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Objective. To systematically evaluate the efficacy and safety of pembrolizumab (PD-1/PD-L inhibitor) and adjuvant chemotherapy to treat NSCLC and provide evidence-based reference for clinical use. Methods. By searching the Cochrane Library, EMBASE, PubMed, and Web of Science, according to the inclusion criteria, literature selection, data extraction, and quality evaluation were carried out for the included literature. The I2 test was used to evaluate heterogeneity between studies, and the meta-analysis was performed using RevMan 5.3 software provided by Cochrane. Results. Finally, 14 relevant documents meeting the standards were included. It is a statistical difference in one-year survival rate [ OR = 1.50 , 95% CI (1.28, 1.76), P < 0.00001 , I 2 = 0 %, Z = 4.99 ]; overall response rate[OR =1.57, 95% CI (1.29, 1.90), P < 0.00001 , I 2 = 0 %, Z = 4.58 ]; progression-free survival [ OR = 2.99 , 95% CI (2.29, 3.91), P < 0.00001 , I 2 = 26 %, Z = 8.00 ]; and overall survival [ OR = 1.38 , 95% CI (1.07, 1.78), P = 0.01 , I 2 = 46 %, Z = 2.50 ] and reduces the incidence of adverse drug reactions [ OR = 2.54 , 95% CI (1.99, 3.25), P < 0.00001 , I 2 = 69 %, Z = 7.43 ]. Conclusion. Pembrolizumab adjuvant chemotherapy is effective in the treatment of advanced NSCLC, but attention should be paid to the occurrence of adverse reactions in clinical. Due to the limitations of the methodology included in the study, this conclusion required more validation of large-sample RCT.

Objectives. Minimally invasive coronary artery bypass grafting (MICS CABG) has emerged as an alternative treatment for patients with multi-vessel coronary artery disease, but there are certain surgical challenges inherent in the adoption of this approach. The present study was conducted to provide insight regarding the outcomes associated with our first 118 cases, to discuss the surgical difficulties encountered in these patients, and to outline the potential countermeasures. Methods. Between January 2017 and January 2020, 118 patients underwent multi-vessel MICS CABG. These patients were stratified into two groups based upon whether they did or did not experience surgical challenges, and early clinical outcomes were compared between these groups to assess the incidence of technical difficulties and associated factors. Results. Surgical challenges arose in 38 of the 118 cases in this study, including 13 cases of exposure-related difficulties, 11 cases of proximal anastomosis-related difficulties, 15 cases of distal anastomosis-related difficulties, 4 cases of LITA-related difficulties, and 3 cases of lung-related difficulties. Relative to the other 80 patients, those patients for whom intraoperative technical challenges arose experience significant increases in operative duration (4.94 ± 0.89 vs. 5.59 ± 1.11 h, P = 0.001 ), intraoperative blood loss (667 ± 313 vs. 892 ± 532 mL, P = 0.005 ), length of the ICU admission (17.59 ± 3.51 vs. 22.59 ± 17.31 h, P = 0.015 ), and the duration of postoperative hospitalization (5.96 ± 1.23 vs. 6.71 ± 1.92 days, P = 0.012 ). There were no significant differences between these groups with respect to the mean graft number, major complications such as stroke or organ dysfunction, or one-year graft patency. Conclusions. There is a substantial learning curve associated with performing off-pump MICS CABG to treat multi-vessel disease. Surgical challenges encountered during this procedure may increase the operative duration, intraoperative blood loss, ICU admission, and the duration of postoperative hospitalization. However, these issues do not appear to compromise the efficacy of complete revascularization, and early clinical outcomes associated with this procedure remain acceptable.

Aiming at overcoming the defects such as slow searching speed and easily trapping into local extremum at anaphase of the shuffled frog leaping algorithm (SFLA), based on the Evolutionary Exploration strategy, a more effective shuffled frog leaping algorithm, Improved Shuffled Frog Leaping Algorithm (ISFLA), which can be applied to the inverse analysis of seepage parameters to dams, is proposed. With the introduction of the threshold value selection in the local search of the original initial population to improve the best frogs in memeplex, the improved algorithm overcomes the shortcomings of traditional SFLA which can easily fall into a local optimum. By comparative analysis between the laboratory test and numerical simulation, the effectiveness and accuracy of ISFLA are demonstrated by the application to the inversion analysis of seepage parameters of earth dams. Furthermore, the inversion analysis of seepage parameters to the earth dam in Lianyungang China is studied by the ISFLA. Moreover, the seepage characteristics of the dam are evaluated; thus, the suggestion that the dam should be reinforced is put forward. All the results show that ISFLA in an inverse analysis of seepage parameters of dams has excellent value to hydropower engineering.

The ongoing enzootic circulation of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and North Africa is increasingly raising the concern about the possibility of its recombination with other human-adapted coronaviruses, particularly the pandemic SARS-CoV-2. We aim to provide an updated picture about ecological niches of MERS-CoV and associated socio-environmental drivers. Based on 356 confirmed MERS cases with animal contact reported to the WHO and 63 records of animal infections collected from the literature as of 30 May 2020, we assessed ecological niches of MERS-CoV using an ensemble model integrating three machine learning algorithms. With a high predictive accuracy (area under receiver operating characteristic curve = 91.66% in test data), the ensemble model estimated that ecologically suitable areas span over the Middle East, South Asia and the whole North Africa, much wider than the range of reported locally infected MERS cases and test-positive animal samples. Ecological suitability for MERS-CoV was significantly associated with high levels of bareland coverage (relative contribution = 30.06%), population density (7.28%), average temperature (6.48%) and camel density (6.20%). Future surveillance and intervention programs should target the high-risk populations and regions informed by updated quantitative analyses.

Spam filtering, which refers to detecting unsolicited, unwanted, and virus-infested emails, is a significant problem because spam emails lead to unnecessary costs of Internet resources, waste of people’s time, and even loss of property. Support vector machine (SVM) is the state-of-the-art method for high accuracy spam filtering. However, SVM incurs high time complexity because of the high dimensionality of the emails. In this study, we propose a manifold learning-based approach for time-efficient spam filtering. From the experiments that most of the features are not decisive, we can obtain the viewpoint that only a minor part of the spam emails can be detected using the nondecisive features. Based on the insight, we propose to employ the Laplace feature map algorithm to obtain the geometrical information from the email text datasets and extract the decisive features. Then, the extracted features are used as the input of SVM to spam filtering. We conduct extensive experiments on three datasets, and the evaluation results indicate the high accuracy time efficiency of our proposed algorithm.

Nucleic acid oxidation plays an important role in the pathophysiology progress of a variety of diseases. 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxo-dGsn) and 8-oxo-7,8-dihydroguanosine (8-oxo-Gsn), which originate from DNA and RNA oxidation, were the most widely used indicators for oxidative stress. The study investigated the relation between 8-oxo-dGsn, 8-oxo-Gsn, and CKD. 146 patients with CKD were divided into five disease stages, and their fasting blood and morning urine were collected. The levels of 8-oxo-dGsn and 8-oxo-Gsn in plasma and urine were quantified by LC-MS/MS. The ratio of urinary 8-oxo-Gsn to creatinine increased from stages 1 to 4 corresponding to the increased severity of CKD, but it decreased in stage 5. And plasma 8-oxo-Gsn gradually increased with the decline of renal function. In particular, the increased ratio of plasma and urine 8-oxo-Gsn in stage 5 exceeded the concentration of creatinine. This trend was similar to the estimated glomerular filtration rate (eGFR), which indicates that 8-oxo-Gsn could be an appropriate indicator for renal function. Our finding indicates that as the disease progresses, RNA oxidation is increased. The significant increase in the ratio of plasma and urinary 8-oxo-Gsn is a novel evaluation index of end-stage renal disease.

The manuscript concerns the power flow characterization in a two-stage nonlinear vibration isolator comprising three springs, which are configured so that each stage of the system has a high-static-low-dynamic stiffness. To demonstrate the distinction of evaluation for vibration isolation using power flow, force transmissibility is used for comparison. The dynamic behavior of the isolator subject to harmonic excitation, however, is of interest here. The harmonic balance method (HBM) could be used to analyze the frequency response curve (FRC) of the strong nonlinear vibration system. A suggested stability analysis to distinguish the stable and the unstable HBM solutions is described. Increasing both upper and lower nonlinear stiffness could bend the first resonant peak to the left. The isolation range in the power and the force transmissibility plot could be extended to the lower frequencies when the nonlinear stiffness is increased, but the rate of roll-off for the power transmissibility is twice the rate for the force transmissibility at each horizontal stiffness setting. An explanation for this phenomenon is given in the paper.

Objective. The purpose of this systematic review is to evaluate the evidence of Yiqi Yangyin Huoxue Method for diabetic nephropathy.Methods. 11 electronic databases, through September 2015, were searched to identify randomized controlled trials of Yiqi Yangyin Huoxue Method for diabetic nephropathy. The quality of the included trials was assessed using the Jadad scale.Results. 26 randomized controlled trials were included in our review. Of all the included trials, most of them were considered as high quality. The aggregated results suggested that Yiqi Yangyin Huoxue Method is beneficial to diabetic nephropathy in bringing down the microalbuminuria (SMD = −0.98, 95% CI −1.22 to −0.74), serum creatinine (SMD = −0.56, 95% CI −0.93 to −0.20), beta-2 microglobulin (MD = 0.06, 95% CI 0.01 to 0.12), fasting plasma glucose (MD = −0.35, 95% CI −0.62 to −0.08), and 2-hour postprandial blood glucose (MD = 1.13, 95% CI 0.07 to 2.20), but not in decreasing blood urea nitrogen (SMD = −0.72, 95% CI −1.47 to 0.02) or 2-hour postprandial blood glucose (SMD = −0.48, 95% CI −1.01 to 0.04).Conclusions. Yiqi Yangyin Huoxue Method should be a valid complementary and alternative therapy in the management of diabetic nephropathy, especially in improving UAER, serum creatinine, fasting blood glucose, and beta-2 microglobulin. However, more studies with long follow-up are warrant to confirm the current findings.

Axially moving stepped beam (AMSB) with different length and tip mass is represented by adopting Euler-Bernoulli beam theory, and its characteristics and displacements of transverse free vibration are calculated by using semianalytical method. Firstly, the governing equation of the transverse free vibration is established based on Hamilton’s principle. The equation is cast into eigenvalue equation through the complex modal analysis. Then, a scheme is proposed to derive the continuous condition accordingly as the displacement, rotation, bending moment, and shear force are all equal at the connections of any two segments. Another scheme is to derive frequency equation from the given boundary conditions which contain a tip mass in the last segment. Finally, the natural frequency and modal function are calculated by using numerical method according to the eigenvalue equation and frequency equation. Due to the introduction of modal truncation, displacement and, the free vibration solution can be obtained by adopting modal superposition after Hilbert transform. The numerical examples illustrate that length, velocity, mass, and geometry affect characteristics and displacements significantly; the series of methods are effective and accurate to investigate the vibration of the AMSB with different length and tip mass after comparing several results.

The pathogenesis of intractable epilepsy is not fully clear. In recent years, both animal and clinical trials have shown that the expression of ATP-binding cassette (ABC) transporters is increased in patients with intractable epilepsy; additionally, epileptic seizures can lead to an increase in the number of sites that express ABC transporters. These findings suggest that ABC transporters play an important role in the drug resistance mechanism of epilepsy. ABC transporters can perform the funcions of a drug efflux pump, which can reduce the effective drug concentration at epilepsy lesions by reducing the permeability of the blood brain barrier to antiepileptic drugs, thus causing resistance to antiepileptic drugs. Given the important role of ABC transporters in refractory epilepsy drug resistance, antiepileptic drugs that are not substrates of ABC transporters were used to obtain ABC transporter inhibitors with strong specificity, high safety, and few side effects, making them suitable for long-term use; therefore, these drugs can be used for future clinical treatment of intractable epilepsy.

The current study used the improved fuzzy analytic hierarchy process to construct a sustainable deforestation development evaluation system and evaluation model, which has refined a diversified system to evaluate the theory of sustainable deforestation development. Leveraging the visual image of the system dynamics causal and power flow diagram, we illustrated here that sustainable forestry development is a complex system that encompasses the interaction and dynamic development of ecology, economy, and society and has reflected the time dynamic effect of sustainable forestry development from the three combined effects. We compared experimental programs to prove the direct and indirect impacts of the ecological, economic, and social effects of the corresponding deforest techniques and fully reflected the importance of developing scientific and rational ecological harvesting and transportation technologies. Experimental and theoretical results illustrated that light cableway skidding is an ecoskidding method that is beneficial for the sustainable development of resources, the environment, the economy, and society and forecasted the broad potential applications of light cableway skidding in timber production technology. Furthermore, we discussed the sustainable development countermeasures of forest ecosystems from the aspects of causality, interaction, and harmony.

The international standardization of auricular acupuncture points (AAPs) is an important basis for auricular therapy or auricular diagnosis and treatment. The study on the international standardization of AAPs has gone through a long process, in which the location method is one of the key research projects. There are different points of view in the field of AAPs among experts from different countries or regions. By only analyzing the nine representative location methods, this paper tried to offer a proper location method to locate AAPs. Through analysis of the pros and cons of each location method, the location method applied in the WFAS international standard of AAPs is thoroughly considered as an appropriate method. It is important to keep the right direction during developing an International Organization for Standardization (ISO) international standard of auricular acupuncture points and to improve the research quality of international standardization for AAPs.