Artificial sweeteners are generally used and recommended to alternate added sugar for health promotion. However, the health effects of artificial sweeteners remain unclear. In this study, we included 6371 participants from the National Health and Nutrition Examination Survey with artificial sweetener intake records. Logistic regression and Cox regression were applied to explore the associations between artificial sweeteners and risks of cardiometabolic disorders and mortality. Mendelian randomisation was performed to verify the causal associations. We observed that participants with higher consumption of artificial sweeteners were more likely to be female and older and have above medium socio-economic status. After multivariable adjustment, frequent consumers presented the OR (95 % CI) for hypertension (1·52 (1·29, 1·80)), hypercholesterolaemia (1·28 (1·10, 1·50)), diabetes (3·74 (3·06, 4·57)), obesity (1·52 (1·29, 1·80)), congestive heart failure (1·89 (1·35, 2·62)) and heart attack (1·51 (1·10, 2·04)). Mendelian randomisation confirmed the increased risks of hypertension and type 2 diabetes. Moreover, an increased risk of diabetic mortality was identified in participants who had artificial sweeteners ≥ 1 daily (HR = 2·62 (1·46, 4·69), P = 0·001). Higher consumption of artificial sweeteners is associated with increased risks of cardiometabolic disorders and diabetic mortality. These results suggest that using artificial sweeteners as sugar substitutes may not be beneficial.

In recent years, the extraction of overlapping relations has received great attention in the field of natural language processing (NLP). However, most existing approaches treat relational triples in sentences as isolated, without considering the rich semantic correlations implied in the relational hierarchy. Extracting these overlapping relational triples is challenging, given the overlapping types are various and relatively complex. In addition, these approaches do not highlight the semantic information in the sentence from coarse-grained to fine-grained. In this paper, we propose an end-to-end neural framework based on a decomposition model that incorporates multi-granularity relational features for the extraction of overlapping triples. Our approach employs an attention mechanism that combines relational hierarchy information with multiple granularities and pretrained textual representations, where the relational hierarchies are constructed manually or obtained by unsupervised clustering. We found that the different hierarchy construction strategies have little effect on the final extraction results. Experimental results on two public datasets, NYT and WebNLG, show that our mode substantially outperforms the baseline system in extracting overlapping relational triples, especially for long-tailed relations.

The Palaeo-Mesozoic geodynamic evolution of the Tangjia–Sumdo accretionary complex belt, which separates the North and South Lhasa Terrane, remains controversial. Moreover, the lack of geological records restricts the understanding of the evolution of the Sumdo Palaeo-Tethys Ocean from the middle Permian until the middle Triassic. Here we present zircon U–Pb geochronology, whole-rock geochemistry and Sr–Nd–Hf isotopic compositions of the Yeqing gabbro. Zircon U–Pb geochronology yields ages from 254 ± 1 to 249 ± 1 Ma. In situ Hf isotopic analyses yield ϵ Hf(t) values of −0.2 to +6.3. These samples have high TiO2 (3.69 wt %) and P2O5 (0.78 wt %) contents, with typical patterns like ocean island basalt (OIB). Besides, they are classified as high-Nb basalts (HNBs) based on the high content of Nb (45.3–113.5 ppm). Whole-rock Sr–Nd isotopic compositions are similar to OIB, with initial 87Sr/86Sr of 0.7047–0.7054, 143Nd/144Nd of 0.512526–0.512647 and ϵ Nd(t) of 0.3–2.7. These signatures suggest that the Yeqing gabbro is mainly derived from low-degree melting of the garnet lherzolite mantle. Based on field observations of HNBs intruding into the continental margin and their geochemical characteristics, we infer that the Yeqing gabbro was generated in a subduction environment. Combined with the regional geology of the subduction environment and the evolution of oceanic islands in the Sumdo Palaeo-Tethys Ocean, we propose that the Yeqing gabbro may represent a product of the asthenosphere upwelling through a slab window produced by subduction of seismic ridge in the Sumdo Palaeo-Tethys Ocean, called plume – subduction-zone interaction, during the late Permian to early Triassic.

Instrument delivery is critical part in vascular intervention surgery. Due to the soft-body structure of instruments, the relationship between manipulation commands and instrument motion is non-linear, making instrument delivery challenging and time-consuming. Reinforcement learning has the potential to learn manipulation skills and automate instrument delivery with enhanced success rates and reduced workload of physicians. However, due to the sample inefficiency when using high-dimensional images, existing reinforcement learning algorithms are limited on realistic vascular robotic systems. To alleviate this problem, this paper proposes discrete soft actor-critic with auto-encoder (DSAC-AE) that augments SAC-discrete with an auxiliary reconstruction task. The algorithm is applied with distributed sample collection and parameter update in a robot-assisted preclinical environment. Experimental results indicate that guidewire delivery can be automatically implemented after 50k sampling steps in less than 15 h, demonstrating the proposed algorithm has the great potential to learn manipulation skill for vascular robotic systems.

The increasing FDI in Africa from China and India in recent years has drawn the attention of scholars, policy makers, and the media. Africa is an arena where the two emerging giants compete on different bases. Indian firms have the advantage of institutional proximity and large diaspora communities in Africa, while Chinese firms rely on government-to-government relationship-building. The rivalry between India's soft power and Chinese hard power in Africa will continue for the foreseeable future.

Intestinal atresia (IA), a common cause of neonatal intestinal obstruction, is a developmental defect, which disrupts the luminal continuity of the intestine. Here, we investigated (i) the process of lumen formation in human embryos; and (ii) how a defective lumen formation led to IA. We performed histological and histochemical study on 6–10 gestation week human embryos and on IA septal regions. To investigate the topology of embryonic intestine development, we conducted 3D reconstruction. We showed that a 6–7th gestation week embryonic gut has no lumen, but filled with mesenchyme cells and vacuoles of a monolayer of epithelial cells. A narrow gut lumen was formed by gestation week-9, the gut was filled with numerous vacuoles of different sizes, some vacuoles were merging with the developing embryonic gut wall. At gestation week-10, a prominent lumen was developed, only few vacuoles were present and were merging with the intestine wall. At IA septal regions, vacuoles were located in the submucous layer, covered by a single layer of epithelium without glandular structure, and surrounded with fibrous tissue. The mucosal epithelium was developed with lamina propria and basement membrane, but the submucosa and the longitudinal smooth muscle layers were not properly developed. Hence, the vacuoles in IA septum could represent a remnant of vacuoles of embryonic gut. In conclusion, the fusion of vacuoles with the developing intestine wall associates with the disappearance of vacuoles and gut lumen formation in human embryos, and perturbation of these developmental events could lead to IA.

Preoperative nutritional status plays an important role in predicting postoperative outcomes. Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) are good tools to assess patients’ nutritional status. They have been used in predicting outcomes in various malignancies, but few studies have focused on pancreatic adenocarcinoma (PDAC) patients. Totally, 306 PDAC patients were enrolled. The propensity score matching (PSM) method was introduced to eliminate the baseline inequivalence. Patients with different PNI (or CONUT) scores showed inequivalence baseline characteristics, and patients with compromised nutritional status were related with a more advanced tumour stage. After PSM, the baseline characteristics were well balanced. Both low PNI (≤45) and high CONUT (≥3) were independent risk factors for poor overall survival (P < 0·05), and the result remained the same after PSM. Survival analysis demonstrated both patients with low PNI and high CONUT score were associated with poorer survival, and the result remained the same after PSM. The results of AUC indicated that CONUT might have a higher sensitivity and specificity in predicting complications and survival. Preoperative low PNI (≤45) and high CONUT (≥3) scores might be reliable predictors of prognosis and surgical complications in PDAC patients. Compared with PNI, CONUT might be more effective.

We aimed to investigate the association between plasma retinol and incident cancer among Chinese hypertensive adults. We conducted a nested case–control study, including 231 patients with incident cancer and 231 matched controls during a median 4·5-year follow-up of the China Stroke Primary Prevention Trial. There was a significant, inverse association between retinol levels and digestive system cancer (per 10 μg/dl increases: OR 0·79; 95 % CI 0·69, 0·91). When compared with participants in the first quartile of retinol (< 52·3 μg/dl), a significantly lower cancer risk was found in participants in quartile 2–4 ( ≥ 52·3 μg/dl: OR 0·31; 95 % CI 0·13, 0·71). However, there was a U-shaped association between retinol levels and non-digestive system cancers where the risk of cancers decreased (although not significantly) with each increment of plasma retinol (per 10 μg/dl increases: OR 0·89; 95 % CI 0·60, 1·31) in participants with retinol < 68·2 μg/dl, and then increased significantly with retinol (per 10 μg/dl increase: OR 1·65; 95 % CI 1·12, 2·44) in participants with retinol ≥ 68·2 μg/dl. In conclusion, there was a significant inverse dose–response association between plasma retinol and the risk of digestive system cancers. However, a U-shaped association was observed between plasma retinol and the risk of non-digestive cancers (with a turning point approximately 68·2 μg/dl).