Performance Assessment of GPT 4.0 on the Japanese Medical Licensing Examination.

OBJECTIVE: To evaluate the accuracy and parsing ability of GPT 4.0 for Japanese medical practitioner qualification examinations in a multidimensional way to investigate its response accuracy and comprehensiveness to medical knowledge. METHODS: We evaluated the performance of the GPT 4.0 on Japanese Medical Licensing Examination (JMLE) questions (2021-2023). Questions are categorized by difficulty and type, with distinctions between general and clinical parts, as well as between single-choice (MCQ1) and multiple-choice (MCQ2) questions. Difficulty levels were determined on the basis of correct rates provided by the JMLE Preparatory School. The accuracy and quality of the GPT 4.0 responses were analyzed via an improved Global Qualily Scale (GQS) scores, considering both the chosen options and the accompanying analysis. Descriptive statistics and Pearson Chi-square tests were used to examine performance across exam years, question difficulty, type, and choice. GPT 4.0 ability was evaluated via the GQS, with comparisons made via the Mann-Whitney U or Kruskal-Wallis test. RESULTS: The correct response rate and parsing ability of the GPT4.0 to the JMLE questions reached the qualification level (80.4%). In terms of the accuracy of the GPT4.0 response to the JMLE, we found significant differences in accuracy across both difficulty levels and option types. According to the GQS scores for the GPT 4.0 responses to all the JMLE questions, the performance of the questionnaire varied according to year and choice type. CONCLUSION: GTP4.0 performs well in providing basic support in medical education and medical research, but it also needs to input a large amount of medical-related data to train its model and improve the accuracy of its medical knowledge output. Further integration of ChatGPT with the medical field could open new opportunities for medicine.

Causal association of immune cells and endometritis: a Mendelian randomization study.

Research exploring the link between immune cell profiles and the development of endometritis remains scant. This gap necessitates further study to decode the complex interrelations influencing this condition. In this analysis, we leveraged two-sample Mendelian randomization to examine the causal ties between the phenotypes of immune cells and the incidence of endometritis. Our evaluation hinged on data from 3757 participants hailing from Sardinia, focusing on a diverse array of 731 immune phenotypes, and cross-referenced with endometritis data sourced from the UK Biobank. To ensure rigor, we performed sensitivity analyses, utilized MR-Egger and MR-Presso to check for pleiotropy, and applied Cochran's Q test for assessing the heterogeneity of our findings. Our investigation identified numerous immune characteristics associated with endometritis. For certain immune traits, a lower risk of endometritis was observed, including: Absolute Counts of CD39 + CD4 + T cells, CD25 + CD39 + CD4 regulatory T cells, and CD25 + + CD8 + T cells; Absolute Counts of Switched Memory B cells; CD19 expression on IgD + CD38dim and Switched Memory B cells; CD20 expression on IgD + CD38- Unswitched Memory B cells; percentage of Switched Memory B cells among lymphocytes; CD16-CD56 expression on HLA DR + Natural Killer cells; percentage of CD11c + CD62L- monocytes; CD86 expression on monocytes; CCR2 expression on CD14 + CD16 + monocytes; and CD14 expression on Monocytic Myeloid-Derived Suppressor Cells, with Odds Ratios (ORs) between 0.413 and 0.703. On the contrary, increased risks of endometritis were linked with: the percentage of Effector Memory CD4 + T cells within the CD4 + T cell population; percentages of HLA DR + T cells and HLA DR + CD8 + T cells among T cells; CD4 expression on CD28 + CD4 + T cells; CD20 expression on CD20- CD38- B cells; percentage of IgD + CD24 + B cells within the B cell population; CD62L expression on CD62L + myeloid Dendritic Cells; and Absolute Counts of Plasmacytoid Dendritic Cells, with ORs from 1.473 to 2.677, indicating these traits potentially elevate the risk of developing endometritis. Our research delineates distinct causal links between specific immune cell phenotypes and endometritis, offering new perspectives that could contribute to the pinpointing of new therapeutic avenues for this condition.

Enhancing Orthopedic Knowledge Assessments: The Performance of Specialized Generative Language Model Optimization.

OBJECTIVE: This study aimed to evaluate and compare the effectiveness of knowledge base-optimized and unoptimized large language models (LLMs) in the field of orthopedics to explore optimization strategies for the application of LLMs in specific fields. METHODS: This research constructed a specialized knowledge base using clinical guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and authoritative orthopedic publications. A total of 30 orthopedic-related questions covering aspects such as anatomical knowledge, disease diagnosis, fracture classification, treatment options, and surgical techniques were input into both the knowledge base-optimized and unoptimized versions of the GPT-4, ChatGLM, and Spark LLM, with their generated responses recorded. The overall quality, accuracy, and comprehensiveness of these responses were evaluated by 3 experienced orthopedic surgeons. RESULTS: Compared with their unoptimized LLMs, the optimized version of GPT-4 showed improvements of 15.3% in overall quality, 12.5% in accuracy, and 12.8% in comprehensiveness; ChatGLM showed improvements of 24.8%, 16.1%, and 19.6%, respectively; and Spark LLM showed improvements of 6.5%, 14.5%, and 24.7%, respectively. CONCLUSION: The optimization of knowledge bases significantly enhances the quality, accuracy, and comprehensiveness of the responses provided by the 3 models in the orthopedic field. Therefore, knowledge base optimization is an effective method for improving the performance of LLMs in specific fields.

Association between frailty and suicidal ideation in older adults: A cross-sectional study.

OBJECTIVES: This study seeks to investigate the potential correlation between various levels of frailty and suicidal ideation (SI) in older adults from the USA. METHODS: Our cross-sectional study extracted data on adults ≥60 years from the NHANES in 2005-2018. Frailty levels were assessed by computing the Frailty Index, classifying individuals into robust, prefrail, and frail categories. SI was evaluated utilizing Item #9 of PHQ-9. Logistic regression and restricted cubic splines were employed for analysis. RESULTS: The analysis comprised 8564 participants, revealing that 3.3% reported experiencing SI. The association between frailty and SI in older adults was statistically significant in crude model (OR: 5.94, 95% CI: 3.46-11.27, P < 0.001). Upon adjusting for baseline characteristics, the association remained robust (AOR: 5.35, 95% CI: 3.09-10.19, P < 0.001). Model II did not substantially alter the association between frailty and SI after further adjustment for lifestyle factors (AOR: 5.23, 95% CI: 3.02-9.98, P < 0.001). In a sensitivity analysis controlling for depression, the association remained statistically significant (AOR:3.62, 95%CI: 1.76-8.75, P = 0.001). Furthermore, the associations between the Frailty Index and SI were pronounced in the restricted cubic spline (RCS) models (P overall < 0.001, P nonlinearity = 0.771). CONCLUSION: Frailty appears to heighten vulnerability to suicidal ideation in older adults. Training healthcare professionals to identify and address mental health issues related to frailty is crucial. Through comprehensive intervention measures, we can better safeguard the mental well-being of older adults and reduce the risk of suicide.

Higher socioeconomic status is associated with higher ultra-processed food intake: a cross-sectional analysis.

OBJECTIVE: To explore the differences in ultra-processed food (UPF) consumption across different socioeconomic status (SES) levels. METHODS: Data on UPF consumption (grams/day) were derived from the 2017-2018 National Health and Nutrition Examination Survey. The analysis controlled for age, marital status, race, and sex. A restricted cubic spline (RCS) model was applied to examine the nonlinear response curve. RESULTS: UPF consumption increased with higher poverty income ratio (PIR), the ratio of household income to the established poverty line. Compared to the low PIR group, the medium group showed a non-significant increase (ß = 34.23[95%CI: -28.81, 97.28], p = 0.287), while the high group exhibited a significant increase (ß = 115.15[95%CI: 43.53, 186.76], p = 0.002). A linear positive correlation was observed in RCS analysis (p-nonlinear = 0.166, p-overall < 0.001). CONCLUSIONS: The study highlights that higher SES is associated with greater consumption of UPF in the US. The findings suggest that policy interventions should take SES into consideration.

Current Status of Nursing Home Distribution in China: A National Cross-Sectional Study.

AIMS: Population aging is a challenge that the whole world is facing, especially in China. This study aims to investigate the current distribution status of nursing homes in China using spatial epidemiology methods. DESIGN: Cross-sectional study in China. METHODS: The data were obtained from the Integrated Civil Affairs Government Service Platform 'China County Statistical Yearbook' for 2020 and the 'China City Statistical Yearbook' for 2020. Using global Moran's index to test the clustering of nursing homes, inter-group and intra-group Theil index was utilised to differentiate the sources of differences. The coupling coordination analysis was conducted to explore the coordination. Geographically weighted regression was utilised to investigate the impact of economic development and aging on nursing home resources. All analyses were conducted by Arcgis 10.8 and R Studio 4.3.2. RESULTS: Global Moran's index indicated that the distribution of nursing homes in China exhibited clustering. The Theil index values for institutions and beds at the national county were 0.32450 and 0.30675. However, upon comparing provinces and regions, it was found that the differences across the country mainly stem from within provinces (contribution rate: institutions 65.0%; beds 73.0%) and within regions (contribution rate: institutions 99.0%; beds 91.0%). The majority of districts and counties had a coupling coordination index of institutions and bed numbers, both of which were < 0.5. CONCLUSION: The development of nursing home resources in China has been rapid, generally presenting a balanced state, but further optimisation is needed. This study established a foundation for the targeted distribution of essential public services, focusing on nursing home healthcare resources tailored to the needs of older persons. IMPLICATIONS: The study underscored the urgent need for targeted elderly care policies, emphasising the optimisation of resource distribution to enhance the overall quality of care provided to the aging population. NO PATIENTS OR PUBLIC CONTRIBUTION: The study did not involve humans.

Adrenal Vein Sampling for Primary Aldosteronism: Recommendations From the Australian and New Zealand Working Group.

Adrenal vein sampling (AVS) is the current recommended procedure for identifying unilateral subtypes of primary aldosteronism (PA), which are amenable to surgery with the potential for cure. AVS is a technically challenging procedure usually undertaken by interventional radiologists at tertiary centres. However, there are numerous variations in AVS protocols relating to patient preparation, sampling techniques and interpretation which may impact the success of AVS and patient care. To reduce practice variations, improve the success rates of AVS and optimise patient outcomes, we established an Australian and New Zealand AVS Working Group and developed evidence-based expert consensus recommendations for the preparation, performance and interpretation of AVS. These recommendations can be used by all healthcare professionals in a multidisciplinary team who look after the diagnosis and management of PA.

Planar Tetracoordinate Silicon in Si3Cu3- Cluster.

Photoelectron spectroscopy and theoretical calculations have identified the global minimum structure of the 16-valence electron Si3Cu3- cluster, which features a planar tetracoordinate silicon (ptSi) in a rhombic arrangement. The Si3 and Cu3 triangles are interconnected by an Si2/Cu2 edge, forming an ordered chain-like structure. Besides the conventional 2c-2e σ-bond connecting Si3 and Cu3, the stability of this cluster is reinforced by a delocalized 3c-2e σ-bond in Cu3 and a π-bond in Si3. Our study provides rare experimental confirmation of a planar hypercoordinate heavier Group 14 element, opening possibilities for exploring similar structures in two-dimensional materials.

Exploring the effects of pemetrexed on drug resistance mechanisms in human lung adenocarcinoma and its association with PGRMC1.

According to the 2022 cancer statistics of the World Health Organization, lung cancer ranks among the top ten causes of death, with lung adenocarcinoma being the most prevalent type. Despite significant advancements in lung cancer therapeutics, many clinical limitations remain, primarily due to the development of drug resistance. The present study investigated the effects of pemetrexed on the drug resistance mechanisms in human lung adenocarcinoma and its association with progesterone receptor membrane component 1 (PGRMC1) expression. Given that KRAS-mutant lung adenocarcinoma cell lines (e.g., A549) exhibit a high folate synthesis activity, pemetrexed, which is structurally similar to folate, was selected as the therapeutic drug. The present study used a lung adenocarcinoma cell line (A549) and established a drug-resistant lung adenocarcinoma cell line (A549/PEM). The findings demonstrated that PGRMC1 expression was elevated in the A549/PEM cells. It has been hypothesized that PGRMC1 regulates iron absorption through heme binding, resulting in a preference for iron-related cell death pathways (ferroptosis). Our findings indicate that drug-resistant lung adenocarcinoma cells with high PGRMC1 levels exhibit elevated antioxidant activity on the cell membrane and increased reliance on iron-dependent cell death pathways. This suggests a correlation between PGRMC1 and pemetrexed-induced iron-dependent cell death. Our study contributes to the development of more effective therapeutic strategies to improve the prognosis of patients with lung adenocarcinoma, particularly those facing drug resistance challenges.

Integrated induction of silver resistance determinants and production of extracellular polymeric substances in Cupriavidus metallidurans BS1 in response to silver ions and silver nanoparticles.

Although the antimicrobial mechanisms of nanomaterials have been extensively investigated, bacterial defense mechanisms associated with AgNPs have not been fully elucidated. We here report that dissolved Ag+ (>0.05 µg mL-1) displayed higher toxicity on cell growth of strain Cupriavidus metallidurans BS1 (GCA_003260185.2) in comparison to 2 and 20 nm AgNPs. The genes necessary for synthesis of distinct abundance and composition of extracellular polymeric substances (EPS) were induced in strain BS1 exposed to Ag stress. This resulted in 20.1% (Ag(I)-EPS) and 24.2% (2 nm AgNPs-EPS) of the CO band integrated intensities being converted into C-OH/C-O-C group vibrations and the Ag-O bond was formed between EPS and 20 nm AgNPs. Meanwhile, the expression of primary resistance genes of the cus, sil and cup operon encoding HME-RND-driven efflux systems as well as a PIB1-type ATPase (CupA) were significantly induced after exposure to Ag(I), 2 and 20 nm AgNPs, respectively. Furthermore, distinct genes involved in biosynthesis pathways responsible for production of EPS were induced to relieve the toxicity of Ag(I), 2 nm and 20 nm AgNPs. This combined action is one potential reason why strain BS1 displayed distinct resistances in response to Ag(I) compared to 2 and 20 nm AgNPs. This work will help in understanding processes important in bacterial defensive mechanisms to AgNPs.

Chinese Herbal Compound Xiaoliu Pingyi Recipe Inhibits the Growth of Lung Adenocarcinoma by Regulating the Tumor Vascular Microenvironment.

BACKGROUND: The traditional Chinese medicine (TCM) Xiaoliu Pingyi recipe (XLPYR) has been clinically used for several decades, demonstrating favorable therapeutic effects. However, the underlying regulatory mechanisms remain unclear. The aim of this study was to explore the anti-tumor effects of XLPYR and its regulatory role in the vascular microenvironment through in vivo and in vitro experiment. MATERIALS AND METHODS: In the in vivo study, a C57BL/6J mouse model of lung adenocarcinoma (LUAD) allografts was established, and various interventions were administered for 14 days (Model group: administered normal saline via oral gavage; Pemetrexed (PEM) group: intraperitoneally injected with a solution of pemetrexed, once every 3d; XLPYR group: administered XLPYR via oral gavage; Combination (COMBI) group: received XLPYR via oral gavage simultaneously with intraperitoneal injection of pemetrexed solution). Tumor volume and weight were then compared among the groups. The impact of XLPYR on the tumor vascular microenvironment was assessed using immunohistochemistry staining. In the in vitro study, XLPYR-containing serum was prepared by oral administration to SD rats. The CCK-8 assay evaluated the effect of the serum on the proliferation of normal lung epithelial BEAS-2B cells and LUAD A549 cells, determining the optimal intervention concentrations. The cell migration and invasion abilities were evaluated using the wound-healing assay and Transwell assay, respectively. Finally, ELISA assay measured VEGF secretion levels in the LUAD cell supernatant, and RT-qPCR and Western Blot were employed to detect differences in HIF-1α, VEGFA, Ang-2, and PI3K/Akt mRNA and protein expression levels in both in vivo and in vitro experiments. RESULTS: In the in vivo study, XLPYR significantly inhibited the growth of mice LUAD allografts, with enhanced anti-tumor effects observed with prolonged drug intervention. Immunohistochemistry staining revealed reduced MVD and increased pericyte coverage in all intervention groups. Regarding vascular function, FITC-Dextran extravasation in the tumor tissues of the Model group was significantly higher than in the intervention groups, particularly with lower extravasation in the COMBI group compared to the PEM group. In the in vitro study, XLPYR demonstrated a time- and concentration-dependent inhibitory effect on LUAD cells, and with greater sensitivity in inhibiting LUAD cells compared to BEAS-2B cells. The wound-healing assay and Transwell assay confirmed that XLPYR significantly suppressed the migration and invasion abilities of LUAD cells. ELISA experiments further revealed a significant decrease in VEGF expression in the supernatant of each intervention group. RT-qPCR and Western Blot results showed consistent findings between the in vivo and in vitro experiments. HIF-1α, VEGFA, and Ang-2 mRNA and protein expression levels were significantly downregulated in the PEM group, XLPYR group, and COMBI group. There were no significant differences in the expression of PI3K and Akt mRNA and total protein, but the expression levels of phosphorylated p-PI3K and p-Akt were notably downregulated. CONCLUSION: XLPYR significantly inhibited C57BL/6J mouse LUAD allograft growth and improved the vascular microenvironment, thereby intervening in tumor angiogenesis and inducing vascular normalization. It suppressed LUAD cell proliferation, migration, and invasion, while reducing VEGF concentration in the cell supernatant. The regulatory mechanism may involve inhibiting PI3K/Akt protein phosphorylation and downregulating angiogenesis-related factors, such as HIF-1α, VEGF, and Ang-2.

Salivary Protein Sfapyrase of Spodoptera frugiperda Stimulates Plant Defence Response.

Plants have developed various resistance mechanisms against herbivorous insects through prolonged coevolution. Plant defence responses can be triggered by specific compounds present in insect saliva. Apyrase, a known enzyme that catalyzes the hydrolysis of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) into adenosine monophosphate (AMP) and inorganic phosphorus, has recently been identified in some herbivorous insects. However, whether insect salivary apyrase induces or inhibits plant responses remains poorly understood. In this study, we identified an apyrase-like protein in the salivary proteome of the fall armyworm, Spodoptera frugiperda, named Sfapyrase. Sfapyrase was primarily expressed in the salivary gland and secreted into plants during insect feeding. Transient expression of Sfapyrase in tobacco and maize enhanced plant resistance and resulted in decreased insect feeding. Knockdown of Sfapyrase through RNA interference led to increased growth and feeding of S. frugiperda. Furthermore, we showed that Sfapyrase activates the jasmonic acid signalling pathway and promotes the synthesis of secondary metabolites, especially benzoxazinoids, thereby enhancing resistance to S. frugiperda. In summary, our findings demonstrated that Sfapyrase acts as a salivary elicitor, inducing maize jasmonic acid defence responses and the production of insect-resistant benzoxazinoids. This study provides valuable insights into plant-insect interactions and offers potential targets for developing innovative insect pest management strategies.

Anatomical Posterior Acetabular Plate Versus Conventional Reconstruction Plates for Acetabular Posterior Wall Fractures: A Comparative Study.

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d'Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d'Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes.

Brain-computer Interaction in the Smart Era.

The brain-computer interface (BCI) system serves as a critical link between external output devices and the human brain. A monitored object's mental state, sensory cognition, and even higher cognition are reflected in its electroencephalography (EEG) signal. Nevertheless, unprocessed EEG signals are frequently contaminated with a variety of artifacts, rendering the analysis and elimination of impurities from the collected EEG data exceedingly challenging, not to mention the manual adjustment thereof. Over the last few decades, the rapid advancement of artificial intelligence (AI) technology has contributed to the development of BCI technology. Algorithms derived from AI and machine learning have significantly enhanced the ability to analyze and process EEG electrical signals, thereby expanding the range of potential interactions between the human brain and computers. As a result, the present BCI technology with the help of AI can assist physicians in gaining a more comprehensive understanding of their patients' physical and psychological status, thereby contributing to improvements in their health and quality of life.

Periodic Domain Inversion in Single Crystal Barium Titanate-on-Insulator Thin Film.

Experimentally achieving the first-ever electric field periodic poling of single crystal barium titanate oxide (BTO, or BaTiO3) thin film on-insulator is reported. Owing to the outstanding optical nonlinearities of BTO, this result is a key step toward achieving quasi-phase-matching (QPM). First, the BTO thin film is grown on a dysprosium scandate substrate using pulsed laser deposition with a thin layer of strontium ruthenate later serving as the bottom electrode for poling. The characterization of the BTO thin film using x-ray diffraction (XRD) and piezo-response force microscopy to demonstrate single crystal, single domain growth of the film that enables the desired periodic poling, are presented. To investigate the poling quality, both non-destructive piezo force response microscopy and destructive etching-assisted scanning electron microscopy (SEM) are applied, and it is shown that high quality, uniform, and intransient poling with 50% duty cycle and periods ranging from 2 µm to 10 µm is achieved. The successful realization of periodic poling in BTO thin film unlocks the potential for highly efficient nonlinear processes under QPM that seemed far-fetched with prior polycrystalline BTO thin films which predominantly relied on efficiency-limited random or non-phase matching conditions and is a key step toward integration of BTO photonic devices.

Empathy as a Mediator of the Relation between Peer Influence and Prosocial Behavior in Adolescence: A Meta-Analysis.

During adolescence, empathy and prosocial behavior contribute to the establishment of positive interpersonal relationships and social connections, promoting holistic development in youth. A substantial amount of research has provided compelling evidence that there is a relationship between peer relationships and empathy and prosocial behavior. Empathy, as a key mediating factor, links the influence of peers with prosocial behavior in adolescents, yet there is currently a lack of robust meta-analytic evidence regarding this mediating role. This study employed a two-stage structural equation modeling approach to synthesize existing research on peer influence, empathy, and prosocial behavior during adolescence. Systematic searches were conducted across three databases (PubMed, Web of Science, and PsycINFO), identifying a total of 49 studies, with a systematic assessment of study quality. The results indicated that empathy plays a mediating role between peer influence and prosocial behavior. Positive peer influence is positively correlated with empathy and prosocial behavior, while negative peer influence is negatively correlated with empathy and prosocial behavior, and empathy is positively correlated with prosocial behavior. This meta-analysis demonstrates that during adolescence, empathy mediates the connection between peer influence and prosocial behavior, representing a potential process that can explain the relationship between peer influence and prosocial behavior.

Contributions of individual qSOFA elements to assessment of severity and for prediction of mortality.

BACKGROUND: The quick sequential [sepsis-related] organ failure assessment (qSOFA) acts as a prompt to consider possible sepsis. The contributions of individual qSOFA elements to assessment of severity and for prediction of mortality remain unknown. METHODS: A total of 3974 patients with community-acquired pneumonia were recruited to an observational prospective cohort study. The area under the receiver operating characteristic curve (AUROC), odds ratio, relative risk and Youden's index were employed to assess discrimination. RESULTS: Respiratory rate ≥22/min demonstrated the most superior diagnostic value, indicated by largest odds ratio, relative risk and AUROC, and maximum Youden's index for mortality. However, the indices for altered mentation and systolic blood pressure (SBP) ≤100 mm Hg decreased notably in turn. The predictive validities of respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg were good, adequate and poor for mortality, indicated by AUROC (0.837, 0.734 and 0.671, respectively). Respiratory rate ≥22/min showed the strongest associations with SOFA scores, pneumonia severity index, hospital length of stay and costs. However, SBP ≤100 mm Hg was most weakly correlated with the indices. CONCLUSIONS: Respiratory rate ≥22/min made the greatest contribution to parsimonious qSOFA to assess severity and predict mortality. However, the contributions of altered mentation and SBP ≤100 mm Hg decreased strikingly in turn. It is the first known prospective evidence of the contributions of individual qSOFA elements to assessment of severity and for prediction of mortality, which might have implications for more accurate clinical triage decisions.

Respiratory rate ≥22/min demonstrated the most superior diagnostic value.Respiratory rate ≥22/min showed the strongest association with severity.Respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg predicted mortality well, adequately and poorly, respectively.

Suicide in China: The Trends and Differentials From 2002 to 2021.

OBJECTIVE: The objective of this study was to provide an updated analysis of suicide characteristics in China from 2002 to 2021, with the aim of informing the development of evidence-based suicide prevention strategies. METHODS: The Ministry of Health-Vital Registration System (MOH-VR) provided the data on suicide mortality, which enabled us to examine the average annual percentage change (AAPC) in suicide rates using a Poisson regression model. RESULTS: Notably, there has been a significant decline in suicide rates observed in both urban and rural areas. In the early years of the study period, higher suicide rates were observed among females compared to males; however, a shift occurred after 2005, with male suicide rates surpassing those of females. Except for 2005, rural areas consistently exhibited higher suicide rates than urban areas. Furthermore, suicide rates exhibited an increasing trend with age, irrespective of gender or region. CONCLUSION: These findings highlight a decreasing trend in suicide rates in China over the past two decades, although gender and regional disparities persist. Going forward, sustained efforts in suicide prevention, with a specific focus on mental health, are warranted.

Effects of rootstocks and developmental time on the dynamic changes of main functional substances in 'Orah' (Citrus reticulata Blanco) by HPLC coupled with UV detection.

Introduction: Citrus fruit is rich in important functional constituents such as flavonoids, phenolic acids terpenes and other functional substances that play an important role for treating clinical diseases or controlling major agricultural diseases and pests. Plant secondary metabolites have become one of the most important resources of novel lead compounds, especially young citrus fruits contain multiple functional substances. 'Orah', a type of citrus reticulata, is known for its fine appearance, productivity, delicious sweetness, late-maturing characteristics, and is widely cultivated in China. Fruit thinning and rootstock selection are commonly used agronomic measures in its production to ensure its quality and tree vigor. However, few studies have demonstrated the effects of these agronomic measures on the functional substances of 'Orah'. Methods: In this study, we used HPLC coupled with UV to detect the dynamic changes of fruit quality, 13 main flavonoids, 7 phenolic acids, 2 terpenes, synephrine and antioxidant capacity in both peel and pulp of citrus fruits grafted on four rootstocks (Red orange Citrus reticulata Blanco cv. red tangerine, Ziyang xiangcheng Citrus junos Sieb. ex Tanaka, Trifoliate orange Poncirus trifoliata L. Raf, and Carrizo citrange Citrus sinensis Osb.×P.trifoliate Raf) at six different developmental stages (from 90 DAF to 240 DAF). Results: The results indicated that rootstock can significantly affect the contents of functional constituents and antioxidant capacity in 'Orah'. Additionally, it was found that pruning at either 90 DAF (days after flowering) or 150 DAF produced the most favorable outcomes for extracting functional substances. We also identified rootstock 'Trifoliate orange' has the highest total soluble solids (TSS) and 'Ziyang xiangcheng' to be the optimal in terms of comprehensive sensory of fruit quality, while 'Red orange' and 'Ziyang xiangcheng' are optimal in terms of functional substance quality, and 'Red orange' excels in antioxidant capacity. Discussion: Overall, the findings demonstrate the important role of rootstocks and developmental stage in shaping fruit sensory quality and functional substance synthesis, providing valuable insights for guiding rootstock selection, determining thinning time, and utilizing pruned fruits in a more informed manner.