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The Venusian clouds originate from the binary condensation of H2SO4 and H2O. The two components strongly interact with each other via chemistry and cloud formation. Previous works adopted sophisticated microphysical approaches to understand the clouds. Here, we show that the observed vapour and cloud distributions on Venus can be well explained by a semi-analytical model. Our model assumes local thermodynamical equilibrium for water vapour but not for sulphuric acid vapour, and includes the feedback of cloud condensation and acidity to vapour distributions. The model predicts strong supersaturation of the H2SO4 vapour above 60 km, consistent with our recent cloud condensation model. The semi-analytical model is 100 times faster than the condensation model and 1000 times faster than the microphysical models. This allows us to quickly explore a large parameter space of the sulphuric acid gas-cloud system. We found that the cloud mass loading in the upper clouds has an opposite response of that in the lower clouds to the vapour mixing ratios in the lower atmosphere. The transport of water vapour influences the cloud acidity in all cloud layers, while the transport of sulphuric acid vapour only dominates in the lower clouds. This cloud model is fast enough to be coupled with the climate models and chemistry models to understand the cloudy atmospheres of Venus and Venus-like extra-solar planets.

Radio signals from India’s Mars Orbiter Mission (MOM) have been used to study turbulence in the solar plasma during the post-maximum phase of solar cycle 24. S-band (2.29 GHz) radio carrier downlink signals from MOM were received at the Indian Deep Space Network, Bangalore, and frequency residuals were spectrally analysed to obtain coronal turbulence spectra at heliocentric distances ranging between 4 and 20 R⊙, corresponding to coronal regions where the solar wind is primarily accelerated. The frequency fluctuation spectrum relates to the turbulence regime in the near-Sun region. The turbulence power spectrum (the temporal spectrum of frequency fluctuations) at smaller heliocentric distances (10 R⊙), the curve steepens with a spectral index αf ∼ 0.7−0.8, a value close to 2/3 and indicative of a developed Kolmogorov-type turbulence spectrum. The findings are consistent with earlier results. Plausible explanations to support the theory of coronal heating by magnetohydrodynamic waves and the acceleration of the solar wind are presented. An insight into the feeble maximum of solar cycle 24 is discussed.

An underwater optical communication link using Ince-Gaussian modes, generated through a nonlinear process using phase modulation of OAM modes, is demonstrated. A 25 Gbit/s power scalable communication link is experimentally verified for turbid conditions, cz~3.5.

Background: APOE ε4 is the best-known risk factor for late-onset alzheimer’s disease (AD). Population studies have demonstrated a relatively low prevalence of APOE ε4 among Chinese population, implying additional risk factors that are Chinese-specific may exist. Apart from - alleles, genetic variation profile along the full-length APOE has rarely been investigated. Objective: In this study, we filled this gap by comprehensively determining all genetic variations in APOE and investigated their potential associations with late-onset AD and mild cognitive impairment (MCI) in southern Chinese. Methods: Two hundred and fifty-seven southern Chinese participants were recruited, of whom 69 were AD patients, 83 had MCI, and 105 were normal controls. Full-length APOE from promoter to 3′UTR regions were sequenced. Genetic variants were identified and compared among the three groups. Results: While APOE ε4 was more significantly found in AD patients, the prevalence of APOE ε4 in southern Chinese AD patients was the lowest when compared to other areas of China and nearby regions, as well as other countries worldwide. We further identified 13 rare non-singleton variants in APOE. Significantly more AD patients carried any of the rare non-singleton variants than MCI and normal subjects. Such difference was observed in the non-carriers of ε4-allele only. Among the identified rare variants, the potential functional impact was predicted for rs532314089, rs553874843, rs533904656 and rs370594287. Conclusion: Our study suggests an ethnic difference in genetic risk composition of AD in southern Chinese. Rare variants on APOE are a potential candidate for AD risk stratification biomarker in addition to APOE-ε4.

AVLIS requires a high average power laser beam of multiple wavelengths. There are two general ways to achieve such a beam. One is generating different wavelength laser beams by individual dye laser MOPA chains, then spatially combining them by a beam combiner. The other is combining different wavelength laser beams into one beam first, then co-amplifying it by a common MOPA chain. The latter one is more efficient. To further develop the method, this paper demonstrates a simulation and experimental study of dual-wavelength dye laser amplifiers. The one of the most critical parameters of a dual-wavelength laser beam is the power ratio of the two constituent beams, which can vary during the co-amplification. The simulation results show that for two laser beams with small wavelength difference, the spatial combination mismatches of two beams are the more dominant factor than the spectral differences in affecting the power ratio during the co-amplification. The result of the experiment is in good agreement with the simulation.

Objective: To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) for fragility hip fracture patients. Design: Prospective cohort study. Patients: Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG), Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and fall risk screening (FS) were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded. Results: A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD) 6.1) ) and 77 in the control group (79.9 (SD 7.2)), respectively. The re-fracture rate in the control group (10.39%) was significantly higher than in the intervention group (1.32%) (p = 0.034). The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively. Conclusion: Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.

PURPOSE/OBJECTIVE(S) Cardiac adverse events such as decreased ejection fraction and heart failure are the major toxicities in breast cancer patients receiving chemoradiotherapy, which significantly compromises patients' survival and quality of life. However, to predict the increased risk of severe cardiotoxicities could be challenging due to the variations of current methods used to evaluate the cardiotoxicity symptoms, individual susceptibility and early markers of injury. A test that facilitates identification of patients who are likely to develop severe cardiotoxicities could have a personalized therapeutic implication for appropriate personalized treatment and/or early intervention in the care of breast cancer patients. In this study, we developed, for the first time to our knowledge, a Light Gradient Boosting Machine (LightGBM)-enabled predictive model to integrate patients' chart from electronic medical records (EMRs) for early prediction of severe cardiotoxicities. MATERIALS/METHODS A total of 179 breast cancer patients were included in this study. The patients were randomly partitioned to the training set and the validation set for LightGBM predictive model development and validation. The training features extracted from each patient include age, cancer stage, tumor size, tumor location, medical history, chemotherapy drugs, targeted therapy drugs, hormone therapy drugs, distant metastases, surgery, radiation therapy position, radiotherapy dose, electrocardiograph (ECG) signal score and left ventricular ejection fraction (LVEF) value before chemoradiotherapy. The utility of the LightGBM predictive model constructed in predicting severe cardiotoxicities was evaluated by the ROC analysis in the validation set. RESULTS Among the 179 breast cancer patients, severe cardiotoxicities were found in the patients with older age, higher LVEF value before radiotherapy, later tumor stage, abnormal ECG signals with bradycardia, tachycardia, T wave and Q wave abnormalities. The patients who received chemotherapy or targeted therapy using epicorubicin, doxorubicin, evacizumab and pertuzumab were more vulnerable to severe cardiotoxicities than others. The AUC value of the LightGBM predictive model achieved in the validation set was 0.82, higher than the clinical significance threshold of 0.70. The feature important analysis showed that age, the LVEF value before chemoradiotherapy, cancer position, targeted therapy, tumor stage and hormone therapy were the most valuable risk predicting factors. CONCLUSION The LightGBM framework proposed herein affords a means to use EMR data to individualize the prediction of severe cardiotoxicities at point of care of patients with breast cancer receiving chemoradiotherapy, which can facilitate the identification of patients for whom early intervention are warranted before the therapy, thus potentially improving the utility of chemoradiotherapy for breast cancer from a precision treatment perspective.

Background Currently, cryoballoon ablation (CBA) has proven to be highly effective in achieving free from atrial fibrillation (AF), especially paroxysmal AF. However, the optimal freezing protocol for each patient to achieve successful pulmonary vein isolation by only CBA is still uncertain. The aim of this study was to evaluate the clinical implications of a reduction in the freezing duration ( Methods From November 2015 to August 2018, 286 consecutive paroxysmal AF patients undergoing CBA were enrolled. We compared 107 patients undergoing a tailor-made CBA procedure (Group A; August 2017-August 2018) to 179 patients with a standard CBA procedure (Group B; November 2015–July 2017). In Group A, the freezing duration was reduced to 150s when the temperature reached ≤−40°C within 40s. Furthermore, we reduced it to 120s when it reached ≤−50°C within 60s. In the other patients, the freezing time was 180s except for excessive freezing over −60°C and/or emergent situations while monitoring the esophageal temperature and for phrenic nerve injury as in Group B. Results The baseline clinical characteristics were similar between two groups. In Group A, 89 patients (83%) underwent CBA with a reduction in the freezing time. The rate of having reduction time in left inferior PV (LIPV) and right inferior PV (RIPV) was lower compared with left superior PV (LSPV) and right superior PV (RSPV) (respectively 17%, 29%, 56%, and 63.5%). However, for right inferior PV, in 31 patients having the reduced freezing time, none of them required touch-up ablation. Although the procedure time and frequency of touch-up ablation did not differ between the 2 groups, total freezing time for each PV was significantly shorter in Group A than Group B as shown in figure (LSPV: 164±28s vs. 216±67s; p The freezing time for each PV Conclusion The safety and efficacy of the new tailor-made CBA strategy were non-inferior to the standard procedure. This study showed that the unnecessary freezing time could be reduced in most of paroxysmal AF patients.

Background Non-obstructive general angioscopy (NOGA) has revealed the intimal damages or atheromatous plaques as well as its spontaneous rupture of the aorta. Recent study revealed that plaque debris or different size of cholesterol crystals were detected in the blood above the spontaneous ruptured aortic plaque observed by NOGA and these plaque materials might cause the peripheral organ damages as the embolic source. These various morphological changes may cause the acute aortic events or atheroembolic events on the peripheral organs, such as brain, kidney, peripheral artery and so on. Purpose EAST-NOGA (Evaluation of AtheroSclerotic and rupture events by Non-Obstructive General Angioscopy) is a multi-center prospective observational study to assess the relationship between the findings of NOGA and future cardiovascular events. Methods Five hundred and seventy-seven patients with atherosclerotic cardiovascular disease who underwent NOGA study. The major cerebrocardiovascular events including cardiovascular death, non-fatal myocardial infarction, non-fatal cerebral infarction, and acute aortic syndrome were accumulated during the 2-year follow-up after NOGA study. Results The median number of aortic atheromatous plaques was 6 [IQR: 3–12]. A total of 514 patients were followed up (89.1%). The mean follow-up duration was 757±120 days. Major adverse cardiovascular events developed in 23 (4.5%) during 2 years follow-up. Patients with MACE and cerebral infarction, had significantly greater number of aortic atheromatous plaques (11 [5–19] vs. 6 [3–11], p Conclusion The number of atheromatous plaques identified by NOGA has a significant relation to the onset of cerebral infarction, which suggest the atheromatous plaque were vulnerable and ruptured spontaneously, then cause the aortogenic cerebral infarction. The NOGA study would be useful for predicting the futured atheroembolic events. Acknowledgement/Funding None

Background Drug-eluting stent restenosis (DES-ISR) is associated with poorer outcomes than those of bare-metal stent restenosis after treatment with paclitaxel-coated balloon (PCB), and late restenosis after PCB angioplasty for DES-ISR is a residual problem. Excimer laser coronary angioplasty (ELCA) is thought to be advantageous for ISR treatment by removing neointima. However, whether the combination of ELCA and PCB angioplasty is more effective than the use of PCB only angioplasty in DES-ISR has not been studied so far. Purpose We evaluated the efficacy of ELCA and PCB combination therapy for DES-ISR at mid-and late-term after revascularization. Methods From January 2014 to March 2016, 166 DES-ISR lesions were treated with ELCA and no-ELCA prior to PCB. Two serial angiographic follow-ups were planned for the patients (at 6–12 and 18–24 months after procedure). Acute procedural and follow-up angiographic results were assessed by quantitative coronary angiography. ELCA and no-ELCA group included 74 lesions and 92 lesions, respectively. Results There was no significant difference between the two groups in the clinical characteristics except the prevalence of hemodialysis, the rate of first-generation DES (37.9% vs 36.8%, p=0.897), previous stent size (2.90±0.39 mm vs 2.77±0.39 mm, p=0.063), and reference vessel diameter (2.65±0.46 mm vs 2.60±0.65 mm, p=0.593). Early follow-up angiography was performed in 66 lesions (89.1%) of ELCA group, and was done in 76 lesions (82.6%) of no-ELCA group. In the ELCA group, percentage diameter stenosis (%DS) just after procedure and at 6–12 months later were significantly smaller than those of no-ELCA group. Besides, target lesion revascularization (TLR) rate at 6–12 months after procedure was tended to be lower in the ELCA group. Late follow-up angiography was performed for 93 lesions (81.6%) of the remaining 114 lesions (excluding TLR lesion), late restenosis was found 9 lesions (18.6%) in the ELCA group and 11 lesions (24.4%) in the no-ELCA group (p=0.504). Late luminal loss was similar in both groups (0.37±0.71 mm vs 0.24±0.82 mm, p=0.438), and %DS at 12–18 months after revascularization was not different between the two groups. Changes of %DS and TLR rate Conclusions %DS in the ELCA group was smaller at just after procedure and the advantage was kept even after 1-year. However, late restenosis and TLR at 2-year after revascularization for DES-ISR could not be reduced by ELCA and PCB combination therapy.

Background Ankle fractures are a common orthopedic injury that frequently involves associated cartilage lesions, soft tissue damage, and a significant inflammatory burden. Despite studies revealing intra-articular pathology in up to 79% of ankle fractures, only 1% of open reduction and internal fixation (ORIF) procedures undergo arthroscopic evaluation. The primary purpose of this study was to determine the cost effectiveness of ankle arthroscopy performed at time of ORIF for ankle fracture. Methods An IRB approved retrospective review of patients who sustained ankle fractures and underwent ORIF with and without concomitant arthroscopic surgery between 2015 and 2020 were investigated. Patient demographics, fracture characteristics, outcomes, and cost data were collected and analyzed. Results There were 567 total ORIF and 28 ORIF and scope included for cost analysis purposes. Total surgical costs averaged $6,537.62 and $6,886.46 for the ORIF only and ORIF and scope procedures respectively. Total direct costs, including operating room time, for the same procedures were found to average $6,212.34 and $7,312.10 for the ORIF only and ORIF and scope procedures respectively. The cost difference between the ORIF only and with arthroscopy was not statistically significant (p = 0.1174). Twelve of the 28 arthroscopic patients (42.86%) had grade 3 or full thickness chondral lesions, and 11/28 (39.28%) arthroscopic patients were found to have grade 1–2 cartilage changes. Conclusion In the acute treatment of ankle fractures, concurrent arthroscopic evaluation does not add a significant cost to the procedure and may result in improved short and long term benefits for the patient. With improved arthroscopic efficiency, the cost differential can be further reduced. LOE IV.

The gold standard for treating peripheral nerve injuries that have large nerve gaps where the nerves cannot be directly sutured back together because it creates tension on the nerve, is to incorporate an autologous nerve graft. However, even with the incorporation of a nerve graft, generally patients only regain a small portion of function in limbs affected by the injury. Although, there has been some promising results using growth factors to induce more axon growth through the nerve graft, many of these previous therapies are limited in their ability to release growth factors in a sustained manner and tailor them to a desired time frame. The ideal drug delivery platform would deliver growth factors at therapeutic levels for enough time to grow axons the entire length of the nerve graft. We hypothesized that mineral coated microparticles (MCMs) would bind, stabilize and release biologically active glial cell-derived neurotrophic factor (GDNF) and nerve growth factor (NGF) in a sustained manner. Therefore, the objective of this study was to test the ability of MCMs releasing growth factors at the distal end of a 10 mm sciatic nerve graft, to induce axon growth through the nerve graft and restore hind limb function. After sciatic nerve grafting in Lewis rats, the hind limb function was tested weekly by measuring the angle of the ankle at toe lift-off while walking down a track. Twelve weeks after grafting, the grafts were harvested and myelinated axons were analyzed proximal to the graft, in the center of the graft, and distal to the graft. Under physiological conditions in vitro, the MCMs delivered a burst release of NGF and GDNF for 3 days followed by a sustained release for at least 22 days. In vivo, MCMs releasing NGF and GDNF at the distal end of sciatic nerve grafts resulted in significantly more myelinated axons extending distal to the graft when compared to rats that received nerve grafts without growth factor treatment. The rats with nerve grafts incorporated with MCMs releasing NGF and GDNF also showed significant improvement in hind limb function starting at 7 weeks postoperatively and continuing through 12 weeks postoperatively when compared to rats that received nerve grafts without growth factor treatment. In conclusion, MCMs released biologically active NGF and GDNF in a sustained manner, which significantly enhanced axon growth resulting in a significant improvement of hind limb function in rats. The animal experiments were approved by University of Wisconsin-Madison Animal Care and Use Committee (ACUC, protocol# M5958) on January 3, 2018.

Summary Placing infill wells in reservoir’s sweet spots and choosing appropriate wells configurations are challenging optimization problems. This work presents an efficient well placement and design optimization approach for full-field scale capitalizing on computational mathematical modeling to maximize wells contact with high-productive hydrocarbon zones. The approach uses mixed integer programming to solve the optimization problem using high-performance optimization solver. Results show that the approach can efficiently place a number of wells optimally in a simulation model in reasonable time and without violating any of the imposed geometrical and intersection constraints. The computational run-time of the optimization solver was used to evaluate the performance between different cases using different constraints and hardware specifications. The approach demonstrated in this work complements sweet spots identification capabilities to maximize ultimate hydrocarbon recovery, maintain and extend plateau, and prolong the fields’ lifetime.

With the ageing of the global population, China is projected to be impacted significantly by the rising number of patients with Alzheimer's disease (AD). A cure for AD is not yet available, so society should be prepared for an increasing AD-related burden. In this review, we examine this impending problem and provide overviews on (a) the magnitude of the problem of AD in Hong Kong/China in the near future; (b) the genetic and lifestyle risk factors that contribute to AD; (c) current diagnostic approaches and the potential of newly discovered genetic biomarkers for early detection; (d) medications, non-pharmacological interventions, and possible preventive measures; and (e) the need for social and psychological care from the community. In Hong Kong, primary care and AD-related support for at-risk individuals, patients, and caregivers are inadequate. A joint effort from the medical community, government, universities, non-governmental organisations/charities, and industry should initiate the development of a long-term programme for AD. Finally, we outline recommendations for the relevant parties to consider.

Objective To explore the change rules of blood ethanol and blood acetaldehyde concentration, the impairment of psychomotor functions of different acetaldehyde dehydrogenase （ALDH） 2 genotype individuals after alcohol consumption and the relationship among them. Methods The不同ALDH2基因型个体饮酒后血乙醛浓度与精神运动功能的关系.目的 探索不同乙醛脱氢酶（aldehyde dehydrogenase，ALDH）2基因型个体饮酒后血乙醇和血乙醛浓度变化规律、精神运动功能损害及其之间的联系。 方法 采用SNaPshot法医毒理学；乙醇；乙醛；乙醛脱氢酶；多态性；精神运动功能.