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With the development of data plane programmable Software-Defined Networking (SDN), Distributed Denial of Service (DDoS) attacks on the data plane increasingly become fatal. Currently, traditional attack detection methods are mainly used to detect whether a DDoS attack occurs and it is difficult to find the path that the attack flow traverses the network, which makes it difficult to accurately mitigate DDoS attacks. In this paper, we propose a detection method based on Spatial-Temporal Graph Convolutional Network (ST-GCN) over the data plane programmable SDN, which maps the network into a graph. It senses the state of switches through In-band Network Telemetry (INT) with sampling, inputs the network state into the spatial-temporal graph convolutional network detection model, and finally finds out the switches through which DDoS attack flows pass. Based on this, we propose a defense method combined with an enhanced whitelist and a precise dropping strategy. The evaluation results show that our detection method can accurately detect the path that the DDoS attack flows pass through. Compared to classic methods, our method improves the detection accuracy by nearly 10%. At the same time, the southbound interface load, CPU overhead and defense process are much lower than the classic methods.

Using a panel of credit default swap (CDS) spreads and supply chain links, we observe that both favorable and unfavorable credit shocks propagate through supply chains in the CDS market. Particularly, the three-day cumulative abnormal CDS spread change (CASC) is 63 basis points for firms whose customers experienced a CDS up-jump event (an adverse credit shock). The value is 74 basis points if their suppliers experienced a CDS up-jump event. The corresponding three-day CASC values are –36 and –38 basis points, respectively, for firms whose customers and suppliers, respectively, experienced an extreme CDS down-jump event (a favorable credit shock). These effects are approximately twice as large for adverse credit shocks originating from natural disasters. Credit shock propagation is absent in inactive supply chains and is amplified if supply chain partners are followed by the same analysts. Industry competition and financial linkages between supply chain partners, such as trade credit and large sales exposure, amplify the shock propagation along supply chains. Strong shock propagation persists through second and third supply chain tiers for adverse shocks but attenuates for favorable shocks. This paper was accepted by Kay Giesecke, finance.

Abstract: miRNA-129-5p belongs to the microRNA-129 (miRNA-129) family. miRNA-129-5p is expressed in many tissues and organs of the human body, and it regulates a wide range of biological functions. The abnormal expression of miRNA-129-5p is related to the occurrence and development of a variety of malignant tumors. miRNA-129-5p plays an important role in the tumorigenesis process and functions by promoting or inhibiting tumors. However, the role of miRNA-129-5p in cancer remains controversial. This article reviews the different biological functions of miRNA- 129-5p in cancer and provides ideas for research in this field to guide the development of targeted therapies and drugs for malignant tumors.

Blau syndrome (BS) is a monogenic autoinflammatory disease caused by mutations in nucleotidebinding oligomerization domain containing 2 (NOD2). BS is characterized by the clinical triad of granulomatous dermatitis, arthritis and recurrent uveitis. Due to the low incidence of BS and the lack of treatment studies with large samples, a specific treatment scheme has not been established. We report the case of a patient with BS that was uncontrollable with various immunosuppressive therapies but had a good response to thalidomide. She had the typical triad of rash, arthritis and uveitis. Gene sequencing indicated a NOD2 heterozygous missense variant (c.1759C > T, p.R587C), which has been reported as a pathogenic mutation. The BS diagnosis was confirmed. After treatment with methotrexate, an anti-tumour necrosis factor (TNF)-α inhibitor and corticosteroids, the patient's clinical symptoms and inflammatory indicators remained uncontrolled, and she experienced multiple side effects, such as hypertension and growth retardation attributed to prolonged corticosteroid use. After treatment with thalidomide, her condition was controlled without recurrence or side effects, and corticosteroids were stopped as soon as possible. This report suggests that thalidomide may be effective for BS treatment, but more research is needed to evaluate its long-term efficacy and side effects.

Post-treatment recurrence remains a challenge for the global control of tuberculosis (TB). This study investigated longitudinal data on pulmonary TB recurrence rates and risk factors for recurrence among successfully treated smear-positive tuberculosis cases in China.Between 1st January 2009 and 31st December 2016 we evaluated 33 441 treatment-naïve patients diagnosed with sputum-smear-positive, non-multidrug-resistant TB in Hangzhou, China. We included the data of 9828 patients with TB who were treated successfully.A total of 4.9% of the cases were recurrent (479/9828), identified within a median observation period lasting 1565 days. Altogether, 51.1% (245/479) of the recurrences occurred within 1 year. The cumulative 2- and 5-year recurrence rates were 3.90% (95% confidence interval (CI) 3.3-4.5%) and 5.4% (95%CI 4.8-6.0%), respectively. Prolonged treatment (over 7 months) occurred in 64.7% (6363/9828), with a median treatment duration of 242 days (interquartile range 195-348 days). Male sex (adjusted hazard ratio (aHR) (95%CI) 1.61 (1.30-2.00), p 0.001), age 60 years old or older (aHR (95%CI) 2.03 (1.70-2.44), p 0.001), pulmonary cavity (aHR (95%CI) 1.51 (1.25-1.82), p 0.001) and sputum positivity at 2 months (aHR (95%CI) 1.39 (1.05-1.81), p 0.02) all increased the risk of TB recurrence. Prolonged treatment was associated with reduced TB recurrence (aHR (95%CI) 0.73 (0.61-0.88), p 0.001).Recurrence remains a problem for successfully treated patients with sputum-smear-positive pulmonary TB, especially those with independent risk factors. Further analysis of prolonged treatment is required.

Gastric cancer is a global cancer with a high mortality rate. A growing number of studies have found the abnormal expression of lncRNA (long noncoding RNA) in many tumors, which plays a role in promoting or inhibiting cancer. Similarly, lncRNA abnormal expression plays an essential biological function in gastric cancer. This article focuses on lncRNA involvement in the development of gastric cancer in terms of cell cycle disorder, apoptosis inhibition, metabolic remodeling, promotion of tumor inflammation, immune escape, induction of angiogenesis, and Epithelial Mesenchymal Transition (EMT). The involvement of lncRNA in the development of gastric cancer is related to drug resistance, such as cisplatin and multi-drug resistance. It can also be used as a potential marker for the diagnosis and prognosis of gastric cancer and a target for the treatment. With an in-depth understanding of the mechanism of lncRNA in gastric cancer, new ideas for personalized treatment of gastric cancer are expected.

Objective There was increasingly demand of participation in surgical decision-making among Chinese patients with prostate cancer. However, due to the complex healthcare system and advanced care settings, it is quite challenging for the patients to gain sufficient support from the institute and the government. This research will investigate the factors that impact the degree of participation in surgical decision-making among Chinese prostate cancer patients. Methods A phenomenological approach of qualitative research based on the results of semi-structured interviews were adopted, to explore the influencing factors which hinder the participation in surgical decision-making. COREQ reporting guidelines were utilized. Up to 160 post-operative patients who had undergone radical prostatectomy along with 68 medical and nursing staffs, were purposively recruited in this research. This retrospective study was carried out from September 2018 to August 2019. After recording and transcribing the interviews, the interview materials were evaluated via the Colaizzi's seven step approach and the QSR Novivo10.0 software to analyze the interview content. Results According to the analysis and summary of the interviews, there are three factors affecting the degree of participation in surgical decision-making: Firstly, insufficient communication time between medical staff and patients before surgery, lack of communication skills, difficulty in developing patient assisted decision-making tools, lack of career experience of young medical staff, and inconsistent in the availability of resources between different hospitals, resulting in insufficient information provided by medical and nursing staff. Secondly, the cognitive level of decision-making among patients is relatively low due to poor psychological endurance, insufficient amount of education, senility and less knowledge and information demand. And ultimately, decisions are constantly made by family members with/without patients. Conclusions The degree of participation of Chinese prostate cancer patients in the surgical decision-making had much space for improvement.

Silicosis is a disease characterized by extensive lung nodules and fibrosis caused by the prolonged inhalation of silica in occupational settings. However, the molecular mechanism of silicosis development is complex and not fully understood. Furthermore, the role of necroptosis, a death receptor-mediated and caspase-independent mode of inflammatory cell death, is not well understood in silicosis. Here, we demonstrate that the necroptotic signaling pathway of macrophages is significantly activated in the lungs of silicosis mouse models. Meanwhile, increased M1 macrophage infiltration and up-regulation of pro-inflammatory cytokines (TNF-α, IL-6) were observed in our silicosis model. Notably, the expression of the pro-fibrotic factor, TGF-β1, and fibrosis biomarkers α-SMA and collagen I were also unregulated; however, these phenomena were recovered by Nec-1, an inhibitor specific for RIP1 kinase-dependent necroptosis. We conclude that macrophage-mediated necroptosis promotes the progression of silicosis by enhancing lung inflammatory responses and fibrogenesis in a mouse model of silicosis. These findings provide new insights for drug discovery and clinical treatment of silicosis.

Background This study aims to explore whether Fufang Shatai Heji (STHJ), as a mixture collected by a decoction of a variety of Chinese herbal medicines for immune system diseases, can improve the cartilage destruction of rheumatoid arthritis (RA). Methods The therapeutic effects of STHJ were studied using collagen induced arthritis (CIA) mice. The improvement effect of STHJ on synovitis and cartilage damage caused by arthritis was studied by joint pathological analysis. The inhibitory effect of STHJ on related degradation enzymes in cartilage was studied by immunohistochemistry and real-time polymerase chain reaction (PCR). The specific targets of STHJ were predicted by molecular docking. Results After successfully inducing CIA, the paws of the mice showed significant swelling, and athological analysis of the ankle and knee joints also showed significant cartilage destruction and synovial hyperplasia. However, synovial hyperplasia and cartilage destruction were markedly alleviated after administration of STHJ. And after SHTJ treatment, the expression of ADAMTS-4, ADAMTS-5, MMP-9 and MMP-13, in the cartilage layer of CIA mice was significantly inhibited. Through molecular docking assays, we proved that acteoside in STHJ could directly bind to the Glu111, Phe110 residues in MMP-9 and glycyrrhizic acid in STHJ bind to the Glu382, Asn433 residues in MMP-13. Conclusions Our results suggested that STHJ may alleviate synovial hyperplasia and cartilage destruction in CIA mice and protect cartilage by inhibiting the expression of MMP-9 and other enzymes.

Background The present study aimed to evaluate the elimination of three common pollutants (dimethoate, benzo(a)pyrene (BaP) and bisphenol A (BPA) by different physical exercises and to assess the possible factors which could affect the pollutants elimination. Methods A total of 200 individuals who chose different kinds of exercises in accordance to their own wish were recruited. The levels of urinary pollutants were measured using β-glucuronidase hydrolysis followed by a high-performance liquid chromatography tandem mass spectrometry-based method. Results Totally, the levels of dimethoate, BaP and BPA were reduced after physical exercises. However, the elimination of BaP in male was higher than that in female but the elimination of BPA in female was higher than that in male. Multivariate logistic regression showed that the degree of heart rate (HR) change was a protective factor affecting the improvement effect of dimethoate, BaP and BPA while BMI (body mass index) was a risk factor. Nevertheless, sex was a risk factor affecting the improvement of dimethoate and BaP but had a lower efficacy on BPA improvement. Conclusion The present findings indicate that physical exercises can be considered as a novel approach to eliminate pollutants level in human body and can also give suggestions for choosing specific physical exercises to male and female individuals. Moreover, those who are with higher BMI need to lose weight before eliminating pollutant level through physical exercises.

Internet of thing (IoT) devices are increasingly growing in mobile networks with the ubiquity of various IoT services. They share the same infrastructure with smartphones while having different requirements for communication resources and security defense mechanisms. Distinguishing IoT devices from smartphones has far-reaching implications on effective network design, resource allocation scheme, pricing scheme etc. In this paper, we distinguish between 12,107 IoT devices and 12,693 smartphones in the real world via characterizing their network traffic. The IoT devices fall into five categories, namely locating, monitoring, portable, point of sale (POS), and vehicle. We analyze the device behaviors from network domain, physical domain, and time domain, make comparisons between each kind of IoT devices and smartphones, and design effective features based on the distinguishable network behavior characteristics at packet level, traffic level, and mobility level. Then we train several classifiers based on our feature set to identify different kinds of mobile devices. Specifically, the accuracy of identifying IoT devices from smartphones achieves 95.86%, and the accuracies of distinguishing IoT devices in each category from smartphones are all over 95%. In the trained classifiers, feature importance verifies the discriminability of different network traffic characteristics observed in our multi-domain measurement. Our study reveals the network traffic behavior characteristics for IoT devices, and successfully distinguishes them from smartphones, which paves the way for better network design, resource allocation, pricing scheme, and security defense mechanisms.

Aging is frequently accompanied by various types of physiological deterioration, which increases the risk of human pathologies. Global public health efforts to increase human lifespan has been increasingly focusing on lowering the risk of incidences of aging-related disease, such as diabetes, neurodegenerative diseases, cardiovascular disease and cancers. Dietary interventions is a promising approach to maintain human health during aging. Lactoferrin (LF) is known for its physiologically pleiotropic properties. Anti-aging interventions of LF have proven to be safe and effective for various pharmacological activities such as antioxidants, anti-cellular senescence, anti-inflammation, and anti-carcinogenic. As well as the pivotal role of LF on the modulating of major signaling pathways that influence longevity of organisms. Thus, LF is expected to be able to attenuate the process of aging and greatly ameliorate its effects.

As supply chain channels physical, financial, and information flows as well as associated risks, a firm’s supply chain information should be helpful in understanding and predicting its credit risks. Credit ratings as an approximate but important measure of corporate credit risks have been widely used by investors, creditors, and supply chain partners in their decision-making. This paper studies the role of supply chain information in predicting companies’ credit ratings. Using firm-level supplier-customer linkages and corporate credit rating data, we develop a machine learning framework with gradient boosted decision tree to examine whether and what supply chain features can significantly improve the prediction accuracy of credit ratings, and what types of supply chain links have higher information content that positively affects the predictability of the supply chain features. We construct a firm’s supply chain variables from its supplier and customer portfolios to be used in the machine learning models. We show that incorporating supply chain features can improve prediction accuracy over the benchmark credit rating model using only the focal firm’s features. Moreover, the informativeness of supply chain links in focal credit risk prediction depends on the focal firm’s industry sector, the relationship strength of such links, and the switching costs. Finally, we develop a focal credit rating prediction model with a high accuracy level using supply chain factors solely, which can potentially be applied to predict credit risks of small and medium-sized enterprises (SMEs) and private firms with no public financial information, as long as their supply chain information is available.

Background Plasma phospholipid fatty acids (FAs) in early and mid-pregnancy have been prospectively related to gestational diabetes mellitus (GDM) risk. Yet, changes of FAs following GDM diagnosis and treatment and their implications for glucose metabolism and control remain understudied. Methods From the Eunice Kennedy Shriver National Institute Child Health and Human Development Fetal Growth Studies–Singleton Cohort of 2802 pregnant women, we ascertained 85 GDM cases using the Carpenter and Coustan criteria and 85 non-GDM controls after exclusion. Using plasma collected before (23–31 weeks) and after GDM diagnosis (33–39 weeks), we quantified 25 saturated, poly- and monounsaturated FAs levels. We estimated the fold change of FAs before and after GDM diagnosis, using multiple linear mixed models adjusting for confounders. Results Eight FAs showed significant fold changes from the baseline values (23–31 weeks) among GDM cases as compared to women without GDM. Five FAs showed reduced fold changes [myristic acid (14:0): β: −0.22 (95% CI: −0.30, −0.14), palmitic acid (16:0): β: −0.02 (95% CI: −0.04, −0.01), cis-palmitoleic acid (16:1n7): β: −0.15 (95% CI: −0.24, −0.05), alpha-linolenic acid (18:3n3): β: −0.19 (95% CI: −0.31, −0.07], and dihomo-gamma-linoleic acid (20:3n6): β:−0.16; 95% CI: −0.21, −0.11)], whereas 3 showed increases [heptadecanoic acid (17:0): β: 0.17 (95% CI: 0.11, 0.22), cis-vaccenic acid (18:1n7): β: 0.06 (95% CI: 0.03, 0.10), and arachidonic acid (20:4n6): β: 0.10 (95% CI: 0.06, 0.13)]. Conclusions Our study identified 8 FAs with unique patterns of change before and after GDM diagnosis that differed significantly between women with and without GDM. Our findings may shed light on the role of FA metabolism in the pathophysiology and disease management and progression of GDM. Clinical Trial Registry NCT00912132

This article presents a new micro-light-emitting diode (LED) pixel circuit driven by the digital pulsewidth modulation (PWM) method, in which the threshold voltage compensation of the driving thin-film transistor (TFT) is included. A scan driver integrated by metal oxide (MO) TFTs is also designed to provide the scan signals for pixel circuits array. A micro-LEDs array with $76\,\, \times $ BBB $\times \,\,78$ and a scan driver with 80 stages are simultaneously fabricated by MO TFTs backplane with back-channel etch (BCE) structure. A respective micro-LED display is consequently realized by a peripheral driving system based on a field-programmable gate array (FPGA), which is used as a core control unit to synchronize the scan signals with the data signals. It is shown that the micro-LED in the pixel circuit can operate at a constant current even at the 5- $\mu \text{s}$ pulsewidth of the emission (EM) signal. The micro-LED display can achieve 256 linear grayscales with an approximately 60 Hz flash rate under the minimum pulsewidth of 40 $\mu \text{s}$ of EM signal.

Aim This study aims to develop an instrument to measure infectious disease specialist nurses’ core competence and examining the scale’s validity and reliability. Background With the increase of infectious diseases, more and more attention has been paid to infectious disease nursing care. The core competence of the infectious disease specialist nurses is directly related to the quality of nursing work. In previous researches, infectious disease specialist nurses’ core competence was measured by the tools developed for general nurses instead of specialized tools, which made it difficult to clarify the core competence of nurses in infectious diseases department. Methods Preliminary items were developed through literature review, theoretical research, qualitative interview and Delphi method. The confirmed 47 items were applied in the two rounds of data collection. Evaluation data on 516 infectious disease specialist nurses’ core competence in the first round were utilized to preliminarily evaluate and explore the scale’s constrution, while evaluation data on 497 infectious disease specialist nurses’ core competence in the second round were utilized to do reliability analysis and validity analysis. In this study, factor analysis, Cronbach’s α, Pearson correlation coefficients were all adopted. Results The final scale is composed of 34 items and 5 factors, and adopted the 5-point scoring method. The factors are Professional Development Abilities, Infection Prevention and Control Abilities, Nursing Abilities for Infectious Diseases, Professionalism and Humanistic Accomplishment, and Responsiveness to Emergency Infectious Diseases. The explanatory variance of the five factors was 75.569%. The reliability and validity of the scale is well validated. The internal consistency, split-half reliability and test-retest reliability were 0.806, 0.966 and 0.831 respectively. The scale has good structural validity and content validity. The content validity was 0.869. Discrimination analysis showed that there were significant differences in the scores of core competence and its five dimensions among infectious disease specialist nurses of different ages, working years in infectious diseases, titles, educational background, marital status and wages (all P Conclusions The proposed scale takes on high reliability and validity, and is suitable for assessing the infectious disease specialist nurses’ core competence. Relevance to clinical practice This scale provides a reference for clinical assessment of infectious disease nursing.

The paper proposes a temperature-compensated sensor for microfluidic application. The sensor consists of a splitter/combiner section with two symmetrical complementary split-ring resonators (CSRR). A polydimethylsiloxane substrate is attached with the microfluidic channel aligned to the meander slot of the CSRR. A split-ring resonator (SRR) with peripheral circuit is added to detect environmental temperature. The water-methanol mixtures with various water fractions are measured at temperature ranging from 20°C to 50°C. The environmental temperature is firstly measured by the resonant frequency shift produced by SRR. Then, the variations in the resonant frequency and quality factor of the differential splitter/combiner section, as well as the temperature, are used as the input data for training the neural network. In comparison with previous designs, the proposed sensor is capable of not only suppressing the influences of environmental factors, but also retrieving the permittivity and loss tangent of liquid sample at specific temperature, thereby identifying the liquid accurately.

Individualized chemotherapy, which is at the forefront of acute myeloid leukemia (AML) treatment, has moderately improved outcomes over the past decade. Monitoring the peripheral blood blast burden during induction by flow cytometry has shown significant value in the evaluation of treatment responses. Our previous study reported the day 5 peripheral blast clearance rate (D5-PBCR) as an indicator of early treatment response, and D5-PBCR (+) patients showed poor outcomes. We performed the present phase 2 trial of early intervention in D5-PBCR (+) patients with homoharringtonine (HHT) introduced in the traditional induction regimen with anthracycline and cytarabine. The primary endpoint was complete remission (CR). This study enrolled 151 patients, 65 patients were D5-PBCR (+) and 55 patients completed induction with HHT addition. The overall CR rate after one course of induction was 84.4%, with 87.5% and 80.0% for the D5-PBCR (-) and D5-PBCR (+) groups, respectively. The incidence of grade 3/4 adverse events was comparable between the two groups. At the median follow-up of 53.1 months, median overall survival (OS) was not reached in the entire cohort, and median event-free survival (EFS) was 42.2 months. Neither the OS nor EFS showed significant differences between the D5-PBCR (-) and D5-PBCR (+) groups. Compared to historical data, significant improvements in both OS (p = .020) and EFS (p = .020) were observed in the D5-PBCR (+) group. In conclusion, optimization of induction chemotherapy with idarubicin and cytarabine according to D5-PBCR is feasible in patients with newly diagnosed AML. The addition of HHT demonstrated a good efficacy and safety profile.

OBJECTIVE We aimed to establish a standardized procedure for white light gastroscopy (WLG) to screen gastric lesions including early gastric cancer (EGC) in China and to verify its efficacy and feasibility in clinical practice. METHODS A standardized WLG procedure for outpatients at nine tertiary hospitals in Beijing was established. Clinical information of the participants and details of the endoscopic procedures were recorded. RESULTS A total of 1051 participants were enrolled in a baseline conventional endoscopic survey between March 2014 and December 2015, while 2156 patients were enrolled in the standardized WLG operation from January 2016 to June 2017. The procedure time of the standardized procedure was significantly longer than that of the baseline conventional procedure (P = 0.003). More images were obtained during the standardized procedure compared with the baseline conventional procedure (P

Ischemic stroke is a leading cause of death and long-term disability worldwide. The aim of this study is to explore the potential function of ephedrine in ischemic stroke and the underlying molecular mechanism. A middle cerebral artery occlusion (MCAO) rat model was established. The potential effects of ephedrine on MCAO rats and LPS-stimulated BV2 microglial cells were evaluated. Ephedrine reduced the infarct volume, cell apoptosis, brain water content, neurological score, and proinflammatory cytokines (TNF-α and IL-1β) production in MCAO rats. Ephedrine treatment also suppressed TNF-α and IL-1β production and NOD-like receptor pyrin domain 3 (NLRP3) inflammasome activation in BV2 microglial cells. The expression of NLRP3, caspase-1, and IL-1β was suppressed by ephedrine. Moreover, ephedrine treatment increased the phosphorylation of Akt and GSK3β and nuclear NRF2 levels in LPS-treated BV2 microglial cells. Meanwhile, LY294002 attenuated the inhibitory effects of ephedrine on NLRP3 inflammasome activation and TNF-α and IL-1β production. In addition, the level of pAkt was increased, while NLRP3, caspase-1, and IL-1β were decreased by ephedrine treatment in MCAO rats. In conclusion, ephedrine ameliorated cerebral ischemia injury via inhibiting NLRP3 inflammasome activation through the Akt/GSK3β/NRF2 pathway. Our results revealed a potential role of ephedrine in ischemic stroke treatment.

Introduction To compare the cost-effectiveness of flash glucose monitoring versus self-monitoring of blood glucose/point of care testing (SMBG/POCT) in both patients with type 1 and patients with type 2 diabetes (T1D/T2D) receiving insulin therapy. Methods The IQVIA CORE Diabetes Model (version 9.5) was used to project the lifetime costs and health outcomes of flash glucose monitoring and SMBG/POCT from a Chinese societal perspective. We considered both hospital and individual version flash glucose monitoring to reflect the clinical practice in China. The clinical inputs leveraged the outcomes from both clinical trials and real-world studies. Cohort characteristics, intervention costs, treatment-related disutility and mortality were extracted from the literature. We also conducted scenario analyses and probabilistic sensitivity analyses to test the robustness of results. Results Compared with SMBG/POCT using efficacy results from clinical trial, flash glucose monitoring brought the incremental costs of Chinese yuan (CNY) 58,021 and CNY 90,997 and additional quality-adjusted life years (QALYs) of 1.22 and 0.65 for patients with T1D and patients with T2D, respectively. According to the “WHO-CHOICE threshold” of three times the gross domestic product per capita in China (CNY 217,341 in 2020) as cost-effectiveness threshold, flash glucose monitoring was cost-effective for both patients with T1D and patients with T2D with incremental cost-effectiveness ratios (ICER) of CNY 47,636 and CNY 140,297 per QALY gained, respectively. According to the real-world effectiveness data, flash glucose monitoring was dominant for patients with T1D (lower costs and better effectiveness) and cost-effective for patients with T2D with an ICER of CNY 124,169 per QALY gained compared with SMBG/POCT. Scenario analyses and probabilistic sensitivity analyses confirmed the robustness of the results. Conclusion Flash glucose monitoring is likely to be considered as a cost-effective strategy compared to SMBG/POCT for Chinese patients with T1D and patients with T2D receiving insulin therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01166-z.

BACKGROUND Attenuation correction can improve the quantitative accuracy of single-photon emission computed tomography (SPECT) images. Existing SPECT-only systems normally can only provide non-attenuation corrected (NC) images which are susceptible to attenuation artifacts. In this work, we developed a post-reconstruction attenuation correction (PRAC) approach facilitated by a deep learning-based attenuation map for myocardial perfusion SPECT imaging. METHODS In the PRAC method, new projection data were estimated via forwardly projecting the scanner-generated NC image. Then an attenuation map, generated from NC image using a pretrained deep learning (DL) convolutional neural network, was incorporated into an offline reconstruction algorithm to obtain the attenuation-corrected images from the forwardly projected projections. We evaluated the PRAC method using 30 subjects with a DL network trained with 40 subjects, using the vendor-generated AC images and CT-based attenuation maps as the ground truth. RESULTS The PRAC methods using DL-generated and CT-based attenuation maps were both highly consistent with the scanner-generated AC image. The globally normalized mean absolute errors were 1.1% ± .6% and .7% ± .4% and the localized absolute percentage errors were 8.9% ± 13.4% and 7.8% ± 11.4% in the left ventricular (LV) blood pool, respectively, and - 1.3% ± 8.0% and - 3.8% ± 4.5% in the LV myocardium for PRAC methods using DL-generated and CT-based attenuation maps, respectively. The summed stress scores after PRAC using both attenuation maps were more consistent with the ground truth than those of the NC images. CONCLUSION We developed a PRAC approach facilitated by deep learning-based attenuation maps for SPECT myocardial perfusion imaging. It may be feasible for this approach to provide AC images for SPECT-only scanner data.

It is challenging to predict the 90-day outcomes of patients infected with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) via prevailing predictive models. This study aimed to develop an innovative model to enhance the analytical efficacy of 90-day mortality in HBV-ACLF.In this study, 149 HBV-ACLF patients were evaluated by constructing a death risk prediction nomogram. Bootstrap resampling and an independent validation cohort comprising 31 patients from June 2019 to February 2020 were assessed for model confirmation.The nomogram was constructed by entering and identifying five factors (age, total bilirubin, prothrombin activity (PTA), lymphocyte (L)%, and monocyte (M)%. Healthy refinement was achieved from the nomogram analysis, where the area under the receiver operating characteristic curve was 0.864 for the training cohort and 0.874 was achieved for the validation cohort. There was admirable concordance between the predicted and true results in the equilibrium curve. The decision curve assessment revealed the useful clinical application of the nomogram.We constructed an innovative nomogram and validated it for the prediction of 90-day HBV-ACLF patient outcomes. This model might help develop optimized treatment protocol recommendations for HBV-ACLF patients.

PURPOSE To assess liver necroinflammation in HCV patients undergone antiviral therapy by Gd-EOB-DTPA-enhanced MRI with histopathologic analyses as reference. METHODS HCV patients were enrolled in this prospective study before antiviral treatment between 09-2016 and 07-2017. Unenhanced MR, Gd-EOB-DTPA-enhanced MR, and liver biopsy were performed before and 24 weeks after treatment of daclatasvir with asunaprevir (DAA). DWI was obtained using a breath-hold single-shot echo planar spin-echo sequence. Twenty minutes after administration of Gd-EOB-DTPA, the relative enhancement (RE) and the contrast enhancement index (CEI) were recorded. Liver necroinflammatory activity grades (G0-18) were categorized on the Ishak Scoring systems. CEI, RE, and DWI of baseline and 24 weeks after treatment were compared by paired t test. Relationship between MR parameters and histologic scores was evaluated by Pearson's correlation. Receiver operating characteristic analysis evaluated the measurements' diagnostic performance. MRI variability between two readers was assessed using the intraclass correlation coefficient.Results RESULTS: A decrease of liver necroinflammatory activity grade (p

To quantitatively evaluate the low-cycle fatigue life of buckling-restrained braces (BRBs), an evaluation method for BRBs based on the combination of the CPD curves and CPD measurement meter (CMM) is established herein. The difference between two CPD curves (i.e., the CPD curves under constant strain amplitude loading history (C-CPD) and under random strain amplitude loading history (R-CPD)), and their selection criteria to evaluate the low-cycle fatigue life of BRBs are discussed. An example under the variable strain amplitude (VSA) loading history and an example under the multiple earthquakes are carried out. Finally, the CPD limit values of BRBs in the ANSI/AISC 341-10 and FEMA-450 are discussed by statistical analysis of the test results of BRBs. The analysis results show that the C-CPD curve can be used to evaluate the low-cycle fatigue life of BRBs under the VSA loading, and the R-CPD curve can be used to evaluate the low-cycle fatigue life of BRBs under the multiple earthquakes. The degree of reliability of the current CPD limit value is not enough. A CPD limit curve is recommended in this study to quantify the low-cycle fatigue performance of BRBs.

Continuously improving freshwater aquaculture efficiency will promote the sustainable development of freshwater aquaculture, which is crucial to ensure aquatic food supply. In particular, measuring the total factor productivity (TFP) of freshwater aquaculture to find ways to improve its efficiency is of great significance to sustainable development of freshwater aquaculture industry. Therefore, based on directional distance function, this paper constructs a meta-frontier Malmquist index (MMI) model by considering the regional heterogeneity to evaluate the TFP of freshwater aquaculture of China from 2004 to 2019. The results show that (1) from the perspective of time, TFP fluctuated significantly from 2004 to 2012, while after 2013, TFP remained around 1 with small fluctuation. In other words, freshwater aquaculture in China began to maintain a relatively negative state of development. (2) From a regional point of view, this study found that freshwater aquaculture TFP of inland region is better than the TFP of coastal region. (3) From the decomposition index, the variation of freshwater aquaculture TFP was driven by the combined effect of technology change (TC) and technical efficiency change (EC). In addition, the decomposition index efficiency shows that the technical efficiency decreases and the management efficiency changes little. (4) The gap of freshwater aquaculture technology in coastal areas is very small, and close to the optimal technical level. While in inland region, on the contrary, there is more room for improvement. According to the above empirical results, this paper finally gives some policy suggestions to improve the TFP to ensure the sustainable development of freshwater aquaculture.

Background information extraction and modeling have always been the cores of hyperspectral anomaly detection (AD) algorithms. In this letter, a simple and efficient weighting strategy based on image segmentation is proposed. The strategy integrates detection results with spatial information from segmentation, and the background is suppressed in the fusion results. First, an improved graph-based image-segmentation algorithm is adopted to isolate potential anomaly targets from the background. The segmentation is based on the spectral similarity of adjacent pixels and can extract the potential target well even if the global background is complex. Then, a weight matrix is constructed according to the segmentation result, and two types of background, narrow boundaries and large homogeneous areas, are suppressed and assigned small weights. Finally, the normalized weight matrix is combined with the detection results of AD algorithms. Experiments conducted on different data sets show that the proposed strategy is efficient and robust and can improve the detection performance and robustness of AD algorithms.

An innovative replaceable energy dissipation connector (REDC) is proposed in this paper that can be used as a connecting component as well as a metal-yield damper in the beam end of a precast concrete frame. In addition to the precast concrete frame for the REDC (REDC-PCF), a construction and post-earthquake repair method for it is proposed. An experimental study on the mechanical behaviour of REDCs under cyclic reverse loading was conducted to study their axial stiffness, hysteretic behaviour, energy dissipation capacity, and other properties. The results revealed that REDCs manufactured using high ductility steel exhibited a stable hysteretic property and high low-cycle fatigue performance under cyclic reverse loading conditions. On the basis of the test results, the REDC has a promising future in seismic design because it can be widely applied in precast concrete frames in high-seismic activity zones. A numerical analysis of the transverse displacement of the mechanical property of the REDC was also conducted. The results showed that the transverse displacement of the specimen had little effect on its mechanical property and low-cycle fatigue capacity. Thus, the uniaxial testing of REDC specimens would be effective in predicting the properties of beam–column joints.

Background The purpose of the present study is to evaluate the prevalence of temporomandibular disorders (TMD) and their associated biological and psychological factors in Chinese university students. Methods A total of 754 students were included from Zunyi Medical University, each participant completed questionnaires and clinical examinations according to the Diagnostic Criteria for Temporomandibular Disorders. Results The overall prevalence of TMD was 31.7% among medical students. Subjects with TMD had a high prevalence of bruxism, empty chewing, unilateral chewing, chewing gum, anterior teeth overbite, anterior teeth overjet, depression, anxiety, and sleep disturbance. Moreover, sleep bruxism, empty chewing, unilateral chewing, anterior teeth overbite, depression, and anxiety were the strongest risk factors for TMD. Conclusions Individuals with TMD have a high prevalence of psychological distress and oral parafunctional habits. Except for the psychological factors associated with TMD, bruxism, abnormal chewing, and malocclusion also shared similar risks for TMD.

Coeliac disease (CD), also known as gluten sensitive enteropathy, is an autoimmune intestinal disease induced by gluten in genetically susceptible individuals. Gluten is a common ingredient in daily diet and is one of the main environmental factors to induce coeliac disease. Adhering to gluten free diet (GFD) is an effective method for treating CD. Microbiota plays an extremely important role in maintaining human health, and diet is the main factor to regulate the composition and function of gut microbiota. Recent studies have shown that gluten metabolism is closely related to gastrointestinal tract (GIT) microbiota. With the increasing prevalence of coeliac disease, there is a need for alternative treatments to GFD. In this review, biological medication of gluten, relationship between gluten and gut microflora, effect of GFD on GIT microflora, and effect of probiotics on CD were reviewed. By analysing the research progress on relationship between gluten and gastrointestinal microbiome in coeliac disease, this review tried to explore the prospective and potential mechanism of microecological agents in treating coeliac disease.

Objective: To explore the influencing factors and logistic regression characteristics of cryptogenic stroke in patients with positive transcranial doppler bubble test (c-TCD). Methods: A total of 134 cases of cryptogenic stroke that were diagnosed by Tianshui First People’s Hospital from November 2018 to April 2020 were selected according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification criteria. According to c-TCD results, there were 70 cases of right to left shunt that were included in the positive group and 64 cases without right to left shunt in the negative group. Gender, age, smoking, diabetes, hypertension, and factors affecting the positive rate of foam were analyzed. According to the abnormal embolism scale scores, logistic regression equation was used to analyze the independent influencing factors. Results: The influencing factors of cryptogenic stroke in patients with positive c-TCD were correlated with age, gender, and abnormal embolism scale scores (p < 0.05). For each grade increase in age, the proportion of positive foam test was calculated to be 3.21 times, and the proportion of female to male was calculated to be 2.25 times. For each grade increase in the scores, the proportion of positive foam test was calculated to be 2.55 times. Conclusion: Female, older age, and higher scores in the abnormal embolism scale are the influencing factors for cryptogenic stroke in patients with positive c-TCD.

Introduction: Hyperbaric oxygen (HBO) has been used for the treatment of cerebral palsy for more than 20 years, but its efficacy and safety are still controversial. In this systematic review and meta-analysis, we evaluated the currently promulgated data related to the efficacy of HBO for patients with cerebral palsy. Methods: We searched the PubMed/Medline, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases (from their inception to April 2020) for randomized controlled trials published in English or Chinese. Two researchers used the Cochrane Collaboration tool for data extraction and an independent quality assessment. The extracted data were analyzed by Review Manager 5.3 software. Results: A total of 25 studies consistent with the inclusion criteria were included, with a total of 2,146 people, which included 1,185 participants in the HBO group and 961 in the control group. This meta-analysis showed that when compared with the controls, HBO therapy can improve the gross motor functions evaluated by the Gross Motor Function Measure (n = 696, SMD 0.29, 95% CI [0.07–0.51], Z = 2.62, p = 0.009) and Gross Motor Function Classification System (n = 248, MD –0.40, 95% CI [–0.52 to –0.27], Z = 6.28, p < 0.00001), global developmental level evaluated by Gesell (n = 560, RR 1.30, 95% CI [1.19–1.42], Z = 6.03, p < 0.00001) and developmental quotient (n = 374, MD 8.25, 95% CI [6.48–10.01], Z = 9.15, p < 0.00001) and language expression (n = 270, MD 4.34, 95% CI [2.30–6.38], Z = 4.17, p < 0.00001) and comprehension (n = 270, MD 4.87, 95% CI [2.87–6.88], Z = 4.76, p < 0.00001). HBO therapy only caused mild ear pain. However, the quality of the data for all outcomes evaluated by the Grading of Recommendations Assessment, Development, and Evaluation analysis was very low. Conclusions: HBO therapy may produce a much more efficient clinical experiment result than the control group with cerebral palsy patients, and HBO therapy is well tolerated and relatively safe for the included participants.

This paper proposes an organic photodiode (OPD) image sensor based on indium zinc oxide (IZO) thin-film transistors (TFTs). The sensor array has a $256\times256$ pixel format with a $50~\mu \text{m}$ pixel size. The continuous OPD fabricated by the solution process is stacked vertically on the top of the IZO TFT backplane. A measurement system is built based on the readout IC driven by the field programmable gate array (FPGA). It is shown that the optical image can be successfully detected by the sensor array with good clarity and high quality. With a leakage current of the IZO TFT as low as $5\times 10^{\vphantom {D^{l}}-14}$ A and a dark current of OPD as low as $10^{-13}$ A, the total electronic noise is less than 683 e−.

Previous studies have suggested that enteral nasogastric nutrition is more effective and safer for patients with moderate-severe acute pancreatitis (MSAP). The aim of this study was to compare the efficacy and safety of nasogastric feeding (NGF) with total parenteral nutrition (TPN) in patients diagnosed with MSAP. Patients were divided into two groups according to the type of feeding they received (117 in the NGF group and 70 in the TPN group), after which the ratio of transferred to severe acute pancreatitis (SAP), ICU admission rate, mortality, feeding associated complications (diarrhea, abdominal distension, abdominal pain), extra-pancreatic infection, hospitalization time were compared. No difference in the ratio of transferred to SAP and the ICU admission rate was found between groups (2.7% vs. 2.6% and 2.7% vs. 2.6%, respectively). No patient died in any of the two groups. The feeding associated complications (diarrhea, abdominal distension, abdominal pain) were seen more often in the NGF group than in the TPN group, yet no significantly statistical difference was observed. Moreover, the NGF group had significantly shorter hospitalization time (8.9 d vs. 10.9 d, P = 0.032) and a lower rate of extrapancreatic infection compared to the TPN group (2.7% vs. 3.9%; P = 0.025). To sum up, NGF seems to be safer and more effective than TPN when treating patients with MSAP.

The paper proposes an ultrahigh sensitivity microwave sensor for retrieving the complex permittivity of the liquid sample. The proposed sensor originally evolves from the complementary split-ring resonator-based sensor, which confines the electric field in the slot of the resonator. A complementary electric-LC resonator structure is applied to substitute the CSRR due to its excellent ability of concentrating the electric field. To further improve the field confinement, a meander slot is embedded in the central arm of the resonator. Then, two etched complementary split-ring resonators are added on both sides of the central meander arm of the modified complementary electric-LC resonator. A polydimethylsiloxane microfluidic channel substrate is placed on the meander arm, and a mixture of water-ethanol is injected. The variations in the resonant frequency and peak attenuation are used to retrieve the complex permittivity of the injected liquid sample. The developed sensors are fabricated and tested, and a good agreement is observed between measured data and reference values. The peak sensitivities in retrieving the relative permittivity achieve 2.5% and 2.71% with the proposed sensors, which are much higher than previously reported designs.

BACKGROUND In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM. AIM To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study. METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels (n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile. RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels (P < 0.001) and higher HOMA2-IR levels (P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40–11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60–2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors. CONCLUSION Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

PURPOSE The net uptake rate constant (Ki ) derived from dynamic imaging is considered the gold standard quantification index for FDG PET. In this study, we investigated the feasibility and assessed the clinical usefulness of generating Ki images for FDG PET using only two 5-min scans with population-based input function (PBIF). METHODS Using a Siemens Biograph mCT, 10 subjects with solid lung nodules underwent a single-bed dynamic FDG PET scan and 13 subjects (five healthy and eight cancer patients) underwent a whole-body dynamic FDG PET scan in continuous-bed-motion mode. For each subject, a standard Ki image was generated using the complete 0-90 min dynamic data with Patlak analysis (t* = 20 min) and individual patient's input function, while a dual-time-point Ki image was generated from two 5-min scans based on the Patlak equations at early and late scans with the PBIF. Different start times for the early (ranging from 20 to 55 min with an increment of 5 min) and late (ranging from 50 to 85 min with an increment of 5 min) scans were investigated with the interval between scans being at least 30 min (36 protocols in total). The optimal dual-time-point protocols were then identified. Regions of interest (ROI) were drawn on nodules for the lung nodule subjects, and on tumors, cerebellum, and bone marrow for the whole-body-imaging subjects. Quantification accuracy was compared using the mean value of each ROI between standard Ki (gold standard) and dual-time-point Ki , as well as between standard Ki and relative standardized uptake value (SUV) change that is currently used in clinical practice. Correlation coefficients and least squares fits were calculated for each dual-time-point protocol and for each ROI. Then, the predefined criteria for identifying a reliable dual-time-point Ki estimation for each ROI were empirically determined as: (1) the squared correlation coefficient (R2 ) between standard Ki and dual-time-point Ki is larger than 0.9; (2) the absolute difference between the slope of the equality line (1.0) and that of the fitted line when plotting standard Ki versus dual-time-point Ki is smaller than 0.1; (3) the absolute value of the intercept of the fitted line when plotting standard Ki versus dual-time-point Ki normalized by the mean of the standard Ki across all subjects for each ROI is smaller than 10%. Using Williams' one-tailed t test, the correlation coefficient (R) between standard Ki and dual-time-point Ki was further compared with that between standard Ki and relative SUV change, for each dual-time-point protocol and for each ROI. RESULTS Reliable dual-time-point Ki images were obtained for all the subjects using our proposed method. The percentage error introduced by the PBIF on the dual-time-point Ki estimation was smaller than 1% for all 36 protocols. Using the predefined criteria, reliable dual-time-point Ki estimation could be obtained in 25 of 36 protocols for nodules and in 34 of 36 protocols for tumors. A longer time interval between scans provided a more accurate Ki estimation in general. Using the protocol of 20-25 min plus 80-85 or 85-90 min, very high correlations were obtained between standard Ki and dual-time-point Ki (R2 = 0.994, 0.980, 0.971 and 0.925 for nodule, tumor, cerebellum, and bone marrow), with all the slope values with differences ≤0.033 from 1 and all the intercept values with differences ≤0.0006 mL/min/cm3 from 0. The corresponding correlations were much lower between standard Ki and relative SUV change (R2 = 0.673, 0.684, 0.065, 0.246). Dual-time-point Ki showed a significantly higher quantification accuracy with respect to standard Ki than relative SUV change for all the 36 protocols (p

The impacts of body mass index (BMI) on the prognosis of primary IgA nephropathy (IgAN) remain controversial. This systematic review and meta-analysis aimed to solve these issues. We searched the PubMed, EMBASE, and Cochrane Library to screen articles investigating the BMI and primary IgAN. BMI was classified according to the World Health Organization as high (≥ 25.0 kg/m2) and low (

BACKGROUND Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection. AIM To manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome. METHODS One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups. RESULTS The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases). CONCLUSION Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.

Cephalopods can swiftly merge into the surroundings by changing their skin color even without the involvement of brains. Inspired by this ability, we designed a tunable, environment- adaptive camouflagic artificial reflex arc that can independently activate electrochromism in response to optical stimuli. The receptor of this arc consists in a light-stimulated synaptic transistor (LSST) that also performs synaptic functions, e.g., excitatory post-synaptic current (EPSC) generation, paired-pulse facilitation (PPF), high-pass filtering, and modulation. Amplified EPSC causes color transform of an electrochromic device (ECD) upon external optical stimuli. We emulate the phenomenon that an octopus changes color according to the background light with or without intentional modulation to demonstrate the camouflage effect of our device.

Summary Background & aims Prospective and longitudinal data on the association between acylcarnitines and gestational diabetes (GDM) are lacking. This study aims to prospectively investigate 28 acylcarnitines in relation to subsequent GDM risk. Methods Within the NICHD Fetal Growth Studies-Singleton Cohort, plasma levels of acylcarnitines and cardiometabolic biomarkers were measured at gestational week (GW) 10–14, 15–26, 23–31, and 33–39 among 107 GDM cases and 214 controls. Results At GW 10–14, per standard deviation (SD) increased level of C14:1-OH was associated with a 55% increased risk of GDM after adjusting for major risk factors for GDM [OR (95% CI): 1.55 (1.05–2.29)]. At GW 15–26, C4, C8:1 and C16:1-OH were associated with an increased risk of GDM [OR (95% CI) for per SD increase: 1.42 (1.01–2.00), 1.41 (1.02–1.96), and 1.77 (1.10–2.84), respectively]. Whereas increased C10 and C18 were related to lower risk of GDM [OR (95% CI) for per SD increase: 0.74 (0.55–1.00), and 0.69 (0.49–0.97), respectively]. Moreover, we observed correlations of individual acylcarnitine with multiple clinical markers implicated in glucose homeostasis and cardiometabolic function among non-GDM women. Conclusions Our results demonstrate that several plasma acylcarnitine species are differentially associated with GDM risk by chain length. Future studies are warranted to investigate the distinct roles of individual acylcarnitine in glucose homeostasis in pregnancy.

The uncertainty of both the generation side and the user side brings certain impacts on the source‐load coordinated operation of integrated energy system (IES). At first, the source‐load characteristics of the IES with large‐scale distributed energy is analyzed. Secondly, considering lower operating cost and higher renewable energy consumption rate, a bilevel optimization model of the source‐load coordination based on the IES operation structure is established, which considers the uncertainty of both the generation side, such as wind and photovoltaic (PV) power output, and the load side. The robust optimization theory and stochastic chance‐constrained programming theory are introduced to establish the upper layer and the lower layer models of the IES. Besides, the firefly algorithm is used to design the solution process of the bilevel optimization model. The results show that the uncertainty of the wind power, PV power, and the load are positively correlated with the comprehensive operation cost. Also, based on the full consideration of the bilevel uncertainties, the system operation cost is significantly reduced. Meanwhile, the improvement of the confidence level of the objective function and constraint conditions will enhance the optimistic value of the comprehensive operation cost of the system, which means gaining higher reliability by sacrificing partial system benefits. Overall, the bilevel optimization model considering the source‐load uncertainty can both improve the renewable energy consumption rate and reduce the comprehensive operation cost of the IES system.

Shujuan Chu,1 Zhilin Wu,1 Zhouyang Wu,1 Jing Wu,1 Yue Qian2 1Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 2Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of ChinaCorrespondence: Jing Wu; Yue Qian Email tounj_002@163.com; qianyue011@sohu.comBackground: The causal relationship between insomnia and migraine is contradictory and no study has been carried out among the Chinese population to date.Methods: In this case, we conducted a case–control study and a bidirectional mendelian randomization (MR) analysis to determine whether insomnia is causally related to the development of migraine. The instrumental variables for insomnia were derived from the largest genome-wide association study of 1,331,010 participants, while the genetic instruments for migraine were available from the largest meta-analysis of migraine with 59,674 cases and 316,078 controls.Results: In case–control study, subjects with insomnia have significantly higher risk of migraine (OR=4.29, 95% CI: 3.21– 5.74, P< 0.001), compared with those without insomnia. The bidirectional two-sample MR analysis revealed that insomnia was significantly associated with higher risk of migraine (OR=1.24, 95% CI: 1.11– 1.38, P=1.01× 10-4), and the results were validated in the UK Biobank data. The results showed no indication for directional pleiotropy effects as assessed by the MR-Egger intercept (P> 0.05).Conclusion: Conclusively, our study highlighted that increased migraine risk was confined to subjects with a genetic pre-disposition to insomnia, and these findings had potential implications for improving the sleep quality to reduce the burden of migraine.Keywords: mendelian randomization, insomnia, migraine, case–control

In this study, we developed radiomic models that utilize a combination of imaging features and clinical variables to distinguish endometrial cancer (EC) from normal endometrium on routine computed tomography (CT). A total of 926 patients consisting of 416 endometrial cancer (EC) and 510 normal endometrium were included. The CT images of these patients were segmented manually, and divided into training, validation, testing and external testing sets. Non-texture and texture features of these images with endometrium or uterus as region of interest were extracted. The clinical feature “age” was also included in the feature set. Feature selection and machine learning classifier were applied to normalized feature set. This manual optimized combination was then compared with the best pipeline exported by Tree-Based Pipeline Optimization Tool (TPOT) on testing and external testing set. The performances of these machine learning pipelines were compared to that of radiologists. The manual expert optimized pipeline using the “reliefF” feature selection method and “Bagging” classifier on the external testing set achieved a test ROC AUC of 0.73, accuracy of 0.73 (95% CI 0.62–0.82), sensitivity of 0.64 (95% CI 0.45–0.79), and specificity of 0.78 (95% CI 0.65–0.87), while TPOT achieved a test ROC AUC of 0.79, accuracy of 0.80 (95% CI 0.70–0.87), sensitivity of 0.61 (95% CI 0.43–0.77), and specificity of 0.90 (95% CI 0.78–0.96). When compared to average radiologist performance, the TPOT achieved higher test accuracy (0.80 vs. 0.49, p