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Poor dimensional stability restricts the commercial utilization of fast-growing wood. In this study, fast-growing poplar (Populus cathayana) was treated by removing hemicellulose with hydrothermal treatment and impregnating alkali lignin via full-cell process, synergistically, for enhanced dimensional stability. After modification, hydroxyl groups were reduced in hemicellulose removed wood (DHC), alkali lignin was observed to fill in the cell lumens of vessels and wood fibers in the impregnated wood (AL) and in the wood modified by hemicellulose removal with alkali lignin impregnation (DHCAL). Compared with untreated wood, the volumetric swelling ratio of DHC and AL decreased by 11 % and 21 % under relative humidity (RH) of 89 %, respectively. The volumetric swelling ratio of DHCAL decreased by over 50 %, indicating a positive synergistic effect. The combination of hemicellulose removal and alkali lignin impregnation treatment improved the dimensional stability of wood significantly by reconstructing wood chemical components with various levels of hygroscopicity. This work could meaningfully contribute to the efficient utilization of fast-growing wood and promote the added value of industrial alkali lignin.

Introduction: Elevated circulatory concentrations of YKL-40 have been reported in patients with ischemic stroke. This study further investigated the association of plasma YKL-40 concentrations at admission and short, long-term prognosis after ischemic stroke. Methods: Based on a prospective, nationwide multicenter registry focusing consecutive patients of ischemic stroke and transient ischemic attack, plasma YKL-40 levels were detected by enzyme-linked immunosorbent assay at admission, and patients were stratified into percentile according to the plasma YKL-40 concentrations. The multivariate Cox or logistic regression model was used to investigate the association of YKL-40 concentration with death and functional outcomes at 3 months, 6 months, and 12 months after ischemic stroke, with potential confounders adjusted. Results: A total of 8,006 first-ever ischemic stroke patients, with the age of 61.7 ± 11.5, were included in this study. The mortality of 0–33%, 34–66%, 67–90%, and 91–100% groups at 12 months follow-up was 0.9%, 2.2%, 4.4%, and 9.4%, respectively (p < 0.0001), and the modified Rankin Scale 3–6 ratio was 6.8%, 10.5%, 15.7%, and 24.0%, respectively (p < 0.0001). In the multivariate regression, after adjusting for potential confounders, 91–100% group had higher risk of death (hazard ratio 2.99, 95% confidence interval 1.75–5.11)and modified Rankin Scale 3–6 (odds ratio 1.42, 95% confidence interval 1.08–1.88) at 12 months since onset of ischemic stroke compared to the 0–33% group. Conclusions: The elevated YKL-40 at admission can potentially help predict death, functional prognosis after ischemic stroke, which may help further studies to explore the potential physiological and pathological mechanism including the effects of vulnerable plaque and collateral circulation.

In this study, two plant derived compounds, namely tannin acid (TA) and tung oil (TO) were used to modify southern yellow pine wood (Pinus spp.) to enhance its durability. Wood samples were firstly impregnated with aqueous TA solutions at 5, 10 and 15%, respectively, and then impregnated with TO. Samples treated by TA or TO alone were also prepared. The dimensional stability, hydrophobicity, mold resistance, and thermal stability of both treated and untreated wood were evaluated. The results showed that the dimensional stability and hydrophobicity of wood treated with 10% TA and TO (T10+TO group) improved significantly. Compared with control group, the water absorption of T10+TO group decreased by 80.0% after 192 h immersion, and the antiswelling efficiency reached up to 90.7%, with the contact angle of 118° at 50 s. The mold resistance of wood after 5% TA and TO treatment presented an effectiveness of 87.5%. Meanwhile, T10+TO group presented better thermal stability. Overall, this study revealed that wood impregnated by TA and TO exhibited excellent dimensional stability and anti-mold properties, which could be applicable to indoor environment.

Recycling agent (RA) is typically used to restore or rejuvenate the properties of aged asphalt to desired properties. This study was motivated to comprehensively characterize the performance of asphalt mixtures treated with RA. The overarching goal of the research project is to provide guidance to agencies for revising asphalt mixture specifications to include RAs. Ten plant-produced mixtures were evaluated including three control mixtures (with 30 and 40% reclaimed asphalt pavement [RAP]) and seven 40% RAP mixtures treated with different RA products. Mixture testing was conducted with and without laboratory conditioning of loose mixture for 6 h at 135°C. Testing included the mixture Complex Modulus (E*) test for viscoelastic characterization, Direct Tension Cyclic Fatigue test for fatigue performance evaluation, Tensile Strength Ratio test for moisture susceptibility evaluation, and Semi-circular Bending test, Cracking Index Test and Disk-shaped Compact Tension test for mixture cracking and fracture behavior at different temperatures. In addition, the Hamburg Wheel Track Testing was conducted for rutting performance characterization on the unaged mixtures. Results show that addition of different RAs can improve the properties of asphalt mixtures by softening the mixtures with RAP and improving the cracking performance as compared with the control mixtures. However, addition of RA could severely deteriorate the rutting performance of mixtures and increase the moisture susceptibility as compared with the control mixtures. In addition, addition of certain RAs can also decrease the aging resistance of asphalt mixtures, specifically in context of cracking performance.

The purpose of this research is to provide a comprehensive evaluation of the effects of a solid pelletized plastomeric polymer on asphalt mixtures’ properties and performance with respect to different distresses. Five asphalt mixtures—a control mixture (no polymer); asphalt mixtures with 2.5%, 5.0%, and 7.5% polymer content; and a mixture with 5% polymer and lower asphalt binder content—were evaluated. The laboratory testing campaign included complex modulus, direct tension cyclic fatigue, semi-circular bending, disk-shaped compact tension, and asphalt pavement analyzer tests. Advanced performance-based simulation programs—MnPAVETM, FlexPAVETM, and ILLITC—were utilized to predict mixture performance in the context of pavement structure and local traffic and climatic conditions. In addition, four field test sections were constructed for all but the mixture with the reduced binder content and falling weight deflectometer (FWD) testing was conducted on the test sections. Based on the results of laboratory testing and performance simulation it can be concluded that the study modifier significantly improved the rutting performance and slightly improved the mixture fatigue performance. The study modifier did not show a considerable positive or negative effect on the thermal cracking performance. Based on the FWD results, solid polymer is potentially a good option to increase the stiffness of the asphalt concrete (AC) layer.

Aging can significantly affect the performance of asphalt mixtures, causing increase in stiffness, reduction in relaxation capability and increase in cracking susceptibility. It is also well known that fundamental viscoelastic properties are used for design and modelling of asphalt mixtures and pavement structures to addressing rutting, fatigue and thermal cracking concerns. The objective of this paper is to study how the viscoelastic properties of asphalt mixture change over time, and evaluate and identify the cracking and aging susceptibility of asphalt mixtures with different mix variables during material selection and mixture design. Ten mixtures are evaluated using different laboratory conditioning protocols to simulate a range of aging levels in the field. The complex modulus test is then conducted on the lab aged mixtures to measure the viscoelastic properties in order to construct the dynamic modulus and phase angle master curves. The mixture Glover-Rowe (G-Rm) parameter and the shape parameters of the dynamic modulus and phase angle master curves, including inflection point frequency (−β/γ), difference between the glassy modulus and the inflection point modulus (γ), peak value of phase angle (a) and the horizontal position (frequency) of the peak phase angle value (c), are determined and evaluated for the mixtures with different aging conditions and mix variables. The study indicates the ability of the G-Rm parameter and all the master curve shape parameters to capture the effect of different aging conditions on linear viscoelastic mixture properties, as well as the cracking and aging susceptibility of asphalt mixtures.

Quantized neural networks (NN) with reduced bit precision are practical solutions to minimize computational and memory resource requirements and play a vital role in machine learning. However, it is still challenging to avoid significant accuracy degradation due to numerical approximation and lower redundancy. In this paper, a novel robustness-aware 2-bit quantization scheme (RAQ) is proposed for NN, based on binary NN and generative adversarial networks (GAN), which improve performance by enriching binary NN information, extracting the structural information and considering the robustness of the quantized NN. Specifically, using a shift-add operation to replace the multiply-accumulate in the quantization process can speed the NN. A structural loss is proposed to represent the difference between the original NN and quantized NN, such that the structural information of data is preserved after quantization. The structural information learned from NN plays an important role in improving the performance and allows for further fine-tuning of the quantized NN by applying the Lipschitz constraint to the structural loss. For the first time, we consider the robustness of the quantized NN and propose a non-sensitive perturbation loss function by introducing an extraneous term of the spectral norm. The experiments were conducted on CIFAR-10, SVHN and ImageNet datasets with popular NN (such as MobileNetV2, ResNet20, etc.). Extensive experiments show that our new 2-bit quantization scheme is more efficient than the state-of-the-art quantization methods. Our scheme effectively reduced the latency by 2 × and the accuracy decline by 1–4%. Meanwhile, the experimental results also demonstrate that the RAQ is robust with adversarial attacks, we not only eliminate the robustness gap between full-precision and quantized models, but also improve the robustness over full-precision ones by 10%.

Background: The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. Methods: In 2020–2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). Findings: We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. Interpretation: The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. Funding: This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].

Context Although the incidence of papillary thyroid carcinoma (PTC) is significantly higher in females than in males, the prognosis of male PTC is more unfavorable. However, the cause of higher malignancy of PTC in male patients remains unclear. Objective We conducted our analysis on microarrays datasets, tissue samples from PTC patients and the RNAseq datasets from TCGA with survival data. Methods We searched all publicly available microarray datasets and performed a genome-wide meta-analysis comparing PTC and normal samples. Gene Ontology analysis was then conducted. The candidate genes were tested by quantitative real-time polymerase chain reaction. The analysis of prognostic value of genes was performed with datasets from The Cancer Genome Atlas. Results After meta-analyses, 150 significantly differentially expressed genes (DEGs) were specifically found in male subjects. Gene Ontology analysis of these 150 genes revealed that the viral process was activated. Seven genes involved in the viral process in male patients showed a significantly differential expression between PTC and normal tissue. Survival analysis exhibited that the 7 genes, used in combination, were prognostically valuable and, of them, PSMB1 possessed a conspicuous prognostic value, especially in males. Conclusion In this study, we searched all publicly available microarray datasets and conducted a comprehensive analysis to understand the male propensity for higher malignancy. We found that markers of viral infection showed significantly differential expression only in male patients compared with their female counterparts and had a sex-sensitive prognostic value in PTC.

The association between haemoglobin A1c (HbA1c) and cerebral microbleeds (CMBs) remains unclear. We aimed to investigate the association between HbA1c and CMBs in community-based individuals without stroke or transient ischaemic attack (TIA) and whether the association differs between individuals with and without diabetes mellitus (DM).All individuals were recruited from a community in Beijing, China, from January 2015 to September 2019. All individuals completed a questionnaire and underwent blood tests and brain magnetic resonance imaging. A susceptibility-weighted imaging sequence was acquired to detect CMBs, which were defined as small, round and low-signal lesions with10 mm diameter. The association between HbA1c and CMBs was analysed using multivariable logistic regression adjusted for demographics, medical history and blood sample test results. Subgroup analyses stratified by history of DM were performed.Of 544 recruited individuals, 119 (21.88%) had CMBs. HbA1c was independently associated with CMBs (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.03-2.22). In 87 individuals with DM, multivariable logistic analysis showed that HbA1c was significantly associated with CMBs (OR, 1.67; 95% CI, 1.04-2.69), whereas in individuals without DM, no significant association was observed between HbA1c and CMBs (OR, 1.07; 95% CI, 0.50-2.30).HbA1c was associated with CMBs in individuals without stroke or TIA, particularly in individuals with DM, suggesting that the status of glycaemic control warrants attention for the prevention of CMBs. It would be beneficial to manage HbA1c specifically to control the risk of CMBs, especially in individuals with DM.

ObjectivesThere is uncertainty with respect to the hospital volume and clinical outcomes for patients with stroke. This study aimed to assess the association between hospital volume, processes of care and outcomes after ischaemic stroke.DesignA multicentre prospective cohort study.SettingTwo hundred and seventeen secondary or tertiary public hospitals from China.ParticipantsA total of 17 550 patients within 7 days of acute ischaemic stroke were included.Main outcome measuresThe outcomes included all-cause mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. The patients were divided into four groups based on quartiles of the hospital volume. We compared the difference in the process of care across the groups and estimated the effects of hospital volume on mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. Restricted cubic splines were used to illustrate the association between hospital volume and clinical outcomes.ResultsThere were no significant differences in the process of care across the four groups. When adjusted for confounders, the effect of hospital volume on mortality, recurrent stroke and combined vascular events was not significant. However, compared with the highest quartile, the patients in the lowest quartile of hospital volume tend to have poor outcome at 1 year (OR=1.29, 95% CI 1.01 to 1.64, p=0.0393). The restricted cubic spline analyses suggested a non-linear relationship between hospital volume and 1-year combined vascular events and poor outcome at 3 months and 1 year.ConclusionsWe found no significant associations between hospital volume, processes of care at the hospital, and mortality, recurrent stroke, and combined vascular events in patients with ischaemic stroke. However, hospital volume may be associated with poor outcome at 1 year.

Studies showed that patients with hemorrhagic stroke are at a higher risk of developing deep vein thrombosis (DVT) than those with ischemic stroke. We aimed to develop a risk score (intracerebral hemorrhage-associated deep vein thrombosis score, ICH-DVT) for predicting in-hospital DVT after ICH.The ICH-DVT was developed based on the Beijing Registration of Intracerebral Hemorrhage, in which eligible patients were randomly divided into derivation (60%) and internal validation cohorts (40%). External validation was performed using the iMCAS study (In-hospital Medical Complication after Acute Stroke). Independent predictors of in-hospital DVT after ICH were obtained using multivariable logistic regression, and β-coefficients were used to generate a scoring system of the ICH-DVT. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively.The overall in-hospital DVT after ICH was 6.3%, 6.0%, and 5.7% in the derivation (The ICH-DVT is a valid grading scale for predicting in-hospital DVT after ICH. Further studies on the effect of the ICH-DVT on clinical outcomes after ICH are warranted.

This work presents the development of new fatigue performance indices for asphalt binders based on viscoelastic continuum damage (VECD) theory and failure energy. Five plant-produced asphalt mixtur...

Numerous studies have examined the associations between air pollution and stroke. However, little is known about the associations between air pollution and transient ischemic attack (TIA). In this study, we aimed to conduct a time-series study to systematically examine the associations between hospital admissions for TIA and air pollutants. Admissions for TIA (ICD-10: G45) from 1 January 2014 to 31 December 2016 were identified based on the primary diagnosis from 134 hospitals in Beijing, China. Hourly measurements of air pollutants were obtained from the National Air Pollution Monitoring System. Generalized additive models with quasi-Poisson regression were used to determine the associations for each pollutant. Additionally, stratified analysis was implemented to examine whether age, gender, temperature, and season were the potential effect modifiers. Restricted cubic spline was applied to investigate the exposure-response curve. In total, 109,975 hospital admissions for TIA were included. The positive associations were detected between PM2.5, PM10, SO2, NO2, and CO and hospital admissions for TIA. The effects of PM2.5 and PM10 in men are stronger than in women. Additionally, the effects of PM2.5, PM10, SO2, and O3 are more pronounced on warm days than cool days. From exposure-response curves, we observe a nearly linear relationship for PM2.5, PM10, CO, and NO2. Further studies are needed to verify the association. This research contributes evidence on the association between air pollution and admissions for TIA in the low- and middle-income countries and may promote related public health policy development.

Aging has a significant effect on performance of asphalt materials. Reliable characterization of asphalt binder properties with aging is crucial to improving asphalt binder specifications as well as modification and formulation methods. The objective of this study is to correlate the laboratory conditioning methods with field aging using evolution of binder rheological parameters with time and pavement depth. Loose mixtures are aged in the lab (5 and 12 days aging at 95°C, and 24 h at 135°C) and recovered binder rheological properties are compared with those from different layers of field cores. The virgin binder results with 20 h pressure aging vessel (PAV) aging are also included. Binder testing is conducted using a dynamic shear rheometer with a 4 mm plate over a wide range of frequencies and temperatures. Rheological parameters calculated from the master curves, performance grade system, and binder Christensen–Anderson–Marasteanu model are used to evaluate changes with aging. The field aging gradient is evaluated, and the laboratory conditioning durations corresponding with the field aging durations at different pavement depths are calculated. The results show that 5 days of aging can simulate around 8 years of field aging (in New Hampshire) for the top 12.5 mm pavement, and 12 days’ aging can simulate approximately 20 years; 20 h PAV binder aging is not adequate to capture the long-term performance of the pavement. This study provides a way to optimize the laboratory conditioning durations and evaluate the performance of asphalt material with respect to pavement life (time) and depth (location) within the pavement structure.

White matter hyperintensity (WMH) is prevalent in elderly populations. Ischemia is characterized by a decline in cerebral blood flow (CBF) and may play a key role in the pathogenesis of WMH. However, the association between CBF reduction and WMH progression remains controversial. This study aimed to investigate the association between CBF and the progression of WMH at a 2-year follow-up of community-based, asymptomatic adults in a longitudinal cohort study across the lifespan.Asymptomatic adults who participated in a community-based study were recruited and underwent brain structural and perfusion magnetic resonance imaging (MRI) at baseline and at a 2-year follow-up visit. The CBF was measured on pseudo-continuous arterial spin-labeling (pCASL) MRI. The WMH was evaluated on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) images. Tissue segmentation was conducted on T1-weighted (T1W) images to derive binary masks of gray matter and normal-appearing white matter. Linear mixed effect models were conducted to analyze the cross-sectional and longitudinal associations between CBF and WMH.A total of 229 adults (mean age 57.3±12.6 years; 94 males) were enrolled at baseline, among whom 84 participants (mean age 54.1±11.9 years; 41 males) completed a follow-up visit with a mean time interval of 2.77±0.44 years. At baseline, there was a decreasing trend in gray matter (GM) CBF with an increase of WMH burden (P=0.063), but this association was attenuated after adjusting for age (P=0.362). In the longitudinal analysis, baseline WMH volume was significantly associated with the reduction of perfusion in GM [coefficient =-1.96, 95% confidence interval (CI): -3.25 to -0.67; P=0.004] and normal appearing white matter (coefficient =-0.99, 95% CI: -1.66 to -0.31; P=0.005) during follow-up. On the contrary, neither baseline CBF in GM (P=0.888) nor normal appearing white matter (P=0.850) was associated with WMH progression. In addition, CBF changes within WMH were significantly associated with both baseline (coefficient =-0.014, 95% CI: -0.025 to -0.003; P=0.017) and progression (coefficient =-1.01, 95% CI: -1.81 to -0.20; P=0.015) of WMH volume.A WMH burden was not found to be directly associated with cortex perfusion at baseline due to the effects of age on both CBF and WMH. However, baseline WMH volume could predict the reduction of perfusion.

Background: The association between hemoglobin A1c (HbA1c) and cerebral microbleeds (CMBs) remains unclear. We aimed to investigate the association between HbA1c and CMBs in community-based individuals without stroke or transient ischemic attack and whether it differs between individuals with and without diabetes mellitus.Methods: This cross-sectional study recruited individuals from a community in Beijing, China from January 2015 to September 2019. All individuals completed the questionnaires and underwent blood tests and brain magnetic resonance imaging. A susceptibility-weighted imaging sequence was used to detect CMBs, defined as small, round, and low-signal lesions with a diameter Results: CMBs were detected in 119 (21.88%) individuals. HbA1c was independently associated with CMBs after adjustment (adjusted odds ratio [OR],1.51; 95% confidence interval [CI], 1.03–2.22). In 87 patients with diabetes mellitus, the multivariable logistic analysis showed that HbA1c was significantly associated with CMBs (adjusted OR, 1.67; 95% CI, 1.04–2.69), whereas in individuals without diabetes mellitus, no significant association was observed between HbA1c and CMBs (adjusted OR, 1.07; 95% CI, 0.50–2.30).Conclusions: HbA1c is associated with CMBs in participants without stroke or transient ischemic attack, particularly in patients with diabetes mellitus. This finding suggests that the status of glycemic control warrants attention for the prevention of CMBs. It would be beneficial to manage HbA1c strictly to control the risk of CMBs, especially in patients with diabetes mellitus.

Previous retrospective studies showed that the incidence and mortality rates for MM in China were lower than those in western countries. A large-scale prospective study on incidence and mortality rates of MM is still lacking.Based on the prospective Kailuan Cohort study in China, we included all patients with MM in Kailuan Cohort from June 1, 2008 to December 31, 2016. Using the numbers of diagnosed cases and deaths during the study period as the numerators and the corresponding observed person-years as the denominators respectively, we calculated crude incidence and mortality rates. The 95% confidence intervals for crude incidence rate and mortality rate were estimated base on Poisson distribution. Rates were standardized by direct standardization according to the China population in 2000 and Segi' world standard population.A total of 22 members from Kailuan Cohort were first diagnosed with MM between 2008 and 2016. The calculated crude incidence rates were 2.8 (95% CI, 1.7-4.2) per 100,000 person-years for all participants. The standardized incidence rate was 0.9 per 100,000 person-years (95% CI, 0.5-2.1) when standardized by 2000 China population census data, and 1.0 per 100,000 person-years (95% CI, 0.6-1.8) when standardized by Segi's world standard population (WSP). The calculated crude mortality rates were 2.3 (95% CI, 1.4-3.6) per 100,000 person-years. The mortality standardized by 2000 China population census data was 0.7 per 100,000 person-years (95% CI, 0.3-1.9), and 0.9 per 100,000 population (95% CI, 0.5-1.7) when standardized by Segi's WSP. Both incidence and mortality for males were higher than that for females almost in all age groups. Both rates increased steadily with age.In this community-based prospective cohort study, we found that the incidence of MM in China was far lower than that in American and Europe.

Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.

Few studies have applied the triglyceride, cholesterol, body weight index (TCBI) in acute ischemic stroke (AIS). We investigated the association between the TCBI and adverse clinical outcomes in patients with AIS.Based on the Third China National Stroke Registry (CNSR-III) data from August 2015 to March 2018, we evaluated the nutritional status of patients with AIS using the TCBI. Patients were categorized according to quartile levels of the TCBI. The main outcomes were poor functional outcomes and recurrent stroke at 1-year and secondary outcomes were adverse outcomes at 3 and 6 months after stroke onset. Poor functional outcomes consisted of all-cause mortality and major disabilities. Multivariate analyses with logistic or Cox regression analysis and restricted cubic splines determined the association between the TCBI and adverse outcomes. We included 9708 patients. At the 1-year follow-up, 1323 patients (13.6%) had died or experienced major disability. The adjusted odds ratios/hazard ratios and 95% confidence intervals of the lowest quartile at 1-year were 1.47 (1.22-1.78) for poor functional outcomes, 1.46 (1.18-1.81) for major disability, and 1.34 (0.94-1.86) for all-cause mortality. Kaplan-Meier analysis demonstrated an inverse relationship between all-cause mortality and the TCBI (log-rank p0.05). An approximately L-shaped relationship between TCBI levels and poor functional outcomes and major disability was observed at 1-year.The novel TCBI was associated with short- and long-term adverse outcomes in AIS. Thus, it may be useful for predicting adverse outcomes in patients with AIS.

It has been widely reported that biochar can be used as a cost-effective amendment to immobilize of heavy metal contaminants in soil. While less research has been conducted on effect of biochar long-term field aging on its properties and the adsorption capability. In this study, the characteristics of aged biochar were investigated by comprehensive characterization to elucidate its mechanism transformation for heavy metal immobilization. Our results showed that, compared to fresh biochar, the relative content of C of aged biochar was reduced by 34.12%, while O was increased by 8.79%. Additionally, the specific surface area, pore volume, pore size and oxygen-containing functional groups of aged biochar were significantly increased compared to the fresh biochar. Batch adsorption experiment indicated that the maximum adsorption for Cd

Background and Purpose: To investigate the prevalence of malnutrition risk in patients with acute ischemic stroke (AIS) at admission, the association between malnutrition risk and long-term outcomes, and whether the predictive ability would be improved after adding to previous prognostic models for poor outcomes. Methods: Based on the Third China National Stroke Registry data from August 2015 to March 2018, we evaluated malnutrition risk using objective scores, including the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index. The primary outcome was death or major disability (modified Rankin Scale score ≥3) at 1 year after stroke onset. We calculated the crude prevalence of malnutrition risk and investigated the association between malnutrition risk and clinical outcomes. Prognostic performance of 3 objective malnutrition scores for poor outcomes was assessed. Results: Moderate to severe malnutrition risk was identified in 5.89%, 5.30%, and 1.95% of the Third China National Stroke Registry AIS patients according to the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index, respectively. At 1-year follow-up, 1143 participants (13.5%) experienced death or major disability. After adjustment for traditional risk factors, moderate to severe malnutrition risk was associated with high risk of composite events (odds ratio, 2.25 [95% CI, 1.75–2.90], for controlling nutritional status score; odds ratio, 2.10 [95% CI, 1.63–2.69], for geriatric nutritional risk index; odds ratio, 3.36 [95% CI, 2.33–4.84], for prognostic nutritional index; all P P Conclusions: The prevalence of moderate or severe malnutrition risk in Chinese patients with AIS ranged from 1.95% to 5.89%. Malnutrition risk in patients with AIS was associated with increased risk of long-term death and major disability. Our study provides evidence supporting the prognostic significance of objective malnutrition scores after AIS.

The use of rejuvenators has seen a consistent increase over the years in the asphalt pavement industry. This is due to the need for maximizing the demand for incorporating a higher amount of Reclaimed Asphalt (RA) in the pavement asphalt mixtures. In order to tackle this challenge, the Task Group 3, focusing on asphalt binders and additives, of the RILEM TC RAP conducted an interlaboratory activity to evaluate the effect of aging on blends of virgin and rejuvenated RA binders. A set of conventional tests including penetration value at 25 °C, softening point temperature and rheological measurements by means of Dynamic Shear Rheometer (DSR) were selected to involve a large number of participants. A binder, recovered from field RA, was treated with a bio-based rejuvenator and blended with a virgin binder to simulate recycling at three different percentages 60, 80, and 100%. These blends, as well as the pure virgin binder, were next short and long term aged and tested to evaluate the changes in the corresponding properties. Relatively consistent results were obtained for the entire set of blends. The aging of combined rejuvenated RA and virgin binders was comparable to that experienced for the pure virgin binder. DSR data provided a more precise evolution of the impact of aging on the materials.

To systematically compare 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. A total number of 1575 patients were included. The mean age was 57.2 ± 14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. In pairwise comparison, the ICH-FOS (0.856, 95%CI = 0.835-0.878, P < 0.001) showed statistically better discrimination than other models for mortality at 3-month after ICH (all P < 0.05). For predicting poor functional outcome (mRS≥3) at 3-month after ICH, AUROC of 27 ICH models ranged from 0.602 to 0.880. In pairwise comparison with other prediction models, the ICH-FOS was superior in predicting poor functional outcome at 3-month after ICH (all P < 0.001). The ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.

Background Functional recovery is an important clinical outcome for patients with stroke. Hospital-level variation occurs in functional outcome after stroke. However, the extent to which patient characteristics, hospital characteristics, process of care, and medication persistence contribute to the hospital variation in poor functional outcome after ischemic stroke is unknown in China. Methods We retrospectively analyzed patients enrolled in the Third China National Stroke Registry from 2015 to 2018. The outcome was poor functional outcome (modified Rankin Scale score of 3-6) at 3 months and 1 year. We used the median odds ratio to quantify the hospital-level variation in rates of poor functional outcome. A series of hierarchical logistic models were constructed to assess the extent to which patient characteristics, hospital characteristics, process of care, and medication persistence contributed to the hospital variation. Results A total of 13,218 patients with acute ischemic stroke from 159 hospitals were included. The riskadjusted rates of the poor functional outcome at 3 months and 1 year after ischemic stroke varied across hospitals, ranging from 6.0% to 26.0% and 6.8% to 24.0%, respectively. The median odds ratio was 1.78 at 3 months and 1.67 at 1 year. Hierarchical logistic models indicated that the patient characteristics, hospital characteristics, process of care, and the medication persistence explained 27.5%, 7.0%, 6.5%, and 5.0% of the variation at 1 year. Altogether, 36.8% and 46.1% of the hospital variation in 3-month and 1-year poor functional outcome, respectively, was explained. Conclusions There was a wide variation in rates of functional outcomes across hospitals. Approximately half of the variation at 1 year can be explained by patient characteristics, hospital characteristics, process of care, and medication persistence. Approximately 11.5% of the variation can be modified through improvements in the process of care and medication persistence. More studies are needed to explore the contribution of post-discharge care in the future.

Aging has a significant effect on the performance of asphalt material. Reliable modelling of the change of asphalt mixture properties over time is crucial to evaluating and predicting the performance of the designed pavement. The objective of this study is to develop an aging model to accurately predict the cracking performance of asphalt mixtures over the pavement service life, as well as evaluate the aging susceptibility of mixtures over time. In this study, nine loose mixtures were conditioned in an oven at 95 °C for multiple durations to simulate different field aging times. The climatic aging index (CAI) developed by the National Cooperative Highway Research Program (NCHRP) 09-54 project was utilized to calculate the appropriate field aging durations corresponding to the different laboratory aging conditions. Complex modulus tests (E*) were conducted to measure the rheological properties of the conditioned mixtures and further construct the dynamic modulus and phase angle mastercurves. The mixture Glover–Rowe (G–Rm) parameter, incorporating both stiffness and relaxation capacity, was selected and used as the Aging Index Property to model the changes in mixture cracking properties with aging. The results of this study indicate that the developed mixture aging model can effectively capture the two aging reaction periods (fast and constant) of asphalt materials. The developed model can not only be used to evaluate the change of cracking properties over pavement service life, but also detect the aging susceptibility of asphalt mixtures.

Atherosclerosis in stroke-related vascular beds is the major cause of stroke. Studies demonstrated that multivascular atherosclerosis is prevalent in stroke patients and those with multivascular plaques had higher risk of recurrent stroke.This study investigated the relationship between homocysteine and multivascular atherosclerosis in stroke-related vascular beds using magnetic resonance imaging.Patients with recent ischemic cerebrovascular symptoms were enrolled and underwent three-dimensional magnetic resonance vessel wall imaging for intracranial arteries, extracranial carotid arteries and aortic arch. Traditional risk factors and homocysteine were measured. Presence of multivascular plaques defined as plaques in at least two stroke-related vascular beds on magnetic resonance imaging was determined. The relationship between homocysteine and characteristics of multivascular plaques was determined.Of 49 enrolled patients (mean age: 56.3 ± 13.8 years; 35 males), 23 had multivascular plaques. Homocysteine (odds ratio, 1.17; 95% confidence interval, 1.02-1.34; p = 0.022) and age (odds ratio, 1.71; 95% confidence interval, 1.22-2.41; p = 0.002) were significantly associated with presence of multivascular plaques. The adjusted associations remained significant (both p 0.05). In discriminating presence of multivascular plaques, the area-under-the-curve of age, homocysteine and combination of them was 0.79, 0.70 and 0.87 respectively.Homocysteine is independently associated with stroke-related multivascular plaques and combination of age and homocysteine has stronger predictive value.

The objective of this study is to evaluate how the viscoelastic, fatigue, and fracture properties of asphalt binders and mixtures change as a function of ageing. Six plant-produced mixtures are eva...

Aging can significantly affect the viscoelastic properties and cracking behavior of asphalt mixtures, causing increase in stiffness, reduction in relaxation capability, and increase in brittleness. Eleven mixtures are evaluated using different laboratory conditioning protocols to evaluate how the properties of asphalt mixtures, including viscoelastic properties, fatigue, and fracture behavior will change over time. Comparisons between different aging levels and mixtures are conducted by using complex modulus (E*) (field cores are included), simplified viscoelastic continuum damage (S-VECD) approach, semi-circular bending (SCB), and disk shaped compact tension (DCT) fracture tests. The climatic aging index developed by the NCHRP 09-54 project is utilized in this study to calculate the appropriate field aging duration corresponding to the different laboratory aging protocols. Pavement evaluation tools FlexPAVETM and IlliTC are also used to predict and compare the fatigue and thermal cracking performance of these mixtures. The results of E* and S-VECD tests indicate that the mixtures are more prone to fatigue cracking with aging, and the two long-term conditioning protocols induce statistically similar changes in linear viscoelastic and fatigue properties. However, prediction of fatigue performance from FlexPAVE TM does not show a consistent trend once pavement structure and traffic are considered. Fracture tests and IlliTC predictions show the virgin mixtures and those with soft base binders will have better capability to resist cracking after long-term aging. In this study, the two mixtures with the largest difference between high and low temperature performance grade (PG) show the largest change in fracture and fatigue properties with aging.

Reduction in cerebral blood flow (CBF), one of the major metrics for cerebral perfusion, is associated with many brain disorders. Therefore, early characterization of CBF prior to occurrence of symptoms is essential for prevention of cerebral ischemic events. We hypothesized that large artery atherosclerosis might be a potential indicator for decline in cerebral perfusion. The aim of this study was to investigate the relationship between large artery atherosclerosis and CBF in asymptomatic adults. A total of 134 asymptomatic subjects (mean age, 56.2 ± 12.8 years; 54 males) were recruited and underwent magnetic resonance (MR) imaging for brain and intracranial and extracranial carotid arteries. Presence or absence of cerebrovascular atherosclerosis was determined on MR vessel wall images. The CBF was measured with pseudo-continuous arterial spin labeling (pCASL) imaging. The CBF values in internal carotid artery (ICA) (37.2 ± 5.8 vs. 39.0 ± 4.9 ml/100 g/min, P = 0.049) and vertebrobasilar artery (VA-BA) territories (42.0 ± 6.8 vs. 44.8 ± 7.0 ml/100 g/min, P = 0.023) were significantly reduced in subjects with cerebrovascular plaque compared to those without. Presence of cerebrovascular plaque was significantly associated with CBF of VA-BA territory before (odds ratio, 2.89; 95% confidence interval, 1.37-6.08; P = 0.005) and after adjusted for confounding factors including age, gender, body-mass-index, diabetes, systolic blood pressure, hyperlipidemia and history of cardiovascular disease (odds ratio, 2.76; 95% confidence interval, 1.18-6.46; P = 0.019). In conclusion, presence of cerebrovascular atherosclerosis is independently associated with reduction in CBF measured by pCASL in asymptomatic adults, suggesting that cerebrovascular large artery atherosclerosis might be an effective indicator for impairment of cerebral microcirculation hemodynamics.

BackgroundTo investigate the association between hemoglobin A1c (HbA1c) and intraplaque hemorrhage (IPH) in carotid atherosclerotic plaque detected by high-resolution magnetic resonance imaging (HR-MRI) in a community-based population. MethodsIn this cross-sectional, community-based study, a total of 598 participants were recruited from May 2015 to September 2019. All participants underwent carotid artery HR-MRI. Data on demographics, medical history, and physical examinations were obtained through face-to-face interview, and fasting blood sample were collected. HbA1c was determined using high-performance liquid chromatographic analysis. Presence or absence of carotid plaque IPH was determined by HR-MRI. Multiple stepwise logistic regression analysis was performed to investigate the association between HbA1c levels and carotid plaque IPH. ResultsOf the 598 participants, 317 (53.0%) had atherosclerotic plaques, and 25 (4.2%) had IPH in carotid arteries. HbA1c was associated with the presence of IPH (OR, 1.94; 95% CI, 1.38-2.73) in the univariate analysis, and the association remained significant after adjustment for age, sex, traditional vascular factors, high-sensitivity C-reactive protein, and other potential confounders (OR, 1.70; 95% CI, 1.14-2.52).Conclusions This study showed that high HbA1c was associated with carotid plaque IPH detected by HR-MRI, which suggests that individuals with high HbA1c may have a higher risk of developing vulnerable carotid plaques.

Lightweight neural network (LNN) nowadays plays a vital role in embedded applications with limited resources. Quantized LNN with a low bit precision is an effective solution, which further reduces the computational and memory resource requirements. However, it is still challenging to avoid the significant accuracy degradation compared with the heavy neural network due to its numerical approximation and lower redundancy. In this paper, we propose a novel robustness-aware self-reference quantization scheme for LNN (SRQ), as Fig. 1 shows, which improves the performance by efficiently distillation of the structural information and takes the robustness of the quantized LNN into consideration. Specifically, SRQ considers a structural loss between the original LNN and quantized LNN, witch enable the scheme not only improve accuracy performance, but also can further fine tuning of the quantization network by applying the Lipschitz constraint to the structural loss. In addition, we also consider the robustness of quantized LNN for the first time, and propose a non-sensitive perturbation loss function by introducing an extraneous term of spectral norm. The experimental results show that the SRQ can effectively improve the accuracy and robustness of the state-of-the-art quantization methods, such as DoReFa and PACT.

We conducted a randomized, open-label, parallel-controlled, multicenter trial on the use of Shuanghuanglian (SHL), a traditional Chinese patent medicine, in treating cases of COVID-19. A total of 176 patients received SHL by three doses (56 in low dose, 61 in middle dose, and 59 in high dose) in addition to standard care. The control group was composed of 59 patients who received standard therapy alone. Treatment with SHL was not associated with a difference from standard care in the time to disease recovery. Patients with 14-day SHL treatment had significantly higher rate in negative conversion of SARS-CoV-2 in nucleic acid swab tests than the patients from the control group (93.4% vs. 73.9%, P = 0.006). Analysis of chest computed tomography images showed that treatment with high-dose SHL significantly promoted absorption of inflammatory focus of pneumonia, which was evaluated by density reduction of inflammatory focus from baseline, at day 7 (mean difference (95% CI), −46.39 (−86.83 to −5.94) HU; P = 0.025) and day 14 (mean difference (95% CI), −74.21 (−133.35 to −15.08) HU; P = 0.014). No serious adverse events occurred in the SHL groups. This study illustrated that SHL in combination with standard care was safe and partially effective for the treatment of COVID-19. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s11684-021-0853-6 and is accessible for authorized users.

Background: Studies showed that patients with hemorrhagic stroke are at higher risk of developing deep vein thrombosis (DVT) than those with ischemic stroke. We aimed to develop a risk score (intracerebral hemorrhage associated deep vein thrombosis score, ICH-DVT) for predicting in-hospital DVT after ICH. Methods: The ICH-DVT was developed based on the Beijing Registration of Intracerebral Hemorrhage, in which eligible patients were randomly divided into derivation (60%) and internal validation cohort (40%). External validation was performed using the iMCAS study (In-hospital Medical Complication after Acute Stroke). Independent predictors of in-hospital DVT after ICH were obtained using multivariable logistic regression and β-coefficients were used to generate scoring system of the ICH-DVT. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test was used to assess model discrimination and calibration. Findings: The overall in-hospital DVT after ICH was 6.3%,6.0%, and 5.7% in the derivation (n=1309), internal (n=655) and external (n=314) validation cohorts, respectively. A 31-point ICH-DVT was developed from the set of independent predictors including age, hematoma volume, subarachnoid extension, pneumonia, gastrointestinal bleeding and length of hospitalization. The ICH-DVT showed good discrimination (AUROC) in the derivation (0.81; 95%CI=0.79-0.83), internal (0.83, 95%CI=0.80-0.86) and external (0.88; 95%CI=0.84-0.92) validation cohorts. The ICH-DVT was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.53), internal (P=0.38) and external (P=0.06) validation cohorts. Interpretation: The ICH-DVT is a valid grading scale for predicting in-hospital DVT after ICH. Further studies on effect of the ICH-DVT on clinical outcomes after ICH are warranted. Funding Information: This study was sponsored by Capital health research and development of special (2011-2004-03) and Beijing Municipal Science & Technology Commission (Z131107002213009). This study was partially supported by the Nova Program of Beijing Science and Technology Commission (2008B30), National Natural Science Foundation of China (81471208, 81641162), Beijing highlevel healthy human resource project (014-3-033) and Shandong Province Key Innovation Project (2019JZZY020901). Declaration of Interests: All authors report no disclosures. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (IRB) of the Beijing Tiantan Hospital (KY2014-023-02). The iMCAS was approved by the ethics committee of Beijing Tiantan hospital. For the present study, only patients with ICH were included.

Background: Despite advances in medical knowledge, treatment for ICH remains strictly supportive with not many evidence-based interventions currently available. Stroke associated pneumonia (SAP) is a common medical complication after stroke and has significant impact on stroke outcomes. In the study, we aimed to systematically compare discrimination and calibration of clinical scores with regard to in-hospital SAP after ICH. Methods: The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. The SAP was diagnosed according to the criteria for hospital-acquired pneumonia of Center for Disease Control and Prevention. Five clinical scores were included in the study: the ICH-APS-A, ICH-ASP-B, ISAN, ACCD4 and PASS score. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Pairwise AUROC was compared by using Delong’s method. Calibration was assessed by performing the Hosmer-Lemeshow goodness-of-fit test and plot of observed versus predicted risk according to 10 deciles of the predicted risk. The Cox and Snell R-square and Nagelkerke R-square of the Hosmer-Lemeshow goodness-of-fit test were calculated. Results: A total number of 1964 patients were enrolled. The mean age was 56.8±14.4 and 67.6% were male. The median admission NIHSS was 11 (IQR: 3-21). The median length of stay (LOS) was 16 days (IQR: 8-22). A total number of 575 (29.2%) patients was diagnosed with in-hospital SAP after ICH. The AUROC of five clinical scores ranged from 0.732 to 0.800. In pairwise comparison, the ICH-APS-B (0.800, 95% CI=0.780-0.820, PConclusion: Several models are externally validated to be effective for risk stratification and outcome prediction for in-hospital SAP after ICH, which would be useful tools for personalized care and clinical trials in prevention of SAP after ICH.