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Abstract Objective Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetes mellitus (DM). The goal of early detection has not yet achieved due to a lack of fast and convenient methods. Therefore, we aim to develop and validate a prediction model to identify DME in patients with type 2 diabetes mellitus (T2DM) using easily accessible systemic variables, which can be applied to an ophthalmologist-independent scenario. Methods In this four-center, observational study, a total of 1994 T2DM patients who underwent routine diabetic retinopathy screening were enrolled, and their information on ophthalmic and systemic conditions was collected. Forward stepwise multivariable logistic regression was performed to identify risk factors of DME. Machine learning and MLR (multivariable logistic regression) were both used to establish prediction models. The prediction models were trained with 1300 patients and prospectively validated with 104 patients from Guangdong Provincial People’s Hospital (GDPH). A total of 175 patients from Zhujiang Hospital (ZJH), 115 patients from the First Affiliated Hospital of Kunming Medical University (FAHKMU), and 100 patients from People’s Hospital of JiangMen (PHJM) were used as external validation sets. Area under the receiver operating characteristic curve (AUC), accuracy (ACC), sensitivity, and specificity were used to evaluate the performance in DME prediction. Results The risk of DME was significantly associated with duration of DM, diastolic blood pressure, hematocrit, glycosylated hemoglobin, and urine albumin-to-creatinine ratio stage. The MLR model using these five risk factors was selected as the final prediction model due to its better performance than the machine learning models using all variables. The AUC, ACC, sensitivity, and specificity were 0.80, 0.69, 0.80, and 0.67 in the internal validation, and 0.82, 0.54, 1.00, and 0.48 in prospective validation, respectively. In external validation, the AUC, ACC, sensitivity and specificity were 0.84, 0.68, 0.90 and 0.60 in ZJH, 0.89, 0.77, 1.00 and 0.72 in FAHKMU, and 0.80, 0.67, 0.75, and 0.65 in PHJM, respectively. Conclusion The MLR model is a simple, rapid, and reliable tool for early detection of DME in individuals with T2DM without the needs of specialized ophthalmologic examinations.

Background Perioperative neurocognitive disorders (PND) refer to neurocognitive abnormalities during perioperative period, which are a great challenge for elderly patients and associated with increased morbidity and mortality. Our studies showed that long non-coding RNAs (lncRNAs) regulate mitochondrial function and aging-related pathologies in the aged hippocampus after anesthesia, and lncRNAs are associated with multiple neurodegenerations. However, the regulatory role of lncRNAs in PND-related pathological processes remains unclear. Methods A total of 18-month mice were assigned to control and surgery (PND) groups, mice in PND group received sevoflurane anesthesia and laparotomy. Cognitive function was assessed with fear conditioning test. Hippocampal RNAs were isolated for sequencing, lncRNA and microRNA libraries were constructed, mRNAs were identified, Gene Ontology (GO) analysis were performed, and lncRNA-microRNA-mRNA networks were established. qPCR was performed for gene expression verification. Results A total of 312 differentially expressed (DE) lncRNAs, 340 DE-Transcripts of Uncertain Coding Potential (TUCPs), and 2,003 DEmRNAs were identified in the hippocampus between groups. The lncRNA-microRNA-mRNA competing endogenous RNA (ceRNA) network was constructed with 29 DElncRNAs, 90 microRNAs, 493 DEmRNAs, 148 lncRNA-microRNA interaction pairs, 794 microRNA-mRNA interaction pairs, and 110 lncRNA-mRNA co-expression pairs. 795 GO terms were obtained. Based on the frequencies of involved pathological processes, BP terms were divided into eight categories: neurological system alternation, neuronal development, metabolism alternation, immunity and neuroinflammation, apoptosis and autophagy, cellular communication, molecular modification, and behavior changes. LncRNA-microRNA-mRNA ceRNA networks in these pathological categories were constructed, and involved pathways and targeted genes were revealed. The top relevant lncRNAs in these ceRNA networks included RP23-65G6.4, RP24-396L14.1, RP23-251I16.2, XLOC_113622, RP24-496E14.1, etc., and the top relevant mRNAs in these ceRNA networks included Dlg4 (synaptic function), Avp (lipophagy), Islr2 (synaptic function), Hcrt (regulation of awake behavior), Tnc (neurotransmitter uptake). Conclusion In summary, we have constructed the lncRNA-associated ceRNA network during PND development in mice, explored the role of lncRNAs in multiple pathological processes in the mouse hippocampus, and provided insights into the potential mechanisms and therapeutic gene targets for PND.

Background: Surgical pain affects postoperative sleep quality, and they jointly form a vicious cycle of mutual influence. The cycle of postoperative pain and sleep disorders could lead to delirium, cardiovascular disease, and hyperalgesia, which significantly affect patients' postoperative recovery. Thus, exploring this phenomenon is of great importance for surgical patients, and warrants further investigation. Objective: By employing bibliometric methods, this study systematically analyzes the publications on postoperative pain-sleep disorders, identifies research trends and field dynamics, and ultimately provides insights for further progress in this research area. Methods: In this study, we searched the Web of Science database for studies on postoperative pain and sleep disorders from 2013 to 2023, and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by utilizing CiteSpace, VOSviewer, and Bibliometrix. Results: The 1894 retrieved publications showed a trend of increasing number of publications and correlations between postoperative pain and sleep disorders from 2013 to 2023. The top countries for publications included the USA, China, etc., establishing a global collaborative network centered around the USA, China, and Europe. The top institutions for publications included University of California System, Harvard University, etc. The top authors include Christine Miaskowski, Steven M. Paul, Qiuling Shi, etc. These publications involved multiple disciplines including surgery, neurology, and anesthesiology, and various research funds including NIH, HHS, NSFC, etc. The top journals for publications included the European Archives of Oto-Rhino-Laryngology, etc. Keywords that appear most frequently in this field include ''pain'', ''surgery'', ''quality of life'', ''sleep'', ''depression'', and ''outcomes''. The thematic map indicated that the hot topics in this area include obstructive sleep apnea, tonsillectomy, children, pain, quality of life, and sleep. The undeveloped topics with research potential included postoperative pain, analgesia and dexmedetomidine, breast cancer, fatigue, and lung cancer. Conclusion: The increased number of publications and correlations between postoperative pain and sleep disorders, and the collaborative network across the USA, China, and Europe indicate a growing global interest in this area. This study also provides valuable insights into the trend of hot topics and frontiers and shows that this is an evolving and dynamic research area.

The electron-phonon (el-ph) and phonon-phonon interactions play a key role in determining electronic and thermal transport properties, respectively, in promising two-dimensional (2D) semiconductor devices. In this study, we investigated el-ph interactions using Wannier-Fourier interpolation method and renormalized phonon scattering considering finite-temperature effects in Bi2TeSe2 monolayer. The results show that the optical phonon modes dominate the carrier scattering, where level repulsion induced by crystal field splitting and spin-orbit coupling (SOC) effect effectively suppresses intervalley scattering, leading to high hole mobility. Moreover, the strong anharmonicity in Bi2TeSe2 monolayer results in the temperature-dependent softening of its optical phonons, along with a corresponding variation in interatomic force constants (IFCs). As a result, the lattice thermal conductivity is remarkably low and exhibits weak temperature dependence. Finally, the predicted dimensionless thermoelectric figure of merit exceeds unity in the range of 200–800 K, indicating the potential of Bi2TeSe2 monolayer for thermoelectric applications. This work provides new insights into the elimination of intervalley scattering by crystal field splitting and SOC effects, and paves the way for the evaluation of thermoelectric properties of materials with complex scattering mechanisms and strong anharmonicity.

PurposeThis study aimed to assess the effectiveness and safety of intravitreal injection of conbercept (IVC) in treating moderate to severe nonproliferative diabetic retinopathy (NPDR), with or without accompanying diabetic macular edema.MethodsIn this longitudinal retrospective study, 35 patients (50 eyes) with moderate to severe NPDR and Diabetic Retinopathy Severity Scale (DRSS) scores between 43 and 53 were treated at the Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, from October 2018 to January 2023. Treatment protocol included three monthly IVC injections followed by a pro re nata (PRN) regimen over a two-year follow-up period. Outcome measures were best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), extent of hard exudate (HE), and changes in DRSS scores. DRSS scores before and after treatment were analyzed using the Wilcoxon rank-sum test. Both systemic and ocular adverse events were meticulously documented to ascertain safety.ResultsFrom baseline to the final follow-up, the mean BCVA improved from 0.41 ± 0.39 to 0.23 ± 0.20 logMAR (p

Background: The reciprocal nexus between sleep and pain is well-documented, with the deleterious impact of operative trauma potentially playing a pivotal role in the dysregulation of this interplay, which could significantly contribute to the manifestation of postoperative delirium (POD). Studies have investigated the effect of adding dexmedetomidine (DEX) to patient-controlled intravenous analgesia (PCIA) pumps on postoperative pain-sleep interaction cycle and POD, but conclusions remained uncertain. The objective of this investigation is to perform a meta-analysis that thoroughly assesses the impact of integrating DEX into PCIA, focusing on analgesic effectiveness, sleep quality, and the incidence of delirium in postoperative patients. Methods: PubMed, Embase, Cochrane Library, SinoMed, and Wanfang Data Knowledge Service Platform were searched, for publications in any language, from database inception to September 2023. Our analysis encompassed randomized controlled trials (RCTs) that examine the therapeutic efficacy and risk profile of adding DEX to the PCIA on the postoperative pain-sleep interaction cycle, by focusing on changes in postoperative analgesia (Visual analog scale (VAS) score), sleep efficiency, sleep structure, subjective sleep score (Assen insomnia scale and numerical rating scale) and adverse event rate. Results: 34 RCTs (4324 patients) were analyzed. This study shows DEX improved analgesia and reduced VAS scores at 6, 12, and 24 h after surgery. Sleep efficiency was enhanced on the 1st and 2nd postoperative night. DEX improved sleep structure at the 1st postoperative night by reducing non-rapid eye movement stage 1 (N1) sleep and increasing non-rapid eye movement stage 2 (N2) and non-rapid eye movement stage 3 (N3) sleep. At the 2nd night, DEX reduced N1 sleep and increased N2 sleep, but not N3 sleep. Data from AIS and NRS showed improvement in subjective sleep scores on the 1st postoperative night and 2nd night. Additionally, DEX decreased the occurrence of POD on the 24 h and first-three days. Conclusion: This study shows that the typical DEX doses added to PCIA with sufentanil were 2–5 μg/kg or approximately 200–250 μg, and the addition of DEX to PCIA can improve pain-sleep interaction cycle from multiple perspectives, and further decrease the occurrence of POD.

Peri-implant disease (PID) is a general term for inflammatory diseases of soft and hard tissues that occur around implants, including peri-implant mucositis and peri-implantitis. Cytokines are a class of small molecule proteins, which have various functions such as regulating innate immunity, adaptive immunity, and repairing damaged tissues. In order to explore the characteristics and clinical significance of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and tumor growth factor (TGF)-β1 expression levels in serum of patients with peri-implant disease, 31 patients with PID and 31 patients without PID were enrolled. The modified plaque index (mPLI), modified sulcus bleeding index (mSBI), and peri-implant probing depth (PD) were recorded. The levels of serum TNF-α, IL-6, IL-10, and TGF-β1 were detected by ELISA. TNF-α, mPLI, mSBI, and PD levels were significantly higher in the PID group. TGF-β1 levels were significantly higher in the control group. There was a significant positive correlation between TNF-α and mPLI, mSBI, and PD. TGF-β1 was negatively associated with TNF-α, mPLI, mSBI, and PD. Multiple logistic regression analysis showed that TNF-α and PD were risk factors for the severity of PID. The receiver operating curve analysis showed that high TNF-α levels (cut-off value of 140 pg/mL) and greater PD values (cut-off value of 4 mm) were good predictors of PID severity with an area under the curve of 0.922. These results indicated that TNF-α and PD can be used as a biological indicator for diagnosing the occurrence and progression of PID.

BackgroundDexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions.MethodsPatients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of “loss of consciousness”, and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed.ResultsThrough the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of “loss of consciousness” were 2.899 (95% CI: 2.703–3.115) and 5.001 (95% CI: 4.544–5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain.ConclusionThis study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.

Circular RNAs are highly stable single-stranded circular RNAs and enriched in the brain. Previous studies showed that circRNAs, as part of competing endogenous RNAs (ceRNAs) network, play an important role in neurodegenerative and psychiatric diseases. However, the mechanism of circRNA-related ceRNA networks in postoperative cognitive dysfunction (POCD) has not been elucidated yet. POCD usually occurs in elderly patients and is characterized by hippocampal dysfunction. Here, aged C57BL/6 mice were subjected to exploratory laparotomy under sevoflurane anesthesia, and this POCD model was verified by Morris water maze test. Whole-transcriptome sequencing was performed on the hippocampus of control group (Con) and surgery group. One hundred and seventy-seven DEcircRNAs, 221 DEmiRNAs and 2,052 DEmRNAs were identified between two groups. A ceRNA network was established with 92 DEcircRNAs having binding sites with 76 DEmiRNAs and 549 target DEmRNAs. In functional enrichment analysis, a pathological pattern of POCD was highlighted in the ceRNA network: Abnormal metabolic process in neural cells, including oxygen metabolism, could promote apoptosis and then affect the synaptic function, which may undermine the neural plasticity and eventually lead to changes in cognitive function and other behavioral patterns. In conclusion, this specific ceRNA network of circRNAs–miRNAs–mRNAs has provided novel insights into the regulatory mechanisms of POCD and revealed potential therapeutic gene targets.

Tourism industry is the first of the five happiness industries, playing a crucial role in enhancing people's well-being and happiness. Its high-quality development cannot be achieved without the use of emerging technologies, and today people have greatly improved the quality and happiness of tourism through smartphones, artificial intelligence, virtual reality and other technologies. Building smart marine tourism also requires widespread use of smart tourism technology. The study aims to examine the implications of perceived smart tourism technologies for tourist well-being in marine tourism, as well as the mediating role memorable tourism experiences play. We collected 445 valid questionnaires through a combination of offline and online methods and developed a theoretical model based on the results. The SPSS 26 statistical software package and Amos were applied in data analysis. There is a significant positive impact of perceived smart tourism technology on both hedonic and eudaimonic well-being of tourists in marine tourism, which is partially mediated by memorable tourism experiences. This paper provides certain suggestions and insights into the construction of smart marine tourism, so that managers can pay more attention to the experience and well-being of tourists and build a humanized, diversified, intelligent and innovative marine tourism. For smart tourism technology suppliers, it can provide them with new ideas for technological improvement, so that they can provide better services and attract more tourists in a market-oriented environment.

BackgroundThe cardiovascular protection effect of metformin on patients with type 2 diabetes mellitus (T2DM) remains inconclusive. This systemic review and meta-analysis were to estimate the effect of metformin on mortality and cardiovascular events among patients with T2DM.MethodsA search of the Pubmed and EMBASE databases up to December 2021 was performed. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled by a random-effects model with an inverse variance method.ResultsA total of 39 studies involving 2473009 T2DM patients were adopted. Compared to non-metformin therapy, the use of metformin was not significantly associated with a reduced risk of major adverse cardiovascular event (MACE) (HR = 1.06, 95%CI 0.91–1.22; I2 = 82%), hospitalization (HR = 0.85, 95%CI 0.64–1.13; I2 = 98%), heart failure (HR = 0.86, 95%CI 0.60–1.25; I2 = 99%), stroke (HR = 1.16, 95%CI 0.88–1.53; I2 = 84%), and risk of AMI (HR = 0.88, 95%CI 0.69–1.14; I2 = 88%) in T2DM patients. Metformin was also not associated with significantly lowered risk of MACE compared to dipeptidyl peptidase-4 inhibitor (DPP-4i) in T2DM patients (HR = 0.95, 95%CI 0.73–1.23; I2 = 84%).ConclusionsThe effect of metformin on some cardiovascular outcomes was not significantly better than the non-metformin therapy or DPP-4i in T2DM patients based on observational studies.

Perioperative immune function, postoperative cognitive function and prognosis are momentous issues for patients undergoing digestive tract cancer surgery. Studies have investigated the efficacy of dexmedetomidine (DEX) administration on these issues, but the results are inconsistent. Therefore, this meta-analysis aimed to summarize all the existing evidence and draw a conclusion more accurately on these associations. Trials were located through electronic searches of the PubMed, Embase, the Cochrane Library and Web of Science databases sources (from the establishment date of databases to April 2022). Bibliographies of the retrieved articles were checked. A total of 17 RCTs involving 1619 patients were included. The results showed that DEX decreased the level of C-reactive protein (SMD = -4.26, 95%CI: -6.16, -2.36), TNF-α (SMD = -4.22, 95%CI: -5.91, -2.54) and IL-6 (SMD = -2.71, 95%CI: -4.46, -0.97), and increased the level of IL-10 (SMD = 1.74, 95%CI: 0.25, 3.24). DEX also increased CD4+ T cells (SMD = 0.55, 95%CI: 0.29, 0.82) and CD4+/CD8+ ratio (SMD = 0.62, 95%CI: 0.24, 1.01). Thus, DEX was associated with alleviation of postoperative systemic inflammatory response and immune dysfunction. Furthermore, DEX increased mini-mental state examination scores at 12h (SMD = 1.10, 95%CI: 0.74,1.45), 24h (SMD = 0.85, 95%CI: 0.59, 1.11), 48h (SMD = 0.89, 95%CI: 0.50, 1.28) and 72h (SMD = 0.75, 95%CI: 0.38, 1.11) after surgery. DEX decreased the occurrence of postoperative cognitive dysfunction (POCD) at 24h (OR = 0.22, 95%CI: 0.11, 0.46) and 72h (OR = 0.39, 95%CI: 0.22, 0.68) after surgery. DEX decreased first flatus time (SMD = -1.55, 95%CI: -2.82, -0.27) and hospital stay (SMD = -1.23, 95%CI: -1.88, -0.59). Therefore, based on perioperative immune dysfunction alleviation, DEX attenuated POCD and potential neuroinflammation, improved postoperative recovery and clinical prognosis of patients undergoing digest tract cancer surgery. Further studies are necessary to elucidate the clinical application of DEX from an immunological perspective.

BackgroundObesity could paradoxically improve prognosis in patients with heart failure (HF), termed the “obesity paradox.” Whether HF etiology could modify the “obesity paradox” is still controversial. In the present study, we aimed to assess the relationship between obesity and death in patients with heart failure with preserved ejection fraction (HFpEF) with non-ischemic versus ischemic etiologies.MethodsWe analyzed 3,360 HFpEF patients from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Cox regression models were used to assess the association of obesity assessed by body mass index (BMI) with short-term and long-term death risk.ResultsOverweight and obesity were associated with a lower risk of long-term all-cause death in patients with non-ischemic HFpEF, even in those with class III obesity (adjusted HR: 0.61, 95% CI 0.38–0.97). However, in the ischemic subgroup, as obesity advanced, this paradoxical relationship was gradually attenuated and disappeared in class III obesity (adjusted HR: 0.93, 95% CI 0.56–1.57). Restricted cubic spline analyses confirmed the differential relationship of baseline BMI with risk of long-term death with a BMI higher than 30 kg/m2 in non-ischemic versus ischemic HFpEF. In the short-term follow-up, the beneficial effects of overweight and obesity on survival were consistently observed in all the BMI categories, with the nadirs of all-cause death risk at class III obesity category both in non-ischemic and ischemic subgroups.Conclusion“Obesity paradox” was evident both in non-ischemic and ischemic HFpEF during short-term follow-up, even in those with class III obesity. However, the beneficial effect of class III obesity disappeared during long-term follow-up in ischemic HFpEF.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT00094302].

As excellent tools for aiding communication, an intelligent reflecting surface (IRS) and an unmanned aerial vehicle (UAV) can extend the coverage area, remove the blind area, and achieve a dramatic rate improvement. In this paper, we improve the secrecy rate (SR) performance of directional modulation (DM) networks using an IRS and UAV in combination. To fully explore the benefits of the IRS and UAV, two efficient methods are proposed to enhance the SR performance. The first approach computes the confidential message (CM) beamforming vector by maximizing the SR, and the signal-to-leakage-noise ratio (SLNR) method is used to optimize the IRS phase shift matrix (PSM), which is called Max-SR-SLNR. To reduce the computational complexity, the CM, artificial noise (AN) beamforming, and IRS phase shift design are independently designed in the following method. The CM beamforming vector is constructed based on the maximum ratio transmission (MRT) criteria along the channel from Alice-to-IRS, the AN beamforming vector is designed by null-space projection (NSP) on the remaining two channels, and the PSM of the IRS is directly given by the phase alignment (PA) method. This method is called the MRT-NSP-PA. The simulation results show that the SR performance of the Max-SR-SLNR method outperforms the MRT-NSP-PA method in the cases of small-scale and medium-scale IRSs, and the latter approaches the former in performance as the IRS tends to a larger scale.

BackgroundPatients with atrial fibrillation (AF) and frailty are a considerable group in clinical practice. However, existing studies provide insufficient evidence of anticoagulation strategies for these patients. Therefore, we conducted a meta-analysis to determine the effectiveness and safety outcomes of direct oral anticoagulants (DOACs) for these patients.MethodsRandomized controlled trials or observational studies reporting the data about the DOACs and warfarin therapy among frail AF patients were included. The search was performed in the PubMed and Embase databases up to March 2022. Frailty was defined using the most widely used claims-based frailty index or the cumulative deficit model-based frailty index.ResultsA total of 4 studies involving 835,520 patients were included. Compared with warfarin, DOACs therapy reduced the risks of stroke or systemic embolism (HR = 0.79, 95%CI: 0.69–0.90), ischemic stroke (HR = 0.79, 95%CI: 0.71–0.87), hemorrhagic stroke (HR = 0.52, 95%CI: 0.35–0.76), and all-cause death (HR = 0.90, 95%CI: 0.84–0.96). In safety outcomes, DOACs was significantly associated with reduced risks of major bleeding (HR = 0.79, 95%CI: 0.64–0.97) and intracranial hemorrhage (HR = 0.58, 95%CI: 0.52–0.65) compared to warfarin, but there were no statistically differences in gastrointestinal bleeding (HR = 0.97, 95%CI: 0.73–1.29).ConclusionsDOACs exerted superior effectiveness and safety outcome than warfarin in AF patients with frailty.

BackgroundCurrent guidelines recommend the utilization of direct-acting oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (AF). However, the optimal anticoagulation strategy for AF patients with bioprosthetic heart valves (BPHV) remains controversial. Therefore, we conducted this meta-analysis to explore the effect of DOACs versus vitamin K antagonists (VKAs) in this population.MethodsWe systematically searched the PubMed and Embase databases until November 2021 for studies reporting the effect of DOACs versus VKAs in AF patients with BPHV. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using the random-effects model with an inverse variance method.ResultsWe selected four randomized clinical trials and seven observational studies (2236 DOAC- and 6403 VKAs-users). Regarding the effectiveness outcomes, there were no significant differences between DOACs and VKAs in stroke or systemic embolism (RR = 0.74, 95%CI: 0.50–1.08), ischemic stroke (RR = 1.08, 95%CI: 0.76–1.55), all-cause death (RR = 0.98, 95%CI: 0.86–1.12), and cardiovascular death (RR = 0.85, 95%CI: 0.40–1.80). In terms of the safety outcomes, DOACs was associated with lower risks of major bleeding (RR = 0.70, 95%CI: 0.59–0.82) and intracranial bleeding (RR = 0.42, 95%CI: 0.26–0.70), but the risks of any bleeding (RR = 0.85, 95%CI: 0.65–1.13) and gastrointestinal bleeding (RR = 0.92, 95%CI: 0.73–1.17) are not significantly different when compared with VKAs. The subgroup analysis with follow-up as a covariate revealed that the DOACs had lower risks of SSE (RR = 0.59, 95%CI: 0.37–0.94) and major bleeding (RR = 0.69, 95%CI: 0.58–0.81) in patients with a mean follow-up of more than 24 months, but no statistical differences were found in patients with the follow-up less than 24 months (SSE: RR = 1.10, 95%CI: 0.92–1.32; major bleeding: RR = 0.91, 95%CI: 0.42–2.01).ConclusionsIn AF with BPHV, patients on DOACs experienced a reduced risk of major bleeding and intracranial bleeding compared with VKAs, while the risks of stroke, cardiovascular death, and all-cause mortality were similar.

Optical properties of the UO2+x film deposited by a polymer-assisted deposition method have been investigated by spectroscopic ellipsometry (SE). This epitaxial film contains at least two kinds of uranium oxides of U3O8 and UO3, and the O/U ratio is 2.74, which is confirmed by x-ray diffraction (XRD) and scanning Auger microscopy methods. By investigating the optical constants, the bandgaps of U3O8 and UO3 are determined as 2.3 and 1.0 eV, respectively, and 80% of the epitaxial film is U3O8 and 20% is UO3. The speciation signatures from the XRD and band structures show that the UO2+x epitaxial film reduced to U3O8 with the heating treatment at 480 K in a vacuum while oxidized to UO3 at 650 K. This work demonstrates a useful tool for studying the optical properties, band structures, and phase transition of uranium oxide film by SE.

The sunlight incident on outdoor solar cells comes from all directions, and the surface reflectance of covered glass of solar cells increases with the sunlight incident angle. The above-mentioned factors together lead to the absorption loss and low utilization of incident photons. An antireflection (AR) layer with micro-/nano-structures provides an omnidirectional-antireflection characteristic because of a gradual refractive index, which is a practical approach for solving the existing problems and further improving the photoelectric conversion efficiency (PCE) of solar cells. Micrometer-sized inverted pyramid structured polydimethylsiloxane AR layers were fabricated on surfaces of dye-sensitized solar cells (DSSCs) by a cost-effective method—nanoimprint lithography. Results show that the AR layers significantly reduce the reflectance and improve the PCE of DSSCs at oblique incidence. Reflectance decreases by 5.6%–10.58%, and the PCE relatively increases by 5.83%–15.25% in the light incidence angle range of 20°–60°. Meanwhile, the AR layer exhibits a hydrophobic surface with a water contact angle of ∼98.1°, which increases by 40.2° compared with the DSSC without the AR layer, and it further provides self-cleaning potential. Moreover, nanoimprint lithography could be integrated with industrial roll-to-roll technology, which reduces the fabrication cost and possesses industrial application potential.

PurposeWe used ultraperformance liquid chromatography coupled with quadrupole/time-of-flight tandem mass spectrometry (UPLC-Q/TOF-MS/MS) to analyze the metabolic profile of reflex tears obtained from patients with dry eye disorders.MethodsWe performed a cross-sectional study involving 113 subjects: 85 patients diagnosed with dry eye syndrome (dry eye group) and 28 healthy volunteers (control group). Reflex tears (20–30 μl) were collected from the tear meniscus of both eyes of each subject using a Schirmer I test strip. MS data were acquired with a standard workflow by UPLC-Q/TOF-MS/MS. Metabolites were quantitatively analyzed and matched with entries in the Metlin, Massbank, and HMDB databases. Least absolute shrinkage and selection operator (LASSO) regression was conducted to detect important metabolites. Multiple logistic regression was used to identify the significant metabolic biomarker candidates for dry eye syndrome. Open database sources, including the Kyoto Encyclopedia of Genes and Genomes and MetaboAnalyst, were used to identify metabolic pathways.ResultsAfter the LASSO regression and multiple logistic regression analysis, 4 of 20 metabolic biomarker candidates were significantly correlated with Ocular Surface Disease Index score, 42 of 57 with fluorescein breakup time, and 26 of 57 with fluorescein staining. By focusing on the overlap of these three sets, 48 of 51 metabolites contributed to the incidence of dry eye and there were obvious changes in different age groups. Metabolic pathway analysis revealed that the main pathways were glucose metabolism, amino acid metabolism, and glutathione metabolism.ConclusionDry eye syndrome induces changes in the metabolic profile of tears, and the trend differs with age. This evidence reveals the relationship between changes in metabolites, symptoms of dry eye syndrome, and age.

Unstructured data and real-time data were storaged by state grid company’s big data platform distributed file system (based on HDFS optimized package).Based on HDFS optimized packaging,HDFS was characterized by high fault tolerance,low cost and high throughput.It was suitable for large-scale data set applications and effectively supports large file storage.The unstructured data storage and real-time data storage was introduced,and the selection of grid data storage technology was studied.

We proposed a method to study the effects of azimuth and the incident angle on the accuracy and stability of rotating polarizer analyzer ellipsometer (RPAE) with bulk Au. The dielectric function was obtained at various incident angles in a range of 55°–80° and analyzed with the spectrum of the principal angle. The initial orientations of rotating polarizing elements were deviated by a series of angles to act as the azimuthal errors in various modes. The spectroscopic measurements were performed in a wavelength range of 300–800 nm with an interval of 10 nm. The repeatedly-measured ellipsometric parameters and determined dielectric constants were recorded monochromatically at wavelengths of 350, 550, and 750 nm. The mean absolute relative error was employed to evaluate quantitatively the performance of instrument. Apart from the RPAE, the experimental error analysis implemented in this work is also applicable to other rotating element ellipsometers.

In this work, a new buffer layer material, a bismuth-indium (Bi-In) alloy, was utilized to improve the quality of large-area, laser-induced periodic ripple structures on silicon. Better-defined ripple structures and larger modification areas were obtained at different scanning speeds by pre-depositing a Bi-In film. The single-spot investigations indicated that ripple structures were much easier to form on silicon coated with the Bi-In film under laser fluences of 2.04 and 2.55 J/cm2 at a fixed pulse number of 200 in comparison with on bare silicon. A physical model in terms of the excellent thermal conductivity contributed by the free electrons in the Bi-In film homogenizing the thermal distribution caused by the laser irradiation in the early stage of the formation of laser-induced periodic surface structures was proposed to explain the above phenomena. The results show that the Bi-In film enabled a wider range of laser fluences to generate periodic structures and helped to form regular ripple structures on the silicon. In addition, the modulation effects of the laser fluence and pulse number on surface structures were studied experimentally and are discussed in detail.

Yttrium fluoride (YF3) columnar thin films (CTFs) were fabricated by electron beam evaporation with the glancing angle deposition method. The microstructures and optical properties of YF3 CTFs were studied systematically. The YF3 films grown at different deposition angles are all amorphous. As the deposition angle increases, the columns in YF3 CTFs become increasingly separated and inclined, and the volume fraction of YF3 decreases, resulting in lower refractive indices. This phenomenon is attributed to the self-shadowing effect and limited adatom diffusion. The YF3 CTFs are optically biaxial anisotropic with the long axis (c-axis) parallel to the columns, the short axis (b-axis) perpendicular to the columns, and the other axis (a-axis) parallel to the film interface. The principal refractive index along the b-axis for the 82°-deposited sample is approximately 1.233 at 550 nm. For the 78°-deposited sample, the differences of principal refractive indices between the c-axis and the b-axis and between the a-axis and the b-axis reach the maximum 0.056 and 0.029, respectively. The differences of principal refractive indices were affected by both the deposition angle and the volume fraction of YF3.

When exposed to sunlight, crystalline silicon solar cells (CSSC) will not only generate electric energy but are also heated by solar radiation. Such a self-heating effect makes the working temperature of CSSC 20–40 °C higher than that of the ambient temperature, which degrades their efficiency and reliability. The elevated operating temperatures of CSSC are mainly derived from absorbing photons that cannot be converted to electrons. Therefore, it is important to prevent CSSC from absorbing useless solar light to have a better cooling effect. In this paper, photonic structures based spectrum-selective mirror is designed to cool the operating temperatures of CSSC passively. The mirror could make CSSC absorb about 93% of the sunlight in the wavelength range of 0.3 to 1.1 µm and only absorb about 4% of the sunlight in the wavelength range of 1.1 to 2.5 µm. Meanwhile, the design has good compatibility with the radiative cooling strategy. By applying selective-absorptive and radiative cooling strategies, the operating temperature of CSSC could be decreased about 23.2 K and 68.1 K under different meteorological conditions. Moreover, unlike the single radiative cooling strategy, the spectrum-selective mirror also has effective cooling effects in high wind speed meteorological conditions.

The objective of this work was to study the influence of Ta doping on the structural, transmittance properties, linear absorption parameter, and nonlinear absorption properties of InTe thin films. The as-deposited samples with different Ta doping concentrations were prepared by a magnetron co-sputtering technique and then annealed in nitrogen atmosphere. Structural investigations by X-ray diffraction revealed the tetragonal structure of InTe samples and that the crystallinity decreases with increasing Ta doping concentration. Further structural analysis by Raman spectra also showed good agreement with X-ray diffraction results. The Ta doping concentration and sample thickness determined by energy-dispersive X-ray spectroscopy and scanning electron microscopy increased as Ta dopant increased. In addition, X-ray photoelectron spectroscopic was carried out to analyze the chemical states of the elements. UV–VIS–NIR transmittance spectra were applied to study the transmittance properties and calculate the linear absorption coefficient. Due to Burstein–Moss effect, the absorption edge moved to shorter wavelengths. Meanwhile, the values of band gap were found to increase from 1.71 ± 0.02 eV to 1.85 ± 0.01 eV with the increase of Ta doping concentration. By performing an open aperture Z-scan technique, we found that all Ta-doped InTe samples exhibited two-photon absorption behaviors. The nonlinear optical absorption parameters, such as modulation depth, two-photon absorption coefficient, and two-photon absorption cross-section, decrease with increasing Ta concentration, whereas the damage threshold increases from 176 ± 0.5 GW/cm2 to 242 ± 0.5 GW/cm2. These novel properties show the potential for applications in traditional optoelectronic devices and optical limiters.

Failure mode and effects analysis (FMEA) is an analysis tool for identifying and preventing flaws or defects in products during the design and process planning stage, preventing the repeated occurrence of problems, reducing the effects of these problems, enhancing product quality and reliability, saving costs, and improving competitiveness. However, FMEA can only analyze one influence factor according to its priority, rendering this method ineffective for systems containing multiple FMs whose effects are simultaneous or interact with one another. Accordingly, when FMEA fails to identify the influence factors and the factors being influenced, the most crucial problems may be placed in lower priority or remain unresolved. Decision-Making Trial and Evaluation Laboratory (DEMATEL) facilitates the determination of cause and effect factors; by identifying the causal factors that should be prioritized, prompt and effective solutions to core problems can be derived, thereby enhancing performance. Using the photovoltaic cell manufacturing industry in China as the research target, the present study combined FMEA with DEMATEL to amend the flaws of FMEA and enhance its effectiveness. First, FMEA was used to identify items requiring improvement. Then, DEMATEL was employed to examine the interactive effects and causal relationships of these items. Finally, the solutions to the problems were prioritized. The proposed method effectively combined the advantages of FMEA and DEMATEL to facilitate the identification of core problems and prioritization of solutions in the Chinese photovoltaic cell industry.

Leukotriene (LT)A4 and closely related allylic epoxides are pivotal intermediates in lipoxygenase (LOX) pathways to bioactive lipid mediators that include the leukotrienes, lipoxins, eoxins, resolvins, and protectins. Although the structure and stereochemistry of the 5-LOX product LTA4 is established through comparison to synthetic standards, this is the exception, and none of these highly unstable epoxides has been analyzed in detail from enzymatic synthesis. Understanding of the mechanistic basis of the cis or trans epoxide configuration is also limited. To address these issues, we developed methods involving biphasic reaction conditions for the LOX-catalyzed synthesis of LTA epoxides in quantities sufficient for NMR analysis. As proof of concept, human 15-LOX-1 was shown to convert 15S-hydroperoxy-eicosatetraenoic acid (15S-HPETE) to the LTA analog 14S,15S-trans-epoxy-eicosa-5Z,8Z,10E,12E-tetraenoate, confirming the proposed structure of eoxin A4. Using this methodology we then showed that recombinant Arabidopsis AtLOX1, an arachidonate 5-LOX, converts 5S-HPETE to the trans epoxide LTA4 and converts 5R-HPETE to the cis epoxide 5-epi-LTA4, establishing substrate chirality as a determinant of the cis or trans epoxide configuration. The results are reconciled with a mechanism based on a dual role of the LOX nonheme iron in LTA epoxide biosynthesis, providing a rational basis for understanding the stereochemistry of LTA epoxide intermediates in LOX-catalyzed transformations.

FTIR (400–4000 cm−1) spectra of “Bisphenol A” are presented. Absorption peaks (400–4000 cm−1) are assigned on the basis of Density Functional Theory (DFT) with configuration as B3LYP 6-311G++ (3df 3pd). Calculated absorption peaks are in reasonable reconciliation with experimental absorption peaks after scaling with scale factor of 0.9679 except C-H and O-H stretching vibrations.

Financial supervision means that monetary authorities have the power to supervise and manage financial institutions according to laws. Monetary authorities have this power because of the requirements of improving financial services, protecting the rights of depositors, adapting to industrial development, ensuring financial fair trade, and maintaining stable financial order. To establish evaluation criteria for bank supervision in China, this study integrated fuzzy theory and the decision making trial and evaluation laboratory (DEMATEL) and proposes a fuzzy-DEMATEL model. First, fuzzy theory was applied to examine bank supervision criteria and analyze fuzzy semantics. Second, the fuzzy-DEMATEL model was used to calculate the degree to which financial supervision criteria mutually influenced one another and their causal relationship. Finally, an evaluation criteria model for evaluating bank and financial supervision was established.

The tumor suppressor LKB1 is a serine/threonine protein kinase that is frequently mutated in human lung adenocarcinoma (LUAD). LKB1 regulates a complex signaling network that is known to control cell polarity and metabolism; however, the pathways that mediate the tumor-suppressive activity of LKB1 are incompletely defined. To identify mechanisms of LKB1-mediated growth suppression, we developed a spheroid-based cell culture assay to study LKB1-dependent growth. We then performed genome-wide CRISPR screens in spheroidal culture and found that LKB1 suppresses growth, in part, by activating the PIKFYVE lipid kinase. Finally, we used chemical inhibitors and a pH-sensitive reporter to determine that LKB1 impairs growth by promoting the internalization of wild-type EGFR in a PIKFYVE-dependent manner. [ABSTRACT FROM AUTHOR]

Subretinal fibrosis (SF) is an important cause of submacular neovascularization that leads to permanent vision loss, but has no effective clinical treatment. The present study examined the influence of metformin on SF, and investigated whether the mechanism involves the microRNA (miR)-140-3p/LIN28B/JNK/STAT3-mediated regulation of oxidative stress, angiogenesis and fibrosis-associated indicators. A mouse model of laser-induced SF was established. In addition, an ARPE-19 fibrotic cell model was established using TGF-β1. A Cell Counting Kit-8 assay was used to examine cell viability. Flow cytometry was used to measure reactive oxygen species levels, and western blotting was used to detect the levels of proteins associated with epithelial-mesenchymal transition (EMT), signaling and fibrosis. The levels of superoxide dismutase, malondialdehyde, glutathione-peroxidase and catalase were measured using kits. Scratch assays and Transwell assays were used to assess cell migration and invasion, respectively, and reverse transcription-quantitative PCR was used to determine the levels of miR-140-3p and LIN28B. Dual-luciferase assays were used to verify the targeting relationship between miR-140-3p and LIN28B, and coimmunoprecipitation was used to confirm the interaction between LIN28B and JNK. Masson staining and hematoxylin and eosin staining were used to examine collagenous fibers and the histopathology of eye tissue. In ARPE-19 cells induced by TGF-β1, metformin promoted miR-140-3p expression and inhibited LIN28B expression and JNK/STAT3 pathway activation, thereby inhibiting oxidative stress, EMT and fibrosis in ARPE-19 cells. The overexpression of LIN28B or treatment with the JNK/STAT3 agonist anisomycin partially reversed the inhibitory effect of metformin on oxidative stress and fibrosis in ARPE-19 cells. The dual-luciferase reporter assay and coimmunoprecipitation assay showed that miR-140-3p targeted the 3' untranslated region of LIN28B mRNA and inhibited LIN28B expression. LIN28B targeted and bound to JNK and regulated the JNK/STAT3 pathway. Therefore, it may be concluded that metformin can promote miR-140-3p expression, inhibit LIN28B and then inhibit the JNK/STAT3 pathway to alleviate SF. [ABSTRACT FROM AUTHOR]