Tirzepatide Once Weekly for the Treatment of Obesity.

BACKGROUND: Obesity is a chronic disease that results in substantial global morbidity and mortality. The efficacy and safety of tirzepatide, a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, in people with obesity are not known. METHODS: In this phase 3 double-blind, randomized, controlled trial, we assigned 2539 adults with a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or more, or 27 or more and at least one weight-related complication, excluding diabetes, in a 1:1:1:1 ratio to receive once-weekly, subcutaneous tirzepatide (5 mg, 10 mg, or 15 mg) or placebo for 72 weeks, including a 20-week dose-escalation period. Coprimary end points were the percentage change in weight from baseline and a weight reduction of 5% or more. The treatment-regimen estimand assessed effects regardless of treatment discontinuation in the intention-to-treat population. RESULTS: At baseline, the mean body weight was 104.8 kg, the mean BMI was 38.0, and 94.5% of participants had a BMI of 30 or higher. The mean percentage change in weight at week 72 was -15.0% (95% confidence interval [CI], -15.9 to -14.2) with 5-mg weekly doses of tirzepatide, -19.5% (95% CI, -20.4 to -18.5) with 10-mg doses, and -20.9% (95% CI, -21.8 to -19.9) with 15-mg doses and -3.1% (95% CI, -4.3 to -1.9) with placebo (P<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85% (95% CI, 82 to 89), 89% (95% CI, 86 to 92), and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% (95% CI, 30 to 39) with placebo; 50% (95% CI, 46 to 54) and 57% (95% CI, 53 to 61) of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% (95% CI, 1 to 5) in the placebo group (P<0.001 for all comparisons with placebo). Improvements in all prespecified cardiometabolic measures were observed with tirzepatide. The most common adverse events with tirzepatide were gastrointestinal, and most were mild to moderate in severity, occurring primarily during dose escalation. Adverse events caused treatment discontinuation in 4.3%, 7.1%, 6.2%, and 2.6% of participants receiving 5-mg, 10-mg, and 15-mg tirzepatide doses and placebo, respectively. CONCLUSIONS: In this 72-week trial in participants with obesity, 5 mg, 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight. (Supported by Eli Lilly; SURMOUNT-1 ClinicalTrials.gov number, NCT04184622.).

Duck circovirus regulates the expression of duck CLDN2 protein by activating the MAPK-ERK pathway to affect its adhesion and infection.

Duck circovirus (DuCV) is widely recognized as a prominent virus in China's duck farming industry, known for its ability to cause persistent infections and significant immunosuppression, which can lead to an increased susceptibility to secondary infections, posing a significant threat to the duck industry. Moreover, clinical evidence also indicates the potential vertical transmission of the virus through duck embryos to subsequent generations of ducklings. However, the limited availability of suitable cell lines for in vitro cultivation of DuCV has hindered further investigation into the molecular mechanisms underlying its infection and pathogenicity. In this study, we observed that oral DuCV infection in female breeding ducks can lead to oviduct, ovarian, and follicular infections. Subsequently, the infection can be transmitted to the fertilized eggs, resulting in the emergence of virus-carrying ducklings upon hatching. In contrast, the reproductive organs of male breeding ducks were unaffected by the virus, thus confirming that vertical transmission of DuCV primarily occurs through infection in female breeding ducks. By analyzing transcriptome sequencing data from the oviduct, we focused on claudin-2, a gene encoding the tight junction protein CLDN2 located on the cell membrane, which showed significantly increased expression in DuCV-infected oviducts of female breeding ducks. Notably, CLDN2 was confirmed to interact with the unique structural protein of DuCV, namely capsid protein (Cap), through a series of experimental approaches including co-immunoprecipitation (co-IP), GST pull-down, immunofluorescence, and adhesion-blocking assays. Furthermore, we demonstrated that the Cap protein binds to the extracellular loop structural domains EL1 and EL2 of CLDN2. Subsequently, by constructing a series of truncated bodies of the CLDN2 promoter region, we identified the transcription factor SP5 for CLDN2. Moreover, we found that DuCV infection triggers the activation of the MAPK-ERK signaling pathway in DEF cells and ducks, leading to an upregulation of SP5 and CLDN2 expression. This process ultimately leads to the transportation of mature CLDN2 to the cell surface, thereby facilitating increased virus adherence to the target organs. In conclusion, we discovered that DuCV utilizes host CLDN2 proteins to enhance adhesion and infection in oviducts and other target organs. Furthermore, we elucidated the signaling pathways involved in the interaction between DuCV Cap proteins and CLDN2, which provides valuable insights into the molecular mechanism underlying DuCV's infection and vertical transmission. IMPORTANCE: Although duck circovirus (DuCV) poses a widespread infection and a serious hazard to the duck industry, the molecular mechanisms underlying DuCV infection and transmission remain elusive. We initially demonstrated vertical transmission of DuCV through female breeding ducks by simulating natural infection. Furthermore, a differentially expressed membrane protein CLDN2 was identified on the DuCV-infected oviduct of female ducks, and its extracellular loop structural domains EL1 and EL2 were identified as the interaction sites of DuCV Cap proteins. Moreover, the binding of DuCV Cap to CLDN2 triggered the intracellular MAPK-ERK pathway and activated the downstream transcription factor SP5. Importantly, we demonstrated that intracellular Cap also interacts with SP5, leading to upregulation of CLDN2 transcription and facilitating enhanced adherence of DuCV to target tissue, thereby promoting viral infection and transmission. Our study sheds light on the molecular mechanisms underlying vertical transmission of DuCV, highlighting CLDN2 as a promising target for drug development against DuCV infection.

Stabilizing the oxidation state of catalysts for effective electrochemical carbon dioxide conversion.

In the electrocatalytic CO2 reduction reaction (CO2RR), metal catalysts with an oxidation state generally demonstrate more favorable catalytic activity and selectivity than their corresponding metallic counterparts. However, the persistence of oxidative metal sites under reductive potentials is challenging since the transition to metallic states inevitably leads to catalytic degradation. Herein, a thorough review of research on oxidation-state stabilization in the CO2RR is presented, starting from fundamental concepts and highlighting the importance of oxidation state stabilization while revealing the relevance of dynamic oxidation states in product distribution. Subsequently, the functional mechanisms of various oxidation-state protection strategies are explained in detail, and in situ detection techniques are discussed. Finally, the prevailing and prospective challenges associated with oxidation-state protection research are discussed, identifying innovative opportunities for mechanistic insights, technology upgrades, and industrial platforms to enable the commercialization of the CO2RR.

Asymmetric Intramolecular Amination Catalyzed with Cp*Ir-SPDO via Nitrene Transfer for Synthesis of Spiro-Quaternary Indolinone.

An asymmetric intramolecular spiro-amination to high steric hindering α-C-H bond of 1,3-dicarbonyl via nitrene transfer using inactive aryl azides has been carried out by developing a novel Cp*Ir(III)-SPDO (spiro-pyrrolidine oxazoline) catalyst, thereby enabling the first successful construction of structurally rigid spiro-quaternary indolinone cores with moderate to high yields and excellent enantioselectivities. DFT computations support the presence of double bridging H-F bonds between [SbF6]- and both the ligand and substrate, which favors the plane-differentiation of the enol π-bond for nitrenoid attacking. These findings open up numerous opportunities for the development of new asymmetric nitrene transfer systems.

Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial.

BACKGROUND: Weight reduction is essential for improving health outcomes in people with obesity and type 2 diabetes. We assessed the efficacy and safety of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, versus placebo, for weight management in people living with obesity and type 2 diabetes. METHODS: This phase 3, double-blind, randomised, placebo-controlled trial was conducted in seven countries. Adults (aged ≥18 years) with a body-mass index (BMI) of 27 kg/m2 or higher and glycated haemoglobin (HbA1c) of 7-10% (53-86 mmol/mol) were randomly assigned (1:1:1), using a computer-generated random sequence via a validated interactive web-response system, to receive either once-weekly, subcutaneous tirzepatide (10 mg or 15 mg) or placebo for 72 weeks. All participants, investigators, and the sponsor were masked to treatment assignment. Coprimary endpoints were the percent change in bodyweight from baseline and bodyweight reduction of 5% or higher. The treatment-regimen estimand assessed effects regardless of treatment discontinuation or initiation of antihyperglycaemic rescue therapy. Efficacy and safety endpoints were analysed with data from all randomly assigned participants (intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT04657003. FINDINGS: Between March 29, 2021, and April 10, 2023, of 1514 adults assessed for eligibility, 938 (mean age 54·2 years [SD 10·6], 476 [51%] were female, 710 [76%] were White, and 561 [60%] were Hispanic or Latino) were randomly assigned and received at least one dose of tirzepatide 10 mg (n=312), tirzepatide 15 mg (n=311), or placebo (n=315). Baseline mean bodyweight was 100·7 kg (SD 21·1), BMI 36·1 kg/m2 (SD 6·6), and HbA1c 8·02% (SD 0·89; 64·1 mmol/mol [SD 9·7]). Least-squares mean change in bodyweight at week 72 with tirzepatide 10 mg and 15 mg was -12·8% (SE 0·6) and -14·7% (0·5), respectively, and -3·2% (0·5) with placebo, resulting in estimated treatment differences versus placebo of -9·6% percentage points (95% CI -11·1 to -8·1) with tirzepatide 10 mg and -11·6% percentage points (-13·0 to -10·1) with tirzepatide 15 mg (all p<0·0001). More participants treated with tirzepatide versus placebo met bodyweight reduction thresholds of 5% or higher (79-83% vs 32%). The most frequent adverse events with tirzepatide were gastrointestinal-related, including nausea, diarrhoea, and vomiting and were mostly mild to moderate in severity, with few events leading to treatment discontinuation (<5%). Serious adverse events were reported by 68 (7%) participants overall and two deaths occurred in the tirzepatide 10 mg group, but deaths were not considered to be related to the study treatment by the investigator. INTERPRETATION: In this 72-week trial in adults living with obesity and type 2 diabetes, once-weekly tirzepatide 10 mg and 15 mg provided substantial and clinically meaningful reduction in bodyweight, with a safety profile that was similar to other incretin-based therapies for weight management. FUNDING: Eli Lilly and Company.

Fluorescent Dye-Based Chiral Crystalline Organic Salt Networks for Circularly Polarized Luminescence.

A facile and general strategy is developed herein for the construction of circularly polarized luminescence (CPL) materials with simultaneously high fluorescence quantum efficiency (Φ) and large luminescence dissymmetry factor (glum). The self-assembly of fluorescent dye, disodium 4,4'-bis(2-sulfonatostyryl)biphenyl (CBS), with chiral diamines such as (R,R)/(S,S)-1,2-diaminocyclohexane (R/S-DACH) and R/S-1,2-diaminopropane (R/S-DAP), produces four chiral crystalline organic salt networks (COSNs). These as-synthesized organic salts emit strong blue-color CPL upon excitation, with both high Φ and glum values of up to 79% and 0.022. The well-defined molecular structures and arrangements of CBS are directly observed through single crystal X-ray analysis, offering crucial information regarding the origins of high-efficiency CPL performance. The chirality of amine is effectively transferred to CBS and further amplified to the supramolecular structure by multiple hydrogen bonding and π-π stacking interactions, giving rise to the large glum factors; meanwhile, the fixation and the ordered arrangement of CBS by these multiple interactions empower efficient suppression of molecular motions, facilitating strong fluorescence. This work can inspire the assembly of CPL organic materials with high Φ and glum via charge-assisted hydrogen bonds between fluorescent dyes and chiral inducers. It also offers important insight into the structural origins of supramolecular chirality and CPL performance.

Plasma Induced Atomic-Scale Soldering Enhanced Efficiency and Stability of Electrocatalysts for Ampere-Level Current Density Water Splitting.

Industrial water electrolysis typically operates at high current densities, the efficiency and stability of catalysts are greatly influenced by mass transport processes and adhesion with substrates. The core scientific issues revolve around reducing transport overpotential losses and enhancing catalyst-substrate binding to ensure long-term performance. Herein, vertical Ni-Co-P is synthesized and employed plasma treatment for dual modification of its surface and interface with the substrate. The (N)Ni-Co-P/Ni3N cathode exhibits an ultra-low overpotential of 421 mV at 4000 mA cm-2, and the non-noble metal system only requires a voltage of 1.85 V to reach 1000 mA cm-2. When integrated into an anion exchange membrane (AEM) electrolyzer, it can operate stably for >300 h at 500 mA cm-2. Under natural light, the solar-driven AEM electrolyzer operates at a current density up to 1585 mA cm-2 with a solar-to-hydrogen efficiency (SHT) of 9.08%. Density functional theory (DFT) calculations reveal that plasma modification leads to an "atomic-scale soldering" effect, where the Ni3N strong coupling with the Co increases free charge density, simultaneously enhancing stability and conductivity. This research offers a promising avenue for optimizing ampere-level current density water splitting, paving the way for efficient and sustainable industrial hydrogen production.

Nitronyl Nitroxide Ameliorates Hypobaric Hypoxia-Induced Cognitive Impairment in Mice by Suppressing the Oxidative Stress, Inflammatory Response and Apoptosis.

Abundant investigations have shown that hypobaric hypoxia (HH) causes cognitive impairment, mostly attributed to oxidative stress, inflammation, and apoptosis. HPN (4'-hydroxyl-2-subsitiuted phenylnitronyl nitroxide) is an excellent free radical scavenger with anti-inflammatory and anti-apoptotic activities. Our previous study has found that HPN exhibited neuroprotective effect on HH induced brain injury. In the present study, we examined the protective effect and potential mechanism of HPN on HH-induced cognitive impairment. Male mice were exposed to HH at 8000 m for 3 days with and without HPN treatment. Cognitive performance was assessed by the eight-arm radical maze. The histological changes were assayed by Nissle staining. The hippocampus cell apoptosis was detected by Tunnel staining. The levels of inflammatory cytokines and oxidative stress markers were detected. The expression of oxidative stress, inflammation-related and apoptosis-related proteins was determined by western blot. HPN administration significantly and mitigated HH induced histological damages and spatial memory loss with the evidence of decreased working memory error (WME), reference memory error (RME), total errors (TE) and total time (TT). In addition, HPN treatment significantly decreased the content of H2O2 and MDA, increased the levels of SOD, CAT, GSH-Px and GSH, and inhibited the synthesis of TNF-α, IL-1ß and IL-6. Moreover, HPN administration could down-regulate the expression of NF-κB, TNF-α, Bax, and cleaved caspase-3 and up-regulate the expression of Nrf2, HO-1 and Bcl-2. The number of apoptotic cells was also significantly decreased in the hippocampus of mice in the HPN group. There results indicate that HPN improve HH-induced cognitive impairment by alleviating oxidative stress damage, suppressing inflammatory response and apoptosis and may be a powerful candidate compound for alleviating memory loss induced by HH.

Central Metal-Triggered Structural Transformation of a 2D Layered MOF: Mechanistic Studies and Applications.

The structural transformation of metal-organic frameworks (MOFs) has attracted increasing interests, which has not only produced various new structures but also served as a fantastic platform for MOF-based kinetic analysis. Multiple reaction conditions have been documented to cause structural transformation; nevertheless, central metal-induced topological alteration of MOFs is rare. Herein, we reported a structural transformation of a 2D layered Cd-MOF driven by Cd(II) ions. After being submerged in the aqueous solution of cadmium nitrate, the twofold interpenetrated 2D network of [Cd(hsb-2)(bdc)·5H2O]n [HSB-W10; bdc: 1,4-benzenedicarboxylate; hsb-2:1,2-bis(4'-pyridylmethylamino)-ethane] was converted into a novel noninterpenetrated 2D network [Cd1.5(hsb-2)(bdc)1.5(H2O)2·H2O]n (HSB-W16). This partial dissolution-recrystallization process was investigated by integrating controlled experiments, 1H NMR spectra, and photographic tracking analysis. Furthermore, a novel strategy combining in situ multicomponent dye encapsulation and central metal-triggered structural transformation was developed for the fabrication of MOF materials with white-light emission. By adopting this strategy, different dye guest molecules were concurrently introduced into the HSB-W16 host matrix, leading to a range of white-light-emitting MOF composites. This work will enable detailed studies of solid-state transformations and demonstrate a promising application prospect for structural transformation.

Thermally Stable and Transparent Polyimide Derived from Side-Group-Regulated Spirobifluorene Unit for Substrate Application.

Advancements in flexible electronic technology, especially the progress in foldable displays and under-display cameras (UDC), have created an urgent demand for high-performance colorless polyimide (CPI). However, current CPIs lack sufficient heat resistance for substrate applications. In this work, four kinds of rigid spirobifluorene diamines are designed, and the corresponding polyimides are prepared by their condensation with 5,5'-(perfluoropropane-2,2-diyl) bis(isobenzofuran-1,3-dione) (6FDA) or 9,9-bis(3,4-dicarboxyphenyl) fluorene dianhydride (BPAF). The rigid and conjugated spirobifluorene units endow the polyimides with higher glass transition temperature (Tg) ranging from 356 to 468 °C. Their optical properties are regulated by small side groups and spirobifluorene structure with a periodically twisted molecular conformation. Consequently, a series of CPIs with an average transmittance ranging from 75% to 88% and a yellowness index (YI) as low as 2.48 are obtained. Among these, 27SPFTFA-BPAF presents excellent comprehensive performance, with a Tg of 422 °C, a 5 wt.% loss temperature (Td5) of 562 °C, a YI of 3.53, and a tensile strength (δmax) of 140 MPa, respectively. The mechanism underlying the structure-property relationship is investigated by experimental comparison and theoretical calculation, and the proposed method provides a pathway for designing highly rigid conjugated CPIs with excellent thermal stability and transparency for photoelectric engineering.

The photosynthetic performance and photoprotective role of carotenoids response to light stress in intertidal red algae Neoporphyra haitanensis.

Neoporphyra haitanensis, a red alga harvested for food, thrives in the intertidal zone amid dynamic and harsh environments. High irradiance represents a major stressor in this habitat, posing a threat to the alga's photosynthetic apparatus. Interestingly, N. haitanensis has adapted to excessive light despite the absence of a crucial xanthophyll cycle-dependent photoprotection pathway. Thus, it is valuable to investigate the mechanisms by which N. haitanensis copes with excessive light and to understand the photoprotective roles of carotenoids. Under high light intensities and prolonged irradiation time, N. haitanensis displayed reduction in photosynthetic efficiency and phycobiliproteins levels, as well as different responses in carotenoids. The decreased carotene contents suggested their involvement in the synthesis of xanthophylls, as evidenced by the up-regulation of lycopene-ß-cyclase (lcyb) and zeaxanthin epoxidase (zep) genes. Downstream xanthophylls such as lutein, zeaxanthin, and antheraxanthin increased proportionally to light stress, potentially participating in scavenging reactive oxygen species (ROS). When accompanied by the enhanced activity of ascorbate peroxidase (APX), these factors resulted in a reduction in ROS production. The responses of intermediates α-cryptoxanthin and ß-cryptoxanthin were felt somewhere between carotenes and zeaxanthin/lutein. Furthermore, these changes were ameliorated when the organism was placed in darkness. In summary, down-regulation of the organism's photosynthetic capacity, coupled with heightened xanthophylls and APX activity, activates photoinhibition quenching (qI) and antioxidant activity, helping N. haitanensis to protect the organism from the damaging effects of excessive light exposure. These findings provide insights into how red algae adapt to intertidal lifestyles.

Molecular basis for cell-wall recycling regulation by transcriptional repressor MurR in Escherichia coli.

The cell-wall recycling process is important for bacterial survival in nutrient-limited conditions and, in certain cases, is directly involved in antibiotic resistance. In the sophisticated cell-wall recycling process in Escherichia coli, the transcriptional repressor MurR controls the expression of murP and murQ, which are involved in transporting and metabolizing N-acetylmuramic acid (MurNAc), generating N-acetylmuramic acid-6-phosphate (MurNAc-6-P) and N-acetylglucosamine-6-phosphate (GlcNAc-6-P). Here, we report that both MurNAc-6-P and GlcNAc-6-P can bind to MurR and weaken the DNA binding ability of MurR. Structural characterizations of MurR in complex with MurNAc-6-P or GlcNAc-6-P as well as in the apo form revealed the detailed ligand recognition chemistries. Further studies showed that only MurNAc-6-P, but not GlcNAc-6-P, is capable of derepressing the expression of murQP controlled by MurR in cells and clarified the substrate specificity through the identification of key residues responsible for ligand binding in the complex structures. In summary, this study deciphered the molecular mechanism of the cell wall recycling process regulated by MurR in E. coli.

Can good neighbourhood perception magnify the positive effect of favourable built environment on recreational walking in China?

BACKGROUND: It remains unknown whether good neighbourhood perception can enhance the benefits of favourable built environment to physical activity. Moreover, the moderation pattern is less understood in developing countries. OBJECTIVES: This work aims to examine the moderation effects of perceived neighbourhood safety and aesthetics on the relationship between built environment and time for recreational walking. METHODS: We performed the examination using a sample of 760 residents in Fuzhou City, China. The Negative Binomial Regression Model was developed to examine the moderation roles of neighbourhood safety and aesthetics on the impact of built environment, adjusting for the effects of location, socioeconomic, personal preferences and social environment factors. Moreover, two sensitivity analyses were performed to test whether the moderators found are robust to the control of residential self-selection, and differential measures of conceptually-comparable aspects of built environment. RESULTS: We found stronger associations of time for recreational walking with road density and proportion of parks and squares POIs for residents with high perception of neighbourhood safety, compared to those with low perception of neighbourhood safety. There was a greater effect of the proportion of parks and squares POIs, when perceived aesthetics was high than when perceived aesthetics was low. The findings of neighbourhood safety and aesthetics as moderator, were robust in the two sensitivity analyses. No significant moderation effect was found for land use diversity. CONCLUSIONS: High perceived neighbourhood safety can magnify the positive effects of road connectivity and accessibility to parks and squares. Neighbourhood aesthetics positively moderates the association of time for recreational walking with accessibility to parks and squares. The findings emphasize the need to consider safety- and aesthetics-specific differences in estimates of built environment effects. Improvements in neighbourhood safety and aesthetics are key to effective interventions in built environment to better promote physical activity.

Building running-friendly cities: effects of streetscapes on running using 9.73 million fitness tracker data in Shanghai, China.

The association between built environment and physical activity has been recognized. However, how and to what extent microscale streetscapes are related to running activity remains underexplored, partly due to the lack of running data in large urban areas. Moreover, few studies have examined the interactive effects of macroscale built environment and microscale streetscapes. This study examines the main and interactive effects of the two-level environments on running intensity, using 9.73 million fitness tracker data from Keep in Shanghai, China. Results of spatial error model showed that: 1) the explanatory power of microscale streetscapes was higher than that of macroscale built environment with R2 of 0.245 and 0.240, respectively, which is different from the prior finding that R2 is greater for macroscale built environment than for microscale streetscape; 2) sky and green view indexes were positively associated with running intensity, whereas visual crowdedness had a negative effect; 3) there were negative interactions of land use Herfindahl-Hirschman index with sky and green view indexes, while a positive interaction was observed for visual crowdedness. To conclude, greener, more open and less visually crowded streetscapes, can promote running behavior and enhance the benefits of land use mix as well. The findings highlight the importance of streetscapes in promoting running behavior, instead of a supplement to macroscale built environment.

The value of the systemic immune-inflammation index in assessing disease severity in autoimmune encephalitis.

BACKGROUND: Autoimmune encephalitis (AE) is a group of autoimmune diseases targeting the central nervous system, characterized by severe clinical symptoms and substantial consumption of medical resources. Neuroinflammation plays a crucial role in disease progression, and detecting inflammatory responses can provide insights into disease status and disease severity. The systemic immune-inflammation index (SII), a novel marker of inflammatory status, has been rarely studied in AE. METHODS: Retrospective analysis of data from AE patients admitted to the First Affiliated Hospital of Zhengzhou University between January 2019 and September 2023 was conducted. Univariate analysis and logistic regression were used to assess the association between SII and patient severity. Nomograms for predicting AE severity were established, and receiver operating characteristic (ROC) curves, concordance index (C-index), calibration curves, and decision curve analysis were employed to evaluate predictive accuracy. Additionally, the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) score was used to assess patient severity. RESULTS: This study enrolled 157 patients, of whom 57 were classified as severe according to the CASE score. SII, cerebrospinal fluid (CSF) cell counts, disturbance of consciousness, and behavioural abnormalities independently associated with the occurrence of severe cases. The C-index of the nomograms was 0.87, indicating strong association with disease severity, as supported by the calibration. Additionally, SII levels were highest within seven days of onset and decreased after one month. In subgroup analyses of different antibodies, SII also associations with severe cases in NMDAR encephalitis. CONCLUSIONS: Higher SII levels are associated with an increased likelihood of developing severe AE, peaking within 7 days of disease onset and decreasing thereafter, potentially offering a prognostic marker to assess disease progression early in its course.

Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial.

Importance: The effect of continued treatment with tirzepatide on maintaining initial weight reduction is unknown. Objective: To assess the effect of tirzepatide, with diet and physical activity, on the maintenance of weight reduction. Design, Setting, and Participants: This phase 3, randomized withdrawal clinical trial conducted at 70 sites in 4 countries with a 36-week, open-label tirzepatide lead-in period followed by a 52-week, double-blind, placebo-controlled period included adults with a body mass index greater than or equal to 30 or greater than or equal to 27 and a weight-related complication, excluding diabetes. Interventions: Participants (n = 783) enrolled in an open-label lead-in period received once-weekly subcutaneous maximum tolerated dose (10 or 15 mg) of tirzepatide for 36 weeks. At week 36, a total of 670 participants were randomized (1:1) to continue receiving tirzepatide (n = 335) or switch to placebo (n = 335) for 52 weeks. Main Outcomes and Measures: The primary end point was the mean percent change in weight from week 36 (randomization) to week 88. Key secondary end points included the proportion of participants at week 88 who maintained at least 80% of the weight loss during the lead-in period. Results: Participants (n = 670; mean age, 48 years; 473 [71%] women; mean weight, 107.3 kg) who completed the 36-week lead-in period experienced a mean weight reduction of 20.9%. The mean percent weight change from week 36 to week 88 was -5.5% with tirzepatide vs 14.0% with placebo (difference, -19.4% [95% CI, -21.2% to -17.7%]; P < .001). Overall, 300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in period compared with 16.6% receiving placebo (P < .001). The overall mean weight reduction from week 0 to 88 was 25.3% for tirzepatide and 9.9% for placebo. The most common adverse events were mostly mild to moderate gastrointestinal events, which occurred more commonly with tirzepatide vs placebo. Conclusions and Relevance: In participants with obesity or overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. Trial Registration: ClinicalTrials.gov Identifier: NCT04660643.

Sandwich Therapy with Radionuclide Combined with Intralesional Injections Based on Differences in the Spatial Structure Components of Keloids.

BACKGROUND: Complications such as ulceration, depigmentation, and recurrence limit the use of intralesional injections and brachytherapy in keloid treatment. We designed a modified "sandwich" therapy based on the spatial distribution of keloid components to reduce the incidence of these complications. METHODS: First, we analyzed the spatial distribution pattern of scar tissue through single-cell sequencing analysis, ultrasound, and pathology. Subsequently, a "sandwich" therapy combining radionuclide and intralesional injections was designed based on the pattern found in the previous stage. Finally, 40 patients with keloid scars at 41 sites were included in the clinical trial. RESULTS: Single-cell sequencing identified two significant cellularly highly expressed genes and enriched pathways in the keloid vascular wall that primarily play essential roles in angiogenesis and promoting collagen synthesis, thereby promoting scar growth. Color ultrasound showed that there were hierarchical differences in the blood supply of the keloid, and further H&E, CD34, and eNOS staining showed that there were hierarchical differences in the spatial structure of blood vessels, fibroblasts, and collagen in the keloid. In clinical studies, the complication rate of "sandwich" therapy is lower than that of conventional treatment. CONCLUSION: The distribution of blood vessels and collagen in keloid scars is characterized by spatial variability. The "sandwich" therapy of radionuclide combined with intralesional injections is a modified type of precisely targeted therapy designed based on this variability; it has fewer complications and good clinical efficacy and is worthy of popularization. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analysis of canopy interception characteristics and influencing factors in typical artificial forest in the Loess Plateau semi-arid region.

Interception loss (IL) is an important process in the hydrological cycle within semi-arid forest ecosystems, directly affecting the amount of effective rainfall. However, the factors influencing IL during individual rainfall events remain to be quantified. This study collected rainfall, vegetation, and interception data during the 2022 and 2023 growing seasons in a typical black locust forest within the Zhifanggou watershed. It employed the Random Forest Regression (RFR) and back-propagation neural network (BPNN) methods to quantitatively evaluate the contribution rates of various factors to the IL and interception loss percentage (ILP). The IL among the 48 effective rainfall events was 172.05 mm, accounting for 19.54% of the rainfall amount. IL and ILP increased as the distance from the trunk decreased. During all rainfall events, both IL and ILP were significantly negatively correlated with the leaf area index (LAI) and canopy cover (CC); IL is significantly positively correlated with total rainfall (TR) and rainfall intensity (RI), while ILP is significantly negatively correlated with TR, RI, and rainfall duration (RD). The BPNN and RFR results indicated that rainfall, canopy, and tree characteristics contributed 43.06%, 44.79%, and 12.15% to IL, respectively, and 57.27%, 34.09%, and 8.63% to ILP, respectively. TR, CC, and LAI represented the primary influencing factors. Rainfall and canopy characteristics were the main factors affecting IL (ILP). As rainfall event magnitude increases, canopy contributions to IL and ILP decrease. In semi-arid areas, managing forest canopies to control IL helps address water imbalances in ecosystems.

Total Syntheses of Polycyclic Diterpenes Phomopsene, Methyl Phomopsenonate, and iso-Phomopsene via Reorganization of C-C Single Bonds.

The first total syntheses of polycyclic diterpenes phomopsene (1), methyl phomopsenonate (2), and iso-phomopsene (3) have been accomplished through the unusual cascade reorganization of C-C single bonds. This approach features: (i) a synergistic Nazarov cyclization/double ring expansions in one-step, developed by authors, to rapid and stereospecific construction of the 5/5/5/5 tetraquinane scaffold bearing contiguous quaternary centers and (ii) a one-pot strategic ring expansion through Beckmann fragmentation/recombination to efficiently assemble the requisite 5/5/6/5 tetracyclic skeleton of the target molecules 1-3. This work enables us to determine that the correct structure of iso-phomopsene is, in fact, the C7 epimer of the originally assigned structure. Finally, the absolute configurations of three target molecules were confirmed through enantioselective synthesis.

Meningeal immunity and neurological diseases: new approaches, new insights.

The meninges, membranes surrounding the central nervous system (CNS) boundary, harbor a diverse array of immunocompetent immune cells, and therefore, serve as an immunologically active site. Meningeal immunity has emerged as a key factor in modulating proper brain function and social behavior, performing constant immune surveillance of the CNS, and participating in several neurological diseases. However, it remains to be determined how meningeal immunity contributes to CNS physiology and pathophysiology. With the advances in single-cell omics, new approaches, such as single-cell technologies, unveiled the details of cellular and molecular mechanisms underlying meningeal immunity in CNS homeostasis and dysfunction. These new findings contradict some previous dogmas and shed new light on new possible therapeutic targets. In this review, we focus on the complicated multi-components, powerful meningeal immunosurveillance capability, and its crucial involvement in physiological and neuropathological conditions, as recently revealed by single-cell technologies.