Large-scale afforestation and forest conservation policies have been widely implemented in Southwest China over past decades.These efforts have significantly protected the remaining long-established forests in the reg...Large-scale afforestation and forest conservation policies have been widely implemented in Southwest China over past decades.These efforts have significantly protected the remaining long-established forests in the region and greatly expanded forested areas.Utilizing nearly 30 years of satellite time-series data,we reveal that the region’s enhanced carbon sequestration(3×10^(12) g·C annually)is primarily driven by crucial changes in forest structure and age,occurring alongside a nearly 120%increase in forested land area.We observe that dense forests maintain a rapid growth rate of approximately 2.5%annually for carbon sequestration in the initial years after establishment.However,this growth rate decelerates with increasing apparent forest age.Meanwhile,the densification(modeled as an increasing forest probability)rate of forests reaches its peak growth during the 10-20 year period,sustaining a high annual growth rate of about 1.8%.We also find that improvements in forest structure,particularly the increasing of forest canopy density and apparent forest age coupled with a notable reduction in forest fragmentation,are also the main driving factors for the enhanced carbon sequestration capacity.Based on these findings,we conclude that forest restoration policies in Southwest China have been successful not only in facilitating large-scale forest growth in Southwest China but,more critically,in promoting the structural maturation(e.g.,densification and reduced fragmentation)that is essential for enhancing the region’s carbon sink capacity and its resilience.展开更多
Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle ane...Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle anesthesia, and bowel incontinence. This case report describes a 59-year-old immunosuppressed male with idiopathic pulmonary fibrosis who developed Elsberg syndrome due to re-activation of latent HSV-2. The patient experienced progressive lower extremity sensory deficits and genitourinary dysfunction, culminating in a vesiculopustular rash. Diagnosis was confirmed via cerebrospinal fluid analysis and PCR testing of skin lesions. Despite early imaging findings being unremarkable, subsequent MRI revealed enhancement of the conus medullaris and cauda equina. Treatment with intravenous acyclovir, corticosteroids, and supportive therapy led to gradual functional improvement, though sensory deficits and neuropathy persisted. This case highlights the diagnostic challenges and importance of clinical suspicion for HSV-2 reactivation in immunosuppressed patients, as well as considerations for long-term symptom management.展开更多
Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clini...Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.展开更多
Objectives:This study had two aims.Aim one is to evaluate the feasibility and acceptability of using an aroma-based,self-managed intervention for adults in outpatient treatment for substance use disorder.Aim two is to...Objectives:This study had two aims.Aim one is to evaluate the feasibility and acceptability of using an aroma-based,self-managed intervention for adults in outpatient treatment for substance use disorder.Aim two is to examine the effects of a Citrus bergamia(Bergamot)essential oil intervention on the variables of comfort,ease,and stress.Methods:A randomized controlled trial was conducted(NCT05660434).Adults in treatment for substance use disorder were randomized to either control group(standard care)(n=55)or intervention group(standard care plus Citrus bergamia[Bergamot]essential oil intervention),three times a day for seven days(n=45).All data were analyzed using an intention-to-treat method.Outcomes were measured using valid and reliable measures.Results:One hundred participants were recruited over 11 months.Reasons for non or limited participation included feeling overwhelmed by the demands of treatment and everyday living.Data analysis showed psychological variable improvement with a significant increase in ease reported(P=0.022)and DASS-21 subscales for depression(P=0.007)and anxiety(P=0.013)in the intervention group.Postsatisfaction survey results were positive,with overall enjoyment,perception of the aroma,and intention to continue to use the aroma inhaler post-trial,which was high.Conclusions:Results from this study provide data to support the feasibility and acceptability of using essential oil via inhalation to help this population.Findings from this study will inform a more extensive study designed to examine effects within and between groups using a placebo.展开更多
The Five-hundred-meter Aperture Spherical Telescope(FAST)is living up to its promise as one of the world's premiere pulsar finding instruments.At the center of FAST's many significant pulsar discoveries(which ...The Five-hundred-meter Aperture Spherical Telescope(FAST)is living up to its promise as one of the world's premiere pulsar finding instruments.At the center of FAST's many significant pulsar discoveries(which in total number 1000 from all projects to date)is the announcement by Han et al.(2025)of a further 473 pulsars.The new discoveries are the latest installment from the FAST Galactic Plane Snapshot Survey(GPPS),bringing its total to 751 pulsars.Full details of the design and observational setup of the FAST GPPS can be found in Han et al.(2021).展开更多
This review provides a comprehensive summary of biomass-based adsorption,with a particular focus on biochar as an innovative,sustainable,and eco-friendly technique for recovering rare earth elements(REEs) from various...This review provides a comprehensive summary of biomass-based adsorption,with a particular focus on biochar as an innovative,sustainable,and eco-friendly technique for recovering rare earth elements(REEs) from various sources.This study details primary adsorption mechanisms,including physical adsorption,ion exchange,electrostatic attraction,surface complexation,and precipitation,providing a nuanced understanding of how these processes contribute to metal recovery.Additionally,it discusses various biochar modification methods aimed at enhancing surface functionalities,thereby improving adsorption capacity and selectivity.It further addresses the critical challenge of biochar regeneration,outlining methods such as thermal,solvent,microwave irradiation,and supercritical fluid regeneration to sustain biochar's efficacy over multiple cycles.Overall,this comprehensive analysis highlights biochar's versatility and potential in environmental remediation and resource recovery,emphasizing the importance of optimized regeneration techniques to maintain its adsorption efficiency and future research directions for large-scale applications.展开更多
Objectives:This study aimed to establish the concept of overcoming exhaustion,providing a reference basis for nursing management and conducting related nursing research.Methods:Liehr and Smith’s three-phase,nine-step...Objectives:This study aimed to establish the concept of overcoming exhaustion,providing a reference basis for nursing management and conducting related nursing research.Methods:Liehr and Smith’s three-phase,nine-step concept-building process was used to create the concept of overcoming exhaustion.The nine steps were as follows:1)write a practice story;2)name the emerging concept;3)select a theoretical lens;4)link concept to literature;5)gather a concept story;6)identify final core qualities;7)formulate concept definition;8)create a concept model;and 9)specify the concept building synthesis.Results:The concept of overcoming exhaustion was identified based on the elements of a practice story,the life experiences of nurses who struggle with the demands of caring for their patients,their families,and themselves.The theory of self-transcendence was then recognized as the theoretical lens from which to ground the concept.The core qualities,despair and moments of calmness,were derived from the literature and confirmed through a concept story.A definition of the concept integrating the core qualities was formed:overcoming exhaustion involves realizing moments of calmness amidst despair.A model was created to demonstrate the relationship between core qualities,despair,and moments of calmness.Conclusions:The concept of overcoming exhaustion was developed and,through the concept-building process,was defined as realizing moments of calmness amidst despair.By identifying the complexities of overcoming exhaustion,this work lays the foundation for a future research program to develop understanding and interventions that support nurse well-being in the context of ongoing personal and professional demands.展开更多
Natural language processing(NLP)technologies,such as ChatGPT,are revolutionizing various fields,including finance research.This article explores the potential of Chat-GPT as a transformative tool for finance researche...Natural language processing(NLP)technologies,such as ChatGPT,are revolutionizing various fields,including finance research.This article explores the potential of Chat-GPT as a transformative tool for finance researchers.We illustrate various applications of ChatGPT in finance research,from analyzing financial charts and providing coding support to the theoretical derivation of financial models.Significant advances in multimodal learning,such as Visual Referring Prompting(VRP),are also explored for their potential to enhance ChatGPT’s image analysis capabilities.Furthermore,we conduct a comparative analysis of ChatGPT-3.5,ChatGPT-4,and Microsoft Bing to examine their distinct features,strengths,and weaknesses to provide valuable insights into their applicability in finance research.We demonstrate the innovative opportunities and insights provided by the development of ChatGPT to enrich the financial research process.By addressing the potential pitfalls and ethical considerations associated with using ChatGPT,we aim to promote responsible AI adoption and a more indepth understanding of the role of advanced NLP technologies in shaping the future of finance research and practice.Overall,this paper underscores ChatGPT’s transformative role in finance research,detailing its applications,benefits,and challenges,and advocating for ethical AI adoption to shape the future of the field.展开更多
Highly energy-efficient buildings have generated remarkable interest over the last few years.There is a need for simulation based effective control systems for efficient usage of electrical and fossil fuel driven devi...Highly energy-efficient buildings have generated remarkable interest over the last few years.There is a need for simulation based effective control systems for efficient usage of electrical and fossil fuel driven devices,as they contribute to energy-efficient buildings and assist in gaining flexibility for the human occupancy-based energy loads.In this context,the integrated energy profile of a building can be ascertained by effective research approaches,as this knowledge would be beneficial to understand the demographics with respect to human occupancy and activities,as well as estimate varying energy consumption over time.Utility data from Smart Meter(SM)readings can reveal detailed information that could be mapped to predict resident occupancy and the usage patterns of specific types of appliances over desired time intervals.This research develops a user-driven simulation tool with realistic data acquisition options and assumptions of potential human behavior to determine energy usage patterns over time without the utility billing information.In this work,factors such as level of human occupancy,the possibility of space being occupied,thermostat settings,building envelope infrastructural aspects,types of appliances used in households,appliance energy related capacities,and the probability of using each appliance is considered,along with variance in weather,and heating-cooling systems specifications.For five specific benchmarked scenarios,the range of the random numbers is specified based on assumed potential human behavior for occupancy and energy-consuming appliances usage probabilities,with respect to the time of the day,weekday,and weekends.The simulation is developed using the Visual Basic Application(VBA)^(R)in Microsoft Excel^(R),based on the discrete-event Monte Carlo Simulation(MCS).The simulated energy usage and the cost are reflected in the sensitivity analysis by comparing factors such as the level of human occupancy,appliance type,and time intervals.展开更多
BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess...BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.展开更多
Civil infrastructure is continuously subject to aging and deterioration due to multiple factors,which lead to a decline in performance and impact structural health.Accumulated damage on structures increases operationa...Civil infrastructure is continuously subject to aging and deterioration due to multiple factors,which lead to a decline in performance and impact structural health.Accumulated damage on structures increases operational costs and poses significant risks to public safety.Effective maintenance,repair,and rehabilitation strategies are needed to ensure civil infrastructure’s overall safety and reliability.Non-Destructive Evaluation(NDE)methods are utilized to assess latent damage and provide decision-makers with real-time information for mitigating hazards.Within the last decade,there has been a significant increase in the research and development of innovative NDE techniques to improve data processing and promote efficient and accurate infrastructure assessment.This paper aims to review one of those methods,namely,Infrared Thermography(IRT),and its applications in civil infrastructure.A comprehensive review is presented by investigating numerous journal articles,research papers,and technical reports describing numerous IRT applications for bridges,buildings,and general civil structures made from different materials.The capability of IRT to identify and pinpoint anomalies,typically in the early stages of degradation,has excellent potential to improve the safety and shore up the dependability of civil infrastructures while reducing expenses tied to maintenance and rehabilitation.Furthermore,the non-invasive nature of IRT is beneficial in mitigating disturbances and downtime that may occur during various inspection procedures.It is highlighted that IRT is a highly versatile and effective tool for infrastructure condition assessment.With further advancement and fine-tuning of the available techniques,it is likely that IRT will continue to gain significant popularity in maintaining and monitoring civil infrastructure.展开更多
BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metasta...BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metastatic colorectal cancer(mCRC).Several studies have also demonstrated the benefit of anti-EGFR therapy in sub-sequent line settings for this patient population.However,direct evidence com-paring the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited,leaving a crucial gap in guiding optimal treatment strategies.AIM To compare overall survival(OS)between frontline and subsequent anti-EGFR treatment in patients with unresectable,RAS and BRAF wild-type,left-sided mCRC.METHODS We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital,Thailand,between January 2013 and April 2023.Patients were classified into two groups based on the sequence of their anti-EGFR treatment.The primary endpoint was OS.RESULTS Among 222 patients with a median follow-up of 29 months,no significant difference in OS was observed between the frontline and subsequent-line groups(HR 1.03,95%CI:0.73-1.46,P=0.878).The median OS was 35.53 months(95%CI:26.59-44.47)for the frontline group and 31.60 months(95%CI:27.83-35.37)for the subsequent-line group.In the subsequent-line group,71 patients(32.4%)who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months(95%CI:12.87-26.53).CONCLUSION Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable,RAS/BRAF wild-type,left-sided mCRC patients,but early exposure is vital for those unlikely to receive subsequent therapy.展开更多
BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is...BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.展开更多
Lithium-rich manganese-based oxide(LRMO)cathode has emerged as a particularly promising candidate for achieving high energy densities in lithium-ion batteries due to its capability to access anion redox reactions at h...Lithium-rich manganese-based oxide(LRMO)cathode has emerged as a particularly promising candidate for achieving high energy densities in lithium-ion batteries due to its capability to access anion redox reactions at high voltage.The successful implementation of LRMO in energy storage systems is contingent upon the enhancement of their rate capabilities.However,the underlying relationship between high-rate cycling and electrode degradation for LRMO,particularly concerning structural evolution,still remains unclear.Benefiting from the high time resolution abilities of liquid-metal-jet operando twodimensional X-ray diffraction,it is observed that the Li_(2)MnO_(3)phase in LRMO is gradually activated accompanied by the emergence of oxygen vacancies during cycling at 1 C(1 C=250 mA/g).Consequently,the crystal lattice flexibility of LRMO is systematically enhanced,thereby preventing the collapse of the bulk structure.While,continuous release of oxygen during extended cycling results in deteriorations of the self-adjusting damping effect of the structure,ultimately leading to a decline in capacity.The findings of this study not only contribute to a more profound understanding of the structural changes of LRMOs at high rates,but also provide novel perspectives for the rational design of LRMOs with superior rate performances.展开更多
BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on pri...BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.展开更多
Marine pollution is a well-recognized phenomenon that has many negative effects on the marine environment.The effects of marine pollution are due to the discharge of hazardous materials,toxins,or other pollutants into...Marine pollution is a well-recognized phenomenon that has many negative effects on the marine environment.The effects of marine pollution are due to the discharge of hazardous materials,toxins,or other pollutants into the marine environment,which includes seas,estuaries,oceans,and other water bodies,and this unwanted input affects the blue economy.The blue economy,which includes industries and research associated with marine and ocean resources,is often affected by marine pollution on multiple levels,such as economic costs,direct resource impacts,health risks,and infrastructure damage.In one report,the pollution-related issues in many countries were estimated at 9 t/inh and clean-up costs between$12 to$160/t.More extensive pollution mitigation projects might take up to 15 years to conclude and cost up to$500/t.To better understand the role of marine pollution and its impact on the blue economy,some key parameters are discussed as follows:the role of biofouling,volatile organic compounds,the impact of metals,anionic pollutants,and antifouling coatings.The review findings also highlight the impact of marine pollution on ecosystems and associated economic activities,which could be reduced through measures such as better international cooperation,waste management,and the development of sustainable practices.Related information on the strategies and policies that could be adopted for sustainable blue economy are stated after each section.展开更多
BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting thera...BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting therapies such as betablockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension.Ivabradine,a selective I(f)channel inhibitor,reduces heart rate(HR)without negative inotropic or hypotensive effects.AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients.METHODS A comprehensive search of PubMed,EMBASE,Scopus,Cochrane Library,and Google Scholar was conducted from inception to April 15,2025.Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol,reporting HR,mortality,left ventricular mass(LVM),or safety.Data were independently extracted by two reviewers,and quality was assessed.Review Manager 5.4 performed pooled analyses using random-effects models.Mean differences(MD)or standardized MD(SMD)were calculated for continuous outcomes,and risk ratios for dichotomous outcomes.RESULTS Of 415 records identified,four studies comprising 264 patients(126 ivabradine,138 control)met the inclusion criteria.Ivabradine significantly reduced resting HR compared with controls(MD=-11.06 beats per minute;95%CI:-19.50 to-2.62;P<0.00001;I^(2)=93%).Sensitivity analysis demonstrated consistent findings(SMD=-6.74;95%CI:-9.23 to-4.24;I^(2)=0%).No significant difference in all-cause mortality was observed(MD=0.52;95%CI:0.17-1.64;P=0.27;I^(2)=85%).Pooled analysis of LVM revealed no significant effect of ivabradine(MD=-3.57 g;95%CI:-29.21 to 22.08;P=0.79;I^(2)=73%),with sensitivity analysis confirming neutrality.Adverse events were rare and mostly comparable between groups.CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes,supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable.Despite potential clinical benefit,small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine’s role in post-transplant care.展开更多
基金funded by the National Natural Science Foundation of China(Grant No.42377331)supported by the U.S.National Science Foundation Division of Environmental Biology award#2331162U.S.National Science Foundation Dynamics of Integrated Socio-Environmental Systems award#2408954.
文摘Large-scale afforestation and forest conservation policies have been widely implemented in Southwest China over past decades.These efforts have significantly protected the remaining long-established forests in the region and greatly expanded forested areas.Utilizing nearly 30 years of satellite time-series data,we reveal that the region’s enhanced carbon sequestration(3×10^(12) g·C annually)is primarily driven by crucial changes in forest structure and age,occurring alongside a nearly 120%increase in forested land area.We observe that dense forests maintain a rapid growth rate of approximately 2.5%annually for carbon sequestration in the initial years after establishment.However,this growth rate decelerates with increasing apparent forest age.Meanwhile,the densification(modeled as an increasing forest probability)rate of forests reaches its peak growth during the 10-20 year period,sustaining a high annual growth rate of about 1.8%.We also find that improvements in forest structure,particularly the increasing of forest canopy density and apparent forest age coupled with a notable reduction in forest fragmentation,are also the main driving factors for the enhanced carbon sequestration capacity.Based on these findings,we conclude that forest restoration policies in Southwest China have been successful not only in facilitating large-scale forest growth in Southwest China but,more critically,in promoting the structural maturation(e.g.,densification and reduced fragmentation)that is essential for enhancing the region’s carbon sink capacity and its resilience.
文摘Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle anesthesia, and bowel incontinence. This case report describes a 59-year-old immunosuppressed male with idiopathic pulmonary fibrosis who developed Elsberg syndrome due to re-activation of latent HSV-2. The patient experienced progressive lower extremity sensory deficits and genitourinary dysfunction, culminating in a vesiculopustular rash. Diagnosis was confirmed via cerebrospinal fluid analysis and PCR testing of skin lesions. Despite early imaging findings being unremarkable, subsequent MRI revealed enhancement of the conus medullaris and cauda equina. Treatment with intravenous acyclovir, corticosteroids, and supportive therapy led to gradual functional improvement, though sensory deficits and neuropathy persisted. This case highlights the diagnostic challenges and importance of clinical suspicion for HSV-2 reactivation in immunosuppressed patients, as well as considerations for long-term symptom management.
文摘Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.
基金funded through the West Virginia Nurses AssociationRosenthal-Riter Scholarship fund+1 种基金the West Virginia University School of Nursing RuthRobert Kuhn Nursing Research Foundation。
文摘Objectives:This study had two aims.Aim one is to evaluate the feasibility and acceptability of using an aroma-based,self-managed intervention for adults in outpatient treatment for substance use disorder.Aim two is to examine the effects of a Citrus bergamia(Bergamot)essential oil intervention on the variables of comfort,ease,and stress.Methods:A randomized controlled trial was conducted(NCT05660434).Adults in treatment for substance use disorder were randomized to either control group(standard care)(n=55)or intervention group(standard care plus Citrus bergamia[Bergamot]essential oil intervention),three times a day for seven days(n=45).All data were analyzed using an intention-to-treat method.Outcomes were measured using valid and reliable measures.Results:One hundred participants were recruited over 11 months.Reasons for non or limited participation included feeling overwhelmed by the demands of treatment and everyday living.Data analysis showed psychological variable improvement with a significant increase in ease reported(P=0.022)and DASS-21 subscales for depression(P=0.007)and anxiety(P=0.013)in the intervention group.Postsatisfaction survey results were positive,with overall enjoyment,perception of the aroma,and intention to continue to use the aroma inhaler post-trial,which was high.Conclusions:Results from this study provide data to support the feasibility and acceptability of using essential oil via inhalation to help this population.Findings from this study will inform a more extensive study designed to examine effects within and between groups using a placebo.
文摘The Five-hundred-meter Aperture Spherical Telescope(FAST)is living up to its promise as one of the world's premiere pulsar finding instruments.At the center of FAST's many significant pulsar discoveries(which in total number 1000 from all projects to date)is the announcement by Han et al.(2025)of a further 473 pulsars.The new discoveries are the latest installment from the FAST Galactic Plane Snapshot Survey(GPPS),bringing its total to 751 pulsars.Full details of the design and observational setup of the FAST GPPS can be found in Han et al.(2021).
文摘This review provides a comprehensive summary of biomass-based adsorption,with a particular focus on biochar as an innovative,sustainable,and eco-friendly technique for recovering rare earth elements(REEs) from various sources.This study details primary adsorption mechanisms,including physical adsorption,ion exchange,electrostatic attraction,surface complexation,and precipitation,providing a nuanced understanding of how these processes contribute to metal recovery.Additionally,it discusses various biochar modification methods aimed at enhancing surface functionalities,thereby improving adsorption capacity and selectivity.It further addresses the critical challenge of biochar regeneration,outlining methods such as thermal,solvent,microwave irradiation,and supercritical fluid regeneration to sustain biochar's efficacy over multiple cycles.Overall,this comprehensive analysis highlights biochar's versatility and potential in environmental remediation and resource recovery,emphasizing the importance of optimized regeneration techniques to maintain its adsorption efficiency and future research directions for large-scale applications.
文摘Objectives:This study aimed to establish the concept of overcoming exhaustion,providing a reference basis for nursing management and conducting related nursing research.Methods:Liehr and Smith’s three-phase,nine-step concept-building process was used to create the concept of overcoming exhaustion.The nine steps were as follows:1)write a practice story;2)name the emerging concept;3)select a theoretical lens;4)link concept to literature;5)gather a concept story;6)identify final core qualities;7)formulate concept definition;8)create a concept model;and 9)specify the concept building synthesis.Results:The concept of overcoming exhaustion was identified based on the elements of a practice story,the life experiences of nurses who struggle with the demands of caring for their patients,their families,and themselves.The theory of self-transcendence was then recognized as the theoretical lens from which to ground the concept.The core qualities,despair and moments of calmness,were derived from the literature and confirmed through a concept story.A definition of the concept integrating the core qualities was formed:overcoming exhaustion involves realizing moments of calmness amidst despair.A model was created to demonstrate the relationship between core qualities,despair,and moments of calmness.Conclusions:The concept of overcoming exhaustion was developed and,through the concept-building process,was defined as realizing moments of calmness amidst despair.By identifying the complexities of overcoming exhaustion,this work lays the foundation for a future research program to develop understanding and interventions that support nurse well-being in the context of ongoing personal and professional demands.
文摘Natural language processing(NLP)technologies,such as ChatGPT,are revolutionizing various fields,including finance research.This article explores the potential of Chat-GPT as a transformative tool for finance researchers.We illustrate various applications of ChatGPT in finance research,from analyzing financial charts and providing coding support to the theoretical derivation of financial models.Significant advances in multimodal learning,such as Visual Referring Prompting(VRP),are also explored for their potential to enhance ChatGPT’s image analysis capabilities.Furthermore,we conduct a comparative analysis of ChatGPT-3.5,ChatGPT-4,and Microsoft Bing to examine their distinct features,strengths,and weaknesses to provide valuable insights into their applicability in finance research.We demonstrate the innovative opportunities and insights provided by the development of ChatGPT to enrich the financial research process.By addressing the potential pitfalls and ethical considerations associated with using ChatGPT,we aim to promote responsible AI adoption and a more indepth understanding of the role of advanced NLP technologies in shaping the future of finance research and practice.Overall,this paper underscores ChatGPT’s transformative role in finance research,detailing its applications,benefits,and challenges,and advocating for ethical AI adoption to shape the future of the field.
文摘Highly energy-efficient buildings have generated remarkable interest over the last few years.There is a need for simulation based effective control systems for efficient usage of electrical and fossil fuel driven devices,as they contribute to energy-efficient buildings and assist in gaining flexibility for the human occupancy-based energy loads.In this context,the integrated energy profile of a building can be ascertained by effective research approaches,as this knowledge would be beneficial to understand the demographics with respect to human occupancy and activities,as well as estimate varying energy consumption over time.Utility data from Smart Meter(SM)readings can reveal detailed information that could be mapped to predict resident occupancy and the usage patterns of specific types of appliances over desired time intervals.This research develops a user-driven simulation tool with realistic data acquisition options and assumptions of potential human behavior to determine energy usage patterns over time without the utility billing information.In this work,factors such as level of human occupancy,the possibility of space being occupied,thermostat settings,building envelope infrastructural aspects,types of appliances used in households,appliance energy related capacities,and the probability of using each appliance is considered,along with variance in weather,and heating-cooling systems specifications.For five specific benchmarked scenarios,the range of the random numbers is specified based on assumed potential human behavior for occupancy and energy-consuming appliances usage probabilities,with respect to the time of the day,weekday,and weekends.The simulation is developed using the Visual Basic Application(VBA)^(R)in Microsoft Excel^(R),based on the discrete-event Monte Carlo Simulation(MCS).The simulated energy usage and the cost are reflected in the sensitivity analysis by comparing factors such as the level of human occupancy,appliance type,and time intervals.
文摘BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.
文摘Civil infrastructure is continuously subject to aging and deterioration due to multiple factors,which lead to a decline in performance and impact structural health.Accumulated damage on structures increases operational costs and poses significant risks to public safety.Effective maintenance,repair,and rehabilitation strategies are needed to ensure civil infrastructure’s overall safety and reliability.Non-Destructive Evaluation(NDE)methods are utilized to assess latent damage and provide decision-makers with real-time information for mitigating hazards.Within the last decade,there has been a significant increase in the research and development of innovative NDE techniques to improve data processing and promote efficient and accurate infrastructure assessment.This paper aims to review one of those methods,namely,Infrared Thermography(IRT),and its applications in civil infrastructure.A comprehensive review is presented by investigating numerous journal articles,research papers,and technical reports describing numerous IRT applications for bridges,buildings,and general civil structures made from different materials.The capability of IRT to identify and pinpoint anomalies,typically in the early stages of degradation,has excellent potential to improve the safety and shore up the dependability of civil infrastructures while reducing expenses tied to maintenance and rehabilitation.Furthermore,the non-invasive nature of IRT is beneficial in mitigating disturbances and downtime that may occur during various inspection procedures.It is highlighted that IRT is a highly versatile and effective tool for infrastructure condition assessment.With further advancement and fine-tuning of the available techniques,it is likely that IRT will continue to gain significant popularity in maintaining and monitoring civil infrastructure.
文摘BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metastatic colorectal cancer(mCRC).Several studies have also demonstrated the benefit of anti-EGFR therapy in sub-sequent line settings for this patient population.However,direct evidence com-paring the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited,leaving a crucial gap in guiding optimal treatment strategies.AIM To compare overall survival(OS)between frontline and subsequent anti-EGFR treatment in patients with unresectable,RAS and BRAF wild-type,left-sided mCRC.METHODS We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital,Thailand,between January 2013 and April 2023.Patients were classified into two groups based on the sequence of their anti-EGFR treatment.The primary endpoint was OS.RESULTS Among 222 patients with a median follow-up of 29 months,no significant difference in OS was observed between the frontline and subsequent-line groups(HR 1.03,95%CI:0.73-1.46,P=0.878).The median OS was 35.53 months(95%CI:26.59-44.47)for the frontline group and 31.60 months(95%CI:27.83-35.37)for the subsequent-line group.In the subsequent-line group,71 patients(32.4%)who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months(95%CI:12.87-26.53).CONCLUSION Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable,RAS/BRAF wild-type,left-sided mCRC patients,but early exposure is vital for those unlikely to receive subsequent therapy.
文摘BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.
基金financial supports from the National Natural Science Foundation of China(52372211,52371225 and 92472115)the Guangdong Province Major Talent Introducing Program(2021QN020687)+1 种基金the Shenzhen Basic Research Foundation(JCYJ20230807112503007)the Guangdong Basic and Applied Basic Research Foundation(Grant No.2020A1515110176)。
文摘Lithium-rich manganese-based oxide(LRMO)cathode has emerged as a particularly promising candidate for achieving high energy densities in lithium-ion batteries due to its capability to access anion redox reactions at high voltage.The successful implementation of LRMO in energy storage systems is contingent upon the enhancement of their rate capabilities.However,the underlying relationship between high-rate cycling and electrode degradation for LRMO,particularly concerning structural evolution,still remains unclear.Benefiting from the high time resolution abilities of liquid-metal-jet operando twodimensional X-ray diffraction,it is observed that the Li_(2)MnO_(3)phase in LRMO is gradually activated accompanied by the emergence of oxygen vacancies during cycling at 1 C(1 C=250 mA/g).Consequently,the crystal lattice flexibility of LRMO is systematically enhanced,thereby preventing the collapse of the bulk structure.While,continuous release of oxygen during extended cycling results in deteriorations of the self-adjusting damping effect of the structure,ultimately leading to a decline in capacity.The findings of this study not only contribute to a more profound understanding of the structural changes of LRMOs at high rates,but also provide novel perspectives for the rational design of LRMOs with superior rate performances.
文摘BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.
基金Supported by the President’s International Fellowship Initiative of Chinese Academy of Sciences(No.2024 PVC 0010)。
文摘Marine pollution is a well-recognized phenomenon that has many negative effects on the marine environment.The effects of marine pollution are due to the discharge of hazardous materials,toxins,or other pollutants into the marine environment,which includes seas,estuaries,oceans,and other water bodies,and this unwanted input affects the blue economy.The blue economy,which includes industries and research associated with marine and ocean resources,is often affected by marine pollution on multiple levels,such as economic costs,direct resource impacts,health risks,and infrastructure damage.In one report,the pollution-related issues in many countries were estimated at 9 t/inh and clean-up costs between$12 to$160/t.More extensive pollution mitigation projects might take up to 15 years to conclude and cost up to$500/t.To better understand the role of marine pollution and its impact on the blue economy,some key parameters are discussed as follows:the role of biofouling,volatile organic compounds,the impact of metals,anionic pollutants,and antifouling coatings.The review findings also highlight the impact of marine pollution on ecosystems and associated economic activities,which could be reduced through measures such as better international cooperation,waste management,and the development of sustainable practices.Related information on the strategies and policies that could be adopted for sustainable blue economy are stated after each section.
文摘BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting therapies such as betablockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension.Ivabradine,a selective I(f)channel inhibitor,reduces heart rate(HR)without negative inotropic or hypotensive effects.AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients.METHODS A comprehensive search of PubMed,EMBASE,Scopus,Cochrane Library,and Google Scholar was conducted from inception to April 15,2025.Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol,reporting HR,mortality,left ventricular mass(LVM),or safety.Data were independently extracted by two reviewers,and quality was assessed.Review Manager 5.4 performed pooled analyses using random-effects models.Mean differences(MD)or standardized MD(SMD)were calculated for continuous outcomes,and risk ratios for dichotomous outcomes.RESULTS Of 415 records identified,four studies comprising 264 patients(126 ivabradine,138 control)met the inclusion criteria.Ivabradine significantly reduced resting HR compared with controls(MD=-11.06 beats per minute;95%CI:-19.50 to-2.62;P<0.00001;I^(2)=93%).Sensitivity analysis demonstrated consistent findings(SMD=-6.74;95%CI:-9.23 to-4.24;I^(2)=0%).No significant difference in all-cause mortality was observed(MD=0.52;95%CI:0.17-1.64;P=0.27;I^(2)=85%).Pooled analysis of LVM revealed no significant effect of ivabradine(MD=-3.57 g;95%CI:-29.21 to 22.08;P=0.79;I^(2)=73%),with sensitivity analysis confirming neutrality.Adverse events were rare and mostly comparable between groups.CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes,supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable.Despite potential clinical benefit,small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine’s role in post-transplant care.
