Family History of Type 2 Diabetes and Its Association with Beta Cell Function and Lipid Profile in Newly Diagnosed Pediatric Patients with Type 1 Diabetes.

OBJECTIVE: The objective of this study was to explore the associations between a family history of type 2 diabetes (T2D) and beta-cell function, as well as lipid profile, in pediatric patients newly diagnosed with type 1 diabetes (T1D). METHODS: A retrospective analysis was conducted on children under 14 years of age who were newly diagnosed with T1D at the Children's Hospital of Zhejiang University between August 2018 and August 2022. Clinical features, metabolic profiles, beta-cell function, and lipid profile were evaluated. RESULTS: A total of 316 children were diagnosed with new-onset T1D. Among them, 28.2% had a family history of T2D. Patients with T1D who had a family history of T2D experienced a later onset of the disease (p = 0.016), improved HOMA2-%B levels (p = 0.003), and increased concentrations of HDL-C (p = 0.005). In addition, no statistically significant differences in age at onset, HOMA2-%B levels, or HDL-C were found when assessing the interaction between family history of T2D and type of diabetes mellitus (autoimmune T1D/idiopathic T1D). CONCLUSION: A family history of T2D may contribute to the heterogeneity of T1D patients in terms of HOMA2-%B levels and lipid profile. This highlights the significance of taking into account T2D-related factors in the diagnosis and treatment of T1D.

Clinical and Genetic Analysis of Multiple Idiopathic Cervical Root Resorption.

OBJECTIVE: To explore the genetic background and clinical phenotypes of multiple idiopathic cervical root resorption (MICRR) in a Chinese family. METHODS: The proband and his three family members were clinically examined and had radiographs taken with a radiovisiography (RVG) system and CBCT to define the diagnosis of MICRR. Genomic DNA (gDNA) was extracted from peripheral blood samples of the patient, his father, mother and younger sister for whole exome sequencing (WES). The pathogenicity of rare variants with minor allele frequency (MAF) less than 0.005 were analysed following possible inheritance patterns, predicted results from 12 software programs, the American College of Medical Genetics (ACMG) 2015 criteria, and information from ClinVar, OMIM and HGMD databases as well as gene function. RESULTS: The proband presented the typical MICRR phenotypes such as thin cervical pulp wall and apple core-like lesions in radiographs. Following the recessive inheritance pattern, WES analysis identified SHROOM2, SYTL5, MAGED1 and FLNA with a higher chance of causing MICRR. Four genes with compound heterozygous variants and another 27 genes with de novo variants either in autosomal-dominant or autosomal-recessive pattern were also found to have the potential pathogenicity. CONCLUSION: A total of 35 novel potential pathogenic genes were found to be associated with MICRR from a Chinese family through WES. The new genetic background of MICRR may be helpful for clinical and molecular diagnosis.

Graded 2D/3D Perovskite Hetero-Structured Films with Suppressed Interfacial Recombination for Efficient and Stable Solar Cells via DABr Treatment.

Several strategies and approaches have been reported for improving the resilience and optoelectronic properties of perovskite films. However, fabricating a desirable and stable perovskite absorber layer is still a great challenge due to the optoelectronic and fabrication limitations of the materials. Here, we introduce diethylammonium bromide (DABr) as a post-treatment material for the pre-deposited methylammonium lead iodide (MAPbI3) film to fabricate a high-quality two-dimensional/three-dimensional (2D/3D) stacked hetero-structure perovskite film. The post-treatment method of DABr not only induces the small crystals of MAPbI3 perovskite secondary growth into a large crystal, but also forms a 2D capping layer on the surface of the 3D MAPbI3 film. Meanwhile, the grains and crystallization of 3D film with DABr post-treatment are significantly improved, and the surface defect density is remarkably reduced, which in turn effectively suppressed the charge recombination in the interface between the perovskite layer and the charge transport layer. The perovskite solar cell based on the DABr-treatment exhibited a significantly enhanced power conversion efficiency (PCE) of 19.10% with a notable improvement in the open circuit voltage (VOC) of 1.06 V and good stability, advocating the potential of this perovskite post-treatment approach.

Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings.

Given the possible pathophysiological links between myocardial ischemia and SARS-CoV-2 infection, several studies have focused attention on acute coronary syndromes in order to improve patients' morbidity and mortality. Understanding the pathophysiological aspects of myocardial ischemia in patients infected with SARS-CoV-2 can open a broad perspective on the proper management for each patient. The electrocardiogram (ECG) remains the easiest assessment of cardiac involvement in COVID-19 patients, due to its non-invasive profile, accessibility, low cost, and lack of radiation. The ECG changes provide insight into the patient's prognosis, indicating either the worsening of an underlying cardiac illnesses or the acute direct injury by the virus. This indicates that the ECG is an important prognostic tool that can affect the outcome of COVID-19 patients, which important to correlate its aspects with the clinical characteristics and patient's medical history. The ECG changes in myocardial ischemia include a broad spectrum in patients with COVID-19 with different cases reported of ST-segment elevation, ST-segment depression, and T wave inversion, which are associated with severe COVID-19 disease.

Simultaneous Interfacial Modification and Defect Passivation for Wide-Bandgap Semitransparent Perovskite Solar Cells with 14.4% Power Conversion Efficiency and 38% Average Visible Transmittance.

Perovskite materials offer a great potential in the application of semitransparent solar cells, owing to the tunable bandgap, ease of preparation and excellent photovoltaic property. A majority of works exhibit high average visible-light transmittance (AVT) for semitransparent perovskite solar cells (ST-PSCs) through decreasing perovskite thickness, leading to sacrificing the power conversion efficiency (PCE) of the device. Herein, a wide-bandgap (WBG) perovskite of Cs0.2 FA0.8 Pb(I0.6 Br0.4 )3 is applied as absorber in ST-PSCs, which is a tremendous progress to balance both large PCE and high AVT. Moreover, a strategy of simultaneous interfacial modification and defect passivation is provided to enhance the performance of WBG ST-PSCs. Consequently, an inverted planar structure WBG perovskite solar cell (PSC) achieves 15.06% of PCE with excellent stability by restraining the interfacial energy loss and suppressing the nonradiative recombination. Furthermore, the ST-PSC obtains high PCE of 14.40% with an AVT of 38% by means of optimizing the transparent electrode. This work provides an efficient and simple method to improve the performance and AVT of ST-PSCs for the application in building-integrated photovoltaics.

Cardiopulmonary Exercise Testing and Cardiac Biomarker Measurements in Young Football Players: A Pilot Study.

Constant and intense physical activity causes physiological adaptive changes in the human body, but it can also become a trigger for adverse events, such as sudden cardiac arrest or sudden cardiac death. Our main objective was to assess the use of combined cardiopulmonary exercise testing (CPET) and cardiac biomarker determinants in young professional athletes. We conducted a study which involved the full examination of 19 football players, all male, aged between 18 and 20 years old. They underwent standard clinical and paraclinical evaluation, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE). Afterwards, a tailored CPET was performed and peripheral venous blood samples were taken before and 3 h after the test in order to determine five biomarker levels at rest and post-effort. The measured biomarkers were cardiac troponin I (cTnI), myoglobin (Myo), the MB isoenzyme of creatine-kinase (CK-MB), the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and D-dimers. While cTnI and NT-proBNP levels were undetectable both at rest and post-effort in all subjects, the variations in Myo, CK-MB and D-dimers showed significant correlations with CPET parameters. This highlights the potential use of combined CPET and biomarker determinants to evaluate professional athletes, and encourages further research on larger study groups.

A Modified Sequential Deposition Route for High-Performance Carbon-Based Perovskite Solar Cells under Atmosphere Condition.

Carbon-based hole transport material (HTM)-free perovskite solar cells have exhibited a promising commercialization prospect, attributed to their outstanding stability and low manufacturing cost. However, the serious charge recombination at the interface of the carbon counter electrode and titanium dioxide (TiO2) suppresses the improvement in the carbon-based perovskite solar cells' performance. Here, we propose a modified sequential deposition process in air, which introduces a mixed solvent to improve the morphology of lead iodide (PbI2) film. Combined with ethanol treatment, the preferred crystallization orientation of the PbI2 film is generated. This new deposition strategy can prepare a thick and compact methylammonium lead halide (MAPbI3) film under high-humidity conditions, which acts as a natural active layer that separates the carbon counter electrode and TiO2. Meanwhile, the modified sequential deposition method provides a simple way to facilitate the conversion of the ultrathick PbI2 capping layer to MAPbI3, as the light absorption layer. By adjusting the thickness of the MAPbI3 capping layer, we achieved a power conversation efficiency (PCE) of 12.5% for the carbon-based perovskite solar cells.

Auxiliary Liver Graft Can Be Protected From HBV Infection in HBsAg Positive Blood Circulation.

Auxiliary grafts have a high risk of Hepatitis B virus (HBV) infection in patients with chronic HBV-related diseases. Hepatitis B virus-related auxiliary partial orthotopic liver transplantation (APOLT) cases were reviewed to show the results of current methods to block native-to-graft HBV transmission. Three patients received APOLT for HBV-related liver cirrhosis and a recurrent upper gastrointestinal hemorrhage between April 2015 and January 2017 by the liver transplant team of Beijing Friendship Hospital affiliated with Capital Medical University. All three patients were positive for HBV surface antigen (HBsAg) and had a negative HBV DNA test result before transplantation. After auxiliary transplantations, HBsAg was found to be positive in two patients and negative in one patient. To avoid graft infection of HBV, entecavir-based therapy was employed and the remnant native livers of the recipients were removed 51-878 days after liver transplantation. Then, serum conversions of HBsAg were found in all three cases. For the first time, this case series shows the possibility of blocking the transmission of HBV from a native liver to a graft in auxiliary transplantation by entecavir-based therapy. Among the cases, a left lobe graft was successfully implanted as a replacement of the right lobe of the recipient, which is also discussed.

Could we employ the queueing theory to improve efficiency during future mass causality incidents?

BACKGROUND: Preparation for a disaster or accident-related mass casualty events is often based on experience. The objective measures or tools for evaluating decision-making and effectiveness during such events are underdeveloped. Queueing theory has been suggested to evaluate the effectiveness of mass causality incidents (MCI) plans. OBJECTIVE: Using different types of real MCI, we aimed to determine if a queueing network model could be used as a tool to assist in preparing plans to address mass causality incidents. METHODS: We collected information from two types of mass casualty events: a motor vehicle accident and a dust explosion. Patient characteristics, time intervals of every working station, numbers of physicians and nurses attending, and time required by physicians and nurses during these two MCIs were collected and used for calculation in a queueing network model. Balanced efficiency was determined by calculating the numbers of server, i.e., nurses and physicians, in the two MCIs. RESULTS: Efficient patient flows were found in both MCIs. However, excessive medical manpower supply was revealed when the queueing network model was applied to assess the MCIs. The best fitting result, i.e., the most efficient man power utilization, can be calculated by the queueing network models. Furthermore, balanced efficiency may be a more suitable condition than the highest efficiency man power utilization when faced with MCIs. CONCLUSION: The queueing network model is a flexible tool that could be used in different types of MCIs to observe the degree of efficiency when handling MCIs.

Carbocisteine Improves Histone Deacetylase 2 Deacetylation Activity via Regulating Sumoylation of Histone Deacetylase 2 in Human Tracheobronchial Epithelial Cells.

Histone deacetylase (HDAC) 2 plays a vital role in modifying histones to mediate inflammatory responses, while HDAC2 itself is commonly regulated by post-translational modifications. Small ubiquitin-related modifier (SUMO), as an important PTM factor, is involved in the regulation of multiple protein functions. Our previous studies have shown that carbocisteine (S-CMC) reversed cigarette smoke extract (CSE)-induced down-regulation of HDAC2 expression/activity in a thiol/GSH-dependent manner and enhanced sensitivity of steroid therapy. However, the mechanism by which S-CMC regulates HDAC2 is worth further exploring. Our study aimed to investigate the relationships between HDAC2 sumoylation and its deacetylase activity under oxidative stress and the molecular mechanism of S-CMC to regulate HDAC2 activity that mediates inflammatory responses in human bronchial epithelial cells. We found that modification of HDAC2 by SUMO1 and SUMO2/3 occurred in 16HBE cells under physiological conditions, and CSE induced SUMO1 modification of HDAC2 in a dose and time-dependent manner. K462 and K51 of HDAC2 were the two major modification sites of SUMO1, and the K51 site mediated deacetylation activity and function of HDAC2 on histone H4 that regulates IL-8 secretion. S-CMC inhibited CSE-induced SUMO1 modification of HDAC2 in the presence of thiol/GSH, increased HDAC activity, and decreased IL-8 expression. Our study may provide novel mechanistic explanation of S-CMC to ameliorate steroid sensitivity treatment in chronic obstructive pulmonary disease.

Look into hepatic progenitor cell associated trait: Histological heterogeneity of hepatitis B-related combined hepatocellular-cholangiocarcinoma.

Combined hepatocellular-cholangiocarcinoma (CHC) is a mixed tumor containing elements of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Its remarkable histological heterogeneity has been linked to putative hepatic progenitor cell (HPC) origin. However, detailed histological or phenotypic description is rarely documented. In the present study, we reassessed 68 cases previously diagnosed as hepatitis B-related CHCs by immunohistochemistry and double-fluorescence immunostaining, focusing on HPC associated phenotypic observation of intermediate area of the tumor. It was found that tumor cells showed remarkable heterogeneity in intermediate area. Tumor cells with intermediate morphology between hepatocytes and cholangiocytes were oval-shaped and small with scant cytoplasm and hyperchromatic nuclei, arranging in solid nests mostly. By Keratin 7 (K7) staining, it appeared that the nests of tumor cells represented a maturation process from the undifferentiated small cells to mature hepatocytes through the "transitional" cells. Then, these small cells were further confirmed with intermediate phenotype as HPC by exploring immature hepatocellular marker and HPC/biliary markers co-localization. In conclusion, the HPC associated trait in CHC can be interpreted by HPC origin or gain of "stemness" by dedifferentiation. It is still too soon to give a final word that it is innate or acquired signature of HPC associated trait in CHC.

Look into Hepatic Progenitor Cell Associated Trait: Histological Heterogeneity of Hepatitis B-Related Combined Hepatocellular-Cholangiocarcinoma / 华中科技大学学报（医学）（英德文版）

Combined hepatocellular-cholangiocarcinoma (CHC) is a mixed tumor containing elements of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).Its remarkable histological heterogeneity has been linked to putative hepatic progenitor cell (HPC) origin.However,detailed histological or phenotypic description is rarely documented.In the present study,we reassessed 68 cases previously diagnosed as hepatitis B-related CHCs by immunohistochemistry and double-fluorescence immunostaining,focusing on HPC associated phenotypic observation of intermediate area of the tumor.It was found that tumor cells showed remarkable heterogeneity in intermediate area.Tumor cells with intermediate morphology between hepatocytes and cholangiocytes were oval-shaped and small with scant cytoplasm and hyperchromatic nuclei,arranging in solid nests mostly.By Keratin 7 (K7) staining,it appeared that the nests of tumor cells represented a maturation process from the undifferentiated small cells to mature hepatocytes through the "transitional" cells.Then,these small cells were further confirmed with intermediate phenotype as HPC by exploring immature hepatocellular marker and HPC/biliary markers co-localization.In conclusion,the HPC associated trait in CHC can be interpreted by HPC origin or gain of"stemness" by dedifferentiation.It is still too soon to give a final word that it is innate or acquired signature of HPC associated trait in CHC.

Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension.

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.

Characterization of surface antigen protein 1 (SurA1) from Acinetobacter baumannii and its role in virulence and fitness.

Acinetobacter baumannii is a Gram-negative bacillus that causes nosocomial infections, such as bacteremia, pneumonia, and meningitis and urinary tract and wound infections. In the present study, the surface antigen protein 1 (SurA1) gene of A. baumannii strain CCGGD201101 was identified, cloned and expressed, and then its roles in fitness and virulence were investigated. Virulence was observed in the human lung cancer cell lines A549 and HEp-2 at one week after treatment with recombinant SurA1. One isogenic SurA1 knock-out strain, GR0015, which was derived from the A. baumannii strain CCGGD201101 isolated from diseased chicks in a previous study, highlighted the effect of SurA1 on fitness and growth. Its growth rate in LB broth and killing activity in human sera were significantly decreased compared with strain CCGGD201101. In the Galleria mellonella insect model, the isogenic SurA1 knock-out strain exhibited a lower survival rate and decreased dissemination. These results suggest that SurA1 plays an important role in the fitness and virulence of A. baumannii.

Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension / 华中科技大学学报（医学）（英德文版）

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.

Shifting the light emitting component from core to shell: an effective approach to improve the efficiency of light-emitting diodes based on multi-junction quantum materials.

Herein, using the light emitting component as the inner shell, we construct an advanced quantum-dot-quantum-well structure, ZnCdS/CdSe/CdZnSeS/ZnS, and use it for the fabrication of a light-emitting-diode. In comparison with the device containing conventional structured quantum dots, CdSe/CdZnSeS/ZnS, the advanced device possesses a superior performance in aspects of luminance, current efficiency, turn-on voltage and emitting wavelength tunability. Therefore, this paper indicates a promising strategy for the fabrication of light emitting devices based on quantum materials.

Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study.

PURPOSE: Insomnia, parasomnia, and obstructive sleep apnea have been associated with a number of disease pathologies, but little is known about the relationship of these sleep disorders and cancer. The study explored the risk of sleep disorder (SD)-induced cancer using nationwide population data. Two million data from the National Health Insurance system of Taiwan was used to assess for the relationship. PATIENTS AND METHODS: Patients with cancer as our cases and patients without cancer as our control group in 2001-20011. The study patients were traced back to seek the exposure risk factor of sleep disorders, which was divided into three categories: insomnia, obstructive sleep apnea (OSA) and parasomnia. Patients were selected excluding patients who had cancer prior to presenting with the sleep disorder and the person-year is less than 2 years. Each case was randomly matched with two cases with the same age, gender, and index year. RESULTS: There were significantly increased risks of breast cancer in the patients with insomnia (AHR=1.73; 95% CI: 1.57-1.90), patients with parasomnia (AHR=2.76; 95% CI: 1.53-5.00), and patients with OSA (AHR=2.10; 95% CI: 1.16-3.80). Moreover, patients with parasomnia had significantly higher risk of developing oral cancer (AHR=2.71; 95% CI: 1.02-7.24) compared with patients without parasomnia. The risk of suffering from nasal cancer (AHR=5.96, 95% CI: 2.96-11.99) and prostate cancer (AHR=3.69, 95% CI: 1.98- 6.89) in patients with OSA was significantly higher than that of patients without OSA. CONCLUSIONS: Our findings provided the evidence that people diagnosed with insomnia, parasomnia and OSA are at a higher risk of developing cancers to remind people to improve sleep quality.

Fully understanding the positive roles of plasmonic nanoparticles in ameliorating the efficiency of organic solar cells.

Herein, we constructed inverted PBDTTT-CF:PC70BM bulk-heterojunction organic solar cells by introducing Au nanoparticles to a ZnO buffer layer and a great improvement in energy conversion efficiency has been realized. To discover the positive roles of such plasmonic nanoparticles in the process of solar energy conversion, photovoltaic devices with the same architecture but different sized Au nanoparticles were purposely fabricated and it has been observed that the overall efficiency can be remarkably improved from 6.67% to 7.86% by embedding 41 nm Au nanoparticles in the buffer layer. The devices with other sizes of Au nanoparticles show a relatively low performance. Subsequent investigations including finite difference time domain simulation and transient photoluminescence studies reveal that the existence of the plasmonic particles could not only improve the optical absorption and facilitate the exciton separation, but can also benefit the collection of charge carriers. Thus, this paper provides a comprehensive perspective on the roles of plasmonic particles in organic solar cells and insights into the photo energy conversion process in the plasmonic surroundings.

Religious affiliation and the risk of dementia in Taiwanese elderly.

INTRODUCTION: Religious affiliations vary across ethnic groups because of different cultural backgrounds. Some studies have explored the association between religious affiliation and cognitive decline. Only a small portion of patients with cognitive decline progress to dementia. However, the association between religious affiliation and dementia risk remains unclear. METHODS: In this case-control study, we recruited 280 patients with Alzheimer's disease (AD) and 138 with vascular dementia (VaD) (both aged ≥60 years) from three teaching hospitals in northern Taiwan between 2007 and 2010. Age-matched healthy controls (n=466) were recruited from an elderly health checkup program and from volunteers visiting the hospital during the same period. Three religious affiliations-Taoism, Buddhism, and Christianity-were evaluated. The study also assessed the effect of important factors such as gender or leisure activities on the association of religious affiliation with dementia risk. RESULTS: Participants with Christianity affiliation showed decreased AD risk (adjusted odds ratio [AOR]=0.46, 95% confidence interval [CI]=0.25-0.87) compared with those without any religious affiliation. Moreover, this effect was stronger in women (AOR=0.38, 95% CI=0.15-0.92) and in participants who exercised regularly (>3 times/week; AOR=0.33, 95% CI=0.14-0.77). No significant association was observed among participants with Taoism and Buddhism affiliations. Affiliation to none of the religions was associated with VaD risk. CONCLUSIONS: Thus, Chinese participants having Christianity affiliation showed decreased AD risk. Moreover, the protective effect was more evident in women and in participants who exercised regularly.

Efficient hybrid plasmonic polymer solar cells with Ag nanoparticle decorated TiO2 nanorods embedded in the active layer.

A hybrid plasmonic polymer solar cell, in which plasmonic metallic nanostructures (such as Ag, Au, and Pt nanoparticles) are embedded in the active layer, has been under intense scrutiny recently because it provides a promising new approach to enhance the efficiency of the device. We propose a brand new hybrid plasmonic nanostructure, which combines a plasmonic metallic nanostructure and one-dimensional semiconductor nanocrystals, to enhance the photocurrent of the device through a strong localized electric field and an enhanced charge transport channel. We demonstrate that when Ag nanoparticle decorated TiO2 nanorods were introduced into the active layer of polymer-fullerene based bulk heterojunction solar cells, the photocurrent significantly increased to 14.15 mA cm(-2) from 6.51 mA cm(-2) without a decrease in the open voltage; thus, the energy conversion efficiency was dramatically enhanced to 4.87% from 2.57%.