Effectiveness of the varicella vaccine in the real world, a matched case-control study.

BACKGROUND: Universal varicella vaccination has been introduced in many countries, but there are a number of important differences in their vaccination strategies. It is essential to establish a vaccination program that can maximize the benefits of varicella vaccine, but there is a lack of comprehensive research on the effectiveness of varicella vaccine in different vaccination status. METHODS: Using data from population-based surveillance platforms we conducted a 1:2 matched case-control study. The cases were clinically diagnosed varicella with onset from 2017 to 2021, 1-14 years old in Chaoyang District, Beijing. The controls were matched according to date of birth (±1 month), sex and residence. The vaccination data of the subjects were obtained from the Childhood Immunization Information Management System in Beijing. Using conditional logistic regression models with or without interaction terms, we evaluated the effectiveness of varicella vaccine in different vaccination status. RESULTS: A total of 2528 cases and 5056 controls were enrolled. This study found that whether the time since last vaccination was adjusted had a substantial effect on the comparing vaccine effectiveness (VE) between subgroups. After adjustment for the time since last vaccination, 1) the incremental VE of 2-dose was 49.6 % (95 % Confidence Interval [CI], 38.8-58.6) compared with 1-dose (93.9 % vs. 88.0 %); 2) Among children who received one dose, the risk of chickenpox in children vaccinated at 18-23 months was 1.382 (95 %CI, 1.084-1.762) times that in children vaccinated at 12-17 months. 3) the VE with less than one, two, and three year intervals is higher than that with six-year-intervals (P < 0.05), respectively. CONCLUSIONS: When comparing VE between subgroups of different vaccination status, the time since last vaccination should be adjusted. The first dose of varicella vaccine should be given as early as the second year of life, and the second dose can improve vaccine effectiveness.

Thermal conduction force under standing and quasistanding temperature field.

Thermal conduction force plays a crucial role in manipulating the local thermal conductivity of crystals. However, due to the diffusive nature of thermal conduction, investigating the force effect is challenging. Recently, researchers have explored the force effect based on the wavelike behavior of thermal conduction, specifically second sound. However, their focus has been primarily on the progressive case, neglecting the more complex standing temperature field case. Additionally, establishing a connection between the results obtained from the progressive case and the standing case poses a challenging problem. In this study, we investigate the force effect of standing and quasistanding temperature fields, revealing distinct characteristics of thermal conduction force. Moreover, we establish a link between the progressive and standing cases through the quasistanding case. Our findings pave the way for research in more intricate scenarios and provide an additional degree of freedom for manipulating the local thermal conductivity of dielectric crystals.

TPDC: Point Cloud Completion by Triangular Pyramid Features and Divide-and-Conquer in Complex Environments.

Point cloud completion recovers the complete point clouds from partial ones, providing numerous point cloud information for downstream tasks such as 3-D reconstruction and target detection. However, previous methods usually suffer from unstructured prediction of points in local regions and the discrete nature of the point cloud. To resolve these problems, we propose a point cloud completion network called TPDC. Representing the point cloud as a set of unordered features of points with local geometric information, we devise a Triangular Pyramid Extractor (TPE), using the simplest 3-D structure-a triangular pyramid-to convert the point cloud to a sequence of local geometric information. Our insight of revealing local geometric information in a complex environment is to design a Divide-and-Conquer Splitting Module in a Divide-and-Conquer Splitting Decoder (DCSD) to learn point-splitting patterns that can fit local regions the best. This module employs the Divide-and-Conquer approach to parallelly handle tasks related to fitting ground-truth values to base points and predicting the displacement of split points. This approach aims to make the base points align more closely with the ground-truth values while also forecasting the displacement of split points relative to the base points. Furthermore, we propose a more realistic and challenging benchmark, ShapeNetMask, with more random point cloud input, more complex random item occlusion, and more realistic random environmental perturbations. The results show that our method outperforms both widely used benchmarks as well as the new benchmark.

Electronic Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: Long-Term Results of a Multicenter, Randomized, Controlled Trial.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported superior symptom control of electronic patient-reported outcome (ePRO)-based symptom management after lung cancer surgery for up to 1 month postdischarge. Here, we present the long-term results (1-12 months) of this multicenter, randomized trial, where patients were assigned 1:1 to receive postoperative ePRO-based symptom management or usual care daily postsurgery, twice weekly postdischarge until 1 month, and at 3, 6, 9, and 12 months postdischarge. Long-term patient-reported outcomes were assessed with MD Anderson Symptom Inventory-Lung Cancer module. Per-protocol analyses were performed with 55 patients in the ePRO group and 57 in the usual care group. At 12 months postdischarge, the ePRO group reported significantly fewer symptom threshold events (any of the five target symptom scored ≥4; median [IQR], 0 [0-0] v 0 [0-1]; P = .040) than the usual care group. From 1 to 12 months postdischarge, the ePRO group consistently reported significantly lower composite scores for physical interference (estimate, -0.86 [95% CI, -1.32 to -0.39]) and affective interference (estimate, -0.70 [95% CI, -1.14 to -0.26]). Early intensive ePRO-based symptom management after lung cancer surgery reduced symptom burden and improved functional status for up to 1 year postdischarge, supporting its integration into standard care.

Comparative characteristics of early-onset vs. late-onset advanced colorectal cancer: a nationwide study in China.

BACKGROUND: The incidence of early-onset colorectal cancer (EOCRC, diagnosed in patients under the age of 50 years) has been increasing around the world. Here, we aimed to systematically identify distinctive features of EOCRC. METHODS: From 2020 to 2021, we conducted a nationwide survey in 19 hospitals, collecting data on advanced CRC patients' demographics, clinical features, disease knowledge, medical experiences, expenditures, and health-related quality of life (HRQOL). We compared these features between EOCRC and late-onset colorectal cancer (LOCRC, ≥ 50 years old) groups and analyzed the association between EOCRC and HRQOL using multivariate linear regression. FINDINGS: In total, 991 patients with EOCRC and 3581 patients with LOCRC were included. Compared to the LOCRC group, the EOCRC group had higher levels of education, were more informed about the risk factors for CRC, were more likely to have widespread metastases throughout the body, were more inclined to undergo gene testing, and were more likely to opt for targeted therapy, radiotherapy, and chemotherapy. However, HRQOL in the EOCRC group was similar to that of the LOCRC group, and no significant association was observed between EOCRC and HRQOL (beta: -0.753, P value: 0.307). INTERPRETATION: In Chinese patients, EOCRC patients had more aggressive features. Despite undergoing more intensified treatments and gene testing, they had similar HRQOL compared with LOCRC. These findings advocate for a more tailored approach to treatment, especially for young CRC patients with advanced TNM stages and metastasis.

Quantum annealing of a frustrated magnet.

Quantum annealing, which involves quantum tunnelling among possible solutions, has state-of-the-art applications not only in quickly finding the lowest-energy configuration of a complex system, but also in quantum computing. Here we report a single-crystal study of the frustrated magnet α-CoV2O6, consisting of a triangular arrangement of ferromagnetic Ising spin chains without evident structural disorder. We observe quantum annealing phenomena resulting from time-reversal symmetry breaking in a tiny transverse field. Below ~ 1 K, the system exhibits no indication of approaching the lowest-energy state for at least 15 hours in zero transverse field, but quickly converges towards that configuration with a nearly temperature-independent relaxation time of ~ 10 seconds in a transverse field of ~ 3.5 mK. Our many-body simulations show qualitative agreement with the experimental results, and suggest that a tiny transverse field can profoundly enhance quantum spin fluctuations, triggering rapid quantum annealing process from topological metastable Kosterlitz-Thouless phases, at low temperatures.

Factors Influencing Breast Cancer Awareness in Rural Southwest China: A Cross-Sectional Study.

Background: This study aimed to explore the current knowledge level of breast cancer among rural women in Southwest China and analyze the influencing factors of breast cancer cognition. Methods: From May to November 2022, 1468 rural women were invited to participate in this study. Demographic information and the Chinese version of the Breast Cancer Awareness Measure (C-BCAM) were collected through one-on-one investigations. The data were analyzed using descriptive statistics, chi-square tests, and multiple regression analysis in SPSS 26.0. Results: The study included a total of 1468 rural women with a median age of 54.0 (IQR, 47.0, 60.0).The average score of breast cancer in the study population was 73.0 (IQR, 66.0, 82.0). Among women in Southwest China, the awareness rates of knowledge on breast cancer symptoms, barriers to seeking medical help, and risk factors were 68.8%, 98.4%, and 62.1%, respectively. The awareness rate was found to increase with higher education levels (P<0.001) and decrease with increasing age (P<0.001). Multivariate logistic regression analysis identified three variables that might influence breast cancer awareness: education level, contraceptive measures, and history of breast disease (all P<0.05). Specifically, history of breast disease (Odds ratio (OR) = 1.907, 95% CI = 1.128 ~ 3.223), middle school education (OR = 2.155, 95% CI = 1.585 ~ 2.928), and junior college education and above (OR = 5.536, 95% CI = 1.898 ~ 16.148) were positive factors for women's breast cancer awareness. Conversely, the use of intrauterine devices (OR = 0.523, 95% CI = 0.384 ~ 0.712) was found to be a negative factor for women's breast cancer awareness. Conclusion: This study highlights the insufficient awareness of breast cancer among women in rural area of Southwest China. It emphasizes the necessity of health education to improve female breast cancer awareness.

Deep learning based automatic internal gross target volume delineation from 4D-CT of hepatocellular carcinoma patients.

BACKGROUND: The location and morphology of the liver are significantly affected by respiratory motion. Therefore, delineating the gross target volume (GTV) based on 4D medical images is more accurate than regular 3D-CT with contrast. However, the 4D method is also more time-consuming and laborious. This study proposes a deep learning (DL) framework based on 4D-CT that can achieve automatic delineation of internal GTV. METHODS: The proposed network consists of two encoding paths, one for feature extraction of adjacent slices (spatial slices) in a specific 3D-CT sequence, and one for feature extraction of slices at the same location in three adjacent phase 3D-CT sequences (temporal slices), a feature fusion module based on an attention mechanism was proposed for fusing the temporal and spatial features. Twenty-six patients' 4D-CT, each consisting of 10 respiratory phases, were used as the dataset. The Hausdorff distance (HD95), Dice similarity coefficient (DSC), and volume difference (VD) between the manual and predicted tumor contour were computed to evaluate the model's segmentation accuracy. RESULTS: The predicted GTVs and IGTVs were compared quantitatively and visually with the ground truth. For the test dataset, the proposed method achieved a mean DSC of 0.869 ± 0.089 and an HD95 of 5.14 ± 3.34 mm for all GTVs, with under-segmented GTVs on some CT slices being compensated by GTVs on other slices, resulting in better agreement between the predicted IGTVs and the ground truth, with a mean DSC of 0.882 ± 0.085 and an HD95 of 4.88 ± 2.84 mm. The best GTV results were generally observed at the end-inspiration stage. CONCLUSIONS: Our proposed DL framework for tumor segmentation on 4D-CT datasets shows promise for fully automated delineation in the future. The promising results of this work provide impetus for its integration into the 4DCT treatment planning workflow to improve hepatocellular carcinoma radiotherapy.

Effect of isotretinoin on CYP2D6 and CYP3A activity in patients with severe acne.

AIMS: Previously, retinoids have decreased CYP2D6 mRNA expression in vitro and induced CYP3A4 in vitro and in vivo. This study aimed to determine whether isotretinoin administration changes CYP2D6 and CYP3A activities in patients with severe acne. METHODS: Thirty-three patients (22 females and 11 males, 23.5 ± 6.0 years old) expected to receive isotretinoin treatment completed the study. All participants were genotyped for CYP2D6 and CYP3A5. Participants received dextromethorphan (DM) 30 mg orally as a dual-probe substrate of CYP2D6 and CYP3A activity at two study timepoints: pre-isotretinoin treatment and with isotretinoin for at least 1 week. The concentrations of isotretinoin, DM and their metabolites were measured in 2-h postdose plasma samples and in cumulative 0-4-h urine collections using liquid chromatography-mass spectrometry. RESULTS: In CYP2D6 extensive metabolizers, the urinary dextrorphan (DX)/DM metabolic ratio (MR) (CYP2D6 activity marker) was numerically, but not significantly, lower with isotretinoin administration compared to pre-isotretinoin (geometric mean ratio [GMR] [90% confidence interval (CI)] 0.78 [0.55, 1.11]). The urinary 3-hydroxymorphinan (3HM)/DX MR (CYP3A activity marker) was increased (GMR 1.18 [1.03, 1.35]) and the urinary DX-O-glucuronide/DX MR (proposed UGT2B marker) was increased (GMR 1.22 [1.06, 1.39]) with isotretinoin administration compared to pre-isotretinoin. CONCLUSIONS: Administration of isotretinoin did not significantly reduce CYP2D6 activity in extensive metabolizers, suggesting that the predicted downregulation of CYP2D6 based on in vitro data does not translate into humans. We observed a modest increase in CYP3A activity (predominantly CYP3A4) with isotretinoin treatment. The data also suggest that DX glucuronidation is increased following isotretinoin administration.

Multi-scale feature selection network for lightweight image super-resolution.

Recently, many super-resolution (SR) methods based on convolutional neural networks (CNNs) have achieved superior performance by utilizing deep and heavy models, which may not be suitable for real-world low-budget devices. To address this issue, we propose a novel lightweight SR network called a multi-scale feature selection network (MFSN). As the basic building block of MFSN, the multi-scale feature selection block (MFSB) is presented to extract the rich multi-scale features from a coarse-to-fine receptive field level. For a better representation ability, a wide-activated residual unit is adopted in each branch of MFSB except the last one. In MFSB, the scale selection module (SSM) is designed to effectively fuse the features from two adjacent branches by adjusting receptive field sizes adaptively. Further, a comprehensive channel attention mechanism (CCAM) is integrated into SSM to learn the dynamic selection weight by considering the local and global inter-channel dependencies. Extensive experimental results illustrate that the proposed MFSN is superior to other lightweight methods.

Modular hierarchical reinforcement learning for multi-destination navigation in hybrid crowds.

Real-world robot applications usually require navigating agents to face multiple destinations. Besides, the real-world crowded environments usually contain dynamic and static crowds that implicitly interact with each other during navigation. To address this challenging task, a novel modular hierarchical reinforcement learning (MHRL) method is developed in this paper. MHRL is composed of three modules, i.e., destination evaluation, policy switch, and motion network, which are designed exactly according to the three phases of solving the original navigation problem. First, the destination evaluation module rates all destinations and selects the one with the lowest cost. Subsequently, the policy switch module decides which motion network to be used according to the selected destination and the obstacle state. Finally, the selected motion network outputs the robot action. Owing to the complementary strengths of a variety of motion networks and the cooperation of modules in each layer, MHRL is able to deal with hybrid crowds effectively. Extensive simulation experiments demonstrate that MHRL achieves better performance than state-of-the-art methods.

Dose-related effects of norepinephrine on early-stage endotoxemic shock in a swine model.

Background: The benefits of early use of norepinephrine in endotoxemic shock remain unknown. We aimed to elucidate the effects of different doses of norepinephrine in early-stage endotoxemic shock using a clinically relevant large animal model. Methods: Vasodilatory shock was induced by endotoxin bolus in 30 Bama suckling pigs. Treatment included fluid resuscitation and administration of different doses of norepinephrine, to induce return to baseline mean arterial pressure (MAP). Fluid management, hemodynamic, microcirculation, inflammation, and organ function variables were monitored. All animals were supported for 6 h after endotoxemic shock. Results: Infused fluid volume decreased with increasing norepinephrine dose. Return to baseline MAP was achieved more frequently with doses of 0.8 µg/kg/min and 1.6 µg/kg/min (P <0.01). At the end of the shock resuscitation period, cardiac index was higher in pigs treated with 0.8 µg/kg/min norepinephrine (P <0.01), while systemic vascular resistance was higher in those receiving 0.4 µg/kg/min (P <0.01). Extravascular lung water level and degree of organ edema were higher in animals administered no or 0.2 µg/kg/min norepinephrine (P <0.01), while the percentage of perfused small vessel density (PSVD) was higher in those receiving 0.8 µg/kg/min (P <0.05) and serum lactate was higher in the groups administered no and 1.6 µg/kg/min norepinephrine (P <0.01). Conclusions: The impact of norepinephrine on the macro- and micro-circulation in early-stage endotoxemic shock is dose-dependent, with very low and very high doses resulting in detrimental effects. Only an appropriate norepinephrine dose was associated with improved tissue perfusion and organ function.

Direct observation of intrinsic room-temperature ferroelectricity in 2D layered CuCrP2S6.

Multiferroic materials have ignited enormous interest owing to their co-existence of ferroelectricity and ferromagnetism, which hold substantial promise for advanced device applications. However, the size effect, dangling bonds, and interface effect in traditional multiferroics severely hinder their potential in nanoscale device applications. Recent theoretical and experimental studies have evidenced the possibility of realizing two-dimensional (2D) multiferroicity in van der Waals (vdW) layered CuCrP2S6. However, the incorporation of magnetic Cr ions in the ferroelectric framework leads to antiferroelectric and antiferromagnetic orderings, while macroscopic spontaneous polarization is always absent. Herein, we report the direct observation of robust out-of-plane ferroelectricity in 2D vdW CuCrP2S6 at room temperature with a comprehensive investigation. Modification of the ferroelectric polarization states in 2D CuCrP2S6 nanoflakes is experimentally demonstrated. Moreover, external electric field-induced polarization switching and hysteresis loops are obtained in CuCrP2S6 down to ~2.6 nm (4 layers). By using atomically resolved scanning transmission electron microscopy, we unveil the origin of the emerged room-temperature ferroelectricity in 2D CuCrP2S6. Our work can facilitate the development of multifunctional nanodevices and provide important insights into the nature of ferroelectric ordering of this 2D vdW material.

Visible-Light-Driven α-Substituted Amines Enabled by In Situ Formation of Amine Substrate Aggregates.

A visible-light-driven, photocatalyst-free, air-promoted, α-substituted reaction of amines with varying nucleophiles is described. The amine substrate aggregates formed in situ through physical π-π stacking by H2O regulation in organic solvent can absorb visible light and then generate iminium ion intermediates, which undergo nucleophilic substitution reactions with varying nucleophiles to afford α-substituted amines. This reaction features catalyst-free, good functional group tolerance, simple operation procedure, and green reaction conditions.

The Stress Phase Angle Measurement Using Spectral Domain Optical Coherence Tomography.

The stress phase angle (SPA), defined as the temporal phase angle between circumferential stress (CS) in the arterial wall and wall shear stress (WSS), is utilized to investigate the interactions between CS and WSS. SPA serves as an important parameter for the early diagnosis of cardiovascular disease. In this study, we proposed a novel method for measuring SPA using spectral domain optical coherence tomography (SD-OCT). The multi-M-mode scan strategy is adopted for interference spectrum acquisition. The phases of CS and WSS are extracted from the corresponding structural and flow velocity images of SD-OCT. The method is validated by measuring SPA in the outflow tract (OFT) of chick embryonic hearts and the common carotid artery of mice. To the best of our knowledge, this is the first time that OCT has been used for SPA measurement.

Frustrated magnetism of the spin-1 kagome antiferromagnetß-BaNi3(VO4)2(OH)2.

We propose the newly synthesizedß-BaNi3(VO4)2(OH)2(space group:R3‾m) as a candidate for the spin-1 kagome Heisenberg antiferromagnet (KHA). The compound features a uniform kagome lattice of Ni2+(S= 1) ions with a large interlayer distance. High-field measurements at low temperatures reveal a susceptibility local minimum at ∼9 T, resembling a 1/3 magnetization plateau as predicted by the pureS= 1 KHA model. Below ∼6 K, approximately 1% of the spins exhibit spin-glass order, which may be attributed to the nanocrystalline grain size of ∼50 nm. Despite the antiferromagnetic exchange coupling strength of ∼7 K, the majority of spins remain disordered down to ∼0.1 K as indicated by the observed power-law behaviors in magnetic specific heatCm∝T1.4. Our results demonstrate that the low-energy magnetic excitations inß-BaNi3(VO4)2(OH)2are gapless, which contradicts the current theoretical expectations of the ideal model.

Study of Foveal Avascular Zone Growth in Individuals With Mild Diabetic Retinopathy by Optical Coherence Tomography.

Purpose: The purpose of this study was to investigate the association between foveal vessels and retinal thickness in individuals with diabetic retinopathy (DR) and control subjects, and to reveal foveal avascular zone (FAZ) growth in early individuals with DR. Methods: The regions with a thickness less than 60 µm were marked from the intima thickness maps and named FAZThic. The avascular zones extracted from the deep vascular plexus were designated as FAZAngi. The boundary of the two FAZ forms a ring region, which we called FAZRing. The FAZ growth rate was defined as the ratio of the FAZRing area to the FAZThic area. Thirty healthy controls and 30 individuals with mild nonproliferative DR were recruited for this study. Results: The FAZThic area in individuals with mild DR and control subjects showed similar distribution. The FAZAngi area in individuals with mild DR are higher than that in control subjects on the whole, but there was no significant difference (P > 0.05). The FAZRing area in individuals with mild DR was significantly higher than that in control subjects (P < 0.001). However, there is still a small amount of overlap data between the two groups. For the FAZ growth rate, the individuals with mild DR were also significantly larger than the control subjects (P < 0.001). But there were no overlapping data between the two groups. Conclusions: The growth of FAZ in individuals with mild DR can be inferred by comparing FAZAngi with FAZThic. This method minimizes the impact of individual variations and helps researchers to understand the progression mechanism of DR more deeply.

Involvement in treatment decision-making and self-reported efficacy among patients with advanced colorectal cancer: a nationwide multi-center cross-sectional study.

Introduction: This cross-sectional study evaluated the involvement of patients with advanced colorectal cancer (CRC) in treatment decision-making, assessed the treatment efficacy according to their self-reports, and investigated the influencing factors. Methods: Patients with advanced CRC were recruited from 19 hospitals from March 2020 to March 2021 by a multi-stage multi-level sampling method. A self-designed questionnaire was used to collect demographic and clinical characteristics, involvement of CRC patients in treatment decision-making, treatment methods, and self-reported efficacy. Univariate and unordered multinomial logistic regression analyses were used to evaluate the factors affecting the involvement in treatment decision-making and self-reported efficacy. Results: We enrolled 4533 patients with advanced CRC. The average age at diagnosis was 58.7 ± 11.8 years. For the treatment method, 32.4% of patients received surgery combined with chemotherapy, 13.1% of patients underwent surgery combined with chemotherapy and targeted therapy, and 9.7% of patients were treated with surgery alone. For treatment decision-making, 7.0% of patients were solely responsible for decision-making, 47.0% of patients shared treatment decision-making with family members, 19.0% of patients had family members solely responsible for treatment decision-making, and 27.0% of patients had their physicians solely responsible for treatment decision-making. Gender, age, education level, family income, marital status, treatment cost, hospital type, and treatment method were significantly associated with the involvement of patients in treatment decision-making. A total of 3824 patients submitted self-reported efficacy evaluations during treatment. The percentage of patients with good self-reported efficacy was 76.5% (for patients treated for the first time), 61.7% (for patients treated for the second time), and 43.2% (for patients treated after recurrence and metastasis), respectively. Occupation, education level, average annual family income, place of residence, time since cancer diagnosis, hospital type, clinical stage, targeted therapy, and involvement in treatment decision-making were the main influencing factors of self-reported efficacy of treatment. Discussion: Conclusively, CRC patients are not highly dominant in treatment decision-making and more likely to make treatment decisions with their family and doctors. Timely and effective communication between doctors and patients can bolster patient involvement in treatment decision-making.

Achieving reinforcement learning in a three-active-terminal neuromorphic device based on a 2D vdW ferroelectric material.

Currently, for most three-terminal neuromorphic devices, only the gate terminal is active. The inadequate modes and freedom of modulation in such devices greatly hinder the implementation of complex neural behaviors and brain-like thinking strategies in hardware systems. Taking advantage of the unique feature of co-existing in-plane (IP) and out-of-plane (OOP) ferroelectricity in two-dimensional (2D) ferroelectric α-In2Se3, we construct a three-active-terminal neuromorphic device where any terminal can modulate the conductance state. Based on the co-operation mode, controlling food intake as a complex nervous system-level behavior is achieved to carry out positive and negative feedback. Specifically, reinforcement learning as a brain-like thinking strategy is implemented due to the coupling between polarizations in different directions. Compared to the single modulation mode, the chance of the agent successfully obtaining the reward in the Markov decision process is increased from 68% to 82% under the co-operation mode through the coupling effect between IP and OOP ferroelectricity in 2D α-In2Se3 layers. Our work demonstrates the practicability of three-active-terminal neuromorphic devices in handling complex tasks and advances a significant step towards implementing brain-like learning strategies based on neuromorphic devices for dealing with real-world challenges.