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BACKGROUND To investigate associations between exposure to various trajectories of severe hypoglycemic events and risk of dementia in patients with type 2 diabetes. METHODS In 2002-2003, 677618 patients in Taiwan were newly diagnosed as having type 2 diabetes. Among them, 35720 (5.3%) experienced severe hypoglycemic events during the 3-year baseline period following diagnosis. All patients were followed from the first day after baseline period to the date of dementia diagnosis, death, or the end of 2011. A group-based trajectory model was used to classify individuals with severe hypoglycemic events during the baseline period. Cox proportional hazard models with the competing risk method were used to relate dementia risk to various severe hypoglycemia trajectories. RESULTS After a median follow-up 6.70 and 6.10 years for patients with and without severe hypoglycemia at baseline, respectively, 1952 (5.5%) individuals with severe hypoglycemia and 23492 (3.7%) without developed dementia during follow-up, for incidence rates of 109.80 and 61.88 per 10000 person-years, respectively. Four groups of severe hypoglycemia trajectory were identified with a proportion of 18.06%, 33.19%, 43.25%, and 5.50%, respectively for Groups 1 to 4. Groups 3 (early manifestation but with later decrease) and 4 (early and sustained manifestation) were associated with a significantly increased risk of dementia diagnosis, with a covariate-adjusted subdistribution hazard ratio of 1.22 (95% confidence interval, 1.14-1.31) and 1.25 (95% confidence interval, 1.02-1.54), respectively. CONCLUSIONS Our analysis highlighted that early manifestation of severe hypoglycemic events may contribute more than does late manifestation to the risk of dementia among individuals newly diagnosed as having type 2 diabetes.

In the last few decades, hyperuricemia has drawn increasing attention owing to its global prevalence. Observational surveys have manifested that there is a relation between hyperuricemia and increased risks of hypertension, chronic kidney disease, cardiovascular events, metabolic disorders, end stage renal disease, and mortality. As alternatives, Traditional Chinese medicinal herbs have demonstrated concrete effects in mitigating hyperuricemia in different experiments. Researchers have made efforts to investigate the role of herbal medicine in attenuating hyperuricemia. This review focuses on traditional Chinese herbal medicines that have been reported to ameliorate hyperuricemia in experimental studies.

The development of smart homes has advanced the concept of user authentication to not only protecting user privacy but also facilitating personalized services to users. Along this direction, we propose to integrate user authentication with human-computer interactions between users and smart household appliances through widely-deployed WiFi infrastructures, which is non-intrusive and device-free. In this paper, we propose $FingerPass$ F i n g e r P a s s which leverages channel state information (CSI) of surrounding WiFi signals to continuously authenticate users through finger gestures in smart homes. $FingerPass$ F i n g e r P a s s separates the user authentication process into two stages, login and interaction, to achieve high authentication accuracy and low response latency simultaneously. In the login stage, we develop a deep learning-based approach to extract behavioral characteristics of finger gestures for highly accurate user identification. For the interaction stage, to provide continuous authentication in real time for satisfactory user experience, we design a verification mechanism with lightweight classifiers to continuously authenticate the user’s identity during each interaction of finger gestures. Experiments in real environments show that $FingerPass$ F i n g e r P a s s can achieve the authentication accuracies of 90.6 percent under in-domain scenarios and 87.6 percent under cross-domain scenarios, as well as $186.6\;ms$ 186 . 6 m s response time during interactions.

Background: To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes. Methods: A cohort of 17,203 patients with type 1 diabetes were identified from Taiwan’s National Health Insurance claims in the period of 1998–2014. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population. Results: In up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The all-cause SMR was significantly elevated at 4.16 (95% confidence interval, 4.04–4.28), with a greater all-cause SMR noted in females than in males (4.62 vs 3.79). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15–24 years (SMR, 8.46). Conclusions: Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.

AIM: Psychotropic drugs like opioids and benzodiazepines are prescribed for traumas resulting from road traffic crashes and the risk of developing an addiction deserves consideration. This study aims to shed light on how the consumption of those drugs evolves over time among older road traffic injury (RTI) victims. METHODS: We conducted a nationwide Swedish register-based longitudinal study to identify trajectories of post-RTI psychotropic drug use. All individuals aged 50 years and older who had a hospital visit for an RTI from 2007 to 2015 were followed up during a two-year period; those who used the drugs prior to the RTI were excluded. Trajectories were identified by performing latent class trajectory analysis on drug dispensation data for opioids and benzodiazepines separately (66,034 and 66,859 adults, respectively, in total). RESULTS: Three trajectories were identified for opioids and four for benzodiazepines. The largest group in both instances included people with no-use/minimal use throughout the follow-up (81.3% and 92.8%). "Sporadic users" were more frequent among users of opioids (16.7%) than benzodiazepines (4.3%), whereas "chronic users" were found in similar proportions (2.0% and 1.8%). "Delayed chronic use" characterized the fourth group of benzodiazepine users (1.0%). CONCLUSION: Several trajectories of psychotropic drug use were identified after RTI, from limited to chronic. Although chronic use was uncommon, a better understanding of the factors likely to increase that risk is warranted given the seriousness of the problem.

OBJECTIVE The association between sleep disturbances and suicidality is not well understood partly because of the variability in research results. This meta-analysis aimed to investigate the predictive value of sleep disturbances for incident suicidality. METHODS A systematic search was conducted in PubMed, EMBASE, PsycINFO, and Web of Science databases for studies examining sleep disturbances and incident suicidality. Cohort studies were screened following a registered protocol, and the eligible ones were meta-analyzed. RESULTS Seven studies comprising 1,570,181 individuals at baseline, with 1407 attempting suicide and 1023 completing suicide during follow-up, were included. Individuals with baseline sleep disturbances had a significantly higher incidence of suicidality than did those without (relative risk = 2.17, 95% confidence interval [CI] = 1.45-3.24, I2 = 82.50%, p < .001). The risk of an incident suicide attempt was 3.54-fold higher (95% CI = 3.07-4.09, I2 = 0%, p = .44), whereas the risk of incident completed suicide was 1.80-fold higher (95% CI = 1.32-2.44, I2 = 59.33%, p = .01) in individuals with baseline sleep disturbances. CONCLUSIONS Incident suicide attempts and deaths are higher among people with sleep disturbances. Regular screening and preventive measures should be undertaken for people with sleep disturbances to prevent progression into suicide attempts and deaths.Clinical Trial Registration:CRD42019136397.

Background:. Non-communicable chronic diseases have become the leading causes of disease burden worldwide. The trends and burden of “metabolic associated fatty liver disease” (MAFLD) are unknown. We aimed to investigate the cardiovascular and renal burdens in adults with MAFLD and non-alcoholic fatty liver disease (NAFLD). Methods:. Nationally representative data were analyzed including data from 19,617 non-pregnant adults aged ≥20 years from the cross-sectional US National Health and Nutrition Examination Survey periods, 1999 to 2002, 2003 to 2006, 2007 to 2010, and 2011 to 2016. MAFLD was defined by the presence of hepatic steatosis plus general overweight/obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation. Results:. The prevalence of MAFLD increased from 28.4% (95% confidence interval 26.3–30.6) in 1999 to 2002 to 35.8% (33.8–37.9) in 2011 to 2016. In 2011 to 2016, among adults with MAFLD, 49.0% (45.8–52.2) had hypertension, 57.8% (55.2–60.4) had dyslipidemia, 26.4% (23.9–28.9) had diabetes mellitus, 88.7% (87.0–80.1) had central obesity, and 18.5% (16.3–20.8) were current smokers. The 10-year cardiovascular risk ranged from 10.5% to 13.1%; 19.7% (17.6–21.9) had chronic kidney diseases (CKDs). Through the four periods, adults with MAFLD showed an increase in obesity; increase in treatment to lower blood pressure (BP), lipids, and hemoglobin A1c; and increase in goal achievements for BP and lipids but not in goal achievement for glycemic control in diabetes mellitus. Patients showed a decreasing 10-year cardiovascular risk over time but no change in the prevalence of CKDs, myocardial infarction, or stroke. Generally, although participants with NAFLD and those with MAFLD had a comparable prevalence of cardiovascular disease and CKD, the prevalence of MAFLD was significantly higher than that of NAFLD. Conclusions:. From 1999 to 2016, cardiovascular and renal risks and diseases have become highly prevalent in adults with MAFLD. The absolute cardiorenal burden may be greater for MAFLD than for NAFLD. These data call for early identification and risk stratification of MAFLD and close collaboration between endocrinologists and hepatologists.

Miao-Miao Zhang, Xiao-Chun Yu, Feng-Li Lu, Ke-Ke Lu Department of Emergency, The Fifth People’s Hospital of Yuhang District, Hangzhou, Zhejiang, 311100, People’s Republic of ChinaCorrespondence: Ke-Ke LuDepartment of Emergency, The Fifth People’s Hospital of Yuhang District, Hangzhou, No. 60 Baojian Road of Linping Street, Yuhang District, Hangzhou, 311100, People’s Republic of ChinaTel +86 571 86163516Email lukekeht@163.comObjective: This study aimed to explore the application effect of lean management in rabies vaccination.Methods: Lean management in rabies vaccination was implemented from July 2020. A total of 2306 patients vaccinated from January to June 2020 were enrolled as routine management group, and 2718 patients vaccinated from July to November 2020 were enrolled as lean management group. The relationship between potential factors and rabies vaccination with 1:1 propensity score matching (PSM) was analysed. The compliance, waiting time for vaccination, and satisfaction of patients of routine and lean management group were statistically analyzed. The changes in the three indicators before and after the implementation and their application effects were compared.Results: Compliance rate in lean management group (98.72%) was significantly higher than that in routine management group (93.87%) (χ2=32.902, P< 0.001). The waiting time for vaccination was also significantly shortened (t = 9.209, P < 0.001), and the satisfaction of patients significantly improved (X2 = 39.611, P < 0.001).Conclusion: Implementing lean management in all aspects of rabies vaccination can significantly improve patient compliance and work efficiency of nursing staff and improve the patient medical experience.Keywords: lean management, rabies, vaccination, compliance, satisfaction rate

Background Neuropsychiatric manifestations occur in up to 75% of adult systemic lupus erythematosus (SLE) patients and are one of the major causes of death in SLE patients. Cognitive dysfunction is a typical clinical feature of neuropsychiatric SLE (NPSLE), which seriously affects the quality of life of patients. Dyslipidaemia and thyroid symptoms, which are prevalent in SLE patients, have both been related to neuropsychiatric disturbances, including significant psychiatric and cognitive disturbances. This study aimed to investigate whether cognitive dysfunction in patients with SLE was related to the expression of serum thyroid hormone and lipoprotein levels. Methods A total of 121 patients with SLE and 65 healthy controls (HCs) at Nanjing Drum Tower Hospital completed a cognitive function test, and 81 SLE patients were divided into a high-cognition (n = 33) group and a low-cognition group (n = 48). The clinical and laboratory characteristics of the patients were compared; moreover, correlations between serum HDL-C, LDL-C, F-T3 and F-T4 levels and cognitive function were analysed. Serum levels of APOE, APOA1, IGF-1, and IGFBP7 in 81 patients were detected by ELISA, and the correlation between these four proteins and cognition was analysed separately. Results The patients with SLE with abnormal cognitive function were less educated than the HCs. For low-cognition patients, the levels of albumin, F-T3 (P Conclusions Serum F-T3 and F-T4 levels were both positively correlated with four indexes of cognition (language was the exception), while serum APOE levels were negatively correlated with line orientation scores, APOA1 levels were positively correlated with coding scores, and IGFBP7 levels were negatively correlated with figure copy scores. These results demonstrated that F-T3 and F-T4 might be clinical biomarkers of cognitive dysfunction in SLE.

Background and aims Systemic immune-inflammation index (SII) has been recently investigated as a novel inflammatory and prognostic marker. SII may be used as an indicator reflecting the progressive inflammatory process in atherosclerosis, although its link to incident cardiovascular disease (CVD) has not been examined in previous studies. This study aims to prospectively assess the association of SII with incident CVD and its main subtypes in Chinese adults. Methods Using data from the Dongfeng-Tongji cohort study, 13,929 middle-aged and older adults with a mean age of 62.56 years (range 35–91 years), who were free of CVD and cancer, were included for analysis. The baseline study was conducted in Shiyan city, Hubei province from 2008 to 2009. The SII was calculated as platelet count (/L) × neutrophil count (/L)/lymphocyte count (/L). Cox regression models were used to examine the associations of SII with incident CVD, including stroke and coronary heart disease (CHD). Results Over a median 8.28 years (maximum 8.98 years) of follow-up, 3386 total CVD cases, including 801 stroke cases and 2585 total CHD cases, were identified. In multivariable Cox regression analyses, higher levels of log-transformed SII were significantly associated with total stroke (HR 1.224, 95% CI 1.065–1.407) and ischemic stroke (HR 1.234, 95% CI 1.055–1.442). For those participants with the highest quartiles of SII versus the lowest quartiles of SII, the HRs were 1.358 (95% CI 1.112–1.658) for total stroke, 1.302 (95% CI 1.041–1.629) for ischemic stroke, and 1.600 (95% CI 1.029–2.490) for hemorrhagic stroke. Conclusions SII may serve as a useful marker to elucidate the role of the interaction of thrombocytosis, inflammation, and immunity in the development of cerebrovascular diseases in the middle-aged and elderly population.

Optimal catheter tip position of a totally implantable venous access port (TIVAP) is important to maintain its function and to avoid severe complications. In this study, we aimed to assess the reliability of a modified surface measurement method to determine optimal tip position of a TIVAP catheter inserted through the right subclavian vein.Clinical and radiologic information of 105 patients who underwent TIVAP implantation through the right subclavian vein was collected retrospectively. The length of the implanted catheter was determined by a modified surface measurement method, as follows. The distance from the puncture point (point A) to the middle point of the sternal notch (point B), then from the middle point of the sternal notch (point B) to the middle point of Louis angle (point C) was added up. The equation for the catheter length is given by catheter length (cm) = AB + BC + 3. Postprocedure plain chest radiography (CXR) and enhanced chest computed tomography (CT) were used to check the catheter tip position and to calculate optimal position rate. Distance from the carina to the catheter tip and the length of the vertebral body unit were measured on both CXR and CT. Distances from carina to caval-atrial junction (CAJ) and from catheter tip to CAJ were measured on CT.Mean length of the implanted catheter of all patients was 17.0 ± 0.7 cm (male vs female, 17.3 ± 0.5 cm vs 16.7 ± 0.7 cm; P .001). On CXR, a catheter tip located within 2.4 vertebral body units below the carina was identified as the optimal position, and the optimal position rate was 97.1% (102/105 cases). On CT, two definitions of optimal position were used: within 2 cm above or below the CAJ and within 2 cm above or at the CAJ; the optimal position rate was 92.4% (97/105 cases) and 78.1% (82/105 cases), respectively. Median follow-up time was 9.4 months. During the follow-up, no severe cardiac complication was recorded.The modified surface measurement had high reliability in determining the optimal catheter length to accurately place the tip in the superior vena cava near the CAJ.

Aldosterone exerts an enormous function on proximal tubular cells (PTC) senescence, which is a common pathomechanism contributing to renal dysfunction. Numerous studies have shown that oxidative stress is deeply involved in the pathophysiologic processes of chronic kidney diseases. The study aims to investigate whether autophagy could regulate the process of senescence through oxidative stress in PTC both in vivo and ex vivo. Our results suggested that aldosterone treatment increased the senescence and oxidative stress as evidenced by increased percent of SA-β-Gal positive cells, reactive oxygen species level, expression of NADPH oxidase 4 (NOX4) rather than NOX2, and the up-regulation of p21 in cultured PTC. Furthermore, the alternation of the expression of p62 and LC3-II/LC3-I demonstrated that aldosterone treatment remarkably influenced autophagic flux. NOX4 siRNA treatment or autophagy induction with rapamycin reduced the oxidative stress and senescence in aldosterone-induced PTC. On the contrary, inhibition of autophagy with chloroquine worsened these changes. Similar results were further confirmed in vivo. Our results suggested that autophagy may become a realistic therapeutic strategy against aldosterone-induced PTC injury via improving oxidative stress.

Condition monitoring for wind turbine (WT) planetary gearbox is of great significance to the reliable operation of WT. A novel condition monitoring method for WT planetary gearbox is proposed in this article. This method can identify and predict the fault in the initial stage. Raw vibration signals are gathered from WT planetary gearbox through an enhanced piezoelectric self-powered wireless sensor. First, after the data processing back-end receives the original samples transmitted by the wireless sensor, the high-dimensional raw vibration signals are compressed and collected by adopting a random Bernoulli matrix to obtain the compressed samples containing the characteristics of the raw signals by compressed sensing (CS). Moreover, the operation of reducing the signal dimension not only eliminates noise pollution but also greatly reduces the overall calculation. Second, the training part of compressed samples is first exploited to optimize the deep belief network (DBN) by the chaotic quantum particle swarm optimization (CQPSO) algorithm. In the optimization process, the CQPSO algorithm can avoid local optimal problem better compared with traditional quantum particle swarm optimization (QPSO) algorithm, which ensures that the optimized DBN architecture can extract distinguishing and deep features from compressed samples. Furthermore, the choice of compression ratio (CR) is realized in this process with the least-squares support vector machine (LSSVM) classifier. Third, testing samples are input into the DBN structure. A regression layer added on the last hidden layer, which stores extracted features, achieves the prediction of fault. In addition, LSSVM is exploited to distinguish fault types of features. The experimental results show that the modified wireless sensor can collect and transmit signals stably and achieve better performance in transmission interval and energy management. More importantly, the experimental results of prediction and diagnosis show that the proposed approach achieves excellent performance in terms of condition monitoring for the WT planetary gearbox.

Background This report describes an outbreak of 71 patients developed B. cepacia urinary tract infection (UTI) by contaminated single-use anesthetic gel. Methods Epidemiological investigation of patients with B. cepacia-positive urine or blood samples between March 19, 2018 and Novemeber 15, 2018 was conducted to identify the source of infection. Microbiological samples from hospital surfaces, endoscopes, disposable items, and the hands of staff were tested for B. cepacia contamination. Pulsed-field gel electrophoresis (PFGE) was used to compare homology in B. cepacia isolates. Results During the outbreak, nosocomial B. cepacia UTI was confirmed in 71 patients. Epidemiological investigation showed that 66 patients underwent invasive urological diagnosis and treatment, while the remaining five patients underwent bedside indwelling catheterization, with all patients exposed to single-use anesthetic gel. All batches of anesthetic gel were recalled and the outbreak abated. Overall, 155 samples were collected from environmental surfaces and disposable items, and B. cepacia contamination was confirmed in samples from one used cystoscope and three anesthetic gels from the same batch. PFGE showed homology between 17 out of 20 B. cepacia isolates from patients and three isolates from the contaminated anesthetic gel. All patients achieved cure. Conclusion Contaminated single-use anesthetic gel was confirmed as the source of the B. cepacia outbreak, with infection occurring during invasive urological diagnostic and treatments. Thus, investigations of nosocomial outbreaks of B. cepacia infection should consider contamination of diagnostic and treatment items used in infected patients.

Suicidal ideation (SI) among college students is frequently reported. However, the mediating roles of depressive and anxiety symptoms between attention-deficit/hyperactivity disorder (ADHD) symptoms and SI has yet to be explored among college students.A cross-sectional survey of college freshmen in China was conducted between October 2018 and December 2018. Standardized questionnaires were used to collect information on basic sociodemographic characteristics, including SI, ADHD symptoms, and anxiety and depressive symptoms. A structural equation model (SEM) was then constructed.A total of 904 college freshmen were included in the analysis. The prevalence of ADHD symptoms and lifetime SI were 11.9% (95% CI: 9.9%-14.2%) and 29.2% (95% CI: 26.3%-32.2%), respectively. The SEM revealed that there were no direct paths from inattention, executive dysfunction, and hyperactivity to SI. Under the mediating role of anxiety and depressive symptoms, executive dysfunction (β = 0.011, p0.05) and hyperactivity (β = 0.015, p0.05) had indirect relationships with the risk of SI, and the role of inattention was not identified. Depressive and anxiety symptoms had direct influences on increasing SI. There also were indirect effects from anxiety symptoms to SI, which were mediated by depressive symptoms (β = 0.023, p0.001).The current study indicated the indirect relationships between ADHD symptoms and SI among college freshmen. The findings could provide useful clues for clinical treatment and school-based prevention that aims to improve college students' mental well-being.

What is already known about this topic? The World Health Organization (WHO) varicella vaccines position paper states that countries where varicella is an important public health burden could consider introducing varicella vaccine (VarV) in the routine childhood immunization program ( 1 ). VarV has been available for many years in China but is not included in most routine immunization programs in China. As a result, substantial heterogeneity in vaccination coverage exists across regions. What is added by this report? In Beijing, adding a second dose of VarV for children and increasing coverage reduced the incidence of varicella. Lowering the age of the first dose of VarV to 12 months could further reduce varicella, especially among toddlers. What are the implications for public health practice? Governments should use economic analysis to consider inclusion of VarV into the routine children immunization program as a free vaccine and adopting a 2-dose schedule that starts at 12 months of age.

What is already known on this topic? Preclinical trials showed the effectiveness of domestic inactivated vaccine candidates for coronavirus disease 2019 (COVID-19). However, it is necessary to evaluate the willingness of the public to receive future domestic vaccines and to understand factors associated with willingness at the early stages of vaccine development. What is added by this report? Through May 25, 2020, 70.48% were willing to receive future domestic COVID-19 vaccines. Confidence in vaccines had the largest impact on public willingness, while age and presence of underlying chronic disease did not significantly increase public willingness. What are the implications for public health practice? It is necessary to increase awareness of COVID-19 vaccines among people with high risk of severe infection and to build public confidence in vaccines. Releasing accurate, timely, and reliable data to the public can help increase willingness to get vaccinated.

Background: The number of new HIV infections has increased and implementation of school-based health education programs on AIDS have been advocated for a long time. Objective: This study aimed to explore the effectiveness of an intervention of HIV/AIDS on the knowledge of HIV/ AIDS prevention and control among first year university students. Methods: An awareness questionnaire was adopted to assess awareness and knowledge of HIV/AIDS pre- and post-health education among first year university students in Qinghai, China. Independent sample t-test, chi-square test, and multiple logistic regression analyses were used. Results: A total of 2,165 and 2,062 first year university students were respectively recruited pre- and post- HIV/AIDS health education. The awareness rate increased significantly after the health education intervention (from 48.59%, 95%CI: 46.47%-50.72% to 76.24%, 95%CI: 74.35%-78.06%). Students from Hui and Tibetan ethnicities, and those holding prej- udices against AIDS patients were less knowledgeable than their counterparts regarding HIV/AIDS related knowledge, whereas urban-dwellers and those with higher paternal education were positively associated with awareness of HIV/AIDS related knowledge (p

Background. China has experienced rapid urbanization in the past 30 years. We aimed to report blood cadmium level (BCL) in the rapidly urbanized Yangtze Plain of China, and explore the association between BCL and 25-hydroxyvitamin D (25(OH)D). Methods. Our data source was the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) cross-sectional study (ChiCTR-ECS-14005052, www.chictr.org). We enrolled 3234 subjects from 12 villages in the Yangtze Plain. BCLs were measured by atomic absorption spectrometry. 25(OH)D was measured with a chemiluminescence assay. Results. A total of 2560 (79.2%) subjects were diagnosed with vitamin D deficiency. The median (interquartile range) BCL was 1.80 μg/L (0.60–3.42) for men and 1.40 μg/L (0.52–3.10) for women. In women, mean 25(OH)D concentrations were inversely associated with BCL (0.401, 95% confidence interval: –0.697 to –0.105 nmol/L lower with each doubling of the BCL) after adjustment for age, educational status, current smoking, body mass index, diabetes, and season. However, there was no significant difference in 25(OH)D across the BCL tertiles for men. Conclusions. BCL in Chinese residents in the Yangtze Plain were much higher than that in developed countries. An inverse association between BCL and 25(OH)D was found in general Chinese women after multivariable adjustment. Future prospective cohort and animal studies are warranted to resolve the direction and temporality of these relationships, and to elucidate the exact mechanisms involved.

Background Albumin is commonly used as a carrier platform for drugs to extend their circulatory half-lives and influence their uptake into tissues that have altered permeability to the plasma protein. The albumin-binding domain (ABD) protein, which binds in vivo to serum albumin with high affinity, has proven to be a versatile scaffold for engineering biopharmaceuticals with a range of binding capabilities. In this study, the ABD protein equipped with a mal-DOTA chelator (denoted ABY-028) was radiolabeled with gallium-68 (68Ga). This novel radiotracer was then used together with positron emission tomography (PET) imaging to examine variations in the uptake of the ABD-albumin conjugate with variations in endothelial permeability. Results ABY-028, produced by peptide synthesis in excellent purity and stored at − 20 °C, was stable for 24 months (end of study). [68Ga]ABY-028 could be obtained with labeling yields of > 80% and approximately 95% radiochemical purity. [68Ga]ABY-028 distributed in vivo with the plasma pool, with highest radioactivity in the heart ventricles and major vessels of the body, a gradual transport over time from the circulatory system into tissues and elimination via the kidneys. Early [68Ga]ABY-028 uptake differed in xenografts with different vascular properties: mean standard uptake values (SUVmean) were initially 5 times larger in FaDu than in A431 xenografts, but the difference decreased to 3 after 1 h. Cutaneously administered, vasoactive nitroglycerin increased radioactivity in the A431 xenografts. Heterogeneity in the levels and rates of increases of radioactivity uptake was observed in sub-regions of individual MMTV-PyMT mammary tumors and in FaDu xenografts. Higher uptake early after tracer administration could be observed in lower metabolic regions. Fluctuations in the increased permeability for the tracer across the blood-brain-barrier (BBB) direct after experimentally induced stroke were monitored by PET and the increased uptake was confirmed by ex vivo phosphorimaging. Conclusions [68Ga]ABY-028 is a promising new tracer for visualization of changes in albumin uptake due to disease- and pharmacologically altered vascular permeability and their potential effects on the passive uptake of targeting therapeutics based on the ABD protein technology.

Purpose In this study, we investigated the acute exacerbation and outcomes of COPD patients during the outbreak of COVID-19 and evaluated the prevalence and mortality of COPD patients with confirmed COVID-19. Methods A prospectively recruited cohort of 489 COPD patients was retrospectively followed-up for their conditions during the COVID-19 pandemic from December 2019 to March 2020 in Hubei, China. In addition, the features of 821 discharged patients with confirmed COVID-19 were retrospectively analyzed. Results Of the 489 followed-up enrolled COPD patients, 2 cases were diagnosed as confirmed COVID-19, and 97 cases had exacerbations, 32 cases of which were hospitalized, and 14 cases died. Compared with the 6-month follow-up results collected 1 year ago, in 307 cases of this cohort, the rates of exacerbations and hospitalization of the 489 COPD patients during the last 4 months decreased, while the mortality rate increased significantly (2.86% vs 0.65%, p=0.023). Of the 821 patients with COVID-19, 37 cases (4.5%) had pre-existing COPD. Of 180 confirmed deaths, 19 cases (10.6%) were combined with COPD. Compared to COVID-19 deaths without COPD, COVID-19 deaths with COPD had higher rates of coronary artery disease and/or cerebrovascular diseases. Old age, low BMI and low parameters of lung function were risk factors of all-cause mortality for COVID-19 patients with pre-existing COPD. Conclusion Our findings imply that acute exacerbations and hospitalizations of COPD patients were infrequent during the COVID-19 pandemic. However, COVID-19 patients with pre-existing COPD had a higher risk of all-cause mortality.

Purpose: Radiation recall dermatitis (RRD) is a rare complication that occurs after completion of radiation therapy (RT) and initiation of a precipitating agent, most commonly chemotherapeutic medications. Various theories attempt to explain the mechanism, including activation of the body’s inflammatory pathways through nonimmune activation. Likewise, radiation-induced organizing pneumonia (RIOP) is an infrequent but potentially life-threatening complication of RT that, while not fully understood, is suspected to be partly an autoimmune reaction. Patient: We present the case of a 71-year-old female with a history of type 2 diabetes mellitus, hypothyroidism, interstitial cystitis, and osteoarthritis who presented with clinical stage T1N0M0 ER+/PR–/HER2– invasive ductal carcinoma of the lower outer quadrant of the left breast, for which she underwent left segmental mastectomy and sentinel lymph node biopsy followed by completion axillary lymph node dissection. Her final pathologic stage was T1N1M0. Result: The patient developed RRD and later RIOP following receipt of radiation and chemotherapy, which resolved with steroid administration. Conclusions: The rarity of both RRD and RIOP occurring in a patient, as in our case, suggests a shared pathophysiology behind these two complications. As both reactions involve some degree of inflammation and respond to corticosteroids, it seems likely that the etiologies of RRD and RIOP lie within the inflammatory pathway. However, further investigation should evaluate the frequency, duration, and triggering of concomitant RRD and RIOP.

Purpose of the study The aim of our study was to investigate potential adverse reactions in healthcare professionals working in Level 3 barrier protection personal protective equipment (L3PPE) to treat patients with COVID-19. Study design By using a convenience sampling approach, 129 out of 205 randomly selected healthcare professionals from the First Affiliated Hospital of Zhejiang University School of Medicine were invited to take part in a WeChat messaging app survey, Questionnaire Star, via a survey link. Healthcare personnel details were collected, including profession, years of professional experience and adverse reactions while wearing L3PPE. Survey results were divided by profession and years of professional experience; differences in adverse reactions were compared. Results Among the 129 healthcare professionals surveyed, 21 (16.28%) were doctors and 108 (83.72%) were nurses. A total of 122 (94.57%) healthcare professionals experienced discomfort while wearing L3PPE to treat patients with COVID-19. The main reasons for adverse reactions and discomfort include varying degrees of adverse skin reactions, respiratory difficulties, heat stress, dizziness and nausea. Doctors had a lower incidence of rashes (χ2=4.519, p=0.034) and dizziness (χ2=4.123, p=0.042) when compared with nurses. Junior (8.5 years of experience or fewer) healthcare personnel also experienced a higher rate of heat stress when compared with senior personnel (more than 8.5 years greater) (χ2=5.228, p=0.022). Conclusion More attention should be offered to healthcare personnel wearing L3PPE to treat patients with COVID-19 because they are susceptible to developing adverse reactions.

Recent years have witnessed the surge of biometric-based user authentication for mobile devices due to its promising security and convenience. As a natural and widely-existed behavior, human speaking has been exploited for user authentication. Existing voice-based user authentication explores the unique characteristics from either the voiceprint or mouth movements, which is vulnerable to replay attacks and mimic attacks. During speaking, the vocal tract, including the static shape and dynamic movements, also exhibits the individual uniqueness, and they are hardly eavesdropped and imitated by adversaries. Hence, our work aims to employ the individual uniqueness of vocal tract to realize user authentication on mobile devices. Moreover, most voice-based user authentications are passphrase-dependent, which significantly degrade the user experience. Thus, such user authentications are pressed to be implemented in a passphrase-independent manner while being able to resist various attacks. In this paper, we propose a user authentication system, VocalLock, which senses the whole vocal tract during speaking to identify different individuals in a passphrase-independent manner on smartphones leveraging acoustic signals. VocalLock first utilizes FMCW on acoustic signals to characterize both the static shape and dynamic movements of the vocal tract during speaking, and then constructs a passphrase-independent user authentication model based on the unique characteristics of vocal tract through GMM-UBM. The proposed VocalLock can resist various spoofing attacks, while achieving a satisfactory user experience. Extensive experiments in real environments demonstrate VocalLock can accurately authenticate user identity in a passphrase-independent manner and successfully resist various attacks.

To observe the clinical efficacy of herbal cake-partitioned moxibustion for dysmenorrhea due to deficiency cold. A total of 70 patients with dysmenorrhea who met the inclusion criteria were randomized into a mild moxibustion group and a herbal cake-partitioned moxibustion group by the random number table, with 35 cases in each group. Shenque (CV 8), Zhongji (CV 3) and bilateral Zigong (EX-CA 1) were selected for both groups. The treatment continued for 3 menstrual cycles. The visual analog scale (VAS) and COX menstrual symptom scale (CMSS) were scored in both groups before treatment, after treatment and at the end of the 3rd menstrual cycle after treatment. The clinical efficacy was evaluated at the end of the 3rd menstrual cycle after treatment. After treatment, the clinical efficacy of the herbal cake-partitioned moxibustion group had the tendency to be superior to that of the mild moxibustion group, while there was no statistically significant difference in the overall efficacy between the two groups (P>0.05). The VAS and CMSS scores after treatment and at the follow-up were significantly lower than those before treatment in both groups (all P 0.05). The CMSS scores in both groups were significantly lower than those after treatment (both P 0.05). After treatment, the CMSS score in the herbal cake-partitioned moxibustion group was significantly lower than that in the mild moxibustion group (P 0.05). The herbal cake-partitioned moxibustion has the same therapeutic efficacy for dysmenorrhea as the mild moxibustion; the two moxibustion methods can significantly improve the concomitant symptoms of dysmenorrhea, and the herbal cake-partitioned moxibustion is little better.

Background Ischemia-reperfusion (I/R) injury, which leads to additionally cardiac tissue damage, is a severe adverse effect of reperfusion therapeutics used for the treatment of acute myocardial infarction. Agents capable of alleviating I/R-induced myocardial injury are urgently needed. In this study, we investigated whether up-regulation of PERK/Nrf2/HO-1 axis provided protective roles for murine myocardium suffering I/R intervention. Methods The in vivo I/R model was formed by ligation of the left anterior descending (LAD) coronary artery of C57BL/6J mice. All animals were assigned into the following groups at random: sham, I/R, rAAV9-PERK + I/R, rAAV9-Nrf2 + I/R, rAAV9-HO-1 + I/R, siRNA-HO-1 + rAAV9-PERK + I/R. The ligation of LAD was released after 30 min of ischemia, which was followed by reperfusion of LAD for 4 h. Then the cardiac tissues and blood serum were collected. TUNEL staining, ELISA assay, TTC staining, Western blotting and real-time PCR were used to determine I/R injury-related indicators. Results Our results showed that I/R administration triggered cardiomyocytes apoptosis and LDH and CK-MB release, yet overexpression of PERK decreased cellular apoptosis index in the cardiac tissue and reduced levels of LDH and CK-MB in the serum. We further found that the protective actions of PERK against I/R-evoked cardiac damage might be attributed to up-regulation of Nrf2/HO-1 signaling transduction, given that overexpression of Nrf2 and HO-1 ameliorated cardiac cell apoptosis and reduced the size of infarction and ischemia in the myocardial tissue, yet gene silencing of HO-1 invalidated the beneficial roles of PERK overexpression in improving I/R-induced cardiac injury. Then, we investigated whether PERK-activated Nrf2/HO-1 cascade affected endoplasmic reticulum stress (ERS), considering the crucial roles of ERS-associated apoptosis in the development of I/R damage. Our findings indicated that up-regulation of PERK-mediated Nrf2/HO-1 pathway induced the expression reduction of GRP78, CRT, CHOP and caspase-12 both at the transcriptional and translational level. Conclusions We, for the first time, discovered that up-regulation of PERK/Nrf2/HO-1 axis improved I/R-induced myocardial injury via reducing ERS-related signal molecules and downstream pro-apoptotic factors.

An anomalous breakdown voltage (BV) walk-in phenomenon of the trench-gate p-type vertical double-diffused metal–oxide–semiconductor (VDMOS) after single avalanche stress has been experimentally investigated. It is found that the BV of the VDMOS is decreased after the single avalanche stress, while other electrical parameters remain unchanged. T-CAD simulations and emission microscope (EMMI) analysis have been carried out. As a result, the shift of the breakdown point of the VDMOS, which results in the hot hole injection and trapping at the termination region, should be responsible for the BV degradation. A novel device structure with different trench depths in the termination region for the trench-gate p-type VDMOS is proposed to suppress the BV walk-in phenomenon.

BACKGROUND An unconventional risk factor, "dysfunction of hemodialysis vascular access", was demonstrated to be associated with subsequent major adverse cardiovascular events (MACE) in our previous study. However, applying this suggestion in a clinical scenario may be not intuitive. A group-based trajectory model was applied to further recognize those patients with the highest risks for MACE.Methods and Results:In a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9,711 cases that developed MACE in the stage of stable maintenance dialysis, and 19,422 randomly selected controls matched to cases on age, gender and duration of dialysis. Events of vascular access dysfunction in the 6-month period before MACE for cases and index dates for controls were evaluated. By group-based trajectory modeling, patients according to their counts of vascular access dysfunction in each month over the 6-month period prior to MACE or index dates were categorized. There were 26,744 patients in group 1 (no dysfunction), 650 in group 2 (escalating dysfunction) and 1,739 in group 3 (persistent dysfunction). Logistic regression analysis indicated that patients in group 3 had the highest chance of subsequent MACE (odds ratio 2.47, in comparison with group 1) after controlling for all the available potential confounders. CONCLUSIONS Uninterrupted clusters of vascular access dysfunction are associated with a higher risk of subsequent MACE.

PET hypoxia imaging can assess tissue viability in acute ischemic stroke (AIS). [18F]FMISO is an established tracer but requires substantial accumulation time, limiting its use in hyperacute AIS. [64Cu]CuATSM requires less accumulation time and has shown promise as a hypoxia tracer. We compared these tracers in a M2-occlusion model (M2CAO) with preserved collateral blood flow. Rats underwent M2CAO and [18F]FMISO ( n = 12) or [64Cu]CuATSM ( n = 6) examinations. [64Cu]CuATSM animals were also examined with MRI. Pimonidazole was used as a surrogate for [18F]FMISO in an immunofluorescence analysis employed to profile levels of hypoxia in neurons (NeuN) and astrocytes (GFAP). There was increased [18F]FMISO uptake in the M2CAO cortex. No increase in [64Cu]CuATSM activity was found. The pimonidazole intensity of neurons and astrocytes was increased in hypoxic regions. The pimonidazole intensity ratio was higher in neurons than in astrocytes. In the majority of animals, immunofluorescence revealed a loss of astrocytes within the core of regions with increased pimonidazole uptake. We conclude that [18F]FMISO is superior to [64Cu]CuATSM in detecting hypoxia in AIS, consistent with an earlier study. [18F]FMISO may provide efficient diagnostic imaging beyond the hyperacute phase. Results do not provide encouragement for the use of [64Cu]CuATSM in experimental AIS.

Acute aortic dissection (AAD) is one of the most common fatal diseases noted in vascular surgery. Human monocytes circulate in dynamic equilibrium and display a considerable heterogeneity. However, the role of monocytes in AAD remains elusive. In our recent study, we firstly obtained blood samples from 22 patients with Stanford type B AAD and 44 age-, sex-, and comorbidity-matched control subjects. And the monocyte proportions were evaluated by flow cytometry. Results showed that the percentage of total CD14+ monocytes in the blood samples of Stanford AAD patients was increased significantly compared with that of normal volunteers (P<0.0005), and the absolute numbers of CD14brightCD16+ and CD14brightCD16- monocytes both increased significantly regardless of the percentage of PBMC or CD14+ cells, while CD14dimCD16+ monocytes displayed the opposite tendency. However, the percentage of CD14+ cells and its three subsets demonstrated no correlation with D-dimer (DD) and C-reactive protein (CRP). Then, blood mononuclear cell (PBMC) samples were collected by Ficoll density gradient centrifugation, followed with CD14+ magnetic bead sorting. After the purity of CD14+ cells was validated over 90%, AAD-related genes were concentrated in CD14+ monocytes. There were no significant differences observed with regard to the mRNA expression levels of MMP1 (P=0.0946), MMP2 (P=0.3941), MMP9 (P=0.2919), IL-6 (P=0.4223), and IL-10 (P=0.3375) of the CD14+ monocytes in Stanford type B AAD patients compared with those of normal volunteers. The expression levels of IL-17 (P<0.05) was higher in Stanford type B AAD patients, while the expression levels of TIMP1(PTGF-β1 (P<0.01), SMAD3 (P<0.01), ACTA2 (P<0.001), and ADAMTS-1 (P<0.001) decreased. The data suggested that monocytes might play an important role in the development of Stanford type B AAD. Understanding of the production, differentiation, and function of monocyte subsets might dictate future therapeutic avenues for Stanford type B AAD treatment and can aid the identification of novel biomarkers or potential therapeutic targets for decreasing inflammation in AAD.

BACKGROUND One-dose voluntary varicella vaccination for children was introduced in Beijing since 1998. In Oct 2012, a second dose varicella vaccine (VarV) was recommended to further decrease varicella disease and the outbreaks. We describe the impact of the 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, China. METHODS Varicella incidence rates and outbreak characteristics in 2011-2017 was examined using surveillance data. Varicella vaccination coverage among children born in 2007-2012 was estimated through Beijing children immunization registry system. Vaccine effectiveness (VE) for VarV2 was estimated by screening method. RESULTS Overall varicella incidence decreased by 37.8% from 103.2 per 100,000 population in 2011 to 64.2 per 100,000 population in 2017. Incidence declines in children aged

Many proposals in exploring topological quantum computation are based on superconducting quantum devices constructed on materials with strong spin-orbit coupling (SOC). For these devices, a full control on both the magnitude and the spatial distribution of the supercurrent would be highly demanded, but has been elusive up to now. We constructed proximity-type Josephson junction on nanoplates of Bi2O2Se, a new emerging semiconductor with strong SOC. Through electrical gating, we show that the supercurrent can be fully turned ON and OFF, and its real-space pathways can be configured either through the bulk or along the edges. Our work demonstrates Bi2O2Se as a promising platform for constructing multifunctional hybrid superconducting devices as well as for searching for topological superconductivity.

To detect oil leakage from a power transformer at its initial stage to prevent environmental pollution, we aimed to detect and localize leaked oil film that had adhered to the surface of a power transformer. Since the inspection for oil leakage is generally carried out in the daytime, in this research, a method to localize the oil film under solar irradiation was developed to support the inspection. To detect oil leakages, observation of the emitted fluorescence when the oil is irradiated with ultraviolet (UV) light has been commonly adopted. However, the fluorescence of an oil film adhered to a surface is too weak to recognize under solar irradiation. Therefore, the detection of strong specular reflection light of the oil film when it was irradiated with a light containing a visible component was used to additionally detect leaked oil film. Moreover, image processing using deep learning was applied on the obtained images to automatically recognize the oil film. By using the proposed oil-localization method, the oil-adhered area on the surface was recognized with a high accuracy of 99.2%. The proposed method is expected to be used to detect oil leakages for various types of oil filled equipment.

Objective: This study assessed whether Chinese herbal medicine (CHM) combined with probiotics/synbiotics for irritable bowel syndrome - diarrhea (IBS-D) was more effective and safer than probiotics/synbiotics alone. Methods: Ten databases were searched for randomized control trials (RCTs) of IBS-D as diagnosed by Manning or Rome criteria. Trials comparing probiotics and probiotics with CHM were included. The Cochrane risk of bias (ROB) was evaluated for each trial. RevMan 5.3 was used to conduct a meta-analysis. Results: Twenty-six RCTs were included (25 Chinese, 1 English), involving 2045 participants. Meta-analysis was conducted on two outcomes: overall symptom improvement and relapse. CHM combined with live Bifidobacterium and Lactobacillus preparations reduced relapse rate (RR 0.28, 95%CI 0.15–0.52, 3 trials, n = 205) compared with probiotics alone. The subgroup analysis showed the benefit of CHM prescriptions based on soothing liver and invigorating spleen (1.28, 1.14–1.44, 3, 244), invigorating spleen and resolving dampness (1.20, 1.03–1.41, 2, 128), or warming and invigorating spleen and kidney formulae (1.27, 1.09–1.46, 2, 210) combined with triple Bifidobacterium preparations than the same probiotics alone which improved overall symptoms for IBS-D. There was unclear bias in almost domains of ROB. Most studies had a high risk of bias due to lack of blinding of investigator and participants, and selective reporting. Conclusions: This study showed that CHM combined with probiotics may reduce relapse rate by 72%, and improve overall symptoms of IBS-D (as diagnosed by Rome II and III) compared to probiotics alone. From the limited subgroup analysis, only soothing liver and invigorating spleen formulae, represented by Tongxie Yaofang, added to triple Bifidobacterium preparations may be superior to the single preparations in terms of overall symptoms. However, due to the poor methodological quality and small sample size of the trials, these findings must be interpreted with caution. Keywords: Chinese herbal medicine, Probiotic, Synbiotic, Irritable bowel syndrome, Randomized controlled trials, Systematic review, Meta-analysis

Purpose To investigate the levels of systemic heparanase, inflammatory markers, and coagulation factor activities in patients with retinal vein occlusion (RVO). Methods This prospective study included 18 patients with central RVO, 22 patients with branch RVO, and 40 patients with age-related cataract as the control group. Serum heparanase protein levels and activities were measured by ELISA and a heparan degrading enzyme assay kit, respectively. Serum levels of MMP-2, MMP-9, TLR-2, and TLR-4 were measured by ELISA kits. The activities of coagulation factors (V, VII, VIII, and IX) were determined with an autoanalyzer. The Mann-Whitney U test was used to compare the above parameters between patients with RVO and control subjects. The relationship between two of the above parameters was analyzed by Spearman's correlation. Results Patients with RVO had higher levels of systemic heparanase protein, heparanase activities, coagulation factors' (V, VIII, and IX) activities, MMP-2, MMP-9, TLR-2, and TLR-4 compared with the control group. Systemic heparanase levels were correlated with serum levels of MMP-2, MMP-9, TLR-2, TLR-4, and activities of coagulation factors VIII and IX. Conclusion Increase of systemic heparanase in RVO is associated with activation of systemic inflammation and blood hypercoagulability.

Dysregulation of microRNA (miRNA) is a frequent event in hepatocellular carcinoma (HCC), but little is known whether it is a bystander or an actual player on residual HCC metastasis during liver microenvironment remodeling initiated by hepatectomy. Methods: The differently expressed miRNAs and mRNAs were identified from RNA-seq data. Western blot, qRT-PCR, fluorescence in situ hybridization, immunofluorescence and immunohistochemical were used to detect the expression of miRNA and mRNA in cell lines and patient tissues. The biological functions were investigated in vitro and in vivo. Chromatin immunoprecipitation, proximity ligation and luciferase reporter assay were used to explore the specific binding of target genes. The expression of HGF/ERBB3 signaling was detected by Western blot. Results: In this study, HGF induced by hepatectomy was shown to promote metastasis of residual HCC cells. miR-17-5p and miR-20a-5p were confirmed to play inhibitory roles on HCC metastasis. And ERBB3 was found to be the common target of miR-17-5p and miR-20a-5p. HCC cells with lower levels of miR-17-5p and miR-20a-5p or higher level of ERBB3 were often more sensitive to response HGF stimuli and to facilitate metastatic colonization both in vitro and in vivo experimental systems. Furthermore, HGF reinforced ERBB3 expression by NF-κB transcriptional activity in a positive feedback loop. Of particular importance, HCC patients with lower levels of miR-17-5p and miR-20a-5p or higher level of ERBB3 had significantly shorter OS and PFS survivals after surgical resection. Conclusion: miR-17-5p and miR-20a-5p could suppress postoperative metastasis of hepatocellular carcinoma via blocking HGF/ERBB3-NF-κB positive feedback loop and offer a new probable strategy for metastasis prevention after HCC resection.

There has been a global outbreak of the coronavirus disease 2019 (COVID-19) since December 2019. Here, we describe the case of a 49-year-old male undergoing maintenance hemodialysis (HD) who got infected with COVID-19 and our experience in performing HD for him. The patient’s symptoms and lung imaging changes were atypical. However, his lymphocyte range decreased upon admission and the polymerase chain reaction of the pharyngeal swab for the ­COVID-19 nucleic acid was positive. The patient developed respiratory failure and required mechanical ventilation 8 days after admission. In the end, he died from multiple organ dysfunction syndrome. The difficulties in diagnosis, infection control, and treatment of COVID-19 in maintenance HD patients are discussed in this report.

Background and Objective: This study compared sleep disturbances between older adults living in nursing home located in high- and low-altitude areas and explored the association between sleep disturbances and quality of life (QoL). Method: In total, 207 participants living in a high-altitude area and 437 participants in a low-altitude area were included. Sleep disturbances (ie, difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening) were measured using standardized questions. The independent demographic and clinical correlates of sleep disturbances in high-altitude area were examined using multiple logistic regression analyses. Each type of sleep disturbance was entered as the dependent variable separately, while those with significant group differences in the univariate analyses (ie, male gender, married status, age and depressive symptoms) were entered as independent variables. Results: The prevalence of any type of sleep disturbances in the whole sample was 26.09%, with 41.54% in the high-altitude area and 18.76% in the low-altitude area. Physical, psychological, social, and environmental QoL domains were negatively associated with sleep disturbances in high-altitude area. Multiple logistic regression analyses revealed that male gender and married status were less likely to have sleep disturbances, while those with more severe depressive symptoms were more likely to have sleep disturbances in high-altitude area. Conclusion: Sleep disturbance is common among older nursing home residents in high-altitude areas. Considering the negative impact of sleep disturbance on QoL, regular screening and treatment strategies need to be developed directly for this population.

Background Henoch-Schönlein purpura nephritis (HSPN) is listed as the most common secondary glomerular diseases among children. Approximately 15 to 20% of children eventually could develop into chronic renal failure. Chinese patent herbal medicine Huaiqihuang (HQH) has been widely used in children with HSPN. This study aimed to evaluate the effectiveness and safety of HQH for HSPN in children, so as to provide evidence for clinical use. Methods Randomized controlled trials (RCTs) on HQH for HSPN in children were searched in eight Chinese and English databases from their inception to December 2020. We included children with HSPN received HQH combined with conventional medicine. Cochrane “Risk of bias” tool was used to assess methodological quality, and “Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach” to summarize the certainty of evidence for main findings. Effect estimates were presented as risk ratio (RR), mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI) in meta-analyses using RevMan 5.3. Data not suitable for statistical pooling were synthesized qualitatively. Results In total seven RCTs were identified. Compared with conventional medicine alone, HQH plus conventional medicine showed the better effect in improving clinical cure rate (RR 1.58; 95%CI 1.17 to 2.14; n = 6) and total effective rate (RR 1.34; 1.16 to 1.54; n = 6); reducing urine sediment erythrocyte count (MD -9.23; − 10.76 to − 7.69; n = 3) and urine β2 micro-globulin level (MD -0.09; − 0.12 to − 0.06; n = 2). No serious adverse event was recorded in all included trials. Conclusions Limited evidence showed HQH combined with conventional medicine had a beneficial effect for children with HSPN, and the side effects were mild. HQH may be a promising complementary therapy. However, long term follow-up, high quality and multicenter RCTs are required to confirm the findings.

Background Liver metastasis is an important cause of death in patients with colorectal cancer(CRC). Increasing evidences indicates that microRNAs (miRNAs) are involved in the pathogenesis of colorectal with liver metastasis(CRLM). This study aims to explore potential miRNA–mRNA regulatory network. Methods The GEO database download the microarray datasets GSE56350 and GSE73178. GEO2R was used to conduct differentially expressed miRNAs (DEMs) between CRC and CRLM. The common miRNAs appeared in the two datasets. The transcription factors were predicted by FunRich and miRNet. Then, GO and KEGG pathway analysis for differentially expressed genes (DEGs) performed via DAVID. Besides, these hub genes network was used the STRING and identified by Cytoscape. Finally, the expression of the hub gene expression was used to assess by the GSE81558.Results Four DEMs were selected in the datasets. The SP1 was likely to adjust the up-regulated DEMs, however, the YY1 could regulate both up-regulated and down-regulated DEMs. The total of the 3925 genes were predicted( 3447 up-regulated DEM genes and 478 down-regulated DEM genes). These predicted genes were mainly linked to Platinum drug resistance, Cellular senescence and ErbB signaling pathway. Through the gene network construction, most of the hub genes were modulated by hsa-miR-204-5p, hsa-miR-122-5p, hsa-miR-95-3p and hsa-miR-552-3p. Among the top 20 hub genes, the expression of CREB1, RHOA and EGFR was significantly different in the GSE81558 dataset.Conclusion In this study, miRNA-mRNA in CRLM were screened between CRC patients and CRLM patients to provide a new method to predict for the pathogenesis and development of CRC.

Introduction The loss of retinal pigment epithelial (RPE) cells is associated with the etiology of diabetic retinopathy (DR). This study investigated the effects of circular RNA ZNF532 (circZNF532) on apoptosis and pyroptosis of RPE cells. Materials and methods Blood samples were collected from DR patients and healthy volunteers. Human RPE cell line ARPE-19 was induced by high glucose (HG) and assayed for cell viability, apoptosis, and pyroptosis. The binding of miR-20b-5p with circZNF532 and STAT3 was confirmed by luciferase activity assay. A mouse DR model of DR was established. Results CircZNF532 and STAT3 were upregulated but miR-20b-5p was downregulated in the serum samples of DR patients and HG-induced ARPE-19 cells. Elevated miR-20b-5p or CircZNF532 knockdown enhanced proliferation but reduced apoptosis and pyroptosis of ARPE-19 cells. CircZNF532 sponged miR-20b-5p and inhibited its expression. STAT3 was verified as a target of miR-20b-5p. MiR-20b-5p modulated ARPE-19 cell viability, apoptosis, and pyroptosis by targeting STAT3. Mice with STZ-induced diabetes showed elevated expressions of circZNF532, STAT3, but decreased level of miR-20b-5p compared with the controls. Knockdown of circZNF532 inhibited apoptosis and pyroptosis in mouse retinal tissues. Conclusion CircZNF532 knockdown rescued human RPE cells from HG-induced apoptosis and pyroptosis by regulating STAT3 via miR-20b-5p.

Simulation-based fault injection is an approach, which is usually conducted in the design phase to evaluate the reliability of circuits. However, this approach is frequently time-consuming, especially for large designs. This paper explores the possibilities of applying machine learning (ML) as enhancement to the fault injection to reduce the runtime of the fault verification. The proposed approach separates the target gates for fault injection into two subsets. Standard simulation-based fault injection is only performed for first subset to get the result of fault propagation in the circuit, and enables machine learning process. Based on such partial classical fault injection campaign, a dataset is built to train and validate machine learning models that are able to predict the fault injection result of the remaining gates. The machine learning approach is based on a set of relevant features that could be easily extracted based on the netlist. The dataset in this study, used to validate the approach, is obtained from the ADC digital core. We have evaluated this netlist and provided ML-driven assessment whether the fault injection in some gate will propagate to primary outputs. We have evaluated several machine learning models with different loss functions. The best prediction accuracy is 95% and achieved by a 4 layer neural network with weighted Cross Entropy.