Systematics and evolutionary dynamics of insect-fern interactions in the specialized fern-spore feeding Cuprininae (Lepidoptera, Stathmopodidae).

Fern-spore-feeding (FSF) is rare and found in only four families of Lepidoptera. Stathmopodidae is the most speciose family that contains FSF species, and its subfamily Cuprininae exclusively specializes on FSF. However, three species of Stathmopodinae also specialize on FSF. To better understand the evolutionary history of FSF and, more generally, the significance of specialization on a peculiar host, a phylogenetic and taxonomic revision for this group is necessary. We reconstructed the most comprehensive molecular phylogeny, including one mitochondrial and four nuclear genes, of Stathmopodidae to date, including 137 samples representing 62 species, with a particular focus on the FSF subfamily, Cuprininae, including 33 species (41% of named species) from 6 of the 7 Cuprininae genera. Species from two other subfamilies, Stathmopodinae and Atkinsoniinae, were also included. We found that FSF evolved only once in Stathmopodidae and that the previous hypothesis of multiple origins of FSF was misled by inadequate taxonomy. Moreover, we showed that (1) speciation/extinction rates do not differ significantly between FSF and non-FSF groups and that (2) oligophage is the ancestral character state in Cuprininae. We further revealed that a faster rate of accumulating specialists over time, and thus a higher number of specialists, was achieved by a higher transition rate from oligophagages to specialists compared to the transition rate in the opposite direction. We finish by describing three new genera, Trigonodagen. nov., Petalagen. nov., and Pediformisgen. nov., and revalidating five genera: Cuprina, Calicotis, Thylacosceles, Actinoscelis, Thylacosceloides in Cuprininae, and we provide an updated taxonomic key to genera and a revised global checklist of Cuprininae.

Chemiresistive effect of p-type delafossite CuScO2 microsheets to gaseous alcohols.

The chemiresistive effect of an oxide significantly influences its electrical properties, which depend greatly on the interactions between the ambient gas molecules and the solid surface, including the gas adsorption and charge transfer still challenging to be clarified. In this work, we investigate the chemiresistive effect of the p-type delafossite CuScO2 microsheets by comparing their responses to various gaseous alcohols, which increase with an approximately linear relationship with the length of straight carbon chains from methanol to n-hexanol. A new mechanism is proposed to elucidate such a dramatic trend of observed chemiresistive change based on the first-principles calculations and test results. The increasing carbon chain length modulates the adsorption configuration and provides supplementary routes for electron transfer, which is assumed to account for the observed chemiresistive effect. This work may provide a novel perspective for the investigation and development of more advanced functional oxides for electrical applications.

The Prognostic Value of D-Dimer in Patients with Acute Myocardial Infarction: A Retrospective Longitudinal Cohort Study in Taiwan.

Background: Serum D-dimer level has been associated with worsening outcomes in patients with acute myocardial infarction. This study aimed to explore the association between serum D-dimer level and clinical outcomes in Taiwanese patients with acute myocardial infarction. Methods: We analyzed Tri-Service General Hospital-Coronary Heart Disease registry data related to patients with acute myocardial infarction who were admitted between January 2014 and December 2018. A total of 748 patients were enrolled and categorized into high (≥ 495 ng/ml) and low (< 495 ng/ml) D-dimer groups. The primary endpoint was in-hospital mortality, and secondary endpoints were post-discharge mortality and post-discharge major adverse cardiovascular events. Results: Overall, 139 patients died, with 77 from cardiovascular causes and 62 from non-cardiovascular causes. In-hospital mortality was higher in the high D-dimer group than in the low D-dimer group. Among the patients alive at discharge, those with a high D-dimer level had higher cardiovascular mortality and future major adverse cardiovascular events than those with a low D-dimer level. Multivariate Cox regression analysis revealed that higher serum D-dimer levels were significantly associated with higher risks of in-hospital mortality [hazard ratio (HR) = 1.11; 95% confidence interval (CI), 1.06-1.16, p < 0.001], subsequent cardiovascular mortality after discharge (HR = 1.15; 95% CI, 1.08-1.22, p < 0.001), and major adverse cardiovascular events (HR = 1.10; 95% CI, 1.04-1.16, p < 0.001). Conclusions: This is the first study in Taiwan to demonstrate that a higher baseline serum D-dimer level was independently associated with higher risks of in-hospital mortality, post-discharge mortality, and major adverse cardiovascular events in patients with acute myocardial infarction.

Magnetometry based on the effect of laser-induced plasmas in a sodium-containing environment.

The magneto-optical resonance response of sodium atoms generated by a high-energy solid-state pulse Nd:YAG laser is studied in different external magnetic fields. We investigate the resonance fluorescence signal of sodium atoms in a simulated sea fog environment based on the laser-induced plasma (LIP) effect. By ionizing an NaCl solution spray to generate sodium atoms in an atmospheric environment, we build a Bell-Bloom magneto-optical resonance system under laboratory conditions. With the help of laser-induced breakdown spectroscopy (LIBS) and extinction spectrum, we obtain sodium atoms with a lifetime of 250 µs. A narrowband tunable continuous wave (CW) 589-nm laser tuned at the D2 line with a modulation frequency around the Larmor frequency is used as the pump beam to polarize sodium atoms in the test magnetic field. We find that the magneto-optical resonance signals vary with different external magnetic fields and the positions of the resonance signal are consistent with the theoretical values. An intrinsic magnetometric sensitivity of 620.4 pT in a 1-Hz bandwidth is achieved.

Proteomic and lipidomics analyses of high fatty acid AhDGAT3 transgenic soybean reveals the key lipase gene associated with the lipid internal mechanism.

Vegetable oil is one of the most important components of human nutrition. Soybean (Glycine max) is an important oil crop worldwide and contains rich unsaturated fatty acids. Diacylglycerol acyltransferase (DGAT) is a key rate-limiting enzyme in the Kennedy pathway from diacylglycerol (DAG) to triacylglycerol (TAG). In this study, we conducted further research using T3 AhDGAT3 transgenic soybean. A high-performance gas chromatography flame ionization detector showed that oleic acid (18:1) content and total fatty acid content of transgenic soybean were significantly higher than those of the wild type (WT). However, linoleic acid (18:2) was much lower than that in the WT. For further mechanistic studies, 20 differentially expressed proteins (DEPs) and 119 differentially expressed metabolites (DEMs) were identified between WT (JACK) and AhDGAT3 transgenic soybean mature seeds using proteomic and lipidomics analyses. Combined proteomic and lipidomics analyses showed that the upregulation of the key DEP (lipase GDSL domain-containing protein) in lipid transport and metabolic process induced an increase in the total fatty acid and 18:1 composition, but a decrease in the 18:2 composition of fatty acids. Our study provides new insights into the deep study of molecular mechanism underlying the enhancement of fatty acids in transgenic soybeans, especially oleic acid and total fatty acid, which are enhanced by over-expression of AhDGAT3.

Copranaerobaculum intestinale gen. nov., sp. nov., a novel anaerobic bacterium isolated from human faeces.

A novel obligate anaerobic organism, designated DONG20-135T, was isolated from human faeces collected in Beijing, PR China. Cells were Gram-stain-negative, rod-shaped, non-motile and non-spore-forming. Growth occurred at 25‒45 °C (optimum, 30‒35 °C), a pH range of 6-9 (optimum, pH 8) and in the presence of 0‒3.5 % (w/v) NaCl (optimum, 0.5‒1.5 %). The major fatty acids were C16 : 0, C18 : 1 ω9c and C10 : 0, the polar lipid profile consisted of diphosphatidylglycerol, phosphatidylglycerol, four glycolipids, six aminolipids, three aminophospholipids and four unidentified lipids. No respiratory quinones were detected. The cell-wall peptidoglycan of the strain was A1γ type, containing meso-diaminopimelic acid. The 16S rRNA gene sequences shared a lower identity (<92.7 % similarity) with the described species. The phylogenetic tree based on 16S rRNA gene sequences and the protein-concatamer tree showed that strain DONG20-135T formed a distinct lineage within the family Erysipelotrichaceae. The genomic DNA G + C content was 42.2 mol%. Based on the results of phenotypic, chemotaxonomic and genomic analyses, strain DONG20-135T represents a novel genus of the family Erysipelotrichaceae, for which the name Copranaerobaculum intestinale gen. nov., sp. nov. is proposed (=KCTC 15868T=CGMCC 1.17357T).

Taurine can improve intestinal function and integrity in juvenile Rhynchocypris lagowskii Dybowski fed high-dose glycinin.

The present study evaluated the protective effect and the regulatory mechanism of taurine on growth inhibition and intestinal damage induced by glycinin in juvenile Rhynchocypris lagowskii Dybowski. The control diets had no glycinin and taurine, the glycinin diets contained only 80 g/kg glycinin, and the glycinin + taurine diets contained 80 g/kg glycinin+10 g/kg taurine. Juvenile Rhynchocypris lagowskii Dybowski (4.65 ± 0.03 g/tail) were respectively fed with these 3 diets for 8 weeks. The results showed that glycinin significantly decreased the final body weight, weight gain rate, specific growth rate, protein efficiency rate, feed efficiency rate and feeding rate of fish compared with the control group (P < 0.05). While taurine supplementation improved the growth performance and feed efficiency, but final body weight, weight gain rate, specific growth rate of the glycinin + taurine group were still significantly lower than the control group (P < 0.05). Compared with the glycinin group, taurine supplementation significantly increased whole-body and muscle crude protein content, and hepatopancreas and intestinal protease activities (P < 0.05). Distal intestinal villous dysplasia and mucosal damage, and increased intestinal mucosal permeability were observed in the glycinin group, while taurine supplementation alleviated these adverse effects. Usefully, taurine supplementation could also partially restore the impaired immune function and antioxidant capacity of fish fed glycinin diets. Compared with the glycinin group, taurine supplementation down-regulated pro-inflammatory cytokines TNF-α and IL-1ß mRNA levels, and up-regulated anti-inflammatory cytokines IL-10 and TGF-ß mRNA levels. Furthermore, taurine partially reversed the reduction of antioxidant genes Nrf2、HO-1, CAT and GPx mRNA levels in distal intestine induced by glycinin. Concluded, 80 g/kg glycinin led to intestinal damage, digestive dysfunction and increased intestinal mucosal permeability in juvenile Rhynchocypris lagowskii Dybowski, and these adverse effects were ultimately manifested in growth inhibition. But taurine supplementation could partially mitigate the negative effects induced by glycinin.

Relationship between post-traumatic disorder and posttraumatic growth in COVID-19 home-confined adolescents: The moderating role of self-efficacy.

Although the COVID-19 pandemic has been traumatogenic for some people, posttraumatic growth (PTG) outcomes have also been observed. This study examined the PTG in adolescents and the moderating effect of self-efficacy on post-traumatic stress disorder (PTSD) symptoms and PTG. An online questionnaire was conducted on 2090 adolescent Chinese students to measure COVID-19 related exposure, self-efficacy, PTSD, and PTG. PTG prevalence was found in 20.6% of the sample, with the relationship between PTSD and PTG being found to be a reverse U-shaped curve. Objective exposure factors were found to be closely associated with PTSD symptoms but not with PTG. Similarly, subjective feelings of extreme fear were significantly associated with PTSD symptoms but not with PTG. Self-efficacy was found to be positively correlated with PTG (r = 0.551) and to moderate the relationship between PTSD and PTG. For those with low self-efficacy, the higher the PTSD, the higher the PTG, and for those with high self-efficacy, the higher the PTSD, the lower the PTG. As an improved sense of self-efficacy in adolescents could promote positive psychological transformations, these results could assist in identifying self-efficacy levels and providing guidance for targeted psychological interventions to promote positive growth.

Alteration of the Catalytic Reaction Trajectory of a Vicinal Oxygen Chelate Enzyme by Directed Evolution.

The vicinal oxygen chelate (VOC) metalloenzyme superfamily catalyzes a highly diverse set of reactions with the mechanism characterized by the bidentate coordination of vicinal oxygen atoms to metal ion centers, but there remains a lack of a platform to steer the reaction trajectories, especially for o-quinone metabolizing pathways. Herein, we present the directed-evolution-enabled bifunctional turnover of ChaP, which is a homotetramer and represents an unprecedented VOC enzyme class. Unlike the ChaP catalysis of extradiol-like o-quinone cleavage and concomitant α-keto acid decarboxylation, a group of ChaP variants (CVs) catalyze intradiol-like o-quinone deconstruction and CO2 liberation from the resulting o-hydroxybenzoic acid scaffolds with high regioselectivity. Enzyme crystal structures, labeling experiments and computational simulations corroborated that the D49L mutation allows the metal ion to change its coordination with the tyrosine phenoxy atoms in different monomers, thereby altering the reaction trajectory with the regiospecificity further improved by the follow-up replacement of the Y92 residue with any of alanine, glycine, threonine, and serine. The study highlights the unpredicted catalytic versatility and enzymatic plasticity of VOC enzymes with biotechnological significance.

Comparative anatomical and transcriptomic insights into Vaccinium corymbosum flower bud and fruit throughout development.

BACKGROUND: Blueberry (Vaccinium spp.) is characterized by the production of berries that are smaller than most common fruits, and the underlying mechanisms of fruit size in blueberry remain elusive. V. corymbosum 'O'Neal' and 'Bluerain' are commercial southern highbush blueberry cultivars with large- and small-size fruits, respectively, which mature 'O'Neal' fruits are 1 ~ 2-fold heavier than those of 'Bluerain'. In this study, the ontogenetical patterns of 'O'Neal' and 'Bluerain' hypanthia and fruits were compared, and comparative transcriptomic analysis was performed during early fruit development. RESULTS: V. corymbosum 'O'Neal' and 'Bluerain' hypanthia and fruits exhibited intricate temporal and spatial cell proliferation and expansion patterns. Cell division before anthesis and cell expansion after fertilization were the major restricting factors, and outer mesocarp was the key tissue affecting fruit size variation among blueberry genotypes. Comparative transcriptomic and annotation analysis of differentially expressed genes revealed that the plant hormone signal transduction pathway was enriched, and that jasmonate-related TIFYs genes might be the key components orchestrating other phytohormones and influencing fruit size during early blueberry fruit development. CONCLUSIONS: These results provided detailed ontogenetic evidence for determining blueberry fruit size, and revealed the important roles of phytohormone signal transductions involving in early fruit development. The TIFY genes could be useful as markers for large-size fruit selection in the current breeding programs of blueberry.

Relationship of social support and health-related quality of life among migrant older adults: The mediating role of psychological resilience.

Migrant older adults are influenced by an accumulation of aging and adversities related to migration. This study aimed to evaluate the effects of psychological resilience and social support on health-related quality of life (HRQOL) among migrant older adults, and examine the mediating effect of psychological resilience between social support and HRQOL. A total of 149 migrant older adults were recruited from five communities in Chongqing, China. Social support and psychological resilience were positively associated with physical and mental HRQOL among migrant older adults. Psychological resilience had a partial mediating effect on the relationship between social support and physical and mental HRQOL. These findings provide a better understanding of how social support and psychological resilience work together to affect HRQOL, and it could guide the interventions to promote HRQOL among migrant older adults in the community.

Random lasing in cesium lead iodide (CsPbI3) thin films with no surface passivation.

We report the CsPbI3 random lasing at room temperature fabricated by a chemical deposition method. The CsPbI3 thin films with high crystalline quality have intense PL emission and easily achieve the lasing behavior with the Q-factor value over 7000. The lasing behavior of CsPbI3 thin films can be classified as random lasing by measuring lasing spectra at different collective angles. The fast Fourier transform analysis of the lasing spectra is employed to determine the effective cavity length. Most important of all, the lasing stability investigation shows the prolonged lasing stability over 4.8 X 105 laser shots in air.

Two life prediction models for optoelectronic displays without conventional life tests.

To precisely predict the life of optoelectronic displays over a short time, two life prediction models were established based on the three-parameter Weibull right approximation method (TPWRAM). In Model I, the acceleration life under each stress was obtained using TPWRAM, the data points formed by acceleration life and acceleration stress were, respectively, fitted by three extrapolation functions and the optimal extrapolation function was determined by comparing the fitting determination coefficient and root-mean-square error. In Model II, after introducing an acceleration parameter, the luminance attenuation data under conventional stress were calculated directly by combining the ones obtained using TPWRAM under each acceleration stress. The luminance attenuation test data from the vacuum fluorescent display (VFD) were collected through four groups of constant-stress accelerated degradation tests (ADT), and the two models were applied to the life prediction of VFD. The results indicated that the designed ADT scheme was feasible, Model I revealed the changing law of life with stress and simplified the process of life prediction, and Model II made it possible to obtain the luminance attenuation formula at conventional stress without conducting a conventional life test, overcoming the shortcomings of long time-consuming traditional life tests. It was verified by comparing the life prediction values that the two models had very high precision, and both of these not only achieve the accurate estimation of optoelectronic product life without resorting to conventional life test, but also improved the method of life prediction and perfect its theoretical system.

A New Alkaloid from the Aerial Parts of Bupleurum chinense DC.

A new isoalloxazine alkaloid, named bupleurine A (1), along with five known compounds (2-6), were isolated from the aerial parts of Bupleurum chinense DC. The structure elucidation of the new alkaloid (1) was employed by combining NMR and HR-MS data with comparison of reference in the literature. Five known compounds (2-6) were isolated from Bupleurum genus for the first time. Additionally, their antiproliferative activities on HeLa cells were evaluated by MTT assay and IC50 of compounds 1 and 4-6 were below 10 µm after treatment for 24 h.

HOTAIR promotes osteosarcoma development by sponging miR-217 and targeting ZEB1.

Long noncoding RNAs (lncRNAs) have drawn increasing attention because of the role which they play in various diseases, including osteosarcoma. So far, the function and mechanism of HOTAIR in osteosarcoma are unclear. In our study, we observed that HOTAIR was elevated accompanied with a decrease of miR-217 and an increase of ZEB1 in human osteosarcoma cells including U2OS, MG63, Saos-2, and SW1353 compared with human osteoblast cell line hFOB. In addition, the subsequent functional assay exhibited that silencing HOTAIR could significantly repress osteosarcoma cell growth, migration, invasion, and induce cell apoptosis capacity, which indicated that HOTAIR exerted an oncogenic role in osteosarcoma. Moreover, it was revealed by using bioinformatics analysis that HOTAIR can be targeted by microRNA-217 (miR-217). miR-217 has been recognized as a crucial tumor suppressive gene in cancers. We verified that mimics of miR-217 were able to suppress the osteosarcoma development. Furthermore, real-time quantitative PCR showed that HOTAIR siRNA increased miR-217 expression. Besides these, ZEB1 was identified as a downstream gene of miR-217 and we found that HOTAIR can mediate osteosarcoma progress by upregulating ZEB1 expression via acting as a competitive endogenous RNA (ceRNA) via miR-217. Taken these together, our findings in this study indicated that HOTAIR/miR-217/ZEB1 axis, as a novel research point can provide new insights into molecular mechanism of osteosarcoma development.

Predictive model for acute respiratory distress syndrome events in ICU patients in China using machine learning algorithms: a secondary analysis of a cohort study.

BACKGROUND: To develop a machine learning model for predicting acute respiratory distress syndrome (ARDS) events through commonly available parameters, including baseline characteristics and clinical and laboratory parameters. METHODS: A secondary analysis of a multi-centre prospective observational cohort study from five hospitals in Beijing, China, was conducted from January 1, 2011, to August 31, 2014. A total of 296 patients at risk for developing ARDS admitted to medical intensive care units (ICUs) were included. We applied a random forest approach to identify the best set of predictors out of 42 variables measured on day 1 of admission. RESULTS: All patients were randomly divided into training (80%) and testing (20%) sets. Additionally, these patients were followed daily and assessed according to the Berlin definition. The model obtained an average area under the receiver operating characteristic (ROC) curve (AUC) of 0.82 and yielded a predictive accuracy of 83%. For the first time, four new biomarkers were included in the model: decreased minimum haematocrit, glucose, and sodium and increased minimum white blood cell (WBC) count. CONCLUSIONS: This newly established machine learning-based model shows good predictive ability in Chinese patients with ARDS. External validation studies are necessary to confirm the generalisability of our approach across populations and treatment practices.

Pyruvate in reduced osmolarity oral rehydration salt corrected lactic acidosis in sever scald rats.

BACKGROUND: A novel pyruvate-based oral rehydration salt (Pyr-ORS) was demonstrated of superiority over bicarbonate- or citrate-based one to preserve organ function and correct lactic acidosis in rehydration of lethal shock in animals. This study further compared these effects between low-osmolar Pyr-ORS and equimolar citrate-based counterpart. METHODS: Eighty rats, using a fatal burn shock model, were randomized into four groups (two subgroups per group: n = 10): the sham group (group SR), Pyr-ORS group (group PR), WHO-ORS III group (group CR), and no rehydration group. ORS was delivered by manual gavage during 24 h following burns. Oral administration consisted of half of counted volume in the initial 8 h plus the rest in the later 16 h. Systemic hemodynamics, visceral organ surface blood flow, organ function, and metabolic acidosis were determined at 8 h and 24 h after burn. Another set of rats with identical surgical procedures without tests was observed for survival. RESULTS: Survival was markedly improved in the groups PR and CR; the former showed a higher survival rate than the latter at 24 h (40% versus 20%, P < 0.05). Systemic hemodynamics, visceral blood flow, and function of heart, liver, and kidney were greatly restored in group PR, compared with group CR (all P < 0.05). Hypoxic lactic acidosis was efficiently reversed in group PR, instead of group CR, (pH 7.36 versus 7.11, base excess 2.1 versus -9.1 mmol/L, lactate 4.28 versus 8.18 mmol/L; all P < 0.05) at 24 h after injury. CONCLUSIONS: Pyruvate was advantageous over citrate in low-osmolar ORS for protection of organs and survival; pyruvate, but not citrate, in the ORS corrected hypoxic lactic acidosis in rats subjected to lethal burn shock in 24 h.

First molecular identification of Buxtonella ciliates from captive-bred mangabeys (Cercocebus torquatus) from China.

Buxtonella species are large cyst-forming ciliates that infect ruminants and monkeys, and are morphologically similar to Balantidium coli ciliates that infect pigs, humans, monkeys, and other animals. In this study, we isolated spherical cysts of ciliates that were similar to those of Balantidium and Buxtonella species within collared mangabeys (Cercocebus torquatus) from the Wangcheng Zoo of Luoyang in the Henan Province of central China. The cysts were further identified and designated as belonging to the Buxtonella monkey genotype based on molecular analyses of 18S rRNA, 5.8S rRNA, and ITS1-5.8S rRNA-ITS2 genetic markers. To our knowledge, this is the first report of Buxtonella monkey genotype within monkeys in China. These results will help clarify the classification of species of cyst-forming ciliate infections in monkeys.

Life prediction for a vacuum fluorescent display based on two improved models using the three-parameter Weibull right approximation method.

To obtain precise life information for vacuum fluorescent displays (VFDs), luminance degradation data for VFDs were collected from a group of normal life tests. Instead of exponential function, the three-parameter Weibull right approximation method (TPWRAM) was applied to describe the luminance degradation path of optoelectronic products, and two improved models were established. One of these models calculated the average life by fitting average luminance degradation data, and the other model obtained VFD life by combining the approximation method with luminance degradation test data from each individual sample. The results indicated that the test design under normal working stress was appropriate, and the selection of censored test data was simple. The two models improved by TPWRAM both revealed the luminance decaying law for VFD, and the pseudo failure time was accurately extrapolated. It was further confirmed by comparing relative error that using the second model gave a more accurate prediction of VFD life. The improved models in this study can provide technical references for researchers and manufacturers in aspects of life prediction methodology for its development.

A nomogram to predict adjuvant chemotherapy recommendation in breast cancer patients with intermediate recurrence score.

OBJECTIVE: The indication of adjuvant chemotherapy recommendation (ACR) in breast cancer patients with intermediate recurrence score (RS) is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients. METHODS: Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December 2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set (378 cases) and validated in an independent validation set (126 cases). A Youden-derived cut-off value was assigned to the nomogram for accuracy evaluation. RESULTS: The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node (LN) status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve (AUC) values were 0.905 [95% confidence interval (95% CI): 0.876-0.934] and 0.883 (95% CI: 0.824-0.942) in the training and validation sets, respectively. The accuracies of the nomogram for ACR were 84.4% in the training set and 82.1% in the validation set. CONCLUSIONS: We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.