Emerging Enterovirus A71 Subgenogroup B5 Causing Severe Hand, Foot, and Mouth Disease, Vietnam, 2023.

We report on a 2023 outbreak of severe hand, foot, and mouth disease in southern Vietnam caused by an emerging lineage of enterovirus A71 subgenogroup B5. Affected children were significantly older than those reported during previous outbreaks. The virus should be closely monitored to assess its potential for global dispersal.

Usefulness of cone-beam computed tomography-reformatted epidurography in percutaneous epidural adhesiolysis: A pilot study.

BACKGROUND: Conventional epidurography (CE) is thought to have insufficient usefulness on percutaneous epidural adhesiolysis (PEA). We aimed to evaluate the association between the outcome of PEA and cone-beam computed tomography-reformatted epidurography (CBCT-RE). METHODS: After ethics board approval and written informed consent were obtained, we performed 30 PEA in 26 participants, and evaluated their post-PEA image findings. Two independent radiologists categorized and recorded the occurrence of contrast in the intracanal ventral and extraforaminal regions on CE, and in the dorsal canal (DC), ventral canal (VC), dorsal foramen (DF), and ventral foramen (VF) on CBCT-RE. Reproducibility was assessed using intraclass correlation coefficients (ICCs). Baseline characteristics along with contrast distribution patterns of CE and CBCT-RE were analyzed in terms of their association with symptom relief at 1 month after PEA. RESULTS: The rate of patients with symptoms relief >50% after PEA was 63.3%. The inter-reader agreement was higher for CBCT-RE (ICC = 0.955) than for CE (ICC = 0.793). Participants with contrast coexisting in VC and DF adjacent to the irritated nerve root on CBCT-RE ( p = 0.015) had a significantly better response after PEA than those without contrast at these locations on CBCT-RE, independent of baseline characteristics (adjusted odds ratio: 11.414 [ p = 0.012]). CONCLUSION: CBCT-RE with identifying contrast distribution patterns is useful for predicting outcome of PEA.

Associations of Glucometabolic Indices with Aortic Stiffness in Patients Undergoing Peritoneal Dialysis with and without Diabetes Mellitus.

Disruptions in glucose metabolism are frequently observed among patients undergoing peritoneal dialysis (PD) who utilize glucose-containing dialysis solutions. We aimed to investigate the relationship between glucometabolic indices, including fasting glucose, insulin resistance, advanced glycation end products (AGEs), PD-related glucose load, and icodextrin usage, and aortic stiffness in PD patients with and without diabetic mellitus (DM). This study involved 172 PD patients (mean age 58.3 ± 13.5 years), consisting of 110 patients without DM and 62 patients with DM. Aortic stiffness was assessed using the carotid-femoral pulse wave velocity (cfPWV). Impaired fasting glucose was defined as a fasting glucose level ≥ 100 mg/dL. Homeostatic model assessment for insulin resistance (HOMA-IR) scores, serum AGEs, dialysate glucose load, and icodextrin usage were assessed. Patients with DM exhibited the highest cfPWV (9.9 ± 1.9 m/s), followed by those with impaired fasting glucose (9.1 ± 1.4 m/s), whereas patients with normal fasting glucose had the lowest cfPWV (8.3 ± 1.3 m/s), which demonstrated a significant trend. In non-DM patients, impaired fasting glucose (ß = 0.52, 95% confidence interval [CI] = 0.01-1.03, p = 0.046), high HOMA-IR (ß = 0.60, 95% CI = 0.12-1.08, p = 0.015), and a high PD glucose load (ß = 0.58, 95% CI = 0.08-1.08, p = 0.023) were independently associated with increased cfPWV. In contrast, none of the glucometabolic factors contributed to differences in cfPWV in DM patients. In conclusion, among PD patients without DM, impaired fasting glucose, insulin resistance, and PD glucose load were closely associated with aortic stiffness.

Spectroscopic Evidence of Localized Small Polarons in Low-Dimensional Ionic Liquid Lead-Free Hybrid Perovskites.

Rational design is an important approach to consider in the development of low-dimensional hybrid organic-inorganic perovskites (HOIPs). In this study, 1-butyl-1-methyl pyrrolidinium (BMP), 1-(3-aminopropyl)imidazole (API), and 1-butyl-3-methyl imidazolium (BMI) serve as prototypical ionic liquid components in bismuth-based HOIPs. Element-sensitive X-ray absorption spectroscopy measurements of BMPBiBr4 and APIBiBr5 reveal distinct resonant excitation profiles across the N K-edges, where contrasting peak shifts are observed. These 1D-HOIPs exhibit a large Stokes shift due to the small polaron contribution, as probed by photoluminescence spectroscopy at room temperature. Interestingly, the incorporation of a small fraction of tin (Sn) into the APIBiBr5 (Sn/Bi mole ratio of 1:3) structure demonstrates a strong spectral weight transfer accompanied by a fast decay lifetime (2.6 ns). These phenomena are the direct result of Sn-substitution in APIBiBr5, decreasing the small polaron effect. By changing the active ionic liquid, the electronic interactions and optical responses can be moderately tuned by alteration of their intermolecular interaction between the semiconducting inorganic layers and organic moieties.

Biological Activities of Citrus aurantium Leaf Extract by Optimized Ultrasound-Assisted Extraction.

Several studies have explored the biological activities of Citrus aurantium flowers, fruits, and seeds, but the bioactivity of C. aurantium leaves, which are treated as waste, remains unclear. Thus, this study developed a pilot-scale ultrasonic-assisted extraction process using the Box-Behnken design (BBD) for the optimized extraction of active compounds from C. aurantium leaves, and their antityrosinase, antioxidant, antiaging, and antimicrobial activities were evaluated. Under optimal conditions in a 150× scaleup configuration (a 30 L ultrasonic machine) of a pilot plant, the total phenolic content was 69.09 mg gallic acid equivalent/g dry weight, which was slightly lower (3.17%) than the theoretical value. The half maximal inhibitory concentration of C. aurantium leaf extract (CALE) for 2,2-diphenyl-1-picrylhydrazyl-scavenging, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid)-scavenging, antityrosinase, anticollagenase, antielastase and anti-matrix metalloprotein-1 activities were 123.5, 58.5, 181.3, 196.4, 216.3, and 326.4 mg/L, respectively. Moreover, the minimal inhibitory concentrations for bacteria and fungi were 150-350 and 500 mg/L, respectively. In total, 17 active compounds were detected in CALE-with linalool, linalyl acetate, limonene, and α-terpineol having the highest concentrations. Finally, the overall transdermal absorption and permeation efficiency of CALE was 95.9%. In conclusion, our CALE demonstrated potential whitening, antioxidant, antiaging, and antimicrobial activities; it was also nontoxic and easily absorbed into the skin as well as inexpensive to produce. Therefore, it has potential applications in various industries.

Practicing Outside the Lines: Using Acupuncture in the Athletic Training Room and on the Field.

Acupuncture can be used to treat athletes in an outpatient clinic setting, athletic training room, or even on a football field sideline. This article details 3 scenarios, in 3 illustrative cases, in which acupuncture was used for sports medicine in more unconventional settings. The author describes each case and shares his observations about them. First, acupuncture was used on a high-school football field sideline to help alleviate acute calf cramping in a player. Second, acupuncture was used in a division 2 college athletic training room to treat a player with subacute thoracic pain that was not improving with the usual treatments provided by the athletic trainers. Third, acupuncture was used to treat hamstring strain and tightness in a professional National Football League player to enhance his performance. These situations demonstrate the versatility of acupuncture in the realm of sports medicine. Acupuncture is an added-value service for athletes, and acupuncture providers should not be afraid to promote it in this population that is always looking for a competitive advantage.

Oxygen enrichment protects against intestinal damage and gut microbiota disturbance in rats exposed to acute high-altitude hypoxia.

Acute high-altitude hypoxia can lead to intestinal damage and changes in gut microbiota. Sustained and reliable oxygen enrichment can resist hypoxic damage at high altitude to a certain extent. However, it remains unclear whether oxygen enrichment can protect against gut damage and changes in intestinal flora caused by acute altitude hypoxia. For this study, eighteen male Sprague-Dawley rats were divided into three groups, control (NN), hypobaric hypoxic (HH), and oxygen-enriched (HO). The NN group was raised under normobaric normoxia, whereas the HH group was placed in a hypobaric hypoxic chamber simulating 7,000 m for 3 days. The HO group was exposed to oxygen-enriched air in the same hypobaric hypoxic chamber as the HH group for 12 h daily. Our findings indicate that an acute HH environment caused a fracture of the crypt structure, loss of epithelial cells, and reduction in goblet cells. Additionally, the structure and diversity of bacteria decreased in richness and evenness. The species composition at Phylum and Genus level was characterized by a higher ratio of Firmicutes and Bacteroides and an increased abundance of Lactobacillus with the abundance of Prevotellaceae_NK3B31_group decreased in the HH group. Interestingly, after oxygen enrichment intervention, the intestinal injury was significantly restrained. This was confirmed by an increase in the crypt depth, intact epithelial cell morphology, increased relative density of goblet cells, and higher evenness and richness of the gut microbiota, Bacteroidetes and Prevotellaceae as the main microbiota in the HO group. Finally, functional analysis showed significant differences between the different groups with respect to different metabolic pathways, including Amino acid metabolism, energy metabolism, and metabolism. In conclusion, this study verifies, for the first time, the positive effects of oxygen enrichment on gut structure and microbiota in animals experiencing acute hypobaric hypoxia.

Temperature-adaptive rooftop covering with synergetic modulation of solar and thermal radiation for maximal energy saving.

The energy consumption for maintaining desired indoor temperature accounts for 20% of primary energy use worldwide. Passive rooftop modulation of solar/thermal radiation without external energy input has a great potential in building energy saving. However, existing passive rooftop modulation techniques failed to simultaneously modulate solar/thermal radiation in response to rooftop surface temperature which is closely related to the building thermal loads, leading to limited or even counter-productive overall energy saving. Here, we report the development of a surface temperature-adaptive rooftop covering with synergetic solar and thermal modulations. The covering, made of a scalable metalized polyethylene film, demonstrated excellent solar absorptance modulation (72.5%) and thermal emissivity modulation (79%) in response to its temperature change from 22°C (indoor heating setpoint) to 25°C (indoor cooling setpoint), and vice versa. Building energy simulations demonstrate that the proposed rooftop covering can achieve all-season energy savings across all climate regions.

Electromagnetic fields ameliorate hepatic lipid accumulation and oxidative stress: potential role of CaMKKß/AMPK/SREBP-1c and Nrf2 pathways.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, and is related to disturbed lipid metabolism and redox homeostasis. However, a definitive drug treatment has not been approved for this disease. Studies have found that electromagnetic fields (EMF) can ameliorate hepatic steatosis and oxidative stress. Nevertheless, the mechanism remains unclear. METHODS: NAFLD models were established by feeding mice a high-fat diet. Simultaneously, EMF exposure is performed. The effects of the EMF on hepatic lipid deposition and oxidative stress were investigated. Additionally, the AMPK and Nrf2 pathways were analysed to confirm whether they were activated by the EMF. RESULTS: Exposure to EMF decreased the body weight, liver weight and serum triglyceride (TG) levels and restrained the excessive hepatic lipid accumulation caused by feeding the HFD. The EMF boosted CaMKKß protein expression, activated AMPK phosphorylation and suppressed mature SREBP-1c protein expression. Meanwhile, the activity of GSH-Px was enhanced following an increase in nuclear Nrf2 protein expression by PEMF. However, no change was observed in the activities of SOD and CAT. Consequently, EMF reduced hepatic reactive oxygen species (ROS) and MDA levels, which means that EMF relieved liver damage caused by oxidative stress in HFD-fed mice. CONCLUSIONS: EMF may activate the CaMKKß/AMPK/SREBP-1c and Nrf2 pathways to control hepatic lipid deposition and oxidative stress. This investigation indicates that EMF may be a novel therapeutic method for NAFLD.

Occlusion-Aware Instance Segmentation Via BiLayer Network Architectures.

Segmenting highly-overlapping image objects is challenging, because there is typically no distinction between real object contours and occlusion boundaries on images. Unlike previous instance segmentation methods, we model image formation as a composition of two overlapping layers, and propose Bilayer Convolutional Network (BCNet), where the top layer detects occluding objects (occluders) and the bottom layer infers partially occluded instances (occludees). The explicit modeling of occlusion relationship with bilayer structure naturally decouples the boundaries of both the occluding and occluded instances, and considers the interaction between them during mask regression. We investigate the efficacy of bilayer structure using two popular convolutional network designs, namely, Fully Convolutional Network (FCN) and Graph Convolutional Network (GCN). Further, we formulate bilayer decoupling using the vision transformer (ViT), by representing instances in the image as separate learnable occluder and occludee queries. Large and consistent improvements using one/two-stage and query-based object detectors with various backbones and network layer choices validate the generalization ability of bilayer decoupling, as shown by extensive experiments on image instance segmentation benchmarks (COCO, KINS, COCOA) and video instance segmentation benchmarks (YTVIS, OVIS, BDD100 K MOTS), especially for heavy occlusion cases.

GCoNet+: A Stronger Group Collaborative Co-Salient Object Detector.

In this paper, we present a novel end-to-end group collaborative learning network, termed GCoNet+, which can effectively and efficiently (250 fps) identify co-salient objects in natural scenes. The proposed GCoNet+ achieves the new state-of-the-art performance for co-salient object detection (CoSOD) through mining consensus representations based on the following two essential criteria: 1) intra-group compactness to better formulate the consistency among co-salient objects by capturing their inherent shared attributes using our novel group affinity module (GAM); 2) inter-group separability to effectively suppress the influence of noisy objects on the output by introducing our new group collaborating module (GCM) conditioning on the inconsistent consensus. To further improve the accuracy, we design a series of simple yet effective components as follows: i) a recurrent auxiliary classification module (RACM) promoting model learning at the semantic level; ii) a confidence enhancement module (CEM) assisting the model in improving the quality of the final predictions; and iii) a group-based symmetric triplet (GST) loss guiding the model to learn more discriminative features. Extensive experiments on three challenging benchmarks, i.e., CoCA, CoSOD3k, and CoSal2015, demonstrate that our GCoNet+ outperforms the existing 12 cutting-edge models. Code has been released at https://github.com/ZhengPeng7/GCoNet_plus.

Spatiotemporal Evolution of SARS-CoV-2 Alpha and Delta Variants during Large Nationwide Outbreak of COVID-19, Vietnam, 2021.

We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interventions.

Multi-Attention Segmentation Networks Combined with the Sobel Operator for Medical Images.

Medical images are used as an important basis for diagnosing diseases, among which CT images are seen as an important tool for diagnosing lung lesions. However, manual segmentation of infected areas in CT images is time-consuming and laborious. With its excellent feature extraction capabilities, a deep learning-based method has been widely used for automatic lesion segmentation of COVID-19 CT images. However, the segmentation accuracy of these methods is still limited. To effectively quantify the severity of lung infections, we propose a Sobel operator combined with multi-attention networks for COVID-19 lesion segmentation (SMA-Net). In our SMA-Net method, an edge feature fusion module uses the Sobel operator to add edge detail information to the input image. To guide the network to focus on key regions, SMA-Net introduces a self-attentive channel attention mechanism and a spatial linear attention mechanism. In addition, the Tversky loss function is adopted for the segmentation network for small lesions. Comparative experiments on COVID-19 public datasets show that the average Dice similarity coefficient (DSC) and joint intersection over union (IOU) of the proposed SMA-Net model are 86.1% and 77.8%, respectively, which are better than those in most existing segmentation networks.

Endoscopically assisted presigmoid retrolabyrinthine approach to the lateral mesencephalic sulcus: a cadaveric study with comparison to the variant supracerebellar infratentorial approaches.

The supracerebellar infratentorial (SCIT) approach is commonly used to gain access to the lateral mesencephalic sulcus (LMS), which has been established as a safe entry point into the posterolateral midbrain. This study describes a lateral variant of the SCIT approach, the supreme-lateral SCIT approach, for accessing the LMS through the presigmoid retrolabyrinthine craniectomy and quantitatively compares this approach with the paramedian and extreme-lateral SCIT approaches. Anatomical dissections were performed in four cadaveric heads. In each head, the supreme-lateral SCIT approach was established on one side, following a detailed description of each step, whereas the paramedian and supreme-lateral SCIT approaches were established on the other side. Quantitative measurements of the exposed posterolateral midbrain, the angles of LMS entry, and the depth of surgical corridors were recorded and compared between the three SCIT approach variants. The supreme-lateral (67.70 ± 23.14 mm2) and extreme-lateral (70.83 ± 24.99 mm2) SCIT approaches resulted in larger areas of exposure anterior to the LMS than the paramedian SCIT approach (38.61 ± 9.84 mm2); the supreme-lateral SCIT approach resulted in a significantly smaller area of exposure posterior to the LMS (65.24 ± 6.81 mm2) than the other two variants (paramedian = 162.75 ± 31.98 mm2; extreme-lateral = 143.10 ± 23.26 mm2; both P < .001). Moreover, the supreme-lateral SCIT approach resulted in a surgical corridor with a shallower depth and a smaller angle relative to the horizontal plane than the other two variants. The supreme-lateral SCIT approach is a more lateral approach than the extreme-lateral SCIT approach, providing a subtemporal approach with direct LMS visualization. The supreme-lateral SCIT offers the benefits of both subtemporal and SCIT approaches and represents a suitable option for the management of selected midbrain pathologies.

Biomechanical evaluation of a novel tri-blade titanium implantable vertebral augmentation device.

BACKGROUND CONTEXT: Titanium implantable vertebral augmentation device (TIVAD) are regarded as having potential in the treatment of vertebral compression fractures (VCFs). However, improper design in current TIVADs results in the inability to effectively restore VCF height and maintain stability. There is still an unmet clinical need for improvement. PURPOSE: The authors tested a newly developed a TIVAD (Tri-blade fixed system) that can provide enough endplate collapse support to restore the vertebral body height in a safe retraction mechanism for VCFs using minimally invasive surgery (MIS). STUDY DESIGN: The performed biomechanical tests included blade expansion force, lifetime of cement embedded and vertebral height restoration efficiency of porcine osteoporosis VCFs for its feasibility. METHODS: A cylinder with 3 surface cuts that form blades that can be expanded into a conical space was designed (Tri-blade fixed system). The 3 blades can be expanded outward with angles between blades as 105°/ 105°/150° for lower left/lower right/upper arms, respectively that reach 15mm in height and 14.8 mm in width. A frame was specifically designed to measure the contact force using force sensing resistors during blade expansion. The Tri-blade fixed system was embedded into a cement block to perform fatigue testing under 2000N pressure (5*106 cycles) for understanding the device lifetime limitation. The Tri-blade system was then inserted into porcine osteoporosis VCFs to examine the vertebral height restoration efficiency. RESULTS: The average maximum contact force for the top, bottom left and right blades were 299.0N, 283.5N and 279.3N, respectively with uniformly outward expansion forces. The fatigue test found that there were no obvious cracks or damage to the cement block. The porcine osteoporosis vertebral body at the anterior, middle, and posterior heights can be restored to 21.9%, 12.6% and 6.4%, respectively. CONCLUSIONS: This study developed a novel TIVAD with conical shape that can provide a more stable structure with sufficient/uniform expansion force, passing the fatigue test with bone cement and high effective in vertebral height restoration tests for porcine osteoporosis VCFs. CLINICAL SIGNIFICANCE: The new 3D Tri-blade TIVAD may offer a new treatment option for VCFs.

Ultrabroadband plasmon driving selective photoreforming of methanol under ambient conditions.

Liquid methanol has the potential to be the hydrogen energy carrier and storage medium for the future green economy. However, there are still many challenges before zero-emission, affordable molecular H2 can be extracted from methanol with high performance. Here, we present noble-metal-free Cu-WC/W plasmonic nanohybrids which exhibit unsurpassed solar H2 extraction efficiency from pure methanol of 2,176.7 µmol g-1 h-1 at room temperature and normal pressure. Macro-to-micro experiments and simulations unveil that local reaction microenvironments are generated by the coperturbation of WC/W's lattice strain and infrared-plasmonic electric field. It enables spontaneous but selective zero-emission reaction pathways. Such microenvironments are found to be highly cooperative with solar-broadband-plasmon-excited charge carriers flowing from Cu to WC surfaces for efficient stable CH3OH plasmonic reforming with C3-dominated liquid products and 100% selective gaseous H2. Such high efficiency, without any COx emission, can be sustained for over a thousand-hour operation without obvious degradation.

First-Principles Calculations with Six Structures of Alkaline Earth Metal Cyanide A(CN)2 (A = Be, Mg, Ca, Sr, and Ba): Structural, Electrical, and Phonon Properties.

This work examines six structures (P4̅3m, P42 nm, R3m, P21/c, R3̅m, and C2/m) of alkaline earth metal cyanide A(CN)2 (A = Be, Mg, Ca, Sr, and Ba) using first-principles calculations. The symmetries of P4̅3m, P42 nm, and R3m reflect a variation of Pn3̅m, previously reported as occurring on Be(CN)2 and Mg(CN)2 in X-ray diffraction studies, while the symmetries of P21/c, R3̅m, and C2/m were selected from the P3̅m1 symmetry found using Mg(OH)2 as the initial structures, with -OH being replaced by -CN. The band structure, density of states, and phonon properties of all A(CN)2 structures were then investigated using density functional theory (DFT), with a generalized gradient approximation (GGA) applied for the exchange and correlation energy values. The simulation results for the phonon spectra indicate that the stable structures are Be(CN)2 (P4̅3m, P42 nm, and C2/m), Mg(CN)2 (P4̅3m, P42 nm, and C2/m), Ca(CN)2 (P21/c), Sr(CN)2 (P21/c and R3̅m), and Ba(CN)2 (R3̅m) at 0 GPa. For the effects of high pressure, Ca(CN)2 and Sr(CN)2 were thus found to be stable as C2/m at pressures above 10 and 3 GPa, respectively, while Ca(CN)2 is as stable as R3̅m above 15 GPa. In the calculated band structures, all of the compounds with the C2/m structure demonstrated good conductivity, while the other structures have a band gap range of 2.83-6.33 eV.

Monkeypox Virus Infection in 2 Female Travelers Returning to Vietnam from Dubai, United Arab Emirates, 2022.

Mpox was diagnosed in 2 women returning to Vietnam from the United Arab Emirates. The monkeypox viruses belonged to an emerging sublineage, A.2.1, distinct from B.1, which is responsible for the ongoing multicountry outbreak. Women could contribute to mpox transmission, and enhanced genomic surveillance is needed to clarify pathogen evolution.

Experimental checking and modeling of the influence of operation conditions on the first order kinetic constants in free water surface wetlands.

The most commonly used model in constructed wetlands is the first-order removal model, and first order kinetic constants (k) are the key parameters. The presumption is often made that k are constants. However, it is possible that k are functions of operating conditions, but the influence of operation conditions on k is unclear. In this study, response surface methodology was used to explore the variation patterns of ka (area rate constants) and kV (volume rate constants) for the removal of total nitrogen (TN) and total phosphorus (TP) in free water surface (FWS) wetlands. The experimental variables included hydraulic loading rate (HLR), water depth, and inlet concentration (Cin). The results showed that kV was more variable than ka, and the area-based first-order model is more suitable for simulating TN and TP in FWS wetlands. Inlet concentration (Cin) was significant for ka; Cin and water depth were significant for kV; HLR and the interaction between factors were insignificant. The effects of Cin on ka and kV can be described by an upward convex quadratic curve, while the effect of water depth on kV demonstrates a downward convex quadratic curve. The first-order area rate constant for TN removal was given by k = -47.66 + 22.01 Cin - 1.154 Cin2; the first-order area rate constant for TP removal was given by k = -27.75 + 95.88 Cin - 30.73 Cin2. Based on the variation patterns, the traditional k-C model was modified to the kψ-C model. The kψ-C model produced the best results at simulating the outlet concentration and removal efficiency (RE).