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Introduction Establishing intravenous access is essential but may be difficult to achieve for patients requiring isolation for SARS-CoV-2 infection. This study aimed to investigate the effectiveness of infrared vein visualizer on the peripheral intravenous catheter therapy in COVID-19 patients. Methods A nonrandomized clinical trial was performed. One-hundred and twenty-two COVID-19 patients that required peripheral intravenous cannulation were divided into two groups with 60 in the control group and 62 in the intervention group. Conventional venipuncture method was applied to the control group while infrared vein imaging device was applied in the intervention group. The first attempt success rate, total procedure time and patients’ satisfaction score were compared between two groups using chi-square, t-test, and z-test (also known as Mann-Whitney U test) statistics. Results The first attempt success rate in the intervention group was significantly higher than that of control group (91.94% vs 76.67%, ꭓ2=5.41, P=0.02). The procedure time was shorter in the intervention group (M=211.44, SD=68.58 seconds vs M=388.27, SD=88.97 seconds, t=12.27, P

‘Co-control’, or synergistically reducing CO2 and local air pollutant emissions, is an important strategy for cities to achieve ‘low carbon’ and ‘blue sky’ simultaneously. However, there were few studies to evaluate and compare the level of co-control of CO2 and local air pollutants in cities yet. The present study proposed qualitative and quantitative methods to evaluate the level of co-control of CO2 and three local air pollutant (SO2, NOx, and particulate matter PM) emissions in key environmental protection cities in China over two periods (2012–2015 and 2015–2018). Statistical analysis found that, though three local air pollutant emissions positively correlated with CO2 emission, no significantly positive correlation was found between local air pollutants emission reductions and CO2 emission reductions, indicating that co-control effects were poor in general. By using the co-control effect coordinate system, qualitative evaluation showed that less than half of the sample cities could achieve co-control of the total amount of CO2 and local air pollutants. By employing the indicator of emission reduction equivalence (EReq), quantitative evaluation showed that the co-control level of the sample cities improved in 2015–2018 compared with 2012–2015. Further regression analysis showed that, reducing coal consumption and economic development significantly enhanced the co-control performance of the observed cities. The present case study proved that the proposed methods for evaluation and comparison of the city co-control performance works well, and can be used in other countries and regions to promote global cities racing to carbon and local air pollutants co-control.

BACKGROUND: Studies have shown that hyperbaric oxygen therapy (HBOT) can improve the extraction rate and latency of cortical evoked potential N20 in patients with severe traumatic brain injury, but there are only a few studies on the effect of flash visual evoked potential. OBJECTIVE: This study investigated the effect of hyperbaric oxygen therapy on the P2 wave of flash visual evoked potentials in patients with severe traumatic brain injury. METHODS: In total, we examined 40 TBI patients who received HBOT, in combination with medication, and 38 TBI patients who received medication alone. The FVEPs apparatus was used to detect the P2 wave extraction rate and the latency of the elicited waveform before and after treatment in both the medicated-only controls and HBOT-treated cohorts. RESULTS: Compared with the control group, the HBOT treatment group showed a higher P2 wave elicitation rate, and the P2 wave latency of the HBOT treatment group was significantly shortened (p

Background Malignancy is a potential comorbidity in patients with systemic lupus erythematosus (SLE). However, risk by malignancy type remains to be fully elucidated. We evaluated the risk of malignancy type in SLE patients in a systematic review and meta-analysis. Methods MEDLINE and EMBASE were searched from inception to July 2018 to identify observational studies that evaluated malignancy risk in adult SLE patients compared with the general population. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Heterogeneity was quantified using the I2 test. Findings Forty-one studies reporting on 40 malignancies (one overall, 39 site-specific) were included in the meta-analysis. The pooled RR for all malignancies from 3694 events across 80 833 patients was 1.18 (95% CI: 1.00-1.38). The risk of 24 site-specific malignancies (62%) was increased in SLE patients. For malignancies with ≥6 studies, non-Hodgkin lymphoma and Hodgkin lymphoma risk was increased >3-fold; myeloma and liver >2-fold; cervical, lung, bladder, and thyroid ≥1.5-fold; stomach and brain >1.3-fold. The risk of four malignancies (breast, uterine, melanoma, prostate) was decreased, whereas risk of 11 other malignancies did not differ between SLE patients and the general population. Heterogeneity ranged between 0% and 96%, and 63% were non-significant. Interpretation The risk of overall and some site-specific malignancies is increased in SLE compared with the general population. However, the risk for some site-specific malignancies is decreased or did not differ. Further examination of risk profiles and SLE patient phenotypes may support guidelines aimed at reducing malignancy risk. Funding AstraZeneca. Systematic review registration PROSPERO number: CRD42018110433.

ObjectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).MethodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults 6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.ResultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6–5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.InterpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.PROSPERO registration numberCRD42019141136.

Circadian rhythm disorder (CRD) in space flight can lead to memory impairment, performance decrements and adverse health outcomes, the main manifestations of which are circadian desynchronization, sleep loss and insomnia. Sleep deprivation (SD) provide the means to evaluate these effects and the risks associated with CRD on ground. Gastrodia elata Blume (GEB) has beneficial effects on the treatment of sleep disturbances and memory loss. Fresh GEB (FG), an unprocessed raw tuber of GEB, has been used as functional health food in Asian countries for a long time. However, the research report of FG to ameliorate memory impairment caused by insomnia or lack of sleep is meager. In this study, ICR male mice were sleep-deprived continuously and water extract of FG (WFG) was orally administrated (3 and 9 g/kg/d, i.g) during the SD process lasted for 25 days, except control and model groups gavage administration with water, positive control group with modafinil (MOD, 0.1 g/kg/d, i.g). We studied the effect of WFG on CRD-induced learning and memory impairment using a set of behavioral analyses including the object location recognition test (OLRT), novel object recognition test (NORT), and the passive avoidance test (PAT). In addition, oxidative stress parameters were assessed by measuring the malondialdehyde (MDA) and superoxide dismutase (SOD) reactivity in serum and hippocampus. Our results revealed that SD decreased discrimination index (DI) in OLRT and NORT, with shorter latency into the dark chamber in PAT. Both WFG and MOD treatment can reverse these changes (P0.05). We concluded that WFG treatment improve CRD-induced learning and memory impairment and oxidative stress damage which makes FG a promising candidate as herbal health product of memory decline in CRD.

Herbicide-resistance in weeds has become a serious threat to agriculture across the world. Thus, there is an urgent need for the discovery and development of herbicides with new modes of action. Thaxtomin phytotoxins are a group of nitrated diketopiperazines produced by potato common scab-causing phytopathogen Streptomyces scabies and other actinobacterial pathogens. They are generally considered to function as inhibitors of cellulose synthesis in plants, and thus have great potential to be used as natural herbicides. Generation of an overproducing strain is crucial for the scale-up production of thaxtomins and their wide use in agriculture. In the present study, we employed a stepwise strategy by combining heterologous expression, repressor deletion, activator overexpression, and optimization of fermentation media for high-level production of thaxtomins. The maximum yield of 728 mg/L thaxtomins was achieved with engineered Streptomyces albidoflavus J1074 strains in shake-flask cultures, and it was approximately 36-fold higher than S. albidoflavus J1074 carrying the unmodified cluster. Moreover, the yield of thaxtomins could reach 1973 mg/L when the engineered strain was cultivated in a small-scale stirred-tank bioreactor. This is the highest titer reported to date, representing a significant leap forward for the scale-up production of thaxtomins. Our study presents a robust, easy-to-use system that will be broadly useful for improving titers of bioactive compounds in many Streptomyces species.

BACKGROUND Because of their cancer and treatment adverse effects, most pediatric oncology patients will experience 1 or more symptoms at one time that can seriously affect their quality of life. Because these children are attached to parents, their symptom burden directly influences the parental stress level and parental interpretations of their children's quality of life. OBJECTIVE The aim of this study was to examine the association between child-reported symptom burden and the pediatric quality of life reported by children with cancer and their parents, and whether parental perceived stress mediates these relationships. METHODS In a cross-sectional design, convenience sampling was used to recruit 80 parent-child dyads. Advanced statistical methods were adopted to analyze the mediating effects of parental stress between children's symptom burden and their quality of life. RESULTS The results revealed that parental stress was the mediator in the relationship between child-reported symptom burden and children's quality of life reported by parents. The results also showed that parental stress was not a mediator in the relationship between child-reported symptom burden and their quality of life. This underscored the differences in interpretations of quality of life reported by children and their parents. CONCLUSION Children's symptom burden is an important factor in predicting parental stress level and the quality of life reported by the children. Children's voice should be incorporated whenever possible. IMPLICATIONS FOR PRACTICE The knowledge gained from this study will facilitate intervention development to enhance parents' abilities in stress management and symptom management for their children with the support of the nursing profession.

Emergency medical services (EMS) activation is an integral component in managing individuals with myocardial infarction (MI). EMS play a crucial role in early MI symptom recognition, prompt transport to percutaneous coronary intervention centres and timely administration of management. The objective of this study was to examine sex differences in prehospital EMS care of patients hospitalized with Ml using data from a retrospective population-based cohort study of linked health administrative data for people with a hospital diagnosis of MI in Australia (2001-18).

Computerized interpretation of electrocardiogram plays an important role in daily cardiovascular healthcare. However, inaccurate interpretations lead to misdiagnoses and delay proper treatments. In this work, we built a high-quality Chinese 12-lead resting electrocardiogram dataset with 15,357 records, and called for a community effort to improve the performances of CIE through the China ECG AI Contest 2019. This dataset covers most types of ECG interpretations, including the normal type, 8 common abnormal types, and the other type which includes both uncommon abnormal and noise signals. Based on the Contest, we systematically assessed and analyzed a set of top-performing methods, most of which are deep neural networks, with both their commonalities and characteristics. This study establishes the benchmarks for computerized interpretation of 12-lead resting electrocardiogram and provides insights for the development of new methods. Graphical AbstractA community effort to assess and improve computerized interpretation of 12-lead resting electrocardiogram Supplementary information The online version contains supplementary material available at 10.1007/s11517-021-02420-z.

GeSe is an emerging promising light-harvesting material for photovoltaics due to its excellent optoelectronic properties, nontoxic and earth-abundant constituents, and high stability. In particular, perovskite-like antibonding states at the valence band maximum arising from Ge-4s and Se-4p coupling enable the bulk-defect-tolerant properties in GeSe. However, a fundamental understanding of surface-defect states in GeSe, another important factor for high-performance photovoltaics, is still lacking. Here, we investigate the surface-defect properties of GeSe through first-principle calculations. We find that different from common semiconductors possessing numerous surface dangling bonds, some GeSe surfaces are prone to reconstruction, thus eliminating the dangling bonds. The rearranged armchair edges exhibit unexpected benign defect properties, similar to those of bulk GeSe, arising from the formation of bulk-like [GeSe3] tetrahedrons. We further show that the stable exposed (111) surfaces are hard to reconstruct due to the stiff structure but are effectively passivated by the addition of H.

BACKGROUND Congenital coronary artery fistula can lead to symptoms of chest tightness, chest pain, or exertional dyspnea, which is a congenital vascular malformation that should not be ignored. Patients who have such malformations are frequently observed with different concurrent abnormal anatomic structures. Collateral circulation may have a positive effect on improving the patients' symptoms. CASE SUMMARY A 53-year-old female experienced episodic chest discomfort for the past month with symptoms manifesting when she was agitated or overexerted. After a positive treadmill test, the patient underwent coronary angiography. “Ghostlike” intermittent appearance of coronary ventricular fistula and collateral branching were observed. The patient was diagnosed with a right coronary ventricular fistula and collateral circulation. CONCLUSION This case shows the likelihood of collateral circulation in patients with coronary artery fistula. This may provide medical staff with novel solutions to treat insufficiency of myocardial blood supply induced by cardiovascular malformations.

Yue-Rong Zhang,1 Hui Wang,2 Ning Zhou,2 Yao-Di Zhang,1,2 Yan Lin,1,2 Li-Yang Wu,1,2 Shi-Fang Wei,2 Yan-Yun Ma,2,3 Chun-Xia Wang3 1Department of Gastroenterology, University-Town Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Infectious Diseases, The First People’s Hospital of Lanzhou, Gansu, 730050, People’s Republic of China; 3Department of Laboratory, The First People’s Hospital of Lanzhou, Gansu, 730050, People’s Republic of ChinaCorrespondence: Yue-Rong ZhangDepartment of Gastroenterology, University-Town Hospital of Chongqing Medical University, No. 55 University Town Middle Road, Shapingba District, Chongqing, 401331, People’s Republic of ChinaTel/Fax +86 102365714142Email zhang_yue_rong@163.comObjective: To explore the feasibility of treating cirrhosis using a multidisciplinary team approach (MDT) and to pinpoint the key factors influencing its implementation.Methods: The data of 307 patients with decompensated cirrhosis were studied retrospectively. Patients who received more than two treatment measures were assigned to the MDT group (n=228), and patients who received symptomatic medical drug treatment only were assigned to the traditional treatment group (n=79). The follow-up period ranged from 4 to 10 years, and the average follow-up period was 5.7 years. The results of the biochemical tests for hepatitis B virus deoxyribonucleic acid, hepatitis C virus ribonucleic acid, and autoantibodies to liver disease were analyzed.Results: The differences in gender and Child–Pugh grade of liver function between the two groups were not statistically significant. The MDT group had obvious advantages over the traditional treatment group in occupational composition, etiology composition, 5-year survival rate and annual hospitalization times. The leading causes of death in the MDT group, in descending order, were liver cancer, infection, mesenteric thrombosis, and non-hepatic disease, and, in the medical treatment group, they were liver failure, gastrointestinal bleeding, infection, and liver cancer. There was a significant statistical difference between the two groups (p < 0.05). In the multidisciplinary treatment, etiological treatment was the most widely used treatment, accounting for 79.8%, followed by endoscopic treatment (33.3%), peritoneal drainage and ascites reinfusion (25%), splenectomy combined with devascularization (11.4%) and stem cell transplantation and liver transplantation (1.8%).Conclusion: An MDT can improve the efficacy and prognosis of patients with cirrhosis and improve patient compliance. After multi-disciplinary intervention, the mortality spectrum of long-term survival patients with cirrhosis changes, and the mortality rate of liver cancer and non-liver disease increases.Keywords: liver cirrhosis, decompensated period, multidisciplinary team mode, traditional treatment, retrospective study

BACKGROUND Respiratory tract infections in the elderly are difficult to cure and can easily recur, thereby posing a great threat to patient prognosis and quality of life. AIM To investigate the therapeutic effects of different antibiotics in elderly patients with respiratory tract infection. METHODS Seventy-four elderly patients with respiratory tract infection were randomly allocated to a study (n = 37; treated with cefoperazone sodium/sulbactam sodium) or control (n = 37; treated with piperacillin sodium/tazobactam sodium on the basis of routine symptomatic support) group. Both groups were treated for 7 d. Time to symptom relief (leukocyte recovery; body temperature recovery; cough and sputum disappearance; and rale disappearance time), treatment effect, and laboratory indexes [procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and neutrophil percentage (NE)] before and 7 d after treatment and the incidence of adverse reactions were assessed. RESULTS In the study group, the time to WBC normalization (6.79 ± 2.09 d), time to body temperature normalization (4.15 ± 1.08 d), time to disappearance of cough and sputum (6.19 ± 1.56 d), and time to disappearance of rales (6.68 ± 1.43 d) were shorter than those of the control group (8.89 ± 2.32 d, 5.81 ± 1.33 d, 8.77 ± 2.11 d, and 8.69 ± 2.12 d, respectively; P = 0.000). Total effective rate was higher in the study group (94.59% vs 75.68%, P = 0.022). Serum PCT (12.89 ± 3.96 μg/L), CRP (19.62 ± 6.44 mg/L), WBC (20.61 ± 6.38 × 109/L), and NE (86.14 ± 7.21%) levels of the study group before treatment were similar to those of the control group (14.05 ± 4.11 μg/L, 18.79 ± 5.96 mg/L, 21.21 ± 5.59 × 109/L, and 84.39 ± 6.95%, respectively) with no significant differences (P = 0.220, 0.567, 0.668, and 0.291, respectively). After 7 d of treatment, serum PCT, CRP, WBC, and NE levels in the two groups were lower than those before treatment. Serum PCT (2.01 ± 0.56 μg/L), CRP (3.11 ± 1.02 mg/L), WBC (5.10 ± 1.83 × 109/L), and NE (56.35 ± 7.17%) levels were lower in the study group than in the control group (3.29 ± 0.64 μg/L, 5.67 ± 1.23 mg/L, 8.13 ± 3.01 × 109/L, and 64.22 ± 8.08%, respectively; P = 0.000). There was no significant difference in the incidence of adverse reactions between the groups (7.50% vs 12.50%, P = 0.708). CONCLUSION Piperacillin sodium/tazobactam sodium is superior to cefoperazone sodium/ sulbactam sodium in the treatment of elderly patients with respiratory tract infection with a similar safety profile.

Since the discovery of the first ferroelectric Rochelle salt, most ferroelectrics have been investigated showing thermally triggered symmetry-breaking phase transition. Although photochromism arising from geometrical isomerization has been reported earlier in 1867, such photoswitchable ferroelectric crystals have scarcely been developed to date. Herein, we report that salicylideneaniline is a photochromic ferroelectric crystal. Upon photoirradiation, the dielectric constant shows obvious switching between high and low dielectric states, and more importantly, the ferroelectric polarization demonstrates quickly and reversibly switching. This work opens the gate of developing photoswitchable ferroelectrics, which holds great potential for applications in optically controlled smart devices.

Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers, and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and erythrocyte sedimentation rate (ESR). In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of N-terminal pro-brain natriuretic peptide, troponin and aspartate aminotransferase were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and alanine aminotransferase and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.

Despite the importance of tourism for poverty relief, limited studies have investigated the relationship between tourism development and multidimensional poverty reduction. The present work investigated the tourism–poverty nexus from the perspective of multidimensional poverty (including poverty related to economic, education, health care and social welfare dimensions) on the basis of a decoupling analysis in 74 national poverty-stricken counties of Southwest China over the period of 2007–2016. The results reveal the following regularities. First, a positive synchronisation relationship exists between tourism development and multidimensional poverty reduction. Second, the relationship between tourism development and multidimensional poverty reduction is unstable, and the poverty reduction effects of tourism have been shrinking over the past decade. Third, with the development of tourism, the poverty reduction in economic, health care and the social welfare dimensions have made achievements in general, whereas the poverty reduction of education demonstrated an opposite trend. The outcomes and implications of this study provide essential insights to the tourism–poverty nexus debate and offer directions for policies to alleviate poverty through tourism development.

Calcyphosine (CAPS) was initially identified from the canine thyroid. It also exists in many types of tumor, but its expression and function in glioma remain unknown. Here we explored the clinical significance and the functional mechanisms of CAPS in glioma. We found that CAPS was highly expressed in glioma and high expression of CAPS was correlated with poor survival, in glioma patients and public databases. Cox regression analysis showed that CAPS was an independent prognostic factor for glioma patients. Knockdown of CAPS suppressed the proliferation, whereas overexpression of CAPS promoted the proliferation of glioma both in vitro and in vivo. CAPS regulated the G2/M phase transition of the cell cycle, but had no obvious effect on apoptosis. CAPS affected PLK1 phosphorylation through interaction with MYPT1. CAPS knockdown decreased p-MYPT1 at S507 and p-PLK1 at S210. Expression of MYPT1 S507 phosphomimic rescued PLK1 phosphorylation and the phenotype caused by CAPS knockdown. The PLK1 inhibitor volasertib enhanced the therapeutic effect of temozolomide in glioma. Our data suggest that CAPS promotes the proliferation of glioma by regulating the cell cycle and the PLK1 inhibitor volasertib might be a chemosensitizer of glioma. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Silo-cave is a unique human habitation form on the Loess Plateau in northern China, which consists of an excavated 6–7 m deep pit as the courtyard and cave dwellings in the surrounding four walls. This architecture has had a history of more than 7000 years, and yet such “living fossils for the history of dwellings” are now facing great crises and challenges during rapid social and economic development. In this paper, remote sensing and GIS techniques are used to comprehensively and systematically investigate the spatial distributions and morphological characteristics of silo-caves at both the macro and micro scales. The research shows that silo-cave villages are mainly distributed in economically underdeveloped areas, such as West Henan (Yuxi), South Shanxi (Jinnan), Central Shaanxi (Guanzhong), and East Gansu (Longdong). The morphological evolution patterns of typical silo-cave villages are identified, including: (1) retaining the periphery and rebuilding the inner parts of the villages, (2) retaining the inner parts and expanding the periphery of the villages, and (3) rebuilding the inner parts and expanding the periphery of the villages. These patterns are demonstrated to be influenced by many factors, including landforms, traffic conditions, economic development, population growth, and administrative division adjustment. Sustainable development of these traditional silo-cave villages relies on administrative policy and planning, people’s awareness of cultural heritage protection, culture inheritance, industrial transformation, and public services.

Background The role of postoperative radiotherapy (PORT) in cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected non-small cell lung cancer (NSCLC) remains uncertain. The purpose of this population-based analysis was to explore the effect of PORT on cardiovascular-pulmonary disease mortality in these patients. Methods Patients aged ≥ 18 years with stage IIIA-N2 resected NSCLC were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and were grouped according to the use of PORT. Propensity score matching (PSM) was used to account for differences in baseline characteristics between the Non-PORT and PORT groups. The cumulative risk for cardiovascular-pulmonary disease death was estimated using the cumulative incidence curve. Competing risk regression was used to run univariate and multivariate analyses to evaluate risk factors. Results A total of 3981 patients were included in the study population. Among them, 1446 patients received PORT, and 2535 did not. A total of 1380 patients remained in each group after PSM, and the baseline characteristics were not significantly different between the two groups. The cumulative incidence of cardiovascular-pulmonary mortality was 10.93% in the Non-PORT group compared with 9.85% in the PORT group. There was no significant difference in the cumulative risk between the two groups (HR 1.07, 95% CI 0.77–1.48, p = 0.703). Multivariate analysis indicated that PORT had no significant impact on increased risk, with an HR of 1.18 (p = 0.377). Conclusions No significant differences between the PORT and Non-PORT groups were found in cardiovascular-pulmonary-specific modalities in this study. Further studies are required to validate these results. This study highlights the importance of long-term surveillance for NSCLC patients.

Recently a novel density-based clustering algorithm , namely, border-peeling (BP) clustering algorithm, is proposed to group data by iteratively identifying border points and peeling off them until separable areas of data remain. The BP clustering is able to correctly recognize the true structure of clusters and automatically detect the outliers on several test cases. However, there are some drawbacks in BP, and these may hinder its widespread application. The BP clustering might yield bad results on datasets with non-uniformly-distributed clusters. Especially, the BP clustering tends to over-partition the data with complex shape. To overcome these defects, a robust border-peeling clustering algorithm (named as ROBP) is proposed in this paper. Our method improves the BP clustering algorithm from two aspects: density influence (i.e. density estimation) and linkage criterion (i.e. association strategy). In density estimation, we use Cauchy kernel with longer tails instead of Gaussian kernel in the local scaling function, and further propose a kernel density estimator , i.e., the density estimator based on Cauchy kernel. It can calculate quickly and accurately the density influence value of each point. In association strategy, we design a linkage criterion based on the shared neighborhood information. The linkage criterion can create some links between peeled border points and their neighboring peeled border points, in order to avoid over-segmentation of the clusters. We integrate the proposed linkage criterion and the uni-directional association strategy, and further propose a bi-directional association strategy. In experiments, we compare ROBP with 7 representative density-based clustering (or hierarchical clustering) algorithms, including BP, DBSCAN, HDBSCAN, density peak (DP) clustering, DPC-KNN, DPC-DBFN and McDPC, on 8 synthetic datasets and 11 real-world datasets. Results show that the proposed algorithm outperforms 7 competitors in most cases. Moreover, we compare the robustness of ROBP and BP, and evaluate their running time. Experimental results indicate that ROBP is much more robust and reliable, as well as it is competitive to BP in computational efficiency.

BACKGROUND The incidence of primary cardiac lymphoma (PCL) is increasing, but the optimal management approach remains unclear. We assessed the clinical characteristics of a single-centre cohort with the goal of determining the optimal management approach. The treatment outcomes and prognostic factors are reported. MATERIAL AND METHODS All PCL patients were diagnosed via biopsy guided by whole-body imaging (positron emission tomography/computed tomography [PET/CT] and/or contrast-enhanced CT]. Curative therapy involved either surgery or prephase steroids followed by definitive immunochemotherapy, depending on the histological type. The primary outcomes were overall survival (OS) and progression-free survival (PFS); the secondary outcome was the treatment response. RESULTS Twenty-two PCL patients (14 males, 8 females; age: 59.5 ± 14.7 years [mean ± S.D.]) were histologically confirmed to have diffuse large B-cell lymphoma (DLBCL; n = 17 [77.3%]), fibrin-associated DLBCL (FA-DLBCL) (n = 4 [18.2%]) and Burkitt lymphoma (n = 1 [4.5%]). Seven patients underwent cardiotomy (three for biopsy, four with curative intent). The median and longest follow-up periods were 16.3 and 180.0 months, respectively. The 16 patients who received curative therapy (complete response [CR], n = 15 [93.8%]; partial response [PR], n = 1 [6.2%]) showed better survival than those who did not (5-year OS: 83.0 ± 11.3% vs. 0%; hazard ratio [HR]: 0.025[95% confidence interval, CI: 0.003-0.187], p

Background Discovery of early-stage biomarkers is a long-sought goal of Alzheimer’s disease (AD) diagnosis. Age is the greatest risk factor for most AD and accumulating evidence suggests that age-dependent elevation of asparaginyl endopeptidase (AEP) in the brain may represent a new biological marker for predicting AD. However, this speculation remains to be explored with an appropriate assay method because mammalian AEP exists in many organs and the level of AEP in body fluid isn’t proportional to its concentration in brain parenchyma. To this end, we here modified gold nanoparticle (AuNPs) into an AEP-responsive imaging probe and choose transgenic APPswe/PS1dE9 (APP/PS1) mice as an animal model of AD. Our aim is to determine whether imaging of brain AEP can be used to predict AD pathology. Results This AEP-responsive imaging probe AuNPs-Cy5.5-A&C consisted of two particles, AuNPs-Cy5.5-AK and AuNPs-Cy5.5-CABT, which were respectively modified with Ala–Ala–Asn–Cys–Lys (AK) and 2-cyano-6-aminobenzothiazole (CABT). We showed that AuNPs-Cy5.5-A&C could be selectively activated by AEP to aggregate and emit strong fluorescence. Moreover, AuNPs-Cy5.5-A&C displayed a general applicability in various cell lines and its florescence intensity correlated well with AEP activity in these cells. In the brain of APP/PS1 transgenic mice , AEP activity was increased at an early disease stage of AD that precedes formation of senile plaques and cognitive impairment. Pharmacological inhibition of AEP with δ-secretase inhibitor 11 (10 mg kg−1, p.o.) reduced production of β-amyloid (Aβ) and ameliorated memory loss. Therefore, elevation of AEP is an early sign of AD onset. Finally, we showed that live animal imaging with this AEP-responsive probe could monitor the up-regulated AEP in the brain of APP/PS1 mice. Conclusions The current work provided a proof of concept that assessment of brain AEP activity by in vivo imaging assay is a potential biomarker for early diagnosis of AD. Graphical abstract

BACKGROUND There is a lack of data on drug-related problems (DRPs) occurring in nephrology department in China. The objective of this study was to identify and categorize the types and causes of DRPs and to assess their severity. DRPs were examined by clinical pharmacists and the results of their interventions were rated. METHODS Clinical pharmacists reviewed all medication orders for patients and documented clinical pharmacy services within a nine-month study period. The Pharmaceutical Care Network Europe (PCNE) classification (Version 9.00) was used to identify DRPs. Our Primary outcomes measured the number, causes, types, potential hazards of DRPs and the types and success rate of intervention. RESULTS Admission medication reconciliation data of 113 patients with chronic kidney disease (CKD) were collected and all of the medications were reviewed retrospectively. Exclude 26 patients who did not occurred DRPs, 87 patients (77%) identified 101 DRPs. The average DRP number per patient was 1.16. The most common type of problem was "treatment effectiveness P1" (84.16%; 85/101). The most common causes were "drug selection C1" (36.00%; 45/125), "dose selection C3" (29.60%; 37/125), and "patient related C7" (26.40%; 33/125). Clinical pharmacists totally proposed 249 interventions, of which 190 (76.31%) were fully accepted and implemented. CONCLUSIONS DRPs are common among CKD patients in the nephrology department. Hence the necessity for pharmaceutical care to be improved to ensure the ongoing safety of patients.

Ropeginterferon alfa-2b is a novel mono-pegylated human recombinant interferon (IFN) with the addition of N-terminal proline covalently attached by a 40-kDa polyethylene (peg) moiety. The present study aimed to evaluate the pharmacokinetics (PK), pharmacodynamics (PD) profiles and safety of the product in healthy Chinese. Forty subjects were enrolled and treated with a single subcutaneous injection of either 180 mcg peg-IFN alfa-2a or 90, 180, and 270 mcg ropeginterferon alfa-2b. The mean Tmax of ropeginterferon alfa-2b was 92–141 h and the elimination half-life was 78–129 h. Dose-related, non-proportional increase in ropeginterferon alfa-2b exposure was observed, which was higher than for peg-IFN alfa-2a. The PD parameters were similar between each dose level of ropeginterferon alfa-2b. The mean Tmax of β2-microglobulin ranged from 118 to 132 h after a single dose of ropeginterferon alfa-2b. The average Emax was 3 mcg/ml in all dose levels and the mean AUEC0–t ranged from 1608 to 1775 h/mcg/ml. The TEAEs were comparable among each treatment group and no death nor drug-related SAE was reported. Ropeginterferon alfa-2b is safe and well tolerated after a single subcutaneous injection up to 270 mcg in healthy Chinese. www.chinadrugtrials.org.cn , CTR20190451.

To study the effect and mechanism of Schistosoma japonicum soluble egg antigen (SEA) on protecting against type 1 diabetes, 4-week-old female BALB/c and NOD mice were divided randomly into four groups: BALB/c control, BALB/c treated with SEA, NOD control, and NOD treated with SEA. Treated mice were injected intraperitoneally with 50 μg of SEA twice a week for 6 weeks, and control mice received the same volume of phosphate-buffered saline. Blood glucose in all mice was determined weekly from 8 weeks of age. Flow cytometry was used to detect the percentages of regulatory T cells of splenocytes in each group. Enzyme-linked immunosorbent assays were used to detect the levels of interferon-γ, interleukin (IL)-2, IL-4, and IL-5 in splenic cell culture supernatants. Compared with those of the NOD group, the blood glucose level and percentage incidence of diabetes in NOD mice treated with SEA decreased significantly. This indicated that SEA treatment prevented spontaneous type 1 diabetes. After SEA administration, the frequency of splenic regulatory T cells increased significantly, and the secretion of IL-4 and IL-5 by splenic cells increased. These results demonstrated that SEA can prevent type 1 diabetes by enhancing regulatory T cells and the T helper 2 cell immune response in NOD mice.

Lupus nephritis is one of the most common and severe systemic lupus erythematosus complications. However, the pathogenesis of lupus nephritis is still poorly understood. Increasing evidence has shown that microRNAs (miRNAs) are extensively involved in the pathophysiology of autoimmune diseases. NZBWF1 is the classical mouse model of lupus nephritis. The present study aimed to investigate the expression profiling of mRNA and miRNAs of NZBWF1 mice with lupus nephritis using microarray, and explored the potential molecular mechanism of miRNA. miRNA and mRNA microarrays were performed to identify miRNA and mRNA expression changes between pre-diseased (8-week-old) NZBWF1 mice and diseased NZBWF1 mice with lupus nephritis (28-week-old). Quantitative polymerase chain reaction (qPCR) validated these results. The target of miRNA was confirmed through a dual-luciferase reporter and stimulated mesangial cells experiment. The combined miRNA and mRNA analysis identified 43 differentially expressed miRNAs and 1796 differentially expressed mRNAs between pre-disease (8-week-old) (n = 4) and diseased (28-week-old) NZBWF1 mice. We found that miR-1968-5p was significantly decreased, and csf1 mRNA was significantly increased in lupus nephritis mouse and verified by RT-PCR. csf1 has been demonstrated to play important roles in SLE. Bioinformatics analysis predicted that the csf1 was a potential target gene of miR-1968-5p. A dual-luciferase reporter assay confirmed the target binding. In cell experiments, overexpression or knockdown of miR resulted in a decrease or increase of csf1 expression, respectively. These results suggest that miR-1968-5p may be involved in the pathogenesis of lupus nephritis of NZBWF1 mice by targeting csf1.

Background Leptomeningeal metastasis (LM) is a severe complication of advanced non-small cell lung cancer (NSCLC). This retrospective study aimed to investigate the potential use of osimertinib for preventing LM in patients with advanced epidermal growth factor receptor (EGFR)-mutated NSCLC. Methods Patients with advanced NSCLC harboring EGFR mutations who underwent tyrosine kinase inhibitors (TKIs) therapy for at least 8 weeks between September 2016 and September 2019 were eligible for this study. All included patients were divided into two groups based on whether they received osimertinib, the osimertinib group (patients treated with osimertinib) and the control group (patients not treated with osimertinib). Propensity score matching (PSM, ratio of 1:1) was used to account for differences in baseline characteristics. The cumulative incidence of LM and the overall survival (OS) were evaluated. Results A total of 304 patients were included in the study population. Among them, 116 patients received osimertinib, and 188 did not. A total of 112 patients remained in each group after PSM, and the baseline characteristics were not significantly different between the two cohorts. LM developed in 11 patients (9.82%) in the osimertinib group and 24 patients (21.42%) in the control group (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.19–0.79, p = 0.009). Multivariate analysis indicated that osimertinib was an independent, statistically significant predictor for determining the risk for LM, with an HR of 0.33 (p = 0.042). At present, the OS rate data are too immature for statistical analysis. Conclusion Real-world data demonstrate that osimertinib can significantly reduce the incidence of LM in patients with advanced NSCLC harboring common EGFR mutations. Given this result, osimertinib should be encouraged in clinical practice for specific patient populations.

Urotensin II (UII) is involved in the formation of atherosclerosis, but its role in the stability of atherosclerotic plaques is unknown. The purpose of this study was to observe the dynamic changes in plasma UII and analyze its relationship to the stability of atherosclerotic plaques. One hundred thirty-five consecutive patients with acute coronary syndrome (ACS) were enrolled. The plasma UII levels were measured immediately after admission and during three-month follow-up. A vulnerable plaque model was established using local transfection of a recombinant P53 adenovirus into plaques in rabbits fed with a high-cholesterol diet and subjected to balloon arterial injury. The levels of plasma UII were measured weekly. The changes in plasma UII during the formation of atherosclerotic plaques and before and after plaque transfection were observed. The morphology of the plaques and the expression, distribution, and quantitative expression of UII in the plaques also were observed. Our results showed that the levels of plasma UII in patients with ACS at admission were lower than levels observed at the three-month follow-up. UII dynamic changes and its correlation with plaque stabilities were further verified in rabbits with atherosclerotic vulnerable plaques. The UII levels in rabbits were significantly decreased immediately after the P53 gene transfection, which led to plaque instability and rupture. These results suggested that UII expression was down-regulated in ACS, which may be related to its ability to modulate mechanisms involved in plaque stability and instability.

LED healthy light source by using a blue LED chip to excite phosphor was prepared successfully. Four kinds of LED commercial phosphors (cyan phosphor with a peak wavelength of 498 nm, green phosphor with 520 nm, yellow-green phosphor with 546 nm, and red phosphor with 628 nm) were selected that could be excited by blue light. A series of experimental studies were carried out on the different amounts of glue, different powder-glue ratio, different combinations of phosphors, and the influence of different driving currents. Trough the optimization of the experimental scheme, we obtained a LED healthy light source spectrum with luminous efficiency higher than 124 lm/w, color rendering index higher than 80, color temperature around 4000 k. These spectra are in good agreement with the full spectrum of sunlight, and the spectral continuity and uniformity are better, which accord with the requirements of bright (dark) vision, and the proportion of the blue spectrum is less than 2.4%, which meets the high quality and healthy lighting requirements of safety and comfort.

Background: Early lactate-guided resuscitation was endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease the mortality of patients admitted to the ICU department with septic shock. However, its effectiveness in elderly Asian patients is uncertain. Method: We conducted a single-center trial to test the effectiveness of the early lactate-guided resuscitation of older Asian patients at the Second Hospital of Hebei Medical University. Eligible septic shock patients who consented to participation in the study were randomly assigned to receive early lactate-guided treatment or regular treatment as controls. Result: A total of 82 patients met the hyperlactatemia criteria and participated in the trial. Forty-two patients received early lactate-guided treatment (lactate group) and 40 received regular treatment (control group). The lactate group received more fluids at initial 6 hours (3.3 ± 1.4 vs 2.4 ± 1.7 L, P = 0.01), but similar proportions of patients in both groups required the use of vasopressors and vasodilators. Patients in the lactate group showed significantly reduced ICU needs compared to the control group, which were weaned from mechanical ventilation more quickly (median 7, IQR 4 to 14 vs median 9, IQR 4.3 to 17.8, P = 0.02) and transferred out of the ICU earlier (median 4.5, IQR 2.8 to 7.3 vs median 6, IQR 3.2 to 8, P = 0.01). However, the hospital mortality (35.7% vs 42.5%, P = 0.35) and ICU mortality (31.0% vs 37.5%, P = 0.38) for both groups were not reduced. Conclusion: For critically ill patients (elderly Asian patients) admitted to the ICU department with hyperlactatemia, early lactate-guided treatment reduced ICU needs but did not reduce mortality.

Thyroid hormone (TH) perturbation is a common medical problem. Because of substantial public health impact, prior researchers have studied hyper- and hypothyroidism in animal models. Although most prior research focused on in utero and/or developmental effects, changes in circulating TH levels are commonly seen in elderly individuals: approximately 20% of persons older than 80 years have clinically impactful hypothyroidism and up to 5% have clinical hyperthyroidism, with women being more often affected than men. TH disease model methodology in mice have varied but usually focus on a single sex, and the impact(s) of TH perturbation on the adult brain are not well understood. We administered thyroxine to middle-aged (13 to 14 months) male and female mice to model hyperthyroidism and TH-lowering drugs propylthiouracil (PTU) and methimazole, to induce hypothyroidism. These pharmacological agents are used commonly in adult humans. Circulating TH-level changes were observed when thyroxine was dosed at 20 µg/mL in drinking water for two weeks. By contrast, PTU and methimazole did not elicit a consistent reproducible effect until two months of treatment. No substantial changes in TH levels were detected in brain tissues of treated animals; however, pronounced changes in gene expression, specifically for TH-processing transcripts, were observed following the treatment with thyroxine. Our study indicated a robust compensatory mechanism by which the brain tissue/cells minimize the TH fluctuation in CNS by altering gene expression. Neurobehavioral changes were related to the TH perturbation and suggested potential associations between cognitive status and hyper- and hypothyroidism.

A randomized controlled study was conducted to investigate the effects of case management on risky sexual behaviors and syphilis in HIV-positive men who have sex with men. Supplemental digital content is available in the text., Background The prevalence of syphilis is very high in human immunodeficiency virus (HIV)–positive men who have sex with men (MSM), and effective interventions are needed to educate HIV-positive individuals about behavioral and biological risk factors. Therefore, we developed a standard case management process and conducted a randomized controlled study to investigate the impact on risky sexual behaviors and syphilis in HIV-positive MSM. Methods Men who have sex with men (n = 220) were enrolled and randomized to the case management intervention group and the control group between May 2016 and January 2017. The control group received routine HIV-related care. In addition to routine HIV-related care, those in the intervention group regularly received extended services from a well-trained case manager. Epidemiological information was collected during the baseline face-to-face interviews by a trained investigator. Serological tests for syphilis and assessments of risky sexual behaviors were performed at baseline and 6 and 12 months after the initiation of treatment. Results The syphilis incidence rates in the intervention and control groups were 11.3 per 100 person-years and 20.6 per 100 person-years, respectively. The multivariable-adjusted hazard ratio (95% confidence inter) for syphilis in case management group was 0.34 (0.14–0.87). The percentages of participants who resumed risky sexual behaviors in both groups were significantly reduced (P < 0.05) but did not significantly differ between the 2 groups. Conclusions A case management intervention reduced the incidence of syphilis in HIV-positive MSM. We should further increase the content of case management on the basis of providing routine HIV-related care to those people.

Summary Background Coronavirus disease 2019 (COVID-19) infection has caused huge impacts on all of people’s lives and health systems. In response to the COVID-19 pandemic, China was the first country to impose lockdown. We aimed to study the influence of COVID-19 on the outpatient visits of rheumatic patients in a non-outbreak area of China. Methods We selected three provincial or ministerial hospitals in Jinan, and collected the outpatient appointments data in rheumatology and immunology departments during the Shandong Province first-level public health emergency response period from 25 January 2020 to 8 March 2020. Results In the early stage, the number of outpatient appointments in the rheumatology and immunology departments of the three provincial or ministerial hospitals were significantly reduced, and gradually restored in the late stage. It showed that in the face of major infectious diseases, strict quarantine measures with the cooperation of the public not only controls the epidemic in a short time, but also lifts the quarantine measures and opens general outpatient clinics in hospitals as soon as possible, thus minimizing the impact on other patients. Interpretation The impact on the western hospital was greater than that on the Chinese medicine hospital, and the impact on the back-up designated hospitals for COVID-19 was the greatest. Online appointment can reduce the risk of infection in outpatients, but not completely solve the follow-up problem of rheumatic patients. Telemedicine provides a new solution for both management of rheumatic patients and control of COVID-19.

Tumour metastasis is a major reason accounting for the poor prognosis of colorectal cancer (CRC), and the discovery of targets in the primary tumours that can predict the risk of CRC metastasis is now urgently needed. In this study, we identified autophagy-related protein 9B (ATG9B) as a key potential target gene for CRC metastasis. High expression of ATG9B in tumour significantly increased the risk of metastasis and poor prognosis of CRC. Mechanistically, we further find that ATG9B promoted CRC invasion mainly through autophagy-independent manner. MYH9 is the pivotal interacting protein for ATG9B functioning, which directly binds to cytoplasmic peptide segments aa368–411 of ATG9B by its head domain. Furthermore, the combination of ATG9B and MYH9 enhance the stability of each other by decreasing their binding to E3 ubiquitin ligase STUB1, therefore preventing them from ubiquitin-mediated degradation, which further amplified the effect of ATG9B and MYH9 in CRC cells. During CRC cell invasion, ATG9B is transported to the cell edge with the assistance of MYH9 and accelerates focal adhesion (FA) assembly through mediating the interaction of endocytosed integrin β1 and Talin-1, which facilitated to integrin β1 activation. Clinically, upregulated expression of ATG9B in human CRC tissue is always accompanied with highly elevated expression of MYH9 and associated with advanced CRC stage and poor prognosis. Taken together, this study highlighted the important role of ATG9B in CRC metastasis by promoting focal adhesion assembly, and ATG9B together with MYH9 can provide a pair of potential therapeutic targets for preventing CRC progression.

Epidermal growth factor receptor (EGFR) fusions are rare genomic events in non-small-cell lung cancer (NSCLC). With advances in detection technology, some uncommon genomic mutation events, including EGFR fusions, have been detected. There are no standard treatment options for NSCLC patients harboring EGFR fusion. Herein, we report a case of KIF5B-EGFR fusion in NSCLC responding to tyrosine kinase inhibitors (TKIs). A 50-year-old male underwent left upper lobectomy followed by adjuvant chemotherapy for pathological stage IA3 lung adenocarcinoma. The tumor tissue was subjected to next-generation sequencing (NGS) and showed a KIF5B-EGFR fusion. When cancer recurrence occurred thirteen months later, the patient received afatinib (40 mg qd) as second-line treatment, and a partial response was observed, which resulted in an 11-month progression-free survival (PFS). This case provides valuable information on the response to afatinib in an NSCLC patient with a novel KIF5B-EGFR fusion. The NGS assay provides a powerful tool for identifying rare or atypical EGFR gene mutations in patients with NSCLC, which should be encouraged in clinical practice.

Aim Emperipolesis, the cell-in-cell structure, is one of the pathological diagnostic standard of AIH. We have already identified that CD8+ T cells participated in the emperipolesis process in liver tissue of AIH patients. In this study, we aimed to clarify the characteristics and molecular mechanisms of emperipolesis in the patients with AIH in vitro and in mice with α-GalCer-induced acute hepatitis. Methods Peripheral blood mononuclear cell (PBMC) of patients with variant chronic liver diseases and healthy controls were co-cultured with hepatic cell line to induce emperipolesis in vitro. Confocal staining was performed to illustrate the cellular types and potential mechanisms of emperipolesis in AIH. In addition, the mouse model of α-GalCer-induced acute hepatitis which mimics human AIH in several features, was used to confirm the role of CD44/p-ERM/F-actin in the emperipolesis process in vivo. Results In co-culture system with PBMC and hepatic cell line, emperipolesis was observed most common in the patients with AIH. CD8+ T cells were the major cells participated in the emperipolesis process, and penetrated into hepatocytes actively via CD44/p-ERM/F-actin pathway. As a result, most CD8+ T cells engulfed in hepatocytes undergo self-apoptosis. In α-GalCer-induced acute hepatitis model, emperipolesis was observed around the inflammatory foci, and was inhibited by Ezrin phosphorylation inhibitor NSC668394. Similarly, activated murine CD8+ T cells penetrated into primary hepatocytes via CD44/p-ERM/F-actin pathway in vitro. Conclusions CD8+ T cells penetrated into hepatocytes actively via CD44/p-ERM/F-actin signaling pathway and undergo apoptosis, may be a compensative mechanism to attenuate overwhelming immune attack in AIH. This article is protected by copyright. All rights reserved.

BackgroundPhysical activity (PA) is important to general health and knee osteoarthritis (OA). Excessive workplace PA is an established risk factor for knee OA however, appropriate methods of measurement are unclear. There is a need to examine and assess the utility of new methods of measuring workplace PA and estimating knee load prior to application to large-scale, knee OA cohorts. Our aims, therefore, were to monitor workplace PA and estimate lower-limb loading across different occupations in health participants.MethodsTwenty-four healthy adults, currently working full-time in a single occupation (≥ 35 h/week) and free of musculoskeletal disease, comorbidity and had no history of lower-limb injury/surgery (past 12-months) were recruited across New South Wales (Australia). A convenience sample was recruited with occupations assigned to levels of workload; sedentary, light manual and heavy manual. Metrics of workplace PA including tasks performed (i.e., sitting), step-count and lower-limb loading were monitored over 10 working days using a daily survey, smartwatch, and a smartphone.ResultsParticipants of light manual occupations had the greatest between-person variations in mean lower-limb load (from 2 to 59 kg*m/s3). Lower-limb load for most participants of the light manual group was similar to a single participant in heavy manual work (30 kg*m/s3) and was at least three times greater than the sedentary group (2 kg*m/s3). The trends of workplace PA over working hours were largely consistent, per individual, but rare events of extreme loads were observed across all participants (up to 760 kg*m/s3).ConclusionsThere are large interpersonal variations in metrics of workplace PA, particularly among light and heavy manual occupations. Our estimates of lower-limb loading were largely consistent with pre-conceived levels of physical demand. We present a new approach to monitoring PA and estimating lower-limb loading, which could be applied to future occupational studies of knee OA.

Hong Zhang,1,2 Yao Yin,1 Huan Wang,1 Ying Han,3 Xia Wang,1 Yi Liu,4 Hong Chen1 1West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China; 2Department of Nursing, Medical School, Hubei Minzu University, Enshi, Hubei Province, People’s Republic of China; 3Clinical Skills Training Center of West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China; 4Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of ChinaCorrespondence: Hong ChenWest China School of Nursing, Sichuan University/West China Hospital, Sichuan University, No. 37, Guoxuexiang, Wuhou District, Chengdu, Sichuan Province, People’s Republic of ChinaTel +861 898 060 1733Email 1366109878@qq.comYi LiuDepartment of Rheumatology and Immunology, West China Hospital, Sichuan University, No. 37, Guoxuexiang, Wuhou District, Chengdu, Sichuan Province, People’s Republic of ChinaTel +861 898 060 2061Email yi2006liu@163.comBackground: Self-management directly affects the health outcomes and quality of life among people living with HIV (PLWH). A better understanding of self-management level will provide evidence for researchers to develop effective interventions.Purpose: This study aims to identify the latent classes among PLWH in their levels of self-management behavior, and to explore the sociodemographic and disease-related predictors within these classes.Materials and Methods: A total of 868 PLWH were recruited from August 2017 to January 2019 in Sichuan Province, China. A latent class profile analysis was used to identify participants’ self-management behavior, and multinomial logistic regression was used to explore the sociodemographic and disease-related predictors of the different latent classes.Results: Model fit indices supported a three-class model. The mean self-management scores in the three classes were 23.56 (SD=6.02), 37.91 (SD=3.80), and 47.95 (SD=4.18), respectively. The latent classes were Class 1 (a poor level of self-management behavior, 12.1%, n=104), Class 2 (a moderate level of self-management behavior, 56.1%, n=491) and Class 3 (a good level of self-management behavior, 31.7%, n=273). Antiretroviral trerapy (ART) status, infection route, and educational level were the main predictors of self-management behavior.Conclusion: The findings indicated that the level of self-management behaviors among PLWH in China is inadequate. Those with a lower educational level, who were infected through blood/injecting drugs, and who were not receiving ART, showed a significantly lower level of self-management behavior. These results could help healthcare professionals to quickly recognize PLWH who are at a high risk of low-level self-management, using individual characteristics and could provide a scientific basis for the development of effective and targeted programs to improve self-management level in PLWH.Keywords: China, cross-sectional study, HIV, AIDS, self-management

Organic-inorganic hybrid lead halide perovskites have attracted great interest for their use in promising optoelectronic applications. However, reports of photoluminescent perovskite molecular ferroelastic semiconductors with sequential high-Tc phase transitions have been scarce. In this work, a one-dimensional lead bromide hybrid perovskite [N,N-dimethylethanolammonium]PbBr3 has been synthesized, undergoing high-Tc sequential phase transitions at around 351 and 444 K, higher than those of most previously discovered hybrid perovskite phase transition materials. The specific intermolecular hydrogen bond between cationic molecules provides the greatest contribution to its high Tc by increasing the barrier of molecular motion under the temperature stimuli. The prominent ferroelastic domain evolution is visually observed under orthogonally polarized light. In addition, [N,N-dimethylethanolammonium]PbBr3 exhibits semiconducting and orange light emission characteristics. This finding opens up an avenue for designing high-performance ferroelastic materials and provides great motivation for discovering new multifunctional materials for the next generation of smart devices.

Background. LncRNA MSC-AS1 has been reported to be a tumor promoter in hepatocellular carcinoma. However, the function of MSC-AS1 in colorectal cancer (CRC) has not been elucidated. It is designed to study the expression level of MSC-AS1 and investigate its biological effect on the progression of CRC. Methods. The expression patterns of MSC-AS1, miR-325, and TRIM14 were explored by RT-qPCR in CRC tissues and cells. The protein expression of TRIM14 was tested by Western blot assay. The association between MSC-AS1 expression and clinicopathological data was analyzed by chi-squared test. CCK-8 assay, colony formation, and Transwell assay were used to investigate the effect of MSC-AS1 on cell growth, invasion, and migration in CRC cells. The correlations among MSC-AS1, miR-325, and TRIM14 were analyzed by Pearson’s correlation coefficient analysis. Results. We found that MSC-AS1 and TRIM14 were upregulated in CRC tissues, while miR-325 was downregulated in CRC tissues. Functional experiments demonstrated that MSC-AS1 knockdown inhibited cell proliferation, migration, and invasion abilities in CRC cells. Additionally, miR-325 was proved to be a target miRNA of MSC-AS1, and TRIM14 might be a downstream gene of miR-325. Besides that, MSC-AS1 counteracted the inhibitory effect of miR-325 on the cell progression and TRIM14 expression. Conclusion. Our results indicated that MSC-AS1 facilitated CRC progression by sponging miR-325 to upregulate TRIM14 expression. We suggested that MSC-AS1 might be a potential lncRNA-target for CRC therapy.

In RFID systems, tag grouping is to inform each tag in the interrogator's RF field which group it belongs to by assigning them a group ID. With this information, the reader can write the same data into a group of tags in one transmission by taking their shared group ID as the destination address, which plays a vital role in improving inventory efficiency. Existing work proposes some efficient protocols but suffers from two defects: slot waste and data redundancy. To address these problems, we in this paper propose a two-phase grouping scheme that improves the grouping efficiency via slot reuse as well as data compression. For slot waste, we try to reconcile collision slots and turn some of them into useful again by re-assigning a new slot to collision tags, which increases the number of useful slots and reduces slot waste. For data redundancy, we encode group IDs with lossless coding algorithms and reduce the data redundancy caused by repetitive transmission of group IDs. Two coding methods, Huffman coding and arithmetic coding , are adopted to shorten the length of the bit vector comprised by group IDs. Theoretical analyses and extensive simulations show that our best protocol improves the time efficiency by 51.9 percent compared with the state-of-the-art.

Objective To establish and verify models predictive of thin periodontal phenotype and alveolar fenestration/dehiscence in the anterior teeth of patients with skeletal Class III malocclusion. Material and methods Retrospective data of 669 anterior teeth (305 in maxillae and 364 in mandibles) from 80 patients with skeletal Class III malocclusion before augmented corticotomy were collected. Distribution of thin periodontal phenotype and alveolar fenestration and dehiscence were evaluated and their associations with potential influencing factors were explored using univariate and multivariate analyses. The predictive models were visualized as nomograms, the accuracy of which was tested by receiver operating curve analyses. Results Thin phenotype was associated with Mazza bleeding index, sex, tooth type, probing depth and width of keratinized gingiva (WKG). Labial dehiscence was associated with age, jaw, labial bone thickness, mandibular plane angle, sagittal root position (SRP), sex, tooth type, and WKG. Labial fenestration was associated with sex, tooth type, SRP, and periodontal phenotype. The areas under the curves of nomogram prediction models for periodontal phenotype, alveolar dehiscence, and alveolar fenestration were 0.84, 0.81, and 0.73, respectively. Conclusions Female sex, lateral incisor, and limited WKG may be risk factors for thin periodontal phenotype. Age, canine, male sex, mandible, thin labial bone thickness, and root positioned against the labial plate may be risk factors for labial dehiscence; and female sex, thick phenotype, root positioned against the labial plate, lateral incisor, and canine may be risk factors for labial fenestration. The predictive performance of the models was acceptable.

Facial expression recognition (FER) on real world databases is an active and challenging research topic. Existing CNN-based facial expression classifiers usually have good performance on common expressions, including happy and surprise, but have lower accuracy on difficult expressions, such as disgust and fear. Two main factors are responsible for this problem. Firstly, intra-class variation makes classification of difficult expressions more complex than other expressions. Secondly, severe data imbalance of difficult expressions in most FER datasets leads to overfitting during training. In this work, a new network architecture is proposed to address the intra-class variation problem. The proposed model consists of a spatial enhancement module and a semantic aggregation module to enhance fine-level expression features and high-level semantic features. To alleviate the data imbalance problem, an iterative learning method is introduced to collect difficult expression samples. New samples with inconsistent labels are classified by using a fuzzy clustering algorithm. The proposed FER framework has been evaluated on three real world expression datasets. Experimental results demonstrate that the proposed method significantly improved the recognition accuracy of difficult expressions and achieved top performance compared with state-of-the-art works.

Background This retrospective study aimed to evaluate the efficacy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) with stereotactic body radiation therapy (SBRT) and to elucidate potential mechanisms of acquired resistance. Methods Patients with advanced NSCLC harboring positive EGFR mutations after initial TKI therapy for at least 8 weeks were eligible for SBRT between August 2016 and August 2019. Eligible patients were treated with thoracic SBRT, and TKI was continued after SBRT until it was considered ineffective. The control group was treated with TKIs monotherapy. Propensity score matching (PSM, ratio of 1:2) was used to account for differences in baseline characteristics. Overall survival (OS), progression-free survival (PFS), treatment safety and resistance mechanisms were evaluated. Results Three hundred eight patients were included in the study population. Among them, 262 patients received TKIs alone, and 46 patients received TKIs with SBRT. Baseline characteristics were not significantly different between the two cohorts after PSM. The median PFS was 19.4 months in the TKIs +SBRT group compared to 13.7 months in the TKIs group (p = 0.034). An influence on OS has not yet been shown (p = 0.557). Of the 135 patients evaluated after PSM, 28 and 71 patients in the TKIs and TKIs +SBRT cohorts, respectively, had plasma cell-free DNA (cfDNA) next-generation sequencing (NGS) performed at baseline and disease progression. In the TKIs +SBRT cohort, the NGS results showed that T790M mutations were detected in 64.3% (18/28) of patients. Patients in the TKIs cohort exhibited fewer T790M-positive mutations (40.8%, p = 0.035) compared to patients in the TKIs +SBRT cohort. Conclusion Real world data prove that TKIs plus thoracic SBRT significantly extend PFS with tolerable toxicity. The mutation ratio of T790M was increased in the TKIs +SBRT group compared to the TKIs only group. Further randomized studies are warranted.

Leptomeningeal metastasis (LM) is a disastrous complication of advanced lung adenocarcinoma (LAC) associated with poor prognosis and rapid deterioration of performance status. The prevalence of epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) co-alterations in patients with LAC was low. Herein, we report a patient with alterations in both EGFR (p. G719A+L747V) and echinoderm microtubule-associated protein-like ALK (EML4-ALK) fusion and LM who was treated with afatinib. The patient’s clinical symptoms improved, and imaging examination revealed reduced intracranial and extracranial lesions. The progression-free survival (PFS) using afatinib for LM was 25 months, and no severe adverse events occurred.

AIM: To evaluate the global trends in and explore hotspots of high myopia (HM) research. METHODS: This bibliometric analysis was used to reveal the publication trends in HM research field based on the Web of Science Core Collection (WoSCC). VOSviewer version 1.6.13 software was used to analyze the data and construct a knowledge map including the yearly publication number, journals, countries, international collaborations, authors, research hotspots, and intellectual base in HM. RESULTS: The search engine found 3544 peer-reviewed publications on HM between 2010 and 2019, and the yearly research output substantially elevated over the past decade. China is the top publishing country, and Sun Yat-sen University was the most active academic institution. Jonas JB is the top publishing scientist, and Investigative Ophthalmology and Visual Science (IOVS) was the most productive journal. The highest cited references mainly focused on epidemiology and management. The keywords formed 6 clusters: 1) refractive surgery; 2) etiology and clinical characteristics; 3) the mechanism of eye growth; 4) management for myopic maculopathy; 5) vitrectomy surgical treatment; 6) myopia-associated glaucoma-like optic neuropathy. CONCLUSION: The evaluation of development trends based on the data extracted from WoSCC can provide valuable information and guidance for ophthalmologists and public health researchers to improve management procedures in HM field.

Smoking remains a strong risk factor for premature death. This study examines the associations of nondaily smoking, daily smoking, and smoking cessation with the risks of mortality from all causes, cardiovascular disease, and cancer.This study used data from the National Health and Nutrition Examination Survey, a population-based, cross-sectional study. Data analysis was conducted in the U.S. from January to October 2020. Cox proportional hazard regression models were used to obtain adjusted hazard ratios.During 255,100 person-years of follow-up, 2,008 participants died (347 from cardiovascular diseases and 501 from cancer). A significant increase in the risk of all-cause mortality was observed for nondaily smokers (hazard ratio=1.50, 95% CI=1.08, 2.08) compared with that for those who had never smoked. For daily smokers, the adjusted hazard ratios for all-cause mortality were 1.54 (95% CI=1.24, 1.90) for those smoking20 cigarettes per day, 2.09 (95% CI=1.65, 2.63) for those smoking 20-40 cigarettes per day, and 2.78 (95% CI=1.75, 4.43) for those smoking ≥40 cigarettes per day. An increased risk of cardiovascular disease and cancer mortality was also observed for daily smokers. Former smokers with ≥5 years since cessation had a lower risk of all-cause mortality than current smokers.This study suggests that nondaily smokers have a higher risk of all-cause mortality. The association of daily smoking with the risk of mortality increased as the number of cigarettes smoked per day increased. Among former smokers, the risk decreased with longer cessation. Tobacco control efforts should be targeted not only toward daily smokers but also toward nondaily smokers to reduce the risk of premature death owing to smoking.

The aims of the study were to assess the contribution of resilience, coping style, and COVID-19 stress on the quality of life (QOL) in frontline health care workers (HCWs). The study was a cross-sectional surveyperformed among 309 HCWs in a tertiaryhospital during the outbreak of COVID-19 in China. Data were collected through an anonymous, self-rated questionnaire, including demographic data, a 10-item COVID-19 stress questionnaire, Generic QOL Inventory-74, Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Hierarchical regression was used to analyse the relationship between the study variables and the QOL. Among the 309 participants, resilience and active coping were positively correlated with the QOL (P