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This article examines designs and depictions of Tenshō karuta, the Latin/Italo-Portuguese-patterned playing cards introduced to Japan between the mid-sixteenth century and the Tenshō era (1573-1592). In the early Edo period (1603-1868) the elaborate designs of these playing cards were gradually simplified into expressive and abstract images and were eventually localized, serving as a basis for a variety of playing cards in the modern era. While such changes can be attributed in part to the producers’ motivation for a more economical mode of production of card games, this study analyzes the reinterpretation and adaptation of images using a semiotic approach. It presents a brief visual history of Tenshō karuta, demonstrating an exemplary case of the localization of foreign images and the creation of meaning in early modern Japan.

PURPOSE Cerebrospinal fluid leakage (CSFL) is a common complication during spinal surgery. This study aimed to compare dural closure with different suture types, sizes, and techniques, and adhesives to reduce the occurrence of CSFL. MATERIALS AND METHODS Using a pig spine model, the PDS II 4-0, 5-0, 6-0, Vicryl 4-0, 5-0, 6-0, and Prolene 4-0, 5-0, 6-0 sutures were compared by calculating the permeability after suturing. Spraying bioprotein glue was also tried. Next, 120 patients who underwent surgery for intraspinal subdural tumors were enrolled and received 5-0 PDSII, Vicryl, or Prolene for dura repair. RESULTS In the animal model study, Vicryl 5-0 showed a reduced leakage flow rate compared with 5-0 Prolene and 5-0 PDS II. In the clinical study, postoperative drainage in the Vicryl group was smaller than that in the other groups during the first 3 days after surgery (p

IntroductionThe prevalence of heart failure (HF) is increasing. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the prognosis of patients with HF. However, the effect of different modes of CR delivery on HF remains unclear. Thus, the purpose of this study is to find out the relative efficacy and safety of different modes of CR delivery for individuals with HF using a network meta-analysis.Methods and analysisWe will perform a systematic review and network meta-analysis of randomised controlled trials which compare different modes of exercise-based CR delivery for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials and Web of Science will be searched up to May 2022. The primary outcomes will focus on the functional capacity and the health-related quality of life (hr-QOL). Functional capacity will be evaluated by peak oxygen consumption (mL/kg/min) and 6 min walking test (metres). The Minnesota Living with Heart Failure questionnaire, Short Form-36, Psychometric properties of the Kansas City cardiomyopathy questionnaire and EuroQol five dimensions questionnaire will serve as measures of hr-QOL. As secondary outcomes, we will assess hospital admissions (all-cause and cardiac) and all-cause mortality, which required a minimum follow-up of 6 months, as well as adverse events during exercise training. The risk of bias for individual studies will be evaluated according to the Cochrane Handbook. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationThis study does not require ethics approval as it is based on published trials. Results of this systematic review and network meta-analysis will be submitted to a peer-reviewed journal for future publication.Trial registration numberCRD42021278351.

Aims and objectives To explore the role of health beliefs in affecting patients' chronic diabetic complication (CDC) screening. Background Patients' adherence to the guideline-recommended CDC screening was far from optimal. While many demographic and clinical characteristics were documented to influence patients' adherence, psychological profiles, such as health beliefs, were not well studied before. It is crucial to understand how health beliefs affect patients' CDC screening behaviour and thus to provide implications for future intervention programmes. Design A cross-sectional study was conducted. Methods 785 type 2 diabetes were enrolled from the community health centre in Wuhou District, Chengdu, China. Structured questionnaires were used to collect data regarding the demographic and clinical information, knowledge about CDC, health belief model constructs and CDC screening behaviour. Mediation analysis was performed to explore the mechanisms of health belief model constructs on CDC screening behaviour. The study methods were compliant with the STROBE checklist. Results Knowledge had a significant indirect effect on CDC screening behaviour through perceived susceptibility, perceived benefits, perceived barriers and self-efficiency. Cues to action exerted both significant direct and indirect effects on CDC screening behaviour. The indirect effects of cues to action were exerted through perceived susceptibility, perceived barriers and self-efficiency. Conclusion Health beliefs played vital roles in mediating the effects of knowledge and cues to action on patients' CDC screening behaviour. Health beliefs should be assessed and modified through creative educational methods. Strategies aimed at increasing cues to action are also expected to facilitate patients' CDC screening behaviour. Relevance to clinical practices The study contributes to the exploration of how health beliefs affect patients' CDC screening behaviour. The results could be used to inspire future community-based intervention programmes.

Background: This study evaluates the effects of wire tension band ventral compression wiring technology paired with artificial femoral head replacement according to the different types of intertrochanteric fractures of the greater trochanter in elderly patients. Methods: Thirty-eight patients with unstable intertrochanteric fractures of the femur treated with artificial femoral head replacement between January 2015 and August 2019 were included. According to the fracture line of the greater trochanter, a new classification system was proposed. Type A fractures include transverse fractures from the greater trochanter tip to the base (2 patients). Type B fractures include oblique fractures from the greater trochanter tip to the base (according to the fracture line direction, type B was further divided into types B1 [4 patients], and B2 [24 patients]). the fracture line of type C fractures runs from the greater trochanter to near the femur end (8 patients). Different wire tension belt ventral compression wiring technologies were used for each fracture type. The Harris hip function score, Parker activity score, and hip pain were evaluated during the follow-up period. Fracture healing and prosthesis positioning, loosening, and dislocation were evaluated using radiographs. Results: The average follow-up period was 28.6 ± 5.8 months. Deep vein embolism was noted in one patient, heterotopic ossification in another, and steel wire fractures in another. All patients had satisfactory fracture healing and femoral prosthesis positioning and no chronic pain. The mean Harris hip function score was 7.21 ± 2.58 preoperatively and 84.74 ± 3.82 at the final follow-up (F = -48.13, P < 0.001).Conclusion: The use of different wire tension band ventral compression wiring technology based on different types of femoral rotation fractures combined with artificial femoral head replacement in elderly patients with unstable intertrochanteric fractures results in favorable clinical outcomes.

Targeting high-speed, low-cost, short-reach intra-datacenter connections, we designed and tested an integrated silicon photonic circuit as a transmitter engine. This engine can be packaged into an optical transceiver module which meets the QSFP-DD Form Factor, together with other electrical/optical components. We first present the design and performance of a high-speed silicon modulator, which had a 3-dB EO bandwidth of &gt, 40 GHz and an ER of &gt, 5 dB. We then incorporated the engine onto a test board and injected a 53.125 Gbaud PAM4 signal. Clear eye patterns were observed at the receiver with TDECQ ~3 dB for all four lanes.

Background: Anti-stress capacity is important to resist the occurrence of adverse events. To observe the effects of exercise, trimetazidine alone or combined on the anti-stress capacity of mice, and further explore its potential mechanism. Methods: Forty-four C57BL/6 male mice aged 8 weeks were randomly divided into four groups (n=11 for each group): control group (group C), exercise group (group E), trimetazidine group (group T), exercise combined with trimetazidine group (group TE). After the intervention, each group was randomly subdivided into the exhaustive exercise (EE, n=6) and the non-EE (n=5) subgroups. The mice in the EE-subgroup underwent EE. Mice were sacrificed 12 hours later after EE. The myocardial ultrastructure and autophagosomes were observed under an electron microscope. The expression of autophagy-related proteins: BNIP3, LC3-II, and P62 were analyzed and the heat shock protein 70 mRNA transcription and protein expression were also investigated. Results: Exercise or trimetazidine increased the expression of BNIP3, LC3-II, and heat shock protein 70, decreased the expression of P62 pre- and post-EE while the combination has the synergistic effect. Conclusion: Exercise and trimetazidine, alone or combined enhanced the anti-stress capacity of mice significantly. The underlying mechanism may be associated with the promotion of autography and the expression of heat shock protein 70.

An RF-Photonic phased array antenna beamformer was previously demonstrated using cascaded fiber Bragg gratings with 1 x 2 couplers for true-time-delay beamforming. This work's focus is to design, build, and test an integrated Si-photonic beamforming circuit to replace the fiber-optics system, allowing for chip-scale beamformers with low size, weight, power, and cost. Several metastructure waveguides were designed to provide a strong slowlight effect near their transmission band edge. By tuning the wavelength near the band edge, tunable optical truetime delay is achieved. We report the design, simulation, fabrication and test of these high-contrast metastructure waveguides to provide group velocity variation against wavelength near the band-edge. Wavelength-tunable delay was verified using both an interferometric approach using an integrated Mach-Zehnder interferometer, and using a direct measurement of the true-time delay of an RF signal modulated onto a C-band optical carrier. We have also designed an integrated photonic beamforming circuit for a small array, including photodetectors, fabricated by AIM Photonics. Experimental test results for those integrated photonic circuits will be discussed. We will continue to improve our integrated photonic circuit to pursue larger array implementation. The goal is to further integrate this photonic circuit with an RF phase array antenna and demonstrate the scan of an RF beam by optical control.

Dense integration of electro-optic (EO) devices in photonic integrated circuits (PICs) is critical to achieve high-capacity, compact and low-cost transceiver modules, and fulfill the increasing bandwidth and/or bandwidth density demands for future computers, servers, data centers, and transport optical network systems. However, the EO crosstalk due to high integration density may degrade the signal transmission performance and eventually limit the possible density of integration. In this content, the study of the EO crosstalk of a PIC and its impact is crucial. In this paper, we systematically investigate and characterize the EO crosstalk between parallel silicon Mach–Zehnder modulators (MZMs). The performance penalty due to crosstalk is measured for different integration densities and data rates. For the MZM pair with a separation of 200 μm, there is a ∼−20 dB RF crosstalk in the frequency range >10 GHz, and up to 1.1 dB power penalty and 2.2 dB optical signal-to-noise ratio penalty are observed for 36-Gb/s on-off-keying signals. Our study can serve as a reference for integration density of large-scale silicon PICs for various applications.

We have demonstrated on-chip optical delay lines that consist of cascaded Bragg grating segments. Our results show that the band gap and the group index of cascaded gratings are very similar to that of a single grating segment, which means longer time delay can be achieved by cascading more grating segments. In our experiment, a maximum group index of 12.2 and a total time delay of 292 ps was achieved using a 7.2 mm-long delay line on Si chip.

This study aimed to investigate the effects of Cyclocarya paliurus (Batal.) Iljinskaja polysaccharides (CPP) on the glucose-lipid metabolism in T2DM rats. T2DM model was established in 40 Wistar rats which were then randomly divided into model, CPP-1, CPP-2 and CPP-3 groups. Ten normal rats were selected as the control group. The CPP-1, CPP-2 and CPP-3 group were intragastrically administrated with 100, 200 and 400 mg/kg CPP for 4 weeks, respectively. Results showed that, during the treatment, compared with model group, in CPP treatment groups the T2DM symptoms were lightened, and the body weight was improved. After treatment, compared with model group, in CPP-3 group the blood fasting plasma glucose, fasting insulin and glycosylated hemoglobin levels were reduced (P < 0.05), the blood total cholesterol, triglyceride and low-density lipoprotein cholesterol levels were decreased (P < 0.05), the serum C-reactive protein, tumor necrosis factor α and interleukin 6 levels were decreased (P < 0.05), the serum malondialdehyde level was reduced (P < 0.05), and the serum superoxide dismutase and glutathione peroxidase levels were increased (P < 0.05). In conclusion, CPP can alleviate the T2DM in rats, which may be related to its resisting inflammatory response and oxidative stress in body.

Mitochondrial quality control (MQC) and function are determinants for cellular energy metabolism, and their disorders are reported to play an important role in the development of insulin resistance (IR). Salidroside was reported to have beneficial effects on MQC through AMPK pathway; however, it is unknown whether salidroside exerts anti-IR effect with this action. This study sought to investigate the effects of salidroside on IR with an exploration of the mechanisms of its action. Experimental IR models were adopted in high-fat-diet (HFD)-fed mice and palmitate-treated C2C12 myotubes, respectively. Blood levels of glucose and insulin as well as cellular glucose uptake were determined, and mitochondrial function and MQC-associated parameters and reactive oxygen species (ROS) production were analyzed based on treatments with the activator (AICAR), inhibitors (compound C and EX-527) or specific siRNA of Ampk/Sirt1 and mitochondrial ROS scavenger (mito-TEMPO). Protein expression level was determined by Western blot, cellular observation by transmission electron microscope and ROS production by functional analysis kits. Salidroside reduced IR and activated insulin signaling along with the stimulation of AMPK/SIRT1 signaling and downstream regulation of MQC and ROS production. These salidroside effects were comparable to those of AICAR and could be prevented by AMPK/SIRT1 inhibitors or siRNAs, respectively. Salidroside reduces IR and regulates MQC and ROS production by activating AMPK/SIRT1 signaling pathway. Since IR is a critical issue for public health, to explore a potent agent against IR is of high interest. The anti-IR effects of salidroside warrant further experimental and clinical studies.

Insulin resistance (IR) is the primary pathological mechanism underlying type 2 diabetes mellitus (T2DM). Here, the study aimed to ascertain whether and how exercise mediates IR in T2DM. An in vivo mouse model of high-fat diet-induced IR and an in vitro high-glucose-induced IR model were constructed. High long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) expression was detected in T2MD and was positively correlated with HOMA-IR and resistin levels. Then, short hairpin RNA targeting MALAT1 (sh-MALAT1) or pcDNA-MALAT1 was delivered into human umbilical vein endothelial cells (HUVECs) to knock down or upregulate its expression, respectively. Silencing of MALAT1 resulted in reduced levels of resistin, Ang II, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1), and p-insulin receptor substrate-1 (p-IRS)/ISR-1, and decreased cell migration, as well as enhanced glucose uptake and levels of nitric oxide (NO) and p-Akt/Akt. In the IR mouse model, exercise was observed to downregulate MALAT1 to reduce resistin, whereby exercise reduced homeostatic model assessment-insulin resistance (HOMA-IR). Besides, exercise also elevated microRNA-382-3p (miR-382-3p) expression in the serum of IR mice. Dual-luciferase reporter and RNA binding protein immunoprecipitation (RIP) assays identified that MALAT1 could bind to miR-382-3p to upregulate resistin. Collectively, the key observations of the study provide evidence that inhibition of MALAT1 elevates miR-382-3p to repress resistin, which consequently underlies the mechanism of exercise protecting against IR, highlighting a direction for T2DM therapy development. Keywords: exercise, type 2 diabetes mellitus, metastasis-associated lung adenocarcinoma transcript 1, microRNA-382-3p, resistin, insulin resistance, vascular endothelial cells

To explore the effects of trimetazidine combined with exercise on EC and anti-fatal stress ability, and illustrate the underlying mechanism.C57BL/6 mice were randomly assigned to four groups (n = 11 in each group): the control, exercise, trimetazidine and trimetazidine + exercise (TE) groups. Mice were accordingly given saline (ig), Aerobic exercise (AE), trimetazidine (ig), or a combination of trimetazidine (ig) and AE for five weeks. After the intervention, each group was randomly subdivided into rest and exhaustive exercise (EE) subgroups. The mice in the control-EE and TE-EE subgroups underwent fatal stress experiments. EC and anti-fatal stress ability were assessed respectively. Mitochondrial quality control (MQC) in skeletal muscle were measured at the protein level and the organelle level.A significantly increased exhaustive swimming time was observed in exercise (39.10 ± 12.58 min vs 14.18 ± 4.37 min), trimetazidine (33.73 ± 8.45 min vs 14.18 ± 4.37 min) and TE groups (73.78 ± 18.95 min vs 14.18 ± 4.37 min) compared with that in the control group, and a synergistic effect was detected (P 0.05). Fatal stress experiments successfully induced skeletal muscle damage, including increased creatine kinase activity, myofibrosis, and impaired antioxidative enzyme system, all those were significantly alleviated by trimetazidine supplementation combined with AE precondition (P 0.05). Meanwhile, AE and trimetazidine alone or combined, significantly enhanced the MQC in normal mice by activating mitochondrial biogenesis, dynamics and mitophagy, and that in mice underwent fatal stress stimulus (P 0.05).This study for the first time found that trimetazidine and AE have synergistic effects on improving EC. Moreover, the combination of both interventions enhances anti-fatal stress ability. Enhancing MQC may be a key mechanism of AE combined with trimetazidine that improves EC and anti-fatal stress ability.

Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question.This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns.Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P 0.05) and use of nearest medical institution (OR = 1.588, P 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P 0.01), type of health problems (OR = 1.641, P 0.01) and self-rated health status (OR = 0.769, P 0.01).Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.

We discuss some potential benefits of using integrated RF-photonic devices/circuits in a phased-array-Radar system. A viable and simple solution is proposed for a low-cost, RF-photonic multi-beams beamformer that meets both transmitting and receiving RF-system specifications/requirements. Proof-of-concept experiments and chip-scale integrated-photonics subsystem development will also be discussed.

We proposed and demonstrated mode-transition Bragg gratings for optical delay line applications. It shows a stronger slow light effect than conventional apodized Bragg gratings, and a maximum group index of 15.8 has been achieved.

Injection-type silicon electro-optic modulators are widely used in onchip optical interconnections due to its high modulation efficiency. However, as the modulator dimension approaches the wavelength limit, it becomes hard to improve the modulator speed by shrinking the device. A new approach to further scale down the dimension of an intrinsic device in injection-type electro-optic modulators without suffering from subwavelength confinement problem is proposed. The device consists of stacked PN or PiN cells connected by tunneling structures to enable current conduction. The diffusion capacitance is reduced due to the reduction of quasi-neutral region width in each device. In this paper, a detail study is given to the case of a two-cell modulator. A twofold of capacitance reduction and speed improvement are observed. Further speed improvement is expected by splitting the modulator into more cells, and the simulation approach for the tunneling structures in such an optical device is also discussed in details.

The electro-optic crosstalk between two parallel silicon Mach-Zehnder modulators is characterized. Up to 1.6 dB power penalty is observed for 36-Gb/s on-off-keying signals with a ∼-20 dB crosstalk, posing challenge to dense photonic integration.

This paper reports the efforts of suppressing Er ion’s second-order cooperative up-conversion (CUC). Er/Yb and Er/Y silicate glass waveguides were fabricated, which have same structure, similar Er concentration and peak emission cross-section. Under same 1480 nm pump power, Er/Yb silicate glass shows 4.7 times weaker visible up-conversion luminescence and four times stronger infrared luminescence than Er/Y silicate glass. Through analyzing the physical mechanism, we found that the energy back transfer from Er to Yb plays a significant role on the luminescence difference, which affects and further suppresses the second-order CUC process in Er/Yb co-doped materials.

In this work, we have designed a novel Si based 1-dimensional high contrast meta-structure waveguide that has slow light effect as well as phase tunability using p-n junction. The goal is to use such waveguide to design active optical devices such as high frequency modulators and tunable filters for analog RF-photonics or data communication applications. The Si ridge waveguide has a pair of high contrast grating wings adhered to the waveguide core in the center. Grating bars at two sides of the waveguide are doped P and N-type respectively, while a p-n junction region is formed in the middle of the waveguide core. By applying a voltage to bias the p-n junction, one can sweep the free carriers to change the effective index of the waveguide as well as the dispersion property of the grating. This metastructure Si waveguide is ideal in the design of high frequency optical modulators since the slow light effect can reduce the modulator waveguide length, increase the modulation efficiency as well as compensate other nonlinearity factors of the modulator for analog applications.

We investigate a linearization technique in silicon electro-optic (EO) modulator for spur-free dynamic range (SFDR) improvement. Using 3rd-order derivative of the transfer function, an optimal DC bias is applied to get a maximum SFDR.

The spontaneous emission (SE) of Er3+ embedded in a double slot dielectric structure was studied by a quantum-electrodynamical formalism. The study shows that the slot width and the position of Er3+ in slot structure have a significant effect on the SE. The double slot waveguides were fabricated by embedding two low-index Er/Yb silicate material layers into high-index silicon. The radiative efficiency of Er3+ in the double slot waveguides is found to be higher than that of the single slot waveguide, which is consistent with the theory simulation. The 0.67 dB signal enhancement at 1.53 µm in a 4.6-mm-long slot waveguide was observed pumped by 1476 nm laser. These results show the relevance of our model to study the SE processes in multilayer structures and are important for future realization of silicon-compatible active optical devices.

We have designed a simplified true-time-delay beamforming architecture using integrated photonics for phased-array antennas. This architecture can independently control multiple RF beams simultaneously with only a single tuning parameter to steer the beam in each direction for each beam. We have made a proof-of-the-principle demonstration of an X-band, 30×4-elements, fiber-optics-based beamformer for one-dimensional steering in transmission mode. The goal is to develop a semiconductor-based integrated photonic circuit so that a 2D beamforming array for both transmit and receive operations can be made on a single chip. For that, we have designed a Si-based integrated waveguide circuit using two types of "slow-light" waveguide for tunable time delays for two-dimensional steering.