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Background Diabetes has emerged as a critical global public health issue. The burden of diabetes is escalating in developing countries, including China. For individuals with diabetes, making informed and rational decisions regarding health-seeking behaviour is crucial to prevent or delay the occurrence of complications. However, prevalent irrational health-seeking behaviours among Chinese patients with diabetes have led to a low treatment rate of only 32.2%. In this study, we explore the subjective experiences of elderly patients with diabetes related to their decision-making experience for seeking healthcare, providing valuable insights for targeted intervention, and provide theoretical basis for establishing an efficient medical and health service system.Methods A qualitative study using descriptive phenomenology research methodology was adopted to explore the decision-making experience of elderly diabetes patients in seeking healthcare services. A purposive sampling approach, specifically maximum variation sampling, was employed to conduct semistructured in-depth interviews with 11 eligible participants between January and February 2023. Data analysis was carried out using QSR Nvivo 12.0 software and Colaizzi’s seven-step analysis method.Results Four themes emerged: ‘lack of disease risk perception and negative coping styles’, ‘ huge medical and economic burden’, ‘lack of family and social support’ and ‘Dissatisfaction with medical services’.Conclusion The health-seeking behavioural decision-making level of elderly diabetic patients is relatively low. Medical and healthcare professionals should formulate targeted intervention measures aimed at improving their disease cognition level, changing their coping styles and enhancing their health-seeking behavioural decision-making level to improve their health outcomes. Meanwhile, policymakers should plan and allocate medical resources in a targeted manner based on the needs and expectations of patients.

Abstract BackgroundAs dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. ObjectiveThis study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. MethodsUsing a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. ResultsBetween July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (PPPPPPPPPPPP ConclusionsInternet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia.

Abstract To investigate the relationship between serum uric acid level and glomerular ischemic lesions (GIL) in patients with primary membranous nephropathy (PMN) and identify relevant risk factors. A total of 201 patients with PMN but normal renal function confirmed by renal biopsy executed in the Liaocheng People’s Hospital, China, during January 2020-January 2023 were analyzed retrospectively. The enrolled patients were divided into a hyperuricemia group and a normal serum uric acid group (control group) according to their serum uric acid levels. Then, the participants were further divided into a non-GIL group or a GIL group based on the patient’s renal biopsy results. The two groups’ clinical and pathological data and meaningful indicators for differences were analyzed by binary logistic regression analysis. Additionally, the serum uric acid level prediction value on GIL was investigated using receiver operating characteristic (ROC) curves. Compared with the control group, the hyperuricemia group exhibited high serum uric acid, the prevalence of GIL, serum albumin, the prevalence of hypertension, and low-density lipoprotein cholesterol (LDL) levels (P

Abstract Background Insufficient interfragmentary compression force (IFCF) frequently leads to unstable fixation of osteoporotic lateral tibial plateau fractures (OLTPFs). A combined cancellous lag screw (CCLS) enhances IFCF; however, its effect on OLTPF fixation stability remains unclear. Therefore, we investigated the effect of CCLS on OLTPF stability using locking plate fixation (LPF). Materials and methods Twelve synthetic osteoporotic tibial bones were used to simulate OLTPFs, which were fixed using LPF, LPF-AO cancellous lag screws (LPF-AOCLS), and LPF-CCLS. Subsequently, 10,000 cyclic loadings from 30 to 400 N were performed. The initial axial stiffness (IAS), maximal axial micromotion of the lateral fragment (MAM-LF) measured every 1000 cycles, and failure load after 10,000 cycles were tested. The same three fixations for OLTPF were simulated using finite element analysis (FEA). IFCFs of 0, 225, and 300 N were applied to the LPF, LPF-AOCLS, and LPF-CCLS, respectively, with a 1000-N axial compressive force. The MAM-LF, peak von Mises stress (VMS), peak equivalent elastic strain of the lateral fragment (EES-LF), and nodes of EES-LF > 2% (considered bone destruction) were calculated. Results Biomechanical tests revealed the LPF-AOCLS and LPF-CCLS groups to be superior to the LPF group in terms of the IAS, MAM-LF, and failure load (all p 2% in the LPF were higher than those in the LPF-AOCLS and LPF-CCLS. Conclusion IFCF was shown to enhance the stability of OLTPFs using LPF. Considering overscrewing, CCLS is preferably recommended, although there were no significant differences between CCLS and AOCLS.

China’s STAR Market, with its registration-based IPO system, blends market-oriented features with growth criteria, making it an ideal research setting to analyze IPO companies’ growth manipulation and its economic impacts. Using data from 2019 to 2021, our study employs non-parametric methods to reveal significant growth manipulation among STAR Market companies during IPOs. We observe that manipulation intensifies across categorical listing criteria I to V, particularly among higher-valued companies. However, the coinvestment system helps curb manipulation in Pre-IPOs. Notably, lower profitability and industry status amplify the effects of listing criteria and valuation on manipulation. Economic tests confirm that Pre-IPO manipulation hastens listings but results in higher IPO underpricing. Our findings shed light on the repercussions of the registration-based IPO system, vital for refining the STAR Market and extending similar reforms to other segments.

Objectives: To evaluate the correlation of oxidative stress and vascular endothelial dysfunction with hippocampal perfusion in patients with atrial fibrillation and cognitive impairment. Methods: In total, 41 atrial fibrillation patients with cognitive impairment were compared to 45 atrial fibrillation patients without cognitive impairment. Oxidative stress, vascular endothelial dysfunction, hippocampal perfusion, and cognitive function were measured. Results: Serum level of oxidized low-density lipoprotein was significantly higher in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Serum levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 were significantly higher, and nitric oxide was lower, in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. The regional cerebral blood volume, mean transit time, and time to peak were significantly higher in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Moreover, regional cerebral blood flow was significantly lower in the atrial fibrillation + cognitive impairment group than in the atrial fibrillation group. Age, left atrial diameter, and regional cerebral blood volume were negatively correlated with the cognitive function score in the atrial fibrillation + cognitive impairment group. Serum levels of oxidized low-density lipoprotein, regional cerebral blood volume, regional cerebral blood flow, mean transit time, and time to peak were significantly correlated with cognitive impairment in atrial fibrillation patients after multivariate logistic regression analysis. Conclusion: Hippocampal perfusion and oxidative stress were significantly correlated with cognitive impairment in atrial fibrillation patients.

In recent years, the high-frequency hybrid sky-surface wave radar (HSSWR) has been increasingly used for target detection applications. Nevertheless, the specific bistatic system layout and the phase path disturbances induced by the ionospheric propagation channel may severely spread the sea clutter spectrum, thereby deteriorating the detection ability of the HSSWR for slow-moving targets. In this work, a novel subspace method based on the hybrid use of the amplitude and phase estimator (APES) and the orthogonal projection (OP) in the spatial–temporal domain, denoted as the APES-OP method, is proposed to suppress the spreading first-order sea clutter of the HSSWR. The distribution characteristics of targets and first-order sea clutter in the spatial–temporal domain were investigated, and a time-domain subspace signal model was adopted to describe targets perturbed by ionospheric phase path modulation. An APES filter was adopted to filter out the potential targets with a traversal approach to avoid attenuating desired signals while suppressing sea clutter. After that, sampling data from multi-channels and slow-time domains at the cell under test were employed to construct a spatial–temporal matrix, which was then utilized to obtain the sea clutter subspace by singular value decomposition. Simulation results indicate that the proposed algorithm can suppress sea clutter while retaining the target, even if the target is buried by sea clutter. The processing results of measured data further demonstrate the efficiency of the proposed algorithm. After sea clutter suppression, the target obscured by clutter can be revealed, and the signal-to-clutter ratio of the target is greatly improved.

Background: The functional movement screen (FMS) has been used to identify deficiencies in neuromuscular capabilities and balance among athletes. However, its effectiveness in detecting movement anomalies within the population afflicted by knee osteoarthritis (KOA), particularly through the application of a family-oriented objective assessment technique, remains unexplored. The objective of this study is to investigate the sensitivity of the FMS and daily activities in identifying kinematic abnormalities in KOA people employing a markerless motion capture system.Methods: A total of 45 persons, presenting various Kellgren–Lawrence grades of KOA, along with 15 healthy controls, completed five tasks of the FMS (deep squat, hurdle step, and in-line lunge) and daily activities (walking and sit-to-stand), which were recorded using the markerless motion capture system. The kinematic waveforms and discrete parameters were subjected to comparative analysis.Results: Notably, the FMS exhibited greater sensitivity compared to daily activities, with knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge emerging as the most responsive indicators.Conclusion: The knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge assessed via the markerless motion capture technique hold promise as potential indicators for the objective assessment of KOA.

Abstract Background Regulating the pluripotency of human dental pulp stem cells (hDPSCs) is key for the self-repair of injured dental pulp. We previously found that OCT4A promotes the proliferation and odontogenic differentiation of human dental pulp cells (hDPCs). Recent studies have shown the interaction between OCT4A and lncRNAs in pluripotency maintenance of various stem cells. The aim of this study was to explore the underlying roles and mechanisms of OCT4A and its related lncRNAs in the proliferation and multidirectional differentiation of hDPSCs in an inflammatory microenvironment. Methods Human lncRNA microarrays were applied to screen out the differentially expressed lncRNAs in hDPSCs between the OCT4A-overexpressing and vector groups. Lipopolysaccharide (LPS) was used to simulate the inflammatory microenvironment. The effects of OCT4A and the lncRNA FTX on the proliferation and multidifferentiation of hDPSCs were observed by the CCK-8 assay, EdU staining, real-time PCR, western blotting, and Alizarin red and oil red O staining. Bioinformatics analysis and chromatin immunoprecipitation (ChIP) assays were performed to clarify the targeted mechanism of OCT4A on FTX. The regulation by FTX of the expression of OCT4A and its downstream pluripotent transcription factors SOX2 and c-MYC was further detected by real-time PCR and western blotting. Results The microarray results showed that 978 lncRNAs (250 of which were upregulated and 728 downregulated) were potentially differentially expressed genes (fold change ≥ 2, P

Community inclusion is a human right for all people, including people with mental illness. It is also an important part of individualized support to enable people experiencing mental illness to live in their preferred communities and to recover. In Taiwan, no study has investigated the social experiences of healthcare professionals. To fill this knowledge gap and inform ongoing mental health system strengthening, this study examined the not-in-my-backyard (NIMBY) phenomenon observed while establishing community mental health clubhouses in Taiwan and corresponding experiences of community inclusion. Data were collected through semi-structured interviews of 16 purposively sampled frontline healthcare professionals from Taiwanese mental health clubhouses. Data were analyzed using qualitative content analysis. Two themes were identified: “NIMBY phenomenon: Community residents’ resistance to clubhouses” and “Measures adopted by the clubhouse for community inclusion”. Two categories with eleven subcategories emerged. The findings demonstrate the following conclusions. First, the NIMBY phenomenon is related to the stigmatization and discrimination faced by individuals with mental disorders in society. Second, in Asian societies, mental disorders are associated with a particular social and cultural context. Third, the fear and rejection of individuals with mental disorders deepen their social exclusion. Forth, community mental health clubhouse models employ seven strategic approaches to community inclusion, listed as follows: capacity building for individuals, direct interaction with the public through community activities, provision of community services, life skills training, repairing and managing neighborhood relationships, assisting individuals in obtaining community employment, and conducting social education for community residents. Clearly, we need to combat social exclusion of people with mental illness and promote inclusive and accessible services and systems across sectors.

As the significance of long-term care services for older adults becomes more pronounced in Taiwan, especially considering the intensifying trend of an aging population, there remains a lack of comprehensive attention to the long-term care needs and experiences of older adult individuals within the LGBTQ+ community. The present study examines the long-term care service awareness, needs, and usage intention of older adult male homosexuals in Taiwan and assesses their ideal long-term care service model. This study of five older adult male homosexual subjects aged 66 to 73 years is intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects displayed high awareness of long-term care services, as they possessed actual experience of these services or had even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and reported problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to opt for home care services if they required long-term support. Due to their personal experiences, the subjects displayed negative awareness of long-term care services and expressed worry that long-term care service staff harbored poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes related to it, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, feeling that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against. Regarding ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, their situations, and care needs.

Taiwanese community mental health facilities encounter opposition/resistance from residents, commonly known as “Not-In-My-Backyard” (NIMBYism). This study investigated NIMBYism during the establishment of such facilities and how they respond to such resistance. A qualitative study through semi-structured interviews was used to obtain purposively sampled data. Fifteen frontline healthcare professionals from community mental health facilities in Taiwan were interviewed individually, using an organizational analysis structure. Data were analyzed using qualitative content analysis. Two themes: “Reasons for Resident Resistance” and “Institutional Response Strategies”, two categories, and 11 subcategories emerged. The findings demonstrated the following: (1) Reasons behind residents’ resistance toward establishing community mental health facilities are diverse. (2) Communities lack understanding regarding people with mental disorders, leading to irrational beliefs. (3) Fear and negative perceptions toward people with mental disorders exist. (4) Strategies employed by the facilities include providing community services to foster amicable relationships, organizing community outreaches, training people with mental disorders within communities, nurturing neighborhood connections, establishing and sustaining friendships within communities, inviting residents to visit community mental health facilities or introducing the facilities to communities, and leveraging governmental support. The government should adopt regulations or laws to reduce discrimination, promote human rights, and legislate to demarcate the use of community land.

Psychological disorders have become more prevalent in the presence of modernization and societal changes. Community-based mental health is important in healthcare. Taiwan has passed the Mental Health Act, and county governments have established community-based mental healthcare centers. This study aimed to fill the research gap regarding the operational status of these centers. A qualitative study design using semi-structured interviews was used to obtain data from a purposive sample. Seventeen healthcare professionals who were front-line workers of a community-based mental healthcare center in Taiwan were interviewed individually. This study uses the organizational analysis structure as the research base. The data were analyzed using qualitative content analysis. The theme—“operational status and difficulties”—and two categories with twelve subcategories emerged. The findings demonstrate (1) unclear objectives and imprecisely defined roles, (2) incomplete services provided, an overly defined area, and ineffectiveness, (3) the central government lacking clear objectives and operational strategies, (4) the public being ignorant of mental diseases and the operation of the centers, and (5) the lack of local resources for mental and social welfare. The government should immediately form clear policies to improve community-based mental healthcare, clarify the structure and models, increase resources for the centers, and provide direct services.

Highlights A novel physical approach is proposed to enhance the electrocatalytic performance by electric field. Under the action of electric field, some stable conductive filaments consisting of oxygen vacancies are formed in the Ni/Co3O4 film, which remarkably reduces the system resistivity. The electric-field-treated Ni/Co3O4 material exhibits significantly superior activity and stability as a bifunctional electrocatalyst for overall water splitting, and its performance exceeds the state-of-the-art electrocatalysts. Abstract Rational design of bifunctional electrocatalysts for oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) with excellent activity and stability is of great significance, since overall water splitting is a promising technology for sustainable conversion of clean energy. However, most electrocatalysts do not simultaneously possess optimal HER/OER activities and their electrical conductivities are intrinsically low, which limit the development of overall water splitting. In this paper, a strategy of electric field treatment is proposed and applied to Ni/Co3O4 film to develop a novel bifunctional electrocatalyst. After treated by electric field, the conductive channels consisting of oxygen vacancies are formed in the Co3O4 film, which remarkably reduces the resistance of the system by almost 2 × 104 times. Meanwhile, the surface Ni metal electrode is partially oxidized to nickel oxide, which enhances the catalytic activity. The electric-field-treated Ni/Co3O4 material exhibits super outstanding performance of HER, OER, and overall water splitting, and the catalytic activity is significantly superior to the state-of-the-art noble metal catalysts (Pt/C, RuO2, and RuO2 ǁ Pt/C couple). This work provides an effective and feasible method for the development of novel and efficient bifunctional electrocatalyst, which is also promising for wide use in the field of catalysis.

Abstract Background The distant metastasis is the primary cause of cancer morbidity and mortality for bladder cancer (BLCA) paitents. All the recommended therapy for it largely depends on how far the cancer has invaded. It has been confirmed that epithelial to mesenchymal transition (EMT) is the leading reason for the BLCA metastasis which makes BLCA difficult to cure. The aim of the present study is to identify the BLCA-related genes that can be used as the new prognostic biomarker and treatment target, and to investigate the functional mechanisms of TEAD4 in EMT dysregulation. Methods The "limma" R package was used to identify the differentially expressed genes (DEGs) between the normal and the tumor samples from TCGA BLCA and GTEx databases. Kaplan–Meier and UniCox analysis were used to filter DEGs with prognostic value in BLCA. Step muti-Cox analysis was used to construct a prognostic risk score model based on clinical phenotype characters. Gene set enrichment analysis (GSEA) was performed to explore the possible molecular mechanisms affecting the prognosis in BLCA. Unsupervised hierarchical clustering analysis was performed to evaluate the effects of EMT process on the prognosis. Single-sample GSEA (ssGSEA) was used to calculate the correlation betweeen the expression of DEGs and EMT enrichment scores. TEAD4 expression and its association with pathological grading and survival were appraised in samples from TCGA dataset and BLCA tissue microarray. Colony formation assays and CCK8 assays were performed to study the changes in BLCA cell proliferation when the TEAD4 levels was down- or up-regulated in BLCA cells. Transwell and wound healing assays were utilized to analyze the impact of TEAD4 on the invasion and metastasis of the BLCA cells. Western Blot was carried out to detect the changes of EMT-related markers and the active molecules involved in PI3K/AKT signaling in BLCA cells. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was conducted on the genes related to TEAD4 expression. 740Y-P (activator of PI3K/AKT pathway) and LY294002 (inhibitor of PI3K/AKT pathway) were applied to evaluate the contribution of PI3K/AKT signaling pathway in the EMT of BLCA cells. To examine the in vivo effect of TEAD4 on tumor metastasis, we designed a metastatic nude-mouse model by tail vein injection of TEAD4-knockdown BLCA cells. And PET/CT imaging was used to assess the extent of lung metastases. Results A total of 1592 DEGs were recognized, among which 4 DEGs have been identified as independent prognostic factors for BLCA, such as FASN, IGFL2, PLOD1 and TEAD4. TCGA BLCA samples were divided into significantly different low- and high-risk groups according to the median risk score; GSEA analysis showed that HALLMARK EMT pathway was the top enriched gene signature when compared high-risk and low-risk groups, which was also verified by unsupervised cluster analysis. EMT signature-derived ssGSEA scores demonstrated that TEAD4 had the most positive correlation with EMT process. In addition, TEAD4 expression was upregulated in TCGA BLCA samples and correlated with pT stage, tumor stage and tumor grade. Functional studies showed that TEAD4 knockdown via lentiviral TEAD4 shRNA inhibited cell migration and invasion in vitro and in vivo, with the reduced expression of EMT related markers in BLCA cell lines; the migration and invasion of TEAD4 knockdown cells could be restored by ectopic expression of TEAD4. Meanwhile, KEGG enrichment analysis of genes related to TEAD4 expression showed that enrichment was significantly related to PI3K/AKT pathway. The pathway inhibitor LY294002 blocked the TEAD4-induced enhancement of migration and invasion as well as the expression EMT-related markers, whereas the agonist 740Y-P rescued the decreased migration, invasion and EMT induced by TEAD4 knockdown. Conclusions TEAD4 is closely correlated with poor prognosis in BLCA and mediates its metastasis through regulating EMT via PI3K/AKT pathway, proving that TEAD4 is not only an effective biomarker for predicting the prognosis but also a great potential target for treatment of metastatic BLCA.

Purpose: To perform a retrospective review of the clinicopathological features of patients with conventional and non-conventional renal cell carcinoma (cRCC and ncRCC). Materials and Methods: A large prospectively maintained uro-oncological registry was accessed to extract clinicopathological data of patients diagnosed with renal tumors who subsequently underwent nephrectomy from 1990–2019. Demographics and operative parameters were extracted. Analyses of overall survival (OS) and cancer-specific survival (CSS) were performed using the Kaplan–Meier method. Cox proportional-hazards analysis was used to identify risk factors which influenced survival. Results: There were a total of 1,686 consecutive nephrectomies which was retrieved, with 1,286 cRCC and 400 ncRCC. The commonest ncRCC subtypes were papillary (n=198, 11.7%), clear cell papillary (n=50, 3.0%) and chromophobe (n=49, 2.9%) RCC. Kaplan–Meier estimates of OS were higher in cRCC (0.74; 95% confidence interval [CI], 0.71–0.78) than ncRCC (hazard ratio, 1.47; 95% CI, 1.16–1.87). Among individual subtypes, chromophobe RCC had the highest 5-year OS (0.90; 95% CI, 0.79–1.0). Among ncRCC subtypes, acquired cystic RCC demonstrated the highest association with end-stage renal failure and hypertension, with the highest CSS. MiT family translocation RCC had the youngest mean age at presentation (45.6±12.8 y) and excellent CSS. Factors associated with increased OS in the entire cohort included shorter operative time, partial nephrectomy and lower tumor stages. Conclusions: This study provides a comprehensive contemporary overview of ncRCCs which are yet poorly characterized, in comparison to cRCCs. Data from this study would contribute towards tailored patient counseling and healthcare resource planning.

Oral inflammatory diseases (OIDs) include many common diseases such as periodontitis and pulpitis. The causes of OIDs consist microorganism, trauma, occlusal factors, autoimmune dis-eases and radiation therapy. When treated unproperly, such diseases not only affect oral health but also pose threat to people’s overall health condition. Therefore, identifying OIDs at an early stage and exploring new therapeutic strategies are important tasks for oral-related research. Mitochondria are crucial organelles for many cellular activities and disruptions of mitochondrial function not only affect cellular metabolism but also indirectly influence people’s health and life span. Mitochondrial dysfunction has been implicated in many common polygenic diseases, including cardiovascular and neurodegenerative diseases. Recently, increasing evidence suggests that mitochondrial dysfunction plays a critical role in the development and progression of OIDs and its associated systemic diseases. In this review, we elucidated the critical insights into mitochondrial dysfunction and its involvement in the inflammatory responses in OIDs. We also summarized recent research progresses on the treatment of OIDs targeting mitochondrial dysfunction and discussed the underlying mechanisms.

Abstract Background Dexmedetomidine promotes normal sleep architecture; the drug also improves analgesia. We therefore tested the hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in older patients recovering from orthopedic surgery. Methods In this double-blinded randomized controlled trial, we enrolled 712 older (aged 65–90 years) patients scheduled for major orthopedic surgery. Postoperative analgesia was provided by patient-controlled intravenous sufentanil, supplemented by randomly assigned dexmedetomidine (1.25 μg/mL) or placebo, for up to three days. The primary outcome was the incidence of delirium assessed twice daily with the Confusion Assessment Method. Among secondary outcomes, pain severity was assessed twice daily and sleep quality once daily, each with an 11-point scale where 0 = no pain/the best possible sleep and 10 = the worst pain/the worst possible sleep. Results The incidence of postoperative delirium was 7.3% (26 of 354) with placebo and 4.8% (17 of 356) with dexmedetomidine; relative risk 0.65, 95% CI 0.36 to 1.18; P = 0.151. Dexmedetomidine reduced pain both at rest (median difference -1 to 0 points, P ≤ 0.001) and with movement (-1 points, P

Abstract Background Due to the multifactorial aetiology and unpredictable long-term stability, skeletal anterior open bite (SAOB) is one of the most intractable conditions for orthodontists. The abnormal orofacial myofunctional status (OMS) may be a major risk factor contributing to the development and relapse of SAOB. This study is aimed at evaluating the OMS and the efficacy of orofacial myofunctional therapy (OMT) alone for SAOB subjects. Methods Eighteen adolescents with SAOB (4 males, 14 females; age: 12–18 years) and eighteen adolescents with normal occlusion (2 males, 16 females; age: 12–18 years) were selected. The electromyographic activity (EMGA) associated with mastication and closed mouth state was measured. Lateral cephalography was used to evaluate craniofacial morphology. Wilcoxon signed rank tests and t-tests were performed to evaluate myofunctional and morphological differences. Pearson or Spearman correlation analysis was used to investigate the correlations between EMGA and morphological characteristics. SAOB subjects were given OMT for 3 months, and the EMGA was compared between before and after OMT. Results During rest, anterior temporalis activity (TAA) and mentalis muscle activity (MEA) increased in SAOB subjects, but TAA and masseter muscle activity (MMA) decreased in the intercuspal position (ICP); and upper orbicularis activity (UOA) and MEA significantly increased during lip sealing and swallowing (P

This study aims to examine the effectiveness of chair yoga therapy on improving functional status and daily life activity scores in older female adults with knee osteoarthritis living in the community. A quasi-experimental design was adopted. In total, 85 female participants with knee osteoarthritis were assigned to the chair yoga therapy intervention group (n = 43) or the comparison (n = 42) group. A 12-week chair yoga exercise program was provided to the intervention group two times per week from January to April 2020. The primary outcomes, which include changes in physical functional ability, body mass index, and biophysiological indicators, were evaluated for all participants in the pre- and post-measures time periods. The analysis shows that the participants had a significantly higher level of functional fitness and daily life activity scores after the chair yoga intervention. This finding indicates that the chair yoga program was effective in improving the functional fitness and daily life activity scores of community-dwelling elderly females with knee osteoarthritis.

Abstract Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P

With the advancement of radio frequency (RF) assisted smart home technology, it is critical for the RF sensors deployed indoors to isolate the target of interest from unwanted clutter sources. This paper presents a novel method for suppressing both moving and stationary clutters in an indoor environment to localize stationary human subjects with a millimeter-wave frequency-modulated continuous-wave (FMCW) radar. The method derives its roots from the intrinsic high-pass filter (HPF) characteristic of the exponential moving average (EMA) algorithm, a preferred approach for background stationary clutter suppression. In this work, emphasis was laid on expanding the capability to detect and suppress unwanted moving clutter sources in the indoor environment along with stationary clutters, which has not been widely explored before. The proposed method removes motion artifacts so that the characteristic respiratory signal can be identified for human-aware localization. The paper provides experimental validation of the proposed method, wherein a 60-GHz FMCW radar with digital beamforming (DBF) capability was used to identify the 2-D location of a sitting human subject, with a moving window curtain in the background acting as a strong moving clutter source along with other stationary clutters. In addition, a lateral hand gesture recognition technique is presented, wherein the EMA algorithm was used to enhance the signature of the hand motion. The instantaneous position of the hand at the beginning and end of the gesture was determined to classify the gesture as a left-to-right or right-to-left hand swipe.

Abstract Background Pulpitis is a common dental disease characterized by sustained inflammation and impaired pulp self-repair. Mesenchymal stem cell-based minimally invasive vital pulp therapy (MSC-miVPT) is a potential treatment method, but its application is limited by the difficulty in acquiring MSCs. We recently revealed the immunomodulatory effects of rat dental follicle stem cells (rDFSCs) on acute lung injury. The present study focused on the paracrine effects of rDFSCs on the inflammation and regeneration of rat injured dental pulp to detect whether DFSCs are a potential candidate for MSC-miVPT. Methods Conditioned medium from rDFSCs (rDFSC-CM) was applied to lipopolysaccharide (LPS)-induced inflammatory rat dental pulp cells (rDPCs). The inflammation and regeneration of rDPCs were detected by RT-qPCR, Western blotting, immunofluorescence staining, Cell Counting Kit-8 (CCK-8) assay, flow cytometry, wound-healing assay, and Masson’s staining. The effects of rDFSC-CM on inflamed rat dental pulp were further evaluated by hematoxylin-eosin and immunohistochemical staining. Results rDFSC-CM downregulated the ERK1/2 and NF-κB signaling pathways, which resulted in suppression of the expression of IL-1β, IL-6, and TNF-α and promotion of the expression of IL-4 and TGF-β, and these findings lead to the attenuation of rDPC inflammation. rDFSC-CM enhanced the in vitro proliferation, migration, and odontogenic differentiation of inflammatory rDPCs and their in vivo ectopic dentinogenesis. Furthermore, rDFSC-CM inhibited inflammatory cell infiltration in rat pulpitis and triggered Runx2 expression in some of the odontoblast-like cells surrounding the injured site, and these effects were conducive to the repair of inflamed dental pulp. Conclusions rDFSC-CM exhibits therapeutic potential by rescuing the regeneration of the inflamed rat dental pulp through an immunomodulatory mechanism, indicating the application prospects of DFSCs in biological regenerative endodontics.

Abstract Background The cropping area of genetically modified (GM) crops has constantly increased since 1996. However, currently, cultivating GM crops is associated with many concerns. Transgenes are transferred to non-GM crops through pollen-mediated gene flow, which causes environmental problems such as superweeds and introgressive hybridization. Rapeseed (Brassica napus L.), which has many GM varieties, is one of the most crucial oil crops in the world. Hybridization between Brassica species occurs spontaneously. B. rapa grows in fields as a weed and is cultivated as a crop for various purposes. Both B. rapa weeds and crops participate in gene flow among rapeseed. Therefore, gene flow risk and the coexistence of these two species should be studied. Results In this study, field experiments were conducted at two sites for 4 years to evaluate gene flow risk. In addition, zero-inflated models were used to address the problem of excess zero values and data overdispersion. The difference in the number of cross-pollination (CP) events was nonsignificant between upwind and downwind plots. The CP rate decreased as the distance increased. The average CP rates at distances of 0.35 and 12.95 m were 2.78% and 0.028%, respectively. In our results, zero-inflated negative binomial models were comprehensively superior to zero-inflated Poisson models. The models predicted isolation distances of approximately 1.36 and 0.43 m for the 0.9% and 3% threshold labeling levels, respectively. Conclusions Cultivating GM crops is prohibited in Taiwan; however, the study results can provide a reference for the assessment of gene flow risk and the coexistence of these two species in Asian countries establishing policies for GM crops.

In this paper, a new approach is proposed to improve the radiation efficiency of a frequency beam-scanning antenna. In this proposed approach, the entire antenna is divided into two subarrays and each subarray includes one primary slow-wave line. Parameters of these two primary slow-wave lines are identical to each other, to achieve identical progressive phase difference between elements within either subarray. Meanwhile, a secondary slow-wave line is designed and connected to the beginning of one of the two primary slow-wave lines, to introduce an additional phase difference between these two subarrays. The above setup provides more flexibility for the allocation of phase-delay units and thus enables a possibility to reduce the overall length and transmission loss of the slow-wave line utilized in a frequency beam-scanning array, which leads to a better radiation efficiency. In order to demonstrate the above topology, a novel microstrip-to-stripline power-divider and a novel broadband magneto-electric dipole element are proposed in multilayer configurations, for the realization of a 20-element prototype centered at 8.75 GHz. A reduction of 29.2% is achieved for the overall loss compared to a conventional array when achieving a scanning range of ±30°.

Remote techniques for measuring human vital signs have attracted great interests due to the benefits shown in medical monitoring and military applications. Compared with continuous-wave Doppler radar, frequency-modulated continuous-wave (FMCW) radar which can discriminate vital signs from different distances, shows potential for reducing the interferences from other targets and the environment. However, in the state-of-the-art algorithms, only one chirp per frame is utilized for FMCW-based vital sign monitoring. Moreover, the vital signal is extracted from only one range bin of the fast Fourier transform. Which does not make full utilization of the long system idle time, and loses the power distributed on other range bins. By exploiting the relationship between respiration and heartbeat vibrations, an adaptive identification embedded ensemble empirical mode decomposition (EEMD) method for joint-range spectral estimation is proposed to measure the heart rate. First, A multi-chirp processing is presented for a 2-dimensional phase accumulation. Then the phase signals from a sequence of range bins are decomposed with a fast adaptive identification process. Finally, with the identified heartbeat components, we solve a multiple measurement vectors problem to estimate the heart rate. Experimental results showed that, at the detection range from 1 m~ 2.5 m, the proposed method can robustly distinguish the heartbeat from respiration and its harmonics and accurately estimate the heart rate with a root mean square error less than 6 bpm.

Purpose: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse outcomes in various malignancies. However, its role in prognosticating testicular cancer (TC) has not been validated. We aim to study the relationship between NLR and TC. Materials and Methods: We retrospectively reviewed 160 patients with histological proven TC from January 2005 to June 2016. Youden's index was used to analyse NLR and a cut-off point of 3.0 was obtained, with statistical receiver operating characteristics of 0.755. Chi-square test, Kaplan-Meier (log rank test) and logistics regression models were used to predict NLR association with survival outcomes. Results: Median age was 34 years old (range, 17–68 years old). There were 102 pure seminomas and 58 non-seminomatous germ cell tumours. Median follow-up period was 8 years (range, 2.5–17 years). NLR ≥3.0 was independently associated with lymph node involvement (p=0.031; odds ratio [OR], 2.91; 95% confidence interval [CI], 1.67–5.83; p=0.038; OR, 4.12; 95% CI, 1.26–6.51) and metastatic disease (p=0.041; OR, 2.48; 95% CI, 1.22–3.98; p=0.043; OR, 2.21; 95% CI, 1.17–3.65) in both seminomatous and non-seminomatous germ cell tumours, translating to a more advanced disease. Moreover, NLR ≥3.0 also predicts poorer cancer specific survival in these patients. Conclusions: NLR can be an inexpensive haematological marker in predicting advanced TC staging and poorer survival outcome. NLR complements the traditional cancer staging by identifying a group of high risk patients who may benefit from multimodal treatment and closer surveillance to achieve long term survival.

Abstract Objective We investigated the protective effect of tetramethylpyrazine (TMP) on injury related to acute myocardial ischemia (AMI) induced by isoproterenol (ISO). Materials and methods Rats were randomly assigned to five groups: control, ISO, ISO + propranolol (10 mg/kg), ISO + TMP (10 mg/kg) and ISO + TMP (20 mg/kg). The rats in the three ISO + groups were pretreated with propranolol or TMP, while the rats in the control and ISO groups were pretreated with an equal volume of saline. Afterwards, the rats in the four administration groups were subcutaneously injected with ISO for two consecutive days. The levels of creatine kinase (CK), lactate dehydrogenase (LDH), superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-1β in the serum were measured using ELISA. The expressions of B-cell lymphoma-associated X-2 (Bax-2), B-cell lymphoma-2 (Bcl-2), phosphoinositide-3-kinase (PI3K), protein kinase B (Akt), glycogen synthase kinase 3β (GSK-3β), MDA5 and SOD1 were determined using western blotting assay. The phosphorylation of PI3K, Akt and GSK-3β were also determined using western blotting assay. The left ventricles of the rats were extracted and stained using hematoxylin and eosin (H&E). The ST segment was recorded using electrocardiograms (ECGs). Results Administration of TMP (10, 20 mg/kg) reduced the levels of MDA and CK and the activities of SOD and LDH in the serum. Pretreatment with TMP significantly reduced the levels of pro-inflammatory cytokines, including IL-1β, IL-6 and TNF-α. Treatment with TMP also improved the histopathological alteration and decreased the ST elevation. Furthermore, TMP ameliorated the expressions of Cu, SOD1, MDA5, Bax-2, Bcl-2, p-PI3K, p-Akt and p-GSK-3β in ISO-induced rats. Conclusions Tetramethylpyrazine protected against injury due to AMI by regulating the PI3K/Akt /GSK-3β signaling pathway.

A tunable microwave photonic notch filter with ultrahigh radio frequency (RF) rejection ratio is achieved by using a dual-drive Mach-Zender modulator and a microring resonator. In addition, we dedicated to clarify the mechanisms of the microwave photonic notch filters based on a microring resonator under both overcoupled and undercoupled states and the performance differences between these two situations are investigated in detail. Furthermore, the experimental results show that the cancellation microwave photonic notch filter with ultrahigh RF rejection ratio can be achieved with both undercoupled and overcoupled microring resonators. Besides, an RF rejection ratio exceeding 50 dB was achieved for a microring resonator with an optical extinction ratio of only 4 dB, where a 46-dB enhancement from optical to RF response is obtained. Also, the bandwidth of the microwave photonic filter can tuned from 0.65 to 2.2 GHz by adjusting the coupling ratio of the ring resonator. Meanwhile, by tuning the wavelength of the optical carrier, the filtering frequency can be tuned and a tuning range of about 25 GHz was achieved. The implementation is much simpler and more economical compared with previous reports and has great potential in monolithic integration of microwave photonic filters on chip.

Empirical wavelet transform (EWT) has been successfully utilized for decomposing multi-component signals into intrinsic mode functions. However, it suffers from the spectrum subdividing problem when signals contain non-stationary components which overlap in both the time and frequency domains. In this paper, a morphological filtering enhanced empirical wavelet transform (EEWT) methodology is presented for mode decomposition of non-stationary signals. Instead of dividing spectrum in terms of the local maxima-minima segmentation principle, the proposed scheme will smooth the spectrum spikes of a signal with morphological filtering so as to keep different intrinsic mode functions in the corresponding spectrum segments. The proposed method is compared to the classical EWT and the EEWT. The experimental results demonstrate that the proposed method is able to achieve better performance of spectrum segmentation and higher resistance to noise than the EWT and EEWT techniques for both synthetic and speech signals.

A 1 × 12 center-fed series antenna array, with a novel probe feeding structure to broaden the bandwidth, is designed for 5G base stations deployed in the land for offshore maritime communications. The improvement of the bandwidth is achieved through a combination of folding and replacing the center feed line to a lower layer away from patch radiators. By moving the center feed line to the lower layer beneath radiators, serious mutual-coupling and corresponding parasitic effect between the feed and radiators are reduced, facilitating better transmission and also resulting in better matching to the 50-Ω coaxial probe. Moreover, a vertically folded-U structure is proposed to be inserted in part of the feed line, to provide a section of a high impedance microstrip line and further broaden the impedance bandwidth. A simulation study is performed on the geometry of the center feed line to investigate how the antenna performance can be controlled. The antenna array design procedure is outlined and a prototype with over 20% bandwidth, which can fully cover the 4.8-4.99 GHz 5G spectrum band, is fabricated and measured for impedance matching, radiation pattern, and broadside gain. For both S-parameter and far-field results, good correspondence is achieved between simulation and measurement. The proposed series-fed antenna array with coaxial feed is very suitable to be deployed in base stations with 1-D beam steering capability.

An antenna-in-package is proposed for a wireless ingestible capsule operated at ISM (2.4-2.48 GHz) band and also experimentally tested in a system level. The proposed antenna is designed for data transmission between the ingestible capsule and a smart phone using Bluetooth. A modified planar inverted-F structure is proposed for the antenna design, whose end section is bent to be vertical with respect to the substrate, mainly for the considerations of frequency tuning, size reduction, and polarization diversity. First, a one-layer cube muscle phantom model is used for initial design and optimization. Then, a comprehensive evaluation method, with considerations of the polarization mismatch loss, is proposed to analyze the radiation performance using a CST human body model. The evaluated results indicate that the proposed design can ensure enough margins for the link budget despite the relative position between the capsule and the smart phone. In addition to the advantages stated above, the proposed antenna is not sensitive to different digestive organs. Reflection measurement is presented using a muscle-mimicking phantom. Radiation characteristics are presented using a simple human torso model filled with pork by measuring the received power in a system. Successful data transmission, between a transmitter using the proposed antenna and a receiver using a smart phone, is performed in a temperature monitoring system.

The coding units (CU) partitioning in the 3D extension of the high efficiency video coding standard (3D-HEVC) is recursively conducted on different block sizes from 64 × 64 to 8 × 8. Besides, the depth coding in 3D-HEVC introduces several new coding tools for each CU to improve the coding efficiency, however, with great computational complexity. It is noted that only a small number of the CUs in recursive partitioning are encoded into the final bitstream. Among these CUs, the CUs with Intra 2N × 2N or Intra N x N as optimal modes have a very small proportion. In this paper, we thus propose an early determination of depth intra coding, where the coding stage of Intra 2N × 2N, Intra N × N or CU Splitting for the CUs could be early skipped based on several Decision Trees. Simulation results show that, with restrict the results from the tree leaves by different Gini thresholds, the proposed algorithm could save 41.14%-71.63% of the depth coding time with only a slight increase in BDBR.

Background/Aims: Increasing evidence has demonstrated the novel roles of mesenchymal stem cells (MSCs) in immunotherapy. However, difficulty in acquiring these cells and possible ethical issues limited their application. Recently, we have isolated a unique MSC population from dental follicles with potent stem cell-like properties. This study focused on the effects of dental follicle stem cells (DFSCs) on macrophage activation and polarization to determine their role in immunomodulation and to test if DFSCs are a promising cell source for MSC-based immunotherapy. Methods: Rat acute lung injury (ALI) models induced by Lipopolysaccharide (LPS) were applied to test the immune-modulatory effects of DFSC/DFSC-CM in vivo. The pulmonary permeability was determined by the dry / wet weight ratios of the left upper lung lobe. The lung histopathological damage was graded on a 0 to 4+ scale. And the inflammatory cytokines in bronchoalveolar lavage fluid (BALF) were tested by ELISA. Then we established LPS-induced inflamed macrophage models in vitro. Inflammatory cytokine production and polarization marker expression were measured by RT-qPCR, ELISA, western blot and flow cytometric analysis in macrophages following DFSC-CM treatment. The paracrine factors in DFSC-CM were revealed by a RayBiotech Protein Array. Thereafter, neutralization studies were performed to confirm the potential immune regulators in DFSC-CM. Results: The DFSC/DFSC-CM not only attenuated histopathological damage and pulmonary permeability, but also downregulated pro-inflammatory cytokines MCP-1, IL-1, IL-6 and TNF-α, and upregulated anti-inflammatory cytokine IL-10 in BALF. Immunofluorescence staining revealed the increased expression of macrophage M2 marker Arg-1. Further in vitro study revealed that macrophages switched to an anti-inflammatory M2 phenotype when co-cultured with DFSC-CM, characterized by suppressed production of pro-inflammatory cytokines MCP-1, IL-1, IL-6, TNF-α and M1-polarizing markers iNOS and CD86; and increased expression of the anti-inflammatory cytokine IL-10 and the M2-polarizing markers Arg-1 and CD163. A RayBiotech Protein Array revealed 42 differentially expressed (> 2-fold) paracrine factors in DFSC-CM compared with the serum-free Ham’s F-12K medium, among which TGF-β3 and Thrombospondin-1 (TSP-1) were upregulated by 18- and 105-fold, respectively. Neutralization studies confirmed the immunoregulatory roles of TGF-β3 and TSP-1 in macrophage activation and polarization. Conclusion: These results indicated that DFSCs can reprogram macrophages into the anti-inflammatory M2 phenotype, the paracrine factors TGF-β3 and TSP-1 may be one of the underlying mechanisms. This study supports the hypothesis that DFSCs are promising for MSC-based immunotherapy.

ObjectiveTo evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore.DesignRetrospective analysis of a large prospective Uro-oncology registry of mPCa.SettingThis study is carried out in a tertiary hospital in Singapore.ParticipantsWe reviewed our institution’s prospectively maintained database of 685 patients with mPCa over a 20-year period (1995–2014). Patients with non-mPCa or those progressed to metastatic disease after previous curative local treatments were excluded.Primary and secondary outcome measuresThe primary outcome was to evaluate the systemic and local morbidity rates associated with mPCa. Local complication was defined as the need for palliative procedures to relieve urinary obstruction, worsening renal function or refractory haematuria, while systemic complication was related to radiographic evidence of skeletal-related pathological fractures. Secondary outcomes analysed were the management and overall survival patterns over 20 years.Results237 (34.6%) patients required local palliative treatments. 88 (12.8%) patients presented with acute urinary retention, 23 patients (9.7%) required repetitive local palliative treatments. On multivariate analyses, prostate-specific antigen >100 (p=0.02) and prostate volume >50 g (p=0.03) were independent prognostic factors for significant obstruction requiring palliative procedures. 118 (17.2%) patients developed skeletal fractures, with poor Eastern Cooperative Oncology Group Performance (ECOG) status (p=0.01) and high volume bone metastasis (p

Purpose: The incidence rate of differentiated thyroid cancer (DTC), the most common type of thyroid cancer, has increased in the past two decades. The present study analyzed the clinical and pathological characteristics of DTC, and discussed the risk factors for survival in elderly age-risk DTC patients.Methods: Elderly patients who were diagnosed with DTC, and subsequently underwent surgery for DTC, were identified from the SEER database (1988–2008). Based on histology, these patients were divided into C-PTC, FV-PTC, and FTC. The clinical characteristics, pathological features, and treatments undertaken were compared among these patients. Cox proportional hazards analysis was performed to evaluate the risk factors to disease-specific survival (DSS).Results: In elderly DTC patients, FV-PTC shows intermediate tumor features compared to C-PTC and FTC, but presented a better outcome. Being male, African-American, tumors sized bigger than 4 cm, extrathyroidal extension, lymph node metastasis, and distant metastasis, were all strong risk factors for DSS in elderly DTC patients (all p < 0.05). No difference was found between lobectomy and total thyroidectomy with respect to DSS, and radiation therapy conferred no apparent advantage with respect to DSS (both p > 0.05).Discussion: Patients with FV-PTC needed more specific histology cataloging and risk assessment, suggesting conservative therapy. Risk stratification should be paid attention to, and treatment should be individualized for elderly patients.

Purpose: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, and 20% of patients eventually require nephrectomies due to compressive symptoms or renal-related complications. Traditionally, nephrectomies were performed via the open approach in view of space constraints. We evaluate our institution's outcomes for laparoscopic nephrectomy (LN) for ADPKD. Materials and Methods: We retrospectively reviewed 33 patients with ADPKD who underwent nephrectomies from November 2005 to December 2016 at a tertiary institution. Preoperative kidney volume was calculated via the ellipsoid method by using computed tomography scan. Results: The median age was 51.0 years (interquartile range [IQR], 44.5–56.0 years). Sixteen patients (48.5%) underwent open nephrectomy (ON), 15 patients (45.5%) had LNs, and 2 patients (6.1%) had laparoscopic converted to ON due to dense adhesions. Thirteen patients had bilateral while 18 patients had unilateral nephrectomies. Median kidney volume in the open group was 1,042 cm3 (IQR, 753–2,365 cm3) versus 899 cm3 (IQR, 482–1,914 cm3) in the laparoscopy group and did not differ significantly. The operative time was comparable between both groups. Patients who underwent LN had lesser blood loss (350 mL vs. 650 mL; 95% confidence interval [CI], 1.822–3.533; p=0.016) and shorter length of hospital stay (4.0 days vs. 6.5 days; 95% CI, 1.445–5.755; p=0.001) compared to patients who underwent ON. Both groups had similar low morbidity rate and no mortality.

Abstract Background Pulmonary lymphangioleimyomatosis (PLAM) is a rare disease involving lung. PLAM primarily affects young women, a characteristic it shares with systemic lupus erythematosus (SLE). Estrogen has long been assumed to play an important role both in PLAM and SLE. We report a menopausal woman, who was found to have PLAM 1 year after she was diagnosed with SLE. Her chest radiograph was normal in the early phase of SLE. Case presentation A 52-year-old Chinese woman was referred to our hospital in August 2014 because of swelling in both legs. She also reported a malar rash and intermittent generalized arthralgia. Laboratory examination showed leukopenia. Her serum albumin level was 23 g/L; 24-h urinary protein excretion was 5.3 g. She tested positive for anti-Smith (Sm) antibody and anti-SS-A antibody. Renal biopsy indicated Class V + IV(G)-A lupus nephritis (LN). The condition of SLE and LN improved on a regime of tapering prednisolone and intermittent intravenous cyclophosphamide therapy until 1 year later when she developed exertional dyspnea accompanied with frequent cough. Thoracic computed tomography revealed numerous well-defined cysts and the diagnosis of PLAM was confirmed by lung biopsy. In the follow-up period, the patient continued to be on prednisolone and mycophenolate mofetil for the treatment of SLE, but only agreed to receive symptomatic treatment for PLAM. One year after the diagnosis of PLAM, during which time the SLE was stable, she died of respiratory failure and cor pulmonale. Conclusion We report a patient with coexisting SLE and PLAM, who was treated with immunosuppressive therapy. SLE was stable but PLAM was not improved. Although the coexistence of SLE and PLAM might be a coincidence, the occurrence of these two diseases in a menopausal woman may warrant further mechanistic exploration.

This paper proposes a new two-dimensional direction finding algorithm for estimating multiple non-Gaussian signals using cumulants. This new algorithm: 1) employs an array geometry consisting of a nine-element non-uniformly spaced cross-shaped sub-array plus another arbitrarily-spaced sub-array; 2) defines five cumulant matrices, from which the signal direction cosines can be estimated by using parallel factor fitting, and hence, requiring no open-form two-dimensional searching and parameter pairing; 3) can achieve array aperture extension by jointly extending array physical aperture and constructing virtual sensors, without adding more sensors; and 4) can resolve 2(L - 4) signals with an array of L sensors in total. Simulation results are presented to verify the efficacy of the proposed algorithm.

Background: Surgical extirpation for renal cell carcinoma (RCC) with inferior venae cavae (IVC) thrombi is the standard of care. The incremental impact of upfront surgery has not been well described. Objective: We aim to quantify the overall survival (OS) benefit of upfront surgery in RCC with IVC thrombi when compared to a conservative approach and also analyze perioperative outcomes. Materials and Methods: Patients with RCC with IVC thrombus between January 1, 2001, and December 31, 2014, in a single institution were identified, and data reviewed for demographics, performance status, and tumor thrombus levels. Pathological and operative outcomes were analyzed in the surgical cohort (Sx). Survival outcomes were computed with Kaplan–Meier analysis. Prognostic factors were determined using univariate and multivariate analyses. Statistical significance was defined as P < 0.1. Results: There were 51 patients identified, comprising 31 and 20 in the Sx and nonsurgical (NSx) cohorts. For the Sx cohort, 5-year OS and recurrence-free survival were 48% and 45%, respectively, with a median OS of 51.7 months. Nodal involvement was an independent predictor for OS (P < 0.1) on multivariate analysis. In the NSx cohort, 75% (15/20) had distant metastasis at diagnosis, with a 5-year OS of 13.4 months. Patients with better baseline ECOG statuses had better survival outcomes (P < 0.1). The mean OS of patients (n = 5) with M0 disease was 18.8 months. The advantage conferred by surgery was a 38.2-month longer median OS (P < 0.0001). In the Sx cohort, 87% had no or minor perioperative complications. Conclusion: Nephrectomy and IVC thrombectomy have an OS survival advantage of 38.2 months with acceptable perioperative morbidity. Therefore, it is preferred over an initial nonsurgical approach where possible.

Objective: Despite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP. Methods: One hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV

Objective: To determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer. Methods: We retrospectively reviewed 84 patients undergoing radical cystectomy (RC) for UCB from January 2002 to June 2012. NLR was computed (median: 5 days) prior to surgery. No patients received neoadjuvant chemotherapy. NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained, with a statistical receiver operating characteristics of 0.74. Kaplan–Meier curves, multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes. Results: The median follow-up period was 30.1 months (range: 3.2–161.7) owing to high recurrence rate and subsequent mortalities, compared to the median 64.7 months in patients alive at the end of study period. NLR ≥2.7 was associated with worse survival outcomes (5-year disease-specific survival: 22% vs 58%, p = 0.017, 95%CI: 1.193–6.009; 5-year overall survival: 23% vs 60%, p = 0.008, 95%CI: 1.322–6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate (p = 0.007, HR =6.999, 95%CI: 1.712–28.606), higher T staging (p = 0.021, HR = 3.479, 95%CI: 1.212–9.990) and lymph node involvement (p = 0.009, HR = 4.534, 95%CI: 1.465–14.034). Conclusion: This study suggests that NLR can be an inexpensive novel factor for patients risk stratification pre-operatively. This improves patient counseling and identifies patients who may benefit from multimodal treatment.

Abstract: Neutrophils are the most abundant white blood cells in circulation and are key components of the innate immune response. Clinical and experimental studies support an important role for the neutrophils in a broad spectrum of acute and chronic inflammatory conditions. However, our understanding of nodal points that control neutrophil activation remains incompletely understood. Over the past decade, studies have linked members of the Kruppel-like family of transcription factors (KLFs) to myeloid cell differentiation and function. Here we show that KLF4 is a critical transcriptional regulator of neutrophil biology. KLF4-deficient neutrophils exhibited impaired responses to inflammatory stimulation ex vivo, including reduced production of cytokines and reactive oxygen species, impaired degranulation, and impaired bacterial killing and clearance. Consequently, mice bearing myeloid-specific conditional KLF4 deficiency (K4-cKO) exhibited enhanced susceptibility to bacterial infection but resistance to lipopolysaccharide-induced septic shock and experimental autoimmune encephalomyelitis. Finally, mechanistic studies revealed that the defects in KLF4-deficient neutrophils likely resulted from the defective Toll-like receptor 4–NF-κB signaling. Collectively, these findings identify KLF4 as a novel transcriptional regulator of neutrophil activation.

Human motion classification is widely used in intelligent house, surveillance, search and rescue operation, intelligent house, and elder monitoring. In this study, a frequency-modulated continuous-wave radar is utilised to classify non-rhythmic human motion in an indoor scenario. Both the range and Doppler features are extracted from echo signals for a machine learning classifier subspace K-nearest neighbour. Extensive experiments demonstrate its feasibility, and an accuracy rate of 94.2% was achieved in recognition of eight typical non-rhythmic motions.

Objective: Serum prostate specific antigen (PSA) is commonly used to evaluate treatment response after definitive radiation therapy (RT). However, PSA levels can temporarily rise without a clear reason, termed “PSA bounce”, and often engender great anxiety for both patients and physicians. The present study aimed to determine the prevalence and factors that predict “PSA bounce” after intensity-modulated radiation therapy (IMRT), and the relevance to biochemical failure and cancer recurrence in an Asian population. Methods: We retrospectively reviewed 206 patients who received IMRT for prostate cancer from 2004 to 2012 in the National Cancer Centre Singapore. These patients were followed up with regular PSA monitoring. We defined “PSA bounce” as a rise of 0.1 ng/mL, followed by two consecutive falls. Patients with biochemical failure (PSA nadir + 2 ng/mL) were further evaluated for cancer recurrence. Results: Sixty-one patients (29.6%) experienced “PSA bounce”, at a median time of 16 months and lasted for 12 months. Age remained the most consistent predictor of the incidence, duration and extent of “PSA bounce”. Other contributory factors included baseline PSA, Gleason score and PSA nadir. Hormonal therapy and prostate volume did not affect this phenomenon. Sixteen patients (7.8%) developed biochemical recurrence, at median time of 32 months, of which 11 were confirmed to have metastatic disease. The median follow-up time was 71 months. Conclusion: A younger age predicts PSA bounce incidence, duration and magnitude. The extent of bounce appears to be lower in Asian population. The interval to occurrence and extent of PSA elevation separates PSA bounce from disease recurrence. Keywords: Prostate specific antigen, Prostate specific antigen bounce, Prostate cancer, Intensity modulated radiation therapy

Objective: Men with benign prostate hyperplasia (BPH) with good urinary flow may still have bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been shown to be able to predict BOO. We aim to investigate the use of IPP to predict BOO in men with good urinary flow. Methods: One hundred and fourteen consecutive men (>50 years old) presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002. They were evaluated with serum prostate specific antigen (PSA), uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume (PV). Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index > 40. Men with Qmax ≥ 12.0 mL/s were considered to have good flow. Results: Among the 114 men, 61 patients had good urinary flow. Their median age, PV and Qmax were 66 years, 32.9 mm3 and 14.5 mL/s respectively. 14/61 (23.0%) patients had BOO and their distribution of IPP were as follows: Grade 1 – 0/20 (0%) obstructed, Grade 2 – 6/22 (27.3%) and Grade 3 – 8/19 (42.1%). Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%. The area-under-curve (AUC) for IPP was greater than that for PV (0.757 vs. 0.696). Conclusion: Even in men with good flow, high grades of IPP were more likely to have BOO and hence, may be a useful adjunct to predict BOO.

Language has been one of the most effective ways of human communication and information exchange. To solve the problem of non-contact robust speech recognition, recovery, and surveillance, this paper presents a speech recovery technology based on a 24 GHz portable auditory radar and webcam. The continuous-wave auditory radar is utilized to extract the vocal vibration signal, and the webcam is used to obtain the fitted formant frequency. The traditional formant speech synthesizer is selected to synthesize and recover speech, using the vocal vibration signal as the sound source excitation and the fitted formant frequency as the vocal tract resonance characteristics. Experiments on reading single English characters and words are carried out. Using microphone records as a reference, the effectiveness of the proposed speech recovery technology is verified. Mean opinion scores show a relatively high consistency between the synthesized speech and original acoustic speech.