How to predict postoperative delirium in geriatric patients with hip fracture as soon as possible? A retrospective study.

PURPOSE: Inflammation may play a role in the mechanism of postoperative delirium (POD), a severe complication among older postoperative patients. The purpose of this study was to investigate the risk factors of POD in postoperative patients with hip fracture, especially the inflammation marker- neutrophil-lymphocyte ratio (NLR). METHODS: This retrospective investigation utilized data from the Seventh Medical Center of People's Liberation Army. 1,242 Eligible patients with hip fracture (829 females), median age 81 years, mean neutrophil-lymphocyte ratio (NLR) 5.28, were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD occurrence, NLR and POD duration were analyzed by multivariable analysis. RESULTS: ROC curve showed that the optimal cut point of NLR for POD was NLR ≥ 7.6. Multivariate logistic regression analysis showed that NLR ≥ 7.6 (odds ratio [OR] 2.75, [95% confidence interval [CI] 1.51 to 5.02], p = 0.001), stroke (OR 1.05, [95% CI 1.02 to 1.09], p = 0.005), complications, general anesthesia, long length of stay were risk factors of POD, with the largest effect for NLR ≥ 7.6. NLR ≥ 7.6 (ß 0.59, [95% CI 0.209 to 0.886], p = 0.038), older age (ß 0.054, [95% CI 0.009 to 0.099], p = 0.019), previous stroke (ß 0.908, [95% CI 0.085 to 1.731], p = 0.031), and previous heart failure (ß 1.679, [95% CI 0.448 to 2.910], p = 0.008) suggested long POD duration. CONCLUSIONS: This study demonstrates an association between NLR and postoperative delirium in geriatric hip fracture patients, and contribute new evidence to support NLR as a potential marker for prediction of POD and POD duration.

Multi-Resolution Learning and Semantic Edge Enhancement for Super-Resolution Semantic Segmentation of Urban Scene Images.

Super-resolution semantic segmentation (SRSS) is a technique that aims to obtain high-resolution semantic segmentation results based on resolution-reduced input images. SRSS can significantly reduce computational cost and enable efficient, high-resolution semantic segmentation on mobile devices with limited resources. Some of the existing methods require modifications of the original semantic segmentation network structure or add additional and complicated processing modules, which limits the flexibility of actual deployment. Furthermore, the lack of detailed information in the low-resolution input image renders existing methods susceptible to misdetection at the semantic edges. To address the above problems, we propose a simple but effective framework called multi-resolution learning and semantic edge enhancement-based super-resolution semantic segmentation (MS-SRSS) which can be applied to any existing encoder-decoder based semantic segmentation network. Specifically, a multi-resolution learning mechanism (MRL) is proposed that enables the feature encoder of the semantic segmentation network to improve its feature extraction ability. Furthermore, we introduce a semantic edge enhancement loss (SEE) to alleviate the false detection at the semantic edges. We conduct extensive experiments on the three challenging benchmarks, Cityscapes, Pascal Context, and Pascal VOC 2012, to verify the effectiveness of our proposed MS-SRSS method. The experimental results show that, compared with the existing methods, our method can obtain the new state-of-the-art semantic segmentation performance.

Puerarin alleviates osteoporosis in rats by targeting the JAK2/STAT3 signaling pathway.

Osteoporosis (OP) is a common chronic progressive bone disease that increases fracture risk in postmenopausal women. Research suggests that puerarin (Pue) may be an effective treatment for OP. This study examined the effects and underlying mechanisms of Pue in treating postmenopausal osteoporosis (PMOP) in rats. Sprague-Dawley (SD) rats underwent bilateral ovariectomy to simulate PMOP and were then treated with subcutaneous injections of Pue. Bone mineral density (BMD) was measured using a bone densitometer. Micro-CT scans assessed femur bone structure and various parameters were calculated: bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and bone surface area-to-bone volume ratio (BS/BV). Hematoxylin-eosin (HE) staining was employed to observe femoral tissue pathology. Serum levels of bone formation metabolism-related markers-osteocalcin (OC), bone alkaline phosphatase (BALP), and procollagen type I N-terminal propeptide (PINP)-were measured via enzyme-linked immunosorbent assay (ELISA). The protein expression levels of the Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in bone tissue were evaluated using Western blotting assay. The results showed improved bone density and reduced bone loss in rats treated with Pue. There were also significant increases in serum levels of OC and BALP, indicating enhanced osteogenesis. Furthermore, there was a decrease in activation of the JAK2/STAT3 pathway in femoral tissue, suggesting a pathway inhibition. These findings indicate that Pue may combat osteoporosis by promoting osteogenesis and inhibiting activation of the JAK2/STAT3 pathway activation.

A Security Information Transmission Method Based on DHR for Seafloor Observation Network.

A seafloor observation network (SON) consists of a large number of heterogeneous devices that monitor the deep sea and communicate with onshore data centers. Due to the long-distance information transmission and the risk of malicious attacks, ensuring the integrity of data in transit is essential. A cryptographically secure frame check sequence (FCS) has shown great advantages in protecting data integrity. However, the commonly used FCS has a collision possibility, which poses a security risk; furthermore, reducing the encryption calculation cost is a challenge. In this paper, we propose a secure, lightweight encryption scheme for transmitted data inspired by mimic defense from dynamic heterogeneous redundancy theory. Specifically, we use dynamic keys to encrypt a data block and generate multiple encrypted heterogeneous blocks for transmission. These continuously changing encrypted data blocks increase the confusion regarding the original encoded data, making it challenging for attackers to interpret and modify the data blocks. Additionally, the redundant information from the multiple blocks can identify and recover tampered data. Our proposed scheme is suitable for resource-constrained environments where lightweight encryption is crucial. Through experimental demonstrations and analysis methods, we determine the effectiveness of our encryption scheme in reducing computational costs and improving security performance to protect data integrity.

Low-threshold lasing from bound states in the continuum with dielectric metasurfaces.

Bound states in the continuum (BICs) with extremely large quality factors (Q factors) can enhance the light-matter interaction and thus achieve low-threshold lasing. Here, we theoretically propose and experimentally demonstrate the low-threshold lasing at room temperature based on BICs. A threshold of approximately 306.7 W/cm2 (peak intensity) under a 7.5 ns-pulsed optical excitation is presented in an all-dielectric metasurface system consisting of titanium dioxide (TiO2) nanopillars with a dye film. Also, the multimode lasing can be excited by the higher pumping. Our results may find exciting applications in on-chip coherent light sources, filtering, and sensing.

Design of Lattice Structures Based on U* Load Path Analysis.

Lattice structures are widely used in lightweight structural components and energy absorption parts. While topology optimization addresses desirable density distribution in lattice structures, there is yet no definitive solution for finding an optimum lattice layout. Since load path analysis can reveal the most efficient route for load transfer, it is preferable to align the lattice trusses with load paths for optimal structural performance. In this work, U* load path analysis is used to tailor the unit cell geometries of body-centered cubic lattice structures. The lattice layout is first determined by stiffness lines and potential lines derived from U* field in the design domain. The truss diameters are then numerically optimized to generate the lattice structure with functionally graded properties. This methodology is validated by a design problem of a cantilever structure. Results from finite element simulations and experimental tests on specimens fabricated by selective laser sintering demonstrate that the U* graded design has a significantly higher specific stiffness and strength compared with the benchmark design with a uniform cell arrangement. This approach enables engineers to create new design concepts of lattice structures with the integration of physically determined load paths.

Spontaneous rupture of the urinary bladder: A rare case report.

Spontaneous rupture of the bladder (SRUB) is an extremely rare emergency that can be misdiagnosed due to its non-specific clinical presentation, leading to patient death. This study aimed to summarize SRUB's clinical features, diagnosis, and treatment through our case. We report a case of a 39-year-old female with preoperative peritonitis and peritoneal effusion diagnosis. We performed an emergency laparoscopic surgery and found she had a ruptured bladder. She was treated with laparoscopic rupture repair and suprapubic cystostomy. She recovered well, was discharged after seven days, and had the cystostomy tube removed after five weeks.

Hyperspectral image reconstruction via patch attention driven network.

Coded aperture snapshot spectral imaging (CASSI) captures 3D hyperspectral images (HSIs) with 2D compressive measurements. The recovery of HSIs from these measurements is an ill-posed problem. This paper proposes a novel, to our knowledge, network architecture for this inverse problem, which consists of a multilevel residual network driven by patch-wise attention and a data pre-processing method. Specifically, we propose the patch attention module to adaptively generate heuristic clues by capturing uneven feature distribution and global correlations of different regions. By revisiting the data pre-processing stage, we present a complementary input method that effectively integrates the measurements and coded aperture. Extensive simulation experiments illustrate that the proposed network architecture outperforms state-of-the-art methods.

A Multi-SCALE Community Network-Based SEIQR Model to Evaluate the Dynamic NPIs of COVID-19.

Regarding the problem of epidemic outbreak prevention and control, infectious disease dynamics models cannot support urban managers in reducing urban-scale healthcare costs through community-scale control measures, as they usually have difficulty meeting the requirements for simulation at different scales. In this paper, we propose combining contact networks at different spatial scales to study the COVID-19 outbreak in Shanghai from March to July 2022, calculate the initial Rt through the number of cases at the beginning of the outbreak, and evaluate the effectiveness of dynamic non-pharmaceutical interventions (NPIs) adopted at different time periods in Shanghai using our proposed approach. In particular, our proposed contact network is a three-layer multi-scale network that is used to distinguish social interactions occurring in areas of different sizes, as well as to distinguish between intensive and non-intensive population contacts. This susceptible-exposure-infection-quarantine-recovery (SEIQR) epidemic model constructed based on a multi-scale network can more effectively assess the feasibility of small-scale control measures, such as assessing community quarantine measures and mobility restrictions at different moments and phases of an epidemic. Our experimental results show that this model can meet the simulation needs at different scales, and our further discussion and analysis show that the spread of the epidemic in Shanghai from March to July 2022 can be successfully controlled by implementing a strict long-term dynamic NPI strategy.

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture.

Hip fractures in nonagenarians is one of the great challenges for patients of this age, the family and the larger society. The purpose of this study was to investigate the risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture. 199 Eligible patients were enrolled. Confusion Assessment Method (CAM) were used to identify the delirium. Logistic regressions were used to investigate the effect of 18 pre-existing conditions on postoperative delirium. Prognosis of postoperative delirium in nonagenarians with hip fracture were also be evaluated. The results indicated the following: (1) the prevalence of postoperative delirium among nonagenarians with hip fracture was 28.1% (56 of 199); (2) coexisting disease ≥ 4 (OR = 5.355, 95% CI = 1.394-9.074, P = 0.007), longer admission to operating time (OR = 1.514, 95% CI = 1.247-1.837, P = 0.000), and general anesthesia (OR = 2.086, 95% CI = 1.804-7.968, P = 0.032) were independent risk factors for postoperative delirium in nonagenarians with hip fracture; (3) nonagenarians with postoperative delirium had a predominantly high burden of perioperative complications, long length of stay, and postoperative mortality at 30 days follow-up and 1 year follow-up than the patients without postoperative delirium. The results could enable clinicians to improve outcome after operation in nonagenarians with hip fracture.

A case report of wandering spleen with pedicle torsion and splenic infarction being misdiagnosed as organ inversion complicated with acute appendicitis.

Wandering spleen is a rare disease that is easily misdiagnosed. When combined with splenic pedicle torsion and even splenic infarction, wandering spleen is a rare and critical cause of surgical acute abdomen. We report an 18-year-old male patient with abdominal organ inversion diagnosed as acute appendicitis before operation. Laparoscopic exploration confirmed wandering spleen with splenic pedicle torsion led to splenic infarction and was complicated by appendicitis. He was treated with laparoscopic appendectomy and abdominal splenectomy. The patient recovered well after the operation and was discharged from the hospital in 7 days. During the 4-year follow-up, there was no report of complicated infections such as pneumonia or sepsis.

Formic acid induces hypertension-related hemorrhage in hSSAOTG in mice and human.

Hypertension is a confirmed risk factor for cerebral hemorrhage in humans. Which endogenous factor directly induces hypertension-related hemorrhage is unclear. In this study, 42 hemorrhagic patients with hypertension and hyperlipidemia and 42 age-matched healthy controls were enrolled. The contents of serum semicarbazide-sensitive amine oxidase (SSAO) and formic acid (FC, FC is a final product of SSAO through the oxidation of endogenous formaldehyde, which results from the enzymatic oxidative deamination of the SSAO substrate, methylamine) were examined in the patients after stroke. Hemorrhagic areas were quantified by computer tomography. In the animal study, hemorrhagic degree was assessed by hemotoxylin & eosin or tissue hemoglobin kits. The relationship between FC and blood pressure/hemorrhagic degree was examined in wild-type mice and hSSAOTG mice fed with high-fat diets or high-fat and -salt diets. The results showed that the levels of serum FC were positively correlated with blood pressure and hemorrhagic areas in hemorrhagic patients. Transfection of microRNA-134 could enhance SSAO expression in human vascular smooth muscle cells. Consistently, after treatment with high-fat and -salt diets, hSSAOTG mice exhibited higher levels of miR134 and FC, higher blood pressure, and more severe hemorrhage than wild-type mice. Interestingly, folic acid reduced hypertension and hemorrhage in hSSAOTG mice fed with high-fat diets. These findings suggest that FC is a crucial endogenous factor for hypertension and hemorrhage.

Transcriptome Profiling to Dissect the Role of Genome Duplication on Graft Compatibility Mechanisms in Watermelon.

Watermelon (Citrullus lanatus) is a popular crop worldwide. Compared to diploid seeded watermelon, triploid seedless watermelon cultivars are in great demand. Grafting in triploid and tetraploid watermelon produces few seedlings. To learn more about how genome duplication affects graft compatibility, we compared the transcriptomes of tetraploid and diploid watermelons grafted on squash rootstock using a splicing technique. WGCNA was used to compare the expression of differentially expressed genes (DEGs) between diploid and tetraploid watermelon grafted seedlings at 0, 3, and 15 days after grafting (DAG). Only four gene networks/modules correlated significantly with phenotypic characteristics. We found 11 genes implicated in hormone, AOX, and starch metabolism in these modules based on intramodular significance and RT-qPCR. Among these genes, two were linked with IAA (r2 = 0.81), one with ZR (r2 = 0.85) and one with POD (r2 = 0.74). In the MElightsteelblue1 module, Cla97C11G224830 gene was linked with CAT (r2 = 0.81). Two genes from the MEivory module, Cla97C07G139710 and Cla97C04G077300, were highly linked with SOD (r2 = 0.72). Cla97C01G023850 and Cla97C01G006680 from the MEdarkolivegreen module were associated with sugars and starch (r2 = 0.87). Tetraploid grafted seedlings had higher survival rates and hormone, AOX, sugar, and starch levels than diploids. We believe that compatibility is a complicated issue that requires further molecular research. We found that genome duplication dramatically altered gene expression in the grafted plants' IAA and ZR signal transduction pathways and AOX biosynthesis pathways, regulating hormone levels and improving plant survival.

Residual Block Based Nested U-Type Architecture for Multi-Modal Brain Tumor Image Segmentation.

Multi-modal magnetic resonance imaging (MRI) segmentation of brain tumors is a hot topic in brain tumor processing research in recent years, which can make full use of the feature information of different modalities in MRI images, so that tumors can be segmented more effectively. In this article, convolutional neural networks (CNN) is used as a tool to improve the efficiency and effectiveness of segmentation. Based on this, Dense-ResUNet, a multi-modal MRI image segmentation model for brain tumors is created. The Dense-ResUNet consists of a series of nested dense convolutional blocks and a U-Net shaped model with residual connections. The nested dense convolutional blocks can bridge the semantic disparity between the feature maps of the encoder and decoder before fusion and make full use of different levels of features. The residual blocks and skip connection can extract pixel information from the image and skip the link to solve the traditional deep traditional CNN network problem. The experiment results show that our Dense-ResUNet can effectively help to extract the brain tumor and has great clinical research and application value.

Microservice Security Framework for IoT by Mimic Defense Mechanism.

Containers and microservices have become the most popular method for hosting IoT applications in cloud servers. However, one major security issue of this method is that if a container image contains software with security vulnerabilities, the associated microservices also become vulnerable at run-time. Existing works attempted to reduce this risk with vulnerability-scanning tools. They, however, demand an up-to-date database and may not work with unpublished vulnerabilities. In this paper, we propose a novel system to strengthen container security from unknown attack using the mimic defense framework. Specifically, we constructed a resource pool with variant images and observe the inconsistency in execution results, from which we can identify potential vulnerabilities. To avoid continuous attack, we created a graph-based scheduling strategy to maximize the randomness and heterogeneity of the images used to replace the current images. We implemented a prototype using Kubernetes. Experimental results show that our framework makes hackers have to send 54.9% more random requests to complete the attack and increases the defence success rate by around 8.16% over the baseline framework to avoid the continuous unknown attacks.

Genome-wide association analysis provides molecular insights into the natural variation of watermelon seed size.

Seed-consumption watermelon tend to have larger-sized seeds, while flesh-consumed watermelon often require relatively smaller seed. Therefore, the seed size of watermelon has received extensive attention from consumers and breeders. However, the study on the natural variation and genetic mechanism of watermelon seed size is not clear enough. In the present study, 100 seed weight, seed hilum length, seed length, seed width, and seed thickness in 197 watermelon accessions were examined. Furthermore, association analysis was conducted between seed size traits and high-quality SNP data. The results revealed that there was a strong correlation between the five seed traits. And seed enlargement was an important feature during watermelon seed size domestication. Meanwhile, the seed consumption biological species C. mucosospermu and C. lanatus edible seed watermelon had a significantly bigger seed size than other species's. Eleven non-repeating significant SNPs above the threshold line were obtained by GWAS analysis. Four of them on chromosome 5 were considered to be closely associated with seed size traits, i.e. S5: 32250307, S5: 32250454, S5: 32256177, S5: 32260870, which could be used as potential molecular markers for the breeding of watermelon cultivars with target seed size. In addition, combined with gene annotation information and previous reports, five genes near the four significant SNPs may regulate seed size. And qRT-PCR analysis showed that two genes Cla97C05G104360 and Cla97C05G104380, which may be involved in abscisic acid metabolism, may play an important role in regulating the seed size of watermelon. Our findings provide molecular insights into natural variation in watermelon seed size, and gives valuable information of molecular marker-assisted breeding.

Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study.

Objective: This study aimed to predict nasogastric tube (NGT) removal in patients with poststroke dysphagia (PSD) by non-swallowing function assessment. Methods: We enrolled 232 eligible patients and performed rehabilitation. The Fugl-Meyer assessment motor (FMM) and National Institute of Health Stroke Scale (NIHSS) scores were used to measure the motor and overall nervous system functions. Predictors for NGT removal in patients with PSD after rehabilitation were analyzed. Results: Of the 232 included patients, the NGTs were removed from 78% of them, while 22% were dependent on a feeding tube after 4 weeks of rehabilitation. Compared to the preserved NGT group, older age, a higher rate of intubation or tracheostomy, and more severe baseline functions were found in the NGT removal group. Age [odds ratio (OR) = 0.907; 95% confidence interval (CI): 0.859-0.957; p = 0.000], difference in the FMM score after 4 weeks of rehabilitation (OR = 1.219; 95% CI: 1.145-1.299; p = 0.00), and item 9 of NIHSS (OR = 0.488; 95% CI: 0.252-0.946; p = 0.034) were predictors of NGT removal after rehabilitation. Conclusion: We established a predictive model in patients with PSD using a non-swallowing assessment, which enabled us to predict swallowing recovery based on the non-swallowing function.

The branchless gene Clbl in watermelon encoding a TERMINAL FLOWER 1 protein regulates the number of lateral branches.

KEY MESSAGE: A SNP mutation in Clbl gene encoding TERMINAL FLOWER 1 protein is responsible for watermelon branchless. Lateral branching is one of the most important traits, which directly determines plant architecture and crop productivity. Commercial watermelon has the characteristics of multiple lateral branches, and it is time-consuming and labor-costing to manually remove the lateral branches in traditional watermelon cultivation. In our present study, a lateral branchless trait was identified in watermelon material WCZ, and genetic analysis revealed that it was controlled by a single recessive gene, which named as Clbl (Citrullus lanatus branchless). A bulked segregant sequencing (BSA-seq) and linkage analysis was conducted to primarily map Clbl on watermelon chromosome 4. Next-generation sequencing-aided marker discovery and a large mapping population consisting of 1406 F2 plants were used to further map Clbl locus into a 9011-bp candidate region, which harbored only one candidate gene Cla018392 encoding a TERMINAL FLOWER 1 protein. Sequence comparison of Cla018392 between two parental lines revealed that there was a SNP detected from C to A in the coding region in the branchless inbred line WCZ, which resulted in a mutation from alanine (GCA) to glutamate (GAA) at the fourth exon. A dCAPS marker was developed from the SNP locus, which was co-segregated with the branchless phenotype in both BC1 and F2 population, and it was further validated in 152 natural watermelon accessions. qRT-PCR and in situ hybridization showed that the expression level of Cla018392 was significantly reduced in the axillary bud and apical bud in branchless line WCZ. Ectopic expression of ClTFL1 in Arabidopsis showed an increased number of lateral branches. The results of this study will be helpful for better understanding the molecular mechanism of lateral branch development in watermelon and for the development of marker-assisted selection (MAS) for new branchless watermelon cultivars.