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To investigate the risk factors for metabolic bone disease of prematurity (MBDP), and to provide a reference for the prevention of MBDP. The databases including China Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Data, and Weipu Periodical Database, PubMed, Web of Science, Embase, Cochrane Library and other databases were searched for studies on the risk factors for MBDP published up to June 18, 2021. RevMan 5.3 and Stata 14.1 software were used to perform a Meta analysis. A total of 15 articles were included, including 13 case-control studies, 1 current investigation, and 1 retrospective cohort study. There were 1,435 cases in the case group and 2,057 cases in the control group, with a total sample size of 3,492 cases. Meta analysis showed that risk factors for MBDP include birth weight <1000g (OR = 6.62, 95%CI: 2.28-19.25), gestational age <32 weeks (OR = 2.73, 95%CI: 1.07-6.95), septicemia (OR = 2.53, 95%CI: 1.69-3.79), parenteral nutrition time (OR = 4.04, 95%CI: 1.72-9.49), cholestasis (OR = 3.50, 95%CI: 1.49-8.23), intrauterine growth retardation (OR = 6.89, 95%CI: 3.81-12.44), while the birth weight(OR = 0.44, 95%CI: 0.21-0.90) and gestational age (OR = 0.57, 95%CI: 0.44-0.73)are the protective factors of MBDP. Factors like birth weight <1000g, gestational age <32 weeks, septicemia, parenteral nutrition time, cholestasis, and intrauterine growth retardation may increase the risk of metabolic bone disease of prematurity.

The relationship between High-mobility group box 1 (HMGB1) and febrile seizures (FS) in children remains unclear. This study aimed to apply meta-analysis to reveal the correlation between HMGB1 levels and FS in children. Databases including PubMed, EMBASE, Web of science, Cochrane library, CNKI, SinoMed and WanFangData were searched for relevant studies. Pooled standard mean deviation and 95% confidence interval were calculated as effect size since the random-effects model was used when I 2  > 50%. Meanwhile, between-study heterogeneity was determined by performing subgroup and sensitivity analyses. A total of 9 studies were finally included. Meta-analysis showed that the children with FS had significantly higher HMGB1 levels compared with healthy children and children with fever but no seizures (P<0.05). Additionally, subgroup analysis showed that the HMGB1 level in children with complex FS was higher than those with simple FS (P<0.05), and children with duration >15 min were higher than those with duration ≤15min (P<0.05). There were no statistical differences between children with or without a family history of FS (P>0.05). Finally, children with FS who converted to epilepsy exhibited higher HMGB1 levels than those who did not convert to epilepsy (P<0.05). The level of HMGB1 may be implicated in the prolongation, recurrence and development of FS in children. Thus, it was necessary to evaluate the precise concentrations of HMGB1 in FS patients and to further determine the various activities of HMGB1 during FS by well-designed, large-scale, and case-controlled trials.

Background: The mechanisms underlying ferroptosis in neonatal hypoxic-ischemic brain damage (HIBD) remain unclear. Method: Four microarray datasets were collected from the GEO database (three mRNA datasets GSE23317, GSE144456, and GSE112137, and one miRNA microarray dataset GSE184939). Weighted gene co-expression network analysis (WGCNA) was used to identify modules of HIBD-related genes. The ferroptosis-related genes were extracted from FerrDb, of which closely correlated to HIBD were obtained after the intersection with existing HIBD’s DEGs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, as well as protein–protein interaction (PPI) network analysis were subsequently conducted. Cytoscape was used to identify central genes. Immune cell infiltration analysis was performed by the CIBERSORT algorithm. Result: Fifty-six ferroptosis-related differentially expressed genes (FRDEGs) were screened, mainly related to ferroptosis, autophagy, hypoxia response, metabolic pathways, and immune inflammation. The seven optimal hub FRDEGs were obtained by intersecting with key modules of WGCNA. Then, the expression levels of the seven optimal hub FRDEGs were validated in the GSE144456 and GSE112137 datasets, and the ferroptosis-related mRNA-miRNA network was established. In addition, this study revealed immune cell infiltration in the HIBD cerebral cortex and the interaction between immune cells. Moreover, notably, specific FRDEGs were strongly positively correlated with immune function. Conclusions: The mechanism of ferroptosis is intricate and closely related to neonatal HIBD. Therefore, targeting ferroptosis-related gene therapy and immunotherapy may have therapeutic prospects for neonatal HIBD.

To solve the problem of soil degradation in coastal saline–alkali land, three different types of biochar (rice straw biochar, magnetic biochar, and humic acid–magnetic biochar) were prepared to remedy the saline–alkali soil under different mixing ratios. The effects of biochar on the growth of crops in saline–alkali soil were explored through a pot experiment on Chinese cabbage. The experimental results showed that the soil leaching treatment combined with humic acid–magnetic biochar could effectively repair the coastal saline–alkali soil. After adding 5% humic acid–magnetic biochar, the content of soil organic matter was 33.95 g/kg, the water content was 13.85%, and the contents of available phosphorus and available potassium were 9.43 mg/kg and 29.51 mg/kg. After adding 5% humic acid–magnetic biochar, the plant height of Chinese cabbage was 9.16 ± 0.19 cm, and the plant germination rate reached 83.33 ± 5.54%. The incorporation of biochar could effectively increase the chlorophyll content and soluble protein content of pakchoi and reduce the soluble sugar content of pakchoi. The study analyzed the effect of different modified biochar on saline–alkali land restoration and crop growth and explored the action rule of hydrochloric acid magnetic biochar on saline–alkali land restoration, which has important practical value for improving coastal saline–alkali land.

Hearing loss is a common disability in infants that significantly impacts their cognitive, language, and literacy development. This study aimed to systematically assess the risk factors for the early identification and intervention in infant hearing loss. Databases were searched for meta-analyses of observational studies until November 2023. The quality assessment was performed using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence. A meta-analysis identified 14 risk factors significantly associated with infant hearing loss. According to the GRADE approach, there were four factors with moderate-certainty evidence (low birth weight(LBW), congenital anomalies, craniofacial anomalies, intracranial hemorrhages), seven factors with low-certainty evidence (ototoxic medications, family history of hearing loss, mechanical ventilation > 5 days, intrauterine infection, admission to neonatal intensive care unit (NICU) > 5 days, mechanical ventilation and asphyxia) and six with extremely-low-certainty evidence (very low birth weight < 1500 g (VLBW), hyperbilirubinemia, sepsis or meningitis, male sex, premature birth, small for gestational age (SGA)). Nevertheless, no significant association was found between infant hearing loss and factors such as small for gestational age (SGA), male sex, and premature birth ( P > 0.05).   Conclusion : The identification of these 14 interrelated risk factors can prove advantageous in clinical practice, as these findings could guide hearing screening and parental counseling. Furthermore, prospective research could be conducted to develop risk-based scoring systems based on these factors. What is Known: • Infant hearing loss is a worldwide issue. • Risk factors for this condition are debated. What is New: • This is the first meta-analysis to comprehensively evaluate perinatal and postnatal risk factors for hearing loss in infants. • Intracranial hemorrhage, mechanical ventilation, and low birth weight are associated with infant hearing loss. However, no evidence of an association was found between premature birth, being small for gestational age, or male sex and hearing loss.

Objectives: The rapid ultrasound in shock examination (RUSH process) is an assessment of patient’s heart function, volume status, and vasculature, which can help anesthesiologist understand the patient’s physical condition. In this study, the RUSH process was applied to elderly emergency surgery patients to evaluate whether it is beneficial to maintain the patient’s vital signs stable during the operation. Methods: In this randomized controlled clinical study one hundred elderly patients who needed general anesthesia and emergency surgery from January 2021 to July 2021 were randomly divided into RUSH group (Group-A, n=52) and control group (Group-B, n=48). The main result include the area under the intraoperative blood pressure curve (AUC), liquid input, urine output, lactic acid levels, number of vasoactive drugs used. Results: There were no significant differences in patients’ basic information, preoperative blood pressure, intraoperative blood loss, intraoperative fluid input, intraoperative blood transfusion, and urine output. Intraoperative systolic blood pressure less than 90mmHg AUC of Group-A is less than Group-B(P<0.05), diastolic blood pressure less than 60mmHg AUC of Group-A is less than Group-B(P<0.05). After the operation, the blood gas analysis lactic acid level in Group-A was lower than that in Group-B(P<0.05). Group-A used more vasoactive drugs than Group-B(P<0.05). Conclusion: The bedside ultrasound RUSH process is of great significance for anesthesiologist to understand the preoperative physical condition of elderly emergency surgery patients, and is beneficial to maintain the stability of intraoperative vital signs. doi: https://doi.org/10.12669/pjms.38.6.5104 How to cite this:Liu D, Chen K, Yao Y, Sun J. A randomized controlled trial of bedside ultrasound RUSH process to improve the quality of anesthesia for elderly emergency surgery patients. Pak J Med Sci. 2022;38(6):---. doi: https://doi.org/10.12669/pjms.38.6.5104 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

To study the chemical evolution during the formation of molecular clouds, we model three types of clouds with different density structures: collapsing spherical, collapsing ellipsoidal, and static spherical profiles. The collapsing models are better than the static models in matching the observational characteristics in typical molecular clouds. This is mainly because the gravity can speed up the formation of some important molecules (e.g., H\\(_2\\), CO, OH) by increasing the number density during collapse. The different morphologies of prolate, oblate, and spherical clouds lead to differences in chemical evolution, which are mainly due to their different evolution of number density. We also study the effect of initial chemical compositions on chemical evolution, and find that H atoms can accelerate OH formation by two major reactions: O + H \\(\\rightarrow\\) OH in gas phase and on dust grain surfaces, leading to the models in which hydrogen is mainly atomic initially better match observations than the models in which hydrogen is mainly molecular initially. Namely, to match observations, initially hydrogen must be mostly atomic. The CO molecules are able to form even without the pre-existence of H\\(_2\\). We also study the influence of gas temperature, dust temperature, intensity of interstellar radiation field and cosmic-ray ionization rate on chemical evolution in static clouds. The static CO clouds with high dust temperature, strong radiation field, and intensive cosmic rays are transient due to rapid CO destruction.

In natural language processing tasks, pure reinforcement learning (RL) fine-tuning methods often suffer from inefficient exploration and slow convergence; while supervised fine-tuning (SFT) methods, although efficient in training, have limited performance ceiling and less solid theoretical foundation compared to RL. To address efficiency-capability trade-off, we propose the Guess-Think-Answer (GTA) framework that combines the efficiency of SFT with the capability gains of RL in a unified training paradigm. GTA works by having the model first produce a provisional guess (optimized via cross-entropy loss), then reflect on this guess before generating the final answer, with RL rewards shaping both the final output and the format of the entire GTA structure. This hybrid approach achieves both faster convergence than pure RL and higher performance ceiling than pure SFT. To mitigate gradient conflicts between the two training signals, we employ loss masking and gradient constraints. Empirical results on four text classification benchmarks demonstrate that GTA substantially accelerates convergence while outperforming both standalone SFT and RL baselines.

Catalysts for the oxygen reduction reaction （ORR） play an important role in fuel cells. Alternative non-precious metal catalysts with comparable ORR activity to Pt-based catalysts are highly desirable for the development of fuel cells. In this work, we report for the first time a spinel MnC0204/C ORR catalyst consisting of uniform MnC0204 nanoparticles cross-linked with two-dimensional （2D） porous carbon nanosheets （abbreviated as porous MnC0204/C nanosheets）, in which glucose is used as the carbon source and NaC1 as the template. The obtained porous MnCo204/C nanosheets present the combined properties of an interconnected porous architecture and a large surface area （175.3 m2-g-1）, as well as good electrical conductivity （1.15 x 102 S.cm-1）. Thus, the as-prepared MnC0204/C nanosheets efficiently facilitate electrolyte diffusion and offer an expedite transport path for reactants and electrons during the ORR. As a result, the as-prepared porous MnC0204/C nanosheet catalyst exhibits enhanced ORR activity with a higher onset potential and current density than those of its counterparts, including pure MnC0204, carbon nanosheets, and Vulcan XC-72R carbon. More importantly, the porous MnC0204/C nanosheets exhibit a com- parable electrocatalytic activity but superior stability and tolerance toward methanol crossover effects than a high-performance Pt/C catalyst in alkaline medium. The synthetic strategy outlined here can be extended to other non- precious metal catalysts for application in electrochemical energy conversion.