Beihua University

Postoperative pleural effusions (PPE) are common complications following gastrectomy, particularly in patients diagnosed with Siewert type II/III esophagogastric cancer. The red blood cell distribution width-to-albumin ratio (RAR) is a marker indicative of systemic inflammation and nutritional status. This study investigates the association between preoperative RAR and the incidence of PPE in patients with Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) who have undergone gastrectomy. A retrospective analysis was performed on data from 299 patients with Siewert type II/III AEG who underwent gastrectomy between January 2020 and December 2024. Logistic regression analysis was utilized to assess the relationship between RAR and PPE, while the receiver operating characteristic curve was employed to evaluate the predictive capability of RAR for PPE risk, with results expressed as the area under the curve (AUC). PPE was diagnosed in 85 patients, representing 28.43% of the study cohort. After adjusting for relevant covariates, a positive association between the RAR and PPE following gastrectomy was observed (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.22-2.34, P = 0.002). The incidence of PPE demonstrated a progressive increase across ascending RAR quartiles, with patients in the highest quartile experiencing a significantly increased risk of PPE compared to those in the lowest quartile (OR = 4.15, 95% CI: 1.28-13.45, P = 0.02). Furthermore, RAR exhibited a strong predictive capacity for PPE risk, as indicated by an AUC of 0.796. Subgroup analysis further confirmed a significant positive association between RAR and PPE. Stratified analysis revealed significant interactions between hemoglobin levels (P = 0.04) and the effect of RAR on PPE. An elevated RAR is independently associated with an increased risk of PPE, suggesting its potential utility as a pragmatic, clinically feasible supplementary index for patients with Siewert type II/III AEG prior to undergoing gastrectomy. However, due to the study's single-center, retrospective design and absence of external validation, further research with external cohorts is needed before RAR can be considered for widespread clinical implementation.

cis-Diols play critical roles in biological systems and form key structural motifs in many pharmaceuticals and vaccines. Specific in vivo recognition of a bioactive cis-diol and subsequent functional manipulation is thus desirable but remains challenging. Here, we present a boronic acid-functionalized gold nanoparticle (AuNP) platform that accomplishes this goal by uncovering the exceptional capacity of o-carborane decorated boronic acid to disrupt P2Y12-Ticagrelor binding and by highlighting the dual stabilizing roles of o-carboranyl via carbon ligation and B-H···Au chemisorption. Furthermore, by exploiting carborane-derived counterions, we introduce a counterion-engineering strategy that decouples water solubility from the chemical vulnerability of boronic acid. The resulting intravenous nanosystem selectively neutralizes Ticagrelor, a cis-diol-containing antiplatelet drug, with high efficacy demonstrated in both mouse and pig bleeding models. This work establishes the first chemical strategy for in vivo Ticagrelor reversal and offers a broadly applicable framework for diol targeting and nanomaterial design in complex biological environments.

To investigate the effects of positional nursing combined with positive suggestions on anxiety, procedural outcomes, and patient comfort in patients undergoing painless gastroscopy. This retrospective cohort study enrolled 153 patients undergoing sedated gastroscopy between March 2024 and August 2025. Patients were assigned to the conventional nursing group (n=73, March-October 2024) or the comprehensive nursing group (n=80, November 2024-August 2025). The comprehensive group received individualized positioning optimization and standardized positive psychological suggestions. Primary outcomes included State-Trait Anxiety Inventory-State subscale (STAI-S), examination success rate, examination duration, and General Comfort Questionnaire (GCQ). Secondary outcomes included hemodynamic stability, adverse events, recovery time, and patient satisfaction. Baseline characteristics were comparable between groups. The comprehensive nursing group demonstrated significantly lower STAI-S scores (43.23±7.68 vs 48.67±8.45, P <0.001) and shorter examination duration (6.54±1.62 min vs 7.23±1.87 min, P =0.016). GCQ scores were significantly higher in the comprehensive group (P <0.001). The comprehensive group maintained better intra-procedural hemodynamic stability with lower heart rates (P =0.002), higher oxygen saturation (P <0.001), and higher blood pressure levels (systolic BP: P =0.020; diastolic BP: P =0.008). Comprehensive group had lower overall adverse event incidence, shorter recovery time and higher modified Patient Satisfaction Questionnaire scores (modified PSQ-18) (all P <0.05). Positional nursing combined with positive suggestion may help reduce pre-procedural anxiety, improve hemodynamic stability, decrease adverse events, and enhance patient comfort and satisfaction in painless gastroscopy. This non-pharmacological intervention shows promise for integration into routine endoscopy nursing protocols.

Incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4is), and the dual GIP/GLP-1 RA tirzepatide, are widely prescribed for type 2 diabetes mellitus (T2DM). Their musculoskeletal adverse events (AEs) remain underexplored. We analyzed FAERS reports (Q1 2004-Q2 2024) for musculoskeletal and connective tissue disorders. After de-duplication, 15,052 reports were subjected to disproportionality analyses using reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayes geometric mean (EBGM), and information component (IC). Differences between serious and non-serious events were assessed, and time to onset was examined by cumulative curves and Weibull models. No signals were detected at the SOC level. At the PT level, GLP-1 RAs were linked to back pain, myalgia, and neck mass, while tirzepatide was associated with muscle atrophy and neck mass. Among DPP-4is, sitagliptin, linagliptin, and alogliptin showed signals for osteoarthritis, rhabdomyolysis, and arthritis. Sex-, age-, and weight-related differences were noted for dulaglutide, liraglutide, semaglutide, sitagliptin, linagliptin, alogliptin, and saxagliptin. Median onset was shorter for GLP-1 RAs and tirzepatide (≤ 30days) and longer for DPP-4is (55-132days), with vildagliptin latest. Weibull analysis indicated an early-failure pattern for most agents, except saxagliptin, which suggested a borderline wear-out trend. Musculoskeletal AEs associated with incretin therapies differ by drug class and onset timing. Vigilant monitoring is needed during early GLP-1 RA or tirzepatide therapy and later during DPP-4i use to optimize patient safety.

Abstract Introduction Postmenopausal osteoporosis, defined by reduced bone mineral density and fracture risk, is a major health concern. Bisphosphonates are standard therapy, but the added value of exercise is uncertain. This study examined their combined effects on BMD, bone turnover, body composition, strength, and balance in postmenopausal women. Content PubMed, Embase, and Cochrane Central were systematically searched for RCTs on bisphosphonates, exercise, or their combination in postmenopausal osteoporosis. Primary outcomes were changes in BMD at lumbar spine, femoral neck, and total hip. Secondary outcomes included bone turnover markers (ALP-B, NTx), body composition (fat and lean mass), and leg extensor strength. Study quality was assessed with Cochrane Risk of Bias tool. Mean differences with 95 % confidence intervals (CI) were calculated using a random-effects model, with heterogeneity evaluated by I 2 . Summary Six RCTs with 1,059 subjects qualified for inclusion. Bisphosphonate + exercise treatment showed small and non-significant improvement in lumbar spine and femoral neck BMD (p=0.41 and p=0.11, respectively), and no significant change in total hip BMD (p=0.48). Levels of ALP-B significantly increased (p=0.0008), reflecting bone turnover rather than a direct clinical benefit; NTx showed non-significant trend (p=0.10). Fat mass significantly decreased (p&lt;0.00001), leg strength significantly increased (p&lt;0.00001), and lean mass showed no significant change (p=0.14). Outlook Combined exercise and bisphosphonates yield modest yet consistent improvements in site-specific BMD, fat loss, and strength in postmenopausal osteoporosis, supporting exercise as an adjunct to pharmacologic therapy for musculoskeletal health.

Particle swarm optimization (PSO) is a widely used bio-inspired optimization algorithm, yet maintaining an effective balance between exploration and exploitation remains challenging. Most existing PSO variants rely on static or predefined regulation strategies, which restrict their adaptability to evolving search states and may lead to premature convergence or search stagnation. Inspired by division of labor and competitive selection mechanisms in biological populations, this paper proposes a dual-subpopulation competitive particle swarm optimization (DCPSO). In DCPSO, the population is explicitly partitioned into exploration and exploitation subpopulations with distinct search roles. A dynamic competition mechanism is designed to evaluate recent search progress, based on which stagnated particles are adaptively migrated between subpopulations, enabling flexible reallocation of computational resources during the optimization process. Experimental results on the CEC2017 benchmark suite demonstrate that DCPSO consistently outperforms standard PSO and several representative state-of-the-art algorithms, achieving statistically significant improvements on the majority of benchmark functions, particularly on hybrid and composition problems. Additional experiments on engineering design problems further verify the robustness, convergence stability, and practical effectiveness of DCPSO.

Smart transportation networks face increasing demands for efficiency and sustainability. This study presents a reinforcement learning approach that optimizes eco-driving strategies for connected and automated vehicles (CAVs) in urban environments, with a particular application to healthcare logistics. Specifically, we propose a novel approach using reinforcement learning, specifically a twin delayed deep deterministic policy gradient (TD3) algorithm, to dynamically optimize CAV trajectories at signalized intersections. The proposed healthcare eco-driving trajectory optimization (TD3-HETO) model incorporates real-time traffic conditions, signal timing information, and healthcare urgency levels to generate optimal acceleration profiles. The reward function is designed to balance energy efficiency, traffic flow, safety, comfort, and healthcare delivery timeliness. Additionally, the model introduces a dynamic exploration strategy that adapts to healthcare task urgency, enabling efficient balancing between energy consumption and delivery timelines. Experimental results show that TD3-HETO reduces energy consumption by up to 28.7% compared to baseline methods while improving average speeds by 3.7% for urgent healthcare deliveries. The model achieves superior safety performance with 98.7% of time steps showing zero conflicts, compared to 95.3% for the best baseline. TD3-HETO also demonstrates remarkable adaptability to varying traffic demands and signal timings, maintaining consistent performance even at high traffic volumes. This research contributes to developing intelligent transportation systems to enhance environmental sustainability and healthcare accessibility in smart cities, potentially improving patient outcomes and operational efficiency in urban healthcare logistics.