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Which of the two mainstream endometrial preparation regimens, assisted natural cycle (NC) or hormone replacement treatment cycle (HRT), help frozen-thawed embryo transfer (FET) cycles after preimplantation genetic testing (PGT) achieve better clinical outcomes?This retrospective analysis included 3400 vitrified-warmed single blastocyst transfer cycles after PGT from January 2011 to November 2020, and involved 2332 patients with regular menstrual cycles. The decision to proceed with an assisted NC (n = 827) or HRT (n = 2573) before FET was reached based on a combination of patient preference and physician guidance. Clinical pregnancy rate, live birth rate, early miscarriage rate and obstetric outcomes were compared.No significant difference was observed between the assisted NC and HRT groups in terms of clinical pregnancy rate (51.6% versus 50.7%, P = 0.634), live birth rate (44.0% versus 43.4%, P = 0.746) or early miscarriage rate (12.6% versus 12.0%, P = 0.707). Multivariate analysis indicated that the endometrial preparation protocol was not an independent factor for a clinical pregnancy or live birth. In the HRT group, the Caesarean section rate (64.7% versus 51.9%, P 0.001) and pregnancy complication rate (20.2% versus 13.8%, P = 0.003) were significantly higher. The two groups were not statistically different with respect to gestational age, early preterm birth rate, fetal weight or fetal birth defect rate.For patients undergoing a PGT-FET cycle involving a single blastocyst transfer, using assisted NC and HRT for the endometrial preparation could lead to comparable rates of clinical pregnancy and live birth. Additionally, NC is safer than HRT in terms of avoiding pregnancy complications and adverse obstetric outcomes.

Background As thyroid-stimulating immunoglobulins (TSI) are a sign of Graves' disease (GD), measuring TSI titers is becoming increasingly important for GD diagnosis. This study evaluated the diagnostic accuracy of a new fully automated TSI immunoassay (Immulite™ TSI assay) in GD patients and compared it to the third generation thyroid-stimulating hormone receptor antibody (TRAb) electrochemiluminescence assay (Elecsys Anti-TSHR assay). Additionally, clinical characteristics associated with responsiveness to methimazole in patients with newly diagnosed GD were preliminarily explored. Methods This study involved 324 subjects, comprising patients with untreated GD (GD-UT), Graves’ ophthalmopathy (GO) patients, GD patients who had been treated for > 12 months (GD-T), autoimmune thyroiditis (AIT) patients, and healthy subjects (HS). The Immulite™ TSI and Elecsys Anti-TSHR assay were performed on all samples. According to their responsiveness to methimazole, the GD-UT patients were divided into rapid and slow responder groups, and their clinical characteristics were compared. Results A receiver operating characteristic (ROC) curve analysis of GD-UT patients showed that the optimal TSI cut-off value was 0.57 IU/L. Logistic regression revealed that age and initial FT4 and TSI levels in the middle-dose methimazole group were related to a rapid response, while the initial FT4 level, but not TSI, in the high-dose group was also associated with a rapid response. Conclusions The clinical diagnostic performance of the Immulite™ TSI assay for diagnosing GD was comparable to that of the Elecsys Anti-TSHR assay. The initial FT4 and TSI levels can be used as predictors of the responsiveness to methimazole in patients with newly diagnosed GD.

BACKGROUND Cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy is characterized by high morbidity, disability and mortality. If the patient also has severe pulmonary embolism (PE) at the same time, the treatment becomes more complex. This report describes the treatment strategy for a patient with PE and cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy. CASE SUMMARY A 70-year-old woman presented to our emergency department with right-sided hemiplegia and mixed aphasia of 2.5 h duration. She was diagnosed with left cerebral embolism, left internal carotid artery occlusion, PE and left calf intramuscular vein thrombosis. Following mechanical thrombectomy, brain magnetic resonance imaging showed cerebral infarction with basal ganglia hemorrhage. We observed changes in cerebral hemorrhage on serial monitoring of brain computed tomography and adjusted the dose of anticoagulant drugs. After 3 wk of treatment, the patient’s neurological and respiratory symptoms significantly improved, and a favorable prognosis was obtained. CONCLUSION Anticoagulation could be a potential option for PE accompanied by hemorrhagic transformation of an ischemic infarct.

The implementation of the p-type metal oxide semiconductor (MOS) in modern sensing systems requires a strategy to effectively enhance its inherent low response. However, for p-type MOS sensors, conventional methods such as catalyst nanoparticle (NP) decoration and grain size regulation do not work as effectively as they do for n-type MOS sensors, which is basically due to the fact that the p-type MOS adopts an unfavorable parallel conduction model. Herein, taking Au@PdO as an example, we demonstrate that the conduction model of the p-type MOS can be manipulated into the series conduction model by inserting a high-conductive metallic core into less-conductive p-type MOS NPs. This unique series conduction model makes the sensor response of Au@PdO nanoparticle arrays (NAs) very sensitive to the catalyst NP decoration as well as the change of structural parameters. For example, Au@PdO NAs demonstrate an ∼9000 times increase in sensor response when decorated with Pd NPs, whereas there is only ∼100 times increase for PdO NAs. This greatly improved response value outperforms all previously reported PdO-based (and most other p-type semiconductor-based) H2 sensors, which helps the obtained sensor to achieve an ultralow detection limit of ∼0.1 ppm at room temperature. Additionally, Au@PdO NAs inherit the high surface reactivity and gas adsorption property of p-type PdO. As a result, the as-prepared sensor exhibits high humidity-resistive property and excellent selectivity. This work provides a new strategy to significantly enhance the sensing performance of p-type gas sensors by manipulating their conduction model.

Background: There has been an increasing number of COVID-19 patients around the world. Since some patients developed with gastrointestinal bleeding, our study focused on the clinical features and gastroscopic findings of these patients, and factors associated with occult gastrointestinal bleeding. Patients and Methods: In this retrospective, observational study, we collected 368 COVID-19 patients who performed fecal or gastric occult blood from Wuhan Tongji Hospital, Jin Yin-tan Hospital, and Wuhan Union Hospital between February 1, 2020 and March 6, 2020. Clinical features were compared between patients with or without occult gastrointestinal bleeding, and gastroscopic findings of seven patients were described. Logistic regression analyses were performed to explore the factors associated with occult gastrointestinal bleeding. Results: In total, 43 (11.7%) patients presented occult gastrointestinal bleeding, whereas 35 (81.4%) of severe cases. CRP level, prothrombin time and D-dimer were higher, while lymphocyte count and albumin levels were decreased in patients with occult gastrointestinal bleeding. Gastroscopy in seven COVID-19 patients showed mucosal congestion, erosion or scattered bleeding at different sites. Albumin levels (OR, 0.856 [95% CI 0.793-0.924]; p < 0.001), prothrombin time (OR, 1.267 [1.089-1.475]; p = 0.002) on admission and severe disease (OR, 4.157 [1.765-9.791]; p = 0.001) were independent factors associated with GIB in COVID-19 patients, while antiviral drugs and glucocorticoid therapy were not associated with it. Conclusion: COVID-19 patients with occult gastrointestinal bleeding suffered from worse prognosis. Patients with decreased serum albumin levels or prolonged prothrombin time, and severe cases were at higher risk of occult gastrointestinal bleeding.

Chaoyue Chen,1,&ast; Ying Zhang,1,&ast; Xi Zhao,1 Meihui Tao,1 Wei Yan,2 Yu Fu1 1Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 2Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu FuDepartment of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, People’s Republic of ChinaTel +8613907194622Fax + 8627-8572630Email futureyu@hust.edu.cnBackground: Hypoalbuminemia has been reported in COVID-19 patients. Exploring the influencing factors and possible adverse consequences of albumin reduction may provide some guidance for the treatment of COVID-19 patients.Methods: In this multicentre retrospective study, we collected information including demographics, comorbidities, clinical symptoms, complications, laboratory tests, treatment, and outcomes of patients diagnosed with COVID-19 from three hospitals in Wuhan, China. We compared the indexes between patients with hypoalbuminemia and normal albumin. Regression model was used to evaluate various influencing factors of patients with hypoalbuminemia and their relationship with clinical outcomes. We also compared the changes of particular laboratory indexes in patients with hypoalbuminemia before and after enteral nutrition therapy.Results: A total of 482 patients were enrolled in the study. About 53.7% patients developed hypoalbuminemia during admission. Patients with hypoalbuminemia were older, had a higher proportion of combined diabetes mellitus, fever, dyspnea, and natriuresis, and had a relatively poorer prognosis than patients with normal albumin. Patients with hypoalbuminemia had higher levels of CRP, leukocytes, ALT, AST, total bilirubin, ALP, GGT, LDH, creatine kinase, D-dimer, globulin, and lower levels of lymphocytes and eosinophils. Severe, older, anorexia, elevated CRP, and decreased lymphocytes were the independent predictors for decreased albumin in COVID-19 patients. In addition, decreased albumin is correlated with adverse outcomes. Nutritional support therapy to correct serum albumin may improve patient outcomes.Conclusion: COVID-19 patients with hypoalbuminemia tend to have more severe clinical manifestations and more abnormal biochemical tests, which may result in poorer clinical outcomes. Nutritional support therapy may improve the clinical outcome of these patients.Keywords: hypoalbuminemia, albumin, COVID-19, enteral nutrition therapy

Current clinical agents for autoimmunity disorders treatment often cause substantial adverse effects and safety concerns, owing to non-specific immune modulation. Due to the prominent contribution of effector T cells in pathogenesis of rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), and preferential location of co-stimulatory receptor-ligand pair OX40-OX40L at the inflamed sites, selectively targeting autoaggressive T cells by blockade OX40-OX40L, might represent an alternative strategy. Herein, we developed a new strategy to antagonize OX40-OX40L interaction by engineering a cell membrane derived nanovesicles (NVs) expressing OX40 receptors (OX40 NVs), and explored their potential for autoimmune disorders therapy. OX40 NVs showed specific binding capability to inflamed HUVECs in vitro, it also possessed distinct arthritic-targeting capacity in RA inflamed joints, and preferential accumulation in IBD inflamed colon. OX40 NVs efficiently suppressed the progression of both RA and IBD diseases through reducing CD4+OX40+ T cells population, and proinflammatory cytokines (i.e., TNF-α and IL-1β), while reinforcing Tregs immune-suppressive effect, with superior therapeutic efficacy than anti-OX40L. Additionally, dexamethasone (DEX) loading can further enhance the potential of OX40 NVs for RA treatment. Owing to their preferential localization to inflamed sites, and potent immune-suppression ability, targeting OX40-OX40L blockade by OX40 NVs for autoimmune therapy is highly promising.

China’s financial service industry is developing rapidly. Under the background of globalization and informatization, the structure of the financial system is constantly adjusted. Therefore, re-examining the spatial layout characterizing the overall financial industry has profound importance. Based on point of interest data, we utilize Nanjing as a case study and the analysis spatial pattern and agglomerative characteristics of the financial service industry. The research is conducted through various spatial measurement methods and negative binomial regression models as well as factors affecting the overall spatial distribution of the industry. Results indicate that Nanjing’s financial service industry has prominent features of agglomeration-oriented characteristics, while spatial distribution generally presents a “northwest–southeast” trend, i.e., a layout formed along transport lines and facilities and from the central business district to the suburbs is steadily being reduced. The spatial distribution, concentration and scale of financial service companies, business halls, and automatic teller machines in Nanjing vary widely. Market demand, corporate agglomeration effect, geographical location, transportation facilities, and population size and dynamics have profoundly affected the distribution pattern of the financial service industry Nanjing-wide. Accordingly, this research provides some reference and suggestion for the construction of financial centers, the formulation of policies to optimize the layout of financial industries, and as a research benchmark for other developing countries in the process of rapid urbanization.

This paper investigated seismic performance of reinforced concrete (RC) single-column bridge bent with flexural failure under near-fault ground motion. Innovative nonlinear fiber-based finite element models (FEM) with combined damage mechanisms were proposed. Cracking and spalling of cover concrete, buckling of longitudinal reinforcing steel bars, and bond-slip effect were considered. To study bond-slip effect, two FEM were developed: model 1 (without bond-slip) and model 2 (with bond-slip). Nonlinear static cyclic pushover analyses and nonlinear response history analyses under scaled near-fault ground motion were conducted. The simulation results were compared with available pseudo-dynamic test results. Various ductility coefficients were evaluated to assess the seismic performance of RC bridge column. The attributes of near-fault ground motion on the seismic responses of RC bridge column were discussed. Model 1 overestimated the ultimate lateral load resistance, longitudinal reinforcing steel bar strain, and cover concrete strain. Model 1 also underestimated the lateral deflection of RC bridge column. The results of model 2 agree well with experimental observations including hysteretic responses and damage mechanisms. In general, the predictions of both models are in good agreement with the experimental observations. However, model 2 provides improved predictions on the seismic performance of RC single-column bridge bent under near-fault ground motion. It was also observed that maximum responses of RC bridge columns under near-fault motion were characterized by one or few large hysteretic cycles. The proposed models could also help practicing engineers and researchers simulate seismic performance of RC bridge columns under near-fault ground motions in a computationally efficient manner.

Aspect-based sentiment analysis has received considerable attention in recent years because it can provide more detailed and specific user opinion information. Most existing methods based on recurrent neural networks usually suffer from two drawbacks: information loss for long sequences and a high time consumption. To address such issues, a hybrid attention model is proposed for aspect-based sentiment analysis in this paper, which utilizes only attention mechanisms rather than recurrent or convolutional structures. In this model, a self-attention mechanism and an aspect-attention mechanism are designed for generating the semantic representation at the word and sentence levels respectively. Two auxiliary features of word location and part-of-speech are also explored for the proposed models to enhance the semantic representation of sentences. A series of experiments are conducted on three benchmark datasets for aspect-based sentiment analysis. Experimental results demonstrate the advantage of the proposed models for both efficiency and execution effectiveness.

High-temperature oxidation is a common failure in high-temperature environments, which widely occur in aircraft engines and aerospace thrusters; as a result, the development of anti-high-temperature oxidation materials has been pursued. Ni-based alloys are a common high-temperature material; however, they are too expensive. High-entropy alloys are alternatives for the anti-oxidation property at high temperatures because of their special structure and properties. The recent achievements of high-temperature oxidation are reviewed in this paper. The high-temperature oxidation environment, temperature, phase structure, alloy elements, and preparation methods of high-entropy alloys are summarized. The reason why high-entropy alloys have anti-oxidation ability at high temperatures is illuminated. Current research, material selection, and application prospects of high-temperature oxidation are introduced.

Respiratory motion estimation is an important part in image-guided radiation therapy and clinical diagnosis. However, most of the respiratory motion estimation methods rely on indirect measurements of external breathing indicators, which will not only introduce great estimation errors, but also bring invasive injury for patients. In this paper, we propose a method of lung respiratory motion estimation based on fast Kalman filtering and 4D CT image registration (LRME-4DCT). In order to perform dynamic motion estimation for continuous phases, a motion estimation model is constructed by combining two kinds of GPU-accelerated 4D CT image registration methods with fast Kalman filtering method. To address the high computational requirements of 4D CT image sequences, a multi-level processing strategy is adopted in the 4D CT image registration methods, and respiratory motion states are predicted from three independent directions. In the DIR-lab dataset and POPI dataset with 4D CT images, the average target registration error (TRE) of the LRME-4DCT method can reach 0.91 mm and 0.85 mm respectively. Compared with traditional estimation methods based on pair-wise image registration, the proposed LRME-4DCT method can estimate the physiological respiratory motion more accurately and quickly. Our proposed LRME-4DCT method fully meets the practical clinical requirements for rapid dynamic estimation of lung respiratory motion.

Constipation and abdominal pain are commonly encountered in opioid-induced bowel dysfunction (OBD). The underlying mechanisms are incompletely understood, and treatments are not satisfactory. As patients with OBD often have fecal retention, we aimed to determine whether fecal retention plays a pathogenic role in the development of constipation and abdominal pain in OBD, and if so to investigate the mechanisms. A rodent model of OBD was established by daily morphine treatment at 10 mg/kg for 7 days. Bowel movements, colonic muscle contractility, visceromotor response to colorectal distention, and cell excitability of colon-projecting dorsal root ganglion neurons were determined in rats fed with normal pellet food, or with clear liquid diet. Morphine treatment (Mor) reduced fecal outputs starting on day 1, and caused fecal retention afterward. Compared with controls, Mor rats demonstrated suppressed muscle contractility, increased neuronal excitability, and visceral hypersensitivity. Expression of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) was upregulated in the smooth muscle of the distended colon in Mor rats. However, prevention of fecal retention by feeding rats with clear liquid diet blocked upregulation of COX-2 and NGF, restored muscle contractility, and attenuated visceral hypersensitivity in Mor rats. Moreover, inhibition of COX-2 improved smooth muscle function and fecal outputs, whereas anti-NGF antibody administration attenuated visceral hypersensitivity in Mor rats. Morphine-induced fecal retention is an independent pathogenic factor for motility dysfunction and visceral hypersensitivity in rats with OBD. Liquid diet may have therapeutic potential for OBD by preventing fecal retention-induced mechanotranscription of COX-2 and NGF. NEW & NOTEWORTHY Our preclinical study shows that fecal retention is a pathogenic factor in opioid-induced bowel dysfunction, as prevention of fecal retention with liquid diet improved motility and attenuated visceral hyperalgesia in morphine-treated animals by blocking expression of cyclooxygenase-2 and nerve growth factor in the colon.

Statement of problem Clinical studies comparing compatible computer-aided design and computer-aided manufacturing (CAD-CAM) titanium abutments (CAs) and original prefabricated 1-piece titanium abutments (PAs) for posterior fixed dental prostheses (FDPs) on Straumann Tissue Level (STL) implants are sparse. Purpose The purpose of this retrospective clinical study was to compare the performance of posterior FDPs supported by CAs and PAs on STL implants after a mean observation period of 7.2 years. Material and methods Patients who received STL implants and posterior FDPs by using CAs or PAs between January 2002 and December 2012 and returned for follow-up between January 2017 and September 2018 were included in this study. Technical and biological complications of FDPs were examined and recorded. Radiographs were used for the measurement of marginal bone loss (MBL) of each implant. Variables, complication rates, and MBL of the 2 groups were analyzed by using a generalized estimating equation and multivariable linear mixed model. Results Ninety-nine patients with 195 implants in the CA group and 75 patients with 143 implants in the PA group were included. The mean functional time of FDPs was 6.5 ±1.1 years for the CA group and 8.1 ±2.6 years for the PA group. No implant failure was noted in either group. The technical complication rate was 20.8% in the CA group and 26.3% in the PA group. Abutment screw loosening (ASL) was noted in the CA group (8.5%). The decementation rate was significantly higher in the PA group (14.1%) than that in the CA group (3.1%) (adjusted odds ratio=4.40, confidence interval=1.41 to 13.69, P=.011). No significant differences were found between the 2 groups in terms of the rates of ceramic chipping, peri-implantitis, peri-implant mucositis, or mean MBL. Conclusions Using CAs or PAs to support posterior FDPs on STL implants has no significant effect on the incidence rate of biological complications. However, a higher ASL rate and a lower decementation rate were noted with CAs than with PAs.

OBJECTIVE This study aimed to analyze changes in melanocyte density and epidermal thickness in vulvar lichen sclerosus (VLS). METHODS Vulvar skin tissues were collected from 15 VLS female patients in Beijing Hospital, classified into early (n = 7) and late VLS (n = 8) groups according to pathological manifestations. Melanocyte density and full epidermal and cell-layer (from the bottom of the stratum corneum to that of the basal layer) thickness were calculated using an image analysis software. The control group was normal vulvar skin tissues from 15 females after plastic surgery. RESULTS The early VLS (0.170 ± 0.071 µm) and late VLS (0.110 ± 0.035 µm) groups had significantly lower densities of epidermal melanocytes than the control group (0.275 ± 0.036) (F = 36.426, P

Objective Diabetes is the fifth leading cause of death in the People's Republic of China. The aim of the article is to compare the effects of nursing care on the laboratory findings and ultrasound results of diabetic patients with chronic liver diseases (CLD) who were treated with antiglycemic drugs. Methods Diabetic were patients treated with metformin hydrochloride in combination with gliclazide, pioglitazone hydrochloride, sitagliptin, exenatide or liraglutide. Non-alcoholic fatty liver disease (NAFLD) was evaluated by abdominal ultrasound, and fibrosis stages were evaluated at baseline and 8 months. All the patients were equally divided into two groups depending on the therapeutic approach. Results The first group of patients additionally received nursing care, and the second group adhered to the prescribed therapy on their own. In total 90 patients, or 55.6%, had NAFLD at baseline, and its course was dependent upon changes in the weight (P = 0.009) and waist circumference (P = 0.012). The proportions of patients who demonstrated an ultrasonographic improvement in the control group were: 24 (56.8%) with gliclazide, 15 (41.3%) with pioglitazone hydrochloride, 28 (66.1%) with sitagliptin, 16 (79%) with exenatide and 15 (66.7%) with liraglutide (P = 0.2). For the group that received nursing care an ultrasonographic improvement was in: 29 (68.16%) with gliclazide, 18 (49.56%) with pioglitazone hydrochloride, 33 (79.32%) with sitagliptin, 19 (94.8%) with exenatide and 21 80.04% with liraglutide (P = 0.2). Conclusions Outcomes from the type 2 diabetes treatment paralleling of CLD were presented. Treatment of type 2 diabetes with pioglitazone hydrochloride, gliclazide, sitagliptin, liraglutide and exenatide was proven effective.

A C–Si bonded SiO2/diamond interface is formed under a SiO2 mask during the selective diamond growth at a high temperature in a H2 atmosphere including methane (5%). A few monolayers with C–Si bonding at the SiO2/diamond surface are confirmed through X-ray photoelectron spectroscopy at the C1s and Si2p core levels from 290 eV to 271 eV and 107 eV–95 eV, respectively. In addition, secondary ion mass spectroscopy results suggest that the C–Si bonds, and not C–H bonds, are majority at the interface and are mainly responsible for the field effect transistor (FET) operation. Two-dimensional hole gas C–Si diamond metal–oxide–semiconductor FET (MOSFETs) are fabricated using the C–Si diamond sub-surface as a p-channel. The MOSFETs in which the actual length from the source to the drain (LSD) is 12 μm–6 μm show appreciable field-effect mobility (e.g. 140 cm2V−1s−1 at LSD = 12 μm and 300 K) and normally-off operation. The wide temperature characteristics of the C–Si MOSFETs are confirmed and the device shows high stability, and a high on/off ratio of 106 is maintained at 673 K. The C–Si bonding at the SiO2/diamond interface provide a lower interface state density which makes the MOSFET show high drain current density and field-effect mobility with normally-off operation.

Background: Increasing the vertical dimension of occlusion (VDO) is a common procedure in complicated prosthodontic treatment. The swallowing technique had been verified as a functional method to determine the VDO. The purpose of this study was to investigate the association between increasing VDO and mandibular movement during swallowing. Methods: 26 females and 14 males were enrolled (age range: 21 to 30 year-old). Under different increased VDO (3, 5, and 8 mm), the mandibular trajectory during swallowing was measured by K7 Evaluation System (Myotronics®). When the subjects were instructed to salivary swallowing, the range of mandibular movement in vertical, anteroposterior and lateral directions were recorded. Results: Increasing VDO significantly impacted the range of mandibular movement in lateral direction during swallowing (p

Aims Seizure outcome of autoimmune encephalitis (AE) varies from seizure‐free to refractory epilepsy, and the associated factors remain unclear. We aimed to describe seizure characteristics, identify seizure outcome‐related factors, and discuss the medication strategy of antiepileptic drugs (AEDs) at the first onset of AE. Methods We retrospectively studied the data of 86 patients with clinically diagnosed AE. The clinical characteristics were described using a chi‐square test. Seizure outcome‐related factors were assessed using multivariable logistic regression analysis. Results 56 patients were finally enrolled, with antibodies to N‐methyl‐D‐aspartate receptor found in 29, to γ‐aminobutyric acid receptor B found in 13, and to leucine‐rich glioma‐inactivated protein 1 found in 14. Status epilepticus occurrence and onset with seizure lead to a poor seizure outcome, while administration of human gamma globulin and a low antibody titer contributed to a good seizure outcome. Conclusions In the acute phase, seizure characteristics may be considered in the utilization of AEDs. For patients with seizure‐free status in the acute phase, clinical manifestation (onset with seizure or not, whether status epilepticus occurs or not), therapy regimen (human gamma globulin administered or not), and antibody titer may be considered when formulating the strategy for withdrawal of AEDs post‐acute phase., In the acute phase, seizure characteristics may be considered in the utilization of antiepileptic drugs. For patients who have achieved seizure‐free status in the acute phase of autoimmune encephalitis, onset with seizure or not, status epilepticus occurs or not, human gamma globulin administered or not and antibody titer may be considered in the withdrawal strategy of AEDs after the acute phase.

Nausea and vomiting are the most painful and feared side effects for patients during chemotherapy. Currently, most studies focus on the occurrence of CINV during the risk phase. We initiated this real-world study to understand the actual occurrence of CINV throughout all phases, to provide a basis to prevent CINV in patients during chemotherapy and improve their quality of life. This prospective real-world study was conducted at 17 major cancer centers in Sichuan, China. Cancer patients who were about to receive moderately/highly emetogenic chemotherapy were included in the study. Occurrences of nausea and vomiting were recorded using patient diaries, and physicians are responsible for recording patient clinical data. A total of 1,139 patients were included in this study between August 2018 and April 2019. In this study, the incidence of acute CINV was 55.3%, delayed CINV was 62.3%, and CINV beyond the risk period was 36%. All phases overall, the overall complete control (CC) rate of CINV was 30.1 and 32.1% for highly and moderately emetogenic chemotherapy regimens, respectively. The median CC time for CINV was 7 days, but only 21.5% of these patients used antiemetic regimens according to the NCCN guideline. In the real world, the incidence of CINV is high in patients receiving chemotherapy, and nausea and vomiting may occur beyond the risk period; the low level of standardized antiemetic treatment in compliance with the guideline might have been the main reason for unsatisfactory prevention and control of CINV in this study.

Rigidity is one of the major manifestations of Parkinson’s disease (PD), but no quantitative and objective imaging method has been developed to measure rigidity. Ultrasound shear wave elastography (SWE) can reflect the stiffness of tissue by providing a quantitative index. Thus, we conducted this study to evaluate the potential clinical value of SWE in assessing rigidity in PD. A total of 63 subjects (44 patients with rigidity-dominant PD and 19 right-dominant-hand normal controls with matched age) were enrolled, and each underwent ultrasound SWE testing. The tests were conducted on the brachioradialis (BR) and biceps brachii (BB) on the more affected side in patients with PD and on the right side in normal controls. Differences in quantitative shear wave velocity (SWV) between patients with PD and normal controls were determined. The relationship of muscle SWV with joint rigidity, UPDRSIII, disease duration, sex, and age in patients with PD was analyzed. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of SWE in assessing muscle stiffness in patients with PD. The mean SWVs of the BB and BR were higher in the PD group (3.65±0.46 and 4.62±0.89 m/s, respectively) than in normal controls (2.79±0.37 and 3.26±0.40 m/s, respectively). Stiffness in BR and BB was correlated with the upper-limb joint rigidity, UPDRSIII, and disease duration but not with sex or age in the PD group. The intraobserver correlation coefficients (ICCs) for interobserver and intraobserver variations in measuring SWV were 0.85 (95% confidence interval 0.56–0.95) and 0.85 (95% confidence interval 0.58–0.95), respectively, for BR and 0.90 (95% confidence interval 0.73–0.97) and 0.86 (95% confidence interval 0.61–0.95), respectively, for BB. SWV is associated with joint rigidity and disease duration, indicating that SWE can be potentially used as an objective and quantitative tool for evaluating rigidity.

Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend p = 0.382; integrated discrimination improvement: 2.41%, p Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

Graphical abstract, Excessive inflammation and the pyroptosis of vascular endothelial cells caused by estrogen deficiency is one cause of atherosclerosis in post-menopausal women. Because autophagy is highly regulated by estrogen, we hypothesized that estrogen can reduce vascular endothelial cell pyroptosis through estrogen receptor alpha (ERα)-mediated activation of autophagy to improve atherosclerosis in post-menopausal stage. Aortic samples from pro-menopausal and post-menopausal women with ascending aortic arteriosclerosis were analyzed, and bilateral ovariectomized (OVX) female ApoE-/- mice and homocysteine (Hcy)-treated HUVECs were used to analyze the effect of estrogen supplementation therapy. The aortic endothelium showed a decrease in ERα expression and autophagy, but presented an increase in inflammation and pyroptosis in female post-menopausal patients. Estrogen treatment accelerated autophagy and ameliorated cell pyroptosis in the cardiac aortas of OVX ApoE-/- mice and Hcy-treated HUVECs. Estrogen had therapeutic effect on atherosclerosis and improved the symptoms associated with lipid metabolism disorders in OVX ApoE-/- mice. Inhibition and silencing of ERα led to a reduction in the autophagy promoting ability of estrogen and aggravated pyroptosis. Moreover, the inhibition of autophagy promoted pyroptosis and abolished the protective effect of estrogen, but had no influence on ERα expression. Thus, the results of the present study demonstrated that post-menopausal women present decreased autophagy and ERα expression and excessive damage to the ascending aorta. In addition, in vitro and in vivo assay results demonstrated that estrogen prevents atherosclerosis by upregulating ERα expression and subsequently induces autophagy to reduce inflammation and pyroptosis.

Vulvovaginal atrophy (VVA) is a common menopause-related symptom affecting more than 50% of midlife and older women and cancer patients whose ovarian function are lost or damaged. Regardless of estrogen deficiency, whether other factors such as the gut microbiota play role in VVA have not been thoroughly investigated. To this end, we performed ovariectomy on 12-weeks' old mice and follow-up at 4 weeks after ovariectomy, and observed atrophied vagina and an altered gut microbiota in ovariectomized mice.. We further performed fecal microbiota transplantation with feces from another cohort of ovary-intact fecund female mice to the ovariectomized ones, and found that the vaginal epithelial atrophy was significantly alleviated as well as the gut microbiota was pointedly changed. All these results suggest that ovarian activity has some influence on the gut microbiota, and the latter from the ovary-intact female mice can somehow make the vagina of mice deficient in ovarian function healthier maybe by up-expressing ESR1 in vaginal cells and enhancing regeneration in vagina. This kind of association between gut microbiota and vaginal health need further exploration such that it may provide an alternative treatment by modulating gut microbiota in patients suffering from VVA but may be reluctant to hormone therapy.

Animal studies implicate meningeal lymphatic dysfunction in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease (PD). However, there is no direct evidence in humans to support this role1-5. In this study, we used dynamic contrast-enhanced magnetic resonance imaging to assess meningeal lymphatic flow in cognitively normal controls and patients with idiopathic PD (iPD) or atypical Parkinsonian (AP) disorders. We found that patients with iPD exhibited significantly reduced flow through the meningeal lymphatic vessels (mLVs) along the superior sagittal sinus and sigmoid sinus, as well as a notable delay in deep cervical lymph node perfusion, compared to patients with AP. There was no significant difference in the size (cross-sectional area) of mLVs in patients with iPD or AP versus controls. In mice injected with α-synuclein (α-syn) preformed fibrils, we showed that the emergence of α-syn pathology was followed by delayed meningeal lymphatic drainage, loss of tight junctions among meningeal lymphatic endothelial cells and increased inflammation of the meninges. Finally, blocking flow through the mLVs in mice treated with α-syn preformed fibrils increased α-syn pathology and exacerbated motor and memory deficits. These results suggest that meningeal lymphatic drainage dysfunction aggravates α-syn pathology and contributes to the progression of PD.

Anabolic resistance to a mechanical stimulus may contribute to the loss of skeletal muscle mass observed with age. In this study, young and aged mice were injected with saline or human LM-111 (1 mg/kg). One week later, the myotendinous junction of the gastrocnemius muscle was removed via myotenectomy (MTE), thus placing a chronic mechanical stimulus on the remaining plantaris muscle for 2 weeks. LM-111 increased α7B integrin protein expression and clustering of the α7B integrin near DAPI+ nuclei in aged muscle in response to MTE. LM-111 reduced CD11b+ immune cells, enhanced repair, and improved the growth response to loading in aged plantaris muscle. These results suggest that LM-111 may represent a novel therapeutic approach to prevent and/or treat sarcopenia.

Integrated energy systems can effectively improve the efficiency of energy utilization and promote sustainable development of energy, while meeting the diversified energy demands. In order to deal with the operation risk caused by system uncertainties, the CVaR method was introduced into the system optimization model for risk management. The CVaR model was adopted to solve a multi-objective optimization problem using a two-stage stochastic programming method, where the uncertainty about solar energy and energy demand are considered at the same time. By comparing the optimization results obtained from the CVaR method and from the conventional scenario-based stochastic programming method, the effectiveness of the CVaR method in risk management of integrated energy systems is verified.

This paper investigates the influence of mineral structure on macromechanical behavior of coal under different loading conditions using X-ray CT scanning experimental and numerical methods. The three-dimensional (3D) reconstruction of coal was conducted to assess the spatial distribution characteristics of the mineral structure by AVIZO software. Based on fractal box dimension (BCD) and equivalent diameter, the mineral structures were quantitatively characterized. The 3D finite element models with three distribution characteristics of minerals were built, and the model was considered as a random heterogeneous two-phase material composed of coal matrix and mineral matter. The results show that the frequency of mineral structures decreases with the increase of equivalent diameter in the coal sample. The BCD of the original mineral structure in coal is greater than 2, but the BCD of each part of the minerals divided based on the screening principle is less than 2. Under uniaxial conditions, the elastic modulus, peak strength, and residual strength of coal are monotonically increasing with the size of the mineral structure. The larger the mineral structure size and the more complex the distribution are, the greater the area of stress concentration and the more uniformity the distribution will be. The failure (plasticity) first occurred at the interface between the matrix and the mineral, and the failure zone is significantly different due to the influence of different mineral structures. Under confining pressure, the presence of mineral structure decreases the brittleness of coal, and the variation of brittleness is related to the size and spatial distribution of mineral structures. The fitting relationship between confining pressure and brittleness index is linear, and the correlation coefficient exceeds 0.95.

In order to investigate the key environmental influencing factors for the change of sediment bacterial community structure (BCS) and antibiotics resistance genes (ARGs) in a long-term Quinolone antibiotics (QNs) and heavy metals (HMs) polluted lake, 16S rRNA MiSeq High-throughput Sequencing and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) analysis methods were applied. Baiyangdian lake was subdivided into three habitats: (1) Habitat 1: greatly influenced by municipal wastewater; (2) Habitat 2: mainly impacted by aquaculture sewage and domestic wastewater; and (3) Habitat 3: with the least human activities. Through One-way ANOVA analysis, the results showed that most of QNs and HMs showed significant difference among three habitats. Both the highest richness and diversity indices of bacterial community appeared in Habitat 3. The abundance of Multidrug, Phenicol, Aminoglycoside, Teracycline, and Quinolone ARGs exhibited the highest values in Habitat 1, while the abundance of Macrolide-Lincosamide-Streptogramin (MLS), Rifamycinm, and Sulfonamide ARGs appeared the highest values in Habitat 2. The result of redundancy analysis exhibited that 68.8% and 93.8% of the change in BCS and ARGs can be explained by environmental factors, respectively. Pb (explained 37.5% (p = 0.002)) and Fleroxacin (FLE) (explained 51.3% (p = 0.026)) were the most important factors for the variation of BCS and ARGs, respectively. Therefore, the effects of antibiotics and HMs on BCS and ARGs should be simultaneously paid more attention. Furthermore, the ARGs results by PICRUSt were similar to the results by metagenomic shotgun sequencing analysis, thus the PICRUSt analysis method can be used in the future research.

Huimin Fu, Yu Fu, Xingguo Xu, Yongtao Gao Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of ChinaCorrespondence: Xingguo Xu; Yongtao GaoDepartment of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu 226001, People’s Republic of ChinaTel +86 15162771638; +86 13962988003Fax +86 051381160318Email TDFYXXG@126.com; gyt19700114@sina.comPurpose: In recent years, ultrasound-guided rectus sheath block (RSB) has been widely used in postoperative analgesia of abdominal operation. However, there is no uniform standard for the optimal dose of local anesthetics (LA) under ultrasound-guided rectus sheath block. This study aimed to determine the dose of ropivacaine combined with butorphanol that is effective in 50% (ED50) and 95% (ED95) of subjects for successful pain-free ultrasound-guided RSB in single-incision laparoscopic cholecystectomy (SILC).Patients and Methods: Twenty-four patients scheduled to undergo single-incision laparoscopic cholecystectomy received an ultrasound-guided RSB. The initial dose of ropivacaine injected was 1.7 mg/kg, which was subsequently increased or decreased by 0.2 mg/kg, depending on whether the previous patient was free from pain (numeric rating scale (NRS) score of incisional pain at rest within 12 h after operation ≤ 3). All patients were treated with butorphanol 0.02 mg/kg as preemptive analgesia. The ED50 and ED95 were calculated using a probit regression model.Results: The ED50 and ED95 of ropivacaine combined with butorphanol in ultrasound-guided rectus sheath block for analgesia in SILC, which were calculated by the probit regression model, were 0.719 mg/kg (95% confidence interval (CI), 0.553 mg/kg− 0.873 mg/kg) and 0.967 mg/kg (95% CI, 0.835 mg/kg− 1.91 mg/kg), respectively.Conclusion: As part of a multimodal analgesia strategy, a dose of 0.719 mg/kg ropivacaine provided successful RSB under ultrasound guidance in 50% of the patients who underwent SILC. A dose of 0.967 mg/kg would be successful in 95% of patients.Keywords: ED50, ED95, single-incision laparoscopic cholecystectomy, rectus sheath block

Objective To explore the economic burdens of hip fracture surgery in patients referred to lower-level medical institutions and to evaluate how referral systems affect costs and outcomes of hip fracture surgery. Design A nationwide population-based retrospective cohort study. Setting All hospitals in Taiwan. Participants A total of 7500 patients who had received hip fracture surgery (International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes 820.0 ∼ 820.9 and procedure codes 79.15, 79.35, 81.52, 81.53) performed in 1997 to 2013. Main outcome measures Total costs including outpatient costs, inpatient costs and total medical costs and medical outcomes including 30-day readmission, 90-day readmission, infection, dislocation, revision and mortality. Results The patients were referred to a lower medical institution after hip fracture surgery (downward referral group) and 3034 patients continued treatment at the same medical institution (non-referral group). Demographic characteristics, clinical characteristics and institutional characteristics were significantly associated with postoperative costs and outcomes (P Conclusions Postoperative costs and outcomes of hip fracture surgery are related not only to demographic and clinical characteristics, but also to institutional characteristics. The advantages of downward referral after hip fracture surgery can save huge medical costs and provide a useful reference for healthcare authorities when drafting policies for the referral system.

Background: The aim of this study was to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) ST76 isolates collected during an outbreak in a hospital's intensive ca...

Developing a simple strategy to fabricate high-performance hydrogen sensors with long-term stability remains quite challenging. Here, we report the H2-sensing performance of Pd-decorated PdO hollow shells (Pd/PdO HSs). In this novel system, the catalyst nanoparticles (Pd NPs) and semiconductor support (PdO) are interconvertible, which is different from traditional hydrogen-sensing systems such as Pd/TiO2 and Pd/ZnO. This Pd/PdO system exhibits multiple unique properties. First, well-distributed Pd NPs with controllable density can be decorated on PdO support through a one-step NaBH4 treatment during which PdO is partially reduced into Pd. Second, the decorated Pd NPs are physically inlaid in the PdO support, which not only prevents the agglomeration or detachment of Pd NPs but also enhances the electron transfer between Pd NPs and PdO. Third, Pd/PdO HSs can be reoxidized into PdO HSs once their sensing performance degrades, which repeatedly manipulates Pd/PdO HSs under the initial reduction process, leading to the reactivation of the sensing performance. With all these advantages, Pd/PdO HSs demonstrate a detection limit lower than 1 ppm, a response/recovery time to 1% H2 of 5 s/32 s at room temperature, and a repeatable reactivation ability. The strategy presented here is convenient and time saving and has no need to prefunctionalize the PdO surface for the decoration of catalyst NPs. Moreover, the unique reactivation ability of Pd/PdO system opens a new strategy toward extending the lifetime of H2 sensors.

This paper presents a novel image compression-encryption scheme, which has the compression-confusion-diffusion Structure. Firstly, based on Chebyshev chaotic map, a Gauss measurement matrix is constructed and optimized, which is applied to compressive sensing. Then, an image compression-encryption algorithm is proposed by using a six-dimensional discrete chaotic map. In the proposed scheme, the original image is transformed into a sparse coefficient matrix by discrete wavelet transform, and the sparse coefficients are measured by using the optimized Gauss measurement matrix to get the measured values. Then, the measured values are quantized into integer values and the compressed image is obtained. Furtherly, the compressed image is encrypted by using a six-dimensional chaotic map. In the process of encryption, the plaintext image is divided into two parts, when encrypting the second part, the first part is used as part of the key. While encrypting the first part, the ciphertext of the second part is used as part of the key. Thus, the algorithm has strong confusion and diffusion effect and makes ciphertext sensitive to plaintext. Experimental results such as effects of compression-encryption, key space analysis, key sensitivity analysis, differential analysis, histograms analysis, information entropy analysis, and correlation coefficients analysis show that the proposed scheme is secure and has high application potential.

PURPOSE To achieve automatic classification of viable and necrotic tumor regions in osteosarcoma, most of the existing deep learning methods can only design a simple model to prevent overfitting on small datasets, which leads to the weak ability of extracting image features and low accuracy of the models. In order to solve the above problem, a deep model with Siamese network (DS-Net) was designed in this paper. METHODS The DS-Net constructed on the basis of full convolutional networks is composed of an auxiliary supervision network (ASN) and a classification network. The construction of the ASN based on the Siamese network aims to solve the problem of a small training set (the main bottleneck of deep learning in medical images). It uses paired data as the input and updates the network through combined labels. The classification network uses the features extracted by the ASN to perform accurate classification. RESULTS Pathological diagnosis is the most accurate method to identify osteosarcoma. However, due to intraclass variation and interclass similarity, it is challenging for pathologists to accurately identify osteosarcoma. Through the experiments on hematoxylin and eosin (H&E)-stained osteosarcoma histology slides, the DS-Net we constructed can achieve an average accuracy of 95.1%. Compared with existing methods, the DS-Net performs best in the test dataset. CONCLUSIONS The DS-Net we constructed can not only effectively realize the histological classification of osteosarcoma, but also be applicable to many other medical image classification tasks affected by small datasets.

While widely used for ovulation induction in assisted reproductive technology, the clinical efficacy of letrozole for endometrial preparation prior to frozen-thawed embryo transfer (FET) cycles remains yet to be elucidated. We performed a meta-analysis to compare pregnancy outcomes after letrozole use with those of other endometrial preparation protocols in patients undergoing FET. PubMed, Scopus, Embase and the Cochrane Library were searched for eligible studies. Clinical pregnancy rate (CPR), live birth rate (LBR) and birth defect rate (BDR) were analysed using odds ratio (OR) and 95% confidence interval (CI). A total of 10 studies representing 75 968 FET cycles were included. Comparable CPR and LBR were observed when comparing letrozole administration with natural cycle (OR 1.24, 95% CI: 0.69 - 2.24; OR 1.18, 95% CI: 0.60 - 2.32), artificial cycle (OR 1.46, 95% CI: 0.87 - 2.44; OR 1.39, 95% CI: 0.77 - 2.52), and artificial cycle with gonadotropin-releasing hormone agonist suppression (OR 1.11, 95% CI: 0.78 - 1.59; OR 1.18, 95% CI: 0.82 - 1.68). Pooled results of the limited studies comparing letrozole with human menopausal gonadotropin demonstrated a similar CPR between groups (OR 1.46, 95% CI: 0.29 - 7.21, two studies), but the letrozole group had a statistically lower LBR (OR 0.67, 95% CI: 0.52 - 0.86, one study). No increased BDR was observed in the letrozole group compared to natural cycles or artificial cycles (OR 0.98, 95% CI: 0.60 - 1.61; OR 1.39, 95% CI; 0.84 - 2.28). This pooled analysis supports the use of letrozole as an efficacious and safe alternative to mainstream regimens for endometrial preparation in FET cycles.Obwohl Letrozol oft in der assistierten Reproduktionstechnik zur Einleitung der Ovulation eingesetzt wird, ist die klinische Wirksamkeit von Letrozol bei der Vorbereitung des Endometriums vor Transferzyklen von konservierten/aufgetauten Embryos (FET) noch unklar. Wir führten eine Metaanalyse durch, um das Schwangerschafts-Outcome nach dem Einsatz von Letrozol mit denen anderer Protokolle zur Vorbereitung des Endometriums bei Patientinnen, bei denen ein FET vorgenommen wurde, zu vergleichen. Die Datenbanken von PubMed, Scopus, Embase und the Cochrane Library wurden nach passenden Studien durchsucht. Die klinische Schwangerschaftsraten (SR), Lebendgeburtenraten (LGR) und Geburtsfehlerraten wurden mithilfe von Odds Ratio (OR) und 95%-Konfidenzintervallen (KI) analysiert. Insgesamt wurden 10 Studien, die 75 968 FET-Zyklen darstellten, in die Analyse aufgenommen. Die SR und die LGR für Letrozol waren statistisch vergleichbar mit den Werten für natürliche Zyklen (OR 1,24; 95%-KI 0,69 – 2,24 bzw. OR 1,18, 95%-KI 0,60 – 2,32), künstliche Zyklen (OR 1,46; 95%-KI 0,87 – 2,44 bzw. OR 1,39; 95%-KI 0,77 – 2,52), sowie künstliche Zyklen mit Gonadotropin-Releasing-Hormon-Agonisten-Suppression (OR 1,11; 95%-KI 0,78 – 1,59 bzw. OR 1,18; 95%-KI 0,82 – 1,68). Die gepoolten Ergebnisse der begrenzten Anzahl an Studien, die Letrozol mit humanem Menopausengonadotropin verglichen, zeigten eine ähnliche SR für beide Gruppen (OR 1,46; 95%-KI 0,29 – 7,21, 2 Studien), wobei die Letrozol-Gruppe eine statistisch niedrigere LGR aufwies (OR 0,67; 95%-KI 0,52 – 0,86, 1 Studie). Die Geburtsfehlerrate in der Letrozol-Gruppe war nicht erhöht verglichen mit den Geburtsfehlerraten für natürliche Zyklen bzw. künstliche Zyklen (OR 0,98; 95%-KI 0,60 – 1,61 bzw. OR 1,39; 95%-KI 0,84 – 2,28). Diese gepoolte Analyse weist darauf hin, dass Letrozol eine wirksame und sichere Alternative zu den Standardprotokollen bei der Vorbereitung des Endometriums in FET-Zyklen darstellen könnte.

Background The mechanisms of neuronal protein γ-synuclein (SNCG) in the malignancy of oral squamous cell carcinoma (OSCC) are not clear. This study tested the hypothesis that SNCG is involved in nicotine-induced malignant behaviors of OSCC. The effect of nicotine on SNCG expression and epithelial-to-mesenchymal transition (EMT) markers were examined. Methods Short hairpin RNA (shRNA) and an antagonist specific for α7-nicotine acetylcholine receptors (α7-nAChRs) were used to examine the role of α7-nAChRs in mediating the effects of nicotine. Knockdown of SNCG in nicotine-treated cells was performed to investigate the role of SNCG in cancer malignancy. The in vivo effect of nicotine was examined using a nude mouse xenotransplantation model. Results Nicotine increased SNCG expression in a time- and dose-dependent manner. Nicotine treatment also increased E-cadherin and ZO-1 and decreased fibronectin and vimentin expression. After specific knockdown of α7-nAChRs and inhibition of the PI3/AKT signal, the effect of nicotine on SNCG expression was attenuated. Silencing of SNCG abolished nicotine-induced invasion and migration of OSCC cells. The xenotransplantation model revealed that nicotine augmented tumor growth and SNCG expression. Conclusion Nicotine upregulated SNCG expression by activating the α7-nAChRs/PI3/AKT signaling that are participated in nicotine-induced oral cancer malignancy.

PurposeNo study has investigated the effects of contralateral noise (CN) on speech-in-noise perception (SINP) in listeners with tinnitus. The mechanisms underlying the involvement of medial olivocochlear (MOC) reflex with SINP remain to be elucidated. This study aimed to investigate the MOC function in patients with bilateral tinnitus by measuring distortion product otoacoustic emission and SINP.MethodEighteen patients with bilateral tinnitus (one male and 17 females; age:M±SD= 45.61 ± 10.18 years) and 19 listeners without tinnitus (six males and 13 females; age:M±SD= 34.11 ± 8.35 years) were recruited for the study. Each subject underwent distortion product otoacoustic emission measurement and the SINP test for both ears. The effects of CN on these two measurements were compared between tinnitus ears (TEs) and no-tinnitus ears (NTEs).ResultsThe presence of CN significantly reduced distortion product (DP) amplitudes and improved SINP for TEs, and the amounts of DP suppression and SINP improvement were similar to those in NTEs. Improvement of SINP was positively correlated with DP suppression at 6185 Hz for NTEs and at 1640 Hz for TEs.ConclusionsThe results of this study suggest that the amounts of DP suppression and SINP improvement were similar between listeners with and without tinnitus. For both ear groups, the MOC reflex was involved with SINP at specific frequencies. Any clinical test outcomes with regard to the MOC bundle in patients with tinnitus should be interpreted with caution until further studies are conducted.

The aim of the present study was to investigate the role of Smad3 inhibitors and the pyroptosis pathway in spinal cord injury, and to determine the underlying mechanism. The pyroptosis signaling pathway may be involved in spinal cord injury during the recovery period. Smad3 inhibitor may serve a role in alleviating spinal cord injury by reducing the pyroptosis of neurons, which is induced by caspase-1, absent in melanoma-2 or NOD-like receptors protein-1 during the recovery period of spinal cord injury. In the present study, spinal cord injury was alleviated by caspase-1 and Smad3 inhibitors. Therefore, a Smad3 inhibitor could relieve spinal cord injury in mice by directly downregulating caspase-1 and reducing neuron pyroptosis following spinal cord injury during the recovery period.

Background The infiltration of neutrophils aggravates inflammatory response in acute myocardial infarction (AMI), and the role of calcium-sensing receptor (CaSR) in neutrophil-associated inflammation is largely unknown. The aim of this study was to evaluate the regulatory effects of CaSR on nucleotide-binding oligomerization domain-like receptor pyrin domain-containing 3 (NLRP3) inflammasome in neutrophils and to explore its role in AMI-related ventricular remodelling. Methods The expression of CaSR, NLRP3 inflammasome, and interleukin 1β (IL-1β) in peripheral blood and infiltrating neutrophils in patients and rats with AMI was detected by western blotting and immunofluorescence. Cardiomyocyte apoptosis was detected by western blotting and transmission electron microscopy. The degree of fibrosis was evaluated by Masson staining and western blotting. Results We found upregulation of CaSR, NLRP3 inflammasome, Caspase-1, and IL-1β in peripheral neutrophils from patients with AMI compared with matched healthy controls, peaking on day 1 and decreasing gradually till 7 days. Peripheral and infiltrating neutrophils from rats with AMI showed the same trend. Calindol enhanced NLRP3 inflammasome activation and IL-1β release in neutrophils from healthy volunteers, which was blocked by inhibitors of the PLC-IP3 pathway and ER-Ca2+ release. Calhex-231 decreased NLRP3 inflammasome activation and IL-1β release in neutrophils from patients with AMI. The calindol-stimulated neutrophils from healthy rats promoted cardiomyocyte apoptosis and fibrosis of cardiac fibroblasts from healthy rats, which were inhibited by calhex-231. Conclusion The results suggest that CaSR activates NLRP3 inflammasome in neutrophils, contributing to ventricular remodelling after AMI. CaSR inhibition may be a potential therapeutic target for heart failure in AMI.

Background Although research on the effects of comorbidities on coronavirus disease 2019 (COVID-19) patients is increasing, the risk of cancer history has not been evaluated for the mortality of patients with COVID-19. Methods In this retrospective study, we included 3232 patients with pathogen-confirmed COVID-19 who were hospitalized between January 18th and March 27th, 2020, at Tongji Hospital in Wuhan, China. Propensity score matching was used to minimize selection bias. Results In total, 2665 patients with complete clinical outcomes were analyzed. The impacts of age, sex, and comorbidities were evaluated separately using binary logistic regression analysis. The results showed that age, sex, and cancer history are independent risk factors for mortality in hospitalized COVID-19 patients. COVID-19 patients with cancer exhibited a significant increase in mortality rate (29.4% vs. 10.2%, P < 0.0001). Furthermore, the clinical outcomes of patients with hematological malignancies were worse, with a mortality rate twice that of patients with solid tumors (50% vs. 26.1%). Importantly, cancer patients with complications had a significantly higher risk of poor outcomes. One hundred nine cancer patients were matched to noncancer controls in a 1:3 ratio by propensity score matching. After propensity score matching, the cancer patients still had a higher risk of mortality than the matched noncancer patients (odds ratio (OR) 2.98, 95% confidence interval (95% CI) 1.76–5.06). Additionally, elevations in ferritin, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, procalcitonin, prothrombin time, interleukin-2 (IL-2) receptor, and interleukin-6 (IL-6) were observed in cancer patients. Conclusions We evaluated prognostic factors with epidemiological analysis and highlighted a higher risk of mortality for cancer patients with COVID-19. Importantly, cancer history was the only independent risk factor for COVID-19 among common comorbidities, while other comorbidities may act through other factors. Moreover, several laboratory parameters were significantly different between cancer patients and matched noncancer patients, which may indicate specific immune and inflammatory reactions in COVID-19 patients with cancer.

It is a hot spot in the field of computer application to diagnose complex brain diseases such as Asperger syndrome (AS) using machine learning technology. To identify AS patients and detect lesions, this paper proposes a novel clustering-evolutionary random support vector machine (SVM) ensemble (CERSVME) based on graph theory. Firstly, we extract graph theory indexes from the resting-state functional magnetic resonance imaging (fMRI) data as sample features and construct an ensemble learner by integrating multiple SVM classifiers. Secondly, the base learners with high redundancy and poor classification ability are deleted through clustering evolutions to improve the performance of the model. Then the CERSVME model is used to classify fMRI image of AS patients and healthy controls. According to the classification results, a multi-stage analysis scheme is designed to find the AS-related brain areas. We validate the proposed approach on 135 participants from autism brain imaging data exchange cohort. The highest accuracy reported by the CERSVME reaches 95.24%. More importantly, the diseased brain areas such as middle frontal gyrus, hippocampus and precuneus are found based on their contributions to classification performances of the CERSVME. Our study provides useful assistances for the clinical detection of patients with AS.

A wide-band push–push common-collector Colpitts voltage-controlled oscillator (VCO) using impedance peaking network and gain enhancing technique is proposed in this work. The impedance peaking network is introduced to increase the coupling factor of the differential inductor in the inductor capacitor (LC) tank without sacrificing the quality factor. The impedance peaking technique could guarantee the push–push VCO unconditionally oscillating in a differential mode without degrading the phase noise performance. The gain enhancing technique employs an LC resonator in series with the emitter degeneration resistor in the common-collector amplifier in the VCO core to improve the VCO oscillating amplitude and then improve the phase noise performance. The proposed VCO oscillates at around 20 GHz with >10.5% frequency tuning range from 18.9 to 21.4 GHz across temperature from −40 to 125°C. The measured phase noise is lower than −107 dBc/Hz at 1 MHz offset across the entire working temperature (−40 125°C). The whole VCO dissipates 45 mA under 3.3 V power supply, and the typical figure of merit is around −177.92.

Huimin Fu,1 Chaochao Zhong,2 Yu Fu,1 Yongtao Gao,2 Xingguo Xu2 1Nantong University, Nantong, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of ChinaCorrespondence: Xingguo XuDepartment of Anesthesiology, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Nantong, Jiangsu 226001, People’s Republic of ChinaTel +86 15162771638Fax +86 051381160318Email TDFYXXG@126.comPurpose: Pain after single-incision laparoscopic cholecystectomy (SILC), especially visceral pain, often troubles patients and doctors. Whether preemptive butorphanol can relieve visceral pain in patients undergoing SILC remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral rectus sheath block (RSB) and butorphanol for perioperative analgesia in patients undergoing SILC.Patients and Methods: Fifty-eight patients who met the criteria were randomly divided into two groups, both of which were given preemptive RSB. Patients were given either butorphanol 0.02mg/kg (group B, n=29) or sufentanil 0.1 μg/kg (group S, n=29) as preemptive analgesia. The primary outcome was the cumulative frequency of rescue analgesic request within 24 hours after operation. Secondary outcomes were numeric rating scale (NRS) scores (from 0 to 10) of incisional pain and visceral pain, the length of hospital stay and the incidence of postoperative adverse events.Results: The frequency of postoperative rescue analgesic request of group S was significantly higher than that of group B (P=0.021). The NRS scores for visceral pain were lower in group B at 2, 6 and 12 hours after surgery than in group S (both P< 0.001). The occurrence of postoperative nausea and vomiting (PONV) was significantly higher in group S. There were no significant differences between two groups for other outcomes.Conclusion: Butorphanol can provide sufficient visceral pain treatment after SILC than the dose of sufentanil in equal analgesic effect.Keywords: rectus sheath block, butorphanol, single-incision laparoscopic cholecystectomy, incisional pain, visceral pain, preemptive analgesia

Recently, there are few reports on three-dimensional (3D) imaging method based on radar network. Aiming at the 3D imaging problem in radar network, a reconstruction method for 3D inverse synthetic ...

On October 21, 2018, a Puyuma express train went overspeed through a sharp curve and derailed in Yilan, Taiwan. This accident resulted in 18 fatalities and 267 injuries. Although such accidents occur once in a while worldwide, this case of an overspeed derailment from a train-set equipped with an automatic train protection (ATP) system (similar to the function of Positive Train Control (PTC) in the U.S.) is rare. A temporary investigation team was appointed by the Executive Yuan, the highest administrative organ in Taiwan, and the investigation was completed within 2 months. This paper presents the process, analysis, findings, and recommendations from the accident investigation. The accident was first analyzed using fault tree analysis to identify potential causes and contributing factors of this derailment. The results were then categorized into layers of defenses by using a Swiss cheese model. We further extended the original Swiss cheese model to a “time-dependent Swiss cheese model” to demonstrate how the barriers were penetrated at different times by incorporating the timestamps of important events. Another modified Swiss cheese model called “causal relationship Swiss cheese model” was presented to further demonstrate the causal relationships. With the proposed process and models, the immediate causes and contributing factors were quickly identified and presented in a way that could be easily understood by the general public. The results showed that the ATP system (or the PTC) cannot guarantee 100% safety. A review of the safety culture and corresponding procedures is important to ensure the safety of railway operations.

CH4-CO2 reforming process can convert CH4 while utilizing a large amount of CO2, thus becoming a green chemical technology and attracting wide attention. Nevertheless, thermodynamic characteristics of this process determine that the reaction requires high operating temperature and its side reactions lead to carbon deposition. The main challenge for industrial applications of this process is to solve the deactivation problem of Ni-based catalysts induced by sintering and carbon deposition. This review summarizes the research progress of CH4-CO2 reforming and Ni-based catalysts and forecasts the future study.

Thermal power generation has increased CO2 emissions, which in turn has put tremendous pressure on the environment. Therefore, analyzing the regional ecological environmental carrying capacity of thermal power carbon emissions is of great significance for countries with high thermal power capacity to guide the development of low-carbon power and industrial layout. To accurately measure the pressure of regional power production for the environment, this paper proposes the concept of renewable energy virtual carbon emission based on the carbon footprint theory. The regional power carbon footprint (PCF) depth model and the regional power carbon deficit model are constructed. Moreover, through the statistics of China’s power production, this paper calculates the depth of China’s PCF and analyzes the temporal and spatial differences of China’s PCF depth from the three aspects of regional power installation structure, power deficit, and PCF transfer. The results obtained illustrate, firstly, that China’s overall PCF continues to increase, with the depth of PCF moving eastward. Secondly, due to the imbalance of China’s PCF, there are significant temporal and spatial differences in the depth of regional PCF. Thirdly, with the rapid development of renewable energy in China, the effect of controlling the depth of regional PCF by renewable energy is rising. Besides, the transfer of PCF among different China’s regions has significant impact on the change of PCF depth of power output provinces.