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OBJECTIVE To investigate the outcomes of patients with mucoepidermoid carcinoma of the palate undergoing pedicled facial-submental artery island flap (FSIF) reconstruction following resection. PATIENTS AND METHODS 41 patients with early stage disease and 9 patients with advanced-stage disease underwent radical excision and neck dissection. 37 IIb, 4 class IIa and 9 IIIb maxillary defects were reconstructed with FSIF, folded FSIF or folded FSIF with titanium mesh respectively. The skin paddles were 3 × 8 to 5 × 15 cm and 3 × 8 to 5 × 14 cm, respectively. 5 patients with high grade disease were treated with cobalt 60 adjuvant radiotherapy after operation. RESULTS One flap failure occurred, yielding a success rate of 98.0% in the reconstruction of palate II and III defects with FSIF or titanium mesh. The patients were seen for follow-up for 16-60 months postoperative. 76.0% patients alive with no disease (AND); 14.0% patients alive with disease (AD) and 10.0% died of disease (DD). Rates of AND, AD and DD differed significantly according to histopathologic grade and TNM stage (P

In this paper, the frequency selective rasorber (FSR) built on multilayer resistive sheets, which achieves a broad absorption band was proposed. Firstly, the detailed analysis of the absorption and transmission performance for FSR with the single/multi-layer resistive sheets based on the equivalent circuit model (ECM) was demonstrated, which proved that the FSR with the multilayer resistive sheets can obtain a broader absorption band. Secondly, the multilayer resonator (MR) of a smaller size and higher design freedom compared with single-layer resonator, was proposed. Then, the FSR on the basis of multilayer resistive sheets using MR was designed. It consists of the three-layered metallic structures and separated by an air spacer. For the top and middle layers, the lumped-resistor-loaded metallic dipole with the MR inserted into the center was applied to generate a wide absorption band and transparent window respectively. For the bottom layer, the square-slot frequency selective surface was optimized to match the transmission band of the resistive sheet. Simulated and measured results show that the broad absorption band and transmission band with low insertion loss have been realized, and the proposed FSR yields the widest relative bandwidth |S11|≤-10 dB of 145.2.

Secondary amyloid A amyloidosis, a lethal complication, is induced when acute or chronic infection coexists with over-secretion of the serum amyloid A 1 (SAA1) protein and deposition in key internal organs. Previously, using the whole-exome sequencing method, we identified a novel deleterious mutation SAA1.2 in rheumatoid arthritis (RA) patients. However, the role of SAA1 in RA pathogenesis and its complications remains unknown. The purpose of this study was to determine the pathogenetic roles of SAA1 protein isoforms in RA progression. We modified an experimental adenovirus infection protocol to introduce SAA1.2 gene alleles into the knee joints of mice and used SAA1.3 and SAA1.5 as controls. Micro-computed tomography analysis was applied to determine changes in bone morphology and density. Immunohistochemical (IHC) analysis, flow cytometry, enzyme-linked immunosorbent assay (ELISA), and real-time polymerase chain reaction (RT-PCR) were used to investigate disease progression and cytokine alterations in the course of adenoviral SAA-induced knee joint inflammation and bone destruction. We found that the arthritis-inducing effect of SAA1.2 transcription in the knee joints and mutant SAA1 protein secretion in blood resulted in the stimulation of immune responses, leading to CD8+ T cell and pro-inflammatory cytokine elevation, such as interleukin (IL)-6, IL-22, matrix metalloproteinase (MMP)-3, MMP-9, with subsequent synovial inflammation and bone destruction. These findings indicate that SAA1 protein isoforms, particularly SAA1.2, play a significant role in the induction and progression of RA and may have potential value in the early diagnosis and severity prediction of RA.

Objective Alström syndrome is an autosomal recessive genetic disease caused by a mutation in the ALMS1 gene. Alström syndrome is clinically characterized by multisystem involvement, including sensorineural deafness, cone-rod dystrophy, nystagmus, obesity, insulin resistance, type 2 diabetes and hypogonadism. The diagnosis is thus challenging for patients without this characteristic set of clinical symptoms. We explored the effectiveness of whole-exome sequencing in the diagnosis of Alström syndrome. Methods A girl with symptoms of Alström syndrome was tested and diagnosed with the disease by whole-exome sequencing. Results Whole-exome sequencing revealed two novel variants, c.6160_6161insAT: p.Lys2054Asnfs*21 (exon 8) and c.10823_10824 delAG:p.Glu 3608Alafs*9 (exon16) in the ALMS1 gene, leading to premature termination codons and the domain of ALMS1 protein. Blood sample testing of her asymptomatic parents revealed them to be heterozygous carriers of the same mutations. Assembly showed that the mutations on both alleles were located in conserved sequences. A review of the ALMS1 gene nonsense mutation status was performed. Conclusion We herein report two novel variants of the ALMS1 gene discovered in a Chinese Alström syndrome patient that expand the mutational spectrum of ALMS1 and provided new insight into the molecular mechanism underlying Alström syndrome. Our findings add to the current knowledge concerning the diagnosis and treatment of Alström syndrome.

This study aimed to explore the health-related quality of life (HRQoL) and associated variables in children with chronic myeloid leukemia in the chronic phase (CML-CP) receiving tyrosine kinase inhibitors (TKIs). A cross-sectional questionnaire was given to children with CML and their parents, who were

Engineered cementitious composite (ECC) is a type of high-performance fibre-reinforced cementitious composite with good ductility and excellent crack control ability. It has attracted increasing attention as a structural repair material in severely corrosive environments. However, the strength improvement is limited when ECC is used alone for shear strengthening of existing reinforced concrete (RC) members, although its shear capacity is much higher than that of other brittle cementitious materials such as cement mortar. This study proposes a novel shear strengthening method for RC beams with both high load-carrying capacity and good durability through the combination of high-strength steel wire and an ECC layer. The shear behaviours of the beams were tested under static loading. The test results showed that the shear strength and the ultimate displacement were significantly improved through shear strengthening. A large number of fine cracks appeared on the ECC layer before the failure of the beams. The load-carrying capacity was reduced by pre-damage owing to the important role of the shear resistance of the concrete with respect to the total shear capacity. The shear strength of the strengthened beams cannot be accurately predicted by the current design code owing to the ignorance of the shear resistance of ECC.

The term “superfruit” usually refers to certain fruits, which are rich in antioxidant components, therefore, are beneficial to human health. In China, there has been the concept of health preservation and dietary therapy through food intake in a long history. However, some other superfruits growing mainly in China have not attracted extensive attention, such as Cili, Goji berry, and sea buckthorn. Many studies suggested all of these superfruits showed strong antioxidant effects and anti‐inflammatory activity in common. However, there are various other advantages and functions in different fruits. This article reviewed the research findings from the existing literature published about major antioxidant bioactive compounds and the potential health benefits of these fruits. The phytochemicals from superfruits are bioaccessible and bioavailable in humans with promising health benefits. More studies are needed to validate the health benefits of these superfruits. It would provide essential information for further research and functional food development., This paper reviewed the recent studies on superfruits in China and emphasized their valuable or unique bioactive components and their nutritional and medicinal values.

Objective To explore the effect of individualized blood pressure (BP)‐lowering treatment on the outcomes of elderly patients with severe intracerebral hemorrhage (ICH). Methods We performed an exploratory analysis of Controlling Hypertension After Severe Cerebrovascular Event (CHASE) trial, which was a multicenter, randomized, controlled clinical trial. Patients with severe ischemic or hemorrhagic stroke (defined as GCS ≤ 12 or NIHSS ≥ 11) were randomized into individualized versus standard BP‐lowering treatment in CHASE trial. In this exploratory analysis, patients with severe ICH were included. The primary outcome was the percentage of patients with 90‐day functional independence defined as modified Rankin Scale (mRS) ≤2. Results We included 242 patients with severe ICH in the present analysis, consisting of 142 patients aged

The aim of this paper was to analyse the impact of service marketing mix (promotion, price, place, product, people,process, physical evidence and after sale service) on customer retention towards clothing store brands in China. Basedon the analysis of past literature, it appeared that there were only few studies examining the empirical relation betweenthe two constructs, particularly in the clothing sector in China. A comprehensive survey approach was used to collectdata from a total of 385 customers visiting clothing stores in the middle part of China (Hubei). SPSS and PLS were usedto analyse the obtained data. The findings showed that there were significant positive effects on customer retention inall dimensions of the service marketing mix. Finally, the findings suggested that after-sales service plays an importantrole in impacting the retention of customers. The contribution of this research was supporting the significancerelationship of the marketing mix elements in influencing the retention of customers in the clothing industry with empiricaldata from China.

Due to the unique advantages including low density, good chemical stability, and superior dielectric property, carbon-based materials have been exploited as potential microwave absorbers and have become a research hotspot. Herein, a superior microwave absorbent consisting of NiCo2S4 nanosheets anchored on hollow carbon spheres is successfully designed and fabricated by a low-cost and facile strategy for the first time. The obtained C/NiCo2S4 composite shows a minimum reflection loss (RLmin) of −65.10 dB with a matching thickness of only 1.56 mm, and the effective absorption bandwidth (EAB) could reach up to 6.60 GHz at a thin thickness of 1.75 mm, which is a highly competitive carbon-based absorber. The existence of NiCo2S4 nanosheets balances the impedance matching property and enhances the dielectric loss effectively, and the cavity structure promotes the multiple reflections of the electromagnetic wave (EMW), which increases the energy loss capacity of the material. This study provides new insight into design and modification of hollow carbon spheres and broadens their application in the field of efficient microwave absorbers.

Meng Miao,1 Fang Yuan,2 Xiaotian Ma,3 Haiming Yang,1 Xiang Gao,1 Zhengyu Zhu,4 Jianzhong Bi4 1Department of Neurology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, 266035, People’s Republic of China; 2Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, 266035, People’s Republic of China; 3Department of Medicine Experimental Center, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, 266035, People’s Republic of China; 4Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of ChinaCorrespondence: Zhengyu Zhu; Jianzhong BiDepartment of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of ChinaTel +8617660083488; +8615153178111Email zhuzhengyu_1@hotmail.com; bjz@sdu.edu.cnBackground: Early cognitive impairment after transient ischemic stroke (TIA)/mild ischemic stroke (MIS) is common but easily overlooked. It has been demonstrated that DNA methylation plays a significant role in cognitive impairment and ischemic stroke. Furthermore, it has been reported that the RIN3 gene influences transportation of the amyloid β-protein. However, to our knowledge, there has been no research related to correlations between RIN3 methylation and early-onset cognitive impairment after TIA/MIS. Therefore, this study aimed to investigate this relationship in TIA/MIS patients.Methods: This study include 28 control subjects and 84 patients with TIA/MIS who were evaluated within 7 days of TIA/MIS onset using four single-domain cognitive scales. In addition, DNA methylation of whole blood was tested. RIN3 methylation was compared between TIA/MIS and control groups and between TIA/MIS patients with early cognitive impairment and those without early cognitive impairment. Clinical variables and RIN3 methylation sites with statistical differences were then used to construct a predictive model.Results: Hypomethylation of the RIN3 gene was observed in the whole blood of TIA/MIS patients relative to healthy controls. Furthermore, patients with early cognitive impairment after TIA/MIS had hypomethylation of RIN3 relative to those without early cognitive impairment.Conclusion: RIN3 methylation is strongly associated with TIA/MIS and TIA/MIS with early cognitive impairment. It is possible to influence the disease process by methylation via appropriate lifestyle and clinical interventions, and methylation of RIN3 gene sites may predict the occurrence of TIA/MIS with early cognitive impairment.Keywords: amyloid &Bgr;-protein, cognitive impairment, hypomethylation, ischemic stroke, transportation

This article aims to achieve a high-transmittance varactor-tunable frequency-selective surface (FSS). First, the impedance condition for the high-transmittance FSS is deduced. Next, a square-slot FSS loaded with varactors, which owns the empirical formulas for equivalent circuit parameter extraction, is selected to demonstrate the proposed method for realizing a high-transmittance varactor-tunable FSS. Several conclusions are deduced and verified through the full-wave simulation. To illustrate the effectiveness of the proposed method, two FSSs operating at the same frequency are designed. The simulation and measurement results show that the FSS with the higher transmission rate follows the deduced conclusions. Note that the transmission rate of the varactor-tunable FSS is more than 77.8% ( $S_{21} =1.09$ dB) from 4.84 to 5.9 GHz when the bias voltage applied to the varactors is tuned from 5 to 20 V. Compared to the reported tunable FSSs, the varactor-tunable FSS achieved in this article obtains the highest transmission rate over the tunable transmission band.

The occurrence of asthma is closely related to environmental factors such as cigarette smoke (CS), one of the common risk factors. Environmental stimuli have the potential to activate transient receptor potential ankyrin 1 (TRPA1) and cause or aggravate asthma. The destruction of tight junctions (TJs) between airway epithelial cells by environmental stimuli in asthma has been researched. It is worth exploring whether CS can injury TJs and aggravate asthma by activating TRPA1. The objective of this study was to investigate the aggravation of CS on ovalbumin (OVA)-induced asthma related phenotypes and TJs expression in mice, and to explore the relationship between TRPA1 and the expression of TJs protein. Female wild type (WT) C57BL/6 mice, induced by OVA, CS and OVA plus CS (OVA + CS) respectively, were used to establish a 42-day asthma model, and mice with TRPA1 knockout (TRPA1−/−) were treated in the same way. This study detected the number of inflammatory cells in peripheral blood and bronchoalveolar lavage fluid (BALF), the levels of IL-4, IL-5, IL-13 in BALF, enhanced pause (Penh) of lung function, pathological changes and the gene and protein expressions of TRPA1 and TJs (including ZO-1, Occludin and Claudin-2) in lung tissues. Compared with normal saline (NS) group, WT mice in the OVA group and OVA + CS group were significantly higher in asthma related phenotypes. The WT-OVA + CS group also showed higher Penh value, levels of IL-5 and IL-13 in BALF and lung tissue injury scores when compared with the WT-OVA group and WT-CS group. However, WT-OVA + CS group mice had significantly larger number of neutrophils in BALF than the WT-OVA group, and had larger number of eosinophils in peripheral blood and higher levels of IL-4 in BALF than the WT-CS group. Meanwhile, compared with the WT-NS group, the expressions of TRPA1 and Claudin-2 in lung tissues increased in other three groups while their expressions of ZO-1 and Occludin decreased, among which, the WT-OVA + CS group showed more remarkable changes. Compared with the WT-OVA + CS group, mice in the TRPA1−/−-OVA + CS showed a significant decrease in the number of inflammatory cells, levels of IL-4, IL-5 and IL-13 in BALF, Penh value and lung tissue injury score, and a downregulation of Claudin-2 expression while an upregulation of ZO-1 and Occludin expressions. In addition, the airway inflammation and injury, and the expressions of ZO-1, Occluding and Claudin-2 expressions were found with no statistic differences between TRPA1−/−-OVA group and TRPA1−/−-OVA + CS group. These results suggest that CS has aggravated the airway inflammation, pathological damage and destruction of TJs in airway epithelium of OVA-induced asthmatic mice, the processes of which are related to the increase of TRPA1 expression.

Objective to explore the differences in the central response after acupuncture and moxibusbution at Zusānlĭ (足三里ST36) in treatment of functional dyspepsia (FD) based on the analysis of fractional amplitude of low frequency fluctuation (fALFF) of resting-state functional magnetic resonance imaging (rfMRI). Methods a total of 60 patients with FD were randomized into an acupuncture group and a moxibustion group, 30 cases in each one. In the acupuncture group, acupuncture was applied to bilateral ST36. In the moxibustion group, moxibustion was exerted at bilateral ST36. The treatment was given once a day, 5 times a week, totally for 4 weeks in each group, including 20 treatments with acupuncture or moxibustion. Separately, before and at the end of treatment, rfMRI scanning was conducted in two groups. Using data processing assistant for resting-state fMRI (DPARSF) software and MATLAB data platform, rfMRI data were collected for preprocessing and fALFF analysis. Results compared with the data before treatment, after treated with acupuncture at ST36 in FD patients, fALFF value was reduced in the right superior frontal gyrus, left superior frontal gyrus, left inferior frontal gyrus, right cuneus, left precuneus, right middle occipital gyrus, left middle occipital gyrus, etc., and it was increased in the left parahippocampus, right parahippocampus, left cerebellum, etc (all P Conclusion the differences in central function responses are induced in treamtent with acupuncture and moxibustion, which is probably related to the resting-state default network associated with targeted regulation and ventral attention of brain areas in functional dyspepsia.

Owing to the good ductility of steel and high strength and excellent corrosion resistance of fibre-reinforced polymer (FRP), concrete beams reinforced with hybrid steel and FRP bars exhibit better ductility than FRP-reinforced concrete beams as well as higher load-carrying capacities and better corrosion resistance than steel-reinforced concrete beams. However, the inherent brittleness of concrete in tension results in steel corrosion because of wide cracks and accelerated fracture of FRP reinforcement because of crack-induced stress concentration. This study investigated the effects of ultra-high ductile engineered cementitious composites (ECCs) on the flexural behaviour of hybrid steel and FRP-reinforced beams. Six hybrid-reinforced beams with various reinforcement ratios, matrix types and ECC pouring positions were tested in four-point bending. The flexural behaviours of the beams in terms of failure modes, crack patterns and developments, load versus deformation relationships and ductility are discussed herein in detail. We observed that substituting ECC with concrete results in a higher load-carrying capacity and better ductility of the hybrid reinforced beams owing to the excellent characteristics of ECC materials. When a layer of ECC is poured in the tension zone, the average crack width and crack spacing along the beam decrease; therefore, the longitudinal reinforcements can be adequately protected.

To explore the differences in the clinical features, treatment responses, and outcomes among children, adolescents, and adults with chronic myeloid leukemia in the chronic phase (CML-CP) receiving imatinib as first-line therapy. Data from children (0–8 years for girls and 0–10 years for boys), adolescents (9–19 years for girls and 11–19 years for boys), and adults (age ≥ 20 years) with newly diagnosed CML-CP receiving imatinib as first-line therapy between 2006 and 2019 were retrospectively reviewed. In total, 135 children (cohort 1), 189 adolescents (cohort 2), and 658 adults (cohort 3: age 20–39 years, n = 305; cohort 4: age 40–59 years, n = 270; and cohort 5: age 60–83 years, n = 83) were included in this study. When compared with children, adolescents showed a significantly higher white blood cell count (P = 0.033) and basophil percentage in peripheral blood (P = 0.002) and a significantly higher prevalence of splenomegaly (P = 0.004). Both children and adolescents presented with more aggressive clinical features than adults. During median follow-ups of 28 months (range, 3–161 months) in children, 33 months (range, 3–152 months) in adolescents, and 48 months (range, 3–157 months) in adults, multivariate analysis showed that children and adolescents had higher probabilities of achieving complete cytogenetic response, major molecular response, and molecular response4.5. Notably, compared with not only adults (cohort 3 vs. cohort 1: HR = 2.03 [1.03, 3.98], P = 0.040; cohort 4 vs. cohort 1: HR = 2.15 [1.07, 4.33], P = 0.033; cohort 5 vs. cohort 1: HR = 4.22 [1.94, 9.15], P

Background and Objectives Obesity is the accumulation of adipose tissue caused by excess energy in the body, accompanied by long-term chronic low-grade inflammation of adipose tissue. More than 50% of interstitial cells in adipose tissue are macrophages, which produce cytokines closely related to insulin resistance. Macrophage biology is driven by two polarization phenotypes, M1 (proinflammatory) and M2 (anti-inflammatory). This study aimed to investigate the effect of gastric hormone des-acyl ghrelin (DAG) on the polarization phenotype of macrophages and elucidate the role of macrophages in adipose tissue inflammation and insulin sensitivity and its molecular mechanism. Methods Mice were subcutaneously administrated with DAG in osmotic minipumps. The mice were fed a normal diet or a high-fat diet (HFD). Different macrophage markers were detected by real-time revere transcription polymerase chain reaction. Results Exogenous administration of DAG significantly inhibited the increase of adipocyte volume caused by HFD and reduced the number of rosette-like structures in adipose tissue. HFD in the control group significantly increased M1 macrophage markers, tumor necrosis factor α (TNFα), and inducible NO synthase (iNOS). However, these increases were reduced or even reversed after DAG administration in vitro. The M2 markers, macrophage galactose type C-type Lectin-1 (MGL1), arginase 1 (Arg1), and macrophage mannose receptor 1 (MRC1) were decreased by HFD, and the downward trend was inhibited or reversed after DAG administration. Although Arg1 was elevated after HFD, the fold increase after DAG administration in vitro was much greater than that in the control group. Conclusion DAG inhibits adipose tissue inflammation caused by HFD, reduces infiltration of macrophages in adipose tissue, and promotes polarization of macrophages to M2, thus alleviating obesity and improving insulin sensitivity.

Objective Carotid body tumors (CBTs) are benign but challenging. This study compared outcomes of 3 techniques of the surgical treatment of CBTs. Study Design This retrospective observational study was conducted from April 2013 to March 2019. The 38 patients enrolled in the study had primary tumors, including 1 with bilateral tumors and another with adrenal gland pheochromocytoma. We collected data on age, sex, size of tumor, Shamblin classification, treatment, blood loss, operative time, hospital stay, complications, and recurrence. Statistical analyses were performed using IBM SPSS Statistics version 20 software. Results Twenty-four patients were male, and 12 were female, and they ranged in age from 11 to 71 years. Cases were assigned to Shamblin groups I (n = 6), II (n = 19), and III (n = 14). Tumor size ranged from 2.0 × 2.0 cm to 5.0 × 6.0 cm. Eleven CBTs underwent blunt dissection (BD), 20 underwent BD plus resection of external carotid artery division plus vessels of encapsulation with allograft dermal matrix (BD + RECA + VE), and 8 tumors underwent surgical resection of tumors plus common carotid artery–internal carotid artery artificial vascular reconstruction (SR +C-IAVR). No perioperative death or stroke occurred. There was a significant difference between Shamblin groups I, II, and III in terms of the size of the tumor, type of treatment used, blood loss, operative time, hospital stay, and complications. Six patients had mandibular branch facial nerve transient paresis; 7 patients had hypoglossal nerve dysfunction; 3 patients had Horner syndrome; and dysphasia occurred in 2 patients. The patients were seen in follow-up for 16 to 45 months, and 1 recurrence was observed. Conclusions Three surgical techniques—BD, BD + RECA + VE, and SR + C-IAVR—are safe and feasible for the treatment of CBTs according to Shamblin classifications.

Formamidinium (FA)-based perovskites have demonstrated excellent advances in optoelectronics recently, but in terms of perovskite compounds, the optimal condition of their composition optimization remains controversial. Herein, we boosted the performance of perovskite light-emitting diodes (PeLEDs) in both efficiency and stability through composition and phase engineering. The low-dimensional FA2PbBr4 particles emerged and mixed with the FAPbBr3 composites when the FABr content is excessive. By regulating the phase composition in multiphase FAPbBr3 perovskites, the maximum external quantum efficiency (EQEmax) of optimal PeLEDs (5.14%) is 2.7-fold higher than that of pure FAPbBr3-based PeLEDs (1.90%), and device stability is improved. Further optimizing the film quality and emission efficiency with Rb+ ions, the EQEmax of PeLEDs can be increased to 6.01%, with a half-lifetime of about 185 s under the high current density. This strategy of phase composition optimization in FA-based perovskites provides an effective way to process high-efficiency and stable PeLEDs.

A novel optical sensor was constructed for the detection of adrenaline (AD) by immobilizing a carbon quantum dots (CQDs)/cellulose acetate (CA) composite film on the tip of an optical fiber via dip-coating method. The emission wavelength of the CQDs was stabled at about 520 nm when it was excited from 410 to 490 nm, showing a special excitation independent characteristic. The fluorescence intensity of the CQDs quenched by AD with high selectivity leads to development of a novel sensitive method for the AD detection. The fluorescence intensity of the optical sensor has a good linear response to the concentration of adrenaline in the range of $5~\mu \text{M}$ to $45~\mu \text{M}$ (R2 = 0.99875). This investigation illustrates that optical fiber sensor platform may have great potential for the detection of AD in biomedical fields.

Background The best treatment approach for wide oral leukoplakia (OL) remains to be determined. Aims To evaluate the outcomes of using an allograft dermal matrix (ADM) for reconstructing large oral epithelial defects following resection of OLs. Patients and methods A total of 27 OLs in 26 patients were excised, and residual large lingual and buccal epithelial defects were reconstructed using an ADM, which ranged in size from 3.0 × 5.0 to 6.0 × 6.0 cm. The patients were classified into mild (n = 1), moderate (n = 13), and severe dysplasia (n = 12) groups; 57.7% of the patients were tobacco smokers, 46.2% were alcoholics, 47.2% were both smokers and alcoholics, and 11.5% were both smoking and betel quid chewers. Patients who underwent surgery were advised to quit smoking, drink alcohol in moderation, or quit betel quid chewing. Results Two patients developed slight hematomas that resolved spontaneously within 2 weeks. A total of 76.9% of the smokers followed the advice to quit smoking, 83.3% of the alcoholics followed the advice to drink in moderation, and all three betel quid chewers followed the advice to quit chewing betel quid. The mean follow-up was 26.7 months. No MT occurred and recurrence was seen in two patients. Conclusions Large epithelial defect reconstruction using an ADM following resection of wide lingual and buccal OLs was safe and reliable for preventing MT of OL. The recurrence of OL may be related to patient habits such as tobacco smoking or/and drinking alcohol.

This paper presents a detailed description of integration, quality assurance procedure, and usage of global aircraft observations for China’s first generation global atmospheric reanalysis (CRA) product (1979–2018). An integration method named “classified integration” is developed. Aircraft observations from nine different sources are integrated into the Integrated Global Meteorological Observation Archive from Aircraft (IGMOAA), a new dataset from the National Meteorological Information Center (NMIC) of the China Meteorological Administration (CMA). IGMOAA consists of global aircraft temperature, wind, and humidity data from the surface to 100 hPa, extending from 1973 to the present. Compared with observations assimilated in the Climate Forecast System Reanalysis (CFSR) of NCEP, the observation number of IGMOAA increased by 12.9% between 2010 and 2014, mainly as a result of adding more Chinese Aircraft Meteorological Data Relay (AMDAR) data. Complex quality control procedures for aircraft observations of NCEP are applied to detect data errors. Observations are compared with ERA-Interim reanalysis from 1979 to 2018 to investigate data quality of different types and aircraft, and subsequently to develop the blacklists for CRA. IGMOAA data have been assimilated in CRA in 2018 and are real-time updated at the CMA Data-as-a-Service (CMADaaS) platform. For CRA, the fits to observations improve over time. From 1994 to 2018, root-mean-square error (RMSE) of observations relative to CRA background decreases from 1.8 to 1.0°C for temperature above 300 hPa, and from 4.5 to 3 m s−1 for zonal wind. The RMSE for humidity appears to exhibit an apparent seasonal variation with larger errors in summer and smaller ones in winter.

We present a high-resolution non-contact method for the measurement of two-dimensional (2D) phosphor surface temperature distribution (PSTD) of phosphor-coated light-emitting diodes (pc-LEDs) based on advanced hyper-spectral imaging technology. The studied pc-LEDs with a surface-mounted device structure are mainly consisted of blue InGaN/GaN-based LED chips (with a spectral emission at about 456 nm), red (Sr,Ca)AlSiN3: Eu2+ phosphors (with a spectral emission at around 623 nm), and transparent silicone gels. Experimental temperature results are compared with those of micro-thermocouple ( $\mu $ -TC) and infrared thermal imaging (TI), and fairly good agreements can be noticed. However, the spatial resolution of this proposed method is more than one order of magnitude higher than that of TI method, and the proposed method provides more detailed surface temperature information of phosphors than the latter. Therefore, we believe that this proposed method can serve as useful tools for the non-contact measurement of PSTD in pc-LEDs with or without optics lens.

This study tested the hypothesis that endothelium-specific GTP cyclohydrolase I (GTPCH I) overexpression (Tg-GCH) restores age-associated endothelial dysfunction in vivo. Aortic GTPCH I expression and serum nitric oxide (NO) release were measured in young and aged mice. Aortic rings from young and aged wild-type (WT) mice and aged Tg-GCH mice were suspended for isometric tension recording. A hind limb ischemia model was used to measure blood flow recovery. Aged mice showed reduced GTPCH I expression in the aorta and decreased NO levels in serum. Compared with aged WT mice, Tg-GCH significantly elevated NO levels in serum in aged Tg-GCH mice, restored the impaired aortic relaxation in response to acetylcholine, and significantly elevated aortic constriction in response to L-NAME. Importantly, aged Tg-GCH mice displayed a significant increase in blood flow recovery compared with aged WT mice. GTPCH I reduction contributes to aging-associated endothelial dysfunction, which can be retarded by Tg-GCH.

BACKGROUND Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is a prevalent problem in patients with chronic kidney disease. It is associated with increased morbidity and mortality in patients who undergo dialysis. A significant proportion of patients do not respond to iron supplementation and conventional ESAs. We report a case of severe ESA hyporesponsiveness-related anemia that was successfully treated with oral roxadustat. CASE SUMMARY A 59-year-old Chinese woman had high blood glucose for 25 years, maintenance hemodialysis for 7 years, and recurrent dizziness and fatigue for more than 2 years. Laboratory tests showed severe anemia (hemoglobin level of 54 g/L), though bone marrow biopsy, fluorescence in situ hybridization, and hemolysis tests were within normal ranges. We initially administered first-line therapies and other adjuvant treatments, such as blood transfusions, ESAs, and adequate dialysis, but the patient did not respond as anticipated. Her erythropoietin-resistant anemia was probably not only due to chronic renal insufficiency. The patient received the hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (100 mg, three times weekly). After 12 wk of treatment, the patient’s hemoglobin increased significantly, and her symptoms were alleviated. During the follow-up period, adverse drug reactions were controllable and tolerable. CONCLUSION Oral roxadustat is effective and tolerable for the treatment of ESA hypores-ponsiveness-related anemia in patients undergoing hemodialysis.

Deep-blue emitters are greatly desirable for preparing white light-emitting diodes and enhancing the color gamut of full-color display. The deep-blue lead halide perovskite light-emitting diodes (PeLEDs) exhibit far inferior performance compared to green and red counterparts and suffer from lead toxicity, hampering their applications. Nontoxic, stable, and wide band gap zero-dimensional (0D) Cs3Cu2I5 with relatively high exciton binding energy has great potential as deep-blue emitters. However, the development of PeLEDs remains a huge challenge due to the difficulties in preparing a high-quality Cs3Cu2I5 film and device design, arising from an inherent wide band gap together with deep ionization potential. Here, a continuous and pin-hole-free Cs3Cu2I5 thin film with deep-blue emission centered at 440 nm was prepared by the dual-source thermal evaporation approach, and a high photoluminescence quantum yield of 58% was achieved, corresponding to significant enhancement of 61% compared with that of the Cs3Cu2I5 thin film synthesized by solution processes. Furthermore, saturated deep-blue PeLEDs at the Commission Internationale de L'Eclairage (CIE) coordinates (0.15, 0.08) were obtained by employing an electron-transfer layer composed of a 1,4,5,8,9,11-hexa-azatriphenylene hexacarboni-trile (HAT-CN) and N,N'-bis(naphthalen-1-yl)-N,N'-bis(phenyl)benzidine (NPB) organic heterojunction to realize the effective hole blocking, rendering an external quantum efficiency of approximately 0.1%. These results will be extensively beneficial to wide band gap material and device preparation.

Municipal wastewater treatment plants (WWTPs) are considered to be major contributors of microplastics to the aquatic environment. Detailed research in China, which is relevant to the local situation, remains in the initial stage. Herein, the microplastic abundance, morphology, and removal efficiency of two WWTPs (C and P) equipped with tertiary treatment processes in different districts of Nanjing, an important city in the Yangtze River Basin, were investigated. The influence of technology, operational parameters, daily capacity, and sewage source and its proportion were discussed. Observations by optical microscope and FT-IR analysis and systematic calculation revealed that the microplastics have four shapes, including fragments, granules, film, and fibers, with various sizes and proportions, which were dependent on wastewater source. The total removal rates of 97.67% and 98.46% for WWTP C and WWTP P, respectively, indicated their highly efficient reduction of microplastics. Treatment technology had a considerable influence on the removal rate, especially the secondary and tertiary processes. However, a large number of microplastics from WWTPs were still released into the environmental waters due to the huge daily capacity. Sewage source determined the concentration, morphology feature, and chemical composition of microplastics to a certain extent. Compared with industrial wastewater, domestic wastewater possibly contained smaller microplastics of polyethylene and polypropylene with lower abundance. Furthermore, additional attention was provided on the flocculation process, drainage system, and treatment efficiency of microplastics with different shapes. This work is expected to provide some technical supports to guide the operation and management of WWTPs.

Background Knee osteoarthritis is a common clinical chronic degenerative disease associated with high morbidity and long-term disability. Previous studies have confirmed the efficacy of acupuncture on knee osteoarthritis. Fire needle acupuncture is a combination of heat and acupuncture, which may be more effective than the commonly used filiform needle acupuncture. This study is designed as a randomized controlled trial to evaluate the efficacy and safety of fire needle acupuncture compared to filiform needle acupuncture in knee osteoarthritis patients. Methods and analysis This is a prospective randomized controlled superiority clinical trial to evaluate the efficacy and safety of fire needle acupuncture compared to filiform needle acupuncture for knee osteoarthritis. A total of 100 participants will be randomly assigned to two different groups. Participants will receive fire needle acupuncture treatment in the fire needle group, while participants in the filiform needle group will be treated with a filiform needle at the same acupuncture points as the fire needle group. All participants will receive 6 weeks of treatment (2 times per week). The primary outcome is the change of the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes include the change of the visual analog scale and 12-item Short Form Health Survey from baseline to endpoint. Ethics and dissemination Ethical approval of this study was granted by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University (2018SB-066). Written informed consent will be obtained from all participants. Outcomes of the trial will be disseminated through peer-reviewed publications. Trial registration Chinese Clinical Trial Registry ChiCTR1800019579. Registered on November 18, 2018

BACKGROUND: Male Kunming mice were divided into the normal diet group (control group) and the high-fat diet group (HF group, 185 g·kg-1 protein, 600 g·kg-1 fat and 205 g·kg-1 carbohydrate). After eight weeks' feeding, the behavioral and biochemical indicators in serum were determined. The double bottle preference experiment was used to study the preference of mice for five sweeteners. The contents of monoamine neurotransmitters and genes expression related to dopamine (DA) and opioid receptor were also determined. RESULTS: The body weight of the mice in HF group increased significantly (p < 0.05) after 36 days compared with the control group. While the feed intake of HF group increased sharply in the first 12 days, and then it became basically unchanged. The preference of the HF group for all the five sweeteners was very significantly lower (p < 0.01) than that of the control group. The depression-related behavior was observed in the HF group mice. The contents of TG, TC and LDLC in the HF group were extremely higher (p < 0.01) than that of the control group. The genes expression related to DA and opioid receptor in the HF group was significantly lower than that of the control group, except for the preproenkephalin (PENK). CONCLUSIONS: In summary, this study suggested that a long-term high-fat diet could result in the decrease of the preference for sweeteners on mice due to the long-term consumption of high-fat diet could result in a state of reward hypofunction on mice. This article is protected by copyright. All rights reserved.

Here, it reports a high-throughput detection method for reliably quantitative analysis of illegal drugs in complex biological samples by means of a surface-enhanced Raman scattering (SERS) active microcavity and rapid pretreatment device. Based on the well-made hemispherical microcavities that regularly distributed on a glass array, the quality-controllable microcavity device is fabricated by the compact self-assembly of core-shell nanopeanuts (CSNPs) onto the inside surface. Both the CSNPs with a quantifiable internal standard signal of crystal violet acetate anchored inside their gap and the well-made microcavity referred to the physical amplification of the microscale groove surface will do well in trace analysis, which will allow us to realize the accurately quantitative SERS analysis of targeted analytes spread on the bottom area of the microcavity array. As an example, 0.8 nM malachite green and 160 ppb methamphetamine (MATM) have been successively detected in a wide range as standard, while even 0.01 ppm MATM mixed in the urine/serum samples has been efficiently tested by the microcavity device equipped with a rapid pretreatment device (manual monolithic column syringe needle). All of the above suggest that the SERS-active microcavity equipped with a rapid pretreatment device has potential in the on-site quick test of trace amounts of illegal drugs in bodily fluid samples or other field analysis of food sanitation, environmental safety, and public health.

Background: The pasteurization is a mandatory step to inactivate pathogenic microorganisms of bank milk. For storage, freezing and thawing are necessary. The concentration of macronutrients and ene...

The purpose of this study was to evaluate the outcomes of survival and functional outcome of patients with Oral cavity squamous cell carcinoma (OCSCC) and HPV-negative oropharyngeal squamous cell carcinoma (HPV-negative OPSCC) using FSAIF reconstruction of the defects. The 275 patients were divided into OCSCC and HPV-negative OPSCC group were treated with surgery and oral cavity and oropharynx reconstruction with the FSAIF. The skin paddles in the OCSCC and OPSCC groups were 3 × 9 to 5 × 14 cm and 3 × 8 to 5 × 15 cm, respectively. The original primary tumor site was the oral cavity in 203 patients and the oropharynx in 72. No significant differences TNM or clinical stage, skin paddle of the flap, rate of flap failure, or local complications were observed between the OCSCC and HPV-negative OPSCC groups. Ten flap failures occurred, yielding a success rate of 96.4%. There are not differences of survival and speech function of patients with OCSCC and HPV--negative OPSCC using FSAIFs reconstruction of the defects following cancer ablation, but there are differences of the swallowing function. This flap is suitable for reconstructing the defect in the oral cavity or oropharynx.

Doxorubicin is a commonly used anthracycline chemotherapeutic drug. Its application for treatment has been impeded by its cardiotoxicity as it is detrimental and fatal. DNA damage, cardiac inflammation, oxidative stress and cell death are the critical links in DOX‐induced myocardial injury. Previous studies found that TLR9‐related signalling pathways are associated with the inflammatory response of cardiac myocytes, mitochondrial dysfunction and cardiomyocyte death, but it remains unclear whether TLR9 could influence DOX‐induced heart injury. Our current data imply that DOX‐induced cardiotoxicity is ameliorated by TLR9 deficiency both in vivo and in vitro, manifested as improved cardiac function and reduced cardiomyocyte apoptosis and oxidative stress. Furthermore, the deletion of TLR9 rescued DOX‐induced abnormal autophagy flux in vivo and in vitro. However, the inhibition of autophagy by 3‐MA abolished the protective effects of TLR9 deletion on DOX‐induced cardiotoxicity. Moreover, TLR9 ablation suppressed the activation of p38 MAPK during DOX administration and may promote autophagy via the TLR9‐p38 MAPK signalling pathway. Our study suggests that the deletion of TLR9 exhibits a protective effect on doxorubicin‐induced cardiotoxicity by enhancing p38‐dependent autophagy. This finding could be used as a basis for the development of a prospective therapy against DOX‐induced cardiotoxicity.

Both regional citrate anticoagulation (RCA) and heparin are used as anticoagulants during membrane therapeutic plasma exchange (mTPE). However, there are few reports of comparisons of the two methods. The aim of this study was to compare different anticoagulants in mTPE and observe the effectiveness, safety, and advantages of RCA. We retrospectively included 85 patients who underwent mTPE in the past 1 year, and divided them into three groups. Patients with no bleeding tendency were administered heparin anticoagulation; patients with bleeding tendency/with liver dysfunction/who had undergone an operation were treated with RCA, or did not receive anticoagulation. In the heparin group, low-dose heparin anticoagulation was administered; in the RCA group, 4% sodium citrate solution was administered, and 10% calcium gluconate solution was pumped from the venous circuit tube. The peripheral blood platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and electrolytes were detected before and after treatment in all patients. A total of 255 sessions of mTPE were performed in 85 patients (2–7 times/case) with 120 sessions of heparin anticoagulation, 93 sessions of RCA, and 42 sessions of no anticoagulation. Compared with pretreatment values, the platelet count decreased by 53.7% and the PT and APTT increased (p

Congenital heart defect (CHD) represents the most common birth deformity, afflicting 1% of all births worldwide, and accounts for substantial morbidity and mortality. Increasing evidence highlights the pivotal roles of genetic etiologies in the pathogenesis of CHD, and pathogenic mutations in multiple genes, including TBX5 encoding a cardiac core transcription factor key to cardiovascular morphogenesis, have been involved in CHD. However, due to pronounced genetic heterogeneity of CHD, the genetic determinants underlying CHD in most cases remain obscure. In this investigation, by sequencing analysis of the coding exons and flanking introns of the TBX5 gene in 198 unrelated patients affected with CHD, a novel heterozygous mutation, NM_000192.3: c.692C>T; p. (Pro231Leu), was identified in an index patient with familial double outlet right ventricle (DORV), ventricular septal defect (VSD), and atrioventricular block (AVB). Genetic analysis of the proband's pedigree showed that the mutation co-segregated with the diseases. The missense mutation, which altered the amino acid conserved evolutionarily, was absent from 266 unrelated healthy subjects. Functional analyses with a dual-luciferase reporter assay system unveiled that the Pro231Leu-mutant TBX5 was associated with significantly reduced transcriptional activity on its target genes MYH6 and NPPA. Furthermore, the mutation disrupted the synergistic transactivation between TBX5 and NKX2-5 as well as GATA4, two other transcription factors causally linked to CHD. This study firstly links TBX5 loss-of-function mutation to familial DORV, VSD, and AVB, which provides novel insight into the mechanism underpinning CHD and AVB, suggesting potential implications for genetic evaluation and individualized treatment of patients affected by CHD and AVB.

Background MicroRNAs (miRNAs) are abnormally expressed in various ocular diseases, including age-related cataract. However, the role of miR-182-5p in the progression of age-related cataract remains unclear. Methods The expression of miR-182-5p in HLE-B3 cells was detected by qRT-PCR. HLE-B3 cells were transfected with miR-182-5p mimics. CCK-8, EdU, flow cytometry, 2′,7′-dichlorodihydrofluorescein diacetate, JC-1 kit, and western blot were used to assess the cell viability, proliferation, apoptosis, reactive oxygen species (ROS) level, mitochondrial membrane potential (MMP), and protein expression, respectively, in vitro. The relationship between miR-182-5p and NOX4 was confirmed using the dual-luciferase reporter gene analysis. Results We found that miR-182-5p expression was significantly decreased by the H2O2 exposure. Overexpression of miR-182-5p promoted cell proliferation and inhibited ROS production and apoptosis in H2O2-induced HLE-B3 cells. Moreover, p-p-38, p-ERK, and p-JNK were up-regulated in H2O2-treated HLE-B3 cells, and overexpression of miR-182-5p reversed the effects of H2O2 on HLE-B3 cells. In addition, dual-luciferase reporter assay substantiated that NOX4 was a direct target and downregulated by miR-182-5p. Conclusions We concluded that miR-182-5p inhibited lens epithelial cells apoptosis through regulating NOX4 and p38 MAPK signaling, providing a novel biomarker for treatment of age-related cataract.

Background Neoadjuvant chemotherapy is currently recommended as preoperative treatment for locally advanced rectal cancer (LARC); however, evaluation of treatment response to neoadjuvant chemotherapy is still challenging. Aim To create a multi-modal radiomics model to assess therapeutic response after neoadjuvant chemotherapy for LARC. Methods This retrospective study consecutively included 118 patients with LARC who underwent both computed tomography (CT) and magnetic resonance imaging (MRI) before neoadjuvant chemotherapy between October 2016 and June 2019. Histopathological findings were used as the reference standard for pathological response. Patients were randomly divided into a training set (n = 70) and a validation set (n = 48). The performance of different models based on CT and MRI, including apparent diffusion coefficient (ADC), dynamic contrast enhanced T1 images (DCE-T1), high resolution T2-weighted imaging (HR-T2WI), and imaging features, was assessed by using the receiver operating characteristic curve analysis. This was demonstrated as area under the curve (AUC) and accuracy (ACC). Calibration plots with Hosmer-Lemeshow tests were used to investigate the agreement and performance characteristics of the nomogram. Results Eighty out of 118 patients (68%) achieved a pathological response. For an individual radiomics model, HR-T2WI performed better (AUC = 0.859, ACC = 0.896) than CT (AUC = 0.766, ACC = 0.792), DCE-T1 (AUC = 0.812, ACC = 0.854), and ADC (AUC = 0.828, ACC = 0.833) in the validation set. The imaging performance for extramural venous invasion detection was relatively low in both the training (AUC = 0.73, ACC = 0.714) and validation (AUC = 0.578, ACC = 0.583) sets. The multi-modal radiomics model reached an AUC of 0.925 and ACC of 0.886 in the training set, and an AUC of 0.93 and ACC of 0.875 in the validation set. For the clinical radiomics nomogram, good agreement was found between the nomogram prediction and actual observation. Conclusion A multi-modal nomogram using traditional imaging features and radiomics of preoperative CT and MRI adds accuracy to the prediction of treatment outcome, and thus contributes to the personalized selection of neoadjuvant chemotherapy for LARC.

This study was to quantitatively investigate the role of morphological and functional parameters of the left atrium (LA) and left atrial appendage (LAA) with 256-slice spiral computed tomography (CT) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA). Eighty-three patients with AF who underwent RFA for the first time were divided into the recurrence (n = 27) and non-recurrence (n = 56) groups. All patients underwent a 256-slice spiral CT examination before the operation. The clinical data and quantitative measurement of the morphology and functional parameters of the LA and LAA were analyzed, including the maximal and minimal volume, ejection fraction and volume, and volume strain of LAA and LA (LAAVmax, LAAVmin, LAAEF, LAAEV, and LAA-VS, LAVmax, LAVmin, LAEF, LAEV and LA-VS, respectively). The CHA2DS2-VASc score and the proportion of patients with heart failure were significantly (P 9.25 ml had the highest predictive value for AF recurrence after RFA, with the sensitivity of 85.2% and specificity of 67.9%. In conclusion, the volume of left atrium, volume and morphology of left atrial appendage have all significantly increased while the ejection fraction and volume strain of left atrium and left atrial appendage have both significantly decreased in recurrence than in non-recurrence after radiofrequency ablation. The ejection fraction and volume of left atrial appendage are significant independent predictors of atrial fibrillation recurrence after radiofrequency ablation.

Objective To investigate the potential prognostic value of sleep electroencephalography (EEG) pattern and serum circadian rhythm biomarkers in the recovery of consciousness in patients at the acute stage of coma. Methods A prospective observational study which included 75 patients with coma was conducted. Twenty-four-hour continuous polysomnography (PSG) was performed to determine the sleep EEG pattern according to the modified Valente's Grade (mVG) that we proposed. Serum levels of melatonin and orexin-A at four consecutive time points during the PSG were examined. Patients were then followed for one month to determine their level of consciousness. Multivariate logistic regression analysis was performed to examine associations between demographics, aetiology, baseline clinical features (pupillary and corneal reflex, and neuron-specific enolase [NSE]), clinical scores (Glasgow Coma Scale-Motor Response [GCS-M], Full Outline of Unresponsiveness [FOUR] scale, Acute Physiology and Chronic Health Evaluation II [APACHE II] scale), mVG, serum circadian biomarkers, and recovery of consciousness within one month. Results Within one month of enrolment, 34 patients regained consciousness and 36 patients remained non-conscious. Spearman rank correlation revealed a significant association between mVG and state of consciousness after one month. Significant variation in serum melatonin or orexin-A was not detected in either the conscious or non-conscious groups. Hypoxic aetiology, APACHE II, and mVG were independently associated with recovery of consciousness within one month. Conclusion Sleep EEG structure, hypoxic aetiology, and APACHE II can independently predict recovery of consciousness in patients with acute coma. Taken together, we encourage neurologists to use sleep elements to assess patients with acute coma.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by myocardial necrosis and fibrofatty substitution of the myocardium, predominantly of the right ventricle. The evaluation of risk associated with gestation and delivery in patients with ARVC is difficult due to the small number of already reported cases. We present our experience of patients with ARVC who completed a pregnancy and delivery.A case series of nine women in Calgary, Canada, from 2013 to 2018, who were diagnosed with ARVC before or during pregnancy. Patients were identified using our Cardiac-Obstetrics database, and information was collected through electronic charts and patient recollection.All pregnancies reported were singleton with an average maternal age of 31 years. Six patients had a related genetic mutation. Beta blockers were being used by eight, and five had an implantable cardioverter-defibrillator (ICD) prior to the pregnancy. None of the patients developed heart failure during pregnancy, but one had a complicated antepartum and postpartum course. All pregnancies delivered at term with eight receiving neuroaxial analgesia. Five patients delivered vaginally. Those without an ICD had continuous cardiac monitoring intrapartum. The incidence of small for gestational age (33%) was higher than the general population. All of the patients breastfed the newborns.Pregnancies in these patients with ARVC were generally well tolerated. Given the rarity of the disease and absence of any clinical guidelines, multidisciplinary care is essential in the management of these patients.

The aim of this systematic review was to summarize the evidence on the efficacy of zinc supplementation in patients with pressure injuries (PIs). Electronic data bases (Embase, MEDLINE, and Web of Science) were searched from inception to 2019 for randomized controlled trials (RCTs) and non-RCTs addressing the efficacy of zinc supplementation compared with a control nutrition invention on PI outcomes. The primary study outcome was the healing rate of PIs during treatment; the secondary outcomes were the improvement of PI area and pressure ulcer scale for healing (PUSH) score. A total of 7 studies were included in this systematic review and meta-analysis. The intervention group significantly had improved healing vs that of the control group (relative risk, 1.44; 95% CI, 1.01-2.06; P = 0.043, I2 = 19.3%). There was no obvious asymmetry in the funnel plot and no strong evidence of publication bias. Sensitivity analysis showed that meta-analysis has good stability. Studies showed a greater mean reduction in PI area. All the studies we included had a significant improvement in the PUSH score of PIs. Our systematic review and meta-analysis from clinical research confirmed that zinc therapy can promote wound healing and suggest that medical staff should consider providing patients with zinc during PI treatment.

Objective This study aimed to investigate whether antibiotic exposure during pregnancy and infancy was associated with childhood overweight or obesity. Methods PubMed, Embase, and Cochrane Library databases were searched from the inception date to April 18, 2019, to identify observational studies that investigated the association between antibiotic exposure during pregnancy and infancy and childhood overweight or obesity. After study selection and data extraction, the meta-analysis was conducted using Stata software version 12.0 (StataCorp LP, College Station, Texas). The evaluation of the methodological quality was carried out by AMSTAR 2 (Bruyere Research Institute, Ottawa, Ontario, Canada). Results A total of 23 observational studies involving 1,253,035 participants were included. The meta-analysis showed that prenatal exposure to antibiotics was not significantly associated with childhood overweight or obesity, whereas an increased risk of overweight or obesity was seen in subgroup analysis of the second trimester (risk ratio = 1.13; 95% CI: 1.06-1.22; P = 0.001). In contrast, antibiotic exposure during infancy could increase the risk of childhood overweight or obesity (risk ratio = 1.14; 95% CI: 1.06-1.23; P = 0.001). Conclusions This meta-analysis found that antibiotic exposure during the second trimester and infancy could increase the risk of childhood overweight or obesity.