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Deep convolutional neural networks have achieved state-of-the-art performance for the removal of atmospheric obscuration. However, most relevant studies have focused on eliminating the effects of atmospheric obscuration but not on the glare in images caused by reflected sunlight. On the basis of a glare image formation model, we propose a deep trident decomposition network with a large-scale sun glare image dataset for glare removal from single images. Specifically, the proposed network is designed and implemented with a trident decomposition module for decomposing an input glare image into occlusion, foreground, and coarse glare-free images by exploring background features from spatial locations. Moreover, a residual refinement module is adopted to refine the coarse glare-free image into fine glare-free image by learning the residuals from features of multiscale receptive field. The experimental results indicated that the proposed network significantly outperforms state-of-the-art atmospheric obscuration removal networks on the built dataset.

Background: Studies have shown that pharmacological and psychological treatments are effective for children and adolescents with obsessive-compulsive disorder (OCD). However, few network meta-analyses have examined whether pharmacological or psychological treatments on their own, or combined, are most effective. Methods: We conducted a database search and selected randomized controlled trials of pharmacological or psychological treatments, alone or in combination, for children and adolescents with OCD. The primary outcome was change in symptom severity as a result of treatment, as assessed using the Yale-Brown Obsessive Compulsive Scale (BOCS) or Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) . Findings: We included 18 studies with 1353 participants and 12 kinds of treatments. In terms of efficacy, all pharmacological and psychotherapy treatments were more effective than placebo. Among the 12 treatments, the efficacy of pharmacological treatment combined with cognitive behavioral therapy (CBT) was better than pharmacological treatment alone. When pharmacological treatment was used alone, escitalopram was significantly better than clomipramine(CY-BOCS average change 3.42; 95% CI 2.11, 4.65), fluvoxamine(CY-BOCS average change 3.59; 95% CI 1.09, 6.20), paroxetine(CY-BOCS average change 2 .80; 95% CI 0.01, 5.64) and sertraline(CY-BOCS average change 3.49; 95% CI 1.53, 5.64). Interpretation: The available evidence suggests that the combination of pharmacological and psychological treatment is likely to be most effective for children and adolescents with OCD. Funding: The National Nature Science Foundation of China (81801357, 81801350), the Science and Technology Education Program of the Sichuan Province (2020JDKP0013), the Key R&D Projects of the Science and Technology Department of Sichuan Province(2020YFS0259 ), and the Chengdu Key Technology R&D Program (2019-YF05– 00284-SN). Declaration of Interest: None to declare.

Producing a high dynamic range (HDR) image from two low dynamic range (LDR) images with extreme exposures is challenging due to the lack of well-exposed contents. Existing works either use pixel fusion based on weighted quantization or conduct feature fusion using deep learning techniques. In contrast to these methods, our core idea is to progressively incorporate the pixel domain knowledge of LDR images into the feature fusion process. Specifically, we propose a novel Prior-Aware Generative Adversarial Network (PA-GAN), along with a new dual-level loss for two exposure fusion. The proposed PA-GAN is composed of a content prior guided encoder and a detail prior guided decoder, respectively in charge of content fusion and detail calibration. We further train the network using a dual-level loss that combines the semantic-level loss and pixel-level loss. Extensive qualitative and quantitative evaluations on diverse image datasets demonstrate that our proposed PA-GAN has superior performance than state-of-the-art methods.

Summary Background We sought to evaluate the safety and feasibility of single-stage treatment with left iliac vein stenting and saphenous stripping in patients with left iliac vein compression (LIVC) and left great saphenous vein (GSV) incompetence. Method s: We conducted a prospective cohort study of 72 patients diagnosed with LIVC and left GSV incompetence between June 2012 to Oct 2018. We evaluated the periprocedural, 30-day, and 1-year outcomes of venous clinical severity score (VCSS), Chronic Venous Insufficiency Questionnaire 2 (CIVIQ2), the success rate of stent placement, duration of intervention, length of hospital stay, duplex recurrence, and clinically visible recurrence. Results There were 43 patients in the two-staged group and 29 patients in the single-staged group. The clinical characteristics of the two groups were similar. There were no differences between the two groups in the technical success rate, perioperative mortality, and surgical morbidity. There was no significant difference in the duplex and clinically visible recurrence. The length of hospital stay was significantly lower in the single-staged group. The single-staged group was associated with a higher complication rate of ecchymosis. There was no death, pulmonary embolism, or contrast-induced nephropathy among the patients. The 1-year primary patency rate was similar. Conclusions Both treatment approaches were equally effective and had a high technical success rate. The single-staged group had a higher complication rate of ecchymosis due to heparin applying during the procedure.

Bilateral filtering has been adopted for edge-preserving image smoothing and achieved the state-of-the-art performance. Most of the existing bilateral filters (BFs), however, focus on accelerating brute-force implementation but not on smoothing quality. In this letter, we propose a two-pass (TP) BF, TP-based BF, and an adaptive control scheme of range kernels for noise-invariant edge-preserving image smoothing. Specifically, the TP-based BF is composed of two bilateral filtering operations, which are, respectively, in charge of coarse context extraction and fine structure refinement. The control scheme of range kernels guides the TP bilateral mechanism to eliminate first high-frequency noisy pixels and then explore contribution between pixels from clean contexts. Experimental results on four aerial-imagery benchmark data sets show that our TP-based BF outperforms the existing BFs in terms of both feature- and gradient-aware measures.

DESIGN This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Background : American Institute of Medicine (IOM) recommends different ranges of gestational weight gain (GWG) based on pre-pregnancy body mass index (BMI). In Taiwan, IOM guidelines are implemented concurrently with the local recommendation for GWG (10–14 kg). This study compared between the two sets of guidelines in relation to adverse perinatal outcomes.Methods : We analyzed 31653 primiparas with singletons from 2011-2016 annual National Breastfeeding Surveys. Logistic regressions for preterm birth, small for gestational age (SGA), large for gestational age (LGA), cesarean section and excessive postpartum weight retention (PWR) were fitted separately for GWG categorized according to IOM and Taiwan ranges. Areas under the receiver-operator curves (AUC) and the predicted probabilities for each outcome were compared in each BMI group.Results : AUC for both guidelines ranged within 0.51 – 0.73. Compared to Taiwan recommendation, IOM ranges showed lower probabilities of SGA for underweight (0.11–0.15 versus 0.14–0.18), of LGA for obese (0.12–0.15 versus 0.15–0.18), of excessive PWR for overweight (0.19–0.30 versus 0.27–0.39), and obese (0.15–0.22 versus 0.25-0.36); and higher probabilities of excessive PWR for underweight (0.17-0.33 versus 0.14-0.22).Conclusions : Discriminative performance of IOM and Taiwan recommendations was poor for the five adverse birth outcomes, and no preference for either set of recommendations could be inferred from our results. In the absence of specific GWG guidelines, health care workers may provide inconsistent information to their patients. Future research is needed to explore optimal GWG ranges that can reliably predict locally relevant perinatal outcomes for mother and child.

Laryngeal disease is a common disease worldwide. However, currently there are no public laryngeal image datasets, which hinders the development of automatic classification of laryngeal disease. In this work, we build a new laryngeal image dataset called Laryngoscope8, which comprises 3057 images of 1950 unique individuals, and the images have been labeled with one of eight labels (including seven pathological labels and one normal label) by professional otolaryngologists. We also propose a laryngeal disease classification method, which uses attention mechanism to obtain the critical area under the supervision of image labels for laryngeal disease classification. That is, we first train a CNN model to classify the laryngeal images. If the classification result is correct, the region with strong response is most likely a critical area. The regions with strong responses are used as training data to train an object localization model that can automatically locate the critical area. Given an image for classification, the trained object localization model is employed to locate the critical area. Then, the located critical area is employed for image classification. The entire process only requires image-level labels and does not require manual labeling of the critical area. Experiment results show that the proposed method achieves promising performance in laryngeal disease classification.

Cancer metastasis is the main cause of mortality associated with non-small-cell lung cancer (NSCLC), accounting for up to 70% of deaths among patients. The mechanisms underlying distal metastasis remain largely unknown. Golgi phosphoprotein 3 (GOLPH3) correlates negatively with overall survival in multiple tumors. In this study, we evaluated the function of GOLPH3 in NSCLC distal metastasis. GOLPH3 was expressed at high levels in samples from patients with NSCLC and was positively associated with clinicopathologic characteristics including clinical stage (P P = 0.001), N (P = 0.007), and M (P = 0.001) classification. Functionally, Transwell and wound-healing assays suggested that GOLPH3 overexpression enhances NSCLC cell migration and invasion abilities. Tumor-sphere formation and flow cytometry assays demonstrated that GOLPH3 overexpression enhances a stem cell-like phenotype of NSCLC cells. Metastasis models established by tail vein and intracardiac injection confirmed the pro-metastatic function of GOLPH3 in vivo. A subcutaneous tumor formation model confirmed that GOLPH3 overexpression increased the tumorigenicity of NSCLC cells. Mechanistically, gene set enrichment analysis revealed a positive association of GOLPH3 mRNA expression with WNT-activated gene signatures. Luciferase-reporter and nuclear extract assays showed that GOLPH3 overexpression enhances metastasis and tumorigenicity through activation of the WNT/β-catenin pathway. Immunoprecipitation-mass spectrometry and gene ontology analysis demonstrated that GOLPH3 interacts with cytoskeleton-associated protein 4 (CKAP4) in exosome-mediated distal metastasis. We found that GOLPH3 decreased the amount of plasma membrane-localized CKAP4 and increased the amount of exosome-localized CKAP4 to promote the formation of CKAP4-containing exosomes. Furthermore, we demonstrated that CKAP4 binds exosomal WNT3A to enhance its secretion. Therefore, the GOLPH3/CKAP4 axis plays a crucial role in promoting exosomal-WNT3A secretion to enhance and maintain the stem-like phenotype and metastasis in NSCLC, thus indicating the therapeutic potential of GOLPH3 in patients with NSCLC metastasis.

PURPOSE: To explore the application value of SMI scoring assignment method combined with 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in differentiating benign and malignant thyroid nodules. METHODS: According to the 2017 ACR TI-RADS classification, the enrolled nodules were divided into 3 points group, 4 points group, 5 points group, 6 points group and≥7 points group. The nodules were assigned scores according to the echocity of the nodules and the microvessels detected by SMI and their distribution patterns based on ACR TI-RADS. Accompany with the scores increased or decreased after assignment, the thyroid nodules were re-grouped. RESULTS: The AUC after the scores assignment is better than before (Z = 3.881, P

BACKGROUND Depression is a common psychiatric disorder affecting 264 million people globally, and the worst outcome is suicide. While regional brain alterations in depressed suicidal brain have previously been reported, knowledge about white matter (WM) microstructure is limited. PURPOSE Automated fiber quantification (AFQ) acquired by magnetic resonance imaging was used to calculate diffusion properties of fiber tracks to explore the structural alteration of WM associated with suicidality in depressive patients. STUDY TYPE Cross-sectional. SUBJECTS Forty-five depressive patients without suicidality (DS- group, 60.00% females), 53 depressed patients with suicidality (DS+ group, 66.04% females), and 59 healthy controls (HC group, 67.80% females). FIELD STRENGTH/SEQUENCE 3.0 T; single-shot echo-planar imaging sequence. ASSESSMENT The point-wise group difference of the fiber tracts was determined by diffusion properties including fractional anisotropy, mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of 18 specific WM tracts. STATISTICAL TESTS Analysis of covariance (ANCOVA) and partial correlation analysis were used. A threshold of P

Objective: Low birth weight (LBW) is associated with adverse health outcomes. Incidence of LBW in Taiwan grew from 5% in 1997 to 8.4% in 2016. This study aims to identify the role of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in LBW rate changes during 2011–2016. Materials and methods: We analyzed 66 135 postpartum women from 6 cross-sectional national surveys. Data were collected through telephone interviews with randomly selected mothers. Logistic regression was applied to assess contribution of maternal characteristics to LBW time changes. Results: LBW increased from 5.3% to 7.0% during 2011–2016 (crude odds ratio (OR) = 1.04/year, p-value for trend = 0.001). Inadequate GWG increased from 27.9% to 41.5% (p-value for trend

Environmental nonprofit organisations (ENPOs) have become crucial policy actors who have undertaken information campaigns to attract public attention and to gain public support for policies. However, the credibility of policy information released by ENPOs is understudied. To fill the gap, this study utilised Douglas and Wildavsky’s cultural theory (CT), to seek answers to two questions: 1) how do ENPOs’ public faces affect public perception of the credibility of the policy information released by their organisations? 2) how do the public’s worldviews affect trust in information released by ENPOs with different types of public faces? The evidence from an online survey confirms what CT predicted: Hierarchs tend to believe information released by policy actors with proper authority; individualists tend to believe information released by policy actors who favour economic growth over environmental protection; egalitarians favour all pro-environmental policy information even if the information is released by noncredible policy actors.

Objective: To explore the effect of ureteroscopy with double J tube placement and drainage on ureteral stones during pregnancy, to compare the clinical effect of ureteroscope with double J tube placement on pregnancy complicated with ureteral stones, and using medical imaging to diagnose the patient’s condition and design a treatment plan. Methods: Eighty pregnant patients with ureteral calculi treated in our hospital were selected as the research object, and were divided into a test group and a control group according to the random number table method, 40 cases in each group. The test group underwent ureteroscope double J tube placement, and the control group underwent ureteroscope lithotripsy. Combined with the ultrasound scan results of the patients before and after the operation, the operation time, time to get out of bed and hospitalization time of the two groups of patients were compared. The operation success rate and the incidence of complications within 1 month after surgery were counted in the two groups of patients. Results: The total effective rate of the observation group was 100.0%, which is higher than that of the control group of 90.0%. The difference between the two groups was statistically significant (P < 0.05). The adverse reaction rate in the observation group was 5.0%, which was lower than 17.5% in the control group. The difference between the two groups was statistically significant (P < 0.05). The comparison results are then prepared. Conclusions: Double J tube placement under ureteroscopy has a significant effect on the treatment of ureteral stones during pregnancy, and it has good safety and is worthy of widespread application.

Background The outbreak of Coronavirus Disease 2019(COVID-19) caused psychological stress in Chinese adults population. But we are unaware of whether the pandemic causes psychological stress on children. Methods We used the Children’s Impact of Event Scale questionnaire (CRIES-13) to investigate the degree of Post-traumatic Stress (PTSD) symptoms caused by the pandemic in students selected from schools in Sichuan, Jiangsu, Henan, Yunnan, and Chongqing provinces of China. Results A total of 7769 students(3692 male and 4077 female), aged 8–18 years, were enrolled in the study, comprising 1214 in primary schools, 2799 in junior high schools and 3756 in senior high schools. A total of 1639 students (21.1%) had severe psychological stress reactions. A large proportion of senior high school students (23.3%) experienced severe psychological stress, and they had the highest median total CRIES-13 score. Female students were more likely to experience severe psychological stress and had higher median CRIES-13 total scores than males. Conclusion COVID-19 has placed psychological stresses on primary and secondary school students in China. These stresses are more likely to reach severe levels among female students and senior high school students.

Introduction: We designed 5 convolutional neural network (CNN) models and ensemble models to differentiate malignant and benign thyroid nodules on CT, and compared the diagnostic performance of CNN models with that of radiologists. Material and methods: We retrospectively included CT images of 880 patients with 986 thyroid nodules confirmed by surgical pathology between July 2017 and December 2019. Two radiologists retrospectively diagnosed benign and malignant thyroid nodules on CT images in a test set. Five CNNs (ResNet50, DenseNet121, DenseNet169, SE-ResNeXt50, and Xception) were trained-validated and tested using 788 and 198 thyroid nodule CT images, respectively. Then, we selected the 3 models with the best diagnostic performance on the test set for the model ensemble. We then compared the diagnostic performance of 2 radiologists with 5 CNN models and the integrated model. Results: Of the 986 thyroid nodules, 541 were malignant, and 445 were benign. The area under the curves (AUCs) for diagnosing thyroid malignancy was 0.587–0.754 for 2 radiologists. The AUCs for diagnosing thyroid malignancy for the 5 CNN models and ensemble model was 0.901–0.947. There were significant differences in AUC between the radiologists’ models and the CNN models (p < 0.05). The ensemble model had the highest AUC value. Conclusions: Five CNN models and an ensemble model performed better than radiologists in distinguishing malignant thyroid nodules from benign nodules on CT. The diagnostic performance of the ensemble model improved and showed good potential.

Lymph node metastases are strongly associated with unfavorable prognosis in papillary thyroid carcinoma (PTC) patients. However, there are few sensitive or specific indicators that can diagnose or predict lymph node metastases in PTC. The objective of our study was to identify reliable indicators for the diagnosis and prediction of lymph node metastases of PTC. The PTC data set was obtained from The Cancer Genome Atlas (TCGA) cohort. Information on tumor-infiltrating immune cells in PTC was acquired using single-sample gene set enrichment analysis (ssGSEA). Then, the progression-free survival (PFS) rates of PTC patients were evaluated by Kaplan-Meier curves. A tissue microarray including 58 normal thyroid tissues and 57 PTC tissues was processed for CD19 immunohistochemistry staining. Finally, evaluation of phenotype permutations was performed using gene set enrichment analysis (GSEA). There was an appreciable association between immune infiltration and lymph node metastases in PTC. Among those immune cells, B cells and cytotoxic cells showed significant predictive accuracy for lymph node metastases in PTC. Tumor-infiltrating B cells and NK cells were associated with favorable prognosis, while tumor-associated NK CD56bright cells were correlated with poor prognosis in PTC patients. IHC analyses of PTC further confirmed a notably negative correlation between B cell infiltration and lymph node metastases in PTC. Additionally, mutations in BRAF, a dominant cause of tumor mutation burden (TMB), were positively correlated with reduced B cell infiltration and lymph node metastases in PTC. GSEA revealed that epithelial-mesenchymal transition, IL-6/JAK/STAT3 signaling, the inflammatory response, and TNF-α signaling via the NFκB pathway were remarkably suppressed pathways in patients with BRAF mutations. Tumor-associated lymphocytic infiltration, especially B cell infiltration, provides diagnostic and prognostic value for lymph node metastases in PTC.

Background During pregnancy, nutritional requirements increase and if not met, pregnancy-related complications may manifest. To prevent these undesirable outcomes, the World Health Organization recommends daily oral iron and folic acid (IFA) supplementation as part of antenatal care. Despite this recommendation, the use of IFA supplements is still very low in several developing countries. Additionally, no prior information exists regarding the level of consumption of IFA in Eswatini. Thus, this study aimed to determine the prevalence of consumption of IFA supplements and to identify factors associated with the consumption of IFA supplements among pregnant women in Eswatini. Methods A cross-sectional questionnaire survey was conducted among 330 pregnant women aged ≥ 18 years in their third trimester in Eswatini. Participants were recruited from eight purposively selected healthcare facilities from July 2019 to October 2019. Good consumption was defined as consuming all or almost all IFA supplements throughout pregnancy. Results During the first trimester, 10.3 % of the participants consumed all or almost all IFA supplements. In the second and third trimesters, those who consumed all or almost all supplements were 37 and 39.7 %, respectively, for iron and 37.6 and 40.9 %, respectively, for folic acid. Barriers, including side effects, forgetfulness, safe previous pregnancies without IFA, others’ advice against consumption, IFA stock-outs, inability to meet transport costs, and inadequate supply of IFA tablets, contribute to low consumption of IFA. Multivariate logistic regression models showed that the barriers were inversely associated with good consumption of IFA supplements. Better knowledge and attitude toward IFA and older maternal age were positively associated with good consumption of IFA supplements. Conclusions Low consumption of IFA supplements in overall pregnancy is mainly owing to the late antenatal care attendance. Strategies such as establishing a preconception care unit and school-based provision of IFA may be helpful. It is evident that most women still lack knowledge, and some have negative attitudes about IFA supplements. Health education to raise awareness and emphasize the importance of starting antenatal care early as well as consuming supplements on time should be revisited and intensified. Multiple strategies such as including community health care workers for distributing IFA supplements, discussing with clients about the measures to reduce forgetfulness, advising ways to prevent and manage the side effects, providing subsidies to cover transport costs, and ensuring adequate supply of IFA supplements in facilities may need to be employed to reduce the identified barriers.

BackgroundPrimary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas.MethodsA total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated.ResultsIn this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; χ2 = 26.224, 18.227 respectively, P 2 = 33.410, 21.587 respectively, P 2 = 0.866, 0.187 respectively, P = 0.352 and 0.665).ConclusionsUS shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.

Body Shop is a well-known cruelty-free cosmetics brand company. This research paper explores how Body Shop is running the campaign 'forever against animal testing' and raising its voice for banning animal testing in cosmetics. The Body Shop has been advocating for animal rights since 1989. Qualitative analysis techniques have been used in this research paper and information is obtained through a questioner focused on convenient sampling. We have discovered in our research that most consumers do not want to purchase goods which are created by harming animals. In manufacturing cosmetics, we say companies must use alternative artificial testing like Body Shop.

Background Major depressive disorder (MDD) is associated with high risk of suicide, but the biological underpinnings of suicidality in MDD patients are far from conclusive. Previous neuroimaging studies using voxel-based morphometry (VBM) demonstrated that depressed individuals with suicidal thoughts or behaviors exhibit specific cortical structure alterations. To complement VBM findings, surface-based morphometry (SBM) can provide more details into gray matter structure, including the cortical complexity, cortical thickness and sulcal depth for brain images. Objective This study aims to use SBM to investigate cortical morphology alterations to obtain evidence for neuroanatomical alterations in depressed patients with suicidality. Methods Here, 3D T1-weighted MR images of brain from 39 healthy controls, 40 depressed patients without suicidality (patient controls), and 39 with suicidality (suicidal groups) were analyzed based on SBM to estimate the fractal dimension, gyrification index, sulcal depth, and cortical thickness using the Computational Anatomy Toolbox. Correlation analyses were performed between clinical data and cortical surface measurements from patients. Results Surface-based morphometry showed decreased sulcal depth in the parietal, frontal, limbic, occipital and temporal regions and decreased fractal dimension in the frontal regions in depressed patients with suicidality compared to both healthy and patient controls. Additionally, in patients with depression, the sulcal depth of the left caudal anterior cingulate cortex was negatively correlated with Hamilton Depression Rating Scale scores. Conclusions Depressed patients with suicidality had abnormal cortical morphology in some brain regions within the default mode network, frontolimbic circuitry and temporal regions. These structural deficits may be associated with the dysfunction of emotional processing and impulsivity control. This study provides insights into the underlying neurobiology of the suicidal brain.

BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient. CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident. She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye. Within 6 d, her consciousness improved considerably; at which time, exposure keratopathy occurred and worsened to corneal ulceration. Lubricating gel, antibiotic ointment, and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy. Instead of tarsorrhaphy, a moisture chamber was applied which successfully controlled the corneal ulceration. The moisture chamber was discontinued when complete eyelid closure recovered a week later. CONCLUSION A moisture chamber may be an effective, noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.

IL-33 is an IL-1 family cytokine that signals through its cognate receptor, ST2, to regulate inflammation. Whether IL-33 serves a pathogenic or protective role during inflammatory bowel disease is controversial. Herein, two different strains of cell-specific conditionally deficient mice were used to compare the role of myeloid- versus intestinal epithelial cell–derived IL-33 during dextran sodium sulfate–induced colitis. Data show that loss of CD11c-restricted IL-33 exacerbated tissue pathology, coinciding with increased tissue Il6 levels and loss of intestinal forkhead box p3(+) regulatory T cells. Surprisingly, the lack of intestinal epithelial cell–derived IL-33 had no impact on disease severity or tissue recovery. Thus, we show that myeloid-derived IL-33 functionally restrains colitic disease, whereas intestinal epithelial cell–derived IL-33 is dispensable.

The interaction between gut microbiota and the host has gained widespread concern. Gut microbiota not only provides nutrients from the ingested food but also generates bioactive metabolites and signalling molecules to impact host physiology, especially in chronic kidney disease (CKD). The development of CKD, accompanied by changed diet and medication, alters the gut flora and causes the effect in distant organs, leading to clinical complications. Vascular calcification (VC) is an actively regulated process and a high prevalence of VC in CKD has also been linked to an imbalance in gut microbiota and altered metabolites. In this review, we focused on gut microbiota‐derived metabolites involved in VC in CKD and explained how these metabolites influence the calcification process. Correcting the imbalance of gut microbiota and regulating microbiota‐derived metabolites by dietary modification and probiotics are new targets for the improvement of the gut‐kidney axis, which indicate innovative treatment options of VC in CKD.

Fabric defect detection plays an important role in ensuring quality control in the textile manufacturing industry. This study introduces a fabric defect detection method based on a multi-scale convolutional neural network (MSCNN) to improve accuracy and time efficiency. For detection accuracy, the MSCNN is constructed to obtain different scales of feature maps, which enhance the representation of tiny scale fabric defects. A faster defect locating method is designed with pre-known size information obtained by clustering analysis to reduce the computation time. An experiment is carried out for illustrating that the accuracy of MSCNN for each defect reaches over 92%, and the frames per second (FPS) is more than 29. Further analysis results demonstrate that the proposed MSCNN can accurately detect the fabric defects with a tiny scale, and the speed of detection can reach 30 m/min to satisfy the industrial requirements.

Image dehazing is a crucial image processing step for outdoor vision systems. However, images recovered through conventional image dehazing methods that use either haze-relevant priors or heuristic cues to estimate transmission maps may not lead to sufficiently accurate haze removal from single images. The most commonly observed effects are darkened and brightened artifacts on some areas of the recovered images, which cause considerable loss of fidelity, brightness, and sharpness. This paper develops a variational image dehazing method on the basis of a color-transfer image dehazing model that is superior to conventional image dehazing methods. By creating a color-transfer image dehazing model to remove haze obscuration and acquire information regarding the coefficients of the model by using the devised convolutional neural network-based deep framework as a supervised learning strategy, an image fidelity, brightness, and sharpness can be effectively restored. The experimental results verify through quantitative and qualitative evaluations of either synthesized or real haze images, and the proposed method outperforms existing single image dehazing methods.

Purpose We examined the possibility that wearing a below-knee compression garment (CG) reduces fatigue-induced strength loss and joint position sense (JPS) errors in healthy adults. Methods Subjects (n = 24, age = 25.5 +/- 4 years) were allocated to either one of the treatment groups that performed 100 maximal isokinetic eccentric contractions at 30 degrees(-1)with the right-dominant knee extensors: (1) with (EXPCG) or (2) without CG (EXP) or to (3) a control group (CONCG:CG, no exercise). Changes in JPS errors, and maximal voluntary isometric contraction (MVIC) torque were measured immediately post-, 24 h post-, and 1 week post-intervention in each leg. All testing was done without the CG. Results CG afforded no protection against JPS errors. Mixed analysis of variance (ANOVA) revealed that absolute JPS errors increased post-intervention in EXPCG and EXP not only in the right-exercised (52%,p = 0.013; 57%,p = 0.007, respectively) but also in the left non-exercised (55%,p = 0.001; 58%,p = 0.040, respectively) leg. Subjects tended to underestimate the target position more in the flexed vs. extended knee positions (75-61 degrees: - 4.6 +/- 3.6 degrees, 60-50 degrees: - 4.2 +/- 4.3 degrees, 50-25 degrees: - 2.9 +/- 4.2 degrees), irrespective of group and time. Moreover, MVIC decreased in EXP but not in EXPCG and CONCG at immediately post-intervention (p = 0.026,d = 0.52) and 24 h post-intervention (p = 0.013,d = 0.45) compared to baseline. Conclusion Altogether, a below-knee CG reduced fatigue-induced strength loss at 80 degrees knee joint position but not JPS errors in healthy younger adults.

The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.

Background To utilise Multiphoton Microscopy as a novel imaging technique to characterize and quantify collagen at the Renal Cell Carcinoma Pseudocapsule, to assess for both intra-tumoral and inter-tumoral variation of collagen characteristics. MPM combines Second Harmonic Generation and Two Photon Excitation Fluorescence to image extracellular matrix architecture. Methods 20 partial nephrectomy specimen tissues were retrieved, cut into 5‎-micron sections, mounted on slides and deparaffinized. The pseudocapsules were imaged with 2X and 20X objective at selected Regions of Interest. Corresponding clinical information was retrieved. Pseudocapsule thickness was determined. Collagen parameters measured included quantification by the Collagen Area Ratio, and qualitative measurements by the Collagen Fiber Density and Collagen Reticulation Index. Results The boundaries between tumor, PC and normal renal parenchyma were distinguished by Multiphoton Microscopy without the need for staining. In the thickest areas of the pseudocapsule, collagen content and density were quantitatively higher compared to the thinnest areas. Median Collagen Area Ratio was higher in the thickest compared to the thinnest areas of the PC (p=0.01). Clear Cell RCC specimens had a consistently higher Collagen Fiber Density in both the thickest and thinnest areas compared to non-Clear Cell RCC specimens (p=0.02). Conclusions In this study, we demonstrated the ability of Multiphoton Microscopy to quantify collagen characteristics of pseudocapsules without fluorescent labelling. Tumor enucleation for Renal Cell Carcinoma along its Pseudocapsule remains debatable with regards to oncological safety. Even with a complete and intact pseudocapsule, the pseudocapsule is not a homogenous structure, and varies in its thickness and its collagen characteristics within, and between, tumours.

Background Balloon dilatation with stent implantation has been proved to be an effective option for left iliac vein compression syndrome (LIVCS), but thrombosis may still occur after the operation. Currently, warfarin is used for anticoagulant therapy, but long-term monitoring is required, while rivaroxaban does not need laboratory monitoring, which can simplify treatment. Therefore, this study aimed to compare the efficacy and safety of rivaroxaban and warfarin in anticoagulation. Methods This study is a multicenter, randomized controlled trial. We will recruit 224 patients with thrombotic LIVCS from 9 hospitals. Moreover, these patients will be randomized to either the experimental group (rivaroxaban) or the control group (warfarin plus nadroparin). The primary outcome is stent occlusion rate. Secondary outcomes are quality of life scale survey results, all-cause mortality, anticoagulation-related mortality, and the proportion of participants with stent displacement/fracture, thrombosis, hemorrhage, and other vascular events. Discussion This study will provide reliable, evidence-based clinical evidence for the efficacy and safety of rivaroxaban antithrombotic therapy after stent implantation. Trial registration ClinicalTrials.gov NCT04067505. Registered on August 26, 2019.

Background This study aimed to compare the efficacy and toxicity of raltitrexed (Saiweijian®) plus cisplatin (SP regimen) and 5‐fluorouracil plus cisplatin (FP regimen) as concurrent chemoradiotherapy (CCRT) in patients with locally advanced nasopharyngeal carcinoma (LA‐NPC). Methods Eligible patients (N = 135) were allocated randomly in a ratio of 1:1 to receive CCRT with either SP or FP. At least 2 cycles of chemotherapy was administrated during radiotherapy. Progression free survival (PFS) was primary endpoint. Secondary endpoints included overall survival (OS), loco‐regional relapse free survival (LRRFS), distant metastasis free survival (DMFS) and toxicity. Results In this study, 68 patients received SP as CCRT, and 67 received FP. Objective responses were noted in 97.1% of the patients in the SP group and in 97.0% of the patients in the FP group (P = 1.00). At the end of a median 36 months follow‐up period, the estimated 3‐year PFS rates were 70.1% for SP and 66.6% for FP, respectively. The 3‐year LRRFS, DMFS and OS rates were 88.9%, 74.7% and 84.0%, respectively, for the SP group, and 92.3%, 71.0% and 73.7%, respectively, for the FP group. Overall, there was no difference between treatment groups with regard to response or survival. The most frequent acute toxicities monitored in both groups were bone marrow suppression, gastrointestinal side effects and oral mucositis (OM). The overall incidence of grade 3‐4 OM in the FP group (47.8%) was higher than in the SP group (11.8%). However, the incidence of other adverse effects observed in both groups was similar (P > .05). Conclusions These data indicate that SP and FP therapies have similar efficacy in treating LA‐NPC. The SP regimen showed a tolerable safety profile along with a lower frequency of severe OM and therefore, an improved life quality. In conclusion, SP was a well tolerated, effective, regimen for LA‐NPC treatment., The incidence of other adverse effects seen in both groups was similar (P > .05).The efficacy of both regimens i.e. SP and FP are found similar. The SP regimen has tolerable safety profile, with a lower incidence of severe OM and consequently, an improved quality of life.

An eye-safe white-lighting source configured with violet laser diode (VLD) and an ultrafast color convertor using the BEHP-PPV + MEH-PPV polymer blend is demonstrated for optical wireless communica...

Autophagy of cardiomyocytes after myocardial infarction (MI) is an important factor affecting the prognosis of MI. Excessive autophagy can lead to massive death of cardiomyocytes, which will seriously affect cardiac function. IKKε plays a crucial role in the occurrence of autophagy, but the functional role in MI remains largely unknown. To evaluate the impact of IKKε on the autophagy of cardiomyocytes after MI, MI was induced by surgical left anterior descending coronary artery ligation in IKKε knockout (KO) mice and wild-type (WT) mice. Starvation of H9c2 cells with IKKε siRNA and rescued with IKKε overexpressed afterwards to test the mechanism of IKKε in autophagy in vitro. Our results demonstrated that the expression of IKKε was upregulated in mice myocardial tissues which were consistent with cardiomyocyte autophagy after MI. Significantly, the IKKε KO mice showed increased infarct size, decreased viable cardiomyocytes, and exacerbated cardiac dysfunction when compared with the wild-type mice. Western blot and electron micrography analysis also revealed that loss of IKKε induces excessive cardiomyocyte autophagy and reduced the expression of p-Akt and p-mTOR. Similar results were observed in IKKε siRNA H9c2 cells in vitro which were under starvation injury. Notably, the levels of p-Akt and p-mTOR can restore in IKKε rescued cells. In conclusion, our results indicated that IKKε protects cardiomyocyte survival by reduced autophagy following MI via regulation of the Akt/mTOR signaling pathway. Thus, our study suggests that IKKε might represent a potential therapeutic target for the treatment of MI.

The prevalence of short texts on the Web has made mining the latent topic structures of short texts a critical and fundamental task for many applications. However, due to the lack of word co-occurrence information induced by the content sparsity of short texts, it is challenging for traditional topic models like latent Dirichlet allocation (LDA) to extract coherent topic structures on short texts. Incorporating external semantic knowledge into the topic modeling process is an effective strategy to improve the coherence of inferred topics. In this paper, we develop a novel topic model—called biterm correlation knowledge-based topic model (BCK-TM)—to infer latent topics from short texts. Specifically, the proposed model mines biterm correlation knowledge automatically based on recent progress in word embedding, which can represent semantic information of words in a continuous vector space. To incorporate external knowledge, a knowledge incorporation mechanism is designed over the latent topic layer to regularize the topic assignment of each biterm during the topic sampling process. Experimental results on three public benchmark datasets illustrate the superior performance of the proposed approach over several state-of-the-art baseline models.

Aims and objectives To examine how changes in physical activity, sitting time and sleep duration through pre‐, mid‐ and late pregnancy are in association with Caesarean section, medically indicated Caesarean section and small for gestational age. Background While circadian activities could change throughout pregnancy, studies exploring the effect of change in those activities on pregnancy outcomes remain limited. Design This study applied a prospective panel design. Methods A self‐reported questionnaire was used to assess the three activities before and during pregnancy and was administered three times from August 2015–July 2017. Multiple logistic regression models were used. The analysis included 488, 477 and 455 participants in the models for Caesarean section, medically indicated Caesarean section and small for gestational age, respectively. This study followed the STROBE guidelines. Results The mean age of participants was 32.18 years, and more than half (54.90%) were primiparous. Sleep duration of >8 hr/day before pregnancy and experiencing a decrease in mid‐pregnancy was a risk factor for Caesarean section and medically indicated Caesarean section. Sitting ≥8 hr/weekday in pre‐, mid‐ and late pregnancy had a protective effect for Caesarean section and medically indicated Caesarean section. Sitting

The work aim to the reaction mechanism of laser engraving polycarbonate (PC)-based films. The calculation of infrared-laser acting on the PC films, was carried out by using one-dimensional heat conduction model. The power density of laser device required for laser engraving polycarbonate-based films was determined to be 4.86~7.73×104 W/cm2. Characterized by the FTIR spectra, SEM, DSC and TGA, the reaction mechanism was studied. The results show that the light-sensitive particles in the PC films absorb the laser energy with wavelength of 1064nm. After reaching the temperature of 509°C, the main chain of PC molecule opened due to the breakage of C-O bond in PC molecular terminal group and C-O bond between PC monomers. As the energy continues to be absorbed, the temperature reach to 610°C, the decomposition products decomposed into carbon black, which can form a black carbon spot.

To investigate the effect of spleen tyrosine kinase (Syk) inhibitor R406 on diabetic retinopathy (DR) in diabetic mellitus (DM) rats. Rats were randomized into Normal, DM, DM + 5 mg/kg R406 and DM + 10 mg/kg R406 groups. DM rats were established via injection of streptozotocin (STZ). One week after model establishment, rats in treatment groups received 5 mg/kg or 10 mg/kg R406 by gavage administration for 12 weeks consecutively, followed by the detection with hematoxylin-eosin (HE) staining, Evans blue angiography, retinal trypsin digestion assay, Western blotting, immunohistochemistry, TUNEL assay, immunofluorescence assay and quantitative reverse transcriptase real-time polymerase chain reaction (qRT-PCR). The retina of DM rats presented different degree of edema, disordered and loose structure, swollen cells with enlarged intercellular space, and dilated and congested capillaries. Besides, the retinal vessels of DM rats showed high fluorescence leakage. However, R406 alleviated the above-mentioned conditions, which was much better with high concentration of R406 (10 mg/kg). R406 also reversed the down-regulations of occludin, claudin-5, ZO-1 and the up-regulation of and VEGF in retinal tissues of DM rats; inhibited retinal cell apoptosis; strengthened retinal cell proliferation; and reduced expressions of IL-1β, IL-6, TNF-α and nuclear p65 NF-κB in retinal tissues. The improvement in all these indexes was much more significant in rats of DM + 10 mg/kg R406 group than in rats of DM + 5 mg/kg R406 group. Syk inhibitor R406 could attenuate retinal inflammation in DR rats via the repression of NF-κB activation.

Controlling solar spectra via the careful design could realize the optimized utilization of energy. Especially for spectrally selective solar absorbers, achieving the appropriate transition wavelength can boom conversion efficiency for a certain application under the consideration of cost. Here, we experimentally demonstrated a kind of WTa-SiO2 cermet based absorbers with transition wavelength of around 1500 nm, 2000 nm, and 2500 nm, which can meet the versatile applications under the conditions of different operating temperatures and different optical concentrations. All the absorbers possess a promising solar absorptance of above 95% and photothermal efficiency of above 91% at 82 °C with 1 sun, as well as the superior thermal stability at 600 °C due to the formation of tantalum oxide in WTa-SiO2 cermet in the annealing process.

Inherited antithrombin deficiency (OMIM 107300) is a rare autosomal dominant disorder that could increase the risk of venous thromboembolism and is usually caused by mutations of SERPINC1. Herein, we present a case of a novel mutation in the SERPINC1 gene in a Chinese patient. The patient was a 54-year-old man who presented with recurrent venous thromboembolism and was without a recent history of any precipitating factors. Whole exome sequencing and Sanger sequencing identified a novel heterozygous variant on exon 2 of SERPINC1 gene (c.142G>A, p.P48S).

Bone is reported to be one of the most common sites of metastasis. Acrometastasis is an extremely rare situation and accounts for approximately 0.1% of all metastatic lesions to the skeleton. Here, we present a case of acrometastasis in a 55-year-old woman who presented with a 3-month history of atraumatic right ring fingertip pain and swelling and was subsequently diagnosed with metastatic renal cell carcinoma. This report highlights the importance of clinical suspicion of malignancy at unusual sites in the setting of non-resolving symptoms.

Previous genome-wide association study showing a novel variant near LSP1P3 was associated with knee osteoarthritis (KOA) in Caucasians. Replication study in different populations was essential to validate the association of novel susceptible genes with KOA. To our knowledge, there is a lack of study concerning the role of the LSP1P3 gene in Chinese KOA patients. We aimed to determine the association between the novel variant near LSP1P3 gene and the susceptibility of KOA in the Chinese population and to further investigate its relationship with the severity of KOA.A total of 532 primary KOA patients who received treatment in our clinic center were included in the current study. Nine hundred twenty-seven age- and gender-matched healthy subjects were recruited as controls. The severity of KOA was graded according to the Kellgren-Lawrence (KL) grading system, with KL grade of 1 or 2 classified as mild KOA and KL grade of 3 or 4 classified as severe KOA. Three variants were genotyped using TaqMan SNP genotyping assay, including rs4867568 of LSP1P3 gene, rs143383 of GDF5, and rs1558902 of FTO. The differences in terms of genotype and allele distributions between the cases and the controls were analyzed by the chi-square test.There were 215 male and 317 female patients with a mean age of 58.1 ± 7.2 years. According to the KL score, 172 (32.3%) patients had mild KOA and 360 (67.7%) had severe KOA. There were remarkably lower frequencies of allele T of rs4867568 and allele C of rs143383 in the patients than in the controls (31.5% vs. 36.0%, p = 0.01 for rs4867568; 24.6% vs. 28.7%, p = 0.02 for rs143383), with an OR of 0.82 and 0.81, respectively. As for rs1558902, no significant difference regarding the frequency of allele and genotype was found between the patients and the controls. Patients with severe KOA had remarkably lower incidence of genotype TT of rs4867568 than patients with mild KOA (6.7% vs. 12.2%, p = 0.04). There was significantly higher frequency of allele T in patients with mild KOA than in those with severe KOA (36.3% vs. 29.2%, p = 0.02, OR = 0.72).The association of rs4867568 and rs143383 with KOA was successfully replicated in the Chinese Han population. Moreover, rs4867568 was found significantly associated with the severity of KOA. More studies are warranted to explore the functional role of rs4867568 in the development of KOA. Key Points • A novel variant near Lsp1p3 is associated with knee osteoarthritis. • Baseline characteristics of the subjects. • Comparison of the genotype and allele frequency of the Lsp1p3, GDF5, and FTO. • Association of the Lsp1p3, GDF5, and FTO with KOA severity.

Background: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear. Methods: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30–79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records. Findings: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10–1·28), cardiovascular mortality (1·24, 1·10–1·39), and respiratory mortality (1·43, 1·10–1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69–0·89). Interpretation: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.

ObjectivesTo describe the need for and utility of online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV.DesignQualitative descriptive study using web-based semi-structured interviews.ParticipantsWe recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: 1) adults living with HIV, 2) rehabilitation professionals, 3) fitness personnel, 4) educators with eLearning experience, and 5) representatives from HIV community-based organizations (CBOs).Data CollectionWe asked participants to describe their experiences with online CBE, need and utility for online CBE, and factors in developing and implementing online CBE interventions. We analyzed data using group-based content analytical techniques.ResultsAmong the 11 participants, most had experience working with adults living with HIV (73%) or with tele-health/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: 1)person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), 2)accessibility of program (physical space to exercise, reliable internet, access to devices, digital literacy), 3)program delivery and technology (live versus pre-recorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), 4)attributes of program personnel (working with CBOs, relatable instructors, diverse staff), 5)program content and design (tailored exercise classes, educational sessions) and 6)building community (shared experiences, peer support, social opportunities).ConclusionsThere is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.STRENGTHS & LIMITATIONS OF THIS STUDYTo our knowledge, this is the first qualitative study exploring the perspectives of key stakeholders in developing and implementing an online community-based exercise (CBE) program for adults living with HIV.Insights gained from this study can help to inform future online community-based exercise programming for adults living with HIV and other chronic and episodic conditions.We used the Model for ASsessment of Telemedicine applications (MAST) framework as a conceptual foundation to design the interview guide, which enabled us to comprehensively explore diverse aspects of telemedicine services in relation to information, communication and technology.All interviews were conducted online with participants who had access to technological devices and reliable internet, therefore, results may not be transferable to individuals or contexts without access to technology.Most participants were living in Canada, hence, it is unclear how results may be transferable to other geographical contexts.

Medical image segmentation has the priori guiding significance for clinical diagnosis and treatment. In the past ten years, a large number of experimental facts have proved the great success of deep convolutional neural networks in various medical image segmentation tasks. However, the convolutional networks seem to focus too much on the local image details, while ignoring the long-range dependence. The Transformer structure can encode long-range dependencies in image and learn high-dimensional image information through the self-attention mechanism. But this structure currently depends on the database scale to give full play to its excellent performance, which limits its application in medical images with limited database size. In this paper, the characteristics of CNNs and Transformer are integrated to propose a dual encoding–decoding structure of the X-shaped network (X-Net). It can serve as a good alternative to the traditional pure convolutional medical image segmentation network. In the encoding phase, the local and global features are simultaneously extracted by two types of encoders, convolutional downsampling, and Transformer and then merged through jump connection. In the decoding phase, a variational auto-encoder branch is added to reconstruct the input image itself in order to weaken the impact of insufficient data. Comparative experiments on three medical image datasets show that X-Net can realize the organic combination of Transformer and CNNs.