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Stress-induced anisotropy has been applied for FeSiBCuNb nanocrystalline alloy ribbons in transformers with large direct current (DC) component. However, the physical mechanism of anisotropy induced by stress annealing during crystallization remains controversial. Here, a systematic study was conducted on the microstructure, residual stress state, dynamic domain structure and properties of the stress-annealed FeSiBCuNb nanocrystalline ribbons. Present results demonstrate that, the increase of the applied stress greatly increases the residual tensile stress and induces lattice distortion, which acts as pinning site during magnetization, resulting in enhanced domain-wall energy and narrower wall width. Meanwhile, stress annealing promotes the flattening of hysteresis loops and decreases the effective permeability, which improves the DC-bias characteristics of the ribbons, thereby promoting the transition from “hard saturation” to “soft saturation” behavior. Also, stress-induced grain refinement is beneficial to obtaining high hardness. Owing to the stress-induced anisotropy, the stress-annealed sample with applied stress of 113 MPa exhibits excellent combined properties, including low constant effective permeability of 438 at wide frequency range (1 kHz–8 MHz), high DC-bias capability of 74% (30 Oe), low power loss of 49 kW/m3 (100 mT, 100 kHz), and high hardness of 644 HV. This discovery provides an insightful understanding of stress-induced anisotropy mechanism on the high-performance Fe-based nanocrystalline alloys.

A novel recrystallization and partial melting process combined radial forging was proposed to prepare long axial 2A50 aluminum alloy semi-solid billets. Microstructure characteristics of the forged and isothermal treated samples were investigated. Results demonstrate that initial elongated grains (fibrous structure) and low angle grain boundaries were substituted by spherical equiaxed grains and high angle grain boundaries when the sample was heated at 585 °C for 10 min. Deformed textures of the forged 2A50 aluminum alloy were remarkably weaken after isothermal treatment. The average grain size and shape factor increased with the increased temperature and holding time. Long holding time resulted in some dendrites. The liquid films at the grain boundaries thickened with the increase in temperature and holding time. Grains growth and spheroidization were determined by coarsening and Ostwald ripening mechanisms. The coarsening rate constant k of grains at 575 °C was 378.5 μm3/s.

Abstract The radiator with heat transfer capability is able to guarantee the stable operation of hydro generator set, while the long-term and continuous scouring on radiator pipes by cooling medium will lead to thinning or even perforation of pipe wall, which triggers wall failure. This paper analyzes and predicts the failure mechanism of radiator’s pipe wall, and investigates the effects of water flow velocity, sand content and sand particle size on erosion damage of radiator pipe by establishing a test bench for pipe erosion. The results show that the increase of above parameters will lead to the increasing erosion rate, especially when the sand content is 1%, the velocity is 8 m/s and the sand particle size is 0.85 mm, the erosion damage will be particularly serious. Based on experimental data, BP and LSSVM models are employed to predict the pipe wall failure, and PSO algorithm is used to optimize the two models. The optimized PSO-BP has the highest accuracy with the mean absolute error (MAE) of 0.2070 and the mean absolute percentage error (MAPE) of 4.702%. The findings provide a reference for wall failure analysis of radiator, which is of great significance for unit's safe operation.

Abstract. Cancer cachexia is a multi-organ syndrome and closely related to changes in signal communication between organs, which is mediated by cancer cachexia factors. Cancer cachexia factors, being the general name of inflammatory factors, circulating proteins, metabolites, and microRNA secreted by tumor or host cells, play a role in secretory or other organs and mediate complex signal communication between organs during cancer cachexia. Cancer cachexia factors are also a potential target for the diagnosis and treatment. The pathogenesis of cachexia is unclear and no clear effective treatment is available. Thus, the treatment of cancer cachexia from the perspective of the tumor ecosystem rather than from the perspective of a single molecule and a single organ is urgently needed. From the point of signal communication between organs mediated by cancer cachexia factors, finding a deeper understanding of the pathogenesis, diagnosis, and treatment of cancer cachexia is of great significance to improve the level of diagnosis and treatment. This review begins with cancer cachexia factors released during the interaction between tumor and host cells, and provides a comprehensive summary of the pathogenesis, diagnosis, and treatment for cancer cachexia, along with a particular sight on multi-organ signal communication mediated by cancer cachexia factors. This summary aims to deepen medical community's understanding of cancer cachexia and may conduce to the discovery of new diagnostic and therapeutic targets for cancer cachexia.

Abstract The surface organs mainly comprise the superficial layers of various parts of the mammalian body, including the skin, eyes, and ears, which provide solid protection against various threats to the entire body. Damage to surface organs could lead to many serious diseases or even death. Currently, despite significant advancements in this field, there remain numerous enigmas that necessitate expeditious resolution, particularly pertaining to diagnostic and therapeutic objectives. The advancements in nanomedicine have provided a significant impetus for the development of novel approaches in the diagnosis, bioimaging, and therapy of superficial organs. The aggregation‐induced emission (AIE) phenomenon, initially observed by Prof. Ben Zhong Tang, stands out due to its contrasting behavior to the aggregation‐caused quenching effect. This discovery has significantly revolutionized the field of nanomedicine for surface organs owing to its remarkable advantages. In this review of literature, we aim to provide a comprehensive summary of recent advances of AIE lumenogen (AIEgen)‐based nanoplatforms in the fields of detection, diagnosis, imaging, and therapeutics of surface organ‐related diseases and discuss their prospects in the domain. It is hoped that this review will help attract researchers’ attention toward the utilization of this field for the exploration of a wider range of biomedical and clinical applications.

Abstract Studies describing the clinical presentation and prognosis of patients with silent PIT1 (pituitary specific transcription factor)‐lineage pituitary neuroendocrine tumors (PitNETs) are rare. We identified patients with positive PIT1 tumor staining but without evidence of hormone hypersecretion at a tertiary center. Clusters were obtained according to cell morphology and immunostaining from each patient's digitally segmented whole slide image. We compared the clinical presentations, radiological features, and prognoses of the different clusters. We identified 146 patients (68 male, 42.9 ± 14.1 years old) with silent PIT1‐lineage PitNETs. Morphology clustering suggested that tumors with large nuclei and apparent eccentricity were associated with a higher proportion of aggressiveness and a higher hazard of recurrence [hazard ratio (HR): 2.64, (95% CI, 1.06–6.55), p = 0.037]. Immunohistochemical clustering suggested that tumors with thyroid stimulating hormone (TSH) staining or all negative PIT1‐lineage hormones were associated with a higher proportion of aggressiveness and a higher risk of recurrence [HR: 12.4, (95% CI, 1.60–93.5), p = 0.015]. We obtained three‐tier risk profiles by combining morphological and immunohistochemical clustering. Patients with the high‐risk profile presented the highest recurrence rate compared with those in the medium‐risk and low‐risk profiles [HR: 3.54, (95% CI, 1.40–8.93), p = 0.002]. In conclusion, digital image analysis based on cell morphology and immunohistochemical staining allows objective stratification of patients with silent PIT1‐lineage tumors. Typical morphological characteristics of high‐risk tumors are large tumor nuclei and high eccentricity, and typical immunostaining characteristics are TSH staining or negative staining for all PIT1‐lineage hormones.

Objectives The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19.Design This is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics.Setting Short-term acute care hospitals and critical access hospitals in the USA.Participants Hospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021.Intervention/exposure Pre-COVID-19 hospital quality.Outcomes Risk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs).Results In-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020–September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%–23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%–30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient −0.41, p

The magnetotelluric (MT) method is a widely used geophysical technique for deep structure exploration. However, rapid industrial development has resulted in significant anthropogenic interference for practical applications of this method in recent years. To carry out MT survey in regions with strong electromagnetic (EM) noise, we develop a strategy, in which part of MT sites are set for night time period and a newly proposed automatic clustering method based on MT signal patterns is applied to process measured data from Yingde area in Guangdong. The MT sites are employed in night time to avoid human activity and measure the quiet time MT signal to make sure that we can capture portion of MT signal. Based on cosine similarity, we can use clustering algorithms to separate the signals from the noise. The application of this strategy for geothermal exploration in Yingde area in Guangdong, indicates the validity of our proposed strategy for real geothermal detection.

Fast and accurate infrared (IR) sea–sky line region (SSLR) detection can improve the early warning capability of the small targets that appear in the remote sea–sky junction. However, the traditional algorithms struggle to achieve high precision, while the learning-based ones have low detection speed. To overcome these problems, a novel learning-based algorithm is proposed; rather than detecting the sea–sky line first, the proposed algorithm directly provides SSLR, which mainly consists of three parts: Firstly, an IR sea–sky line region detection module (ISRDM) is proposed, which combines strip pooling and the connection mode of a cross-stage partial network to extract the features of the SSLR target, with an unbalanced aspect ratio, more specifically, thus improving the detection accuracy. Secondly, a lightweight backbone is presented to reduce the parameters of the model and, therefore, improve the inference speed. Finally, a Detection Head Based on the spatial-aware attention module (SAMHead) is designed to enhance the perception ability of the SSLR and further reduce the inference time. Extensive experiments conducted on three datasets with more than 26,000 frames show that the proposed algorithm achieved approximately 80% average precision (AP), outperforms the state-of-the-art algorithms in accuracy, and can realize real-time detection.

As an important piece of equipment for hydrogen energy application, the hydrogen internal combustion engine is helpful for the realization of zero carbon emissions, where the aluminum connecting rod is one of the key core components. A semi-solid forging forming process for the 7075 aluminum alloy connecting rod is proposed in this work. The influence of process parameters, such as the forging ratio, sustaining temperature, and duration time, on the microstructures of the semi-solid blank is experimentally investigated. The macroscopic morphology, metallographic structure, and physical properties of the connecting-rod parts are analyzed. Reasonable process parameters for preparing the semi-solid blank are obtained from the experimental results. Under the reasonable parameters, the average grain size is 41.48~42.57 μm, and the average shape factor is 0.80~0.81. The yield strength and tensile strength improvement ratio of the connecting rod produced by the proposed process are 47.07% and 20.89%, respectively.

Craniopharyngioma patients often suffer from a diminished quality of life after surgery, which is usually associated with metabolic disorders and hypothalamic obesity. However, the precise etiology of these conditions remains elusive. To identify the metabolic changes after surgery, we conducted a cross-sectional study using metabolomic and lipidomic analysis to profile metabolic alterations in adult-onset craniopharyngioma patients with postoperative obesity. A cohort of 120 craniopharyngioma patients who had undergone surgery were examined. Differential analyses, including clinical characteristics, serum metabolome, and lipidome, were conducted across distinct body mass index (BMI) groups. Our findings indicated no statistically significant differences in age, sex, and fasting blood glucose among postoperative craniopharyngioma patients when stratified by BMI. However, a noteworthy difference was observed in uric acid and blood lipid levels. Further investigation revealed that alterations in metabolites and lipids were evidently correlated with increased BMI, indicating that postoperative obesity of craniopharyngioma patients affected their whole-body metabolism. Additionally, the multi-omics analysis identified specific metabolites and lipids, including uric acid and DG(18:2/20:4), as contributors to the metabolic disorders associated with postoperative obesity of craniopharyngioma patients. This work provides valuable insight into the involvement of metabolites and lipids in metabolic disorders subsequent to craniopharyngioma surgery.

With the wide application potential of wrought aluminium alloy in aerospace, automobile and electronic products, high-quality aluminium bars prepared by the radial forging (RF) process have received extensive attention. Penetration performance refers to the depth of radial plastic deformation of forgings, which is the key factor in determining the quality of forging. In this work, the penetration performance of the radial forging process for 6063 wrought aluminium bars is investigated by simulation using FORGE software. The minimum reduction amount of the hammer is calculated based on the forging penetration theory of forging. The influence of process parameters including forging ratio (FR) and billet temperature on the effective stress and hammer load in the RF process are investigated. The RF-deformed billet is then produced with the optimal process parameters obtained from the simulation results. The average grain size of aluminium alloy semi-solid spherical material is used to evaluate the forging penetration. Simulation results showed that the effective strain at the edge and the centre of the RF-deformed billet gradually increases, but the increasing speed of the effective strain at the edge becomes low. The hammer load first decreases quickly and then gradually maintains stability by increasing the FR. It is found that low billet temperature and high FR should be selected as appropriate process parameters under the allowable tonnage range of RF equipment. Under an isothermal temperature of 630 °C and a sustaining time of 10 min, the difference in the average grain dimension between the edge and the centre positions of the starting extruded blank is 186.43 μm, while the difference in the average grain dimension between the edge and the centre positions of the RF-deformed blank is 15.09 μm. The improvement ratio of penetration performance for the RF-deformed blank is obtained as 91.19%.

An innovative rheo-extrusion process for aluminium alloy miniature gears is proposed in this work to overcome the disadvantages of inefficiency and high cost in the existing forming methods. Numerical simulation and experiment were conducted on the rheo-extrusion process of 2A50 aluminium alloy miniature gear. Simulation results reveal that the metal fills into the cavity of the gear die along the axial and radial directions at different flowing velocities, mostly varying from 0 mm/s to 6 mm/s depending on the position of the metal in the gear die. The temperature of the billet rises with increasing extruded displacement, and the side of the gear near the punch has a high temperature of 593 °C at the end of extrusion. The equivalent stress of the parts in the billet near the top and bottom lands of the gear die is higher than others, with a maximum value of approximately 290 MPa at the top lands of the gear die when the extrusion is finished. The rheo-extrusion experiment shows that the miniature gear is fully filled, and its microstructure consists of fine grains with an average size of 19–31 μm. The micro-Vickers hardness distribution of the miniature gear is related to the grain size. The hardness of the parts near the dies are higher than others, with value of 81–85 HV, and the grains in these regions are finer than the other positions.

Screw compressors are highly researched and developed prospects in industry because of their long service life, high transmission efficiency, low footprint and low vibration. As the key core part of the screw compressor, the screw is a typical, long-shaft, complex profile part. Its processing method, manufacturing accuracy and quality have an extremely important impact on the performance of the whole screw compressor. In this work, the research progress on the manufacturing of screw-shaped parts in screw compressors is summarised from the aspects of the cutting process, solid plastic forming, casting and additive manufacturing. The merits and demerits of these manufacturing processes are provided and discussed, which is conducive to the development of the high-efficiency, precise and high-performance forming process of screw-shaped parts. Additionally, a novel forming process is proposed to solve the problems of serious material waste and low production efficiency for the screw-shaped parts. In the proposed process, the semi-solid spherical grain is firstly prepared by radial forging and the isothermal treatment of long-shaft raw materials. The large strain energy can be stored in the bar by the radial forging of long-shaft raw materials, which is used to induce the generation of semi-solid spherical grains with the assistance of the isothermal procedure. After that, the screw is fabricated by the high-efficiency semi-solid closed extrusion process.

The prediction of “sweet spot” of multi-lithology composite tight oil and gas reservoirs within mixed siliciclastic-carbonate sequences is a hot topic in oil and gas exploration. There are mixed lacustrine carbonate-siliciclastic rocks in the Da'anzhai Member of Ziliujing Formation in the Eastern Slope of western Sichuan Depression. The reservoir lithology is complex, and the main factors controlling the development of high-quality reservoirs are yet to be known. Based on a large number of drilling, core and thin section observation, well log and seismic data, this paper systematically studies the characteristics and factors controlling the development of the mixed siliciclastic-carbonate reservoir. The results show that the reservoir is composed primarily of coquina, sandstone, breccia and shale in lithology, and its development is mainly controlled by sedimentary microfacies, diagenesis, tectonism (fracturing) and paleogeomorphology during the sedimentary period. The effective fractures in reservoirs of the low-energy shell shoal facies are well developed with relatively good physical properties. With the change of sedimentary microfacies from low-energy shoal to high-energy shoal to arenaceous shoal, the hydrocarbon production capacity worsens step by step. Diagenesis, such as dissolution and fracturing, has a certain effect on reservoir physical properties. The palaeogeomorphic highs and slopes had well-developed fractures during the sedimentary period which are conducive to constructive dissolution, and thus they are favorable zones for reservoir development. The development of structural fractures further amplifies the influence of dissolution; thus the fracture zones are also favorable for the development of high-quality reservoirs. The favorable sedimentary facies zone and fracture development degree serve as the core factors for the formation of high-quality mixed reservoirs. The muddy limestone with certain dissolved pores and structural fractures deposited under the low-energy shell shoal setting is of relatively high-quality reservoir in the Da'anzhai Member.

Abstract Skull base chordoma (SBC) is a bone cancer with a high recurrence rate, high radioresistance rate, and poorly understood mechanism. Here, we profiled the transcriptomes of 90,691 single cells, revealed the SBC cellular hierarchies, and explored novel treatment targets. We identified a cluster of stem-like SBC cells that tended to be distributed in the inferior part of the tumor. Combining radiated UM-Chor1 RNA-seq data and in vitro validation, we further found that this stem-like cell cluster is marked by cathepsin L (CTSL), a gene involved in the packaging of telomere ends, and may be responsible for radioresistance. Moreover, signatures related to partial epithelial–mesenchymal transition (p-EMT) were found to be significant in malignant cells and were related to the invasion and poor prognosis of SBC. Furthermore, YL-13027, a p-EMT inhibitor that acts through the TGF-β signaling pathway, demonstrated remarkable potency in inhibiting the invasiveness of SBC in preclinical models and was subsequently applied in a phase I clinical trial that enrolled three SBC patients. Encouragingly, YL-13027 attenuated the growth of SBC and achieved stable disease with no serious adverse events, underscoring the clinical potential for the precision treatment of SBC with this therapy. In summary, we conducted the first single-cell RNA sequencing of SBC and identified several targets that could be translated to the treatment of SBC.

Background: Based on the literature and data on its clinical trials, the incidence of venous thromboembolism (VTE) in patients undergoing neurosurgery has been 3.0%~26%. We used advanced machine learning techniques and statistical methods to provide a clinical prediction model for VTE after neurosurgery. Methods: All patients (n = 5867) who underwent neurosurgery from the development and retrospective internal validation cohorts were obtained from May 2017 to April 2022 at the Department of Neurosurgery at the Sanbo Brain Hospital. The clinical and biomarker variables were divided into pre-, intra-, and postoperative. A univariate logistic regression (LR) was applied to explore the 67 candidate predictors with VTE. We used a multivariable logistic regression (MLR) to select all significant MLR variables of MLR to build the clinical risk prediction model. We used a random forest to calculate the importance of significant variables of MLR. In addition, we conducted prospective internal (n = 490) and external validation (n = 2301) for the model. Results: Eight variables were selected for inclusion in the final clinical prediction model: D-dimer before surgery, activated partial thromboplastin time before neurosurgery, age, craniopharyngioma, duration of operation, disturbance of consciousness on the second day after surgery and high dose of mannitol, and highest D-dimer within 72 h after surgery. The area under the curve (AUC) values for the development, retrospective internal validation, and prospective internal validation cohorts were 0.78, 0.77, and 0.79, respectively. The external validation set had the highest AUC value of 0.85. Conclusions: This validated clinical prediction model, including eight clinical factors and biomarkers, predicted the risk of VTE following neurosurgery. Looking forward to further research exploring the standardization of clinical decision-making for primary VTE prevention based on this model.

Hydrogen energy is a plentiful and environmentally friendly form of secondary energy that could play a crucial role in achieving global energy sustainability. At the same time, the electrolysis of water for hydrogen production is a significant future-oriented advancement in the energy sector, whereas appropriate hydrogen evolution catalysts have always been the key to hydrogen evolution reactions. In this study, lignin was utilized as an appropriate raw material for modification in order to obtain carbon materials, which was then supported with Ru to prepare an Ru0.8@MLC catalyst. At a current density of 10 mA cm−2, the required overpotential was a mere 35.6 mV and the slope of Tafel was 31.7 mV dec−1. This study provides a feasible strategy and pathway for preparing highly efficient electrocatalysts for the hydrogen evolution reaction.

Introduction: Most studies reporting posterior pituitary tumors (PPTs) are small case series or single cases. Methods: Patients with a histological diagnosis of PPT from January 2010 to December 2021 in a tertiary center were identified. We reported clinical symptoms, endocrine assessments, radiological and pathological features, and surgical outcomes of PPTs. Results: A total of 51 patients (23 males, 51.3 ± 10.3 years old) with PPT were included in this study. Major symptoms were visual defects, headache, and hypopituitarism, while diabetes insipidus was uncommon (9.8%). The typical radiological feature was homogeneous enhancement (84.3%) of a regular-shaped mass on T1 contrast imaging without cystic change, calcification, or cavernous sinus invasio n. We achieved gross total resection in 38/51 patients (74.5%). Pathologically, all tumors showed thyroid transcription factor 1 immunoreactivity. Among 29 patients with suprasellar PPTs, postoperative hemorrhage due to tumor residue was encountered in 2/15 cases in the transcranial group and 0/14 in the endoscopy group. Patients with spindle cell oncocytoma (SCO) were more likely to be surgically treated (25% vs 0%, P = 0.018), harbor a higher Ki-67 index (16.7% vs 0% > 5% P = 0.050), and present a lower 2-year recurrence-free survival rate (67.5% vs 90.9%) compared with patients with pituicytoma or granular cell tumor. Conclusion: PPTs should be considered in the differential diagnosis of pati ents with sellar and suprasellar masses with a regular lesion with homogeneous enhancement. SCOs had high proliferation activity and risk of recurrence.

Shell limestone tight reservoirs are developed in the Lower Jurassic Da'anzhai Member of the Sichuan Basin. Fractures are important storage spaces and seepage channels in shell limestone tight oil reservoirs and are key factors for high oil and gas production in wells. In this study, considering the shell limestone reservoir of the Da'anzhai Member on the eastern slope of the Western Sichuan Depression as an example, we used multiple fracture interpretation models based on conventional logging to identify fractures. Our results show that: (1) the reservoirs in the Da'anzhai Member primarily showed low-angle structural fractures, mostly filled with calcite. The effective linear density of fractures in each well varied greatly, which primarily explains the strong heterogeneity of tight reservoirs. (2) The logging response characteristics of the fractured and non-fractured segments differ considerably, and the fractured segment shows the characteristics of high acoustic time difference and low resistivity. (3) The well log recombination method, principal component analysis method, multivariate discriminant method, backpropagation (BP) neural network method, and K-nearest neighbor (KNN) algorithm are used for fracture identification. According to the consistency of the fracture identification results with the core observation results, we established a comprehensive fracture identification standard using the multi-logging method. In this study, we established a fracture identification method based on the coupling of multiple linear and nonlinear multi-logging models through core calibration, which avoids the errors and uncertainties caused by using a single method. Additionally, this study provides a foundation for the control factors and the prediction of fracture distribution.

Low-carbon steel has been popularly applied in numerous applications because of its unique features, such as good plasticity, high strength, great hardness, and excellent toughness. Additionally, the semi-solid thixotropic forging forming method has been widely used in light alloys, due to its advantages of low forming force and high forming quality, whereas its application in ferrous materials is still limited. In this study, the semi-solid thixotropic forging forming process is proposed for producing the low-carbon steel claw pole, with the main stages being radial forging deformation, isothermal treatment, and forging forming. The effect of the area reduction rate on the effective strain from the cross sections of the radial-forged metal bar was studied using numerical simulations. The effect of the isothermal holding process on the microstructures of radial-forged billets was investigated, to obtain the ideal semi-solid microstructures. The microstructure and mechanical properties of low-carbon steel claw poles from the thixotropic forging experiment are presented and discussed. It was found that when the area reduction rate was 67%, the effective strain at the edge of the metal bar exceeded 5.0, while the effective strain at the center was above 1.2, indicating an excellent quality of forging for the bar. The optimization of the process parameters for preparing low-carbon steel semi-solid billets with fine and globular microstructures was achieved with an area reduction rate of 67%, an isothermal temperature of 1500 °C, and a duration time of 15 min. Moreover, the low-carbon steel claw pole fabricated with the optimized operating parameters was found fully filled, with a sharp profile and a flat surface, where the yield strength and tensile strength increased by 88.5% and 79.8%, respectively, compared to the starting materials.

Tight sandstone reservoir is characterized by ultra-low porosity, complex microporous structure and water residues, which shows different gas storage and transport mechanism from conventional reservoirs. Therefore, effective development of tight sandstone gas reservoirs is faced with technical challenges. Microporous structures, distribution mechanism of fluid is a basic issue in gas reservoir evaluation. In this work, we take gas reservoir in the 2nd member of Xujiahe Formation in Yuanba area as an example to analyze the microscopic feature of pore structure and fluid distribution. The three-dimensional digital core has been applied to represent the real microporous structure. Specifically, a digital core reconstruction method based on SEM and casting slice images has been proposed. Ultimately, the mechanism of distribution, mode of occurrence of water residues in tight sandstone reservoirs has been simulated and quantitatively analyzed. The results show that the water residues could been visualized and categorized into three modes, water mass in corner, water film on surface, and water column in throat. The water residues could cause dramatic influence on pore structures, active pore size could be decreased with rising residual water saturation, the magnitude falls by over 50%. In addition, grain size would affect the distribution of water residues, which shows different percentage in medium and fine sand. Pore connectivity is another characteristic factor to describe the microporous structures. In this study, cluster marking algorithm has been applied to obtain the pore connectivity in tight sandstone with different grain size. In medium sand, the pore connectivity is dramatically decreased with rising water saturation, the downward trend become slower when water saturation reaches to 60%. Compared to fine sand, the tendency variation appears when water saturation reaches to 40%. This paper provides an applicable method to reveal the micro-scale reservoir properties and fluid distribution mechanisms in tight sandstone gas reservoirs.

Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non‐cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post‐GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) >35%, and the probability that a patient's death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7±12.0 years, 24.5% women, 34.1% with LVEF >35%), Seattle Heart Failure Model–predicted annual mortality had the greatest effect size for decreased post‐GC survival (P35% had a lower Seattle Heart Failure Model–adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11–1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF ≤35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD 65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre‐GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF >35% alone or both LVEF ≤35% and PRAD

An analysis of the effect on the flow regime caused by reservoir operation is crucial to balancing the exploitation and protection of water resources. The long-term effect of this on the intraday scale and small storage capacity is considerable, but rarely analyzed. This study examines the world’s largest dual-cascade hydro-junction, the Three Gorges Dam and Gezhouba Dam junction, as a case study, adopting eight indices to characterize the reservoir’s inflow and outflow fluctuation. In doing this, we evaluate the alteration of the flow regime induced by an up-cascade reservoir and its alleviation caused by the down-cascade re-regulation. The results show: (1) an increment of the river flow fluctuation at the Three Gorges Dam, matched with hourly scale alleviation at the Gezhouba Dam; (2) a reduction (25.09~41.35%) in the quantitative indices of the river flow regime fluctuation; (3) perturbations on the power output. These findings provide references for developing methods to assess the re-regulation mechanisms in systems with upper- and lower-cascades.

Obesity is an epidemic all around the world. Weight loss interventions that are effective differ from each other with regard to various lipidomic responses. Here, we aimed to find lipidomic biomarkers that are related to beneficial changes in weight loss. We adopted an untargeted liquid chromatography with tandem mass spectrometry (LC-MS/MS) method to measure 953 lipid species for Exercise (exercise intervention cohort, N = 25), 1388 lipid species for LSG (laparoscopic sleeve gastrectomy cohort, N = 36), and 886 lipid species for Cushing (surgical removal of the ACTH-secreting pituitary adenomas cohort, N = 25). Overall, the total diacylglycerol (DG), triacylglycerol (TG), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylserine (PS), and sphingomyelin (SM) levels were associated with changes in BMI, glycated hemoglobin (HbA1c), triglyceride, and total cholesterol according to weight loss interventions. We found that 73 lipid species changed among the three weight loss interventions. We screened 13 lipid species with better predictive accuracy in diagnosing weight loss situations in either Exercise, LSG, or Cushing cohorts (AUROC > 0.7). More importantly, we identified three phosphatidylcholine (PC) lipid species, PC (14:0_18:3), PC (31:1), and PC (32:2) that were significantly associated with weight change in three studies. Our results highlight potential lipidomic biomarkers that, in the future, could be used in personalized approaches involving weight loss interventions.

Background We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI). Methods and Results Patients undergoing PVI in the American College of Cardiology’s (ACC) National Cardiovascular Data Registry’s PVI Registry who could be linked to Centers for Medicare and Medicaid Services data were included. The primary outcomes were MACE, MALE, and readmission within 1 month and 1 year following index CLTI‐PVI or non‐CLTI‐PVI. Cox proportional hazards regression was used to identify factors associated with the development of the primary outcomes among patients undergoing CLTI‐PVI. There were 1758 (49.7%) patients undergoing CLTI‐PVI and 1779 (50.3%) undergoing non‐CLTI‐PVI. By 1 year, MACE occurred in 29.5% of patients with CLTI (n=519), and MALE occurred in 34.0% of patients with CLTI (n=598). By 1 year, MACE occurred in 8.2% of patients with non‐CLTI (n=146), and MALE occurred in 26.1% of patients with non‐CLTI (n=465). Predictors of MACE at 1 year in CLTI‐PVI included end‐stage renal disease on hemodialysis, congestive heart failure, prior CABG, and severe lung disease. Predictors of MALE at 1 year in CLTI‐PVI included treatment of a prior bypass graft, profunda femoral artery treatment, end‐stage renal disease on hemodialysis, and treatment of a previously treated lesion. Conclusions Patients ≥65 years old undergoing PVI experience high rates of MACE and MALE. A range of modifiable and non‐modifiable patient factors, procedural characteristics, and medications are associated with the occurrence of MACE and MALE following CLTI‐PVI.

Abstract Background To estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Methods The centers for Medicare & Medicaid Services (CMS) Integrated Data Repository, including the Medicare beneficiary enrollment database, was accessed in June 2015, February 2017, and February 2018. We evaluated patterns of delay in Medicare claims accrual, and used incomplete, non-final claims data to develop and validate models for real-time estimation of admissions, readmissions, and observation stays. Results These real-time reporting models accurately estimate, within 2 months from admission, the monthly numbers of admissions, 30-day readmission and observation-stay rates for patients with AMI, HF, or pneumonia. Conclusions This work will allow CMS to track the impact of policy decisions in real time and enable hospitals to better monitor their performance nationally.

Abstract Background Multidrug resistance (MDR) generally leads to breast cancer treatment failure. The most common mechanism of MDR is the overexpression of ATP-binding cassette (ABC) efflux transporters such as P-glycoprotein (P-gp) that reduce the intracellular accumulation of various chemotherapeutic agents. Celecoxib (CXB), a selective COX-2 inhibitor, can dramatically enhance the cytotoxicity of doxorubicin (DOX) in breast cancer cells overexpressing P-gp. Thus it can be seen that the combination of DOX and CXB maybe obtain synergistic effects against breast cancer by overcoming drug resistance. Results In this study, we designed a pH and redox dual-responsive nanocarrier system to combine synergistic effects of DOX and CXB against drug resistant breast cancer. This nanocarrier system denoted as HPPDC nanoparticles showed good in vitro stability and significantly accelerated drug releases under the acidic and redox conditions. In drug-resistant human breast cancer MCF-7/ADR cells, HPPDC nanoparticles significantly enhanced the cellular uptake of DOX through the endocytosis mediated by CD44/HA specific binding and the down-regulated P-gp expression induced by COX-2 inhibition, and thus notably increased the cytotoxicity and apoptosis-inducing activity of DOX. In MCF-7/ADR tumor-bearing nude mice, HPPDC nanoparticles showed excellent tumor-targeting ability, remarkably enhanced tumor chemosensitivity and reduced COX-2 and P-gp expressions in tumor tissues. Conclusion All results demonstrated that HPPDC nanoparticles can efficiently overcome drug resistance in breast cancer both in vitro and in vivo by combining chemotherapy and COX-2 inhibitor. In a summary, HPPDC nanoparticles show a great potential for combination treatment of drug resistant breast cancer.

Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging.Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081–0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48–59) and 39 (95% CI 28–50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05).Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.

BackgroundSolitary intracranial hypothalamic mass occurs rarely. The etiological diagnosis of solitary hypothalamus lesion is challenging and often unachievable. Although previous studies indicated that lesions affecting the hypothalamus often cause significant metabolic disorders, few reports about the metabolic disturbances of patients with solitary hypothalamic mass have been reported.MethodTwenty-five patients with solitary hypothalamus lesions who had been evaluated and treated in Huashan Hospital from January 2010 to December 2020 were retrospectively enrolled. The clinical manifestations, radiological features, endocrine and metabolic disorders, and pathology were analyzed.ResultsThe male to female ratio was 5/20. The median age of onset was 22 (19, 35) years old. The most common initial symptom was polydipsia/polyuria (19/25, 76.0%) and amenorrhea (9/20, 45.0%). A high prevalence of hypopituitarism of different axes was found, with almost all no less than 80%. Central hypogonadism (21/22, 95.5%) and central diabetes insipidus (19/21, 90.5%) were the top two pituitary dysfunctions. Conclusive diagnoses were achieved by intracranial surgical biopsy/resection or stereotactic biopsy in 16 cases and by examining extracranial lesions in 3 cases. The pathological results were various, and the most common diagnoses were Langerhans cell histiocytosis (7/19) and hypothalamitis (5/19). The mean timespan from onset to diagnosis in the 19 cases was 34 ± 26 months. Metabolic evaluations revealed remarkable metabolic disorders, including hyperlipidemia (13/16, 81.3%), hyperglycemia (10/16, 62.5%), hyperuricemia (12/20, 60%), overweight/obesity (13/20, 65.0%), and hepatic adipose infiltration (10/13, 76.6%).ConclusionEither surgical or stereotactic biopsy will be a reliable and relatively safe procedure to help to confirm the pathological diagnosis of solitary hypothalamic mass. Metabolic disorders were severe in patients with solitary hypothalamic mass. The management of such cases should cover both the treatment of the primary disease, as well as the endocrine and metabolic disorders

Summary: Rosiglitazone, a synthetic peroxisome proliferator-activated receptor γ (PPARγ) ligand, has been reported to reduce growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in 10 patients with acromegaly. However, the mechanisms remain unknown. Here, we reveal that PPARγ directly enhances 15-hydroxyprostaglandin dehydrogenase (15-PGDH) expression, whose expression is decreased and negatively correlates with tumor size in acromegaly. Rosiglitazone decreases GH production and promotes apoptosis and autophagy in GH3 and primary somatotroph adenoma cells and suppresses hepatic GH receptor (GHR) expression and IGF-1 secretion in HepG2 cells. Activating the PGE2/cAMP/PKA pathway directly increases GHR expression. Rosiglitazone suppresses tumor growth and decreases GH and IGF-1 levels in mice inoculated subcutaneously with GH3 cells. The above effects are all dependent on 15-PGDH expression. Rosiglitazone as monotherapy effectively decreases GH and IGF-1 levels in all nineteen patients with active acromegaly. Evidence suggests that rosiglitazone may be an alternative pharmacological approach for acromegaly by targeting both pituitary adenomas and liver.

ContextHypothalamic obesity (HO) is a severe complication following craniopharyngioma, but studies regarding the sequelae in adult-onset patients with craniopharyngioma are sparse.ObjectiveThe objective of the study was to describe weight changes after surgical treatment in adult-onset craniopharyngioma patients and to analyze risk factors for postoperative weight gain and HO.Subjects and MethodA retrospective analysis was conducted of 120 adult-onset patients who underwent surgery for craniopharyngioma and follow-up at the institution of the authors between January 2018 and September 2020. Clinical characteristics, anthropometric data, image features, treatment modalities, and endocrine indices were collected. Multivariable logistic regression analysis was used to identify independent risk factors for postoperative weight gain and HO.ResultsForty-nine (40.8%) patients had clinically meaningful weight gain (≥5%) in a median follow-up time of 12.0 months (range 1.0–41.0 months) after surgery. The mean postoperative weight gain in this subgroup was 17.59 ± 12.28 (%). Weight gain continued in the first year following surgery. Patients with lower preoperative BMI [OR 0.78, 95% CI (0.67–0.90), P = 0.001] and the adamantinomatous subtype [OR 3.46, 95% CI (1.02–11.76), P = 0.047] were more likely to experience postoperative weight gain ≥5%. The prevalence of HO was 19.2% preoperatively and increased to 29.2% at last follow-up postoperatively. Only preoperative BMI [OR 2.51, 95% CI (1.64–3.85), P < 0.001] was identified as an independent risk factor for postoperative HO.ConclusionsHO is a common complication in patients with adult-onset craniopharyngioma. Patients with higher preoperative BMI had a greater risk for developing HO postoperatively.

ObjectiveTo determine the risk factors for erectile dysfunction (ED) in male patients with acromegaly and to prospectively investigate the short-term changes of erectile function after surgery or medical treatment.MethodsSixty-three male patients were subjected to nocturnal penile tumescence and rigidity (NPTR) test for the evaluation of erectile function. The measurement of serum nitric oxide (NO) was also performed. Twenty-seven patients were re-evaluated by NPTR after surgery or long-term somatostatin analogues (SSA) treatment.ResultsTwenty-two patients (34.9%) had ED. Patients with ED showed higher random GH (17.89 [10.97-44.19] μg/L vs 11.63 [4.31-28.80] μg/L, p = 0.020) and GH nadir (GHn) (10.80 [6.69-38.30] μg/L vs 8.76 [3.62-18.19] μg/L, p = 0.044) during oral glucose tolerance test (OGTT). The NO levels of ED patients were lower than non-ED patients (9.15 [5.58-22.48] μmol/L vs 16.50 [12.33-31.78] μmol/L, p = 0.012). After treatment, patients who present improvement in erectile function showed lower post-GHn (0.07 [0.03-0.12] ng/ml vs 1.32 [0.09-3.60] ng/ml, p = 0.048) and post-IGF-1 index (1.03 ± 0.38 vs 1.66 ± 0.95, p = 0.049). The multivariate analysis indicated post-GHn was still associated with the improvement of erectile function after correction of other covariates (OR: 0.059, 95% CI: 0.003-1.043, p = 0.053).ConclusionsExcessive GH is related to ED in male patients with acromegaly. GH normalization after treatment is beneficial for short-term erectile function recovery.

Objective: The aim of this study was to evaluate thyroid functions in Cushing’s syndrome (CS), the dynamic changes of thyroid hormones and antithyroid antibodies in Cushing’s disease (CD) pre- and postoperatively. Design and methods: This is a retrospective study enrolling 118 patients with CS (102 CD, 10 adrenal CS and 6 ectopic adrenocorticotropic syndrome (EAS)). Thyroid functions (thyroid-stimulation hormone (TSH), T3, free T3 (FT3), T4 and free T4 (FT4)) were measured in all CS at the time of diagnosis and in all CD 3 mon ths after transsphenoidal pituitary tumor resection. Postoperative hormone monitoring within 3 months was conducted in 9 CD patients completing remission. Twenty-eight remitted CD patients experienced hormone and antithyroid antibody evaluation preoperatively and on the 3rd, 6th and 12th month after surgery. Results: TSH, T3 and FT3 were below the reference range in 31%, 69% and 44% of the 118 CS patients. Remitted CD patients (81/102) had significantly higher TSH (P = 0.000), T3 (P = 0.000) and FT3 (P = 0.000) than those in the non-remission group (21/102). After remission of CD, TSH, T3 and FT3 showed a significant increase, with a few cases above the reference range. By 12 months, most CD patients’ thyroid fu nctions returned to normal. Thyroid hormones (including TSH, T3 and FT3) were negatively associated with serum cortisol levels both before and after surgery. No signific ant changes of antithyroid autoantibodies were observed. Conclusions: TSH, T3 and FT3 are suppressed in endogenous hypercortisolemia. After remission of CD, TSH, T3 and FT3 increased significantly, even a bove the reference range, but returned to normal 1 year after surgery in most cases. Anti thyroid antibodies did not change significantly after remission of CD.

Abstract Background As the major storage protein in rice seeds, glutelins are synthesized at the endoplasmic reticulum (ER) as proglutelins and transported to protein storage vacuoles (PSVs) called PBIIs (Protein body IIs), where they are cleaved into mature forms by the vacuolar processing enzymes. However, the molecular mechanisms underlying glutelin trafficking are largely unknown. Results In this study, we report a rice mutant, named glutelin precursor accumulation6 (gpa6), which abnormally accumulates massive proglutelins. Cytological analyses revealed that in gpa6 endosperm cells, proglutelins were mis-sorted, leading to the presence of dense vesicles (DVs) and the formation paramural bodies (PMBs) at the apoplast, consequently, smaller PBII were observed. Mutated gene in gpa6 was found to encode a Na+/H+ antiporter, OsNHX5. OsNHX5 is expressed in all tissues analyzed, and its expression level is much higher than its closest paralog OsNHX6. The OsNHX5 protein colocalizes to the Golgi, the trans-Golgi network (TGN) and the pre-vacuolar compartment (PVC) in tobacco leaf epidermal cells. In vivo pH measurements indicated that the lumens of Golgi, TGN and PVC became more acidic in gpa6. Conclusions Our results demonstrated an important role of OsNHX5 in regulating endomembrane luminal pH, which is essential for seed storage protein trafficking in rice.

Abstract One significant challenge for electronic devices is that the energy storage devices are unable to provide sufficient energy for continuous and long-time operation, leading to frequent recharging or inconvenient battery replacement. To satisfy the needs of next-generation electronic devices for sustainable working, conspicuous progress has been achieved regarding the development for nanogenerator-based self-charging energy storage devices. Herein, the development of the self-charging energy storage devices is summarized. Focus will be on preparation of nanomaterials for Li-ion batteries and supercapacitors, structural design of the nanogenerator-based self-charging energy storage devices, performance testing, and potential applications. Moreover, the challenges and perspectives regarding self-charging energy storage devices are also discussed.

Distributed denial of service (DDoS) attack is an attempt to make an online service unavailable by overwhelming it with traffic from multiple sources. Therefore, it is necessary to propose an effective method to detect DDoS attack from massive data traffics. However, the existing schemes have some limitations, including that supervised learning methods, need large numbers of labeled data and unsupervised learning algorithms have relatively low detection rate and high false positive rate. In order to tackle these issues, this paper presents a semi-supervised weighted k-means detection method. Specifically, we firstly present a Hadoop-based hybrid feature selection algorithm to find the most effective feature sets and propose an improved density-based initial cluster centers selection algorithm to solve the problem of outliers and local optimal. Then, we provide the Semi-supervised K-means algorithm using hybrid feature selection (SKM-HFS) to detect attacks. Finally, we exploit DARPA DDoS dataset, CAIDA “DDoS attack 2007” dataset, CICIDS “DDoS attack 2017” dataset and real-world dataset to carry out the verification experiment. The experiment results have demonstrated that the proposed method outperforms the benchmark in the respect of detection performance and technique for order preference by similarity to an ideal solution (TOPSIS) evaluation factor.

Perovskite quantum dots (PQDs), as the promising materials for the blue light-emitting diodes (LEDs), own huge advantages as ultra-high color purity, flexibility and whole-spectrum tunability. Through dimensional and compositional engineering, PQD-LEDs have shown superiority in deep-blue light emission. However, compared with the fast development of red and green PeLEDs, the electroluminescent performance of PQD-LEDs has faced more obstacles. In this review, we aim to explore and state the uniqueness and the possible solutions for the bottleneck problems of the PQD-LEDs.

PurposeTo investigate the different clinical characteristics of silent corticotroph adenomas (SCAs) with positive and negative adrenocorticotropic hormone (ACTH) immunostaining, and to explore the value of pituitary-restricted transcription factor (Tpit) immunostaining for diagnosing SCAs.MethodsThe clinical materials of patients with SCAs who had a typical pathological feature with positive Tpit immunostaining and positive/negative ACTH immunostaining, and without clinical features and biochemical evidence for Cushing’s Syndrome in our center from April 2018 to March 2019 were analyzed retrospectively. The differences in clinical characteristics and surgical results between ACTH-positive and -negative SCAs were explored.ResultsA total of one hundred and five patients (94.3% female) with SCAs were included. There were 66 SCAs with ACTH-negative (66/105, 62.9%), and 39 SCAs with ACTH-positive (39/105, 37.1%). Cases with ACTH-negative SCAs were more likely to have lower ACTH levels (27.5 ± 24.0 vs. 54.4 ± 58.6, P = 0.011), more multiple microcysts (81.8% vs. 61.5%, P = 0.022) and lower levels of Ki-67 expression (low expression rate 90.9% vs. 74.4%, P = 0.023). No statistical significant differences were observed between patients with ACTH-positive and -negative SCAs regarding gender (97.0% vs. 89.7%, P = 0.192), age (50.3 ± 10.3 vs. 49.0 ± 11.2, P = 0.543), surgical history (16.7% vs. 23.1%, P = 0.419), suprasellar extension (66.7% vs. 74.4%, P = 0.408), sphenoid sinus extension (51.5% vs. 56.4%, P = 0.627), cavernous sinus invasion (75.8% vs. 66.7%, P = 0.314), large cyst on Magnetic Resonance Imaging (MRI) (47.0% vs. 61.5%, P = 0.149), or gross total resection rate (42.4% vs. 51.3%, P = 0.379).ConclusionsACTH-negative SCAs were observed to be more clinically silent and more likely to demonstrate multiple microcysts on MRI. The prevalence of SCAs, especially ACTH-negative SCAs, proved to be substantially underestimated and thus they should be given enough attention in consideration of the high aggressiveness of this subtype of refractory pituitary adenoma (PA).

We report a low-voltage-operated organic field-effect transistor that uses a hybrid gate insulator that has a high dielectric constant k . The gate insulator consists of a high- k polymer cyanoetylated pullulan (CEP) that can be efficiently cross-linked by glycidoxypropyltrimethoxysilane (GOPTMS) at low temperature (∼110 °C). The very low curing temperature is below the glass transition temperature T _g of conventional plastic substrates for plastic electronics, and is therefore compatible with many plastic substrates for plastic electronics. The cross-linking is very efficient in that only 1/10 (w:w) GOPTMS: CEP produced densely cross-linked thin films with a smooth surface, good insulating property, high capacitance density and high k . The devices functioned at low voltage, and exhibited charge carrier mobility ∼1.83 cm ^2 V ^−1 s ^−1 , and steep substheshold swing ∼88 mV dec ^−1 . These results imply that high quality polymer gate insulators are achievable at low temperature with a very small fraction of blended crosslinking agents; this characteristic offers a method to achieve portable all-plastic flexible electronics that function at low voltage.

To understand the anisotropy dependence of the damage evolution and material removal during the machining process of MgF _2 single crystals, nanoscratch tests of MgF _2 single crystals with different crystal planes and directions were systematically performed, and surface morphologies of the scratched grooves under different conditions were analyzed. The experimental results indicated that anisotropy considerably affected the damage evolution in the machining process of MgF _2 single crystals. A stress field model induced by the scratch was developed by considering the anisotropy, which indicated that during the loading process, median cracks induced by the tensile stress initiated and propagated at the front of the indenter. Lateral cracks induced by tensile stress initiated and propagated on the subsurface during the unloading process. In addition, surface radial cracks induced by the tensile stress were easily generated during the unloading process. The stress change led to the deflection of the propagation direction of lateral cracks. Therefore, the lateral cracks propagated to the workpiece surface, resulting in brittle removal in the form of chunk chips. The plastic deformation parameter indicated that the more the slip systems were activated, the more easily the plastic deformation occurred. The cleavage fracture parameter indicated that the cracks propagated along the activated cleavage planes, and the brittle chunk removal was owing to the subsurface cleavage cracks propagating to the crystal surface. Under the same processing parameters, the scratch of the (001) crystal plane along the [100] crystal-orientation was found to be the most conducive to achieving plastic machining of MgF _2 single crystals. The theoretical results agreed well with the experimental results, which will not only enhance the understanding of the anisotropy dependence of the damage evolution and removal process during the machining of MgF _2 crystals, but also provide a theoretical foundation for achieving the high-efficiency and low-damage processing of anisotropic single crystals.

Introduction: This study aims to develop a machine learning-based model integrating clinical and ophthalmic features to predict visual outcomes after transsphenoidal resection of sellar region tumors. Methods: Adult patients with optic chiasm compression by a sellar region tumor were examined to develop a model, and an independent retrospective cohort and a prospective cohort were used to validate our model. Predictors included demographic information, and ophthalmic and laboratory test results. We defined “recovery” as more than 5% for a p-value in mean deviation compared with the general population in the follow-up. Seven machine learning classifiers were employed, and the best-performing algorithm was selected. A decision curve analysis was used to assess the clinical usefulness of our model by estimating net benefit. We developed a nomogram based on essential features ranked by the SHAP score. Results: We included 159 patients (57.2% male), and the mean age was 42.3 years old. Among them, 96 patients were craniopharyngiomas and 63 patients were pituitary adenomas. Larger tumors (3.3 cm vs. 2.8 cm in tumor height) and craniopharyngiomas (73.6%) were associated with a worse prognosis (p < 0.001). Eyes with better outcomes were those with better visual field and thicker ganglion cell layer before operation. The ensemble model yielded the highest AUC of 0.911 [95% CI, 0.885–0.938], and the corresponding accuracy was 84.3%, with 0.863 in sensitivity and 0.820 in specificity. The model yielded AUCs of 0.861 and 0.843 in the two validation cohorts. Our model provided greater net benefit than the competing extremes of intervening in all or no patients in the decision curve analysis. A model explanation using SHAP score demonstrated that visual field, ganglion cell layer, tumor height, total thyroxine, and diagnosis were the most important features in predicting visual outcome. Conclusion: SHAP score can be a valuable resource for healthcare professionals in identifying patients with a higher risk of persistent visual deficit. The large-scale and prospective application of the proposed model would strengthen its clinical utility and universal applicability in practice.

Background Outcomes data in patients with cardiac amyloidosis after implantable cardioverter‐defibrillator (ICD) implantation are limited. We compared outcomes of patients with ICDs implanted for cardiac amyloidosis versus nonischemic cardiomyopathies (NICMs) and evaluated factors associated with mortality among patients with cardiac amyloidosis. Methods and Results Using National Cardiovascular Data Registry’s ICD Registry data between April 1, 2010 and December 31, 2015, we created a 1:5 propensity‐matched cohort of patients implanted with ICDs with cardiac amyloidosis and NICM. We compared mortality between those with cardiac amyloidosis and matched patients with NICM using Kaplan‐Meier survival curves and Cox proportional hazards models. We also evaluated risk factors associated with 1‐year mortality in patients with cardiac amyloidosis using multivariable Cox proportional hazards regression models. Among 472 patients with cardiac amyloidosis and 2360 patients with propensity‐matched NICMs, 1‐year mortality was significantly higher in patients with cardiac amyloidosis compared with patients with NICMs (26.9% versus 11.3%, P2.5 (HR, 4.34; 95% CI, 2.72–6.93). Conclusions Mortality after ICD implantation is significantly higher in patients with cardiac amyloidosis than in patients with propensity‐matched NICMs. Factors associated with death among patients with cardiac amyloidosis include prior syncope, ventricular tachycardia, cerebrovascular disease, diabetes mellitus, and impaired renal function.

Background: Although increased age is associated with higher systolic blood pressure (SBP) in general, there may be variation across individuals in how SBP changes over time. The goal of this paper is to identify heterogeneity in SBP trajectories among young adults with similar initial values and identify personal characteristics associated with different trajectory patterns. This may have important implications for prevention and prognosis. Methods: A cohort of 12,468 individuals aged 18–35 years in the Qingdao Port Cardiovascular Health Study in China was followed yearly during 2000–2011. Individuals were categorized into three strata according to their baseline SBP: ≤110 mmHg, 111–130 mmHg, and >130 mmHg. Within each stratum, group-based trajectory analyses were conducted to identify distinct SBP trajectory patterns, and their association with sociodemographic and baseline health characteristics was assessed by ordinal logistic regression. Results: Five distinct groups of individuals exhibiting divergent patterns of increasing, stable or decreasing SBP trends were identified within each stratum. This is a first report to identify a subgroup with decreasing trend in SBP. Individuals with more advanced age, having less than high school education, family history of cardiovascular diseases, greater body mass index, greater waist circumference, and hyperlipidemia at baseline were more likely to experience trajectories of higher SBP within each stratum. Conclusions: The diverging trajectories among young adults with similar initial SBP highlight the need for prevention and feasibility of effective blood pressure control, while the identified risk factors may inform targeted interventions.

Deformation monitoring is one of the most important means of providing feedback to ensure the safety of projects. Problems plague the existing automatic monitoring system, such as the small monitoring range of monitoring devices, the inadequate field safety protection, and the low accuracy under extreme weather conditions. These problems greatly reduce the real time and reliability of deformation monitoring data and restrict the real-time intelligent control of engineering safety risk. In this paper, a multitype instrument-integrated monitoring system based mainly on the total positioning station (TPS) and supplemented by the Global Navigation Satellite System (GNSS) was promoted with the methods of large field angle, data complementation, environmental perception and judgment, automatic status control, and baseline calibration-meteorological fusion correction. The application results of Pubugou Station show that the averages of mean square error of points (APMSE) for the dam are 0.41∼1.65 mm and the averages of mean square error of height (AHMSE) are 0.42∼0.89 mm. Moreover, the APMSE and AHMSE for the slope are less than 3 mm. The maximum relative error of the TPS and GNSS data compared with the artificial monitoring data is less than 10%. Besides, the system has good overall performance and is of significant comprehensive benefits. The proposed system realizes the all-weather real-time monitoring of deformation and enhances the emergency response capability of special conditions in dams during the operation period.

A high cost-performance carbon dioxide sorbent based on hierarchical porous carbons (HPCs) was easily prepared by carbonization of raw sugar using commercially available nano-CaCO3 as a double-acting template. The effects of the initial composition and carbonization temperature on the micro-mesoporous structure and adsorption performance were examined. Also, the importance of post-activation behavior in the development of micropores and synthesis route for the formation of the interconnected micro-mesoporous structure were investigated. The results revealed excellent carbon dioxide uptake reaching up 2.84 mmol/g (25oC, 1 bar), with micropore surface area of 786 m2/g, micropore volume of 0.320 cm3/g and mesopore volume of 0.233 cm3/g. We found that high carbon dioxide uptake was ascribed to the developed micropores and interconnected micro-mesoporous structure. As an expectation, the optimized HPCs offers a promising new support for the high selective capture of carbon dioxide in the future.

Abstract Cushing’s disease results from corticotroph adenomas of the pituitary that hypersecrete adrenocorticotropin (ACTH), leading to excess glucocorticoid and hypercortisolism. Mutations of the deubiquitinase gene USP8 occur in 35–62% of corticotroph adenomas. However, the major driver mutations in USP8 wild-type tumors remain elusive. Here, we report recurrent mutations in the deubiquitinase gene USP48 (predominantly encoding p.M415I or p.M415V; 21/91 subjects) and BRAF (encoding p.V600E; 15/91 subjects) in corticotroph adenomas with wild-type USP8. Similar to USP8 mutants, both USP48 and BRAF mutants enhance the promoter activity and transcription of the gene encoding proopiomelanocortin (POMC), which is the precursor of ACTH, providing a potential mechanism for ACTH overproduction in corticotroph adenomas. Moreover, primary corticotroph tumor cells harboring BRAF V600E are sensitive to the BRAF inhibitor vemurafenib. Our study thus contributes to the understanding of the molecular mechanism of the pathogenesis of corticotroph adenoma and informs therapeutic targets for this disease.

Introduction: The purpose of the study was to describe lipid profile and explore pathogenetic role of LDL-c on hypertension in patients with Cushing’s disease (CD). Hypertension is a common feature in patients with CD. Previous study found low-density lipoprotein cholesterol (LDL-c) uptake in vascular cells might be involved in vascular remodeling in patients with CD. Therefore, we evaluated the relationship between lipid profile and the blood pressure in patients with CD. Methods: This retrospective study included 84 patients referred to Huashan Hospital for the evaluation and diagnosis of CD from January 2012 to December 2013. All subjects had detailed clinical evaluation by the same group of endocrinology specialists to avoid subjective influences. Results: We found that high LDL-c patients had significant higher body mass index (BMI), systolic blood pressure (SBP), cholesterol (CHO), triglyceride (TG), and apolipoproteinB (apoB) (P < 0.05). An association was detected between SBP values and lipids profile including CHO, TG, LDL-c, apolipoproteinA (apoA), apoB and lipoprotein(a) (LP(a)). After adjustment for all covariates, the LDL-c remained positively associated with SBP. In patients with or without taking statins, patients with LDL-c ≥3.37 mmol/L had higher SBP than patients with LDL-c