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Background The Blumgart anastomosis has been established as one of the safest anastomoses for pancreas remnant reconstruction, with low rates of postoperative pancreatic fistula (POPF) and postoperative complications. However, how to make laparoscopic pancreaticoenterostomy easier and safer is still a subject to be discussed. Methods Data of patients undergoing laparoscopic pancreaticoduodenectomy from April 2014 to December 2019 were retrospectively analyzed. Results 20 cases of half-invagination anastomosis (Group HI) and 26 cases of Cattell-warren anastomosis (Group CW) were included. Intraoperative blood loss, Operative time and Postoperative drainage tube placement time of Group HI was significantly less than those of Group CW. Patients of Clavien-Dindo grade III and above in Group HI was significantly less than Control Group. Group Incidence of POPF in Group HI was significantly lower than that in Group CW. No high-risk group emerged during Fistula risk score analytical phase, and the highest risk of moderate-risk group was pancreatic leakage. Respectively, incidence of pancreatic leakage in Group HI and Group CW was 7.7% and 46.67%, while incidence of Group HI was significantly lower than that in the Group CW. Conclusions The Blumgart-anastomosis based half-invagination pancreaticoenterostomy with better applicability to laparoscopy can effectively reduce the incidence of postoperative pancreatic leakage.

Esophageal squamous cell carcinoma (ESCC) is malignant while the carcinogenesis is still unclear. Here, we perform a comprehensive multi-omics analysis of 786 trace-tumor-samples from 154 ESCC patients, covering 9 histopathological stages and 3 phases. Proteogenomics elucidates cancer-driving waves in ESCC progression, and reveals the molecular characterization of alcohol drinking habit associated signatures. We discover chromosome 3q gain functions in the transmit from nontumor to intraepithelial neoplasia phases, and find TP53 mutation enhances DNA replication in intraepithelial neoplasia phase. The mutations of AKAP9 and MCAF1 upregulate glycolysis and Wnt signaling, respectively, in advanced-stage ESCC phase. Six major tracks related to different clinical features during ESCC progression are identified, which is validated by an independent cohort with another 256 samples. Hyperphosphorylated phosphoglycerate kinase 1 (PGK1, S203) is considered as a drug target in ESCC progression. This study provides insight into the understanding of ESCC molecular mechanism and the development of therapeutic targets.

Data privacy is a fundamental challenge for Deep Learning (DL) in many applications. In this work, we propose SecureTrain, which aims to achieve privacy-preserved DL model training efficiently and without accuracy loss. SecureTrain enables joint linear and non-linear computation based on the Homomorphic Secret Share (HSS) technique, to carry out approximation-free non-polynomial operations, to achieve training stability and prevent accuracy loss. Meanwhile, it eliminates the time consuming Homomorphic permutation operation (Perm) and features an efficient piggyback design, by carefully devising the share set and exploiting the dataflow of the whole training process. This design significantly reduces the overall system training time. We analyze the computation and communication complexity of SecureTrain and prove its security. We implement SecureTrain and benchmark its performance with well-known dataset for both inference and training. For inference, SecureTrain not only ensures privacy-preserved inference, but achieves an inference speedup as high as 48x compared with state-of-the-art inference frameworks. For training, SecureTrain maintains the model accuracy and stability comparable to plaintext training, which is a sharp contrast to other schemes. To the best of knowledge, this is the first work that addresses two fundamental challenges, accuracy loss/training instability, and computation efficiency, in privacy-preserved deep neural network training.

Background: Despite the implementation of the universal salt iodization (USI) program for correction of iodine deficiency in China for ∼20 years, the actual iodine nutrition status of Chinese residents and the prevalence of iodine deficiency and iodine excess are issues that need to be addressed. This nationally representative cross-sectional study was conducted across all 31 provinces of mainland China to gather extensive data on iodine nutrition status and the influential factors. Methods: This study included 78,470 participants, aged 18 years or older, who were interviewed and asked to answer a questionnaire. Urine iodine concentration (UIC) was measured by the inductively coupled plasma mass spectrometry method, and goiter was examined by thyroid ultrasonography. In addition, sixty 9-11 years old school children in each province were randomly selected to evaluate the UIC and thyroid ultrasonography. The iodine nutrition status was determined according to the World Health Organization guidelines. Results: The iodized salt coverage was 95.37%. The median urine iodine (MUI) was 177.89 μg/L (interquartile range [IQR], 117.89-263.90 μg/L) and goiter prevalence was 1.17% (confidence interval [95% CI 0.95-1.43]) in the adult population. The MUI was 199.75 μg/L (IQR, 128.41-303.37 μg/L) in school-age children, and goiter prevalence was 3.50% [95% CI, 2.93-4.13]. The percentage of individuals with UIC

Background Irisin is a novel myokine associated with obesity, which is a traditional cardiovascular risk factor (CVRF). The present study aimed to investigate the association between serum irisin and a single CVRF as well as the clustering of CVRFs among Chinese overweight/obese population. Methods A total of 98 overweight and 93 obese subjects without clinical treatments were enrolled in this study. Subjects were then divided into two groups, based on the serum irisin level: a low irisin group (1.10–13.44 ng/ml) and a high irisin group (13.49–29.9 ng/ml). The clustering of CVRFs, smoking, diabetes mellitus, dyslipidemia and hypertension, was classified as 0, 1, 2 and ≥ 3 CVRFs. The demographic and baseline clinical characteristics of all participants were collected and serum irisin was measured. Results The high serum irisin group had significantly higher high-density lipoprotein cholesterol but lower fasting plasma glucose than the low serum irisin group. Additionally, the high serum irisin group had a significantly lower prevalence of smoking, diabetes mellitus and dyslipidemia than the low serum irisin group. Increased serum irisin was significantly associated with a reduced risk of smoking and dyslipidemia in both the unadjusted and adjusted models. Furthermore, high serum irisin significantly reduced the risk of the prevalence of 1, 2 and ≥ 3 CVRFs. Conclusions among the Chinese overweight/obese populations, high serum irisin is negatively associated with smoking, dyslipidemia and the clustering of CVRFs. Thus, high serum irisin is potentially associated with a low risk of cardiovascular diseases in the Chinese overweight/obese population.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension.Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017.Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged

Laparoscopic hepatectomy (LH) has been widely used in the treatment of hepatocellular carcinoma (HCC). It is generally believed that the long-term outcomes of LH are not inferior to open hepatectomy (OH). However, the quality of evidence is low. The purpose of this study was to reconstruct time-to-event data for meta-analysis based on Kaplan–Meier curves from propensity-score matched studies and compare survival rates following LH and OH for hepatocellular carcinoma. All published propensity-score matched studies reported in English that compared LH and OH for hepatocellular carcinoma with Kaplan–Meier curves were screened. Patients’ survival information was reconstructed with the aid of a computer vision program. Different models (fixed-effects model for two-stage survival analysis and Cox regression for one-stage survival analysis) were performed for sensitivity analysis. In addition to the primary meta-analysis, two specific subgroup analyses were performed on patients by types of resection, cirrhosis status. Time-to-event data were extracted from 45 propensity-score matched studies (N = 8905). According to the time-to-event data and the reconstructed Kaplan–Meier curves, the cumulative overall survival rate was 49.0% and 50.9% in the LH and OH cohorts, respectively, a log-rank test did not demonstrate statistical significance (p > 0.05). The cumulative recurrence-free survival (RFS) probability was both close to 0.0%. The median RFS time was 49.1 (95% CI 46.1 ~ 51.7) and 44.3 (95% CI 41 ~ 46.1) months. The difference in disease status was statistically significant by the Log-rank test (p

Background:. The basis of individualized treatment should be individualized mortality risk predictive information. The present study aimed to develop an online individual mortality risk predictive tool for acute-on-chronic liver failure (ACLF) patients based on a random survival forest (RSF) algorithm. Methods:. The current study retrospectively enrolled ACLF patients from the Department of Infectious Diseases of The First People's Hospital of Foshan, Shunde Hospital of Southern Medical University, and Jiangmen Central Hospital. Two hundred seventy-six consecutive ACLF patients were included in the present study as a model cohort (n = 276). Then the current study constructed a validation cohort by drawing patients from the model dataset based on the resampling method (n = 276). The RSF algorithm was used to develop an individual prognostic model for ACLF patients. The Brier score was used to evaluate the diagnostic accuracy of prognostic models. The weighted mean rank estimation method was used to compare the differences between the areas under the time-dependent ROC curves (AUROCs) of prognostic models. Results:. Multivariate Cox regression identified hepatic encephalopathy (HE), age, serum sodium level, acute kidney injury (AKI), red cell distribution width (RDW), and international normalization index (INR) as independent risk factors for ACLF patients. A simplified RSF model was developed based on these previous risk factors. The AUROCs for predicting 3-, 6-, and 12-month mortality were 0.916, 0.916, and 0.905 for the RSF model and 0.872, 0.866, and 0.848 for the Cox model in the model cohort, respectively. The Brier scores were 0.119, 0.119, and 0.128 for the RSF model and 0.138, 0.146, and 0.156 for the Cox model, respectively. The nonparametric comparison suggested that the RSF model was superior to the Cox model for predicting the prognosis of ACLF patients. Conclusions:. The current study developed a novel online individual mortality risk predictive tool that could predict individual mortality risk predictive curves for individual patients. Additionally, the current online individual mortality risk predictive tool could further provide predicted mortality percentages and 95% confidence intervals at user-defined time points.

Novel cross-coupled dual-band bandpass filters (BPFs) with compact size are proposed based on dual-mode isosceles right-angled triangular (IRAT) resonators. The dominant mode in the IRAT resonator is the TM100Z mode. By introducing posts in the resonators, an LC resonant unit is formed, which resonates at a lower frequency than the TM100Z mode. In the design of novel dual-band filters, the LC mode constitutes the first passband while the TM100Z mode produces the second passband. As cross-coupling is applied, two and eight transmission zeros (TZs) are produced in the responses of third-order and fourth-order dual-band BPFs, respectively. Two third-order cross-coupled dual-band BPFs with altered passbands and one fourth-order cross-coupled dual-band BPF are fabricated and measured. The measured results agree very well with the simulated results, demonstrating attractive advantages of the proposed BPFs such as compact size and decent performance.

Coal is the primary source of energy in China’s energy structure system. With the large-scale mining of mineral resources, a large amount of mine water will be produced in the process of development, construction, and production, which will pollute and damage the ecological environment of mine water. At present, China vigorously advocates coal revolution, implements low-carbon economy, and carries out clean production of energy development and utilization. Green mining, precision mining, and other strategic ideas have been applied to mine development to guide production practice. This paper does an in-depth analysis of the physical, chemical, biological, and environmental characteristics of mine water, puts forward the basic classification of mine water, and points out the characteristics of environmental hazards of mine water. Aiming at different types of mine water, such as mine wastewater, drainage water, goaf water, mine water with suspended solids, high salinity mine water, acid mine water, and mine water with special pollution, the paper puts forward the mine water treatment and resource utilization technology with different characteristics and strong pertinence. On this basis, the comprehensive treatment and development direction of mine water in the future are prospected.

Aims/Introduction To explore the potential role of irisin in the outcomes of newly diagnosed prediabetes. Materials and Methods Data were obtained from the Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 2,530 participants had newly diagnosed prediabetes at baseline and completed follow up. The nested 1:1 case–control study included 161 participants who developed diabetes mellitus at follow up, and 161 age‐ and sex‐matched controls. The follow‐up study included 86 matched case–control pairs. Fasting serum irisin levels were measured using enzyme‐linked immunosorbent assay. Results Baseline serum irisin levels were higher in the cases than in the controls (P = 0.002); high baseline serum irisin levels were an independent risk factor for the development of diabetes (odds ratio 1.235, 95% confidence interval 1.025–1.488). After adjustment for age, sex, body mass index, glycated hemoglobin (HbA1c), smoking, exercise, and family history of diabetes, subjects in the highest quartile of irisin levels had a higher risk of diabetes than those in the lowest quartile (odds ratio 3.065, 95% confidence interval 1.511–6.218). The extent of decrease in irisin levels during follow‐up was greater in the cases than in the controls (P, This is the first longitudinal study to investigate the potential role of irisin in the outcomes of newly diagnosed prediabetes and whether it can be a predictor of diabetes in prediabetic individuals. We believe that our study makes a significant contribution to the literature, because we found a clear association between serum irisin levels and the outcomes of newly diagnosed prediabetes.

Hydrogen network integration is a crucial way to achieve resource conservation and cost reduction of refinery and it is performed on quantitative and thermodynamic properties of hydrogen streams su...

Background: Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder without gallstones in the setting of critical illness. It represents 2%–15% of acute cholecystitis (AC) cases....

A new strategy for designing single‐band and dual‐band balanced bandpass filters (BPFs) based on a circular patch resonator is proposed in this study. By altering the output balanced ports of the balanced BPFs to inhibit or transport the TM31 mode of the circular patch resonator under the differential‐mode (DM) excitation, a single‐band or dual‐band balanced BPF can be realized. As the odd modes could be restrained under the common‐mode (CM) excitation, the balanced BPFs could feature high CM suppression in the DM passbands. Meanwhile, several perturbing tactics are introduced to improve the performance of the balanced BPFs. Specifically, perturbation vias are presented to disturb the electric field distribution to enhance the CM suppression in the DM passbands, and slots are applied on the circular patch resonators to perturb the current distribution to amend the second DM passband of the dual‐band balanced BPF. The proposed single‐band and dual‐band balanced BPFs are fabricated and characterized. Good agreement can be achieved between the simulated and measured results of the fabricated balanced BPFs, which validates the feasibility of the proposed design method.

Hydrogen is the core source to both refinery and synthetic plant of chemicals. Refinery consumes high purity hydrogen while synthetic plant of chemicals needs syngas consists of hydrogen and carbon oxides. As main hydrogen production technologies, industrial coal gasification and steam methane reforming based pathways generate H2, CO and CO2, which is actually the mixture of hydrogen and carbon oxides. Hence, the gases demand of refinery and synthetic plant of chemicals and their supply from hydrogen production can form hybrid hydrogen networks. On the basis of complementary reuse, this paper firstly proposes integration of hybrid hydrogen network for refinery and synthetic plant of chemicals. Superstructures of individual and hybrid hydrogen networks are employed as problem illustration and corresponding linear programming (LP) mathematical models are formulated. Practical refinery and synthetic plant of chemicals cases are employed to demonstrate its application. Compared with individual networks, the natural gas conservation case can recover 8660.4 Nm3·h-1 hydrogen in purge gas, reduce 1386.6 Nm3·h-1 CO2 emission, equaling to reduction of 278.11 kmol·h-1 natural gas feedstock and 14.8% of total gas production load; the coal conservation case can even waive the total coal consumption and extra 104.1 kmol·h-1 natural gas, recover 8660.4 Nm3·h-1 hydrogen in purge gas, reduce 5255.8 Nm3·h-1 of CO2 emission and decrease 21.2% of the total gas production load. Furthermore, economic evaluation is also placed to account for the economic advantage of hybrid network.

Pancreatic cancer is associated with poor prognosis due to limited therapeutic options. Excision repair cross-complementing 3 (ERCC3) is an important member of nucleotide excision repair (NER) that is overexpressed in some cancers and may be regarded as a poor prognostic factor. Yet, its role in pancreatic cancer remains unclear. This study aimed to investigate the expression and functions of ERCC3 in pancreatic cancer patients and its relation with clinicopathological features. Our data suggested that the protein expression level of ERCC3 was higher in tumor tissues than in adjacent tissues. In addition, the expression of ERCC3 has shown to be associated with the tumor extent (p=0.035). Besides, analysis of the dataset in The Cancer Genome Atlas (TCGA) revealed that high expression of ERCC3 was associated with poor overall survival in pancreatic cancer patients (p=0.0136). In Cox regression analysis, ERCC3 was an independent prognostic factor for overall survival in pancreatic cancer (p

Background: Subclinical hypothyroidism is diagnosed based on serum thyrotropin (TSH) reference intervals, which in turn are affected by many factors. Methods: Data were acquired from a Chinese nati...

Background: Recommended treatment for complicated peri-rectal abscess is incision and drainage (I&D) in conjunction with antibiotics. However, there is no standard antibiotic regimen for post-opera...

Chemical etching of metals generally brings about undesirable surface damage accompanied by deteriorated performance. However, new possibilities in view of structured interfaces and functional surfaces can be explored by wisely incorporating corrosion chemistry. Here, an ultrafast route to scalable Al foils with desired porous structures originating from Fe(III)-induced oxidation etching was presented. Coupling with efficient electron polarization involving microwave interaction, straightforward surface engineering is well established on various commercial Al foils within minutes, which can be successfully extended to bulk Al alloys. As a proof-of-concept demonstration, the well-defined porous Al foils featuring regulated surface energy, demonstrate great potential as current collectors in promoting cycling stability, for example, 85.2% reversible capacity sustained after 550 cycles (comparable to commercial Al/C foils), and energy density, that is, approximately 3 times of that by using pristine Al foils for LiFePO4-Li half cells.

Background: Fungal infections are associated with increased morbidity and death. Few studies have examined risk factors associated with post-operative fungal intra-abdominal infections (FIAIs) in t...

A facile strategy for the preparation of a nanoconfined Ti3C2/Ru cocatalyst by direct reduction of Ru3+ ions without an additional reductant was developed. The in situ formation of TiO2 nanosheets on the Ti3C2/Ru surface ensures the separation of the semiconductor and cocatalyst (TiO2-Ti3C2/Ru), resulting in charge segregation and migration more effective than those achieved by traditionally prepared Ru-TiO2-Ti3C2. Owing to its low Fermi level, the self-assembled Ti3C2/Ru cocatalyst accepted the photogenerated electrons and promoted H2 evolution without an induction period, while exhibiting high surface structure stability. The changes in the work function and surface terminations of Ti3C2 during the photocatalysis were revealed by DFT calculations and in situ diffuse reflectance infrared Fourier transform spectroscopy. The efficient electron transfer enabled by the structurally separated Ti3C2/Ru-based photocatalyst significantly reduced the electron-hole recombination, increasing the photocatalytic H2 evolution activity. This work provides a guiding design approach for future solar energy conversion with the semiconductor-cocatalyst system.

Summary Given the lack of defining features in the clinical manifestations and radiographic findings for children with mycoplasma pneumoniae pneumonia (MPP), quantitative polymerase chain reaction (qPCR) has become a useful diagnostic method. This study was performed to explore the relationship between the qPCR findings, clinical symptoms, and inflammatory markers in children with MPP. Four hundred children with MPP have been enrolled in this retrospective analysis. All clinical and analytical information, including mycoplasma pneumoniae (MP) PCR results, has been collected. Based on the PCR results, the patients were divided into groups with load values (copy number) < 105 (54 cases), ≥105 and 108 (49 cases). The clinical features (including symptoms and signs) and inflammatory indicators were compared among the groups. The incidence of high fever (above 39°C), thermal peak during the entire hospitalization period, fever duration, days of hospitalization, and plasma lactate dehydrogenase (LDH) levels were statistically correlated with the MP PCR load value in children with MPP. The analysis of relevance degree showed the correlative order as a thermal peak of hospitalization > duration of fever > period of hospitalization > LDH value > C-reactive protein value. The host immune response was significantly greater in the complication group than in the non-complication group.

Importance Age-related cataract is the leading cause of blindness worldwide. The pathological mechanisms causing this disease remain elusive. Background To examine the involvement of uric acid (UA) in the pathogenesis of posterior subcapsular cataract (PSC). Design Retrospective study and experimental investigation. Participants A total of 180 patients with PSC or non-PSC were included. Methods Samples obtained from the patients were used to analyse content of UA and for histochemical examinations. The effects of UA on human lens epithelial cells were also investigated. Main outcome measures Aqueous humour UA and urate deposits. Results The results showed a significant increase of aqueous humour UA in patients with PSC. After adjustment for potential confounders, elevated aqueous humour UA (odds ratio [OR] = 1.45) showed a stronger association with PSC than serum UA (OR = 1.10). Gomori methenamine silver staining revealed in PSC an intense deposit of urates in the lens fibres in equatorial regions, and in subcapsular fibres in posterior regions of the lens. Such staining was not detected in the lens with non-PSC. Treatment with UA-induced senescence and apoptosis in human lens epithelial cells in a dose dependent manner. Our results suggest that the elevated level of UA in aqueous humour causes a deposition of urates in human lens epithelium, which could possibly lead to dysfunction of these cells that generates opacification in PSC. Conclusions and relevance These findings indicate the local action of excessive UA in the pathogenesis of PSC. Control of serum UA level could delay the progression of PSC.

Solar-driven interfacial steam generation is a promising technique for clean water production because it can minimize thermal loss by localizing solar-to-heat conversion at the air/liquid interface. Here we report an integrated solar evaporator by partially growing 2D polypyrrole microsheets within a melamine foam through chemical vapor polymerization. These microsheets can induce multiple light reflections within the foam, enable omnidirectional light absorption, provide abundant surfaces to promote heat transfer, and achieve spatially defined hydrophobicity to facilitate vapor escape. Meanwhile, the inherent hydrophilicity of the bottom part of the foam promotes spontaneous upward water transport and suppresses heat loss. The composite foam exhibits an excellent apparent evaporation rate of ∼2 kg/(m

Background: Iodine is important in both thyroid function and human metabolism. Studies have explored the effect of iodine on metabolic disorders through thyroid function. This study aimed to investigate the relationship between iodine status and metabolic disorders. Methods: Data were obtained from the TIDE program, including 51795 subjects aged ≥18 years. The prevalence of metabolic disorders and its related components were calculated based on the level of urinary iodine concentrations (UICs) using the chi-square method. To further explore whether prevalence was associated with UIC, quadratic and UIC-stratified logistic regression models were used. Findings: The prevalence of metabolic disorders presented as a U-shaped curve as the UICs change with a lower prevalence of 76% at a UIC of 300-499 µg/L. After adjusting for confounding factors, UIC of 300-499 µg/L was found to be a protective factor for metabolic disorders [OR=0·857, 95%CI (0·796-0·922)] and hypertension. A UIC of 300-799 µg/L was found to be protective against the occurrence of metabolic syndrome (MetS), impaired fasting glucose (IFG). 500-799 µg/L was protective against the occurrence of prediabetes, UIC ≥ µg/L was found to be protective against the occurrence of dyslipidemia. Furthermore, a UIC of

Metastasis is the primary cause of high mortality in patients with osteosarcoma (OS). However, the molecular mechanisms underlying the regulation of metastatic disease are yet to be determined. Differentially expressed in FDCP 6 homolog (DEF6) has been demonstrated to be correlated with the metastatic behavior of several cancers, such as breast, ovarian and colorectal cancers. However, the role of DEF6 in OS remains unknown. Accordingly, the current study aimed to investigate the relationship between DEF6 expression and the malignant behavior of OS. The results revealed that high levels of DEF6 in OS tissues were associated with advanced clinical stage and metastases. Furthermore, immunohistochemistry results predicted a poor prognosis in 58 human OS specimens. Additionally, DEF6 expression was reported to be upregulated in human OS cell lines compared with a normal osteoblast cell line. small interfering RNA transfection, cell proliferation and colony formation assays, wound healing assays and Transwell assays were performed. DEF6 was not identified to be a major driver of OS cell proliferation, but it significantly contributed to metastatic potential in vitro. In addition, bioinformatics, western blotting and immunohistochemistry results indicated that MMP9 expression was positively correlated with DEF6 expression in human OS. To summarize, the results revealed that increased levels of DEF6 were associated with metastasis and poor prognosis in human OS and that DEF6 expression is positively correlated with MMP9 expression. The results indicated that DEF6 may serve as a potential antimetastatic target for OS.

Background Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) infection; however, nephrotoxicity happened with a high incidence of 15%~40%. Weighting the risk before receiving vancomycin treatment facilitates timely prevention of nephrotoxicity, but no standardized strategy exists for this purpose. Methods A retrospective cohort study was performed. A total of 524 hospitalized patients treated with vancomycin were included in this study. They were divided into derivation cohort (n=341) and externally validation cohort (n=183) according to their admission time. Using univariate and multivariable logistic regression, we identified potential predictors of vancomycin-associated acute kidney injury (AKI) and developed a risk score by plotting nomogram. The predictive performance of this novel risk score was assessed and validated by discrimination and calibration. Besides, the risk score was also compared with existing prediction models according to integrated discrimination index (IDI) and net reclassification index (NRI). Results The incidence of AKI was 16.1% (55/341) in the derivation cohort and 16.4% (30/183) in the validation cohort. Three factors (vancomycin serum trough concentration, piperacillin/tazobactam and furosemide) were determined as predictors for vancomycin-associated AKI. The established three-item risk score showed a comparable discrimination in both derivation cohort (AUC=0.793, 95% CI: 0.732-0.855) and validation cohort (AUC=0.788, 95% CI: 0.698-0.877). The risk score also demonstrated a good calibration in the derivation cohort (χ2=6.079, P=0.638>0.05) and validation cohort (χ2=5.665, P=0.686>0.05). Compared with prediction by Cmin alone, this risk score significantly improved reclassification accuracy (IDI=0.050, 95% CI: 0.024-0.076, P

Background: Mandatory universal salt iodization (USI) has been implemented in China for 20 years. Although iodine deficiency disorders are effectively controlled, the risk of excess iodine have bee...

Glyburide is a classic antidiabetic drug that is dominant in inflammation regulation, but its specific role in ozone-induced lung inflammation and injury remains unclear. In order to investigate whether glyburide prevents ozone-induced pulmonary inflammation and its mechanism, C57BL/6 mice were intratracheally pre-instilled with glyburide or the vehicle 1 hour before ozone (1 ppm, 3 hours) or filtered air exposure. After 24 hours, the total inflammatory cells and total protein in bronchoalveolar lavage fluid (BALF) were detected. The pathological alternations in lung tissues were evaluated by HE staining. The expression of NLRP3, interleukin-1β (IL-1β), and IL-18 protein in lung tissues was detected by immunohistochemistry. Western blotting was used to examine the levels of caspase-1 p10 and active IL-1β protein. Levels of IL-1β and IL-18 in BALF were measured using ELISA kits. Glyburide treatment decreased the total cells in BALF, the inflammatory score, and the mean linear intercept induced by ozone in lung tissues. In addition, glyburide inhibited the expression of NLRP3, IL-18, and IL-1β protein in lung tissues, and also suppressed NLRP3 inflammasome activation, including caspase-1 p10, active IL-1β protein in lung tissues, IL-1β, and IL-18 in BALF. These results demonstrate that glyburide effectively attenuates ozone-induced pulmonary inflammation and injury via blocking the NLRP3 inflammasome.

Miniaturized stretchable strain sensors are key components in E-skins for applications such as personalized health-monitoring, body motion perception, and human-machine interfaces. However, it remains a big challenge to fabricate miniaturized stretchable strain sensors with high imperceptibility. Here, we reported for the first time novel ultraminiaturized stretchable strain sensors based on single centimeter-long silicon nanowires (cm-SiNWs). With the diameter of the active materials even smaller than that of spider silks, these sensors are highly imperceptible. They exhibit a large strain sensing range (45%) and a high durability (10 000 cycles). Their optimum strain sensing ranges could be modulated by controlling the prestrains of the stretchable cm-SiNWs. On the basis of this capability, sensors with appropriate sensing ranges were chosen to respectively monitor large and subtle human motions including joint motion, swallow, and touch. The strategy of applying single cm-SiNWs in stretchable sensors would open new doors to fabricate ultraminiaturized stretchable devices.

Aims: To investigate the expression levels of serum interleukin-17 (IL-17) and interleukin-27 (IL-27) in children with bronchial asthma and to correlate these expression levels with lung function i...

The Schottky junction, composed of a rectifying metal–semiconductor interface, is an essential component for microelectronic and optoelectronic devices. However, due to the considerable reverse tunneling current, typical Schottky junctions cannot be widely applied in devices requiring high signal-to-noise ratios, such as photodetectors with high detectivity. Here, a van der Waals (vdW) Schottky junction is constructed by mechanically stacking a gold (Au) electrode onto a multilayer indium selenide (InSe) nanosheet, which shows an ultralow reverse current in sub-picoamperes and an excellent rectification ratio exceeding 106 at room temperature. The reverse current, which corresponds to the thermionic emission transport model, is independent of the applied reverse bias. As a result, the Au–InSe vdW Schottky junction device can function as an ultrasensitive photodetector with a photodetectivity over 2.4 × 1015 Jones, corresponding to a photoresponsivity of 853 A W−1 and a light on/off ratio exceeding 1 × 107. The work offers an idea for investigating electronic and optoelectronic devices with high signal-to-noise ratios based on vdW Schottky junctions.

Background: The role of Epstein–Barr virus (EBV) in inflammatory bowel disease (IBD) remains to be elucidated. The aim of this study was to investigate the presence of EBV in the blood and intestinal mucosa of patients with IBD and evaluate the association between EBV positivity and IBD. Methods: Patients with IBD, hospitalized between January 2015 and April 2018, were enrolled. The EBV-DNA load in blood samples from each subject was analyzed by quantitative real-time polymerase chain reaction. EBV-encoded small-RNA 1 (EBER-1) was detected by in-situ hybridization in intestinal mucosa tissue sections of patients with IBD. Result: EBV-DNA was detected in 48 out of 568 patients with IBD (8.4%), and EBER-1 positivity was detected in 27 of these patients (56.3%). Refractory IBD and severe mucosal inflammation were more common in patients with detectable levels of EBER-1 than in those without; the number of EBER-1-positive cells positively correlated with mucosal inflammation (P value < 0.05). Age (≥60 years old) and use of azathioprine were risk factors for EBV infection. There was no significant difference in clinical remission rate and surgical rate between the EBER-1 positive group and EBER-1 negative group, antiviral group and the non-antiviral group, among IBD patients who tested positive for EBV-DNA. Conclusion: Elderly patients with IBD, treated with azathioprine, are more susceptible to EBV positivity. Further, EBV mucosal detection correlated with the severity of mucosal damage and refractoriness, but not prognosis.

In this paper, a low-noise charge-sensitive preamplifier (CSA) is designed based on passivation ion implanted planar silicon (PIPS: The Passivated Implanted Planar Silicon) detectors. This charge-sensitive preamplifier uses Junction Field-Effect Transistor (JFET) as the first stage of the amplifier. In order to maximize the signal-to-noise ratio and consider the resistance-capacitance matching problem, according to different PIPS detector junction capacitances, different numbers of junction field effect transistors are matched in parallel in the first stage. Slotting technology is used at the feedback end to reduce the influence of the parasitic capacitance of the PCB board on the feedback, and the feedback capacitor resistance is adjusted to achieve the best signal-to-noise ratio. Experimental test results show that the charge-sensitive preamplifier can achieve a signal-to-noise ratio greater than 100 at room temperature, the output signal rise time is less than 60 ns, and the electronic equivalent capacitance noise is 19 eV/pF. The charge-sensitive preamplifier is connected to the Canberra PD450-17-100AM PIPS detector, and the standard α source 238Pu is measured in a vacuum environment. The energy resolution can reach 17keV@5499keV.

In this paper, we present a diode-pump continuous wave laser amplifier chain where master the oscillator power amplifier (MOPA) architecture is used. The laser amplifier chain consists of two Yb:YAG surface-doped slab laser modules and the 1030nm fiber laser is used as seed. We theoretically calculate the conditions for obtaining high output laser power and systematically analyze the advantages of surface-doped slab. The maximum output power is 6.1 kW and the optical to optical conversion efficiency is 27% when the pump power is 22 kW at room temperature. The beam quality (β) is 2.8 times diffraction limit. These results demonstrate that the surface-doped slab structure has the potential to obtain high output laser power.

In order to realize the dream of the practical application of hydrogen energy from solar energy and water, it is necessary to use efficient and earth-abundant cocatalysts for photocatalytic H2 evolution. Compared with a one-component cocatalyst, the multicomponent cocatalysts with a synergistic effect can effectively accelerate the separation of photogenerated electron–hole pairs in photocatalysis. Hence, a novel bicomponent Co3S4/Co@C cocatalyst on a CdS semiconductor photocatalyst is successfully synthesized by a one-step hydrothermal method. The Co3S4/Co-CdS photocatalyst obtained exhibits a highly efficient photocatalytic H2 evolution rate of 15.17 mmol h−1 g−1, which is 2.8 times higher than that of Pt-CdS. Furthermore, the quantum efficiency of Co3S4/Co-CdS reaches a maximum value of 16.80% at 475 nm. The significant improvement in the performance is because of the unique energy level structure of the Co3S4/Co-CdS photocatalyst, which has the maximum efficiency of charge separation and migration. This work not only presents a new protocol for constructing bicomponent cocatalysts on a semiconductor structure, but also proves that the bicomponent Co3S4/Co@C is a promising and low-cost cocatalyst.

Creating highly branched plasmonic superparticles can effectively induce broadband light absorption and convert light to heat regardless of the light wavelength, angle, and polarization. However, their direct synthesis in a controllable manner remains a significant challenge. In this work, we propose a strain modulation strategy to produce branched Au nanostructures that promotes the growth of Au on Au seeds in the Volmer-Weber (island) mode instead of the typical Frank-van der Merwe (layer-by-layer) mode. The key to this strategy is to continuously deposit polydopamine formed in situ on the growing surface of the seeds to increase the chemical potential of the subsequent deposition of Au, thus achieving continuous heterogeneous nucleation and growth. The branched Au superparticles exhibit a photothermal conversion efficiency of 91.0% thanks to their small scattering cross-section and direction-independent absorption. Even at a low light power of 0.5 W/cm2 and a low dosage of 25 ppm, these particles show an excellent efficacy in photothermal cancer therapy. This work provides the fundamental basis for designing branched plasmonic nanostructures and expands the application scope of the plasmonic photothermal effect.

The objective of this study is to explore the effect and mechanism of ultrasound on chitin extraction from shrimp shells (SSP) by the co-fermentation of Bacillus subtilis and Acetobacter pasteurianus. After pre-treating the SSP with high-intensity ultrasound (HIU, 800 W), the protease activity in the fermentation solution reached 96.9 U/mL on Day 3, which was significantly higher than for SSP that had not been pre-treated with ultrasound (81.8 U/mL). The fermentation time of the chitin extraction process was 5.0 days without ultrasound pre-treatment, while it was shortened to 4.5 days when using 800 W ultrasound to treat SSP. However, there were no obvious differences when we applied low-intensity ultrasound (200 W, 400 W) treatment. Furthermore, chitin purified from shrimp shells pre-treated with HIU exhibited lower molecular weight (11.2 kDa), higher chitin purity (89.8%), and a higher degree of deacetylation (21.1%) compared to SSP with no ultrasound pre-treatment (13.5 kDa, 86.6%, 18.5%). Results indicate that HIU peels off the protein-CaCO3 matrix that covers the SSP surface. About 9.1% of protein and 4.7% of Ca2+ were released from SSP pre-treated with 800 W ultrasound. These figures are both higher than with no ultrasound pre-treatment (4.5%, 3.2%). Additionally, the amount of soluble protein extracted from SSP through HIU was 50% higher than for the control sample. SDS-PAGE analysis indicated that the soluble protein was degraded to the micromolecule. It also revealed that HIU induced the secondary and tertiary structure destruction of protein extracted from SSP. In conclusion, HIU-induced degradation and structural damage of protein enhances the protein-CaCO3 matrix to be peeled off from SSP. Also, in the co-fermentation process, an increase of protease activity further accelerates deproteinization.

Dual-frequency unidirectional reflectionlessness is investigated in a quantum system consisting of a two-level and a V-type three-level quantum dots coupled to a plasmonic waveguide based on electromagnetically induced transparency-like effect. The results show that the dual-frequency unidirectional reflectionlessness can be obtained by appropriately adjusting the phase shift between two quantum dots, decay rates of quantum dots, and coupling strengths between quantum dots and plasmonic waveguide. Moreover, the dual-frequency low unidirectional reflection can be manipulated in the wide ranges of decay rates and coupling strengths.

Background Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging. Objective We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles. Results We studied 349 older patients with newly diagnosed MM (age range, 65–86 years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA ‘fit’ group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26 months (range 1–38). The median overall survival (OS) was 34.7 months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327). Conclusions Our study justifies the need for a CGA in older patients with newly diagnosed MM.

The fractional derivative (FD) and memory-dependent derivative (MDD) are efficient methods to predict the transient thermal responses. In the present paper, for the first time, the FD and MDD are introduced into classical Pennes bio-heat conduction equation with single phase-lag and the corresponding bio-heat transfer models have been formulated with the aids of thermal energy conservation equation. The Laplace transform and numerical inverse transform method are adopted to get access to thermal responses due to temperature shock. Reductions of the present models to classical Pennes and single phase-lag bio-heat transfer models are presented and comparison between different FD and MDD in transient bio-heat transfer is carried out firstly. An approximate formulation of propagation speed of thermal signal in FD models is given according to results firstly. Influences of fractional derivative parameter and tempered parameter in FD, delay time in MDD, phase-lag time and rate of blood perfusion on temperature variation and distribution are carried out numerically. Both fractional derivative and memory-dependent derivative have the ability to predict thermal response between diffusion and wave behavior and CF fractional derivative and MDD with K3 may be suitable methods.

Background: Trichohepatoenteric syndrome (THES) is a rare disease that mainly causes intractable diarrhea. It is classified into THES1 and THES2, which are associated with the tetratricopeptide repeat domain 37 (TTC37) gene and Ski2-like RNA helicase (SKIV2L) gene, respectively. THES is not very prevalent in China or worldwide, but new cases have increasingly been reported.Methods and Results: Here, we report the clinical and genetic information of a 1.5-month-old girl who was admitted to our hospital due to diarrhea and failure to thrive. Whole-exome sequencing (WES) revealed novel compound-heterozygous variants of the SKIV2L gene, c.3602_3609delAGCGCCTG (p.Q1201Rfs*2), and c.1990A > G (p.T664A) as the causative factors, which were confirmed via Sanger sequencing. Upon continuous feeding with an amino-acid formula through a gastric tube and parenteral nutrition, the patient resumed thriving and her stool frequency decreased.Conclusion: We report a girl carrying novel variants of the SKIV2L gene that cause THES2, thereby providing valuable information on the diagnosis of THES2 and expanding the spectrum of disease-causing SKIV2L mutations.

Background: There is an increasing trend of Metabolic syndrome (MetS) prevalence, which has been considered as an important contributor for cardiovascular disease (CVD), cancers and diabetes. However, there is often a long asymptomatic phase of MetS, resulting in not diagnosed and intervened so timely as needed. It would be very helpful to explore tools to predict the probability of suffering from MetS in daily life or routinely clinical practice. Objective: To develop models that predict individuals’ probability of suffering from MetS timely with high efficacy in general population. Methods: The present study enrolled 8964 individuals aged 40-75 years without severe diseases, which was a part of the REACTION study from October 2011 to February 2012. We developed three prediction models for different scenarios in hospital (Model 1, 2) or at home (Model 3) based on LightGBM (LGBM) technique and corresponding logistic regression (LR) models were also constructed for comparison. Model 1 included variables of laboratory tests, lifestyles and anthropometric measurements while model 2 was built with components of MetS excluded based on model 1, and model 3 was constructed with blood biochemical indexes removed based on model 2. Additionally, we also investigated the strength of association between the predictive factors and MetS, as well as that between the predictors and each component of MetS. Results: In this study, 2714 (30.3%) participants suffer from MetS accordingly. The performances of the LGBM models in predicting the probability of suffering from MetS produced good results and were presented as follows: model 1 had an area under the curve (AUC) value of 0.993 while model 2 indicated an AUC value of 0.885. Model 3 had an AUC value of 0.859, which is close to that of model 2. The AUC values of LR model 1 and 2 for the scenario in hospital and model 3 at home were 0.938, 0.839 and 0.820 respectively, which seemed lower than that of their corresponding machine learning models, respectively. In both LGBM and logistic models, gender, height and resting pulse rate (RPR) were predictors for MetS. Women had higher risk of MetS than men (OR 8.84, CI: 6.70-11.66), and each 1-cm increase in height indicated 3.8% higher risk of suffering from MetS in people over 58 years, whereas each 1-bpm increase in RPR showed 1.0% higher risk in individuals younger than 62 years. Conclusion: The present study showed that the prediction models developed by machine learning demonstrated effective in evaluating the probability of suffering from MetS, and presented prominent predicting efficacies and accuracies. Additionally, we found that women showed a higher risk of MetS than men, and height in individuals over 58 years was important factor in predicting the probability of suffering from MetS while RPR was of vital importance in people aged 40-62 years. Funding: The study was supported by the grants from the Ministry of Science and Technology of China (2016YFC0901200 and 2016YFC0901203), National Natural Science Foundation of China (81471069, 81770843 and 81800762), Natural Science Foundation of Hubei Province (2017CFB257) and Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (02.03.2017-328 and 02.03.2017-332). Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Ethics Committee of Huazhong University of Science and Technology, and all participants gave signed informed consent.

Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope.Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated.Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up (P < 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm2 preoperatively and 890.8 ± 367.7 mm2 postoperatively, the difference was statistically significant (P < 0.05).Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.

Real-life data on guselkumab in psoriasis are limited and not available in China hitherto. This study aimed to evaluate the short-term effectiveness and safety of guselkumab in patients with psoriasis under Chinese real-life conditions and to explore the effect of guselkumab on CD4+ CD25+ Foxp3+ regulatory T cells (Tregs). A Chinese prospective and real-life study involving patients with psoriasis in Dermatology Hospital of Southern Medical University, Guangzhou, China from April to September 2020 was conducted. A total of 45 patients with psoriasis were finally enrolled in the study. Psoriasis Area Severity Index (PASI) 90 and 100 responses at week 16 were achieved by 88.6% and 45.5% of patients, respectively. The analysis of PASI response in different subgroups showed no statistically significant difference. Univariate logistic regression analysis revealed that at week 16, none of the variables were associated with decreasing PASI 90 response, whereas age at onset of disease was a predictor of PASI 100 response. Dynamic detection of CD4+ CD25+ Foxp3+ Tregs frequency from peripheral blood suggested a stable maintained trend in terms of guselkumab treatment duration. No severe adverse events occurred during the follow-up period. This study confirmed the short-term effectiveness and safety of guselkumab, as well as its good tolerance against psoriasis, in the Chinese population. Guselkumab treatment maintains levels of Tregs in patients with psoriasis.

In order to explore the clinical characteristics of pediatric patients admitted to the pediatric intensive care unit (PICU) who suffered from hematological neoplasms complicated with acute respiratory distress syndrome (ARDS), we retrospectively analyzed 45 ARDS children with hematological neoplasms who were admitted to the PICU of Shanghai Children's Medical Center from January 1, 2014, to December 31, 2020. The 45 children were divided into a survival group and a non-survival group, a pulmonary ARDS group and an exogenous pulmonary ARDS group, and an agranulocytosis group and a non-agranulocytosis group, for statistical analysis. The main clinical manifestations were fever, cough, progressive dyspnea, and hypoxemia; 55.6% (25/45) of the children had multiple organ dysfunction syndrome (MODS). The overall mortality rate was 55.6% (25/45). The vasoactive inotropic score (VIS), pediatric critical illness scoring (PCIS), average fluid volume in the first 3 days and the first 7 days, and the incidence of MODS in the non-survival group were all significantly higher than those in the survival group (P < 0.05). However, total length of mechanical ventilation and length of hospital stay and PICU days in the non-survival group were significantly lower than those in the survival group (P < 0.05). The PCIS (OR = 0.832, P = 0.004) and the average fluid volume in the first 3 days (OR = 1.092, P = 0.025) were independent risk factors for predicting death. Children with exogenous pulmonary ARDS were more likely to have MODS than pulmonary ARDS (P < 0.05). The mean values of VIS, C-reactive protein (CRP), and procalcitonin (PCT) in children with exogenous pulmonary ARDS were also higher (P < 0.05). After multivariate analysis, PCT was independently related to exogenous pulmonary ARDS. The total length of hospital stay, peak inspiratory pressure (PIP), VIS, CRP, and PCT in the agranulocytosis group were significantly higher than those in the non-agranulocytosis group (P < 0.05). Last, CRP and PIP were independently related to agranulocytosis. In conclusion, children with hematological neoplasms complicated with ARDS had a high overall mortality and poor prognosis. Children complicated with MODS, positive fluid balance, and high VIS and PCIS scores were positively correlated with mortality. In particular, PCIS score and average fluid volume in the first 3 days were independent risk factors for predicting death. Children with exogenous pulmonary ARDS and children with agranulocytosis were in a severely infected status and more critically ill.