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Objectives This study evaluated optimum stability of different screw techniques for condylar head fractures (CHF) (P close to an M fracture with the lateral pole preserved according to AO classification 2014) by finite element analysis (FEA) and provided a biomechanical basis for clinical treatment. Study Design Four CHF fixation models were evaluated: (A) single bicortical screw, (B) 2 bicortical screws, (C) 1 bicortical screw and 1 monocortical screw (used as a positional screw) inserted via a 2-hole titanium plate, and (D) 2 bicortical screws inserted via a titanium plate. Stresses were calculated (FEA) to measure mechanical properties. Results The displacement for A and C was larger than for B and D. The maximum stress on the screws for A and C exceeded their breaking limit but was safe for B and D. The stress on the titanium plate for C and D was safe. The stress on bone for A and C was larger than for B and D. Conclusions The 2 bicortical screw fixation reduced the stress on implanted materials and surrounding bone tissue. Titanium plates further alleviated the lever action. Two bicortical screw fixation was more reliable for CHF, and early postoperative loading and functional training can be expected.

This letter presents an ultra-compact two-stage 60-GHz differential bi-directional amplifier (DBA) design in a 65-nm CMOS process. To satisfy the stability and gain requirements, a differential neutralized bi-directional common-source gain cell combined with the cross-coupled gm-boosting technique is proposed. In addition, a layout-symmetrical coupled line transformer is used as the inter-stage matching network to achieve broadband operation, reducing insertion loss and ensuring identical responses in both forward/backward modes. The proposed DBA achieves a peak gain of 16.1 dB with a 3-dB bandwidth of 15 GHz (52-67 GHz), maximum OP $_{{1 ,,dB}}$ of 5.1 dBm, $P_{{SAT}}$ of 9.6 dBm, a peak PAE of 11.5% at 62 GHz, respectively, consuming 70 mW from a power supply of 1.2 V. The circuit core occupies an ultra-compact area of only 0.0675 mm².

To explore the value of T2 mapping in the dynamic quantitative evaluation of renal ischemia- reperfusion injury (IRI).Forty-eight healthy New Zealand rabbits were randomly divided into IRI group (n = 40) and control group (n = 8). Rabbits in the IRI group underwent left renal artery clamping for 60 minutes. Rabbits underwent MRI examinations (T2WI and T2 mapping) before and 1, 12, 24, and 48 hours after IRI. The inter-observer and intra-observer reproducibility of the T2 values were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI). Correlations between the T2 value of the renal outer medulla and injury scores were assessed by Spearman correlation analysis. The repeated measures analysis of variance was used to compare the differences in T2 values of the IRI and control group across the different time points.Both of the intra-observer (ICC = 0.97, 95% CI 0.95-0.99) and inter-observer reproducibility (ICC = 0.92, 95% CI 0.86-0.96) were excellent for T2 values. The T2 value of the renal outer medulla was moderately positive correlated with tubular epithelial edema (ρ = 0.686, p0.001). In IRI group, T2 values of the renal outer medulla were increase at 1 h after IRI (p = 0.001) and were decrease from 1 h to 12 h (p = 0.002). At 1 h after IRI, the T2 values of the renal outer medulla for the IRI group were higher than those for the control group (p0.001).T2 mapping can reflect the dynamic changes of renal parenchyma in an animal model of IRI and be used to assess the early renal IRI.

Hypoxic-ischemic encephalopathy (HIE) is recognized as the main cause of neonatal death, and efficient treatment strategies remain limited. This study aims to investigate the mechanism of sevoflurane (SF) post-treatment in alleviating HIE in rats. The HIE rat model and oxygen-glucose deprivation (OGD) cell model were established, and adeno-associated virus (AAV)-histone-lysine N-methyltransferase EHMT2 (G9a) was transfected after SF treatment. The learning and memory ability and the levels of nerve growth factor (NGF)/brain-derived neurotrophic factor (BDNF) were evaluated and determined. The levels of G9a/histone H3 lysine 9 dimethylation (H3K9me2) and the enrichment level of H3K9me2 in the promoter region of BDNF gene were analyzed. After SF post-treatment, the neurons in cerebral cortex, the learning and memory skills and the contents of NGF/BDNF were increased, while the apoptosis and G9a/H3K9me2 levels were reduced. After overexpression of G9a in vitro/vivo, the enrichment levels of H3K9me2 in the promoter region of BDNF were increased, the levels of BDNF were decreased, the neurons were damaged and the learning and memory abilities of HIE rats were impaired. The conclusion is that SF post-treatment can promote the expression of BDNF by inhibiting H3K9me2 on the BDNF gene promoter and inhibiting G9a, thus alleviating HIE in rats.

OBJECTIVE The aim of this study was to investigate whether serum HE4 was associated with clinical risk prognostic factors and survival outcome. METHODS In this study, 72 patients with primary peritoneal carcinoma (PPC) from January 2011 to October 2019 participated. Serum HE4 and CA125 levels were detected at primary diagnosis, post-surgery, pre-recurrence and the presence of recurrence. The relations between serum HE4 levels with clinical prognostic factors were analyzed, and the hazard ratios between serum HE4 levels with overall survival and recurrence-free survival were also analyzed by univariate and multivariate survival analysis. RESULTS HE4 and CA125 levels were significantly elevated in serous type, high histological grade, advanced stage and positive lymph node status and residual tumor diameter more than 1 cm, respectively, compared with those in non-serous type, low histological grade, early stage, negative lymph node status and residual tumor diameter no more than 1 cm, respectively. HE4 was an independent prognostic factor for recurrence-free survival and overall survival with hazard ratios of 5.36 (95% confidence interval: 2.19-13.15) and 4.48 (95% confidence interval: 1.87-10.74), respectively. CONCLUSION HE4 is correlated with clinical risk prognostic factors in PPC and is effective in the recurrence detection and predicting outcome in PPC patients.

Introduction We examined the temporal sequence of the core features in probable dementia with Lewy bodies (DLB). Methods In 488 patients with probable DLB, the onset of each core feature and time to diagnosis was determined for men and women, and a pathologic subgroup (n = 209). Results REM sleep behavior disorder (RBD) developed before the other core features in men and women. Men were more likely to have RBD and were diagnosed with probable DLB earlier than women. Visual hallucinations developed after the other core features in men, but in women, they appeared earlier and concurrently with fluctuations and parkinsonism. Women were older and more cognitively impaired at first visit, were less likely to have RBD, more likely to be diagnosed with probable DLB later than men, and more likely to have neocortical tangles. Discussion An earlier latency to probable DLB was associated with men, RBD, and Lewy body disease without neocortical tangles.

Human life expectancy increases as society becomes more developed. This increased life expectancy poses challenges associated with the rapid aging of the population. Sarcopenia, an age-related disease, has become a worldwide health issue. Patients with sarcopenia experience decreases in muscle mass and function, becoming frail and eventually bedridden. Type 2 diabetes mellitus (T2DM) is also a major health issue; the incidence of T2DM increases with aging. T2DM is associated with reduced muscle strength and poor muscle quality and may contribute to acceleration of the aging process, augmenting age-related sarcopenia. Recent studies indicate that elderly patients with diabetes are at an increased risk for sarcopenia. Therefore, these older diabetic patients with sarcopenia need specific anti-diabetic therapies targeting not only glycemic control but also sarcopenia, with the goal of preventing sarcopenia in pre-sarcopenic patients. Presently, various types of hypoglycemic drugs are available, but which hypoglycemic drugs are better suited for geriatric T2DM patients with sarcopenia remains undetermined. In this review, we discuss the association between diabetes and sarcopenia in geriatric patients, and how anti-diabetic drugs may influence sarcopenia outcomes. This review will guide clinical workers in the selection of drugs best suited for this patient population.

Background The prognostic value of lactate dehydrogenase (LDH) in colorectal cancer patients has remained inconsistent between nonmetastatic and metastatic settings. So far, very few studies have included LDH in the prognostic analysis of curative‐intent surgery for colorectal liver metastases (CRLM). Patients and Methods Five hundred and eighty consecutive metastatic colorectal cancer patients who underwent curative‐intent CRLM resection from Sun Yat‐sen University Cancer Center (434 patients) and Sun Yat‐sen University Sixth Affiliated Hospital (146 patients) in 2000–2019 were retrospectively collected. Overall survival (OS) was the primary end point. Cox regression model was performed to identify the prognostic values of preoperative serum LDH levels and other clinicopathology variables. A modification of the established Fong CRS scoring system comprising LDH was developed within this Chinese population. Results At the median follow‐up time of 60.5 months, median OS was 59.5 months in the pooled cohort. In the multivariate analysis, preoperative LDH >upper limit of normal (250 U/L) was the strongest independent prognostic factor for OS (HR 1.73, 95% confidence interval [CI], 1.22–2.44; p, We retrospectively analyzed 580 patients with colorectal liver metastases (CRLM) who underwent curative‐intent hepatectomy. Our study implicated preoperative LDH level as a reliable and independent laboratory biomarker to predict the clinical outcome of curative‐intent surgery for CRLM. Composite of LDH and Fong score is a potential stratification tool for CRLM resection.

BACKGROUND Implanted intravenous infusion port (IVAP) is indicated for patients undergoing chemotherapy, total parenteral nutrition and long-term antibiotic treatment. Among their complications, the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition. CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer. A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery. Therefore, we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap. CONCLUSION When the fractured catheter of an IVAP was detected, the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.

Background:. Pregnancy-associated breast cancer (PABC) is a special type of breast cancer that occurs during pregnancy and within 1 year after childbirth. With the rapid social development and the adjustment of reproductive policies in China, the average age of females at first childbirth is increasing, which is expected to lead to an increase in the incidence of PABC. This study aimed to accumulate clinical experience and to investigate and summarize the prevalence, diagnosis, and treatment of PABC based on large multicenter samples in China. Methods:. According to the Chinese Society of Breast Surgery, a total of 164 patients with PABC in 27 hospitals from January 2016 to December 2018 were identified. The pregnancy status, clinicopathological features, comprehensive treatment methods, and outcomes were retrospectively analyzed. Survival curves were plotted using the Kaplan-Meier method. Results:. A total of 164 patients of PABC accounted for 0.30% of the total number of cases in the same period; of which, 83 patients were diagnosed during pregnancy and 81 patients during lactation. The median age of PABC was 33 years (24–47 years). Stage I patients accounted for 9.1% (15/164), stage II 54.9% (90/164), stage III 24.4% (40/164), and stage IV 2.4% (4/164). About 9.1% (15/164) of patients were luminal A. Luminal B patients accounted the most (43.3% [71/164]). About 15.2% (25/164) of patients were human epidermal growth factor receptor 2 (Her-2) overexpression and 18.9% (31/164) of patients were triple-negative breast cancer. For pregnancy breast cancer, 36.1% (30/83) of patients received direct surgery and 20.5% (17/83) received chemotherapy during pregnancy. About 31.3% (26/83) chose abortion or induction of labor. The median follow-up time was 36 months (3–59 months); 11.0% (18/164) patients had local recurrence or distant metastasis and 3.0% (5/164) died. Conclusions:. It is safe and feasible to standardize surgery and chemotherapy for PABC.

AIM: To compare visual field defects using the Swedish Interactive Thresholding Algorithm (SITA) Fast strategy with SITA Faster strategy, a newly developed time-saving threshold visual field strategy. METHODS: Ninety-three participants (60 glaucoma patients and 33 normal controls) were enrolled. One eye from each participant was selected randomly for the study. SITA Fast and SITA Faster were performed using the 24-2 default mode for each test. The differences of visual field defects between the two strategies were compared using the test duration, false-positive response errors, mean deviation (MD), visual field index (VFI) and the numbers of depressed test points at the significant levels of P0.05). Correlation analysis showed a high correlation for MD (r=0.986, P

Purpose This study aimed to explore whether the attitudes of nursing students toward the use of mobile learning are positive or negative and to identify the factors influencing their attitudes by reviewing the literature. Methods Electronic search of six databases, including PubMed, the Cumulative Index of Nursing and Allied Health Literature, ProQuest, Web of Science, EMBASE, and Cochrane Library, was conducted, and relevant references within articles were manually searched. Retrieval time was from inception to October 21, 2020. The literature review was conducted in accordance with the PRISMA guidelines and the integrative review method. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. Results A total of 316 articles were identified, and 18 English-language studies were finally included by reviewing titles, abstracts, and full text. Six quantitative, five qualitative, and seven mixed-method articles related to nursing students’ attitudes toward the use of mobile learning were identified. The results showed that most nursing students had positive attitudes toward mobile learning. Although students expressed strong intentions for mobile learning, the actual usage rate in practical settings was low. Several advantageous factors included usefulness, convenience, and ease of use, whereas disadvantageous factors included hardware facility, updated content, and software stability. Conclusion Most nursing students have positive attitudes and willingness to mobile learning, but the actual use rate remains low. Advantageous and disadvantageous factors coexist. Further studies are needed to assess how mobile learning improves nursing students’ clinical knowledge and improves patient care.

Yiyang Tang,1 Qin Chen,1 Lihuang Zha,1 Yilu Feng,1 Xiaofang Zeng,1 Zhenghui Liu,2 Famei Li,1 Zaixin Yu1 1Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Zaixin YuDepartment of Cardiology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, People’s Republic of ChinaTel/Fax +86 731-8432749Email yuzaixin@126.comPurpose: Acute myocardial infarction (AMI) is a common cardiovascular disease with a poor prognosis. The aim of this study was to construct a nomogram for predicting the long-term survival of critically ill patients with AMI. This nomogram will help in assessing disease severity, guiding treatment, and improving prognosis.Patients and Methods: The clinical data of patients with AMI were extracted from the MIMIC-III v1.4 database. Cox proportional hazards models were adopted to identify independent prognostic factors. A nomogram for predicting the long-term survival of these patients was developed on the basis of the results of multifactor analysis. The discriminative ability and accuracy of the multifactor analysis were evaluated according to concordance index (C-index) and calibration curves.Results: A total of 1202 patients were included in the analysis. The patients were randomly divided into a training set (n = 841) and a validation set (n = 361). Multivariate analysis revealed that age, blood urea nitrogen, respiratory rate, hemoglobin, pneumonia, cardiogenic shock, dialysis, and mechanical ventilation, all of which were incorporated into the nomogram, were independent predictive factors of AMI. Moreover, the nomogram exhibited favorable performance in predicting the 4-year survival of patients with AMI. The training set and the validation set had a C-index of 0.789 (95% confidence interval [CI]: 0.765– 0.813) and 0.762 (95% CI: 0.725– 0.799), respectively.Conclusion: The nomogram constructed herein can accurately predict the long-term survival of critically ill patients with AMI.Keywords: acute myocardial infarction, nomogram, long-term prognosis, MIMIC-III, retrospective study

This study revisits the association between bilateral relations and trade based on rare-event data from Integrated Data for Event Analysis (IDEA). Our results suggest that a country imports more from another if the two countries are friendlier. We further argue that states face two constraints when attempting to manipulate trade. First, they are constrained by domestic institutions such as elections and congress. Second, they are constrained by international institutions such as the World Trade Organization (WTO). Our results show that the imports of authoritarian countries follow the flag of politics, but democratic countries’ imports are less likely to be affected by bilateral relations. Moreover, WTO membership can gradually restrict democratic states from intervening on imports but has little impact on authoritarian governments.

To establish a dynamic nomogram based on preoperative clinical data for prediction of lateral lymph node metastasis (LLNM) of papillary thyroid carcinoma.Retrospective study.The Sixth Affiliated Hospital of Sun Yat-Sen University.The data of 477 patients from 2 centers formed the training group and validation group and were retrospectively reviewed. Preoperative clinical factors influencing LLNM were identified by univariable and multivariable analysis and were to construct a predictive dynamic nomogram for LLNM. Receiver operating characteristic analysis and calibration curves were used to evaluate the predictive power of the nomogram.The following were identified as independent risk factors for LLNM: male sex (odds ratio [OR] = 4.6,The dynamic nomogram for preoperative prediction of LLNM in papillary thyroid carcinoma can help surgeons identify high-risk patients and develop individualized treatment plans.

Piezoelectric semiconductor-based piezocatalysis has emerged as a promising approach for converting mechanical energy into chemical energy for renewable hydrogen generation and wastewater treatment under the action of mechanical vibration. Similar to photocatalysis, piezocatalysis is triggered by the separation, transfer, and consumption of piezo-generated electrons and holes. Inspired by this, herein, we report that the cocatalyst, which is widely used in photocatalysis, can also improve the semiconductor-based piezocatalytic properties. In the proof-of-concept design, well-defined Pd as a model cocatalyst has been deposited on the surface of piezoelectric BiFeO3 nanosheets, which not only facilitates the separation of charge carriers by accepting the piezoelectrons from BiFeO3 but also lowers the activation energy/overpotential through supplying highly active sites for the proton reduction reaction. Consequently, the as-obtained hybrid piezocatalyst delivers a high H2 evolution rate of 11.4 μmol h-1 (10 mg of catalyst), 19.0 times as high as that of bare BiFeO3. The band tilting induced by the piezoelectric potential is proposed to lower or eliminate the Schottky barrier and smooth the electron transfer from BiFeO3 to Pd, while the exposed facet, domain size, and loading amount of Pd cocatalyst are proved to be the key parameters determining the ultimate piezocatalytic activity. Our work provides some enlightenment on advancing the design and fabrication of more efficient piezocatalysts for H2 evolution based on rational engineering on the cocatalyst.

PURPOSE To explore if R2 ' mapping can assess renal hypoxia in rabbits with ischemia reperfusion injury (IRI). METHODS Forty rabbits were randomly divided into 4 groups according to the clipping time: the sham group and 45 min, 60 min, and 75 min for the mild, moderate, and severe groups (with n = 10 each group), respectively. Intravenous furosemide (FU) was administered 24 h after IRI. All rabbits were performed 5 times (IRIpre , IRI24h , FU5min , FU12min , and FU24min ) with a 3.0 Tesla MR. The R2 ' values and the hypoxic scores were then recorded. The repeated measurement analysis of variance and Spearman correlation analysis was used for statistical analysis. RESULTS Compared to the baseline, the medullary R2 ' values increased significantly 24 h after the IRI (baseline 19.31 ± 1.21 s-1 , mild group 20.05 ± 1.26 s-1 , moderate group 25.38 ± 1.38 s-1 , and severe group 25.79 ± 1.10 s-1 ; each P < .001). FU led to a significant decrease in the medullary R2 ' value (sham group 11.17 ± 4.33 s-1 , mild group 7.80 ± 0.74 s-1 , moderate group 3.92 ± 0.28 s-1 , and severe group 3.82 ± 0.23 s-1 ; each P < .05). Quantitative hypoxic scores revealed significant differences among the 4 groups in the outer medulla (P < .001 each). The medullary R2 ' differences (before and after intravenous FU) were significantly correlated with the hypoxic scores, respectively (P < .001). CONCLUSION R2 ' mapping can evaluate the renal hypoxia in the procession of IRI in rabbits and might serve as a quantitative biomarker for IRI.

Reduced nigrostriatal uptake on N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-[123I]iodophenyl) nortropane (123I-FP-CIT) SPECT reflects dopamine dysfunction, while other imaging markers could be complementary when used together. We assessed how well 123I-FP-CIT SPECT differentiates dementia with Lewy bodies (DLBs) from Alzheimer's disease dementia (ADem) and whether multimodal imaging provides additional value. 123I-FP-CIT SPECT, magnetic resonance imaging, [18F]2-fluoro-deoxy-D-glucose-positron emission tomography (PET), and 11C-Pittsburgh compound B (PiB)-PET were assessed in 35 participants with DLBs and 14 participants with ADem (autopsy confirmation in 9 DLBs and 4 ADem). Nigrostriatal dopamine transporter uptake was evaluated with 123I-FP-CIT SPECT using DaTQUANT software. Hippocampal volume was calculated with magnetic resonance imaging, cingulate island sign ratio with FDG-PET, and global cortical PiB retention with PiB-PET. The DaTQUANT z-scores of the putamen showed the highest c-statistic of 0.916 in differentiating DLBs from ADem among the analyzed imaging biomarkers. Adding another imaging modality to 123I-FP-CIT SPECT had c-statistics ranging from 0.968 to 0.975, and 123I-FP-CIT SPECT in combination with 2 other imaging modalities presented c-statistics ranging from 0.987 to 0.996. These findings suggest that multimodal imaging with 123I-FP-CIT SPECT aids in differentiating DLBs and ADem and in detecting comorbid Lewy-related and Alzheimer's disease pathology in patients with DLBs and ADem.

To enable deep learning-based computer-aided diagnosis to achieve excellent performance in differentiating benign and malignant breast tumors in ultrasound images, a large number of labeled training samples must be collected. However, it is difficult to acquire sufficient samples due to the high costs of data collection and labeling. Fortunately, breast ultrasound images have two labels from different sources of domain knowledge: the biopsy results are “clean” labels, and the Breast Imaging Reporting and Data System (BI-RADS) score functions as a “noisy” label. Based on these two label types, we propose a multitask classification method based on label distribution correction (MTLC-Net). In our method, we propose different tasks to address the noisy and clean labels. Specifically, we propose a label distribution correction task for noisy labels that includes jointly training the network parameters and soft labels. The model is generalizable and robust by correcting the noisy label distribution based on the BI-RADS score, and it extracts knowledge from the noisy label task to improve the learning in the clean-label task. We conducted extensive comparisons with existing methods. Our method achieved a classification accuracy of 75.8%, a precision of 73.0%, a recall of 80.1% and an F1 score of 0.764—results that are significantly better than those of the existing state-of-the-art methods for differentiating benign and malignant breast tumors in ultrasound images.

Background The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy remains controversial. This study aimed to evaluate the benefits of external and internal stents using the Fistula Risk Score system with regard to the incidence of clinically relevant postoperative pancreatic fistula. Methods A total of 382 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy were retrospectively enrolled from January 2015 to October 2019. The receiver operating characteristic curve was performed for subgroup analysis of the patients at different levels of risk for pancreatic fistula. Results There were no significant differences in terms of pancreatic fistula or other postoperative complications. According to the receiver operating characteristic curve threshold of 3.5, 172 patients with a Fistula Risk Score ≥ 4 and 210 patients with a Fistula Risk Score P = 0.039), at ameliorating the incidence of clinically relevant postoperative pancreatic fistula (P = 0.019). Additionally, the incidence of lymphatic leakage was significantly higher in the external stent group compared with the internal stent group (P = 0.040). Conclusions Compared with internal stents, the use of an external stent could reduce the incidence of clinically relevant postoperative pancreatic fistula in patients with a Fistula Risk Score ≥ 4. More large-scale prospective clinical trials are warranted to further clarify our results.

Animal studies implicate meningeal lymphatic dysfunction in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease (PD). However, there is no direct evidence in humans to support this role1-5. In this study, we used dynamic contrast-enhanced magnetic resonance imaging to assess meningeal lymphatic flow in cognitively normal controls and patients with idiopathic PD (iPD) or atypical Parkinsonian (AP) disorders. We found that patients with iPD exhibited significantly reduced flow through the meningeal lymphatic vessels (mLVs) along the superior sagittal sinus and sigmoid sinus, as well as a notable delay in deep cervical lymph node perfusion, compared to patients with AP. There was no significant difference in the size (cross-sectional area) of mLVs in patients with iPD or AP versus controls. In mice injected with α-synuclein (α-syn) preformed fibrils, we showed that the emergence of α-syn pathology was followed by delayed meningeal lymphatic drainage, loss of tight junctions among meningeal lymphatic endothelial cells and increased inflammation of the meninges. Finally, blocking flow through the mLVs in mice treated with α-syn preformed fibrils increased α-syn pathology and exacerbated motor and memory deficits. These results suggest that meningeal lymphatic drainage dysfunction aggravates α-syn pathology and contributes to the progression of PD.

ObjectiveTo determine the clinical phenotypes associated with the β-amyloid PET and dopamine transporter imaging (123I-FP-CIT SPECT) findings in mild cognitive impairment (MCI) with the core clinical features of dementia with Lewy bodies (DLB; MCI-LB).MethodsPatients with MCI who had at least 1 core clinical feature of DLB (n = 34) were grouped into β-amyloid A+ or A− and 123I-FP-CIT SPECT D+ or D− groups based on previously established abnormality cut points for A+ with Pittsburgh compound B PET standardized uptake value ratio (PiB SUVR) ≥1.48 and D+ with putamen z score with DaTQUANT 123I-FP-CIT SPECT. Individual patients with MCI-LB fell into 1 of 4 groups: A+D+, A+D−, A−D+, or A−D−. Log-transformed PiB SUVR and putamen z score were tested for associations with patient characteristics.ResultsThe A−D+ biomarker profile was most common (38.2%), followed by A+D+ (26.5%) and A−D− (26.5%). The least common was the A+D- biomarker profile (8.8%). The A+ group was older, had a higher frequency of APOE ε4 carriers, and had a lower Mini-Mental State Examination score than the A− group. The D+ group was more likely to have probable REM sleep behavior disorder. Lower putamen DaTQUANT z scores and lower PiB SUVRs were independently associated with higher Unified Parkinson’s Disease Rating Scale-III scores.ConclusionsA majority of patients with MCI-LB are characterized by low β-amyloid deposition and reduced dopaminergic activity. β-Amyloid PET and 123I-FP-CIT SPECT are complementary in characterizing clinical phenotypes of patients with MCI-LB.

Non-orthogonal multiple access (NOMA) technology is expected to effectively improve the spectrum efficiency of fifth-generation and later wireless networks. As a new technology, reconfigurable Intelligent surfaces (RIS) can achieve high spectral and energy efficiency with a low cost in wireless networks. These are achieved by integrating a great quantity of low-cost passive reflective units (RUs) on the plane. In this article, in order to meet the needs of high efficiency, low power consumption, and wide coverage, we combine RIS-assisted NOMA technology with the internet of things (IoT). Because in the actual wireless communication system, the residual hardware impairment (RHI) characteristics of the actual transceiver equipment will have an important impact on system secrecy performance. Therefore, the study will propose a single eavesdropper RIS-assisted downlink NOMA system with RHI (E-RHI-RIS-NOMA). The study will also investigate the impact of RHI on the physical layer security (PLS) performance of the system and the closed-form expression of the user’s secrecy outage probability (SOP) is derived. Finally, the simulation results show that 1) the main factors affecting the SOP are the quantity of RUs in RIS, the transmit SNR, and the target data rate, 2) it is proved that the hardware impairment of the transceiver harms the system’s secrecy outage performance while the severity of the impact of RHI on the system performance depends on the transmit SNR and target data rate. Moreover, RHI at different nodes has a different influence on system secrecy performance. 3) the system performance of RIS relying on NOMA is improved compared with orthogonal multiple access (OMA) and conventional NOMA.

Background The aim of this study is to assess the incidence, clinical manifestations, management, and prognosis of graft infection after bypass surgery with prosthetic conduit for infectious femoral artery pseudoaneurysms (IFAPs) in patients with a history of intravenous drug use (IVDU). Methods A single-center retrospective chart review of IVDU presenting with graft infections after previously being treated with extra-anatomic prosthetic conduit bypass surgery for IFAPs between 2009 and 2019 was performed. Relevant clinical data and patient demographics were collected and analyzed. All patients underwent procedures consisting of graft removal with analysis of operative details and complications. Results Of all 122 patients who underwent IFAP resection with extra-anatomic prosthetic bypass, the incidence of graft infection was 38.5% (47 patients, 48 grafts) with an average age of 35.7 ± 7.3 years. The average interval between bypass surgery and infectious symptoms was 9.2 ± 2.5 months and average time from bypass to graft removal was 13.6 ± 3.4 months. The most common presentation was repeated or unhealable chronic ulcers with sinus formation or purulence either within the bypass area or along the graft conduit route (43, 89.6%). Occlusion of the infected bypass graft occurred in nearly all cases (46, 95.8%). Severe hemorrhage occurred in only 1 case (2.1%). After graft removal, the stumps were ligated in the majority of patients (33, 68.8%) with 15 patients (31.2%) not amenable to ligation due to a difficult dissection. The average time of operation was 35.4 ± 8.7 min with an average blood loss of 35.8 ± 6.7 mL. There were no significant complications such as infection reoccurrence, severe limb ischemia, amputation, or death observed postoperatively. Conclusions Patients who receive bypass surgery with prosthetic conduit for IFAPs carry a high incidence of graft infection and subsequent occlusion. However, the presenting symptoms are generally mild, and the incidence of fatal complications is rare. This study suggests that a safe treatment option consists of direct graft removal without reconstruction. Additionally, the procedure proved to be relatively convenient and straightforward, which provides further support toward the strategy of treating IFAPs in IVDUs with pseudoaneurysm resection and prosthetic conduit bypass surgery.

It has been found that the dielectric constants of transparent conductive oxides (TCOs) can be adjusted in an extremely large range by tuning the carrier density. Due to the remarkable light confinement property of the epsilon-near-zero (ENZ) effect of TCOs, it has attracted extensive interests of light modulation. However, the operation wavelength bandwidth is usually limited by optical resonance that is applied to enhance the light-TCOs interaction. In this work, a dual-resonance light coupling scheme is proposed to expand the modulation depth-bandwidth product with almost one order-of-magnitude improvement. In a metallic subwavelength grating structure with deep trenches backed by a ground plane, the ENZ mode can be coupled to both magnetic resonance and Fabry-Perot resonance respectively by tuning the bias. Decent light modulation can be obtained in a large operation wavelength band covering two resonances by optimizing the dual-resonance configuration. Such a reconfigurable efficient broadband modulation is important for robust communication link and possesses remarkable capacity for wavelength division multiplexing.

Background:Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients.Methods:During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h.Results:For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L.Conclusion:We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.

With the improvement of the global food safety regulatory system, there is an increasing importance for food safety risk assessment. Veterinary drugs are widely used in poultry and livestock products. The abuse of veterinary drugs seriously threatens human health. This article explains the necessity of risk assessment for veterinary drug residues in meat products, describes the principles and functions of risk assessment, then summarizes the risk assessment process of veterinary drug residues, and then outlines the qualitative and quantitative risk assessment methods used in this field. We propose the establishment of a new meat product safety supervision model with a view to improve the current meat product safety supervision system.

Yuanming Pan,1 Chaoqin Chen,1 Lingya Yu,2 Shengmei Zhu,1 Yueying Zheng1 1Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People’s Republic of China; 2Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People’s Republic of ChinaCorrespondence: Shengmei Zhu; Yueying ZhengDepartment of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 31003, People’s Republic of ChinaTel +86-13777408863Email 1507128@zju.edu.cnBackground: The present study aimed to investigate the incidence and extent of difficult airway management in patients with massive retrosternal goiter.Design: An 8-year retrospective analysis was performed to identify patients who underwent massive retrosternal thyroidectomy. A total of 22 cases were identified as giant retrosternal goiter, followed by a review of each patient’s preoperative computerized tomography imaging.Interventions: There were no cases of failed intubation. Twenty patients underwent uneventful tracheal intubation using direct laryngoscopy or Glidescope. Thirteen patients received a muscle relaxant intravenously, and two patients were induced with sevoflurane. Five patients underwent awake tracheal intubation, including awake fiberoptic intubation in three patients. Before entering the operating theatre, the remaining two patients underwent oral tracheal intubation with Glidescope in the emergency department.Results: Two patients had tracheal intubation before they entered the operating theatre. Once entering vocal cords, tracheal intubation can pass beyond the site of the tracheal obstruction without difficulty. One patient died because of serious perioperative bleeding owing to the adhesion between the retrosternal goiter and large vessel within the thoracic cavity. One patient experienced dyspnea after extubation and was intubated again.Conclusion: Intravenous induction of muscle relaxant using laryngoscopy or Glidescope is feasible in patients with massive benign retrosternal goiter. The incidence of difficult intubation and postoperative tracheomalacia is likely too rare. Furthermore, perioperative bleeding and postoperative airway complication seem frequent.Keywords: airway management, anesthesia, retrosternal goiter, postoperative tracheomalacia

Since the first two novel coronavirus cases appeared in January of 2020, the outbreak of the COVID-19 epidemic seriously threatens the public health of Italy. In this article, the distribution characteristics and spreading of COVID-19 in various regions of Italy were analysed by heat maps. Meanwhile, spatial autocorrelation, spatiotemporal clustering analysis and kernel density method were also applied to analyse the spatial clustering of COVID-19. The results showed that the Italian epidemic has a temporal trend and spatial aggregation. The epidemic was concentrated in northern Italy and gradually spread to other regions. Finally, the Google Trends index of the COVID-19 epidemic was further employed to build a prediction model combined with machine learning algorithms. By using Adaboost algorithm for single-factor modelling,the results show that the AUC of these six features (mask, pneumonia, thermometer, ISS, disinfection and disposable gloves) are all >0.9, indicating that these features have a large contribution to the prediction model. It is also implied that the public's attention to the epidemic is increasing as well as the awareness of the need for protective measures. This increased awareness of the epidemic will prompt the public to pay more attention to protective measures, thereby reducing the risk of coronavirus infection.

Objective A systematic review and analysis of data from several rheumatoid arthritis metabolomics studies attempts to determine which metabolites can be used as potential biomarkers for the diagnosis of rheumatoid arthritis and to explore the pathogenesis of rheumatoid arthritis. Methods We searched all the subject-related documents published by EMBASE, PubMed, Web of Science, and Cochrane Library from the database to the September 2019 publication. Two researchers independently screened the literature and extracted the data. QUADOMICS tool was used to assess the quality of studies included in this systematic review. Results A total of 10 studies met the inclusion criteria of systematic review, including 502 patients with rheumatoid arthritis and 373 healthy people. Among them, the biological samples utilised for metabolomic analysis include: serum (n = 8), urine (n = 1) and synovial fluid (n = 1). Some metabolites play an important role in rheumatoid arthritis: glucose, lactic acid, citric acid, leucine, methionine, isoleucine, valine, phenylalanine, threonine, serine, proline, glutamate, histidine, alanine, cholesterol, glycerol, and ribose. Conclusions Metabolomics provides important new opportunities for further research in rheumatoid arthritis and is expected to elucidate the pathogenesis of rheumatoid arthritis that has not been fully understood before.

To compare natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic (LAP) surgery in treating colorectal cancer. The present authors conducted a systematic search in the PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective nonrandomized studies, and retrospective studies up to May 2019. We used postoperative complications as the main endpoints, and used hospital stay, time to first flatus, operative time, postoperative pain, cosmetic result, wound infections, and oncological outcomes as the secondary endpoints. Subgroup analyses were conducted according to the different specimen extraction sites (transanal and transvaginal). A sensitivity analysis was carried out to evaluate the reliability of the outcomes. RevMan5.3 software was used for statistical analysis. Twelve studies (one RCT, ten retrospective studies, and one prospective nonrandomized study) involving a total of 1437 patients (NOSES group 665 patients and LAP surgery group 772 patients) were included. Meta-analysis showed that compared with LAP surgery, NOSES resulted in a shorter hospital stay (WMD = −0.79 days; 95% CI −1.17 to −0.42; P

Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound.

Background: Dairy safety has caused widespread concern in society. Unsafe dairy products have threatened people's health and lives. In order to improve the safety of dairy products and effectively prevent the occurrence of dairy insecurity, countries have established different prevention and control measures and safety warnings. Objective: The purpose of this study is to establish a dairy safety prediction model based on machine learning to determine whether the dairy products are qualified. Methods: The 34 common items in the dairy sampling inspection were used as features in this study. Feature selection was performed on the data to obtain a better subset of features, and different algorithms were applied to construct the classification model. Results: The results show that the prediction model constructed by using a subset of features including “total plate”, “water” and “nitrate” is superior. The SN, SP and ACC of the model were 62.50%, 91.67% and 72.22%, respectively. It was found that the accuracy of the model established by the integrated algorithm is higher than that by the non-integrated algorithm. Conclusion: This study provides a new method for assessing dairy safety. It helps to improve the quality of dairy products, ensure the safety of dairy products, and reduce the risk of dairy safety.

The quality of the perovskite light absorption layer plays a dynamic role in the photovoltaic properties of solar cells. The existing methods to prepare methylammonium lead iodide (MAPbI3) films render substantial structural defect density, particularly at the grain boundaries and film surface, constituting a challenge that hinders the further optoelectronic enhancement of perovskite solar cells. Herein, a unique approach was introduced: using a simple ethylammonium chloride (EACl) additive in perovskite precursor mixture to produce high-quality MAPbI3 thin films. The results indicated that EACl could encourage perovskite crystal growth without experiencing the intermediate phase formation and would evaporate from the perovskite after annealing. Additionally, a gradient perovskite structure was achieved using this technique, which impressively enhanced the performance of the perovskite films. A high power conversion efficiency (PCE) of 20.03% was achieved under the optimal amount of EACl, and the resultant efficient device could retain over 89% of the original PCE after aging for 1000 h at room temperature. This novel technique leads to a facile fabrication of high-quality and less-defect perovskite thin films for competent and stable devices.

This article presents a fully integrated 100-GHz continuous-wave Doppler radar transceiver with the double-sideband low-intermediate-frequency (IF) architecture for mechanical vibration and vital sign detection. Fabricated in a 65-nm CMOS process, the whole radar chip transceiver consumes 262 mW with a size of 0.9 mm $\times2.0$ mm. Instead of utilizing a fundamental 100-GHz voltage controlled oscillator (VCO) in the chip, a push–push frequency doubler with the 50-GHz external source is adopted to drive the transceiver. Under a dedicated design on the system architecture and circuit blocks, the chip could transmit 4-dBm saturated power ( $P_{\mathrm {sat}}$ ) over 93–105 GHz with a 40-mV 1-kHz IF carrier and achieve good I/Q performance of phase mismatch $\mu \text{m}$ displacement from 1.5 m, the human vital-sign signal from 2 m, and even a small bullfrog’s hybrid respiratory motion from 0.6 m. To the best of our knowledge, this is the first 100-GHz CMOS Doppler radar transceiver chip with the low-IF architecture for the biological vital sign detection.

Background Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB patients under this service model, often with inconsistent conclusions. In addition, there has been no published studies from China using the updated 2018 World Health Organization (WHO) definition of catastrophic total costs due to TB. This study used the latest criterion recommended by the WHO to analyze the incidence of catastrophic total costs for households affected by TB under the designated hospital model and explore its influencing factors. Methods A cross-sectional analysis was carried out in all ten designated hospitals in Ningbo, China. Eligible pulmonary TB cases confirmed by sputum culture of Mycobacterium tuberculosis were recruited and surveyed from September 2018 to October 2018. We evaluated catastrophic total costs using total costs for TB treatment exceeding 20% of the household’s annual pre-TB income. A sensitivity analysis was performed while varying the thresholds. The least absolute shrinkage and selection operator (LASSO) regression were applied to select variables, and multiple logistic regression analysis were used to identify the determinants of catastrophic total costs. Results A total of 672 patients were included, with a median age of 41 years old. The rate of catastrophic total costs of surveyed households was 37.1%, and that of households affected by MDR was 69.6%. Medical cost accounted for more than 60% of the total cost. 57.7% cases were hospitalized. The hospitalization rates of patients with no comorbidities, no severe adverse drug reactions, and rifampin-sensitive TB were 53.9, 54.9, and 55.3%, respectively. Patients in the poorest households had the highest hospitalization rates (Q1:54.8%, Q2:61.4%, Q3:52.2%, Q4:49.5%, Q5:69.7%, P = 0.011) and the highest incidence of severe adverse drug reactions (Q1:29.6%, Q2:19.6%, Q3:28.0%, Q4:33.7%, Q5:35.3%, P = 0.034). Factors such as elderly, minimum living security, unemployed before or after illness, poor economic status, seeking medical care outside the city, hospitalization, absence of local basic medical insurance coverage and MDR were positively associated with catastrophic costs. Conclusion Substantial proportions of patients and households affected by pulmonary TB faced catastrophic economic risks in Ningbo, China. The existing policies that focus on expanding the coverage of basic medical insurance and economic protection measures (such as cash transfers to compensate low-income households for direct non-medical costs and income loss) might be insufficient. Tailored program that mitigate inappropriate healthcare and address equity of care delivery are worthy of attention.

Background We aimed to identify metabolic biomarkers and investigate the metabolic alterations in relation to primary open-angle glaucoma (POAG) and cataract in human aqueous humor. Methods Sixteen POAG patients undergoing surgical treatments and 24 patients undergoing cataract surgeries were included in this case-control study. We performed the metabolomic analysis of aqueous humor samples using a non-targeted gas chromatography coupled to time-of-flight mass spectrometer. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacities of each metabolite marker. Databases including the Kyoto Encyclopedia of Genes and Genomes (KEGG) and MetaboAnalyst were utilized to search for the potential pathways of metabolites. Results Aqueous humor metabolomic profiles could well distinguish POAG from controls. Fourteen metabolic biomarkers were identified as potential aqueous humor biomarkers for POAG, yielding AUC values from 0.62 to 0.86. In pathway analysis, Biotin metabolism was highly impacted, implying that these metabolic markers play important roles in the regulation of this pathway. Conclusions This study identified valuable metabolic biomarkers and pathways that may facilitate an improved understanding of the POAG pathogenesis. The finding holds translational value in the development of new therapeutic measures for POAG.

Loss-of-function mutations in the progranulin gene (GRN) are one of the major causes of familial frontotemporal lobar degeneration. Our objective was to determine the rates and trajectories of lobar cortical atrophy from longitudinal structural magnetic resonance imaging in both asymptomatic and symptomatic GRN mutation carriers. Individuals in this study were from the ADRC and LEFFTDS studies at the Mayo Clinic. We identified 13 GRN mutation carriers (8 asymptomatic, 5 symptomatic) and noncarriers (n= 10) who had at least 2 serial T1-weighted structural magnetic resonance images and were followed annually with a median of 3years (range 1.0-9.8years). Longitudinal changes in lobar cortical volume were analyzed using the tensor-based morphometry with symmetric normalization (TBM-SyN) algorithm. Linear mixed-effect models were used to model cortical volume change over time among 3 groups. The annual rates of frontal (p < 0.05) and parietal (p < 0.01) lobe cortical atrophy were higher in asymptomatic GRN mutation carriers than noncarriers. The symptomatic GRN mutation carriers also had increased rates of atrophy in the frontal (p < 0.01) and parietal lobe (p < 0.01) cortices than noncarriers. In addition, greater rates of cortical atrophy were observed in the temporal lobe cortices of symptomatic GRN mutation carriers than noncarriers (p < 0.001). We found that a decline in frontal and parietal lobar cortical volume occurs in asymptomatic GRN mutation carriers and continues in the symptomatic GRN mutation carriers, whereas an increased rate of temporal lobe cortical atrophy is observed only in symptomatic GRN mutation carriers. This sequential pattern of cortical involvement in GRN mutation carriers has important implications for using imaging biomarkers of neurodegeneration as an outcome measure in potential treatment trials involving GRN mutation carriers.

The delivery of optical signals from an external light source to a nanoscale waveguide is highly important for the development of nanophotonic circuits. However, the efficient coupling of external light energy into nanophotonic components is difficult and still remains a challenge. Herein, we use an external silica nanofiber to light up an organic-inorganic hybrid nano-waveguide, namely a system composed of a polymer filament doped with MoS$_{2}$ quantum dots. Nanofiber-excited nano-waveguides in a crossed geometry are found to asymmetrically couple excitation signals along two opposite directions, with different energy dissipation resulting in different colors of the light emitted by MoS$_{2}$ quantum dots and collected from the waveguide terminals. Interestingly, rainbow-like light in the hybrid waveguide is achieved by three-in-one mixing of red, green, and blue components. This hetero-dimensional system of dots-in-waveguide represents a significant advance towards all-optical routing and full-color display in integrated nanophotonic devices., Comment: 26 pages, 11 Figures, Journal of Physical Chemistry Letters, 2021

Spinal cord injury (SCI) is the most common disabling spinal injury, and the complex pathological process can eventually lead to severe neurological dysfunction. Many studies have reported that the mammalian target of rapamycin (mTOR) signaling pathway plays an important role in synaptogenesis, neuron growth, differentiation, and survival after central nervous system injury. It is also involved in various traumatic and central nervous system diseases, including traumatic brain injury, neonatal hypoxic-ischemic brain injury, Alzheimer's disease, Parkinson's disease, and cerebral apoplexy. mTOR has also been reported to play an important regulatory role in various pathophysiological processes following SCI. Activation of mTOR signals after SCI can regulate physiological and pathological processes, such as proliferation and differentiation of neural stem cells, regeneration of nerve axons, neuroinflammation, and glial scar formation, through various pathways. Inhibition of mTOR activity has been confirmed to promote repair in SCI. At present, many studies have reported that Chinese herbal medicine can inhibit the SCI-activated mTOR pathway to improve the microenvironment and promote nerve repair after SCI. Due to the role of the mTOR pathway in SCI, it may be a potential therapeutic target for SCI. This review is focused on the pathophysiological process of SCI, characteristics of the mTOR pathway, role of the mTOR pathway in SCI, role of inhibition of mTOR on SCI, and role and significance of inhibition of mTOR by related Chinese herbal medicine inhibitors in SCI. In addition, the review discusses the deficiencies and solutions to mTOR and SCI research shortcomings. This study hopes to provide reference for mTOR and SCI research and a theoretical basis for SCI biotherapy.

PurposeThe present study aimed to clarify the potential predictive significance of Systemic immune-inflammation index (SII) in assessing the poor prognosis of critically ill patients with congestive heart failure (CHF).MethodsDetailed clinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III database after gaining access and building the local platform. The 30- and 90-day and hospital all-cause mortalities of the patient was the primary outcome, and the readmission rate and the occurrence of major cardiovascular adverse events (MACEs) were the secondary outcomes. the Cox proportional hazard model and Logistic regression analysis were selected to reveal the relationship between SII level and the research outcome. Further, the propensity score matching (PSM) analysis was performed to improve the reliability of results by reducing the imbalance across groups.ResultsThere were a total of 4606 subjects who passed the screening process and entered the subsequent analysis. Multivariate regression analysis showed that after adjusting for possible confounders, including age, heart rate, and albumin, etc., the high level of SII was independently associated with 30- and 90-day and hospital mortalities (tertile 3 versus tertile 1: HR, 95% CIs: 1.23, 1.04-1.45; 1.21, 1.06-1.39; 1.26, 1.05-1.50) and the incidence of MACEs (tertile 3 versus tertile 1: OR, 95% CI: 1.39, 1.12-1.73) in critically ill patients with CHF, but no significant correlation was found between SII and the readmission rate. Consistently, patients with high SII level still presented a significantly higher short-term mortality than patients with low SII in the PSM subset.ConclusionIn critically ill patients with CHF, high level of SII could effectively predict high 30- and 90-day and hospital mortalities, as well as the high risk of occurrence of MACEs.

Users usually consult the manufacturers or the internet when they encounter operation questions with an electronics product. In this paper, we explore to represent an operation question as a procedure graph and formulate the problem of operation diagnosis as two sub-tasks, namely error node detection, and correction, on top of the graph. We construct the first benchmark for this task and propose a transformer-based model to integrate external knowledge and context information to enhance the performance. Experimental results show the effectiveness of our proposed model.

Visual grounding has attracted much attention with the popularity of vision language. Existing one-stage methods are far ahead of two-stage methods in speed. However, these methods fuse the textual feature and visual feature map by simply concatenation, which ignores the textual semantics and limits these models' ability in cross-modal understanding. To overcome this weakness, we propose a semantic-aware framework that utilizes both queries' structured knowledge and context-sensitive representations to filter the visual feature maps to localize the referents more accurately. Our framework contains an entity filter, an attribute filter, and a location filter. These three filters filter the input visual feature map step by step according to each query's aspects respectively. A grounding module further regresses the bounding boxes to localize the referential object. Experiments on various commonly used datasets show that our framework achieves a real-time inference speed and outperforms all state-of-the-art methods.

Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes.Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models.Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71).Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.

In this article, dexmedetomidine (Dex) was used to prevent neurological disorders in patients anesthetized with sevoflurane and the effect was analyzed using ultrasound images based on the restoration algorithm of the linear system model. Children injected with Dex were in the experimental group, while children injected with normal saline were in the control group. The mean arterial pressure (MAP), arterial oxygen saturation (SpO2), heart rate (HR), Pediatric anesthesia agitation scale (PAED) score, Face, Legs, Activity, Cry, Consolability (FLACC) score, and adverse drug event (ADE) in the two groups were compared before the injection (T1), at 5 min (T2), 10 min (T3), and 20 min (T4) after the injection, and when the patient came to himself (T5). It was found that in contrast with the control group, the MAP in the experimental group at T2, T3, and T4 periods was lower, while it was higher at T5 period and its HR at T2, T3, T4, and T5 periods was higher ( P P P P > 0.05). In conclusion, the restoration algorithm-based ultrasound images had high quality, and they demonstrated good application value in evaluating the effect of Dex to prevent neurological disorders in patients anesthetized by sevoflurane.

Purpose: To investigate the clinical significance of macular estimated retinal ganglion cell (mRGC) and estimated retinal ganglion cell (eRGC) in the diagnosis and staging of glaucoma.Methods: This is a cross-section study. All enrolled subjects underwent standard automated perimetry (SAP) and optical coherence tomography (OCT) examination. Swedish Interactive Threshold Algorithm (SITA)-FAST detection strategy and 24-2, 10-2 detection programs were employed in SAP assessment. The visual-field parameters and OCT parameters were calculated according to three formulas to obtain the eRGC and mRGC1 or mRGC2. The efficiency of eRGC, mRGC1, and mRGC2 estimates for the staging of glaucoma was compared. The sensitivity and specificity of each parameter for diagnosis of glaucoma were analyzed using the receiver operating characteristic (ROC) curve.Results: A total of 119 eyes were included in the analysis. Compared with the healthy controls, eRGC, mRGC1, and mRGC2 estimates were significantly decreased in patients with glaucoma. As glaucoma progressed, eRGC, mRGC1, and mRGC2 estimates were gradually reduced. In preperimetric glaucoma, mRGC1, mRGC2, and eRGC were reduced by 13.2, 14.5, and 18%, respectively. In the mild stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 28, 34, and 38%, respectively. In the advanced stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 81, 85, and 92% respectively. The proportion of retinal ganglion cell (RGC) loss in the macula was close to that outside the macula. The specificity at 95% gave a sensitivity of 95.51, 86.52, and 87.64% for eRGC, mRGC1, and mRGC2, respectively. The sensitivity of structural parameters macular ganglion cell complex thickness and retinal nerve fiber layer (RNFL) were 98.88 and 95.51%, respectively. The sensitivity of functional parameters mean deviation (24-2) and visual field index (VFI) were 80.90 and 73.03%, respectively. The area under ROC curve of mRGC1, mRGC2, and eRGC were 0.982, 0.972, and 0.995 (P < 0.0001), respectively.Conclusion: Estimated retinal ganglion cell, mRGC1, and mRGC2 provide value to the staging of glaucoma and better diagnostic performance. Macular RGC estimatesthat integration of both structural and functional damages in macular may serve as a sensitive indicator for assessing macular damage in glaucoma and are of importance for the diagnosis and progression management of glaucoma.

Mixed-lineage leukemia (MLL) gene rearrangements trigger aberrant epigenetic modification and gene expression in hematopoietic stem and progenitor cells, which generates one of the most aggressive subtypes of leukemia with an apex self-renewal. It remains a challenge to directly inhibit rearranged MLL itself because of its multiple fusion partners and the poorly annotated downstream genes of MLL fusion proteins; therefore, novel therapeutic targets are urgently needed.qRT-PCR, receiver operating characteristic (ROC), and leukemia-free survival analysis were used to validate LAMP5-AS1 (LAMP5 antisense 1) expression and evaluate its clinical value. We performed in vitro and in vivo experiments to investigate the functional relevance of LAMP5-AS1 in MLL leukemia progression and leukemia cell stemness. RNA electrophoretic mobility shift assays (EMSA), histone methyltransferase assay, RNA pull-down assay, and RNA fluorescence in situ hybridization (FISH) were used to validate the relationship between LAMP5-AS1 and the methyltransferase activity of DOT1L. The downstream ectopic target genes of LAMP5-AS1/DOT1L were validated by the chromatin immunoprecipitation (ChIP) and western blot.We discovered that a long noncoding RNA (lncRNA) LAMP5-AS1 can promote higher degrees of H3K79 methylation, followed by upregulated expression of the self-renewal genes in the HOXA cluster, which are responsible for leukemia stemness in context of MLL rearrangements. We found that LAMP5-AS1 is specifically overexpressed in MLL leukemia patients (n = 58) than that in the MLL-wt leukemia (n = 163) (p0.001), and the patients with a higher expression level of LAMP5-AS1 exhibited a reduced 5-year leukemia-free survival (p0.01). LAMP5-AS1 suppression significantly reduced colony formation and increased differentiation of primary MLL leukemia CD34+ cells. Mechanistically, LAMP5-AS1 facilitated the methyltransferase activity of DOT1L by directly binding its Lys-rich region of catalytic domain, thus promoting the global patterns of H3K79 dimethylation and trimethylation in cells. These observations supported that LAMP5-AS1 upregulated H3K79me2/me3 and the transcription of DOT1L ectopic target genes.This is the first study that a lncRNA regulates the self-renewal program and differentiation block in MLL leukemia cells by facilitating the methyltransferase activity of DOT1L and global H3K79 methylation, showing its potential as a therapeutic target for MLL leukemia.

We develop a novel network to segment water with significant appearance variation in videos. Unlike existing state-of-the-art video segmentation approaches that use a pre-trained feature recognition network and several previous frames to guide segmentation, we accommodate the object’s appearance variation by considering features observed from the current frame. When dealing with segmentation of objects such as water, whose appearance is non-uniform and changing dynamically, our pipeline can produce more reliable and accurate segmentation results than existing algorithms.