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Hemorrhagic fevers (HF) caused by viruses and bacteria are a major public health problem in China and characterized by variable clinical manifestations, such that it is often difficult to achieve accurate diagnosis and treatment. The causes of HF in 85 patients admitted to Dandong hospital, China, between 2011-2012 were determined by serological and PCR tests. Of these, 34 patients were diagnosed with Huaiyangshan hemorrhagic fever (HYSHF), 34 with Hemorrhagic Fever with Renal Syndrome (HFRS), one with murine typhus, and one with scrub typhus. Etiologic agents could not be determined in the 15 remaining patients. Phylogenetic analyses of recovered bacterial and viral sequences revealed that the causative infectious agents were closely related to those described in other geographical regions. As these diseases have no distinctive clinical features in their early stage, only 13 patients were initially accurately diagnosed. The distinctive clinical features of HFRS and HYSHF developed during disease progression. Enlarged lymph nodes, cough, sputum, and diarrhea were more common in HYSHF patients, while more HFRS cases presented with headache, sore throat, oliguria, percussion pain kidney area, and petechiae. Additionally, HYSHF patients displayed significantly lower levels of white blood cells (WBC), higher levels of creations kinase (CK) and alanine aminotransferase (ALT), while HFRS patients presented with an elevation of blood urea nitrogen (BUN) and creatinine (CREA). These clinical features will assist in the accurate diagnosis of both HYSHF and HFRS. Overall, our data reveal the complexity of pathogens causing HFs in a single Chinese hospital, and highlight the need for accurate early diagnosis and a better understanding of their distinctive clinical features.

Understanding the temporal and spatial patterns of soil water extraction and their impacts on growth response of winter wheat to deficit subsurface drip irrigation (SDI) conditions is critical for managing water scarcity and stabilizing yield. A field experiment was conducted from 2016 to 2018 involving five SDI amounts: 0.25, 0.4, 0.6, 0.8, and 1.0 ETc, representing 25, 40, 60, 80, and 100% of crop evapotranspiration (ETc), respectively. The results showed that the 0.6 ETc treatment significantly increased soil water extraction from 40–80 and 80–140-cm from jointing to maturity as compared to the 1.0 ETc treatment. Whereas the 0.8 ETc treatment significantly increased soil water extraction from 80–140-cm deep soil from flowering to maturity in the first growing season. The crop was most water-stressed under the 0.25 and 0.4 ETc treatments, thus extracted more soil water from 0–140-cm soil profile. However, both treatments exhibited minimum plant tillers, lowest leaf water content, leaf area index (LAI), photosynthetic rate ( P n ), and transpiration rate ( T r ) as well as grain yield. All these parameters, except for leaf water content, P n after the flowering stage, and grain productivity, were also reduced in the 0.6 ETc treatment than the 1.0 ETc treatment. The differences between the 0.8 and 1.0 ETc treatments were minor in terms of plant height, LAI, spike number, P n and T r , but infertile tillers were fewer in the 0.8 ETc treatment. We obtained high yield from the 0.8 ETc treatment, and the 0.6ETc treatment resulted in the highest harvest index with improved WUE than other treatments. Integrating deficit irrigation into SDI can save water in winter wheat production in water-limited regions, which can not only enhance soil water extraction from deep soil layers, but also sustained yield by stimulating crop growth. Therefore, a deficit SDI system would be used to conserve water in water-limited regions.

Kidney transplantation is considered the most effective treatment for end-stage renal failure. Recent studies have shown that the significance of the immune microenvironment after kidney transplantation in determining prognosis of patients. Therefore, this study aimed to conduct a bibliometric analysis to provide an overview of the knowledge structure and research trends regarding the immune microenvironment and survival in kidney transplantation. Our search included relevant publications from 2013 to 2023 retrieved from the Web of Science core repository and finally included 865 articles. To perform the bibliometric analysis, we utilized tools such as VOSviewer, CiteSpace, and the R package \"bibliometrix\". The analysis focused on various aspects, including country, author, year, topic, reference, and keyword clustering. Based on the inclusion criteria, a total of 865 articles were found, with a trend of steady increase. China and the United States were the countries with the most publications. Nanjing Medical University was the most productive institution. High-frequency keywords were clustered into 6 areas, including kidney transplantation, transforming growth factor β, macrophage, antibody-mediated rejection, necrosis factor alpha, and dysfunction. Antibody mediated rejection (2019-2023) was the main area of research in recent years. This groundbreaking bibliometric study comprehensively summarizes the research trends and advances related to the immune microenvironment and survival after kidney transplantation. It identifies recent frontiers of research and highlights promising directions for future studies, potentially offering fresh perspectives to scholars in the field.

Carbon-fiber-reinforced polyetheretherketone (CF/PEEK) composites are being increasingly used in aerospace, biomedical, and other industries due to their superior mechanical properties. However, CF/PEEK structural components require secondary processing after curing and molding to meet connection and assembly precision requirements. This process, however, often results in defects such as burrs and pits, which significantly compromise the mechanical performance and assembly quality of the structural components. This study first employed finite element simulations to analyze the laser-assisted milling of CF/PEEK composites, investigating the material removal mechanism under thermal coupling, which was then experimentally validated. Variations in the cutting force, cutting heat, surface damage, and fiber fracture mechanisms during milling were investigated. During laser-assisted milling, the fibers fractured mainly in bending at a cutting angle of 0°, in bending shear at a cutting angle of 45°, in compression at a cutting angle of 90°, and in compression shear at a cutting angle of 135°. The experimental findings were generally consistent with the simulation results. In addition, laser-assisted milling effectively reduced the cutting forces, cutting temperatures, and surface damage compared to conventional milling; laser-assisted milling reduced the cutting forces in the 90° fiber direction by 24.8% (total cutting forces) and 16.3% (feed-cutting forces). The fiber integrity was further increased with increasing spindle speed.

High-altitude environments are characterised by extreme conditions, including hypoxia, low temperatures, and intense ultraviolet radiation. Mammals inhabiting these environments have evolved unique adaptive mechanisms, the study of which elucidates survival strategies and evolutionary pathways under extreme conditions. Understanding how native high-altitude animals respond to such environments is highly important. This study investigated the high-altitude adaptation mechanisms of the five-toed jerboa ( Orientallactaga sibirica ) distributed in Qinghai Province (4229 m) and Hebei Province (498 m), China, through comparative transcriptomic analysis of heart, lung, and kidney tissues. The results revealed greater mRNA transcriptional differences in the lung tissue than in the heart and kidney tissues of high-altitude jerboas, indicating heightened lung sensitivity to high-altitude conditions. In lung tissue, high-altitude jerboas show differential expression of genes related to the Complement and Coagulation cascades, Heme binding, Oxidation-reduction process (such as MASP1, A2M, SERPING1, CD55, FGA, C5AR1, and KNG1), which may be associated with modulating immune functions to mitigate hypobaric hypoxia, intense radiation, and cold-induced damage and reducing thrombosis and inflammation risks. Heart tissue exhibits differential expression of Oxidative phosphorylation and Lipid metabolism genes (such as NDUFC2, NDUFA3, NDUFS4, COX4I2, PAFAH1B3, SGMS2 and PPAR2B), which may help maintain energy equilibrium under hypoxic and cold challenges. Kidney tissue exhibits differential enrichment of pathways such as arachidonic acid metabolism and steroid hormone biosynthesis mediated by genes including CYP4A11, CYP2C29, GPX2, PTGDS, CBR1, and UGT2B31, which may help coordinate vascular regulation, immune response, and oxidative balance to maintain systemic homeostasis. These pathways and genes are differentially enriched and expressed between high-altitude and low-altitude five-toed jerboas, which may be candidates for further functional studies of plateau environmental adaptability. Our findings provide candidate genes and pathways for intraspecies adaptations across microenvironments and highlight the need for further functional validation.

Carbon fiber/polyether ether ketone (CF/PEEK) is widely used in aerospace, transportation, and other high-end industries for its light weight, high strength, and recyclability. However, its inherently brittle–ductile two-phase structure presents challenges in processing CF/PEEK. This paper introduces a laser-assisted milling method, wherein four types of CF/PEEK unidirectional plates (0°, 45°, 90°, and 135°) are milled under varying laser powers and spindle speeds. The results are compared with conventional milling (CM) techniques, based on cutting forces, temperatures, surface roughness, and damage defects. The cutting force, temperature, and surface quality were optimal at a fiber direction of 0° and were least favorable at 90° under identical machining conditions. When the fiber direction was 90°, the milling temperatures at 400 W and 500 W laser power decreased by 19.8% and 7.9%, respectively, while the average values of Fx and Fy decreased by 20.5% and 9.55%, compared to conventional milling. Furthermore, the laser-assisted milling method significantly reduces surface defects and improves surface roughness. In CF/PEEK composites, brittle fracture is the primary material removal mechanism, with damage characteristics such as fiber fracture, fiber pullout, and fiber/matrix debonding. The optimal parameter combination is a 0° fiber orientation, 400 W laser power, and a spindle speed of 4000 rpm. This study provides theoretical and technical support for the high-quality processing of CF/PEEK composites.

Background This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products. Methods This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves. Results A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values. Conclusions A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.

Background Percutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS. Methods We retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED ( n  = 16) and PDL( n  = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR). Results The patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P  > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p  < 0.05), blood loss (mL) (18.21 vs 228.57, p  < 0.05),drainage volume(mL) (15.5 vs 601.4, p  < 0.05), and hospital stay (d) (3.6 vs 5.6, p  < 0.05). Conclusions Both PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.

Background The current surveillance system only focuses on notifiable infectious diseases in China. The arrival of the big-data era provides us a chance to elaborate on the full spectrum of infectious diseases. Methods In this population-based observational study, we used multiple health-related data extracted from the Shandong Multi-Center Healthcare Big Data Platform from January 2013 to June 2017 to estimate the incidence density and describe the epidemiological characteristics and dynamics of various infectious diseases in a population of 3,987,573 individuals in Shandong province, China. Results In total, 106,289 cases of 130 infectious diseases were diagnosed among the population, with an incidence density (ID) of 694.86 per 100,000 person-years. Besides 73,801 cases of 35 notifiable infectious diseases, 32,488 cases of 95 non-notifiable infectious diseases were identified. The overall ID continuously increased from 364.81 per 100,000 person-years in 2013 to 1071.80 per 100,000 person-years in 2017 ( χ 2 test for trend, P  < 0.0001). Urban areas had a significantly higher ID than rural areas, with a relative risk of 1.25 (95% CI 1.23–1.27). Adolescents aged 10–19 years had the highest ID of varicella, women aged 20–39 years had significantly higher IDs of syphilis and trichomoniasis, and people aged ≥ 60 years had significantly higher IDs of zoster and viral conjunctivitis (all P  < 0.05). Conclusions Infectious diseases remain a substantial public health problem, and non-notifiable diseases should not be neglected. Multi-source-based big data are beneficial to better understand the profile and dynamics of infectious diseases.

Purpose Open-label phase Ib/II study to investigate the safety and efficacy of LBL-007, an anti-LAG-3 antibody, plus toripalimab, an anti-PD-1 antibody, in patients with previously treated advanced nasopharyngeal carcinoma (NPC) and other solid tumors. Methods Patients with advanced tumors refractory to prior standard therapies were enrolled. In phase Ib, patients received LBL-007 200 mg or 400 mg and toripalimab 240 mg intravenously once every 3 weeks. In phase II, all patients received LBL-007 at the recommended phase II dose (RP2D) and toripalimab 240 mg intravenously once every 3 weeks. The primary end points were safety in phase Ib and objective response rate (ORR) in phase II. The exploratory end point was the predictive capability of LAG-3 and PD-L1 expression for efficacy. Results Between November 30, 2021, and December 1, 2023, 80 patients were enrolled, including 30 (37.5%) with NPC and 50 (62.5%) with other tumors. Median follow-up was 26.0 months. In Phase Ib, LBL-007 was administered at 200 mg to four patients and 400 mg to six patients, with no dose-limiting toxicities observed. Therefore, the 400 mg dose of LBL-007 was established as the RP2D and administered to 70 patients in phase II. Nine (11.3%) of 80 patients had grade 3 or 4 treatment-related adverse events, the most common of which included anemia (2.5%), hyponatremia (2.5%), increased alanine aminotransferase (2.5%), increased aspartate aminotransferase (1.3%), and fatigue (1.3%). Eight patients (10.0%) had treatment-related serious adverse events. No treatment-related deaths were reported. In immunotherapy-naive NPC patients ( n  = 12), ORR was 33.3%, disease control rate (DCR) was 75%, and median progression-free survival (PFS) was 10.8 months (95% CI, 1.3 to not estimated). In IO-treated NPC patients ( n  = 17), ORR was 11.8%, DCR was 64.7%, and median PFS was 2.7 months (95% CI, 1.4 to 4.9). For other tumors, ORRs were 15.8% in immunotherapy-naive patients and 3.7% in immunotherapy-treated patients. Patients with ≥ 2 + LAG-3 expression had a higher ORR of 28.0%, compared to 7.7% in those with < 2 + LAG-3 expression. Conclusion LBL-007 plus toripalimab exhibited a manageable safety profile in patients with advanced solid tumors and demonstrated promising antitumor activity in NPC, especially in immunotherapy-naive patients. These findings warrant further validation in future studies.