Evaluation of China's long-term care insurance policies.

Introduction: In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. Methods: We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Results: Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. Discussion: The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

Integrated assessment of potentially toxic elements in soil of the Kangdian metallogenic province: A two-point machine learning approach.

The accumulation of potentially toxic elements in soil poses significant risks to ecosystems and human well-being due to their inherent toxicity, widespread presence, and persistence. The Kangdian metallogenic province, famous for its iron-copper deposits, faces soil pollution challenges due to various potentially toxic elements. This study explored a comprehensive approach that combinescombines the spatial prediction by the two-point machine learning method and ecological-health risk assessment to quantitatively assess the comprehensive potential ecological risk index (PERI), the total hazard index (THI) and the total carcinogenic risk (TCR). The proportions of copper (Cu), cadmium (Cd), manganese (Mn), lead (Pb), zinc (Zn), and arsenic (As) concentrations exceeding the risk screening values (RSVs) were 15.03%, 5.1%, 3.72%, 1.24%, 1.1%, and 0.13%, respectively, across the 725 collected samples. Spatial prediction revealed elevated levels of As, Cd, Cu, Pb, Zn, mercury (Hg), and Mn near the mining sites. Potentially toxic elements exert a slight impact on soil, some regions exhibit moderate to significant ecological risk, particularly in the southwest. Children face higher non-carcinogenic and carcinogenic health risks compared to adults. Mercury poses the highest ecological risk, while chromium (Cr) poses the greatest health hazard for all populations. Oral ingestion represents the highest non-oncogenic and oncogenic risks in all age groups. Adults faced acceptable non-carcinogenic risks. Children in the southwest region confront higher health risks, both non-carcinogenic and carcinogenic, from mining activities. Urgent measures are vital to mitigate Hg and Cr contamination while promoting handwashing practices is essential to minimize health risks.

Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial.

INTRODUCTION: Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural 'nudge' interventions on low-value care for ED patients with low back pain. METHODS AND ANALYSIS: NUDG-ED is a 2×2 factorial, open-label, before-after, cluster randomised controlled trial. The trial includes 8 ED sites in Sydney, Australia. Participants will be ED clinicians who manage back pain, and patients who are 18 years or over presenting to ED with musculoskeletal back pain. EDs will be randomly assigned to receive (i) patient nudges, (ii) clinician nudges, (iii) both interventions or (iv) no nudge control. The primary outcome will be the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge or both. We will require 2416 encounters over a 9-month study period (3-month before period and 6-month after period) to detect an absolute difference of 10% in use of low-value care due to either nudge, with 80% power, alpha set at 0.05 and assuming an intra-class correlation coefficient of 0.10, and an intraperiod correlation of 0.09. Patient-reported outcome measures will be collected in a subsample of patients (n≥456) 1 week after their initial ED visit. To estimate effects, we will use a multilevel regression model, with a random effect for cluster and patient, a fixed effect indicating the group assignment of each cluster and a fixed effect of time. ETHICS AND DISSEMINATION: This study has ethical approval from Southwestern Sydney Local Health District Human Research Ethics Committee (2023/ETH00472). We will disseminate the results of this trial via media, presenting at conferences and scientific publications. TRIAL REGISTRATION NUMBER: ACTRN12623001000695.

Primary study of the relative and compound biological effectiveness model for boron neutron capture therapy based on nanodosimetry.

BACKGROUND: The current radiobiological model employed for boron neutron capture therapy (BNCT) treatment planning, which relies on microdosimetry, fails to provide an accurate representation the biological effects of BNCT. The precision in calculating the relative biological effectiveness (RBE) and compound biological effectiveness (CBE) plays a pivotal role in determining the therapeutic efficacy of BNCT. Therefore, this study focuses on how to improve the accuracy of the biological effects of BNCT. PURPOSE: The purpose of this study is to propose new radiation biology models based on nanodosimetry to accurately assess RBE and CBE for BNCT. METHODS: Nanodosimetry, rooted in ionization cluster size distributions (ICSD), introduces a novel approach to characterize radiation quality by effectively delineating RBE through the ion track structure at the nanoscale. In the context of prior research, this study presents a computational model for the nanoscale assessment of RBE and CBE. We establish a simplified model of DNA chromatin fiber using the Monte Carlo code TOPAS-nBio to evaluate the applicability of ICSD to BNCT and compute nanodosimetric parameters. RESULTS: Our investigation reveals that both homogeneous and heterogeneous nanodosimetric parameters, as well as the corresponding biological model coefficients α and ß, along with RBE values, exhibit variations in response to varying intracellular 10B concentrations. Notably, the nanodosimetric parameter M 1 C 2 $M_1^{{{\mathrm{C}}}_2}$ effectively captures the fluctuations in model coefficients α and RBE. CONCLUSION: Our model facilitates a nanoscale analysis of BNCT, enabling predictions of nanodosimetric quantities for secondary ions as well as RBE, CBE, and other essential biological metrics related to the distribution of boron. This contribution significantly enhances the precision of RBE calculations and holds substantial promise for future applications in treatment planning.

Weak correlations among leaf thermal metrics, economic traits and damages under natural heatwaves.

The frequency and intensity of heatwaves are increasing around the world, causing severe damages to plants, but whether leaf thermal metrics is in line with leaf economic spectrum is still controversial. Here, we measured leaf damage ratio, leaf thermal metrics (tolerance and sensitivity) and economic traits of 131 woody species across five cities along the Yangtze River after a two-month natural extreme temperature event. We found that leaf thermal sensitivity but not thermal tolerance was correlated with leaf damage ratio, and the relationships between leaf thermal metrics and economic traits were weak, indicating that leaf thermal adaptation may be independent from leaf carbon construction. This study suggests a potential indicator for predicting plant survival under heatwaves, urging future research to explore more physiological traits to comprehensively understand plant heat responses and adaptations.

[Pollution Characteristics and Ecological Risk Assessment of Typical Antibiotics in Environmental Media in China].

To investigate the environmental pollution status of antibiotics in China on a national scale, a large number of the latest pollution data of antibiotics in water, sediment, and soil were collected, and ecological risks of antibiotics were evaluated using the risk quotients (RQs). The results showed that water, sediments, and soils in different parts of China were contaminated with antibiotics to varying degrees; antibiotics pollution of water bodies was relatively severe in the south of China but moderate in the west. The ecological risk assessment revealed that erythromycin, roxithromycin, tetracycline, colistin, sulfamethoxazole, and norfloxacin were high-risk pollutants in water, accounting for 20.9% of the total antibiotics, and were mainly distributed in Shandong, Hubei, Zhejiang, Sichuan, Guangdong, Hainan, Jiangsu, and Jiangxi provinces. Furthermore, norfloxacin was identified as the primary high-risk pollutant in river sediments, such as those of the Yellow River, Haihe River, Liaohe River, and Pearl River, accounting for 11.11% of all antibiotics. In contrast, tetracycline, tylosin, colistin, and norfloxacin were the main high-risk pollutants in aquaculture sediments, accounting for 72.5% of the total. In soil, tetracycline and colistin contents comprised a high ratio of the total amount (up to 28.6%); these were mainly distributed in Liaoning, Sichuan, Tianjin, and Shandong provinces. Relevant authorities should focus on the above-mentioned high-risk regions. This study provides sufficient scientific basis and data support for preventing and controlling antibiotic pollution in China.

[Application of brain functional connectivity and nonlinear dynamic analysis in brain function assessment for infants with controlled infantile spasm]. / 脑功能连接及非线性动力学分析在发作控制的婴儿痉挛症患儿脑功能评估中的应用.

OBJECTIVES: To investigate the role of brain functional connectivity and nonlinear dynamic analysis in brain function assessment for infants with controlled infantile spasm (IS). METHODS: A retrospective analysis was performed on 14 children with controlled IS (IS group) who were admitted to the Department of Neurology, Anhui Provincial Children's Hospital, from January 2019 to January 2023. Twelve healthy children, matched for sex and age, were enrolled as the control group. Electroencephalogram (EEG) data were analyzed for both groups to compare the features of brain network, and nonlinear dynamic indicators were calculated, including approximate entropy, sample entropy, permutation entropy, and permutation Lempel-Ziv complexity. RESULTS: Brain functional connectivity showed that compared with the control group, the IS group had an increase in the strength of functional connectivity, and there was a significant difference between the two groups in the connection strength between the Fp2 and F8 channels (P<0.05). The network stability analysis showed that the IS group had a significantly higher network stability than the control group at different time windows (P<0.05). The nonlinear dynamic analysis showed that compared with the control group, the IS group had a significantly lower sample entropy of Fz electrode (P<0.05). CONCLUSIONS: Abnormalities in brain network and sample entropy may be observed in some children with controlled IS, and it is suggested that quantitative EEG analysis parameters can serve as neurological biomarkers for evaluating brain function in children with IS.

Hydrochemical characterizations and groundwater quality assessment in the coastal region of the Jiaodong peninsula, North China.

Groundwater resources constitute a primary water source in the coastal region of Jiaodong Peninsula (CRJP), serving as an essential foundation for socio-economic development and municipal water supply. This study sought to evaluate the hydrogeochemical properties of the CRJP's groundwater using 73 samples collected in 2017, comprehensively analyzing the chemical composition and environmental factors using mathematical statistics and hydrochemical techniques. The results demonstrate that groundwater in the CRJP possesses TDS values ranging from 262 to 28,160 mg/L, with a pH ranging between 6.4 and 8.5, characterizing a weakly alkaline water system. The cation order in groundwater is Na+ > Ca2+ > Mg2+ > K+, while the anionic sequence comprises Cl- > HCO3- > SO42- > NO3-. According to the Piper diagram, groundwater samples predominantly clustered into SO4·Cl-Ca·Mg and SO4·Cl-Na types. Additionally, significant spatial variations exist in the primary chemical components of groundwater. Hydrogeochemical characteristics within the region are influenced both by natural and human activities; natural elements include weathering of silicate rocks, gypsum and carbonate minerals dissolution, while human practices comprise industrial and mining activities, agricultural practices, and domestic waste discharge. The results from a health risk assessment show that non-carcinogenic risks posed by nitrate intake via drinking water are considerably high for infants in comparison to adults, teenagers, and children. Furthermore, certain regions within the CRJP show notable seawater intrusion effects on groundwater studied.

Deep learning-based fast denoising of Monte Carlo dose calculation in carbon ion radiotherapy.

BACKGROUND: Plan verification is one of the important steps of quality assurance (QA) in carbon ion radiotherapy. Conventional methods of plan verification are based on phantom measurement, which is labor-intensive and time-consuming. Although the plan verification method based on Monte Carlo (MC) simulation provides a more accurate modeling of the physics, it is also time-consuming when simulating with a large number of particles. Therefore, how to ensure the accuracy of simulation results while reducing simulation time is the current difficulty and focus. PURPOSE: The purpose of this work was to evaluate the feasibility of using deep learning-based MC denoising method to accelerate carbon-ion radiotherapy plan verification. METHODS: Three models, including CycleGAN, 3DUNet and GhostUNet with Ghost module, were used to denoise the 1 × 106 carbon ions-based MC dose distribution to the accuracy of 1 × 108 carbon ions-based dose distribution. The CycleGAN's generator, 3DUNet and GhostUNet were all derived from the 3DUNet network. A total of 59 cases including 29 patients with head-and-neck cancers and 30 patients with lung cancers were collected, and 48 cases were randomly selected as the training set of the CycleGAN network and six cases as the test set. For the 3DUNet and GhostUNet models, the numbers of training set, validation set, and test set were 47, 6, and 6, respectively. Finally, the three models were evaluated qualitatively and quantitatively using RMSE and three-dimensional gamma analysis (3 mm, 3%). RESULTS: The three end-to-end trained models could be used for denoising the 1 × 106 carbon ions-based dose distribution, and their generalization was proved. The GhostUNet obtained the lowest RMSE value of 0.075, indicating the smallest difference between its denoised and 1 × 108 carbon ions-based dose distributions. The average gamma passing rate (GPR) between the GhostUNet denoising-based versus 1 × 108 carbon ions-based dose distributions was 99.1%, higher than that of the CycleGAN at 94.3% and the 3DUNet at 96.2%. Among the three models, the GhostUNet model had the fewest parameters (4.27 million) and the shortest training time (99 s per epoch) but achieved the best denoising results. CONCLUSION: The end-to-end deep network GhostUNet outperforms the CycleGAN, 3DUNet models in denoising MC dose distributions for carbon ion radiotherapy. The network requires less than 5 s to denoise a sample of MC simulation with few particles to obtain a qualitative and quantitative result comparable to the dose distribution simulated by MC with relatively large number particles, offering a significant reduction in computation time.

Comparison of cardiac biomarkers on risk assessment of contrast-associated acute kidney injury in patients undergoing cardiac catheterization: A multicenter retrospective study.

AIM: Cardiac biomarkers' predictive value of contrast-associated acute kidney injury (CA-AKI) remains unclear. We analysed whether creatine kinase isoenzyme-MB (CKMB), cardiac troponin I (cTnI) and preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) are tied to CA-AKI patients undergoing cardiac catheterization. METHODS: In the multi-center study, we included 3553 people underwent cardiac catheterization for analysis. CA-AKI was defined as the absolute increase of over 0.3 mg/dL or an increase of more than 50% compared with the baseline serum creatinine within 48 hours following cardiac catheterization. Logistic regression model and receiver operating characteristic (ROC) curves were used to examine the association between cardiac biomarkers and CA-AKI and the efficacy of Mehran risk score (MRS) model on CA-AKI prediction with and without cardiac biomarkers. RESULTS: Among 3553 people, 200 people eventually developed CA-AKI. The logistic regression model showed that log10 CKMB (odds ratio (OR): 1.97, 95%CI:1.51-2.57, p < .001), cTnI (OR: 1.03, 95%CI: 1.02-1.04, p < .001) and log10 NT-proBNP (OR: 3.19, 95%CI: 2.46-4.17, p < .001) were independent predictors of CA-AKI. The ROC curve demonstrated that area under the curve (AUC) of MRS was 0.733. CKMB, cTnI and NT-proBNP all significantly improved the AUC value in combination with MRS model. (NT-proBNP: 0.798, p < .001; CKMB: 0.758, p = .003; cTnI: 0.755, p = .002), among which the NT-proBNP had the best predictive efficacy improvement. CONCLUSION: Cardiac biomarkers of CKMB, cTnI and NT-proBNP are all independently associated with CA-AKI among patients undergoing cardiac catheterization while NT-proBNP remains the best indicator. Adding CKMB, cTnI and NT-proBNP to MRS improved the prognostic efficacy and may be considered effective tools to predict the risk of CA-AKI in clinical practice.

Psychological Inoculation for Credibility Assessment, Sharing Intention, and Discernment of Misinformation: Systematic Review and Meta-Analysis.

BACKGROUND: The prevalence of misinformation poses a substantial threat to individuals' daily lives, necessitating the deployment of effective remedial approaches. One promising strategy is psychological inoculation, which pre-emptively immunizes individuals against misinformation attacks. However, uncertainties remain regarding the extent to which psychological inoculation effectively enhances the capacity to differentiate between misinformation and real information. OBJECTIVE: To reduce the potential risk of misinformation about digital health, this study aims to examine the effectiveness of psychological inoculation in countering misinformation with a focus on several factors, including misinformation credibility assessment, real information credibility assessment, credibility discernment, misinformation sharing intention, real information sharing intention, and sharing discernment. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a meta-analysis by searching 4 databases (Web of Science, APA PsycINFO, Proquest, and PubMed) for empirical studies based on inoculation theory and outcome measure-related misinformation published in the English language. Moderator analyses were used to examine the differences in intervention strategy, intervention type, theme, measurement time, team, and intervention design. RESULTS: Based on 42 independent studies with 42,530 subjects, we found that psychological inoculation effectively reduces misinformation credibility assessment (d=-0.36, 95% CI -0.50 to -0.23; P<.001) and improves real information credibility assessment (d=0.20, 95% CI 0.06-0.33; P=.005) and real information sharing intention (d=0.09, 95% CI 0.03-0.16; P=.003). However, psychological inoculation does not significantly influence misinformation sharing intention (d=-0.35, 95% CI -0.79 to 0.09; P=.12). Additionally, we find that psychological inoculation effectively enhances credibility discernment (d=0.20, 95% CI 0.13-0.28; P<.001) and sharing discernment (d=0.18, 95% CI 0.12-0.24; P<.001). Regarding health misinformation, psychological inoculation effectively decreases misinformation credibility assessment and misinformation sharing intention. The results of the moderator analyses showed that content-based, passive inoculation was more effective in increasing credibility and sharing intention. The theme of climate change demonstrates a stronger effect on real information credibility. Comparing intervention types showed that pre-post interventions are more effective for misinformation credibility assessment, while post-only interventions are better for credibility discernment. CONCLUSIONS: This study indicated that psychological inoculation enhanced individuals' ability to discern real information from misinformation and share real information. Incorporating psychological inoculation to cultivate an informed public is crucial for societal resilience against misinformation threats in an age of information proliferation. As a scalable and cost-effective intervention strategy, institutions can apply psychological inoculation to mitigate potential misinformation crises.

High-Quality Genome Assembly and Genome-Wide Association Study of Male Sterility Provide Resources for Flax Improvement.

Flax is an economic crop with a long history. It is grown worldwide and is mainly used for edible oil, industry, and textiles. Here, we reported a high-quality genome assembly for "Neiya No. 9", a popular variety widely grown in China. Combining PacBio long reads, Hi-C sequencing, and a genetic map reported previously, a genome assembly of 473.55 Mb was constructed, which covers ~94.7% of the flax genome. These sequences were anchored onto 15 chromosomes. The N50 lengths of the contig and scaffold were 0.91 Mb and 31.72 Mb, respectively. A total of 32,786 protein-coding genes were annotated, and 95.9% of complete BUSCOs were found. Through morphological and cytological observation, the male sterility of flax was considered dominant nuclear sterility. Through GWAS analysis, the gene LUSG00017705 (cysteine synthase gene) was found to be closest to the most significant SNP, and the expression level of this gene was significantly lower in male sterile plants than in fertile plants. Among the significant SNPs identified in the GWAS analysis, only two were located in the coding region, and these two SNPs caused changes in the protein encoded by LUSG00017565 (cysteine protease gene). It was speculated that these two genes may be related to male sterility in flax. This is the first time the molecular mechanism of male sterility in flax has been reported. The high-quality genome assembly and the male sterility genes revealed, provided a solid foundation for flax breeding.

Risk assessment for postoperative venous thromboembolism using the modified Caprini risk assessment model in lung cancer.

Background: Postoperative venous thromboembolism (VTE) is a well-documented cause of morbidity and mortality in lung cancer patients. However, risk identification remains limited. In this study, we sought to analyze the risk factors for VTE and verify the predictive value of the modified Caprini risk assessment model (RAM). Methods: This prospective single-center study included patients with resectable lung cancer who underwent resection between October 2019 and March 2021. The incidence of VTE was estimated. Logistic regression was used to analyze the risk factors for VTE. Receiver operating characteristic (ROC) curve analysis was performed to test the ability of the modified Caprini RAM to predict VTE. Results: The VTE incidence was 10.5%. Several variables, including age, D-dimer, hemoglobin (Hb), bleeding, and patient confinement to bed were significantly associated with VTE after surgery. The difference between the VTE and non-VTE groups in the high-risk levels was statistically significant (P<0.001), while the low and moderate risk levels showed no significant difference. The combined use of the modified Caprini score and the Hb and D-dimer levels showed an area under the curve (AUC) was 0.822 [95% confidence interval (CI): 0.760-0.855. P<0.001]. Conclusions: The risk-stratification approach of the modified Caprini RAM is not particularly valid after lung resection in our population. The use of the modified Caprini RAM combined with Hb and D-dimer levels shows a good diagnostic performance for VTE prediction in patients with lung cancer undergoing resection.

Clinical utility of [18F]FDG PET/CT in the assessment of mediastinal lymph node disease after neoadjuvant chemoimmunotherapy for non-small cell lung cancer.

OBJECTIVES: The performance of positron emission tomography/computed tomography (PET/CT) for the prediction of ypN2 disease in non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy has not been reported. This multicenter study investigated the utility of PET/CT to assess ypN2 disease in these patients. METHODS: A total of 181 consecutive patients (chemoimmunotherapy = 86, chemotherapy = 95) at four institutions were enrolled in this study. Every patient received a PET/CT scan prior to surgery and complete resection with systematic nodal dissection. The diagnostic performance was evaluated through area under the curve (AUC). Kaplan-Meier method and Cox analysis were performed to identify the risk factors affecting recurrences. RESULTS: The sensitivity, specificity, and accuracy of PET/CT for ypN2 diseases were 0.667, 0.835, and 0.779, respectively. Therefore, the AUC was 0.751. Compared with the false positive cases, the mean value of max standardized uptake value (SUVmax) (6.024 vs. 2.672, p < 0.001) of N2 nodes was significantly higher in true positive patients. Moreover, the SUVmax of true positive (7.671 vs. 5.976, p = 0.365) and false (2.433 vs. 2.339, p = 0.990) positive cases were similar between chemoimmunotherapy and chemotherapy, respectively. Survival analysis proved that pathologic N (ypN) 2 patients could be stratified by PET/CT-N2(+ vs. -) for both chemoimmunotherapy (p = 0.023) and chemotherapy (p = 0.010). CONCLUSIONS: PET/CT is an accurate and non-invasive test for mediastinal restaging of NSCLC patients who receive neoadjuvant chemoimmunotherapy. The ypN2 patients with PET/CT-N2( +) are identified as an independent prognostic factor compared with PET/CT-N2(-). CLINICAL RELEVANCE STATEMENT: Imaging with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) plays an integral role during disease diagnosis, staging, and therapeutic response assessments in patients with NSCLC. PET/CT could be an effective non-invasive tool for predicting ypN2 diseases after neoadjuvant chemoimmunotherapy. KEY POINTS: • PET/CT could serve as an effective non-invasive tool for predicting ypN2 diseases. • The ypN2 patients with PET/CT-N2( +) were a strong and independent prognostic factor. • The application of PET/CT for restaging should be encouraged in clinical practice.

Rapid Identification of Chinese Hamster Ovary Cell Apoptosis and Its Potential Role in Process Robustness Assessment.

Currently, the assessment of process robustness is often time-consuming, labor-intensive, and material-intensive using process characterization studies. Therefore, a simple and time-saving method is highly needed for the biopharmaceutical industry. Apoptosis is responsible for 80% of Chinese hamster ovary (CHO) cell deaths and affects the robustness of the cell culture process. This study's results showed that a more robust process can support cells to tolerate apoptosis for a longer time, suggesting that the robustness of the process could be judged by the ability of cells to resist apoptosis. Therefore, it is necessary to establish a rapid method to detect the apoptosis of CHO cells. In trying to establish a new method for detecting apoptosis in large-scale cell cultures, glucose withdrawal was studied, and the results showed that CHO cells began to apoptose after glucose was consumed. Then, the concentration of extracellular potassium increased, and a prolongation of apoptosis time was observed. Further study results showed that the process with poor robustness was associated with a higher proportion of apoptosis and extracellular potassium concentration, so potassium could be used as a biochemical index of apoptosis. The strategy we present may be used to expedite the assessment of process robustness to obtain a robust cell culture process for other biologics.

Green financing role on climate change-supportive architectural design development: directions for green architectural designs.

The purpose of the study is to study the role of green financing in developing climate change supportive architectural design development to shift the modern world towards the idea of green architectural designs. Thus, the research estimated the nexus among green financing, green architectural development, and climate change mitigation by using the unit root analysis technique, co-integration analysis technique, bound-test estimates, auto-regressive distributive lag-error correction modeling (ARDL-ECM) technique to predict different short-run and long-run relationships, and robustness analysis technique. Following the previous study, modeling green financing index and green architectural design index are used to measure the variables. The findings of the study confirmed that green financing has significant role in supporting the climate change induction in architectural design development both in short run and long run. Moreover, green financing supports in promoting green architectural designs. By this, the viability of green financing in climate change that induces architecturally designed building is confirmed. Correspondingly, empirical results have shown that green financing contributes in climate change with 0.66, green infrastructure development with 0.72, and economic development with 0.31. While in long-run, green financing role in changing inside of climate of the architectural design is 0.74, supports in green infrastructure development with 0.67, and holds the 0.29 percent potential of contributing in economic development. These findings are robust with the 0.74 value of F-statistics, 1.89 value of t-statistics, and 110 value of Narayan standard estimate. In last, the study suggested way forward for stakeholders to promote green architectural designs to achieve SDG 8, SDG 11, and SDG 13.

Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial.

Background: Intensive blood pressure lowering may adversely affect evolving cerebral ischaemia. We aimed to determine whether intensive blood pressure lowering altered the size of cerebral infarction in the 2196 patients who participated in the Enhanced Control of Hypertension and Thrombolysis Stroke Study, an international randomised controlled trial of intensive (systolic target 130-140 mm Hg within 1 h; maintained for 72 h) or guideline-recommended (systolic target <180 mm Hg) blood pressure management in patients with hypertension (systolic blood pressure >150 mm Hg) after thrombolysis treatment for acute ischaemic stroke between March 3, 2012 and April 30, 2018. Methods: All available brain imaging were analysed centrally by expert readers. Log-linear regression was used to determine the effects of intensive blood pressure lowering on the size of cerebral infarction, with adjustment for potential confounders. The primary analysis pertained to follow-up computerised tomography (CT) scans done between 24 and 36 h. Sensitivity analysis were undertaken in patients with only a follow-up magnetic resonance imaging (MRI) and either MRI or CT at 24-36 h, and in patients with any brain imaging done at any time during follow-up. This trial is registered with ClinicalTrials.gov, number NCT01422616. Findings: There were 1477 (67.3%) patients (mean age 67.7 [12.1] y; male 60%, Asian 65%) with available follow-up brain imaging for analysis, including 635 patients with a CT done at 24-36 h. Mean achieved systolic blood pressures over 1-24 h were 141 mm Hg and 149 mm Hg in the intensive group and guideline group, respectively. There was no effect of intensive blood pressure lowering on the median size (ml) of cerebral infarction on follow-up CT at 24-36 h (0.3 [IQR 0.0-16.6] in the intensive group and 0.9 [0.0-12.5] in the guideline group; log Δmean -0.17, 95% CI -0.78 to 0.43). The results were consistent in sensitivity and subgroup analyses. Interpretation: Intensive blood pressure lowering treatment to a systolic target <140 mm Hg within several hours after the onset of symptoms may not increase the size of cerebral infarction in patients who receive thrombolysis treatment for acute ischaemic stroke of mild to moderate neurological severity. Funding: National Health and Medical Research Council of Australia; UK Stroke Association; UK Dementia Research Institute; Ministry of Health and the National Council for Scientific and Technological Development of Brazil; Ministry for Health, Welfare, and Family Affairs of South Korea; Takeda.

Quantitative model for assessment of lower-extremity perfusion in patients with diabetes.

BACKGROUND: Although diabetic and atherosclerotic vascular diseases have different pathophysiological mechanisms, the screening methods currently used for diabetic lower-extremity vascular diseases are mainly based on the evaluation methods used for atherosclerotic vascular diseases. Thus, assessment of microvascular perfusion is of great importance in early detection of lower-extremity ischemia in diabetes. PURPOSE: This cross-sectional study aimed to develop a quantitative model for evaluating lower-extremity perfusion. METHODS: We recruited 57 participants (14 healthy participants and 43 diabetes patients, of which 16 had lower-extremity arterial disease [LEAD]). All participants underwent technetium-99 m sestamibi (99mTc-MIBI) scintigraphy and ankle-brachial index (ABI) examination. We derived two key perfusion kinetics indices named activity perfusion index (API) and basal perfusion index (BPI). This study was registered in ClinicalTrials.gov (URL: https://www. CLINICALTRIALS: gov, NCT02752100). RESULTS: The estimated limb perfusion values in our lower-extremity perfusion assessment (LEPA) model showed excellent consistency with the actual measured data. Diabetes patients showed reduced lower-extremity perfusion in comparison with the control group (BPI: 106.21 ± 11.99 vs. 141.56 ± 17.38, p < 0.05; API: 12.34 ± 3.27 vs. 14.56 ± 3.12, p < 0.05). Using our model, the reductions in lower-extremity perfusion could be detected early in approximately 96.30% of diabetes patients. Patients with LEAD showed more severe reductions in lower-extremity perfusion than diabetes patients without LEAD (BPI: 47.85 ± 20.30 vs. 106.21 ± 11.99, p < 0.05; API: 7.06 ± 1.70 vs. 12.34 ± 3.27, p < 0.05). Discriminant analysis using API and BPI could successfully screen all diabetes patients with LEAD with a sensitivity of 100% and specificity of 80.77%. CONCLUSIONS: We established a LEPA model that could successfully assess lower-extremity microvascular perfusion in diabetes patients. This model has important application value for the recognition of early-stage LEAD in patients with diabetes.

Assessment of stromal SCD-induced drug resistance of PDAC using 3D-printed zPDX model chips.

Lipid metabolism is extensively reprogrammed in pancreatic ductal adenocarcinoma (PDAC). Stearoyl-coenzyme A desaturase (SCD) is a critical lipid regulator that was unexplored in PDAC. Here, we characterized the existence of cancer-associated fibroblasts (CAFs) with high SCD expression, and revealed them as an unfavorable prognostic factor. Therefore, primary CAFs and pancreatic cancer cells were harvested and genetically labeled. The mixture of CAFs and cancer cells were co-injected into scd-/-; prkdc-/-, or hIGF1/INS-expressing zebrafish to generate patient-derived xenograft models (zPDX). The models were aligned in 3D-printed chips for semi-automatic drug administration and high-throughput scanning. The results showed that chaperoning of the SCD-high CAFs significantly improved the drug resistance of pancreatic cancer cells against gemcitabine and cisplatin, while the administration of SCD inhibitors neutralized the protective effect. Our studies revealed the prognostic and therapeutic value of stromal SCD in PDAC, and proposed the application of zPDX model chips for drug testing.

Uretero-enteric Strictures After Robot Assisted Radical Cystectomy: Prevalence and Management Over Two Decades.

INTRODUCTION: To evaluate the prevalence, predictors, management, and trends for ureteroenteric strictures (UES) after robot-assisted radical cystectomy (RARC). METHODS: Retrospective review of our RARC database was performed (2005-2022). UES was described in terms of timing, laterality, and management. Kaplan-Meier curves were used to depict time to UES. Local regression was used to assess trend of UES over time and multivariable regression to identify variables associated with UES. RESULTS: UES occurred in 109 patients (15%). UES occurred in 13%, 17%, and 19% at 1, 3, and 5 years after RARC, respectively. Incidence of UES decreased in 2017, coinciding with stentless uretero-enteric anastomosis. UES occurred on the right in 33%, on the left in 46%, and bilaterally in 21%. All patients were initially managed by nephrostomy/stent. Surgical revision was required in 45% of patients, of which 13% developed recurrent UES after revision. On MVA, UES formation was associated with ureteral stents (OR 2.27, 95%CI 1.01-5.10, P = .05) and receipt of neoadjuvant chemotherapy (OR 2.01, 95%CI 1.24-3.25, P = .005). CONCLUSION: UES occurred in 15% of patients after RARC, with 45% of patients requiring surgical reimplantation. Ureteral stents and the receipt of neoadjuvant chemotherapy were associated with UES formation.