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Abstract Background China has the highest number of people with dementia globally, and the responsibility of caring for people with dementia primarily falls on relatives, who bear heavy caregiving burdens and pressure. Providing care for an individual with dementia is emotionally and physically demanding, particularly due to the frequent manifestation of behavioral and psychological symptoms associated with dementia (BPSD). This underscores the crucial need to comprehend and address caregivers’ emotional expression (EE). Aim To explore the characteristics of relatives with high expressed emotion of people with dementia and related factors in mainland China. Methods A survey using cross-sectional questionnaires conducted with 165 relatives of individuals with dementia in China. Results A significant number of relatives had high EE (n = 61, 39%). The variation in EE, about 37.8%, is explained by seven independent variables. The proportion of psychological distress among relatives in EE variation is 14.5%. (b = 0.387, p

Abstract Previous research has established that the formation of Gardnerella vaginalis (GV) biofilm is one of the primary reasons for bacterial vaginosis (BV) recurrence. This study was the first to explore the impact of Streptococcus agalactiae (group B Streptococcus, GBS) on GV biofilm in a co-culture scenario. The results revealed that GBS could significantly increased the GV biomass in 48-hours dual-species biofilms. The luxS gene of GBS was significantly higher in dual-species biofilm, while knockdown of the luxS gene resulted in a significant decrease in mono- and dual-species biofilms. Meanwhile, in vitro addition of AI-2 (product of luxS gene) substantially increased biofilm biomass. Furthermore, we found that the expression of two genes related to biofilm formation was notably elevated in GV after receiving AI-2 signals. Collectively, these findings suggest that GBS enhances GV biofilm formation via luxS/AI-2 in an in vitro co-culture model, which in turn may promotes recurrence of BV.

Abstract To evaluate the differences in the agreement between wedged hepatic venous pressure (WHVP) and portal venous pressure (PVP) at different hepatic venous pressure gradient (HVPG) levels to identify specific HVPG thresholds where WHVP can reliably estimate PVP, thus enhancing the accuracy of risk stratification and treatment decision-making for portal hypertension (PHT) patients. A multicenter study of 616 patients with PHT from three centers was stratified into five groups by their HVPG: HVPG

Abstract This study aimed to investigate the benefits of using three-dimensional (3D)-printed hip joint fixators after intra-arterial chemotherapy (IAC) by inguinal femoral artery puncture in children with retinoblastoma. Overall, 79 cases of retinoblastoma who had undergone IAC through the femoral artery were selected and divided into an observation group of 50 cases and an intervention group of 29 cases according to the hemostasis method employed. The patients in the observation group were treated with sandbags for hemostasis, while those in the intervention group were given 3D-printed hip joint fixators to help immobilize the hips and sandbags. We used the Face, Legs, Activity, Cry and Consolability scale (FLACC), the Wong–Baker Facial Expression Pain Scale, and self-made questionnaires to evaluate demographics, clinical characteristics, pain, complications, satisfaction, and other indicators of the two groups. There were no significant differences in general data, such as age, gender, height, weight, manual compression time, diseased eye, tumor stage, platelet count, puncture times, pain distribution, and total score, between the groups. There was a positive correlation between FLACC pain and the total Wong–Baker pain score (r = 0.599, p

Abstract Some studies have identified influencing factors of COVID-19 illness in elderly, such as underlying diseases, but research on the effect of nutritional status is still lacking. This study retrospectively examined the influence of nutritional status on the outcome of elderly COVID-19 inpatients. A retrospective analysis of the clinical data of 4241 COVID-19 patients who were admitted to a third-class hospital of Nanchang between November 1, 2022 and January 31, 2023 was conducted. Nutritional status was assessed using the prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). The influence of nutritional status on the outcome of COVID-19 patients was determined through multivariate adjustment analysis, restrictive cubic spline, and receiver operating characteristic curve (ROC). Compared with mild/no malnutrition, severe malnutrition substantially increased the critical outcome of COVID-19. A linear relationship was observed between the odds ratio (OR) and PNI and CONUT (P > 0.05). The area under the ROC curve indicated that PNI was the better predictor. The optimal cutoff value of PNI was 38.04 (95%CI: 0.797 ~ 0.836, AUC = 0.817), with a sensitivity of 70.7% and a specificity of 79.6%. The critical illness of elderly COVID-19 patients shows a linear relationship with malnutrition at admission. The use of PNI to assess the prognosis of COVID-19 eldeely patients is reliable, highlighting the importance for doctors to closely pay attention to the nutritional status of COVID-19 patients. Focusing on nutritional status in clinical practice can effectively reduce the critical illness of elderly COVID-19 patients.

Abstract Seawater direct electrolysis (SDE) using renewable energy provides a sustainable pathway to harness abundant oceanic hydrogen resources. However, the side-reaction of the chlorine electro-oxidation reaction (ClOR) severely decreased direct electrolysis efficiency of seawater and gradually corrodes the anode. In this study, a redox-mediated strategy is introduced to suppress the ClOR, and a decoupled seawater direct electrolysis (DSDE) system incorporating a separate O2 evolution reactor is established. Ferricyanide/ferrocyanide ([Fe(CN)6]3−/4−) serves as an electron-mediator between the cell and the reactor, thereby enabling a more dynamically favorable half-reaction to supplant the traditional oxygen evolution reaction (OER). This alteration involves a straightforward, single-electron-transfer anodic reaction without gas precipitation and effectively eliminates the generation of chlorine-containing byproducts. By operating at low voltages (~1.37 V at 10 mA cm−2 and ~1.57 V at 100 mA cm−2) and maintaining stability even in a Cl−-saturated seawater electrolyte, this system has the potential of undergoing decoupled seawater electrolysis with zero chlorine emissions. Further improvements in the high-performance redox-mediators and catalysts can provide enhanced cost-effectiveness and sustainability of the DSDE system.

Abstract Background Stroke-associated pneumonia (SAP) is a common complication in stroke patients, and the Barthel Index (BI) is a well-established metric for assessing activities of daily living (ADL). However, the association between BI and SAP in acute ischemic stroke (AIS) patients remains unclear. This study aims to investigate the relationship between BI at admission and SAP, and explore the factors in AIS elderly patients. Method Retrospective data were collected from ischemic stroke patients hospitalized at the Second Affiliated Hospital of Nanchang University between January 2018 and July 2021, including their basic demographic and laboratory test results. Restricted cubic spline regression, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to investigate the relationship between BI and SAP. Additionally, the Shapley Additive exPlanations (SHAP) method was used to identify the factors influencing SAP. Results The study included 7,548 eligible stroke patients with a mean age of 75.1 ± 7.6 years, among which 41.14% were female. The SAP group demonstrated significantly lower BI compared to the non-SAP group (50.86 ± 35.60 vs. 75.27 ± 26.33, P

Semantic segmentation of aerial images is crucial yet resource-intensive. Inspired by human ability to learn rapidly, few-shot semantic segmentation offers a promising solution by utilizing limited labeled data for efficient model training and generalization. However, the intrinsic complexities of aerial images, compounded by scarce samples, often result in inadequate feature representation and semantic ambiguity, detracting from the model's performance. In this article, we propose to tackle these challenging problems via dual semantic metric learning and multisemantic features fusion and introduce a novel few-shot segmentation Network (DSMF-Net). On the one hand, we consider the inherent semantic gap between the feature of graph and grid structures and metric learning of few-shot segmentation. To exploit multiscale global semantic context, we construct scale-aware graph prototypes from different stages of the feature layers based on graph convolutional networks (GCNs), while also incorporating prior-guided metric learning to further enhance context at the high-level convolution features. On the other hand, we design a pyramid-based fusion and condensation mechanism to adaptively merge and couple the multisemantic information from support and query images. The indication and fusion of different semantic features can effectively emphasize the representation and coupling abilities of the network. We have conducted extensive experiments over the challenging iSAID-5$^{i}$ and DLRSD benchmarks. The experiments have demonstrated our network's effectiveness and efficiency, yielding on-par performance with the state-of-the-art methods.

Abstract To solve the problem of undesired relative motion of human-machine interaction positions caused by misalignment of the human-machine joints rotation axis of the knee exoskeleton, this study designed an adaptive knee exoskeleton based on a gear-link mechanism (GLM) by considering the human body as a component of the exoskeleton mechanism. Simultaneously, the concept of the wearable area (WA) was proposed, which transformed the operation of aligning the exoskeleton rotation axis with the human knee joint rotation axis into a "face alignment point" in the sagittal plane, reducing the difficulty of aligning the human-machine joint rotation axis. In the kinematic analysis of GLM, the phenomenon of instantaneous movement of the central axis of the human knee joint was considered. Based on the kinematic model, the WA, velocity transfer ratio, and initial position static stiffness of GLM were analyzed. The NSGA-II optimization algorithm was used to optimize the size parameters of GLM, which increased the WA by 18.4%, the average velocity transfer ratio by 4.98%, and the average initial position static stiffness by 6.01%. Finally, the ability of the exoskeleton to absorb movement displacement (MD) was verified through simulation, and the good human-machine kinematic compatibility of the exoskeleton was verified through wearable tests conducted on the initial mechanism principle prototype.

Abstract Erythropoietin (EPO), expressed in red blood progenitor cells, primarily regulates erythropoiesis by binding to its receptor. Besides anemia, recent studies have identified new therapeutic indications for EPO that are not connected to red blood cell formation. Elevated EPO levels harm bone homeostasis in adult organisms and are associated with increased osteoclast; however, the underlying molecular mechanisms remain unclear. This study demonstrated that EPO enhanced osteoclast differentiation and bone resorption in vitro. We showed that EPO promoted osteoclast formation by up-regulating PPARγ expression through activating the Jak2/ERK signaling pathway. Consistently, PPARγ antagonists rescued the hyperactivation of osteoclasts due to EPO, while PPARγ agonists reversed the EMP9-mediated decrease in osteoclast differentiation. Further, exposing female mice to EPO for two months led to a decrease in bone mass and increased osteoclast numbers. The present results suggested that EPO promotes osteoclastogenesis by regulating the Jak2/ERK/ PPARγ signaling pathway. From a clinical perspective, the risk of compromised bone health should be considered when using EPO to treat anemia in post-operative patients with intertrochanteric fractures of the femur, as it could significantly impact the patient’s recovery and quality of life.

Abstract Coxiella burnetii (C. burnetii) is the causative agent of Q fever, a type of zoonoses withwidespread distribution. In 2019, a case of Q fever was diagnosed by metagenomic next-generation sequencing (mNGS) method in Xuyi County (Jiangsu province, China). The seroprevalence of previous fever patients and the molecular epidemiology of Coxiella in wild hedgehogs and harbouring ticks around the confirmed patient were detected to reveal the genetic characteristics and pathogenicity of the Coxiella strains. Four of the 90 serum samples (4.44%) were positive for specific C. burnetii IgM antibody, suggesting that local humans are at risk of Q fever. The positive rates of C. burnetii in hedgehogs and ticks were 21.9% (7/32) and 70.5% (122/173), respectively. At least 3 strains of Coxiella were found prevalent in the investigated area, including one new genotype of pathogenic C. burnetii (XYHT29) and two non-pathogenic Coxiella-like organisms (XYHT19 and XYHT3). XYHT29 carried by ticks and wild hedgehogs successfully infected mice, imposing a potential threat to local humans. XYHT19, a novel Coxiella-like microorganism, was first discovered in the world to co-infect with C. burnetii in Haemaphysalis flava. The study provided significant epidemic information that could be used for prevention and control strategies against Q fever for local public health departments and medical institutions.

Despite the pressing demand for integrated spectrometers, a solution that deliver high-performance while being practically operated is still missing. Furthermore, current integrated spectrometers lack reconfigurability in their performance, which is highly desirable for dynamic working scenarios. This study presents a viable solution by demonstrating a user-friendly, reconfigurable spectrometer on silicon. At the core of this innovative spectrometer is a programmable photonic circuit capable of exhibiting diverse spectral responses, which can be significantly adjusted using on-chip phase shifters. The distinguishing feature of our spectrometer lies in its inverse design approach, facilitating effortless control and efficient manipulation of the programmable circuit. By eliminating the need for intricate configuration, our design reduces power consumption and mitigates control complexity. Additionally, our reconfigurable spectrometer offers two distinct operating conditions. In the Ultra-High-Performance mode, it is activated by multiple phase-shifters and achieves exceptional spectral resolution in the picometer scale while maintaining broad bandwidth. On the other hand, the Ease-of-Use mode further simplifies the control logic and reduces power consumption by actuating a single-phase shifter. Although this mode provides a slightly degraded spectral resolution of approximately 0.3 nm, it prioritizes ease of use and is well-suited for applications where ultra-fine spectral reconstruction is not a primary requirement.

Building use identification is crucial in urban planning and management. Current identification methods often rely on a single data source and neglect spatial proximity. In this paper, we propose a stepwise urban building use identification framework that integrates remote sensing and social sensing data with spatial constraints based on the association of buildings with Point of Interest (POI), Area of Interest (AOI) and remote sensing data. First, the study data are preprocessed using geometric correction and POI and AOI reclassification. Then, we identify buildings with the quantitative-density index of the POIs as well as the spatial relationships between the AOIs and the buildings. Next, we generate Traffic Analysis Zones (TAZs) from road network data and utilize the similarity in physical features of buildings from remote sensing data to identify building use within spatial constraints. Finally, POI kernel density estimation is used to determine the semantic features of the buildings, and the similarity of the features between the buildings is utilized to identify the remaining buildings. The specificity of our proposed framework lies not only in the combination of multiple source data at the building-level but also in the introduction of the spatial relationships of AOIs and spatial constraints. Shenyang is selected as an example. The proposed framework identifies buildings as commercial, residential, industrial, public service and scenic spots. The accuracy assessment indicates that the proposed framework performs well, with an Overall Accuracy (OA) of 87.1% and a kappa coefficient (kappa) of 73.4%. The results of the comparison experiments show that the consideration of spatial constraints and the integration of multiple data sources help to improve the accuracy of building use identification. The proposed framework provides a new tool for better identification of urban building use, and the generated data are suitable for in-depth analyses such as building-level urban heat islands.

Abstract Primary retroperitoneal liposarcoma (RLPS) is a rare heterogeneous tumor occurring within retroperitoneal space, and its overall survival has not improved much in the past few decades. Based on a small-sample clinical practice at our center, patients with RLPS can greatly benefit from anlotinib and eribulin combination. In this study, we investigated the combinational effect of anlotinib and eribulin on RLPS. In vitro experiments revealed that a low dose of anlotinib significantly enhances the cytotoxic effects of eribulin, leading to a remarkable suppression of RLPS cell proliferation, viability, colony formation, migration, and cell-cycle progression compared to individual drug treatments. At the organoid level, the combination treatment causes the spheroids in Matrigel to disintegrate earlier than the single-drug group. In vivo, RLPS patient-derived xenograft (PDX) models demonstrated that the combination of these two drugs can obviously exert a safe and effective anti-tumor effect. Through transcriptome analysis, we uncovered and validated that the synergistic effect mainly is induced by the endoplasmic reticulum stress (ERS) pathway both in vitro and in vivo. Further analyses indicate that anlotinib plus eribulin treatment results in micro-vessel density and PD-L1 expression alterations, suggesting a potential impact on the tumor microenvironment. This study extensively explored the combination regimen at multiple levels and its underlying molecular mechanism in RLPS, thus providing a foundation for translational medicine research.

Abstract The mislocalization of proteins leads to breast cancer, one of the world’s most prevalent cancers, which can be identified from immunohistochemical images. Here, based on the deep learning framework, location prediction models were constructed using the features of breast immunohistochemical images. Ultimately, six differentially localized proteins that with stable differentially predictive localization, maximum localization differences, and whose predicted results are not affected by removing a single image are obtained (CCNT1, NSUN5, PRPF4, RECQL4, UTP6, ZNF500). Further verification reveals that these proteins are not differentially expressed, but are closely associated with breast cancer and have great classification performance. Potential mechanism analysis shows that their co-expressed or co-located proteins and RNAs may affect their localization, leading to changes in interactions and functions that further causes breast cancer. They have the potential to help shed light on the molecular mechanisms of breast cancer and provide assistance for its early diagnosis and treatment.

Abstract To determine the independent risk factors of cardiopulmonary exercise test (CPET) parameters related to adverse prognostic events within 5 years in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and establish a prediction model for the occurrence of adverse events within 5 years to provide a reference for cardiac rehabilitation training. From August 2015 to December 2021, patients who underwent PCI for AMI and completed CPET within 1–2 weeks after surgery before discharge from the Department of Cardiovascular Medicine of Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan Provincial Hospital of Traditional Chinese Medicine, and Anyang District Hospital were selected as participants. Univariate and multivariate analyses were used to screen for independent risk factors associated with 5-year adverse events. Feature importance was interpreted using SHapley Additive exPlanations (SHAP), and a logistic regression model was established for prediction. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of the prediction model. Calibration was assessed by the Hosmer–Lemeshow test and the calibration curve. In total, 375 patients met the inclusion criteria. Based on whether adverse events occurred during the 5-year follow-up period, the patients were divided into two groups: the event group (n = 53) and the non-event group (n = 322). Peak oxygen uptake (peakVO2), carbon dioxide ventilation equivalent slope (VE/VCO2slop), and peak end-tidal carbon dioxide partial pressure (PETCO2) were three independent risk factors for re-acute myocardial infarction (re-AMI), heart failure (HF), and even death after PCI for AMI (P 0.05). The calibration curve of the three models was close to the ideal diagonal lines. CPET parameters can predict the prognosis of adverse events within 5 years after PCI in patients with AMI and provide a theoretical basis for cardiac rehabilitation training.

Abstract Synthetic Notch (synNotch) receptors are genetically encoded, modular synthetic receptors that enable mammalian cells to detect environmental signals and respond by activating user-prescribed transcriptional programs. Although some materials have been modified to present synNotch ligands with coarse spatial control, applications in tissue engineering generally require extracellular matrix (ECM)-derived scaffolds and/or finer spatial positioning of multiple ligands. Thus, we develop here a suite of materials that activate synNotch receptors for generalizable engineering of material-to-cell signaling. We genetically and chemically fuse functional synNotch ligands to ECM proteins and ECM-derived materials. We also generate tissues with microscale precision over four distinct reporter phenotypes by culturing cells with two orthogonal synNotch programs on surfaces microcontact-printed with two synNotch ligands. Finally, we showcase applications in tissue engineering by co-transdifferentiating fibroblasts into skeletal muscle or endothelial cell precursors in user-defined micropatterns. These technologies provide avenues for spatially controlling cellular phenotypes in mammalian tissues.

Abstract To improve locomotion and operation integration, this paper presents an integrated leg-arm quadruped robot (ILQR) that has a reconfigurable joint. First, the reconfigurable joint is designed and assembled at the end of the leg-arm chain. When the robot performs a task, reconfigurable configuration and mode switching can be achieved using this joint. In contrast from traditional quadruped robots, this robot can stack in a designated area to optimize the occupied volume in a nonworking state. Kinematics modeling and dynamics modeling are established to evaluate the mechanical properties for multiple modes. All working modes of the robot are classified, which can be defined as deployable mode, locomotion mode and operation mode. Based on the stability margin and mechanical modeling, switching analysis and evaluation between each mode is carried out. Finally, the prototype experimental results verify the function realization and switching stability of multimode and provide a design method to integrate and perform multimode for quadruped robots with deployable characteristics.

Objective: Assess the safety and effectiveness of acupuncture for acute ischemic stroke (AIS). Methods: We conducted a comprehensive search across the PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang, and SinoMed databases from their inception until October 3, 2023. Two reviewers screened eligible randomized controlled trials (RCTs) according to criteria and extracted data using a pre-established form. Cochrane tool was used for risk of bias assessment, and Revman 5.3 was used for subsequent meta-analysis. The GRADE tool will be used to assess the quality of evidence. Results: Thirty-one RCTs were included, involving 3604 patients. Meta-analysis showed that compared with conventional treatments (CTs), acupuncture combined with CTs could improve in National Institutes of Health Stroke Scale (NIHSS) and Efficiency (MD:1.70, 95 %CI [-2.27, -1.14], P < 0.00001;RR: 1.21, 95 %CI [1.12, 1.31], P < 0.00001,);On the Chinese Stroke Scale (CSS) and effectiveness based on CSS, acupuncture showed positive effects (MD:4.33, 95 %CI [-5.67, -2.98], P < 0.00001; RR: 1.26, 95 %CI [1.13, 1.41], P < 0.0001). Furthermore, ADL, Fugl-Meyer Assessment Scale (FMA), prognosis analyses also showed the effectiveness of acupuncture. (SMD: 0.98, 95 % CI [0.64, 1.31], P < 0.00001; MD: 16.46, 95 %CI [12.56, 20.35], P < 0.00001; RR: 0.38, 95 %CI [0.16, 0.89], P = 0.03). However, the certainty of evidence was low. Conclusion: According to current evidence, Acupuncture may be effective and safe for AIS. The future still needs high-quality evidence to support this conclusion.

Background Recent individual studies have indicated that ultra-processed food (UPF) consumption may be associated with the incidence of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis based on those longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD, and synthesizing the results.Method PubMed, Embase, The Cochrane Library, Web of Science, and Scopus were searched from inception through 22 March 2023. Any longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD were included. Two researchers independently conducted the literature screening and data extraction. RR and its 95% CI were regarded as the effect size. The Newcastle–Ottawa Scale (NOS) was applied to assess the quality of the studies included, and the effect of UPF consumption on the risk of incident CKD was analyzed with STATA version 15.1. This study’s protocol was registered in PROSPERO (CRD42023411951).Results Four cohort studies with a total of 219,132 participants were included after screening. The results of the meta-analysis suggested that the highest UPF intake was associated with an increased risk of incident CKD (RR = 1.25; 95% CI: 1.18–1.33).Conclusions High-dose UPF intake was associated with an increased risk of incident CKD. However, the underlying mechanisms remain unknown. Thus, more standardized clinical studies and further exploration of the mechanisms are needed in the future.

IntroductionGBS (group B streptococcus) is an opportunistic pathogen that can colonize healthy individuals but presents significant challenges in clinical obstetrics and gynecology, as it can cause miscarriage, preterm birth, and invasive infections in newborns. To develop specific and personalized preventative strategies, a better understanding of the epidemiological characteristics and pathogenic features of GBS is essential.MethodsWe conducted a comprehensive strain-level genomic analysis of GBS, examining serotype and genotype distributions, as well as the composition and correlations of virulence genes using the blastn-short mode of the BLAST program(v2.10.0+), mlstsoftware (https://github.com/tseemann/mlst), Snippy (v4.6.0), FastTree (v2.1.11) and iTOL. The coding sequence region of virulence factors was annotated by Prodigal (v2.6.3) and Glimmer(v3.02b). We further identified host protein interacting with Srr2 by mass spectrometry analysis.ResultsWhile certain genotypes showed strong serotype consistency, there was no significant association between overall serotypes and genotypes. However, the composition of virulence genes was more closely related to the phylogeny of GBS, among which simultaneous presence of Srr2 and HygA exhibit significant association with hypervirulence. Tubulin emerged as the most distinct and abundant hit. The specific interaction of Tubulin with Srr2-BR, rather than Srr1-BR, was further confirmed by immunoblotting.DiscussionConsidering the impact of cytoskeleton rearrangement on GBS pathogenesis, this observation offers a plausible explanation for the hypervirulence triggered by Srr2. Collectively, our findings indicate that in the future clinical practice, virulence gene detection should be given more attention to achieve precise GBS surveillance and disease prevention.

BackgroundStress urinary incontinence (SUI), the most common form of urinary incontinence, is a condition that affects many women. It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as sneezing, coughing, or physical exertion, according to the International Continence Society. SUI affects patients’ quality of life and causes depression and emotional disorders, which negatively influences physical and mental health. The participants in the studies in this review comprised women with mild to moderate SUI, because there are more female patients than male patients, and most patients with severe SUI are treated surgically. Moreover, after retrieval, there were no systematic reviews or network meta-analyses (NMAs) of conservative treatments, such as electroacupuncture (EA), in women with mild to moderate SUI. ObjectiveThis study aims to investigate the efficacy of electroacupuncture among women with mild to moderate SUI using an NMA. MethodsRandomized clinical trials related to conservative treatments for SUI will be searched in 5 English and 3 Chinese literature databases: EMBASE, PubMed, Cochrane, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Chinese BioMedical Literature Database. The search period for these 8 electronic databases will be from 2002 to 2022. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database will also be searched. Two reviewers will independently complete the research selection. After screening the studies, 2 other researchers will extract the data, and the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Collaboration Tool (version 2). The primary outcomes will be the change in urine leakage determined by a 1-hour pad test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores at baseline and at the conclusion of the follow-up. The secondary outcomes will be 72-hour incontinence episodes, residual bladder volume, effective rate, urodynamic indexes, and other reported measurements. Stata (version 14.0; StataCorp) and Review Manager (RevMan version 5.3; Cochrane) will be implemented for data synthesis and meta-analysis. ResultsThe results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol was registered on INPLASY on February 22, 2023. By April 6, 2023, we had completed the literature search of the 8 databases and completed the selection and data extraction of the articles. ConclusionsThe results of this systematic review will demonstrate the efficacy of EA among women with mild to moderate SUI. The results will provide evidence for clinicians and guideline makers to choose suitable treatments for SUI. Trial RegistrationInternational Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) 202320098; https://inplasy.com/inplasy-2023-2-0098/ International Registered Report Identifier (IRRID)DERR1-10.2196/55870

Introduction Physical inactivity is prevalent and associated with adverse outcomes among patients with chronic kidney disease (CKD). Most previous studies have relied on subjective questionnaires to assess levels of physical activity (PA) and mainly focused on patients undergoing dialysis. Therefore, the Physical Activity Elements and Adverse Outcomes in Patients with Chronic Kidney Disease in Guangdong study aims to investigate the levels and types of PA elements and their association with adverse outcomes in Chinese non-dialysis CKD (ND-CKD) patients.Methods and analysis In this prospective cohort study, 374 patients with ND-CKD will be recruited from Guangdong province, South of China. The primary exposure will be levels of PA assessed by ActiGraph GT3X+ accelerometer including the intensity, duration, frequency and type of PA. The traditional Chinese exercises such as tai chi and Baduanjin will also be assessed. The primary outcomes will be all-cause mortality. Other variables including demographics, comorbidities, medication and laboratory markers will be registered. All data will be updated annually for at least 5 years, or until the occurrence of death or initiation of renal replacement therapy. The Spearman correlation coefficient will be used to investigate the correlation between questionnaire-derived and accelerometry-derived PA. The Cox proportional hazards model will be used to investigate the association between level of PA and adverse outcomes. Non-linear associations between PA levels and outcomes, as well as the minimum desirable PA level, will be evaluated using restricted cubic splines.Ethics and dissemination The ethical permission for this study was obtained from the ethics committee of Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China (B2015-152-02). Written informed consent is obtained from all participants. The results will be disseminated by publication in a peer-reviewed journal and presented at relevant conferences.

IntroductionThis study aimed to investigate the virome diversity of the SLE disease and the association between viral infections and the disease.MethodsSLE-related RNA-Seq data were retrieved from public databases. A rigorous computational workflow was employed to identify the human viruses. Differential expression analysis and functional enrichment analysis were conducted in R.ResultsWe identified ten human virus species from 826 RNA-Seq samples of human blood, comprising 688 SLE patients and 138 healthy controls. Eight of the ten virus species exhibited higher positive rates in SLE patients compared to healthy controls, with Human betaherpesvirus 5 (HHV5) having the highest positive rate (4.1%) and being exclusively detected in SLE samples. The virus abundances were low and comparable in both SLE patients and healthy controls. Analysis of the antiviral interferon-stimulated genes (ISGs) in samples showed higher ISG expression levels in HHV4 and HHV5-positive samples compared to virus-negative samples. Several genes that were up-regulated in SLE patients were further up-regulated after HHV5 infection, and they were mainly enriched in immune response-related biological processes. Additionally, the expression levels of several marker genes of SLE severity were compared between HHV5-positive and virus-negative SLE patients, suggesting that HHV5 infection may be associated with aggravated SLE disease.DiscussionWe found that SLE patients are more susceptible to viral infections than healthy individuals. Viral infections, such as HHV5, may be associated with aggravated SLE disease. This study deepens our understanding of the association between viruses and SLE and provides new insights into prevention and control of the disease.

BackgroundDexmedetomidine (DEX) and propofol are popular anesthetics, but it remains unknown whether DEX reduces the incidence of arrhythmias compared with propofol after cardiac surgery.MethodsWe performed a comprehensive search for RCTs (Randomized Controlled Trials) that compared the incidence of arrhythmias between DEX and propofol in adults who had undergone cardiac surgery across three databases (PubMed, Embase, the Cochrane Library), and ClinicalTrials.gov up to October 3, 2023. The primary outcome was ventricular arrhythmias, the secondary outcomes were bradycardia and atrial fibrillation (AF).ResultsOur analysis included 7 RCTs with 1,004 patients (mean age: 64.37, male: 71.11%) undergoing cardiac surgery, and the incidence of in-hospital arrhythmia was 22.01% (ventricular arrhythmias 2.75%, bradycardia 3.33%, AF 18.63%). Perioperative or postoperative use of DEX reduced the incidence of in-hospital ventricular arrhythmias [Odds Ratio (OR) 0.14, 95% Confidence Interval (CI) 0.03–0.66], but increased the risk of in-hospital bradycardia (OR 2.88, 95% CI 1.02–8.17) compared with propofol. The trial sequence analysis verified the adequacy of sample size and robustness of the ventricular arrhythmias and bradycardia. There was no significant reduced incidence of the use of DEX in the incidence of AF (OR 0.69, 95% CI 0.36–1.29). The GRADE assessment indicated a high certainty for ventricular arrhythmias and bradycardia and a moderate certainty for AF.ConclusionsOur findings suggested the use of DEX reduces in-hospital ventricular arrhythmias but increases bradycardia incidence compared to propofol in adult patients undergoing cardiac surgery. Further studies are needed to assess the impact of dexmedetomidine on atrial fibrillation compared to propofol.Systematic Review Registrationhttp://www.crd.york.ac.uk/prospero/ PROSPERO, identifier (CRD42023482193).

Abstract Direct hydrogen production from inexhaustible seawater using abundant offshore wind power offers a promising pathway for achieving a sustainable energy industry and fuel economy. Various direct seawater electrolysis methods have been demonstrated to be effective at the laboratory scale. However, larger-scale in situ demonstrations that are completely free of corrosion and side reactions in fluctuating oceans are lacking. Here, fluctuating conditions of the ocean were considered for the first time, and seawater electrolysis in wave motion environment was achieved. We present the successful scaling of a floating seawater electrolysis system that employed wind power in Xinghua Bay and the integration of a 1.2 Nm3 h−1-scale pilot system. Stable electrolysis operation was achieved for over 240 h with an electrolytic energy consumption of 5 kWh Nm−3 H2 and a high purity (>99.9%) of hydrogen under fluctuating ocean conditions (0~0.9 m wave height, 0~15 m s−1 wind speed), which is comparable to that during onshore water electrolysis. The concentration of impurity ions in the electrolyte was low and stable over a long period of time under complex and changing scenarios. We identified the technological challenges and performances of the key system components and examined the future outlook for this emerging technology.

This paper studies a stochastic Leslie-Gower model with a Holling-II functional response that is driven by the Ornstein-Uhlenbeck process. Some asymptotic properties of the solution of the stochastic Leslie-Gower model are introduced: The existence and uniqueness of the global solution of the model are given; the ultimate boundedness of the model is proven; by constructing the Lyapunov function and applying Ito's formula, the existence of the stationary distribution of the model is demonstrated; and the conditions for system extinction are discussed. Finally, numerical simulations are used to validate our conclusion.

Canada’s decentralized healthcare system may lead to regional disparities in survival among Canadians diagnosed with central nervous system (CNS) tumours. We identified 50,670 patients diagnosed with a first-ever primary CNS tumour between 2008 and 2017 with follow-up until 31 December 2017. We selected the four highest incidence histologies and used proportional hazard regression to estimate hazard ratios (HRs) for five regions (British Columbia, Prairie Provinces, Ontario, Atlantic Provinces and the Territories), adjusting for sex, tumour behaviour and patient age. Ontario had the best survival profile for all histologies investigated. The Atlantic Provinces had the highest HR for glioblastoma (HR = 1.26, 95% CI: 1.18–1.35) and malignant glioma not otherwise specified (NOS) (Overall: HR = 1.87, 95% CI:1.43–2.43; Pediatric population: HR = 2.86, 95% CI: 1.28–6.39). For meningioma, the Territories had the highest HR (HR = 2.44, 95% CI: 1.09–5.45) followed by the Prairie Provinces (HR = 1.52, 95% CI: 1.38–1.67). For malignant unclassified tumours, the highest HRs were in British Columbia (HR = 1.45, 95% CI: 1.22–1.71) and the Atlantic Provinces (HR = 1.40, 95% CI: 1.13–1.74). There are regional differences in the survival of CNS patients at the population level for all four specific histological types of CNS tumours investigated. Factors contributing to these observed regional survival differences are unknown and warrant further investigation.

Abstract The system time of the four major navigation satellite systems is mainly maintained by multiple high-performance atomic clocks at ground stations. This operational mode relies heavily on the support of ground stations. To enhance the high-precision autonomous timing capability of next-generation navigation satellites, it is necessary to autonomously generate a comprehensive space-based time scale on orbit and make long-term, high-precision predictions for the clock error of this time scale. In order to solve these two problems, this paper proposed a two-level satellite timing system, and used multiple time-keeping node satellites to generate a more stable space-based time scale. Then this paper used the sparse sampling Long Short-Term Memory (LSTM) algorithm to improve the accuracy of clock error long-term prediction on space-based time scale. After simulation, at sampling times of 300 s, 8.64 × 104 s, and 1 × 106 s, the frequency stabilities of the spaceborne timescale reach 1.35 × 10–15, 3.37 × 10–16, and 2.81 × 10–16, respectively. When applying the improved clock error prediction algorithm, the ten-day prediction error is 3.16 × 10–10 s. Compared with those of the continuous sampling LSTM, Kalman filter, polynomial and quadratic polynomial models, the corresponding prediction accuracies are 1.72, 1.56, 1.83 and 1.36 times greater, respectively.

Abstract Background Low concentrations of S100B have neurotrophic effects and can promote nerve growth and repair, which plays an essential role in the pathophysiological and histopathological alterations of major depressive disorder (MDD) during disease development. Studies have shown that plasma S100B levels are altered in patients with MDD. In this study, we investigated whether the plasma S100B levels in MDD differ between genders. Methods We studied 235 healthy controls (HCs) (90 males and 145 females) and 185 MDD patients (65 males and 120 females). Plasma S100B levels were detected via multifactor assay. The Mahalanobis distance method was used to detect the outliers of plasma S100B levels in the HC and MDD groups. The Kolmogorov–Smirnov test was used to test the normality of six groups of S100B samples. The Mann–Whitney test and Scheirer-Ray-Hare test were used for the comparison of S100B between diagnoses and genders, and the presence of a relationship between plasma S100B levels and demographic details or clinical traits was assessed using Spearman correlation analysis. Results All individuals in the HC group had plasma S100B levels that were significantly greater than those in the MDD group. In the MDD group, males presented significantly higher plasma S100B levels than females. In the male group, the plasma S100B levels in the HC group were significantly higher than those in the MDD group, while in the female group, no significant difference was found between the HC and MDD groups. In the male MDD subgroup, there was a positive correlation between plasma S100B levels and years of education. In the female MDD subgroup, there were negative correlations between plasma S100B levels and age and suicidal ideation. Conclusions In summary, plasma S100B levels vary with gender and are decreased in MDD patients, which may be related to pathological alterations in glial cells.

Abstract Kidney stones require surgical removal when they grow too large to be broken up externally or to pass on their own. Upper tract urothelial carcinoma is also sometimes treated endoscopically in a similar procedure. These surgeries are difficult, particularly for trainees who often miss tumours, stones or stone fragments, requiring re‐operation. Furthermore, there are no patient‐specific simulators to facilitate training or standardized visualization tools for ureteroscopy despite its high prevalence. Here a system ASSIST‐U is proposed to create realistic ureteroscopy images and videos solely using preoperative computerized tomography (CT) images to address these unmet needs. A 3D UNet model is trained to automatically segment CT images and construct 3D surfaces. These surfaces are then skeletonized for rendering. Finally, a style transfer model is trained using contrastive unpaired translation (CUT) to synthesize realistic ureteroscopy images. Cross validation on the CT segmentation model achieved a Dice score of 0.853 ± 0.084. CUT style transfer produced visually plausible images; the kernel inception distance to real ureteroscopy images was reduced from 0.198 (rendered) to 0.089 (synthesized). The entire pipeline from CT to synthesized ureteroscopy is also qualitatively demonstrated. The proposed ASSIST‐U system shows promise for aiding surgeons in the visualization of kidney ureteroscopy.

Abstract Endoscopic renal surgeries have high re‐operation rates, particularly for lower volume surgeons. Due to the limited field and depth of view of current endoscopes, mentally mapping preoperative computed tomography (CT) images of patient anatomy to the surgical field is challenging. The inability to completely navigate the intrarenal collecting system leads to missed kidney stones and tumors, subsequently raising recurrence rates. A guidance system is proposed to estimate the endoscope positions within the CT to reduce re‐operation rates. A Structure from Motion algorithm is used to reconstruct the kidney collecting system from the endoscope videos. In addition, the kidney collecting system is segmented from CT scans using 3D U‐Net to create a 3D model. The two collecting system representations can then be registered to provide information on the relative endoscope position. Correct reconstruction and localization of intrarenal anatomy and endoscope position is demonstrated. Furthermore, a 3D map is created supported by the RGB endoscope images to reduce the burden of mental mapping during surgery. The proposed reconstruction pipeline has been validated for guidance. It can reduce the mental burden for surgeons and is a step towards the long‐term goal of reducing re‐operation rates in kidney stone surgery.

Abstract In the railway system, fasteners have the functions of damping, maintaining the track distance, and adjusting the track level. Therefore, routine maintenance and inspection of fasteners are important to ensure the safe operation of track lines. Currently, assessment methods for fastener tightness include manual observation, acoustic wave detection, and image detection. There are limitations such as low accuracy and efficiency, easy interference and misjudgment, and a lack of accurate, stable, and fast detection methods. Aiming at the small deformation characteristics and large elastic change of fasteners from full loosening to full tightening, this study proposes high-precision surface-structured light technology for fastener detection and fastener deformation feature extraction based on the center-line projection distance and a fastener tightness regression method based on neural networks. First, the method uses a 3D camera to obtain a fastener point cloud and then segments the elastic rod area based on the iterative closest point algorithm registration. Principal component analysis is used to calculate the normal vector of the segmented elastic rod surface and extract the point on the centerline of the elastic rod. The point is projected onto the upper surface of the bolt to calculate the projection distance. Subsequently, the mapping relationship between the projection distance sequence and fastener tightness is established, and the influence of each parameter on the fastener tightness prediction is analyzed. Finally, by setting up a fastener detection scene in the track experimental base, collecting data, and completing the algorithm verification, the results showed that the deviation between the fastener tightness regression value obtained after the algorithm processing and the actual measured value RMSE was 0.2196 mm, which significantly improved the effect compared with other tightness detection methods, and realized an effective fastener tightness regression.