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Abstract COVID-19 may induce a state of hypercoagulability, particularly in critically ill patients, for reasons that remain unknown. Numerous studies have identified the presence of antiphospholipid antibodies in patients with COVID-19; however, the definitive diagnosis of antiphospholipid syndrome continues to pose challenges. Here, we present the case of a patient infected with SARS-CoV-2 who developed life-threatening severe thrombocytopenia, profound anaemia, acute pulmonary hypertension, right ventricular failure, and renal insufficiency. Laboratory investigations revealed significantly elevated levels of antiphospholipid antibodies. We conducted a one-year follow-up study with blood sampling performed every 12 weeks. The patient exhibited persistent high titres of antiphospholipid antibodies and ongoing renal dysfunction necessitating daily oral warfarin antithrombotic therapy. Antiphospholipid syndrome is a complex clinical condition that poses challenges for clinicians, particularly in critically ill patients, and is often associated with delayed and inaccurate diagnosis and treatment. Therefore, we extensively reviewed the literature and international guidelines to conduct a comprehensive analysis of the aetiology, pathogenesis, and treatment strategies of APS. We hope this work will provide a valuable reference for health care professionals.

Driving Taiwan's digital revolution, the DIGI Plus 2017-2025 policy, a cornerstone of the Smart Nation 2025 initiative (Executive Yuan, 2021), prioritized rural empowerment in education amidst COVID-19 challenges. In this study, the authors explored the impact of teacher-student relationships in remote teaching, emphasizing the critical role of high-quality connections transcending geographical boundaries. The authors identified factors influencing these relationships, such as interaction levels and student autonomy, and discussed the concept of transactional distance, a psychological gap due to spatial separation. Proposing face-to-face interaction activities, the authors conducted a survey involving 175 university students (e-tutors), revealing positive changes in teacher-student interaction post face-to-face activities. The authors' recommendations include continued activities, alignment with school calendars, and comprehensive e-tutor training for improved relationships.

Purpose: Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset. Methods: A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival. Results: Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all p 8 and duration of consciousness disorders ≤ 24 h. Conclusions: Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.

Purpose: The incidence of heatstroke (HS) is not particularly high; however, once it occurs, the consequences are serious. It is reported that calcitonin gene-related peptide (CGRP) is protective against brain injury in HS rats, but detailed molecular mechanisms need to be further investigated. In this study, we further explored whether CGRP inhibited neuronal apoptosis in HS rats via protein kinase A (PKA)/p-cAMP response element-binding protein (p-CREB) pathway. Methods: We established a HS rat model in a pre-warmed artificial climate chamber with a temperature of (35.5 ± 0.5) °C and a relative humidity of 60% ± 5%. Heatstress was stopped once core body temperature reaches above 41 °C. A total of 25 rats were randomly divided into 5 groups with 5 animals each: control group, HS group, HS+CGRP group, HS+CGRP antagonist (CGRP8-37) group, and HS+CGRP+PKA/p-CREB pathway blocker (H89) group. A bolus injection of CGRP was administered to each rat in HS+CGRP group, CGRP8-37 (antagonist of CGRP) in HS+CGRP8-37 group, and CGRP with H89 in HS+CGRP+H89 group. Electroencephalograms were recorded and the serum concentration of S100B, neuron-specific enolase (NSE), neuron apoptosis, activated caspase-3 and CGRP expression, as well as pathological morphology of brain tissue were detected at 2 h, 6 h, and 24 h after HS in vivo. The expression of PKA, p-CREB, and Bcl-2 in rat neurons were also detected at 2 h after HS in vitro. Exogenous CGRP, CGRP8-37, or H89 were used to determine whether CGRP plays a protective role in brain injury via PKA/p-CREB pathway. The unpaired t-test was used between the 2 samples, and the mean ± SD was used for multiple samples. Double-tailed p

This study investigated the effect of educational board games and the creative thinking spiral teaching strategy (CTSTS) on the learning outcomes of beginner-level Chinese language learners. Two dimensions were measured: learning outcome and writing ability. A total of 82 learners from one university in Taiwan participated in this study. Participants were non-randomly selected using convenience sampling. The participants were divided into the control group (40 participants) and experimental group (42 participants). In the control group, the teacher used the board game "Conveyance GO" as a teaching tool; in the experimental group, both Conveyance GO and CTSTS were used to teach the Chinese language. The results indicate no significant difference in learning outcomes between the groups. However, the experimental group exhibited a significantly larger improvement in writing abilities than did the control group, especially in terms of cohesion, coherence, and grammatical accuracy.

Background: The benefits of hyperbaric oxygen (HBO) in treating animals with heat stroke (HS) have been established. This study aims to retrospectively analyze the effect of HBO on multiple organ dysfunction following HS in humans. Methods: Retrospective data were collected from patients with HS admitted to our hospital in the past 7 years. Patients were categorized into groups based on whether they received HBO therapy. The study compared various factors, including sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) scores, mortality rates, neurological function scores, serum myocardial enzyme levels, liver, kidney, and coagulation function indicators, blood routine results, electrolyte levels, and modified Barthel index (MBI) score for standard daily living ability before treatment and after 2 and 4 weeks of treatment. Results: The mortality rates in the HBO and control group were 0% and 8.49%, respectively. Upon admission, the HBO group had higher SOFA and APACHE-Ⅱ scores and lower neurological, coagulation, and liver functions than those of the control group. HBO treatment significantly improved SOFA, APACHE-Ⅱ, and neurological scores while relieving levels of alanine aminotransferase, aspartate aminotransferase, creatinine, and myocardial enzymes. Additionally, it mitigating lymphocyte and platelet count decline caused by HS. The MBI score was significantly enhanced after treatment in the HBO group. Conclusions: Clinical practice advocates administering HBO therapy to patients with severe illness, organ damage, and nerve impairment. Compared with conventional treatment, combined HBO therapy demonstrated superior efficacy in alleviating multiple organ dysfunction and improving daily living ability in patients with HS.

Purpose: COVID-19 is also referred to as a typical viral septic pulmonary infection by 2019-nCoV. However, little is known regarding its characteristics in terms of systemic inflammation and organ injury, especially compared with classical bacterial sepsis. This article aims to investigate the clinical characteristics and prognosis between COVID-19-associated sepsis and classic bacterial-induced sepsis. Methods: In this retrospective cohort study, septic patients with COVID-19 in the intensive care unit (ICU) of a government-designed therapy center in Shenzhen, China between January 14, 2020 and March 10, 2020, and septic patients induced by carbapenem-resistant klebsiella pneumonia (CrKP) admitted to the ICU of the Second People's Hospital of Shenzhen, China between January 1, 2014 and October 30, 2019 were enrolled. Demographic and clinical parameters including comorbidities, critical illness scores, treatment, and laboratory data, as well as prognosis were compared between the two groups. Risk factors for mortality and survival rate were analyzed using multivariable logistic regression and survival curve, respectively. Results: A total of 107 patients with COVID-19 and 63 patients with CrKP were enrolled. A direct comparison between the two groups demonstrated more serious degrees of primary lung injury following 2019-nCoV infection (indicated by lower PaO2/FiO2), but milder systemic inflammatory response, lower sequential organ failure assessment score and better functions of the organs like heart, liver, kidney, coagulation, and circulation. However, the acquired immunosuppression presented in COVID-19 patients was more severe, which presented as lower lymphocyte counts (0.8×109/L vs. 0.9×109/L). Moreover, the proportion of COVID-19 patients treated with corticosteroid therapy and extracorporeal membrane oxygenation was larger compared with CrKP patients (78.5% vs. 38.1% and 6.5% vs. 0, respectively) who required less invasive mechanical ventilation (31.6% vs. 54.0%). The incidence of hospitalized mortality and length of ICU stay and total hospital stay were also lower or shorter in viral sepsis (12.1% vs. 39.7%, 6.5 days vs. 23.0 days and 21.0 days vs. 33.0 days, respectively) (all p < 0.001). Similar results were obtained after being adjusted by age, gender, comorbidity and PaO2/FiO2. Lymphocytopenia and high acute physiology and chronic health evaluation II scores were common risk factors for in-hospital death. While the death cases of COVID-19 sepsis mostly occurred at the later stages of patients’ hospital stay. Conclusion: Critical COVID-19 shares clinical characteristics with classical bacterial sepsis, but the degree of systemic inflammatory response, secondary organ damage and mortality rate are less severe. However, following 2019-nCoV infection, the level of immunosuppression may be increased and thus induce in more death at the later stage of patients’ hospitalstay.

Abstract In the last years, subspace‐based multi‐view face recognition has attracted increasing attention and many related methods have been proposed. However, the most existing methods ignore the specific local structure of different views. This drawback can cause these methods' discriminating ability to degrade when many noisy samples exist in data. To tackle this problem, a multi‐view low‐rank representation method is proposed, which exploits both intrinsic relationships and specific local structures of different views simultaneously. It is achieved by hierarchical Bayesian methods that constrain the low‐rank representation of each view so that it matches a linear combination of an intrinsic representation matrix and a specific representation matrix to obtain common and specific characteristics of different views. The intrinsic representation matrix holds the consensus information between views, and the specific representation matrices indicate the diversity among views. Furthermore, the model injects a clustering structure into the low‐rank representation. This approach allows for adaptive adjustment of the clustering structure while pursuing the optimization of the low‐rank representation. Hence, the model can well capture both the relationship between data and the clustering structure explicitly. Extensive experiments on several datasets demonstrated the effectiveness of the proposed method compared to similar state‐of‐the‐art methods in classification and clustering.

Peripherally-induced neuropathic pain (pNP) is a kind of NP that is common, frequent, and difficult to treat. Tuina, also known as massage and manual therapy, has been used to treat pain in China for thousands of years. It has been clinically proven to be effective in the treatment of pNP caused by cervical spondylosis, lumbar disc herniation, etc. However, its analgesic mechanism is still not clear and has been the focus of research. In this review, we summarize the existing research progress, so as to provide guidance for clinical and basic studies. The analgesic mechanism of tuina is mainly manifested in suppressing peripheral inflammation by regulating the TLR4 pathway and miRNA, modulating ion channels (such as P2X3 and piezo), inhibiting the activation of glial cells, and adjusting the brain functional alterations. Overall, tuina has an analgesic effect by acting on different levels of targets, and it is an effective therapy for the treatment of pNP. It is necessary to continue to study the mechanism of tuina analgesia.

BackgroundHeat stroke is a potentially fatal condition that is caused by elevated core temperature. Guillain–Barré syndrome (GBS) induced by heat stroke is extremely rare and has only been reported in few case reports. The purpose of this case study was to evaluate the clinical symptoms, neuroelectrophysiological and imageological features of GBS after heat stroke.MethodsWe reviewed our hospital records and previously published reports to find the cases of GBS after heat stroke. The clinical, imageological, and electrophysiological profiles, treatment and prognosis were presented and analyzed.ResultsWe retrieved three cases of GBS induced by heat stroke from our hospital, which presented as lesions on multiple cranial and peripheral nerves and albuminocytologic dissociation in the cerebrospinal fluid. All of these patients had disorders of consciousness at the early stage of heat stroke and a “pseudo-recovery period” after they recovered from coma after heat stroke. After immunoglobulin administration and immunoregulation therapy, these patients' neurological deficiencies were relieved significantly. But there are still disabilities and almost totally reliant on others.ConclusionsThe number of the cases of GBS induced by HS reported in this study has been the most in the recent 5 years. Clinicians should pay attention to patients with heat stroke with sustained coma and the sudden quadriplegia. Early, exact and timely diagnosis and treatment of GBS need to be performed, to accelerate recovery and improve prognosis.

Abstract The roles of RNA m6A modification in carcinogenesis have attracted much interest recently. However, the dysregulation of RNA m6A regulators (writers, readers, and erasers) in nasopharyngeal carcinoma (NPC) has never been reported. In this study, we showed that METTL3, one of the writers, was upregulated in NPC. Functional studies revealed that METTL3 promoted the migration and invasion of NPC cells. However, METTL3 knockdown reversed this effect and inhibited the migration, invasion and metastasis of NPC cells. METTL3 activated the luciferase activity of TOPflash (a reporter for beta‐catenin/TCF signaling), and downregulation of METTL3 inhibited the expression of beta‐catenin/TCF target genes vimentin and N‐cadherin, which are two regulators of epithelial‐mesenchymal transition. Moreover, dominant negative beta‐catenin blocked the migration and invasion of NPC cells. Further mechanistic studies showed that METTL3 silencing decreased the m6A methylation and total mRNA levels of Tankyrase, a negative regulator of axin. Moreover, Tankyrase overexpression abrogated the repressive effects of METTL3 silencing on the migration of NPC cells. Collectively, our study demonstrates the oncogenic roles of METTL3 in NPC, and suggests that METTL3 might be a therapeutic target for NPC.

Abstract Background Intracranial infection after craniotomy is one of the most serious postoperative complications, especially multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacterial meningitis, and strongly affects the prognosis of patients. Current treatment experience regarding these infections is scarce. Case presentation We report a case of severe intracranial infection of XDR Acinetobacter baumannii (A. baumannii) that was treated by intravenous (IV) injection, sequential intraventricular (IVT) injection of tigecycline and polymyxin B, and other anti-infective drugs. Good results were obtained, and the patient was eventually discharged from the hospital. This case is characterized by intracranial infection. Conclusions The polymyxin B IV + IVT pathway is an ideal treatment strategy for XDR A. baumannii. The tigecycline IVT pathway is also a safe treatment option.

The purpose of this study is to compare the impacts of flashcard and board games on the learning motivation, flow experience, and learning outcomes of learners of Chinese language. The subjects of this research were 34 learners who took beginner Chinese courses. Empirical research found out that both flashcard and board games have positively significant effects on learners’ learning motivation, flow experience and learning outcomes. In which, learners in the board game group have significantly higher learning outcomes than those in the flashcards group. However, the learning motivation and flow experience of the flashcard group are significantly higher than that of the educational board game group.

Microbial oligosaccharides have been regarded as one of the most appealing natural products attributable to their potent and selective bioactivities, such as antimicrobial activity, inhibition of α-glucosidases and lipase, interference of cellular recognition and signal transduction, and disruption of cell wall biosynthesis. Accordingly, a handful of bioactive oligosaccharides have been developed for the treatment of bacterial infections and type II diabetes mellitus. Given that naturally occurring oligosaccharides have increasingly gained recognition in recent years, a comprehensive review is needed. The current review highlights the chemical structures, biological activities and divergent biosynthetic origins of three subgroups of oligomers including the acarviosine-containing oligosaccharides, saccharomicins, and orthosomycins.

Usage control (UCON) is an access control model to enforce digital resources protection in highly distributed, heterogeneous network computing environment. Firstly, each core model of UCON was specified formally with TCSP#, and a combination specification mechanism was proposed for general UCON. Secondly, as the basis of the security analysis, the concepts and calculation method of the reachable space were given. Various combination mechanisms of processes based on single-session was presented to achieve formal specifications of complex concurrent sessions, timings and nondeterminism. Then the reachable space of combined processes was the desired space. Finally, the security analysis method based on the reachable space and the conflict analysis of access control policies based on the equivalent checking in process algebras were proposed for UCON model. All the proposed work had been formal checked in PAT. The experiment result shows that the proposed approaches are feasible, and PAT is a really great tool for the systematic formal specification and security analysis of UCON.

Three new acylated aminooligosaccharide (1–3), along with five known congeners (4–8), were isolated from the marine-derived Streptomyces sp. HO1518. Their structures were fully elucidated by extensive spectroscopic analysis, mainly based on 1D-selective and 2D TOCSY, HSQC-TOCSY, and HRESIMS spectrometry measurements, and by chemical transformations. All of the compounds were evaluated for their α-glucosidase and pancreatic lipase inhibitory activities. Among the isolates, D6-O-isobutyryl-acarviostatin II03 (3) and D6-O-acetyl-acarviostatin II03 (8), sharing acarviostatin II03-type structure, showed the most potent α-glucosidase and lipase inhibitory effects, far stronger than the antidiabetic acarbose towards α-glucosidase and almost equal to the anti-obesity orlistat towards lipase in vitro. This is the first report on inhibitory activities against the two major digestive enzymes for acylated aminooligosaccharides. The results from our investigation highlight the potential of acylated aminooligosaccharides for the future development of multi-target anti-diabetic drug.

In photovoltaic and wind power storage systems, the reliability of the battery directly affects the overall reliability of the energy storage system. Failed batteries can seriously affect the stable operation of energy storage systems. This paper aims to improve the reliability of the storage systems by accurately predicting battery life and identifying failing batteries in time. The current prediction models mainly use artificial neural networks, Gaussian process regression and hybrid models. Although these models can achieve high prediction accuracy, the computational cost is high due to model complexity. Least squares support vector machine (LSSVM) is a computationally efficient alternative. Hence, this study combines the improved chicken swarm optimization algorithm (ICSO) and LSSVM into a hybrid ICSO-LSSVM model for the reliability of photovoltaic and wind power storage systems. The following are the contributions of this work. First, the optimal penalty parameter and kernel width are determined. Second, the chicken swarm optimization algorithm (CSO) is improved by introducing chaotic search behavior in the hen and an adaptive learning factor in the chicks. The performance of the ICSO algorithm is shown to be better than CSO using standard test problems. Third, the prediction accuracy of the three models is compared. For NMC1 battery, the predicted relative error of ICSO-LSSVM is 0.94%; for NMC2 battery, the relative error of ICSO-LSSVM is 1%. These findings show that the proposed model is suitable for predicting the failure of batteries in energy storage systems, which can improve preventive and predictive maintenance of such systems.

In this paper, Au nanoshell arrays, serving as a photo-activated material, are fabricated via the combination of self-assembled nanosphere lithography and the thermal decomposing polymer method. The intensity and position of surface plasmonic resonance can be tuned from the visible region to the near-infrared region by changing the size of Au nanoshell arrays. When resonance absorption peaks of metal nanoparticles are matched with emission wavelengths of core-shell CdSe/CdS quantum dots, fluorescent intensity of CdSe/CdS quantum dots can be strongly enhanced. The physical mechanism of fluorescent enhancement is explained.