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Inverse design has long been an efficient and powerful design tool in the aircraft industry. In this paper, a novel inverse design method for supercritical airfoils is proposed based on generative models in deep learning. A Conditional Variational AutoEncoder (CVAE) and an integrated generative network CVAE-GAN that combines the CVAE with the Wasserstein Generative Adversarial Networks (WGAN), are conducted as generative models. They are used to generate target wall Mach distributions for the inverse design that matches specified features, such as locations of suction peak, shock and aft loading. Qualitative and quantitative results show that both adopted generative models can generate diverse and realistic wall Mach number distributions satisfying the given features. The CVAE-GAN model outperforms the CVAE model and achieves better reconstruction accuracies for all the samples in the dataset. Furthermore, a deep neural network for nonlinear mapping is adopted to obtain the airfoil shape corresponding to the target wall Mach number distribution. The performances of the designed deep neural network are fully demonstrated and a smoothness measurement is proposed to quantify small oscillations in the airfoil surface, proving the authenticity and accuracy of the generated airfoil shapes.

Background A nomogram is a tool that transforms complex regression equations into simple and visual graphs and enables clinicians and patients to conveniently compute output probabilities without needing medical knowledge and complex formulas. The aim of this study was to develop and validate a predictive nomogram to screen for severe caries among 12-year-old children based on risk factors in Sichuan Province, China. Methods A cross-sectional study of 4573 12-year-olds was conducted up to May 2016 in middle schools from three districts and three counties in Sichuan Province, China. All the children underwent oral examinations and completed questionnaires to assess general information, oral impacts on daily performance, dietary habits, subjective health conditions, history of dental trauma, frequency of toothache, dental visits, and knowledge, attitudes, and behaviours toward oral hygiene. Univariate analysis and multivariate logistic regression analysis were used to determine which variables were significantly associated with severe caries (operationalized as DMFT ≥ 3). A nomogram was developed and validated by using the ‘rms’ package and two cross-validation methods. Results Severe caries was found in 537 of the 4573 children (11.74%). Multivariate logistic regression analysis revealed that the following variables predicted a higher risk of severe caries: ‘female’ [odds ratio (OR) = 1.985, 95% confidence interval (95% CI): 1.63–2.411], ‘urban’ (OR = 2.389, 95% CI: 1.96–2.91), ‘non-only child’ (OR = 1.317, 95% CI: 1.07–1.625), ‘very poor self-assessment of oral health status’ (OR = 2.157, 95% CI: 1.34–3.467) and ‘visited a dentist less than 6 months’ (OR = 1.861, 95% CI: 1.38–2.505). Multivariate logistic regression analysis also indicated that the following variables predicted a lower risk of severe caries: ‘middle level of urbanization’ (OR = 0.395, 95% CI: 0.32–0.495) and ‘high level of urbanization’ (OR = 0.466, 95% CI: 0.37–0.596). Both the fivefold and leave-one-out cross-validation methods indicated that the nomogram model built by these 6 variables displayed good disease recognition ability. Conclusions The nomogram was a simple-to-use model to screen children for severe caries. This model was found to facilitate non-dental professionals in assessing risk values without oral examinations and making referrals to dental professionals.

BACKGROUND Hepatitis B surface antigen (HBsAg) loss, a functional cure in patients with chronic hepatitis B (CHB) undergoing antiviral therapy, might be an ideal endpoint of antiviral treatment in clinical practice. The factors that contribute to the functional cure remain unclear, and the predictors of functional cure are worth exploring. The concentration and kinetics of soluble programmed death-1 (sPD-1) in patients with CHB may play an important role in elucidating the immune response associated with functional cure after nucleos(t)ide analogs therapy. AIM To investigate the factors associated with HBsAg loss and explore the influence of sPD-1 Levels. METHODS This study analyzed the data and samples from patients with CHB who underwent antiviral treatment in a non-interventional observational study conducted at Peking University First Hospital in Beijing (between 2007 and 2019). All patients were followed up: Serum samples were collected every 3 mo during the first year of antiviral treatment and every 6 mo thereafter. Patients with positive hepatitis B e antigen levels at baseline and with available sequential samples who achieved HBsAg loss during antiviral treatment served as the case group. This case group (n = 11) was further matched to 44 positive hepatitis B e anti patients without HBsAg loss as controls. The Spearman’s rank correlation test and receiver operating characteristic curves analysis were performed. RESULTS The sPD-1 Levels were higher in patients with HBsAg loss than in those without HBsAg loss from baseline to month 96, and the differences were significant between the groups at baseline (P = 0.0136), months 6 (P = 0.0003), 12 (P < 0.0001), 24 (P = 0.0007), 48 (P < 0.0001), and 96 (P = 0.0142). After 6 mo of antiviral treatment, the sPD-1 levels were positively correlated with alanine transaminase (ALT) levels (r = 0.5103, P = 0.0017), and the sPD-1 levels showed apparent correlation with ALT (r = 0.6883, P = 0.0192) and HBV DNA (r = 0.5601, P = 0.0703) levels in patients with HBsAg loss. After 12 mo of antiviral treatment, the sPD-1 levels also showed apparent correlation with ALT (r = 0.8134, P = 0.0042) and HBV DNA (r = 0.6832, P = 0.0205) levels in patients with HBsAg loss. The sPD-1 levels were negatively correlated with HBsAg levels in all patients after 12 mo of antiviral treatment, especially at 24 (r = -0.356, P = 0.0497) and 48 (r = -0.4783, P = 0.0037) mo. After 6 mo of antiviral treatment, the AUC of sPD-1 for HBsAg loss was 0.898 (P = 0.000), whereas that of HBsAg was 0.617 (P = 0.419). The cut-off value of sPD-1 was set at 2.34 log pg/mL; the sensitivity and specificity were 100% and 66.7%, respectively. CONCLUSION The sPD-1 levels at 6 mo can predict HBsAg loss after 144 mo of antiviral treatment.

Ran Cheng,&ast; Jinghang Xu,&ast; Ning Tan, Hao Luo, Jiali Pan, Xiaoyuan Xu Department of Infectious Diseases, Peking University First Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this work.Correspondence: Xiaoyuan XuDepartment of Infectious Diseases, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034, People’s Republic of ChinaTel/Fax +86-10-83575787Email xiaoyuanxu6@163.comObjective: Many scores have been constructed to predict liver-related events in chronic hepatitis B, while most of them are based on baseline clinical parameters. The objective of this study was to develop nomograms based on on-treatment improvement in established scores to predict clinical outcomes in patients with hepatitis B virus (HBV)-related cirrhosis who are receiving antiviral therapy.Methods: The Cox proportional hazards regression model was used. Nomograms were constructed for the prediction of liver-related events, hepatocellular carcinoma (HCC), and liver-related mortality risk during long-term antiviral therapy.Results: A total of 277 treatment-naive patients with HBV-associated cirrhosis were enrolled from January 2010 to December 2013. After a median follow-up of 63.3 months, 95 patients developed liver-related events, including 59 patients with liver-related death. Multivariate Cox analysis showed that the albumin-bilirubin score at year 1 was an independent predictor of liver-related events, liver-related mortality, and HCC. Age, decompensation, and delayed virological remission were independent factors for liver-related mortality. Age was also a risk factor for liver-related events. The concordance index values of event-nomogram, mortality-nomogram, and HCC-nomogram were 0.742 (95% confidence interval [CI], 0.691∼ 0.793), 0.799 (95% CI, 0.748∼ 0.850), and 0.613 (95% CI, 0.540∼ 0.686), respectively. The calibration plots showed an agreement between the predicted and observed incidences, which indicates good calibration of the model of event-nomogram and mortality-nomogram.Conclusion: The nomograms achieved an optimal preoperative prediction of liver-related events, mortality, and HCC development in patients with HBV-related cirrhosis receiving antiviral therapy. These findings may help to identify high-risk patients for further optimal surveillance and intervention strategies.Keywords: antiviral therapy, liver-related events, hepatocellular carcinoma, liver-related mortality, albumin-bilirubin

Limited data are currently available regarding fibrosis progression after hepatitis C virus (HCV) eradication. The goal of the present study was to evaluate the effects of HCV eradication on liver stiffness measurements (LSMs), aspartate aminotransferase/platelet ratio index (APRI) scores, fibrosis-4(FIB-4) scores, chitinase-3-like protein 1 (CHI3L1) levels and Golgi protein 73 (GP73) levels in patients with chronic hepatitis C (CHC). One hundred and two patients who received direct antiviral agents (DAAs) therapy at Peking University First Hospital participated in the present study. Clinical information and serum samples were collected at baseline, at the end of treatment (EOT), and at the weeks 12, 24 and 48 after treatment (W12, W24 and W48, respectively). Of the 102 patients, 51 had mild-to-moderate fibrosis (F1/F2), and 51 had advanced fibrosis (F3/F4). The LSMs improved for all patients at the EOT, with observed changes of 2.85 kPa, and the decrease continued to W12. However, a more pronounced improvement was noted for the advanced fibrosis (F3/F4) patients, with a change of 3.6 kPa from baseline to the EOT. Significant decreases between the baseline and EOT measurements were observed in the APRI and FIB-4 scores [0.64 (0.39-1.21) vs. 0.35 (0.26-0.52), p

Juan Chen,1,* Yong-Ran Cheng,2,* Wen Wen,1,* Chunyi Wang,1,* Jie Ni,1 Jingjie Jiang,1 Xinyan Fu,1 Mengyun Zhou,3 Lan Ye,4 Zhong-Jun Ge,5 Han-Xia Tan,6 Mingwei Wang,1 Zhan-Hui Feng,7 Xingwei Zhang1 1Department of Cardiology, Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, People’s Republic of China; 2School of Public Health, Hangzhou Medical College, Hangzhou, People’s Republic of China; 3Department of Molecular and Cellular Physiology, Shinshu University School of Medicine, Nagano, Japan; 4Basic Medical College, Guizhou Medical University, Guizhou, People’s Republic of China; 5Department of Cardiology, The Fourth People’s Hospital of Lin’an, Hangzhou, People’s Republic of China; 6Department of Oncology, The Third People’s Hospital of Hangzhou, Hangzhou, People’s Republic of China; 7Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhan-Hui FengAffiliated Hospital of Guizhou Medical University, No. 28, Guiyi Street, Guiyang, People’s Republic of ChinaEmail h9450203@126.comXingwei ZhangHangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Gongshu District, Hangzhou, People’s Republic of ChinaEmail hsdzxw@126.comBackground: Many people have experienced novel coronavirus pneumonia since the beginning of the COVID-19 pandemic in Wuhan, China. The Chinese government has encouraged people to wear face masks in public places; however, due to the large population, there may be a series of problems related to this recommendation, including shortages of masks and lack of an optimal disposal method for used masks.Objective: The purpose of this study is to understand the current status of mask shortages and used masks in China.Methods: A questionnaire survey was designed to assess the current status of mask shortages and used masks. The differences among groups were analyzed with chi-square tests.Results: The constituent ratio of those who reuse masks was 61%. Obtaining masks from the drugstore was reported to be very difficult due to high demand and short supply, and approximately 1/3 of the respondents purchased expensive masks. Most people know how to properly handle used masks, and only 7% of them casually discard masks. However, 50% of respondents have seen others throw away used masks at will. A further subgroup analysis showed that respondents in Central China tended to use masks repeatedly, as did medical personnel. Females, people living in the central region, and medical personnel may find it more difficult to purchase masks in drugstores. Non-medical personnel may be more likely to buy expensive masks. Females, people living in the western region, and medical personnel may be more likely to know how to properly handle used masks and not to discard used masks at will. Medical personnel may be more likely to observe others discarding used masks at will.Conclusion: In response to COVID-19, the public should be encouraged to use face masks and are advised not to reuse or throw away masks at will due to safety concerns.Keywords: COVID-19, mask, epidemic outbreak

Aims We aimed to evaluate the impact of the COVID-19 epidemic on emergency and cardiovascular disease–related calls in Hangzhou, China. Methods We conducted a single-center retrospective study, collecting data on emergency calls to the Hangzhou Emergency Center (HEC) during the COVID-19 epidemic (January 20, 2020, to March 15, 2020). Data were compared with the same period in 2019. Results Compared to 2019, the number of emergency calls has dropped by 21.63%, ambulance calls by 29.02%, rescue calls by 22.57%, and cardiovascular disease-related emergency calls by 32.86%. The numbers of emergency, ambulance, and rescue calls in 2020 were significantly lower than in 2019. Conclusions During the COVID-19 epidemic in Hangzhou, the numbers of emergency and cardiovascular disease–related calls have decreased significantly. These results point to a severe social problem that requires the attention of the medical community and the government.

The performance of deep neural networks is heavily dependent on its architecture and various neural architecture search strategies have been developed for automated network architecture design. Recently, evolutionary neural architecture search (EvoNAS) has received increasing attention due to the attractive global optimization capability of evolutionary algorithms. However, EvoNAS suffers from extremely high computational costs because a large number of performance evaluations are usually required in evolutionary optimization, and training deep neural networks is itself computationally very expensive. To address this issue, this article proposes a computationally efficient framework for the evolutionary search of convolutional networks based on a directed acyclic graph, in which parents are randomly sampled and trained on each mini-batch of training data. In addition, a node inheritance strategy is adopted so that the fitness of all offspring individuals can be evaluated without training them. Finally, we encode a channel attention mechanism in the search space to enhance the feature processing capability of the evolved neural networks. We evaluate the proposed algorithm on the widely used datasets, in comparison with 30 state-of-the-art peer algorithms. Our experimental results show that the proposed algorithm is not only computationally much more efficient but also highly competitive in learning performance.

Chemotherapy for patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer, and with midrange Oncotype DX breast recurrence scores (RS) still needs to be further individualized. To improve the treatment decision making, we aimed to develop a method that provides a single score based on multiple factors associated with chemotherapy benefit. We analyzed Surveillance, Epidemiology, and End Results registry data from 31,731 patients with hormone receptor-positive, HER2-negative, node-negative breast cancer and midrange RS characterized by sociodemographic (age and marital status) and clinicopathologic (tumor size, histologic grade, progesterone receptor status, broad histological classification, lesion laterality, and lesion overlap) features and stratified by RS ranges. For the entire sample and for each characteristic, overall survival was compared between patients who underwent chemotherapy and those who did not (or status unknown) within each RS stratum. There was no any association between chemotherapy and survival for patients with RS = 11–15. However, for patients with RS = 16–25, a chemotherapy benefit was associated with tumor size, histologic grade, progesterone receptor status, histological type, and lesion laterality. In addition, overlapping lesion of breast and married at diagnosis might provide additional predictive information of chemotherapy benefit when RS = 21–25. A simple and effective algorithm was designed by combining these factors to output a novel and personalized chemotherapy benefit score to effectively identify patients with RS = 16–25 who would most likely benefit from chemotherapy, which might facilitate improved treatment by providing individualized recommendations.

Objectives To investigate the factors and virological significance of serum hepatitis B virus (HBV) pregenomic RNA (pgRNA) status after long-term antiviral therapy with nucleos(t)ide analogues (NAs) in patients with chronic hepatitis B (CHB). Methods In total, 51 treatment-naive patients with CHB were included in the study. Clinical data were collected at baseline, during 5 years and at year 10 of NA treatment. Serum HBV pgRNA status of 51 patients was determined at year 5. Results At year 5, 45% of the patients remained positive for HBV pgRNA. There were significant differences in baseline hepatitis B e antigen (HBeAg) status, HBV DNA load and hepatitis B surface antigen (HBsAg) levels between patients testing positive and negative for HBV pgRNA at year 5. Serum HBV pgRNA status and serum HBV DNA load were correlated after 5 years of NA treatment (r = 0.347, P = 0.013). Being HBV pgRNA positive at year 5 was an independent risk factor for sustainedly undetectable HBV DNA after 10 years of NA treatment (odds ratio 13.638, 95% confidence interval 1.32–140.81; P = 0.028). Furthermore, HBV pgRNA status at year 5 was associated with HBV DNA re-appearance at year 10 (P = 0.009). Conclusions HBV pgRNA status at year 5 can reveal HBV covalently closed circular DNA (cccDNA) activity, and HBV pgRNA positivity after long-term antiviral therapy may indicate higher transcriptional activity of HBV cccDNA. Long-term dynamic monitoring of HBV pgRNA should be considered.

Background:. Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH. Methods:. Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0–3 months) and a follow-up phase (3–12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance). Results:. Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P 0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference. Conclusions:. The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research. Trial Registration:. ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.

Acute high‐altitude (HA) exposure induces physiological responses of the heart and blood pressure (BP). However, few studies have investigated the responses associated with dipper and non‐dipper BP patterns. In this prospective study, 72 patients underwent echocardiography and 24‐h ambulatory BP testing at sea level and HA. Patients were divided into dipper and non‐dipper groups according to BP at sea level. Acute HA exposure elevated 24‐h systolic and diastolic BP and increased BP variability, particularly in the morning. Moreover, acute exposure increased left ventricular torsion, end‐systolic elastance, effective arterial elastance, and untwisting rate, but reduced peak early diastolic velocity/late diastolic velocity and peak early diastolic velocity/early diastolic velocity, implying enhanced left ventricular systolic function but impaired filling. Dippers showed pronounced increases in night‐time BP, while non‐dippers showed significant elevation in day‐time BP, which blunted differences in nocturnal BP fall, and lowest night‐time and evening BP. Dippers had higher global longitudinal strain, torsion, and untwisting rates after acute HA exposure. Variations in night‐time systolic BP correlated with variations in torsion and global longitudinal strain. Our study firstly demonstrates BP and cardiac function variations during acute HA exposure in different BP patterns and BP increases in dippers at night, while non‐dippers showed day‐time increases. Furthermore, enhanced left ventricular torsion and global longitudinal strain are associated with BP changes. Non‐dippers showed poor cardiac compensatory and maladaptive to acute HA exposure. However, the exact mechanisms involved need further illumination.

Chengxiang Yuan,1,* Siyan Chen,1,* Yiting Ruan,1 Yuntao Liu,1 Haoran Cheng,1 Yaying Zeng,1 Yunbin Chen,1 Qianqian Cheng,2 Guiqian Huang,1 Weilei He,1 Jincai He1 1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of China; 2School of Mental Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jincai HeDepartment of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of ChinaTel/Fax +86 0577 55579363Email hjc@wmu.edu.cnBackground: Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. Stress hyperglycemia is frequent in patients with acute illness such as stroke. We aimed to explore the association between stress hyperglycemia and HT in AIS patients.Methods: A total of 287 consecutive participants with HT and 285 age- and sex-matched stroke patients without HT were enrolled in this study. Baseline glucose and glycated hemoglobin (HbA1c) levels were collected to measure stress hyperglycemia. The stress hyperglycemia ratio (SHR) was calculated by dividing the fasting plasma glucose at admission with HbA1c. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction type (HI) 1 or 2 or parenchymal hematoma type (PH) 1 or 2.Results: Univariate analysis showed that SHR is significantly higher among patients with HT than those without HT. Compared to the patients in the lower three quartiles of SHR, the incidence of HT was significantly higher among patients with the highest quartile of SHR in total population, diabetic and non-diabetic population. We also observed that patients with the highest SHR quartile were associated with an increased risk of hemorrhagic transformation after adjusted for potential covariates (68.4% versus 39.1%; adjusted odds ratio, 2.320; 95% confidence interval, 1.207– 4.459; P=0.012).Conclusion: The stress hyperglycemia ratio, representing the state of stress hyperglycemia, was significantly associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.Keywords: hyperglycemia, hemorrhagic transformation, acute ischemic stroke, stress hyperglycemia

Periodontal disease is common in Chinese adolescents. There is little information about the effect of different altitudes on gingival health. This study aimed to investigate the gingival status at different altitudes and to identify relative factors that affect adolescents' gingival status. A total of 1033 adolescents aged 12–14 years were included in this cross-sectional study in Ganzi (plateau, 1400 m, 2560 m, 3300 m) and Suining (plain, 300 m). Gingival status was assessed by the presence of gingival bleeding on probing (BOP) and dental calculus (DC). Demographic variables, socioeconomic status, dairy habits and oral health-related knowledge, attitudes and behaviors were obtained via questionnaire. Univariate and multivariate binary logistic regression analyses were performed to identify potential relative factors. A total of 64.09% and 77.15% of adolescents had BOP and DC, respectively. The prevalence rates of BOP and DC were higher in the plateau than the plain (P

OBJECTIVES Depression is the most common mental complication in stroke survivors with about one-third of patients suffering from poststroke depression (PSD). This was the first prospective study aimed to compare the prevalence of PSD and its symptoms between two cohorts of patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). METHODS Both AIS and ICH patients were simultaneously enrolled in the study. Depression symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17) after a 1-month follow-up. Patients were diagnosed with PSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition and the HAMD-17 (HAMD scores >7). RESULTS The prevalence of PSD (42.3%) in the ICH group was significantly higher than that (22.9%) in the AIS group (p < 0.001). After adjustment for conventional confounding factors, the odds ratio of PSD was 2.65 (95% CI, 1.34-5.24, p = 0.005) for ICH compared to AIS. Depressive symptoms consisting of anxiety, loss of interest, insomnia, and fatigue were more frequent in patients with ICH than in AIS patients. CONCLUSIONS PSD was more prevalent, and the risk was over twofold higher in patients with ICH than AIS.

With an exponential explosive growth of various digital text information, it is challenging to efficiently obtain specific knowledge from massive unstructured text information. As one basic task for natural language processing (NLP), relation extraction aims to extract the semantic relation between entity pairs based on the given text. To avoid manual labeling of datasets, distant supervision relation extraction (DSRE) has been widely used, aiming to utilize knowledge base to automatically annotate datasets. Unfortunately, this method heavily suffers from wrong labelling due to the underlying strong assumptions. To address this issue, we propose a new framework using hybrid attention-based Transformer block with multi-instance learning to perform the DSRE task. More specifically, the Transformer block is firstly used as the sentence encoder to capture syntactic information of sentences, which mainly utilizes multi-head self-attention to extract features from word level. Then, a more concise sentence-level attention mechanism is adopted to constitute the bag representation, aiming to incorporate valid information of each sentence to effectively represent the bag. Experimental results on the public dataset New York Times (NYT) demonstrate that the proposed approach can outperform the state-of-the-art algorithms on the evaluation dataset, which verifies the effectiveness of our model for the DSRE task.

Background Based on a national survey in 2015, people’s oral health behaviour (OHB) has not kept up with the pace of knowledge and attitudes in China after decades of oral health education (OHE). Thus, we need to improve OHE to strengthen people’s OHB. Undergraduates are regarded as the best candidates for the improvement of OHE. The objective of this study is to determine undergraduates’ oral health status and existing problems in OHB by comparing dental and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE to improve people’s OHB. Methods A quasi-experimental study designed with a pre-test and post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were administered an OHE course focused on OHB. A survey about oral health behaviour and knowledge was conducted before and after the course. Results According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, and time, but unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their OHB. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course. Conclusions OHE focused on behaviour has a positive effect on university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.

Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological data were collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The “resect and discard” scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline. Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80–87) for adenomatous histology in the rectosigmoid. Applying the ‘resect and discard’ strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively. Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

In many areas affected by climate change, agriculture is an industry sensitive to climate change. Many scholars have studied the relationship between climate factors and rice, but these studies did not quantitatively construct high temperature indicator and determine the threshold for high temperature hazard. In this paper, we constructed the index of high temperature intensity (HTI) based on the daily maximum temperature and high temperature days, and then used multiple regression analysis method to determine the hazard factor. Based on this, we can analyze the risk distribution of hazard factor for late rice in Zhejiang. The results showed that: (i) high temperature values and high temperature days above 35 °C during the growth period of late rice are the main meteorological factors for the decrease of late rice yield in Zhejiang Province. The high temperature intensity comprehensive index constructed in this paper can quantitatively evaluate the effect of high temperature on late rice yield; (ii) With the increase of the level of recurrence, the high temperature intensity spreads around Lishui City and Yunhe County, and the intensity of the hazard factor in central Zhejiang is higher than that in the surrounding area.

Background and aim Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS). This study explored the potential relationship between serum vitamin D levels and SAP. Methods This study recruited 863 consecutive AIS patients. In-hospital SAP was defined as a complication that occurred after stroke, during hospitalization, that was confirmed radiographically. Serum vitamin D levels were measured within 24 hrs of admission and the patients were divided into vitamin D sufficient (>50 nmol/L), insufficient (25-50 nmol/L), and deficient (

Background Stroke-associated pneumonia (SAP) is a serious and common complication in stroke patients. Purpose We aimed to develop and validate an easy-to-use model for predicting the risk of SAP in acute ischemic stroke (AIS) patients. Patients and methods The nomogram was established by univariate and multivariate binary logistic analyses in a training cohort of 643 AIS patients. The prediction performance was determined based on the receiver operating characteristic curve (ROC) and calibration plots in a validation cohort (N=340). Individualized clinical decision-making was conducted by weighing the net benefit in each AIS patient by decision curve analysis (DCA). Results Seven predictors, including age, NIHSS score on admission, atrial fibrillation, nasogastric tube intervention, mechanical ventilation, fibrinogen, and leukocyte count were incorporated to construct the nomogram model. The nomogram showed good predictive performance in ROC analysis [AUROC of 0.845 (95% CI: 0.814-0.872) in training cohort, and 0.897 (95% CI: 0.860-0.927) in validation cohort], and was superior to the A2DS2, ISAN, and PANTHERIS scores. Furthermore, the calibration plots showed good agreement between actual and nomogram-predicted SAP probabilities, in both training and validation cohorts. The DCA confirmed that the SAP nomogram was clinically useful. Conclusion Our nomogram may provide clinicians with a simple and reliable tool for predicting SAP based on routinely available data. It may also assist clinicians with respect to individualized treatment decision-making for patients differing in risk level.

Gait phase classification is important for rehabilitation training in patients with lower extremity motor dysfunction. Classification accuracy of the gait phase also directly affects the effect and rehabilitation training cycle. In this article, a multiple information (multi-information) fusion method for gait phase classification in lower limb rehabilitation exoskeleton is proposed to improve the classification accuracy. The advantage of this method is that a multi-information acquisition system is constructed, and a variety of information directly related to gait movement is synchronously collected. Multi-information includes the surface electromyography (sEMG) signals of the human lower limb during the gait movement, the angle information of the knee joints, and the plantar pressure information. The acquired multi-information is processed and input into a modified convolutional neural network (CNN) model to classify the gait phase. The experiment of gait phase classification with multi-information is carried out under different speed conditions, and the experiment is analyzed to obtain higher accuracy. At the same time, the gait phase classification results of multi-information and single information are compared. The experimental results verify the effectiveness of the multi-information fusion method. In addition, the delay time of each sensor and model classification time is measured, which shows that the system has tremendous real-time performance.

Surface-enhanced Raman scattering (SERS) spectroscopy has been used extensively to study biology, chemistry, and materials. However, a point-by-point SERS mapping is time-consuming, taking minutes to hours for large-scale imaging. Here, we report a wide-field surface-enhanced coherent anti-Stokes Raman scattering (WISE-CARS) microscopy for monitoring nanotags in live cells and label-free detection of metabolic molecules. The WISE-CARS microscope achieves an imaging speed as fast as 120 frames per second for a large field of view of 130 microns X 130 microns. By spectral focusing of femtosecond lasers, a hyperspectral WISE-CARS stack of 120 frames can be acquired with a spectral resolution of 10 cm-1, where over 1 million Raman spectra are parallelly recorded within 0.5 seconds. As applications, we demonstrate time-lapse, 3D WISE-CARS imaging of nanotags in live cells as well as label-free detection of adenine released from S. aureus.

Aim: Metabolic syndrome (MS) screening is essential for the early detection of the occupational population. This study aimed to screen out biomarkers related to MS and establish a risk assessment and prediction model for the routine physical examination of an occupational population.Methods: The least absolute shrinkage and selection operator (Lasso) regression algorithm of machine learning was used to screen biomarkers related to MS. Then, the accuracy of the logistic regression model was further verified based on the Lasso regression algorithm. The areas under the receiving operating characteristic curves were used to evaluate the selection accuracy of biomarkers in identifying MS subjects with risk. The screened biomarkers were used to establish a logistic regression model and calculate the odds ratio (OR) of the corresponding biomarkers. A nomogram risk prediction model was established based on the selected biomarkers, and the consistency index (C-index) and calibration curve were derived.Results: A total of 2,844 occupational workers were included, and 10 biomarkers related to MS were screened. The number of non-MS cases was 2,189 and that of MS was 655. The area under the curve (AUC) value for non-Lasso and Lasso logistic regression was 0.652 and 0.907, respectively. The established risk assessment model revealed that the main risk biomarkers were absolute basophil count (OR: 3.38, CI:1.05–6.85), platelet packed volume (OR: 2.63, CI:2.31–3.79), leukocyte count (OR: 2.01, CI:1.79–2.19), red blood cell count (OR: 1.99, CI:1.80–2.71), and alanine aminotransferase level (OR: 1.53, CI:1.12–1.98). Furthermore, favorable results with C-indexes (0.840) and calibration curves closer to ideal curves indicated the accurate predictive ability of this nomogram.Conclusions: The risk assessment model based on the Lasso logistic regression algorithm helped identify MS with high accuracy in physically examining an occupational population.

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BACKGROUND: Since the end of 2019, the coronavirus disease (COVID-19) outbreak rapidly became a pandemic. The psychological state of people during the COVID-19 pandemic has gained interest. Our aim was to study the prevalence of anxiety, depression, and stress in college students during the COVID-19 pandemic. Methods: A systematic search of Medline, Embase, Web of Science, and the Cochrane Library was conducted up to September 20, 2020. Reviewers independently assessed full-text articles according to predefined criteria. Stata14/SE was used to calculate the prevalence and 95% confidence intervals (CIs) of anxiety, depression, and stress among college students from different countries. A random effects model was adopted. The Egger test was used to determine publication bias. Results: A total of 280 references were retrieved, and 28 papers met our inclusion criteria, for a total of 436,799 college students. Thirteen studies involved non-Chinese college students, and 15 studies involved Chinese college students. The prevalence of anxiety, depression, and stress was 29% (95% CI, 19-25%), 37% (95% CI, 32-42%), and 23% (95% CI, 8-39%), respectively. Conclusion: The COVID-19 pandemic has had a negative psychological effect on college students, and the prevalence of anxiety, depression, and stress among Chinese college students is lower than among non-Chinese college students.

Background: The coronavirus pneumonia is still spreading around the world. Much progress has been made in vaccine development, and vaccination will become an inevitable trend in the fight against this pandemic. However, the public acceptance of COVID-19 vaccination still remains uncertain. Methods: By calculating the sample size of random sampling, anonymous questionnaire was used in Wen Juan Xing survey platform. Multinomial logistic regression analyses were performed to identify the key sociodemographic, cognitive, and attitude associations with samples of healthcare workers and nonhealth care workers. Findings: A total of 2580 respondents have completed the questionnaire, including 1,329 healthcare workers and 1,251 nonhealthcare workers. This study showed that 76.98% of healthcare workers accepted the COVID-19 vaccine, 18.28% workers were hesitant, and 4.74% workers were resistant. Among the nonhealthcare workers, 56.19% workers received the COVID-19 vaccine, 37.57% workers were hesitant, and 6.24% workers were resistant. Among the healthcare workers, compared with vaccine recipients, vaccine-hesitant individuals were more likely to be female (AOR = 1.52, 95% CI: 1.12–2.07); vaccine-resistant individuals were more likely to live in the suburbs (AOR = 2.81, 95% CI: 1.44–3.99) with an income of 10,000 RMB or greater (AOR = 2.00, 95% CI: 1.03–3.90). Among the nonhealthcare workers, vaccine-hesitant individuals were more likely to be female (AOR = 1.66, 95% CI: 1.31–2.11); vaccine-resistant individuals were also more likely to be female (AOR =1.87, 95% CI: 1.16–3.02) and older than 65 years (AOR = 4.96, 95% CI: 1.40–7.62). There are great differences between healthcare workers and nonhealthcare workers in their cognition and attitude towards vaccines. Interpretation: Our study shows that healthcare workers are more willing to be vaccinated than nonhealthcare workers. Current vaccine safety issues continue to be a major factor affecting public acceptance, and to expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for nonhealthcare workers. Funding: Medical and Technology Project of Zhejiang Province Declaration of Interest: None to declare. Ethical Approval: This study is a nation-wide cross-sectional study in China; the ethics committee of Affiliated Hospital of Hangzhou Normal University approved all the procedures performed.

Background: Acute high-altitude (HA) exposure results in blood pressure (BP) and cardiac function variations in most subjects, some of whom suffer from acute mountain sickness (AMS). Several previous studies have found that cardiovascular function indicators are potentially correlated with AMS.Objectives: This study aims to examine HA-induced cardiovascular adaptations in AMS patients and compare them with healthy subjects. It also aims to investigate the relationship between cardiovascular function indicators and AMS, as well as to provide some insightful information about the prevention and treatment of AMS.Methods: Seventy-two subjects were enrolled in this cohort study. All the subjects ascended Litang (4,100 m above sea level). They were monitored by a 24-h ambulatory blood pressure (ABP) device and underwent echocardiography examination within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: Acute mountain sickness group consisted of more women (17 [60.7%] vs. 10 [22.7%], p = 0.001) and fewer smokers (5 [17.9%] vs. 23 [52.3%], p = 0.003). Compared with subjects without AMS, subjects with AMS had lower pulse pressure (PP) (daytime PP, 45.23 ± 7.88 vs. 52.14 ± 4.75, p < 0.001; nighttime PP, 42.81 ± 5.92 vs. 49.39 ± 7.67, p < 0.001) and lower effective arterial elastance (Ea) (1.53 ± 0.24 vs. 1.73 ± 0.39, p = 0.023). Multivariate regression indicated that female sex (OR = 0.23, p = 0.024), lower daytime PP (OR = 0.86, p = 0.004), and lower Ea (OR = 0.03, p = 0.015) at low altitude (LA) were independent risk factors for AMS. Combined daytime PP and Ea at LA had a high predictive value for AMS (AUC = 0.873; 95% CI: 0.789–0.956). Correlation analysis showed that AMS-induced headache correlated with daytime PP (R = −0.401, p < 0.001) and nighttime PP at LA (R = −0.401, p < 0.001).Conclusion: Our study demonstrated that AMS patients had a lower PP and Ea at LA. These baseline indicators of vasodilation at LA were closely associated with AMS, which may explain the higher headache severity in subjects with higher PP at LA.

IntroductionMaternal exposure to dibutyl phthalate (DBP) may result in glucolipid dysfunction in female offspring. However, the underlying mechanisms remain elusive. We hypothesized that chronic maternal DBP exposure could induce abnormal metabolism of glucolipid.Materials and methodsSprague-Dawley rats were intraperitoneally injected with different doses of DBP, estradiol, and corn oil from gestational day 7 until the end of lactation. The weights, visceral fat percentage, serum lipid, insulin and glucose, protein levels of PI3K signal pathway in muscle were detected in F1 female offspring.ResultsAlthough the birth weight of F1 female offspring was not different among groups, the weights were heavier in DBP groups from postnatal day 7 to adult (PConclusionMaternal perinatal exposure to DBP induced obesity and accumulation of visceral adipose tissue for the adult female offspring. Serum glucolipid and local signal transduction of PTEN/PI3K/AKT pathway in muscle were not adversely affected by perinatal exposure to DBP for adult female offspring.

In this paper, a novel recognition method of multi-information fusion is proposed to improve the recognition accuracy of the gait phase. Firstly, a multi-information wireless multi-channel gait information acquisition system is built. Then, the system collects multiple gait information including plantar pressure information, joint angle information, and sEMG information, and uses a deep learning convolution neural network (CNN) for fusion to quickly and accurately identify the gait phase. Finally, three kinds of speed task experiments were carried out on three healthy subjects, and different models were compared to study the ability of multi-information used in gait phase recognition at different speeds. The experimental results verify the feasibility and superiority of the method.

Background: Diffuse midline glioma (DMG) with histone H3 K27M mutation is a recently identified entity documented in the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System. Spinal cord DMGs with H3 K27M-mutant are commonly reported in adults. Herein, we reported a pediatric patient with spinal cord H3 K27M-mutant DMG.Case Report: A 7-year-old girl with 1-month history of neck pain and 3-week history of progressive weakness in the right hand was presented. Spinal magnetic resonance imaging showed an intramedullary lesion with slight enhancement at the C2-7 levels. With intraoperative neuroelectrophysiological monitoring, the lesion was subtotally resected. Histopathological examination revealed a DMG with histone H3 K27M mutation corresponding to WHO grade IV. Postoperatively, the neck pain was relieved, and the upper-extremity weakness remained unchanged. Oral temozolomide was administrated for 7 months, and radiotherapy was performed for 22 courses. After an 18-month follow-up, no tumor recurrence was noted.Conclusion: Spinal cord H3 K27M-mutant DMGs are extremely rare in pediatric patients. Preoperative differential diagnosis is challenging, and surgical resection with postoperative chemoradiotherapy may be an effective treatment.

Autonomous robotic systems and self driving cars rely on accurate perception of their surroundings as the safety of the passengers and pedestrians is the top priority. Semantic segmentation is one of the essential components of road scene perception that provides semantic information of the surrounding environment. Recently, several methods have been introduced for 3D LiDAR semantic segmentation. While they can lead to improved performance, they are either afflicted by high computational complexity, therefore are inefficient, or they lack fine details of smaller object instances. To alleviate these problems, we propose (AF)2-S3Net, an end-to-end encoder-decoder CNN network for 3D LiDAR semantic segmentation. We present a novel multibranch attentive feature fusion module in the encoder and a unique adaptive feature selection module with feature map re-weighting in the decoder. Our (AF)2-S3Net fuses the voxel-based learning and point-based learning methods into a unified framework to effectively process the potentially large 3D scene. Our experimental results show that the proposed method outperforms the state-of-the-art approaches on the large-scale nuScenes-lidarseg and SemanticKITTI benchmark, ranking 1st on both competitive public leaderboard competitions upon publication.

The autonomous positioning of tunneling equipment is the key to intellectualization and robotization of a tunneling face. In this paper, a method based on simultaneous localization and mapping (SLAM) to estimate the body pose of a roadheader and build a navigation map of a roadway is presented. In terms of pose estimation, an RGB-D camera is used to collect images, and a pose calculation model of a roadheader is established based on random sample consensus (RANSAC) and iterative closest point (ICP), constructing a pose graph optimization model with closed-loop constraints. An iterative equation based on Levenberg–Marquadt is derived-, which can achieve the optimal estimation of the body pose. In terms of mapping, LiDAR is used to experimentally construct the grid map based on open-source algorithms, such as Gmapping, Cartographer, Karto, and Hector. A point cloud map, octree map, and compound map are experimentally constructed based on the open-source library RTAB-MAP. By setting parameters, such as the expansion radius of an obstacle and the updating frequency of the map, a cost map for the navigation of a roadheader is established. Combined with algorithms, such as Dijskra and timed-elastic-band, simulation experiments show that the combination of octree map and cost map can support global path planning and local obstacle avoidance.

Finite element analysis (FEA) is an engineering method for the numerical analysis of complex structures based on their material properties. It is used to determine the distribution of stress when a structure is subjected to force. Recently, FEA has been employed in endodontic. Endodontic diseases, such as pulpits or periradicular periodontitis, often require root canal therapy. During or after treatment, the pulpless teeth are more prone to fracture as an increasing amount of tooth structure is lost from disease or operative procedures. An important cause of endodontic failure is vertical root fracture (VRF), defined as a longitudinal fracture confined to the root that usually begins on the internal wall and extends outward to the root surface (Walton 2002). VRF is an increasingly common cause of failure of tooth restoration. Beside the difficult diagnosis, the management often requires rather aggressive approaches, i.e., extraction or root amputation. Although a conservative approach has been suggested, the long-term outcomes are still questionable (Kawai & Masaka 2002, Trope & Rosenberg 1992). It has been reported that approximately 0.2% of root filled teeth each year are lost directly because of VRF (Dammaschke et al. 2003, Fuss et al. 1999). Due to the high prevalence, poor diagnosis and prognosis of VRF, prevention is therefore of great importance. To avoid the problems caused by VRF, a full understanding of the etiological factors of root fractures is pivotal before preventive measures can be developed. Finite element analysis was first used more than 10 years ago to determine the factors that influencing fracture susceptibility. This chapter will focus on the contribution of finite element analysis to root canal therapy. Root canal therapy and the use of intraradicular dowels are the two main iatrogenic factors associated with VRF. In root canal instrumentation, enlargement of the coronal third of the root canal space is considered important to support root canal length measurement, debris removal, and canal obturation. However, extensive use of rotary instruments, to be cut dentin to straight lines at curvatures during preparation of the canal space, weakens the root structure. With infected root canals especially, a balance should therefore be sought between the need to remove infected dentin and to maintain sufficient root thickness to withstand the forces of mastication. Special attention to securing sufficient remaining dentin should be given to the teeth and roots most susceptible to fracture, i.e., the maxillary and mandibular premolars and the mesial roots of the mandibular molars. 4

Aim: Hepatocellular carcinoma (HCC) is considered to be the third leading cause of cancer death. The homologous gene of TP53 is significant in the occurrence and development of cancer. This study explored the relationship between TP53 rs28934571 polymorphism and HCC risk in Guangxi, China. Materials & methods: We first screened the association through bioinformatics. Additionally, a case–control study was performed to further verify the relationship between gene polymorphism and HCC risk after collecting clinical characteristics. Results: Results showed that allele A on TP53 rs28934571 was a risk factor for HCC and mutation from C to A on TP53 rs28934571 would increase the risk of poor prognosis of HCC. Conclusion: Therefore, the study concluded that TP53 rs28934571 may become a diagnostic indicator in judging the prognosis of HCC.

In this paper, a novel mobile phone antenna with a metal rim for LTE/WWAN/5G band is proposed, which is low-frequency, tunable and multi-band. The antenna is composed of a controlling circuit for the varactor and the monopole and loop branch strips. The overall antenna radiation performance could be optimized and enhanced through the metal rim and a lumped component matching circuit. It is fabricated on the FR-4 PCB substrate. It is showed that the antenna can get a −6dB bandwidth covering the LTE/5G bands from 700MHz to 6GHz. The radiation efficiency of low-frequency is more than 30% (-5dB). And it varies from 46% to 76% for the 1.7GHz to 6GHz high band. It features tunable low band without affecting the high frequency part.

Background Many studies have shown that the fine particulate matter in air is related to the incidence rate of chronic diseases. However, research on air pollution and metabolism-associated fatty liver disease (MAFLD) is limited. The purpose of this study was to explore the relationship between the incidence rate of MAFLD and air pollutants.Methods using a quasi-Poisson regression generalized additive model. Stratified analyses by season and age were also performed. Results A 10 µg/m3 increase of PM10, PM2.5, and NO2 concentrations corresponded to 0.82 (95%Cl: 0.49, 1.15), 0.57(95%Cl: 0.18,0.98), and 0.86(95%Cl: 0.59,1.13) elevation in MAFLD. In terms of season, the impact estimates of NO2 and PM2.5 were 3.55 (95% CI, 1.23-5.87) and 1.12 (95% CI, 0.78-1.46) in the hot season and transition season, respectively. Compared with warm season, the impact estimates of PM10 were more significant in the cool season: 2.88 (95% CI, 0.66-5.10). NO2 has the highest effect in the transition season, while PM10 has the highest effect in the cool and hot seasons. In the two age groups with 45 years as the dividing line, PM2.5 has the highest impact estimate: 2.69 (95% CI, 0.77-5.61) and 2.88 (95% CI, 0.37-6.40). The impact values of PM2.5 in male and Female were 3.60 (95% CI, 0.63-6.57) and 1.65 (95% CI, 1.05-2.25), respectively. The most important link is in different lag models, there is a significant correlation.Conclusion: This study shows that the air pollutants are related to the incidence rate of MAFLD. The effects of different air pollutants on MAFLD incidence rate were different in different seasons, ages, and gender. It is found that air pollution has a lag effect on MAFLD.

This systematic review evaluated whether single nucleotide polymorphisms of AMH and AMHRII genes are associated with ovarian function. A literature search of PubMed and Embase was complemented by hand searches in the reference lists. Eight studies involving 3155 participants were included in a meta-analysis and 10 studies included for description. For AMH c.146T>G polymorphism, no significant difference in serum anti-Mullerian hormone (AMH) levels was found between participants with different genotypes (weighted mean difference [WMD] 0.42, 95% confidence interval [CI] −0.16 to 0.99). Subgroup analyses showed similar results for the European region and in healthy and infertile populations. Regarding AMHRII −482 A>G, there was no significant difference in serum AMH levels between participants with A/A genotype and G/A or G/G genotype carriers (WMD –0.04, 95% CI −0.31 to 0.23). In subgroup analysis, an interesting trend was confirmed in healthy women and polycystic ovary syndrome (PCOS) patients (WMD –0.36, 95% CI −0.63 to –0.09, P = 0.009; WMD 0.46, 95% CI 0.15 to 0.77, P = 0.004). The review suggests that AMH c.146T>G is not associated with AMH levels, while AMHRII −482 A>G may be related to AMH levels in PCOS and healthy subgroups. However, the impact of polymorphisms in the AMH signalling pathway on ovarian function still requires further investigation.

Diversity preservation plays an important role in the design of multi-objective evolutionary algorithms, but the diversity performance assessment of these algorithms remains challenging. To address this issue, this paper proposes a performance metric and a multi-objective test suite for the diversity assessment of multiobjective evolutionary algorithms. The proposed metric assesses both the evenness and spread of a solution set by projecting it to a lower-dimensional hypercube and calculating the "volume" of the projected solution set. The proposed test suite contains eight benchmark problems, which pose stiff challenges for existing algorithms to obtain a diverse solution set. Experimental studies demonstrate that the proposed metric can assess the diversity of a solution set more precisely than existing ones, and the proposed test suite can be used to effectively distinguish between algorithms with respect to their diversity performance.

Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. We explored the association between low triiodothyronine (T3) syndrome and HT in AIS patients. A total of 208 consecutive participants with HT and 208 age- and sex-matched stroke patients without HT were enrolled in this study. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction (HI) type 1 or 2 or parenchymal hematoma (PH) type 1 or 2. HT was also classified into asymptomatic or symptomatic. The incidence of low T3 syndrome was significantly higher among patients who developed HT than among those without HT. Moreover, the more severe the HT, the lower the detected T3 levels. Multivariate-adjusted binary logistic regression showed that low T3 syndrome was an independent risk factor for HT and symptomatic HT in AIS patients. Low T3 syndrome was also significantly associated with a higher risk of PH, but not with the risk of HI. Thus, low T3 syndrome was independently associated with the risk of HT, symptomatic HT, and severe HT (PH) in AIS patients, which suggests monitoring T3 could be a useful means of preventing HT in patients with ischemic stroke.

Preeclampsia (PE) is a major cause of maternal mortality and morbidity worldwide. Although there has been great progress in the understanding of PE, the exact cause for the disease development is still unclear. Recently, studies showed that genetic deletion of ELABELA (ELA, also known as APELA) could induce PE-like symptoms in mice. However, the role of ELA in the disease development of PE remains elusive. Our objective was to measure the changes of ELA levels in maternal serum, urine, and placenta from preeclamptic pregnant women and healthy pregnant women and evaluate the correlation between ELA levels and the occurrence of PE. Additionally, we investigated the effect of ELA on the migration and proliferation of human trophoblast cells. ELA levels are significantly decreased in late-onset PE pregnancies compared with normal pregnancies. The mRNA and protein expressions of ELA and the apelin receptor (APLNR or APJ) in late-onset PE placental tissues are also decreased. Furthermore, our in vitro study showed that the addition of ELA significantly increased the invasion ability and proliferation of trophoblast cells, which were inhibited by the APJ-specific antagonist ML221. Our study identified ELA as significantly decreased in late-onset PE; therefore, it might play an important role in the pathogenesis of late-onset PE.

Analysis of protein interaction networks can identify previously unknown oncogenic drivers

In this paper, a novel discrete solar dish concentrator (DSDC) and its optimization method are proposed for improving the flux uniformity of the absorber surface inside cavity receiver. The creation of DSDC generatrix is very simple by dividing an ideal parabolic generatrix into several parts and rotating each part around its one end. The mirror equation, spot radius and optimization model of DSDC are established and an integrated approach coupling the ray tracing method and genetic algorithm is applied to optimize the DSDC to homogenize the flux distribution on absorber surface. A program in C++ is developed for performing the above functions and its correctness is verified by literature. Then, a cylindrical cavity receiver is used to verify the validity of proposed method. The results show that the optimized DSDC not only significantly improving the flux uniformity of absorber surface, i.e., the non-uniformity factor is reduced from 0.55 to 0.63 (using parabolic concentrator) to 0.10–0.22, but also reducing the peak flux and maintaining the excellent optical efficiency between 88.93% and 92.19%. Finally, the application of optimized DSDC in photovoltaic, thermoelectric generation and heat utilization are discussed and flux homogenization effect of optimized DSDC on cylindrical cavity receiver with metal tubes is analyzed.

In this brief, we investigate the reliability issues of MOSFETs with bulk 28-nm technology for its possible application in resistive-type nonvolatile memory (RNVM). The impact of electrical stress on transistors when working in the 1T1R array cells is discussed. It is found that the high source–drain voltage bias during the 1T1R array operation is the main reason causing the MOSFET degradation. Furthermore, by comparing the electrical characteristics of MOSFETs with different channel lengths, it is confirmed that the degradation is caused by high-energy electrons drifting from the source side to the drain end under a high electric field. As a result, this issue will be more serious as the gate length continues to scale down. An ultralow operation voltage RNVM is required for a better lifetime if RNVM is embedded in sub-28-nm technologies.

BackgroundAcute high altitude (HA) exposure elicits blood pressure (BP) responses in most subjects, and some of them suffer from acute mountain sickness (AMS). However, a 24-h ambulatory BP (ABP) change and the correlation with the occurrence of AMS in different sexes are still unclear.ObjectivesThis prospective study aimed to investigate HA induced BP responses in males and females and the relationship between AMS and 24-h ABP.MethodsForty-six subjects were matched according to demographic parameters by propensity score matching with a ratio of 1:1. All the subjects were monitored by a 24-h ABP device; the measurement was one period of 24 h BP. 2018 Lake Louise questionnaire was used to evaluate AMS.ResultsBoth the incidence of AMS (14 [60.9%] vs. 5 [21.7%], P = 0.007) and headache (18 [78.3%] vs. 8 [34.8%], P = 0.003) were higher in females than in males. All subjects showed an elevated BP in the early morning [morning systolic BP (SBP), 114.72 ± 13.57 vs. 120.67 ± 11.10, P = 0.013]. The elevation of morning SBP variation was more significant in females than in males (11.95 ± 13.19 vs. −0.05 ± 14.49, P = 0.005), and a higher morning BP surge increase (4.69 ± 18.09 vs. −9.66 ± 16.96, P = 0.005) was observed after acute HA exposure in the female group. The increase of morning SBP was associated with AMS occurrence (R = 0.662, P < 0.001) and AMS score (R = 0.664, P = 0.001). Among the AMS symptoms, we further revealed that the incidence (R = 0.786, P < 0.001) and the severity of headache (R = 0.864, P < 0.001) are closely correlated to morning SBP.ConclusionsOur study demonstrates that females are more likely to suffer from AMS than males. AMS is closely associated with elevated BP in the early morning period, which may be correlated to higher headache incidence in subjects with higher morning SBP.

The first therapeutic use of insulin by Frederick Banting and Charles Best in 1921 revolutionized the management of type 1 diabetes and considerably changed the lives of many patients with other types of diabetes. In the past 100 years, significant pharmacological advances took place in the field of insulin therapy, bringing closer the goal of optimal glycemic control along with decreased diabetes-related complications. Despite these developments, several challenges remain, such as increasing treatment flexibility, reducing iatrogenic hypoglycemia, and optimizing patient quality of life. Ongoing innovations in insulin therapy (e.g., new insulin analogs, alternative routes of insulin administration, and closed-loop technology) endeavor to overcome these hurdles and change the landscape of diabetes mellitus management. This report highlights recent advances made in the field of insulin therapy and discusses future perspectives.

Background The high prevalence of periodontal diseases is an important oral health problem worldwide. It is necessary to increase public knowledge on and influence attitudes towards periodontal diseases in order to prevent them. However, the effect of oral health education (OHE) as a primary preventive method in China is unsatisfactory. The aim of this study is to investigate the feasibility of extending an e-learning course regarding periodontal health by comparing the effects of oral health education regarding periodontal health (OHE-PH) on dental and non-dental students and the effects between a traditional course and an e-learning course among non-dental students at Sichuan University. Methods A quasi-experimental study with a pre-test and a post-test was performed. A total of 217 dental students and 134 non-dental students attended a traditional course; 69 non-dental students attended an e-learning course. Before- and after-course questionnaires about periodontal health knowledge, attitudes and behaviours were administered. Results After the traditional/e-learning course, the knowledge of both dental and non-dental students about periodontal diseases and self-reported behaviours for gingival bleeding and oral care improved. The non-dental students reached or surpassed the level of dental students before the course. The non-dental students taking the e-learning course performed better in some areas than those taking the traditional course. Conclusions OHE-PH was effective for dental and non-dental students. The e-learning course on OHE-PH was sufficient for improving knowledge and self-reported behaviours among non-dental undergraduates and was even better than the traditional course in some areas. The e-learning course may be an effective method for periodontal health education and oral health promotion among undergraduates.

Background Although isolated distal deep vein thrombosis (IDDVT) is a clinical complication for acute ischemic stroke (AIS) patients, very few clinicians value it and few methods can predict early IDDVT. This study aimed to establish and validate an individualized predictive nomogram for the risk of early IDDVT in AIS patients. Methods This study enrolled 647 consecutive AIS patients who were randomly divided into a training cohort (n = 431) and a validation cohort (n = 216). Based on logistic analyses in training cohort, a nomogram was constructed to predict early IDDVT. The nomogram was then validated using area under the receiver operating characteristic curve (AUROC) and calibration plots. Results The multivariate logistic regression analysis revealed that age, gender, lower limb paralysis, current pneumonia, atrial fibrillation and malignant tumor were independent risk factors of early IDDVT; these variables were integrated to construct the nomogram. Calibration plots revealed acceptable agreement between the predicted and actual IDDVT probabilities in both the training and validation cohorts. The nomogram had AUROC values of 0.767 (95% CI: 0.742–0.806) and 0.820 (95% CI: 0.762–0.869) in the training and validation cohorts, respectively. Additionally, in the validation cohort, the AUROC of the nomogram was higher than those of the other scores for predicting IDDVT. Conclusions The present nomogram provides clinicians with a novel and easy-to-use tool for the prediction of the individualized risk of IDDVT in the early stages of AIS, which would be helpful to initiate imaging examination and interventions timely.