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BackgroundThe increasing prevalence of dementias in China has imposed a substantial burden on caregivers, posing a serious threaten to their physical and mental well-being. It is imperative to explore practical measures to alleviate the stress experienced by those caregivers of older adults with dementia.MethodsA semi-structured questionnaire was adopted for conducting interviews with the participants from December 2022 to January 2023. Subsequently, the interviews were meticulously recorded and transcribed in their entirety, followed by a rigorous analysis of the resulting data and information.ResultsA total of 17 participants who provided care for older adults with dementia were interviewed across various settings including rural areas, communities, hospitals, and nursing homes in Shandong Province. These caregivers encountered challenges such as limited social interaction, significant mental strain, deteriorating physical health, financial insufficiency, and a lack of professional expertise. The current social support systems were deemed insufficient for families caring for older adults with dementia. To alleviate the burden on dementia caregivers, particularly for those with low-income status, the government needs to prioritize enhancing the coverage of the long-term healthcare system and expanding the essential medication list. Given the growing population of older adults in China and the fact that most individuals with dementia are cared for by family members, it is recommended to establish a multifaceted support system involving collaboration among government, social organizations, and volunteers within both urban and rural communities.ConclusionThe gradual expansion of coverage of long-term care insurance, the proactive inclusion of dementia treatment drugs into the essential medication list, and optimization of a diversified dementia care system ought to be a matter of significant concern.

Objectives To explore the risk factors for thrombi occurring in patients with immune thrombocytopenia (ITP) and establish a risk prediction model to better predict the risk of thrombosis in patients with ITP. Methods We retrospectively analyzed 350 ITP patients who had been hospitalized in the First People's Hospital of Yunnan Province between January 2024 and June 2024. For all patients, we recorded demographic characteristics and clinical data, analyzed the risk factors for thrombosis in ITP patients and then developed a risk prediction model. Results Stepwise logistic regression analysis indicated that a high D-dimer level, a low PC (platelet count) and a high Padua score were independent risk factors for thrombosis in ITP patients. According to multivariate analysis, a predictive model for thrombus risk showed that the area; the area under the ROC curve (AUC) was 0.673 (95% CI: 0.615-0.730) and the maximum Youden index, sensitivity and specificity were 0.272, 47.0% and 80.2%, respectively. Conclusion A high D-dimer level, low PC, and high Padua score were shown to be independent risk factors for thrombosis in ITP patients. Also, the study showed that these three risk factors might be used as a risk predictors for thrombosis in ITP patients to some extent.

Understanding the complex spatiotemporal dynamics of lake water systems is critical in the context of intensifying global environmental changes. In this study, a novel stable isotope analysis method, combined with Bayesian mixing models, is applied to investigate hydrological connections and water source contributions in a specific area on the southwest shore of Dianchi Lake, China, at a monthly scale. The study reveals a significant “memory effect,” where 56.76% of the lake water volume in the current month is associated with the lake water volume in the prior month, with notable seasonal variations. The relative contributions of precipitation, surface water, soil water for different agricultural land uses, and groundwater to the lake water balance are assessed. The hydrological processes in Dianchi Lake are significantly influenced by agricultural land use, with greenhouse soils contributing less water than open field soils. Water outflow, rather than evaporation, is the primary factor reducing the nearshore lake volume, highlighting the impact of human activities. The dependency of water source contributions on meteorological factors is also examined, with seasonal and weather effects on lake water dynamics and agricultural water availability observed. By integrating isotope data with meteorological records and advanced modeling techniques, a quantitative framework for evaluating hydrological changes in lake catchments is developed. The developed approach enhances our understanding of lake water system dynamics and can enhance agricultural water management strategies, water resource allocation, irrigation planning, and climate change adaptation in agricultural watersheds.

The extrinsic black tooth stain (EBS) is commonly found in primary dentition. Patients cannot clean the EBS; this can only be done by professional scaling and debridement. It also has a tendency to reform, which significantly compromises children's aesthetics and even affects their quality of life. However, there is no conclusive evidence on the etiology of the EBS. The associations between the EBS and related oral microbial features is one of the research hot topics. No literature review summarized these research progresses in this area. Therefore, we reviewed the literature on the microbiology of the EBS since 1931 and reported as the following 5 aspects: molecular biotechnology, morphological structure and physiochemical characteristics, microbial etiology hypothesis and core microbial characteristics. The EBS is a special dental plaque mainly composed of Gram-positive bacilli and cocci with scattered calcium deposits that acquired salivary pellicle activates. Early studies showed that the Actinomyces was the main pathogenic bacteria. With advances in biological research techniques, the ‘core microbiome’ was proposed. The potential pathogenic genera were Actinomyces, Prevotella nigrescens, Pseudotropinibacterium, Leptotrichia, Neisseria and Rothia. However, the pathogenic species of the above genera were still unclear. Currently, it is believed that the EBS consists of iron compounds or black substances that oral bacterial metabolism produces or that the bacterial metabolites formed after chemical reactions in the micro-ecological environment.

Abstract The encryption of user data is crucial when employing electronic health record services to guarantee the security of the data stored on cloud servers. Attribute-based encryption (ABE) scheme is considered a powerful encryption technique that offers flexible and fine-grained access control capabilities. Further, the multi-user collaborative access ABE scheme additionally supports users to acquire access authorization through collaborative works. However, the existing multi-user collaborative access ABE schemes do not consider the different weights of collaboration users. Therefore, using these schemes for weighted multi-user collaborative access results in redundant attributes, which inevitably reduces the efficiency of the ABE scheme. This paper proposes a revocable and verifiable weighted attribute-based encryption with collaborative access scheme (RVWABE-CA), which can provide efficient weighted multi-user collaborative access, user revocation, and data integrity verification, as the fundamental cornerstone for establishing a robust framework to facilitate secure sharing of electronic health records in a public cloud environment. In detail, this scheme employs a novel weighted access tree to eliminate redundant attributes, utilizes encryption version information to control user revocation, and establishes Merkle Hash Tree for data integrity verification. We prove that our scheme is resistant against chosen plaintext attack. The experimental results demonstrate that our scheme has significant computational efficiency advantages compared to related works, without increasing storage or communication overhead. Therefore, the RVWABE-CA scheme can provide an efficient and flexible weighted collaborative access control and user revocation mechanism as well as data integrity verification for electronic health record systems.

The consensus of the automotive industry and traffic management authorities is that autonomous vehicles must follow the same traffic laws as human drivers. Using formal or digital methods, natural language traffic rules can be translated into machine language and used by autonomous vehicles. In this paper, a translation flow is designed. Beyond the translation, a deeper examination is required, because the semantics of natural languages are rich and complex, and frequently contain hidden assumptions. The issue of how to ensure that digital rules are accurate and consistent with the original intent of the traffic rules they represent is both significant and unresolved. In response, we propose a method of formal verification that combines equivalence verification with model checking. Reasonable and reassuring digital traffic rules can be obtained by utilizing the proposed traffic rule digitization flow and verification method. In addition, we offer a number of simulation applications that employ digital traffic rules to assess vehicle violations. The experimental findings indicate that our digital rules utilizing metric temporal logic (MTL) can be easily incorporated into simulation platforms and autonomous driving systems (ADS).

ObjectiveThis study aims to evaluate inpatient services in 49 tertiary comprehensive hospitals using indicators from the diagnosis related groups (DRG) payment system.MethodDRG data from 49 tertiary comprehensive hospitals were obtained from the quality monitoring platform for provincial hospitals, and relevant indicators were identified. The analytic hierarchy process (AHP) was used to compute the weight of each indicator. The rank sum ratio method was used to calculate the weight rank sum ratio (WRSR) value and the corresponding probit value of each hospital. The hospitals were divided into four grades based on the threshold value: excellent, good, fair, and poor.ResultsEight indicators of the 49 hospitals were scored, and the hospital rankings of indicators varied. The No. 1 hospital ranked first in the indicators of “total number of DRG”, “number of groups”, and “proportion of relative weights (RW) ≥ 2”. The WRSR value of the No.1 hospital was the largest (0.574), and the WRSR value of the No. 44 hospital was the smallest (0.139). The linear regression equation was established: WRSRpredicted =-0.141+0.088*Probit, and the regression model was well-fitted (F = 2066.672, p < 0.001). The cut-off values of the three WRSRspredicted by the four levels were 0.167, 0.299, and 0.431, respectively. The 49 hospitals were divided into four groups: excellent (4), good (21), average (21), and poor (3). There were significant differences in the average WRSR values of four categories of hospitals (p < 0.05).ConclusionThere were notable variances in the levels of inpatient services among 49 tertiary comprehensive hospitals, and hospitals of the same category also showed different service levels. The evaluation results contribute to the health administrative department and the hospital to optimize the allocation of resources, improve the DRG payment system, and enhance the quality and efficiency of inpatient services.

Abstract MicroRNAs play a critical regulatory role in different cancers, but their functions in renal cell carcinoma (RCC) have not been elucidated. Reportedly, miR-142-3p is involved in the tumorigenesis and the development of RCC in vitro and is clinically correlated with the poor prognosis of RCC patients. However, the molecular target of miR-142-3p and the underlying mechanism are unclear. In this study, we found that miR-142-3p was upregulated in RCC tumor tissues and downregulated in exosomes compared to normal tissues. The expression of miR-142-3p was inversely associated with the survival of patients with kidney renal clear cell carcinoma (KIRC). RhoBTB3 was reduced in RCC, and miR-142-3p plays an inverse function with RhoBTB3 in KIRC. The direct interaction between RhoBTB3 and miR-142-3p was demonstrated by a dual luciferase reporter assay. miR-142-3p promoted metastasis in the xenograft model, and the suppression of miR-142-3p upregulated RhoBTB3 protein expression and inhibited the mRNAs and proteins of HIF1A, VEGFA, and GGT1. Also, the miR-142-3p overexpression upregulated the mRNA of HIF1A, VEGFA, and GGT1. In conclusion, miR-142-3p functions as an oncogene in RCC, especially in KIRC, by targeting RhoBTB3 to regulate HIF-1 signaling and GGT/GSH pathways, which needs further exploration.

BackgroundClozapine is considered one of the most effective antipsychotic drugs, but it is most likely to cause metabolic abnormalities. Researchers have studied the causes of metabolic abnormalities caused by clozapine from multiple perspectives, but the reasons remain unclear.PurposeCharacterize the gut microbiota of people with schizophrenia taking clozapine, exploring the association between gut microbiota and glucose lipid metabolic markers in schizophrenia patients taking clozapine.Research designSixty-one long-term inpatients with schizophrenia in clozapine monotherapy were selected as study subjects. We got four subgroups by sex and the presence of metabolic syndrome.Data analysis16s analysis technology was applied at the genus level to determine the classification of gut microbiota. Then we compared the characteristics of gut microbiota and the association of gut microbiota with glucose lipid metabolic markers in each group.FindingsWe found differences in the diversity of gut microbiota among groups. The association between gut microbiota and glucose lipid metabolic markers was complicated. Gender was an important differentiating factor. Oscillibacter has a low abundance. However, it was the only genus associated with glycemic or lipids in each group. Among metabolic syndromes, Gemmiger was positively correlated with most lipids in females but negatively correlated in males, showing gender differences. In female non-metabolic syndromes, Bifidobacterium lost its probiotic character; instead, showing pathogenicity, which has strong positive correlations with fasting blood glucose and low-density lipoprotein but negative correlations with Apolipoprotein A1. Maybe schizophrenia, taking clozapine, and gender factors influenced the gut microbiota, which complicated our findings. The significance of the results remains to be determined by in-depth studies.

AimThe objective of this study was to translate the Barriers to Insulin Treatment Questionnaire (BIT) into Chinese and test its psychometric properties in middle-aged and elderly type 2 diabetes mellitus (T2D) patients using insulin in the Han people of urban China.MethodsWe established the Barriers to Insulin Treatment Questionnaire in Chinese (BIT-C). We selected 296 patients with T2D for testing BIT-C's the reliability and validity, of which 120 patients were retested four weeks later. Another 200 patients with T2D were selected to perform the confirmatory factor analysis (CFA).ResultsThe final BIT-C consisted of 11 items (BIT-C-11) and four factors. The explained variances of the BIT-C-11 and its four factors were 90.153%, 51.308%, 18.810%, 10.863%, and 9.173%. CFA validated that the four-factor model fit with the data of the BIT-C-11. Standardized factor loadings ranged between 0.77 and 0.90. The Cronbach’s α coefficients of the BIT-C-11 and its four factors were 0.903, 0.952, 0.927, 0.938, and 0.917. Correlation analysis was performed between the BIT-C-11 and General Adherence Scale in Chinese (GAS-C) to calculate the criterion-related validity (r = 0.598, p < 0.001). The correlation coefficient r of the BIT-C-11’s test–retest reliability was 0.810 (p < 0.001).ConclusionThe BIT-C-11 has good reliability and validity. It can be used for psychological resistance to insulin therapy studies of middle-aged and elderly patients with T2D using insulin in the Han people of Chinese cities.

Background Increased proliferation and impaired death of fibroblast-like synovial cells play an important role in the development of rheumatoid arthritis (RA). Survivin plays an important role in the prodromal stage and prognosis of RA and has been introduced as a biomarker of joint injury in RA patients. The purpose of this study was to explore whether propionate alleviates RA through miR-140-5p/survivin pathway. Methods The synovial tissues of RA patients were collected to detect the expression levels of miR-140-5p and survivin; normal human fibroblast-like synovial cells (HLSs) and RA fibroblast-like synovial cells (RA-FLSs) were cultured and treated with 10 mM of sodium propionate (SP), then the expressions of miR-140-5p and survivin, cell viability and apoptosis were detected; collagen induced arthritis (CIA) rat model was constructed and treated with SP, then the tissue inflammation level and the expression levels of miR-140-5p and Survivin were detected. Results The expression of miR-140-5p decreased in synovial tissues of RA patients and RA-FLSs cells, while the expression of survivin increased significantly in RA patients. SP promoted miR-140-5p expression and apoptosis in RA-FLSs cells and inhibited survivin expression and cell viability of RA-FLSs cells. In addition, miR-140-5p plays a protective role by targeting survivin. Importantly, in the CIA rat model, SP reduced joint inflammatory response, and the miR-140-5p inhibitor weakened the protective effect of SP. Conclusion SP can alleviate RA by promoting the expression of miR-140-5p and inhibiting the excessive proliferation and death impairment of RA-FLSs cells induced by survivin.

Aims: The study aimed to analyze the changes in mental health and social support in patients with cerebral infarction during the recovery period at the early stage of coronavirus disease pandemic. Subjects and Methods: During January–March 2020, 98 patients with cerebral infarction during the recovery period were selected from Wuhan city. Among them, 42 patients were living alone (called the solitary group) and 56 patients lived with their spouses (called the spouse group). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate anxiety and depression, respectively, and Multi-Dimensional Scale of Perceived Social Support (MSPSS), social support for patients. Statistical Analysis Used: The statistical calculations were carried out using GraphPad Prism 5.01 software (GraphPad, San Diego, California, USA). Results: At the early stage of the pandemic, patients with cerebral infarction in the solitary group and the spouse group experienced varying degrees of anxiety and depression. The SAS and SDS scores in the solitary group were significantly higher than those in the spouse group (P < 0.01). The subscale scores of MSPSS in the solitary group were lower than those in the spouse group (P < 0.01). Conclusions: It is necessary for medical staff to help the patients to overcome anxiety and depression and provide more social support to patients, especially for those patients living alone.

Procecidochares utilis is an obligatory parasitic insect to Eupatorium adenophorum. Both organisms have been spread to some metal mines areas. The objective of this study is to comprehend the trend of heavy metals transfer and the process of their bio-accumulation in the soil-E. adenophorum-P. utilis system and particularly their impact on the parasitic effect of P. utilis to E. adenophorum to reflect the impact of heavy metals on obligate parasitic insect and its host. Therefore, a detailed investigation was carried out at the Suzu Lead–Zinc Mine in Yunnan Province using the concentric circle's method. The results showed that the parasitic rate of P. utilis to a single plant and branch is positively correlated with distance. The metals content of the soil in E. adenophorum and P. utilis, decreased dramatically with an increase in distance away from the center of the mining area. From which is cleared that these metals could enter to E. adenophorum and P. utilis through the soil-E. adenophorum-P. utilis system which likely to affect its parasitic activities. In addition, the parasitic rate is impacted by per Zn content greatly, and the parasitic rate per plant is affected by Cd content enormously. This work could provide important basis of data for further understanding and clarifying the effects of bioaccumulation and heavy metals pollution on various aspects of the food chain. Simultaneously, it could clarify and simplify whether heavy metal contamination affects the parasitic behaviour of some obligatory parasitic insects.

Encouraging response has been achieved in relapsed/refractory (R/R) B-cell lymphoma treated by chimeric antigen receptor T (CAR-T) cells. The efficacy and safety of CAR-T cells in central nervous system lymphoma (CNSL) are still elusive. Here, we retrospectively analyzed 15 patients with R/R secondary CNSL receiving CD19-specific CAR-T cell-based therapy. The patients were infused with CD19, CD19/CD20 or CD19/CD22 CAR-T cells following a conditioning regimen of cyclophosphamide and fludarabine. The overall response rate was 73.3% (11/15), including 9 (60%) with complete remission (CR) and 2 (13.3%) with partial remission (PR). During a median follow-up of 12 months, the median progression-free survival (PFS) was 4 months, and the median overall survival (OS) was 9 months. Of 12 patients with systemic tumor infiltration, 7 (58.3%) achieved CR in CNS, and 5 (41.7%) achieved CR both systemically and in CNS. Median DOR for CNS and systemic disease were 8 and 4 months, respectively. At the end point of observation, of the 7 patients achieved CNS disease CR, one was still alive with sustained CR of CNS disease and systemic disease. The other 6 died of systemic progression. Of the 15 patients, 11 (73.3%) experienced grades 1-2 CRS, and no patient had grades 3-4 CRS. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 3 (20%) patients, including 1 (6.6%) with grade 4 ICANS. All the CRS or ICANS were manageable. The CD19-specific CAR-T cell-based therapy appeared to be a promising therapeutic approach in secondary CNSL, based on its antitumor effects and an acceptable side effect profile, meanwhile more strategies are needed to maintain the response.

Transforming data into ciphertexts and storing them in the cloud database is a secure way to simplify data management. Public key encryption with keyword search (PEKS) is an important cryptographic primitive as it provides the ability to search for the desired files among ciphertexts. As a variant of PEKS, certificateless public key authenticated encryption with keyword search (CLPAEKS) not only simplifies certificate management but also could resist keyword guessing attacks (KGA). In this paper, we analyze the security models of two recent CLPAEKS schemes and find that they ignore the threat that, upon capturing two trapdoors, the adversary could directly compare them and distinguish whether they are generated using the same keyword. To cope with this threat, we propose an improved security model and define the notion of strong trapdoor indistinguishability. We then propose a new CLPAEKS scheme and prove it to be secure under the improved security model based on the intractability of the DBDH problem and the DDH problem in the targeted bilinear group.

Abstract Background Many studies focused on health inequality between migrant older adults and local older adults, while few study concerned the health inequalities between urban-to-urban and rural-to-urban migrant older adults. This study aimed to compare physical health and mental health between these two groups in Hangzhou, Zhejiang Province, China, and to explore the relationship between cognitive social capital, social integration and health among migrant older adults. Methods A two-stage stratified sampling method was employed to recruit participants from May to August 2013 in Hangzhou. Measurement data were compared with student’s t-tests and multivariate analysis of variance (MANOVA). Multiple linear regression was adopted in this study. Results A total of 1000 of participants who met the inclusion criteria were analyzed, consisting of 527 (52.7%) urban-to-urban and 473 (47.3%) rural-to-urban migrant older adults. There were no statistically significant difference in physical health and mental health between urban-to-urban and rural-to-urban groups on the whole. However, urban-to-urban migrant older adults had a higher reciprocity and social integration than did in rural-to-urban group (13.36 vs. 12.50, p

Plaintext-checkable encryption (PCE), first introduced by Canard et al., allows users searching on encrypted data through plaintexts. It provides a useful primitive in the cloud computing security. However, existing PCE schemes could not guarantee verifiability to prevent from malicious adversaries. To concentrate with, we provide the notion of plaintext-verifiably-checkable encryption (PVCE). Our PVCE scheme could check that if a ciphertext is valid, even though it could pass the check procedure, to avoid malicious ciphertexts. Furthermore, we extend the work in dual-server setting, called dual-server plaintext-verifiably-checkable encryption (DS-PVCE), to resist offline message recover attack. We also give the security definition IND-CCA-FS, IND-CCA-BS and IND-CCA-BS-II in standard model for DS-PVCE and prove that DS-PVCE is secure under these security notions. Then we give constructions of PVCE and DS-PVCE from pairing-friendly smooth projective hash function (PF-SPHF) and their instantiations based on k-MDDH assumption. At the end of this paper, we provide implementation to compare existing PCE schemes and our schemes, which shows that DS-PVCE has very high check efficiency compared with other PCE schemes.

Abstract Background Histone H2AX phosphorylation at the site of Tyr-142 can participates in multiple biological progressions, which is including DNA repair. Ras pathway is closely involved in human cancers. Our study investigated the effects of Ras pathway via regulating H2AX.Y142ph. Methods Gastric cancer cell line SNU-16 and MKN1 cells were transfected with Ras for G12D and T35S site mutation. The phosphorylation of H2A.XY142 and ERK1/2, WSTF and MDM2 was detected by western blot. Cell viability, cell colonies and migration was analyzed by MTT assay, soft-agar colony formation assay, and Transwell assay, respectively. The expression of Ras pathway related downstream factors, EYA3 and WSTF was detected by qRT-PCR. The relationship between Ras and downstream factors were detected by ChIP. The cell cycle progression was measured by flow cytometry. Results RasG12D/T35V transection decreased the phosphorylation of H2A.XY142 and activated phosphorylation of ERK-1/2. H2A.XY142 inhibited cell viability, colonies and migration. H2A.XY142ph altered the expression of Ras downstream factors. CHIP assay revealed that RasG12D/T35V could bind to the promoters of these Ras pathway downstream factors. Silence of EYA3 increased H2A.XY142ph and inhibited cell viability, migration and percent cells in S stage. Furthermore, silence of EYA3 also changed the downstream factors expression. WSTF and H2A.XY142ph revealed the similar trend and MDM2 on the opposite. Conclusion Ras/ERK signal pathway decreased H2A.XY142ph and promoted cell growth and metastasis. This Ras regulation process was down-regulated by the cascade of MDM2-WSTF-EYA3 to decrease H2A.XY142ph in SNU-16 cells.

Abstract Background Owing to the increase in life expectancy and sickliness, caring for older adults has become a major challenge in China, where the traditional care system is disintegrating and community- and home-based care have been introduced to respond to this ‘silver wave’. However, there is limited knowledge of the dilemmas associated with caring for older adults and the acceptability of community- and home-based care for this population. Methods Participants were recruited from Xihu District, Hangzhou, from June to July 2017. In-depth interviews were conducted using semi-structured questionnaires. Audio recording, verbatim transcription, and thematic analysis were conducted. Results A total of 64 older adults from four communities were interviewed. Half of the participants had multiple chronic diseases. The very old individuals and those with severe diseases and in poor financial conditions were observed to be struggling the most. Health status, financial capability, and personality were the main factors affecting the care process. Participants cited the following reasons for staying away from nursing homes: misunderstanding, negative environment, a sense of shame, loneliness, and financial limitations. Community- and home-based cares are popular forms of old-age care; however, some participants exhibited a lack of knowledge about such services. Conclusion A multi-layered old-age care system is urgently needed for older adults in Zhejiang Province. Further, it is important that such a system integrates the care provided through community- and home-based services with that offered by nursing homes. Community- and home-based care for older adults needs to be prioritised, and the quality of care provided in nursing homes should be improved.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12885-019-5750-x

In this study, subjective questionnaires and a building energy simulation were utilized to investigate the impact of air conditioner operation on the energy consumption/savings of a model building with different types of exterior wall thermal insulation. The results indicate that an intermittent energy usage mode is generally used in residential buildings in hot summer and cold winter areas. Air conditioner operation behavior is affected by the human thermal experience. The greater the indoor temperature deviates from the human comfort range, the higher the air conditioner operation frequency. Under continuous energy usage mode, the annual heating and cooling effect of the exterior thermal insulation was found to be better than that of interior thermal insulation. Under the intermittent energy usage mode without considering residents’ temperature tolerance, the annual heating and cooling effect of the interior thermal insulation was better than that of the exterior insulation. Under the intermittent energy usage mode considering tolerance levels, the energy-saving effect of the interior and exterior thermal insulation of the exterior wall was different. In the case of low and medium temperature tolerance, the annual heating and cooling energy-saving effect of the interior thermal insulation was better than the exterior thermal insulation; in the case of high tolerance, the heating and cooling energy saving effect of the exterior thermal insulation was better.

Introduction Amyotrophic lateral sclerosis (ALS) is a representative rare disease characterised by progressive, fatal motor neuron degeneration. Due to the unknown aetiology and variability of the phenotypes, there are no accurate reports concerning the epidemiology or clinical characteristics of the disease. The low prevalence, as previously reported, makes it difficult to carry out studies with large samples. The aim of this study was to explore the natural history and clinical features of ALS in mainland China through a multicentre, prospective cohort study. The findings will both offer a better understanding of ALS and also support the development of a model to study other rare diseases.Methods and analysis Patients from 88 representative hospitals in different parts of mainland China will be recruited through a specially designed online data system (http://www.chalsr.net/). We aim to recruit 4752 ALS patients over a 3-year period. Baseline data will be recorded, and follow-up data will be collected every 3 months. The primary outcome is effective survival. Overall survival and indices of disease progression will be measured as the secondary outcomes.Ethics and dissemination Ethical approval has been obtained from the ethics committee of Peking University Third Hospital (M2019388). Informed written consent will be obtained from each participant. Dissemination of the study protocol and data will take place primarily through a specially designed online data system (http://www.chalsr.net/). The collective results of the study will be published in peer-reviewed journals and shared in scientific presentations.Trial registration number NCT04328675

With the higher rate of using cloud storage, protecting data privacy becomes an important issue. The most effective solution is to encrypt data before uploading to the cloud. However, how to efficiently search over data encrypted with different keys is still an open problem. To address this problem, we introduce a new notion of the identity-based encryption with equality test supporting flexible authorization (IBEET-FA). It supports the test of whether two ciphertexts encrypted under the different keys encapsulate the same message, and in the meanwhile supports fine-grained authorization of the test. Based on the equality test on ciphertexts, there is a direct way to support an authorized user to search over ciphertexts of different users, which accelerates secret data sharing among a group of users. Besides, IBEET-FA does not suffer from the complex key management problem of its counterpart in the traditional public key infrastructure. We propose a concrete construction of IBEET-FA and prove it to be securely based on simple mathematical assumptions. The experimental results show that our IBEET-FA scheme is efficient and can satisfy various types of search over encrypted data.

Abstract Background While much literature reported the access of Chinese older migrants to health services, little was known about the differences among sub-groups of older adults, including urban-to-urban and rural-to-urban migrants, and urban and rural permanent residents. This study aimed to examine the access of these four groups to health services in Zhejiang Province, China and provide an evidence for the development of health services policies. Methods A cross-sectional survey was conducted in community-dwelling older adults (aged 60 years or above) in 2013. Participants were recruited by random sampling. Demographic information and access to health services for the elderly populations were obtained via interviews using a self-designed structured questionnaire. Pearson’s chi-square tests and Cochran-Mantel-Haenszel (CMH) tests were performed to examine the differences in access to health services among the four groups. Binary logistic regression was conducted to explore the associations of participants’ visits to doctors with their group status after controlling confounding factors. Results The two-week hospital visiting rates were significantly lower in migrants (55.56% in rural-to-urban and 62.50% in urban-to-urban) than that in urban and rural permanent residents (67.40 and 82.25%, respectively; p

The incident direction of earthquake motion is an important factor affecting the seismic response of underground structures. In this study, a three-dimensional (3D) oblique incidence method of SV waves is proposed and the effects of incident angles of SV waves on the seismic response of a lined arched tunnel are evaluated. Based on wave field decomposition principle and equivalent node force method and together with viscous-spring artificial boundary, the oblique incidence method of SV waves is implemented by transforming seismic wave field into the equivalent nodal forces acting on the artificial boundaries. By deriving the distance of the incident waves and the reflected wave on free surface to artificial boundaries, this method can comprehensively consider the phase difference of the seismic wave propagation and the influence of the damping effect of the rock medium on the seismic wave propagation. The method is programed into a dynamic finite element program and its effectiveness is examined by a numerical example. Consequently, the oblique incidence method is applied to evaluate the seismic behaviors of the tunnel. The numerical results reveal that (1) the oblique incidence of the seismic wave results in a larger seismic response; (2) the response amplitudes of the stress and displacement increase with the increase of incident angles and reaching the maximum in the case of 30° incident angle; (3) the damage extent increases with an increase in the incident angles, and the oblique incidence of the seismic wave is believed to increase the spatial difference of damage distribution.