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Background. Transfemoral (TF) access is the gold standard for transcatheter aortic valve replacement (TAVR). Alternative peripheral (AP) artery access such as the carotid or axillary artery is considered when the feasibility of femoral access is in doubt. The outcomes comparison of these 2 approaches is unclear due to limited sample sizes in prior studies. Our aim is to compare the clinical outcomes of TF- and AP-TAVR by conducting a meta-analysis of propensity-matched studies. Methods. The PubMed, EMBASE, and Cochrane Library databases from inception up to and including February 2022 were searched by 3 separate researchers to identify articles reporting propensity-matched, comparative data on TF vs. AP-TAVR. Clinical outcomes were extracted from the articles and pooled for analysis. Results. Seven prior studies, including 9,004 patients, were included in our study, with 6,729 in the TF group and 2,275 in the AP group. In all studies, the baseline characteristics of the patients were highly propensity-matched with the full Newcastle-Ottawa scale. Meta-analysis revealed higher in-hospital/30-day mortality (3.3% vs. 4.4%; OR 0.69; 95% CI (0.51, 0.94); P = 0.02 ) as well as the incidence of stroke (1.9% vs. 3.5%; OR 0.60; 95% CI (0.43, 0.84); P = 0.003 ) for the AP group. There were no significant differences in the incidence of major vascular complications, pacemaker implantation, bleeding, or acute kidney injury. Conclusions. Our meta-analysis of propensity-matched studies showed AP-TAVR contains an additional 1.1% risk of early mortality and an additional 1.6% risk of stroke compared to TF-TAVR. These risks should be considered when deciding on access.

Background Aortic dissection (AD) during pregnancy and puerperium is a rare catastrophe with devastating consequences for both parent and fetus. Population‐level incidence trends and outcomes remain relatively undetermined. Methods and Results We queried a US population‐based health care database, the National Inpatient Sample, and identified all patients with a pregnancy‐related AD hospitalization from 2002 to 2017. In total, 472 pregnancy‐related AD hospitalizations (mean age, 30.9±0.6 years) were identified from 68 514 000 pregnancy‐related hospitalizations (0.69 per 100 000 pregnancy‐related hospitalizations), with 107 (22.7%) being type A and 365 (77.3%) being type B. The incidence of AD appeared to increase over the 16‐year study period but was not statistically significant ( P for trend >0.05). Marfan syndrome, primary hypertension, and preeclampsia/eclampsia were found in 21.9%, 14.4%, and 11.5%, respectively. On multivariable logistic regression analysis, Marfan syndrome was associated with the highest risk of developing AD during pregnancy and puerperium (adjusted odds ratio, 3469.36 [95% CI, 1767.84–6831.75]; P Conclusions We quantified population‐level incidence and in‐hospital mortality in the United States and observed an increase in the incidence of pregnancy‐related AD. In contrast, its in‐hospital mortality appears lower than that of non–pregnancy‐related AD.

The homodimerization of CD44 plays a key role in an intercellular-to-extracellular signal transduction and tumor progression. Acylated modification and specific membrane environments have been reported to mediate translocation and oligomerization of CD44; however, the underlying molecular mechanism remains elusive. In this study, extensive molecular dynamics simulations are performed to characterize the dimerization of palmitoylated CD44 variants in different bilayer environments. CD44 forms homodimer depending on the cysteines on the juxta-membrane domains, and the dimerization efficiency and packing configurations are defected by their palmitoylated modifications. In the phase-segregated (raft included) membrane, homodimerization of the palmitoylated CD44 is hardly observed, whereas PIP2 addition compensates to realize dimerization. However, the structure of CD44 homodimer formed in the phase-segregated bilayer turns susceptive and PIP2 addition allows for an extensive conformation of the cytoplasmic domain, a proposal prerequisite to access the cytoskeleton linker proteins. The results unravel a delicate competitive relationship between PIP2, lipid raft, and palmitoylation in mediating protein homodimerization, which helps to clarify the dynamic dimer conformations and involved cellular signaling of the CD44 likewise proteins.

Thrombopoietin (TPO) is a primary regulator of thrombopoiesis in physiological conditions. TPO, in combination with its specific cytokine receptor c-Mpl, drives platelet production by inducing the proliferation and differentiation of megakaryocytes. However, the role of TPO in sepsis is not well determined. The elevated levels of TPO are often accompanied by a decrease of platelet count (PLT) in systemic infected conditions, which is contrary to the view that TPO promotes platelet production under physiological conditions. In addition, whether TPO mediates organ damage in sepsis remains controversial.To explore the relationships between TPO and inflammatory factors, platelet indices, and thrombotic indicators in sepsis.A total of 90 patients with sepsis diagnosed and treated at the emergency medicine department of The First People's Hospital of Foshan between January 2020 and March 2021 were enrolled in this study. In addition, 110 patients without sepsis who came to the emergency medicine department were included as controls. Clinical and laboratory parameters including age, gender, TPO, blood cell count in peripheral blood, platelet indices, inflammatory factors such as high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-21, and IL-6, organ damage indicators, and thrombotic indicators were collected and analyzed by using various statistical approaches.The results showed that the TPO levels were higher in the sepsis group than in controls [86.45 (30.55, 193.1)TPO levels are independently associated with sepsis. High TPO levels and low PLT suggest that TPO might be an acute-phase response protein in patients with infection.

The reliability of the machining process is a vital indicator in the manufacturing process of mechanical parts, and directly related to the machining quality of mechanical products. In order to effectively utilize machining process information and machining quality inspection data to evaluate the reliability of the machining process, this paper extends the relevant concepts of information theory to the field of mechanical manufacturing error analysis and establishes a reliability analysis model of the machining process. The model introduces information entropy into the analysis of machining process reliability by defining vertex entropy to measure the uncertainty of the machining quality of each process, and thus realizing the determination of critical processes using a fully quantitative method. Meanwhile, the transfer coefficient defined by mutual information is used to measure the transfer of machining error between two processes. Through combining vertex entropy and the transfer coefficient, the quantitative analysis of machining process reliability is achieved. The model proposed in this paper addresses the issue that the subjective factors of researchers in other related studies have an impact on the analysis results. Finally, the correctness of the proposed model is verified using Monte Carlo simulations.

BackgroundGastric cancer (GC) is a serious threat to human health. The clinical GC characteristics in China may be impacted by changes in people’s lifestyles and the promotion of early GC (EGC) screening. The present study aims to evaluate the recent trends of GC characteristics in South China and search for hazardous factors limiting the survival time of GC patients.MethodsData on GC patients that were hospitalized in the Department of Digestive Center, the First Affiliated Hospital, Sun Yat-sen University, from 1994 to 2019 were collected and divided into two categories according to the time when the EGC screening began in China: the PRE group (previous 13 years, 1994–2006) and the PAS group (past 13 years, 2007–2019).ResultsWe found that, although the 5-year survival rate increased in the PAS group compared with the PRE group (P < 0.0001), patients with age ≥60 years or Borrmann type IV still had a worse prognosis. In the PAS group, the larger percentages of elderly patients and patients with Borrmann type IV in the lymphatic metastases (N1) group (41.0% vs. 51.1%, P = 0.0014) and stage IV subgroup (20.7% vs. 32.2%, P = 0.016), respectively, when compared with the PRE group, may have contributed to the poor outcome of GC. By comparing the odds ratio (OR) of 5-year overall survival (OS) in the two 13-year periods, female sex and T2 turned into risk factors because of a greater proportion of Borrmann type IV or elderly patients in the PAS group (OR = 0.983, 95% CI = 0.723–1.336 vs. OR = 1.277, 95% CI = 1.028–1.586 and OR = 1.545, 95% CI = 0.499–4.775 vs. OR = 2.227, 95% CI = 1.124–4.271, respectively).ConclusionsDespite the GC epidemiology changes, the overall prognosis of GC patients has improved in South China. However, old age and Borrmann type IV are still the major restrictions affecting the survival of GC patients, a situation which calls for additional attention.

The emerging and ongoing outbreak of human monkeypox (hMPX) in 2022 is a serious global threat. An understanding of the evolution of the monkeypox virus (MPXV) at the single-gene level may provide clues for exploring the unique aspects of the current outbreak: rapidly expanding and sustained human-to-human transmission. For the current investigation, alleles of 156 MPXV coding genes (which account for >95% of the genomic sequence) have been gathered from roughly 1,500 isolates, including those responsible for the previous outbreaks. Using a range of molecular evolution approaches, we demonstrated that intra-species homologous recombination has a negligible effect on MPXV evolution. Despite the fact that the majority of the MPXV genes (64.10%) were subjected to negative selection at the whole gene level, 10 MPXV coding genes (MPXVgp004, 010, 012, 014, 044, 098, 138, 178, 188, and 191) were found to have a total of 15 codons or amino acid sites that are known to evolve under positive Darwinian selection. Except for MPXVgp138, almost all of these genes encode proteins that interact with the host. Of these, five ankyrin proteins (MPXVgp004, 010, 012, 178, and 188) and one Bcl-2-like protein (MPXVgp014) are involved in poxviruses’ host range determination. We discovered that the majority (80%) of positive amino acid substitutions emerged several decades ago, indicating that these sites have been under constant selection pressure and that more adaptable alleles have been circulating in the natural reservoir. This finding was also supported by the minimum spanning networks of the gene alleles. The three positive amino acid substitutions (T/A426V in MPXVgp010, A423D in MPXVgp012, and S105L in MPXVgp191) appeared in 2019 or 2022, indicating that they would be crucial for the virus’ eventual adaptation to humans. Protein modeling suggests that positive amino acid substitutions may affect protein functions in a variety of ways. Further study should focus on revealing the biological effects of positive amino acid substitutions in the genes for viral adaptation to humans, virulence, transmission, and so on. Our study advances knowledge of MPXV’s adaptive mechanism and provides insights for exploring factors that are responsible for the unique aspects of the current outbreak.

Two series of novel 2-cyano-5-oxopentanoic acid derivatives (1a−l, 2a−l) were designed, synthesized, and characterized by IR, 1H NMR, 13C NMR, and HRMS. Their in vitro antifungal activity against five plant pathogenic fungi were then assessed, including Gibberella zeae, Helminthosporium maydis, Rhizoctonia solani, Botrytis cinerea, and Sclerotinia sclerotiorum. Single crystals of compound 1c were determined and crystallized in the orthorhombic system with space group Fdd2. The inhibitory rate and the median effect concentrations (EC50) of compounds 1c, 1g, 1k, and 2i were better than carbendazim against S. sclerotiorum at 20 µg/mL. Meanwhile, the half inhibitory concentrations (IC50) of compounds 1c, 1g, 1k, and 2i against succinate dehydrogenase (SDH) and their score in molecular docking were both lower than carbendazim, indicating that these four compounds have stronger antifungal activities and affinities than carbendazim. Therefore, we conclude that compounds 1c, 1g, 1k, and 2i might be potential succinate dehydrogenase inhibitors (SDHIs).

As a neuroendocrine tumor derived from the neural crest, neuroblastoma (NB) is the most common extracranial solid tumor in children. The prognosis in patients with low- and intermediate-risk NB is favorable while that in high-risk patients is often detrimental. However, the management of the considerably large proportion of high-risk patients remains challenging in clinical practice. Among various new approaches, oncolytic virus (OV) therapy offers great advantages in tumor treatment, especially for high-risk NB. Genetic modified OVs can target NB specifically without affecting normal tissue and avoid the widespread drug resistance issue in anticancer monotherapy. Meanwhile, its safety profile provides great potential in combination therapy with chemo-, radio-, and immunotherapy. The therapeutic efficacy of OV for NB is impressive from bench to bedside. The effectiveness and safety of OVs have been demonstrated and reported in studies on children with NB. Furthermore, clinical trials on some OVs (Celyvir, Pexa-Vec (JX-594) and Seneca Valley Virus (NTX-010)) have reported great results. This review summarizes the latest evidence in the therapeutic application of OVs in NB, including those generated in cell lines, animal models and clinical trials.

Medication administration is a critical safety issue in hospitals and the community. Children are especially at risk because of their dependence on adults to safely administer medications. The purpose of this study was to examine non-compliance with state child care medication administration regulations and factors associated with improved compliance. The data included routine, unannounced inspections of child care programs by state licensing specialists collected in two time periods over 10 years. Factors potentially associated with regulatory compliance were included in this secondary analysis. Most child care center medication administration regulations showed decreased non-compliance between the two time periods. However, regulations pertaining to prescriber orders and parent permission revealed a significant increase in non-compliance (58.4%). Factors positively associated with medication administration regulatory compliance included: compliance with annual professional development (p

As a clean and renewable energy, wave energy has abundant reserves, and its reasonable development and utilization can effectively alleviate the problems of energy shortage and environmental pollution. This paper proposes a mechanical rectification wave energy converter. The reciprocating linear motion of the buoy is directly converted into the rotary motion through the ball screw. The magnetic coupling force transmission system is adopted to ensure the sealing of the device. Using mechanical rectification mechanism to ensure the service life of the generator. In addition, a dynamic model of the mechanical rectification wave energy converter is established. Through simulation analysis, the curve of power with load resistance is obtained. And there is an optimal load resistance value corresponding to the maximum power in different wave conditions. In order to improve the power generation efficiency, the maximum power point tracking control algorithm is designed based on the admittance differentiation method. By controlling the duty cycle of the switch tube in the Buck‐Boost chopper circuit, the variable load is realized, and then the maximum power point tracking control is realized. Finally, simulation analysis verifies the feasibility of the algorithm under different wave conditions.

Biliary atresia (BA) is a devastating inflammatory and fibrosing cholangiopathy of neonates with unknown aetiology. We aim to investigate the relationship between these two main characteristics.Single-cell RNA sequencing and spatial transcriptomics were performed on liver samples from a cohort of 14 objects (BA: n = 6; control: n = 8). We conducted data integration and cell-type annotation based on gene expression profiling. Furthermore, we identified fibrosis-related immune cells according to their spatial locations, GO and KEGG analysis. Finally, SPOTlight and CIBERSORTx were used to deconvolute ST data and microarray data of the GSE46960 cohorts, respectively.Immune subpopulations inhabiting the 'fibrotic niche' (areas of scarring), comprising 'intermediate' CD14Fibrosis is an important feature of BA, in which the immune system plays an important role. Our work reveals the subpopulations of immune cells enriched in the fibrotic niche of BA liver, as well as key related pathways and molecules; some are highlighted for the first time in liver fibrosis. These newly identified interactions might partly explain why the rate of liver fibrosis occurs much faster in BA than in other liver diseases.Our study revealed the molecular, cellular and spatial immune microenvironment of the fibrotic niche of BA.

Legionnaires’ disease (LD), caused by Legionella, including the most prevalent Legionella pneumophila, has been treated primarily with antibiotics. Environmental water and soil are the reservoirs for L. pneumophila. Studying antimicrobial susceptibility using a large number of isolates from various environmental sources and regions could provide an unbiased result. In the present study, antimicrobial susceptibility of 1464 environmental L. pneumophila isolates that were derived from various environmental water and soil sources of 12 cities in China to rifampin (RIF), erythromycin (ERY), clarithromycin (CLA), azithromycin (AZI), ciprofloxacin (CIP), moxifloxacin (MOX), levofloxacin (LEV), and doxycycline (DOX) was investigated, and minimum inhibitory concentration (MIC) data were obtained. We show that regarding macrolides, ERY was least active (MIC90 = 0.5 mg/L), while CLA was most active (MIC90 = 0.063 mg/L). A total of three fluoroquinolones have similar MICs on L. pneumophila. Among these antimicrobials, RIF was the most active agent, while DOX was the most inactive one. We observed different susceptibility profiles between serogroup 1 (sg1) and sg2-15 or between water and soil isolates from different regions. The ECOFFs were ERY and AZI (0.5 mg/L), RIF (0.002 mg/L), CIP, CLA and MOX (0.125 mg/L), LEV (0.063 mg/), and DOX (32 mg/L). Overall, two fluoroquinolone-resistant environmental isolates (0.14%) were first documented based on the wild-type MIC distribution. Not all azithromycin-resistant isolates (44/46, 95.65%) harbored the lpeAB efflux pump. The MICs of the ERY and CLA on the lpeAB + isolates were not elevated. These results suggested that the lpeAB efflux pump might be only responsible for AZI resistance, and undiscovered AZI-specific resistant mechanisms exist in L. pneumophila. Based on the big MIC data obtained in the present study, the same defense strategies, particularly against both CLA and RIF, may exist in L. pneumophila. The results determined in our study will guide further research on antimicrobial resistance mechanisms of L. pneumophila and could be used as a reference for setting clinical breakpoints and discovering antimicrobial-resistant isolates in the clinic, contributing to the antibiotic choice in the treatment of LD.

During the rough marine environment, heave compensation is used to offset the heave motion of the vessel when a marine crane lifts and lands the load. Thus, load motion and vessel motion are realized decoupled. In previous studies, the interference items such as hydraulic cylinder friction, underwater drag force and nonlinear friction in the active heave compensation system of a marine hydraulic crane are compensated as a concentrated interference force to be estimated. In this paper, we disassembled the interference items; the disturbance observer and adaptive rate are designed to estimate unmodeled disturbance force and system uncertain parameters, respectively; and we designed an active heave compensator with the adaptive nonlinear cascade controller which has the disturbance observer (DOB-ANCC). For the heave compensation of load displacement, this paper derived the control law of the nonlinear system model based on the backstepping method. The outer loop control is displacement control and the inner loop control is pressure control. The simulation verifies the effectiveness of the control strategy proposed in this paper and the availability of heave displacement compensation for a marine crane hoisting load. The compensation efficiency of the designed controller (DOB-ANCC) for the heave motion of the load can reach more than 95%, and the maximum displacement tracking error of the controller can reach ± 0.035 m.

This study examined the impact of attitudes toward life, recreational sports values, and workplace risk perceptions on urban development and public well-being under the risk of the COVID-19 epidemic in China. A mixed-method research study was conducted, and 2400 valid questionnaires were collected via purposeful sampling. The questionnaires were analyzed using the SPSS 26.0 statistical software and validated with basic statistical methods and Pearson’s correlation analysis. Semi-structured interviews were then conducted to collect the opinions of 12 respondents on the questionnaire results, including academics, foreign entrepreneurs and employees, local entrepreneurs and employees, and official institutions. Finally, all the data collected were discussed via triangulation analysis. The survey found that different cities’ social and industrial development and job market needs lead to different attitudes toward life, leisure values, and perceptions of job-seeking and employment risks. The smoother a person’s growing-up background, the better their learning history, the better their learning and working experience, and the richer their life experience; consequently, positive attitudes toward life, correct leisure values, and positive attitudes toward job hunting and employment can be cultivated. In addition, people with positive attitudes toward life, leisure values, and job hunting and employment can improve their city’s economy and environment for sustainable development, thereby improving their quality of life and increasing their well-being.

Breast cancer is a malignant disease that seriously threatens women’s health. Studying the mechanism of cancer occurrence and development is an urgent problem to be solved. In this paper, the eigen-microstate method was used to study conversion of normal breast cells into breast cancer cells and the reason. The main conclusions are as follows: the microstates of normal breast cell and breast cancer cell are different. There is a state conversion when a normal breast cell transforms into a breast cancer cell. The main reason for this state conversion is the combined effect of tumor suppressor genes and oncogenes. By analyzing the function of key genes, it was found that these genes do play an important role in the development of breast cancer. The findings contribute to understanding the mechanism by which breast cancer occurs and progresses, and key genes can serve as potential biomarkers or target genes for breast cancer treatment.

Calcium-activated chloride channels (CaCCs) are widespread chloride channels which rely on calcium activation to perform their functions. In 2008, TMEM16A (also known as anoctamin1, ANO1) was identified as the molecular basis of the CaCCs, which provided the possibility to study the physiological function of CaCCs. TMEM16A is widely expressed in various cells and controls basic physiological functions, including neuronal and cardiac excitability, nerve transduction, smooth muscle contraction, epithelial Cl- secretion and fertilization. However, the abnormal function of TMEM16A may cause a variety of diseases, including asthma, gastrointestinal motility disorder and various cancers. Therefore, TMEM16A is a putative drug target for many diseases, and it is important to determine specific and efficient modulators of TMEM16A channel. In recent years, we and others have screened several natural modulators of TMEM16A against cancers and gastrointestinal motility dysfunction. This article reviews the screening methods, efficacy of TMEM16A modulators and pharmacological effects of TMEM16A modulators on different diseases. GRAPHIC ABSTACT.

A 39-year-old woman with a 3-year human papillomavirus (HPV) 18 infection history was admitted to the hospital for a 16-day history of vaginal bleeding after sex. She was diagnosed with cervical cancer based on the results of the electronic colposcopy, cervical cytology, microscopy, and magnetic resonance imaging (MRI). Then, she received chemotherapy, with paclitaxel 200 mg (day 1), cisplatin 75 mg (day 2), and bevacizumab 700 mg (day 3) twice with an interval of 27 days. During the examination for the diagnosis and treatment, many invasive operations, including removal of intrauterine device, colposcopy, and ureteral dilatation, were done. After that, the patient was discharged and entered the emergency department about 2.5 months later with a loss of consciousness probably caused by septic shock. The patient finally died of multiple organ failure and bacterial infection, although she has received antimicrobial therapy. The blood cultures showed a monobacterial infection with an anaerobic Gram-positive bacterial strain, designated as SAHP1. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI–TOF MS) indicated that the patient was infected with Peptoniphilus asaccharolyticus, while molecular analysis and genome-based taxonomy confirmed the infection with a novel Peptoniphilus species that has a close genetic relationship with Peptoniphilus vaginalis and proposed provisionally as Peptoniphilus septimus sp. nov., which may also act as a commensal of the human vagina. Genomic features of SAHP1 have been fully described, and comparative genomic analysis reveals the known prokaryote relative of Peptoniphilus septimus sp. nov. in the genus Peptoniphilus. The invasive operations on the genital tract during the diagnosis and treatment of the patient and the tumor tissue damage and bleeding may have a certain role in the bloodstream infection. This study casts a new light on the Peptoniphilus bacteria and prompts clinicians to include anaerobic blood cultures as part of their blood culture procedures, especially on patients with genital tract tumors. Furthermore, due to the incomplete database and unsatisfying resolution of the MALDI–TOF MS for Peptoniphilus species identification, molecular identification, especially whole-genome sequencing, is required for those initially identified as bacteria belonging to Peptoniphilus in the clinical laboratory.

Pathogenic Legionella spp. is the causative agent of Legionnaires’ disease (LD), and L. pneumophila is the most common one. Most studies have focused on L. pneumophila from water and clinical samples.

This study constructs comprehensive panel data based on the China City Statistical Yearbook and environmental indicators disclosed by the Ministry of Ecology and Environment from 2013 to 2017, using a difference-in-difference (DID) model to empirically validate the effects of the ecological environmental damage compensation system on urban air quality, followed by a further analysis of the system’s effect mechanism, namely, how the system has generated effects on reducing environmental pollution. This study finds that: (1) the ecological environmental damage compensation system can significantly improve urban air quality, and small cities are more sensitive to the pilot policy; and (2) the main impact is that the pilot policy mechanism improved the urban pollutant treatment capacity and reduced the proportion of the secondary industry. After multiple robustness tests, this conclusion still holds. This study provides empirical evidence for fully implementing an ecological environmental damage compensation system.

Osteoclast over-activation leads to bone loss and chloride homeostasis is fundamental importance for osteoclast function. The calcium-activated chloride channel Anoctamin 1 (also known as TMEM16A) is an important chloride channel involved in many physiological processes. However, its role in osteoclast remains unresolved. Here, we identified the existence of Anoctamin 1 in osteoclast and show that its expression positively correlates with osteoclast activity. Osteoclast-specific Anoctamin 1 knockout mice exhibit increased bone mass and decreased bone resorption. Mechanistically, Anoctamin 1 deletion increases intracellular Cl− concentration, decreases H+ secretion and reduces bone resorption. Notably, Anoctamin 1 physically interacts with RANK and this interaction is dependent upon Anoctamin 1 channel activity, jointly promoting RANKL-induced downstream signaling pathways. Anoctamin 1 protein levels are substantially increased in osteoporosis patients and this closely correlates with osteoclast activity. Finally, Anoctamin 1 deletion significantly alleviates ovariectomy induced osteoporosis. These results collectively establish Anoctamin 1 as an essential regulator in osteoclast function and suggest a potential therapeutic target for osteoporosis.

Burstable billing is widely adopted by colocation data center providers to charge their users for data transferring. This paper proposes a cost-aware traffic management approach for a colocation data center user under burstable billing where it is charged based on the 95th percentile bandwidth usage. To do this, we first develop a tractable mathematical expression to calculate the 95th percentile usage of a user. Then, we develop an optimization problem to maximize the user’s surplus based on both deterministic and stochastic predictions of the user’s demand. We show that the resulted optimization problem, while non-convex by nature, can be efficiently solved or approximated using a convex program. We also show that the proposed approach can also be applied in a more general scenario where the user gets services from multiple service providers. Using real-world workload traces, we show that the proposed approach can reduce a colocation data center user’s IP transit cost by 26 percent and increase its total surplus by 23 percent, compared to the current practice of allocating bandwidth on-demand.

The distribution of pathogenic

Legionnaires' disease (LD), caused by

Background and ObjectiveIt is urgent to find out an alternative therapy for Kawasaki disease (KD) since around 20% patients are resistant to intravenous immunoglobulin (IVIG) or aspirin. Tanshinone IIA is the active component of the traditional Chinese medicine Danshen (Salvia miltiorrhiza), which has anti-inflammatory and anti-platelet properties; however, whether or not tanshinone IIA has a therapeutic effect on KD remains unclear. Therefore, the present study aimed to examine the effect of tanshinone IIA on KD patients and rabbits with immune vasculitis, and to identify the potential mechanisms with special emphasis on megakaryopoiesis and megakaryocytic apoptosis.MethodsKawasaki disease patients were recruited and prescribed with tanshinone IIA in the absence or presence of aspirin and IVIG, and the inflammatory responses and platelet functions were determined. Megakaryocytes (MKs) isolated from rabbits with immune vasculitis and human megakaryocytic CHRF-288-11 cells were treated with tanshinone IIA to examine the colony forming unit (CFU) and apoptosis, respectively. Microarray assay was conducted to identify potential targets of tanshinone IIA-induced apoptosis.ResultsTanshinone IIA reduced the serum levels of C-reactive protein (CRP), interleukin (IL)-1β, IL-6, and P-selectin in KD patients; such inhibitory effect was more significant compared to aspirin and IVIG. It also dose-dependently lowered the levels of tumor necrosis factor (TNF)-α and IL-8 in peripheral blood mononuclear cells isolated from KD patients. In rabbits with immune vasculitis, tanshinone IIA significantly reduced the serum levels of proinflammatory cytokines and platelet functions. In addition, tanshinone IIA significantly decreased the number of bone marrow MKs and inhibited the Colony Forming Unit-Megakaryocyte (CFU-MK) formation. In human megakaryocytic CHRF-288-11 cells, tanshinone IIA induced caspase-dependent apoptosis, probably through up-regulating TNF receptor superfamily member 9 (TNFRSF9) and the receptor (TNFRSF)-interacting serine/threonine-protein kinase 1 (RIPK1), which may contribute to its anti-platelet and anti-inflammatory properties.ConclusionTanshinone IIA exerts better anti-inflammatory and anti-platelet effects in treating KD patients than aspirin and IVIG. It attenuates immune vasculitis likely by inhibiting IL-mediated megakaryopoiesis and inducing TNFRSF9/RIPK1/caspase-dependent megakaryocytic apoptosis. The findings therefore suggest that tanshinone IIA may be a promising alternative therapy for the treatment of KD.

Sialoblastoma (SBL) is an infrequent embryonal malignant tumor originating from the salivary gland, resembling primitive salivary gland anlage, whereas hepatoblastoma (HB) is the most common pediatric liver malignancy. The simultaneous occurrence of both tumors is extremely rare. Here we reported a case of a 6-month-old infant diagnosed with synchronous SBL and HB. The patient received neoadjuvant chemotherapy followed by surgical resection. Fresh tissues of both tumors were collected before and after chemotherapy, which were further profiled by whole exome sequencing (WES) and single-cell RNA sequencing (scRNA-seq). WES analysis revealed potential somatic driver mutation PIK3CA p.Glu454Lys for SBL and canonical mutation CTNNB1 p.Ser45Pro for HB. No shared somatic variants or common copy number alterations were found between SBL and HB primary tumor samples. Though scRNA-seq, single-cell atlases were constructed for both tumors. SBL may recapitulate a pre-acinar stage in the development of salivary gland, including basaloid, duct-like, myoepithelial-like, and cycling phenotypes. In the meantime, HB was composed of tumor cells resembling different stages of the liver, including hepatocyte-like, hepatic progenitor-like, and hepatoblast-like cells. After chemotherapy, both tumors were induced into a more mature phenotype. In terms of transcriptional signatures, SBL and HB showed enhanced expression of epithelial markers KRT8, KRT18, and essential embryo development genes SDC1, MDK, indicating the disruption of normal embryo epithelium development. Finally, heterozygous deleterious germline mutation BLM and FANCI were identified which could predispose the patient to higher cancer risk. It partially explained the reason for the co-occurrence of SBL and HB. Taken together, we provided valuable resources for deciphering cellular heterogeneity and adaptive change of tumor cells after chemotherapy for synchronous SBL and HB, providing insights into the mechanisms leading to synchronous pediatric tumors.

Wound management remains a worldwide challenge. It is undeniable that patients with problems such as difficulties in wound healing, metabolic disorder of the wound microenvironment and even severely infected wounds etc. always suffer great pain that affected their quality of lives. The selection of appropriate wound dressings is vital for the healing process. With the advances of technology, hydrogels dressings have been showing great potentials for the treatment of both acute wounds (e.g., burn injuries, hemorrhage, rupturing of internal organs/aorta) and chronic wounds such as diabetic foot and pressure ulcer. Particularly, in the past decade, polysaccharide-based hydrogels which are made up with abundant and reproducible natural materials that are biocompatible and biodegradable present unique features and huge flexibilities for modifications as wound dressings and are widely applicable in clinical practices. They share not only common characteristics of hydrogels such as excellent tissue adhesion, swelling, water absorption, etc., but also other properties (e.g., anti-inflammatory, bactericidal and immune regulation), to accelerate wound re-epithelialization, mimic skin structure and induce skin regeneration. Herein, in this review, we highlighted the importance of tailoring the physicochemical performance and biological functions of polysaccharide-based hydrogel wound dressings. We also summarized and discussed their clinical states of, aiming to provide valuable hints and references for the future development of more intelligent and multifunctional wound dressings of polysaccharide hydrogels.

Aims: This study aimed to determine the expression of asparagine synthetase (ASNS) in breast cancer (BC) tissues and estimate its prognostic value for BC patients. Besides, the roles of ASNS in the...

Background Transaxillary access (TAx) has shown promise as an excellent alternative TAVR option, but data on the Edwards SAPIEN 3 in TAx-TAVR is limited. We sought to study the safety and efficacy of TAx-TAVR using this current-generation balloon-expandable valve. Methods A retrospective study of our first 24 TAx and 20 transthoracic (TT) TAVR patients treated with the SAPIEN 3 valve was performed, and the patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were compared to our first 100 transfemoral (TF) patients using the SAPIEN 3 device. Results There were no statistical differences observed for outcomes between the TAx and TF groups, despite the TAx patients having more comorbidities (STS-PROM 11.3 ± 7.6 versus 7.3 ± 5.2, p = 0.042). In addition, no significant difference was found in the fluoroscopy time and contrast amount between the two groups. The patients’ baseline characteristics were similar between the TAx and TT groups. Their procedural and clinical outcomes were comparable, but there was a trend towards lower incidence of acute kidney injury (13.0% versus 23.5%), new-onset atrial fibrillation (5.6% versus 33.3%), shorter median length of stay postoperatively (4 versus 6 days), fewer discharges to rehabilitation (16.7% versus 35.0%), and a lower rate of readmission within 30-days (8.3% versus 35.0%), all favoring TAx access. Conclusions TAx-TAVR with the SAPIEN 3 valve is a safe alternative to TF access. It offers advantages of improved recovery over TT access, and appears to be a superior alternative-access option for TAVR. TAx access could be preferred when TF access is not feasible.

Objective We aimed to evaluate the short-term efficacy and safety of fecal microbiota transplantation (FMT) by washed preparation for moderate to severely active UC. Methods An open-label prospective trial was conducted in an inflammatory bowel disease (IBD) tertiary referral center from April 2016 to March 2018. Patients with moderate to severely active UC were randomly assigned to undergo FMT thrice on day 1, 3 and 5 by nasojejunal tube (NJT) or transendoscopic enteral tubing (TET). The primary end-point was a clinical response at week 2 post-FMT. The secondary end-points were clinical and endoscopic remission at week 12 post-FMT, safety and disease progression. Results Of the nine patients included, 77.8% (7/9) achieved a clinical response at week 2. And 55.6% (5/9) and 33.3% (3/9), respectively, achieved clinical remission and endoscopic remission at week 12. In two patients who had no response to FMT, one switched to anti-tumor necrosis factor-α therapy, and the other underwent a colectomy. FMT was delivered through NJT in 44.4% (4/9) of the patients, while TET was used in 55.6% (5/9). The clinical outcomes did not differ significantly based on the delivery route (P > 0.05). Adverse events, all mild and self-limiting, were observed in 33.3% (3/9) of the patients. Conclusions FMT by washed preparation appears to be a safe and effective adjunct therapy for moderate to severely active UC during a short-term follow-up. The efficacy did not differ significantly between the NJT or TET delivery routes. Further randomized controlled studies are needed to confirm these findings.

Sesamum indicum has various biological effects, and this study aimed to investigate its hypolipidemic effect. A hyperlipidemia rat model was established by feeding rats with high-fat diets in this study, then the hyperlipidemia rats were fed with different doses of black and white sesame seeds and black and white sesame kernels. The serum and liver biochemical indicators of the rats were determined, and liver pathology analysis was conducted to evaluate the hypolipidemic effect of sesame. The results showed that the blood lipid of SD (Sprague-Dawley) rats fed with high-fat diet for three weeks was higher than 200 mg/dL, indicating that the hyperlipidemia rat model was successfully established. At the same dose, the final body weights of the rats of white sesame seed and kernel groups were higher than those of the black sesame seed and kernel groups; and the weights of the black and white sesame seed groups were lower than those of the black and white sesame kernel groups. The liver indexes of the normal control group and the experimental groups were significantly lower than the model control group (P

The homeostasis of the gut-brain axis has been shown to exert several effects on physiological and psychological health. The gut hormones released by enteroendocrine cells scattered throughout the gastrointestinal tract are important signaling molecules within the gut-brain axis. The interaction between gut microbiota and gut hormones has been greatly appreciated in gut-brain cross-talk. The microbiota plays an essential role in modulating many gut-brain axis-related diseases, ranging from gastrointestinal disorders to psychiatric diseases. Similarly, gut hormones also play pleiotropic and important roles in maintaining health, and are key signals involved in gut-brain axis. More importantly, gut microbiota can affect the release and functions of gut hormones. This review highlights the role of gut microbiota in the gut-brain axis and focuses on how microbiota-related gut hormones modulate various physiological functions. Future studies could target the microbiota-hormones-gut brain axis to develop novel therapeutics for different psychiatric and gastrointestinal disorders, such as obesity, anxiety, and depression.