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This Element examines Tian Qinxin (1969– ), one of the most prominent theatre directors in contemporary China, and her significant contribution to the development of mainstream Chinese theatre in the 21st century. Since her debut productions in the late 1990s, Tian has cultivated a distinctive directorial style, marked by a syncretic fusion of Western and traditional Chinese theatrical elements. While she has worked across a variety of genres, her primary focus has been on stage adaptations. Adaptation is not only a defining feature of her theatrical practice but also a central aspect of her professional life, where shifting political and cultural contexts necessitate her “performance” of various expressions of both femininity and masculinity. Tian's remarkable adaptability enables her to skillfully navigate the evolving landscape of Chinese theatre, the demands of state cultural policy, and the requirements of the commercial theatre sector.
This study aimed to determine the optimal Biological Effective Dose (BED)-based compensation strategy for treatment interruptions in left-sided breast cancer radiotherapy, with a focus on evaluating cardiac substructures to address a previously unmet clinical need.
Methods:
Twenty patients with left-sided breast cancer who had received radiotherapy were retrospectively enrolled.
Simulations assumed treatment interruptions (number of interruption days) occurred after the first week, ranging from 1 to 10 days. Three BED-based compensation strategies were evaluated: (A) maintaining total fractions and days while delivering twice-daily treatments; (B) maintaining total days while increasing the dose per fraction; and (C) keeping the dose per fraction constant while extending the overall treatment course. Original uninterrupted plans served as the baseline. BEDs for the planning target volume (PTV), simultaneous integrated boost (SIB), cardiac substructures and other organs at risk (OARs) were calculated. Physical and BED differences among the schemes were systematically compared.
Results:
Compared to the original scheme, physical doses to PTV and SIB were lower in Scheme B but higher in Scheme C. As interruptions increased from 1 to 10 days, PTV and SIB doses in Scheme B decreased to minimum values of 42.71 Gy and 50.58 Gy, respectively, while Scheme C resulted in maximum values of 58.60 Gy and 67.15 Gy. Analysis of BED changes (ΔBED) in OARs revealed that the left anterior descending artery (LAD) was the most affected cardiac substructure, with ΔBED values of 0.41, –1.20 and 0.60 for Schemes A, B and C, respectively, at 10 interruption days. Among other OARs, the left lung showed the highest ΔBED changes (0.39, –0.30 and 0.32, respectively). Most OAR comparisons reached statistical significance (ANOVA, p < 0.05).
Conclusion:
Compensation strategies for radiotherapy interruptions significantly influence the BED of OARs, particularly in the LAD and left lung. Scheme B most effectively reduced the BED of OARs but requires replanning. Schemes A and C offer clinical convenience at the cost of a higher BED of OARs. The choice of compensation strategy should be individualised based on clinical priorities and patient-specific anatomy.
Cognitive impairment in major depressive disorder (MDD) may be driven by neuro-inflammatory processes involving pro-inflammatory cytokines.
Aims
This study aimed to examine the relationship between serum tumour necrosis factor-alpha (TNF-α) levels and cognitive performance across different domains in individuals with MDD.
Method
Sixty patients with MDD and 60 healthy controls were recruited. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and serum TNF-α levels were measured via flow cytometry.
Results
After adjusting for covariates, RBANS total and subscale scores were significantly lower in MDD patients compared with controls (P < 0.001), while log10-transformed TNF-α levels were significantly higher in the MDD group (P = 0.006). In MDD patients, log10TNF-α levels were inversely correlated with immediate memory scores after adjusting for confounding factors (r = −0.35, P = 0.009); however, this relationship was not observed in healthy controls (r = −0.02, P = 0.90). Stepwise multivariate regression analysis further confirmed the negative association of log10TNF-α with immediate memory scores in MDD patients (β = −14.58, t = −4.14, P < 0.001), but not in healthy controls (β = −0.02, t = −0.14, P = 0.89).
Conclusions
These findings suggest that elevated serum TNF-α may contribute to the pathophysiology of MDD and is specifically associated with deficits in immediate memory.
Magnetohydrodynamic turbulence with Hall effects is ubiquitous in heliophysics and plasma physics. Direct numerical simulations reveal that, when the forcing scale is comparable to the ion inertial scale, the Hall effects induce remarkable cross-helicity. It then suppresses the cascade efficiency, leading to the accumulation of large-scale magnetic energy and helicity. The process is accompanied by the disruption of current sheets through the entrainment by vortex tubes or the excitation of whistler waves. Using the solar wind data from the Parker Solar Probe, the numerical findings are separately confirmed. These findings provide new insights into the emergence of large-scale solar wind turbulence driven by helical fields and Hall effects.
High-order harmonic generation (HHG) in noble gases driven by femtosecond lasers is currently a feasible solution to obtain ultrafast pulses in the extreme ultraviolet (EUV) wavelength range. Implementation of high-flux EUV sources requires driving HHG using an ultrafast laser source in the visible wavelength range with MHz repetition rate. In this paper, we employ a multi-pass cell followed by chirped mirrors to compress 1-MHz, 200-W, 300-fs pulses at 1.03 μm to a duration of 35 fs. The resulting 186-W compressed pulses are focused onto 0.5-mm thick beta barium borate crystal to drive second-harmonic generation and produce positively chirped pulses at 520 nm. These green pulses are de-chirped to 26 fs in duration with an average power of 64 W, which, to the best of our knowledge, represents the highest average power of green pulses with a duration below 100 fs.
Burkholderia cenocepacia is an environmental Gram-negative bacterium, resistant to many antibiotics and antiseptics, that can survive in aqueous hospital environments. We investigated an outbreak of B. cenocepacia in the intensive care unit (ICU) of Ng Teng Fong General Hospital, aiming to identify the source and prevent further transmission.
Methods:
The outbreak was detected after two ICU patients developed B. cenocepacia bacteremia. Environmental samples, including ultrasound gels, and disinfectants, were collected. Whole genome sequencing (WGS) was used to determine clonality between clinical and environmental isolates. Immediate actions were taken, including a recall of ultrasound gel batches and the use of sterile gel sachets for high-risk procedures.
Results:
Ultrasound gels from opened and unopened bottles from multiple hospital areas, including ICU and Radiology, were found to be contaminated with B. cenocepacia, with a specific batch (Brand A) linked to the outbreak. WGS analysis confirmed the genetic relatedness of clinical and environmental isolates. A hospital-wide recall of affected gel batches was implemented. Through our regional networks, notification of countries in our immediate region along with alerting our local health authorities for further investigation was also undertaken. Additionally, we continued surveillance of gels and identified further contaminated products.
Conclusions:
This outbreak highlights the risks of contaminated medical products, specifically ultrasound gels. Effective environmental sampling, rapid identification, and clear communication with health authorities were key to controlling the outbreak. We have since revised our protocols to mandate the use of sterile gel for invasive procedures and continue monitoring for potential contamination in ultrasound gels.
This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.
Background:
The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.
Methods:
Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.
Results:
A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).
Conclusion:
Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.
Milk fat is a crucial component for evaluating the production performance and nutritional value of goat milk. Previous research indicated that the composition of ruminal microbiota plays a significant role in regulating milk fat percentage in ruminants. Thus, this study aimed to identify key ruminal microorganisms and blood metabolites relevant to milk fat synthesis in dairy goats as a mean to explore their role in regulating milk fat synthesis. Sixty clinically healthy Xinong Saanen dairy goats at mid-lactation and of similar body weight, and similar milk yield were used in a feeding study for 15 days. Based on daily milk yield of dairy goats and the results of milk component determination on the 1st and 8th days, five goats with the highest milk fat content (H group) and five goats with the lowest milk fat content (L group) were selected for further analysis. Before the morning feeding on the 15th day of the experiment, samples of milk, blood and ruminal fluid were collected for analyses of components, volatile fatty acids, microbiota and metabolites. Results revealed that acetate content in the rumen of H group was greater compared with L group. H group had abundant beneficial bacteria including Ruminococcaceae_UCG-005, Saccharofermentans, Ruminococcaceae-UCG-002 and Prevotellaceae_UCG-3, which were important for plant cellulose and hemicellulose degradation and immune regulation. Metabolomics analysis revealed H group had greater relative concentrations of 4-acetamidobutanoic acid and azelaic acid in serum, and had lower relative concentrations of Arginyl-Alanine, SM(d18:1/12:0) and DL-Tryptophan. These altered metabolites are involved in the sphingolipid signaling pathway, arginine and proline metabolism. Overall, this study identified key ruminal microorganisms and serum metabolites associated with milk fat synthesis in dairy goats. These findings offer insights for enhancing the quality of goat milk and contribute to a better understanding of the regulatory mechanisms involved in milk fat synthesis in dairy goats.
High-power 808 nm vertical-cavity surface-emitting laser (VCSEL) chips have unique characteristics for neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pumping compared with conventional edge-emitting laser bars, including a chip surface with high reflectivity, near flat top distribution in the near field, larger emitting width and smaller divergence. A novel symmetrical pump cavity with an inter-reflective chamber was invented by introducing even-numbered pumping geometry and removing the conventional internal reflector. Several optical tuning measures were taken to improve the uniformity of the pumping distribution, including power and spectrum balancing in the cross-section and the long axis of the laser rod, a diffuse mechanism in the pump chamber by a frosted flow tube and optional eccentric pumping geometry. A series of VCSEL pumping experiments were conducted and optical tuning measures were evaluated through distribution profiles and efficiencies. A new design philosophy for the VCSEL side-pumped Nd:YAG laser cavity was finally developed.
A dual-beam platform is developed for all-optical Thomson/Compton scattering, with versatile parameter tuning capabilities including electron energy, radiation energy, radiation polarization, etc. By integrating this platform with a 200 TW Ti:sapphire laser system, we demonstrate the generation of inverse Compton scattering X-/gamma-rays with tunable energies ranging from tens of keV to MeV. The polarization of X-/gamma-rays is manipulated by adjusting the polarization of the scattering laser. In the near future, by combining this platform with multi-PW laser facilities, our goal is to explore the transition from nonlinear Thomson scattering to nonlinear Compton scattering, ultimately verifying theories related to strong-field quantum electrodynamics effects induced by extreme scattering.
Nd-Hf isotope evolution in arc magmas has been widely used to trace the advance and retreat of subduction zones over time. However, the reliability of this method has been questioned. One way to assess its validity is by comparing it with LaN/YbN or Sr/Yb ratios, which are well-established proxies for crustal thickness. In this study, we present new Nd-Hf isotopic data from the Permian to Triassic Hangay Batholith in the western Mongol-Okhotsk Orogen (Hangay Mountains), to evaluate the role of Nd-Hf isotopes in tracing crustal thickness variations along convergent plate boundaries. Our results show that granitoids from the Hangay Batholith likely originated from partial melting of crustal materials, with a possible mantle contribution. These granitoids have moderate εNd(t) and εHf(t) values, with no significant shift from Permian to Triassic, which contrasts with the continuous crustal thickening indicated by LaN/YbN ratios. This inconsistency between Nd-Hf isotope evolution and crustal thickness variation is likely due to the heterogeneous crustal architecture in this accretionary orogen. Our findings highlight the need for caution when linking Hf and Nd isotope evolution with extensional and contractional tectonics.
We undertake a comprehensive investigation into the distribution of in situ stars within Milky Way-like galaxies, leveraging TNG50 simulations and comparing their predictions with data from the H3 survey. Our analysis reveals that 28% of galaxies demonstrate reasonable agreement with H3, while only 12% exhibit excellent alignment in their profiles, regardless of the specific spatial cut employed to define in situ stars. To uncover the underlying factors contributing to deviations between TNG50 and H3 distributions, we scrutinise correlation coefficients among internal drivers (e.g. virial radius, star formation rate [SFR]) and merger-related parameters (such as the effective mass-ratio, mean distance, average redshift, total number of mergers, average spin-ratio, and maximum spin alignment between merging galaxies). Notably, we identify significant correlations between deviations from observational data and key parameters such as the median slope of virial radius, mean SFR values, and the rate of SFR change across different redshift scans. Furthermore, positive correlations emerge between deviations from observational data and parameters related to galaxy mergers. We validate these correlations using the Random Forest Regression method. Our findings underscore the invaluable insights provided by the H3 survey in unravelling the cosmic history of galaxies akin to the Milky Way, thereby advancing our understanding of galactic evolution and shedding light on the formation and evolution of Milky Way-like galaxies in cosmological simulations.
After right ventricular outflow tract obstruction reconstruction for CHD, surgical pulmonary valve replacement, or transcatheter pulmonary valve replacement may be performed if complicated by moderately severe or severe right ventricular outflow tract dysfunction. However, for patients whose anatomy is not suitable for transcatheter pulmonary valve replacement, surgical pulmonary valve replacement is the only option, but it has a higher rate of perioperative complications and longer hospitalisation for patients. In two cases of severe transcatheter pulmonary valve replacement in which percutaneous pulmonary valve implantation could not be performed directly due to the presence of a large right ventricle, a significant decrease in right ventricular function, and significant widening of the pulmonary arteries, we used a new hybridisation procedure to partially fold and reduce the diameter of the significantly widened pulmonary artery trunk without cardiopulmonary bypass by surgically opening the thorax in a median way, and then successfully implanted a percutaneous self-expanding pulmonary valve valve, with good immediate results in the postoperative period. The postoperative recovery was rapid and the recent results were excellent.
Few empirical studies have examined the collective impact of and interplay between individual factors on collaborative outcomes during major infectious disease outbreaks and the direct and interactive effects of these factors and their underlying mechanisms. Therefore, this study investigates the effects and underlying mechanisms of emergency preparedness, support and assurance, task difficulty, organizational command, medical treatment, and epidemic prevention and protection on collaborative outcomes during major infectious disease outbreaks.
Methods
A structured questionnaire was distributed to medical personnel with experience in responding to major infectious disease outbreaks. SPSS software was used to perform the statistical analysis. Structural equation modeling was conducted using AMOS 24.0 to analyze the complex relationships among the study variables.
Results
Organizational command, medical treatment, and epidemic prevention and protection had significant and positive impacts on collaborative outcomes. Emergency preparedness and supportive measures positively impacted collaborative outcomes during health crises and were mediated through organizational command, medical treatment, and epidemic prevention and protection.
Conclusions
The results underscore the critical roles of organizational command, medical treatment, and epidemic prevention and protection in achieving positive collaborative outcomes during health crises, with emergency preparedness and supportive measures enhancing these outcomes through the same key factors.
Language comprehension requires integration of multiple cues, but the underlying mechanisms of how accentuation, as a significant prosodic feature, influences the processing of words with different levels of cloze probability remains unclear. This study exploits event-related potentials (ERPs) to examine the processing of accented and unaccented words with high-, medium-, and low-cloze probabilities embedded in the final position of highly constrained contexts during spoken sentence comprehension. Our results indicate that accentuation and cloze probability interact across the N400 and post-N400 positivity (PNP) time windows. Under the accented condition, N400 amplitudes gradually increased as cloze probability decreased. Conversely, under the unaccented condition, PNP amplitudes gradually increased as cloze probability decreased with a frontal distribution. These results suggest that the effect of predictability is influenced by accentuation, which is likely due to the processing speed and depth of the critical words, modulated by the amount of attentional resources allocated to them.
The selection of random sampling points is crucial for the path quality generated by probabilistic roadmap (PRM) algorithm. Increasing the number of sampling points can enhance path quality. However, it may also lead to extended convergence time and reduced computational efficiency. Therefore, an improved probabilistic roadmap algorithm (TL-PRM) is proposed based on topological discrimination and lazy collision. TL-PRM algorithm first generates a circular grid area among start and goal points. Then, it constructs topological nodes. Subsequently, elliptical sampling areas are created between each pair of adjacent topological nodes. Random sampling points are generated within these areas. These sampling points are interconnected using a layer connection strategy. An initial path is generated using a delayed collision strategy. The path is then adjusted by modifying the nodes on the convex outer edges to avoid obstacles. Finally, a reconnection strategy is employed to optimize the path. This reduces the number of path waypoints. In dynamic environments, TL-PRM algorithm employs pose adjustment strategies for semi-static and dynamic obstacles. It can use either the same or opposite pose adjustments to avoid dynamic obstacles. Experimental results indicate that TL-PRM algorithm reduces the average number of generated sampling points by 70.9% and average computation time by 62.1% compared with PRM* and PRM-Astar algorithms. In winding and narrow passage maps, TL-PRM algorithm significantly decreases the number of sampling points and shortens convergence time. In dynamic environments, the algorithm can adjust its pose orientation in real time. This allows it to safely reach the goal point. TL-PRM algorithm provides an effective solution for reducing the generation of sampling points in PRM algorithm.