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Objective: We propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients. Methods: This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed. Results: Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8 mm (range, 6-10 mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P <.01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P =.9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively. Conclusion: The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach. [ABSTRACT FROM AUTHOR]

Background: Rapidly growing healthcare demand associated with global population aging has spurred the development of new digital tools for the assessment of cognitive performance in older adults. Objective: To develop a fully automated Mini-Mental State Examination (MMSE) assessment model and validate the model's rating consistency. Methods: The Automated Assessment Model for MMSE (AAM-MMSE) was an about 10-min computerized cognitive screening tool containing the same questions as the traditional paper-based Chinese MMSE. The validity of the AAM-MMSE was assessed in term of the consistency between the AAM-MMSE rating and physician rating. Results: A total of 427 participants were recruited for this study. The average age of these participants was 60.6 years old (ranging from 19 to 104 years old). According to the intraclass correlation coefficient (ICC), the interrater reliability between physicians and the AAM-MMSE for the full MMSE scale AAM-MMSE was high [ICC (2,1)=0.952; with its 95% CI of (0.883,0.974)]. According to the weighted kappa coefficients results the interrater agreement level for audio-related items showed high, but for items "Reading and obey", "Three-stage command", and "Writing complete sentence" were slight to fair. The AAM-MMSE rating accuracy was 87%. A Bland-Altman plot showed that the bias between the two total scores was 1.48 points with the upper and lower limits of agreement equal to 6.23 points and −3.26 points. Conclusions: Our work offers a promising fully automated MMSE assessment system for cognitive screening with pretty good accuracy. [ABSTRACT FROM AUTHOR]

The longitudinal trajectory planning of connected and autonomous vehicle (CAV) has been widely studied in the literature to reduce travel time or fuel consumptions. The safety impact of CAV trajectory planning to the mixed traffic flow with both CAV and human-driven vehicle (HDV), however, is not well understood yet. This study presents a reinforcement learning modeling approach, named Monte Carlo tree search-based autonomous vehicle safety algorithm, or MCTS-AVS, to optimize the safety of mixed traffic flow, on a one-lane roadway with signalized intersection control. Crash potential index (CPI) is defined to quantitively measure the safety performance of the mixed traffic flow. The CAV trajectory planning problem is firstly formulated as an optimization model; then, the solution procedure based on reinforcement learning is proposed. The tree-expansion determination module and rollout termination module are developed to identify and reduce the unnecessary tree expansion, so as to train the model more efficiently towards the desired direction. The case study results showed that the proposed algorithm was able to reduce the CPI by 76.56%, when compared with a benchmark model without any intelligence, and 12.08%, when compared with another benchmark model that the team developed earlier. These results demonstrated the satisfactory performance of the proposed algorithm in enhancing the safety of the mixed traffic flow., Author(s): Yanqiu Cheng [1,2]; Chenxi Chen [2]; Xianbiao Hu (corresponding author) [2]; Kuanmin Chen [1]; Qing Tang [2]; Yang Song [2] 1. Introduction Connected and automated vehicles (CAVs) have been [...]

Studies have been initiated to investigate the potential impact of connected and automated vehicles (CAVs) on transportation infrastructure. However, most existing research only focuses on the wandering patterns of CAVs. To bridge this gap, an apple-to-apple comparison is first performed to systematically reveal the behavioural differences between the human-driven vehicle (HDV) and CAV trajectory patterns for the first time, with the data collected from the camera-based next generation simulation dataset and autonomous driving co-simulation platform, CARLA and SUMO, respectively. A gradient boosting-based ensemble learning model for pavement performance (i.e. international roughness index) prediction is then developed with the input features including three driving pattern features, namely, lateral wandering deviation, longitudinal car-following distance and driving speed, plus 20 other context variables. A total of 1707 observations is extracted from the long-term pavement performance database for model training purposes. The result indicates that the trained model can accurately predict pavement deterioration and that CAV deteriorates pavement faster than HDV by 8.1% on average. According to the sensitivity analysis, CAV deployment will create a greater impact on the younger pavements, and the rate of pavement deterioration is found to be stable under light traffic, whereas it will increase under congested traffic. This article is part of the theme issue 'Artificial intelligence in failure analysis of transportation infrastructure and materials'. [ABSTRACT FROM AUTHOR]

This manuscript focused on analyzing electric vehicles' (EV) charging behavior patterns with a functional data analysis (FDA) approach, with the goal of providing theoretical support to the EV infrastructure planning and regulation, as well as the power grid load management. 5-year real-world charging log data from a total of 455 charging stations in Kansas City, Missouri, was used. The focuses were placed on analyzing the daily usage occupancy variability, daily energy consumption variability, and station-level usage variability. Compared with the traditional discrete-based analysis models, the proposed FDA modeling approach had unique advantages in preserving the smooth function behavior of the data, bringing more flexibility in the modeling process with little required assumptions or background knowledge on independent variables, as well as the capability of handling time series data with different lengths or sizes. In addition to the patterns revealed in the EV charging station's occupancy and energy consumption, the differences between EV driver's charging time and parking time were analyzed and called for the needs for parking regulation and enforcement. The different usage patterns observed at charging stations located on different land-use types were also analyzed., Author(s): Chenxi Chen [1]; Yang Song [1]; Xianbiao Hu (corresponding author) [1]; Ivan G. Guardiola [2] 1. Introduction Electric vehicles (EVs) produce fewer emissions that contribute to climate change and [...]

The general consensus is that physical activity can prevent and manage lifestyle-induced chronic diseases, and moderate-to-vigorous physical activity (MVPA) has been included in several guidelines of WHO as an indicative intensity standard. Numerous studies have confirmed that improving the spatial quality of urban parks can be very helpful in supporting physical activities, and that the quality of parks is significantly related to the intensity of physical activities. However, few studies have explored the spatial characteristics of activating physical activities. Using a modified System for Observing Play and Recreation in Communities (SOPARC), this study examines the relationship between spatial characteristics and MVPA through a binary logistic regression model. The results reveal that: firstly, inconsistent with other similar studies, the most observed group in the park is the adults rather than the seniors, and the proportion of the females (51%) is higher; secondly, the distribution of MVPA in different groups shows that the seniors have less interaction with other groups, and they have a significant spatial attachment. Thirdly, in functionality, large lawn and jogging trails have been proved to be the most effective features to promote the occurrence of MVPA; among the activity, except for the significant correlation between equipped and MVPA, other attributes can be proved to encourage MVPA as well as those in comfort. In conclusion, our results can contribute to the planning and design of the urban park as well as the further management and allocation of the space and facilities under the vision of promoting public health. [ABSTRACT FROM AUTHOR]

Background: The overwhelming interest in economically cost‐effective treatments had led to an increase in the development of cosmetic facial injections. Concomitantly, complications have been also on the increasing trend. This article aimed to investigate the social–economic impact caused by infection after cosmetic facial injection. Methods: A retrospective study was conducted between January 2014 and December 2019. Information including demographics, location of the original injection site, treatments, economic loss, and time away from work associated with complications was documented. Patients were asked to complete 2 FACE‐Q domains 4 weeks after the first presentation, including quality of life and patient experience. Results: Complete data were available for 12 patients. All patients were female; the mean age was 32.66 years (range, 26–49 years). The mean therapeutic cost of atypical mycobacterium was 18170.58 USD. The mean time away from work was 51.25 days (range, 21–103 days). The mean cost of time away from work was 400.80 USD (range, 164.23–805.50 USD). From FACE‐Q, patients reported a decreased quality of social life, including social function (38.83 ± 12.10), psychological distress (48.67 ± 11.01), and early‐life impact (39.92 ± 10.15). Patients also reported low satisfaction with their decision to undergo the cosmetic facial injection. Conclusions: Infection after cosmetic facial injection comes at a considerable social–economic impact on patients. Patients who responded in this study were extremely unsatisfied with the quality of life following the infection. [ABSTRACT FROM AUTHOR]

Background: The follow-up study on neuropsychiatric changes after the lifting of coronavirus disease 2019 (COVID-19) quarantine in patients with cognitive impairment and their caregivers is still lacking, and relative information is needed to formulate more comprehensive healthcare prevention measures worldwide. Aims: To provide data on the changes in neuropsychiatric performance after the lifting of COVID-19 quarantine in patients with cognitive disorders and their caregivers. Methods: Two surveys in Chongqing, China were conducted via telephonic interview with 531 patients and their caregivers. The baseline survey was performed from February 11 to 23, 2020, and the follow-up was from October 24 to November 9, 2020. The data of neuropsychiatric symptoms (NPSs), sleep, nutrition, and chronic diseases of patients, as well as the burden of care, anxiety, and depression of caregivers were evaluated. Results: Significant alleviation of NPSs after the lifting of COVID-19 quarantine was observed in patients with mild cognitive impairment (MCI) and dementia (both P < 0.05). Compared with baseline, the prevalence for NPSs of all participants dropped from 57.94 to 38.82%. Among NPS subdomains, apathy displayed the biggest decline at follow-up by 10.72%, followed by nighttime behavior by 8.65%. Mixed effect generalized estimation equation analysis showed significant amelioration in hallucination, depression, apathy, irritability, aberrant motor behavior, and nighttime behavior (all P < 0.05), with the most prominent changes in nighttime behavior and apathy. Among the patients with unsatisfactory control of chronic disease, the medication adherence rate dropped by approximately 30% after the lifting of quarantine. More importantly, around 13% increase of care burden was observed among the caregivers at follow-up, with both depression and anxiety rising by nearly 4%. Conclusion: The prolonged quarantine may exacerbate NPS in patients with memory disorders, while the care burden and mental stability of the caregivers after the pandemic should also be concerned. [ABSTRACT FROM AUTHOR]

Abstract Background Fungal plant pathogens cause serious agricultural losses worldwide. Alternaria arborescens is a major pathogen of tomato, with its virulence determined by the presence of a conditionally dispensable chromosome (CDC) carrying host-specific toxin genes. Genes encoding these toxins are well-studied, however the genomic content and organization of the CDC is not known. Results To gain a richer understanding of the molecular determinants of virulence and the evolution of pathogenicity, we performed whole genome sequencing of A. arborescens. Here we present the de-novo assembly of the CDC and its predicted gene content. Also presented is hybridization data validating the CDC assembly. Predicted genes were functionally annotated through BLAST. Gene ontology terms were assigned, and conserved domains were identified. Differences in nucleotide usage were found between CDC genes and those on the essential chromosome (EC), including GC3-content, codon usage bias, and repeat region load. Genes carrying PKS and NRPS domains were identified in clusters on the CDC and evidence supporting the origin of the CDC through horizontal transfer from an unrelated fungus was found. Conclusions We provide evidence supporting the hypothesis that the CDC in A. arborescens was acquired through horizontal transfer, likely from an unrelated fungus. We also identified several predicted CDC genes under positive selection that may serve as candidate virulence factors.

We consider a class of convex decentralized consensus optimization problems over connected multi-agent networks. Each agent in the network holds its local objective function privately, and can only communicate with its directly connected agents during the computation to find the minimizer of the sum of all objective functions. We propose a randomized incremental primal-dual method to solve this problem, where the dual variable over the network in each iteration is only updated at a randomly selected node, whereas the dual variables elsewhere remain the same as in the previous iteration. Thus, the communication only occurs in the neighborhood of the selected node in each iteration and hence can greatly reduce the chance of communication delay and failure in the standard fully synchronized consensus algorithms. We provide comprehensive convergence analysis including convergence rates of the primal residual and consensus error of the proposed algorithm, and conduct numerical experiments to show its performance using both uniform sampling and important sampling as node selection strategy. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to elucidate whether malnutrition is associated with cognitive impairment in an older Chinese population. Methods: A cross‐sectional study was conducted in 2365 participants aged 60 years or older from January 2013 to September 2019. Nutritional status was measured by using the Mini Nutritional Assessment Short Form (MNA‐SF). Cognitive function was assessed with the Mini‐Mental State Examination (MMSE). The relationship between malnutrition or each Mini Nutritional Assessment Short Form domain and cognitive impairment was examined with univariate and multivariate logistic regression analysis. Results: The prevalence of malnutrition, risk of malnutrition, and cognitive impairment was 5.54%, 33.45%, and 36.74%, respectively. The prevalence was higher in those 80 years and older: 7.88%, 40.75%, and 53.65%, respectively. The Mini‐Mental State Examination score was positively correlated with the Mini Nutritional Assessment Short Form score (r = 0.364, P < 0.001). After adjustment for age, gender, education, marital status, and living alone, malnutrition (odds ratio (OR) = 3.927, 95% confidence interval (CI): 2.650–5.819), anorexia (OR = 1.454, 95%CI: 1.192–1.774), weight loss (OR = 1.697, 95%CI: 1.406–2.047), impaired mobility (OR = 4.156, 95%CI: 3.311–5.218), and psychological stress (OR = 1.414, 95%CI: 1.070–1.869) were significantly associated with an increased risk of cognitive impairment. Conclusions: Our results suggest that the prevalence of malnutrition and cognitive impairment is relatively high and increases with age. Malnutrition, anorexia, weight loss, impaired mobility, and psychological stress are significantly associated with an increased risk of cognitive impairment. Therefore, clinicians should assess the nutritional and cognitive status of the elderly regularly to improve early detection and timely intervention. [ABSTRACT FROM AUTHOR]

In this paper, we incorporate importance sampling strategy into accelerated framework of stochastic alternating direction method of multipliers for solving a class of stochastic composite problems with linear equality constraint. The rates of convergence for primal residual and feasibility violation are established. Moreover, the estimation of variance of stochastic gradient is improved due to the use of important sampling. The proposed algorithm is capable of dealing with the situation, where the feasible set is unbounded. The experimental results indicate the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

Background: It has been reported that the functional telomerase reverse transcriptase (TERT) rs2853669 polymorphism might contribute to different types of human cancer. However, the association of this mutation with cancer remains controversial. Here, we conducted a meta-analysis to characterize this relationship. Materials and methods/Main results: A systematic search of studies on the association of TERT rs2853669 polymorphism with all types of cancer was conducted in PubMed, Embase and Cochrane Library. The summary odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were used to pool the effect size in a fixed-effects model or a random-effects model where appropriate. A total of 13 articles and 15 case-control studies, including 9,157 cases and 11,073 controls, were included in this meta-analysis. Overall, the pooled results indicated that the rs2853669 polymorphism was significantly associated with increased cancer risk in a homozygote comparison model (CT vs. TT: OR = 1.085, 95% CI: 1.015–1.159, P = 0.016). In the stratified analyses, a significant increased cancer risk was observed in Asian, but not Caucasian patients. A subgroup analysis by cancer type also revealed a significant increase in the risk of lung cancer, but not breast cancer. Conclusions: The results of this meta-analysis suggest that the TERT rs2853669 polymorphism is associated with a significantly increased risk of cancer, particularly lung cancer, in Asian populations. [ABSTRACT FROM AUTHOR]

A spergillus fumigatus is an opportunistic pathogen and allergen of mammals. Calcium signalling is essential for A . fumigatus pathogenicity and is regulated by the CrzA transcription factor. We used ChIP-seq ( Chromatin Immunoprecipitation DNA sequencing) to explore CrzA gene targets in A . fumigatus. In total, 165 potential binding peaks including 102 directly regulated genes were identified, resulting in the prediction of the A[ GT][ CG] CA[ AC][ AG] CrzA-binding motif. The 102 CrzA putatively regulated genes exhibited a diverse array of functions. The phkB ( Afu3g12530) histidine kinase and the sskB ( Afu1g10940) MAP kinase kinase kinase of the HOG (high-osmolarity glycerol response) pathway were regulated by CrzA. Several members of the two-component system ( TCS) and the HOG pathway were more sensitive to calcium. CrzA:: GFP was translocated to the nucleus upon osmotic stress. CrzA is important for the phosphorylation of the SakA MAPK in response to osmotic shock. The Δ sskB was more sensitive to CaCl2, NaCl, and paraquat stress, while being avirulent in a murine model of invasive pulmonary aspergillosis. The presence of CaCl2 and osmotic stresses resulted in synergistic inhibition of Δ crzA and Δ sskB growth. These results suggest there is a genetic interaction between the A. fumigatus calcineurin- CrzA and HOG pathway that is essential for full virulence. [ABSTRACT FROM AUTHOR]