Search

Endovascular thrombectomy is a first ⁃ line treatment option for acute large vessel occlusive ischemic stroke after strict selection, which is an effective method to improve the good prognosis rate of patients. More and more evidence⁃based medicine proves that balloon guide catheter (BGC) can shorten the reperfusion time, increase the rate of initial reperfusion, and reduce the risk of distal embolism due to it's proximal blood flow occlusion, but the application of BGC in emergency endovascular thrombectomy is still limited. This review summarizes the clinical application progress of BGC to provide theoretical basis for it's application in emergency endovascular thrombectomy.

Objective To evaluate the long⁃term prognosis in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window (> 24 h) who received endovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated with BMT alone. Methods This study included 158 patients from a prospective cohort of acute ischemic stroke due to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July 2023. The 158 patients with anterior circulation large vessel occlusion were divided into received EVT combined with BMT (EVT group, n = 70) and received BMT alone (BMT group, n = 88). Long ⁃ term neurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset. Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factors of long⁃term neurological prognosis. Sensitivity analyses were performed using propensity score matching (PSM) and multiple imputation (MI). Results Logistic regression analysis showed that EVT was a protective factor for good long ⁃term neurological prognosis (mRS score ≤ 2; OR = 3.110, 95%CI: 1.460- 6.620, P = 0.003), increasing age (OR = 0.955, 95%CI: 0.924-0.987; P = 0.007) and hypertension (OR = 0.418, 95%CI: 0.187-0.936; P = 0.034) were risk factors. In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long ⁃ term neurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR = 3.610, 95%CI: 1.370-9.550, P = 0.010; MI: aOR = 3.870, 95%CI: 1.780-8.440, P = 0.000). The results were consistent with the main analysis. Conclusions Compared to BMT group, EVT group patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window was demonstrated a significantly better long⁃term neurological prognosis.

Abstract Background Over the past decade, the adoption of screening programs, digital mammography, and magnetic resonance imaging (MRI) has increased early-stage breast cancer diagnosis rates. Mortality rates have decreased due to early detection and improved treatments, including personalized therapies. Accelerated partial-breast irradiation (APBI) is emerging as a convenient and effective treatment for some patients, with studies exploring its preoperative use. Preoperative APBI, especially with MRI guidance, offers improved tumor targeting and potentially reduced side effects. Magnetic Resonance Imaging-Guided Single-Fraction Pre-Operative Radiotherapy for Early-Stage Breast Cancer (RICE trial) aims to assess the feasibility and efficacy of MRI-guided single-dose radiotherapy (RT) for early-stage breast cancer. Methods The RICE study is a prospective, single-arm study evaluating single-fraction preoperative, APBI treatment for patients with early-stage breast cancer using a magnetic resonance imaging linear accelerator (MRI linac). Eligible patients enrolled in this study will have a core biopsy to confirm estrogen receptor-positive and HER2-negative sub-type. RT planning will use a planning computed tomography (CT) co-registered with a MRI with the patient in either the supine or prone position. For the diagnostic workup, [18F] fluorodeoxyglucose positron emission tomography/CT ([18F] FDG PET/CT) and [18F] fluoroestradiol positron emission tomography/CT ([18F] FES PET/CT) will be performed prior to treatment. Thirty patients will receive a single ablative RT dose of 21 Gray to the tumor. Pre-treatment and post-treatment MRI scans will be acquired at baseline and 5 weeks post-RT respectively. Breast-conserving surgery will be scheduled for 6 weeks after APBI treatment using the MRI linac. The primary study endpoint is the successful administration of a single fraction of preoperative breast RT under the guidance of an MRI linac. Secondary endpoints include evaluating the utility of MRI, [18F] FDG PET/CT, and [18F] FES PET/CT as a non-invasive method for assessing treatment response in patients undergoing single-fraction preoperative APBI. Conclusion The RICE trial represents a significant step in breast cancer treatment, offering insights that could lead to treatment protocols with minimized RT appointments and enhanced patient outcomes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 31st of May 2021. Registration number: ACTRN12621000659808 .

Abstract During cell division, the microtubule cytoskeleton undergoes dramatic cell cycle-driven reorganizations of its architecture. Coordinated by changes in the phosphorylation patterns of a multitude of microtubule associated proteins, the mitotic spindle first self-assembles to capture the chromosomes and then reorganizes in anaphase as the chromosomes are segregated. A key protein for this reorganization is PRC1 which is differentially phosphorylated by the mitotic kinases CDK1 and PLK1. How the phosphorylation state of PRC1 orchestrates spindle reorganization is not understood mechanistically. Here, we reconstitute in vitro the transition between metaphase and anaphase-like microtubule architectures triggered by the changes in PRC1 phosphorylation. We find that whereas PLK1 regulates its own recruitment by PRC1, CDK1 controls the affinity of PRC1 for antiparallel microtubule binding. Dephosphorylation of CDK1-phosphorylated PRC1 is required and sufficient to trigger the reorganization of a minimal anaphase midzone in the presence of the midzone length controlling kinesin KIF4A. These results demonstrate how phosphorylation-controlled affinity changes regulate the architecture of active microtubule networks, providing new insight into the mechanistic underpinnings of the cell cycle-driven reorganization of the central spindle during mitosis.

Highlights The introduction of MoS2 generates a “kill three birds with one stone” effect to the original binary MXene/ANF system: lubrication toughening mechanical performance; reduction in secondary reflection pollution of electromagnetic wave; and improvement in the performance of photothermal conversion. After the introduction of MoS2 into MXene/ANF (60:40), the strain and toughness were increased by 53.5% (from 18.3% to 28.1%) and 61.7% (from 8.9 to 14.5 MJ m−3), respectively. Fortunately, the SER decreases by 22.4%, and the photothermal conversion performance was increased by 22.2% from ~ 45 to ~ 55 °C.

ObjectiveTo compare the application value of three image post-processing techniques volume rendering （VR）, multiplanar reformation （MPR） and curved planar reformation （CPR） in the identification of rib fracture malunion.MethodsThe types and numbers of rib fracture malunion in 75 patients were recorded, and the sensitivity, specificity, accuracy and Youden index of VR, MPR and CPR in the diagnosis of rib fracture malunion were compared. Receiver operator characteristic （ROC） curve was drawn and area under the curve （AUC） was calculated, and the detection rates of three image post-processing techniques for different types of rib fracture malunion were compared.ResultsA total of 243 rib fractures were malunion in 75 patients. The diagnostic sensitivity of VR, MPR and CPR for rib fracture malunion was 52.67%, 79.84% and 91.36%, the specificity was 99.58%, 97.89% and 99.15%, the accuracy was 83.66%, 91.76% and 96.51%, the Youden index was 0.52, 0.78 and 0.91, the AUC was 0.761, 0.889 and 0.953, respectively. Compared with VR, there were statistically significant differences in the number of broken rib end misalignment over 1/3, broken rib end overlap, broken rib end angulation and intercostal bridge detected in MPR （P

ABSTRACT Background Next‐generation sequencing (NGS) technology enables sample multiplexing for interrogation of multiple regions of interest (ROI). Leveraging this, together with access to affordable NGS platforms, we explored the practicality of moving capillary electrophoresis (CE), noncapillary electrophoresis and single‐gene testing to NGS. In this work, we evaluated the iSeq 100's capacity to validate 89 samples at once. Methods Genomic DNA was extracted from 89 archival samples of varying specimen types. Polymerase chain reaction (PCR) was done with in house primers, library preparation with the Nextera XT Library Preparation Kit and cleaning up with paramagnetic beads. The sequencing was performed on one Illumina iSeq 100 flow cell. Results With our workflow, 88 out of 89 samples were accurately sequenced with variant alleles identified. One sample of the 88 samples was initially discordant because the primers used were in a heterozygous deletion region. Upon redesigning of primers, the sample proved concordant. Conclusions The iSeq‐Nextera workflow proved accurate. However, variant allele frequencys generated by the Nextera are not precise.

A nuclear explosion in the rock mass medium can produce strong shock waves, seismic shocks, and other destructive effects, which can cause extreme damage to the underground protection infrastructures. With the increase in nuclear explosion power, underground protection engineering enabled by explosion-proof impact theory and technology ushered in a new challenge. This paper proposes to simulate nuclear explosion tests with on-site chemical explosion tests in the form of multi-hole explosions. First, the mechanism of using multi-hole simultaneous blasting to simulate a nuclear explosion to generate approximate plane waves was analyzed. The plane pressure curve at the vault of the underground protective tunnel under the action of the multi-hole simultaneous blasting was then obtained using the impact test in the rock mass at the site. According to the peak pressure at the vault plane, it was divided into three regions: the stress superposition region, the superposition region after surface reflection, and the approximate plane stress wave zone. A numerical simulation approach was developed using PFC and FLAC to study the peak particle velocity in the surrounding rock of the underground protective cave under the action of multi-hole blasting. The time-history curves of pressure and peak pressure partition obtained by the on-site multi-hole simultaneous blasting test and numerical simulation were compared and analyzed, to verify the correctness and rationality of the formation of an approximate plane wave in the simulated nuclear explosion. This comparison and analysis also provided a theoretical foundation and some research ideas for the ensuing study on the impact of a nuclear explosion.

The consumption value seems to be insufficient to explain consumers' domestic electric vehicle purchase behaviour, especially in a highly competitive global environment. This study aims to investigate how consumer ethnocentrism and perceived interactivity influence consumption value and pro-environmental value, subsequently affecting attitude and intention. A total of 353 valid questionnaires were collected through convenience sampling in Xuzhou, China, and the partial least square (PLS) path modelling approach was performed to test the hypotheses. The results show that consumer ethnocentrism and perceived interactivity positively influence function value, emotional value, and social value; perceived interactivity also positively influences altruistic value, biospheric value, and collectivistic value. Function value, social value, and collectivistic value positively influence attitude; however, emotional value, altruistic value and biospheric value did not find a correlation with attitude. Furthermore, attitude positively influences intention to adopt domestic electric vehicles. Finally, the theoretical and practical implications, as well as limitations were discussed accordingly.

Atherosclerosis, a chronic inflammatory disease of the arterial wall, serves as the pathophysiological basis for ischemic stroke and coronary heart disease, and stands as the primary cause of cardiovascular and cerebrovascular comorbidity. Both the heart and brain share similar risk factors, including hypertension, hyperlipidemia and diabetes, and so on. Furthermore, most patients with cardiovascular and cerebrovascular comorbidity experience more severe disease and poorer prognosis. This article comprehensively reviews research progress in the pathophysiology of cardiovascular and cerebrovascular comorbidity, their related risk factors, and proposes the strategies of "synchronous treatment for brain and heart" to offer new insights for the prevention and management of cardiovascular and cerebrovascular comorbidity.

Background: Shock-refractory ventricular fibrillation (VF) or ventricular tachycardia (VT) is a treatment challenge in out-of-hospital cardiac arrest (OHCA). This study aimed to develop and validate machine learning models that could be implemented by emergency medical services (EMS) to predict refractory VF/VT in OHCA patients. Methods: This was a retrospective study examining adult non-traumatic OHCA patients brought into the emergency department by Singapore EMS from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Data from April 2010 to March 2020 were extracted for this study. Refractory VF/VT was defined as VF/VT persisting or recurring after at least one shock. Features were selected based on expert clinical opinion and availability to dispatch prior to arrival at scene. Multivariable logistic regression (MVR), LASSO and random forest (RF) models were investigated. Model performance was evaluated using receiver operator characteristic (ROC) area under curve (AUC) analysis and calibration plots. Results: 20,713 patients were included in this study, of which 860 (4.1%) fulfilled the criteria for refractory VF/VT. All models performed comparably and were moderately well-calibrated. ROC-AUC were 0.732 (95% CI, 0.695 – 0.769) for MVR, 0.738 (95% CI, 0.701 – 0.774) for LASSO, and 0.731 (95% CI, 0.690 – 0.773) for RF. The shared important predictors across all models included male gender and public location. Conclusion: The machine learning models developed have potential clinical utility to improve outcomes in cases of refractory VF/VT OHCA. Prediction of refractory VF/VT prior to arrival at patient’s side may allow for increased options for intervention both by EMS and tertiary care centres.

Background Vaginal birth after cesarean (VBAC) is generally regarded as a safe and viable birthing option for most women with prior cesarean delivery. Nonetheless, concerns about heightened risks of adverse maternal and perinatal outcomes have often dissuaded women from considering VBAC. This study aimed to assess the performance of an artificial intelligence (AI)-powered VBAC prediction system integrated into a decision-aid birth choice platform for shared decision-making (SDM). Materials and Methods Employing a retrospective design, we collected medical records from a regional hospital in northern Taiwan from January 2019 to May 2023. To explore a suitable model for tabular data, we compared two prevailing modeling approaches: tree-based models and logistic regression models. We subjected the tree-based algorithm, CatBoost, to binary classification. Results Forty pregnant women with 347 records were included. The CatBoost model demonstrated a robust performance, boasting an accuracy rate of 0.91 (95% confidence interval (CI): 0.86–0.94) and an area under the curve of 0.89 (95% CI: 0.86–0.93), surpassing both regression models and other boosting techniques. CatBoost captured the data characteristics on the significant impact of gravidity and the positive influence of previous vaginal birth, reinforcing established clinical guidelines, as substantiated by the SHapley Additive exPlanations analysis. Conclusion Using AI techniques offers a more accurate assessment of VBAC risks, boosting women’s confidence in selecting VBAC as a viable birthing option. The seamless integration of AI prediction systems with SDM platforms holds a promising potential for enhancing the effectiveness of clinical applications in the domain of women's healthcare.

Objective: This study aimed to purify crude polyphenols from wormwood and to study inhibitory activity of its against α-glucosidase. Methods: The adsorption-desorption properties of wormwood polyphenols by seven kinds of macroporous resins were studied. The suitable resin for separating and purifying Wormwood polyphenols was obtained and the purification parameters were optimized. Using different concentration ethanol solution for dynamic elution, the inhibitory activity of different elution fractions on α-glucosidase was investigated. Results: The results indicated that D101 resin was a suitable material for purifying wormwood polyphenols and the macroporous resin reached equilibrium within 120 min. The optimal conditions for purifying wormwood polyphenols were as follows, crude polyphenol 1.5 mg/mL, pH 2.0, flow velocity of 1.5 mL/min, and 60% ethanol was used as the eluent with the elution flow rate of 1.5 mL/min. The purity of polyphenols increased from 21.42% to 69.19% after purification by D101 resin, which was enhanced 3.23 times. Different elution components were obtained by using different concentration ethanol as eluents, respectively. The 60% ethanol elution fraction that contained isoquercitrin, phloridzin and rutin had the best inhibitory effect on α-glucosidase activity. Conclusion: wormwood polyphenols have good development prospects for hypoglycemic effect.

Glioblastoma, a formidable brain tumor characterized by dysregulated NAD metabolism, poses a significant therapeutic challenge. The NAMPT inhibitor FK866, which induces NAD depletion, has shown promise in controlling tumor proliferation and modifying the tumor microenvironment. However, the clinical efficacy of FK866 as a single drug therapy for glioma is limited. In this study, we aim to disrupt NAD metabolism using fluorinated NAD precursors and explore their synergistic effect with FK866 in inducing cytotoxicity in glioblastoma cells. The synthesized analogue of nicotinamide riboside (NR), ara-F nicotinamide riboside (F-NR), inhibits nicotinamide ribose kinase (NRK) activity in vitro, reduces cellular NAD levels, and enhances FK866’s cytotoxicity in U251 glioblastoma cells, indicating a collaborative impact on cell death. Metabolic analyses reveal that F-NR undergoes conversion to fluorinated nicotinamide mononucleotide (F-NMN) and other metabolites, highlighting the intact NAD metabolic pathway in glioma cells. The activation of SARM1 by F-NMN, a potent NAD-consuming enzyme, is supported by the synergistic effect of CZ-48, a cell-permeable SARM1 activator. Temporal analysis underscores the sequential nature of events, establishing NAD depletion as a precursor to ATP depletion and eventual massive cell death. This study not only elucidates the molecular intricacies of glioblastoma cell death but also proposes a promising strategy to enhance FK866 efficacy through fluorinated NAD precursors, offering potential avenues for innovative therapeutic interventions in the challenging landscape of glioblastoma treatment.

Abstract Background Singapore and Osaka in Japan have comparable population sizes and prehospital management; however, the frequency of ECPR differs greatly for out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm. Given this disparity, we hypothesized that the outcomes among the OHCA patients with initial shockable rhythm in Singapore were different from those in Osaka. The aim of this study was to evaluate the outcomes of OHCA patients with initial shockable rhythm in Singapore compared to the expected outcomes derived from Osaka data using machine learning-based prediction models. Methods This was a secondary analysis of two OHCA databases: the Singapore PAROS database (SG-PAROS) and the Osaka-CRITICAL database from Osaka, Japan. This study included adult (18–74 years) OHCA patients with initial shockable rhythm. A machine learning-based prediction model was derived and validated using data from the Osaka-CRITICAL database (derivation data 2012–2017, validation data 2018–2019), and applied to the SG-PAROS database (2010–2016 data), to predict the risk-adjusted probability of favorable neurological outcomes. The observed and expected outcomes were compared using the observed–expected ratio (OE ratio) with 95% confidence intervals (CI). Results From the SG-PAROS database, 1,789 patients were included in the analysis. For OHCA patients who achieved return of spontaneous circulation (ROSC) on hospital arrival, the observed favorable neurological outcome was at the same level as expected (OE ratio: 0.905 [95%CI: 0.784–1.036]). On the other hand, for those who had continued cardiac arrest on hospital arrival, the outcomes were lower than expected (shockable rhythm on hospital arrival, OE ratio: 0.369 [95%CI: 0.258–0.499], and nonshockable rhythm, OE ratio: 0.137 [95%CI: 0.065–0.235]). Conclusion This observational study found that the outcomes for patients with initial shockable rhythm but who did not obtain ROSC on hospital arrival in Singapore were lower than expected from Osaka. We hypothesize this is mainly due to differences in the use of ECPR.

With the continuous increase in tunnel construction, the significant deformation of the surrounding tunnel rock is often difficult to predict and control. In addition, the lithology, structure, and various asymmetric large deformation of surrounding rock mass during operation and maintenance severely affect the ultimate bearing and stability of the tunnel. To explore the deformation mechanisms and failure modes of surrounding rock under large asymmetric stress and complex geological conditions, a physical model of a tunnel through granite was constructed based on the similarity theory. The model had 30° dip lithology under asymmetric stress and was emplaced a new quasi-negative Poisson’s ratio (NPR) bolt. By analyzing the variation law of displacement and axial force of the bolt under an asymmetric load, the asymmetric deformation and failure mechanism of the granite tunnel and the support effect of the quasi-NPR bolt were determined. The energy absorbed by the surrounding rock was analyzed, and the influence mechanism and control countermeasures of asymmetric stress on the granite tunnel were explored. This work provides a reference for the design of asymmetric support of tunnels with similar engineering backgrounds.

Introduction: Consistent delineation of the breast conserving surgery (BCS) tumour bed (TB) for breast cancer remains a challenge for radiation oncologists. Accurate delineation allows for better local control and reduces toxicity when planning partial breast or TB boost radiation therapy (RT). Methods: In the operating theatre (OT) breast surgeons inserted stabilised hyaluronic acid (sHA) gel as small drops approximately one cm into the walls surrounding the resection cavity. Surgical feasibility was determined by the rate of successful sHA gel insertion procedure, the ease of insertion as rated by surgeons, the time required for insertion procedure, the quantity used, and any adverse events (AE) relating to sHA gel insertion. Results: Thirty-five patients were enrolled. All patients underwent sHA gel insertion successfully. The procedure added a median of 2.8 min to the OT time and was rated as ‘easy’ in 89 % of patients. There were no immediate AE in OT. Five (14 %) patients experienced a grade 2 or higher AE. Three of the five patients were prescribed oral antibiotics for breast infection. Two of the five patients experienced a grade 3 AE – haematoma which required evacuation in OT day 1 post-BCS, and infected seroma which required drainage and washout in OT 2 months post-BCS. All five patients recovered and underwent the planned adjuvant therapies for their BC. The AE data reflects common risks with standard BCS and are not clearly attributed to sHA gel insertion alone. Conclusion: We show that sHA gel is surgically feasible as a marker to help define the TB cavity for post-BCS adjuvant MRI-based RT planning.

Objectives: With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS. Methods: All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18–64, 65–79, 80–89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS. Results: 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18–64, 65–79- and 80–89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR. Conclusions: Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.

Abstract Context Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making? Methods This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein’s integrative model of behavioural prediction to underpin secondary data analysis. Results Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., “better safe than sorry”); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system). Discussion Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.

The excavation of deep caverns can result in significant nonlinear large deformations caused by dynamic impact effects, such as high-stress rock bursts, impact ground pressure, or external explosions. To address this issue, a research team led by Academician He Manchao has developed a new 2G-NPR (Second Generation Negative Poisson’s Ratio) bolt material with the characteristics of uniform large deformation, obvious disappearance of necking, and disappearance of yield platform. On this basis, a large deformation control technique for the rigid-flexible structural systems of rock supported by the 2G-NPR bolt has been developed. To provide a basis for the application of 2G-NPR bolt support in national defense and civil air defense engineering, this study investigated the overall dynamic response law and mechanical behavior of the 2G-NPR bolt support engineering rock mass under the strong impact of explosions. The attenuation model of explosion shock wave in granite was studied in the explosion test site and the charging parameters required for explosion were determined. The support parameters of the PR bolt support composite structure and the 2G-NPR bolt support composite structure cavern were obtained. The dynamic response and interaction law of the peak pressure of the arch crown, the acceleration of the arch crown, the axial force of the anchor rod and the surrounding rock in the two different supporting systems were studied and compared. Impact and explosion resistance characteristics and failure modes of the different supporting caverns were revealed. The results indicate that the 2G-NPR bolt can resist stronger plane impact load with a higher energy absorption share and more significant energy absorption characteristics in underground explosion-proof support, and can play a supporting and protection effect that traditional bolt support cannot match. Moreover, the cavern excavation stress compensation theory for the change of surrounding rock stress state caused by underground cavern excavation was proposed and the theoretical solutions of stress components and displacement components at the anchorage end of bolt were studied, which provides a theoretical reference for subsequent cavern support research.

One of the contraindications to patella resurfacing in total knee arthroplasty is a thin and severely eroded ‘deficient’ patella. However, such patients often present with severe patellofemoral joint arthritis, patellar lateral subluxation, and patella maltracking, which can only be treated effectively with resurfacing. While various treatments have been proposed, options remain limited.Here we introduce a method of patella reconstruction using four 2.7-mm titanium cortical screws crossing each other into the inner shell of the patella. This provides a scaffold onto which bone cement and any standard polyethylene patellar component can be fixed. Postoperatively, the patient had no anterior knee pain, no patella maltracking, and no component loosening.Advantages of this technique include minimization of extensor disruption, low costs, easy accessibility, reproducibility, and improved mechanical strength.

Supercapacitors are emerging as a viable alternative to batteries in a variety of applications. In recent years, extensive research has been carried out on the development of new electrode material to produce supercapacitors with high energy density. In this study, 2 different types of activated carbon (AC) namely commercialized AC (i.e. steam-activated charcoal) and self-prepared phosphoric acid-treated orange peel AC were used to fabricate the supercapacitor electrodes. Prior to the fabrication, the structural properties and surface morphology of both ACs were examined using the Brunaeuer-Emmett-Teller (BET) analysis and Scanning Electron Microscope (SEM). The results revealed that commercialized AC exhibited more pores on its surface and a higher BET surface area of 818.8441 m2/g than orange peel-derived AC, which had a surface area of 137.9910 m2/g. The fabricated coil cell supercapacitor in sodium sulfate electrolyte demonstrated specific capacitance of 35.5880 F/g for the commercialized AC and 57.7056 F/g for the orange peel-derived AC. Higher energy density was recorded for supercapacitor fabricated using orange peel-derived AC (8.0147 Wh/kg), compared to the commercialized AC counterpart (4.9428 Wh/kg). Despite its inferior physical properties, the superiority of supercapacitor performance (e.g., specific capacitance and energy density) with orange peel AC suggested that there is a potential for orange peel AC-based supercapacitors to be used in real-world applications, but more research on the optimization of electrode composition, type, and electrolyte concentration is required.

Background: Community first responders (CFRs) strengthen the Chain of Survival for out-of-hospital cardiac arrest (OHCA) care. Considerable efforts have been invested in Singapore’s CFR program, during the years 2016–2020, by developing an app-based activation system called myResponder. This paper reports on national CFR response indicators to evaluate the real-world impact of these efforts. Methods: We matched data from the Singapore Civil Defence Force’s CFR registry with the Pan Asian Resuscitation Outcomes Study (PAROS) registry data to calculate performance indicators. These included the number of CFRs receiving and accepting an issued alert per OHCA event. Also calculated were the fraction of OHCA events where CFRs received an issued alert, or accepted the alert, and arrived at the scene either before or after EMS. We also present trends of these indicators and compare the prevalence of these fractions between the CFR-attended and CFR-unattended OHCA events. Results: Of 6577 alerted OHCA events, 42.7% accepted an alert, 50% of these arrived at the scene and 71% of them arrived before EMS. Almost all CFR response indicators improved over time even for the pandemic year (2020). The fraction of OHCA events where >2 CFRs received an alert increased from 62% to 96%; the same figure for accepting an alert did not change much but >2 CFRs arriving at the scene increased from 0% to 7.5%. The fraction of OHCA events with an automated external defibrillator applied and defibrillation performed by CFR increased from 4.2% to 10.3% and 1.6% to 3%, respectively. Statistically significant differences were observed in these indicators when CFR-attended and CFR-unattended OHCA events were compared. Conclusion: This real-world study shows that activating CFRs using mobile technology can improve community response to OHCA and are bearing fruit in Singapore at a national level. Some targets for improvement and future research are highlighted in this report.

With the gradual decrease and exhaustion of shallow mineral resources, underground mining has progressed to greater depths. Here, the geological environment is significantly more complex and nonlinear, and large deformations of rock masses have great potential to occur. Many geotechnical engineering disasters have occurred even while using Poisson’s ratio (PR) anchor cable supports. To efficiently deal with these issues, a new support material called negative Poisson’s ratio (NPR) anchor cable is proposed; this material can withstand large deformations and provide high constant resistance. In this study, the support characteristics of macro-NPR anchor cable under blasting impact were mainly studied. The support effects of PR anchor cable and macro-NPR anchor cable were compared and analyzed with the help of field experiments and numerical simulations. The results indicate that field experiments and discontinuous deformation analysis accurately reflect the failure state of the selected roadway, as well as the tension and deformation of the anchor cables. The roadway supported by PR anchor cables cannot resist rock bursts under ordinary circumstances. However, the NPR anchor cable-supported roadway resisted a rock burst caused by the impact equivalent to a mine earthquake magnitude above 3; it meets the requirements of roadway stability.

For the problem that how the grouting reinforcement of a single penetrated structural plane affects the bearing capacity of surrounding rock, an approach of rock samples preparation with single penetrated fracture surface is proposed firstly, and the rock samples are injected with ultrafine cement and epoxy resin, respectively. Then, the strength and deformation characteristics of the consolidated body under uniaxial (triaxial) compression are investigated with the RMT-150C experimental system. Finally, the micro consolidation mechanism of structural plane grouting is revealed using theoretical analysis and electron microscope scanning. It is found that the fracture surface generated under the triaxial loading-unloading condition is closer to the engineering practice and meets the experimental requirements. The stress−strain characteristic curves of the specimens injected with ultrafine cement show phased deformation characteristics, and the curves of the specimens injected with epoxy resin are relatively smooth. For the strength characteristics, the influence of confining pressure is significantly larger than that of grouting material selection. Grouting reinforcement can improve the residual strength of rock mass. With the increase of confining pressure, the increase of improvement coefficient of residual strength is less obvious, and the peak strength of the consolidated body is closer to that of intact rock. For the failure characteristics, the main fracture surface of the specimen injected with ultrafine cement shears and slips along the original fracture surface, and the main fracture surface of the specimen injected with epoxy resin is a new penetrated fracture surface. Finally, based on the Mohr-Coulomb criterion, the relationship between the bonding force of grouting materials and the strength improvement coefficient of structural plane is established. It is found that the strength improvement coefficient of structural plane has a linear relationship with the bonding force of grout. The comparison between the calculation and test results shows that the formula is reasonable and can provide a reference for the optimization of deep surrounding rock support.

SARM1 is a key player in axon degeneration. Here, the authors generate a nanobody, which specifically recognizes the NMN-bound state of SARM1 and helps resolve the SARM1 structure in an intermediate state of activation.

BackgroundGout is associated with significant morbidity and mortality, yet suboptimal gout control remains a problem globally. Identifying the risk factors associated with poor gout control among patients in primary care allows targeted interventions to improve their clinical management. This study aimed to determine the prevalence of poor gout control and its associated demographic and clinical factors among urbanized community-dwelling Asian patients.MethodsThis retrospective study was based on data extracted from the electronic medical records of 8 public primary care clinics in Singapore. Patients with a diagnostic code of gout who had 2 or more visits between 1st January 2018 and 31st December 2019 were included in the analysis. Data extracted included: demographics, anthropological measurements, comorbidities, serum uric acid levels and medication prescription. A patient is defined to have poor gout control if they suffer two or more acute gout attacks within a year. Chi-Squared test was used for categorical parameters. For continuous variables, univariate logistic regression analysis was first performed. Significant factors (p ≤ 0.1) were then included in the logistics regression model to account for confounders.ResultsA total of 7,970 patients and 24,624 visits were included in the analysis. The prevalence of poorly controlled gout was 28.2% (n = 2,244/7,970); only 46.3% of them (n = 1,039/2,244) were prescribed allopurinol and 13.4% (n = 301/2,244) were taking doses ≥300 mg. Using logistic regression, factors associated with poor gout control were: male gender [adjusted OR (AOR) =1.66, p

Objective: The objective of this research was to assess the level and determinants of medical personnel's knowledge, attitudes, and practices regarding the management of sexual health in breast cancer survivors residing in western China. Background: Sexual well-being is a crucial aspect of one's overall satisfaction with life. Once female sexual dysfunction (FSD) occurs, it will affect patients' satisfaction and life quality seriously. In all healthcare settings, the management of sexual health relies heavily on the vital contribution of medical personnel. Nevertheless, the sexual requirements of individuals with breast cancer are still partially unmet. Design: A web-based questionnaire was used to conduct a multi-centered, cross-sectional study involving medical staff from 26 hospitals in nine cities of Guizhou Province, China. Methods: Data was gathered from healthcare professionals using a validated tool, the knowledge, attitudes, practices assessment scale for managing the sexual health of breast cancer patients in medical staff. This tool was used to evaluate the knowledge, attitudes, and practices of medical staff regarding sexual health management. Results: In this study, a grand total of 3181 healthcare professionals took part. The overall KAP scores, including knowledge, attitudes, and practices, were 47.15 ± 11.91, 72.55 ± 12.56, and 58.61 ± 11.45, respectively. Three variables exhibited a strong and favorable correlation. The study identified significant concerns regarding the limited understanding of medical personnel regarding effective strategies for enhancing sexual health function in breast cancer patients, as well as their diminished confidence in addressing FSD. The scores of knowledge, attitudes, and practices related to sexual health management were significantly influenced by whether or not training was received. Conclusions: The study results emphasize the importance of adopting a holistic approach to enhance the understanding, perspectives, and behaviors of healthcare professionals regarding the management of sexual health. In addition to enhancing the standard of care for individuals with breast cancer.

A top-notch travel experience is vital for boosting a destination's competitiveness. Outbound travel notes of online travel agency capture tourists' experiences and emotions during their journeys, providing valuable insights for understanding tourist consumption behavior and improving tourism service policies. This study analyzes 1,012 travel blogs of Chinese tourists visiting Malaysia using grounded theory methodology. A dual-factor theoretical model is developed through open coding, spindle coding, and selective coding, illustrating the attention allocation problem of outbound tourists in their travel experiences. The study's hygiene factors comprise basic features, management aspects, and transportation components, while motivational factors include cultural elements, resource considerations, emotional factors, media influences, and commercial aspects. Research findings indicate that outbound tourists prioritize motivational factors, such as interpersonal service attributes and inherent emotional components. These factors play a crucial role in stimulating travel motivation and crafting memorable experiences. Moreover, hygiene factors, like infrastructure and security conditions, also impact tourists' experiences and are crucial for reducing dissatisfaction among outbound travelers. These results provide fresh perspectives on the factors influencing outbound tourists' experiences and their focal points during trips. The findings have significant implications for public sectors and industry professionals in tourism. By addressing the motivating and hygiene factors important to outbound tourists, they can enhance and fine-tune tourism service policies, ultimately increasing destination competitiveness. Measures such as improving infrastructure, raising service quality, and amplifying cultural experiences at the destination can all contribute to better travel experiences for tourists.

Asphalt pavement has been repeatedly subjected to vehicle loads during service. The probability and risk of water damage and asphalt deterioration of asphalt pavements is relatively higher in high temperature and rainy areas such as the Guangxi region of China. In this paper, the changes in rubbermodified asphalt and its mixtures under high temperature, water cycling, and ultraviolet light have been investigated. The coupled water-light-heat effects on asphalt pavements were simulated by developing a freeze-thaw cycle test protocol and a UV environment simulator. The high temperature performance of asphalt and asphalt mixtures before and after aging was compared and statistically analyzed by indoor tests of needle penetration, ductility, softening point, rutting factor and dynamic stability. Under water-light-heat coupling, rubberized asphalt showed a deeper degree of aging, accelerated conversion of asphalt to a highly elastic material, and an increased tendency to reduce flow capacity. The results showed decreasing dynamic stability of rubberized asphalt mixtures with decreasing needle penetration and ductility, increasing softening point, increasing rutting factor and decreasing phase angle. The effect of UV light on asphalt needle penetration was more significant, while the number of freeze-thaw cycles had a more pronounced effect on softening point.

The complete chloroplast (cp) genome of Sparganium angustifolium was sequenced and annotated in the present study. The circular genome is 161,720 bp in length and exhibits a typical quadripartite structure with a large single-copy (LSC, 88,981 bp) and small single-copy (SSC, 18,731 bp) regions, separated by a pair of inverted repeats (IRs, 27,004 bp). The cp genome contains 114 unique genes, including 80 protein-coding, 30 tRNA, and four rRNA genes. The phylogenetic analysis of Typhaceae strongly supported the monophyly of Sparganium and resolved two clades that represented newly revised two subgenera. S. angustifolia has the closest relationship with S. emersum in the present sampling extent.

To improve the heat exchange effect of energy piles in coastal areas, a new energy pile with a combination of long and short heat exchanger tubes is proposed. This technology combines the characteristics of implanted pile construction and arranges heat exchanger tubes of different lengths inside and outside the precast pipe pile, which can make full use of the geological conditions in coastal areas. Finite element analysis was applied for a project in a deep, soft soil ground to study the effectiveness of the new combined energy pile technology. The influences of the combined heat exchanger tubes and groundwater seepage conditions on the heat transfer and stress state of the energy pile were analyzed. The results show that the deformation and internal force of the pile body are closely related to temperature change. The temperature change is determined by heat transfer, which is closely related to the arrangement of heat exchanger tubes and underground water flow. With the increase of groundwater seepage velocity, the heat taken away by the heat exchanger tubes gradually increases; thus, the heat exchange between the heat exchanger tubes and the pile body decreases. The inner heat exchanger tube of the pile leads to an increase in heat exchange. However, as the length of the inner heat exchanger tube increases from 40 m to 80 m, the heat exchange decreases. The research results provide technical support for further development of the new energy pile technology.

Detecting the vertical motions of the atmosphere in convective clouds is difficult. The cost of aircraft detection is expensive, limited by maximum flight altitude, high detection risk, low frequency, etc. In recent years, remote sensing instruments are applied with the development of detection technology. Ground-based vertical pointing radar has become a reliable way to obtain atmospheric vertical motions, through which the cloud structure and dynamic characteristics of convective precipitation clouds can be obtained, and the distribution and evolution characteristics of the intensity and proportion of atmospheric vertical movement during the mature stage of convection can be monitored in detail. Based on the vertical structure detection data of precipitation clouds from ground to 15 km height by a vertical pointing radar with 5520 MHz C-band Frequency Modulation Continuous Wave (VPR-CFMCW) technology, the vertical motions in the convective precipitation cloud are retrieved, and the vertical structure of convection and evolution characteristics of vertical motions at different heights are analyzed. The VPR-CFMCW is used to carry out the atmospheric vertical motion retrieval experiments on 4 convective precipitation events at the Longmen Station in Guangdong Province during pre-monsoon from 20 April to 22 April in 2019. It is found that the updrafts of the atmosphere before convective precipitation have a positive contribution to the intensity of reflectivity and surface precipitation afterwards. The deep convection is inclined, which causes the vertical section to show a layered structure at certain moments. Convective precipitation is dominated by downdrafts of the entire level, updrafts and downdrafts of the upper-level atmosphere appear alternately, when downdrafts account for the highest proportion in the lower-level, and the updrafts account for an increased proportion above 6 km height. The intensity of atmospheric vertical motions is strong in the upper-level, as strong updrafts and downdrafts exceeding 10 m·s-1 mostly appear above 6 km height. The vertical motions vary greatly at 4-6 km height. The average downdraft speed is less than 5 m·s-1 and the average updraft speed is around 2 m·s-1 under 4 km height. The development of ground-based vertical pointing radar can improve the understanding of vertical structure evolution and dynamic characteristics of convective precipitation clouds.

Objective To observe the dynamic changes of free CD147 and its induced product matrix metalloproteinase-9 (MMP-9) of patients with traumatic brain injury (TBI) in peripheral blood, and to explore the relationship between its expression changes and short-term prognosis. Methods Thirty-nine patients with TBI admitted to the Second Hospital of Tianjin Medical University from May 2014 to December 2016 were included in the study. The expression changes of free CD147 and MMP-9 in peripheral blood were determined by enzyme-linked immunosorbent assay (ELISA), and the activity of MMP-9 was determined through gelatin zymography. The prognosis was evaluated via Glasgow Outcome Scale (GOS) at discharge. Results There was no significant difference in GOS score between male and female patients at discharge (2.63±1.28 vs. 2.57±1.14; t = 0.161, P = 0.873). There was a statistically significant difference in GOS score between different age groups at discharge (t = 2.191, P = 0.038). The GOS scores of patients over 60 years old were lower than those of patients under 40 years old (t = 2.645, P = 0.014) and those between 40 and 60 years old (t = 2.320, P = 0.029). According to the GOS score, they were divided into a good prognosis group (GOS score ≥3, n = 25) and a poor prognosis group (GOS score < 3, n = 14). Free CD147 in peripheral blood of patients with poor prognosis [(5.07±1.89) ng/ml vs. (10.37±1.69）ng/ml; t = 2.080, P = 0.048] and MMP-9 [(41.55±4.67) ng/ml vs. (75.23±5.18) ng/ml; t = 2.512, P = 0.019] were higher than the good prognosis group. Correlation analysis showed that the GOS score at discharge was negatively correlated with free CD147 (r =﹣0.473, P = 0.000) and MMP-9 (r =﹣0.435, P = 0.036) in peripheral blood. Conclusions The higher the level of free CD147 and its induced product MMP-9 in peripheral blood of patients with TBI, the worse the prognosis, which indicated that free CD147 and MMP-9 can be used as important indicators for poor prognosis of patients with TBI.

Abstract Emotional design refers to imbuing a multimedia learning environment with design attributes that promote learners’ positive affect and motivation to enhance learning. One such feature is anthropomorphism, in which human-like attributes are infused into learning elements in a multimedia learning environment. This study examines the affective, motivational, and cognitive effects of incorporating cute and funny human-like images and dialogues into learning objects depicting malware, bots, and servers in an animation conveying a lesson on how a distributed denial-of-service attack occurs. A between-subjects online experiment was conducted in which undergraduates from a large Asian university (n = 70) engaged with either the anthropomorphized or non-anthropomorphized multimedia lesson. The findings partially supported the anthropomorphism effects on learners’ affective-motivational states insofar as the anthropomorphized multimedia lesson evoked a significantly greater change of positive affect but did not differently affect intrinsic motivation and learning outcome than the non-anthropomorphized version. Concerning cognitive load, anthropomorphism led to significantly lower perceived difficulty regarding the learning topic (intrinsic load), which conforms with most emotional design findings. There was a marginal trend in which learners engaged longer with the anthropomorphized than the non-anthropomorphized multimedia lesson. This study offers insights on anthropomorphism in multimedia learning that extends to cultural factors unique to Asian learners and information technology subject domain. Theoretical and practical implications are discussed through the lens of cognitive-affective theory of learning with media, integrated cognitive affective model of learning with multimedia, and cognitive load theory. Future directions concerning anthropomorphism research in the multimedia learning context are addressed in this paper.

Safety is paramount in AV deployment. Traditionally, AV safety is incorporated during development by identifying the failure of vehicular components using risk and scenarios-based validation approaches with risk indicators. The main challenge of having a comprehensive risk assessment for AV safety is to include all potential complex environments that could occur in real-time, which is more critical for higher AV automation levels. Real-world real-time risk assessment research addresses this shortcoming by providing an advanced warning to the AV during deployment either at the vehicle level or at the infrastructure level. This paper proposes a risk tagging methodology to quantitatively risk tag the severity rating of the real-world environment for real-time risk assessment of AV using the existing roadside infrastructure. The proposed methodology - Spatial-Temporal Risk Estimation Ensemble Technique (STREET), provides advanced risk indicators in the form of pedestrian risk tag figure and time to collision value to the AV. This paper includes the evaluation of STREET, tested on four events over a pre-defined uncontrolled traffic scene from the infrastructure and validated using ground truth and heatmap of pedestrian occurrence. This methodology includes three different algorithms developed to emphasize different events depending on the AV risk and safety management strategy. The STREET reduces the bandwidth needed compared to traditional approaches of streaming video images for lightweight integration of AV risk assessment. The outcome of the pedestrian risk tag from STREET can be used as a severity rating for the existing real-time risk assessment of AV via cooperative mode.

Summary: Background: Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort. Methods: We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan–Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up. Results: We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5–17.8), decreasing to 1.2 (95% CI:0.7–1.8) at three years, and 0.4 (95% CI:0.2–0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02–1.04, p

ABSTRACT Background: Among patients with acute ischemic stroke with a mismatch between deficit severity and infarct volume, thrombectomy performed within a 6-24 hours time window has efficacy and safety similar to treatment within 6 hours. However, whether magnetic resonance imaging with T2 diffusion-weighted imaging (DWI) is feasible remains to be validated. Objective: To investigate prognosis among stroke patients receiving endovascular treatment (EVT) within 6 hours and 6-24 hours using non-contrasted computed tomography (NCCT) and DWI. Methods: Overall, 209 anterior-circulation ischemic stroke patients with large-vessel occlusion who underwent EVT were divided into ≤ 6 hours and 6-24 hours groups. Patients presenting symptoms within 6 hours were treated if their NIHSS score was ≥ 7 and ASPECTS score was ≥ 5, whereas those with wake-up stroke (WUS) or presenting symptoms 6-24 hours after last seen well (WUS/late-presenting stroke, LPS) were managed if their NIHSS score was ≥ 7 and ASPECTS score was ≥ 5. Results: The percentages of patients undergoing intracranial stenting and intracranial ballooning without stenting significantly differed between two groups (p < 0.001). Grades 0, 1, 2a and 2b recanalization rates did not differ between the 6 hours and 6-24 hours groups (all p > 0.05). Grade 3 recanalization rate in the 6 hours group was significantly lower than in the 6-24 hours group (p = 0.043). The 3-month Rankin Scale score did not significantly differ between the two groups (p = 0.629). Conclusions: EVT is a safe and effective treatment for patients with WUS and LPS selected through NCCT and DWI-based simple imaging.

Background and Objectives: There is scarce data about the epidemiology, clinical features, investigations, diagnosis, treatment, and outcome in patients attending Singapore emergency departments (EDs) with nontraumatic headache. We sought to describe these characteristics of adult patients presenting to the ED with a primary complaint of headache. Materials and Methods: We performed a cross-sectional study on adult patients with nontraumatic headache over 4 consecutive weeks from 18 March 2019 to 14 April 2019 across four EDs in Singapore. Exclusion criteria were history of head trauma within 48 h of presentation, missing records, interhospital transfers, representation with the same headache as a recent previous visit and headache as an associated symptom. Results: During the study period, 579 patients (representing 1.8% of the total ED census) comprising 55.3% males and with a median age of 36 years presented to the four Singapore EDs with a primary complaint of nontraumatic headache. Paracetamol (41.5%), non-steroidal anti-inflammatory drugs (34.4%) and tramadol (31.5%) were the three commonest analgesics used either singly or in combination. Prochlorperazine (22.9%) and metoclopramide (17.4%) were frequent anti-emetic adjuncts. One-third of patients had computed tomography of the brain performed, which found abnormalities among 20.9% of them. ED diagnoses of primary headache conditions were made in 73.6% of patients. Conclusions: Primary headaches constituted most ED headache diagnoses. ED imaging of selected patients yielded a relatively high pick-up rate for significant intracranial abnormalities. Opioid use for symptomatic relief of headaches in the ED was found to be high, underscoring the need for improvement in headache analgesia relief practices in the ED.

Squall line often leads to heavy rain, gale and hail, which is a difficult key problem in nowcasting. In order to explore the feasibility of deep learning for squall line identification, the training, validation and test set sample sets are established based on the radar data of Zhengzhou and Zhumadian in Henan Province during 2008-2020. The convolutional neural network (CNN) algorithm is used to construct a squall line identification model. The critical success index (CSI), equitable threat score (ETS), hit rate (POD) and false positive rate (FAR) are used to quantitatively evaluate the identification effect of the model. The influence of different sample composition and network structure on squall line identification effect are compared. The results show that the composition ratio of sample is imbalanced, because squall line accounts for very small proportion in all kinds of weather processes. This imbalance will degrade the classification performance of the identification model to squall line samples. The imbalance of sample composition can be improved by changing sampling mode and optimizing network structure, both can improve the identification efficiency, especially the latter. However, the combination of the two methods does not bring further improvement. The over fitting problem in network training can be alleviated by increasing the sparsity and randomness of the network structure. The validation set shows that CSI is 0.87, ETS is 0.82, POD is 0.96, and FAR is 0.10. Based on the test set, the echo can be correctly identified by network as non-squall line in the weak stage of convection development, and as squall line in the strong stage of squall line development. The echo intensity and spatial distribution of squall line cases differ greatly, and the samples in the test set have the image features which are not included in the training set, and therefore the identification effect reduces. The test set show that CSI is 0.66, ETS is 0.58, POD is 0.86, and FAR is 0.24. The research reveals that CNN can extract and learn the image features of squall line echo, and it has a certain ability to identify squall line.

Abstract Background Female sex workers (FSW) are highly susceptible to chlamydia and gonorrhea infection. However, there is limited literature examining their testing uptake to date. This study aimed to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China. Methods A cross-sectional study with convenience sampling was performed in five cities in Southern China. Data on socio-demographic characteristics, sexual behaviors, chlamydia and gonorrhea testing, and the utilization of health care services from participants were collected through face-to-face interviews. Univariate and multivariable logistic regressions were used to determine factors associated with chlamydia and gonorrhea testing, respectively. Results Overall, 1207 FSWs were recruited, with the mean age of 30.7 ± 6.8 years and an average number of clients of 7.0 (4.0–10.0) per week. 65.4% participants constantly used condoms with clients during the past month. Only 7.5 and 10.4% had been tested for chlamydia and gonorrhea in the last year, respectively. Multivariable analysis indicated that FSW who worked at low tiers (adjusted Odds Ratio (aOR) = 2.36, 95%CI:1.23–10.14), had more clients in the last month (aOR = 1.03, 95%CI:1.01–1.05), used condoms consistently (aOR = 1.79, 95%CI:1.12–2.86), had STD symptoms (aOR = 4.09,95%CI:2.62–6.40), had been tested for HIV (aOR = 5.16, 95%CI:3.21–8.30) or syphilis (aOR = 6.90, 95%CI:4.21–11.22) in the last year were more likely to have chlamydia testing. In addition, FSW who had more clients in the past month (aOR = 1.02,95%CI:1.00–1.04), had STD symptoms (aOR = 3.33, 95%CI:2.03–5.46), had been tested for HIV (aOR = 3.94, 95%CI:2.34–6.65) and syphilis (aOR = 3.27, 95%CI:1.96–5.46) in the last year were more likely to have gonorrhea testing. Conclusions The testing rates of chlamydia and gonorrhea are low among Chinese FSW. Integrating chlamydia and gonorrhea testing into HIV testing promotion programs may help bridge the gap among FSW.

Torasemide, a pyridine-3-sulfonylurea derivative, is a high-efficiency loop diuretic. During the process development of torasemide, five process-related substances, which have been specified in the pharmacopeia, would be produced. In this study, all these related substances, including compounds A–E, were synthesized via simple procedures and subsequently characterized by 1H nuclear magnetic resonance (NMR), 13C NMR, and mass spectrometry. Particularly, a simple synthetic method for compound A has not been found in previous literature. It is worth noting that other related substances could be prepared from compound B in one or two steps. The availability of these related substances could allow for quality control in the process of torasemide.

Prognostic techniques attempt to predict the Remaining Useful Life (RUL) of a subsystem or a component. Such techniques often use sensor data which are periodically measured and recorded into a time series data set. Such multivariate data sets form complex and non-linear inter-dependencies through recorded time steps and between sensors. Many current existing algorithms for prognostic purposes starts to explore Deep Neural Network (DNN) and its effectiveness in the field. Although Deep Learning (DL) techniques outperform the traditional prognostic algorithms, the networks are generally complex to deploy or train. This paper proposes a Multi-variable Time Series (MTS) focused approach to prognostics that implements a lightweight Convolutional Neural Network (CNN) with attention mechanism. The convolution filters work to extract the abstract temporal patterns from the multiple time series, while the attention mechanisms review the information across the time axis and select the relevant information. The results suggest that the proposed method not only produces a superior accuracy of RUL estimation but it also trains many folds faster than the reported works. The superiority of deploying the network is also demonstrated on a lightweight hardware platform by not just being much compact, but also more efficient for the resource restricted environment.