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The increasing demand for road freight has raised tremendous attentions to vehicle platooning, which reduces air resistance and improves fuel economy. To achieve a small and safe spacing between vehicles while ensuring platoon stability, wireless communication assistance is indispensable. However, the imperfection of communication brings degradation of platooning performance (i.e., spacing error) and more possibilities for adversarial attacks. This article proposes a prediction-assisted platooning mechanism from the perspective of performance optimization, wherein each vehicle establishes its local platoon model based on the information received from the communication network, thereby reducing information latency. Then, to secure the system against malicious vehicles, we carry out analysis and design of a detection algorithm for a typical attack type, i.e., data injection attack. The detection is based on three indicators: absolute spacing error, spacing prediction error, and acceleration prediction error. The advantages of the novel platooning mechanism and detection algorithm are ultimately demonstrated on a road-traffic simulation platform that considers the imperfection of realistic vehicle perceptions and Cellular-Vehicle-to-Everything (C-V2X) communication.

Objective To explore the association between early neutrophil-to-lymphocyte ratio (ENLR) and prognosis of anterior circulation large-vessel occlusion stroke (LVOS) after patients undergo endovascular treatment (EVT) with successful revascularization. Methods Patients who experienced acute anterior circulation LVOS and underwent EVT at Changzhou Second People's Hospital Affiliated to Nanjing Medical University between May 2017 and May 2020 were included in this retrospective study. We collected information about patients' baseline characteristics, medical history, laboratory test results, imaging data, and endovascular treatment outcomes, as well as data from follow-up at 3 months. Univariate and multivariate logistic regression models were used to evaluate the association between ENLR and functional disease prognosis. A piecewise linear regression model was also applied to compute the threshold effect of ENLR on poor prognosis (defined as modified Rankin Scale score 3–6) at 3 months using a smoothing plot. Results Of 224 patients who received EVT during the study period, 160 patients were included in the analysis. After adjustments were made for potential confounders, multivariate analysis demonstrated a significant association between ENLR and poor prognosis at 3 months (odds radio 1.19; 95% confidence interval 1.07–1.32; P = 0.0016). An ENLR ≥9.75 was found to be significantly associated with poor prognosis at 3 months (odds ratio 1.54; 95% confidence interval 1.19–2.00; P = 0.0119). Conclusions Increased ENLR after successful revascularization is independently associated with poor prognosis. These findings suggest that ENLR could be used to inform treatment strategies for patients who experience anterior circulation LVOS.

Orthogonal frequency division multiplexing (OFDM) has been widely applied in current communication systems. The artificial intelligence (AI)-aided OFDM receivers are currently brought to the forefront to replace and improve the traditional OFDM receivers. In this study, we first compare two AI-aided OFDM receivers, namely, data-driven fully connected deep neural network and model-driven ComNet, through extensive simulation and real-time video transmission using a 5G rapid prototyping system for an over-the-air (OTA) test. We find a performance gap between the simulation and the OTA test caused by the discrepancy between the channel model for offline training and the real environment. We develop a novel online training system, which is called SwitchNet receiver, to address this issue. This receiver has a flexible and extendable architecture and can adapt to real channels by training only several parameters online. From the OTA test, the AI-aided OFDM receivers, especially the SwitchNet receiver, are robust to real environments and promising for future communication systems. We discuss potential challenges and future research inspired by our initial study in this paper., Comment: 30 pages, 12 figures. Copyright may be transferred without notice, after which this version may no longer be accessible

Various materials, depending on the personality of the artist, are required for contemporary art. Thus, it is necessary to decipher the expressive intentions of the artist and characteristics of the materials required for the conservation of such art. The purpose of this study is to analyze the causes underlying the deterioration of sculptures made from soap and to determine the ideal hygrothermal environment required to stably exhibit and store these artworks. Furthermore, we aim to maintain the long-term structures of the artworks in accordance with the changing expressions and intentions of the artist. Our analysis confirmed that the extracts of the soap sculptures were composed of glycerin and that the sculptures were sensitive to humidity. Moreover, we determined that a relative humidity (RH.) of approximately 60~65% made for an appropriate hygrothermal environment required to preserve the sculptures. We also preserved each work in various ways by applying appropriate preservation treatment, and found that the optimum preservation environment for soap sculptures was a temperature of 20±2°C and a RH. of 60±5%.

Photogating and electrical gating are key physical mechanisms in organic phototransistors (OPTs). However, most OPTs are based on thick and polycrystalline films, which leads to substantially low efficiency of both photogating and electrical gating and thus reduced photoresponse. Herein, high-performance OPTs based on few-layered organic single-crystalline heterojunctions are proposed and the obstacle of thick and polycrystalline films for photodetection is overcome. Because of the molecular scale thickness of the type I organic single-crystalline heterojunctions in OPTs, both photogating and electrical gating are highly efficient. By synergy of efficient photogating and electrical gating, key figures of merit of OPTs reach the highest among those based on planar heterojunctions so far as we know. The production of few-layered organic single-crystalline heterojunctions will provide a new type of advanced materials for various applications.

BACKGROUND: Citrin deficiency (CD) is an autosomal recessive disease resulting from biallelic mutations of the SLC25A13 gene. This study aimed to investigate the molecular epidemiological features of CD in the Guangdong and Shaanxi provinces of China. METHODS: A total of 3,409 peripheral blood samples from Guangdong and 2,746 such samples from Shaanxi province were collected. Four prevalent SLC25A13 mutations NG_012247.2 (NM_014251.3): c.852_855del, c.1638_1660dup, c.615+5G>A, and c.1751-5_1751-4ins(2684) were screened by using the conventional polymerase chain reaction (PCR)/PCR-restriction fragment length polymorphism and newly-developed multiplex PCR methods, respectively. The mutated SLC25A13 allele frequencies, carrier frequencies, and CD morbidity rates were calculated and then compared with the Chi-square and Fisher’s exact tests. RESULTS: The mutations were detected in 68 out of 6,818 SLC25A13 alleles in Guangdong and 29 out of 5,492 alleles in the Shaanxi population. The carrier frequencies were subsequently calculated to be 1/51 and 1/95, while the CD morbidity rates were 1/10,053 and 1/35,865, in the 2 populations, respectively. When compared with the Shaanxi population, Guangdong exhibited a higher frequency of mutated SLC25A13 allele (68/6,818 vs. 29/5,492, χ(2)=8.570, P=0.003) in general, with higher c.852_855del (54/6,818 vs. 13/5,492, χ(2)=17.328, P=0.000) but lower c.1751-5_1751 -4ins(2684) (2/6,818 vs. 9/5,492, P=0.015) allele frequencies. The distribution of c.615+5G>A and c.1638_1660dup between the 2 provinces, as well as all 4 prevalent mutations among different geographic regions within the 2 provinces, did not differed significantly. CONCLUSIONS: Our findings depicted the CD molecular epidemiological features in Guangdong and Shaanxi populations, providing preliminary but significant laboratory evidences for the subsequent CD diagnosis and management in the 2 provinces of mainland China.

Heterosis, which describes the superior vigor and yield of F1 hybrids with respect to their parents, is observed in many rice hybrid crosses. The exploitation of heterosis is a great leap in the history of rice breeding. With advances in genomics and genetics, high-resolution mapping and functional identification of heterosis-associated loci have been performed in rice. Here we summarize advances in understanding the genetic basis of grain yield heterosis in hybrid rice and provide a vision for the genetic study and breeding application of rice heterosis in the future.

The distribution of welding residual stress is the basis of controlling environmental cracking failure in the joint area of steel pipeline. In this study, 3D actual-size finite element models were developed for X80 steel pipe to predict the welding stress field in four typical girth joints. Electrochemical measurements under multi-stage loading revealed the relationship among tensile stress level, dislocation multiplication, and corrosion. The increased number of weld passes reduced the peak residual stress, and the adopted fully automatic welding decreased the high-stress zone where dislocation multiplication might occur. Therefore, adopting automatic welding and moderately increasing the number of weld passes are recommended to control welding residual stress.

Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.

PURPOSE Propagation of contours from high-quality magnetic resonance (MR) images to treatment planning ultrasound (US) images with severe needle artifacts is a challenging task, which can greatly aid the organ contouring in high dose rate (HDR) prostate brachytherapy. In this study, a deep learning approach was developed to automatize this registration procedure for HDR brachytherapy practice. METHODS Because of the lack of training labels and difficulty of accurate registration from inferior image quality, a new segmentation-based registration framework was proposed for this multi-modality image registration problem. The framework consisted of two segmentation networks and a deformable registration network, based on the weakly -supervised registration strategy. Specifically, two 3D V-Nets were trained for the prostate segmentation on the MR and US images separately, to generate the weak supervision labels for the registration network training. Besides the image pair, the corresponding prostate probability maps from the segmentation were further fed to the registration network to predict the deformation matrix, and an augmentation method was designed to randomly scale the input and label probability maps during the registration network training. The overlap between the deformed and fixed prostate contours was analyzed to evaluate the registration accuracy. Three datasets were collected from our institution for the MR and US image segmentation networks, and the registration network learning, which contained 121, 104, and 63 patient cases, respectively. RESULTS The mean Dice similarity coefficient (DSC) results of the two prostate segmentation networks are 0.86 ± 0.05 and 0.90 ± 0.03, for MR images and the US images after the needle insertion, respectively. The mean DSC, center-of-mass (COM) distance, Hausdorff distance (HD), and averaged symmetric surface distance (ASSD) results for the registration of manual prostate contours were 0.87 ± 0.05, 1.70 ± 0.89 mm, 7.21 ± 2.07 mm, 1.61 ± 0.64 mm, respectively. By providing the prostate probability map from the segmentation to the registration network, as well as applying the random map augmentation method, the evaluation results of the four metrics were all improved, such as an increase in DSC from 0.83 ± 0.08 to 0.86 ± 0.06 and from 0.86 ± 0.06 to 0.87 ± 0.05, respectively. CONCLUSIONS A novel segmentation-based registration framework was proposed to automatically register prostate MR images to the treatment planning US images with metal artifacts, which not only largely saved the labor work on the data preparation, but also improved the registration accuracy. The evaluation results showed the potential of this approach in HDR prostate brachytherapy practice.

Background and Purpose: Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods: We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results: EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion: Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.

The multi-principal-component concept of high-entropy alloys (HEAs) generates numerous new alloys. Among them, nanoscale precipitated HEAs have achieved superior mechanical properties and shown the potentials for structural applications. However, it is still a great challenge to find the optimal alloy within the numerous candidates. Up to now, the reported nanoprecipitated HEAs are mainly designed by a trial-and-error approach with the aid of phase diagram calculations, limiting the development of structural HEAs. In the current work, a novel method is proposed to accelerate the development of ultra-strong nanoprecipitated HEAs. With the guidance of physical metallurgy, the volume fraction of the required nanoprecipitates is designed from a machine learning of big data with thermodynamic foundation while the morphology of precipitates is kinetically tailored by prestrain aging. As a proof-of-principle study, an HEA with superior strength and ductility has been designed and systematically investigated. The newly developed γ′-strengthened HEA exhibits 1.31 GPa yield strength, 1.65 GPa ultimate tensile strength, and 15% tensile elongation. Atom probe tomography and transmission electron microscope characterizations reveal the well-controlled high γ′ volume fraction (52%) and refined precipitate size (19 nm). The refinement of nanoprecipitates originates from the accelerated nucleation of the γ′ phase by prestrain aging. A deeper understanding of the excellent mechanical properties is illustrated from the aspect of strengthening mechanisms. Finally, the versatility of the current design strategy to other precipitation-hardened alloys is discussed.

The effect of perioperative acupuncture on accelerating gastrointestinal function recovery has been reported in colorectal surgery and distal gastrectomy (Billroth-II). However, the evidence in pancreatectomy and other gastrectomy is still limited. A prospective, randomized controlled trial was conducted between May 2018 and August 2019. Consecutive patients undergoing pancreatectomy or gastrectomy in our hospital were randomly assigned to the electroacupuncture (EA) group and the control group. The patients in the EA group received transcutaneous EA on Bai-hui (GV20), Nei-guan (PC6), Tian-shu (ST25), and Zu-san-li (ST36) once a day in the afternoon, and the control group received sham EA. Primary outcomes were the time to first flatus and time to first defecation. In total, 461 patients were randomly assigned to the groups, and 385 were analyzed finally (EA group, n = 201; control group, n = 184). Time to first flatus (3.0 ± 0.7 vs 4.2 ± 1.0, P < 0.001 ) and first defecation (4.2 ± 0.9 vs 5.4 ± 1.2, P < 0.001 ) in the EA group were significantly shorter than those in the control group. Of patients undergoing pancreatectomy, those undergoing pancreaticoduodenectomy and intraoperative radiation therapy (IORT) surgery benefitted from EA in time to first flatus ( P < 0.001 ) and first defecation ( P < 0.001 ), while those undergoing distal pancreatectomy did not ( P flatus = 0.157 , P defecation = 0.007 ) completely. Of patients undergoing gastrectomy, those undergoing total gastrectomy and distal gastrectomy (Billroth-II) benefitted from EA ( P < 0.001 ), as did those undergoing proximal gastrectomy ( P = 0.015 ). Patients undergoing distal gastrectomy (Billroth-I) benefitted from EA in time to first defecation ( P = 0.012 ) but not flatus ( P = 0.051 ). The time of parenteral nutrition, hospital stay, and time to first independent walk in the EA group were shorter than those in the control group. No severe EA complications were reported. EA was safe and effective in accelerating postoperative gastrointestinal function recovery. Patients undergoing pancreaticoduodenectomy, IORT surgery, total gastrectomy, proximal gastrectomy, or distal gastrectomy (Billroth-II) could benefit from EA. This trial is registered with NCT03291574.

In this study, a human-chair model was developed as the basis for a wearable-chair design. A prototype chair, HUST-EC, based on the model was fabricated and evaluated. Employing the optimization under the golden divisional method, an optimized simulation of the operating mode with the lowest chair height was implemented. A novel multi-link support structure has been established with parameters optimized using Matlab software. The stress analysis of the solid models was conducted to ensure the adequate support from the designed chair for the user. Ten subjects participated in the evaluation experiment, who performed both static tasks and dynamic tasks. The experimental results consisted of subjective evaluation and objective evaluation. The experimental data demonstrate that (1) the HUST-EC can effectively reduce the activation level of related muscles at a variety of tasks; (2) the plantar pressure was reduced by 54%–67%; (3) the angle between the upper body and the vertical axis was reduced by 59%–77%; (4) the subjective scores for chair comfortability, portability, and stability were all higher than 7. The results further revealed that the designed chair can reduce the musculoskeletal burden and may improve work efficiency.

Background Neuroinflammation and immune responses occurring minutes to hours after stroke are associated with brain injury after acute ischemic stroke (AIS). PPARγ coactivator-1α (PGC-1α), as a master coregulator of gene expression in mitochondrial biogenesis, was found to be transiently upregulated in microglia after AIS. However, the role of microglial PGC-1α in poststroke immune modulation remains unknown. Methods PGC-1α expression in microglia from human and mouse brain samples following ischemic stroke was first determined. Subsequently, we employed transgenic mice with microglia-specific overexpression of PGC-1α for middle cerebral artery occlusion (MCAO). The morphology and gene expression profile of microglia with PGC-1α overexpression were evaluated. Downstream inflammatory cytokine production and NLRP3 activation were also determined. ChIP-Seq analysis was performed to detect PGC-1α-binding sites in microglia. Autophagic and mitophagic activity was further monitored by immunofluorescence staining. Unc-51-like autophagy activating kinase 1 (ULK1) expression was evaluated under the PGC-1α interaction with ERRα. Finally, pharmacological inhibition and genomic knockdown of ULK1 were performed to estimate the role of ULK1 in mediating mitophagic activity after ischemic stroke. Results PGC-1α expression was shortly increased after ischemic stroke, not only in human brain samples but also in mouse brain samples. Microglia-specific PGC-1α overexpressing mice exhibited significantly decreased neurologic deficits after ischemic injury, with reduced NLRP3 activation and proinflammatory cytokine production. ChIP-Seq analysis and KEGG pathway analysis revealed that mitophagy was significantly enhanced. PGC-1α significantly promoted autophagic flux and induced autolysosome formation. More specifically, the autophagic clearance of mitochondria was enhanced by PGC-1α regulation, indicating the important role of mitophagy. Pharmacological inhibition or knockdown of ULK1 expression impaired autophagic/mitophagic activity, thus abolishing the neuroprotective effects of PGC-1α. Conclusions Mechanistically, in AIS, PGC-1α promotes autophagy and mitophagy through ULK1 and reduces NLRP3 activation. Our findings indicate that microglial PGC-1α may be a promising therapeutic target for AIS.

BACKGROUND Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease, which is characterized by daily fever and arthritis, with an evanescent rash and neutrophilic leukocytosis. To date, there has been no definite laboratory or imaging test available for diagnosing AOSD; the diagnosis is one of exclusion, which can be very challenging. In particular, AOSD patients may experience different complications affecting their clinical picture, management, and prognosis. The treatment of AOSD remains largely empirical and involves therapeutic agents. CASE SUMMARY We report the case of a 36-year-old woman who presented with fever, red rash, arthralgia, and sore throat. Her serum ferritin level and white blood cell count were markedly elevated, and the first diagnosis 22 years prior was "juvenile rheumatoid arthritis of systemic type". The patient was treated with prednisone, sulfasalazine, methotrexate, and leflunomide. After remission of her symptoms, the patient stopped taking the medications, and the disease recurred. Ultimately, the patient was diagnosed with adult-onset Still's disease. Relapse occurred several times due to self-medication withdrawal, and an interleukin-6 antagonist (tocilizumab/Actemra) was administered to control the disease. Recently, she was hospitalized because an incision did not heal, and the patient suddenly developed high fever and diarrhea during hospitalization. The patient's disease progressed violently and quickly developed into macrophage activation syndrome, disseminated intravascular coagulation, shock, and multiple organ failure. The patient had sudden cardiac arrest, and she died despite emergency rescue efforts. CONCLUSION AOSD patients need regular follow-up in the long-term treatment process, and must press formulary standard medication, and do not voluntarily withdraw or reduce the dose. Otherwise it may cause disease back-and-forth or serious life-threatening complications. Meanwhile, strict management of trauma, infections, tumors, and other diseases may contribute to improved outcomes in patients with complications.

This article proposes a three-stage dead-time adjustment scheme for the leading-leg and lagging-leg switches of phase-shift full-bridge converter (PSFBC) according to the load conditions to enhance the conversion efficiencies at light loads. This article also investigates an iterative rigorous loss calculation for light loads under dead-time adjustment. The proposed iterative calculation can be used to modify the duty ratio of the transition region and estimate the operating currents more accurately; therefore, the losses of a PSFBC at light loads and under the dead-time adjustments can be effectively estimated. A PSFBC prototype with an input voltage of 380 V, an output voltage of 48 V, and a rated output power of 480 W is designed and implemented in this article. Experimental results show that comparing with the PSFBC without the dead-time adjustment and with the conventional dead-time adjustment, the conversion efficiency enhancements of 12.13% and 5.97% can be achieved by the proposed three-stage dead-time adjustment scheme at about 5% load condition, respectively. For a small-scale data center with 100 designed PSFBCs, simulated results indicate that about 3.21 MWh of electricity and 1.03 tons of carbon dioxide emission can be saved and reduced per year, respectively, by the proposed dead-time adjustment scheme.

In this study, the concentrations of 16 kinds of polycyclic aromatic hydrocarbons (PAHs) in surface sediments of Daya Bay were determined and analyzed. Results showed that 16 PAHs were detected in all the samples, and the total PAH concentration ranged from 70.18 to 128.04 ng g-1, with an average of 103.17 ng g-1. The cyclic number distribution of PAHs in the sediments was mainly 4 and 5 rings. Six classic PAH ratios named Ant/(Ant + Phe), Fla/(Fla + Pyr), [InP/(InP + BghiP)], [BaA/(BaA + Chr)], BaA/BghiP, and LMW/HMW, and principal component analyses showed that the main source of PAHs in this region was combustion (biomass, coal, and petroleum combustion), and the secondary source was petroleum. The ecological risk analysis of PAHs by using effect range low/median method and mean effects range-median quotient method showed that all of PAHs are lower than the effect range low (ERL) level and the effects range-median quotient (M-ERM-Q) value of all stations is 0.0027-0.0067, with an average value of 0.0046. Thus, it can be seen that PAHs are at a low-risk level in surface sediments of Daya Bay.

Crop production is facing unprecedented challenges. Despite the fact that the food supply has significantly increased over the past half-century, ~8.9 and 14.3% people are still suffering from hunger and malnutrition, respectively. Agricultural environments are continuously threatened by a booming world population, a shortage of arable land, and rapid changes in climate. To ensure food and ecosystem security, there is a need to design future crops for sustainable agriculture development by maximizing net production and minimalizing undesirable effects on the environment. The future crops design projects, recently launched by the National Natural Science Foundation of China and Chinese Academy of Sciences (CAS), aim to develop a roadmap for rapid design of customized future crops using cutting-edge technologies in the Breeding 4.0 era. In this perspective, we first introduce the background and missions of these projects. We then outline strategies to design future crops, such as improvement of current well-cultivated crops, de novo domestication of wild species and redomestication of current cultivated crops. We further discuss how these ambitious goals can be achieved by the recent development of new integrative omics tools, advanced genome-editing tools and synthetic biology approaches. Finally, we summarize related opportunities and challenges in these projects.

Background BRAFV600E mutation is the most common mutation in thyroid cancer. It strongly activates MAPK/ERK pathway and indicates an invasive subtype of thyroid cancer. PLX4032 is a selective oral inhibitor of the BRAFV600 kinase although with limited effect in treating this panel of thyroid cancer, due to the feedback activation of MAPK/ERK as well as PI3K/AKT pathways. It was investigated that Vitamin C plays a positive role in inhibiting these pathways in thyroid cancer. However, whether Vitamin C could enhance the antitumor effect of PLX4032 remains largely unclear. Methods The antitumor efficacy of combination therapy with PLX4032 and Vitamin C on BRAFMT thyroid cancer cell was assessed by the MTT assay, EdU assay and colony formation, Chou-Talalay way was employed to analyze the synergistic effect. Flow cytometry were employed to assess cells’ apoptosis and cell cycle arrest in response to combination therapy. Xenograft models were used to test its in vivo antitumor activity. Western blot and IHC were applied to investigate the mechanism underlying synergistic effect. Results PLX4032 or Vitamin C monotherapy was mildly effective in treating BRAFMT thyroid cancer cell and xenografts model. The combination therapy significantly inhibited cancer cell proliferation and tumor growth in nude mice, and induced cell apoptosis and cell cycle arrest compared to either monotherapy. PLX4032 monotherapy induced feedback activation of MAPK/ERK as well as PI3K/AKT pathway; while combination therapy significantly relieved this feedback. Conclusion Vitamin C promotes the antitumor effect of PLX4032 in BRAFMT thyroid cancer cell and xenografts model via relieving the feedback activation of MAPK/ERK as well as PI3K/AKT pathway. PLX4032/Vitamin C combination may be a potential therapeutic approach to treat BRAFMT thyroid cancer.

In this study, the WC reinforced Fe-based composite coatings with various CeO2 contents were fabricated on the H13 hot-working die steel by laser cladding. The high-temperature wear resistance of c...

OBJECTIVEFew studies have addressed that dynamic sagittal imbalance can develop distal to the spinal fusion and cause sagittal malalignment, unlike proximal junctional kyphosis (PJK) in the proximal portion. The purpose of this study was to investigate risk factors between the 2 different types of postoperative sagittal imbalance after long fusion to the sacrum for the treatment of degenerative sagittal imbalance (DSI).METHODSEighty patients who had undergone surgical correction for DSI were included. Radiographic measurements included spinopelvic parameters on whole-spine plain radiographs and degeneration of paravertebral muscles on MRI. Univariate and multivariate analyses for clinical and radiological factors were conducted for respective risk factors. In subgroup analyses, the 2 different types of postoperative sagittal imbalance were directly compared.RESULTSForty patients (50%) developed postoperative sagittal imbalance; of these patients, 22 (55.0%) developed static proximal kyphosis from PJK, and 18 patients (45.0%) developed dynamic sagittal imbalance without PJK. The independent risk factors in proximal kyphosis were greater postoperative pelvic tilt (HR 1.11) and less change in sacral slope (SS) (HR 1.09), whereas there were more fusion levels (HR 3.11), less change in SS (HR 1.28), and less change in thoracic kyphosis (HR 1.26) in dynamic sagittal imbalance. Directly compared with the proximal kyphosis group, dynamic sagittal imbalance was more commonly found in patients who had less correction of sagittal parameters as well as fatty atrophy of the paravertebral muscles. Clinical outcomes in the dynamic sagittal imbalance group were superior to those in the proximal kyphosis group.CONCLUSIONSOptimal correction of sagittal alignment should be considered in long instrumented fusion for DSI, because insufficient correction might cause one of 2 different types of postoperative sagittal imbalance at different sites of decompression. Dynamic sagittal imbalance compared with proximal kyphosis was significantly associated with less correction of sagittal alignment, in conjunction with more fusion levels and degeneration of the paravertebral muscles.

Purpose Contouring intraprostatic lesions is a prerequisite for dose-escalating these lesions in radiotherapy to improve the local cancer control. In this study, a deep learning-based approach was developed for automatic intraprostatic lesion segmentation in multiparametric magnetic resonance imaging (mpMRI) images contributing to clinical practice. Methods Multiparametric magnetic resonance imaging images from 136 patient cases were collected from our institution, and all these cases contained suspicious lesions with Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 4. The contours of the lesion and prostate were manually created on axial T2-weighted (T2W), apparent diffusion coefficient (ADC) and high b-value diffusion-weighted imaging (DWI) images to provide the ground truth data. Then a multiple branch UNet (MB-UNet) was proposed for the segmentation of an indistinct target in multi-modality MRI images. An encoder module was designed with three branches for the three MRI modalities separately, to fully extract the high-level features provided by different MRI modalities; an input module was added by using three sub-branches for three consecutive image slices, to consider the contour consistency among different image slices; deep supervision strategy was also integrated into the network to speed up the convergency of the network and improve the performance. The probability maps of the background, normal prostate and lesion were output by the network to generate the segmentation of the lesion, and the performance was evaluated using the dice similarity coefficient (DSC) as the main metric. Results A total of 162 lesions were contoured on 652 image slices, with 119 lesions in the peripheral zone, 38 in the transition zone, four in the central zone and one in the anterior fibromuscular stroma. All prostates were also contoured on 1,264 image slices. As for the segmentation of lesions in the testing set, MB-UNet achieved a per case DSC of 0.6333, specificity of 0.9993, sensitivity of 0.7056; and global DSC of 0.7205, specificity of 0.9993, sensitivity of 0.7409. All the three deep learning strategies adopted in this study contributed to the performance promotion of the MB-UNet. Missing the DWI modality would degrade the segmentation performance more markedly compared with the other two modalities. Conclusions A deep learning-based approach with proposed MB-UNet was developed to automatically segment suspicious lesions in mpMRI images. This study makes it feasible to adopt boosting intraprostatic lesions in clinical practice to achieve better outcomes.

In view of the urgent need for the safety performance of the braided wire ropes in power grid construction, this study analyzes the mechanical responds of a braided wire rope under the tension and torsional loads. The mechanical responds of the strands under tension, torsional, and tension–torsion loads are studied, and the mechanical response equations of the strands under the above loads are obtained. Furthermore, a mechanical respond model of the rope under the tension and torsional loads is established using the method of rope strand unfolding. The strain of the strands in the axial direction of the rope is used to determine the strain of the braided wire rope. The stress and strain expressions of the whole rope under the tensile–torsional load are obtained. The whole rope test under the tension–torsion load is carried out, and the axial displacement curve under the same load is obtained. The reliability of the mechanical model is verified by comparing the experimental value with the theoretical value.

Although intravesical bacillus Calmette-Guérin (BCG) immunotherapy has been the gold standard for nonsurgical management of non–muscle-invasive bladder cancer, a considerable number of patients exhibit resistance to the adjuvant treatment with unexplained mechanisms. This study aimed to investigate whether and how androgen receptor (AR) signals modulate BCG cytotoxicity in bladder cancer. AR knockdown or overexpression in bladder cancer lines resulted in induction or reduction, respectively, in intracellular BCG quantity and its cytotoxic activity. Microarray screening identified Rab27b, a small GTPase known to mediate bacterial exocytosis, which was upregulated in BCG-resistant cells and downregulated in AR-shRNA cells. Knockdown of Rab27b, or its effector SYTL3, or overexpression of Rab27b also induced or reduced, respectively, BCG quantity and cytotoxicity. In addition, treatment with GW4869, which was previously shown to inhibit Rab27b-dependent secretion, induced them and reduced Rab27b expression in bladder cancer cells. Meanwhile, AR expression was upregulated in BCG-resistant lines, compared with respective controls. In a mouse orthotopic xenograft model, Rab27b/SYTL3 knockdown or GW4869 treatment enhanced the amount of BCG within tumors and its suppressive effect on tumor growth. Moreover, in non–muscle-invasive bladder cancer specimens from patients subsequently undergoing BCG therapy, positivity of AR/Rab27b expression was associated with significantly higher risks of tumor recurrence. AR activation thus correlates with resistance to BCG treatment, presumably via upregulating Rab27b expression. Mechanistically, it is suggested that BCG elimination from urothelial cells is induced by Rab27b/SYTL3-mediated exocytosis. Accordingly, Rab27b inactivation, potentially via antiandrogenic drugs and/or exocytosis inhibition are anticipated to sensitize the efficacy of BCG therapy, especially in patients with BCG-refractory AR/Rab27b-positive bladder cancer.

Subchannel code analysis is one of the key thermal-hydraulic approaches for nuclear reactor design and safety analysis. At present, subchannel codes are employed to compute local thermal-hydraulic ...

Background This study investigated the prognostic impact of (neo‐)adjuvant radiation therapies in early stage esophageal cancer. Methods A retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database was conducted from 2004 to 2016. Patients with pathologically staged T1‐4N0M0 esophageal cancer were divided into two treatment groups: (i) neoadjuvant radiotherapy followed by surgery; and (ii) upfront esophagectomy followed by adjuvant radiotherapy. Propensity scored match and Cox proportional hazards model were used to identify covariates associated with overall survival and cancer‐specific survival. Results There were 821 patients selected, of whom 588 (71.6%) received neoadjuvant radiotherapy and 233 (28.4%) received adjuvant radiotherapy. For the entire cohort, neoadjuvant radiotherapy was associated with a significantly benefit in five‐year survival outcomes compared with adjuvant radiotherapy (P, In this population‐based study, we indicated that the addition of neoadjuvant RT for pT3‐4N0 diseases followed by esophagectomy was associated with improved cancer‐specific survival in patients with tumor lengths 5 cm and squamous cell carcinoma. The identification of higher‐risk patients for neoadjuvant therapy would be expected to yield better results than taking a uniform approach to this population, to avoid unnecessary and possibly harmful treatment in node‐negative diseases.

Background The impact of neoadjuvant chemoradiotherapy (nCRT) on early stage esophageal cancer is unknown. Here, we compared the outcomes after esophagectomy alone or nCRT plus surgery for clinically staged node‐negative esophageal cancer. Methods We searched the Surveillance, Epidemiology, and End Results database for patients with clinically node‐negative (cN0) esophageal cancer from 2004 to 2016 who underwent surgery alone or nCRT plus surgery. Propensity score matching and Cox regression analysis were used to identify covariates associated with overall survival and cancer‐specific survival. Results A total of 1587 patients were retrospectively identified, of whom 49.8% (n = 791) received nCRT and 80.2% (n = 1273) were truly node‐negative diseases. For the entire cohort, surgery alone was associated with a statistically significant but modest absolute increase in survival outcomes (P, This study focuses on the use of neoadjuvant chemoradiotherapy to esophageal carcinoma patients with clinically staged node‐negative (cN0) status. Finally, compared with surgery alone, cN0 esophageal cancer with falsely node‐negative (pN+) or localized truly node‐negative (pT3‐4N0) gain a significant survival benefit from neoadjuvant chemoradiation. However, neoadjuvant chemoradiation plus surgery was associated with decreased survival for early‐staged true node‐negative (pT1‐2N0) patients. Despite the inherent limitations, this population‐based study allows for a robust analysis of patients with cN0 esophageal carcinoma and the benefits of neoadjuvant chemoradiation when stratified by nodal and tumor status, and this finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN0 disease.

PURPOSE High-Dose-Rate (HDR) brachytherapy is one of the most effective ways to treat the prostate cancer, which is the second most common cancer in men worldwide. This treatment delivers highly conformal dose through the transperineal needle implants and is guided by a real time ultrasound (US) imaging system. Currently, the brachytherapy needles in the US images are manually segmented by physicists during the treatment, which is time consuming and error prone. In this study, we propose a set of deep learning-based algorithms to accurately segment the brachytherapy needles and locate the needle tips from the US images. METHODS Two deep neural networks are developed to address this problem. First, a modified deep U-Net is used to segment the pixels belonging to the brachytherapy needles from the US images. Second, an additional VGG-16-based deep convolutional network is combined with the segmentation network to predict the locations of the needle tips. The networks are trained and evaluated on a clinical US images dataset with labeled needle trajectories collected in our hospital (Institutional Review Board approval (IRB 41755)). RESULTS The evaluation results show that our method can accurately extract the trajectories of the needles with a resolution of 0.668 mm and 0.319 mm in x and y direction, respectively. 95.4% of the x direction and 99.2% of the y direction have error ≤ 2 mm. Moreover, the position resolutions of the tips are 0.721, 0.369, and 1.877 mm in x, y, and z directions, respectively, while 94.2%, 98.3%, and 67.5% of the data have error ≤ 2 mm. CONCLUSIONS This paper proposed a neural network-based algorithm to segment the brachytherapy needles from the US images and locate the needle tip. It can be used in the HDR brachytherapy to help improve the efficiency and quality of the treatments.

The perioperative optimal blood pressure targets during mechanical thrombectomy for acute ischemic stroke are uncertain, and randomized controlled trials addressing this issue are lacking. There is still no consensus on the optimal target for perioperative blood pressure in acute ischemic stroke patients with large vessel occlusion. In addition, there are many confounding factors that can influence the outcome including the patient’s clinical history and stroke characteristics. We review the factors that have an impact on perioperative blood pressure change and discuss the influence of perioperative blood pressure on functional outcome after mechanical thrombectomy. In conclusion, we suggest that blood pressure should be carefully and flexibly managed perioperatively in patient-received mechanical thrombectomy. Blood pressure changes during mechanical thrombectomy were independently correlated with poor prognosis, and blood pressure should be maintained in a normal range perioperatively. Postoperative blood pressure control is associated with recanalization status in which successful recanalization requires normal range blood pressure (systolic blood pressure 120–140 mmHg), while non-recanalization requires higher blood pressure (systolic blood pressure 160–180 mmHg). The preoperative blood pressure targets for mechanical thrombectomy should be tailored based on the patient’s clinical history (systolic blood pressure ≤185 mmHg). Blood pressure should be carefully and flexibly managed intraoperatively (systolic blood pressure 140–180 mmHg) in patient-received endovascular therapy.

Background Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) accounts for approximately 5% ‐ 6% of acute myocardial infarction (AMI) patients. Anxiety symptoms are common in patients with coronary artery disease (CAD), and are associated with a poor prognosis. However, the association between anxiety and MINOCA outcomes is less clear. Hypothesis Anxiety will be associated with clinical outcomes in patients with MINOCA. Methods and Results Between November 2014 and December 2016, 620 hospitalized patients with MINOCA were recruited from a single center. Within 7 days of coronary angiography, anxiety was assessed using the Zung Self‐Rating Anxiety Scale. The primary endpoint was all‐cause mortality; secondary endpoint was any major adverse cardiovascular event (MACE). After 3 years, 87 deaths and 151 MACE had occurred. Kaplan‐Meier curves indicated the unadjusted rates of all‐cause mortality (log‐rank P = .045) and MACE (log‐rank P = .023) were significantly higher in the anxiety group compared with the control group of patients without anxiety. Multivariate Cox regression analysis showed that clinically significant anxiety was an independent prognostic factor for all‐cause mortality as well as MACE (hazard ratio [HR] = 1.547; 95% confidence interval [CI], 1.006‐2.380; P = .047; HR = 1.460; 95% CI, 1.049‐2.031; P = .025; respectively). Conclusions Anxiety is significantly and independently associated with an increased risk of all‐cause mortality and MACE in patients with MINOCA.

Automatic polyp recognition in endoscopic images is challenging because of the low contrast between polyps and the surrounding area, the fuzzy and irregular polyp borders, and varying imaging light conditions. In this article, we propose a novel densely connected convolutional network with “unbalanced discriminant (UD)” loss and “category sensitive (CS)” loss (DenseNet-UDCS) for the task. We first utilize densely connected convolutional network (DenseNet) as the basic framework to conduct end-to-end polyp recognition task. Then, the proposed dual constraints, UD loss and CS loss, are simultaneously incorporated into the DenseNet model to calculate discriminative and suitable image features. The UD loss in our network effectively captures classification errors from both majority and minority categories to deal with the strong data imbalance of polyp images and normal ones. The CS loss imposes the ratio of intraclass and interclass variations in the deep feature learning process to enable features with large interclass variation and small intraclass compactness. With the joint supervision of UD loss and CS loss, a robust DenseNet-UDCS model is trained to recognize polyps from endoscopic images. The experimental results achieved polyp recognition accuracy of 93.19%, showing that the proposed DenseNet-UDCS can accurately characterize the endoscopic images and recognize polyps from the images. In addition, our DenseNet-UDCS model is superior in detection accuracy in comparison with state-of-the-art polyp recognition methods. Note to Practitioners —Wireless capsule endoscopy (WCE) is a crucial diagnostic tool for polyp detection and therapeutic monitoring, thanks to its noninvasive, user-friendly, and nonpainful properties. A challenge in harnessing the enormous potential of the WCE to benefit the gastrointestinal (GI) patients is that it requires clinicians to analyze a huge number of images (about 50 000 images for each patient). We propose a novel automatic polyp recognition scheme, namely, DenseNet-UDCS model, by addressing practical image unbalanced problem and small interclass variances and large intraclass differences in the data set. The comprehensive experimental results demonstrate superior reliability and robustness of the proposed model compared to the other polyp recognition approaches. Our DenseNet-UDCS model can be further applied in the clinical practice to provide valuable diagnosis information for GI disease recognition and precision medicine.

All-metallic sandwich-walled cylindrical and conical structures for aerospace applications often require simultaneous excellent vibration and load-carrying capacities. In the present study, the free vibration and axial compression behaviors of cylindrical and truncated conical sandwich shells with corrugated cores are investigated using a combined experimental and numerical approach. Excellent agreement between experimental measurements and finite element simulations for representative vibration and axial compression characteristics is achieved. Parametric studies based on the response surface model are subsequently performed to quantify the influence of key geometrical parameters on vibration and axial compression performance. A multi-functional collaborative design to meet the requirement of high load-bearing capacity subjected to the constraint of low natural frequency is also carried out, which demonstrates the unique advantages of the novel sandwich-walled shells for aeronautical and astronautical applications.

Background Anastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another. Method We retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side-to-side: posterior-to-posterior linear stapled (TM-STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short-term outcomes are analyzed in this study. Results There were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity. Conclusions The results of our study suggest that this improved TM-STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.

Purpose This paper aims to present wireless passive temperature sensors by using high-temperature stable polymer-derived silicoaluminum carbonitride (PDC-SiAlCN) ceramic materials. Design/methodology/approach In this paper, a novel PDC-SiAlCN ceramic was synthesized by using polyvinylsilazne and aluminum-tri-sec-butoxide as precursors. Then, PDC-SiAlCN was used as the sensing material to fabricate sensors. The sensors are based on a cavity resonator and an integrated slot antenna. The resonant frequencies of the sensors are determined by the dielectric constants of PDC-SiAlCN ceramic, which monotonically increase versus temperature. Findings The effect of sensor dimension on the performance of the sensors was investigated using simulation and experimental methods. The using temperature, reliability and sensing distance of the sensors were studied experimentally. The sensors performed measurement up to 1100°C with excellent reliability and repeatability. The sensing distance varied from 38 to 14 mm when the temperature increasing from 20°C to 1100°C. Originality/value PDC-SiAlCN ceramic based wireless passive temperature sensors have the advantage of seamless integration of slot antennas and resonators, which greatly reduces the size of the sensor, reduces the direction of antenna transmission and increases the transmission space. The sensors can be used for many harsh environment applications such as engine monitoring.

The surface texture of die can reduce friction, and the reasonable texture type can also form oil film on the die surface to save the use of lubricant. In this paper, a method of preparing surface texture on the die by chemical etching is proposed. This paper mainly studies the law of preparation of surface texture by chemical etching and the effect of chemically etched surface texture on die friction. In the experiments, the surface of samples of Cr12 were treated by chemical etching to obtain several groups of surface texture, and the morphology of the chemically etched surface was observed by laser confocal microscope to obtain the characteristics of the surface. Then, four gradients of surface texture with different etching time are selected according to the three-dimensional parameters to obtain the frictional property of samples with chemically etched surface texture using the home-made friction testing machine. Finally, the mechanical rheological model is used to analyze the lubrication state and load-bearing mechanism to prove the results. The results show that the chemically etched surface texture was composed of asperities and pits. The characteristics of surface texture with different etching time show a certain pattern, and the surface of the die had certain hydrophilicity. In addition, the chemically etched surface texture can effectively reduce the friction coefficient between the die and the plate under high load condition (nominal pressure ≥ 32MPa), with an average reduction of 35.6%, a maximum reduction of 49.5% (nominal pressure = 72 MPa, arithmetical mean height of the scale limited surface Sn=1.3.And the analysis results show that the friction coefficient is mainly determined by the area ratio of closed oil pit which was obtained using the image processing technology of MATLAB to verification experiment results. The calculation data and the experiment results are consistent which proves the conclusion.

Polysaccharides from Chinese medicines are attracting increasing attention to their wide range of valuable biological activities. As these polysaccharides are mostly from edible materials, their safety can be greatly ensured. Therefore, the Chinese medicine polysaccharides have been the focus of research and development of new drugs and health products. However, there are rarely successful cases. Here, based on the authors' own research experience, the difficulties and challenges in chemical analysis and mechanism study of Chinese medicine polysaccharides are discussed, in the hope of eliciting more innovative ideas and solutions.

We propose an effective method to manipulate the flow of surface plasmons propagating in a longitudinally modulated metasurface formed by periodic silver ridge gratings. We show that band structures with elliptical, flat and hyperbolic dispersion profiles can be achieved in surface ridge grating metasurface with different ridge height and width, therefore, the propagation behaviors of the surface plasmons in the metasurface can be actively molded in longitudinally modulated ridge grating metasurface. Both self-focusing and self-bending propagation of surface plasmons are demonstrated. Such longitudinally modulated metasurfaces provide a good platform to steer or mold the flow of surface plasmons, which may have many potential applications in nanoplasmonics such as on-chip directional routing of surface plasmons, subwavelength beam steering and on-chip signal processing.

An improved analytical model is developed to predict the dynamic response of clamped lightweight sandwich beams with cellular cores subjected to shock loading over the entire span. The clamped face sheets are simplified as a single-degree-of-freedom (SDOF) system, and the core is idealized using the rigid-perfectly-plastic-locking (RPPL) model. Reflection of incident shock wave is considered by incorporating the bending/stretching resistance of the front face sheet and compaction of the core. The model is validated with existing analytical predictions and FE simulation results, with good agreement achieved. Compared with existing analytical models, the proposed model exhibits superiority in two aspects: the deformation resistance of front face sheet during shock wave reflection is taken into account; the effect of pulse shape is considered. The practical application range of the proposed model is therefore wider. Keywords: Sandwich beam, Cellular core, Shock loading, Analytical model

Background CpG oligodeoxynucleotides, which boast anti-inflammatory, anti-infectious, and chemotherapeutic activities, are promising immunomodulators. Recently, some preclinical studies have highlighted the potent immunostimulatory and anti-tumor effects of CpG oligodeoxynucleotides, which has aroused interest in their potential clinical effects on human cancers. Methods In this study, we evaluated the therapeutic effect of a new type of CpG oligodeoxynucleotide whose sequence (5’-AACGTTGTCGTCGACGTCGTCGTCAGGCCTGACGTTATCGATGGCGTTGTCGTCAACGTTGTCGTTAACGTT-3’) was designed by our laboratory in combination with epirubicin in a bladder tumor rat model induced by N-methyl-N-nitrosourea instillation. Moreover, we explored the safety of the novel CpG oligodeoxynucleotide for bladder tumor therapy by observing the degree of cystolith in the bladder and comparing the results against those of Bacillus Calmette–Guérin therapy, which is a gold-standard treatment for bladder tumor. Results All results showed that CpG oligodeoxynucleotide combined with epirubicin significantly inhibited the growth of bladder tumors and reduced the pathological grading. As compared with bladder cells or cytokines observed under the positive control or epirubicin-alone treatment conditions, all indexes including histopathological grading, Mutation P53 gene protein expression, and Interleukin-2 (IL-2) level were significantly optimized by instillation of CpG oligodeoxynucleotide. Immunohistochemical examination indicated that CpG oligodeoxynucleotide reduced the expression of Mutation P53 gene protein in the bladder tumor rat model. Specifically, the level of IL-2 in rat serum was increased by more than 30% CpG oligodeoxynucleotide treatment combined with epirubicin. Also, in comparison with the degree of cystolith observed in the Bacillus Calmette–Guérin group, no obvious side effects were caused by CpG oligodeoxynucleotide. Conclusions CpG oligodeoxynucleotide as an immunomodulator can enhance the efficacy of epirubicin and presents higher safety than Bacillus Calmette–Guérin in treating bladder cancer.

Anisotropic microstructures are utilized in various fields owing to their unique properties, such as reversible shape transitions or on-demand and sequential release of drug combinations. In this study, anisotropic multicompartmental microfibers composed of different polymers are prepared via charge reversal electrohydrodynamic (EHD) co-jetting. The combination of various polymers, such as thermoplastic polyurethane, poly(D,L-lactide-co-glycolide), poly(vinyl cinnamate), and poly(methyl methacrylate), results in microfibers with distinct compositional boundaries. Charge reversal during EHD co-jetting enables facile fabrication of multicompartmental microfibers with the desired composition and tunable inner architecture, broadening their spectrum of potential applications, such as functional microfibers and cell scaffolds with multiple physical and chemical properties.

AudienceMR is designed as a multi-user mixed reality space that seamlessly extends the local user space to become a large, shared classroom where some of the audience members are seen seated in a real space, and more members are seen through an extended portal. AudienceMR can provide a sense of the presence of a large-scale crowd/audience with the associated spatial context. In contrast to virtual reality (VR), however, with mixed reality (MR), a lecturer can deliver content or conduct a performance from a real, actual, comfortable, and familiar local space, while interacting directly with real nearby objects, such as a desk, podium, educational props, instruments, and office materials. Such a design will elicit a realistic user experience closer to an actual classroom, which is currently prohibitive owing to the COVID-19 pandemic. This paper validated our hypothesis by conducting a comparative experiment assessing the lecturer’s experience with two independent variables: (1) an online classroom platform type, i.e., a 2D desktop video teleconference, a 2D video screen grid in VR, 3D VR, and AudienceMR, and (2) a student depiction, i.e., a 2D upper-body video screen and a 3D full-body avatar. Our experiment validated that AudienceMR exhibits a level of anxiety and fear of public speaking closer to that of a real classroom situation, and a higher social and spatial presence than 2D video grid-based solutions and even 3D VR. Compared to 3D VR, AudienceMR offers a more natural and easily usable real object-based interaction. Most subjects preferred AudienceMR over the alternatives despite the nuisance of having to wear a video see-through headset. Such qualities will result in information conveyance and an educational efficacy comparable to those of a real classroom, and better than those achieved through popular 2D desktop teleconferencing or immersive 3D VR solutions.

Purpose The RefleXion™ X1 is a novel radiotherapy system that is designed for image-guided radiotherapy, and eventually, biology-guided radiotherapy (BgRT). BgRT is a treatment paradigm that tracks tumor motion using real-time positron emission signals. This study reports the small-field measurement results and the validation of a Monte Carlo (MC) model of the first clinical RefleXion unit. Methods The RefleXion linear accelerator (linac) produces a 6 MV flattening filter free (FFF) photon beam and consists of a binary multileaf collimator (MLC) system with 64 leaves and two pairs of y-jaws. The maximum clinical field size achievable is 400 × 20 mm2 . The y-jaws provide either a 10 or 20 mm opening at source-to-axis distance (SAD) of 850 mm. The width of each MLC leaf at SAD is 6.25 mm. Percentage depth doses (PDDs) and relative beam profiles were acquired using an Edge diode detector in a water tank for field sizes from 12.5 × 10 to 100 × 20 mm2 . Beam profiles were also measured using films. Output factors of fields ranging from 6.25 × 10 to 100 × 20 mm2 were measured using W2 scintillator detector, Edge detector, and films. Output correction factors k of the Edge detector for RefleXion were calculated. An MC model of the linac including pre-MLC beam sources and detailed structures of MLC and lower y-jaws was validated against the measurements. Simulation codes BEAMnrc and GATE were utilized. Results The diode measured PDD at 10 cm depth (PDD10) increases from 53.6% to 56.9% as the field opens from 12.5 × 10 to 100 × 20 mm2 . The W2-measured output factor increases from 0.706 to 1 as the field opens from 6.25 × 10 to 100 × 20 mm2 (reference field size). The output factors acquired by diode and film differ from the W2 results by 1.65% (std = 1.49%) and 2.09% (std = 1.41%) on average, respectively. The profile penumbra and full-width half-maximum (FWHM) measured by diode agree well with the film results with a deviation of 0.60 mm and 0.73% on average, respectively. The averaged beam profile consistency calculated between the diode- and film-measured profiles among different depths is within 1.72%. By taking the W2 measurements as the ground truth, the output correction factors k for Edge detector ranging from 0.958 to 1 were reported. For the MC model validation, the simulated PDD10 agreed within 0.6% to the diode measurement. The MC-simulated output factor differed from the W2 results by 2.3% on average (std = 3.7%), while the MC simulated beam penumbra differed from the diode results by 0.67 mm on average (std = 0.42 mm). The MC FWHM agreed with the diode results to within 1.40% on average. The averaged beam profile consistency calculated between the diode and MC profiles among different depths is less than 1.29%. Conclusions This study represents the first small-field dosimetry of a clinical RefleXion system. A complete and accurate MC model of the RefleXion linac has been validated.