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Summary: In this study, we report on mosaic variegated aneuploidy (MVA) syndrome with tetraploidy and predisposition to infertility in a family. Sequencing analysis identified that the CEP192 biallelic variants (c.1912C>T, p.His638Tyr and c.5750A>G, p.Asn1917Ser) segregated with microcephaly, short stature, limb-extremity dysplasia, and reduced testicular size, while CEP192 monoallelic variants segregated with infertility and/or reduced testicular size in the family. In 1,264 unrelated patients, variant screening for CEP192 identified a same variant (c.5750A>G, p.Asn1917Ser) and other variants significantly associated with infertility. Two lines of Cep192 mice model that are equivalent to human variants were generated. Embryos with Cep192 biallelic variants arrested at E7 because of cell apoptosis mediated by MVA/tetraploidy cell acumination. Mice with heterozygous variants replicated the predisposition to male infertility. Mouse primary embryonic fibroblasts with Cep192 biallelic variants cultured in vitro showed abnormal morphology, mitotic arresting, and disruption of spindle formation. In patient epithelial cells with biallelic variants cultured in vitro, the number of cells arrested during the prophase increased because of the failure of spindle formation. Accordingly, we present mutant CEP192, which is a link for the MVA syndrome with tetraploidy and the predisposition to male infertility.

BackgroundRing enhancement on magnetic resonance imaging (MRI) is an important characteristic of GBM. Though patients suffering from glioblastoma multiforme (GBM) with BRAF mutation (MUT BRAF) in V600E benefit from BRAF-targeted inhibitors, the relationship between ring enhancement and MUT BRAF remains elusive. The purpose of this study was to investigate the relationship between BRAF mutation status and the appearance of ring enhancement so as to guide preoperative targeted therapy for MUT BRAF GBM.MethodsPatient’s population, clinical data and characteristic ring enhancement appearances on MRI were compared between GBM with MUT BRAF and GBM with WT BRAF. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the differential diagnostic significance. A nomogram was developed to predict the mutation status of BRAF. Moreover, all the variables were re-analyzed between epithelioid GBM (E-GBM) with or without MUT BRAF.ResultsCompared to GBM with WT BRAF, GBM with MUT BRAF had specific ring enhancement appearances with multiple rings, multiple located lobes, regular shape of ring, uniform thickness of ring and smaller diameter of ring. Area under the curve (AUC) of all the variables’ combination was 0.929. The nomogram was developed and validated. The re-analyzed results between E-GBM with or without MUT BRAF were similar to these above. AUC of the combination of quantity of ring, quantity of located lobe and shape of ring was 0.962.ConclusionThe characteristic ring enhancement appearances of GBM may play an important role in predicting BRAF mutation status preoperatively, especially in E-GBM. Further study with larger cases may provide more evidences to guide the pretreatment of targeted medicine for GBM patients with MUT BRAF in future.

BackgroundGlioblastoma multiforme (GBM) is a common malignant brain tumor with high mortality. It is urgently necessary to develop a new treatment because traditional approaches have plateaued.PurposeHere, we identified an immune-related gene (IRG)-based prognostic signature to comprehensively define the prognosis of GBM.MethodsGlioblastoma samples were selected from the Chinese Glioma Genome Atlas (CGGA). We retrieved IRGs from the ImmPort data resource. Univariate Cox regression and LASSO Cox regression analyses were used to develop our predictive model. In addition, we constructed a predictive nomogram integrating the independent predictive factors to determine the one-, two-, and 3-year overall survival (OS) probabilities of individuals with GBM. Additionally, the molecular and immune characteristics and benefits of ICI therapy were analyzed in subgroups defined based on our prognostic model. Finally, the proteins encoded by the selected genes were identified with liquid chromatography-tandem mass spectrometry and western blotting (WB).ResultsSix IRGs were used to construct the predictive model. The GBM patients were categorized into a high-risk group and a low-risk group. High-risk group patients had worse survival than low-risk group patients, and stronger positive associations with multiple tumor-related pathways, such as angiogenesis and hypoxia pathways, were found in the high-risk group. The high-risk group also had a low IDH1 mutation rate, high PTEN mutation rate, low 1p19q co-deletion rate and low MGMT promoter methylation rate. In addition, patients in the high-risk group showed increased immune cell infiltration, more aggressive immune activity, higher expression of immune checkpoint genes, and less benefit from immunotherapy than those in the low-risk group. Finally, the expression levels of TNC and SSTR2 were confirmed to be significantly associated with patient prognosis by protein mass spectrometry and WB.ConclusionHerein, a robust predictive model based on IRGs was developed to predict the OS of GBM patients and to aid future clinical research.

B3GALT6 is a well-documented disease-related gene. Several B3GALT6-recessive variants have been reported to cause Ehlers–Danlos syndrome (EDS). To the best of our knowledge, no dominant B3GALT6 variant that causes human disease has been reported. In 2012, we reported on a three-generation, autosomal-dominant family with multiple members who suffered from radioulnar joint rotation limitation, scoliosis, thick vermilion of both lips, and others, but the genetic cause was unknown. Here, exome sequencing of the family identified mutant B3GALT6 as the cause of the multiplex affected family. We observed that, in the compound heterozygous pattern (i.e., c.883C>T:p.R295C and c.510_517del:p.L170fs*268), mutant B3GALT6 led to severe consequences, and in the dominant pattern, an elongated B3GALT6 variant co-segregated with moderate phenotypes. The functional experiments were performed in vitro. The R295C variant led to subcellular mislocalization, whereas the L170fs*268 showed normal subcellular localization, but it led to an elongated protein. Given that most of the catalytic galactosyltransferase domain was disrupted for the L170fs*268 (it is unlikely that such a protein has activity), we propose that the L170fs*268 occupies the normal B3GALT6 protein position in the Golgi and exerts a dominant-negative effect.

This article proposes to utilize linear-quadratic tracking (LQT) control to reduce the air brake system response time and vehicle stopping distance, and hence, to significantly improve the system performance of a commercial vehicle air brake system equipped with electro-pneumatic proportional valve actuators. The nonlinear dynamic model of the air brake system, consisting of a control actuator (a proportional valve) and braking actuator (the brake chamber), is developed and linearized using the q-Markov COVariance Equivalent Realization (q-Markov Cover) method in our early work. Based on the linearized dynamic model, an infinite horizon LQT controller is designed along with Kalman state estimation at each linearized operational condition. To apply the LQT control law over a wide operational range to track the target pressure, the designed controller was interpolated between the neighboring controllers to have a control law cover the entire operational range. To validate this control law, the control scheme is implemented into a dSPACE unit and validated through bench tests under different supply and reference pressures. The LQT control performance is also compared with the PID (proportional-integral-derivative) one. The bench test results confirm the effectiveness of the proposed control scheme.

The increasing number of quick response (QR) code mobile payment users heralds the coming of a cashless society. However, the extent to which the coronavirus disease 2019 (COVID-19) pandemic accelerated the adoption of QR code mobile payment has not been sufficiently researched. Based on social learning theory, this study models how external interaction with the environment has affected the internal appraisal and behavioral intention to adopt QR code mobile payment during COVID-19. Empirical results from 248 respondents revealed that perceived severity and social influence positively affected the perception of utilitarian and health benefits of respondents, which in turn influenced the behavioral intention to use the QR code mobile payment. The theoretical contribution and managerial implications of this study are also discussed.

BackgroundGlioblastoma (GBM) is one of the most malignant types of tumors in the central nervous system, and the 5-year survival remains low. Several studies have shown that preoperative peripheral blood tests and preoperative conventional Magnetic Resonance Imaging (MRI) examinations affect the prognosis of GBM patients. Therefore, it is necessary to construct a risk score based on a preoperative peripheral blood test and conventional MRI and develop a multielement prognostic nomogram for GBM.MethodsThis study retrospectively analyzed 131 GBM patients. Determination of the association between peripheral blood test variables and conventional MRI variables and prognosis was performed by univariate Cox regression. The nomogram model, which was internally validated using a cohort of 56 GBM patients, was constructed by multivariate Cox regression. RNA sequencing data from Gene Expression Omnibus (GEO) and Chinese Glioma Genome Atlas (CGGA datasets were used to determine peripheral blood test-related genes based on GBM prognosis.ResultsThe constructed risk score included the neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), albumin/fibrinogen (AFR), platelet/lymphocyte ratio (PLR), and center point–to-ventricle distance (CPVD). A final nomogram was developed using factors associated with prognosis, including age, sex, the extent of tumor resection, IDH mutation status, radiotherapy status, chemotherapy status, and risk. The Area Under Curve (AUC) values of the receiver operating characteristic curve (ROC) curve were 0.876 (12-month ROC), 0.834 (24-month ROC) and 0.803 (36-month ROC) in the training set and 0.906 (12-month ROC), 0.800 (18-month ROC) and 0.776 (24-month ROC) in the validation set. In addition, vascular endothelial growth factor A (VEGFA) was closely associated with NLR and LMR and identified as the most central negative gene related to the immune microenvironment and influencing immune activities.ConclusionThe risk score was established as an independent predictor of GBM prognosis, and the nomogram model exhibit appropriate predictive power. In addition, VEGFA is the key peripheral blood test-related gene that is significantly associated with poor prognosis.

Brusatol (Bru), a Chinese herbal extract, has a variety of anti-tumor effects. However, little is known regarding its role and underlying mechanism in glioblastoma cells. Here, we found that Bru could inhibit the proliferation of glioblastoma cells in vivo and in vitro. Besides, it also had an inhibitory effect on human primary glioblastoma cells. RNA-seq analysis indicated that Bru possibly achieved these effects through inhibiting the expression of extracellular matrix protein 1 (ECM1). Down-regulating the expression of ECM1 via transfecting siRNA could weaken the proliferation and invasion of glioblastoma cells and promote the inhibitory effect of Bru treatment. Lentivirus-mediated overexpression of ECM1 could effectively reverse this weakening effect. Our findings indicated that Bru could inhibit the proliferation and invasion of glioblastoma cells by suppressing the expression of ECM1, and Bru might be a novel effective anticancer drug for glioblastoma cells.

Abstract Speech emotion recognition methods combining articulatory information with acoustic features have been previously shown to improve recognition performance. Collection of articulatory data on a large scale may not be feasible in many scenarios, thus restricting the scope and applicability of such methods. In this paper, a discriminative learning method for emotion recognition using both articulatory and acoustic information is proposed. A traditional ℓ 1-regularized logistic regression cost function is extended to include additional constraints that enforce the model to reconstruct articulatory data. This leads to sparse and interpretable representations jointly optimized for both tasks simultaneously. Furthermore, the model only requires articulatory features during training; only speech features are required for inference on out-of-sample data. Experiments are conducted to evaluate emotion recognition performance over vowels /AA/, /AE/, /IY/, /UW/ and complete utterances. Incorporating articulatory information is shown to significantly improve the performance for valence-based classification. Results obtained for within-corpus and cross-corpus categorical emotion recognition indicate that the proposed method is more effective at distinguishing happiness from other emotions.

Diesel engines are widely used in agricultural tractors. During field operations, the tractors operate at low speed and high load for a long time, the fuel efficiency is only about 15% to 35%, and the exhaust waste heat accounts for 38% to 45% of the energy released from the fuel. The use of tractor exhaust waste heat can effectively reduce fuel consumption and pollutant emissions, of which the organic Rankine cycle (ORC)-based waste heat recovery conversion efficiency is the highest. First, the diesel engine map is achieved through the test rig, a plate-fin evaporator is trial-produced based on the tractor size, and the thermodynamic and economic performance model of the ORC are established. Then, taking the thermal efficiency of ORC and the specific investment cost (SIC) as the objective function, the particle swarm optimization (PSO) algorithm and the technique for order of preference by similarity to ideal solution (TOPSIS) decision method were used to obtain the optimal operating parameter set under all working conditions. Finally, the results showed that the ORC thermal efficiency could reach a maximum of 12.76% and the corresponding SIC value was 8539.66 $/kW; the ORC net output power could be up to 8.31 kW compared with the system without ORC; and the maximum brake specific fuel consumption (BSFC) could be reduced by 8.3%. The improvement in the thermodynamic performance will lead to a sacrifice in economic performance, and at high speeds, the economic benefits and thermal efficiency reach a balance and show a better thermal economic performance. Recovering exhaust heat energy through ORC can reduce tractor fuel consumption and pollution emissions, which is one of the effective technical means to achieve “carbon neutrality” in agricultural production. At the same time, through the PSO algorithm, the optimal combination of ORC operating parameters is obtained, which ensures that the exhaust heat energy can be effectively recovered during the tractor field operation, and provides a basis for the adjustment of real-time work strategies for future research.

In order to solve the problem of high labor intensity of a traditional pontoon lotus root machine with manual pushing operation, a riding pontoon digging lotus root machine was proposed in this paper. The working principle of the digging machine was introduced, the key components were designed, and the buoyancy of the pontoon was calculated and analyzed. The performance of the digging machine was tested in a lotus root pond, the lotus root digging rate was 76%, and hydraulic flushing generated by the digging machine can disperse the soil within 30 cm under water. In addition, the best flushing effect was achieved when the number of working nozzles was controlled to three. Finally, according to the test results, the optimization measures of the hydraulic lotus root digging machine were proposed, and the CFD-DEM coupled simulation model was used to simulate and analyze the soil disturbance effect of hydraulic flushing upward from the bottom of the lotus root. The results showed the relationship between nozzle diameter, angle and hydraulic flushing depth. When the nozzle angle was fixed, the soil disturbance effect decreased with increasing flushing depth and increased with decreasing nozzle diameter. When the nozzle depth was fixed, both the diameter and the angle had a significant effect on the soil disturbance effect. When the nozzle diameter was fixed, the interaction of angle and depth had no significant effect on the soil disturbance effect.

In response to the problems of small working width and low operating efficiency of existing hydraulic scouring lotus root harvesters, a wide-width hydraulic scouring system was designed based on a wide-width self-propelled lotus root harvester. The main parameters of the key components were determined through theoretical analysis of the water flow energy of the hydraulic scouring system pipelines. An experimental study was also carried out on the main factors affecting the working performance of this hydraulic scouring system. Through hydrodynamic simulation tests, the effect of nozzle type and constriction section structure on the turbulence intensity at the nozzle outlet and the pressure loss per unit mass of fluid between the nozzle inlet and outlet sections were compared and analysed. The test yielded conical-cylindrical nozzle geometry parameters for nozzle inlet diameter of 40 mm, shrinkage angle of 30°, nozzle outlet straight section length of 20 mm, nozzle outlet diameter of 16 mm, the nozzle had better flushing performance. Single-factor tests were carried out with nozzle outlet pressure, scouring angle and nozzle height from the mud surface as influencing factors. Based on the optimum effective scour depth, a three-factor, three-level Box–Behnken central combination design test was completed. The primary and secondary factors affecting the effective scouring depth were obtained in the following order: nozzle height from the mud surface, nozzle outlet pressure, and scouring angle. Finally, the performance test of the hydraulic scouring system was completed. Results showed that when the nozzle outlet pressure of 0.30 MPa, the scouring angle of 60° and the nozzle height from the mud surface of 0 mm, the effective scouring depth was 395 mm, the lotus root floating rate was 90% and the damage rate was 5%, which meet the requirements of lotus root harvesting operations.

Hydraulic scouring is the most effective approach to harvest lotus roots, but its application is largely restricted by the low harvesting rate. After hydraulic scouring, some mature lotus roots are still partially buried in the soil. Therefore, it is highly necessary to develop an appropriate approach to harvest semi-buried lotus roots. In this work, we for the first time studied the interaction between semi-buried lotus roots and soil, as well as analyzing the pull-out process and the factors affecting the pull-out force of semi-buried lotus roots. Firstly, a simple testing platform was designed based on the virtual prototype technology and the tests on pull-out force were conducted on five lotus roots with similar shape but different weights, with the burial depth and pull-out speed as the experimental factors. The results revealed that the maximum pull-out force is not significantly affected by the pull-out speed, whereas it is significantly influenced by the burial depth and the surface area of lotus roots. The maximum pull-out force increased with increasing lotus root surface area and burial depth. In addition, the discrete element method was employed to simulate the pull-out process of lotus root at different pull-out speeds. The simulation results indicated that a higher pull-out speed would result in a greater pull-out force at the same displacement of the lotus root from the soil. Both experimental and simulation results revealed that soil adhesion contributes the most to the pull-out resistance. It was also observed that a slight loosening of semi-buried lotus roots could drastically reduce the pull-out force. These results suggest that some kind of mechanical structure or improvement of water flow can be applied to the existing lotus root harvester to reduce the adhesion between lotus roots and soil. Overall, our findings provide a novel direction for optimizing hydraulic harvesting machines of lotus roots.

Drawing on social cognitive theory, we propose a moderated-mediation model to examine when and why workplace ostracism impairs employee creativity in China. We collected 195 valid questionnaires with a two-wave employee-supervisor dyadic research design from one large Chinese company. Results indicate workplace ostracism affects employee creativity negatively. Moreover, the negative effect of workplace ostracism on employee creativity is not only mediated by employee creative self-efficacy (CSE), but the mediation effects of employee CSE are also found to be stronger when employee collectivism orientation is high. Finally, the theoretical and practical implications of these findings are discussed.

High-speed railway (HSR) traction transformer, as a connection between traction power supply system and the power grid, is critical in electrified railway design, which requires a drastic change of traction load and frequent external short circuits. In the actual operation process, the traction transformer can produce minor faults that are difficult to detect such as the deformation of the winding, which may result in a serious problem. This study analyses the topology structures and winding fault characteristics of six HSR traction transformers consisting of single phase, Vv, YNd11, Scott, YNvd and impedance matching wiring. Both circuit models of normal operation and fault operation of HSR traction transformer are established. Results show that real-time diagnosis of HSR traction transformer can be accomplished through measuring the voltage signal of the input and output points during operation and establishing real-time monitoring statistics of small faults standardisation（I^2 and squared prediction error）based on fast independent component analysis algorithm, as well as the signal statistics distribution, thereby improving the safety and reliability of HSR operation.

Infantile cystinosis (IC) is a rare autosomal recessive disorder characterized by a defect in the lysosomal-membrane transport protein, cystinosin. It serves as a prototype for lysosomal transport disorders. To date, several CTNS mutations have been identified as the cause of the prototypic disease across different ethnic populations worldwide. However, in Asia, the CTNS mutation is very rarely reported. For the Chinese population, no literature on CTNS mutation screening for IC is available to date. In this paper, by using the whole exome sequencing and Sanger sequencing, we identified two novel CTNS splicing deletions in a Chinese IC family, one at the donor site of exon 6 of CTNS (IVS6+1, del G) and the other at the acceptor site of exon 8 (IVS8-1, del GT). These data give information for the genetic counseling of the IC that occurred in Chinese population.

Objective To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting.Design Prospective cohort study.Setting Community setting.Participants We recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke.Outcome measures SCR participation over the first 3 months and subsequent 3 to 12 months post-strokeResults 251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor’s disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver’s positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068).Conclusion We established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.

Abstract Background We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care. Methods A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1–30/6/2010) were included. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary artery disease (CAD). We fit cox proportional hazard model adjusting death as competing risk factor to estimate the cause-specific hazard ratio (csHR). Results A total of 466 patients (mean age, 71.5 years) were included. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CAD. Age was an independent risk factor for recurrent stroke, CAD and death. Statin therapy at baseline had a protective effect for recurrent stroke (csHR = 0.476; 95% confidence interval [CI] 0.285–0.796, P = 0.005) after adjusting death as a competing risk factor and all-cause mortality (HR = 0.693, 95% CI 0.486–0.968, P = 0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival. Conclusions Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.

Abstract Because of their large surface areas, nanotubes and nanowires demonstrate exquisite mechanical coupling to their surroundings, promising advanced sensors and nanomechanical devices. However, this environmental sensitivity has resulted in several ambiguous observations of vibrational coupling across various experiments. Herein, we demonstrate a temperature-dependent Radial Breathing Mode (RBM) frequency in free-standing, electron-diffraction-assigned Double-Walled Carbon Nanotubes (DWNTs) that shows an unexpected and thermally reversible frequency downshift of 10 to 15%, for systems isolated in vacuum. An analysis based on a harmonic oscillator model assigns the distinctive frequency cusp, produced over 93 scans of 3 distinct DWNTs, along with the hyperbolic trajectory, to a reversible increase in damping from graphitic ribbons on the exterior surface. Strain-dependent coupling from self-tensioned, suspended DWNTs maintains the ratio of spring-to-damping frequencies, producing a stable saturation of RBM in the low-tension limit. In contrast, when the interior of DWNTs is subjected to a water-filling process, the RBM thermal trajectory is altered to that of a Langmuir isobar and elliptical trajectories, allowing measurement of the enthalpy of confined fluid phase change. These mechanisms and quantitative theory provide new insights into the environmental coupling of nanomechanical systems and the implications for devices and nanofluidic conduits.

Background: To revisit the association between vitamin D deficiency (VDD, defined as serum 25(OH)D

Abstract Charge density waves (CDWs) involved with electronic and phononic subsystems simultaneously are a common quantum state in solid-state physics, especially in low-dimensional materials. However, CDW phase dynamics in various dimensions are yet to be studied, and their phase transition mechanism is currently moot. Here we show that using the distinct temperature evolution of orientation-dependent ultrafast electron and phonon dynamics, different dimensional CDW phases are verified in CuTe. When the temperature decreases, the shrinking of c-axis length accompanied with the appearance of interchain and interlayer interactions causes the quantum fluctuations (QF) of the CDW phase until 220 K. At T

The COVID-19 pandemic increased online shopping, including for potted plants; however, research on plant-purchasing behaviors outside of physical stores is limited. This study examined key factors that influence online plant purchases. Initially, 47 factors related to online plant purchases were identified. Personal factors encompassed gender, age, educational level, monthly income, gardening education, online purchase frequency, and living environment. Age quota sampling was used and 400 valid questionnaires were collected. Six common factors and 21 items were identified: consumer assurance, plant care and safety, well-being, service quality, pricing and promotions, and size and habits. Well-being was the most influential for online plant purchases. Service quality, data security, after-sales service, and pricing strategies were also important, with plant care and safety as secondary factors. Compared with men, women emphasized well-being and plant care more. Environmental factors such as naturalness and building density affected purchasing decisions. This study highlights the need for tailored marketing strategies focusing on service quality and emotional benefits to meet diverse consumer needs and preferences.

Abstract Spatially resolved omics technologies reveal the spatial organization of cells in various biological systems. Here we propose SLAT (Spatially-Linked Alignment Tool), a graph-based algorithm for efficient and effective alignment of spatial slices. Adopting a graph adversarial matching strategy, SLAT is the first algorithm capable of aligning heterogenous spatial data across distinct technologies and modalities. Systematic benchmarks demonstrate SLAT’s superior precision, robustness, and speed over existing state-of-the-arts. Applications to multiple real-world datasets further show SLAT’s utility in enhancing cell-typing resolution, integrating multiple modalities for regulatory inference, and mapping fine-scale spatial-temporal changes during development. The full SLAT package is available at https://github.com/gao-lab/SLAT .

Abstract The SARS-CoV-2 virus has caused a public health crisis globally. Against the backdrop of global resilience, studies have demonstrated the therapeutic value of home gardening as a measure to strengthen human health. However, there is a lack of comparative studies on its benefits across countries. Studies need to examine the role of home gardening in improving public health in various societies to understand and encourage this practice broadly and effectively. We chose Taiwan, Thailand, and Vietnam as case studies, which have suffered substantial pandemic impacts, with millions of infections and thousands of deaths. We explored and compared the perceptions of people on home gardening and its health benefits during the COVID-19 pandemic. We conducted online surveys in three countries between May 1 and September 30, 2022, with a total of 1172 participants. Data were collated on perceived pandemic stress, challenges and solutions in gardening, home gardening intentions, and mental and physical health benefits. In these countries, we found that perceived pandemic stress positively affects home gardening intentions, whereby the motivation of Vietnamese people is the highest. Challenges hinder gardening intentions, while the solutions only positively affect gardening intentions in Taiwan and Vietnam. Home gardening intentions positively affect mental and physical health, whereby there are higher mental health benefits in Taiwanese people than in Thai people. Our findings potentially support public health recovery and promote healthy lifestyles during the COVID-19 pandemic.

Abstract Objectives To investigate the utility of a novel serum miRNA biomarker panel to distinguish teratoma from nonmalignant necrotic/fibrotic tissues or nonviable tumours in patients with NSGCT undergoing post‐chemotherapy consolidation surgery. Patients and methods We prospectively collected pre‐surgical serum samples from 22 consecutive testicular NSGCT patients with residual NSGCT after chemotherapy undergoing post‐chemotherapy consolidation surgery. We measured serum miRNA expression of four microRNAs (miRNA‐375, miRNA‐200a‐3p, miRNA‐200a‐5p and miRNA‐200b‐3p) and compared with pathologic findings at time of surgery. Receiver operating characteristic (ROC) curves were performed to assess the ability of these miRNA to differentiate between teratoma and necrosis or viable malignancy. Results Twenty‐two patients with NSGCT were split into two groups based on pathology at time of post‐chemotherapy consolidation surgery (teratoma group vs. necrosis/fibrosis/viable tumour group, i.e., NFVT). Patients with teratoma were older at diagnosis compared with those patients with NFVT (median age 28.7 vs. 23.9). Patients with NFVT were more likely to have embryonal carcinoma in their primary tumour (81.8% vs. 27.3%; p = 0.01). The majority of patients in both groups were stage III (63.6% vs. 72.7%). In this analysis, none of the miRNAs had good sensitivity or specificity to predict teratoma. There was no significant association between the expression levels of the miRNAs and the presence of teratoma. There was no statistically significant correlation between any of the miRNAs and teratoma size. Conclusion This novel miRNA panel (miRNA‐375, miRNA‐200a‐3p, miRNA‐200a‐5p and miRNA‐200b‐3p) did not distinguish teratoma from nonmalignant necrotic/fibrotic tissues or nonviable tumours in patients with NSGCT undergoing post‐chemotherapy consolidation surgery.

Abstract Pathogen contamination of water has a massive impact on global human health. In particular, viruses pose unique challenges to water treatment techniques due to their small size and presence in water as both individual virions and when absorbed onto larger particles. Low-energy water treatment processes such as media filtration are not capable of completely removing viruses owing to their small size. Hence, less sustainable processes with high chemical or energy consumption such as chemical disinfection, ultraviolet irradiation, and membrane filtration are usually required. To overcome high energy and/or chemical requirements for virus treatment, designs for sustainable fiber filters fabricated from minimally processed natural materials for efficient virus (MS2) and bacteria (E. coli) removal are presented in this work. These filters were created by functionalizing readily accessible natural fibers including cotton, silk, and flax with a simple aqueous extract containing cationic proteins from Moringa oleifera seeds. The proposed filters offer a comprehensive low cost, low energy, and low environmental impact solution for pathogen removal from water with removals of >7log10 (99.99999%) for viruses and bacteria.

Abstract The ankle‐link complex (ALC) consists of USH2A, WHRN, PDZD7, and ADGRV1 and plays an important role in hair cell development. At present, its architectural organization and signaling role remain unclear. By establishing Adgrv1 Y6236fsX1 mutant mice as a model of the deafness‐associated human Y6244fsX1 mutation, the authors show here that the Y6236fsX1 mutation disrupts the interaction between adhesion G protein‐coupled receptor V subfamily member 1 (ADGRV1) and other ALC components, resulting in stereocilia disorganization and mechanoelectrical transduction (MET) deficits. Importantly, ADGRV1 inhibits WHRN phosphorylation through regional cAMP‐PKA signaling, which in turn regulates the ubiquitination and stability of USH2A via local signaling compartmentalization, whereas ADGRV1 Y6236fsX1 does not. Yeast two‐hybrid screening identified the E3 ligase WDSUB1 that binds to WHRN and regulates the ubiquitination of USH2A in a WHRN phosphorylation‐dependent manner. Further FlAsH‐BRET assay, NMR spectrometry, and mutagenesis analysis provided insights into the architectural organization of ALC and interaction motifs at single‐residue resolution. In conclusion, the present data suggest that ALC organization and accompanying local signal transduction play important roles in regulating the stability of the ALC.

It is challenging to construct lateral homostructures with controllable geometry and repeated alternating configurations. Here the authors develop a generic approach for fabricating twisted lateral homostructures with tunable crystal orientation, epitaxial constrain, and phase stability.

In order to correctly evaluate the phosphating effect on the surface of galvanized steel plate,the two most typical phosphating film evaluation methods,namely P ratio and crystal coverage rate determination method were compared and analyzed.Different methods were used to determine P ratio and crystal coverage rate of phosphating film,respectively.Results showed that when the accuracy of XRD data of phosphating film could not be determined,the method of measuring the diffraction peak area of P phase and H phase was more accurate than that of determining the P ratio.When the XRD data of phosphating film was accurate,the P ratio calculated by directly measuring the diffraction intensity of P phase and H phase was more accurate.When there were many grain shapes and complex grain distribution in SEM morphology,the crystal coverage rate of phosphating film could be measured more accurately according to Q/JL J130012-2018.When the grain distribution was relatively uniform,the crystal coverage rate of the phosphating film could be measured by Photoshop software analysis method,which was more intuitive to observe the distribution of grain interstice.

Abstract Background Informal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor’s outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore. Methods Stroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients’ likelihood of requiring informal care, hours of informal care required, and informal caregivers’ Zarit’s Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients’ and informal caregivers’ demographic characteristics, arrangement of informal care, and patients’ health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities. Results Three hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit’s Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden. Conclusions Informal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.

Introduction: Detection of atrial fibrillation (AF) is challenging in patients after ischemic stroke due to its paroxysmal nature. We aim to determine the utility of a combined clinical, electrocardiographic and genetic variables model to predict AF in a post-stroke population. Materials and Methods: We performed a cohort study at a single comprehensive stroke centre from 09/11/2009 to 31/10/2017. All patients recruited were diagnosed with acute ischemic stroke or transient ischemic attacks. Electrocardiographic variables including p-wave terminal force (PWTF), corrected QT interval (QTc) and genetic variables including single nucleotide polymorphisms (SNP) at the 4q25 (rs2200733) were evaluated. Clinical, electrocardiographic and genetic variables of patients without AF and those who developed AF were compared. Multiple logistic regression analysis and receiver operating characteristics were performed to identify parameters and determine their ability to predict the occurrence of AF. Results: Out of 709 patients (median age of 59 years, IQR 52-67) recruited, sixty (8.5%) were found to develop AF on follow-up. Age (odds ratio (OR): 3.49, 95% confidence interval (CI): 2.03-5.98, p

Kalman filter has been applied extensively to the target tracking. The estimation performance of Kalman filter is closely resulted by the quality of prior information about the process noise covariance (Q) and the measurement noise covariance (R). Therefore, the development of adaptive Kalman filter is mainly to reduce the estimation errors produced by the uncertainty of Q and R. In this paper, the proposed self-adaptive Kalman filter algorithm has solved the problems of covariance-matching method about the determination of the width of the window and the addition of storage burden and that can update Q and R simultaneously. Simulation results confirm that the proposed method outperforms the traditional Kalman filter and has the better estimation performance than the other two adaptive Kalman filters in the target tracking. The developed filtering algorithm has the following characteristics: high robustness, low computing load, easy operation and tuning Q, R simultaneously.

Objective The aim of this systematic review is to evaluate the various modalities available for extended ECG monitoring in the detection of atrial fibrillation (AF) following a cryptogenic stroke.Methods MEDLINE (Ovid), EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched from January 2011 to November 2021. All randomised controlled trials and prospective cohort studies including the use of extended ECG monitoring >24 hours with a minimum duration of AF of 30 s in patients with either cryptogenic strokes or transient ischaemic attacks were included. A random-effects model was used to pool effect estimates of AF detection rates from different ECG modalities.Results 3924 studies were identified, of which 47 were included reporting on a pooled population of 6448 patients with cryptogenic stroke. The pooled AF rate for implantable loop recorders (ILRs) increased from 4.9% (3.0%–7.9%) at 1 month to 38.4% (20.4%–60.2%) at 36 months. Mobile cardiac outpatient telemetry (MCOT) had a significantly higher pooled AF detection rate of 12.8% (8.9%–17.9%) versus 4.9% (3.0%–7.9%) for ILR at 1 month (p

Abstract Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007.

Abstract Precision medicine is associated with favorable outcomes in selected patients with cancer. Herein, we report an interim analysis of IMPACT2, an ongoing randomized study evaluating genomic profiling and targeted agents in metastatic cancer. Patients with metastatic cancer underwent tumor genomic profiling (ClinialTrials.gov: NCT02152254), and 69 patients met the criteria for randomization. Tumor board and multidisciplinary review of molecular alterations optimized treatment selection. From 5/2014 to 4/2017, 320 patients (median age, 63 years; men, 47%) had tumor molecular aberrations, and 213 (66.56%) received anticancer therapy. The most frequently mutated genes were TP53 (42%), KRAS (16%), PIK3CA (12%), and CDKN2A (11%). The median OS was 10.9 months (95% CI, 8.8–12.9). OS was shorter in patients with higher tumor mutational burden. Independent factors associated with shorter OS were age ≥60 years, liver metastases, low albumin levels, high LDH levels, and KRAS and TP53 mutations. Outcomes for randomized patients will be reported after completion of the study.

This study analyzed RNA expression of genes for three serum tumor markers, alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH), in patients with testicular germ cell tumors (TGCT) type 2. The gene AFP encodes AFP, the gene for chorionic gonadotropin beta polypeptide 5 (CGB5) encodes a major part of the specific beta subunit of hCG, and the genes for LDH subunit A (LDHA), LDH subunit B (LDHB), and LDH subunit C (LDHC) encode three different subunits of LDH. LDHB encodes the LDHB subunit present as a tetramer in LDH isoenzyme 1 (LDH-1). We examined three datasets with 203 samples of normal testis tissue (NT) and TGCT type 2. Yolk sac tumor (YST) expressed RNA of AFP fourteen thousand times higher than seminoma (SE), embryonal carcinoma (EC), and teratoma (TER) combined (P = 0.00015). In the second microarray, choriocarcinoma (CC) expressed RNA of CGB5 ten times higher than other histologic types of TGCT combined. EC expressed RNA of LDHB twice higher than SE, YST and TER combined (P = 0.000041). EC expressed RNA of LDHB higher than that YST expressed RNA of AFP and that CC expressed RNA of CGB5. In conclusion, TGCT type 2 expressed RNA of LDHB markedly higher than the RNA of 23 other candidate genes for TGCT type 2.

IntroductionPrimary aldosteronism (PA) is associated with increased risk of cardiovascular events. However, treatment of PA has not been shown to improve left ventricular (LV) systolic function using the conventional assessment with LV ejection fraction (LVEF). We aim to use speckle-tracking echocardiography to assess for improvement in subclinical systolic function after treatment of PA.MethodsWe prospectively recruited 57 patients with PA, who underwent 24-h ambulatory blood pressure (BP) measurements and echocardiography, including global longitudinal strain (GLS) assessment of left ventricle, at baseline and 12 months post-treatment.ResultsAt baseline, GLS was low in 14 of 50 (28.0%) patients. On multivariable analysis, GLS was associated with diastolic BP (P = 0.038) and glomerular filtration rate (P = 0.026). GLS improved post-surgery by −2.3, 95% CI: −3.9 to −0.6, P = 0.010, and post-medications by −1.3, 95% CI: −2.6 to 0.03, P = 0.089, whereas there were no changes in LVEF in either group. Improvement in GLS was independently correlated with baseline GLS (P < 0.001) and increase in plasma renin activity (P = 0.007). Patients with post-treatment plasma renin activity ≥1 ng/ml/h had improvements in GLS (P = 0.0019), whereas patients with persistently suppressed renin had no improvement. Post-adrenalectomy, there were also improvements in LV mass index (P = 0.012), left atrial volume index (P = 0.002), and mitral E/e’ (P = 0.006), whereas it was not statistically significant in patients treated with medications.ConclusionTreatment of hyperaldosteronism is effective in improving subclinical LV systolic dysfunction. Elevation of renin levels after treatment, which reflects adequate reversal of sodium overload state, is associated with better systolic function after treatment.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03174847.

Introduction Patients who had a stroke are at increased risk of sepsis, dehydration and fluctuations in blood pressure, which may result in acute kidney injury (AKI). The impact of AKI on long-term stroke survival has not been studied well.Objective We aimed to identify incidence of AKI during acute stroke, follow-up period and its impact on long-term survival and development of chronic kidney disease (CKD).Design, setting and participants Retrospective analysis of patients who had a stroke admitted at the rehabilitation facility in Changi General Hospital, Singapore, between June 2008 and May 2017, with median follow-up of 141 (95% CI 120 to 163) months.Outcome measures and results of univariate analysis Total 681 patients, median age (63.6) years, 173 (28%) died during follow-up. Elevated blood urea (3.02, 95% CI 2.17 to 4.22; p≤0.001) and creatinine (1.96, 95% CI 1.50 to 2.57; p≤0.001) during stroke affected survival adversely.Excluding patients with CKD, we analysed the remaining 617 patients. AKI was noted in 75 (12.15%) patients during the index admission, and it affected survival adversely (2.16, 95% CI 1.49 to 3.13; p

BackgroundPrimary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at an increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke.MethodsWe recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischaemic) or transient ischaemic attack. Three months post-stroke, plasma renin and aldosterone were measured. Patients with an elevated aldosterone–renin ratio proceeded to the confirmatory saline loading test.ResultsTwenty-six of 192 (14%) patients had an elevated aldosterone–renin ratio. Three of 14 patients who proceeded to saline loading were confirmed with PA (post-saline aldosterone >138 pmol/l). Another three patients were classified as confirmed/likely PA based on the markedly elevated aldosterone–renin ratio and clinical characteristics. The overall prevalence of PA amongst stroke patients with hypertension was 4.0% (95% confidence interval (CI): 0.9%–7.1%). Prevalence of PA was higher amongst patients with cardioembolic stroke, 11% (95% CI: 1.3%–33%), resistant hypertension, 11% (95% CI: 0.3%–48%), and hypertension and AF, 30% (95%CI: 6.7%–65%). If only young patients or those with hypokalaemia were screened for PA, half of our patients with PA would not have been diagnosed. Our decision tree identified that stroke patients with AF and diastolic blood pressure ≥83mmHg were most likely to have PA.ConclusionWe found that amongst hypertensive patients with stroke, PA was more prevalent in those with AF, or cardioembolic stroke. Screening for PA should be considered for all patients with stroke.

Abstract Background Acute ischemic stroke is a time-sensitive emergency where accurate diagnosis is required promptly. Due to time pressures, stroke mimics who present with similar signs and symptoms as acute ischemic stroke, pose a diagnostic challenge to the emergency physician. With limited access to investigative tools, clinical prediction, tools based only on clinical features, may be useful to identify stroke mimics. We aim to externally validate the performance of 4 stroke mimic prediction scales, and derive a novel decision tree, to improve identification of stroke mimics. Methods We performed a retrospective cross-sectional study at a primary stroke centre, served by a telestroke hub. We included consecutive patients who were administered intravenous thrombolysis for suspected acute ischemic stroke from January 2015 to October 2017. Four stroke mimic prediction tools (FABS, simplified FABS, Telestroke Mimic Score and Khan Score) were rated simultaneously, using only clinical information prior to administration of thrombolysis. The final diagnosis was ascertained by an independent stroke neurologist. Area under receiver operating curve (AUROC) analysis was performed. A classification tree analysis was also conducted using variables which were found to be significant in the univariate analysis. Results Telestroke Mimic Score had the highest discrimination for stroke mimics among the 4 scores tested (AUROC = 0.75, 95% CI = 0.63–0.87). However, all 4 scores performed similarly (DeLong p > 0.05). Telestroke Mimic Score had the highest sensitivity (91.3%), while Khan score had the highest specificity (88.2%). All 4 scores had high positive predictive value (88.1 to 97.5%) and low negative predictive values (4.7 to 32.3%). A novel decision tree, using only age, presence of migraine and psychiatric history, had a higher prediction performance (AUROC = 0.80). Conclusion Four tested stroke mimic prediction scales performed similarly to identify stroke mimics in the emergency setting. A novel decision tree may improve the identification of stroke mimics.

Objective Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long‐term results. The present study aimed to evaluate the long‐term safety and efficiency of CDA and ACDF for cervical disc disease. Methods We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: “anterior cervical fusion,” “arthroplasty,” “replacement” and “artificial disc”. RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients’ satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P

Objectives To analyze the optimum particle size or formula ratio of surgical‐grade calcium sulfate (CS) for appropriate compressive strength, setting time, and vitro degradation rate. Methods Three types of calcium sulfate hemihydrate (CSH) particles with diameters of 0–37.5 μm, 37.5–75 μm, and >75 μm were screened. Based on formulation ratio of different particles, this topic is divided into 10 groups by the unconstrained third‐order simplex lattice mixing design scheme in formula design experiment. The optimum formulation ratio of particle diameter for compressive strength, solidification time, and degradation rate in vitro was analyzed. Results When the percentage of the particle diameter of CS with 0–37.5 μm, 37.5–75 μm and >75 μm are 55.0%, 17.4%, and 27.6% respectively, the compressive strength of the test sample is the highest, which is 14.16 MPa. When the percentage of the particle diameter of CS with 0–37.5 μm, 37.5–75 μm, and >75 μm are 0.00%, 0.00%, and 100.00% respectively, the initial setting time of the sample is the longest, which is 410.0 s. When the percentage of the particle diameter of CS with 0–37.5 μm, 37.5–75 μm, and >75 μm are 0.00%, 0.00%, and 100.00% respectively, the final setting time of the sample is the largest, and the final setting time of the sample is 460.00 s. When the percentage of the particle diameter of CS with 0–37.5 μm, 37.5–75 μm, and >75 μm are 0.00%, 0.00%, and 100.00% respectively, the degradation rate of the sample in vitro is the slowest, which is 18.8%. Conclusion The morphological structure of surgical‐grade CS can affect compressive strength, setting time, and in vitro degradation rate. Surgical CS should be prepared based on different uses.

Objective To assess the long‐term outcomes after percutaneous reduction (PR) and screw fixation versus plate fixation via the sinus tarsi approach (STA) for displaced intra‐articular calcaneal fractures (DIACF). Methods This retrospective study included a total of 150 patients (June 2008–August 2011), comprising 85 men and 65 women (mean age, 38.4 years), who were assigned to the PR group or the STA group. The inclusion criteria were DIACF (>2 mm) including Sanders type II and III, closed fracture, unilateral fracture, no history of smoking or no smoking during hospitalization and 3 months after surgery, and follow‐up time not less than 8 years. The exclusion criteria were clear surgical contraindications (severe cardiovascular and cerebrovascular diseases), local or systemic infection symptoms, diagnosis with diabetes or lower extremity vascular disease, and Sanders type IV or open fractures. Outcomes were assessed by means of the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores, radiographic images, and postoperative complications. Results The mean follow‐up period was 8.7 years (range, 8.0–10.0 years). The AOFAS scores in the PR group during the follow‐up period were 54.2 ± 5.1, 85.8 ± 4.0, 88.1 ± 3.8, 87.9 ± 3.6, 87.8 ± 3.9, 86.9 ± 3.9, respectively, and in the STA group were 55.0 ± 5.6, 84.5 ± 5.2, 87.1 ± 3.8, 86.9 ± 3.8, 87.7 ± 3.3, and 87.6 ± 2.8, respectively. There was no significant difference in AOFAS scores, Bohler's angle, Gissane's angle, calcaneal length, and height between the two groups (P > 0.05). The good to excellent rate of the PR group (80.8%) was less than that of the STA group (91.7%) (P = 0.055). For Sanders III fractures, the good to excellent rate of the PR group (33.3%) was less than that of the STA group (76.9%) (P = 0.029). For calcaneal width recovery, the STA group performed better than the PR group (P 0.05). Conclusion From the 8–10‐year follow‐up results of PR and STA as surgical procedures for the treatment of DIACF, it was found that there was no significant difference in the overall efficacy between them. STA was found to be superior to the PR in terms of the recovery of calcaneal width, providing more stable fixation for Sanders III fractures. PR was found to be more effective in reducing wound complications.

Heritage managers often reuse heritage sites to attract tourists and conserve the sites. Not all adaptive heritage reuses achieve sustainable development. Biophilia is an innate, biological tendency to be close to natural and cultural elements, which may be a critical motivation for achieving sustainable heritage management. Past studies used qualitative and quantitative methods to extract participants' pull and push motivations toward heritage tourism and captured the six motivations of the biophilia framework that should be confirmed: heritage architecture; art activity; wide nature; regional attraction; recreational benefits; and long-term values. The purpose of this study was to conduct a confirmatory factor analysis to test the biophilia framework for understanding biophilic heritage tourism. A questionnaire with 18 items of heritage tourism motivation was used to explore the purpose of this study. A total of 193 valid questionnaires were obtained. Confirmatory factor analysis was used to examine the six motivations of the biophilia framework. The results indicated that heritage tourism motivation consisted of a second-order six-factor structure with high validity and reliability. These six dimensions reflected the biophilic requirements and provided a biophilic planning principle to achieve sustainable heritage management to satisfy the needs of the participants.

Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or 10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.

Abstract Aim To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3–12 months post-stroke in Singapore. Methods Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome. Results Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with a child caregiver had an almost three times greater rate of hospitalizations over 3–12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at the 3-month point was associated with the higher subsequent rate of hospitalization. Conclusion Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.

Neural style transfer (NST) is a technique based on the deep learning of a convolutional neural network (CNN) to create entertaining pictures by cleverly stylizing ordinary pictures with the predetermined visual art style. However, three issues must be carefully investigated during the generation of neural-stylized artwork: the color scheme, the strength of style of the strokes, and the adjustment of image contrast. To solve these problems and select image colorization based on personal preference, in this paper, we propose modified universal-style transfer (UST) method combined with the image fusion and color enhancement methods to design a good post-processing framework to tackle the three above-mentioned issues simultaneously. This work provides more visual effects for stylized images, and also can integrate into the UST method effectively. In addition, the proposed method is suitable for stylized images generated by any NST method, but it also works similarly to the Multi-Style Transfer (MST) method, which mixes two different stylized images. Finally, our proposed method successfully combined the modified UST method and post-processing method to meet personal preference.