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ABSTACT BACKGROUND: Studies comparing C-RARP and RS-RARP have reported different results and the choice between the two operation methods remains controversia. METHODS We present the meta-analysis on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The meta-analysis was carried out using Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom) and Stata SE 14.0. The mean difference (MD) with 95% confidence intervals (CI) were used to describe the results of continuous data; odds ratio (OR) with 95% CI were used to describe dichotomous data. Statistical significance was set at P

Purpose The differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome remains a challenge in clinical practice. The present study was aimed at assessing the diagnostic performance of pituitary dynamic contrast-enhanced magnetic resonance imaging (dMRI), high-dose dexamethasone suppression test (HDDST), and a combination of both tests for patients with ACTH-dependent Cushing's syndrome. Methods A total of 119 consecutive patients with ACTH-dependent Cushing's syndrome confirmed surgically were enrolled: 101 with proven Cushing's disease and 18 with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and specificity of pituitary dMRI, HDDST, and a combination of both tests were determined. Results The sensitivity and specificity of pituitary dMRI for diagnosing Cushing's disease were 80.2 and 83.3%, respectively, with a positive predictive value of 96.4%. The sensitivity and specificity of HDDST were 70.3 and 77.8%, respectively, with positive predictive value of 94.7%. A combination of both tests showed that the combined criteria of more than 50% suppression of serum cortisol on HDDST and a positive pituitary dMRI finding yielded a high specificity of 94.4 and sensitivity of 59.4%. The combined criteria of more than 68% suppression on HDDST and/or a positive pituitary dMRI finding yielded a sensitivity of 86.1% and specificity of 83.3%. Conclusions Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing's syndrome. HDDST is recommended in combination with pituitary dMRI to establish a diagnosis process because of the significantly increased specificity with the combination.

Electric arc furnaces (EAFs) are used for steel production, particularly when recycling scrap material. In EAFs, carbonaceous material is charged with other raw materials or injected into molten slag to generate foam on top of liquid metal to increase energy efficiency. However, the consumption of fossil carbon leads to greenhouse gas emissions (GHGs). To reduce net GHG emissions from EAF steelmaking, the substitution of fossil carbon with sustainable biogenic carbon can be applied. This study explores the possibility of the substitution of fossil material with biogenic material produced by different pyrolysis methods and from various raw materials in EAF steelmaking processes. Experimental work was performed to study the effect of biogenic material utilization on steel and slag composition using an induction melting furnace with 50 kg of steel capacity. The interaction of biogenic material derived from different raw materials and pyrolysis processes with molten synthetic slag was also investigated using a tensiometer. Relative to other biogenic materials tested, a composite produced with densified softwood had higher intensity interfacial reactions with slag, which may be attributed to the rougher surface morphology of the densified biogenic material.

We have demonstrated air-stable n-type single-walled carbon nanotube (SWCNT)-based field-effect transistors (FETs) with hafnium (Hf) contacts. Unlike previously reported p-type characteristics for ...

Background: Left ventricular thrombus (LVT) can complicate ST-Elevation myocardial infarction (STEMI) and is associated with poor outcomes. Conventional triple anticoagulation [Vitamin K Antagonists (VKA) plus dual-antiplatelet therapy (DAPT)] is the first-line therapy for LVT after STEMI. In patients with LVT following STEMI, contemporary data of triple therapy with rivaroxaban are lacking. Methods: We conducted a retrospective cohort study involving 1335 STEMI patients who underwent primary percutaneous coronary intervention (PCI). Among patients who developed LVT after STEMI, we observed differences in efficacy between rivaroxaban plus DAPT therapy and VKA plus DAPT. The time of LVT resolution was also evaluated, as well as net clinical adverse events, and rates of bleeding events. Results: In 1335 patients with STEMI, a total of 77 (5.7%) developed LVT over the follow-up period (median 25.0 months). Of the patients diagnosed with LVT, 31 patients were started on triple therapy with VKA, 33 patients on triple therapy with rivaroxaban. There was a consistent similarity in LVT resolution with rivaroxaban application compared to VKA application during the follow-up period [HR (log-rank test) 1.57(95% CI 0.89–2.77), p = 0.096; Adjusted HR 1.70(95% CI 0.90–3.22), p = 0.104]. Triple therapy with rivaroxaban showed quicker resolution than with VKA (6 months: p = 0.049; 12 months: p = 0.044; 18 months: p = 0.045). Similar risks of ISTH bleeding were not significantly different between the 2 groups [VKA 9.7% vs Rivaroxaban 6.1%, Adjusted HR 0.48 (95% CI 0.73–3.20); p = 0.444)]. Fewer net adverse clinical events (NACE) were observed in the rivaroxaban group [VKA 58.1% vs Rivaroxaban 24.2%; HR (log-rank test) 0.31(95% CI 0.14–0.68), p = 0.003; Adjusted HR 0.23(95% CI 0.09–0.57), p = 0.001]. Conclusion: In the observational study, triple therapy with rivaroxaban has similar and quicker LVT resolution in patients with LVT after STEMI, compared with triple therapy with VKA, and perhaps was associated with a better clinical benefit. Larger sample sizes and randomized controlled trials are needed to confirm this observation.

Purpose A high-precision rotated elliptical beam profiling method based on pixel ion chamber is proposed in this paper. This method aims to improve the accuracy by modeling the transverse profile of rotated beam as an ellipse with additional correlation coefficient and eliminating the fitting error due to the volume averaging effect of pixel ion chamber. Methods In pencil beam scanning (PBS) proton therapy systems, the transverse beam profile model is generally represented as a standard Gaussian distribution. Considering the elliptical spots, two-dimensional (2D) joint Gaussian distribution characterized with the correlation coefficient ρ is adopted in this study. Gaussian-type particle distribution with white noise was generated and processed in MATLAB to simulate the secondary particle collection in the pixel ion chamber. The simulated pixel ion chamber is a commercially available ion chamber which consists of 12 × 12 small square pixels (3.75 × 3.75 mm2 ) with a 0.05 mm interval. The simulated signals were preprocessed by filtering with the noise threshold and extracting the maximum simply connected domain (MSCD) of the signal. Then, five geometric parameters that identify the transverse beam profiles were fitted under different signal-to-noise ratio (SNR) conditions: the center of the beam (x0 , y0 ), the spot size (σmajor , σminor ), and the rotation angle θ formed between the major axes of elliptical spot and the x axes of the ion chamber. First, the simulated signals were preprocessed by filtering with the noise threshold and extracting the MSCD of the signal. Second, a rectification curve of systematic error in fitted spot size versus the prescribed spot size was used to predict the systematic error due to the volume averaging effect. Finally, the effects of fitting errors on therapeutic dose were evaluated in terms of gamma index and relative dose difference. Results When the SNR is not less than 20 dB, the relative fitting error of spot size and the absolute fitting error of angle θ are less than 1% and 6.1°, respectively. The fitting error of beam center increases with spot size and will not exceed 0.22 mm when spot size reaches up to 12 mm. At a SNR equal to 20 dB, neither cold nor hot spots were presented in dose distribution calculated with the fitted spot parameters. Conclusion The improved Gaussian fitting algorithm performs well when SNR is not less than 20 dB. This method can effectively distinguish the nominal beam and rotated elliptical beam. An ideal systematic error curve can be predicted and used to correct the fitted spot size, thus eliminating the systematic error due to the volume averaging effect of the pixel ion chamber. The fitting error of spot size cannot be fully corrected, but it is negligible and shows little effect on the overall therapeutic dose.

To increase the robustness of the traditional Sobel operator and realize automatic edge detection, an improved Sobel operator based on eight-directional convolution and the reciprocal of image entropy was proposed in this paper. First, median filtering was employed to filter the noise images. Then, eight convolution templates were derived to calculate the gradient of restored images, and gradient images were obtained. According to the reciprocal of the entropy, a threshold was determined to obtain edge detection results. Finally, experiments were carried out on a global dataset and the performance of the improved Sobel operator was verified with the peak signal-to-noise ratio (PSNR) and Pratt’s figure of merit (FOM). The results showed that the PSNR of the improved Sobel operator is 3.26% and 4.08% higher than that of the traditional Sobel operator and Canny operator, respectively. The FOM of the improved Sobel operator is 5.29% higher than that of the traditional Sobel operator. The PSNR and FOM of the improved Sobel operator are 6.98% and 24.1%, respectively, higher than those of the traditional Sobel operator in the case of image noise. Therefore, the detection performance and noise robustness of the improved Sobel operator are notably better than those of the traditional Sobel operator.

The development of low power consumption sensing devices for detecting trace toxic gases is imperative for a wide variety of applications. Recently, hybrid organic–inorganic lead perovskite-based sensors have been fabricated to demonstrate their potential for gas sensing application. However, the poor repeatability and toxicity of lead halide perovskites severely restrict their further practical applications. Here, the lead-free all-inorganic cesium copper iodide (CsCu2I3) perovskite nanostructured networks are deposited onto interdigital electrodes patterned substrate as the gas sensitive layer via simply spin coating the precursors. The sensor exhibites excellent room temperature NO2 sensing properties, including ultra-low limit of detection, excellent repeatability, and good selectivity. Dynamic testing displays the good cycling repeatability of the sensor for ppb level NO2. The ultra-sensitive NO2 sensing behavior of the CsCu2I3 nanostructure networks are mainly attributed to the unique nanoneedle clusters network structure and large amount of cation vacancies on the perovskite surface. In conclusion, the high sensitivity and environmentally friendly CsCu2I3 sensor shows great potential for trace indoor pollutants detection and breathe analysis for disease diagnosis.

Background: Aerobic capacity is associated with metabolic, cardiovascular, and neurological health. Low-capacity runner (LCR) rats display low aerobic capacity, metabolic dysfuction, and spatial memory deficits. A heat treatment (HT) can improve metabolic dysfunction in LCR peripheral organs after high fat diet (HFD). Little is known about metabolic changes in the brains of these rats following HT. Objective: Our objective was to examine the extent to which high or low aerobic capacity impacts Akt (a protein marker of metabolism) and heat shock protein 72 (HSP72, a marker of heat shock response) after HFD and HT in hippocampus. Methods: We measured phosphorylated Akt (pAkt) in the striatum and hippocampus, and HSP72 in the hippocampus, of HFD-fed and chow-fed LCR and high-capacity runner (HCR) rats with and without HT. Results: pAkt was lower in the hippocampus of chow-fed LCR than HCR rats. HFD resulted in greater pAkt in LCR but not HCR rats, but HT resulted in lower pAkt in the LCR HFD group. HSP72 was greater in both HCR and LCR rat hippocampus after HT. The HFD blunted this effect in LCR compared to HCR hippocampus. Conclusion: The abnormal phosphorylation of Akt and diminished HSP response in the hippocampus of young adult LCR rats might indicate early vulnerability to metabolic challenges in this key brain region associated with learning and memory.

Background and Objective: Type 2 Diabetes (T2D) patients are more prone to develop Alzheimer’s Disease (AD). We have previously shown that Glucagon-like peptide-1 receptor agonist exendin-4 (Ex-4) reduces tau hyperphosphorylation in T2D animals through upregulating insulin signaling, and peripheral injected Ex-4 increases insulin levels in the T2D brain. This study aims to further clarify whether the elevated insulin in the brain is produced by nerve cells under the action of Ex-4. Methods: The neuronal cell line-HT22 was treated with Ex-4 under high glucose or normal cultivation, and the number of insulin-positive cells as well as the expression levels of insulin synthesis-related genes were examined. The db/db mice were treated with the peripheral injection of Ex-4 and/or IntraCerebroVentricular (ICV) injection of siRNA to inhibit the expression of insulin synthesis- related genes and the behavior tests were carried on. Finally, plasma glucose, Cerebrospinal Fluid (CSF) glucose, CSF insulin, phosphorylation of tau, phosphorylation of AKT and GSK-3β of db/db mice were detected. Results : We found that Ex-4 promoted the expression of insulin synthesis-related genes and induced an obvious increase of insulin-positive HT-22 neuronal cells in a high glucose environment. Peripheral injection of Ex-4 improved the cognitive function of db/db mice and increased brain insulin levels which activated brain insulin signaling and subsequently alleviated tau hyperphosphorylation. However, when siRNA-neurod1 was injected to block insulin synthesis, the cognitive function of db/db mice was not improved under the action of Ex-4 anymore. Moreover, the brain insulin levels dropped to an extremely low level, and the phosphorylation level of tau increased significantly. Conclusion: This study demonstrated that Ex-4 improved cognition function by promoting brain insulin synthesis followed by the activation of brain insulin signaling and alleviation of tau hyperphosphorylation.

This meta-analysis was performed to evaluate the effect of Seprafilm® on postoperative small bowel obstruction.A literature search was conducted in the PubMed and EMBASE databases through August 2020. The pooled risk ratios as well as the corresponding 95% confidence intervals were calculated using RevMan 5.3 software.A total of 9 clinical control trials involving 4,351 patients (2,123 in the Seprafilm® group and 2,228 in the control group) were included. The overall analysis showed that the pooled risk ratio was 0.45 (95% confidence interval = 0.34-0.60; P.00001), indicating that the risk of postoperative small bowel obstruction can be significantly decreased by the application of Seprafilm®. Similarly, an obvious effect of Seprafilm® on reducing the rate of postoperative small bowel obstruction was also shown in the subgroup analyses by population (adult participants), study design (randomized control study or nonrandomized control study), region (Japan or Korea), follow-up duration (2 years or 5 years), and sheet number of Seprafilm® (1 sheet or1 sheet).In conclusion, the use of Seprafilm® is beneficial for decreasing the rate of postoperative small bowel obstruction.

Crowd-sourced geographic information has great potential in scientific and public domains, and is recently under consideration by geospatial professionals as an alternative to traditional spatial data collection. The success, however, implies a need to build long-term reliance on the crowd-sourcing projects, and poses growing concern over the quality of the constantly evolving data. In general, we aim to develop an approach that uses geographic rules to identify inconsistent information in street networks without relying on external sources. This paper focuses on a more challenging sub-process that aims to identifying inconsistent information using the rule of symmetry. That is, information (e.g. name, class, speed limit, etc.) in parallel carriageways (e.g. divided highways) always constrains each other. The process starts with a clustering of related streets into well-defined or ambiguous situations using a DBSCAN-inspired technique; then two pairing strategies are designed for both situations. To address the challenging problem of pairing carriageways in ambiguous situations, three pairing algorithms (stroke-based, tree-based, and mixed) are devised based on the idea of using expanded ‘receptive field’ to disentangle the ambiguities; each has a focus on efficiency, effectiveness, or their tradeoff. Evaluating the algorithms against 7 selected datasets shows that all three algorithms reached satisfactory performance (F1-score > 92%) for ambiguous situations, and much higher accuracy for the whole datasets. Then, we applied our approach to over 40 datasets worldwide and detected inconsistencies (i.e. dissimilar values in paired carriageways) in crowd-sourced and authoritative street networks. We evaluate the identified inconsistencies, analyze the possibilities of our approach in suggesting corrections to problematic data, and discuss its effectiveness, issues, and future directions. We thereby demonstrate that the proposed approach is effective for quality assurance, and can be used to assure the quality of crowd-sourced and authoritative mapping projects during their evolution without relying on ground-truth.

To assess the win-win of both China and Zimbabwe if Zimbabwe diversifies its agricultural exports into the Chinese market, this study employs a Computable General Equilibrium (CGE) model that is becoming popular in analyzing economic issues. With Zimbabwe having been in a constant financial and economic crisis and the major sector not contributing much to the economic growth, a bilateral Free Trade Agreement on Agriculture and Agri-based commodities between China and Zimbabwe was proposed based on the Forum for China-Africa Cooperation Action Plan (2019-2021). To evaluate the policy change, the study used a CGE and Dynamic Global Trade Analysis Project (GTAP) model 2011 and employed two policy scenarios of baseline and that of zero tariffs. By comparing the baseline and policy simulation results for the periods (2020-2030), the research found that the policy would be a win-win to both countries but with more negative impacts on Zimbabwe. The study therefore proposed some recommendations aimed at sustaining the policy change should the two countries engage in it. The recommendations included the need for agricultural research and development to boost agricultural production and exports in Zimbabwe. Key words: Computable general equilibrium dynamic model, global trade analysis project, bilateral free trade agreement, Zimbabwe, China.

Purpose. To perform fundus examinations of full-term and premature infants to identify common congenital ocular diseases and determine the incidence and additional risk factors in Ningbo, China. Methods. Fundus examinations were performed on newborns between January 2017 and July 2020 in Ningbo using a RetCam3 or PanoCam LT wide-field digital imaging system. The neonates’ birth weight, gestational age, gender, delivery mode, oxygen intake, and other conditions were recorded. We compared the incidence of ocular abnormalities in both full-term newborns and premature infants. Results. There were 23,861 newborns in this study comprising 12,605 (52.8%) male and 11,256 (47.2%) female infants, 20,938 full-term babies, and 2,923 premature babies. The average gestational age was 37.9 ± 5.6 weeks, and the average birth weight was 3,189 ± 417 g. Overall, we found ocular abnormalities in 6,645 (27.8%). The most common abnormality in full-term newborns was retinal hemorrhage (RH), which we found in 3,827 (18.3%) cases. Other diseases identified included familial exudative vitreoretinopathy (FEVR), retinoblastoma (RB), and congenital cataracts. The delivery method had a significant impact on the incidence of neonatal RH ( P < 0.001 ). Retinopathy of prematurity (ROP) was observed in 617 newborns accounting for 21.1% of all screened premature infants. Logistic analysis showed that gestational age and birth weight were important risk factors for ROP ( P < 0.001 ). For treatable diseases, such as ROP, FEVR, congenital cataract, glaucoma, and RB, early identification allows for active treatment or referral to a specialized hospital for further treatment. Conclusion. Early examination and prompt treatment of ocular disorders in newborns are important to avoid lifelong visual impairment. Eye examinations should be performed during the neonatal period and at regular follow-up visits.

The effects of TiO 2 / Al 2 O 3 / MgF 2 triple-layer (TL) antireflection (AR) coating on reducing optical loss of GaInP/InGaAs/Ge triple-junction (TJ) solar cell have been investigated by using Essential Macleod Program software and Crosslight Apsys software, and compared to that of TiO 2 / Al 2 O 3 dual-layer (DL) AR coating. The DLAR and TLAR coatings have reduced the average optical reflectivity values of the TJ solar cells by around 18.9% and 22.2%, respectively. The conversion efficiency of TJ solar cell was increased by 21.29% and 29.44% with DLAR and TLAR coatings. External quantum efficiency values of TJ solar cells with DL and TLAR coating increased in full wavelength region due to the increase of photo generated current density caused by the reduction of surface reflectivity. Both simulation and experimental results showed that the TiO 2 / Al 2 O 3 / MgF 2 TLAR coating has better anti-reflecting properties over TiO 2 / Al 2 O 3 DLAR coating, and improved the overall performance of TJ solar cell more.

Background: Among various chalcogenides, GeSbSe shows a good transmittance in the visible, NIR and, midIR spectrum from 1-20 μm and also demonstrates excellent moldability. Objective: In current work, we have characterized GeSbSe glass for use in sensor mechanism and for adaptive polarization control. Methods: After analysing an earlier work regarding GeSbSe based Silicon on insulator optical waveguide, we implemented GeSbSe in a low refractive index slot region of SOI slot optical waveguide. Change in waveguide geometry can cause a shift in the dispersion profile, but a relatively distinct pattern has been observed. T-slot waveguide structure has also been analysed, where GeSbSe has been implemented in low refractive index slot regions with the Graphene layer beneath the horizontal slot region for enhancement in tailoring ability of the birefringence parameters. Results: Literature review led to the presence of absorption resonance wavelength in SOI slot optical waveguide with our proposed composition, which is attributed to the single average harmonic oscillator property of the chalcogenides. In the T-slot waveguide structure, it was found that a shift in Fermi energy and Mobility values can bring a change in birefringence, even with constant waveguide geometry and operating wavelength. Conclusion: Absorption resonance wavelength in GeSbSe slot optical waveguide has been exploited for proposing the refractive index dispersion sensor. Our design approach regarding T-slot waveguide may lead to the provision of automated polarization management sources for the light on chip circuits.

Recurrence is a major concern for adult patients with glioblastomas (GBMs), and the prognosis remains poor. Although several therapies have been assessed, most of them have not achieved satisfactory results. Therefore, there is currently no standard treatment for adult recurrent GBM (rGBM). Here, we review the results of clinical trials for the systematic therapy of rGBM. Regorafenib, rindopepimut and neoadjuvant programmed death 1 (PD-1) inhibitors are promising agents for rGBM, while regorafenib is effective in both O6-methylguanine DNA methyltransferase (MGMT) promoter methylated and unmethylated patients. Temozolomide rechallenge and alkylating agents combined with bevacizumab can be useful for patients with MGMT methylation, and patients with isocitrate dehydrogenase (IDH) mutations or second recurrence can benefit from vocimagene amiretrorepvec (Toca 511). Some phase I trials on targeted therapy and immunotherapy have shown positive results, and results from further studies are expected. In addition to the analysis of existing clinical trial results, forthcoming trials should be well designed, and patients are encouraged to participate in appropriate clinical trials.

In software crowdsourcing, task prize is a primary incentive for engaging crowd developers. One of the main challenges in crowdsourcing task pricing is to determine appropriate prizes in order to attract qualified workers. Few studies proposed methods to address this challenge. However, they are either too theoretical or too restricted to be applied for early crowdsourcing planning. In this study, we propose a novel approach, i.e., PTMA, to support early task pricing in software crowdsourcing from textual task requirements. PTMA consists of three phases, namely data pre-processing, topic extraction, and topic-based task pricing analysis, integrating 6 machine learning algorithms and 3 analogy-based models for topic-based pricing analysis. PTMA is evaluated using data from 2016 software crowdsourcing tasks extracted from TopCoder, the largest software crowdsourcing platform. The results show that: 1) textual requirement information can aid early task pricing in software crowdsourcing; 2) the best predictor in PTMA, based on logistic regression, achieves an accuracy of 88.3% in Pred (30); and 3) PTMA outperforms the existing baseline models by 9% in Pred (30). PTMA greatly simplifies the pricing process by only leveraging textual task description as inputs, and can achieve better prediction accuracy in making task pricing decisions.

Purpose The aim of this study was to investigate the quantitative F-fluoroethylcholine (CHO) PET characteristics for differentiating lower-grade glioma (LGG) from glioblastoma (GBM). Patients and methods Thirty-nine patients who underwent CHO PET with histopathologically confirmed primary diffuse glioma were prospectively enrolled. The 3-dimensional region of interest was semiautomatically defined based on the SUV threshold, and a total of 74 quantitative features, including 13 shape features, 31 SUV-based features, and 30 normalized SUV-based features, were calculated. Wilcoxon rank sum test, receiver operating characteristic curve, and correlation coefficient analyses were applied to select independent representative features, and patient prognosis was stratified by the World Health Organization (WHO) grade and CHO features. Results A total of 89.2% of the quantitative features were significantly different between LGG and GBM, and the SUV-based features displayed higher area under the receiver operating characteristic curve (AUC) values than the other feature groups. Among the 5 traditional features, the SUVmax and the total lesion CHO uptake were the most distinguishing, with AUCs of 0.880 and 0.860 (0.938 and 0.927 after reclassification of 2 outliers), respectively, both of which could also stratify patient prognosis better than WHO grade. Five alternative features, including 2 shape features and 3 SUV-based features, were considered representative, with AUCs ranging from 0.754 to 0.854. Conclusions Quantitative features from CHO PET are reliable in determining the WHO grade of primary diffuse gliomas. Our findings suggest that GBM has a larger volume, a more spherical shape, higher choline activity in most interval segments, and a more symmetrical distribution than LGG.

The fast fault diagnosis of large-scale pulse-forming network (PFN) of electromagnetic rail launch system is of great significance. It is an important research direction to diagnose the PFN fault by detecting the anomaly of multidimensional time series in each pulse-formatting unit (PFU). Due to the high sampling rate of time series and the characteristics of aperiodic instantaneous pulse, the current time series diagnosis method is not suitable. Multidimensional coupling aggravates the complexity of the problem. In order to solve the problem, this article proposes a method of multidimensional time series anomaly detection based on convolutional neural network. First, the multidimensional time series is transformed into a gray-scale image, which can reflect the health status of a PFU. Second, a deep convolution neural network is constructed to identify the abnormal images based on the existing data trainers. Finally, a convolution neural network is constructed to locate the fault. The results show that the model can identify 100% of the abnormal PFU waveform, and the fault classification model can also accurately locate the fault, which proves the effectiveness of the proposed algorithm.

Objective: A case of primary first bite syndrome (FBS), diagnosed in a patient with nonspecific adenocarcinoma of the deep lobe of the parotid gland. Data Sources: A Medline literature search was conducted on PubMed, using the keywords “first bite syndrome.” Review Methods: Using primary FBS and existence of a definite etiology as inclusion criteria. Results: We report on an unusual case of primary FBS, which had no surgical history. After multiple examinations, the pain was localized to a mass in the deep lobe of the parotid gland. After tumorectomy, the FBS pain was significantly relieved. The postoperative pathological examination determined that the excised mass was a nonspecific adenocarcinoma. Reviewing the literature, we found that primary FBS was mostly caused by malignant tumors in the inferior temporal fossa, the deep lobe of the parotid gland, and (or) the parapharyngeal space. Surgery was reported to be an effective treatment. Conclusion: The case highlights the critical importance of identifying the etiology of primary FBS. When manifested with a primary FBS, malignant tumors must be high on the differential diagnosis list, especially those in the region of the inferior temporal fossa, the deep lobe of the parotid gland, and the parapharyngeal space.

Background Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described. Objective To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT. Design, setting, and participants Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019. Surgical procedure The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals. Measurements Clinicopathological, operative, and survival outcomes were collected and analyzed. Results and limitations All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p Conclusions RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation. Patient summary In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.

Background The role of adrenal venous sampling (AVS) has been challenged by some recent evidence. This study aimed to compare the role of AVS and computed tomography (CT) in the management of primary aldosteronism. Methods Patients who underwent unilateral adrenalectomy for primary aldosteronism at a single center between January 2015 and December 2018 were included, and postoperative outcomes of the patients who underwent surgery based on CT (n = 195) or AVS (n = 40) were compared. The data of all the patients who underwent AVS successfully (n = 75) during this period were also collected and analyzed. Results There were no significant differences between the CT-guided and AVS-guided adrenalectomies in most of the postoperative outcomes, and the proportion of patients achieving cure of hypokalemia (CT vs. AVS, 98.3 vs. 96.4%) and alleviation of hypertension (89.2 vs. 92.9%) were similar between the two groups. However, since the baseline characteristics of the two groups were not identical, the AVS-guided group showed greater improvement in postoperative hypokalemia and greater reduction in the number of antihypertensive medications than the CT-guided group. In addition, for the 75 patients who underwent AVS successfully, the concordance rate between CT abnormalities and AVS lateralization was 60.0% in total, and 22.7% patients changed treatment plans according to the AVS results. Conclusion Although the clinical outcomes were not significantly different between the CT-guided and AVS-guided group, the AVS-guided group seemed to benefit more from the surgery, and a considerable number of patients with primary aldosteronism would have received inappropriate treatment if they did not undergo AVS.

Primary thyroid lymphoma (PTL) is an exceptionally rare and highly aggressive potentially curable malignant disease. We report three typical cases of PTL referred to our hospital. All three cases had long history of Hashimoto's thyroiditis, and presented with progressively enlarging neck mass. The first two cases were confirmed by surgical biopsy to be diffuse large B cell lymphoma, and received radiotherapy combined with chemotherapy, or received only chemotherapy. The third case was confirmed by core needle biopsy to be mucosa-associated lymphoid tissue lymphoma, and received radiotherapy. In summary, confirmation of PTL diagnosis is essential for further clinical decisions. Core biopsy should be one of the most important methods to make the diagnosis of PTL, while the use of fine needle aspiration cytology alone is still limited in diagnosing PTL.

Quantifying the economic effects of climate change is a crucial step for planning adaptation in developing countries. For Egypt, global warming has put it among the most vulnerable countries. Where...

BACKGROUND: Liver cancer is one of the most common malignant tumors with a high incidence and mortality. Hepatitis-liver cirrhosis-liver cancer is known as the trilogy of liver cancer. At present, due to significant development of imaging interventions, they occupy an irreplaceable position in the field of liver cancer treatment, especially ultrasound-guided ablation. Because patients with liver cancer often present with liver cirrhosis, which leads to morphological deformation of the liver, it is difficult to perform a linear ablation of liver cancer in the areas near the phrenic top and within large blood vessels, among others. The present study reports on two cases of liver cancer that have been subjected to curvilinear ablation. After 1 mo, magnetic resonance imaging showed complete ablation, demonstrating that ultrasound-guided curved ablation is feasible and effective in the treatment of liver cancer. CASE SUMMARY: Two patients were treated at the Liver Disease Department of the Xixi Hospital Affiliated to Zhejiang University of Chinese Medicine in 2019. Because the first liver cancer patient’s tumor was located close to the diaphragm, it was difficult to complete a straight needle ablation procedure in one session. In order to achieve accurate and minimally invasive treatment of this tumor, a curved needle ablation procedure was designed. The second patient presented with a hepatic cyst in front of the tumor. In order not to damage the hepatic cyst, a looper needle ablation technique was used. The procedure was successfully completed in both cases. CONCLUSION: Curved ablation is a new technique that can be used to treat tumors situated in a variety of locations, providing new ideas for interventional techniques. Its operation difficulty is higher and further animal experiments are necessary to improve the operation procedure.

The utilisation and transfer of renewable energy and grid energy in the downlink of multiuser communication systems is studied. In the considered multiuser system, the base station (BS) is powered by both harvested energy and grid. When the BS transmits data to one user terminal, other terminals can replenish energy opportunistically from received radio-frequency signals, which is called simultaneous wireless information and power transfer (SWIPT). The objective is to maximise the average throughput by multiuser scheduling and energy allocation utilising imperfect causal channel state information while satisfying the requirement for harvested energy and the average power constraint of the grid. With channel dynamics and energy arrival modelled as Markov processes, the authors characterise the problem as a Markov decision process (MDP). The standard reinforcement learning framework is considered as an effective solution to MDP. If the transition probability of MDP is known, the policy iteration (PI) algorithm is used to solve the problem; otherwise, the R-learning algorithm is adopted. Simulation results show that the proposed algorithm can improve the average throughput of the system and increase the energy harvested by idle user terminals compared with existing works. Also, R-learning can achieve performance close to the PI algorithm under the condition that the channel transition probability is unknown.

Use of growth retardants enables post-planting optimization of vegetative growth, which is particularly important given ongoing climate change. Mepiquat chloride is an economical and safe retardant widely applied in cotton farming, but it is not uniformly effective. Here, identification of its molecular target as the ent-copalyl diphosphate synthase that initiates gibberellin biosynthesis enabled the introduction of selective agrochemical inhibition, leaving intact more specialized metabolism important for resistance to biotic and abiotic stresses. Mepiquat chloride is a growth retardant used in cotton farming to optimize growth by inhibiting gibberellin metabolism, but it is not effective in other crops. Now, its molecular target is found, enabling selective agrochemical inhibition of growth in cereals.

Accurate multiphase flowrate measurement is challenging but vital in the energy industry to monitor the production process. Machine learning has recently emerged as a promising method for estimating multiphase flowrates based on different conventional flow meters. In this paper, we propose a Convolutional Neural Network (CNN)-Long-Short Term Memory (LSTM) model and a Temporal Convolutional Network (TCN) model to estimate the volumetric liquid flowrate of oil/gas/water three-phase flow based on the Venturi tube. The volumetric flowrates of the liquid and gas phase vary from 0.1 - 10 m3/h and 7.6137 - 86.7506 m3/h, respectively. We collected time series sensing data from a Venturi tube installed in a pilot-scale multiphase flow facility and utilized single-phase flowmeters to acquire reference data before mixing. Experimental results suggest that the proposed CNN-LSTM and TCN models can effectively deal with the time series sensing data from the Venturi tube and achieve a good accuracy of multiphase flowrate estimation under different flow conditions. TCN achieves a better accuracy for both liquid and phase flowrate estimation than CNN-LSTM. The results indicate the possibility of leveraging conventional flow meters for multiphase flowrate estimation under various flow conditions.

BackgroundPrevious studies showed altered angiopoietin-like protein-8 (ANGPTL-8) and resistin circulating levels in type 2 diabetes mellitus (T2DM). Whether or not the alteration in ANGPTL-8 and resistin level can be a predictive maker for increased diabetic nephropathy risk remains unclear.AimTo Investigate the possible association of ANGPTL-8 and resistin with DN, and whether this association is affected by NAFLD status.MethodsA total of 278 T2DM patients were enrolled. Serum levels of ANGPTL8, resistin, BMI, blood pressure, duration of diabetes, glycosylated hemoglobin (HbA1c), fasting blood glucose (FPG), hypersensitive C-reactive protein (hs-CRP), lipid profile, liver, and kidney function tests were assessed. The relationship between DN with ANGPTL8 and resistin was analyzed in the unadjusted and multiple-adjusted regression models.ResultsSerum levels of ANGPTL8 and resistin were significantly higher in DN compared with T2DM subjects without DN (respectively; P PP=0.05). Analysis showed ANGPTL8 levels were positively associated with resistin but only in T2DM patients with DN(r=0.1867; PConclusionThis study highlights a close association between ANGPTL8, resistin and DN, especially in non-NAFLD populations. These results suggest that ANGPTL-8 and resistin may be risk predictors of DN.

China has set high water-conservation, energy-saving, and pollutant-reduction goals for the petrochemical industry. This represents a challenge to petrochemical enterprises because of the complex coupling between water, energy, and environmental pollutant (WEE) subsystems, elements (different types of WEE), and production units. However, there has been little research on the element-level coupling relationship. The connection and difference between the coupling relationships of the system, element, and unit levels are not well understood. Therefore, an integrated analysis method was developed to quantify the petrochemical WEE nexus (WEEN) at these three levels, including a generic WEEN model, material and energy flow analysis, and a WEEN analysis matrix. Three indicators were proposed to analyze three-level coupling quantitatively and to formulate improvement strategies for water-conservation, energy-saving, and pollutant-reduction. A case study demonstrated significant three-level coupling. The coupled percentage of WEE subsystems were 95.87%, 61.97%, and 54.99%, respectively. The dominant energy subsystem was the root of high consumption and pollution. Based on synergies and trade-offs, we proposed element optimization priorities: High priority (deoxidized water and fuel), medium priority (steam, circulating water, and wastewater), and low priority (fresh water, demineralized water, waste gas, and electricity). The identified unit improvement potential revealed overestimation (hydrotreating and delayed coking units) and underestimation (crude distillation units) of conventional methods that overlook three-level coupling.

Citron kinase (CIT) is a Rho-effector protein kinase that is associated with several types of cancer. However, the role of CIT in prostate cancer (PCa) is unclear. The current study utilized microarray data obtained from The Cancer Genome Atlas, which was analyzed via Biometric Research Program array tools. Additionally, reverse transcription-quantitative (RT-q)PCR was performed to compare the mRNA expression of CIT in PCa tissue and in benign prostatic hyperplasia. The protein expression of CIT was detected in a consecutive cohort via immunochemistry and CIT was screened as a potential oncogene in PCa. The results of RT-qPCR demonstrated that the mRNA expression of CIT was increased in PCa tissues. Furthermore, immunochemistry revealed that CIT protein expression was positively associated with age at diagnosis, Gleason grade, serum PSA, clinical T stage, risk group, lymph node invasion and metastasis. When compared with the low expression group, patients with a high CIT expression exhibited shorter survival rates, cancer specific mortalities (CSM) and biochemical recurrence (BCR). In addition, multivariate analysis revealed that CIT was a potential predictor of CSM and BCR. The results revealed that CIT is overexpressed during the malignant progression of PCa and may be a predictor of a poor patient prognosis.

Introduction: To evaluate the potential predictive value of the Mayo Adhesive Probability (MAP) score combined with the RENAL score for intraoperative outcomes in retroperitoneal laparoscopic nephron-sparing surgery (NSS) in an Eastern Asian population. Methods: An initial of 388 patients undergoing retroperitoneal laparoscopic NSS were identified. MAP and RENAL scores were calculated according to CT and a logistic regression model was adopted as a combination of the RENAL score and the MAP score. Results: A total of 293 patients were included. The overall intraoperative complication rate was 7.5% (21 cases). The MAP score was found to correlate with operation time (OT; r = 0.169), estimated blood loss (EBL; r = 0.318), and intraoperative complications (r = 0.242). The RENAL score was correlated with warm is­chemia time (r = 0.503), OT (r = 0.334), intraoperative complications (r = 0.178), and EBL (r = 0.218). The MAP score and the RENAL score were reliable predictors of overall intraoperative complications, with areas under the curve (AUC) of 0.728 and 0.759, respectively. After combination of these 2 scores, the AUC of overall intra-operative complications was improved with statistical significance (AUC = 0.847, combination vs. RENAL score: p = 0.044 < 0.05; combination vs. MAP score: p = 0.005 < 0.05). Conclusion: The MAP score is an important predictor of EBL, OT, and intraoperative complications in retroperitoneal laparoscopic NSS and its combination with the RENAL score showed a superior predictive value compared to a single score in overall intraoperative complications. The MAP score might be considered in preoperative radiologic aspects as regularly as the RENAL score.

Due to the wide adoption of photovoltaic power generation, non-isolated high step-up DC–DC converters are becoming more and more popular. Among these converters, the switched/coupled-inductor-based converter is more attractive due to the fact that it has fewer power devices and a high efficiency. This paper presents a three-level high step-up DC–DC topology with a three-winding coupled-inductor. When compared with a conventional switched/coupled-inductor-based converter, a higher efficiency can be achieved, owing to low voltage stresses devices, fewer semiconductors in the power loop, lower current stresses, and ZCS of the main switches. The operating principle of the proposed topology is analyzed in detail via equivalent circuits, where a theoretical analysis is carried out using state space modelling. Experimental results obtained on a 24–300 V, 360 W lab prototype have verified the excellent performance of the proposed DC–DC converter.

Perioperative hyperglycemia was associated with postoperative infection, and proper management of perioperative glucose has become critical in improving the prognosis of patients.A total of 1015 diabetic patients who underwent surgery and received insulin treatment for their hyperglycemia in our hospital were retrospectively reviewed. According to propensity matching, we obtained 253 pairs of patients from the group which received continuous subcutaneous insulin infusion (CSII) therapy (CSII group) and the group which received insulin injection therapy (non-CSII group). Perioperative glucose levels and corresponding outcomes were compared between the two groups.Compared with the non-CSII group, the CSII group had lower fasting and mean glucose levels, lower incidence of fever (operation day: 18.6% vs 10.2%; P = .014; first postoperative day: 55.1% vs 34.7%; P .001), a positive rate of postoperative secretion culture (6.3% vs 1.2%; P = .004), and a shorter time of antibiotics use (total antibiotics use: P = .002; postoperative antibiotics use: P .001) and hospital stays (P .001). However, there was no difference in the total medical expenditure between the two groups (P = .499). Further analysis showed that CSII therapy was superior to multiple daily insulin injection (MDI) therapy in its effect on infection and other postoperative outcomes when 64 pairs of patients from the CSII group and MDI group were compared.CSII therapy provides better perioperative glucose control and a lower risk of postoperative infection without increasing the total medical expenditure.背景: 围手术期的高血糖与术后的感染密切相关, 合理管理围手术期患者的血糖已经成为改善患者预后的关键。 方法: 本文回顾性分析了在我院接受手术并使用胰岛素控制血糖的1015例糖尿病患者资料。通过采用倾向性配对, 我们获得了253对患者。一组是接受持续皮下胰岛素输注治疗的患者(CSII组), 另一组是接受常规的胰岛素注射治疗的患者(non-CSII组)。比较两组患者围手术期血糖水平和其他相关结局。 结果: 与non-CSII组的患者相比, CSII组的患者空腹血糖和平均血糖水平明显改善; 同时, CSII组的患者术后发热率 (手术当天:18.6% vs.10.2%, P=0.014; 术后第一天:55.1% vs. 34.7%, P0.001)和术后分泌物培养阳性率(6.3% vs. 1.2%, P=0.004)也均下降。此外, CSII 组的抗生素使用时间[包括总体抗生素的使用时间(P=0.002)和术后抗生素使用时间(P0.001)]和住院天数(P0.001)均缩短。然而, 两组患者总体的医疗费用没有明显的差异(P=0.499)。此外, 我们还对CSII治疗组和non-CSII治疗中采用每天多次胰岛素注射治疗(MDI)的患者进行了倾向性配对, 共得到64对患者。经过比较发现, 在感染和术后其他指标上, CSII治疗仍然优于MDI治疗。 结论: 围手术期患者接收CSII治疗有更好的血糖控制和更低的术后感染风险, 而总体的医疗费用并不增加。.

This paper addresses a target-enclosing problem for multiple spacecraft systems by proposing a two-layer affine formation control strategy. Compared with the existing methods, the adopted two-layer network structure in this paper is generally directed, which is suitable for practical space missions. Firstly, distributed finite-time sliding-mode estimators and formation controllers in both layers are designed separately to improve the flexibility of the formation control system. By introducing the properties of affine transformation into formation control protocol design, the controllers can be used to track different time-varying target formation patterns. Besides, multi-layer time-varying encirclements can be achieved with particular shapes to surround the moving target. In the sequel, by integrating adaptive neural networks and specialized artificial potential functions into backstepping controllers, the problems of uncertain Euler-Lagrange models, collision avoidance as well as formation reconfiguration are solved simultaneously. The stability of the proposed controllers is verified by the Lyapunov direct method. Finally, two simulation examples of triangle formation and more complex hexagon formation are presented to illustrate the feasibility of the theoretical results. Keywords: Affine formation control, Collision avoidance, Lyapunov stability, Target enclosing, Two-layer strategy