Smart Imitator: Learning from Imperfect Clinical Decisions.

Objectives: This study introduces Smart Imitator (SI), a 2-phase reinforcement learning (RL) solution enhancing personalized treatment policies in healthcare, addressing challenges from imperfect clinician data and complex environments.

Materials And Methods: Smart Imitator's first phase uses adversarial cooperative imitation learning with a novel sample selection schema to categorize clinician policies from optimal to nonoptimal. The second phase creates a parameterized reward function to guide the learning of superior treatment policies through RL.

Treatment of very high risk membranous nephropathy complicated by pulmonary embolism with glucocorticoids and rituximab: Case report.

Rationale: We report the efficacy of combination prednisolone and intravenous (IV) rituximab as an immunosuppressive regimen for a young male presenting with extensive venous thromboembolism including a submassive pulmonary embolism secondary to life-threatening nephrotic syndrome from very high risk anti-phospholipase-A2 receptor (PLA2R) positive membranous nephropathy. Initial treatment was with mechanical thrombectomy and anticoagulation. Thereafter, oral prednisolone was initiated to induce remission, during a period of uninterrupted anticoagulation.

Harnessing spatiotemporal transformation in magnetic domains for nonvolatile physical reservoir computing.

Combining physics with computational models is increasingly recognized for enhancing the performance and energy efficiency in neural networks. Physical reservoir computing uses material dynamics of physical substrates for temporal data processing. Despite the ease of training, building an efficient reservoir remains challenging.

Sequential Targeting Chondroitin Sulfate-Bilirubin Nanomedicine Attenuates Osteoarthritis via Reprogramming Lipid Metabolism in M1 Macrophages.

The infiltration and excessive polarization of M1 macrophages contribute to the induction and persistence of low-grade inflammation in joint-related degenerative diseases such as osteoarthritis (OA). The lipid metabolism dysregulation promotes M1 macrophage polarization by coordinating the compensatory pathways of the inflammatory and oxidative stress responses. Here, a self-assembling, licofelone-loaded nanoparticle (termed LCF-CSBN), comprising chondroitin sulfate and bilirubin joined by an ethylenediamine linker, is developed to selectively reprogram lipid metabolism in macrophage activation.

Use of Electroconvulsive Therapy Treatment in Adolescents in Singapore.

Background: Electroconvulsive therapy (ECT) is a highly effective treatment for schizophrenia and mood disorders; however, most evidence is derived from the adult population, with less evidence in adolescents. We sought to determine the use of ECT in adolescents in the Institute of Mental Health (IMH) and evaluate the treatment outcome.

Methods: We conducted a retrospective naturalistic analysis of ECT registry data of patients aged from 10 to 19 years from March 2017 to March 2023.

Patients' Willingness to Perform Self-Wound Care: A Cross-sectional Study in the Primary Healthcare Sector in Singapore.

Background: Patient adherence to performing self-wound care (SWC) has a direct influence on the success of telewound care, a healthcare delivery mode that emerged in 2016 in National Healthcare Group Polyclinics in Singapore to relieve the healthcare burden. This mode of delivery was useful during the pandemic, when nonurgent face-to-face visits were switched to the use of telecommunications for consultation. Telewound care requires that patients be willing to perform wound care on their own; however, whether patients are willing to do so remains unknown.

Reprogrammable Flexible Piezoelectric Actuator Arrays with a High Degree of Freedom for Shape Morphing and Locomotion.

The high degree of freedom (DoF) shape morphing widely exists in biology for mimicry, camouflage, and locomotion. Currently, a lot of bionic soft/flexible actuators and robots with shape-morphing functions have been developed to realize conformity, grasp, and movement. Among these solutions, two-dimensional responsive materials and structures that can shape morph into different three-dimensional configurations are valuable for creating reversible high DoF shape morphing.

Molecular Epidemiology and Clinical Aspects of Dermatophytosis in Guiyang, Southwest China (2017-2023): A Single-Institution Retrospective Study.

Epidemiological studies combining taxonomic and clinical data have been limited globally, particularly Guiyang, the most under-developed economic provincial capital city in southwestern China. A retrospective analysis was performed of dermatophyte epidemiology involving all culture-positive cases received between May 2017 and May 2023 at the Affiliated Hospital of Guizhou Medical University. Phylogenetic analysis was conducted on 391 dermatophyte isolates collected from patients using the rDNA internal transcribed spacer sequences.

Whole-genome phylogenetic analysis of complex from clinical respiratory samples.

Unlabelled: The complex (MAC) is a common causative agent causing nontuberculous mycobacterial (NTM) pulmonary disease worldwide. Whole-genome sequencing was performed on a total of 203 retrospective MAC isolates from respiratory specimens. Phylogenomic analysis identified eight subspecies and species.

A ladder-type organic molecule with pseudocapacitive properties enabling superior electrochemical desalination.

The availability of clean water is fundamental for maintaining sustainable environments and human ecosystems. Capacitive deionization offers a cost-effective, environmentally friendly, and energy-efficient solution to meet the rising demand for clean water. Electrode materials based on pseudocapacitive adsorption have attracted significant attention in capacitive deionization due to their relatively high desalination capacity.

Highly Photoreactive Semiconducting Polymers with Cascade Intramolecular Singlet Oxygen and Energy Transfer for Cancer-Specific Afterglow Theranostics.

Afterglow luminescence provides ultrasensitive optical detection by minimizing tissue autofluorescence and increasing the signal-to-noise ratio. However, due to the lack of suitable unimolecular afterglow scaffolds, current afterglow agents are nanocomposites containing multiple components with limited afterglow performance and have rarely been applied for cancer theranostics. Herein, we report the synthesis of a series of oxathiine-containing donor-acceptor block semiconducting polymers (PDCDs) and the observation of their high photoreactivity and strong near-infrared (NIR) afterglow luminescence.

Country-specific key lifestyle factors and health outcomes for resource allocation in the general population: a network analysis across 29 countries.

Background: We aimed to identify the central lifestyle, the most impactful among lifestyle factor clusters; the central health outcome, the most impactful among health outcome clusters; and the bridge lifestyle, the most strongly connected to health outcome clusters, across 29 countries to optimise resource allocation for local holistic health improvements.

Methods: From July 2020 to August 2021, we surveyed 16 461 adults across 29 countries who self-reported changes in 18 lifestyle factors and 13 health outcomes due to the pandemic. Three networks were generated by network analysis for each country: lifestyle, health outcome, and bridge networks.

MOF-derived Carbon-Based Materials for Energy-Related Applications.

New carbon-based materials (CMs) are recommended as attractively active materials due to their diverse nanostructures and unique electron transport pathways, demonstrating great potential for highly efficient energy storage applications, electrocatalysis, and beyond. Among these newly reported CMs, metal-organic framework (MOF)-derived CMs have achieved impressive development momentum based on their high specific surface areas, tunable porosity, and flexible structural-functional integration. However, obstacles regarding the integrity of porous structures, the complexity of preparation processes, and the precise control of active components hinder the regulation of precise interface engineering in CMs.

Valence Electron: A Descriptor of Spinel Sulfides for Sulfur Reduction Catalysis.

Catalysts are essential for achieving high-performance lithium-sulfur batteries. The precise design and regulation of catalytic sites to strengthen their efficiency and robustness remains challenging. In this study, spinel sulfides and catalyst design principles through element doping are investigated.

Remission of persistent hypertension and hypokalaemia following redo adrenalectomy for primary aldosteronism - case report.

We report on a case of a 67-year-old male who was referred to our care with persistent aldosteronism post adrenalectomy. Biochemical failure after surgery is rare after surgery for primary aldosteronism (PA). Persistent hypokalaemia and raised aldosteronism is an indication of treatment failure after surgery.

Insulinoma With Ambiguous Biochemistry, Positive Ga-DOTA-Exendin-4 PET-CT, and Effective Endoscopic Ablation.

A 75-year-old female presented with fasting hypoglycemic episodes. A supervised fast ended at 72 hours fulfilling Whipple triad, with suppressed insulin and C-peptide levels, but discordantly suppressed serum β-hydroxybutyrate levels. After 21 months of recurring symptoms, a repeat fast ended at 48 hours with Whipple triad, suppressed serum β-hydroxybutyrate level, and borderline nonsuppressed C-peptide level, suggesting endogenous hyperinsulinism.

Severe neonatal hypotonia due to variant affecting function of ZnT5 zinc transporter.

The tightly-regulated spatial and temporal distribution of zinc ion concentrations within cellular compartments is controlled by two groups of Zn transporters: the 14-member ZIP/SLC39 family, facilitating Zn influx into the cytoplasm from the extracellular space or intracellular organelles; and the 10-member ZnT/SLC30 family, mobilizing Zn in the opposite direction. Genetic aberrations in most zinc transporters cause human syndromes. Notably, previous studies demonstrated osteopenia and male-specific cardiac death in mice lacking the ZnT5/ zinc transporter, and suggested association of two homozygous frameshift variants with perinatal mortality in humans, due to hydrops fetalis and hypertrophic cardiomyopathy.

A Pilot Randomized Controlled Trial to Examine the Impact of a Therapy Dog Intervention on Loneliness in Hospitalized Older Adults.

Background And Objectives: Loneliness is linked to significant health threats and is potentially more dangerous than obesity; it affects as many as 29% of noninstitutionalized older adults. Loneliness is exacerbated for those who require inpatient rehabilitation, are displaced from their social networks, spend little time receiving therapy, and are physically inactive and socially isolated. Emerging evidence suggests that companion animals provide a number of health and well-being benefits and that interacting with a trained therapy dog may reduce loneliness.

Highly Selective AIEgen-Based "Turn On" Fluorescent Imaging for Inflammation Detection.

Hypochlorous acid (HClO) is released by immune cells in the immune system, and it helps the body fight off infections and inflammation by killing bacteria, viruses, and other pathogens. However, tissue damage or apoptosis may also be induced by excess HClO. On this basis, we designed the probe TPE-NS by choosing tetraphenylethylene (TPE) as the luminescent unit and dimethylthiocarbamoyl chloride as the recognition site.

Sustainable synthesis of silver nanoparticles from Conocarpus seeds for removal of methylene blue.

This study introduces a sustainable biological approach for synthesizing silver nanoparticles (AgNPs) using Conocarpus seeds, aimed at improving the adsorption and photocatalytic degradation of methylene blue (MB) in wastewater treatment. The photocatalytic efficiency of AgNPs, synthesized under varying concentrations of silver nitrate (AgNO) and pH levels, was evaluated, together with the effectiveness of a photocatalytic reactor. The synthesized samples were characterized using scanning electron microscopy (SEM), thermogravimetric analysis (TGA), Fourier-transform infrared (FT-IR) spectroscopy, and atomic force microscopy (AFM).

Correlates Between Temporomandibular Disorder Symptom Severity, Psychological Distress, Well-Being, and Oral Health-Related Quality of Life: Insights From Chinese Young Adults.

Background: There is limited understanding of how temporomandibular disorder (TMD) symptoms, psychological distress, and well-being are related to each other and to OHRQoL in Chinese young adults.

Objectives: This study aimed to identify correlations between TMD symptom severity, psychological status, and OHRQoL while also examining factors associated with low OHRQoL.

Methods: Participants, recruited from a major university in the capital city, completed a survey that included demographics, the Chinese versions of the expanded five TMD symptoms (5Ts) screener, Depression, Anxiety, Stress Scales-21 (DASS-21), Ryff's Scales of Psychological Well-being-18 (SPWB-18), and Oral Health Impact Profile for TMDs (OHIP-TMD).

[The mediational role of cognitive function on occupational outcomes in persons with major depressive and bipolar disorder].

Background: Improving functioning in adults with major depressive disorder (MDD) and bipolar disorder (BD) is a priority therapeutic objective.

Methods: This retrospective post hoc secondary analysis evaluated 108 patients with MDD or BD receiving the antidepressants vortioxetine, ketamine, or infliximab. The analysis aimed to determine if changes in objective or subjective cognitive function mediated the relationship between depression symptom severity and workplace outcomes.