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Purpose: To re-statistical analysis of the Pentacam or Corvis ST parameters from literatures, and to obtain more sensitive diagnostic parameters for clinical keratoconus (CKC) and forme fruste keratoconus (FFKC), respectively. Methods: The parameters and the corresponding area of ROC curve (AUC) in previous studies were extracted and screened to obtain the database of CKC (Data-CKC) and FFKC (Data-FFKC), respectively. Two different importance evaluation methods (%IncMSE and IncNodePurity) of random forest were used to preliminary select the important parameters. Then, based on the partial dependency analysis, the sensitive diagnostic parameters that had promotion to the diagnostic performance were obtained. Data-FFKC was analyzed in the same way. Finally, a diagnostic test meta-analysis on the sensitive parameter of interest was conducted to verify the reliability of the above analysis methods.Results: There were 88 parameters with 766 records in Data-CKC, 57 parameters with 346 records in Data-FFKC. Based on two importance evaluation methods, 60 important parameters were obtained, of which 20 were further screened as sensitive parameters of keratoconus, and most of these parameters were related to the thinnest point of cornea. The stiffness parameter at first applanation (SPA1) was the only Corvis ST output parameter sensitive to FFKC except the Tomographic and Biomechanical Index (TBI) and the Corvis Biomechanical Parameter (CBI). A total of 4 records were included in the meta-analysis of diagnostic tests on SPA1. The results showed that there was threshold effect, but no significant heterogeneity (I2=33%), and the area under the SROC curve was 0.87 (95% CI, 0.84-0.90).Conclusions: the sensitive diagnostic parameters of keratoconus mainly include the 7 categories. The diagnostic value of SPA1, which represents the biomechanical properties of cornea, is worthy of further attention in the diagnosis of keratoconus in forme fruste keratoconus. Moreover, the morphological parameters based on the typical position of the thinnest point of corneal thickness have potential special significance for the diagnosis of disease.

Introduction The risk of venous thromboembolism (VTE) varies among tumour types, and different cancer type-specific risks for VTE prediction remain undefined. We aimed to establish a prediction model for non-small lung cancer (NSCLC)-associated VTE. Materials and methods We analysed data from a prospective cohort of patients with newly diagnosed NSCLC. We then developed a VTE risk prediction model using data of patients who were recruited from 2013 to 2017 (n = 602, development cohort) and validated this model using date of patients recruited from 2018 to 2019 (n = 412, validation cohort). The cumulative 6 months VTE incidence observed in both cohorts was calculated. Results The parameters in this new model included Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (1 point), EGFR mutation (−1 point), neutrophil count ≥7.5 × 109/L (2 points), hemoglobin Conclusions The new VTE risk prediction model incorporated patient characteristics, laboratory values, and oncogenic status, and was able to stratify patients at high risk of VTE in newly diagnosed NSCLC within 6 months of diagnosis.

Background: Cerebral ischemia-reperfusion injury is caused by a blood reperfusion injury in the ischemic brain and usually occurs in the treatment stage of ischemic disease, which can aggravate brain tissue injury. Objective: Curcumin was reported to exert a good therapeutic effect on neural cells against ischemia- reperfusion injury, However, the mechanism is not clear. Methods: In this study, Oxygen-Glucose Deprivation (OGD) model of fetal rat cerebral cortical neurons and the Middle Cerebral Artery Occlusion (MCAO) model of rats were employed to mimic cerebral ischemia-reperfusion injury in vitro and in vivo, respectively. Results: We confirmed that curcumin has a promotive effect on neuronal proliferation and an inhibitory effect on neuronal pyroptosis. Furthermore, we found that curcumin could improve cerebral infarction. The results of western blotting showed that curcumin down-regulated the expression of nucleotide-binding oligomerization domain-containing protein-, leucine-rich repeats-, and pyrin domain-containing protein 1 (NLRP1), cysteinyl aspartate-specific protease 1 (caspase-1), gasdermin D (GSDMD), IL-1β, IL-6, TNF-α, and iNOS proteins in OGD and MCAO models. NLRP1- dependent neuronal pyroptosis played an important role in cerebral ischemia-reperfusion injury. Conclusion: Curcumin could effectively inhibit NLRP1-dependent neuronal pyroptosis by suppressing the p38 MAPK pathway and therefore exerted neuroprotective effects against cerebral ischemia- reperfusion injury.

In the assembly workshops of some heavy special equipment, the bridge cranes for payload lifting often needs to be located frequently. However, the locating position is often determined by the operator, which is random and results in significant payload oscillation and difficulties in trolley positioning. Furthermore, in practice, the bridge crane always exhibits more complicated double-pendulum dynamics compared with single-pendulum crane. To solve these problems, this paper establishes the double-pendulum model of bridge crane. Derived from the proportional-derivative (PD) control, the single closed-loop is designed based on the hook oscillation during acceleration and transporting; when locating, the double closed-loop is presented by utilizing the position and the hook oscillation. Combining the two control methods, a single and double closed-loop compound anti-sway control (SDCAC) method for the bridge crane is proposed. On this basis, to improve the performance of the SDCAC system, the sequential quadratic optimization (SQP) method is adopted to optimize PD parameters. Besides, a novel bumpless transfer control method is proposed to realize the smooth transition between the two control modes. Finally, the simulations and experiments are conducted. The results demonstrate the effectiveness of the proposed method.

OBJECTIVE Previous reports of the annual incidence of type 1 diabetes (T1D) in China were conducted using retrospective hospital cases, which may not reflect the reality. This longitudinal study estimated T1D incidence in a Chinese population of 21.7 million from 2007 to 2017. RESEARCH DESIGN AND METHODS A population-based registry of T1D was performed by the Beijing Municipal Health Commission Information Center. Annual incidence and 95% CIs were calculated by age group and sex. The association of sex with T1D incidence and predicted new cases of T1D were assessed using Poisson regression models. Annual percentage change and average annual percentage of change were assessed using Joinpoint regression. RESULTS Overall, there were 6,875 individuals who developed T1D from 2007 to 2017 in this population. T1D incidence (/100,000 persons) (95% CI) significantly increased from 2.72 (2.51, 2.93) in 2007 to 3.60 (3.38, 3.78) in 2017 (P < 0.001). The T1D onset peak was in the 10–14-year-old age group. While no significant trend was found in the 0–14- and 15–29-year-old age groups, T1D incidence markedly increased from 1.87 to 3.52 in the ≥30-year-old age group (P < 0.05). The prevalence of diabetic ketoacidosis at diagnosis was highest in the 0–4-year-old age group. We predicted new cases of T1D will increase 1.57-fold over the next decade. CONCLUSIONS T1D incidence in this large Chinese population is higher than has been reported previously. From 2007 to 2017, although the incidence peak was in the 10–14-year age group, the T1D incidence increased sharply in adults but not in youth.

Objective To evaluate the clinical therapeutic effect of acupuncture bloodletting therapy on local swelling and pain of snakebite in the patients bitten by snakes. Methods A total of 106 patients with trimeresurus stejnegeri bite were randomly divided into two groups, a conventional treatment group and a conventional treatment combined with bloodletting therapy group, 53 cases in each one. In the conventional treatment group, the convention treatment of western medicine was adopted. In the conventional treatment combined with bloodletting therapy group, on the base of the conventional treatment, bloodletting therapy was applied at Ashi points selected at the tender points around the wound. The intervention and observation were performed not less than 7 days in two groups. Before and after treatment, swelling and pain degrees were measured and remission time of both the limb swelling and pain were recorded in the patients. Results Compared with the values on day 1 of treatment, swelling degree and visual analogue scale (VAS) score of the upper and lower limbs were all lower on day 3 and day 7 of treatment in the patients of the two groups (all P Conclusion Acupuncture bloodletting therapy can effectively relieve the local swelling and pain caused by snakebite, promote the recovery of limb function, shorten the treatment course and improve the clinical therapeutic effect.

Introduction The effect of ketorolac addition for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of ketorolac addition for renal colic. Methods We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ketorolac addition for renal colic. This meta-analysis is performed using the random-effect model. Results Four RCTs are included in the meta-analysis. In patients with renal colic pain, ketorolac addition is associated with significantly lower pain scores at 10–20 min (SMD=-2.50; 95% CI=-4.31 to −0.68; P=0.007) and analgesic rescue (RR=0.68; 95% CI=0.52 to 0.89; P=0.006), but reveals no notable effect on nausea (RR=0.36; 95% CI=0.12 to 1.12; P=0.08), vomiting (RR=0.50; 95% CI=0.13 to 1.95; P=0.31), or dizziness (RR=0.68; 95% CI=0.05 to 0.60; P=0.007). Conclusions Ketorolac addition may improve the analgesic efficacy for renal colic pain.

Yanping Su,1 Meirong Huo,1 Lin Hua,2 Yuan Zhang,1 Jiawen Yi,1 Shu Zhang,1 Jie Li,1 Yuhui Zhang1 1Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, People’s Republic of China; 2School of Biomedical Engineering, Capital Medical University, Beijing, 100069, People’s Republic of ChinaCorrespondence: Yuhui ZhangDepartment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, 8 Gongtinan Road, Chaoyang District, Beijing, People’s Republic of ChinaTel +86 13520208369Email zhangyhcy@163.comPurpose: To explore the relationship between venous thromboembolism (VTE) and early mortality (within six months) in Chinese patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) after entering the era of precision treatment.Methods: A cohort of 706 consecutive subjects with newly diagnosed metastatic NSCLC were prospectively observed. Clinical and survival data were recorded over a six-month follow-up period. The predictive factors for the occurrence of VTE and the relationship with early mortality were evaluated through univariate and multivariate analyses.Results: During the six-month follow-up period, VTE events occurred in 12.2% (86/706) of the enrolled patients. In the multivariate analyses for VTE, an age older than 70 years (vs < 70: sub-distribution hazard radio [SHR], 1.678; 95% confidence interval (CI), 1.073– 2.600; P=0.022), an Eastern Cooperative Oncology Group performance status ≥ 2 (vs 0/1: SHR, 1.946; 95% CI, 1.277– 2.970; P=0.002), and having an ALK rearrangement (vs non-rearrangement: SHR, 2.377; 95% CI, 1.186– 4.760; P=0.015) were significantly associated with the occurrence of VTE. Within six months, 116 subjects (16.4%) died, and the occurrence of VTE (vs no VTE: adjusted HR: 1.863; 95% CI: 1.178– 2.947, P=0.008) was remarkably associated with early mortality. Further analysis showed 98 patients (13.9%) with early mortality had EGFR/ALK wild-type genes, with a risk of early mortality 5.935-fold higher than that of patients with an EGFR mutation/ALK rearrangement. Finally, subgroup analyses showed that VTE occurrence was a significant factor for predicting early mortality in patients with EGFR/ALK wild-type genes (adjusted HR: 1.682; 95% CI: 1.023– 2.768, P=0.041).Conclusion: Patients with an EGFR mutation/ALK rearrangement had a significantly decreased risk of early mortality in the era of targeted therapy; however, VTE occurrence remained an important predictor for early mortality in metastatic NSCLC patients, especially in patients with EGFR/ALK wild-type genes.Keywords: venous thromboembolism, non-small cell lung cancer, early mortality

Consumption of copper and aluminum has increased significantly in recent years; therefore, recycling these elements from the end-of-life vehicles (ELVs) will be of great economic value and social benefit. However, the separation of non-ferrous materials is difficult because of their different sources, various shapes and sizes, and complex surface conditions. In experimental study on the separation of these materials, few non-ferrous metal scraps can be used. To address these limitations, a traditional image recognition model and a small sample multi-target detection model (which can detect multiple targets simultaneously) based on deep learning and transfer learning were used to identify non-ferrous materials. The improved third version of You Only Look Once (YOLOv3) multi-target detection model using data augmentation, the loss function of focal loss, and a method of adjusting the threshold of Intersection over Union (IOU) between candidate bound and ground truth bound has superior target detection performance than methods. We obtained a 95.3% and 91.4% accuracy in identifying aluminum and copper scraps, respectively, and an operation speed of 18 FPS, meeting the real-time requirements of a sorting system. By using the improved YOLOv3 multi-target detection algorithm and equipment operation parameters selected, the accuracy and purity of the separation system exceeded 90%, meeting the needs of actual production.

To explore the diagnostic value of a galactomannan (GM) detection for non-immunocompromised critically ill patients with influenza-associated aspergillosis (IAA). In this retrospective case-control study, we explored the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) of serum and bronchoalveolar lavage fluid (BALF) GM tests by four detection strategies at different detection time points and with different compound modes. In total, 90 patients were evaluated. The AUC values of the second serum GM test, the first and second BALF GM tests, were significantly higher (0.839 (95% CI 0.716 to 0.963), P < 0.01; 0.904 (95% CI 0.820 to 0.988), P < 0.01; 0.827 (95% CI 0.694 to 0.961), P = 0.043) than that of the first serum GM test (0.548 (95% CI 0.377 to 0.718)). We found that at least one positive result on two consecutive serum GM tests (0.719 (95% CI 0.588 to 0.849)) was the best compared with the first positive test (0.419 (95% CI 0.342 to 0.641), P < 0.01) and positives on two consecutive tests (0.636 (95% CI 0.483 to 0.790), P = 0.014). However, there were no differences between those three detection strategies of BALF GM. The BALF GM test might have a better diagnostic value for IAA in the ICU than the serum GM test. A possible cutoff value of 1.0 to 1.3 was set for GM from BALF specimens for IAA. A single serum GM test is not routinely recommended, but at least one positive result on two consecutive tests appeared to be useful.

This prospective, randomized, split-mouth clinical trial assessed the 3-year clinical performance of a highly filled flowable composite and a conventional paste-type composite in non-carious cervical lesions (NCCLs). A total of 84 NCCLs in 27 subjects were included in this split-mouth design study and randomly divided into two groups: a highly filled flowable composite Clearfil Majesty ES Flow group (ES, n = 42) and a conventional paste-type composite Majesty group (MJ, n = 42). Clearfil SE Bond was used following the manufacturer’s instructions. The restorations were evaluated at baseline (BL) and 1, 2, and 3 years using FDI (World Dental Federation) criteria. Data were analysed by a paired chi-squared test for intergroup comparisons and the Friedman test for intragroup comparisons (α = 0.05). Both groups had a 97.3% retention rate at the 3-year evaluation. The acceptable scores (FDI scores 1–3) for each criterion exhibited no significant difference between the MJ and ES groups at any time point (p = 1.00). The marginal adaptation performance of ES was significantly better than that of MJ at every evaluation point (p < 0.05). The 3-year clinical performance of ES in NCCLs was similar to that of MJ. When the restorations were clinically acceptable, ES showed better marginal adaptation than MJ. Compared with conventional paste-type composites, highly filled flowable composites showed similar clinical performance and better marginal adaptation for restoring NCCLs after 3 years. TRN: ChiCTR1900028484 . Date of registration: December 22, 2019, retrospectively registered.

For the robotic GMAW on complex surface, the welding position is various along the welding path at different region, which results in the diverse molten pool behaviors, forming appearance or even the defects. To investigate the molten pool behaviors and forming appearance on the complex surface, the welding pose on the surface was described, the computational fluid dynamics model of the weld pool considering the droplet impingement, gravity, arc force, heat and mass transfer for four typical welding position was developed. The influence of gravity on the fluid flow for different position was investigated, and the results were validated with the high-speed welding camera. The deposition experiments with different welding current and local inclined angle were conducted to analyze the influence of the welding parameters and surface geometrical structure on the forming appearance. The results indicated that the influence of the gravity on the flow field and forming appearance at various welding position was different. The effect increased with the welding current, the surface local inclined angle (α∈[0, 90°]), and the absolute value of speed angle (|β|∈[0, 90°]), which was minimized when the torch travel direction was perpendicular to the gravity (β = 0°), because of the attenuated influence on the backward fluid flow. The findings help explain the molten metal forming mechanism of the welding on complex surface and improve the forming appearance.

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.

To observe the efficacy of long-retaining scalp acupuncture plus interactive training in improving upper-extremity dysfunction in cerebral stroke patients. Ninety-five patients with upper-extremity dysfunction after cerebral stroke were randomized into two groups, with 48 cases in the treatment group and 47 cases in the control group. Conventional internal medicine treatment was offered to both groups. In both groups, Anterior Oblique Line of Vertex-temporal (MS 6, the middle 2/5) and Posterior Oblique Line of Vertex-temporal (MS 7, the middle 2/5) were selected from the same side of the brain lesion (the side apposing to the hemiplegic limb) for scalp acupuncture treatment. In the treatment group, the scalp acupuncture needles were retained for 7 h, in combination with interactive training, while the needles were also retained for 7 h in the control group but without interactive training. Prior to treatment and at 2-week and 4-week treatment, the two groups were scored using the functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK) and simplified Fugl-Meyer assessment-upper extremity (FMA-UE). The total effective rate was 97.9% in the treatment group, higher than 74.5% in the control group (P

Ulcerative colitis (UC) is a type of refractory and recurrent inflammatory disorder that occurs in colon and rectum. Immune cell infiltration plays a critical role in UC progression; therefore, this study aims to explore potential biomarkers for UC and to analyze characteristics of immune cell infiltration based on the bioinformatic analysis. In this study, 248 differentially expressed genes (DEGs) were screened, and the top 20 immune-related hub genes and pathways were assessed. Moreover, four candidate diagnostic biomarkers (DPP10, S100P, AMPD1, and ASS1) were identified and validated. Immune cell infiltration analysis identified 13 differentially infiltrated immune cells (IICs) in UC samples compared to normal samples, and the result showed that two IICs only expressed in UC samples. In addition, the present research found that DPP10 was negatively correlated with neutrophils, S100P exhibited a positive correlation with resting CD4 memory T cells, AMPD1 was positively correlated with M2 macrophages, and ASS1 was inversely associated with neutrophils and positively related to CD8 T cells. Taken together, these findings indicated that DPP10, S100P, AMPD1, and ASS1 may act as diagnostic biomarkers for UC, and that differential IICs may help to illustrate the progression of UC., Graphical Abstract

Previous research on perceptual grouping primarily focused on the dynamics of single grouping principle in light of the Gestalt psychology. Yet, there has been comparatively little emphasis on the dissociation across two or more grouping principles. To tackle this issue, the current study aims at investigating how, when, and where the processing of two grouping principles (proximity and similarity) are established in the human brain by using a dimotif lattice paradigm and adjusting the strength of one grouping principle. Specifically, we measured the modulated strength of the other grouping principle, thus forming six visual stimuli. The current psychophysical results showed that similarity grouping effect was enhanced with reduced proximity effect when the grouping cues of proximity and similarity were presented simultaneously. Meanwhile, electrophysiological (EEG) response patterns were able to decode the specific pattern out of the six visual stimuli involving both principles in each trail by using time-resolved multivariate pattern analysis (MVPA). The onsets of the dissociation between the two grouping principles coincided within three time windows: the earliest proximity-defined local visual element arrangement in the middle occipital cortex, the middle-stage processing for feature selection modulating low-level visual cortex in the inferior occipital cortex and fusiform cortex, and the higher-level cognitive integration to make decisions for specific grouping preference in the parietal areas. In addition, brain responses were highly correlated with behavioral grouping. The results therefore provide direct evidence for a link between human perceptual space of grouping decision-making and neural space of these brain response patterns.Significance statementHow does our brain aggregate meaningless local elements to meaningful global patterns? Here, we used visual stimuli that can be perceived as a whole orientation from one of the two grouping cues (proximity and similarity) when they were presented simultaneously. Behavioral responses showed a trade-off between proximity and similarity. Further, time-resolved MVPA and source estimation results showed three stages for the processing of two grouping cues, involving an early stage in the low-level visual cortex, then the middle stage in the lateral visual cortex, and finally the late stage in the parietal areas. This was among the first attempt employing multivariate analysis to decode the dissociative processing of both proximity and similarity principles within one single study.

Infection is one of the primary causes of death from immune thrombocytopenia (ITP), and the lungs are the most common site of infection. We identified the factors associated with hospitalization for community-acquired pneumonia (CAP) in nonsplenectomized adults with ITP and established the ACPA prediction model to predict the incidence of hospitalization for CAP. This was a retrospective study of nonsplenectomized adult patients with ITP from 10 large medical centers in China. The derivation cohort included 145 ITP inpatients with CAP and 1360 inpatients without CAP from 5 medical centers, and the validation cohort included the remaining 63 ITP inpatients with CAP and 526 inpatients without CAP from the other 5 centers. The 4-item ACPA model, which included age, Charlson Comorbidity Index score, initial platelet count, and initial absolute lymphocyte count, was established by multivariable analysis of the derivation cohort. Internal and external validation were conducted to assess the performance of the model. The ACPA model had an area under the curve of 0.853 (95% confidence interval [CI], 0.818-0.889) in the derivation cohort and 0.862 (95% CI, 0.807-0.916) in the validation cohort, which indicated the good discrimination power of the model. Calibration plots showed high agreement between the estimated and observed probabilities. Decision curve analysis indicated that ITP patients could benefit from the clinical application of the ACPA model. To summarize, the ACPA model was developed and validated to predict the occurrence of hospitalization for CAP, which might help identify ITP patients with a high risk of hospitalization for CAP.

Resistance spot welding (RSW) quality substantially influences the autobody’s mechanical properties and safety performance. Nondestructive testing (NDT) method is widely used to evaluate the quality of RSW, but the traditional ultrasonic testing method has high requirements for coupling conditions and flat surface of the weld part. The electromagnetic acoustic transducer (EMAT) is a novel NDT technology, which has advantages of noncontact, no coupling media, and low requirements for surface flatness of the workpiece. Therefore, the electromagnetic ultrasonic transverse wave (EUTW) is developed to realize the evaluation of RSW quality in this paper. Under the COMSOL platform, the finite element method (FEM) modeling is proposed by multiphysics simulation. The multiphysical fields include electromagnetic field, acoustic field, and solid mechanics. The generation mechanism and propagation rules of EUTW in various spot welds are studied by simulation analysis. The correctness of FEM modeling is validated by EUTW experiments; results show that the experimental waveforms of EUTW are consistent with the simulation waveforms. Finally, an evaluation method of the nugget size of RSW is proposed based on the simulation and experiments analysis of EUTW detection of RSW with different nugget diameter and indentation depth. The approach presented in this paper can provide the theoretical foundation and new method for the noncontact, high efficient, and low-cost detection of RSW quality of the autobody.

PurposeThe purpose of this study is to provide evidence on the impact of network flexibility and its ambidextrous influence on a firm's exploratory and exploitative partnership selection.Design/methodology/approachThe authors develop our hypotheses based on the literature of network flexibility and draw on a sample of publicly listed firms in Taiwan semiconductor and optoelectronics industries. The authors collect our data from survey questionnaires and archival sources and examine our hypotheses by using the generalized linear model (GLM) approach.FindingsThe authors’ empirical findings show that configuration flexibility has a greater influence on exploratory partnerships, while manufacturing flexibility has a greater impact on exploitative partnerships. In addition, when firms are ambidextrous (i.e. have both types of flexibility), they are able to simultaneously obtain both exploratory and exploitative partnerships. The authors’ findings indicate that balancing network flexibility is critical when firms execute ambidextrous alliance strategies.Research limitations/implicationsThe authors’ use of survey data to measure network flexibility may limit our observations related to network evolution. In addition, the authors’ use of public annual reports to capture firm partnerships may cause us to ignore informal relationships between partners.Practical implicationsThe authors’ empirical findings suggest that the types of partnerships firms develop depend on which types of flexibility they possess. The results further suggest that decision makers have to find a way to develop a balanced strategy between network configuration and manufacturing flexibility when they would like to develop an ambidextrous alliance strategy.Originality/valueThe authors’ study advances the understanding in the literature on supply chain flexibility and its ambidexterity by connecting network flexibility and ambidextrous alliance strategy. The authors offer a guide to supply chain managers in the area of network design.

Background The pathogenesis underlying the alterations of orbital architecture in Graves’ orbitopathy (GO) is not yet fully understood. The present study aimed to investigate the association of DNA methylation in peripheral blood and orbital volumetry in Chinese patients with GO. Methods A total of 35 GO subjects (70 orbits) were subjected to CT scan. The total cross-sectional area of the extraocular muscles (orbital muscles, OM), total orbit area (TOA), and the exophthalmometry were measured and OM/TOA ratio was calculated. Targeted bisulfite sequencing was performed on seven candidate genes. Results No significant correlation was established between the DNA methylation levels of these genes and exophthalmometry. The MBP methylation level was found to be correlated with OM/TOA ratio (P < 0.05). Multiple linear regression analysis on parameters including age, sex, TRAb, duration of GO, and DNA methylation levels of seven genes with OM/TOA ratio confirmed that MBP and OM/TOA ratio had a significant correlation (P < 0.05). The partial least squares analysis showed that the top three genes with the highest loadings were MBP, BOLL, and BECN1 and that OM/TOA ratio affected the DNA methylation block than exophthalmometry. Conclusions This study provided preliminary evidence that MBP is a potential gene associated with OM enlargement in GO patients according to the combination of DNA methylation sequencing and orbital CT measurement.

PurposeNo study has investigated the effects of contralateral noise (CN) on speech-in-noise perception (SINP) in listeners with tinnitus. The mechanisms underlying the involvement of medial olivocochlear (MOC) reflex with SINP remain to be elucidated. This study aimed to investigate the MOC function in patients with bilateral tinnitus by measuring distortion product otoacoustic emission and SINP.MethodEighteen patients with bilateral tinnitus (one male and 17 females; age:M±SD= 45.61 ± 10.18 years) and 19 listeners without tinnitus (six males and 13 females; age:M±SD= 34.11 ± 8.35 years) were recruited for the study. Each subject underwent distortion product otoacoustic emission measurement and the SINP test for both ears. The effects of CN on these two measurements were compared between tinnitus ears (TEs) and no-tinnitus ears (NTEs).ResultsThe presence of CN significantly reduced distortion product (DP) amplitudes and improved SINP for TEs, and the amounts of DP suppression and SINP improvement were similar to those in NTEs. Improvement of SINP was positively correlated with DP suppression at 6185 Hz for NTEs and at 1640 Hz for TEs.ConclusionsThe results of this study suggest that the amounts of DP suppression and SINP improvement were similar between listeners with and without tinnitus. For both ear groups, the MOC reflex was involved with SINP at specific frequencies. Any clinical test outcomes with regard to the MOC bundle in patients with tinnitus should be interpreted with caution until further studies are conducted.

This study aimed to evaluate the feasibility and safety of a 2-μm thulium laser to perform lung nodule resection under video-assisted thoracoscopic surgery (VATS) compared with disposable linear cutting staplers. In total, 72 patients underwent thoracoscopic resection of lung nodules between January 2016 and December 2017 in the Department of Thoracic Surgery, Xuanwu Hospital. Of them, 31 underwent 2-μm thulium laser dissection, while 41 underwent the standard technique with a stapler. The primary endpoints of the study included analysis of intraoperative and postoperative course and costs. There was no significant difference between the laser and stapler groups in terms of clinical characteristics including sex, age, smoking history, and lesion size. Intraoperative evaluation demonstrated grade ≤ 2 air leaks with 29 cases in the laser group and 40 cases in the stapler group (P = 0.574). No significant intergroup differences were seen in the postoperative hospital stay (P = 0.063) or total hospital stays (and P = 0.993). Chest tube placement duration was significantly shorter in the laser group than in the stapler group (P = 0.015). However, total hospitalization costs were not significantly different between the two groups. In addition, 10 patients in each group were given a Thopaz digital chest drainage system after surgery. The postoperative hospitalization time was significantly shorter in the laser group than that in the stapler group (P = 0.049). Our results suggest that the 2-μm thulium laser has high value with minimal invasiveness, higher accuracy, and safety during thoracoscopic resection of pulmonary nodules in comparison with the controls.

An improved nonlinear dynamic model of high-speed ball bearings with elastohydrodynamic lubrication is adopted to predict the movements of balls and power loss of ball bearings for defining the boundary conditions of a computational fluid dynamics (CFD) model. Then, this method of combining nonlinear dynamic and CFD models is validated through the experimental verification. Subsequently, oil–air flow and temperature distribution inside the bearing chamber are studied at low and high speeds and light and heavy loads. The effect of nozzle’s position on the formation of oil film and heat dissipation is revealed under combined loads. The research results provide a theoretical basis for engineering application of high-speed rolling bearings.

BACKGROUND: Many studies have indicated that autophagy plays an important role in multiple cancers, including hepatocellular carcinoma (HCC). This study aimed to establish a prognostic signature for HCC based on autophagy-related genes (ARGs) to predict the prognosis of patients. METHODS: The list of ARGs was derived from screening National Center for Biotechnology Information (NCBI)-Gene and Molecular Signatures Database (MSigDB) datasets. Differential analysis was conducted via the R limma package in HCC patients based on The Cancer Genome Atlas (TCGA) database. Univariate and multivariate Cox regression analysis were conducted to identify key prognostic ARGs via the survival package. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed by clusterProfiler package. The Estimation of Stromal and Immune cells in MAlignant Tumor tissues using Expression data (ESTIMATE) algorithm was used to conduct immune analysis. Finally, the correlation between the prognostic model and clinical characteristics was also assessed, including age, tumor-node-metastasis (TNM) stages, and tumor grades. RESULTS: Firstly, 106 differential ARGs were identified and 10 candidates were further confirmed via Cox regression analysis, including BAMBI, HIF1A, SERPINE1, EZH2, SLC9A3R1, IGFBP3, HSPB8, DAB2, CXCL1 and PRNP. The receiver operating characteristic (ROC) curve analysis revealed that the ARGs risk model had a well diagnostic positive rate with 1-year area under the curve (AUC) =0.688 and 3-year AUC =0.674. Correlation analysis indicated that only advanced tumor stages were positively associated with high ARGs scores with P=0.0227. There were also significant differences in tumor purity (P=6.71e-05), infiltrating cell analysis (P=7.77e-05), immune analysis (P=7.9e-05), and stromal cells analysis (P=0.0015) in high- and low-risk ARGs samples. The genes HIF1A, IGFBP3, and DAB2 were found to have high frequent missense mutations in samples with high-risk ARGs scores. Lastly, we also established a nomogram to predict overall survival (OS) of HCC by integrating ARGs scores and other clinical parameters. CONCLUSIONS: Our study established an autophagy-related signature for predicting the prognosis of HCC patients, providing a thorough understanding of the underlying mechanisms of autophagy in HCC.

BackgroundDiabetic kidney disease (DKD), as one of the significant complications of diabetes, has been the focus of attention. Our previous retrospective study indicated that Shenzhou Formula (SZF) might reduce the macroalbuminuria secondary to the DKD.Methods and designThis trial is a 24-week, randomized, multicentric, double-blinded, double-dummy clinical trial. 120 DKD patients (60 in each group) will be randomly divided randomized into two groups: SZF+ Irbesartan Simulator or Irbesartan + SZF Simulator. 24-h UP is the primary outcome measure is. The secondary outcome measures include Serum creatinine, estimated glomerular filtration rate, urinary albumin excretion rate, improvement in TCM symptoms, FBG, 2-h postprandial plasma glucose, HbA1C, Cholesterol, triglycerides, HDL, LDL, blood pressure, albumin to creatinine ratio, and the audit of diabetes-dependent quality of life 19 . Our recruitment began in May 2015, and we have enrolled 100 participants in this ongoing study, with a designed maximum sample size of 120. The interim results have been reviewed at N = 60 and continuing recruitment was recommended. This statistical analysis plan includes our approach to impute missing data, analysis primary, secondary outcomes, and safety endpoints.ConclusionThis SAP will standardize the clinical trial's statistical analysis, avoid outcome selective reporting bias and data-driven analysis. This trial will provide further clinical evidence for SZF treatment of macroalbuminuria secondary to DKD.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR-ICR-15006311, registered on 26 May 2013. http://www.chictr.org.cn/showproj.aspx?proj=10862

Objectives: To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the inflammatory response and viral clearance in coronavirus disease 2019 (COVID-19) patients.Methods: We included 229 patients with confirmed COVID-19 in a multicenter, retrospective cohort study. Propensity score matching at a ratio of 1:3 was introduced to eliminate potential confounders. Patients were assigned to the ACEI/ARB group (n = 38) or control group (n = 114) according to whether they were current users of medication.Results: Compared to the control group, patients in the ACEI/ARB group had lower levels of plasma IL-1β [(6.20 ± 0.38) vs. (9.30 ± 0.31) pg/ml, P = 0.020], IL-6 [(31.86 ± 4.07) vs. (48.47 ± 3.11) pg/ml, P = 0.041], IL-8 [(34.66 ± 1.90) vs. (47.93 ± 1.21) pg/ml, P = 0.027], and TNF-α [(6.11 ± 0.88) vs. (12.73 ± 0.26) pg/ml, P < 0.01]. Current users of ACEIs/ARBs seemed to have a higher rate of vasoconstrictive agents (20 vs. 6%, P < 0.01) than the control group. Decreased lymphocyte counts [(0.76 ± 0.31) vs. (1.01 ± 0.45)*109/L, P = 0.027] and elevated plasma levels of IL-10 [(9.91 ± 0.42) vs. (5.26 ± 0.21) pg/ml, P = 0.012] were also important discoveries in the ACEI/ARB group. Patients in the ACEI/ARB group had a prolonged duration of viral shedding [(24 ± 5) vs. (18 ± 5) days, P = 0.034] and increased length of hospitalization [(24 ± 11) vs. (15 ± 7) days, P < 0.01]. These trends were similar in patients with hypertension.Conclusions: Our findings did not provide evidence for a significant association between ACEI/ARB treatment and COVID-19 mortality. ACEIs/ARBs might decrease proinflammatory cytokines, but antiviral treatment should be enforced, and hemodynamics should be monitored closely. Since the limited influence on the ACEI/ARB treatment, they should not be withdrawn if there was no formal contraindication.

Zhaoxian Yan,1 Yahui Chen,2 Xin Zhang,3 Lin Hua,3 Lifa Huang3 1First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China; 2Department of Rheumatology, Ningbo No.6 Hospital, Ningbo, 315040, Zhejiang, People’s Republic of China; 3Department of Neurosurgery, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People’s Republic of ChinaCorrespondence: Lifa HuangDepartment of Neurosurgery, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, People’s Republic of ChinaEmail eaybig@163.comBackground: Tumor necrosis factor-α (TNF-α)-induced protein 3-interacting protein 2 (TNIP2) has been well demonstrated to act as a principal contributor to the development of inflammatory diseases; however, the role of TNIP2 in cerebral ischemic/reperfusion injury has never been studied.Methods: Gene expression was examined by using quantitative real-time polymerase chain reaction and Western blot. The functional role of TNIP2 in oxygen and glucose deprivation/reoxygenation (OGD/R)-induced neuronal injury was evaluated using cell counting kit-8, terminal deoxynucleotidyl transferase dutp nick end labeling assay and enzyme-linked immunosorbent assay. Commercial kits were applied to evaluate the activity of NF-kappa-B (NF-κB) and caspase-3, as well as the release of lactate dehydrogenase release (LDH).Results: TNIP2 expression was substantially declined in HT22 cells following OGD/R stimulation. TNIP2 overexpression attenuated ODG/R-induced inflammation in HT22 cells, as evidenced by reduced levels of TNF-α, interleukin (IL)-1β, and intercellular cell adhesion molecule-1 (ICAM-1), and increased levels of IL-10. TNIP2 overexpression also reduced activity of NF-κB under ODG/R condition. Meanwhile, OGD/R treatment caused a reduction of cell viability and an elevation of cell apoptosis in HT22 cells, as indicated by the increase in LDH and caspase-3 activity. Whereas, OGD/R-induced HT22 cell injury was mitigated by TNIP2 overexpression in HT22 cells. Besides, we found the involvement of toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)/NF-κB pathway in the neuroprotective effect of TNIP2 on OGD/R-induced HT22 cell damage.Conclusion: TNIP2 overexpression mitigates OGD/R-induced inflammatory response and apoptosis. Moreover, TLR4/MyD88/NF-κB pathway participates in the protective effect of TNIP2 on OGD/R-induced neuronal damage.Keywords: TNF-α-induced protein 3-interacting protein 2, ischemic reperfusion injury, inflammation, apoptosis, toll-like receptor 4/myeloid differentiation factor 88/NF-kappa-B signaling

Background: B-cell subsets may be involved in the pathogenesis of childhood steroid-sensitive nephrotic syndrome (SSNS). Horizontal control studies have shown that homeostasis of B-cell subsets changes at different stages of the SSNS. However, there is a lack of longitudinal studies that have investigated dynamic changes in B cell subpopulations.Methods: Blood samples were collected at the following time points from 15 children with SSNS treated at our hospital: before administration of steroid and after 3 days, 1 week, and 3, 6, 9, and 12 months. The proportions of circulating total B cells (CD19+), transitional B cells (CD19+CD24highCD38high), mature B cells (CD19+CD24lowCD38intermediate), and memory B cells (CD19+CD24highCD38−) were monitored by flow cytometry.Results: The proportion of CD19+ B cells before steroid administration was significantly higher than that observed at any other time point or in the healthy control (HC) group (p < 0.001). However, this proportion was significantly lower than that in the HC group at 12 months (p = 0.031). Transitional B cells before (%BL 9.5 ± 4.4) and 3 days after steroid administration (%BL 10.6 ± 5.1) were significantly higher than at any other time point or in the HC group (p < 0.001). Although these cells declined after the 3rd day the percentage was still significantly lower than that of the HC group at 12 months (p = 0.029). Memory B cells increased gradually after steroid administration and decreased to the normal range after 9 months.Conclusions: B cell subpopulations show dynamic changes in children with SSNS, suggesting that they are involved in the pathogenesis of the disorder. Further studies are required to determine whether this change can guide individualized treatment.

A memory-based quantum repeater architecture provides a solution to distribute quantum information to an arbitrary long distance. Practical quantum repeaters are likely to be built in optical-fiber networks which take advantage of the low-loss transmission between quantum memory nodes. Most quantum memory platforms have characteristic atomic transitions away from the telecommunication band. A nondegenerate photon pair source is therefore useful for connection of a quantum memory to optical fibers. Here, we report a high-brightness narrowband photon-pair source which is compatible with a rare-earth-ion-doped crystal Pr3+:Y2SiO5. The photon-pair source is generated through a cavity-enhanced spontaneous parametric down-conversion process with the signal photon at 606 nm and the idler photon at 1540 nm. Moreover, using the telecom C-band idler photons for heralding, we demonstrate the reversible transfer of orbital-angular-momentum qubit between the signal photon and the quantum memory based on Pr3+:Y2SiO5.

Objectives. To describe the incidence, risk factors, and potential causes of preterm birth (PTB) in China between 2015 and 2016.Methods. The China Labor and Delivery Survey was a population-based multicenter study conducted from 2015 to 2016. We assigned each birth a weight based on the sampling frame. We calculated the incidence of PTB and the multivariable logistic regression, and we used 2-step cluster analysis to examine the relationships between PTB and maternal, fetal, and placental conditions.Results. The weighted nationwide incidence of PTB was 7.3% of all births and 6.7% of live births at 24 or more weeks of gestation. Of the PTBs, 70.5% were born after 34 weeks and 42.7% were iatrogenic. Nearly two thirds of all preterm births were attributable to maternal, fetal, or placental conditions, and one third had unknown etiology.Conclusions. This study provided information on the incidence of PTB in China and identified several factors associated with PTB. The high frequency of iatrogenic PTB calls for a careful assessment and prudent management of such pregnancies, as PTB has short- and long-term health consequences.

BACKGROUND Portal hypertension (PHT) is primarily caused by an increase in resistance to portal outflow and secondarily by an increase in splanchnic blood flow. Vascular hyporeactivity both in systemic circulation and in the mesenteric artery plays a role in the hyperdynamic circulatory syndrome. AIM To explore gender differences and the role of endogenous sex hormones in PHT and vascular reactivity of mesenteric arterioles in rats. METHODS Cirrhosis and PHT were established by subcutaneous injection of carbon tetrachloride (CCl4) in both male and female integral and castrated rats (ovariectomized [OVX] in female rats, orchiectomy [ORX] in male rats). The third-order branch of the mensenteric artery was divided and used to measure vascular reactivity to vasoconstrictors. RESULTS No significant difference in portal pressure was observed between integral and castrated male PHT rats (15.2 ± 2.1 mmHg vs 16.7 ± 2.7 mmHg, P > 0.05). The portal pressure in integral female PHT rats was lower than that in OVX female PHT rats (12.7 ± 2.7 mmHg vs 16.5 ± 2.4 mmHg, P < 0.05). In PHT rats, the concentration response curves of the mesenteric arterioles to norepinephrine were shifted to the right, and the maximal responses (Emax) values were decreased and effective concentrations causing half maximum responses (EC50) values were increased, compared to those of non-PHT rats, both in male and female rats. Compared to non-PHT integral male rats, the sensitivity of the mesenteric arterioles of non-PHT ORX male rats to norepinephrine was decreased (P > 0.05). However, there was no difference between integral and ORX male rats with PHT. In integral female PHT rats, the concentration response curves were shifted to the left (P < 0.05), and the Emax values were increased and EC50 values were decreased compared to OVX female PHT rats. CONCLUSION Clear gender differences were observed in mesenteric vascular reactivity in CCl4-induced cirrhotic and PHT rats. Conservation of estrogen can retain the sensitivity of the mesenteric arterioles to vasoconstrictors and has a protective effect on splanchnic vascular function in PHT.

The transient receptor potential melastatin‐related 2 (TRPM2) channel, a reactive oxygen species (ROS)‐sensitive cation channel, has been well recognized for being an important and common mechanism that confers the susceptibility to ROS‐induced cell death. An elevated level of ROS is a salient feature of ischaemia‐reperfusion, chronic cerebral hypo‐perfusion and neonatal hypoxia‐ischaemia. The TRPM2 channel is expressed in hippocampus, cortex and striatum, the brain regions that are critical for cognitive functions. In this review, we examine the recent studies that combine pharmacological and/or genetic interventions with using in vitro and in vivo models to demonstrate a crucial role of the TRPM2 channel in brain damage by ischaemia‐reperfusion, chronic cerebral hypo‐perfusion and neonatal hypoxic‐ischaemia. We also discuss the current understanding of the underlying TRPM2‐dependent cellular and molecular mechanisms. These new findings lead to the hypothesis of targeting the TRPM2 channel as a potential novel therapeutic strategy to alleviate brain damage and cognitive dysfunction caused by these conditions.

Background: Contrast-induced nephropathy (CIN) is a frequent cause of hospital-acquired acute kidney injury. Previous animal models developed to explore the pathogenesis of CIN were based primarily on surgery or indomethacin treatment. Thus, we sought to explore a novel CIN rat model comparable to the human CIN. Methods and results: Both serum creatinine and tubular injury score were used to assess the successful establishment of the present model. In our study, dehydration duration and the iohexol dosage were found to be the two most important factors to develop a rat CIN model. And, dehydration for 3 days plus furosemide (10 mL/kg) injection before iohexol (15 mL/kg) administration was demonstrated the optimal strategy. Renal injury induced by 15 mL/kg iohexol was almost twice more severe than 10 mL/kg. Moreover, significant renal function decrease, morphological damage and mitochondrial dysfunction occurred as early as 6 h after iohexol injection, not 24 h as previous studies reported. Unexpectedly, we firstly discovered that dehydration after iohexol administration did not increase the extent of renal damage, indicating that hydration after contrast media exposure may be ineffective. Conclusions: A novel CIN rat model based on dehydration and iohexol exposure was established and validated to assist in understanding and preventing CIN. Keywords: Contrast-induced nephropathy, Iohexol, Rat model, Dose-related, Hydration

Food safety is a prevalent concern around the world. As such, detection, removal, and control of risks and hazardous substances present from harvest to consumption will always be necessary. Metal-organic frameworks (MOFs), a class of functional materials, possess unique physical and chemical properties, demonstrating promise in food safety applications. In this review, the synthesis and porosity of MOFs are first introduced by some representative examples that pertain to the field of food safety. Following that, the application of MOFs and MOF-based materials in food safety monitoring, food processing, covering preservation, sanitation, and packaging is overviewed. Future perspectives, as well as potential opportunities and challenges faced by MOFs in this field will also be discussed. This review aims to promote the development and progress of MOF chemistry and application research in the field of food safety, potentially leading to novel solutions.

Building on Cyert and March’s (1963) behavioral theory of the firm, we investigate how firms adjust their exploratory and exploitative innovation activities in response to performance feedback, and how this adjustment is moderated by the firms’ financial slack. We find that firms invest in a different mix of innovation activities when they receive positive versus negative performance feedback. Specifically, our empirical results show that the higher a firm’s performance is above its aspiration level, the lower will be the share of exploratory innovation in its total portfolio of innovation activities. In contrast, the lower a firm’s performance is below its aspiration level, the higher will be the share of exploratory innovation in its total innovation activities. While financial slack has the direct effect of increasing the share of exploratory innovation activities, its interaction with performance feedback appears to moderate this effect when the firm is underperforming.

Background The relationship between vitamin D levels and peripheral arterial disease (PAD) remains unclear. We assessed the association of serum 25-hydroxyvitamin D (25(OH)D) levels with the prevalence of PAD in patients with type 2 diabetes mellitus(T2DM). Methods A total of 1018 T2DM patients participated in this cross-sectional study. Serum 25(OH)D levels were measured and risk factors of PAD were recorded. PAD was diagnosed as an ankle-brachial index (ABI)

The slider, which is made of polyoxymethylene, is the key component of an automotive window regulator. Its function is to guide the window's movement, but it is prone to wear and tear. To reduce noise and improve the wear life of slider, a study of its contact characteristic and the wear life is significant. In this paper, the wear and friction properties of polyoxymethylene under dry sliding condition and grease lubrication condition are investigated using a pin-on-disc apparatus. The complex force conditions of the slider at the normal working condition are studied by a mechanics analysis method. The contact pressure of slider is analyzed by the finite element analysis and the wear of slider is calculated by the proposed wear prediction model. Prediction of the wear life of slider is verified by a window regulator wear experiment. Results show that the value of wear rate of polyoxymethylene under unlubricated condition is much higher than that under lubricated condition. The estimation of wear depth of slider, based on the combination of finite element contact pressure analysis and wear properties of polyoxymethylene, is in accordance with window regulator wear test under unlubricated condition. Besides, the practical wear depth of slider under grease lubrication condition is also in the range of the predicted wear depth of slider under dry and grease lubrication condition.

Tooth variations in spur bevel gears have significant effects on the transmission performance, noise, and vibration and directly affect the reliability and stationarity of equipment. The hot forging process is the principal method used for the mass production of spur bevel gears owing to its high efficiency and high quality of products. However, hot forging of spur bevel gears is a high-pressure, high-temperature, and instantaneous forming process; hence, the evolution of tooth variations is extremely difficult to predict and measure. An accurate prediction of tooth variations in the hot forging process of spur bevel gears is an important precondition for tooth variation control to improve tooth accuracy. In this study, a new finite element (FE) analysis strategy of tooth variation prediction in the hot forging of spur bevel gears is proposed according to transitive relations of stress, strain, and temperature. Following this new strategy, a series of FE models are developed, so that the positional and shape variations on the tooth surface caused by die shrink-fitting (DSF), die elastic deformation (DED), die thermal expansion (DTE), gear elastic recovery (GER), and nonuniform cooling shrinkage of gear (NCSG) are comprehensively investigated. To verify the reliability of this FE analysis strategy, a hot forging experiment of a spur bevel gear was carried out, and the tooth variations of the tooth die and hot forged gear were measured using a gear-measuring machine. The results show that the factors causing the positional variation in order of importance from highest to lowest are DSF, DED, GER, NCSG, and DTE, and those for shape variation are DSF, DED, GER, DTE, and NCSG. Moreover, the shape variation of the final hot forged gear increases in the tooth profile direction and decreases in the tooth lengthwise direction. Finally, the simulation results closely agree with the experimental results, confirming the reliability of the FE analysis strategy proposed in this study.

Background Helicobacter pylori infection is associated with several extragastric conditions including dyslipidemia and metabolic syndrome. This study aimed to investigate additional metabolic parameters associated with H. pylori infection in a Chinese population. Methods Using a case-control approach we studied 617 subjects with 13C-urea breath test (13C-UBT) values ≥10‰ who were defined as being positive for H. pylori (cases), while 617 sex and age- matched subjects with 13C-UBT values ≤1‰ were defined as H. pylori negative (controls) in Beijing Tongren Hospital from March 2016 to May 2017. Biochemical parameters including serum bilirubin and lipids were tested. Results A total of 1982 subjects participated in this study. The H. pylori infected subjects had significantly lower serum direct bilirubin concentrations (2.34 ± 0.38 vs. 2.47 ± 0.90 μmol/L, P = 0.008). H. pylori infection was independently associated with lower direct bilirubin levels (OR = 1.497, 95% CI =1.121–1.999, P = 0.006) or total bilirubin levels (OR = 1.322, 95% CI =1.005–1.738, P = 0.046) after adjustment for age, sex, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), total cholesterol (TC) and triglycerides(TG). In addition, the H. pylori infected subjects had higher LDL-C levels (2.98 ± 0.76 vs. 2.89 ± 0.75 mmol/L, P = 0.033) and lower HDL-C levels (1.39 ± 0.37 vs. 1.44 ± 0.41 mmol/L, P = 0.044). LDL-C was negatively correlated with direct bilirubin concentration (R = − 0.260, P

The intestinal microbiota was linked to autoimmune diseases. Graves’ orbitopathy (GO) is an autoimmune disease that is usually associated with Graves’ disease. However, information on the microbiome of GO patients is yet lacking. To investigate whether GO patients differ from healthy controls in the fecal microbiota. A cross-sectional study. 33 patients with severe and active GO and 32 healthy controls of Han nationality were enrolled between March 2017 and March 2018. The Gut microbial communities of the fecal samples of GO patients and healthy controls were analyzed and compared by 16S rRNA gene sequencing. Community diversity (Simpson and Shannon) was significantly reduced in fecal samples from patients with GO as compared to controls (p

Disseminated intravascular coagulation (DIC) is a severe complication of critical conditions. There are several scoring systems used for the diagnosis of DIC, including the International Society on Thrombosis and Hemostasis (ISTH) Overt-DIC criteria, the Japanese Ministry of Health and Welfare (JMHW) criteria and the Chinese Society of Thrombosis and Hemostasis scoring system for DIC (CDSS). The objective of this prospective study was to evaluate the accuracy and predictive value of the CDSS.1318 patients, aged 18-70 years old and suspected of DIC were enrolled from 18 hospitals across China. Participants were divided into two groups for analysis (group 1, non-hematological diseases; group 2, hematological diseases). 242 patients were excluded because of incomplete data collection and failure to follow-up.The rates of concordance of diagnosis of DIC between the CDSS and two other scoring systems were close to 80%. The area under ROC curves of CDSS had a slight advantage when using the ISTH, JMHW criteria or prognosis as gold standard, respectively. The CDSS DIC was an independent predictor of mortality, and its odds-ratio was superior or comparable to that of the ISTH and JMHW criteria in the two groups. The CDSS DIC score also had a significant correlation with the APACHE II and SOFA score (p 0.05). In summary, as a quantification standard of the Chinese experts' consensus, the CDSS is conducive to the standardized diagnosis of DIC because of its favorable diagnostic and prognostic utility.

The traditional basketball teaching mode cannot meet the needs of students for the basic cooperation of basketball tactics. Therefore, a basic cooperation teaching system of basketball tactics based on artificial neural network is studied and designed. The system has a professional basketball game video tactical learning module. The events in the basketball game video are classified through a convolutional neural network and combined with the explanation of teachers to make the students have an intuitive understanding of the basic cooperation of basketball tactics and then design the basketball game module based on a BP neural network to provide students with an online basketball tactics training platform. Finally, the teacher scores the performance of the actual on-site training students in the basic cooperation of basketball tactics through the tactical scoring module on the system. The results show that after the introduction of global and collective motion patterns, the classification accuracy of the convolutional neural network is improved by 22.48%, which has significant optimization. The average accuracy of basketball game video event classification is 62.35%, and the accuracy of snatch event classification is improved to 95.28%. The recognition rate of the BP neural network combined with momentum gradient descent method is 75%, the number of weight adjustment is less, and the memory is small while ensuring fast running speed. Students who accept the basic basketball tactics cooperation teaching system based on the artificial neural network for basketball teaching have an overall score of 27.99 ± 2.11 points The overall score of exchange defense cooperation was 24.12 ± 2.03, which was higher than that of the control group. The above results show that the basketball tactical basic cooperation teaching system based on the artificial neural network has a good teaching effect in improving students’ basketball tactical basic cooperation ability.

ObjectiveTo explore the association between serum LH levels and the cumulative live birth rate (CLBR) within one complete cycle, and the impact of serum LH levels on the live birth rate (LBR) after the initial embryo transfer (ET) considering different ET strategies (fresh or freeze-all).DesignA retrospective cohort study.SettingUniversity-affiliated reproductive center.Patients1480 normogonadotrophic women who underwent COS with GnRH antagonist protocol for the first IVF/ICSI attempt.Intervention(s)The sample was stratified into low and higher LH groups according to serum LH peak levels of Main outcome measure(s)The LBR after the initial embryo transfer and the CLBR within one complete cycle.Secondary outcome measure(s)The numbers of day-3 high-quality embryos, the numbers of embryos available, and the other pregnancy outcomes after the initial ET.Result(s)In the whole cohort, the CLBRs decreased significantly in the low (63.1% vs. 68.3%, P=.034) LH group compared to the higher LH group. Subgroup analysis revealed that patients with low LH levels had lower LBR after fresh ET (38.0% vs. 51.5%, P=.005) but comparable LBR after the first frozen-thawed ET (FET) in freeze-all cycles (49.8% vs. 51.8%, P=.517) than patients with higher LH peak levels. Likewise, patients with low LH levels had lower CLBR for conventional fresh/frozen ET cycles (54.8% vs. 66.1%, P=.015) but comparable CLBR for the freeze-all cycles (66.8% vs. 69.2%, P=.414) than those with higher LH levels. Following confounder adjustment, multivariable regression analyses showed that low LH level was an independent risk factor for the CLBR in the whole cohort (odds ratio (OR): 0.756, 95% confidence interval (CI): 0.604-0.965, P=.014) and in patients who underwent the conventional ET strategy (OR: 0.596, 95% CI: 0.408-0.917, P=.017). Moreover, the adverse impact of low LH levels on LBRs maintained statistically significant after fresh transfers (OR: 0.532, 95% CI: 0.353-0.800, P=.002) but not after the first FETs in freeze-all cycles (OR: 0.918, 95% CI: 0.711-1.183, P=.508).Conclusion(s)In comparison with higher LH levels, low LH levels decrease the CLBRs per oocyte retrieval cycle for normogonadotrophic women who underwent COS using GnRH antagonists. This discrepancy may arise due to the significant detrimental effect of low LH levels on the LBRs after fresh embryo transfers.

Background: Over/under-estimating renal function may increase inappropriate dosing strategy associated adverse outcomes; however, previously reported equations to estimate renal function have limited accuracy in chronic kidney disease (CKD) patients. Consequently, we intended to develop a novel equation to precisely estimate renal function and subsequently guide clinical treatment for CKD patients.Methods: A novel approach, Xiangya-s equation, to estimate renal function for CKD patients was derived by linear regression analysis and validated in 1885 patients with measured glomerular filtration rate (mGFR) < 60 ml/min/1.73 m2 by renal dynamic imaging at three representative hospitals in China, with the performance evaluated by accuracy, bias and precision. In the meanwhile, 2,165 atrial fibrillation (AF) patients who initiated direct oral anticoagulants (DOACs) between December 2015 and December 2018 were identified and renal function was assessed by estimated creatinine clearance (eCrCl). Events per 100 patient-years was calculated. Cox proportional hazards regression was applied to compare the incidence of outcomes of each group.Results: Xiangya-s equation demonstrated higher accuracy, lower bias and improved precision when compared with 12 creatinine-based and 2 CysC-based reported equations to estimate GFR in multi-ethnic Chinese CKD patients. When we applied Xiangya-s equation to patients with AF and CKD prescribed DOACs, wide variability was discovered in eCrCl calculated by the Cockcroft-Gault (CG), Modification of Diet in Renal Disease Study (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Xiangya equation which we had developed for generally patients and Xiangya-s equations, which persisted after grouping by different renal function stages. Equation choice affected drug-dosing adjustments, with the formulas agreeing for only 1.19%, 5.52%, 33.22%, 26.32%, and 36.61% of potentially impacted patients for eCrCl cutoffs of Conclusion: Xiangya-s equation provides more accurate GFR estimates in Chinese CKD patients who need consecutive monitoring of renal function, which may assist clinicians in choosing appropriate drug dosages.

Introduction: The mechanism through which mesenchymal stromal cells (MSCs) enhance functional recovery in experimental models of stroke remains to be elucidated. This study was carried out to determine the microRNA (miRNA) profile elicited in response to MSC transplantation after stroke. Methods: This was an in vivo study on the effect of MSC transplantation on the exosomal miRNA profile in a rat model of middle cerebral artery occlusion (MCAO)-induced stroke. Eighteen male Sprague-Dawley rats were subjected to MCAO surgery (model group), and half received a transplantation of MSCs (model + MSC group) isolated from rat bone marrow. A sham-operated group (Sham) was included as a control. After 7 days, the volume of the brain lesion and severity of the functional impairments were measured. Exosomes were isolated from blood plasma samples for miRNA transcriptome analysis by Illumina sequencing. Results: The MCAO surgery successfully induced infarcts and neurological deficits in the rats, whereas the MSC transplantation significantly repaired these impairments. Illumina sequencing identified 764 known miRNAs, including 135 that were differentially expressed in common between the model + MSC and model, model and Sham, and model + MSC and Sham groups, respectively. Gene Ontology enrichment analysis revealed that the target genes of these miRNAs were associated with biological processes relevant to learning or memory and the development of the central and peripheral nervous systems. Pathway enrichment analysis identified a cluster of miRNAs (e.g., rno-miR-19b-3p, rno-miR-204-3p, rno-miR-125a-5p, rno-miR-672-3p, and rno-miR-667-3p) to be significantly related to the Janus kinase-signal transducer and activator of transcription, mechanistic target of rapamycin, phosphoinositide 3-kinases–Akt, and insulin signaling pathways via their control of their gene targets. Conclusion: We confirmed that MSC transplantation repaired stroke-induced functional impairments in rats by regulating various pathways associated with nervous system protection and MSC differentiation through the deregulation of exosomal miRNAs.

Modular Multilevel Converter (MMC) with integrated Battery Energy Storage System (BESS) has attracted amount of interest in recent years. However, compared with the common MMC, the SM capacitor voltage fluctuation in MMC-BESS become worse because of the integration of batteries, requiring larger SM capacitor to ensure the operation. This paper analyzes the influence of the integration of battery units on capacitor voltage ripples. Then a novel configuration for integration of BESS into MMC is presented. By using an isolated three-port converter as the battery interface converter, this configuration allows the batteries to connect both upper and lower arms and alleviates the SM voltage ripples problem. After that, the corresponding control strategy is presented. The simulation and experiment results are given to validate the effectiveness of the proposed configuration and control strategy.

Oxidative stress resulting from the accumulation of high levels of reactive oxygen species is a salient feature of, and a well-recognised pathological factor for, diverse pathologies. One common mechanism for oxidative stress damage is via the disruption of intracellular ion homeostasis to induce cell death. TRPM2 is a non-selective Ca2+-permeable cation channel with a wide distribution throughout the body and is highly sensitive to activation by oxidative stress. Recent studies have collected abundant evidence to show its important role in mediating cell death induced by miscellaneous oxidative stress-inducing pathological factors, both endogenous and exogenous, including ischemia/reperfusion and the neurotoxicants amyloid-β peptides and MPTP/MPP+ that cause neuronal demise in the brain, myocardial ischemia/reperfusion, proinflammatory mediators that disrupt endothelial function, diabetogenic agent streptozotocin and diabetes risk factor free fatty acids that induce loss of pancreatic β-cells, bile acids that damage pancreatic acinar cells, renal ischemia/reperfusion and albuminuria that are detrimental to kidney cells, acetaminophen that triggers hepatocyte death, and nanoparticles that injure pericytes. Studies have also shed light on the signalling mechanisms by which these pathological factors activate the TRPM2 channel to alter intracellular ion homeostasis leading to aberrant initiation of various cell death pathways. TRPM2-mediated cell death thus emerges as an important mechanism in the pathogenesis of conditions including ischemic stroke, neurodegenerative diseases, cardiovascular diseases, diabetes, pancreatitis, chronic kidney disease, liver damage and neurovascular injury. These findings raise the exciting perspective of targeting the TRPM2 channel as a novel therapeutic strategy to treat such oxidative stress-associated diseases., Graphical abstract Image 1

Background Epigenetic mechanisms play an important role in the chemoresistance of acute myeloid leukemia (AML). The clinical response to epigenetic modifier-based chemotherapy in patients with relapsed/refractory AML (r/r AML) is unclear. This multicenter clinical trial evaluated the safety and efficacy of epigenetic modifiers (chidamide and decitabine) in combination with aclarubicin, cytarabine, and granulocyte colony-stimulating factor (G-CSF) in patients with r/r AML. Results Adult patients with r/r AML were treated with chidamide, decitabine, cytarabine, aclarubicin, and G-CSF (CDCAG). The primary measures were overall response (OR), overall survival (OS), and safety. Next-generation sequencing was performed to analyze the correlation between gene mutations and response. A total of 93 patients with r/r AML were enrolled. Overall, 24 patients had a complete remission (CR) and 19 patients achieved CR with incomplete blood count recovery (CRi). The overall response rate (ORR) was 46.2%. The overall survival of these 43 patients who achieved CR/CRi was significantly longer than that of patients who failed to achieve remission (563 vs 152 days, P < 0.0001). Of the patients with mutations in epigenetic and transcription factor-related genes, but without internal tandem duplications in FMS-like tyrosine kinase3 (FLT3-ITDs), 55.6% achieved CR/CRi, whereas the ORR was 28.2% for patients with mutations in other genes. Conclusions The CDCAG regimen was well tolerated and effective in r/r AML. Patients with epigenetic and transcription factor-related gene mutations, but without FLT3-ITD mutations, may benefit from this regimen. Trial registration Clinical Trials, NCT02886559. Registered 01 September 2016

Intracranial hemorrhage (ICH) is a devastating complication of immune thrombocytopenia (ITP). However, information on ICH in ITP patients under the age of 60 years is limited, and no predictive tools are available in clinical practice. A total of 93 adult patients with ITP who developed ICH before 60 years of age were retrospectively identified from 2005 to 2019 by 27 centers in China. For each case, 2 controls matched by the time of ITP diagnosis and the duration of ITP were provided by the same center. Multivariate analysis identified head trauma (OR = 3.216, 95%CI 1.296-7.979