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ABSTRACT: Back pain is a significant public health problem that accounts for a high percentage of morbidity and disability worldwide. Low back pain is a frequent cause of missed workdays and job-specific disability and is associated with poor outcomes for employees and employers. An online learning module that focused on normal anatomy of the spine, common pathophysiologic diagnosis or findings that may contribute to back pain, and techniques for back pain reduction was created for employees at risk due to the nature of their labor-intensive jobs. This module also contained case studies and graphics that demonstrated ways to reduce risks or hazards by incorporating job-specific changes in the work environment. A mixed method statistical analysis of knowledge change was completed after participation in the online module. This demonstrated that participants had a marked increase in knowledge in all areas examined. In addition, participants perceived the module as beneficial for grasping anatomical concepts, understanding injury prevention and management strategies, valuing the shared information, leveraging visual aids, and applying practical examples per qualitative questions answered. Participants gained knowledge that can be used on the job to decrease risk of sustaining back pain or injury. The intervention approach enhances the understanding of back pain among industrial workers and holds profound implications for public health on a broader scale. Monitoring population health and preventing back pain and injury while at work is essential for safety and is also a core competency in public health.
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Syngas, composed of hydrogen and carbon monoxide, serves as an alternative fuel for hydrogen energy and a key raw material for chemical synthesis. However, due to its flammable nature, syngas poses risks of forming explosive mixtures in the event of a leak. This study explores potential accident scenarios in coal chemical environments involving syngas reaction vessels. Experimental investigations focus on the overpressure and propagation dynamics of jet flames resulting from syngas leakage, with CO volume fractions ranging from 50 to 80% and release pressures between 2 and 5 MPa. Results reveal that maximum flame overpressure occurs within a CO volume fraction range of 55-65%, with no consistent relationship observed between overpressure and CO fraction at fixed release pressures. During our experiments, the maximum recorded overpressure of 28.4 kPa was reached during vented explosions. Additionally, ignition outcomes categorize into three types based on flame propagation speed: combustion/flare, resembling normal deflagration; and high-velocity deflagration, characterized by rapid propagation and potential for steady jet fire formation. While shockwave-like features may be observed, these do not indicate true detonation. These findings offer insights for the safe handling and storage of syngas.
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BACKGROUND AND OBJECTIVES: Self-perception of aging (SPA) is associated with various health outcomes in the aging process. This study aimed to conduct a systematic review of existing interventions targeting SPA among older adults, and to synthesize their effects on self-perception of aging, physical performance, and mental health. RESEARCH DESIGN AND METHODS: A systematic search was performed in PubMed, Embase, PsycINFO, CINAHL, Web of Science, CENTRAL, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials that reported intervention effects on self-perception of aging, physical performance, and mental health in older adults. Two researchers independently conducted study selection, data extraction and quality assessment. RESULTS: A total of 16 studies were included for qualitative analysis, and 12 studies of them were included for meta-analysis. The results showed a significant impact of interventions on self-perception of aging, with the effect size of -0.56 (95% CI -1.06 to -0.07, P=0.03). And the results also supported a significant improvement in physical performance and mental health among older adults. DISCUSSION AND IMPLICATIONS: Self-perception of aging interventions present a promising approach to enhance positive aging perception for older adults, with potential benefits extending to physical performance and mental health. However, larger-scale and more robust trials are still required to validate these findings and obtain more accurate conclusions.
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Stable magnetic core-shell nanostructures are developed by lattice locking lanthanide-iron (La-Fe) oxide shells with magnetite cores to prevent the release of La from the surfaces of the magnetite nanostructures. The resulting core-shell nanostructures demonstrate excellent outstanding regeneration performance and high adsorption capacity for phosphate (115 mg P·g-1). These nanostructures release minimal La from the magnetite core surfaces after adsorbent regeneration, with a La loss of only 20% compared to the control sample, Mag@La(OH)3. La3+ ions were released at concentrations ranging from 1 to 2.3 µg·L-1 at pH levels of 4 to 8, which is within the metal content range found in natural aquatic environments. These results demonstrate the high stability of the nanostructures after regeneration. Furthermore, the adsorbent exhibits high extraction capacity across a wide pH range of 4 to 10 and performs well even in the presence of interfering anions at phosphate-to-anion molar ratios of 1:5, 1:25, and 1:100. Microscopic and spectroscopic analyses reveal that the primary extraction mechanism of phosphate in the La-containing shells is surface precipitation. This approach not only improves the use of magnetic core-shell nanostructures as adsorbents but also demonstrates the creation of a broad range of stable magnetic functional materials for diverse applications.
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Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths. Saliva diagnosis is an essential approach for clinical applications owing to its noninvasive and material-rich features. The purpose of this study was to investigate differences in wheat germ agglutinin (WGA)-based recognition of salivary protein N-linked glycan profiles to distinguish non-small cell lung cancer (NSCLC) patients from controls. We used WGA-magnetic particle conjugates to isolate glycoproteins in the pooled saliva of healthy volunteers (HV, n = 35), patients with benign pulmonary disease (BPD, n = 35), lung adenocarcinoma (ADC, n = 35), and squamous cell carcinoma (SCC, n = 35), following to release the N-linked glycans from the isolated proteins with PNGase F, and further identified and annotated the released glycans by MALDI-TOF/TOF-MS, respectively. The results showed that 34, 35, 39, and 44 N-glycans recognized by WGA were identified and annotated from pooled saliva samples of HV, BPD, ADC, and SCC, respectively. Furthermore, the proportion of N-glycans recognized by WGA in BPD (81.2 %), ADC (90.1 %), and SCC (88.7 %), increased compared to HV (71.9 %). Two N-glycan peaks (m/z 2286.799, and 3399.211) specifically recognized by WGA were present only in NSCLC. These findings suggest that altered salivary glycopatterns such as sialic acids and GlcNAc containing N-glycans recognized by WGA might serve as potential personalized biomarkers for the diagnosis of NSCLC patients.
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Tooth cracks, one of the most common dental diseases, can result in the tooth falling apart without prompt treatment; dentists also have difficulty locating cracks, even with X-ray imaging. Indocyanine green (ICG) assisted near-infrared fluorescence (NIRF) dental imaging technique can solve this problem due to the deep penetration of NIR light and the excellent fluorescence characteristics of ICG. This study extracted 593 human cracked tooth images and 601 non-cracked tooth images from NIR imaging videos. Multiple imaging analysis methods such as classification, object detection, and super-resolution were applied to the dataset for cracked image analysis. Our results showed that machine learning methods could help analyze tooth crack efficiently: the tooth images with cracks and without cracks could be well classified with the pre-trained residual network and squeezenet1_1 models, with a classification accuracy of 88.2% and 94.25%, respectively; the single shot multi-box detector (SSD) was able to recognize cracks, even if the input image was at a different size from the original cracked image; the super-resolution (SR) model, SR-generative adversarial network demonstrated enhanced resolution of crack images using high-resolution concrete crack images as the training dataset. Overall, deep learning model-assisted human crack analysis improves crack identification; the combination of our NIR dental imaging system and deep learning models has the potential to assist dentists in crack diagnosis.
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Gastric cancer (GC) is one of the most aggressive and lethal diseases in the world. Cancer metastasis is the mainly leading cause of death in GC patients. Aberrant Protein O-glycosylation is closely associated with tumor occurrence and metastasis. However, the effect of aberrant O-glycosylation on the progress of GC is not completely clear. This study aimed to investigate the biological function and its underlying effects mechanism of core 1 ß 1, 3-galactosyltransferase 1 (C1GALT1) C1GALT1-mediated O-glycan T antigen on GC progress. We conducted data mining analysis that C1GALT1 was obviously up-regulated in GC tissues than in para-carcinoma tissues. Elevated expression of C1GALT1 was closely associated with advanced TNM stage, lymph node metastasis, histological grade, and poor overall survival. In addition, C1GALT1 overexpression could promote GC cell proliferation, migration, and invasion, which was due to C1GALT1 overexpression-mediated O-glycan T antigen increase. Moreover, MUC1 was predicted to be a new downstream target of C1GALT1, which may be abnormally O-glycosylated by C1GALT1 thereby activating the cell adhesion signaling pathway. In conclusion, our studies proved that C1GALT1-mediated O-glycosylation increase could promote the metastasis of gastric cancer cells. These discoveries hint that C1GALT1 may serve as a novel therapeutic target for GC treatment.
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Although the Omicron variant has been associated with greater transmissibility and tropism of the upper respiratory tract, the clinical and pathogenic features of patients infected with the Omicron variant during an outbreak in China have been unclear. Adults with COVID-19 were retrospectively enrolled from seven medical centers in Guangzhou, China, and clinical information and specimens ( BALF, sputum, and throat swabs) from participants were collected. Conventional detection methods, metagenomics next-generation sequencing (mNGS), and other methods were used to detect pathogens in lower respiratory tract samples. From December 2022 to January 2023, we enrolled 836 patients with COVID-19, among which 56.7% patients had severe/critical illness. About 91.4% of patients were infected with the Omicron strain (BA.5.2). The detection rate of possible co-infection pathogens was 53.4% by mNGS, including Klebsiella pneumoniae (16.3%), Aspergillus fumigatus (12.2%), and Pseudomonas aeruginosa (11.8%). The co-infection rate was 19.5%, with common pathogens being Streptococcus pneumoniae (11.5%), Haemophilus influenzae (9.2%), and Adenovirus (6.9%). The superinfection rate was 75.4%, with common pathogens such as Klebsiella pneumoniae (26.1%) and Pseudomonas aeruginosa (19.4%). Klebsiella pneumoniae (27.1%% vs 6.1%, P < 0.001), Aspergillus fumigatus (19.6% vs 5.3%, P = 0.001), Acinetobacter baumannii (18.7% vs 4.4%, P = 0.001), Pseudomonas aeruginosa (16.8% vs 7.0%, P = 0.024), Staphylococcus aureus (14.0% vs 5.3%, P = 0.027), and Streptococcus pneumoniae (0.9% vs 10.5%, P = 0.002) were more common in severe cases. Co-infection and superinfection of bacteria and fungi are common in patients with severe pneumonia associated with Omicron variant infection. Sequencing methods may aid in the diagnosis and differential diagnosis of pathogens. IMPORTANCE: Our study has analyzed the clinical characteristics and pathogen spectrum of the lower respiratory tract associated with co-infection or superinfection in Guangzhou during the outbreak of the Omicron strain, particularly after the relaxation of the epidemic prevention and control strategy in China. This study will likely prompt further research into the specific issue, which will benefit clinical practice.
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The blood-brain barrier is known to consist of a variety of cells and complex inter-cellular junctions that protect the vulnerable brain from neurotoxic compounds; however, it also complicates the pharmacological treatment of central nervous system disorders as most drugs are unable to penetrate the blood-brain barrier on the basis of their own structural properties. This dramatically diminished the therapeutic effect of the drug and compromised its biosafety. In response, a number of drugs are often delivered to brain lesions in invasive ways that bypass the obstruction of the blood-brain barrier, such as subdural administration, intrathecal administration, and convection-enhanced delivery. Nevertheless, these intrusive strategies introduce the risk of brain injury, limiting their clinical application. In recent years, the intensive development of nanomaterials science and the interdisciplinary convergence of medical engineering have brought light to the penetration of the blood-brain barrier for brain-targeted drugs. In this paper, we extensively discuss the limitations of the blood-brain barrier on drug delivery and non-invasive brain-targeted strategies such as nanomedicine and blood-brain barrier disruption. In the meantime, we analyze their strengths and limitations and provide outlooks on the further development of brain-targeted drug delivery systems.
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BACKGROUND: Gastric cancer (GC), a prevalent malignant tumor which is a leading cause of death from malignancy around the world. Peritoneal metastasis accounts for the major cause of mortality in patients with GC. Despite hyperthermia intraperitoneal chemotherapy (HIPEC) improves the therapeutic effect of GC, it's equivocal about the mechanism under HIPEC. METHODS: MiR-183-5p expression was sifted from miRNA chip and detected in both GC patients and cell lines by qRT-PCR. Gene interference and rescue experiments were performed to identified biological function in vitro and vivo. Next, we affirmed PPP2CA as targeted of miR-183-5p by dual luciferase reporter assay. Finally, the potential relationship between HIPEC and miR-183-5p was explored. RESULTS: MiR-183-5p is up-regulated in GC and associated with advanced stage and poor prognosis. MiR-183-5p accelerate GC migration in vitro which is influenced by miR-183-5p/PPP2CA/AKT/GSK3ß/ß-catenin Axis. HIPEC exerts migration inhibition via attenuating miR-183-5p expression. CONCLUSION: MiR-183-5p can be used as a potential HIPEC biomarker in patients with CC.
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Movimiento Celular , Glucógeno Sintasa Quinasa 3 beta , Hipertermia Inducida , MicroARNs , Proteínas Proto-Oncogénicas c-akt , Neoplasias Gástricas , beta Catenina , Humanos , Neoplasias Gástricas/patología , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , MicroARNs/genética , Glucógeno Sintasa Quinasa 3 beta/metabolismo , Glucógeno Sintasa Quinasa 3 beta/genética , Hipertermia Inducida/métodos , beta Catenina/metabolismo , beta Catenina/genética , Proteínas Proto-Oncogénicas c-akt/metabolismo , Ratones , Animales , Masculino , Femenino , Proteína Fosfatasa 2/metabolismo , Proteína Fosfatasa 2/genética , Línea Celular Tumoral , Ratones Desnudos , Ensayos Antitumor por Modelo de Xenoinjerto , Regulación Neoplásica de la Expresión Génica , Pronóstico , Persona de Mediana Edad , Ratones Endogámicos BALB C , Antineoplásicos Fitogénicos/farmacologíaRESUMEN
Biliary obstruction is a common gastrointestinal disorder with many etiological factors, such as benign and malignant diseases of the biliary tract, pancreas, and liver. Endoscopic ultrasound guided biliary drainage provides a new method for the treatment of biliary obstruction when ERCP cannula fails.
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Postoperative anastomotic stenosis is a common complication after biliary, pancreatic and gastrointestinal surgery, which may be caused by multiple factors such as tissue proliferation and cancer recurrence. Endoscopic therapy is often hampered when the lens is difficult to pass through. A patient with intestinal stricture complicated by bilioenterostomy stenosis was treated by superselection of guide wire and stent.
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In order to improve the dispersion of molybdenum disulfide (MoS2) and enhance the performance of MoS2, two alginate-derived biomass carbon-MoS2 (BC-MoS2) composites: CMB/CMS, were prepared by introducing BC during the synthesis of MoS2 by hydrothermal. The effects of different gels, times and temperatures of the synthesized BC-MoS2 were investigated, and the adsorption capacity for methylene blue (MB), basic fuchsin (BF) and copper ions (Cu2+) was tested. The results indicated that the vertical growth of MoS2 on the BC surface could be realized when using xero-gel, while the BC and MoS2 were mixed uniformly when using wet-gel. Compared with MoS2, the hydrophilicity and water dispersibility of BC-MoS2 were greatly improved, and BC-MoS2 had better adsorption capacity for MB/BF/Cu2+ (99.61/86.83/60 mg/g). The adsorption mechanism exhibits that the adsorption force of BC-MoS2 on MB/BF is mainly based on the electrostatic force, and the adsorption on Cu2+ comes from the electrostatic force and the Lewis soft-soft interaction. This study dramatically enriches the application of transition metal chalcogenides and provides a meaningful reference for wastewater treatment.
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Mitochondria, vital organelles that generate ATP, determine cell fate. Dysfunctional and damaged mitochondria are fragmented and removed through mitophagy, a mitochondrial quality control mechanism. The FDA-approved drug IMQ, a synthetic agonist of Toll-like receptor 7, exhibits antitumor activity against various skin malignancies. We previously reported that IMQ promptly reduced the level of the antiapoptotic Mcl-1 protein and that Mcl-1 overexpression attenuated IMQ-triggered apoptosis in skin cancer cells. Furthermore, IMQ profoundly disrupted mitochondrial function, promoted mitochondrial fragmentation, induced mitophagy, and caused cell death by generating high levels of ROS. However, whether Mcl-1 protects mitochondria from IMQ treatment is still unknown. In this study, we demonstrated that Mcl-1 overexpression induced resistance to IMQ-induced apoptosis and reduced both IMQ-induced ROS generation and oxidative stress in cancer cells. Mcl-1 overexpression maintained mitochondrial function and integrity and prevented mitophagy in IMQ-treated cancer cells. Furthermore, IL-6 protected against IMQ-induced apoptosis by increasing Mcl-1 expression and attenuating IMQ-induced mitochondrial fragmentation. Mcl-1 overexpression ameliorates IMQ-induced ROS generation and mitochondrial fragmentation, thereby increasing mitochondrial stability and ultimately attenuating IMQ-induced cell death. Investigating the roles of Mcl-1 in mitochondria is a potential strategy for cancer therapy development.
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Although the xylose mutarotation and transformation have been investigated largely separately, their relationship has been rarely systematically elaborated. The effect of several factors such as xylose concentration, temperature, and salt concentration, affecting the mutarotation of xylose are discussed. Nine alkali halides (LiCl, NaCl, KCl, LiBr, NaBr, KBr, LiI, NaI, and KI) are used to test salt effects. The relationship between xylose rotation rate constant (kM), specific optical rotation at equilibrium ([α]eqm), α/ß ratio, H chemical shift difference (ΔΔδ), Gibbs free energy difference (ΔG), hydrogen ion or hydroxide ion concentration ([H+] or [OH-]), and xylose conversion is discussed. Different salts dissolved in water result in different pH of the solutions, which affect the mutarotation of xylose, with the nature of both cation and anion. Shortly, the smaller the cation radius is and the larger the anion radius is, the greater the mutarotation rate is. In the dehydration of xylose to furfural in salty solutions, xylose conversion is positively correlated to mutarotation rate, H+ or OH- concentration, and the energy difference between α-xylopyranose and ß-xylopyranose. Although the [α]eqm of xylose is positively correlated with α/ß configuration ratio, there is no obvious correlation with xylose dehydration. The conversion to furfural in chlorides is superior to that in bromines and iodides, which is due to the fact that the pH of chloride salts is smaller than that of the corresponding bromide and iodized salts. Higher H+ concentration prefers to accelerate the formation of furfural. In basic salt solutions, the xylulose selectivity is higher than that of furfural at the initial stage of reaction. The furfural selectivity and carbon balance are better in acidic condition rather than in basic condition. In H2O-MTHF (2-Methyltetrahydrofuran) biphasic system, the optimal furfural selectivity of 81.0 % is achieved at 190 °C in 1 h with the assistance of LiI and a little HCl (0.2 mmol, 8 mmol/L in aqueous phase). A high mutarotation rate represents rapid xylose conversion, but a high furfural selectivity prefers in acidic solutions, which would be perfect if organic solvents were available to form biphasic systems.
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In neurological diseases, the regulation of autophagy plays a crucial role in their pathology, particularly the relationship between autophagy and hepatic encephalopathy (HE) which merits detailed investigation. Glycosphingolipids are abundant and broadly functional in the nervous system and are closely associated with autophagy. However, the specific link and mechanisms between glycosphingolipids and autophagy in HE remain unclear. This study aims to explore the impact of glycosphingolipid changes on the autophagy in HE and its potential mechanisms. Utilizing lectin microarrays, we observed elevated expression levels of α2-3 sialylated glycosphingolipid in the brain tissue of HBV transgenic mice and ammonia-induced astrocyte models, suggesting that the increase in α2-3 sialylated glycosphingolipid is related to HE. Further research revealed that the increased expression of α2-3 sialylated glycosphingolipid, mediated by ST3GAL2, affects autophagy by regulating the autophagy initiation complex Vps34-Beclin-1. In summary, our research not only comprehensively reveals the changes in brain glycosphingolipid during HBV-related HE but also elucidates the interactions and regulatory mechanisms between α2-3 sialylated glycosphingolipid and autophagy. This study provides a new perspective on understanding the pathogenesis of HE and offers novel theories and targets for future research and treatment strategies.
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Autofagia , Glicoesfingolípidos , Encefalopatía Hepática , Sialiltransferasas , Animales , Encefalopatía Hepática/metabolismo , Encefalopatía Hepática/patología , Ratones , Glicoesfingolípidos/metabolismo , Sialiltransferasas/metabolismo , Sialiltransferasas/genética , Ratones Transgénicos , Encéfalo/metabolismo , Encéfalo/patología , Humanos , beta-Galactosida alfa-2,3-Sialiltransferasa , Astrocitos/metabolismo , MasculinoRESUMEN
BACKGROUND: Breast cancer poses a significant health risk to women worldwide, with approximately 30% being diagnosed annually in the United States. The identification of cancerous mammary tissues from non-cancerous ones during surgery is crucial for the complete removal of tumors. RESULTS: Our study innovatively utilized machine learning techniques (Random Forest (RF), Support Vector Machine (SVM), and Convolutional Neural Network (CNN)) alongside Raman spectroscopy to streamline and hasten the differentiation of normal and late-stage cancerous mammary tissues in mice. The classification accuracy rates achieved by these models were 94.47% for RF, 96.76% for SVM, and 97.58% for CNN, respectively. To our best knowledge, this study was the first effort in comparing the effectiveness of these three machine-learning techniques in classifying breast cancer tissues based on their Raman spectra. Moreover, we innovatively identified specific spectral peaks that contribute to the molecular characteristics of the murine cancerous and non-cancerous tissues. CONCLUSIONS: Consequently, our integrated approach of machine learning and Raman spectroscopy presents a non-invasive, swift diagnostic tool for breast cancer, offering promising applications in intraoperative settings.
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INTRODUCTION: This study aims to investigate the changing epidemiology and antimicrobial susceptibility of bacteria isolated from cerebrospinal fluid (CSF) in the Shandong region. METHODOLOGY: We conducted a retrospective analysis of bacterial distribution and resistance patterns in CSF samples, utilizing data from the SPARSS network and analyzed with WHONET 5.6 software. RESULTS: A total of 3968 pathogenic bacterial strains were isolated, consisting of 70.6% Gram-positive bacteria, 27.2% Gram-negative bacteria, and 0.2% fungi. The six most commonly detected bacteria were coagulase-negative staphylococcus, Acinetobacter baumannii, Klebsiella pneumoniae, Streptococcus pneumoniae, Escherichia coli, and staphylococcus aureus. Analysis revealed gender and seasonal variations in the distribution of CSF pathogens, with a higher incidence observed in males and during autumn compared to other seasons. The susceptibility profiles of these bacterial species varied significantly, with many exhibiting multidrug resistances. A. baumannii showed a high resistance rate to cephalosporins and carbapenems but was sensitive to tigecycline and polymyxins. For treating multidrug-resistant A. baumannii infections, polymyxin-based combinations with tigecycline or sulbactam are recommended for adults, while tigecycline combined with meropenem is suggested for children. Enterobacteriaceae species were generally sensitive to carbapenems, such as meropenem and other carbapenems that can penetrate the blood-brain barrier can be recommended. Linezolid and vancomycin are the first choice for treating common gram-positive bacterial infections. CONCLUSIONS: The high resistance rates observed among common CSF isolates and their varied distributions across different demographics highlight the necessity for customized treatment strategies.
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Antibacterianos , Meningitis Bacterianas , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Humanos , China/epidemiología , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/líquido cefalorraquídeo , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Prevalencia , Masculino , Femenino , Adulto , Niño , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Farmacorresistencia Bacteriana Múltiple , Persona de Mediana Edad , Farmacorresistencia Bacteriana , Preescolar , Lactante , Adolescente , Adulto Joven , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificaciónRESUMEN
The field of 3D medical image segmentation is witnessing a growing trend in the utilization of combined networks that integrate convolutional neural networks and transformers. Nevertheless, prevailing hybrid networks are confronted with limitations in their straightforward serial or parallel combination methods and lack an effective mechanism to fuse channel and spatial feature attention. To address these limitations, we present a robust multi-scale 3D medical image segmentation network, the Transformer-Driven Pyramid Attention Fusion Network, which is denoted as TPAFNet, leveraging a hybrid structure of CNN and transformer. Within this framework, we exploit the characteristics of atrous convolution to extract multi-scale information effectively, thereby enhancing the encoding results of the transformer. Furthermore, we introduce the TPAF block in the encoder to seamlessly fuse channel and spatial feature attention from multi-scale feature inputs. In contrast to conventional skip connections that simply concatenate or add features, our decoder is enriched with a TPAF connection, elevating the integration of feature attention between low-level and high-level features. Additionally, we propose a low-level encoding shortcut from the original input to the decoder output, preserving more original image features and contributing to enhanced results. Finally, the deep supervision is implemented using a novel CNN-based voxel-wise classifier to facilitate better network convergence. Experimental results demonstrate that TPAFNet significantly outperforms other state-of-the-art networks on two public datasets, indicating that our research can effectively improve the accuracy of medical image segmentation, thereby assisting doctors in making more precise diagnoses.