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Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is regionally distributed in Asia, with high fatality. Constructing the transmission model of SFTS could help provide clues for disease control and fill the gap in research on SFTS models. Methods We built an SFTS transmission dynamics model based on the susceptible–exposed–infectious–asymptomatic–recovered (SEIAR) model and the epidemiological characteristics of SFTS in Jiangsu Province. This model was used to evaluate the effect by cutting off different transmission routes and taking different interventions into account, to offer clues for disease prevention and control. Results The transmission model fits the reported data well with a minimum R 2 value of 0.29 and a maximum value of 0.80, P

BackgroundThis study aimed to explore whether the transmission routes of severe fever with thrombocytopenia syndrome (SFTS) will be affected by tick density and meteorological factors, and to explore the factors that affect the transmission of SFTS. We used the transmission dynamics model to calculate the transmission rate coefficients of different transmission routes of SFTS, and used the generalized additive model to uncover how meteorological factors and tick density affect the spread of SFTS.MethodsIn this study, the time-varying infection rate coefficients of different transmission routes of SFTS in Jiangsu Province from 2017 to 2020 were calculated based on the previous multi-population multi-route dynamic model (MMDM) of SFTS. The changes in transmission routes were summarized by collecting questionnaires from 537 SFTS cases in 2018-2020 in Jiangsu Province. The incidence rate of SFTS and the infection rate coefficients of different transmission routes were dependent variables, and month, meteorological factors and tick density were independent variables to establish a generalized additive model (GAM). The optimal GAM was selected using the generalized cross-validation score (GCV), and the model was validated by the 2016 data of Zhejiang Province and 2020 data of Jiangsu Province. The validated GAMs were used to predict the incidence and infection rate coefficients of SFTS in Jiangsu province in 2021, and also to predict the effect of extreme weather on SFTS.ResultsThe number and proportion of infections by different transmission routes for each year and found that tick-to-human and human-to-human infections decreased yearly, but infections through animal and environmental transmission were gradually increasing. MMDM fitted well with the three-year SFTS incidence data (P28°C). Sunshine duration and temperature had the greatest effect on transmission from host animals to humans. The effect of extreme weather conditions on SFTS was short-term, but there was no effect on SFTS after high temperature and sunshine hours.ConclusionsDifferent factors affect the infection rate coefficients of different transmission routes. Sunshine duration, relative humidity, temperature and tick density are important factors affecting the occurrence of SFTS. Hurricanes reduce the incidence of SFTS in the short term, but have little effect in the long term. The most effective intervention to reduce the incidence of SFTS is to reduce population exposure to high-risk environments.

With the increasing for function, scale, hierarchy and complexity of software project, the software life cycle and development stage show a trend of cross-cutting and fuzzy boundary. The non-technical factors, such as poor management and control during the implementation of software projects, are the major reason for causing the low success rate of software projects recently. Therefore, the software quality evaluation under complex environment should take the cross-influence between different stages of software life cycle and different quality evaluation standards into consideration. Our research is to construct a new software quality evaluation model by using the influence relationship and the influence intensity index between project management domain and project quality evaluation criteria including scope, cost, and time. First, we came up with the definition of software project management domain in the process of software project development and management. Second, we proposed a mathematical method for extracting the direct or indirect influence relation between them, and give a definition for the quantitative evaluation index and its calculation formula. At last we proposed to construct a neural network training model which includes evaluation model logic relationships and software quality quantitative evaluation index. Through study and training by simulated software project management data, we can discover some key data, such as normal threshold range of influence, factor weights, etc. Therefore, a complete evaluation system is built, and the scientific nature and accuracy of the proposal evaluation system will be improved.

Summary Glycosylation of natural products can influence their pharmacological properties, and efficient glycosyltransferases (GTs) are critical for this purpose. The polyketide epothilones are potent anti‐tumour compounds, and YjiC is the only reported GT for the glycosylation of epothilone. In this study, we phylogenetically analysed 8261 GTs deposited in CAZy database and revealed that YjiC locates in a subbranch of the Macrolide I group, forming the YjiC‐subbranch with 160 GT sequences. We demonstrated that the YjiC‐subbranch GTs are normally efficient in epothilone glycosylation, but some showed low glycosylation activities. Sequence alignment of YjiC‐subbranch showed that the 66th and 77th amino acid residues, which were close to the catalytic cavity in molecular docking model, were conserved in five high‐active GTs (Q66 and P77) but changed in two low‐efficient GTs. Site‐directed residues swapping at the two positions in the two low‐active GTs (BssGT and BamGT) and the high‐active GT BsGT‐1 demonstrated that the two amino acid residues played an important role in the catalytic efficiency of epothilone glycosylation. This study highlights that the potent GTs for appointed compounds are phylogenetically grouped with conserved residues for the catalytic efficiency.

Abstract Background The CRISPR/dCas9 system is a powerful tool to activate the transcription of target genes in eukaryotic or prokaryotic cells, but lacks assays in complex conditions, such as the biosynthesis of secondary metabolites. Results In this study, to improve the transcription of the heterologously expressed biosynthetic genes for the production of epothilones, we established the CRISPR/dCas9-mediated activation technique in Myxococcus xanthus and analyzed some key factors involving in the CRISPR/dCas9 activation. We firstly optimized the cas9 codon to fit the M. xanthus cells, mutated the gene to inactivate the nuclease activity, and constructed the dCas9-activator system in an epothilone producer. We compared the improvement efficiency of different sgRNAs on the production of epothilones and the expression of the biosynthetic genes. We also compared the improvement effects of different activator proteins, the ω and α subunits of RNA polymerase, and the sigma factors σ54 and CarQ. By using a copper-inducible promoter, we determined that higher expressions of dCas9-activator improved the activation effects. Conclusions Our results showed that the CRISPR/dCas-mediated transcription activation is a simple and broadly applicable technique to improve the transcriptional efficiency for the production of secondary metabolites in microorganisms. This is the first time to construct the CRISPR/dCas9 activation system in myxobacteria and the first time to assay the CRISPR/dCas9 activations for the biosynthesis of microbial secondary metabolites.

Abstract Background The CRISPR/Cas9 system is a powerful tool for genome editing, in which the sgRNA binds and guides the Cas9 protein for the sequence-specific cleavage. The protocol is employable in different organisms, but is often limited by cell damage due to the endonuclease activity of the introduced Cas9 and the potential off-target DNA cleavage from incorrect guide by the 20 nt spacer. Results In this study, after resolving some critical limits, we have established an efficient CRISPR/Cas9 system for the deletion of large genome fragments related to the biosynthesis of secondary metabolites in Myxococcus xanthus cells. We revealed that the high expression of a codon-optimized cas9 gene in M. xanthus was cytotoxic, and developed a temporally high expression strategy to reduce the cell damage from high expressions of Cas9. We optimized the deletion protocol by using the tRNA–sgRNA–tRNA chimeric structure to ensure correct sgRNA sequence. We found that, in addition to the position-dependent nucleotide preference, the free energy of a 20 nt spacer was a key factor for the deletion efficiency. Conclusions By using the developed protocol, we achieved the CRISPR/Cas9-induced deletion of large biosynthetic gene clusters for secondary metabolites in M. xanthus DK1622 and its epothilone-producing mutant. The findings and the proposals described in this paper were suggested to be workable in other organisms, for example, other Gram negative bacteria with high GC content.

Abstract Background Microbial secondary metabolism is regulated by a complex and mostly-unknown network of global and pathway-specific regulators. A dozen biosynthetic gene clusters for secondary metabolites have been reported in myxobacteria, but a few regulation factors have been identified. Results We identified a transcription regulator Esi for the biosynthesis of epothilones. Inactivation of esi promoted the epothilone production, while overexpression of the gene suppressed the production. The regulation was determined to be resulted from the transcriptional changes of epothilone genes. Esi was able to bind, probably via the N-terminus of the protein, to an inverted repeat sequence in the promoter of the epothilone biosynthetic gene cluster. The Esi-homologous sequences retrieved from the RefSeq database are all of the Proteobacteria. However, the Esi regulation is not universal in myxobacteria, because the esi gene exists only in a few myxobacterial genomes. Conclusions Esi binds to the epothilone promoter and down-regulates the transcriptional level of the whole gene cluster to affect the biosynthesis of epothilone. This is the first transcription regulator identified for epothilone biosynthesis.

MP2 (Second order approximation of Møller–Plesset perturbation theory) and DFT/TD-DFT (Density functional theory/Time-dependent_density_functional_theory) investigations have been performed on metallophilic nanomaterials of host clusters [Au(NHC)2]+⋅⋅⋅[M(CN)2]−⋅⋅⋅[Au(NHC)2]+ (NHC = N-heterocyclic carbene, M = Au, Ag) with high phosphorescence. The phosphorescence quantum yield order of clusters in the experiments was evidenced by their order of μS1/ΔES1−T1 values ( μ S 1 : S0 → S1 transition dipole, ∆ E S 1 − T 1 : splitting energy between the lowest-lying singlet S1 and the triplet excited state T1 states). The systematic variation of the guest solvents (S1: CH3OH, S2: CH3CH2OH, S3: H2O) are employed not only to illuminate their effect on the metallophilic interaction and phosphorescence but also as the probes to investigate the recognized capacity of the hosts. The simulations revealed that the metallophilic interactions are mainly electrostatic and the guests can subtly modulate the geometries, especially metallophilic Au⋅⋅⋅M distances of the hosts through mutual hydrogen bond interactions. The phosphorescence spectra of hosts are predicted to be blue-shifted under polar solvent and the excitation from HOMO (highest occupied molecular orbital) to LUMO (lowest unoccupied molecular orbital) was found to be responsible for the 3MLCT (triplet metal-to-ligand charge transfer) characters in the hosts and host-guest complexes. The results of investigation can be introduced as the clues for the design of promising blue-emitting phosphorescent and functional materials.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus. Previous studies about risk factors for SFTSV infection have yielded inconsistent results, and behavior factors have not been fully clarified.A community-based, 1:4 matched case-control study was carried out to investigate the risk factors for SFTS in China. Cases of SFTS were defined as laboratory-confirmed cases that tested positive for real-time PCR (RT-PCR) for severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) or positive for IgM antibodies against SFTSV. Controls of four neighborhood subjects were selected by matching for sex, age, and occupation. Standardized questionnaires were used to collect detailed information about their demographics and risk factors for SFTSV infection.A total of 334 subjects participated in the study including 69 cases and 265 controls. The median age of the cases was 59.5 years, 55.1% were male, and 87.0% were farmers. No differences in demographics were observed between cases and controls. In the final multivariate analysis, tick bites two weeks prior to disease onset (OR = 8.04, 95%CI 3.34-19.37) and the presence of weeds and shrubs around the house (OR = 3.46, 95%CI 0.96-12.46) were found to be risk factors for SFTSV infection; taking preventative measures during outdoor activities (OR = 0.12, 95%CI 0.01-1.01) provided greater protection from SFTSV infection.Our results further confirm that SFTSV is transmitted by tick bites and prove that preventative measures that reduce exposure to ticks can prevent SFTSV infection. More efforts should be directed toward health education and behavior change for high-risk populations, especially outdoor workers, in SFTS endemic areas.

Ziyuglycoside I (ZGS1) is a promising drug candidate for the treatment of leucopenia. Currently, information on ZGS1 and its in vivo metabolite ziyuglycoside II (ZGS2) is limited. The objective of this study was to investigate the pharmacokinetics, tissue distribution, and excretion of ziyuglycoside I (ZGS1) and its metabolite ziyuglycoside II (ZGS2) in rats. In our study, a simple and sensitive high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) method was established for simultaneous determination of ZGS1 and its metabolite for Sprague-Dawley rat pharmacokinetics studies. The method was validated following internationally-approved guidelines. The results presented in this study indicated that subcutaneous administration of ZGS1 prolonged its extension time and increased the area under the curve (AUC0–t) of ZGS2 during 0 to t minutes. In summary, in this study, the pharmacokinetic characteristics of ZGS1 and its metabolite ZGS2 were defined and its tissue distribution, and excretion in rats were described. Our finding may be beneficial for leucopenia drug that focus on ZGS1.

Several atmospheric residues (AR) of Kuwaiti crude, in the absence, or in the presence, of light cycle oil (LCO) as an aromatic additive, were hydrotreated in an experimental plant. Asphaltenes (precipitated from Kuwaiti AR, a hydrotreated AR, and a hydrotreated blend of AR and LCO) were characterised by chemical structure and changes during residue hydrotreatment. The average structural parameters of these asphaltenes, obtained from a combined method of element analysis, average molecular weight, X-ray diffraction, and NMR, demonstrate that, after hydrotreatment, the aromatic cores of the asphaltenes become more compact and smaller whereas the peripheral alkyl branches are decreased in number and shortened. The influence of LCO on residue hydrotreating is also studied in terms of structural changes in the asphaltenes. The findings imply that LCO added to AR during hydrotreating improves the degree of aromatic substitution, the total hydrogen/carbon atomic ratio per average molecule, the distance between aromatic sheets and aliphatic chains, and so forth, by modifying the colloidal nature and microstructure of asphaltene: this is beneficial for the further hydroprocessing of AR. Three hypothetical average molecules are proposed to represent the changes undergone by such asphaltenes during hydrotreatment as well as the effects of additive LCO.

In the title coordination polymer, [Dy2(C6H8O4)(C2O4)2(H2O)2]n, the asymmetric unit consists of one Dy3+ cation, one half of an adipate anion, two halves of oxalate anions and one coordinating water molecule. The adipate and oxalate ions are located on centres of inversion. The Dy3+ cation has a distorted tricapped trigonal–prismatic geometry and is coordinated by nine O atoms, four belonging to three adipate anions, four to two oxalate anions and one from an aqua ligand. The cations are bridged by adipate ligands, generating a two-dimensional network parallel to (010). This network is further extended into three dimensions by coordination of the rigid oxalate ligands and is further consolidated by O—H...O hydrogen bonds. A part of the adipate anion is disordered over two positions in a 0.75:0.25 ratio.

In the polymeric title compound, [Cd(C7H4O6S)(C11H6N2O)(H2O)2]n, the Cd2+ atom is seven-coordinated by two water O atoms, by three O atoms from two 2-hydroxy-5-sulfonatobenzoate (Hssal2−) ligands and by two N atoms from a 4,5-diazafluoren-9-one (Dafo) ligand in a distorted pentagonal–bipyramidal geometry. The Cd2+ atoms are monodentately coordinated by the sulfonate group of one Hssal2− ligand and bidentately coordinated by the carboxylate group of another Hssal2− ligand, generating zigzag chains running parallel to [010]. The chains are linked by O—H...O hydrogen bonds into a three-dimensional architecture.

The gene encoding the GroEL chaperonin is duplicated in nearly 30% of bacterial genomes; and although duplicated groEL genes have been comprehensively determined to have distinct physiological functions in different species, the mechanisms involved have not been characterized to date. Myxococcus xanthus DK1622 has two copies of the groEL gene, each of which can be deleted without affecting cell viability; however, the deletion of either gene does result in distinct defects in the cellular heat-shock response, predation, and development. In this study, we show that, from the expression levels of different groELs, the distinct functions of groEL1 and groEL2 in predation and development are probably the result of the substrate selectivity of the paralogous GroEL chaperonins, whereas the lethal effect of heat shock due to the deletion of groEL1 is caused by a decrease in the total groEL expression level. Following a bioinformatics analysis of the composition characteristics of GroELs from different bacteria, we performed region-swapping assays in M. xanthus, demonstrating that the differences in the apical and the C-terminal equatorial regions determine the substrate specificity of the two GroELs. Site-directed mutagenesis experiments indicated that the GGM repeat sequence at the C-terminus of GroEL1 plays an important role in functional divergence. Divergent functions of duplicated GroELs, which have similar patterns of variation in different bacterial species, have thus evolved mainly via alteration of the apical and the C-terminal equatorial regions. We identified the specific substrates of strain DK1622's GroEL1 and GroEL2 using immunoprecipitation and mass spectrometry techniques. Although 68 proteins bound to both GroEL1 and GroEL2, 83 and 46 proteins bound exclusively to GroEL1 or GroEL2, respectively. The GroEL-specific substrates exhibited distinct molecular sizes and secondary structures, providing an encouraging indication for GroEL evolution for functional divergence.

In the centrosymmetric title compound, [Gd2(C6H8O4)(C2O4)2(H2O)2]n, the Gd3+ cations are each coordinated by nine O atoms, three from adipate anions, two from oxalate anions and one from an aqua ligand, completing a distorted tricapped trigonal-prismatic geometry. These tricapped trigonal prisms are bridged by the adipate ligands, generating layers lying parallel to (010). The coordination polymer layers are linked into a three-dimensional framework by the rigid oxalate ligands. The adipate and oxalate ions are all located on centers of inversion. A part of the adipate anion is disordered over two positions in a 0.75:0.25 ratio.

The crystal structure of the title complex, [Yb2(C8H4O4)2(C2O4)(H2O)2]n, features an extended three-dimensional framework made up of Yb3+ ions coordinated by terephthalate ligands, oxalate ligands and water molecules. The Yb3+ ion has a distorted square-antiprismatic coordination formed by one aqua ligand, two O atoms from an oxalate ligand and five O atoms belonging to four terephthalate anions. Two symmetry-independent terephthalate anions, as well as the oxalate anion, occupy special positions on inversion centers. The water molecule participates in O—H...O hydrogen bonding with both terephthalate anions.

In the title compound, [Lu2(C8H4O4)2(C2O4)(H2O)2]n, the Lu3+ cations are each coordinated by eight O atoms of four terephthalate anions, one oxalate anion and one aqua ligand to complete a distorted square-antiprismatic geometry. They are bridged by the terephthalate ligands, generating a three-dimensional framework, which is further stabilized by the oxalate ligands. The terephthalate ions and oxalate ions are all located on centers of inversion.

In the title compound, [Y2(C4H4O4)2(C2O4)(H2O)2]n, the flexible succinate anion assumes a gauche conformation and bridges the eight-coordinated Y atoms, generating two-dimensional layers parallel to (010). The coordination polymer layers are linked into a three-dimensional framework by the rigid oxalate ligands. The oxalate ions are located on a center of inversion. Intermolecular O—H...O hydrogen bonds help to stabilize the crystal structure.

The title complex, [Sm2(C3H5O2)6(C12H8N2)2], is a dinuclear centrosymmetric molecule, in which two crystallographically equivalent Sm atoms, separated by 3.9502 (2) Å, are bridged by four propanoate anions. Each Sm atom is coordinated by two N atoms from one chelating phenanthroline ligand and seven carboxylate O atoms from five propanoate anions, to form a distorted tricapped trigonal prism.

Abstract Quantum information masking (QIM) allows encoding quantum information in multipartite systems. Complete QIM is of great significance in quantum foundation and application. However, the realization of complete QIM, even for single-qubit encoded information, is still lacking. Here, we propose to demonstrate complete QIM with 4-qubit entangled states. The proposed QIM can be readily extended to multipartite systems with arbitrary number of subsystems, enabling quantum secret sharing (QSS) and quantum teleportation between multiplayers. In experiment, we build up a 4-qubit hyperentangled state to implement complete QIM. The trace distance of 16 encoded single-qubit states falls within the range of 0.12 ± 0.02 to 0.03 ± 0.02. Furthermore, we implement QSS between six players by expanding the 4-qubit state to a 6-qubit state entangled in hybrid manner, in which we observe an average fidelity 0.85 ± 0.03 of the recovered states. Our results open the door towards QIM-enabled quantum information processing and provide applications in quantum communications.

The occurrence of sequelae is common after heatstroke. There is a lack of risk prediction data regarding the prevalence of sequelae. This study aims to develop a predictive model for the sequelae after heatstroke, including cerebellar dysfunction. Heatstroke patients admitted to our hospital in the past 8 years were retrospectively enrolled. Regression analyses were conducted to identify risk factors associated with sequelae and cerebellar dysfunction. A prediction model for post-heatstroke sequelae was developed and internally and externally validated. Twenty-three percent of the patients experienced sequelae, with cerebellar dysfunction accounting for 51.7%. Patients with sequelae had longer duration of hyperthermia and coma, lower Glasgow Coma Scales scores, elevated core temperature, increased incidence of multiple organ dysfunction upon admission, and a worse prognosis compared to non-sequelae patients. Patients with cerebellar injury exhibited impaired balance, and a Sepsis-related Organ Failure Assessment (SOFA) score > 5 is an independent risk factor. The prediction system included advanced age, coma, and an APACHE-II score > 10 upon admission, predicting sensitivity = 0.8966, specificity = 0.8925, and AUC of ROC curve = 0.941 (95% CI: 0.884 ~ 0.976). The C-index in the internal verification was 0.942 (95% CI: 0.847 ~ 0.981) and the AUC in the external verification was 0.816 (95% CI: 0.699 ~ 0.902). The prediction system included advanced age, coma, and higher APACHE-II scores as variables, indicating a significant prevalence of sequelae. Higher SOFA scores were associated with the increased occurrence of cerebellar dysfunction and balance impairment. The prediction system could better predict sequelae after heatstroke.

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.

Objective To explore the relationship between monocyte/high-density lipoprotein cholesterol ratio （MHR） and the progression and prognosis of type 2 diabetic kidney disease （DKD）. Methods From January 1， 2017 to December 31， 2022， 269 type 2 DKD patients were selected as DKD group while 269 healthy medical check-ups during the same period as healthy group. And the differences in MHR levels of two groups were compared. According to median MHR， DKD group were assigned into low-level MHR and high-level MHR sub-groups. General profiles， clinical data， the incidence rate of endpoint events and cumulative renal survival were compared two groups. Cox regression analysis was performed for exploring the independent risk factors for poor renal prognosis in DKD patients and drawing receiver operator characteristic curve （ROC） for exploring the diagnostic efficacy of MHR for poor prognosis of DKD. Results MHR level was higher in DKD group than that in healthy group [0.4918（0.3788，0.6818）×109/mmol vs 0.2984（0.1867，0.4112）×109/mmol] （P＜0.05）； high-level MHR group had higher levels of white blood cells （WBC） [7.70（6.40， 8.70）×109/L vs 6.50（5.40， 8.00）×109/L]， neutrophils （Ne） [4.60（3.60， 5.53）×109/L vs 3.99（3.18， 5.19）×109/L] and monocyte （Mono） [0.69（0.60， 0.70）×109/L vs 0.50（0.40， 0.60）×109/L]， urinary albumin to creatinine ratio （UACR） [1214.59（373.48， 3410.02）mg/g vs 1050.96（180.26， 3341.06） mg/g]， 24 h urine protein （24 hUP） [3.21（1.42， 5.51）g vs 2.66 （0.58， 4.56） g]， low-density lipoprotein cholesterol （LDL-C） [2.72（2.06， 3.40）mmol/L vs 2.23（1.63， 2.80）mmol/L]， serum creatinine （Scr） [152.10（95.20， 221.60）μmol/L vs 126.00（92.48， 186.55）μmol/L] than those in low-level MHR group； lymphocyte （Lym） [1.60（1.27， 2.20）×109/L vs 1.82（1.30， 2.40）×109/L]， high-density lipoprotein cholesterol （HDL-C） [0.94（0.83， 1.07）mmol/L vs 1.39（1.15， 1.65）mmol/L] and estimated glomerular filtration rate （eGFR） [39.69（25.19， 65.10）mL·min−1·（1.73 m²）−1 vs 47.12（28.86， 73.60）mL·min−1·（1.73 m²）−1] were lower than those in low-level MHR group； high-level MHR group had a cumulative kidney survival time and it was shorter than that in low level MHR group [63（39， 72）month vs 72（46， 72）month] （P＜0.05）； MHR was correlated positively with WBC， Ne， Mono， UACR， 24h UP， Scr and LDL-C （P＜0.05） and negatively with Lym， HDL-C， eGFR and cumulative renal survival time （P＜0.05）； the incidence of endpoint events was higher in high-level MHR group than that in low-level MHR group （52.59% vs 38.06%）（P＜0.05）； baseline MHR [0.5492（0.4030， 0.7235）×109/mmol vs 0.4255（0.3117， 0.5134）×109/mmol]， UACR [2062.65（752.80， 4234.80）mg/g vs 608.56（88.63. 1912.44）mg/g]， 24 hUP [3.79（2.54， 5.53）g vs 1.58（0.39， 4.85）g] and Scr [178.40（134.00， 234.23）μmol/L vs 100.95（74.25， 152.10）μmol/L] were higher than those in DKD patients without endpoint events； eGFR was lower than that in DKD patients without endpoint events [33.45（23.33， 46.41）mL·min−1·（1.73 m²）−1 vs 61.59（38.57， 95.98）mL·min−1·（1.73 m²）−1]（P＜0.05）. The results of Cox regression analysis indicated that MHR was an independent risk factor for a poor prognosis of DKD； The results of ROC curve showed that the area under the curve of MHR was 0.747 with a sensitivity of 0.820 and a specificity of 0.605. Conclusion DKD patients tend to have higher levels of MHR as compared with healthy individuals. As an independent risk for the progression of renal function in DKD patients， MHR has some diagnostic value for a poor prognosis of DKD. However， its specificity is not high.

Background:. The occurrence of blindness resulting from facial injection is a catastrophic complication that remains a significant safety concern for patients. The aim was to assess public awareness of blindness caused by hyaluronic acid injection. Methods:. The Tencent questionnaire platform was used to gather self-reported demographic data, information about injection experience, and factors influencing the understanding of blindness. Additionally, we included an educational section on blindness caused by hyaluronic acid injection and evaluated the respondents’ intention to undergo injections. Results:. A total of 1000 respondents completed the questionnaire, 15.4% had received filler injections, and 53.7% expressed their consideration of facial filler injections. The majority of respondents (68.3%) reported being aware of the risk of blindness associated with filler injections, with professional health blogs, social media, and news serving as the primary sources of information. Furthermore, 93.4% of the respondents believed that plastic surgeons should discuss the risk of blindness with patients before injection. Conclusions:. The majority of the respondents in this study were aware of the possibility of blindness resulting from filler injections. Health blogs, news outlets, and social media platforms are likely the primary channels through which the public obtains information on this topic.

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.