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This study aimed to determine the 50% effective dose (ED50) of ciprofol when combined with different doses of remifentanil for upper gastrointestinal endoscopy of school-age children and to evaluate its safety. This study involved school-aged children who were scheduled to undergo upper gastrointestinal endoscopy under deep sedation. The children were randomly assigned to two groups: remifentanil 0.3 μg/kg (R0.3) and remifentanil 0.5 μg/kg (R0.5). Anesthesia was induced with remifentanil, followed by ciprofol. The dose of ciprofol for each patient was determined using the Dixon up-down sequential method. If the MOAA/S score was ≤1 and the child did not exhibit significant movement or coughing during the endoscopy process, sedation was considered successful. The first patient in each group received 0.5 mg/kg ciprofol. The dose of ciprofol was adjusted by 0.05 mg/kg based on the response of the previous patient. The primary outcome was the ED50 of the ciprofol-induction dose. The total ciprofol doses, onset times, awakening times, and adverse reactions were recorded. 1) The Dixon method was used to collect crossovers data from each group, and the ED50 values of the R0.3 and R0.5 groups were calculated to be 0.390 mg/kg (95% CI 0.356-0.424 mg/kg) and 0.332 mg/kg (95% CI 0.291-0.374 mg/kg), respectively. The ED50 of ciprofol in the R0.3 group was significantly higher than that in the R0.5 group ( < 0.05). 2) The onset time and recovery time of the R0.5 group were shorter than those of the R0.3 group ( < 0.05). When the two groups were compared, the total dose of ciprofol in the R0.5 group decreased ( < 0.05). 3) Compared with the R0.3 group, the incidence of respiratory depression during induction in the R0.5 group increased ( < 0.05). This study explored the ED50 of ciprofol combined with different doses of remifentanil for successful sedation in upper gastrointestinal examinations in school-aged children. Compared to the use of remifentanil 0.3 μg/kg, the combination of ciprofol with remifentanil 0.5 μg/kg significantly reduced the ED50 required to prevent body movement or cough during endoscope insertion but increased the incidence of respiratory depression.

Background The association of longitudinal uric acid (UA) changes with cardiac conduction block risk is unclear. We aimed to identify the trajectories of UA and explore its association with cardiac conduction block. Methods A total of 67,095 participants with a mean age of 53.12 years were included from the Kailuan cohort in Tangshan, China, who were free of cardiac conduction block and with repeated measurements of UA from 2006 to 2012. UA trajectories during 2006 to 2012 were identified by group-based trajectory modeling. Cox proportional hazard regression models were used to assess the association of UA trajectories with cardiac conduction block. Results We categorized three observed discrete trajectories of UA during 2006–2012 period: low-stable, moderate-stable, and high-stable. Over a median follow-up of 6.19 years, we identified 1405 (2.09%) incident cardiac conduction block. Compared to those in the low-stable trajectory, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) of cardiac conduction block in the moderate-stable and high-stable trajectory were 1.30 (1.16–1.47) and 1.86 (1.56–2.22), and HRs of atrioventricular block were 1.39 (1.12–1.72) and 2.90 (2.19–3.83), and HRs of bundle branch blocks were 1.27 (1.10–1.47) and 1.43 (1.13–1.79). Notably, although the average UA level in the moderate-stable UA trajectory group is within the normal range, the risk of cardiac conduction block has increased. Conclusions The moderate-stable and high-stable trajectories are associated with increased risk for new-onset cardiac conduction block. Monitoring UA trajectories may assist in identifying subpopulations at higher risk for cardiac conduction block.

Background Hyperbilirubinemia (HB) is a serious complication in aortic arch surgery, which is associated with acute kidney injury (AKI). The association between HB and chronic kidney disease (CKD) is unknown. The aim of this study was to investigate the impact of HB associated AKI on CKD after aortic arch surgery. Methods We reviewed 284 patients who underwent aortic arch surgery from 2016 to 2020 in our hospital. AKI was defined as a 50% increase in sCr from baseline value within the first 7 postoperative days. HB was defined as total bilirubin > 51.3 μmol/L. Patients were divided into 3 groups based on AKI and HB: HB associated AKI (HB-AKI) group (AKI patients suffered HB within the first 7 postoperative days); AKI without HB group and Non-AKI group. Results Follow-up for 204 patients ranged from 3 to 12 months. Kaplan–Meier analysis showed that the 1-year cumulative incidence of CKD was highest in HB-AKI (32.6%) than AKI without HB (17.8%) and Non-AKI (7.4%, log-rank test, p < 0.001), and the incidence of CKD was higher in HB group than that in Non-HB group (26.7% vs. 13.9%, log-rank test, p = 0.015). Preoperative sCr (HR 1.010, 95% CI 1.004–1.016, p = 0.001), AKI without HB (HR 2.887, 95% CI 1.133–7.354, p = 0.026) and HB-AKI (HR 4.490, 95% CI 1.59–12.933, p = 0.005) were associated with CKD during 1-year follow-up. Conclusions Patients suffering HB associated AKI were at more increased odds of CKD than patients suffering AKI without HB after aortic arch surgery.

Active learning (AL) is a powerful method for accelerating novel materials discovery but faces huge challenges for extracting physical meaning. Herein, we novelly apply an interpretable AL strategy to efficiently optimize the photothermal conversion efficiency (PCE) of carbon dots (CDs) in photothermal therapy (PTT). An equivalent value (SHapley Additive exPlanations equivalent value [SHAP‐EV]) is proposed which explicitly quantifies the linear contributions of experimental variables to the PCE, derived from the joint SHAP values. The SHAP‐EV, with an R2 of 0.960 correlated to feature's joint SHAP, is integrated into the AL utility functions to enhance evaluation efficiency during optimization. Using this approach, we successfully synthesized iron‐doped CDs (Fe‐CDs) with PCE exceeding 78.7% after only 16 experimental trials over four iterations. This achievement significantly advances the previously low PCE values typically reported for CDs. Furthermore, Fe‐CDs demonstrated multienzyme‐like activities, which could respond to the tumor microenvironment (TME). In vitro and in vivo experiments demonstrate that Fe‐CDs could enhance ferroptosis through synergistic PTT and chemodynamic therapy (CDT), thereby achieving remarkable antitumor efficacy. Our interpretable AL strategy offers new insights for accelerating bio‐functional materials development in antitumor treatments. On the basis of active learning strategy, we propose an equivalent value—SHapley Additive exPlanations equivalent value—to optimize carbon dots’ photothermal conversion efficiency. Within four iterations, iron‐doped carbon dots are synthesized with the efficiency exceeding 78.7%. Furthermore, the final functional nanomaterial demonstrates multienzyme‐like activities and enhances ferroptosis through synergistic photothermal therapy and chemodynamic therapy, achieving remarkable antitumor efficacy.

ObjectiveTo explore whether cumulative serum urate (cumSU) is correlated with diabetes type II mellitus incidence.MethodsIn this study, we recruited individuals participating in all Kailuan health examinations from 2006 to 2013 without stroke, cancer, gestation, myocardial infarction, and diabetes type II diagnosis in the first three examinations. CumSU was calculated by multiplying the average serum urate concentration and the time between the two examinations (umol/L × year). CumSU levels were categorized into five groups: Q1–Q5. The effect of cumSU on diabetes type II incidence was estimated by logistic regression.ResultsA total of 36,277 individuals (27,077 men and 9200 women) participated in the final analysis. The multivariate logistic regression model showed the odds ratios (95% confidence intervals) of diabetes type II from Q1 to Q5 were 1.00 (reference), 1.25 (1.00 to 1.56), 1.43 (1.15 to 1.79), 1.49 (1.18 to 1.87), and 1.80 (1.40 to 2.32), respectively. Multivariable odds ratios per 1-standard deviation increase in cumSU were 1.26 (1.17 to 1.37) in all populations, 1.20 (1.10 to 1.32) for men, and 1.52 (1.27 to 1.81) for women, respectively.ConclusionsCumSU is a significant risk factor for diabetes type II. Individuals with higher cumSU, especially women, are at a higher risk of diabetes type II independent of other known risk factors.Key Points• Cumulative exposure to serum urate is a significant risk factor for diabetes type II.• Individuals with higher cumSU, especially women, are at a higher risk of diabetes type II.

PB is a rare condition characterized by casts formation in tracheobronchial tree that result from inspissated, thick, and tenacious secretions [1]. [See PDF for image] Fig. 1 (a) The preoperative chest radiograph showing an opacity in the left lung; (b) Mucus plug forming a branching bronchial cast removed from the patient; (c) The chest radiograph on day 2 post-bronchoscopy showed a significant improvement of atelectasis in the left lung. LIAn Left anteromedial basal segment, LILa Left lateral basal segment, LIPo Left posterior basal segment, LISu Left inferior superior segment Acknowledgements The work was supported by the Qingdao Key Health Discipline Development Fund (QDZDZK2022094) and Qingdao Outstanding Health Professional Development Fund (2022).

The technological process of the clamp part is analyzed, the design of the stamping and bending process for the clamp is introduced, including determination of the operation sequence and operation position parts dimensions. The process is used side blade settles to distance, pilot pin was used in exact positioning, the blanking and bending of the part were carried out continuously. The design of the general structure, layout of the progressive and forming characteristics die for the clamp is introduced in detail, the method for designing and calculating the key parts.

Reportedly, TWIK-related spinal cord K + (TRESK) deficiency in spinal cord neurons positively correlates with the mechanism underlying neuropathic pain (NP). However, the precise effects of TRESK on neurons of the spinal cord remain elusive. In the present study, we investigated the impact of TRESK silencing on spinal cord neurons to further elucidate the downstream mechanisms of TRESK. Herein, neurons of the dorsal spinal cord were cultured as a cell model for investigations. Apoptosis, oxidative stress, and DNA damage-related proteins were evaluated. Additionally, flow cytometry, microarray profiling, real-time polymerase chain reaction (PCR), western blotting, fluorescence in situ hybridization (FISH), immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) were performed. In cultured neurons, the downregulation of TRESK mRNA expression induced apoptosis of dorsal spinal cord neurons. Using real-time PCR and western blotting, the upregulation of LncRNA Gm11874 (Gm11874) and ATP5i, screened from the gene chip, was confirmed. On silencing TRESK, expression levels of γ-H2AX, poly [ADP-ribose] polymerase 1 (PARP-1), FoxO1, FoxO3, MitoSOX, malondialdehyde (MDA), and 8-hydroxy-2′ -deoxyguanosine (8-OHdG), which are known indices of oxidative stress and DNA damage, were significantly elevated. Moreover, ATP induced oxidative stress, DNA damage, and apoptosis were reduced by ATP5i siRNA. Finally, Gm11874 and ATP5i were co-expressed in spinal cord neurons in a FISH experiment, and the expression of ATP5i was positively regulated by Gm11874. These results implied that ATP5i induced oxidative stress and DNA damage, resulting in neuronal apoptosis, and Gm11874 was confirmed to act upstream of ATP5i. Our study revealed that TRESK silencing upregulated Gm11874 to induce apoptosis of spinal cord neurons, which resulted in ATP5i promoting oxidative stress and DNA damage. These findings could highlight the TRESK-mediated NP mechanism.

Objectives To develop an artificial intelligence (AI) system for predicting cervical lymph node metastasis (CLNM) preoperatively in patients with papillary thyroid cancer (PTC) based on CT images. Methods This multicenter retrospective study included the preoperative CT of PTC patients who were divided into the development, internal, and external test sets. The region of interest of the primary tumor was outlined manually on the CT images by a radiologist who has eight years of experience. With the use of the CT images and lesions masks, the deep learning (DL) signature was developed by the DenseNet combined with convolutional block attention module. One-way analysis of variance and least absolute shrinkage and selection operator were used to select features, and a support vector machine was used to construct the radiomics signature. Random forest was used to combine the DL, radiomics, and clinical signature to perform the final prediction. The receiver operating characteristic curve, sensitivity, specificity, and accuracy were used by two radiologists (R1 and R2) to evaluate and compare the AI system. Results For the internal and external test set, the AI system achieved excellent performance with AUCs of 0.84 and 0.81, higher than the DL ( p  = .03, .82), radiomics ( p  < .001, .04), and clinical model ( p  < .001, .006). With the aid of the AI system, the specificities of radiologists were improved by 9% and 15% for R1 and 13% and 9% for R2, respectively. Conclusions The AI system can help predict CLNM in patients with PTC, and the radiologists’ performance improved with AI assistance. Clinical relevance statement This study developed an AI system for preoperative prediction of CLNM in PTC patients based on CT images, and the radiologists’ performance improved with AI assistance, which could improve the effectiveness of individual clinical decision-making. Key Points • This multicenter retrospective study showed that the preoperative CT image-based AI system has the potential for predicting the CLNM of PTC. • The AI system was superior to the radiomics and clinical model in predicting the CLNM of PTC. • The radiologists’ diagnostic performance improved when they received the AI system assistance.

The Songnen Plain is a key region for Quaternary stratigraphic research in Northeast China. In this area, the Quaternary strata of the Bayan borehole reached a thickness of 58.00 m, offering excellent potential for investigation and research. A comprehensive analysis of the borehole was conducted using lithological characteristics, optically stimulated luminescence (OSL), electron spin resonance (ESR), magnetic susceptibility, grain-size distribution, and magnetostratigraphy. Based on these results, a polarity stratigraphic framework was established, subdividing the sequence into four units: the Holocene Series (0–1.50 m), Guxiangtun Formation (1.50–18.80 m), Harbin Formation (18.80–35.50 m), and Huangshan Formation (35.50–58.00 m). Chronostratigraphic and paleoenvironmental interpretations were derived to establish a Quaternary stratigraphic framework for the eastern Songnen Plain. Grain-size end-member analysis was applied to the Bayan borehole using the Analysize method to extract three effective grain-size components. EM 1 (6.72 μm) corresponded to the atmospheric background dust; EM 2 (21.20 μm) reflected the input from distal dust sources associated with southwesterly wind signals; and EM 3 (45.60 μm) indicated the proximal deposition influenced by winter monsoon intensity. Comparative analysis of magnetic susceptibility (MS), mean grain size ( M z ), grain-size end-members (EM), and marine isotope stages revealed strong correlations, identifying multiple climate response events. In the eastern Songnen Plain, the Middle Pleistocene was marked by a transition from dry-cold to cool-moist conditions, with a boundary at approximately 250 ka. During the Late Pleistocene, the region experienced alternating phases of dry-cold and cool-semi-humid conditions. The Holocene was characterized by a warm and semi-humid climate. These findings provide a robust data foundation for refining the Quaternary stratigraphy of the Songnen Plain and offer critical insights into its formation history, stratigraphic evolution, and paleoclimatic development.