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Cold-formed steel members are usually used as purlins in buildings to support roof cladding and thus they can be treated as beams restrained fully or partially in the lateral and torsional directions. However, when these beams are subjected to wind suction loading, their free flange is in compression, which may cause web–flange distortional buckling (WFDB). This paper presents an analytical study on the WFDB of zed-section purlins when subjected to uplift bending. A simplified model is proposed to describe the WFDB of partially restrained purlins, from which the formula for calculating the critical stress of the WFDB is derived. The present model is validated by the results obtained from the finite strip analysis.

Scene classification of high spatial resolution (HSR) images can provide data support for many practical applications, such as land planning and utilization, and it has been a crucial research topic in the remote sensing (RS) community. Recently, deep learning methods driven by massive data show the impressive ability of feature learning in the field of HSR scene classification, especially convolutional neural networks (CNNs). Although traditional CNNs achieve good classification results, it is difficult for them to effectively capture potential context relationships. The graphs have powerful capacity to represent the relevance of data, and graph-based deep learning methods can spontaneously learn intrinsic attributes contained in RS images. Inspired by the abovementioned facts, we develop a deep feature aggregation framework driven by graph convolutional network (DFAGCN) for the HSR scene classification. First, the off-the-shelf CNN pretrained on ImageNet is employed to obtain multilayer features. Second, a graph convolutional network-based model is introduced to effectively reveal patch-to-patch correlations of convolutional feature maps, and more refined features can be harvested. Finally, a weighted concatenation method is adopted to integrate multiple features (i.e., multilayer convolutional features and fully connected features) by introducing three weighting coefficients, and then a linear classifier is employed to predict semantic classes of query images. Experimental results performed on the UCM, AID, RSSCN7, and NWPU-RESISC45 data sets demonstrate that the proposed DFAGCN framework obtains more competitive performance than some state-of-the-art methods of scene classification in terms of OAs.

Statement of problem Three-dimensionally printed custom open trays have become a popular option in clinical implant dentistry because of advantages such as individualization, efficiency, and effectiveness. However, clinical evidence on their accuracy and feasibility is lacking. Purpose The purpose of this clinical study was to evaluate the accuracy and feasibility for impressions of multiple implants by using 3D-printed custom open trays versus conventional custom open trays. Material and methods Twenty-two partially edentulous individuals needing impression making for restorations supported by multiple implants were enrolled. Two types of custom open trays were made for each participant, a 3D-printed tray (test) and a conventional tray (control). With a splinted technique, silicone definitive impressions were obtained with the 2 custom open trays and poured with Type IV dental stone. Impression accuracy (primary outcome) was evaluated by measuring linear distances and the marginal gaps between the implant replicas and verification devices on the test and control casts. Clinical tray fit, impression quality, and cast quality were rated by an independent technician through a visual analog scale (VAS). The fabrication time and cost of the 2 types of custom open trays were recorded. The feasibility of 3D-printed trays was determined from these outcomes. The paired Student t test and Wilcoxon rank-sum tests were used for statistical analysis (α=.05). Results For impression accuracy, no statistically significant difference was found between test and control groups (P>.05). In terms of clinical tray fit, impression quality, and cast quality, no statistically significant difference was found (all P>.05). Regarding fabrication time and cost, the test group (57.65 ±6.49 minutes, 0.37 ±0.07 United States dollars [USD]) exhibited superiority over the control group (101.96 ±2.92 minutes, 4.41 ±0.37 USD) (both P Conclusions Within the limitations of this study, the 3D-printed custom open trays were clinically accurate, efficient, and cost-effective for impressions of multiple implants.

In this study, based on a closed bomb test combined with computational fluid dynamics, a structural finite element method, and an acoustic boundary element method, a fluid-solid acoustic one-way coupling calculation model is established for the combustion process of energetic materials in a closed bomb, and the effectiveness of the model is verified by experiments. It is found that the maximum peak sound pressure increases exponentially with an increase in loading doses or gas pressure. However, a change in the combustion coefficient of the energetic materials has little effect on the noise generated during the combustion process in the closed bomb. When the combustion coefficient is reduced by a multiple of 16, the maximum transient sound pressure is reduced by 1.79 dB, and the sound pressure level in the frequency band is reduced by 1.75 dB. With an increase in shell thickness, the combustion noise of the energetic materials in the closed bomb decreases, and the reduction range of the combustion noise increases with the increase in shell thickness.

Since the terrorist attacks on 11 September 2001, structural resistance to explosion has received increasing attention. As bridges are controlling factors in traffic systems, explosion-induced bridge damage will cause great economic loss and social impact, but there is a lack of anti-explosion research for bridges. The purpose of this work was to investigate the failure modes and safety distances of cylindrical reinforced concrete (RC) bridge piers on highways and urban viaducts as a result of vehicle explosion. TNT equivalents were selected to represent explosions of five different vehicles (car, sport utility vehicle/van, delivery truck, water truck and semi-trailer). The multi-Euler domain method, was adopted for structural analysis of the explosion process using the commercial software Autodyn. The results showed that RC piers have three failure modes at the base: full-section punching-shear failure and large displacement; shear failure of full-section concrete; local shear failure of concrete. The explosion energy decayed rapidly with distance. For the five vehicle explosions, the safety distances were found to be 2 m, 3 m, 4 m, 8 m and 14 m, respectively. The results of this work are meaningful for explosion-resistant design and damage assessments of existing highway cylindrical RC piers subjected to vehicle explosion.

The prognosis for cervical cancer (CC) patients with lymph node metastasis (LNM) is extremely poor. Lipid droplets (LDs) have a pivotal role in promoting tumor metastasis. The crosstalk mechanism between LDs and LNM modulated in CC remains largely unknown.This study aimed to construct a miRNA-dependent progonostic model for CC patients and investigate whether miR-532-5p has a biological impact on LNM by regualting LDs accumulation.LASSO-Cox regression was applied to establish a prognostic prediction model. miR-532-5p had the lowest P-value in RNA expression (P 0.001) and prognostic prediction (P 0.0001) and was selected for further study. The functional role of the prognostic miR-532-5p-correlated competing endogenous RNA (ceRNA) network was investigated to clarify the crosstalk between LDs and LNM. The underlying mechanism was determined using site-directed mutagenesis, dual luciferase reporter assays, RNA immunoprecipitation assays, and rescue experiments. A xenograft LNM model was established to evaluate the effect of miR-532-5p and orlistat combination therapy on tumor growth and LNM.A novel 5-miRNAs prognostic signature was constructed to better predict the prognosis of CC patient. Further study demonstrated that miR-532-5p inhibited epithelial-mesenchymal transition and lymphangiogenesis by regulating LDs accumulation. Interestingly, we also found that LDs accumulation promoted cell metastasis in vitro. Mechanistically, we demonstrated a miR-532-5p-correlated ceRNA network in which LINC01410 was bound directly to miR-532-5p and effectively functioned as miR-532-5p sponge to disinhibit its target gene-fatty acid synthase (Our findings highlight a LD accumulation-dependent mechanism of miR-532-5p-modulated LNM and support treatment with miR-532-5p/orlistat as novel strategy for treating patients with LNM in CC.

BACKGROUND Right ventricular outflow tract (RVOT) obstruction relief is one of the major procedures during the total correction of tetralogy of Fallot (TOF). Pulmonary insufficiency (PI) is usually inevitable after a transannular incision with a patch repair is performed. Therefore, some surgeons advocate to place a monocusp valve within the transannular patch (TAP) in order to decrease the severity of the PI. However, the monocusp valve seemed not be very effective in some patients who underwent the complete TOF repair. METHODS Patients who had the classic form of TOF between January 2009 and January 2017 and underwent the corrective surgery with a TAP by the same cardiovascular surgeon were identified for further analysis. Clinical information including demographics at operation, perioperative data, and postoperative outcome were collected retrospectively and compared between the group with and without a monocusp valve. RESULTS A total of 24 TOF cases were included in the final analysis, and 16 (66.7%) patients received a monocusp valve placement. The patients' characteristics before and during the surgery were similar between the two groups. The median duration of chest tube drainage after the total correction in the monocusp group was longer than those without the valve (p = 0.04). There was no difference in the immediate postoperative data, including the inflammation/infection status, the duration of mechanical ventilation, and the length of ICU and hospital stay. CONCLUSION Implantation of a monocusp valve during the total TOF correction using a TAP did not bring benefit to improve the immediate postoperative outcomes, especially the duration of the pleural drainage. Further study with a prospective design and a larger number of cases is needed.

In the last few decades, ciphertext-policy attribute-based encryption (CP-ABE) technology has attracted great interest, since it can provide fine-grained, flexible and access control for sensitive data to implement high secure and efficient data sharing mechanism. In this paper, based on the linear secret sharing scheme (LSSS), an efficient scheme is proposed to realize collaborative decryption function. For any user group, when the user’s attribute set cannot access the ciphertext alone, the private key of other users in the same group can be used for collaborative decryption with the permission of the data owner. Our scheme uses the LSSS matrix can significantly reduce the computation and storage overhead when comparing with the existing schemes. Then a multi-authorization model is created based on the Bohen-Lynn-Shacham technology in order to solve the key-management issue. Finally, we implemented the specific functions of the framework through JAVA, and built a private chain to verify the feasibility of data transfer between users.

Background The overwhelming majority of hangman’s fractures cause anterior dislocation of C2. Hangman’s fracture with C2 posterior dislocation is extremely rare, only one paediatric case was reported in 2018 to date. This kind of injury cannot be catalogued using current classification schemes and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems and discuss management technical notes to avoid pitfalls. Methods Description of case, review of relevant literatures and share our experience. Results A 31-year-old male sustained hangman’s fracture with C2 posterior dislocation after fell into a 50cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography (CT) on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging (MRI) on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of cervical spinal cord by posterior dislocation of C2 vertebral body. A C2-3 anterior cervical discectomy and fusion (ACDF) was performed. At 6 months after operation, bony fusion was achieved, and MRI showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared. Conclusion C2–C3 ACDF is recommended for hangman's fractures with C2 posterior dislocation. Traction before surgery is not recommended.

Lung adenocarcinomas manifesting as subsolid nodules usually have a favorable prognosis. This study aimed to have a comprehensive investigation of the radiological and clinicopathologic features and oncological outcomes of subsolid nodules. Between March 2010 and December 2015, 865 patients with surgically resected clinical IA subsolid lung adenocarcinoma were retrospectively reviewed. Patients were classified into the pure ground-glass nodules (GGN) (pGGN [n = 358], without solid component on lung and mediastinal windows), heterogeneous GGN (hGGN [n = 65], only with solid components on lung window), and real part-solid nodule (rPSN [n = 442], with solid component on both lung and mediastinal windows) groups. The clinicopathological features and survival time of the three groups were compared between groups. There was a significant increase in median tumor size (P0.001), solid component size measured at lung window (LW-SCS) (P0.001), and the proportion of invasive adenocarcinoma subtypes (P0.001) from pGGNs to hGGNs to rPSNs. After adjustment for LW-SCS, adenocarcinomas with predominant lepidic patterns were still more common in hGGNs than in rPSNs (P = 0.009). Patients with rPSNs had a significantly worse recurrence-free survival (RFS) than those with pGGNs and hGGNs (5-year: 91.9% versus 100% versus 100%, P0.001). Multivariate Cox analyses revealed that gender (both P0.05) and clinical T category (based on lung window [LW-cT] [P = 0.002] or mediastinal window [MW-cT] [P0.001]) were independent prognostic factors of RFS in the rPSN group. HGGNs represented as an intermediate subtype between pGGNs and rPSNs. Both pGGNs and hGGNs had excellent outcomes, while rPSNs exhibited a worse prognosis than them. Clinical T category and gender had prognostic implications for rPSNs.

The ninth edition of lung cancer staging system recommends that specific driver mutations should be considered as prognostic factors in survival models. This study comprehensively investigated the prognostic value of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in patients with resected lung adenocarcinomas according to different clinicopathologic and radiologic characteristics.In total, 1464 patients with completely resected primary lung adenocarcinomas were examined for KRAS mutations from November 2008 to March 2015. Age, sex, smoking status, performance status, tumor-node-metastasis stage, radiologic features, and histologic subtypes were collected. Competing risk model was used to estimate the cumulative incidence rate of recurrence. Cox regression multivariable analyses on recurrence-free survival (RFS) and overall survival (OS) were performed.KRAS mutations were more frequent in male subjects (P .001), current/former smokers (P .001), invasive mucinous adenocarcinoma (P .001), and solid tumors (P .001). In general, KRAS-mutated patients had greater cumulative recurrence rate (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.23-3.08; P .001) and worse overall survival (OS; HR, 1.88; 95% CI, 1.23-2.87; P .001) than KRAS wild-type patients. The OS (P .001) of patients harboring KRAS-G12C/V mutations was shorter than that of other KRAS-mutated patients. Cox multivariable analyses demonstrated that KRAS mutations were independently associated with worse RFS (HR, 5.34; 95% CI, 2.53-11.89; P = .001) and OS (HR, 2.63; 95% CI, 1.03-6.76; P = .044) in part-solid lung adenocarcinomas. For stage I patients, Cox multivariable analyses revealed that KRAS mutation was an independent risk factor for RFS (HR, 2.05; 95% CI, 1.19-3.56; P = .010) and OS (HR, 2.38; 95% CI, 1.29-4.40; P = .005).In this study, we revealed that KRAS mutations was an independent prognostic factor in part-solid tumors and in stage I lung adenocarcinomas. These findings may contribute to the ninth edition of lung cancer staging project.

Background/Purpose: Hypertension is a risk factor of incident diabetes. In 2017, the ACC/AHA updated the definition of hypertension to above 130/80 mmHg, while the 2018 ESC/ESH guideline and the JNC7 criteria remained the cutoff of 140/90 mmHg. This study was aimed to investigate how different cutoffs of hypertension affect the association of hypertension to incident diabetes and the progression of insulin resistance. Methods: A total of 1177 subjects without diabetes at baseline were followed for 4.5 years. Diabetes was diagnosed by the results of oral glucose tolerance tests and hemoglobin A1c, or if anti-diabetic agents were used. Results: Hypertension by both criteria was associated with incident diabetes. Change of HOMA2-IR every 5 years (ΔHOMA2-IR/5 yr) was higher in subjects with hypertension than those without (adjusted p = 0.044). Subjects with treated hypertension had the highest risk of diabetes (HR 2.98, p

Background: Curcumin possesses multiple bioactivities that have beneficial effects on diabetic foot ulcers. Herein, we aimed to conduct a preclinical systematic review of 9 studies, including a total of 262 animals, to assess the possible mechanisms of curcumin for wound healing in diabetic animals. Methods: Five databases were searched from inception to May 12, 2020; Rev-Man 5.3 software was applied for data analyses. Cochrane Collaboration’s tool 10-item checklist was used to evaluate the methodological quality, and data revealed scores of risk of bias ranging from 2 to 5. Results: Meta-analysis indicated that curcumin had significant effects on wound healing rate and blood vessel density when compared with control (P < 0.05). The wound regeneration properties of curcumin for diabetic wounds are thought to mainly work through the possible mechanisms of antioxidation, enhanced cell proliferation, increased collagen formation, and angiogenesis. However, the anti-inflammatory effect on wounds in diabetic animals remain controversial. Conclusions: The findings indicate that more randomized controlled trials should be pursued to obtain more reliable results regarding inflammatory response. Overall, curcumin might be a probable candidate for diabetic foot ulcers and may contribute to future clinical trials. Prospero Registration: CRD42020188981.

Objective To investigate structural and functional alterations in patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) compared with healthy controls. Methods Twenty-seven patients with polysomnography-confirmed iRBD and 33 healthy subjects were recruited. All subjects underwent a 3-tesla structural and resting-state functional magnetic resonance imaging (fMRI) examination. Voxel-based morphometry (VBM) analysis was performed to assess grey matter alterations between groups. The amplitude of low-frequency fluctuations (ALFF) was calculated and then compared to measure differences in spontaneous brain activity. Correlations were performed to explore associations between imaging metrics and clinical characteristics in iRBD patients. Results Compared with healthy controls, patients with iRBD had decreased grey matter volume in the frontal, temporal, parietal, occipital cortices as well as increased grey matter volume in cerebellum posterior lobe, putamen, and thalamus. Patients with iRBD also exhibited increased ALFF values in the right parahippocampal gyrus. Olfaction correlated with ALFF value changes in occipital cortices. Conclusions Patients with iRBD had widespread decreases of grey matter volume. Increases of grey matter volume in cerebellum, putamen, and thalamus may suggest a compensatory effect, while the altered ALFF values in parahippocampal gyrus and occipital cortices may play a role in the underlying process of neurodegeneration in this disorder.

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6–31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] 0.2 ng ml−1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

The human microflora is a complex ecosystem composed of diverse microorganisms mainly distributed in the epidermal and mucosal habitats of the entire body, including the mouth, lung, intestines, skin, and vagina. These microbial communities are involved in many essential functions, such as metabolism, immunity, host nutrition, and diseases. Recent studies have focused on the microbiota associated with cancers, particularly the oral and intestinal microbiota. Radiotherapy, the most effective cytotoxic modality available for solid tumors, contributes to the treatment of cancer patients. Mounting evidence supports that the microbiota plays pivotal roles in the efficacy and prognosis of tumor radiotherapy. Here, we review current research on the microbiota and cancer development, and describe knowledge gaps in the study of radiotherapy and the microbiota. Better understanding of the effects of the microbiome in tumorigenesis and radiotherapy will shed light on future novel prevention and treatment strategies based on modulating the microbiome in cancer patients.

On December 18, 2020, the FDA approved osimertinib as adjuvant therapy in patients with non–small cell lung cancer (NSCLC) whose tumors have EGFR exon 19 deletions or exon 21 (L858R) mutations, as detected by an FDA-approved test. The approval was based on the ADAURA study, in which 682 patients with NSCLC were randomized to receive osimertinib (n = 339) or placebo (n = 343). Disease-free survival (DFS) in the overall population (stage IB–IIIA) was improved for patients who received osimertinib, with an HR of 0.20; 95% confidence interval (CI), 0.15–0.27; P < 0.0001. Median DFS was not reached for the osimertinib arm compared with 27.5 months (95% CI, 22.0–35.0) for patients receiving placebo. Overall survival data were not mature at the time of the approval. This application was reviewed under FDA's Project Orbis, in collaboration with Australia Therapeutic Goods Administration, Brazil ANVISA, Health Canada, Singapore Health Sciences Authority, Switzerland Swissmedic, and the United Kingdom Medicines and Healthcare products Regulatory Agency. This is the first targeted therapy adjuvant approval for NSCLC and has practice-changing implications.

Aims To determine the effectiveness and dose–response of nurse-led hospital-to-home transitional care interventions (TCIs) on patient mortality and psychosocial outcomes of health-related quality of life (HRQoL), self-care behaviours, and emotional well-being in adults hospitalized with heart failure (HF) and to recognize pertinent characteristics that potentially affect the overall effectiveness. Methods and results Relevant studies were identified through electronic database searches, including MEDLINE, Embase, CINAHL, and Cochrane Library from January 2000 until January 2021. Two independent authors performed study selection, data abstraction, and risk-of-bias assessment. When appropriate, we used random-effects meta-analysis to derive pooled effect estimates, investigated dose–response relationships, and ran meta-regressions to locate the source of heterogeneity. A total of 27 studies with 7635 participants were included. Our findings revealed that nurse-led hospital-to-home TCIs reduced the risk of all-cause mortality by 21% [risk ratio = 0.79; 95% confidence interval (CI) 0.68–0.92; P = 0.003] and improved HRQoL (mean difference = −3.29; 95% CI −6.51 to −0.07; P = 0.04) compared to usual care, but non-significant effects were found for emotional well-being. The narrative summary of evidence for self-care behaviours showed positive intervention effects. Meta-regression did not find any covariates that were significantly related to mortality or HRQoL. Dose–response analysis showed that mortality risk was reduced with increased intensity and complexity of the nurse-led TCIs. Conclusion Generally, nurse-led hospital-to-home TCIs may play a beneficial role in decreasing mortality, and improving HRQoL and self-care behaviours for adults with HF. Additional studies are warranted to characterize the optimal nurse-led TCIs for HF management.

The aim of this study was to evaluate the pharmacokinetic bioequivalence of a generic budesonide nasal spray and a branded product in healthy Chinese subjects under fasting condition. A single-center, single-dose, randomized, open-label, crossover study was conducted in 32 healthy Chinese subjects under fasting condition. The subjects were administered 256 μg of generic budesonide nasal spray (test drug) or branded budesonide nasal spray (RHINOCORT AQUA, reference drug), respectively. For each period, the subjects were administered with 64 μg of budesonide per spray and 2 sprays for each nostril followed by a washout period of 7 days. Plasma concentration of budesonide was determined by a validated high-performance liquid chromatography-tandem mass spectrometry method. The pharmacokinetic (PK) parameters were calculated, and the bioequivalence was compared using the noncompartment model with the Phoenix WinNonlin 7.0 program. Results show that the 90% confidence intervals of the test/reference ratios of maximum concentration, area under the plasma concentration-time curve from time 0 to the last measurable concentration, and area under the plasma concentration-time curve from time 0 to infinity for the budesonide concentration were 84.8% to 102.7%, 84.6% to 94.4%, and 85.4% to 95.2%, respectively, all fall within the bioequivalent range of 80% to 125%. The test and reference budesonide nasal sprays were PK bioequivalents in healthy Chinese subjects with comparable PK parameters. No serious adverse events were reported, and the 2 products have a good and similar safety profile.

Atomically thin two‐dimensional (2D) bismuth oxychalcogenides (Bi2O2X, X = S, Se, Te) have recently attracted extensive attention in the material research community due to their unique structure, outstanding long‐term ambient stability, and high carrier mobility, which enable them as promising candidates for high‐performance electronic and optoelectronic applications. Herein, we present a comprehensive review on the recent advances of 2D bismuth oxychalcogenides research. We start with an introduction of their fundamental properties including crystal structure and electronic band structure. Next, we summarize the common techniques for synthesizing these 2D structures with high crystallinity and large lateral size. Furthermore, we elaborate on their device applications including transistors, artificial synapses, optical switch and photodetectors. The last but not the least, we summarize the existing challenges and prospects for this emerging 2D bismuth oxychalcogenides field.

Flavonoid glycoside scutellarin (SCU) has been widely applied in the treatment of cerebral ischemic diseases in China. In this article, we conducted research on the working mechanisms of SCU in hypoxia reoxygenation (HR) injury of isolated cerebral basilar artery (BA) and erebral ischemia reperfusion (CIR) injury in rat models. In isolated rat BA rings, HR causes endothelial dysfunction (ED) and acetylcholine (ACh) induces endothelium-dependent vasodilation. The myography result showed that SCU (100 µM) was able to significantly improve the endothelium-dependent vasodilation induced by Ach. However, SCU did not affect the ACh-induced relaxation in normal BA. Further studies suggested that SCU (10–1000 µM) dose-dependently induced relaxation in isolated BA rings which were significantly blocked by the cGMP dependent protein kinase (PKG) inhibitor Rp-8-Br-cGMPs (PKGI-rp, 4 µM). Pre-incubation with SCU (500 µM) reversed the impairment of endothelium-dependent vasodilation induced by HR, but the reversing effect was blocked if PKGI-rp (4 µM) was added. The brain slice staining test in rats’ model of middle cerebral artery occlusion (MCAO) induced CIR proved that the administration of SCU (45, 90 mg/kg, iv) significantly reduced the area of cerebral infarction. The Western blot assay result showed that SCU (45 mg/kg, iv) increased brain PKG activity and PKG protein level after CIR surgery. In conclusion, our findings suggested that SCU possesses the ability of protecting brain cells against CIR injury through vascular endothelium protection and PKG signal. Graphic Abstract

Purpose As a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), osimertinib has a powerful ability to penetrate the blood-brain barrier and a high potency for controlling brain metastases (BMs) from EGFR-mutant non-small cell lung cancer (NSCLC). The clinical value of cranial radiation therapy in osimertinib-treated NSCLC with BMs remains largely unknown. Methods and Materials Patients with NSCLC and BMs and receiving osimertinib treatment as the standard of care were retrospectively enrolled from 2 institutions. Cranial radiation therapy (RT; whole-brain radiation therapy [WBRT] or/and stereotactic radiosurgery [SRS]) performed before disease progression (PD) to osimertinib was categorized as upfront cranial radiation therapy (ucRT group), excluding those treatments performed during prior EGFR-TKI treatment. Overall survival (OS), progression-free survival (PFS), and the time to intracranial progression (iTTP) were compared between the 2 groups, with adjustment by covariates in propensity-score matched (PSM) analyses. The state of having 1 to 3 BM lesions, with a maximal size of ≤3 cm, was defined as having oligo-BM; otherwise; the cases were defined as having multiple BMs. Results Of the 205 patients enrolled, osimertinib was used as first-line therapy in 74 and second-line therapy in 131. There were 48 patients who received ucRTs, including WBRT in 24 and SRS in 24. All patients with oligo-BM in the ucRT group received SRS alone (n = 17), whereas most (n = 28; 90.3%) patients with multiple BMs received WBRT. Failure pattern analyses indicated that in the non-ucRT group, 40.2% of the initial PD involved the brain and 76.9% of the cranial PD involved the original sites, indicating the potential roles of ucRT. Indeed, the iTTP was significantly prolonged (P = .010) in the ucRT group among the whole population. In the PSM oligo-BM cohort, the ucRT group showed superior PFS (P = .033) and OS (P = .026) compared with the non-ucRT group, and the differences remained after multivariate Cox analyses. No such differences were observed in the subpopulation with multiple BMs. Conclusions In osimertinib-treated NSCLC patients with BMs, oligo-BM status could be used as a potential factor to select patients for upfront cranial RT. Further investigation by well-designed clinical trials is warranted.

Background China is facing big challenges to achieve the “90–90-90 targets”. The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China. Methods The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective. Results 129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02–5.91), age(≥60 vs. 50–59, OR = 0.41, 95% CI = 0.19–0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16–0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0–0.52), and undecided (AOR =0.02, 95%CI = 0.01–0.09) and objection (AOR =0.04, 95%CI = 0.01–0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior. Conclusions High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50–59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.

There are around 300 million adolescent pregnancies worldwide, accounting for 11% of all births worldwide. Accumulating evidence demonstrates that many adverse perinatal outcomes are associated with adolescent pregnancies. However, how and why these abnormalities occur remain to be defined. In this study, pregnancy at different stages was compared between 25- and 30- day-old and mature female mice. We found that the litter size of adolescent pregnancy is significantly decreased from F1 to F3 generations compared to mature pregnancy. On days 8 and 12 of pregnancy, multiple abnormalities in decidual and placental development appear in F3 adolescent pregnancy. On days 5 and 8, uterine endoplasmic reticulum stress is dysregulated in F3 adolescent pregnancy. Embryo implantation and decidualization are also compromised in adolescent pregnancy. Many genes are abnormally expressed in adolescent estrous uteri. The abnormal endocrine environment and abnormal implantation from uterine immaturity may result in multiple pregnancy failures in adolescent pregnancy. The aim of this study is to shed light on human adolescent pregnancy.

Background. Colorectal cancer (CRC) is the third most common tumor worldwide. Aberrant N6-methyladenosine (m6A) modification can influence the progress of the CRC. Additionally, long noncoding RNA (lncRNA) plays a critical role in CRC and has a close relationship with m6A modification. However, the prognostic potential of m6A-related lncRNAs in CRC patients still remains to be clarified. Methods. We use “limma” R package, “glmnet” R package, and “survival” R package to screen m6A-related-lncRNAs with prognostic potential. Then, we comprehensively analysed and integrated the related lncRNAs in different TNM stages from TCGA database using the LASSO Cox regression. Meanwhile, the relationship between functional enrichment of m6A-related lncRNAs and immune microenvironment in CRC was also investigated using the TCGA database. A prognostic model was constructed and validated to determine the association between m6A-related lncRNAs in different TNM stages and the prognosis of CRC. Result. We demonstrated that three related m6A lncRNAs in different TNM stages were associated with the prognosis of CRC patients. Patients from the TCGA database were classified into the low-risk and the high-risk groups based on the expression of these lncRNAs. The patients in the low-risk group had longer overall survival than the patients in the high-risk group ( P < 0.001 ). We further constructed and validated a prognostic nomogram based on these genes with a C-index of 0.80. The receiver operating characteristic curves confirmed the predictive capacity of the model. Meanwhile, we also found that the low-risk group has the correlation with the dendritic cell (DC). Finally, we discovered the relationship between the m6A regulators and the three lncRNAs. Conclusion. The prognostic model based on three m6A-related lncRNAs exhibits superior predictive performance, providing a novel prognostic model for the clinical evaluation of CRC patients.

We propose a GaN-based superjunction current-aperture vertical electron transistor (CAVET) with a dipole layer (DL-SJ CAVET) and demonstrated two-dimensional numerical simulations by Silvaco-Atlas. The dipole layer (DL) formed by Al0.1Ga0.9N is attached to the Al0.15Ga0.85N barrier layer and located in the passivation layer between the source and the gate electrodes. The simulated results of the proposed device exhibit high breakdown voltage (BV) and low specific on-resistance (RonA).The BV can reach 2453 V and the RonA reach 2.23 mΩ·cm2.Compared with the conventional GaN SJ CAVET, the improvement of RonA and BV can realized in DL-SJ CAVET based on the special structure features. To improve the RonA, we proposed a novel DL-SJ CAVET with step-doping p-pillars and n-pillars (DS-SJ CAVET). Compared with DL-SJ CAVET under the same aspect ratio, DS-SJ CAVET can further decrease RonA by increasing differently doped layers in p-pillars and n-pillars. The RonA reaches 1.76 mΩ·cm2 while BV reaches 2640 V. Further reduction in RonA can be achieved by adding differently doped layers and differently doped concentrations in n-pillars and p-pillars with decreasing BV. The proposed devices can be fabricated by selective area growth (SAG) technology and it shows significant potential in microwave power applications.

To explore the significance of Fluorine-18 labeled fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in diagnosing connective tissue diseases (CTDs) in fever of unknown origin (FUO) or inflammation of unknown origin (IUO) patients.Clinical and image data of 242 consecutive FUO/IUO patients who underwent PET/CT examination and eventually diagnosed CTDs were retrospectively analyzed, including distribution of diseases, clinical characteristics, and PET/CT imaging findings. The role of FDG PET/CT in differential diagnosis of CTDs was evaluated through clinical questionnaire survey.Patients diagnosed as CTDs accounted for 48.1% of FUO/IUO patients. Among them, adult-onset Still's disease was most frequently diagnosed. Other common diseases included systemic vasculitis, undifferentiated connective tissue disease, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and polymyalgia rheumatica. On FDG PET/CT examination, 97.9% of the patients had positive findings. Inflammatory lesions were detected in 66.5% and non-specific abnormal uptakes were found in 31.4%. Detected lesions distributed consistently with corresponding susceptible organs and tissues in various diseases. Clinical questionnaire results shown that FDG PET/CT excluded malignant tumors, focal infections, or other typical CTDs in 45.5% of the patients; indicated important diagnostic clues or appropriate biopsy sites in 20.6% of patients; and directly suggested the diagnosis of a CTD in 33.1% of patients.FDG PET/CT could reveal inflammatory lesions in organs and tissues that reflect the clinical characteristics in different CTDs, thus providing an objective evidence for differential diagnosis, classification, and treatment decision of these diseases. Key Points • FDG PET/CT is a useful tool for differential diagnosing connective tissue diseases among patients with fever of unknown origin/inflammatory of unknown origin.

Atherosclerotic cardiovascular disease resulting from dysregulated lipid metabolism is the leading cause of morbidity and mortality worldwide. Apolipoprotein E (ApoE) plays a critical role in cholesterol metabolism. Knockouts in lipid-metabolizing proteins including ApoE in multiple model organisms such as mice and rats exhibiting elevated levels of cholesterol have been widely used for dissecting the pathology of atherosclerosis, but few of these animal models exhibit advanced atherosclerotic plaques leading to ischemia-induced clinical symptoms, limiting their use for translational studies. Here we report hypercholesterolemia and severe atherosclerosis characterized by stenosis and occlusion of arteries, together with clinical manifestations of stroke and gangrene, in ApoE knockout dogs generated by CRISPR/Cas9 and cloned by somatic cell nuclear transfer technologies. Importantly, the hypercholesterolemia and atherosclerotic complications in F0 mutants are recapitulated in their offspring. As the ApoE-associated atherosclerosis and clinical manifestations in mutant dogs are more similar to that in human patients compared with those in other animal models, these mutant dogs will be invaluable in developing and evaluating new therapies, including endovascular procedures, against atherosclerosis and related disorders.

Multiple Object Tracking (MOT) has attracted increasing interests in recent years, which plays a significant role in video analysis. MOT aims to track the specific targets as whole trajectories and locate the positions of the trajectory at different times. These trajectories are usually applied in Action Recognition, Anomaly Detection, Crowd Analysis and Multiple-Camera Tracking, etc. However, existing methods are still a challenge in complex scene. Generating false (impure, incomplete) tracklets directly affects the performance of subsequent tasks. Therefore, we propose a novel architecture, Siamese Bi-directional GRU, to construct Cleaving Network and Re-connection Network as trajectory post-processing. Cleaving Network is able to split the impure tracklets as several pure sub-tracklets, and Re-connection Network aims to re-connect the tracklets which belong to same person as whole trajectory. In addition, our methods are extended to Multiple-Camera Tracking, however, current methods rarely consider the spatial-temporal constraint, which increases redundant trajectory matching. Therefore, we present Position Projection Network (PPN) to convert trajectory position from local camera-coordinate to global world-coodrinate, which provides adequate and accurate temporal-spatial information for trajectory association. The proposed technique is evaluated over two widely used datasets MOT16 and Duke-MTMCT, and experiments demonstrate its superior effectiveness as compared with the state-of-the-arts.

Breast cancer, a hormone‐dependent tumour, generally includes four molecular subtypes (luminal A, luminal B, HER2 enriched and triple‐negative) based on oestrogen receptor, progesterone receptor and human epidermal growth factor receptor‐2. Multiple hormones in the body regulate the development of breast cancer. Endocrine therapy is one of the primary treatments for hormone‐receptor‐positive breast cancer, but endocrine resistance is the primary clinical cause of treatment failure. Prolactin (PRL) is a protein hormone secreted by the pituitary gland, mainly promoting mammary gland growth, stimulating and maintaining lactation. Previous studies suggest that high PRL levels can increase the risk of invasive breast cancer in women. The expression levels of PRL and PRLR in breast cancer cells and breast cancer tissues are elevated in most ER+ and ER− tumours. PRL activates downstream signalling pathways and affects endocrine therapy resistance by combining with prolactin receptor (PRLR). In this review, we illustrated and summarized the correlations between endocrine therapy resistance in breast cancer and PRL, as well as the pathophysiological mechanisms and clinical practices. The study on PRL and its receptor would help explore reversing endocrine therapy‐resistance for breast cancer.

Information and knowledge are two foundational concepts in Information Systems (IS) research, but their relationship remains vague, and researchers continue to use them interchangeably in studies. This limits the ability to clearly specify what information is in the systems and how it is used for operations and decisions. We address the issue in the context of computer-aided decision-making. In contrast to the traditional view that information is the input of knowledge, we argue, from the knowledge-based view of information, that information is produced from knowledge and functions as the basis of decisions. Further, cognitive factors such as one’s general knowledge in the task domain and guidance in decision aids influence knowledge and information for decisions. An information-centric framework is developed and tested based on a popular production-planning decision task. The result supports the direct impact of information on decisions and the indirect impact of knowledge via its influence on information. This study is the first to empirically test the relationship between knowledge and information in IS research. It calls for more attention to the information concept and how it is processed in IS.

Peri‑implantitis, which is characterized by peri‑implant mucositis and alveolar bone resorption, significantly shortens the service life of dental implants. Melatonin is well-known for its anti-inflammatory and osteoprotective activities. Nevertheless, the effects and mechanisms of melatonin to prevent peri‑implantitis remain unknown. In this study, the lipopolysaccharide-induced peri‑implantitis model was established after the titanium implants were osseointegrated, and the rats received daily administrations of melatonin. The gingival fibroblasts and osteoclasts/osteoblasts were also co-cultured to simulate the inflammatory environment in vitro. We found that prophylactic administration of melatonin decreased proinflammatory cytokine levels and osteoclast numbers, attenuated alveolar bone resorption, and reduced the incidence of peri‑implantitis in vivo. Furthermore, melatonin suppressed osteoclastic formation and function in the inflammatory co-culture environment, while melatonin promoted osteoblastic differentiation and function in the in vitro model. Mechanistically, melatonin reduced TLR4 protein levels, and inhibited activation of NF-κB to downregulate the levels of TNF, IL-1β, and IL-6. These data showed that melatonin was a potent agent to prevent peri‑implantitis through inhibiting TLR4/NF-κB signaling. Our findings provide a novel strategy to prevent peri‑implantitis, and expand the applications of melatonin. Statement of significance Dental implants have become the first choice for restoring partial and full edentulism, but its service life is seriously affected by peri‑implantitis. Exploration of novel and effective approaches to prevent peri‑implantitis is an important and urgent need. In the present study, we have reported for the first time that prophylactic administration of melatonin delayed the occurrence and reduced the incidence of peri‑implantitis by decreasing proinflammatory cytokine levels, inhibiting osteoclastogenesis, and promoting osteogenesis. The study is expected to have an important significance on the prevention of peri‑implantitis.

Impaired wound healing is a major complication of diabetes and involves sustained inflammation and oxidative stress at the wound site. Here, we investigated the potential involvement of ferroptosis, a newly discovered form of cell death characterized by iron-dependent accumulation of lipid peroxides in the pathogenesis of diabetic wound healing. Fibroblasts and vascular endothelial cells exposed to high glucose concentrations in vitro contained elevated levels of reactive oxygen species (ROS), lipid peroxidation products, and ferroptosis-associated proteins and displayed reduced survival and migration. These effects of high glucose were all significantly reduced by treatment with the ferroptosis inhibitor ferrostatin-1 (Fer-1). Similarly, in a rat model of diabetes, direct application of Fer-1 to the wound site reduced the expression of oxidative stress and inflammation markers and accelerated wound healing via activation of the anti-inflammatory phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. Our results implicate ferroptosis in wound healing and identify a potential new therapeutic target for difficult-to-treat diabetic wounds.

There exists an increasing need for precision measurement & pointing control and extreme motion stability for current and future space systems, e.g., Ultra-Performance Spacecraft (UPS). Some notable technologies of realizing Ultra-Pointing (UP) ability have been developed particularly for Ultra-accuracy Ultra-stability Ultra-agility (3U) spacecraft over recent decades. Usually, Multilevel Compound Pointing Control Techniques (MCPCTs) are deployed in aerospace engineering, especially in astronomical observation satellites and Earth observation satellites. Modern controllers and/or algorithms, which are a key factor of MCPCTs for 3U spacecraft, especially the jitter phenomena that commonly exist in a UPS Pointing Control System (PCS), have also been effectively used in some UP spacecraft for a number of years. Micro-vibration suppression approaches, however, are often proposed to deal with low-level mechanical vibration or disturbance in the microgravity environment that is common for UPS. This latter approach potentially is one of the most practical UP techniques for 3U tasks. Some emerging advanced Disturbance-Free Payload (DFP) satellites that exploit the benefits of non-contact actuators have also been reported in the literature. This represents an interesting and highly promising approach for solving some challenging problems in the area. This paper serves as a state-of-the-art review of UP technologies and/or methods which have been developed, mainly over the last decade, specifically for or potentially could be used for 3U spacecraft pointing control. The problems discussed in this paper are of reference significance to UPS and millisecond optical sensors, which are involved in Gaofeng Project, deep space exploration, manned space flight, and gravitational wave detection.

In this letter, a new semisupervised dimensionality reduction (DR) method, termed geodesic-based manifold joint hypergraphs (GMJHs), is proposed for hyperspectral image (HSI). This method first builds a geodesic-based reconstruction model to discover the nonlinear similarity between two manifold reconstruction neighborhoods. Then, it implies the probabilistic relationship between unlabeled samples and each class via the geodesic-based reconstruction distance. With the probabilistic class relationship, a supervised hypergraph and an unsupervised hypergraph are constructed to represent the multivariate manifold relationship of samples. Finally, the supervised and unsupervised hypergraphs are jointed for learning optimal projection matrix and enhancing the intraclass compactness in low-dimensional embedding space. Experiments on two HSI data sets show that the proposed GMJH algorithm performs better performance than some state-of-the-art DR methods.

Introduction We aimed to validate the use of the novel grading system proposed by the International Association for the Study of Lung Cancer pathology committee for prognosis stratification of invasive pulmonary adenocarcinomas (ADCs) in Chinese patients. Correlations between the grading system, common driver mutations, and adjuvant chemotherapy (ACT) were also investigated. Methods From 2008 to 2016, the histologic patterns of a large cohort of 950 patients with invasive ADCs (stage I–III) were retrospectively analyzed and classified according to the proposed grading system. Subsequently, tumor grading was correlated with genetic data, ACT, and patient outcome. Results Compared with conventional predominant pattern-based groups, the novel grading system carried improved survival discrimination (area under the curve = 0.768 for recurrence-free survival and 0.775 for overall survival). The area under the curve was not further improved when incorporated lymphovascular invasion status. EGFR mutations (p Conclusions The novel International Association for the Study of Lung Cancer grading system is a practical and efficient discriminator for patient prognosis and should be part of an integrated pathologic-genetic subtyping to improve survival prediction. In addition, it may support patient stratification for aggressive adjuvant chemotherapy.

Osimertinib is the standard treatment for advanced non-small cell lung cancer (NSCLC) patients with T790M mutation after the failure of first-/second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). We comprehensively analyzed factors that affect the therapeutic efficacy of the osimertinib treatment in NSCLC patients. 351 NSCLC patients with T790M mutation receiving osimertinib treatment were included. We investigated the value of different factors in predicting the clinical outcomes of the osimertinib therapy, including progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Logistic and COX regression were used to identify prognosticators. In osimertinib therapy, EGFR mutation status (19Del/L858R) at initial diagnosis and the therapeutic choice of prior EGFR-TKI agent was not associated with patients’ prognosis. Notably, the PFS of the prior EGFR-TKI was independently related to ORR (OR, 95% CI 0.98, 0.96–1.00, p = 0.030), PFS (HR, 95% CI 0.98, 0.97–1.00, p = 0.009) and OS (HR, 95% CI 0.96, 0.93–0.98, p

BACKGROUND Maternal sepsis is a major cause of gestational morbidity and neonatal mortality worldwide and particularly in China. AIM To evaluate the etiology of maternal sepsis and further identify its risk factors. METHODS In this retrospective study, we evaluated 70698 obstetric patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 1, 2009 and June 30, 2018. Subjects were divided into sepsis group and non-sepsis group based on the incidence of sepsis. Data about medical history (surgical and obstetric history) and demographic information were collected. The Mann-Whitney U test was used to compare patient age, gestational age and duration of hospitalization between the two groups. Univariate and multivariate logistic regression models were used to analyze the etiology and the risk factors for maternal sepsis. Unadjusted and adjusted odds ratios (OR) are reported. RESULTS A total of 561 of 70698 obstetric patients were diagnosed with infection; of the infected patients, 492 had non-sepsis associated infection (87.7%), while 69 had sepsis (12.3%). The morbidity rate of maternal sepsis was 9.76/10000; the fatality rate in the sepsis group was 11.6% (8/69). Emergency admission (OR = 2.183) or transfer (OR = 2.870), irregular prenatal care (OR = 2.953), labor induction (OR = 4.665), cervical cerclage (OR = 14.214), first trimester (OR = 6.806) and second trimester (OR = 2.09) were significant risk factors for maternal sepsis. CONCLUSION Mode of admission, poor prenatal care, labor induction, cervical cerclage, first trimester and second trimester pregnancy were risk factors for maternal sepsis. Escherichia coli was the most common causative organism for maternal sepsis, and the uterus was the most common site of infection.

In multiphase batch processes, the final product quality prediction results depend on the common cumulative effects of all the critical phases with transitions on quality rather than a separated one. However, the common cumulative effect are rarely considered at the same time. To address this issue, a double cumulative model is proposed in this paper. The double model includes the internal cumulative model and the external cumulative model. On one hand, the critical local cumulative quality is introduced to isolate the local cumulative effect of different phases and transitions in the internal cumulative model. Especially, for transitions modeling, an average process trajectories method based on the dominant phase identification is developed to deal with the dynamic and uncertainty. On the other hand, the correlation of different cumulative models is extracted by constructing the external cumulative model. In this way, the cumulative effect of all the phases and transitions are considered simultaneously. The proposed method is applied to penicillin fermentation. The simulation results demonstrate the effectiveness and superiority of the proposed method over the competing models.

BACKGROUND The most commonly ingested foreign body in Asians is fish bone. The vast majority of patients have obvious symptoms and can be timely diagnosed and treated. Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported. The absence of pharyngeal or esophageal discomfort and negative computed tomography (CT) findings of fish bone have not been reported. We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion. CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week, and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously. She did not complain of any pharyngeal or esophageal discomfort. Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses. No sign of fish bone was detected on lateral cervical radiography and CT scans. The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization. Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue. Simultaneously, flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found. The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively. CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion, even though local discomfort symptoms are absent and the radiological examinations are negative.

Objective To explore the development and pregnancy potential of non-pronuclear (0PN) zygote-derived embryos in conventional in vitro fertilization (IVF) cycles. Study design Embryonic development in 1039 oocyte retrieval cycles and clinical outcomes of 659 frozen-thawed blastocyst transfer cycles were retrospectively studied. Results Developmental potential of embryos with different blastomere numbers on day 3 were inconsistent in 0PN and 2PN groups. For 0PN-derived embryos, blastocyst rate of fast developing embryos (75.4%) was similar to that of intermediately developing embryos (72.9%), but good quality blastocyst rate of the former (49.2%) was significantly higher than that of the later (39.6%). In 2PN group, intermediately developing embryos had the highest blastocyst rate (77.9%) and good quality blastocyst rate (51.5%) (statistically significant). Comparison of frozen-thawed transfer was carried out between 0PN- and 2PN-derived blastocysts. For both single (SBT) and double blastocyst transfer (DBT) groups, no statistical differences existed between 0PN- and 2PN-derived blastocysts in clinical pregnancy rates (45.2% and 49.1% in SBT group, 64.7% and 66.4% in DBT group), implantation rates (45.2% and 49.1% in SBT group, 41.2% and 47.7% in DBT group) and live birth rates (35.5% and 36.8% in SBT group, 52.9% and 51.2% in DBT group). Conclusion The developmental characteristic of 0PN-derived embryos was different from that of 2PN-derived embryos in IVF cycles. 0PN-derived blastocysts could obtain acceptable clinical pregnancy and live birth, but more studies are needed to confirm the safety..

Daoming Zhang,1 Yuan Li,1 Haoyue Li,2 Tian Tang,1 Yongfa Zheng,1 Xufeng Guo,1 Ximing Xu1 1Cancer Center, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China; 2Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of ChinaCorrespondence: Ximing XuCancer Center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People’s Republic of ChinaTel +86-13707120651Email doctorxu120@aliyun.comObjective: To evaluate the value of serum complement component 1q (C1q) levels in predicting the efficacy of combined immunotherapy in patients with lung cancer.Methods: A total of 42 patients with lung cancer who received combined immunotherapy in the cancer center of Renmin Hospital of Wuhan University were included in this study. The clinical data of serum C1q and lactate dehydrogenase (LDH) levels before and three weeks after immunotherapy were collected.Results: Response evaluation showed that the number of patients with complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) was 0 (0%), 26 (61.9%), 14 (33.3%), and 2 (4.8%), respectively. The CR/PR group (patients with CR or PR) showed higher pC1q (C1q level before immunotherapy) and iC1q (C1q level 3 weeks after immunotherapy) than the SD/PD group (patients with SD or PD). The LDH reduction (96.2%) and C1q increment (84.6%) in the CR/PR group 3 weeks after immunotherapy were higher than those of the SD/PD group, and the differences were statistically significant. Logistic regression analysis indicated that pC1q, iC1q, and LDH level trends 3 weeks after the treatment were significantly correlated to the efficacy of combined immunotherapy with odds ratios of 8.185, 5.500, and 0.031, respectively.Conclusion: High C1q levels before immunotherapy and increased C1q levels and decreased LDH levels 3 weeks afterward suggest good therapeutic effects of combined immunotherapy in patients with lung cancer. Serum C1q levels have certain clinical significance in predicting the efficacy of combined immunotherapy.Keywords: immunotherapy, efficacy prediction, complement component 1q

A metal pipe is a key factor affecting the performance of the oil well downhole radio frequency identification (RFID) system. This letter investigates the optimum separation for coping with the impact of metal pipe on the solenoid coil antenna so as to improve the performance of the downhole RFID system. Through the equivalent circuit model of RFID communication, a new objective of maximizing the reader antenna inductance is introduced from the perspective of demodulating the tag data easily. Then, a small optimum separation with a large antenna diameter is given out by the electromagnetic simulation of solenoid antenna in the metal pipe, which could not only ensure the trafficability of tag ball and decrease the tag speed in the antenna area but also reduce the minimum magnetic field required for the reader to read the tag. Finally, the calculation of optimum separation is compared with that of the experimental test and shows good agreement.

BACKGROUND Granulomatous lobular mastitis (GLM) is a type of benign chronic inflammatory disease that poses therapeutic challenges to healthcare providers. The diagnosis of GLM relies on tissue biopsy, and incorrect treatment may lead to delayed diagnosis, considerable aesthetic damage, and even mastectomy. CASE SUMMARY We report the case of a 37-year-old Chinese woman who was lactating and had GLM in both breasts. At the time of treatment, the right breast had a mass of approximately 15 cm × 11 cm, which was hard and had poor mobility. Multiple skin ulcerations and pus spills were also observed on the surface of the breast. The left breast had a mass of about 13 cm × 9 cm, which was hard and had poor mobility. CONCLUSION Herein, we report a case of bilateral GLM in a lactating woman that was successfully treated with traditional Chinese medicine (TCM), without the requirement for surgery or other treatments. Therefore, TCM may have advantages in the nonsurgical treatment of GLM.

Summary Service industries are generally considered “green” because of their marginal direct emissions; however, they account for 65% of the world gross domestic product and over 20% of total global trade in 2019. Here, we quantify the evolution of carbon emissions embodied in services trade from 2010 to 2018 and identify the driving factors of emission change at the global and regional scales. The annual growth rate of embodied emissions exported from the Global South (2.0%) is double that of the Global North (1.0%), with a different trade structure. We further identify three trade patterns of service export in the Global South based on the bilateral trade partnership and annual growth rate. Three kinds of specific emission mitigation policies are proposed based on the characters of services trade and different trade structures between different regions. The results provide quantitative evidence currently lacking and critical to policy decision making.