no study has mentioned the influencing factors of delayed extubation in neonates and infants undergoing angioplasty surgery. Materials and Methods We performed a retrospective study of neonates and infants who underwent anorectal malformation surgery between June 2018 and June 2022. The principal goal of this study was to observe the incidence of delayed extubation in pediatric anorectal malformation surgery. The secondary goals were to identify the factors associated with delayed extubation in these infants. Results We collected data describing 123 patients who had anorectal malformations from 2019 to 2022. It shows that 74(60.2%) in the normal intubation group and 49(39.8%) in the longer extubation. In the final model, anesthesia methods were independently associated with delayed extubation (P

Background We conducted a post hoc analysis of the ATAMIS (Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke) trial to investigate whether the priority of clopidogrel plus aspirin to aspirin alone was consistent between patients with and without stroke pathogenesis of large‐artery atherosclerosis (LAA). Methods and Results Patients with stroke classification randomized to a clopidogrel‐plus‐aspirin group and aspirin‐alone group in a modified intention‐to‐treat analysis set of ATAMIS were classified into LAA and non‐LAA subtypes. The primary outcome was early neurologic deterioration at 7 days, defined as a >2‐point increase in National Institutes of Health Stroke Scale score compared with baseline, and safety outcomes were bleeding events and intracranial hemorrhage. We compared treatment effects in each stroke subtype and investigated the interaction. Among 2910 patients, 225 were assigned into the LAA subtype (119 in the clopidogrel‐plus‐aspirin group and 106 in the aspirin‐alone group) and 2685 into the non‐LAA subtype (1380 in the clopidogrel‐plus‐aspirin group and 1305 in the aspirin‐alone group). Median age was 66 years, and 35% were women. A lower proportion of early neurologic deterioration was found to be associated with dual antiplatelet therapy in the LAA subtype (adjusted risk difference, −10.4% [95% CI, −16.2% to −4.7%]; P=0.001) but not in the non‐LAA subtype (adjusted risk difference, −1.4% [95% CI, −2.6% to 0.1%]; P=0.06). No significant interaction was found (P=0.11). Conclusions Compared with the non‐LAA subtype, patients with stroke of the LAA subtype may get more benefit from dual antiplatelet therapy with clopidogrel plus aspirin with respect to early neurologic deterioration at 7 days. Registration URL: clinicaltrials.gov; UnIque identifier: NCT02869009.

Introduction Acupuncture is widely used for metabolic-associated fatty liver disease (MAFLD) treatment; however, the clinical efficacy has not been confirmed due to the lack of high-level evidence-based clinical practice. The purpose of this study is to design a research protocol that will be used to determine the efficacy of acupuncture versus sham acupuncture (SHA) for MAFLD treatment.Methods and analysis This will be a multicentre, randomised and sham-controlled trial. Ninety-eight participants with MAFLD will be enrolled in this trial. Participants will be randomly assigned in a 1:1 ratio to receive acupuncture or SHA for 12 weeks. The primary outcome is the rate of patients with a 30% relative decline in liver fat after 12 weeks of treatment in MRI-proton density fat fraction (MRI-PDFF), which will be obtained by quantitative chemical shift imaging such as the multipoint Dixon method at 0, 12 and 24 weeks. Secondary outcomes include the changes in the relative liver fat content measured by MRI-PDFF, magnetic resonance elastography, liver function, lipid metabolism, homeostatic model assessment for insulin resistance (HOMA-IR) and serum high sensitivity C reactive protein, which will be obtained at 0, 6, 12 and 24 weeks. Body measurement indicators (body mass index, waist circumference, hip circumference and waist-to-hip ratio) will be obtained at 0, 3, 6, 9, 12 and 24 weeks. The alteration in the gut microbiota composition and its metabolism will be assessed by 16S ribosomal RNA sequencing and liquid chromatography-mass spectrometry at 0 and 12 weeks.Ethics and dissemination This study protocol has been approved by the ethics committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (2023-1347-114-01). The results of this study will be published in a peer-reviewed journal and presented at academic conferences.Trial registration number ChiCTR2300075701.

Objective: To identify the risk factors contributing to cerebral microbleeds (CMBs), analyze the correlation between the quantity and distribution of CMBs and overall cognitive performance, including specific cognitive domains in patients, and investigate the underlying mechanisms by which CMBs impact cognitive function. Methods: Patients diagnosed with cerebral small vessel disease were recruited between September 2022 and September 2023. Clinical baseline data were systematically gathered. The Montreal Cognitive Assessment (MoCA) was employed to evaluate patients’ cognitive status. CMBs were identified via susceptibility-weighted imaging (SWI), noting their locations and quantities. Patients were categorized into two cohorts: those without CMBs and those with CMBs. This division facilitated the comparison of basic clinical data and laboratory indicators, aiming to elucidate the risk factors associated with CMBs. Within the CMBs cohort, patients were further classified based on the number of CMBs into mild, moderate, and severe groups, and according to CMBs’ locations into deep, cortical-subcortical, and mixed groups. Spearman correlation analysis and ANOVA were utilized to compare the total MoCA scores, as well as scores in specific cognitive domains, across these groups. This approach enabled the analysis of the relationship between the quantity and location of CMBs and cognitive impairment. Results: Statistically significant differences were noted between patients with and without cerebral microbleeds (CMBs) regarding gender, age, hypertension, diabetes, history of cerebral infarction, history of alcohol consumption, glycosylated hemoglobin levels, low-density lipoprotein cholesterol, and homocysteine levels ( p

Summary: Background: Retrograde intrarenal surgery (RIRS) is the main treatments for upper urinary tract stones. The Ureteral Access Sheath (UAS) serves as a supplementary tool, facilitating direct kidney access during RIRS. High quality of evidence comparing tip bendable suction ureteral access sheath (S-UAS) with traditional UAS in RIRS for the treatment of renal and ureteral stones is lacking. The purpose of the study is to compare the efficacy and safety of S-UAS with traditional UAS in RIRS for the treatment of renal or ureteral stones ≤30 mm. Methods: An international, multicenter, and superiority randomized controlled trial included 320 intention-to-treat patients across 8 medical centers in China, the Philippines, Malaysia and Turkey from August 2023 to February 2024. The inclusion criteria were patients ≥18 years old with renal or ureteral stones ≤30 mm. RIRS was performed using either S-UAS or traditional UAS. The primary outcome was the immediately stone-free rate (SFR). Secondary outcomes included SFR 3 months after operation, operating time, hospital stay, auxiliary procedures, complications (using the Clavien–Dindo grading system), and improvement in the Quality of Life (QoL) score. Differences between proportions [risk difference (RD)]/means [mean difference (MD)] and 95% confidence intervals (CI) were presented. This study is registered at ClinicalTrials.gov: NCT05952635. Findings: The S-UAS group demonstrated a significantly higher immediately SFR (81.3% versus 49.4%; RD 31.9%; 95% CI 22.5%–41.7%; p = 0.004) compared to the traditional UAS group, as determined by the one-side superiority test. Additionally, the S-UAS group exhibited a higher SFR at 3 months post-operation (87.5% versus 70.0%; RD 17.5%; 95% CI 8.7%–26.3%; p

BackgroundThe Centre for Disease Control and Prevention in Yangquan, China, has taken a series of preventive and control measures in response to the increasing trend of Kala-Azar. In response, we propose a new model to more scientifically evaluate the effectiveness of these interventions.MethodsWe obtained the incidence data of Kala-Azar from 2017 to 2021 from the Centre for Disease Control and Prevention (CDC) in Yangquan. We constructed Poisson segmented regression model, harmonic Poisson segmental regression model, and improved harmonic Poisson segmented regression model, and used the three models to explain the intervention effect, respectively. Finally, we selected the optimal model by comparing the fitting effects of the three models.ResultsThe primary analysis showed an underlying upward trend of Kala-Azar before intervention [incidence rate ratio (IRR): 1.045, 95% confidence interval (CI): 1.027–1.063, p

ObjectivesNewborns and small infants are unable to cooperate actively during diagnostic procedures; therefore, sedation is often employee to maintain immobilization and obtain high-quality images. However, these procedures are often indicated in sick, vulnerable, or hemodynamically unstable neonates and young infants, which raises the associated risks of sedation. This study summarizes our 4-year of experience with safe and effective procedural sedation in this vulnerable population.Study designThis retrospective study analyzed data on neonates and young infants who underwent non-painful diagnostic procedures from December 2019 to November 2023. Patients were categorized into the neonate (aged≦ 28 days) and the young infant (29 days ≦ aged ≦ 90 days) groups.ResultsNon-pharmacological strategies, including sleeping naturally, swaddling/facilitated tucking, non-nutritive sucking, and skin-to-skin care, can achieve a success rate for sedation about 98.4%. In terms of pharmacological methods, our institution primarily utilizes chloral hydrate for procedural sedation in neonates and young infants undergoing non-painful diagnostic procedures. Midazolam serves as an alternative sedative. Chloral hydrate alone demonstrated a 92.5% success rate on the first attempt, compared to midazolam alone, with an 85.11% success rate. Neonates experienced a higher incidence of adverse events during sedation compared to young infants.ConclusionThis study reviews our 4-year experience with procedural sedation in neonates and young infants. Chloral hydrate demonstrated a high degree of safety and efficacy in this population. However, supervision by skilled medical personnel and extended observation is required. In our institution, the experience with midazolam is limited in this population, and further research is warranted to establish its safety and efficacy. Non-pharmacological strategies can achieve an acceptable rate of sedation success, which can be used based on patient’s tolerance.

The risk of rock burst during the retracement of large inclined workface in the deep tectonic area is high, in order to study the mechanism of rock burst and prevention and control technology for the retracement of the workface, the research is carried out by theoretical analysis and numerical simulation with the background of 6199 workface of Panxi Coal Mine. It was concluded that: the workface is in a complex high static load environment under the influence of many factors, the shear stress concentration in upper basic top corner is obvious, the hydraulic support of the workface is retreated, the pressure of the overburden rock layer is transferred to the front of the workface, the high static load loading type rock burst may occur locally exceeding the limit load, and the activation of the basic roof broken and faults generates the dynamic load, and it may induce the dynamic and static load superposition type rock burst; the mine pressure data before the retracement indicate that the rock activity ahead is more intense, the resistance of the support increases before and after the occurrence of the working face micro-seismic warning event, there is a basic top break and fault activation may be, the risk of rock burst is high; based on the mechanism of rock burst during the retracement period, it is proposed to decompress-support cooperative prevention technology of rock burst, by weakening the influence of the high static load and decreasing the possibility of the dynamic load, and it assists in increasing the strength of the support of the tunnel of the workface, and controlling the roof of the workface to reduce the risk of rock burst during the retraction period. During the retracement of workface, there is no obvious increase in mine pressure monitoring data, and the effect of decompress-support cooperative prevention technology is good.

Abstract Background The high costs of innovative anticancer drugs hinder a number of cancer patients’ access to these drugs in China. To address this problem, in 2018, the medical insurance access negotiation (MIAN) policy was implemented, when the prices of 17 innovative anticancer drugs were successfully negotiated and they were therefore included in the reimbursement list. This study aimed to explore the impact of the MIAN policy on the utilization of innovative anticancer drugs. Methods With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs. Results From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy. Conclusions The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.

ABSTRACTObjectives Acute undifferentiated leukemia (AUL) is a clinical rare leukemia with an overall poor prognosis. Currently, there are no well-established treatment guidelines for AUL, further exploration of optimal treatment options is now required.Methods We report an AUL patient who was complicated by a NRAS mutation and del5q was admitted to our hospital and we present the clinical features. In addition, we conducted a literature review.Results The “VA” scheme combines agents Venetoclax and Azacitidine that have synergistic therapeutic effect with a tolerable safety profile. There is no previous report of the “VA” scheme employed in AUL treatment. An AUL patient who was complicated by a NRAS mutation and del5q was admitted to our hospital. The “VA” scheme was administrated, and complete remission (CR) was achieved at the end of the first cycle. The patient then underwent HLA-identical sibling allogeneic hematopoietic stem cell transplantation.Discussion The “VA” scheme has been extensively used in AML treatment, but its application in AUL treatment has not yet been reported. This study is the first to report an AUL patient treated with the “VA” scheme and achieved CR. Our result preliminarily suggested the effectiveness and safety of the “VA” scheme in AUL treatment, but validation is required in more clinical samples. The “VA” scheme provides a new treatment option for AUL patients and deserves further clinical promotion.

Background and Purpose: Sex differences in acute ischemic stroke have been widely investigated, but the difference in acute ischemic stroke patients who received intravenous thrombolysis is not well understood. The current study was to investigate the issue based on a prospective cohort. Methods: From the Intravenous Thrombolysis Registry for Chinese Ischemic Stroke within 4.5h onset (INTRECIS) cohort, a total of 953 eligible patients with acute ischemic stroke were enrolled in final analysis. Based on 3-month modified Rankin scale score (mRS), patients were classified into good outcome group (mRS 0–1) and poor outcome group (mRS 2–6). Univariate and multivariate logistic regression analyses were used to identify predictive factors for clinical outcome in male or female patients. Results: Of the 953 patients treated with intravenous thrombolysis, 314 (32.9 %) were women. At day 90, we found no significant gender differences in good outcome (72.5 % vs 65.6 %, adjusted p = 0.414). We got the same results after propensity score matching (69.5 % vs 63.4 %, adjusted p = 0.637). Furthermore, we found that initial National Institute of Health Stroke Scale (NIHSS) score (odd ratio [OR] 0.877; 95 % CI 0.847–0.909, p

The memristor, characterized by its resistive switching (RS) behavior, has garnered significant interest within the scientific community, particularly because of its vast potential applications in the fields of artificial intelligence (AI) and information storage. This is attributed to its unique properties, which align well with the requirements of advanced computational and memory systems. Ferroelectric memristors are currently a thriving area of research, and this study uses Sm-doped Pb(Mg1/3Nb2/3)O3–PbTiO3 (Sm-PMN-PT) and polyvinylidene difluoride (PVDF) as the functional layer. A multi-factor responsive memristor based on a Ag/Sm-PMN-PT:PVDF/ITO sandwich structure is fabricated, for which the RS behavior of the memristor can be adjusted by multi-factors such as voltage scanning rate, bias voltage amplitude, temperature and environmental humidity. Specifically, this device is sensitive to changes in environmental humidity and exhibits the properties of an artificial neural synapse. These advantageous characteristics endow this device with great potential for use in environmental sensors and artificial neural network (ANN) systems.

BackgroundVaricose veins (VV) are a common chronic venous disease that is influenced by multiple factors. It affects the quality of life of patients and imposes a huge economic burden on the healthcare system. This study aimed to use integrated analysis methods, including Mendelian randomization analysis, to identify potential pathogenic genes and drug targets for VV treatment.MethodsThis study conducted Summary-data-based Mendelian Randomization (SMR) analysis and colocalization analysis on data collected from genome-wide association studies and cis-expression quantitative trait loci databases. Only genes with PP.H4 > 0.7 in colocalization were chosen from the significant SMR results. After the above analysis, we screened 12 genes and performed Mendelian Randomization (MR) analysis on them. After sensitivity analysis, we identified four genes with potential causal relationships with VV. Finally, we used transcriptome-wide association studies and The Drug-Gene Interaction Database data to identify and screen the remaining genes and identified four drug targets for the treatment of VV.ResultsWe identified four genes significantly associated with VV, namely, KRTAP5-AS1 [Odds ratio (OR) = 1.08, 95% Confidence interval (CI): 1.05–1.11, p = 1.42e-10] and PLEKHA5 (OR = 1.13, 95% CI: 1.06–1.20, p = 6.90e-5), CBWD1 (OR = 1.05, 95% CI: 1.01–1.11, p = 1.42e-2) and CRIM1 (OR = 0.87, 95% CI: 0.81–0.95, p = 3.67e-3). Increased expression of three genes, namely, KRTAP5-AS1, PLEKHA5, and CBWD1, was associated with increased risk of the disease, and increased expression of CRIM1 was associated with decreased risk of the disease. These four genes could be targeted for VV therapy.ConclusionWe identified four potential causal proteins for varicose veins with MR. A comprehensive analysis indicated that KRTAP5-AS1, PLEKHA5, CBWD1, and CRIM1 might be potential drug targets for varicose veins.

Background Remote ischemic conditioning has been found to be effective in improving functional outcomes in acute ischemic stroke. We conducted a post hoc analysis of the RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial to determine whether long‐term remote ischemic conditioning duration after stroke onset is associated with better clinical outcomes in ischemic stroke. Methods and Results Patients from the full analysis set were included in this secondary analysis. The primary outcome was the proportion of patients with an excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. Among the 1776 patients, there were 55 patients in the 1 to 7 days remote ischemic conditioning group, 345 in the 8 to 10 days group, 412 in the 11 to 13 days group, 51 in the 14 to 16 days group, and 913 in the control group. Compared with the control group, a significantly higher proportion of excellent functional outcomes at 90 days was found in the 11 to 13 days remote ischemic conditioning group (adjusted absolute difference, 9.1% [95% CI, 3.7%–14.5%]; P =0.001), which was attenuated in the other groups (adjusted absolute difference in the 8–10 days group, 2.0% [95% CI, −4.0% to 8.0%]; P=0.51; adjusted absolute difference in the 14–16 days group, 7.4% [95% CI, −5.8% to 20.5%]; P=0.27), but compared to the control group, there was lower proportion of excellent functional outcomes in the 1 to 7 days group (adjusted absolute difference, −14.4% [95% CI, −27.8% to 0.0%]; P=0.05). Conclusions Among patients with acute moderate ischemic stroke, a higher likelihood of excellent clinical outcome was found in patients with longer duration of remote ischemic conditioning.

Abstract Background Since the inconspicuous nature of early signs associated with Chronic Obstructive Pulmonary Disease (COPD), individuals often remain unidentified, leading to suboptimal opportunities for timely prevention and treatment. The purpose of this study was to create an explainable artificial intelligence framework combining data preprocessing methods, machine learning methods, and model interpretability methods to identify people at high risk of COPD in the smoking population and to provide a reasonable interpretation of model predictions. Methods The data comprised questionnaire information, physical examination data and results of pulmonary function tests before and after bronchodilatation. First, the factorial analysis for mixed data (FAMD), Boruta and NRSBoundary-SMOTE resampling methods were used to solve the missing data, high dimensionality and category imbalance problems. Then, seven classification models (CatBoost, NGBoost, XGBoost, LightGBM, random forest, SVM and logistic regression) were applied to model the risk level, and the best machine learning (ML) model’s decisions were explained using the Shapley additive explanations (SHAP) method and partial dependence plot (PDP). Results In the smoking population, age and 14 other variables were significant factors for predicting COPD. The CatBoost, random forest, and logistic regression models performed reasonably well in unbalanced datasets. CatBoost with NRSBoundary-SMOTE had the best classification performance in balanced datasets when composite indicators (the AUC, F1-score, and G-mean) were used as model comparison criteria. Age, COPD Assessment Test (CAT) score, gross annual income, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), anhelation, respiratory disease, central obesity, use of polluting fuel for household heating, region, use of polluting fuel for household cooking, and wheezing were important factors for predicting COPD in the smoking population. Conclusion This study combined feature screening methods, unbalanced data processing methods, and advanced machine learning methods to enable early identification of COPD risk groups in the smoking population. COPD risk factors in the smoking population were identified using SHAP and PDP, with the goal of providing theoretical support for targeted screening strategies and smoking population self-management strategies.

Abstract Background Literature regarding the advantages of gasless vNOTES is insufficient. The aim of our study is to compare gasless vNOTES vs. traditional vNOTES on hemodynamic profiles and outcomes in patients with benign gynecological disease. We hypothesize that compared with those in the traditional vNOTES group, hemodynamic profiles will be changed less during gasless vNOTES, while safety can be promised. Methods This is a single-center, prospective, single-blind, randomized controlled clinical trial, which has been approved by the Institutional Review Board of Chengdu Women’s and Children’s Hospital on September 27, 2022. One hundred and twenty patients will be recruited and randomly assigned to either the traditional vNOTES group or the gasless vNOTES group in a 1:1 ratio. For patients allocated to the traditional vNOTES group, after insertion of one port through the vagina, CO2 gas is infused with a pressure of 12–14 mmHg; while for those allocated to the gasless vNOTES group, a special device is used as an abdominal wall-lifting device to facilitate gasless surgery. CO2 pneumoperitoneum will not be used during the whole gasless vNOTES procedure. The primary outcome is vital signs at different time points. The secondary outcomes include surgical conversion rate, duration of surgery and anesthesia, anesthetic consumption, intraoperative estimated blood loss, VAS and PONV scores at postoperative 2 h and 24 h, administration of vasopressor drugs from the beginning of general anesthesia induction to 15 min after endotracheal intubation, including times, dosage, and type, intraoperative and postoperative complications, time of first getting out of bed after surgery, and time of first eating after surgery, including light drink. Discussion This is the first randomized controlled trial to compare the impacts of gasless vNOTES vs. traditional vNOTES on hemodynamic profiles and outcomes in patients with benign gynecological disease. If a favorable effect and safety of gasless vNOTES for hemodynamic profiles and outcomes in patients are shown, gasless vNOTES would be an optimal treatment option for patients with benign gynecological disease. Trial registration The trial was registered at https://www.chictr.org.cn/showproj.html?proj=182441 with registration No. ChiCTR2200064779 on Oct 17, 2022.

Abstract Background Pulmonary Tuberculosis is a major public health problem endangering people's health, a scientifically accurate predictive model is of great practical significance for the prevention and treatment of pulmonary tuberculosis. Methods The reported incidence data of pulmonary tuberculosis were from the National Public Health Science Data Center ( https://www.phsciencedata.cn/ ). The ARIMA, LSTM, EMD-SARIMA, EMD-LSTM, EMD-ARMA-LSTM models were established using the reported monthly incidence of tuberculosis reported in China from January 2008 to December 2018. The MSE, MAE, RMSE and MAPE were used to evaluate the performance of the models to determine the best model. Results Comparing decomposition-based single model with undecomposed single model, it was found that: when predicting the incidence trend in the next year, compared with SARIMA model, the MSE, MAE, RMSE and MAPE of EMD-SARIMA decreased by 39.3%, 19.0%, 22.1% and 19.8%, respectively. The MSE, MAE, RMSE and MAPE of EMD-LSTM were reduced by 40.5%, 12.8%, 22.9% and 12.7%, respectively, compared with the LSTM model; Comparing the decomposition-based hybrid model with the decomposition-based single model, it was found that: when predicting the incidence trend in the next year, compared with EMD-SARIMA model, the MSE, MAE, RMSE and MAPE of EMD-ARMA-LSTM model decreased by 21.7%, 10.6%, 11.5% and 11.2%, respectively. The MSE, MAE, RMSE and MAPE of EMD-ARMA-LSTM were reduced by 16.7%, 9.6%, 8.7% and 12.3%, respectively, compared with EMD-LSTM model. Furthermore, the performance of the model were consistent when predicting the incidence trend in the next 3 months, 6 months and 9 months. Conclusion The prediction performance of the decomposition-based single model is better than that of the undecomposed single model, and the prediction performance of the combined model using the advantages of different models is better than that of the decomposition-based single model, so the EMD-ARMA-LSTM combination model can improve the prediction accuracy better than other models, which can provide a theoretical basis for predicting the epidemic trend of pulmonary tuberculosis and formulating prevention and control policies.

The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179–1.500) and HGS (HR = 0.745, 95%CI = 0.645–0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120–1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053–1.899) and male (HR = 1.586; 95%CI = 1.114–2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.

The inhalation of zinc chloride (ZnCl2) smoke is one of common resources of lung injury, potentially resulting in severe pulmonary complications and even mortality. The influence of ZnCl2 smoke on lysine succinylation (Ksucc) in the lungs remains uncertain. In this study, we used a ZnCl2 smoke inhalation mouse model to perform global proteomic and lysine succinylome analyses. A total of 6781 Ksucc sites were identified in the lungs, with injured lungs demonstrating a reduction to approximately 2000 Ksucc sites, and 91 proteins exhibiting at least five differences in the number of Ksucc sites. Quantitative analysis revealed variations in expression of 384 proteins and 749 Ksucc sites. The analysis of protein-protein interactions was conducted for proteins displaying differential expression and differentially expressed lysine succinylation. Notably, proteins with altered Ksucc exhibited increased connectivity compared with that in differentially expressed proteins. Beyond metabolic pathways, these highly connected proteins were also involved in lung injury-associated pathological reactions, including processes such as focal adhesion, adherens junction, and complement and coagulation cascades. Collectively, our findings contribute to the understanding of the molecular mechanisms underlaying ZnCl2 smoke-induced lung injury with a specific emphasis on lysine succinylation. These findings could pave the way for targeted interventions and therapeutic strategies to mitigate severe pulmonary complications and mortality associated with such injuries in humans.

The burgeoning urbanization of major cities has precipitated a critical examination of deep foundation pit projects, with escalating costs, protracted construction phases, complex site conditions, and specialized technical requirements. Selecting the optimal design scheme from multiple alternatives in a multiattribute decision-making environment poses a significant challenge. This study presents a novel model tailored for the design of deep foundation pits in design-build (DB) contracting projects. The model combines multiattribute ideal point theory with the analytic hierarchy process to evaluate 22 key factors and their uncertainties. It computes the deviations of potential design schemes from ideal benchmarks across all considered attributes. By employing the lexicographic hierarchy aggregation operator, the model aggregates group-level deviations and linguistically weighted evaluations to calculate a comprehensive score for each design scheme. This approach aids in identifying the most suitable design to meet the deep foundation requirements of DB projects. The effectiveness of the model is demonstrated through its application in the decision-making process for a commercial hotel’s deep foundation pit design scheme. The empirical findings affirm the model’s ability to identify critical factors and accurately assess their impact on engineering design decisions in DB contracting projects. Among the four evaluated designs, the continuous retaining wall scheme achieved the lowest group deviation score, marking it as the preferred option. Consequently, this research offers a robust framework for making informed decisions in the design of deep foundation pits within DB contracting projects, effectively handling the complexities of uncertain linguistic evaluations and the collaboration of multiple attributes.

Summary: RNA splicing is a post-transcriptional event that regulates many physiological and pathological events. However, whether RNA splicing regulates cerebral I/R-induced brain injury remains largely unknown. In this study, we found that the chromatin target of Prmts (CHTOP) was highly expressed in neurons, and anti-inflammatory cytokine interleukin-10 (IL-10) upregulates its expression after ischemia. In addition, overexpression or knockdown of CHTOP alleviated or exacerbated neuronal death in both experimental stroke mice and cultured neurons. Mechanistically, RNA alternative splicing is altered early after oxygen and glucose deprivation/reoxygenation (OGD/R). CHTOP interacted with nuclear speckle-related proteins to regulate alternative mRNA splicing of neuronal survival-related genes after OGD/R. In addition, I/R injury-induced cytokines IL-10 regulate CHTOP-mediated RNA splicing to alleviate ischemic brain injury. Taken together, this study reveals the alteration of RNA splicing after OGD/R and identifies the IL-10-CHTOP-RNA splicing axis as a modulator of brain injury, which may be promising therapeutic targets for ischemic stroke.

Background and Purpose Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset. Methods In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5–24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0–1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH). Results Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46–2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0–2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group. Conclusion This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5–24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.

Abstract Diabetes mellitus (DM) has become the third chronic non-infectious disease affecting patients after tumor, cardiovascular and cerebrovascular diseases, becoming one of the major public health issues worldwide. Detection of early warning risk factors for DM is key to the prevention of DM, which has been the focus of some previous studies. Therefore, from the perspective of residents' self-management and prevention, this study constructed Bayesian networks (BNs) combining feature screening and multiple resampling techniques for DM monitoring data with a class imbalance in Shanxi Province, China, to detect risk factors in chronic disease monitoring programs and predict the risk of DM. First, univariate analysis and Boruta feature selection algorithm were employed to conduct the preliminary screening of all included risk factors. Then, three resampling techniques, SMOTE, Borderline-SMOTE (BL-SMOTE) and SMOTE-ENN, were adopted to deal with data imbalance. Finally, BNs developed by three algorithms (Tabu, Hill-climbing and MMHC) were constructed using the processed data to find the warning factors that strongly correlate with DM. The results showed that the accuracy of DM classification is significantly improved by the BNs constructed by processed data. In particular, the BNs combined with the SMOTE-ENN resampling improved the most, and the BNs constructed by the Tabu algorithm obtained the best classification performance compared with the hill-climbing and MMHC algorithms. The best-performing joint Boruta-SMOTE-ENN-Tabu model showed that the risk factors of DM included family history, age, central obesity, hyperlipidemia, salt reduction, occupation, heart rate, and BMI.

Abstract Prolonged exposure of power transmission lines to extreme ice disasters in the atmosphere disrupts transmission. First, this study establishes a comprehensive failure probability model for the impact of extreme ice disasters on the transmission lines to better understand and improve the transmission lines' ability to withstand such disasters. It predicts the line failure probability based on the initial design data of the lines. Second, the system's weak points are identified, and the fault scenario set is established using the Monte Carlo state sampling method. Next, the system's state is calculated using the resilience assessment index and the DC optimal load reduction model. Finally, an optimal decision‐making method for the transmission line maintenance sequence is proposed from the post‐disaster maintenance scheduling perspective. Considering the travel time and maintenance effect, this method can effectively restore the system state in response to extreme ice disasters. The IEEE 30‐bus power system is taken as an example of simulation verification. The results show that this method can effectively complete the system load state restoration and improve the transmission system's resilience. It also has certain practicality and good practical application values.

With the deep coal tunnel surrounding rock as the research object, in view of the serious rock burst hazards, incomplete rock burst mechanism research, and the lack of more targeted guidance on the prevention and control of rock burst engineering, indoor tests, numerical simulation, theoretical analysis and other methods were used to reveal the deep coal roadway surrounding rock burst mechanism from the three-way stress difference perspective. Based on the understanding that excavation activity disturbs the three-way isobaric state of the coal rock body and causes damage to the surrounding rock, the response characteristics of the coal unit body under the action of different stress paths were studied by PFC simulation. The criterion of unit body instability based on the stress difference was obtained. The concepts of stress difference gradient and the rate of change of stress difference gradient were proposed. The Dg evolution characteristics of the surrounding rock were analyzed based on the Drucker-Prager criterion, and then the mechanism of action of the rock burst caused by the concentration of Dg in the surrounding rock was obtained. Finally, the prevention and control mechanism and rock burst accident cases were analyzed. The results show that the stress differential withstand capacity of the coal body differs significantly depending on the stress path. The objective of the evolution of the internal stresses in the surrounding rock is to reduce the peak Dg to a very small value, with the failure and yielding of the surrounding rock being the result of Dg-driven action. The stress difference gradient grows with the increasing depth of burial and coal seam bursting liability, and reflects the nature of the “rise-fall-fall” gradient. The Dgc characterizes the degree of Dg concentration within the surrounding rock. Under stress perturbation, a more stable deformation and displacement of the coal body in the Dg elevation zone occurs when the condition Dgc0 < D' gc < k1Dgc0 is satisfied, a more stable overall instability occurs when k1Dgc0≤D' gc < [Dgc] is satisfied, and a rock burst occurs when D' gc≥[Dgc] is satisfied. Rock burst of the surrounding rock is an extreme form of evolution of their own deformation and destruction. Rock burst prevention should be centered on weakening the Dg of the surrounding rock, with Dgc control as the main focus.

Abstract We aim to explore the effect of head-down position (HDP), initiated within 24 hours of onset, in moderate anterior circulation stroke patients with probable large artery atherosclerosis (LAA) etiology. This investigator-initiated, multi-center trial prospective, randomized, open-label, blinded-endpoint, multi-center and phase-2 trial was conducted in China and completed in 2021. Eligible patients were randomly assigned (1:1) into the HDP group receiving −20° Trendelenburg, or control group receiving standard care according to national guideline. The primary endpoint was proportion of modified Rankin Scale (mRS) of 0 to 2 at 90 days, which is a scale for measuring the degree of disability after stroke. 90-day mRS was assessed by a certified staff member who was blinded to group assignment. A total of 96 patients were randomized (47 in HDP group and 49 in control group) and 94 (97.9%) patients were included in the final analysis: 46 in HDP group and 48 in control group. The proportion of favorable outcome was 65.2% (30/46) in the HDP group versus 50.0% (24/48) in the control group (unadjusted: OR 2.05 [95%CI 0.87-4.82], P = 0.099). No severe adverse event was attributed to HDP procedures. This work suggests that the head-down position seems safe and feasible, but does not improve favorable functional outcome in acute moderate stroke patients with LAA. This trial was registered with ClinicalTrials.gov, NCT03744533.

Background: The overall incidence of acute kidney injury (AKI) in neonates undergoing emergency gastrointestinal surgery is yet to be determined. The study aims are to analyze our experience in emergency gastrointestinal surgery for neonates and to evaluate the incidence of AKI. Methods: We conducted a retrospective study of neonates undergoing emergency gastrointestinal surgery between June 31, 2018 and May 10, 2022 (N = 329). The primary outcome was the overall incidence of AKI. The diagnostic AKI was based on the Modified Kidney Disease: Improving Global Outcomes (KDIGO) definition of neonatal AKI. The secondary outcomes, including the postoperative length of hospital stay (PLOS), 24-h mortality, in-hospital mortality, and total in-hospital cost, were analyzed. The risk factors associated with the development of postoperative AKI were also analyzed. Results: The incidence of postoperative AKI was 9.1% (30/329). No significant differences were detected in the 24-h mortality and in-hospital mortality between the two cohorts. In the final model, patients undergoing mechanical ventilation before surgery, vasopressor support, surgical duration, intraoperative oliguria and preoperative lowest serum creatinine (SCr), were independently associated with AKI. Conclusion: Our study found that patients undergoing mechanical ventilation before surgery, vasopressor support, surgical duration, intraoperative oliguria and preoperative lowest SCr were independently associated with postoperative AKI in neonates who accepted emergency gastrointestinal surgeries.

ABSTRACT The advancement of neuroimaging technology offers a pivotal reference for the early detection of mild cognitive impairment (MCI), a significant area of focus in contemporary cognitive function research. Structural MRI scans present visual and quantitative manifestations of alterations in brain tissue, whereas functional MRI scans depict the metabolic and functional state of brain tissues from diverse perspectives. As various magnetic resonance techniques possess both strengths and constraints, this review examines the methodologies and outcomes of multimodal magnetic resonance technology in MCI diagnosis, laying the groundwork for subsequent diagnostic and therapeutic interventions for MCI.

The interaction between the peripheral immune system and the brain is increasingly being recognized as an important layer of neuroimmune regulation and plays vital roles in brain homeostasis as well as neurological disorders. As an important population of T-cell lymphocytes, the roles of CD8+ T cells in infectious diseases and tumor immunity have been well established. Recently, increasing number of complex functions of CD8+ T cells in brain disorders have been revealed. However, an advanced summary and discussion of the functions and mechanisms of CD8+ T cells in brain injury and neurodegeneration are still lacking. Here, we described the differentiation and function of CD8+ T cells, reviewed the involvement of CD8+ T cells in the regulation of brain injury including stroke and traumatic brain injury and neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), and discussed therapeutic prospects and future study goals. Understanding these processes will promote the investigation of T-cell immunity in brain disorders and provide new intervention strategies for the treatment of brain injury and neurodegeneration.

Zinc oxide (ZnO) is an attractive material for gas sensors, and various ZnO-based sensors have been developed to detect gas pollution. In this work, a series of SiC/ZnO composites were fabricated by incorporating silicon carbide nanocrystals (SiC NCs) into ZnO microspheres by a grinding method. The SiC/ZnO composite exhibited a significantly enhanced gas sensitivity response toward NO gas in comparison to ZnO. The test revealed that the response of the composite was 251.1 for 100 ppm of nitrogen monoxide (NO), and the detection limit was as low as 100 ppb. Through spectral and comparative analyses, it has been indicated that the active functional groups of the SiC NCs have a substantial impact on the detection of NO, and the corresponding mechanism is studied and discussed. This work offers a simple strategy for the fabrication of SiC/ZnO material with enhanced sensitivity in sensing applications.

Abstract The imbalanced carrier mobility remains a bottleneck for performance breakthrough in even those organic solar cells (OSCs) with recorded power conversion efficiencies (PCEs). Herein, a counter electrode doping strategy is proposed to reshape the internal potential distribution, which targets to extract the low mobility carriers at far end. Device simulations reveal that the key of this strategy is to partially dope the active layer with a certain depth, therefore it strengthens the electric field for low mobility carriers near counter electrode region while avoids zeroing the electric field near collection electrode region. Taking advantage of these, PCE enhancements are obtained from 15.4% to 16.2% and from 16.9% to 18.0%, respectively, via cathode p‐doping and anode n‐doping. Extending its application from opaque to semitransparent devices, the PCE of dilute cell rises from 10.5% to 12.1%, with a high light utilization efficiency (LUE) of 3.5%. The findings provide practical solutions to the core device physical problem in OSCs.

The interaction between peripheral immune cells and the brain is an important component of the neuroimmune axis. Unconventional T cells, which include natural killer T (NKT) cells, mucosal-associated invariant T (MAIT) cells, γδ T cells, and other poorly defined subsets, are a special group of T lymphocytes that recognize a wide range of nonpolymorphic ligands and are the connection between adaptive and innate immunity. Recently, an increasing number of complex functions of these unconventional T cells in brain homeostasis and various brain disorders have been revealed. In this review, we describe the classification and effector function of unconventional T cells, review the evidence for the involvement of unconventional T cells in the regulation of brain homeostasis, summarize the roles and mechanisms of unconventional T cells in the regulation of brain injury and neurodegeneration, and discuss immunotherapeutic potential as well as future research goals. Insight of these processes can shed light on the regulation of T cell immunity on brain homeostasis and diseases and provide new clues for therapeutic approaches targeting brain injury and neurodegeneration.

Abstract Background Influenza is an acute respiratory infectious disease that is highly infectious and seriously damages human health. Reasonable prediction is of great significance to control the epidemic of influenza. Methods Our Influenza data were extracted from Shanxi Provincial Center for Disease Control and Prevention. Seasonal-trend decomposition using Loess (STL) was adopted to analyze the season characteristics of the influenza in Shanxi Province, China, from the 1st week in 2010 to the 52nd week in 2019. To handle the insufficient prediction performance of the seasonal autoregressive integrated moving average (SARIMA) model in predicting the nonlinear parts and the poor accuracy of directly predicting the original sequence, this study established the SARIMA model, the combination model of SARIMA and Long-Short Term Memory neural network (SARIMA-LSTM) and the combination model of SARIMA-LSTM based on Singular spectrum analysis (SSA-SARIMA-LSTM) to make predictions and identify the best model. Additionally, the Mean Squared Error (MSE), Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) were used to evaluate the performance of the models. Results The influenza time series in Shanxi Province from the 1st week in 2010 to the 52nd week in 2019 showed a year-by-year decrease with obvious seasonal characteristics. The peak period of the disease mainly concentrated from the end of the year to the beginning of the next year. The best fitting and prediction performance was the SSA-SARIMA-LSTM model. Compared with the SARIMA model, the MSE, MAE and RMSE of the SSA-SARIMA-LSTM model decreased by 38.12, 17.39 and 21.34%, respectively, in fitting performance; the MSE, MAE and RMSE decreased by 42.41, 18.69 and 24.11%, respectively, in prediction performances. Furthermore, compared with the SARIMA-LSTM model, the MSE, MAE and RMSE of the SSA-SARIMA-LSTM model decreased by 28.26, 14.61 and 15.30%, respectively, in fitting performance; the MSE, MAE and RMSE decreased by 36.99, 7.22 and 20.62%, respectively, in prediction performances. Conclusions The fitting and prediction performances of the SSA-SARIMA-LSTM model were better than those of the SARIMA and the SARIMA-LSTM models. Generally speaking, we can apply the SSA-SARIMA-LSTM model to the prediction of influenza, and offer a leg-up for public policy.

The corrosion behavior of Ni-based superalloy GH4169 in the marine environment was simulated and investigated by the alternation of intermediate temperature salt spraying and the marine atmosphere. The results suggested that promoted corrosion caused by intermediate temperature NaCl spraying was primary and severe in the form of an over-parabolic weight gain while a weight loss in marine atmosphere. After long-term exposure, corrosion further invaded the matrix alloy and resulted in severe internal corrosion. The corrosion preferentially occurred at the vertices of NaCl particles and led to the consumption of Cr2O3. A complex mixture of Cr2O3, NaCrO2, and Na2CrO4 was thus caused and evolved under the “active oxidation” mechanism. Accordingly, actual corrosion behavior of aircraft engine blades serviced and parked in the marine environment was revealed in the work.

Dockless bike-sharing (DBS) is a green and flexible travel mode, which has been considered as an effective way to address the first-and-last mile problem. A two-level process is developed to identify the integrated DBS–metro trips. Then, DBS trip data, metro passenger data, socioeconomic data, and built environment data in Shanghai are used to analyze the spatiotemporal characteristics of integrated trips and the correlations between the integrated trips and the explanatory variables. Next, multicollinearity tests and autocorrelation tests are conducted to select the best explanatory variables. Finally, a geographically and temporally weighted regression (GTWR) model is adopted to examine the determinants of integrated trips over space and time. The results show that the integrated trips account for 16.8% of total DBS trips and that departure-transfer trips are greater than arrival-transfer trips. Moreover, the integrated trips are concentrated in the central area of the city. In terms of impact factors, it is found that GDP, government count, and restaurant count are negatively correlated with the number of integrated trips, while house price, entropy of land use, transfer accessibility index, and metro passenger flow show positive relationships. In addition, the results show that the GTWR model outperforms the OLS model and the GWR model.

Background: Topical lidocaine microemulsion preparations with low toxicity, low irritation, strong transdermal capability and convenient administration are urgently needed.Methods: Box-Behnken design was performed for three preparation conditions of 5% lidocaine microemulsions: mass ratio of the mass ratio of surfactant/(oil phase + surfactant) (X1), the mass ratio of olive oil/(α-linolenic acid + linoleic acid) (X2) and the water content W% (X3). Then, five multi-objective genetic algorithms were used to optimize the three evaluation indices to optimize the effects of lidocaine microemulsion preparations. Finally, the ideal optimization scheme was experimentally verified.Results: Non-dominated Sorting Genetic Algorithm-II was used for 30 random searches. Among these, Scheme 2: X1 = 0.75, X2 = 0.35, X3 = 75%, which resulted in Y1 = 0.17 μg/(cm2·s) and Y2 = 0.74 mg/cm2; and the Scheme 19: X1 = 0.68, X2 = 1.42, X3 = 75% which resulted in Y1 = 0.14 μg/(cm2·s) and Y2 = 0.80 mg/cm2, provided the best matches for the objective function requirements. The maximum and average fitness of the method have reached stability after 3 generations of evolution. Experimental verification of the above two schemes showed that there were no statistically significant differences between the measured values of Y1 and Y2 and the predicted values obtained by optimization (p > 0.05) and are close to the target value.Conclusion: Two lidocaine microemulsion preparation protocols were proposed in this study. These preparations resulted in good transdermal performance or long anesthesia duration, respectively.

Three rat sarcoma (RAS) gene isoforms, KRAS, NRAS, and HRAS, constitute the most mutated family of small GTPases in cancer. While the development of targeted immunotherapies has led to a substantial improvement in the overall survival of patients with non-KRAS-mutant cancer, patients with RAS-mutant cancers have an overall poorer prognosis owing to the high aggressiveness of RAS-mutant tumors. KRAS mutations are strongly implicated in lung, pancreatic, and colorectal cancers. However, RAS mutations exhibit diverse patterns of isoforms, substitutions, and positions in different types of cancers. Despite being considered “undruggable”, recent advances in the use of allele-specific covalent inhibitors against the most common mutant form of RAS in non-small-cell lung cancer have led to the development of effective pharmacological interventions against RAS-mutant cancer. Sotorasib (AMG510) has been approved by the FDA as a second-line treatment for patients with KRAS-G12C mutant NSCLC who have received at least one prior systemic therapy. Other KRAS inhibitors are on the way to block KRAS-mutant cancers. In this review, we summarize the progress and promise of small-molecule inhibitors in clinical trials, including direct inhibitors of KRAS, pan-RAS inhibitors, inhibitors of RAS effector signaling, and immune checkpoint inhibitors or combinations with RAS inhibitors, to improve the prognosis of tumors with RAS mutations.

Investigation of germanium gate hydrogen-terminated (H-terminated) diamond field effect transistor (FET) with Al2O3 dielectric layer has been successfully performed. The device demonstrates a normally-on characteristics, whose maximum drain-source current density, threshold voltage, maximum transconductance, on/off ratio, subthreshold swing, capacitance, carrier density, saturation carrier mobility, fixed charge density and interface state density are of −37.3 mA/mm, 0.22 V, 6.42 mS/mm, 108, 134 mV/dec, 0.33 μF/cm2, 9.83 × 1012 cm−2, 97.9 cm2/V·s, 7.63 × 1012 cm−2 and 2.56 × 1012 cm−2·eV−1, respectively. This work is significant to the development of H-terminated diamond FET.

Abstract Background Randall’s plaques (RP) are identified as anchored sites for kidney calcium oxalate stones, but the mechanism remains unclear. Given the importance of osteogenic-like cells in RP formation and OCT4 in reprogramming differentiated cells to osteoblasts, the current study explored the potential role of OCT4 in RP formation. Methods OCT4 and biomineralization were evaluated in RP, and immunofluorescence co-staining was performed to identify these cells with alteration of OCT4 and osteogenic markers. Based on the analysis of tissue, we further investigated the mechanism of OCT4 in regulating osteogenic-like differentiation of primary human renal interstitial fibroblasts (hRIFs) in vitro and vivo. Results We identified the upregulated OCT4 in RP, with a positive correlation to osteogenic markers. Interestingly, fibroblast marker Vimentin was partially co-localized with upregulated OCT4 and osteogenic markers in RP. Further investigations revealed that OCT4 significantly enhanced the osteogenic-like phenotype of hRIFs in vitro and in vivo. Mechanically, OCT4 directly bound to BMP2 promoter and facilitated its CpG island demethylation to transcriptionally promote BMP2 expression. Furthermore, combination of RIP and RNA profiling uncovered that lncRNA OLMALINC physically interacted with OCT4 to promote its stabilization via disrupting the ubiquitination. Additionally, OLMALINC was upregulated in fibroblasts in RP visualized by FISH, and a positive correlation was revealed between OLMALINC and OCT4 in RP. Conclusions The upregulation of OCT4 in hRIFs was a pathological feature of RP formation, and OLMALINC/OCT4/BMP2 axis facilitated hRIFs to acquire osteogenic-like phenotype under osteogenic conditions, through which the pathway might participate in RP formation. Our findings opened up a new avenue to better understand RP formation in which osteogenic-like process was partially triggered by lncRNAs and pluripotency maintenance related genes.

Abstract Background Quadratus lumborum block was recently proposed as an alternative technique for post-cesarean delivery analgesia. However, there is not a definite optimum concentration of local anesthetics. A biased coin design up-and-down method was used to explore the minimum effective concentration of ropivacaine in quadratus lumborum block for satisfactory analgesia after cesarean delivery. Methods Fifty-six patients weighing 60–80 kg after cesarean section and with ages between 18 and 40 years were recruited. For the posterior quadratus lumborum block, a volume of 25 ml of the assigned concentration of ropivacaine was injected bilaterally. The concentration administered to each patient depended on the response to the previous dose. The first patient received 0.25%. If a successful block was observed, the next patient was randomized to receive the same ropivacaine concentration (with a probability of 0.89) or 0.025% less (with a probability of 0.11). After any block failure, the concentration was always increased by 0.025% for the next. The study ended when 45 successful blocks were obtained. We defined effective quadratus lumborum block as a resting visual analog score ≤ 3 and the absence of a need for rescue anesthetics. Results The 90% minimum effective concentration of ropivacaine was 0.335% (95% CI 0.306 to 0.375%), and the 99% minimum effective concentration was 0.371% (95% CI 0.355 to 0.375%). The sufentanil consumption was 11 (11,13) and 24 (22,27) μg at 12 and 24 hours after quadratus lumborum block, respectively. Conclusions The optimum dosage of ropivacaine is a 25 ml volume of 0.335% for quadratus lumborum block after cesarean delivery. Trial registration The study was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000040415 ).

As an exceptional nonlinear material, graphene offers versatile appealing properties, such as electro-optic tunability and high electromagnetic field confinement in the terahertz regime, spurring advance in ultrashort pulse formation, photodetectors and plasmonic emission. However, limited by atomic thickness, weak light–matter interaction still limits the development of integrated optical devices based on graphene. Here, an exquisitely designed meta-cavities combined with patterned graphene is used to overcome this challenge and promote THz-graphene interaction via terahertz location oscillation. By using an 800 nm pump laser, the local field-induced strong interaction allows sensitive responses to the ultrafast energy transfer from the ultrafast optical pump to graphene electron heat, enabling 46.2% enhancement of terahertz transparency. Such optical modulation of terahertz waves shows ultrafast response in delay less than 10 ps. Moreover, thanks to the nature of graphene, the device shows unique potential for electrically dynamic tuning and further bandwidth broadening.

Abstract Background Local environmental factors are associated with health and healthcare-seeking behaviors. However, there is a paucity in the literature documenting the link between air pollution and healthcare-seeking behaviors. This study aimed to address the gap in the literature through a cross-sectional study of domestic migrants in China. Methods Data were extracted from the 2017 China Migrants Dynamic Survey (n = 10,051) and linked to the official air pollution indicators measured by particulate matter (PM2.5 and PM10) and air quality index (AQI) in the residential municipalities (n = 310) of the study participants over the survey period. Probit regression models were established to determine the association between air pollution and refraining from visiting health facilities after adjustment for variations in the predisposing, enabling and needs factors. Thermal inversion intensity was adopted as an instrumental variable to overcome potential endogeneity. Results One unit (µg/m3) increase in monthly average PM2.5 was associated with 1.8% increase in the probability of refraining from visiting health facilities. The direction and significance of the link remained unchanged when PM2.5 was replaced by AQI or PM10. Higher probability of refraining from visiting health facilities was also associated with overwork (β = 0.066, p = 0.041) and good self-related health (β = 0.171, p = 0.006); whereas, lower probability of refraining from visiting health facilities was associated with short-distance (inter-county) migration (β=-0.085, p = 0.048), exposure to health education (β=-0.142, p

Using first-principles calculations, hydrogen evolution reaction (HER) activity on two-dimensional (2D) gallium chalcogenides monolayers GaX (X = O, S, Se, and Te) as well as the derived Janus monolayers Ga2XY (X≠Y, X/Y = O, S, Se, and Te) were systematically examined. It was found that Ga2OSe Janus monolayer with a 0.3% strain has the lowest ΔGH∗ of 0.19 eV (modified to −0.01 eV including the solvation effect) because (i) O is the most electronegative among X/Y atoms, (ii) the Ga2OSe monolayer has a larger lattice parameter with respect to GaO monolayer, and (iii) the built-in electric field is enhanced after H adsorption. The enhanced H adsorption with the lattice stretching is a result of the weaker Ga–O bond strength before H adsorption and the reduced electron fillings of anti-bonding molecular orbital formed by H 1s and O 2pz orbitals after H adsorption. The O-pz band center can be served as a descriptor to describe the HER activity trend for these p-block materials. Moreover, Ga2OSe monolayer has appropriate band alignment, distinguished optical absorption coefficient (105 cm−1), low exciton binding energy (0.71 eV), and the spontaneous HER process, indicating that it is a highly potential candidate for near-infrared photocatalyst for hydrogen production. Our research provides a novel paradigm that forming Janus structure can effectively tune the HER activity, which would guide the searching for excellent HER photocatalysts for clean hydrogen production.

Abstract The corrosion behavior of pure Ti under continuous NaCl solution spraying at 600 °C, compared with that under solid NaCl deposit film in H2O + O2 environment, has been studied by mass gain curves, detailed microstructural investigation and phase-stability diagram. The results indicate that the oxide scale consists of three repeated multi-layered subscales composed of Na2TiO3 and TiO2. Continuous NaCl increases the volatilization of TiCl4 towards oxide/atmosphere interface as well as introduces pores and cracks. Pores and cracks allow the oxidizing atmosphere to enter and rapidly spread and resulting in a repeat multi-layered oxide scale. Relatively dense repeat TiO2 delayed active oxidation process, which will decrease the corrosion rate of the pure Ti under NaCl spraying.

Abstract Objective China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty. Method Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants. Results The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME. Conclusion The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective.

With the improvement in survival of patients with tumors, and continuous advancement of diagnostic technology and treatment modalities, instances of multiple primary malignancies (MPMs) are becoming an increasingly common phenomenon. The occurrence of esophageal-relevant MPMs increases the difficulty of diagnosis and treatment, and the overall prognosis is poor. Esophageal cancer related-MPMs tend to occur in areas such as the head, neck, stomach, and lungs. “Field cancerization” is one theoretical basis for the disease, and chemoradiotherapy, environmental life factors, and gene polymorphism are etiological factors. However, the influence of new therapeutic methods on MPM is still unclear, and the relationship between gene polymorphism and MPMs related to esophageal cancer needs further elucidation. Additionally, there is a lack of unified standards for diagnosis and treatment. Therefore, this study aimed to review the causes, clinical features, and prognostic factors of MPMs related to esophageal cancer.