Serum growth differentiation factor 15 as a biomarker for malnutrition in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that often coexists with malnutrition during acute exacerbation (AECOPD) and significantly affects the prognosis. Previous studies have shown that growth differentiation factor 15 (GDF15) levels promote appetite suppression, weight loss, and muscle weakness, and are markedly high in peripheral blood following inflammatory stimulation. However, it is still unknown whether serum GDF15 levels can be used to predict malnutrition in patients with AECOPD. Methods: A total of 142 patients admitted to the Department of Respiratory Medicine at Anshun People's Hospital between December 2022 and August 2023 were selected for this study. The participants were divided into two groups: malnutrition group (n = 44) and non-malnutrition group (n = 98) based on a body mass index (BMI) < 18.5 kg/m2, according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Serum GDF15 levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Spearman correlation analysis was used to examine the association between serum GDF15 levels, baseline data, and clinical indicators. Binary logistic regression was used to identify the independent risk factors for AECOPD combined with malnutrition. The predictive value of serum GDF15, albumin (ALB), and a combination of these was evaluated to identify malnutrition in patients with AECOPD using a receiver operating characteristic (ROC) curve. Results: Serum GDF15 levels in patients with malnutrition and AECOPD were significantly higher than those in patients without malnutrition, whereas the serum ALB levels were significantly lower than those in patients without malnutrition (p < 0.001). Moreover, serum GDF15 levels were negatively correlated with BMI (r = -0.562, p < 0.001), mid-arm circumference (r = -0.505, p < 0.001), calf circumference (r = -0.490, p < 0.001), total protein (r = -0.486, p < 0.001), ALB (r = -0.445, p < 0.001), and prognostic nutritional index (r = -0.276, p = 0.001), and positively correlated with C-reactive protein (r = 0.318, p < 0.001), COPD assessment test score (r = 0.286, p = 0.001), modified medical research council classification (r = 0.310, p < 0.001), and global initiative for chronic obstructive pulmonary disease grade (r = 0.177, p = 0.035). Furthermore, serum GDF15 levels were an independent risk factor for malnutrition in patients with AECOPD (OR = 1.010, 95% CI, 1.003∼1.016). The optimal cut-off value of serum GDF15 level was 1,092.885 pg/mL, with a sensitivity of 65.90% and a specificity of 89.80%, while the serum ALB level was 36.15 g/L, with a sensitivity of 86.40% and a specificity of 65.00%, as well as a combined sensitivity of 84.10% and a specificity of 73.90%. Serum GDF15 and serum ALB levels had a good predictive ability (AUC = 0.856, AUC = 0.887), and the ROC revealed a greater combined prediction value for the two (AUC = 0.935). Conclusion: Serum GDF15 levels could be used as a potential biomarker in the prediction of malnutrition in patients with AECOPD, offering a guidance for future clinical evaluation of malnutrition.

Experimental and numerical study on the shear performance of stainless steel-GFRP connectors for use in precast concrete sandwich panels.

Precast Concrete Sandwich Panel (PCSP) is composed of concrete load-bearing panels, thermal insulation panels, and decorative panels, which are assembled through connectors, integrating load-bearing, thermal insulation, and decorative functions. The connector bears the main shear force between the wall panels, and the shear resistance and insulation performance of the connector largely determine the mechanical stability and insulation effect of the wall panels, which is a key component in PCSPs. The current common practice is to cross assemble stainless steel insulation (SSI) connectors and Glass-Fiber-Reinforced Plastic (GFRP) connectors into PCSPs, which can reduce building energy consumption and save resources while meeting strength and insulation requirements. A large-scale pull-out test on a PCSP with intersecting SSI-GFRP connectors was conducted in this paper. The damage process and damage pattern of PCSP were observed and the shear performance of SSI-GFRP connectors was analyzed. Secondly, a numerical analysis model of the test PCSP was built using ABAQUS finite element software and its validity was verified through the test data. In addition, parameters such as connector diameter, connector number ratio and concrete strength were analyzed for their effect on the shear performance of SSI-GFRP connectors and it was found that connector diameter and connector number ratio had a significant effect. Finally, it is found that there are some differences between the classical theory for calculating the shear performance of SSI-GFRP connectors and the actual results. A theoretical correction factor (ζ) is given to improve the accuracy of the calculation of the classical theory, and its influencing factors and changing rules are investigated.

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix.

BACKGROUND: Frey syndrome, also known as ototemporal nerve syndrome or gustatory sweating syndrome, is one of the most common complications of parotid gland surgery. This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes, visual stimuli, or eating. AIM: To investigate the preventive effect of acellular dermal matrix (ADM) on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection. METHODS: Retrospective data from 82 patients were analyzed to assess the correlation between sex, age, resection sample size, operation time, operation mode, ADM usage, and occurrence of postoperative Frey syndrome. RESULTS: Among the 82 patients, the incidence of Frey syndrome was 56.1%. There were no significant differences in sex, age, or operation time between the two groups (P > 0.05). However, there was a significant difference between ADM implantation and occurrence of Frey syndrome (P < 0.05). ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes. CONCLUSION: ADM can effectively prevent Frey syndrome and delay its onset.

Analysis of the spatio-temporal evolution of sustainable land use in China under the carbon emission trading scheme: A measurement idea based on the DID model.

Sustainable development is the theme of world economic development in the 21st century. As a key part of sustainable development, sustainable land use (SLU) encompasses economic development and environmentally friendly and social progress. In recent decades, China has formulated many environmental regulatory policies to achieve sustainable development and "carbon peaking and carbon neutrality (double-carbon)" goals, among which the carbon emission trading scheme (CETS) is the most representative and provides valuable research. In this paper, we aimed to reflect the spatio-temporal evolution of SLU in China under the influence of environmental regulatory policies through an indicator measurement strategy based on the DID estimation method. The study conclusions are as follows: (1) The CETS can effectively improve SLU from the perspectives of economic development and environmentally friendly progress, and the impact has primarily been in the pilot areas. And, its effectiveness is closely linked to local locational factors. (2) With respect to the dimension of economic development, the CETS has not changed the provincial distribution patterns of SLU; rather, it continues to remain "high to low, east to west". However, regarding the environmentally friendly progress dimension, the CETS has significantly changed the provincial distribution patterns of SLU, which are characterized by spatial agglomeration with urban agglomerations such as the Pearl River Delta (PRD) and the Yangtze River Delta (YRD) as the core. (3) The screening results of the SLU indicators based on economic development showed that the CETS primarily improved the innovation capacities of pilot regions, and the impacts on economic levels were relatively small. Similarly, the screening results of the SLU indicators based on environmentally friendly progress showed that the CETS had primarily acted on reducing pollution emission intensity and strengthening greening construction, revealing only short-term effects on improving energy use efficiency. Based on the above, this paper explored the meaning and role of the CETS in more detail, with a view to providing insight into the implementation and formulation of environmental regulation policies.

Investigation on compression and mildew of mixed and separated maize.

This study explores the influence of different segregation configurations on the creep behaviors and mildew of maize. An inexpensive and easy-to-use system was designed, and three configurations of maize kernels distribution, i.e., uniform mixing (Mdm), alternating distribution (Mda), and segregated state distribution (Mds), with wet basis moisture content of 22.9%, were compressed under vertical pressure of 200 kPa through a one-dimensional oedometer. The compression and creep behaviors were investigated using the strain/settlement-time results, and aerobic plate counting (APC) was performed to study the effect of distribution configuration on the mildew effect. A finite-element model was established to simulate the temperature variation caused by physical environmental factors, and the heat production by fungi was quantified using the difference in temperature between simulation and test. The results indicate that the three-element Schiffman model can represent the creep behavior of the maize with different distribution configurations. The average temperature of Mdm, Mda, and Mds were 7.53%, 12.98%, and 14.76% higher than the average room temperature, respectively. The aerobic plate count of Mdm, Mda, and Mds were 1.0 × 105, 2.2 × 105, and 8.8 × 105 cfu g-1 stored for 150 h, respectively. In general, the temperature and APC in segregated maize bulk are higher than uniform grain. The effectiveness of the numerical model was verified, and the heat production by maize bulk fungi was quantified using the test and numerical temperature difference. The average heat was the least in Mdm with 2.8 × 106 J m-3, and Mda and Mds were 1.7 and 2 times more than Mdm. And the heat was related to the segregation configurations and agreed very well with the APC and temperature results.

A hierarchical reinforcement learning method for missile evasion and guidance.

This paper proposes an algorithm for missile manoeuvring based on a hierarchical proximal policy optimization (PPO) reinforcement learning algorithm, which enables a missile to guide to a target and evade an interceptor at the same time. Based on the idea of task hierarchy, the agent has a two-layer structure, in which low-level agents control basic actions and are controlled by a high-level agent. The low level has two agents called a guidance agent and an evasion agent, which are trained in simple scenarios and embedded in the high-level agent. The high level has a policy selector agent, which chooses one of the low-level agents to activate at each decision moment. The reward functions for each agent are different, considering the guidance accuracy, flight time, and energy consumption metrics, as well as a field-of-view constraint. Simulation shows that the PPO algorithm without a hierarchical structure cannot complete the task, while the hierarchical PPO algorithm has a 100% success rate on a test dataset. The agent shows good adaptability and strong robustness to the second-order lag of autopilot and measurement noises. Compared with a traditional guidance law, the reinforcement learning guidance law has satisfactory guidance accuracy and significant advantages in average time and average energy consumption.

The Impact of Partnerships and Information Sharing on Corporate Sustainable Performance: A Mediation Model Moderated by Government Support.

Based on the theory of strategic alliances and social networks, this article empirically studies the relationship between partnership, information sharing, and sustainable performance through a questionnaire survey of Chinese sports equipment manufacturers. The findings show that partnerships have a positive impact on sustainable performance; that information sharing plays a role in mediating the relationships between trust, cooperation, and sustainable performance; and that government support can positively impact the effect of partnerships on sustainable performance. Through empirical research, this article proves the mechanism of the impact of partnership on alliance performance, further expands the theoretical basis for enterprises' establishment of strategic alliances, and has important enlightening significance for enterprises within alliances aiming to rationally use the networks inside and outside their alliances to obtain knowledge and resources and improve their sustainable performance.

The Impact of eSports Industry Knowledge Alliances on Innovation Performance: A Mediation Model Based on Knowledge Sharing.

This study investigates the associations among member ability, member relationships, knowledge sharing, and innovation performance in eSports industry knowledge alliance. A survey strategy and purposive sampling were applied, and the analysis was conducted on a sample of 311 senior managers from the China eSports Association. The hypotheses were tested using SPSS 24.0 software and AMOS 24.0 software. This study shows that member ability and member relationships have both a direct and indirect effect on innovation performance. Firstly, member ability, member relationships, and member knowledge sharing significantly impact the innovation performance of eSports industry knowledge alliances. Secondly, member knowledge sharing plays a mediating role in the effect of member ability and membership relationship on innovation performance. This pioneering article explores the interaction mechanisms between member ability, member relationships, and innovation performance in eSports industry knowledge alliance. The research results are conducive to the development of the eSports industry toward deep integration and sustainable development and provide a reference for similar knowledge-intensive enterprise alliance behaviors.

Research on reinforcement learning-based safe decision-making methodology for multiple unmanned aerial vehicles.

A system with multiple cooperating unmanned aerial vehicles (multi-UAVs) can use its advantages to accomplish complicated tasks. Recent developments in deep reinforcement learning (DRL) offer good prospects for decision-making for multi-UAV systems. However, the safety and training efficiencies of DRL still need to be improved before practical use. This study presents a transfer-safe soft actor-critic (TSSAC) for multi-UAV decision-making. Decision-making by each UAV is modeled with a constrained Markov decision process (CMDP), in which safety is constrained to maximize the return. The soft actor-critic-Lagrangian (SAC-Lagrangian) algorithm is combined with a modified Lagrangian multiplier in the CMDP model. Moreover, parameter-based transfer learning is used to enable cooperative and efficient training of the tasks to the multi-UAVs. Simulation experiments indicate that the proposed method can improve the safety and training efficiencies and allow the UAVs to adapt to a dynamic scenario.

Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China.

Objective: Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a high morbidity and mortality among the elderly. Low levels of high-density lipoprotein cholesterol (HDL-C), a traditional risk marker for CVD, are common in CKD patients. Little is known about the association of low HDL-C with renal dysfunction in the community dwelling population. Methods: This was a population-based cross-sectional study included 4,753 participants enrolled in a prospective study, the Shanghai Elderly Cardiovascular Health (SHECH) study. Estimated glomerular filtration rate (eGFR), calculated by the Chinese Modification of Diet in Renal Disease (C-MDRD equation), was used to assess renal dysfunction. Associations between renal dysfunction and low HDL-C were evaluated using multiple logistic regression models and restricted cubic splines. Results: Of 4,649 individuals who met inclusion criteria, 620 (13.34%) had low HDL-C at <40 mg/dl. In the fully adjusted model, lower eGFR of <60 ml/min/1.73 m2 (OR, 2.03; 95% CI, 1.21-3.43) and marginal eGFR of 60 to 90 ml/min/1.73 m2 (OR, 1.26; 95% CI, 1.01-1.58) were significantly associated with low HDL-C, compared with normal eGFR of ≥90 ml/min/1.73 m2. Moreover, consistent findings were obtained in subsidiary analyses using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Fully adjusted cubic spline models indicated a significant dose-response relationship between eGFR and low HDL-C (P for non-linearity, 0.356). Conclusion: In this general elderly population, renal dysfunction was independently and significantly associated with low HDL-C, and the prevalence of low HDL-C increased with decreasing eGFR, such that even slight changes in renal function may be associated with altered lipid levels.

Insulin resistance surrogates predict hypertension plus hyperuricemia.

AIMS/INTRODUCTION: To compare the association of hypertension plus hyperuricemia with four insulin resistance surrogates, including glucose and triglycerides (TyG index), TyG index with body mass index (TyG-BMI), the ratio of triglycerides divided by high-density lipoprotein cholesterol (TG/HDL-C) and metabolic score for insulin resistance (METS-IR). MATERIALS AND METHODS: Data from a cross-sectional epidemiological study enrolling a representative population sample aged ≥65 years were used to calculate the four indexes. The association with hypertension plus hyperuricemia and insulin resistance surrogates was examined with multivariate logistic regression and receiver operating characteristic. RESULTS: A total of 4,352 participants were included, including 93 (2.1%) patients with hyperuricemia alone, 2,875 (66.1%) with hypertension alone and 587 (13.5%) with hypertension plus hyperuricemia. Mutivariate logistic regression showed that TyG index, TyG-BMI, TG/HDL-C and METS-IR were all significantly correlated with hyperuricemia, hypertension and hypertension plus hyperuricemia. Compared with the lowest quartile, the odds ratios (OR) of the highest quartile of the four indicators for hypertension plus hyperuricemia were TyG index: OR 6.39 (95% confidence interval [CI] 4.17-9.78); TyG-BMI: OR 8.54 (95% CI 5.58-13.09); TG/HDL-C: OR 7.21 (95% CI 4.72-11.01); METS-IR: OR 9.30 (95% CI 6.00-14.43), respectively. TyG-BMI and METS-IR had moderate discriminative abilities for hypertension plus hyperuricemia and the AUC values were 0.72 (95% CI 0.70-0.74) and 0.73 (95% CI 0.70-0.75). CONCLUSIONS: The present study suggested that TyG index, TyG-BMI, TG/HDL-C and METS-IR had a significant correlation with hypertension plus hyperuricemia, and TyG-BMI and METS-IR had discriminative abilities for hypertension plus hyperuricemia.

Long-term antibacterial stable reduced graphene oxide nanocomposites loaded with cuprous oxide nanoparticles.

Stable reduced graphene oxide-cuprous oxide (rGO-Cu2O) nanocomposites with long-term antibacterial activities were prepared by reducing copper sulfate supported on GO using ascorbic acid as reducing agent in the presence of polyethylene glycol (PEG) and sodium hydroxide at room temperature. The rGO provided a protective barrier for Cu2O, preventing Cu2O from reacting with external solution to leach copper ions too quickly. Meanwhile, the rGO also promoted the separation of photoexcited charge carriers of Cu2O nanoparticles to enhance the oxidative stress reactive and protected Cu2O from falling apart in the phosphate buffered solution (PBS) solution to prolong the generation time of reactive oxygen species (ROS). More importantly, the large specific surface area of rGO improved the dispersibility of Cu2O by electrostatic interaction. The synergistic effect of sustained release of copper ions, elevated ROS production ability and uniform dispersion of rGO-Cu2O nanocomposites resulted in the excellent antibacterial activities of rGO-Cu2O nanocomposites against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) which were maintained around 70% and 65% and were increased by 40% and 35% compared with free Cu2O after immersing 30 days in PBS solutions.

Environmentally relevant impacts of nano-TiO2 on abiotic degradation of bisphenol A under sunlight irradiation.

Understanding the effects of nano-TiO2 particles on the environmental behaviors of organic pollutants in natural aquatic environments is of paramount importance considering that large amount of nano-TiO2 is being released in the environment. In this study, the effect of nano-TiO2 on the degradation of bisphenol A (BPA) in water was investigated under simulated solar light irradiation. The results indicated that nano-TiO2 at environmentally relevant concentration (1 mg/L) could significantly facilitate the abiotic degradation of BPA (also at low concentration) under mild solar light irradiation, with the pseudo first-order rate constant (kobs) for BPA degradation raised by 1-2 orders of magnitude. As reflected by the inhibition experiments, hydroxyl radicals (OHs) and superoxide radical species were the predominant active species responsible for BPA degradation. The reaction was affected by water pH, and the degradation rate was higher at acidic or alkaline conditions than that at neutral condition. Humic acid (HA) also affected the reaction rate, depending on its concentration. At lower concentration (the mass ratio of HA/nano-TiO2 was 0.1:1), HA improved the dispersion and stability of nano-TiO2 in aquatic environment. As a result, the yield of OHs by nano-TiO2 under sunlight irradiation increased and BPA degradation was facilitated. When the HA concentration increased, a coating of HA formed on the surface of nano-TiO2. Although nano-TiO2 became more stable, the light absorption by nano-TiO2 was significantly reduced due to the strong light absorption of the HA coated on the surface. As a consequence, the yield of OH decreased and BPA degradation was depressed. The results imply that nano-TiO2 at low concentration may distinctly mediate BPA degradation, and can contribute to the natural attenuation of some organic pollutants in aquatic environment with low level of HA. However, this process would be significantly reduced in the presence of high level of HA.

Novel mesoporous graphite carbon nitride/BiOI heterojunction for enhancing photocatalytic performance under visible-light irradiation.

A novel organic-inorganic three-dimensional (3D) mesoporous graphite carbon nitride/BiOI (MCN/BiOI) heterojunction photocatalyst with excellent visible-light-driven photocatalytic performance was synthesized by a facile solvothermal method and used for degradation of bisphenol A (BPA) in water. After hybridization with MCN, a heterojunction was formed and the photogenerated carriers could be effectively separated by the internal electric field built at the heterojunction interface. The photocatalytic and photoelectrochemical performance of BiOI were improved and much higher than pure BiOI and MCN. The best photocatalytic performance was achieved with MCN proportion of 10%, and the kobs was approximately 1.6 times of pure BiOI and 3.4 times of MCN under simulated solar light irradiation, respectively. The photocurrent intensity generated by 10%-MCN/BiOI electrode was about 1.5 and 2.0 times of those induced by BiOI and MCN under visible-light irradiation, respectively. The superoxide radical species were predominant in the reaction system.