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Tripterygium wilfordii Hook F ( Tw HF) is one of the most commonly used and effective traditional Chinese herbal medicines against rheumatoid arthritis (RA). Both Tripterygium Glycoside Tablets (TGT) and Tripterygium wilfordii Tablets (TWT) are the representative Tw HF-based agents enrolled into the 2019 edition of Medicine Catalog for National Basic Medical Insurance, Injury Insurance, and Maternity Insurance. However, individual differences in TGT/TWT response across patients usually exist in the process of treating RA, implying that the clinical application of the two agents may not be standardized leading to the ineffective treatment and the risk of side effects. Growing evidence show that the bioactive constituents of Tw HF may often have toxicity, the package insert of TGT and TWT may not be described in detail, and the therapeutic windows of the two agents are narrow. Thus, it is an urgent task to develop a standardized clinical practice guideline for TGT and TWT in the treatment of RA. In the current study, a group of clinical experts of traditional Chinese medicine and Western medicine in the research field of rheumatism diseases, pharmacists, and methodologists of evidence-based medicine were invited to select the clinical questions, to determine the levels of the evidence and the strength of the recommendations, and to develop the recommendations and good practice points. The guideline is formed based on the combination of clinical research evidence and expert experience (evidence-based, consensus, supplemented by experience). The clinical problems which are supported by clinical evidence may form recommendations, and the clinical problems without clinical evidence may form experts’ suggestions. Both recommendations and experts' suggestions in this guideline summarized the clinical indications, usage, dosage, combined medication, and safety of TGT and TWT against RA systematically and comprehensively, which may offer a professional guidance in the context of the clinical application of the two Tw HF-based agents.

Natural medicines were the only option for the prevention and treatment of human diseases for thousands of years. Natural products are important sources for drug development. The amounts of bioactive natural products in natural medicines are always fairly low. Today, it is very crucial to develop effective and selective methods for the extraction and isolation of those bioactive natural products. This paper intends to provide a comprehensive view of a variety of methods used in the extraction and isolation of natural products. This paper also presents the advantage, disadvantage and practical examples of conventional and modern techniques involved in natural products research.

A panoptic driving perception system is an essential part of autonomous driving. A high-precision and real-time perception system can assist the vehicle in making reasonable decisions while driving. We present a panoptic driving perception network (you only look once for panoptic (YOLOP)) to perform traffic object detection, drivable area segmentation, and lane detection simultaneously. It is composed of one encoder for feature extraction and three decoders to handle the specific tasks. Our model performs extremely well on the challenging BDD100K dataset, achieving state-of-the-art on all three tasks in terms of accuracy and speed. Besides, we verify the effectiveness of our multi-task learning model for joint training via ablative studies. To our best knowledge, this is the first work that can process these three visual perception tasks simultaneously in real-time on an embedded device Jetson TX2(23 FPS), and maintain excellent accuracy. To facilitate further research, the source codes and pre-trained models are released at https://github.com/hustvl/YOLOP.

The challenges of developing neuromorphic vision systems inspired by the human eye come not only from how to recreate the flexibility, sophistication, and adaptability of animal systems, but also how to do so with computational efficiency and elegance. Similar to biological systems, these neuromorphic circuits integrate functions of image sensing, memory and processing into the device, and process continuous analog brightness signal in real-time. High-integration, flexibility and ultra-sensitivity are essential for practical artificial vision systems that attempt to emulate biological processing. Here, we present a flexible optoelectronic sensor array of 1024 pixels using a combination of carbon nanotubes and perovskite quantum dots as active materials for an efficient neuromorphic vision system. The device has an extraordinary sensitivity to light with a responsivity of 5.1 × 10 7  A/W and a specific detectivity of 2 × 10 16 Jones, and demonstrates neuromorphic reinforcement learning by training the sensor array with a weak light pulse of 1 μW/cm 2 . To emulate nature biological processing, highly-integrated ultra-sensitive artificial neuromorphic system is highly desirable. Here, the authors report flexible sensor array of 1024 pixels using combination of carbon nanotubes and perovskite QDs as active matetials, achieving highly responsive device for reinforcement learning.

Sarcopenia is a progressive and widespread skeletal muscle disease that is related to an increased possibility of adverse consequences such as falls, fractures, physical disabilities and death, and its risk increases with age. With the deepening of the understanding of sarcopenia, the disease has become a major clinical disease of the elderly and a key challenge of healthy ageing. However, the exact molecular mechanism of this disease is still unclear, and the selection of treatment strategies and the evaluation of its effect are not the same. Most importantly, the early symptoms of this disease are not obvious and are easy to ignore. In addition, the clinical manifestations of each patient are not exactly the same, which makes it difficult to effectively study the progression of sarcopenia. Therefore, it is necessary to develop and use animal models to understand the pathophysiology of sarcopenia and develop therapeutic strategies. This paper reviews the mouse models that can be used in the study of sarcopenia, including ageing models, genetically engineered models, hindlimb suspension models, chemical induction models, denervation models, and immobilization models; analyses their advantages and disadvantages and application scope; and finally summarizes the evaluation of sarcopenia in mouse models.

With the spread of the novel coronavirus disease 2019 (COVID-19) around the world, the estimation of the incubation period of COVID-19 has become a hot issue. Based on the doubly interval-censored data model, we assume that the incubation period follows lognormal and Gamma distribution, and estimate the parameters of the incubation period of COVID-19 by adopting the maximum likelihood estimation, expectation maximization algorithm and a newly proposed algorithm (expectation mostly conditional maximization algorithm, referred as ECIMM). The main innovation of this paper lies in two aspects: Firstly, we regard the sample data of the incubation period as the doubly interval-censored data without unnecessary data simplification to improve the accuracy and credibility of the results; secondly, our new ECIMM algorithm enjoys better convergence and universality compared with others. With the framework of this paper, we conclude that 14-day quarantine period can largely interrupt the transmission of COVID-19, however, people who need specially monitoring should be isolated for about 20 days for the sake of safety. The results provide some suggestions for the prevention and control of COVID-19. The newly proposed ECIMM algorithm can also be used to deal with the doubly interval-censored data model appearing in various fields.

Diapause, a programmed developmental arrest primarily induced by seasonal environmental changes, is very common in the animal kingdom, and found in vertebrates and invertebrates alike. Diapause provides an adaptive advantage to animals, as it increases the odds of surviving adverse conditions. In insects, individuals perceive photoperiodic cues and modify endocrine signaling to direct reproductive diapause traits, such as ovary arrest and increased fat accumulation. However, it remains unclear as to which endocrine factors are involved in this process and how they regulate the onset of reproductive diapause. Here, we found that the long day-mediated drop in the concentration of the steroid hormone ecdysone is essential for the preparation of photoperiodic reproductive diapause in Colaphellus bowringi , an economically important cabbage beetle. The diapause-inducing long-day condition reduced the expression of ecdysone biosynthetic genes, explaining the drop in the titer of 20-hydroxyecdysone (20E, the active form of ecdysone) in female adults. Application of exogenous 20E induced vitellogenesis and ovarian development but reduced fat accumulation in the diapause-destined females. Knocking down the ecdysone receptor ( EcR ) in females destined for reproduction blocked reproductive development and induced diapause traits. RNA-seq and hormone measurements indicated that 20E stimulates the production of juvenile hormone (JH), a key endocrine factor in reproductive diapause. To verify this, we depleted three ecdysone biosynthetic enzymes via RNAi, which confirmed that 20E is critical for JH biosynthesis and reproductive diapause. Importantly, impairing Met function, a component of the JH intracellular receptor, partially blocked the 20E-regulated reproductive diapause preparation, indicating that 20E regulates reproductive diapause in both JH-dependent and -independent manners. Finally, we found that 20E deficiency decreased ecdysis-triggering hormone signaling and reduced JH production, thereby inducing diapause. Together, these results suggest that 20E signaling is a pivotal regulator that coordinates reproductive plasticity in response to environmental inputs.

BackgroundIdiopathic thrombocytopenic purpura (ITP) may play a role in early-stage systemic lupus erythematosus (SLE). The incidence of SLE in patients with ITP and the potential relationship between them is still unclear. This study was performed to provide epidemiological evidence regarding the relationship between ITP and SLE occurrence.MethodsIn this population-based retrospective cohort study, the risk of SLE was analysed in a cohort of patients newly diagnosed with ITP between 2000 and 2013. Controls were selected at a 1:2 ratio through propensity score matching (PSM) using the greedy algorithm. The Cox proportional hazard model was used to analyse the association between ITP and SLE incidence. There were four different Cox regression models, and the sensitivity analyses were implemented to evaluate the HR of SLE after exposure with ITP.ResultsIn the age-matched and sex-matched ITP and non-ITP cohort, the average follow-up time was about 80 months in this study. There were 34 (4.70%) and 27 (0.19%) incident cases of SLE in ITP and non-ITP group. The incidence rates were 62.0 (95% CI 44.3 to 86.8) and 2.10 (95% CI 1.44 to 3.06), respectively. The adjusted HR of incidental SLE in the ITP group was 25.1 (95% CI 13.7 to 46.0). The other risk factors for SLE were female sex and Sjogren’s syndrome. After PSM, the incidence rate and Kaplan-Meir curves of SLE were consistent with the results for the age-matched and sex-matched population, the HR 17.4 (95% CI 5.28 to 57.4) was estimated by conditional Cox model.ConclusionThis cohort study demonstrated that patients with ITP have a higher risk of SLE. Clinically, patients with ITP should be monitored for incidental lupus.

Background Digital leadership might be an innovative approach to decreasing the elevated rates of anxiety and depression symptoms among medical professionals, while also enhancing their psychological well-being. This emerging pathway may offer promising strategies to support the mental health of medical professionals. This study seeks to investigate the association among digital leadership, organizational identity, family-work conflict, and anxiety and depression symptoms, and further to uncover the underlying moderating mechanisms interplay. Methods A cross-sectional online survey with 657 valid data were collected from four tertiary hospitals in Harbin, Heilongjiang Province, China, with a response rate of 69.3%. The statistical analysis was conducted employing IBM SPSS Statistics 22.0. Hierarchical regression analysis was performed to scrutinize the pertinent factors associated with anxiety and depression symptoms among medical professionals, while also evaluating the moderating influence of organizational identity and family-work conflict on the nexus among those. Results The prevalence of anxiety and depression symptoms among medical professionals was 50.1%. Anxiety and depression symptoms were negatively correlated with digital leadership ( r = -0.278, p  < 0.01) and organizational identity (r  = − 0.318, p  < 0.01), and positively correlated with family-work conflict (r  = 0.445, p  < 0.01). Organizational identity ( β  = − 0.938, p  < 0.05) and family-work conflict (β  = 0.698, p  < 0.05) moderate the relationship between digital leadership and anxiety and depression symptoms; The results of the simple slope analysis indicated that high organizational identity and low family-work conflict strengthened the effect of digital leadership on anxiety and depression symptoms among Chinese medical professionals. Conclusions The prevalence of anxiety and depression symptoms among medical professionals was noted to be high. This study posits that strengthening digital leadership could apparently improve anxiety and depression symptoms among medical professionals. Moreover, it highlights the moderating role of organizational identity and family-work conflict in the relationship between digital leadership and anxiety and depression symptoms. These discoveries underscore the significance of implementing support and interventions to enhance the mental well-being of medical professionals, encompassing the cultivation of organizational identity, reduction of family-work conflict, and acknowledgment of the potential role of digital leadership in addressing mental health challenges.

In the past 37 years, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has undergone various major transmission routes in China, with the world most complex co-circulating HIV-1 subtypes, even the prevalence is still low. In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection, China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing, which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection. China has been providing free antiretroviral therapy (ART) since 2003, which covered >80% of the identified patients and achieved a viral suppression rate of 91%. To bend the curve of increasing the disease burden of HIV and finally end the epidemic, China should consider constraining HIV spread through sexual transmission, narrowing the gaps in identifying HIV cases, and the long-term effectiveness and safety of ART in the future.