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Background Macular corneal dystrophy (MCD) is a rare corneal stromal dystrophy with bilateral progressive vision loss. The pathogenic gene of MCD is carbohydrate sulfotransferase 6 (CHST6). Herein, we report a novel missense mutation and a rare exon deletion mutation in the CHST6 gene in a Chinese family with MCD. Methods Genomic DNA was extracted from the peripheral blood, and next generation sequencing was used to analyse the gene sequence. The pathogenic mutations were identified in all affected family members. The proband successively received binocular penetrating keratoplasty (PKP), and the corneas were examined by histopathology and colloidal iron staining to prove the diagnosis. A long-term follow-up was made to observe the changes after PKP. Results Genetic analysis demonstrated hemizygous mutations in the proband, including a novel c.520A>C (p.K174Q) missense mutation and a rarely reported exon 3 deletion mutation, which were co-segregated with the MCD phenotypes in the pedigree. The positive colloidal iron staining confirmed the diagnosis of MCD in the proband. However, the clinical phenotype and pathological manifestation of both eyes were different from each other because of complicated keratitis in the left eye. During the nine years of follow-up, visual acuity was improved significantly, and the cornea was transparent without rejection and postoperative recurrence in both eyes. Conclusions The novel hemizygous mutations were thought to contribute to the loss of CHST6 function, which induced typical clinical and pathological features of MCD. PKP was an effective treatment for MCD.

Background In the era of immunotherapy, it is still unclear which is the best first-line therapy for patients with oncogenic driver negative advanced non-squamous non-small cell lung cancer (NS-NSCLC) who cannot tolerate immunotherapy, or subsequent therapy for patients with oncogenic driver positive NS-NSCLC whose disease progressed on prior targeted therapy. To assess the optimal choice of first-line and maintenance treatment regimens, we performed a meta-analysis of prospective randomized controlled clinical trials (RCTs) of patients with NS-NSCLC on bevacizumab combined with chemotherapy. Methods All eligible RCTs comparing pemetrexed-platinum with or without bevacizumab (PP ± B) and paclitaxel-carboplatin with bevacizumab (PC + B) as a first-line therapy, or comparing bevacizumab plus pemetrexed (Pem + B) and bevacizumab alone (B) as a maintenance treatment for advanced NS-NSCLC, were included after systematically searching web databases and meeting abstracts. The main research endpoints were comparisons of overall survival (OS) and progression-free survival (PFS). The other endpoints were objective response rate (ORR), 1-year PFS rate (PFSR1y) and major grade 3/4 treatment-related adverse events. Results Data of 3139 patients from six RCTs were incorporated into analyses. Three RCTs were included in an analysis that compared PP ± B and PC + B as a first-line therapy for advanced NS-NSCLC. Patients treated with first-line PP ± B showed similar OS and ORR, but significantly improved PFS (hazard ratio [HR], 0.88) and PFSR1y (risk ratio [RR], 0.83), as compared to patients treated with PC + B (all P P P Conclusion Although the first-line PP + B regimen had longer PFS and PFSR1y than the PC + B regimen, no OS difference was observed. Addition of pemetrexed to bevacizumab as maintenance therapy significantly improved OS compared with bevacizumab maintenance alone, but led to more toxicity.

PurposeConstruction productivity issues have constantly surfaced in Singapore's construction industry. To push for productivity, the Government has implemented various initiatives to encourage industry players, particularly small and medium enterprises (SMEs), and to adopt more productive construction technologies. One of these technologies is prefabrication prefinished volumetric construction (PPVC), a concept of the design for manufacturing and assembly (DfMA) approach. This exploratory study sheds lights on PPVC adoption and its issues in Singapore in the context of the launch of the Construction Industry Transformation Map (ITM).Design/methodology/approachThe methodology used here is mainly a quantitative approach in the form of a survey. A questionnaire was developed and distributed to a pool of about 100 contractors, randomly chosen as part of a stratified sample. The questionnaire survey helps gain further insights into the industry's perceptions of PPVC and its adoption.FindingsThe study succeeded in identifying and analysing a list of drivers of and barriers to the adoption of PPVC. The top three most important potential drivers were “increase efficiency,” “technological change” and “changing nature of composition of workforce”. The three most important barriers were “ineffective on-site storage,” “high up-front payment” and “transportation issues”.Originality/valueThis study also looked into the organizational change management theory. Various theories were considered to help understand and implement change. It is understood that it is not only important for an organization to focus on the steps of these frameworks and models when the change is initiated but also for the organization to acknowledge and be mindful of the emotions of employees and take measures to overcome their emotions as part of organizational change management.

Non-SMC condensin I complex subunit H (NCAPH) is a structural component of chromosomes during mitosis, which up-regulates in various cancers. However, the role of NCAPH in breast cancer still hasn't been clearly explored. Our aim is to confirm the value of NCAPH as a prognostic biomarker of breast cancer. We revealed the high expression of NCAPH in breast cancer by using Oncomine, Ualcan and GOBO analysis. Quantitative Real-time PCR (qRT-PCR) analysis was conducted to detect the mRNA expression of NCAPH in MCF-7 and MCF-10A cells, and thus higher mRNA level of NCAPH in MCF-7 cells was confirmed. STRING and gene enrich analysis were conducted to explore the interaction between NCAPH and other proteins, hence the functionality of NCAPH in mitosis is demonstrated. With Kaplan-Meier plotter we found that upregulation of NCAPH is indicative of a poor prognosis especially in hormone receptor positive breast cancer. We confirmed the potential competence of NCAPH as a promising biomarker in breast cancer prognosis.

Purpose To assess the efficacy and safety of recombinant human endostatin in combination with radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC). Methods We searched eligible literature in available databases using combinations of the following search terms: lung cancer, endostatin or endostar, radiotherapy or radiation therapy or chemoradiotherapy. The inclusion criteria were: prospective or retrospective (including single-arm) studies that evaluated the efficacy and safety of endostatin plus radiotherapy (ERT) or concurrent chemoradiotherapy (ECRT) in patients with LA-NSCLC. Primary outcomes included the following: objective response rate (ORR), local control rates (LCR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Tests of heterogeneity, sensitivity, and publication bias were performed. Results A total of 271 patients with LA-NSCLC from 7 studies were enrolled, including six prospective trials and one retrospective study. The pooled median PFS was 11.3 months overall, 11.2 months in the ECRT group, and 11.8 months in the ERT group. Pooled median OS and ORR were 18.9 months and 77.2% overall, 18.4 months and 77.5% in the ECRT group, and 19.6 months and 76.1% in the ERT group, respectively. The incidences of major grade ≥ 3 AEs for all patients, subgroups of ECRT and ERT were 10.9% vs 11.9% vs 9.4% for radiation pneumonitis, 11.6% vs 12.2% vs 9.4% for radiation esophagitis, 35.5% vs 43.4% vs 0 for leukopenia, 27.8% vs 40.7% vs 2.1% for neutropenia, and 10.5% vs 12.3% vs 2.1% for anemia. Conclusions Combined endostatin with RT or CCRT is effective and well tolerated in treating LA-NSCLC, and less toxicities occur. Further validation through prospective randomized control trials is required.

Colorado potato beetle (CPB), Leptinotarsa decemlineata, is a notorious destructive pest that mainly feeds on the leaves of potato and several other solanaceous plants. CPB is widely recognized for its adaptation to a remarkable variety of host plants and diverse climates, and its high resistance to insecticides and Bacillus thuringiensis toxins. RNA interference (RNAi) is a sequence-specific, endogenous gene silencing mechanism evoked by small RNA molecules that is used as a robust tool for virus and pest control. RNAi has been extensively tested for CPB management by employing various target genes and delivery methods. This article reviews the screening of RNAi target genes, efficient RNAi delivery systems, and factors affecting RNAi efficiency in CPB, which may help understand the mechanisms of RNAi and its application in CPB control strategy.

Sarcopenia, characterized by the excessive loss of skeletal muscle mass, strength, and function, is associated with the overall poor muscle performance status of the elderly, and occurs more frequently in those with chronic diseases. The causes of sarcopenia are multifactorial due to the inherent relationship between muscles and molecular mechanisms, such as mitochondrial function, inflammatory pathways, and circulating hormones. Age-related changes in sex steroid hormone concentrations, including testosterone, estrogen, progesterone, and their precursors and derivatives, are an important aspect of the pathogenesis of sarcopenia. In this review, we provide an understanding of the treatment of sarcopenia through the regulation of sex steroid hormones. The potential benefits and future research emphasis of each sex steroid hormone therapeutic intervention (testosterone, SARMs, estrogen, SERMs, DHEA, and progesterone) for sarcopenia are discussed. Enhanced understanding of the role of sex steroid hormones in the treatment for sarcopenia could lead to the development of hormone therapeutic approaches in combination with specific exercise and nutrition regimens.

BACKGROUND The angulation of nasal bones and superior border of septal cartilage forms a slight convex profile at rhinion area. Taking this angulation into account, we bring forth a modification of dorsal onlay graft. METHODS Sixty-one consecutive patients underwent primary rhinoplasty between the years of 2017 and 2020 were enrolled in the study. The angle between nasal bones and superior border of septal cartilage, angle of external dorsal contour, thickness of soft tissue at sellion and rhinion were measured on reformed computed tomographic scanning image. Three variants of dorsal onlay graft modification were designed. RESULTS Sixty-one patients underwent primary nasal augmentation were enrolled in this study. Mean follow-up was 13.1 months. The angle between nasal bones and the superior border of the septal cartilage was 166.7° by mean. Mean angle of external dorsal contour was 180.2°. Thickness of soft tissue at sellion was 4.01 and 2.03 mm at rhinion by mean. All cases showed content dorsal profiles. Two patients (3.3%) presented discernible nostril asymmetry due to the deviation of the columellar grafts and underwent secondary surgery with satisfying outcomes. CONCLUSIONS Modification of the dorsal onlay graft reserves nasal midvault to the most extent especially in small-humped nose and fits the dorsal contour properly. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Non-small cell lung cancer (NSCLC) is frequently associated with oncogenic driver mutations, which play an important role in carcinogenesis and cancer progression. Targeting epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase rearrangements has become standard therapy for patients with these aberrations because of the greater improvement of survival, tolerance, and quality-of-life compared to chemotherapy. Clinical trials for emerging therapies that target other less common driver genes are generating mixed results. Here, we review the literature on rare drivers in NSCLC with frequencies lower than 5% (e.g., ROS1, RET, MET, BRAF, NTRK, HER2, NRG1, FGFR1, PIK3CA, DDR2, and EGFR exon 20 insertions). In summary, targeting rare oncogenic drivers in NSCLC has achieved some success. With the development of new inhibitors that target these rare drivers, the spectrum of targeted therapy has been expanded, although acquired resistance is still an unavoidable problem.

Objective To compare the relative efficacy of immune checkpoint inhibitors (ICIs) or chemotherapy (CT) alone, or their combination modality in the first‐line treatment of advanced nonsmall cell lung cancer (NSCLC). Methods This meta‐analysis was performed on the eligible randomized controlled trials (RCTs) after searching web databases and meeting abstracts. The main research endpoints were the comparisons of median overall survival (mOS), the OS rate of 6 months (OSR6m), 1 year (OSR1y) and 2 years (OSR2y), median progression‐free survival (mPFS), the PFS rate of 6 months (PFSR6m) and 1‐year (PFSR1y), objective response rates (ORR), and treatment‐related adverse events (TRAEs). Results Eleven RCTs comprising 6278 cases were included. In the subgroup of programmed death‐ligand 1 (PD‐L1) ≥50%, compared with chemotherapy, the ICIs showed similar OSR6m (P > 0.05), but significantly improved efficacy in mOS, OSR1y, OSR2y, and ORR (all P 0.05), but significantly improved mPFS, PFSR6m, and ORR (all P

Q690 high strength steel (HSS) is a structural steel with yield-to-tensile ratio being generally greater than 0.90 and elongation lower than 20%, resulting in considerable decrease in steel member ductility. In seismic affecting zones, steel members are usually designed as compact sections to avoid premature local buckling for attaining fully developed plasticity. However, this approach increases the potential risk of fracture for Q690 steel structures. Thus, cyclic behaviors of Q690D HSS compact section beam-columns need to be thoroughly investigated. To this end, this paper conducted five cyclic loading tests of Q690 HSS compact H-section beam-columns based on a reliable testing system. The influences of the flange width-to-thickness ratio, web height-to-thickness ratio, axial-load ratio and overall slenderness on the failure mode, energy dissipation capacity and hysteretic behavior were analyzed. It shows that plastic local buckling dominates the failure mechanism of all the specimens without overall buckling being observed. The ultimate inter-story drift ratio was more than 1/50. The Q690 welded beam-columns with Class 1 and Class 2 H-section exhibit not only favorable plastic deformability but also excellent energy dissipation capacity and therefore could be applied in seismic steel frames. To attain accurate evaluation of damage and cyclic response, two damage models and two point-oriented hysteretic models were selected and combined to form four damage-based hysteretic models. The four hysteretic models were then implemented to simulate the cyclic loading experiments. It was found that the ultimate strength-oriented hysteretic model incorporated with Kumar Satish damage model provides the most accurate simulation. The hysteretic model parameters were calibrated using experiments data. The simulation results of the developed hysteretic model match well with those experimental curves.

Solid pseudopapillary tumor of the pancreas (SPTP), also known as solid and papillary epithelial neoplasm of the pancreas, is a rare pancreatic exocrine tumor that is difficult to diagnose before surgery. Pancreatic panniculitis is a rare type that occurs in less than 3% of all patients with pancreatic diseases. We here report a 19-year-old woman who presented with persistent left upper quadrant pain without obvious cause for 1 d. The patient also developed subcutaneous nodules involving lower abdomen bilaterally and lower limbs, and subcutaneous nodules were pathologically diagnosed as pancreatic panniculitis. Plain abdominal computed tomography revealed a soft-tissue mass in the body and tail of the pancreas, which was closely associated with the gastric wall. Contrast-enhanced ultrasound showed inhomogeneous echogenicity in the anterior pancreatic body, which had blurred parenchymal demarcation of the body and tail of the pancreas. Contrast-enhanced abdominal computed tomography revealed a mixed density mass with solid and cystic components in the body and tail of the pancreas, and the solid component was markedly enhanced. The lesion was pathologically diagnosed as SPTP after laparoscopic resection. Clinicians should be aware of the clinical manifestation, diagnosis, and treatment of pancreatic panniculitis and SPTP.

This chapter is devoted to the uniform material behavior model adapted to low–yielding strength steel, moderate–yielding strength steel, and high–yielding strength steel under monotonic action and cyclic action. The monotonic and hysteretic stress–strain constitutive relations can be established with relying on only yielding strength of any grade of constructional steel.

PurposeThe role of neoadjuvant epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) targeted therapy for patients with EGFR-mutant non-small cell lung cancer (NSCLC) has not been clarified. A pooled analysis of prospective clinical trials was conducted to evaluate the efficacy and safety of neoadjuvant EGFR-TKI therapy.MethodsThe PubMed, Embase, Web of Science, and Cochrane Library databases, as well as meeting abstracts were searched for prospective clinical trials evaluating the efficacy and safety of neoadjuvant EGFR-TKI for treatment of EGFR-mutant NSCLC. The main outcomes included the objective response rate (ORR), downstaging rate, surgical resection rate (SRR), pathologic complete response (pCR) rate, progression-free survival (PFS), and adverse events.ResultsA total of five, phase II, prospective, clinical trials involving 124 patients with resectable or potentially resectable EGFR-mutant NSCLC treated with neoadjuvant erlotinib or gefitinib treatment were included in this pooled analysis. The median neoadjuvant medication time was 42 (range, 21–56) days and the median time of response evaluation was 45 (range, 42–56) days. The pooled ORR was 58.5% [95% confidence interval (CI), 45.5%–71.8%] and the surgical resection and complete resection (R0) rates were 79.9% (95% CI, 65.3%–94.5%) and 64.3% (95% CI, 43.8%–84.8%), respectively. In the stage IIIA subgroup (n = 68), the pooled ORR, SRR, and R0 rate were 51.4%, 72.9%, and 57.0%, respectively, while the downstaging and pCR rates were 14.0% and 0.0%, respectively. The pooled median PFS and overall survival were 13.2 and 41.9 months, respectively. Of the most common grade 3/4 adverse events in the overall group, the incidences of hepatotoxicity and skin rash were 5.3% and 14.7%, respectively. The most commonly reported postoperative complications were lung infection, arrhythmia, and pneumothorax.ConclusionNeoadjuvant EGFR-TKI therapy provides a feasible treatment modality for patients with resectable or potentially resectable EGFR-mutant NSCLC, with satisfactory surgical outcomes and low toxicity. Although further phase III clinical trials are needed to confirm these findings, it is necessary to explore the feasibility of a more effective EGFR-TKI combination neoadjuvant therapy given the modest downgrade and pCR rates for EGFR-TKI alone.

IEEE 802.11ah, marketed as Wi-Fi HaLow, is a new sub-1GHz Wi-Fi technology for the Internet of Things (IoT), aiming to address the major challenge of the IoT: providing connectivity among a large number of power-constrained stations deployed over a wide area. In order to achieve this goal, several novel features are introduced in IEEE 802.11ah in both the Physical Layer (PHY) and Media Access Control (MAC) layer. These features have been extensively studied from various perspectives in the past years. To provide readers with an insight into these novel features, this article provides an overview of the IEEE 802.11ah technology and conducts a comprehensive summary and analysis on the related research, revealing how to utilize these novel features to satisfy the demanding IoT performance criteria. Furthermore, the remaining issues that need to be addressed to fully realize the vision of large-scale and low power Wi-Fi networks for the IoT are discussed.

As an important part of intrusion detection, feature selection plays a significant role in improving the performance of intrusion detection. Krill herd (KH) algorithm is an efficient swarm intelligence algorithm with excellent performance in data mining. To solve the problem of low efficiency and high false positive rate in intrusion detection caused by increasing high-dimensional data, an improved krill swarm algorithm based on linear nearest neighbor lasso step (LNNLS-KH) is proposed for feature selection of network intrusion detection. The number of selected features and classification accuracy are introduced into fitness evaluation function of LNNLS-KH algorithm, and the physical diffusion motion of the krill individuals is transformed by a nonlinear method. Meanwhile, the linear nearest neighbor lasso step optimization is performed on the updated krill herd position in order to derive the global optimal solution. Experiments show that the LNNLS-KH algorithm retains 7 features in NSL-KDD dataset and 10.2 features in CICIDS2017 dataset on average, which effectively eliminates redundant features while ensuring high detection accuracy. Compared with the CMPSO, ACO, KH, and IKH algorithms, it reduces features by 44%, 42.86%, 34.88%, and 24.32% in NSL-KDD dataset, and 57.85%, 52.34%, 27.14%, and 25% in CICIDS2017 dataset, respectively. The classification accuracy increased by 10.03% and 5.39%, and the detection rate increased by 8.63% and 5.45%. Time of intrusion detection decreased by 12.41% and 4.03% on average. Furthermore, LNNLS-KH algorithm quickly jumps out of the local optimal solution and shows good performance in the optimal fitness iteration curve, convergence speed, and false positive rate of detection.

Purpose. A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the difference in efficacy and safety between epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) with antiangiogenic inhibitors ( A + T ) and EGFR-TKI monotherapy in patients with treatment-naïve advanced EGFR-mutant non-small-cell lung cancer (NSCLC). Methods. PubMed, Embase, Web of Science, and Cochrane electronic databases were searched for relevant RCTs. Meeting abstracts were also reviewed to identify appropriate studies. The endpoints included progression-free survival (PFS), overall survival (OS), 1- and 2-year OS rates, objective response rate (ORR), and grade ≥ 3 adverse events. All pooled outcomes were expressed using hazard ratios (HRs) or relative risk ratios (RRs). Results. Data were collected from six eligible RCTs, which included 1,244 participants (619 in the A + T group and 625 in the TKI alone group). PFS was significantly improved with A + T compared to TKI alone ( HR = 0.60 ; P < 0.01 ) regardless of EGFR mutation types (exon 19 deletion or L858R) and brain metastasis status (with or without brain metastases). There was no significant difference in median OS between the A + T and TKI alone groups ( HR = 0.933 ; P = 0.551 ) regardless of EGFR mutation type. The ORR for A + T combination therapy was significantly increased compared to TKI monotherapy in exon 19 deletion subgroups ( RR = 0.774 ; P = 0.008 ). There was no difference in the positive rates of acquired T790M mutation between the two groups ( RR = 0.967 ; P = 0.846 ). More patients in the TKI alone group received a variety of subsequent systemic treatments than those in the A + T group ( RR = 0.881 ; P = 0.002 ). Conclusion. Addition of antiangiogenic inhibitors to first-line EGFR-TKI therapy significantly reduced the risk of disease progression for patients with advanced EGFR-mutant NSCLC regardless of EGFR mutation type and brain metastasis status. The lack of OS benefit may be explained by differences in subsequent treatments rather than drug resistance mechanisms.

As a defense technology with endogenous security, mimic defense plays an important role in network security research. The scheduling of executors is one of the severe problems to take into account for mimic defense, and current research lacks comprehensive consideration of the influence of system architecture and attack behavior on scheduling algorithm. Based on previous research, this paper first introduces concept of heterogeneity and confidence according to vulnerability attributes and attack distribution characteristics to characterize the executors. Moreover, the TOPSIS (Technique for Order Preference by Similarity to an Ideal Solution) algorithm is brought in to optimize the system security and improve operating efficiency. Experimental results showed that,compared with the existing algorithms, Random, MD, RSMS, it improves the security of the system in non-uniform distributed attack scenario and the operating efficiency in each attack scenario.

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) greatly improve the survival and quality of life of non-small cell lung cancer (NSCLC) patients with EGFR mutations. However, many patients exhibit de novo or primary/early resistance. In addition, patients who initially respond to EGFR-TKIs exhibit marked diversity in clinical outcomes. With the development of comprehensive genomic profiling, various mutations and concurrent (i.e., coexisting) genetic alterations have been discovered. Many studies have revealed that concurrent genetic alterations play an important role in the response and resistance of EGFR-mutant NSCLC to EGFR-TKIs. To optimize clinical outcomes, a better understanding of specific concurrent gene alterations and their impact on EGFR-TKI treatment efficacy is necessary. Further exploration of other biomarkers that can predict EGFR-TKI efficacy will help clinicians identify patients who may not respond to TKIs and allow them to choose appropriate treatment strategies. Here, we review the literature on specific gene alterations that coexist with EGFR mutations, including common alterations (intra-EGFR [on target] co-mutation, TP53, PIK3CA, and PTEN) and driver gene alterations (ALK, KRAS, ROS1, and MET). We also summarize data for other biomarkers (e.g., PD-L1 expression and BIM polymorphisms) associated with EGFR-TKI efficacy.

Small satellite constellations are an attractive alternative to provide ubiquitous connectivity to Internet of Things (IoT) and 5G machine-type communication (MTC) applications in areas where terrestrial network coverage is limited. In order to provide global coverage using small satellite networks flying in low earth orbit (LEO), a large constellation of at least hundreds of satellites is needed. As LEO satellites can only connect directly to the ground earth station (GES) sporadically, they need to forward data over inter-satellite links (ISLs) to reach the GES. In this paper, we propose a novel self-organising architectural design for small satellite constellations with ISLs, supporting automated commissioning and control of the satellite network. We specifically present an algorithm for autonomous ISL establishment and channel selection, that avoids interference among ISLs of the same satellite.

Background The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. Method A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. Results In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. Conclusion RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

Background& AimsThe Coronavirus Disease 2019 (COVID-19) has become a global epidemic and has caused a lasting and huge loss of life security, economic development and social stability in more than 180 countries around the world. Unfortunately, there is still no specific treatment for COVID-19 till now, therefore, at this point, all potential therapies need to be critically considered. LL-37 is one of the best-studied human antimicrobial peptide (AMPs) that has a broad-spectrum activity against bacteria and viruses. The use of living, genetically modified organisms (GMOs) is an effective approach for delivery of therapeutic proteins. The aim of this study was to determine the safety and efficacy of the Lactococcus lactis which has been genetically modified to produce the therapeutic human antimicrobial peptide LL-37 (herein after referred to cas001) in the patients of COVID-19.MethodsFirstly we constructed genetically modified food-grade probiotic, Lactococcus lactis, with sequence of seven tandem repeats of mature human LL-37 under control of the nisin-inducible nisA promoter to produce the cas001. A total of 20 healthy SD rats, half male and half female (There were five male and five female in the control group, the same in treatment group) were used to observe the acute toxic reaction and death after daily administration of cas001 for three weeks, which helps to provide necessary reference basis for clinical dose selection, verificaition of toxic reaction and possible target organs. According to the estimated clinical dosage of 1 × 108CFU /kg/day, considering the conversion of body surface area, the dose for rats should be multiplied by 6.17 to 6 × 108 CFU/kg/day. We administrated 100 times higher dose at 6 × 1010 CFU/ /kg/day to rats. In order to investigate the pharmacokinetics of cas001, male SD rats (body weight 250-300g, 1 × 1010 /animal, n=3) were given oral administration of LL-37 bacteria powder. The concentration of LL-37 in the blood before and after gavage was detected by ELISA kit (Hycult biotechnology Cat# HK321).Human clinical study was approved by Ethics committee of Chinese PLA General Hospital (S2020-074-04) and a total of 11 patients with mild symptoms were enrolled in Wuhan hankou hospital and Huoshenshan hospital. They were enrolled voluntarily and all patients signed informed consent. Among them, there were 5 males and 6 females, aged 55 ± 12 (36-70) years old, and the duration from onset to medication enrollment was 35 ± 19 (5-68) days. 6 patients were nucleic acid positive and 5 patients were nucleic acid negative when they were enrolled. All patients received the oral drug cas001 treatment according to requirement(1 × 109 CFU/capsule, 3 capsules/time, three times a day for 3weeks), with an average follow-up time of 33 ± 15 days (see table 1 for the results).FindingsWestern blot analysis shows that reasonable amount of LL-37 were induced by different concentrations of nisin, which means we have successfully constructed cas001. In the pre-clinical safety evaluation test, after three weeks administration of cas001, no adverse effects were observed on the rat’s body weight, food and water intake, hematological or serum biochemical parameters. The results showed that the LD50 of cas001 was higher than that of the 100 times of the expected clinical dose of 6 × 1010 CFU/day. These results showed that cas001 could be safe in animal experiments. In addition, rat pharmacokinetics results showed that the serum concentration of LL-37 reached peak 2 hours after gavage of cas001 and returned to basal level 6 hours after gavage. During study period, the volunteers did not feel any discomfort while taking the cas001 capsules, and two hours after oral administration, the concentration of LL-37 were increased in healthy volunteers.cas001 shows definite effect in the improvement of gastrointestinal symptoms and is possible to have effects in improving the systemic symptoms and respiratory symptoms and may play a role in the improvement of results of nucleic acid test and lung CT test. 11 patients enrolled showed good compliance, tolerance, subjective feeling and actively interacted with the doctors. None of the patients had any adverse reactions.ConclusionsBased on above observations, we conclude here that as an oral anti-viral agent, cas001 displayed good safety profiles. It is very hard to reach conclusion of clinical outcomes related to the cas001, although changes of several symptoms indicate encouraging findings.

Diabetic nephropathy (DN) is one of the most common causes of end-stage renal disease worldwide. ω3-Fatty acids (ω3FAs) were found to attenuate kidney inflammation, glomerulosclerosis, and albuminuria in experimental and clinical studies of DN. As G protein-coupled receptor 120 (GPR120) was firstly identified as the receptor of ω3FAs, we here investigated the function of GPR120 in DN. We first examined the renal biopsies of DN patients, and found that GPR120 expression was negatively correlated with the progression of DN. Immunofluorescence staining analysis revealed that GPR120 protein was mainly located in the podocytes of the glomerulus. A potent and selective GPR120 agonist TUG-891 (35 mg · kg −1 · d −1 , ig) was administered to db/db mice for 4 weeks. We showed that TUG-891 administration significantly improved urinary albumin excretion, protected against podocyte injury, and reduced collagen deposition in the glomerulus. In db/db mice, TUG-891 administration significantly inhibited the mRNA and protein expression of fibronectin, collagen IV, α-SMA, TGF-β1, and IL-6, and downregulated the phosphorylation of Smad3 and STAT3 to alleviate glomerulosclerosis. Similar results were observed in high-glucose-treated MPC5 podocytes in the presence of TUG-891 (10 μM). Furthermore, we showed that TUG-891 effectively upregulated GPR120 expression, and suppressed TAK1-binding protein-1 expression as well as the phosphorylation of TAK1, IKKβ, NF-κB p65, JNK, and p38 MAPK in db/db mice and high-glucose-treated MPC5 podocytes. Knockdown of GPR120 in MPC5 podocytes caused the opposite effects of TUG-891. In summary, our results highlight that activation of GPR120 in podocytes ameliorates renal inflammation and fibrosis to protect against DN.

Successful treatment of esophagogastric varices (EGV) with giant portal-systemic shunt is challenging. To explore the feasibility and safety of a novel hybrid procedure involving interventional radiology and endoscopy in the same sitting. Three cases clinically diagnosed to have decompensated cirrhosis and EGV with giant gastrorenal shunt (GRS) on contrast-enhanced computed tomography (CT) were included. The hybrid procedures included: indirect portography, hepatic vein pressure gradient (HVPG) measurement, HVPG-based partial splenic embolization (PSE), retrospective GRS balloon occlusion, endoscopic histoacryl injection (EHI), balloon catheter radiography and withdrawal. All the procedures were done in the same operation room. Main outcomes measurements included operation time, complications, and re-bleeding events. Hybrid interventions were performed successfully in 3 cases with a mean operation time of 63.3 minutes without any major intra- and post-operation complications. No rebleeding occurred at 6-month follow-up. Synchronous hybrid intervention combining radiology and endoscopy is feasible and safe for patients with EGV and giant GRS, preliminary study with limited cases deserves further exploration.

BACKGROUND: This study aimed to assess the impact of pre-existing pulmonary interstitial lesions (PIL) on the efficacy and prognosis of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitor (TKI). METHODS: Patients with advanced NSCLC harboring EGFR exon 19 deletion (E19 del) or exon 21 (E21) L858R were enrolled in this study. All patients underwent high resolution computed tomography (HRCT) chest scans prior to EGFR-TKI treatment. Pre-existing PIL was graded according to HRCT imaging (PIL 0, 1, 2, and 3). Cox proportional-hazards regression models were used to identify the prognostic factors for progression-free survival (PFS). RESULTS: A total of 134 eligible patients were enrolled. The overall objective response rate (ORR) and median PFS were 73.1% and 10.0 months (95% CI: 7.51–12.49), respectively. There were 62 (46.3%), 25 (18.7%), 28 (20.9%), and 19 (14.1%) cases of PIL grade 0, 1, 2, and 3, respectively, with median PFS and ORR of 12.9 months and 80.6%, 11.0 months and 72.0%, 10.0 months and 71.4%, and 7.0 months and 52.6%, respectively. Multivariate analysis showed that squamous cell carcinoma (vs. adenocarcinoma, HR =4.33), E21 L858R (vs. E19 del, HR =1.57), and PIL grade 3 (vs. grade 0–2, HR =1.60–2.48) were poor prognostic factors for PFS (P

High strength structural steels have recently achieved increasing application in civil and structural engineering worldwide. For instance, the sony center tower located in Berlin were constructed through steel truss made of S460 and S690 high strength steel whose nominal yield stress is 460 MPa and 690 MPa respectively. The utilization of high strength steel considerably reduced the structure deadweight and produced larger architecture space. Besides, steel connections of one military steel bridge in Mittadalenthe, Sweden were fabricated of 960 MPa ultra-high strength steel. This application remarkably increases the construction convenience since high strength steel presents excellent ability to reduce member size as well as improve structure performance. Nevertheless, limited test data have been available on the monotonic properties and cyclic behavior of these structural steels. In this study, uniaxial coupons were tested for four types of Chinese high strength structural steels, including grades Q460D, Q550D, Q690D as well as ultra-high strength structural steel Q890D, to investigate their stress-strain response and energy-dissipation behavior under monotonic and various cyclic strain demands. The monotonic test results of the tested steels were then compared with the requirements of current seismic design codes GB 50011-2010 and Eurocode8. Besides, cyclic strength, deformability and energy dissipation capacity were evaluated through the tested strain-stress loops. The experimental observations in cyclic tests show that cyclic softening, which significantly affects the shape of cyclic loops and energy dissipation capacity, is an important hysteretic characteristic for all tested high strength structural steels. Moreover, cyclic backbones of these four steels were calibrated using Ramberg-Osgood model. To fundamentally define the cyclic stress-strain relationship, essential parameters of three commonly used constitutive models, including Chaboche model, Dong-Shen model and Giuffre-Menegotto-Pinto model were calibrated based on the experimental data under cyclic loading. Those calibrated models were then employed in simulations of aforementioned cyclic loading tests and their validity were compared. Good agreements between experimental response and simulated performance by Dong-Shen model were achieved, demonstrating that the calibrated Dong-Shen model can elaborately describe the cyclic behavior of these four types of high strength structural steels.

Recently structural members fabricated of high strength constructional steels in civil and building engineering has been widely explored. However, their usage in earthquake zones is still restricted by seismic standards worldwide due to its poor ductility. In order to attain potential seismic application, this paper conducted five cyclic lateral loading experiments on H-shaped beam-columns fabricated of Q690D high strength structural steel. The tested members were cyclically bent about the weak axis. It was recognized that the low-fatigue fracture of edge fiber around bottom cross-section was the main failure mode. Besides, the hysteretic curves, cyclic backbones and energy dissipation characteristics were thoroughly discussed. The ultimate inter-storey drift was greater than the limitation of 1/50. All tested beam-columns exhibit favorable cyclic deformability and energy dissipated ability. To further study the influence of several factors, a series of FEA simulations were performed through verified numerical models. Ductile damage behaviors and advanced cyclic constitutive relationships were considered to improve the simulation performance. The influences of plate component slenderness and axial load ratio on seismic performance of steel beam-columns were thoroughly discussed. It is concluded that there exist interdependence characteristics between different influential factors on seismic performance.

Chaboche model has gained prominent utilization in numerical simulation on cyclic behaviors of metal structure. However, the calibration of its material parameter may produce considerable cost. A simplified calibration way is of great importance to ease its application. To this end, a re-evaluation on chaboche model material parameters and simulated elastic-plastic laws was conducted regarding various steel grades. Futhermore, the characterisitcs of isotropic softening was coupled with the present model hardening rule. The kinematic rule was correlated with cumulative plastic strain. The modified model was then calibrated and validated base upon the coupon test result on 41 batches of steels, whose yield stress ranges from 100 MPa to 890 MPa. The calibrated material parameter were then correlated with corresponding monotonic mechanical properties. Accordingly, a simplified calibration procedure, based upon which the material parameters of modifed Chaboche model can be fastly estimated by yield strength and yield ratio, was constructed. As for low yield point steels, mild steels and high strength steels, this calibration method can ease the calibration of modified Chaboche model considerably.

Subglottic stenosis (SGS) is a common cause of obstructed airway in children, and the treatment of pediatric SGS, especially congenital SGS, remains a challenge for the otolaryngologist. Objective To analyze the outcomes of endoscopic management in young children with SGS. Methods We performed a retrospective review of treatment with endoscopic balloon dilation (EBD) or EBD combined with endoscopic anterior cricoid split (EACS) for young SGS children, from December 2008 to December 2015. The ages of patients ranged from 2 days to 12 years, median age was 5 months. The grade of them ranged from II to IV. Results For acute acquired SGS, 19 cases received EBD alone and the other 3 cases received EBD and EACS, the success rate was about 95.5%; For chronic acquired SGS, EBD and EACS was performed in 6 patients with a success rate of 66.7%; For congenital SGS, EBD and EACS was performed in 28 patients with a success rate of 85.7%. Overall, the success rate of endoscopic management in 56 young children was about 87.5%. Besides, No procedure-related complications were observed in any patients. Conclusions Endoscopic surgical technique offers a safe and effective approach for treatment of young children with SGS, especially in congenital SGS.

The agricultural science and technology cloud of is an important project in Chinese Academy of Agricultural Sciences (CAAS) informatization planning from 2015 to 2017. The cloud aims at realizing the integration of network, computing, storage and application of scattered in various scientific research resources, and enhance the ability of innovation of science and technology of CAAS. This chapter presents the ideas and techniques of construction of the cloud, introduces the scheme of network, virtualization, storage and backup, security. Finally, the future development direction of the cloud is discussed briefly.

Minimizing the energy consumption is one of the main challenges in Internet of Things (IoT) networks. Recently, the IEEE 802.11ah standard has been released as a new low-power Wi-Fi solution for IoT. It has several features, such as Restricted Access Window (RAW) and Target Wake Time (TWT), that promise to improve energy consumption. In this paper, we present an extension of the IEEE 802.11ah module in ns-3 with support for the TWT feature. We study how the energy consumption is affected by the coexistence of RAW and TWT stations (STAs). The results show that the presence of RAW STAs can have an extreme negative effect on the energy efficiency of TWT STAs. Proper scheduling of channel access for both RAW and TWT STAs can mitigate this effect without negatively affecting throughput of RAW STAs.

In the signal processing software testing for synthetic aperture radar (SAR), the verification for algorithms is professional and has a very high proportion. However, existing methods can only perform a degree of validation for algorithms, exerting an adverse effect on the effectiveness of the software testing. This paper proposes a procedure-based approach for algorithm validation. Firstly, it describes the processing procedures of polar format algorithm (PFA) under the motion-error circumstance, based on which it analyzes the possible questions that may exist in the actual situation. By data simulation, the SAR echoes are generated flexibly and efficiently. Then, algorithm simulation is utilized to focus on the demonstrations for the approximations adopted in the algorithm. Combined with real data processing, the bugs concealed are excavated further, implementing a comprehensive validation for PFA. Simulated experiments and real data processing validate the correctness and effectiveness of the proposed algorithm.

Multi-mode quantum memory is a basic element required for long-distance quantum communication, as well as scalable quantum computation. For on-demand readout and long storage times, control pulses are crucial in order to transfer atomic excitations back and forth into spin excitations. Here, we introduce noise-robust composite pulse sequences for high-fidelity excitation transfer in multi-mode quantum memory. These pulses are robust to the deviations in amplitude and the detuning parameters of realistic conditions. We show the efficiency of these composite pulses with a typical rare-earth ion-doped system. This approach could be applied to a variety of quantum memory schemes.

Named-data Network (NDN) is a new network architecture, and its purpose is to achieve network architecture from the host-centric to the data-centric. NDN uses the data name of the application to communicate directly. Since the data name is defined by the application and unrelated to the connection, it relieves the need for IP address configuration, so as long as the physical connection exists, data exchange can occur. The NDN-based forwarding mechanism is very important for effective communication in Vechicle Ad-hoc Network (VANET) and Wireless Sensor Network (WSN). Location-based routing and forwarding utilizes the location information of neighboring nodes or destination nodes to improve the efficiency of routing search. The paper mainly discusses the geographical routing and forwarding strategies of NDN-based VANET and WSN and the existing problems, and proposes future challenges for NDN routing and forwarding.

Communication is an important resource for multiagent coordination. Interactive Dynamic Influence Diagrams I-DIDs have been used extensively in multiagent planning when there is uncertainty, and they are recognized graphical representations of Interactive Partially Observable Markov Decision Processes I-POMDPs. We establish a communication model among multiple agents based on the I-DID framework. We use the AND-communication method by assuming a separate communication and action phase in each step, rather than replacing domain actions, in order that communication facilitates better domain-action selection. We use a synchronized communication type: when an agent initiates communication, all of the agent’s teammates synchronize to share their recent observations. We give a general algorithm to calculate communicative decision from a single-agent perspective by comparing expected rewards with and without communication. Finally, we use multiagent “tiger” and “concert” problems to validate the model’s effectiveness.

Under seismic loading, a cyclic deterioration in strength and stiffness of high-strength steel beam-column can be caused by two main damage modes including local buckling and low-cycle fatigue, which can remarkably change the cyclic response and needs to be considered in seismic design for high-strength steel beam-column. Driven by this need, a hysteretic model considering cyclic deterioration is investigated for H-section beam-column made of high-strength steel with a specified yielding strength of 690 MPa (Q690 steel). First, the effects of the key factors including flange and web slenderness, axial load ratio, and lateral load amplitude on the damage evolution are numerically analyzed using the validated finite element model for Q690 steel beam-columns. Second, according to the results of parametric analysis, the deterioration law and damage index are proposed and calibrated considering two damage-driven modes: local buckling and low-cycle fatigue. Finally, incorporating the developed deterioration evolution law together with damage index, a hysteretic model is developed and calibrated for Q690 steel beam-columns with cyclic deterioration. The proposed hysteresis model with cyclic deterioration is further validated against the test results of Q690 steel beam-columns. It could be concluded that the increase of the axial load ratio, flange and web slenderness and loading amplitude, may result in the increase of cyclic deterioration in high-strength steel beam-column and compared with low-cycle-fatigue-driven mode, local-buckling-driven mode may result in a more significant cyclic deterioration. It also demonstrates that the proposed hysteresis model with cyclic deterioration can reasonably predict the cyclic response of Q690 steel beam-columns.

Composite beams and girders with corrugated steel webs have been achieving promising application in structure and bridge engineering around the world. Nevertheless, there still exists few research related with the behavior of box-girders with corrugated steel webs under pure torsion. To gain a deep insight of such subjects, two steel-concrete composite box girders with trapezoidally corrugated webs and steel bottom flange plate were designed and experimentally investigated. The experimental results including the failure mode, mechanical characteristics, bearing capacity, deformability, strain and stress evolution of each component were thoroughly analyzed. The prediction formulas for stiffness, crack torque and ultimate torque were then thoroughly developed. Moreover, a series of finite element models were established and verified by using experimental results. A parametric study was then conducted and compared with the corresponding prediction results. The good agreements between them confirm the validity of prediction formulas.

The significance of clinical and dosimetric risk factors in relation to chest wall (CW) injury after stereotactic body radiation therapy (SBRT) for lung tumors were analyzed through a meta-analysis of 57 published studies.Studies related to CW injury after lung SBRT were obtained through searching PubMed, Embase, and Cochrane electronic databases. An estimate of the incidence of CW pain (CWP) or rib fracture (RF) was derived using a Bayesian hierarchical model. Linear regression analysis was performed to assess the relationship between CWP or RF and clinical or dosimetric factors.A total of 57 studies incorporating 5985 cases reporting clinical data on CW injury after SBRT were analyzed. The overall CWP and RF rates by Bayesian hierarchical modeling were 11.0% (95% confidence interval [CI], 8.0-14.4) and 6.3% (95% CI, 3.7-9.7), respectively. The rates of grade ≥2 and grade ≥3 CWP were 6.2% (95% CI, 3.88-8.93) and 1.2% (95% CI, 0.48-2.12), respectively. Sex was significantly correlated with RF (P .001), with female patients having a greater risk of RF than male patients (hazard ratio = 0.59; 95% CI, 0.46-0.76). No correlation was found between RF, grade ≥2 CWP, or grade ≥3 CWP, with the clinical and dosimetric factors of age, tumor size, origin of lung tumor, gross tumor volume, planning target volume, fractional dose, number of fractions, or biologically effective dose. However, tumor to CW distance (16-25 mm), body mass index, maximum dose (Dmax) of 0.5 to 5 cmThe overall rates of RF and grade ≥2 CWP after thoracic SBRT are relatively low. Sex, tumor to CW distance, maximum dose, and the radiation exposure of the CW or ribs are factors associated with the risk of CW toxicity after SBRT.

Background: Apatinib is a tyrosine kinase inhibitor (TKI) that selectively inhibits the vascular endothelial growth factor receptor-2. A weighted pooled analysis was performed to evaluate the clinical outcome, efficacy, and toxicity of apatinib in patients with advanced nonsmall cell lung cancer (NSCLC) that failed prior treatment with chemotherapy or epidermal growth factor receptor-TKIs (EGFR-TKIs). Methods: The literature published in PubMed, Embase, and Cochrane Library databases was searched (from inception to November 30, 2017) for eligible trials using the following search terms: apatinib AND (lung cancer OR NSCLC). Meeting abstracts were also reviewed to identify appropriate studies. Inclusion criteria were as follows: prospective or retrospective studies that evaluated efficacy and/or safety of apatinib in patients with advanced NSCLC that failed prior chemotherapy or EGFR-TKIs; primary outcome included one of these endpoints, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), or adverse events (AEs); English language; and number of cases in the study ≥10 cases. Results: A total of 457 patients with advanced NSCLC were treated with apatinib in 14 studies (10 retrospective and 4 prospective studies) and were included in this pooled analysis. The pooled median PFS was 4.77 months [95% confidence interval (CI), 4.11–5.00] in all groups, 4.80 months (95% CI, 4.65–4.95) in the 750 mg apatinib (high-dose) group, and 3.88 months (95% CI, 3.11–4.65) in the 250 to 500 mg apatinib (low-dose) group. Median PFS stratified by single apatinib therapy or apatinib combined with continuous EGFR-TKIs was 4.76 months (95% CI, 3.66–5.06) and 5.20 months (95% CI, 3.66–6.74), respectively. The pooled median OS, ORR, and DCR values were 6.85 months, 18%, and 72%, respectively; pooled median ORR and DCR were 15% and 72% in the 750 mg apatinib group versus 20% and 72% in the 250 to 500 mg apatinib group. ORR and DCR stratified by therapeutic regimens were 14% and 70% for single-agent apatinib, 29% and 88% for apatinib combined with continuous EGFR-TKIs, and 26% and 63% for apatinib combined with chemotherapy, respectively. The pooled AE rates of grade 3/4 were hypertension (7%), proteinuria (3%), hand-foot-skin reaction (6%), fatigue (4%), decreased appetite (1.1%), oral mucositis (3%), and thrombocytopenia (3%). Conclusion: Apatinib has promising antitumor activity and manageable toxicity profile in patients with advanced NSCLC that failed prior chemotherapy or EGFR-TKIs. This result needs to be confirmed through the ongoing Phase III clinical trial.

In December 2016, the Union for International Cancer Control (UICC) published the 8th edition of the Tumor-Node-Metastasis (TNM) classification of malignant tumors, including a number of vital changes in the definitions of the T2 category, the N category and the stages of gallbladder cancer (GBC). The clinical value of this newly updated classification in patients with surgically treated GBC has not been rigorously validated. The present study aimed to analyze the prognosis of patients with GBC in a high-volume surgical unit, and to validate the prognostic value of the new UICC TNM classification, particularly the main changes in the stages of GBC. Data from 307 patients who were surgically treated and histopathologically diagnosed with GBC between January 2011 and July 2016 in The West China Hospital (Chengdu, Sichuan, China) were retrospectively collected and analyzed. The new UICC criteria distributed 32, 60, 99 and 116 eligible patients in stages I, II, III and IV, respectively. The differences in overall survival time between each stage (I–IV) demonstrated statistical significance (P

The goal of nasal reconstruction surgery is to restore normal nasal shape and function, and its success begins with creating a stable framework. In this article the authors discuss the most advantageous materials for building such a framework and how to design this element to achieve better and more durable outcomes. This is a retrospective study including patients who underwent nasal reconstruction in our rhinoplasty and nasal reconstruction center at a tertiary referral hospital between 2006 and 2016. Data included patient characteristics, defect location, the reason for defect, use of supporting structure, flap, lining, and complications were recorded. The minimum postoperative follow-up was at least 6 months after the last operation. This study included 455 patients. Nasal defects treated most commonly involved zone 2 and an average defect of 4.2 subunits. Expanded forehead flap for cover with costal cartilage as a framework and turn-over flap combined with distal end of the flap for lining was the most common reconstruction method used in this study. The complication rate was 4.39% and nearly half of these complications were related to usage of an expander during reconstruction. Regardless of flap used, the supporting structure was the most critical element for the 3-dimensional shape of the reconstructed nose. As 1 of the 3 elements of nasal reconstruction, framework deserves adequate attention during such reconstruction.

The Clavien-Dindo (C-D) classification is a simple and feasible grading system of postoperative complications. The aim of the present study was to apply this system to retrospectively classify all types of post-pancreaticoduodenectomy (PD) complications (PPCs) and to systematically identify associated risk factors. Between January 2009 and December 2014, the C-D classification was applied to retrospectively classify PPCs for 1,056 patients who had undergone PD at the West China Hospital. Univariate and multivariate analyses were performed to link perioperative parameters and mortality with the severity of PPCs, which were subdivided into overall PPCs (Grade I-V), severe PPCs (Grade III-V) and mortality (Grade V). The number of patients with Clavien-Dindo grade I, II, IIIa, IIIb, IVa, IVb and V complications was 185 (17.5%), 128 (12.1%), 50 (4.7%), 25 (2.4%), 35 (3.3%), 19 (1.8%) and 33 (3.1%), respectively. A total of 475 (45.0%) patients experienced overall PPCs; 168 (15.9%) patients experienced severe PPCs; and 33 patients succumbed to mortality following PD. The following risk factors were identified following PD: Preoperative hypoproteinemia was correlated with all three subdivisions; obstructive jaundice was associated with severe PPCs and mortality; and older age was revealed to be an independent risk factor of mortality. A large retrospective study was performed in the present study and PD was correlated with a high occurrence of PPCs. The Clavien-Dindo system represents a broad applicable and feasible approach to evaluating PPCs in patients following PD. The independent risk factors of PPCs that were identified in the present study require further validation using the Clavien-Dindo classification in additional prospective studies.

Wi-Fi HaLow is an adaptation of the widespread Wi-Fi technology for the Internet of Things scenarios. Such scenarios often involve numerous wireless stations connected to a shared channel, and contention for the channel significantly affects the performance in such networks. Wi-Fi HaLow contains numerous solutions aimed at handling the contention between stations, two of which, namely, the Centralized Authentication Control (CAC) and the Distributed Authentication Control (DAC), address the contention reduction during the link set-up process. The link set-up process is special because the access point knows nothing of the connecting stations and its means of control of these stations are very limited. While DAC is self-adaptive, CAC does require an algorithm to dynamically control its parameters. Being just a framework, the Wi-Fi HaLow standard neither specifies such an algorithm nor recommends which protocol, CAC or DAC, is more suitable in a given situation. In this paper, we solve both issues by developing a novel robust close-to-optimal algorithm for CAC and compare CAC and DAC in a vast set of experiments.

Background It remains controversial whether the additional Braun enteroenterostomy (BEE) is necessary in decreasing delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD). This meta-analysis aims to assess the efficacy of the additional BEE in reducing DGE after PD. Methods PubMed, EMBASE, Science Citation Index and The Cochrane Library were searched to identify relevant studies. Articles published before May 15, 2015 comparing BEE with traditional gastrojejunostomy during PD were selected. The evaluated end points consist of intro-operative outcomes as well as postoperative complications. Results Seven observational clinical studies that recruited 1401 patients were included. This meta-analysis indicated that the occurrence of DGE was lower in Braun group (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.15 to 0.60; P = 0.0007). Overall morbidity (OR, 0.61; 95%CI, 0.47 to 0.80; P = 0.0003) and the length of hospital stay (LOS) (weighted mean difference [WMD], −1.80; 95%CI, −3.4 to −0.18; p = 0.03) were also in favor of the Braun group. However, Braun group had no advantage over Non-Braun group in terms of intra-operative blood loss, mortality, pancreatic fistula, bile Leakage and intra-abdominal abscess. Conclusion The additional of BEE plays an important role in reducing DGE, overall morbidity and LOS.

Using the same bend waveguide with two different E-field polarization directions, the breakdown phenomena in a curved waveguide with different power capacities were studied. For the case of lower power capacity, breakdown happens at the curved arm; with increasing incident power, the reflected peak amplitude increases, the breakdown delay time becomes shorter, and the reflected pulse gradually overlaps with the incident one, forming a slower falling edge at the end of incident pulse. For the case of higher power capacity, discharge may occur at the connected flanges without the choke shot. Using the four-frame intensified-charged-coupled device diagnosing the nanosecond light emission in each of the vertical and horizontal polarization cases, the intensities in both of the surface layer and the space beyond were found to first become bright during the microwave pulse, and then get dark after the pulse. The multiple bright spots on the wall illustrate the nonuniform plasma development and local high-density plasma at the microprotrusions with field enhancement, triggering the intense high-field emission or explosive emission.