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Abstract Objective Recent studies have indicated a potential association between giant cell arteritis (GCA) and diabetes mellitus, encompassing both type 1 diabetes (T1D) and type 2 diabetes (T2D). However, the exact nature of this relationship requires further investigation to be fully elucidated. Methods Genetic links between T1D/T2D and GCA were explored using data from genome-wide association studies available to the public, focusing on populations of European ancestry. We applied a bidirectional mendelian randomization (MR) approach to assess the potential association between these diseases. Confirmatory analyses, including additional datasets and a comprehensive meta-analysis, were utilized. The inverse-variance-weighted (IVW) method was applied to pinpoint heterogeneity and pleiotropy, while subsequent sensitivity analyses aimed to trace the origins of any heterogeneity. Results Initial analysis demonstrated a correlation between T1D and an elevated likelihood of developing GCA (IVW odds ratio = 1.33, with a 95% confidence interval of 1.22–1.46, and a P-value of 9.42E−10). The causal association was verified through four validation datasets and meta-analysis (all P-value

Summary Background The descending genicular artery (DGA) and medial thigh region have been underused as donor sites for perforator flaps. This study evaluated the anatomical relationship between the perforators of the DGA and the saphenous vein (SV) to review the clinical applications of the free descending genicular artery perforator (DGAP) flap for locoregional reconstruction. Methods Fifteen cadavers were arterially perfused with red latex and dissected. Thirty-one patients with extremity tissue defects were treated with a free DGAP flap, including six patients who received a chimeric flap. The minimum distance between the DGAP and the SV was measured during surgery. Results In all patients, the skin branch of the descending genicular artery was found in the medial femoral condyle plane in front of the SV. The average distance between the descending genicular artery perforator and the SV was 3.71 ± 0.38 cm (range: 2.9–4.3 cm). Thirty flaps survived completely, and one flap developed partial necrosis; however, this flap healed two weeks after skin grafting. The average follow-up time was 11.23 months. Conclusions We conclude that the SV can be preserved when harvesting the descending genicular artery perforator flap, causing less damage to the donor site and having no effect on flap survival. The free descending genicular artery perforator flap without the SV is a better therapy for complicated tissue defects.

Abstract Background The worldwide occurrence of triplet pregnancy is estimated to be 0.093%, with a natural incidence of approximately 1 in 8000. This study aims to analyze the neonatal health status and birth weight discordance (BWD) of triplets based on chorionicity from birth until discharge. Methods This was a retrospective study. We reviewed a total of 136 triplet pregnancies at our tertiary hospital between January 1, 2001, and December 31, 2021. Maternal and neonatal outcomes, inter-triplet BWD, neonatal morbidity, and mortality were analyzed. Results Among all cases, the rates of intrauterine death, neonatal death, and perinatal death were 10.29, 13.07, and 24.26%, respectively. Thirty-seven of the cases resulted in fetal loss, including 13 with fetal anomalies. The maternal complications and neonatal outcomes of the 99 triplet pregnancies without fetal loss were compared across different chorionicities, including a dichorionic (DC) group (41 cases), trichorionic (TC) group (37 cases), and monochorionic (MC) group (21 cases). Neonatal hypoproteinemia (P 25% increased the risk of neonatal anemia (AOR = 10.135) and need for blood transfusion after birth (AOR = 7.127). TC pregnancy, MCDA or MCTA, and BWD > 25% increased neonatal hypoproteinemia, with AORs of 4.629, 5.123, and 5.343, respectively. Conclusions The BWD differed significantly according to chorionicity. Additionally, TC pregnancies reduced the risk of neonatal anemia and need for blood transfusion, but increased the risk of neonatal hypoproteinemia. In contrast, the BWD between the largest and smallest triplets increased the risk of neonatal anemia and the need for blood transfusion. TC pregnancy, MCDA or MCTA, and BWD > 25% increased the risks of neonatal hypoproteinemia. However, due to the limited number of triplet pregnancies, further exploration of the underlying mechanism is warranted.

Abstract Achievement of national climate targets and the corresponding costs would entirely depend on regional actions within the country. However, because of substantial inequalities and heterogeneities among regions, especially in developing economies, aggressive or uniform actions may exacerbate inequity and induce huge economic losses, which in turn challenges the national climate pledges. Hence, this study extends prior research by proposing economically optimal strategies that can achieve national climate targets and ensure the greatest local and national benefits as well as regional equality. Focusing on the biggest developing country China, we find this strategy can avoid up to 1.54% of cumulative GDP losses for approaching carbon neutrality, and more than 90% of regions would obtain economic gains compared either with existing independently launched targets or with the uniform strategy that all regions achieve peak carbon emissions before 2030. We also provide optimal carbon mitigation pathways to regional peak carbon, carbon intensity and energy consumption.

Abstract Background The tumor microenvironment plays a key role in non-small cell lung cancer (NSCLC) development and also influences the effective response to immunotherapy. The pro-inflammatory factor interleukin-17A mediates important immune responses in the tumor microenvironment. In this study, the potential role and mechanisms of IL-17A in NSCLC were investigated. Methods We detected IL-17A by immunohistochemistry (IHC) in 39 NSCLC patients. Its expression was correlated with the programmed cell death-ligand1 (PD-L1). IL-17A knockdown and overexpression in A549 and SPC-A-1 cell models were constructed. The function of IL-17A was examined in vitro by wound healing, migration, invasion, plate colony formation and T cell killing assay. Western blot analysis, immunofluorescence assay and IHC were performed to investigate the regulation effects of IL-17A on autophagy in A549 and SPC-A-1. The effect of IL-17A on ROS/Nrf2/p62 signaling pathway was detected. Subcutaneous tumor models were established to examine the tumor-promoting effect of IL-17A in vivo and its effect on immunotherapy. Results We found a prevalent expression of IL-17A in NSCLC tumor tissues and it was positively correlated with PD-L1 expression (r = 0.6121, p

Background Minimally invasive reduction and fixation of intra‐articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra‐articular calcaneal fractures, and propose the indications of our protocol. Methods In this retrospective study, a series of 34 consecutive closed and displaced intra‐articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X‐ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot‐ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed‐rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired‐Samples t‐test. Results Thirty‐two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow‐up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor. Conclusions For intra‐articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub‐talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.

Abstract Background To explore the role of skeletal muscle specific TGF-β signaling on macrophages efferocytosis in inflamed muscle caused by Cardiotoxin (CTX) injection. Methods CTX myoinjury was manipulated in TGF-βr2flox/flox (control) mice or transgenic mice with TGF-β receptor 2 (TGF-βr2) being specifically deleted in skeletal muscle (SM TGF-βr2−/−). Gene levels of TGF-β signal molecules, special inflammatory mediators in damaged muscle or in cultured and differentiated myogenic precursor cells (MPC-myotubes) were monitored by transcriptome microarray or qRT-PCR. TGF-β pathway molecules, myokines and embryonic myosin heavy chain in regenerating myofibers, the phenotype and efferocytosis of macrophages were evaluated by immunofluorescence, immunoblotting, Luminex, or FACS analysis. In vitro apoptotic cells were prepared by UV-irradiation. Results In control mice, TGF-β-Smad2/3 signaling were significantly up-regulated in regenerating centronuclear myofibers after CTX-myoinjury. More severe muscle inflammation was caused by the deficiency of muscle TGF-β signaling, with the increased number of M1, but the decreased number of M2 macrophages. Notably, the deficiency of TGF-β signaling in myofibers dramatically affected on the ability of macrophages to conduct efferocytosis, marked by the decreased number of Annexin-V−F4/80+Tunel+ macrophages in inflamed muscle, and the impaired uptake of macrophages to PKH67+ apoptotic cells transferred into damaged muscle. Further, our study suggested that, the intrinsic TGF-β signaling directed IL-10-Vav1-Rac1 efferocytosis signaling in muscle macrophages. Conclusions Our data demonstrate that muscle inflammation can be suppressed potentially by activating the intrinsic TGF-β signaling in myofibers to promote IL-10 dependent-macrophages efferocytosis. Video Abstract

Abstract High-precision microelectromechanical system (MEMS) gyroscopes are significant in many applications. Bias instability (BI) is an important parameter that indicates the performance of a MEMS gyroscope and is affected by the 1/f noise of the MEMS resonator and readout circuit. Since the bandgap reference (BGR) is an important block in the readout circuit, reducing its 1/f noise is key to improving a gyroscope’s BI. In a traditional BGR, the error amplifier is applied to provide a virtual short-circuit point, but it introduces the main low-frequency noise sources. This paper proposes an ultralow 1/f noise BGR by removing the error amplifier and applying an optimized circuit topology. In addition, a simplified but accurate noise model of the proposed BGR is obtained to optimize the BGR’s output noise performance. To verify this design, the proposed BGR has been implemented in a 180 nm CMOS process with a chip area of 545 × 423 μm. The experimental results show that the BGR’s output integrated noise from 0.1 to 10 Hz is 0.82 μV and the thermal noise is 35 nV/√Hz. Furthermore, bias stability tests of the MEMS gyroscope fabricated in our laboratory with the proposed BGR and some commercial BGRs are carried out. Statistical results show that reducing the BGR’s 1/f noise can nearly linearly improve the gyroscope’s BI.

Abstract Endoplasmic reticulum stress (ERS) and the unfolded protein response (UPR) are involved in various muscle pathological states. The IRE1α arm of UPR can affect immunological properties of myofiber through restraining p38 mitogen-activated protein kinases (MAPK) activation under inflammatory milieu. However, the relevant pathway molecules regulating the initiation of the IRE1α arm in myofiber remain unclear. In this work, expression of transforming growth factor-beta (TGF-β) and TGF-β receptor II (TGF-βr2), and UPR pathway activation were examined in cardiotoxin (CTX)-damaged mouse muscle, which revealed the activation of TGF-β signaling and UPR in CTX-damaged muscle and in regenerating myofibers. Using control or transgenic mice with TGF-βr2 deleted in skeletal muscle (SM TGF-βr2−/−) and the derived primary differentiating myogenic precursor cells (MPCs) treated with/without ERS activator or inhibitor, IRE1α pathway inhibitor, or TGF-β signaling activator, this study further revealed an essential role of intrinsic TGF-β signaling in regulating muscle cell to express inflammation-related molecules including H-2Kb, H2-Eα, TLR3, and special myokines. TGF-β signaling prompted UPR IRE1α arm and restrained p38 MAPK activation in myofiber under inflammatory milieu. This study uncovers a previously unrecognized function of TGF-β signaling acting as an upstream factor controlling myofiber immune capacities in the inflamed state through the UPR–IRE1α–p38 MAPK pathway.

Abstract Objective To investigate the clinical characteristics and the site of pulmonary involvement in Takayasu arteritis (TAK) patients with pulmonary artery involvement (PAI). Methods We retrospectively investigated data of 141 TAK patients. The clinical and image data of the patients with and without PAI were analyzed and compared. The patients were followed up. The major outcome was all-cause mortality. The minor outcome was exacerbation or new occurrence of PAI, which leads to disease progression events. Results For the 141 TAK patients considered, PAI was detected in 65 (46.1%) patients. TAK patients with PAI had a significantly higher cumulative incidence of events than those without PAI (P < 0.001). The frequencies of the following were significantly higher in TAK with PAI than those in TAK without PAI: disease duration [median 96 months (IQR: 24–174) vs. median 42 months (IQR: 6–120); P = 0.012], hemoptysis (10.8% vs. 1.32%; P = 0.040), oppression in the chest (40.0% vs. 21.1%; P = 0.014), fever (23.1% vs. 9.21%; P = 0.024), Mycobacterium tuberculosis infection (21.5% vs. 6.57%; P = 0.010), pulmonary hypertension (PAH) (21.5% vs. 2.6%; P < 0.001), pulmonary infarction (41.5% vs. 0%; P < 0.001), and hypoxemia (18.5% vs. 1.3%; P < 0.001). Multivariate logistic regression analysis of data of TAK patients with symptom presentation showed that oppression in the chest (OR: 2.304; 95% CI: 1.024–5.183; P = 0.044) and thoracic aorta involvement (OR: 2.819; 95% CI: 1.165–6.833; P = 0.022) were associated with PAI. The cluster analysis performed for data of TAK patients with PAI revealed that the cluster characterized as the upper lobe of the right lung (Cluster1) had the worst prognosis. Conclusion In TAK, PAI is associated with thoracic aorta involvement. In TAK patients with PAI, the involvement of the upper lobe of the right lung is characterized with the worst prognosis.

Abstract Background Cervical cerclage has been proposed as an effective treatment for cervical insufficiency, but there has been controversy regarding the surgical options of cervical cerclage in singleton and twin pregnancies. This study aimed to compare the pregnancy outcomes between transvaginal cervical cerclage (TVC) and laparoscopic abdominal cervical cerclage (LAC) in patients with cervical insufficiency. We also aimed to evaluate the efficacy and safety, and provide more evidence to support the application of cervical cerclage in twin pregnancies. Methods A retrospective study was carried out from January 2015 to December 2021. The primary outcomes were the incidence of spontaneous preterm birth (sPTB)

Abstract As the understanding of skeletal muscle inflammation is increasingly clarified, the role of Treg cells in the treatment of skeletal muscle diseases has attracted more attention in recent years. A consensus has been reached that the regulation of Treg cells is the key to completing the switch of inflammation and repair of skeletal muscle, whose presence directly determine the repairing quality of the injured skeletal muscle. However, the functioning process of Treg cells remains unreported, thereby making it necessary to summarize the current role of Treg cells in skeletal muscle. In this review, the characteristics, origins, and cellular kinetics of these Treg cells are firstly described; Then, the relationship between Treg cells and muscle satellite cells (MuSCs), conventional T cells (Tconv) is discussed (the former is involved in the entire repair and regeneration process, while the latter matters considerably in causing most skeletal muscle autoimmune diseases); Next, focus is placed on the control of Treg cells on the phenotypic switch of macrophages, which is the key to the switch of inflammation; Finally, factors regulating the functional process of Treg cells are analyzed, and a regulatory network centered on Treg cells is summarized. The present study summarizes the cell-mediated interactions in skeletal muscle repair over the past decade, and elucidates the central role of regulatory T cells in this process, so that other researchers can more quickly and comprehensively understand the development and direction of this very field. It is believed that the hereby proposed viewpoints and problems can provide fresh visions for the latecomers.

As global temperatures rise, the impact on health becomes increasingly apparent, especially for vulnerable seniors. This study analyzed the additional financial burden caused by heatwaves on outpatient healthcare spending among China’s older people, using data from the China Health and Retirement Longitudinal Study (CHARLS) covering 126 cities between 2011 and 2018. Applying generalized estimating equations (GEE) models and incorporating local weather data, we examined the data from 22 023 questionnaires. The findings show that each heatwave in the past 30 d increased individual outpatient costs by 2.29 CNY (95% CI: 0.31–4.27), affecting individuals with chronic diseases, those without air conditioning, and those in rural areas more severely. Naps proved effective in mitigating heatwave effects. Projections suggest that in the summer of 2050, under the SSP5-8.5 scenario, additional healthcare expenses attributable to rising temperatures might reach 29.14 billion CNY (95% CI: 3.94–54.33). These findings highlight the urgent need for proactive heat and health strategies in China and support naps as a protective measure against heat-induced health risks for older people.

Lithium-sulfur batteries (LSBs) are promising candidates for next-generation high-efficiency energy storage, yet their practical implementation is seriously impeded by the parasitic shuttle effect and sluggish reaction kinetics. Herein, we develop a unique Cu, Co layered double hydroxide (CuCo-LDH) with a hollow and hierarchical structure as an advanced electrocatalyst to tackle these challenges. Combining the compositional, architectural, and chemical advantages, the as-developed CuCo-LDH enables facile charge transfer, fully exposed active interfaces, and strong interactions with polysulfides via metal–sulfur bonding. When employed in the functional separator, a reliable polysulfide barrier can be established against the shuttling behavior, while the excellent catalytic activity realizes fast and efficient sulfur electrochemistry. As a result, the CuCo-LDH-based LSBs achieve a well-restrained capacity decay of 0.049% per cycle over 500 cycles together with a good rate capability up to 5 C. Moreover, a favorable areal capacity of 4.39 mAh cm−2 and decent cyclability are still attainable even under a high sulfur loading of 4.2 mg cm−2 and a low E/S ratio of 6 ml g−1. This work affords a feasible and instructive pathway toward advanced sulfur electrocatalysts as well as high-performance LSBs.

Raster maps provide intuitive visualizations of remote sensing data representing various phenomena on the Earth’s surface. Reading raster maps with intricate information requires a high cognitive workload, especially when it is necessary to identify and compare values between multiple layers. In traditional methods, users need to repeatedly move their mouse and switch their visual focus between the map content and legend to interpret various grid value meanings. Such methods are ineffective and may lead to the loss of visual context for users. In this research, we aim to explore the potential benefits and drawbacks of gaze-adaptive interactions when interpreting raster maps. We focus on the usability of the use of low-cost eye trackers on gaze-based interactions. We designed two gaze-adaptive methods, gaze fixed and gaze dynamic adaptations, for identifying and comparing raster values between multilayers. In both methods, the grid content of different layers is adaptively adjusted depending on the user’s visual focus. We then conducted a user experiment by comparing such adaptation methods with a mouse dynamic adaptation method and a traditional method. Thirty-one participants (n = 31) were asked to complete a series of single-layer identification and multilayer comparison tasks. The results indicated that although gaze interaction with adaptive legends confused participants in single-layer identification, it improved multilayer comparison efficiency and effectiveness. The gaze-adaptive approach was well received by the participants overall, but was also perceived to be distracting and insensitive. By analyzing the participants’ eye movement data, we found that different methods exhibited significant differences in visual behaviors. The results are helpful for gaze-driven adaptation research in (geo)visualization in the future.

Abstract Background Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn. Prenatal screening and diagnosis of conjoined twins is usually performed by ultrasonography. Magnetic resonance imaging can be used to assist in the diagnosis if necessary. Conjoined twins in dichorionic diamniotic triplet pregnancy are extremely rare. Case presentation We reported three cases of dichorionic diamniotic triplet pregnancy with conjoined twins. Due to the poor prognosis of conjoined twins evaluated by multidisciplinary teams, selective termination of conjoined twins was performed in three cases. In case 1, selective reduction of the conjoined twins was performed at 16 gestational weeks, and a healthy female baby weighing 3270 g was delivered at 37 weeks. In case 2, the conjoined twins were selectively terminated at 17 weeks of gestation, and a healthy female baby weighing 2760 g was delivered at 37 weeks and 4 days. In case 3, the conjoined twins were selectively terminated at 15 weeks and 2 days, and a healthy female baby weighing 2450 g was delivered at 33 weeks and 6 days. The babies of all three cases were followed up and are in good health. Conclusion(s) Surgical separation is the only treatment for conjoined twins after birth. Early determination of chorionicity and antenatal diagnosis of conjoined twins in triplet gestations are critical for individualized management options and the prognosis of normal triplets. Expecting parents should be extensively counseled by multidisciplinary teams. If there are limitations in successful separation after birth, early selective termination of the conjoined twins by intrathoracic injection of potassium chloride may be a procedure in dichorionic diamniotic triplet pregnancy to improve perinatal outcomes of the normal triplet.

Purpose: Takayasu’s arteritis (TAK) is a large-vessel vasculitis. Glucocorticoids (GCs) combined with cyclophosphamide (CTX) is a common treatment option, but their efficacy is limited. The aim of this retrospective study was to study the efficacy and safety of tocilizumab (TCZ) in the treatment of TAK. Patients and methods: A total of 63 patients with TAK were divided into two groups according to different treatment strategies: 31 patients in the TCZ group and 32 patients in the CTX group. After 6 months of treatment, disease activity and side effects were evaluated and were compared between the two groups. Results: After 3 months of treatment, the National Institutes of Health (NIH) score ( p = 0.005), Indian Takayasu Clinical Activity Score (ITAS) 2010 ( p = 0.043), and the Indian Takayasu Activity Score with the Acute-Phase Response (ITAS.A; p = 0.036) were lower in patients treated with TCZ compared with those treated with CTX. In the TCZ group, the proportion of patients with NIH scores ⩽1 reached 50% after 1 month, 90% after 3 months, and 96% after 6 months of treatment, whereas in the CTX group, these proportion were 36%, 30%, and 78%, respectively. Thus, TCZ treatment of TAK is accompanied with a faster remission rate than CTX treatment. Moreover, the total cumulative incidence of adverse events was lower in the TCZ group than in the CTX group ( p = 0.035). Conclusion: TCZ was faster and safer in alleviating TAK.

Abstract Interferon-gamma (IFN-γ) is a cytokine involved in the pathogenesis of Takayasu’s arteritis (TAK). However, the source of IFN-γ in TAK patients is not fully clear. We aimed to investigate the source of IFN-γ in TAK. 60 TAK patients and 35 health controls were enrolled. The lymphocyte subsets of peripheral blood were detected by flow cytometry, cytokines were detected by Bio-plex. The correlation among lymphocyte subsets, cytokines and disease activity indexes was analyzed by person correlation. The level of serum IFN-γ in TAK patients was significantly increased (P

Abstract Background Monochorionic diamniotic triplet pregnancies are rare. Twin reversed arterial perfusion sequence in monochorionic triplet pregnancies is extremely rare, and it is associated with high perinatal morbidity and mortality rates in the “pump fetus.” Case presentation We reported a case of monochorionic diamniotic triplet pregnancy with twin reversed arterial perfusion sequence, including two acardiac fetuses sharing a single amniotic sac and a normal fetus in another amniotic sac. Due to rapid growth of the acardiac fetuses, intrafetal laser therapy was performed in both of them under ultrasound guidance at 15 weeks +5 days. Subsequently, regular and careful antenatal care including fetal ultrasonography and doppler and fetal echocardiography was conducted. At 37 weeks +4 days, a healthy female baby weighing 2510 g was delivered. The baby was followed up and now at 11 months old is in good health. Conclusions Twin reversed arterial perfusion sequence in monochorionic triplet pregnancy should be diagnosed early by ultrasound imaging during pregnancy. Individualized management should be based on clinical conditions to improve the perinatal outcome of the pump twin. Intrafetal laser therapy could be an alternative procedure when intrauterine intervention is required.

Abstract Background Sacrococcygeal teratoma is one of the most common congenital tumors in newborns and infancy. The incidence is 1 per 20,000–40,000 live births. Ultrasonography is an optimal method for prenatal screening and diagnosis of fetal sacrococcygeal teratoma. MRI can be used to assist in the diagnosis. However, sacrococcygeal teratoma in the twin pregnancy is rare. Case presentation We reported a case of one twin with sacrococcygeal teratoma in dichorionic-diamniotic twin pregnancy.One twin with sacrococcygeal teratoma was diagnosed at the second trimester by ultrasonic examination and another twin was normal. A regular and careful antenatal care was conducted by the multidisciplinary team. The parents refused to perform the fetal MRI and examine the chromosome of both twin.At 37 + 1 of gestation, planned cesarean section was performed. The healthy male co-twin (twin A) weighed 2880 g.The male twin with SCT (twin B) weighed 2900 g, complying with 6 × 3 × 3 cm cystic and solid mass in sacrococcygeal region. At four days of age twin B underwent excisional surgery of the sacrococcygeal teratoma and coccyx and discharged 7 days after surgery. The mother and both babies were followed up and are all in good health until now. Conclusion(s) Sacrococcygeal teratoma in twin pregnancy is rare. Early antenatal diagnosis is important. Once the sacrococcygeal teratoma is diagnosed, clinicians should be aware of the associated maternal and fetal complications. Expecting parents should be counseled by the multidisciplinary team about the management and prognosis of the STC twin and co-twin. Prompt surgical excision of the sacrococcygeal teratoma after birth should be suggested.

Maps based on virtual reality (VR) are evolving and are being increasingly used in the field of geography. However, the advantages of VR based on the map use processes of users over desktop-based environments (DEs) are not fully understood. In this study, an experiment was conducted in which 120 participants performed map use tasks using maps and globes in VR and DE. The participants’ eye movements and questionnaires were collected to compare the map use performance differences. We analyzed the general metrics, information searching and processing metrics of participants (e.g. response time, RT; average fixation duration, AFD; average saccade duration, ASD; saccade frequency, SF, etc.) using maps and globes in different environments. We found that the participants using VR processed information more efficiently (AFDDE = 233.34 ms, AFDVR = 173.09 ms), and the participants using DE had both a significantly shorter response time (RTDE = 88.68 s, RTVR = 124.05 s) and a shorter visual search time (ASDDE = 60.78 ms, ASDVR = 112.13 ms; SFDE = 6.30, SFVR = 2.07). We also found similarities in accuracy, satisfaction and readability. These results are helpful for designing VR maps that can adapt to human cognition and reflect the advantages of VR.

The emission allocation strategies of global scenarios do not specify the potential benefits from extra climate mitigation efforts. Here the authors show that compared to the current Nationally Distributed Contributions, the proposed self-preservation strategy might generate 126–616 trillion dollars of additional benefits by 2100.

Background: Osteosarcoma (OS) is a primary malignant tumor of the bone that occurs in adolescents and is characterized by a young age at onset, high malignancy, high rate of metastasis, and poor prognosis. However, the factors influencing disease progression and prognosis remain unclear. Methods: In this study, we aimed to investigate the role of chondrocyte-derived exosomal miR-195 in OS. We used normal human chondrocytes to form miR-195-carrying exosomes to deliver miR-195 into OS cells. Xenograft tumor experiments were performed in mice intratumorally injected with exosomal miR-195. We found that kinesin superfamily protein 4A (KIF4A) promoted OS tumor progression and anti-apoptotic. Resules: We demonstrated that miR-195 inhibited the expression of KIF4A by directly targeting its 3’-untranslated region. Moreover, we observed that exosomal miR-195 successfully inhibited OS cell tumor growth and antiapoptotic in vitro and suppressed tumor growth in vivo. Conclusion: Collectively, these results demonstrate that normal human chondrocyte-derived exosomal miR-195 can be internalized by OS cells and inhibit tumor growth and antiapoptotic by targeting KIF4A, providing a new direction for clarifying the molecular mechanism underlying OS development.

Abstract Background Estrogen signaling is indispensable for muscle regeneration, yet the role of estrogen in the development of muscle inflammation, especially in the intramuscular T cell response, and the influence on the intrinsic immuno-behaviors of myofibers remain largely unknown. We investigated this issue using the mice model of cardiotoxin (CTX)-induced myoinjury, with or without estrogen level adjustment. Methods CTX injection i.m. (tibialis anterior, TA) was performed for preparing mice myoinjury model. Injection s.c. of 17β-estradiol (E2) or estrogen receptor antagonist 4-OHT, or ovariectomy (OVX), was used to change estrogen level of animal models in vivo. Serum E2 level was evaluated by ELISA. Gene levels of estrogen receptor (ERs) and cytokines/chemokines in inflamed muscle were monitored by qPCR. Inflammatory infiltration was observed by immunofluorescence. Macrophage and T cell phenotypes were analyzed by FACS. Immunoblotting was used to assess protein levels of ERs and immunomolecules in C2C12 myotubes treated with E2 or 4-OHT, in the presence of IFN-γ. Results We monitored the increased serum E2 level and the upregulated ERβ in regenerated myofibres after myotrauma. The absence of estrogen in vivo resulted in the more severe muscle inflammatory infiltration, involving the recruitment of monocyte/macrophage and CD4+ T cells, and the heightened proinflammatory (M1) macrophage. Moreover, estrogen signaling loss led to Treg cells infiltration decrease, Th1 response elevation in inflamed muscle, and the markedly expression upregulation of immunomolecules in IFN-γ-stimulated C2C12 myotubes in vitro. Conclusion Our data suggest that estrogen is a positive intervention factor for muscle inflammatory response, through its effects on controlling intramuscular infiltration and phenotypes of monocytes/macrophages, on affecting accumulation and function of Treg cells, and on suppressing Th1 response in inflamed muscle. Our findings also imply an inhibition effect of estrogen on the intrinsic immune behaviors of muscle cells.

Abstract. Background:. Clinical remission is the treatment target in rheumatoid arthritis (RA). This study aimed to investigate clinical remission and related factors in a large cohort of patients with RA. Methods:. This study composed of 342 patients with RA. Data were collected by face-to-face interview of 1049 patients with RA who visited the Department of Rheumatology of three teaching hospitals from September 2015 to May 2016. The patients with RA were clinically assessed by rheumatologists and a four-page questionnaire was completed on site. Subsequently, patients fulfilled remission criteria were further analyzed. The practicability of different definitions of remission of RA was rated by a panel of rheumatologists. Sustained intensive disease modifying anti-rheumatic drug (DMARD) treatment was defined as a combination treatment with two or more DMARDs for at least 6 months. Results:. In this cohort of 342 patients with RA, the proportions of patients achieving remission were 38.0%, 29.5%, 24.9%, 21.1%, 19.0%, 18.1%, and 17.0%, based on criteria of disease activity score in 28 joints (DAS28) using CRP (DAS28-CRP), DAS28 using ESR (DAS28-ESR), routine assessment of patient index data 3 (RAPID-3), Boolean, simplified disease activity index (SDAI), clinical disease activity index, and the newly described clinical deep remission (CliDR), respectively. Boolean and CliDR are the best in practicability scored by rheumatologists (7.5 and 8.0, respectively). Compared with the non-sustained intensive group, sustained intensive treatment with DMARDs yielded higher remission rates of 25.6%, 23.8%, and 21.3% in patients with RA based on Boolean (χ2 = 3.937, P = 0.047), SDAI (χ2 = 4.666, P = 0.031), and CliDR criteria (χ2 = 4.297, P = 0.038). The most commonly prescribed conventional synthesized DMARDs (csDMARDs) in patients with RA was leflunomide, followed by methotrexate, and hydroxychloroquine. Compared with the non-remission group, patients achieving remission had a longer median duration of DMARDs (45.0 [22.8–72.3] months, Z = −2.295, P = 0.022). Conclusions:. The findings in this study indicated that clinical deep remission is achievable in patients with RA. Sustained intensive DMARD treatment is needed to achieve a better outcome in RA.

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic, causing a global public health crisis. Many frontline healthcare workers providing ear, nose and throat services have been reported to contract COVID-19 at work. Early during the COVID-19 outbreak, several medical professionals in Otolaryngology-Head and Neck Surgery were infected in Wuhan, China. A series of measures were then taken immediately, which successfully halted the spread of the disease. Here we would like to share the lessons we have learned, and our experience to protect our health care workers during the COVID-19 pandemic.

Background: Pulmonary hypertension (PH) is a life-threatening disease with significant maternal morbidity and mortality. Methods: To assess pregnancy and neonatal outcomes and determine the risk factors for adverse maternal and neonatal outcomes in women with pulmonary hypertension (PH), a retrospective analysis was carried out examining 71 pregnancies in patients with PH who delivered at a tertiary care center in West China between January 2011 and May 2016. Results: One pregnancy resulted in spontaneous abortion and six resulted in terminated abortions. Cardiac complications were encountered in 16.9% including three maternal mortalities. At least one pregnancy complication occurred in 28.2% of all the pregnancies. Diagnosis after the third trimester, severe PH and/or right ventricular systolic dysfunction were predictive of adverse fetal/neonatal events. A history of prior cardiac events and right ventricular systolic dysfunction and/or baseline New York Heart Association (NYHA) class III or IV were the main predictive factors of adverse maternal cardiac events. Conclusions: In our study, we found that PH poses high risks for maternal and fetal morbidity and mortality. A detailed pre-pregnancy baseline assessment is strongly recommended in women with PH to identify those with the highest risk and subsequently guide clinical management.

Eye movement biometrics can enable continuous verification for highly secure environments such as financial transactions and defense establishments, as well as a more personalized and tailored experience in gaze-based human–computer interactions. However, there are numerous challenges to recognizing people in real environments using eye movements, such as implicity and stimulus independence. In the instance of wayfinding, this research intends to investigate implicit and stimulus-independent eye movement biometrics in real-world situations. We collected 39 subjects’ eye movement data from real-world wayfinding experiments and derived five sets of eye movement features (the basic statistical, pupillary response, fixation density, fixation semantic and saccade encoding features). We adopted a random forest and performed biometric recognition for both identification and verification scenarios. The best accuracy we obtained in the identification scenario was 78% (equal error rate, EER = 6.3%) with the 10-fold classification and 64% (EER = 12.1%) with the leave-one-route-out classification. The best accuracy we achieved in the verification scenario was 89% (EER = 9.1%). Additionally, we tested performance across the 5 feature sets and 20 time window sizes. The results showed that the verification accuracy was insensitive to the increase in the time window size. These findings are the first indication of the viability of performing implicit and stimulus-independent biometric recognition in real-world settings using wearable eye tracking.

Abstract A series of novel visible light driven all-solid-state Z-scheme BiOBr0.3I0.7/Ag/AgI photocatalysts were synthesized by facile in situ precipitation and photo-reduction methods. Under visible light irradiation, the BiOBr0.3I0.7/Ag/AgI samples exhibited enhanced photocatalytic activity compared to BiOBr0.3I0.7 and AgI in the degradation of methyl orange (MO). The optimal ratio of added elemental Ag was 15%, which degraded 89% of MO within 20 min. The enhanced photocatalytic activity of BiOBr0.3I0.7/Ag/AgI can be ascribed to the efficient separation of photo-generated electron–hole pairs through a Z-scheme charge-carrier migration pathway, in which Ag nanoparticles act as electron mediators. The mechanism study indicated that ·O2 − and h+ are active radicals for photocatalytic degradation and that a small amount of ·OH also participates in the photocatalytic degradation process.

Background/Aims: Whether calcium/calmodulin-dependent protein kinase IV (CaMKIV) plays a role in regulating immunologic features of muscle cells in inflammatory environment, as it does for immune cells, remains mostly unknown. In this study, we investigated the influence of endogenous CaMKIV on the immunological characteristics of myoblasts and myotubes received IFN-γ stimulation. Methods: C2C12 and murine myogenic precursor cells (MPCs) were cultured and differentiated in vitro, in the presence of pro-inflammatory IFN-γ. CaMKIV shRNA lentivirus transfection was performed to knockdown CaMKIV gene in C2C12 cells. pEGFP-N1-CaMKIV plasmid was delivered into knockout cells for recovering intracellular CaMKIV gene level. CREB1 antagonist KG-501 was used to block CREB signal. qPCR, immunoblot analysis, or immunofluorescence was used to detect mRNA and protein levels of CaMKIV, immuno-molecules, or pro-inflammatory cytokines and chemokines. Co-stimulatory molecules expression was assessed by FACS analysis. Results: IFN-γ induces the expression or up-regulation of MHC-I/II and TLR3, and the up-regulation of CaMKIV level in muscle cells. In contrast, CaMKIV knockdown in myoblasts and myotubes leads to expression inhibition of the above immuno-molecules. As well, CaMKIV knockdown selectively inhibits pro-inflammatory cytokines/chemokines, and co-stimulatory molecules expression in IFN-γ treated myoblasts and myotubes. Finally, CaMKIV knockdown abolishes IFN-γ induced CREB pathway molecules accumulation in differentiated myotubes. Conclusions: CaMKIV can be induced to up-regulate in muscle cells under inflammatory condition, and positively mediates intrinsic immune behaviors of muscle cells triggered by IFN-γ.

The modes of interaction (e.g., mouse and touch) between maps and users affect the effectiveness and efficiency of transmitting cartographic information. Recent advances in eye tracking technology have made eye trackers lighter, cheaper and more accurate, broadening the potential to interact with maps via gaze. In this study, we focused exclusively on using gaze to choose map features (i.e., points, polylines and polygons) via the select operation, a fundamental action preceding other operations in map interactions. We adopted an approach based on the dwell time and buffer size to address the low spatial accuracy and Midas touch problem in gaze-based interactions and to determine the most suitable dwell time and buffer size for the gaze-based selection of map features. We conducted an experiment in which 38 participants completed a series of map feature selection tasks via gaze. We compared the participants’ performance (efficiency and accuracy) between different combinations of dwell times (200 ms, 600 ms and 1000 ms) and buffer sizes (point: 1°, 1.5°, and 2°; polyline: 0.5°, 0.7° and 1°). The results confirmed that a larger buffer size raised efficiency but reduced accuracy, whereas a longer dwell time lowered efficiency but enhanced accuracy. Specifically, we found that a 600 ms dwell time was more efficient in selecting map features than 200 ms and 1000 ms but was less accurate than 1000 ms. However, 600 ms was considered to be more appropriate than 1000 ms because a longer dwell time has a higher risk of causing visual fatigue. Therefore, 600 ms supports a better balance between accuracy and efficiency. Additionally, we found that buffer sizes of 1.5° and 0.7° were more efficient and more accurate than other sizes for selecting points and polylines, respectively. Our results provide important empirical evidence for choosing the most appropriate dwell times and buffer sizes for gaze-based map interactions.

Objective Reconstruction of soft tissue defects in the foot and ankle remains challenging. This study was performed to investigate the technical points and clinical effects of a double-pedicle propeller flap for repair of foot and ankle soft tissue defects. Methods We used five fresh calf specimens to investigate the anatomical and operative aspects of a double-pedicle propeller flap. Eighteen patients with soft tissue defects in the foot and ankle subsequently underwent defect repair with double-pedicle propeller flaps. Results The anatomical study showed that the peroneal artery perforators and the sural nerve bundle (two blood supply systems) provided the theoretical anatomical basis for the double-pedicle propeller flap. The relative positions of the peroneal artery perforators and the sural nerve bundle differ according to the peroneal artery perforating level. Flap rotation in different directions can reduce or prevent the pedicles from compressing each other. All flaps survived, and three flaps developed local epidermal necrosis at the proximal end; these flaps healed after 1 to 2 weeks of dressing changes. The other 15 patients healed well. Conclusions The double-pedicle propeller flap can enhance the blood supply and venous return in the “big paddle” region of the flap, reducing the distal necrosis rate.

Skeletal muscle repair and systemic inflammation/immune responses are linked to endoplasmic reticulum stress (ER stress) pathways in myopathic muscle, and muscle cells play an active role in muscular immune reactions by exhibiting immunological characteristics under persistent proinflammation stimuli. Whether ER stress affects the intrinsic immunological capacities of myocytes in the inflammatory milieu, as it does to immune cells, and which arms of the unfolded protein response (UPR) mainly participate in these processes remain mostly unknown. We investigated this issue and showed that inflammatory stimuli can induce the activation of the protein kinase R (PKR)-like endoplasmic reticulum kinase (PERK) and inositol-requiring enzyme 1α (IRE1α) arms of the UPR in myocytes both in vivo and in vitro. UPR stressor administration reversed the increased IFN-γ-induced expression of the MHC-II molecule H2-Ea, the MHC-I molecule H-2Kb, toll-like receptor 3 (TLR3) and some proinflammatory myokines in differentiated primary myotubes in vitro. However, further IRE1α inhibition thoroughly corrected the trend in the UPR stressor-triggered suppression of immunobiological molecules. In IFN-γ-treated myotubes, dramatic p38 MAPK activation was observed under IRE1α inhibitory conditions, and the pharmacological inhibition of p38 reversed the immune molecule upregulation induced by IRE1α inhibition. In parallel, our coculturing system verified that the ovalbumin (OVA) antigen presentation ability of inflamed myotubes to OT-I T cells was enhanced by IRE1α inhibition, but was attenuated by further p38 inhibition. Thus, the present findings demonstrated that p38 MAPK contributes greatly to IRE1α arm-dependent immunobiological suppression in myocytes under inflammatory stress conditions.

The maneuverability and hydrodynamic performance of the tethered underwater robot in a uniform flow field is investigated. In this research, a tethered underwater robot symmetrically installed with NACA66 hydrofoils and Ka 4-70/19A ducted propellers around its main body is first constructed. The method of overlapping grid combined with sliding mesh is applied in the numerical simulations, and the principle of relative motion is adopted to describe the hydrodynamic responses of the tethered underwater robot during the robot manipulation. The reliability of the CFD methods applied in this research is verified by experimental results, and the comparison between numerical and experimental ones shows that there is very little difference being found. The numerical results indicate that computational cost due to the research’s large-scale domain can be effectively reduced by the adopted numerical methods, hydrofoils’ control effect is greatly influenced by the towing speeds, and thrusts issued from the ducted propellers are related to the tethered underwater robot’s position and towing speed.

This paper presents a new perspective of national power—sustainable national power (SNP)—emphasizing both the traditional comprehensive national power (CNP) and social and environmental sustainability. We propose a measurement to quantify the SNP based on the measurement of comprehensive national power and a sustainable adjusted index. In addition, density-equalizing maps are adopted to visualize the sustainable national power of countries in order to gain a better understanding for its current state and future development from a cartographic perspective. China and its neighboring countries are selected as a case study area. The results show that China outperforms other countries in most of the CNP dimensions but performs poorly in various SNP-adjusted dimensions within the study area. The composite score shows that China is with the highest regional SNP, followed by Japan, Russia, South Korea and India. Furthermore, time series of cartograms reveal evidence showing power transitions among countries. In addition, the effectiveness of cartograms for cartographic communication is discussed.

Borderland regions are special areas and deserve more attention in global sustainable development. Reliable geo-information and effective analysis tools are requested to support borderlands studies through the integrated utilization of geospatial analysis, web service, as well as the other domain-specific expertise. This paper has reviewed the state-of-the-art of geospatial information sciences, (GIS)-based borderlands modeling, and understanding. From the perspective of GIS, integrated data modeling, comprehensive analysis, and collaborative information service are identified as the three major challenges in this filed. A research agenda is further proposed with four topics, i.e., classification and representation of borderland information, derivation of neighborhood information, development of synergetic analysis, and design and development of a geo-portal for borderlands studies. This interdisciplinary study requires a closer and in-depth collaboration of geopolitics, international relation, geography and geo-spatial information sciences.

Background Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have been reported to reflect the inflammatory response and disease activity in a variety of autoimmune diseases.Objectives This study aimed to evaluate the value of PLR and NLR as markers to monitor disease activity in Takayasu’s arteritis (TAK).Methods A retrospective case–control study involving 88 patients with TAK and 78 healthy controls was performed. We compared the PLR and NLR between patients and healthy controls, and also analysed the correlations between PLR or NLR and indices of TAK disease activity.Results Increased PLR and NLR were observed in patients with TAK. PLR was positively correlated with hs-C-reactive protein (hs-CRP) (r=0.239, p=0.010) and erythrocyte sedimentation rate (ESR) (r=0.270, p=0.010). NLR also exhibited a positive relationship with Kerr’s score (r=0.284, p=0.002), hs-CRP (r=0.313, p=0.006) and ESR (r=0.249, p=0.019). A PLR level of 183.39 was shown to be the predictive cut-off value for TAK (sensitivity 37.8%, specificity 93.0%, area under the curve (AUC)=0.691). A NLR level of 2.417 was found to be the predictive cut-off value for TAK (sensitivity 75.6%, specificity 55.8%, AUC=0.697).Conclusions PLR and NLR could be useful markers to reflect inflammation and disease activity in patients with TAK.

Spatial orientation is an important task in human wayfinding. Existing research indicates sex-related similarities and differences in performance and strategies when executing spatial orientation behaviors, but few studies have investigated the similarities and differences in visual behaviors between males and females. To address this research gap, we explored visual behavior similarities and differences between males and females using an eye-tracking method. We recruited 40 participants to perform spatial orientation tasks in a desktop environment and recorded their eye-tracking data during these tasks. The results indicate that there are no significant differences between sexes in efficiency and accuracy of spatial orientation. In terms of visual behaviors, we found that males fixated significantly longer than females on roads. Males and females had similar fixation counts in building, signpost, map, and other objects. Males and females performed similarly in fixation duration for all five classes. Moreover, fixation duration was well fitted to an exponential function for both males and females. The base of the exponential function fitted by males’ fixation duration was significantly lower than that of females, and the coefficient difference of exponential function was not found. Females were more effective in switching from maps to signposts, but differences of switches from map to other classes were not found. The newfound similarities and differences between males and females in visual behavior may aid in the design of better human-centered outdoor navigation applications.

Users more easily become lost in complex indoor environments than in outdoor environments. Users with diverse backgrounds encounter different self-location, route memorization, and route following problems during wayfinding. This study intends to explore gender and age effects on the use of indoor maps for wayfinding in real environments. We used eye-tracking and retrospective verbal protocol methods to conduct a wayfinding experiment in a newly opened building. Statistical data were collected and three findings were obtained. Finding 1: Males had no significant differences with females in indoor self-location, route reading, and route following. However, males paid less visual attention to the landmark and legend than females during route reading. Finding 2: Age-related differences were significant in indoor wayfinding. Younger adults generally outperformed elderly adults in wayfinding in real indoor environments. Finding 3: Gender and age interactive effects were significant in self-location and route memorization. The mean differences of visual attention on the self-location map reading and route memorization between males and females increased with age.

In this study, ternary Cu2SnS3 (CTS) nanostructure materials with high crystallinity were successfully prepared via a facile solvothermal method, which was followed by high-temperature treatment. The morphology of the as-synthesized samples is uniform flower-like spheres, with these spheres consisting of hierarchical nanosheets and possessing network features. Sodium storage measurements demonstrate that the annealed CTS electrodes have high initial reversible capacity (447.7 mAh·g−1 at a current density of 100 mA·g−1), good capacity retention (200.6 mAh·g−1 after 50 cycles at a current density of 100 mA·g−1) and considerable rate capability because of their high crystallinity and unique morphology. Such good performances indicate that the high crystallinity CTS is a promising anode material for sodium ion batteries.

Metformin is a first-line drug for the management of type 2 diabetes. Recent studies suggested cardioprotective effects of metformin against ischemia/reperfusion injury. However, it remains elusive whether metformin provides direct protection against hypoxia/reoxygenation (H/R) injury in cardiomyocytes under normal or hyperglycemic conditions. This study in H9C2 rat cardiomyoblasts was designed to determine cell viability under H/R and high-glucose (HG, 33 mM) conditions and the effects of cotreatment with various concentrations of metformin (0, 1, 5, and 10 mM). We further elucidated molecular mechanisms underlying metformin-induced cytoprotection, especially the possible involvement of AMP-activated protein kinase (AMPK) and Jun NH(2)-terminal kinase (JNK). Results indicated that 5 mM metformin improved cell viability, mitochondrial integrity, and respiratory chain activity under HG and/or H/R (P

3D representations in applications that provide self-localization and orientation in wayfinding have become increasingly popular in recent years because of technical advances in the field. However, human factors have been largely ignored while designing 3D representations in support of pedestrian navigation. This exploratory study aims to explore gender effects on using 3D maps for spatial orientation. We designed a 3D map that combines salient 3D landmarks and 2D layouts, and evaluated gender differences in their performance during direction-pointing tasks by administrating an eye tracking experiment. The results indicate there was no significant overall gender difference on performance and visual attention. However, we observed that males using the 3D map paid more attention to landmarks in the environment and performed better than when using the conventional 2D map, whereas female performance did not show any significant difference between the two types of map usage. We also observed contrary gender differences in visual attention on landmarks between the 3D and 2D maps. While males fixated longer on landmarks than females when using the 3D map, females paid more visual attention to landmarks than males when using the 2D map. In addition, verbal protocols showed that males had more confidence while make decisions. These empirical results can be helpful in the design of map-based wayfinding enhancement tools.

Recent studies in patients suffering from inflammatory autoimmune myopathies suggested that moderate exercise training improves or at least stabilizes muscle strength and function without inducing disease flares. However, the precise mechanisms involved in this beneficial effect have not been extensively studied. Here we used a model of in vitro stretched C2C12 myoblasts to investigate whether mechanical stretch could influence myoblast proliferation or the expression of proinflammatory genes. Our results demonstrated that cyclic mechanical stretch stimulated C2C12 cell cycling and early up-regulation of the molecules related to mechanical-stretch pathway in muscle (calmodulin, nNOS, MMP-2, HGF and c-Met). Unexpectedly, mechanical stretch also reduced the expression of TLR3 and of proteins known to represent autoantigens in inflammatory autoimmune myopathies (Mi-2, HRS, DNA-PKcs, U1-70). Interestingly, stimulation or inhibition of calmodulin, NOS, HGF or c-Met molecules in vitro affected the expression of autoantigens and TLR3 proteins confirming their role in the inhibition of autoantigens and TLR3 during mechanical stretch. Overall, this study demonstrates for the first time that mechanical stretch could be beneficial by reducing expression of muscle autoantigens and of pro-inflammatory TLR3 and may provide new insight to understand how resistance training can reduce the symptoms associated with myositis.

There are many uncertainties and risks in residential electricity consumption associated with economic development. Knowledge of the relationship between residential electricity consumption and its key determinant—income—is important to the sustainable development of the electric power industry. Using panel data from 30 provinces for the 1995–2012 period, this study investigates how residential electricity consumption changes as incomes increase in China. Previous studies typically used linear or quadratic double-logarithmic models imposing ex ante restrictions on the indistinct relationship between residential electricity consumption and income. Contrary to those models, we employed a reduced piecewise linear model that is self-adaptive and highly flexible and circumvents the problem of “prior restrictions”. Robust tests of different segment specifications and regression methods are performed to ensure the validity of the research. The results provide strong evidence that the income elasticity was approximately one, and it remained stable throughout the estimation period. The income threshold at which residential electricity consumption automatically remains stable or slows has not been reached. To ensure the sustainable development of the electric power industry, introducing higher energy efficiency standards for electrical appliances and improving income levels are vital. Government should also emphasize electricity conservation in the industrial sector rather than in residential sector.