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This article's objectives encompassed investigating the factors influencing early romantic relationships among high school students, analyzing the repercussions of such relationships on these students, and proposing policy interventions to address the issue. The research involved a sample of 26 participants, including students with romantic experiences, teachers familiar with student romantic issues, parents, and school leaders. Data collection employed interviews, with subsequent analysis using descriptive and content analysis techniques. The study identified psychological, physiological, and social factors as the primary influencers of early love among high school students. It also highlighted the impact of early romantic involvement on students, encompassing psychological, physiological, academic, and interpersonal dimensions. To mitigate this issue, the study recommends a multifaceted approach, including the establishment of a comprehensive student support system, enhanced legal education, standardized uniforms for all high schools, media coverage regulations, strengthened social monitoring, rigorous internet content management, and the creation of a dedicated research institution. These measures collectively aim to create a healthier environment for high school students grappling with early romantic relationships.

Background: This study aimed to investigate the impact of intrauterine adhesions (IUA) therapy and endometrial receptivity by implanting autologous bone marrow mesenchymal stem cells (BMSCs) into the Interceed and subsequently placing them in the uterine cavity of rats. Methods: Fifty rats were divided into 5 groups according to the random number table method (10 rats in each group). Following the development of the IUA model through mechanical injury, the animals were categorized into different treatment groups: the IUA model (intrauterine perfusion of saline), Interceed therapy (intrauterine placement of Interceed), BMSCs therapy (intrauterine perfusion of BMSCs), BMSCs + Interceed therapy (intrauterine placement of BMSCs + Interceed), and a control group (intrauterine perfusion of saline). The Hematoxylin-eosin (HE) staining technique was employed to identify and assess the pathological alterations in the endometrium. Additionally, it facilitated the quantification of endometrial glands and the determination of endometrial thickness. Masson staining was used to detect fibrosis in rat uterus. The number of microvascular density (MVD) was detected by immunohistochemistry (IHC). Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blot were used to detect the levels of leukemia inhibitory factor (LIF), integrin ανβ3, and vascular endothelial growth factor (VEGF) in uterine tissue. Male and female rats were combined in cages for reproductive and conception evaluation. Results: In comparison to the control, the number of endometrial glands in the IUA model was significantly reduced, and the degree of endometrial thinning and fibrosis was significantly increased (p 0.05). The number of endometrial glands, endometrial thickness, and MVD in the BMSCs therapy group were significantly increased. Moreover, the expressions of LIF, integrin ανβ3, and VEGF in uterine tissue exhibited a significant increase, leading to a comparatively higher pregnancy rate (p

Abstract Background A significant research gap exists regarding the role of tissue exosomes in intrauterine adhesions (IUAs). This study aims to investigate the involvement of miR-195-5p and its regulatory network in IUAs through the analysis of tissue exosomes. Methods Exosomes from rat uterine tissue with intrauterine adhesions were analyzed via transcriptomics to identify downstream target genes of miR-195-5p, cross-referencing with the human endometrial transcriptomics database GSE224093. Dual luciferase labeling confirmed miRNA-target gene interactions. The therapeutic efficacy of a miR-195-5p agonist was assessed in vivo through HE staining, Masson staining, and mating tests. The mechanisms underlying extracellular matrix (ECM) deposition and myofibroblast transdifferentiation in endometrial fibrosis were investigated both in vitro and in vivo using RT-PCR, Western Blot, immunofluorescence, and immunohistochemistry. Migration ability of endometrial stromal cells was evaluated using CCK8, scratch tests, and Transwell assays. Finally, the clinical potential of miR-195-5p was compared with autologous adipose-derived mesenchymal stem cells. Results The expression of miR-195-5p in uterine tissue exosomes from intrauterine adhesions was found to be decreased. Treatment with a miR-195-5p agonist resulted in improved endometrial health, reduced fibrosis, increased glandular density, and enhanced birth rates in rats. Both in vivo and in vitro experiments confirmed that miR-195-5p decreased ECM deposition, reduced myofibroblast transdifferentiation, and inhibited the migration of endometrial stromal cells. This was achieved through the downregulation of YAP expression in the Hippo pathway and the upregulation of Smad7. Notably, the therapeutic efficacy of miR-195-5p agonists was comparable to that of stem cell therapy, offering promising avenues for clinical application. Conclusions Differential expression of miR-195-5p in tissue exosomes can reduce ECM deposition and myofibroblast transdifferentiation, improving endometrial fibrosis by regulating the YAP-Smad7 pathway in the Hippo signaling cascade.

Abstract Accurate monitoring of the depth of anesthesia (DoA) is essential for ensuring patient safety and effective anesthesia management. Existing methods, such as the Bispectral Index (BIS), are limited in real-time accuracy and robustness. Current methods have problems in generalizability across diverse patient datasets and are sensitive to artifacts, making it difficult to provide reliable DoA assessments in real time. This study proposes a novel method for DoA monitoring using EEG signals, focusing on accuracy, robustness, and real-time application. EEG signals were pre-processed using wavelet denoising and discrete wavelet transform (DWT). Features such as Permutation Lempel–Ziv Complexity (PLZC) and Power Spectral Density (PSD) were extracted. A random forest regression model was employed to estimate anesthetic states, and an unsupervised learning method using the Hurst exponent algorithm and hierarchical clustering was introduced to detect transitions between anesthesia states. The method was tested on two independent datasets (UniSQ and VitalDB), achieving an average Pearson correlation coefficient of 0.86 and 0.82, respectively. For the combined dataset, the model demonstrated an R-squared value of 0.70, a RMSE of 6.31, a MAE of 8.38, and a Pearson correlation of 0.84, showcasing its robustness and generalizability. This approach offers a more accurate and reliable real-time DoA monitoring tool that could significantly improve patient safety and anesthesia management, especially in diverse clinical environments.

Abstract Background High-frequency ventilation (HFV) is commonly used in neonatal intensive care units to provide respiratory support for critically ill neonates. Currently, there is no standardized procedure for weaning from HFV. Two commonly used strategies are transitioning from HFV to conventional mechanical ventilation (CMV) before extubation (HFV-CMV) and extubation after decreasing mean airway pressure during HFV (HFV-HFV). The impact of these strategies on neonatal cerebral oxygenation and hemodynamics remains incompletely understood. Methods We will conduct a prospective, single-center, randomized controlled trial to investigate the effects of two different HFV weaning strategies (HFV-CMV, HFV-HFV) on neonatal cerebral oxygenation and hemodynamics. The patients enrolled in the trial will be randomly allocated to either the HFV-CMV group or the HFV-HFV group in a 1:1 ratio. The primary outcome will be cerebral oxygen saturation (ScO2) before and after the intervention. Second outcomes are cerebral fractional tissue oxygen extraction, heart rate, blood pressure, and the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia. We hypothesize that HFV-CMV results in positive impact on neonatal cerebral oxygenation compared to HFV-HFV. This study aims to identify a better weaning strategy for HFV and contribute evidence-based data to enhance its clinical application in newborns, potentially improving the care and outcomes for neonates receiving HFV. Discussion This study aims to assessing the impact of different HFV weaning strategies on neonatal cerebral oxygenation and hemodynamics, as well as the relationship between the duration of HFV under different strategies and neurological complications, to identify better weaning methods for HFV. We hope to contribute evidence-based data to enhance clinical application of HFV in newborns, potentially improving the care and outcomes for neonates receiving HFV. Trial registration Chinese Clinical Trial Registry: ChiCTR2400088628. Registered on August 22, 2024, https://www.chictr.org.cn/bin/project/edit?pid=235926 .

Abstract Surgical site infection (SSI) following lumbar disc herniation (LDH) surgery leads to prolonged hospital stays, increased costs and reoperations. Therefore, we aim to develop and validate a nomogram to predict the risk of SSI following LDH surgery, thereby helping spine surgeons design personalized prevention strategies and promote early recovery. Data from 647 patients with SSI who underwent LDH surgery at the First Affiliated Hospital of Air Force Medical University (AFMU) from 2020 to 2023 were collected. Ultimately, 241 patients with SSI were selected based on inclusion and exclusion criteria. Patients were randomly divided into training and validation sets with a ratio of 7:3. LASSO regression, univariate, and multivariate logistic regression were utilized to identify target variables and establish the prediction model, which was subsequently validated. Six factors—Age, Body Mass Index (BMI), Postoperative Suction Drainage (PSD), Gelatin Sponge (GS), None-Preoperative Antibiotic (NPTA), and Thrombin Time (TT)—were selected to construct the nomogram model. In the training set, the area under the curve (AUC) for the nomogram was 0.818 (95% CI 0.779–0.857). In the validation set, the AUC was 0.782 (95% CI 0.717–0.846). Calibration curves for both sets showed satisfactory agreement between predicted and actual SSI probabilities. Decision curve analysis indicated that the nomogram is clinically useful with a threshold range of 1–90%. The Clinical Impact Curve (CIC) demonstrated an acceptable cost-benefit ratio. The developed nomogram model effectively predicts the risk of SSI following LDH surgery, enabling spine surgeons to formulate more professional and rational clinical prevention strategies.

Abstract Cervical cerclage is an established procedure for treating cervical insufficiency; however, its efficacy in twin pregnancies remains uncertain. This study aimed to evaluate the effectiveness of transvaginal cervical cerclage in twin pregnancies complicated by cervical insufficiency. Data were retrospectively collected from 155 women with twin pregnancies diagnosed with cervical insufficiency. Participants were divided into two groups: the cerclage group (n = 131) and the non-cerclage group (n = 24). The cerclage group was further subdivided into emergency cerclage and ultrasound-indicated cerclage subgroups for detailed analysis. The duration of gestation was found to be longer in the cerclage group compared to the non-cerclage group. Procedures performed included both emergency and ultrasound-indicated cerclage. No significant difference in gestational outcomes was observed between the ultrasound-indicated cerclage subgroup and the non-cerclage group, regardless of cervical length ( 1 cm or ≤ 1 cm). Overall, cervical cerclage appears to improve pregnancy outcomes in twin pregnancies under specific conditions. While ultrasonographically indicated cerclage did not significantly enhance pregnancy outcomes, emergency cerclage may be effective in improving perinatal prognosis.

Abstract Delays or misdiagnoses in detecting pneumoperitoneum can significantly increase mortality and morbidity. We developed and validated a deep learning model designed to identify pneumoperitoneum in computed tomography images. The model is trained on abdominal scans from Far Eastern Memorial Hospital (January 2012–December 2021) and evaluated using a simulated test set (14,039 scans) and a prospective test set (6351 scans) collected from the same center between December 2022 and May 2023. External validation included 480 scans from Cedars-Sinai Medical Center. Overall, the model achieves a sensitivity of 0.81–0.83 and a specificity of 0.97–0.99 across retrospective, prospective, and external validation; sensitivity improves to 0.92–0.98 when cases with a small amount of free air (total volume

Objective When implanting the Zero‐P device, the screws of Zero‐P form a bone wedge with a 40 ± 5° cranial and caudal angle (CCA). However, no study has been performed in the optimal CCA of the Zero‐P implant. To investigate whether the cranial/caudal angles (CCA) of the screws affect the clinical and radiological outcomes in patients undergoing ACDF with the Zero‐P implant. Methods From January 2016 to December 2023, we retrospectively analyzed 186 patients who underwent 1‐level ACDF with the Zero‐P device. The patients were divided into four groups: group A (cranial angle ≤40°, caudal angle ≤40°); group B (cranial angle ≤40°, caudal angle >40°); group C (cranial angle >40°, caudal angle ≤40°); and group D (cranial angle >40°, caudal angle >40°). The clinical outcomes, including Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS) scores, the radiological parameters, including cervical lordosis (CL), cervical lordosis of operated segments (OPCL), intervertebral space height (ISH) and fusion rate (FR), and the complications, were evaluated and compared. Parametric tests, non‐parametric tests, and chi‐square tests were conducted to analyze the data. Results The OPCL of group A was significantly less than that of the other groups at the final follow‐up (p 0.05). Conclusion A larger CCA of the screws (cranial angle >40°, caudal angle >40°) was better for maintaining OPCL and reducing the incidence of ASD. A smaller CCA of the screws (cranial angle ≤40°, caudal angle ≤40°) was better for maintaining ISH and reducing the rate of subsidence.

Abstract Background To analyze the clinical manifestations, diagnostic and therapeutic processes of perinatal tuberculosis in children, providing reference for clinicians in the diagnosis and treatment of this disease. Methods A retrospective analysis was conducted on the epidemiological history, clinical manifestations, laboratory and imaging findings, and treatment follow-up of 20 cases of perinatal tuberculosis diagnosed in the Second Department of Infectious Disease, Kunming Children’s Hospital, from February 2014 to September 2021. Results Of the 20 cases, 13 were male (65.0%) and 7 were female (35.0%). The average age at onset was 35.35 ± 23.03days, with an average time from onset to diagnosis of 24.75 ± 15.55days. Tuberculin skin test (TST) was positive in 1 out of 4 cases (25.0%). Gamma interferon release assays (IGRAs) were positive in 9 out of 17 cases (52.9%).acid-fast staining was positive in 7 out of 16 cases (43.7%), and Mycobacterium tuberculosis nucleic acid polymerase-chain-reaction(PCR) was positive in 14 out of 20 cases (70.0%). Chest CT showed miliary changes in 4 out of 19 cases (21.0%), multiple nodular and patchy opacities in 6 out of 19 cases (31.6%), and pulmonary consolidation and atelectasis in 10 out of 19 cases (52.6%). After anti-tuberculosis treatment, 16 out of 20 cases (80.0%) improved, and no recurrence of tuberculosis was observed during follow-up periods ranging from 9 months to 3 years. The growth and development of these children were similar to those of healthy children. Conclusion The clinical manifestations and chest imaging features of perinatal tuberculosis are nonspecific. In suspected cases, it is crucial to investigate the mother’s condition thoroughly and complete etiological examinations to achieve early diagnosis and timely treatment, which can improve prognosis.

Abstract Background Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, early readmissions due to complications are common. This study assessed the ability of the hemoglobin-to-red cell distribution width ratio (HRR), hemoglobin-to-monocyte ratio (HMR), and hemoglobin-to-leukocyte ratio (HLR) to predict readmission within 14 days after TKA. Methods Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary TKA were eligible for inclusion. Patients with incomplete data on the indices of interest or follow-up

Abstract For the multistage progression of prostate cancer (PCa) and resistance to immunotherapy, tumour‐associated macrophage is an essential contributor. Although immunotherapy is an important and promising treatment modality for cancer, most patients with PCa are not responsive towards it. In addition to exploring new therapeutic targets, it is imperative to identify highly immunotherapy‐sensitive individuals. This research aimed to establish a signature risk model, which derived from the macrophage, to assess immunotherapeutic responses and predict prognosis. Data from the UCSC‐XENA, GEO and TISCH databases were extracted for analysis. Based on both single‐cell datasets and bulk transcriptome profiles, a macrophage‐related score (MRS) consisting of the 10‐gene panel was constructed using the gene set variation analysis. MRS was highly correlated with hypoxia, angiogenesis, and epithelial‐mesenchymal transition, suggesting its potential as a risk indicator. Moreover, poor immunotherapy responses and worse prognostic performance were observed in the high‐MRS group of various immunotherapy cohorts. Additionally, APOE, one of the constituent genes of the MRS, affected the polarisation of macrophages. In particular, the reduced level of M2 macrophage and tumour progression suppression were observed in PCa xenografts which implanted in Apolipoprotein E‐knockout mice. The constructed MRS has the potential as a robust prognostic prediction tool, and can aid in the treatment selection of PCa, especially immunotherapy options.

Abstract Effective antibacterial therapy while accelerating the repair of bone defects is crucial for the treatment of osteomyelitis. Inspired by the protective mechanism of Andrias davidianus, we constructed an antibacterial hydrogel scaffold with excellent rigidity and long-term slow-release activity. While retaining the toughness of the skin secretion of Andrias davidianus (SSAD), the rigidity of the hydrogel material is increased by incorporating hydroxyapatite to meet the demands of bone-defect-filling materials. It also exerted antibacterial effects via the slow-release of vancomycin from local osteomyelitis lesions. Notably, the hydrogel can also carry a high stable recombinant miR-214-3p inhibitor (MSA-anti214). By the delivery of nano vector polyvinylamine, the long-term slow-release of MSA-anti214 is achieved to promote bone repair, making this composite hydrogel a potential SSAD-based osteomyelitis alleviator (SOA). In vitro and vivo results verified that the SOA effectively eliminated Staphylococcus aureus and repaired bone defects, ultimately mitigating the progression of osteomyelitis. This composite hydrogel extends the economic application prospects of A. davidianus and has provided new insights for the treatment of osteomyelitis. The study also explored new insights for the bone filling materials of bone defection and other skeletal system diseases.

Direct preparation of glass-ceramics from slag is an efficient way to use the “slag” and “heat” of the slag, making this preparation a sought-after research topic. To prepare glass-ceramics using the Petrurgic method, this paper used silico–manganese slag as the main raw material, along with chromite and serpentine as modifiers. The Petrurgic method is a heat treatment process involving controlled crystallization during slag cooling to form glass-ceramics. The prepared glass-ceramic samples had a diameter of 100 mm and a height of 20 mm. Various tests and analyses such as X-ray diffraction (XRD), differential scanning calorimetry (DSC), scanning electron microscopy with energy dispersive X-ray spectroscopy, flexural strength, compressive strength, water absorption, and bulk density were performed on the samples. The influence of different heat treatment regimens on the phase composition and properties of silico–manganese slag microcrystalline glass was discussed. Additionally, the study investigated the temperature variation inside the glass-ceramic samples, and the results indicated that by modifying the slag and annealing it at 700℃ after cooling to the crystallization temperature, microcrystalline glass meets the performance requirements of natural granite. The temperature range of 900–1050 ℃ was found to be associated with the crystallization of the augite phase, while the temperature range of 1000–1050 ℃ was related to the crystallization of the akermanite phase. With improvements in the heat treatment system, the amount of akermanite phase precipitation will increase, and the grain will become coarser than before. At 900 ℃, the grain growth of the microcrystalline glass was not as significant as that of the samples annealed at 1000 ℃ and 1050 ℃, and the lack of excessive crystallization led to fewer defects inside the glass-ceramics. After studying the temperature profile data, it was observed that during the heat treatment process at 1000–1050 ℃, inconsistent crystallization between the inner and outer parts of the sample resulted in a temperature gradient from the center to the edge. After studying the temperature profile data, it was observed that during the heat treatment process at 1000–1050 ℃, inconsistent crystallization between the inner and outer parts of the sample resulted in a temperature gradient from the center to the edge. However, at 900 ℃, the temperatures of the central and edge regions remained consistent during the crystallization stage. For the heat treatment at 800 ℃, the slag temperature quickly decreased below 900–1050 ℃, making crystallization difficult. The overall trend of the temperature difference between the central and side parts of the sample was similar for all four heat-treatment conditions. After casting the slag into the mold, temperature gradients were formed within the sample. These formations do not affect the types of crystalline phases that precipitate; however, they do affect the quantity of crystallization.

Abstract The frequencies of marine heatwaves and thermal coral bleaching events (CBEs) over the Great Barrier Reef (GBR) continue to increase with five mass CBEs reported since 2016. While changes in the local meteorology, such as reduced wind speeds and decreased cloud cover, are known to heat the shallow reef waters, little consideration has been given to the overriding synoptic meteorology. The 2022 CBE, occurring under La Niña conditions, saw ocean temperatures at Davies Reef increase 1.9 $$^\circ \hbox {C}$$ ∘ C over 19-days and subsequently cool 2.1 $$^\circ \hbox {C}$$ ∘ C back to seasonal norms over eight days. This event was found to be triggered by repeated Rossby wave breaking disrupting the local trade winds, thus inhibiting the latent heat flux. Latent heat fluxes, the primary driver of the event, tripled as the trade winds returned via rapid coastal ridging. These same synoptic features are concurrent with the historic Lismore flooding located hundreds of kilometres south of the GBR.

Abstract The current throughput of conventional organic chemical synthesis is usually a few experiments for each operator per day. We develop a robotic system for ultra-high-throughput chemical synthesis, online characterization, and large-scale condition screening of photocatalytic reactions, based on the liquid-core waveguide, microfluidic liquid-handling, and artificial intelligence techniques. The system is capable of performing automated reactant mixture preparation, changing, introduction, ultra-fast photocatalytic reactions in seconds, online spectroscopic detection of the reaction product, and screening of different reaction conditions. We apply the system in large-scale screening of 12,000 reaction conditions of a photocatalytic [2 + 2] cycloaddition reaction including multiple continuous and discrete variables, reaching an ultra-high throughput up to 10,000 reaction conditions per day. Based on the data, AI-assisted cross-substrate/photocatalyst prediction is conducted.

Abstract Background Abdominal obesity, a significant risk factor for the progression of diabetic retinopathy (DR), may lead to improved visual outcomes through early assessment. This study aims to evaluate any potential associations between DR and novel lipid metabolism markers, including the Atherogenic Index of Plasma (AIP), Visceral Adiposity Index (VAI), and Lipid Accumulation Product (LAP). Methods This study aimed to elucidate the association between various lipid markers and DR by screening the National Health and Nutrition Examination Survey (NHANES) database in the United States from 2005 to 2008. To examine the correlation, multifactor logistic regression analysis, subgroup analysis, threshold effect analysis, interaction test, and smooth curve fitting were used. Results Among the 2591 participants included, the incidence of DR was 13.6% and the mean age was 59.55 ± 12.26 years. After adjusting for important confounding covariates, logistic regression studies suggested a possible positive association between LAP, VAI, AIP, and DR occurrence (odds ratio [OR] = 1.004; 95% confidence interval [CI]: 1.002, 1.006; P 0.05 for all interactions). Conclusion Studies have shown that elevated levels of LAP, VAI, and AIP increase the likelihood of DR, suggesting that they have the potential to be predictive markers of DR, emphasizing their potential utility in risk assessment and prevention strategies, and advocating for early intervention to mitigate the likelihood of DR.

Public awareness of health-related topics is increasing, and an increase in average life expectancy has increased the senior citizen population in Taiwan. Furthermore, because of the high cost of raising young children, people's willingness to give birth has decreased. Taiwan's aging population and declining birth rate are key challenges for its population development, and the promotion of interactions between young children and senior citizens is also a crucial topic for scholars. Therefore, intergenerational learning has been proposed, and several Taiwanese preschools have attempted to develop intergenerational learning courses. This study explored the perceptions of young children and senior citizens during the implementation of intergenerational learning courses in a preschool. The results revealed that the implementation of such courses allowed young children and senior citizens to influence each other's life experiences and develop positive feelings. The interactions also promoted their psychological well-being. Through this study, we clarified the effectiveness of intergenerational learning courses. Finally, we proposed that intergenerational learning courses with the themes of 'caring' and 'love' should be developed and integrated into intergenerational learning courses.

Purpose: We present a patient who is undergoing regular HD and received Lu-177-PSMA-617 treatment, regarding radiation safety issues including environmental radiation, exposure of medical personnel, and the radioactivity in the dialysate. Methods: A 78 years old man with metastatic castration-resistant prostate cancer undergoing HD received 84.4 mCi (3.1 GBq) of Lu-177-PSMA-617. First HD during the 20th-24th hours after injection, and the second HD during 68th-71st hours. The environmental exposure rate and personnel exposure monitoring were measured. The dialysate was collected and sampled, and the activity was measured. Results: During the first HD session, where dialysate was collected in the room, medical personnels received exposure of 3-19µSv. Dialysate was drained out in the second HD, and medical personnels received 2-4 µSv. The radiation exposure rates in the first HD were measured as follows: 3-4 µSv/hr bedside, 1.2-1.5 µSv/hr at 1 meter, and less than 0.3 µSv/hr at 4 meters. In the second HD, the rates were 2-3 µSv/hr bedside, 1.2-1.8 µSv/hr at 1 meter, and less than 0.3 µSv/hr at 4 meters.The dialysate had an activity of 6.88 mCi (0.25 GBq) in 120 liters of the first HD, while in the second HD, it had 2.13 mCi (0.08 GBq) in 90 liters. Conclusion: For the medical personnel involving HD, the accumulative exposure doses were than 2-19 µSv after 20 hour of injection. The environmental exposure rate would drop to background at 4m away from the patient. The dialysate contained minimal amounts of Lu-177 radioactivity.

Abstract Background Clostridium innocuum, previously considered a commensal microbe, is a spore-forming anaerobic bacterium. C. innocuum displays inherent resistance to vancomycin and is associated with extra-intestinal infections, antibiotic-associated diarrhea, and inflammatory bowel disease. This study seeks to establish a multilocus sequence typing (MLST) scheme to explore the correlation between C. innocuum genotyping and its potential pathogenic phenotypes. Methods Fifty-two C. innocuum isolates from Linkou Chang Gung Memorial Hospital (CGMH) in Taiwan and 60 sequence-available C. innocuum isolates from the National Center for Biotechnolgy Information Genome Database were included. The concentrated sequence of housekeeping genes in C. innocuum was determined by amplicon sequencing and used for MLST and phylogenetic analyses. The biofilm production activity of the C. innocuum isolates was determined by crystal violet staining. Results Of the 112 C. innocuum isolates, 58 sequence types were identified. Maximum likelihood estimation categorized 52 CGMH isolates into two phylogenetic clades. These isolates were found to be biofilm producers, with isolates in clade I exhibiting significantly higher biofilm production than isolates in clade II. The sub-inhibitory concentration of vancomycin seemed to minimally influence biofilm production by C. innocuum isolates. Nevertheless, C. innocuum embedded in the biofilm structure demonstrated resistance to vancomycin treatments at a concentration greater than 256 µg/mL. Conclusions This study suggests that a specific genetic clade of C. innocuum produces a substantial amount of biofilm. Furthermore, this phenotype assists C. innocuum in resisting high concentrations of vancomycin, which may potentially play undefined roles in C. innocuum pathogenesis.

臺灣的教育與課程發展至今，全球化影響顯而易見。臺灣各個面向的演變，包 括歷史、經濟、政治、文化等，皆指出臺灣與他國的關聯，以及受到他國引動之狀 態。臺灣的教育與課程如何演變至今，如何受到各種歷史因素形塑、改變或斷裂， 諸如全球化、國際趨勢、國際關係與交流等，值得探究。本文導讀國際課程史研 究專書─《課程史研究的跨國觀點》（Transnational Perspectives on Curriculum History），說明此專著探究的各種跨國面向與研究取徑，希冀能拓展臺灣教育與課 程史研究的面向與方法。 本書由任教於英國倫敦大學學院教育研究院（Institute of Education, University College London）之Brian Simon教育史講座教授G. McCulloch、英國Brighton大學教育研究中心學習理論教授I. Goodson和西班牙La Laguna大學教育史助理教授M. González-Delgado共同主編。本書為2017年英國教育研究學會（British Educational Research Association, BERA）於薩塞克斯大學（University of Sussex）舉辦年會的 研討成果，目的為彰顯跨國面向（transnational dimension）對於課程的影響。本書 集結課程史專長的國際學者之研究，呈現教育與課程史的新視角與方法。本書內容 除了三位主編的前言與結語之外，共收錄了11篇論文，以跨國觀點分析多國課程歷 史，包含英國、愛沙尼亞、美國、西班牙、日本、瑞典、中國大陸、臺灣、南非、 法國、巴西和葡萄牙等國。

Abstract Ferritin, comprising heavy (FTH1) and light (FTL) chains, is the main iron storage protein, and pancreatic cancer patients exhibit elevated serum ferritin levels. Specifically, higher ferritin levels are correlated with poorer pancreatic ductal adenocarcinoma (PDAC) prognosis; however, the underlying mechanism and metabolic programming of ferritin involved in KRAS-mutant PDAC progression remain unclear. Here, we observed a direct correlation between FTH1 expression and cell viability and clonogenicity in KRAS-mutant PDAC cell lines as well as with in vivo tumor growth through the control of proline metabolism. Our investigation highlights the intricate relationship between FTH1 and pyrroline-5-carboxylate reductase 1 (PYCR1), a crucial mitochondrial enzyme facilitating the glutamate-to-proline conversion, underscoring its impact on proline metabolic imbalance in KRAS-mutant PDAC. This regulation is further reversed by miR-5000-3p, whose dysregulation results in the disruption of proline metabolism, thereby accentuating the progression of KRAS-mutant PDAC. Additionally, our study demonstrated that deferasirox, an oral iron chelator, significantly diminishes cell viability and tumor growth in KRAS-mutant PDAC by targeting FTH1-mediated pathways and altering the PYCR1/PRODH expression ratio. These findings underscore the novel role of FTH1 in proline metabolism and its potential as a target for PDAC therapy development.

Objectives: This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City, China, and provide suggestions to enhance these competencies. Methods: This study was conducted in 204 hospitals in Southwest China from December 24, 2022 to January 7, 2023. The “Geriatric Nursing Competence of Clinical Nurse Investigation Tool” was used to explore factors that influence geriatric nurses’ competencies via stratified sampling. The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing. Results: A total of 10,692 nurses answered the questionnaires. Of these questionnaires, 9,442 were valid. The total geriatric nursing competence score of the clinical nursing staff was 2.29 ± 0.81, the secondary hospital score was 2.23 ± 0.78, and the tertiary hospital’s overall mean score was 2.33 ± 0.83. The factors that influenced secondary hospitals included the department of medicine, age of nurses and total length of career (P

Abstract The authors propose a novel yet simple way of passive beamforming using a liquid antenna. A hemispherical dielectric resonator antenna filled with a dielectric liquid is considered to realise the fundamental TE111 mode, and a small, weighted metal ball is dropped inside the hemispherical container. This metal ball functions as a movable director and passively steers the realised fundamental mode of the DRA always towards the ground. The proposed design finds its applications in static‐subject‐based applications such as indoor base stations, and beam‐stabilisation/pattern‐correction works in case of dynamic‐subject‐based applications. The overall profile of the antenna is 0.60λ0 × 0.60λ0 × 0.19λ0 targeting the ISM band at 2.4 GHz with decent efficiency and far‐field characteristics. The working prototype is developed and experimentally verified.

A study on Platydracus species of Hainan Province, China is presented. Platydracus hainanensis sp. nov., Platydracus aureolus sp. nov. and Platydracus zhouchenglini sp. nov. are described as new species. Platydracus marmorellus Fauvel, 1895 and Platydracus subirideus Kraatz, 1859 are recorded from China for the first time. Habitus and diagnostic characters of all species are photographed, and a key to Platydracus species of Hainan is provided.

In China, despite the continuous efforts to preserve traditional villages in recent years, a significant amount of cultural heritages continue to vanish. Commonly observed issues such as the lack of coordination between preservation and development, the imbalance in spatial environment conservation and utilization, are pervasive. Regrettably, there is a conspicuous absence of theoretical underpinning in addressing these challenges. In this study, The evaluation factor of spatial environmental protection was selected, and these factors were weighted through expert surveys and the Analytic Hierarchy Process, and applied the multi-objective linear weighting function method to obtain a comprehensive evaluation calculation formula. Subsequently, we conducted an assessment of 28 representative traditional villages in the southern Chinese regions of Guangdong, Fujian, and Jiangxi. Their current issues were systematically analyzed and cluster analysis was applied to discern 11 distinct typologies of traditional village development. Besides, the temporal evolution patterns of these villages were delved into, and their development were categorized into five stages: initiation, enhancement, prosperity, over-development, and decline. Ultimately, based on the spatial environment characteristics of each development type and evolution stage, corresponding guidelines for spatial environment conservation and utilization are proposed, which provides necessary theoretical frameworks for future work this region.

Abstract Inspired by the natural shape-morphing abilities of biological organisms, we introduce a strategy for creating energy-efficient dynamic 3D metasurfaces through spatiotemporal jamming of interleaved assemblies. Our approach, diverging from traditional shape-morphing techniques reliant on continuous energy inputs, utilizes strategically jammed, paper-based interleaved assemblies. By rapidly altering their stiffness at various spatial points and temporal phases during the relaxation of the soft substrate through jamming, we enable the formation of refreshable, intricate 3D shapes with a desirable load-bearing capability. This process, which does not require ongoing energy consumption, ensures energy-efficient and lasting shape displays. Our theoretical model, linking buckling deformation to residual pre-strain, underpins the inverse design process for an array of interleaved assemblies, facilitating the creation of diverse 3D configurations. This metasurface holds notable potential for tactile displays, particularly for the visually impaired, heralding possibilities in visual impaired education, haptic feedback, and virtual/augmented reality applications.

Abstract Despite advancements in chemotherapy and the availability of novel therapies, the outcome of adult patients with B-cell acute lymphoblastic leukemia (B-ALL) remains unsatisfactory. Therefore, it is necessary to understand the molecular mechanisms underlying the progression of B-ALL. Brahma-related gene 1 (BRG1) is a poor prognostic factor for multiple cancers. Here, the expression of BRG1 was found to be higher in patients with B-ALL, irrespective of the molecular subtype, than in healthy individuals, and its overexpression was associated with a poor prognosis. Upregulation of BRG1 accelerated cell cycle progression into the S phase, resulting in increased cell proliferation, whereas its downregulation facilitated the apoptosis of B-ALL cells. Mechanistically, BRG1 occupies the transcriptional activation site of PPP2R1A, thereby inhibiting its expression and activating the PI3K/AKT signaling pathway to regulate the proto-oncogenes c-Myc and BCL-2. Consistently, silencing of BRG1 and administration of PFI-3 (a specific inhibitor targeting BRG1) significantly inhibited the progression of leukemia and effectively prolonged survival in cell-derived xenograft mouse models of B-ALL. Altogether, this study demonstrates that BRG1-induced overactivation of the PPP2R1A/PI3K/AKT signaling pathway plays an important role in promoting the progression of B-ALL. Therefore, targeting BRG1 represents a promising strategy for the treatment of B-ALL in adults.

Abstract Background and objectives Early neurological deterioration (END) post-intravenous thrombolysis significantly impacts the long-term prognosis of stroke patients. This study aimed to establish a rapid risk prediction model for unexplained END following intravenous thrombolysis. Methods This prospective study consecutively enrolled patients with acute ischemic stroke treated with recombinant tissue plasminogen activator intravenous thrombolysis at the Department of Neurology, Third People’s Hospital of Hubei Province, and Yangluo Hospital District between June 2019 and December 2022. Unexplained END was defined as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and 24 h. A nomogram was developed and assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC). The calibration was assessed using the Hosmer–Lemeshow test. Results A total of 211 patients (130 males and 110 patients aged

Abstract Glycosylated haemoglobin index (HGI) has been shown to correlate with the prognosis of metabolic diseases, but the relationship with mortality remains unclear. This study included 18,285 US adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. During the median follow-up period of 115 months, a total of 2572 all-cause deaths and 671 cardiovascular disease (CVD) deaths occurred. The restricted cubic spline revealed a U-shaped correlation between HGI and all-cause and CVD mortality. After adjusting for all covariates, the optimal inflection point values in all-cause and CVD deaths were 0.17 and 0.02, respectively. In the left side of the inflection point, the risk of all-cause mortality and CVD mortality decreased by approximately 24% (HR 0.76, 95% CI 0.69, 0.84) and 25% (HR 0.75, 95% CI 0.60, 0.96) with the increase in HGI. Conversely, in the right of the inflection point, an increase of 1 unit in the HGI was linked with a 17% (HR 1.17, 95% CI 1.07, 1.27) and 31% (HR 1.31, 95% CI 1.15, 1.49) increase in all-cause and CVD mortality. Our study showed that HGI is an important tool for predicting the risk of all-cause mortality and CVD death in US adults and there is a U-shaped relationship between HGI and mortality.

Abstract Older adults with major depressive disorder (MDD) or early cognitive decline during the subjective cognitive decline (SCD) stage may exhibit neuropsychiatric symptoms such as anxiety, depression, and subtle cognitive impairment. The clinicopathological features and biological mechanisms of MDD differ from those of SCD among older adults; these conditions thus require different treatment strategies. This study enrolled 82 participants above 50 years old with normal cognitive levels from the communities to examine biomarker–behavior correlations between MDD (n = 23) and SCD (n = 23) relative to a normal control (NC) group (n = 36). Multidomain assessments were performed for all participants, including immunomagnetic reduction tests to detect plasma beta-amyloid (Aβ), total tau (Tau), phosphorylated tau-181 (p-Tau181), neurofilament light chain, and glial fibrillary acidic protein (GFAP). This study observed that depressive symptoms in MDD were associated with amyloid pathology (plasma Aβ40 vs. HADS-D: R = 0.45, p = 0.031; Aβ42/Aβ40 vs. HADS-D: R = −0.47, p = 0.024), which was not observed in the NC (group difference p

Abstract In this paper, we propose a deformed Reuleaux-triangle resonator (RTR) to form exceptional point (EP) which results in the detection sensitivity enhancement of nanoparticle. After introducing single nanoparticle to the deformed RTR at EP, frequency splitting obtains an enhancement of more than 6 times compared with non-deformed RTR. In addition, EP induced a result that the far field pattern of chiral mode responses significantly to external perturbation, corresponding to the change in internal chirality. Therefore, single nanoparticle with far distance of more than 4000 nm can be detected by measuring the variation of far field directional emission. Compared to traditional frequency splitting, the far field pattern produced in deformed RTR provides a cost-effective and convenient path to detect single nanoparticle at a long distance, without using tunable laser and external coupler. Our structure indicates great potential in high sensitivity sensor and label-free detector. Graphical Abstract

Impact Immune dysregulation is thought to contribute to chronic lymphocytic leukemia (CLL) risk, but biological mechanisms are unclear. We discovered that increased serum levels of B-cell activating factor (BAFF), an important regulator of B-cell maturation, were associated with a decreased risk of CLL, even >10 years after blood draw. Our findings suggest that BAFF could be a useful biomarker to assess risk among individuals at high risk, such as those with monoclonal b-cell lymphocytosis.

Soil salinization is a globally prevalent abiotic environmental stress. The imbalance of ions caused by high concentrations of sodium chloride results in a 40% reduction in soybean yield. Soybean, as an important crop for soil quality improvement, necessitates the identification of salt-tolerant varieties and germplasms to effectively utilize and enhance saline-alkali land. In this study, we assessed the salt tolerance of 435 soybean varieties and germplasms during the seedling stage. Among them, Qihuang34, You2104, Hongzhudou, Pamanheidou, and Osage exhibited grade 1 salt tolerance rates surpassing other tested materials. Furthermore, Hongzhudou and Qihuang34 demonstrated higher salt tolerance during germination and emergence stages based on their elevated rates of emergence, salt tolerance index, chlorophyll content, and shoot fresh weights. Overall findings provide valuable resources for molecular breeding efforts aimed at developing salt-tolerant soybean varieties suitable for cultivation in saline-alkali soils.

Abstract Aim Recent imaging studies have found significant abnormalities in the brain’s functional or structural connectivity among patients with high myopia (HM), indicating a heightened risk of cognitive impairment and other behavioral changes. However, there is a lack of research on the topological characteristics and connectivity changes of the functional networks in HM patients. In this study, we employed graph theoretical analysis to investigate the topological structure and regional connectivity of the brain function network in HM patients. Methods We conducted rs-fMRI scans on 82 individuals with HM and 59 healthy controls (HC), ensuring that the two groups were matched for age and education level. Through graph theoretical analysis, we studied the topological structure of whole-brain functional networks among participants, exploring the topological properties and differences between the two groups. Results In the range of 0.05 to 0.50 of sparsity, both groups demonstrated a small-world architecture of the brain network. Compared to the control group, HM patients showed significantly lower values of normalized clustering coefficient (γ) (P = 0.0101) and small-worldness (σ) (P = 0.0168). Additionally, the HM group showed lower nodal centrality in the right Amygdala (P

Abstract Cell fate decisions remain poorly understood at the molecular level. Embryogenesis provides a unique opportunity to analyze molecular details associated with cell fate decisions. Works based on model organisms have provided a conceptual framework of genes that specify cell fate control, for example, transcription factors (TFs) controlling processes from pluripotency to immunity1. How TFs specify cell fate remains poorly understood. Here we report that SALL4 relies on NuRD (nucleosome-remodeling and deacetylase complex) to interpret BMP4 signal and decide cell fate in a well-controlled in vitro system. While NuRD complex cooperates with SALL4 to convert mouse embryonic fibroblasts or MEFs to pluripotency, BMP4 diverts the same process to an alternative fate, PrE (primitive endoderm). Mechanistically, BMP4 signals the dissociation of SALL4 from NuRD physically to establish a gene regulatory network for PrE. Our results provide a conceptual framework to explore the rich landscapes of cell fate choices intrinsic to development in higher organisms involving morphogen-TF-chromatin modifier pathways.

Abstract The functions of natural killer (NK) and T cells in innate and adaptive immunity, as well as their functions in tumor eradication, are complementary and intertwined. Here we show that utilization of multi-specific antibodies or nano-antibodies capable of simultaneously targeting both NK and T cells could be a valuable approach in cancer immunotherapy. Here, we introduce a tri-specific Nano-Antibody (Tri-NAb), generated by immobilizing three types of monoclonal antibodies (mAbs), using an optimized albumin/polyester composite nanoparticle conjugated with anti-Fc antibody. This Tri-NAb, targeting PDL1, 4-1BB, and NKG2A (or TIGIT) simultaneously, effectively binds to NK and CD8+ T cells, triggering their activation and proliferation, while facilitating their interaction with tumor cells, thereby inducing efficient tumor killing. Importantly, the antitumor efficacy of Tri-NAb is validated in multiple models, including patient-derived tumor organoids and humanized mice, highlighting the translational potential of NK and T cell co-targeting.

Abstract Background Aripiprazole is the most frequently recommended antipsychotic for the treatment of tics in children and adolescents with Tourette’s disorder (TD). However, to date, a randomized controlled trial for aripiprazole oral solution has not been conducted despite being widely preferred by children. Therefore, we examined whether aripiprazole oral solution is effective for treating tics. Methods All patients received a flexible dose of aripiprazole oral solution (1 mg/mL, range: 2–20 mg) with a starting dose of 2 mg. The target dose for patients weighing

Abstract Background Studies have shown that Chinese Clinicians and nurses have positive attitudes toward ACP, but no local tools exist to assess their need for ACP knowledge and skills training. resulting in their inability to initiate ACP conversations as well as poor end-of-life care for patients. Therefore, this study aims to assess the needs of Chinese Clinicians and nurses for ACP knowledge and skills training and assess the validity and reliability of a questionnaire on the Training Needs for Advance Care Planning (TNACP) scale. Methods From October to November 2021, 170 clinicians and nurses were pre-surveyed using a preliminary draft of the questionnaire. The responses were screened using item analysis, Cronbach’s alpha coefficient, and the intraclass correlation coefficient (ICC) to describe the internal consistency and stability of the questionnaire. The Content validity index (CVI), Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used to test the validity of the questionnaire. Results After independent samples t-test analysis, Except for the entry “A2”, the critical ratio between the two groups of the remaining 23 items was statistically significant (p 0.40). The results of confirmatory factor analysis showed that the Training Needs for Advance Care Planning (TNACP) scale model fit well(X2/df = 2.504, RMSEA = 0.092, GFI = 0.809, AGFI = 0.745, CFI = 0.931, IFI = 0.932, TLI = 0.916); the Cronbach’s α = 0.888 for the total questionnaire, and the three dimensions of Cronbach’s α were 0.729 to 0.959; and the ICC for the overall scores between the test-retest evaluations was 0.884 (p

Abstract Pancreatic ductal adenocarcinoma (PDAC) is a devastating cancer with dismal prognosis due to distant metastasis, even in the early stage. Using RNA sequencing and multiplex immunofluorescence, here we find elevated expression of mixed lineage kinase domain-like pseudo-kinase (MLKL) and enhanced necroptosis pathway in PDAC from early liver metastasis T-stage (T1M1) patients comparing with non-metastatic (T1M0) patients. Mechanistically, MLKL-driven necroptosis recruits macrophages, enhances the tumor CD47 ‘don’t eat me’ signal, and induces macrophage extracellular traps (MET) formation for CXCL8 activation. CXCL8 further initiates epithelial–mesenchymal transition (EMT) and upregulates ICAM-1 expression to promote endothelial adhesion. METs also degrades extracellular matrix, that eventually supports PDAC liver metastasis. Meanwhile, targeting necroptosis and CD47 reduces liver metastasis in vivo. Our study thus reveals that necroptosis facilitates PDAC metastasis by evading immune surveillance, and also suggest that CD47 blockade, combined with MLKL inhibitor GW806742X, may be a promising neoadjuvant immunotherapy for overcoming the T1M1 dilemma and reviving the opportunity for radical surgery.

Abstract Background Metabolic syndrome (MetS) presents a notable public health challenge on a global scale, exerting a considerable impact on individuals’ health and quality of life. There is mounting evidence indicating a robust association between MetS and levels of sex hormones. Therefore, the study aims to explore the relationship between sex hormone binding-globulin (SHBG) and MetS, and to provide evidence that could inform the development of effective prevention strategies for MetS. Methods Data for this cross-sectional investigation were collected during the 2013–2016 cycle of the National Health and Nutrition Examination Survey (NHANES), from which 5,499 adults were sampled. The criteria established by the Adult Treatment Program III of the National Cholesterol Education Program were utilized to define MetS. SHBG levels were measured using a standardized technique. Multivariate-adjusted logistic regression, multivariate restricted cubic spline, and threshold effect analyses were utilized to investigate the association between SHBG levels and MetS. Moreover, the stratified analyses and interaction tests of covariables were presented in a forest plot. Finally, sensitivity analysis was utilized to ensure the robustness of the results. Results Overall, 1822 participants had MetS. After adjusting for possible confounders, SHBG levels were associated with MetS (Odds ratio [OR], 0.984; 95% confidence interval [CI], 0.981–0.986; P

Abstract The current study aims to develop an efficient, reliable and valid assessment, the affective states for online learning scale (ASOLS), for measuring learners’ affective states during online learning using a sample of 173 young learners. The assessment consists of 15 items which assess five affective states, including concentration, motivation, perseverance, engagement, and self-initiative. To improve efficiency, five items (one for each affective state) are randomly selected and presented every 30 min during online learning. In addition, 14 among the participants were further invited to perform on-site online learning, and their affective states were validated by observations conducted by two psychologists. The ASOLS was found to be reliable and valid, with high internal consistency reliabilities and good construct, convergent and criterion validity. Confirmatory factor analyses showed that the hypothesized five-factor structure demonstrated a satisfactory fit to the data. Moreover, engagement was found to be positively associated with learning performance. Our findings suggest that the ASOLS provides a useful tool for teachers to identify students in upper primary and junior secondary schools with deficits in affective states and offer appropriate remedy or support. It can also be used to evaluate the effectiveness of interventions aimed at enhancing students’ affective states during online learning.