Search

Background The EXTREME regimen (chemotherapy [CT; cisplatin/carboplatin and 5-fluorouracil]) plus cetuximab is a standard-of-care first-line (1L) treatment for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), as supported by international guidelines. The phase III CHANGE-2 trial assessed the efficacy and safety of a modified CT regimen (with a reduced dose of both components) and cetuximab versus CT for the 1L treatment of Chinese patients with R/M SCCHN. Methods Patients were randomised to receive up to six cycles of CT plus cetuximab followed by cetuximab maintenance until progressive disease or CT alone. The primary end-point was the progression-free survival (PFS) time assessed by the independent review committee (IRC). Results Overall, 243 patients were randomised (164 to CT plus cetuximab; 79 to CT). The hazard ratios for PFS by IRC and overall survival (OS) were 0.57 (95% CI: 0.40–0.80; median: 5.5 versus 4.2 months) and 0.69 (95% CI: 0.50–0.93; median: 11.1 versus 8.9 months), respectively, in favour of CT plus cetuximab. The objective response rates (ORR) by IRC were 50.0% and 26.6% with CT plus cetuximab and CT treatment, respectively. Treatment-emergent adverse events of maximum grade 3 or 4 occurred in 61.3% (CT plus cetuximab) and 48.7% (CT) of patients. Conclusions CHANGE-2 showed an improved median PFS, median OS and ORR with the addition of cetuximab to a modified platinum/5-fluorouracil regimen, with no new or unexpected safety findings, thereby confirming CT plus cetuximab as an effective and safe 1L treatment for Chinese patients with R/M SCCHN. Clinical trial registration number NCT02383966.

Summary Background The addition of camrelizumab to gemcitabine and cisplatin showed promising activity as first-line therapy in patients with recurrent or metastatic nasopharyngeal carcinoma in a phase 1 trial. We therefore compared camrelizumab plus gemcitabine and cisplatin with placebo plus gemcitabine and cisplatin in a randomised phase 3 trial. Methods In this randomised, double-blind, phase 3 trial done at 28 hospitals in China, patients were eligible if they were aged 18–75 years, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and had previously untreated recurrent or metastatic nasopharyngeal carcinoma. Patients were randomly assigned (1:1; using an interactive web-response system with a block size of four) to receive either camrelizumab (200 mg on day 1) or matching placebo intravenously, plus gemcitabine and cisplatin (gemcitabine 1000 mg/m2 on days 1 and 8; cisplatin 80 mg/m2 on day 1) intravenously every 3 weeks for four to six cycles, followed by maintenance therapy with camrelizumab or placebo, until radiographic progression, unacceptable toxicity, start of new anticancer treatment, investigator decision, or withdrawal of consent. Stratification factors used in randomisation were liver metastases, previous radical concurrent chemoradiotherapy, and ECOG performance status. The allocation sequence was generated by an independent randomisation group. The primary endpoint was progression-free survival per independent review committee. The significance threshold for independent review committee-assessed progression-free survival was p=0·0086 (one-sided) at the interim analysis. Efficacy and safety analyses included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov , NCT03707509 , and is closed for enrolment but is ongoing. Findings Between Nov 13, 2018, and Nov 29, 2019, 343 patients were screened and 263 were eligible and were randomly assigned to the camrelizumab group (n=134) or placebo group (n=129). At the prespecified interim analysis (June 15, 2020), independent review committee-assessed progression-free survival was significantly longer in the camrelizumab group (median 9·7 months [95% CI 8·3–11·4]) than in the placebo group (median 6·9 months [5·9–7·3]; hazard ratio 0·54 [95% CI 0·39–0·76]; one-sided p=0·0002). As of Dec 31, 2020, the most common grade 3 or worse adverse events of any cause were decreased white blood cell count (89 [66%] of 134 patients in the camrelizumab group vs 90 [70%] of 129 patients in the placebo group), decreased neutrophil count (86 [64%] vs 85 [66%]), anaemia (53 [40%] vs 57 [44%]), and decreased platelet count (53 [40%] vs 52 [40%]). Serious adverse events were reported in 59 (44%) of 134 patients in the camrelizumab group and 48 (37%) of 129 patients in the placebo group. Treatment-related deaths occurred in five (4%) patients in the camrelizumab group (two unknown cause of death, one multiple organ dysfunction syndrome, one pharyngeal haemorrhage, and one arrhythmia) and one ( Interpretation Our findings suggest that camrelizumab plus gemcitabine and cisplatin could be a new standard of care for patients with recurrent or metastatic nasopharyngeal carcinoma in the first-line setting. Longer follow-up is needed to confirm this conclusion. Funding Jiangsu Hengrui Pharmaceuticals (formerly Jiangsu Hengrui Medicine). Translation For the Chinese translation of the abstract see Supplementary Materials section.

Colorectal cancer (CRC) is the third and second most common type of cancer diagnosed in males and females, respectively, and is the fourth leading cause of cancer-associated mortality worldwide. Liver metastasis is the primary cause of mortality in patients with CRC, and therefore requires therapeutic focus. Regulatory T cells (Tregs) and hepatic stellate cells (HSCs) are potentially involved in regulating the immune response during liver metastasis. The aim of the present study was to evaluate the influence of CD4+ forkhead box p3 (Foxp3)+ Tregs and the HGF/c-Met signaling pathway in the liver metastasis of CRC. A model of the latter was established using Balb/c mice via splenic injection of human CRC cells (CT-26 line). The mice were monitored for 3 weeks after being injected, and the spleens and livers were removed on day 22 for further analysis. Moreover, the single-cell suspensions were labeled with CD4 and Foxp3 antibodies, and were analyzed using flow cytometry. Expression levels of α-smooth muscle actin (SMA), hepatocyte growth factor (HGF) and hepatocyte growth factor receptor (c-Met) were analyzed using immunohistochemistry. Mice injected with CT-26 cells exhibited signs of illness and significant weight loss, compared with the control mice (P=0.013), and they also developed liver metastases, at an average of 20.5 tumors per mouse. Pathological evaluation using hematoxylin and eosin staining confirmed the tumors as liver metastases of CRC. The numbers of CD4+ T cells were significantly decreased in the spleen (P

Background The tumor immune microenvironment is one of the most important prognostic factors in liver metastasis from colorectal cancer. Low-dose cyclophosphamide (CTX) is widely believed to be involved in the modulation of the immune system. However, the underlying mechanism of low-dose CTX remains unknown. This study aimed to investigate the antitumor immunity of low-dose CTX in the treatment of colon-cancer liver metastasis. Methods Thirty mice were randomly divided into five groups. After liver metastasis was established in colon-cancer models, mice in the treatment groups were injected with low-dose CTX (20 mg/kg) at different time points. Liver and spleen tissues were examined for T-cell markers via flow cytometry. Interleukin (IL)-10 and transforming growth factor (TGF)-β1 expression levels in liver tissues were analysed by immunohistochemistry. Serum interferon (IFN)-γ and IL-10 levels were detected by enzyme-linked immunosorbent assay. An additional 20 mice were randomly allocated into two groups and the survival times were recorded. Results The expression levels of CD4+ T cells, CD8+ T cells, and IFN-γ were down-regulated, whereas those of IL-10 and TGF-β1 were up-regulated in liver metastasis from colon cancer in mice. Furthermore, the local and systemic microenvironments of the liver were altered, which led to reduced antitumor immune responses and subsequently liver metastasis. However, treatment with low-dose CTX reversed these effects. The survival times of mice treated with low-dose CTX were significantly longer than those of the other groups. Conclusions Low-dose CTX exerts its antitumor activity by changing the systemic and local immune microenvironments and enhancing immune regulation in mice. CTX could be used as a drug to prevent and treat liver metastasis from colon cancer.

BACKGROUND Complications of Crohn's disease such as intestinal obstruction, fistula or perforation often need surgical treatment. Nearly 70%-80% patients with Crohn's disease would receive surgical treatment during the lifetime. However, surgical treatment is incurable for Crohn's disease. The challenge of recurrence postoperatively troubles both doctors and patients. Over 50% patients would suffer recurrence postoperatively. Some certain risk factors are associated with recurrence of Crohn's disease. AIM To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn's disease. METHODS Patients diagnosed Crohn's disease and received intestinal resection between April 2007 and December 2013 were included in this study. Data on the general demographic information, preoperative clinical characteristics, surgical information, postoperative clinical characteristics were collected. Continuous data are expressed as median (inter quartile range), and categorical data as frequencies and percentages. Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence, then log-rank test was applied to test the homogeneity of those clinical variables. Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence. RESULTS A total of 64 patients were included in this study. The median follow-up time for the patients was 17 (9.25-25.75) mo. In this period, 41 patients (64.1%) had endoscopic recurrence or clinical recurrence. Endoscopic recurrence occurred in 34 (59.6%) patients while clinical recurrence occurred in 28 (43.8%) patients, with the interval between the operation and recurrence of 13.0 (8.0-24.5) months and 17.0 (8.0-27.8) mo, respectively. In univariate analysis, diagnosis at younger age (P < 0.001), disease behavior of penetrating (P = 0.044) and preoperative use of anti-tumor necrosis factor (TNF) (P = 0.020) were significantly correlated with endoscopic recurrence, while complication with perianal lesions (P = 0.032) and preoperative use of immunomodulatory (P = 0.031) were significantly correlated with clinical recurrence. As to multivariate analysis, diagnostic age (P = 0.004), disease behavior (P = 0.041) and preoperative use of anti-TNF (P = 0.010) were independent prognostic factors for endoscopic recurrence, while complication with perianal lesions (P = 0.023) was an independent prognostic factor for clinical recurrence. CONCLUSION Diagnostic age, disease behavior, preoperative use of anti-TNF and complication with perianal lesions were independent risk factors for postoperative recurrence in Crohn's disease.

Background Caroli syndrome (CS) is a rare congenital disorder without pathognomonic clinical symptoms or laboratory findings; therefore, the diagnosis is often delayed. The objective of this study was to investigate the diagnostic delay and associated risk factors in CS patients. Methods This was a retrospective analysis of 16 CS patients admitted to a single tertiary medical center on mainland China. The diagnostic timelines of CS patients were reviewed to demonstrate the initial findings of CS at diagnosis, the risk factors associated with diagnostic delay, and potential clues leading to early diagnosis. Results The median diagnostic delay was 1.75 years (range: 1 month to 29 years, interquartile range: 6.2 years) in 16 enrolled CS patients. Sex, age, and initial symptoms were not associated with diagnostic delay. 87.5% of CS patients were diagnosed by imaging, and the accuracies of ultrasonography, computed tomography (CT), and magnetic resonance cholangiopancreatography were 25, 69.2, and 83.3%, respectively. The median diagnostic delays for patients with or without CT performed at the first hospital visited according to physician and radiologist suspicion of the diagnosis were 7.4 months and 6 years, respectively (p = 0.021). Hepatic cysts with splenomegaly were detected by ultrasound in over half of CS patients. Conclusions The majority of CS patients were not diagnosed until complications of portal hypertension had already developed. Recognition and early suspicion of the disease were important factors influencing diagnostic delay of CS. Hepatic cysts plus splenomegaly detected by US might raise the clinical suspicion to include CS in the differential diagnosis.

Orbital venous malformation results from the aberrant angiogenesis in the orbit; however, the detailed molecular mechanism is still not clear. In this study, tissue samples from 27 patients with orbital venous malformation were collected and subjected to whole exome sequencing. Melanocortin 4 receptor was the gene with highest incidence (7/27) of mutation identified in this series. A total of four types of mutations were found in the coding region and the 5ʹ-untranslated region of melanocortin 4 receptor. All these mutations resulted in the upregulation of melanocortin 4 receptor expression. In vitro assays using human umbilical vein endothelial cells demonstrated that the endothelial properties including cell proliferation, cell cycle, cell migration, and tube formation are positively correlated with the expression level of melanocortin 4 receptor. Melanocortin 4 receptor mutations resulted in increased cAMP production in a cell-based assay. By RNA sequencing technique, melanocortin 4 receptor was found to modulate the downstream genes of PI3K/AKT/mTOR pathway, including p21, cyclin B1, ITGA10, and ITGA11, which are known to regulate the endothelial properties. These data demonstrated that mutations in melanocortin 4 receptor modulate the downstream signaling pathway, facilitate the angiogenic activity of endothelial cells, and therefore is one potential mechanism of orbital venous malformation pathogenesis.Impact statementThe detailed molecular mechanism of orbital venous malformation (OVM) is still not clear. Using whole exome sequencing, 4 types of melanocortin 4 receptor (MC4R) mutation were detected in 7 of 27 patients with OVM, and all types of MC4R mutations resulted in the upregulation of MC4R expression. In vitro study indicated that MC4R has impacts on the proliferation, cell cycle, migration, and tube formation of the endothelial cells. Moreover, MC4R mutations altered the downstream signaling, including cAMP concentration and the expression levels of several PI3K/AKT/mTOR downstream genes, including p21, cyclin B1, ITGA10, and ITGA11. MC4R mutations may lead to the pathogenesis of OVM through modulating the downstream signaling to alter the angiogenic activity of endothelial cells.

The paper aims to provide a theoretical method of multi-parameter optimization collocation for sealing structure design. Based on the tightness analysis method, the paper analyzed the effects of several major influence factors on the maximal gasket contact stress. Some sensitive parameters were chosen according to the tightness analysis results. Orthogonal experiment method was applied in the current work to find the optimum combination of parameters which will contribute to a better sealing performance of the connections. The theoretical way proposed in this paper can effectively shorten the design period and is helpful to improve the quality of the design and reduce the design cost.

Based on mass real data with the method of statistical experiment, this paper attempts to take the winning rate, annual rate of return and net profit margin as the management objectives for the comparative analysis on the strengths and weaknesses of the four systems of RSI, BIAS, KDJ and W&R among the securities trading software through testing, the results of which show that RSI expert system is the best one with its overall testing results superior to other anti-trend expert systems (MA, MACD, MTM). So it is suggested that investors should choose only RSI expert system.

This paper presents tests and comparisons between SAR and BOLL, tow security transaction expert systems, through statistical experiments, with the wining rate, annual rate of return and net profit rate as the management objectives, on basis of the mass data generated by the security market; the results suggest a ratio among the wining rate, annual return rate and net profit rate of the two as 0.876, 0.936 and 0.936 respectively, and the yearly numbers of transactions of SAR is 3.7 times more than that of BOLL. The lower rate of SAR is, as believed, a result of the higher transaction cost of it comparing with BOLL.

This paper focus on overvoltage protection and insulation coordination in Modular Multilevel Converter based HVDC system planning. An overvoltage protection scheme, which bases on the topology used inTransbay project by Siemens, is proposed in this paper. Thescheme draws fromthe characteristics of MMC-HVDC systems and the research results in classic HVDC systems, byplacing arresters at some key locations in the MMC-HVDC converter station.With this scheme, the overvoltage at those key pointscan be limitedto an acceptable range and hence protect the key equipment concerned. Since all the DC lines of the project are undersea cables, no lighting overvoltage is considered and 14 faults which could happen are carefully selected to serve as the verification conditions for the insulation design. Based on the PSCAD/EMTDC simulations and the deterministic method, the specified withstand voltage levels of the critical equipment in the converter station is calculated.

Thyroidectomy can be performed in a variety of ways, and gasless video-assisted approaches have recently become more popular. We performed a study of thyroidectomy on 77 patients with bilateral thyroid lesions carried out using a gasless video-assisted unilateral anterior chest wall approach. Seventy-seven patients underwent bilateral thyroidectomy by the gasless video-assisted unilateral anterior chest wall approach, whereas 64 patients underwent conventional surgery during the same time frame and were considered to be the control group. The eligibility criteria for thyroid surgery by gasless video-assisted unilateral anterior chest wall approach were: no previous neck surgical history, no radiotherapy history, a diagnosis of benign thyroid tumor according to preoperative computed tomographic scan, no inflammation-related diseases or thyroid hyperfunction, no lymphadenectasis, and bilateral tumors ≤ 4 cm in diameter (1 side ≤ 2 cm, located in the lower part of the thyroid and near the surface of the thyroid). The 2 groups were compared by surgical style, complications, operative time, cosmetic result, and postoperative pain. The 2 groups were matched in terms of age and sex; the scoring for operative procedure (P=0.443), postoperative drainage (P=0.686), and postoperative pain (P=0.294) were not significantly different. The gasless video-assisted group had less bleeding during surgery than the conventional group and had better cosmetic results (P

Based on the equivalence principle of bending deflection and torsional displacement, the concentrated vertical load which acts on the center of a continuously reinforced concrete pavement (CRCP) is translated into an equivalent half-wave sine load by Fourier transform. On the basis of this transform and deformation harmony condition of crack, the equations of load transfer are established. According to the translation principle of the force, the equations of load transfer of adjacent slabs are worked out. With the small deflection theory of elastic thin slabs, the bending deflection and torsional displacement formulas of CRCP under the concentrated vertical load with hollow foundation are deduced, which is verified by the results of finite element(FE). The results show that the characteristic of CRCP after cracking is related to the rigidity factor which is proportional to the spacing of adjacent cracks and the width of CRCP.

Based on the equivalence principle, the concentrated vertical load which acts on the Continuously Reinforced Concrete Pavement(CRCP) transverse crack is translated into the equivalent half-wave sine load by Fourier transform. According to the translation principle of the force, the half-wave sine vertical load acting on the CRCP transverse crack is decomposed to the half-wave sine vertical load and the torsion force acting on the center of CRCP. Lastly, the deflection, torsional displacement and stress formulas of CRCP under the concentrated vertical load with hollow foundation are put forward, which is on the basis of the small deflection theory of elastic thin plate and torsion theory. The results show that increasing the slab thickness is the most effective measure to reduce maximal deflection, distortion displacement and stress of CRCP concentrated vertical load with hollow foundation.

Based on the small deflection theory of elastic thin plate and the equivalence principle of deflection and stress, the concentrated vehicle load which acts on the CRCP is translated into the equivalent half-wave sine load by Fourier transform. On the basis of this transform, the deflection and stress formulas are put forward when CRCP is subjected to a concentrated vehicle load with hollow foundation. The following results are obtained from the analysis. The maximal deflection is proportional to the concentrated vehicle load and slab width, and inversely proportional to the lateral bending stiffness and slab thickness. The slab width and thickness have a significant influence on the maximal deflection. The maximal stress is proportional to the concentrated vehicle load and slab width as well as inversely proportional to the slab thickness. The influence of slab thickness is significant to the maximal stress. In conclusion, increasing the slab thickness is the preferential choice to reduce the maximal deflection and stress.

Damage evolution equations of asphalt mixture specimen beams were analyzed using the fracture toughness index and the ultimate tension strain index, respectively. The fracture toughness of the asphalt mixture was calculated by FEM. Damage evolution equations controlled apart by the stress and the strain were given. Their coefficients were back-calculated using partial fatigue tests data. The fully coupled stress-damage method and the fully coupled strain-damage method were used. The life prediction precision of each equation was verified by residual fatigue tests data. The results show that FEM is effective to calculate the fracture toughness of the asphalt mixture. Two damage evolution equations have better life prediction abilities comparing with the S-N equation used usually.

A finite element analysis model including rubber tread and flexible pavement was established by FEM software (ANASYS) and a friction contact problem between tread and flexible pavement was numerically analyzed. The deformational features of tread and surface and distribution of tangent stress in the conditions of different interfacial friction coefficients between tread and surface under freely rolling and emergent braking states are discussed. Results are presented.

Flexible base asphalt pavements have been used widely in high grade roads in China. The fatigue performance is one of the most important properties for asphalt-treated base mixtures. Firstly, five kinds of asphalt mixtures were tested with the third-point flexure fatigue test under strain controlled mode with the effects of aggregate gradation, asphalt content, asphalt property and test temperature on fatigue performance of asphalt-treated base was analyzed, which can be considered in asphalt-treated base mixtures design. The result shows that the fatigue performance of suspend-dense mixtures is better than framework-dense mixtures. Fatigue life is improved markedly by the increase of bitumen content and the optimal asphalt content (OAC) determined by Marshall method is less than the OAC with best fatigue performance. Fatigue life of asphalt mixture in higher temperature is longer than in lower temperature. The asphalt mixture with modified asphalt is better than ordinary asphalt mixture in terms ...

“Bed crisis” is a buzz word of the 90’s in the National Health Services (NHS). Medical emergency admissions keep rising and hospital resources remain limited. Faced with such a dilemma, many hospitals have endeavoured to improve their service efficiencies in order to meet the challenge. This paper describes a real‐life hospital process re‐engineering project in which computer simulation and optimisation models were applied to provide decision making support in determining the size of the proposed medical assessment unit and the allocation of the available medical beds to minimise hospital bed overflows.

According to requirements of power quality and other indicators of every single online unit of the photovoltaic system and the fact that more electric harmonic are generated in the process of photovoltaic grid inverter operation. This paper designs a simple photovoltaic grid system through computer technology and modern control techniques. The process of photovoltaic (pv) grid is simulated in the Matlab/Simulink platform. On the basis of the simulation platform, LCL filter is designed, which finally reached the expected effect of the power quality.

The local and systemic regulation of the immune system may play important roles in the process of liver metastasis of colorectal carcinoma. The aim of this study was to establish a reproducible experimental liver metastasis model, to identify changes in T cells and cytokines TGF-β1 and IL-10, and to explore a possible mechanism of liver metastasis of colon carcinoma.We used a colon carcinoma liver metastasis model, in which different numbers of CT-26 murine colon carcinoma cells (1 × 10(3), 5 × 10(3), 1 × 10(4), 5 × 10(4), and 1 × 10(5)) were injected into the spleen. The liver and spleen tissues were examined for T cell markers using flow cytometry. Liver tissues were analyzed for IL-10 and transforming growth factor beta 1 (TGF-β1) expression using immunohistochemistry.Spleen injection of colon carcinoma cells is a reproducible animal model for liver metastases, which resulted in quantity-dependent metastatic growth. We provided a snapshot of the hepatic immune microenvironment in the mouse liver metastasis model. Injection of A large number of tumor cells (5 × 10(4) and 1 × 10 (5) ) decreased anti-tumor cell counts, such as CD4(+) and CD8(+) T cells, and increased immune-suppressive cell counts (CD4(+)CD25(+) Treg cells). In addition, the expression levels of immunosuppressive cytokines IL-10 and TGF-β1 were also increased with the number of tumor cells.Changes in the systemic and local immunological environment contribute to immunological escape mechanisms during liver metastasis of colon carcinoma, and therapies aiming at immune microenvironment may prove a useful strategy in the treatment of metastatic disease in the future.

As a result of the National Health Service (NHS) reforms, the publication of the Patients Charter and Performance League Tables, providers are under persistent pressure to improve their efficiency. This article describes a recent simulation study of an Accident and Emergency (A&E) department in a large NHS Trust. A data collection survey is described which was essential for identifying patient flows and activity times in the A&E department We then discuss in more detail how to model patient arrivals which proved to be the most difficult part of the simulation. Some light is also shed on the attempt we made to develop a valid and credible model. Finally the preliminary findings are presented.

Through the creep test of a geogrid under different stress levels, three strain types (instantaneous elastic strain, viscoelastic strain and plastic strain) were analyzed with stress and time variables. The constitutive model fit for the geogrid was given by the e = e (σ, t) form. User-defined material subroutines (UMAT) of ABAQUS were used to implement the constitutive model, whose results were validated with test data. All of three strain types increase rapidly with the increasing stress in a stress region. The region is an important section for the characteristic study of the geogrid creep properties. The constitutive model can be used to choose suitable locations and densities of the geogrid in a structure, whose design can make the structure last through its design life.

The differential settlement and pavement cracking along the joint between an old and new embankment often appear for an embankment widening, which will deteriorate the riding performance of the widened road greatly. Centrifuge model test and numerical analysis using ABAQUS have been carried out for the geosynthetic-reinforced embankment of a road widening. Tensile strain in the geogrid was measured in the centrifuge model test and a sensitivity analysis was carried out with numerical analysis. It was found that the geogrid in the new embankment not only reduces the differential settlement between the new and old embankments, but also limits the horizontal deformation of the new embankment. The effect of geosynthetic-reinforcement in the widening embankments is enhanced with the increase of the geogrid modulus.

According to the load requirements, the DC operating power system adopting high-frequency charger module and maintained-free battery group, system protection methods including TN-S earthing, door body keeping equal potential with the steel track, and also isolating from platform construction are designed for Metro Platform Screen Doors (PSD). One cycle of open and close door is considered a short impact to determine the time of electrical discharge of the battery group. The terminal voltage and battery storage capacity as constraints, the total fee is regarded as a goal function to reasonably obtain the optimized number of high-frequency charger module and battery group by optimized calculation. One optimized example is given. The assessment guidelines on electromagnetic compatibility for the DC Operating Power was proposed, that also could be available for inspection of the same type of subway equipment. The design and assessment guidelines have been widely used in the relevant Platform Screen Door projects.

X-ray tube's cathode space charge effect is the main interference for real-time control of x-ray tube current. Those factors making filament current drift are unpredictable, which affects the dynamic response performance of the tube current. In order to quickly respond to a wide range of X-ray tube anode voltage, based on closed-loop control strategy of X-ray tube current, real-time voltage control signal (duty cycle) is introduced into feed forward control part to constitute non-linear real-time dynamic compensator for X-ray tube's cathode space charge effect, Filament current is introduced as a deputy control variable into the cascade control of tube current to rapidly respond the current lag, improve the accuracy and reduce the process time constant, Intelligent Chips are utilized to manufacture a high-performance low-cost controller for X-ray machine. MC34067 is utilized to construct main circuit of high-frequency quasi-resonant, which aims to achieve rapid soft-switch control for X-ray tube anode voltage, TL494 is utilized to construct main circuit of X-ray tube current control strategy, MCU is utilized to chose the compensation factor depending on anode voltage range. Based on above ideas, two sets of prototype are made to test, preliminary results show that these control methods and circuit devices are effective.

Foamed asphalt treated mixture is a kind of material whose properties are between semi-rigid and flexible. However, there is not enough information of strength characteristics of this material for the authors. In this study, the authors monitored the foamed asphalt treated mixture’s characteristics of strength, density and moisture content with different curing conditions to study the formation process and regularity of it’s strength character. The authors investigated the relationship between strength forming and asphalt dispersion with the help of micro-scale analysis observations and it was found that in the study that obtained strength factors for foamed asphalt mixture was directly related to the evaporation of water and there was a migration process for asphalt. In this process, asphalt blocked some of the void of test specimen, so that the opening voids decreased and the closed void increased instead. As a result, water stability of foamed asphalt concrete was improved.

The slope stability of the joint roadbed, which based on the example of freeway continuation from Hefei to Nanjing, was analyzed by strength reduction finite element method (FEM) using ABAQUS software. Infinite elements were used on the boundary to avoid the influence of FEM dimension. The transform of mechanical parameters was expounded from the M-C model to the D-P model with equal area in plane strain questions. Unitary safety factor controlled by the maximal plastic strain which a pavement structure can withstand was given. Analysis means about the joint roadbed stability were mostly validating a hypothetic design time and again at present. This paper suggested drawing critical parameter curves of the slope stability in different safety factors. It would be fast to choose a primary project by above curves using the cohesion and internal friction angle data in direct shear tests or triaxial undrain shear tests. Designs according to need with filling material and joint condition could be implemented.

Bridge deck pavement suffers from more complicated stresses than ordinary pavement, and mechanical states of the paving layers are influenced by material design parameters. After mechanical computation, the effects of material design parameters on the mechanical state and the variation law of pavement are analyzed. Analytical results indicate that following the traditional HAM design method can not adapt to actual mechanical states, and easily result in usual distress types on the asphalt concrete paving. Economical and reasonable paving materials should be designed or developed according to mechanical paving characteristics, such as multilevel dense built-in modified HMA, fiber-reinforced asphalt concrete and modified SMA, which can harmonize paving layers as a whole, adapt to the deformations of bridge decks, improve the mechanical states of the paving layers, increase the service years, and offer some helpful references for similar bridge deck pavement design.

The result of reirradiation in recurrent T1 (rT1) nasopharyngeal carcinoma (NPC) is unsatisfactory. We sought to study the efficacy and complications of endoscopic microwave coagulation therapy (MCT) in salvaging rT1 NPC after primary radiotherapy. Between August 1994 and April 2005, 55 patients with rT1 NPC were treated with endoscopic MCT. With a median follow-up of 102.1 months, 52 of 55 patients are still alive. Five patients had local failure after retreatment. The overall survival and local progression-free survival were 100% (95% CI, 99.4% to 100%) and 94.5% (95% CI, 94.1% to 94.9%) at 2 years, respectively, and 93.6% (95% CI, 93.5% to 94.4%) and 90.7% (95% CI, 90.2% to 91.2%) at 5 years. The common complications of endoscopic MCT were mild postoperative pain and headache. Nasopharyngeal necrosis was transient in one patient and subsided in 1 month. Endoscopic MCT achieved significant survival and tumour control without severe complications in selective rT1 NPC.

Plymouth Hospitals NHS Trust is one of the largest non-teaching Trusts in the country, with contract income to the value of £107 million, a staff of 3,500 and over 1,050 beds at the present time, serving a population of over 430,000.

Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management. This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise. The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed.