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Background Parapharyngeal lymph node metastasis is very rare in patients with thyroid carcinoma. In this study, we elucidated on the clinical features, diagnosis, surgical treatment, and outcomes for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Methods Patients with thyroid carcinoma who had been subjected to surgery through the transcervical approach at our institution between April 1999 and January 2019 were retrospectively enrolled in this study. Results Parapharyngeal lymph node metastases were successfully resected through the transcervical approach in all the 97 patients. There were 32 treatment-naive patients, while 65 patients had a history of treatment before parapharyngeal lymph node metastases. All 97 cases of parapharyngeal lymph node metastases were detected by enhanced CT scans. Lateral neck lymph nodes metastases were confirmed in 96 patients. Unexpected postoperative neurological side effects were reported in 11 (11%) patients, including dysphagia in 5 (5%) patients, Horner’s syndrome in 2 (2%) patients, glossal deviation in 3 (3%) patients, and asymmetrical mouth in 1 (1%) patient. During the follow-up period, 6 of the 97 patients exhibited parapharyngeal lymph node recurrence (recurrence rate 6.2%). The incidence of distant metastases was 44.3% (43 out of 97). The 5- and 10-year disease-specific survival was 93.4% and 88.9%, respectively. Conclusion Parapharyngeal lymph node metastases should be considered in patients with widespread cervical lymph node metastases. Enhanced CT scan is one of the best methods for diagnosing such metastases. Surgical resection through the transcervical approach is an effective and safe option for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Moreover, parapharyngeal lymph node metastasis is associated with distant metastases that may lead to poor prognosis.

Anomaly detection in a hyperspectral image (HSI) has been actively researched in the field of remote sensing due to its significant application requirements. Traditional methods were based on the spatial models for the background to detect the anomaly targets. However, in detecting the spectral anomaly targets, they led to two problems: 1) the spatial characteristics of spectral anomaly targets are not obvious, which causes many false alarms in detection and 2) spectral anomaly usually occurs in the local band of targets, while the rest of the spectrum is similar to the ones of surrounding backgrounds, which leads to missed detection. This article proposes a novel hyperspectral anomaly detection method for spectral anomaly targets based on spatial and spectral constraints (SASCs). This model finds suspected anomaly target part as spatial anomaly results through SASCs. Then, the feedback process determines the spectral anomaly through the spectral difference between the tested pixel and the surrounding background. It is fed back to the spatial anomaly results to obtain final detection results. Furthermore, in order to enlarge the spectral difference between anomaly and background while suppressing the background, the optimal order of fractional Fourier transform (FrFT) is determined by combining spatial anomaly results with the uncertainty principle, which is used in FrFT of HSI. Experimental results show that the proposed method suppresses the background and reduces the false alarm rate. The feedback mechanism effectively reduces the missing detection rate, achieving a promising detection accuracy.

With the wide application of deep learning (DL), change detection (CD) for remote sensing images (RSIs) has realized the leap from the traditional to the intelligent methods. However, many existing methods still need further improvement in practical applications, especially in increasing the effectiveness of feature extraction and reducing model computational cost. In this paper, we propose a novel deep multiscale Siamese network with parallel convolutional structure (PCS) and self-attention (SA) (MSPSNet), which has excellent capabilities of feature extraction and feature integration under an acceptable consumption. It mainly contains three subnetworks: deep multiscale feature extraction, feature integration by the PCS, and feature refinement based on the SA. In the first subnetwork, a deep multiscale Siamese network based on convolutional block is designed to depict image features at different scales for different temporal images. In the subsequent subnetworks, a PCS model is proposed to integrate multiscale features of different temporal images, and then, a SA model is constructed to further enhance the representation of image information. Experiments are conducted on two public RSIs datasets, indicating that the proposed framework performs well in detecting changes.

Anomaly detection is a hot topic in the field of hyperspectral image processing, which aims to find anomalous targets through spatial and spectral differences from a complex background. However, there still remains two unsolved problems in anomaly detection methods: i) since the global image covers more complex scenes, it inevitably suffers a lot of false alarms in the anomaly detection; ii) the sensitivity of the target to the global mode or the local mode detector is different. A detector that only considers one mode usually misses some targets, which makes the detection rate low. This paper proposes an anomaly detection method for hyperspectral images with potential target region extraction. The potential target region is extracted through the combination of the tensor RPCA and the curvature circle model. The obtained sub-regions are used in the region traversing method to filter out the areas not containing the target. In addition, in order to adapt to the different targets contained in the region, the proposed method combines the isolated forest of the global model and the statistical correlation of the local model, thereby enhancing the separability of the target and the background. Experimental results show that the proposed method can effectively extract potential target regions and greatly reduce the false alarm rate. Further, the proposed method can highlight the target for a higher detection rate and accuracy.

In hyperspectral image classification, deep learning (DL) based on abundant training samples has demonstrated its significance in classification performance. However, due to the limitation of available samples and the imbalance/similarity of classes in small-sized datasets, data-driven DL algorithms can hardly extract representative and effective features for interclass classification, and the subtle diagnostic spectral features for intraclass classification are easily covered or lost in the iterative feature extraction (FE). The restricted FE of interclass/intraclass results in the accuracy reduction and performance limitation of refined classification. To mitigate these issues, an attention network with multiscale receptive fields (MRFs) is proposed, embedding an inversion subnet for relative water content retrieval (RWCR). In classification, the three critical parts in the proposed network, namely, MRFs, embedded subnet, and multiple-attention mechanism, are responsible for multiscale feature merging, relative water content (RWC) feature enhancement, and paying attention to bands, channels, and multiscale features, respectively. The ablation studies on small-sized datasets show the accuracy improvements of interclass and intraclass in refined classification, which verifies the effectiveness of critical parts for extracting representative features and taking RWC features as the diagnostic biochemical signature from unbalanced and similar classes. The comparison results with typical DL models demonstrate the superiority of the proposed network. Moreover, the competitive advantage of the proposed network is demonstrated in comparison with traditional and state-of-the-art HSI classification methods.

Cloud contamination is a common phenomenon in the optical remote sensing field, which limits their application in land surface studies and causes the waste of satellite images. This letter presents a new framework for removing thin clouds from visible images based on multiscale dark channel prior (MDCP). The cloud removal of cloudy images (target images) is carried out with the assistance of a different temporal cloudless image (reference image) from the perspective view of multiscale transform (MST). In order to make it more suitable for the application of thin cloud removal, two improvements are made to this traditional fusion method. For one thing, a dark channel prior module is integrated into the low-frequency component of the target image in the framework of MST. For another, we choose the weighted average for high-frequency components and sparse representation (SR) for low-frequency components as fusion rules. After the fusion process, the modified Laplacian sharpening whose model is optimized is carried out. The performance of MDCP was evaluated with both simulated and real cloudy images. Experimental results show that the proposed MDCP has a good performance.

Due to the difficulty and time-consuming of labeling ground truth map in practical situations, unsupervised multiple change detection (MCD) for multispectral images (MSIs) have attracted much attention in recent years. One possible strategy to obtain multiple changes is to assign labels to the binary change result. However, some methods are difficult to obtain the accurate binary result because of the complexity of backgrounds; moreover, assigning labels is also a challenge owing to the limitation of the number of spectral channels in MSIs. Therefore, we propose a novel unsupervised MCD framework based on auto-updating multitemporal matrix factorization (AMMF) and spatiospectral channel augmentation (SSCA). In AMMF, the accurate binary change result can be detected based on joint matrix factorization, during which the distribution and subspace information of each temporal image are regularized to encode the spatiotemporal correlation. In SSCA, some novel augmentation strategies are introduced to increase the number of channels in MSIs to form the normalized high-dimensional maps for each temporal image based on nonlinear operations and convolutional sparse analysis, respectively. MCD can be achieved by integrating the binary change result and directional information that can be calculated by high-dimensional maps of different temporal images. Experiments are conducted on two real MSIs, indicating that the proposed framework performs well in detecting multiple changes.

PURPOSE Growing evidence proved the efficacy of multi-parametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) is highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer. METHODS One hundred twelve suspicious PCa patients were enrolled from September 2020 to June 2021. Patients with anyone of positive dual-tracer PET/CT or mpMRI underwent TB, and all enrolled patients underwent systematic biopsy (SB) after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. McNemar's tests and Bonferroni correction in multiple comparisons were used to compare the primary and secondary outcomes. RESULTS In 112 men, clinically significant PCa (grade group[GG] ≥ 2) accounted for 34.82% (39/112), and nonclinically significant PCa (GG = 1) accounted for 4.46% (5/112). 68 Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P

Summary Synthetic understanding is crucial for designing halide perovskites with controlled properties and for paving ways to create a new family of structures. With expanding synthetic approaches, it is especially necessary to elucidate the formation of halide perovskites and how that influences their associated properties to inform a unifying design principle. In this perspective, we summarize key milestones in the synthesis community of inorganic halide perovskite nanostructures and highlight how the reaction kinetics and thermodynamics of halide perovskites distinguish them from traditional inorganic semiconductors. We then present a retrospective view that conceptually unites physical chemistry theories with advanced synthesis and address lingering questions in the field along with possible solutions. This perspective aims to articulate the relation between structural properties, synthetic tunability, and the environmental stability of halide perovskites and to provide an outlook for new generations of halide perovskite nanostructures for efficient and stable devices.

Pancreatic ductal adenocarcinoma accounts for the primary type of pancreatic cancer (PC) with a 5-year survival rate of only about 10% in the United States. Early diagnosis will improve chances for curative treatment. To date, a broadly used serum marker for PC diagnosis is carbohydrate antigen 19-9, which is the only approved biomarker currently by the United States Food and Drug Administration. However, it has low specificity; therefore, development of novel biomarkers is urgently needed. Clinical trials are ongoing to evaluate candidate biomarkers for PC diagnosis, and the use of a multi-biomarker panel with current PC diagnostic biomarkers appears promising.

The outbreak of coronavirus disease 2019 (COVID‐19) has globally strained medical resources and caused significant mortality. This study was aimed to develop and validate a prediction model based on clinical features to estimate the risk of patients with COVID‐19 at admission progressing to critical patients. Patients admitted to the hospital between January 16, 2020, and March 10, 2020, were retrospectively enrolled, and they were observed for at least 14 days after admission to determine whether they developed into severe pneumonia. According to the clinical symptoms, all patients were divided into four groups: mild, normal, severe, and critical. A total of 390 patients with COVID‐19 pneumonia were identified, including 212 severe patients and 178 nonsevere patients. The least absolute shrinkage and selection operator (LASSO) regression reduced the variables in the model to 6, which are age, number of comorbidities, computed tomography severity score, lymphocyte count, aspartate aminotransferase, and albumin. The area under curve of the model in the training set is 0.898, and the specificity and sensitivity were 89.7% and 75.5%. The prediction model, nomogram might be useful to access the onset of severe and critical illness among COVID‐19 patients at admission, which is instructive for clinical diagnosis.

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas, such as hypopharyngeal carcinoma with thoracic esophageal carcinoma. However, neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients. CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case, and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up. Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively. CONCLUSION For selected patients, local random flaps (with a split thickness skin graft) can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis, especially when the necrosis extends below the thoracic inlet.

Previous studies on the association of insomnia with body mass index (BMI) have been controversial. Physiological hyperarousal, the key pathological mechanism of insomnia, may be an important reason for different findings. We explored whether insomnia with physiological hyperarousal measured by the multiple sleep latency test (MSLT) is associated with body-weight differences. A total of 185 normal sleepers and 440 insomniacs were included in this study. Insomnia was defined by standard diagnostic criteria with symptoms lasting ≥6 months. All subjects underwent one night of laboratory polysomnography followed by a standard MSLT. We used the median MSLT value (i.e., ≥14 min) to define physiological hyperarousal. BMI was based on measured height (cm) and weight (kg) during the subjects’ sleep laboratory visit. BMI > 25 kg/m2 was defined as overweight, while BMI 2 was defined as underweight. After controlling for confounders, the odds of lower weight rather than overweight were significantly increased among insomnia patients with increased MSLT: insomnia with MSLT 14–17 min and MSLT > 17 min increased the odds of lower weight by approximately 89% (OR = 1.89, 95% CI 1.00–4.85) and 273% (OR = 3.73, 95% CI 1.51–9.22) compared with normal sleepers, respectively. In contrast, insomnia in patients with MSLT 11–14 min and 8–11 min was not different from normal sleepers in terms of body weight. Insomnia associated with physiological hyperarousal, the most severe phenotype of chronic insomnia, is associated with higher odds of lower weight and underweight compared with normal sleepers. This is a novel finding consistent with previous physiologic data and has significant clinical implications.

The richness of spectral information in multitemporal hyperspectral images (MHSIs) offers the possibility to effectively detect subtle changes and properties of grounds. However, severe spectral variabilities and inadequate spatial co-exploitation capabilities limit the performance of existing methods due to differences in acquisition times and conditions. Therefore, this article proposes a strategy of joint unmixing and multitemporal spatial information coguidance (JUC) to fully exploit the spatio-temporal-spectral features. First, a multitemporal joint unmixing method is used to achieve endmembers’ extraction and abundance estimation. Wherein the method adds spectral perturbed regularization when compared to the traditional unmixing strategy, making it robust to spectral variability. Second, we propose a multitemporal coguidance method that highlights the contrast between changed and unchanged regions and removes the noise by transferring the common structure information between the multitemporal first principal component map and the abundance difference maps. It will obtain an enhanced abundance difference maps and achieve effective combination of multitemporal spatial information. The final change result can be obtained by combining and thresholding these enhanced abundance difference maps. Experiments on some data sets demonstrate that the proposed algorithm is sufficiently valid and robust for multitemporal images, especially for data containing spectral variabilities and obvious structures.

Purpose This study aims to examine a topic of growing significance to hospitality and tourism scholars and practitioners – how emerging technologies can fulfill accessible hospitality and tourism services for people with disabilities. Design/methodology/approach A systematic review of the literature based on the Web of Science database and qualitative research were conducted. Specifically, bibliometric analysis and thematic analyzes of expert interviews were used. The obtained views from experts in the field further validated and enriched the obtained findings. Findings The primary topics of exploration in existing literature were identified, such as social networks and data-empowered services. The potential areas of further advances are also revealed such as the need for cross-country collaborations and potential gaps between scholarly and practitioner interest in the topic. Research limitations/implications This research is limited by the scope of adopted search keywords and databases. Practical implications This study offers vital practical implications for the future integration of emerging technologies to fulfill accessible hospitality and tourism. It also demonstrates the pressing need for more interconnected global collaborations for this important initiative. Social implications This study emphasizes how the hospitality and tourism industry could better leverage technological power to empower people with disabilities. It also points out the importance of an inclusive process for technology implementation for accessible hospitality and tourism services to fully represent the interests of disabled customers (including the consideration of their different backgrounds). Originality/value This study sheds light on the future research directions of technological empowerment of accessible hospitality/tourism. It also makes methodological contributions by demonstrating what bibliometric analysis has to offer to relevant fields of studies. The solicited views of experts in the field from different countries on the topic further add to the depth and value of the findings while demonstrating the combination of these two approaches as a promising mixed-methods route to produce richer and more robust findings.

Background His-Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). Methods A Bayesian random-effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until 21 September 2021. Results Twenty-eight studies involving 4,160 patients were included in this meta-analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R-wave amplitude compared with HBP. LBBP also demonstrated a non-significant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all-cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rate, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. Conclusions This network meta-analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger-scale, long-term comparative studies are warranted for further verification. This article is protected by copyright. All rights reserved.

Videoconferencing focus groups have emerged as a popular method for collecting qualitative data. However, its use in sexual and reproductive health research is still very much in its infancy. Based on participants’ feedback and researchers’ reflections on using videoconferencing focus groups to collect sexual and reproductive health data with 39 heterosexual and non-heterosexual Chinese im/migrants in Australia, we discuss some of the key lessons learned, and considerations involved in shifting from face-to-face to online focus groups. Overall, videoconferencing focus groups appeared to be a highly feasible and acceptable way to discuss “sensitive” topics with Chinese im/migrants. Importantly, researchers need to be both creative and reflexive during the research process and must not forget that the success of a study lies not only in troubleshooting technical issues but also in cultivating and maintaining a trusting relationship with research participants.

PurposeAlthough leader humility is generally considered a positive leadership behavior, this study aims to examine when the positive influences of leader humility are likely weakened.Design/methodology/approachData were collected from a two-wave survey. Ordinary least squares regression analyses were conducted to test the hypotheses.FindingsAlthough leader humility is positively related to perceived leader support, this relationship is weakened when the environment is uncertain, resulting in comparatively lower follower performance.Practical implicationsLeaders should be aware that environmental constraints may weaken the desired outcomes of humility and therefore adapt leadership to situational needs.Originality/valueContrasting to predominant research on leader humility, this study examines a critical boundary condition by which its positive influences are compromised. In light of the disruption caused by the ongoing COVID-19, this study suggests that what usually are considered positive characteristics of leader humility are likely perceived as little leader support when the environment is uncertain. Findings of this study echo contingency leadership theories, which suggest that effective leadership should be context-dependent.

The sharing city is a normative framework for sharing resources collaboratively, fairly, and sustainably. Because many sharing practices require some face-to-face interactions, the Covid-19 pandemic has impacted these practices in unprecedented ways. This article aims to assess how Covid-19 has impacted sharing activities and practices and discusses these impacts focusing on four key points: (i) the enduring alternative of sharing in the commons;(ii) the uneven adaption of sharing practices;(iii) the rise of digital surveillance;and (iv) the civic delight of sharing. The article concludes with a reaffirmation that despite the challenges presented by the pandemic on the sharing city project, there is no better time than the present to accelerate the momentum of rediscovering and redefining sharing systems in cities. In short – the Sharing City will not wither. © 2021. All Rights Reserved.

Acquiring training samples in remote sensing images is always expensive and time-consuming. As a consequence, it would be preferable if one domain without training samples (the target domain) could be classified given a priori knowledge from another domain (the source domain). In this letter, an iterative training sample updating (ITSU) approach is proposed based on a posteriori spatial feature extraction. First, the classifier is trained with initial training samples from the source domain and applied to the target domain, producing a preclassification map. Then, as an invariant feature, the a posteriori spatial features are extracted with a guided filter. Based on the spectral features and the a posteriori spatial features, a criterion measuring the similarity of the cross-domain samples is defined. New training samples from the target domain are assigned with pseudo-labels, and the original samples in the source domain are removed. Furthermore, the a posteriori spatial feature maps are fed back to the input images, and new classifiers are trained with an updated training sample set in the updated feature space. This procedure is repeated until the stopping rule is satisfied. Finally, the adapted classifier is obtained based on the updated training samples. The experimental results on three hyperspectral data sets indicated that ITSU achieved the best performance compared with the other two state-of-the-art methods.

The hospitality industry increasingly adopted well-being practices. However, academic literature has neglected to understand how hospitality organizations design services to improve well-being for customers, employees, communities, and societal and environmental well-being. This paper develops a novel concept, Transformative Hospitality Services (THS), which emanates from an ecosystem view and considers hospitality services as holding the possibility to transform the well-being of various constituents. Building on insights from in-depth interviews with industry experts, this paper identifies organizational dimensions that foster hospitality organizations’ transformative services offerings. Data also reveal facilitators and barriers for hospitality organizations to consider when developing THS offerings. A four-stage journey map is proposed to assess hospitality organizations’ journey towards becoming more transformative. As a result, this research presents contributions to transformative service research by advancing the concept of THS. Additionally, this research offers practical guidance for hospitality organizations through the development of the THS dimensions and journey map.

Intense green emission is extremely significant to the color rendering index (CRI) of white LEDs. Various green-emitting YLuAG:Ce phosphor ceramics were successfully prepared by vacuum sintering. The effects of Lu3+ doping on structure and luminescence property were investigated in detail. In comparison with YAG:Ce, YLuAG:Ce ceramics own smaller grain size, better luminescence performance and higher thermal stability. The photoluminescence (PL) intensity of YLuAG:Ce ceramics increases by 23.6 % due to the “light scattering enhanced effect”. Furthermore, the Ce3+ emission is obviously blue-shifting from 533 nm to 519 nm, and the intensity of YLuAG:Ce ceramics reduces only about 8.9 % at 250 °C, showing better thermal stability (vs 11.1 % of YAG:Ce). The LE of LED packaged by YLuAG:Ce ceramic is up to 148.88 lm/W when the doping Lu3+ y is 2.1. The above results show that tailored YLuAG:Ce phosphor ceramic is a potential green-emitting color converter for high-power LEDs (hp-LEDs).

Background Little is known about the targets in the CNS that mediate ethanol analgesia. This study explores the role of spinal astrocyte aldehyde dehydrogenase-2 (ALDH2), a key ethanol-metabolising enzyme, in the analgesic effects of ethanol in mice. Methods Astrocyte and hepatocyte ALHD2-deficient mice were generated and tested in acute and chronic pain models. Cell-type-specific distribution of ALDH2 was analysed by RNA in situ hybridisation in spinal slices from astrocytic ALDH2-deficient mice and their wild-type littermates. Spinal ethanol metabolites and γ-aminobutyric acid (GABA) content were measured using gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Results ALDH2 mRNA was expressed in both astrocytes and neurones in spinal cord slices. Astrocyte ALDH2-deficient mice had decreased expression of ALDH2 mRNA in astrocytes, but not in neurones. Astrocyte ALDH2 deficiency inhibited ethanol-derived acetate, but not acetaldehyde content in spinal cord tissues. Depletion of spinal astrocyte ALDH2 selectively inhibited ethanol-induced anti-nociceptive effect, but not the effect of ethanol, on motor function. Astrocyte ALDH2 deficiency abolished ethanol-induced GABA elevation. The ethanol metabolite acetate produced anti-nociception and increased GABA synthesis in a manner similar to ethanol. I.T. delivery of either GABAA or GABAB receptor antagonists prevented ethanol and acetate-induced analgesia. Conclusions These findings provide evidence that ALDH2 in spinal astrocytes mediates spinal ethanol metabolism and ethanol-induced analgesic effects by promoting GABA synthesis and GABAergic transmission in spinal cord.

Objective Chronic obstructive pulmonary disease (COPD) can be prevented and treated, although presenting with persistent airflow restriction; the airflow restriction caused by COPD is mostly progressive. In recent years, more attention has been paid to the home-based pulmonary rehabilitation (PR) and its influence on COPD. Exercise training is the basic constituent of PR. However, it is not clear which exercise trainings are the ideal ways to deliver home-based PR. Methods In this review, we focus on the effect of home-based exercise training on patients with COPD. We searched literature, which was necessarily required to be randomized controlled trails (RCTs) from the establishment of the four respective databases (Medline, PubMed, Web of Science, and China National Knowledge Infrastructure) from January 2008 to January 2018. We used the Cochrane collaborative “risk of bias” tool to assess the quality of evidence. A total of 21 trials (1694 participants) were included. Through the analysis of the literature, we find that a simple, low-cost, and low-intensity family-based lung-rehabilitation plan to adapt to the real life may lead to the improvement of the ability to exercise, the reduction of the difficulty in breathing, and the improvement of carrying out daily activities. Results In the exercise training of home-based PR, lower limb exercise (LLE) training demonstrated a more perceptible effect in improving the quality of life of patients with COPD. At the same time, the combination of LLE training, breathing training, and upper limb exercise training is more obvious than the simple LLE training. In addition, home-based low-intensity aerobic training may sometimes be no less than the outpatient or center intervention to improve dyspnea, health status, and exercise tolerance. In conclusion, the simple and easy home-based PR exercise program is useful. Long-term home-based PR may require an enhanced need for maintenance. Conclusions A simple, low-cost, and low-intensity high blood pressure response (HBPR) plan to adapt to the real life may lead to an augmentation in the ability to exercise, a reduction of the difficulty in breathing, and an improvement in carrying out day-to-day activities. HBPR strategies can benefit patients (elderly patients with COPD at home) in the long term.

Vaginal structural defects are involved in pelvic organ prolapse (POP). We tested whether mesenchymal stem cell (MSC) therapy can repair the weakened vaginal wall of POP patients as a novel POP treatment. Ninety-six ovariectomized rats were divided into 4 groups (n = 24/group): saline (sal), collagen (col), sal + MSC, and col + MSC groups. Two weeks after ovariectomy, rats received subepithelial injection of 0.3 ml saline, 0.3 ml collagen I gel, and 0.3 ml saline: 3 × 106 human umbilical cord mesenchymal stem cells (HUMSCs), or 0.3 ml collagen I gel: 3 × 106 HUMSCs into the anterior vaginal wall. Eight additional rats underwent in vivo bioluminescence imaging (BLI) to evaluate in vivo cell viability. The BLI signal disappeared within 1 week after MSC injection, and no in vivo MSC differentiation was found. Collagen I content was significantly lower at 4 and 12 weeks in the two MSC groups than in the sal and col groups, while collagen III was significantly higher (P

The objective of this study was to explore a new method for the differential diagnosis between fetal double aortic arch (DAA) and right aortic arch with mirror-image branches (RAA-MB). Clinical data and prenatal echocardiographic features of the DAA (n = 22) and RAA-MB (n = 65) confirmed by postnatal or autopsy findings were analyzed retrospectively. The angles between the two aortic arches in the DAA group and between the right aortic arch and the mirror branch were measured. The differences between the two groups and differential diagnosis value of the angles were compared and analyzed based on the receiver operating characteristic curve. The proportion of left-sided ductal arteriosus (100%) was higher in the DAA group than that (32.3%) in the RAA-MB group, (P

Aims Studies examining the prevalence of and factors associated with switching from sulphonylureas (SUs) to dipeptidyl peptidase 4 (DPP-4) inhibitors in real-world settings are lacking. We assessed the factors associated with switching from SUs to DPP-4 inhibitors in the United States. Materials and methods This retrospective cohort study was conducted using the Optum Clinformatics® Data Mart (2009-2018). Adults with type 2 diabetes and newly prescribed at least two SUs were included and were followed for 2 years after the initiation of SU (index date). We compared the characteristics of those who switched from SUs to DPP-4 inhibitors (only; no additional antidiabetic drugs) with those who continued with SUs (without adding other antidiabetic drugs) using multivariate logistic regression. Multinomial regression analyses were also conducted to assess the factors associated with switching to different drug classes versus continuation with SUs. Results In a sample of 119 107 new SU users, 2.2% (2633) switched to DPP-4 inhibitors, 3.8% (4542) switched to antidiabetic drugs other than DPP-4 inhibitors, 68.3% (81 394) discontinued SUs but did not switch to another antidiabetic drug, 12.9% (15 345) continued with SUs and added other antidiabetic drugs, and 12.8% (15 193) continued with SUs only. Multivariate logistic regression showed that those who had significantly higher likelihood of switching were younger, female [vs. males; adjusted odds ratio (AOR) = 0.70], and living in the south; had previous use of DPP-4 inhibitors (AOR = 1.71); were not using antidiabetic drugs at baseline; had more baseline diabetes-related emergency room visits (AOR = 1.13), depression (AOR = 1.34), post-index hypoglycaemia (AOR = 2.20), and an earlier index year; and were glyburide users (vs. glimepiride users; AOR = 1.29). Conclusions The discontinuation rate for SUs is high. Factors associated with switching from SUs to DPP-4 inhibitors included age, sex, geographic region, baseline antidiabetic drug use, type of SU, baseline diabetes-related emergency room visits, hypoglycaemia and depression.

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-010-69156114Email jiaoli_569@163.comObjective: The present study aimed to explore the relationship between non-alcoholic fatty liver disease (NAFLD) and abdominal and pericardial adipose tissue in middle-aged and elderly subjects.Methods: Between July 2019 and July 2020, 471 subjects attending the Health Care Medical Department of Peking Union Medical College Hospital for a medical examination were enrolled in the study. The volume and distribution of abdominal adipose tissue together with the volume of pericardial adipose tissue were calculated according to the results of the abdominal computed tomography. The differences between subjects with NAFLD and the normal population were analyzed.Results: The volume of pericardial adipose tissue, abdominal visceral and subcutaneous adipose tissue, the total volume of abdominal adipose tissue, and volume of pelvic visceral adipose tissue were all significantly increased in subjects with NAFLD. For every 100 cm3 increase in the volume of abdominal visceral adipose tissue, the incidence of developing NAFLD increased by 9.4%. According to the results of the receiver operating curve, the cut-off point of abdominal visceral adipose tissue for the diagnosis of NAFLD was 2691.1 cm3.Conclusion: Overall, the risk of NAFLD increases significantly with the increase in the volume of adipose tissue.Keywords: fatty liver, abdominal adipose tissue, abdominal visceral adipose tissue, abdominal subcutaneous adipose tissue

In this article, the three-dimensional (3-D) surface reconstruction techniques of space targets were studied with a multiple-input-multiple-output (MIMO) linear array in the terahertz band. Conventional wavenumber domain integration-based reconstruction algorithm is unable to accurately reconstruct the continuous surfaces owing to the fixed step length in the range direction. To overcome this shortcoming, a phase unwrapping-free multilayer wideband frequency interferometry algorithm (MWFIA) was proposed. The MWFIA divides the targets into several layers based on the range resolution corresponding to the bandwidth of interference phase images, which can achieve surface reconstruction of targets with arbitrary varying range of distance. Besides, to ensure a satisfactory reconstruction accuracy under low signal-to-noise ratio environments, the interference phase errors introduced by noise are greatly suppressed by performing interference phase extraction between wideband two-dimensional imaging results of adjacent center frequency points. Both simulation and experimental results in the 0.22 THz band were provided to demonstrate the performance of the proposed method in comparison with those of the wavenumber domain integration-based and the previous frequency interferometry-based surface reconstruction techniques.

Smart hospitals are important components of smart cities. An intelligent medical system for brain tumor segmentation is required to construct smart hospitals. To achieve intelligent brain tumor segmentation, morphological variety and serious category imbalance must be managed effectively. Conventional deep neural networks have difficulty in predicting high-accuracy segmentation images due to these issues. To solve these problems, we propose using multimodal brain tumor images combined with the UNET and LSTM models to construct a new network structure with a mixed loss function to solve sample imbalance and describe an intelligent segmentation process to identify brain tumors. To verify the practicability of this algorithm, we used the open source Brain Tumor Segmentation Challenge dataset to train and verify the proposed network. We obtained DSCs of 0.91, 0.82, and 0.80; sensitivities of 0.93, 0.85, and 0.82; and specificities of 0.99, 0.99, and 0.98 in three tumor regions, including the whole tumor ( WT ), tumor core ( TC ), and enhanced tumor ( ET ). We also compared the results of the proposed network with those of other brain tumor segmentation methods, and the results showed that the proposed algorithm could segment different tumor lesions more accurately, highlighting its potential application value in the clinical diagnosis of brain tumors.

Introduction Post-operative visceral pain is common in early postoperative period after laparoscopic surgery. As a kappa opioid receptor agonist, the antinociceptive effects of nalbuphine in visceral pain are consistent across a multitude of experimental conditions irrespective of species. We hypothesized that preemptive nalbuphine can decrease the visceral pain for patients with incisional infiltration of ropivacaine after laparoscopic cholecystectomy. Methods In a multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial, 2094 participants scheduled for laparoscopic cholecystectomy were randomly assigned to receive nalbuphine (Nal group, n = 1029) or placebo (Con group, n = 1027). The Nal group received intravenous nalbuphine 0.2 mg·kg-1 and the Con group received saline in a similar way. The primary endpoint was the effect of nalbuphine on post-operative visceral pain intensity scores within 24 h postoperatively. The total amount of analgesic as well as complications were recorded. Results A total of 1934 participants were analyzed. Nalbuphine reduced the visceral pain both at rest (β = - 0.1189, 95% CI - 0.23 to - 0.01, P = 0.037) and movement (β = - 0.1076, 95% CI - 0.21 to - 0.01, P = 0.040) compared with placebo. Patients in the Nal group required less frequent supplemental analgesic administration during the first 24 h after surgery. There were fewer patients in the Nal group who experienced nausea and vomiting (PONV) (P = 0.008). Conclusions Preemptive nalbuphine administered at a dose of 0.2 mg·kg-1 was safe and effective at reducing the postoperative visceral pain and supplemental analgesic use in patients undergoing laparoscopic cholecystectomy. Trial registration Chinese Clinical Trial Registry; ChiCTR1800014379.

Objective: To study the long-term outcomes of laparoscopically assisted uterovaginal canalization and vaginoplasty in patients with congenital cervical and vaginal atresia and to introduce the surgery step-by-step.Methods: A prospective observational study was conducted including 10 patients diagnosed with congenital cervical and vaginal atresia underwent laparoscopically assisted cervicovaginal canalization between January 2016 and Jun 2020 in a tertiary teaching hospital. Clinical characteristics and perioperative data were recorded. Patients were followed up in outpatient clinic at 3, 6 and 12 months postoperatively, and once a year thereafter. Menstruation cycles and degree of dysmenorrhea were recorded. Gynecological examination was performed to measure vaginal length and to examine whether there was restenosis.Results: All procedures went smoothly, with no case requiring conversion to laparotomy or no intraoperative complications occurred. Postoperative febrile morbidity occurred in one patient (1/10, 10%). The median (quartile) follow-up time was 26.0 (21.3, 48.3) months. All patients resumed menstruation, including nine patients (9/10, 90%) with regular monthly menstruation. Eight patients (8/10, 80%) experienced mild-to-moderate dysmenorrhea; the remaining 2 patients (2/10, 20%) had no dysmenorrhea. Cervical restenosis occurred in one patient (1/10,10%) 12 months postoperatively, and cervical dilation was performed. So far, eight months after the second surgery, no restenosis has been found. The mean postoperative vaginal length was 7.9 ± 1.3 cm by the time of last follow up. Only one patient prepared for pregnancy for two years, but she had not conceived yet.Conclusion: Laparoscopically assisted uterovaginal canalization and vaginoplasty is an easy, safe and promising management option for correcting congenital cervical and vaginal atresia.

A spectral–spatial (SS) hyperspectral classifier generally implements a spectral classifier (SC) followed by a spatial filter (SF) for classification. This article develops a new approach to fusing multiple SC-SF classifiers for hyperspectral image classification (HSIC) as to improve classification performance. To accomplish this goal an iterative process is particularly designed to fuse the spatial-filtered classification maps (SFMaps) produced by each of SC-SF classifiers into one single SFMap via maximum a posteriori (MAP) criterion. Such fused SFMaps are then fed back and added to the current data cube to create a new data set for next round SC-SF classifier fusion. The same process is repeated iteratively until it satisfies an automatic stopping rule. To further fuse more than two SS methods, two approaches are also developed, called simultaneous multiple SC-SF fusion (SMSSF) method and progressive multiple SC-SF fusion (PMSSF) method. Experimental results demonstrate that fusing multiple SC-SF classifiers can indeed perform better than using an individual single SC-SF classifier alone without fusion.

Purpose Conditional survival (CS) and failure hazard estimations can provide important dynamic prognostic information for clinical decision‐making and surveillance counseling. The current study aimed to investigate the CS and dynamic failure hazard in non‐metastatic nasopharyngeal carcinoma (NPC) treated with intensity‐modulated radiotherapy (IMRT). Methods Conditional overall survival (COS) and progression‐free survival (CPFS) estimates adjusted for age and gender against each AJCC 8th stage were calculated. Multivariable Cox regression (MCR) models were fitted in the entire population at baseline and subsequently separate MCR models were fitted in patients who have maintained event‐free time of 1 to 10 years to generate respective hazard ratio (HR). Annual hazard rates of death and progression over 10 years for each stage were also estimated. Results A total of 1993 patients were eligible for analysis. The estimated 5‐year OS and PFS for entire cohort were 79.0% and 70.7% at initial diagnosis. After 5 years of event‐free follow‐up, additional 5‐year COS and CPFS increased to 85.9% and 85.5%, respectively. Stage I/II maintained dramatically favorable CS and low hazard (< 5%) of death and progression over time. Relative to stage I/II, stage III manifested non‐significantly higher failure hazard for the first 3 years of survivorship and approached to similar level of stage I/II afterwards. Stage IVA presented most impressive improvement in terms of both COS (∆=9.8%) and CPFS (∆ = 16.8%) whereas still drastically inferior to that of stage I‐III across all conditional time points. After 4 years of follow‐up, progression hazard of stage IVA became relatively steady of approximate 6%. Conclusions Survival prospect of non‐metastatic NPC improves over years with distinct dynamic patterns across stages, providing important implications for personalized decision‐making in terms of both clinical management and surveillance counseling. Stage‐dependent and hazard‐adapted clinical management and surveillance are warranted., This study aimed to investigate the conditional survival (CS) and dynamic failure hazard in non‐metastatic nasopharyngeal carcinoma (NPC) treated with intensity‐modulated radiotherapy (IMRT). Survival prospect of non‐metastatic NPC improved over years with distinct dynamic patterns across stage, providing important implications for personalized decision‐making in terms of both clinical management and surveillance counseling. Stage‐dependent and hazard‐adapted clinical management and surveillance are warranted.

Background and purpose Deformable image registration (DIR) is an important component for dose accumulation and associated clinical outcome evaluation in radiotherapy. However, as an ill-posed problem, the resulting deformation vector field (DVF) is subject to unavoidable discrepancies when different algorithms are applied, leading to dosimetric uncertainties of the accumulated dose. We propose here an approach for proton therapy to estimate dosimetric uncertainties as a consequence of modeled or estimated DVF uncertainties. Materials and methods A patient-specific DVF uncertainty model was built on the first treatment fraction, by correlating the magnitude differences of five DIR results at each voxel to the magnitude of any single reference DIR. In the following fractions, only the reference DIR needs to be applied, and DVF geometric uncertainties were estimated by this model. The associated dosimetric uncertainties were then derived by considering the estimated geometric DVF uncertainty, the dose gradient of fractional recalculated dose distribution and the direction factor from the applied reference DIR of this fraction. This estimated dose uncertainty was respectively compared to the reference dose uncertainty when different DIRs were applied individually for each dose warping. This approach was validated on seven NSCLC patients, each with nine repeated CTs. Results The proposed model-based method is able to achieve dose uncertainty distribution on a conservative voxel-to-voxel comparison within ±5% of the prescribed dose to the 'reference' dosimetric uncertainty, for 77% of the voxels in the body and 66-98% of voxels in investigated structures. Conclusion We propose a method to estimate DIR induced uncertainties in dose accumulation for proton therapy of lung tumor treatments.

Background Recurrent infections of animal hosts with avian influenza viruses (AIVs) have posted a persistent threat. It is very important to understand the avian influenza virus distribution and characteristics in environment associated with poultry and wild bird. The aim of this study was to analyze the geographic and seasonal distributions of AIVs in the 31 provinces, municipalities and autonomous region (PMA) of China, compare the AIVs prevalence in different collecting sites and sampling types, analyze the diversity of AIVs subtypes in environment. Methods A total of 742 005 environmental samples were collected from environmental samples related to poultry and wild birds in different locations in the mainland of China during 2014–2018. Viral RNA was extracted from the environmental samples. Real-time RT-PCR assays for influenza A, H5, H7 and H9 subtypes were performed on all the samples to identify subtypes of influenza virus. The nucleic acid of influenza A-positive samples were inoculated into embryonated chicken eggs for virus isolation. Whole-genome sequencing was then performed on Illumina platform. SPSS software was used to paired t test for the statistical analysis. ArcGIS was used for drawing map. Graphpad Prism was used to make graph. Results The nucleic acid positivity rate of influenza A, H5, H7 and H9 subtypes displayed the different characteristics of geographic distribution. The nucleic acid positivity rates of influenza A were particularly high (25.96%–45.51%) in eleven provinces covered the Central, Eastern, Southern, Southwest and Northwest of China. The nucleic acid positivity rates of H5 were significantly high (11.42%–13.79%) in two provinces and one municipality covered the Southwest and Central of China. The nucleic acid positivity rates of H7 were up to 4% in five provinces covered the Eastern and Central of China. The nucleic acid positivity rates of H9 were higher (13.07%–2.07%) in eleven PMA covered the Southern, Eastern, Central, Southwest and Northwest of China. The nucleic acid positivity rate of influenza A, H5, H7 and H9 showed the same seasonality. The highest nucleic acid positivity rates of influenza A, H5, H7, H9 subtypes were detected in December and January and lowest from May to September. Significant higher nucleic acid positivity rate of influenza A, H5, H7 and H9 were detected in samples collected from live poultry markets (LPM) (30.42%, 5.59%, 4.26%, 17.78%) and poultry slaughterhouses (22.96%, 4.2%, 2.08%, 12.63%). Environmental samples that were collected from sewage and chopping boards had significantly higher nucleic acid positivity rates for influenza A (36.58% and 33.1%), H5 (10.22% and 7.29%), H7(4.24% and 5.69%)and H9(21.62% and 18.75%). Multiple subtypes of AIVs including nine hemagglutinin (HA) and seven neuraminidase (NA) subtypes were isolated form the environmental samples. The H5, H7, and H9 subtypes accounted for the majority of AIVs in environment. Conclusions In this study, we found the avian influenza viruses characteristics of geographic distribution, seasonality, location, samples types, proved that multiple subtypes of AIVs continuously coexisted in the environment associated with poultry and wild bird, highlighted the need for environmental surveillance in China. Graphic Abstract

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86 10 69157229Email li_jiao24@163.comObjective: The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population.Methods: The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages.Results: The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age.Conclusion: 1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.Keywords: middle-aged and elderly, abdominal fat, pericardial fat, psoas major muscle, age, gender

The aim of this study was to compare the effect of Gap Balancing (GB) versus Measured Resection (MR) techniques on the early clinical and radiological results of Total Knee Arthroplasty (TKA).In this prospective study, 99 patients (99 knees) who underwent unilateral TKA between March 2018 and January 2019 were randomly allocated to one of two groups: The GP group, TKA with GB technique (19 male, 31 female; mean age = 55.9 ±16.5) and the MR group, TKA with MR technique (19 male, 30 female; mean age = 54.2 ± 18.7). Patients in both groups were comparable in terms of the demographic and clinical data. The angle of cutting block to PCA and Cutting Thickness of the Medial and Lateral Condyle (CTMC, CTLC) were intraoperatively measured. In radiographic analysis, Preoperative Mechanical Femorotibial Angle (Pre-mFTA), Postoperative Mechanical Femorotibial Angle (Post-mFTA), and joint line changes were examined. Femoral component Rotation Angle (FCRA) was also measured by computed tomography. In gait analysis, the spatiotemporal parameters (walking speed, step length, and single support time) and kinematics parameters (flexion angle, extension angle, and transversal rotation) were collected at 12 months postoperatively. Furthermore, Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed at 12 months after surgery.CTMC and CTLC were both significantly higher in GB group than in the MR group (9.8±2.0 mm vs 8.5 ± 1.2 mm; 7.9 ± 1.8mm vs 6.8 ± 1.4mm; P = 0.001, P = 0.002, respectively). Angle of cutting block to PCA was statistically lower in GB group than in the MR group (1.7 ± 1.5° vs 3.1 ± 0.5 °; P0.001). FCRA is greater in the GB group compared to the MR group, but the difference did not reach statistical significance (1.2 ± 2.8 ° vs 0.7 ± 2.0 °; P0.05). Although post-mFTA significantly improved compared with pre-mFTA in both groups, no significant difference was observed in the changes of post-mFTA between the two groups (0.9 ± 1.7° vs 0.3 ± 1.8°, P0.05). No significant differences were determined between the two groups in spatiotemporal gait parameters including walking speed, step length, and single support time. The sagittal max knee flexion range was significantly larger in the GB group than in the MR group (49.27 ± 5.24 ° vs 45.99 ± 8.21 °, P0.05). The flexion range did not reach the level of the control group. There was no significant difference between the two groups in WOMAC at 12 months follow-up (P0.05).Evidence from this study has revealed GB and MR techniques have both little effect on early clinical results of TKA. Nonetheless, GB technique can provide better knee flexion in the early postoperative gait status compared with MR technique.Level I, Therapeutic Study.

sRecent evidence suggests that CD147 serves as a novel receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Blocking CD147 via anti-CD147 antibody could suppress the in vitro SARS-CoV-2 replication. Meplazumab is a humanized anti-CD147 IgG2 monoclonal antibody, which may effectively prevent SARS-CoV-2 infection in coronavirus disease 2019 (COVID-19) patients. Here, we conducted a randomized, double-blinded, placebo-controlled phase 1 trial to evaluate the safety, tolerability, and pharmacokinetics of meplazumab in healthy subjects, and an open-labeled, concurrent controlled add-on exploratory phase 2 study to determine the efficacy in COVID-19 patients. In phase 1 study, 59 subjects were enrolled and assigned to eight cohorts, and no serious treatment-emergent adverse event (TEAE) or TEAE grade ≥3 was observed. The serum and peripheral blood Cmax and area under the curve showed non-linear pharmacokinetic characteristics. No obvious relation between the incidence or titer of positive anti-drug antibody and dosage was observed in each cohort. The biodistribution study indicated that meplazumab reached lung tissue and maintained >14 days stable with the lung tissue/cardiac blood–pool ratio ranging from 0.41 to 0.32. In the exploratory phase 2 study, 17 COVID-19 patients were enrolled, and 11 hospitalized patients were involved as concurrent control. The meplazumab treatment significantly improved the discharged (P = 0.005) and case severity (P = 0.021), and reduced the time to virus negative (P = 0.045) in comparison to the control group. These results show a sound safety and tolerance of meplazumab in healthy volunteers and suggest that meplazumab could accelerate the recovery of patients from COVID-19 pneumonia with a favorable safety profile.

Anaplastic thyroid carcinoma (ATC) is a rare and highly aggressive fatal tumor. Most ATC patients using traditional surgery or radio-chemotherapy have poor prognosis and experience recurrence in a very short time. There is no optimal therapy for ATC, and the median survival time is about 5 months. We report a 67-year-old ATC patient, who experienced rapid local recurrence after radical thyroidectomy. The resected tumor tissue was sent for immunohistochemistry analysis and targeted next-generation sequencing. The results indicated high PD-L1 expression, a tumor mutation burden of 0.48 muts/Mb, microsatellite stable, and somatic mutations of TERT promoter, EIF1AX, NRAS and TP53. However, none of the mutations indicated corresponding target therapy. An immediate operation was unsuitable because of rapid recurrence after surgery. The patient was also not in a condition to tolerate chemotherapy. Based on the high expression of PD-L1, an optimum strategy was used, combining immunotherapeutic agent, sintilimab, with an anti-angiogenesis drug, anlotinib. The patient obtained remarkable tumor shrinkage and an 18.3-month-sustained remission period. This is an effective case of using immunotherapy and anti-angiogenesis agent in the first-line treatment of ATC. It demonstrates a feasible and novel therapeutic option for future treatment of ATC patients.

Objective The aim was to evaluate the voiding function and voiding dysfunction 3 months after laparoscopic uterosacral ligament suspension (LUSLS). We identified risk factors for postoperative voiding dysfunction. Study design This retrospective study included 57 women with apical prolapse who underwent LUSLS with stage II or greater apical prolapse and without advanced anterior vaginal prolapse (stage III or IV). Data were collected from electronic medical records. Voiding function was assessed by uroflowmetry, PVR examination, and self-report questionnaires (the Pelvic Floor Distress Inventory-20 and the Urinary Impact Questionnaire) at baseline and 3 months after surgery. Voiding dysfunction was defined as an average flow rate (Qave)＜10 ml/s, a maximum flow rate (Qmax)＜15 ml/s, or a postvoid residual volume (PVR)＞50 ml. Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression. Results Thirty-five percent of women suffered from voiding dysfunction preoperatively. Uroflowmetry parameters and PVR, objective symptoms including voiding difficulties, incomplete empty, frequency and urinary incontinence didn’t show significant improvement postoperatively (all p＞0.05). Low Qave was identified as an independent risk factor of post voiding dysfunction (odds ratio, 0.558; 95 % CI, 0.324−0.963). Conclusions Approximately one-third of women suffering from apical prolapse without advanced anterior vaginal wall had evidence of voiding dysfunction preoperatively. LUSLS has no obvious effect on uroflowmetry parameters and clinical symptoms.

At present, medical images have played a more and more important role in clinical treatment. Lung images provide an important reference for doctors to make a diagnosis. Especially for surgical patients, a tumor can be accurately removed based on the full cognition about its size, position, and quantity. Therefore, computer-aided diagnosis for the analysis and treatment of a lot of lung tumor images is very important. Aiming at complexity and self-adaption of image segmentation in lung tumors, this article proposed a parallel deep learning algorithm with hybrid attention mechanism for image segmentation. First, lung parenchyma was extracted via preprocessing images. Then, images were input into hybrid attention mechanism and densely connected convolutional networks (DenseNet) module, respectively, where hybrid attention mechanism consisted of a spatial attention mechanism and a channel attention mechanism. Finally, four feasible solutions were proposed for the verification through changing the convolution quantity of dense block in DenseNet. The network structure with the better performance was achieved. The experimental results prove the parallel deep learning algorithm with hybrid attention mechanism performed well in image segmentation of lung tumors, and its accuracy can reach 94.61%.

Change detection (CD) for multitemporal remote sensing images can find change trends and reveal the development patterns. However, the typical methods based on algebraic operation, image transformation, or segmentation may not yield satisfactory results due to the spectral variability and noise complexity. In a sense, it can be considered that multitemporal images are composed of unchanged and changed regions, as well as noise. In the light of this, a stepwise subtraction method for CD is proposed, based on auto-updating multitemporal matrix factorization (AMMF) and spectral constraint, to remove the unchanged regions and noise from the original images step by step. The unchanged regions are first identified by AMMF, during which the distribution and subspace information of each temporal image are regularized to encode the spatio-temporal correlation. Then, mean shift smoothness is adopted as a spectral constraint so as to remove the noise. In this way, the changed regions have been highlighted so that the change map can be obtained by a postsegmentation method. Experiments have been conducted on three multitemporal data sets, including images from Quick Bird, aerial, and GF-1, indicating that the proposed method is effective and robust, which is superior to some state-of-the-art methods.

Background: Assembly Sequence Planning (ASP) is an important stage in the process of product design and manufacturing. A reasonable assembly sequence can reduce the complexity of assembly operations, reduce the number of tools and fixtures, improve assembly efficiency, reduce assembly time, and reduce assembly costs. Methods: The purpose of this paper is to review the objective function, constraint conditions, and the solving methods of the ASP. Conclusion: The research methods can be roughly divided into three categories: graph-based method, knowledge-based method, and artificial intelligence algorithm. The advantages and disadvantages of the three methods are compared. Finally, future research is discussed, which could provide a reference for the ASP.

To evaluate the necessity of postoperative repetitive uroflowmetry and postvoid residual volume (PVR) in women with advanced anterior vaginal prolapse.Women with anterior vaginal prolapse stages III and IV who underwent surgery were included in this prospective cohort study. The surgical procedures included laparoscopic sacrocolpopexy (LSC), transvaginal mesh repair (TVM) and native tissue repair (NTR). Uroflowmetry, a PVR examination, the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire-7 (UIQ-7) were administered pre- and postoperatively. Moreover, pre- and postoperative uroflowmetry parameters were compared in women with/without an improvement in voiding difficulties according to the answer of questionnaires at one year after surgery. Paired sample t-tests, Wilcoxon signed-rank test, χ2 tests were used for analyses.A total of 85 women were included in the study, and data were available for 47 of them at 1-year follow-up. Approximately half of women with advanced anterior vaginal prolapse had symptoms of voiding dysfunction, the rate of which decreased to approximately 10% postoperatively. The UDI-6 and UIQ-7 indicated a significant improvement postoperatively from baseline (both p0.05). The PVR decreased significantly after surgery (p = 0.000). Uroflowmetry parameters remained stable within 1 year after surgery (all p＞0.05) both in the improved and unimproved groups (both p＞0.05).Symptoms of voiding dysfunction are improved significantly after surgery. Postoperative uroflowmetry appears to be unnecessary one year after pelvic floor reconstructive surgery.

Anomaly detection is a key problem in hyperspectral image (HSI) analysis with important remote sensing applications. Traditional methods for hyperspectral anomaly detection are mostly based on the distinctive statistical features of the HSIs. However, the anomaly-detection performance of these methods has been negatively impacted by two major limitations: 1) failure to consider the spatial pixel correlation and the ground-object correlation and 2) the existence of the mixing pixels caused by both lower spatial resolution and higher spectral resolution, which leads to higher false-alarm rates. In this article, these two problems are largely solved through a novel hyperspectral anomaly-detection method based on image super-resolution (SR) and spatial correlation. The proposed method encompasses two innovative ideas. First, based on the spectral variability in the anomaly targets, an extended linear mixing model can be obtained with more accurate ground-object information. Then, image SR is used to improve the spatial resolution of the HSIs by injecting the ground-object information from the mixing model. This alleviates the effect of mixed pixels on anomaly detection. Second, spatial correlation is exploited jointly with the global Reed-Xiaoli (GRX) method and the ground-object correlation detection for anomaly detection. Experimental results show that the proposed method not only effectively improves the hyperspectral spatial resolution and reduces the false-alarm rate but also increases the detectability with the spatial correlation information. Furthermore, the results for the real HSIs demonstrate that the proposed method achieves higher rates of anomaly detection with lower false-alarm rates.

OBJECTIVE To evaluate the 5-year pessary continuation rate and identify clinical risk factors associated with discontinuation in patients with symptomatic pelvic organ prolapse (POP). METHODS In this prospective observational study, 312 women with symptomatic POP received pessary treatment between November 2013 and July 2015 in Peking Union Medical College Hospital, China, a tertiary referral center. Patients were initially fitted with a ring pessary with support. Those who failed were fitted with a Gellhorn pessary. A successful pessary fitting was defined as a patient who was fitted and continued to use the pessary 2 weeks later. Patients with successful pessary fitting were followed for 5 years. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression. RESULTS In total, 265 patients (84.9%) had successful pessary fitting. After 5 years, 180 of 239 patients continued pessary use (75.3% continuation rate), with 26 lost to follow-up. The discontinuation rates decreased over time, from 8.7% at 1 year to 2.7% at 5 years. Total vaginal length