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Background This study aims to identify the risk factors associated with pupillary changes in patients with diabetic retinopathy (DR) and cataract undergoing phacoemulsification with intraocular lens implantation (PHACO + IOL). Methods This retrospective observational study included patients with DR and cataract who underwent phacoemulsification and intraocular lens implantation between February 2021 and August 2023. Patients were categorized into two groups based on the presence or absence of pupillary changes following surgery. Results A total of 162 patients were analyzed, with pupillary changes occurring in 33 cases (20.37%). Multivariate logistic regression analysis revealed that a longer duration of diabetes (OR = 2.73; 95% CI: 1.02–7.27, P  = 0.045), higher lens nucleus grade (OR = 3.95; 95% CI: 1.58–9.89, P  = 0.003), greater severity of DR (OR = 3.60; 95% CI: 1.40–9.28, P  = 0.008), and intraoperative posterior lens capsule rupture (OR = 6.41; 95% CI: 1.75–23.47, P  = 0.005) were significant risk factors for postoperative pupillary changes in DR patients undergoing PHACO + IOL. Conclusion Phacoemulsification with intraocular lens implantation is an effective treatment for patients with DR and cataract. However, factors such as the duration of diabetes, severity of DR, and intraoperative complications are associated with an increased risk of pupillary changes. Therefore, rigorous blood glucose control, adherence to standardized surgical protocols, and preventive care are recommended to optimize patient outcomes. Trial registration Not applicable. Clinical trial number Not applicable.

About 120 million tons of steel slag are produced annually in China, making it one of the largest sources of industrial solid waste; however, its utilization rate remains only around 30%. The presence of f-CaO is the main factor in its widespread application. Currently, the carbonation of steel slag is mainly through indirect wet mineralization, which is difficult to implement on an industrial scale. Direct dry carbonation, on the other hand, consumes more energy due to its slow kinetics. In this study, steam coupled with CO2 was used to directly mineralize steel slag, a process fully compatible with existing iron and steel industry treatment processes. The required temperature can be achieved using the waste heat from hot steel slag, eliminating the need for additional heat supply. With 15% steam injection, the CaCO3 content increased to 12.02 g/100 g (52.8 kg CO2 t−1 slag utilization), representing a 16.7% improvement. After mineralization, the f-CaO decreased to 0.61%, with 91.73% of f-CaO in steel slag mineralized. The mineralization efficiency of f-CaO increased by 20.24%. This enhancement was attributed to steam entering the interior pores of steel slag, generating intermediate Ca(OH)2, causing steel slag particle breakage and fully exposing the previously enclosed f-CaO for complete carbonation. To further utilize flue gas, the effects of different CO2 concentrations on carbon fixation were investigated. At a concentration of 20% CO2, the carbon fixation reached 69.90% of that achieved at 100% CO2. This research not only addresses the stability issues of steel slag but also reduces CO2 emissions and effectively utilizes waste heat, making the process suitable for large-scale industrial application.

About 120 million tons of steel slag are produced annually in China, making it one of the largest sources of industrial solid waste; however, its utilization rate remains only around 30%. The presence of f-CaO is the main factor in its widespread application. Currently, the carbonation of steel slag is mainly through indirect wet mineralization, which is difficult to implement on an industrial scale. Direct dry carbonation, on the other hand, consumes more energy due to its slow kinetics. In this study, steam coupled with CO was used to directly mineralize steel slag, a process fully compatible with existing iron and steel industry treatment processes. The required temperature can be achieved using the waste heat from hot steel slag, eliminating the need for additional heat supply. With 15% steam injection, the CaCO content increased to 12.02 g/100 g (52.8 kg CO t slag utilization), representing a 16.7% improvement. After mineralization, the f-CaO decreased to 0.61%, with 91.73% of f-CaO in steel slag mineralized. The mineralization efficiency of f-CaO increased by 20.24%. This enhancement was attributed to steam entering the interior pores of steel slag, generating intermediate Ca(OH) , causing steel slag particle breakage and fully exposing the previously enclosed f-CaO for complete carbonation. To further utilize flue gas, the effects of different CO concentrations on carbon fixation were investigated. At a concentration of 20% CO , the carbon fixation reached 69.90% of that achieved at 100% CO . This research not only addresses the stability issues of steel slag but also reduces CO emissions and effectively utilizes waste heat, making the process suitable for large-scale industrial application.

About 120 million tons of steel slag are produced annually in China, making it one of the largest sources of industrial solid waste; however, its utilization rate remains only around 30%. The presence of f-CaO is the main factor in its widespread application. Currently, the carbonation of steel slag is mainly through indirect wet mineralization, which is difficult to implement on an industrial scale. Direct dry carbonation, on the other hand, consumes more energy due to its slow kinetics. In this study, steam coupled with CO[sub.2] was used to directly mineralize steel slag, a process fully compatible with existing iron and steel industry treatment processes. The required temperature can be achieved using the waste heat from hot steel slag, eliminating the need for additional heat supply. With 15% steam injection, the CaCO[sub.3] content increased to 12.02 g/100 g (52.8 kg CO[sub.2] t[sup.−1] slag utilization), representing a 16.7% improvement. After mineralization, the f-CaO decreased to 0.61%, with 91.73% of f-CaO in steel slag mineralized. The mineralization efficiency of f-CaO increased by 20.24%. This enhancement was attributed to steam entering the interior pores of steel slag, generating intermediate Ca(OH)[sub.2], causing steel slag particle breakage and fully exposing the previously enclosed f-CaO for complete carbonation. To further utilize flue gas, the effects of different CO[sub.2] concentrations on carbon fixation were investigated. At a concentration of 20% CO[sub.2], the carbon fixation reached 69.90% of that achieved at 100% CO[sub.2]. This research not only addresses the stability issues of steel slag but also reduces CO[sub.2] emissions and effectively utilizes waste heat, making the process suitable for large-scale industrial application.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder frequently requiring oxygen therapy to relieve symptoms and improve survival. In recent years, telehealth-supported interventions have emerged as promising strategies to optimize home oxygen therapy by promoting adherence, reducing hospitalizations, and enhancing health-related quality of life. However, evidence regarding their effectiveness remains inconsistent and equivocal, underscoring the need for further rigorous evaluation. This study aimed to evaluate the clinical and cost-effectiveness of telehealth-supported home oxygen therapy on adherence, hospital readmission, and health-related quality of life in patients with COPD. A comprehensive search was conducted across 6 databases (PubMed, Cochrane Central, Embase, Web of Science, PsycINFO, and CINAHL) up to October 1, 2024, and updated on April 28, 2025. Randomized controlled trials involving patients with COPD comparing telehealth-supported home oxygen therapy with usual care, and reporting outcomes on adherence, hospital readmissions, or health-related quality of life, were included. In addition, 2 reviewers independently screened the studies, extracted data, assessed the risk of bias using the Cochrane Risk of Bias 2 tool, and evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analyses and heterogeneity assessments were conducted using R software (R Core Team). Standardized mean differences with 95% CIs were calculated to evaluate the intervention effects under a random-effects model. In total, 8 studies comprising 1275 patients were included in the review. Telehealth-supported home oxygen therapy significantly reduced hospital readmissions (standardized mean difference [SMD]=-0.40, 95% CI -0.60 to -0.21) and improved health-related quality of life (SMD=0.49, 95% CI 0.25-0.73). No significant effect was observed on therapy adherence (SMD=0.19, 95% CI -0.76 to 1.14). Furthermore, 3 economic evaluations suggested that although telehealth interventions may incur higher initial costs, they are likely to result in long-term savings by reducing hospital admissions. Sensitivity analyses confirmed the robustness of the findings for hospital readmissions and health-related quality of life, for which the quality of evidence was rated as high, whereas the evidence for therapy adherence was rated as low. Telehealth-supported home oxygen therapy significantly reduces hospital admissions and improves health-related quality of life in patients with COPD, but does not significantly improve therapy adherence. Tailored interventions that consider patient demographics, combined with supportive policies, may further enhance clinical outcomes. Future research should incorporate economic evaluations to better inform policy decisions regarding the implementation of telehealth-supported home oxygen therapy. However, the overall certainty of evidence is limited by study-level risk of bias, variability in intervention designs, and imprecision of effect estimates, highlighting the need for further high-quality, standardized trials.

Firms in the fashion industry frequently launch new styles of their products, thereby leading to a ‘two-period’ phenomenon in product sales: the normal selling time and the last salvage time. Researches about cooperative (co-op) advertising, however, seldom concentrate on this phenomenon. This study explores co-op advertising in a two-period fashion supply chain system in which the retailer offers a price discount in the second period. We derive the optimal pricing, product design level and advertising efforts in two scenarios: a decentralised scenario with a co-op advertising program and integrated scenario. Additionally, we propose a bilateral participation-revenue-sharing contract to coordinate this channel. Some insights and management implications are obtained. Firstly, if the consumers are insensitive to the first-period price, the retailer will set a high retail price in this period, while selling the product at a big discount in the second period to stimulate extra consumption. Secondly, if the price elasticity of demand is small, the retailer will spend more on the advertisement, otherwise the condition is opposite. Lastly, this study verifies that the bilateral participation-revenue-sharing contract can achieve a seamless coordination in this supply chain with a transfer payment.

Activating the immune costimulatory receptor 4-1BB (CD137) with agonist antibody binding and crosslinking-inducing agents that elicit 4-1BB intracellular signaling potentiates the antitumor responses of CD8+ T cells. However, the underlying in-depth mechanisms remain to be defined. Here, we show that agonistic 4-1BB treatment of activated CD8+ T cells under continuous antigenic stimulation makes them more metabolically vulnerable to redox perturbation by ablation of intracellular glutathione (GSH) and glutathione peroxidase 4 (GPX4) inhibition. Further, genetic deletion of adenosine A2B receptor (A2BR) induces superior survival and expansion advantage of competent CD8+ T cells with agonistic 4-1BB costimulation, leading to more effective antitumor efficacy of adoptive cell therapy (ACT). Mechanistically, A2BR deletion helps sustain the increased energy and biosynthetic requirements through the GSH/GPX4 axis upon 4-1BB costimulation. A2BR deletion in combination with agonistic 4-1BB costimulation displays a greater ability to promote antitumor CD8+ effector T cell survival and expansion while mitigating T cell exhaustion. Thus, the A2BR pathway plays an important role in metabolic reprogramming with potentiation of the GSH/GPX4 cascade upon agonistic 4-1BB costimulation that allows the fine-tuning of the antitumor responses of CD8+ T cells.

Background Exome sequencing (ES) is becoming more widely available in prenatal diagnosis. However, data on its clinical utility and integration into clinical management remain limited in practice. Herein, we report our experience implementing prenatal ES (pES) in a large cohort of fetuses with anomalies detected by ultrasonography using a hospital-based in-house multidisciplinary team (MDT) facilitated by a three-step genotype-driven followed by phenotype-driven analysis framework. Methods We performed pES in 1618 fetal cases with positive ultrasound findings but negative for karyotyping and chromosome microarray analysis between January 2014 and October 2021, including both retrospective ( n =565) and prospective ( n =1053) cohorts. The diagnostic efficiency and its correlation to organ systems involved, phenotypic spectrum, and the clinical impacts of pES results on pregnancy outcomes were analyzed. Results A genotype-driven followed by phenotype-driven three-step approach was carried out in all trio pES. Step 1, a genotype-driven analysis resulted in a diagnostic rate of 11.6% (187/1618). Step 2, a phenotype-driven comprehensive analysis yielded additional diagnostic findings for another 28 cases (1.7%; 28/1618). In the final step 3, data reanalyses based on new phenotypes and/or clinical requests found molecular diagnosis in 14 additional cases (0.9%; 14/1618). Altogether, 229 fetal cases (14.2%) received a molecular diagnosis, with a higher positive rate in the retrospective than the prospective cohort (17.3% vs. 12.4%, p <0.01). The diagnostic rates were highest in fetuses with skeletal anomalies (30.4%) and multiple organ involvements (25.9%), and lowest in fetuses with chest anomalies (0%). In addition, incidental and secondary findings with childhood-onset disorders were detected in 11 (0.7%) cases. Furthermore, we described the prenatal phenotypes for the first time for 27 gene-associated conditions (20.0%, 27/135) upon a systematic analysis of the diagnosed cases and expanded the phenotype spectrum for 26 (19.3%) genes where limited fetal phenotypic information was available. In the prospective cohort, the combined prenatal ultrasound and pES results had significantly impacted the clinical decisions (61.5%, 648/1053). Conclusions The genotype-driven approach could identify about 81.7% positive cases (11.6% of the total cohort) with the initial limited fetal phenotype information considered. The following two steps of phenotype-driven analysis and data reanalyses helped us find the causative variants in an additional 2.6% of the entire cohort (18.3% of all positive findings). Our extensive phenotype analysis on a large number of molecularly confirmed prenatal cases had greatly enriched our current knowledge on fetal phenotype-genotype correlation, which may guide more focused prenatal ultrasound in the future. This is by far the largest pES cohort study that combines a robust trio sequence data analysis, systematic phenotype-genotype correlation, and well-established MDT in a single prenatal clinical setting. This work underlines the value of pES as an essential component in prenatal diagnosis in guiding medical management and parental decision making.

Purpose This pilot study aimed to investigate the effects of REX exoskeleton rehabilitation robot training on the balance and lower limb function in patients with sub-acute stroke. Methods This was a pilot, single-blind, randomized controlled trial. Twenty-four patients with sub-acute stroke (with the course of disease ranging from 3 weeks to 3 months) were randomized into two groups, including a robot group and a control group. Patients in control group received upright bed rehabilitation ( n  = 12) and those in robot group received exoskeleton rehabilitation robot training ( n  = 12). The frequency of training in both groups was once a day (60 min each) for 5 days a week for a total of 4 weeks. Besides, the two groups were evaluated before, 2 weeks after and 4 weeks after the intervention, respectively. The primary assessment index was the Berg Balance Scale (BBS), whereas the secondary assessment indexes included the Fugl-Meyer Lower Extremity Motor Function Scale (FMA-LE), the Posture Assessment Scale for Stroke Patients (PASS), the Activities of Daily Living Scale (Modified Barthel Index, MBI), the Tecnobody Balance Tester, and lower extremity muscle surface electromyography (sEMG). Results The robot group showed significant improvements ( P  < 0.05) in the primary efficacy index BBS, as well as the secondary efficacy indexes PASS, FMA-LE, MBI, Tecnobody Balance Tester, and sEMG of the lower limb muscles. Besides, there were a significant differences in BBS, PASS, static eye-opening area or dynamic stability limit evaluation indexes between the robotic and control groups ( P  < 0.05). Conclusions This is the first study to investigate the effectiveness of the REX exoskeleton rehabilitation robot in the rehabilitation of patients with stroke. According to our results, the REX exoskeleton rehabilitation robot demonstrated superior potential efficacy in promoting the early recovery of balance and motor functions in patients with sub-acute stroke. Future large-scale randomized controlled studies and follow-up assessments are needed to validate the current findings. Clinical trials registration URL: https://www.chictr.org.cn/index.html.Unique identifier: ChiCTR2300068398.

PurposeFallowing is an improvement process aimed at promoting the soil health and the sustainability of cultivated land. How it affects the soil health-related abiotic properties and microbial community composition under different levels of cadmium (Cd) contamination is not well known.Materials and methodsThis study involved applying consistent fallowing practices to paddy soils of low and high Cd content, in order to examine changes in the soil Cd, nutrient, and microbial community using a high-throughput sequencing method.Results and discussionFallowing significantly decreased available Cd and phosphorus (P) content, but increased ammonium nitrogen (N) on lightly contaminated plots, whereas only P variables changed significantly for heavily contaminated plots. Furthermore, fallowing significantly decreased bacterial Shannon diversity on lightly contaminated plots and altered bacterial community composition on heavily contaminated plots, but it had no impact on archaeal or fungal communities, indicating that bacteria are more sensitive to fallowing than archaea and fungi. Specifically, fallowing significantly promoted some copiotrophic bacteria (Alphaproteobacteria and Betaproteobacteria) but suppressed some oligotrophic taxa (Chloroflexi phylum and OTU5837 belonging to the phylum Acidobacteria) on highly contaminated plots. Interestingly, the soil microbial community in the lightly contaminated plots was mainly affected by soil pH, C, and N properties, whereas on heavily contaminated plots, it was largely influenced by soil Cd and P variables.ConclusionsOverall, these findings showed that fallowing significantly improved soil N availability but decreased Cd availability in lightly contaminated conditions, while shifts in microbial community composition under heavily contaminated conditions may indirectly enhance soil nutrient availability and reduce available Cd. These findings highlight the significance of fallowing to promote the health and the sustainability of Cd-contaminated cultivated land.