Trace elements are the essential mineral nutrients in grassland, however, we still know little about the distributions of trace elements in grassland with long-term grazing exclusion. The contents, stocks, and proportions of iron (Fe), aluminum (Al), manganese (Mn), and boron (B) in green plant-litter-root-soil were evaluated by enclosing for 18, and 39 years inside the fence (F18 and F39) and grazing outside the fence (F0) in Inner Mongolia grassland. The results showed that F18 and F39 decreased the stocks of Fe, Al, and Mn in green plant and root compared to F0 (p < .05), while increased the stocks of them in litter (p < .05). The stock of Fe, Al, and Mn in green plant at F39 was 28.6%, 13.9%, and 39.2% higher than that at F18. The stocks of four trace elements in first layer litter at F39 were increased by 12.7%-52.2% compared to F18, whereas the stocks of them in third layer litter were decreased by 32.2%-42.5%. The F18 obviously increased the stocks of Fe and Mn in soil, especially B (p < .05). While the stocks of these trace elements in soil at F39 were 9.1%-28.0% lower than that at F18, especially B (p < .05). In conclusion, the trace elements were mainly shifted from green plant and root to soil and third layer litter with 18-year grazing exclusion. Compared to 18-year grazing exclusion, the trace elements were shifted from third layer litter and soil to root with 39-year grazing exclusion.

Focal segmental glomerulosclerosis (FSGS) is a common pathological form of nephrotic syndrome. This study analyzed the value of pathological lesions and clinical prognosis of different segmental glomerulosclerosis ratios in FSGS. Two hundred and six FSGS patients were collected from Dec 2013 to Apr 2016. The patients were divided into two groups according to the proportion of glomerular segmental sclerosis: F1 (SSR ≤ 15%, n = 133) and F2 (SSR > 15%, n = 73). The clinical and pathological data were recorded and analyzed, and statistical differences were observed between the serum uric acid level and the percentage of chronic renal failure. The pathological results showed significant differences in interstitial fibrosis and tubular atrophy (IFTA), degree of mesangial hyperplasia, vascular lesions, synaptopodin intensity, and foot process effacement between the two groups. Multivariate logistic regression analysis showed significant differences in creatinine (OR: 1.008) and F2 group (OR: 1.19). In all patients, the prognoses of urine protein and serum creatinine levels were statistically different. Multivariate Cox regression analysis revealed that F2 (hazard ratio: 2.306, 95% CI 1.022-5.207) was associated with a risk of ESRD (end stage renal disease). The proportion of segmental glomerulosclerosis provides a guiding value in the pathological diagnosis and clinical prognosis of FSGS.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of online medical services. Although some researchers have investigated how numerical ratings affect consumer choice, limited studies have focused on the effect of negative reviews that most concern physicians.
OBJECTIVE: This study aimed to investigate how negative review features, including proportion (low/high), claim type (evaluative/factual), and physician response (absence/presence), influence consumers\' physician evaluation process under conditions in which a physician\'s overall rating is high.
METHODS: Using a 2×2×2 between-subject decision-controlled experiment, this study examined participants\' judgment on physicians with different textual reviews. Collected data were analyzed using the t test and partial least squares-structural equation modeling.
RESULTS: Negative reviews decreased consumers\' physician selection intention. The negative review proportion (β=-0.371, P<.001) and claim type (β=-0.343, P<.001) had a greater effect on consumers\' physician selection intention compared to the physician response (β=0.194, P<.001). A high negative review proportion, factual negative reviews, and the absence of a physician response significantly reduced consumers\' physician selection intention compared to their counterparts. Consumers\' locus attributions on the negative reviews affected their evaluation process. Physician attribution mediated the effects of review proportion (β=-0.150, P<.001), review claim type (β=-0.068, P=.01), and physician response (β=0.167, P<.001) on consumer choice. Reviewer attribution also mediated the effects of review proportion (β=-0.071, P<.001), review claim type (β=-0.025, P=.01), and physician response (β=0.096, P<.001) on consumer choice. The moderating effects of the physician response on the relationship between review proportion and physician attribution (β=-0.185, P<.001), review proportion and reviewer attribution (β=-0.110, P<.001), claim type and physician attribution (β=-0.123, P=.003), and claim type and reviewer attribution (β=-0.074, P=.04) were all significant.
CONCLUSIONS: Negative review features and the physician response significantly influence consumer choice through the causal attribution to physicians and reviewers. Physician attribution has a greater effect on consumers\' physician selection intention than reviewer attribution does. The presence of a physician response decreases the influence of negative reviews through direct and moderating effects. We propose some practical implications for physicians, health care providers, and online medical service platforms.

UNASSIGNED: Although both anemia and schizophrenia (SCZ) can cause cognitive decline, it is unclear whether anemia worsens cognitive decline in patients with SCZ. The primary objective of this study was to investigate the prevalence of anemia and the relationship between anemia, SCZ symptom severity, and cognitive function in patients with SCZ.
UNASSIGNED: We obtained demographic and clinical data from 1690 inpatients with SCZ. All psychiatric symptoms and cognitive functioning were assessed by the Positive and Negative Syndrome Scale (PANSS), the Mini-Mental State Examination (MMSE), and the Repeated Battery for the Assessment of Neuropsychological Status (RBANS). Hemoglobin (HGB) values as well as red blood cell (RBC) counts were collected by routine blood tests.
UNASSIGNED: The proportion of anemia in patients with SCZ was 26.36 % (383/1453). Compared to SCZ patients without anemia, SCZ patients with anemia were older, had a lower bodyweight, a smaller waist circumference and lower apolipoprotein B levels, but longer QT intervals. Further logistic regression analysis revealed that anemia was associated with age, gender, and weight. In addition, there was no difference in cognitive function between SCZ patients with and without anemia.
UNASSIGNED: Our findings suggest a high proportion of anemia in patients with chronic SCZ in the Han Chinese population. Several demographic and clinical variables are associated with anemia in SCZ patients.

Globally, coronary artery disease (CAD) and cancer are the leading causes of death. Studies focusing on the proportion and spectrum of cancer mortality among CAD patients are lacking. We aim to characterize the proportion and spectrum of cancer-specific mortality among patients with CAD.
We analyzed 93,797 hospitalized survivors with angiographically documented CAD between 2007 and 2020 (mean age: 62.8 ± 11.1 years, 24.7% female) from Cardiorenal ImprovemeNt II (CIN-II) cohort.
During the median follow-up of 4.8 years (IQR: 2.6-7.5), 13,162 (14.0%) patients died after discharge. A total of 1223/7703 (15.8% of cause-specific death) CAD patients died of cancer. The three most common types of cancer-specific death were lung (36.1%), liver (13.3%), and colorectum cancer (12.8%). Furthermore, male (adjusted HR 2.38, 95% CI: 1.99-2.85) and older (≥60 vs. <60 years, adjusted HR 3.25, 95%CI 2.72-3.88) patients had a significantly increased cancer-specific mortality.
Our data suggest that nearly one-sixth of death is accounted for cancer among CAD patients within a median follow-up of 4.8 years. Lung, liver, and colorectum cancer are top three cancer-specific mortality. Further studies are needed to reduce cancer mortality for CAD patients, especially in older and male ones.
(ClinicalTrials.gov NCT05050877).

The upper limits of normal (ULNs) of ALT are not consistent across the major international guidelines which may affect the eligibility for antiviral therapy for chronic hepatitis B (CHB).
To estimate the proportions of histological changes among treatment-naïve patients with CHB within differently defined ALT ULNs.
We searched PubMed and Embase up to May 15th, 2023, to identify studies of treatment-naïve CHB patients with liver biopsies. We pooled proportions of moderate to severe necroinflammation, significant fibrosis, and cirrhosis in those patients within different ALT ULNs by using random-effect models.
We included 23 studies with 4010 participants. Within ALT ULN at 40 IU/L, the pooled proportions of moderate to severe necroinflammation, significant fibrosis, and cirrhosis were 33% (95% CI: 26%-42%), 32% (95% CI: 27%-38%), and 3% (95% CI: 1%-5%), respectively. Within ALT ULN at 30 IU/L for men and 19 IU/L for women, the pooled proportion of significant fibrosis remained at 30% (95% CI: 25%-34%; 432 participants). However, it was 21% (95% CI: 11%-37%; 361 participants) even in those within ALT ULN at 20 IU/L. Subgroup analyses suggested a significantly higher proportion of significant fibrosis among studies with prospective design or enrolled patients\' mean age >35 or >40 years.
Significant histological changes occurred in approximately 1/3 of treatment-naïve CHB patients within ALT ULN at 40 IU/L, whereas the proportion of significant fibrosis was approximately 1/5 even in those within ALT ULN at 20 IU/L.

The authors of this study sought to evaluate the predictive role of global sagittal alignment and upper instrumented vertebra (UIV) level in symptomatic proximal junctional kyphosis (PJK) among patients with adult spinal deformity (ASD).
Data on ASD patients who had undergone fusion of ≥ 5 vertebrae from 2008 to 2018 and with a minimum follow-up of 1 year were obtained from a prospectively collected multicenter database and evaluated (n = 1312). Radiographs were obtained preoperatively and at 6 weeks, 6 months, 1 year, 2 years, and 3 years postoperatively. The 22-Item Scoliosis Research Society Patient Questionnaire Revised (SRS-22r) scores were collected preoperatively, 1 year postoperatively, and 2 years postoperatively. Symptomatic PJK was defined as a kyphotic increase > 20° in the Cobb angle from the UIV to the UIV+2. At 6 weeks postoperatively, sagittal parameters were evaluated and patients were categorized by global alignment and proportion (GAP) score/category and SRS-Schwab sagittal modifiers. Patients were stratified by UIV level: upper thoracic (UT) UIV ≥ T8 or lower thoracic (LT) UIV ≤ T9.
Patients who developed symptomatic PJK (n = 260) had worse 1-year postoperative SRS-22r mental health (3.70 vs 3.86) and total (3.56 vs 3.67) scores, as well as worse 2-year postoperative self-image (3.45 vs 3.65) and satisfaction (4.03 vs 4.22) scores (all p ≤ 0.04). In the whole study cohort, patients with PJK had less pelvic incidence-lumbar lordosis (PI-LL) mismatch (-0.24° vs 3.29°, p < 0.001) but no difference in their GAP score/category or SRS-Schwab sagittal modifiers compared with the patients without PJK. Regression showed a higher risk of PJK with a pelvic tilt (PT) grade ++ (OR 2.35) and less risk with a PI-LL grade ++ (OR 0.35; both p < 0.01). When specifically analyzing the LT UIV cohort, patients with PJK had a higher GAP score (5.66 vs 4.79), greater PT (23.02° vs 20.90°), and less PI-LL mismatch (1.61° vs 4.45°; all p ≤ 0.02). PJK patients were less likely to be proportioned postoperatively (17.6% vs 30.0%, p = 0.015), and regression demonstrated a greater PJK risk with severe disproportion (OR 1.98) and a PT grade ++ (OR 3.15) but less risk with a PI-LL grade ++ (OR 0.45; all p ≤ 0.01). When specifically evaluating the UT UIV cohort, the PJK patients had less PI-LL mismatch (-2.11° vs 1.45°) but no difference in their GAP score/category. Regression showed a greater PJK risk with a PT grade + (OR 1.58) and a decreased risk with a PI-LL grade ++ (OR 0.21; both p < 0.05).
Symptomatic PJK leads to worse patient-reported outcomes and is associated with less postoperative PI-LL mismatch and greater postoperative PT. A worse postoperative GAP score and disproportion are only predictive of symptomatic PJK in patients with an LT UIV.

BACKGROUND: Many researches have reported the impairment of regulatory T cells (Tregs) in autoimmune hepatitis (AIH), whilst the change of Tregs in peripheral blood remains controversial. We performed this systematic review and meta-analysis to clarify the numerical change of circulating Tregs in AIH patients compared with healthy individuals.
METHODS: Relevant studies were identified from Medline, PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and WanFang Data. Twenty-nine studies involving 968 AIH patients and 583 healthy controls were included. Subgroup analysis stratified by Treg definition or ethnicity was performed, and analysis of active-phase AIH was conducted.
RESULTS: The proportions of Tregs among CD4 T cells and PBMCs were generally decreased in AIH patients compared with healthy controls. Subgroup analysis showed that circulating Tregs identified by CD4+CD25+/high, CD4+CD25+Foxp3+, CD4+CD25+/highCD127-/low, and Tregs in Asian population were decreased among CD4 T cells in AIH patients. No significant change of CD4+CD25+/highFoxp3+CD127-/low Tregs and Tregs in Caucasian population among CD4 T cells were found in AIH patients, whereas the number of studies was limited in these subgroups. Moreover, analysis of the active-phase AIH patients showed that Treg proportions were decreased generally, whereas no significant differences in Tregs/CD4 T cells were observed when markers CD4+CD25+Foxp3+, CD4+CD25+/highFoxp3+CD127-/low were used or in Caucasian population.
CONCLUSIONS: The proportions of Tregs among CD4 T cells and PBMCs were decreased in AIH patients compared with healthy controls generally, whereas Treg definition markers, ethnicity, and disease activity had influence on the results. Further large-scale and rigorous study is warranted.

The article introduces a novel class of estimators designed for estimating finite population proportions. These estimators utilize dual auxiliary attributes and are applicable under simple random sampling. The proposed class of estimators includes various members with distinct characteristics. The article provides numerical terminologies for the bias and MSE of the estimators, acquire up to first order of approximation. Four actual data sets are used. Additionally, a simulation study is accompanied to perceive the presentations of estimators. The MSE criterion is used to assess how well the proposed estimator performed as likened to the preliminary estimators. The simulation analysis revealed that, in contrast to other examined estimators, the suggested class of estimators provided better results. The empirical investigation offers evidence to substantiate the findings of the argument. Theoretical research also displays that the suggested class of estimators outperforms its competitors.

Objectives: Impact of the proportion of human milk (HM) in mixed feeding on necrotizing enterocolitis (NEC) remains unknown. This study explores the influence of different proportions of HM on the risk of NEC. Materials and Methods: A retrospective cohort study was performed in infants with very low birth weight (VLBW). A spline smoothing curve was used to evaluate the dose-dependent association between HM and the risk of NEC. Univariate and multivariate analyses were performed to detect the association between the proportion of HM and NEC. Results: Twenty-four infants developed NEC, with 4 (1.9%) in the high HM group, 18 (28.1%) in the low HM group, and 2 (8.0%) in the exclusive formula group (p < 0.001). After adjusting for the relevant confounders, low HM (proportion of HM ≤54%) (OR 33.526, 95% confidential interval [CI] 7.183-156.475, p < 0.001) and exclusive formula feeding (OR 8.493, 95% CI 1.107-65.187, p = 0.040) significantly increased the incidence of NEC, compared with the high HM feeding (proportion of HM >54%). Similarly, low HM was independently associated with an increased risk of feeding intolerance compared with high HM feeding (OR 4.383, 95% CI 2.243-8.564, p < 0.001). Conclusion: A low ratio of HM (≤54%) significantly increased the risk of intestinal complications in VLBW infants. Mixed feeding should relate to the proportion of HM in premature infants.