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Reports on the application of metagenomic next-generation sequencing (mNGS) in adult patients with severe pneumonia after cardiac surgery remain limited. This study aimed to evaluate the clinical outcomes of mNGS analysis of bronchoalveolar lavage fluid (BALF) in such patients.A retrospective cohort study was conducted on adult patients with severe pneumonia after cardiac surgery. Samples were collected from patients in the surgical intensive care unit (SICU) of Sichuan Provincial People’s Hospital between January 2019 and March 2024. Upon diagnosis of severe pneumonia, bronchoalveolar lavage fluid was obtained via bronchoscopy within 24 h. The mNGS group was composed of patients tested using mNGS and conventional microbiological tests. BALF was detected only by the conventional microbiological test (CMT) method in the CMT group, which involved examining bacterial and fungal smears and cultures at least. We reviewed a total of 4,064 cardiac surgeries, and based on the inclusion criteria, a total of 113 adult patients with severe pneumonia after cardiac surgery were included in this study. The overall positive rate detected by mNGS was significantly higher than that of the culture method (98% vs. 58%, P <0.0001). After receipt of the microbiological results, the mNGS group exhibited a higher incidence of antibiotic adjustments in comparison to the CMT group ( P  = 0.0021). After adjusting the treatment plan based on microbial testing results, the mNGS group showed an improvement in ventilator-free days within 28 days ( P  = 0.0475), with a shorter duration of invasive ventilation compared to the CMT group ( P  = 0.0208). The detection of mNGS can significantly improve the Acute Physiology and Chronic Health Evaluation-II (APACHE II) score ( P  = 0.0161) and Sequential Organ Failure Assessment (SOFA) score ( P  = 0.0076) on the 7th day after admission to the SICU. In this study, the mNGS group showed signs of having a positive impact on the length of stay in ICU (median: 9 days, IQR: 7–10 days vs. median: 10 days, IQR: 8-13.75 days, P  = 0.0538), length of stay in Hospital (median: 20 days, IQR: 17–28 days vs. median: 25 days, IQR: 18–29 days, P  = 0.1558), mortality in 28 days (19% vs. 20%, P  = 0.8794), in-hospital mortality (19% vs. 22%, P  = 0.7123); however, statistical analysis did not confirm these differences to be significant. mNGS could serve as a valuable complement to conventional diagnostic approaches in adult patients with severe pneumonia after cardiac surgery, potentially improving diagnostic accuracy and leading to more precise and timely interventions, with significant potential to inform clinical decision-making and enhance patient outcomes.

In order to ensure energy security, China should make full use of existing resources, such as the open space on highways, highways and railways, the roofs of industrial and mining areas, towns and villages, and the large-scale clustering of deserts, gobi, wastelands and grasslands to vigorously develop new energy such as photovoltaic power and wind power. At the same time, large-scale construction of pumping and solar thermal energy storage power stations on the mountains of various provinces, cities and counties in China will adjust and balance China’s large power grid, To achieve the goal of reducing carbon without reducing productivity, this paper also analyzes and demonstrates its feasibility from the perspective of comprehensive social benefits and investment, and proposes that large-scale cluster construction of wind and electricity in offshore waters should no longer be carried out globally.

This investigation was undertaken in response to an outbreak of suspected shellfish poisoning in Zhejiang Province, China. The objectives of this project were to confirm the outbreak and to identify the aetiology, source and mode of transmission. A probable case was defined as an individual with diarrhea (≥3 times/day) plus at least one of the following symptoms: fever (≥37.5°C), vomiting, or abdominal pain after consuming seafood between May 23(rd) and May 28(th), 2011. Using a case-control study design, we compared exposures to suspected seafood items and cooking methods between 61 probable cases and 61 controls. Over 220 suspected or probable cases of diarrhetic shellfish poisoning (DSP) were identified (incidence of 18 cases per 100,000). The case control study revealed that 100% of cases and 18% of controls had eaten mussels during the exposure period (OR = ∞, χ(2) = 84.72,P = 0.000). The number of mussels consumed was related to DSP risk (P = 0.004, χ2 test for trend). Consumption of other seafood items was not associated with disease. The frequency of diarrhea and vomiting were positively correlated with the number of mussels consumed (r = 0.424 and r = 0.562, respectively). The frequency of vomiting and the incubation period were significantly correlated with the total time the mussels were boiled (r = 0.594 and r = -0.336, respectively). Mussels from 3 food markets and one family contained Okadaic acid (OA) and Dinophysistoxin-1 (DTX-1). This outbreak was attributed to the consumption of mussels contaminated by DSP-toxins (OA and DTX-1) which are produced by different species of dinoflagellates (toxic microalgae) from the genus Dinophysis or Prorocentrum. Suspension of mussel sales and early public announcements were highly effective in controlling the outbreak, although oversight of seafood quality should be a priority to prevent future contamination and outbreaks.

In this study, a numerical model for electro-mechanical coupling analysis of geometrically nonlinear functionally graded piezoelectric shell is developed based on the weak form quadrature element method. Both piezoelectric and flexoelectric effects are introduced to establish the geometrically exact shell model with its constituent BaTiO 3 and PZT-5H graded through the thickness. The electric potentials are assumed quadratic along the shell thickness to introduce the electric field for numerical implementation, while four different closed- or open-circuit conditions are considered. Four typical examples are presented to demonstrate the effectiveness of the present model and illustrate the influences of electro-mechanical couplings and functional graded materials on the responses of shells undergoing large displacements and rotations. This model is a feasible scheme for studying complex nonlinear behaviors of piezoelectric shells that might be helpful in devising piezoelectric shell-based nanoelectronics.

In this article, a geometrically exact flexoelectric beam model and its weak form quadrature element formulation are established. The coupling of strain gradient and electric field in flexoelectricity involving size effects is taken into account and the resulting C1 continuity requirements are satisfied. The formulation owns the advantage of high-order approximation to circumvent locking problems after discretization. Several numerical examples originating from benchmark nonlinear beam problems are studied to validate the feasibility of the formulation. Compared to existing flexoelectric beam models, the use of geometrically exact beam theory in the present model makes an innovative contribution to analyzing flexoelectric microbeams undergoing large displacements and rotations. This study is a step forward to better understandings of flexoelectric effects on microbeams under large deflections, while also providing a viable approach to predict their nonlinear behaviors in such conditions.

Breast cancer remains the leading cause of female mortality worldwide, necessitating innovative and multifaceted approaches to address its various subtypes. Nanotechnology has attracted considerable attention due to its nanoscale dimensions, diverse carrier types, suitability for hydrophobic drug delivery, and capacity for controlled and targeted administration. Nano-sized particles have become prevalent carriers for therapeutic agents targeting breast cancer, thanks to their reproducible synthesis and adjustable properties, including size, shape, and surface characteristics. In addition, certain nanoparticles can enhance therapeutic effects synergistically. However, the immune system often detects and removes these nanoparticles, limiting their efficacy. As a promising alternative, cell membrane-based delivery systems have gained attention due to their biocompatibility and targeting specificity. These membrane-coated drug delivery systems are derived from various cell sources, including blood cells, cancer cells, and stem cells. Leveraging the unique properties of these cell membranes enables precise targeting of breast cancer tumors and associated biomarkers. Inspired by natural structures, cell membranes disguise nanoparticles in the bloodstream, enhancing their retention time in vivo and improving tumor targeting. Consequently, cell membrane-derived nanoparticles (CMDNPs) have been investigated for their potential applications in breast cancer diagnostics, photothermal therapy (PTT), and vaccine development. This review comprehensively explores the potential and limitations of cell membrane-derived drug delivery systems in clinical applications against breast cancer.

Aiming at the nonlinear high-frequency micro-vibration (HFMV) phenomenon that would cause hidden faults of blade fracture failure of a wind turbine, this study calibrated a new type of HFMV aerodynamic force, elaborated on the nonlinear aeroelastic behavior of a 2D airfoil-based structural nonlinear system driven by HFMV aerodynamic forces, and proposed a control plan based on flutter suppression. Based on structural reinforcement based on a nonlinear tuned vibration absorber (NTVA), the flutter wind speed was increased, and artificial structural damping was introduced to analyze the flutter wind speed. The control planning adopted a new unified pitch control system based on the “screw rod–translational slider (nut)” transmission, which was driven by the hydraulic system to drive the ball screw and further drive the slider translation, achieving pitch motion. The control method adopted an optimal trajectory control and the optimal proportional-derivative (PD) controller adjustment technology based on the differential evolution algorithm (DEA). It achieved analysis of flap-wise bending/twist displacement responses, analysis of pitch angle changing, and display of slider driving force. The robustness of the control algorithm was validated by the control results displayed at different wind speeds near the flutter wind speed. The robustness of engineering applications for controlling performance was also validated on the controller hardware-in-the-loop simulation platform through an “object linking and embedding (OLE)” technology based on process control. Finally, the driving performance and wear consumption in engineering applications were discussed. On the basis of ensuring the control effect, the control algorithm was improved, and the fractional-order optimal PD control was adopted, so that the system could stabilize at the “0” consumption state when achieving flutter suppression.

Despite the widespread presence of all-carbon quaternary centers in natural products and bioactive compounds, a concise construction strategy remains very challenging. Herein, we introduce a highly controllable sequential dechlorination strategy of tetrachloromethane by means of relay catalysis with different photocatalysts of eosin Y, 1,2,3,5-tetrakis(carbazol-9-yl)−4,6-dicyanobenzene and Au 2 (µ-dcpm) 2 Cl 2 . Four C-Cl bonds in CCl 4 can undergo sequential, highly selective cleavage by combination of outer-sphere and inner-sphere crossover single electron transfer mechanism, enabling radical-addition reactions with a wide range of terminal alkenes to construct all-carbon quaternary centers in four steps with 17-38% yields. Furthermore, using 1,1-disubstituted styrene as the substrates, cyclopropanes bearing with challenging vicinal all-carbon quaternary centers are also successfully constructed from CCl 4 in two-pots three steps with moderate yields of 10-50%. This work suggests the possibility of tetrachloromethane as an editable C1 synthon to facilitate the construction of all-carbon quaternary centers. All-carbon quaternary centers are ubiquitous in natural products and bioactive molecules, yet strategies for their streamlined construction remain scarce. Here, the authors report a sequential dechlorination strategy of tetrachloromethane, offering a concise route to quaternary carbon frameworks.

Aspergillus invading hosts may manifest as Allergic bronchopulmonary aspergillosis (ABPA) or invasive pulmonary aspergillosis (IPA) in individuals with varying immune statuses. ABPA predominantly occurs in severe asthma patients, whereas IPA is typically observed in immunocompromised individuals. ABPA management centers on glucocorticoids to mitigate hypersensitivity-driven inflammation, while IPA requires aggressive antifungal therapy. Concurrent ABPA and IPA presents a therapeutic dilemma, as glucocorticoids use may exacerbate fungal dissemination, while antifungal agents alone inadequately address the allergic component. Adjusting treatment strategies to balance immunosuppression to control ABPA with sufficient antifungal coverage for IPA is critical step. The case report presents an innovative therapeutic strategy for a 73-year-old female with co-existing ABPA and IPA. After suboptimal clinical response to conventional glucocorticoid-antifungal therapy, we implemented a guideline-aligned, evidence-based regimen combining omalizumab with voriconazole. While this dual therapy achieved clinical stabilization, persistently elevated serum IgE (>5000 IU/mL). By reviewing the literature and comparing the differences between the mechanisms of omalizumab and dupilumab, the treatment was finally changed from omalizumab to dupilumab and followed up. This case is also a practice guided by ISHAM guidelines while pioneering a mechanism-driven transition from omalizumab to dupilumab in ABPA-IPA co-management. In order to provide guidance for the treatment of ABPA-IPA disease.

In the current context of the wide application of Internet of Things (IoT) technology, cross-domain data sharing based on industrial IoT (IIoT) has become the key to maximizing data value, but it also faces many challenges. In response to the security and privacy issues in cross-domain data sharing, we proposed a cross-domain secure data sharing scheme (CDAS) based on multiple blockchains. The scheme first designs the cross-domain blockchain in layers and assists the device in completing the data sharing on the chain through the blockchain layer close to the edge device. In addition, we combine smart contract design to implement attribute-based access control (ABAC) and anonymous identity registration. This method simplifies device resource access by minimizing middleware confirmation, double-checking device access rights, and preventing redundant requests caused by illegal access attempts. Finally, in terms of data privacy and security, IPFS is used to store confidential data. In terms of ensuring data sharing security, searchable encryption (SE) is applied to the overall data sharing and improved. Users can find the required data by searching the ciphertext links in the blockchain system to ensure the secure transmission of private data. Compared with the traditional ABAC scheme, we have added modules for data privacy protection and anonymous authentication to further protect user data privacy. At the same time, compared with the access control scheme based on attribute encryption, our scheme has certain advantages in the time complexity calculation of key algorithms such as policy matching and encryption algorithm. At the same time, with the assistance of the edge blockchain layer, it can reduce the burden of limited computing resources of the device. This scheme can solve the security and efficiency problems of cross-domain data sharing in the industrial Internet of Things through security and experimental analysis.