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Background Ankle-subtalar joint complex instability is not uncommonly presented in the clinic, but symptoms and signs similar to other conditions can easily lead to its misdiagnosis. Due to the lack of appropriate animal models, research on ankle-subtalar joint complex instability is limited. The aims of the present study were to establish an animal model of ankle-subtalar joint complex instability in mice and to explore its relationship with post-traumatic osteoarthritis (PTOA). Methods Twenty-one male C57BL/6J mice were randomly divided into three groups: SHAM group (sham surgery group), transected cervical ligament + anterior talofibular ligament (CL+ATFL) group, and transected cervical ligament + deltoid ligament (CL+DL) group. Two weeks after surgery, all mice underwent cage running training. Balance beam and gait tests were used to evaluate the changes in self-movement in the mice after ankle-subtalar ligament injury. Micro-CT and histological staining were used to evaluate the progress of PTOA. Results Compared with the SHAM group, balance and gait were affected in the ligament transection group. Twelve weeks after surgery, the time required to cross the balance beam in the CL+ATFL group was 35.1% longer and the mice slipped 3.6-fold more often than before surgery, and the mean step length on the right side was 7.2% smaller than that in the SHAM group. The time required to cross the balance beam in the CL+DL group was 32.1% longer and the mice slipped 3-fold more often than prior to surgery, and the average step length on the right side was 5.6% smaller than that in the SHAM group. CT images indicated that 28.6% of the mice in the CL+DL group displayed dislocation of the talus. Tissue staining suggested that articular cartilage degeneration occurred in mice with ligament transection 12 weeks after surgery. Conclusions Transected mice in the CL+ATFL and CL+DL groups displayed mechanical instability of the ankle-subtalar joint complex, and some mice in the CL+DL group also suffered from talus dislocation due to ligament injury leading to loss of stability of the bone structure. In addition, as time progressed, the articular cartilage displayed degenerative changes, which affected the ability of animals to move normally.

Receiver-side control has been a reliable practice for regulating the transferred energy to the batteries in the electric vehicle (EV) wireless power transfer (WPT) systems. Nonetheless, the unpredictable fluctuation of the mutual inductance in dynamic wireless charging brings extreme instability to the charging process. This overshoot that appears in instant vibrations may largely increase the voltage/current stress of the system, and even cause catastrophic failure in the battery load. In addition, the speed of the vehicles may lead to untraceable steady-state operation. However, existing solutions to the above two issues suffer from either long communication time delay or significantly compromised output regulation. In this paper, the slow dynamics and the overshoot issues of the WPT system are elaborated in theory, and the small-signal model mainly considering mutual inductance disturbance is established. A simple feedforward control is proposed for overshoot damping and fast system dynamics. Experimental results validate that the overshoot can be reduced by 13% and the settling time is improved by 50% in vehicle braking or acceleration. In constant speed driving, the battery charging ripple is decreased by 12% and ensures better system stability.

In a 3-year cohort study of adult patients with proven or probable IA, fewer patients initially treated with isavuconazole experienced adverse events compared with voriconazole, but more patients required a change in therapy due to lack of clinical efficacy.

Background Hearts and lungs from donors with hepatitis C viremia are typically not transplanted. The advent of direct-acting antiviral agents to treat hepatitis C virus (HCV) infection has raised the possibility of substantially increasing the donor organ pool by enabling the transplantation of hearts and lungs from HCV-infected donors into recipients who do not have HCV infection. Methods We conducted a trial involving transplantation of hearts and lungs from donors who had hepatitis C viremia, irrespective of HCV genotype, to adults without HCV infection. Sofosbuvir-velpatasvir, a pangenotypic direct-acting antiviral regimen, was preemptively administered to the organ recipients for 4 weeks, beginning within a few hours after transplantation, to block viral replication. The primary outcome was a composite of a sustained virologic response at 12 weeks after completion of antiviral therapy for HCV infection and graft survival at 6 months after transplantation. Results A total of 44 patients were enrolled: 36 received lung transplants and 8 received heart transplants. The median viral load in the HCV-infected donors was 890,000 IU per milliliter (interquartile range, 276,000 to 4.63 million). The HCV genotypes were genotype 1 (in 61% of the donors), genotype 2 (in 17%), genotype 3 (in 17%), and indeterminate (in 5%). A total of 42 of 44 recipients (95%) had a detectable hepatitis C viral load immediately after transplantation, with a median of 1800 IU per milliliter (interquartile range, 800 to 6180). Of the first 35 patients enrolled who had completed 6 months of follow-up, all 35 patients (100%; exact 95% confidence interval, 90 to 100) were alive and had excellent graft function and an undetectable hepatitis C viral load at 6 months after transplantation; the viral load became undetectable by approximately 2 weeks after transplantation, and it subsequently remained undetectable in all patients. No treatment-related serious adverse events were identified. More cases of acute cellular rejection for which treatment was indicated occurred in the HCV-infected lung-transplant recipients than in a cohort of patients who received lung transplants from donors who did not have HCV infection. This difference was not significant after adjustment for possible confounders. Conclusions In patients without HCV infection who received a heart or lung transplant from donors with hepatitis C viremia, treatment with an antiviral regimen for 4 weeks, initiated within a few hours after transplantation, prevented the establishment of HCV infection. (Funded by the Mendez National Institute of Transplantation Foundation and others; DONATE HCV ClinicalTrials.gov number, NCT03086044.).

In order to improve the customers’ continuous usage of electrical vehicles (EVs) and reduce the weight of the energy storage devices, wireless charging technology has been widely studied, updated, and commercialized in recent decades, regarding to its distinct superiority of great convenience and low risk. A higher coupling coefficient is the key factor that impacts the transmission efficiency, thus in most medium-power (hundreds of watts) to high-power (several kilowatts) wireless charging systems, ferrites are used to guide the magnetic flux and intensify the magnetic density. However, the weight of the ferrite itself puts an extra burden on the system, and the core loss during operation also reduces the total efficiency and output power. This paper proposes an optimized design algorithm based on a core-less method for the magnetic core, where the core loss and the coupling coefficient are consequently balanced, and the overall weight and efficiency of the system can be optimized. The iteration procedure is applied on the basis of removed ferrite length and thickness in the algorithm. In the simulation, a square coupler with a total volume of 300 mm × 150 mm, a circular coupler of 150 mm × 150 mm and a Double-D (DD) coupler of 300 mm × 150 mm are used to verify the advantages of the proposed method. The optimized ferrite structures are specific for each coupler shape, and the improvement is proved to be universal in current scale by means of 3-D finite element analysis.

Letermovir is approved for the prevention of cytomegalovirus (CMV) reactivation and clinical disease in patients undergoing allogeneic hematopoietic-cell transplantation (HCT). However, there is uncertainty about letermovir's ability to prevent clinical events during the period of prophylaxis as well as after the discontinuation of prophylaxis in the post-transplant setting. We performed a retrospective cohort study in CMV-seropositive allogeneic HCT recipients at high risk of CMV events, who received letermovir for primary prophylaxis from November 2017 through December 2019. We analyzed CMV outcomes for these patients during and after prophylaxis was discontinued. Patient outcomes were followed through June 2020. Sixty patients received letermovir for a median of 13 weeks (range, 1-72 weeks). Thirteen (22%) patients had quantifiable CMV DNAemia (reactivation) during letermovir prophylaxis a median of 9 days (range, 1-59 days) after starting letermovir. Five (8%) of these patients discontinued prophylaxis and received preemptive therapy (PET) with valganciclovir; eight (13%) continued letermovir as prophylaxis and CMV DNAemia resolved without PET. Thirteen patients (22%) had post-prophylaxis CMV reactivation a median of 33 days (range, 14-109 days) after letermovir discontinuation. In four (7%) of these patients, CMV DNAemia resolved without PET, and nine (15%) received PET. No patient developed CMV disease. Patients who developed CMV reactivation during prophylaxis did so shortly after initiation of letermovir, and most patients who developed CMV reactivation post-prophylaxis did so within 60 days after discontinuation of letermovir. Letermovir prophylaxis has changed the presentation of CMV infection in high-risk HCT patients.

The microgrid in this paper is a low-voltage distribution system composed of photovoltaic equipment, energy storage device, load, power electronic devices and control devices. The control objective of direct-current (DC) microgrid is to maintain the voltage stability of DC bus and equal load sharing in energy storage units. At present, droop control is used in distributed energy storage system to realize energy equilibrium of multiple energy storage units. However, the method causes low current accuracy and imbalance of state of charge (SOC) in multiple energy storage units. In this paper, the performance of different SOC equalizers with large disturbance is investigated, which is determined by response speed and SOC balancing time from the supercapacitors (SCs). The shorter rising time and the anti-jamming performance are obtained by the partial swarm optimization (PSO) SOC equalizer with adaptive fuzzy proportion integral differential (PID) controller. The performance of SOC balancing is obtained in SCs by classic droop SOC equalizer and PID controller.

Each year, thousands of new utilities are installed within the highway right-of-way (ROW) nationwide. This proliferation of utilities yields a great challenge to the traditional practice at...

Modular multilevel dc-ac-dc converters (MMDACs) serve as an enabler for dc distribution systems. The modular multilevel structure enables flexible voltage transforms, but raises issues over balancing of the submodule (SM) capacitor voltages. This letter focuses on the dynamics of inherent balancing of MMDACs under circulant modulation. We provide an invariance-like result using a variant of Barbalat's Lemma and prove that the SM capacitor voltages converge to the kernel of the circulant switching matrix, which is the intersection of the invariant sets for each switching state. We further interpret the balancing dynamics as a permuted linear time-invariant system and prove that the envelop of the balancing trajectories is governed by the eigenvalues of the permuted state-transition matrix. This result extends previous full-rank criterion for inherent balancing in a steady state and provides new insight into the dynamic behavior of MMDACs.

Allogeneic hematopoietic cell transplantation (HCT) provides effective treatment for hematologic malignancies and immune disorders. Monitoring of post-transplant complications is critical, yet current diagnostic options are limited. Here, we show that cell-free DNA (cfDNA) in blood is a highly versatile analyte for monitoring of the most important complications that occur after HCT: graft-versus-host disease (GVHD), a frequent immune complication of HCT; infection; relapse of underlying disease; and graft failure. We demonstrate that these different therapeutic complications can be informed from a single assay, low-coverage bisulfite sequencing of cfDNA, followed by disease-specific bioinformatic analyses. To inform GVHD, we profile cfDNA methylation marks to trace the cfDNA tissues-of-origin and to quantify tissue-specific injury. To inform on infections, we implement metagenomic cfDNA profiling. To inform cancer relapse, we implement analyses of tumor-specific genomic aberrations. Finally, to detect graft failure we quantify the proportion of donor and recipient specific cfDNA. We applied this assay to 170 plasma samples collected from 27 HCT recipients at predetermined time points before and after allogeneic HCT. We found that the abundance of solid-organ derived cfDNA in the blood at one-month after HCT is an early predictor of acute graft-versus-host disease (area under the curve, 0.88). Metagenomic profiling of cfDNA revealed the frequent occurrence of viral reactivation in this patient population. The fraction of donor specific cfDNA was indicative of cell chimerism, relapse and remission, and the fraction of tumor specific cfDNA was informative of cancer relapse. This proof-of-principle study shows that cfDNA has the potential to improve the care of allogeneic HCT recipients by enabling earlier detection and better prediction of the complex array of complications that occur after HCT.

Background The aim of this study was to evaluate the different clinical outcomes after removing or retaining syndesmotic screws, and the difference in clinical outcomes after retaining broken or loose syndesmotic screws was also evaluated.Methods A systematic literature search was performed using PubMed, Web of Science, EMBASE and the Cochrane Central Register of Controlled Trials. In this meta-analysis, we conducted online searches using the search terms “syndesmotic diastasis”, “syndesmotic injury”, “syndesmotic screw”, “syndesmotic fixation”, and “tibiofibular syndesmosis”. The analysis was performed on data from all the studies that met the selection criteria. Clinical outcomes were expressed as standard mean differences for continuous outcomes with 95 % confidence intervals. Heterogeneity was assessed using the Chi2 test and the I2 statistic.Results There were 2 randomized controlled trials (RCTs) and 6 observational articles included in this analysis. In the comparison between retained and removed screws and the comparison between broken or loose and removed screws, no significant difference was found in terms of visual analogue scale (VAS), Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Broken or loose screws were associated with better AOFAS scores compared with removed or intact screws, and no significant difference was found in terms of VAS and OMAS scores.Conclusions According to our analysis, there was no significant difference in clinical outcomes between removed and retained screws. Broken or loose screws were not associated with bad functional outcomes and may even lead to better function compared with removed or retained screws.

s Social impacts have become increasingly important for urban development in China. In addition, unlike general construction projects, construction projects in high-density urban areas have high levels of complexity and uncertainty. Thus, from a network perspective, an improved social risk analysis theory and a method for these projects were generated in this paper. A case study involving 66 cases of social conflicts in construction projects in China was performed, and 16 social risk factors were summarized. Eight stakeholders related to these social risk factors were then identified based on a literature review and the case database. A theoretical model for social risk network analysis considering the interrelationships between stakeholders and risks was developed by using NetMiner, a social network analysis (SNA) tool. A 2-mode network and two 1-mode networks were used to analyze the relationships among the identified 16 social risk factors and 8 stakeholders. In terms of three-level challenges such as complex environments, the unreasonable behavior of individuals or organizations, and diversified interaction between behaviors and environments, the most important social risks of construction projects in high-density urban areas were explored to help the government implement effective social risk management measures. In addition, multiple, complicated relationships among residents, contractors, governmental authorities, and owners represented a major factor leading to social risk; therefore, more attention should be focused on this topic. The proposed social risk analysis method can increase the attention paid by project managers, governmental authorities, and project owners to social risk factors in high-density areas and provide a structured framework to analyze such social risks, as well as put forth possible solutions to reduce the social impacts on construction projects in high-density urban areas.

Patients treated with allogeneic hematopoietic cell transplantation (HCT) are at risk of cytomegalovirus (CMV) reactivation and disease, which results in increased morbidity and mortality. Although universal antiviral prophylaxis against CMV improves outcomes in solid organ transplant recipients, data have been conflicting regarding such prophylaxis in patients undergoing allogeneic HCT. We conducted a systematic review of randomized trials of prophylactic antivirals against CMV after allogeneic HCT to summarize the evolution of the field over the last 35 years and evaluate the prophylactic potential of antiviral agents against CMV after allogeneic HCT. Electronic databases were queried from database inception through 31 December 2017. For included studies, incidence of CMV infection and all-cause mortality were collected as primary outcomes; CMV disease incidence, use of preemptive therapy, and drug toxicities were collected as secondary outcomes. Nineteen clinical trials conducted between 1981 and 2017 involving a total of 4173 patients were included for review. Prophylactic strategies included use of acyclovir, valacyclovir, ganciclovir, maribavir, brincidofovir, and letermovir compared with placebo or a comparator antiviral. Fourteen trials that compared antiviral prophylaxis with placebo demonstrated overall effectiveness in reducing incidence of CMV infection (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.42-0.58), CMV disease (OR, 0.56; 95% CI, 0.40-0.80), and use of preemptive therapy (OR, 0.51; 95% CI, 0.42-0.62; 6 trials); however, none demonstrated reduction in all-cause mortality (OR, 0.96; 95% CI, 0.78-1.18) except the phase 3 trial of letermovir (week-24 OR, 0.59; 95% CI, 0.38-0.98). Additional research is warranted to determine patient groups most likely to benefit from antiviral prophylaxis and its optimal deployment after allogeneic HCT.

Nowadays, unmanned aerial vehicles (UAVs) are frequently used for periodic visual inspection of building envelopes to detect unsafe conditions or vulnerable damages. Inspection practitioners have to manually examine the large amounts of high-resolution images collected by UAVs to identify anomalies or damages on building facades for reporting and repairs. The computer vision and deep learning technologies have emerged as promising solutions to automate the image-based inspection process. However, for the detection of facade cracks from UAV-captured images, existing deep learning solutions may not perform well due to the complicated background noises caused by different facade components and materials. Towards that end, this paper proposed a two-step deep learning method for the automated detection of facade cracks from UAV-captured images. In the first step, a convolutional neural network (CNN) model was designed and trained on 26,177 images to classify images in a patch-level size of 128 × 128 pixels into crack or non-crack. In the second step, a U-Net neural network model was trained on 2870 image sets to segment crack pixels within those patches classified as cracks. Experimental results show a high performance of 94% and 96% precision, 94% and 95% recall, and 94% and 96% F1-scores was achieved by the CNN model and the U-Net model respectively. The experimental results proved that the two-step method can improve the reliability and efficiency of detecting and differentiating facade cracks from complicated facade noises. The proposed method can also be extended to detect other types of facade anomalies (e.g., corrosion and joint failures), thus facilitating a comprehensive assessment of facade conditions for better decision-making for the maintenance of building facades during its service life.

TO THE EDITOR: Certain therapies for hematologic malignancies, including anti-CD20 monoclonal antibodies and allogeneic hematopoietic cell transplantation (allo-HCT), are associated with increased risk of hepatitis B virus (HBV) reactivation in patients previously infected with HBV.[1][1],[2][2]

How to Obtain a Nasopharyngeal Swab Specimen Collecting specimens from the surface of the respiratory mucosa with nasopharyngeal swabs is a procedure used to diagnose Covid-19 as well as other resp...

Aiming at improving the knowledge management in PPP projects, the development of an ontology-based knowledge base for Residual Value Risk (RVR) in PPPs was conducted. Through literature review and typical case study of knowledge management in PPP projects, the RVR in PPP projects was analyzed from the perspective of risk structure, risk process and vulnerability, based on which the formation mechanism of RVR was explored. The RVR was deconstructed into five risk consequences. Furthermore, an improved RVR framework was established as a platform for organizing all kinds of knowledge for RVR in PPPs. Meanwhile, in order to express knowledge more effectively and promote their sharedness and transferability, the knowledge base was built by means of ontology. Finally, the ontology editing software Protege was used to build ontology-based RVR knowledge base, to achieve a more in-depth data processing function. The study can be used to analyze risk probability and vulnerability for both of public and private sectors in PPPs.