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Background: The purpose of this study was to investigate the effect of oral nutritional supplements (ONS) on patients with esophageal cancer during radiotherapy. Materials and Methods: Patients wit...

In people's daily lives, travel takes up an important part, and many trips are generated everyday, such as going to school or shopping. With the widely adoption of GPS-integrated devices, a large amount of trips can be recorded with GPS trajectories. These trajectories are represented by sequences of geo-coordinates and can help us answer simple questions such as “where did you go”. However, there is another important question awaiting to be answered, that is “what did/will you do”, i.e., the trip purpose inference. In practice, people's trip purposes are very important in understanding travel behaviors and estimating travel demands. Obviously, it is very challenging to infer trip purposes solely based on the trajectories, because the GPS devices are not accurate enough to pinpoint the venues visited. In this paper, we infer individual's trip purposes by combining the knowledge from heterogeneous data sources including trajectories, POIs and social media data. The proposed Dynamic Bayesian Network model (DBN) captures three important factors: the sequential properties of trip activities, the functionality and POI popularity of trip end areas. In addition, we propose an efficient method with local candidate pools to identify POIs from geo-tagged social media messages, and learn the POI popularities from nearby social media data. Moreover, trip data is usually imbalanced across different activities. This data imbalance problem can cause serious challenges because the DBN model could be biased by those “popular” class labels. Considering this challenge, we propose an ensemble DBN method with sampling technique (eDBN) which results in more accurate inference. Furthermore, real-world trip data are continuously collected on a daily basis. The batch model would result in unnecessary computation because historical data need to be revisited. We handle this problem by proposing an incremental DBN method (iDBN) which is both effective and efficient. Extensive experiments are conducted on real-world data sets with trajectories of 8,361 residents and the 6.9 million geo-tagged tweets in the Bay area. Experimental results demonstrate the advantages of the proposed method on correctly inferring the trip purposes.

Purpose The aim of the study was to test the reproducibility of performing conventional point shear wave elastography (pSWE), auto-pSWE, and ultrasound derived fat fraction (UDFF) in adult livers. Methods The Institutional Review Board approved the study and all participants provided written informed consent. Conventional pSWE (obtaining 10 measurements through 10 acquisitions), auto-pSWE (automatically obtaining 15 measurements by a single acquisition), and UDFF (one measurement obtained by one acquisition) of the liver were prospectively performed in 21 participants (10 men, 11 women, mean age 63y) by senior and junior operators in February-May 2021. Shear wave velocity (SWV, m/s) of the liver was measured by conventional pSWE and auto-pSWE. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to test intra-observer repeatability and inter-observer reproducibility in measuring pSWE, auto-pSWE, and UDFF. Results ICC for testing intra-observer repeatability and inter-observer reproducibility in performing pSWE, auto-pSWE, and UDFF was >0.85 (95% confidence interval 0.85-0.99). The mean difference of 95% Bland-Altman limits of agreement was -0.02 (upper 0.09, lower -0.12) and the correlation of SWV measured between conventional pSWE and auto-pSWE methods was strong (r2 = 0.87). Conclusion Our results suggest good repeatability and reproducibility in measuring UDFF and SWV in adult livers. The auto-pSWE has higher reliability, reproducibility and time efficacy in measuring SWV of adult livers when compared to conventional pSWE method.

Fact extraction, which aims to extract (entity, attribute, value)-tuples from massive text corpora, is crucial in the area of text data mining . Recent approaches have focused on extracting facts by mining textual patterns with semantic types, where the quality of a pattern is evaluated based on content-based criteria, such as frequency. However, these approaches overlook the dimension of pattern reliability , which reflects how likely the extracted facts are correct. As a result, a pattern of good content-quality (e.g., high frequency) may still extract incorrect facts. In this study, we consider both pattern reliability and fact trustworthiness in addressing the pattern-based fact extraction problem. To learn the complex relationship between pattern reliability and fact trustworthiness, we propose a novel deep learning model using a hybrid of the CNN and LSTM architecture. For fact embedding, we adopt CNN to extract a fix-sized representation of each component, i.e., entity, attribute, and value, of the fact. For pattern embedding, we represent the pattern as a semantic composition of its extracted fact representations. To de-emphasis the noisy facts, we consider the fact trustworthiness and frequency during the process of pattern embedding, where the features of the tuple trustworthiness information are extracted by a long short-term memory (LSTM) model. To learn the pattern-fact relational dependency, we train the model with both pattern and tuple labels. Extensive experiments involving three real-world datasets demonstrated that the proposed model significantly improves the quality of the patterns and the extracted facts in the pattern-based information extraction.

Early recognition of gestures gives a better user experience during human–computer interaction in a near real-time way. However, the inadequate information accumulated in the early stages of the gesture will make the machine ambiguous and respond wrongly. Therefore, the challenge of early recognition lies in choosing the right time to trigger gesture prediction and using limited information to achieve reliable accuracy. In this article, an early gesture recognition method is proposed to achieve almost the same accuracy as a complete gesture sequence. For this purpose, we design a new architecture to modify the current feature sequence according to the existing information and introduce a new loss function to maximize the probability of correct gesture label as early as possible. At the same time, gesture recognition is triggered when the maximum probability of model output is greater than a set threshold. The publicly available data set used for evaluation comes from Google’s Project Soli sensor. Experimental results show that the proposed method for early recognition can achieve a gesture recognition rate of 88.85% with an average time saving of 69.47%. Compared with the results of all sequence recognition, the recognition rate drops by only 1.7%. In addition, the proposed method based on the data set constructed by terahertz radar also shows similar early recognition performance and can be applied to other radar sensors.

This review summarizes the current state of non-invasive diagnosis of non-alcoholic fatty liver disease (NAFLD). This begins with a brief discussion of blood-based analysis (serum biomarkers) then progresses through various imaging modalities (imaging biomarkers) including magnetic resonance (MR), computed tomography (CT), and ultrasound-based imaging methods. The review concludes with comment on the advantages, disadvantages, and prospects of commercially available modalities and the impact they may have on diagnosis and management of patients with NAFLD.

Compound Danshen dropping pill (CDDP), a famous Chinese medicine formula, has been widely used to treat high-altitude heart disease in China. However, its molecular mechanisms, potential targets, and bioactive ingredients remain elusive. In this study, network pharmacology, molecular docking, and validation experiments were combined to investigate the effective active ingredients and molecular mechanisms of CDDP in the treatment of high-altitude heart disease. Tan IIA may be the main active component of CDDP in the treatment of high-altitude heart disease via HIF-1/PI3K/Akt pathways.

Metal carbide Ti3C2Tx as a new two-dimensional material with excellent metallic conductivity, good water solubility, and superior transmittance in the visible light range shows great potential for applications in optoelectronic devices. Herein, Ti3C2Tx/PEDOT:PSS composite films were fabricated by a simple solution process and employed as an anode interfacial layer in organic solar cells. By introducing the Ti3C2Tx/PEDOT:PSS composite interface into the devices, the highest power conversion efficiency (PCE) of 17.26% was achieved while using PM6:Y6 as the active layer, with a high short-circuit current (Jsc) of 26.52 mA/cm2 and a fill factor of up to 0.76. The PCE is much higher than 15.89% for the pure PEDOT:PSS interfacial layer-based device without doping. The dramatically improved performance was attributed to the increased conductivity of the Ti3C2Tx/PEDOT:PSS composite interface and the increased charge extraction and collection efficiency of the devices. This work presents an effective method to prepare the Ti3C2Tx/PEDOT:PSS composite interface and high-performance organic solar cells.

This study explored the potential effects of mild hyperhomocysteinemia (HHcy) on the blood–brain barrier (BBB) and neuroinflammation. Seven-week-old male wild-type C57BL/6 mice were fed normal mouse chow (the control group) or a methionine-enriched diet (the HHcy group) for 14 weeks. Mice in the HHcy group exhibited a slight increase in serum Hcy levels (13.56 ± 0.61 μmol/L). Activation of the ERK signaling pathway, up-regulation of matrix metalloproteinase-9 (MMP-9), and degradation of tight junction proteins (occludin and claudin-5) were observed in both the cerebral cortex and hippocampus of mice with mild HHcy. However, microglia were not activated and the levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were not changed in either the cerebral cortex or hippocampus of mice with mild HHcy. Moreover, the signaling activity of STAT3 also did not differ significantly between the two groups. These findings demonstrate that the BBB is highly vulnerable to homocysteine insult. Even a slight increase in serum homocysteine levels up-regulates MMP-9 expression and disrupts the BBB integrity. Meanwhile, microglia activation or the STAT3 pathway might not contribute to the effects of mild HHcy on the brain.

Background: Alzheimer’s disease with a causative genetic mutation (AD-CGM) is an uncommon form, characterized by a heterogeneous clinical phenotype and variations in the genotype of racial groups affected. Objective: We aimed to systemically describe the phenotype variance and mutation spectrum in the large sample size of the Peking Union Medical College Hospital (PUMCH) cohort, Beijing, China. Methods: Next-generation sequencing (NGS) was carried out in 1108 patients diagnosed with dementia. A total of 40 Han Chinese patients with three AD gene mutations were enrolled. A systemic review of all the patients was performed, including clinical history, neurocognitive assessment, brain magnetic resonance imaging, and cerebrospinal fluid (CSF) biomarkers. Results: We studied the following gene mutation variants: 12 AβPP, 13 PSEN1, and 9 PSEN2, and 23 among them were novel. Most of them were early-onset, but PSEN1 mutation carriers had the youngest onset age. The commonest symptoms were similar to those of AD, including an amnestic syndrome, followed by psychiatric symptoms and movement disorder. On MRI, parietal and posterior temporal atrophy was prominent in PSEN1 and PSEN2 mutation carriers, while AβPP mutation carriers had more vascular changes. The CSF biomarkers profile was indistinguishable from sporadic AD. Conclusion: We identified a small group of AD-CGM subjects representing 3.6% among more than 1000 demented patients in the PUMCH cohort. These subjects usually presented with early-onset dementia and exhibited significant clinical and genetic heterogeneity. Identification required complete screening of genetic mutations using NGS. Although family history was usually present, we found non-familial cases of all three genetic mutations.

Two‐dimensional (2D) van der Waals heterostructure (vdWH)‐based floating gate devices show great potential for next‐generation nonvolatile and multilevel data storage memory. However, high program voltage induced substantial energy consumption, which is one of the primary concerns, hinders their applications in low‐energy‐consumption artificial synapses for neuromorphic computing. In this study, we demonstrate a three‐terminal floating gate device based on the vdWH of tin disulfide (SnS2), hexagonal boron nitride (h‐BN), and few‐layer graphene. The large electron affinity of SnS2 facilitates a significant reduction in the program voltage of the device by lowering the hole‐injection barrier across h‐BN. Our floating gate device, as a nonvolatile multilevel electronic memory, exhibits large on/off current ratio (~105), good retention (over 104 s), and robust endurance (over 1000 cycles). Moreover, it can function as an artificial synapse to emulate basic synaptic functions. Further, low energy consumption down to ~7 picojoule (pJ) can be achieved owing to the small program voltage. High linearity (

Both bench and bedside investigations have challenged the supportive role of Hedgehog (Hh) activity in the progression of colorectal cancers, thus raising a critical need to further deeply determine the contribution of Hh to the growth of colorectal cancer. Combining multiple complementary means, including in vitro and in vivo inflammatory colorectal cancer models, and pathological analysis of clinical colorectal cancer patients samples. We report that colorectal cancer cells hijack prostaglandin E2 (PGE2) to non-canonically promote Hh transcriptional factor Gli activity and Gli-dependent proliferation of colorectal cancer cells in a Smo-independent manner. Mechanistically, PGE2 activates c-Jun N-terminal kinase (JNK), which in turn enables Gli2 to evade ubiquitin-proteasomal degradation by phosphorylating Gli2 at Thr1546. This study not only presents evidence for understanding the contribution of Hh to colorectal cancers, but also provides a novel molecular portrait underlying how PGE2-activated JNK fine-tunes the evasion of Gli2 from ubiquitin-proteasomal degradation. Therefore, it proposes a rationale for the future evaluation of chemopreventive and selective therapeutic strategies for colorectal cancers by targeting PGE2-JNK-Gli signaling route.

Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently.This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are 500 mL/min in the brachial artery and 200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is 1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion.Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P .05), whereas the secondary patency rates had no difference.For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.

The aim of this trial was to evaluate the effects of an immunomodulatory supplement (OmniGen AF, OG; Phibro Animal Health Corp.) and heat stress on hormonal, inflammatory, and immunological responses of lactating dairy cows. Sixty multiparous Holstein cows were randomly assigned to 4 treatments in a 2 × 2 factorial arrangement using 2 environments: cooled using fans and misters, or noncooled, and 2 top-dressed feed supplements (56 g/d): OG or a placebo (CTL). Temperature-humidity index averaged 78 during the 8-wk trial. Blood was drawn to analyze cortisol, prolactin, and circulating tumor necrosis factor (TNF)-α and IL-10. Peripheral blood mononuclear cells (PBMC) were isolated and stimulated with hydrocortisone, prolactin, or lipopolysaccharide (LPS), individually or in several combinations, to assess induced proliferation and cytokine production. At d 52, 6 cows per treatment were injected i.v. with an LPS bolus (ivLPS) to assess hormone and cytokine responses. For cooled cows, feeding OG increased plasma cortisol concentration relative to CTL. Noncooled cows fed CTL had lower circulating TNF-α concentrations than noncooled-OG and cooled-CTL cows, with cooled-OG intermediate. Hydrocortisone+LPS-stimulated PBMC from OG cows tended to proliferate more than CTL. Relative to cooled cows, PBMC from noncooled cows produced more TNF-α and IL-10 when stimulated with LPS. Following ivLPS, cooled-OG cows had a greater cortisol response than the other treatments. In conclusion, OG supplementation enhanced cortisol release under basal condition and induced inflammation with cooling compared with CTL. This suggests that heat stress inhibits OG-mediated cortisol release. Heat stress seemed to enhance the inflammatory responses of PBMC from lactating cows. However, OG supplementation promoted PBMC proliferation under stress, or in the presence of hydrocortisone.

Despite significant progress in the treatment of patients with diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL), the prognosis of patients with relapsed disease remains poor due to the emergence of drug resistance and subsequent disease progression. Identification of novel targets and therapeutic strategies for these diseases represents an urgent need. Here, we report that both MCL and DLBCL are exquisitely sensitive to transcription-targeting drugs, in particular THZ531, a covalent inhibitor of cyclin-dependent kinase 12 (CDK12). By implementing pharmacogenomics and a cell-based drug screen, we found that THZ531 leads to inhibition of oncogenic transcriptional programs, especially the DNA damage response pathway, MYC target genes and the mTOR-4EBP1-MCL-1 axis, contributing to dramatic lymphoma suppression in vitro. We also identified de novo and established acquired THZ531-resistant lymphoma cells conferred by over-activation of the MEK-ERK and PI3K-AKT-mTOR pathways and upregulation of multidrug resistance-1 (MDR1) protein. Of note, EZH2 inhibitors reversed resistance to THZ531 by competitive inhibition of MDR1 and, in combination with THZ531, synergistically inhibited MCL and DLBCL growth in vitro. Our study indicates that CDK12 inhibitors, alone or together with EZH2 inhibitors, offer promise as novel effective approaches for difficult-to-treat DLBCL and MCL.

Background: Acute colonic pseudo-obstruction (ACPO) is characterized by acute colonic dilation in the absence of anatomical obstruction. Neostigmine is an acetylcholinesterase inhibitor recommended as first-line salvage therapy for uncomplicated ACPO. Decompressive colonoscopy is recommended if neostigmine is contraindicated or unsuccessful. There is a need to better characterize relative efficacy and factors impacting treatment choice. The aim of the study was to examine the use, efficacy, and safety of neostigmine and decompressive colonoscopy in the management of ACPO at a single academic center.Methods: Patients ≥ 18 years of age meeting established criteria for uncomplicated ACPO and with cecal diameter ≥ 10 cm on imaging between 1999 and 2019 were identified. Individuals were categorized as having received supportive care alone or subsequent trials of neostigmine or decompressive colonoscopy. Demographics and pre- and post-intervention data were collected, including indication and contraindication to intervention used, time to intervention, initial response, and adverse events.Results: In 46 cases of ACPO (N = 42 patients), all but one individual received initial supportive care. Seven responded to conservative measures alone. Of the patients failing supportive care, 15 cases were initially treated with neostigmine (response rate 86.7%) and 24 initially underwent decompressive colonoscopy (response rate 95.8%) (P = 0.390). One episode of transient bradycardia, resolved with atropine, occurred in the neostigmine group. One patient experienced respiratory instability during colonoscopy.Conclusions: Both neostigmine and decompressive colonoscopy appear effective for treating uncomplicated ACPO in individuals failing conservative therapy. Adverse events were infrequent in both cohorts. Future prospective studies examining treatment for ACPO should focus on whether either intervention is superior to the other.Gastroenterol Res. 2021;14(3):157-164doi: https://doi.org/10.14740/gr1394

Background Approximately 10% of patients with gastric cancer (GC) have a genetic predisposition toward the disease. However, there is scant knowledge regarding germline mutations in predisposing genes in the Chinese GC population. This study aimed to determine the spectrum and distribution of predisposing gene mutations among Chinese GC patients known to have hereditary high-risk factors for cancer. Methods A total of 40 GC patients from 40 families were recruited from seven medical institutions in China. Next-generation sequencing was performed on 171 genes associated with cancer predisposition. For probands carrying pathogenic/likely pathogenic germline variants, Sanger sequencing was applied to validate the variants in the probands as well as their relatives. Results According to sequencing results, 25.0% (10/40) of the patients carried a combined total of 10 pathogenic or likely pathogenic germline variants involving nine different genes: CDH1 (n = 1), MLH1 (n = 1), MSH2 (n = 1), CHEK2 (n = 1), BLM (n = 1), EXT2 (n = 1), PALB2 (n = 1), ERCC2 (n = 1), and SPINK1 (n = 2). In addition, 129 variants of uncertain significance were identified in 27 patients. Conclusions This study indicates that approximately one in every four Chinese GC patients with hereditary high risk factors may harbor pathogenic/likely pathogenic germline alterations in cancer-susceptibility genes. The results further indicate a unique genetic background for GC among Chinese patients.

Maintaining dialysis vascular access is a source of considerable morbidity in patients with end-stage renal disease (ESRD). High-resolution radiofrequency (RF) ultrasound vascular strain imaging has been applied experimentally in the vascular access setting to assist in diagnosis and management. Unfortunately, high-resolution RF data are not routinely accessible to clinicians. In contrast, the standard DICOM formatted B-mode ultrasound data are widely accessible. However, B-mode, representing the envelope of the RF signal, is of much lower resolution. If strain imaging could use open-source B-mode data, these imaging techniques could be more broadly investigated. We conducted experiments to detect wall strain signals with submillimeter tracking resolutions ranging from 0.2 mm (3 pixels) to 0.65 mm (10 pixels) using DICOM B-mode data. We compared this submillimeter tracking to the overall vascular distensibility as the reference measurements to see if high-strain resolution strain could be detected using open-source B-Mode data. We measured the best-fit coefficient of determination between signals, expressed as the percentage of strain waveforms that exhibited a correlation with a p value of 0.05 or less. The lowest percentage was 86.7%, and most were 90% and higher. This indicates high-resolution strain signals can be detected within the vessel wall using B-mode DICOM data.

The aim of the study was to test inter-observer and intra-observer reliability of measuring multiparametric ultrasound in adult livers.We prospectively measured shear wave velocity (SWV, m/s), shear wave dispersion slope (SWD, m/s/kHz), attenuation coefficient (ATI, dB/cm/MHz), normalized local variance (NLV), and echo intensity ratio of liver to kidney (L/K ratio) in 21 adults who underwent liver magnetic resonance imaging-proton density fat fraction (MRI-PDFF). Intraclass correlation coefficient and 95% Bland-Altman limits of agreement (95% LOA) were used to analyze intra- and inter-observer reproducibility.Based on liver MRI-PDFF, 21 participants (8 men and 13 women, mean age 55 years) were divided into group 1 (11 normal livers, MRI-PDFF5%) and group 2 (10 steatotic livers, MRI-PDFF ≥5%). ICCs for intra-observer repeatability and inter-observer reproducibility in measuring multiple ultrasound parameters in both normal and steatotic livers were above 0.75. However, 95% confidence interval for measuring SWD in all livers and L/K ratio in normal livers was 0.38-0.90 and 0.47-0.91, respectively. Differences in SWV, SWD, ATI, NLV, L/K ratio, and MRI-PDFF between participants with and without hepatic steatosis were significant (p .05), whereas serum biomarkers and body mass index were not (p .05), based on a two-tailed t-test.The results suggest that the repeatability and reproducibility for measuring liver SWV, ATI, and NLV are moderate to excellent, while those for SWD and L/K ratio are poor. Standardized machine settings, scanning protocols, and operator training are suggested in performing multiparametric ultrasound of the liver.

Background:. The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM. Methods:. We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated. Results:. In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. The duration of T2DM also significantly associated with the prevalence of “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. Subsequently, the prevalence of “disturbances of pigmentation” was higher in males than females in NGT (P

Brazilian grain production increased more than fourfold from 1980 to 2016. The grain boom was achieved primarily by soybean–corn double cropping and cropland expansion—both show changing spatiotemporal patterns since the 1980s. Here, we quantified the contributions of these two strategies to corn and soybean production in Brazil using municipality-level data from 1980 to 2016. We found the contribution of double cropping to the grain boom steadily increased to 35% and the largest driving force was the increasing demand for grain export. While double cropping dominated the conventional agricultural regions, cropland expansion was still the major strategy in agricultural frontiers such as the Centre-West and Matopiba. The implementation of double cropping offset the equivalent of 76.7 million ha of Brazilian arable land for grain production from 2003 to 2016. Double cropping in Brazil has the potential to help alleviate land burdens in other pantropical countries with increasing global food demand. Soybean and corn production in Brazil increased more than fourfold from 1980 to 2016, which was achieved by double cropping and cropland expansion. The contribution patterns of the two strategies were spatiotemporally specific, while double cropping shows increasing impacts over land expansion to the grain boom.

With the advent of the era of artificial intelligence, deep reinforcement learning (DRL) has achieved unprecedented success in high-dimensional and large-scale artificial intelligence tasks. However, the insecurity and instability of the DRL algorithm have an important impact on its performance. The Soft Actor-Critic (SAC) algorithm uses advanced functions to update the policy and value network to alleviate some of these problems. However, SAC still has some problems. In order to reduce the error caused by the overestimation of SAC, we propose a new SAC algorithm called Averaged-SAC. By averaging the previously learned action-state estimates, it reduces the overestimation problem of soft Q-learning, thereby contributing to a more stable training process and improving performance. We evaluate the performance of Averaged-SAC through some games in the MuJoCo environment. The experimental results show that the Averaged-SAC algorithm effectively improves the performance of the SAC algorithm and the stability of the training process.

This brief presents a low-ripple, fully-integrated, linear-regulated charge pump with transient-response improvement for CMOS image sensors. A compensator is proposed to accelerate the recovery of the output when an undershoot occurs. The regulated charge pump is designed with 0.11 $\mu \text{m}$ 1-poly 4-metal CMOS process and occupies an area of 0.073 mm2. According to the post-layout simulation, the worst steady-state ripple is 0.95 mV PP and the recovery time (99.9%) of the regulated output is 155 ns when the undershoot is 114 mV. The application of the compensator leads to a 78% decrease on the recovery time. When achieving similar recovery time, the area cost of the proposed topology is reduced by 49% compared to the traditional method of increasing filter capacitance. The total power dissipation of the charge pump is 1.476 mW, and the compensator only consumes 28 $\mu \text{W}$ .

Wheat bran is widely used in the food industry to produce fibre-rich food products with enhanced health benefits. The present study explored the effect of bran size reduction by superfine grinding on the microstructure and quality of bran-enriched dried white noodle (DWN). Coarse (D50 = 330.7 μm) and superfine-ground (D50 = 50.7 and 27.9 μm) wheat brans were fortified into DWN at levels of 10, 20 and 30%. The physical modifications by bran addition on the microstructure, cooking performance, and textural properties of DWN were determined. Then, the sensory quality of the products was evaluated by the human panel using both the hedonic and “difference-from-control” tests. With the increasing amount of bran added, noodle quality deteriorated in all aspects. DWN fortified with 30% of bran presented a highly obstructed or disrupted microstructure, and their appearance and taste were least favoured by the consumers. Superfine grinding effectively pulverized wheat bran into micro-scale, and DWN fortified with the finest bran (D50 = 27.9 μm) possessed the darkest colour and a compromised cooking yield rate. However, they maintained superior taste and texture that were comparable to the control, with up to 20% of bran addition. The present study demonstrated that superfine grinding not necessarily improves all aspects of noodle processing and cooking but would promote an overall improvement on the sensory quality of bran-fortified noodle. Besides, it was possible to produce fibre-rich DWN with relatively high (10–20%) bran addition levels with acceptable quality. The results may guide future development of bran-enriched products to stimulate consumer’s fibre intake.

Due to the advantages of easy harvesting and escaping from immune rejection, autologous bone marrow-derived mesenchymal stem cells (BMSCs) are promising in immunosuppressive therapy against inflammation and autoimmune diseases. However, it is still a challenge because the immunomodulatory properties of BMSCs always are impaired by the immunopathogenesis in patients. Because of reliable and extensive multiple biological activities, osthole have got more and more clinical attention. In this article, we found that BMSCs derived from osteoporosis donors was ineffective in cell therapy for experimental inflammatory colitis and osteoporosis.In vivo and in vitro tests showed that due to the downregulated Fas and FasL expression, the ability of osteoporotic BMSCs to induce T cell apoptosis decreased. Through the application of osthole, we successfully restored the immunosuppressive ability of osteoporotic BMSCs and improved its treatment efficacy in experimental inflammatory colitis and osteoporosis. In addition, we found the immunomodulatory properties of BMSCs were enhanced after osthole pretreatment. In this study, our data unravel a new approach that pharmacological modification (i.e., osthole) can improve the immune regulatory performance of BMSCs from a healthy or inflammatory microenvironment. The development of targeted strategies to enhance the immunosuppressive therapy of BMSCs might be significantly improved by these findings. Funding Statement: This work was supported by Nature Science Foundation of China (81800979 to Yang Yu.， 31970783 to Deqin Yang, 81700958 to Liang Chen, 32000577 to Bingyi Shao,81800958 to Dou Lei). Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: All the animal experiments were conducted under the experimental animal guidelines of the National Institutes of Health and approved by the Animal Care and Use Committee of Chongqing Medical University.

Wencui Wan,1,* Zhen Wu,2,* Jia Lu,2,* Weiwei Wan,1 Jing Gao,3 Hongxia Su,4 Wei Zhu5 1Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Ear, Nose, and Throat, Changshu No. 2 People’s Hospital, Changshu, People’s Republic of China; 3Department of Ophthalmology, First Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 4Department of Rhinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 5Department of Ophthalmology, Changshu No. 2 People’s Hospital, Changshu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongxia SuDepartment of Rhinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of ChinaTel +86-137726129234Email hxs_ent@163.comWei ZhuDepartment of Ophthalmology, Changshu No. 2 People’s Hospital, No. 99, Xiannan Street, Changshu, Jiangsu, 215000, People’s Republic of ChinaTel +86-13776212565Email shzhuwei0722@163.comBackground: Retinal vein occlusion (RVO) was a vision-threatening retinal vascular disorder, however, the relationship between obstructive sleep apnea (OSA) and RVO risk remained unclear.Methods: A total of 45 RVO cases and 45 controls between April 2018 and April 2020 were included. All the participants underwent full-night polysomnography (PSG) and thus detected the severity of OSA. Besides, the relationship between the apnea–hypopnea index (AHI) and oxidative and inflammatory biomarkers, including 8-hydroxy-2 deoxyguanosine (8-OHdG), C-reactive protein (CRP), interleukin 1 beta (IL1β), interleukin 6 (IL6) and tumor necrosis factor alpha (TNFα) were detected. The incidences of macular edema (ME) and neovascular glaucoma (NVG) were detected in a three-months follow-up.Results: In this case–control study, it was found that OSA incidence was increased in the RVO cases comparing with the cataract controls. Advanced analyses about the RVO subtypes demonstrated that incidence of OSA was higher in the central RVO (CRVO) cases comparing with branch RVO (BRVO) cases. Plasma samples from OSA cases demonstrated relatively higher concentrations of oxidative stress parameters and inflammatory biomarkers, including 8-OHdG, CRP, IL1β, and IL6, in the RVO cases. Significant linear correlations between AHI and oxidative/inflammatory biomarkers were detected, and advanced analyses on the OSA subtypes demonstrated that these biomarkers were significantly higher in cases with later stages of OSA. In a three months follow-up, an impaired visual activity improvement rate and increased ME incidence in the OSA group among all the RVO cases were detected.Conclusion: OSA was related with an increased incidence of RVO. Besides, OSA would lead to increased oxidative and inflammatory biomarkers concentrations in the RVO cases. OSA could be used as a harmful prognostic factor of visual activity improvement and ME incidences. These findings highlighted the role of OSA in the development of RVO.Keywords: obstructive sleep apnea, retinal vein occlusion, risk factor, prognosis, oxidative stress

Background Streptococcus anginosus (S. anginosus) was reported increased in oral squamous cell carcinoma (OSCC) tissue. The aim of this study was to investigate the response of oral cancer cells in the biological characteristics evoked by the S. anginosus and investigate its potential mechanisms. Methods The growth curve and concentration standard curve of S. anginosus were determined, and a series of concentrations of S. anginosus supernatant were applied to OSCC cell lines SCC15, then selected an optimal time and concentration by CCK-8 assay. Then autophagic response, proliferative activity, cell cycle and apoptosis, invasion and migration abilities were evaluated in SCC15. Results The results showed that when the ratio of S. anginosus supernatant to cell culture medium was 1:1 and the co-culture time was 16 h, the inhibitory effect on SCC15 was the most obvious; Furthermore, the supernatant of Streptococcus upregulated the autophagy activity of SCC15, thus significantly inhibiting its proliferation, migration and invasion ability. Compared with control groups, the cell cycle showed G1 arrest, S and G2/M phases decreased, and the percentage of apoptotic cells relatively increased (P Conclusion S. anginosus reduced the proliferation, migration and invasion of SCC15 cells and promoted cell apoptosis; Moreover, autophagy may be one of the mechanisms in this process.

We aimed to explore the utility of multiple biomarkers with GRACE risk stratification for non-ST-elevation myocardial infarction (NSTEMI). A total of 1,357 patients diagnosed with NSTEMI were enrolled in this study at multiple medical centers in Tianjin, China. The outcomes were 1-year all-cause death and major adverse cardiac events (MACE: all-cause death, hospital admission for unstable angina, hospital admission for heart failure, nonfatal recurrent myocardial infarction, and stroke). C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to verify that the biomarkers improve the predictive accuracy of the GRACE score. A total of 57 participants died, while 211 participants experienced 231 MACEs during follow-up (mean: 339 days). For all-cause death, the combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer improved the predictive accuracy of GRACE the most, with C-index, IDI, and NRI values of 0.88, 0.085, and 1.223, respectively. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer resulted in C-index, IDI, and NRI values of 0.80, 0.079, and 0.647, respectively. As a result, NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant increase in 1-year mortality (score ≥3.85 vs

Background Observational data under real-life conditions in idiopathic pulmonary fibrosis (IPF) is scarce. We explored anti-fibrotic treatment, disease severity and phenotypes in patients with IPF from the Swedish IPF Registry (SIPFR). Methods Patients enrolled between September 2014 and April 2020 and followed ≥ 6 months were investigated. Demographics, comorbidities, lung function, composite variables, six-minute walking test (6MWT), quality of life, and anti-fibrotic therapy were evaluated. Agreements between classification of mild physiological impairment (defined as gender-age-physiology (GAP) stage 1) with physiological and composite measures of severity was assessed using kappa values and their impact on mortality with hazard ratios. The factor analysis and the two-step cluster analysis were used to identify phenotypes. Univariate and multivariable survival analyses were performed between variables or groups. Results Among 662 patients with baseline data (median age 72.7 years, 74.0% males), 480 had a follow up ≥ 6 months with a 5 year survival rate of 48%. Lung function, 6MWT, age, and BMI were predictors of survival. Patients who received anti-fibrotic treatment ≥ 6 months had better survival compared to untreated patients [p = 0.007, HR (95% CI): 1.797 (1.173–2.753)] after adjustment of age, gender, BMI, smoking status, forced vital capacity (FVC) and diffusion capacity of carbon monoxide (DLCO). Patients with mild physiological impairment (GAP stage 1, composite physiological index (CPI) ≤ 45, DLCO ≥ 55%, FVC ≥ 75%, and total lung capacity (TLC) ≥ 65%, respectively) had better survival, after adjustment for age, gender, BMI and smoking status and treatment. Patients in cluster 1 had the worst survival and consisted mainly of male patients with moderate-severe disease and an increased prevalence of heart diseases at baseline; Cluster 2 was characterized by mild disease with more than 50% females and few comorbidities, and had the best survival; Cluster 3 were younger, with moderate-severe disease and had few comorbidities. Conclusion Disease severity, phenotypes, and anti-fibrotic treatment are closely associated with the outcome in IPF, with treated patients surviving longer. Phenotypes may contribute to predicting outcomes of patients with IPF and suggest the patients’ need for special management, whereas single or composite variables have some limitations as disease predictors.

This work focuses on the fixed-time event-triggered formation control problem for multi-AUV systems with external uncertainties, which can significantly reduce energy consumption and the frequency of the controller updates. At the same time, the convergence speed of the system is improved. To tackle with the problem of explosion of differentiation terms in backstepping method, a command filter is introduced to represent the derivative of virtual variables. Moreover, the distributed control strategy is considered and the lumped uncertainties are tackled with the super-twisting sliding mode method. It is proved that under the proposed event-triggered control strategies the Zeno behavior is avoided. Further, fixed-time formation control method can be finished within a fixed settling time with arbitrary initial states of the multi-AUV. Finally, simulation is presented to show the effectiveness and validity of the fixed-time event-triggered formation protocols for the multi-AUV systems.

Two-dimensional (2D) transition metal dichalcogenides (TMDs) have been rapidly established as promising building blocks for versatile atomic scale circuits and multifunctional devices. However, the high contact resistance in TMDs based transistors seriously hinders their applications in complementary electronics. In this work, we show that an Ohmic homojunction n-type tungsten diselenide (WSe2) transistor is realized through spatially controlling cesium (Cs) doping region near the contacts. We find that the remarkable electron doping effect of Cs stimulates a semiconductor to metal (2H to 1T’) phase transition in WSe2, and hence the formation of 2H-1T’ hetero-phase contact. Our method significantly optimizes the WSe2 transport behavior with a perfect low subthreshold swing of ∼ 61 mV/dec and ultrahigh current on/off ratio exceeding ∼ 109. Meanwhile, the electron mobility is enhanced by nearly 50 times. We elucidate that the ideal n-type behavior originates from the negligible Schottky barrier height of ∼ 19 meV and low contact resistance of ∼ 0.9 kΩ·µm in the 2H-1T’ homojunction device. Moreover, based on the Ohmic hetero-phase configuration, a WSe2 inverter is achieved with a high gain of ∼ 270 and low power consumption of ∼ 28 pW. Our findings envision Cs functionalization as an effective method to realize ideal Ohmic contact in 2D WSe2 transistors towards high performance complementary electronic devices.

Content platforms are becoming popular all over the world, especially in China. As a content platform, Bilibili’s story shows the development process of content platforms in emerging economies. This research explores the content of Bilibili at different stages of development from the perspective of business model, and tries to show a new growth path for enterprises in emerging economies. This research finds that in the three development stages of Bilibili, the nine elements of business model presented different characteristics and were combined into three distinct models. This study provides a reference for the theory and practice of the growth of emerging economies and the evolution of business models.

Non-fullerene all-small-molecule organic solar cells (ASM-OSCs) have attracted considerable attention for industrial application owing to their well-defined molecular structure, high purity and good batch-to-batch reproducibility. However, nearly all the high power conversion efficiencies (PCEs) of ASM-OSCs rely heavily on the extra treatment of their active layers. Herein, two A-π-D-π-A-type benzodithiophene trimer (3BDT)-based large planar conjugated rigid small molecules (3BDT-4 and 3BDT-5) were successfully designed and synthesized. When blended with a non-fullerene acceptor (Y6), the 3BDT-4 and 3BDT-5-based solution-processed bulk heterojunction OSCs exhibited PCEs of 5.8% and 10.4% under 1.5G illumination without extra treatment, respectively. To the best of our knowledge, 3BDT-5 is the first small molecule-based OSC device with Y6 as an acceptor to exhibit a PCE breaking 10% without thermal annealing, solvent vapor annealing, or use of additives. More importantly, when using post-treatments on the 3BDT-5:Y6 blend film, the PCEs of the devices did not change obviously. Thus, the excellent photovoltaic properties of 3BDT-5 make it an alternative material for the industrial large-scale fabrication of high-performance OSCs. This result demonstrates that the molecular design method can be a very effective strategy for controlling the active layer morphology.

Background: Increased stress among medical personnel had been reported in previous virus outbreaks. The novel coronavirus disease (COVID-19) emerged in December 2019, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No qualitative assessment has yet described the physical and mental health conditions of frontline medical personnel in the COVID-19 outbreaks. Methods: Here, 251 frontline medical personnel involved in COVID-19 missions completed electronic questionnaires, consisting of 31 categorical variables related to their physical and mental health status, medical history and environmental conditions. We constructed a correlation amongst these variables through pairwise Kendall rank correlation coefficient test. Then, clusters of highly correlated variables were identified using the leading eigenvector. Finally, we used the network and clusters to clarify the correlations amongst variables. Results: This qualitative study identified the six clusters. Cluster 1 was characterized by skin allergy. Cluster 2 was predominantly associated with anxiety. Cluster 3 consisted mostly of respiratory symptoms. The participants in cluster 4 had medical history. Cluster 5 and cluster 6 were characterized by disinfection and demography, respectively. Finally, we revealed three major findings. First, more than 80% of medical personnel worry about COVID-19-related infection and experience newly appearing anxiety (56.2%), airway or heart symptoms (34.3%) and skin allergies (20.3%). Second, COVID-19- related worry significantly associates with all variables in the anxiety and respiratory symptom clusters. Third, new-onset skin allergies did not associate with either disinfection or anxiety, but did associate with a previous history of allergies. Conclusions: COVID-19-related worry leads to physical and mental health problems amongst medical personnel. Effective responses and interventions could relieve a series of new-onset physical and mental health problems.

Aim of the study To assess the effect of water intake on ultrasound tissue characteristics and hemodynamics of adult livers. Material and methods In February 2020, we prospectively performed ultrasound shear wave elastography and attenuation imaging (ATI) of the liver parenchyma, and spectral Doppler sonography of the portal vein and hepatic artery in 19 adult healthy volunteers (10 men and 9 women, mean age 27 years, mean body mass index 24.65 kg/m2). We measured liver shear wave velocity (SWV, m/s), shear wave dispersion (SWD, m/s/kHz), attenuation coefficient (dB/cm/MHz), main portal vein velocity (PVV, cm/s), hepatic artery peak systolic velocity (PSV, cm/s), and end diastolic velocity (EDV, cm/s) immediately before and at different time points (15, 30, 45, and 60 minutes) after water intake (1.0 l water and 1.5 l water for body weight < 150 lbs. and ≥ 150 lbs., respectively). Results The differences in SWV, PVV, hepatic artery PSV and EDV before and after water intake were significant (p < 0.01) whereas the differences in SWD and ATI were not (p > 0.05) based on repeated measures ANOVA tests. The values of SWV, PVV, PSV, and EDV reached a peak at 30-45 minutes and returned to baseline 60 minutes after water intake. We observed positive correlations of SWV with PVV, PSV, and EDV in linear regression analyses (r2 > 0.73). Conclusions Water intake affects the liver stiffness and hemodynamics. No water intake at least one hour prior to liver ultrasound elastography and Doppler sonography is recommended.

Cu2−xS (0 < x ≤ 1) nanoparticles (NPs) heavily doped with copper vacancies can support localized surface plasmon resonance (LSPR) in near-infrared and mid-infrared spectral wavelengths, causing resonant absorption, scattering of photons and near-surface electric field enhancement. In this review, we will firstly discuss the fundamentals of optical responses in Cu2−xS and their numerical modeling, followed by the highlights of their flexible LSPR manipulation and LSPR correlated photoluminescence. Furthermore, we will present recently exploited applications based on the LSPR of Cu2−xS NPs. Finally, we will give a brief conclusion of the review and discuss the remaining open issues relating to the particle synthesis, chemistries, physics, optics and industrial applications, and we will propose some possible further research directions as well.

The rapid development of Internet technology and information technology is rapidly changing the way people think, recognize, live, work and learn. In the context of Internet + education, the emerging learning form of a cloud classroom has emerged. Cloud classroom refers to the process in which learners use the network as a way to obtain learning objectives and learning resources, communicate with teachers and other learners through the net-work, and build their own knowledge structure. Because it breaks the boundaries of time and space, it has the characteristics of freedom, high effi-ciency and extensiveness, and is quickly accepted by learners of different ag-es and occupations. The traditional cloud classroom teaching mode has no personalized recommendation module and cannot solve an information over-load problem. Therefore, this paper proposes a cloud classroom online teach-ing system under the personalized recommendation system. The system adopts a collaborative filtering recommendation algorithm, which helps to mine the potential preferences of users and thus complete more accurate recommendations. It not only highlights the core position of personalized curriculum recommendation in the field of online education, but also makes the cloud classroom online teaching mode more intelligent and meets the needs of intelligent teaching.

For efficient intranasal transport of parathyroid hormone (1-34) [PTH(1-34)], there is a great medical need to investigate permeation enhancers for intranasal formulations. In this study, the development of PTH(1-34) intranasal formulations was conducted. Based on conformation and chemical stability studies, the most preferable aqueous environment was determined to be 0.008 M acetate buffer solution (ABS). Subsequently, citric acid and Kolliphor® HS·15 were compared as permeation enhancers. The mechanisms of action of citric acid and Kolliphor® HS·15 were investigated using an in vitro model of nasal mucosa, and Kolliphor® HS·15 led to higher permeability of fluorescein isothiocyanate-labeled PTH(1-34) (FITC-PTH) by enhancing both the transcellular and paracellular routes. Moreover, citric acid showed severe mucosal toxicity resulting in cilia shedding, while Kolliphor® HS·15 did not cause obvious mucosa damage. Finally, Kolliphor® HS·15 was studied as a permeation enhancer using a liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The results showed that 5% and 10% Kolliphor® HS·15 increased the bioavailability of PTH(1-34) to 14.76% and 30.87%, respectively. In conclusion, an effective and biosafe PTH(1-34) intranasal formulation was developed by using 10% Kolliphor® HS·15 as a permeation enhancer. Intranasal formulations with higher concentrations of Kolliphor® HS·15 for higher bioavailability of PTH(1-34) could be further researched.

Introduction: The aim of this study was to evaluate the prognostic value of the albumin-to-alkaline phosphatase ratio (AAPR) in patients with nonmetastatic nasopharyngeal carcinoma (NPC). Methods: Patients with nonmetastatic NPC who underwent chemoradiotherapy (CRT) were retrospectively analyzed. The AAPR was calculated using the last value of albumin to alkaline phosphatase that was measured within 1 week before CRT. The optimal cutoff value for the AAPR value was determined by an X-tile plot. Propensity score matching (PSM) was performed to balance the differences of the baseline characteristics. The Kaplan-Meier method and log-rank test were used to calculate the survival. A Cox proportional hazards regression model was conducted for the multivariate analysis. Results: Totally, 87 patients with nonmetastatic NPC who underwent CRT were included in the analysis. The optimal cutoff level for the AAPR was 0.46. The group with an AAPR ≤0.46 was more likely to have poorer overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) (p = 0.023, p = 0.031 and p = 0.027, for OS, PFS, and DMFS, respectively). In Cox proportional hazards analysis, high AAPR was a better prognostic predictor. Conclusion: AAPR may be a reliable prognostic index for nonmetastatic NPC patients.

Trigeminal neuropathic pain (TNP) is a significant health problem but the involved mechanism has not been completely elucidated. Toll-like receptors (TLRs) have recently been demonstrated to be expressed in the dorsal root ganglion and involved in chronic pain. Here, we show that TLR8 was persistently increased in the trigeminal ganglion (TG) neurons in model of TNP induced by partial infraorbital nerve ligation (pIONL). In addition, deletion or knockdown of Tlr8 in the TG attenuated pIONL-induced mechanical allodynia, reduced the activation of ERK and p38-MAPK, and decreased the expression of pro-inflammatory cytokines in the TG. Furthermore, intra-TG injection of the TLR8 agonist VTX-2337 induced pain hypersensitivity. VTX-2337 also increased the intracellular Ca2+ concentration, induced the activation of ERK and p38, and increased the expression of pro-inflammatory cytokines in the TG. These data indicate that TLR8 contributes to the maintenance of TNP through increasing MAPK-mediated neuroinflammation. Targeting TLR8 signaling may be effective for the treatment of TNP.

Despite the growing popularity of organizational citizenship behavior (OCB) in hospitality, no significant studies have examined OCB through the lens of the theory of planned behavior (TPB). To address this gap, the present study aimed to examine whether norms (hotels' customer orientation) and perceived behavioral control (empowerment practices) can influence hotel employees' OCB toward internal and external customers, and whether culture can moderate the proposed relationships. A quantitative cross-cultural research design was supported with data collected from hotel employees in Australia and the U.S. The results showed that customer orientation (norm) was a universal predictor for all three types of OCBs while empowerment (perceived behavioral control) was only a significant predictor for employees' OCB toward customers. Culture moderated these relationships. The study extended the application of the TPB framework in understanding and predicting employees’ behaviors, opening up more opportunities for the application of the TPB to hospitality.

Background Currently, medical treatment of inflammatory pain is limited by a lack of safe and effective therapies. Triptonide (TPN), a major component of Tripterygium wilfordii Hook.f. with low toxicity, has been shown to have good anti-inflammatory and neuroprotective effects. The present study aims to investigate the effects of TPN on chronic inflammatory pain. Materials and Methods Inflammatory pain was induced by intraplantar injection of complete Freund's adjuvant (CFA). TPN's three different doses were intravenously administered to compare the analgesic efficacy: 0.1 mg/kg, 0.5 mg/kg, and 2.0 mg/kg. The foot swelling was quantitated by measuring paw volume. Mechanical allodynia and thermal hyperalgesia were assessed with von Frey filament testing and Hargreaves' test, respectively. Western blots, qRT-PCR and immunofluorescence tests were used to analyze the expression of pAKT, tumor necrosis factor-α (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6). Two AKT inhibitors, AKT inhibitor Ⅳ and MK-2206, were used to examine AKT's effects on pain behavior and cytokines expression. Results Intravenous treatment with TPN attenuated CFA-induced paw edema, mechanical allodynia, and thermal hyperalgesia. Western blotting and immunofluorescence results showed that CFA induced AKT activation in the dorsal root ganglion (DRG) neurons. However, these effects were suppressed by treatment with TPN. Furthermore, TPN treatment inhibited CFA-induced increase of pro-inflammatory cytokines, including TNF-α, IL-1β, and IL-6. Consistent with the in vivo data, TPN inhibited LPS-induced Akt phosphorylation and inflammatory mediator production in ND7/23 cells. Finally, intrathecal treatment with AKT inhibitor Ⅳ or MK-2206, attenuated CFA-induced mechanical allodynia and thermal hyperalgesia, and simultaneously decreased the mRNA expression of TNF-α, IL-1β, and IL-6 in DRG. Conclusion These data indicate that TPN attenuates CFA-induced pain potentially via inhibiting AKT-mediated pro-inflammatory cytokines production in DRG. TPN may be used for the treatment of chronic inflammatory pain.

Objective: The postoperative complications of minimally invasive percutaneous nephrolithotomy (PCNL) should not be ignored. The aim of this study is to explore the application value of enhanced recovery (ER) concept in PCNL. Method: A retrospective analysis was made of 60 patients with renal and upper ureteral calculi admitted to our hospital from March 2019 to December 2019. According to different treatment measures, they were divided into two groups: ER group (n = 30) and traditional group (n = 30). All the time related to surgery and postoperative recovery, incidence of postoperative diseases, and the anxiety and depression scores were compared between the two groups. Result: Ultrasonic examination showed that all the stones were discharged smoothly. Compared with traditional group, the rehydration time, the time of first exhaust and first defecation were significantly shortened; the incidence of hypothermia and postoperative fever and bleeding were significantly reduced; the anxiety scores were significantly decreased. Conclusion: It is safe and effective to apply ER concept in PCNL operation, which can improve the comfort, promote the recovery of gastrointestinal function and physical fitness, and do not increase the postoperative complications.

The study aimed to investigate the role of serum homocysteine in hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) within 24 h of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients. 236 consecutive AIS patients (169 men, median 65 years old) who underwent to IV rt-PA within 4.5 h of symptom onset were retrospectively recruited and analyzed. The serum homocysteine levels ranged from 4.45 to 67.71 (median 12.05) μmol/L. HT was observed in 28 (11.9%) patients, including 7 (3.0%) sICH patients within 24 h of IV rt-PA. Multiple parameters were compared between HT and non-HT patients as well as sICH and non-sICH patients. The serum homocysteine levels were higher in patients with HT than in those without HT (13.00 vs. 11.70 μmol/L, P = 0.025) and an independent association between serum homocysteine level and HT within 24 h of IV rt-PA was identified via multivariable logistic regression analysis (odds ratio [OR] = 1.103, 95% confidence interval [CI] = 1.021–1.191, P = 0.013). Moreover, serum homocysteine levels were also significantly higher in patients with sICH than in those without sICH (15.19 vs. 11.73 μmol/L, P = 0.005).Our study suggests that serum homocysteine level is an independent predictor for HT within 24 h of IV rt-PA in AIS patients.