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Diaphragmatic injury is a common clinical condition, and it may be difficult to avoid diaphragmatic hernia if detection and treatment is not timely. Parasternal hernia is mostly congenital. It is relatively rare in adults, and intestinal obstruction as a complication of intrathoracic intestinal herniation occurs only rarely. We treated a patient in whom parasternal hernia occurred 2 years after thoracic injuries. We present the plain radiography and computed tomography findings of this adult patient with acute abdomen symptoms caused by parasternal hernia. Keywords: Parasternal hernia, Obstruction, Jejunal necrosis

Abstract The vertical variations and key drivers of ozone and its precursors, namely NOx and VOCs, in the atmospheric boundary layer, have vital impacts on surface ozone budgets but are poorly understood so far. Using online gradient measurements from a 356 m tower, we obtained continuous vertical profiles of ozone and its precursors, which exhibited strong gradients throughout the day. In the daytime, the vertical gradients of ozone precursors are significantly regulated by reactions with OH radicals. At night, our observations confirmed more intense VOC reactions with NO3 radicals in the residual layer than in the boundary layer. Additionally, we found that residual layer entrainment could contribute to over half of the boundary-layer ozone enhancements in the morning periods. Our results underscore the importance of considering vertical changes of ozone and its precursors in the atmospheric boundary layer when developing future ozone mitigation strategies.

Abstract To study the effects of caspase inhibitors on hemodynamics and inflammatory factors in acute respiratory distress syndrome (ARDS) model rats. Sixty healthy male Wistar rats were randomly divided into three groups, namely, the control group, ARDS group and ARDS + Caspase inhibitor group, with 20 rats in each group. The control group was intraperitoneally injected with 2 mL/kg saline, and the ARDS model group was established by intraperitoneally injecting 4 mg/kg Lipopolysaccharide (LPS), ARDS + Caspase inhibitor group was adminstered 20 mg/kg caspase inhibitor after intraperitoneal LPS injection. Changes in pulmonary arterial pressure (PAP) and mean arterial pressure (MAP) at 6 and 12 h before and after administration were recorded. Moreover, arterial blood gas was evaluated with a blood gas analyzer and changes in the partial pressure of O2 (PaO2), partial pressure of CO2 (PaCO2), partial pressure of O2/fraction of inspired O2 (PaO2/FiO2) were evaluated. In addition, the lung wet/dry weight (W/D) ratio and inflammatory factor levels in lung tissue were determined. Finally, pathological sections were used to determine the pulmonary artery media thickness (MT), MT percentage (MT%), and the degree of muscle vascularization. The pulmonary arterial pressure of rats was determined at several time points. Compared with the control group, the model group had a significantly increased pulmonary arterial pressure at each time point (P

Abstract Background Acute exposures to high levels of air pollutants are thought to be associated with hospitalization of patients with lung infection, while relatively little is known about the association between air pollutants and HOSPITAL ADMISSIONS FOR pulmonary sepsis. Objectives To assess the correlation between low-level exposure to air pollutants and the hospitalizations for pulmonary sepsis in elderly patients. Methods A total of 249 elderly patients with pulmonary sepsis from January 2018 to December 2020 in Shenzhen people’s hospital were included. The data regarding hospitalizations for pulmonary sepsis, meteorological factors, and daily average levels of air pollutants on single-day lags (Lag0 to Lag7) in Shenzhen were collected. Low-level exposure was defined as the annual means of air pollutants below the levels of the Ambient Air Quality Standard (AAQS) in China (NO. GB3095-2012) and/or Global Air Quality Guidelines (AQG). A time-stratified case-crossover study design approach was used to evaluate the associations between exposure to air pollutants and incidence of the disease, univariate and multivariate logistic regression analysis to analyze the association between levels of air pollutants and hospitalizations for pulmonary sepsis in elderly patients. Results Exposure to PM1(P = 0.007, Lag 2 day; P = 0.038, Lag6 day), PM2.5(P = 0.046, Lag2 day), PM10(P = 0.048, Lag4 day), and O3(P = 0.044, Lag6 day) was positively correlated with elevated risk of hospitalizations for pulmonary sepsis. In addition, logistic regression analysis revealed that exposure to PM1 (OR = 1.833, 95%CI:1.032 ~ 3.256, Lag6 day) and O3 (OR = 2.091, 95%CI:1.019 ~ 4.289, Lag6 day) were the independent risk factors of pulmonary sepsis in elderly patients. Conclusion Our results demonstrate that short-term low-level exposure to PM1 and O3 could elevate the risk of hospitalizations for pulmonary sepsis in elderly patients in Shenzhen, providing evidence for developing early warning and screening systems for pulmonary sepsis.

ObjectiveTo investigate the therapeutic effect and mechanism of sivelestat sodium on acute lung injury (AIL).MethodsA rat model for ALI/acute respiratory distress syndrome (ALI/ARDS) was established. Pathological examination of lung tissue was conducted to assess lung injury. Blood gas in the arteries was measured using a blood analyzer. Changes in PaO2, PaO2/FiO2, and lung wet/dry (W/D) weight ratio were carefully compared. ELISA assay was conducted to estimate cell adhesion and inflammation response. Finally, real-time reverse transcription polymerase chain reaction and western blotting assay was used to determine the activation of PI3K/AKT/mTOR pathway.ResultsARDS in vivo model was successfully constructed by LPS injection. Compared with the sham group, PaO2 and PaO2/FiO2 were significantly lower in the vehicle group, while the lung W/D ratio, the lung injury score, NE, VCAM-1, IL-8 andTNF-αwere significantly increased. After treatment with different doses of sivelestat sodium, we found PaO2, PaO2/FiO2 were prominently increased, while the lung W/D ratio, the lung injury score, NE, VCAM-1, IL-8, TNF-α levels were decreased in the dose-dependent manner. Meanwhile, compared with the vehicle group, the expression levels of Bax, PI3K, Akt and mTOR were significantly lower, and the expression of Bcl-2 was significantly higher after injection with sivelestat sodium.ConclusionSivelestat sodium has an interventional effect on ALI in sepsis by inhibiting the PI3K/AKT/mTOR signalling pathway.

Establishing the absolute age of palaeoearthquakes is of great significance for the assessment of the seismicity and seismic hazards of a region. As such, several different geochronological techniques to date earthquake-related material have been developed to provide answers on the time of past earthquakes. The present study is part of a wider palaeoseismic research project conducted in the Nojima Fault Zone (NFZ), where the 1995 Mw 6.9 Kobe (Japan) earthquake was triggered, to assess the suitability of the isothermal thermoluminescence (ITL) dating technique on fine-grained quartz and medium-grained feldspar and to provide a sequence of ages for fault-rock samples separated from a drilled core that was retrieved from a depth of ~506 m. Our analysis reveals that ITL can produce consistent dating results and can be considered a reliable luminescence technique for the absolute dating of fault-gouge material. The produced ITL ages signified the existence of repeated seismic events within the NFZ that took place through the late Pleistocene period, with gouge ages spanning from 78.6 ± 4.2 to 13.4 ± 1.4 ka; however, overestimation of the produced ITL dating results may be apparent. Nonetheless, even though some degree of overestimation is considered, ITL dating results denote the oldest possible age boundary of formation (or luminescence signal resetting) of the collected fault-gouge layers.

Abstract Background Lysine(K)-specific demethylase 5C (KDM5C) dysfunction causes X-linked syndromic intellectual developmental disorder Claes-Jensen type in male patients. The clinical presentations of female individuals with heterozygous KDM5C variations vary widely and are only now beginning to be characterized in detail. Case presentation Herein, we identified a novel de novo heterozygous nonsense variation of KDM5C (c.3533C > A, p.S1178X) in a sporadic 4-year-old Chinese girl, who presented with Claes-Jensen type-like phenotypes, such as moderate developmental delay, serious expressive language delay, short stature, microcephaly, and typical facial particularities. Moreover, X-chromosome inactivation (XCI) analysis showed no significant skewed X-inactivation. Conclusion The report expands the genotype of KDM5C variation in female patients, delineates the phenotype of affected females in this well-known X-linked disorder, and also reinforces the necessity to consider this X-linked gene, KDM5C, in sporadic female patients.

Objective To evaluate the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure. Methods Seventy-two patients with AECOPD and type II respiratory failure were randomly allocated to an HFNC oxygen therapy trial group or a non-invasive positive-pressure ventilator therapy (NIPPV) control group. Their arterial blood gas parameters and comfort, evaluated using a questionnaire, were compared before and after the therapeutic interventions. Results The PaCO 2 and blood HCO 3 − concentration of both groups were significantly reduced by the treatments, whereas the pH, PaO 2 and PaO 2 /FiO 2 were increased. The PaCO 2 of the experimental group was significantly lower than that of the control group following treatment. The PaO 2 of the experimental group was significantly higher than that of the control group. The tracheal intubation rates of the two groups did not significantly differ. After treatment, all the indices of comfort were rated higher in the HFNC group than in the NIPPV group. Conclusions HFNC has a good therapeutic effect in patients with AECOPD and type II respiratory failure. It improves patient comfort and has clinical value.

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases. In most cases, NAFLD progresses from benign steatosis to steatohepatitis (NASH), and then to cirrhosis. No treatment is currently approved for NAFLD/NASH in the clinic. Fenofibrate (FENO) has been clinically used to treat dyslipidemia for more than a half century, but its effects on NASH are not established. FENO’s half-life is quite different between rodent and human. The aim of this study was to investigate the potential of pharmacokinetic-based FENO regime for NASH treatment and the underlying mechanisms.Methods: Two typical mouse NASH models, methionine-choline deficient (MCD) diet-fed mice and choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD)-fed mice, were used. MCD model was designed as therapeutic evaluation in experiment 1 and CDAHFD model was designed as preventive in experiment 2. Three doses of FENO (5, 25, 125 mg/kg), two times a day (BID), were administered to the above models. Serum markers of liver injury, cholestasis, and the histology of liver tissues were investigated. Normal mice were used as a model in experiment 3 for toxicity evaluation, Quantitative-PCR and Western Blot assays were used to investigate the inflammatory responses, bile acid synthesis as well as lipid catabolism.Results: Mice on the MCD and CDAHFD diets developed steatohepatitis as expected. Treatment with FENO (25 mg/kg·BID) significantly decreased hepatic steatosis, inflammation and fibrosis in both therapeutic and preventive models. In the MCD model, the therapeutic action of FENO (25 mg/kg·BID) and 125 mg/kg·BID on histopathology and the expression of inflammatory cytokines were comparable. In reducing macrophage infiltration and bile acid load, FENO (25 mg/kg·BID) was superior to 125 mg/kg·BID. In all the aspects mentioned above, FENO (25 mg/kg·BID) was the best among the 3 doses in the CDAHFD model. In a third experiment, the effects of FENO (25 mg/kg·BID) and 125 mg/kg·BID on lipid catabolism were comparable, but 125 mg/kg·BID increased the expression of inflammatory factors and bile acid load. In both models, FENO (5 mg/kg·BID) showed little effect in hepatic steatosis and inflammation, neither the adverse effects. FENO (125 mg/kg·BID) aggravated liver inflammation, increased bile acid synthesis, and promoted the potential of liver proliferation. In toxicity risk assay, FENO (25 mg/kg·BID) treatment showed low potential to trigger bile acid synthesis, inflammation and hepatocyte proliferation.Conclusion: A new regime, FENO (25 mg/kg·BID) is potentially a therapeutic strategy for the NASH treatment. Translational medicine is warranted to prove its effectiveness in the clinic.

ObjectiveThe purpose of this study was to assess the psychological status of medical workers from other locations who helped support the fight against COVID-19 in Shanghai and to provide a basis for psychological crisis intervention plans under designated emergencies.MethodsWhile supporting the Shanghai Lingang Shelter Hospital, we investigated 1,097 medical staff from other cities working in the hospital. A questionnaire comprising the general information questionnaire, health questionnaire depression scale, generalized anxiety scale, insomnia severity index scale, and mental health self-assessment questionnaire was used.ResultsThere were no statistically significant differences in the incidence rates of anxiety, depression, and sleep disorders among subjects of different genders, ages, and educational levels. There were statistically significant differences in the incidences of anxiety, depression, stress response, and sleep disturbance among subjects with different levels of worry about COVID-19.ConclusionDuring the COVID-19 pandemic, the Lingang Shelter Hospital team experienced more psychological pressure, suggesting that medical institutions should pay attention to the mental health of frontline medical workers during COVID-19 and prepare psychological intervention measures for team members.

Peroxisome proliferator-activated receptors (PPARs) have been suggested to play crucial roles in the pathology of NAFLD with a vague understanding of the underlying mechanism. Here, we integrated large-scale literature data and clinical data to explore the potential role of the PPAR-APOA1 signaling pathway in the pathology of NAFLD. First, the signaling pathway connecting PPARs, APOA1, and NAFLD was constructed. Then, we employed clinical data to explore the association between APOA1 levels and NAFLD. In addition, we built the APOA1-driven pathway analysis to explore the potential mechanism of the APOA1-NAFLD association. Pathway analysis showed that APOA1 serves as a hubprotein connecting PPARs and NAFLD through a beneficial modulation of 16 out of 21 NAFLD upstream regulators. Each relationship within the composed pathway was supported by results from multiple previous studies. Clinical data analysis showed that an increase of APOA1 level was associated with a significantly decreased NAFLD prevalence (χ2=292.109; P

Platelet hyperreactivity and increased atherothrombotic risk are specifically associated with dyslipidemia. Peroxisome proliferator-activated receptor alpha (PPARα) is an important regulator of lipid metabolism. It has been suggested to affect both thrombosis and hemostasis, yet the underlying mechanisms are not well understood. In this study, the role and mechanism of PPARα in platelet activation and thrombosis related to dyslipidemia were examined. Employing mice with deletion of PPARα (Pparα-/-), we demonstrated that PPARa is required for platelet activation and thrombus formation. The effect of PPARα is critically dependent on platelet dense granule secretion, and is contributed by p38MAPK/Akt, fatty acid b-oxidation, and NAD(P)H oxidase pathways. Importantly, PPARα and the associated pathways mediated a prothrombotic state induced by a high-fat diet and platelet hyperactivity provoked by oxidized low density lipoproteins. Platelet reactivity was positively correlated with the levels of expression of PPARα, as revealed by data from wild-type, chimeric (Pparα+/-), and Pparα-/- mice. This positive correlation was recapitulated in platelets from hyperlipidemic patients. In a lipid-treated megakaryocytic cell line, the lipid-induced reactive oxygen species-NF-kB pathway was revealed to upregulate platelet PPARα in hyperlipidemia. These data suggest that platelet PPARα critically mediates platelet activation and contributes to the prothrombotic status under hyperlipidemia.

Background: Although proton pump inhibitors (PPIs) are widely used in the prevention of gastric bleeding caused by endoscopic submucosal dissection (ESD), there is no consensus on the optimal regimen for these patients. Therefore, we aim to investigate whether intermittent use of low-dose PPI is sufficient to prevent post-ESD bleeding. Methods: This multicenter, non-inferiority, randomized controlled trial was conducted at 9 hospitals in China. Consecutive eligible patients with a diagnosis of gastric mucosal lesions after ESD treatment were randomly assigned (1:1) to receive either intermittent low-dose or continuous high-dose PPIs treatment. After three days, all patients administered orally esomeprazole 40 mg once a day for 8 weeks. The primary endpoint was post-ESD bleeding within 7 days. Analysis was done according to the intention-to-treat principle with the non-inferiority margin (Δ) of 5%. Results: 526 consecutive patients were assessed for eligibility from 30 September 2017 to 30 July 2019, of whom 414 were randomly assigned to low-dose (n = 209) or high-dose (n = 205) esomeprazole treatment group without dropouts within7 days. The total post-ESD bleeding is occurred in 13 (6.2 %, 95 % CI 3.3–9.6) of 209 within 7 days in the intermittent low-dose group, and 12 (5.9 %, 95 % CI 2.9–9.3) of 205 in the continuous high-dose group. The absolute risk reduction (ARR) was 0.4 % (−4.2, 4.9). One month after ESD, There are 44 patients (21.1 %, 95 % CI 15.8, 26.8) and 39 patients (19.0 % 95 % CI 13.7, 24.4) in scar stage respectively in low-dose group and high-dose group (P = 0.875).The hospital costs in the low-dose PPI group was lower than high -dose group (P = 0.005). Conclusion: The intermittent use of low-dose PPIs is sufficient to prevent post-ESD bleeding. It might be applied in clinical practice to prevent post-ESD bleeding and reduce the costs related to PPIs.

Background: Since the existing teaching quality evaluation method is rather troublesome and cumbersome, a teaching quality evaluation method of BP neural network optimized by FOA based on human-computer interaction is proposed by introducing the attribute mathematics theory into teaching quality evaluation and using the good global optimization ability of FOA based on experts' scores. Methods: The single-index evaluation and multi-index evaluation of teaching quality are realized through the attribute mathematics theory. The teaching courses of Basis of Computer Engineering of 100 universities of "211 projects" such as Tsinghua University and Peking University were selected as the objects of study. Results: As shown in the experimental result, the effect of teaching quality evaluation by using the FOA-BP neural network is rather good and better than the evaluation result by using BP; with the average relative error of prediction of 0.5%, its effect is good; meanwhile, the BP neural network optimized by FOA has a quick convergence rate, which is better than that of the BP algorithm. Conclusion: The validity and reliability of teaching quality evaluation by using FOA-BP is verified. [ABSTRACT FROM AUTHOR]

Industrial robots consume a considerable amount of energy in the manufacturing industry. As sustainable manufacturing is one of the directions of manufacturing, the energy efficiency of the industrial robots should be considered. The energy consumption model is the key to analyze and improve the energy efficiency of industrial robots. This article focuses on the energy consumption characteristic analysis and energy consumption modeling of the industrial robot. The inertial and friction parameters which are the base of energy consumption modeling need to be identified. Since the torque which is usually used for parameter identification may be unavailable, we propose to use the software-simulated power data to perform the parameter identification and model the energy consumption of the robot. Then, comprehensive simulations are carried out to verify the effectiveness of the proposed method for parameter identification and the energy consumption model. The relation between the speed of the robot and its energy consumption is also analyzed.

Traditional compliance control of a rehabilitation robot is implemented in task space by using impedance or admittance control algorithms. The soft robot actuated by pneumatic muscle actuators (PMAs) is becoming prominent for patients as it enables the compliance being adjusted in each active link, which, however, has not been reported in the literature. This paper proposes a new compliance control method of a soft ankle rehabilitation robot that is driven by four PMAs configured in parallel to enable three degrees of freedom movement of the ankle joint. A new hierarchical compliance control structure, including a low-level compliance adjustment controller in joint space and a high-level admittance controller in task space, is designed. An adaptive compliance control paradigm is further developed by taking into account patient’s active contribution and movement ability during a previous period of time, in order to provide robot assistance only when it is necessarily required. Experiments on healthy and impaired human subjects were conducted to verify the adaptive hierarchical compliance control scheme. The results show that the robot hierarchical compliance can be online adjusted according to the participant’s assessment. The robot reduces its assistance output when participants contribute more and vice versa, thus providing a potentially feasible solution to the patient-in-loop cooperative training strategy.

Motor Imagery (MI) electroencephalography (EEG) is widely studied for its non-invasiveness, easy availability, portability, and high temporal resolution. As for MI EEG signal processing, the high dimensions of features represent a research challenge. It is necessary to eliminate redundant features, which not only create an additional overhead of managing the space complexity, but also might include outliers, thereby reducing classification accuracy. The firefly algorithm (FA) can adaptively select the best subset of features, and improve classification accuracy. However, the FA is easily entrapped in a local optimum. To solve this problem, this paper proposes a method of combining the firefly algorithm and learning automata (LA) to optimize feature selection for motor imagery EEG. We employed a method of combining common spatial pattern (CSP) and local characteristic-scale decomposition (LCD) algorithms to obtain a high dimensional feature set, and classified it by using the spectral regression discriminant analysis (SRDA) classifier. Both the fourth brain–computer interface competition data and real-time data acquired in our designed experiments were used to verify the validation of the proposed method. Compared with genetic and adaptive weight particle swarm optimization algorithms, the experimental results show that our proposed method effectively eliminates redundant features, and improves the classification accuracy of MI EEG signals. In addition, a real-time brain–computer interface system was implemented to verify the feasibility of our proposed methods being applied in practical brain–computer interface systems.

Taking the stock market as a whole object, we assume that prior losses and gains are two different factors that can influence risk preference separately. The two factors are introduced as separate explanatory variables into the time-varying GARCH-M (TVRA-GARCH-M) model. Then, we redefine prior losses and gains by selecting different reference point to study investors’ time-varying risk preference. The empirical evidence shows that investors’ risk preference is time varying and is influenced by previous outcomes; the stock market as a whole exhibits house money effect; that is, prior gains can decrease investors’ risk aversion while prior losses increase their risk aversion. Besides, different reference points selected by investors will cause different valuation of prior losses and gains, thus affecting investors’ risk preference.