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A pruned and parameter-efficient Xception framework for skin cancer classification
Skin cancer is one of the most prevalent and potentially lethal diseases worldwide, with early detection being critical for patient survival. This study presents a novel framework that leverages transfer learning, pruning, SMOTE, data augmentation, and the advanced Avg-TopK pooling method to improve the accuracy and efficiency of skin cancer classification using dermoscopic images. The HAM10000 dataset was used to evaluate the performance of various transfer learning models, with Xception as the top performer. A layer-based pruning strategy was proposed to optimize the model and reduce its complexity. SMOTE and data augmentation were applied to address the class imbalance within the dataset, significantly improving the model’s generalization across all skin lesion classes. The utilization of the Avg-TopK pooling technique further enhanced model accuracy by preserving crucial image features during the downsampling process. The proposed approach achieved an overall accuracy of 91.52%, surpassing several state-of-the-art models. Following pruning, the model’s parameter count was reduced by approximately 35%, from 20.9 million to 13.5 million, improving efficiency and performance. This framework demonstrates the effectiveness of combining model pruning, oversampling, and advanced pooling methods to build robust and efficient skin cancer classification systems suitable for clinical applications.
Response by Skaarup and Biering-Sørensen to Letter Regarding Article, “A Nationwide Factorial Randomized Trial of Electronic Nudges to Patients With Chronic Kidney Disease and Their General Practices for Increasing Guideline-Directed Medical Therapy: The NUDGE-CKD Trial”
A spiking neural network inspired by neuroscience and psychology for Western mode- and key-conditioned music learning and composition
Association between the atherogenic index of plasma and acute kidney injury in sepsis patients
Background Although metabolic abnormalities are directly linked to acute kidney injury (AKI) in septic patients, the function of the atherogenic index of plasma (AIP) is yet unknown. Objectives This study examined the relationship between AIP and AKI risk in septic patients, providing insight into the role of lipid metabolism in renal injury. Methods This study investigated patients with sepsis using data from the eICU Collaborative Research Database (eICU-CRD). The AIP was calculated as the base-10 logarithm of the ratio of triglycerides to high-density lipoprotein cholesterol. We employed multivariate logistic regression to evaluate the association between AIP and AKI. Potential nonlinear relationships were assessed using restricted cubic spline (RCS) curve modeling. Additionally, subgroup and sensitivity analyses were conducted to assess the robustness of these findings. Results The median age of the 771 patients was 66.6 years, with 173 (22.4%) developing AKI. A positive linear association was observed between the AIP and the risk of AKI. Specifically, each 0.1-unit increase in AIP was associated with a 10% higher risk of AKI (OR = 1.10, 95% CI: 1.05–1.15, P < 0.001). Sensitivity analyses after excluding patients with renal infections showed that AIP remained associated with the risk of acute kidney injury. Stratified analyses showed no significant interactions (all P for interaction > 0.05) in gender, age, BMI, SOFA score, GCS score, presence of other diseases (diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure). Conclusions For septic patients, the relationship between AIP and risk of AKI was positively linear, with higher AIP indicating higher risk of AKI.
Coronary Atherosclerosis in Patients With Cancer and Survivors: A Scientific Statement From the American Heart Association
There is an emerging convergence between atherosclerotic cardiovascular disease and cancer, driven by shared risk factors and overlapping pathophysiologic mechanisms. Traditional factors, such as smoking, aging, obesity, hypertension, and diabetes, alongside novel markers, such as clonal hematopoiesis of indeterminate potential, not only predispose individuals to both malignancies and coronary atherosclerosis but also amplify the risk of cardiotoxicity from cancer therapies. Inflammatory processes play a central role in atherogenesis, a process further accelerated by oncologic treatments—including chemotherapy (eg, anthracyclines, 5-fluorouracil), targeted and hormone therapies (eg, tyrosine kinase inhibitors, androgen deprivation, aromatase inhibitors), immune checkpoint inhibitors, and radiation therapy (RT)—that contribute to endothelial dysfunction and plaque instability. This scientific statement synthesizes the evidence on the interplay between cancer and coronary atherosclerosis, highlighting advances in noninvasive imaging modalities (ie, cardiac CT, nuclear imaging, cardiac magnetic resonance, echocardiography) for early detection, risk stratification, and surveillance of coronary artery disease in oncologic populations, and examines the role of invasive imaging techniques in guiding revascularization decisions. Given the elevated bleeding and thrombotic risks in these patients, individualized management of post–percutaneous coronary intervention medications and abbreviated dual antiplatelet therapy regimens is emphasized. This scientific statement also addresses knowledge gaps and reinforces the need for more evidence to improve risk stratification for atherosclerotic cardiovascular disease in patients with cancer. The shared pathobiology between coronary atherosclerosis and cancer necessitates an integrated, multidisciplinary approach to screening, diagnosis, and management.
Simultaneous effect of ZnO nanoparticles and silica fume on the mechanical properties of the concrete
Transcriptomic profiling of clear cell renal cell carcinoma reveals age-dependent molecular signatures and clinical stratification patterns
Clear cell renal cell carcinoma (ccRCC) represents the most prevalent form of kidney cancer, yet age-related molecular heterogeneity remains poorly characterized in clinical specimens. We performed comprehensive transcriptomic profiling of 73 formalin-fixed paraffin-embedded (FFPE) ccRCC samples using RNA sequencing to investigate age-dependent molecular signatures and their clinical implications. Principal component analysis (PCA) revealed that PC1 significantly separated younger versus older patients (p = 0.04), while PC2 distinguished tumors by gender (p = 0.00012), size (p = 8 × 10 ⁻ ⁴), and histological class (p = 0.043), suggesting an orthogonal aging molecular axis alongside with disease progression. Differential gene expression analysis identified 330 age-associated genes, with elderly patients showing upregulation of immune checkpoint regulators (CD70), apoptosis modulators (DEDD, HTATIP2), and proton pump components (TCIRG1), alongside downregulation of metabolic enzymes (DIO2) and cytoskeletal regulators (MICALL2). Pathway enrichment analysis revealed dysregulation of aldosterone-regulated sodium reabsorption, B cell receptor signaling, and Th17 cell differentiation pathways, reflecting age-related immunometabolic reprogramming. Integrative analysis of DEGs across clinical variables identified 1,536 shared genes between tumor size and stage comparisons, with CK7-positive tumors exhibiting distinct transcriptional profiles potentially representing a novel molecular subtype. These findings demonstrate that aging fundamentally alters the ccRCC transcriptome through coordinated changes in immune surveillance, metabolic homeostasis, and tumor microenvironment composition, providing a molecular framework for age-stratified therapeutic approaches and precision oncology strategies in renal cell carcinoma.
Letter by Zhang and Lai Regarding Article, “A Nationwide Factorial Randomized Trial of Electronic Nudges to Patients With Chronic Kidney Disease and Their General Practices for Increasing Guideline-Directed Medical Therapy: The NUDGE-CKD Trial”
Nurturing creativity in comfort; Gently pushing the boundaries within a zone of safety
In today’s rapidly evolving world, fostering creativity within educational settings is essential to prepare individuals for complex global challenges. This study explores the dynamic interplay between individuals and their environments in nurturing creative potential. The research focuses on the influence of participants’ experiences of challenge, comfort, destabilization, support, connection, engagement, and emotions on developing students’ creative potential throughout a creative dance intervention. Ninety-three university students (62 men and 35 women; Mean age: 20.5) participated in 36 creative dance classes over four months. Creative self-efficacy, tolerance for ambiguity, emotional creativity, and ideational behaviors were assessed before and after the intervention. After every class, a brief questionnaire assessing students’ experience of creative dance was filled out. A two-step approach, firstly estimating a mixed effect location scale model and secondly following a simpler linear regression model, was applied to assess how variations in the students’ experience of the creative dance program impact creativity-related variables. Contrary to the common belief that discomfort and stepping out of one’s comfort zone are necessary for creative growth, the findings suggest a more nuanced relationship. While challenges and destabilizing activities can stimulate creativity by preventing routine responses, the study found that comfort, support, and positive emotional experiences were significantly associated with creative self-efficacy and emotional creativity. Social support and connection emerged as critical factors in nurturing creativity. Environments characterized by psychological safety, where individuals feel secure to take risks without fear of negative consequences, seemed to be associated with creative engagement. The formation of group synergies through shared goals and mutual trust were associated with innovative outcomes and individual creative development. The study also highlighted the importance of consistent engagement and positive emotional experiences in fostering tolerance for ambiguity and ideational behaviors. While consistent support and engagement were linked to a greater ability to tolerate ambiguity, variability in peer connection and emotional responses during collaborative processes seemed to be associated with creative ideation. In conclusion, the research emphasizes the significance of person-environment interactions in creative development interventions. Supportive and comfortable environments that foster positive connections and emotional well-being were more consistently associated with favourable creativity-related outcomes than environments centred primarily on challenge. Integrating creativity and emotional awareness into educational practices, particularly in movement-based activities like dance and physical education, can unlock the full potential of these disciplines and better prepare individuals for the complexities of the modern world.
Cyclic Periodicity of High-Risk Viral Myocarditis: Implications From a Recent Parvovirus B19 Outbreak in Europe
Potential synergistic effect of polystyrene nanoplastics on cadmium toxicity to Sedum alfredii Hance
Micro/nanoplastics (MPs/NPs) and cadmium (Cd) are among the most serious pollutants in soils, and the coexistence of MPs/NPs and Cd is therefore inevitable. Several studies have investigated the effects of MPs/NPs or Cd stress alone on plant growth. However, little is known regarding the combined effects of NPs and Cd stress on plants and Cd accumulation, particularly in hyperaccumulators. The study selected Sedum alfredii Hance as a test material, and investigated the individual and combined effects of polystyrene nanoplastics (PS-NPs) (100 and 1000 mg·kg -1 ) and Cd (0.6 and 4 mg·kg -1 ) on the physiological indices, trace element contents, Cd content, Cd chelation, and Cd speciation. The growth of S. alfredii was significantly inhibited under PS-NPs or Cd alone, and the inhibitory effect of Cd stress was more significant than that of PS-NPs stress. Combined treatments increased the growth-inhibition effect. The individual PS-NPs treatments had no significant effects on antioxidant enzyme activity or malondialdehyde (MDA) and trace element contents, but combined treatments significantly increased antioxidant enzyme activity and MDA content, thereby reducing the trace element contents compared to the individual PS-NPs or Cd treatments. Combined treatments increased the contents of the exchangeable Cd, carbonate-bound Cd, and reduced organic-bound Cd, thereby significantly increasing the Cd content in the aboveground parts and roots of S. alfredii ; the Cd content in the aboveground parts and roots of S. alfredii under combined Cd (4 mg·kg -1 ) and PS-NPs (1000 mg·kg -1 ) treatment was 1.2-fold and 1.36-fold higher, respectively, than under Cd stress alone (4 mg·kg -1 ). Furthermore, Cd chelation under combined treatments increased significantly compared to the PS-NPs or Cd treatments alone. The nonprotein thiol (NPT) and phytochelatin (PC) contents under combined PS-NPs (1000 mg·kg -1 ) and Cd (4 mg·kg -1 ) increased by 12.9% and 13.0%, respectively, compared to Cd stress alone (4 mg·kg -1 ). These findings elucidate the impact of NPs on Cd accumulation in hyperaccumulator plants, which holds significant implications for understanding the environmental risks associated with the combination of NPs and Cd.
Global Rounds México: Improving Cardiovascular Health Through Integration
Correction: Estimation of enteric methane emissions in dairy cows under grazing a silvopastoral system and a grass monoculture in the Colombian Amazonian foothills
Phase III ATTR-CM Trials: Rethinking the “Placebo” Arm
Research on active collision avoidance control technology for intelligent connected monorail transit trains in the virtual coupling environment
The development of an intelligent connected monorail transit system offers an effective solution to the mismatch between passenger flow and system capacity at various time intervals within urban rail networks. As the core of such a system lies the virtual coupling (VC) technology, which dynamically adjusts train configurations in response to real-time passenger demand, thereby improving resource utilization. However, during VC operations, severe communication delays between vehicles or the sudden emergence of obstacles ahead may still result in rear-end collisions among coupled vehicles, posing significant safety risks. To address these challenges, this paper focuses on the active collision avoidance control of intelligent connected monorail vehicles operating within the VC environment. At the modeling level, a control model is developed to facilitate VC between leading and following vehicles, and the dynamic characteristics of typical operational scenarios—including station approach coupling, tracking coupling, and departure decoupling—are thoroughly analyzed. Building upon this foundation, the train’s behaviors under collision avoidance during accelerated departures, decelerated arrivals, and unexpected obstacle encounters are further investigated. In terms of control strategy, a Model Predictive Control (MPC) algorithm is introduced to enable efficient coordination and proactive collision avoidance among trains. Ultimately, a simulation platform based on Chongqing Rail Transit Line 3 is established for validating the proposed model and algorithm under representative operating scenarios. The evaluation demonstrates gains in system flexibility and safety and technical foundation for the practical implementation of intelligent rail transit systems.
Life-Threatening Delayed Myocardial Ischemia and Malignant Arrhythmias Occurring After Pulsed Field Ablation of Atrial Fibrillation
Two’s company, three’s a crowd: Social situations alter group dynamics in the maritime earwig (Anisolabis maritima)
Sexual selection can lead to dimorphic traits that can affect an individual’s behavior including how individuals respond to different social situations. We examined how sex and body size influence aggression and courtship in different-sized groups of the maritime earwig, Anisolabis maritima (Order Dermaptera), an insect in which males and females differ morphologically and behaviorally. In this study, we videotaped mixed-sex pairs and trios of earwigs for two hours to determine the effects of sex and size on their interactions. We found that, in pairs, females were more aggressive than males and both sexes show size-based aggression. However, sex was a stronger determinant of aggression in male-biased trios whereas sex and size were more important in female-biased trios. Male size did not affect courtship in pairs, as large and small males were equally likely to engage in copulatory activity. The presence of intrasexual selection altered the results in the two types of trios. In male-biased trios, the larger male had more copulatory opportunities as his size relative to his rival increased, indicating that intrasexual domination by larger males can overcome female preferences for smaller males observed in previous studies. Interestingly, in female-biased trios, there were no such patterns since copulatory opportunities were relatively rare, the likely result of elevated aggression with two interacting females. Our results indicate that sex and size affect both aggression and sexual behavior differently based on group size and composition, which highlights the need to examine behaviors in a variety of social contexts.
Letter by Zhu et al Regarding Article, “Joint Exposure to Ozone and Temperature and Acute Myocardial Infarction Among Adults Aged 18 to 64 Years in the United States”
Trust over repeated interactions: Majority group members generalize more from interactions with non-coethnic partners
People increasingly live in complex, heterogeneous communities characterized by differentiation, where groups may lack the shared history and/or close ties that can nurture trust in more traditional communities. How does trust generalize from an interaction with one stranger––either trustworthy or untrustworthy––to subsequent interactions with other strangers? Does trust generalize more from or toward interactions with outgroup members than ingroup members? And, does an interaction with one stranger affect someone’s willingness to interact with strangers from the same group moving forward? This study examines these questions using a repeated trust game in which 1,255 US White adults were paired with a White or Latino partner who behaved in a trustworthy or untrustworthy way. Results reveal that participants paired with an untrustworthy outgroup member in the first round were less likely to choose an outgroup partner for the second round. This effect is pronounced among participants who likely were uncertain initially about their partner’s behavior. These participants also gave less in the second round when their first-round partner behaved in an untrustworthy way. Our findings highlight the need to treat a willingness to interact with outgroup members as an outcome of intergroup contact.