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Labile traits, such as behavioural, physiological traits or body mass, exhibit variation within an individual either over time or across environments. Such changes within an individual can be linked across traits, forming within-individual trait correlations. These correlations are particularly expected when ageing causes changes in the expression of multiple traits. The direction of these correlations also depends on mechanisms explaining age-related changes in each traits, such as physiological deterioration or changes in future fitness expectations. Therefore, assessing within-individual trait correlations offers insights into the trait-specific ageing patterns, their integration and age-related reproductive strategies. Here, we tracked individual male cicadas (Tettigetta isshikii) in their natural habitat, repeatedly assessing their plant use (narrow vs. wide-leafed), calling activity, and body mass. Results revealed that male cicadas lost mass, increased calling activity and a preference for narrow-leafed plants as they aged. This integration of age-related plasticity led to negative within-individual correlations between body mass and behaviours. The asset protection principle could explain the age-related increase in calling activity and the preference for narrow-leafed plants. Such an age-related increase in energetically demanding calling activity may also cause an age-related decrease in body mass. Considering that adult cicadas consume nutritionally poor xylem sap, the negative within-individual correlations between body mass and risk-taking behaviour suggest that T. isshikii males follow a capital breeding strategy rather than an income breeding strategy. Therefore, we emphasise the importance of individual-level tracking study in the wild to achieve a comprehensive understanding of the life-history strategies and behavioural ecology of a study animal.

1 INTRODUCTIONRadiofrequency ablation has been demonstrated to be a low-risk and effective treatment for eliminating premature ventricular complexes (PVC).1,2 The retrograde transaortic approach is a widely used access route for the mapping and ablation of ventricular arrhythmias arising from the left ventricle, including the papillary muscles.1 It has been reported that some complications were associated with the retrograde transaortic approach, including iatrogenic aortic dissection, coronary damage, valve leaflets damage, complete atrioventricular block and so on.1,3 However, acute ischemic stroke (AIS) associated with the retrograde transaortic manipulation during radiofrequency ablation of PVC was rarely reported.4 In this case report, we shared a case of AIS encountered after the retrograde transaortic manipulation, during a procedure of PVC ablation.2 CASE HISTORYA 66-year-old woman (Height 164cm, Weight 72Kg) was referred for radiofrequency ablation of frequent PVC (Figure 1A), after the treatment of which by medication had been ineffective. She had a history of palpitation for one year. Her PVC burden was 14.5%, with a total of 12735 PVCs during the 24-hour Holter. Regular examination confirmed the diagnosis of hypercholesteremia (total cholesterol 6.08mmol/L, low-density lipoprotein cholesterol 4.16 mmol/L). No other disease (hypertension, diabetic mellitus, stroke) was recorded. Before the procedure, transthoracic echocardiography revealed the patient had normal cardiac diameters and normal left ventricular ejection function (68%).

Breynia enchengensis, a new species with a narrowly geographic distribution in limestone areas of southwestern Guangxi, China, is described and illustrated. The new species is morphologically similar to B. poomae (Welzen & Chayam.) Welzen & Pruesapan in having creeping stems, ovate to oblong leaf blade and reddish brown to dark purple flowers, but can be easily distinguished from the latter by the size of leaf blade and flowers, the number of lateral veins, the growing way of inflorescence and the shape of ovary. A table to distinguish the new species from B. poomae, as well as color plates and type specimens of the new species are also provided.

A type 1 diabetic patient with unilateral active thyroid-related eye disease was intolerant to systemic steroid therapy due to uncontrollable blood sugar levels. She was treated with low-dose methotrexate monotherapy which resulted in a marked improvement of her condition with no adverse events.

PURPOSE: To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN: Retrospective case series study. METHODS: 63 cases (84 eyes) of RP with cataract were collected, including 30 males and 33 females. Phacoemulsification with 3.0 mm clear corneal incision was performed in all the patients. IOL and CTR implantation was performed in 44 eyes, and IOL implantation alone was performed in 40 eyes. All cases were followed up at 1 week and 1, 3, 6 months after the surgery to compare the best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count (ECC) and complications before and after the surgery. RESULTS: All surgeries were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91±0.88 LogMAR. It improved a little compared with the BCVA(1.3±0.7LogMAR) before surgery and there was statistically significant difference (P=0.003). Four cases of capsule contraction syndrome (CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was statistically significant difference in the incidence of CCS between two groups(P=0.047). CONCLUSIONS: Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is helpful in reducing the complications caused by capsule contraction

Residual neuromuscular blockade (RNB) commonly occurs when using neuromuscular blockers and increases the risk for pulmonary complications, such as airway obstruction and severe hypoxemia, in extubated patients. Rocuronium exhibits a high variability in recovery time, contributing to an increased risk for RNB. This study aimed to identify and characterize the sources of variability in rocuronium exposure and response via a population pharmacokinetic/pharmacodynamic (PK/PD) analysis and to apply the developed PK/PD model to investigate clinical implications. A nonlinear mixed-effect model was developed for rocuronium in patients undergoing general anaesthesia, using doses of 0.3–1.2 mg/kg. Plasma concentrations and the neuromuscular block [train of four ratio] were assessed up to 6 h after dosing. The influence of age, body mass index, renal function, and sex on PK and PD was explored. Simulations were performed to predict the recovery time. A two-compartment model with linear elimination and an indirect sigmoid I-max model was used to describe PK and PD. The transfer rate into the periphery increases with age. The predicted recovery time was significantly longer in older subjects compared to young adults following single bolus administrations of doses ≥ 0.7 mg/kg. Our findings suggest that geriatric patients take slightly longer to recover than younger adults due to an age-dependent increase in tissue uptake. However, a priori dose adjustments for rocuronium in elderly patients are not feasible, since age contribution is overshadowed by the overall variability in the recovery time.

Reply to Wang et al.To the Editor,We sincerely appreciate the thoughtful response from Wang et al.1, regarding our recent study2. We are grateful for the effort the authors put into expressing potential limitations of our work, as such comments enrich the dialogue in the emerging intersection of pediatric healthcare and health geography. In this interdisciplinary field, constructive discourse is essential to refining methodologies and fostering collaborations that drive innovative solutions. We welcome the opportunity to address their concerns and engage further in this important conversation.Firstly, we acknowledge that a more diverse study sample would have been beneficial. The overall patient population in our health system are diverse across race, ethnicity, language, illness, environmental exposures, and geography. However, the nature of this single center study, as Wang et al. correctly point out, is that our patient study population are less diverse, particularly, in overall geographic composite index measures such as the Social Vulnerability Index (SVI) and Child Opportunity Index (COI). Notably, our study sample represents a group with particularly high scores on SVI and lower scores on COI. That said, a multicenter study involving patients from other health systems would indeed help us further understand the association between SVI or COI and the risk for pediatric intensive care unit (PICU) admission for status asthmaticus. Scaling out to a multicenter study using patient addresses and spatially granular data can be challenging due to the need to protect patient privacy3. Establishing the partnerships, information sharing infrastructure, and processes necessary to conduct a more comprehensive multicenter study is an ongoing area of focus for our team. We are committed to advancing this critical work.Secondly, we acknowledge that a large percentage of patients at the time of our study have reported race and ethnicity values of “other” or “unknown.” Unfortunately, this can be common across health systems with diverse patient populations. Despite the Meaningful Use mandate by the Centers for Medicare and Medicaid Services requiring the collection of race and ethnicity values in electronic health records (EHR), many health systems lack comprehensive race and ethnicity data for their patient populations4. While sub-optimal, there are multiple reasons for responses of “other” and “unknown.” For one, EHRs were traditionally designed with limited race and ethnicity options for patients to choose from, leading to an oversimplification of race and ethnicity categories. Limited options and discrete choices may not always reflect the identity of patients4. Not to mention, directly asking patients how they identify is difficult because the conversation can be uncomfortable for all those involved4. Also, the value of race and ethnicity data for research may not always be fully understood by healthcare professionals and patients leading to subpar data collection4. Still, it is worth noting that since our study was completed, our health system has conducted a large systemic effort to improve the collection of race and ethnicity data. For instance, patients are given more options to self-identify their race and ethnicity with better processes in place during clinic appointments to facilitate data collection. Efforts to minimize missing race and ethnicity data for health disparities research and other health system applications continues to be an important work for all healthcare systems.Thirdly, we concur that other factors, including the residential environment, air pollution, and indoor allergens are important considerations in pediatric healthcare and respiratory diseases. The exposome encompasses a wide array of factors that are associated with asthma5. As we work toward improving our understanding of addressing pediatric health, future work will integrate the physical, social, and environment as key drivers of health. A more holistic approach to understanding this extended environment as it relates to patient health can unlock a better understanding of health and open opportunities to create meaningful and effective interventions. Linking individual environmental factor data remains a key focus for this team.We are thankful for the insightful comments provided by Wang et al. Response to research work provides us all with the opportunity to engage in thoughtful discourse amongst our colleagues to drive research and healthcare forward. Our study of PICU admissions for status asthmaticus is ongoing and a part of a growing work in progress. We share the same ideals Wang et al. express, but more importantly, we share the same desire to advance the health of children everywhere through research.Alicia Adiwidjaja, BS1,2Justin Jones, MD1Patrick Ross, MD1,3Matthew Keefer, MD1,3Margaret J Klein, MS1Jonathan M. Tan, MD MPH MBI1,2,31Children’s Hospital Los Angeles, Los Angeles, California, USA2University of Southern California Spatial Sciences Institute, Los Angeles, California, USA3University of Southern California Keck School of Medicine, Los Angeles, California, USAConflicts of InterestJonathan Tan receives research grant funding from the Anesthesia Patient Safety Foundation, Foundation for Anesthesia Education and Research, and the Southern California Environmental Health Sciences Center. Jonathan Tan is a consultant for GE HealthCare, Edwards Lifesciences, and Medtronic. Jonathan Tan is on the Board of Directors for the Society for Pediatric Anesthesia.ReferencesWang C, Tian H, Shang J. Comment on Justin Jones et al.Pediatric Allergy and Immunology. 2024.Jones J, Klein MJ, Adiwidjaja A, Ross P, Keefer M, Tan JM. The association between composite measures of social vulnerability and PICU admission for status asthmaticus. Pediatric Allergy and Immunology. 2024;35(11). doi:https://doi.org/10.1111/pai.14278. PMID: 39526837. U.S. Department of Health and Human Services. Summary of the HIPAA Privacy Rule. 2003.Diallo MS, Tan JM, Heitmiller ES, Vetter TR. Achieving Greater Health Equity: An Opportunity for Anesthesiology. Anesth Analg. 2022 Jun 1;134(6):1175-1184. doi: 10.1213/ANE.0000000000005937. Epub 2022 Feb 2. PMID: 35110516.Guillien, A., Cadiou, S., Slama, R., & Siroux, V. (2021). The Exposome Approach to Decipher the Role of Multiple Environmental and Lifestyle Determinants in Asthma. International Journal of Environmental Research and Public Health, 18(3), 1138. https://doi.org/10.3390/ijerph18031138

In this paper, the damage mechanisms and residual strength prediction models of unidirectional glass-fiber reinforced polymers are investigated by acoustic emission(AE) technique. The material exhibits three damage modes: matrix cracking, fiber fracture, and interface damage. A novel AE descriptor, amplitude/centroid frequency (ACF), is introduced to differentiate interface damage from other damage modes. Moreover, three signal types exhibit a strong clustering effect when correlated with ACF and average frequency. Microscopic damage mechanisms of the samples are observed using scanning electron microscopy and correlated with AE signals. The AE signals are analyzed using machine learning, and the clustering analysis results are used as a training set to obtain classification models using support vector machine (SVM) and K-nearest neighbor (KNN) methods. Leveraging the traditional mechanical regression analysis prediction model, the study achieves prediction of the material’s residual strength post-fatigue through improvement in AE cumulative counting. Additionally, optimization of prediction results can be achieved by a certain kind of signal after clustering. The combination of supervised learning and residual strength prediction models can realize the real-time classification of AE signals and apply them to the prediction of residual strength, which has a significant application value in real-time monitoring.

Thiopurines are a class of immunosuppressant and anti-neoplastic agents. They are widely used in the treatment of inflammatory bowel disease, hematological malignancies, and autoimmune diseases, but can cause significant toxicity. Inherited gene mutations are now recognized as independent risk factors for severe adverse drug reactions to thiopurines even at tenfold dose reductions. We present a case of thiopurine toxicity resulting in severe myelosuppression, hepatotoxicity, and alopecia in an individual with homozygous *3/*3 loss-of-function alleles in the NUDT15 gene. Our case highlights important differences in gene mutation frequencies between races that can help guide pharmacogenomic testing.

not-yet-known not-yet-known not-yet-known unknown Introduction: Understand the drug-resistant situation and trend of tuberculosis patients in Yuexiu District, Guangzhou City, from 2013 to 2022, provide a scientific basis for development of rational drug-resistant tuberculosis prevention and control strategies. Methods: All patients who were diagnosed with active tuberculosis in Guangzhou Chest Hospital from January 1, 2013 to December 31, 2022 were collected as study subjects, a total of 5,191 patients were enrolled in the study. The basic conditions and diagnostic and therapeutic information of the study subjects were collected. Sputum specimens were subjected to smear and isolation and culture. Culture-positive strains of bacteria were identified by bacterial groups. A total of 1,659 strains of Mycobacterium tuberculosis (MTB) isolates were obtained. The drug susceptibility test was used the proportionality method on the MTB isolates for nine types of anti-tuberculosis medicines,and comparatively analyzed the resistance of the strains. Results: A total of 1,659 patients with MTB were cultured, 439 were drug-resistant, 255 were mono-resistant, and 121 were poly-resistant, 62 were multidrug-resistant. The resistance rate was 26.46% (439/1659), the mono-resistance rate was 15.37 % (255/1659), and the poly-resistance rate was 7.29% (121/1659), the multidrug resistance rate was 3.74 % (62/1659) . The number (rate) of drug-resistant patients in the primary treatment was 389 [(25.63%).(389/1659）].The number (rate)of drug-resistant patients in retreatment was 50[ (35.46%) (50/1659）]. The number (rate) of multidrug-resistant patients in the primary treatment was 39 (2.57%)[(39/1659）]. The number (rate) of multidrug-resistant cases in retreatment patients was 23 [(16.31%)(23/1659）]. The resistance rate and multidrug resistance rate of isolates from retreatment patients were higher than those of isolates from primary treatment patients, and the differences were statistically significant. Conclusions: The problem of drug-resistant tuberculosis transmission in Guangzhou needs to be focused on, and drug-resistant screening should be further increased to do a good job of controlling the source of infection.

TitleUpper appendicular, pelvic and axial skeletal pathology with poor performance

Considering the local magnetic characteristics of surface-mounted permanent magnet (SPM) motors, the paper proposes an adaptive connecting equivalent magnetic network (ACEMN) model to accurately predict SPM motor performance. First, for modeling the magnetic field at the inclined boundary of the stator pole shoe, a diagonal hybrid permeance element covering two materials is developed. And considering the parallel magnetization of PMs, a branching calculation of the magnetomotive force source is performed inside a cross-shaped permeance of a fan-shaped mesh. Then, by analyzing the phenomenon of magnetic field line deflection at the air gap boundary, an air gap node connecting way based on adaptive conversion of connecting permeances is built. Thereby, the rotating magnetic field of the air gap can be accurately described using the different connecting permeances with variable size. To accelerate the nonlinear solution for saturated element permeability, a hybrid iterative method is used. The validity of this modeling method is verified by finite element analysis (FEA) and prototype experiments, which allows a satisfactory compromise between accuracy and calculation speed.

Background: Atrial fibrillation (AF) and dementia are increasingly prevalent in aging U.S. populations. Their association raises public health concerns, emphasizing the need to understand mortality trends in older adults. This study examines AF and dementia-related mortality trends from 2000 to 2020. Methods: Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates for individuals aged 65 and older, reporting age-adjusted mortality rates (AAMRs) per 100,000 persons. Trends were assessed through annual percent change (APC) analysis via Joinpoint regression, with stratifications by sex, race/ethnicity, urbanization, and Census regions. Results: A total of 400,103 AF and dementia-related deaths were recorded between 2000 and 2020. The AAMR increased markedly from 25.4 in 2000 to 70.4 in 2020. The overall AAMR showed a steady increase from 2000 to 2018 (APC: +4.4%; 95% CI: 3.7–4.8), with a sharper rise from 2018 to 2020 (APC: +9.5%; 95% CI: 4.5–12.2; p < 0.001). Mortality rates were comparable between men (AAMR: 72.7) and women (AAMR: 71.6). NH White individuals exhibited the highest AAMR (47.0), followed by NH Black (26.6), Hispanic (23.1), and NH Asian/Pacific Islander (18.0) populations. Nonmetropolitan areas had higher AAMRs (48.1) compared to metropolitan areas (43.5). Regionally, the Western U.S. recorded the highest AAMR at 48.2, while state-level disparities showed a nearly threefold difference between the top 90th and bottom 10th percentiles. Conclusion: Rising AF and dementia-related mortality rates among older adults highlight a need for targeted screening and intervention, particularly for high-risk demographics and underserved regions.

Traditional beta-cyclodextrin (beta-CD) in biomedical applications faces challenges due to its inherent physical and biochemical limitations. One of the most effective strategies to enhance the properties of beta-CD for drug delivery is the synthesis of supramolecular polycyclodextrins. In this study, we designed a novel beta-CD nanocage-like structure for drug delivery, incorporating imine and disulfide bonds through Schiff base reactions. Aldehyde group-functionalized beta-CD units were used to construct the main backbone of the nanocage, forming dual-dynamic covalent bonds. The chemical structure of the beta-CD nanocage was confirmed using ¹H nuclear magnetic resonance (¹H NMR) and fourier transform infrared spectroscopy (FTIR). Additionally, atomic force microscopy (AFM) and dynamic light scattering (DLS) revealed that varying amounts of beta-CD crosslinked with cystamine resulted in nanocages approximately 200 nm in size. In vitro drug release experiments demonstrated that doxorubicin (DOX)-loaded beta-CD nanocages exhibited accelerated DOX release in acidic and reductive environments compared to normal physiological conditions, owing to the pH-sensitive imine bond and the glutathione (GSH)-cleavable disulfide bond. The DOX-loaded beta-CD nanocages showed exceptional tumor-killing effects, particularly in acid/reduction-enhanced tumor cells. Both cellular fluorescence imaging and flow cytometry confirmed the potential of the beta-CD nanocages for acid/reduction-specific drug release. Consequently, this precision medicine model using imine/disulfide-linked beta-CD nanocage structures as acidity/reduction-sensitive drug carriers promises to improve oncotherapy through more targeted drug delivery and release, supporting individualized treatment approaches.

We establish necessary and sufficient conditions for a weight v guaranteeing the boundedness of multilinear Riemann-Liouville operators from ∏ j = 1 m L p j to L v q .

Background: Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive mesenchymal tumor that usually occurs in children. When it occurs in adults, it poses a diagnostic challenge for the medical team. The clinical manifestations are not specific, imaging studies show a hepatic mass with a mixed component (solid and cystic). To date, surgical resection with neoadjuvant therapy has yielded satisfactory results in terms of survival. Case: We present the case of a 19-year-old patient, which, to our knowledge is the only case reported in Central America, which was surgically resected and received adjuvant chemotherapy. The patient has been followed for 34 months, and she remains free of disease. Conclusion: The presented case highlights the need to raise awareness about UESL in the Central American region and promote a comprehensive diagnostic and therapeutic approach to improve disease-free survival in these patients.

Waterskiing has been a commonplace and generally well-accepted activity on inland waterways for many decades. More recently, there has been a significant increase in wakeboarding and wakesurfing, with the latter relying heavily upon ‘enhanced’ boat wake. This has seen an increase in issues such as shoreline erosion and damage to public and private property, often resulting in additional complications for those tasked with the management of sheltered waterways. This is most prevalent in situations where lateral distance is limited, such as rivers and small lakes, where there may be insufficient distance for the larger boat-generated waves to disperse and attenuate. This has become a hot topic, with disputes occurring at many locations – for example, there are known cases in at least 20 US States. This paper investigates the key differences in characteristics of the waves generated by typical waterski and wake boats, with and without wake enhancing devices. Measurements of the waves generated by a variety of recreational and wake boats were acquired from full-scale field trials. Results are presented graphically and compared with data from other published studies of a similar nature. It is confirmed that there are significant differences in both the height and energy of the maximum wave generated by the three different water sports (and to a lesser extent, wave period). Data is acquired at multiple locations over a relatively large lateral distance from the sailing line of the test boats which should assist regulators to identify management options for waterways with sensitive shorelines and vulnerable property.