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Dietary nutrients are associated with the development of cardiovascular disease (CVD) both through traditional pathways (inducing hyperlipidemia and chronic inflammation) and through the emergence of a metaorganism-pathogenesis pathway (through the gut microbiota, its metabolites, and host). Several molecules from food play an important role as CVD risk-factor precursors either themselves or through the metabolism of the gut microbiome. Animal-based dietary proteins are the primary source of CVD risk-factor precursors; however, some plants also possess these precursors, though at relatively low levels compared with animal-source food products. Various medications have been developed to treat CVD through the gut-microbiota–circulation axis, and they exhibit potent effects in CVD treatment. Nevertheless, such medicines are still being improved, and there are many research gaps that need to be addressed. Furthermore, some medications have unpleasant or adverse effects. Numerous foods and herbs impart beneficial effects upon health and disease. In the past decade, many studies have focused on treating and preventing CVD by modulating the gut microbiota and their metabolites. This review provides an overview of the available information, summarizes current research related to the gut-microbiota–heart axis, enumerates the foods and herbs that are CVD-risk precursors, and illustrates how metabolites become CVD risk factors through the metabolism of gut microbiota. Moreover, we present perspectives on the application of foods and herbs—including prebiotics, probiotics, synbiotics, postbiotics, and antibiotic-like substances—as CVD prevention agents to modulate gut microbiota by inhibiting gut-derived CVD risk factors. Taxonomy (classification by EVISE) Cardiovascular disease, gut microbiota, herbal medicine, preventive medicine, dietary therapy, nutrition supplements.

This study examines whether bank lenders have different reactions to various types of real transaction management (RTM) by borrowing firms. Drawing upon Jensen and Meckling’s asset substitution theory (1976) as well as banks’ unique payoff functions and monitoring incentives, we predict and find that banks offer more favorable loan terms (i.e., lower interest spreads, reduced probability for required collateral, reduced number and strictness of financial covenants) for firms displaying higher levels of RTM through reductions in R&D expenditures. In contrast, banks offer less favorable loan terms for firms displaying higher levels of RTM through aggressive price discounts, overproduction of inventories, and abnormal reduction of SG&A expenses. Additional analysis reveals that the favorable effect on loan pricing for R&D outlay reductions is smaller for longer-maturity loans. Overall, our study suggests that banks do not negatively view all forms of RTM.

The relationship among the microstructure, hardness and electrical conductivity of the as-forged ZYK530 Mg alloy after heat treatment was analyzed and studied using a microscope, X-Ray Diffractometer, eddy current conductivity meter, and Vickers microhardness tester, to explore optimum heat treatment process of ZYK530 Mg alloy. The results show that: with the prolongation of holding time, the electrical conductivity and microhardness show the same change trend, both of which show an oscillatory upward trend, and then decrease in an oscillatory downward trend after reaching the peak value. There is a linear positive correlation between the conductivity and the hardness, and the fitting results of the conductivity and hardness are in good agreement with the measured results; combined with the actual production, when the heat-treatment is 480 ℃ × 8 h + 220 ℃ × 3 h, the highest hardness is 79.2 HV, the electroconductivity is 36.2%IACS, and the comprehensive performance is the best, which is the best heat treatment process.

Background/purpose Esophageal variceal bleeding (EVB) is a medical emergency in patients with portal hypertension (PHT). However, studies on the long-term outcomes of prophylactic endoscopic variceal ligation (EVL) in pediatric-onset PHT are lacking. Methods Between 1999 and 2020, patients who received EVL in the Electronic Report System of the Pediatric Endoscopy Unit were included in this retrospective study. EVL was classified as primary prophylaxis when it was performed for esophageal varices (EVs) without previous bleeding. If it was implemented in acute EVB, the subsequent EVL was classified as secondary prophylaxis. Results Fifty-eight patients aged 10 months to 33 years with 31 males were included. Thirty-eight patients were classified as primary prophylaxis group, and twenty, secondary prophylaxis group. The primary prophylaxis group experienced fewer 5-year EVB events than the secondary prophylaxis group (cumulative risk: 14.4% versus 32.4%). Still, it didn't significantly affect overall survival and biliary atresia transplant-free survival. Long-term mortality was significantly associated with higher serum direct bilirubin levels (≥0.55 mg/dL) and lower albumin levels (≤2.54 mg/dL) at the first EVL. Aspartate aminotransferase-to-platelet ratio index (APRI) with a cut-off value of 1.24 helped to predict EV presence at the initial esophagogastroduodenoscopy (EGD) (AUROC = 0.762, sensitivity 75.0%, and specificity 66.7%). Conclusion Primary prophylactic EVL, despite reducing acute EVB, may not change overall survival and biliary atresia transplant-free survival. APRI > 1.24 may predict EV presence at the first EGD and help to schedule a surveillance EGD. Higher direct bilirubin and lower albumin levels at the first EVL may relate to long-term mortality.

Background Fecal microbiota transplantation (FMT) has been shown to highly effective in the treatment of recurrent or refractory Clostridioides difficile infection (rCDI) in many countries of the world. Not until 2018, Ministry of Health and Welfare, Taiwan approved the application of FMT for rCDI under a special law. The study reported the first implementation of the technology in the medical center in Taiwan and the preliminary outcome. Methods FMT was used to treat patients with rCDI in Chang Gung Memorial Hospital. FMT was delivered by gastroenterologists using colonoscope. Strict donor screening was performed according to the guidelines. We followed up the clinical course of patients after FMT. 16S rRNA sequencing of fecal samples for donor, and also recipient before and after FMT was carried out. Results From September 2018 to June 2020, 39 patients with rCDI received FMT, with a successful rate of 89.7%. Two patients died due to causes unrelated to FMT, and two other cases showed no clinical improvement after the procedure. High school and college students showed the best pass rate during donor screening. The presence of multi-drug resistant pathogen was the most common cause for screening failure. We demonstrated in a case the use of rRNA sequencing as a biomarker indicating for the improvement of dysbiosis in a patient after FMT. Conclusions FMT was successfully implemented in a medical center in Taiwan and showed a comparable successful rate in treating rCDI, compared to other countries. Safety remains the most important issue when applying FMT in the clinical setting.

Cytoreductive surgery (CRS) for colorectal cancer peritoneal carcinomatosis has been shown to prolong survival with acceptable morbidity rates. Total pelvic peritonectomy (TPP), or complete removal of all pelvic peritoneum, constitutes an important and technically challenging component of CRS. Here we report our experience and describe our technique of laparoscopic total pelvic peritonectomy (LTPP), using a photographic/videographic step-by-step guide. All patients who underwent LTPP for pelvic carcinomatosis from a colorectal origin were included in the study. Only patients with peritoneal cancer index (PCI) score of ≤ 10 were selected for CRS with LTPP. Patients who had extra-abdominopelvic cavity metastases were excluded. The final decision to proceed with CRS was made following laparoscopic assessment. From January 2017 to December 2020, 15 consecutive patients underwent LTPP for colorectal cancer pelvic carcinomatosis. Median patient age and PCI score was 53 years (range 33–78) and 8 (range 3–10), respectively. Complete cytoreduction was achieved in all patients. Thirteen patients (87%) underwent concomitant hyperthermic intraperitoneal chemotherapy (HIPEC). The median operative duration was 748 min (interquartile range [IQR] 681–850). Median intra-operative blood loss and length of hospital stay was 100 ml (IQR 50–300) and 10 days (IQR 8–12), respectively. Five patients (33%) experienced 30-day post-operative morbidity, with one (6.7%) experiencing a higher grade (Clavien–Dindo IIIa) complication. Median follow-up duration was 13 months (IQR 3–19), during which four (27%) had systemic recurrence and one (6.7%) died after 15 months following peritoneal and systemic recurrences. LTPP is a feasible option for low-volume pelvic carcinomatosis from colorectal cancer, offering the benefits of a minimally invasive approach. Strict patient selection is essential, and the procedure should be converted if the PCI score cannot be assessed or complete cytoreduction cannot be achieved. Proficiency at laparoscopic pelvic surgery is mandatory for performing LTPP.

Acute kidney injury (AKI) is a common syndrome that has a significant impact on prognosis in various clinical settings. To evaluate whether new evidence supports changing the current definition/classification/staging systems for AKI suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline, the Taiwan AKI-TASK Force, composed of 64 experts in various disciplines, systematically reviewed the literature and proposed recommendations about the current nomenclature and diagnostic criteria for AKI. The Taiwan Acute Kidney Injury (TW-AKI) Consensus 2020 was established following the principles of evidence-based medicine to investigate topics covered in AKI guidelines. The Taiwan AKI-TASK Force determined that patients with AKI have a higher risk of developing chronic kidney disease, end-stage renal disease, and death. After a comprehensive review, the TASK Force recommended using novel biomarkers, imaging examinations, renal biopsy, and body fluid assessment in the diagnosis of AKI. Clinical issues with regards to the definitions of baseline serum creatinine (sCr) level and renal recovery, as well as the use of biomarkers to predict renal recovery are also discussed in this consensus. Although the present classification systems using sCr and urine output for the diagnosis of AKI are not perfect, there is not enough evidence to change the current criteria in clinical practice. Future research should investigate and clarify the roles of the aforementioned tools in clinical practice for AKI.

Fecal microbiota transplantation (FMT) is a new and adequate route to modify the microbial ecosystem in gastrointestinal tract of the hosts. Intestinal microbiota is highly associated with human health and disease. According to the reports of human clinical trials or case series, the application of FMT ranged from Clostridiodes difficile infection (CDI), inflammatory bowel disease (IBD), irritable bowel syndrome, refractory diarrhea, diabetes mellitus, metabolic syndrome, and even neurologic diseases, including Parkinson disease, and neuropsychiatric disorder (autism spectrum disorder, ASD). Although the current allowed indication of FMT is CDI in Taiwan, more application and development are expectable in the future. There is a relative rare data available for children in application of fecal microbiota transplantation. Thus, we review previous published research inspecting FMT in children, and address particular considerations when conducting FMT in pediatric patients.

Modern advanced phasor measurement units are developed with ultrahigh reporting rates to meet the demand for monitoring the power systems dynamics in detail. Due to the large volume of data, the communication and storage systems are seriously challenged with the presence of ultrahigh-density (UHD) synchrophasor and point-on-wave (POW) data. Therefore, it is an urgent task to compress the UHD data for more efficient communication and data storage. This article proposes several methods to compress the synchrophasor and POW data in a lossless manner. First, an improved time-series special compression (ITSSC) method is proposed to compress the UHD frequency data. Second, a delta-difference Huffman method is combined with the time-series special compression algorithm to compress the UHD phase angle data. Finally, a cyclical high-order delta modulation method is proposed to compress the UHD POW data. The proposed models are extensively tested and compared with different existing lossless compression algorithms using the field-collected synchrophasor and POW data at different reporting rates. The results indicate that the proposed algorithms are efficient in performing lossless compression for the UHD synchrophasor and POW data in real time.

A high selectivity and high efficiency filtering antenna is presented in this paper. A double-layer filtering patch antenna is first proposed, which can generate a radiation null due to the mixed electric and magnetic coupling between the two patches. By changing the length of the slot line on the patch, the position of the radiation null can be flexibly set at the lower band edge or upper band edge. Based on this mechanism, a three-layer patch antenna with two radiation nulls is designed. Two radiation nulls are introduced on both sides of the passband, consequently, a quasi-elliptic bandpass response can be obtained. Moreover, the proposed antenna features high efficiency since no extra filtering circuit is utilized. A prototype antenna operating at 1 GHz is designed, fabricated, and measured for validity verification. The measured results agree well with the simulated one, showing that the prototype antenna has a fractional impedance bandwidth of 16% (0.91-1.07 GHz), a flat passband gain response with peak value of 8.83 dBi, a high efficiency about -0.41 dB in the passband. The band-edge selectivity is highly improved by the radiation nulls near the passband edge.

Objective To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). Methods A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. Results The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. Conclusions Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.

Background Radiomics-based biomarkers enable the prognostication of resected non-small cell lung cancer (NSCLC), but their effectiveness in clinical stage and pathologic stage IA pure-solid tumors requires further determination. Purpose To construct an efficient radiomics signature for survival risk stratification personalized for patients with clinical stage and pathologic stage IA pure-solid NSCLC. Materials and Methods In this retrospective study, six radiomics signatures were constructed for patients with stage IA pure-solid NSCLC who underwent resection between January 2011 and December 2013 at authors' institution and were tested in the radiogenomics data set. The radiomics features were extracted from the intratumoral two-dimensional region, three-dimensional volume, and peritumoral area using PyRadiomics. The discriminative abilities of the signatures were quantified using the area under the time-dependent receiver operating characteristic curve (AUC), and the optimal signature was selected for patient stratification. Results The study included 592 patients with stage IA pure-solid NSCLC (median age, 61 years; interquartile range, 55-66 years; 269 women) for radiomics analysis: 381 patients for training, 163 for internal validation, and 48 for external validation. The radiomics signature combining three-region features yielded the highest 3- and 5-year AUCs of 0.77 and 0.78, respectively, in the internal validation set and 0.76 and 0.75, respectively, in the external validation set. Multivariable analysis suggested that the radiomics signature remained an independent prognostic factor (hazard ratio, 6.2; 95% CI: 3.5, 11.0; P < .001) and improved the discriminative ability and clinical usefulness of conventional clinical predictors. Conclusion The radiomics signature with multiregional features helped stratify the survival risk of patients with clinical stage and pathologic stage IA pure-solid non-small cell lung cancer. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Hsu and Sohn in this issue.

Summary Background SARS-CoV-2 has caused millions of deaths, and, since Aug 11, 2020, 20 intramuscular COVID-19 vaccines have been approved for use. We aimed to evaluate the safety and immunogenicity of an aerosolised adenovirus type-5 vector-based COVID-19 vaccine (Ad5-nCoV) in adults without COVID-19 from China. Method This was a randomised, single-centre, open-label, phase 1 trial done in Zhongnan Hospital (Wuhan, China), to evaluate the safety and immunogenicity of the Ad5-nCoV vaccine by aerosol inhalation in adults (≥18 years) seronegative for SARS-CoV-2. Breastfeeding or pregnant women and people with major chronic illnesses or history of allergies were excluded. Participants were enrolled and randomly assigned (1:1:1:1:1) into five groups to be vaccinated via intramuscular injection, aerosol inhalation, or both. Randomisation was stratified by sex and age (18–55 years or ≥56 years) using computer-generated randomisation sequences (block sizes of five). Only laboratory staff were masked to group assignment. The participants in the two aerosol groups received an initial high dose (2 × 1010 viral particles; HDmu group) or low dose (1 × 1010 viral particles; LDmu group) of Ad5-nCoV vaccine on day 0, followed by a booster on day 28. The mixed vaccination group received an initial intramuscular (5 × 1010 viral particles) vaccine on day 0, followed by an aerosolised booster (2 × 1010 viral particles) vaccine on day 28 (MIX group). The intramuscular groups received one dose (5 × 1010 viral particles; 1Dim group) or two doses (10 × 1010 viral particles; 2Dim group) of Ad5-nCoV on day 0. The primary safety outcome was adverse events 7 days after each vaccination, and the primary immunogenicity outcome was anti-SARS-CoV-2 spike receptor IgG antibody and SARS-CoV-2 neutralising antibody geometric mean titres at day 28 after last vaccination. This trial is registered with ClinicalTrials.gov, number NCT04552366. Findings Between Sept 28, 2020, and Sept 30, 2020, 230 individuals were screened for inclusion, of whom 130 (56%) participants were enrolled into the trial and randomly assigned into one of the five groups (26 participants per group). Within 7 days after vaccination, adverse events occurred in 18 (69%) in the HDmu group, 19 (73%) in the LDmu group, 19 (73%) in the MIX group, 19 (73%) in the 1Dim group, and 15 (58%) in the 2Dim group. The most common adverse events reported 7 days after the first or booster vaccine were fever (62 [48%] of 130 participants), fatigue (40 [31%] participants), and headache (46 [35%] participants). More adverse events were reported in participants who received intramuscular vaccination, including participants in the MIX group (49 [63%] of 78 participants), than those who received aerosol vaccine (13 [25%] of 52 participants) after the first vaccine vaccination. No serious adverse events were noted within 56 days after the first vaccine. At days 28 after last vaccination, geometric mean titres of SARS-CoV-2 neutralising antibody was 107 (95% CI 47–245) in the HDmu group, 105 (47–232) in the LDmu group, 396 (207–758) in the MIX group, 95 (61–147) in the 1Dim group, and 180 (113–288) in the 2Dim group. The geometric mean concentrations of receptor binding domain-binding IgG was 261 EU/mL (95% CI 121–563) in the HDmu group, 289 EU/mL (138–606) in the LDmu group, 2013 EU/mL (1180–3435) in the MIX group, 915 EU/mL (588–1423) in the 1Dim group, and 1190 EU/mL (776–1824) in the 2Dim group. Interpretation Aerosolised Ad5-nCoV is well tolerated, and two doses of aerosolised Ad5-nCoV elicited neutralising antibody responses, similar to one dose of intramuscular injection. An aerosolised booster vaccination at 28 days after first intramuscular injection induced strong IgG and neutralising antibody responses. The efficacy and cost-effectiveness of aerosol vaccination should be evaluated in future studies. Funding National Key Research and Development Programme of China and National Science and Technology Major Project. Translation For the Chinese translation of the Summary see Supplementary Material.

Shale gas is a green, low-carbon and clean unconventional natural gas energy. China is rich in shale gas resources. Accelerating shale gas exploration and development is of great practical significance to improve China's energy structure and achieve the goal of “2030 carbon peak neutralization and 2060 carbon neutralization”. The Ordovician Wufeng Formation to Silurian Longmaxi Formation in Sichuan Basin is the key strata for shale gas exploration and development in China. Based on the experimental analysis of shale gas in Wufeng Formation to Longmaxi Formation in Weiyuan, Changning, Zhaotong, Fuling and Weirong areas of Sichuan Basin, this paper systematically analyzes the geochemical characteristics of shale gas in Wufeng Formation to Longmaxi Formation, discusses the genesis of shale gas, the causes of hydrocarbon isotope inversion and the source of shale gas, and looks forward to the exploration prospects of shale gas resources in the basin. It has important guiding significances for shale gas exploration and development in Sichuan Basin and even in China. The results show that: (1) The shale gas of Wufeng-Longmaxi formations is a typical dry gas, and the hydrocarbon isotopes are distributed in negative sequence. The carbon isotopes of alkane gas in Changning, Zhaotong and Fuling areas are heavier and have a higher degree of thermal evolution than those in Weiyuan and Weirong areas, and the rare gas is of crustal origin. (2) Shale gas of Wufeng-Longmaxi formations is a thermogenic oil type gas at high-over mature stage, which is mainly the mixture of crude oil cracking gas and kerogen cracking gas. The hydrocarbon isotope inversion of alkane gas is mainly caused by the mixing of crude oil cracking gas and kerogen cracking gas at high-over mature stage, the exchange between formation water and methane at high evolution stage and so on. (3) The carbon isotopic values of methane in shale gas of Wufeng-Longmaxi formations match the carbon isotopic values of kerogen in mudstone of Longmaxi Formation of Lower Silurian, which conforms to the law of carbon isotopic fractionation δ13Ckerogen>δ13Coil>δ13Calkane gas. (4) The total amount of marine, marine continental transitional and continental facies shale gas resources in Sichuan Basin is about 41.5 × 1012 m3, with broad exploration prospects in resource potential.

Large‐scale power systems exhibit more complex dynamics due to the increasing integration of inverter‐based resources (IBRs). Therefore, there is an urgent need to enhance the situational awareness capability for better monitoring and control of power grids dominated by IBRs. As a pioneering Wide‐Area Measurement System, FNET/GridEye has developed and implemented various advanced applications based on the collected synchrophasor measurements to enhance the situational awareness capability of large‐scale power grids. This study provides an overview of the latest progress of FNET/GridEye. The sensors, communication, and data servers are upgraded to handle ultra‐high density synchrophasor and point‐on‐wave data to monitor system dynamics with more details. More importantly, several artificial intelligence (AI)‐based advanced applications are introduced, including AI‐based inertia estimation, AI‐based disturbance size and location estimation, AI‐based system stability assessment, and AI‐based data authentication.

Although reduced port laparoscopic surgery (RPLS), defined as laparoscopic surgery performed with the minimum possible number of ports and/or small-sized ports, is less invasive than conventional laparoscopic surgery by reducing the number of surgical wounds, an extension of the incision is still needed for specimen extraction, which can undermine the merits of RPLS. To determine the impact of natural orifice specimen extraction (NOSE) in patients undergoing RPLS for colorectal cancer. The endpoints were perioperative outcome and oncologic safety at 3 years. Single-center experience (2013–2019). We retrospectively analyzed our prospectively collected patient records (American Joint Committee on Cancer (AJCC) stage I–III sigmoid or upper rectal cancer (tumor diameter ≤ 5 cm) who underwent curative anterior resection via RPLS. We excluded patients who did not undergo intestinal anastomosis. Perioperative and oncologic outcomes were compared between patients undergoing natural orifice (RPLS-NOSE) or conventional (mini-laparotomy) specimen extraction (RPLS-CSE). Patients were matched by propensity scores 1:1 for tumor diameter, AJCC stage, American Society of Anesthesiologists score and tumor location. Of 119 eligible patients, 104 were matched (52 RPLS-NOSE; 52 RPLS-CSE) by propensity scores. Compared with RPLS-CSE, RPLS-NOSE was associated with longer operative time (223.9 vs. 188.7 min; p = 0.003), decreased use of analgesics (morphine dose 33.9 vs. 43.4 mg; p = 0.011) and duration of hospital stay (4.2 vs. 5.1 days; p = 0.001). No statistically significant difference was found in morbidity or wound-related complication rates between the two groups. After a median follow-up of 34.3 months, no local recurrence was observed in RPLS-NOSE. The 3-year disease-free survival did not differ statistically significantly between groups (90.9 vs. 90.5%; p = 0.610). NOSE enhances the advantages of RPLS by avoiding the need for abdominal wall specimen extraction in patients with tumor diameter ≤ 5 cm. Surgical and oncologic safety are comparable to RPLS with CSE.

The diagnostic performance of 18F-FDG PET for detecting regional lymph node metastasis in resectable lung cancer is variable, and its sensitivity for adenocarcinoma is even lower. We aimed to evaluate the value of 18F-FDG PET-derived features in predicting pathological lymph node metastasis in patients with lung adenocarcinoma. We retrospectively analyzed pretreatment 18F-FDG PET-derived features of 126 lung adenocarcinoma patients who underwent curative surgery. A logistic regression model was used to analyze the association between study variables and pathological regional lymph node status obtained from the curative surgery. Furthermore, Cox regression analysis was used to test the effect of the study variables on survival outcomes, including disease-free survival (DFS) and overall survival (OS). The primary tumor entropy (OR = 1.7, p = 0.014) and visual interpretation of regional nodes via 18F-FDG PET (OR = 2.5, p = 0.026) independently predicted pathological regional lymph node metastasis. The areas under the receiver-operating-characteristic curves were 0.631, 0.671, and 0.711 for visual interpretation, primary tumor entropy, and their combination, respectively. Based on visual interpretation, a primary tumor entropy ≥ 3.0 improved the positive predictive value of positive visual interpretation from 51.2% to 63.0%, whereas an entropy

Background Balloon microcatheters are widely used for endovascular treatment. However, no reports on direct coil embolization from dual-lumen balloon microcatheters are available in the literature. This report is the first description of direct coil embolization using this type of balloon microcatheter for looming bleeding emergencies. Methods This retrospective review demonstrates the indications and advantages of coil embolization from an inflated balloon catheter to reduce blood loss and simultaneously occlude bleeding. Results Five patients who underwent emergency endovascular treatment using coil embolization directly delivered from a dual-lumen balloon were identified. Etiologies included vertebro-vertebral arteriovenous fistula, ruptured vertebral artery dissecting aneurysm, vertebral artery injury during cervical spinal operation, and failed stent retrieval procedures for acute infarction. Complete hemostasis was achieved with all procedures. Conclusion Our experience demonstrates the feasibility of direct coil embolization by using a dual-lumen balloon to rapidly halt bleeding in some rare emergency situations, which may save lives.

This study aimed to propose a novel four-type deformity and treatment-oriented classification of the lower eyelids that directs the therapeutic combination of three-step lower blepharoplasty for Asian populations. We reviewed 183 patients who underwent a therapeutic combination of three steps of lower blepharoplasty after being diagnosed with four types of lower eyelid deformities between July 2018 and April 2021. The three-step lower blepharoplasty includes: (1) mid-face and lower eyelid augmentation, (2) transconjunctival eye bag removal, and (3) skin pinch removal. Consecutive digital images, detailed fat graft volume, fat removal amount, skin pinch removal amount, complications, and patient’s satisfaction and aesthetic improvement score were recorded. The overall patient’s satisfy score is 91. Aesthetic improvement score is 80.2 and 83.3 among lay persons and experts, respectively. The volume of the fat graft ranges from 2 to 3 mL per orbit according to the severity of the deformity. The amount of fat removed was 0.53 ± 0.36 and 0.61 ± 0.40 mL per orbit in types II and III patients, respectively. There is no lower lid malposition. Eleven patients had over-correction of fat grafting, and they need steroid injection; 20 patients had under-correction of fat grafting, and they need secondary fat grafting. Ten patients need secondary skin pinch excision due to post-op skin redundancy. Two patients had conjunctiva wound granuloma. The combination of three-step lower blepharoplasty according to the novel classification is a straightforward and effective method to correct lower eyelid deformities. The complication rate was low with high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND Several materials can serve as spacer grafts in the repair of retracted lower eyelids. However, previous studies did not reveal any of these to be superior to the others. From our perspective, autologous dermal grafts are ideal because they are biologically compatible and abundantly available. However, the absorption of these grafts is an issue, and the thickness of the dermal grafts is crucial. We evaluated the dermal thickness at five potential donor sites using ultrasonography and the efficacy and safety of the posterior neck dermis as a spacer graft in the correction of retracted lower eyelids. METHODS In 20 healthy volunteers, the dermal thickness was assessed using ultrasonography and compared between the posterior neck, upper arm, inguinal area, intergluteal cleft, and gluteal sulcus. Between January 2018 and June 2021, eight retracted lower eyelids in eight patients were repaired using a posterior neck dermal graft. The surgical results of these grafts were also evaluated. RESULTS The mean age of the volunteers was 37.8 years, and the mean body mass index was 24.45 kg/m2. The intergluteal cleft provided the thickest dermis followed by the posterior neck and gluteal sulcus, which were not significantly different. The upper arm and inguinal area had the thinnest dermis without significant differences between them. The mean marginal reflex distance 2/iris ratio decreased by 0.15 (p=0.008). The mean cosmetic score (0-10) for evaluation of lower eyelid reconstruction increased by 3.38 (p=0.011). The mean Vancouver Scar Scale score for evaluation of donor site scarring was 3.21. CONCLUSIONS Although the posterior neck dermis is the second thickest, it is an ideal spacer graft in the reconstruction of retracted lower eyelids. Adequate thickness, uncomplicated methods, and a closer surgical field are its advantages. Additionally, donor site morbidity is minimal, with acceptable scarring. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Whether hepatitis B virus (HBV) infection poses risk to patients with nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era remains unclear. Methods 953 patients with non-metastatic, newly diagnosed NPC who received detection of serologic hepatitis B surface antigen (HBsAg) and treated with IMRT were retrospectively reviewed. 171 patients had HBV infection (HBsAg seropositive). Propensity score matching method (PSM) and stabilized inverse probability of treatment weighting (IPTW) were used to address confounding. The survival rates were evaluated by Kaplan-Meier analysis and the survival curves were compared by Log-rank test. Prognostic factors were explored by multivariate analysis. Results No significant survival differences were observed between HBsAg-negative group and HBsAg-positive group [5-year overall survival (OS), 87.7% vs. 83.9%, P=0.181; locoregional recurrence-free survival (LRFS), 83.5% vs. 78.3%, P=0.109; distant metastasis-free survival (DMFS), 80.2% vs. 77.9%, P=0.446; progression-free survival (PFS), 77.4% vs. 71.4%, P=0.153], consistent with the results of PSM and IPTW analysis. Further analyses revealed that HBV infection was an independent prognostic factor for poor OS [multivariate analysis; hazard ratio (HR), 3.74; 95% confidence interval (CI), 1.45–9.68; P=0.006], LRFS (HR, 2.86; 95% CI, 1.37–5.95); P=0.005] in patients with stage N1, DMFS (HR, 2.65; 95% CI, 1.15–6.09; P=0.022) and PFS (HR, 2.63; 95% CI, 1.34–5.14; P=0.005). Among HBsAg-positive patients, liver protection improved OS (90.3% vs. 77.2%; P=0.022). Conclusions HBV infection is an independent risk factor for patients with stage N1 NPC in the IMRT era. Hepatic protection may benefit the survival of HBsAg-positive patients.

Objective Helicobacter pyloriinfection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-basedH. pyloriinfection control and management to reduce the related disease burden. Methods Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements. Results Experts discussed and modified the original 23 statements on family-basedH. pyloriinfection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1)H. pyloriinfection and transmission among family members, (2) prevention and management ofH. pyloriinfection in children and elderly people within households, and (3) strategies for prevention and management ofH. pyloriinfection for family members. In addition to the ‘test-and-treat’ and ‘screen-and-treat’ strategies, this consensus also introduced a novel third ‘family-basedH. pyloriinfection control and management’ strategy to prevent its intrafamilial transmission and development of related diseases. Conclusion H. pyloriis transmissible from person to person, and among family members. A family-basedH. pyloriprevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.

Chronic kidney disease (CKD) increases the risk of arrhythmia. The right ventricular outflow tract (RVOT) is a crucial site of ventricular tachycardia (VT) origination. We hypothesize that CKD increases RVOT arrhythmogenesis through its effects on calcium dysregulation. We analysed measurements obtained using conventional microelectrodes, patch clamp, confocal microscopy, western blotting, immunohistochemical examination and lipid peroxidation for both control and CKD (induced by 150 mg/kg neomycin and 500 mg/kg cefazolin daily) rabbit RVOT tissues or cardiomyocytes. The RVOT of CKD rabbits exhibited a short action potential duration, high incidence of tachypacing (20 Hz)‐induced sustained VT, and long duration of isoproterenol and tachypacing‐induced sustained and non‐sustained VT. Tachypacing‐induced sustained and non‐sustained VT in isoproterenol‐treated CKD RVOT tissues were attenuated by KB‐R7943 and partially inhibited by KN93 and H89. The CKD RVOT myocytes had high levels of phosphorylated CaMKII and PKA, and an increased expression of tyrosine hydroxylase‐positive neural density. The CKD RVOT myocytes exhibited large levels of I to, I Kr, NCX and L‐type calcium currents, calcium leak and malondialdehyde but low sodium current, SERCA2a activity and SR calcium content. The RVOT in CKD with oxidative stress and autonomic neuron hyperactivity exhibited calcium handling abnormalities, which contributed to the induction of VT.

PURPOSE: Feature maps created from deep convolutional neural networks (DCNNs) have been widely used for visual explanation of DCNN-based classification tasks. However, many clinical applications such as benign-malignant classification of lung nodules normally require quantitative and objective interpretability, rather than just visualization. In this paper, we propose a novel interpretable multi-task attention learning network named IMAL-Net for early invasive adenocarcinoma screening in chest computed tomography images, which takes advantage of segmentation prior to assist interpretable classification. METHODS: Two sub-ResNets are firstly integrated together via a prior-attention mechanism for simultaneous nodule segmentation and invasiveness classification. Then, numerous radiomic features from the segmentation results are concatenated with high-level semantic features from the classification subnetwork by FC layers to achieve superior performance. Meanwhile, an end-to-end feature selection mechanism (named FSM) is designed to quantify crucial radiomic features greatly affecting the prediction of each sample, and thus it can provide clinically applicable interpretability to the prediction result. RESULTS: Nodule samples from a total of 1626 patients were collected from two grade-A hospitals for large-scale verification. Five-fold cross validation demonstrated that the proposed IMAL-Net can achieve an AUC score of 93.8% ± 1.1% and a recall score of 93.8% ± 2.8% for identification of invasive lung adenocarcinoma. CONCLUSIONS: It can be concluded that fusing semantic features and radiomic features can achieve obvious improvements in the invasiveness classification task. Moreover, by learning more fine-grained semantic features and highlighting the most important radiomics features, the proposed attention and FSM mechanisms not only can further improve the performance but also can be used for both visual explanations and objective analysis of the classification results.

Objectives To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P, Graphical abstract 30 cases are needed to lay the technical foundation and 90 cases are required to achieve proficiency. Significant improvements concerning the perioperative outcomes were observed as the learning curve developed. CUSUM, Cumulative sum; OT, operative time.

In this communication, a high-selectivity and high-gain filtering slot antenna operating in $X$ -band is designed based on a triple-mode cavity resonator. Three modes of the cavity resonator, namely, TE101, TE011, and TM110, are excited by properly selecting the position and size of the coupling aperture. By adjusting the frequency and external coupling of the three modes, transmission zero can be introduced on both sides of the passband, achieving high selectivity of antenna gain. Because the cavity has a high unload quality factor, the radiation efficiency in the passband is high and flat. In order to increase the gain of the filtering waveguide antenna, a grid-slotted patch is added on the top of the slot. To demonstrate the concept, an $X$ -band waveguide filtering antenna is designed and fabricated. Measured results show the filtering antenna can obtain a gain of greater than 8.5 dBi in the frequency range of 9.8–10.2 GHz.

Chronic respiratory diseases (CRDs), including pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), lung cancer, and asthma, are significant global health problems due to their prevalence and rising incidence. The roles of protein tyrosine kinases (PTKs) and protein tyrosine phosphatases (PTPs) in controlling tyrosine phosphorylation of targeting proteins modulate multiple physiological cellular responses and contribute to the pathogenesis of CRDs. Src homology-2 domain-containing PTP2 (SHP2) plays a pivotal role in modulating downstream growth factor receptor signaling and cytoplasmic PTKs, including MAPK/ERK, PI3K/AKT, and JAK/STAT pathways, to regulate cell survival and proliferation. In addition, SHP2 mutation and activation are commonly implicated in tumorigenesis. However, little is known about SHP2 in chronic pulmonary inflammation and fibrosis. This review discusses the potential involvement of SHP2 deregulation in chronic pulmonary inflammation and fibrosis, as well as the therapeutic effects of targeting SHP2 in CRDs.

Mg is a macronutrient for plant growth. Mg deficiency has become an important limiting factor in intensive agricultural production, resulting in reduced crop yield and quality. Given that Mg is also essential for human and animals’ diets, Mg nutrition in plants has become an important issue not only for food security but also for human health. We review recent progress in physiological and molecular mechanisms underlying Mg biological functionality, as well as Mg transport and Mg deficiency symptoms in plants. As both a structural component and a regulatory factor, Mg helps plants achieve higher photosynthetic efficiency, nitrogen use efficiency and stress resistance. Plants need a certain range of Mg concentration for their growth, and a number of key genes responsible for Mg uptake, translocation and detoxification have been identified. Despite its functional importance, basic researches on Mg nutrition are still scarce. A deeper investigation of the genetic and molecular mechanisms employed in Mg nutrition will help to improve crop yield and intensify Mg application in the field. Developing more approaches to enhance Mg concentration in crop edible parts is urgently required for human diet and health.

PURPOSE To provide updated estimates of the clinical and economic burden in patients with ocular hypertension (OHT) or open-angle glaucoma (OAG) by disease severity in the United States and to estimate incremental costs associated with disease progression. DESIGN Retrospective cohort study. PARTICIPANTS Patients with 1 or more International Classification of Diseases, 10th Revision, Clinical Modification, diagnoses for OAG or OHT who are 40 years of age or older. METHODS Patients were identified from IQVIA's PharMetrics Plus database during the index period (October 1, 2015, to August 31, 2017). Patients had continuous health plan enrollment for 12 months or more before and after the index date (first OAG or OHT diagnosis during index period) and were stratified by baseline disease severity based on diagnosis code. Annual eye-related outpatient healthcare use and costs were estimated on a per-user basis. A generalized linear model was used to estimate adjusted mean costs by severity and to evaluate the impact of observed disease worsening on costs. A multivariate logistic regression analysis evaluated the relationship between severity and odds of falls or fractures. MAIN OUTCOME MEASURES Total eye-related outpatient costs and odds of falls or fractures. RESULTS One hundred seventy-seven thousand three hundred fifty-two OHT and OAG patients were identified (67.8% with OAG). Open-angle glaucoma patients showed higher eye-related outpatient costs than OHT patients (median, $516 [interquartile range (IQR), $323-$898] vs. $344 [IQR, $197-$617], respectively). Patients with severe OAG showed higher eye-related outpatient costs than moderate and mild OAG patients (median, $639 [IQR, $381-$1264] vs. $546 [IQR, $345-$950] vs. $476 [IQR, $304-$765], respectively; P < 0.0001), as well as higher glaucoma-related pharmacy costs (median, $493 [IQR, $122-$1457] vs. $244 [IQR, $84-$1113] vs. $139 [IQR, $66-$818], respectively; P < 0.0001). In adjusted analyses, disease worsening was associated with at least 2-fold higher annual eye-related outpatient costs (P < 0.0001). Severe OAG patients had significantly higher odds of fall or fracture compared with OHT patients (odds ratio, 1.34; 95% confidence interval, 1.13-1.59). CONCLUSIONS Updated estimates showed highest eye-related costs for those with severe disease and disease progression among patients with OAG and OHT. Severe OAG was associated with increased risk of falls or fractures compared with patients with OHT. Therapies that delay disease progression may provide clinical and economic benefits.

Objectives To compare the perioperative and oncologic outcomes following pneumonectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS) and thoracotomy in patients with centrally located non–small cell lung cancer (NSCLC). Materials and methods Patients with NSCLC who underwent pneumonectomy at the Shanghai Pulmonary Hospital (SPH) and Sun Yat-sen University Cancer Center (SYUCC) with the U-VATS approach or open approach between 2011 and 2016 were selected. Propensity score matching (1:3) was performed to balance the baseline covariates. Overall survival (OS) rates and recurrence-free survival (RFS) rates were estimated and compared using the Kaplan–Meier method, respectively. Results The enrollees in the study were 579 patients in the SPH cohort, with 501 (86.5%) in the open group and 48 (13.5%) in the U-VATS group, and 271 patients in the SYUCC cohort, with 245 (90.4%) in the open group and 26 (9.6%) in the U-VATS group. After propensity score matching, morbidity rates and 30-day mortality rates were found to be similar between the U-VATS group and open group in both the SPH and SYUCC cohorts. The long-term OS rate of patients who underwent U-VATS pneumonectomy did not significantly differ compared with the patients who underwent open pneumonectomy in both cohorts (SPH, p = .900; SYUCC, p = .240). Cox regression analysis revealed that the surgical option was not a risk factor for the OS rate (SPH: hazard ratio [HR], 0.925; 95% confidence interval [CI], 0.555 to 1.542; SYUCC: HR, 1.524; 95% CI, 0.752 to 3.087). Conclusion U-VATS can be used to safely perform pneumonectomy in patients with centrally located NSCLC without compromising the perioperative and oncologic outcomes compared with an open approach.

Yuxin Che,1 Yang Yang,1 Jinguo Suo,1 Chang Chen,2 Xuelian Wang1 1Department of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, Shenyang, Liaoning, People’s Republic of China; 2Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of ChinaCorrespondence: Xuelian WangDepartment of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People’s Republic of ChinaTel/Fax +86 24-31939077Email xlwang18@cmu.edu.cnPurpose: The route of administration of a therapeutic tumor vaccine is a critical factor in inducing antitumor activity. In this study, we explored the effects of three vaccination routes (subcutaneous, peritumoral, and intratumoral injection) on antitumor activity induced by a human papillomavirus (HPV) therapeutic vaccine containing HPV16 E7 peptide combined with the adjuvant CpG ODN in established TC-1 grafted tumors.Methods: We used flow cytometry to evaluate splenic and tumor-infiltrating immune cells. We also assessed transcriptional changes in a sequence of immune-related genes in tumors of different treatment groups using quantitative real-time polymerase chain reaction. Immunohistochemistry was used to determine the expression of molecules related to tumor infiltrating immune cells, angiogenesis, and cancer-associated fibroblasts in tumor tissues.Results: Our results suggested that intratumoral and peritumoral vaccination generated enhanced antitumor activity compared to subcutaneous delivery. In particular, intratumoral vaccination elicited a stronger antitumor effect, with two of the six treated mice being nearly tumor-free at day 28. Three vaccination routes induced increases in splenic CD4+ and/or CD8+ T lymphocytes, and marked decreases in immunosuppressive cells. Peritumoral vaccination increased the tumor-infiltrating CD8+T cells in tumors, while intratumoral vaccination enhanced the tumor-infiltrating CD4+ and CD8+ T lymphocytes, as well as decreased the tumor-infiltrating of immunosuppressive cells, which may result in stronger inhibition of tumor growth and prolonged survival in mice bearing tumors. Furthermore, compared to the subcutaneous route, intratumoral vaccination led to a significant increase in antitumor cytokines and chemokines. In addition, our data showed marked downregulation of MMP-2, MMP-9, VEGF, CD31, and α-SMA in the intratumoral vaccination group, which might contribute to the suppression of tumor invasion, angiogenesis, and metastasis.Conclusion: Overall, intratumoral vaccination is superior to subcutaneous delivery and has the potential to inhibit tumor growth by improving the tumor microenvironment.Keywords: human papillomavirus, cervical cancer, therapeutic vaccine, intratumoral injection, immunosuppression

BACKGROUND: New treatment alternatives have revolutionized the management of nAMD. However, there is limited evidence on the clinical and economic burden of nAMD in commercially insured US patients...

Introduction Information on the long-term treatment satisfaction with secukinumab for patients with plaque psoriasis in real-world settings is limited. The objective of this study was to describe real-world treatment satisfaction in patients with plaque psoriasis who initiated secukinumab using data from an electronic medical records-based dermatology database. Methods Patients aged ≥ 18 years with plaque psoriasis in Modernizing Medicine Data Services’ affiliate’s database who received secukinumab 3/1/2018–1/21/2020 were included. Satisfaction with the treatment’s effectiveness in clearing the skin of psoriasis was evaluated using a 5-point Likert scale during the 12-month baseline period and at 6-, 12-, 18-, and 24-month postindex visits for the overall population and at 6-, 12-, and 18-month postindex visits for subgroups stratified by prior biologic and systemic therapy use. Additionally, satisfaction levels were assessed among patients who were unsatisfied with treatment at baseline. Results Overall, 82.3% agreed that secukinumab was effective in clearing their skin at 6 months, which was maintained through 12 (81.7%), 18 (83.3%), and 24 months (81.4%). Similar results were observed in biologic-experienced/naive and systemic-experienced/naive patients. Overall mean (SD) treatment satisfaction improved from 2.49 (1.36) at baseline to 1.77 (1.06) at 6 months, with similar improvements in satisfaction scores reported at each follow-up period up through 24 months. Of the patients who were not satisfied at baseline, 77.9% reported being satisfied with their treatment at 6 months, which continued through 12 (74.4%), 18 (82.8%), and 24 months (71.4%). Patients receiving secukinumab experienced meaningful changes in percent affected body surface area and Physician Global Assessment scores that were sustained through 24 months, regardless of prior treatment experience. Conclusions These real-world findings highlight the high level of sustained satisfaction with secukinumab treatment for improving and maintaining skin clearance in patients with moderate-to-severe disease, regardless of prior treatment experience. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00599-5.

With the development of agriculture, a huge amount of vegetable waste (VW) is produced every year, posing a large considerable environmental problem that cannot be ignored. Anaerobic digestion (AD), as an eco-friendly, efficient, and sustainable biomass conversion technology, may be used to address the pollution caused by VW. The compositional components of various VWs are different, which will affect their biomethane potential and directly determine whether they are suitable substrates for AD. Thus, this study involved a systematic analysis of the composition and biomethane potential of 20 typical VWs. The results showed that the methane yields of the VWs were different (207.5-346.3 mL/g VS) owing to the differences in composition. More importantly, a correlation between the contents of organic components and methane production was established, and then used to predict methane production by VW rapidly. In addition, first-order model, modified Gompertz, and Cone models were used to describe the biochemical methanogenesis mechanism of these VWs. The results of this study can provide a reference for fundamental research on the AD of VW as well as serve a convenient and precise method to predict methane production by different VWs through analyzing compositional components, which will be beneficial for pollution prevention and the comprehensive utilization of VW in the future.

Most prior studies focused on developing models for the severity or mortality prediction of COVID-19 patients. However, effective models for recovery-time prediction are still lacking. Here, we present a deep learning solution named iCOVID that can successfully predict the recovery-time of COVID-19 patients based on predefined treatment schemes and heterogeneous multimodal patient information collected within 48 hours after admission. Meanwhile, an interpretable mechanism termed FSR is integrated into iCOVID to reveal the features greatly affecting the prediction of each patient. Data from a total of 3008 patients were collected from three hospitals in Wuhan, China, for large-scale verification. The experiments demonstrate that iCOVID can achieve a time-dependent concordance index of 74.9% (95% CI: 73.6-76.3%) and an average day error of 4.4 days (95% CI: 4.2-4.6 days). Our study reveals that treatment schemes, age, symptoms, comorbidities, and biomarkers are highly related to recovery-time predictions.

Background Necrotizing enterocolitis (NEC) is one of the most serious complications in preterm infants. Probiotics have been used to prevent NEC. Safety is a major concern for this practice. Methods We reported a female preterm infant who received oral Lactobacillus rhamnosus GG but developed sepsis 12 days after the treatment. Cultures of blood and the catheter tip yielded L. rhamnosus. Next-generation sequencing was performed to analyze isolates from blood, stool, catheter, and product capsules. We also determined the capacities of these isolates to form biofilms. A literature review was performed. Results The patient was treated with ampicillin and piperacillin/tazobactam, and she subsequently recovered without complications. The analysis of genome sequences indicated that all the isolates belonged to the clone of L. rhamnosus GG (ATCC 53103), suggesting that sepsis was a catheter-related infection caused by the oral probiotic. L. rhamnosus GG (ATCC 53103) and the probiotic strain tested formed biofilms under all growth conditions. Isolates from the blood and catheter tip also formed biofilms, but the stool isolate did not. The capacity of intrinsic biofilm formation in L. rhamnosus GG depended on environmental factors and the type of culture medium. Literature review of L. rhamnosus GG sepsis in preterm and young infants found that nearly 60% of the patients had a suspected or confirmed infected catheter. Conclusion The study showed that the capacity of L. rhamnosus GG to form biofilms, especially in the presence of glucose, is a critical factor leading to the probiotic-related sepsis in preterm infants.

Parkinson's disease (PD), the typical neurodegenerative disease, is characterized by the progressive loss of dopaminergic neurons in the substantia nigra (SN). However, no therapeutic agent used currently could slow down neuronal cell loss so as to decelerate or halt the progression of PD. Traditional Chinese medicine (TCM) has been utilized to treat the dysfunction of the autonomic nervous system. Wen-Shen-Yang-Gan decoction (WSYGD) has a good effect on the clinical treatment of PD with constipation. However, it is not clear which ingredients and what mechanism are responsible for the therapeutic effect. In this study, the pharmacodynamic study of WSYGD in PD mice was applied. Concurrently, a novel method for the identification of metabolic profiles of WSYGD has been developed. Finally, we found that WSYGD could protect the PD mice induced by rotenone. The underlying mechanism of the protective effect may be related to the reduction of the DA neurons apoptosis via reducing inflammatory reaction. By virtue of UPLC-MS and chemoinformatics method, 35 prototype compounds and 27 metabolites were filtered out and tentatively characterized. In conclusion, this study provides an insight into the metabolism of WSYGD in vivo to enable understanding of the metabolic process and therapeutic mechanism of PD.

This article presents a novel quad-ridge cavity resonator to realize a trimode response based on the TE101, TE011, and TE111 modes. The basic structure of the quad-ridge resonator (QRR) contains four ridges located at the center around the cavities. With an appropriate combination of the main parameters (length and width of the resonator and heights of the ridges), the first three TE resonant modes can be flexibly controlled, and each mode can carry the signal of a channel. Compared with a traditional rectangular cavity, the QRR provides more design freedoms for controlling the first three TE resonant modes and features a wider spurious-free window. The electric field distributions of the QRR are thoroughly analyzed to guide the realization of a filtering response. Intracavity coupling is achieved by an all-iris structure, including horizontal and vertical coupling slots with offsets to the cavity center, capable of easy fabrication and assembly. A nine-pole triple-band filter and a 12-pole triplexer are designed and manufactured to validate the concept. A comparison with other reported multiplexers indicates that the proposed triplexer exhibits the advantages of size reduction and high isolation.

Lichang Chen,1,&ast; Lingling Wu,1,&ast; Dongzhu Lu,1 Mei Zi,2 Huapeng Yu1 1Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huapeng YuDepartment of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510220, People’s Republic of ChinaTel +86 020 61643175Fax +86 020 84306143Email huapengyu@aliyun.comPurpose: To evaluate the contribution of fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) and spirometric parameters in predicting bronchial hyperresponsiveness (BHR) in adults with chronic cough.Patients and Methods: In total, 112 patients with chronic cough were enrolled in this prospective diagnostic study. Receiver operating characteristic (ROC) curves were generated to assess the diagnostic efficiency and optimal cut-off values of FeNO and IOS and spirometric parameters in predicting BHR. Optimal combinations of FeNO and IOS and spirometric parameters for BHR prediction were investigated using univariate and multivariate logistic regression models. Bootstrapping was employed for internal validation. Model discrimination and calibration were assessed using indices and calibration plots.Results: Rhinitis and values of FeNO, IOS parameters (resonant frequency (Fres), reactance at 5 Hz (X5), and integrated area of low-frequency X (AX)) and spirometric parameters (FEV1, PEF, MEF75, MEF50, MEF25, MMEF) were significantly different between patients with BHR and those without BHR (P < 0.05). After adjusting for rhinitis, logistic analyses showed that FeNO combined with Fres, FeNO combined with MMEF, or the combination of FeNO, Fres and MMEF had high predictive value in diagnosing BHR; the areas under the ROC curves (AUCs) of the corresponding three models were 0.914, 0.919 and 0.927, respectively. In addition, the three models displayed good discrimination, with high C-index values and good calibration.Conclusion: FeNO combined with Fres or MMEF or a combination of these three parameters may be conveniently used as indicators in BHR prediction.Keywords: maximum mid-expiratory flow, resonant frequency, cough variant asthma, ROC curve, diagnosis

This article analyzed the safety and efficacy of ultrasound-guided mini-percutaneous nephrolithotomy (MPCNL) with low-pressure perfusion for the treatment of upper urinary tract stones in children. The clinical data of 690 patients (805 renal units) aged 1–7 years were retrospectively analyzed in terms of postoperative outcome. The mean patient age was 3.7 ± 1.6 years, and the stone burden was 2.8 ± 2.1 cm2. A middle posterior calyceal puncture was created in 719 (89%) renal units, and 16F puncture tracts were the most common method used in 557 (69%) renal units. The stone-free rate was 711 (88%) renal units, and the mean operation time was 35 ± 15.3 min (between 15 and 110 min). Among all cases, the transfusion rate was 4 (0.6%) patients, and the mean decrease in hemoglobin was 1.3 ± 0.9 g/L. In addition, the incidence rates of fever, sepsis, perirenal effusion, and intraperitoneal effusion were 40 (5.9%), 3 (0.4%), 28 (4.1%), and 8 (1.2%) patients, respectively. After the operation, 348 patients were followed-up for 32.8 ± 11.3 months, and stone recurrence occurred in 136 (39%) of 348 patients. This study suggests that ultrasound-guided MPCNL with low-pressure perfusion technology is a safe and feasible treatment.

Ilena Pochiero,1 Fabrizio Calisti,1 Alessandro Comandini,1 Alessandra Del Vecchio,1 Isabella Costamagna,1 Maria Teresa Rosignoli,1 Agnese Cattaneo,1 Sasikiran Nunna,2 Ilaria Peduto,3 Franca Heiman,3 Hsiu-Ching Chang,2 Chi-Chang Chen,2 Christoph Correll4– 6 1Angelini Regulatory, Research & Development, Angelini Pharma S.p.A., Rome, Italy; 2IQVIA, Plymouth Meeting, PA, USA; 3IQVIA Solutions Italy S.r.l., RWS, Milan, Italy; 4Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; 5Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 6Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USACorrespondence: Ilena PochieroAngelini Pharma S.p.A., Viale Amelia 70, Rome, ItalyEmail ilena.pochiero@angelinipharma.comPurpose: The primary objectives were to describe weight changes following initiation of lurasidone versus other antipsychotics and estimate the risk of clinically relevant (≥ 7%) weight changes.Patients and Methods: This retrospective, longitudinal comparative cohort study was based on electronic medical records (EMRs) of United States (US) adult patients with schizophrenia who were prescribed lurasidone or other antipsychotics as monotherapy between 1 April 2013 and 30 June 2019.Results: Overall, the study included 15,323 patients with a diagnosis of schizophrenia; 6.1% of patients received lurasidone, 60.4% received antipsychotics associated with a medium-high risk of weight gain (clozapine, olanzapine, quetiapine, risperidone, paliperidone) and 33.5% received antipsychotics with a low risk of weight gain (aripiprazole, first-generation antipsychotics, ziprasidone). Lurasidone was associated with the smallest proportion of patients experiencing clinically relevant weight gain and the greatest proportion of patients with clinically relevant weight loss. The risk of clinically relevant weight gain was numerically higher with all antipsychotics versus lurasidone and was statistically significant for olanzapine (hazard ratio [HR]=1.541; 95% confidence interval [CI]=1.121; 2.119; p=0.0078) versus lurasidone. The likelihood of ≥ 7% weight loss was significantly greater with lurasidone versus all antipsychotics (p< 0.05), except ziprasidone.Conclusion: This real-world study suggests that lurasidone has a lower risk of clinically relevant weight gain and a higher likelihood of clinically relevant weight loss than other commonly used antipsychotics.Keywords: retrospective studies, weight gain, real world clinical trials

An ultrawideband antenna is proposed for base station using loop resonator below the dual-polarized antenna. The designed loop resonator below is able to introduce new resonance to the antenna for ultrawideband operation. The energy is coupled by the loop dipole. This design can effectively enhance the bandwidth without using extra antenna space, which contributes to the multiarray arrangement in the future. Consequently, a full parameter wideband dual-polarized antenna is obtained. Simulation and measurement exhibit a wide bandwidth of 54.3% (| S 11| < −15 dB) from 550 to 960 MHz with polarization isolation of more than 31 dB. Desirable stable radiation patterns are also obtained over the whole band. It is a good candidate for the future base station communication system, etc.

Human serum albumin (HSA) is a non-glycosylated, negatively charged, single-chain polypeptide composed of 585 amino acid residues with a relative molecular mass of 66.438 kD. It is synthesized by the liver at a rate of approximately 200 mg·kg−1·day−1, with a half-life of 21 days, and subjected to catabolism in the muscles, liver, and kidneys at a rate of 4% per day.[1] Albumin, accounting for 60% of the total plasma protein, has various physiological functions,[2] such as maintaining 70% to 80% of effective plasma colloid osmotic pressure, coordinating vascular endothelial integrity, anti-oxidant and anti-inflammatory activities, maintaining the acid-base balance, and participating in the transport, distribution, and metabolism of a variety of endogenous and exogenous substances. The normal concentration of plasma albumin is 35 to 50 g/L. In clinical practice, hypoalbuminemia often occurs because of reduced albumin synthesis due to liver dysfunction, redistribution of serum albumin due to capillary leakage, or increased loss via the intestinal and renal routes. Hypoalbuminemia (defined as a serum albumin concentration less than 35 g/L) reportedly has an incidence of 24% to 87% in critically ill patients,[3] while severe hypoalbuminemia (a serum albumin concentration less than 25 g/L) has an incidence of 5.0–9.6%.[4] Hypoalbuminemia is an independent risk factor for increased short- and long-term mortality and an increased incidence of acute kidney injury (AKI) in patients with acute conditions such as trauma, cardiogenic shock, and sepsis.[5] A meta-analysis showed that for every 10 g/L decrease in the serum albumin concentration in critically ill patients, there was a 137% increase in in-hospital mortality, an 89% increase in the incidence of comorbidities, and a 72% increase in the length of hospital stay.[6] Hypoalbuminemia can also alter the pharmacokinetics of antibiotics, leading to either insufficient or excessively high blood concentrations, thereby resulting in treatment failure or excessive toxicity.[7] HSA is mainly used for fluid resuscitation and the treatment of hypoproteinemia in critically ill patients.[2] Existing studies have shown controversial results regarding whether the use of albumin in critically ill patients improves their clinical prognosis.[8] Albumin consumption varies greatly among countries,[9] and its inappropriate use is frequently seen, with 40% to 90% of reported HSA applications failing to follow clinical guidelines.[10] A tertiary hospital in China reported that hypoproteinemia was the most common indication for the use of HSA (35.6%); however, it was also used in 11.8% of patients with serum albumin concentrations more than 40 g/L. The reason for its use was not documented in 22% of cases.[11] In clinical practice, guidelines and consensus are lacking regarding the selection of HSA concentration, the timing of administration, dosage, and target concentration. Inappropriate use of HSA will cause adverse effects and increase medical costs inevitably, whereas guidance from clinical pharmacists or hospital standards can help reduce inappropriate HSA use by 30% and decrease medical costs without affecting patient prognosis.[12] To further strengthen the standardized application of HSA in critically ill patients and achieve optimal clinical outcomes, the Chinese Society of Critical Care Medicine convened a panel of relevant experts who reviewed and summarized data on the clinical use of HSA, outlined 11 relevant clinical problems, and formulated the “Expert Consensus on the Use of Human Serum Albumin in Critically Ill Patients” using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Background The eighth edition of nodal classification for non-small cell lung cancer (NSCLC) is defined only by the anatomical location of metastatic lymph nodes. Research Question We sought to evaluate the prognostic significance and discriminatory capability of the number of involved nodal stations (nS) in a large Chinese cohort. Study Design and Methods A total of 4,011 patients with NSCLC undergoing surgical resection between 2009 and 2013 were identified. The optimal cutoff values for nS classification were determined with X-tile software. Kaplan-Meier and multivariate Cox analysis were used to examine the prognostic performance of nS classification in comparison with location-based N classification. A decision curve analysis was performed to evaluate the standardized net benefit of nS classification in predicting prognosis. Results All the patients were classified into four prognostically different subgroups according to the number of involved nodal stations: (1) nS0 (none positive), (2) nS1 (one involved station), (3) nS2 (two involved stations), and (4) nS ≥ 3 (three or more involved stations). The prognoses among all the neighboring categories of nS classification were statistically significantly different in terms of disease-free survival and overall survival. The multivariate Cox analysis demonstrated that nS was an independent prognostic factor of disease-free survival and overall survival. Patients with N1 or N2 stage disease could be divided into three prognostically different subgroups according to nS classification. However, the prognosis was similar between the N1 and N2 subgroups when patients were staged in the same nS category. The decision curve analysis showed that nS classification tended to have a higher predictive capability than location-based N classification. Interpretation The nS classification could be used to provide a more accurate prognosis for patients with resected NSCLC. The nS is worth taking into consideration when defining nodal category in the forthcoming ninth edition of the staging system.

Novel cross-coupled dual-band bandpass filters (BPFs) with compact size are proposed based on dual-mode isosceles right-angled triangular (IRAT) resonators. The dominant mode in the IRAT resonator is the TM100Z mode. By introducing posts in the resonators, an LC resonant unit is formed, which resonates at a lower frequency than the TM100Z mode. In the design of novel dual-band filters, the LC mode constitutes the first passband while the TM100Z mode produces the second passband. As cross-coupling is applied, two and eight transmission zeros (TZs) are produced in the responses of third-order and fourth-order dual-band BPFs, respectively. Two third-order cross-coupled dual-band BPFs with altered passbands and one fourth-order cross-coupled dual-band BPF are fabricated and measured. The measured results agree very well with the simulated results, demonstrating attractive advantages of the proposed BPFs such as compact size and decent performance.