Determination of MYD88 and CXCR4 mutation for clinical detection and their significance in Waldenström macroglobulinemia.

PURPOSE: This study aims to explore the incidence and clinical features of MYD88 and CXCR4 mutations in patients with Waldenström macroglobulinemia (WM) and determine the optimal method for routine clinical practice. Additionally, we seek to evaluate the prognostic significance of these features across various therapeutic backgrounds [cytotoxic group, the Rituximab/Bortezomib-based group, and the Bruton's tyrosine kinase inhibitor (BTKi) group]. EXPERIMENTAL DESIGN: 385 symptomatic WM patients were analyzed for MYD88 and CXCR4 mutations using Sanger sequencing, next-generation sequencing (NGS), allele-specific quantitative polymerase chain reaction (AS-PCR), and/or droplet digital PCR (ddPCR). RESULTS: The overall MYD88 mutation rate was 87.8%, relatively lower than that in Western cohort. Both AS-PCR and ddPCR demonstrated high sensitivity in unsorted samples, detecting 98.5% and 97.7% of mutations, respectively, including those with low tumor burdens. The total CXCR4 mutation rate was 30.9%, with NGS exhibiting the highest sensitivity of 78.0%. CXCR4 mutation was significantly linked to shorter OS only within the BTKi treatment group. The multivariate analysis indicated that MYD88 and CXCR4 mutations were not independent prognostic factors in the non-BTKi group when considering IPSSWM clinical staging. However, in the BTKi treatment group, these mutations emerged as independent adverse prognostic factors, overshadowing the prognostic significance of IPSSWM classification (MYD88: HR=0.229, P=0.030; CXCR4: HR=3.349, P=0.012). CONCLUSIONS: Testing for MYD88 mutations using AS-PCR or ddPCR in unsorted samples is viable for routine clinical practice. Under BTKi treatment, MYD88 and CXCR4 mutations hold greater prognostic importance than IPSSWM staging in WM.

Source Apportionment and Human Health Risks of Potentially Toxic Elements in the Surface Water of Coal Mining Areas.

Contamination with potentially toxic elements (PTEs) frequently occurs in surface water in coal mining areas. This study analyzed 34 surface water samples collected from the Yunnan-Guizhou Plateau for their hydrochemical characteristics, spatial distribution, source apportionment, and human health risks. Our statistical analysis showed that the average concentrations of PTEs in the surface water ranked as follows: Fe > Al > Zn > Mn > Ba > B> Ni > Li > Cd > Mo > Cu > Co > Hg > Se > As > Pb > Sb. The spatial analysis revealed that samples with high concentrations of Fe, Al, and Mn were predominantly distributed in the main stream, Xichong River, and Yangchang River. Positive matrix factorization (PMF) identified four sources of PTEs in the surface water. Hg, As, and Se originated from wastewater discharged by coal preparation plants and coal mines. Mo, Li, and B originated from the dissolution of clay minerals in coal seams. Elevated concentrations of Cu, Fe, Al, Mn, Co, and Ni were attributed to the dissolution of kaolinite, illite, chalcopyrite, pyrite, and minerals associated with Co and Ni in coal seams. Cd, Zn, and Pb were derived from coal melting and traffic release. The deterministic health risks assessment showed that 94.12% of the surface water samples presented non-carcinogenic risks below the health limit of 1. Meanwhile, 73.56% of the surface water samples with elevated As posed level III carcinogenic risk to the local populations. Special attention to drinking water safety for children is warranted due to their lower metabolic capacity for detoxifying PTEs. This study provides insight for PTE management in sustainable water environments.

Natural background level, source apportionment and health risk assessment of potentially toxic elements in multi-layer aquifers of arid area in Northwest China.

Groundwater contaminated by potentially toxic elements has become an increasing global concern for human health. Therefore, it is crucial to identify the sources and health risks of potentially toxic elements, especially in arid areas. Despite the necessity, there is a notable research gap concerning the sources and risks of these elements within multi-layer aquifers in such regions. To address this gap, 54 phreatic and 24 confined groundwater samples were collected from an arid area in Northwest China. This study aimed to trace the sources and evaluate the human health risks of potentially toxic elements by natural background level (NBL), positive matrix factorization (PMF) model, and health risk model. Findings revealed exceeding levels of potentially toxic elements existed in phreatic and confined aquifers. Source apportionment and NBL results indicated that mineral dissolution, evaporation, redox reactions, and human activities were the main factors for elevated concentrations of potentially toxic elements. High Fe and Mn concentrations were attributed to reduction environments, while F accumulation resulted from slow runoff, and irrigation from the Yellow River. Due to high F levels, more than one-third of groundwater samples (phreatic: 33.14 %, confined: 56.22 %) posed non-carcinogenic health risks to population groups. Adults displayed higher carcinogenic risks (phreatic: 19.47 %, confined: 34.16 %) than infants (phreatic: 0 %, confined: 0 %) and children (phreatic: 1.26 %, confined: 7.97 %) owing to the toxic elements of Cr. The confined aquifer presented greater health risks than the phreatic aquifer. Consequently, controlling the levels of F and Cr in multi-layered aquifers is key to reducing health risks. These findings provide valuable insights into protecting groundwater from contamination by potentially toxic elements in multi-layered aquifers worldwide.

Predicting the clinical prognosis of acute ischemic stroke using machine learning: an application of radiomic biomarkers on non-contrast CT after intravascular interventional treatment.

Purpose: This study aimed to develop a radiomic model based on non-contrast computed tomography (NCCT) after interventional treatment to predict the clinical prognosis of acute ischemic stroke (AIS) with large vessel occlusion. Methods: We retrospectively collected 141 cases of AIS from 2016 to 2020 and analyzed the patients' clinical data as well as NCCT data after interventional treatment. Then, the total dataset was divided into training and testing sets according to the subject serial number. The cerebral hemispheres on the infarct side were segmented for radiomics signature extraction. After radiomics signatures were standardized and dimensionality reduced, the training set was used to construct a radiomics model using machine learning. The testing set was then used to validate the prediction model, which was evaluated based on discrimination, calibration, and clinical utility. Finally, a joint model was constructed by incorporating the radiomics signatures and clinical data. Results: The AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.900, 0.863, 0.727, and 0.591, respectively, in the training set. In the testing set, the AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.885, 0.840, 0.721, and 0.590, respectively. Conclusion: Our results provided evidence that using post-interventional NCCT for a radiomic model could be a valuable tool in predicting the clinical prognosis of AIS with large vessel occlusion.

Fuzzy inference system enabled neural network feedforward compensation for position leap control of DC servo motor.

To improve dynamic performance and steady-state accuracy of position leap control of the direct current (DC) servo motor, a fuzzy inference system (FIS) enabled artificial neural network (ANN) feedforward compensation control method is proposed in this study. In the method, a proportional-integral-derivative (PID) controller is used to generate the baseline control law. Then, an ANN identifier is constructed to online learn the reverse model of the DC servo motor system. Meanwhile, the learned parameters are passed in real-time to an ANN compensator to provide feedforward compensation control law accurately. Next, according to system tracking error and network modeling error, an FIS decider consisting of an FI basic module and an FI finetuning module is developed to adjust the compensation quantity and prevent uncertain disturbance from undertrained ANN adaptively. Finally, the feasibility and efficiency of the proposed method are verified by the tracking experiments of step and square signals on the DC servo motor testbed. Experimental results show that the proposed FIS-enabled ANN feedforward compensation control method achieves lower overshoot, faster adjustment, and higher precision than other comparative control methods.

JianPiTongLuo (JPTL) Recipe regulates anti-apoptosis and cell proliferation in colorectal cancer through the PI3K/AKT signaling pathway.

Background: JianPiTongLuo Recipe (JPTL Recipe) is a traditional Chinese medicine formula commonly used in the clinical treatment of colorectal cancer. Clinical studies have found that it can significantly improve the prognosis of patients with colorectal cancer. However, its mechanisms of action are not well understood, which has limited its further clinical application. Methods: We investigated the potential mechanisms of action of the JianPiTongLuo (JPTL) Recipe on colorectal cancer (CRC) using a multi-step approach. Initially, network pharmacology and bioinformatics analyses were conducted using databases such as TCMSP, HERB, BATMAN-TCM, and STRING to identify active components of JPTL Recipe and predict their therapeutic targets. Interaction networks and functional enrichment analyses were constructed to hypothesize relevant biological processes and pathways. In vitro studies involved treating human CRC cell lines HCT116, LoVo and SW480 with varying concentrations of JPTL Recipe extract, measuring cell viability with the CCK-8 assay, assessing apoptosis via flow cytometry, and analyzing signaling pathways through Western blotting. To corroborate these findings, in vivo experiments were performed on BALB/c nude mice implanted with HCT116 cells, divided into control, JPTL Recipe-treated, 5-fluorouracil (5-FU)-treated, and JPTL Recipe combined with 5-FU groups, with tumor growth and histological changes monitored. Mechanistic studies focused on the PI3K/AKT signaling pathway, examining the phosphorylation status of key pathway proteins using immunofluorescence and Western blot analyses to elucidate JPTL Recipe 's interaction with pathway activity. Results: We demonstrated that JPTL Recipe effectively inhibits colorectal cancer cell proliferation, anti-apoptotic ability, and exerts synergistic therapeutic effects with fluorouracil. Further analysis revealed that JPTL Recipe affects the activity of colorectal cancer cells by inhibiting the phosphorylation of the PI3K/AKT signaling pathway. Conclusion: In summary, we have discovered and confirmed that the traditional Chinese medicine compound JPTL Recipe can serve as a novel adjuvant therapy for colorectal cancer, offering a new treatment approach for the integration of traditional Chinese and Western medicine in the treatment of colorectal cancer.

Microsecond-Scale Transient Thermal Sensing Enabled by Flexible Mo1-xWxS2 Alloys.

Real-time thermal sensing through flexible temperature sensors in extreme environments is critically essential for precisely monitoring chemical reactions, propellant combustions, and metallurgy processes. However, despite their low response speed, most existing thermal sensors and related sensing materials will degrade or even lose their sensing performances at either high or low temperatures. Achieving a microsecond response time over an ultrawide temperature range remains challenging. Here, we design a flexible temperature sensor that employs ultrathin and consecutive Mo1-x W x S2 alloy films constructed via inkjet printing and a thermal annealing strategy. The sensing elements exhibit a broad work range (20 to 823 K on polyimide and 1,073 K on flexible mica) and a record-low response time (about 30 µs). These properties enable the sensors to detect instantaneous temperature variations induced by contact with liquid nitrogen, water droplets, and flames. Furthermore, a thermal sensing array offers the spatial mapping of arbitrary shapes, heat conduction, and cold traces even under bending deformation. This approach paves the way for designing unique sensitive materials and flexible sensors for transient sensing under harsh conditions.

C─H Activation Enables the Construction of New Bis-Polyaryl Phenylpyridine Ruthenium Complexes: Conjugation and Rigidity Synergistic Effect for Advanced Electrochemiluminescence.

The access to bench-stable organometallic compounds unfolds new chemical space for medicinal and material sciences. In particular, stable organoruthenium compounds with constitutional and stereoisomeric forms for subtle regulation of electrochemiluminescence are intriguing and challenging. Here, coordination of polycyclic aromatic hydrocarbons on (2-phenylpyridine)2(CO)2Ru complex allows access to bis-polyaryl phenylpyridine (BPP) Ruthenium complex through C─H activation strategy and coupling reactions for installation of the functionalities with steric and electronic purposes. The photoluminescence and electrochemiluminescence of BPP Ru complexes are affected by the actual polycyclic aromatic hydrocarbons inherent properties. The anthracene derivatized BPP Ru complex (BPP-Ant) shows the best ECL performance and reveals an enormous ECL quantum efficiency of 1.6-fold higher than the golden standard Ru(bpy)3 2+. The unprecedentedly high efficiency is due to the best compromise between the structural conjugation and molecular rigidity from BPP-Ant providing a providential energy gap that facilitated the feasibility of electron transfer and favored the radiative energy release by experimentally and DFT calculations. Moreover, PL and spooling ECL spectroscopies are used to track and link multiple emission peaks of BPP-Ant at 445, 645, and 845 nm to different emissive species. These discoveries will add a new member to the efficient ECL ruthenium complex family and bring more potentials.

Pattern of heterogeneity in normal brain ageing: screening for mild cognitive impairment and its risk of progression with a radiomics model.

PURPOSE: This study aimed to develop a normal brain ageing model based on magnetic resonance imaging and radiomics, therefore identifying radscore, an imaging indicator representing white matter heterogeneity and exploring the significance of radscore in detecting people's cognitive changes. METHODS: Three hundred sixty cognitively normal (CN) subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database and 105 CN subjects from the Parkinson's Progression Markers Initiative database were used to develop the model. In ADNI, 230 mild cognitive impairment (MCI) subjects were matched with 230 CN old-aged subjects to evaluate their heterogeneity difference. One hundred four MCI subjects with 48 months of follow-up were divided into low and high heterogeneity groups. Kaplan-Meier survival curve analysis was used to observe the importance of heterogeneity results for predicting MCI progression. RESULTS: The area under the receiver operating characteristic curve of the model in the training, internal test and external test sets was 0.7503, 0.7512 and 0.7514, respectively. There was a significantly positive correlation between age and radscore of CN subjects (r = 0.501; P < .001). The radscore of MCI subjects was significantly higher than that of matched CN subjects (P < .001). The median radscore ratios of MCI to CN from four age groups (66-70y, 71-75y, 76-80y and 81-85y) were 1.611, 1.760, 1.340 and 1.266, respectively. The probability to progression of low and high heterogeneity groups had a significant difference (P = .002). CONCLUSION: When radscore is significantly higher than that of normal ageing, it is necessary to alert the possibility of cognitive impairment and deterioration.

Utilisation of Lactiplantibacillus plantarum and propionic acid to improve silage quality of amaranth before and after wilting: fermentation quality, microbial communities, and their metabolic pathway.

Objective: The aim of this study was to investigate the effects of Lactiplantibacillus plantarum (L. plantarum) and propionic acid (PA) on fermentation characteristics and microbial community of amaranth (Amaranthus hypochondriaus) silage with different moisture contents. Methods: Amaranth was harvested at maturity stage and prepared for ensiling. There were two moisture content gradients (80%: AhG, 70%: AhS; fresh material: FM) and three treatments (control: CK, L. plantarum: LP, propionic acid: PA) set up, and silages were opened after 60 d of ensiling. Results: The results showed that the addition of L. plantarum and PA increased lactic acid (LA) content and decreased pH of amaranth after fermentation. In particular, the addition of PA significantly increased crude protein content (p < 0.05). LA content was higher in wilted silage than in high-moisture silage, and it was higher with the addition of L. plantarum and PA (p < 0.05). The dominant species of AhGLP, AhSCK, AhSLP and AhSPA were mainly L. plantarum, Lentilactobacillus buchneri and Levilactobacillus brevis. The dominant species in AhGCK include Enterobacter cloacae, and Xanthomonas oryzae was dominated in AhGPA, which affected fermentation quality. L. plantarum and PA acted synergistically after ensiling to accelerate the succession of dominant species from gram-negative to gram-positive bacteria, forming a symbiotic microbial network centred on lactic acid bacteria. Both wilting and additive silage preparation methods increased the degree of dominance of global and overview maps and carbohydrate metabolism, and decreased the degree of dominance of amino acid metabolism categories. Conclusion: In conclusion, the addition of L. plantarum to silage can effectively improve the fermentation characteristics of amaranth, increase the diversity of bacterial communities, and regulate the microbial community and its functional metabolic pathways to achieve the desired fermentation effect.

Groundwater suitability assessment for irrigation and drinking purposes by integrating spatial analysis, machine learning, water quality index, and health risk model.

An in-depth understanding of nitrate-contaminated surface water and groundwater quality and associated risks is important for groundwater management. Hydrochemical characteristics and driving forces of groundwater quality and non-carcinogenic risks of nitrate were revealed by the integrated approaches of self-organizing map analysis, spatial visualization by geography information system, entropy and irrigation water quality indices, and human health risk model. Groundwater samples were categorized into two clusters by SOM analysis. Cluster I including three samples were Ca-SO4 type and cluster II of remaining 136 samples were Ca-HCO3 type. Hydrochemical compositions of two cluster samples were dominated by water-rock interaction: (1) calcite and gypsum dissolution for cluster I samples and (2) calcite dissolution, silicate weathering, and positive cation exchange for cluster II samples. Nitrate contamination occurred in both cluster I and II samples, primarily induced by agricultural nitrogen fertilizer. The EWQI results showed that 90.97% in total groundwater samples were suitable for drinking purpose, while the IWQI results demonstrated that 65.03% in total groundwater samples were appropriate for irrigation purpose. The HHR model and Monte Carlo simulation indicated that the non-carcinogenic nitrated risk was highest in children. Exposure frequency was the most sensitive factor (86.33% in total) influencing the total non-carcinogenic risk, indicated by sensitivity analysis. Compared with the two clusters of groundwater, surface water has a shorter circulation cycle and lower ion concentrations resulting in better water quality. This study can provide scientific basis for groundwater quality evaluation in other parts of the world.

Natural background levels, source apportionment and health risks of potentially toxic elements in groundwater of highly urbanized area.

Identifying the natural background levels (NBLs), threshold values (TVs), sources and health risks of potentially toxic elements in groundwater is crucial for ensuring the water security of residents in highly urbanized areas. In this study, 96 groundwater samples were collected in urban area of Sichuan Basin, SW China. The concentrations of potentially toxic elements (Li, Fe, Cu, Zn, Al, Pb, B, Ba and Ni) were analyzed for investigating the NBLs, TVs, sources and health risks. The potentially toxic elements followed the concentration order of Fe > Ba > B > Al > Zn > Li > Cu > Ni > Pb. The NBLs and TVs indicated the contamination of potentially toxic elements mainly occurred in the northern and central parts of the study area. The Positive Matrix Factorization (PMF) model identified elevated concentrations of Fe, Al, Li, and B were found to determine groundwater quality. The primary sources of Fe, Al, Pb, and Ni were attributed to the dissolution of oxidation products, with Fe additionally affected by anthropogenic reduction environments. Li and B were determined to be originated from the weathering of tourmaline. High levels of Ni and Cu concentrations were derived from electronic waste leakage, while excessive Ba and Zn were linked to factory emissions and tire wear. The reasonable maximum exposure (RME) of hazard index (HI) was higher than safety standard and reveal the potential health risks in the southwestern study area. Sensitivity analysis demonstrated the Li concentrations possessed the highest weight contributing to health risk. This study provides a valuable information for source-specific risk assessments of potentially toxic elements in groundwater associated with urban areas.

Maritime Freight Carbon Emission in the U.S. using AIS data from 2018 to 2022.

Global maritime emissions, a 3% contributor to greenhouse gases, anticipate a surge of 90-130% by 2050. Regulatory challenges persist due to international governance gaps. Legislative strides, including the EU Emission Trading System, highlight global efforts. In the U.S., despite legislative commitment, consensus hurdles impede cross-regional carbon management. Prevailing top-down emissions estimation methods warrant scrutiny. This paper unveils U.S. maritime emissions intricacies, focusing on carbon accounting, transfer, and compensation for cargo and tanker vessels. Leveraging AIS data (2018-2022), an activity-based/bottom-up approach navigates emissions calculations, aiming to reshape understanding and foster strategic reductions. The study bridges gaps in U.S. maritime emission research, promising insights into transfer and compensation dynamics. By concentrating on high-impact vessel types, it contributes to emissions mitigation strategies, steering towards a sustainable U.S. maritime future.

Evaluate the groundwater quality and human health risks for sustainable drinking and irrigation purposes in mountainous region of Chongqing, Southwest China.

Groundwater is crucial for agriculture and domestic consumption. This research investigated the hydrogeochemical properties and contaminant sources of groundwater within the mountainous terrain of northern Chongqing, with the objective of evaluating its appropriateness for irrigation and potable use. The hydrochemical type of the groundwater was HCO3 - Ca, dominated by silicate and calcite dissolutions. High NO3- (29.03% exceeds 10 mg/L) were attributed to the overuse of agricultural fertilizers. A comprehensive evaluation was conducted to determine the groundwater suitability for agricultural and potable uses. The results showed that groundwater in the southwestern region, particularly within the Yangtze River mainstem watershed, exhibited less suitability for irrigation owing to its lower mineralization, in contrast to the northeastern region near the Daning River watershed. But this trend is reversed for drinking purposes. Overall, the groundwater was appropriate for both drinking (93.55% were classified as excellent) and irrigation (70.98% were classified as low restriction) purposes in the study area. Deterministic and probabilistic noncarcinogenic health risk analyses centered on nitrate exposure revealed that infants (with 13.79% of samples >1) were at greater risk than children (8.58%), adult males (6.98%), and adult females (5.24%). This underscores the urgency to reduce nitrogen fertilizer usage and improve water management in the region. This research will provide guidance for the sustainable groundwater management in mountainous regions.

Comparison between morphometry and radiomics: detecting normal brain aging based on grey matter.

Objective: Voxel-based morphometry (VBM), surface-based morphometry (SBM), and radiomics are widely used in the field of neuroimage analysis, while it is still unclear that the performance comparison between traditional morphometry and emerging radiomics methods in diagnosing brain aging. In this study, we aimed to develop a VBM-SBM model and a radiomics model for brain aging based on cognitively normal (CN) individuals and compare their performance to explore both methods' strengths, weaknesses, and relationships. Methods: 967 CN participants were included in this study. Subjects were classified into the middle-aged group (n = 302) and the old-aged group (n = 665) according to the age of 66. The data of 360 subjects from the Alzheimer's Disease Neuroimaging Initiative were used for training and internal test of the VBM-SBM and radiomics models, and the data of 607 subjects from the Australian Imaging, Biomarker and Lifestyle, the National Alzheimer's Coordinating Center, and the Parkinson's Progression Markers Initiative databases were used for the external tests. Logistics regression participated in the construction of both models. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were used to evaluate the two model performances. The DeLong test was used to compare the differences in AUCs between models. The Spearman correlation analysis was used to observe the correlations between age, VBM-SBM parameters, and radiomics features. Results: The AUCs of the VBM-SBM model and radiomics model were 0.697 and 0.778 in the training set (p = 0.018), 0.640 and 0.789 in the internal test set (p = 0.007), 0.736 and 0.737 in the AIBL test set (p = 0.972), 0.746 and 0.838 in the NACC test set (p < 0.001), and 0.701 and 0.830 in the PPMI test set (p = 0.036). Weak correlations were observed between VBM-SBM parameters and radiomics features (p < 0.05). Conclusion: The radiomics model achieved better performance than the VBM-SBM model. Radiomics provides a good option for researchers who prioritize performance and generalization, whereas VBM-SBM is more suitable for those who emphasize interpretability and clinical practice.

[Pollution Characteristics and Ecological Risk Assessment of Microplastics in the Yangtze River Basin].

The Yangtze River, the largest river in China, has not been comprehensively studied for its basin's microplastic pollution status. Therefore, a comprehensive investigation and assessment system of microplastics was developed at the river basin scale to characterize the spatial distribution and composition of microplastics in the Yangtze River Basin in order to analyze their influencing factors and assess their ecological risks. The results showed that the microplastic abundance in the study area ranged from 21 to 44 080 n·m-3, with an average abundance of 4 483 n·m-3. The spatial distribution of microplastic abundance was higher in the tributaries than in the main streams (except the Ganjiang Basin), with the Chengdu of the Minjiang Basin being the tributary area with the highest abundance of microplastics detected. The size of microplastics in the river basin was concentrated in the 0-1 mm range; the shapes were mainly fiber and fragment; and the colors were mainly colored and transparent. Further, introducing the diversity index of microplastics, it was found that both the Simpson index and the Shannon-Wiener index could quantify the diversity of microplastic characteristic composition in the river basin, but there were certain differences in the changing trends between the two. Regression analysis showed that anthropogenic activities were significantly and positively correlated with microplastic abundance (P<0.05), and among the eight anthropogenic activity factors, civilian vehicle ownership and tourism income were the most strongly correlated with microplastic abundance, indicating that transportation and tourism were the main factors influencing microplastic distribution. From the perspective of the potential ecological risk index of microplastics, microplastics in the Yangtze River Basin posed a certain ecological risk, with 68.97% of the area falling within risk zones III and IV, with the ecological risk of microplastics in Taihu Lake warranting more widespread attention.

Water quality's responses to water energy variability of the Yangtze River.

River energy serves as an indicator of pollutant-carrying capacity (PCC), influencing regional water quality dynamics. In this study, MIKE21 hydrodynamics-water quality models were developed for two scenarios, and grid-by-grid numerical integration of energy was conducted for the Yangtze River's mainstream. Comparison of predicted and measured values at monitoring points revealed a close fit, with average relative errors ranging from 5.17 to 8.37%. The concept of PCC was introduced to assess water flow's ability to transport pollutants during its course, elucidating the relationship between river energy and water quality. A relationship model between Unit Area Energy (UAE) and PCC was fitted (R2 = 0.8184). Temporally, reservoir construction enhanced the smoothness of UAE distribution by 74.47%, attributable to peak shaving and flow regulation. While this flood-drought season energy transfer reduced PCC differences, it concurrently amplified pollutant retention by 40.95%. Spatially, energy distribution fine-tuned PCC values, showcasing binary variation with energy changes and a critical threshold. Peak PCC values for TP, NH3-N, and COD were 2.46, 2.26, and 54.09 t/(km·a), respectively. These insights support local utility regulators and decision-makers in navigating low-carrying capacity, sensitive areas, enhancing targeted water protection measures for increased effectiveness and specificity.

Ultrasonic AccV: a potential indicator of peripheral arteriosclerosis in patients with chronic obstructive pulmonary disease.

OBJECTIVE: This study aimed to investigate the risk factors for peripheral arteriosclerosis (PAS) and peripheral artery disease (PAD) in chronic obstructive pulmonary disease (COPD) patients and potential ultrasound indicators that could be used to improve detection. METHOD: Outpatients seeking care between January 1, 2017, and December 31, 2020, in The First Affiliated Hospital of China Medical University were prospectively recruited. Subjects were divided into COPD and non-COPD (control) groups, and the COPD group was further divided into PAD and non-PAD subgroup, at the same time, PAS and non-PAS subgroup. Indicators of PAD -ankle-brachial index (ABI), indicators of PAS- pulse wave velocity (PWV), and ultrasound indices -peak systolic blood flow velocity (PSV) and blood flow acceleration velocity (AccV) were compared. RESULT: Sixty-nine (61.6%) of 112 enrolled subjects had COPD. COPD patients had higher age, and blood pressure (BP)lower than controls. Seventeen (24.6%) COPD patients had PAD, the prevalence of PAD increases with the decrease of lung function, and seven (16.3%) non-COPD patients had PAD, however, there was no significant statistical difference between COPD and non-COPD groups. Fifty (72.5%) COPD patients had PAS, and thirty-four (79.1%) non-COPD patients had PAS, however, there was also no significant difference. The PAS subgroup had higher age, body mass index(BMI), body fat percentage(BFP), lower FEV1 and FEV1/FVC, as well as higher levels of right brachial artery and left dorsalis pedis artery AccV. Factors that correlated with ABI were 6MWD, post-bronchodilator FEV1, FEV1/ FVC, and maximal middle expiratory flow between 75% and 25% of FVC. Age, BP, and 6MWD, but not pulmonary function, were associated with brachial-ankle PWV (baPWV). There was a positive correlation between baPWV and radial artery AccV bilaterally. CONCLUSION: Radial artery AccV correlated well with baPWV, which suggests that ultrasound could be used to assess both morphological and functional changes in vessels, may serving as a better method to identify PAS in high-risk COPD patients.

Sequential treatment escalation improves survival in patients with Waldenstrom macroglobulinemia.

Waldenstrom macroglobulinemia (WM) is a type of incurable, indolent B-cell lymphoma that is prone to relapse. Over time, treatment strategies have progressed from cytotoxic drugs to rituximab (R)- or bortezomib (V)-based regimens, and have now entered into an era of Bruton tyrosine kinase inhibitor (BTKi)-based regimens. However, the optimal treatment for the relapsed patients is still unclear. Herein, we analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy. After a median follow-up of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. The major response rates (MRR) of first- and second-line treatment were 65.1% and 67.9% (P = 0.678). The median progression-free survival (PFS) for the second-line therapy (PFS2) was shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, P = 0.03). However, PFS2 in targeted drugs group (R-/V-/BTKi-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, P = 0.21). Regarding second-line therapy, patients who underwent sequential treatment escalation-such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens (escalation group) -had higher MRR (80.6% vs 47.1%, respectively, P = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, P < 0.001) compared to the non-escalation group. Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, P = 0.039). Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.