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Integrated circuit anti-counterfeiting based on optical physical unclonable functions (PUFs) plays a crucial role in guaranteeing secure identification and authentication for Internet of Things (IoT) devices. While considerable efforts have been devoted to exploring optical PUFs, two critical challenges remain: incompatibility with the complementary metal-oxide-semiconductor (CMOS) technology and limited information entropy. Here, we demonstrate all-silicon multidimensionally-encoded optical PUFs fabricated by integrating silicon (Si) metasurface and erbium-doped Si quantum dots (Er-Si QDs) with a CMOS-compatible procedure. Five in-situ optical responses have been manifested within a single pixel, rendering an ultrahigh information entropy of 2.32 bits/pixel. The position-dependent optical responses originate from the position-dependent radiation field and Purcell effect. Our evaluation highlights their potential in IoT security through advanced metrics like bit uniformity, similarity, intra- and inter-Hamming distance, false-acceptance and rejection rates, and encoding capacity. We finally demonstrate the implementation of efficient lightweight mutual authentication protocols for IoT applications by using the all-Si multidimensionally-encoded optical PUFs. The researchers introduce an all-silicon optical PUF that enhances IoT device security through CMOS-compatible fabrication, showcasing five unique optical responses per pixel for advanced authentication and high information entropy.

Density functional theory was used to study the effects of different types of oxygen-containing functional groups on the adsorption of oxygen molecules and single active oxygen atoms on carbonaceous materials. During gasification or combustion reactions of carbonaceous materials, oxygen-containing functional groups such as hydroxyl(-OH), carbonyl(-CO), quinone(-O), and carboxyl(-COOH) are often present on the edge of graphite and can affect graphite's chemical properties. When oxygen-containing functional groups appear on a graphite surface, the oxygen molecules are strongly adsorbed onto the surface to form a four-member ring structure. At the same time, the O-O bond is greatly weakened and easily broken. The adsorption energy value indicates that the adsorption of oxygen molecules changes from physisorption to chemisorption for oxygen-containing functional groups on the edge of a graphite surface. In addition, our results indicate that the adsorption energy depends on the type of oxygen-containing functional group. When a single active oxygen atom is adsorbed on the bridge site of graphite, it gives rise to a stable epoxy structure. Epoxy can cause deformation of the graphite lattice due to the transition of graphite from sp2 to sp3 after the addition of an oxygen atom. For quinone group on the edge of graphite, oxygen atoms react with carbon atoms to form the precursor of CO2. Similarly, the single active oxygen atoms of carbonyl groups can interact with edge carbon atoms to form the precursor of CO2. The results show that oxygen-containing functional groups on graphite surfaces enhance the activity of graphite, which promotes adsorption on the graphite surface.

The global clinical trial landscape for multiple primary lung cancer (MPLC) exhibits a striking geographic anomaly. Through a systematic analysis of 8212 lung cancer registrations (2015–2024), we identified a cohort of 17 trials explicitly targeting MPLC. Analysis revealed an absolute geographic monopole: 100% of these trials were investigator-initiated in China, with a complete absence of active protocols in Western registries. We argue that this segregation is not accidental but driven by the “Asian phenotype”,which is characterized by indolent, multifocal ground-glass nodules (GGNs), demands lung-sparing local strategies distinct from the systemic paradigms favored in the West. We urge the international community to transition from universal guidelines to phenotype-stratified management frameworks.

Objective To assess geographical disparities in hospice and palliative care (HPC) based on provider-reported practices across Chinese provinces and to identify associated socioeconomic and health system factors. Study design Descriptive cross-sectional study. Methods A large cross-sectional survey was conducted among 6,393 healthcare providers from 903 institutions across 87 pilot cities in 29 provinces using a multi-stage stratified sampling strategy. Provider practice levels were measured using a validated 14-item scale (Cronbach’s α = 0.98; score range 14–70), reflecting the frequency of essential HPC activities. Spatial patterns were assessed using Global and Local Moran’s I, and factors associated with practice levels were examined using Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR). Results The average practice level score was 53.35 ± 1.52. Significant spatial clustering of HPC practice levels was observed, with high-high clusters in Shandong and Yunnan and low-low clusters in Xinjiang. Higher practice levels were unexpectedly associated with lower GDP per capita (β = -0.07, 95%CI: -1.31 to -0.13) and fewer hospitals per 10,000 people (β = -0.67, 95%CI: -1.24 to -0.10). Conclusions Substantial geographic disparities in provider practice levels reveals inequities in HPC service delivery across China. These findings underscore the need for region-specific interventions, strengthened community-based services, and policy frameworks to improve equitable access to HPC nationwide.

Background China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China’s public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. Methods We established a hypothetical model that comprised patients’ awareness of insurance policies, the fulfillment of patients’ expectations of insurance benefits, patients’ perceived value of health insurance coverage, patients’ satisfaction with health insurance programs, patients’ complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. Results The SEM model, with good fit indices, showed that patients’ awareness of health insurance policies, insurance program’s fulfillment of expectations, and patients’ perceived value of insurance coverage, positively predicted patient satisfaction ( P  < 0.01). The fulfillment of patients’ expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P  < 0.001), while the patients’ perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P  < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average ( P  < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. Conclusions Our findings highlight the importance of incorporating patients’ perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients’ expectations.

Objective This study aims to evaluate the application value of contrast‐enhanced transthoracic echocardiography (cTEE) in the diagnosis of patent foramen ovale (PFO) under different states of stimulation, with the goal of enhancing the accuracy and efficiency of PFO diagnosis. Methods This research consecutively enrolled patients suspected of having PFO from October 2022 to February 2024, presenting primary clinical symptoms such as unexplained syncope, headache, dizziness, and stroke. Patients underwent standard transthoracic echocardiography (TTE) and cTEE under three different states of stimulation (resting state, coughing, and Valsalva maneuver). Based on the presence of microbubbles in the left heart and their initial appearance time, patients were classified into PFO and control groups, with further diagnostic confirmation via transesophageal echocardiography (TEE) or foramen ovale closure procedures. Results The study results revealed significant differences between the PFO and control groups regarding age (p = 0.034) and headache symptoms (p = 0.001). In the PFO group, TTE showed a higher positivity rate both at rest and during coughing, highlighting the association between PFO and specific clinical symptoms. The number of microbubbles observed during TTE increased significantly under various stimulation states, particularly during the Valsalva maneuver (p < 0.05). This increase became more pronounced as the duration of the maneuver was extended, underscoring the differential response of PFO patients under varied physiological testing conditions, especially during prolonged Valsalva maneuvers. Conclusion The study confirms the significant value of cTEE in diagnosing PFO under different stimulation states, particularly emphasizing the application of the Valsalva maneuver to significantly improve the sensitivity and specificity of PFO detection. Thus, incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis. Patients suspected of having patent foramen ovale (PFO) were enrolled to investigate the diagnostic performance of transthoracic echocardiography in different states of stimulation. The results showed that incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis.

The prognosis of poorly differentiated lung adenocarcinoma (PDLA) is determined by many clinicopathological factors. The aim of this study is identifying prognostic factors and developing reliable nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) in patients with PDLA. Patient data from the Surveillance, Epidemiology and End Results (SEER) database was collected and analyzed. The SEER database was used to screen 1059 eligible patients as the study cohort. The whole cohort was randomly divided into a training cohort ( n  = 530) and a test cohort ( n  = 529). Cox proportional hazards analysis was used to identify variables and construct a nomogram based on the training cohort. C-index and calibration curves were performed to evaluate the performance of the model in the training cohort and test cohorts. For patients with PDLA, age at diagnosis, gender, tumor size were independent prognostic factors both for overall survival (OS) and cancer-specific survival (CSS), while race and number of nodes were specifically related to OS. The calibration curves presented excellent consistency between the actual and nomogram-predict survival probabilities in the training and test cohorts. The C-index values of the nomogram were 0.700 and 0.730 for OS and CSS, respectively. The novel nomogram provides new insights of the risk of each prognostic factor and can assist doctors in predicting the 1-year, 3-year and 5-year OS and CSS in patients with PDLA.

Plant-parasitic nematodes cause huge agricultural economic losses. Two major families of Bacillus thuringiensis crystal proteins, Cry5 and Cry6, show nematicidal activity. Previous work showed that binding to midgut receptors is a limiting step in Cry toxin mode of action. In the case of Cry5Ba, certain Caenorhabditis elegans glycolipids were identified as receptors of this toxin. However, the receptors for Cry6 toxin remain unknown. In this study, the C. elegans CUB-like-domain containing protein RBT-1, released by phosphatidylinositol-specific phospholipase C (PI-PLC), was identified as a Cry6Aa binding protein by affinity chromatography. RBT-1 contained a predicted glycosylphosphatidylinositol (GPI) anchor site and was shown to locate in lipid rafts in the surface of the midgut cells. Western ligand blot assays and ELISA binding analysis confirmed the binding interaction between Cry6Aa and RBT-1 showing high affinity and specificity. In addition, the mutation of rbt-1 gene decreased the susceptibility of C. elegans to Cry6Aa but not that of Cry5Ba. Furthermore, RBT-1 mediated the uptake of Cry6Aa into C. elegans gut cells, and was shown to be involved in triggering pore-formation activity, indicating that RBT-1 is required for the interaction of Cry6Aa with the nematode midgut cells. These results support that RBT-1 is a functional receptor for Cry6Aa.

Background Primary health care (PHC) is central to achieving universal health coverage, yet longitudinal assessments of residents’ experiences—especially regarding urban–suburban disparities—remain scarce. This study aims to examine changes in PHC service experiences among Shanghai residents between 2023 and 2024, identify urban–suburban differences, and explore key influencing factors. Methods A two-wave cross-sectional survey was conducted at 248 community health centers in Shanghai from May to June in 2023 and 2024. The Chinese version of the Primary Care Assessment Tool–Adult Short Version (PCAT-AS) was used. Propensity score matching ensured comparability between survey waves. Descriptive statistics, hypothesis testing, and multiple linear regression were employed to assess temporal changes, regional disparities, and associated predictors. Results Residents reported significantly improved PHC experiences in 2024 across all domains ( P  < 0.001), with the largest gains in service comprehensiveness (+ 0.23) and referral coordination (+ 0.18). Urban residents consistently reported better experiences in continuity, service delivery, and cultural competence, while suburban residents rated higher in first-contact accessibility and service availability. Improvements from 2023 to 2024 were most notable in first-contact accessibility (Δ = +0.11) and comprehensiveness (Δ = +0.10), though domains such as family-centeredness and cultural competence showed limited progress (Δ = +0.01). Multivariate analyses identified residential location, chronic disease burden, psychological distress, and self-rated health as significant predictors of overall PCAT scores. Suburban residence was associated with lower scores (B = − 1.59, P  < 0.001), while comorbidities (B = 1.94, P  < 0.001) and psychological distress (B = 2.06, P  < 0.001) were linked to higher scores. Conclusion This study demonstrates that while overall perceptions of PHC services among permanent residents in Shanghai improved significantly compared to the previous year—particularly in terms of service comprehensiveness and referral coordination—urban–suburban disparities persist. Specifically, urban residents reported more favorable experiences in first-contact utilization, continuity of care, and cultural competence, whereas suburban residents expressed better perceptions of first-contact accessibility and service availability. Notably, the urban–suburban gaps in first-contact accessibility and service comprehensiveness narrowed between 2023 and 2024, suggesting a positive trajectory toward greater equity in basic health service delivery. Multivariate regression analysis further indicated that residential location, chronic disease burden, psychological distress, and self-rated health status were significant determinants of residents’ PHC experiences. Based on these findings, we recommend the implementation of more targeted interventions focusing on enhancing continuity of care and strengthening integrated management for both mental health and chronic conditions. Special attention should be given to addressing structural disparities between urban and suburban areas and to meeting the health service needs of priority populations, in order to continuously advance both equity and quality in PHC delivery.

Abstract Background: To evaluate the efficacy and safety of the first cohort of people in China treated with a responsive neurostimulation system (EpilcureTM, GenLight MedTech, Hangzhou, China) for focal drug-resistant epilepsy in this study. Methods: This multicenter, before-and-after self-controlled study was conducted across 8 centers from March 2022 to June 2023, involving patients with drug-resistant epilepsy who were undergoing responsive neurostimulation (RNS). The study was based on an ongoing multi-center, single-blind, randomized controlled study. Efficacy was assessed through metrics including median seizure count, seizure frequency reduction (SFR), and response rate. Multivariable linear regression analysis was conducted to explore the relationships of basic clinical factors and intracranial electrophysiological characteristics with SFR. The postoperative quality of life, cognitive function, depression, and anxiety were evaluated as well. Results: The follow-up period for the 19 participants was 10.7 ± 3.4 months. Seizure counts decreased significantly 6 months after device activation, with median SFR of 48% at the 6th month (M6) and 58% at M12 (P <0.05). The average response rate after 13 months of treatment was 42%, with 21% (n = 4) of the participants achieving seizure freedom. Patients who have previously undergone resective surgery appear to achieve better therapeutic outcomes at M11, M12 and M13 (β <0, P <0.05). No statistically significant differences were observed in patients’ scores of quality of life, cognition, depression and anxiety following stimulation when compared to baseline measurements. No serious adverse events related to the devices were observed. Conclusions: The preliminary findings suggest that EpilcureTM exhibits promising therapeutic potential in reducing the frequency of epileptic seizures. However, to further validate its efficacy, larger-scale randomized controlled trials are required. Registration: Chinese Clinical Trial Registry (No. ChiCTR2200055247)