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Sepsis can cause sepsis-associated encephalopathy (SAE), but whether SAE was induced or exacerbated by ferroptosis remains unknown. In this study, the rat sepsis model was constructed using the cecal ligation and puncture method. The blood–brain barrier (BBB) permeability was measured by Evans blue dye (EBD) in vivo. The levels of ROS, Fe ion, MDA, GSH, and GPX4 were assessed by enzyme-linked immunosorbent assay (ELISA). The exosomes isolated from serum were cultured with bEnd.3 cells for the in vitro analysis. Moreover, bEnd.3 cells cultured with 100 μM FeCl3 (iron-rich) were to simulate ferroptosis stress. The cell viability was evaluated by Cell Counting Kit-8 (CCK-8) assay. A dual-luciferase reporter gene assay was performed to confirm the relationship between miR-9-5p with NEAT1, TFRC , and GOT1 . In vivo, it is found that BBB permeability was damaged in model rats. Level of ROS, Fe ion, and MDA was increased, and level of GSH and GPX4 was decreased, which means ferroptosis was induced by sepsis. Exosome-packaged NEAT1 in serum was significantly upregulated in model rats. In vitro, it is found that NEAT1 functions as a ceRNA for miR-9-5p to facilitate TFRC and GOT1 expression. Overexpression of NEAT1 enhanced ferroptosis stress in bEnd.3 cells. Increased miR-9-5p alleviated sepsis-induced ferroptosis by suppressing the expression of TFRC and GOT1 both in vivo and in vitro. In conclusion , these findings suggest that sepsis induced high expression of serous exosome-derived NEAT1, and it might exacerbate SAE by promoting ferroptosis through regulating miR-9-5p/ TFRC and GOT1 axis.

It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural area without relevant expertise. To help diagnose BA based on sonographic gallbladder images, an ensembled deep learning model is developed. The model yields a patient-level sensitivity 93.1% and specificity 93.9% [with areas under the receiver operating characteristic curve of 0.956 (95% confidence interval: 0.928-0.977)] on the multi-center external validation dataset, superior to that of human experts. With the help of the model, the performances of human experts with various levels are improved. Moreover, the diagnosis based on smartphone photos of sonographic gallbladder images through a smartphone app and based on video sequences by the model still yields expert-level performances. The ensembled deep learning model in this study provides a solution to help radiologists improve the diagnosis of BA in various clinical application scenarios, particularly in rural and undeveloped regions with limited expertise. It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural areas without relevant expertise. Here, the authors develop a diagnostic deep learning model which favourable performance in comparison with human experts in multi-center external validation.

Background/Objectives: Hyperuricemia is a metabolic disorder characterized by renal dysfunction and systemic inflammation. While Clematis chinensis Osbeck is traditionally used for gout-related conditions, its chemical basis and precise mechanisms remain poorly understood. This study aimed to characterize the bioactive fraction (CWE-60EF) and elucidate its multi-target regulatory mechanisms against hyperuricemia. Methods: Qualitative and quantitative chemical profiling of CWE-60EF was performed using high-resolution LC-MS/MS. Its anti-hyperuricemic activity was validated using in vitro xanthine oxidase (XOD) inhibition, a zebrafish model, and HK-2 cell injury models. Mechanisms were explored through an integrated approach combining bioinformatics, Mendelian randomization (MR), and molecular docking. Results: A total of 50 compounds, primarily alkaloids and flavonoids (e.g., magnoflorine and phloretin), were characterized in CWE-60EF, and major marker compounds were quantitatively standardized. The fraction significantly inhibited XOD activity and rescued hyperuricemia-associated phenotypes in zebrafish. In HK-2 cells, CWE-60EF suppressed adenosine- and urate-induced cellular injury and the transcriptional expression of pro-inflammatory cytokines (IL-6 and IL-1β). MR analysis provided genetic evidence supporting IL-6 as a causal mediator of gout risk. Integrative analysis revealed that the protective effects of CWE-60EF are mediated through the coordinated regulation of purine metabolism, inflammatory cascades, and urate transporters (URAT1/GLUT9). Conclusions: This study demonstrates that CWE-60EF is a quantitatively standardized bioactive fraction that exerts anti-hyperuricemic, renoprotective, and anti-inflammatory effects by modulating uric acid metabolism and inflammation. By integrating genetic causality with phytochemical validation, our findings provide a novel mechanistic foundation for the traditional application of C. chinensis in hyperuricemic disorders.

Recently, various designs and material manufactured interspinous process devices (IPDs) are on the market in managing symptomatic lumbar spinal stenosis (LSS). However, atraumatic fracture of the intervening spinous process has been reported in patients, particularly, double or multiple level lumbar decompression surgery with IPDs. This study aimed to biomechanically investigate the effects of few commercial IPDs, namely DIAM TM , Coflex TM , and M-PEEK, which were implanted into the L2-3, L3-4 double-level lumbar spinal processes. A validated finite element model of musculoskeletal intact lumbar spinal column was modified to accommodate the numerical analysis of different implants. The range of motion (ROM) between each vertebra, stiffness of the implanted level, intra stress on the intervertebral discs and facet joints, and the contact forces on spinous processes were compared. Among the three implants, the Coflex system showed the largest ROM restriction in extension and caused the highest stress over the disc annulus at the adjacent levels, as well as the sandwich phenomenon on the spinous process at the instrumented levels. Further, the DIAM device provided a superior loading-sharing between the two bridge supports, and the M-PEEK system offered a superior load-sharing from the superior spinous process to the lower pedicle screw. The limited motion at the instrumented segments were compensated by the upper and lower adjacent functional units, however, this increasing ROM and stress would accelerate the degeneration of un-instrumented segments.

This Web-based cross-sectional study aimed to evaluate the knowledge, attitudes, and practices (KAP) of patients with type 2 diabetes mellitus (T2DM) regarding insulin treatment. It was conducted from March 2023 to July 2023. A self-designed questionnaire was used to collect demographic information from patients with T2DM and assess their KAP regarding insulin treatment. Structural equation modeling (SEM) was applied, and model adequacy was evaluated using established fit indices, including chi-square fit statistic/degrees of freedom, root mean square error of approximation, incremental fit index, Tucker–Lewis index, and comparative fit index. A total of 679 questionnaires were collected. Among patients with T2DM, 434 (63.92%) were male, 568 (84.65%) resided in urban areas, 328 (48.31%) had a high school or technical secondary school education, and 302 (44.48%) reported a familial predisposition to diabetes. The KAP scores were 4.43 ± 2.49 (possible range: 0–8), 36.63 ± 6.30 (possible range: 10–50), and 28.90 ± 10.69 (possible range: 9–45), respectively. SEM demonstrated that knowledge was positively associated with attitudes ( β  = 0.844, P  < 0.001), and attitudes significantly predicted practices ( β  = 0.903, P  < 0.001). The study found that participants in this sample demonstrated limited knowledge (mean score of 4.43/8), moderately negative attitudes (mean score of 36.63/50), and generally passive practices (mean score of 28.90/45) regarding insulin treatment. This the necessity of comprehensive training programs to enhance patient understanding and foster effective insulin administration behaviors. These findings highlight the need for strengthened patient education strategies and clinical interventions to improve insulin-related knowledge, attitudes, and self-management behaviors in routine diabetes care.

Background Microcolon helps diagnose small bowel atresia (SBA) using contrast enema. However, there are no ultrasonography (US) microcolon criteria for diagnosing SBA. Therefore, this study aimed to evaluate colon accuracy and other characteristics for diagnosing SBA by US, using surgical or clinical information as the reference standard. Methods US was performed on 46 neonates aged ≤ 7 days old. In the study group (n = 15), neonates with SBA were confirmed following surgery. In the study group without SBA (n = 15), neonates with other gastrointestinal problems besides SBA were confirmed by surgical or clinical follow-up. Sixteen neonates without gastrointestinal problems were classified as the control group. The colonic diameter was measured, and colonic gas was sought and observed. Statistical analysis was performed to compare US parameters between the study group and other two groups. The optimal cut-off value of the colonic diameter for SBA diagnosis was obtained using receiver operating characteristic analysis. Results Colonic diameters (0.5 cm) in the study group (interquartile ranges [IQR], 0.5–0.6 cm) was significantly smaller than that in the group without SBA (0.9 cm; IQR, 0.8–1.2 cm) ( P <   0.001) and in the control group (1.2 cm; IQR, 0.8–1.35 cm) ( P <  0.001). Optimum cut-off value for diagnosing SBA was 0.65 cm (sensitivity, 90.3%; specificity, 86.7%; accuracy, 89.1%) for the colonic diameter. Combining microcolon and gas-negativity showed the best performance in SBA diagnosis using US, with increased accuracy (91.3%). Conclusion A colon < 0.65 cm in diameter should be called a microcolon; combining US with gas-negativity is an essential diagnostic basis for SBA.

The diagnostic value of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules is still controversial, so we used meta-analysis to seek controversial answers. The PubMed, OVID, and CNKI databases were searched according to the inclusion and exclusion criteria. The literature was selected from the establishment of each database to February 2024. The QUADAS-2 tool assessed diagnostic test accuracy. SROC curves and Spearman's correlation coefficient were made by Review Manager 5.4 software to assess the presence of threshold effects in the literature. Meta-Disc1.4 software was used for Cochrane-Q and χ 2 tests, which be used to evaluate heterogeneity, with P -values and I 2 indicating heterogeneity levels. The appropriate effect model was selected based on the results of the heterogeneity test. Stata18.0 software was used to evaluate publication bias. The diagnostic accuracy of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules was evaluated by calculating the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, DOR, and area under the SROC curve. A total of 31 studies included 3811 patients with 4718 nodules were analyzed. There is no heterogeneity caused by the threshold effect, but there is significant non-threshold heterogeneity. Combined diagnostic metrics were: sensitivity = 0.93, specificity = 0.91, DOR = 168.41, positive likelihood ratio = 10.60, and negative likelihood ratio = 0.07. The SROC curve area was 0.97. Contrast-enhanced ultrasound and elastography show high diagnostic accuracy for thyroid nodules, offering a solid foundation for early diagnosis and treatment. Trial registration . CRD42024509462.

: Xyloglucan endotransglucosylase/hydrolase (XTH) acts as a key cell wall-modifying enzyme and contributes to plant stress resilience. This study aimed to identify the gene family in cassava and characterize its potential functions in abiotic stress adaptation. : A full set of bioinformatic analyses was performed, including phylogeny, gene structure, conserved motifs, chromosomal localization, synteny, promoter cis-elements and subcellular localization. Expression patterns were examined by quantitative real-time PCR (qRT-PCR). : Forty-two genes were identified and distributed on 14 chromosomes, encoding proteins with conserved Glyco_hydro_16 (Glycoside hydrolase family 16) and XET_C (Xyloglucan endotransglycosylase C-terminal domain) domains. Genes were clustered into four subfamilies with similar structures. Synteny was closer between cassava and dicots than monocots. Twenty-four stress-, hormone- and light-related cis-elements were detected. Ten genes showed obvious differential expression under stress, and most proteins were located in the cell wall. : The gene family is structurally conserved and can serve as a readout of abiotic stress in cassava. These results provide a theoretical basis for molecular breeding aimed at enhancing stress resistance in cassava.

This paper presents a comprehensive review of energy management control strategies utilized in hybrid electric vehicles (HEVs). These can be categorized as rule-based strategies and optimization-based strategies. Rule-based strategies, as the most basic strategy, are widely used due to their simplicity and practical application. The focus of rule-based strategies is to determine and optimize the optimal threshold for mode switching; however, they fall into a local optimal solutions. To have better performance in energy management, optimization-based strategies were developed. The categories of the existing optimization-based strategies are identified from the latest literature, and a brief study of each strategy is discussed, which consists of the main research ideas, the research focus, advantages, disadvantages and improvements to ameliorate optimality and real-time performance. Deterministic dynamic programming strategy is regarded as a benchmark. Based on neural network and the large data processing technology, data-driven strategies are put forward due to their approximate optimality and high computational efficiency. Finally, the comprehensive performance of each control strategy is analyzed with respect to five aspects. This paper not only provides a comprehensive analysis of energy management control strategies for HEVs, but also presents the emphasis in the future.

Pulmonary arterial hypertension (PAH) is a destructive and rare disorder characterized by a progressive increase in pulmonary artery pressure and vasoconstriction, ultimately leading to right ventricular failure and death. 18β-Glycyrrhetinic acid (18β-GA) is an active ingredient in the commonly used Chinese herbal medicine radix glycyrrhizae, and it possesses antioxidant, anti-inflammatory, anti-tumor, and other pharmacological properties. This study aimed to determine whether 18β-GA has protective effects against monocrotaline (MCT)-induced PAH and whether it is associated with oxidative stress. The PAH of rats was induced by MCT (60 mg/kg) and oral administration of 18β-GA (100, 50, or 25 mg/kg/day), sildenafil (30 mg/kg), or saline for 21 consecutive days. The development of PAH was evaluated by hemodynamic parameters and right ventricular hypertrophy index. Hematoxylin and eosin staining, Masson trichrome staining, and electron microscopy were used to determine the degree of vascular remodeling and proliferation in lung tissue. Moreover, the antioxidant capacity and malondialdehyde levels in the lungs were measured according to the instructions provided by the test kits, and the expression levels of nicotinamide adenine dinucleotide phosphate oxidase-2 (Nox2) and Nox4 were detected through Western blot analysis. Results of our study indicated that 18β-GA treatment significantly improved the hemodynamic and pathomorphological data of the rats, reduced the changes in oxidative stress biomarkers, and inhibited Nox2 and Nox4 expression. Our research indicated that 18β-GA has a protective effect against MCT-induced PAH by inhibiting oxidative stress in rats.