A strategy for boosting photovoltaic performance based on a two-dimensional ZrSSe/HfSSe van der Waals heterostructure.

Identifying high-efficiency solar photovoltaic systems with two-dimensional (2D) materials is still an urgent challenge to meet modern energy requirements. Very recently, a 2D heterostructure with type-II band alignment has been confirmed to be more favorable for application in photoelectric conversion. However, the staggered band offset of 2D type-II heterostructures cannot always be guaranteed, nor the intrinsic hindrance mechanism of carrier recombination being clear. In this study, taking the emerging ZrSSe/HfSSe van der Waals heterostructure (vdWH) as a generic example, a boosting strategy for improving the photoelectric performances of 2D vdWHs is proposed. Through a series of in-depth systematic research studies based on first-principles, we demonstrate that via applying a vertical strain, an anticipated band alignment transition from type-I to favorable type-II of this ZrSSe/HfSSe vdWH can be induced due to the interfacial charge redistribution, during which a corresponding enlarged photocurrent can be detected from the latter based device compared to the former. Essentially, such enhanced photocurrent at the incident photon energy (Eph) around the band gap is attributed to the suppressed recombination rate of photoexcited carriers. Moreover, when Eph is increased into the visible light region, the photoelectric conversion performances can be further controlled by vertical strain. These generalized findings not only provide an effective manipulation strategy for enhancing the performances of 2D solar photovoltaic systems, but the intrinsic physical mechanism can also be extended to the next practical design and regulation of other 2D photovoltaic devices.

Development, scrutiny, and modulation of transient reporter gene assays of the xenobiotic metabolism pathway in zebrafish hepatocytes.

The "toxicology in the twenty-first century" paradigm shift demands the development of alternative in vitro test systems. Especially in the field of ecotoxicology, coverage of aquatic species-specific assays is relatively scarce. Transient reporter gene assays could be a quick, economical, and reliable bridging technology. However, the user should be aware of potential pitfalls that are influenced by reporter vector geometry. Here, we report the development of an AhR-responsive transient reporter-gene assay in the permanent zebrafish hepatocytes cell line (ZFL). Additionally, we disclose how viral, constitutive promoters within reporter-gene assay cassettes induce squelching of the primary signal. To counter this, we designed a novel normalization vector, bearing an endogenous zebrafish-derived genomic promoter (zfEF1aPro), which rescues the squelching-delimited system, thus, giving new insights into the modulation of transient reporter systems under xenobiotic stress. Finally, we uncovered how the ubiquitously used ligand BNF promiscuously activates multiple toxicity pathways of the xenobiotic metabolism and cellular stress response in an orchestral manner, presumably leading to a concentration-related inhibition of the AhR/ARNT/XRE-toxicity pathway and non-monotonous concentration-response curves. We named such a multi-level inhibitory mechanism that might mask effects as "maisonette squelching." A transient reporter gene assay in zebrafish cell lines utilizing endogenous regulatory gene elements shows increased in vitro toxicity testing performance. Synthetic and constitutive promotors interfere with signal transduction ("squelching") and might increase cellular stress (cytotoxicity). The squelching phenomenon might occur on multiple levels (toxicity pathway crosstalk and normalization vector), leading to a complete silencing of the reporter signal.

Facile synthesis of Bi2Se3/nitrogen-doped carbon dot nanoplates for aqueous zinc ion battery cathodes.

Bi2Se3 is a promising cathode material for aqueous zinc ion batteries (AZIBs), but its limited capacity and poor cycling stability deter its further use in the development of AZIBs. To solve this issue, Bi2Se3/NCD composites have been synthesized via a simple two-step solvothermal method. The introduction of nitrogen-doped carbon dots (NCDs) provides more active sites and makes the composite surface rich in functional groups, which facilitates contact with aqueous electrolytes. The results showed that Bi2Se3/NCDs improved the zinc storage properties of Bi2Se3 as a cathode material. The discharge specific capacity is 318 mA h g-1 at 0.1 A g-1. The cycling performance of Bi2Se3/NCDs was also relatively excellent compared to that of Bi2Se3. This work offers a productive and feasible strategy for metal chalcogenides (MCs) as cathode materials for AZIBs to improve the zinc storage capacity.

Characteristics of Leaf Spot Disease Caused by Didymella Species and the Influence of Infection on Tea Quality.

Leaf spots are the most damaging and common foliar diseases of tea and are caused by several species of fungi. During 2018 to 2020, leaf spot diseases showing different symptoms (large and small spots) were observed in commercial tea plantations in Guizhou and Sichuan provinces of China. The pathogen causing the two different sized leaf spots was identified as the same species (Didymella segeticola) based on morphological characteristics, pathogenicity, and multilocus phylogenetic analysis using the combined ITS, TUB, LSU, and RPB2 gene regions. Microbial diversity analysis of lesion tissues from small spots on naturally infected tea leaves further confirmed Didymella to be present as the main pathogen. Results of sensory evaluation and quality-related metabolite analysis of tea shoots infected with the small leaf spot symptom indicated that D. segeticola negatively affected the quality and flavor of tea by changing the composition and content of caffeine, catechins, and amino acids. In addition, the significantly reduced amino acid derivatives in tea are confirmed to be positively associated with the enhanced bitter taste. The results improve our understanding of the pathogenicity of Didymella species and the influence of Didymella on the host plant, Camellia sinensis.

Pre-Configured Error Pattern Ordered Statistics Decoding for CRC-Polar Codes.

In this paper, we propose a pre-configured error pattern ordered statistics decoding (PEPOSD) algorithm and discuss its application to short cyclic redundancy check (CRC)-polar codes. Unlike the traditional OSD that changes the most reliable independent symbols, we regard the decoding process as testing the error patterns, like guessing random additive noise decoding (GRAND). Also, the pre-configurator referred from ordered reliability bits (ORB) GRAND can better control the range and testing order of EPs. An offline-online structure can accelerate the decoding process. Additionally, we also introduce two orders to optimize the search order for testing EPs. Compared with CRC-aided OSD and list decoding, PEPOSD can achieve a better trade-off between accuracy and complexity.

A new NCDs@ZIF-90-based sensor: fluorescent "turn-on" detection of Al3+ ions with high selectivity and sensitivity.

A new NCDs@ZIF-90 composite as fluorescence sensor was designed and prepared by encapsulation of N-doped carbon dots (NCDs) in metal-organic framework (MOF) ZIF-90 in one-pot synthesis. NCDs@ZIF-90 retained the crystal structure and high thermal stability of ZIF-90; meanwhile, it also displayed the good chemical stability. NCDs@ZIF-90 dispersion in ethanol exhibited selective "turn-on" fluorescence response towards Al3+. The other coexisting competing metal ions had no obvious influence on the sensing performance of NCDs@ZIF-90 for Al3+. The fluorescence intensity at 447 nm of NCDs@ZIF-90 dispersion in ethanol had good linear relation with the concentrations of Al3+ with a low detection limit of 3.196 µM. The fluorescence enhancement after the addition of Al3+ was attributed to the release of NCDs from the inside of ZIF-90 to ethanol solution. In addition, NCDs@ZIF-90 displayed good recovery in detection of Al3+ in water samples indicating its practical application capability. The high selectivity and sensitivity indicate that NCDs@ZIF-90 is a good candidate as a "turn-on" fluorescence chemosensor to identify and detect Al3+.

Image quality enhancement of CT hepatic portal venography using dual energy blending with computer determined parameters.

BACKGROUND: Previous studies have shown that using some post-processing methods, such as nonlinear-blending and linear blending techniques, has potential to improve dual-energy computed (DECT) image quality. OBJECTIVE: To improve DECT image quality of hepatic portal venography (CTPV) using a new non-linear blending method with computer-determined parameters, and to compare the results to additional linear and non-linear blending techniques. METHODS: DECT images of 60 patients who were clinically diagnosed with liver cirrhosis were selected and studied. Dual-energy scanning (80 kVp and Sn140 kVp) of CTPV was utilized in the portal venous phase through a dual-source CT scanner. For image processing, four protocols were utilized including linear blending with a weighing factor of 0.3 (protocol A) and 1.0 (protocol B), non-linear blending with fixed blending width of 200 HU and set blending center of 150HU (protocol C), and computer-based blending (protocol D). Several image quality indicators, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and contrast of hepatic portal vein and hepatic parenchyma, were evaluated using the paired-sample t-test. A 5-grade scale scoring system was also utilized for subjective analysis. RESULTS: SNR of protocols A-D were 9.1±2.1, 12.1±3.0, 11.6±2.8 and 14.4±3.2, respectively. CNR of protocols A-D were 4.6±1.3, 8.0±2.3, 7.0±2.0 and 9.8±2.4, respectively. The contrast of protocols A-D were 37.7±11.6, 91.9±21.0, 66.2±19.0 and 107.7±21.3, respectively. The differences between protocol D and other three protocols were significant (P < 0.01). In subjective evaluation, the modes of protocols A, B, C, and D were rated poor, good, generally acceptable, and excellent, respectively. CONCLUSION: The non-linear blending technique of protocol D with computer-determined blending parameters can help improve imaging quality of CTPV and contribute to a diagnosis of liver disease.

Analysis of Adaptive Evolution and Coevolution of rbcL Gene in the Genus Galdieria (Rhodophyta).

To research the adaptive evolution and coevolution of the rbcL gene in the genus Galdieria, 36 sequences were selected. The bioinformatics of proteins encoded by rbcL genes of Galdieria were analyzed, and phylogenetic trees were constructed by the maximum-likelihood method. Then, adaptive evolution and coevolution were analyzed. The phylogenetic tree showed that the inner groups were clustered into four branches, in which the sequences of Galdieria maxima were divided into two small branches, and the posterior probability of each branch is above 94.9%. Eleven reliable positive selection sites were detected in the branched-site model, indicating that the rbcL protein-coding gene of Galdieria underwent adaptive evolution to adapt to extreme environments. Site 269 F is located in the loop 6 domain, while sites 272 D and 273 W are located in the 6-helix structure. Many coevolution pairs were detected, which were closely related to the hydrophobic and molecular weight correlation values of amino acids. The results are helpful to research the evolution process of freshwater red algae, to explore the changes of its essential genes and protein functions to adapt to different environmental pressures, and to understand the close relationship between amino acids in proteins and the molecular mechanism of evolution.

Pulmonary cryptococcosis coexisting with central type lung cancer in an immuocompetent patient: a case report and literature review.

BACKGROUND: Pulmonary Cryptococcosis is a common fungal infection mainly caused by Cryptococcus neoformans/C.gattii species in immunocompromised patients. Cases of pulmonary cryptococcosis in patients with normal immune function are increasingly common in China. Clinical and radiographic features of pulmonary cryptococcosis are various and without obvious characteristics, so it is often misdiagnosed as pulmonary metastatic tumor or tuberculosis. When coexisting with malignant lung tumors, it was more difficult to differentiate from metastatic lung cancer, although the coexistence of pulmonary cryptococcosis and central type lung cancer is rare. Reviewing the imaging manifestations and diagnosis of the case and the relevant literature will contribute to recognition of the disease and a decrease in misdiagnoses. CASE PRESENTATION: A 72-year-old immunocompetent Han Chinese man had repeated dry cough for more than half a year. CT examination of chest showed an irregular mass at the left hilum of the lung, and two small nodules in the right lung, which were considered as the left central lung cancer with right lung metastasis. However, the patient was diagnosed with pulmonary cryptococcosis coexisting with central type lung cancer based on the results of laboratory examination, percutaneous lung biopsy, fiberoptic bronchoscopy, and surgical pathology. The patient underwent surgical resection of the left central type lung cancer and was placed on fluconazole treatment after a positive diagnosis was made. Five years after the lung cancer surgery, the patient had a recurrence, but the pulmonary cryptococcus nodule disappeared. CONCLUSION: Our case shows that CT findings of central type lung cancer with multiple pulmonary nodules are not necessarily metastases, but may be coexisting pulmonary cryptococcosis. CT images of cryptococcosis of the lung were diverse and have no obvious characteristics, so it was very difficult to distinguish from metastatic tumors. CT-guided percutaneous lung biopsy was a simple and efficient method for identification.

Amino acids and flavonoids analysis reveals quality constituents difference among different albino tea resources.

Albino tea has attracted increased attention due to its unique flavor. To reveal the difference in key metabolites constituting the important quality of different tea resources, amino acids and flavonoids profiles in three albino resources with different degrees of albinism and one normal green variety were comprehensively investigated. K-means analysis revealed 35 amino acids were significantly enriched in 'Jibai', while 3 and 2 were specifically accumulated in 'Huangjinya' and 'Anjibaicha', respectively. Based on OPLS-DA models, 40, 31 and 45 significantly differential flavonoids were determined in 'Huangjinya', 'Anjibaicha' and 'Jibai' compared to 'Fudingdabaicha', and most were down-regulated. Among them, 10, 5 and 13 differential flavonoids were exclusively found in 'Huangjinya', 'Anjibaicha' and 'Jibai', respectively, which may contribute to unique quality for different resources. The differential flavonoids and amino acids involved in their metabolic pathways were obviously different among four resources, resulting in the difference in tea quality and flavor.

Effect of blister blight disease caused by Exobasidium on tea quality.

Blister blight, as one of the most threatening and damaging disease worldwide, mainly infects young organs and tissues seriously affecting tea growth and quality. In this study, the spread of pathogen on tea leaves were examined by toluidine blue staining, scanning electron microscope and transmission electron microscope analysis. The composition and abundance of fungal community on leaf tissues were firstly analyzed. Sensory evaluation and metabolites analysis indicated that diseased tea leaves had strong sweet taste and soluble sugars contributed significantly to the taste, while metabolites showing bitter and astringent taste (caffeine, catechins) were significantly decreased. According to the biological functions of differential metabolites, sugars including 7 monosaccharides (d-xylose, d-arabinose, d-mannose, d-glucuronic acid, glucose, d-galactose and d-fructose), 2 disaccharide (sucrose and maltose) and 1 trisaccharide (raffinose) were the main differential sugars increased in content (>2 fold change), which was of great significance to sweet taste of diseased tea.

Red-Fluorescent Covalent Organic Framework Nanospheres for Trackable Anticancer Drug Delivery.

Covalent organic frameworks (COFs) have emerged as promising drug carriers due to their structural variability, inherent porosity, and customizable functions. However, most COFs used in drug delivery suffer from low cellular bioavailability and poor luminescence properties. In this study, we designed a series of size-tunable, crystalline, and red-fluorescent COF nanospheres (COFNSs) for trackable anticancer drug delivery. The semiconducting COFNSs were prepared by condensations of 1,3,5-triformylbenzene (TFB) with various dihydrazide blocks through the Schiff-base reaction, resulting in red emission at 647 nm and excellent fluorescence stability (∼100% for 1 h). Such fluorescence property allowed for systematic investigation of the cellular endocytosis pathway of COFNSs, visualization of drug delivery, and observation of the cell apoptosis process. The COFNSs exhibited high cell viability (>90%), a loading capacity of 183 wt % for the anticancer drug camptothecin (CPT), and significant enhancement in inhibiting 4T1 cancers both in vitro and in vivo as the CPT nanocarrier. This progress presents a valuable approach to design COF nanocarriers with integrated fluorescent and drug delivery functions.

Exercise preference in stroke survivors: a concept analysis.

Background: Exercise preference in stroke survivors is related to their adherence to long-term rehabilitation regimen and functional recovery. Although explored recently, the term exercise preference still lacks a clear definition. Objective: The aim of this study is to conceptualize exercise preference in stroke survivors. Methods: The Walker and Avant method was applied as a framework for the conceptual analysis of exercise preference. Data from 34 publications were collected using seven databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, and CBM) and applied in the analysis. The search period was from the inception of the database to April 30, 2023. Results: Exercise preference in stroke survivors was defined according to four attributes: priority of choice, behavioral tendency, affective priming, and patience in adherence. The common antecedents of the concept of exercise preference in stroke survivors were classified into patient-related, therapy-related, and environmental-related categories and the consequences were classified into three categories: patient-related, rehabilitation provider-related, and rehabilitation service system-related. Conclusion: Exercise preference in stroke survivors refers to the patient's choice, tendency, affective response, and attitude toward engagement in the recommended rehabilitation regimen. It is beneficial for understanding the essential attributes of exercise preference in stroke survivors by clarifying the concept. In addition, it will facilitate the development of instruments for assessing exercise preference in stroke survivors and the construction of theory-based intervention programs that can improve adherence to exercise rehabilitation.

Role of Ferroptosis in the Progression of COVID-19 and the Development of Long COVID.

OBJECTIVES: To examine the role of ferroptosis on the pathogenesis and progression of COVID-19. MATERIALS AND METHODS: A total of 127 patients who were hospitalized for COVID-19 were categorized into two groups according to the intensity of oxygen therapy (high-flow or low-flow). Clinical characteristics, laboratory parameters, plasma markers, and peripheral blood mononuclear cell (PBMC) markers were measured at baseline and one or two weeks after treatment. Telephone follow-up was performed 3 months after discharge to assess long COVID. RESULTS: Patients receiving high-flow oxygen therapy had greater levels of neutrophils; D-dimer; C reactive protein; procalcitonin; plasma protein levels of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), IL-17, and acyl-CoA synthetase long-chain family member 4 (ACSL4); and PBMC mRNA level of TNF-α; but had lower levels of lymphocytes and plasma glutathione peroxidase 4 (GPX4). There were negative correlations of plasma GPX4 and cystine/glutamate transporter-11 (SLC7A11) with TNF-α, IL-6, and IL-17, and positive correlations of ACSL4 with inflammatory markers in plasma and PBMCs. The plasma levels of TNF-α, IL-6, IL-17, and ACSL4 were significantly lower after treatment than at baseline, but there were higher post-treatment levels of lymphocytes, GPX4, and SLC7A11. Patients with long COVID had a lower baseline level of plasma SLC7A11. CONCLUSION: Ferroptosis is activated during the progression of COVID-19, and a low baseline level of a ferroptosis marker (SLC7A11) may indicate an increased risk for long COVID-19. Ferroptosis has potential as a clinical indicator of long COVID and as a therapeutic target.

The dominant role of extracellular polymeric substances produced by Achromobacter xylosoxidans BP1 in Cr(VI) microbial reduction.

Extracellular polymeric substances (EPS) have demonstrated significant benefits for reducing multivalent metal contamination. Using Achromobacter xylosoxidans BP1 isolated from a coal chemical site in China, this study elucidated the contribution of EPS production to Cr (VI) reduction and revealed its biological removal mechanism. BP1 grew at an optimum pH of 8 and the lowest inhibitory concentration of Cr(VI) was 300 mg/L. The spent medium completely removed Cr(VI), whereas resting cells were only able to remove 10.47 % and inactivated cells were nearly incapable of Cr(VI) removal. S-EPS and B-EPS reduced Cr(VI) by 98.59 % and 11.64 %, respectively. SEM-EDS analysis showed that the BP1 cells were stimulated to produce EPS under Cr stress. The XPS results showed that 29.63 % of Cr(VI) was enriched by intracellular bioaccumulation or biosorption and 70.37 % of Cr(VI) was reduced by extracellular enzymes to produce Cr(OH)3 and organic Cr(III) complexes. According to FTIR, EPS with -OH, COO-, and amide groups supplied binding sites and electrons for the reductive adsorption of Cr(VI). Genomic studies showed that BP1 primarily produces extracellular polysaccharides, metabolises sulphur and nitrogen, and reduces reactive oxygen species damage as a result of DNA repair proteases.

Development and application of one-step multiplex Real-Time PCR for detection of three main pathogens associated with bovine neonatal diarrhea.

Introduction: Neonatal calf diarrhea (NCD) is one of the most common diseases in calves, causing huge economic and productivity losses to the bovine industry worldwide. The main pathogens include bovine rotavirus (BRV), bovine coronavirus (BCoV), and Enterotoxigenic Escherichia coli (ETEC) K99. Since multiple infectious agents can be involved in calf diarrhea, detecting each causative agent by traditional methods is laborious and expensive. Methods: In this study, we developed a one-step multiplex Real-Time PCR assay to simultaneously detect BRV, BCoV, and E. coli K99+. The assay performance on field samples was evaluated on 1100 rectal swabs of diseased cattle with diarrhea symptoms and compared with the conventional gel-based RT-PCR assay detect BRV, BCoV, and E. coli K99+. Results: The established assay could specifically detect the target pathogens without cross-reactivity with other pathogens. A single real-time PCR can detect ~1 copy/µL for each pathogen, and multiplex real-time PCR has a detection limit of 10 copies/µL. Reproducibility as measured by standard deviation and coefficient of variation were desirable. The triple real-time PCR method established in this study was compared with gel-based PT-PCR. Both methods are reasonably consistent, while the real-time PCR assay was more sensitive and could rapidly distinguish these three pathogens in one tube. Analysis of surveillance data showed that BRV and BCoV are major enteric viral pathogens accounting for calves' diarrhea in China. Discussion: The established assay has excellent specificity and sensitivity and was suitable for clinical application. The robustness and high-throughput performance of the developed assay make it a powerful tool in diagnostic applications and calf diarrhea research. ​.

Phospholipid-inspired alkoxylation induces crystallization and cellular uptake of luminescent COF nanocarriers.

The porous nature and structural variability of covalent organic frameworks (COFs) make them preferred for drug loading and delivery applications. However, most COF materials suffer from poor luminescent properties and inefficiency for cell uptake. Herein, we experimentally demonstrate the crucial role of long alkoxy chains in the synthesis of crystalline COF nanostructures with high cellular uptake efficiency. After luminescence integration through band engineering, the semiconducting COF exhibits an optical bandgap of 2.05 eV, an emission wavelength of 632 nm, a high quantum yield of 37 %, and excellent fluorescence stability (100 % at 3 h). Such excellent optical properties of the designed COF nanocarriers enable quantitative evaluations of cellular uptake and visual tracking of drug delivery. It was demonstrated that the cellular uptake efficiency was enhanced by orders of magnitude for the COF after the introduction of long n-octyloxy chains, which firstly delivered the anticancer camptothecin (CPT) to cell lysosomes, and then underwent "endo/lysosomal escape" to induce cell apoptosis. In vivo assay evidenced a significant enhancement in the therapeutic effect with a 96 % inhibition of tumor growth after 14 days of treatment. This progress sheds light on designing cutting-edge drug delivery nanosystems based on COF materials with integrated diagnostic and therapeutic functions.

TiO2-modified two-dimensional composite of nitrogen-doped molybdenum trioxide nanosheets as a high-performance anode for lithium-ion batteries.

Nitrogen-doped molybdenum trioxide (MoO3/NC) has drawbacks such as volume expansion during long-term charging and discharging cycles, which severely limit its further application. This work proposes the addition of titanium dioxide nanoparticles (TiO2 NPs) for performance improvement of MoO3/NC. TiO2 NPs embedded on the surface of a MoO3/NC nanosheet can alleviate its volume expansion and the accumulation of lithiated products and improve the conductivity of the electrode material. The results show that the MoO3/NC nanosheet decorated with TiO2 NPs (TiO2@MoO3/NC), when used as an electrode material, exhibited a discharge specific capacity of 419 mA h g-1 at a current density of 0.05 A g-1 and retained a discharge specific capacity of 517 mA h g-1 after 600 cycles at a current density of 1 A g-1.

Safety and efficacy of sequential treatments for postmenopausal osteoporosis: a network meta-analysis of randomised controlled trials.

Background: The sequential anti-osteoporotic treatment for women with postmenopausal osteoporosis (PMO) is important, but the order in which different types of drugs are used is confusing and controversial. Therefore, we performed a network meta-analysis to compare the efficacy and safety of available sequential treatments to explore the most efficacious strategy for long-term management of osteoporosis. Methods: In this network meta-analysis, we searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov from inception to September 19, 2023 to identify randomised controlled trials comparing sequential treatments for women with PMO. The identified trials were screened by reading the title and abstract, and only randomised clinical trials involving sequential anti-osteoporotic treatments and reported relevant outcomes for PMO were included. The main outcomes included vertebral fracture risk, the percentage change in bone mineral density (BMD) in different body parts, and all safety indicators in the stage after switching treatment. A frequentist network meta-analysis was performed using the multivariate random effects method and evaluated using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was assessed using the Confidence in the Network Meta-Analysis (CINeMA) framework. This study is registered with PROSPERO: CRD42022360236. Findings: A total of 19 trials comprising 18,416 participants were included in the study. Five different sequential treatments were investigated as the main interventions and compared to the corresponding control groups. The intervention groups in this study comprised the following treatment switch protocols: switching from an anabolic agent (AB) to an anti-resorptive agent (AR) (ABtAR), transitioning from one AR to another AR (ARtAAR), shifting from an AR to an AB (ARtAB), switching from an AB to a combined treatment of AB and AR (ABtC), and transitioning from an AR to a combined treatment (ARtC). A significant reduction in the incidence of vertebral fractures was observed in ARtC, ABtAR and ARtAB in the second stage, and ARtC had the lowest incidence with 81.5% SUCRA. ARtAAR and ABtAR were two effective strategies for preventing fractures and improving BMD in other body parts. Especially, ARtAAR could improve total hip BMD with the highest 96.1% SUCRA, and ABtAR could decrease the risk of total fractures with the highest 94.3% SUCRA. Almost no difference was observed in safety outcomes in other comparisons. Interpretation: Our findings suggested that the ARtAAR and ABtAR strategy are the effective and safe sequential treatment for preventing fracture and improving BMD for PMO. ARtC is more effective in preventing vertebral fractures. Funding: The National Natural Science Foundation of China (82170900, 81970762), the Hunan Administration of Traditional Chinese Medicine, and the Hunan Province High-level Health Talents "225" Project.

[Prediction model of recurrence after parathyroidectomy in secondary hyperparathyroidism].

Objective:To quantitatively evaluate the risk of recurrence in patients with secondary hyperparathyroidism after parathyroidectomy. Methods:The clinical data of 168 patients who underwent parathyroidectomy（PTX） from June 2017 to May 2019 were collected. The prediction model was constructed by using Akaike information criterion（AIC） to screen factors. A total of 158 patients treated with PTX from June 2019 to September 2021 were included in the validation set to conduct external validation of the model in three aspects of differentiation, consistency and clinical utility. Results:The prediction model we constructed includes different dialysis methods, ectopic parathyroid gland, the iPTH level at one day and one month after surgery, the number of excisional parathyroid and postoperative blood phosphorus. The C index of external validation of this model is 0.992 and the P value of the Calibration curve is 0.886[KG0.5mm]1. The decision curve analysis also shows that the evaluation effect of this model is perfect. Conclusion:The prediction model constructed in this study is useful for individualized prediction of recurrence after PTX in patients with secondary hyperparathyroidism.