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The development and application of lithium (Li) anode is hindered by volumetric variation, dendritic Li growth, and parasitic reactions. Herein, a dual-phase Li-barium (Ba) alloy with self-assembled microchannels array is synthesized through a one-step thermal fusion method to investigate the inhibition effect of lithiophilic composite porous array on Li dendrites. The Li-rich Li-Ba alloy (BaLi24) as composite Li electrode exhibits an ordered porous structure of BaLi 4 intermetallic compound after delithiation, which acts as a built-in 3D current collector during Li plating/striping process. Furthermore, the lithiophilic BaLi 4 alloy scaffold is a mixed conductor, featuring with Li + ions diffusion capability, which can efficiently transport the reduced Li to the interior of the electrode structure. This unique top-down growth mode can effectively prohibit Li dendrites growth and improve the space utilization of 3D electrode structure. The spin-polarized density functional theory (DFT) calculations suggest that the absorption capability of BaLi 4 benefits the deposition of Li metal. As a result, the cell performance with the dual-phase Li-Ba alloy anode is significantly improved., (© 2023 Wiley‐VCH GmbH.)

Abstract Objective To characterize the retinal microvasculature and structure in subjective cognitive decline (SCD) and identify the potential biomarker for the early stage of the Alzheimer's disease (AD) spectrum. Methods In this study, 35 patients with SCD, 36 with cognitive impairment, and 29 with normal cognition (NC) were enrolled. Optical coherence tomography angiography was employed to assess retinal vascular density, fovea avascular zone area, and retinal thickness. The parameters reflecting retinal perfusion and structure were compared among the three groups. In addition, the association between retinal parameters, cerebral blood flow (CBF), and peripheral blood biomarkers in the SCD stage was analyzed. Results The superficial vascular complex (SVC) vascular density in the macula and retinal nerve fiber layer thickness in the peripapillary were significantly reduced in individuals with SCD compared to NC. Furthermore, there was a positive correlation between macular ganglion cell complex thickness and CBF in SCD. Interpretation The retinal microvasculature and structure exhibit alterations in individuals with SCD. Macular ganglion cell complex thickness demonstrates correlations with cerebral perfusion. The retina holds potential as a novel biomarker for early detection of AD.

Arterial agenesis is a rare condition and has been reported to affect the internal carotid artery, common carotid artery, and pulmonary artery. However, to the best of our knowledge, it has not yet been reported to affect the subclavian arteries. We present a case of asymptomatic bilateral subclavian artery agenesis and left subclavian artery aneurysm. This patient's abnormal vasculature was found incidentally. Despite being asymptomatic, repair of the aneurysm via vertebral transposition and ligation of the subclavian artery was performed to prevent eventual thrombosis, emboli, and stroke.

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital, autosomal-dominant disorder characterized by a triad of macrocephaly, lipomatosis, and pigmentation of the glans penis. The symptoms of this rare syndrome vary greatly and include multiple hamartomatous polyps, macrocephaly, increased birth weight, developmental delay, and intellectual disability. Vascular abnormalities, including arteriovenous malformations (AVMs), have rarely been reported as part of the vascular manifestations associated with BRRS. Congenital AVMs can rarely progress, resulting in limb- or life-threatening complications. We present the case of a young man with BRRS diagnosed in childhood and presenting with three AVMs involving the right upper extremity and chest. We also provide a brief literature summary of reported cases of BRRS with AVMs. Our paper highlights the importance of recognizing and understanding the vascular manifestations in patients with BRRS. Knowledge of the association between BRRS and AVMs is crucial for guiding patient diagnosis and management, optimizing treatment strategies, and improving overall patient outcomes.

Fever is one of the most common clinical conditions and is characterized by pyrogenic infection, malignancy, inflammation, and tissue damage, among others. Ellagic acid (EA) can inhibit the expression of related proteins on the pathway by blocking the nuclear factor kappa-B(NF-κB) signaling pathway, inhibit the levels of pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α), increase the level of anti-inflammatory factor IL-10, and effectively alleviate inflammatory symptoms. In addition, EA can also reduce the levels of malondialdehyde(MDA) and nitric oxide(NO) in the body, increase the activities of superoxide dismutase (SOD), glutathione (GSH), and catalase(CAT), scavenge oxidative free radicals, inhibit lipid oxidation, and achieve antipyretic and anti-inflammatory effects. The purpose of this study was to establish the relationship between EA and various inflammatory markers, such as TNF-α, IL-6, IL-1β, prostaglandin E2(PGE2), and cyclic adenosine monophosphate(cAMP), and clarify the mechanism of the cyclooxidase-2(COX-2)/NF-κB signaling pathway. Combined with the metabolomics analysis, our study revealed the effects of EA on multiple endogenous biomarkers, reflecting the characteristics of a multi-component, multi-target, and multi-pathway mechanism. Compared to lipopolysaccharide (LPS)- treated animals, subsequent administration of EA significantly lowered the LPS-induced rectal temperature increase (p < 0.05 or p < 0.01), significantly increased serum SOD and GSH levels (p < 0.05 or p < 0.01), and significantly decreased serum MDA, IL-1β, IL-6, and TNF-α levels (p < 0.05 or p < 0.01). In addition, compared to LPS-treated animals, subsequent administration of EA significantly decreased cerebrospinal fluid cAMP and PGE2 levels (p < 0.05 or p < 0.01), significantly decreased cAMP, significantly increased 5-HT levels (p < 0.05 or p < 0.01), and significantly down-regulated p-NF-κB p65 and COX-2 protein levels in the hypothalamus. Subsequent gas chromatography mass spectrometry(GC-MS) metabolite analysis indicated that 12 differential metabolites were detected in serum isolated 4 h after LPS treatment, and 10 differential metabolites were detected in serum collected 7 h after LPS treatment. Next, Pearson correlation analysis was used to systematically characterize the relationship between the identified metabolites and TNF-α, IL-6, MDA, SOD, PGE2, and cAMP. The levels of propionic acid, pyridine, and L-valine were up-regulated by EA, which inhibited the expression of MDA, IL-1β, and TNF-α and increased the activity of GSH. The levels of inositol, urea, and 2-monopalmitin were down-regulated by EA, which inhibited the expression of MDA, IL-1β, and TNF-α, increased the activity of SOD and GSH, reduced the inflammatory response, and alleviated the oxidative stress state. Combined with the results of the metabolic pathway analysis, we suggest that the pathways of the galactose metabolism, synthesis and degradation of ketone bodies, as well as ascorbic acid and aldehyde acid metabolism are closely related to the antipyretic and anti-inflammatory effects of EA. Our study established the relationship between EA and various inflammatory markers, such as TNF-α, IL-6, IL-1β, PGE2, and cAMP, and clarified the mechanism of the COX-2/NF-κB signaling pathway. Combined with the metabolomics analysis, our study revealed the effects of EA on multiple endogenous biomarkers, reflecting the characteristics of a multi-component, multi-target, and multi-pathway mechanism.

In order to investigate the hydrogen embrittlement sensitivity of the low-grade pipeline steel in medium-pressure hydrogen environment，the hydrogen embrittlement sensitivity of L245 steel in air environment and 4 MPa hydrogen environment was studied by smooth and notched slow tensile tests，combined with macroscopic and microscopic fracture characterization and analysis.Results showed that the loss rates of tensile strength，area reduction，and elongation of the L245 steel smooth samples under slow stretching in 4 MPa hydrogen were 5.2%，4.8%，and -0.1%，respectively.However，the loss rates of tensile strength，area reduction and tensile displacement of the notched samples under slow stretching in 4 MPa hydrogen were 19.1%，45.6%and 15.4%，respectively，indicating the occurrence of hydrogen embrittlement.The slow tensile fracture mode of the L245 steel smooth sample in air was ductile fracture.After the notch was opened，the crack source of the smooth samples started at a certain position of the notch and expanded inward in the way of quasi-cleavage fracture，accelerating the fracture process of the sample，but the overall fracture method was still ductile fracture.In contrast，the crack source generated at the necking position when the L245 steel smooth sample was exposed to 4 MPa hydrogen.After the notch was opened，a significant increase in the quasi-cleavage fracture area generated from the notch position towards the interior，which rapidly accelerated the fracture process，and the hydrogen-induced ductile fracture occurred in the center.The fracture mode of L245 steel after notch opening in 4 MPa hydrogen gas was a combination of quasicleavage fracture and hydrogen induced ductile fracture.

Applicants in the 2020-2021 residency interview cycle were unable to attend in-person meetings or visit prospective sites of future training. Instead, they relied on printed or digital media for information. Over the past few years, many graduate medical education programs have increased the use of social media to disseminate information to attract and retain faculty, staff, and trainees. Previous studies have quantified the relative presence of social media in residency programs, but there has been limited work on the assessment of social media platforms that applicants use to evaluate internal medicine programs. To more effectively target residency applicants through social media, we sought to understand the use of social media in general and specifically in the residency application process of an incoming intern class recruited during the 2020-2021 interview season. We administered an anonymous survey after matching to a single institution’s 2021 class of 40 internal medicine interns in both categorical and preliminary tracks. The group surveyed came from US medical schools (MD and DO degrees) and international programs. The group surveyed comprised 66% women and 16.7% underrepresented groups as defined by Association of American Medical Colleges guidelines. Our data found that the internal medicine residency applicants mostly used hospital websites and Instagram to evaluate programs. Twitter, which is often assumed to be highly used in academic circles, was rarely used. Our work suggests that a better understanding of the use of digital resources by applicants can allow programs to reach residency applicants in a meaningful way.

In order to find the optimum solvent for the growth of nonlinear optical β-BaB2O4 crystals, the phase relationships in the ternary reciprocal system Li, Ba // BO2, F have been studied using solid state synthesis, differential thermal analysis and X-ray powder diffraction. Isothermal and polythermal sections of the system Li, Ba // BO2, F are reported. In the studied system, the following compounds are formed: LiBa2B5O10 (melts by peritectic reaction at 930°C, i.e. 1203 K) and LiBaF3 (melts incongruently at 850°C, i.e. 1123 K). Visual polythermal analysis of seeding and growth of β-BaB2O4 crystals in this system was carried out. The primary crystallization field of β-BaB2O4 was defined. Using the top-seeded pulling technique, a β-BaB2O4 crystal of 93 mm in diameter, 34 mm in height and 520 g in weight has been grown. [ABSTRACT FROM AUTHOR]

Understanding of the extent of cation disorder and its effect on the properties in glasses and melts is among the fundamental puzzles in glass sciences, materials sciences, physical chemistry, and geochemistry. Particularly, the nature of chemical ordering in mixed-cation silicate glasses is not fully understood. The Li-Ba silicate glass with significant difference in the ionic radii of network-modifying cations (~0.59 Å) is an ideal system for revealing unknown details of the effect of network modifiers on the extent of mixing and their contribution to the cation mobility. These glasses also find potential application as energy and battery materials. Here, we report the detailed atomic environments and the extent of cation mixing in Li-Ba silicate glasses with varying XBaO [BaO/(Li2O + BaO)] using high-resolution solid-state nuclear magnetic resonance (NMR) spectroscopy. The first 17O MAS and 3QMAS NMR spectra for Li-Ba silicate glasses reveal the well-resolved peaks due to bridging oxygen (Si-O-Si) and those of the nonbridging oxygens including Li-O-Si and mixed {Li, Ba}-O-Si. The fraction of Li-O-Si decreases with an increase in XBaO and is less than that predicted by a random Li-Ba distribution. The result demonstrates a nonrandom distribution of Li+ and Ba+ around NBOs characterized by a prevalence of the dissimilar Li-Ba pair. Considering the previously reported experimental results on chemical ordering in other mixed-cation silicate glasses, the current results reveal a hierarchy in the degree of chemical order that increases with an increase in difference in ionic radius of the cation in the glasses [e.g., K-Mg (~0.66 Å) ≈Ba-Mg (~0.63 Å) ≈Li-Ba (~0.59 Å) > Na-Ba (~0.33 Å) > Na-Ca (~0.02 Å)]. The 7Li MAS NMR spectra of the Li-Ba silicate glasses show that the peak maximum increases with increasing XBaO, suggesting that the average Li coordination number and thus Li-O distance decrease slightly with increasing XBaO, potentially leading to an increased activation energy barrier for Li diffusion. Current experimental results confirm that the degree of chemical ordering due to a large difference in ionic radii controls the transport properties of the mixed-cation silicate glasses. [ABSTRACT FROM AUTHOR]

Abstract Aim To examine and analyze the level of spiritual care competency among community nurses. Design The study employed a cross‐sectional design. Methods From May to July 2022, 442 nurses from community health clinics were chosen as survey respondents using the convenience sample method. The General Information Questionnaire, the version in Chinese of the Nurses' Spiritual Caregiving Awareness Scale and the Chinese version of the Spiritual Caregiving Competence Scale were used in the survey. There were 442 questionnaires distributed, 422 were collected, and the response rate was 95.4%. Results The amount of spiritual care competencies of community nurses was positively correlated with the level of spiritual awareness. Simultaneously, their level of education, religious beliefs, marital status and the degree of knowledge of spirituality were all influenced.

Conventional quality control methodologies are inadequate for fully elucidating the aberrant patterns of product quality. A multitude of factors influence product quality, yet the limited number of controlled quality characteristics is insufficient for accurately diagnosing quality abnormalities. Additionally, there are asymmetries in data collection, data pre-processing, and model interpretation. In this context, a quality anomaly recognition and diagnosis model for the complex product manufacturing process is constructed based on a deep residual network, support vector machine (SVM), and Shapley additive explanation (SHAP). Given the numerous complex product quality characteristic indexes and unpredictable accidental factors in the production process, it is necessary to mine the deep relationship between quality characteristic data and quality state. This mining is achieved by utilizing the strong feature extraction ability of the deep residual shrinkage network (DRSN) through self-learning. The symmetry of the data within the model has also been taken into account to ensure a more balanced and comprehensive analysis. The excellent binary classification ability of the support vector machine is combined with the DRSN to identify the quality anomaly state. The SHAP interpretable model is employed to diagnose the quality anomaly problem of a single product and to identify and diagnose quality anomalies in the manufacturing process of complex products. The effectiveness of the model is validated through case analysis. The accuracy of the DRSN-SVM quality anomaly recognition model reaches 99%, as demonstrated by example analysis, and the model exhibits faster convergence and significantly higher accuracy compared with the naive Bayesian model classification and support vector machine classification models.

ObjectiveThe objective of this study was to explore the learning preferences and habits of medical students during the pandemic home e-learning, and to investigate the incidence of adverse emotions, optimistic character level and coping style. To explore the influencing factors of adverse emotions.MethodsA cross-sectional survey was conducted in China from March to June 2022. Medical students were recruited from three universities in China, and a questionnaire survey was conducted. The questionnaires consisted of a “e-learning preferences and habits questionnaire”, life orientation test questionnaire (LOT-R), and simple coping style questionnaire (SCSQ). Finally, a total of 492 medical students who met the inclusion and exclusion criteria became the research subjects and completed the survey.ResultsA total of 57.7% believed they experienced no adverse emotions during home e-learning. ① During the COVID-19 pandemic, the score of optimistic personality of medical students was (7.25 ± 1.933), and the score of pessimistic personality was (5.82 ± 2.240). The score of positive coping was (21.75 ± 5.379), and the score of negative coping was (11.75 ± 3.611). ② The occurrence of medical students' adverse emotions during e-learning was influenced by “Whether there is a private, quiet space to study”, “Degree of knowledge mastery”, “Physical discomfort or not”, “Keep a regular schedule or not”, “Optimistic personality tendency”.ConclusionThis study demonstrates the during home e-learning, most medical students have their own learning equipment and can meet their learning needs. Their favorite mobile device to use is a mobile phone, and their favorite method of teaching is to provide course playback. More than half of medical students believe that they have some inconvenience in conducting research during home e-learning. With regard to teacher's real-time screen, the largest number of medical students support teachers turning on live screens so that they feel like they are interacting with the teacher. The preference for blended teaching is highest among medical students. In general, medical students were highly adaptive of the newest e-learning approach. Based on the statistic analysis, the factors that “Whether there is a private, quiet space to study”, “Degree of knowledge mastery”, “Physical discomfort or not”, “Keep a regular schedule or not”, and “Optimistic personality tendency” may be the influencing factors for the occurrence of adverse emotions.

PurposeTo investigate the effective connectivity (EC) changes after multisite repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training (COG).MethodWe selected 51 patients with mild or moderate Alzheimer's disease (AD) and delivered 10 Hz rTMS over the left dorsal lateral prefrontal cortex (DLPFC) and the lateral temporal lobe (LTL) combined with COG or sham stimulation for 4 weeks. The selected AD patients were divided into real (real rTMS+COG, n = 11) or sham (sham rTMS+COG, n = 8) groups to undergo neuropsychological assessment, resting-state fMRI, and 3D brain structural imaging before (T0), immediately at the end of treatment (T4), and 4 weeks after treatment (T8). A 2 × 3 factorial design with “time” as the within-subjects factor (three levels: T0, T4, and T8) and “group” as the between-subjects factor (two levels: real and sham) was used to investigate the EC changes related to the stimulation targets in the rest of the brain, as well as the causal interactions among seven resting-state networks based on Granger causality analysis (GCA).ResultsAt the voxel level, the EC changes from the left DLPFC out to the left inferior parietal lobe and the left superior frontal gyrus, as well as from the left LTL out to the left orbital frontal cortex, had a significant group × time interaction effect. At the network level, a significant interaction effect was identified in the increase in EC from the limbic network out to the default mode network. The decrease in EC at the voxel level and the increase in EC at the network level were both associated with the improved ability to perform activities of daily living and cognitive function.ConclusionMultisite rTMS combined with cognitive training can modulate effective connectivity in patients with AD, resulting in improved ability to perform activities of daily living and cognitive function.

Purpose: To determine the treatment patterns and outcomes of pediatric retinal detachments (RDs) associated with hereditary vitreoretinopathies. Design: Retrospective cohort analysis using IRIS® Registry (Intelligent Research in Sight) database. Participants: Patients < 18 years old with a rhegmatogenous RD and a systemic disorder associated with vitreoretinal degeneration (e.g., Stickler syndrome) or other malformation of the vitreous from 2013-2019. Methods: Cases were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9, ICD-10) diagnostic codes from the IRIS® Registry cohort. Other hereditary vitreoretinopathies that are not encoded by specific ICD code(s) were captured by text search. Nonspecific vitreous abnormality ICD codes were also included. Exclusion criteria included traumatic retinal detachments using ICD codes for ocular trauma and serous or exudative retinal detachment. Surgical procedures were identified using Current Procedural Terminology (CPT) codes for repair of retinal detachment. Baseline demographic information collected included age, gender, race/ethnicity, geographic region of the provider location, and health insurance status. Main Outcome Measures: Main outcomes measured in this study were average time to first surgery, number of eyes presenting with bilateral detachments, and choice of initial surgical procedure. Results: A total of 2115 eyes of 1722 patients were identified (mean age, 10.4 years; 58% male). The median time to first surgery was 7 days (interquartile range, 40 days). One thousand four hundred seven eyes of 1134 patients had ≥ 1 year of follow-up, with 506 eyes (36%) developing a fellow eye RD. Thirty-three percent of patients presenting with bilateral detachments, and 349 eyes had initial RD surgery within 1 year of the index date documented by CPT code. Fellow eye detachment occurred a mean of 32 days after initial presentation. The mean number of surgeries per eye within 1 year was 1.68. Best-corrected visual acuity did not improve from a baseline 20/54 to 20/62. The initial procedure was most commonly complex RD repair (n = 176), followed by scleral buckle (n = 102), pars plana vitrectomy (n = 89), laser (n = 59), cryotherapy (n = 5), and pneumatic retinopexy (n = 5). There were 51 new diagnoses of glaucoma and 37 new diagnoses of aphakia within 1 year after the surgical procedure. Conclusions: IRIS Registry data provide insight into rare pediatric vitreoretinopathy-associated RDs, which have a high rate of reoperation and fellow eye involvement. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.