Search

During the coronavirus disease 2019 (COVID-19) pandemic, a novel multisystem inflammatory syndrome in children (MIS-C) has been reported worldwide since the first cases were reported in Europe in April 2020. MIS-C is temporally associated with severe acute respiratory syndrome coronavirus 2 infection and shows Kawasaki disease (KD)-like features. The epidemiological and clinical characteristics in COVID-19, KD, and MIS-C differ, but severe cases of each disease share similar clinical and laboratory findings such as a protracted clinical course, multiorgan involvement, and similar activated biomarkers. These findings suggest that a common control system of the host may act against severe disease insult. To solve the enigmas, we proposed the protein-homeostasis-system hypothesis in that every disease involves etiological substances and the host’s immune system controls them by their size and biochemical properties. Also, it is proposed that the etiological agents of KD and MIS-C might be certain strains in the microbiota of human species and etiological substances in severe COVID-19, KD, and MIS-C originate from pathogen-infected cells. Since disease severity depends on the amounts of inflammation-inducing substances and corresponding immune activation in the early stage of the disease, an early proper dose of corticosteroids and/or intravenous immunoglobulin (IVIG) may help reduce morbidity and possibly mortality among patients with these diseases. Corticosteroids are low cost and an analogue of host-origin cortisol among immune modulators. This study’s findings will help clinicians treating severe COVID-19, KD, and MIS-C, especially in developing countries, where IVIG and biologics supplies are insufficient.

The purpose of this study was to investigate the monthly contamination rate of pathogenic Escherichia coli, a major cause of food poisoning, in vegetables sold in agricultural wholesale markets, wh...

We developed a novel therapeutic radioligand, [177Lu]1h, with an albumin binding motif and evaluated it in a prostate-specific membrane antigen (PSMA)-expressing tumor xenograft mouse model. Fourteen PSMA target candidates were synthesized, and binding affinity was evaluated with an in vitro competitive binding assay. First, four compound candidates were selected depending on binding affinity results. Next, we selected four compounds ([68Ga]1e, [68Ga]1g, [68Ga]1h, and [68Ga]1k) were screened for tumor targeting efficiency by micro–positron emission tomography/computed tomography (micro-PET/CT) imaging. Finally, [177Lu]1h compound was evaluated the tumor targeting efficiency and therapeutic efficiency by micro–single-photon emission computed tomography/computed tomography (micro-SPECT/CT), biodistribution, and radiotherapy studies. Estimated human effective dose was calculated by biodistribution data. Compound 1h showed a high binding affinity (Ki value = 4.08 ± 0.08 nmol/L), and [177Lu]1h showed extended blood circulation (1 hour = 10.32 ± 0.31, 6 hours = 2.68 ± 1.07%ID/g) compared to [177Lu]PSMA-617 (1 h = 0.17 ± 0.10%ID/g). [177Lu]1h was excreted via the renal pathway and showed high tumor uptake (24.43 ± 3.36%ID/g) after 1 hour, which increased over 72 hours (72 hours = 51.39 ± 9.26%ID/g). Mice treated with 4 and 6 MBq of [177Lu]1h showed a median survival rate of >61 days. In particular, all mice treated with 6 MBq of [177Lu]1h survived for the entire monitoring period. The estimated human effective dose of [177Lu]1h was 0.07 ± 0.01 and 0.03 ± 0.00 mSv/MBq in total body and kidney, respectively. The current study indicates that [177Lu]1h has the potential for further investigation of metastatic castration-resistant prostate cancer (mCRPC) therapy in clinical trials.

A compact monolithic trantenna (transistor-antenna) device is presented for a high-performance sub-THz wave detector using 28-nm CMOS foundry process. Based on a highly localized plasmonic wave in a silicon nano-ring field-effect transistor (FET), we obtained a total 535-fold photoresponse (Δu) enhancement in an on-chip measurement as compared with our previous works using the same asymmetry ratio (ηa= 30). The inner contact diameter (din) was scaled down from 8 to 0.13 μm for the parasitic resistance limit case. By changing the ground source from inside to outside the nano-ring FET, we could generate different Δu polarities, which in turn reduced the junction leakage with improved |Δu|. From a fabricated nano-ring FET with the outer ring grounded source, we observed 5× of additional |Δu| enhancement followed by 107× with din scaling. In addition, based on the highly localized plasmonic wave nano-ring FET without any external gain, a record-high free-space responsivity of 12.4 kV/W and a reduced noise equivalent power of 1 pW/Hz0.5 were experimentally demonstrated under 0.12-THz radiation.

Purpose: To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma.Methods: This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX).Results: All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis.Conclusions: Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis of the skin and internal organs. Despite the recent advances in the pathogenesis and treatment of SSc, effective therapies for fibrosis caused by SSc have not yet been established. In this study, we investigated the potential role of mirodenafil, a potent phosphodiesterase 5 (PDE5) inhibitor, in the treatment of fibrosis in SSc. We used a bleomycin (BLM)-induced SSc mouse model to mimic the typical features of fibrosis in human SSc and examined the dermal thickness to assess the degree of skin fibrosis after staining with hematoxylin and eosin or Masson’s trichrome stains. The effect of mirodenafil on the expression of profibrotic genes was also analyzed by treating fibroblasts with transforming growth factor (TGF)-β and mirodenafil. We showed that mirodenafil ameliorated dermal fibrosis and downregulated the protein levels of fibrosis markers including COL1A1 and α-SMA in the BLM-induced SSc mouse model. Further, using mouse embryonic fibroblasts and human lung fibroblasts, we demonstrated that the expression of collagen and profibrotic genes was reduced by treatment with mirodenafil. Finally, we showed that mirodenafil inhibited TGF-β-induced phosphorylation of Smad2/3 in fibroblasts, which suggested that this drug may ameliorate fibrosis by suppressing the TGF-β/Smad signaling pathway. Our findings suggest that mirodenafil possesses a therapeutic potential for treating fibrosis in SSc.

This article presents an electromagnetic compatibility (EMC) aware motor design method based on the prediction of the impedances of a stator winding structure. The stator structure is divided into several two-dimensional parts, and their network parameters are extracted by electromagnetic (EM) simulations. Through conversion and synthesis of the multiport network parameters, the input impedance can be found for the full-winding structure. The calculated input impedance approximately follows the measured impedance of tested induction motors. The impedance calculation method has been realized in a parametric analysis platform to enable the EMC-aware design of induction motors. By using the platform, the variations of the input impedances by different design parameters can be analyzed along with consideration of loss and torque ripple. To verify the proposed method, prototype motors were assembled and the common-mode (CM) currents were measured under driving operation. The results show that the CM current can be reduced up to 10 dB in the frequency range of interest when the number of parallel circuit is reduced, as estimated from the calculated input impedances.

The human microbiome, which consists of a collective cluster of commensal, symbiotic, and pathogenic microorganisms living in the human body, plays a key role in host health and immunity. The human nasal cavity harbors commensal bacteria that suppress the colonization of opportunistic pathogens. However, dysbiosis of the nasal microbial community is associated with many diseases, such as acute respiratory infections including otitis media, sinusitis and bronchitis and allergic respiratory diseases including asthma. The nasopharyngeal acquisition of pneumococcus, which exists as a pathobiont in the nasal cavity, is the initial step in virtually all pneumococcal diseases. Although the factors influencing nasal colonization and elimination are not fully understood, the adhesion of opportunistic pathogens to nasopharyngeal mucosa receptors and the eliciting of immune responses in the host are implicated in addition to bacterial microbiota properties and colonization resistance dynamics. Probiotics or synbiotic interventions may show promising and effective roles in the adjunctive treatment of dysbiosis; however, more studies are needed to characterize how these interventions can be applied in clinical practice in the future.

In a large-scale randomized field experiment in Chisinau, Moldova, with over 120,000 households, we tested the influence of a simple, one-time letter presenting electricity-usage social comparison feedback. The letter was framed in either kilowatt-hour units or monetary values. We find that both letter versions significantly reduce recipient households’ electricity consumption by 1.7–2.1 percent in the following month, and the effect persists for at least three months. The effect's magnitude and duration resemble those seen in similar trials in the U.S., even though Moldova's average household electricity consumption level is much lower. As the first large-scale field experiment testing social comparison energy reports in a post-Soviet environment, this study provides empirical evidence that non-price nudges can be an inexpensive yet useful energy conservation policy tool even in non-Western and less industrialized settings. We explore the relationship between Moldova's socioecological contexts and environmental attitudes as a former Soviet Union country and the relatively strong social norm effect that we observed.

Cisplatin has been reported to cause side effects such as muscle wasting in humans and rodents. The physiological mechanisms involved in preventing muscle wasting, such as the regulation of AKT, PGC1-α, and autophagy-related factor FOXO3a by MuRF 1 and Atrogin-1, remain unclear following different types of exercise and in various skeletal muscle types. Eight-week-old male Wistar rats (n = 34) were assigned to one of four groups: control (CON, n = 6), cisplatin injection (1 mg/kg) without exercise (CC, n = 8), cisplatin (1 mg/kg) + resistance exercise (CRE, n = 9) group, and cisplatin (1 mg/kg) + aerobic exercise (CAE, n = 11). The CRE group performed progressive ladder exercise (starting with 10% of body weight on a 1-m ladder with 2-cm-interval grids, at 85°) for 8 weeks. The CAE group exercised by treadmill running (20 m/min for 60 min daily, 4 times/week) for 8 weeks. Compared with the CC group, the levels of the autophagy-related factors BNIP3, Beclin 1, LC3-II/I ratio, p62, and FOXO3a in the gastrocnemius and soleus muscles were significantly decreased in the CRE and CAE groups. The CRE and CAE groups further showed significantly decreased MuRF 1 and Atrogin-1 levels and increased phosphorylation of AKT, FOXO3a, and PGC1-α. These results suggest that both ladder and aerobic exercise directly affected muscle wasting by modulating the AKT/PGC1-α/FOXO3a signaling pathways regardless of the skeletal muscle type.

Warfarin dosing varies due to individual genetic and clinical factors. The utility of genotype‐guided warfarin dosing to improve stable warfarin dose is not extensively studied in non-European popu...

BACKGROUND The survival rate of aneurysmal subarachnoid hemorrhage (aSAH) has gradually increased, leading to more clinical cases of de novo intracranial aneurysms (DNIAs). OBJECTIVE To identify the characteristics of patients with DNIA growth or rupture. METHODS We included 1601 patients with aSAH treated by clipping from January 1993 to May 2010. According to the inclusion and exclusion criteria, 233 patients had no DNIAs, and 63 patients had 77 DNIAs. We assessed the incidence rate of DNIAs and risk factors for DNIA formation. After dichotomizing the DNIA group into the heed (patients with DNIA rupture or growth) and stable groups (patients without DNIA growth), we assessed the risk factors for DNIA growth or rupture. RESULTS The total follow-up period was 4427.9 patient-years. The incidence rate per patient-year was 1.42%. Age ≤50 yr, family history of aneurysm, and multiplicity at initial aSAH were significant risk factors for DNIA formation. Multivariate regression analysis revealed that female sex (odds ratio [OR], 5.566; 95% confidence interval [CI], 1.241-24.952), duration from initial aSAH to DNIA detection

In this study, experiments were carried out to evaluate the seismic performance of a hybrid prestressed precast concrete (HPPC) system devised to ensure the integrity of precast concrete (PC) beam-column joints by introducing the post-tensioning method. A total of four full-scale HPPC beam-column joints were fabricated, and the presence of a topping slab, a post-tensioned length, and a type of tendon were set as the main variables. The quasi-static cyclic loading tests were performed to analyze the load-story drift ratio response, failure mode, ductility, residual deformation, and energy dissipation capacity of each specimen. The seismic performance of the specimen was then quantitatively evaluated based on the acceptance criteria of the ACI 374 report. The shear strength estimation model for the HPPC beam-column joints was also proposed and the proposed model was verified in detail using the test results.

This paper deals with the implementation of test facility for DC AFCI(Arc fault circuit interrupter) series arc detection performance evaluation based on UL1699B standard. The implemented test facility consists of DC source, decoupling network, line impedance, inverter and arc generator. The developed electric arc generator enables precise control for spacing between the arc electrodes. Implemented test facility complies with a single full string model presented on UL1699B. Mode 1 to Mode 4 are presented as test modes. The test conditions of inverter voltage, current, minimum arc current conditions, electrode separation speed and distance are satisfied by implemented test facility when arcing occurred in all test modes. Also the series arc detection performance evaluation result of DC AFCI under the mode 1 condition is presented. The implemented test facility is expected to be applied to the series arc detection performance evaluation of DC AFCI under all test mode conditions.

Consensus remains lack regarding whether sleep-disordered breathing (SDB) is an independent risk factor for lung cancer. We therefore conducted a meta-analysis to clarify the relationship of SDB and lung cancer. Longitudinal follow-up studies investigating the association between SDB and incidence of lung cancer were included by search of electronic databases including PubMed, Embase, and Cochrane's Library. A random-effects model was adopted to combine the results. Seven studies were included. Pooled results showed that presence of SDB was independently associated with higher incidence of lung cancer [adjusted risk ratio (RR): 1.28; 95% confidence interval (CI), 1.11-1.47; P 0.001; I2 = 37%]. Sensitivity analysis limited to studies with adjustment of smoking showed consistent results (three studies, RR: 1.34; 95% CI, 1.22-1.48; P 0.001; I2 = 8%). Subgroup analysis suggested that the association between SDB and higher risk of lung cancer was not significantly affected by study characteristics such as study design, source of population, sample size, evaluation methods for SDB, follow-up duration, methods for validation of lung cancer, or score of study quality (P values for subgroup difference all0.05). No significant publication bias was observed (P for Egger's regression test = 0.258). These results suggested that SDB may be an independent risk factor of lung cancer in adult population. Intensive screening and prevention of lung cancer in subjects with SDB should be considered.

To evaluate the differences in the pullout strength and displacement of pedicle screws in cadaveric thoracolumbar vertebrae with or without artificial demineralization.Five human lumbar and five thoracic vertebrae from one cadaver were divided into two hemivertebrae. The left-side specimens were included in the simulated osteopenic model group and the right-side bones in a control group. In the model group, we immersed each specimen in HCl (1 N) solution for 40 minutes. We measured bone mineral density (BMD) using dual-energy X-ray absorptiometry and quantitative computerized tomography. We inserted polyaxial pedicle screws into the 20 pedicles of the cadaveric lumbar and thoracic spine after measuring the BMD of the 2 hemivertebrae of each specimen. We measured the pullout strength and displacement of the screws before failure in each specimen using an Instron system.The average pullout strength of the simulated osteopenic model group was 76% that of the control group. In the control and model groups, the pullout strength was 1678.87±358.96 N and 1283.83±341.97 N, respectively, and the displacement was 2.07±0.34 mm and 2.65±0.50 mm, respectively (p.05). We detected positive correlations between pullout strength and BMD in the control group and observed a negative correlation between displacement and BMD in the model group.By providing an anatomically symmetric counterpart, the human cadaveric model with or without demineralization can be used as a test bed for pullout tests of the spine. In the simulated osteopenic model group, pullout strength was significantly decreased compared with the untreated control group.Decreased bone mineral density may significantly reduce the pullout strength of a pedicle screw, even though the range is osteopenic rather than osoteoporotic.

To evaluate the outcomes of flow-diverting device (FDD) treatment for large vertebral artery dissecting aneurysms (VADAs). This retrospective study evaluated 12 patients with 12 VADAs who were treated using FDD between 2013 and 2020. Clinical and radiographic data, including procedure-related complications and clinical outcomes assessed using the modified Rankin Scale (mRS) at the time of the last follow-up, were collected and reviewed. All 12 patients had unruptured aneurysms. There were 3 (25%) female and 9 (75%) male patients, and the mean patient age was 54.6 years. The mean size of the aneurysm was 15.9 ± 4.8 mm. The mean follow-up duration was 15.8 months. Single FDD without additional coils was used in all patients. One patient underwent second-line treatment with FDD for recurrence of large VADA after stent-assisted coiling. Immediate follow-up angiography after placement of the FDD demonstrated intra-aneurysmal contrast stasis. There were 2 (17%) patients who had peri-procedural stroke. Angiography at the 6-month follow-up in 10 patients showed favorable occlusion (OKM grade C3 + D). A total of 11 (92%) patients had good clinical outcome (modified Rankin Scale ≤ 2) at the last follow-up. No re-treatment or delayed aneurysm rupture occurred during the follow-up period. Reconstructive technique with FDD is a feasible and effective modality for the treatment of large VADAs, showing favorable occlusion rate and clinical outcome.

Background To evaluate the combined effect of rotational error and dose gradient on target dose coverage in frameless stereotactic radiotherapy. Methods Three spherical targets of different diameters (1, 1.5, and 2 cm) were drawn and placed equidistantly on the same axial brain computed tomography (CT) images. To test the different isocenter-target distances, 2.5- and 5-cm configurations were prepared. Volumetric modulated arc therapy plans were created for different dose gradients from the target, in which the dose gradients were modified using the maximum dose inside the target. To simulate the rotational error, CT images and targets were rotated in two ways by 0.5°, 1°, and 2°, in which one rotation was in the axial plane and the other was in three dimensions. The initial optimized plan parameters were copied to the rotated CT sets, and the doses were recalculated. The coverage degradation after rotation was analyzed according to the target dislocation and 12-Gy volume. Results A shallower dose gradient reduced the loss of target coverage under target dislocation, and the effect was clearer for small targets. For example, the coverage of the 1-cm target under 1-mm dislocation increased from 93 to 95% by increasing the Paddick gradient index from 5.0 to 7.9. At the same time, the widely accepted necrosis indicator, the 12-Gy volume, increased from 1.2 to 3.5 cm3, which remained in the tolerable range. From the differential dose volume histogram (DVH) analysis, the shallower dose gradient ensured that the dose-deficient under-covered target volume received a higher dose similar to that in the prescription. Conclusions For frameless stereotactic brain radiotherapy, the gradient, alongside the margin addition, can be adjusted as an ancillary parameter for small targets to increase target coverage or at least limit coverage reduction in conditions with probable positioning error.

Development of acquired resistance to lapatinib, a dual epidermal growth factor receptor (EGFR)/human epidermal growth factor receptor 2 (HER2) tyrosine kinase inhibitor, severely limits the duration of clinical response in advanced HER2‐driven breast cancer patients. Although the compensatory activation of the PI3K/Akt survival signal has been proposed to cause acquired lapatinib resistance, comprehensive molecular mechanisms remain required to develop more efficient strategies to circumvent this therapeutic difficulty. In this study, we found that suppression of HER2 by lapatinib still led to Akt inactivation and elevation of FOX3a protein levels, but failed to induce the expression of their downstream pro‐apoptotic effector p27kip1, a cyclin‐dependent kinase inhibitor. Elevation of miR‐221 was found to contribute to the development of acquired lapatinib resistance by targeting p27kip1 expression. Furthermore, upregulation of miR‐221 was mediated by the lapatinib‐induced Src family tyrosine kinase and subsequent NF‐κB activation. The reversal of miR‐221 upregulation and p27kip1 downregulation by a Src inhibitor, dasatinib, can overcome lapatinib resistance. Our study not only identified miRNA‐221 as a pivotal factor conferring the acquired resistance of HER2‐positive breast cancer cells to lapatinib through negatively regulating p27kip1 expression, but also suggested Src inhibition as a potential strategy to overcome lapatinib resistance., The downregulation of p27kip1 by Src/NF‐κB axis‐induced miR‐221 expression as a novel mechanistic insight into lapatinib resistance. Targeting Src would be a promising strategy to overcome lapatinib resistance.

Background and Objectives: Biomarkers of allergic rhinitis (AR) have been studied; however, little is known regarding their practical application in the diagnosis of AR. Previous studies collected samples using saline lavage, nasal brushing, or nasal biopsy. To utilize nasal fluid as a diagnostic tool, we need to standardize the method of sample collection. Therefore, this study aimed to evaluate the difference in concentration of biomarkers depending on the method of nasal fluid collection.Materials and Method: Forty-five AR patients who had greater than moderate AR symptoms and who had positive results on skin prick test and serum-specific IgE tests were enrolled in this study. Nasal fluid was collected using the direct method or saline lavage method. The concentration of each biomarker was analyzed using enzyme-linked immunosorbent assay and the values compared.Results: Nasal fluid samples were collected directly from 14 patients and were collected via saline lavage in 31 patients. No significant differences were found in the median value of each biomarker between the two methods of nasal sample collection.Conclusion: Nasal fluid collection method does not significantly affect biomarker concentration.

This study reviewed the pattern of malocclusion among orthodontic patients in East Coast of Sabah and the type of treatment indicated for the patients. A total of 138 pre-treatment orthodontic records of patients who attended the orthodontic consultation clinic in year 2018 were included in this cross-sectional retrospective study. Data taken were demographic data, source of referral, BSI (British Standards Institutes) incisor classification, skeletal pattern, and type of treatment. All data were analysed descriptively using Stata 15. Based on the results, mean age of the patients was 16.89 ± 0.37 years. More females sought orthodontic treatment (n=101, 73.19%) than males. Majority of the patients were Chinese (n=68, 49.28%) and Bumiputera Sabah (n=55, 39.86%). Main source of referral was from dental officers (n=128, 92.75%). The distribution of malocclusion showed high percentage of Class II division 1 (n=56, 40.58%), followed by Class III (n=45, 32.61%), Class I (n=34, 24.64%) and Class II division 2 (n=3, 2.17%). For skeletal pattern, more patients presented with Class II (n=54, 39.13%), while the number of patients presented with Class I and Class III were equal (n=42, 30.43%). Class III malocclusion (n=29, 42.65%) and Class III skeletal pattern (n=29, 42.65%) were more common in Chinese patients. Treatment indicated was mostly fixed orthodontic appliance (n=120, 86.96%). In conclusion, Class II Division 1 malocclusion and Class II skeletal pattern were most common among the patients. Class III malocclusion and Class III skeletal pattern were typical features among the Chinese patients. Fixed orthodontic appliance was the most common treatment method. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-06

Introduction As most patients with polytrauma or open fractures are converted from temporary external fixation to definite stabilization, the prevention of complications such as infection is especially important. To overcome the high risk of infection associated with the use of the conventional bicortical pin for temporary external fixation, the authors developed a novel unicortical pin and analyzed it in a biomechanical study. Methods The unicortical pin consisted of an inner screw, purchasing the cortical bone, and an outer sleeve with 6 spikes. A bicortical pin was used for the purpose of comparison. A fracture gap model was stabilized using a monoplanar configuration. Both the unicortical pins (Uni group) and bicortical pins (Bi group) underwent axial compressive and torsional load testing using a servo-hydraulic testing machine. Stiffness, load to failure, and mode of failure were documented. Results Stiffness and load to failure of the Uni group (average, 40.5 N/mm and 1098.4 N, respectively) were greater than that of the Bi group (average, 33.7 N/mm and 968.6 N, respectively) in the axial compressive load test (P = 0.008 and 0.032). Stiffness and load to failure of the Uni group (average, 1.2 Nm/degree and 1.7 Nm, respectively) were also significantly higher than those of the Bi group (average, 0.8 Nm/degree and 0.6 Nm, respectively) in the torsional load test (P = 0.008 and 0.016). All pins in the Bi group were bent at the pin-synthetic bone interface without synthetic bone failure. Contrarily, the Uni group did not show any pin bending or failure. However, in the axial compression test, partial cracks in the synthetic bone were found at the interface with spikes in the outer shell. In addition, in the torsion test, incomplete fractures were seen through the inner screws' holes. Conclusion Compared with the conventional bicortical pin, the newly designed unicortical pin significantly increased fracture stability under both axial compressive and torsional loads. The unicortical pin can be considered an alternative biomechanical solution to obtain adequate stability when performing external fixation of fractures.

Cloud computing, while becoming more and more popular as a dominant computing platform, introduces new security challenges. When virtual machines are deployed in a cloud environment, virtual machine placement strategies can significantly affect the overall security risks of the entire cloud. In recent years, the attacks are specifically designed to co-locate with target virtual machines in the cloud. The virtual machine placement without considering the security risks may put the users, or even the entire cloud, in danger. In this article, we present a fine-grained model to quantify the risk level caused by co-residency. Using a large scale dataset collected from Microsoft Azure Platform, we profile the behavior patterns of normal service subscribers (tenants) using our proposed feature metrics. Tenants are clustered into multiple categories. After the baseline is established based on the normal behavior pattern, the derivation can be evaluated for each category and the high-risk group can be labeled accordingly. With the labeled datasets, a classification component and a quantification component are constructed to dynamically quantify the co-residency risks for a specific virtual machine. Our experimental results demonstrate the robustness of our model to the new data and the accuracy is verified by examination of F-score Matrix.

Overweight and obesity, which have rapidly increased around the world in recent years, are significant health problems. They can lead to various morbidities, including cardiovascular diseases, cerebrovascular diseases, type 2 diabetes, some types of cancer, and even death. Obesity is caused by an energy imbalance due to excessive calorie intake and insufficient energy consumption, and genetic factors and individual behavioral problems are also known to be major contributing factors. However, these are insufficient to explain the surge in obesity that has occurred in recent decades. Recent studies have suggested that environmental factors arising from the process of socioeconomic development and modernization contribute to this phenomenon. These environmental factors include light pollution due to artificial lighting, air pollution, endocrine-disrupting chemicals, and reduced exposure to green spaces due to urbanization of residential areas. In this manuscript, the findings and mechanisms of these novel risk factors causing overweight and obesity are reviewed.

Object detection algorithms based on deep learning have made continuous progress in recent years. On the premise of ensuring the accuracy of object detection, reducing model complexity and improving detection speed have always been the goals pursued by current object detection algorithms. A lightweight object detection model its backbone based on ShuffleNetV2 network structure named L-Net is presented in this paper. A suitable backbone network was obtained by changing from 3 × 3 depth convolution to 5 × 5 depth convolution and reducing the number of input channels. In order to obtain a more discriminative image feature description, Pyramid Pooling Module and Attention Pyramid Module are added after the backbone network. Experimental results show that the L-Net model only uses 1.54B FLOPs (floating point operations) to achieve 70.2% mAP (mean average precision) on PASCAL VOC2007 and 21.8% mAP on the MS COCO dataset. The model has achieved competitive results in terms of accuracy and speed while being lightweight.

In this paper, we leverage predictive uncertainty of deep neural networks to answer challenging questions material scientists usually encounter in machine learning-based material application workflows. First, we show that by leveraging predictive uncertainty, a user can determine the required training data set size to achieve a certain classification accuracy. Next, we propose uncertainty-guided decision referral to detect and refrain from making decisions on confusing samples. Finally, we show that predictive uncertainty can also be used to detect out-of-distribution test samples. We find that this scheme is accurate enough to detect a wide range of real-world shifts in data, e.g., changes in the image acquisition conditions or changes in the synthesis conditions. Using microstructure information from scanning electron microscope (SEM) images as an example use case, we show that leveraging uncertainty-aware deep learning can significantly improve the performance and dependability of classification models.

Objective To determine monogenic syndromes in cases of fetal akinesia in order to understand the genetic aetiology. Study design Clinical trio exome sequencing (ES) was performed on DNA extracted from postnatal samples in 12 cases with fetal akinesia identified by prenatal ultrasound and a normal chromosomal micro-array analysis result. This test targets coding exons for 4200 clinically relevant disease-causing genes. The interpretation of variants was performed according to the guidelines of the American College of Medical Genetics. Results A definite molecular diagnosis was achieved in six (50 %) of the 12 cases using clinical trio ES. In five cases, the pathogenic variants were located in known fetal-akinesia-associated genes. In one case, the underlying pathogenic variants were in known disease genes that had not been linked to fetal akinesia previously. Six pregnancies were terminated by the parents, and six pregnancies were continued to term. Conclusion Genetic defects leading to fetal akinesia were found in half of the study cases using clinical trio ES. This information will be useful in genetic counselling with regard to prognosis and risk of recurrence.

Background Acute exacerbation of interstitial lung disease (AE-ILD) causes clinically significant deterioration and has an extremely poor prognosis with high mortality. There are currently no demonstrated effective treatments. Recently, several studies reported the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-ILD as a potential therapy. This study describes the clinical effectiveness and safety of PMX-DHP in patients with AE-ILD. Methods We retrospectively reviewed the medical records of 10 patients (11 episodes) with AE-ILD treated with PMX-DHP from January 2018 to June 2019. We compared laboratory and physiologic data of the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) and inflammatory markers before and after implementation of PMX-DHP. Results Ten patients (11 episodes) were included according to the 2016 revised definition of acute exacerbation of idiopathic pulmonary fibrosis (IPF). Nine patients had IPF and one patient had fibrotic nonspecific interstitial pneumonia. Most patients (90.9%) were treated with a steroid pulse, and four patients (36.4%) were treated with an immunosuppressant. The median number of PMX-DHP cycles was 2, and the median duration of each cycle was 6 hours. After PMX-DHP, the mean P/F ratio improved (86 [range, 63-106] vs. 145 [86-260], P=0.030) and interleukin-6 and c-reactive protein decreased (79 [35-640] vs. 10 [5-25], P=0.018 and 14 [4-21] vs. 5 [2-6], P=0.019, respectively). The 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%. There were no adverse events related to PMX-DHP treatment. Conclusion PMX-DHP treatment improved P/F ratio and reduced inflammatory markers in AE-ILD patients.

LiDAR odometry algorithms are extensively studied for vehicular positioning. However, achieving high-precision positioning using low-cost 16-channel LiDAR in urban canyons remains a challenging problem due to the limited point cloud density from low-cost LiDAR and excessive dynamic surrounding objects. To fill this gap, this paper proposes enriching sparse 3D point clouds to denser clouds via a novel deep learning-based superresolution (SR) algorithm before its utilization in 3D LiDAR odometry. We validate the effectiveness of the proposed method using the KITTI dataset and a challenging dataset collected in an urban canyon (with complex environmental structures and dynamic objects) of Hong Kong. We conclude that significantly denser point clouds are achieved with considerable accuracy. In addition, significantly improved performance of 3D LiDAR odometry is obtained in the evaluated dataset collected in an urban canyon of Hong Kong.

Aims/Introduction It is not clear whether survival in kidney transplant recipients with pre‐transplant diabetes has improved over the past decades. We compared the rates of mortality and major adverse cardiovascular events (MACE) after renal transplantation in patients with and without pre‐transplant diabetes. Furthermore, we investigated whether transplant era and recipient age affected the association between diabetes status and adverse events. Materials and Methods This retrospective cohort study included 691 patients who underwent renal transplantation between 1994 and 2016 at a single tertiary center. We compared the incidences of post‐transplant mortality and four‐point MACE in patients with and without pre‐transplant diabetes using Kaplan–Meier analysis and the Cox proportional hazard model, and assessed the interactions between diabetes status and transplant era and recipient age. Results Of 691 kidney recipients, 143 (20.7%) had pre‐transplant diabetes. The mean follow‐up duration was 94.5 months. Kaplan–Meier analysis showed that patients with pre‐transplant diabetes had higher incidences of post‐transplant mortality and four‐point MACE compared with those without pre‐transplant diabetes (log–rank test, P, It is not clear whether survival in kidney transplant recipients with pre‐transplant diabetes has improved over the past decades. We compared the rates of mortality and major adverse cardiovascular events after kidney transplantation in patients with and without pre‐transplant diabetes. In this study, pre‐transplant diabetes remains a significant risk factor for mortality and four‐point major adverse cardiovascular events in kidney transplant recipients.

To expedite new molecular compound development, a long-sought goal within the chemistry community has been to predict molecules' bulk properties of interest a priori to synthesis from a chemical structure alone. In this work, we demonstrate that machine learning methods can indeed be used to directly learn the relationship between chemical structures and bulk crystalline properties of molecules, even in the absence of any crystal structure information or quantum mechanical calculations. We focus specifically on a class of organic compounds categorized as energetic materials called high explosives (HE) and predicting their crystalline density. An ongoing challenge within the chemistry machine learning community is deciding how best to featurize molecules as inputs into machine learning models-whether expert handcrafted features or learned molecular representations via graph-based neural network models-yield better results and why. We evaluate both types of representations in combination with a number of machine learning models to predict the crystalline densities of HE-like molecules curated from the Cambridge Structural Database, and we report the performance and pros and cons of our methods. Our message passing neural network (MPNN) based models with learned molecular representations generally perform best, outperforming current state-of-the-art methods at predicting crystalline density and performing well even when testing on a data set not representative of the training data. However, these models are traditionally considered black boxes and less easily interpretable. To address this common challenge, we also provide a comparison analysis between our MPNN-based model and models with fixed feature representations that provides insights as to what features are learned by the MPNN to accurately predict density.

The inactivated trivalent influenza vaccine (TIV) offers limited protection when two influenza B lineages co-circulate or when there is a vaccine mismatch (i.e., discordance in the predominant circulating B strain and WHO-recommended B strain). Inactivated quadrivalent influenza vaccine (QIV) may reduce the burden of influenza. Here, we report the results of a phase 3 clinical trial that evaluated the immunogenicity and safety of a novel QIV, GC3110A, in Korean children aged 6–35 months, which has been approved and is currently in use in Korea. The study involved two parts. In Part 1, the safety of GC3110A was evaluated in 10 subjects. After none of the subjects reported grade 3 adverse events (AEs), we proceeded to Part 2. Part 2 was a randomized, double-blind, multicenter phase 3 trial wherein we compared the immunogenicity and safety of GC3110A with those of a licensed control TIV. Immunogenicity was evaluated by measuring hemagglutination inhibition titers. The 200 participants enrolled in Part 2 were randomized in a 4:1 ratio to receive GC3110A or control TIV. The study vaccine group met both primary (i.e., the lower limit of 95% confidence interval [CI] of the seroconversion rate exceeds 40% for four strains) and secondary (i.e., the lower limit of 95% CI of the seroprotection rate exceeds 70% for four strains) immunogenicity endpoints. There was no significant between-group difference in the seroconversion rate, seroprotection rate, and geometric mean titer for the shared strains. However, the study vaccine group demonstrated significantly higher immunity for the additional strain B/Yamagata. In the safety analysis, there was no significant between-group difference in the proportion of participants with solicited local AEs, solicited systemic AEs, and unsolicited AEs. In conclusion, the results indicate that GC3110A has comparable immunogenicity and safety to those of TIV. Clinical Trial Registry Number: NCT03285997.

The detection of unexpected loose parts in the primary coolant system in a nuclear power plant remains an extremely important issue. It is essential to develop a methodology for the localization and mass estimation of loose parts owing to the high prediction error of conventional methods. An effective approach is presented for the localization and mass estimation of a loose part using machine-learning and deep-learning algorithms. First, a methodology was developed to estimate both the impact location and the mass of a loose part at the same times in a real structure in which geometric changes exist. Second, an impact database was constructed through a series of impact finite-element analyses (FEAs). Then, impact parameter prediction modes were generated for localization and mass estimation of a simulated metallic loose part using machine-learning algorithms (artificial neural network, Gaussian process, and support vector machine) and a deep-learning algorithm (convolutional neural network). The usefulness of the methodology was validated through blind tests, and the noise effect of the training data was also investigated. The high performance obtained in this study shows that the proposed methodology using an FEA-based database and deep learning is useful for localization and mass estimation of loose parts on site.

We aimed to investigate the optimal number of oocytes retrieved in normal responders with the gonadotropin-releasing hormone (GnRH) antagonist (GnRHant) protocol in comparison with the GnRH agonist (GnRHa) long protocol. This retrospective study is based on a single-center cohort including 657 fresh cycles with day 3 embryo transfer using the GnRHa long protocol and the GnRHant flexible protocol at the fertility clinic of a university hospital between 2005 and 2019. The rate ratios (RR) of clinical pregnancy were evaluated using log-binomial regression depending on the categories by the number of retrieved oocytes and pituitary suppression methods. After controlling for age, body mass index, and basal follicle-stimulating hormone, women with 10–11 oocytes retrieved demonstrated a significantly higher chance of clinical pregnancy compared to the reference group (4–5 oocytes) (RR 1.68, 95% CI 1.12-2.53). However, retrieval of more than 11 oocytes did not show a significant difference in pregnancy rates (PR) from the reference group. In women treated with GnRHant, a significantly higher clinical PR was also observed in women with 10–11 oocytes retrieved compared to the reference group (RR 1.90, 95% CI 1.05–3.42). In women treated with GnRHa long protocol, a higher probability of clinical pregnancy was observed (RR 1.30, 95% CI 0.98–1.73) in the group with 8–11 oocytes retrieved and it demonstrated borderline statistical significance (P = 0.07). In summary, the optimal number of oocytes for maximizing the rate of a clinical pregnancy is different according to the method of pituitary suppression. Too many oocytes do not seem to be beneficial for achieving better clinical outcomes.

Objectives(s) The purpose of this study was to explore the experiences of women's reproductive health in North Korea through statements from North Korean female refugees. Design and sample A qualitative phenomenological study was conducted using Colaizzi's methods. Through purposive and snowball sampling, a total of eight North Korean women refugees were recruited. Measures Data were collected through in-depth, unstructured interviews with individual participants. Results A total of 18 themes, eight theme clusters, and three categories emerged. The three categories of North Korean women's reproductive health experience were: distorted sexual concepts, internalization of sexual repression, and threat of women's health rights. The study on the reproductive health experiences of North Korean women was based on the premise that their "right to health was threatened due to the internalization of sexual repression by distorted sexual concepts." Conclusion The reproductive health of North Korean women must be approached as a fundamental right, and as a human and health right.

Background and aim Non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to non-alcoholic steatohepatitis, which is characterized by hepatic inflammation that can progress to fibrosis, cirrhosis, and hepatocellular carcinoma. Visfatin, an adipocytokine, was reported to induce pro-inflammatory cytokines and can be associated with liver fibrosis. We investigated the role of visfatin on hepatic inflammation and fibrosis in a methionine-choline-deficient (MCD)-diet-induced steatohepatitis mouse model. Methods Eight-week-old male C57BL/6 J mice were randomly assigned into one of three groups: (1) saline-injected control diet group; (2) saline-injected MCD diet group; and (3) visfatin-injected MCD diet group (n = 8 per group). Mice were administered intravenous saline or 10 μg/kg of recombinant murine visfatin for 2 weeks. Histologic assessment of liver and biochemical and molecular measurements of endoplasmic reticulum (ER) stress, reactive oxidative stress (ROS), inflammation, and fibrosis were performed in livers from these animals. Results Visfatin injection aggravated hepatic steatosis and increased plasma alanine aminotransferase and aspartate aminotransferase concentrations. Visfatin increased inflammatory cell infiltration (as indicated by F4/80, CD68, ly6G, and CD3 mRNA expression) and expression of chemokines in the liver. Visfatin also increased the expression of pro-inflammatory cytokines (IL-1β, TNF-α, and IL-6) and activated fibrosis markers (CTGF, TIMP1, collagen 1α2, collagen 3α2, αSMA, fibronectin, and vimentin) in liver. Livers of visfatin-injected mice showed upregulation of ER stress and ROS and activation of JNK signaling. Conclusions These results suggest that visfatin aggravates hepatic inflammation together with induction of ER and oxidative stress and exacerbates fibrosis in an MCD-diet-fed mouse model of NAFLD.

This study is to examine if the populations with different distress levels can gain different psychological stabilization benefits from the video intervention. The study randomly assigned 21 university students to two intervention arms(Only and Mix) and psychophysiological indicators were measured before and after video stimuli. Then, psychophysiological responses were analyzed to verify if there are any significant changes in the key variables. The analysis discovered that the negative affect decreased in the high-distress population of the Only and Mix arms and state anxiety dropped after the Mix intervention. However, the low-distress populations in both arms did not show significant changes in affect. In the high-distress population of the Only arm, gamma waves at the left prefrontal, right frontal and temporal lobe increased, while right prefrontal gamma waves decreased. The high-distress subjects of the Mix arm showed an increase in beta waves at the left prefrontal, while the right frontal theta waves decreased. In conclusion, it was verified that the video interventions can boost cognitive processing regardless of the distress level, and the video invention can be effective in regulating the negative affect in the high-distress population.

An infundibulum of the posterior communicating artery (PcomA) or infundibular dilatation (ID) is considered to be a benign anatomical variant. However, some evidence suggests that ID is a pre-aneurysmal state. This case series presents cases of ruptured IDs and aneurysms originating from the IDs. Between April 2002 and June 2020, 1337 patients were treated for aneurysmal subarachnoid hemorrhage (SAH). Among them, 7 patients with ruptured PcomA IDs were identified. Rupture IDs of the PcomA were categorized into 1) direct rupture of IDs, and 2) rupture of aneurysms originating from IDs. The clinical and radiographic factors were retrospectively reviewed. Two patients experienced direct rupture of IDs, while the other 5 patients presented with ruptured aneurysms originating from IDs. The 2 patients with direct rupture of IDs at presentation were relatively younger (< 50 years), while the other 5 patients with ruptured aneurysms originating from IDs were over 70 and had a history of aneurysmal SAH due to other intracranial aneurysms. Ruptured IDs were treated with microsurgery or endovascular treatment. There were no complications related to the procedure for securing ruptured IDs. Five (71.4%) patients showed favorable outcomes. One patient with initial Hunt and Hess grade 4 died due to initial brain damage with cerebral vasospasm and medical complications. ID of the PcomA rarely causes SAH with or without aneurysm formation. Thus, patients with IDs of the PcomA should be carefully followed up for a long period, especially those with a history of aneurysmal SAH.

Key Points SCD patients with COVID-19 display a broad range of severity, with a higher case fatality than the non-SCD population (10.9% vs 3.3%). Older patients not treated with hydroxyurea with end organ damage who present with acute kidney injury, and elevated LDH and D-dimer level are at higher risk of death., We aimed to identify predictors of outcomes and survival in patients living in 4 major metropolitan areas who had sickle cell disease (SCD) and COVID-19 to inform best approaches to prevention and care. Data were collected at baseline and during the clinical course in SCD patients diagnosed with COVID-19 in four COVID-19 epicenters. Patients were followed up posthospital discharge for up to 3 months. Of sixty-six SCD patients with COVID-19, fifty patients (75%) required hospitalization, and seven died (10.6%). Patients with preexisting kidney disease (chronic kidney disease) were more likely to be hospitalized. The most common presenting symptom was vaso-occlusive pain. Acute chest syndrome occurred in 30 (60%) of the 50 hospitalized patients and in all who died. Older age and histories of pulmonary hypertension, congestive heart failure, chronic kidney disease, and stroke were more prevalent in patients who died, as were higher creatinine, lactate dehydrogenase, and D-dimer levels. Anticoagulation use while inpatient was twice less common in patients who died. All deaths occurred in individuals not taking hydroxyurea or any other SCD-modifying therapy. Patients with SCD and COVID-19 exhibited a broad range of disease severity. We cannot definitively state that the overall mortality is higher in patients with SCD, although our case fatality rate was ∼10% compared with ∼3% in the general population, despite a median age of 34 years. Individuals with SCD aged >50 years, with preexisting cardiopulmonary, renal disease, and/or stroke not receiving hydroxyurea, who present with high serum creatinine, lactate dehydrogenase, and D-dimer levels, are at higher risk of death, irrespective of genotype or sex., Visual Abstract

This paper attempts to explore more precise and intelligent assisted methodological references for the diagnosis and treatment of diabetes in Traditional Chinese Medicine (TCM) by using medical record data from TCM diabetes, and to construct a TCM diabetes assisted diagnosis and treatment framework of “association mining-quantifying calculation-intelligent assisted diagnosis and treatment” what can be described as cluster analyzing and match mining for symptom and drug by association mining, as quantitatively calculating and evaluating for the condition of diabetes; as disease diagnosis, drug recommendation and decision making by intelligent assisted diagnosis and treatment. This paper synthetically employs the technical methodology of association rules, topic clustering, emotion recognition and content recommendation, to realize the knowledge mining, quantify the evaluation and assist decision-making of TCM diabetes, and to propose a reference for the process of consultation and treatment. Overall, the study contributes to the academic and practical value in diabetes by elaborating a new technical methodology and providing a brief empirical test for doctors and researchers.