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Aim. The study is aimed at exploring the relationship between newly graduated nurses’ transition shock, negative coping, job satisfaction, and intent to stay during the time of COVID-19. Background. The shortage of nurses is a global dilemma aggravated by the COVID-19 pandemic. It has been a hot topic in recent years to help newly graduated nurses transition smoothly. Transition shock is one of the essential indicators to describe the transition state of newly graduated nurses, which has a far-reaching impact on the intention of newly graduated nurses to stay in their posts. However, few studies have studied the mechanism behind this relationship, which may affect the effectiveness of retention strategies. Methods. A descriptive cross-sectional study was conducted from July to August 2021 in 31 tertiary hospitals in Shanghai, China. Participants comprised a convenience sample of 759 newly graduated nurses for surveys. Structural equation models were used to examine the study’s hypothetical model. Results. The results showed that transition shock had a significant direct effect on job satisfaction (b = −0.412, p < 0.001 ) and intent to stay (b = −0.145, p < 0.001 ). Job satisfaction had a significant direct effect on intent to stay (b = 0.702, p < 0.001 ). The indirect effect of transition shock on intent to stay through job satisfaction was statistically significant (b = −0.289), the 95% C.I. was (−0.493, −0.357), and the proportion of mediating effect to total effect was 66.59%. Moreover, the moderated mediation analysis showed that the interaction effect of transition shock and negative coping style on job satisfaction was significant (b = −0.082, p < 0.001 ). Conclusion. This study revealed the impact of transition shock on intent to stay of newly graduated nurses during the time of COVID-19, and found that job satisfaction played a mediating role and negative coping played a moderating role. These findings are of great significance for nursing managers to take measures to improve the intention of newly graduated nurses to stay. Implication for Nursing Management. The level of transition shock is an important indicator reflecting the transition state of newly graduated nurses, and can further predict the job satisfaction and intention of newly graduated nurses to stay. Therefore, nursing managers should pay attention to taking corresponding measures to reduce the level of transition shock of newly graduated nurses.

To present a case series of the exstrophy-epispadias complex (EEC) with isolated ectopic bowel segment (IEBS) with the literature review, highlighting the clinical findings and treatments.We present 3 cases of bladder exstrophy (BE) with IEBS in our institute and reviewed the literature in PubMed with the terms "("bladder exstrophy" OR "epispadias") AND ("visceral sequestration" OR "sequestered" OR "ectopic bowel")."There were 2 males and 1 female. The IEBS was detected by physical examination in 2 cases and by ultrasonography in another one. All cases were BE accompanying with lower abdominal mass which adhered to the bladder wall but was separated from the digestive system. All cases underwent the IEBS excision and BE repair simultaneously. Pathological result of IEBS suggested the histological structures of colon. There were totally 13 cases of EEC with IEBS reported in the literature, including 2 (15%) epispadias, 9 (69%) covered BE, 1 (8%) duplicate BE and 1 (8%) classic bladder exstrophy. Although their clinical manifestations were various, IEBS excision were safely conducted in all cases.EEC with IEBS is an extremely rare congenital malformation. Physical and imaging examinations are important for diagnoses. Surgical excision is safe and effective for managing IEBS.

To quantitatively measure the anatomical variations of the pelvic floor in children with exstrophy-epispadias complex using magnetic resonance imaging.Six cases of classic bladder exstrophy (CBE), 5 cases of penile epispadias (PE) and 11 cases of penopubic epispadias (PPE) were included. Another 8 cases with the testicular tumor were taken as the controls. A series of measurements obtained from the pelvic floor magnetic resonance imaging were analyzed, and the measurements with significant differences were obtained by ANOVA.The pelvic floor of the CBE was significantly different from that of controls in measurements including wider pubic diastasis (P.001), greater posterior anal distance (P = .019), greater posterior bladder neck distance (P = .004), larger iliac wing angle (P.001), diminutive ischial angle (P.001), bigger puborectalis angle (P.001), larger ileococcygeous angle (P = .002) and shortened anterior corporal length (P.001). For the PE, the posterior bladder neck distance (P = .038) was greater than that of controls. In the PPE, the posterior bladder neck distance (P = .001) and puborectalis angle (P = .026) was greater than that of controls, respectively.CBE shows severe anatomical variations of the pelvic floor. The bladder neck moves more anteriorly both in PE and PPE than the control. The enlarged puborectalis angle resulting from wider pubic diastasis and more anterior position of the anorectal canal is also noticed in PPE.

Both voice communication and automatic speech verification (ASV) over smart devices are vulnerable to voice impersonation (VI) attack, which is often launched via imitating a target’s voice characteristics to deceive human auditory sense or fool the ASV system. Researchers have designed a number of defense schemes yet without consideration of universality due to the lack of comprehensive datasets. In this paper, we propose a universal defense scheme based on the VI dataset collected from a famous TV show named “The Sound”. First, we deliver a thorough study on the VI attacks in both auditory and ASV systems to verify the collected simulated voice could spoof the auditory and the ASV system with a notable probability. Second, we propose a quasi-gaussian distribution (QGD) based defense scheme with the discovery about specific voice characteristics are distinct between attackers and targets. Finally, we conduct extensive experimental results on our collected VI dataset as well as the auxiliary ASVspoof2017 dataset, to indicate the proposed QGD scheme outperforms the state-of-the-art schemes: Back-Propagation Neural Network, Support Vector Machine and Gaussian Mixture Model, in terms of accuracy.

Cloud-assisted Internet of Medical Things (IoMT) is becoming an emerging paradigm in the healthcare domain, which involves collection, storage and usage of the medical data. Considering the confidentiality and accessibility of the outsourced data, secure and fine-grained data sharing is a crucial requirement for the patients. Attribute-based encryption (ABE) is a promising solution to deal with this issue, but considering its property of each attribute sharing with multiple users, how to flexibly and efficiently update access privileges of certain users without affecting others is still a serious challenge. In this paper, we propose a secure and fine-grained data sharing scheme with flexible user access privilege update in cloud-assisted IoMT environment. Specifically, we take ABE as the basic building block, and utilize proxy re-encryption and key blinding techniques to empower the cloud server to re-encrypt the ciphertext affected by revocation and update keys for unrevoked users. In addition, adding attributes for users to extend their access rights is realized only based on few key components stored in cloud without entirely re-computing and re-issuing keys for them. As a result, the patients are able to flexibly and efficiently share their data and manage users' privileges. Formal proof and detailed performance evaluation demonstrate the security and efficiency of the proposed scheme.

Body composition was associated with nonalcoholic steatohepatitis (NASH), but results were controversial probably due to gender differences. Hence, we aim to explore the association of body composition and NASH in males and females.We conducted a cross-sectional analysis of obese subjects undergone liver biopsy. According to NASH Clinical Research Network system, subjects were categorized as Normal Control (NC), non-NASH or NASH. Body composition was accessed by dual-energy X-ray absorptiometry.This study enrolled 336 subjects (mean age 32.0 years, mean BMI 39.15 kg/mWe firstly revealed that low RMM and high AGR were the independent risk factors for NASH in males and females, respectively, indicating that sex-specific interventions for improving body composition may reduce the risk of NASH in obese subjects.

BackgroundBlood-brain barrier disruption is a prominent pathological characteristic of aneurysmal subarachnoid hemorrhage (aSAH), which can be measured as Ktransusing CT perfusion.PurposeTo monitor Ktranswithin 24 hours of aSAH and during the time window associated with a delayed cerebral ischemia (DCI) event (DCITW), and to explore its association with the trajectory of DCI, including outcome at three months.MethodsWe retrospectively assessed consecutive aSAH patients from a prospective database between July 2020 and September 2022. Patients were grouped according to the DCI occurrence and three months modified Rankin scale. Ktransat admission (admission Ktrans) and during DCITW (DCITW Ktrans) were compared between DCI and non-DCI groups, and between good outcome and poor outcome groups. The changes in Ktranswere also analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of DCI and poor outcome.ResultsOne hundred and twenty-eight patients (mean age, 61±12 [SD]; 75 women) were included. Both admission Ktrans(0.58±0.18 vs 0.47±0.12,P=0.002) and DCITW Ktrans(0.54±0.19 vs 0.41±0.14,PP=0.198). Ktransin the non-DCI group (0.47±0.12 vs 0.41±0.14,P=0.004) and good outcome group (0.49±0.14 vs 0.41±0.14,Ptransand admission Ktransas independent predictors of poor outcome (OR=1.73, 95%CI: 1.24-2.43,P=0.001) and DCI (OR=1.75, 95%CI: 1.25-2.44,P=0.001), respectively.ConclusionElevated Ktransat admission is associated with the occurrence of DCI, but not with outcome at three months. Continuous monitoring of Ktransfrom admission to DCITW can accurately identify reversible and irreversible changes in Ktrans, and can predict outcome.

Aim To investigate the protective effect of α-lipoic acid on sodium arsenite (NaAsO2) induced INS-1 cells injury and its mechanism. Methods The cell viability was measured by CCK-8 assay. The autophagosomes was observed under transmission electron microscopy. The autophagosomes in cells transfected with green fluorescent protein microtubule-associated protein light chain 3 (GFP-LC3) plasmids were observed under a laser scanning con-focal microscope. The expression of LC3-II, P62, PI3K, and mTOR proteins in INS-1 cells treated with a combination of chloroquine (CQ, autophagy inhibitor) and NaAsO2 were detected by Western blot assay. The expression of LC3-II, P62, PI3K, and mTOR proteins were detected in INS-1 cells treated with a combination of rapamycin (autophagy inducer, mTOR inhibitor) and α-LA. Results The cytotoxicity induced by NaAsO2 was reversed by α-LA, and the viability of NaAsO2-treated INS-1 cells increased. α-LA pretreatment decreased the autophagosome accumulation induced by NaAsO2. α-LA also reduced the fluorescence spot aggregation of GFP-LC3 in INS-1 cells exposed to NaAsO2 as observed under a laser scanning con-focal microscope. α-LA inhibited NaAsO2 induced autophagy by up-regulating PI3K and mTOR and down-regulating LC3-II and P62. CQ inhibited NaAsO2 induced autophagy by up-regulating PI3K, mTOR, P62 and down-regulating LC3-II. α-LA inhibited rapamycin-induced autophagy by up-regulating PI3K, mTOR and P62 and down-regulating LC3-II. The results showed that NaAsO2 could induce autophagy activation in INS-1 cells. The α-LA may inhibit autophagy activation by regulating the PI3K/mTOR pathway. Conclusion The data indicated that α-LA might inhibit the NaAsO2-induced autophagic death of INS-1 cells by regulating the PI3K/mTOR pathway.

Purpose Preoperative fasting is a necessary experience for pediatric patients undergoing elective surgery. The American Society of Anesthesiologist guideline shows that preoperative fasting times were reduced and safe (no solid food up to 8 hours, no fluid or formula up to 6 hours, no breast milk up to 4 hours, and no clear fluids up to 2 hours before surgery). However, preoperative fasting is usually more prolonged than the suggested time. This study aimed to investigate the duration of preoperative fasting for elective surgery at a pediatric hospital in Shanghai, China, and compare it with the evidence from guidelines. Design The study used a descriptive cross-sectional design. Methods A total of 211 children under anesthesia in a Shanghai's pediatric hospital were included in the study. The preoperative fasting status was assessed using a self-administered record card of preoperative fasting developed by Chinese researchers. Findings The results indicated that the length of time fasted preoperatively was longer for all participants than that recommended by the American Society of Anesthesiologists. With the long length of fasting time, it is evident that the majority of children experienced hunger (17.5%), thirst (19.4%), and anxiety (16.1%) as indicated with 8 points of the Likert 10-point scale. The degrees of these experiences were relevant to the length of preoperative fasting time. Conclusions A big gap was revealed between the recommendation and actual practice, and children underwent an uncomfortable experience before the surgery. These results suggest that evidence-based clinical improvement is required, and the recommended preoperative fasting instruction transform into clinical practice should be promoted.

Cloud storage services allow a data owner to share her/his outsourced data with other users, and enable the users to search target data by keywords. To ensure the data confidentiality, data owner always encrypt data using traditional encryption schemes before outsourcing. Whereas, it makes efficiently searching impossible. Symmetric searchable encryption (SSE) is a cryptographic primitive that resolves this tension. However, most existing SSE schemes do not consider the individual characteristics of users during the search, such that they cannot support personalized search services over encrypted data. Meanwhile, security and efficiency issues in the cloud service model have also severely affected the user’s search experience, and the introduction of mobile edge servers can solve these problems to some extent. In this paper, we propose a personalized searchable encryption scheme (PSED) for mobile edge-assisted cloud storage. Our contribution consists of three aspects. First, we incorporate the user’s preference factors into the user’s query which enable users to get accurate personalized search results. Second, the computational overhead of the cloud server is reduced by calculating the relevance scores of the subqueries and subindexes on mobile edge servers. Third, by cutting the index and the query matrix, the encryption efficiency of the index and the query matrix is improved. Security analysis shows that PSED can guarantee the privacy of the data and the user. Experimental results demonstrate that the proposed schemes are highly efficient and accurate.

Objective：Coronary artery disease (CAD) is an immune-mediated chronic disease, and interleukin-27(IL-27) regulates CD4+ T cell differentiation. However, little is known about its effects on CAD. Therefore, we aimed to investigate the changes of IL-27 and its effect on CD4+ T cells in patients with CAD.Methods: The severity of coronary artery stenosis was assessed by Gensini score, and the concentrations of plasma IL-27, ox-LDL were measured by ELISA. qRT-PCR and Western Blotting (WB) were performed to evaluate the mRNA and protein expression of T-bet, IFN-γ, GATA-3, and RORγt. After monocytes were stimulated with recombinant IL-2 and/or IL-27, CD4+IFN-γ+T cells, CD4+IL-4+T cells, CD4+IL-17+T cells, CD4+LAP+T cells and CD4+CD25+Foxp3+ Tregs were counted by flow cytometry. Results: Plasma IL-27 levels were significantly elevated in patients with Acute Coronary Syndromes (ACS). IL-27 levels were positively correlated with ox-LDL and Gensini scores (P < 0.01) and ox-LDL levels were positively correlated with Gensini scores (P < 0.01). The more severe the stenosis in CAD patients, the more Th1 and Th17 cells, and the less Th2, CD4+CD25+Foxp3+Tregs and CD4+LAP+T cells. IL-27 can increase the expression of T-bet and IFN-γ, and inhibit the expression of RORγt and GATA-3, and finally promote the differentiation of CD4+T cells into Th1 cells, and inhibit the differentiation of Th2, Th17, CD4+CD25+Foxp3+Tregs and CD4+LAP+T cells.Conclusion: IL-27 regulates CAD by increasing the expression of T-bet and IFN-γ and inhibiting the expression of RORγt and GATA-3, thereby increasing the frequency of Th1 cells and decreasing the frequency of Th2, Th17, CD4+CD25+Foxp3+Tregs and CD4+LAP+T cells.

Mobile crowdsensing is an emerging paradigm that selects users to complete sensing tasks. Recently, mobile vehicles are adopted to perform sensing data collection tasks in the urban city due to their ubiquity and mobility. In this article, we study how mobile vehicles can be optimally selected in order to collect maximum data from the urban environment in a future period of tens of minutes. We formulate the recruitment of vehicles as a maximum data limited budget problem. The application scenario is generalized to a realistic online setting where vehicles are continuously moving in real-time and the data center decides to recruit a set of vehicles immediately. A deep learning-based scheme through mobile vehicles (DLMV) is proposed to collect sensing data in the urban environment. We first propose a deep learning-based offline algorithm to predict vehicle mobility in a future time period. Furthermore, we propose a greedy online algorithm to recruit a subset of vehicles with a limited budget for the NP-Complete problem. Extensive experimental evaluations are conducted on the real mobility dataset in Rome. The results have not only verified the efficiency of our proposed solution but also validated that DLMV can improve the quantity of collected sensing data compared with other algorithms.

Background Proximal region of chromosome 15 long arm is rich in duplicons that, define five breakpoints (BP) for 15q rearrangements. 15q11.2 microdeletion has been previously associated with developmental delay, mental retardation, epilepsy, autism, schizophrenia and congenital heart defects. The literature on this microdeletion is extensive and confusing, which is a challenge for genetic counselling. Case presentation We have performed prenatal diagnosis and genetic counseling of a paternally inherited 15q11.2 microdeletion. In this family, father with normal phenotype and fetus with abnormal phenotype have the same microdeletion. Conclusion Chromosomal microdeletions and microduplications are difficult to detect by conventional cytogenetics, combination of prenatal ultrasound, karyotype analysis, CMA and genetic counseling is helpful for the prenatal diagnosis of chromosomal microdeletions/microduplications.

Background Delivery of therapeutic small interfering RNA (siRNA) via functionalized nanoparticles holds great promise for cancer therapy. However, developing a safe and efficient delivery carrier of siRNA is a challenging issue. Methods RGDfC peptide was used to modify the surface of selenium nanoparticles (SeNPs) to synthesize a biocompatible siRNA delivery vehicle (R-SeNPs), and MEF2D-siRNA was loaded onto R-SeNPs to prepare a functionalized selenium nanoparticle R-Se@MEF2D-siRNA. The chemical properties of R-SeNPs were characterized, and the anticancer efficacy as well as related mechanisms of R-Se@MEF2D-siRNA were further explored. Results R-Se@MEF2D-siRNA was significantly taken up by SKOV3 cells and could enter SKOV3 cells mainly in the clathrin-associated endocytosis way. The result of in vitro siRNA release demonstrated that R-Se@MEF2D-siRNA could release MEF2D-siRNA quicker in a microenvironment simulating a lysosomal environment in tumor cells compared to a normal physiological environment. The results of qRT-PCR assay proved that R-Se@MEF2D-siRNA could effectively silence the expression of the MEF2D gene in SKOV3 cells. R-Se@MEF2D-siRNA remarkably suppressed the proliferation of SKOV3 cells and further triggered its apoptosis. In addition, R-Se@MEF2D-siRNA had the capability to disrupt mitochondrial membrane potential (MMP) in SKOV3 cells and resulted in the overproduction of reactive oxygen species (ROS), indicating that mitochondrial dysfunction and ROS generation played an important role in the apoptosis of SKOV3 cells induced by R-Se@MEF2D-siRNA. In vivo, R-Se@MEF2D-siRNA also exhibited excellent antitumor activity mainly through decreasing tumor cells proliferation and triggering their apoptosis in tumor-bearing nude mice. Conclusion R-Se@MEF2D-siRNA provides an alternative strategy for ovarian cancer treatment in the clinic.

Objective To characterize the inferior adrenal artery (IAA) pulsatility index (PI) in intrauterine growth–restricted (IUGR) fetuses without brain sparing. Methods Twenty-three IUGR fetuses with a normal Doppler cerebroplacental ratio (CPR) and 23 normal controls were included in this prospective cross-sectional study. The PI of the IAA was recorded using routine transabdominal Doppler ultrasound. The differences in Doppler characteristics, perinatal outcomes, and steroidogenesis in the umbilical vein at birth (adrenocorticotropic hormone [ACTH] and cortisol [F] levels) were compared between the 2 groups. The correlations between IAA-PI and steroidogenesis were assessed in the IUGR group. Results IAA-PI was significantly lower in IUGR fetuses than in normal controls (0.85 vs 1.18 at first scan, 0.78 vs 0.92 at last scan; both P < 0.001). The plasma F and ACTH levels in IUGR cases were significantly higher than those of the normal controls (18.2 vs 12.4 µg/dL and 280.5 vs 125.6 pg/mL for F and ACTH, respectively; both P < 0.001). There were negative correlations between IAA-PI and plasma F values and between IAA-PI and ACTH values in the IUGR group (r = −0.774 and −0.82 at first scan, r = −0.525 and −0.45 at last scan, respectively; P < 0.001). Conclusion Increased adrenal gland blood flow with concomitant increases in ACTH and F levels were observed in IUGR fetuses. IAA-PI is useful to assess early blood redistribution and may be beneficial for evaluating the steroidogenic response in high-risk pregnancies.

Mobile crowdsourcing enables mobile requesters to publish tasks, which can be accomplished by workers with awards. However, existing task allocation schemes face tradeoff between effectiveness and privacy preservation, and most of them lack consideration of win-win incentives for both requesters and workers participation. In this paper, we propose a privacy-preserving task recommendation scheme with win-win incentives in crowdsourcing through developing advanced attribute-based encryption with preparation/online encryption and outsourced decryption technologies. Specifically, we design bipartite matching between published tasks and participant workers, to recommend tasks for eligible workers with interests and provide valuable task accomplishment for requesters in a win-win manner. Furthermore, our scheme reduces encryption cost for requesters by splitting encryption into preparation and online phases, as well as shifts most of the decryption overhead from the worker side to the service platform. Privacy analysis demonstrates requester and worker privacy preservation under chosen-keyword attack and chosen-plaintext attack. Performance evaluation shows cost-efficient computation overhead for requesters and workers.

In this paper, we consider the issue of the secure transmissions for the cognitive radio-based Internet of Medical Things (IoMT) with wireless energy harvesting. In these systems, a primary transmitter (PT) will transmit its sensitive medical information to a primary receiver (PR) by a multi-antenna-based secondary transmitter (ST), where we consider that a potential eavesdropper may listen to the PT’s sensitive information. Meanwhile, the ST also transmits its own information concurrently by utilizing spectrum sharing. We aim to propose a novel scheme for jointly designing the optimal parameters, i.e., energy harvesting (EH) time ratio and secure beamforming vectors, for maximizing the primary secrecy transmission rate while guaranteeing secondary transmission requirement. For solving the nonconvex optimization problem, we transfer the problem into convex optimization form by adopting the semidefinite relaxation (SDR) method and Charnes–Cooper transformation technique. Then, the optimal secure beamforming vectors and energy harvesting duration can be obtained easily by utilizing the CVX tools. According to the simulation results of secrecy transmission rate, i.e., secrecy capacity, we can observe that the proposed protocol for the considered system model can effectively promote the primary secrecy transmission rate when compared with traditional zero-forcing (ZF) scheme, while ensuring the transmission rate of the secondary system.

Background Epilepsy is one of the most common chronic neurological diseases that adversely impact the quality of life of patients and their families. The “Quality of Life of Childhood Epilepsy Questionnaire” (hereinafter referred to as “QOLCE-16”) is a 16-item measure that was designed to assess health-related quality of life (HRQOL) among children with epilepsy. The purpose of the study was to translate and evaluate the psychometric properties of the QOLCE-16. Methods The 10 steps of Principles of Good Practices for translation and cultural adaptation of measures were adopted to translate the QOLCE-16 into Chinese. After that, item analysis, floor effect and ceiling effect, internal consistency, test–retest reliabilities, content validity and construct validity were conducted to test its applicability in children with epilepsy in China. A total of 435 native Chinese-speaking parents with children who had epilepsy from one children’s hospital were invited to take part in the study, including a cognitive interview sample of 5 and a validation sample of 430. Results A total of 414 objects were enrolled in our study for psychometric testing. The results of the item analysis revealed QOLCE-16-C to have good discrimination, the floor effect and ceiling effect were 0.2% and 1.0% respectively, and each item was significantly related to the total scale (P 2/df = 1.698, GFI = 0.913, CFI = 0.974, RMSEA = 0.058). Conclusion The Chinese version of QOLCE-16-C appears to be a culturally appropriate, valid and reliable tool to assess the health-related quality of life of children with epilepsy in China.

The association between the severity of obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) in patients with obesity remains unclear. We conducted this study to determine the effects of OSA on the severity of NAFLD in individuals with obesity and its link to the development of non-alcoholic steatohepatitis (NASH).Patients were subjected to standard polysomnography up to 1 week before undergoing bariatric surgery, during which liver biopsy specimens were obtained. The apnea-hypopnea index (AHI) obtained by polysomnography was used to determine the severity of OSA.In total, 183 patients with obesity and biopsy-confirmed NAFLD were included; 49 (27%) had NASH. Patients with NASH had higher AHIs (p = 0.014) and oxygen desaturation indices (p = 0.031), more frequent OSA (p = 0.001), and lower minimum oxygen saturation (p = 0.035). The severity of OSA was directly correlated with the NAFLD activity score (p 0.001), NASH activity grade (p 0.001), semi-quantitative indices of lobular inflammation (p = 0.001), and hepatocyte ballooning (p = 0.006). The odds ratios (95% confidence intervals) for NASH and severe NASH (activity grade ≥ 3) associated with moderate-to-severe OSA were 3.85 (1.35-10.94; p 0.05) and 5.02 (1.66-15.18; p 0.01), respectively, after adjusting for sex, age, body mass index, waist circumference, insulin resistance values, and metabolic syndrome.Chronic intermittent hypoxia caused by OSA may aggravate NAFLD and lead to a higher risk of NASH in patients with obesity.

This study aimed to investigate the alteration of circulating CD34In this study, 36 patients with newly diagnosed type 2 diabetes and 22 control subjects matched by age and gender were enrolled. All of the patients with diabetes received intensive insulin therapy. The number of EPCs was assessed by flow cytometry based on the expression of CD34, CD133, and kinase insert domain-containing receptor (KDR).Levels of circulating CD34These results showed that type 2 diabetes is associated with an increase of circulating CD34NCT03710811.

Objective: Cutaneous T cell lymphoma (CTCL) is a kind of extranodal non-Hodgkin Tcell lymphoma without healable treatment in the clinic. JAK2 amplification in CTCL patients makes it a potential target for CTCL treatment. In the present study, we aimed to evaluate the anticancer effect of ND-16, a novel nilotinib derivate, on CTCL cells and the underlying mechanism targeting JAK2. Methods and Results: We found that ND-16 was capable of regulating JAK2 and had a selective inhibitory effect on CTCL H9 cells. The surface plasmon resonance and molecular docking study indicated ND-16 bound to JAK2 with a high binding affinity. Further investigation revealed that ND-16 inhibited the downstream cascades of JAK2, including STATs, PI3K/AKT/mTOR, and MAPK pathways, followed by regulation of Bcl-2 family members and cell cycle proteins CDK/- Cyclins. Flow cytometry analysis confirmed these results that ND-16-treated H9 cells showed cell apoptosis and cell cycle arrest at S-phase. Conclusion: ND-16 may be of value in a potential therapy for the management of CTCL.

Background Hepatocellular carcinoma (HCC) is the third leading cause of cancer‐related deaths worldwide. Overexpression of pleomorphic adenoma gene like‐2 (PLAGL2) is associated with tumorigenesis. However, its function in HCC is unclear, and there are currently no anti‐HCC drugs that target PLAGL2. Drug repositioning may facilitate the development of PLAGL2‐targeted drug candidates. Methods The expression of PLAGL2 in HCC clinical tissue samples and HCC cell lines was analyzed by western blotting. The constructed HCC cell models were used to confirm the underlying function of PLAGL2 as a therapeutic target. Multiple in vitro and in vivo assays were conducted to determine the anti‐proliferative and apoptosis‐inducing effects of selenium sulfide (SeS2), which is clinically used for the treatment of seborrheic dermatitis and tinea versicolor. Results PLAGL2 expression was higher in HCC tumor tissues than in normal adjacent tissues. Its overexpression promoted the resistance of HCC cells of mitochondrial apoptosis through the regulation of the downstream C‐MET/STAT3 signaling axis. SeS2 exerted significant anti‐proliferative and apoptosis‐inducing effects on HCC cells in a PLAGL2‐dependent manner. Mechanistically, SeS2 suppressed C‐MET/STAT3, AKT/mTOR, and MAPK signaling and triggered Bcl‐2/Cyto C/Caspase‐mediated intrinsic mitochondrial apoptosis both in vitro and in vivo. Conclusions Our data reveal an important role of PLAGL2 in apoptosis resistance in HCC and highlight the potential of using SeS2 as a PLAGL2 inhibitor in patients with HCC., The C‐MET/STAT3 signaling axis as a novel downstream target of pleomorphic adenoma gene like‐2 (PLAGL2) contributed to PLAGL2‐induced mitochondrial apoptosis resistance in HCC. Selenium sulfide (SeS2) induced cell proliferation inhibition and apoptosis on HCC cells by inhibiting the activity of PLAGL2 and restraining the novel PLAGL2/C‐MET/STAT3, AKT/mTOR and MAPK signaling pathways.

Disturbance of intestinal homeostasis promotes the development of type 2 diabetes. Although intensive insulin therapy has been shown to promote extended glycemic remission in newly diagnosed type 2 diabetic patients through multiple mechanisms, its effect on intestinal homeostasis remains unknown. This study evaluated the effects of intensive insulin therapy on intestinal morphometric parameters in a hyperglycemic mice model induced by high-fat diet (HFD). 16S rRNA V4 region sequencing and multivariate analysis were utilized to evaluate the structural changes of gut microbiota. HFD-induced increases in the lengths of villus, microvillus and crypt depth were significantly reversed after intensive insulin therapy. Moreover, intestinal proliferation was notably decreased after intensive insulin therapy, whereas intestinal apoptosis was further increased. Importantly, intensive insulin therapy significantly shifted the overall structure of the HFD-disrupted gut microbiota toward that of mice fed a normal diet and changed the gut microbial composition. The abundances of 54 operational taxonomic units (OTUs) were changed by intensive insulin therapy. Thirty altered OTUs correlated with two or more intestinal morphometric parameters and were designated ‘functionally relevant phylotypes.’ For the first time, our data indicate that intensive insulin therapy recovers diabetes-associated gut structural abnormalities and restores the microbiome landscape. Moreover, specific altered ‘functionally relevant phylotypes’ correlates with improvement in diabetes-associated gut structural alterations.

In spite of the achievement in treatment, the gastric cancer (GC) mortality still remains high. MicroRNAs (miRNAs) are a group of small noncoding RNAs that play a crucial part in tumor progression. In this study, we explored the expression and function of microRNA-501-5p (miR-501-5p) in GC cell lines. Quantitative real-time polymerase chain reaction assay results suggested that miR-501-5p was significantly upregulated in GC tissues and cell lines. And, the Cell Counting Kit-8 colony formation and cell migration assay results showed that the downregulation of miR-501-5p decreased GC cell proliferation and migration. Besides that, we found that GC cell cycle was arrested in G2 phase and cell apoptosis rate was increased by silencing the expression of miR-501-5p in GC cell lines using the flow cytometry. We also found that miR-501-5p could directly target lysophosphatidic acid receptor 1 (LPAR1) and negatively regulate LPAR1 expression in GC cell lines by performing dual-luciferase reporter gene assay and Western blot analysis. And, LPAR1 was significantly downregulated in GC tissues and inversely correlated with miR-501-5p expression. Furthermore, LPAR1 downregulation promoted cell proliferation and migration, which were attenuated by cotransfection of miR-501-5p inhibitor in GC cells. In conclusion, miR-501-5p can promote GC cell proliferation and migration by targeting and downregulating LPAR1. miR-501-5p/LPAR1 may become a potential therapeutic target for GC treatment.

Pervasive data collected from e-healthcare devices possess significant medical value through data sharing with professional healthcare service providers. However, health data sharing poses several security issues, such as access control and privacy leakage, as well as faces critical challenges to obtain efficient data analysis and services. In this article, we propose an efficient and privacy-preserving fog-assisted health data sharing (PFHDS) scheme for e-healthcare systems. Specifically, we integrate the fog node to classify the shared data into different categories according to disease risks for efficient health data analysis. Meanwhile, we design an enhanced attribute-based encryption method through combination of a personal access policy on patients and a professional access policy on the fog node for effective medical service provision. Furthermore, we achieve significant encryption consumption reduction for patients by offloading a portion of the computation and storage burden from patients to the fog node. Security discussions show that PFHDS realizes data confidentiality and fine-grained access control with collusion resistance. Performance evaluations demonstrate cost-efficient encryption computation, storage and energy consumption.

With rapid development of e-healthcare systems, patients that are equipped with resource-limited e-healthcare devices (Internet of Things) generate huge amount of health data for health management. These health data possess significant medical value when aggregated from these distributed devices. However, efficient health data aggregation poses several security and privacy issues such as confidentiality disclosure and differential attacks, as well as patients may be reluctant to contribute their health data for aggregation. In this paper, we propose a privacy-preserving heath data aggregation scheme that securely collects health data from multiple sources and guarantee fair incentives for contributing patients. Specifically, we employ signature techniques to keep fair incentives for patients. Meanwhile, we add noises into the health data for differential privacy. Furthermore, we combine Boneh–Goh–Nissim cryptosystem and Shamir’s secret sharing to keep data obliviousness security and fault tolerance. Security and privacy discussions show that our scheme can resist differential attacks, tolerate healthcare centers failures, and keep fair incentives for patients. Performance evaluations demonstrate cost-efficient computation, communication and storage overhead.

OBJECTIVES To assess features and outcome in fetuses with pulmonary atresia with ventricular septal defect (PA-VSD). METHODS Fetuses with PA-VSD were prospectively enrolled and grouped on the basis of the pulmonary blood supply, including type A (only arterial duct [DA]), type B (both DA and major aortopulmonary collateral arteries [MAPCAs] present), and type C (MAPCAs only). The echocardiography features, associated chromosomal/genetic malformations, and postnatal outcome were compared among the three groups. RESULTS Fifty-five fetuses with PA-VSD were enrolled. The presence of confluent PAs varied, with the highest displaying rate in type A and lowest rate in type C (100% vs 41.1%). The intrapericardial pulmonary arteries in all groups were hypoplastic but smaller in types B and C than in type A (P < .05). Deletion of 22q11.2 and right aortic arch were more frequently observed in types B and C than in type A. At the end of the study, overall survival rates in type C were lower than those in type A (22.1% vs 77.3%). CONCLUSION There are great differences in the size of pulmonary arteries, associated genetic malformations, and perinatal outcomes among fetuses with PA-VSD. These results could be used for family counseling and surgical planning.

In the autonomous driving era, V2X communication is essential since it enables rapid message dissemination via periodical beacon exchange (broadcast communication), which contributes to better situation awareness and maneuvering cooperation. However, designing a MAC protocol for reliable V2X broadcasting is challenging, as minimal beacon delivery delay and collision avoidance should be achieved simultaneously. In this article, we design a fine-grained TDMA-based MAC protocol to support ultra-reliable broadcast for autonomous vehicles. Specifically, three critical issues are first identified: mobility-caused time slot collision, time slot shortage, and stiff beacon rate limitation. Accordingly, three fine-grained solutions are provided to tackle those issues: mobility-aware time slot assignment, beacon rate adaption with safety awareness, and flexible beacon rates support. Moreover, a case study on mobility-aware time slot assignment based on road topology and lane distribution is presented, with simulation results' verification. Finally, we elaborate the steps to implement the fine-grained MAC protocol in autonomous driving environments.

Cytology and histology obstacles have been the main barriers to multiple tissues injury repair. In search of the most promising treatment strategies for spinal cord injury (SCI), stem cell-based transplantation coupled with various materials/technologies have been explored extensively to enhance SCI repair. Chitosan (CS) has demonstrated immense potential for widespread application in the form of scaffolds and micro-particles for SCI repair. The current review summarizes the evidences for stem cell-based transplantation and CS in SCI repair. Stem cells transplantation, which plays a key role in the repair of SCI, mainly results from its neural differentiation potential and neurotrophic effects. Application of CS enhances the survival of grafted stem cells, upregulates the expression level of neurotrophic factors and heightens the neural differentiation of stem cells as well as the functional recovery of spinal cord. Meanwhile, CS can also be exploited as growth factors/RNA carriers to control the release of regenerating molecules which are beneficial to damage spinal cord repair.

The rise of smart health promotes ubiquitous healthcare services with the adoption of information and communication technologies. However, increasing demands of medical services require more computing and storage resources in proximity of medical users for intelligent sensing, processing, and analysis. Fog computing emerges to enable in situ data processing and service provision for smart health in proximity of medical users, exploiting a large number of small-scale servers. In this article, we investigate fog-enabled smart health toward cooperative and secure healthcare service provision. Specifically, we first introduce the overall infrastructure and some promising applications, including emergent healthcare service, health risk assessment, and healthcare notification. We then discuss the challenges of fog-enabled smart health from the perspectives of cooperation and security. A case study is presented to demonstrate efficient and secure health data sharing through naive Bayes classification and attribute-based encryption with assistance from fog computing. Finally, by exploring interesting future directions, more attention can be attracted to this emerging area.

Social Media Health Networks provide a promising paradigm to attract patients to share and communicate their personal health status with other online patients, and consult healthcare services from online caregivers with social networks. Social Media Health Networks transform healthcare services from time-consuming offline hospital-centered paradigm to the convenient and efficient online paradigm through Internet, which can expand the traditional healthcare services and shorten the information gap between patients and caregivers. However, how to build the trust between patients and caregivers raises a challenging issue due to the openness of the social networks; meanwhile, the personal privacy may be disclosed when sharing personal health information with other patients and caregivers. In this paper, we propose a personalized and trusted healthcare service approach to enable trusted and privacy-preserving healthcare services in social media health networks, which can improve the trustiness between patients and caregivers through authentic ratings toward caregivers and guarantee the patients’ privacy. Specifically, we employ the collaborative filtering model to seek appropriate personalized caregivers, bloom filter to extract and map the personal healthcare symptoms, and inner product to compute the similarity between patients for finding patients with similar health symptoms in a privacy-preserving way. Meanwhile, to guarantee authentic ratings and reviews toward caregivers, we develop a sybil attack detection scheme to find patients’ fake ratings and reviews using different pseudonyms. Security analysis shows that our proposed approach can preserve the privacy of patients and prevent sybil attacks. Performance evaluation demonstrates that our approach can achieve prominent performance improvement, in terms of personalized caregivers finding and sybil attack resistance.

Infantile-onset inflammatory bowel disease can be caused by defects in interleukin-10 signalling. The natural history and clinical outcomes of allogeneic haematopoietic stem cell transplantation, medical treatment and surgery have not been thoroughly described.This study evaluates disease progression and clinical outcome in patients with interleukin-10 signalling deficiency.One hundred and nine patients with interleukin-10 signalling deficiency were retrospectively reviewed from a single tertiary centre. The Kaplan-Meier method was applied to calculate probabilities of survival and interval between transplant and stoma closure.One hundred and nine patients were reviewed, and 102 patients were included in the survival analysis. One hundred and eight patients were identified with IL10RA mutations, and one patient harboured IL10RB mutation. Seventy-three patients received haematopoietic stem cell transplantation. The overall survival after transplantation was 64.2% (95% confidence interval, 52.8 to 75.6), and without transplantation, it was 47.5% (95% confidence interval, 14.8 to 80.2, P = 0.47). The median timeframe between transplant and stoma closure was 19.6 months. The probability of survival was significantly lower in patients with perforation (P 0.001), ileus (P = 0.038) and without thalidomide treatment (P 0.001) among patients who did not receive haematopoietic stem cell transplantation. The survival probability was not associated with timeframe between transplant and onset, graft source and genotypes.The survival probability was not significantly different between patients with transplantation and the non-transplanted patients.

To investigate the effect of nutritional factors on bone mineral density (BMD) using quantitative computed tomography combined with blood biochemistry in patients on maintenance hemodialysis (MHD).Sixty patients on MHD were divided into osteopenia (n = 20) and nonosteopenia (n = 40) groups. BMD, fat, and muscle mass were measured by quantitative computed tomography. The calcification of coronary artery and hilar lymph node and computed tomography attenuation values of the liver and spleen were also analyzed. Differences between the two groups were compared, and the risk factors for osteopenia were analyzed by logistic regression analysis.Patients in the osteopenia group had lower albumin levels than those in the nonosteopenia group (37.84 ± 3.00 vs 42.03 ± 4.05 g/L; P .001). Logistic regression showed that patients with lower albumin levels had a higher risk of osteopenia (odds ratio, 1.462; 95% confidence interval, 1.313-1.801; P = .003). BMD was negatively correlated with fat mass (r = -0.365, P = .004) and positively correlated with the ratio of muscle mass to fat mass (r = 0.431, P = .001). There was no significant difference in the rate of calcification of coronary artery or hilar lymph nodes between the two groups. Computed tomography values of the liver and spleen were positively correlated with the duration of dialysis (r = 0.55, P = .001; r = 0.42, P .001, respectively).Low albumin levels are associated with an increased risk of osteopenia in patients on MHD. Abdominal fat is a risk factor for reduction in BMD in MHD patients, and the ratio of abdominal muscle mass to fat mass is a protective factor for BMD.

Objective The objective of this study was to determine fetal foramen ovale blood flow utilizing pulsed Doppler combined with spatiotemporal image correlation. Methods A cross-sectional study was performed in 440 normal fetuses between 20 and 40 weeks of gestation. In order to calculate foramen ovale blood flow, the foramen ovale flow velocity–time integral was obtained by pulsed Doppler ultrasonography, and the foramen ovale area was measured by using spatiotemporal image correlation rendering mode. Foramen ovale blood flow was calculated as the product of the foramen ovale area and the velocity–time integral. Results Gestational age-specific reference ranges are given for the absolute blood flow (ml/min) of foramen ovale, showing an exponential increase from 20 to 30 weeks of gestation, and a flat growth trend during the last trimester, while the weight-indexed flow (ml/min/kg) of foramen ovale decreased significantly. The median weight-indexed foramen ovale blood flow was 320.82 ml/min/kg (mean 319.1 ml/min/kg; SD 106.33 ml/min/kg). Conclusions The reference range for fetal foramen ovale blood flow was determined from 20 to 40 weeks of gestation. The present data show that the volume of foramen ovale blood flow might have a limited capacity to increase during the last trimester.

Background School is the second most important environment for children second to the family. An increasing number of children with epilepsy (CWE) are able to go back to school to continue to study after treatment. In school, CWE can be involved in studies and activities, which is conducive to their growth. However, CWE have to face more barriers than other children in school, such as cognitive impairment, poor attendance, school absenteeism, and learning disability. What is more, even if CWE have been taking antiepileptic medicines, they still have a risk of seizure. Therefore, it is important to ensure the safety of CWE in the school. Teachers play a significant part in managing CWE in school, so we aimed to deeply explore the experiences of school teachers in managing CWE during school. Method Purposive sampling was used to recruit teachers (n = 17) who cared for children with epilepsy in their class. Semi-structured interviews were used to access qualitative data. Framework analysis was used to analyze qualitative data. Result Five major themes emerged after analyzing: the recognition of epilepsy, the attitude to children with epilepsy, the barriers to communicate with parents about epilepsy, the reaction to a seizure, and the need for training. Conclusion The findings of this qualitative study reported teachers’ knowledge of and attitude toward epilepsy, the barriers for them to communicate with parents, the reaction to seizure, and the need for training. Although teachers know little about epilepsy, they have a positive attitude toward CWE. There are many obstacles in terms of the communication between teachers and parents. Parents’ cover-ups and teachers’ lack of professional training will put teachers and CWE at risk. In view of the fact that teachers and parents are not professionals, it is necessary for hospitals to play a coordinating role between the two.

BackgroundCpG island methylator phenotype (CIMP), featured with concurrent and widespread hypermethylation of a cluster of CpGs, has been reported to play an important role in carcinogenesis. Limited studies have investigated the CIMP in pancreatic cancer (PC). The aim of this study was to explore the CIMP in PC patients and its clinical-pathological and genomic characteristics. Methods:DNA methylation, somatic mutation, mRNA and corresponding clinical data of PC patients were downloaded from TCGA (184 patients) and ICGC (264 patients). Univariate and multivariate regression analysis were used to identify prognosis related CpGs. Consensus clustering analysis was used for identification of the CIMP in PC patients. ESTIMATE and CIBORORT were used for estimation of tumor microenvironment (TME) in PC patients.ResultsIn TCGA PC cohort, 22,450 differential CpGs, including 12,937 hypermethylated CpGs and 9,513 hypomethylated CpGs were identified between185 PC patients and 10 normal controls. Univariate and multivariate Cox analysis further screened out 72 OS related CpGs and three distinct CIMP groups with distinctly different prognosis and molecular features, including CIMP-L subgroup, CIMP-M subgroup and CIMP-H subgroup were identified based on unsupervised consensus clustering analysis of these CpGs. Patients of the CIMP-H subgroup had poorer OS and RFS, while patients of CIMP-L subgroup had better OS and RFS. The CIMP status were also an independent prognostic factors for OS and PFS. In molecular features, significantly higher somatic mutation burdens and tumor mutational burden were found at patients of CIMP-H subgroup compared to that in patients of CIMP-L subgroup. Besides, lower stromal score, immune score and higher cancer stemness indices and tumor purity were also found at patients of CIMP-H subgroup compared to that in patients of CIMP-L subgroup. Correspondingly, significantly total T cells, total B cells, CD8 T cells, memory CD4 T cells and higher regulatory T cells were found at patients of CIMP-H subgroup. Moreover, significantly lower expression of immune checkpoint genes, such as PD-1, CTLA4, CD86, VTCN1 and LAG-3 were also found at patients of CIMP-H subgroup compared to that in patients of CIMP-L subgroup. In the end, we validated the CIMP status in PC patients of ICGC dataset.ConclusionThree distinct CIMP subgroups of PC patients with distinct clinical characteristic, prognosis, gene mutation landscape and TME were identified and validated. The CIMP may help to make an assertion to provide specific and efficient treatment options for patients of different subtypes.

BACKGROUND To evaluate the effects of exercise programmes on pain, function and disease activity in patients with ankylosing spondylitis (AS). MATERIALS AND METHODS We searched PubMed, Embase, CNKI and Wanfang from inception to February 2020. Randomized controlled trials comparing exercises with nonexercise interventions in AS patients were applied. Studies that assessed the visual analogue scale (VAS) pain score, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were included. Outcomes of home-based exercise intervention were also reported independently. RESULTS Ten studies met the inclusion criteria in all, including 534 patients (278 exercise, 256 control). Compared with the nonexercise group, exercise group had statistically significant improvements in pain (weighted mean difference [WMD]: -1.02 [95% CI: -1.50 to -0.55]) (I2 : 31%, P

Background Delivery of therapeutic small interfering RNA (siRNA) via functionalized nanoparticles holds great promise for cancer therapy. However, developing a safe and efficient delivery carrier of siRNA is a challenging issue. Methods RGDfC peptide was used to modify the surface of selenium nanoparticles (SeNPs) to synthesize a biocompatible siRNA delivery vehicle (R-SeNPs), and MEF2D-siRNA was loaded onto R-SeNPs to prepare a functionalized selenium nanoparticle R-Se@MEF2D-siRNA. The chemical properties of R-SeNPs were characterized, and the anticancer efficacy as well as related mechanisms of R-Se@MEF2D-siRNA were further explored. Results R-Se@MEF2D-siRNA was significantly taken up by SKOV3 cells and could enter SKOV3 cells mainly in the clathrin-associated endocytosis way. The result of in vitro siRNA release demonstrated that R-Se@MEF2D-siRNA could release MEF2D-siRNA quicker in a microenvironment simulating a lysosomal environment in tumor cells compared to a normal physiological environment. The results of qRT-PCR assay proved that R-Se@MEF2D-siRNA could effectively silence the expression of the MEF2D gene in SKOV3 cells. R-Se@MEF2D-siRNA remarkably suppressed the proliferation of SKOV3 cells and further triggered its apoptosis. In addition, R-Se@MEF2D-siRNA had the capability to disrupt mitochondrial membrane potential (MMP) in SKOV3 cells and resulted in the overproduction of reactive oxygen species (ROS), indicating that mitochondrial dysfunction and ROS generation played an important role in the apoptosis of SKOV3 cells induced by R-Se@MEF2D-siRNA. In vivo, R-Se@MEF2D-siRNA also exhibited excellent antitumor activity mainly through decreasing tumor cells proliferation and triggering their apoptosis in tumor-bearing nude mice. Conclusion R-Se@MEF2D-siRNA provides an alternative strategy for ovarian cancer treatment in the clinic.