Regional variations in HIV diagnosis in Japan before and during the COVID-19 pandemic.

Background: The number of people undergoing voluntary HIV testing has abruptly decreased since 2020. The geographical heterogeneity of HIV infection and the impact of COVID-19 on the diagnosis of HIV at regional level are important to understand. This study aimed to estimate the HIV incidence by geographical region and understand how the COVID-19 pandemic influenced diagnosis of HIV. Methods: We used an extended back-calculation method to reconstruct the epidemiological dynamics of HIV/AIDS by geographical region. We used eight regions: Tokyo, the capital of Japan, Hokkaido plus Tohoku, Kanto plus Koshinetsu (excluding Tokyo), Hokuriku, Tokai, Kinki, Chugoku plus Shikoku, and Kyushu plus Okinawa. Four different epidemiological measurements were evaluated: (i) estimated HIV incidence, (ii) estimated rate of diagnosis, (iii) number of undiagnosed HIV infections, and (iv) proportion of HIV infections that had been diagnosed. Results: The incidence of HIV/AIDS during the COVID-19 pandemic from 2020 to 2022 increased in all regions except Kanto/Koshinetsu (51.3 cases/year), Tokyo (183.9 cases/year), Hokuriku (1.0 cases/year), and Tokai (43.1 cases/year). The proportion of HIV infections that had been diagnosed only exceeded 90% in Tokyo (91.7%, 95% confidence interval (CI): 90.6, 93.3), Kanto/Koshinetsu (91.0%, 95% CI: 87.3, 97.8), and Kinki (92.5%, 95% CI: 90.4, 95.9). The proportion of infections that had been diagnosed was estimated at 83.3% (95% CI: 75.1, 98.7) in Chugoku/Shikoku and 80.5% (95% CI: 73.9, 91.0) in Kyusyu/Okinawa. Conclusions: In urban regions with major metropolitan cities, including Tokyo, Kinki, and Kanto/Koshinetsu, the number of undiagnosed HIV infections is substantial. However, the proportion of undiagnosed infections was estimated to be smaller than in other regions. The diagnosed proportion was the lowest in Kyusyu/Okinawa (80.5%), followed by Chugoku/Shikoku and Hokkaido/Tohoku. The level of diagnosis in those regional prefectures may have been more influenced and damaged by the COVID-19 pandemic than in urban settings.

Identification of structural variation related to spawn capability of Penaeus vannamei.

BACKGROUND: The genetic basis underlying spawning abilities in the Pacific white shrimp, Penaeus vannamei, remains largely unexplored. To investigate genetic variations potentially related to reproductive performance, a systematic bioinformatic analysis was conducted to identify structural variations (SVs) with different polymorphic spectra in P. vannamei with high fertility (HF) and low fertility (LF). RESULTS: A total of 2,323 and 1,859 SV events were identified exclusively in the HF and LF groups, respectively. These SVs were mapped to 277 genes in the HF group and 231 genes in the LF group. Gene Ontology (GO) enrichment analysis based on SNPs (single nucleotide polymorphism) and SVs revealed several neural-related processes, suggesting the importance of neural regulation in reproduction. Notably, we identified a set of promising genes, including Cttn, Spast, Ppp4c, Spire1, Lhcgr, and Ftz-f1, which may enhance fertility in shrimp. CONCLUSION: In conclusion, this study is the first to establish a link between SVs and reproductive traits in P. vannamei. The promising genes discovered have the potential to serve as crucial markers for enhancing reproductive traits through targeted genotyping.

Reappraisal of the Variations in the Origin of the Obturator Artery With Clinical and Developmental Perspectives: A Cadaveric Analysis.

Background The obturator artery (OA), typically originating from the anterior division of the internal iliac artery (ADIIA), shows significant variability in its origin. Such variations can present clinical challenges during pelvic surgeries, potentially causing unnoticed bleeding and complicating effective treatment. This study aims to thoroughly document the diverse anatomical variations of the OA and explore their implications for surgical practice. Materials and methods Forty-eight hemipelvis specimens from adult human cadavers were dissected. The origin of each OA was meticulously documented, photographed, and analyzed descriptively. Results In 38 specimens (79.2%), the OA originated from the IIA. It branched off at various levels from either the ADIIA or the posterior division of the IIA (PDIIA), either individually or in combination with other named branches. In nine cases (18.8%), the OA originated directly from the external iliac artery (EIA), either as a distinct branch or alongside the inferior epigastric artery (IEA). Additionally, one specimen (2%) exhibited a dual origin involving both the ADIIA and the IEA. Conclusion These findings highlight the frequent anatomical variations in the origin and pathway of the OA. Understanding these variations is crucial for accurately assessing pelvic anatomical relationships, which is essential for effective surgical planning and ensuring procedural safety. This knowledge is particularly important during vascular and surgical procedures, as it can impact the risk of bleeding and the effectiveness of treatment strategies.

Ship emission variations during the COVID-19 from global and continental perspectives.

The COVID-19 pandemic and the International Maritime Organization's (IMO) 2020 fuel-switching policy have profoundly impacted global maritime activities, leading to unprecedented changes in shipping emissions. This study aimed to examine the effects from different scales and investigate the underlying drivers. The big data model Ship Emission Inventory Model (SEIM) was updated and applied to analyze the spatiotemporal pattern of global ship emissions as well as the main contributors in 2019 and 2020. Overall, ships emitted NOx, CO, HC, CO2, and N2O declined by 7.4 %-13.8 %, while SO2, PM2.5, and BC declined by 40.9 %-81.9 % in 2020 compared with 2019. The decline in CO2 emissions indicated a comparable reduction across vessel tonnages. Ship emissions occurring at cruising status accounted for over 90 % of the ship's CO2 emission reduction. Container ships, chemical tankers, and Ro-Ro vessels were the primary contributors to the emission reductions, with container ships alone responsible for 39.4 % of the CO2 decrease. The ship's CO2 emissions variations revealed the decline-rebound patterns in response to the pandemic. Asian-related routes saw emissions drop in February 2020, followed by a rebound in May, while European and American routes experienced declines starting in May, with a recovery in August. Further analysis of CO2 emission in Exclusive Economic Zones (EEZs) showed high temporal consistency between vessel CO2 emissions, sailing speeds, and international trade volumes across continents, and exhibited heterogeneity in main contributing ship type of emission reduction on continental scale. Our study reveals the short-term fluctuation characteristics of global ship emissions during the pandemic, particularly focusing on their spatiotemporal evolution and the inherent disparities. The results highlight the correlation between global ship emissions and trade, as well as the operational status of ships, and their rigidity.

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Biallelic Deletion of PEX26 Exon 4 in a Boy with Phenotypic Features of both Zellweger Syndrome and Infantile Refsum Disease.

Introduction: Peroxisome biogenesis disorders (PBDs) encompass a group of diseases marked by clinical and genetic heterogeneity. Phenotypes linked to PBDs include Zellweger syndrome, neonatal adrenoleukodystrophy, infantile Refsum disease (IRD), rhizomelic chondrodysplasia punctata type 1, and Heimler syndrome. PBD phenotypes manifest through hypotonia, developmental delay, facial dysmorphism, seizures, liver dysfunction, sensorineural hearing loss, and retinal dystrophy. Methods: The proband underwent comprehensive clinical evaluation, followed by whole-exome sequencing (WES) coupled with copy number analysis (CNV), aimed at identifying potential disease-causing variants aligning with the observed phenotype. Results: Our findings detail an individual exhibiting developmental delay, hearing loss, visual impairment, hepatomegaly, and splenomegaly, attributed to a biallelic deletion of exon 4 in the PEX26 gene. The WES analysis of the index case did not uncover any pathogenic/likely pathogenic single-nucleotide variations that could account for the observed clinical findings. However, the CNV data derived from WES revealed a homozygous deletion in exon 4 of the PEX26 gene (NM_001127649.3), providing a plausible explanation for the patient's clinical features. The exon 4 region of PEX26 encodes the transmembrane domain of the protein. The transmembrane domain plays a crucial role in anchoring the protein within lipid bilayers, and its absence can disrupt proper localization and functioning. As a result, this structural alteration may impact the protein's ability to facilitate essential cellular processes related to peroxisome biogenesis and function. Conclusion: The index patient, which presented with hearing loss, retinal involvement and hepatic dysfunction in adolescence age, has atypical clinical course that can be considered unusual for Zellweger syndrome (ZS) and IRD phenotypes, and its rare genotypic data (in-frame single exon deletion) expands the PBD disease spectrum. This study revealed for the first time that PEX26 protein transmembrane domain loss exhibits an unusual course with clinical findings of IRD and ZS phenotypes. WES studies, incorporating CNV analyses, empower the identification of novel genetic alterations in genes seldom associated with gross deletion/duplication variations, such as those in the PEX26 gene. This not only enhances diagnostic rates in rare diseases but also contributes to broadening the spectrum of causal mutations.

Natural sorting of sediments in the wave run-up zone works for microplastics as well.

The distribution of plastic pollution in the marine environment is highly variable in time and space, making it difficult to assess pollution levels. This study shows that mixing and natural sorting of material in the wave run-up zone of a sandy beach results in a relatively stable abundance of microplastics in the size range 0.5-2 mm (S-MPs). Based on 175 samples collected over 14 months during 42 monitoring surveys at 6 stations along the shore of the Vistula Spit (Baltic Sea), the mean abundance of S-MPs was found to be 64 ± 36 items/kg DW (98.6 % fibers), with a coefficient of variation of only 56 % over more than one year. Statistical tests confirmed its independence from current wind speed, significant wave height, mean sediment grain size, sediment sorting, percentage of certain sand fractions, month, season, or location along the shore. It can therefore be used as a suitable indicator for long-term monitoring of increasing plastic pollution in the marine environment.

Spatiotemporal distribution of pCO2 and CO2 flux and the regulatory factors: From the perspective of a subtropical canyon-shaped reservoir, southwest China.

Reservoir carbon cycling is a critical component of the global carbon cycle, particularly in subtropical canyon-shaped reservoirs where unique geomorphological features and hydrological regulation under monsoon climate provide a distinct perspective for carbon cycle research. This study takes the Zipingpu Reservoir (ZPPR) in southwestern China as an example and reveals significant seasonal variations in partial pressure of carbon dioxide (pCO2) and carbon dioxide flux at the water-air interface (FCO2) through annual monitoring. The average pCO2 in ZPPR is 486 µatm, and the average FCO2 is 0.093 g C m-2d-1, with approximately 42.4 % of FCO2 measurements being negative, indicating the reservoir's role can act as a carbon sink. The study also estimated the gas transfer coefficient (K), with an average value of 1.888 md-1. Peak FCO2 during spring and summer is three times higher than in other seasons, consistent with the main influencing factors of inflow dynamics, metabolic processes, and reservoir operation strategies. Inflow and operational activities, particularly during spring and summer, drive CO2 emissions in the downstream reach and upstream tributary, while biological activity facilitates CO2 uptake in the lacustrine area and forebay tributary, with enhanced absorption occurring in the autumn. Concurrently, high-intensity FCO2 emissions from the upstream river section during summer underscore the importance of carbon emission monitoring and management during critical periods. The findings not only enhance the understanding of FCO2 assessment accuracy but also provide a framework for evaluating and optimizing carbon dynamics management strategies in canyon-shaped reservoirs, contributing valuable insights to global carbon cycle research.

Relationship between optic nerve length and interoptic angle in the prediction of optic chiasm location.

INTRODUCTION AND OBJECTIVES: The sellar region is an area in the base of the skull that is among the most common sites for tumors of the central nervous system. Surgical interventions are currently performed via different routes. While the optic chiasm occupies its expected position in 70% of the population, it can deviate from this position. In such cases, surgery involving this region becomes more difficult as the known surgical routes are narrowed. Advance awareness of these variations can help surgeons to identify the optimal route for safe surgical intervention in the sellar region. By performing simple measurements of both the lengths of the optic nerves and the angle between them, a surgeon can predict the location of the chiasm. MATERIALS AND METHODS: Twenty specimens collected from autopsies performed at Bursa Forensic Medicine Institute were examined to determine the optic chiasm types and the relationships between the surrounding subchiasmal structures. RESULTS: Among the 20 specimens, we found two prefixed (10%), 10 normo-fixed (50%), and eight postfixed chiasms (40%). The mean interoptic angle was 81.03 (±17.41)°. Prefixed chiasms had angles in the range 115.36°-124.76 ° (mean 120.06 [±6.65]°), normo-fixed chiasm angles were between 83.11°-97.53 ° (mean 86.07 [±6.73]°), and postfixed chiasms ranged between 53.01°-78.71 ° (mean 69.20 [±9.13]°). The length of the right optic nerve ranged between 6.95-13.83 mm (mean 10.25 [±1.81] mm), and the length of the left between 7.25-12.51 mm (mean 10.40 [±1.47] mm). Obtuse angles indicated that the chiasm was prefixed, and acute angles were indicative of a postfixed chiasm. There was a strong negative correlation between optic nerve lengths and the interoptic angle; thus, as the length of the nerves increases, the interoptic angle becomes more acute. CONCLUSIONS: We have proposed a simple measurement of the optic nerve lengths and the angle between them to predict the relative location of the OC, which can be done easily on MRI.

Complete dorsal wall agenesis of the sacral canal in a Greek population: an osteological study.

INTRODUCTION: The failure of closure of the dorsal wall of the sacral canal (SC) has been known since the eve of modern osteology, appearing in prehistoric times. Variants include partial or complete absence of the dorsal wall of the SC. SC presents a pathway for minimally invasive therapeutic and diagnostic procedures for spinal diseases and for ensuring analgesia and anesthesia in operations, including labor and genitourinary surgery.

Transverse testicular ectopia in a newborn with transposition of the great arteries: A unique case report.

INTRODUCTION: Transverse testicular ectopia (TTE) is an extremely rare though well-documented congenital anomaly. In males with a 46XY karyotype, it is characterised by the herniation of both testes and part of the Müllerian organs into a single processus vaginalis. TTE is one of the three main clinical presentations of persistent Müllerian duct syndrome (PMDS). Transposition of the great arteries (TGA) is another rare congenital anomaly and severe cardiac condition. We present the likely first reported case of TTE with an accompanying malformation of TGA in a newborn. CASE PRESENTATION: A 3-day-old Caucasian 46XY newborn with TGA was referred to the paediatric surgeons and endocrinologists for possible variations of sex characteristics (VSC). Despite a clinical examination revealing phenotypical male genitalia, an early postnatal ultrasound (US) suggestive of a uterine structure raised the suspicion of VSC. This patient had an arterial switch operation at 2 weeks of age before undergoing an exploration of the left groin at 8 weeks of age. Intraoperative findings revealed bilateral testes either side of a rudimentary uterus with fallopian tubes in the left inguinal canal. To avoid de-vascularising any structures, modified bilateral orchidopexy was performed placing each testis in the respective hemiscrotum with the uterus placed across the scrotal septum. CONCLUSION: We present the first reported case of TGA accompanying TTE. Early and accurate diagnosis, combined with the coordinated care by the specialist paediatric surgeon, cardiothoracic team, endocrinologist, and radiologist are essential for delivering timely, optimal care. This unique case raises the possibility of there being a link between TTE and TGA.

Spatiotemporal variations of farmland crop residue burning in China from 2013 to 2022.

Farmland crop residue burning (FCRB) significantly impacts air quality, necessitating understanding its spatiotemporal variations to evaluate control measures and guide future policies. This study analyzes FCRB across China from 2013 to 2022 using remote sensing technology and spatiotemporal analysis. Results indicate that the first phase (2013-2017) of the "Clean Air Action" control measures has been proven ineffective, with a 30.9 % increase in FCRB. Effective measures implemented in the second phase (2018-2020) resulted in a reduction of 41.4 % and led to a decrease of 34.3 % in 2022 compared to 2013. FCRB exhibits significant seasonal and regional variations, with a 69 % decrease in autumn and a 23 % increase in spring. While the variations in FCRB across regions are found to be significantly negatively correlated with the stringency of control measures, there is a 61.2 % reduction in the central region, 42.4 % in the western region, 29.7 % in the eastern region with the highest intra-regional disparities, and only 4.5 % in the northeastern region, which is attributed to the high FCRB in Heilongjiang province. FCRB demonstrates the "club convergence" phenomenon and the spillover effects of adjacent provinces, leading to high-high clusters in the northeastern region, emphasizing the need for region-specific control measures (e.g., Heilongjiang province in the northeastern) and the implementation of similar control measures in adjacent areas. Additionally, it is necessary to avoid the rebound phenomenon determined by the analysis of the kernel density estimation curve. Our findings underscore the importance of tailored strategies in managing FCRB and improving air quality in critical areas.

Sternalis Muscle: A Cadaveric Case Report of a Rare Variant With Multiple Branching.

The sternalis muscle is a rare anatomical variant located in the anterior thoracic wall. Understanding variations in the sternalis muscle anatomy is essential for clinicians, especially radiologists and surgeons to prevent misdiagnosis and avoid complications during surgical procedures in the anterior thoracic region. We present a unique case of bilateral branched sternalis muscles. On either side, the sternalis muscle lies deep to the breast and superficial fascia and superficial to pectoralis major muscle and pectoral fascia. Each sternalis muscle is branched into medial and lateral slips with the medial slip larger than the lateral slip. The medial slip of the right sternalis was larger than the medial slip of the left sternalis. The lateral slip of the left sternalis was larger than the lateral slip of the right sternalis. The lateral slip of the left sternalis muscle has a curved course with superior-lateral convexity and inferomedial concavity. Near its middle, the left sternalis lateral slip is branched into two smaller slips separated by a narrow cleft. The left sternalis muscle in our report is a new variant with multiple branching, which cannot be matched to any type of the previously described classifications. In this case report, we discussed the need of modification of the currently available sternalis classification system to accommodate all types of the previously reported sternalis muscles including the branching pattern of this muscle.

Diagnostic yield of exome sequencing-based copy number variation analysis in Mendelian disorders: a clinical application.

Next-generation sequencing (NGS) coupled with bioinformatic tools has revolutionized the detection of copy number variations (CNVs), which are implicated in the emergence of Mendelian disorders. In this study, we evaluated the diagnostic yield of exome sequencing-based CNV analysis in 449 patients with suspected Mendelian disorders. We aimed to assess the diagnostic yield of this recently utilized method and expand the clinical spectrum of intragenic CNVs. The cohort underwent whole exome sequencing (WES) and clinical exome sequencing (CES). Using GATK-gCNV, we identified 12 pathogenic CNVs that correlated with their clinical findings and resulting in a diagnostic yield of 2.67%. Importantly, the study emphasizes the role of CNVs in the etiology of Mendelian disorders and highlights the value of exome sequencing-based CNV analysis in routine diagnostic processes.

Multiple Variations in Abdominal Aorta Branching and Their Clinical Significance: A Case Report.

The abdominal aorta extends from the T12 vertebra and terminates at the L4 vertebra. It gives off anterior, lateral, and posterior branches that supply the abdominal viscera and vertebrae at this level, eventually dividing into the common iliac arteries. Dissection of the abdominal aorta and its branches from a female cadaver revealed several variations: the right inferior phrenic artery arose from the celiac trunk, the left middle suprarenal artery originated at the L1 vertebra, while the right middle suprarenal artery arose at the L2 vertebra, and the left and right renal arteries emerged from the L2 and L1 vertebrae, respectively. The gonadal arteries did not originate from the abdominal aorta. Inferior phrenic arteries may arise from the abdominal aorta, celiac trunk, or occasionally form renal arteries and are linked with extrahepatic supply in hepatocellular carcinoma. Middle suprarenal arteries typically originate from the abdominal aorta at L1, but may occasionally arise from L2 or be absent. Variations in the middle suprarenal arteries often correspond with variations in the inferior phrenic and gonadal arteries. Renal arteries may arise at the L1 vertebra, the L1/L2 intervertebral disc, or the L2 vertebra, with additional variations reported. The gonadal arteries may not originate from the abdominal aorta in some cases. These branching variations of the abdominal aorta are important for clinical, diagnostic, and therapeutic procedures and should be documented accordingly.

Epidemiological Characteristics of Upper Respiratory Tract Pathogens in Children in Guangdong, China.

OBJECTIVE: Researches on the epidemiology of various respiratory pathogens at multiple testing points in the pediatric population are limited, and these are crucial for the prevention of respiratory tract infections in children. METHODS: We obtained 1788 upper respiratory tract swabs from children exhibiting symptoms of respiratory infection (notably fever with a body temperature exceeding 38.5°C) across five hospitals in Guangdong between November 2020 and June 2022. We used the multiplex probe amplification (MPA) PCR testing to identify 11 respiratory viruses and subsequently analyzed the prevalence characteristics of these pathogens among febrile children in hospitals. RESULTS: The overall detection rate of the pathogens was 58.1% (1039/1788). Human rhinovirus (HRV) exhibited the highest detection rate at 19.0% (339/1788), succeeded by human parainfluenza virus (HPIV), human adenovirus (HAdV), and respiratory syncytial virus (RSV). The positivity and coinfection rates were higher in children aged 5 years and below compared to those above 5 years. Moreover, a distinct pathogen spectrum was observed across different age groups. Hospitalized patients demonstrated a significantly higher positivity and coinfection rate compared to outpatients. During COVID-2019, RSV appeared a counter-seasonal trend. CONCLUSION: Respiratory viral infections in children display distinct characteristics concerning age, hospitalization status, and seasonality. Children under the age of 5 and minor patients admitted to hospitals at least be tested for RSV, HRV, HPIV, and HAdV. The epidemiological patterns of RSV in the post-epidemic period require ongoing surveillance.

Genome-wide identification of m6A-related gene family and the involvement of TdFIP37 in salt stress in wild emmer wheat.

KEY MESSAGE: The genomic organization, phylogenetic relationship, expression patterns, and genetic variations of m6A-related genes were systematically investigated in wild emmer wheat and the function of TdFIP37 regulating salt tolerance was preliminarily determined. m6A modification is one of the most abundant and crucial RNA modifications in eukaryotics, playing the indispensable role in growth and development as well as stress response in plants. However, its significance in wild emmer wheat remains elusive. Here, a genome-wide search of m6A-related genes was conducted in wild emmer wheat to obtain 64 candidates, including 21 writers, 17 erasers, and 26 readers. Phylogenetic and collinearity analysis demonstrated that segmental duplication and polyploidization contributed mainly to the expansion of m6A-related genes in wild emmer. A number of cis-acting elements involving in stress and hormonal regulation were found in the promoter regions of them, such as MBS, LTR, and ABRE. Genetic variation of them was also investigated using resequencing data and obvious genetic bottleneck was occurred on them during wild emmer wheat domestication process. Furthermore, the salt-responsive candidates were investigated through RNA-seq data and qRT-PCR validation using the salt-tolerant and -sensitive genotypes and the co-expression analysis showed that they played the hub role in regulating salt stress response. Finally, the loss-function mutant of Tdfip37 displayed the significantly higher salt-sensitive compared to WT and then RNA-seq analysis demonstrated that FIP37 mediated the MAPK pathway, hormone signal transduction, as well as transcription factor to regulate salt tolerance. This study provided the potential m6A genes for functional analysis, which will contribute to better understand the regulatory roles of m6A modification and also improve the salt tolerance from the perspective of epigenetic approach in emmer wheat and other crops.

Assessment and prediction of Water Quality Index (WQI) by seasonal key water parameters in a coastal city: application of machine learning models.

The Water Quality Index (WQI) provides comprehensive assessments in river systems; however, its calculation involves numerous water quality parameters, costly in sample collection and laboratory analysis. The study aimed to determine key water parameters and the most reliable models, considering seasonal variations in the water environment, to maximize the precision of WQI prediction by a minimal set of water parameters. Ten statistical or machine learning models were developed to predict the WQI over four seasons using water quality dataset collected in a coastal city adjacent to the Yellow Sea in China, based on which the key water parameters were identified and the variations were assessed by the Seasonal-Trend decomposition procedure based on Loess (STL). Results indicated that model performance generally improved with adding more input variables except Self-Organizing Map (SOM). Tree-based ensemble methods like Extreme Gradient Boosting (XGB) and Random Forest (RF) demonstrated the highest accuracy, particularly in winter. Nutrients (Ammonia Nitrogen (AN) and Total Phosphorus (TP)), Dissolved Oxygen (DO), and turbidity were determined as key water parameters, based on which, the prediction accuracy for Medium and Low grades was perfect while it was over 80% for the Good grade in spring and winter and dropped to around 70% in summer and autumn. Nutrient concentrations were higher at inland stations; however, it worsened at coastal stations, especially in summer. The study underscores the importance of reliable WQI prediction models in water quality assessment, especially when data is limited, which are crucial for managing water resources effectively.

Metabolic processes drive spatio-temporal variations of carbon sink/source in a karst river.

Riverine carbon dioxide (CO2) exchange is a crucial component of the global carbon cycle. However, the changes in the CO2 sink/source in karst rivers caused by differences in lithological features and climate, hindered the resolution of the spatio-temporal heterogeneity of global inland water carbon emissions. Here, we use hydrochemical data and CO2 gas isotopic data to reveal the spatio-temporal variations of CO2 sink/source in karst rivers and their controlling mechanisms. Fifty-two monitoring transects were set up in the subtropical Lijiang River in southwest China in June and December 2019. Our results indicated that the CO2 flux across the water-air interface (FCO2) in the Lijiang River basin ranged from -43.77 to 519.67 mmol/(m2·d). In June, the Lijiang River acted as an atmospheric carbon source due to higher water temperatures (Twater). However, driven by hydrodynamic conditions and the metabolism of aquatic photosynthesis, the river shifts from being an atmospheric carbon source in June to an atmospheric carbon sink in December. The stable isotopes of CO2 (δ13C-CO2) show significant differences in the spatio-temporal variations of CO2 sink/source. In December, the transects of the Lijiang River basin with a negative CO2 flux are significantly negatively correlated with dissolved oxygen (DO) and chlorophyll-a (Chl-a) concentration (p < 0.05). This confirms that the enhancement of aquatic photosynthesis efficiency increased water DO concentrations, which resulted in the positive movement of water δ13C-CO2 and a decrease in the partial pressure of CO2 (pCO2) and FCO2. Comparative analysis with global river FCO2 indicates that under the combined driving forces of metabolic processes of aquatic photosynthetic organisms and hydrodynamic conditions, rivers tend to act more frequently as CO2 sinks, particularly in subtropical and temperate rivers. In conclusion, this study represents a new example focusing on CO2 dynamics to address the spatio-temporal heterogeneity of carbon emissions in inland waters on a global scale.

A real world analysis of secondary BRAF variations after targeted therapy resistance in driver gene positive NSCLC.

Secondary BRAF variations have been identified as a mechanism of resistance to tyrosine kinase inhibitors (TKIs) in patients with driver gene-positive NSCLC. Nevertheless, there is still a lack of consensus regarding the characteristics and subsequent treatment strategies for these patients. We retrospectively reviewed the medical records of patients with driver gene-positive NSCLC who received TKIs therapy at Zhejiang Cancer Hospital between May 2016 and December 2023. The clinical and genetic characteristics of these patients were assessed, along with the impact of various treatment strategies on survival. This study enrolled 27 patients with advanced NSCLC, in whom BRAF variations occurred at a median time of 28 months after the initiation of targeted therapy. The multivariate accelerated failure time (AFT) model revealed that, compared to chemotherapy-based regimens group, the combined targeted therapy group (p < 0.001) and the combined local treatment group for oligo-progression (p < 0.001) significantly extended patient survival. In contrast, continuing the original signaling pathway's targeted monotherapy was associated with shorter survival (p = 0.034). The median global OS for each treatment group was as follows: chemotherapy-based regimens group, 45 months; combined targeted therapy group, 59 months; combined local treatment group for patients with oligo-progression, 46 months; and targeted monotherapy group, 36 months. Study results indicate that the combination targeted therapy group (including TKIs, BRAF inhibitors, and/or MEK inhibitors) and the localized treatment group are more effective than traditional chemotherapy-based regimens in improving survival. Additionally, continuing targeted monotherapy along the original signaling pathway proves less effective than chemotherapy-based regimens.