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Current care models are inadequate to address the dual epidemic of hypertension and HIV in sub-Saharan Africa. We developed a community health worker (CHW)-delivered educational intervention, integrated into existing HIV care to address hypertension in persons living with HIV. A detailed educational curriculum was created with five sessions: three in-person clinic sessions and two telephone sessions. The intervention was piloted among hypertensive adults at one HIV clinic in northern Tanzania over a 4-week period. Primary outcomes were feasibility, fidelity, and acceptability of the intervention. Secondary outcomes included hypertension care engagement and systolic and diastolic blood pressure (SBP and DBP). Among 16 eligible participants, 14 (64% women, median age of 54.5 years) were recruited into the study, and 13 (92.9%) completed all five intervention sessions. The intervention was delivered with 98.8% fidelity to the curriculum content. Hypertension care engagement improved following the intervention. At baseline, two (15.4%) participants had seen a doctor previously for hypertension, compared to 11 (84.6%) participants post-intervention (P = .0027). No participant was using antihypertensives at baseline, compared to 10 (76.9%) post-intervention (P = .0016). Pre-intervention median SBP was 164 (IQR 152-170) mmHg, compared to post-intervention SBP of 146 (IQR 134-154) mmHg (P = .0029). Pre-intervention median DBP was 102 (IQR 86-109) mmHg, compared to post-intervention DBP of 89 (IQR 86-98) mmHg (P = .0023). A CHW-delivered educational intervention, integrated into existing HIV care, is feasible and holds promise in improving hypertension care engagement and reducing blood pressure. Further research is needed to evaluate the efficacy and scale-up of our intervention.

Prediction models indicate that melioidosis may be common in parts of East Africa, but there are few empiric data. We evaluated the prevalence of melioidosis among patients presenting with fever to hospitals in Tanzania. Patients with fever were enrolled at two referral hospitals in Moshi, Tanzania, during 2007–2008, 2012–2014, and 2016–2019. Blood was collected from participants for aerobic culture. Bloodstream isolates were identified by conventional biochemical methods. Non–glucose-fermenting Gram-negative bacilli were further tested using a Burkholderia pseudomallei latex agglutination assay. Also, we performed B. pseudomallei indirect hemagglutination assay (IHA) serology on serum samples from participants enrolled from 2012 to 2014 and considered at high epidemiologic risk of melioidosis on the basis of admission within 30 days of rainfall. We defined confirmed melioidosis as isolation of B. pseudomallei from blood culture, probable melioidosis as a ≥ 4-fold rise in antibody titers between acute and convalescent sera, and seropositivity as a single antibody titer ≥ 40. We enrolled 3,716 participants and isolated non-enteric Gram-negative bacilli in five (2.5%) of 200 with bacteremia. As none of these five isolates was B. pseudomallei, there were no confirmed melioidosis cases. Of 323 participants tested by IHA, 142 (44.0%) were male, and the median (range) age was 27 (0–70) years. We identified two (0.6%) cases of probable melioidosis, and 57 (17.7%) were seropositive. The absence of confirmed melioidosis from 9 years of fever surveillance indicates melioidosis was not a major cause of illness.

We present the design and the test results of a quad-channel optical transceiver module (QTRx) possibly for future particle physics experiments. The transmitters of QTRx, each at 10 Gbps, are based on a Quad-channel VCSEL Diode array Driver (QLDD) and 1 x 4 VCSEL array. The receivers of QTRx, with data rates of 2.56 Gbps or 10 Gbps per channel, are based on a Quad-channel Trans-Impedance and limiting Amplifier (QTIA) and 1 x 4 photodiode array of GaAs or InGaAs. QTRx is 20 mm x 10 mm x 5 mm and couples to an MT fiber connector. Test results indicate that QTRx achieves the design goals with a power consumption of 124 mW per transmitter channel at 10 Gbps and 120 mW at 2.56 Gbps for the receiver channel with an on-chip charge pump. The sensitivities of QTIA are -17 dBm at 2.56 Gbps and -8 dBm at 10 Gbps, respectively. Further improvements with a gold-finger interface and a more compact optical lens are being designed., Comment: 7 pages, 7 figures

We present the design and test results of a novel data transmitter ASIC operating up to 20.48 Gbps with 4-level Pulse-Amplitude-Modulation (PAM4) for particle physics experiments. This ASIC, named GBS20, is fabricated in a 65 nm CMOS technology. Two serializers share a 5.12 GHz Phase Locked Loop (PLL) clock. The outputs from the serializers are combined into a PAM4 signal that directly drives a Vertical-Cavity-Surface-Emitting-Laser (VCSEL). The input data channels, each at 1.28 Gbps, are scrambled with an internal 27-1 Pseudo-Random Binary Sequence (PRBS), which also serves as a frame aligner. GBS20 is tested to work at 10.24 and 20.48 Gbps with a VCSEL-based Transmitter-Optical-Subassembly (TOSA). The power consumption of GBS20 is below 238 mW and reduced to 164 mW in the low-power mode., Comment: 7 pages, 7 figures

Background Rigorous incidence data for acute myocardial infarction (AMI) in sub‐Saharan Africa are lacking. Consequently, modeling studies based on limited data have suggested that the burden of AMI and AMI‐associated mortality in sub‐Saharan Africa is lower than in other world regions. Methods and Results We estimated the incidence of AMI in northern Tanzania in 2019 by integrating data from a prospective surveillance study (681 participants) and a community survey of healthcare‐seeking behavior (718 participants). In the surveillance study, adults presenting to an emergency department with chest pain or shortness of breath were screened for AMI with ECG and troponin testing. AMI was defined by the Fourth Universal Definition of AMI criteria. Mortality was assessed 30 days following enrollment via in‐person or telephone interviews. In the cluster‐based community survey, adults in northern Tanzania were asked where they would present for chest pain or shortness of breath. Multipliers were applied to account for AMI cases that would have been missed by our surveillance methods. The estimated annual incidence of AMI was 172 (207 among men and 139 among women) cases per 100 000 people. The age‐standardized annual incidence was 211 (263 among men and 170 among women) per 100 000 people. The estimated annual incidence of AMI‐associated mortality was 87 deaths per 100 000 people, and the age‐standardized annual incidence was 102 deaths per 100 000 people. Conclusions The incidence of AMI and AMI‐associated mortality in northern Tanzania is much higher than previously estimated and similar to that observed in high‐income countries.

Numerous tuberculosis (TB) deaths remain undetected in low-resource endemic settings. With autopsy-confirmed tuberculosis as our standard, we assessed the diagnostic performance of Xpert MTB/RIF Ultra (Ultra; Cepheid) on nasopharyngeal specimens collected postmortem.From October 2016 through May 2019, we enrolled pediatric and adult medical deaths to a prospective autopsy study at two referral hospitals in northern Tanzania with next-of-kin authorization. We swabbed the posterior nasopharynx prior to autopsy and tested the samples later by Ultra. At autopsy we collected lung, liver, and, when possible, cerebrospinal fluid for mycobacterial culture and histopathology. Confirmed tuberculosis was defined as Mycobacterium tuberculosis complex recovery by culture with consistent tissue histopathology findings; decedents with only histopathology findings, including acid-fast staining or immunohistochemistry, were defined as probable tuberculosis.Of 205 decedents, 78 (38.0%) were female and median (range) age was 45 (0,96) years. Twenty-seven (13.2%) were found to have tuberculosis at autopsy, 22 (81.5%) confirmed and 5 (18.5%) probable. Ultra detected M. tuberculosis complex from the nasopharynx in 21 (77.8%) of 27 TB cases (sensitivity 70.4% [95% confidence interval {CI} 49.8-86.2%], specificity 98.9% [95% CI 96.0-99.9%]). Among confirmed TB, the sensitivity increased to 81.8% (95% CI 59.7-94.8%). Tuberculosis was not included as a death certificate diagnosis in 14 (66.7%) of the 21 MTBc detections by Ultra.Nasopharyngeal Ultra was highly specific for identifying in-hospital tuberculosis deaths, including unsuspected tuberculosis deaths. This approach may improve tuberculosis death enumeration in high-burden countries.

Growing evidence suggests considerable variation in endemic typhoid fever incidence at some locations over time, yet few settings have multi-year incidence estimates to inform typhoid control measures. We sought to describe a decade of typhoid fever incidence in the Kilimanjaro Region of Tanzania. Cases of blood culture confirmed typhoid were identified among febrile patients at two sentinel hospitals during three study periods: 2007–08, 2011–14, and 2016–18. To account for under-ascertainment at sentinel facilities, we derived adjustment multipliers from healthcare utilization surveys done in the hospital catchment area. Incidence estimates and credible intervals (CrI) were derived using a Bayesian hierarchical incidence model that incorporated uncertainty of our observed typhoid fever prevalence, of healthcare seeking adjustment multipliers, and of blood culture diagnostic sensitivity. Among 3,556 total participants, 50 typhoid fever cases were identified. Of typhoid cases, 26 (52%) were male and the median (range) age was 22 (

The Quad transimpedance and limiting amplifier (QTIA) is a 4-channel array optical receiver ASIC, developed using a 65 nm CMOS process. It is configurable between the bit rate of 2.56 Gbps and 10 Gbps per channel. QTIA offers careful matching to both GaAs and InGaAs photodiodes. At this R&D stage, each channel has a different biasing scheme to the photodiode for optimal coupling. A charge pump is implemented in one channel to provide a higher reverse bias voltage, which is especially important to mitigate radiation effects on the photodiodes. The circuit functions of QTIA successfully passed the lab tests with GaAs photodiodes., 6 pages, 6 figures, accepted for publication in JINST (TWEPP2021)

The novel use of the α-methylene-β-lactone (MeLac) moiety as a warhead of multiple electrophilic sites is reported. In this study, we demonstrate that a MeLac-alkyne is a competent covalent probe and reacts with diverse proteins in live cells. Proteomics analysis of affinity-enriched samples identifies probe-reacted proteins, resolves their modified peptides/residues, and thus characterizes probe-protein reactions. Unique methods are developed to evaluate confidence in the identification of the reacted proteins and modified peptides. Tandem mass spectra of the peptides reveal that MeLac reacts with nucleophilic cysteine, serine, lysine, threonine, and tyrosine residues, through either Michael addition or acyl addition. A peptide-centric proteomics platform, using MeLac-alkyne as the measurement probe, successfully analyzes the Orlistat selectivity in live HT-29 cells. MeLac is a versatile warhead demonstrating enormous potential to expedite the development of covalent probes and inhibitors in interrogating protein (re)activity. MeLac-empowered platforms in chemical proteomics are widely adaptable for measuring the live-cell action of reactive molecules.

Failure to address hypertension among people living with HIV (PLWH) may undermine the significant progress made towards reducing mortality among this high-risk population in sub-Saharan Africa (SSA). Here the authors report hypertension prevalence, diagnosis and treatment among patients enrolled in HIV care in Tanzania. Patients attending an HIV clinic were consecutively screened for hypertension. Hypertension was defined as follows: a single blood pressure measurement ≥ 160 mm Hg systolic or ≥ 100 mm Hg diastolic, two measurements at separate visits ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic, or self-reported hypertension diagnosis. The authors screened 555 patients and 19.6% met hypertension criteria. Among a subset of 91 hypertensive participants, 44 (48.4%) reported previous blood pressure measurements, 32 (35.2%) were aware of diagnosis, 10 (11.0%) reported current antihypertensive use, and none had controlled blood pressure. Addressing barriers along the hypertension treatment cascade must be a top priority to improve cardiovascular outcomes among PLWH in SSA.

As the number of effective antiretroviral therapy (ART) options increases, there is greater opportunity to involve HIV patients in ART selection. To establish the parameters for a shared ART decision-making process, we sought to identify ART characteristics that are important to patients and understand considerations in ART selection from both patient and provider perspectives. Using a mixed-methods approach, 16 patients and 12 healthcare providers were interviewed, and ranking tasks were conducted with 26 patients to identify ART characteristics that are relevant for shared decision making. Interviews were coded using direct content analysis and complemented by a quantitative analysis of references to specific attributes. Ranking data were analyzed through count analysis. Qualitative analysis of patient interviews identified four major categories of ART characteristics that are pertinent to shared decision making: side effects (14/16 patients), administration characteristics (14/16 patients), dosing (13/16 patients), and long-term effects (12/16 patients). Other considerations included expectations for patient involvement in ART decision making, relationship with provider, and efficacy. The degree of concordance between patients and providers differed across categories. Ranking exercises demonstrated differences in the ways providers and patients prioritize specific side effects and food requirements. Expectations for patient involvement in the selection process also varied greatly among and between patients and providers. We identify specific attributes of ART that are decision-relevant to patients and providers, describe heterogeneity of their relative importance, and note variable perceptions of shared decision making. Individualizing ART will require greater investment in understanding an individual patient's preferences, including her/his desire to participate in shared decision making.

This prognostic study compares the performance of the Universal Vital Assessment with that of other common illness severity tests for predicting the risk of in-hospital death among febrile hospitalized patients in northern Tanzania., Key Points Question How does the Universal Vital Assessment (UVA) score perform compared with other common illness severity scores in predicting in-hospital death for febrile hospitalized patients in a lower-income setting? Findings In this prognostic study of 597 adults hospitalized with febrile illness in northern Tanzania, the UVA score and National Early Warning Score outperformed other illness severity scores at predicting risk of in-hospital death. Scores of 2 or higher on the UVA were associated with significant increases in risk of death. Meaning The findings of this study indicate that, as a clinical illness severity measure using readily available clinical data appropriate to resource-limited settings, the UVA shows promise for predicting risk of in-hospital mortality among febrile inpatients in lower-income settings., Importance Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low- and middle-income settings such as sub-Saharan Africa. Objective To assess the performance of the Universal Vital Assessment (UVA) score, derived in 2017, compared with other illness severity scores for predicting in-hospital mortality among adults with febrile illness in northern Tanzania. Design, Setting, and Participants This prognostic study used clinical data collected for the duration of hospitalization among patients with febrile illness admitted to Kilimanjaro Christian Medical Centre or Mawenzi Regional Referral Hospital in Moshi, Tanzania, from September 2016 through May 2019. All adult and pediatric patients with a history of fever within 72 hours or a tympanic temperature of 38.0 °C or higher at screening were eligible for enrollment. Of 3761 eligible participants, 1132 (30.1%) were enrolled in the parent study; of those, 597 adults 18 years or older were included in this analysis. Data were analyzed from December 2019 to September 2021. Exposures Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) assessment, and UVA. Main Outcomes and Measures The main outcome was in-hospital mortality during the same hospitalization as the participant’s enrollment. Crude risk ratios and 95% CIs for in-hospital death were calculated using log-binomial risk regression for proposed score cutoffs for each of the illness severity scores. The area under the receiver operating characteristic curve (AUROC) for estimating the risk of in-hospital death was calculated for each score. Results Among 597 participants, the median age was 43 years (IQR, 31-56 years); 300 participants (50.3%) were female, 198 (33.2%) were HIV-infected, and in-hospital death occurred in 55 (9.2%). By higher risk score strata for each score, compared with lower risk strata, risk ratios for in-hospital death were 3.7 (95% CI, 2.2-6.2) for a MEWS of 5 or higher; 2.7 (95% CI, 0.9-7.8) for a NEWS of 5 or 6; 9.6 (95% CI, 4.2-22.2) for a NEWS of 7 or higher; 4.8 (95% CI, 1.2-20.2) for a qSOFA score of 1; 15.4 (95% CI, 3.8-63.1) for a qSOFA score of 2 or higher; 2.5 (95% CI, 1.2-5.2) for a SIRS score of 2 or higher; 9.1 (95% CI, 2.7-30.3) for a UVA score of 2 to 4; and 30.6 (95% CI, 9.6-97.8) for a UVA score of 5 or higher. The AUROCs, using all ordinal values, were 0.85 (95% CI, 0.80-0.90) for the UVA score, 0.81 (95% CI, 0.75-0.87) for the NEWS, 0.75 (95% CI, 0.69-0.82) for the MEWS, 0.73 (95% CI, 0.67-0.79) for the qSOFA score, and 0.63 (95% CI, 0.56-0.71) for the SIRS score. The AUROC for the UVA score was significantly greater than that for all other scores (P

Introduction: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa.Methods: A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL.Results: Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P

Background Characterization of the epidemiology of Escherichia coli bloodstream infection (BSI) in sub-Saharan Africa is lacking. We studied patients with E. coli BSI in northern Tanzania to describe host risk factors for infection and to describe the antimicrobial susceptibility of isolates. Methods Within 24 h of admission, patients presenting with a fever at two hospitals in Moshi, Tanzania, were screened and enrolled. Cases were patients with at least one blood culture yielding E. coli and controls were those without E. coli isolated from any blood culture. Logistic regression was used to identify host risk factors for E. coli BSI. Results We analyzed data from 33 cases and 1615 controls enrolled from 2007 through 2018. The median (IQR) age of cases was 47 (34–57) y and 24 (72.7%) were female. E. coli BSI was associated with (adjusted OR [aOR], 95% CI) increasing years of age (1.03, 1.01 to 1.05), female gender (2.20, 1.01 to 4.80), abdominal tenderness (2.24, 1.06 to 4.72) and urinary tract infection as a discharge diagnosis (3.71, 1.61 to 8.52). Of 31 isolates with antimicrobial susceptibility results, the prevalence of resistance was ampicillin 29 (93.6%), ceftriaxone three (9.7%), ciprofloxacin five (16.1%), gentamicin seven (22.6%) and trimethoprim-sulfamethoxazole 31 (100.0%). Conclusions In Tanzania, host risk factors for E. coli BSI were similar to those reported in high-resource settings and resistance to key antimicrobials was common.

Objectives: Lack of racial and ethnic diversity in clinical trials (CT) limits the generalizability of results to individuals who have unique cultural, environmental and physiological factors that affect outcomes. Consequently, the NIH and FDA issued directives to include historically underrepresented racial and ethnic groups in research studies. We sought to determine the enrollment of black relative to non-black populations in cardiovascular clinical trials and whether racial enrollment varied across trial characteristics. Methods: Clinical trials were identified using PubMed, Embase, and Cochrane. Between 2000-2018, studies were included if they were English language, CT of cardiovascular disease or risk factors and race/ethnicity were reported. Trial characteristics were extracted from the primary manuscript or clinical trials.gov and included: study area, funding source, intervention type, location, sample size, and distribution of female participants. Summary statistics for each study included percentage of blacks enrolled with 95% CI. Meta-analysis of the proportion of black enrollment across relevant CT was conducted to analyze overall estimates of the effect compared to non-black enrollment using an inverse variance weighted random effects model. Additional meta-analyses compared candidate variables that could influence the likelihood of black enrollment. All analyses were performed with SAS version 9.4 (SAS Institute Inc., Cary NC). Results: We identified 2501 trials, 85 met inclusion criteria, comprising a total of 159,791 patients: 25,720 black and 134,071 non-black. The percentage of blacks 38.2% (95%CI: 33.0%-43.6%) enrolled was significantly less than non-blacks 61.8% (95%CI: 56.4%-67%). Enrollment differed significantly across study type with peripheral vascular disease enrolling the largest 59.9% (95%CI: 47.3%-71.4%) and cerebrovascular disease the least 25.1% (16.1%-37%). Industry only studies accounted for 41% (35 of 85) of total trials and were less likely 30.3% (95%CI: 22.7%-39.1%), than NIH 40.9% (95%CI: 34%-48.1%), joint NIH/Industry 46.8% (95%CI: 33.3%-60.7%), and non-NIH/Industry 76.6% (95%CI: 38.7%-94.4%) funded studies to enroll black patients. Pharmacotherapy studies 29.3% (23.3%-36.1%) enrolled fewer black patients than behavioral 43.8% (36.9%-51%) and device/other 48.2% (37.5%-59.1%) studies. Black enrollment decreased for non-US based studies, and as a function of decreasing female sex enrollment and increasing sample sizes of studies. Conclusion: CTs of cardiovascular disease and risk factors were significantly less likely to enroll blacks when compared to non-black patients. Trial characteristics such as study area, funding source, intervention type, study site location, sample size, female percentage, and mean age had statistically significant impacts on black patient accrual in cardiovascular CTs.

Background Little is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa. Methods A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain. Results Of 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified ‘heart attack’ as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were less likely to prefer a hospital than males (OR 0.65, 95% CI 0.47–0.90, p = 0.008). Conclusions There is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom. There is an urgent need for educational interventions to address this knowledge deficit and guide appropriate care-seeking behavior.

Background Blastomycosis is an endemic mycosis in North America that is caused by the dimorphic fungus Blastomyces dermatitidis. The illness is a systemic disease with a wide variety of pulmonary and extra-pulmonary manifestations. The initial presentation of blastomycosis may easily be mistaken for other infectious or non-infectious etiologies. Case presentation We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss. Initially diagnosed with primary lung malignancy, the patient was subsequently found to have pulmonary blastomycosis mimicking lung cancer. The patient underwent a successful course of treatment with posaconazole. Conclusions Chronic blastomycosis can present with clinical and radiographic features indistinguishable from thoracic malignancies. There is no clinical syndrome specific for blastomycosis, thus a high degree of suspicion is required for early diagnosis. In this case report, we review recent evidence in radiographic features, diagnostic considerations and treatment of the disease.

Background: Myelination, degeneration and regeneration are implicated in crucial responses to injury in the peripheral nervous system. Considering the progression of amyotrophic lateral sclerosis (ALS), we used the superoxide dismutase 1 (SOD1)-G93A transgenic mouse model of ALS to investigate the effects of mutant SOD1 on the peripheral nerves. Methods: Changes in peripheral nerve morphology were analyzed in SOD1 mutant mice at various stages of the disease by toluidine blue staining and electron microscopy (EM). Schwann cell proliferation and recruitment of inflammatory factors were detected by immunofluorescence staining and quantitative reverse transcription PCR and were compared between SOD1 mutant mice and control mice. Furthermore, western blotting (WB) and TUNEL staining were used to investigate axonal damage and Schwann cell survival in the sciatic nerves of mice in both groups. Results: An analysis of the peripheral nervous system in SOD1-G93A mice revealed the following novel features: (i) Schwann cells and axons in mutant mice underwent changes that were similar to those seen in the control mice during the early development of peripheral nerves. (ii) The peripheral nerves of SOD1-G93A mice developed progressive neuropathy, which presented as defects in axons and myelin, leading to difficulty in walking and reduced locomotor capacity at a late stage of the disease. (iii) Macrophages were recruited and accumulated, and nerve injury and a deficit in the blood-nerve barrier were observed. (iv) Proliferation and the inflammatory micro-environment were inhibited, which impaired the regeneration and remyelination of axons after crush injury in the SOD1-G93A mice. Conclusions: The mutant human SOD1 protein induced axonal and myelin degeneration during the progression of ALS and participated in axon remyelination and regeneration in response to injury.

Lumbar intervertebral disc degeneration (IDD) is a common clinical pathology and has become a focus for research in recent years. Matrix metalloproteinases (MMPs) are enzymes responsible for the degradation of almost all extracellular matrix proteins (ECM). The over-expression of MMPs or tissue inhibitors of metalloproteinases (TIMPs) may disrupt the dynamic balance of the ECM. Therefore, in the current study, the expression levels of MMP-1 and TIMP-1 in lumbar IDD patients were evaluated in an attempt to elucidate their role in IDD pathogenesis and progression. In total, 60 IDD patients were recruited as the experimental group, along with 20 cases of lumbar vertebral injury without disc degeneration as the control group. Preoperative venous blood samples were collected, and intervertebral disc tissues were collected from the lesion during surgery. Serum and tissue levels of MMP-1 and TIMP-1 were quantified by enzyme-linked immunosorbent assay and immunohistochemical staining, respectively. Serum and tissue MMP-1 levels in IDD patients were significantly higher than those in the control group (P0.05). Additionally, sub-group analysis revealed that severe IDD patients had higher MMP-1 levels compared with mild or moderate IDD patients (P0.05). However, there were no significant differences in TIMP- 1 levels in either the serum or tissues of IDD patients compared to patients in the control group (P0.05). These results demonstrate that MMP-1 expression is increased in IDD, with higher expression observed in more severe cases, whereas TIMP-1 expression was similarly expressed in both normal and degenerated discs.

A simple tie-over dressing using a transparent gasbag, which has been used successfully in skin grafting on rabbits and human beings, allows objective pressure survey and subjective direct inspection of the underlying grafted skin. Moreover, if hematoma or any other complication is recognized, the gasbag can be deflated and removed, being reapplied after the hematoma is expressed or the complication is treated.

The structure of the $(\sqrt{5}\times\sqrt{5})R26.6^\circ$ reconstruction of LaAlO$_3$ (001) has been determined using transmission electron diffraction combined with direct methods. The structure is relatively simple, consisting of a lanthanum oxide termination with one lanthanum cation vacancy per surface unit cell. The electronic structure is unusual since a fractional number of holes or atomic occupancies per surface unit cell are required to achieve charge neutrality. Density functional calculations indicate that the charge compensation mechanism occurs by means of highly delocalized holes. The surface contains no oxygen vacancies and with a better than 99% confidence level, the holes are not filled with hydrogen. The reconstruction can be understood in terms of expulsion of the more electropositive cation from the surface followed by an increased covalency between the remaining surface lanthanum atoms and adjacent oxygen atoms., Comment: 4 Pages, 3 Figures

The ternary semiconductor CdIn(2)S(4) nanorods were synthesized by a method based on CdS nanorods via the hydrothermal route, in which CdS nanorods were converted by reaction with InCl(3) and thiourea in aqueous solution. Transmission electron microscopy (TEM) images revealed that the typical sizes of the CdIn(2)S(4) nanorods were 10-30 nm in diameter and 200-1000 nm in length. X-ray photoelectron spectra (XPS) analysis of the surface stoichiometry (CdIn(2.03)S(4.15)) and room-temperature Raman spectrum (RS) were recorded. The influences of reaction temperature, time, and sulfur sources on the formation for CdIn(2)S(4) nanorods were investigated. A possible formation mechanism of the CdIn(2)S(4) nanorods was also proposed.

We observed that human megakaryocytes expressed the heterodimeric tyrosine kinase RON, which serves as a receptor for macrophage-stimulating protein (MSP). MSP appears to be structurally related to hepatocyte growth factor (HGF), which is a pleiotropic growth factor for a broad spectrum of tissues and cell types. The effects of human rMSP and rHGF on permanent human megakaryocytic cell lines as well as on human and murine primary marrow megakaryocytes were studied. MSP enhanced the maturation of the primary bone marrow megakaryocytes and human megakaryocytic cell lines, CMK and DAMI, as assessed by an increase in ploidy content. The increase in ploidy was blocked by specific Abs for MSP and by anti-IL-6 Abs. MSP treatment of primary human marrow megakaryocytes, DAMI cells, or CMK cells resulted in enhanced secretion of IL-6. The addition of MSP to cultures of immature murine megakaryoblasts showed a significant growth response, similar to that of exogenous IL-6. This increased growth of immature murine megakaryoblasts in response to MSP was abrogated either by Abs against MSP or by neutralizing mAbs to IL-6. HGF, over a range of concentrations (10 to 100 ng/ml) alone or in combination with IL-3, granulocyte-macrophage-CSF, or IL-6, had no effect on differentiation of human or murine marrow megakaryocytes. These results indicate that megakaryocytes express a novel tyrosine kinase receptor (RON), and that its ligand, MSP, appears capable of regulating megakaryocyte maturation, possibly via an autocrine mechanism mediated by induction of the cytokine IL-6.

Choosing a suitable color palette can typically improve image aesthetic, where a naive way is choosing harmonious colors from some pre-defined color combinations in color wheels. However, color palettes only consider the usage of color types without specifying their amount in an image. Also, it is still challenging to automatically assign individual palette colors to suitable image regions for maximizing image aesthetic quality. Motivated by these, we propose to construct a contribution-aware color palette from images with high aesthetic quality, enabling color transfer by matching the coloring and regional characteristics of an input image. We hence exploit public image datasets, extracting color composition and embedded color contribution features from aesthetic images to generate our proposed color palettes. We consider both image area ratio and image location as the color contribution features to extract. We have conducted quantitative experiments to demonstrate that our method outperforms existing methods through SSIM (Structural SIMilarity) and PSNR (Peak Signal to Noise Ratio) for objective image quality measurement and no-reference image assessment (NIMA) for image aesthetic scoring., Perception and Visualization, Bailin Yang, Qingxu Wang, Frederick W. B. Li, Xiaohui Liang, Tianxiang Wei, and Changrui Zhu

Modern manufacturing demands are characterized by high fluctuations with negative impact on resource efficiency. In this framework, Industry 4.0 key enabling technologies such as cloud manufacturing enable the sharing of distributed resources for effective use at industrial network level. In this work, an intelligent cloud manufacturing platform is proposed to increase resource efficiency in a manufacturing network through dynamic sharing of manufacturing services, including computational, software as well as physical manufacturing resources, that can be offered on demand according to a service-oriented paradigm. The cloud-based platform includes a database module where user input data are collected, an intelligent module for data processing, optimization and feasible solutions generation, and a decision support module for solutions evaluation and comparison. A case study demonstrates technical and economic advantages for industrial resource efficiency improvement.

Industry 4.0 key enabling technologies such as cloud manufacturing allow for the dynamic sharing of distributed resources for efficient use at industrial network level. Interconnected users, i.e. suppliers and customers, offer and request manufacturing services over a cloud manufacturing platform, where an intelligent engine generates a number of solutions based on functional and geometrical requirements. A high number of suppliers leads to a higher number of solutions available for customers increasing the decision-making complexity from a customer perspective. Recommendation systems play a crucial role in expanding the opportunities in decision-making processes under complex information environments. In this scope, this paper proposes the conceptualization and the development of a recommendation decision support tool to be implemented in a cloud manufacturing platform to assist customers in appropriately selecting manufacturing services with reference to sheet metal cutting operations. In terms of solution selection, a Deep Neural Network (DNN) paradigm is adopted to allow for the automatic learning of optimal solution recommendation list based both on customers past experiences and new choices. In this respect, a virtual interaction environment is firstly built for system pre-training. Subsequently, users’ data are inputted in the pre-trained model to predict a recommendation list. This is then subject to user interaction, i.e. selection, which will be fed back into the model to update the training parameters. This paper concludes with a simulated case study reported to exemplify the proposed methodology for a variety of decision-making scenarios.