Disparity of serum uric acid threshold for CKD among hypertensive and non-hypertensive individuals

INTRODUCTION

Hypertension and rising serum uric acid (sUA) played a pivotal role in the development of Chronic Kidney Disease (CKD). This study investigates the interactive effect of sUA and hypertension on CKD and identifies the optimal threshold of sUA among individuals with and without hypertension in the Chinese community population.

MATERIALS AND METHODS

The study included 4180 individuals aged 45-85 years, derived from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015. Additionally, a hospital-based study enrolled subjects in the Department of Nephrology at Zhongshan Hospital, China from January 1, 2019, to December 31, 2021. The interaction effect analysis were used to assess the impact of sUA and hypertension on CKD. We also compared the distribution of sUA and the CKD risk in community populations, distinguishing between those with and without hypertension. For the hospital-based population, kidney injury was marked by a KIM-1 positive area.

RESULTS

Our results indicate a higher prevalence of CKD in the community population with hypertension (10.2% vs. 3.9%, p < .001). A significant additive synergistic effects of the sUA and hypertension on the CKD risk were found. When the sUA level was < 4.55 mg/dL in the hypertensive population and < 5.58 mg/dL in the non-hypertensive population, the risk of CKD was comparable (p = .809). In the propensity score matched (PSM) population, the result remained roughly constant.

CONCLUSION

Therefore, even moderate levels of sUA was associated with a higher risk of CKD in middle-aged hypertensive patients, who warrant stricter sUA control.

Metabolic dysfunction, rather than obesity, is a risk factor for chronic kidney disease in Chinese population

BACKGROUND

Metabolic dysfunction and obesity are closely related to chronic kidney disease (CKD). However, studies on the relationship between various metabolic syndrome-body mass index (MetS-BMI) phenotypes and the risk of CKD in the Chinese population have not yet been explored.

MATERIALS AND METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed in this study. This study enrolled 12,054 participants. Participants were divided into six distinct groups according to their MetS-BMI status. Across the different MetS-BMI groups, the odd ratios (ORs) for CKD were determined using multivariable logistic regression models.

RESULTS

The prevalence of CKD was higher in metabolically unhealthy groups than in the corresponding healthy groups. Moreover, the fully adjusted model showed that all metabolically unhealthy individuals had an increased risk of developing CKD compared to the metabolically healthy normal weight group (OR = 1.62, p = 0.002 for the metabolically unhealthy normal weight group; OR = 1.55, p < 0.001 for the metabolically unhealthy overweight group; and OR = 1.77, p < 0.001 for the metabolically unhealthy obesity group.

CONCLUSIONS

This study is the first to evaluate the relationship between the MetS-BMI phenotype and renal prognosis in the Chinese population. Individuals with normal weights are at different risk of developing CKD depending on their different metabolic phenotypes.

Improving photochemical indicators for attributing ozone sensitivities in source apportionment analysis

Comprehensive Air Quality Model with extensions (CAMx)-Decoupled Direct Method (DDM) simulations of first-order ozone (O3) sensitivity to nitrogen oxides (NOx) and volatile organic compounds (VOCs) emissions were performed and combined with modelled [Formula: see text] ratios to obtain a range of thresholds for determining O3-sensitivity regimes for different areas of China. Utilising the new threshold ranges for photochemical indicators, the method for determining O3 formation in the Ozone Source Apportionment Technology (OSAT) module within CAMx was improved by a dynamically varied threshold of [Formula: see text] ratio. The O3 concentration contributions in the newly added transition regime were apportioned to NOx and VOCs emissions in proportion to the relationship between the [Formula: see text] ratio and first-order O3 sensitivity. The source contributions of O3 concentrations from different emission sectors from June to September 2019 were compared using the original and improved CAMx-OSAT. The results showed that the O3 concentration contributions changed significantly in the NOx-limited regime, with a maximum decrease of 21.89%, while the contributions increased by up to 7.57% in the VOC-limited regime, and were within 15 µg/m3 in the transition regime. The modified OSAT module enabled a more sophisticated attribution of O3 to precursor emissions and may have far-reaching implications for informing O3 pollution control policy.

Smart windows based on ultraviolet-B persistent luminescence phosphors for bacterial inhibition and food preservation

Herein, ultraviolet B (UVB) persistent luminescence phosphors containing SrAl12O19: Ce3+, Sc3+ nanoparticles were reported. Thermoluminescence (TL) spectrum analysis reveals that the shallow trap induced by Sc3+ co-doping plays an important role in photoluminescence persistent luminescence (PersL) development, while the deep trap dominates the generation of optical stimulated luminescence (OSL). Owing the appearance of deep trap, the OSL is observed under light (700 nm - 900 nm) excitation. UVB luminescence exerts good bactericidal effects on pathogenic bacteria involved in the process of food spoilage. Thus, the smart window with SrAl12O19: Ce3+, Sc3+/PDMS produces UVB PersL to efficiently inactivate Escherichia coli and Staphylococcus aureus. In addition, the presence of the smart window delays the critical point of pork decay, and greatly reduces the time of pork spoilage. It maximizes the convenience of eradicating bacteria and preserving food, thus offering a fresh perspective on the use of UV light for food sterilization and preservation.

Hydrogel forming microneedles loaded with VEGF and Ritlecitinib/polyhydroxyalkanoates nanoparticles for mini-invasive androgenetic alopecia treatment

Androgenetic alopecia (AGA), the most prevalent clinical hair loss, lacks safe and effective treatments due to downregulated angiogenic genes and insufficient vascularization in the perifollicular microenvironment of the bald scalp in AGA patients. In this study, a hyaluronic acid (HA) based hydrogel-formed microneedle (MN) was designed, referred to as V-R-MNs, which was simultaneously loaded with vascular endothelial growth factor (VEGF) and the novel hair loss drug Ritlecitinib, the latter is encapsulated in slowly biodegradable polyhydroxyalkanoates (PHAs) nanoparticles (R-PHA NPs) for minimally invasive AGA treatment. The integration of HA based hydrogel alongside PHA nanoparticles significantly bolstered the mechanical characteristics of microneedles and enhanced skin penetration efficiency. Due to the biosafety, mechanical strength, and controlled degradation properties of HA hydrogel formed microneedles, V-R-MNs can effectively penetrate the skin's stratum corneum, facilitating the direct delivery of VEGF and Ritlecitinib in a minimally invasive, painless and long-term sustained release manner. V-R-MNs not only promoted angiogenesis and improve the immune microenvironment around the hair follicle to promote the proliferation and development of hair follicle cells, but also the application of MNs to the skin to produce certain mechanical stimulation could also promote angiogenesis. In comparison to the clinical drug minoxidil for AGA treatment, the hair regeneration effect of V-R-MN in AGA model mice is characterized by a rapid onset of the anagen phase, improved hair quality, and greater coverage. This introduces a new, clinically safer, and more efficient strategy for AGA treatment, and serving as a reference for the treatment of other related diseases.

Comparison of the physical stability, microstructure and protein-lipid co-oxidation of O/W emulsions stabilized by l-arginine/l-lysine-modified soy protein hydrolysate

This work investigated the physical stability, microstructure, and oxidative stability of the emulsions prepared by soy protein hydrolysate (SPH) after modification with different concentrations of l-arginine and l-lysine. l-Arginine and l-lysine significantly increased the absolute zeta potential values, and decreased droplet sizes of the emulsions, thereby improving the physical stability of the emulsions. Meanwhile, l-arginine and l-lysine markedly decreased the apparent viscosity of the emulsions. The measurement of interfacial protein adsorption percentage showed that l-arginine (≤0.5 %) promoted the adsorption of SPH at the oil-water interface, whereas l-lysine (≤1%) reduced the adsorption of SPH at the oil-water interface. In addition, l-arginine and l-lysine (≤0.5 %) could retard lipid and protein oxidation. Correlation analysis indicated that the improvement in the physical stability of the emulsions by l-arginine and l-lysine also enhanced the oxidative stability of the emulsions. In summary, l-arginine and l-lysine could be effective modifiers for the protein-based emulsion systems.

Unraveling the binding mechanism between soybean protein isolate and selected bioactive compounds

The present study was aimed to investigate the interactions between soybean protein isolate (SPI) with resveratrol (RESV) and lutein (LUT). The binding forces, molecular interactions and functional properties were explored by multi-spectroscopic analysis, molecular docking and functional property indexes between SPI and RESV/LUT. The RESV/LUT quenched SPI chromophore residues with static mechanism and the endothermic reaction. The SPI- RESV/LUT complexes were formed through hydrogen bond, electrostatic and hydrophobic interactions. Molecular docking confirmed van-der-Waals force as one of the important forces. The interaction of RESV/LUT led to SPI's secondary structure alterations with a decrease in α-helix and random coil and an increase in β-sheet and β-turns. RESV/LUT developed foaming and emulsifying properties of SPI and showed a significant decrease of the surface hydrophobicity with RESV/LUT concentrations increase attributed to SPI's partial unfolding. Our study exposed molecular mechanisms and confirmations to understand the interactions in protein- RESV/LUT complexes for protein industrial base promotion.

Designing a Se-intercalated MOF/MXene-derived nanoarchitecture for advancing the performance and durability of lithium-selenium batteries

Lithium-selenium batteries have emerged as a promising alternative to lithium-sulfur batteries due to their high electrical conductivity and comparable volume capacity. However, challenges such as the shuttle effect of polyselenides and high-volume fluctuations hinder their practical implementation. To address these issues, we propose synthesizing Fe-CNT/TiO2 catalyst through high-temperature sintering of an amalgamated nanoarchitecture of carbon nanotubes decorated metal-organic framework (MOF) and MXene, optimized for efficient selenium hosting, leveraging the distinctive physicochemical properties. The catalytic features inherent in the porous Se@Fe-CNT/TiO2 nanoarchitecture were instrumental in promoting efficient ion and electron transport, and lithium-polyselenide kinetics, while its inherent porosity could play a crucial role in inhibiting electrode stress during cycling. This nanoarchitecture exhibits remarkable battery performance, retaining 99.7% of theoretical capacity after 425 cycles at 0.5 C rate and demonstrating 95.8% capacity retention after 2000 cycles at 1 C rate, with ∼100% Coulombic efficiency. Additionally, the Se@Fe-CNT/TiO2 electrode exhibited an impressive recovery of 297.5 mAh/g (97.9%) capacity after undergoing 450 cycles at a charging rate of 10 C and a discharging rate of 1 C. This synergistic integration of MOF- and MXene-derived materials unveils new possibilities for high-performance and durable LSeBs, thus advancing electrochemical energy storage systems.

Visualizing the crucial roles of plasma membrane and peroxynitrite during abdominal aortic aneurysm using two-photon fluorescence imaging

Peroxynitrite (ONOO-) and cell plasma membrane (CPM) are two key factors in cell pyroptosis during the progression of abdominal aortic aneurysm (AAA). However, their combined temporal and spatial roles in initiating AAA pathogenesis remain unclear. Herein, we developed a two-photon fluorescence probe, BH-Vis, enabling real-time dynamic detection of CPM and ONOO- changes, and revealing their interplay in AAA. BH-Vis precisely targets CPM with reduced red fluorescence intensity correlating with diminished CPM tension. Concurrently, a blue shift of the fluorescence signal of BH-Vis occurs in response to ONOO- offering a reliable ratiometric detection mode with enhanced accuracy by minimizing external testing variables. More importantly, two photon confocal imaging with palmitic acid (PA) and ganglioside (GM1) manipulation, which modulating cell pyroptosis, showcases reliable fluorescence fluctuations. This groundbreaking application of BH-Vis in a mouse AAA model demonstrates its significant potential for accurately identifying cell pyroptosis levels during AAA development.

Sulfate radical dominated rapid pollutants degradation leaded by selenium vacancies in core-shell N-doped carbon wrapped cobalt diselenide nanospheres

Herein, a new heterogeneous CoSe2-x@NC material with abundant selenium vacancies is synthesized via an in-situ carbonization-selenization process from cobaltic metal organic framework (Co-MOF). The obtained CoSe2-x@NC has a unique electronic structure and rich active sites, which can activate peroxymonosulfate (PMS) to degrade carbamazepine (CBZ) with superior catalytic performance and stability. The quenchingexperiments and EPR test show that SO4•- is the dominant reactive oxidation species (ROSs) for CBZ degradation. Significantly, systemic electrochemical tests and theoretical calculations illustrated that the dominant role of SO4•- is attributed to the existence of abundant selenium vacancies in CoSe2-x@NC, which can adjust the density of electron cloud of the Co atoms in CoSe2-x@NC to improve the PMS adsorption and promoting the conversion of transition metallic redox pairs (Co3+/Co2+). This work provides a facile way to improve the activity and stability of CoSe2 by defect engineering in the PMS based advanced oxidation process (AOPs).

Photoelectric dual-mode triggered phase change materials for all-weather personal thermal management and shape memory

To cope with the demand of more complex and variable applications, it is urgent to develop dual-mode triggered, breathable, and shape-memory wearable heaters for all-weather personal thermal management of composite phase change materials (PCMs). Herein, after high-temperature carbonization of ZnCo-MOF (metal-organic framework) nanosheet array grown in situ on flexible and breathable carbon cloth (CC) and subsequent encapsulation of polyethylene glycol (PEG), the as-prepared PEG/CC@Co/CNT (carbon nanotube) composite PCMs exhibited good breathability, mechanical strength (tensile strength of 9.15 MPa), thermal energy storage density (114.19 J/g), and shape memory due to the synergy of flexible CC skeleton and rigid PEG. More importantly, composite PCMs possessed excellent solar-thermal (93.7 %, 100 mW/cm2) and electro-thermals (94.5 %, 2.0 V) conversion and storage capacity, benefiting from the conjugation effect of high graphitized carbon/carbon heterostructure with fast electron/photon/phonon transmission and the localized surface plasmon resonance effect of Co nanoparticles. Therefore, the integration of solar heating and Joule heating into breathable composite PCMs can be accurately used for next-generation all-weather, all-season, dual-mode triggered personal thermal management, including indoor/outdoor, daytime/night, rainy/cloudy and other complex and changeable scenarios.

Exploring causal correlations between circulating levels of cytokines and colorectal cancer risk: A Mendelian randomization analysis

Colorectal cancer has the highest mortality rate of all digestive system diseases. Considering the debate about cytokines and biases that exist in traditional observational study designs, we performed a two-sample Mendelian randomization (MR) analysis to explore the association of circulating cytokines with CRC risk. In this study, we used cytokine genetic variants from a recently published genome-wide association study (GWAS) including 14,824 European-ancestry participants. Summary-level data for colorectal cancer were obtained from genome-wide association analyses of the FinnGen consortium. In addition, we conducted independent supplementary analyses using genetic variation data of colorectal cancer and cytokines from a large public GWAS in 2021. Among 91 circulating factors, we only found IL-12B to be significantly associated with CRC risk (odds ratio [OR]: 1.19; 95% confidence interval [CI]: 1.00-1.42; p = .046). We used 2021 data for analysis and found that higher Interleukin-12p70 levels (IL-12p70) were revealed to have a significant positive association with CRC risk (OR: 1.27; 95% CI: 1.13-1.43; p < 1.22 × 10-3). Moreover, CRC was suggestively correlated with an elevated level of vascular endothelial growth factor (VEGF) (OR: 1.17; 95% CI: 1.02-1.35; p = .026), macrophage colony-stimulating factor (M-CSF) (OR: 0.85; 95% CI: 0.76-0.96; p = .005), IL-13 (OR: 1.15; 95% CI: 1.02-1.30; p = .028), IL-10 (OR: 1.23; 95% CI: 1.01-1.49; p = .037), and IL-7 (OR: 1.19; 95% CI: 1.02-1.39; p = .024). Our MR studies support that one cytokine IL-12 is significantly associated with CRC risk and that five cytokines VEGF, M-CSF, IL-13, IL-10, and IL-7 are associated with CRC risk.

Effect of sodium alginate block type on the physicochemical properties and curcumin release behavior of quaternized chitosan-oxidized sodium alginate Schiff base hydrogels

Controlling bioactive ingredients release by modulating the 3D network structure of cross-linked hydrogels is important for functional food development. Hereby, oxidized sodium alginate (OSA) with varying aldehyde contents was formed by periodate oxidation of sodium alginate (SA) with different β-d-mannuronic acid (M) and α-l-guluronic acid (G) ratios (M/G = 1:2, 1:1, and 2:1) and its structure was characterized. Moreover, hydrogels were prepared via Schiff base and electrostatic interactions between quaternized chitosan (QCS) and OSA. The properties of hydrogels such as microstructure, thermal stability, swelling and controlled release were investigated. The results showed that OSA with M/G = 1:2 had the highest content of aldehyde groups, and the hydrogel formed by it and QCS had higher thermal stability and a denser network structure with the lowest equilibrium swelling rate, which could better control the release of curcumin. Additionally, it had good self-healing and can recover rapidly after the rupture of its network structure.

Dry fractionation efficiency of milk fats from different sources and the characteristics of their fractions in chemical composition, thermal property, and crystal morphology

The physicochemical properties of anhydrous milk fats (AMF) often change according to different regions and seasons, inevitably affecting dry fractionation. This study analyzed the differences in the fraction yields and physicochemical characteristics of four AMFs from different sources. The results showed that single-stage dry fractionation conducted at 25 °C easily separated AMFs into liquid fractions (L25) and solid fractions (S25) via pressure filtration, both producing satisfactory yields. Moreover, all L25s exhibited few crystals with good fluidity at 25 °C, while S25s presented as semi-solids supported by β crystal networks with a certain hardness and plasticity. However, four AMFs displayed fractionation efficiency variation, while the thermal differences among them showed no obvious correlation with those among their fractions. Generally, more trisaturated triglycerides with 48 to 54 carbon atoms in the AMF increased the S25 yield and decreased the slip melting points (SMP) of both fractions.

Construction of emulsion gel based on the interaction of anionic polysaccharide and soy protein isolate: Focusing on structural, emulsification and functional properties

In this study, the effects on the structures and emulsion gels of carrageenan (CA) and gum arabic (GA) with soybean protein isolate (SPI) were investigated. The results showed that CA and GA exposed hydrophobic groups to SPI, and formed complexes through non-covalent interactions to improve the stability of the complexes. Furthermore, the emulsion gels based on the emulsions exhibited that CA formed emulsion-filled gels with higher elasticity, stronger gel strength, and thermal reversibility, whereas GA formed emulsion-aggregated gels with higher viscosity, and a weak-gel network. The results of digestion showed that, CA was more helpful to slow down the release of free fatty acids and protect vitamin E during digestion. Compared with SPI-GA emulsion gel, SPI-CA emulsion gel had better physicochemical properties and stronger network structure. The results of this study may be useful in the development of anionic polysaccharides that interact with SPI, and they may provide new insights on the preparation of emulsion gels that slowly release fat-soluble nutrients.

Effects of umami substances as taste enhancers on salt reduction in meat products: A review

Sodium is one of the essential additives in meat processing, but excessive sodium intake may increase risk of hypertension and cardiovascular disease. However, reducing salt content while preserving its preservative effect, organoleptic properties, and technological characteristics poses challenges. In this review, the mechanism of salt reduction of umami substances was introduced from the perspective of gustation-taste interaction, and the effects of the addition of traditional umami substances (amino acids, nucleotides, organic acids(OAs)) and natural umami ingredients (mushrooms, seaweeds, tomatoes, soybeans, tea, grains) on the sensory properties of the meat with reduced-salt contents were summarized. In addition, the impacts of taste enhancers on eating quality (color, sensory, textural characteristics, and water-holding capacity (WHC)), and processing quality (lipid oxidation, pH) of meat products (MP) and their related mechanisms were also discussed. Among them, natural umami ingredients exhibit distinct advantages over traditional umami substances in terms of enhancing quality and nutritional value. On the basis of salt reduction, natural umami ingredients improve the flavor, texture, WHC and antioxidant capacity. This comprehensive review may provide the food industry with a theoretical foundation for mitigating salt consumption through the utilization of umami substances and natural ingredients.

A Model generation method and iteration algorithm for optimising fire protection thickness

With temperatures rising above 1000 °C within 5 min, hydrocarbon fire causes rapid strength degradation of structural steel members. It is among the most dangerous hazards, such as boiling liquid expanding vapour explosion (BLEVE) in the oil and gas industry. Intumescent coating as passive protection is widely adopted to prevent the steel structure from material property reduction. However, when optimising fire protection with heat transfer simulation, repetitive modelling work and lacking recalculation principle hinder productivity improvement. This method is developed to generate steel beam models and provides an effective algorithm to optimise coating thickness considering the temperature of a specific region. The main functions of the method include: •Providing section dimensions, initial insulation thickness, target temperature and heating time, temperature allowance and mesh size as variables.•Automatically generating the Abaqus steel beam model under 3-side heating conditions.•Effective iteration algorithm to modify fire protection thickness: test containing 38 Universal beam sections with a 5 °C allowance below target shows that 55.2% were completed within five iterations and 76.3% were completed within eight iterations.

The PIEZO1/miR-155-5p/GDF6/SMAD2/3 signaling axis is involved in inducing the occurrence and progression of osteoarthritis under excessive mechanical stress

OBJECTIVE

To elucidate the molecular mechanism of overloading-induced osteoarthritis (OA) and to find a novel therapeutic target.

METHODS

We utilized human cartilage specimens, mouse chondrocytes, a destabilization of the medial meniscus (DMM) mouse model, and a mouse hindlimb weight-bearing model to validate the role of overloading on chondrocyte senescence and OA development. Then, we observed the effect of PIEZO1-miR-155-5p-GDF6-SMAD2/3 signaling axis on the preservation of joint metabolic homeostasis under overloading in vivo, in vitro and ex vivo by qPCR, Western blot, enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, immunofluorescence, SA-β-gal staining, CCK8 assay, et al. Finally, we verified the therapeutic effects of intra-articular injection of miR-155-5p inhibitor or recombinant GDF6 on the murine overloading-induced OA models.

RESULTS

Chondrocytes sensesed the mechanical overloading through PIEZO1 and up-regulated miR-155-5p expression. MiR-155-5p mimics could copy the effects of overloading-induced chondrocyte senescence and OA. Additionally, miR-155-5p could suppress the mRNA expression of Gdf6-Smad2/3 in various tissues within the joint. Overloading could disrupt joint metabolic homeostasis by downregulating the expression of anabolism indicators and upregulating the expression of catabolism indicators in the chondrocytes and synoviocytes, while miR-155-5p inhibition or GDF6 supplementation could exert an antagonistic effect by preserving the joint homeostasis. Finally, in the in vivo overloading models, intra-articular injection of miR-155-5p inhibitor or recombinant GDF6 could significantly mitigate the severity of impending OA and lessened the progression of existing OA.

CONCLUSION

GDF6 overexpression or miR-155-5p inhibition could attenuate overloading-induced chondrocyte senescence and OA through the PIEZO1-miR-155-5p-GDF6-SMAD2/3 signaling pathway. Our study provides a new therapeutic target for the treatment of overloading-induced OA.

The AMPK and AKT/GSK3β pathways are involved in recombinant proteins fibroblast growth factor 1 (rFGF1 and rFGF1a) improving glycolipid metabolism in rainbow trout (Oncorhynchus mykiss) fed a high carbohydrate diet

Fibroblast growth factor 1 (FGF1) regulates vertebrate cell growth, proliferation and differentiation, and energy metabolism. In this study, we cloned rainbow trout (Oncorhynchus mykiss) fgf1 and fgf1a, prepared their recombinant proteins (rFGF1 and rFGF1a), and described the molecular mechanisms by which they improve glycolipid metabolism in carnivorous fish. A 31-d feeding trial was conducted to investigate whether they could enhance glycolipid metabolism in rainbow trout on high-carbohydrate diets (HCD). A total of 720 rainbow trout (8.9 ± 0.5 g) were equally divided into 4 groups: the chow diet (CD) group injected with PBS, the HCD group injected with PBS, the HCD group injected with rFGF1 (400 ng/g body weight), and the HCD group injected with rFGF1a (400 ng/g body weight). The results showed that short-term HCD had a significant positive effect on the specific growth rate (SGR) of rainbow trout (P < 0.05). However, it led to an increase in crude fat, serum triglyceride (TG) and glucose content, as well as serum glutamic pyruvic transaminase (GPT) and glutamic oxalacetic transaminase (GOT) contents (P < 0.05), suggesting a negative health effect of HCD. Nevertheless, rFGF1 and rFGF1a showed beneficial therapeutic effects. They significantly reduced the crude fat content of the liver, serum TG, GOT, and GPT contents caused by HCD (P < 0.05). The upregulation in atgl, hsl, and acc2 mRNAs implied the promotion of TG catabolism. Moreover, rFGF1 and rFGF1a contributed to promoting lipolysis by activating the AMPK pathway and reducing lipid accumulation in the liver caused by HCD. In addition, the rFGF1 and rFGF1a-treated groups significantly reduced serum glucose levels and elevated hepatic glycogen content under HCD, and increased glucose uptake by hepatocytes. We observed a decrease in mRNA levels for pepck, g6pase, and pygl, along with an increase in mRNA levels for gys, glut2, and gk in the liver. Furthermore, these proteins regulated hepatic gluconeogenesis and glycogen synthesis by increasing the phosphorylation level of AKT, ultimately leading to an increase in GSK3β phosphorylation. In conclusion, this study demonstrates that rFGF1 and rFGF1a can enhance lipolysis and glucose utilization in rainbow trout by activating the AMPK pathway and AKT/GSK3β axis.

Exploring the associations of demographics and scale measures with cognitive driving behavior among older drivers in China

Age-related changes and frailty are reasons for the high proportion of older drivers in certain types of crashes, such as giving right of way at intersections and turning left. The identified crash causes include the driver's demographics, driving style, cognitive function, and mental workload. This study aimed to explore the associations of demographics and scale measures with cognitive driving behavior. Thirty-nine drivers, consisting of twenty younger drivers (18-60 years old) and nineteen older drivers (above 60 years old), participated in driving simulation experiments after completing scale tests. The selected scale measures included the demographic questionnaire, Multidimensional Driving Style Inventory (MDSI-C), Mini-Mental State Examination (MMSE), Trail Making Test Part A (TMT-A) and Part B (TMT-B), and the National Aeronautics and Space Administration Task Load Index (NASA-TLX) for obtaining subjective information from drivers. Driving scenarios were developed based on the driving characteristics of older adults to investigate age-related driving ability. The driving behavior parameters included reaction time, lateral stability, and driving speed, corresponding to reaction, perception, and execution. Three stepwise regression models showed that NASA-TLX, the interaction between age and driving experience, and the interaction between age and TMT-A significantly explained 53.3 % of reaction time variance; TMT-A, risk driving style, anxiety driving style, and gender significantly explained 53.5 % of lateral stability variance; TMT-A, NASA-TLX, and MMSE significantly explained 60.6 % of driving speed variance. Subsequently, the impact of four age-related predictor variables on driving behavior was further discussed. It is worth noting that a rich driving experience may compensate for driving performance. However cognitive impairment impairs this compensation. Driving behavior is influenced by a combination of various factors. Age, as a physiological indicator, is not sufficient to be a strong predictive factor for lateral stability and driving speed. The results provide a reference for traffic safety management departments to streamline driving suitability test procedures and propose targeted training methods for older drivers.

Evaluation of electromagnetic scattering characteristics of construction solid waste-A theoretical study of solid waste identification

The surge in urban development has resulted in a substantial accumulation of construction solid waste (CSW). However, prevailing identification methods of CSW remain predominantly two-dimensional in scope and need to be more efficient. This study employs an approach, combining simulation and experimental analyses, to delve into the factors influencing the electromagnetic scattering characteristics of CSW, investigating the feasibility of employing Synthetic Aperture Radar (SAR) to recognize CSW. The findings show that the computational time of MLFMM and PO is only 3.28 % and 0.029 % of MM among different simulation methods. The results underscore the collective impact of material types, surface structures, and curvature on the scattering characteristics of CSW. The difference in average intensity between different materials can reach up to 13 dB. Exploiting these distinctions in scattering enables the precise identification of high-value waste components, such as intact bricks and steel bars, within the intricate landscape of CSW.

Study on induced radioactivity and individual dose evaluation in Gantry room for Varian ProBeam Proton Therapy System

Proton therapy has emerged as an advantageous modality for tumor radiotherapy due to its favorable physical and biological properties. However, this therapy generates induced radioactivity through nuclear reactions between the primary beam, secondary particles, and surrounding materials. This study focuses on systematically investigating the induced radioactivity in the gantry room during pencil beam scanning, utilizing both experimental measurements and Monte Carlo simulations. Results indicate that patients are the primary source of induced radioactivity, predominantly producing radionuclides such as 11C, 13N, and 15O. Long-term irradiation primarily generates radionuclides like 22Na, 24Na, and 54Mn etc. Additionally, this study estimates the individual doses received by medical workers in the gantry room, the irradiation dose for patient escorts, and the additional dose to patients from residual radiation. Finally, the study offers recommendations to minimize unnecessary irradiation doses to medical workers, patient escorts, and patients.

An improved method for generating human spinal cord neural stem cells

Neural stem cells have exhibited efficacy in pre-clinical models of spinal cord injury (SCI) and are on a translational path to human testing. We recently reported that neural stem cells must be driven to a spinal cord fate to optimize host axonal regeneration into sites of implantation in the injured spinal cord, where they subsequently form neural relays across the lesion that support significant functional improvement. We also reported methods of deriving and culturing human spinal cord neural stem cells derived from embryonic stem cells that can be sustained over serial high passage numbers in vitro, providing a potentially optimized cell source for human clinical trials. We now report further optimization of methods for deriving and sustaining cultures of human spinal cord neural stem cell lines that result in improved karyotypic stability while retaining anatomical efficacy in vivo. This development improves prospects for safe human translation.

Self-assembly and aggregation behavior of temperature-controlled modified glycinin and d-galactose colloidal particles

The molecular structure and morphologies of complex colloidal particles with modified glycine (S-11S) and d-galactose were studied by multispectral, microscopic imaging and chromatographic techniques at different temperatures, and the self-assembly and aggregation mechanisms were determined. Overall, high-temperature-treated S-11S and d-galactose associate at cysteine and phenylalanine sites and self-assemble into colloidal particles of greater stability than glycinin and S-11S via ionic and disulfide bonds. The structure and subunit content of composite colloidal particles were changed. Assessing the sub-microstructure reveals that temperature can regulate the directional aggregation of complex colloidal particles. The elasticity of the complex colloidal particles is maximum enhanced at 95 ℃ as confirmed by the rheological. Thus, the heat-treated aggregation of the soy protein and its complex was evaluated to provide a new theoretical basis for the application of soy protein in gels and other areas and contribute to the design of new soy protein products.

Quemeiteng granule relieves goiter by suppressing thyroid microvascular endothelial cell proliferation and angiogenesis via miR-217-5p-mediated targeting of FGF2-induced regulation of the ERK pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Goiters are enlargements of the thyroid gland and are a global public issue. Quemeiteng granule (QMTG) is a traditional Chinese medicine (TCM) formula used to treat goiter in Yunnan Province. However, the effectiveness and underlying mechanism of these treatments have not been fully elucidated.

AIM OF THE STUDY

This study aimed to investigate the therapeutic effects of QMTG on goiter and the downstream regulatory mechanisms.

MATERIALS AND METHODS

In this study, we first evaluated the antigoiter efficacy of QMTG through biochemical indices [body weight, thyroid coefficient, triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH)] and hematoxylin-eosin (HE) staining in a Propylthiouracil (PTU)-induced model. Based on microRNA sequencing (miRNA-seq) and bioinformatics analysis, key miRNA was screened out. A dual-luciferase reporter assay was performed to confirm the transcriptional regulation of the target gene by the miRNA. The viability of rat thyroid microvascular endothelial cells (RTMECs) and human thyroid microvascular endothelial cells (HTMECs) was assessed using the CCK-8 assays. The migration and angiogenesis of RTMECs and HTMECs were visualized through tube formation and wound scratch assays. Proteins involved in angiogenesis and the ERK pathway were assessed via Western blotting.

RESULTS

QMTG significantly increased body weight, decreased the thyroid coefficient, increased the levels of T3, T4, FT3 and FT4 and reduced TSH levels in rats with goiter. QMTG also promoted the morphological recovery of thyroid follicles. MiR-217-5p was identified as a key miRNA. Our studies revealed that miR-217-5p directly targets FGF2 and that QMTG promotes the recovery of thyroid hormone (TH) levels and morphological changes in the thyroid, suppresses thyroid microvascular endothelial cell vitality, tube formation and migration, and reduces the expression of VEGF, Ang-1 and VCAM-1 triggered by miR-217-5p, thereby inhibiting the Ras/MEK/ERK cascade through FGF2.

CONCLUSIONS

Our experiments demonstrated that the QMTG had therapeutic effects on goiter. These effects were attributed to the inhibition of ERK pathway-induced proliferation and angiogenesis through the targeting of FGF2 by miR-217-5p.

Different effects of 24 dietary intakes on gastroesophageal reflux disease: A mendelian randomization

BACKGROUND

In observational studies, dietary intakes are associated with gastroesophageal reflux disease (GERD).

AIM

To conduct a two-sample mendelian randomization (MR) analysis to determine whether those associations are causal.

METHODS

To explore the relationship between dietary intake and the risk of GERD, we extracted appropriate single nucleotide polymorphisms from genome-wide association study data on 24 dietary intakes. Three methods were adopted for data analysis: Inverse variance weighting, weighted median methods, and MR-Egger's method. The odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the causal association between dietary intake and GERD.

RESULTS

Our univariate Mendelian randomization (UVMR) results showed significant evidence that pork intake (OR, 2.83; 95%CI: 1.76-4.55; P = 1.84 × 10^–5), beer intake (OR, 2.70, 95%CI: 2.00-3.64; P = 6.54 × 10^–11), non-oily fish intake (OR, 2.41; 95%CI: 1.49-3.91; P = 3.59 × 10^–4) have a protective effect on GERD. In addition, dried fruit intake (OR, 0.37; 95%CI: 0.27-0.50; 6.27 × 10^–11), red wine intake (OR, 0.34; 95%CI: 0.25-0.47; P = 1.90 × 10^-11), cheese intake (OR, 0.46; 95%CI: 0.39-0.55; P =3.73 × 10^-19), bread intake (OR, 0.72; 95%CI: 0.56-0.92; P = 0.0009) and cereal intake (OR, 0.45; 95%CI: 0.36-0.57; P = 2.07 × 10^-11) were negatively associated with the risk of GERD. There was a suggestive association for genetically predicted coffee intake (OR per one SD increase, 1.22, 95%CI: 1.03-1.44; P = 0.019). Multivariate Mendelian randomization further confirmed that dried fruit intake, red wine intake, cheese intake, and cereal intake directly affected GERD. In contrast, the impact of pork intake, beer intake, non-oily fish intake, and bread intake on GERD was partly driven by the common risk factors for GERD. However, after adjusting for all four elements, there was no longer a suggestive association between coffee intake and GERD.

CONCLUSION

This study provides MR evidence to support the causal relationship between a broad range of dietary intake and GERD, providing new insights for the treatment and prevention of GERD.

Integrated surface-enhanced Raman spectroscopy and convolutional neural network for quantitative and qualitative analysis of pesticide residues on pericarp

Pesticide residue poses a significant global public health concern, necessitating improved detection methods. Here, a novel platform was introduced based on surface-enhanced Raman spectroscopy (SERS) to detect ten distinct types of pesticides. Notably, the sensitivity of this approach is exemplified by detecting trace amounts of 50 pM (10 ppt) thiabendazole. The correlation between the characteristic peak intensity of coexisting pesticides and their concentrations displays an exceptional linear relationship (R2 = 0.9999), underscoring its utility for quantitative mixed pesticide detection. Additionally, qualitative analysis of five mixed pesticides was conducted leveraging distinctive peak labeling. Harnessing machine learning techniques, a model for classifying and predicting pesticides on pericarps was developed. Remarkably, the convolutional neural network achieved classification accuracy of 100 % and prediction accuracy of 99.62 %. This innovative approach accurately identifies and quantifies diverse pesticides, thus offering a feasible scheme for in-situ detection of pesticide residues. Ultimately, this strategy contributes to ensuring food safety and public health.

Serum tRF-33-RZYQHQ9M739P0J as a novel biomarker for auxiliary diagnosis and disease course monitoring of hepatocellular carcinoma

Objective

In most cases, patients with hepatocellular carcinoma (HCC) develop advanced disease when diagnosed. Finding new molecules to combine with traditional biomarkers is crucial for HCC early diagnosis. In cancer development, tRNA-derived small RNAs (tsRNA) play a crucial role. Here, we aimed to identify a novel biomarker among tsRNAs that can facilitate HCC diagnosis and monitor its prognosis.

Methods

We screened candidate tsRNAs in 3 pairs of HCC and adjacent tissues through high-throughput sequencing. tRF-33-RZYQQ9M739P0J was screened in tissues, sera, and cells through quantitative real-time polymerase chain reaction (qRT-PCR) for further analysis. tRF-33-RZYQHQ9M739P0J was characterized using agarose gel electrophoresis, Sanger sequencing, and nuclear and cytoplasmic RNA isolation. Experiments at room temperature and repeated freeze-thaw cycles were conducted to evaluate the detection performance of tRF-33-RZYQHQ9M739P0J. We measured the levels of differential expression of tRF-33-RZYQHQ9M739P0J in sera using qRT-PCR. We applied the chi-square test to evaluate the correlation between tRF-33-RZYQHQ9M739P0J expression levels and clinicopathological features, and assessed its prognostic value by plotting Kaplan-Meier curves. The diagnostic efficacy of tRF-33-RZYQHQ9M739P0J was evaluated using the receiver operating characteristic (ROC) curve. Finally, the downstream genes related to tRF-33-RZYQHQ9M739P0J were explored through bioinformatics prediction.

Results

tRF-33-RZYQHQ9M739P0J was highly expressed in HCC tissues and sera, and its expression was correlated with metastasis, TNM stage, BCLC stage, and vein invasion. Expression of tRF-33-RZYQHQ9M739P0J were decreased after surgery in patients with HCC. High serum tRF-33-RZYQHQ9M739P0J levels are associated with low survival rates, and they can predict survival times in patients with HCC according to the Kaplan-Meier analysis. Combining tRF-33-RZYQHQ9M739P0J with serum alpha-fetoprotein and prothrombin induced by vitamin K absence II can improve the diagnostic efficiency of HCC, suggesting its potential as a biomarker for HCC.

Conclusion

tRF-33-RZYQHQ9M739P0J may not only be a promising non-invasive marker for early diagnosis, but also a predictor of liver cancer progression.

Effects of microplastics on soil microorganisms and microbial functions in nutrients and carbon cycling - A review

The harmful effects of microplastics (MPs) pollution in the soil ecosystem have drawn global attention in recent years. This paper critically reviews the effects of MPs on soil microbial diversity and functions in relation to nutrients and carbon cycling. Reports suggested that both plastisphere (MP-microbe consortium) and MP-contaminated soils had distinct and lower microbial diversity than that of non-contaminated soils. Alteration in soil physicochemical properties and microbial interactions within the plastisphere facilitated the enrichment of plastic-degrading microorganisms, including those involved in carbon (C) and nutrient cycling. MPs conferred a significant increase in the relative abundance of soil nitrogen (N)-fixing and phosphorus (P)-solubilizing bacteria, while decreased the abundance of soil nitrifiers and ammonia oxidisers. Depending on soil types, MPs increased bioavailable N and P contents and nitrous oxide emission in some instances. Furthermore, MPs regulated soil microbial functional activities owing to the combined toxicity of organic and inorganic contaminants derived from MPs and contaminants frequently encountered in the soil environment. However, a thorough understanding of the interactions among soil microorganisms, MPs and other contaminants still needs to develop. Since currently available reports are mostly based on short-term laboratory experiments, field investigations are needed to assess the long-term impact of MPs (at environmentally relevant concentration) on soil microorganisms and their functions under different soil types and agro-climatic conditions.

Unveiling biomarkers and therapeutic targets in IgA nephropathy through large-scale blood transcriptome analysis

INTRODUCTION

IgA nephropathy (IgAN) is the most prevalent form of glomerulonephritis. Unfortunately, molecular biomarkers for IgAN derived from omics studies are still lacking. This research aims to identify critical genes associated with IgAN through large-scale blood transcriptome analysis.

METHODS

We constructed novel blood transcriptome profiles from peripheral blood mononuclear cells (PBMCs) of 53 Chinese IgAN patients and 28 healthy individuals. Our analysis included GO, KEGG, and GSEA for biological pathways. We analyzed immune cell profiles with CIBERSORT and constructed PPI networks with STRING, visualized in Cytoscape. Key differentially expressed genes (DEGs) were identified using CytoHubba and MCODE. We assessed the correlation between gene expressions and clinical data to evaluate clinical significance and identified hub genes through machine learning, validated with an open-access dataset. Potential drugs were explored using the CMap database.

RESULTS

We identified 333 DEGs between IgAN patients and healthy controls, mainly related to immune response and inflammation. Key pathways included NK cell mediated cytotoxicity, complement and coagulation cascades, antigen processing, and B cell receptor signaling. Cytoscape revealed 16 clinically significant genes (including KIR2DL1, KIR2DL3, VISIG4, C1QB, and C1QC, associated with sub-phenotype and prognosis). Machine learning identified two hub genes (KLRC1 and C1QB) for a diagnostic model of IgAN with 0.92 accuracy, validated at 1.00 against the GSE125818 dataset. Sirolimus, calcifediol, and efaproxiral were suggested as potential therapeutic agents.

CONCLUSION

Key DEGs, particularly VISIG4, KLRC1, and C1QB, emerge as potential specific markers for IgAN, paving the way for future targeted personalized treatment options.

Programming Tetrathiafulvalene-Based Covalent Organic Frameworks for Promoted Photoinduced Molecular Oxygen Activation

Despite the pivotal role of molecular oxygen (O2) activation in artificial photosynthesis, the activation efficiency is often restricted by sluggish exciton dissociation and charge transfer kinetics within polymer photocatalysts. Herein, we propose two tetrathiafulvalene (TTF)-based imine-linked covalent organic frameworks (COFs) with tailored donor-acceptor (D-A) structures, TTF-PDI-COF and TTF-TFPP-COF, to promote O2 activation. Because of enhanced electron push-pull interactions that facilitated charge separation and transfer behavior, TTF-PDI-COF exhibited superior photocatalytic activity in electron-induced O2 activation reactions over TTF-TFPP-COF under visible light irradiation, including the photosynthesis of (E)-3-amino-2-thiocyano-α,β-unsaturated compounds and H2O2. These findings highlight the significant potential of the rational design of COFs with D-A configurations as suitable candidates for advanced photocatalytic applications.

A novel fluorescence probe for ultrafast detection of SO2 derivatives/biogenic amines and its multi-application: Detecting food and fish freshness, fluorescent dye and bioimaging

In this study, we have effectively prepared a novel fluorescent probe named HDXM based on benzopyran derivatives for the ultrafast detection (within 3 s) of SO2 derivatives or biogenic amines. HDXM showed a noticeable color change after the addition of SO2 derivatives (from purple to colorless) or biogenic amines (from purple to blue), indicating that HDXM can identify two analytes with the naked eye. It is worth noting that HDXM can be used to detect SO2 derivatives in actual sugar samples, and to image HSO3-/SO32- in living cells. More importantly, sensing labels (HDXM-loaded filter paper or agarose hydrogel) enable real-time visual monitoring of salmon freshness through colorimetric and fluorescence dual channels. Compared with the Chinese national standard method, the sensing label is an effective tool for evaluating the freshness of fish. Benefiting from its excellent solubility and fluorescence performance, HDXM can be used as a versatile fluorescent material in various applications, including flexible films, glass coatings, impregnating dyes, printing, and fingerprint ink. HDXM is expected to be a promising and valuable multifunctional tool for food safety and fluorescent materials.

Dual Challenge-Response Systems of a Three-Dimensional "Bionic" Fluorescent Physically Unclonable Function Label

Inspired by the light and dark variations observed in natural cloud clusters under sunlight, we propose a three-dimensional (3D) "bionic" fluorescent physically unclonable function (PUF) label. The minimalist preparation process eliminates the need for expensive traditional instruments, thus offering new insight into the widespread adoption of 3D PUF labels. The Eu(CCA)3(H2O)2 powder, which is the first to propose its secondary building unit, was chosen as the fluorescent material. Its 3D morphology is preserved in the resin to mimic cloud-like structures. Furthermore, the luminescent properties are elucidated through experimental tests and first-principles calculations. To overcome the coding capacity limitation of traditional two-dimensional (2D) fluorescent PUF labels, a dual challenge-response system model is proposed. The shallow and deep models provide anticounterfeiting information from macro and micro perspectives, respectively. This successfully increases the encoding capacity from 210×10 to 2100×10000 for a 10 × 10 pixel binary code. Therefore, 3D "bionic" fluorescent PUF labels strike a balance between the simple usage of PUF labels and enhanced label security.

Development of an immunoinflammatory indicator-related dynamic nomogram based on machine learning for the prediction of intravenous immunoglobulin-resistant Kawasaki disease patients

BACKGROUND

Approximately 10-20% of Kawasaki disease (KD) patients suffer from intravenous immunoglobulin (IVIG) resistance, placing them at higher risk of developing coronary artery aneurysms. Therefore, we aimed to construct an IVIG resistance prediction tool for children with KD in Shanghai, China.

METHODS

Retrospective analysis was conducted on data from 1271 patients diagnosed with KD and the patients were randomly divided into a training set and a validation set in a 2:1 ratio. Machine learning algorithms were employed to identify important predictors associated with IVIG resistance and to build a predictive model. The best-performing model was used to construct a dynamic nomogram. Moreover, receiver operating characteristic curves, calibration plots, and decision-curve analysis were utilized to measure the discriminatory power, accuracy, and clinical utility of the nomogram.

RESULTS

Six variables were identified as important predictors, including C-reactive protein, neutrophil ratio, procalcitonin, CD3 ratio, CD19 count, and IgM level. A dynamic nomogram constructed with these factors was available at https://hktk.shinyapps.io/dynnomapp/. The nomogram demonstrated good diagnostic performance in the training and validation sets (area under the receiver operating characteristic curve = 0.816 and 0.800, respectively). Moreover, the calibration curves and decision curves analysis indicated that the nomogram showed good consistency between predicted and actual outcomes and had good clinical benefits.

CONCLUSION

A web-based dynamic nomogram for IVIG resistance was constructed with good predictive performance, which can be used as a practical approach for early screening to assist physicians in personalizing the treatment of KD patients in Shanghai.

Sodium oligomannate activates the enteroendocrine-vagal afferent pathways in APP/PS1 mice

Enteroendocrine cells (EECs) and vagal afferent neurons constitute functional sensory units of the gut, which have been implicated in bottom-up modulation of brain functions. Sodium oligomannate (GV-971) has been shown to improve cognitive functions in murine models of Alzheimer's disease (AD) and recently approved for the treatment of AD patients in China. In this study, we explored whether activation of the EECs-vagal afferent pathways was involved in the therapeutic effects of GV-971. We found that an enteroendocrine cell line RIN-14B displayed spontaneous calcium oscillations due to TRPA1-mediated calcium entry; perfusion of GV-971 (50, 100 mg/L) concentration-dependently enhanced the calcium oscillations in EECs. In ex vivo murine jejunum preparation, intraluminal infusion of GV-971 (500 mg/L) significantly increased the spontaneous and distension-induced discharge rate of the vagal afferent nerves. In wild-type mice, administration of GV-971 (100 mg· kg-1 ·d-1, i.g. for 7 days) significantly elevated serum serotonin and CCK levels and increased jejunal afferent nerve activity. In 7-month-old APP/PS1 mice, administration of GV-971 for 12 weeks significantly increased jejunal afferent nerve activity and improved the cognitive deficits in behavioral tests. Sweet taste receptor inhibitor Lactisole (0.5 mM) and the TRPA1 channel blocker HC-030031 (10 µM) negated the effects of GV-971 on calcium oscillations in RIN-14B cells as well as on jejunal afferent nerve activity. In APP/PS1 mice, co-administration of Lactisole (30 mg ·kg-1 ·d-1, i.g. for 12 weeks) attenuated the effects of GV-971 on serum serotonin and CCK levels, vagal afferent firing, and cognitive behaviors. We conclude that GV-971 activates sweet taste receptors and TRPA1, either directly or indirectly, to enhance calcium entry in enteroendocrine cells, resulting in increased CCK and 5-HT release and consequent increase of vagal afferent activity. GV-971 might activate the EECs-vagal afferent pathways to modulate cognitive functions.

Duhamel and transanal endorectal pull-throughs for Hirschsprung disease: a Bayesian network meta-analysis

BACKGROUND

To comprehensively compare the effects of open Duhamel (OD), laparoscopic-assisted Duhamel (LD), transanal endorectal pull-through (TEPT), and laparoscopic-assisted endorectal pull-through (LEPT) in Hirschsprung disease.

METHODS

PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP were comprehensively searched up to August 4, 2022. The outcomes were operation-related indicators and complication-related indicators. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Network plots, forest plots, league tables and rank probabilities were drawn for all outcomes. For measurement data, weighted mean differences (WMDs) and 95% credibility intervals (CrIs) were reported; for enumeration data, relative risks (RRs) and 95%CrIs were calculated.

RESULTS

Sixty-two studies of 4781 patients were included, with 2039 TEPT patients, 1669 LEPT patients, 951 OD patients and 122 LD patients. Intraoperative blood loss in the OD group was more than that in the LEPT group (pooled WMD = 44.00, 95%CrI: 27.33, 60.94). Patients lost more blood during TEPT versus LEPT (pooled WMD = 13.08, 95%CrI: 1.80, 24.30). In terms of intraoperative blood loss, LEPT was most likely to be the optimal procedure (79.76%). Patients undergoing OD had significantly longer gastrointestinal function recovery time, as compared with those undergoing LEPT (pooled WMD = 30.39, 95%CrI: 16.08, 44.94). The TEPT group had significantly longer gastrointestinal function recovery time than the LEPT group (pooled WMD = 11.49, 95%CrI: 0.96, 22.05). LEPT was most likely to be the best operation regarding gastrointestinal function recovery time (98.28%). Longer hospital stay was observed in patients with OD versus LEPT (pooled WMD = 5.24, 95%CrI: 2.98, 7.47). Hospital stay in the TEPT group was significantly longer than that in the LEPT group (pooled WMD = 1.99, 95%CrI: 0.37, 3.58). LEPT had the highest possibility to be the most effective operation with respect to hospital stay. The significantly reduced incidence of complications was found in the LEPT group versus the LD group (pooled RR = 0.24, 95%CrI: 0.12, 0.48). Compared with LEPT, OD was associated with a significantly increased incidence of complications (pooled RR = 5.10, 95%CrI: 3.48, 7.45). Patients undergoing TEPT had a significantly greater incidence of complications than those undergoing LEPT (pooled RR = 1.98, 95%CrI: 1.63, 2.42). For complications, LEPT is most likely to have the best effect (99.99%). Compared with the LEPT group, the OD group had a significantly increased incidence of anastomotic leakage (pooled RR = 5.35, 95%CrI: 1.45, 27.68). LEPT had the highest likelihood to be the best operation regarding anastomotic leakage (63.57%). The incidence of infection in the OD group was significantly higher than that in the LEPT group (pooled RR = 4.52, 95%CrI: 2.45, 8.84). The TEPT group had a significantly increased incidence of infection than the LEPT group (pooled RR = 1.87, 95%CrI: 1.13, 3.18). LEPT is most likely to be the best operation concerning infection (66.32%). Compared with LEPT, OD was associated with a significantly higher incidence of soiling (pooled RR = 1.91, 95%CrI: 1.16, 3.17). Patients with LEPT had the greatest likelihood not to develop soiling (86.16%). In contrast to LD, LEPT was significantly more effective in reducing the incidence of constipation (pooled RR = 0.39, 95%CrI: 0.15, 0.97). LEPT was most likely not to result in constipation (97.81%). LEPT was associated with a significantly lower incidence of Hirschprung-associated enterocolitis (HAEC) than LD (pooled RR = 0.34, 95%CrI: 0.13, 0.85). The OD group had a significantly higher incidence of HAEC than the LEPT group (pooled RR = 2.29, 95%CrI: 1.31, 4.0). The incidence of HAEC was significantly greater in the TEPT group versus the LEPT group (pooled RR = 1.74, 95%CrI: 1.24, 2.45). LEPT was most likely to be the optimal operation in terms of HAEC (98.76%).

CONCLUSION

LEPT may be a superior operation to OD, LD and TEPT in improving operation condition and complications, which might serve as a reference for Hirschsprung disease treatment.

Associations of ambient temperature and total cloud cover during pregnancy with newborn vitamin D status

OBJECTIVES

We aimed to estimate the effects of temperature and total cloud cover before birth on newborn vitamin D status.

STUDY DESIGN

Prospective birth cohort.

METHODS

This study included 2055 mother-newborn pairs in Wuhan, Hubei province, China. The data of temperature and total cloud cover from 30 days before birth were collected, and cord blood 25-hydroxyvitamin D [25(OH)D] were determined. Restricted cubic spline regression models, multiple linear regression models, and logistic regression models were applied to estimate the associations.

RESULTS

A "J" shaped curve was observed between temperature and vitamin D status, and an inverse "J" shaped curve was observed between total cloud cover and vitamin D status. Compared to the fourth quartile (75-100th percentile, Q4) of average temperature (30 days before birth), the odds ratio (OR) for Q1 (0-25th percentile) associated with the vitamin D deficiency occurrence (<20 ng/mL) was 3.63 (95% CI, 1.54, 8.65). Compared to Q1 of the average total cloud cover (30 days before birth), the OR associated with the occurrence of vitamin D deficiency was 2.38 (95% CI, 1.63, 3.50) for the Q4.

CONCLUSIONS

Low temperature and high cloud cover before delivery were significantly associated with an increased probability of vitamin D deficiency in newborns. The findings suggested that pregnancy women lacking sufficient sunlight exposure still need vitamin D supplement to overcome the potential vitamin D deficiency status.

Dual-specificity phosphatase 26 protects against kidney injury caused by ischaemia-reperfusion through restraint of TAK1-JNK/p38-mediated apoptosis and inflammation of renal tubular epithelial cells

Dual-specificity phosphatase 26 (DUSP26) acts as a pivotal player in the transduction of signalling cascades with its dephosphorylating activity. Currently, DUSP26 attracts extensive attention due to its particular function in several pathological conditions. However, whether DUSP26 plays a role in kidney ischaemia-reperfusion (IR) injury is unknown. Aims of the current work were to explore the relevance of DUSP26 in kidney IR damage. DUSP26 levels were found to be decreased in renal tubular epithelial cells following hypoxia-reoxygenation (HR) and kidney samples subjected to IR treatments. DUSP26-overexpressed renal tubular epithelial cells exhibited protection against HR-caused apoptosis and inflammation, while DUSP26-depleted renal tubular epithelial cells were more sensitive to HR damage. Upregulation of DUSP26 in rat kidneys by infecting adenovirus expressing DUSP26 markedly ameliorated kidney injury caused by IR, while also effectively reducing apoptosis and inflammation. The mechanistic studies showed that the activation of transforming growth factor-β-activated kinase 1 (TAK1)-JNK/p38 MAPK, contributing to kidney injury under HR or IR conditions, was restrained by increasing DUSP26 expression. Pharmacological restraint of TAK1 markedly diminished DUSP26-depletion-exacebated effects on JNK/p38 activation and HR injury of renal tubular cells. The work reported a renal-protective function of DUSP26, which protects against IR-related kidney damage via the intervention effects on the TAK1-JNK/p38 axis. The findings laid a foundation for understanding the molecular pathogenesis of kidney IR injury and provide a prospective target for treating this condition.

[Current status of pubertal sexual characteristics development of 2 704 girls aged 6-18 years in Tongzhou District of Beijing]

Objective: To understand the current status of pubertal sexual characteristics development of girls aged 6-18 years in Tongzhou District of Beijing and to compare the differences in sexual characteristics development among girls characterized as thin, normal, overweight, and obese. Methods: A cross-sectional survey was conducted among 2 844 girls aged 6-18 years in Tongzhou District of Beijing from September 2022 to July 2023. The developmental stages of breast and pubic hair were assessed on site, and menarche status was inquired. Weight and height were measured. The girls were subsequently characterized into thin, normal, overweight and obese groups. Basic information (including family and personal history) was obtained through questionnaires. Probit probability unit regression was applied to calculate the age of each Tanner stage of sexual characteristics development and the age of menarche. The χ2 test was applied to compare the counting data between two or multiple groups. Results: A total of 2 844 girls were surveyed and 2 704 girls met the inclusion criteria, resulting in a valid response rate of 95.1%. Among these girls, 1 105 (40.9%) were aged 6-9 years, 1 053 (38.9%) were aged 10-13 years, and 546 (20.2%) were aged 14-18 years. The of height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and body mass index-for-age Z-score (BAZ) were 0.46(-0.23,1.16), 0.69(-0.16,1.67), and 0.67(-0.27,1.73) respectively. The prevalences of thin, overweight, and obesity were respectively 1.7% (45/2 704), 17.3% (467/2 704), and 19.9% (538/2 704), respectively. There were 45 girls in the thin group, 1 654 girls in the normal weight group, 1 005 girls in the overweight and obesity group. The age of Tanner stage breast 2 (B2), Tanner stage pubic hair 2 (P2), and menarche was 9.0 (95%CI 8.9-9.1), 10.5 (95%CI 10.4-10.6), and 11.4 (95%CI 11.3-1.5) years, respectively. The current status of breast and pubic hair maturity in girls with pubertal development shows that 64.6% (1 211/1 874) of these girls had breast development preceding pubic hair development, 32.4% (607/1 874) had concurrent breast and pubic hair development, and 3.0% (56/1 874) had pubic hairs development preceding breast development. The interval age between B2 and B5 was 4.7 (95%CI 4.6-4.8) years, between P2 and P5 was 4.5 (95%CI 4.4-4.6) years, and between B2 and menarche was 2.4 (95%CI 2.3-2.5) years. The ages of sexual characteristics development in overweight and obese groups were earlier than that in normal and thin groups. The ages of B2 in thin, normal, overweight, and obese groups were 10.0 (95%CI 9.5-10.6), 9.3 (95%CI 9.2-9.4), and 8.6 (95%CI 8.4-8.7) years, respectively. The age of menarche in thin, normal, overweight, and obese groups were 13.1 (95%CI 12.4-13.7), 11.6 (95%CI 11.4-11.7), and 11.1 (95%CI 11.0-11.2) years, respectively. The interval ages between B2 and B5 and between P2 and P5 was 4.5 and 4.1 years, respectively in the overweight and obese groups, and those in normal group and thin group was 4.7 and 4.5 years, 4.6 and 4.7 years, respectively. Conclusions: The ages of sexual characteristics development and menarche tend in Tongzhou District of Beijing to be earlier than that being reported of Beijing's survey 20 years ago. Girls characterized as overweight and obese not only start puberty at an earlier age than girls of normal weight, but also have a shorter developmental process.

[Clinical characteristics of children with severe SARS-CoV-2 infection in Yunnan]

Objective: To investigate the clinical characteristics of 130 children with severe SARS-CoV-2 infection in Yunnan province after the relaxation of non-pharmaceutical interventions, and analyze the risk factors for mortality. Methods: This study is a retrospective case summary that analyzed the demographic data, underlying diseases, clinical diagnoses, disease outcomes, and laboratory results of 130 children with severe COVID-19 infections admitted to nine top-tier hospitals in Yunnan Province from December 2022 to March 2023. According to the prognosis, the patients were divided into survival group and death group. The clinical and laboratory data between the two groups were compared, and the risk factors of death were evaluated. The χ2 test and Mann-Whitney U test were employed to compare between groups, while Spearman correlation test and multiple Logistic regression were used to analyze the risk factors for death. The predictive value of independent risk factors was evaluated by receiver operating characteristic curve. Results: The 130 severe patients included 80 males and 50 females with an onset age of 28.0 (4.5, 79.5) months. There were 97 cases in the survival group and 33 cases in the death group with no significant differences in gender and age between the two groups (P>0.05). Twenty-five cases (19.2%) out of the 130 patients had underlying diseases, and the number with underlying diseases was significantly higher in death group than in survival group (36.4% (12/33) vs. 13.4%(13/97), χ2=8.36, P=0.004). The vaccination rate in the survival group was significantly higher than that in the death group (86.1% (31/36) vs. 7/17, χ2=9.38, P=0.002). A total of 42 cases (32.3%) of the 130 patients were detected to be infected with other pathogens, but there was no significant difference in the incidence of co-infection between the death group and the survival group (39.3%(13/33) vs. 29.9% (29/97), χ2=1.02, P>0.05). Among the 130 cases, severe respiratory cases were the most common 66 cases (50.8%), followed by neurological severe illnesses 34 cases (26.2%) and circulatory severe 13 cases (10%). Compared to the survival group, patients in the death group had a significantly higher levels of neutrophil, ferritin, procalcitonin, alanine aminotransferase, lactate dehydrogenase, creatine kinase isoenzyme, B-type natriuretic peptide, interleukin-6 and 10 (6.7 (4.0, 14.0) vs. 3.0 (1.6, 7.0)×109/L, 479 (298, 594) vs. 268 (124, 424) μg/L, 4.8 (1.7, 10.6) vs. 2.0 (1.1, 3.1) μg/L, 66 (20, 258) vs. 23 (15, 49) U/L, 464 (311, 815) vs. 304 (252, 388) g/L, 71(52, 110) vs. 24(15, 48) U/L, 484 (160, 804) vs. 154 (26, 440) ng/L, 43 (23, 102) vs. 19 (13, 27) ng/L, 216 (114, 318) vs. 86 (45, 128) ng/L, Z=-4.21, -3.67, -3.76, -3.31, -3.75, -5.74, -3.55, -4.65, -5.86, all P<0.05). The correlated indexes were performed by multivariate Logistic regression and the results showed that vaccination was a protective factor from death in severe cases (OR=0.01, 95%CI 0-0.97, P=0.049) while pediatric sequential organ failure assessment (PSOFA) (OR=3.31, 95%CI 1.47-7.47, P=0.004), neutrophil-to-lymphocyte ratio (NLR) (OR=1.56, 95%CI 1.05-2.32, P=0.029) and D dimer (OR=1.49, 95%CI 1.00-1.02, P=0.033) were independent risk factors for death (all P<0.05). The area under the curve of the three independent risk factors for predicting death were 0.86 (95%CI 0.79-0.94), 0.89 (95%CI 0.84-0.95) and 0.87 (95%CI 0.80-0.94), all P<0.001, and the cut-off values were 4.50, 3.66 and 4.69 mg/L, respectively. Conclusions: Severe SARS-CoV-2 infection can occur in children of all ages, primarily affecting the respiratory system, but can also infect the nervous system, circulatory system or other systems. Children who died had more severe inflammation, tissue damage and coagulation disorders. The elevations of PSOFA, NLR and D dimer were independent risk factors for death in severe children.

Oxygen-Evolving Radiotherapy-Radiodynamic Therapy Synergized with NO Gas Therapy by Cerium-Based Rare-Earth Metal-Porphyrin Framework

The efficacy of traditional radiotherapy (RT) has been severely limited by its significant side effects, as well as tumor hypoxia. Here, the nanoscale cerium (Ce)-based metaloxo clusters (Ce(IV)6)-porphyrin (meso-tetra (4-carboxyphenyl) porphyrin, TCPP) framework loaded with L-arginine (LA) (denoted as LA@Ce(IV)6-TCPP) is developed to serve as a multifarious radio enhancer to heighten X-ray absorption and energy transfer accompanied by O2/NO generation for hypoxia-improved RT-radiodynamic therapy (RDT) and gas therapy. Within tumor cells, LA@Ce(IV)6-TCPP will first react with endogenous H2O2 and inducible NO synthase (iNOS) to produce O2 and NO to respectively increase the oxygen supply and reduce oxygen consumption, thus alleviating tumor hypoxia. Then upon X-ray irradiation, LA@Ce(IV)6-TCPP can significantly enhance hydroxyl radical (•OH) generation from Ce(IV)6 metaloxo clusters for RT and synchronously facilitate singlet oxygen (1O2) generation from adjacently-coordinated TCPP for RDT. Moreover, both the •OH and 1O2 can further react with NO to generate more toxic peroxynitrite anions (ONOO-) to inhibit tumor growth for gas therapy. Benefitting from the alleviation of tumor hypoxia and intensified RT-RDT synergized with gas therapy, LA@Ce(IV)6-TCPP elicited superior anticancer outcomes. This work provides an effective RT strategy by using low doses of X-rays to intensify tumor suppression yet reduce systemic toxicity.

Symmetry-Reduction Enhanced Polarization-Sensitive Photoresponse Based on One-Dimensional van der Waals Materials

Designing high-performance polarization-sensitive photodetectors is essential for photonic device applications. Anisotropic one-dimensional (1D) van der Waals (vdW) materials have provided a promising platform to that end. Despite significant advances in 1D vdW photonic devices, their performance is still far from delivering practical potential. Herein, we propose the design of high-performance polarization-sensitive photodetectors using unique 1D vdW materials. By leveraging the chemical vapor transport technique, we successfully fabricate high-quality 1D vdW Nb2Pd1-xSe5 (x = 0.29) nanowires. The 1D vdW Nb2Pd1-xSe5 photodetector exhibits a high mobility of ∼56 cm2/(V s) and superior photoresponse performance, including a high responsivity of 1A/W and an ultrafast response time of ∼8 μs under 638 nm illumination. Moreover, the 1D vdW Nb2Pd1-xSe5 photodetector demonstrates excellent polarization-sensitive photoresponse with a degree of linear polarization (DOLP) up to 0.85 and can be modulated by adjusting the gate voltage, laser power density, and wavelength. Those exceptional performance are believed to be relevant to the symmetry-reduction induced by the partial occupation of Pd sites. This study offers feasible approaches to enhance the anisotropy of 1D vdW materials and the modulation of their polarization-sensitive photoresponse, which may provide deep insights into the physical origin of anisotropic properties of 1D vdW materials.

Novel alternative tools for metastatic pheochromocytomas/paragangliomas prediction

OBJECTIVE

The existing prediction models for metastasis in pheochromocytomas/paragangliomas (PPGLs) showed high heterogeneity in different centers. Therefore, this study aimed to establish new prediction models integrating multiple variables based on different algorithms.

DESIGN AND METHODS

Data of patients with PPGLs undergoing surgical resection at the Peking Union Medical College Hospital from 2007 to 2022 were collected retrospectively. Patients were randomly divided into the training and testing sets in a ratio of 7:3. Subsequently, decision trees, random forest, and logistic models were constructed for metastasis prediction with the training set and Cox models for metastasis-free survival (MFS) prediction with the total population. Additionally, Ki-67 index and tumor size were transformed into categorical variables for adjusting models. The testing set was used to assess the discrimination and calibration of models and the optimal models were visualized as nomograms. Clinical characteristics and MFS were compared between patients with and without risk factors.

RESULTS

A total of 198 patients with 59 cases of metastasis were included and classified into the training set (n = 138) and testing set (n = 60). Among all models, the logistic regression model showed the best discrimination for metastasis prediction with an AUC of 0.891 (95% CI, 0.793-0.990), integrating SDHB germline mutations [OR: 96.72 (95% CI, 16.61-940.79)], S-100 (-) [OR: 11.22 (95% CI, 3.04-58.51)], ATRX (-) [OR: 8.42 (95% CI, 2.73-29.24)] and Ki-67 ≥ 3% [OR: 7.98 (95% CI, 2.27-32.24)] evaluated through immunohistochemistry (IHC), and tumor size ≥ 5 cm [OR: 4.59 (95% CI, 1.34-19.13)]. The multivariate Cox model including the above risk factors also showed a high C-index of 0.860 (95% CI, 0.810-0.911) in predicting MFS after surgery. Furthermore, patients with the above risk factors showed a significantly poorer MFS (P ≤ 0.001).

CONCLUSIONS

Models established in this study provided alternative and reliable tools for clinicians to predict PPGLs patients' metastasis and MFS. More importantly, this study revealed for the first time that IHC of ATRX could act as an independent predictor of metastasis in PPGLs.

Facile synthesis of pyrite FeS2 on carbon spheres for high-efficiency Fenton-like reaction

Designing iron-based catalysts for Fenton-like reactions with peroxymonosulfate (PMS) as oxidants have attracted growing attentions. Herein, pyrite FeS2 supported on carbon spheres (FeS2@C) is synthesized by a facile low-temperature method. The FeS2@C/PMS system can degrade carbamazepine (CBZ) effectively in a wide pH range. Sulfate radicals (SO4·-), hydroxyl radicals (·OH), superoxide radical (O2·-), and singlet oxygen (1O2) are the responsible reactive oxygen species (ROSs) for CBZ degradation. Moreover, in the simulated fixed-bed reactor, the FeS2@C/PMS system can maintain a high CBZ removal ratio of >95% for than 8 h, exhibiting its excellent stability. The outstanding performance of FeS2@C/PMS system is attributed to the presence of carbon spheres and lattice S2-, which together promote the Fe(III)/Fe(II) redox cycle. The FeS2@C is a promising catalyst due to its facile synthesis, low cost, high efficiency, and excellent stability to activate PMS for organics degradation.

Dual targeting of TIGIT and PD-1 with a novel small molecule for cancer immunotherapy

Immune checkpoint inhibitors have unveiled promising clinical prospects in cancer treatment. Nonetheless, their effectiveness remains restricted, marked by consistently low response rates and affecting only a subset of patients. The co-blockade of TIGIT with PD-1 has exhibited substantial anti-tumor effects. Notably, there is a dearth of reports on small-molecule inhibitors concurrently targeting both TIGIT and PD-1. In this study, we employed Microscale Thermophoresis (MST) to screen our laboratory's existing repository of small molecules. Our findings illuminated Gln(TrT) 's affinity for both TIGIT and PD-1, affirming its potential to effectively inhibit TIGIT/PVR and PD-1/PD-L1 pathways. In vitro co-culture experiments substantiated Gln(TrT)'s proficiency in restoring Jurkat T-cell functionality by blocking both TIGIT/PVR and PD-1/PD-L1 interactions. In the MC38 murine tumor model, Gln(TrT) emerges as a pivotal modulator, promoting the intratumoral infiltration and functional competence of CD8+ T cells. Furthermore, whether used as a monotherapy or in conjunction with radiotherapy, Gln(TrT) substantially impedes MC38 tumor progression, significantly extending the survival of murine subjects.

Assessment of spilled oil dispersion affected by dispersant: Characteristic, stability, and related mechanism

Oil dispersion, a crucial process in oil transport, involves the detachment of oil droplets from slicks and their introduction into the water column, influencing subsequent oil migration and transformation. This study examines oil dispersion, considering characteristics, stability, and mechanisms, while evaluating the impact of dispersants and salinity. Results show the significant role of surfactant type in dispersants on oil dispersion characteristics, with anionic surfactants exhibiting higher sensitivity to salinity changes compared to nonionic surfactants. The dispersion efficiency varies with salinity, with anionic surfactants performing better in low salinity (<20‰) and nonionic surfactants showing superior performance at 30-35‰ salinities. Rheological analysis illustrates the breakup and coalescence of oil droplets within the shear rates of breaking waves. An increase in interfacial film rigidity impedes the coalescence of oil droplets, contributing to the dynamic stability of the oil-water hybrid system. The use of GM-2, a nonionic dispersant, results in the formation of a solid-like interface, characterized by increased elastic modulus, notably at 20‰ salinity. However, stable droplet size distribution (DSD) at 35‰ salinity for 60 h suggests droplets can remain dispersed in seawater. The enhancement of stability of oil dispersion is interpreted as the result of two mechanisms: stabilizing DSD and developing the strength of viscoelastic interfacial film. These findings offer insights into oil dispersion dynamics, highlighting the importance of surfactant selection and salinity in governing dispersion behavior, and elucidating mechanisms underlying dispersion stability.

Federated Multiagent Deep Reinforcement Learning Approach via Physics-Informed Reward for Multimicrogrid Energy Management

The utilization of large-scale distributed renewable energy (RE) promotes the development of the multimicrogrid (MMG), which raises the need of developing an effective energy management method to minimize economic costs and keep self energy sufficiency. The multiagent deep reinforcement learning (MADRL) has been widely used for the energy management problem because of its real-time scheduling ability. However, its training requires massive energy operation data of microgrids (MGs), while gathering these data from different MGs would threaten their privacy and data security. Therefore, this article tackles this practical yet challenging issue by proposing a federated MADRL (F-MADRL) algorithm via the physics-informed reward. In this algorithm, the federated learning (FL) mechanism is introduced to train the F-MADRL algorithm, thus ensures the privacy and the security of data. In addition, a decentralized MMG model is built, and the energy of each participated MG is managed by an agent, which aims to minimize economic costs and keep self energy sufficiency according to the physics-informed reward. At first, MGs individually execute the self-training based on local energy operation data to train their local agent models. Then, these local models are periodically uploaded to a server and their parameters are aggregated to build a global agent, which will be broadcasted to MGs and replace their local agents. In this way, the experience of each MG agent can be shared and the energy operation data are not explicitly transmitted, thus protecting the privacy and ensuring data security. Finally, experiments are conducted on Oak Ridge National Laboratory distributed energy control communication laboratory MG (ORNL-MG) test system, and the comparisons are carried out to verify the effectiveness of introducing the FL mechanism and the outperformance of our proposed F-MADRL.