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Objective To analyze the clinical value of high b-value 3.0 T biparametric magnetic resonance with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) in biopsy-naive men. Methods A retrospective analysis of the data of 224 patients who underwent prostate biopsy (cognitive fusion targeted biopsy combined with systematic biopsy) after a high b-value 3.0 T magnetic resonance examination at Haikou Hospital from July 2018 to July 2020 was performed. Two radiologists performed multi-parameter magnetic resonance imaging (mp-MRI) with the prostate imaging report and data system version 2 (PI-RADS v2) and biparametric magnetic resonance imaging (bp-MRI) with the simplified prostate image reporting and data system (S-PI-RADS). The detection efficacy of the two regimens was evaluated by classifying prostate cancer (PCa) and clinically significant prostate cancer (csPCa) according to pathology, and the statistical significance of the differences between the two regimens was determined by Z-test. Results The area under the receiver operating curve (AUC) values of mp-MRI based on PI-RADS v2 and bp-MRI based on S-PI-RADS to detect PCa were 0.905 and 0.892, respectively, while the AUC values for the detection of csPCa were 0.919 and 0.906, respectively. There was no statistically significant difference between the two tests (Z values were 0.909 and 1.145, p > 0.05). Conclusion There was no significant difference in the detection efficacy of high b-value bp-MRI based on the S-PI-RADS score for prostate cancer and clinically significant prostate cancer compared with the standard PI-RADS v2 score with mp-MRI protocols, which can be applied clinically.

For McKeown esophagectomy, hand-sewn and mechanical esophagogastric anastomosis techniques have been improved for constructing esophagogastrostomy. However, postoperative anastomosis-related complication rates remain high in patients undergoing cervical anastomosis. Here, we report an original and reliable hand-sewn cervical tunnel esophagogastric anastomosis technique to maximally reduce cervical anastomotic leakage and stricture rates after McKeown esophagectomy. The key features and innovations of cervical tunnel esophagogastric anastomosis are the right gastroepiploic artery as the center for the esophagogastric anastomosis to reduce ischemia, sufficient width of the anastomotic site for anastomosis without stricture, enfolding of the anastomotic site by the tunnel, and tension- and rotation-free anastomosis.

PURPOSE BCL2 is overexpressed and confers prosurvival signaling in malignant lymphoplasmacytic cells in Waldenström macroglobulinemia (WM). Venetoclax is a potent BCL2 antagonist and triggers in vitro apoptosis of WM cells. The activity of venetoclax in WM remains to be clarified. PATIENTS AND METHODS We performed a multicenter, prospective phase II study of venetoclax in patients with previously treated WM ( NCT02677324 ). Venetoclax was dose-escalated from 200 mg to a maximum dose of 800 mg daily for up to 2 years. RESULTS Thirty-two patients were evaluable, including 16 previously exposed to Bruton tyrosine kinase inhibitors (BTKis). All patients were MYD88 L265P–mutated, and 17 carried CXCR4 mutations. The median time to minor and major responses was 1.9 and 5.1 months, respectively. Previous exposure to BTKis was associated with a longer time to response (4.5 v 1.4 months; P < .001). The overall, major, and very good partial response rates were 84%, 81%, and 19%, respectively. The major response rate was lower in those with refractory versus relapsed disease (50% v 95%; P = .007). The median follow-up time was 33 months, and the median progression-free survival was 30 months. CXCR4 mutations did not affect treatment response or progression-free survival. The only recurring grade ≥ 3 treatment-related adverse event was neutropenia (n = 14; 45%), including one episode of febrile neutropenia. Laboratory tumor lysis without clinical sequelae occurred in one patient. No deaths have occurred. CONCLUSION Venetoclax is safe and highly active in patients with previously treated WM, including those who previously received BTKis. CXCR4 mutation status did not affect treatment response.

To enhance the photocatalytic activity, loading proper semiconductor with high efficiency and low cost is one of the most valid approaches. Herein, various amounts of CoWO4 as a novel metal-free material were loaded on Mn0.47Cd0.53S (MCS) nanorods for photocatalytic hydrogen production reaction. The CoWO4/Mn0.47Cd0.53S-25 (CW/MCS-25) exhibits the highest hydrogen production rate of 41.53 mmol·h−1·g−1 in the Na2S/Na2SO3 system, which is about 2.68 times higher than that of pristine MCS. The Mapping and HRTEM reveals the deposited of CoWO4 on the MCS. The detailed analyses of XPS, EIS, TRPL spectra and transient photocurrent responses indicate that CoWO4 and MCS interacted closely and the photogenerated electrons of CoWO4 can be transferred into MCS. In particular, the introduction of CoWO4 can further transfer the photogenerated holes of MCS, thereby inhibiting the photocorrosion of MCS and improving photocatalytic activity. This work provides a reference for the exploration of noble metal-free composite material and shows great potential in the photocatalytic application.

Semi-supervised learning provides great significance in left atrium (LA) segmentation model learning with insufficient labelled data. Generalising semi supervised learning to cross-domain data is of high importance to further improve model robustness. However, the widely existing distribution difference and sample mismatch between different data domains hinder the generalisation of semi-supervised learning. In this study, we alleviate these problems by proposing an Adaptive Hier10 archical Dual Consistency (AHDC) for the semi-supervised LA segmentation on cross-domain data. The AHDC mainly consists of a Bidirectional Adversarial Inference module (BAI) and a Hierarchical Dual Consistency learning module (HDC). The BAI overcomes the difference of distributions and the sample mismatch between two different domains. It mainly learns two mapping networks adversarially to obtain two matched domains through mutual adaptation. The HDC investigates a hierarchical dual learning paradigm for cross-domain semi-supervised segmentation based on the obtained matched domains. It mainly builds two dual modelling networks for mining the complementary information in both intra-domain and inter-domain. For the intra domain learning, a consistency constraint is applied to the dual-modelling targets to exploit the complementary modelling information. For the inter-domain learning, a consistency constraint is applied to the LAs modelled by two dual modelling networks to exploit the complementary knowl28 edge among different data domains. We demonstrated the performance of our proposed AHDC on four 3D late gadolinium enhancement cardiac MR (LGE-CMR) datasets from different centres and a 3D CT dataset. Compared to other state-of-the-art methods, our proposed AHDC achieved higher segmentation accuracy, which indicated its capability in the cross-domain semi-supervised LA segmentation.

Incentive mechanism design and quality control are two key challenges in data crowdsourcing, because of the need for recruitment of crowd users and their limited capabilities. Without considering users' social influences, existing mechanisms often result in low efficiency in terms of the platform's cost. In this paper, we exploit social influences among users as incentives to motivate users' participation, in order to reduce the cost of recruiting users. Based on social influences, we design incentive mechanisms with the goal of achieving high quality of crowdsourced data and low cost of incentivizing users' participation. Specifically, we consider three scenarios. In the full information scenario, we design task assignment and user recruitment mechanisms to optimize the data quality while reducing the incentive cost. In the partial information scenario, users' qualities and costs are unknown. We exploit the correlation between tasks to overcome the information asymmetry, for both cases of opportunistic crowdsourcing and participatory crowdsourcing. Further, in the dynamic social influence scenario, we investigate the dynamics of users' social influences and design extra rewards for users to make full use of the social influence and achieve maximum cost saving. We evaluate the incentive mechanisms using numerical results, which demonstrate their effectiveness.

Nondipping heart rate (HR), defined as a night/day HR ratio0.90, has been associated with increased mortality in epidemiologic studies. However, its prognostic value in stage 5 chronic kidney disease (CKD5) patients and the effects of parathyroidectomy (PTX) on nondipping HR remain unknown.This case-control study of 162 healthy controls and 502 CKD5 patients was performed between 2011 and 2018, in which CKD5 patients were further divided into non-PTX (n = 186) and severe secondary hyperparathyroidism (SHPT) with PTX (n = 316) subgroups. Each participant underwent 24-hour Holter monitoring for HR ratio. Mortality was followed up in CKD5 patients (median time: 46.0 months).The HR ratio in CKD5 patients was higher than in controls (0.92 ± 0.08 vs 0.81 ± 0.08, P.001), associated with a 44% increase in mortality risk per 0.1 increment (hazard ratio, 1.44; 95% CI: 1.02-2.03; P =.04), and was positively related to serum intact parathyroid hormone levels (P.001). PTX reversed nondipping HR in SHPT patients (n = 50, median time: 6.3 months, P.001). Survival probabilities for PTX (n = 294) were better than non-PTX (n = 47) (hazard ratio, 0.31; 95% CI: 0.14-0.67; P.01) in SHPT patients (serum intact parathyroid hormone500.0 pg/mL).CKD5 patients displayed a nondipping HR pattern, which is a prognostic marker of all-cause mortality. PTX for SHPT patients was associated with a reversal in nondipping HR ratio, which may mediate a better outcome.

To develop and validate a radiomics nomogram for differentiating between malignant pulmonary nodules and benign nodules.56 benign and 51 malignant nodules from 96 patients were analyzed using manual segmentation of the T2-fBLADE-TSE, while the nodules signal intensity (SIlesion), lesion muscle ratio (LMR) and nodule size were all measured and recorded. The maximum relevance and minimum redundancy (mRMR) and the least absolute shrinkage and selection operator (LASSO) were used to select nonzero coefficients and develop the model in pulmonary nodules diagnosis. The radiomics nomogram was also developed. The clinical prediction value was determined by the decision curve analysis (DCA).The nodule size, SIlesion and LMR of the benign group were 1.78 ± 0.57 cm, 227.50 ± 81.39 and 2.40 ± 1.27 respectively, in contrast to the 2.00 ± 0.64 cm, 232.87 ± 82.21 and 2.17 ± 0.91, respectively, in the malignant group (P = 0.09, 0.60 and 0.579). A total of 13 radiomics features were retained. The Rad-score of the benign nodules group was lower than that of the malignant nodules group (P0.0010.049, trainingtest set). The AUC of radiomics signature for nodules diagnosis was 0.82 (95% CI, 0.73-0.91) in the training set and 0.71 (95% CI, 0.51-0.90) in the test set. A nomogram, consisting of 13 radiomics features and nodule size, produced good prediction in the training set (AUC, 0.82; 95% CI, 0.73-0.91), which was significantly better than that of T2-based quantitative parameters (AUC, 0.62; 95% CI, 0.50-0.75, P = 0.003). In the test set, the performance of radiomics nomogram (AUC, 0.70; 95% CI, 0.51-0.90) was also better than that of T2-based quantitative parameters (AUC, 0.46; 95% CI, 0.25-0.67) (P = 0.145). The DCA showed that radiomics nomogram and T2-based quantitative parameter had overall net benefits, while the performance of nomogram was better.We constructed and validated a T2-fBLADE-TSE-based radiomics nomogram that can help to differentiate between malignant pulmonary nodules and benign nodules.

Purpose: Nonampullary duodenal adenocarcinoma (NADA) is a rare disease. Although several prognostic factors have been reported for this disease, they remain controversial due to their rarity. In this study, we retrospectively analyzed 54 cases of invasive NADA, focusing on the microsatellite instability (MSI) phenotype, programmed cell death-ligand 1 (PD-L1) expression, and prognostic factors. Methods: Expression of the PD-L1 protein and cell differentiation markers in tumors was detected by immunohistochemistry. Microsatellite markers (NR-21, NR-22, NR-24, BAT-25, and BAT-26) were amplified for MSI assessment by PCR. Results: The incidence of MSI in invasive NADA was 35.2%. No significant correlation between the MSI phenotype and clinicopathological factors was observed. Positive expression of PD-L1 by immune cells was common in advanced-stage disease (p = 0.054), and positive expression of PD-L1 in cancer cells correlated significantly with the histologically undifferentiated type (p = 0.016). Kaplan-Meier survival analysis demonstrated a significantly better overall survival (OS) in patients with MSI (p = 0.013) and at early-stage disease (p = 0.000) than in those with microsatellite-stable or at late tumor stages. Univariate and multivariate analyses showed that MSI (hazard ratio [HR]: 0.282, 95% confidence interval [CI]: 0.106–0.751, p = 0.011) and early tumor stage (stage I-II) (HR: 8.81, 95% CI: 2.545–30.500, p = 0.001) were independent better prognostic factors of OS. Conclusions: MSI and early tumor stage (stage I-II) were independent better prognostic factors of OS. A high proportion of MSI phenotypes and positive PD-L1 expression may be helpful for identifying immune checkpoint inhibitors as a novel therapeutic strategy.

Semantic segmentation is a fundamental task in remote sensing image processing. It provides pixel-level classification, which is important for many applications, such as building extraction and land use mapping. The development of convolutional neural network has considerably improved the performance of semantic segmentation. Most semantic segmentation networks are the encoder-decoder structure. Bilinear interpolation is an ordinary upsampling method in the decoder, but bilinear interpolation only considers its own features and inserts three times its own features. This over-simple and data-independent bilinear upsampling may lead to suboptimal results. In this work, we propose an upsampling method based on local relations to replace bilinear interpolation. Upsampling is performed by correlating the local relationship of feature maps of adjacent stages, which can better integrate local and global information. We also design a fusion module based on local similarity. Our proposed method with ResNet101 as the backbone of the segmentation network can improve the average F₁ score and overall accuracy of the Vaihingen data set by 2.69% and 1.31%, respectively. Our proposed method also has fewer parameters and less inference time.

Explainable Artificial Intelligence (XAI) is an emerging research topic of machine learning aimed at unboxing how AI systems' black-box choices are made. This research field inspects the measures and models involved in decision-making and seeks solutions to explain them explicitly. Many of the machine learning algorithms can not manifest how and why a decision has been cast. This is particularly true of the most popular deep neural network approaches currently in use. Consequently, our confidence in AI systems can be hindered by the lack of explainability in these black-box models. The XAI becomes more and more crucial for deep learning powered applications, especially for medical and healthcare studies, although in general these deep neural networks can return an arresting dividend in performance. The insufficient explainability and transparency in most existing AI systems can be one of the major reasons that successful implementation and integration of AI tools into routine clinical practice are uncommon. In this study, we first surveyed the current progress of XAI and in particular its advances in healthcare applications. We then introduced our solutions for XAI leveraging multi-modal and multi-centre data fusion, and subsequently validated in two showcases following real clinical scenarios. Comprehensive quantitative and qualitative analyses can prove the efficacy of our proposed XAI solutions, from which we can envisage successful applications in a broader range of clinical questions., 68 pages, 19 figures, submitted to the Information Fusion journal

When a laser beam induces surface tension gradient at the free surface of a liquid, a weak surface depression is expected and has been observed. Here we report giant depression and rupture in “optothermocapillary fluids” under the illumination of laser and sunlight. Computational fluid dynamics models were developed to understand the surface deformation and provided desirable physical parameters of the fluid for maximum deformation. New optothermocapillary fluids were created by mixing transparent lamp oil with different candle dyes. They can be cut open by sunlight and be patterned to different shapes and sizes using an ordinary laser show projector or a common laser pointer. Laser driving and elevation of optothermocapillary fluids, in addition to the manipulation of different droplets on their surface, were demonstrated as an efficient controlling method and platform for optofluidic operations. The fundamental understanding of light-induced giant depression and creation of new optothermocapillary fluids encourage the fundamental research and applications of optofluidics.

At metro stations with very large passenger volumes and severe congestion, random disturbances often occur, resulting in the original offline optimal timetable no longer applicable. Deep reinforcement learning has the advantages of self-learning and online learning, making it possible to solve the energy-aimed train timetable rescheduling (ETTR) problem under random disturbances. In this article, a deep reinforcement learning approach (DRLA) has been proposed and applied to the ETTR problem to reschedule the train timetable in order to achieve the online optimal timetable for the minimum energy usage under disturbances. The proposed DRLA has the advantages of a real-time performance, high learning efficiency, and better energy-saving effect compared with the traditional heuristic algorithms such as genetic algorithm (GA), deep learning methods such as the combination of improved GA and long short-term memory (IGSA-LSTM), or other reinforcement learning algorithms such as deep deterministic policy gradient (DDPG) algorithm. Various experiments are conducted to compare the performance of DRLA and other algorithms. The experimental results indicate that in the two-train metro system and the five-train metro system, DRLA can save an average of energy by 5.11% and 7.29% with an average reaction time of only 0.0013 and 0.0019 s against disturbances, respectively.

BACKGROUND Acute lung injury (ALI) is a common and life-threatening complication of severe acute pancreatitis (SAP). There are currently limited effective treatment options for SAP and associated ALI. Calycosin (Cal), a bioactive constituent extracted from the medicinal herb Radix Astragali exhibits potent anti-inflammatory properties, but its effect on SAP and associated ALI has yet to be determined. AIM To identify the roles of Cal in SAP-ALI and the underlying mechanism. METHODS SAP was induced via two intraperitoneal injections of L-arg (4 g/kg) and Cal (25 or 50 mg/kg) were injected 1 h prior to the first L-arg challenge. Mice were sacrificed 72 h after the induction of SAP and associated ALI was examined histologically and biochemically. An in vitro model of lipopolysaccharide (LPS)-induced ALI was established using A549 cells. Immunofluorescence analysis and western blot were evaluated in cells. Molecular docking analyses were conducted to examine the interaction of Cal with HMGB1. RESULTS Cal treatment substantially reduced the serum amylase levels and alleviated histopathological injury associated with SAP and ALI. Neutrophil infiltration and lung tissue levels of neutrophil mediator myeloperoxidase were reduced in line with protective effects of Cal against ALI in SAP. Cal treatment also attenuated the serum levels and mRNA expression of pro-inflammatory cytokines tumor necrosis factor-α, interleukin-6, IL-1β, HMGB1 and chemokine (CXC motif) ligand 1 in lung tissue. Immunofluorescence and western blot analyses showed that Cal treatment markedly suppressed the expression of HMGB1 and phosphorylated nuclear factor-kappa B (NF-κB) p65 in lung tissues and an in vitro model of LPS-induced ALI in A549 cells suggesting a role for HGMB1 in the pathogenesis of ALI. Furthermore, molecular docking analysis provided evidence for the direct interaction of Cal with HGMB1. CONCLUSION Cal protects mice against L-arg-induced SAP and associated ALI by attenuating local and systemic neutrophil infiltration and inflammatory response via inhibition of HGMB1 and the NF-κB signaling pathway.

Chronic visceral pain (CVP) is one of the common symptoms of many diseases triggered by underlying diseases of the internal organs of the human body. Its causes include vascular mechanisms, mechanical factors, persistent inflammation, and unexplained functional mechanisms. Although the pathogenesis is unclear, more and more research has begun to shift from the neuronal aspect to the glial cells in recent years. Some data highlight that the spinal glial cells, particularly the microglia and astrocytes, play an essential role in CVP. Based on this, we highlight the mechanisms of microglia and astrocytes in CVP concerning the release of cytokines, chemokines, and neuroactive substances and alterations in intracellular signaling pathways during the process. Finally, because CVP is widespread in various diseases, we present future perspectives targeting microglia and astrocytes for treatment.

Activating mutations in MYD88 promote malignant cell growth and survival through hematopoietic cell kinase (HCK)–mediated activation of Bruton tyrosine kinase (BTK). Ibrutinib binds to BTKCys481 and is active in B-cell malignancies driven by mutated MYD88. Mutations in BTKCys481, particularly BTKCys481Ser, are common in patients with acquired ibrutinib resistance. We therefore performed an extensive medicinal chemistry campaign and identified KIN-8194 as a novel dual inhibitor of HCK and BTK. KIN-8194 showed potent and selective in vitro killing of MYD88-mutated lymphoma cells, including ibrutinib-resistant BTKCys481Ser-expressing cells. KIN-8194 demonstrated excellent bioavailability and pharmacokinetic parameters, with good tolerance in rodent models at pharmacologically achievable and active doses. Pharmacodynamic studies showed sustained inhibition of HCK and BTK for 24 hours after single oral administration of KIN-8194 in an MYD88-mutated TMD-8 activated B-cell diffuse large B-cell lymphoma (ABC DLBCL) and BCWM.1 Waldenström macroglobulinemia (WM) xenografted mice with wild-type BTK (BTKWT)– or BTKCys481Ser-expressing tumors. KIN-8194 showed superior survival benefit over ibrutinib in both BTKWT- and BTKCys481Ser-expressing TMD-8 DLBCL xenografted mice, including sustained complete responses of >12 weeks off treatment in mice with BTKWT-expressing TMD-8 tumors. The BCL_2 inhibitor venetoclax enhanced the antitumor activity of KIN-8194 in BTKWT- and BTKCys481Ser-expressing MYD88-mutated lymphoma cells and markedly reduced tumor growth and prolonged survival in mice with BTKCys481Ser-expressing TMD-8 tumors treated with both drugs. The findings highlight the feasibility of targeting HCK, a key driver of mutated MYD88 pro-survival signaling, and provide a framework for the advancement of KIN-8194 for human studies in B-cell malignancies driven by HCK and BTK.

Lymphovascular invasion (LVI) is a factor significantly impacting treatment and outcome of patients with gastric cancer (GC). We aimed to investigate prognostic aspects of a preoperative LVI prediction in GC using radiomics and deep transfer learning (DTL) from contrast-enhanced CT (CECT) imaging. A total of 1062 GC patients (728 training and 334 testing) between Jan 2014 and Dec 2018 undergoing gastrectomy were retrospectively included. Based on CECT imaging, we built two gastric imaging (GI) markers, GI-marker-1 from radiomics and GI-marker-2 from DTL features, to decode LVI status. We then integrated demographics, clinical data, GI markers, radiologic interpretation, and biopsies into a Gastric Cancer Risk (GRISK) model for predicting LVI. The performance of GRISK model was tested and applied to predict survival outcomes in GC patients. Furthermore, the prognosis between LVI (+) and LVI (−) patients was compared in chemotherapy and non-chemotherapy cohorts, respectively. GI-marker-1 and GI-marker-2 yield similar performance in predicting LVI in training and testing dataset. The GRISK model yields the diagnostic performance with AUC of 0.755 (95% CI 0.719–0.790) and 0.725 (95% CI 0.669–0.781) in training and testing dataset. Patients with LVI (+) trend toward lower progression-free survival (PFS) and overall survival (OS). The difference of prognosis between LVI (+) and LVI (−) was more noticeable in non-chemotherapy than that in chemotherapy group. Radiomics and deep transfer learning features on CECT demonstrate potential power for predicting LVI in GC patients. Prospective use of a GRISK model can help to optimize individualized treatment decisions and predict survival outcomes.

Background Ulcerative colitis (UC) and Crohn’s disease (CD) are 2 subtypes of inflammatory bowel disease (IBD). Several studies have reported brain abnormalities in IBD patients. This study aims to identify differences of gray matter volume (GMV) between patients with UC and healthy controls (HCs). Methods Fifty-seven patients with UC and 40 HCs underwent structural magnetic resonance imaging. Voxel-based morphometry method was used to detect GMV differences. Receiver operating characteristic (ROC) curve was applied to investigate reliable biomarkers for identifying patients with UC from HCs. Regression analysis was used to examine relationships between the structure alternations and clinical symptoms. Results Compared with HCs, patients with UC showed decreased GMV in the insula, thalamus, pregenual anterior cingulate cortex, hippocampus/parahippocampus, amygdala, and temporal pole; they showed increased GMV in the putamen, supplementary motor area, periaqueductal gray, hypothalamus, and precentral gyrus. Receiver operating characteristic analysis showed the highest classification power of thalamus. The inclusion of anxiety and depression as covariates eliminated the differences in the right insula, pregenual anterior cingulate cortex, supplementary motor area, and precentral gyrus. Most of the GMV changes were found in active patients with UC, with few changes in patients with UC in remission. We also found significantly negative correlation between UC duration and GMV in several regions. Conclusion The current neuroimaging findings were involved in visceral sensory pathways and were partially associated with the levels of anxiety and depression and clinical stage of patients with UC. This study might provide evidence for possible neuromechanisms of UC.

A visually meaningful image encryption algorithm is presented. More specifically, a strategy of M-ary decomposition is first presented to be used to represent a positive integer in multi base. Then the concept of virtual bits is presented and the relationship between it and the M-ary decomposition is discussed. Based on the M-ary decomposition strategy, a non-standard image pre-encryption algorithm is proposed where each pixel value of the pre-encrypted image is limited to a specified range thus saving a small amount of virtual bits which can also be used to improve the visual quality of cipher images. A Generalized Embedding Model is proposed, where the Generalized-LSB (G-LSB) method is used to embed virtual bits into the host domain and an error-correcting strategy is also presented. The optimal static virtual embedded bits (SVEB) are found and a set of rules for dynamic virtual embedded bits (DVEB) are constructed. Experimental simulations show that the visual quality of cipher images is better than that using existing visually meaningful image encryption algorithms.

In cloud, sensitive data is stored in an encrypted form, and searchable encryption is a technique which allows user to search over encrypted data by keyword and it leaks no useful information. However, the secure searchable encryption scheme which can prevent inside keyword guessing attacks (IKGA) and satisfy multi-trapdoor privacy has not been proposed. We first review the security of Wu et al.’s scheme and demonstrate that their scheme is insecure under IKGA and multi-keyword guessing attacks in this paper. To solve these issues, we propose an improved certificateless public key searchable encryption scheme. Furthermore, we give the proof of the security of our scheme under the computational bilinear Diffie-Hellman assumption. It shows that our scheme can resist IKGA successfully, and provides multi-ciphertext indistinguishability and multi-trapdoor privacy. The better performance is shown in our experiment.

Ejaculation represents a crucial component of sexual behavior in men, which is involved in reward functions of certain brain areas including the nucleus accumbens (NAcc). Lifelong premature ejaculation (PE) is one of the most prevalent sexual dysfunctions in men. It is suggested to be related to abnormal brain function. This study aimed to explore changes of the functional connectivity patterns of NAcc and possible correlations of the neuroimaging abnormalities with clinical features in lifelong PE patients. The sample consisted with 42 lifelong PE patients and 30 healthy controls. All participants underwent functional magnetic resonance imaging scans and clinical symptoms. The functional connectivity (FC) approach was applied to investigate differences of NAcc-seed intrinsic connectivity between two groups and correlation analysis was used to access possible relationships between the imaging findings and clinical features, such as premature ejaculation diagnostic tool (PEDT) or intravaginal ejaculatory latency time (IELT). Results showed that lifelong PE patients had decreased FC between the NAcc and thalamus, superior temporal pole, superior temporal cortex (STC), inferior frontal gyrus (IFG), orbitofrontal cortex, caudate and putamen. A significantly negative correlation between the PEDT score and NAcc-STC connectivity (r = −0.46) was found in lifelong PE patients, while IELT score positively correlated with the NAcc-IFG connectivity (r = 0.48) and NAcc-thalamus connectivity (r = 0.46). The findings may facilitate a more sophisticated understanding of neural mechanisms of lifelong PE, particularly associated with the NAcc-related intrinsic connectivity during the resting state.

MYD88 and CXCR4 mutations are common in Waldenström macroglobulinemia (WM). Mutated CXCR4 (CXCR4Mut) impacts BTK-inhibitor response. We conducted a phase 1 trial of the CXCR4-antagonist ulocuplumab with ibrutinib in this first-ever study to target CXCR4Mut in WM. Ibrutinib was initiated at 420 mg/d with cycle 1 and continued until intolerance or progression; ulocuplumab was given cycles 1 to 6, with a 3 + 3 dose-escalation design. Each cycle was 4 weeks. Thirteen symptomatic patients, of whom 9 were treatment-naive patients were enrolled. Twelve were evaluable for response. At best response, their median serum immunoglobulin M declined from 5574 to 1114 mg/dL; bone marrow disease decreased from 65% to 10%, and hemoglobin increased from 10.1 to 14.2 g/dL (P < .001). The major and VGPR response rates were 100% and 33%, respectively, with VGPRs observed at lower ulocuplumab dose cohorts. Median times to minor and major responses were 0.9 and 1.2 months, respectively. With a median follow-up of 22.4 months, the estimated 2-year progression-free survival was 90%. The most frequent recurring grade ≥2 adverse events included reversible thrombocytopenia, rash, and skin infections. Ulocuplumab dose-escalation did not impact adverse events. The study demonstrates the feasibility of combining a CXCR4-antagonist with ibrutinib and provides support for the development of CXCR4-antagonists for CXCR4Mut WM. This trial was registered at www.clinicaltrials.gov as #NCT03225716.

Background Cumulative CT radiation damage was positively correlated with increased tumor risks. Although it has recently been known that non-radiation MRI is alternative for pulmonary imaging. There is little known about the value of MRI T1-mapping in the diagnosis of pulmonary nodules. This article aimed to investigate the value of native T1-mapping-based radiomics features in differential diagnosis of pulmonary lesions. Methods 73 patients underwent 3 T-MRI examination in this prospective study. The 99 pulmonary lesions on native T1-mapping images were segmented twice by one radiologist at indicated time points utilizing the in-house semi-automated software, followed by extraction of radiomics features. The inter-class correlation coefficient (ICC) was used for analyzing intra-observer’s agreement. Dimensionality reduction and feature selection were performed via univariate analysis, and least absolute shrinkage and selection operator (LASSO) analysis. Then, the binary logical regression (LR), support vector machine (SVM) and decision tree classifiers with the input of optimal features were selected for differentiating malignant from benign lesions. The receiver operative characteristics (ROC) curve, area under the curve (AUC), sensitivity, specificity and accuracy were calculated. Z-test was used to compare differences among AUCs. Results 107 features were obtained, of them, 19.5% (n = 21) had relatively good reliability (ICC ≥ 0.6). The remained 5 features (3 GLCM, 1 GLSZM and 1 shape features) by dimensionality reduction were useful. The AUC of LR was 0.82(95%CI: 0.67–0.98), with sensitivity, specificity and accuracy of 70%, 85% and 80%. The AUC of SVM was 0.82(95%CI: 0.67–0.98), with sensitivity, specificity and accuracy of 70, 85 and 80%. The AUC of decision tree was 0.69(95%CI: 0.49–0.87), with sensitivity, specificity and accuracy of 50, 85 and 73.3%. Conclusions The LR and SVM models using native T1-mapping-based radiomics features can differentiate pulmonary malignant from benign lesions, especially for uncertain nodules requiring long-term follow-ups.

Due to flexible deployment, an unmanned aerial relaying (UAR) system has been considered as a promising aerial communication platform to complement current terrestrial infrastructure in scenarios like temporary hotspots, disaster areas, and complex terrains. However, practical UAR systems may not be able to provide ubiquitous and high-quality wireless connections, mainly due to frequent landing for replenishing the limited on-board energy storage. Hence, they are unable to hover for a long time before landing to replenish energy. To save UAR's energy, we propose a joint communication and placement design for energy-efficient communications in a multi-hop UAR system. Specifically, we formulate the energy-efficient communication problem, called ECR, by jointly considering routing, data rate, transmission power, and UAV position. Since ECR is a non-convex nonlinear programming, we reformulate ECR as ECR-C and ECR-P by fixing UAV position and data rate, respectively. Then we develop an -bounded approximation algorithm to solve ECR-C, and reformulate ECR-P as a global consensus optimization problem solved by an ADMM (alternating direction method of multipliers) method. In particular, all UAVs locally update their positions in parallel, reducing the computation and implementation complexity significantly. Extensive simulation results show the energy efficiency improvement by about 15% compared with other existing algorithms.

Background Enteral nutrition is a major pathway of nutrition for patients requiring critical care. However, it remains unclear whether intermittent or continuous feeding is the better approach, especially after nasogastric enteral nutrition via a gastric tube. Therefore, this randomized controlled clinical study was designed to observe the effects of different methods on critically ill patients. Methods Different Feeding Methods on Gastrointestinal Function of Critical patients (DFM-GFC) is a randomized clinical study that will be performed to assess the effects of three feeding methods on critically ill patients. A total of 90 critically ill patients will be equally randomized into three groups: continuous feeding, cyclic feeding, and intermittent feeding. The patients will be administered a gastrointestinal nutrition preparation over 24 h via a gastric tube or over 16 h via an intermittent pump. The primary outcome is the mean duration (days) to reach the caloric goal in each group. Secondary outcomes include the rate of onset of gastric residual, abdominal pressure, the rate of onset pneumonia, and the proportion of individuals achieving the caloric goal. Additionally, the length of intensive care unit (ICU) stay and mortality rate at 28 days post-enrolment will be evaluated. Discussion This study will observe the effects of different feeding methods on various parameters, such as the energy target and gastrointestinal motility, in critically ill patients to improve quality of life and reduce the case fatality rate. The purpose of this study is to explore whether there is a more effective, safer and cost-efficient feeding method for the clinical treatment of critically ill patients. Trial registration ID: NCT04224883, ClinicalTrials.gov, registered January 9, 2020

Data from the cellular network have been proved as one of the most promising way to understand large-scale human mobility for various ubiquitous computing applications due to the high penetration of cellphones and low collection cost. Existing mobility models driven by cellular network data suffer from sparse spatial-temporal observations because user locations are recorded with cellphone activities, e.g., calls, text, or internet access. In this paper, we design a human mobility recovery system called CellSense to take the sparse cellular billing data (CBR) as input and outputs dense continuous records to recover the sensing gap when using cellular networks as sensing systems to sense the human mobility. There is limited work on this kind of recovery systems at large scale because even though it is straightforward to design a recovery system based on regression models, it is very challenging to evaluate these models at large scale due to the lack of the ground truth data. In this paper, we explore a new opportunity based on the upgrade of cellular infrastructures to obtain cellular network signaling data as the ground truth data, which log the interaction between cellphones and cellular towers at signal levels (e.g., attaching, detaching, paging) even without billable activities. Based on the signaling data, we design a system CellSense for human mobility recovery by integrating collective mobility patterns with individual mobility modeling, which achieves the 35.3% improvement over the state-of-the-art models. The key application of our recovery model is to take regular sparse CBR data that a researcher already has, and to recover the missing data due to sensing gaps of CBR data to produce a dense cellular data for them to train a machine learning model for their use cases, e.g., next location prediction.

Background With the increasing fragmentation of landscape induced by rapid urbanization, the construction of ecological networks is of great significance to alleviate the degradation of urban habitats and protect natural environments. However, there is considerable uncertainty when constructing ecological networks, especially the different approaches to selecting ecological sources. We used the southern Chinese city of Shenzhen as a study area to construct and optimize ecological networks using a coupling approach. Ecological source areas were extracted using morphological spatial pattern analysis (MSPA) and the landscape index method. Ecological networks were constructed using the minimal cumulative resistance (MCR) model and the gravity model. Stepping stones and ecological fault points were added in corridors to optimize the ecological network. Results Ten core areas with maximum importance patch values were extracted by the landscape index method as ecological source areas according to MSPA, after which corridors between ecological sources were constructed based on the MCR model. The constructed ecological networks were optimized using 35 stepping stones and 17 ecological fault points. The optimized ecological networks included 11 important corridors, 34 general corridors, and seven potential corridors. The results of corridor landscape-type analysis showed that a suitable ecological corridor is 60 to 200 m wide. Conclusions Overall, our results imply that ecological source areas can be identified virtually, and that ecological networks can be significantly optimized by combining MSPA and MCR models. These results provide a methodological reference for constructing ecological networks, and they will be useful for urban planning and biodiversity protection in Shenzhen and other similar regions around the world.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious drug-related adverse event. To identify pharmacogenomic markers of MRONJ associated with bisphosphonate therapy, we conducted a genomewide association study (GWAS) meta-analysis followed by functional analysis of 5,008 individuals of European ancestry treated with bisphosphonates, which includes the largest number of MRONJ cases to date (444 cases and 4,564 controls). Discovery GWAS was performed in randomly selected 70% of the patients with cancer and replication GWAS was performed in the remaining 30% of the patients with cancer treated with intravenous bisphosphonates followed by meta-analysis of all 3,639 patients with cancer. GWAS was also performed in 1,369 patients with osteoporosis treated with oral bisphosphonates. The lead single-nucleotide polymorphism (SNP), rs2736308 on chromosome 8, was associated with an increased risk of MRONJ with an odds ratio (OR) of 2.71 and 95% confidence interval (CI) of 1.90–3.86 (P=3.57*10−8) in the meta-analysis of patients with cancer. This SNP was validated in the MRONJ GWAS in patients with osteoporosis (OR: 2.82, 95% CI: 1.55–4.09, P=6.84*10−4). The meta-analysis combining patients with cancer and patients with osteoporosis yielded the same lead SNP rs2736308 on chromosome 8 as the top SNP (OR: 2.74, 95% CI: 2.09–3.39, P=9.65*10−11). This locus is associated with regulation of the BLK, CTSB, and FDFT1 genes, which had been associated with bone mineral density. FDFT1 encodes a membrane-associated enzyme, which is implicated in the bisphosphonate pathway. This study provides insights into the potential mechanism of MRONJ.

To retrospectively compare the efficacy and safety of prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) and simple TURP in treating large (> 100 mL) benign prostatic hyperplasia (BPH). We retrospectively analyzed the clinical data of 13 and 17 patients with large BPH who underwent TURP and PAE + TURP, respectively, from January 2016 to January 2020. The changes in various indices before and after surgery were compared between the two groups. In the PAE + TURP group, the operation time (OT), intraoperative blood loss (BL), postoperative bladder flushing time (PBFT), and postoperative catheter retention time (PCRT) were lower, and the speed of the excised lesion (SEL) was higher than that in the TURP group (P

Premenstrual syndrome (PMS) is a menstrual cycle-related disorder. Previous studies have indicated alterations of brain functional connectivity in PMS patients. However, little is known about the overall organization of brain network in PMS patients. Functional magnetic resonance imaging data deriving from 20 PMS patients and 21 healthy controls (HCs). Pearson correlation between mean time-series was used to estimate connectivity matrix between each paired regions of interest, and the connectivity matrix for each participant was then binarized. Graph theory analysis was applied to assess each participant's global and local topological properties of brain functional network. Correlation analysis was performed to evaluate relationships between the daily rating of severity of problems (DRSP) and abnormal network properties. PMS patients had lower small-worldness values than HCs. PMS-related alterations of nodal properties were mainly found in the posterior cingulate cortex, precuneus and angular gyrus. The PMS-related abnormal connectivity components were mainly associated with the thalamus, putamen and middle cingulate cortex. In the PMS group, the DRSP score were negatively correlated with the area under the curves of nodal local efficiency in the posterior cingulate cortex. Our study suggests that the graph-theory method may be one potential tool to detect disruptions of brain connections and may provide important evidence for understanding the PMS from the disrupted network organization perspective.

Fluorophores with emission in the second near-infrared window (NIR-II) have displayed salient advantages for biomedical applications. However, the common strategy of reducing the energy bandgap of fluorophores so as to achieve red-shifted wavelengths always leads to compromised fluorescent brightness. Herein, we propose a molecular design concept of "ring-fusion" to modify the acceptor of AIEgen that can extend the luminous wavelength from NIR-I to NIR-II. The fused-acceptor-containing fluorophore yielded, TTQP, has an enhanced absorption coefficient with a higher brightness in nanoparticle formation compared to its NIR-I emissive counterpart (TTQ-DP) with a non-fused acceptor. Theoretical calculation further confirms that the ring fusion can efficiently promote the rigidity and planarity of the electron-deficient core, leading to a lower reorganization energy and nonradiative decay. The TTQP NPs yielded thus allow sensitive NIR-II fluorescence imaging of vasculature and intestinal inflammation in mice models. Therefore, we anticipate that our work will provide a promising molecular-engineering strategy to enrich the library and broaden the application scope of NIR-II fluorophores.

The interoperability between the vehicle assembly and ground assembly of wireless charging systems has been specified in international standards. SAE J2954 first proposed an interoperability evaluation method based on interface impedance. However, the impedance measurement is challenging at high frequency since the phase difference between the voltage and current is not easy to measure accurately, especially when it is close to 90°. Small errors in phase angle measurement are amplified in impedance calculation due to the sine/cosine function. This letter proposes an impedance measurement method using the power decomposition algorithm. By decomposing the input power into two orthogonal components, the impedance angle can be calculated without directly measuring the phase difference between the voltage and current. Thus, the measurement results of the impedance angle do not introduce errors. With the proposal, the high-cost probe or complex high-precision phase difference measurement circuit is not needed. The experimental results show that the conventional method's maximum relative error reaches 80%, making interoperability hard to determine. Reversely, with the proposed method, the relative error of impedance measurement is reduced to less than 10%.

Deep convoloutional networks have been widely deployed in modern cyber–physical systems performing different visual classification tasks. As the fog and edge devices have different computing capacity and perform different subtasks, models trained for one device may not be deployable on another. Knowledge distillation technique can effectively compress well trained convolutional neural networks into light-weight models suitable to different devices. However, due to privacy issue and transmission cost, manually annotated data for training the deep learning models are usually gradually collected and archived in different sites. Simply training a model on powerful cloud servers and compressing them for particular edge devices failed to use the distributed data stored at different sites. This offline training approach is also inefficient to deal with new data collected from the edge devices. To overcome these obstacles, in this article, we propose the heterogeneous brain storming (HBS) method for object recognition tasks in real-world Internet of Things (IoT) scenarios. Our method enables flexible bidirectional federated learning of heterogeneous models trained on distributed datasets with a new “brain storming” mechanism and optimizable temperature parameters. In our comparison experiments, this HBS method outperformed multiple state-of-the-art single-model compression methods, as well as the newest multinetwork knowledge distillation methods with both homogeneous and heterogeneous classifiers. The ablation experiment results proved that the trainable temperature parameter into the conventional knowledge distillation loss can effectively ease the learning process of student networks in different methods. To the best of authors’ knowledge, this is the first IoT-oriented method that allows asynchronous bidirectional heterogeneous knowledge distillation in deep networks.

Metal halide perovskite solar cells have demonstrated a high power conversion efficiency (PCE), and further enhancement of the PCE requires a reduction of the bandgap-voltage offset (WOC) and the non-radiative recombination photovoltage loss (ΔVOC,nr). Here, we report an effective approach for reducing the photovoltage loss through the simultaneous passivation of internal bulk defects and dimensionally graded two-dimensional perovskite interface defects. Through this dimensionally graded perovskite formation approach, an open-circuit voltage (VOC) of 1.24 V was obtained with a champion PCE of 21.54% in a 1.63 eV perovskite system (maximum VOC = 1.25 V, WOC = 0.38 V and ΔVOC,nr = 0.10 V); we further decreased the WOC to 0.326 V in a 1.53 eV perovskite system with a VOC of 1.21 V and a PCE of 23.78% (certified 23.09%). This approach is equally effective in achieving a low WOC (ΔVOC,nr) in 1.56 eV and 1.73 eV perovskite solar cell systems, and further leads to the substantially improved operational stability of perovskite solar cells. The use of a dimensionally graded 2D perovskite interface and passivation results in perovskite solar cells with very low photovoltage loss.

Visually meaningful image encryption (VMIE) means that a plain image can be encrypted into a visually meaningful cipher image (VMCI), which makes the secret more imperceptible than noise-like cipher images. Here, we first present a universal embedding model (UEM) and further present a new UEM-based VMIE algorithm. The plain image is pre-encrypted and then embedded into the integer wavelet subbands of the host image in a dynamic way. In order to avoid the overflow, a threshold limiting function is used to modify the range of pixel values of the host image. To adapt different types of wavelet transform subbands, a UEM is proposed to be used to embed the secret information domain into the host domain. Moreover, in the embedding process, a four-dimensional discrete chaotic system is used to ensure the security of embedding. The numbers of embedded bits in the four embedded domains can be adjusted flexibly. A traversal algorithm is designed to find the optimal numbers of embedded bits for different types of wavelet transform in order to achieve an optimal visual quality of cipher images. A matrix-bit-depth-conversion algorithm is designed where a large matrix with low bit depth can be transformed into a small matrix with high bit depth to meet the input requirements of UEM, which means that the size of the plain image is not limited to a quarter of the size of the host image. Simulation results and performance comparisons show that the proposed VMIE algorithm can achieve a better visual quality than existing VMIE algorithms.

Summary Electric vertical takeoff and landing (eVTOL) aircraft have attracted considerable interest as a disruptive technology to transform future transportation systems. Their unique operating profiles and requirements present grand challenges to batteries. This work identifies the primary battery requirements for eVTOL in terms of specific energy and power, fast charging, cycle life, and safety, revealing that eVTOL batteries have more stringent requirements than electric vehicle batteries in all aspects. Notably, we find that fast charging is essential for downsizing aircraft and batteries for low cost while achieving high vehicle utilization rates to maximize revenues. We experimentally demonstrate two energy-dense Li-ion battery designs that can recharge adequate energy for 80 km eVTOL trips in 5–10 min and sustain over 2,000 fast-charge cycles, laying a foundation for eVTOL batteries.

BACKGROUND: Lifelong premature ejaculation (PE) is one common male sexual dysfunction and is implicated in widespread structural and functional abnormalities of bilateral hemispheres. However, whether the inter-hemisphere functional connectivity (FC) of lifelong PE patients was altered still remain unclear. METHODS: Thirty-four lifelong PE patients and 30 healthy controls (HCs) were enrolled in this study and all underwent T1-weighted and resting-state functional MRI (fMRI) scan. The voxel-mirrored homotopic connectivity (VMHC) measure and independent sample t-test were applied to examine the alterations of VMHC values in the patients relative to HCs with the significant threshold at P

Background and rationale Idiopathic pulmonary fibrosis is a critical disease with a poor prognosis. Although different studies have been conducted for the treatment of idiopathic pulmonary fibrosis, limited treatments are available. Jin-shui Huan-xian granule (JHG), which is a Chinese medicine herbal compound, has shown promising efficacy in reducing frequencies of acute exacerbations, improving exercise capacity the quality of life of patients with idiopathic pulmonary fibrosis. This study is to evaluate the efficacy and safety of JHG for IPF. Subjects and methods This is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 312 idiopathic pulmonary fibrosis patients will be enrolled and randomly allocated to one of the two groups with 1:1. After a 2-week washout period, 52-week treatment will also be performed for all the patients. Patients in the experimental group and the control group will be given JHG and JHG placebo, respectively. Outcome measures including acute exacerbations, pulmonary function, dyspnea, exercise capacity, and quality of life will be evaluated in this study. Discussion Based on our previous study, it is hypothesized that JHG will reduce acute exacerbations; improve exercise capacity, pulmonary function, and quality of life; and delay the disease progression-free. High-level evidence-based support for TCM in IPF will also be obtained in this study. Trial registration ClinicalTrials.gov NCT04187690. Register on December 11, 2019

Purpose: Despite significant benefit for other cancer subtypes, immune checkpoint blockade (ICB) therapy has not yet been shown to significantly improve outcomes for men with castration-resistant prostate cancer (CRPC). Prior data have shown that DNA damage response (DDR) deficiency, via genetic alteration and/or pharmacologic induction using DDR inhibitors (DDRi), may improve ICB response in solid tumors in part due to induction of mitotic catastrophe and innate immune activation. Discerning the underlying mechanisms of this DDRi–ICB interaction in a prostate cancer–specific manner is vital to guide novel clinical trials and provide durable clinical responses for men with CRPC. Experimental Design: We treated prostate cancer cell lines with potent, specific inhibitors of ATR kinase, as well as with PARP inhibitor, olaparib. We performed analyses of cGAS–STING and DDR signaling in treated cells, and treated a syngeneic androgen-indifferent, prostate cancer model with combined ATR inhibition and anti–programmed death ligand 1 (anti–PD-L1), and performed single-cell RNA sequencing analysis in treated tumors. Results: ATR inhibitor (ATRi; BAY1895433) directly repressed ATR–CHK1 signaling, activated CDK1–SPOP axis, leading to destabilization of PD-L1 protein. These effects of ATRi are distinct from those of olaparib, and resulted in a cGAS–STING-initiated, IFN-β–mediated, autocrine, apoptotic response in CRPC. The combination of ATRi with anti–PD-L1 therapy resulted in robust innate immune activation and a synergistic, T-cell–dependent therapeutic response in our syngeneic mouse model. Conclusions: This work provides a molecular mechanistic rationale for combining ATR-targeted agents with immune checkpoint blockade for patients with CRPC. Multiple early-phase clinical trials of this combination are underway.

Objectives This study sought to investigate nonculprit plaque characteristics in patients with ST-segment elevation myocardial infarction (STEMI) presenting with plaque erosion (PE) and plaque rupture (PR). Pancoronary vulnerability was considered at nonculprit sites: 1) the CLIMA (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome) study ( 180o; and macrophage accumulation); and 2) the presence of plaque ruptures or thin-cap fibroatheromas (TCFA). Background PE is a unique clinical entity associated with better outcomes than PR. There is limited evidence regarding pancoronary plaque characteristics of patients with culprit PE versus culprit PR. Methods Between October 2016 and September 2018, 523 patients treated by 3-vessel OCT at the time of primary percutaneous intervention were included with 152 patients excluded from final analysis. Results Overall, 458 nonculprit plaques were identified in 202 STEMI patients with culprit PE; and 1,027 nonculprit plaques were identified in 321 STEMI patients with culprit PR. At least 1 CLIMA-defined OCT nonculprit high-risk plaque was seen in 11.4% of patients with culprit PE, but twice as many patients were seen with culprit PR (25.2%; p Conclusions STEMI patients with culprit PE have a limited pancoronary vulnerability that may explain better outcomes in these patients than in STEMI patients with culprit PR.

Water resources infrastructure is critical for energy and food security; however, the development of large-scale infrastructure, such as hydropower dams, may significantly alter downstream flows, potentially leading to water resources management conflicts and disputes. Mutually agreed upon water sharing policies for the operation of existing or new reservoirs is one of the most effective strategies for mitigating conflict, yet this is a complex task involving the estimation of available water, identification of users and demands, procedures for water sharing, etc. A water sharing policy framework that incorporates reservoir operating rules optimization based on conflicting uses and natural hydrologic variability, specifically tailored to drought conditions, is proposed. First, the trade-off between downstream and upstream water availability utilizing multi-objective optimization of reservoir operating rules is established. Next, reservoir operation with the candidate (optimal) rules is simulated, followed by their performance evaluations, and the rule selections for balancing water uses. Subsequently, a relationship between the reservoir operations simulated from the selected rules and drought-specific conditions is built to derive water sharing policies. Finally, the reservoir operating rules are re-optimized to evaluate the effectiveness of the drought-specific water sharing policies. With a case study of the Grand Ethiopian Renaissance Dam (GERD) on the Blue Nile river, it is demonstrated that the derived water sharing policy can balance GERD power generation and downstream releases, especially in dry conditions, effectively sharing the hydrologic risk in inflow variability among riparian countries. The proposed framework offers a robust approach to inform water sharing policies for sustainable management of water resources.

It is difficult to realize a traveling wavemode current on a single conductor loop to generate a wideband circularly polarized (CP) radiation wave using a single feeding structure. In this communication, with the help of the characteristic mode analysis, we cut a wide gap in the annular ring conductor patch and design the feeding structure with capacitive coupling effect on the patch. By this way, the annular patch is effectively distributed with traveling wave currents and a printed annular ring antenna operating in the 2.4 GHz band is constructed. The experimental results show that the proposed antenna can generate CP radiation with impedance and axial ratio bandwidths of 26% and 10.6%, respectively. Meanwhile, this antenna has a good structural tolerance capability.

Two-dimensional (2D) heterostructures show great potential in achieving negative differential resistance (NDR) effects by Esaki diodes and or resonant tunneling diodes. However, most of the reported Esaki diode-based NDR devices realized by bulk 2D films lack sufficient gate tunability, and the tuning of NDR behavior from appearing to vanishing remains elusive. Here, a gate-tunable NDR device is reported based on a vertically stacked black phosphorus (BP) and molybdenum disulfide (MoS2) thin 2D heterojunction. At room temperature, a rectifying ratio of ∼6 orders of magnitude from a reverse rectifying diode to a forward rectifying diode by gate modulation is obtained. Through analyzing the temperature-dependent electrical properties, the tunneling mechanism at a certain gate voltage range is revealed. Moreover, the switchable and continuously gate-tunable NDR behavior is realized with a maximum peak-to-valley ratio of 1.23 at 77 K, as shown in the IDS mappings by sweeping VDS under different VGS. In addition, a compact model for gate-tunable NDR behavior in 2D heterostructures is proposed. To our best knowledge, this is the first demonstration of NDR behavior in BP-MoS2 heterostructures. Consequently, this work sheds light on the gate-tunable NDR devices and reconfigurable logic devices for realizing ternary and reconfigurable logic systems.

The associations between high-density lipoprotein cholesterol (HDL-C) and blood pressure (BP) or hypertension are inconsistent in previous studies. This study aimed to assess these associations in a large cohort of Chinese adults and across different age groups. This cross-sectional association study included 22,081 Chinese adults. Associations of HDL-C with BP and hypertension were analyzed using linear or logistic regression, with or without adjustment for confounding factors. HDL-C was inversely associated with BP and hypertension. These associations were still apparent after adjustment for age, sex, fasting plasma glucose, and low-density lipoprotein cholesterol. Sub-analyses revealed: (1) in the whole cohort and females alone, HDL-C was inversely associated with BP and hypertension in young and middle-aged but not older participants; (2) in males alone, HDL-C was not associated with systolic BP or hypertension. However, HDL-C was either inversely, or not, or positively associated with BP in young, middle-aged, and older males, respectively. After further adjustment for body mass index (BMI), the negative associations of HDL-C with BP and hypertension in the whole cohort became positive ones, and the positive associations only presented in males. These findings suggest that further adjustment for BMI changes inverse associations of HDL-cholesterol with BP and hypertension to positive associations in a cohort of Chinese adults.

Wireless charging for electric vehicles has been investigated in recent years. One of the critical issues of the research is to improve the weak interoperability between two popular charging pads—rectangular pad (RCP) and double-D pad (DDP). This article intends to model the interoperability under pad misalignment and improve it by adjusting the pads’ relative position. First, the variation of interoperability with pad misalignment is analyzed by the flux model. Full output power and high transmission efficiency can be achieved when the two pads are misaligned to a certain distance. Second, the optimal misalignment is obtained by flux calculation and simulation. Third, an adaptive position adjustment method for the transmitting pad based on the variable-step perturbation and observation algorithm is proposed. By searching the maximum dc input current, the optimal position of the transmitting pad can be found. Finally, in the experiment, a 3.3 kW output with 95% coil-coil efficiency is realized when the RCP and DDP interoperate at the optimal position. Compared with the scenario without position adjustment, the improvement of output power and efficiency proves that the proposal can optimize the interoperability between the RCP and DDP.

Far-field super-resolution optical microscopies have achieved incredible success in life science for visualization of vital nanostructures organized in single cells. However, such resolution power has been much less extended to material science for inspection of human-made ultrafine nanostructures, simply because the current super-resolution optical microscopies modalities are rarely applicable to nonfluorescent samples or unlabeled systems. Here, we report an antiphase demodulation pump-probe (DPP) super-resolution microscope for direct optical inspection of integrated circuits (ICs) with a lateral resolution down to 60 nm. Because of the strong pump-probe (PP) signal from copper, we performed label-free super-resolution imaging of multilayered copper interconnects on a small central processing unit (CPU) chip. The label-free super-resolution DPP optical microscopy opens possibilities for easy, fast, and large-scale electronic inspection in the whole pipeline chain for designing and manufacturing ICs.

High-performance electromagnetic interference (EMI) shielding materials with ultralow density, excellent flexibility, and good mechanical properties are highly desirable for aerospace and wearable electronics. Herein, honeycomb porous graphene (HPG) fabricated by laser scribing technology is reported for EMI shielding and wearable applications. Due to the honeycomb structure, the HPG exhibits an EMI shielding effectiveness (SE) up to 45 dB at a thickness of 48.3 μm. The single-piece HPG exhibits an ultrahigh absolute shielding effectiveness (SSE/t) of 240 123 dB cm

Background: Bladder cancer (BLCA) is one of the most common urinary tract malignant tumors. It is associated with poor outcomes, and its etiology and pathogenesis are not fully understood. There is great hope for immunotherapy in treating many malignant tumors; therefore, it is worthwhile to explore the use of immunotherapy for BLCA.Methods: Gene expression profiles and clinical information were obtained from The Cancer Genome Atlas (TCGA), and immune-related genes (IRGs) were downloaded from the Immunology Database and Analysis Portal. Differentially-expressed and survival-associated IRGs in patients with BLCA were identified using computational algorithms and Cox regression analysis. We also performed functional enrichment analysis. Based on IRGs, we employed multivariate Cox analysis to develop a new prognostic index.Results: We identified 261 IRGs that were differentially expressed between BLCA tissue and adjacent tissue, 30 of which were significantly associated with the overall survival (all P

BACKGROUND Abnormalities in the melanocortin receptor 4 (MC4R) gene often lead to obesity, but are rarely associated with other conditions such as epilepsy and sleep disorder. CASE SUMMARY Here, we present a case of a male obese child with a heterozygous variant in MC4R (c.494G>A, p.Arg165Gln) inherited from his father, who presented with disordered sleep and abnormal facial movements. Examination through melatonin rhythm testing and electroencephalography led to a diagnosis of sleep disorder and epilepsy, as his melatonin rhythm was markedly distorted and the electroencephalography revealed epileptic discharges. He received treatment with an antiepileptic drug; however, the therapy was ineffective and the sleep disorder appeared to be deteriorating. Subsequently, we initiated adjuvant treatment with melatonin. Upon re-examination, his body mass index had decreased, the sleep disturbance had resolved, and his seizures were well controlled. Electro-encephalography review was normal, and a typical melatonin rhythm was restored. CONCLUSION We concluded that, in addition to causing obesity, abnormalities in the MC4R gene may contribute to the development of sleep disorders and epilepsy, and that melatonin can be used as an adjuvant therapy to alleviate these symptoms.