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Objectives. To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods. The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014–2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results. The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs ( APC = − 9.31 , P = 0.044 ) and the total BD prevalence rate in Shifeng ( APC = − 14.14 , P = 0.039 ). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational age < 37 weeks, PIs with birth weight < 2500 g , and migrant pregnancies. Conclusions. We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance.

In cell-free massive multiple-input-multiple-output system with wireless backhaul, the distributed access points (APs) and the center processing unit (CPU) are connected via wireless links. Hence, the limited backhaul bandwidth becomes a critical challenge to uplink transmission. To save the bandwidth while maintaining high transmission accuracy, we propose to deploy non-orthogonal transmissions in backhaul link and jointly optimize the detection computation mappings at the APs and the CPU under the non-orthogonal backhaul. First, we formulate the joint design problem subject to backhaul bandwidth constraint aiming at a better end-to-end transmission accuracy. Then, the non-trivial problem is parameterized and solved with a novel model-driven deep neural network, where wireless backhaul is integrated as a neural computing layer by exploiting the reciprocity between non-orthogonal transmission and additive operation. Evaluations show that, the proposed integration method outperforms the conventional approaches by a margin in both backhaul bandwidth cost and the symbol error rate.

Background. This facility-based study analyzed the epidemiology and incidence of maternal near miss (MNM) and mortality by hospital level as part of Hunan Province’s efforts to raise the quality of hospital care for women. Methods. We used data for MNM and mortality cases for 2012–2018 from 17 hospitals (12 resource-poor facilities, five resource-rich facilities) that receive referrals for obstetric complications in Hunan Province. Data were drawn from China’s National Maternal Near Miss Surveillance System and collected using the World Health Organization near miss tool. We calculated the ratio of severe maternal outcomes (SMO) (i.e., MNM and maternal death (MD) cases), mortality index (MI), and MNM to mortality ratio (MNM : MD), and epidemiological factors, organ dysfunction, and maternal complications stratified by hospital level. The chi-square tests to examine differences between groups and total ratios and 95% CI were calculated. Results. There were 518 SMO cases (489 MNM and 29 MD) among 279407 live births (LBs) and 1299 SMO cases (1262 MNM and 37 MD) among 232386 LBs in resource-poor and resource-rich facilities. The total MNM ratio in resource-poor and resource-rich hospitals was 1.75 (95% CI: 1.60–1.91) and 5.43 (95% CI: 5.14–5.74) per 1000 LBs, respectively. There were differences in SMO cases between resource-poor and resource-rich hospitals in maternal age, education, parity, antenatal visits, and history of cesarean sections. In MNM cases, coagulation dysfunction was the main organ dysfunction (resource-poor hospitals: 59.10%; resource-rich hospitals: 79.32%), and the main maternal complications were obstetric hemorrhage (resource-poor hospitals: 71.98%) and hepatopathy (resource-rich hospitals: 69.49%). For MD cases, the main maternal complications were neurologic dysfunction (resource-poor hospitals: 41.38%) and coagulation dysfunction (resource-rich hospitals: 42.55%). Anemia was the main maternal complication for SMO cases in both resource-poor (69.69%) and resource-rich (68.59%) hospitals. Conclusions. MNM and MD are higher in resource-rich hospitals compared with resource-poor hospitals. The obstetric emergency capacity of resource-rich hospitals is higher than that of resource-poor hospitals. Future government policies should consider upgrading the obstetric emergency treatment capacity in resource-poor hospitals or to redistinguish the social functions of different medical institutions.

In the multi-attribute decision-making (MADM) problems, decision makers refer to the extreme attribute values in general when evaluating the alternatives. However, in the real world, the ideal solution may lie in somewhere between the extreme values. The recently proposed reference ideal method (RIM) is able to solve the problem rightly. This study aims at developing a novel MADM framework combining best–worst method (BWM), maximizing deviation method (MDM), and RIM under Z-number environment. In this framework, Z-number is used to depict the inherent uncertainty and reliability of information in the decision makers’ judgments. And BWM and MDM are combined to determine the comprehensive attribute weights, in which BWM is utilized to obtain the subjective weights, while MDM is utilized to obtain the objective weights. In addition, Z-RIM is proposed by extending the traditional RIM under Z-number environment, which is employed for ranking the alternatives. An illustrative example of cloud service selection problem is implemented to illustrate the proposed framework. By comparison analysis, we demonstrate that Z-RIM can not only avoid rank reversal problem, but also generate reasonable results during the MADM processes.

Objective The aim of this study was to analyse the characteristics of the prenatal diagnosis (PD) of birth defects (BDs) and termination of pregnancy (TOP) for fetal anomalies and to suggest perinatal management. Methods BD surveillance data were collected from 52 registered hospitals in Hunan between 2015 and 2018. The PD and TOP rates of BDs were calculated to examine the associations between infant sex, maternal age, and region. Results From 2015 to 2018, a total of 18 931 fetuses with BDs were identified, of which 10 299 fetuses (54.4%) were diagnosed prenatally and 9343 pregnancies (90.7% among PDs and 49.3% among BDs) were terminated. The mean gestational age at diagnosis for fetuses with BDs was 25.1 ± 5.9 weeks and showed a downward trend over the study period. The average PD rate of the BDs was higher in rural areas than in urban areas (58.1% vs 50.3%), higher for female than male fetuses (57.25% vs 48.92%), and higher for mothers older than age 35 than for those younger (58.62% vs 53.69%). The average TOP rate of fetuses with BDs in rural areas was higher than that in urban areas (91.99% vs 89.12%) and decreased with increasing maternal age ( x trend 2 = 7.926, P = .005). The five BDs with the highest PD rates were conjoined twins (100%), anencephaly (97.87%), congenital hydrocephalus (97.66%), chromosomal malformation (96.07%), and encephalocele (95.54%). The five BDs with the highest TOP rates among the PDs were conjoined twins (100%), exstrophy of the urinary bladder (100%), chromosomal malformation (98.09%), encephalocele (98%), and anencephaly (97.28%). Conclusions More than half of BDs were diagnosed prenatally, with the majority diagnosed at less than 28 gestational weeks. The TOP rates following PD in Hunan Province were high, especially for rural and younger mothers. The findings suggest a need for high-quality, targeted counselling following PD.

Background In recent 10 years, with the rapid socioeconomic development and the extensive implementation of children nutrition improvement projects, the previous epidemiological data cannot reflect the actual level of anemia among children in China, especially in rural areas. Therefore, this study analyzed the prevalence, severity and associated factors of anemia among children aged 6–71 months in rural Hunan Province. Methods A community-based cross-sectional study was conducted. Through multistage stratified cluster sampling, 5229 children aged 6 to 71 months and their caregivers were randomly selected from 72 villages across 24 towns in 12 counties from rural Hunan. The demographic characteristics of children and their caregivers, feeding practice, nutritional status of children, caregivers’ anemia-related feeding knowledge, and gestational conditions of mothers were acquired by using a unified questionnaire. Peripheral blood from the left-hand middle fingertip was sampled from each child, and hemoglobin concentration was measured using a HemoCue301 portable hemoglobin analyzer (Sweden). Associated factors analyses involving overall anemia and anemia severities were conducted on multivariate logistic regression models. Results The overall anemia prevalence was 8.8%, and the prevalence of mild, moderate and severe anemia was 6.3, 2.5 and 0.1%, respectively. Children age groups of 6–11 months, 12–23 months and 36–47 months, exclusive breast-feeding within 6 months after birth, and maternal moderate/severe anemia were significantly associated with an increased risk of overall anemia in children. Children age groups of 6–11 months and 12–23 months were significantly associated with an increased risk of mild anemia in children. Children age groups of 6–11 months, 12–23 months and 36–47 months, low caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia were significantly associated with an increased risk of moderate/severe anemia in children. Children who underwent regular physical examination were less likely to have moderate/severe anemia. The common protective factor for overall, mild and moderate/severe anemia in children was high family income. Conclusions The anemia status of preschool children in rural Hunan Province was a mild public health problem and associated with children age group, feeding practice, regular physical examination, family income, caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia.

In order to meet the tremendous requirements on the convergence between broadband and broadcast, this paper proposes to incorporate layered division multiplexing (LDM), an important variant of non-orthogonal multiple access (NOMA) technologies, into Millimeter wave (mmWave) multiple-input multiple-output (MIMO) system with device-to-device (D2D) communications to simultaneously provide broadcast and unicast services. The performance of the proposed full-duplex D2D-aided mmWave MIMO-NOMA with randomly deployed users is then analyzed under practical assumptions. Closed-form expressions of both the outage probability and the ergodic capacity are then derived by using the Laplace transform technique. Finally, detailed numerical results reveal the performance gains of the proposed scheme compared with the LDM without D2D communications and conventional time division multiplexing based scheme. The impacts of the antenna array gain and the transmission power of both the base station and the full-duplex link on system performance are also presented. Besides, we observe that it is vital to optimal the transmission power of the full-duplex link which ensures less self-interference to enhance the system capacity.

This paper proposes a new approach to single depth image super-resolution (SR), based upon a novel joint sparse coding model. A low-resolution color is used as a guide in the SR process. Firstly, we introduce synthetic characteristic image patch to learn a joint dictionary from the low-resolution depth map as well as its corresponding low-resolution intensity image. Then, we derive the joint nonlocal center sparse representation model based on sparse coding and theoretical analysis. In reconstruction process, we use Bayesian interpretation approach to estimation the sparse code coefficients for each unknown HR image patch. Meanwhile, we use an iterative algorithm to solve the JSC model. In addition, we exploit image patch redundancy within and across different scales, produce visually pleasing results without extensive training on external database. Experimental results demonstrate that the proposed method outperforms favorably many current state-of-the-art depth map super-resolution approaches on both visual effects and objective image quality and underpin the validity of our proposed model.

Having effective and reliable risk management is essential for the development of futures trading companies in China. Research analyzing early warnings on related risks for futures trading companie...

Background China is the first country to initiate a nationwide program for prevention of mother-to-child transmission of human immunodeficiency virus, syphilis and hepatitis B virus by an integrated approach. However, the progress of this program remains unreported at national or local level for China. Therefore, we performed a hospital-based longitudinal study to assess the integrated prevention effect in Hunan, South-central China. Methods This study was conducted at 123 counties in Hunan and covered all local hospitals providing midwifery and antenatal care services from 2010 to 2016. We used the Cochran–Armitage test to examine the temporal changes of the indicators related with prevention of mother-to-child transmission. Besides, we used Spearman rank correlation analysis to assess the association between mother-to-child transmission rates and the process indicators related with prevention of mother-to-child transmission. Results After implementation of integrated prevention program, the indicators related with prevention of mother-to-child transmission are moving in the right direction. From 2010 to 2016, mother-to-child transmission rates significantly decreased from 19.4% to 9.6% for human immunodeficiency virus, and from 116.3 to 13.6 cases per 100,000 live births for syphilis. The proportion of children receiving hepatitis B immunoglobulin injection within 24 h after birth increased from 95.2% to 98.9% among exposed neonates. Mother-to-child transmission rates were negatively associated with the process indicators related with prevention of mother-to-child transmission (all P Conclusions Our prevention program of mother-to-child transmission for three diseases by an integrated approach proved to be viable and effective. Our model may be of interest to other countries.

Aim We aimed to develop a simple model combining protein induced by vitamin K antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) to detect early hepatocellular carcinoma (HCC) in liver cirrhosis (LC) patients. Method One hundred and sixty-nine newly diagnosed early HCC patients and 242 LC patients without HCC were enrolled in the current case-control study. All subjects were randomly divided into analysis group and validation group. Serum levels of PIVKA-II, AFP and other laboratory parameters were detected. Chi-squared test, t-test and logistic regression were employed in statistical analysis. Results PIVKA-II level in early HCC was significantly higher than that in LC (90.97 mAU/mL vs 18.00 mAU/mL, P < 0.01), as well as AFP level (15.00 ng/mL vs 2.00 ng/mL, P < 0.01) in analysis groups. Multivariate analysis showed that PIVAK-II, AFP, gender, and age were independent risk factors for early HCC detection among LC patients. A logistic regression model and a simple model combining PIVKA and AFP were conducted to detect early HCC. The ROC curve showed that among analysis groups, the area under the ROC curve (AUROC) of the logistic regression model and the simple model were 0.96 (95% CI 0.94-0.98) and 0.94 (95% CI 0.92-0.97), respectively. At a cut-off value of 56.03 the sensitivity and specificity of the simple model were 81.1% and 91.4%, respectively. In the validation group, the sensitivity and specificity of the simple model was 82.4% and 94.2%, respectively. The two models are comparable statistically for early HCC detection, but the logistic regression requires complex calculation. Conclusion The present study indicates that the simple model combining PIVKA-II and AFP has comparable diagnostic efficiency in contrast to the logistic model but is easy to use clinically. It might be helpful for early HCC detection among liver cirrhosis patients.

Background Prolactinoma is a functional pituitary adenoma that secretes excessive prolactin. Dopamine agonists (DAs) such as bromocriptine (BRC) are the first-line treatment for prolactinomas, but the resistance rate is increasing year by year, creating a clinical challenge. Therefore, it is urgent to explore the molecular mechanism of bromocriptine resistance in prolactinomas. Activation of the P38 MAPK pathway affects multidrug resistance in tumours. Our previous studies have demonstrated that inhibiting MAPK14 can suppress the occurrence of prolactinoma, but the role of MAPK11/12/13/14 (p38 MAPK) signalling in dopamine agonist-resistant prolactinomas is still unclear. Methods A prolactinoma rat model was established to determine the effect of bromocriptine on MAPK11/12/13/14 signalling. DA-resistant GH3 cells and DA-sensitive MMQ cells were used, and the role of MAPK11/12/13/14 in bromocriptine-resistant prolactinomas was preliminarily verified by western blot, RT-qPCR, ELISA, flow cytometry and CCK-8 experiments. The effects of MAPK11 or MAPK14 on bromocriptine-resistant prolactinomas were further verified by siRNA transfection experiments. Results Bromocriptine was used to treat rat prolactinoma by upregulating DRD2 expression and downregulating the expression level of MAPK11/12/13/14 in vivo experiments. The in vitro experiments showed that GH3 cells are resistant to bromocriptine and that MMQ cells are sensitive to bromocriptine. Bromocriptine could significantly reduce the expression of MAPK12 and MAPK13 in GH3 cells and MMQ cells. Bromocriptine could significantly reduce the expression of MAPK11, MAPK14, NF-κB p65 and Bcl2 in MMQ but had no effect on MAPK11, MAPK14, NF-κB p65 and Bcl2 in GH3 cells. In addition, knockdown of MAPK11 and MAPK14 in GH3 cells by siRNA transfection reversed the resistance of GH3 cells to bromocriptine, and haloperidol (HAL) blocked the inhibitory effect of bromocriptine on MAPK14, MAPK11, and PRL in MMQ cells. Our findings show that MAPK11 and MAPK14 proteins are involved in bromocriptine resistance in prolactinomas. Conclusion Bromocriptine reduces the expression of MAPK11/12/13/14 in prolactinomas, and MAPK11 and MAPK14 are involved in bromocriptine resistance in prolactinomas by regulating apoptosis. Reducing the expression of MAPK11 or MAPK14 can reverse bromocriptine resistance in prolactinomas.

To investigate the prevalence of underweight, overweight and obesity as defined by pre-pregnancy body mass index (BMI) and the relationship between pre-pregnancy BMI and pregnancy and perinatal outcomes in women based on a retrospective cohort. Women registered via the Free Pre-pregnancy Health Check (FPHC) program from 2017 to 2019 in Hunan Province, China, were included to the study cohort. The data regarding maternal characteristics, pregnancy outcomes, and infant characteristics were retrieved from the surveillance system of the FPHC program. Logistic regressions were performed to calculate odds ratios (ORs) and adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) to assess the associations between pre-pregnancy BMIs and the outcomes. Among a total of 398,368 women, 54,238 (13.62%) were underweight (BMI 2), 51,251 (12.87%) were overweight (24.0 kg/m2 ≤ BMI 2), and 10,399 (2.61%) were obese (BMI ≥ 28.0 kg/m2). Underweight occurred more commonly in the 20–24 years old (17.98%), Han Chinese (13.89), college-educated (16.09%), rural (13.74%), and teacher/public servant/office clerk (16.09%) groups. Obesity occurred more often in the older than 35-year-old (4.48%), minority (3.64%), primary school or below (4.98%), urban (3.06%), and housewife (3.14%) groups (P

To detect the concentration of high-sensitivity cardiac troponin T (hs-cTnT) in healthy children aged 0-14 years by electrochemiluminescence immunoassay (ECLIA), so as to explore the differences in different ages and genders. The aim of this study is to establish the reference interval for hs-cTnT in healthy children aged 0-14 years.After screening, 3463 healthy children, including 1924 boys and 1539 girls, were selected from 4617 children aged 0-14 years. They were divided into nine groups: one day (umbilical cord blood; 'UCB'), one day (venous blood; 'VB'), 2-28 days, 29 days-3 months, 3-6 months, 6 months-1 year old, 1-3 years old, 3-6 years old and 6-14 years old. A nonparametric test was used to detect the hs-cTnT concentration. The upper limit of the reference interval is the mean of the 99th percentile after bootstrap sampling.Hs-cTnT levels conformed to a non-Gaussian distribution. There was no significant difference in the concentration of hs-cTnT between boys and girls in the general data, but there were differences between boys and girls in the 3-6 years old and 6-14 years old age groups. Except for UCB and 2-28 days, the concentration of hs-cTnT was significantly different in other age groups. The level of hs-cTnT in neonatal serum (2-28 days) was the highest. In other groups, it decreased gradually with age and dropped to the reference range of adults (0-14ng/L) at one-year old. The upper limit of reference interval of hs-cTnT concentration in each group was, respectively, 60.8, 78.8, 96.6, 58.6, 34.2, 16.2, 11.4, 8.0 (7.8 female), and 7.9 (7.3 female) ng/L.Referring to WS/T 402-2012 establishment of reference intervals for clinical laboratory testing projects and CLSI (Clinical and Laboratory Standards Institute) C28-A3 documents and the joint expert consensus of ESC (European Society of Cardiology) and ACC (American College of Cardiology) in 2007, we established the reference interval of hs-cTnT concentration in children aged 0-14 years in Chongqing Nan'an district of China which can provide certain reference value for clinical diagnosis and treatment of myocarditis and myocardial (micro) injury in children.

ObjectiveFew studies have analysed accidental maternal deaths. This study analysed the basic situation and classification of maternal accidental deaths and compared the differences between urban and rural areas.DesignA cross-sectional study on accidental deaths during pregnancy and puerperium from 2009 to 2019 in Hunan Province.SettingHunan Province, with a population of 74 million, has an area of 210 000 km2 and 123 counties/districts.ParticipantsA collection of 239 cases of accidental death during pregnancy and puerperium in Hunan Province from 2009 to 2019, including 181 cases of rural pregnancy and puerperium and 58 cases of urban pregnancy and puerperium.Main outcome measureClassification of accidental mortality of pregnant women.ResultsA total of 239 accidental deaths occurred in Hunan Province, with an accidental mortality rate of 2.8 per 100 000 live births. The accidental mortality rate in rural areas (3.2 per 100 000 live births) was higher than in urban areas (2.0 per 100 000 live births). The proportion of accidental deaths among pregnancy-related deaths showed an upward trend. The main types of accidental deaths were suicide (1.0 per 100 000 live births), traffic accidents (0.8 per 100 000 live births), accidental poisoning/overdose and assault/homicide (0.2 per 100 000 live births), and other accidents (0.6 per 100 000 live births). Maternal accidental deaths were mainly concentrated in low-income families, in rural areas and in those with low level of education. 74.5% of accidental deaths occurred before childbirth. 49.2% of pregnant women gave birth by caesarean section.ConclusionIn response to the different causes of accidental maternal death, public health programmes and policy interventions should pay special attention to maternal suicide and traffic injuries.

Compared to the step tariff, the real-time pricing (RTP) could be more stimulated for household consumers to change their electricity consumption behaviors. It can reduce the reserve capacity, peak load, and of course the electricity bill, which could achieve the purpose of saving energy. This paper proposes a coordinated optimization algorithm and data-driven RTP strategy in electricity market. First, the electricity price is divided into two parts, basic electricity price and fluctuating price. When the electricity consumption is equal to the average daily electricity consumption, the price is defined as the basic electricity price, which is the clearing electricity price. The consumer electricity data are analyzed. A random forest algorithm is adopted to predict the load data. Optimal adjustment parameters are obtained and the load fluctuation and the fluctuation of the electricity price are further quantified. Secondly, the appliances are modeled. The operation priority is established based on the preferences of customers and the Monte Carlo method is used to form the power load curve. Then, the smart energy planning unit is proposed to optimize the appliances on/off time and running time of residential electrical appliances. An incentive mechanism is used to further standardize the temporary electricity consumption. An improved multiobjective particle swarm optimization (IMOPSO) algorithm is adopted, which adopts the linear weighted evaluation function method to maximize the consumer’s social welfare while minimizing the electricity bill. The simulation proves that the stability of the power grid is improved while obtaining the best power strategy.

BACKGROUND Coronavirus disease 2019 (COVID-19) has emerged as a global threat. This study was performed to gain an understanding of COVID-19-related knowledge, attitudes, and practices among susceptible individuals. MATERIAL AND METHODS Patients who had been diagnosed with old myocardial infarction were followed up via telephone survey based on an established follow-up system at the beginning of the COVID-19 outbreak (January 2020) in Chongqing, Southwest China. RESULTS A total of 631 eligible patients participated in this survey, and 40.6% of the rural respondents did not know the transmission routes of SARS-CoV-2, which was higher than the proportion of urban respondents (40.6% vs 31.0). Rural residents had a lower rate of adopting preventive measures than urban residents, such as wearing masks (76.7% vs 90.1%), avoiding meetings and gatherings (58.6% vs 68.5%), and hand washing (56.0% vs 63.8%). A higher percentage of women than men did not take any preventive measures (11.3% vs 7.6%), while a lower percentage of women than men wore masks (77.7% vs 84.5%). Multiple logistic regression revealed that rural patients were more likely to lack knowledge about transmission (odds ratio (OR): 1.51). Rural patients had an increased risk of failing to implement protective measures. CONCLUSIONS Female and rural populations lacked knowledge and failed to adopt protective measures during the beginning of the COVID-19 epidemic. Therefore, these populations may benefit from health education campaigns and policies.

Satellite Internet of Things (IoT) is a promising technical trend to tackle the ubiquitous connection requirements for 5G and beyond. In satellite IoT, the conventional random access scheme faces huge interaction overhead caused by the complicated signaling interactions and the large propagation delay of the satellite-ground link. To tackle this problem, we propose a simplified random access scheme. By utilizing the collision tolerance of non-orthogonal multiple access (NOMA) technology, random access and data transmission are integrated to reduce the overall interaction delay. At the transmitter side, the transmitted symbols are spread by the non-orthogonal sequence and the preamble corresponding to the non-orthogonal sequence. At the receiver side, the received signal is iteratively processed based on the minimum mean square error (MMSE) and serial interference cancellation (SIC). The simulation results show that the proposed scheme can reduce the transmission delay without losing the success rate of random access compared with the conventional scheme that only relies on preamble detection.

Aims This network meta-analysis aimed to evaluate the asthma risk associated with dipeptidyl peptidase (DPP)-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium-glucose co-transporter (SGLT) 2 inhibitors. Methods Electronic databases were systematically searched up to March 2021 to include placebo-controlled cardiovascular (or cardiorenal) outcome trials that reported the asthma incidents in patients taking DPP-4 inhibitors, GLP-1RAs, or SGLT2 inhibitors. A random-effects network meta-analysis was conducted to estimate their odds ratio (ORs) and 95% confidence intervals (CIs). Results Nineteen trials including 218 asthma cases among 159,705 patients were included. Compared with placebo, SGLT2 inhibitors (OR, 0.59; 95% CI, 0.38-0.93) were significantly associated with a decreased risk of asthma while both DPP-4 inhibitors and GLP-1RAs did not significantly affect asthma risk. SGLT2 inhibitors were significantly associated with a lower risk of asthma than DPP-4 inhibitors (OR, 0.38; 95% CI, 0.18-0.79). There was no association between GLP-1RAs and DPP-4 inhibitors and between SGLT2 inhibitors and GLP-1RAs in risk of asthma. Conclusions SGLT2 inhibitors might protect against asthma while DPP-4 inhibitors and GLP-1RAs did not significantly affect the asthma incident. Given the underreporting of asthma in this study, further investigations using real-world data as well as mechanistic studies are warranted to confirm our results.

Background Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of ovarian stimulation in assisted reproduction technology (ART). It is characterised by enlarged ovaries and an acute fluid shift from the intravascular space to the third space, resulting in bloating, increased risk of venous thromboembolism and decreased organ perfusion. Most cases are mild, but forms of moderate or severe OHSS appear in 3% to 8% of in vitro fertilisation (IVF) cycles. The dopamine agonist cabergoline was introduced as a secondary prevention intervention for OHSS in women at high risk of OHSS undergoing ART treatment. As cabergoline seemed to be effective in preventing OHSS, other types of dopamine agonists, such as quinagolide and bromocriptine, have since been studied in ART to prevent OHSS. Objectives To assess the effectiveness and safety of dopamine agonists in preventing OHSS in high-risk women undergoing ART treatment. Search methods We searched several databases from inception to August 2016 (Cochrane Gynaecology and Fertility Specialised Register of trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, Clinicaltrials.gov and the World Health Organization International Trials Registry Platform (ICTRP)) for randomised controlled trials (RCTs) assessing the effect of dopamine agonist in preventing OHSS. We handsearched the reference lists of relevant studies. Selection criteria We considered RCTs which compared dopamine agonists with placebo/no intervention or another intervention for preventing OHSS in high-risk women for inclusion. Primary outcome measures were incidence of moderate or severe OHSS and live birth rate. Secondary endpoints were clinical pregnancy rate, multiple pregnancy rate, miscarriage rate and any other adverse effects of the treatment. Data collection and analysis Two authors independently screened titles, abstracts and full texts of publications, selected studies, extracted data and assessed risk of bias. We resolved any disagreements by consensus. We reported pooled results as odds ratios (OR) and 95% confidence interval (95% CI) by the Mantel-Haenszel method. In addition, we graded the overall quality of the evidence using GRADE criteria. Main results The search identified 14 new RCTs since the last published version of this review, resulting in 16 included RCTs involving 2091 high-risk women for this updated review. They evaluated three types of dopamine agonists: cabergoline, quinagolide and bromocriptine. When compared with placebo or no intervention, dopamine agonists seemed effective in the prevention of moderate or severe OHSS (OR 0.27, 95% CI 0.19 to 0.39; 1022 participants; 8 studies; I2 = 0%; moderate quality evidence). This suggests that if 29% of women undergoing ART experience moderate or severe OHSS, the use of dopamine agonists will lower this to 7% to 14% of women. There was no evidence of a difference in live birth rate, clinical pregnancy rate, multiple pregnancy rate or miscarriage rate (very low to moderate quality evidence). However, taking dopamine agonists (especially quinagolide) may increase the incidence of adverse events such as gastrointestinal adverse effects (OR 4.54, 95% CI 1.49 to 13.84; 264 participants; 2 studies; I2 = 49%, very low quality evidence). When we compared dopamine agonist plus co-intervention with co-intervention, there was no evidence of a difference in the outcomes of moderate or severe OHSS, live birth rate, clinical pregnancy rate, miscarriage rate or adverse events. The co-interventions were hydroxyethyl starch (two RCTs) and albumin (one RCT). Cabergoline was associated with a lower risk of moderate or severe OHSS compared with human albumin (OR 0.21, 95% CI 0.12 to 0.38; 296 participants; 3 studies; I2 = 72%). However, there was no evidence of a difference between cabergoline and hydroxyethyl starch, coasting (withholding any more ovarian stimulation for a few days) or prednisolone. There was an increased clinical pregnancy rate in the cabergoline group when cabergoline was compared with coasting (OR 2.65, 95% CI 1.13 to 6.21; 120 participants; 2 studies; I2 = 0%). In other respects, there was no evidence of a difference in clinical pregnancy rate, multiple pregnancy rate or miscarriage rate between cabergoline and other active interventions. The quality of the evidence between dopamine agonist and placebo or no intervention ranged from very low to moderate, mainly due to poor reporting of study methods (mostly a lack of details on randomisation or blinding) and serious imprecision for some comparisons. Authors' conclusions Dopamine agonists appear to reduce the incidence of moderate or severe OHSS in women at high risk of OHSS (moderate quality evidence). If a fresh embryo transfer is performed, the use of dopamine agonists does not affect the pregnancy outcome (live birth rate, clinical pregnancy rate and miscarriage rate) (very low to moderate quality evidence). However, dopamine agonists might increase the risk of adverse events, such as gastrointestinal symptoms. Further research should focus on dose-finding, comparisons with other effective treatments and consideration of combination treatments. Therefore, large, well-designed and well-executed RCTs that involve more clinical endpoints (e.g., live birth rate) are necessary to further evaluate the role of dopamine agonists in OHSS prevention.

The study explores a new disaggregated data-set on bilateral gross equity flows among 33 high-income countries over the 2001–2014 period. The disaggregation is available over equities for various different economic sectors of the economy, namely; monetary authorities, banks, insurance, non-financial institutions, households and government. Employing a typical financial gravity model via GMM methodology, we have found persistency effect on bilateral cross-border equity investments. In particular, the decisions of financial sector holders indicate strong persistency compared to non-financial companies and households, where they have the incline in changing the markets they invest. Unlike the previous literature, bilateral trade and foreign asset trading linkage is not significant, for the financial sector of holders; i.e; banks, insurance and monetary authorities. This finding indicates that financial sector holder's decision on market selection is immune to the bilateral trade linkage between countries, implying their motivation scattering the portfolio as much as possible. The return and diversification motives reveal the differences across sector holders' investment decisions. The investors-almost all sector holders-generally have strong diversification motives, which is mostly consistent for the sector holders.

Tactile Internet of Things (IoT) requires ultraresponsive and ultrareliable connections for massive IoT devices. As a promising enabler of tactile IoT, grant-free nonorthogonal multiple access (NOMA) exploits the joint benefit of grant-free access and nonorthogonal transmissions to achieve low latency massive access. However, it suffers from the reduced reliability caused by random interference. Hence, we formulate a variational optimization problem to improve the reliability of grant-free NOMA. Due to the intractability of this problem, we resort to deep learning by parameterizing the intractable variational function with a specially designed deep neural network, which incorporates random user activation and symbol spreading. The network is trained according to a novel multiloss function where a confidence penalty based on the user activation probability is considered. The spreading signatures are automatically generated while training, which matches the highly automatic applications in tactile IoT. The significant reliability gain of our scheme is validated by simulations.

Background ATG-010 (selinexor), a novel, oral selective inhibitor of nuclear export, inhibits exportin1. In preclinical and clinical studies, ATG-010 has demonstrated activity against multiple myeloma (MM). ATG-010 (80 mg biweekly) plus dexamethasone (20 mg biweekly) (Sd) has been approved by US FDA for treatment of patients (pts) with penta-refractory MM based on the STORM study. MARCH is a single arm, Phase 2 study to assess efficacy and safety of Sd in Chinese pts with RRMM. Methods Enrolled Chinese pts were previously treated with and refractory to PI, IMiD, and the last line of therapy. Sd was administered in 4-week cycles. The primary endpoint was overall response rate (ORR) per independent review committee. The total planned 82 pts provide -80% power to test against H0 of 15% ORR at one-sided α of 0.025. This abstract includes data from the first 60 treated pts. Results As of 13 Oct 2020, 18 (30%) of the 60 pts were on treatment. Median follow-up was 9.5 months (mo) (range: 1.9-12.8). Median age was 61 years (range 43-82; 42% > 65). Pts had received a median of 5 (range 1-16) prior MM regimens, with the following baseline risk factors: 72% R-ISS II/III, 70% cytogenetic abnormalities, 22% del (17p13),20% renal impairment, 15% prior CAR-T therapy, and 25% pre-treated with daratumumab (considered ‘triple-class exposed’). ORR was 26.7% (95% CI: 16.1, 39.7). Median duration of response (DOR) was 4.6 mo (95% CI: 1.42, NE). Median progression free survival was 3.7 mo (95% CI: 1.92, 4.66). Median overall survival (OS) was not reached; 9-mo OS rate was 68.5%. ORR was 33.3% in triple-class-exposed pts. Nine pts had prior CAR-T therapy with a median of 9 prior regimens (range 5-12). Among them, ORR was 44.4%, and median DOR was 3 mo (95% CI; 0.96, 4.63). Common treatment emergent adverse events (TEAEs) of any grade included: thrombocytopenia (87%), nausea (87%), leukopenia (85%), anemia (85%), lymphopenia (78%), neutropenia (73%), weight loss (72%), hyponatremia (65%), decreased appetite (63%), asthenia (62%)/fatigue (17%), hyperglycemia (53%), vomiting (52%), hypocalcemia (38%), hypokalemia (30%), diarrhea (30%), and pneumonia (27%). Common TEAEs of Grade ≥ 3 included: anemia (60%), thrombocytopenia (55%), leukopenia (42%), lymphopenia (42%), neutropenia (38%), hyponatremia (28%), and pneumonia (23%). Thirty pts (50%) had TESAEs, including (>3%): thrombocytopenia (15%), pneumonia (15%), anemia (6.7%), and hyponatremia (3.3%). Eight pts (13.3%) had TEAEs leading to treatment discontinuation, including (>2%): thrombocytopenia (5%) and pneumonia (3%). There were three fatal TEAEs: pneumonia, intracranial hemorrhage, and sudden death (1 each). Conclusions MM pts refractory to both IMiD and PI remain a high unmet medical need. The MARCH study confirms the efficacy of Sd in Chinese patients with a manageable safety profile. These data are consistent with the STORM trial and offer a new, oral therapeutic option for MM patients.

Aims The aim of this study was to make a quantitative comparison of plan quality between MLC-based EDGE system and the cone-based CyberKnife system in stereotactic body radiation therapy (SBRT) for patients with localized prostate cancer. Materials and methods Ten patients with prostate volumes ranging from 34.65 to 82.16 cc were used for prostate SBRT. Treatment plans were created for both EDGE and CyberKnife G4 systems using the same dose-volume constraints. Dosimetric indices including Planning Tumor Volume (PTV) coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI) were applied for target, while the sparing of critical organs, including bladder, rectum, femoral heads, urethra, penile bulk and normal tissue outside PTV), were evaluated interms of various dose-volume metrics and integral dose (ID). Meanwhile, the required delivery time and number of monitor units (MUs) during irradiation were measured to estimate the treatment efficiency. The radiobiological indices such as equivalent uniform dose (EUD), tumor control probability (TCP) and the normal tissue complication probability (NTCP) were also analyzed. Results All dose constraints were achieved by both systems. It showed that the DEGE plans results were closest to the CK plans results in terms of PTV coverage, HI and GI. For EDGE, more conformal dose distribution in the target as well as reduced exposure of critical organs were obtained together with reduction of 91% delivery time and 72% monitor units. EDGE plans also got lower EUD for bladder, rectum, urethra and penile bulk, which associated with reduction of NTCPs. However, higher values of EUD and TCP for tumor were obtained with CK plans. Conclusions Our study indicated that both systems were capable of producing almost equivalent plan quality and can meet clinical requirements. CyberKnife G4 system has higher target dose while EDGE system has more advantages based on the considerations of normal tissue sparing and delivery efficiency. With abundant clinical experience, CK provides accurate SBRT treatment with high quality. EDGE system also can be considered to be an option for SBRT treatment for localized prostate cancer treatment.

PurposeStandardised Training of Paediatric Resident (STPR) plays an essential role in training qualified paediatricians. Until now, China had no paediatric resident competency index system to effectively guide and evaluate the competence of paediatric residents. This study aimed to establish a competency index system for paediatric residents in China to provide a reference for improving the training system and quality of STPR.Study design and settingThis study conducted two rounds of Delphi expert consultation survey among paediatric medical experts (n=16), followed by screening, revising and supplementing indicators using the boundary value method. Next, the analytic hierarchy process was used to determine the weight of indicators and finally establish a competency index system for paediatric residents.ResultsThe results of the statistical analysis revealed a positive coefficient of 100% for both rounds of expert consultation. The expert authority coefficient values were 0.82 and 0.83, and the expert coordination coefficient test was pConclusionsIn this study, a competency index system for paediatric residents was constructed following the characteristics and quality requirements for paediatric residents in China and is expected to significantly improve the overall level of paediatricians’ medical service quality and supply.

ObjectiveFew studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups, gender, rural versus urban locations and related healthcare services.DesignA cross-sectional study on unintentional suffocation death of infants under 1 year of age in Hunan Province from 2009 to 2018.SettingHunan Province, with a population of 74 million, has an area of 210 000 square kilometres and 123 counties/districts.ParticipantsThe total data of 4109 unintentional suffocation deaths of infants in Hunan Province from 2009 to 2018 was collected, including 2331 boys, 1766 girls, 12 infants of unknown gender, 2906 rural children and 1203 urban children.Main outcome measureThe unintentional suffocation mortality rate of infants is defined as the number of unintentional suffocation deaths of children under 1 year of age per 100 000 live births in the same year.ResultsThe infant mortality rate showed a downward trend from 2009 to 2018. Infant unintentional suffocation death decreased first and then fluctuated. The proportion of unintentional suffocation death to infant death showed an upward trend in fluctuation. Boys and rural children had higher mortality rates than those of girls and urban children. A total of 43.5% of the deaths occurred in winter. Forty-eight per cent of the unintentional suffocations were infants between 1 and 4 months of age. A total of 46.4% of the deaths occurred at home, and 71.6% were not treated; approximately 81.8% of the untreated cases were mainly due to a lack of time to get to the hospital. A total of 65.2% of the deaths were diagnosed postmortem.ConclusionThe mortality rate of unintentional suffocation among infants in Hunan Province should attract the attention of the population, and measures should be taken according to epidemiological investigations.

As China gradually enters the age of network information, technologies such as the Internet of Things based on computer networks have been more and more widely used, and they have also greatly improved the convenience of people's production and life. The development and promotion of the Internet of Things not only need to further strengthen the application of remote control technology, but also put forward higher requirements for network security. The Internet of Things must reduce the security risks in the computer network based on the realization of remote automatic control, so as to ensure the safety of data and information and ensure the normal operation of the Internet of Things. This can ensure that the Internet of Things can give full play to its due functions, thereby promoting the modern development of my country's social economy.

Retrofitting energy-inefficient external walls would improve the energy performance of building envelope by utilizing new insulation materials to decrease heat transfer. However, previous researches mainly based on environmental and economic considerations are still partial and could hardly provide a holistic perspective for the optimal selection of external walls retrofit techniques. To address this problem, this paper proposes a novel heterogeneous multi-criteria group decision-making (MCGDM) framework in which the ratings of schemes are described with real numbers and linguistic variables and the weights of criteria are unknown. Firstly, an evaluation index system is established covering criteria of thermal insulation property, technique, durability, and economic efficiency. Secondly, building information modeling (BIM) is utilized to determine multiple retrofit schemes and derive the heat transfer coefficient. Thirdly, after heterogeneous evaluation values are unified, a combined weighting approach is developed based on best worst method (BWM) and the similarity method before fuzzy VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method is applied to rank the alternatives. Fourthly, the applicability of the proposed framework is demonstrated by a case study of the external wall retrofit scheme selection in Beijing, which reveals that extruded polystyrene (XPS) and expanded polystyrene (EPS) insulation schemes are the compromise choices with aggregating index Qk of 0.0032 and 0.0967 respectively, while rock wool insulation scheme is the last option with Qk of 0.7182. The stability of ranking results is proved with the changing weight of maximum group utility, and the effectiveness of the proposed framework is verified by a comparative analysis. This study can facilitate the implementation of building envelope retrofit by providing useful guidance for selection of external wall retrofit schemes.

Delay-Tolerant Networks (DTN) use “carrystorage-forward” mechanism to deal with high latency and frequent interruption in the extreme network environment. It requires sufficient storage of nodes. As network load increases, buffer overload and network congestion of some essential nodes have been resistance to DTN development. For the issue of congestion control in DTN, this article proposes a congestion control algorithm based on load forecasting. As traffic conditions are complex and non-linear, we selected back propagation neural networks to predict the future load. First, a forecast function is trained based on the historical buffer information. And then forecast function is used to predict short-term future buffer occupancy. Finally, the prediction result is broadcasted to surrounding nodes. When neighbor nodes have data to transmit, buffer occupancy forecast serves as reference to avoid that packets are transmitted to congestion nodes, thus reducing traffic input when node’s buffer is almost full. Simulation results indicate that this algorithm performs well according to network indicators such as buffer occupancy and delivery ratio, which means it can effectively alleviate network congestion and improve network efficiency.

Millimeter wave (mmWave) multiple-input and multiple-output (MIMO) technology is one of the key technologies of the fifth generation (5G) wireless communication system. The application of non-orthogonal multiple access (NOMA) to mmWave MIMO system can further improve the throughput and spectrum efficiency. The existing researches on mmWave MIMO-NOMA normally assume that multiple UEs are served by one beam and thus suffers from beam misalignment. In this paper, we propose a novel beam aggregation-based mmWave MIMO-NOMA scheme where multiple UEs are served by a group of beams in a non-orthogonal fashion. Numerical simulation results reveal that our proposed NOMA scheme has significant advantages with respect to the achievable sum-rate and fairness compared with power-domain NOMA.

Supplemental Digital Content is available in the text, Background and objective: miRNA-146a is a microRNA that plays an important role in systemic lupus erythematosus (SLE). Several studies have examined the role of miRNA-146a in SLE, but have demonstrated equivocal or even contradictory conclusions. Therefore, this meta-analysis aimed to assess the role of miRNA-146a in SLE by examining data from previous studies. Methods: A meta-analysis of relevant papers published before August 31, 2019, in the WanFang, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), PubMed, EMBASE, and Web of Science databases was performed to verify the relationship of miRNA-146a expression level to SLE. Two investigators independently extracted the data and conducted a quality assessment of the studies. All statistical analyses were performed using Stata 14.0. Trial sequence analysis (TSA) was conducted to assess the quality and strength of the studies using the TSA software. Results: Six publications, involving 151 SEL patients and 132 healthy individuals as controls were included in this meta-analysis. The results showed that the expression of miRNA-146a was associated with SLE risk [standard mean difference (SMD) = −1.21, 95% confidence interval (95% CI) (−2.18, −0.23), P = .015]. The stratified analysis revealed that the expression of miRNA-146a was highly related to higher SLE risk among Asian (SMD = −1.30, 95% CI (−2.52, −0.07), P = .038) and Caucasian (SMD = −0.72, 95% CI (−1.20, −0.24), P = .003) populations. Besides, the serum levels of miRNA146a were significantly different (SMD = −1.73, 95% CI (−3.11, −0.36), P = .014). The TSA revealed that the cumulative Z-curve crossed the typical boundary value, and reached the TSA monitoring boundary, but did not reach the required information size. This indicates that even if the cumulative sample size did not meet required information size, no more trials were needed and a reliable conclusion was reached in advance. Sensitivity analyses indicated the instability of the meta-analysis. Conclusions: Overall, the expression of miRNA-146a is associated with SLE risk. Therefore, miRNA-146a is a promising candidate for the effective diagnosis of SLE. But, due to the limitations of this study, it is necessary to cautiously explain the results of this study. Systematic review registration: PROSPERO CRD42019151381.

Background Breastfeeding plays an important role in the early stages of humans and throughout the development process. Breastfeeding competency is a self-assessment of pregnant women’s overall competency to breastfeeding which could predict the breastfeeding behaviours of pregnant women. However, a valid and reliable scale for assessing breastfeeding competency has not yet been developed and validated. This study was conducted to develop and validate an assessment scale designed to assess pregnant women’s breastfeeding competency in the third trimester: the Breastfeeding Competency Scale (BCS). Methods The BCS was developed and validated over three phases between September 2018 and September 2019, and these phases included item statistical analysis, exploratory factor analysis (EFA), content validation, internal consistency assessment, split-half reliability assessment and confirmatory factor analysis (CFA). Results The item statistical analysis and EFA resulted in 38 items and 4 factors that explained 66.489% of the total variance. The Cronbach’s α coefficients for the total scale and the 4 factors were 0.970, 0.960, 0.940, 0.822 and 0.931. The split-half reliability of the BCS was 0.894 and 0.890. CFA model showed that the 4-factor model fits the data well. Conclusions The BCS is a new valid and reliable instrument for assessing the breastfeeding competency of pregnant women in the third trimester.

BackgroundTo investigate the occurrence frequency, changing trends, and epidemiological distribution of unintentional suffocation in children under 5 years old.MethodsThe data were collected from the Maternal and Child Health Surveillance system from 2009 to 2018. The cause of death was classified by ICD-10. Data on unintentional suffocation death were calculated according to the characteristics of the population, time, space, cause of death and medical treatment, and constituent ratio were calculated.ResultsThe mortality rate of children under 5 years old showed a downward trend, but the mortality of unintentional suffocation initially decreased and then increased. The death rate of unintentional suffocation in children less than 1-year-old was much higher than that in children aged 1 to 4 years old. The death rate of unintentional suffocation was higher in boys than in girls, and the rate was higher for rural children than for urban children. The number of low-weight and pre-term infants in the group under 1-year-old was significantly higher than that in the group of 1–4 years old. Children under 1-year-old are more likely to die at home than children aged 1 to 4 years old, and a higher proportion of younger children did not receive treatment. More than 80% of children under the age of 5 go untreated because it was too late to go to the hospital.ConclusionFor areas and populations with a high incidence of unintentional suffocation, we suggest that priorities should include prevention, the development of a safe environment, strengthened prevention, the development of safety habits, and the popularization of first aid knowledge.

Aim To investigate the epidemiology of chromosomal abnormalities (CA) in fetuses of all pregnancies based on a provincial-wide birth defects-monitoring system, which could provide scientific basis for making relatively policy and research. Methods Chromosomal abnormalities cases were collected from all hospitals in Hunan Province, China, between 2016 and 2019. The prevalence of CAs was calculated to examine associations among infant sex, maternal age and region. The rates of prenatal diagnosis and termination of pregnancy (TOP) involving CA or associated anomalies were calculated as rates or proportions. Results From 2016 to 2019, a total of 2 883 890 perinatal infants (28 weeks of gestation to postpartum 7 days) underwent prenatal screening and diagnostic tests, and 3181 fetuses were diagnosed as CA, with the prevalence of 11.03/10 000. The average prevalence of CAs was higher for male than female fetuses (11.33/10 000 vs 10.06/10 000) (OR = 1.13, 95% CI: 1.05-1.21), which was higher in urban areas than rural areas (23.03/10 000 vs 7.13/10 000) (OR = 3.23, 95% CI: 3.02-3.47), and the prevalence increased linearly with maternal age ( X trend 2 = 1821.844, P = 0.000). Among the fetuses with CAs, 3097 (97.36%) were diagnosed prenatally, and 3046 (98.35%) underwent TOP. The majority of CA were numerical abnormalities (90.18%). The main types of numerical autosomal abnormalities were trisomy 21 (6.69/10 000, 59.57%), trisomy 18 (1.13/10 000, 10.04%) and trisomy 13 (0.21/10 000, 1.88%). The main types of numerical gonosomal abnormalities were Klinefelter syndrome (0.68/10 000, 6.02%), Turner syndrome (0.49/10 000, 4.39%), Triple X syndrome (0.26/10 000, 2.29%) and 47,XYY syndrome (0.21/10 000, 1.91%). The three associated anomalies with the highest proportions were congenital heart defects (CHD) (41.06%), cleft palate or/and cleft lip (10.89%) and congenital talipes equinovarus (8.94%). Conclusion The prevalence of CA was lower than that reported. Chromosome detection should be further promoted including test contest and coverage, especially for urban areas, older mothers and fetuses with CHD, cleft palate or/and cleft lip or congenital talipes equinovarus.

Smart City Internet of Things will become a fundamental infrastructure to support massive machine-type communications between the widely deployed sensors serving big cities. Since there exists many location constraints for the existing terrestrial Internet of Things, the non-terrestrial Internet of Things sheds light on breaking these limits. Therefore, this article conducts a comprehensive survey on non-terrestrial Internet of Things technologies for Smart City, which is an important complement to terrestrial Internet of Things. We first present the application scenarios of Internet of Things and point out where the existing terrestrial Internet of Things cannot work perfectly. Two non-terrestrial Internet of Things technical proposals are then introduced, namely satellite Internet of Things and unmanned aerial vehicle Internet of Things. However, the focuses of these non-terrestrial Internet of Things are distinct, that is, the major problems of satellite and unmanned aerial vehicle Internet of Things are the high dynamic nature of channel and high maneuverability of unmanned aerial vehicles, respectively. The key technologies for satellite and unmanned aerial vehicle Internet of Things are then reviewed separately. Both physical and non-physical layer technologies are surveyed for satellite Internet of Things, and the route planning is mainly investigated for the unmanned aerial vehicle Internet of Things. Finally, we draw a conclusion and give some potential research directions of non-terrestrial Internet of Things.

The rapid booming of future smart city applications and Internet of things (IoT) has raised higher demands on the next-generation radio access technologies with respect to connection density, spectral efficiency (SE), transmission accuracy, and detection latency. Recently, faster-than-Nyquist (FTN) and nonorthogonal multiple access (NOMA) have been regarded as promising technologies to achieve higher SE and massive connections, respectively. In this paper, we aim to exploit the joint benefits of FTN and NOMA by superimposing multiple FTN-based transmission signals on the same physical recourses. Considering the complicated intra- and interuser interferences introduced by the proposed transmission scheme, the conventional detection methods suffer from high computational complexity. To this end, we develop a novel sliding-window detection method by incorporating the state-of-the-art deep learning (DL) technology. The data-driven offline training is first applied to derive a near-optimal receiver for FTN-based NOMA, which is deployed online to achieve high detection accuracy as well as low latency. Monte Carlo simulation results validate that the proposed detector achieves higher detection accuracy than minimum mean squared error-frequency domain equalization (MMSE-FDE) and can even approach the performance of the maximum likelihood-based receiver with greatly reduced computational complexity, which is suitable for IoT applications in smart city with low latency and high reliability requirements.

Objective. To study the clinical manifestations, magnetic resonance imaging (MRI) findings, and prognosis of delayed encephalopathy after carbon monoxide poisoning (DEACMP). Methods. The medical records of 20 patients with DEACMP were retrospectively reviewed. All the patients received hyperbaric oxygen treatment and other treatments as necessary. Results. The patients had diverse clinical manifestations, including memory deficits, personality changes, cognitive or executive function deficits, mood disorders, Parkinsonism, dystonia or other motor impairments, and akinetic mutism. MRI revealed lesions in the bilateral cerebral white matter and/or basal ganglia. Except for the pathologically confirmed DEACMP, epileptic seizure, hemiplegia, and vegetative state, the remaining symptoms had been improved, especially the cognitive impairment, which had been decreased from 95% to 25% and psychiatric symptoms also decreased from 95% to 55% at the 6-month follow-up. Conclusions. The prognosis of patients with DEACMP was poor, and they had a relatively severe disability. The early use of hyperbaric oxygen is of great significance to improve clinical efficacy and get a better prognosis.

The network-based IEEE 1588 precision clock synchronization protocol is an accurate time synchronization method that meets the requirements of key applications in smart substation in the future. In this paper, a dynamic delay curve, comprehensive curve fitting and bad data analysis are used to rationally plan the active curve delay between two substations, and finally determine the situation. The same profile improves the usability of the IEEE 1588 time synchronization system.

Backgroud Patients with acute ischemic stroke (AIS) often experience low serum free triiodothyronine (FT3), but the association of low FT3 with stroke severity, subtype and prognosis has not yet been thoroughly studied, and the molecular events underlying these clinical observation were also unclear. Methods We retrospectively collected 221 cases of AIS and 182 non-AIS cases with detailed clinical data from our department. FT3 concentrations were measured on admission to predict functional outcome within 3 months using multivariable models adjusted for other risk factors. Receiver operating characteristic (ROC) curves were calculated to define the best cutoff value of FT3 of stroke severity, subtypes and neurological outcome. Gene set enrichment, pathway mapping and network analyses of deferentially expressed genes (DEGs) were performed. Results FT3 was significantly decreased in AIS patients with National Institutes of Health Stroke Scale (NIHSS) > 3 and 3-months modified Rankin Scale (mRS) > 2. The cut-off value of FT3 for NIHSS on admission was 4.30 pmol/L. Also, FT3 level was significantly lower in large artery atherosclerosis (LAA) group and cardioembolism (CE) group than that in small vessel occlusion (SVO). FT3 value served as an independent predictor for neurological outcomes for which the cut-off value of FT3 was 4.38 pmol/l. Gene ontology (GO) analysis showed that the biological function of DEGs was mainly enriched in multicellur organism, neuron differentiation and cellular response to hypoxia. The cellular components were involved in extracelluar region, exosome and matrix, and the molecular functions were transcriptional activator activity, DNA binding and nuclear hormone receptor binding. Signal pathways analysis was indicative of neuroactive ligand-receptor interaction, thyroid hormone signaling pathway, and protein digestion and absorption these DEGs were involved in. Six related gene were identified as hubs from the protein-protein interaction (PPI) networks. Three modules were selected from PPI, of which MMP4, ADRA2C and EIF3E were recognized as the seed genes. Conclusions Low FT3 value on admission was associated with stroke severity, subtype and prognosis. In addition, DEGs identified from bioinformatics analysis are likely to be candidates for elucidating clinical outcomes with low FT3, and provide us with therapeutic targets for improving stroke prognosis.

Grant-free transmission, which simplifies the signaling procedure via uplink instant transmission, has been recognized as a promising multiple access protocol to address the massive connectivity and low latency requirements for future machine type communications. The major drawback of grant-free transmission is that the contaminations among uncoordinated transmissions can reduce the data throughput and deteriorate the outage performance. In this paper, we propose a rate-adaptive multiple access (RAMA) scheme to tackle the collision problems caused by the grant-free transmission. Different from the conventional grant-free (conv-GF) scheme which transmits a single signal layer, RAMA transmits the signals with a multilayered structure, where different layers exhibit unequal protection property. At the receiver, the intra- and interuser successive interference cancellation (SIC) receiving algorithm is employed to detect multiple data streams. In RAMA, the users can achieve rate adaptation without the prior knowledge of the channel conditions, since the layers with high protection property can be successfully recovered when the interference is severe, while other layers can take advantage of the channel when the interference is less significant. Besides, RAMA also facilitates the SIC receiving since the multiple layers in the transmission signals can provide more opportunities for interference cancellation. To evaluate the system performance, we analyze the exact expressions of the throughout and the outage probability of both conv-GF and RAMA. Finally, theoretical analysis and simulation results validate that the proposed RAMA scheme can simultaneously achieve higher average throughput and lower outage performance than conv-GF. Meanwhile, RAMA shows its robustness with large user activation probability, where the collisions among users are severe.

Several papers studied dietary protein intake as a potential influence factor for esophageal cancer, but their findings were inconsistent. Thus, this meta-analysis was performed to identify the effect of protein intake on esophageal cancer risk. Potential case–control studies or cohort studies from the databases of Embase, Web of Science and PubMed were searched. The strength of association was quantified by pooling odds ratio (OR) and 95% confidence interval (CI). In total, 11 articles involving 2537 cases and 11432 participants were included in this meta-analysis. As a result, dietary protein intake had non-significant association on esophageal cancer risk overall (pooled OR = 1.11, 95% CI = 0.88–1.40). Meanwhile, we obtained consistent results in the subgroups analyses by study design, protein type, geographic locations and number of cases. Interestingly, dietary protein intake could significantly increase the risk of esophageal squamous cell carcinoma (pooled OR = 1.29, 95% CI = 1.02–1.62), instead of other disease type. To sum up, dietary protein intake had no significant association with esophageal cancer risk in the overall analysis; but, protein intake may be associated with the risk of esophageal squamous cell carcinoma. While some limitations existed in the present paper, more studies with large sample size are warranted to further confirm this result.

Background Malignant pleural effusion is a common complication of non-small cell lung cancer (NSCLC); however, treatment options remain limited. This study evaluated the safety and efficacy of sequential intrapleural therapy with lobaplatin and erythromycin for NSCLC-mediated malignant pleural effusion. Methods Fifty-six patients with NSCLC complicated with malignant pleural effusion were recruited for a prospective single-arm study from December 2014 to 2016; one patient dropped out. In addition to conventional systemic chemotherapy, lobaplatin and erythromycin were intrapleurally injected into subjects. Short and long-term responses were analyzed. The concentration of ultrafilterable platinum in the pleural effusion and plasma were detected at different time points. Incidences of severe adverse reactions were observed. Results In the 55 evaluable patients, the effective rate of pleural effusion was 81.8% after six weeks of treatment. Six and twelve months after treatment, the effective rates were 60% and 21.8%, respectively, and the one-year survival rate was 83.6%. The concentrations of lobaplatin in pleural effusion and plasma two hours after injecting 50 mg lobaplatin into the thoracic cavity were 13.763 ± 1.523 μg/mL and 1.120 ± 0.164 μg/mL, and 17 hours later were 1.961 ± 0.351 μg/mL and 0.578 ± 0.095 μg/mL, respectively. The rate of severe adverse reactions of the first cycle of systemic chemotherapy combined with lobaplatin and erythromycin did not significantly differ from the rate in the second cycle. Conclusion Intrapleural combination therapy with lobaplatin and erythromycin is a safe and efficient treatment for patients with NSCLC-mediated malignant pleural effusion.

Owing to the superior performance in spectral efficiency, connectivity, and flexibility, nonorthogonal multiple access (NOMA) is recognized as the promising access protocol and is now undergoing the standardization process in 5G. Specifically, dozens of NOMA schemes have been proposed and discussed as the candidate multiple access technologies for the future radio access networks. This paper aims to make a comprehensive overview about the promising NOMA schemes. First of all, we analyze the state-of-the-art NOMA schemes by comparing the operations applied at the transmitter. Typical multiuser detection algorithms corresponding to these NOMA schemes are then introduced. Next, we focus on grant-free NOMA, which incorporates the NOMA techniques with uplink uncoordinated access and is expected to address the massive connectivity requirement of 5G. We present the motivation of applying grant-free NOMA, as well as the typical grant-free NOMA schemes and the detection techniques. In addition, this paper discusses the implementation issues of NOMA for practical deployment. Finally, we envision the future research challenges deduced from the recently proposed NOMA technologies.

Our previous study revealed that early application of electrical field stimulation (EFS) with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was neuroprotective in the dorsal corticospinal tract after spinal cord injury (SCI). The objective of this study was to further evaluate the effect of EFS on protection of anterior horn motoneurons and their target musculature after SCI and its mechanism. Rats were randomized into three equal groups. The EFS group received EFS for 30 minutes immediately after injury at T10. SCI group rats were only subjected to SCI and sham group rats were only subjected to laminectomy. Luxol fast blue staining demonstrated that spinal cord tissue in the injury center was better protected; cross-sectional area and perimeter of injured tissue were significantly smaller in the EFS group than in the SCI group. Immunofluorescence and transmission electron microscopy showed that the number of spinal cord anterior horn motoneurons was greater and the number of abnormal neurons reduced in the EFS group compared with the SCI group. Wet weight and cross-sectional area of vastus lateralis muscles were smaller in the SCI group to in the sham group. However, EFS improved muscle atrophy and behavioral examination showed that EFS significantly increased the angle in the inclined plane test and Tarlov's motor grading score. The above results confirm that early EFS can effectively impede spinal cord anterior horn motoneuron loss, promote motor function recovery and reduce muscle atrophy in rats after SCI.

Here, T b 3 + ions are incorporated into C s 2 A g 0.6 N a 0.4 I n C l 6 : B i double perovskite microcrystals via a re-crystallization method. T b 3 + ions doping not only makes the white light spectrum adjustable, but also maintains the high photoluminescence quantum yield (PLQY). The optimal value of PLQY is 95%. These are comparable to the current highest values. Noteworthy is that, intrinsic emission of T b 3 + ions is attributed to the effective energy transfer from the trapped exciton state of the double perovskite host to T b 3 + ions. Finally, mixing 30% T b 3 + alloyed C s 2 A g 0.6 N a 0.4 I n C l 6 : B i and C s 2 N a I n C l 6 : 10 % S b phosphors, a series of double-perovskite-based white light-emitting diodes (WLEDs) are prepared. The color coordinates of the best WLEDs are (0.34, 0.32), the lumen efficiency is 42 lm/W, and the color rendering index is 94.3. It is worth mentioning here that there is no blue light loss caused by energy reabsorption between the two phosphors, because the excitation wavelengths of the two phosphors are concentrated in the ultraviolet band. This work provides a new strategy for preparing high-performance WLED.

With the increasing awareness of environmental protection, green supplier selection as an indispensable part of green supply chain management has received extensive attention. Effective and reliable green supplier evaluation criteria are crucial to the success of green supplier selection. Therefore, identifying the critical criteria and determining the causality of these criteria is an important requirement of stakeholders. However, the existing approaches on identifying critical causal criteria suffer at least two weaknesses: firstly it assumes the same cognitive levels between different decision makers by using a pre-determined and uniformed formation to characterize evaluation judgements, which may cause potential decision bias; secondly there is a lack of effective methods to analyse and identify critical causal criteria in the face of heterogeneous judgements, potentially causing the duplication consideration of the impacts of some criteria in green supplier selection. To address these issues, this study proposes a new approach integrating cloud model and DEMATEL (decision making trial and evaluation laboratory) to determine critical causal criteria for green supplier evaluation with qualitative heterogeneous judgements. The contribution of this study is threefold. First, to address the difficulty in processing uncertain and heterogeneous judgements, the cloud model theory is utilized and further developed to convert heterogeneous qualitative judgements into homogeneous quantitative data with the form of interval integrated clouds, which realizes the flow of uncertainty from qualitative judgements to quantitative data. Second, to enable the identification of critical causal criteria, the DEMATEL method is extended to accommodate the cloud model environment to solve the identification problem. Third, a case study, followed by a comparison analysis is provided to illustrate the applicability and advantages of the proposed approach. The results indicate that the proposed approach can handle heterogeneous judgements effectively as well as that staff environmental training, green production innovation, green marketing and green corporate culture are the critical causal criteria for the given application.

In order to win in the market competition, enterprises have considered sustainable high-quality development (SHQD) as an important goal. However, prior studies on SHQD mainly emphasized theoretical discussions, and few scholars have conducted quantitative data analysis, especially in the state-owned enterprises (SOEs) area. Given this research gap, this paper proposes a novel framework to evaluate and select state-owned enterprise with sustainable high-quality development capacity (SHQDC) in China under linguistic distribution assessment (LDA) environment. This study has been done in four stages. In the first stage we present a detailed evaluation index system for SHQDC. In the second stage, to determine the comprehensive weights of evaluation criteria and sub-criteria, we extend the traditional fuzzy analytic hierarchy process (FAHP) method to determine the subjective weights of criteria and sub-criteria, and propose a novel method to compute the objective weights of criteria and sub-criteria under linguistic distribution assessment environment. In the third stage, we extend the traditional bidirectional projection method to the linguistic distribution environment and further put forward a ranking method to select SOEs with SHQDC, in which the ratings of sub-criteria are assessed in linguistic distribution assessments to reflect the qualitative evaluation of experts’ subjective opinions. Finally, we demonstrate the validity of the proposed approach by means of comparing the sustainable high-quality development capacity of three state-owned enterprises in China.

Background The prognosis of R/R PTCL and ENKTL remains poor. Current therapeutic options are limited, highlighting the need for novel approaches. ATG-010 (selinexor) is a novel, oral selective inhibitor of nuclear export, which blocks exportin 1. It has demonstrated clinical activity in different hematological malignancies. Preclinical synergistic anti-tumor effects are confirmed when combined with gemcitabine, cisplatin, or etoposide. Method The aim of this study was to evaluate safety and efficacy of ATG-010 plus GemOx or ICE regimen followed by ATG-010 maintenance in patients (pts) with R/R PTCL or ENKTL in China. The study planned to enroll 30 pts with PTCL-NOS, AITL, ALCL, PTCL-TFH, FTL and ENKTL. Pts must have had prior exposure to an anthracycline-based regimen for PTCL or an asparaginase-based regimen for ENKTL, and were relapsed or refractory from the last therapy. ATG-010 was administered orally (60 mg day 1, 8) plus standard-dose of either ICE or GemOx regimen every 3 weeks as per investigator's choice. If response was achieved after initial 2-6 cycles, pts continued to receive ATG-010 maintenance at the dose of 60 mg weekly until disease progression, intolerability or withdrawal of consent. Primary endpoints included safety according to the NCI CTCAE 5.0 and overall response rate (ORR) evaluated by investigators according to the Lugano criteria (2014). Secondary endpoints included duration of response (DOR), progression-free survival (PFS) and overall survival (OS). This trial was registered at ClinicalTrials.gov (NCT04425070). Results From Aug 18, 2020 to June 25, 2021, 24 pts (20 in GemOx cohort, 4 in ICE cohort) were enrolled and received at least one cycle of treatment. In this abstract, we report results of the GemOx cohort with 9 (45%) PTCL-NOS, 6 (30%) ENKTL, 4 (20%) AITL, and 1 (5%) ALCL ALK-. At study entry, median age was 55 years (range 35-69); 17 (85%) had stage III/IV disease. Five (36%) pts with PTCL had IPI score ≥3, and 5 (83%) ENKTL pts with had PINK-E score ≥2. Median number of prior regimens was 3.5 (range 1-7) with 5.5 for ENKTL and 2 for PTCL. All pts were refractory from last therapy; 11 (55%) pts had received gemcitabine-based regimens. Median time from last-line therapy to this trial was 1.5 months (range 1.0-16.7). The most common treatment-emergent adverse events (TEAEs) were hematological toxicities. All grade hematological TEAEs were neutropenia (90%), thrombocytopenia (90%) and anemia (85%). Grade≥3 hematological TEAEs included neutropenia (85%), thrombocytopenia (80%) and anemia (40.0%). The most common (>30%) non-hematological TEAEs were nausea (70%), diarrhea (65%), decreased appetite (65%), asthenia/fatigue (60%), vomiting (50%), pyrexia (40%), and hyponatremia (35%). Grade≥3 non-hematological TEAEs (≥10%) were diarrhea (15%) and pyrexia (10%). Serious TEAEs occurred in 7 (35%) pts with the most common being thrombocytopenia (20%). Three (15%) pts discontinued treatment due to TEAEs. TEAEs with a fatal outcome occurred in 1(5%) patient, who experienced rapid disease progression before death. The majority of adverse events were manageable by dose modification and supportive care. Of 17 efficacy evaluable pts, ORR was 52.9% (9/17), and CR rate was 35.3% (6/17). ORR of PTCL-NOS, ENKTL, AITL, ALCL were 62.5% (5/8), 60% (3/5), 0 (0/3), 100% (1/1); CR rate were 37.5%, 40%, 0, 100%, respectively. At a median follow-up of 6.1months, median PFS, DOR and OS of the whole cohort was 2.9, 3.1 months, and not reached (6-month OS rate 68.9%), respectively. Patients with ENKTL enjoyed a relatively longer median PFS (4.7 months). Conclusions ATG-010 plus GemOx regimen showed a manageable safety profile, and favorable activity with impressive CR rate in refractory pts, potentially offering a new therapeutic option for heavily pretreated pts with refractory PTCL or ENKTL. Disclosures Lou: Antengene Therapeutics Ltd.: Current Employment. Fei: Antengene Therapeutics Ltd.: Current Employment. Wang: Antengene Therapeutics Ltd.: Current Employment. Lynch: Antengene Therapeutics Ltd.: Current Employment.