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ObjectivesThis study aimed to investigate the relationship between knowledge, attitude and practice (KAP) regarding arteriovenous fistula (AVF) care in uremic patients undergoing haemodialysis (HD).DesignA web-based cross-sectional study was conducted among uremic patients receiving HD at the First Affiliated Hospital of Chongqing Medical University between April 2023 and June 2023.SettingThe study took place at the First Affiliated Hospital of Chongqing Medical University.ParticipantsA total of 522 valid questionnaires were collected from patients undergoing HD, representing 85.57% of the 610 patients eligible for the study.InterventionsPathway analysis was used to assess the interplay among KAP scores related to AVF care in the participants.Primary and secondary outcome measuresThe study evaluated KAP scores (ranging 0–20, 8–40 and 6–30, respectively) to gauge patients’ KAP regarding AVF care.ResultsThe findings indicated that patients exhibited adequate knowledge, positive attitudes and proactive practices towards AVF care. Patients’ knowledge directly influenced their attitudes and practices, with attitudes also positively impacting practices. Additionally, knowledge indirectly affected practices through attitudes.ConclusionsUremic patients undergoing HD demonstrated satisfactory understanding, favourable attitudes and proactive behaviours concerning AVF care. The pathway analysis provided insights into the relationships between KAP, illustrating the direct and indirect effects of these factors on each other in the context of AVF care among patients.

Objective We performed a meta-analysis to create a quantitative estimate of the association between non-alcoholic fatty liver disease (NAFLD) and the risk of cardiac arrhythmia (including atrial fibrillation (AF), prolonged QT interval, premature atrial/ventricular contraction [PAC/PVC] and heart block). Methods A literature review was conducted using PubMed, Embase, Web of Science and the Cochrane Library database to identify observational studies of the link between NAFLD and cardiac arrhythmia. Effect sizes were expressed as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs). The method of analysis of AF was also analysed separately, according to the effect estimate (OR or HR). Results Nineteen studies of 7,012,960 individuals were included. NAFLD was independently associated with higher risks of AF (OR 1.71, 95% CI: 1.14–2.57; HR 1.12, 95% CI: 1.11–1.13), prolonged QT interval (OR 2.86, 95% CI: 1.64–4.99), PAC/PVC (OR 2.53, 95% CI: 1.70–3.78) and heart block (OR 2.65, 95% CI: 1.88–3.72). The heterogeneity of the data with respect to AF and prolonged QT was moderate on sensitivity analysis. Conclusions We found a significantly higher risk of cardiac arrhythmia in patients with NAFLD, but the observational design of the studies does not permit conclusions regarding causality.

Background With the demand for more effective and engaging teaching strategies in higher education, there is an imperative to blend traditional and innovative methods to optimize student learning outcomes. To address this educational need, this study sets out to design and evaluate a hybrid learning approach that integrates a flipped classroom based on working process systematization (termed “W + flipped classroom”) teaching design with blended online and offline methods based on the BOPPPS (bridge-in, objective/outcome, preassessment, participatory learning, post assessment, summary, termed “B + BOPPPS”) teaching model and explore its application effects in the field of biological separation engineering. Methods The undergraduate class of 2020 majoring in biomedical engineering from Huanghuai University was designated the control group ( n  = 74), while the undergraduate class of 2021 was chosen as the experimental group ( n  = 79). The control group received traditional teaching methods. The experimental group adopted the integrated “W + flipped classroom” and B + BOPPPS teaching models. After the conclusion of the teaching period, comparisons were made between the two groups in terms of course objective achievement, academic performance, and critical thinking skills. A survey was distributed to assess learning effectiveness. Semistructured interviews were conducted with teachers and students from the experimental group to evaluate teaching effectiveness. Results The integrated “W + flipped classroom” and B + BOPPPS teaching models significantly improved the academic performance and critical thinking skills of the experimental group. The teaching evaluation revealed high levels of acceptance among both teachers and students, along with improved satisfaction with the teaching methodology. Conclusion The integration of the “W + flipped classroom” teaching design with the “B + BOPPPS” teaching model provides a scientific foundation for future teaching reforms. This study serves as a valuable reference for implementing the OBE philosophy, enhancing learning outcomes, achieving engineering education accreditation, and cultivating high-quality applied talents in the field of bioengineering at applied universities.

Objective To explore the influencing factors of posterior capsular opacification (Posterior Capsular Opacification, PCO) after intraocular lens implantation treated with Nd: YAG(Neodymium: Yttrium-Aluminum-Garnet) laser and to establish a predictive model to evaluate its risk. Methods From January 2018 to June 2023, the data of 312 patients with posterior capsule opacification and Nd: YAG laser treatment in our hospital were retrospectively analyzed. All patients were randomly divided into training group (218 cases) and verification group (94 cases) at the ratio of 7:3. In the training set, the independent risk factors of posterior capsule opacification before operation were identified by multivariate Logistic regression analysis, and the nomogram prediction model was constructed. By drawing ROC (receiver operating characteristic) curve and calibration curve, the prediction effectiveness of the model is evaluated, and the verification is carried out in the verification set, and its clinical application value is explored by Decision Curve Analysis (DCA). Results Among 312 patients, 84 (22.92%) developed PCO. The logistic results showed that age ≥ 60 years, extracapsular excision surgery, multifocal intraocular lens, axial length ≥ 24 mm, preoperative visual acuity < 0.3, high laser energy, and large posterior capsule incision aperture were associated with the occurrence of PCO ( P  < 0.05). The C-index indexes of the nomograph model were 0.870 and 0.842 in the training set and verification set, respectively, and the average was absolute. In the Hosmer-Lemeshow test, the χ 2 values of the training set and the verification set are 4.007( P  = 0.856) and 2.841( P  = 0.943), respectively. The ROC curve shows that the AUC(Area Under Curve) values of the training set and the verification set are 0.870 (95% CI: 0.810–0.929) and 0.843 (95% CI: 0.732–0.954) respectively, and the combination of sensitivity and specificity is 0.792, 0.810, 0.765 and 0.792 respectively. Conclusion The nomogram prediction model based on Nd: YAG laser treatment of PCO risk factors after intraocular lens implantation has high accuracy and calibration, which can provide a key reference for formulating preventive measures, help to reduce the incidence of PCO and improve the prognosis of patients.

Extreme learning machine (ELM) is a training algorithm for single hidden layer feedforward neural network (SLFN), which converges much faster than traditional methods and yields promising performance. However, the ELM also has some shortcomings, such as structure selection, overfitting and low generalization performance. This article a new functional neuron (FN) model is proposed, we takes functional neurons as the basic unit, and uses functional equation solving theory to guide the modeling process of FELM, a new functional extreme learning machine (FELM) model theory is proposed. The FELM implements learning by adjusting the coefficients of the basis function in neurons. At the same time, a simple, iterative-free and high-precision fast parameter learning algorithm is proposed. The standard data sets UCI and StatLib are selected for regression problems, and compared with the ELM, support vector machine (SVM) and other algorithms, the experimental results show that the FELM achieves better performance.

In order to automatically recover chips during the drilling process of carbon fiber reinforced polymer (CFRP), a new chip removal system of drilling processing, the suction-type internal chip removal system, has been put forward. The developed system can effectively recover chips produced in the drilling processing, which helps realize the green production. For this, at first, a method for solving the negative pressure value of the drilling of the suction-type internal chip removal system is given based on the calculation of suspension velocity of particles in gas-solid two-phase fluid mechanics. Secondly, the influence of inner-chip-removal drilling bit chip removal channel structure on the chip removal system performance is analyzed by FLUENT simulation. Finally, the correctness of the above theoretical analysis and simulation is verified through experiments, and the influence of drill speed and feed ratio on the performance of the system is further analyzed.

Solid cutting tool is more and more widely used, such as aerospace, automobile and 3C. Helical groove is an important feature which influences the performance of solid cutting tool. Furthermore, groove grinding is the longest and largest material removal process in whole grinding of solid tool. Therefore, the most wear of grinding wheel occurs in its grinding. The worn wheel would result in groove grinding error without a proper compensation. The traditional compensation relies on the experience of machine operator, and generally, it is performed on site. In this paper, a compensation algorithm of worn wheel is proposed by analysing the boundary contact condition which is influenced by wheel wear. Furthermore, the algorithm is implemented by using C# and validated by a set of and experiments. The experimental results show that the ground tool flutes under compensation algorithm are controlled within designed tolerances; i.e., core radius errors are 1.7% and 0.7%, rake angle errors are 1.5% and 0.6%, and edge width errors are 4.3% and 5%.

Idiopathic membranous nephropathy (IMN) is an autoimmune disease in which the immune system produces an antibody response to its own antigens due to impaired immune tolerance. Although antibodies are derived from plasma cells differentiated by B cells, the T-B cells also contribute a lot to the immune system. In particular, the subsets of helper T (Th) cells, including the dominant subsets such as Th2, Th17, and follicular helper T (Tfh) cells and the inferior subsets such as regulatory T (Treg) cells, shape the immune imbalance of IMN and promote the incidence and development of autoimmune responses. After reviewing the physiological knowledge of various subpopulations of Th cells and combining the existing studies on Th cells in IMN, the role model of Th cells in IMN was explained in this review. Finally, the existing clinical treatment regimens for IMN were reviewed, and the importance of the therapy for Th cells was highlighted.

Phosphodiesterase-5 (PDE5) inhibitors have been shown to have potential as an adjuvant therapy for cancer. Tadalafil is a potent and selective PDE5 inhibitor that has been shown to inhibit the aggregation of myeloid-derived suppressor cells (MDSC) within tumors. Given the pivotal role of STAT3 signaling in mediating MDSC immunosuppression, we investigated the impact of tadalafil on MDSC differentiation and inhibitory function. Our findings indicate that tadalafil significantly attenuates in situ breast tumor growth and metastasis while impairing the capacity of MDSCs to suppress T-cell proliferation, concomitant with reduced STAT3 phosphorylation. Transcriptomic analysis revealed that tadalafil modulates MDSC metabolism, upregulates NAD + nucleotidase activity, and disrupts chemotaxis-related transcriptional programs, including downregulation of key chemokine receptors. Consistent with these observations, in vitro migration assays confirmed tadalafil-mediated inhibition of MDSC chemotaxis toward tumor cells. Furthermore, tadalafil markedly enhanced nuclear PARP1 expression, which exhibits a negative regulatory relationship with STAT3. Collectively, these data demonstrate that tadalafil exerts systemic and local immunomodulatory effects on MDSCs during tumor infiltration, primarily through PARP1-STAT3 axis regulation. These insights underscore the therapeutic potential of tadalafil in reprogramming MDSC-mediated immunosuppression in cancer. Graphical abstract

Background L-theanine, a non-protein amino acid was found principally in the green tea, has been previously shown to exhibit potent anti-obesity property and hepatoprotective effect. Herein, we investigated the effects of L-theanine on alleviating nonalcoholic hepatic steatosis in vitro and in vivo, and explored the underlying molecular mechanism. Methods In vitro, HepG2 and AML12 cells were treated with 500 μM oleic acid (OA) or treated with OA accompanied by L-theanine. In vivo, C57BL/6J mice were fed with normal control diet (NCD), high‐fat diet (HFD), or HFD along with L-theanine for 16 weeks. The levels of triglycerides (TG), accumulation of lipid droplets and the expression of genes related to hepatocyte lipid metabolic pathways were detected in vitro and in vivo. Results Our data indicated that, in vivo, L-theanine significantly reduced body weight, hepatic steatosis, serum levels of alanine transaminase (ALT), aspartate transaminase (AST), TG and LDL cholesterol (LDL-C) in HFD-induced nonalcoholic fatty liver disease (NAFLD) mice. In vitro, L-theanine also significantly alleviated OA induced hepatocytes steatosis. Mechanic studies showed that L-theanine significantly inhibited the nucleus translocation of sterol regulatory element binding protein 1c (SREBP-1c) through AMPK-mTOR signaling pathway, thereby contributing to the reduction of fatty acid synthesis. We also identified that L-theanine enhanced fatty acid β-oxidation by increasing the expression of peroxisome proliferator–activated receptor α (PPARα) and carnitine palmitoyltransferase-1 A (CPT1A) through AMP-activated protein kinase (AMPK). Furthermore, our study indicated that L-theanine can active AMPK through its upstream kinase Calmodulin-dependent protein kinase kinase-β (CaMKKβ). Conclusions Taken together, our findings suggested that L-theanine alleviates nonalcoholic hepatic steatosis by regulating hepatocyte lipid metabolic pathways via the CaMKKβ-AMPK signaling pathway.