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Purpose Vessel segmentation from volumetric medical images is becoming an essential pre-step in aiding the diagnosis, guiding the therapy, and patient management for vascular-related diseases. Deep learning-based methods have drawn many attentions, but most of them did not fully utilize the multi-scale spatial information of vessels. To address this shortcoming, we propose a multi-scale network similar to the well-known multi-scale DeepMedic. It also includes a double-pathway architecture and a class-balanced loss at the voxel level (MDNet-Vb) to achieve both the computation efficiency and segmentation accuracy. Methods The proposed network consists two parallel pathways to learn the multi-scale vessel morphology. Specifically, the pathway with a normal resolution uses three-dimensional (3D) U-Net fed with small inputs to learn the local details with relatively small storage and time consumption. The pathway with a low-resolution employs 3D fully convolutional network (FCN) fed with downsampled large inputs to learn the overall spatial relationships between vessels and adjacent tissues, and the morphological information of large vessels. To cope with the class-imbalanced issue in vessel segmentation, we propose a class-balanced loss at the voxel level with uniform sampling strategy. The class-balanced loss at the voxel level re-balances the loss function with a coefficient that is inversely proportional to the normalized effective number at the voxel level of each class. The uniform sampling strategy extracts training data by sampling uniformly from two classes in every epoch. Results Our MDNet-Vb outperforms several state-of-the-art methods including ResNet, DenseNet, 3D U-Net, V-Net, and DeepMedic with the highest dice coefficients of 72.91% and 69.32% on cardiac computed tomography angiography (CTA) dataset and cerebral magnetic resonance angiography (MRA) dataset, respectively. Among four different double-pathway networks, our network (3D U-Net+3D FCN) not only has the fewest training parameters and shortest training time, but also gets competitive dice coefficients on both the CTA and MRA datasets. Compared with classical losses, our class-balanced focal loss (FL-Vb) and dice coefficient loss at the voxel level (Dsc-Vb) alleviates class imbalanced issue by improving both the sensitivity and dice coefficient on the CTA and MRA datasets. Moreover, simultaneously training on two datasets shows that our method has the highest dice coefficient of 73.06% and 65.40% on CTA and MRA datasets, respectively, outperforming the commonly used methods, such as U-Net and DeepMedic, which demonstrates the generalization potential of our network for segmenting different blood vessels. Conclusions Our MDNet-Vb method demonstrates its superiority over other state-of-the-art methods, on both cardiac CTA and cerebral MRA datasets. For the network architecture, the MDNet-Vb combined the 3D U-Net and 3D FCN, which dramatically reduces the network parameters yet maintains the segmentation accuracy. The class-balanced loss at the voxel level further improves accuracy by properly alleviating the class-imbalanced issue between different classes. In summary, MDNet-Vb is promising for vessel segmentation from various volumetric medical images.

Background Local recurrence is the main cause of death among patients with oral squamous cell carcinoma (OSCC). This study assessed near-infrared fluorescence (NIF) imaging and spectroscopy to monitor surgical margins intraoperatively for OSCC. Methods Cytological and animal experiments were first performed to confirm the feasibility of monitoring surgical margins with NIF imaging and spectroscopy. Then, 20 patients with OSCC were included in the clinical trials. At 6–8 h after 0.75 mg/kg indocyanine green (ICG) injection, all patients underwent surgery with NIF imaging. During the surgery, both NIF images and quantified fluorescence intensity were acquired to monitor the surgical margins. Results In cytological and animal experiments, the results showed it was feasible to monitor surgical margins with NIF imaging and spectroscopy. Fluorescence was detected in primary tumors in all patients. The fluorescence intensities of the tumor, peritumoral, and normal tissues were 398.863 ± 151.47, 278.52 ± 84.89, and 274.5 ± 100.93 arbitrary units (AUs), respectively (P < 0.05). The SBR of tumor to peritumoral tissue and normal tissues was computed to be 1.45 ± 0.36 and 1.56 ± 0.41, respectively. After primary tumor excision, the wounds showed abnormal fluorescence in four patients (4/20), and residual cancer cells were confirmed by pathological examination in two patients (2/20). Conclusion These findings confirmed the complementary value of NIF imaging during radical tumor resection of OSCC. Before tumor resection, we could utilize the fluorescence margin produced by ICG NIF imaging to determine the surgical margin. Moreover, after tumor blocks were removed, the status of surgical margin could also be evaluated rapidly by ICG NIF imaging of tumor bed and in vitro specimens.

Reactive oxygen species (ROS), an important molecule inducing oxidative stress in organisms, play a key role in tumorigenesis, tumor progression and recurrence. Recent findings on ROS have shown that ROS can be used to treat cancer as they accelerate the death of tumor cells. At present, pro-oxidant drugs that are intended to increase ROS levels of the tumor cells have been widely used in the clinic. However, ROS are a double-edged sword in the treatment of tumors. High levels of ROS induce not only the death of tumor cells but also oxidative damage to normal cells, especially bone marrow hemopoietic cells, which leads to bone marrow suppression and (or) other side effects, weak efficacy of tumor treatment and even threatening patients’ life. How to enhance the killing effect of ROS on tumor cells while avoiding oxidative damage to the normal cells has become an urgent issue. This study is a review of the latest progress in the role of ROS-mediated programmed death in tumor treatment and prevention and treatment of oxidative damage in bone marrow induced by ROS.

Piebaldism is a rare, autosomal dominant and congenital pigmentary disorder characterized by stable depigmentation of the skin and white forelock. Mutations in KIT or SNAI2 genes result in piebaldism. Most individuals with piebaldism have a family history of the disorder. Herein, we report a 5-month-old Chinese girl with severe piebaldism but no family history thereof. She has white forelock and large patches of depigmentation in the jaw, central anterior trunk, perineum and extremities. We performed whole-exome and Sanger sequencing and identified a de novo KIT mutation (NM_000222.2: c.2657G>A, p.Gly886Val) in exon 18 of KIT in the proband. Currently, this mutation is located in the most extreme C-terminal of the tyrosine kinase domain 2 of the KIT gene amongst all reported mutations and causes a severe clinical phenotype. We further reviewed literature on piebaldism and summarized 79 KIT gene mutations that lead to this disease. Our study may expand knowledge on the genotype-phenotype correlation in piebaldism and serve as a reference for genetic counseling and prenatal diagnosis of affected families.

BackgroundAcrodermatitis enteropathica (AE) is a rare autosomal recessive hereditary skin disease caused by mutations in the SLC39A4 gene and is characterized by periorificial dermatitis, alopecia and diarrhoea due to insufficient zinc absorption. Only one of the three known sets of twins with AE has genetic information. This case reports the discovery of new mutation sites in rare twin patients and draws some interesting conclusions by analysing the relationship between genetic information and clinical manifestations.Case presentationHere, we report a pair of 16-month-old twin boys with AE exhibiting periorificial and acral erythema, scales and blisters, while subsequent laboratory examination showed normal plasma zinc and alkaline phosphatase levels. Further Sanger sequencing demonstrated that the patients were compound heterozygous for two unreportedSLC39A4mutations: a missense mutation in exon 5 (c.926G > T), which led to a substitution of the 309th amino acid residue cysteine with phenylalanine, a splice site mutation occurring in the consensus donor site of intron 5 (c.976 + 2 T > A). A family study revealed that the boys’ parents were heterozygous carriers of these two mutations.ConclusionWe identified a new compound heterozygous mutation in Chinese twins with AE, which consisted of two previous unreported variants in exon 5 and intron 5 of SLC39A4. We propose an up-to-date review that different mutations in SLC39A4 may exhibit different AE manifestations. In conjunction with future research, our work may shed light on genotype-phenotype correlations in AE patients and provide knowledge for genetic counselling and treatment for AE patients.

BACKGROUND Both healthcare provider-patient communication and self-care efficacy affect psychological distress, which is prevalent among patients with gastrointestinal (GI) cancers. It is essential to explore the underlying mechanism among them to relieve psychological distress. OBJECTIVE The aim of this study was to examine whether self-care efficacy mediated the association between healthcare provider-patient communication and psychological distress among patients with GI cancers. METHODS A cross-sectional study was conducted between March 2018 and May 2019 in China. In total, 219 patients with GI cancers were recruited before discharge from chemotherapy. Healthcare provider-patient communication was assessed by the revised Physician-Patient Communication Scale; patient self-care efficacy was assessed by the Strategies Used by People to Promote Health; and psychological distress was assessed by the Distress Thermometer and the Hospital Anxiety and Depression Scale. Mediation analyses were conducted to examine the mediating effect of self-care efficacy on the association between healthcare provider-patient communication and psychological distress. RESULTS A total of 54.34% of patients experienced psychological distress. Patients reported a mean score of 89.93 (SD, 13.81) for healthcare provider-patient communication and 93.91 (SD, 23.39) for self-care efficacy. Self-care efficacy completely mediated the association between healthcare provider-patient communication and psychological distress, and communication outcome was the only domain that significantly influenced self-care efficacy. CONCLUSION Psychological distress is prevalent among patients with GI cancers. Healthcare provider-patient communication, especially communication outcome, promoted patients' self-care efficacy to reduce psychological distress. IMPLICATIONS FOR PRACTICE Healthcare providers should design interventions to improve communication outcomes and eventually increase self-care efficacy to relieve psychological distress among patients with GI cancers.

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

An 80-year-old women complained of painful erythema, papules, nodules on her right wrist for 9 months. Granuloma and inflammatory infiltrates with septate fungal hyphae were observed in pathological sections. Growth of demaciatious fungus on SDA was confirmed to be Exophiala spinifera by microscopic appearance and ITS rDNA sequencing. The diagnosis of phaeohyphomycosis due to E. spinifera was established. The patient had a poor response to oral itraconazole (200 mg/d) combining with terbinafine (250 mg/d) for 6 weeks. Then, following three courses of ALA-PDT, used as adjuvant therapy, skin lesions greatly improved and remained stable after 3 months follow-up. The case suggests that ALA-PDT is an effective adjuvant treatment option for patients with recalcitrant local subcutaneous fungal infection.

Graphene has some outstanding properties in the photoelectric field, especially ultra fast response and broad spectrum absorption, which have led to strong attraction on graphene photodetector. However, the photoresponsivity of pure graphene device is below 10 mA W−1. It would limit the application of graphene photodetector. Here, we design a metamaterial structure with a broadband high absorption spectrum. And by integrating it into the graphene photodetector, the high photoresponsivity of a pure graphene photodetector in a broadband range could be acquired. The photoresponsivity of photodetector can achieve nearly 200 mA W−1, which is two orders higher than the one of pure monolayer graphene photodetector. Besides, the photodetector also keeps the broadband photoresponse. The hot carriers can be generated by coupling of multiple resonances and effectively transported to graphene with the advantage of ultrathin metal film. Based on this work, more potential applications of graphene photodetector could be developed in some related fields.

Transition metal dichalcogenides (TMDs) are a category of promising two-dimensional (2D) materials for the optoelectronic devices, and their unique characteristics include tunable band gap, nondang...

Graphene and other two-dimensional (2D) materials have emerged as promising materials for future optoelectric applications. However, low detectivity of two-dimensional materials based photodetector inhibits their application. Here, we report a lateral graphene/MoS2/graphene (GMG) heterostructure photodetector which was synthesized by chemical vapor disposition (CVD). Electrical measurement shows that on/off ratio is up to 10 6 and two opposing Schottky junctions are connected in a series. Photocurrent mapping indicates that the Schottky junctions formed by graphene and MoS2 are the core part of the device, where photoexcited electron-hole pairs are spontaneously and rapidly separated. The responsivity is more than 2 × 10 3 m A / W and the maximum specific detectivity is as high as 10 13 J o n e s , respectively. This special design for the 2D materials based photodetector with high detectivity gives great potential for future application in nano-optoelectronic devices.

Two-dimensional transition-metal dichalcogenides (TMDs) have attracted significant attention, owing to their excellent electrical and optoelectrical properties, especially MoS2. However, the photoresponse of pure MoSe2 is still unsatisfactory due to the absence of a photoresponse enhancement mechanism, which impedes its rapid development in optoelectronics. Here, we report a pure MoSe2 phototransistor with an in-plane lateral thickness-dependent MoSe2 homojunction in the channel perpendicular to the charge transfer direction as an enhancement scheme for the first time. An in-plane lateral built-in field is spontaneously formed due to the different electrical band structure of MoSe2 with different thickness, which facilitates the efficient separation of photo-excited carriers. Furthermore, with an increase in the applied negative back-gate voltage, separation could be further strengthened due to the increase of the built-in field in the homojunction resulting in optimization of the photoresponse performance. These results suggest a facile approach for the enhancement of photoresponse performance to materials which possesses a thickness-dependent energy band structure.

Strain engineering is proposed to be an effective technology to tune the properties of two-dimensional (2D) transition metal dichalcogenides (TMDCs). Conventional strain engineering techniques (e.g., mechanical bending, heating) cannot conserve strain due to their dependence on external action, which thereby limits the application in electronics. In addition, the theoretically predicted strain-induced tuning of electrical performance of TMDCs has not been experimentally proved yet. Here, a facile but effective approach is proposed to retain and tune the biaxial tensile strain in monolayer MoS2 by adjusting the process of the chemical vapor deposition (CVD). To prove the feasibility of this method, the strain formation model of CVD grown MoS2 is proposed which is supported by the calculated strain dependence of band gap via the density functional theory (DFT). Next, the electrical properties tuning of strained monolayer MoS2 is demonstrated in experiment, where the carrier mobility of MoS2 was increased by two orders (∼ 0.15 to ∼ 23 cm2·V−1·s−1). The proposed pathway of strain preservation and regulation will open up the optics application of strain engineering and the fabrication of high performance electronic devices in 2D materials.

Background: D-dimer is a small protein fragment and high levels of D-dimer have been associated with increased mortality in patients presenting to emergency departments with infection. Previous studies have reported increased levels of D-dimer in COVID-19; however, it is unclear whether an increased D-dimer level provides early warning of poor prognosis. Therefore, this study aimed to assess the usefulness of D-dimer as an early indicator of prognosis in patients with coronavirus disease (COVID-19).Methods: We conducted a retrospective study of patients with COVID-19 admitted to Leishenshan Hospital in Wuhan, China, from February 15 to March 30, 2020. The final date of follow-up was April 11, 2020.Results: Of the 1,643 patients with COVID-19, 691 had elevated D-dimer levels. Their median age was 65 years. Of the patients with elevated D-dimer levels, 45% had comorbidities, with cardiovascular disease (205 [29.7%]) being the most common. Patients with elevated D-dimer were more likely to require treatment with high-flow oxygen, anticoagulation, antibiotics, and admission to the intensive care unit They were also more likely to have increased interleukin-6, monocytes, and lymphocytes. Patients with elevated D-dimer levels had significantly higher mortality than those with normal or low D-dimer levels.Conclusion: In patients with COVID-19, elevated D-dimer was associated with abnormal immunity, underlying disease, increased disease severity, and increased mortality. Taken together, D-dimer may be a marker for the early warning of disease severity and increased risk of death. These findings provide insights into the potential risk of elevated D-dimer in patients with COVID-19.

Capsaicin is a chili pepper extract with multiple therapeutic properties including anti-liver fibrosis. However, the paucity of its underlying mechanisms limited its widely clinical application.In the present study, carbon tetrachloride (CClHere, we show that capsaicin attenuates liver fibrosis progression by mediating macrophage inflammatory response. Capsaicin inhibited M1 polarization of macrophage by regulating Notch signaling leading to the reduced secretion of inflammatory cytokine TNF-α that correspondingly attenuates myofibroblasts regeneration and fibrosis formation of hepatocyte stellate cells (HSCs).Taken together, capsaicin alleviates liver fibrosis by inactivation of Notch signaling and further inhibiting TNF-α secretion from M1 macrophage. Targeting TNF-α or Notch signaling in macrophage represents a promising strategy to combat liver fibrosis.

Background Shen-ling-bai-zhu-san (SLBZS) regulates inflammation and gut microbiota which are associated with Streptococcus pneumoniae (Spn)-induced pneumonia. So, we studied the therapeutic effect of SLBZS and evaluated whether gut microbiota is associated with the effects of SLBZS in improving Spn-induced pneumonia. Methods Spn-induced pneumonia NIH mice were treated by SLBZS and cefixime. A CT scan was performed and Myeloperoxidase (MPO) activity in lung homogenates was determined using the MPO Colorimetric Assay Kit. Inflammation levels in lung homogenates were measured using ELISA. Bacterial load was coated on a TSAII sheep blood agar. Intestinal gut microbiota information was analyzed according to sequencing libraries. Results SLBZS decreased bacterial load, reduced wet/dry weight ratio, inhibited myeloperoxidase activity, reduced the neutrophils count, and ameliorated lung injury. Furthermore, SLBZS inhibited interleukin (IL)-1β, IL-6, tumor necrosis factor-α, IL-2, IL-8, IL-12, and interferon-γ secretion and enhanced IL-10 secretion. These results suggest that SLBZS ameliorates lung injury in mice with Spn-induced pneumonia. Moreover, SLBZS reduced inflammatory cytokine levels in a concentration-dependent manner and increased gut microbiota abundance and diversity. After SLBZS treatment, bacteria such as Epsilonbacteraeota, Bacteroidetes, Actinobacteria, Proteobacteria, and Patescibacteria were significantly reduced, while Tenericutes and Firmicutes were significantly increased. Conclusion SLBZS ameliorates inflammation, lung injury, and gut microbiota in mice with S. pneumoniae-induced pneumonia.

ObjectiveTo investigate the blood coagulation function in COVID-19 patients, and the correlation between coagulopathy and disease severity.MethodsWe retrospectively collected 147 clinically diagnosed COVID-19 patients at Wuhan Leishenshan Hospital of Hubei, China. We analyzed the coagulation function in COVID-19 patients through the data including thrombin-antithrombin complex (TAT), α2-plasmininhibitor-plasmin Complex (PIC), thrombomodulin (TM), t-PA/PAI-1 Complex (t-PAIC), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-Dimer (DD), and platelet (PLT).ResultThe levels of TAT, PIC, TM, t-PAIC, PT, INR, FIB, and DD in COVID-19 patients were higher than health controls (pConclusionThe coagulation systems in COVID-19 patients are inordinate, and dynamic monitoring of them, might be a key in the control of COVID-19 death.

RationaleIn late December 2019, an outbreak of acute respiratory illness, now officially named as COVID-19, or coronavirus disease 2019, emerged in Wuhan, China, now spreading across the whole country and world. More data were needed to understand the clinical characteristics of the disease.ObjectivesTo study the epidemiology, clinical features and outcomes of patients with COVID-19.Methodswe performed a single center, retrospective case series study in 221 patients with laboratory confirmed SARS-CoV-2 pneumonia at a university hospital.Measurements and Main ResultsThe median age was 55.0 years and 48.9% were male and only 8 (3.6%) patients had a history of exposure to the Huanan Seafood Market. Compared to the non-severe pneumonia patients, the median age of the severe patients was significantly older, and they were more likely to have chronic comorbidities. Most common symptoms in severe patients were high fever, anorexia and dyspnea. On admission, 33.0% patients showed leukopenia and 73.8% showed lymphopenia. In addition, the severe patients suffered a higher rate of co-infections with bacteria or fungus and they were more likely to developing complications. As of February 15, 2020, 19.0% patients had been discharged and 5.4% patients died. 80% of severe cases received ICU care, and 52.3% of them transferred to the general wards due to relieved symptoms, and the mortality rate of severe patients in ICU was 20.5%.ConclusionsThe COVID-19 epidemic spreads rapidly by human-to-human transmission. Patients with elder age, chronic comorbidities, blood leukocyte/lymphocyte count, procalcitonin level, co-infection and severe complications might increase the risk of poor clinical outcomes.

Background: Since the end of 2019, coronavirus disease-2019 (COVID-19) outbreak spreads around the world We aimed to share the details of critically ill patien

Background: In late December 2019, an outbreak of acute respiratory illness, now officially named as COVID-19, or coronavirus disease 2019, emerged in Wuhan, China. We aimed to study the epidemiology and clinical features of patients diagnosed as coronavirus disease 2019 (COVID-19) and their treatment and outcome in Wuhan, China. Methods: We did a single center, retrospective case series study in patients from Zhongnan Hospital of Wuhan University, Wuhan, China. 221 admitted patients with laboratory confirmed SARS-CoV-2 infection, including 55 severe patients and 166 non-severe patients, were recruited from January 2, 2020 to February 10, 2020. Data of epidemiology, clinic, laboratory exams, radiology and treatment were collected from standardized case report forms and compared between the severe and non-severe patients with COVID-19. Specifically, the outcome of corticosteroid therapy was analyzed in the severe patients in intensive care unit (ICU). Findings: Of the 221 patients with COVID-19, 108 (48.9%) of them were male and only 8 (3.6%) patients had a history of exposure to the Huanan Seafood Market. Compared to the non-severe patients, the median age of the severe patients was significantly older (62.0 vs 51.0 years), and they were more likely to have chronic comorbidities, including hypertension, cardiovascular disease and cerebrovascular disease. Most common symptoms in severe patients were high fever, anorexia and dyspnea. On admission, 73 (33.0%) of the 221 patients showed leukopenia and 163 (73.8%) showed lymphopenia. The laboratory results showed more severity of aberrant coagulation pathway, hepatic injury, myocardial injury and kidney injury in the severe patients. In addition, the severe patients suffered a higher rate of co-infections with bacteria or fungus and they were more likely to developing complications, including acute respiratory distress syndrome (ARDS), arrhythmia, acute cardiac injury, shock and acute kidney injury. As of Feb 15, 2020, a total of 42 (19.0%) patients had been discharged and 12 (5.4%) patients died. In the 55 severe patients, 44 (80%) of them received ICU care, and 23 of them transferred to the general wards due to relieved symptoms, and the mortality rate was 21.8%. Interpretation: In this single-center case series of 221 hospitalized patients with confirmed COVID-19 in Wuhan, China, 55 severe patients with elder age and chronic comorbidities, developed more than one complication. The mortality rate was significantly higher in the severe patients compared to that in the non-severe patients (21.8% vs 0.0%). Older and male patients with higher APACHE II & SOFA scores, elevated PCT level, excessive fluid volume input, as well as the delayed use of corticosteroid might increase the risk of death in ICU. Funding Statement: This work was supported by the National Natural Science Foundation of China (grant no. 81700493 to Dr. Pan; grant no. 81971816 to Dr. Peng). Declaration of Interests: The authors declared no conflicts. Ethics Approval Statement: This study was approved by the National Health Commission of China and Ethics Commission of Zhongnan Hospital. Written informed consent was waived by the Ethics Commission for emerging infectious disease.

Plant trials were carried out to compare multiphase flow using a conventional ladle shroud (CLS) and a trumpet-shaped ladle shroud (TLS) in a steelmaking tundish. Steel splashing, slag exposure, smoke and flame were recorded to investigate the fluid flow during both transient and steady casting. A large eddy simulation model was employed to visualize the flow structure and obtain detailed flow information. The results showed that the TLS outperformed the CLS in relieving steel splashing during ladle change due to the braking effect of the TLS on the jet. During steady casting, a relatively calm melt bath was achieved with less exposed steel using the TLS, which is attributed to the reduced turbulence in the tundish. An eccentric tundish open eye was observed using the CLS, which is related to the misaligned flow pattern when the slide gate is partially open.

The superficial inferior epigastric artery (SIEA) flap is widely used in the repair of large soft tissue defects of the extremities and in breast reconstruction. Because of the high fat content of the abdomen, it has been less used for glossectomy reconstruction. Here we present a series of seven patients who each underwent reconstruction with a thin SIEA flap after resection of the tongue. There were six men and one woman (mean age 48, range 24-66 years). All patients underwent preoperative computed tomographic (CT) angiography, and colour Doppler ultrasound (US) was used to select and map the most suitable SIEA. The flap was raised above the Scarpa's layer while adjusted the plane of dissection according to the specific needs for bulk in each case. All the flaps survived; one flap required a secondary anastomosis because of a venous anastomotic embolus. The size of flap used was 5.0cm×6.0cm - 7.0cm×9.0cm, and the flap was 0.8cm-1.4cm thick. The functional outcome was evaluated at 6 - 18 months follow up, when speech and swallowing were both good in all cases. The dissection above the pubic symphysis is an important refinement of the SIEA flap, and we conclude that the thin SIEA flap is a good choice for reconstruction after excision of cancer of the tongue.

Ds-type inclusions during production are an important factor affecting the performance and quality of manufactured 10B21 steel. To minimize Ds-type inclusions in steel and improve the production qualification rate of steelmaking plants, a refining slag system optimization scheme was proposed based on the analysis of current inclusion evolution during the steelmaking process, and industrial tests were conducted to verify improvements resulting from application of the proposed scheme. The results showed that the composition of Ds inclusions in 10B21 steel are mainly CaO–Al2O3–MgO–CaS–TiN, which exists in the form of calcium–magnesium aluminate coated with titanium nitride and calcium sulfide. The main reason for the formation of Ds inclusions is the poor fluidity of the refining slag and its low capability to absorb inclusions. The poor coverage of the refining slag on the molten steel during refining can easily cause secondary oxidation of the molten steel. Thus, the formation and growth of Ds-type inclusions are aggravated after the calcium feeding line and soft blowing operation. Here, we propose to minimize Ds inclusions using our optimized refined slag system. The mass percentage of the optimized slag system is CaO: 55–60%, Al2O3: 20–35%, SiO2: 3–7%, MgO: 4–8%, (MnO + FeO) &lt, 1%, and the basicity is controlled within the range of 7–11. We observed that our optimized refining slag system has a significantly improved ability to remove inclusions, particularly Ds inclusions, which improves the qualification rate of 10B21 steel.

Acute lymphoblastic leukemia (ALL) is a hematological malignancy originating from B- or T-lymphoid progenitor cells. Recent studies have shown that redox dysregulation caused by overproduction of reactive oxygen species (ROS) has an important role in the development and progression of leukemia. The application of pro-oxidant therapy, which targets redox dysregulation, has achieved satisfactory results in alleviating the conditions of and improving the survival rate for patients with ALL. However, drug resistance and side effects are two major challenges that must be addressed in pro-oxidant therapy. Oxidative stress can activate a variety of antioxidant mechanisms to help leukemia cells escape the damage caused by pro-oxidant drugs and develop drug resistance. Hematopoietic stem cells (HSCs) are extremely sensitive to oxidative stress due to their low levels of differentiation, and the use of pro-oxidant drugs inevitably causes damage to HSCs and may even cause severe bone marrow suppression. In this article, we reviewed research progress regarding the generation and regulation of ROS in normal HSCs and ALL cells as well as the impact of ROS on the biological behavior and fate of cells. An in-depth understanding of the regulatory mechanisms of redox homeostasis in normal and malignant HSCs is conducive to the formulation of rational targeted treatment plans to effectively reduce oxidative damage to normal HSCs while eradicating ALL cells.

Introduction: More than 42 million people are estimated to suffer from valvular heart disease (VHD) worldwide with a prevalence of 5.3% to 7.7% in the Chinese adult population. The purpose of this study was to examine the associations between symptoms, hope, self-management behaviors, and quality of life (QOL) for preoperative patients with symptomatic VHD in a rural area of China. Method: This was a descriptive comparative study that took place in Nanning, China, between January 2015 and March 2016. The sample was 128 preoperative patients with symptomatic VHD. Data were collected using the Symptom Distress Questionnaire, Herth Hope Index, Self-Management Scale, and Minnesota Living with Heart Failure Questionnaire. Results: Data from 122 patients were included in the final analysis. Mean scores of hope, self-management, and QOL were 36.71, 55.27, and 55.56. Worse total scores of symptom severity ( r = 0.57 to 0.69, p < .001) and self-management behaviors ( r = −0.22 to −0.25, p < .05) were associated with poorer QOL. Fatigue, loss of appetite, and self-management behaviors explained 49.90% variance of QOL ( p < .001). Discussion: Fatigue, loss of appetite, and self-management influenced QOL of patients with symptomatic VHD. Interventions aimed at strengthening self-management and relieving symptoms should be tailored for patients with symptomatic VHD base on their traditional animist belief and food culture in rural areas of China such as the Zhuang Autonomous Region.

Background The purpose of this study was to analyze the association between the genetic polymorphism of genes (PAX6, SOSTDC1and FAM20B) and the susceptibility to mesiodens. Methods This study was carried out on 50 patients with mesiodens and 50 controls. The family history of each patient with mesiodens were recorded. Genomic DNA was extracted from saliva samples, and single nucleotide polymorphisms were detected in all exons and exon/intron boundaries of PAX6, SOSTDC1 and FAM20B using Sanger sequencing. The data were analyzed using pearson chi-square test with theoretical frequency ≥ 5. For theoretical frequency less than 5 but at least 1 (≤20% cell), the data were analyzed by continuity correction. For the rest, Fisher’s Exact test was used. A P-value

Morphea profunda (MP) is a variant of morphea that presents clinically as localized fibrotic plaques. Based on previous reports, there was no unified standard treatment for MP. Here we report a rare case of MP, which is the first report about treatment by hydroxychloroquine in combination with superficial X-ray. Compared with other regular therapeutic methods, this method not only produced a positive clinical effect in a short amount of time, but also caused fewer side effects.

Introduction: Acquired resistance to reversible EGFR tyrosine kinase inhibitors remains a significant obstacle, and acquired ERBB2 amplification is the most common “bypass” mechanism. For patients with sensitizing EGFR mutation who experience resistance via ERBB2 amplification, no targeted drug has been demonstrated to be effective. Patient concerns: A 56-year-old female nonsmoker suffered from left leg paralysis and low back pain. Imaging examination revealed a mass in the anterior segment of the right upper lobe lung and possible multiple metastases in the right hilar, mediastinal lymph nodes, bone metastases, and soft tissue invasion. Diagnosis: Transbronchial lung biopsy revealed a moderately differentiated adenocarcinoma (cT4N2M1c, stage IV). An EGFR exon 19 deletion was identified using amplification refractory mutation system. Interventions: After the patient was treated with gefitinib initiation (250 mg/d) for 15 months, the tumor progressed with ERBB2 amplification revealed by next-generation sequencing test. Then, the patient was started on afatinib (40 mg/d) plus bevacizumab (7.5 mg/kg every 3 weeks). Outcomes: The combination therapy of afatinib and bevacizumab in this patient was effective with some slight side effects. Computed tomography scans showed the tumor shrinkage and the pleural effusion disappeared in the right lung. The overall survival was 23.5 months. Conclusion: To date, there is no targeted therapy approved and demonstrated to be effective for non-small cell lung cancer patients with EGFR sensitizing mutations, and ERBB2 amplification. The effectiveness of combination therapy with afatinib and bevacizumab may provide a new therapeutic option for these patients.

This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.

Human fibroblast-like synoviocytes play a vital role in joint synovial inflammation in rheumatoid arthritis (RA). Proinflammatory cytokines induce fibroblast-like synoviocyte activation and dysfunction. The inflammatory mediator Krüppel-like factor 4 is upregulated during inflammation and plays an important role in endothelial and macrophage activation during inflammation. However, the role of Krüppel-like factor 4 in fibroblast-like synoviocyte activation and RA inflammation remains to be defined. In this study, we identify the notion that Krüppel-like factor 4 is higher expressed in synovial tissues and fibroblast-like synoviocytes from RA patients than those from osteoarthritis patients.In vitro, the expression of Krüppel-like factor 4 in RA fibroblast-like synoviocytes is induced by proinflammatory cytokine tumor necrosis factor-α. Overexpression of Krüppel-like factor 4 in RA fibroblast-like synoviocytes robustly induced interleukin-6 production in the presence or absence of tumor necrosis factor-α. Conversely, knockdown of Krüppel-like factor 4 markedly attenuated interleukin-6 production in the presence or absence of tumor necrosis factor-α. Krüppel-like factor 4 not only can bind to and activate the interleukin-6 promoter, but also may interact directly with nuclear factor-kappa B. These results suggest that Krüppel-like factor 4 may act as a transcription factor mediating the activation of fibroblast-like synoviocytes in RA by inducing interleukin-6 expression in response to tumor necrosis factor-α.

Transition metal dichalcogenides (TMDCs) are promising for future electronic and optoelectronic applications, such as field effect transistors (FETs), for their high carrier mobility with a thin layer, wide bandgap, and organic-like flexibility. However, background doping and unipolar electrical characteristics are commonly observed in TMDCs and their based FETs due to the naturally inevitable vacancy defects, which limit their application in electronics and optoelectronics systems. Here, taking MoS2 as an example, in a TMDC FET, ambipolar properties were achieved at room temperature by introducing an amorphous solid ionic conductor lithium tantalate (LiTaO3) as the gate dielectric, which could guarantee the modulation of the Fermi level in the MoS2 channel by the gate electric field. Based on the modulation mechanisms by the solid ionic conductor-gated electric field for the transformation of conduction mode, the three-terminal device exhibits a gate-controlled rectifying, that is, thyristor performance with a high rectification ratio over 300 obtained at a low gate voltage of 2 V. The present results show the great potential of TMDCs in future logic and other electronic device applications.

Background In late December 2019, an outbreak of acute respiratory illness, coronavirus disease 2019 (COVID-19), emerged in Wuhan, China. We aimed to study the epidemiology, clinical features and short-term outcomes of patients with COVID-19 in Wuhan, China. Methods We performed a single center, retrospective case series study in 221 patients with laboratory confirmed SARS-CoV-2 pneumonia at a university hospital, including 55 severe patients and 166 non-severe patients, from January 2, 2020 to February 10, 2020. Results Of the 221 patients with COVID-19, the median age was 55.0 years and 48.9% were male and only 8 (3.6%) patients had a history of exposure to the Huanan Seafood Market. Compared to the non-severe pneumonia patients, the median age of the severe patients was significantly older, and they were more likely to have chronic comorbidities. Most common symptoms in severe patients were high fever, anorexia and dyspnea. On admission, 33.0% patients showed leukopenia and 73.8% showed lymphopenia. In addition, the severe patients suffered a higher rate of co-infections with bacteria or fungus and they were more likely to developing complications. As of February 15, 2020, 19.0% patients had been discharged and 5.4% patients died. 80% of severe cases received ICU (intensive care unit) care, and 52.3% of them transferred to the general wards due to relieved symptoms, and the mortality rate of severe patients in ICU was 20.5%. Conclusions Patients with elder age, chronic comorbidities, blood leukocyte/lymphocyte count, procalcitonin level, co-infection and severe complications might increase the risk of poor clinical outcomes.

Background A lot of time and money was needed during the diagnosis and treatment process of leprosy, the delayed leprosy would also impair the labor capability of patients as well, and these put a heavy burden for the leprosy patients. The migrant leprosy patient is a special group and need more concern. Our goal was to assess the economic burden of leprosy on migrant and resident patient populations in Guangdong province, China. Methods We conducted a population-based cross-sectional survey from February to July of 2016. A self-designed questionnaire was administered to leprosy patients who: (1) had registered in Leprosy Management Information System in China (LEPMIS) by the end of February 2016, (2) had received multiple drug treatment (MDT) drugs at a local leprosy control institution for three consecutive months or had had at least one physical check in the past half year, and (3) were willing to take part in the investigation and give informed written consent. Demographic characteristics, Financial and disease information, and costs before and after leprosy diagnosis were collected and compared using t-test and χ2 test. Results A total of 254 participants completed the questionnaires, including 168 males and 86 females. Migrants and residents accounted for 33.9% and 66.1% of patients, respectively. Among migrant patients, the median cost before diagnosis was $131.6 (39.2–450.9), the median yearly cost of leprosy treatment after diagnosis was $300.6 (158.4–868.5), and the median yearly cost of leprosy complications was $69.5 (11–178.4). In comparison, among residents the median yearly costs were $152.4 (30.7–770.9) pre-diagnosis, $309.7 (103.2–1016.7) after diagnosis, and $91.9 (32.6–303.1) for leprosy complications. Base on this, we determined that the median yearly total expense after diagnosis amounted to 15% of migrant and 38% of resident patients’ annual income. Conclusion Leprosy places a heavy economic burden on both migrant and resident leprosy patients and governmental policies and programs could substantially alleviate this. Measures to implement more active surveillance and early diagnosis would benefit both populations, while labor protection and medical insurance are urgently needed for migrant patients and easier access to medical services and social aids could substantially decrease the burden of leprosy for resident patients.

The aim of the present study was to review the effectiveness of psychological and/or educational interventions for reducing psoriasis severity and improving psychological and quality of life (QOL) outcomes in psoriasis. Sixteen papers met the inclusion criteria. Overall, the effectiveness of the existing interventions from this narrative synthesis is positive, especially in psychological and QOL outcomes. Of the 16 included studies, only five were randomized controlled trials (RCTs). The strength of the evidence to support the effectiveness of the existing interventions was limited due to methodological weakness in the included studies. The review concludes that further research is needed to examine the effectiveness of psychological and/or educational interventions for individuals with psoriasis, including a greater number of RCTs in order to increase the methodological validity of intervention studies. Also, future research needs to be conducted to establish which interventions are most effective for specific sub-populations who may best profit from psycho-educational interventions.

Self-assembled structures of 2D materials with novel physical and chemical properties, such as the good electrical and optoelectrical performance in nanoscrolls, have attracted a lot of attention. However, high photoresponse speed as well as high responsivity cannot be achieved simultaneously in the nanoscrolls. Here, a photodiode consisting of single MoS2 nanoscrolls and a p-type WSe2 is demonstrated and shows excellent photovoltaic characteristics with a large open-circuit voltage of 0.18 V and high current intensity. Benefiting from the heterostructure, the dark current is suppressed resulting in an increased ratio of photocurrent to dark current (two orders of magnitude higher than the single MoS2 nanoscroll device). Furthermore, it yields high responsivity of 0.3 A W-1 (corresponding high external quantum efficiency of ≈75%) and fast response time of 5 ms, simultaneously. The response speed is increased by three orders of magnitude over the single MoS2 nanoscroll device. In addition, broadband photoresponse up to near-infrared could be achieved. This atomically thin WSe2 /MoS2 nanoscroll integration not only overcomes the disadvantage of MoS2 nanoscrolls, but also demonstrates a single nanoscroll-based heterostructure with high performance, promising its potential in the future optoelectronic applications.

Slag entrainment in a continuous casting mold is one of the major causes of macro nonmetallic inclusions in continuous casting steel products. Stabilizing the level fluctuation is an important factor to improve steel quality. A new type of submerged entry nozzle (SEN) named self-braking SEN was designed. In the current study, water modeling experiments were performed to study the effect of self-braking SEN on level fluctuation in a continuous casting slab mold. The level position and the root mean square value of level fluctuation were analyzed through the online detection data. The results showed that the flow in the mold was more symmetrical and the tracer dispersion was more uniform. Moreover, the meniscus was also more uniform than the conventional nozzle with the self-braking SEN, especially at high casting speed.

Researches on the relation of a loaded mechanical energy to the damaged banana maturation and its quality evolution has significance to its storage, but there are few researches at present. This paper studied on the effect of the loaded energy on banana to its internal maturation substance evolution and stored quality with time, including the change of maximum impact stress, re-enduring impact energy. The results showed there existed a significant correlation between energy transformation and increment of maturity substance in the damaged banana. Also, there existed a significant association between energy transformation and increment of maturity substance in the damaged banana in its storage time, and appeared a trends that the mechanical energy being transferred into fruit internal energy increased its maturity substance and decreased its stored quality, but individual maturity difference had less effect. Thus, decreasing the energy and the substance transformation in damage area are the important means of extending the physiology life of fruits, which is an urgent problem to be solved in their field of processing and storage at present.