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BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a highly invasive procedure and a highcost medical measure, but the economic impact of nosocomial infection after ECMO support remains largely uninvestigated. METHODS We constructed a retrospective cohort of all patients hospitalized at the First Affiliated Hospital of Nanjing Medical University from 2013 to 2020 who had ECMO supported clinical samples. Propensity score matching (PSM) was used to control the impact of potential confounding variables, including demographics, commodities, and treatment, and to estimate the economic burden of nosocomial infection after ECMO support. RESULTS There were 194 patients with ECMO support, 136 patients had no infection after ECMO, 38 patients had infection after ECMO, of which 97.4% was lower respiratory tract infection. Compared with patients among ECMO non infection group, the main reasons for ECMO treatment of patients among ECMO infection group were supportive treatment of cardiac dysfunction (63.16% vs. 42.31%, P=0.021) and longer use of catheter (13.74±14.97 vs. 15.97±14.33 days, P=0.034). The total hospital expenses for patients among ECMO infection group and ECMO non infection group were about $55,878 and $51,277 respectively. Patients with ECMO infection had significantly higher radiate expenses, operational expenses and anesthetic expenses than those among ECMO non infection group ($119.06 vs. $69.32, P=0.025; $6,458.81 vs. $4,882.49, P=0.034; $331.62 vs. $145.56, P=0.030). CONCLUSIONS Our study demonstrates that the incidence of nosocomial infection after ECMO support was relatively high, which did not lead to high total hospital expenses, but lead to higher radiate expenses, operational expenses and anesthetic expenses.

Zhan-jie Li,1,&ast; Ke-wei Wang,2,&ast; Bo Liu,1 Feng Zang,1 Yu Zhang,3 Wei-hong Zhang,1 Su-ming Zhou,4 Yong-xiang Zhang1 1Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People’s Republic of China; 2Institute of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, People’s Republic of China; 3Department of Infection Management, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People’s Republic of China; 4Department of Geriatric Critical Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yong-xiang ZhangDepartment of Infection Control, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People’s Republic of ChinaTel +86-025-68306917; +86-13951951616Email Yongxiang216021ICU@163.comSu-ming ZhouDepartment of Geriatric Critical Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People’s Republic of ChinaEmail zhousmco@aliyun.comBackground: To analyze the distribution and source of MDROs infection in the ICUs and to provide a basis for formulating more effective prevention and control programs for MDROs.Methods: A retrospective investigation was conducted on MDROs infection in 8 ICUs of a large tertiary hospital from July 2013 to June 2019. A total of 2629 strains of MDROs isolated from 1701 inpatients were selected for analysis. The MDROs of the 8 ICUs were divided into two types of four categories according to source: out-of-hospital (out-of-hospital transfer and community acquisition) and in-hospital (in-hospital transfer and department acquisition) infections.Results: CRAB (41.84%) and CRE (35.07%) accounted for the majority of the infecting MDROs. The detection rates of MRSA, CRAB, CRPA and CRE were 61.24%, 83.75%, 43.01% and 30.15%, respectively. The top three infection sites of MDROs were the lower respiratory tract (81.10%), blood (6.70%) and abdominal cavity (5.80%). The out-of-hospital and in-hospital infection rates of MDROs were 50.51% and 49.49%, respectively; the out-of-hospital infection rates for MRSA, CRAB, CRPA and CRE were 43.56%, 55.91, 64.44% and 44.58%, respectively. The proportions of MRSA, CRAB, CRPA and CRE infections contracted in the department were 40.98%, 36.27%, 25.56% and 46.62%, respectively. There was a statistically significant difference between comprehensive ICU and specialized ICU wards as sources for CRAB infections (P < 0.001).Conclusion: The main source of MDROs in the ICU is not the hospital itself entirely. It is particularly important to strengthen the identification of MDRO sources and implement more effective and accurate infection prevention and control measures.Keywords: MDRO, intensive care unit, ICU, source

BACKGROUND: Organ/space surgical site infections (OSSI) after pancreaticoduodenectomy (PD) are not rare events. The role of diagnosis and treatment for pancreatic and biliary diseases with an endoscopic retrograde cholangio-pancreatography (ERCP) procedure is currently controversial. However, the ERCP procedure might play a role in surgical outcomes after PD. METHODS: We conducted a retrospective cohort study for patients who underwent PD in the First Affiliated Hospital with the Nanjing Medical University from 1st September 2012 to 31st January 2018. The relationship between ERCP exposure and OSSI after PD was analyzed by univariate and forward stepwise multivariate logistic regression model. RESULTS: Of the 1,365 patients who underwent PD, 136 developed OSSI (10.0%). We found that ERCP exposure before PD (EEBPD) was significantly associated with an increased incidence rate of post-operative pancreas fistula (POPF) [24.2% (23/95) vs. 14.9% (189/1,270), risk ratio (RR) =1.63, 95% confidence interval (CI), 1.11–2.38, P=0.015]. Hypertension, a higher level of preoperative low-density lipoprotein (LDL) and creatinine (Cr) were associated with elevated risks of post-operative OSSI [adjusted odds ratio (Adj-OR) (95% CI) were 1.59 (1.09–2.32), 1.70 (1.16–2.51), 1.99 (1.36–2.92)], whereas a preoperatively higher level of aspartate aminotransferase (AST) would decrease the risk [Adj-OR (95% CI), 0.62 (0.42–0.91)]. Remarkably, EEBPD would significantly increase and more than double the OSSI risk [Adj-OR (95% CI), 2.56 (1.46–4.47)] especially if it was within 14 days before surgery (Spearman =–0.698, P

At present, the bearing fault is one of the major mechanical faults, deep learning-based bearing fault diagnosis methods have been successfully developed. However, the fault data of bearings in the industrial environment are very few, which leads to the failure or performance degradation of conventional intelligent diagnosis methods. It costs a large amount of manpower and material to obtain complete samples of the industrial environment, which is unrealistic. Therefore, it is necessary to use a small number of actual fault signals for incremental learning. The existing incremental learning models cannot solve the entanglement problem of sample features, and the ability to obtain new samples by combining features is limited. In this article, the filter style-based generative adversarial network (FSGAN) is used to separate hidden features by mapping data features to intermediate latent space, and then, new signals are generated by feature reorganization. The different signals are generated by controlling the weight coefficient of style after network training, and then, valuable signals are selected by the t-distributed stochastic neighbor embedding (t-SNE) clustering analysis. The model can generate fault signals with unknown sizes under unknown conditions. Finally, the advantages of FSGAN are further verified by the quality evaluation of the generated signals and comparison with other models.

The bearing fault feature for complex equipment in early failure period is so weak and susceptible to complicated transmission path and random noise that it’s very difficult to be extracted, so Fast Iterative Filtering Decomposition (FIFD) with Probabilistic Neural Network (PNN) are combined for diagnosing the bearing fault. A bearing simulator was used to collect vibration signals of bearing under different fault locations, and then FIFD was applied to decompose them into several Intrinsic Mode Functions, where their energy entropy as an feature vector was calculated respectively. Finally PNN was used to classify different bearing faults. The bearing fault simulator shows that this method can quickly and accurately identify the different fault locations of bearings.

Background: The aim of the present study was to systematically review the exiting literature and to proceed a meta-analysis to determine the impact of chronic obstructive pulmonary disease (COPD) on mortality in patients with community acquired pneumonia. Materials & methods: Eligible studies were searched from PubMed, Cochrane Library and EMBASE. Odds ratios (ORs) with 95% CIs were used as effect estimates. Results: Twenty cohort studies were included. Analysis of unadjusted data revealed nonsignificant short- and long-term mortality associated with COPD. Analysis of adjusted 30-days mortality showed similarly no association between COPD and increased 30-days mortality (OR: 1.06, [0.68, 1.44]) but a positive association when COPD was confirmed spirometrically (OR: 1.84, [1.06, 2.62]). Conclusion: There is still no evidence to clear the impact of COPD on mortality in patients with community acquired pneumonia. More prospective studies with spirometrically-defined COPD and adequate adjustment for confounders are needed.

An improved internal structure is proposed to improve the distribution of cooling capacity in refrigerated container. Firstly, a computational fluid dynamics model was established and the fruit stacks was simplified to be porous medium. The flow resistance coefficient was obtained by combining theory and numerical simulation and then verified. Secondly, three baffles were added to reduce the loss of cold airflow by blocking the airflow through air-gaps. The velocity and temperature of the previous refrigerated container and the improved refrigerated container were obtained and compared. The cold airflow distribution in the improved refrigerated container is more uniform. The improvement of vertical velocity in all stacks is in the range of 5.24% – 425.04%. The cooling performance of the two refrigerated containers were also obtained. The variation of temperature distribution is within ±1 °C and the cooling time is also reduced by at least 22.9% in the improved refrigerated container. Finally, the proposed structure showed good applicability for different fruits and vegetables. For all produce tested, the decrease ratio of temperature rise in the improved refrigerated container relative to the previous refrigerated container ranges from 34.0% to 59.5%.

In this research, a newly proposed method combining Chemkin with CONVERGE was used to study the transient in-cylinder chemical reaction process in NG-diesel dual fuel engine. The selected mechanism was verified by comparing the results of CONVERGE with experimental data, and then the calibrated model of CONVERGE was used to provide boundary conditions for Chemkin. On this basis, the detailed combustion process was simulated at different natural gas substitution ratio (NGSR). The results show that, the chain branching reaction, long-chain to short-chain reaction, and reactions associated with OH radicals have significant impacts on temperature. It can also be found that the combustion of fuel shows a distinct two-stage reaction process. During the low temperature stage, both the CO and NO emissions are little. While at the high temperature stage, the CO emissions first rapidly increase and then decrease due to the consumption reaction, and the NO emissions also have a quick increase. When the NGSR is reduced, a new path for CO generation occurs at low temperature stage, resulting in minor increase (up to 0.0019 mol fraction) of CO concentration. Meanwhile, the ignition delay is reduced significantly (by 88.5%), but the increase of diesel species does not alter the formation mechanism of emissions. All these provide guidance for improving combustion and emission performance of NG-diesel dual fuel engine.

Epidemiological studies have demonstrated an increased risk of non-Hodgkin lymphoma (NHL) in patients with chronic hepatitis C virus (HCV) infection. Therefore, we investigated the risk of extrahepatic malignancies associated with HCV infection. Inpatients diagnosed with lymphoma, breast, thyroid, kidney, or pancreatic cancer (research group, n = 17,925) as well as inpatients with no malignancies (control group, n = 16,580) matched by gender and age were enrolled from The First Affiliated Hospital of Nanjing Medical University between January 2008 and December 2016. A case-control study was conducted by retrospective analysis. The difference in HCV prevalence was analyzed between the research group and the control group. Also, the research group was compared to the 2006 National Hepatitis C sero-survey in China. A total of 86 cases were positive for anti-HCV in the research group. Compared with the control group (103 cases were anti-HCV positive), no significant associations between extrahepatic malignancies and HCV infection were observed. Meanwhile, compared to the 2006 National Hepatitis C sero-survey, we observed a significant association between the chronic lymphoma leukemia/small lymphocytic lymphoma (CLL/SLL) and HCV seropositivity in females in the research group aged 1–59 years old (OR = 14.69; 95% CI, 1.94–111.01). HCV infection had a potential association with CLL/SLL in females aged 1–59 years old. Our study did not confirm an association between HCV infection and the risk of extrahepatic malignancies. In regions with a low HCV prevalence, the association between HCV infection and extrahepatic malignancies needs further investigation.

It is an open question whether Wada basin exists in control systems. We investigate coexisting attractors and their Wada basins for a given set of parameters in an uncontrolled and controlled vibration isolation system. Wada basins are verified by the Nusse–Yorke method. All coexisting chaotic attractors can be converted into periodic attractors but the basin structure can still possess Wada property by two control methods (an external drive control and a piecewise damping control) with the appropriate control parameters. The Wada basins of controlled systems imply a particular kind of unpredictability, and we should avoid selecting such control parameters although chaotic attractors are effectively controlled.

Background No studies have yet reported the effect of prevention and control measures, which were implemented to combat COVID-19, on the prevention and control of common HAIs. We aimed to examine the effect of the “Normalized Epidemic Prevention and Control Requirements” (implemented in May 2020) by comparison of hospital-acquired infections (HAIs) and community-acquired infections (CAIs) in China during 2018, 2019, and 2020. Methods Data of inpatients before and after implementation of new requirements were retrospectively analyzed, including infection rate, use of alcohol-based hand cleaner, anatomical sites of infections, pathogen species, infection by multi-drug resistant species, and use of different antibiotics. Results The HAI rate was significantly higher in 2020 than in 2018 and 2019 (P P P P P P Conclusions The new prevention and control requirements provided important benefits during the COVID-19 pandemic. However, their effects on HAIs were not obvious.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) leads to impairment of pulmonary hemodynamics, triggers secondary right heart dysfunction, regularly accompanied by systemic malperfusion, and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD) may also adversely affect CTEPH prognosis. This study aimed to assess how Brain natriuretic peptide (BNP) combined with balloon pulmonary angioplasty (BPA) improve right heart hemodynamics and estimated GFR (eGFR) of CKD in CTEPH patients.MethodsWe retrospectively studied 47 patients with confirmed CTEPH with CKD who were treated with BPA and admitted to the intensive care unit between December 2012 and September 2020. The patient was divided into two groups based on whether to receive recombinant human brain natriuretic peptide treatment (rhBNP). The information of patients between two groups was systematically compared in hospital and follow up. eGFR were assessed at several time points. ResultsFor rhBNP group, eGFR was significantly higher in the two periods of Prior to last BPA and 6-month follow-up. A significantly higher Δ eGFR from baseline to follow-up was observed. There was significant difference on levels of troponin I, NT-proBNP, and right ventricle diameter at follow-up. Conclusion rhBNP combined BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function, which maybe an alternative treatment option for improving clinical outcomes.

Cellular autoimmune responses, especially those mediated by T-cells, play vital roles in the immunopathogenesis of dilated cardiomyopathy (DCM). Metabolic reprogramming directly controls T-cell function, imprinting distinct functional fates. However, its contribution to T-cell dysfunction and the immunopathogenesis of DCM is unknown. Here, we found that in DCM patients, CD4+ T-cells exhibited immune dysfunction and glycolytic metabolic reprogramming based on extracellular acidification and oxygen consumption rates. Similar results were observed in splenic and cardiac CD4+ T-cells from autoimmune-induced DCM mice. In vitro, the glycolysis inhibitor 2-deoxy-d-glucose (2-DG) reversed T-cell dysfunction; thus, heightened metabolic activity directly controls CD4+ T-cell immunological status. Adoptive transfer of CD4+ T-cells from DCM mice to normal recipients induced cardiac remodeling and cardiac T-cell dysfunction. Strikingly, these effects were abolished by preconditioning cells with 2-DG, indicating that CD4+ T-cell dysfunction partially induced by metabolic reprogramming contributes to cardiac remodeling. Moreover, the microRNA let-7i modulated the metabolism and function of T-cells from DCM mice by directly targeting Myc. Collectively, our results show that metabolic reprogramming occurs in T-cells of autoimmune-induced DCM mice and patients. Further, our findings highlight that glycolytic metabolism is a critical contributor to T-cell dysfunction and DCM immunopathogenesis. Our data position the modulation of the metabolism as a central integrator for T-cell function, representing a promising strategy against autoimmune-mediated DCM progression.

Rationale Our pilot study suggested that noninvasive ventilation (NIV) reduced the need for intubation compared with conventional administration of oxygen on patients with “early” stage of mild acute respiratory distress syndrome (ARDS, PaO2/FIO2 between 200 and 300). Objectives To evaluate whether early NIV can reduce the need for invasive ventilation in patients with pneumonia-induced early mild ARDS. Methods Prospective, multicenter, randomized controlled trial (RCT) of NIV compared with conventional administration of oxygen through a Venturi mask. Primary outcome included the numbers of patients who met the intubation criteria. Results Two hundred subjects were randomized to NIV (n = 102) or control (n = 98) groups from 21 centers. Baseline characteristics were similar in the two groups. In the NIV group, PaO2/FIO2 became significantly higher than in the control group at 2 h after randomization and remained stable for the first 72 h. NIV did not decrease the proportion of patients requiring intubation than in the control group (11/102 vs. 9/98, 10.8% vs. 9.2%, p = 0.706). The ICU mortality was similar in the two groups (7/102 vs. 7/98, 4.9% vs. 3.1%, p = 0.721). Multivariate analysis showed minute ventilation greater than 11 L/min at 48 h was the independent risk factor for NIV failure (OR, 1.176 [95% CI, 1.005–1.379], p = 0.043). Conclusions Treatment with NIV did not reduce the need for intubation among patients with pneumonia-induced early mild ARDS, despite the improved PaO2/FIO2 observed with NIV compared with standard oxygen therapy. High minute ventilation may predict NIV failure. Trial registration NCT01581229. Registered 19 April 2012 Electronic supplementary material The online version of this article (10.1186/s13054-019-2575-6) contains supplementary material, which is available to authorized users.

Mounting evidence has shown that inflammation might drive Alzheimer's disease (AD) pathology and contribute to its exacerbation. Previous studies have indicated that indomethacin or atorvastatin are beneficial in treating AD; however, no significant clinical effects have been shown. Furthermore, no study has investigated the efficacy of combining these agents for treating AD. This study sought to determine the effect of a combination of indomethacin and atorvastatin in the PrP-hAβPPswe/PS1ΔE9 (APP/PS1) transgenic AD mouse model. Treatment with indomethacin and atorvastatin ameliorated impairments in spatial learning and memory, and the active avoidance response in APP/PS1 mice. Moreover, we found a suppression of Aβ plaques and decreased concentration of Aβ1-42 in the hippocampus of APP/PS1 mice following treatment. In addition, indomethacin and atorvastatin ameliorated abnormal cytokine secretion, lymphocyte subset disorder, and hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axis imbalances in APP/PS1 mice. The combination of indomethacin and atorvastatin restored immune and neuroendocrine processes, attenuated pathologic changes and cognitive impairments in APP/PS1 transgenic mice, and could thus be a potential therapeutic agent for AD.

ObjectivesCardiac rehabilitation (CR) improves outcomes after myocardial infarction (MI), but it is underused in China. The purpose of this study was to develop a set of quality indicators (QIs) to improve clinical practices and to confirm the measurability and performance of the developed QIs for CR in Chinese patients after MI.Design and settingThe QIs were developed by a Chinese expert consensus panel during in-person meetings. The five QIs most in need of improvement were selected using a national questionnaire. Finally, the completion rate and feasibility of the QIs were verified in a group of MI survivors at university hospitals in China.ParticipantsSeventeen professionals participated in the consensus panel, 89 personnel in the field of CR participated in the national questionnaire and 165 MI survivors participated in the practice test.ResultsA review of 17 eligible articles generated 26 potential QIs, among which 17 were selected by the consensus panel after careful evaluation. The 17 QIs were divided into two domains: (1) improving participation and adherence and (2) CR process standardisation. Nationwide telephone and WeChat surveys identified the five QIs most in need of improvement. A multicenter practice test (n=165) revealed that the mean performance value of the proposed QIs was 43.9% (9.9%–86.1%) according to patients with post-MI.ConclusionsThe consensus panel identified a comprehensive set of QIs for CR in patients with post-MI. A nationwide questionnaire survey was used to identify the QIs that need immediate attention to improve the quality of CR. Although practice tests confirmed the measurability of the proposed QIs in clinical practice, the implementation of the QIs needs to be improved.Trial registration numberThis study is part of a study registered in ClinicalTrials.gov (NCT03528382).

IntroductionHomelessness is a global issue with a detrimental impact on health. Individuals who experience homelessness are often labelled as frequent healthcare users; yet it is a small group of individuals who disproportionately use the majority of services. This protocol outlines the approach to combine survey data from a prospective cohort study and randomised controlled trial with administrative healthcare data to characterise patterns and predictors of healthcare utilisation among a group of adults with a history of homelessness.Methods and analysisThis cohort study will apply survey data from the Health and Housing in Transition study and the At Home/Chez Soi study linked with administrative healthcare databases in Ontario, Canada. We will use count models to quantify the associations between baseline predisposing, enabling, and need factors and hospitalisations, emergency department visits and physician visits in the following year. Subsequently, we will identify individuals who are high-cost users of the health system (top 5%) and characterise their patterns of healthcare utilisation. Logistic regression will be applied to develop a set of models to predict who will be high-cost users over the next 5 years based on predisposing, enabling and need factors. Calibration and discrimination will be estimated with bootstrapped optimism (bootstrap performance—test performance) to ensure the model performance is not overestimated.Ethics and disseminationThis study is approved by the St Michael’s Hospital Research Ethics Board and the University of Toronto Research Ethics Board. Findings will be disseminated through publication in peer-reviewed journals, presentations at research conferences and brief reports made available to healthcare professionals and the general public.Trial Registration NumberThis is a secondary data analysis of a cohort study and randomized trial. The At Home/Chez Soi study has been registered with the International Standard Randomised Control Trial Number Register and assignedISRCTN42520374.

BACKGROUND This study investigated the relationship between the pathological alteration of alveolar septa and (1) pulmonary function and (2) matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor matrix metalloproteinase 1 (TIMP-1) expression in chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS Sixty patients with pulmonary disease were divided into control (n=20) and COPD (n=40) groups. Postoperative lung tissue specimens were examined. Hematoxylin and eosin and elastin van Gieson staining detected pathological alterations of pulmonary alveolar septa. Septa thickness was measured. MMP-2, MMP-9, and TIMP-1 expression levels were detected by immunohistochemical staining. Correlations were determined by Pearson analysis. RESULTS Forced expiratory volume in 1 s (FEV₁), forced vital capacity, FEV₁ percent predicted (FEV₁%pre), and diffusion capacity of carbon monoxide percent predicted (DLCO%pre) in COPD patients were significantly lower than in those of the control group (P

It is vast significance to explore the spatial and temporal evolution characteristics and influencing factors of herbivorous animal husbandry industry based on the context of China's agriculture pursuing high-quality development. In this paper, we analyze the spatial and temporal evolution of the layout of China's herbivorous animal husbandry industry and its influencing factors based on the spatial autocorrelation analysis, standard deviation ellipse, and spatial Durbin model with data from 1980 to 2017. The results show that there are significant positive autocorrelation characteristics of "high-high" aggregation and "low-low" aggregation in the Chinese herbivorous animal husbandry industry. To be specific, in the past four decades, the spatial distribution center of China's herbivorous animal husbandry industry has moved towards the northeast, crossing the boundary between agriculture and animal husbandry in China, presenting a clear trend of moving from pastoral area to agricultural area; the gradual narrowing of the spatial distribution range indicates the gradually increased degree of aggregation within the industry; the east-west stretch of spatial distribution has been strengthened, and the azimuth angle shows clockwise change, suggesting that the industrial expansion in the northeast-southwest direction is prominent; the influencing factors of changes in the spatial distribution of the industry reveal that the quantity and production capacity of productive land, people's income and living standards, and the level of mechanization will promote the development of China's herbivorous animal husbandry industry, and are essential factors influencing industrial distribution and transfer, while policy factor has small or even not significant impact on industrial aggregation, reflecting that the policy has not played the expected role, and policy support needs to be further intensified.

Fracture to fifth metatarsal's base is one the most common injury experienced at the foot. Studies have for long debated the use of operative and non-operative interventions for the management of the fracture, especially owing to its peculiar vasculature. However, to date, no attempt has been made to synthesize the evidence comparing the efficacy of operative and non-operative interventions for managing the fifth metatarsal's base fracture. To meta-statistically compare the effects of operative and non-operative management of fifth metatarsal base fracture. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of operative and non-operative interventions on rate of non-union, mean duration of union, duration of return to activity, duration of return to sport, visual analog scale, and the American orthopedic foot & ankle scale. Out of 1,170 records, 11 articles including 404 participants (mean age: 29.8 ± 7.4 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of operative interventions for enhancing fracture union as compared to non-operative interventions. The meta-analysis reveals beneficial effects for operative interventions by demonstrating medium to large effect reduction of rate of non-union (Hedge's g: -0.66), duration of union (-1.7), duration of return to activity (-2.07), visual analog scale (-0.86), and enhancement of the American orthopedic foot & ankle scale score (0.73) as compared to non-operative intervention. The current systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal's base fracture. The review reports beneficial effects of operative interventions as compared to non-operative interventions for reducing the rate of non-union, duration of union, duration of return to activity, duration of return to sport, visual analog scale, and increasing the American orthopedic foot & ankle scale score.

Aging is a natural biological process associated with cognitive decline and neuroendocrine-immune system changes; the neuroendocrine-immune system plays crucial role in brain aging and neurodegeneration, and it is essential to discern beneficial attempts to delay the aging progress based on immunological aging. In this study, we have investigated the effects of Traditional Chinese Medicine (TCM)-Liuwei Dihuang decoction (LW)-and donepezil, memantine, and melatonin on cognitive decline in aging mice. The aged SAMR1 mice received oral administration of donepezil (1mg/kg), memantine (10 mg/kg), melatonin (10 mg/kg), and LW (10 g/kg) for 3 months. A shuttle box, Morris water maze, and elevated-zero maze were performed to assess cognitive function, and flowcytometry, Luminex, and radioimmunoassay were performed to measure the lymphocyte subsets, inflammatory factors, and hormones. We observed that survival days of mice was increased with melatonin and LW, the anxiety behavior was significantly improved by memantine, melatonin, and LW treatment, active avoidance responses significantly improved by LW, donepezil, and memantine, the spatial learning ability was significantly improved by donepezil, and LW and melatonin were beneficial to the spatial memory of old mice. For immune function, LW increased CD4+ and CD4+CD28+ cells and reduced TNF-α, IL-1β, and G-CSF in plasma, and it also promoted the secretion of anti-inflammatory factors IL-4, IL-5, and IL-10 by regulating the active of Th2 cells in spleen. Donepezil and memantine exerted protective effects against CD4+CD28+ cell decrease caused by aging and reduced the pro-inflammatory factors TNF-α, IL-1β, and G-CSF in plasma. Melatonin could reverse CD8+CD28+ cell imbalances and increased B cells. For endocrine factors, LW increased TSH levels in the pituitary, and melatonin increased the GH level in blood. Our findings indicated that LW improved the cognitive decline in aging mice, and this might be associated with modulation of the active T cells and HPG axis hormones as well as increasing anti-inflammatory factors. Meanwhile, donepezil and memantine have advantages in regulating adaptive immunity, melatonin has advantages in the regulation of B cells and pituitary hormones, and LW exhibits a better effect on neuroendocrine immune function compared with the others from a holistic point of view. LW might be a potential therapeutic strategy for anti-aging-related syndromes, and it can also provide a value on medication guidance about drug combinations or treatment in clinic.

A seven-core fiber torsion sensor with microcavity structure based on intensity measurement is proposed. It is composed of a seven-core fiber (SCF) and two multi-mode fibers (MMF). The first end of the SCF has a microcavity structure. Because the mode fields between the MMF and SCF do not match at the splicing point, the phenomenon of mode interference will be formed between cladding modes and core modes. Experimental results show that in a clockwise situation, the intensity of transmission spectrum increases in the torsion range of 0 ∼ 70°, the torsion sensitivity is 0.098 dB/ ∘ . And in a counterclockwise situation, the intensity of transmission spectrum decreases, the torsion sensitivity is 0.103 dB/ ∘ . The sensor has a simple structure and easy to fabricate, so it has wide application prospects in the field of torsion sensing.

Spot size is an important factor affecting the interaction between laser and single crystal silicon. Different radius millisecond pulsed laser is used to irradiate single crystal silicon. The effects of laser irradiation on large and small spot size, including temperature rise, damage area and damage morphology, are compared and analyzed. The influence rule of spot size on laser-induced single crystal silicon is determined and its mechanism is analyzed. The results show that the peak temperature of the laser irradiation center point is higher when the spot radius is 0.2 cm than when the spot radius is 0.1 cm; the damage area of single crystal silicon increases with the increase of laser energy density; the damage threshold decreases with the increase of laser spot size, and increases with the increase of pulse width.

Recently, automation, shared use, and electrification are viewed as the “three revolutions” in the future transportation sector, and the traditional scheduled public transit system will be greatly enhanced with flexible services and autonomous vehicle scheduling capabilities. Many emerging scheduled transportation applications include the fully automatic operation system in urban rail transit, joint line planning, and timetabling for high-speed rail as well as emerging self-driving vehicle dispatching. The vehicle routing problem (VRP) holds promise for seeking an optimal set of vehicle routes and schedules to meet customers’ requirements and plays a vital role in optimizing services for feature scheduled transportation systems. Due to the difficulty of finding optimal solutions for large-scale instances, enormous research efforts have been dedicated to developing efficient algorithms, while our paper presents a unique perspective based on a time-dependent and state-dependent path searching framework. An open-source and light-weight VRP with pickup and delivery with time windows (VRPPDTW) modeling package, namely VRPLite, has been developed in this research to provide a high-quality and computationally efficient solution engine for transportation on demand applications. This paper describes the space–time–state modeling process of VRPPDTW using a hyper-network representation. This solution framework can be embedded in a column generation or Lagrangian relaxation framework to handle many general applications. A number of illustrated examples are presented to demonstrate the effectiveness of the path search algorithm under various traffic conditions and passenger travel requirements.

The timely and effective evaluation of spatially-explicit urban PM2.5 concentrations is highly important for an improved understanding of urban environmental health and sustainability in China. However, recent studies examining the spatiotemporal patterns of PM2.5 concentrations has not been comprehensively clarified due to the absence of spatial-detailed urban landscape linkage. In this study, a general non-linear model was developed to depict the non-linear relationship between spatially explicit impervious surface area (ISA) fractions and associated PM2.5 concentrations gradient changes for individual cities from multi-source satellite-based dataset. The comparative results of environmental quality across 32 major cities in China showed that the spatial pattern of urban PM2.5 concentrations is correlated with geographical orientation and socio-economic clusters—high baseline and more balanced states of PM2.5 concentrations are prevalent in North China and the Yangtze delta agglomerations. Temporally, during the period of 2000-2018, most of cities have the path dependency, whereas high concentration of PM2.5 diffused from the original east of ‘Hu-Huanyong Line’ toward some cities in north-eastern, central and western regions. In addition, our study highlights the optimizing regional economic structure and promoting urban greening construction will be of great significance in sustainable urban environmental health management.

An effective degradation indicator created from the general features is still a hotspot for the condition monitoring of bearing. To cover the shortage of the general features based indicator, some new indicators are built using multiple general features extracted from the original vibration signal without considering the internal relevancy among the features. To address that problem, a new indicator is proposed using the Orthogonal Neighborhood Preserving Projections (ONPP) and 2-Dimensional Hidden Markov Model (2-D HMM). With the ability of keeping the local structure of data set, Orthogonal Neighborhood Preserving Projections is used to obtain the low dimensional features with the main information remained. Unlike 1-Dimensional data-processing algorithm that commonly converts the multiple features into a vector to deal with the high-dimensional data with the integral property of the multiple features considered only, 2-Dimensional Hidden Markov Model not only take the relevance between the individuals of fault features into consideration but also capture the global characteristics of the multiple features. Then a likelihood probability based health assessment indication can be constructed by combing 2-D HMM with the data pre-processed by ONPP. The experiment results indicate that the proposed indicator show great abilities to make degradation performance of the bearing and is sensitive to incipient defects.

BACKGROUND: Serum procalcitonin (PCT) is a widely recognized inflammatory marker which can distinguish systemic bacterial infection from other types of infections. The ability of PCT levels to distinguish different pathogens from different focus of infection is contradictory. METHODS: This study included 551 patients with bloodstream infection (BSI) diagnosed with positive blood culture (BC) during Jan 2013 and May 2018. The patients were divided into two groups with or without definite focus of infection. In this study, we analyzed PCT levels induced by Gram-positive bacteria, Gram-negative bacteria and fungal infection. Relationship of time between PCT peak and BC collection, and the impact of antibiotics usage on PCT peak distribution were examined. RESULTS: For patients without definite focus of infection, the serum PCT values of Gram-negative bacteria were higher than that of Gram-positive bacteria (P0.05) among all patients. Moreover, among patients who use antibiotics before BC collection, the longer antibiotics used, the higher trend of the proportion for PCT peak distribution after BC collection. The higher proportion of antibiotics combined before BC collection, the lower proportion of PCT peak distribution appeared before BC collection, and the higher the proportion of PCT peak distribution appeared after BC collection. CONCLUSIONS: PCT value is determined by many factors. PCT value is related to not only Gram-positive bacteria or Gram-negative bacteria, but also related to specific pathogens, and specific of infection sites etc. The use of Antibiotics is also an important factor of PCT value.

Healthcare associated infection (HAI) control and prevention is the important component of medical safety. Healthcare workers (HCWs) are the core forces for implementing good HAI control and prevention. Several cases of outbreaks occurred in outpatient and emergency department (OED) strengthened the importance of infection control and prevention. Recently, the “Regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities” was released by National health Commission of the People’s Republic of China on May 10, 2018 and was going to implement on Nov 1, 2018. This regulation stipulates basic infection prevention requirements for safe care in OED of healthcare facilities. In this article, we would provide the interpretation and clinical practice of regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities and give a summary introduction.

We report a case of a 66-year-old woman with congenital cystic adenomatoid malformation (CCAM) that presented as a thin walled cyst on radiological imaging and mimicked lung cancer. The right pulmonary wedge resection was performed via thoracoscopic surgery. Pathologic results proved CCAM which though, uncommon may be misdiagnosed in adults.

A numerical method based on the finite fracture mechanics model was proposed in this study to accurately predict the failure of irregular arranged multi-bolt composite repair. The stress distribution and the stress intensity factors required in the model were obtained using a two-stage analysis strategy, which can effectively lower the FE model scale and computational cost while keeping high computational accuracy. In the two-stage analysis strategy, the bolt load distribution was calculated using the global analysis method. After obtaining the fastener load from the first-level model, detailed stress and stress intensity factor analysis were conducted around individual fasteners and cutouts, which were then used to evaluate the failure behaviour of the composite panels. To validate the numerical method, tensile tests were carried out on three kinds of bolted composite repairs with circular, elliptical and oblong cutouts. Failure mode, failure location and failure strength predicted by the proposed numerical method were consistent with the experimental results, illustrating the effectiveness and applicability of the numerical method on predicting the failure behaviour of bolted composite repairs.

Non-planar composite π joints are receiving increasing attention in marine engineering. Efficient two-dimensional (2D) finite element (FE) methods, which can accurately predicted the failure behavior of this kind of joint, are critically meaningful for structural design emphasizing low computational time and easy operation. A material model is developed here, from which the equivalent engineering constants of plies with various angles can be obtained. Based on the material model, a 2D FE model is built to determine distributions of the shear and peel strain in a single-lap adhesively bonded joint. The strain distribution results from the 2D FE model agree well with experimental results, validating the accuracy of the material model. In addition, 2D FE modelling of the non-planar composite π joint under tensile loading is developed by combining the proposed material model and progressive damage method. The damage behavior and ultimate failure load are predicted and good agreements present between the numerical and experimental results. Totally, the reduced computational method combining the 2D FE model and progressive damage method is efficient and simple, can provide an accurate simulation of the damage behavior of complex composite bonded structures and has good prospects for engineering applications.

Bolt pre-tightening force and the characteristics of contact surfaces have great influence on structural modes and transfer functions, which are usually ignored due to the difficulty in treatment. Using the ANSYS Workbench software, the finite element model of the whole structure and the bolt connection structure are established, and the vibration modes and harmonic responses in different structures are investigated. By comparing the finite element calculation data and test data, the influence of bolt connection structure is analyzed. Comparing the results when the bolt pre-tightening force is varied, the results show that the natural frequencies of bolt connection structure decrease compared with the whole structure. The transfer characteristics of the system are influenced by the pre-tightening force, and the natural frequencies increase with the increase in pre-tightening force.

// Jian-hui Wang 1,2,* , Xiao-rui Cheng 1,2,* , Xiao-rui Zhang 1,2 , Tong-xing Wang 1,2 , Wen-jian Xu 3 , Fei Li 3 , Feng Liu 1,2 , Jun-ping Cheng 1,2 , Xiao-chen Bo 3 , Sheng-qi Wang 3 , Wen-xia Zhou 1,2 and Yong-xiang Zhang 1,2 1 Department of Neuroimmunopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, China 2 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing, China 3 Department of Biotechnology, Beijing Institute of Radiation Medicine, Beijing, China * These authors contributed equally to this work and as co-first authors Correspondence to: Xiao-rui Cheng, email: // Wen-xia Zhou, email: // Yong-xiang Zhang, email: // Keywords : Alzheimer's disease, neuroendocrine immunomodulation, Senescence-accelerated mouse prone 8 strain (SAMP8), PrPhAβPPswe/PS1ΔE9 (APP/PS1) mice, learning and memory, Gerotarget Received : February 14, 2016 Accepted : March 18, 2016 Published : March 28, 2016 Abstract Senescence-accelerated mouse prone 8 strain (SAMP8) and PrP-hAβPPswe/PS1 ΔE9 (APP/PS1) mice are classic animal models of sporadic Alzheimer’s disease and familial AD respectively. Our study showed that object recognition memory, spatial learning and memory, active and passive avoidance were deteriorated and neuroendocrine immunomodulation (NIM) network was imbalance in SAMP8 and APP/PS1 mice. SAMP8 and APP/PS1 mice had their own specific phenotype of cognition, neuroendocrine, immune and NIM molecular network. The endocrine hormone corticosterone, luteinizing hormone and follicle-stimulating hormone, chemotactic factor monocyte chemotactic protein-1, macrophage inflammatory protein-1β, regulated upon activation normal T cell expressed and secreted factor and eotaxin, pro-inflammatory factor interleukin-23, and the Th1 cell acting as cell immunity accounted for cognitive deficiencies in SAMP8 mice, while adrenocorticotropic hormone and gonadotropin-releasing hormone, colony stimulating factor granulocyte colony stimulating factor, and Th2 cell acting as humoral immunity in APP/PS1 mice. On the pathway level, chemokine signaling and T cell receptor signaling pathway played the key role in cognition impairments of two models, while cytokine-cytokine receptor interaction and natural killer cell mediated cytotoxicity were more important in cognitive deterioration of SAMP8 mice than APP/PS1 mice. This mechanisms of NIM network underlying cognitive impairment is significant for further understanding the pathogenesis of AD and can provide useful information for development of AD therapeutic drug.

Understanding the different effects of CO2 dilution on the laminar premixed flame is an effective strategy for combustion control. Thus, a chemical kinetic modeling study of laminar burning velocity (LBV) for CH4/air/CO2 mixtures coupling with a detailed chemical reaction mechanism was employed under a wide range of initial conditions. After validation and comparison, the FFCM 1.0 was selected for this study. Based on the numerical prediction of LBV, the decoupling method was carried out to separate the effects of diluent CO2, including dilution, thermal and chemical effects, whose variations show that the rising initial temperature facilitates the three effects whereas the elevated pressure shows the opposite impact. In order to explain the particular process physically and chemically, the parameters analysis, sensitivity analysis and mole fraction analysis methods were conducted, and the LBV enhancement made by per unit of fuel, relevant thermal parameters and the important active radicals were proved to be responsible for the variation of the three effects, respectively. Furthermore, the domain reactions contributing to chemical effect are reactions (R32) and (R62), respectively, as temperature and pressure vary. Through this work, it not only completes the research on the effect of CO2 dilution on the laminar premixed flame, but also expands the commonly exploring initial conditions to a wide range, which provides the reference for the research on the operation condition and intensity setting of exhaust gas recirculation (EGR).

Inspection images of power transmission line provide vision interaction for the operator and the environmental perception for the cable inspection robot (CIR). However, inspection images are always contaminated by severe outdoor working conditions such as uneven illumination, low contrast, and speckle noise. Therefore, this paper proposes a novel method based on Retinex and fuzzy enhancement to improve the image quality of the inspection images. A modified multi-scale Retinex (MSR) is proposed to compensate the uneven illumination by processing the low frequency components after wavelet decomposition. Besides, a fuzzy enhancement method is proposed to perfect the edge information and improve contrast by processing the high frequency components. A noise reduction procedure based on soft threshold is used to avoid the noise amplification. Experiments on the self-built standard test dataset show that the algorithm can improve the image quality by 3&ndash, 4 times. Compared with several other methods, the experimental results demonstrate that the proposed method can obtain better enhancement performance with more homogeneous illumination and higher contrast. Further research will focus on improving the real-time performance and parameter adaptation of the algorithm.

AEOL-10150 is a broad-spectrum metalloporphyrin superoxidase dismutase (SOD) mimic specifically designed to neutralize reactive oxygen and nitrogen species. Research has shown that AEOL-10150 is a potent medical countermeasure against national security threats including sulfur mustard (SM), nerve agent exposure and radiation pneumonitis following a radiological/nuclear incident sufficient to cause acute radiation syndrome (ARS). AEOL-10150 performed well in animal safety studies, and two completed phase 1 safety studies in patients demonstrated that the drug was safe and well tolerated, indicating that AEOL-10150 has potential as a new catalytic antioxidant drug. In this article, we review improvements in AEOL-10150 in preclinical pharmacodynamic studies, especially regarding anti-SM, chlorine gas and radiation exposure studies.

With the increasingly restrictive emission regulations, the emission requirements for internal combustion (IC) engines become more stringent, especially the amount of nitrogen oxides (NOx) emissions. In this investigation, a convenient thermodynamic model was employed to study the effects of operating parameters on NOx emissions for a liquefied methane fueled spark-ignition engine. The selected GRI-MECH 3.0 mechanism was verified by the experimental data and the thermodynamic model was calibrated by the in-cylinder pressure and heat release rate (HRR). The validated model with detailed combustion chemistry mechanism was utilized to perform the numerical investigation. The results showed that equivalence ratio and engine load have the greatest impact on NOx emissions, followed by the intake gas temperature, and finally the engine speed and intake gas pressure have the least impact on NOx emissions. The intake gas temperature, engine speed and intake gas pressure have a limited influence on NOx emissions in ultra-lean mixtures (φ = 0.5 and 0.6). However, under stoichiometric conditions, a reduction appears in NOx emissions compared to the lean fuels of corresponding operating conditions. In addition, >90% NOx emissions are NO pollutants, with an occupation of 85% from thermal mechanism and a proportion of 12% from N2O-intermediate mechanism. More importantly, liquefied methane shows an advantage in terms of NOx emissions compared to multi-component natural gas. All these have provided research direction for the following 3-D CFD simulation work, and offered theoretical basis for selecting technology route to meet emission regulations of liquefied methane engine (LME).

VTE has emerged as a major public health problem. However, data on VTE burden in China are seldom reported.This study collected data on patients with a principal diagnosis of VTE, pulmonary embolism (PE), or DVT by using the International Classification of Diseases, 10th Revision, from 90 hospitals across China. The trends in hospitalization rates, mortality, length of stay (LOS), and comorbidities from 2007 to 2016 were analyzed.In total, 105,723 patients with VTE were identified. For patients with VTE, the age- and sex-adjusted hospitalization rate increased from 3.2 to 17.5 per 100,000 population, and in-hospital mortality decreased from 4.7% to 2.1% (P .001). The mean LOS declined from 14 to 11 days (P .001). In addition, the data in 2016 showed that the hospitalization rate of VTE was higher in elderly male patients (male patients vs female patients, 155.3 vs 125.4 per 100,000 population in patients aged ≥ 85 years; P .001) and in northern China (north vs south, 18.4 vs 13.4 per 100,000 population; P .001). Higher mortality rates were found in patients with cancer and Charlson Comorbidity Index scores2. Similar trends were also observed in patients with PE and those with DVT. The hospitalization rate in China was much lower than that of the United States or selected sites in Canada and Europe, the LOS was much longer, and the in-hospital mortality rates were similar.The hospitalization rates of VTE increased steadily, and the mortality declined. This study provides important information on the disease burden of VTE in China.

Background Cardiac rehabilitation (CR) has been shown to provide the best social, psychological and physical conditions for patient recovery after myocardial infarction (MI). Objectives The aim of present study was to quantify the efficacy of exercise-based CR treatments in terms of relief from symptoms of anxiety and depression symptoms among patients with MI. Methods Literature published up to August 2017 was reviewed systematically using relevant keywords, MeSH terms, and Emtree headings to search PubMed, Embase, CINAHL (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science. The results of included studies were compared meta-analytically. Results We found that exercise-based CR had a significant effect on decreasing anxiety and depression scores. Furthermore, exercise-based CR may alleviate anxiety and depressive symptoms at different time periods. Conclusions For patients with MI, exercise-based CR has been demonstrated to alleviate anxiety and depressive symptoms. These findings highlight CR as essential and beneficial for minimizing MI patient anxiety and depression during recovery.

IntroductionThe aim of this study was to investigate the potential role of a microRNA panel as early diagnostic markers for Alzheimer’s disease (AD).MethodsThe differentially expressed serum microRNAs were screened with microarray among cognitively normal controls (CNC), mild cognitive impairment (MCI), and AD. QRT-PCR assay was applied to evaluate differentially expressed microRNAs with two independent cohorts including 202 participants. Logistic regression model based on microRNA panel was constructed using a training cohort and then validated using an independent cohort.ResultsFirst, four differentially expressed serum microRNAs (let-7g, miR-197, miR-126 and miR-29a) were found, which expressions were positively correlated with mini mental state examination (MMSE) score. Second, a microRNA panel with the four microRNAs demonstrated good diagnostic performance for MCI and AD with 84% and 92% accuracy. Third, when combined with MMSE score, the diagnostic performance of the microRNA panel was further improved.DiscussionBlood microRNAs are potential AD biomarkers that may lead to new diagnostic strategies.

This study aimed to investigate the expression levels of microRNA-195 (miRNA-195) in different types of patients with cholangiocarcinoma (CCA) and its correlation with the prognosis. Serum samples were collected from different types of patients with CCA (I, II, III, IV) and normal cases, followed by detection of expression of miRNA-195 using quantitative polymerase chain reaction (qPCR). The serum samples of 204 patients with CCA, including 75 cases of type I, 68 cases of type II, 35 cases of type III and 26 cases of type IV and 200 healthy subjects were selected. The baseline clinicopathological data of patients with CCA were assessed and recorded, and patients were followed up constantly. The receiver operating characteristic (ROC) curve was established, and the area under the ROC curve (AUC) was calculated to evaluate the difference of miRNA-195 expression levels between patients with CCA and normal controls. Survival curves were set up for groups with high and low expression levels via the Kaplan-Meier method, and the log-rank test was used to evaluate the difference of survival curves between the two groups. The expression of miR-195 in patients with CCA was significantly lower than that in the normal control group, with a sensitivity of 0.78 and a specificity of 0.76, and it was positively correlated with the pathological grade of CCA. Additionally, the expression level of serum miRNA-195 was associated with lymph node metastasis (P=0.009) and tumor-node-metastasis (TNM) classification (P=0.010). The survival analysis revealed that the prognosis in patients with CCA in types III and IV was poorer than that in those with types I and III who had a low expression of miRNA-195 (P=0.0026). The results show that miR-195 is an important marker that reflects the malignant degree of CCA, and it is expected to be a reference marker to determine the prognosis of CCA.

Accurate and reliable prediction of groundwater level is essential for water resource development and management. This study was carried out to test the validity of three nonlinear time-series intelligence models, artificial neural networks (ANN), support vector machines (SVM) and adaptive neuro fuzzy inference system (ANFIS) in the prediction of the groundwater level when taking the interaction between surface water and groundwater into consideration. These three models were developed and applied for two wells near Lake Okeechobee in Florida, United States. 10 years data-sets including hydrological parameters such as precipitation (P), temperature (T), past groundwater level (G) and lake level (L) were used as input data to forecast groundwater level. Five quantitative standard statistical performance evaluation measures, correlation coefficient (R), normalized mean square error (NMSE), root mean squared error (RMSE), Nash-Sutcliffe efficiency coefficient (NS) and Akaike information criteria (AIC), were employed to evaluate the performances of these models. The conclusions achieved from this research would be beneficial to the water resources management, it proved the necessity and effect of considering the surface water-groundwater interaction in the prediction of groundwater level. These three models were proved applicable to the prediction of groundwater level one, two and three months ahead for the area that is close to the surface water, for example, the lake area. The models using P, T, G and L achieved better prediction result than that using P, T and G only. At the same time, results from ANFIS and SVM models were more accurate than that from ANN model.

Effective degradation indicator and robust prediction model are very important for residual life prediction. Thus a new residual life prediction based on Markov indicator and support vector is proposed. Since the Markov model is good at dealing with stochastic characteristics in time domain, Markov model is joined with multiple fault features for the construction of an effective degradation indicator of rolling element bearings. The support vector regression is used to construct an adaptive prediction model composed of two prediction models that are, respectively, based on historical data and online data. Thus the ultimate prediction result is obtained by taking a weighted average of the two prediction results captured by the two prediction models, and the weights are adjusted by the LMS to enhance the prediction accuracy. The experimental results show that the Markov indicator is more sensitive than the common features, and the proposed prediction method is more effective in comparison to other methods.

In order to obtain a sensitive bearing degradation indicator with significant trend, a new approach is proposed. For the capability of preserving the local structure of data manifold, locality preserving projections are used for features dimension reduction without missing the original information. Since continuous hidden Markov model (CHMM) can take multiple fault features into consideration and also capture the stochastic characteristics of fault features in the time domain, CHMM-based negative log likelihood probability is built as a new health assessment indication. The experiment results show that, compared with the general features, the proposed degradation indicator shows great trend of the bearing health and is more sensitive to incipient defects.

A new approach is proposed to quickly determine the optimal band-pass filter for the resonant demodulation of rolling element bearings. The combined wavelet filter is joined with quantum-behaved particle swarm optimization for optimal filtering. The correlated kurtosis is used as an evaluation index to identify the optimal filtered signal. The proposed approach possesses good band-pass filtering properties and improves optimal filtering speed and effect to converge rapidly to an optimal solution. Simulation and experiment results show that this approach can generate fault features that are superior to those produced with the classic algorithm. It also shortens the time spent on the same filtering effect in comparison.

Depth to water, net recharge, aquifer media, soil media, topography, impact of the vadose zone media, and hydraulic conductivity of the aquifer (DRASTIC) model based on a geographic information system (GIS) is the most widely adopted model for the evaluation of groundwater vulnerability. However, the model had its own disadvantages in various aspects. In this work, several methods and the technologies have been introduced to improve on the traditional model. The type of the aquifer was replaced by the thickness of the aquifer, and the index of topography was removed. The indexes of the exploitation of the groundwater and the type of land use that reflected the special vulnerability were added to the system. Furthermore, considering the wideness of the study area, the fixed weights in the DRASTIC model were not suitable. An analytic hierarchy process (AHP) method and an entropy weight (Ew) method were introduced to calculate the weights of parameters. Then, the Spearman Rho correlation coefficients between IVI and the Nemerow synthetical pollution index (NI) of the groundwater quality were significantly improved, after the four steps of modification. The level differences with little gaps between Nemerow comprehensive pollution indexes and groundwater vulnerability occupied the proportion of the area from 75.68 to 84.04%, and finally, a single-parameter sensitivity analysis for the two models was used to compute the effective weights of these parameters. By comparison, the DRMSICEL model seems to perform better than the DRASTIC model in the study area. And the results show discrepancies between the vulnerability indices and groundwater quality as indicated by existence of vulnerable areas with bad water quality and vice versa.

In order to select the effective health index and build reasonably the prediction model for prognostics, a new approach is proposed. The generative topographic mapping-based negative likelihood probability is used as the health index, and K-means clustering algorithm is employed for state division. The adaptive prediction model based on Markov model and least mean square algorithm is built by the historical data and the online monitoring data. According to the given threshold, the remaining life can be captured. Based on experimental verification, the results indicate that the selected health index is able to effectively reflect the condition of rolling bearings and the proposed model shows high prediction accuracy in comparison to the common one.

Background: Healthcare-associated infections (HAIs) are still a major health threats worldwide. Traditional surveillance methods involving manual surveillance by infection control practitioners (ICPs) for data collection processes are laborious, inefficient, and generate data of variable quality. In this study, we sought to evaluate the impact of surveillance and interaction platform system (SIPS) for HAIs surveillance compared to manual survey in tertiary general hospitals. Methods: A large multi-center study including 21 tertiary general hospitals and 63 wards were performed to evaluate the impact of electronic SIPS for HAIs. Results: We collected 4,098 consecutive patients and found that the hospitals installed with SIPS significantly increased work efficiency of ICPs achieving satisfactory diagnostic performance of HAIs with 0.73 for sensitivity, 0.81 for specificity and 0.81 area under the curve (AUC). However, there were significant heterogeneity own to regions, time of SIPS installation, departments and sample size. Conclusions: SIPS significantly improved ICPs efficiency and HAIs monitoring effectiveness, but there were shortcomings such as untimely maintenance and high cost.

Rationale Congenital pulmonary airway malformation (CPAM) is a rare developmental deformity of the lower respiratory tract. The disease occurs more in newborns. However, on rare occasions, CPAM can be found in adults. Radiologic features of CPAM include cystic or solid mass pattern. In an elderly patient, CPAM can be easily misdiagnosed as lung cancer. Patient concerns A 66-year old woman was admitted with complaints of chronic cough, expectoration. Her past history was unremarkable with no history of tuberculosis or smoking. Physical examination was normal. Computerized tomography of the chest showed an irregular cystic lesion in right lower lobe. Diagnosis Histopathological results confirmed the diagnosis of CPAM. Intervention The right pulmonary wedge resection was performed via thoracoscopic surgery. Outcomes On follow up 1 year later, the patient is asymptomatic. Lessons CPAM is rare in adults, and imaging cannot accurately distinguish CPAM from thin-walled cystic lung cancer. Hence, histopathology is mandatory to confirm the diagnosis.