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Background The Quick Mild Cognitive Impairment (Qmci) test has been suggested to be an easy-to-use and precise screening tool for detecting postoperative cognitive dysfunction (POCD). To provide essential information for future POCD studies in Taiwan, the present study provided data regarding the Taiwan version of the Qmci (Qmci-TW) test conducted in the normative Taiwanese population and changes in them over time. Methods The present study recruited adult native Taiwanese volunteers without known neurologic or psychiatric diseases. All enrolled participants received protocolized serial Qmci-TW test at baseline, 2-day follow-up, and 6-month follow-up. Results In total, 30 participants, 15 men and 15 women, were enrolled in this study. The baseline Qmci-TW score ranged from 55 to 80, with a mean of 68.9 and a standard deviation (SD) of 7. At 2-day follow-up, the mean Qmci-TW test score was significantly higher (by 5.3; SD = 7.3) than that at baseline (P = 0.001). At 6-month follow-up, the mean Qmci-TW score was 71.3 (SD = 6.1), with no significant difference compared with that at baseline. The decline in Qmci-TW scores by > 9 points on postoperative day 1 and by > 11 points at 6-month follow-up was the criterion for POCD. Conclusion The present study provided data regarding the Qmci-TW test conducted in the normative Taiwanese population and its time trajectory during the 6-month follow-up.

Diffracted waves provide an opportunity to detect small-scale subsurface structures because they give wide illumination direction of geologic discontinuities, such as faults, pinch outs, and collapsed columns. However, separating diffracted waves is challenging because diffracted waves have greater geometric amplitude losses and are generally weaker than reflections. To retain more diffracted waves, we have developed a prestack diffraction separation method based on the local slope pattern and plane-wave destruction (PWD) method. In general, it is difficult to distinguish between hyperbolic reflections and hyperbolic diffractions using data-driven local slope estimation in the shot domain. Therefore, we transfer slope estimation in the shot domain to velocity analysis in the common-midpoint domain and ray parameter calculation in the stack domain. The connection between local slope and the normal moveout velocity and the surface-ray parameter is known, which provides a novel approach for estimating the local slope of hyperbolic reflected waves in the shot domain. The estimated slope can provide an exact slope-based operator for the PWD method, thus allowing the PWD to separate diffracted waves from reflected waves in the shot domain. Synthetic and field data tests demonstrate the feasibility and effectiveness of our prestack diffraction separation method.

Among the recently described subtypes in childhood B-lymphoblastic leukemia (B-ALL) were DUX4- and PAX5-altered (PAX5alt). By using whole transcriptome RNA sequencing in 377 children with B-ALL from the Malaysia-Singapore ALL 2003 (MS2003) and Malaysia-Singapore ALL 2010 (MS2010) studies, we found that, after hyperdiploid and ETV6-RUNX1, the third and fourth most common subtypes were DUX4 (n = 51; 14%) and PAX5alt (n = 36; 10%). DUX4 also formed the largest genetic subtype among patients with poor day-33 minimal residual disease (MRD; n = 12 of 44). But despite the poor MRD, outcome of DUX4 B-ALL was excellent (5-year cumulative risk of relapse [CIR], 8.9%; 95% confidence interval [CI], 2.8%-19.5% and 5-year overall survival, 97.8%; 95% CI, 85.3%-99.7%). In MS2003, 21% of patients with DUX4 B-ALL had poor peripheral blood response to prednisolone at day 8, higher than other subtypes (8%; P = .03). In MS2010, with vincristine at day 1, no day-8 poor peripheral blood response was observed in the DUX4 subtype (P = .03). The PAX5alt group had an intermediate risk of relapse (5-year CIR, 18.1%) but when IKZF1 was not deleted, outcome was excellent with no relapse among 23 patients. Compared with MS2003, outcome of PAX5alt B-ALL with IKZF1 codeletion was improved by treatment intensification in MS2010 (5-year CIR, 80.0% vs 0%; P = .05). In conclusion, despite its poor initial response, DUX4 B-ALL had a favorable overall outcome, and the prognosis of PAX5alt was strongly dependent on IKZF1 codeletion.

Spectroscopic stimulated Raman scattering (SRS) imaging has become a useful tool finding a broad range of applications. Yet, wider adoption is hindered by the bulky and environmentally sensitive solid-state optical parametric oscillator (OPO) in a current SRS microscope. Moreover, chemically informative multiwindow SRS imaging across C-H, C-D, and fingerprint Raman regions is challenging due to the slow wavelength tuning speed of the solid-state OPO. In this work, we present a multiwindow SRS imaging system based on a compact and robust fiber laser with rapid and wide tuning capability. To address the relative intensity noise intrinsic to a fiber laser, we implemented autobalanced detection, which enhances the signal-to-noise ratio of stimulated Raman loss imaging by 23 times. We demonstrate high-quality SRS metabolic imaging of fungi, cancer cells, and Caenorhabditis elegans across the C-H, C-D, and fingerprint Raman windows. Our results showcase the potential of the compact multiwindow SRS system for a broad range of applications.

Objective This study investigated the role of radiomics in evaluating the alterations of oncogenic signaling pathways in head and neck cancer. Methods Radiomics features were extracted from 106 enhanced computed tomography images with head and neck squamous cell carcinoma. Support vector machine-recursive feature elimination was used for feature selection. Support vector machine algorithm was used to develop radiomics scores to predict genetic alterations in oncogenic signaling pathways. The performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic curve. Results The alterations of the Cell Cycle, HIPPO, NOTCH, PI3K, RTK RAS, and TP53 signaling pathways were predicted by radiomics scores. The AUC values of the training cohort were 0.94, 0.91, 0.94, 0.93, 0.87, and 0.93, respectively. The AUC values of the validation cohort were all greater than 0.7. Conclusions Radiogenomics is a new method for noninvasive acquisition of tumor molecular information at the genetic level.

The two underground powerhouses on the left and right banks of Baihetan Hydropower Station (BHT-HS) are symmetrically arranged inside basaltic rocks in the alpine gorge reach of the lower Jinsha River. Each of them is equipped with 8 sets of 1,000 MW hydraulic turbine generators, with the largest unit capacity, total installed capacity, span of main powerhouse (i.e. 34 m), diameter of dome-shaped tail-regulating chamber (max diameter of 48 m) and scale of underground caverns around the world. Due to complex layout, interaction between caverns and high hollowing rate, the construction process of the underground cavern group is faced many challenges. For example, the cavern excavation is located in the high ground stress area dominated by horizontal tectonic stress; the underlying basalt fractures are well developed, and the rock is hard and brittle, with low crack initiation strength; columnar jointed basalts develop locally; a number of large and weak gently-sloped shear zones develop diagonally cutting the main powerhouse. Following the construction ideology of “understanding, utilization, protection, monitoring, and feedback analysis on the surrounding rock masses during the construction period”, and with the engineering construction procedure of “the excavation, analysis, prediction and inspection of each rock layer”, this paper proposes a set of innovation construction technologies including “advanced pre-control, thin vertical layer, small planar partition, short excavation progress, fine blasting, strong and quick support, short interval monitoring, quick feedback, precise dynamic optimization” to control the internal cracking of the hard and brittle basaltic rocks, discontinuous deformation of staggered zones and spatio-temporal deformation of underground caverns in high geostress. It has promoted the safe and orderly construction of BHT-HS, the technical progress of the construction of hydropower station projects in China, and may also be applicable to the design and construction of similar projects worldwide.

Purpose: There is still no standard nonsurgical regimen for conventional chondrosarcoma (CHS). We aimed to identify whether any CHSs have a favored microenvironment for immunotherapy via multidimensional evaluation of the immunologic characteristics of this tumor. Experimental Design: We obtained 98 newly-diagnosed CHS fresh tumors from several institutions and performed comprehensive analysis of data from CyTOF, whole-exome sequencing, and flow cytometry in 22 cases. Clinical data from immunotherapy responders and nonresponders were compared to explore possible biomarkers of immunotherapy response. Mechanism studies were conducted to interpret the biomarker phenotype. Results: Based on the integrated data of single-cell CyTOF and flow cytometry, the CHS immune-microenvironment phenotypes were classified into three groups: subtype I, the “granulocytic–myeloid-derived suppressor cell (G-MDSC) dominant” cluster, with high number of HLA-DR− CD14− myeloid cells; subtype II, the “immune exhausted” cluster, with high exhausted T-cell and dendritic-cell infiltration; and subtype III, the “immune desert” cluster, with few immune cells. Immune cell–rich subtypes (subtype I and II) were characterized by IDH mutation, pathologic high grade, and peritumoral edema, while subtype I cases were exclusively featured by myxoid transformation. In clinical practice involving 12 individuals who received PD-1 antibody immunotherapy, all of the 3 cases with controlled diseases were retrospectively classified as subtype II. In mechanism, IDH mutation significantly elevated chemokine levels and immune-cell infiltration in immune-inactivated tumors. Conclusions: This study is the first to provide immune characterization of CHS, representing a major step to precise immunotherapy against this malignancy. Immunotherapy is promising for the “immune exhausted” subtype of patients with CHS.

High-grade gliomas are notorious for a high recurrence rate even after curative resection surgery. Studies regarding the influence of scalp block on high-grade gliomas have been inconclusive, possibly because the condition’s most important genetic mutation profile, namely the isocitrate dehydrogenase 1 (IDH1) mutation, had not been analyzed. Therefore, we conducted a single-center study including patients with high-grade glioma who underwent tumor resection between January 2014 and December 2019. Kaplan–Meier survival analysis revealed that scalp block was associated with longer progression-free survival (PFS; 15.17 vs. 10.77 months, p = 0.0018), as was the IDH1 mutation (37.37 vs. 10.90 months, p = 0.0149). Multivariate Cox regression analysis revealed that scalp block (hazard ratio: 0.436, 95% confidence interval: 0.236–0.807, p = 0.0082), gross total resection (hazard ratio: 0.405, 95% confidence interval: 0.227–0.721, p = 0.0021), and IDH1 mutation (hazard ratio: 0.304, 95% confidence interval: 0.118–0.784, p = 0.0138) were associated with better PFS. Our results demonstrate that application of scalp block, regardless of IDH1 profile, is an independent factor associated with longer PFS for patients with high-grade glioma.

Engaging in disaster relief and, more recently, post-disaster reconstruction in developing countries with critical geoeconomic and geopolitical interests has become an increasingly regular and institutionalized component of China’s evolving humanitarian diplomacy over the past decade. Drawn upon novel evidence from China’s growing disaster-related humanitarian assistance to Nepal and unprecedented engagement in Nepal’s long-term post-earthquake rebuild since 2015, this article explores the dynamics behind China’s transforming humanitarian diplomacy. The findings of this article suggest that: 1) geopolitical and geoeconomic interests, represented by the Belt-and-Road Initiative, serve as a critical driver for the development of China’s bilateral partnership with other countries in the disaster sector; 2) long-term cooperation with underdeveloped countries like Nepal provides China, both government and non-state actors (NSAs), with an effective channel to engage with the international humanitarian community and to internalize humanitarian norms; 3) although humanitarian missions remain contingent and instrumental in China’s international relations, they are laying the foundations for a specialized humanitarian policy area with more relevant normative assets, more professional actors, and more sophisticated institutions; 4) NSAs, represented by private foundations and civil NGOs, have played active roles in the state-dominant cooperation in disaster management. This article also suggests that intensified geopolitical confrontations, such as military clashes between India and China along their disputed borders over the past year, would lead to a high degree of politicization of humanitarian missions and partnerships counter-conducive to humanitarian goals.

Background Septic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class. Methods Patients with septic shock in 25 tertiary care teaching hospitals in China from January 2016 to December 2017 were enrolled in the study. Clinical and laboratory variables were collected on days 0, 1, 2, 3 and 7 after ICU admission. Subclasses of septic shock were identified by both finite mixture modeling and K-means clustering. Individualized fluid volume and norepinephrine dose were estimated using dynamic treatment regime (DTR) model to optimize the final mortality outcome. DTR models were validated in the eICU Collaborative Research Database (eICU-CRD) dataset. Results A total of 1437 patients with a mortality rate of 29% were included for analysis. The finite mixture modeling and K-means clustering robustly identified five classes of septic shock. Class 1 (baseline class) accounted for the majority of patients over all days; class 2 (critical class) had the highest severity of illness; class 3 (renal dysfunction) was characterized by renal dysfunction; class 4 (respiratory failure class) was characterized by respiratory failure; and class 5 (mild class) was characterized by the lowest mortality rate (21%). The optimal fluid infusion followed the resuscitation/de-resuscitation phases with initial large volume infusion and late restricted volume infusion. While class 1 transitioned to de-resuscitation phase on day 3, class 3 transitioned on day 1. Classes 1 and 3 might benefit from early use of norepinephrine, and class 2 can benefit from delayed use of norepinephrine while waiting for adequate fluid infusion. Conclusions Septic shock comprises a heterogeneous population that can be robustly classified into five phenotypes. These classes can be easily identified with routine clinical variables and can help to tailor resuscitation strategy in the context of precise medicine.

Femoral shaft fractures (FSFs) are associated with significant blood loss, resulting in anemia and hemorrhagic shock. However, there has been limited data for the blood loss of FSFs during the whole perioperative period. Our primary aim is to quantify the blood loss associated with FSFs treated with intramedullary nail or locking compression plate fixation, as well as to identify the relative affecting factors for perioperative hidden blood loss (HBL).131 consecutive patients with FSFs were enrolled in the retrospective study between January 2009 and January 2020, including 90 cases for intramedullary nail (Nail group) and 41 cases for locking compression plate fixation (Plate group). Demographics and perioperative data were collected and analyzed. Total blood loss (TBL), visible blood loss (VBL), HBL, and percentage of HBL (PHBL) were calculated based on hematocrit (Hct) changes.There was a large drop of hemoglobin (Hb) during the perioperative time. Of all 131 patients, the average HBL was 1445.5 ± 443.2 mL, accounting for 78.7% of TBL (1815.1 ± 446.3 mL). TBL and HBL in Nail group were 1886.1 ± 438.6 mL and 1546.0 ± 424.7 mL; while TBL and HBL in Plate group were 1659.5 ± 427.9 mL and 1225.1 ± 405.7 mL. The differences between the two groups were statistically significant (p = 0.007, p0.001, respectively). Besides, statistical significance (p0.05, p0.05, respectively) was also reported in HBL between Type-A and Type-C, and between Type-B and Type-C (1395.8 ± 444.8 mL vs. 1651.6 ± 495.7 mL; and 1411.2 ± 383.4 mL vs. 1651.6 ± 495.7 mL, respectively).Patients of FSFs had significant TBL and HBL, the amount of which was much larger than that observed intra-operatively. Moreover, two readily available preoperative factors for nail fixation and Type-C were associated with a higher likelihood of more HBL. Therefore, it was argued that regular perioperative monitoring and timely blood transfusion were crucially important for patients to avoid possible risks of anemia and facilitate recovery.

Hepatoblastoma is a kind of extreme malignancy frequently diagnosed in children. Although surgical resection is considered as the first-line treatment for hepatoblastoma, a relatively large population of patients have lost the preferred opportunity for surgery. Administration of locoregional ablation enables local tumor control but with the deficiency of insufficient ablation, residual tumor, and rapid progression. In this study, we integrated 219 hepatoblastoma and 121 non-cancer liver tissues to evaluate the expression of NR2F6, from which a higher NR2F6 level was found in hepatoblastoma compared with non-cancer livers with a standard mean difference (SMD) of 1.04 (95% CI: 0.79, 1.29). The overexpression of NR2F6 also appeared to be an efficient indicator in distinguishing hepatoblastoma tissues from non-cancer liver tissues from the indication of a summarized AUC of 0.90, with a pooled sensitivity of 0.76 and a pooled specificity of 0.89. Interestingly, nude mouse xenografts provided direct evidence that overexpressed NR2F6 was also detected in residual tumor compared to untreated hepatoblastoma. Chromatin immunoprecipitation-binding data in HepG2 cells and transcriptome analysis of HepG2 xenografts were combined to identify target genes regulated by NR2F6. We finally selected 150 novel target genes of NR2F6 in residual tumor of incomplete ablation, and these genes appeared to be associated with the biological regulation of lipid metabolism-related pathway. Accordingly, targeting NR2F6 holds a therapeutic promise in treating residual recurrent hepatoblastoma after incomplete ablation., GRAPHICAL ABSTRACT

Oesophageal squamous cell carcinoma (ESCC) is a malignant tumour of the digestive system that is associated with high morbidity and mortality rates worldwide. With the increased use of immunotherapy in cancer treatment, there is an urgent need to elucidate the immune-related mechanisms in ESCC and other digestive system carcinomas.In our study, single-sample gene set enrichment analysis (ssGSEA) was first performed to analyse the expression profile downloaded from the NCBI Gene Expression Omnibus (GEO) database. Then,Our analyses showed that the numbers of infiltrating macrophages were obviously higher in advanced stages in ESCC compared with other types of immunocytes. MEOX2 was identified as a biomarker correlated with macrophage infiltration in ESCC and other types of digestive system carcinomas. And MEOX2 expression was strongly associated with the mRNA expression of colony-stimulating factor 1 (CSF-1) and CSF-1 receptor (CSF-1R) in these kinds of carcinomas.We speculated that MEOX2 could facilitate macrophage infiltration

The evolution of the Internet of Things (IoT) makes an increased emphasis on extending their computing and storage capabilities by relying particularly on the cloud/edge computing (EC) for cyber–physical systems (CPSs). Especially, in software-defined CPS (SD-CPS), different software-defined networking (SDN) controllers share information and cooperate to make global decisions. To further enhance system security during the information sharing process, we introduce blockchain technology into SD-CPS. However, because many security-related decisions are sensitive to latency, it is vital to minimize the system latency in blockchain-empowered SD-CPS. In this article, a blockchain-empowered distributed SD-CPS framework is proposed to realize consensus and distributed resource management by offloading data in a hybrid network paradigm that combines cloud computing and EC. Moreover, to adaptively implement offloading and control strategies while guaranteeing data security, we design a resource management scheme for reducing system latency and provide the flexibility of cooperation. To foster intelligence, we formulate the joint communication, computation, and consensus problems as a Markov decision process and use deep reinforcement learning to balance resource allocation, reduce latency, and guarantee data security. Compared with other schemes, simulation results verify the effectiveness of the proposed scheme, which performs better on self-adaptation decision making and system delay reduction.

Purpose This work proposes a research model that explains investment intention in online peer-to-peer (P2P) lending based on the persuasion theory of elaboration likelihood model (ELM). In the proposed model, investment intention indirectly relates to source credibility and argument quality through the mediation of trust. At the same time, the study hypothetically moderates the relationships between source credibility and trust and between argument quality and trust by financial self-efficacy and risk preference.Design/methodology/approach This research presents an experiment to empirically validate its theoretical rationales. The hypotheses herein were tested using data from working professionals at a large science park in Taiwan. A total of 500 participants took part in the experiment in which the scenario of a pseudo-online P2P lending intermediary was first presented for their perusal, and then questionnaires based on the scenario were provided for the participants to fill out.Findings Trust cannot be improved over night without making great efforts on source credibility and argument quality in the long run. Online marketers should study market segmentations to decide what appropriate elements and promises should be provided in advertisements in order to improve their source credibility. Moreover, how online intermediaries formulate convincing messages and Polish their delivery communication skills should be improved so as to increase argument quality.Originality/value First, the theoretical conceptualization of source credibility and argument quality built upon the ELM not only broadens the boundary of virtual communities beyond the literature that considers source credibility and argument quality as important determinants, but also shows the practical status quo of trust as a critical mediator. Second, this research incorporates financial self-efficacy (based on social cognitive theory) and risk preference (based on economic theory) as important moderators in the development of trust. For that reason, customer education initiatives that influence financial self-efficacy and risk preference are discussed in greater detail.

Objective The adipokine asprosin, which was recently discovered, facilitates hepatic glucose production. The aim of this study is to see whether serum asprosin concentrations are linked to diabetic nephropathy (DN). Methods We performed this investigation in a group of 212 type 2 diabetes (T2DM) patients. These patients were classified into three subgroups: DN0 group (normal to mildly increased), DN1 group (moderately increased), and DN2 group (severely increased) on the basis of urine albumin-to-creatinine ratio (ACR). Results When compared to the controls, T2DM patients had higher serum asprosin levels. The DN2 group had significantly higher serum asprosin than the DN0 and DN1 groups. Furthermore, the DN1 group had higher serum asprosin than the DN0 group. Serum asprosin was linked to a higher risk of T2DM and DN in a logistic regression analysis. Serum asprosin was found to be positively related with disease duration, systolic blood pressure, blood urea nitrogen, creatinine, uric acid, ACR, calcium channel blockers, and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy, but negatively related with glomerular filtration rate, metformin, and acarbose therapy. Conclusion Serum asprosin increase with the progression of DN. Serum asprosin is correlated with renal function and ACR.

Objective The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease. Introduction Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice. Results The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73-95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches. Conclusion The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice.

Virtual reality (VR) over wireless has promising applications in healthcare, education, entertainment, and industrial production. However, it is difficult for the existing wireless systems to meet the needs of massive content transmission, ultra-low latency, and high computation in wireless VR. In this article, with the recent advances of edge intelligence and the Internet of Intelligence, we propose a novel framework that can jointly provide computation, storage, and communication resources for wireless VR in beyond 5G systems. In this framework, intelligence can be fully exploited to coordinate the computing, caching, and transmission systems to enable ubiquitous deployments of wireless VR. We present some key techniques and propose specific methods to support wireless VR. In addition, we propose a novel quantum-inspired RL reinforcement learning (QRL) algorithm for the multidimensional resource provisioning issue in wireless VR. In the simulations, some essential performance metrics are evaluated and some interesting results are presented, showing the effectiveness of the proposed strategy.

Background: Erigeron breviscapus (Vant.) Hand-Mazz. is a plant species in the Compositae family. More than ten types of compounds-such as flavonoids, caffeinate esters, and volatile oils-have been identified in Erigeron breviscapus; however, it remains unknown as to which compounds are associated with clinical efficacy. In recent years, flavonoids and phenolic acids have been considered as the main effective components of Erigeron breviscapus. The metabolism and mechanisms of these compounds in vivo have been extensively studied to improve our understanding of the drug. Methods: In the present review, we summarize the relationships among these compounds, their metabolites, and their pharmacodynamics. Many methods have been implemented to improve the separation and bioavailability of these compounds from Erigeron breviscapus. Results: In China, Erigeron breviscapus has been used for many years. In recent years, through the study of its metabolism and the mechanisms of its effective components, the effects of Erigeron breviscapus in the treatment of various diseases have been extensively studied. Findings have indicated that Erigeron breviscapus improves cardiovascular and cerebrovascular function and that one of its ingredients, scutellarin, has potential value in the treatment of Alzheimer's disease, cancer, diabetic vascular complications, and other conditions. In addition, phenolic acid compounds and their metabolites also play an important role in anti-oxidation, anti-inflammation, and improving blood lipids. Conclusion: Erigeron breviscapus plays an important role in the prevention and treatment of cardiovascular/ cerebrovascular diseases, neuroprotection, and cancer through many different mechanisms of action. Further investigation of its efficacious components and metabolites may provide more possibilities for the clinical application of traditional Chinese medicine and the development of novel drugs.

Background To explore the postoperative prognosis of esophageal squamous cell carcinoma (ESCC) patients with stage IB/IIA, using a prognostic score (PS). Methods Stage IB/IIA ESCC patients who underwent esophagectomy from 1999 to 2010 were included. We retrospectively recruited 153 patients and extracted their medical records. Moreover, we analyzed the programmed death ligand-1 (PD-L1) expression of their paraffin tissue. The cohort were randomly divided into a training group (N = 123) and a validation group (N = 30). We selected overall survival (OS) as observed endpoint. Prognostic factors with a multivariable two-sided P Results Univariable and multivariable analyses identified pTNM stage, the number of lymph nodes (NLNs) and PD-L1 expression as independent OS predictors. Primary prognostic score which comprised above three covariates adversely related with OS in two cohorts. PS discrimination of OS was comparable between the training and internal validation cohorts (C-index = 0.774 and 0.801, respectively). In addition, the PS system had an advantage over pTNM stage in the identification of high-risk patients (C-index = 0.774 vs. C-index = 0.570, P Conclusion Our study suggested a PS for significant clinical stratification of IB/IIA ESCC to screen out subgroups with poor prognosis.

Objective To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. Methods This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1–2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO2 20%); grade II, severe hypoxia (SpO2 40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis. Results A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self‐limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events. Conclusion Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor., The incidence of bone cement implantation syndrome (BCIS) in bone tumor surgeries was 26%. The incidence of grade I and grade II BCIS was 22% and 4%, respectively.

Temperature monitoring and control is of great significance to ensure concrete quality during the construction of dam concrete. In this study, a 3D thermal field restructuring method is developed for the complex evolution process of thermal field in dam concrete during construction, based on real-time temperature monitoring. The proposed method is related to the ordinary Kriging interpolation and the distributed optical fiber temperature sensing (DTS) technology. Based on the temperature monitoring of the Wudongde (WDD) super-high arch dam, the 3D thermal field can be acquired effectively and fast by the proposed restructuring method. The results indicate the temperature difference between the temperature measured by thermometers and the restructured temperature is within 1 °C. The evolution process of the restructured 3D thermal field for the WDD arch dam is in good agreement with the site situation. In addition, the uncertainty, cons and pros of the proposed method and the optimal layout of temperature sensors are further discussed. Although the proposed thermal field restructuring method has some limitations, it is believed to be a valuable tool for acquiring the 3D thermal field and thermal gradient of dam concrete.

Type 1 diabetes is a chronic metabolic disease characterized by hyperglycemia due to progressive destruction of pancreatic beta cells via autoimmune attack. Meteorin-like protein (metrnl) is a secreted protein homologous to the neurotrophin metrn and it is induced after exercise in the skeletal muscle. In our paper published previously, we showed that the serum level of metrnl was significantly correlated with the lipid profile, glucose profile and insulin resistance. In this experiment, we asked whether intravenous administration of metrnl could delay the onset of diabetes in non-obese diabetic (NOD) mice. 4-week-old NOD mice were injected intravenously with metrnl. Blood glucose levels were measured weekly. Insulitis scoring, intraperitoneal glucose tolerance test, adoptive T cell transfer, flow cytometry analysis and real-time PCR were performed to investigate the underlying mechanism. The results showed that intravenous administration of metrnl delayed the onset of diabetes in NOD mice. Histology of pancreas showed a decreased infiltration of leukocytes, which was in association with augmentation of regulatory T cells, suppression of autoreactive T cells and altered cytokine secretion. To sum up, the present study showed that intravenous administration of metrnl ameliorated islet lymphocyte infiltration and modulated immune cell responses, raising the possibility that it might be beneficial in improving islet function clinically.

Background: Carcinoembryonic antigen (CEA) is one of the important indexes for the diagnosis and prognosis of gastrointestinal cancer. Systemic inflammatory response (SIR) is closely related to the occurrence and development of gastrointestinal cancer. Methods: A total of 803 patients who underwent radical gastrectomy in Qinghai University Affiliated Hospital from January 2012 to December 2016 were included as training set. Multivariable Cox proportional hazard regression was used to identify associations with outcome of gastric cancer (GC). CNLR was established by combining CEA and the neutrophils to lymphocytes ratio (NLR, a typical parameter in SIR) to generate a novel prognostic score system and its prognostic value was externally validated. Results: Multivariate analysis showed that CEA and NLR were independent prognostic factors for GC patients (both p < 0.05). A higher CNLR was significantly associated with older age, male sex, larger tumor size, vascular invasion and advanced stages (all p < 0.05). Patients with higher CNLR had poor prognosis than those with lower CNLR (p < 0.05). Multivariate analysis showed that CNLR was an independent prognostic factor (p < 0.05). Incorporation of the CNLR into a prognostic model including age and TNM stage generated a nomogram, which predicted accurately 3- and 5-year survival for GC patients. And similar results were obtained in the external validation set. Conclusions: The CNLR prognostic scoring system established by combining CEA and NLR is an independent prognostic factor for GC, which can be incorporated into the traditional TNM staging to improve the prediction of long-term survival outcomes.

Fundamental systematic errors in point cloud data are inevitable due to a variety of factors, ranging from the external environment during scanning or observation by a terrestrial laser scanner (TLS) to the assembly of the instrument. For low-cost scanners, error terms may be further accentuated and included, in addition to systematic errors, random or even serious errors that directly affect the coordinates of each point in the point cloud, which are directly related to the quality of the point cloud data and subsequent processing. To address the above issues, we attempted to propose a robust target-based self-calibration method for TLS at the algorithmic level without considering the network design and measurement configuration, and derived its solution by normalizing the residual vector and calculating an equivalent covariance matrix based on the IGG III function. After validating the simulated and measured data, the experimental results showed that the proposed self-calibration method could effectively eliminate the random and gross errors associated with the observations; improved the accuracy of the points from centimeter to millimeter level; and increased the accuracy of the corrected checkpoints by 58%, 47%, and 33%, respectively, compared to the three existing methods. However, the proposed method was unable to take into account the attenuation of parameter correlations and further refinement in terms of measurement configurations would be subsequently required.

Traditional electrochemical measurements based on either current or potential responses only present the average contribution of an entire electrode's surface. Here, we present an electrochemical photothermal reflectance microscope (EPRM) in which a potential-dependent nonlinear photothermal signal is exploited to map an electrochemical process with sub-micron spatial resolution. By using EPRM, we are able to monitor the photothermal signal of a Pt electrode during the electrochemical reaction at an imaging speed of 0.3 s per frame. The potential-dependent photothermal signal, which is sensitive to the free electron density, clearly revealed the evolution of surface species on the Pt surface. Our results agreed well with the reported spectroelectrochemical techniques under similar conditions but with a much faster imaging speed. We further mapped the potential oscillation during the oxidation of formic acid on the Pt surface. The photothermal images from the Pt electrode well matched the potential change. This technique opens new prospects for real-time imaging of surface chemical reaction to reveal the heterogeneity of electrochemical reactivity, which enables broad applications to the study of catalysis, energy storage, and light harvest systems., The potential-dependent photothermal signal, which is sensitive to the free electron density, map the evolution of surface species on the electrode in real time.

Objective To examine the association between lymph node status and recurrence patterns in completely resected gastric adenocarcinoma. Methods We retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were compared. Results Of all, 517 (30.5%) patients developed recurrent disease, and complete data of recurrence could be obtained in 493 (95.4%) patients. For pN0 patients, the patterns of recurrence were different according to pT stage: locoregional recurrence was most common in patients with pT1-2 disease (57.1%), distant recurrence was most common in patients with pT3 disease (57.1%), and peritoneal recurrence was most common in patients with pT4a disease (66.7%). For pN+ patients, distant metastasis was most common pattern irrespective of pT stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with pN0-2 disease but plateaued 3 years after surgery in patients with pN3 disease. Time to recurrence was significantly longer for the pN0 patients compared with the pN+ patients (median: 25 vs. 16 months, P=0.001). Moreover, post-recurrence survival was significantly better for the pN0 patients than for the pN+ patients (median: 12 vs. 6 months, P

2D van der Waals (vdW) heterostructures as potential materials for solar energy-related applications have been brought to the forefront for researchers. Here, by employing first-principles calculations, we proposed that the PtS2/GaSe vdW heterostructure is a distinguished candidate for photocatalytic water splitting and solar cells. It is shown that the PtS2/GaSe heterostructure exhibits high thermal stability with an indirect band gap of 1.81 eV. We further highlighted the strain induced type-V to type-II band alignment transitions and band gap variations in PtS2/GaSe heterostructures. More importantly, the outstanding absorption coefficients in the visible light region and high carrier mobility further guarantee the photo energy conversion efficiency of PtS2/GaSe heterostructures. Interestingly, the natural type-V band alignments of PtS2/GaSe heterostructures are appropriate for the redox potential of water. On the other hand, the power conversion efficiency of ZnO/(PtS2/GaSe heterostructure)/CIGS (copper indium gallium diselenide) solar cells can achieve ∼17.4%, which can be further optimized up to ∼18.5% by increasing the CIGS thickness. Our present study paves the way for facilitating the potential application of vdW heterostructures as a promising photocatalyst for water splitting as well as the buffer layer for solar cells.

Bladder cancer is a common tumor type of the urinary system, which has high levels of morbidity and mortality. The first‑line treatment is cisplatin‑based combination chemotherapy, but a significant proportion of patients relapse due to the development of drug resistance. Therapy‑induced senescence can act as a 'back‑up' response to chemotherapy in cancer types that are resistant to apoptosis‑based anticancer therapies. The circadian clock serves an important role in drug resistance and cellular senescence. The aim of the present study was to investigate the regulatory effect of the circadian clock on paclitaxel (PTX)‑induced senescence in cisplatin‑resistant bladder cancer cells. Cisplatin‑resistant bladder cancer cells were established via long‑term cisplatin incubation. PTX induced apparent senescence in bladder cancer cells as demonstrated via SA‑β‑Gal staining, but this was not observed in the cisplatin‑resistant cells. The cisplatin‑resistant cells entered into a quiescent state with prolonged circadian rhythm under acute PTX stress. It was identified that the circadian protein cryptochrome1 (CRY1) accumulated in these quiescent cisplatin‑resistant cells, and that CRY1 knockdown restored PTX‑induced senescence. Mechanistically, CRY1 promoted p53 degradation via increasing the binding of p53 with its ubiquitin E3 ligase MDM2 proto‑oncogene. These data suggested that the accumulated CRY1 in cisplatin‑resistant cells could prevent PTX‑induced senescence by promoting p53 degradation.

Coronavirus disease-2019 (COVID-19) has become a pandemic disease globally. The First Affiliated Hospital of Chengdu Medical College has adopted telestroke to make stroke care accessible in remote areas. During the period January 2020 to March 2020, there was no COVID-19 case reported in our stroke center. A significant reduction of stroke admission was observed between the ischemic stroke group (235 vs. 588 cases) and the intracerebral hemorrhage group (136 vs. 150 cases) when compared with the same period last year (p < 0.001). The mean door-to-needle time (DNT) and door-to-puncture time (DPT) was 62 and 124 min, respectively. Compared to the same period last year, a significant change was observed in DNT (62 ± 12 vs. 47 ± 8 min, p = 0.019) but not in DPT (124 ± 58 vs. 135 ± 23 min, p = 0.682). A total of 46 telestroke consultations were received from network hospitals. Telestroke management in the central hospital was performed on 17 patients. Of them, 3 (17.6%) patients had brain hernia and died in hospital and 8 (47.1%) patients were able to ambulation at discharge and had a modified Rankin Scale of 0–2 at 3 months. The COVID-19 pandemic impacted stroke care significantly in our hospital, including prehospital and in-hospital settings, resulting in a significant drop in acute ischemic stroke admissions and a delay in DNT. The construction of a telestroke network enabled us to extend health-care resources and make stroke care accessible in remote areas. Stroke education and public awareness should be reinforced during the COVID-19 pandemic.

3D printing of hydrogels with high intrinsic mechanical performance has significant applications in many fields yet has been proven to be a fundamental challenge. Here, 3D printing of ultrahigh str...

Background:. Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome. Methods:. Patients from Chinese People's Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis. Results:. A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ2 = 41.063, P

Microscopic type-1 tympanoplasty (T1T) is a classical method for the treatment of chronic otitis media. However, it has its limitations. The development of otoendoscopy provided a new method for T1T.To investigate the difference between endoscopic T1T and microscopic T1T.Seventy-four patients who underwent T1T were evaluated retrospectively. About 52 cases underwent endoscopic T1T, and 22 cases accepted microscopic T1T. Parameters including operative duration, incision size, graft site, duration of postoperative hospitalization, visual analog scale (VAS) score, complications, hearing improvement, and expenses were compared.Operative duration of endoscopic T1T (47.0 ± 8.2 min) was shorter than microscopic T1T (58.0 ± 9.3 min) (Endoscopic T1T is a minimally invasive surgery with similar graft success rate, comparable hearing improvement, fast recovery, low cost, and high patient satisfaction compared to microscopic T1T.

Purpose: The tumor immune microenvironment (TIME) has an important impact on response to cancer immunotherapy using immune checkpoint inhibitors. Specifically, an “infiltrated-excluded”/“cold” TIME is predictive of poor response. The antidiabetic agent metformin may influence anticancer immunity in esophageal squamous cell carcinoma (ESCC). Experimental Design: We analyzed matched pre- and posttreatment ESCC specimens in a phase II clinical trial of low-dose metformin treatment (250 mg/day) to evaluate direct anti-ESCC activity and TIME reprogramming. Follow-up correlative studies using a carcinogen-induced ESCC mouse model were performed with short-term (1 week) or long-term (12 weeks) low-dose metformin (50 mg/kg/day) treatment. Results: In the clinical trial, low-dose metformin did not affect proliferation or apoptosis in ESCC tumors as assayed by Ki67 and cleaved caspase-3 immunostaining. However, metformin reprogrammed the TIME toward “infiltrated-inflamed” and increased the numbers of infiltrated CD8+ cytotoxic T lymphocyte and CD20+ B lymphocyte. Further, an increase in tumor-suppressive (CD11c+) and a decrease in tumor-promoting (CD163+) macrophages were observed. Metformin augmented macrophage-mediated phagocytosis of ESCC cells in vitro. In the ESCC mouse model, short-term metformin treatment reprogrammed the TIME in a similar fashion to humans, whereas long-term treatment further shifted the TIME toward an active state (e.g., reduction in CD4+ FoxP3+ regulatory T cells) and inhibited ESCC growth. In both humans and mice, metformin triggered AMPK activation and STAT3 inactivation, and altered the production of effector cytokines (i.e., TNFα, IFNγ, and IL10) in the immune cells. Conclusions: Low-dose metformin reprograms the TIME to an activated status and may be a suitable immune response modifier for further investigation in patients with ESCC.

This study bridges social cognitive theory and Turner’s theory of social interaction to develop a model that explains how work teams in technology industry can be motivated to enhance team performa...

Background Laryngocarcinoma (LC), in most cases a squamous cell carcinoma, accounts for 1 ~ 5% of the incidence of all tumors. At present, laryngocarcinoma is mainly managed with the integration of surgery and radio- and chemo-therapies. The current development trend of treatment is to improve the local control rate of tumor and the quality of life of patients. Intraoperative radiation therapy (IORT) is a radiotherapy that delivers single high dose irradiation at a close range to the tumor bed during the surgical operation process. It has particular radiobiological advantages in protecting normal surrounding tissues by directly applying the irradiation dose to the high-risk tumor bed area. Two forms of IORT, i.e., high dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT, including electron and photono IORT), had been studied before the treatment of head and neck tumors (including laryngocarcinoma). However, no relevant assessment had been carried out on 50KV low-energy X-ray. We are convinced by certain arguments that the application of low-energy X-ray for intraoperative local radiotherapy of laryngocarcinoma can not only achieve the therapeutic effect of IORT but also reduce the incidence of high-energy irradiation related toxic and side effects. The purpose of this study is to observe the safety and short-term efficacy of IORT when used in conjunction with standard of care for the treatment of local advanced laryngocarcinoma (LAL). Methods/design In consideration of the applications of precise targeted IORT in oncosurgery and in line with the application range and reference clinical medical guidances approved by SFDA (ZEISS radiosurgical operation system has been used for the treatment of solid tumors since 31 December, 2013 with an approval from SFDA), we have preliminarily planned the tumors suitable for IORT, determined the members of MDT in our hospital, improved the MDT diagnosis and treatment processes for the tumors, established the standards, indications and contraindications for the application of IORT, determined the indicators to be observed after the treatment of tumors with surgical operations plus IORT, and carried out follow-up visits and statistical analysis. This is a single-arm, prospective Phase II clinical trial of the treatment of LAL patients with IORT + EBRT. The study subjects are followed up for statistics and information of their acute/chronic toxic reactions and local control rate, DFS, and OS etc. The safety and short-term efficacy of the application of IORT as SIB for the treatment of LAL. The sample size of the study is 125 subjects. Discussion The safety and efficacy of IORT for the treatment of head and neck cancers have been proven in studies by multiple institutions (1–3). The purpose of this study is to investigate the maximum safe dose and short-term efficacy of IORT for providing a theoretical basis for clinical trials. Trial registration Trial registration: Clinicaltrials.gov, NCT04278638. Registered 18 February 2020 - prospectively registered, https://clinicaltrials.gov/ct2/show/NCT04278638

A memristor1 has been proposed as an artificial synapse for emerging neuromorphic computing applications2,3. To train a neural network in memristor arrays, changes in weight values in the form of device conductance should be distinct and uniform3. An electrochemical metallization (ECM) memory4,5, typically based on silicon (Si), has demonstrated a good analogue switching capability6,7 owing to the high mobility of metal ions in the Si switching medium8. However, the large stochasticity of the ion movement results in switching variability. Here we demonstrate a Si memristor with alloyed conduction channels that shows a stable and controllable device operation, which enables the large-scale implementation of crossbar arrays. The conduction channel is formed by conventional silver (Ag) as a primary mobile metal alloyed with silicidable copper (Cu) that stabilizes switching. In an optimal alloying ratio, Cu effectively regulates the Ag movement, which contributes to a substantial improvement in the spatial/temporal switching uniformity, a stable data retention over a large conductance range and a substantially enhanced programmed symmetry in analogue conductance states. This alloyed memristor allows the fabrication of large-scale crossbar arrays that feature a high device yield and accurate analogue programming capability. Thus, our discovery of an alloyed memristor is a key step paving the way beyond von Neumann computing.

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular peripheral disease, and has increasingly become the focus of research on vertigo diseases in recent years. In particular, otolaryngology and neurology societies worldwide have placed a greater focus on the study of BPPV. This article reviews the current diagnosis and treatment status and research progress of benign paroxysmal positional vertigo in China from the aspects of disease etiology, pathology, and pathophysiology. We will also consider potential future research in this field.

Obstructive sleep apnea syndrome (OSAS) is a common and complex disorder that is associated with liver injury. Moreover, previous studies have revealed that chronic intermittent hypoxia (CIH) is associated with the development of non-alcoholic fatty liver disease and hepatic fibrosis. However, the underlying molecular mechanisms remain largely unknown. The present study aimed to investigate whether chronic intermittent hypoxia induced hepatic fibrosis, in addition to determining its underlying mechanisms, in CIH model rats using immunohistochemistry, western blotting and reverse transcription-quantitative PCR. The present results suggested that CIH caused hepatic fibrosis and increased the expression levels of interleukin (IL)-1β, IL-8, monocyte chemotactic-1, tumor necrosis factor-α, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in the liver; these conditions could be reversed by Toll-like receptor 4 (TLR4) short hairpin RNA lentivirus treatment. Moreover, immunohistochemistry and western blotting results indicated that TLR4 and NF-κB expression levels were significantly increased in the CIH and CIH-TLR4 empty vector lentivirus group. However, protein expression levels of TLR4, NF-κB, inhibitor of NF-κB and phosphorylated-mitogen-activated protein kinase (MAPK)-1 in the hypoxia/reoxygenation group were significantly higher compared with the control group (P

Background In clinical practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most common markers measured before and after surgery for gastric cancer (GC). However, which pre- or post-operative combined tumour markers (CEA and CA19-9) have more prognostic value remains unclear. Methods Consecutive patients undergoing a resection for GC at the Fujian Medical University Union Hospital were included as a discovery database between January 2011 and December 2014. The prognostic impact of pre- and post-operative tumour markers was evaluated using Kaplan–Meier log-rank survival analysis and multivariable Cox regression analysis. The results were then externally validated. Results A total of 735 and 400 patients were identified in the discovery cohort and in the validation cohort, respectively. Overall survival rates decreased in a stepwise manner in association with the number of pre- and post-operative positive tumour markers (both P P Conclusion Pre-operative tumour markers have a better discriminatory ability for post-operative survival in GC patients than post-operative tumour markers, and the normalisation of tumour markers after surgery was associated with better survival.

Constructing a computing circuit in three dimensions (3D) is a necessary step to enable the massive connections and efficient communications required in complex neural networks. 3D circuits based on conventional complementary metal–oxide–semiconductor transistors are, however, difficult to build because of challenges involved in growing or stacking multilayer single-crystalline silicon channels. Here we report a 3D circuit composed of eight layers of monolithically integrated memristive devices. The vertically aligned input and output electrodes in our 3D structure make it possible to directly map and implement complex neural networks. As a proof-of-concept demonstration, we programmed parallelly operated kernels into the 3D array, implemented a convolutional neural network and achieved software-comparable accuracy in recognizing handwritten digits from the Modified National Institute of Standard and Technology database. We also demonstrated the edge detection of moving objects in videos by applying groups of Prewitt filters in the 3D array to process pixels in parallel. A three-dimensional circuit composed of eight layers of monolithically integrated memristive devices is built and used to implement complex neural networks, demonstrating accurate MNIST classification and effective edge detection in videos.

PurposeDrawing upon social exchange theory, this study justified the indirect effects of responsible leadership and knowledge sharing on job performance through the mediation of work engagement and helping initiatives. Job tenure was examined as a moderator.Design/methodology/approachThe hypotheses of this study were empirically tested with structural equation modeling (SEM) and moderated regression analyses. This study conducted a field survey on 512 knowledge workers who employed a high portion of or highly specialized tacit knowledge to do their job.FindingsThis research presented that both work engagement and helping initiatives mediated the indirect effects of responsible leadership and knowledge sharing on job performance. The empirical results revealed that job tenure moderated the relationships between responsible leadership and work engagement, and between responsible leadership and helping initiatives. However, job tenure did not moderate the relationships between knowledge sharing and work engagement, and between knowledge sharing and helping initiatives.Originality/valueThis research is one of the few to verify the key role of responsible leadership from the theoretical aspect of social exchange, complementing the leadership literature based on stakeholder theory. This research is a pioneer by taking into account the simultaneous influences of responsible leadership and knowledge sharing on job performance in a single model setting.

Air curtain is an effective means to stop the propagation of smoke in buildings to provide smoke-free area for safe egress of occupants in case of fires. To understand its effectiveness of smoke confinement in tunnel fires, full-scale tests were conducted in a tunnel of 140 m long and with varying heights of 5.0 m to 5.9 m and varying widths of 5.8 m to 10.8 m. A 20 cm-wide air curtain spanning entire lateral section was installed underneath the tunnel ceiling. The experiment showed that air curtain at exit velocities of 12 m/s and 16 m/s can stop the propagation of smoke produced by 1 MW fire and 2 MW fire respectively. Numerical simulation using ANSYS FLUENT was then conducted and the numerical results were basically consistent with those of experiment. To explore how the design parameters of air curtain, i.e., the width, the exit velocity and its angle, affect its effectiveness of smoke confinement at varying heat release rates, a number of numerical simulations were further conducted. The relationship of design parameters of air curtain with heat release rates was proposed and it can be used in the design of air curtain in tunnel fires.

Background: Neoadjuvant chemotherapy is important for advanced laryngeal and hypopharyngeal carcinoma (LHC).Aims/objectives: To determine the efficacy and toxicity of the combination of docetaxel, ...

The 1970s marked the beginning of childhood cancer services in Malaysia and Singapore, two neighbours in South-East Asia. Between 1995 and 2002, Malaysia utilized a treatment regimen based on the Dutch DCOG 7 and German BFM protocols for children with acute lymphoblastic leukaemia (ALL), whilst Singapore in collaboration with Hong Kong employed the HK-ALL 1997 protocol, based on BFM ALL 95. In 2002, the overall 6-year event-free survival (EFS) for childhood ALL in Malaysia stood at 56%, while the 5-year EFS for HK-ALL 1997 was 79%. Formal collaboration between Malaysia and Singapore for the treatment of childhood ALL began in 2003. The first collaborative trial was the seminal MASPORE ALL2003 study which utilized a single PCR-based minimal residual disease marker to risk stratify patients according to disease severity, and used a 3-drug induction regimen for non-high-risk patients. This effort resulted in an improvement in 6-year EFS for both countries, at 80%, with an overall survival of 88%. The study showed that treatment could be appropriately tailored to disease risk, and that an anthracycline-free induction strategy did not compromise outcome for the majority (86%) of patients. The follow-up study, MASPORE ALL2010 focused on delivering therapy that was more intensive for those in high-risk group while reducing intensity for standard and intermediate risk groups. The study also took into consideration patients with IKZF1 gene deletion (IKZF1del) and moved these patients into a higher risk category. Increasing treatment intensity for patients with IKZF1del resulted in a reduction in 5-year cumulative incidence of relapse (CIR) from 30 to 13%, and improved overall 5-year survival from 69 to 91%. The MASPORE ALL2010 trial also studied TPMT and NUDT15 gene variants in its patient population to optimize thiopurine dosing. As the study moves into its next phase (MASPORE ALL2020), precision medicine and risk-adapted therapy remain the cornerstone strategies for childhood ALL, especially in the era of increased recognition of late effects amongst survivors of childhood cancer. Future therapies will likely focus on further targeted treatment for childhood ALL as more molecularly distinct subtypes become known.

Purpose To compare renal sinus fat volume (RSFV) separately within the right and left kidneys between bilateral nephrolithiasis patients and healthy controls. Methods This cross-sectional study analyzed patients who underwent unenhanced abdominal computed tomography (CT) divided into nephrolithiasis (n = 102) and healthy control (n = 130) groups. Age, sex, blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], estimated glomerular filtration rate (eGFR), body weight, and height of each participant were extracted. Volumetric renal sinus adipose tissue was measured separately for both kidneys on CT images. Urea, serum creatinine (Scr), uric acid (UA), total serum cholesterol (TCH), serum triglyceride (TG), and serum high- and low-density lipoprotein (HDL and LDL, respectively) cholesterol levels were obtained. Results Overall, 232 participants (mean age 47 years, 50% women) were enrolled. There were no differences in sex, DBP, urea, and LDL-cholesterol between the two groups (all p > 0.05). However, nephrolithiasis patients had higher age, BMI, SBP, and RSFV; higher Scr, UA, TCH, and TG serum levels; and lower HDL-cholesterol level and eGFR. Average left RSFV was significantly higher than right RSFV in healthy controls (4.56 ± 2.29 versus 3.34 ± 1.90 cm3, p Conclusions Our data showed renal sinus adipose tissue accumulation and the relationship among RSFV, age, BMI, and LDL-cholesterol in bilateral nephrolithiasis patients.

This study explored the classroom luminous environment with prism daylight redirecting fenestrations. The differences between the International Commission on Illumination standard sky and the Perez all-weather sky models were analysed. The study described the method of generating a valid bi-directional scattering distribution functions .xml data for the prism daylight redirecting fenestrations. A new evaluation metric, daylight evenness, was proposed to describe indoor illuminance dispersion. Radiance simulation results indicate that at various solar altitude angles, compared with conventional glazing, the micro-prism film and micro-prism with an added diffuse layer on clerestories can improve the space average illuminance levels 23.2% and 18.7% under the International Commission on Illumination sky, as well as 15.4% and 10.6% under the Perez sky, respectively. The analysis results indicate that prism daylight redirecting fenestrations clerestories can improve indoor illuminance uniformity and daylight evenness when the solar altitudes range from 23.8° to 75°. A method combined field questionnaire and high dynamic range image analysis were conducted for discomfort glare study. Adding a diffused layer to the prism film clerestory is expected to alleviate discomfort glare for east- and west-facing prism daylight redirecting fenestrations clerestory with the daylight glare probability reduction of 3.8% to 21.7% at various solar altitudes. The research results present promising advantages of applying prism daylight redirecting fenestrations at classroom clerestories to improve the daylight luminous environment.

In the power operation scenario, user information, power equipment, environment, tasks, time and other data are collected through sensors, mobile terminals, wearable devices, GPS/Beidou/UWB positioning system, and computer input. The information space model is constructed from five dimensions: people, equipment, environment, task, time, etc., to realize the logical correspondence between physical space and information space. In the power operation scenario, the user wears the wearable device to automatically perceive the power operation scene information, and the information space model provides target positioning, path planning, navigation, electronic fence, audio and video conference, intelligent interaction, etc. as needed to realize the power field operation process precise guidance.