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In this traffic-scene-modeling study, we propose an image-captioning network which incorporates element attention into an encoder-decoder mechanism to generate more reasonable scene captions. A visual-relationship-detecting network is also developed to detect the relative positions of object pairs. Firstly, the traffic scene elements are detected and segmented according to their clustered locations. Then, the image-captioning network is applied to generate the corresponding description of each traffic scene element. The visual-relationship-detecting network is utilized to detect the position relations of all object pairs in the subregion. The static and dynamic traffic elements are appropriately selected and organized to construct a 3D model according to the captions and the position relations. The reconstructed 3D traffic scenes can be utilized for the offline test of unmanned vehicles. The evaluations and comparisons based on the TSD-max, KITTI and Microsoft's COCO datasets demonstrate the effectiveness of the proposed framework.

The robot-held laparoscope efficiently maintains the stability of the surgical screen in comparison with the laparoscope held by the assistant. The collaboration between the robot-held laparoscope with the surgeon is achieved without the artificial manipulation by tracking surgical instruments automatically. In this work, a visual tracking space vector method is proposed to autonomously control the field-of-view (FOV) by tracking multiple surgical instruments. In the proposed method, a visual tracking space vector is introduced to track the motion of multiple instruments, and a constraint vector is defined to ensure that the laparoscope is always within the safe working space. In addition, a modified YOLOv3 algorithm is proposed to robustly detect and classify the surgical instruments. The proposed method automatically adapts to the changes in the number of surgical instruments, as compared to other visual servoing methods for tracking surgical instruments. The proposed method does not require the depth information of the tracked surgical instruments. Experimental and simulation results verify that the proposed method accurately and efficiently controls the robot-held laparoscope to track the motion of multiple surgical instruments and ensure safe tracking movement.

BACKGROUND: Acetowhite (AW) region is a critical physiological phenomenon of precancerous lesions of cervical cancer. An accurate segmentation of the AW region can provide a useful diagnostic tool for gynecologic oncologists in screening cervical cancers. Traditional approaches for the segmentation of AW regions relied heavily on manual or semi-automatic methods. OBJECTIVE: To automatically segment the AW regions from colposcope images. METHODS: First, the cervical region was extracted from the original colposcope images by k-means clustering algorithm. Second, a deep learning-based image semantic segmentation model named DeepLab V3+ was used to segment the AW region from the cervical image. RESULTS: The results showed that, compared to the fuzzy clustering segmentation algorithm and the level set segmentation algorithm, the new method proposed in this study achieved a mean Jaccard Index (JI) accuracy of 63.6% (improved by 27.9% and 27.5% respectively), a mean specificity of 94.9% (improved by 55.8% and 32.3% respectively) and a mean accuracy of 91.2% (improved by 38.6% and 26.4% respectively). A mean sensitivity of 78.2% was achieved by the proposed method, which was 17.4% and 10.1% lower respectively. Compared to the image semantic segmentation models U-Net and PSPNet, the proposed method yielded a higher mean JI accuracy, mean sensitivity and mean accuracy. CONCLUSION: The improved segmentation performance suggested that the proposed method may serve as a useful complimentary tool in screening cervical cancer.

The development of environmentally friendly ceramics for electrostatic energy storage has drawn growing interest due to the wide application in high power and/or pulsed power electronic systems. However, it is difficult to simultaneously achieve ultrahigh recoverable energy storage density (Wrec > 8 J/cm3) and high efficiency (η > 80 %), which restricts their application in the miniaturized, light weight and easy integrated electronic devices. Herein, the novel NaNbO3-(Bi0.8Sr0.2)(Fe0.9Nb0.1)O3 relaxor antiferroelectric ceramics, which integrates the merits of antiferroelectrics and relaxors, are demonstrated to exhibit stabilized antiferroelectric phase and enhanced dielectric relaxor behavior. Of particular importance is that the 0.88NN-0.12BSFN ceramic achieves giant electric breakdown strength Eb = 98.3 kV/mm, ultrahigh Wrec = 16.5 J/cm3 and high η = 83.3 %, as well as excellent frequency, cycling and thermal reliability simultaneously. The comprehensive energy storage performance of NN-BSFN not only outperforms state-of-the-art dielectric ceramics by comparison, but also displays outstanding potential for next-generation energy storage capacitors.

Background The optimal cumulative cisplatin dose (CCD) during radiation therapy for locoregionally advanced nasopharyngeal carcinoma (LA‐NPC) patients receiving induction chemotherapy (IC) plus CCRT remains controversial. This study aimed to explore the treatment efficiency of CCD for high‐and low‐risk patients with LA‐NPC. Methods Data from 472 LA‐NPC patients diagnosed from 2014 to 2018 and treated with IC plus CCRT were reviewed. After propensity score matching, the therapeutic effects of a CCD > 200 and CCD ≤ 200 mg/m2 were evaluated comparatively. Five factors selected by multivariate analysis were incorporated to develop a nomogram. Subgroup analysis was conducted to explore the role of different CCDs in nomogram‐defined high‐ and low‐risk groups. Additionally, acute toxicities were evaluated comparatively between the high‐ and low‐CCD groups. Results After matching, there was no difference between different CCD groups for all patients in terms of 3‐year overall survival (OS), distant metastasis‐free survival (DMFS), locoregional recurrence‐free survival (LRRFS), or progression‐free survival (PFS). A nomogram was built by integrating pretreatment EBV DNA, clinical stage, and post‐IC EBV DNA, post‐IC primary gross tumor and lymph node volumes obtained a C‐index of 0.674. The high‐risk group determined by the nomogram had poorer 3‐year PFS, OS, DMFS, and LRRFS than the low‐risk group. A total of CCD > 200 mg/m2 increased the survival rates of 3‐year PFS and DMFS (PFS: 72.5% vs. 54.4%, p = 0.012; DMFS: 81.9% vs. 61.5%, p = 0.014) in the high‐risk group but not in the low‐risk group. Moreover, the high CCD increased treatment‐related acute toxicities. Conclusions A high CCD was associated with better 3‐year PFS and DMFS rates than a low dose for high‐risk patients but could not produce a survival benefit for low‐risk patients.

Background Findings concerning gender differences in the associations between tobacco smoke exposure (TSE) and depression are inconsistent. This study aimed to investigate the gender-specific associations between active and passive TSE with depressive symptoms in a large, nationally representative sample of U.S. adults. Methods Data were from 27,175 adults aged ≥20 years in the 2007–2018 National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression was used to adjust for possible confounders. Whether the TSE-depression relationships may differ by age, race/ethnicity, socioeconomic status, body mass index (BMI), and self-reported health status was examined. Results After adjustment for lifestyle- and health-related variables, no significant associations between active (OR, 1.16 [95% CI, 0.87–1.55]) and passive TSE (OR, 0.84 [95% CI, 0.59–1.19]) and depressive symptoms were found among men. Among women, active TSE was associated with depressive symptoms (OR, 1.90 [95% CI, 1.51–2.39]), while the association for passive TSE was nonsignificant (OR, 1.11 [95% CI, 0.91–1.34]) after adjusting for lifestyle- and health-related variables. Interaction and subgroup analyses showed that self-reported health status could modify the relationship between passive TSE and depressive symptoms among women. Furthermore, a dose-response relationship between serum cotinine and depressive symptoms was found in women, but not in men. Conclusions This study suggests a stronger TSE-depression association in women than in men. Understanding these gender-specific patterns and identifying the potential moderators of such relationships will enable better targeting of public health interventions.

To determine the relationship of intraocular pressure (IOP) control with subsequent retinal nerve fiber layer (RNFL) thinning in patients with primary angle closure disease (PACD).Prospective cohort study.The study monitored 517 treated PACD eyes from 280 Chinese patients at least 24 months. IOP was measured every 3 months using Goldmann applanation tonometry, and RNFLs were measured by spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering) every 6 months. IOP mean and fluctuation were calculated as the average and the coefficient of variation of IOP measurements during the first 18 months of the study period. The relationship between IOP and subsequent RNFL changes over time were examined using multivariable linear mixed models. Intraclass correlations at the patient and eye levels were also controlled using nested random intercepts in the models.IOP mean (β = -1.20 µm/y per 1 mm Hg, P.001) and IOP fluctuation (β = -3.10 µm/y per 10% unit change in the coefficient of variation, P.001) were independently negatively associated with subsequent progressive global RNFL changes, after adjustment for age, sex, and baseline RNFL thickness. In the sectoral analysis, both higher mean IOP and IOP fluctuation predicted progressive RNFL thinning in the inferotemporal, superotemporal, superonasal, and temporal sectors in the order of strength of association. In the subgroup analysis by disease category, IOP fluctuation showed greater association with global RNFL thinning in eyes with primary angle closure glaucoma (P = .010) than in eyes without glaucomatous changes (P = .07).In treated PACD eyes, large IOP fluctuation is an independent predictor for subsequent progressive RNFL thinning in addition to high mean IOP during follow-up.

The study aimed to compare the performance of human papillomavirus (HPV)-based strategies to cytology for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in routine program in China. The study included 50,434 women ages 30–64 years from January 2015 to December 2019, to assess four strategies: cytology with HPV triage (strategy 1), primary HPV testing with reflex cytology (strategy 2), primary HPV testing with HPV-16/18 genotyping and reflex cytology for non-16–18 high-risk HPV genotypes (strategy 3), and co-testing (strategy 4). The main outcomes were sensitivity for CIN3+ and colposcopy referral rate. Overall, the rates of HPV positivity and cytologic abnormality were 7.0% [95% confidential interval (CI), 6.8–7.2] and 3.5% (95% CI, 3.3–3.6], respectively. The sensitivity for CIN3+ were 88.5% for strategy 4, 83.2% for strategy 3, 64.6% for strategy 1, and 60.1% for strategy 2. The relative sensitivity of strategy 4 and strategy 3 compared with strategy 1 for detecting CIN3+ were 1.38 (95% CI, 1.24–1.54) and 1.29 (95% CI, 1.14–1.46), respectively. The colposcopy referral rates of strategies 4 and 3 were significantly higher than that of strategy 1 (2.4% and 2.2% vs. 1.4%, P < 0.001). In conclusion, co-testing and primary HPV testing with HPV-16/18 genotyping and reflex cytology improved the sensitivity for CIN3+ compared with cytology but increased the colposcopy referral rate. Long-term negative predicted value for HPV-negative women should be studied to determine the screening interval. Our study provides further evidence to the introduction of HPV-based strategies in China. Prevention Relevance: Both co-testing and primary HPV testing with HPV-16/18 genotyping and reflex cytology triage provided higher sensitivity for detecting CIN3+; however, the number of colposcopy referrals also increased compared with cytology in a routine program. It has great public health implications for the introduction of HPV-based screening strategies in China.

Objectives: To discuss the effective mechanism of vitiligo treatment by compound glycyrrhizin combined with fractional laser and triamcinolone acetonide injection. Methods: Forty-two patients with vitiligo vulgaris in the stable phase were classified into combined group (19 cases) and medicine group (23) admitted in dermatology department, Baoding First Central Hospital from January 2017 to July 2018. Both groups took 50mg compound glycyrrhizin orally three times per day, and applied halometasone cream externally once per day. Based on this treatment method, after the combined group adopted fractional laser, triamcinolone acetonide injection encapsulation was used immediately. After the treatment for six months, the curative effect was judged for both groups. Flow cytometry was used to test the changes of T lymphocyte subpopulation in peripheral blood before and after treatment. Meanwhile, immunohistochemical method was adopted to determine CD4+ and CD8+ T lymphocyte expression level. Besides, the normal control group was set up. Results: The efficacy of combined group and medicine group were 73.68% and 56.52% respectively, P0.05). Serum CD4+ T cells of vitiligo patients reduced, compared with the normal control group (P

The double-layer a-IGZO thin film transistors (DL-TFTs) using a quantum well channel and a top barrier can reduce the subthreshold swing and hysteresis by 0.73 $\times$ and 0.13 $\times$ , respectively, in the transfer characteristics using the bottom gate sweep as compared to the single-layer TFTs (SL-TFTs). The wide bandgap barrier on top of the narrow bandgap IGZO channel serves as a protection layer between the IGZO channel and the SiO2 top gate insulator to prevent plasma-induced damage on the IGZO channel caused by the S/D metal etching and the top gate insulator deposition. As for the mobility using the bottom gate operation with the top gate grounded, the DL-TFTs show higher mobility (1.06 $\times$ ) at the room temperature due to less Coulomb scattering caused by the plasma-induced damage for percolation conduction, while the SL-TFTs have higher mobility at low temperatures due to the improved hopping efficiency for thermally activated hopping. The hysteresis is temperature independent down to 160 K, indicating the electrons tunneling between the channel and the top gate insulator is dominant. As for the reliability, DL-TFT has a smaller Vth shift than SL-TFT under both positive bias temperature stress (PBTS) due to less subgap defect in the channel.

Recently, numerous studies validated frequent pancreatic exocrine dysfunction in patients with diabetes. However, the prevalence of pancreatic exocrine insufficiency (PEI) in diabetes mellitus (DM) varies widely among studies. This study aims to determine the prevalence of PEI in Chinese people with type 2 DM (T2DM) by measuring the fecal elastase-1 (FE-1) levels and further identify potential factors that influence pancreatic exocrine function in patients with T2DM.A total of 85 patients with T2DM without known exocrine pancreatic disorders or digestive system diseases were recruited. Fecal samples were submitted to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. The multiple logistic regression analysis was established to evaluate the influencing factors of PEI in patients with T2DM. The potential predictors of PEI were examined using receiver operating characteristic (ROC) curves.The prevalence of PEI measured by low FE-1 in T2DM was 18.8%. The Spearman correlation demonstrated that the FE-1 level was inversely correlated with DM duration (r = - 0.360, P = 0.001) and glycated hemoglobin (HbA1c) level (r = - 0.228, P = 0.036). A highly significant positive association was observed between FE-1 and fasting C-peptide (FCP) levels (r = 0.451, P 0.001). Furthermore, the multiple logistic regression analysis showed that FCP was an independent influencing factor of PEI (OR = 0.204, P = 0.024, 95% CI: 0.051-0.813). The ROC analysis indicated that the FCP level had a predictive value for low FE-1 (AUC = 0.793, P 0.001) with an optimal cutoff value of 1.20 ng/ml.Chinese patients with T2DM show high PEI prevalence. FCP may be a potential predictor of pathological exocrine function in T2DM. The exocrine and endocrine functions of patients with T2DM in clinical practice should be evaluated. Further studies are needed to clarify the internal association between exocrine and endocrine pancreases.

Dielectric capacitors have drawn growing attention for their wide application in future high power and/or pulsed power electronic systems. However, the recoverable energy storage density (Wrec) for dielectric ceramics is relatively low up to now, which largely restricts their actual application. Herein, the domain engineering is employed to construct relaxor antiferroelectric NaNbO3-BiFeO3 bulk ceramics, which integrates the merits of antiferroelectrics and relaxors. It is revealed that the antiferroelectric phase transforms from orthorhombic P to R phase, and antiferroelectric domain evolves from micron-sized blocks to nanoscale clusters. Of particular importance is that the 0.90NaNbO3–0.10BiFeO3 ceramic demonstrates ultrahigh Wrec of 18.5 J cm−3 with giant electric breakdown strength of 99.5 kV mm−1, which is superior than state-of-the-art bulk dielectric ceramics. Moreover, the 0.90NaNbO3–0.10BiFeO3 ceramic exhibits superior frequency, cycling and thermal reliability, as well as the substantial current density (2140.6 A cm−2), ultrahigh power density (428.1 MW cm−3) and ultrafast discharge rate (14 ns). These results not only suggest that the NaNbO3-based relaxor antiferroelectric ceramics are promising candidates for advanced energy storage capacitors, but also provide feasible strategy of domain engineering to develop novel lead-free high-performance dielectric materials.

Background The pandemic of COVID‐19 has a persistent impact on global health, yet its sequelae need to be addressed at a wide scale around the globe. This study aims to investigate the characteristics, prevalence, and risk factors for mid‐term (>6 months) clinical sequelae in a cohort of COVID‐19 survivors. Methods Totally 715 COVID‐19 survivors discharged before April 1, 2020, from three medical centers in Wuhan, China, were included. The longitudinal study was conducted by telephone interviews based on a questionnaire including the clinical sequelae of general, respiratory, and cardiovascular systems. Demographics and some characteristics of clinical sequelae of the survivors were recorded and analyzed. Multivariate logistic regression analysis was applied to explore the risk factors for the sequelae. Results The median time interval from discharge to telephone interview was 225.0 days. The COVID‐19 survivors' median ages were 69 years, and 51.3% were male. Among them, 29.9% had at least one clinical sequela. There were 19.2%, 22.7%, and 5.0% of the survivors reporting fatigue, respiratory symptoms, and cardiovascular symptoms, respectively. Comorbidities, disease severity, the application of mechanical ventilation and high‐flow oxygen therapy, and the history of re‐admission were associated with the presence of clinical sequelae. Conclusions Our study provides further evidence for the prevalence and characteristics of clinical sequelae of COVID‐19 survivors, suggesting long‐term monitoring and management is needed for their full recovery.

Limited sample size hinders the application of deep learning in brain image analysis, and transfer learning is a possible solution. However, most pretrained models are 2D based and cannot be applied directly to 3D brain images. In this study, we propose a novel framework to apply 2D pretrained models to 3D brain images by projecting surface-based cortical morphometry into planar images using computational geometry mapping. Firstly, 3D cortical meshes are reconstructed from magnetic resonance imaging (MRI) using FreeSurfer and projected into 2D planar meshes with topological preservation based on area-preserving geometry mapping. Then, 2D deep models pretrained on ImageNet are adopted and fine-tuned for cortical image classification on morphometric shape metrics. We apply the framework to sex classification on the Human Connectome Project dataset and autism spectrum disorder (ASD) classification on the Autism Brain Imaging Data Exchange dataset. Moreover, a 2-stage transfer learning strategy is suggested to boost the ASD classification performance by using the sex classification as an intermediate task. Our framework brings significant improvement in sex classification and ASD classification with transfer learning. In summary, the proposed framework builds a bridge between 3D cortical data and 2D models, making 2D pretrained models available for brain image analysis in cognitive and psychiatric neuroscience.

Interfacial solar steam generation (ISSG) system has attracted extensive attention as a sustainable desalination technology because of its cost efficiency and zero fossil-energy consumption. Aiming at optimizing the desalination properties, materials and system design have been the current research focus. Recently, many novel bio-derived/bio-inspired design strategies were proposed owing to their highly efficient structures inherited from nature, which were fine-tuned over eons of evolution, as well as their low cost and ease of treatment. In this review, we are going to systematically report recent progress of various bio-derived/bio-inspired strategies in terms of optical design, wetting, thermal management, and overall system design, presenting an overview of the current challenges of bio-inspired materials in ISSG system and other application fields. This article is intended to provide a comprehensive review of recent developments about bio-derived/bio-inspired materials in ISSG system and conclude with suggestions regarding further research directions for performance enhancement through design of bio-derived/bio-inspired materials.

To establish and validate a nomogram for predicting lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) in the cervical central region. This retrospective study included 287 PTC patients with 309 nodules treated from December 2018 to May 2020 at our hospital. The cohort was divided randomly into a training set and a testing set according to a 7:3 ratio. The training set contained 216 nodules, and the testing set contained 93 nodules. The nomogram was developed using the training set, and the data of the testing set were used to validate the performance of nomogram. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. The study showed multifocality, thyroid lesion size, and American College of Radiology Thyroid Imaging, Reporting and Data System (TI-RADS) score were significantly independently associated with LNM in the cervical central region. In the testing set, the calibration curve showed that the nomogram had good discrimination with a C-index of 0.775 (95% confidence interval, 0.680-0.869) and adequate calibration (P = 0.808). By decision curve analysis and clinical impact curve analysis, the nomogram was shown to have a satisfactory net benefit between thresholds of 0.40 and 0.75. The nomogram can be used for predicting LNM of PTC in the cervical central region and may provide valuable guidance for planning the surgical treatment of PTC patients.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. Its pathogenesis is closely related to insulin resistance, obesity, type 2 diabetes, and hyperlipidemia. Due to the complex pathogenesis, there are no specific medications for treating NAFLD. The most effective way to treat NAFLD is to lose weight through diet intervention and exercise, but a large number of in vitro and in vivo experiments have confirmed that a variety of natural drugs can interfere with NAFLD through many mechanisms, and the curative effect is remarkable. This paper reviews the action mechanism of crude extracts of medicinal plants (Polygonum multiflorum, Artemisia annua leaves, and Artemisia annua leaves) and natural products such as berberine (BBR), curcumin, betulinic acid (BA), ginsenoside Rg1 (G-rg1), and silybin on NAFLD, which aims to provide useful information for further research and development of new drugs to improve the cure rate of non-alcoholic fatty liver.

Objectives: Childhood trauma (ChT) is a risk factor for psychosis. Negative lifestyle factors such as rumination, negative schemas, and poor diet and exercise are common in psychosis. The present study aimed to perform a network analysis of interactions between ChT and negative lifestyle in patients and controls.Methods: We used data of patients with early-stage psychosis (n = 500) and healthy controls (n = 202). Networks were constructed using 12 nodes from five scales: the Brief Core Schema Scale (BCSS), Brooding Scale (BS), Dietary Habits Questionnaire, Physical Activity Rating, and Early Trauma Inventory Self Report-Short Form (ETI). Graph metrics were calculated.Results: The nodes with the highest predictability and expected influence in both patients and controls were cognitive (Co) and emotional domains (Em) of the BS and emotional abuse (EMO) of the ETI. The EMO was a mediator in the shortest pathway connecting the ETI and negative lifestyle for both groups. The negative other (NO) and negative self (NS) of the BCSS mediated EMO to other BCSS or BS for patients and controls, respectively.Conclusion: Our findings suggest that rumination and EMO were central symptoms in both groups and that NO and NS played important mediating roles for patients and controls, respectively.Trial Registration: ClinicalTrials.gov identifier: CUH201411002

Purpose This study aims to explore the impact of applying a blockchain-based information system in the international students’ administrative workflow in the context of a public research university in the USA. Design/methodology/approach Specifically, a prototype of the blockchain-based information system was developed and tested. The system has the potential advantages of being more efficient, more transparent, faster and safer. Findings The results show that digital registration could increase student registration efficiency with a blockchain-based application. Research limitations/implications There are also some limitations of this study. As an early exploration of the use of blockchain technology in higher education, this study could be further extended in several aspects: different institutions (e.g. private vs public school) may have different operational strategies towards international student affairs. The different administrative processes should be discussed in the context of different institutions, and thus the proposed system should be tested and evaluated based on the requirements of different institutions. Use experience and feedback from different users such as university administrators and students should be considered and investigated with respect to the necessary improvement of the proposed system. The extensibility and scalability of the system should be assessed to accommodate any potential modifications of the administrative process. Originality/value The findings show that a blockchain-based information management system has the potential to improve data transmission efficiency and protect information privacy.

Lead (Pb) is a potent environmental toxic metal. Few studies have focused on low-level Pb exposure in children. This study evaluated the relationships of dietary patterns with low-level Pb exposure in children from Hunan province of China. A cross-sectional study was conducted in a single primary school, located in Hunan Province. In total, 425 children were recruited. Principal component analysis was used to identify dietary patterns based on dietary intake from a food frequency questionnaire (FFQ). Blood lead levels (BLLs) were measured. Multivariate regression analysis was used to investigate the associations of BLLs with dietary patterns. Three dietary patterns were identified: balanced, plant, and beverage and snack. The concentration of blood lead (median (IQR)) was 2.00 (2.00, 15.96) μg/L. Only 0.24% children’s BLLs were ≥100 µg/L and 1.18% children’s BLLs were ≥ 50 µg/L. There was a significant difference for BLLs in gender of children (p = 0.007). No significant associations were found between dietary patterns and BLLs by logistic regression analysis based on 50th percentile (P50) of blood lead. The plant pattern had a positive association with blood log-Pb (B = 0.04, 95% CI: 0.00, 0.08, p = 0.035) in group of > P50 by linear regression analysis. Systolic blood pressure (SBP) (B = 7.44, 95% CI: 2.80, 12.09, p = 0.002) and diastolic blood pressure (DBP) (B = 5.46, 95% CI: 1.53, 9.40, p = 0.007) were positively associated with blood log-Pb in group of > P50. BLLs were low among children aged 4–7 years in Hunan province of China. There was a significant difference for BLLs in gender of children. Low BLLs had no associations with dietary patterns. However, the plant pattern may become an important source of blood lead with increasing BLLs. Increasing BLLs may contribute to elevated blood pressure of children.

While β-hemolytic streptococcus (β-HS) infections are known to predispose patients to acute poststreptococcal glomerulonephritis, there is evidence that implicates α-hemolytic streptococcus (α-HS) in IgA nephropathy (IgAN). The alternative pathway of the complement system has also been implicated in IgAN. We aimed to explore the association between α-HS and complement activation in human tonsillar mononuclear cells (TMCs) in IgAN. In our study, α-HS induced higher IgA levels than IgG levels, while β-HS increased higher IgG levels than IgA levels with more activation-induced cytidine deaminase, in TMCs in the IgAN group. Aberrant IgA1 O-glycosylation levels were higher in IgAN patients with α-HS. C3 and C3b expression was decreased in IgAN patients, but in chronic tonsillitis control patients, the expression decreased only after stimulation with β-HS. Complement factor B and H (CFH) mRNA increased, but the CFH concentration in culture supernatants decreased with α-HS. The percentage of CD19 + CD35 + cells/complement receptor 1 (CR1) decreased with α-HS more than with β-HS, while CD19 + CD21 + cells/complement receptor 2 (CR2) increased more with β-HS than with α-HS. The component nephritis-associated plasmin receptor (NAPlr) of α-HS was not detected on tonsillar or kidney tissues in IgAN patients and was positive on cultured TMCs and mesangial cells. We concluded that α-HS induced the secretion of aberrantly O-glycosylated IgA while decreasing the levels of the inhibitory factor CFH in culture supernatants and CR1 + B cells. These findings provide testable mechanisms that relate α-HS infection to abnormal mucosal responses involving the alternative complement pathway in IgAN.

The management and disposal of excess sludge are emerging issues owing to the high costs associated with treatment. In this study, the viability of a modified bentonite was investigated as a conditioning agent for the stabilisation of heavy metals (i.e., Cu, Zn, Cr, Pb, and Cd) and the retention of nutrient species (i.e., total nitrogen (TN), total phosphorus (TP), available nitrogen (available N), and Olsen-phosphorus (Olsen-P)) in sewage sludge for agricultural use. Five grams of modified bentonite resulted in the highest stabilisation rate of heavy metals and strongly contributed to the stabilisation of heavy metals. However, increased amounts of modified bentonite might increase the TN, available N, and TP losses in the conditioned sewage sludge. Through the analytic hierarchy process modelling, optimal concentrations of nutrient species and heavy metals remaining in the conditioned sewage sludge were achieved when the ratio of bentonite to sewage sludge was 1:12.5 (4 g bentonite : 50 g sludge). Moreover, the optimal mixing ratio of the conditioned sewage sludge to the soil (1:2) was suggested for agricultural use. Based on these observations, modified bentonite allowed the sewage sludge to be used as a fertiliser in agriculture by stabilising heavy metals and retaining nutrient species. HIGHLIGHTS The modified bentonite stabilised the heavy metals and retained the nutrient elements in the sewage sludge.; The AHP modelling revealed the optimal ratio of bentonite to sewage sludge (4 g bentonite : 50 g sludge).; The optimal mixing ratio of the conditioned sewage sludge to the soil (1:2) was suggested for agricultural use.; The modified bentonite allowed sewage sludge to be used as a fertiliser in agriculture.

Aiming at overcoming the defects such as slow searching speed and easily trapping into local extremum at anaphase of the shuffled frog leaping algorithm (SFLA), based on the Evolutionary Exploration strategy, a more effective shuffled frog leaping algorithm, Improved Shuffled Frog Leaping Algorithm (ISFLA), which can be applied to the inverse analysis of seepage parameters to dams, is proposed. With the introduction of the threshold value selection in the local search of the original initial population to improve the best frogs in memeplex, the improved algorithm overcomes the shortcomings of traditional SFLA which can easily fall into a local optimum. By comparative analysis between the laboratory test and numerical simulation, the effectiveness and accuracy of ISFLA are demonstrated by the application to the inversion analysis of seepage parameters of earth dams. Furthermore, the inversion analysis of seepage parameters to the earth dam in Lianyungang China is studied by the ISFLA. Moreover, the seepage characteristics of the dam are evaluated; thus, the suggestion that the dam should be reinforced is put forward. All the results show that ISFLA in an inverse analysis of seepage parameters of dams has excellent value to hydropower engineering.

Background Stress-induced hyperglycaemia at time of hospital admission has been linked to worse prognosis following acute myocardial infarction (AMI). In addition to glucose, other glucose-related indices, such as HbA1c, glucose-HbA1c ratio (GHR), and stress-hyperglycaemia ratio (SHR) are potential predictors of clinical outcomes following AMI. However, the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting adverse outcomes post-AMI are unknown. As such, we determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting 1-year all cause mortality in diabetic and non-diabetic ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods We undertook a national, registry-based study of patients with AMI from January 2008 to December 2015. We determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values using the Youden’s formula for 1-year all-cause mortality. We subsequently analyzed the sensitivity, specificity, positive and negative predictive values of the cut-off values in the diabetic and non-diabetic subgroups, stratified by the type of AMI. Results There were 5841 STEMI and 4105 NSTEMI in the study. In STEMI patients, glucose, GHR, and SHR were independent predictors of 1-year all-cause mortality [glucose: OR 2.19 (95% CI 1.74–2.76); GHR: OR 2.28 (95% CI 1.80–2.89); SHR: OR 2.20 (95% CI 1.73–2.79)]. However, in NSTEMI patients, glucose and HbA1c were independently associated with 1-year all-cause mortality [glucose: OR 1.38 (95% CI 1.01–1.90); HbA1c: OR 2.11 (95% CI 1.15–3.88)]. In diabetic STEMI patients, SHR performed the best in terms of area-under-the-curve (AUC) analysis (glucose: AUC 63.3%, 95% CI 59.5–67.2; GHR 68.8% 95% CI 64.8–72.8; SHR: AUC 69.3%, 95% CI 65.4–73.2). However, in non-diabetic STEMI patients, glucose, GHR, and SHR performed equally well (glucose: AUC 72.0%, 95% CI 67.7–76.3; GHR 71.9% 95% CI 67.7–76.2; SHR: AUC 71.7%, 95% CI 67.4–76.0). In NSTEMI patients, glucose performed better than HbA1c for both diabetic and non-diabetic patients in AUC analysis (For diabetic, glucose: AUC 52.8%, 95% CI 48.1–57.6; HbA1c: AUC 42.5%, 95% CI 37.6–47. For non-diabetic, glucose: AUC 62.0%, 95% CI 54.1–70.0; HbA1c: AUC 51.1%, 95% CI 43.3–58.9). The optimal cut-off values for glucose, GHR, and SHR in STEMI patients were 15.0 mmol/L, 2.11, and 1.68 for diabetic and 10.6 mmol/L, 1.72, and 1.51 for non-diabetic patients respectively. For NSTEMI patients, the optimal glucose values were 10.7 mmol/L for diabetic and 8.1 mmol/L for non-diabetic patients. Conclusions SHR was the most consistent independent predictor of 1-year all-cause mortality in both diabetic and non-diabetic STEMI, whereas glucose was the best predictor in NSTEMI patients.

Background The presence of pleural effusion is an independent predictor for poor survival in patients with small‐cell lung cancer (SCLC). The aim of this study was to assess the efficacy and safety of anlotinib in patients with SCLC and pleural effusion. Methods This was a randomized, double‐blind, multicenter, phase II trial. Patients histologically diagnosed with SCLC and pleural effusion and had received at least two lines of chemotherapy were enrolled into the study. The patients received anlotinib 12 mg/day or a placebo. Results The overall response rate (ORR) was 3.7% for anlotinib (n = 27) and 0% in the placebo group (n = 15) (p = 1.000). The disease control rate (DCR) of the anlotinib group (63.0%) was higher than that of the placebo group (0%, p, Patients with pleural effusion in this study came from a double‐blind, randomized, multicenter, controlled, phase II study, which was designed to examine the efficacy and safety of anlotinib in limited‐ or extensive‐stage SCLC. The median PFS (mPFS) was higher in the anlotinib group (2.8, 95% CI: 1.4–4.1) months compared to the placebo group (0.7, 95% CI: 0.5–0.7) months. The HR of PFS for the anlotinib group vs. the placebo group was 0.10 (95% CI: 0.03–0.28, p

Patients with cancer are at increased risk of myocardial infarction (MI) and stroke. Guidelines do not address lipid profile targets for these patients. Within the lipid profiles, we hypothesized that patients with cancer develop MI or stroke at lower low density lipoprotein cholesterol (LDL-C) concentrations than patients without cancer and suffer worse outcomes. We linked nationwide longitudinal MI, stroke and cancer registries from years 2007–2017. We identified 42,148 eligible patients with MI (2421 prior cancer; 39,727 no cancer) and 43,888 eligible patients with stroke (3152 prior cancer; 40,738 no cancer). Median LDL-C concentration was lower in the prior cancer group than the no cancer group at incident MI [2.43 versus 3.10 mmol/L, adjusted ratio 0.87 (95% CI 0.85–0.89)] and stroke [2.81 versus 3.22 mmol/L, adjusted ratio 0.93, 95% CI 0.91–0.95)]. Similarly, median triglyceride and total cholesterol concentrations were lower in the prior cancer group, with no difference in high density lipoprotein cholesterol. Prior cancer was associated with higher post-MI mortality [adjusted hazard ratio (HR) 1.48, 95% CI 1.37–1.59] and post-stroke mortality (adjusted HR 1.95, 95% CI 1.52–2.52). Despite lower LDL-C concentrations, patients with prior cancer had worse post-MI and stroke mortality than patients without cancer.

BACKGROUND Endometrial thickness (ET) is closely related to many gynecological symptoms. The measurement of ET is also an important tool for evaluating adverse symptoms such as bleeding in postmenopausal women. However, the significance of ET in asymptomatic women is still unclear. The purpose of this study was to determine the correlation between ET and the incidence of endometrial lesions in asymptomatic women after menopause, and to statistically analyze the correlation with a 5 mm cutoff value. METHODS A systematic literature search was conducted in May 2021 to screen out articles that reported that ET measurement was used to diagnose endometrial carcinoma (EC), endometrial hyperplasia (EH), and endometrial polyps (EP) in asymptomatic postmenopausal women who did not use hormone replacement therapy (HRT). The endometrial membrane was set at 5 mm as the cut-off, and using 5 mm as the cut-off of the ET, the relationship between the thickness of the endometrium and the prevalence of EC, EH, and EP was evaluated. Relative risk (RR) and standardized mean difference (SMD) were extrapolated with 95% confidence interval (CI). RESULTS After screening, 9 studies reported a total of 3,620 cases of asymptomatic postmenopausal women whose ET was measured. Among them, there were 1,758 cases of ET

Background Current evidence suggests that acupuncture is an effective adjunctive therapy that can bring potential benefits to patients with cardiac arrhythmias. However, there are relevant gaps in the optimal therapeutic strategy, which may cause uncertainties on the best practice of acupuncture treatment for arrhythmia. We aim to develop consensus-based recommendations for clinical guidance on acupuncture treatment of cardiac arrhythmias. Methods A multidisciplinary panel of specialists was invited to participate in a two-round semi-open clinical issue investigation. Meanwhile, relevant literature reviews were searched in 3 databases to provide evidence. Subsequently, an initial consensus voting list on acupuncture as an adjunctive therapy for cardiac arrhythmias was derived from the clinical investigation and literature review. Finally, 30 authoritative experts reached a consensus on the key issues of the voting list by a three-round modified Delphi survey. Consensus was defined when >80% agreement was achieved. Results Following the three-round Delphi survey, there were 32 items (91.43%) finally reaching consensus, including the following 5 domains: (I) the benefits of acupuncture for the appropriate population; (II) the general therapeutic principle; (III) the acupuncture strategy; (IV) the relevant adverse events; (V) others. Conclusions Consensus was achieved on some key elements. Given the lack of guidelines and the substantial heterogeneity of previous studies, these recommendations are of value in providing guidance for clinical practice of acupuncturists and in assisting patients with arrhythmia to obtain standardized acupuncture treatment. It also pointed out some problems that need to be carefully explored in future studies.

Background Aortic aneurysm (AA) patients after vascular surgery are at high risk of death, some of them need intensive care. Our aim was to develop a simplified model with baseline data within 24 hours of intensive care unit (ICU) admission to early predict mortality. Methods Univariate analysis and least absolute shrinkage and selection operator were used to select important variables, which were then taken into logistic regression to fit the model. Discrimination and validation were used to evaluate the performance of the model. Bootstrap method was conducted to perform internal validation. Finally, decision clinical analysis curve was used to test the clinical usefulness of the model. Results We obtained baseline data of 482 AA patients from Medical Information Mart for Intensive Care III database, 33 (6.8%) of whom died in ICU. Our final model contained three variables and was called SAB model based on initials of three items [Sepsis, Anion gap, Bicarbonate (SAB)]. Area under the curve of SAB was 0.904 (95% CI: 0.841-0.967) while brier score was 0.043 (95% CI: 0.028-0.057). After internal validation, corrected area under the curve was 0.898 and brier score was 0.045, which showed good prediction ability of SAB model. The model can be assessed on https://vascularmodel.shinyapps.io/ AorticAneurysm/. Conclusions SAB model derived in this study can be easily used to predict in-ICU mortality of AA patients after surgery precisely.

In recent years, the telecom industry has faced digital transformation challenges and fierce market competition. The challenges push telecom operators to grow their subscriber bases by offering low...

The ability to draw a structured surface plasmon polariton (SPP) field is an important step toward many new opportunities for a broad range of nanophotonic applications. Previous methods usually require complex experimental systems or holographic optimization algorithms that limit their practical applications. Here, we propose a simple method for flexible generation of structured SPP field with on-chip plasmonic metalenses. The metalens is composed of multiple plasmonic focusing nanostructures whose focal shape and position can be independently manipulated, and through their superposition, SPP fields with specially designed patterns are obtained. Based on this method, we demonstrate several structured SPP fields including S- and W-shaped SPP focal fields and tunable SPP bottle beams. This work could provide new ideas for on-chip manipulation of optical surface waves, and contribute to applications such as on-chip photonic information processing and integrated photonic circuits.

Background Acute pancreatitis (AP) is a common digestive disease with increased incidence globally but without internationally licenced pharmacological therapy. Moderately severe and severe acute pancreatitis (MSAP/SAP) contributes predominately for its morbidities and mortality and has been managed in West China Hospital for decades using the traditional Chinese medicinal formula chaiqin chengqi decoction (CQCQD). The current study tests whether the early administration of CQCQD will result in improved clinical outcomes in predicted MSAP/SAP patients. Methods This is a single-centre, randomised, controlled, double-blind pragmatic clinical trial. AP patients aged 18–75 admitted within 72 h of onset will be assessed at admission for enrolment. We excluded the predicted mild acute pancreatitis (Harmless Acute Pancreatitis Score > 2 at admission) and severe organ failure (Sequential Organ Failure Assessment [SOFA] score of respiratory, cardiovascular, or renal systems > 3) at admission. Eligible patients will be randomly allocated on a 1:1 basis to CQCQD or placebo control administration based on conventional therapy. The administration of CQCQD and placebo is guided by the Acute Gastrointestinal Injury grade-based algorithm. The primary outcome measure will be the duration of respiratory failure (SOFA score of respiratory system ≥ 2) within 28 days after onset. Secondary outcome measures include occurrence of new-onset any organ failure (SOFA score of respiratory, cardiovascular, or renal system ≥ 2) and new-onset persistent organ failure (organ failure lasts > 48 h), dynamic surrogate biochemical markers and clinical severity scores, gut-centred treatment modalities, local complications status, intensive care need and duration, surgical interventions, mortality, and length of hospital stay. Follow-up will be scheduled on 6, 12, and 26 weeks after enrolment to assess AP recurrence, local complications, the requirement for surgical interventions, all-cause mortality, and patient-reported outcomes. Discussion The results of this study will provide high-quality evidence to appraise the efficacy of CQCQD for the early management of AP patients. Trial registration Chictr.org.cn Registry (ChiCTR2000034325). Registered on 2 July, 2020.

Aim In the present study, the prevalence and predictors of symptomatic and full remission were investigated in patients with first-episode psychosis (FEP) at the 12-month follow-up. Methods A total of 308 participants aged 18-45 years fulfilled the study inclusion criteria and 214 completed the 12-month follow-up. Results At the 12-month follow-up, 67.3% (142) and 25.9% (55) of the FEP patients met the criteria for symptomatic and full remission, respectively. Stepwise logistic regression analysis showed a shorter duration of untreated psychosis (DUP), no family history, lower Positive and Negative Syndrome Scale (PANSS) negative symptom scores at baseline and higher familial support predicted symptomatic remission at the 12-month follow-up. A higher educational level, shorter DUP, lower PANSS general symptoms scores at baseline and higher subjective well-being under neuroleptics emotional regulation scores predicted full remission. Conclusions Our findings regarding the rates of symptomatic and full remission are consistent with previous studies. The results indicate a large discrepancy between symptomatic versus full remission rates at a 12-month follow-up in patients with FEP. Effective psychosocial interventions are necessary to improve the outcomes of FEP patients.

Purpose: To investigate the patterns and predictors of intraocular pressure (IOP) changes after intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGFs).Methods: This study enrolled 32 men and 16 women (mean age, 65.3±12.3 years) who underwent IVI of anti-VEGFs between January and March 2020 in our department. IOPs were measured using Goldmann applanation tonometry. Potential predictors included age, sex, lens status, axial length, history of glaucoma, number of previous IVIs, diagnosis, and post-injection vitreous reflux.Results: The respective mean IOP was 16.2 mmHg, 32.7 mmHg, 21.7 mmHg, and 18.3 mmHg at baseline and at 5, 15, and 30 minutes after IVI. IOP elevation of ≥15 mmHg was observed in 48% of eyes at 5 minutes after IVI; all spikes resolved and the IOP reduced to

Background. With the progress of shock therapy and the establishment and promotion of methods such as thrombolytic therapy and percutaneous coronary intervention (PCI), many tissues and organs have been reperfused after ischemia which may cause even worse disorder called ischemia-reperfusion injury (IRI). mRNAs have been found to have significant impacts on ischemia-reperfusion through various mechanisms. In view of the accessibility of mRNAs from blood, we aimed to find the association between mRNA and ischemia-reperfusion. Methods. We used the GSE83472 dataset from the Gene Expression Omnibus (GEO) database to find differential RNA expression between ischemia-reperfusion tissue and control samples. In addition, Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to find the biological property of 449 RNAs from GSE83472 via the Database for Annotation, Visualization, and Integrated Discovery (DAVID). Besides, Gene Set Enrichment Analysis (GSEA), a tool to find the pathway orientation of a gene set, was used for further study in the four most significant KEGG pathways. Furthermore, we constructed a protein-protein interaction (PPI) network. In the end, we used quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and western blotting to measure and compare the expression of Spp1 in patients who accepted percutaneous coronary intervention. Results. The bioinformatics analyses suggested that Spp1 was a hub gene in reperfusion after ischemia. The qRT-PCR result showed that the Spp1 expression was significantly downregulated in ischemia-reperfusion cells after PCI compared with normal samples and so as the western blotting. Conclusion. Spp1 might play an essential role in acute myocardial infarction after ischemia and reperfusion injury.

BackgroundType D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI).MethodsThis prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period.ResultsA total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients.ConclusionsThese findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

Ru-Rong Peng,1 Zhong-Guo Liang,1 Kai-Hua Chen,1 Ling Li,1 Song Qu,1 Xiao-Dong Zhu1,2 1Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China; 2Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, People’s Republic of ChinaCorrespondence: Xiao-Dong ZhuDepartment of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 He-di Road, Nanning, 530021, People’s Republic of ChinaTel +86 15778028340Email zhuxdonggxmu@126.comPurpose: The prognosis of inflammation-related indicators like lactate dehydrogenase/albumin ratio (LAR) and the platelet/lymphocyte ratio (PLR) in nasopharyngeal carcinoma (NPC) is not yet clear. Our objective is to establish and verify the nomogram using LAR and PLR ratio for the first time to explore the prognostic value in NPC.Patients and Methods: This was a retrospective collection of 1661 patients with non-metastatic NPC admitted to our hospital from 2010 to 2017. The final variables of overall survival (OS) and progression-free survival (PFS) were selected by Cox regression analysis to establish nomograms, and the methods to verify the prediction precision and discriminative ability of the nomograms were concordance index (C index), the receiver operating characteristic (ROC) curve and calibration curve. The risk stratification was carried out through the nomograms and compared with the current staging system by the Kaplan–Meier methods.Results: Multivariate Cox analysis resulted that age, plasma Epstein–Barr Virus (EBV) DNA, T stage, N stage, white blood cells (WBC), PLR and LAR were independent prognostic risk factors for OS and PFS, and sex is an independent prognostic risk factor for OS. The C-indexes of OS nomogram were 0.722 (95% CI: 0.706– 0.738) and 0.747 (95% CI: 0.717– 0.777) in the training cohort and validation cohort, which were statistically higher than the current 8th AJCC staging system (0.646 and 0.688). The C-indexes of PFS nomogram were 0.696 (95% CI: 0.680– 0.713) and 0.690 (95% CI: 0.660– 0.720), which were also statistically higher than the current 8th AJCC staging system (0.632 and 0.666). Otherwise, ROC curves and the calibration curve for probability also confirmed satisfied consistency with actual observations.Conclusion: LAR is a novel useful independent factor in NPC. The proposed nomogram LAR and PLR resulted in more accurate prognostic prediction than current staging system for NPC patients.Keywords: intensity-modulated radiotherapy, nasopharyngeal carcinoma, lactate dehydrogenase to albumin ratio, platelet-to-lymphocyte ratio, tumor–node–metastasis staging system

Introduction: To investigate the ablation efficiency of super-pulse thulium fiber laser (SPTFL) with different laser settings and fiber usage. Materials and Methods: SPTFL machine was attached with...

BackgroundHigh prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels.MethodsUsing a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions.ResultsThe prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%,p ConclusionChildren with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors.Trial registrationThe study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number:ChiCTR2000031194).

Background The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal. Methods Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes. Results In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%. Conclusions In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation–associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.

Immunotherapy has dramatically altered the treatment of non-small cell lung cancer. Currently, the emergence of combination strategies in immunotherapy has brightened the prospects of improved clinical outcomes and manageable safety profiles in the first/second-line settings. However, sub-optimal response rates are still observed in several clinical trials. Hence, alternative combination models and candidate selection strategies need to be explored. Herein, we have critically reviewed and commented on the published data from several clinical trials, including combined immunotherapy and chemotherapy, anti-angiogenic agents, epidermal growth factor receptor/anaplastic lymphoma kinase tyrosine kinase inhibitors, radiotherapy, and other immune checkpoint inhibitors.

Gestational diabetes mellitus (GDM) pregnant women are under more psychological stress than normal pregnant women. With the deepening of the study of gestational diabetes mellitus, research has shown that anxiety and depression are also an important cause of gestational diabetes mellitus. Anxiety and depression can cause imbalances in the hormone levels in the body, which has a serious impact on the pregnancy outcome and blood glucose control of pregnant women with GDM. Therefore, the main purpose of this paper is to provide a systematic review of the association between anxiety, depression, and GDM, as well as the adverse effects on pregnant women with GDM. To this end, we searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases. Studies on the incidence of anxiety, depression, and GDM, blood glucose in pregnant women with GDM, delivery mode, and maternal and infant outcomes were included to be analyzed, and the source of anxiety and depression in pregnant women with GDM and related treatment measures were discussed.

This study aimed to investigate the concentration of Wingless-type (Wnt)-inducible signaling pathway protein-1 (WISP1) in the serum, and its expression in the abdominal subcutaneous adipose tissue (SAT), and placenta of women with gestational diabetes mellitus (GDM). A total of 69 patients with GDM and 71 pregnant women with normal glucose tolerance (NGT, control) were recruited. Carbohydrate metabolism, alanine aminotransferase (ALT), lipid profiles, thyroid function, interleukin-6 (IL-6), and WISP1 levels were assessed. Fasting sera were collected between 25 and 30 weeks of gestation. Tissues of placenta and abdominal SAT samples were obtained from 24 women who had undergone cesarean section and were divided into a GDM group and a control group. Reverse transcription polymerase chain reaction (RT-PCR) and western blot were used to detect the WISP1 expression. The serum WISP1 concentrations were higher in the GDM group than in the control group (p

AIM: The aim of this study is to construct a quality evaluation system for fever clinic nursing management. BACKGROUND: Fever clinic is the first line of defence against the epidemic during COVID-19 in China. METHODS: Our study combines the Delphi method and the analytic hierarchy process. Delphi method was used to carry out two rounds of consultation for 18 experts, to select and revise indicators at all levels. Analytic hierarchy process was used to calculate the weight of indicators at all levels. RESULTS: A quality evaluation system of nursing management for fever clinics is built using Delphi method. It includes five first-level indexes, 14 second-level indexes and 82 third-level indexes. A two-round expert consultation is used to build the indicators. The recovery rates of expert questionnaires in the two rounds were, respectively, 100% and 94%, and expert authority coefficients were 0.925. The Kendall coefficients in the two rounds were, respectively, 0.205 and 0.162 (P < .001). The weight analysis shows that health management of nursing staff (0.2803) and disinfection isolation and treatment of medical waste (0.2803) are most important, followed by nursing post management and personnel training (0.1889), configuration and management of equipment (0.1427) and patient consultation management and nursing (0.1078). CONCLUSION: The quality evaluation system of nursing management in the constructed fever clinic is used to put forward a specific, objective and quantifiable evaluation criteria of nursing quality for fever clinic management, which can better meet the needs of epidemic prevention and control, and has a certain application and promotion value. IMPLICATIONS FOR NURSING MANAGEMENT: The establishment and improvement of a quality system for fever clinic care management will help to respond to outbreaks such as COVID-19.

Purpose There is no optimal prognostic model for T-cell lymphoblastic lymphoma (T-LBL). Here, we discussed the predictive value of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) measured on 18F-fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) in T-LBL.Materials and Methods Thirty-seven treatment naïve T-LBL patients with PET-CT scans were enrolled. TMTV was obtained using the 41% maximum standardized uptake value (SUVmax) threshold method, and TLG was measured as metabolic tumor volume multiplied by the mean SUV. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier curves and compared by the log-rank test.Results The optimal cutoff values for SUVmax, TMTV, and TLG were 12.7, 302 cm3, and 890, respectively. A high SUVmax, TMTV, and TLG indicated a shorten PFS and OS. On multivariable analysis, TMTV ≥ 302 cm3, and central nervous system (CNS) involvement predicted inferior PFS, while high SUVmax, TLG and CNS involvement were associated with worse OS. Subsequently, we generated a risk model comprising high SUVmax, TMTV or TLG and CNS involvement, which stratified the population into three risk groups, which had significantly different median PFS of not reached, 14 months, and 7 months for low-risk group, mediate-risk group, and high-risk group, respectively (p < 0.001). Median OS were not reached, 27 months, and 13 months, respectively (p < 0.001).Conclusion Baseline SUVmax, TMTV, and TLG measured on PET-CT are strong predictors of worse outcome in T-LBL. A risk model integrating these three parameters with CNS involvement identifies patients at high risk of disease progression.

Phototherapy usually includes photodynamic therapy (PDT) and photothermal therapy (PTT) to induce cell death. PDT utilizes the sensitization of the photosensitizers to generate reactive oxygen species by the intersystem crossing while PTT undergoes nonradiative decay to generate heat. Cancer immunotherapy has evolved as a new therapeutic modality to eradicate tumor cells by activating antigen-presenting cells, and thus, inducing innate or adaptive immune responses. Phototherapy is able to stimulate the immune system, usually by inducing immunogenic cell death (ICD). Photoimmunotherapy (PIT) is an oncological treatment that combines the phototherapy of the tumor with immunotherapy treatment. Combining phototherapy with immunotherapy enhances the immunostimulating response and has synergistic effects for metastatic cancer treatment. PIT is able to enhance the antitumor immune response by ICD and prevent tumor metastases and recurrence. In this review article, we would like to summarize the recent advances in the development of phototherapy (such as PDT, PTT, and synergistic PDT/PTT) triggered immunotherapy for cancer treatment. In addition, immunotherapy triggered by phototherapy and other therapeutic modalities will be discussed. PIT may be a win-win strategy to fight against cancer.