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Nick K. Jones1,2*, Lucy Rivett1,2*, Chris Workman3, Mark Ferris3, Ashley Shaw1, Cambridge COVID-19 Collaboration1,4, Paul J. Lehner1,4, Rob Howes5, Giles Wright3, Nicholas J. Matheson1,4,6¶, Michael P. Weekes1,7¶1 Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK2 Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge, UK3 Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, UK4 Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK5 Cambridge COVID-19 Testing Centre and AstraZeneca, Anne Mclaren Building, Cambridge, UK6 NHS Blood and Transplant, Cambridge, UK7 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK*Joint first authorship¶Joint last authorshipCorrespondence: [email protected] UK has initiated mass COVID-19 immunisation, with healthcare workers (HCWs) given early priority because of the potential for workplace exposure and risk of onward transmission to patients. The UK’s Joint Committee on Vaccination and Immunisation has recommended maximising the number of people vaccinated with first doses at the expense of early booster vaccinations, based on single dose efficacy against symptomatic COVID-19 disease.1-3At the time of writing, three COVID-19 vaccines have been granted emergency use authorisation in the UK, including the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). A vital outstanding question is whether this vaccine prevents or promotes asymptomatic SARS-CoV-2 infection, rather than symptomatic COVID-19 disease, because sub-clinical infection following vaccination could continue to drive transmission. This is especially important because many UK HCWs have received this vaccine, and nosocomial COVID-19 infection has been a persistent problem.Through the implementation of a 24 h-turnaround PCR-based comprehensive HCW screening programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT), we previously demonstrated the frequent presence of pauci- and asymptomatic infection amongst HCWs during the UK’s first wave of the COVID-19 pandemic.4 Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and cycle threshold (Ct) values in the asymptomatic arm of our programme, which now offers weekly screening to all staff.Vaccination of HCWs at CUHNFT began on 8th December 2020, with mass vaccination from 8th January 2021. Here, we analyse data from the two weeks spanning 18thto 31st January 2021, during which: (a) the prevalence of COVID-19 amongst HCWs remained approximately constant; and (b) we screened comparable numbers of vaccinated and unvaccinated HCWs. Over this period, 4,408 (week 1) and 4,411 (week 2) PCR tests were performed from individuals reporting well to work. We stratified HCWs <12 days or > 12 days post-vaccination because this was the point at which protection against symptomatic infection began to appear in phase III clinical trial.226/3,252 (0·80%) tests from unvaccinated HCWs were positive (Ct<36), compared to 13/3,535 (0·37%) from HCWs <12 days post-vaccination and 4/1,989 (0·20%) tests from HCWs ≥12 days post-vaccination (p=0·023 and p=0·004, respectively; Fisher’s exact test, Figure). This suggests a four-fold decrease in the risk of asymptomatic SARS-CoV-2 infection amongst HCWs ≥12 days post-vaccination, compared to unvaccinated HCWs, with an intermediate effect amongst HCWs <12 days post-vaccination.A marked reduction in infections was also seen when analyses were repeated with: (a) inclusion of HCWs testing positive through both the symptomatic and asymptomatic arms of the programme (56/3,282 (1·71%) unvaccinated vs 8/1,997 (0·40%) ≥12 days post-vaccination, 4·3-fold reduction, p=0·00001); (b) inclusion of PCR tests which were positive at the limit of detection (Ct>36, 42/3,268 (1·29%) vs 15/2,000 (0·75%), 1·7-fold reduction, p=0·075); and (c) extension of the period of analysis to include six weeks from December 28th to February 7th 2021 (113/14,083 (0·80%) vs 5/4,872 (0·10%), 7·8-fold reduction, p=1x10-9). In addition, the median Ct value of positive tests showed a non-significant trend towards increase between unvaccinated HCWs and HCWs > 12 days post-vaccination (23·3 to 30·3, Figure), suggesting that samples from vaccinated individuals had lower viral loads.We therefore provide real-world evidence for a high level of protection against asymptomatic SARS-CoV-2 infection after a single dose of BNT162b2 vaccine, at a time of predominant transmission of the UK COVID-19 variant of concern 202012/01 (lineage B.1.1.7), and amongst a population with a relatively low frequency of prior infection (7.2% antibody positive).5This work was funded by a Wellcome Senior Clinical Research Fellowship to MPW (108070/Z/15/Z), a Wellcome Principal Research Fellowship to PJL (210688/Z/18/Z), and an MRC Clinician Scientist Fellowship (MR/P008801/1) and NHSBT workpackage (WPA15-02) to NJM. Funding was also received from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. We also acknowledge contributions from all staff at CUHNFT Occupational Health and Wellbeing and the Cambridge COVID-19 Testing Centre.

Scene flow tracks the three-dimensional (3D) motion of each point in adjacent point clouds. It provides fundamental 3D motion perception for autonomous driving and server robot. Although the Red Green Blue Depth (RGBD) camera or Light Detection and Ranging (LiDAR) capture discrete 3D points in space, the objects and motions usually are continuous in the macro world. That is, the objects keep themselves consistent as they flow from the current frame to the next frame. Based on this insight, the Generative Adversarial Networks (GAN) is utilized to self-learn 3D scene flow with no need for ground truth. The fake point cloud of the second frame is synthesized from the predicted scene flow and the point cloud of the first frame. The adversarial training of the generator and discriminator is realized through synthesizing indistinguishable fake point cloud and discriminating the real point cloud and the synthesized fake point cloud. The experiments on Karlsruhe Institute of Technology and Toyota Technological Institute (KITTI) scene flow dataset show that our method realizes promising results without ground truth. Just as human, the proposed method can identify the similar local structures of two adjacent frames even without knowing the ground truth scene flow. Then, the local correspondence can be correctly estimated, and further the scene flow is correctly estimated.   Corresponding author(s) Email: [email protected]

Leukocyte differential test is a widely performed clinical procedure for screening infectious diseases. Existing hematology analyzers require labor-intensive work and a panel of expensive reagents. Here we report an artificial-intelligence enabled reagent-free imaging hematology analyzer (AIRFIHA) modality that can accurately classify subpopulations of leukocytes with minimal sample preparation. AIRFIHA is realized through training a two-step residual neural network using label-free images of isolated leukocytes acquired from a custom-built quantitative phase microscope. By leveraging the rich information contained in quantitative phase images, we not only achieved high accuracy in differentiating B and T lymphocytes, but also classified CD4 and CD8 cells, therefore outperforming the classification accuracy of most current hematology analyzers. We validated the performance of AIRFIHA in a randomly selected test set and cross-validated it across all blood donors. Owing to its easy operation, low cost, and accurate discerning capability of complex leukocyte subpopulations, we envision AIRFIHA is clinically translatable and can also be deployed in resource-limited settings, e.g., during pandemic situations for the rapid screening of infectious diseases.  Corresponding author(s) Email:    [email protected],  [email protected]

Tam Hunt [1], Jonathan SchoolerUniversity of California Santa Barbara Synchronization, harmonization, vibrations, or simply resonance in its most general sense seems to have an integral relationship with consciousness itself. One of the possible “neural correlates of consciousness” in mammalian brains is a combination of gamma, beta and theta synchrony. More broadly, we see similar kinds of resonance patterns in living and non-living structures of many types. What clues can resonance provide about the nature of consciousness more generally? This paper provides an overview of resonating structures in the fields of neuroscience, biology and physics and attempts to coalesce these data into a solution to what we see as the “easy part” of the Hard Problem, which is generally known as the “combination problem” or the “binding problem.” The combination problem asks: how do micro-conscious entities combine into a higher-level macro-consciousness? The proposed solution in the context of mammalian consciousness suggests that a shared resonance is what allows different parts of the brain to achieve a phase transition in the speed and bandwidth of information flows between the constituent parts. This phase transition allows for richer varieties of consciousness to arise, with the character and content of that consciousness in each moment determined by the particular set of constituent neurons. We also offer more general insights into the ontology of consciousness and suggest that consciousness manifests as a relatively smooth continuum of increasing richness in all physical processes, distinguishing our view from emergentist materialism. We refer to this approach as a (general) resonance theory of consciousness and offer some responses to Chalmers’ questions about the different kinds of “combination problem.”  At the heart of the universe is a steady, insistent beat: the sound of cycles in sync…. [T]hese feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order. Steven Strogatz, Sync: How Order Emerges From Chaos in the Universe, Nature and Daily Life (2003) If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.Nikola Tesla (1942) I.               Introduction Is there an “easy part” and a “hard part” to the Hard Problem of consciousness? In this paper, we suggest that there is. The harder part is arriving at a philosophical position with respect to the relationship of matter and mind. This paper is about the “easy part” of the Hard Problem but we address the “hard part” briefly in this introduction.  We have both arrived, after much deliberation, at the position of panpsychism or panexperientialism (all matter has at least some associated mind/experience and vice versa). This is the view that all things and processes have both mental and physical aspects. Matter and mind are two sides of the same coin.  Panpsychism is one of many possible approaches that addresses the “hard part” of the Hard Problem. We adopt this position for all the reasons various authors have listed (Chalmers 1996, Griffin 1997, Hunt 2011, Goff 2017). This first step is particularly powerful if we adopt the Whiteheadian version of panpsychism (Whitehead 1929).  Reaching a position on this fundamental question of how mind relates to matter must be based on a “weight of plausibility” approach, rather than on definitive evidence, because establishing definitive evidence with respect to the presence of mind/experience is difficult. We must generally rely on examining various “behavioral correlates of consciousness” in judging whether entities other than ourselves are conscious – even with respect to other humans—since the only consciousness we can know with certainty is our own. Positing that matter and mind are two sides of the same coin explains the problem of consciousness insofar as it avoids the problems of emergence because under this approach consciousness doesn’t emerge. Consciousness is, rather, always present, at some level, even in the simplest of processes, but it “complexifies” as matter complexifies, and vice versa. Consciousness starts very simple and becomes more complex and rich under the right conditions, which in our proposed framework rely on resonance mechanisms. Matter and mind are two sides of the coin. Neither is primary; they are coequal.  We acknowledge the challenges of adopting this perspective, but encourage readers to consider the many compelling reasons to consider it that are reviewed elsewhere (Chalmers 1996, Griffin 1998, Hunt 2011, Goff 2017, Schooler, Schooler, & Hunt, 2011; Schooler, 2015).  Taking a position on the overarching ontology is the first step in addressing the Hard Problem. But this leads to the related questions: at what level of organization does consciousness reside in any particular process? Is a rock conscious? A chair? An ant? A bacterium? Or are only the smaller constituents, such as atoms or molecules, of these entities conscious? And if there is some degree of consciousness even in atoms and molecules, as panpsychism suggests (albeit of a very rudimentary nature, an important point to remember), how do these micro-conscious entities combine into the higher-level and obvious consciousness we witness in entities like humans and other mammals?  This set of questions is known as the “combination problem,” another now-classic problem in the philosophy of mind, and is what we describe here as the “easy part” of the Hard Problem. Our characterization of this part of the problem as “easy”[2] is, of course, more than a little tongue in cheek. The authors have discussed frequently with each other what part of the Hard Problem should be labeled the easier part and which the harder part. Regardless of the labels we choose, however, this paper focuses on our suggested solution to the combination problem.  Various solutions to the combination problem have been proposed but none have gained widespread acceptance. This paper further elaborates a proposed solution to the combination problem that we first described in Hunt 2011 and Schooler, Hunt, and Schooler 2011. The proposed solution rests on the idea of resonance, a shared vibratory frequency, which can also be called synchrony or field coherence. We will generally use resonance and “sync,” short for synchrony, interchangeably in this paper. We describe the approach as a general resonance theory of consciousness or just “general resonance theory” (GRT). GRT is a field theory of consciousness wherein the various specific fields associated with matter and energy are the seat of conscious awareness.  A summary of our approach appears in Appendix 1.  All things in our universe are constantly in motion, in process. Even objects that appear to be stationary are in fact vibrating, oscillating, resonating, at specific frequencies. So all things are actually processes. Resonance is a specific type of motion, characterized by synchronized oscillation between two states.  An interesting phenomenon occurs when different vibrating processes come into proximity: they will often start vibrating together at the same frequency. They “sync up,” sometimes in ways that can seem mysterious, and allow for richer and faster information and energy flows (Figure 1 offers a schematic). Examining this phenomenon leads to potentially deep insights about the nature of consciousness in both the human/mammalian context but also at a deeper ontological level.

Cannabis sativa is an extraordinarily versatile species. Hemp and its cousin marijuana, both C. sativa, have been used for millennia as a source of fibre, oil and for medicinal, spiritual and recreational purposes. Because the consumption of Cannabis can have psychoactive effects, the plant has been widely banned throughout the last century. In the past decade, evidence of its medicinal properties did lead to the relaxation of legislation in many countries around the world. Consequently, the genetics and development of Cannabis as well as Cannabis-derived products are the subject of renewed attention.Here, we review the biology of C. sativa, including recent insights from taxonomy, morphology and genomics, with an emphasis on the genetics of cannabinoid synthesis. Because the female Cannabis flower is of special interest as the site of cannabinoid synthesis, we explore flower development, flowering time well as the species’ unique sex determination system in detail. Furthermore, we outline the tremendous medicinal, engineering, and environmental opportunities that Cannabis bears. Together, the picture emerges that our understanding of Cannabis biology currently progresses at an unusual speed. A future challenge will be to preserve the multi-purpose nature of Cannabis, and to harness its medicinal properties and sustainability advantages simultaneously.

Quantum chemistry must evolve if it wants to fully leverage the benefits of the internet age, where the world wide web offers a vast tapestry of tools that enable users to communicate and interact with complex data at the speed and convenience of a button press. The Open Chemistry project has developed an open source framework that offers an end-to-end solution for producing, sharing, and visualizing quantum chemical data interactively on the web using an array of modern tools and approaches. These tools build on some of the best open source community projects such as Jupyter for interactive online notebooks, coupled with 3D accelerated visualization, state-of-the-art computational chemistry codes including NWChem and Psi4 and emerging machine learning and data mining tools such as ChemML and ANI. They offer flexible formats to import and export data, along with approaches to compare computational and experimental data.

This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary principle; drawn conclusions that were not supported by empirical research; and failed to take account of potential harms. But before that, I remind Martin et al that the evidence on mask wearing goes beyond the contested trials and observational studies they place centre stage. I set out some key findings from basic science, epidemiology, mathematical modelling, case studies and natural experiments, and use this rich and diverse body of evidence as the backdrop for my rebuttal of their narrowly-framed objections. I challenge my critics’ apparent assumption that a particular kind of systematic review should be valorised over narrative and real-world evidence, since stories are crucial to both our scientific understanding and our moral imagination. I conclude by thanking my academic adversaries for the intellectual sparring match, but exhort them to remember our professional accountability to a society in crisis. It is time to lay straw men to rest and engage, scientifically and morally, with the dreadful tragedy that is unfolding across the world.

This Supporting information includes interactive plots, videos, and data captured while performing evaluation and validation experiments for our paper. 

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues including increasing burden of chronic disease, widening inequality, concerns over environmental degradation and anthropogenic climate change. While these criticisms overlook recent developments, there remains a need for biopsychosocial models that extend theoretical grounding beyond individual wellbeing, incorporating overlapping contextual issues relating to community and environment. Our first GENIAL model \cite{Kemp_2017} provided a more expansive view of pathways to longevity in the context of individual health and wellbeing, emphasising bidirectional links to positive social ties and the impact of sociocultural factors. In this paper, we build on these ideas and propose GENIAL 2.0, focusing on intersecting individual-community-environmental contributions to health and wellbeing, and laying an evidence-based, theoretical framework on which future research and innovative therapeutic innovations could be based. We suggest that our transdisciplinary model of wellbeing - focusing on individual, community and environmental contributions to personal wellbeing - will help to move the research field forward. In reconceptualising wellbeing, GENIAL 2.0 bridges the gap between psychological science and population health health systems, and presents opportunities for enhancing the health and wellbeing of people living with chronic conditions. Implications for future generations including the very survival of our species are discussed.  

Floral plantings are promoted to foster ecological intensification of agriculture through provisioning of ecosystem services. However, a comprehensive assessment of the effectiveness of different floral plantings, their characteristics and consequences for crop yield across global regions is lacking. Here we quantified the impacts of flower strips and hedgerows on pest control and pollination services in adjacent crops using a global dataset of 529 sites. Flower strips, but not hedgerows, enhanced pest control services in adjacent fields by 16% on average. However, effects on crop pollination and yield were more variable. Our synthesis identifies several important drivers of variability in effectiveness of plantings: pollination services declined exponentially with distance from plantings, and perennial and older flower strips with higher flowering plant diversity enhanced pollination more effectively. These findings provide promising pathways to optimize floral plantings to more effectively contribute to ecosystem service delivery and ecological intensification of agriculture in the future.

Researchers' ability to accurately screen fossil and subfossil specimens for preservation of DNA and protein sequences remains limited. Thermal exposure and geologic age are usable proxies for sequence preservation on a broad scale but are of nominal use for specimens of similar depositional environments. Cell and tissue biomolecular histology is thus proposed as a novel proxy for determining sequence preservation potential of ancient specimens with improved accuracy. Biomolecular histology as a proxy is hypothesized to elucidate why fossils/subfossils of some depositional environments preserve sequences while others do not and to facilitate selection of ancient specimens for use in molecular studies.

IntroductionConsistent with World Health Organization (WHO) advice [1], UK Infection Protection Control guidance recommends that healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment (RPE), unless aerosol generating procedures (AGPs) are being undertaken or are likely, when a filtering face piece 3 (FFP3) respirator should be used [2]. In a recent update, an FFP3 respirator is recommended if “an unacceptable risk of transmission remains following rigorous application of the hierarchy of control” [3]. Conversely, guidance from the Centers for Disease Control and Prevention (CDC) recommends that HCWs caring for patients with COVID-19 should use an N95 or higher level respirator [4]. WHO guidance suggests that a respirator, such as FFP3, may be used for HCWs in the absence of AGPs if availability or cost is not an issue [1].A recent systematic review undertaken for PHE concluded that: “patients with SARS-CoV-2 infection who are breathing, talking or coughing generate both respiratory droplets and aerosols, but FRSM (and where required, eye protection) are considered to provide adequate staff protection” [5]. Nevertheless, FFP3 respirators are more effective in preventing aerosol transmission than FRSMs, and observational data suggests that they may improve protection for HCWs [6]. It has therefore been suggested that respirators should be considered as a means of affording the best available protection [7], and some organisations have decided to provide FFP3 (or equivalent) respirators to HCWs caring for COVID-19 patients, despite a lack of mandate from local or national guidelines [8].Data from the HCW testing programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT) during the first wave of the UK severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic indicated a higher incidence of infection amongst HCWs caring for patients with COVID-19, compared with those who did not [9]. Subsequent studies have confirmed this observation [10, 11]. This disparity persisted at CUHNFT in December 2020, despite control measures consistent with PHE guidance and audits indicating good compliance. The CUHNFT infection control committee therefore implemented a change of RPE for staff on “red” (COVID-19) wards from FRSMs to FFP3 respirators. In this study, we analyse the incidence of SARS-CoV-2 infection in HCWs before and after this transition.

Studies conducted in recent years have demonstrated the positive effects of sacubitril/valsartan and dapagliflozin on cardiac prognosis and performance. These drugs can potentially be abused as doping agents by professional athletes. In our study, we evaluated the effects of sacubitril/valsartan and dapagliflozin on athletic performance. In the study, the swimming performances of three groups of rats were evaluated by dividing them into control, sacubitril/valsartan and dapagliflozin groups. Additionally, echocardiography, weight and rotarod data were evaluated during follow-up. In the comparison of sacubitril/valsartan and control groups, a statistical difference was seen in the 13th, 19th and 20th swimming sessions, and when the total and average swimming times were compared, the p values were 0.115 and 0.015. In the comparison of dapagliflozin and control groups, a statistical difference was observed starting from the 10th swimming session, and when the total and average swimming times were compared, the p values were <0.001 and <0.001. In triple analysis, a statistical difference was seen from the 9th swimming session until the end of the experiment. Furthermore, a statistical difference was observed in rotarod results for sacubitril/valsartan and dapagliflozin compared to baseline. (p value <0.001 and 0.011 respectively) Our study showed a limited positive effect of sacubitril/valsartan on athletic performance. The impact of dapagliflozin on athletic performance was shown to be particularly significant.

The stability of methylammonium lead iodide (MAPbI 3)-based flexible perovskite (PVK) mini modules was studied under thermal stress. For this purpose, PVK mini modules, consisting of 10 serially connected cells with an aperture area of 9 cm 2, were subjected to elevated temperatures of 85℃, 95℃, and 105℃ for 4000 h. The photovoltaic (PV) parameters of PVK mini modules were periodically measured by interrupting the thermal stress tests. Evolution of series resistance, short circuit current, and fill factor showed monotonic reduction, whereas shunt resistance and open circuit voltage depicted three stage degradation: (i) initial rapid degradation; (ii) quasi stable range; and (iii) gradual monotonic degradation stages, which are the indication for the presence of several degradation mechanisms. Using the experimental data, activation energy ( E a) of degradation was studied by adopting the Arrhenius model. E a of 1.062 eV (102.5 kJ/mol) was obtained for the maximum output of the total device. Device lifetime, which is defined as the point where the efficiency has reduced to 80% of its initial value, 30.6 years was estimated, i.e., performance loss of around 0.65% per year, at module temperature of 45℃.

Objective: Severe fever with thrombocytopenia syndrome (SFTS) and hemorrhagic fever with renal syndrome (HFRS) usually have different infection routes, and coinfection is relatively rare. The clinical and etiological characteristics of coinfection by the two pathogens will provide important references for clinical diagnosis and treatment. Methods: Blood samples and epidemiological data on HFRS patients were collected and classified into severe and non-severe groups according to clinical severity. The differences in clinical characteristics and levels of pathogens were evaluated and compared. Results: A total of 22 HFRS patient cases were collected from December 2021 to October 2022. Of these patients, 16 were non-severe and 6 severe. Patients with rodent exposure history, muscle and joint pain, weight loss, pharyngeal and conjunctival hyperemia, and positive urine protein and antibody IGM had a high severe rate (P< 0.05). Molecular tests on blood samples showed that 3 of the 6 severe patients were positive for hantavirus, 2 of the 3 hantavirus positives were positive for bunyavirus. Conclusion: Severe HFRS patients have different epidemiological, clinical, and laboratory characteristics. The coinfection of hantavirus and bunyavirus leads to severe HFRS. These findings have implications and references for diagnosis and treatment of coinfected severe cases.

Background: Pelvic floor dysfunction (PFD), mainly including stress urinary incontinence (SUI) and pelvic organ prolapse (POP), is escalating at an alarming rate globally, bringing a significant economic burden. The incapacity of nerves and muscles to regenerate following damage incurred during vaginal delivery potentially stands as a pivotal mechanism contributing to PFD. Objectives: While a consensus on the precise role and mechanism of the pelvic nerve in the pathogenesis of PFD remains elusive, numerous studies have delved into the relationship between PFD and the pelvic nerve. The analysis aims to elucidate the intricate workings of pelvic nerves in the context of these conditions, encompassing their mechanisms of action, the design of animal models, assessment methods, and the trajectory of research, and provides a foundation and inspiration for future neuro-centric investigations into PFD. Search Strategy: To encompass all potentially pertinent articles, four independent investigators conducted a thorough search on both PubMed and CNKI, with the last search executed on January 20, 2024. The retrieval process amalgamated all pertinent Medical Subject Headings (MeSH) terms. Selection Criteria: Records excluded Review, Book, etc.; retrieved; full text found; SUI and POP; assessment methods related pelvic nerve. Data Collection and Analysis: Five independent investigators extracted a range of data from each study using a standardized data-collecting form: article, title, first author, publication year, experimental groups, evaluation time, evaluation method, conclusions. All relevant data is contained within the 61 included articles. Main Results: This systematic review includes a total of 61 articles, including 32 animal or cell research, 12 human tissue research, and 17 clinical research. The vaginal dilation (VD) model, utilizing a 3ml balloon to expand the vagina for 4 hours and the pudendal nerve transection (PNT) model, achieved through the bilateral crushing of pudendal nerves, and the assessment of neurological damage in women tissue samples are currently well-established. Various electrical stimulation treatments, including Sacral neuromodulation, Electroacupuncture, Transcutaneous Mechanical Nerve Stimulation (TMNS), Electrical stimulation of pudendal nerve (EPNS), targeting the pelvic nerve have also been proven effective. Conclusions: The animal model related to POP and SUI are currently well-established, which have significantly different stress areas within the pelvic floor structure with human. Consequently, the findings derived from all animal models should be applied to human subjects with careful consideration. The precise mechanism of pelvic nerves in POP remains elusive based on existing research, however, relevant literature research generally believes that the pathogenesis of POP and SUI is closely related to the pelvic nerve. This highlighting a direction that demands additional endeavors and potentially necessitates further relevant experimental studies for validation.

Objectives: The aim of this study was to demonstrate the interaction and influence of gestational age and parity on the lung volume and lung density through Computed Tomography (CT) imaging data among healthy pregnant women. Design: Retrospective cross-sectional study Setting: Two clinical sites in Wuhan Hubei Province. Sample: pregnant women and non-pregnant women. Methods： Linear mixed-effects regression model and generalized additive mixed model (GAMM) were taken to control the potential confounders and evaluate the interact effects of lung volume and lung density. Univariate analysis estimated the influence of gestational age and parity on the lung volume and lung density. Main Outcome Measures: Lung volume (left, right, total), lung density (left, right, total). Results: The total lung density of all patients in GAMM was significantly increased with gestational age (p<0.001). Univariate analysis showed that the absolute value of total lung volume decreases with the progression of gestation ( p=0.040), this tendency is also displayed in both the left lung and right volume. Lung volume of multipara in the third trimester was lower than the first trimester, and it had significant difference between T1 and T3 ( p=0.0196). Furthermore, this study found that the lung volume of multiparous women was lower that primiparous in the third trimester ( p=0.009). Nevertheless, the lung density increased with gestational age in primiparous, particularly in the third trimester ( p=0.007), the lung density of multipara was lower than nullipara ( p<0.001), more delivery times follow lower lung density, and there was a significant difference when compared with each parity state. During the third trimester, the lung density of multiparous declined when compared with primiparous ( p<0.001). Conclusion: Parity and gestation age tended to have an impact on the alterations of lung volume and lung density in physiological pregnant women. Lung density of multipara was lower than nullipara, more delivery times follow lower lung density, indicating parity was associated with lung density.

In this paper, we investigate the Lipschitz stability of a perturbed impulsive differential system concerning the unperturbed system. We employ the variation of parameters or the constant of variation for impulsive differential systems with an initial time difference.

Background Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts often involves the use of hemostatic methods, with electrocoagulation using bipolar energy as a common approach. This study aimed to assess the impact of electrocoagulation compared to nonthermal hemostatic methods on ovarian reserve during such surgeries. Objectives To evaluate the influence of electrocoagulation using bipolar energy versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for endometriomas and benign ovarian cysts. Search Strategy A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Entry terms associated with MeSH terms, such as “ovarian cysts,” “laparoscopy,” “electrocoagulation,” and “anti-Müllerian hormone” or “antral follicle count” were used for articles published before October 2022. Selection Criteria Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods with electrocoagulation on ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of included studies. Data Collection and Analysis Thirteen RCTs involving 1043 patients were included in the meta-analysis. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFC) were analyzed using Review Manager ver. 5.4. Main Results In patients with endometriomas, the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at one, three, six, and 12 months compared to the bipolar group. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, the AFC levels showed no significant differences, except for a lower postoperative AFC in the electrocoagulation group for endometrioma cases. Conclusions Nonthermal hemostatic methods are associated with better preservation of ovarian reserve compared to bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact on ovarian reserve was observed with bipolar electrocoagulation in patients with benign ovarian cysts.

** Other clinical commentaries don’t have an abstract, so I have assumed one is not expected?

Title pageMultiple extremely overdose of antipsychotics with minimal side effects: A case report

Recent research has indicated that the relationship between age-related cognitive decline and falling may be mediated by the individual’s capacity to quickly cancel or inhibit a motor response. This longitudinal investigation demonstrates that higher white matter fibre density in the motor inhibition network paired with low physical activity was associated with falling in elderly participants. We measured the density of white matter fibre tracts connecting key nodes in the inhibitory control network in a large sample (n=414) of older adults. We modelled their self-reported frequency of falling over a four year period with white matter fibre density in pathways corresponding to the direct and hyperdirect cortical-subcortical loops implicated in the inhibitory control network. Only connectivity between right Inferior Frontal Gyrus and right Subthalamic Nucleus was associated with falling as measured cross-sectionally. The connectivity was not, however, predictive of future falling when measured two and four years later. Higher white matter fibre density was associated with falling, but only in combination with low levels of physical activity. No such relationship existed for selected control brain regions that are not implicated in the inhibitory control network. The direction of this effect was counterintuitive and warrants further longitudinal investigation into whether white matter fibre density changes over time in a manner correlated with falling, and mediated by physical activity.

1Pedro M Antunes*, 2Sidney L. Stürmer*, 3James D. Bever,4Pierre-Luc Chagnon, 5V. Bala Chaudhary, 10Coline Deveautour,1Catherine Fahey, 6Vasilis Kokkoris,7Ylva Lekberg, 8Jeff R. Powell,9Carlos A. Aguilar-Trigueros,8Haiyang Zhang1Biology Department, Algoma University, Sault Ste. Marie, Ontario, Canada, P6A 2G42Departamento de Ciências Naturais, Universidade Regional de Blumenau, Blumenau, SC, 89030-903, Brazil3Kansas Biological Survey and Center for Ecological Research and Department of Ecology and Evolutionary Biology, University of Kansas, Lawrence, Kansas, USA4Institut de Recherche en Biologie Vegetale, Universite de Montreal, 4101 Sherbrooke Est, Montreal, QC, H1X2B2, Canada5Department of Environmental Studies, Dartmouth College, Hanover, New Hampshire, USA6Amsterdam Institute for Life and Environment (A-LIFE), Faculty of Science, Section Systems Ecology, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands7MPG Ranch & Department of Ecosystem and Conservation Sciences, W.A. Franke College of Forestry and Conservation, University of Montana, Missoula, Montana, USA8Hawkesbury Institute for the Environment, Western Sydney University, Penrith, New South Wales, Australia9Institute of Biology, Freie Universität Berlin, Altensteinstrasse 6, 14195 Berlin, Germany.10UniLaSalle, Rouen, France*Equal contribution

Background: Diagnosis and treatment of obstructive sleep apnea (OSA) in infants and young children is challenging because of its clinical heterogeneity and lack of age-specific guidelines. Aim: We report the management and treatment outcome of OSA in children below two years of age. Treatment decisions were based upon the pattern of upper airway (UA) obstruction, clinical presentation and OSA severity. Methods: Retrospective, non-randomized observational cohort study at a tertiary center. Children with OSA who underwent an UA evaluation (drug-induced sleep endoscopy or direct laryngoscopy) were included. Results: The study population comprised 100 patients, 57 boys and 43 girls, with a median age of 0.72 years (range 0.0-2.0) and OSA confirmed by polysomnography. Multilevel UA collapse was present in 26%, (adeno)tonsillar hypertrophy in 31% and 21% had laryngomalacia. Laryngomalacia was more common in children below six months of age and adenotonsillar hypertrophy was observed mainly in children older than 1.5 year of age. Treatment improved OSA severity in the entire study population with a significant reduction in obstructive apnea/hypopnea index from 10.8/h (range 2.1-99.1) to 1.7/h (range 0.0-73.0) (p<0.001), an improvement in mean oxygen saturation from 96.9% (range 88.9-98.4) to 97.4% (range 92.3-99.0) (p<0.001) and in minimal oxygen saturation from 85.4% (range 37.0-96.0) to 88.8% (range 51.0-95.5) (p<0.001). Conclusion: Multidisciplinary management of young children with OSA guided by the pattern of UA obstruction and OSA severity, results in favorable treatment outcomes. The pattern of UA obstruction changes in the first two years of life from a dynamic collapse to structural abnormalities.