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The aim of this study was to explore and analyze the main features of the top 100 most-cited original articles, systematic reviews (SRs)/meta-analyses (MAs) in the field of robotic surgery, through scientometric analysis. VOSviewer and Excel 2019 were employed to conduct this scientometric study. We found that the majority of original articles (72/100) were published during the 2000s, while the majority of the top 100 most-cited SRs/MAs (91/100) during the 2010s. The USA was the most dominant country (n = 78), Henry Ford Health System was the most productive institution (n = 10), and Menon M was the largest contributing first author (n = 5) of the top 100 most-cited original articles. The USA was the most dominant country (n = 33), University of Padua was the most productive institution (n = 9), and Ficarra V was the largest contributing first author (n = 4) of the top 100 most-cited SRs/MAs. The top 100 most-cited original articles in robotic surgery have focused on the feasibility, outcomes and learning curve of robotic surgery for various neoplasms and cancers. The top 100 most-cited SRs/MAs have focused on the differences between robotic surgery and other types of surgery, with respect to the learning curve, costs, outcomes and experience in treating neoplasms, cancer and other diseases. In the future, the formation of cross-institutional and cross-disciplinary cooperation teams should be promoted and corresponding regulations and standards for specific diseases should be developed to regulate and promote the development of robotic surgery.

This study aims to systematically assess the effectiveness and safety of Huazhi Rougan granule in the treatment of non-alcoholic fatty liver.The PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), WanFang databases, VIP databases, Chinese Biomedical Literature Database (SinoMed) were searched to identify the relevant randomized controlled trials, from the establishment of the database to June 7, 2020. The Cochrane risk of bias tool for assessing risk of bias was employed to evaluate the quality of the literatures included. Meta-analyses were performed using RevMan 5.3 software.A total of 23 related literature were retrieved, 9 studies with 1,142 participants were included in the meta-analysis. The overall quality of evidence for this study is low. Meta-analysis results suggest that, Huazhi Rougan granule combined with conventional treatment was significantly superior to the silybin control group in the improvement of liver B-ultrasound, reduction of serological indexes, increase of high-density lipoprotein and total clinical effective rate, which was statistically significant. The improvement of serum lipid parameters included alanine aminotransferase (ALT): [mean deviation (MD) =-10.49, 95% confidence interval (CI): -17.09, -3.90, P0.05], aspartate transaminase (AST): (MD =-9.44, 95% CI: -14.62, -4.26, P0.05), total cholesterol (TC): (MD =-0.77, 95% CI: -0.94, -0.60, P0.05), triglyceride (TG): (MD =-0.40, 95% CI: -0.56, -0.24, P0.05). Reduce low-density lipoprotein cholesterol: (MD =-0.40, 95% CI: -0.56, -0.24, P0.05). Clinical effective rate: [risk ratio (RR) =1.25, 95% CI: 1.16, 1.36, P0.05]. Occurrence of adverse reactions: Of the 9 studies included, 5 reported adverse reactions, of which 3 reported no drug-related adverse reactions. Adverse reactions were reported in 2 cases, all of which were mild adverse reactions.The clinical efficacy of Huazhi Rougan granule combined with conventional basic therapy in the treatment of non-alcoholic fatty liver may be better than that of conventional basic therapy combined with silybin, which may improve the B-ultrasonic grading effect of the liver and reduce the serum lipid parameters of the patients. it may improve the clinical symptoms of non-alcoholic fatty liver, and the incidence of adverse reactions is low, but the number of existing clinical studies is small and the quality is low, in order to further verify the above conclusions. More high-quality clinical RCT trials need to be carried out, and internationally recognized outcome indicators should be selected and uniformly included in the scoring criteria.

Background As the use of Chinese herbal medicine (CHM) in the international market increases, the number of clinical studies including randomized controlled trials (RCTs) of CHM which published in international journals has also increased. Using bibliometrics, we systematically and comprehensively analyzed the research status of CHM RCTs published in English during the period of 2010 to 2019. Methods Electronic searches in MEDLINE, EMBASE, and Cochrane Library databases were undertaken. CHM RCTs published in English between January 2010 and December 2019 were included. We randomly selected 20% from the eligible articles. Descriptive statistical analysis was carried out by extracting information on general information, characteristics of the study participants, interventions, outcomes, and risk of bias assessment of included RCTs. Results Two hundred and twenty-seven CHM RCTs published in English were included in our study. Chinese Journal of Integrative Medicine was the journal which published most of the relevant papers (22.0%). A total of 45,774 participants were included, sample size ranged from 12 to 3,143 (median: 115). The most common disease was the circulatory diseases (n=36, 15.9%). Decoction was the most common dosage form (28.2%), and "CHM vs. placebo" was the most common type of control (36.1%). The median of the total number of outcomes was 4 (range: 1-14), 92 (40.5%) did not clearly specify any primary outcome, 56 (24.7%) did not report any adverse event, 41 (18.1%) and 68 (30.0%) reported traditional Chinese medicine (TCM)- specific outcomes and quality of life, respectively. Eighty-five (37.4%) did not report sufficient information about the random sequence generation process, 100 (44.1%) used the adequate allocation concealment, 92 (40.5%) blinded participants and key study personnel, and 24 (10.6%) blinded outcome assessors. Conclusions Our results provided insight into the research status regarding CHM RCTs published in English during the past decade, this study may be helpful in understanding research trends in this field.

Purpose To investigate characteristics of intra- and extracranial arterial culprit plaques between patients with single infarct and multiple-infarcts by a head-neck combined high resolution magnetic resonance vessel wall imaging (HR-MRVWI). Materials and methods Forty-three patients with recent ischemic stroke due to large artery atherosclerosis were enrolled. The head-neck combined HR-MRVWI was performed in all patients both pre- and post-contrast administration. Based on diffusion weighted imaging findings, patients were divided into single-infarction and multiple-infarction groups. For patients with anterior circulation ischemic stroke, they were also divided into perforating artery infarction (PAI) and non-PAI groups. Patient demographics, number and location of culprit plaques, artery stenosis percentage, intraplaque hemorrhage, and plaque enhancement were evaluated and compared between single-infarction and multiple-infarction groups, as well as between PAI and non-PAI groups. Results A total of 83 culprit plaques were identified. The artery stenosis degree was more severe and plaque enhancement more prominent in multiple-infarction group than in single-infarction group. Patients with multiple infarcts also had more culprit plaques per patient than those with single infarct, which contributed to the occurrence of multiple infarcts. For comparison of PAI and non-PAI groups, a higher artery stenosis percentage was observed in non-PAI group, and patients with non-PAI had more culprit plaques per patient, which contributed to a variety of infarct manifestations. Conclusion A higher stenosis grade and higher number of culprit plaques seem to be associated with a higher number of cerebral infarcts in patients with large artery atherosclerosis.

A new cleaner power generation system (IPGS) is proposed and investigated in this paper. Integrating combined cycle with supercritical water gasification of coal, the thermodynamic energy of the produced syngas is cascade utilized according to its temperature and pressure, both sensible and latent heat of the syngas can be recycled into the system, and thereby the net power efficiency can be about 6.4 percentage points higher than that of the traditional GE gasification based power plant (GEPP). The exergy analysis results show that the exergy efficiency of the proposed system reaches 52.45%, which is 13.94% higher than that of the GEPP, and the improvement in exergy efficiency of the proposed system mainly comes from the exergy destruction decline in the syngas energy recovery process, the condensation process and the syngas purification process. The syngas combustion process is the highest exergy destruction process with a value of 157.84 MW in the proposed system. Further performance improvement of the proposed system lies in the utilization process of syngas. Furthermore, system operation parameters have been examined on the coal mass fraction in the supercritical water gasifier (GF), the gasification temperature, and the gasification pressure. The parametric analysis shows that changes in coal concentration in the GF exert more influence on the exergy efficiency of the system compared with the other two parameters.

Background: Catechol-O-methyltransferase (COMT) contributes to the control of synaptic dopamine (DA) transmission by catalyzing DA degradation in the presynaptic space. The COMT Val158Met polymorphism (rs4680) substantially alters enzymatic activity and consequently synaptic DA concentration in the prefrontal cortex and hippocampus. The COMT genotype could, therefore, exert a major influence on antipsychotic treatment response as many of these agents also target dopaminergic transmission. Objective: The present meta-analysis aimed to test a putative relationship between the COMT Val158Met polymorphism and antipsychotic response across different populations and antipsychotic types. Methods: Searches of PubMed, Web of Science, EMBASE, OVID, Google Scholar, and Baidu Scholar databases yielded 30 peer-reviewed studies published before January 2020 with a pooled total of 6291 participants. The Lipták-Stouffer Z score method for meta-analysis was applied to combine data. The Z score was also calculated separately for Caucasian and Asian subgroups. Results: Pooled results indicated a highly significant association between COMT Val158Met and antipsychotic response (Z = 6.709, P = 9.8 × 10-12). Further, this relationship remained significant in subgroup analyses of Caucasian patients (Z = 3.180, P = 7.4 × 10-4) and Asian patients (Z = 4.487, P = 3.6 × 10-6). Conclusions: Pooled evidence supports the hypothesis that the COMT Val158Met polymorphism influences the antipsychotic response in Caucasian and Asian schizophrenia patient populations. Prediction of antipsychotic response by patient genotyping may warrant closer consideration in randomized clinical trials of efficacy.

Aim To review the clinical features of systemic lupus erythematosus (SLE) complicated by central nervous system (CNS) infection due to Listeria monocytogenes. Method A patient with SLE receiving high-dose glucocorticoids combined with cyclophosphamide who developed multiple brain abscesses due to Listeria infection is described. The case is compared with known cases in a literature review. Results A review of the literature showed that CNS infections are rare bacterial complications of SLE, but they can be a significant cause of mortality, especially those due to L. monocytogenes. The most significant risk factor for listerial meningitis is a prior history of receiving immunosuppressive therapy. At-risk patients should avoid unpasteurized milk and soft cheeses along with deli-style, ready-to-eat prepared meats, particularly poultry products. The case we report is the fifth SLE patient with multiple brain abscesses due to L. monocytogenes, and the first to be discharged with no sequelae. Timely and accurate identification and treatment of CNS infections and neuropsychiatric lupus are very important for favorable disease prognosis. Conclusion Repeated blood culture is helpful for early diagnosis, and empirical anti-infective treatment that covers L. monocytogenes is recommended for SLE patients with risk factors when CNS infection occurs. A comprehensive assessment might be helpful to distinguish CNS infections from neuropsychiatric SLE. For severe infection, the dosage of steroids does not need to be reduced immediately but can be gradually adjusted based on the results of a comprehensive evaluation of the disease.

Background and aims Hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis and plaque vulnerability. The macrophage apoptosis mediated by endoplasmic reticulum (ER) stress plays an important role in the pathogenesis of HHcy-aggravated atherosclerosis. Endoplasmic reticulum oxidoreductase 1α (Ero1α) is critical for ER stress-induced apoptosis. We hypothesize that Ero1α may contribute to ER-stress induced macrophage apoptosis and plaque stability in advanced atherosclerotic lesions by HHcy. Methods Apoe−/− mice were maintained on drinking water containing homocysteine (Hcy, 1.8 g/L) to establish HHcy atherosclerotic models. The role of Ero1α in the atherosclerotic plaque stability, macrophage apoptosis and ER stress were monitored in the plaque of aortic roots in HHcy Apoe−/− mice with or without silence or overexpression of Ero1α through lentivirus. Mouse peritoneal macrophages were used to confirm the regulation of Ero1α on ER stress dependent apoptosis in the presence of HHcy. Results The atherosclerotic plaque vulnerability and macrophage apoptosis were promoted in Apoe−/− mice by high Hcy diet, accompanied by the upregulation of Ero1α expression and ER stress. Inhibition of Ero1α prevented macrophage apoptosis and atherosclerotic plaque vulnerability, and vice versa. Consistently, in mouse peritoneal macrophages, ER stress and apoptosis were attenuated by Ero1α deficiency, but enhanced by Ero1α overexpression. Conclusions Hcy via upregulating Ero1α expression activates ER stress-dependent macrophage apoptosis, so as to promote vulnerable plaque formation in atherosclerosis. Ero1α may be a potential therapeutic target for atherosclerosis induced by Hcy.

Background The aim of the study was to define the clinical significance of circulating tumor cells (CTCs)/circulating tumor endothelial cells (CTECs) and their subtypes in small cell lung cancer (SCLC) patients. Methods CTCs/CTECs and their subtypes were determined using SE‐iFISH technology in 33 SCLC patients before initial treatment (B1), after two cycles of chemotherapy (B2), at the completion of chemotherapy (B3), and disease progression (B4). The correlations with clinical characteristics, progression‐free survival (PFS), and overall survival (OS) were analyzed. Results CTCs and CTECs were detected in 96.6% and 65.5% of patients, respectively. Patients had higher levels of CTCs compared with CTECs in circulation (p, It has been proved in many studies that CTCs can be used as a prognostic biomarker in SCLC patients. Here, we report that CTC‐WBC clusters may also be a valuable predictor for SCLC prognosis. In this study, patients with CTC‐WBC clusters before chemotherapy (17.3 vs. 22.6 months, p = 0.041) and after two cycles of treatment (19.9 vs. 25.2 months, p = 0.018) tended to have a significantly shorter overall survival duration.

Background Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and can lead to heart failure (HF), stroke, pulmonary embolism (PE), and other complications, seriously affecting people’s quality of life and health. Western medicine is limited in the treatment of AF, while Traditional Chinese Medicine (TCM) has unique advantages, such as less side effects, low toxicity, long effect duration, and high compliance. The prescription of HTDJ is a common prescription for the treatment of atrial fibrillation in Longhua Hospital, Shanghai University of Traditional Chinese Medicine. It has been used for many years and has a large number of clinically effective cases. It has a good clinical application prospect, but there is a lack of effective evaluation of its clinical efficacy. Method This study adopts a randomized double-blind, single-simulated, placebo-controlled research method. Participants were randomly assigned in a 1:1 ratio through a centrally controlled, computer-generated, simple randomization schedule. Participants would take the medicine for 1 month, and the curative effect would be evaluated. Subsequently, the participants would not take TCM and only receive western medicine treatment. They would be followed up for another 8 weeks, and a clinical evaluation would be conducted. The secondary outcomes include echocardiography, Hamilton Anxiety Scale, Hamilton Depression Scale, rate of increase and decrease of anti-arrhythmia western medicine, the MOS 36-item short-form health survey, N-terminal-pro hormone B-type natriuretic peptide level, and integral TCM syndrome score. Adverse events will be monitored throughout the trial. Cases are from outpatient and inpatient with atrial fibrillation in the Cardiology Department of Longhua Hospital. Evaluations will be conducted at baseline and at weeks 4 and 12 after randomization. Discussion In this study, the efficacy and safety of HTDJ plus western medicine in the treatment of atrial fibrillation (qi deficiency and phlegm opacities) will be evaluated, so as to provide medical evidence of short-term and medium-term clinical efficacy for the treatment of atrial fibrillation with integrated traditional and western medicine and lay a foundation for further clinical development and application. Trial registration ClinicalTrials.govChiCTR2000030517. Registered on March 5, 2020, with the Chinese Clinical Trial Registry

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.

Photodetectors operating in the shortwave infrared region are of great significance due to their extensive applications in both commercial and military fields. Narrowbandgap two-dimensional layered materials (2DLMs) are considered as the promising candidates for constructing next-generation high-performance infrared photodetectors. Nevertheless, the performance of 2DLMs-based photodetectors can hardly satisfy the requirements of practical applications due to their weak optical absorption. In the present study, a strategy was proposed to design high-performance shortwave infrared photodetectors by integrating metal-organic frameworks (MOFs) nanoparticles with excellent optical absorption characteristics and 2DLM with high mobility. Further, this study demonstrated the practicability of this strategy in a MOF/2DLM (Ni-CAT-1/Bi2Se3) hybrid heterojunction photodetector. Due to the transfer of photo-generated carriers from the MOF to Bi2Se3, the MOF nanoparticles integrated on the Bi2Se3 layer can increase the photocurrent by 2–3 orders of magnitude. The resulting photodetector presented a high responsivity of 4725 AW−1 and a superior detectivity of 3.5 × 1013 Jones at 1500 nm. The outstanding performance of the hybrid heterojunction arises from the synergistic function of the enhanced optical absorption and photogating effect. In addition, the proposed device construction strategy combining MOF photosensitive materials with 2DLMs shows a high potential for the future high-performance shortwave infrared photodetectors.

Different from conventional oil and gas, the storage and seepage space of heavy oil reservoirs are extremely complicated, thereby making it difficult to describe reservoirs in detail over the heavy oil production process. Acquiring development results accurately in real time is still a demanding task, and it is also a challenge to predict the average remaining heavy oil saturation during the production process. Tracers are mostly used to monitor steam flooding to obtain the real-time dynamics during heavy oil production in fields. However, the flow pattern of gas tracers in heavy oil is still unclear, with very rare investigations. In this work, a new one-dimensional gas tracer convection–diffusion model that considered the retention and oil phase migration velocity was established using the percolation law of gas tracers. The reservoir description coefficient f was introduced to describe the relationship between the migration velocities of the oil and gas phases in the heavy oil reservoir. Subsequently, a new gas tracer well pattern flow model was also constructed based on the gas tracer linear flow model and verified simultaneously. The results revealed that at a larger partition coefficient, more amounts of gas tracers were distributed in the crude oil, the duration of stagnation was extended, and the start time of tracer production was moved backward. The injection velocity had a very minor effect on the tracer production performance. As the fluid injection rate increased, the duration of gas tracer production was extended; however, after the injection rate reached a certain level, the difference in the arrival time of the peak become minor. The effects of crude oil viscosity on the tracer production were reflected by the breakthrough time, production time, peak concentration, and peak arrival time of the tracer. Compared with the production curve of the crude oil viscosity, the peak of the production curve with high crude oil viscosity has a faster peak time and a large peak value. The reservoir description coefficient mainly affects the peak concentration of tracer production and has very minor effects on the production time and other parameters. The outcomes of this work can be applied in the field of heavy oil development, in particular, for the heavy oil reservoir description and dynamic monitoring.

A new broadband circularly polarized antenna is presented for K -band application in this letter. The circularly polarized radiation is realized by orthogonal-polarized slots based on a special structure of the L-shaped waveguide cavity. To verify the proposed idea, a single element and a 2 × 4-element array are designed, fabricated, and measured. The simulations are agree well with experiments. The results show that the single element achieves the 10 dB impedance bandwidth of 27.5% (18.5–24.5 GHz) and the 3 dB axial ratio bandwidth of 7.1% (19.6–21.2 GHz), while the 2 × 4 element array achieves the 10 dB impedance bandwidth of 27.1% (18.5–24 GHz) and the 3 dB axial ratio bandwidth of 18.7% (19.3–22.6 GHz). Moreover, all-metal structure of the proposed antenna is very appropriate for tough environment applications.

Cerebral ischemia is one of the leading causes of human mortality and disability worldwide. The treatment of cerebral ischemia is refractory due to its short therapeutic window and lack of effective clinical drugs. Mitophagy, the autophagic elimination of damaged mitochondria, attenuates neuronal injury in cerebral ischemia, indicating the potential of mitophagy inducers as therapies for cerebral ischemia. We previously determined that, by enhancing autophagy flux, the steroidal alkaloid tomatidine can function as a neuroprotective agent against ischemic injury. However, its effects on mitophagy remain unknown. For this purpose, neuroblastoma cell lines Neuro‐2a and SH‐SY5Y were subjected to ischemic injury induced by oxygen–glucose deprivation/reperfusion (OGD/R) and then treated with tomatidine. OGD/R induced a general decrease of cellular contents, and this study revealed that tomatidine had no impact on mitophagy. In addition, tomatidine did not affect mitochondrial contents, including translocase of outer mitochondrial membrane 20 and voltage‐dependent anion channel 1, in either OGD/R‐treated or intact SH‐SY5H cells. Our results indicate that tomatidine exhibits its neuroprotective effects by enhancing autophagy, but in a potentially mitophagy‐independent manner, and provide insights for further investigation into its mechanism(s) and potential therapeutic use against cerebral ischemia., The steroidal alkaloid, tomatidine, has been shown to treat cerebral ischemia by enhancing autophagy, but its effect on mitophagy is still unknown. Our work indicates that the neuroprotective role of tomatidine is independent of mitophagy. Further research should be performed to determine how autophagy contributes to the neuroprotective effects of tomatidine in ischemic neurons.

A number of studies reported that miR-224-5p is involved in a variety of cancer-related cellular processes, yet its physiological role in clear cell renal cell carcinoma (ccRCC) remains unclear. In order to clarify the function of miR-224-5p in ccRCC, real-time quantitative-PCR was conducted to compare the expression of miR-224-5p in human normal renal tubular epithelial cell lines and ccRCC cell lines first, and a strikingly upregulated expression was observed in ccRCC cell lines. Inhibition of miR-224-5p expression by microRNA inhibitors could inhibit the proliferation, migration, and invasion of ccRCC cells. Besides, it was validated by dual-luciferase assay in which miR-224-5p directly targeted OCLN gene. The expression of OCLN was downregulated in ccRCC cells, and overexpression of miR-224-5p could inhibit the mRNA and protein expression levels of OCLN. Overexpression of OCLN could reduce the proliferation, migration, and invasion of ccRCC cells, while overexpressed miR-224-5p could partially reverse that inhibitory effect. Therefore, the promotive effect of miR-224-5p on the proliferation, invasion, and migration of ccRCC cell lines was at least partly due to the inhibition of OCLN expression. These findings highlighted the important function of miR-224-5p, which was promoting cell proliferation, migration, and invasion by downregulating OCLN, in the pathogenesis of ccRCC, and provided a potential treatment strategy.

BACKGROUND Under physiological conditions, sputum produced during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can move passively with the cilia in the airway; the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway. However, when the sputum is thick, the cough is weak, or the tracheal cilia are abnormal, sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung. Furthermore, the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients, which is the main factor leading to AECOPD. Therefore, promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention. AIM To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia. METHODS We selected 126 patients with AECOPD and difficulty of expectoration at our hospital, and divided them into a refined care group and a routine care group, with 63 cases each, using a random number table. The two groups of patients were treated with expectorant, anti-infection, oxygen inhalation, and other basic treatment measures; patients in the refined care group were given refined nursing intervention during hospitalization, and the routine care group received conventional nursing intervention. The differences in sputum expectoration, negative pressure suction rate, blood gas parameters, dyspnea score measured through the tool developed by the Medical Research Council (MRC), and quality of life were compared between the two groups. RESULTS After 7 d of intervention, the sputum expectoration effect of the refined care group was 62.30%, the effective rate was 31.15%, and the inefficiency rate was 6.56%. The sputum expectoration effect of the routine care group was 44.07%, the effective rate was 42.37%, and the inefficiency rate was 13.56%. The refined care group had better sputum expectoration than the routine care group (P < 0.05). The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment (22.95% vs 44.07%, P < 0.05). Before the intervention, the arterial oxygen saturation (PaO2) and arterial carbon dioxide saturation (PaCO2) values were not significantly different between the two groups (P > 0.05); the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention (P > 0.05). Before the intervention, there was no significant difference in the MRC score between the two groups (P > 0.05); the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention, but the difference was not statistically significant (P > 0.05). Before intervention, there was no significant difference in the symptoms, activities, disease impact, or St. George’s Respiratory questionnaire (SGRQ) total scores between the two groups (P > 0.05). After 7 days of intervention, the symptoms, activities, and total score of SGRQ of the refined care group were higher than those of the routine care group, but the difference was not statistically significant (P > 0.05). CONCLUSION AECOPD with thick sputum, weak coughing reflex, and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung. Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration, alleviate clinical symptoms, and improve the quality of life.

Objective The endoscopic endonasal approach (EEA) has been applied in the treatment of olfactory neuroblastoma (ONB). However, there is a lack of research examining the impact of EEA on locally advanced ONB. This study assessed the outcomes of EEA in patients with locally advanced ONB and its impact on the quality of life (QOL). Methods We retrospectively reviewed patients with Kadish stage C ONB who underwent EEA between December 2004 and October 2019 and assessed demographic data, histopathologic grade, the extent of resection, postoperative complications, and outcomes. Preoperative and postoperative QOL was assessed using the Sino-Nasal Outcome Test. Results Twenty-six patients (18 men, 8 women; aged 26–79 years) were enrolled, with 12 cases of Hyams grade II and III and 1 case of grade I and IV each. In total, 25 patients received radiotherapy and 16 patients received chemotherapy, of whom 11 received preoperative neoadjuvant chemotherapy. Postoperative nasal bleeding was observed in 2 patients. The follow-up ranged from 8 to 124 months (median, 42.3 months). The 1-year and 5-year overall survival were 96.2% and 84.8%, respectively. The 1-year and 5-year disease-free survival were 76.9% each. The analysis of the postoperative Sino-Nasal Outcome Test scores showed significant improvement in certain psychological and sleep-associated domains, compared with the preoperative scores. Conclusions Our results showed that pure EEA followed by radiotherapy offered excellent outcomes in the management of selected patients with locally advanced ONB. The postoperative QOL was significantly improved. More research is required on neoadjuvant chemotherapy to establish its role.

BackgroundIn the last 30 years, significant progress in the field of surgery has been achieved with the advent of robotic surgery. In this study, we aimed to conduct a bibliometric analysis to identify the distribution and characteristics overall and of the top 100 most-cited studies about robotic surgery versus open surgery.MethodsA systematic search was conducted on March 26, 2021 using Web of Science Core Collection. Two reviewers independently screened documents, and the top 100 most-cited studies were identified. Excel 2019 and VOSviewer were used to collect the data, and visual information was obtained.ResultsA total of 2306 documents were searched from the Web of Science Core Collection, and 1065 journals and 2913 institutes were extracted. A significant growth was observed in the last 15 years. The number of citations from the United States accounted for 33.31% of the total number of citations. There were nine American institutes and one Swedish institute in the top 10 institutes. Four journals in the field of urology or gynecology were present in the top 10 published journals. Few global communications between authors, institutes, and countries authors were observed.ConclusionThe lack of close cooperation among scientific research institutions may have affected the industrialization process of surgical robots. Some developing countries, including South America and Africa, should seize the development opportunity of robotic surgery to improve the level of domestic research on robotic surgery.

In view of the situation that tasks or activities in the GERT model may have multiple realizations, this paper explores the time dependence of each repeated execution node under the condition of fuzzy information, and studies the characteristics of the z-tag fuzzy GERT model and its analytic algorithm. Firstly, the F-GERT model related to the number of executions of activities is defined, and the simplified rules, related properties and theorems of the network model are examined. Secondly, solving algorithm, conditional moment generating function and process arrival time of the F-GERT model for repeated execution time are studied. Finally, the application of F-GERT queuing system based on element execution time in weapon equipment management is discussed. The feasibility and effectiveness of the model and algorithm are verified by the practical application of the project.

It has been established that obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. Chronic intermittent hypoxia (CIH) activates sympathoadrenal system and upregulates β3 adrenergic receptor (β3 AR). However, the effect of selective β3 AR agonist mirabegron in CIH-induced atherosclerosis remains unknown. We generated a CIH-induced atherosclerosis model through exposing ApoE−/− mice to CIH (8 h per day, cyclic inspiratory oxygen fraction 5–21%, 60-s cycle) for 6 weeks after 4-week high-fat dieting and investigated the effects of mirabegron, a selective β3 AR agonist, on CIH-induced atherosclerosis. The coronary endarterectomy (CE) specimens from coronary artery disease patients with OSA and without OSA were collected. The expression of β3 AR was significantly elevated in CIH-induced atherosclerosis model. Furthermore, treatment with mirabegron (10mg/kg per day by oral administration for 6 weeks) ameliorated atherosclerosis in ApoE−/− mice in CIH but not in normoxia. Mechanistically, mirabegron activated β3 AR and ameliorated intraplaque oxidative stress by suppressing p22phox expression and reactive oxygen species (ROS) level. In addition, in human CE specimens, β3 AR was also upregulated associated with increased p22phox expression and ROS level both in the lumen and in the plaque of coronary artery in OSA subjects. This study first demonstrated that mirabegron impeded the progression of CIH-induced atherosclerosis, at least in part, via β3 AR–mediated oxidative stress, suggesting a promising therapeutic strategy for protecting against atherosclerosis induced by CIH.

Decreased secretion of melatonin was reported to be associated with an enhanced risk of hypertension and diabetes. However, the effect of melatonin on gestational hypertension (GH) and the underlying mechanism remain unclear. A GH mouse model was established via electrical stimulation. The hypertensive phenotypes were indicated by systolic blood pressure (SBP) and urinary protein levels. Uterine artery (UtA) endothelial function was detected by relaxation, peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). Protein expression levels were determined using immunochemistry and Western blots. Pregnancy outcomes were indicated by the fetal live ratio, fetal weight and placental weight. Melatonin supplementation ameliorated hypertensive phenotypes in the mice with GH and enhanced UtA endothelial response to acetylcholine. The BKCa potassium channel was involved in the effect of melatonin on UtA endothelial function, and melatonin promoted BKCa potassium channel expression and function in UtAs. Finally, melatonin improved pregnancy outcomes in pregnant mice. In conclusion, melatonin ameliorates hypertension in hypertensive pregnant mice and suppresses hypertension-induced decreases in Ca2+-activated K+ channels in uterine arteries.

Detecting defects in metal structures quickly and robustly is critical to maintaining safe operation in industry. This work discloses an eddy current (EC) testing probe with coils carrying three-phase currents as excitation and integrated array tunnel magnetoresistance (TMR) sensors measuring the magnetic field as receiver. The three-phase currents in the planar layout coils induce EC that migrates electrically in the material under test. This excitation method does not require multiplexing of the coils and is sensitive to defects of any orientations. The TMR array contains 64 sensors, which are microfabricated and packaged in a line. Within single probe pass, the sensors generate magnetic field image with high sensitivity ( $\text{1.99}\;\text{nT}/\sqrt {\text{Hz}} @\text{30}\;\text{kHz}$ ) and fine spatial resolution (0.5 mm pitch). By analyzing the output image, defects are identified and localized. The operating principle of the probe was investigated based on a finite-element method model. A prototype probe was developed and tested, with which machined defects in aluminum samples were inspected. Experimental results show that the probe has comparable sensitivity for horizontal and vertical defects, and it can recognize a small defect with length × width × depth = 1 × 0.2 × 1 mm3. The defects are located within 1 mm with an artificial neural network.

Background Coronary artery calcification (CAC) is an independent risk factor of major adverse cardiovascular events; however, the impact of CAC on in-hospital death and adverse clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective To explore the association between CAC and in-hospital mortality and adverse events in patients with COVID-19. Methods This multicenter retrospective cohort study enrolled 2067 laboratory-confirmed COVID-19 patients with definitive clinical outcomes (death or discharge) admitted from 22 tertiary hospitals in China between January 3, 2020 and April 2, 2020. Demographic, clinical, laboratory results, chest CT findings, and CAC on admission were collected. The primary outcome was in-hospital death and the secondary outcome was composed of in-hospital death, admission to intensive care unit (ICU), and requiring mechanical ventilation. Multivariable Cox regression analysis and Kaplan–Meier plots were used to explore the association between CAC and in-hospital death and adverse clinical outcomes. Results The mean age was 50 years (SD,16) and 1097 (53.1%) were male. A total of 177 patients showed high CAC level, and compared with patients with low CAC, these patients were older (mean age: 49 vs. 69 years, P

We conducted a population-based retrospective cohort study to evaluate whether the association between cigarette smoking and dementia risk is modified by genetic predisposition including apolipoprotein E (APOE) genotype and polygenic risk (without APOE gene). We included 193,198 UK Biobank participants aged 60 to 73 years without dementia at baseline who were recruited from 2006 to 2010 and followed until 2018. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards model. The cohort was followed up for 1,700,886 person-years (median [interquartile range] follow-up, 9.0 [8.3-9.7] years). 1788 participants with incident dementia cases were detected. Of non-APOE-ε4 carriers, 0.89% (95% CI, 0.73%-1.08%) current smokers developed dementia compared with 0.49% (95% CI, 0.44%-0.55%) of never smokers (adjusted HR 1.78; 95% CI, 1.39-2.29). Of participants with high polygenic risk, 1.77% (95% CI, 1.35%-2.27%) current smokers developed dementia compared with 1.05% (95% CI, 0.91%-1.21%) of never smokers (adjusted HR 1.63; 95% CI, 1.16-2.28). A significant interaction was found between APOE genotype and smoking status (P = 0.002) while no significant interaction was identified between polygenic risk and smoking status on risk of dementia (P = 0.25). APOE genotype while not polygenic risk modified the effect of smoking on dementia risk.

CD100 is an important immune semaphorin that is a secreted and membrane bound protein involved in infectious diseases. However, CD100 expression profile and the regulation to innate immune system in hepatitis B virus (HBV)-associated acute-on-chronic liver failure (ACLF) was not previously reported. The aim of this study was to investigate CD100 level and modulatory function of CD100 to CD14+ monocytes in HBV-ACLF patients. Plasma-soluble CD100 (sCD100) level and membrane-bound CD100 (mCD100) expression on peripheral CD14+ monocytes was analyzed in HBV-ACLF patients. CD14+ monocytes-induced cytotoxicity and CD14+ monocytes-mediated T cell activation in response to CD100 stimulation was also assessed in direct and indirect contact coculture culture systems. HBV-ACLF patients had lower plasma sCD100 and higher mCD100 level on CD14+ monocytes compared with asymptomatic HBV carriers, chronic hepatitis B patients, and controls. CD14+ monocytes from HBV-ACLF patients induced limited target Huh7.5 cell death and secreted less interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and granzyme B in both direct and indirect contact coculture systems compared with controls. Recombinant sCD100 not only enhanced CD14+ monocytes-mediated Huh7.5 cell death and granzyme B secretion, but it also elevated CD14+ monocytes-induced IFN-γ/interleukin-17 production by CD4+ T cells as well as IFN-γ/TNF-α secretion by CD8+ T cells in HBV-ACLF patients. The current data indicated that severe inflammation induced sCD100/mCD100 imbalance to inactivate CD14+ monocytes response, which might be beneficial for the survival of HBV-ACLF patients.

BACKGROUND AND AIMS High prevalence of minimal change lesion (MCL) in nonerosive reflux esophagitis (NERD) patients is commonly recognized by many endoscopists. However, it is difficult to detect MCL with conventional white-light imaging (WLI) endoscopy. Linked color imaging (LCI), a novel image-enhanced endoscopy technology with strong, unique color enhancement, is used for easy recognition of early gastric cancer and detection of Helicobacter pylori infection. The aim of the study was to compare the efficacy of LCI and WLI endoscopy in evaluating MCL in patients with NER. MATERIALS AND METHODS Forty-one patients with NERD and 38 subjects with nongastroesophageal reflux disease (non-GERD) were recruited in this study between August 2017 and July 2018. During upper gastrointestinal endoscopy, the distal 5 cm of the esophageal mucosal morphology at the squamocolumnar junction was visualized using WLI followed by LCI. MCL was defined as areas of erythema, blurring of the Z-line, friability, decreased vascularity, white turbid discoloration, and edema or accentuation of the mucosal folds. Three experienced endoscopists evaluated the color patterns for MCL on WLI images and on WLI combined with LCI images in both groups. A biopsy was taken 2 cm above the esophagogastric junction. Histologic slides were scored by a pathologist in a blinded manner. RESULTS The proportion of MCL was higher in the patients with NERD (70.7%, 29/41) than in patients with non-GERD (39.5%, 15/38) using WLI combined with LCI. In 12 patients with NERD, both WLI and LCI showed normal mucosa. The MCL detection rate was significantly higher when using WLI combined with LCI than when using WLI (70.7% vs. 51.2%, P=0.039) in patients with NERD. The histopathologic score of MCL (+) was significantly higher than that of MCL (-) patients in both the NERD group (4.59±0.32 vs. 2.36±0.34, P

HBB gene mutations lead to many kinds of diseases, of which, except for the two most common diseases of thalassemia and sickle cell anemia, rare kinds of hemolytic anemia, such as hemoglobin Bristol-Alesha, are rarely reported, no ideal treatment in clinic. A child suffered from chronic recurrent hemolytic attacks and the related genes of hereditary hemolytic anemia were detected on her. Hematopoietic stem cell transplantation was conducted in the treatment of the patient. The patient was diagnosed as hemoglobin Bristol-Alesha and achieved complete recovery after hematopoietic stem cell transplantation. For Bristol-Alesha, without characteristic clinical manifestation and specific biochemical examination, diagnosis is dependent on the gene mutation detection and hematopoietic stem cell transplantation is an effective and curable method.

Introduction Recurrent cystitis, defined as at least two episodes within six months or three episodes within one year, presented among about one fifth to one-third of women with history of cystitis or urinary tract infection (UTI) according to previous studies. However, the use of antibiotics can only resolve the urinary symptoms but not reduce the frequency of urinary symptoms recurrence, and meanwhile increasing rates of adverse effect of repetitive antimicrobial therapy and bacterial antimicrobial resistance became clinical concerns. This case report aims to present a case of recurrent cystitis treated by electroacupuncture (EA) in reducing recurrent frequency, amount of antibiotics used and urinary symptoms. Case presentation A 42-year-old woman diagnosed with recurrent cystitis for five years presented mainly with recurrent dysuria, urine frequency and urgency. She received EA treatment 3 to 5 sessions a week and 30 min per session from August 2019 to August 2020 with 3-month suspension due to Coronavirus Disease 2019 (COVID-19). During the treatment, both the frequency of recurrent urinary episode and symptoms were reduced. Although there was some fluctuation, the mean frequencies of daytime voiding reduced dramatically from 17.7 to 8.3, and night-time voiding from 4 to 1, and the number of voiding with moderate urgency was reduced from 17.7 to 2.3, and severe urgency dropped from 2.7 to 0. The patient's scores of overactive bladder symptom score (OABSS) and overactive bladder questionnaire short form (OAB-q SF) were also improved. The postvoid residual urine volume (PVR) reduced from 42 mL to less than 10 mL. Conclusion This case of individual effect of EA for a woman with frequent recurrent cystitis suggested a plausible benefit of EA on reducing frequency, amount of antibiotics used and symptoms of recurrent cystitis, but further research is necessary to proof the efficacy and effectiveness among a wider population.

Making impressions in patients with microstomia is often rather problematic due to their restricted mouth opening. Herein, this report describes a novel digital workflow for making impressions with computer-aided design and computer-aided manufacturing (CAD/CAM) custom sectional trays for a 58-year-old female patient with scleroderma and microstomia. CAD/CAM custom sectional trays were made based on digital dentition models from another case with similar arch scale. After the sectional impressions were obtained, the sectional casts were scanned and digitally aligned to form the final dentition models. The removable partial dentures were designed on the final digital models and printed using a 3D printer. This procedure was executed with a successful prosthetic outcome that included good fit and acceptable esthetics. The patient also reported a high level of satisfaction.

PurposeIn recent years, online public opinion reversal incidents have been occurring frequently, which has increased the complexity of the evolution of online public opinion, and they have become a difficult issue for public opinion management and control. It is of great significance to explore the regularity of online public opinion reversal.Design/methodology/approachCombined with the grey characteristics of online public opinion information, a grey graphical evaluation review technique (G-GERT) network model is constructed based on kernel and grey degree, and the frequency, probability and time of online public opinion reversal nodes are calculated using C-marking method and Z-marking method.FindingsThroughout the online public opinion reversal events, there are all repeated outbreak nodes occurring, so the authors regard the repeated occurrence of outbreak nodes as reversal. According to the average frequency, probability and time of repeated outbreak nodes in the G-GERT network model, the authors predict the corresponding key information of reversal. It can simulate the evolution process of public opinion events accurately.Originality/valueThe G-GERT network model based on kernel and grey degree reveals the regulation of public opinion reversal, predicts the frequency, probability and time of reversal nodes, which are the most concerned and difficult issues for decision-makers. The model provides the decision basis and reference for government decision-making departments.

Background The aim of the present study was to propose a new approach for 3D computed tomography (CT) airway evaluation-guided endobronchial blocker placement in pediatric patients, and to determine its efficiency in clinical application. Methods A total of 127 pediatric patients aged 0.5-3 years who were scheduled for elective thoracic surgery using one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO) group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, intensive care unit (ICU) stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were compared between the 2 groups. Results The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, ICU stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were similar between the 2 groups (all P>0.05). Conclusions For pediatric patients undergoing surgery with OLV, preoperative 3D CT airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of BRO-guided blocker placement.

Conductor-dielectric-magnetic multicomponent coordination composites with rhombic Fe2O3 lumps doping hollow ZnFe2O4 spheres through oxidative decomposition process implanted into graphene conductive network (hollow ZnFe2O4 spheres/rhombic Fe2O3 lumps/rGO composites) were successfully constructed by a facile method. The countless hollow ZnFe2O4 spheres were compactly attached to the curled-paper rGO and larger sized-rhombic Fe2O3 lumps were relatively dispersed. Among, the hollow structure of ZnFe2O4 spheres could attenuate the electromagnetic wave by multiple reflections and scatterings. Intriguingly, hollow ZnFe2O4 spheres reacted with GO to form intermediate rhombic Fe2O3 lump products, which ameliorated the hetero-interfaces structure and helped to improve impedance matching by weakening the strong magnetic ZnFe2O4 (Ms = 91.2 emu/g) and high conductive rGO after the introduction of weakly magnetic Fe2O3 semiconductor. Moreover, all three components could induce dielectric polarization losses, such as multilayer or dipole polarization. Therefore, the maximum absorption of ternary composites was up to −64.3 dB at 7 GHz and 3.4 mm, simultaneously, and a bandwidth exceeding −10 dB was 4.2 GHz at 1.7 mm. Meanwhile, with a thin thickness range of 1.5–5 mm, the absorption bandwidth below −10 dB was from 2 to 18 GHz which occupied for 91.5% of whole study frequency range. These results provided a new approach and reference for the design and property regulation of electromagnetic materials at electronic communications, aerospace and military radar flied.

Sleep deprivation (SD) has become a serious concern worldwide. This study aimed to identify key modules and candidate hub genes correlated with diseases caused by SD, using co-expression analysis. The weighted gene co-expression network analysis was performed to construct a co-expression network of hub genes correlated with SD. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to search for signaling pathways. The protein–protein interaction network analysis of central genes was performed to recognize the interactions among central genes. Molecular Complex Detection, a plugin in Cytoscape, was used to discover the hub gene clusters involved in SD. A total of 564 genes in the yellow module were identified based on the results of topological overlap measure–based clustering. The yellow module showed a pivotal correlation with SD. Six hub gene clusters prominently associated with SD were identified. Heat shock protein family and circadian clock genes among them may be the hub genes involved in SD. These genes and pathways might become therapeutic targets with clinical usefulness in the future.

Background: Post-mastectomy radiation therapy (PMRT) is part of standard regimen in the management of breast cancer. It has been shown to decrease the incidence of local regional recurrence (LRR) and improve breast cancer survival. Yet, its role in patients with 1-3 positive lymph nodes (N1) remains unclear. The lack of biological markers to evaluate the efficacy of PMRT for N1 patients leads to excessive treatment of low-risk patients and ignore of those at high risk. A clinical-genomic model RecurIndex® (RI-LR), based on a genomic database from mRNA expression as well as clinical factors (lymph node involvement, ER status,age at diagnosis, and lymphovascular invasion), is mainly developed for predicting the LRR in early stage breast cancer patients. Method: The preliminary result enrolled 107 breast cancer patients with N1 involvement in a retrospective study atthe fourth hospital of Hebei Medical University. Kaplan Meier method is used to calculate the survival rates in terms of LRR-free interval (LRFI). The log rank test and cox regression model are applied for the survival difference between two independent groups, and for investigating prognostic factors related to high-risk patients. The primary endpoint is LRFI. Results: With a median follow-up of 84 [IQR 64-84] months, RI-LR partitioned these N1 patients into 70% high-risk group and 30% low-risk group. LRR rate was 14.7% in the high-risk group whereas only 3.1% in the low-risk group. The survival curve clearly showed a partitioned trend of two groups (5-year LRFI 87.5%vs 100%, p = 0.085). Patients identified in the RI-LR high-risk group showed significantly higher LRFI if they had PMRT compared to those without PMRT (5-year LRFI 94% vs 70%, p =0.043), suggesting that higher radiosensitive patients could be identified by RI-LR. Multivariate analysis revealed that high-risk patients treated with PMRT has a 71 % reduction of LRR compared to those without PMRT (HR 0.29, 95%CI: 0.08-1.00, p = 0.051). Conclusions:The present study provided robust evidence that RI-LR could partition N1 breast cancer patients into good and poor prognosis of LRR. RI-LR is capable of identifying high-risk patients who would benefit from PMRT. This observation warrants to validate in a larger cohort. Key words: Early breast cancer, genomic assay, recurrence index (RI), local-regional recurrence (LRR), post mastectomy radiotherapy (PMRT) Citation Format: Li-Na Zhang, Yue-Ping Liu, Chun-Xiao Li, Chao Song, Ning Wang, Ji-Yu Tang, Meng-Li Zhou, Ting-Hao Chen, Ming-Shuo Chen, Skye Hung-Chun Cheng, Cui-Zhi Geng. Recurindex® predicts local regional recurrence for n1 breast cancer after mastectomy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-26.

Minimally invasive surgery includes traditional laparoscopic and robot-assisted surgery. Although many studies related to robotic surgery and laparoscopic surgery have been published, when doing our search, scientometric studies that focus on related robotic surgery versus laparoscopic surgery were limited. In this study, we aimed to analyze and review the research hots and research status of robotic surgery versus laparoscopic surgery. We searched publications that involved robotic surgery versus laparoscopic surgery in the Web of Science database from 1980 to May 23, 2020. The top 100 publications were published in 2012 with the number of 17 and citations ranged from 618 to 64. Published across 34 different journals, namely European urology (n = 17) and others, the greatest contribution among 36 institutes was made by the Cleveland Clinic (n = 11). Of the top 100 publications, a total of 429 unique words were identified and the most frequently occurring keyword was laparoscopy (n = 33). The co-occurrence of keywords in the top 100 publications indicated that the study of diseases mainly focused on prostatectomy, complications, prostate cancer, retropubic prostatectomy, nephron-sparing surgery, lymph-node dissection, total mesenteric excision, sexual function, rectal cancer, and assisted distal gastrectomy. In recent years, comparative research on robot and laparoscopic surgery has decreased and most studies focus on cancer.

Background. The impact of postmastectomy radiotherapy (PMRT) in patients receiving neoadjuvant chemotherapy (NAC) is unclear. The purpose of this study is to identify the patients who may benefit from PMRT. Methods. We retrospectively analysed patients with clinical stage II-III breast cancer who underwent NAC and modified radical mastectomy at our centre from 2007 to 2015. We investigated the relationship amongst locoregional recurrence rate (LRR), disease-free survival (DFS), and clinical pathological characters. Results. A total of 554 patients were analysed in this study. The median follow-up time was 65 months. Amongst the patients, 58 (10.5%) had locoregional recurrence, 138 (24.9%) had distant metastasis, and 72 (13.0%) patients died. The 5-year cumulative incidence of LRR and DFS was 9.2% and 74.2%, respectively. A total of 399 (72%) patients received PMRT and 155 (28%) did not. The 5-year LRR of the patients with PMRT (7.3% vs. 14.1%, P = 0.01 ) decreased significantly. We found that PMRT was an independent prognostic factor of LRR and DFS. Patients with the persistent involvement of 1–3 lymph nodes (ypN1) and more than 4 positive lymph nodes (ypN2-3) had a better outcome after PMRT than those without. However, the LRR and DFS of patients with negative lymph nodes at the time of surgery (ypN0) and who received PMRT showed no significant benefits. Amongst all patients with the three molecular subtypes of breast cancer, patients with triple-negative breast cancer had the highest pathological complete response rate but the worst prognosis ( P = 0.001 ). Conclusion. Results showed that PMRT significantly reduced the LRR of patients with clinical stage II-III breast cancer after receiving NAC and mastectomy. YpN0 patients derived no local control or survival benefit after receiving PMRT, whereas those with ypN1 and ypN2-3 could obviously benefit from PMRT.

OBJECTIVE To assess the efficacy of intensive acupuncture (3 times weekly for 8 weeks) versus sham acupuncture for knee osteoarthritis (OA). METHODS In this multicenter, randomized, sham-controlled trial, patients with knee OA were randomly assigned to receive electroacupuncture (EA), manual acupuncture (MA), or sham acupuncture (SA) 3 times weekly for 8 weeks. Participants, outcome assessors, and statisticians were blinded with regard to treatment group assignment. The primary outcome measure was response rate, which is the proportion of participants who simultaneously achieved minimal clinically important improvement in pain and function by week 8. The primary analysis was conducted using a Z test for proportions in the modified intent-to-treat population, which included all randomized participants who had ≥1 post-baseline measurement. RESULTS Of the 480 participants recruited in the trial, 442 were evaluated for efficacy. The response rates at week 8 were 60.3% (91 of 151), 58.6% (85 of 145), and 47.3% (69 of 146) in the EA, MA, and SA groups, respectively. The between-group differences were 13.0% (97.5% confidence interval [97.5% CI] 0.2%, 25.9%; P = 0.0234) for EA versus SA and 11.3% (97.5% CI -1.6%, 24.4%; P = 0.0507) for MA versus SA. The response rates in the EA and MA groups were both significantly higher than those in the SA group at weeks 16 and 26. CONCLUSION Among patients with knee OA, intensive EA resulted in less pain and better function at week 8, compared with SA, and these effects persisted though week 26. Intensive MA had no benefit for knee OA at week 8, although it showed benefits during follow-up.

An opportunistic network is a special type of wireless mobile ad hoc network that does not require any infrastructure, does not have stable links between nodes, and relies on node encounters to complete data forwarding. The unbalanced energy consumption of ferry nodes in an opportunistic network leads to a sharp decline in network performance. Therefore, identifying the ferry node group plays an important role in improving the performance of the opportunistic network and extending its life. Existing research studies have been unable to accurately identify ferry node clusters in opportunistic networks. In order to solve this problem, the concepts of k-core and structural holes have been combined, and a new evaluation indicator, namely, ferry importance rank, has been proposed in this study for analyzing the dynamic importance of nodes in a network. Based on this, a ferry cluster identification model has been designed for accurately identifying the ferry node clusters. The results of the simulations conducted for verifying the performance of the proposed model show that the accuracy of the model to identify the ferry node clusters is 100%.

Background Chronic obstructive pulmonary disease (COPD) has become a major public-health problem in China. Surfactant protein D (SP-D) is a very promising biomarker and therapeutic target for COPD. To assess whether baseline serum SP-D is associated with lung function decline and incident COPD. Methods This longitudinal study was initiated in 2009 in a community in Beijing. Data were collected on spirometry, and the baseline level of serum SP-D was measured in 772 non-COPD subjects aged 40-70 years old. In 2012, spirometry was repeated in 364 individuals, 37 of whom subjects had incident COPD. Results From 2009 to 2012, subjects with incident COPD had a more rapid decline in FEV1 (MD 98.27 vs. MD 43.41 mL) compared with those without COPD. There was no association between baseline serum SP-D and the COPD incidence. Smoking (OR =2.72; P=0.002) and age (OR =1.06; P=0.000) were risk factors for COPD. The rate of FEV1 decline varies widely in the general population, and the univariate analysis showed that baseline serum SP-D levels (R=-0.169; P=0.003), income level, home-road distance, and statin use were inversely correlated with the decline in FEV1. After multivariable analyses, only smoking was consistently associated with the decline in FEV1. Conclusions There was no correlation between baseline serum SP-D levels and incident COPD in a general population. Smoking and age were major risk factors for COPD. The effect of serum SP-D levels on the decline in FEV1 needs further investigation.

Photonic crystal has been proved to manipulate light effectively and improve the performance of solar cells. In this paper, high-performance GaAs-based solar cells with photonic crystal were fabricated to decrease the dependence on the angle of incident light. Photoluminescence (PL) intensity of solar cells with photonic crystal reduced only 8% when the incident angle changed from 10° to 30°, while the PL intensity of the ordinary solar cells decreased 39% under the same condition. It manifests the photonic crystal can manipulate the incident light in turn reduce the dependence of incident light angle. Besides, the short circuit current of solar cells was increased by 32% after the photonic crystal was added. When the incident angle of light increased to 30° from 0°, the short circuit current of ordinary solar cell decreased 29.5%, while that of solar cell with photonic crystals reduced 12%. Correspondingly, the photoelectric conversion efficiency (PCE) of ordinary solar cells was reduced 31.2%. In contrast, solar cells with photonic crystal decreased only 11.5%. The enhancement factor of the PCE of solar cells with photonic crystal to that of ordinary solar cells increases from 1.26 to 1.6 as the incident angle rises to 30°from 0°. In summary, solar cells with photonic crystal are less sensitive to the incident angle and could absorb more light without angle limits, then increase the PCE. These solar cells with photonic crystals are promising in low-cost and high power conversion efficiency solar cell fields.

The thermography camera is widely used to inspect electrical equipment. The existing defect assessment indicators are mainly the hot spot temperature and the relative temperature difference (RTD), and the analyzing process used to calculate the indicators is usually off-site. A smart thermography camera is designed and its application in the diagnosis of electrical equipment is investigated in this article. For the camera, the regional RTD is calculated automatically based on equipment detection and image registration algorithms, and the defects can be judged according to the existing criteria. Firstly, the regional RTD and its implementation method are proposed to reduce the error when the hot spot is unmeasurable. Then the object detection method based on the convolutional neural network (CNN) is modified dedicated to infrared (IR) images. Over 12 000 historical images and 18 000 labels are used for training and tests. The modified model can identify 16 classes of substation equipment with 86.4% mAP. With low latency, the inference speed of this on-site smart camera reaches 30 frames/s. The test results show that the similarity of diagnosis result between our method and the criteria is 92.2%.

Background Microwave ablation is effective for severe secondary hyperparathyroidism, but the difference in efficacy between microwave ablation and parathyroidectomy remains unclear. In this multicenter retrospective cohort study, we compared the long-term clinical efficacy of microwave ablation and parathyroidectomy for severe secondary hyperparathyroidism undergoing hemodialysis. Materials and methods The patients were divided into microwave ablation and parathyroidectomy groups. The primary endpoint was the proportion of patients with intact parathyroid hormone (iPTH) concentrations within the target range (100–600 pg/mL) during the efficacy assessment phase. The secondary endpoints were (i) differences in iPTH concentrations over time between the two groups, and (ii) decreases in iPTH concentrations over time in the two groups. Results Microwave ablation was performed in 47/92 patients and parathyroidectomy in 45/92. Primary endpoint: iPTH concentrations within the target range were achieved during the efficacy assessment phase in 26/47 patients (55.3%) and in 14/45 (31.1%) patients in the microwave ablation and parathyroidectomy groups, respectively (p = .02). Secondary endpoints: (i) Mean iPTH concentrations during the efficacy assessment phase were significantly higher in the microwave ablation versus parathyroidectomy groups (649 ± 519 pg/mL versus 136 ± 228 pg/mL, respectively; p

Positron emission tomography (PET) is an advanced medical imaging technique widely used in various clinical applications, such as tumor detection and neurologic disorders. Reducing the radiotracer dose is desirable in PET imaging because it decreases the patient’s radiation exposure. However, reducing the dose can also increase noise, affecting the image quality. Therefore, an advanced image reconstruction algorithm based on low-dose PET data is needed to improve the quality of the reconstructed image. In this article, we propose the use of a direct PET image reconstruction network (DPIR-Net) using an improved Wasserstein generative adversarial network (WGAN) framework to enhance image quality. This article provides two main findings. First, our network uses sinogram data as input and outputs high-quality PET images direct, resulting in shorter reconstruction times compared with traditional model-based reconstruction networks. Second, we combine perceptual loss, mean square error, and the Wasserstein distance as the loss function, which effectively solves the problem of excessive smoothness and loss of detailed information in traditional network image reconstruction. We performed a comparative study using maximum-likelihood expectation maximization (MLEM) with a post-Gaussian filter, a total variation (TV)-norm regularization, a nonlocal means (NLMs) denoising method, a neural network denoising method, a traditional deep learning PET reconstruction network, and our proposed DPIR-Net method and evaluated the proposed method using both human and mouse data. The mouse data were obtained from a small animal PET prototype system developed by our laboratory. The quantitative and qualitative results show that our proposed method outperformed the conventional methods.

Growth of AlGaN-based multiple quantum wells (MQWs) has been attempted on nano-patterned sapphire substrates (NPSSs). By adopting a critical-temperature approach and optimizing the growth conditions including the V/III ratio and Si doping level, high-efficiency AlGaN-based MQWs with an internal quantum efficiency (IQE) greater than 80% at room temperature are realized with an emission wavelength shorter than 280 nm. Taking such high IQE MQWs as the active region, a deep-ultraviolet light-emitting-diode (DUV-LED) device is fabricated and presents single peak emission with a wavelength of 276.1 nm. The light output power (LOP) of this device reaches 17.3 mW at an injection current of 100 mA, presenting an excellent device performance.

BACKGROUND: The characteristics of plaque that ultimately lead to different subcortical infarctions remain unclear. We explored the differences in plaque characteristics between patients with small subcortical infarction (SSI) and large subcortical infarction (LSI) of the middle cerebral artery (MCA) using high-resolution magnetic resonance vessel wall imaging (HR-MRVWI). METHODS: The study group comprised 71 patients (mean age, 47.49±11.5 years; 55 male) with MCA territory ischemic stroke. Whole-brain HR-MRVWI was performed using a three-dimensional T1-weighted variable-flip-angle turbo spin echo (SPACE) sequence. Patients were divided into SSI and LSI groups based on routine MRI images. Plaque distribution was classified as the superior, inferior, ventral, or dorsal wall of the MCA. The number of quadrants with plaque formation, location of plaque, plaque burden (PB), arterial remodeling pattern (positive or negative), and degree of stenosis were analyzed and compared between groups. RESULTS: Of the 71 patients, 43 (60.6%) and 28 (39.4%) were identified as the SSI and LSI groups, respectively. The proportion of plaques involving only one quadrant was significantly higher in the SSI group, and these plaques were located in the superior or dorsal MCA vessel wall. There was no significant difference between groups in the proportion of plaques involving two or more quadrants, plaque distribution, or PB. Most plaques in both groups showed positive remodeling, and the percentage of remodeling pattern was similar. A significantly higher incidence of low-grade stenosis (

Energy modeling and energy-saving have attracted extensive attention in the manufacturing industry. Energy monitoring, modeling, and management issues of grinding, milling, and turning processes have been widely studied. However, special research on drilling power and energy consumption needs to be strengthened. The existing drilling power and energy models have the problems of high computational complexity and low practicability. To address this issue, an improved rapid power and energy prediction method of drilling process is proposed in this study. The motivation of the proposed method is to reduce the computational complexity and improve the practicability without losing the predictive accuracy for drilling power and energy. To verify the effectiveness of the proposed method, experimental and case studies were carried out. The results show that the number of formulas, variables, coefficients of the proposed method are all decreased significantly, therefore, the computational complexity is greatly reduced. Meanwhile, power predictive accuracy is improved by 1.91% instead of decreasing compared with the traditional method. Consequently, the simpler model, lower computational complexity, and higher power accuracy make the proposed method more practical in manufacturing industry.