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Background With its high nutritional value and productivity, Italian ryegrass as a biomass feedstock constantly supplies rumen degradable nitrogen and digestible fiber to ruminants. However, biofuel production is easily reduced during ensiling due to the high-moisture content of Italian ryegrass, leading to economic losses. Lactic acid bacteria inoculants could improve lignocellulosic degradation and fermentation quality and decrease dry matter loss during the bioprocessing of silage. Therefore, this study analyzed the effects of Lactobacillus buchneri TSy1-3 (HE), Lactobacillus rhamnosus BDy3-10 (HO), and the combination of HE and HO (M) on fermentation quality, bacterial community and metabolome in high-moisture Italian ryegrass silage during ensiling. Results The results showed that the pH value was significantly lower in the HO groups than in the other treatments at the end of ensiling, and the dry matter and acetic acid contents were significantly higher in the HO group than in the other inoculated groups. All inoculants decreased the diversity of the bacterial community and significantly increased the relative abundance of Lactobacillus. Inoculation with HO significantly improved the concentrations of organic acids, dipeptides, ferulic acid, apigenin, and laricitrin. Compared with Lactobacillus buchneri TSy1-3 (HE), HO significantly upregulated the flavonoid compounds in the flavone and flavonol biosynthesis pathway. Conclusions Overall, these findings suggest that inoculation with HO was beneficial for the development of Italian ryegrass as a biomass feedstock, improving fermentation quality, accelerating changes in bacterial community composition and increasing biofunctional metabolites in high-moisture Italian ryegrass silage.

Lyonia doyonensis is a deciduous shrub native to high-altitude regions of Asia. So far, there is no report on any chemical and biological properties of L. doyonensis. An EtOH extract of L. doyonensis twigs and leaves showed inhibitory activities on PTP1B and lipopolysaccharide (LPS)-induced inflammation in BV-2 microglial cells. Phytochemical investigation of this extract led to the isolation of a, so far only ambiguously described, 24-norursane-type triterpenoid, now named lyonensinol A (1), along with its two new derivatives, lyonensinols B and C (2 and 3), and six known triterpenoids (4–9). Their structures were elucidated by detailed analysis of spectroscopic data. A combination of chemical conversions, ECD, and Mo2(OAc)4-induced ECD was used to confirm their absolute configurations. Lyonensinols B (2) and C (3) represent the first examples of norursane-type triterpenoids acylated with a p-coumaroyl moiety. The potential anti-inflammatory and PTP1B inhibitory activities of all the isolates were evaluated. Compounds 3, 7, and 8 at 10 μM showed potent inhibitory activities on LPS-induced NO production in BV-2 microglial cells with NO levels decreased to 31.5%, 41.9%, and 27.1%, respectively, while compounds 3, 4, 7, and 8 exhibited notable inhibitory activities against PTP1B with IC50 values ranging from 1.7 to 18.2 μM. Interestingly, compounds 3 and 8 bearing a C-3 trans-p-coumaroyl group showed not only more potent anti-inflammatory effects, but also exhibited stronger PTP1B inhibition, than their respective stereoisomers (2 and 7) with a cis-p-coumaroyl group.

Background: Human babesiosis is a worldwide disease caused by intraerythrocytic protozoa of the genus Babesia, which are transmitted by bites from ixodid ticks but also mechanically transmitted by blood transfusion. This disease is primarily treated with quinine and/or atovaquone, which are not readily available in China. A novel treatment regimen with doxycycline monotherapy in one severe patient with Babesia venatorum infection was achieved as an alternative therapeutic medication. Case presentation: A 73-year-old male who underwent splenectomy and blood transfusion 8 years previously had unexplained fever, headache and thrombocytopenia and was admitted to the Fifth Medical Center of the PLA General Hospital. The cases were confirmed to be infected with B. venatorum by morphological observations on thin peripheral blood smears, multi-gene PCR, and sequencing of the entire 18s-rRNA and partial β-tubulin encoding genes, as well as isolation by animal inoculation. The doxycycline monotherapy regimen was administered following pharmacological guidance and an effective outcome was observed. The patient recovered rapidly following doxycycline monotherapy. The Babesia protozoan load in peripheral blood samples decreased by 88% in hematocrit counts 8 days later, and negative PCR results were achieved in 90 days when he was examined in our hospital. The treatment course of the patient lasted 3 months without side effects or sequelae. The 9-month follow-up survey of the patient did not show signs of recrudescence or anti-babesial tolerance. Conclusions: We first reported an interesting clinical practice of successful doxycycline monotherapy for human babesiosis caused by B. venatorum, which provides an optional medical intervention for human babesiosis.

Background The impact of host skin microbiome on horizontal transmission of tick-borne pathogens , and of pathogen associated transstadial and transovarial changes in tick microbiome are largely unknown, but are important to control increasingly emerging tick-borne diseases worldwide. Methods Focusing on a rickettsiosis pathogen, Rickettsia raoultii, we used R. raoultii-positive and R. raoultii-negative Dermacentor spp. tick colonies to study the involvement of skin microbiota in cutaneous infection with rickettsiae in laboratory mice, and the function of the tick microbiome on maintenance of rickettsiae through all tick developmental stages (eggs, larvae, nymphs, adults) over two generations. Results We observed changes in the skin bacteria community, such as Chlamydia, not only associated with rickettsial colonization but also with tick feeding on skin. The diversity of skin microbiome differed between paired tick-bitten and un-bitten sites. For vertical transmission, significant differences in the tick microbiota between pathogenic rickettsia-positive and -negative tick chorts was observed across all developmental stages at least over two generations, which appeared to be a common pattern not only for R. raoultii but also for another pathogenic species, Candidatus Rickettsia tarasevichiae. More importantly, bacterial differences were complemented by functional shifts primed for genetic information processing during blood feeding. Specifically, the differences in tick microbiome gene repertoire between pathogenic Rickettsia-positive and -negative progenies were enriched in pathways associated with metabolism and hormone signals during vertical transmission. Conclusions We demonstrate that host skin microbiome might be a new factor determining the transmission of rickettsial pathogens through ticks. While pathogenic rickettsiae infect vertebrate hosts during blood-feeding by the tick, they may also manipulate the maturation of the tick through changing the functional potential of its microbiota over the tick’s life stages. The findings here might spur the development of new-generation control methods for ticks and tick-borne pathogens.

The rickettsiae are a group of obligate intracellular Gram-negative bacteria that include human pathogens causing an array of clinical symptoms and even death. There is an important question in the field, that is whether one infection can block the superinfection of other rickettsiae.

Rickettsiae are obligate intracellular bacteria that can cause life-threatening illnesses. There is an ongoing debate as to whether established infections by one

Understanding the mechanisms regulating PD-L1 expression in hepatocellular carcinoma (HCC) is important to improve the response rate to PD-1/PD-L1 blockade therapy. Here, we show that DKK1 expression is positively associated with PD-L1 expression and inversely correlated with CD8

Background Spermine is frequently elevated in tumor tissues and body fluids of cancer patients and is critical for cancer cell proliferation, migration and invasion. However, the immune functions of spermine in hepatocellular carcinoma progression remains unknown. In the present study, we aimed to elucidate immunosuppressive role of spermine in hepatocellular carcinoma and to explore the underlying mechanism. Methods Whole-blood spermine concentration was measured using HPLC. Human primary HCC tissues were collected to examine the expression of CaSR, p-Akt, β-catenin, STT3A, PD-L1, and CD8. Mouse model of tumorigenesis and lung metastasis were established to evaluate the effects of spermine on hepatocellular carcinoma. Western blotting, immunofluorescence, real time PCR, digital Ca2+ imaging, and chromatin immunoprecipitation assay were used to investigate the underlying mechanisms by which spermine regulates PD-L1 expression and glycosylation in hepatocellular carcinoma cells. Results Blood spermine concentration in the HCC patient group was significantly higher than that in the normal population group. Spermine could facilitate tumor progression through inducing PD-L1 expression and decreasing the CD8+ T cell infiltration in HCC. Mechanistically, spermine activates calcium-sensing receptor (CaSR) to trigger Ca2+ entry and thereby promote Akt-dependent β-catenin stabilization and nuclear translocation. Nuclear β-catenin induced by spermine then activates transcriptional expression of PD-L1 and N-glycosyltransferase STT3A, while STT3A in turn increases the stability of PD-L1 through inducing PD-L1 protein N-glycosylation in HCC cells. Conclusions This study reveals the crucial function of spermine in establishing immune privilege by increasing the expression and N-glycosylation of PD-L1, providing a potential strategy for the treatment of hepatocellular carcinoma.

Background This study explored the impact of MTM service on MMD patients with hypertension. Methods A total of 120 MMD inpatients from September to November 2019 were received and randomly divided into intervention group and control group. General services for noninfectious chronic diseases were given to the control group, while a standard MTM service was given to the intervention group. Patients’ blood pressure, EQ-5D utility value, readmission rate, drug-related problems, and average daily medication therapy cost were compared between the two groups and within the groups. This was done at the initial admission phase and in the first, third, sixth, and twelfth months after discharge. Results The intervention group had significantly lower blood pressure and average daily medication therapy cost 12 months after discharge compared to the control group (systolic blood pressure: P = 0.023, diastolic blood pressure: P P = 0.049); the number of DRPs decreased in both groups 12 months after discharge; the number of DRPs solved in the intervention group in the third, sixth and twelfth months after discharge were statistically higher compared with that in the control group (P = 0.013, P = 0.012, P = 0.001); there was no significant difference in the EQ-5D utility value and readmission rate between the two groups (P > 0.05). Conclusions MTM implementation in MMD patients can improve health outcomes and reduce healthcare-related costs among MMD patients. Trial registration Chinese Clinical Trial Register ChiCTR2200065111, date of registration: October 28, 2022.

The increasing prevalence and expanding distribution of tick-borne viruses globally have raised health concerns, but the full repertoire of the tick virome has not been assessed. We sequenced the meta-transcriptomes of 31 different tick species in the Ixodidae and Argasidae families from across mainland China, and identified 724 RNA viruses with distinctive virome compositions among genera. A total of 1,801 assembled and complete or nearly complete viral genomes revealed an extensive diversity of genome architectures of tick-associated viruses, highlighting ticks as a reservoir of RNA viruses. We examined the phylogenies of different virus families to investigate virome evolution and found that the most diverse tick-associated viruses are positive-strand RNA virus families that demonstrate more ancient divergence than other arboviruses. Tick-specific viruses are often associated with only a few tick species, whereas virus clades that can infect vertebrates are found in a wider range of tick species. We hypothesize that tick viruses can exhibit both 'specialist' and 'generalist' evolutionary trends. We hope that our virome dataset will enable much-needed research on vertebrate-pathogenic tick-associated viruses.

Background: Chronic kidney disease (CKD) is a global public health issue. In recent years, the effectiveness of finerenone for treatment of CKD has been the subject of considerable debate. The main objective of the current meta-analysis was to validate the clinical efficacy and safety of finerenone in patients with CKD.Methods: Seven databases were searched for randomized controlled trials (RCTs) comparing finerenone with placebo in patients with CKD. Data from eligible studies were extracted, and the Cochrane risk of bias tool utilized for evaluating the methodological quality of RCTs. The effect size was estimated using the risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI).Results: Five trials (n = 13,078) were included. Compared to placebo groups, the urinary albumin-to-creatinine ratio (UACR) mean from the baseline was significantly lower [MD −0.30 (95% CI −0.32, −0.28), p < 0.00001], while a decrease in the estimated glomerular filtration rate (eGFR) from baseline was significantly higher [MD −2.44 (95% CI −2.82, −2.05), p < 0.00001] for the finerenone groups. Furthermore, the proportion of patients with decreased eGFR (≥40%) post-baseline was significantly lower [RR 0.85 (95% CI 0.78, 0.93), p = 0.0002], along with end-stage kidney disease (ESKD) [RR 0.80 (95% CI 0.65, 0.99), p = 0.04] and cardiovascular events (CVs) [RR 0.88 (95% CI 0.80, 0.95), p < 0.003] in the finerenone groups. In terms of safety, the increase in the serum potassium concentration and incidence of hyperkalemia was significantly higher for the finerenone groups [MD 0.17 (95% CI 0.10, 0.24), p < 0.00001; RR 2.03 (95% CI 1.83, 2.26), p < 0.00001, respectively], but the incidence of adverse events (AEs) was similar to placebo [RR 1.00 (95% CI 0.98–1.01), p = 0.67]. In all cases, the results were rated as providing moderate-quality or high-quality evidence.Conclusion: Data from our meta-analysis suggest that finerenone confers significant renal and cardiovascular benefits in patients with CKD. While higher risk of hyperkalemia was observed with finerenone than placebo, differences in AEs were not significant. Finerenone may therefore present a novel promising therapeutic agent for patients with CKD.Systematic Review Registration: [https://inplasy.com/inplasy-2021-9-0020/], identifier [INPLASY202190020].

Successful regeneration of cartilage tissue at a clinical scale has been a tremendous challenge in the past decades. Microcarriers (MCs), usually used for cell and drug delivery, have been studied broadly across a wide range of medical fields, especially the cartilage tissue engineering (TE). Notably, microcarrier systems provide an attractive method for regulating cell phenotype and microtissue maturations, they also serve as powerful injectable carriers and are combined with new technologies for cartilage regeneration. In this review, we introduced the typical methods to fabricate various types of microcarriers and discussed the appropriate materials for microcarriers. Furthermore, we highlighted recent progress of applications and general design principle for microcarriers. Finally, we summarized the current challenges and promising prospects of microcarrier-based systems for medical applications. Overall, this review provides comprehensive and systematic guidelines for the rational design and applications of microcarriers in cartilage TE.

Category: Hindfoot; Other Introduction/Purpose: When the hindfoot is in varus the tarsal canal becomes visible on a lateral Xray (XR) and has been referred to as a 'target sign'. However, the sinus tarsi (ST) and tarsal canal (TC) are not easily visible radiographically when associated with a flatfoot. The dimensions of both the ST and TC in normal and flatfeet are unknown, but if understood, could help with the design and implantation of an arthroereisis, a commonly performed procedure for correction of pediatric flatfoot deformity. Knowing the size of the TC will also reduce postoperative complications of arthroereisis such as stiffness, resulting from too large an implant. The aim of this study was to take three-dimensional (3D) measurements of the TC in pediatric flatfeet under weightbearing (WB) conditions. Methods: This was a prospective IRB approved study in pediatric patients with flexible flatfeet and asymptomatic children without flatfeet who were reviewed and analyzed. Using 3D computer-aided design (CAD) models from weightbearing CT (WBCT) scans, the following parameters were measured: the widest diameter of the posteromedial tarsal canal (WDPTC), the narrowest supero- inferior diameter of the tarsal canal (NSDTC), the length of the tarsal sinus, (LTS), the length of the tarsal canal (LTC) and the tarsal sinus and canal volume (TSCV). Correlations between patient age, Meary's angle, foot and ankle offset (FAO), and each of the above measured parameters were investigated. Both weight bearing and non-weight bearing CT scans were used for study to investigate the effect of bearing weight on the above-mentioned parameters. (Figures 1, 2). Results: Twenty-two children with flexible flatfeet (age range 9-14) and fourteen children with no foot deformity (age 9-15) were included for study. With the WBCT the TSCV decreased by 20% in comparison with non-weightbearing evaluation. The TSCV, the widest diameter of the anterolateral tarsal sinus (WDATS) and LTC decreased in flatfeet both under WB and NWB conditions compared with the control group. A positive linear correlation was found between the TSCV and patient age (r = 0.7307, P < 0.0001), while negative linear correlations were found between the TSCV and FAO (r = -0.5188, P < 0.0001) and Meary's angle (r = -0.3132, P = 0.0019). The tarsal sinus and tarsal canal volume significantly decreased in the flatfoot group during weight bearing, while the volume of the tarsal canal remained unchanged. Older age was not associated with either a wider tarsal canal or its orientation. Conclusion: Although the tarsal sinus and canal volume was positively associated with patient age, there was a negative correlation with both the FAO and Meary's angle. These findings may be very relevant in future study of the subtalar joint in both children and adults, and clearly have an implication for treatment of the pediatric flatfoot with arthroereisis.

Category: Hindfoot; Ankle Introduction/Purpose: Weight Bearing CT (WBCT) has been proven to be effective in hindfoot alignment assessment. However, we have noted that in both WBCT examination and evaluation, positioning of the foot has not been sufficiently prioritized. We hypothesized that changing the foot orientation will significantly affect the measurement of the hindfoot, which will in turn affect further clinical decision making. Methods: WBCT scans of ten feet without any foot and ankle deformity were loaded in CubeVue software. The foot was aligned to a neutral (0°) position based on the 2nd ray and the heel, and was then rotated 5°, 10°, 15° and 20° both externally and internally to simulate malposition. The 'semi' three dimensional hindfoot Moment Arm (HMA) was evaluated with the foot in these different positions. For measured parameters, varus alignment was recorded as a negative value, and valgus alignment was recorded as a positive value. Each measurement was repeated twice to minimize bias. A linear regression model was used to analyze the relationship of the HMA value and the rotation angles. An intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliability. Statistical analysis was completed using SAS 9.4. Results: When rotating the foot from external 20° to internal 20°, the HMA demonstrated a linear change in hindfoot alignment from varus to valgus. A 1° increase in the rotation angle caused 0.52 (±0.03) mm increase in the HMA value (Figure 1). The HMA measurements had excellent inter- and intra-observer reliability (ICC >= 0.9) (Table 1). Both CT images and measured values confirmed that internal rotation changed a neutral into a valgus hindfoot, and external rotation changed a neutral hindfoot into varus (Figure 2). Conclusion: When using current two or 'semi' three-dimensional methods to evaluate hindfoot alignment on WBCT scans, positioning the foot in the correct orientation is critical. Malrotation and malposition of the foot will cause significant impact on measurements and generate false data as well as misdiagnoses. This study was performed on normal feet but is clinically relevant when applied to deformities, particularly those associated with abduction or adduction of the midfoot and forefoot while current knowledge about deformed foot positioning is limited. This is an important topic for future investigation.

Category: Hindfoot; Ankle Introduction/Purpose: The Hindfoot Moment Arm (HMA) has been used to evaluate the hindfoot alignment with the Saltzman weightbearing XRay images (1), and was recently introduced into the field of weightbearing CT (WBCT) by Saltzman et al (2). The authors of this study have noticed that when using the Saltzman WBCT HMA technique, it is very difficult to determine the specific 'one' image in coronal plane scans with the widest tibial diaphyseal to draw the long axis of the tibia. The purpose of this study was to introduce a modified technique of measuring HMA in WBCT scans and compare the inter and intra-observer reliabilities between the modified and the Saltzman WBCT HMA techniques. Methods: WBCT scans of ten healthy limbs were loaded in CubeVue software. The foot was aligned in the correct orientation in the transverse plane based on the 2nd ray and the heel and the HMA was evaluated using the modified and Saltzman techniques. Using the modified technique, the sagittal plane thickness of one scan cut was increased to include the full width and length of the tibia and the axis of the distal tibia was identified by connecting two circles tangential to both cortices of the tibia. The weightbearing point of the calcaneus was located and the HMA was evaluated by measuring the perpendicular distance of the calcaneus weightbearing point to the axis of the distal tibia with varus a negative and valgus alignment a positive value. Intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliability of the two HMA techniques in SAS 9.4. Results: Both techniques had excellent intra- and interobserver reliability (Saltzman WBCT HMA intra-observer ICC=0.97, Saltzman WBCT HMA inter-observer ICC=0.94, the modified WBCT HMA intra-observer ICC=0.99, the modified WBCT HMA inter-observer ICC=0.91) (Table 1). Conclusion: The modified WBCT HMA was equivalent to the Saltzman technique in both inter and intra-observer reliabilities. The authors found that the modified technique was easier and less time consuming to perform in identifying the axis of the tibia since the modified technique uses multiple cuts to restore the full thickness of tibia, which not only reduces potential error, but also saves time during measurements. Compared with a relatively shorter tibia in one cut, the reconstructed tibia provides a longer and clearer shaft to work with, which allows both proximal and distal circles to be drawn with higher precision (Figure 1). 1. Saltzman, C. L., & El-Khoury, G. Y. (1995). The hindfoot alignment view. Foot & Ankle International, 16(9), 572-576. 2. Arena, C. B., Sripanich, Y., Leake, R., Saltzman, C. L., & Barg, A. (2021). Assessment of hindfoot alignment comparing weightbearing radiography to weightbearing computed tomography. Foot & Ankle International, 42(11), 1482-1490.

Category: Hindfoot; Other Introduction/Purpose: Radiographic characteristics of Müller-Weiss disease (MWD) include compression and flattening of the lateral one-third of the tarsal navicular, lateral and inferior the shift of the talar head, followed by a varus hindfoot which produces a paradoxical planovarus. The radiographic Stage of the disease has no direct correlation with symptoms and therefore X-ray and CT have limitations in the surgical decision making for treatment. This study aimed to determine the predictive value of the use of SPECT-CT in surgical decision making. We hypothesized that SPECT-CT will highlight the specific joints actively involved in the disease process, and with the correct selective arthrodeses as well as intraoperative correction of malalignment of the hind and midfoot, improved clinical outcomes can be achieved. Methods: This was an IRB approved prospective study with 24 MWD patients (25 feet) enrolled. All patients failed conservative treatment and agreed to undergo SPECT-CT examination for further diagnostic purposes. The SPECT-CT scans were evaluated to identify the joints that were actively involved. Weightbearing X-rays (WBXR) and weightbearing CT scans (WBCT) were performed to assess the pre and postoperative midfoot and hindfoot alignment, including the talo-first metatarsal angle (TFMA), talonavicular coverage angle (TNCA), talocalcaneal angle (TCA), the Tomeno-Méary angle (TMA) and calcaneal pitch angle (CPA), and the hindfoot alignment angle (HAA). The surgical plan was based on the SPECT-CT and included guided arthrodesis, correction of hindfoot varus, talonavicular subluxation, and restoration of the medial arch. The AOFAS midfoot scale, visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports subscale, and the 36-Item Short Form Health Survey (SF-36) were used pre and postoperatively to evaluate the clinical outcomes. Results: There were 20 females and 4 males with a mean age of 57.2 years and a mean duration of symptoms of 5.24 years. According to the Maceira staging system, there were 2 stage II, 8 stage III, 13 stage IV and 2 stage V. Three feet received isolated talonavicular arthrodesis, a talonavicular-cuneiform arthrodesis (10), triple arthrodesis (9), and triple plus navicular-cuneiform arthrodesis (3). The median follow-up time was 53.5 (range, 20-91) months. There were statistically significant improvements in the midfoot and hindfoot alignments (TNCA, TMA, CPA, HAA) and patient reported outcome measure scores (AOFAS, VAS, SF- 36 PF, SF-36 BP). Six patients required additional surgery (3 for hardware removal, and 3 for nonunion). No patient required revision surgery for arthritic pain in adjacent joints. Conclusion: SPECT-CT guided selective arthrodesis and correction of midfoot and hindfoot alignment can achieve both satisfactory clinical and radiographic outcomes in treating different stages of MWD. SPECT-CT is a very helpful tool to identify actively involved joints with arthritis secondary to the malalignment associated with this disease process, and avoids unnecessary arthrodesis of joints not actively involved in the disease process.

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: The foot and ankle offset (FAO) was developed as a 3D biometric tool to measure hindfoot alignment on weightbearing CT (WBCT) scans. It corresponds to the offset between the hindfoot-to-forefoot midline and the talus and is reported as a percentage of foot-length. (1) Recently, with increased availability of WBCT in both research and clinical practice, the FAO has been widely used for hindfoot alignment assessment. (2) However, after extensive review of WBCT scans the authors of this study have noticed that FAO has a high false negative rate. This study aimed to demonstrate why FAO is inadequate in assessing 3D hindfoot alignment using both case examples and mathematical algorithms. Methods: This was a retrospective study including a cohort of 31 cases with various clinical diagnoses selected from a data base of WBCT in 260 patients. The deformities included valgus or varus ankle deformities, hindfoot deformities combined with sagittal plane deformities of the foot and ankle, rocker bottom foot deformity, ankle equinus, metatarsus primus elevatus, and first metatarsal plantarflexion. All of the latter deformities caused one or more parts of the triangular base for FAO evaluation (the 1st metatarsal, the 5th metatarsal and the calcaneus) to remain off the floor. The medical charts and WBCT scans of each patient were reviewed to evaluate the deformities in more detail. The FAO was measured by two fellowship trained foot and ankle surgeons separately. The clinical and radiographic diagnoses were compared with the FAO value to determine the accuracy and utility of the latter measurement. Limitations of FAO as a semi 3D tool using the tripod theory in assessing the hindfoot alignment were also demonstrated mathematically. Results: For each of these 31 cases examined, the hindfoot alignment information reflected by the FAO value was vastly different from the clinical and imaging study findings. (Table 1). Using the reference value for FAO (Normal 2.3% ± 2.9%, Varus −11.6%± 6.9%, and Valgus 11.4% ± 5.7%), 24 out of 31 cases in the cohort had a normal FAO value, however, among them there were 7 with a valgus ankle or distal tibia plus a normal or cavovarus hindfoot, 2 varus ankles with a normal hindfoot, 1 varus ankle with a valgus hindfoot, 3 cavovarus feet, 1 clubfoot, 1 equinus ankle with cavovarus foot, 2 equinus ankle with severe valgus hindfoot, 4 severe valgus hindfoot and 1 varus hindfoot with sagittal plane deformities, 2 Muller Weiss Disease; 5 out of 31 cases had a varus FAO value, but they all had a valgus ankle with either a varus hindfoot or sagittal plane deformities; 2 out of 31 cases had a valgus FAO value, however both cases had a valgus ankle with a varus hindfoot. Thorough algorithm and geometric evidence were provided. Conclusion: FAO has a very limited capacity to reflect hindfoot deformities, understandable when analyzing how the FAO is designed and measured mathematically. It is not a 3D tool. It does not include the level of the ankle nor the tibia, therefore it is not appropriate nor capable to be used as a hindfoot alignment evaluation tool. The tripod and talus projection theories cannot reflect sagittal plane deformities or coronal plane rotation, and false results are inevitably generated. Reference: 1. Lintz F, Barton T, Millet M, Harries WJ, Hepple S, Winson IG. Ground reaction force calcaneal offset: a new measurement of hindfoot alignment. Foot Ankle Surg. 2012;18(1):9-14. 2. de Cesar Netto C, Day J, Godoy-Santos AL, Roney A, Barbachan Mansur NS, Lintz F, Ellis SJ, Demetracopoulos CA. The use of three-dimensional biometric Foot and Ankle Offset to predict additional realignment procedures in total ankle replacement. Foot Ankle Surg. 2022 Feb 16:S1268-7731(22)00036-4.

The long-lasting co-evolution of ticks with pathogens results in mutual adaptation. Blood-feeding is one of the critical physiological behaviors that have been associated with the tick microbiome; however, most knowledge was gained through the study of laboratory-reared ticks. Here we detached

This qualitative study aims to understand the emotional labor of early childhood teachers between China and Norway in the perspective of cultural comparison. Altogether six teachers from Ch...

Objective Neuraxial block is the most common anesthesia method for cesarean section (CS). However, for some urgent and high-risk cesarean delivery, general anesthesia (GA) also plays a very important role. We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2016. Clinical data (baseline maternal status, preoperative status, perioperative information, maternal and fetal outcomes) of parturients and neonates were collected and analyzed. We summarized the common reasons for applying general anesthesia, and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists (ASA) grade, gestational weeks and intraoperative blood loss, as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study. Among the maternal and fetal factors, pregnancy with internal or surgical diseases is the most common reason (59 cases, 60.2%) for choosing GA, followed by the placenta and fetal membrane abnormalities (38 cases, 38.8%) and the pregnancy-specific disorders (36 cases, 36.7%). ASA grade Ⅲ-Ⅳ of parturients (χ 2=44.3, P 800 ml (χ 2=5.5, P

Genetic polymorphisms in the MTNR1B gene is associated with type 2 diabetes mellitus (T2DM); however, there is no evidence about its impact on the therapeutic efficacy of nateglinide. This prospective case–control study was designed to investigate the effect of MTNR1B rs10830963 gene variant on the therapeutic efficacy of nateglinide in treating T2DM. We genotyped untreated T2DM patients (N = 200) and healthy controls (N = 200) using the method of the high resolution of melting curve (HRM). Newly diagnosed T2DM patients (n = 60) with CYP2C9*1 and SLCO1B1 521TT genotypes were enrolled and given oral nateglinide (360 mg/d) for 8 weeks. The outcome was measured by collecting the venous blood samples before and at the 8th week of the treatment. The risk G allelic frequency of MTNR1B rs10830963 was higher in T2DM patients than the healthy subjects (P P MTNR1B rs10830963 polymorphism was associated with the therapeutic efficacy of nateglinide in T2DM patients. Also, the CC homozygotes had a better effect than G allele carriers.Trial registration Chinese Clinical Trial Register ChiCTR13003536, date of registration: May 14, 2013.

Background: Diarrhea is a common symptom of acquired immune deficiency syndrome (AIDS) occurring either at the early stage of human immunodeficiency virus (HIV) infection or advanced stage, generally not fetal but seriously affect the quality of life.The treatment of HIV/AIDS-associated diarrhea based on traditional Chinese medicine (TCM) syndrome differentiation or combined with conventional therapy has showed better effect, and improve the immune status of patients to a certain extent, which may have a good application prospect. This is a protocol for a systematicreview on health care intervention. The objective is toassess the beneficial effect and safety of Chinese herbal medicine for people with HIV/AIDS-associated diarrhea.Methods: We will search and include randomized controlled trials comparing Chinese herbal medicine with placebo or other active interventions, regardless of language and publication status. The primary outcome will be diarrhea frequency (per day or per week) and fecal character. Databases to be searched include The Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; PubMed;China National Knowledge Infrastructure (CNKI); Wanfang Data; Chinese Biomedical Literature Database (SinoMed) and China Science and Technology Journal database (VIP). For each step, two reviewers will independently perform the selection of studies, data extractionand assess their methodological quality by the Cochrane risk of bias tool. We will analyze data, and performmeta-analyses if data available.Discussion: By providing current evidence of the beneficial effect and safety of Chinese herbal medicine for people with HIV/AIDS-associated diarrhea,we intend toidentify potentialtherapeutic modality that may be of benefits so to inform practice.

Although previous studies have demonstrated that Glut-1 is the predominant glucose transporter, is significantly overexpressed in various types of tumor and is correlated with poor prognosis, the potential function and clinical value of Glut-1 expression in osteosarcoma remains largely unclear. In particular, the prospective associations between Glut-1 expression levels and clinicopathological factors remains to be elucidated. In the present study, immunohistochemistry was performed to detect Glut-1 protein expression in 51 paired osteosarcoma specimens and adjacent non-cancerous tissues, and reverse transcription-quantitative polymerase chain reaction analysis was performed to examine Glut-1 mRNA expression levels in 6 pairs of these tissues. Statistical analyses were conducted to determine the associations between Glut-1 expression and various clinicopathological parameters. Glut-1 protein was revealed to be overexpressed in 38 (74.5%) osteosarcoma tissues, but only in 6 (11.8%) adjacent non-cancerous tissues. Glut-1 mRNA levels were also upregulated in osteosarcoma tissues compared with adjacent non-cancerous tissues. While there were no clear statistical relationships between Glut-1 expression and patient sex, resection, tumor location, size, T stage and adjuvant treatment, Glut-1 expression levels were significantly associated with age, tumor-node-metastasis stage, lymph node metastasis and survival. The median survival time in patients with low Glut-1 expression levels was longer than in patients with a high expression level. Glut-1 was significantly overexpressed in osteosarcoma tissues, and Glut-1 expression was associated with clinicopathological factors which upregulate the invasion and metastasis of osteosarcoma, and may be a potential predictor of survival in patients with osteosarcoma. Refereed/Peer-reviewed

The aim of the present study was to identify whether sepsis-induced vascular hyporeactivity is associated with microcirculation disturbance and multiple organ injuries. The current study assessed the impact of resveratrol (Res) treatment on lipopolysaccharide (LPS) challenge mediated vascular hyporeactivity. Effects of Res treatment (30 mg/kg; i.m.) at 1 h following LPS stimulation (5 mg/kg; i.v.) on the survival time, mean arterial pressure (MAP), and maximal difference of MAP (ΔMAP) to norepinephrine (NE; 4.2 µg/kg) in mice were observed. The reactivity to gradient NE of isolated mesenteric arterioles and the association with the RhoA-RhoA kinase (ROCK)-myosin light chain phosphatase (MLCP) pathway were investigated by myography, and the signaling molecule protein levels were assessed using ELISA. Res treatment prolonged the survival time of mice subjected to LPS challenge, but did not prevent the LPS-induced hypotension and increase in ΔMAP. Res treatment and RhoA agonist U-46619 incubation prevented LPS-induced vascular hyporeactivity ex vivo, which were suppressed by incubation with ROCK inhibitor Y-27632. LPS-induced vascular hyporeactivity was not affected by the MLCP inhibitor okadaic acid incubation, but was further downregulated by the co-incubation of OA plus Y-27632. The inhibiting effect of Y-27632 on Res treatment was eradicated by incubation with U-46619. Furthermore, RhoA inhibitor C3 transferase did not significantly inhibit the enhancing role of Res treatment, which was further increased by U-46619 plus C3 transferase co-incubation. In addition, Res treatment eradicated the LPS-induced decreases in p-RhoA and p-Mypt1 levels and increases in MLCP levels. The results of the present study indicate that post-treatment of Res significantly ameliorates LPS-induced vascular hyporeactivity, which is associated with the activation of the RhoA-ROCK-MLCP pathway.

Oxidative stress has been reported to serve an important role in the development and progression of diabetic nephropathy (DN). Epithelial-mesenchymal transition (EMT) of renal tubular epithelial cells promotes renal fibrosis in DN, while the mechanism of reactive oxygen species (ROS)-mediated EMT is not fully understood. The aim of the present study was to investigate the effect of high glucose-induced ROS on the activation of the transforming growth factor (TGF)-β1/phosphoinositide 3 kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway in a normal rat kidney tubular epithelial cell line (NRK-52E) and rats with type 1 diabetes. In vitro, high glucose-stimulated ROS production resulted in increased TGF-β1 expression as well as an increase in the Akt and mTOR phosphorylation ratio, resulting in EMT. When cells were pre-treated with ROS inhibitors, changes in TGF-β1, Akt and mTOR were significantly ameliorated. In vivo, diabetic rats experienced a significant decline in renal function and severe renal fibrosis compared with control rats at 8 weeks following streptozocin injection. Levels of malondialdehyde and TGF-β1/PI3K/Akt/mTOR pathway activation were increased in the renal cortex of rats with diabetes compared with the control rats. Furthermore, renal fibrosis was further aggravated in DN compared with the control rats. The results of the present study suggest that ROS serves an important role in mediating high glucose-induced EMT and inhibits activation of the TGF-β1/PI3K/Akt/mTOR pathway. ROS may therefore have potential as a treatment approach to prevent renal fibrosis in DN.

This paper describes the establishment and verification of an accurate pointing model for a 1.2 m aperture slant-axis terahertz antenna. A new analytical pointing model for the slant-axis antenna is presented based on an analogy to that of the alt-azimuth antennas. Furthermore, extra error terms are added to the pointing model based on the structure and mechanical analysis of the slant-axis antenna. To verify the pointing model experimentally, a pointing error measurement method based on photogrammetric techniques is proposed. Using this method, pointing behaviors of the antenna are accurately measured without the aid of astronomical observations, and major sources of the pointing errors are measured individually by photogrammetry and their respective coefficients are compared with those in the analytical pointing model. The results show that an extended pointing model consisting 21 error terms can significantly reduce the residual systematic errors compared with the traditional model, more details are given in the following sections.

Diarrhea can occur at an early or advanced stage of acquired immunodeficiency syndrome (AIDS) as a usual symptom in people with human immunodeficiency virus (HIV) infection. While it is usually not fatal, it can influence patients' quality of life seriously. It has shown to be efficacious and improves people's immune status to a certain extent to treat HIV/AIDS-related diarrhea on the basis of syndrome differentiation and treatment or Chinese herbs plus conventional treatment. Therefore, it may have a good application potential. Here, we outline a protocol for the systematic review of this health-care intervention, with the aim to evaluate the beneficial effects and safety of Traditional Chinese Medicine (TCM) for patients who suffer from HIV/AIDS-associated diarrhea. Randomized controlled trials that compare Chinese herbs with placebo or other effective treatments will be searched and included, in spite of publication status or language. The primary outcomes include diarrhea frequency and fecal character. The databases we will search as follows: China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), Wanfang Data, China National Knowledge Infrastructure, PubMed and the CENTRAL in Cochrane Library. Two authors will respectively conduct the screening of trials, data extraction, and use the Cochrane risk of bias tool to assess the methodological quality. We will analyze the data and perform a meta-analysis if possible. We intend to identify potential therapeutic modalities that may be of benefit to inform clinical practice by supplying existing evidence of the helpful effects and safety of TCM to treat patients suffering from HIV/AIDS-associated diarrhea.

In the background of the service industry transformation and upgrading about the new retail, new model, new technology and new logistics, big data, cloud computing and Internet of things are widely used. it's important to improve the urban distribution system using the means and mode of modern logistics. This study selected the city distribution system as the research object, to build the distribution system of city, According to the new technology and new model of logistics, the paper puts forward the framework, construction path and configuration of the distribution system.

It is a tough task for teachers to answer all questions from students effectively and timely. In this paper, we design and implements an intelligent question answering system using Natural Language Processing, template classification, support vector machine. This system also calculates the similarity between the question and answer pairs by cosine similarity algorithm, and returns the most similar answer. If the user is not satisfied with the answer, the system will write the question into the public section to fall back on other users. The answer will be evaluated and added to the QA base if it is passed with the corresponding question. So that the questions and answers in the QA base continue to expand. We use the QA base of a network forum as the basic library to carry out the experiments. The implementation and experimental results indicate that the proposed approach is achievable.

The drag-type vertical axis wind turbines (VAWTs) have advantages of simple structure, self-starting at low wind speed and low cost, but they show low wind energy conversion efficiencies. A novel vertical axis wind turbine is proposed aiming to improve the disadvantage of the traditional wind turbines based on bionic principle in this paper. The structure of the novel vertical axis wind rotor is designed by combining traditional Savonius wind rotor structure and fish's ridge structure. Aerodynamic performance of the novel wind rotor and a traditional Savonius wind rotor are numerically explored and predicted by numerical simulation method for their non-linear two-dimensional unsteady flows. Performance comparison of the two wind rotors is also carried out. The results show that the novel wind rotor has better performance for torque and power coefficient on lower tip speed ratio (TSR) conditions than traditional Savonius rotor. Based on the simulation analysis of the two different types of wind rotors, we present the approach of changing and reconstructing different curvatures to obtain higher efficiency.

To develop the control system of multi-range hydro-mechanical continuously variable transmission (HMCVT), a model of a multi-range HMCVT is built using the principle of dynamics. According to the characteristic of power split, HMCVT is separated as axes set, variable displacement pump-motor system, clutch set. With wheel tractor as application instance, the whole model of vehicle power train is made, which includes the engine, HMCVT, running system and control system. Based on the theory of Finite State Machine, an automatic control method of speed change and range shift is present, which employs the throttle value, engine speed, range number and transmission ratio as the control parameters. The dynamic characteristic of automatic speed changing and ranges shifting is simulated. The result indicates that the model can correctly represent the dynamic characteristic of HMCVT, the engine can run at the optimal working point, the multi-range HMCVT can shift range steadily and change transmission ratio continuously when the load changes, the circularly shift range is avoided. The model can be used conveniently for the analysis of vehicle dynamic performance and the research of multi-range HMCVT control method.

Through utilizing node interest community in P2P network, put forward a new method on how to combine node interest community and traditional Chord algorithm. By using piecewise hash, making nodes in the same interest community adjacent to each other in the Chord algorithm, forming a virtual double Chord ring structure. Simulation tests show that this method is superior to the original Chord algorithm at path length and routing latency, improving the scalability of system.

Based on the hydro-mechanical continuous variable transmission (HMCVT) of 400 house-power of Dongfanghong, the synchronization in period of contions to content to multiple period of HMCVT was established by analyzing its transmission principle, and the relation fomulas of power distributing ratio and efficiency was presented. That results showed that the characteristics of power flow at the first half and at the second half were different, when it was within the certain grade to do the boundary of e equaled with zero; while it was each grade in section points, that characters were the same; the more grades, the greater HMCVT system transmitting power and the higher the transmission efficiency of the entire system. The high efficiency features of multiple range hydro-mechanical stepless transmission, meet the requirement of tractor operation.

In this paper, a robot handling system was developed with the functions of visual positioning and position adjustment by using the MOTOMAN-SV3X robot. System components, workflow, robot pose and the method of solving the problem of pick-up position deviation were detailed. An automated and flexible application program was provided for robot handling technology, and the problem that there was pick-up position deviation in the process of transporting workpiece can be effectively resolved, thereby handling precision and efficiency can be improved.

Nano-zirconia (Nano-ZrO2) has good natural color, high strength, high toughness, high chemical stability, excellent corrosion resistance and resistant to chemical attack and microbial erosion particularly, which is one of the biocompatible inert materials and is widely used in biology, medicine and other fields. There are cubic (c-ZrO2), tetragonal (t-ZrO2) and monoclinic (m-ZrO2) phase three different crystal structures of zirconia (ZrO2) in normal atmosphere and different temperatures. In the three different crystal structures, t-ZrO2 has the best performance for ceramic dental materials. However, ZrO2 is usually in the form of m-ZrO2 at room temperature. So to study the synthesis and stabilization methods at room temperature of nano-t-ZrO2 is very important in scientific significance and application prospects.

Coal gas accident is the main threat to the safety production in coal mine,it needs a safe and efficient drilling equipment to detection and drainage in the gas area.At present,the equipments detect and drainage in underground coal mines are mainly fission rigs,which move time-consuming, and the efficiency of drilling is low.This paper introduces a new kind of full hydraulic drill car used in coal,it includes the integral design of the car, the structure layout, the drilling arm and the main parts of design ideas.The new drill carriage adopts the caterpillar vehicle structures,full hydraulic pressure drives,it can automatically change the drill rod, prevent bit-stuck device,can freely passage in the narrow roadway,arrived at the reservation of the drilling position and carries on the omni-directional drilling,it can meets various mine construction requirements, and it has a broad market prospect.

In view of the processing characteristic of large equipment, The CNC system of the fine milling machine tool for the large double-sided of aluminum ingot is designed, the hardware of the system is introduced, the software is illuminated mainly, the system is configured based on SCOUT, and the control programs of the manual and automatic processing are designed. Based on WINCC Flexible, the operating system which can meet the multi-interface easy to operate and live real-time monitoring is designed. As the result of the commissioning, the system is stable and reliable.

In this paper a PLC control system is designed to control the sorting, transmission and loading/unloading in the manufacturing, in view of the defects of the relay control system which usually has poor reliability and bad flexibility in use. On the basis of the superior performance of PLC control system and the working principle of frequency converter, AC transducer drive technology is applied to achieve stable starting, reliable operation and low breakdown rate in the assembly line of manufacturing. In the design of the upper monitoring system, the functions of parameter settings, process monitoring and control, data processing, fault location can be well implemented via configuration software. The research work of this paper will lay a solid foundation for the design of material automatic sorting system based on the PLC controller.

This paper mainly introduces the principle of preparation for nano-materials via vapor-phase technics, the design and assembly of nano-material synthesizer. Vapor-phase techniques include physical and chemical vapor synthesis, which involves vapor particle nucleation, nuclei growth, cohesion and a series of basic process in particle growth. Based on the principle of vapor-phase, this paper also details the invention of the process equipment for nano-material synthesis, which realizes an adjustable process in automatic control. The design aims to achieve a synthesizer being adjustable, automatic, intuitive and easy to operate. It mainly includes the following features. First, the invention helps show that preparation for nano-materials via vapor-phase technics is feasible. Second, with the high output of vapor-phase reaction, the synthesizer can not only be carried out in the experimental environment to demonstrate the synthesis of nano-materials, but also be applied in industrial production.

Automobile traffic has become the financial, entertainment, office and communications function as one of the mobile sites. In automotive design and manufacturing and modification, eliminating the noise of car audio systems to improve driving safety and the occupants enjoy audio and video quality is very important. This paper analyzes the car audio system composition, explains automobile noise is divided into mechanical noise and circuit system inner noise, circuit system noise inside mainly includes thermal noise, induction noise and transmission noise, and puts forward the relevant measures to reduce noise.

In this paper, we introduce a new test method for friction performance of wind turbine pitch bearing. Four loading devices are used to put on load on the pitch bearing from different directions through load board. It can accurately simulate the axial force, radial force and overturning moment of wind turbine pitch bearing. The data acquisition device can measure the value of speed, torque and actual output load of loading hydraulic cylinder. After analysis and calculation, the influence of additional friction torque produced by loading device can be obviated, the friction torque of wind turbine pitch bearing under different loads can be test accurately in the laboratory. The research shows that the structure of test bed is compact, mechanical rigidity is good, the replacement of bearing model is expedient. It puts on load easily and can measure the frictional torque of wind turbine pitch bearing under different loads more accurately. It can provide data for performance analysis of wind turbine pitch bearing and ensure the pitch bearing satisfying the application requirements.

Category: Midfoot/Forefoot Introduction/Purpose: To characterize clinical treatment of the malunion after midfoot injury. Methods: 22 cases of malunion following complex midfoot injury from 2004 to 2012. They were 19 men and 3 women with mean age of 37.8. The foot deformity was categorized into 3 types and 3 subtypes, with type? indicating normal foot arch (type ?a forefoot abduction, ?b forefoot adduction and Ic forefoot normal), type? Cavus deformity (subtype is same as?), and type ? flatfoot deformity (subtype is same as?) . There were 2 cases of type?a, 4 cases of type?c, 9 cases of type?a, 4 cases of type ?a, 3 cases of type ?c in our cohort. According to the malunion typing, osteotomy, joint arthrodesis, or realignment was used to correct deformity. Clinical outcomes were evaluated by AOFAS score and VAS. Results: All the patients were followed up for average 34.7 months.The mean VAS score was 2.0 points (0-6) and mean AOFAS score was 83.9±2.3 points (73-94) at the last follow-up, giving an excellent to good rate of 81.8%. All cases obtained favorable functional outcomes without bone nonunion, except one patient who still suffered from midfoot walking discomfort 3 years after operation. Conclusion: Operative management of malunion following midfoot injury is effective and good results can only be obtained by stabilizing injured joint, realignment and recover foot arch.Our typing of the midfoot malunion is helpful in the operative treatment.

Oral Diseases (2010) 16, 343–350 Objective: Toll-like receptors (TLRs) are the essential components in the innate and adaptive immune systems. Colony stimulating factor 2 (CSF2) is a cytokine that may prevent endotoxin tolerance, and LY64 has the ability to interfere with the recognition of bacteria via TLR4. The aim of this study was to explore the in vivo expressions of TLR2, TLR4, CSF2 and LY64 in Chinese chronic periodontitis patients. Methods: Gingival biopsies were collected from 24 chronic periodontitis patients and 19 healthy controls. The gene expression profiles of TLR2, TLR4, CSF2 and LY64 were investigated by real-time polymerase chain reaction, and the protein expressions of TLR2 and TLR4 were detected by immunohistochemistry. In addition, the levels of CSF2 in gingival crevicular fluid (GCF) were determined by ELISA. Results: The higher mRNA expressions of TLR2, TLR4 and CSF2, and the lower mRNA expression of LY64 were detected in chronic periodontitis patients. And the increased protein expressions of TLR2 and TLR4 were confirmed by immunohistochemistry. In addition, the increase of total amount of CSF2 in GCF was observed in chronic periodontitis patients. Conclusions: Our results suggest that TLR2 and TLR4 may play a role in periodontal pathogenesis. In addition, CSF2 and LY64 may contribute to the regulation of inflammatory response and maintaining periodontal homeostasis.