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The new media environment driven by digital intelligence technologies provides new opportunities for enterprise development, but also brings new challenges for enterprise crisis management and network public opinion information (referred as public opinion) guidance. Focusing on the contradictions between the complex diversity of crisis types and the limited governance resources, it is of great significance for enterprises to determine the best public opinion guidance strategy. Considering the dynamic complexity of public opinion derived from enterprise crisis, this paper innovatively proposed a decision-making model of enterprise public opinion under crisis differentiation based on differential game. Then, the balance strategy of each stakeholder and the guiding effect of public opinion were discussed under four decision scenarios. Finally, the optimal resources allocation ratio of different types of crises is determined under the constraints of governance resources, and the key parameters of public opinion guidance process are identified. The results show that, under four decision scenarios, the dual-guidance strategy achieves the best public opinion guidance effect and Pareto-optimal outcome for the game system. The overall benefit is maximized when the optimal investment ratio for the four types of crises (Values-type, Product-type, Marketing-type, and Internal management-type) is 60:28:8.4:3.6. The subsidy coefficients of enterprise to netizens and media both significantly the guidance effect of public opinion, but compared with the former, it is more sensitive to the changes of the letter. Based on the research results, this paper provides targeted suggestions for enterprises crisis response and their sustainable development under the new media environment.

Background To update a meta-analysis of randomized controlled trials (RCTs) and further explore the outcome of IV vitamin C (IVVC) administration in sepsis or septic shock patients. Methods This study is a meta-analysis of RCTs. The RCTs of vitamin C therapy in sepsis or septic shock were searched in PubMed, EMBASE and Clinical Trials.gov from inception to January 16, 2023. We registered the protocol with PROSPERO (CRD42022354875). The primary outcome was delta Sequential Organ Failure Assessment (SOFA) score at 72–96 h. Two reviewers independently assessed RCTs according to eligibility criteria: (1) study type: RCT; (2) patient population: patients ≥ 18 years with sepsis or septic shock; (3) intervention: IVVC at any doses as monotherapy or combined with thiamine or and hydrocortisone compared with standard of care, no intervention or placebo (defined as control group); (4) the RCT described short-term mortality or SOFA score. Then, two authors independently extracted related information from RCTs. Results Eighteen RCTs ( n  = 3364 patients) were identified in this meta-analysis. There were significant effects in the delta SOFA score from baseline to 72–96 h (MD, − 0.62; 95% CI, − 1.00 to − 0.25; p  = 0.001) and the duration of vasopressor use (MD, − 15.07; 95% CI, − 21.59 to − 8.55; p  < 0.00001) with IVVC therapy. Treatment with IVVC was not shown to improve short-term mortality (OR, 0.89; 95% CI, 0.77 to 1.04; p  = 0.14); nevertheless, dose at 25–100 mg/kg/d subgroup associated with a significant reduction in short-term mortality (OR, 0.80; 95% CI, 0.65 to 0.97; p  = 0.03). An increase adverse event was observed in IVVC therapy (OR, 1.98; 95% CI, 1.06 to 3.68; p  = 0.03). Conclusion In this meta-analysis, IVVC in sepsis or septic shock patients significantly improved delta SOFA score and reduced the duration of vasopressor use, whereas it was not associated with reduction in short-term mortality and had higher adverse events.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterized by a slow progression and caused by the inhalation of harmful particulate matter. Cigarette smoke and air pollutants are the primary contributing factors. Currently, the pathogenesis of COPD remains incompletely understood. The PI3K/Akt signaling pathway has recently emerged as a critical regulator of inflammation and oxidative stress response in COPD, playing a pivotal role in the disease’s progression and treatment. This paper reviews the association between the PI3K/Akt pathway and COPD, examines effective PI3K/Akt inhibitors and novel anti-COPD agents, aiming to identify new therapeutic targets for clinical intervention in this disease.

Efficiently removing excess reactive oxygen species (ROS) generated by various factors on the ocular surface is a promising strategy for preventing the development of dry eye disease (DED). The currently available eye drops for DED treatment are palliative, short-lived and frequently administered due to the short precorneal residence time. Here, we developed nanozyme-based eye drops for DED by exploiting borate-mediated dynamic covalent complexation between n-FeZIF-8 nanozymes (n-Z(Fe)) and poly(vinyl alcohol) (PVA) to overcome these problems. The resultant formulation (PBnZ), which has dual-ROS scavenging abilities and prolonged corneal retention can effectively reduce oxidative stress, thereby providing an excellent preventive effect to alleviate DED. In vitro and in vivo experiments revealed that PBnZ could eliminate excess ROS through both its multienzyme-like activity and the ROS-scavenging activity of borate bonds. The positively charged nanozyme-based eye drops displayed a longer precorneal residence time due to physical adhesion and the dynamic borate bonds between phenyboronic acid and PVA or o-diol with mucin. The in vivo results showed that eye drops could effectively alleviate DED. These dual-function PBnZ nanozyme-based eye drops can provide insights into the development of novel treatment strategies for DED and other ROS-mediated inflammatory diseases and a rationale for the application of nanomaterials in clinical settings. Graphical Abstract Highlights Modification of dynamic covalent bonds based on borate bonds can improve the solubility and dispersion of Fe-based nanozymes in solution. The nanozyme-based eye drops enable reactive groups to bind to the chemical groups present in the mucin layer to confer carrier adhesion, thereby increasing the retention time of the carrier on the ocular surface. Nanozyme-based eye drops have synergistic effects on Fe-based nanozymes, and borate bonds effectively neutralize excess ROS in the microenvironment of the ocular surface, thereby reducing oxidative stress and direct oxidative damage. Nanozyme-based eye drops could effectively alleviate DED and may be a promising nanotherapeutic strategy for DED treatment.

Background The Atherogenic Index of Plasma (AIP) is a newly identified biomarker associated with lipid metabolism, demonstrating significant prognostic capabilities in individuals diagnosed with cardiovascular disease. However, its impact within the context of chronic coronary syndromes (CCS) remains unexplored. Thus, the present investigation sought to examine the potential association between AIP levels and long-term clinical outcomes in patients diagnosed with CCS. Methods A total of 404 patients diagnosed with CCS and who underwent coronary angiography were included in this study. The AIP index was calculated as log (triglycerides / high-density lipoprotein-cholesterol). The patients were categorized into four groups based on their AIP values: Q1 (< -0.064), Q2 (-0.064 to 0.130), Q3 (0.130 to 0.328), and Q4 (> 0.328). The occurrence of major adverse cardiovascular events (MACE) was monitored during the follow-up period for all patients. Cox regression analysis and Kaplan-Meier curve analysis were employed to examine the relationship between AIP and MACE. Furthermore, ROC analysis was utilized to determine the optimal cut-off value of AIP for predicting clinical MACE. Results During the median 35 months of follow-up, a total of 88 patients experienced MACE. Notably, the group of patients with higher AIP values (Q4 group) exhibited a significantly higher incidence of MACE compared to those with lower AIP values (Q1, Q2, and Q3 groups) (31.7% vs. 16.8%, 15.7%, and 23.0% respectively; P = 0.023). The Kaplan-Meier curves illustrated those patients in the Q4 group had the highest risk of MACE relative to patients in the other groups (log-rank P = 0.014). Furthermore, the multivariate Cox regression analysis demonstrated that individuals in the Q4 group had a 7.892-fold increased risk of MACE compared to those in the Q1 group (adjusted HR, 7.892; 95% CI 1.818–34.269; P = 0.006). Additionally, the ROC curve analysis revealed an optimal AIP cut-off value of 0.24 for predicting clinical MACE in patients with CCS. Conclusion Our data indicate, for the first time, that AIP is independently associated with poor long-term prognosis in patients suffering from CCS. The optimal AIP cut-off value for predicting clinical MACE among CCS patients was 0.24.

Background It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients’ satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. Methods We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0 . 05. Results The monthly average length of waiting time decreased 3 . 49 min ( P  = 0 . 003) for consultations and 8 . 70 min ( P  = 0 . 02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions ( P  =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services ( r  = −0 . 71, P  = 0 . 004). Conclusions The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This case provides a model of carrying out continuous quality improvement and optimizing management process with the support of relevant evidence.

This study investigates the problem of time-varying formation tracking (TVFT) control involving event-triggered and switching topological mechanisms. Specifically, TVFT is evaluated with a consensus analysis and deduced via the use of linear matrix inequality techniques combined with Lyapunov stability theory. This strategy obtains sufficient conditions for system stability and the feedback and coupling gains. In addition, the TVFT compensational signals are presented in two cases to enhance the algorithm’s applicability. Given that ideal multi-agent systems (MASs) should be highly flexible and resilient, we propose a co-design algorithm that strikes a balance between the need for a lower communication frequency and a reduction in the state disagreements of agents. Finally, the effectiveness of the theoretical analysis is demonstrated through 3D figures and comparison tables, from which it can be concluded that the communication frequency of the MAS was clearly reduced on the basis of ensuring consensus performance via applying the algorithm proposed in this paper.

Epigenetic regulation of inflammatory macrophages governs inflammation initiation and resolution in the pathogenesis of rheumatoid arthritis (RA). Nevertheless, the mechanisms underlying macrophage‐mediated arthritis injuries remain largely obscure. Here, we found that increased expression of lysine acetyltransferase 2A (KAT2A) in synovial tissues was closely correlated with inflammatory joint immunopathology in both RA patients and experimental arthritis mice. Administration of MB‐3, the KAT2A‐specific chemical inhibitor, significantly ameliorated the synovitis and bone destruction in collagen‐induced arthritis model. Both pharmacological inhibition and siRNA silencing of KAT2A, not only suppressed innate stimuli‐triggered proinflammatory gene (such as Il1b and Nlrp3) transcription but also impaired NLR family pyrin domain containing 3 (NLRP3) inflammasome activation in vivo and in vitro. Mechanistically, KAT2A facilitated macrophage glycolysis reprogramming through suppressing nuclear factor‐erythroid 2‐related factor 2 (NRF2) activity as well as downstream antioxidant molecules, which supported histone 3 lysine 9 acetylation (H3K9ac) and limited NRF2‐mediated transcriptional repression of proinflammatory genes. Our study proves that acetyltransferase KAT2A licenses metabolic and epigenetic reprogramming for NLRP3 inflammasome activation in inflammatory macrophages, thereby targeting KAT2A represents a potential therapeutic approach for patients suffering from RA and relevant inflammatory diseases. KAT2A licenses the epigenetic and metabolic reprogramming of inflammatory macrophages. In synovial tissues of RA patients, the increased expression of KAT2A promotes the inducible transcription of Il1b and Nlrp3 genes by catalyzing H3K9ac and limiting NRF2 activation, thereby leading to uncontrolled IL‐1β production and inflammatory injury in RA progression.

Key summary points Aim To carry out a meta-analysis to reveal and describe the association between sarcopenia and cognitive impairment in the older people. Finding Patients with sarcopenia were at higher risk of cognitive impairment and there was statistically significant difference, confirming their correlation. Message Comprehensive screening and active prevention of sarcopenia are in need for those older people with cognitive decline, which may help enhance the quality of everyday life. Purpose The effects of sarcopenia on the older people are profound, increasing the risk of adverse outcomes for older patients. Although the substantial impact of sarcopenia on maintaining functional independence and adverse health outcomes has been described many times in the past, the link between sarcopenia and cognitive impairment in older adults remains lacking in evidence and controversial. Therefore, we conducted a comprehensive search of available national and international databases and carried out a meta-analysis to examine the association between sarcopenia in older people and cognitive impairment. Methods Relevant experiments had been recognized via looking out electronic databases and conference sessions. The present study included case–control, cohort, or cross-sectional studies of the association between sarcopenia and cognitive impairment in the older people. Results The meta-analysis included 26 articles and 18,788 participants were involved after assessment of eligibility. The results of this meta-analysis showed that the risk of developing cognitive impairment was significantly higher in patients with sarcopenia than in those without sarcopenia [OR = 1.75; 95% CI = 1.57, 1.95; P <  0.00001], MMSE score of sarcopenia group was lower than that of non-sarcopenia group, the difference was statistically significant [OR = − 2.23; 95% CI = − 2.48, − 1.99; P <  0.00001]. Conclusion Overall, this meta-analysis showed an association between sarcopenia and cognitive impairment in the older people, demonstrating a significant association between sarcopenia and cognitive impairment. This suggested that providing comprehensive sarcopenia screening and active prevention for the older people with cognitive decline has certain clinical value for improving the quality of life of the older people.

To explore the effects of acoustic perception on outdoor thermal comfort, acoustic perception in five typical open spaces in a campus in China’s cold region with common soundscapes was evaluated by using meteorological measures, sound level devices, and a questionnaire survey. Eight adjectives were used to evaluate an individual’s acoustic perception, and the physiological equivalent temperature (PET) was selected as a thermal index. The correlations between acoustic perception and thermal comfort in these typical open spaces were further analyzed. We demonstrated that: (1) Acoustic sensation and comfort varied significantly among sound types (STPs). Respondents reported pleasant perceptions of broadcasting music, running water and birdsong, and wind (a gentle breeze) and insects. (2) Although there was no significant difference in the thermal sensation vote (TSV), we found large differences in the thermal comfort vote (TCV) among STPs. (3) The respondents’ neutral PET (NPET) varied among STPs. In autumn, the ranked order of NPET was machines > running water and birdsong > crowds > broadcasting music > wind (a gentle breeze) and insects. In winter, the order of the NPET was machines > wind (a gentle breeze) and insects > crowds > broadcasting music > running water and birdsong. (4) When people perceived “acoustic comfort”, their TSV improved, and vice versa.