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As Internet of Things (IoT) service becomes richer, data sharing among different IoT systems gets popular. Traditional IoT system provides data storage and access service with central cloud, which faces serious trust and security challenges. To provide cross-system data sharing service, we adopt blockchain to build a multi-center data management framework, construct a trustable environment for data sharing. As regards to security problem, Attribute Based Encryption (ABE) has been applied to IoT system, but it still relies on central server. Therefore, we design an ABE algorithm which could be used for multi-center scenario, and shift data management to blockchain instead of a central server. Moreover, IoT devices always cannot afford complex encrypt computations as they have limited computing resource. To solve this, we design obfuscating policy to shift encryption computations to cloud instead terminals. In this way, IoT devices could encrypt data with low computation cost. Security analysis and simulations prove that the algorithm we designed could reduce computation burdens of IoT terminals in data encryption and decryption phases effectively and safely.

In this paper, we survey state-of-the-art research outcomes in the burgeoning field of reconfigurable intelligent surface (RIS) in view of its potential for significant performance enhancement for next generation wireless communication networks by means of adapting the propagation environment. Emphasis has been placed on several aspects gating the commercially viability of a future network deployment. Comprehensive summaries are provided for practical hardware design considerations and broad implications of artificial intelligence techniques, so are in-depth outlooks on salient aspects of system models, use cases, and physical layer optimization techniques., 22 pages, 18 figures

Rain streaks showing in images or videos would severely degrade the performance of computer vision applications. Thus, it is of vital importance to remove rain streaks and facilitate our vision systems. While recent convolutinal neural network based methods have shown promising results in single image rain removal (SIRR), they fail to effectively capture long-range location dependencies or aggregate convolutional channel information simultaneously. However, as SIRR is a highly illposed problem, these spatial and channel information are very important clues to solve SIRR. First, spatial information could help our model to understand the image context by gathering long-range dependency location information hidden in the image. Second, aggregating channels could help our model to concentrate on channels more related to image background instead of rain streaks. In this paper, we propose a non-local channel aggregation network (NCANet) to address the SIRR problem. NCANet models 2D rainy images as sequences of vectors in three directions, namely vertical direction, transverse direction and channel direction. Recurrently aggregating information from all three directions enables our model to capture the long-range dependencies in both channels and spaitials locations. Extensive experiments on both heavy and light rain image data sets demonstrate the effectiveness of the proposed NCANet model.

Xiao Li,1,&ast; Zicheng Xu,1,&ast; Ting Xu,1,&ast; Feng Qi,1 Ninghong Song2 1Department of Urology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, People’s Republic of China; 2Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Feng QiDepartment of Urology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, People’s Republic of ChinaEmail qf199408@163.comNinghong SongDepartment of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of ChinaEmail songninghong@126.comBackground: To explore the baseline characteristics, pathological and survival outcomes of Asian-American patients with clear cell renal cell carcinoma (ccRCC), and make comparisons with White patients.Materials and Methods: In this study, patients diagnosed with ccRCC between 2010 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Basic characteristics of Asian-American patients were analysed and compared with White patients. Then, proportional mortality ratio (PMR) analyses were performed in Asian population to investigate the proportions of different cause of deaths (CODs), and make comparisons with White patients. Moreover, Kaplan–Meier (KM) analyses were developed to investigate the survival disparities of ccRCC patients between Asian-Americans and White patients. Finally, a competing risk regression model was constructed to identify potential prognostic factors for ccRCC patients in the whole population.Results: A total of 1586 Asian-American patients were eventually identified, and the median age at diagnosis was 61 years old. In Asian patients, those from South Asian had the youngest age at diagnosis (P< 0.001) and the earliest stage of diseases (localized: 76.83%, T1: 70.73%, all P< 0.05) when compared with other ethnicities. No significant differences were detected in tumor characteristics between Asian-Americans and White patients. Older age (P< 0.001), earlier stage (P< 0.001) and the administration of surgery (P=0.050) were tightly associated with a lower risk of dying of RCC in Asian-American patients. Additionally, Asian-American patients had comparable survival outcomes when compared with White patients. Lastly, competing risk regression model revealed that age at diagnosis (P< 0.001), tumor grade (P< 0.001), histological stage (P< 0.001), median household income (P< 0.001) and the administration of surgery (P< 0.001) were prognostic factors for cancer-specific survival (CSS) in ccRCC patients, while died of other causes was regarded as a competing event.Conclusion: Asian-American patients had similar tumor characteristics and survival outcomes with White patients. In Asian patients, those from South Asian had the youngest age at diagnosis and the earliest stage of diseases. Age, grade, histological stage, household income and surgery were identified to be closely related to CSS in ccRCC patients. In the future, prospective and well-designed studies are needed to verify our findings.Keywords: ccRCC, Asian-American, SEER, White, prognosis

Background Recurrent hepatocellular carcinoma (HCC) shows strong resistance to sorafenib, and the tumor-repopulating cells (TRCs) with cancer stem cell-like properties are considered a driver for its high recurrent rate and drug resistance. Methods Suppression of TRCs may thus be an effective therapeutic strategy for treating this fatal disease. We evaluated the pharmacology and mechanism of sulfarotene, a new type of synthetic retinoid, on the cancer stem cell-like properties of HCC TRCs, and assessed its preclinical efficacy in models of HCC patient-derived xenografts (PDXs). Results Sulfarotene selectively inhibited the growth of HCC TRCs in vitro and significantly deterred TRC-mediated tumor formation and lung metastasis in vivo without apparent toxicity, with an IC50 superior to that of acyclic retinoid and sorafenib, to which the recurrent HCC exhibits significant resistance at advanced stage. Sulfarotene promoted the expression and activation of RARα, which down-regulated SOS2, a key signal mediator associated with RAS activation and signal transduction involved in multiple downstream pathways. Moreover, sulfarotene selectively inhibited tumorigenesis of HCC PDXs with high expression for SOS2. Conclusions Our study identified sulfarotene as a selective inhibitor for the TRCs of HCC, which targets a novel RARα-SOS2-RAS signal nexus, shedding light on a new, promising strategy of target therapy for advanced liver cancer.

BACKGROUND Patients with ankylosing spondylitis (AS) combined with severe cervical fusion deformity have difficult airways. Awake fiberoptic intubation is the standard treatment for such patients. Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists. Bronchial blockers (BBs) have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation. AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB. METHODS We studied 12 AS patients (11 men and one woman) with lung or esophageal cancer who underwent thoracotomy with a BB. Preoperative airway evaluation found that all patients had a difficult airway. All patients received an intramuscular injection of penehyclidine hydrochloride (0.01 mg/kg) before anesthesia. In the operating room, dexmedetomidine(0.5 μg/kg) was infused intravenously for 10 min, with 2% lidocaine for airway surface anesthesia, and a 3% ephedrine cotton swab was used to contract the nasal mucosa vessels. Before tracheal intubation, fentanyl (1 μg/kg) and midazolam (0.02 mg/kg) were administered intravenously. Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position. Intravenous anesthesia was administered immediately after successful intubation, and a BB was inserted laterally. The pre-intubation preparation time, intubation time, facial grimace score, airway responsiveness score during the fiberoptic introduction, time of end tracheal catheter entry into the nostril, and lung collapse and surgical field score were measured. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded while entering the operation room (T1), before intubation (T2), immediately after intubation (T3), 2 min after intubation (T4), and 10 min after intubation (T5). After surgery, all patients were followed for adverse reactions such as epistaxis, sore throat, hoarseness, and dysphagia. RESULTS All patients had a history of AS (20.4 ± 9.6 years). They had a Willson's score of 5 or above, grade III or IV Mallampati tests, an inter-incisor distance of 2.9 ± 0.3 cm, and a thyromental (T-M) distance of 4.8 ± 0.7 cm. The average pre-intubation preparation time was 20.4 ± 3.4 min, intubation time was 2.6 ± 0.4 min, facial grimace score was 1.7 ± 0.7, airway responsiveness score was 1.1 ± 0.7, and pulmonary collapse and surgical exposure score was 1.2 ± 0.4. The SBP, DBP, and HR at T5 were significantly lower than those at T1-T4 (P < 0.05). While the values at T1 were not significantly different from those at T2-T4 (P > 0.05), they were significantly different from those at T5 (P < 0.05). Seven patients had minor epistaxis during endotracheal intubation, two were followed 24 h after surgery with a mild sore throat, and two had hoarseness without dysphagia. CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia. Proper doses of penehyclidine hydrochloride, dexmedetomidine, fentanyl, and midazolam, combined with 2% lidocaine, administered prior to intubation, can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients. BBs are safe and effective for one-lung ventilation in such patients during thoracotomy.

Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death. Women with immune thrombocytopenia (ITP) are at increased risk of developing PPH. Early identification of PPH helps to prevent adverse outcomes but is underused because clinicians do not have a tool to predict PPH for women with ITP. We therefore conducted a nationwide multicenter retrospective study to develop and validate a prediction model of PPH in patients with ITP. We included 432 pregnant women (677 pregnancies) with primary ITP from 18 academic tertiary centers in China from Jan 2008 to Aug 2018. A total of 157 (23.2%) pregnancies experienced PPH. The derivation cohort included 450 pregnancies. For the validation cohort, we included 117 pregnancies in the temporal validation cohort and 110 pregnancies in the geographical validation cohort. We assessed 25 clinical parameters as candidate predictors and used multivariable logistic regression to develop our prediction model. The final model included seven variables and was named MONITOR (maternal complication, WHO bleeding score, antepartum platelet transfusion, placental abnormalities, platelet count, previous uterine surgery, and primiparity). We established an easy-to-use risk heatmap and risk score of PPH based on the seven risk factors. We externally validated this model using both a temporal validation cohort and a geographical validation cohort. The MONITOR model had an AUC of 0.868 (95% CI 0.828-0.909) in internal validation, 0.869 (95% CI 0.802-0.937) in the temporal validation, and 0.811 (95% CI 0.713-0.908) in the geographical validation. Calibration plots demonstrated good agreement between MONITOR-predicted probability and actual observation in both internal validation and external validation. Therefore, we developed and validated a very accurate prediction model for PPH. We hope that the model will contribute to more precise clinical care, decreased adverse outcomes, and better health care resource allocation. This article is protected by copyright. All rights reserved.

Thrombocytopenia is a common complication of human cytomegalovirus (HCMV) infection in immunocompromised hosts, which contributes to poor prognosis even in patients receiving antiviral treatment. Here, we investigated the megakaryo/thrombopoiesis process, including the involvement of the c-Mpl/IEX-1 pathway, after HCMV infection, identified receptors mediating the interaction between megakaryocytes (MKs) and HCMV, and explored novel therapeutic targets. Our data shows that HCMV directly infects megakaryocytes in patients with HCMV DNAemia and influences megakaryopoiesis via the c-Mpl/IEX-1 pathway throughout megakaryocyte maturation, apoptosis, and platelet generation in vivo and in vitro. After treatment with inhibitors of PDGFRα and αvβ3, the HCMV infection rate in MKs was significantly reduced, suggesting that IMC-3G3 and anti-αvβ3 are potential therapeutic alternatives for viral infection. In summary, our study proposes a possible mechanism and potential treatments for thrombocytopenia caused by HCMV infection and other viral diseases associated with abnormal hemostasis.

Background To shed light on the survival outcomes of prostate cancer (PCa) patients diagnosed after a prior cancer and identify prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in PCa patients. Methods In the primary group, a total of 1,778 PCa patients with a prior cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2005 to 2015, retrospectively. Baseline characteristics and causes of death (COD) of these patients were collected and compared. In the second group, a total of 10,296 PCa patients [5,148 patients with PCa as the only malignancy and 5,148 patients with PCa as their second primary malignancy (SPM)] diagnosed between 2010 and 2011 were extracted to investigate the impact of prior cancers on survival outcomes. Results In PCa patients with a prior cancer, the most common type of prior cancer was from gastrointestinal system (29.92%), followed by urinary system (21.37%). Patients were more likely to die of the prior caner, and those with prior cancer from respiratory system had the worst survival outcomes. Moreover, the overall ratios in patients with stage (PCa) I-II and III-IV diseases were 0.21 and 1.65, indicating that patients with higher stage diseases were more likely to die of PCa. In the second group, patients with PCa as the SPM had worse OS than those with PCa as the first primary cancer. Lastly, prognostic factors for OS and CSS in PCa patients were explored. Conclusions PCa remains to be an important COD for patients with a prior malignancy, especially for those with high-stage diseases. PCa patients with a prior cancer had worse survival outcomes than those without.

An efficient modes analyses technique for isotropic or anisotropic material filled 2D metallic waveguides with an arbitrary contour using the multifilament current method (MFCM) is presented. The ideal PEC boundary of a 2D waveguide is replaced by a shell with a high conductivity and electrical small thickness. The thin lossy shell not only can well approximate the boundary condition of PEC waveguide wall therefore without altering the initial waveguide modes, but also can let the external excitation penetrate through to excite the inside modes, resulting in a high internal field intensity at the frequency of each mode. In this case, the modes are revealed by the peaks of field intensity responses, and the spurious modes which existed in traditional source‐free modes determination techniques can be completely avoided. Based on this idea, a generalized impedance boundary condition (GIBC) is formulated to represent the lossy waveguide wall and further utilized in the MFCM for simulating the internal field intensity over frequency. Three different configurations of a 2D waveguide are considered. The computed modes are compared with that obtained from commercial software, and an excellent agreement is achieved, yet an competitive advantage on simulation performances is observed by using the proposed technique.

Gastrointestinal bleeding (GIB) accounts for a significant proportion of life-threatening bleeding cases occurring after allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, data on GIB after haploidentical HSCT (haplo-HSCT) are not available. A total of 3180 patients received haplo-HSCT at Peking University People’s Hospital from January 2015 to November 2019, and GIB occurred in 188 of these patients (incidence of 5.9%). Platelet counts

Nanozymes are multi-functional nanomaterials with enzyme-like activity, which rapidly won a place in biomedicine due to their number of nanocatalytic materials types and applications. Yan and Gao first discovered horseradish peroxidase-like activity in ferromagnetic nanoparticles in 2007. With the joint efforts of many scientists, a new concept-nanocatalytic medicine-is emerging. Nanozymes overcome the inherent disadvantages of natural enzymes, such as poor environmental stability, high production costs, difficult storage and so on. Their progress in dentistry is following the advancement of materials science. The oral research and application of nanozymes is becoming a new branch of nanocatalytic medicine. In order to highlight the great contribution of nanozymes facilitating dental health, we first review the overall research progress of multi-functional nanozymes in oral related diseases, including treating dental caries, dental pulp diseases, oral ulcers and peri-implantitis; the monitoring of oral cancer, oral bacteria and ions; and the regeneration of soft and hard tissue. Additionally, we also propose the challenges remaining for nanozymes in terms of their research and application, and mention future concerns. We believe that the new catalytic nanomaterials will play important roles in dentistry in the future.

The aim of this study is to identify types and grades of Chinese liquors. For this, a hand-held electronic nose (e-nose) system is designed and a triangular difference-based binary coding (TDBC) recognition method is proposed. For a test sample of liquors, features extracted from five gas sensors of the e-nose are converted into binary codes (0 and 1) for each liquor category. Specifically, for each liquor category, if a feature value of a test sample is within the feature value range of all training samples, we mark it as 1, otherwise 0. Subsequently, for each liquor category, the sum of binary codes of the test sample is calculated, and the category corresponding to the maximum sum value is determined as the predicted label of the test sample. Using the e-nose-based TDBC method, average recognition accuracies of 97.5% and 99.0% for liquor-type identification and grade evaluation were achieved, which were considerably higher than those obtained using four traditional recognition methods. These results indicate that as a novel approach, the e-nose-based TDBC method allows the recognition of Chinese liquors accurately and quickly, which is of great significance for liquor detection and industrial quality assurance methods.

All-inorganic perovskite solar cells (PVSCs) have attracted intensive attention owing to their tunable bandgaps and excellent photo- and thermostability, making them promising absorbers in tandem solar cells (TSCs). Herein, we develop an all-inorganic perovskite/organic TSC with a wide bandgap all-inorganic perovskite CsPbI2.1Br0.9 and a narrow bandgap organic photoactive layer (PM6:Y6) serving as top and bottom sub cells respectively. The fabricated tandem solar cell demonstrated a remarkable PCE of 18.06%, with an open-circuit voltage (VOC) of 1.89 V, short-circuit current (JSC) of 12.77 mA cm−2, and fill factor (FF) of 74.81%, which is higher than that of both single junction PVSCs (14.43%) and organic solar cells (14.01%). Moreover, benefiting from the outstanding UV and thermal stability of inorganic perovskites, all-inorganic perovskite-based tandem devices showed superior stability under light and heat, with negligible degradation after 150 h of UV irradiation, 250 h under one sun illumination and 100 h of heating at 80 °C. This work demonstrates that all-inorganic perovskites are an appropriate candidate for the fabrication of efficient and stable TSCs.

We developed this study to describe the patterns of distant metastasis (DM) and explore the predictive and prognostic factors of DM in clear cell renal cell carcinoma (ccRCC) patients. We collected the eligible patients from the Surveillance, Epidemiology, and End Result (SEER) database from 2010 to 2015. Then, comparisons of baseline characteristics between patients in different metastatic patterns were made. In addition, proportional mortality ratios (PMRs) and proportion trends of different patterns were calculated. Afterward, survival outcomes were explored by Kaplan–Meier (KM) analyses. Finally, predictive and prognostic factors of DM were investigated. A total of 33,449 ccRCC patients were eventually identified, including 2931 patients with DM and 30,518 patients without DM. 8.76% of patients suffered DM at their initial diagnosis, 35.01% of them had multiple metastases. Generally, lung (6.19%) was the most common metastatic site in patients with DM, and brain (1.20%) was the least frequent metastatic organ. The proportion trends of different metastatic patterns tended to be stable between 2010 and 2015. Moreover, higher tumor grade, T stage, and N stage were identified as risk factors of DM. Finally, age at diagnosis, grade, T stage, N stage, the administration of surgery, the number of metastatic sties, marital status, and household income were found to be significantly associated with prognosis. Lung was the most common metastatic site in ccRCC patients. Different survival outcomes and prognostic factors were identified for different metastatic patterns. Hence, our study would have great value for clinical practice in the future., Lung was the most common metastatic site in ccRCC patients. Different survivals and prognostic factors were identified for different metastatic patterns. Hence, our study would have great value for clinical practice in the future.

After cardiac valve replacement, most patients will have different degrees of thrombosis, different parts of the thrombus, and even more frequent occurrence of postoperative thrombosis; therefore, the prevention of postoperative thrombosis is particularly important. The purpose of this study was to investigate the preventive effect of albumin nano tPA gene plasmid ultrasound microbubble carrier system on thrombosis, especially in cardiac valve. The experimental control method was used. Firstly, 11 dogs meeting the experimental requirements were selected. Secondly, the data of albumin nanoparticles and microbubbles were analyzed. The average size of albumin particles was 132.0 nm, the average size of microbubbles was 3.1 ± 1.6 μm, and the zeta potential was 13.70 ± 1.95 MV. The concentration of microbubbles was 4.2 ± 1.3 × 10/ml. Finally, 11 dogs were divided into two groups. The experimental group was treated with albumin nanoparticles ultrasound microbubble, and the others were the control group. It was found that the levels of tPA and D-dimer in the experimental group were significantly increased and maintained at a high level at 1 week after operation, and the prothrombin time was detected and the international normalized ratio was calculated at the same time. No significant changes were found in the experimental group.

For Unmanned Aerial Vehicles (UAV), the intelligent video analysis is a key technology in intelligent autonomous control, real-time navigation and surveillance. However, poor UAV wireless links would degrade the quality of video communication, leading to difficulties in video analysis. To meet the challenges of packet-loss and limited bandwidth in adverse UAV channel environments, this paper proposes a parameter optimization mechanism for UAV intelligent video analysis. In the proposed method, an Optimal Strategy Library (OSL) is designed to optimize the parameters for video encoding and forward error correction. Adapted to the packet-loss rate and bandwidth in practical UAV wireless network, the proposed OSL can facilitate the encoding of video sequences and the recovery of degraded videos with optimal performance. Experimental results demonstrate that the proposed solution can keep intelligent video analysis working efficiently with adverse UAV wireless links, and is capable of maximizing the inference accuracy of Multi-Object Tracking (MOT) algorithms in various scenarios.

Background Hemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever, hemorrhage, and acute kidney injury. Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection. Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically. Here, we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection. Case summary A 56-year-old man complained of high fever and generalized body ache, with decreased platelet counts of 10 × 109/L and acute kidney injury. The enzyme-linked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive. During the convalescent period, he complained sudden onset acute chest pain radiating to the back, and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery. He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection. The patient recovered completely after surgery with other support treatments. Conclusion Hemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition. Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment. A causal relationship has yet to be confirmed.

Background: The combination of prebiopsy MRI and transperineal targeted biopsies is being increasingly used to obtain tissues from patients with suspected prostate cancer (PCa). Objective: To inves...

Nowadays, the widely used Internet-of-Things (IoT) mobile devices (MDs) generate huge volumes of data, which need analyzing and extracting accurate information in real time by compute-intensive deep learning (DL) inference tasks. Due to its multilayer structure, the deep neural network (DNN) is appropriate for the mobile-edge computing (MEC) environment, and the DL tasks can be offloaded to DNN partitions deployed in MEC servers (MECSs) for speed-up inference. In this article, we first assume the arrival process of DL tasks as Poisson distribution and develop a tandem queueing model to evaluate the end-to-end (E2E) inference delay of DL tasks in multiple DNN partitions. To minimize the E2E delay, we develop a joint optimization problem model of partition deployment and resource allocation in MECSs (JPDRA). Since the JPDRA is a mixed-integer nonlinear programming (MINLP) problem, we decompose the original problem into a computing resource allocation (CRA) problem with fixed partition deployment decision and a DNN partition deployment (DPD) problem that optimizes the optimal-delay function related to the CRA problem. Next, we design a CRA algorithm based on Markov approximation and a low-complexity DPD algorithm to obtain the near-optimal solution in the polynomial time. The simulation results demonstrate that the proposed algorithms are more efficient and can reduce the average E2E delay by 25.7% with better convergence performance.

This article presents a decentralized decision-making strategy for the multi-area integrated electricity and natural gas system (IEGS). Independent system operators (ISOs) in the electric power sector and natural gas system operators (NGSOs) in the natural gas sector operate their respective systems independently with the consideration that a limited set of information is shared, and the information privacy and decision-making independence are preserved among operators. In this article, uncertainties associated with the proliferation of variable wind and solar generation as well as load forecast errors are addressed in a chance-constrained programming framework, and the loss of load probability (LOLP) as well as the transmission line overload probability (TLOP) are introduced to ensure a secure and economic operation of IEGS. The proposed multi-area & multi-layer problem is solved by a hierarchical iterative algorithm in which the inner loop deals with the collaboration between ISO and NGSO in each area, and the collaboration among areas is managed by the outer loop. Finally, case studies are carried out on two multi-area IEGSs with different sizes in which numerical results demonstrate the effectiveness of the proposed methods.

To explore the performance of targeted biopsy (TB) in combination with systematic biopsy (SB) in the detection of prostate cancer (PCa) in biopsy naïve patients.From May 2018 to January 2020, 230 biopsy-naïve men with suspicious bi-parametric MRI [bpMRI; Prostate Imaging Reporting and Data System (PI-RADS) score ≥3] were enrolled. All patients had prostate-specific antigen (PSA) levels of 20 ng/ml or less. For each patient, transrectal ultrasound-guided prostate biopsy was performed. The primary endpoint was the detection rate of CSPC [clinically-significant PCa, International Society of Urological Pathology grade group (ISUP GG) 2 or higher tumors]. The secondary endpoints were the detection rates of CIPC (clinically insignificant PCa, ISUP GG 1 tumors).CSPC was detected in 90 patients. Twelve (13.33%) of them were detected by TB only and 18 (20.00%) by SB only. Detection of CSPC by SB and TB did not differ significantly (No significant difference was found in the detection of CSPC between TB and SB; however, both techniques revealed substantial added value and combination of TB and SB could further improve this detection rate without increasing the detection of CIPC.

Despite the notable progress in perovskite solar cells, maintaining long-term operational stability and minimizing potentially leaked lead (Pb2+) ions are two challenges that are yet to be resolved. Here we address these issues using a thiol-functionalized 2D conjugated metal–organic framework as an electron-extraction layer at the perovskite/cathode interface. The resultant devices exhibit high power conversion efficiency (22.02%) along with a substantially improved long-term operational stability. The perovskite solar cell modified with a metal–organic framework could retain more than 90% of its initial efficiency under accelerated testing conditions, that is continuous light irradiation at maximum power point tracking for 1,000 h at 85 °C. More importantly, the functionalized metal–organic framework could capture most of the Pb2+ leaked from the degraded perovskite solar cells by forming water-insoluble solids. Therefore, this method that simultaneously tackles the operational stability and lead contamination issues in perovskite solar cells could greatly improve the feasibility of large-scale deployment of perovskite photovoltaic technology. Two-dimensional conjugated metal–organic frameworks used as an electron-extraction layer enable the realization of highly stable perovskite solar cells with minimized lead ion leakage.

Background Myofascial pain syndrome (MPS) has a high global prevalence and is associated with myofascial trigger points (MTrPs) in taut bands or nodules. Little is known about the aetiology. The current study assessed the pathophysiological characteristics of MTrPs in MPS patients. Methods Biopsies of the trapezius muscle were collected from the MTrPs of MPS patients (MTrP group; n = 29) and from healthy controls (control group; n = 24), and their morphologies were analysed via haematoxylin‐eosin (H&E) and Masson staining. A protein microarray was used to detect the receptor tyrosine kinase (RTK) family proteins. mRNA and long non‐coding RNA (lncRNA) sequencing and analysis were conducted, and immunohistochemistry and Western blotting were used to examine the expression of EphB and Rho family proteins. Results Abnormally contracted sarcomeres showed enlarged, round fibres without inflammation or fibrosis. An lncRNA‐mRNA network analysis revealed activation of muscle contraction signalling pathways in MTrP regions. Among RTK family proteins, 15 exhibited increased phosphorylation, and two exhibited decreased phosphorylation in the MTrP regions relative to control levels. In particular, EphB1/EphB2 phosphorylation was increased on the muscle cell membranes of abnormal sarcomeres. RhoA and Rac1, but not cell division control protein 42 (Cdc42), were activated in the abnormal sarcomeres. Conclusions EphB1/EphB2 and RhoA/Rac1 might play roles in the aetiology of abnormally contracted sarcomeres in MTrPs without inflammatory cell infiltration and fibrotic adhesion. Significance Contracted sarcomeres were found in MTrP regions, which is consistent with the MTrP formation hypothesis. EphB1/EphB2 and RhoA/Rac1 might play roles in the sarcomere contractile sites of MTrPs, which may be promising therapeutic targets.

With the fast development of smart cities and 5G, the amount of mobile data is growing exponentially. The centralized cloud computing mode is hard to support the continuous exchanging and processing of information generated by millions of the Internet-of-Things (IoT) devices. Therefore, mobile-edge computing (MEC) and software-defined networking (SDN) are introduced to form a cloud-edge-terminal collaboration network (CETCN) architecture to jointly utilize the communicational and computational resources. Although the CETCN brings many benefits, there still exist some challenges, such as the unclear operation mode, low utilization of edge resources, as well as the limited energy of terminals. To address these problems, a reinforcement learning-based joint communicational-and-computational resource allocation mechanism (RJCC) is proposed to optimize overall processing delay under energy limits. In RJCC, a $Q$ -learning-based online offloading algorithm and a Lagrange -based migration algorithm are designed to jointly optimize computation offloading across multisegments and on edge platform, respectively. The simulation results show that the proposed RJCC outperforms the delay-optimal, energy-optimal, and edge-to-terminal offloading algorithm by 42%–74% in long-term average energy consumption while maintaining relatively low delay.

Bone defects caused by trauma, tumor resection, congenital malformation and infection are still a major challenge for clinicians. Biomimetic bone materials have attracted more and more attention in science and industry. Insulin and insulin-like growth factor-1 (IGF-1) have been increasingly recognized as an inducible factor for osteogenesis and angiogenesis. Spatiotemporal release of insulin may serve as the promising strategy. Considering the successful application of nanoparticles in drug loading, various insulin delivery systems have been developed, including (poly (lactic-co-glycolic acid), PLGA), hydroxyapatite (HA), gelatin, chitosan, alginate, and (γ-glutamic acid)/β-tricalcium phosphate, γ-PGA/β-TCP). Here, we have reviewed the progress on nanoparticles carrying insulin/IGF for bone regeneration. In addition, the key regulatory mechanism of insulin in bone regeneration is also summarized. The future application strategies and the challenges in bone regeneration are also discussed.

Terahertz Time-Domain Spectroscopy (THz-TDS) has been a powerful tool for material characterization. The Fabry–Perot (FP) effect caused by the multiple reflections within the sample exists inherently, which makes the echoes contaminated. In the case of thin samples, different reflection signals may merge together and even the echoes corresponding to the main reflection disappears, making the characterization improper or impossible. To deal with this problem, a novel time-domain optimization method is proposed for removing the FP effect. By introducing a new term which describes the variation of the waveform in time-domain, not only the complex refractive index but also the thickness of material are obtained for a very thin silicon wafer (∼100 μm) whose thickness is less than 2/3 lambda at the central frequency of the THz-TDS system. The accuracy of the algorithm is quite comparable to an iterative method, which is considered to be the most accurate one at the moment, but it is more than 100 times faster, with a better convergence performance. Hence, it is promising for rapid material scenarios such as the in-line quality control and imaging-related applications.

With the proliferation of natural gas combined cycle units, the modern energy infrastructure has evolved into a coupled electricity and natural gas system, which often encompasses multiple large-scale and geographically-diverse energy areas. The similarity in electricity and natural gas consumption profiles in coupled systems gives rise to critical mandates for the coordinated optimization of electricity and natural gas operation. This paper presents a decentralized optimization framework, which considers wind energy and power-to-gas (P2G) technologies in the operation of integrated multi-area electricity and natural gas transmission system (IEGTS). First, a comprehensive optimal dispatch model is established for the multi-area IEGTS in a centralized manner where bi-directional flows of electricity and natural gas among multi-areas are optimized considering the stochastic nature of wind energy. In particular, a linearized transient-state gas flow model under mild assumptions is proposed to represent the dynamic characteristics of the natural gas sector. The centralized optimization problem is decomposed into a set of computationally-tractable subproblems that are solved independently in individual areas. The alternating direction multiplier method is employed to achieve a rapidly convergent solution while preserving the privacy of operation data shared among participating areas. Finally, case studies are carried out on two multi-area IEGTS with multiple wind generation scenarios which demonstrate the computational performance of the proposed method with P2G facilities operating in variable conditions.

Private and public networks sharing resources for Internet of Things (IoT) network through network function virtualization (NFV) and software-defined networking (SDN) forms a heterogeneous cloud-edge environment. However, the heterogeneous cloud-edge network faces trust and adaptation issues in resource allocation. To address these two problems, we introduce consortium blockchain and deep reinforcement learning (DRL) to construct the trusted and auto-adjust service function chain (SFC) orchestration architecture. In the architecture, this article integrates the consortium blockchain into the distributed SFC orchestration model to realize trusted resource sharing. In addition, for realizing auto-adjusted service provision, this article designs a dynamic hierarchical SFC orchestration algorithm (DHSOA) based on DRL to minimize the orchestration cost and improve the quality of service. Moreover, considering the dynamics of network entities, this article proposes a time-slotted model to support dynamic service migration which adapts to the high-mobility IoT network. The simulation results show that DHSOA has better performance than the link-state routing algorithm and deep $Q$ -network placement algorithm not only in cost saving of 15.8% and 10.1% but also in time saving of 22.0% and 10.0%.

We analyse a method of high repetition rate, efficient terahertz wave difference frequency generation (DFG) by using a self-Raman Nd-doped vanadate laser to pump 4’-dimethylamino-N-methyl-4-stilbaz...

Myofascial pain syndrome (MPS) is a type of skeletal pain identified by myofascial trigger points (MTrPs). The formation of MTrPs is linked to muscle damage. The fibroblast growth factor receptor (FGFR1) has been found to cause pain sensitivity while repairing tissue damage. The aim of the current study was to explore the mechanism of FGFR1 in MTrPs. We used a RayBio human phosphorylation array kit to measure p-FGFR1 levels in human control subjects and patients with MTrPs. P-FGFR1 was upregulated in the patients with MTrPs. Then a rat model of MPS was established by a blunt strike on the left gastrocnemius muscles (GM) and eccentric-exercise for 8 weeks with 4 weeks of recovery. After establishing the MPS model, the morphology of the GM changed, and the differently augmented sizes of round fibers (contracture knots) in the transverse section and fusiform shapes in the longitudinal section were clearly seen in the rats with myofascial pain. The expression of p-FGFR1 was upregulated on the peripheral nerves and dorsal root ganglion neurons in the MTrPs group. The spinal Fos protein expression was increased in the MTrPs group. Additionally, the mechanical pain threshold was reduced, and the expression of FGF2, p-FGFR1, PI3K-p110γ, and p-AKT increased in the MTrPs group. PD173074 increased the mechanical pain threshold of the MTrPs group, and inhibited the expression of p-FGFR1, PI3K-p110γ, and p-AKT. Moreover, LY294002 increased the mechanical pain threshold of the MTrPs group. These findings suggest that FGFR1 may regulate myofascial pain in rats through the PI3K/AKT pathway.

Blockchain technology is developing rapidly and has been applied in various aspects, among which there are broad prospects in Internet of Things (IoT). However, IoT mobile devices are restricted in communication and computation due to mobility and portability, so that they can’t afford the high computing cost for blockchain mining process. To solve it, the free resources displayed on non-mining-devices and edge cloud are selected to construct collaborative mining network(CMN) to execute mining tasks for mobile blockchain. Miners can offload their mining tasks to non-mining-devices within a CMN or the edge cloud when there are insufficient resources. Considering competition for resource of non-mining-devices, resource allocation problem in a CMN is formulated as a double auction game, among which Bayes-Nash Equilibrium (BNE) is analyzed to figure out the optimal auction price. When offloading to edge cloud, Stackelberg game is adopted to model interactions between edge cloud operator and different CMNs to obtain the optimal resource price and devices’ resource demands. The mechanism realizes improving the mining utility in mining networks while ensuring the maximum profit of edge cloud operator. Finally, profits of mining networks are compared with an existing mode which only considers offloading to edge cloud. Under the proposed mechanism, mining networks obtain 6.86% more profits on average.

Background To develop and validate prognostic nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in patients with penile cancer (PC). Methods Based on the Surveillance, Epidemiology, and End Result (SEER) database, patients diagnosed with PC from 2010 to 2015 were enrolled in this study. For each patient, clinical characteristics and survival results were respectively collected. With the method of random-number generation, included patients were divided into the training cohort and the validation group. Subsequently, nomograms were constructed to predict 3‐ and 5‐year OS and CSS based on the results of multivariate analyses. Kaplan-Meier (KM) method and the log-rank test were used to estimate survival curves of each variables. Finally, the calibration plots, concordance index (C-index), area under the receiver operating characteristic (ROC) curves were used to evaluate nomograms performance. Results Totally, 1,418 patients were eventually enrolled in the study, including 994 patients in the training cohort and 424 patients in the validation cohort. No significant difference was detected in the baseline characteristics between two cohorts. According to results of the uni- and multivariate analysis in the training cohort, 7 factors (including age, race, T stage, N stage, M stage, histology codes, and the use of surgery) for OS and 7 factors (including race, T stage, N stage, M stage, histology codes, the use of surgery and lymph node removal) for CSS were selected for constructing the nomograms. The C-indices for OS and CSS were 0.755 and 0.805 in the training cohort and 0.711, 0.737 in the validation cohort. In addition, the 3- and 5-year area under the ROC curve (AUC)s for OS were 0.792 and 0.771 in the training cohort, and 0.687 and 0.695 in the validation group. When it came to CSS, it was 0.83 and 0.826 in the training cohort and 0.758 and 0.746 in the validation cohort. Lastly, the calibration curves indicated a good consistency between the actual survival and the predictive survival. Conclusions We firstly established survival models to predict OS and CSS in PC patients with good predictive ability. Further studies are needed to validate our results before clinical application in the future.

As the great prevalence of various Internet of Things (IoT) terminals, how to solve the problem of isolated information among different IoT platforms attracts attention from both academia and industry. It is necessary to establish a trusted access system to achieve secure authentication and collaborative sharing. Therefore, this article proposes a distributed and trusted authentication system based on blockchain and edge computing, aiming to improve authentication efficiency. This system consists of physical network layer, blockchain edge layer and blockchain network layer. Through the blockchain network, an optimized practical Byzantine fault tolerance consensus algorithm is designed to construct a consortium blockchain for storing authentication data and logs. It guarantees trusted authentication and achieves activity traceability of terminals. Furthermore, edge computing is applied in blockchain edge nodes, to provide name resolution and edge authentication service based on smart contracts. Meanwhile, an asymmetric cryptography is designed, to prevent connection between nodes and terminals from being attacked. And a caching strategy based on edge computing is proposed to improve hit ratio. Our proposed authentication mechanism is evaluated with respect to communication and computation costs. Simulation results show that the caching strategy outperforms existing edge computing strategies by 6%–12% in terms of average delay, and 8%–14% in hit ratio.

Sensitive and specific diagnostic and prognostic biomarkers for prostate cancer (PCa) are urgently needed. Urine samples are a non-invasive means to obtain abundant and readily accessible “liquid biopsies”. Herein we used urine liquid biopsies to identify and characterize a novel group of urine-enriched RNAs and metabolites in patients with PCa and normal individuals with or without benign prostatic disease. Differentially expressed RNAs were identified in urine samples by deep sequencing and metabolites in urine were measured by mass spectrometry. mRNA and metabolite profiles were distinct in patients with benign and malignant disease. Integrated analysis of urinary gene expression and metabolite signatures unveiled an aberrant glutamate metabolism and tricarboxylic acid (TCA) cycle node in prostate cancer-derived cells. Functional validation supported a role for glutamate metabolism and glutamate oxaloacetate transaminase 1 (GOT1)-dependent redox balance in PCa, which could be exploited for novel biomarkers and therapies. In this study, we discovered cancer-specific changes in urinary RNAs and metabolites, paving the way for the development of sensitive and specific urinary PCa diagnostic biomarkers either alone or in combination. Our methodology was based on single void urine samples (i.e., without prostatic massage). The integrated analysis of metabolomic and transcriptomic data from these liquid biopsies revealed a glutamate metabolism and tricarboxylic acid cycle node that was specific to prostate-derived cancer cells and cancer-specific metabolic changes in urine.

Background Older adults exposed to periods of inactivity during hospitalization, illness, or injury lose muscle mass and strength. This, in turn, predisposes poor recovery of physical function upon reambulation and represents a significant health risk for older adults. Bed rest (BR) results in altered skeletal muscle fuel metabolism and loss of oxidative capacity that have recently been linked to the muscle atrophy program. Our primary objective was to explore the effects of BR on mitochondrial energetics in muscle from older adults. A secondary objective was to examine the effect of β-hydroxy-β-methylbuturate (HMB) supplementation on mitochondrial energetics. Methods We studied 20 older adults before and after a 10-day BR intervention, who consumed a complete oral nutritional supplement (ONS) with HMB (3.0 g/d HMB, n = 11) or without HMB (CON, n = 9). Percutaneous biopsies of the vastus lateralis were obtained to determine mitochondrial respiration and H2O2 emission in permeabilized muscle fibers along with markers of content. RNA sequencing and lipidomics analyses were also conducted. Results We found a significant up-regulation of collagen synthesis and down-regulation of ribosome, oxidative metabolism and mitochondrial gene transcripts following BR in the CON group. Alterations to these gene transcripts were significantly blunted in the HMB group. Mitochondrial respiration and markers of content were both reduced and H2O2 emission was elevated in both groups following BR. Conclusions In summary, 10 days of BR in older adults causes a significant deterioration in mitochondrial energetics, while transcriptomic profiling revealed that some of these negative effects may be attenuated by an ONS containing HMB.

As a mode of processing task request, edge computing paradigm can reduce task delay and effectively alleviate network congestion caused by the proliferation of Internet of things(IoT) devices compared with cloud computing. However, in the actual construction of the network, there are various edge autonomous subnets in the adjacent areas, which leads to the possibility of unbalance of server load among autonomous subnets during the peak period of task request. In this paper, a deep reinforcement learning algorithm is proposed to solve the complex computation offloading problem for the heterogeneous Edge Computing Server(ECS) collaborative computing. The problem is solved based on the real-time state of the network and the attributes of the task, which adopts Actor Critic and Policy Gradient's Deep Deterministic Policy Gradient(DDPG) to make optimized decisions of computation offloading. Considering multi-task, the heterogeneity of edge subnet and mobility of edge devices, the proposed algorithm can learn the network environment and generate the computation offloading decision to minimize the task delay.The simulation results show that the proposed DDPG-based algorithm is competitive compared with the Deep Q Network(DQN) algorithm and Asynchronous Advantage Actor-Critic(A3C) algorithm. Moreover, the optimal solutions are leveraged to analyze the influence of edge network parameters on task delay.

Background: Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences. A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses. A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines. Methods and analysis: a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up. The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC) The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers. Ethics: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. Trial registration number: NCT02751086

Background To identify prognostic genes which were associated with adrenocortical carcinoma (ACC) tumor microenvironment (TME). Methods and materials Transcriptome profiles and clinical data of ACC samples were collected from The Cancer Genome Atlas (TCGA) database. We use ESTIMATE (estimation of stromal and Immune cells in malignant tumor tissues using expression data) algorithm to calculate immune scores, stromal scores and estimate scores. Heatmap and volcano plots were applied for differential analysis. Venn plots were used for intersect genes selection. We used protein‐protein interaction (PPI) networks and functional analysis to explore underlying pathways. After performing stepwise regression method and multivariate Cox analysis, we finally screened hub genes associated with ACC TME. We calculated risk scores (RS) for ACC cases based on multivariate Cox results and evaluated the prognostic value of RS shown by receiver operating characteristic curve (ROC). We investigated the association between hub genes with immune infiltrates supported by algorithm from online TIMER database. Results Gene expression profiles and clinical data were downloaded from TCGA. Lower immune scores were observed in disease with distant metastasis (DM) and locoregional recurrence (LR) than other cases (P = .0204). Kaplan‐Meier analysis revealed that lower immune scores were significantly associated with poor overall survival (OS) (P = .0495). We screened 1649 differentially expressed genes (DEGs) and 1521 DEGs based on immune scores and stromal scores, respectively. Venn plots helped us find 1122 intersect genes. After analysing by cytoHubba from Cytoscape software, 18 hub genes were found. We calculated RS and ROC showed significantly predictive accuracy (area under curve (AUC) = 0.887). ACC patients with higher RS had worse survival outcomes (P, To identify prognostic genes in adrenocortical carcinoma (ACC) tumor microenvironment (TME).

Real-time network resource allocation based on virtualization technology is an important method to solve the solidification problem of Fiber-wireless (FiWi) access networks. To increase the resource utilization and meet the specific QoS requirements of smart gird communication services, a Load-balancing and QoS based dynamic resource allocation method (LbQ-DR) is proposed with three sub-mechanisms. A time-window based substrate network resource update mechanism is designed to describe the realtime resource consumption of substrate networks, which can balance the accuracy of resource status and the complexity of the allocation algorithm. A QoS-based Virtual network request (VNR) sorting mechanism is presented to precisely calculate the priority of VNRs and reasonably sort the incoming services. A load-balancing based resource allocation mechanism is designed to avoid unbalanced resource consumption. Especially, the channel interference is considered in the cost of embedding and a collision domain mechanism is introduced to decrease interference. Simulation results demonstrate that the proposed method can provide heterogeneous smart grid businesses with differentiated service, improve the utilization and economic benefits of the network and make the network more balanced.

PD-L1(CD274) is a well-known immunosuppressive molecule, which confers immunoescape features to cancer cells and has become one of the major targets in cancer immunotherapies. Understanding the regulatory mechanisms that control PD-L1 protein expression is important for guiding immune checkpoint blockade therapy. Here, we showed that ubiquitin specific peptidase 5 (USP5) was a novel PD-L1 deubiquitinase in non-small cell lung cancer (NSCLC) cells. USP5 directly interacted with PD-L1 and deubiquitinated PD-L1, therefore enhances PD-L1 protein stability. Meanwhile, USP5 protein levels were highly elevated and positively correlated to PD-L1 levels in NSCLC tissues, and were closely correlated with poor prognosis of these patients. In addition, knockdown of USP5 retarded tumor growth in the Lewis lung carcinoma mouse model. Thus, we identified that USP5 was a new regulator of PD-L1 and targeting USP5 is a promising strategy for cancer therapy.

Background:Cough variant asthma (CVA) is a chronic inflammatory airway disease characterized by airway hyper-responsiveness (AHR). However, it’s precise mechanism is not clear yet. The date show that latent myofascial trigger points (MTrPs) can induce autonomic phenomena, such as over secretion, airway hyper-responsiveness, and so on. Therefore, we assumed that latent MTrPs might disrupt the balance between sympathetic and parasympathetic, which might play an essential role in the etiology of CVA.Results:Recurrence rate was lower in the intervention group than the control group (36w, 5.0% vs. 34.5%, P=0.001). There were significant between-group differences in change from baseline to 36 weeks in VAS (5.80±1.20 to 1.70±1.49 and 5.53±1.21 to 3.18±2.04, respectively; 95%CI, -2.00 to -1.00; P=0.001); ACT-scores (12.78±1.86 to 21.38±2.65 and 13.09±1.97 to 18.53±3.00, respectively; 95%CI, 2.00 to 4.00; P PPP=0.003). Fewer adverse events were founded between the two groups (7.5% vs. 14.5%, P=0.462). Conclusions:Compared with budesonide-formoterol plus montelukast therapy, latent MTrPs injection therapy provided a long-acting, practical, short treatment course and safety methods for CVA. The findings indicated that latent MTrPs might play a vital role in the pathogenesis of CVA.Clinical Trials Registration: Chinese Clinical Trial Registry, ChiCTR2100044079. Registered 9 March 2021, http://www.chictr.org.cn/index.aspx

BackgroundTransarterial chemoembolization (TACE) stands for the most commonly utilized therapy for hepatocellular carcinoma (HCC) worldwide. This study was to explore the potential predictive and prognostic roles of LAG-3 and PD-L1 as serum biomarkers in HCC patients underwent TACE treatment.MethodsA total of 100 HCC patients receiving TACE as well as 30 healthy controls were enrolled in the study. Serum LAG-3 and PD-L1 levels were determined at baseline and 3 day after TACE using enzyme-linked immunosorbent assay (ELISA).ResultsWe found serum levels of LAG-3 and PD-L1 were significantly elevated in HCC patients compared with healthy controls. Interestingly, patients with low pre-TACE and post-TACE levels of LAG-3 but not PD-L1 had a high probability of achieving an objective response (OR) after TACE treatment. Additionally, high pre-TACE LAG-3 level was correlated with poor disease outcome, and the patients with both high serum LAG-3 and PD-L1 level had the shorter overall survival (OS) than patients who are either PD-L1 or LAG-3 high or both PD-L1 and LAG-3 low. High pre-TACE serum LAG-3 level was positively associated with more cirrhosis pattern, advanced BCLC stage, pre-TACE alanine aminotransferase (ALT) level, and pre-TACE aspartate aminotransferase (AST) level. Furthermore, in 50 patients who underwent TACE, the serum LAG-3 level was significantly decreased at 3 day after TACE.ConclusionBoth pre-TACE and post-TACE serum LAG-3 levels could serve as powerful predictors for tumor response of TACE, and high pre-TACE serum LAG-3 level was an indicator for poor prognosis in HCC.

Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy for gastric cancer. Methods: The protocol-based, international IMIGASTRIC (International study group on Minimally Invasive surgery for Gastric Cancer) registry was queried to retrieve data on patients undergoing laparoscopic or open gastrectomy with D2 lymphadenectomy for gastric cancer with curative intent from January 2000 to December 2014. Eleven predefined, demographical, clinical, and pathological variables were used to conduct a 1:1 propensity score matching (PSM) analysis to investigate intraoperative and recovery outcomes, complications, pathological findings, and survival data between the two groups. Predictive factors of long-term survival were also assessed. Results: A total of 3033 patients from 14 participating institutions were selected from the IMIGASTRIC database. After 1:1 PSM, a total of 1248 patients, 624 in the laparoscopic group and 624 in the open group, were matched and included in the final analysis. The total operative time (median 180 versus 240 min, p &lt, 0.0001) and the length of the postoperative hospital stay (median 10 versus 14.8 days, p &lt, 0.0001) were longer in the open group than in the laparoscopic group. The conversion to open rate was 1.9%. The proportion of patients with in-hospital complications was higher in the open group (21.3% versus 15.1%, p = 0.004). The median number of harvested lymph nodes was higher in the laparoscopic approach (median 32 versus 28, p &lt, 0.0001), and the proportion of positive resection margins was higher (p = 0.021) in the open group (5.9%) than in the laparoscopic group (3.2%). There was no significant difference between the groups in five-year overall survival rates (77.4% laparoscopic versus 75.2% open, p = 0.229). Conclusion: The adoption of the laparoscopic approach for gastric resection with D2 lymphadenectomy shortened the length of hospital stay and reduced postoperative complications with respect to the open approach. The five-year overall survival rate after laparoscopy was comparable to that for patients who underwent open D2 resection. The types of surgical approaches are not independent predictive factors for five-year overall survival.

Tumor mutation burden (TMB) is associated with immune infiltration, while its underlying mechanism in hepatocellular carcinoma (HCC) remains unclear. A long noncoding RNA (lncRNA)-related competitive endogenous RNA (ceRNA) network can regulate various tumor behaviors, and research about its correlation with TMB and immune infiltration is warranted. Data were downloaded from TCGA and ArrayExpress databases. Cox analysis and machine learning algorithms were employed to establish a lncRNA-based prognostic model for HCC. We then developed a nomogram model to predict overall survival and odds of death for HCC patients. The association of this prognostic model with TMB and immune infiltration was also analyzed. In addition, a ceRNA network was constructed by using DIANA-LncBasev2 and the starBase database and verified by luciferase reporter and colocalization analysis. Multiplex immunofluorescence was applied to determine the correlation between ULBP1 and PD-L1. An eight-lncRNA (SLC25A30-AS1, HPN-AS1, LINC00607, USP2-AS1, HCG20, LINC00638, MKLN1-AS and LINC00652) prognostic score model was constructed for HCC, which was highly associated with TMB and immune infiltration. Next, we constructed a ceRNA network, LINC00638/miR-4732-3p/ULBP1, that may be responsible for NK cell infiltration in HCC with high TMB. However, patients with high ULBP1 possessed a poorer prognosis. Using multiplex immunofluorescence, we found a significant correlation between ULBP1 and PD-L1 in HCC, and patients with high ULBP1 and PD-L1 had the worst prognosis. In brief, the eight-lncRNA model is a reliable tool to predict the prognosis of HCC patients. The LINC00638/miR-4732-3p/ULBP1 axis may regulate immune escape via PD-L1 in HCC with high TMB.