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This study contributes to understanding the dynamic evolution process of green tourism industry, for which the evaluation system is constructed combining stakeholder theory with the characteristic of green tourism industry. Data from Mainland China from 2011 to 2017 are used to build the evaluation system of green tourism industry. The data are also analyzed comprehensively by applying entropy weighted TOPSIS and geospatial visualization. Following a horizontal comparison between provinces in Mainland China and a longitudinal comparison of the development history of these provinces, results show that the development of green tourism presents regional differences. Developed areas in the eastern region are superior to that in central and western regions in Mainland China. Interestingly, the relationship between green tourism development and the economy is non-linear. Green tourism resources, traffic accessibility, macroeconomic development level, and tourists’ characteristics will affect the development potential of green tourism. Ultimately, this study brings managerial implications to the development of green tourism.

Background The average body weight of the Chinese population is rising rapidly over the past two decades and the old 2001 body mass index (BMI) cut-off value for malnutrition may underestimate malnutrition diagnosis. We explored the BMI cut-off value for malnutrition diagnosis based on national BMI data over the past 30 years and applied it to the Global Leadership Initiative on Malnutrition (GLIM) criteria when investigating malnutrition in hospitalized older adult patients. Methods To explore the BMI cut-off value for malnutrition, we established a linear stepwise model to predict the annual increasing BMI trend based on data from the national BMI dataset (1990-2009). The new cut-off value was applied to a large-scale dataset from a cross-sectional study pertaining to older hospitalized patients (≥65) recruited from 30 large hospitals in China. Results The average BMI increased from 21.8 to 23 kg/m2 in two decades. Using the linear model, we calculated that the net BMI increase will be 1.49 kg/m2 from 2009 to 2019. We subsequently proposed that the BMI cut-off value for malnutrition should rise to 20 kg/m2 . This cut-off value was applied to the validation dataset, containing 8,725 patients, and the GLIM-determined malnutrition rate was 24.58% (using the NRS-2002) and 23.32% (using the MNA-SF). The results significantly differed from those obtained using the 2001 Chinese BMI criteria (p Conclusion The GLIM tool has good applicability in Asian populations, especially in Chinese older adult patients. The BMI cut-off value for malnutrition should be adjusted to 20 kg/m2 for Chinese adults. This article is protected by copyright. All rights reserved.

Objective To evaluate the proprioceptive and clinical function of the knee joint after anterior cruciate ligament reconstruction (ACLR) with various amounts of remnant preserved with as few confounding factors as possible. Methods This retrospective study included 46 patients who underwent ACLR with remnant preservation between March 2013 and February 2019. These patients had less than 6 months injury‐to‐surgery interval and no concomitant injuries. The researchers divided these subjects into two groups based on the length of the remnant preserved after ACLR, with group A defined as having more than 1/3 of the original length preserved and group B defined as less than 1/3 of the original length preserved. Clinical scores were obtained using the Lysholm knee scoring scale and the Tegner activity scale. The Lysholm score was calculated preoperatively, at 3, 6, and 12 months postoperatively, and at the last follow up. The Tegner score was calculated preoperatively, at 12 months postoperatively and at the last follow up. Anterior laxity was measured using the KT2000 arthrometer preoperatively and at 12 months postoperatively. Proprioceptive function was evaluated through reproduction of passive positioning (RPP) and threshold to detection of passive motion (TDPM). Both RPP and TDPM were measured at the angle of 15° at 3, 6, and 12 months postoperatively. Unpaired t‐tests were performed to investigate the difference in each parameters between the two groups. Results In the present study, 20 patients were classified into group A and 26 into group B. All patients were followed up for an average of 34.70 ± 12.79 months. All 46 patients were satisfied with the outcome of the surgery and no complications were reported at the end of the study. No significant differences were found between the two groups in terms of the Lysholm score and anterior laxity by KT2000 at all time points. The Tegner score was significantly higher in group A at 12 months postoperatively and at the final follow‐up. In addition, group A's RPP was significantly better than that of group B's when tested at the angles of 15° and 30° at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Group A's TDPM was also significantly better than that of group B's at all three tested angles at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Conclusion Patients with ACLR with more than 1/3 of the original length preserved demonstrated a higher activity level 12 months postoperatively and better proprioceptive function at 15° of extension at 3 and 6 months postoperatively.

Both ligament-advanced reinforcement system (LARS) and hamstring tendon autograft can serve as grafts for posterior cruciate ligament (PCL) reconstruction. However, few studies have compared the effectiveness of these two approaches. This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft.A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed. Within this cohort, 15 patients received a reconstruction using the LARS (LARS group) and 21 using the hamstring tendon autograft (HT group).The pre- and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years (4.11±2.0 years on average). The last follow-up showed that functional scores and knee stability were significantly improved in both groups (P0.05). Six months after operation, Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group (P0.05). Nonetheless, the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups (P0.05). In the LARS and HT groups, 12 and 9 patients, respectively exhibited KT1000 values3 mm, with the difference being statistically significant (P0.05). In the HT group, the diameter of the four-strand hamstring tendon was positively correlated with height (P0.05), which was 7.37±0.52 mm in males and 6.50±0.77 mm in females (P0.05).Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction, but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term. LARS is especially suitable for those who hope to resume activities as early as possible.

Background With widespread utilization of instant social media, people desire a minimally invasive treatment to improve alar dynamic aesthetic, but few practical procedures on reducing alar mobility have been conducted. Objectives This study aimed to verify the effects of botulinum toxin on reducing nasal alar mobility and provide a supplemental treatment of rhinoplasty. Methods This single-blind prospective study included a cohort of 20 participants with the desire to improve their alar dynamic aesthetic. The experimental group was injected with 3U botulinum toxin type A at dilator naris anterior, dilator naris vestibularis, levator labii superioris alaeque nasi, and dilator naris, and the control group received the equivalent of saline. Standardized facial movement (from rest to maximum smile without revealing teeth) was recorded with a 3-dimensional imaging system. The changes between rest and maximum smile statuses represented alar mobility and were generated by MOBILITY=WIDTHsmile−WIDTHrestWIDTHrest×100 % . Alar mobility and root mean square analysis were employed for postoperative evaluations. Results In the experimental group, alar flaring mobility decreased from 10.05% ± 6.40% to 4.91% ± 3.48%(P < 0.05), and alar base mobility decreased from 16.83% ± 5.69% to 12.50% ± 4.89% (P < 0.05), whereas no significant changes in alar mobility were found in the control group. In root mean square analysis, changes in the experimental group were significantly higher than in the control group (P < 0.05). Conclusions Botulinum toxin type A can effectively restrain alar mobility without any significant adverse events and improve alar dynamic esthetic, which can serve as a minimally invasive method or supplemental treatment for rhinoplasty. Level of Evidence: 2

Objectives This study aims to explore the prevalence of sexual satisfaction among Chinese cancer survivors, and explore the association of sexual satisfaction with comorbidity and lifestyle factors. Methods A cross‐sectional study was performed among 3996 Chinese cancer survivors recruited at Shanghai Cancer Rehabilitation Club from March to April 2017. Data were collected through self‐reported questionnaires. The questionnaire includes information about demographic, cancer characteristics, comorbidities, lifestyle factors, and sexual satisfaction. Sexual satisfaction was measured by a single‐item scale. The distribution of sexual satisfaction among different demographic and cancer characteristics was compared using the chi‐squared test. Logistic regression models were conducted to assess the effects of lifestyle factors, comorbidities on sexual satisfaction after adjustment for demographic and cancer characteristics. Results More than 40% of male and female cancer survivors reported no sexual satisfaction. Sexual satisfaction of cancer survivors is significantly associated with both the number and the type of comorbidities. Heart disease, musculoskeletal system disease, diabetes, and hyperlipidemia are the comorbidities significantly associated with sexual satisfaction of cancer survivors. Lifestyle factors other than smoking, including exercise or fitness, drinking alcohol, and eating fruits and vegetables are significantly correlated with sexual satisfaction. Besides, all of the above associations show gender differences. In addition, demographic characteristics include sex, age, marital status, living status, and average monthly income are also significantly associated with sexual satisfaction of cancer survivors. Conclusion Comorbidity and lifestyle factors are associated with sexual satisfaction of cancer survivors, and the associations show gender differences. Improving the lifestyles of cancer survivors, and controlling and reducing their comorbidities are important for improving their sexual satisfaction., This study aims to investigate the prevalence of sexual satisfaction among Chinese cancer survivors, and explore the association of sexual satisfaction with comorbidity and lifestyle factors. Comorbidity and lifestyle factors are associated with sexual satisfaction of cancer survivors, and the associations show gender differences. Improving the lifestyles of cancer survivors, and controlling and reducing their comorbidities are important for improving their sexual satisfaction.

Top-k dominating (TKD) query is one of the methods to find the interesting objects by returning the k objects that dominate other objects in a given dataset. Incomplete datasets have missing values in uncertain dimensions, so it is difficult to obtain useful information with traditional data mining methods on complete data. BitMap Index Guided Algorithm (BIG) is a good choice for solving this problem. However, it is even harder to find top-k dominance objects on incomplete big data. When the dataset is too large, the requirements for the feasibility and performance of the algorithm will become very high. In this paper, we proposed an algorithm to apply MapReduce on the whole process with a pruning strategy, called Efficient Hadoop BitMap Index Guided Algorithm (EHBIG). This algorithm can realize TKD query on incomplete datasets through BitMap Index and use MapReduce architecture to make TKD query possible on large datasets. By using the pruning strategy, the runtime and memory usage are greatly reduced. What's more, we also proposed an improved version of EHBIG (denoted as IEHBIG) which optimizes the whole algorithm flow. Our in-depth work in this article culminates with some experimental results that clearly show that our proposed algorithm can perform well on TKD query in an incomplete large dataset and shows great performance in a Hadoop computing cluster.

BACKGROUND The reduction malarplasty has become one of the most popular esthetic surgeries among Asian women to improve facial contour. However, it is still controversial whether midfacial soft tissue changes after surgery, and more studies are needed. METHODS This retrospective observational study reviewed 30 patients who underwent L-shaped reduction malarplasty during January 2018 and August 2019. The preoperative and postoperative soft tissue thickness and the angle of nasolabial fold of the midfacial were assessed using photographs, three-dimensional skull computerized tomography images, and the Wrinkle Severity Rating Scale. RESULTS The postoperative average level of nasolabial fold angle was lower than that observed in preoperative conditions, with the difference being statistically significant (t = -10.262, P

Background: Insulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control. Objectives: To evaluate the impact of pharmacist’s monthly re-education on insulin injection technique (IT), lipohypertrophy, patients’ perception on insulin therapy and its effect on glycaemic control. Methods: This randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government health clinics. 160 diabetics with baseline HbA1C ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)). Results: 139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient’s perception. Mean HbA1C decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p

Introduction Craniosynostosis is one of the most common craniofacial abnormalities. It involves premature closure of one or more cranial sutures. Mutations in many genes have been and continue to be identified in patients. Settings and sample population Whole blood samples were collected from the patient and family members. Material and methods Whole exome sequencing was performed to identify potential mutations in the patient. The results were verified by Sanger sequencing by comparing SPECC1L gene sequence of blood samples from 100 unrelated population-matched controls. Results The patient presented with craniosynostosis with fusion of the bicoronal and sagittal sutures. A novel missense mutation (c.2612C>T, p.Pro871Leu) in the SPECC1L gene was identified. Gene analysis showed a missense mutation in exon1 of SPECC1L that led to an amino acid substitution in the region between coiled-coil domain 3 and calponin homology domain. Conclusion Our observations expand the molecular spectrum of gene mutations in craniosynostosis and emphasize the importance of gene testing in the diagnosis of craniosynostosis. The observations also reinforce the characteristics of SPECC1L-related cranial disorders.

In this paper, a novel launch dynamics measurement system based on the photoelectric sensor pair is built. The actual muzzle time (i.e. a time duration that originates from the initial movement to the rocket’s departure from the muzzle) and the muzzle velocity are measured. Compared with the classical methods, the actual muzzle time is obtained by eliminating the ignition delay. The comparative analysis method is proposed with numerical simulations established by the transfer matrix method for multibody systems. The experiment results indicate that the proposed measurement system can effectively measure the actual muzzle time and reduce the error of classical methods, which match well with the simulation results showing the launch dynamics model is reliable and helpful for further analysis and design of the MLRS.

Background To introduce a treatment option: dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy and assess its efficacy in treating membranous congenital nasolacrimal duct obstruction (CNLDO) in children older than 1 year with history of initial probing failure. Methods 52 eyes of 43 children with membranous CNLDO who underwent dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy between May 2012 and October 2020 were enrolled in this retrospective study. All participants were older than 1 year and all the eyes had gone through probing at least once but still had symptoms of epiphora and discharge. Surgical success was defined as a normal fluorescein dye disappearance test (FDDT) and the absence of pre-operation complaints, including epiphora, muco-purulent discharge, increased tear lake or the symptoms of acute infection such as acute dacryocystitis. Patients’ demographics, clinical features and follow-up outcomes were evaluated. Results Of all these operated cases, surgical success was achieved in 52/52 eyes without any early or late complications. The overall success rate was 100%. Conclusions Dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy is an effective and minimally invasive surgical treatment in membranous CNLDO patients with initial probing failure.

OBJECTIVE A major obstacle to improving bedside neurosurgical procedure safety and accuracy with image guidance technologies is the lack of a rapidly deployable, real-time registration and tracking system for a moving patient. This deficiency explains the persistence of freehand placement of external ventricular drains, which has an inherent risk of inaccurate positioning, multiple passes, tract hemorrhage, and injury to adjacent brain parenchyma. Here, the authors introduce and validate a novel image registration and real-time tracking system for frameless stereotactic neuronavigation and catheter placement in the nonimmobilized patient. METHODS Computer vision technology was used to develop an algorithm that performed near-continuous, automatic, and marker-less image registration. The program fuses a subject’s preprocedure CT scans to live 3D camera images (Snap-Surface), and patient movement is incorporated by artificial intelligence–driven recalibration (Real-Track). The surface registration error (SRE) and target registration error (TRE) were calculated for 5 cadaveric heads that underwent serial movements (fast and slow velocity roll, pitch, and yaw motions) and several test conditions, such as surgical draping with limited anatomical exposure and differential subject lighting. Six catheters were placed in each cadaveric head (30 total placements) with a simulated sterile technique. Postprocedure CT scans allowed comparison of planned and actual catheter positions for user error calculation. RESULTS Registration was successful for all 5 cadaveric specimens, with an overall mean (± standard deviation) SRE of 0.429 ± 0.108 mm for the catheter placements. Accuracy of TRE was maintained under 1.2 mm throughout specimen movements of low and high velocities of roll, pitch, and yaw, with the slowest recalibration time of 0.23 seconds. There were no statistically significant differences in SRE when the specimens were draped or fully undraped (p = 0.336). Performing registration in a bright versus a dimly lit environment had no statistically significant effect on SRE (p = 0.742 and 0.859, respectively). For the catheter placements, mean TRE was 0.862 ± 0.322 mm and mean user error (difference between target and actual catheter tip) was 1.674 ± 1.195 mm. CONCLUSIONS This computer vision–based registration system provided real-time tracking of cadaveric heads with a recalibration time of less than one-quarter of a second with submillimetric accuracy and enabled catheter placements with millimetric accuracy. Using this approach to guide bedside ventriculostomy could reduce complications, improve safety, and be extrapolated to other frameless stereotactic applications in awake, nonimmobilized patients.

Introduction Aneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. Traditional markers of aSAH have established their utility in the prediction of aSAH outcomes while frailty markers have been validated in other surgical specialties. We aimed to compare the predictive value of frailty indices and markers of sarcopaenia and osteopaenia, against the traditional markers for aSAH outcomes. Methods An observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. The best performing marker in predicting the modified Rankin scale (mRS) on discharge was selected and an appropriate threshold for the definition of frail and non-frail was derived. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]) and markers of sarcopaenia and osteopaenia (temporalis [TMT] and zygoma thickness), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. Univariable and multivariable analysis was then performed for various inpatient and long-term outcomes. Results TMT was the best performing marker in our cohort with an AUC of 0.82, Somers’ D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68). The threshold of 5.5 mm in TMT thickness was found to have a specificity of 0.93, sensitivity of 0.51, positive predictive value of 0.95 and negative predictive value of 0.42. After multivariate analysis, patients with TMT ≥ 5.5 mm (defined as non-frail), were less likely to experience delayed cerebral ischaemia (OR 0.11 [0.01 – 0.93], p = 0.042), any complications (OR 0.20 [0.06 – 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. Conclusion TMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes.

Objective To assess the accuracy of dynamic computer-assisted implant surgery. Materials and methods An electronic search up to March 2020 was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trial to identify studies using dynamic navigation in implant surgery, and additional manual search was performed as well. Clinical trials and model studies were selected. The primary outcome was accuracy. A single-arm meta-analysis of continuous data was conducted. Meta-regression was utilized for comparison on study design, guidance method, jaw and systems. Results Ten studies, four randomized controlled trials (RCT) and six prospective studies, met the inclusion criteria. A total of 1298 drillings and implants were evaluated. The meta-analysis of the accuracy (five clinical trials and five model studies) revealed average global platform deviation, global apex deviation and angular deviation were 1.02 mm, CI: 95% [0.83, 1.21], 1.33 mm, CI: 95% [0.98, 1.67], and 3.59°, CI: 95% [2.09, 5.09]. Meta-regression shown no difference between model studies and clinical trials (p=0.295, 0.336, 0.185), drilling holes and implant (p =0.36, 0.279, 0.695), maxilla and mandible (p =0.875, 0.632, 0.281) and five different systems (p =0.762, 0.342, 0.336). Conclusion Accuracy of dynamic computer-aided implant surgery reaches a clinically acceptable range and has potential in clinical usage, but more patient-centered outcomes and socio-economic benefits should be reported.

Aim To assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China. Materials and methods In this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019. Results Of the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes. Conclusions The prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.

The paper proposes the farmers credit optimization decision model and applications based on common risk guarantee fund. By considering two conditions of with default risk and without default risk, the individual rationality of bank and farmer is designed, respectively, and the mathematical formulas for calculating the risk loss ratio of bank loans under the guarantee fund are established and discussed innovatively, respectively. A nonlinear optimal model based on risk compensation fund is established in the paper. By mathematical proof, the optimal bank credit decision mechanism is studied. By the analysis of numeric experiments of two cases of with default risk and without default risk, the expected income and invest income are varied by the changing of farmer project success probability and default probability, and the relationship of loan interest, farmer expected income and invest income is studied. The research has scientific guiding significance and practical application value for farmers' credit decision making.

On-skin displays are emerging as a wearable form factor for the display of information; however, the perception of using such devices in public could determine whether they are eventually adopted or rejected. This study investigated the means by which on-skin notification displays are perceived by the general public. We adopted a mixed-methods approach to the analysis of results from an online survey (n = 254) and in-lab interviews (n = 36) pertaining to the novel form factor, device materiality, and envisioned use cases. The study was conducted in the US and Taiwan in order to examine cross-cultural attitudes toward device usage. The results of this structured examination provide valuable insights into the design of on-skin notification displays for everyday use across cultures.

When focusing on the general area of data mining, high-utility itemset mining (HUIM) can be defined as an offset of frequent itemset mining (FIM). It is known to emphasize more factors critically, which gives HUIM its intrinsic edge. Due to the flourishing development of the IoT technique, the uncertainty patterns mining is also attractive. Potential high-utility itemset mining (PHUIM) is introduced to reveal valuable patterns in an uncertainty database. Unfortunately, even though the previous methods are all very effective and powerful to mine, the potential high-utility itemsets quickly. These algorithms are not specifically designed for a database with an enormous number of records. In the previous methods, uncertainty transaction datasets would be load in the memory ultimately. Usually, several pre-defined operators would be applied to modify the original dataset to reduce the seeking time for scanning the data. However, it is impracticable to apply the same way in a big-data dataset. In this work, a dataset is assumed to be too big to be loaded directly into memory and be duplicated or modified; then, a MapReduce framework is proposed that can be used to handle these types of situations. One of our main objectives is to attempt to reduce the frequency of dataset scans while still maximizing the parallelization of all processes. Through in-depth experimental results, the proposed Hadoop algorithm is shown to perform strongly to mine all of the potential high-utility itemsets in a big-data dataset and shows excellent performance in a Hadoop computing cluster.

In this paper,we propose a random-access model for describing several wireless communication technologies. These networks have found application in the construction of wireless sensor networks, and the proposed model can be used for flows with different properties, considering the corresponding distribution functions. The model considers the technical features of the LoRa technology and subscriber traffic. We also address the management of random multiple wireless access in a Software-Defined Networking (SDN) like control architectures, and proposing a model for flows with different properties, considering the corresponding distribution functions. We develop a method for optimizing the parameters of an access network by the probability of data delivery. Then we describe the probability of bit error, frame loss, collision, and the choice of network parameters considering the heterogeneity of conditions for different users. Numerical results show the efficiency of our proposed scheme by maintaining the required network parameters in case of its function conditions changing.

In order to meet strict Quality-of-Service (QoS) constraints imposed by some industrial applications, the configuration of industrial networks must address the requirements of traffic flows with different priorities such as minimum delay and packet loss. The performance is affected significantly if the end-to-end delay and packet loss surpasses a specific limit, and may become unbefitting for the destination. In this paper, we select Software-Defined Networking (SDN) technology to manage centralized devices and design an optimal path to guarantee the QoS requirements by taking into consideration two types of traffic flows: the first is low-delay while the second is both low-delay and low-loss. By using this optimal path, the Reactive Flow Installation (RFI) method increases the time delay in the forwarding of packets. So as to solve this issue, we propose a Mixed Flow Installation (MFI) method based on caching the flow rules which correspond to the optimal paths in the hash table deployed in the SDN controller memory in order to reduce the computation time of the forwarding path and the load at the SDN controller. Alternatively, the pre-configured flow rules in switches by the Proactive Flow Installation (PFI) method achieves the delay-sensitive. However, the PFI is not modified when the network status or the traffic type changes till the timeout value expires. This can affect the QoS requirements for industrial applications. To handle this challenge, we propose a PFI Re-routing (PFIR) method that redefined faster a new optimal path according to change without waiting the SDN controller for new flow rules. With the care of wireless and wired networks, we have built a simulation network via the OpenDayLight SDN controller and conducted an experimental testbed. The framework results are demonstrated by the performances through reduction of end-to-end delay, packet loss rate, and packet violation ratio.

The immunosuppressive microenvironment that is shaped by hepatic metastatic pancreatic ductal adenocarcinoma (PDAC) is essential for tumor cell evasion of immune destruction. Neutrophils are important components of the metastatic tumor microenvironment and exhibit heterogeneity. However, the specific phenotypes, functions and regulatory mechanisms of neutrophils in PDAC liver metastases remain unknown. Here, we show that a subset of P2RX1-negative neutrophils accumulate in clinical and murine PDAC liver metastases. RNA sequencing of murine PDAC liver metastasis-infiltrated neutrophils show that P2RX1-deficient neutrophils express increased levels of immunosuppressive molecules, including PD-L1, and have enhanced mitochondrial metabolism. Mechanistically, the transcription factor Nrf2 is upregulated in P2RX1-deficient neutrophils and associated with PD-L1 expression and metabolic reprogramming. An anti-PD-1 neutralizing antibody is sufficient to compromise the immunosuppressive effects of P2RX1-deficient neutrophils on OVA-activated OT1 CD8+ T cells. Therefore, our study uncovers a mechanism by which metastatic PDAC tumors evade antitumor immunity by accumulating a subset of immunosuppressive P2RX1-negative neutrophils., Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive metastatic disease characterized by an immunosuppressive microenvironment. Here the authors show that a subset of P2RX1-negative neutrophils with immunosuppressive properties accumulate in PDAC metastatic liver tissues and promote tumor growth.

Hepatitis B e antigen (HBeAg) is a widely used marker both for chronic hepatitis B (CHB) clinical management and HBV-related basic research. However, due to its high amino acid sequence homology to hepatitis B core antigen (HBcAg), most of available anti-HBe antibodies are cross-reactive with HBcAg resulting in high interference against accurate measurement of the status and level of HBeAg. In the study, we generated several monoclonal antibodies (mAbs) targeting various epitopes on HBeAg and HBcAg. Among these mAbs, a novel mAb 16D9, which recognizes the SKLCLG (aa −10 to −5) motif on the N-terminal residues of HBeAg that is absent on HBcAg, exhibited excellent detection sensitivity and specificity in pairing with another 14A7 mAb targeting the HBeAg C-terminus (STLPETTVVRRRGR, aa141 to 154). Based on these two mAbs, we developed a novel chemiluminescent HBeAg immunoassay (NTR-HBeAg) which could detect HBeAg derived from various HBV genotypes. In contrast to widely used commercial assays, the NTR-HBeAg completely eliminated the cross-reactivity with secreted HBcAg from precore mutant (G1896A) virus in either cell culture or patient sera. The improved specificity of the NTR-HBeAg assay enables its applicability in cccDNA-targeting drug screening in cell culture systems and also provides an accurate tool for clinical HBeAg detection.

Photodynamic therapy (PDT), a non-invasive therapeutic modality, has received increasing attention owing to its high selectivity and limited side effects. Although significant clinical research progress has been made in PDT, the breadth and depth of its clinical application have not been fully realized due to the limitations such as inadequate light penetration depth, non-targeting photosensitizers (PSs), and tumor hypoxia. Consequently, numerous investigations put their emphasis on innovative strategies to overcome the aforementioned limitations and enhance the therapeutic effect of PDT. Herein, up-to-date advances in these innovative methods for PDT are summarized by introducing the design of PS systems, their working mechanisms and application examples. In addition, current challenges of these innovative strategies for clinical application, and future perspectives on further improvement of PDT are also discussed.

In order to improve the effective sunshine time, heat storage capacity and temperature distribution uniformity of traditional arch shed under low temperature, this paper designed a large-span arch shed which has larger sunny side span and east-west orientation. According to the numerical and measured data, it is concluded that the heat storage capacity and temperature distribution of asymmetrical arch shed are better than those of symmetrical arch shed within a certain range of the ratio between sunny and shaded side. After that, ten different asymmetric arch sheds were designed. It is concluded that the structure of 11+9 m along north-south direction has the best heat storage capacity. Besides that, the analysis of outside wind speed and opening size of top vent were carried out. It is found that the outside wind and top vent can effectively promote convection and exchange of the air, and then achieve the purpose of reducing the temperature. At the end of this paper, in order to identify the relationship of temperature with the structure of arch shed, outside wind speed, and opening size of top vent, a mathematical model was built based on response surface methodology, which would provide theoretical guidance for the design of arch sheds.

It is essential to know whether COVID-19 patients have a history of cerebrovascular disease, as it may be predictive of prognosis and useful for allocation of limited medical resources. This meta-analysis was performed to assess the incidence of cerebrovascular disease as a comorbidity in COVID-19 patients. The PubMed, Cochrane Library, Embase, CNKI, WFSD, and VIP databases were systematically searched. The pooled analysis of relevant data was conducted using RevMan 5.3 software. The primary outcome was incidence of cerebrovascular disease as a comorbidity. Forty-seven studies involving 16,143 COVID-19 patients were included in this analysis. The incidences of a history of cerebrovascular disease and hypertension in COVID-19 patients were estimated to be 3.0% (95% CI, 2.0%-4.0%; P

Objective To present the case of a patient on long-term anticoagulants who developed acute spinal epidural hematoma (SEH) after percutaneous kyphoplasty (PKP) without signs of major cement extravasation to the spinal canal. Methods A 64-year-old woman with long-term oral antiplatelet drugs underwent the L1 PKP. Immediately after the operation, the back pain improved significantly without neurological deficit. However, 12 hours later, she developed progressive weakness of the bilateral lower limbs. No intraspinal cement leakage was obvious on the postoperative lumbar radiograph and computed tomography. Results An emergency MRI examination revealed a high signal aggregation in front of the spinal cord from T12 to L1, indicating spinal cord compression. The SEH was verified and removed during the laminectomy from T12-L1. Following the decompression surgery, the neurological deficit of the lower limbs improved. On follow-up after 6 months, the muscle strength of the bilateral lower limbs had returned to normal. Conclusion For the patient with long-term oral antiplatelet drugs or coagulation malfunction, the transpedicle approach or that via the costovertebral joint with a smaller abduction angle is recommended to reduce the risk of injury to the inner wall of the pedicle. For progressive aggravation of neurological dysfunction after surgery, SEH formation should be suspected despite the absence of intraspinal bone cement leakage. Secondary emergency decompression should be considered to avoid permanent damage to spinal cord nerve function caused by continuous compression.

The anomalous photovoltaic effect and resistive switching behaviors in ferroelectric materials attract much attention in recent years. Dozens of researches revealed that the two effects coexist and affect each other in electrode/ferroelectric/electrode structures. Therefore, the conductive mechanisms and research progresses of the two effects were discussed in this study, which suggested the interface coupling effect caused by polarization states led to switchable photovoltaic and different resistance states. On the other hand, electrode/ferroelectric/electrode structures have great potential in the application of high-density memories, and a novel non-volatile optoelectronic memory which can write multiple storage states and read information non-destructively can be realized by exploiting the two effects properly.

BACKGROUND Inflammation and postinflammatory hyperpigmentation (PIH) are two adverse side effects of ablative fractional CO2 laser (ablative Fr CO2 ) treatment for both rejuvenation and acne scars. AIMS To evaluate the efficacy of fusidic acid cream versus erythromycin ointment as postoperative therapy in patients who underwent ablative Fr CO2 treatment for atrophic acne scars. METHODS Sixty Chinese patients who fulfilled the study criteria were recruited and randomly assigned to an experimental group treated with fusidic acid cream or a control group treated with erythromycin ointment. Postoperative treatment lasted for 7 days in each group. Each patient had two follow-up visits at 8 and 12 weeks. In total, three patients dropped out of the study, one in the experimental group at week 8 and two in the control group at weeks 8 and 12. Baseline and postoperative inflammation and PIH were assessed by facial examination, photographs, and questionnaires. Besides, PIH was evaluated by the Hyperpigmentation Activity and Severity Index (HASI) and a five-point grading system. RESULTS Moderate-to-severe PIH was observed in both groups. However, the mean HASI score and severity of PIH in the experimental group were lower than those of the control group at weeks 8 and 12 (P

Lessons Learned The efficacy of single-agent chemotherapy was not significantly different from that of double-agent chemotherapy in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma. Single-agent concurrent chemoradiotherapy had lower gastrointestinal and hematologic toxicity. Overall survival and progression-free survival were not significantly different between single- and double-agent concurrent chemoradiotherapy. Background This multicenter, randomized, phase II trial aimed to compare the efficacy and safety of single-agent concurrent chemoradiotherapy using the oral fluoropyrimidine S-1 with those of double-agent concurrent chemoradiotherapy using S-1 and cisplatin in patients with inoperable esophageal squamous cell carcinoma. Methods Patients with inoperable esophageal squamous cell carcinoma (clinical stages I to III) were randomly allocated to the single-agent group (S-1) or the double-agent group (S-1/cisplatin). The concurrent intensity-modulated radiation therapy plan was similar for both groups: planning target volume 1.8 Gy/f*30–33f and planning gross target volume of 2 Gy/f*30–33f. The primary outcome measure was the endoscopic complete response rate. Results Of the 105 patients randomized, 89 were assessable. The endoscopic complete response rate was 46.9% (23/49) in the single-agent group and 52.5% (21/40) in double-agent group. The median progression-free survival within a median follow-up of 23 months was 20 and 21 months, respectively. The median overall survival was 26 months and not reached, respectively. Grade 3 hematological toxicities occurred in 4.1% and 27.5% of the patients in the single- and the double-agent group, respectively. Conclusion Single-agent chemotherapy in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma has good efficacy and safety, thus warranting a phase III trial.

Tourists’ environmentally responsible behavior (TERB) is crucial to the destination’s natural environment. Drawing on self-congruity theory, this study extends the existing literature on the underl...

The aim of the present work is to propose an innovative magnetorheological fluid-elastomeric damper which is applied to small amplitude vibration reduction occasions, especially for helicopter rotor. The damper is compact in structure and possesses the controllable dynamic characteristics. The magnetic circuit structure of the damper is designed and optimized emphatically in order to ensure its rationality. After the completion of the prototype, the damper is tested by a hydraulically actuated dynamic testing system under different excitation amplitudes, excitation frequencies, and input currents. Subsequently, a new phenomenological model is established to describe the nonlinear behavior of the proposed magnetorheological fluid-elastomeric damper. A series of parameter identification is conducted to fit both this model and Bouc–Wen model to experimental data for the purpose of verifying the accuracy of the established model.

Jing-Yong Xu,1 Chen Li,2 He Zhang,3 Yuan Liu,2 Jun-Min Wei1 1Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, People’s Republic of China; 2Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, People’s Republic of China; 3Community Health Service Administration Center of Dongcheng District, Beijing 100006, People’s Republic of ChinaCorrespondence: Jun-Min Wei Tel +86-13810351797Email weijunminsci@163.comBackground and Aim: Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD.Patients and Methods: We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cut-off values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed.Results: The optimal cut-off values of TPAI were 4.78 cm2/m2 for males and 3.46 cm2/m2 for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAI-defined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications.Conclusion: Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cut-off values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.Keywords: psoas muscle area index, CT scan, sarcopenia, sarcopenic obesity, pancreatoduodenectomy

Multiple Launch Rocket System (MLRS) has been widely used in recent years; vibration control in launching process is an effective way to improve its dispersion characteristics. In this paper, a novel vibration control system applying Annularly Arranged Thrusters (AAT) for MLRS in launching process is introduced and the prototype of the proposed system is built. The dynamic model of the MLRS with the AAT is established based on the Transfer Matrix Method for Multibody Systems (MSTMM). The LQR-PID control law and the management for the AAT are presented. The simulation and experiment of the proposed system are carried out and analyzed. The results show that the vibration of MLRS is effectively attenuated by the proposed control system. The study in this paper provides a new idea to improve the dispersion characteristic by reducing the vibration of MLRS in launching process.

Background Dilatation of Virchow-Robin spaces (dVRS) have been described in the development of hydrocephalic syndromes. We report an unusual case of a type III dVRS presenting as a mimic of normal pressure hydrocephalus (NPH), due to distortion at the level of the cerebral aqueduct. Case Description A 59-year-old woman presented with mild traumatic brain injury and possible NPH, due to a history of progressive gait disturbance, recurrent falls, and cognitive decline over a year, in the context of ventriculomegaly. Detailed structural imaging of the brain revealed multiple dilated cystic lesions consistent with dVRS causing distortion at the level of the cerebral aqueduct. Cerebrospinal fluid examination was negative for infection. The patient was treated with endoscopic third ventriculostomy; at 12 months postoperatively, she demonstrated a sustained improvement in gait and stabilization of cognitive decline. Conclusions This is an illustrative case of a subacute obstructive hydrocephalus due to a collection of periaqueductal dVRS, leading to an insidious clinical presentation mimicking NPH. We reviewed the literature for key clinical presentations and describe neuroanatomical considerations as well as primary treatment strategies. Various hydrocephalic syndromes may present with classic symptoms from Hakim's triad; such symptoms are not specific to idiopathic NPH. Both endoscopic third ventriculostomy and shunting may be efficacious. In our case, dVRS may serve as both a cause of and compensatory mechanism in a subacute obstructive hydrocephalus of unknown etiology. Our case highlights the need to understand the neuroanatomy of aberrant cerebrospinal fluid spaces in hydrocephalic syndromes. Further studies of dVRS would provide valuable insights into the pathogenesis of hydrocephalus.

Perineural invasion is a common feature of pancreatic ductal adenocarcinoma (PDAC). Here, we investigated the effect of perineural invasion on the microenvironment and how this affects PDAC progression. Transcriptome expression profiles of PDAC tissues with different perineural invasion status were compared, and the intratumoral T-cell density and levels of neurotransmitters in these tissues were assessed. Perineural invasion was associated with impaired immune responses characterized by decreased CD8+ T and Th1 cells, and increased Th2 cells. Acetylcholine levels were elevated in severe perineural invasion. Acetylcholine impaired the ability of PDAC cells to recruit CD8+ T cells via HDAC1-mediated suppression of CCL5. Moreover, acetylcholine directly inhibited IFNγ production by CD8+ T cells in a dose-dependent manner and favored Th2 over Th1 differentiation. Furthermore, hyperactivation of cholinergic signaling enhanced tumor growth by suppressing the intratumoral T-cell response in an orthotopic PDAC model. Conversely, blocking perineural invasion with bilateral subdiaphragmatic vagotomy in tumor-bearing mice was associated with an increase in CD8+ T cells, an elevated Th1/Th2 ratio, and improved survival. In conclusion, perineural invasion–triggered cholinergic signaling favors tumor growth by promoting an immune-suppressive microenvironment characterized by impaired CD8+ T-cell infiltration and a reduced Th1/Th2 ratio. Significance: These findings provide a promising therapeutic strategy to modulate the immunosuppressive microenvironment of pancreatic ductal adenocarcinoma with severe perineural invasion.

Background Human immunodeficiency virus type 1 (HIV-1) clades and clusters have different epidemic patterns and phenotypic profiles. It is unclear if they also affect patients’ immune recovery (IR) in combination antiretroviral therapy (cART). Methods We conducted a cohort study on 853 patients under cART for evaluating the impacts of viral factor on host IR. We used generalized estimating equations for factors affecting CD4 recovery, Kaplan-Meier curves for probability of achieving IR, and Cox hazards model for factors influencing IR capability. Results Besides low baseline CD4 and old age, CRF01_AE and its cluster 4 were independently associated with lower CD4 cell level (P ≤ .003), slower IR (P ≤ .022), fewer patients (P < .001), and longer time achieving IR (P < .001), compared with CRF07_BC and CRF01_AE cluster 5. Higher percentage of CXCR4 (X4) viruses in the CRF01_AE and cluster 4–infected patients, compared with their respective counterparts (P < .001), accounted for the poor IR in infected patients (P < .001). Finally, we revealed that greater X4 receptor binding propensity of amino acids was exhibited in CRF01_AE clade (P < .001) and its cluster 4 (P ≤ .004). Conclusions Our study demonstrates that the CRF01_AE clade and cluster are associated with poor IR in patients under cART, which is ascribed to a high proportion of viruses with X4 tropism. HIV-1 genotyping and phenotyping should be used as a surveillance tool for patients initiating cART. CCR5 inhibitors should be used with caution in regions with high prevalence of X4 viruses.

Background In countries in East Asia, the typical treatment for curable gastric cancer is gastrectomy with D2 lymphadenectomy. However, whether D2 lymphadenectomy is beneficial for high-risk N3 node disease remains controversial. We conducted a multi-institution retrospective study on patients with high-risk, locally advanced gastric cancer. To compare the rates of disease-free survival (DFS) and overall survival (OS) between radical D2-type gastric resection and lymphadenectomy and the more limited D1 type resection and lymphadenectomy. Methods From July 2010 to June 2015, 74 patients out of 949 who underwent curative-intent R0 surgery were selected in pairs to compare the survival outcomes between those who underwent radical D2 type (n=37) vs. the more limited D1 type (n=37) gastric resection and lymphadenectomy. Results The median DFS was 9.72 and 7.81 months for the D2 and D1 types, respectively (P=0.746), and the OS was 16.39 and 15.85 months for the D2 and D1 types, respectively (P=0.937). Conclusions No statistically significant differences in DFS and OS were noted between D1 and D2 procedures for those with N3 disease. Our results support the hypothesis that a novel multidisciplinary approach rather than a surgical approach alone is needed to improve the survival outcomes of high-risk patients with N3 gastric cancer.

We sought to compare the clinical and radiologic outcomes after anterior cervical surgery between zero-profile (Zero-P) cage and plate-cage construct (PCC).One-hundred and sixteen patients with single-level cervical disk herniation who underwent anterior cervical diskectomy and fusion between May 2015 and March 2017 were enrolled. They were divided into a Zero-P group (61 cases) and a PCC group (55 cases). At 1, 6, 12, and 24 months after the operation, routine follow-up evaluation was recommended including visual analog scale score and Japanese Orthopaedic Association score. The lateral x-ray film was performed at 1 and 24 months postoperatively.All 116 patients successfully completed the operation and achieved bone fusion. While there was no significant difference in the amount of bleeding between the 2 groups, the operation time of the Zero-P group was significantly shorter than that of the PCC group with statistically difference. The visual analog scale score and Japanese Orthopaedic Association score of the 2 groups at each follow-up interval postoperatively were significantly improved compared with that before operation; the difference was statistically significant (P0.05, respectively). While all the C2-7 cervical curvature, segmental Cobb angle, and height of adjacent vertebral body were lost at the 24-month follow-up, the significant difference was observed in the Zero-P group (P0.05, respectively).Compared with the Zero-P system, the PCC system provides a comparable clinical outcome. Although it showed the disadvantages in controlling the operation time and surgical bleeding, the radiologic outcome was better at the 2-year follow-up.

Objective Ventriculostomy-related infection (VRI) is associated with potential serious morbidity, extended hospitalization duration, increased health care costs, and mortality. We assessed the effectiveness of a pragmatic risk-stratification pathway for external ventricular drain (EVD) management, allowing for surgical decision making, in reducing the rate of VRIs. Methods Two studies were performed concurrently. A retrospective audit of EVD infection rates and outcomes in our unit across 3 hospitals was conducted from January to December 2014. The second prospective study compared the same variables during the implementation of the EVD pathway across the 3 sites from January 2015 to December 2016. Results The number of patients requiring EVDs increased from 2014 to 2016 (165 vs. 189 vs. 197 patients, respectively), with a significant increase in patients with intraventricular hemorrhage (P = 0.009). Despite increasing risk, overall EVD infections decreased during the implementation period, from 4.8% (8/165) in 2014 to 3.7% in 2015 (7/189) and 2.0% in 2016 (4/197, P = 0.33). In 2 sites (site 1, 2.0% vs. 2.1% vs. 1.9%, and site 2, 4.7% vs. 5.0% vs. 5.3%), transition to the EVD risk-stratification pathway maintained already low infection rates; in site 3, EVD infections decreased from 6.8% (5/73) to 3.9% (4/102) and 0% (0/86, P = 0.06). Conclusions The introduction of a pragmatic evidence-based risk-stratification pathway, in which different options for EVD management are incorporated, results in low EVD infection rates across a multisite institutional practice. Our results are comparable to published protocols involving the implementation of standard care bundles and/or antibacterial EVDs alone, in reducing VRIs.

ROSAH syndrome was recently identified as an autosomal dominant systemic disorder due to mutations in ALPK1. It was characterized by retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache. We collected and summarized the clinical data of two patients with juvenile onset splenomegaly and oculopathy. Whole exome sequencing (WES) was adapted for genetic analysis. Mutations in ALPK1 were confirmed by Sanger sequencing. Besides juvenile oculopathy and splenomegaly, both patients had intermittent fever and anhidrosis. Patient 2 also experienced recurrent upper respiratory infections in her infancy and developed dental and nail problems in childhood. Elevated TNF-α was their prominent laboratory features. Both patients were found to have a previously reported mutation, c.710C>T, p. T237M (NM_001102406) in ALPK1. Anti-TNF treatment of adalimumab was applied to patient 1, after which her optic disc edema in the left eye continued and the visual acuity deteriorated further. Patient 1 underwent elective splenectomy due to concern for spontaneous rupture of the spleen. Up to date, 18 patients of ROSAH syndrome have been reported. The clinical manifestations were relatively homogeneous, prominently presenting with juvenile onset oculopathy and splenomegaly. As it mainly involves ocular fundus, severe oculopathy deeply affects the quality of life and prognosis of ROSAH patients. Now little has been known about its treatment. As a newly recognized inherited systemic disorder, ROSAH syndrome needs to be paid more attention to, especially for those with juvenile onset splenomegaly and oculopathy.

Light absorbers have widespread applications in plasmonic sensing, optical imaging, solar energy harvesting and photovoltaics. In this paper, a new class of metamaterial perfect absorbers (MPAs) is presented: core–shell Au@SiO2 meta-atoms randomly arranged onto an aluminum nanofilm that is capable of the near-perfect absorption of visible light over a wide spectral wavelength region. The MPAs were fabricated by a facile bottom-up self-assembly technique at the air–liquid interface. Interestingly, core–shell Au@SiO2 plasmonic nanoparticles (NPs) were designed as the meta-atoms and a matched synergistic electrostatic and capillary self-assembly strategy was proposed. Optical characterization showed that the well-designed MPA with four layers of Au@SiO2 meta-atoms exhibited a particular absorption behavior at visible frequencies: two near-perfect absorption peaks (absorptance both above 99%) were recorded near λ = 537 nm and λ = 575 nm with TE- and TM-polarized light, respectively, at different incident angles. Moreover, under ∼45° incidence, the TE-polarized light absorption (average absorptivity of more than 90%) of the MPA ranged from 506 to 580 nm, suggesting that the MPA achieved a polarization-dependent broadband response. It has been demonstrated that the exotic absorbing properties of our designed MPAs were due to the effective Mie resonances (localized and coupled Mie resonances) from adjacent Au@SiO2 meta-atoms and the positive interferometric enhancement from the SiO2 dielectric shells. Besides, the proper self-assembled layer (i.e. 4) of Au@SiO2 meta-atoms and the suitable light incidence angle (i.e. 45 degrees) were critical for the desired resonance absorption behaviors.

Exercise training is believed to have a positive effect on cardiac hypertrophy after hypertension. However, its mechanism is still not fully understood. Herein, our findings suggest that heat shock transcription factor 1 (HSF1) improves exercise‐initiated myocardial angiogenesis after pressure overload. A sustained narrowing of the diagonal aorta (TAC) and moderately‐ intense exercise training protocol were imposed on HSF1 heterozygote (KO) and their littermate wild‐type (WT) male mice. After two months, the cardiac function was assessed using the adaptive responses to exercise training, or TAC, or both of them such as catheterization and echocardiography. The HE stains assessed the area of myocyte cross‐sectional. The Western blot and real‐time PCR measured the levels of expression for heat shock factor 1 (HSF1), vascular endothelial growth factor (VEGF) and hypoxia inducible factor‐1 alpha (HIF‐1α) in cardiac tissues. The anti‐CD31 antibody immunohistochemical staining was done to examine how exercise training influenced cardiac ontogeny. The outcome illustrated that exercise training significantly improved the cardiac ontogeny in TAC mice, which was convoyed by elevated levels of expression for VEGF and HIF‐1α and preserved the heart microvascular density. More importantly, HSF1 deficiency impaired these effects induced by exercise training in TAC mice. In conclusion, exercise training encourages cardiac ontogeny by means of HSF1 activation and successive HIF‐1α/VEGF up‐regulation in endothelial cells during continued pressure overload.

This study evaluates the efficacy and safety of bevacizumab (BEV) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases (BM) by performing meta-analyses of response and survival indices. Seventeen studies were included. BEV treatment was associated with a lower new BM incidence (hazard ratio: 0.30 [95% confidence interval (CI): 0.14, 0.46]) during follow-up. Disease control rate (DCR) of BEV-treated patients with BM was 91% [95% CI: 85, 95]. However, intracranial DCR was relatively higher (94% [95% CI: 87, 98]) than extracranial DCR (86% [95% CI: 74, 96]). DCR of NSCLC patients with BM was significantly better with BEV than with control therapies (odds ratio: 2.71 [95% CI: 1.26, 5.86], P = 0.01). Progression-free survival (PFS) of BEV-treated patients with and without BM was 7.1 months [95% CI: 6.2, 8.0] and 7.4 months [95% CI: 6.3, 8.4], respectively. Intracranial PFS of BEV-treated patients with BM was 8.0 months [95% CI: 6.0, 10.0]. Overall survival of BEV-treated NSCLC patients with and without BM was 13.5 months [95% CI: 11.4, 15.6] and 12.5 months [95% CI: 10.2, 14.8], respectively. The incidence of bleeding/hemorrhage in the central nervous system was 1% with BEV treatment.

Ploughbreast is the crucial soil-engaging component of horizontally reversible plough (HRP). Its biggest merit, compared to conventional ploughs, is to enable the ploughbody to perform alternative and shifting tillage operations with high speeds. A major technical challenge in the aforementioned operation is violent flowing interaction between soil and ploughbreast. This flowing interaction may result in severe wear rate on the ploughbreast, particularly along its cutting edge, i.e. ploughshank, thereby reducing the tool life. The objective of the present paper is to evaluate influences of the flowing interaction on the ploughshank by studying interaction force, wear rate and their correlation. The interaction forces were predicted using a numerical calculation with finite volume approach in computational fluid dynamics (CFD) software. The wear rates were measured using scanning electron microscope (SEM). There were very good qualitative agreements between numerical and experimental results that either the maximum force or the most severe wear rate appears at the same section and has a direct relationship with the Tillage speed and tilling depth. Closer examination of the calculated and measured confirms that the more violent sliding & rubbing, the greater stress gradient and the larger abrupt stress cause the more severe wear rate along the ploughshank.

With the rapid expansion of the Internet, intelligent question answering for information retrieval has once again gained widespread attention. However, current question answering models mainly focus on the general and common-sense questions in open domains and are incapable to effectively solve more complex professional domain questions. This paper proposed an integrated framework for Chinese intelligent question answering in restricted domains. The proposed model fused convolutional neural network and bidirectional long short-term memory network which performs efficient semantic analysis on the question pairs to extract more effective features of the text. Meanwhile, the coattention mechanism and attention mechanism were combined to obtain the semantic interaction and feature representation of the question pair for providing complete information for subsequent calculations. In addition, we introduced the method of question pair matching to implement the Chinese intelligent question answering in a restricted domain. Experiments were tested and evaluated on the open-source CCKS2018 dataset and our private self-built inverted pendulum control question answering (IPC-QA) dataset for automation control virtual learning environment. Experimental results confirm that the proposed models are efficient and achieve a high precision of 0.86042 and 0.8031 on CCKS2018 and IPC-QA respectively.

OBJECTIVE To summarize and analyze the postoperative complications of box-shift osteotomy performed at our center for Chinese orbital hypertelorism patients from 2008 to 2017. METHOD This retrospective study reviews the records of 78 patients with complete medical records and at least 2 years of postoperative follow-up data. Both radiologic and anthropometric assessments were conducted before, 1 month after and 2 years after surgery to evaluate the bony and soft-tissue alterations. Postoperative complications were recorded during hospitalization and at each follow-up visit and divided into 3 groups: acute complications that occurred within 1 month after surgery; early complications that occurred within 6 months after surgery; and long-term complications that occurred within 2 years after surgery. RESULTS Both bony and soft-tissue alterations were significant at 1 month after surgery. The acute complications that occurred in our center included infection (12.8%), cerebrospinal fluid leakage (29.5%), epilepsy (2.6%), and nasal tip skin necrosis (1.3%). The early complications included strabismus (11.5%) and nasolacrimal duct obstruction (3.8%). The long-term complications included insufficient correction (55.1%), palpable metal implants (92.3%) and a drooping nasal tip (33.9%). Due to the insufficient correction and the continued growth of rib graft, the difference in the hypertelorism index and nasal length, between one month and 2 years postoperatively were statistically significant (P

Synchronous resection of primary pancreatic ductal adenocarcinoma (PDAC) and liver metastases in highly selective patients is being accepted based on oncology research progress showing safe surgical outcomes with low morbidity and mortality. We also tried to determine patients who would benefit from the operation.From January 2012 to October 2017, 48 patients who underwent synchronous resection of primary PDAC and liver metastases were retrospectively evaluated. Twenty-three of them underwent oligometastatic synchronous resection.The majority of synchronous resection PDAC patients underwent hepatic wedge resection, and no oligometastatic patient was treated with hemihepatectomy. The median overall survival (OS) of the synchronous resection patients was 7.8 months. Hepatic oligometastatic PDAC patients had a longer OS than that of non-oligometastatic synchronous resection patients, systemic chemotherapy patients and palliative patients (16.1 vs 6.4 months, P = 0.02; 16.1 vs 7.6 months, P = 0.02; 16.1 vs 4.3 months, P 0.0001; respectively). Further analysis showed that localized pancreatic body/tail PDAC had a better OS in oligometastatic patients than in non-oligometastatic synchronous resection patients (16.8 months vs 7.05 months, P = 0.0004) and systemic chemotherapy patients (16.8 months vs 8 months, P = 0.003).Patients with pancreatic body/tail PDAC with liver oligometastases can benefit from synchronous resection.