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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...

Recently, a popular line of research in face recognition is adopting margins in the well-established softmax loss function to maximize class separability. In this paper, we first introduce an Additive Angular Margin Loss (ArcFace), which not only has a clear geometric interpretation but also significantly enhances the discriminative power. Since ArcFace is susceptible to the massive label noise, we further propose sub-center ArcFace, in which each class contains $K$ sub-centers and training samples only need to be close to any of the $K$ positive sub-centers. Sub-center ArcFace encourages one dominant sub-class that contains the majority of clean faces and non-dominant sub-classes that include hard or noisy faces. Based on this self-propelled isolation, we boost the performance through automatically purifying raw web faces under massive real-world noise. Besides discriminative feature embedding, we also explore the inverse problem, mapping feature vectors to face images. Without training any additional generator or discriminator, the pre-trained ArcFace model can generate identity-preserved face images for both subjects inside and outside the training data only by using the network gradient and Batch Normalization (BN) priors. Extensive experiments demonstrate that ArcFace can enhance the discriminative feature embedding as well as strengthen the generative face synthesis., Comment: ArcFace TPAMI version

Esophageal squamous cell carcinoma (ESCC) is a major histological subtype of esophageal cancer with a poor prognosis. Although several serum metabolomic investigations have been reported, ESCC tumor-associated metabolic alterations and predictive biomarkers in sera have not been defined. Here, we enrolled 34 treatment-naive patients with ESCC and collected their pre- and post-esophagectomy sera together with the sera from 34 healthy volunteers for a metabolomic survey. Our comprehensive analysis identified ESCC tumor-associated metabolic alterations as represented by a panel of 12 serum metabolites. Notably, postoperative abrosia and parenteral nutrition substantially perturbed the serum metabolome. Furthermore, we performed an examination using sera from carcinogen-induced mice at the dysplasia and ESCC stages and identified three ESCC tumor-associated metabolites conserved between mice and humans. Notably, among these metabolites, the level of pipecolic acid was observed to be progressively increasing in mouse sera from dysplasia to cancerization, and it could be used to accurately discriminate between mice at the dysplasia stage and healthy control mice. Furthermore, this metabolite is essential for ESCC cells to restrain oxidative stress-induced DNA damage and cell proliferation arrest. Together, this study revealed a panel of 12 ESCC tumor-associated serum metabolites with potential for monitoring therapeutic efficacy and disease relapse, presented evidence for refining parenteral nutrition composition, and highlighted serum pipecolic acid as an attractive biomarker for predicting ESCC tumorigenesis.

Adaptive-Network-based Fuzzy Inference System, ANFIS, offers a popular and powerful fuzzy inference mechanism. As with many other advanced data driven techniques, developing an effective ANFIS typically requires sufficient training data. However, in many real-world applications it is not always straightforward to obtain a large amount of representative data that covers the entire problem space to accomplish the required training, seriously restricting the performance of a learned ANFIS. This paper introduces a new ANFIS learning approach through an evolutionary process, which is able to generate an ANFIS with only a small number of training data in a certain problem region, by interpolating well trained ANFISs in the neighbouring regions. Such a process works by firstly producing an initial population of candidate fuzzy rules in the region of data shortage, through interpolating a rule dictionary constructed from trained ANFISs in the neighbourhood regions. The crossover and mutation operations over these candidate rules are then executed in an effort to attain candidates of improved performance. When this genetic learning process terminates the chromosomes in the final population either collectively form or each individually represent a learned ANFIS, depending on whether a single fuzzy rule or a set of fuzzy rules representing an entire ANFIS is implemented with a chromosome within the evolving population. Comparative experimental evaluations on both synthetic and real world datasets are carried out, demonstrating that in spite of data shortage, the proposed interpolation approach is able to produce ANFIS models that significantly outperform those trained using existing learning mechanisms.

OBJECTIVE Delta-24-RGD is an oncolytic adenovirus that is capable of replicating in and killing human glioma cells. Although intratumoral delivery of Delta-24-RGD can be effective, systemic delivery would improve its clinical application. Bone marrow–derived human mesenchymal stem cells (BM-hMSCs) obtained from healthy donors have been investigated as virus carriers. However, it is unclear whether BM-hMSCs can be derived from glioma patients previously treated with marrow-toxic chemotherapy or whether such BM-hMSCs can deliver oncolytic viruses effectively. Herein, the authors undertook a prospective clinical trial to determine the feasibility of obtaining BM-hMSCs from patients with recurrent malignant glioma who were previously exposed to marrow-toxic chemotherapy. METHODS The authors enrolled 5 consecutive patients who had been treated with radiation therapy and chemotherapy. BM aspirates were obtained from the iliac crest and were cultured to obtain BM-hMSCs. RESULTS The patient-derived BM-hMSCs (PD-BM-hMSCs) had a morphology similar to that of healthy donor–derived BM-hMSCs (HD-BM-hMSCs). Flow cytometry revealed that all 5 cell lines expressed canonical MSC surface markers. Importantly, these cultures could be made to differentiate into osteocytes, adipocytes, and chondrocytes. In all cases, the PD-BM-hMSCs homed to intracranial glioma xenografts in mice after intracarotid delivery as effectively as HD-BM-hMSCs. The PD-BM-hMSCs loaded with Delta-24-RGD (PD-BM-MSC-D24) effectively eradicated human gliomas in vitro. In in vivo studies, intravascular administration of PD-BM-MSC-D24 increased the survival of mice harboring U87MG gliomas. CONCLUSIONS The authors conclude that BM-hMSCs can be acquired from patients previously treated with marrow-toxic chemotherapy and that these PD-BM-hMSCs are effective carriers for oncolytic viruses.

This study aimed to explore the analgesic effect among adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block, ACB, and IPACK block following total knee arthroplasty (TKA).One hundred twenty patients were randomly allocated into 3 groups including group A (ACB + IPACK block), group B (ACB), and group C (IPACK block). The primary outcome was postoperative pain score. The secondary outcome was opioid consumption. Other outcomes included functional evaluation and postoperative complications.Group A showed the lowest pain scores within 8 hours at rest and with knee maximum flexion (P.001). From 12 to 24 hours, group C showed the highest pain scores, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups 24 hours postoperatively. Group C showed the most opioid consumption within the first 24 hours and during the hospitalization, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups including function evaluation and postoperative complications.ACB + IPACK block can improve early analgesia when compared with ACB. However, the small statistical benefit to the addition of IPACK block to ACB may be unlikely to be clinically significant. Further studies may focus on patient selection and how to prolong the effect of IPACK block.

Local pseudorandom generators are a class of fundamental cryptographic primitives having very broad applications in theoretical cryptography. Following Couteau et al.'s work in ASIACRYPT 2018, this paper further studies the concrete security of one important class of local pseudorandom generators, i.e., Goldreich's pseudorandom generators. Our first attack is of the guess-and-determine type. Our result significantly improves the state-of-the-art algorithm proposed by Couteau et al., in terms of both asymptotic and concrete complexity, and breaks all the challenge parameters they proposed. For instance, for a parameter set suggested for 128 bits of security, we could solve the instance faster by a factor of about $2^{61}$, thereby destroying the claimed security completely. Our second attack further exploits the extremely sparse structure of the predicate $P_5$ and combines ideas from iterative decoding. This novel attack, named guess-and-decode, substantially improves the guess-and-determine approaches for cryptographic-relevant parameters. All the challenge parameter sets proposed in Couteau et al.'s work in ASIACRYPT 2018 aiming for 80-bit (128-bit) security levels can be solved in about $2^{58}$ ($2^{78}$) operations. We suggest new parameters for achieving 80-bit (128-bit) security with respect to our attacks. We also extend the attack to other promising predicates and investigate their resistance.

There is growing evidence that air pollution plays a role in TB, but few studies have comprehensively included the six common air pollutants. Our objectives were to investigate the association between short-term exposure to six common air pollutants and the risk of tuberculosis outpatient visits in Fuyang, China, during the period 2015-2020. We combined the two models to explore the effects of exposure to six air pollutants on the risk of tuberculosis outpatient visits, including Poisson generalized linear regression model and distributed lag non-linear model (DLNM). We performed stratified analyses for season, gender and age. We used the lag-specific relative risks and cumulative relative risk obtained by increasing pollutant concentration by per 10 units to evaluate the connection between six air pollutants and TB, PM2.5 (RR=1.0018, 95%CI: 1.0004-1.0032, delay of 12 days) and (RR=1.0169,95%CI: 1.0007-1.0333, lag 0-16 days), SO2 were 0.9549 (95%CI: 0.9389-0.9712, lag 0 days) and 0.8212 (95%CI: 0.7351-0.9173, 0-20 days lag). Stratified analyses showed that seasonal differences had a greater impact on TB, and male more likely to develop TB than female, older people more likely to develop TB than younger people. Exposure to O3, CO, PM10, PM2.5, and NO2 increases the risk of TB outpatient visits, except SO2 reduces the risk. Male and elderly people should be protected. We need to pay more attention to the impact of seasonal effects on TB.

Colorectal cancer (CRC) is a common malignancy of the gastrointestinal tract, which has the second highest incidence among gastrointestinal tumors. At present, due to the limitations of current CRC treatment strategies, there is an urgent need for developing more effective therapies. B7 family member H4 (B7-H4) is associated with the progression of a wide spectrum of cancers, but its functional role in CRC is unknown. The purpose of this study is to clarify the role of B7-H4 in CRC and the underlying mechanisms in controlling the progression of CRC. Our data showed that B7-H4 expression in CRC tissues and cell lines was significantly upregulated as compared with normal tissues and normal cell lines. High B7-H4 expression was correlated with a poor prognosis of CRC patients. B7-H4 overexpression promoted the proliferation and invasion of CRC cells, which could be suppressed by Wnt signaling inhibitor. In a mouse xenograft model, silencing B7-H4 suppressed tumor growth and epithelial–mesenchymal transition (EMT) of CRC cells. Collectively, our study demonstrated the oncogenic roles of B7-H4 in regulating the proliferation, EMT as well as the migration of CRC cells through Wnt signaling pathway. The heightened expression of B7-H4 could serve as a prognostic marker for CRC patients.

Previous studies have shown that the ATP-P2X4 receptor signaling pathway mediates the activation of the Nod-like receptor family protein 3 (NLRP3) inflammasome. The NLRP3 inflammasome may promote renal interstitial inflammation in diabetic nephropathy. As inflammation also plays an important role in the pathogenesis of Parkinson's disease, we hypothesized that the ATP-P2X4 receptor signaling pathway may activate the NLRP3 inflammasome in Parkinson's disease. A male rat model of Parkinson's disease was induced by stereotactic injection of 6-hydroxydopamine into the pars compacta of the substantia nigra. The P2X4 receptor and the NLRP3 inflammasome (interleukin-1β and interleukin-18) were activated. Intracerebroventricular injection of the selective P2X4 receptor antagonist 5-(3-bromophenyl)-1,3-dihydro-2H-benzofuro[3,2-e]-1,4-diazepin-2-one (5-BDBD) or knockdown of P2X4 receptor expression by siRNA inhibited the activation of the NLRP3 inflammasome and alleviated dopaminergic neurodegeneration and neuroinflammation. Our results suggest that the ATP-P2X4 receptor signaling pathway mediates NLRP3 inflammasome activation, dopaminergic neurodegeneration, and dopamine levels. These findings reveal a novel role of the ATP-P2X4 axis in the molecular mechanisms underlying Parkinson's disease, thus providing a new target for treatment. This study was approved by the Animal Ethics Committee of Qingdao University, China, on March 5, 2015 (approval No. QYFYWZLL 26119).

Summary Background Over the past 20 years, schistosomiasis control has been scaled up. Preventive chemotherapy with praziquantel is the main intervention. We aimed to assess the effect of preventive chemotherapy on schistosomiasis prevalence in sub-Saharan Africa, comparing 2000–10 with 2011–14 and 2015–19. Methods In this spatiotemporal modelling study, we analysed survey data from school-aged children (aged 5–14 years) in 44 countries across sub-Saharan Africa. The data were extracted from the Global Neglected Tropical Diseases database and augmented by 2018 and 2019 survey data obtained from disease control programmes. Bayesian geostatistical models were fitted to Schistosoma haematobium and Schistosoma mansoni survey data. The models included data on climatic predictors obtained from satellites and other open-source environmental databases and socioeconomic predictors obtained from various household surveys. Temporal changes in Schistosoma species prevalence were estimated by a categorical variable with values corresponding to the three time periods (2000–10, 2011–14, and 2015–19) during which preventive chemotherapy interventions were scaled up. Findings We identified 781 references with relevant geolocated schistosomiasis survey data for 2000–19. There were 19 166 unique survey locations for S haematobium and 23 861 for S mansoni, of which 77% (14 757 locations for S haematobium and 18 372 locations for S mansoni) corresponded to 2011–19. Schistosomiasis prevalence among school-aged children in sub-Saharan Africa decreased from 23·0% (95% Bayesian credible interval 22·1–24·1) in 2000–10 to 9·6% (9·1–10·2) in 2015–19, an overall reduction of 58·3%. The reduction of S haematobium was 67·9% (64·6–71·1) and that of S mansoni 53·6% (45·2–58·3) when comparing 2000–10 with 2015–19. Interpretation Our model-based estimates suggest that schistosomiasis prevalence in sub-Saharan Africa has decreased considerably, most likely explained by the scale-up of preventive chemotherapy. There is a need to consolidate gains in the control of schistosomiasis by means of preventive chemotherapy, coupled with other interventions to interrupt disease transmission. Funding European Research Council and WHO.

Background The COVID-19 frontline nurses' stress-reduction program by the cooperation of manager with the nurses is not-well developed. Aim This study aimed to examine the effect of an emergency nurse-led stress reduction project on reducing stress levels during the COVID-19 pandemic. Methods The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress, and needs at the 50th, 80th, and 110th days of the pandemic from March to May 2020. Results The numbers of nurses participating in three-time survey were 160, 166, and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from PPE, information about infection control, family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information, and a forum for sharing experiences of COVID-19 care decreased while needs of allowing more days off increased. Conclusions The stress-reduction project targeting at nurses' views of their needs can reduce their' stress during the COVID-19 pandemic. Implication for nursing management The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.

Ferroelectric materials are considered as a promising candidate for photovoltaic devices owing to spontaneous polarization which may affect the photocarrier dynamics and raise photovoltaic effect. However, the interaction mechanism between the ferroelectric polarization and the photocarrier dynamics is still unclear, which limits the practical applications of this kind of materials. Here, we used femtosecond time-resolved reflectance measurements to monitor the photocarrier dynamics of PbTi1-xNixO3 (PTNO) films with different Ni doping concentrations, therefore the samples have different ferroelectric polarizations. We found that in the PTNO films with larger polarizations, the photocurrents are higher and the photocarriers recombined slower. We deduce that the depolarization fields are stronger in films with larger polarizations, and the photogenerated electrons and holes are separated more effectively. The recombination of photocarriers is retarded and the photocurrent is improved. Our study supplies a novel way for the enhancement of photovoltaic performances of ferroelectric material.

Background: Despite the implementation of the universal salt iodization (USI) program for correction of iodine deficiency in China for ∼20 years, the actual iodine nutrition status of Chinese residents and the prevalence of iodine deficiency and iodine excess are issues that need to be addressed. This nationally representative cross-sectional study was conducted across all 31 provinces of mainland China to gather extensive data on iodine nutrition status and the influential factors. Methods: This study included 78,470 participants, aged 18 years or older, who were interviewed and asked to answer a questionnaire. Urine iodine concentration (UIC) was measured by the inductively coupled plasma mass spectrometry method, and goiter was examined by thyroid ultrasonography. In addition, sixty 9-11 years old school children in each province were randomly selected to evaluate the UIC and thyroid ultrasonography. The iodine nutrition status was determined according to the World Health Organization guidelines. Results: The iodized salt coverage was 95.37%. The median urine iodine (MUI) was 177.89 μg/L (interquartile range [IQR], 117.89-263.90 μg/L) and goiter prevalence was 1.17% (confidence interval [95% CI 0.95-1.43]) in the adult population. The MUI was 199.75 μg/L (IQR, 128.41-303.37 μg/L) in school-age children, and goiter prevalence was 3.50% [95% CI, 2.93-4.13]. The percentage of individuals with UIC

This study aims to explore social bots' role in online climate change discussions. By analyzing 491,279 climate-change-related tweets, we found that social bots were actively engaged in climate change discussions on Twitter and contributed up to 1.5.4% of related contents. Bots promote the saliency of energy, climate actions and climate strikes on public agenda. 83.1% of tweets posted by social bots support climate change activism, and 16.9% support climate change skepticism. However, social bot skeptics are more strategical than social bot activists in terms of launching conversations with opposing-minded humans, and avoiding amplification of opposing voices. They are also more successful in inciting opposing-minded humans' initiative conversation and like-minded humans' amplification. Based on the above findings, we suggest cultivating individuals’ media literacy in terms of distinguishing malicious social bots as a potential solution to deal with social bot skeptics disguised as humans, as well as making use of benign social bots for science popularization.

With the deepening of diversified and professional business philosophy in large enterprises, enterprises play more and more abundant social functions in society. Sense of mission and honor play an important role in the healthy development of enterprises. With the in-depth integration of enterprise management and computer technology, some human resource management problems related to corporate social responsibility often appear in this process. From the traditional human resource management paradigm to people-oriented social responsibility human resource management, “strengthening effectiveness” has become the main research direction of enterprise management in the electronic age. On this basis, through the discrete modeling method of a large amount of data, this paper creatively puts forward the coupling correlation between corporate social responsibility and enterprise human resource management based on grey correlation algorithm. Compared with the management mode based on trapezoidal data analysis and cluster center adopted in the current mainstream enterprise human resource management research, the innovation of this algorithm is to analyze the dynamic data of corporate social responsibility and enterprise human resources and establish a coupling model related to corporate social responsibility. It can not only realize the dynamic tracking of human resource data, but also make full use of the relevant characteristic information of the coupling relationship between enterprise human resource management and corporate social responsibility. According to the dynamic big data such as employee welfare, employee compensation, employee training, employee overtime, and timeliness of transaction processing, this paper analyzes the social problems such as corporate social responsibility evaluation index, employee turnover rate, and enterprise income, so as to provide theoretical support for enterprise business strategy.

AIM: To evaluate therapeutic outcomes of human umbilical cord-derived mesenchymal stem cells (HUC-MSCs) treatment in patients with refractory uveitis. METHODS: A retrospective and noncomparative review was performed on four patients with refractory uveitis from December 2013 to December 2017. HUC-MSCs were administered intravenously at a dose of 1×106 cells/kg. Clinical response, relapse rate, change of visual acuity, and other metrics were evaluated. RESULTS: All four patients presented with responses to HUC-MSCs treatment, with three males and one female. The numbers of uveitis attacks per year after the HUC-MSCs treatment (0, 2, 0, 0 respectively) all decreased compared with the numbers before the treatment (3, 6, 4, 4 respectively). The oral steroid and immunosuppressive agents were tapered in all patients without recrudescence of ocular inflammation, and three patients discontinued their oral medicine at the last visit. The best corrected visual acuity (BCVA) of 3 patients was improved to varying degrees, and the BCVA of 1 patient remained at 20/20 (Snellen chart) from the first to the last consultation. CONCLUSION: The study provides an effective therapy of HUC-MSCs in maintaining remission in patients affected by uveitis refractory to previous immunosuppressant treatments.

Background Neuroimaging studies in posttraumatic stress disorder (PTSD) have identified various alterations in white matter (WM) microstructural organization. However, it remains unclear whether these are localized to specific regions of fiber tracts, and what diagnostic value they might have. This study set out to explore the spatial profile of WM abnormalities along defined fiber tracts in PTSD. Methods Diffusion tensor images were obtained from 77 treatment-naive noncomorbid patients with PTSD and 76 demographically matched trauma-exposed non-PTSD (TENP) controls. Using automated fiber quantification, tract profiles of fractional anisotropy, axial diffusivity, mean diffusivity, and radial diffusivity were calculated to evaluate WM microstructural organization. Results were analyzed by pointwise comparisons, by correlation with symptom severity, and for diagnosis-by-sex interactions. Support vector machine analyses assessed the ability of tract profiles to discriminate PTSD from TENP. Results Compared to TENP, PTSD showed lower fractional anisotropy accompanied by higher radial diffusivity and mean diffusivity in the left uncinate fasciculus, and lower fractional anisotropy accompanied by higher radial diffusivity in the right anterior thalamic radiation. Tract profile alterations were correlated with symptom severity, suggesting a pathophysiological relevance. There were no significant differences in diagnosis-by-sex interaction. Tract profiles allowed individual classification of PTSD versus TENP with significant accuracy, of potential diagnostic utility. Conclusions These findings add to the knowledge of the neuropathological basis of PTSD. WM alterations based on a tract-profile quantification approach are a potential biomarker for PTSD.

Broadband high-efficiency luminescent materials have become a hot spot in lead-free perovskite research. There are relatively few broadband yellow-green phosphors with both ultraviolet and blue excitation ranges, which make them more suitable for phosphor-converted white LEDs. Through the ion-exchanged strategy, Cs2Hf1-xTexCl6 (CH1-xTxC) vacancy halide double perovskites were successfully prepared at room temperature. Using different excitation ranges of CH1-xTxC, two types of high-quality white LEDs are obtained. By combining density functional theory calculations and experiments, it is proved that this bright broadband yellow-green emission (photoluminescence quantum yield of 83.46%) is not only derived from the ion transitions of Te4+ but also exhibits the inherent characteristics of self-trapped exciton emission. Our results not only broaden the application fields of lead-free halide perovskites but also provide further insights into the luminescence mechanism.

Automatic image captioning is an interesting task that lies at the intersection of computer vision and natural language processing. Although image captioning based on reinforcement learning has made significant progress in the past few years, the problem of inconsistent evaluation indicators for training and testing remains. Reinforcement learning optimizes a single metric, and the caption generated by the model is monotonous and non-characteristics. The model cannot reflect the diversity among images. In response to the above problems, we design a novel image captioning model based on lightweight spatial attention and a generative adversarial network. The lightweight spatial attention module discards the coarse-grained approach of maximum pooling after convolution and transforms the spatial information to preserve key information in the feature map. Then, the game mechanism between the generator and the discriminator is used to optimize the evaluation metric of the model. Finally, we design a discriminator network that cooperates with reinforcement learning to update the model parameters and objectively optimize the language metric inconsistencies between the evaluation and test indicators. We verified the effectiveness of the proposed model on the MS-COCO and Flickr 30K datasets. The experimental results show that the model proposed in this paper achieves state-of-the-art results.

This study aimed to evaluate the value of perfusion-weighted magnetic resonance imaging (MR-PWI) in assessing cerebral alveolar echinococcosis (CAE) biological activity.Totally, 15 cases of CAE patients who underwent surgery were enrolled. The MR-PWI perfusion parameters were measured and compared.The MR-PWI perfusion parameters cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time were different among different areas. Their values were in the descending order of lesion marginal areacontralateral normal brain arealesion center area. However, time-to-peak value was in the ascending order of lesion marginal areacontralateral normal brain arealesion center area. Spearman correlation analysis showed that CBF and CBV at the edge of the lesion were significantly positively correlated with microvessel density. Moreover, CBF and CBV at the edge of the lesion were also significantly positively correlated with maximum standardized uptake value.Perfusion-weighted magnetic resonance imaging can be used to dynamically reflect the neovascularization of CAE lesions and may have a good application prospect in evaluating the biological activity of CAE.

To investigate whether HBV genotype influences the effect of tenofovir and telbivudine on HBV DNA and RNA levels in HBsAg‐positive pregnant women. This was a retrospective study of 74 HBsAg‐positive pregnant women in Guizhou of China. All patients were treated with telbivudine or tenofovir from 12 weeks of pregnancy and HBV infection to the date of delivery. Blood samples were collected at 12–24, 28–32, and 36–40 weeks of pregnancy for the measurement of genotype, HBsAg, hepatitis B e antigen (HBeAg), HBV DNA, HBV RNA, and liver function, including alanine transaminase, aspartate transaminase, total bilirubin, total bile acids, cholinesterase, alkaline phosphatase (ALP), and gamma‐glutamyl transferase. All women with HBsAg were followed up. The HBV genotype was B in 64.9% and C in 35.1%. There were 37 patients of telbivudine and tenofovir group respectively. The telbivudine and tenofovir groups showed no differences in demographic and clinical characteristics, including liver function tests, HBsAg, HBeAg, log10(HBV DNA), and log10(HBV RNA). Compared with baseline (12–24 weeks), telbivudine group showed a significant increase in ALP and significant reductions in HBsAg, HBeAg, log10(HBV DNA), and log10(HBV RNA) at 36–40 weeks (p

Accurate high-definition maps with lane markings are often used as the navigation back-end for commercial autonomous vehicles. Currently, most high-definition maps are manually constructed by human labelling. Therefore, it is urgently required to propose a multi-class lane detection method that can automatically mark the road lanes to assist in generating high-precision maps for autonomous driving. We propose a lane segmentation detection method, named Lane-DeepLab, which is based on semantic segmentation for detecting multi-class lane lines in unmanned driving scenarios. The proposed method is based on the DeepLabv3+ network as the baseline, and we have redesigned the encoder-decoder structure to generate more accurate lane line detection results. More specifically, we restructure the atrous convolution at multi-scale by applying attention mechanism. Subsequently, we employ the Semantic Embedding Branch (SEB) to combine the high-level and low-level semantic information to obtain more abundant features, and use the Single Stage Headless (SSH) context module to obtain multi-scale information. Finally, we fuse the results to generate automatic high-precision mapping results. Our method has improved performance compared with other methods in the ApolloScape part of the dataset. Besides, in the database of Cityscapes, our approach has also achieved good results in semantic segmentation. Experimental results demonstrate that our proposed Lane-DeepLab can provide excellent performance in real traffic scenarios.

Fibroblast-like synoviocytes (FLS) obtained from the joint synovium of rheumatoid arthritis (RA) patients exhibit hyperplasia and aggressive inflammatory phenotypes. This study was designed to explore the anti-inflammatory mechanism of IL-6R inhibitor, tocilizumab, in FLS-mediated inflammation in RA from the perspective of non-coding RNAs (ncRNAs). To this end, we sorted primary FLS obtained from the synovium of patients with RA and cultured them in vitro. The cells were then treated with tocilizumab and subjected to lncRNA- and miRNA-seq to identify the ncRNAs regulated by tocilizumab treatment using bioinformatic analysis and experimental verification. Tocilizumab treatment enhanced the expression of lncRNA MIR31HG and reduced that of micoRNA-214 (miR-214). In addition, miR-214 activated the AKT signaling pathway by directly targeting MIR31HG and PTEN. In addition, the tocilizumab-MIR31HG-miR-214-PTEN-AKT axis regulated the proliferation, migration, and production of inflammatory molecules and matrix metalloproteinases (MMPs) in RA-FLS. Furthermore, co-culture experiments showed that this axis could inhibit the inflammatory phenotype of macrophages and protect chondrocytes. In summary, our study shows that tocilizumab suppresses RA-FLS inflammation by regulating the MIR31HG-miR-214-PTEN-AKT pathway, and presents new insights on RA pathogenesis and potential targets for RA therapy.

Identification of semen and spermatozoa is crucial in the forensic investigation of alleged sexual assault cases. In cases of alleged sexual assault where there is a long time gap between the incident and sample collection, or in cases of low sperm count, current methods have limitations of specificity, in the case of presumptive tests for semen, or the problem of recording spermatozoa by microscopy if they are few in number. A 3-plex MSRE-PCR (methylation-sensitive restriction enzyme-PCR) assay using a spermatozoa-specific DNA methylated marker to identify spermatozoa has been reported previously by our laboratory. A key advantage over current methods is the increased sensitivity and specificity. A transition from a research tool to operational use requires blind trial testing and inter-laboratory trials. We report on a collaborative exercise where reagents of the 3-plex MSRE-PCR were sent to six participating laboratories. Each laboratory used their own equipment, consumables, and the presumptive reagents conventionally for body fluid (such as acid phosphatase or PSA), DNA extraction, and quantification in practical casework. The reagents and protocol for the 3-plex MSRE-PCR assay and 9 samples were provided by the organizing laboratory. The participating laboratories were requested to fill in the questionnaire after testing. The reported results from all the six participating laboratories were concordant and the expected correct results for the presence of spermatozoa. These outcomes verified the reproducibility and feasibility of the 3-plex MSRE-PCR assay. The results also indicated that the 3-plex MSRE-PCR assay was readily accessible to forensic laboratories for integrating it into current forensic casework processes.

Face images, as an information carrier, are rich in sensitive information. Direct publication of these images would cause privacy leak, due to their natural weak privacy. Most of the existing privacy protection methods for face images adopt data publication under a non-interactive framework. However, the E-effect under this framework covers the entire image, such that the noise influence is uniform across the image. To solve the problem, this paper proposes region growing publication (RGP), an algorithm for the interactive publication of face images under differential privacy. This innovative algorithm combines the region growing technique with differential privacy technique. The privacy budget E is dynamically allocated, and the Laplace noise is added, according to the similarity between adjacent sub-images. To measure this similarity more effectively, the fusion similarity measurement mechanism (FSMM) was designed, which better adapts to the intrinsic attributes of images. Different from traditional region growing rules, the FSMM fully considers various attributes of images, including brightness, contrast, structure, color, texture, and spatial distribution. To further enhance algorithm feasibility, RGP was extended to atypical region growing publication (ARGP). While RGP limits the region growing direction between adjacent sub-images, ARGP searches for the qualified sub-images across the image, with the aid of the exponential mechanism, thereby expanding the region merging scope of the seed point. The results show that our algorithm can satisfy E-differential privacy, and the denoised image still have a high availability.

Summary Background and objectives Juvenile idiopathic arthritis (JIA), an autoimmune disease, has been proposed to be comorbid with obstructive sleep apnoea (OSA). We aimed at testing the hypothesis that patients with JIA may presented with high risk of OSA in a cohort study. Subjects and methods This is a cohort study including patients with JIA from 1999 to 2013 identified from a longitudinal health registry. A matched non-JIA control group was also included. The primary outcome variable was presence of OSA. A Cox proportional hazard model was developed to estimate the risk of OSA in patients with JIA. A cumulative probability model was adopted to assess the time-dependent effect of JIA on OSA development, implying a causal link of the association. Results A total of 2791 patients with JIA were included, and 11 164 individuals without JIA were selected as matched controls. A total of 95 included subjects had OSA: 31 in the JIA group and 64 in the control group. Patients with JIA were more likely to have OSA compared with controls (adjusted hazard ratio, aHR = 1.922, 95% confidence interval [CI] = 1.244–2.970). The incidence of developing OSA was particularly high among patients with JIA-associated deformity that presented at age 18–30 years (aHR = 1.993, 95% CI = 1.277–3.113) and males (aHR = 1.786, 95% CI = 1.097–2.906). The risk of developing OSA increased over 60 months (aHR = 2.523, 95% CI = 1.322–4.815) of follow-up after the JIA diagnosis. Conclusions Patients with JIA have a significantly increased risk of developing OSA compared with matched individuals without JIA.

Flat foot can alter the lower limb alignment and cause knee and back pain. To explore the association between flat foot and spinal degeneration.By using a claims dataset containing 1 million random samples, individuals with flat foot were identified between January 1, 2000, and December 31, 2013. The study assembled a flat foot group and a matched non-flat foot group. Definition of flat foot was according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The diagnosis date was defined as the index date for follow-up initiation. The follow-up period was defined as the duration from the index date (or nested index date for controls) to the occurrence of spinal degenerative joint disease (DJD), or December 31, 2013. The primary outcome was record of spinal DJD retrieved from the same database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with the control group as a reference.We identified 13,965 patients (most aged30 years, 88%); 2793 patients were assigned to the flat foot group and 11,172 individuals to the non-flat foot group matched by age, sex, and index year. The mean follow-up duration was approximately 74 months. In total, 329 (11.78%) patients in the study group and 931 (8.33%) patients in the comparison group developed spinal DJD. The adjusted HR (95% CI) of spinal DJD for study group was 1.423(1.250-1.619) compared with the control. Sensitivity analyses with propensity score match and different scenario about spinal DJD enrollment showed similar results. Subgroup analysis showed that in patients aged45 years with history of flat foot, the adjusted hazard ratios were 1.434, 3.065, 3.110, and 2.061 in association with spondylosis, intervertebral disc disorder, cervical stenosis, thoracic-lumbar-sacral stenosis, respectively.Flat foot was found to be an independent risk factor for subsequent spinal DJD.

Objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has significantly impacted the global public health system, making nucleic acid detection an important tool in epidemic prevention and control. Detection kits based on real-time reverse transcriptase polymerase chain reaction (rRT-PCR) have been widely used in clinics, but their analytical sensitivity (limit of detection) remains controversial. Moreover, there is limited research evaluating the analytical sensitivity of other molecular detection kits. Methods In this study, we used self-developed armored ribonucleic acid reference materials to evaluate the analytical sensitivity of SARS-CoV-2 detection kits approved by the National Medical Products Administration. These were based on rRT-PCR and other molecular detection assays. Results The percentage re-testing required with rRT-PCR kits is as follows: 0%, 7.69%, 15.38%, and 23.08% for samples with concentrations ranging from 50,000 to 781 copies/mL. In total, 93% of rRT-PCR kits had a limit of detection (LOD) 1000 copies/mL. The LOD of other molecular detection kits ranged from 68 to 2,264 copies/mL. Conclusions Our findings can help pharmaceutical companies optimize and improve detection kits, guide laboratories in selecting kits, and assist medical workers in their daily work., Graphical Abstract Graphical Abstract Image, graphical abstract.

This study aimed to explore the efficacy of two unique combinations of nerve blocks on postoperative pain and functional outcome after total knee arthroplasty (TKA).Patients scheduled for TKA were randomized to receive a combination of adductor canal block (ACB) + infiltration between the popliteal artery and capsule of the posterior knee block (IPACK) + sham obturator nerve block (ONB) + sham lateral femoral cutaneous nerve block (LFCNB) (control group), or a combination of ACB + IPACK + ONB + sham LFCNB (triple nerve block group), or a combination of ACB + IPACK + ONB + LFCNB (quadruple nerve block group). All patients received local infiltration analgesia. Primary outcome was postoperative morphine consumption. Secondary outcomes were the time until first rescue analgesia, postoperative pain assessed on the visual analog scale (VAS), QoR-15 score, functional recovery of knee, and postoperative complications.Compared with the control group, the triple and quadruple nerve block groups showed significantly lower postoperative morphine consumption (17.2 ± 9.7 mg vs. 11.2 ± 7.0 mg vs. 11.4 ± 6.4 mg, P = .001). These two groups also showed significantly longer time until first rescue analgesia (P = .007 and .010, respectively, analyzed with Kaplan-Meier method), significantly lower VAS scores on postoperative day 1 (P.01), significantly better QoR-15 scores on postoperative days 1 and 2 (P.001), and significantly better functional recovery of knee including range of motion (P = .002 and .001 on postoperative days 1 and 2), and daily ambulation distance (P.001 and P = .004 on postoperative days 1 and 2). However, the absolute change in morphine consumption, VAS scores, and QoR-15 scores did not exceed the reported minimal clinically important differences (MCIDs) (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement; QoR-15 scores: 8.0). The MCIDs of other outcomes have not been reported in literature. The triple and quadruple nerve block groups showed no significant differences in these outcomes between each other. The three groups did not show a significant difference in complication rates.Adding ONB or ONB + LFCNB to ACB + IPACK can statistically reduce morphine consumption, improve early pain relief, and functional recovery. However, the absolute change in morphine consumption, VAS scores, and QoR-15 scores did not exceed the MCIDs. Based on our findings and considering the sample size of this study, there is not enough clinical evidence to support the triple or quadruple nerve block use within a multimodal analgesic pathway after TKA.

To evaluate the clinical efficacy and safety of the new autologous tissue filler derived from autologous skin and hairs for correction of nasolabial folds. The new injectable soft tissue filler is prepared from autologous fibroblasts and keratin gel. A total of 40 patients were enrolled in this single-armed pilot study, all of them received the new filler injection treatment for correction nasolabial folds. Following up with the patients, collection of their clinical features, including photographs, satisfaction, and information on adverse events at the 1st, 3rd, 6th, 12th, and 24th months after injection. The clinical efficacy of each patient was evaluated by masked evaluators and independent expert panels, based on the Wrinkle Severity Rating Scale (WSRS) at different time points after the injection. Thirty-two patients completed the 24-months follow-up, obtaining at least 93.8% improvement, and 75% of them had significantly improved. Base on the self-satisfaction assessment (SSA) indicated that all of them were satisfied with the results. No adverse effects of filler injection treatment were observed during the follow-up. The combination of autologous keratin and fibroblasts as a new tissue engineering soft tissue filler has shown safety and long-term efficiency in correcting nasolabial folds, with high satisfaction and desirable result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Caching in device-to-device (D2D) networks is emerging a promising trend, which enables to reduce backhaul traffic. Moreover, social interaction among users influences the performance of overall system network. Therefore, it is crucial to consider social attributes in the D2D networks to develop a caching strategy to resolve the problem of unbalanced content distributed. In this paper, we consider two types of users according to their activeness, i.e., active users and inactive users. Inactive users assist active users cache contents during off-peak periods and provide the contents to the active users during peak periods to relieve the pressure of base station (BS). In addition, caching system model is divided into physical domain model and social domain model. In physical domain, the quality of communication links is judged by the delay between D2D users. In social domain, based on a real-world dataset, CiaoDVD, we calculate user similarity in three dimensions and obtain user trust by a trust topology to measure user relationships. Finally, in order to maximize the cache hit ratio, a joint action deep Q -networks (JADQN) framework is proposed to pair the active users with inactive users and distribute the contents to inactive users. Simulation results indicate that the proposed strategy improves the cache hit ratio by 42.9% and reduces the download delay by 48.8% compared with least frequency used (LFU) algorithm, which validates the effectiveness of our method.

In order to improve the effect of intensive care, this paper proposes a lean nursing intervention method and evaluates the lean nursing intervention through a controlled experiment. According to the actual situation of intensive care, this paper starts with the research from several aspects of patients’ ICU nursing time, patients’ satisfaction, patients’ pathological knowledge familiarity, patients’ autonomous nursing, and enthusiasm of patients and their families. Moreover, this paper collects and displays experimental results through mathematical statistics, gives patients lean management concepts and methods based on routine care, and finds that it has good management effects. Thus, lean management concepts and methods can effectively improve the anxiety state of critically ill patients, improve the patient’s knowledge of disease, and reduce adverse nursing events to improve patient nursing satisfaction, which is worthy of further promotion in the clinic.

Objective To evaluate the correlation of neonatal parameters with late-onset sensorineural hearing loss (SNHL) and vestibular dysfunction in individuals with congenital cytomegalovirus (cCMV) infection using the National Health Insurance Research Database (NHIRD) in Taiwan. Design Retrospective cohort study. Setting The whole Taiwanese population. Participants Patients with related diagnostic codes and examinations in their records were regarded as having cCMV infection. Each subject in that group was matched to 10 control individuals with noncongenital CMV infection on the basis of several neonatal parameters, including low gestational age, low birth weight, low Apgar score, maternal history of CMV infection and prolonged cCMV infection. A total of 5893 and 58 930 participants were enrolled in the study and control groups, respectively. Main outcome measures The main outcomes were the development of SNHL and the development of vestibular dysfunction within one year after birth as reflected by diagnostic codes and specific examinations. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (HR) and 95% confidence interval (CI) of each primary outcome between the two groups. Results Overall, 109 and 397 episodes of SNHL developed in the study group and the control group, respectively, and the study group demonstrated a significantly higher incidence of SNHL (adjusted HR: 2.56; 95% CI: 2.07-3.18). In addition, similar incidence rates of vestibular dysfunction were found in the study group and the control group, with 7 and 90 events, respectively (adjusted HR: 0.77; 95% CI: 0.36-1.67). In subgroup analyses, a higher incidence of SNHL was correlated with lower gestational age (GA) (adjusted HR: 2.09; 95% CI: 1.29-3.39), lower birth weight (BW) (adjusted HR: 2.05; 95% CI: 1.28-3.30) and prolonged cCMV infection (adjusted HR: 3.92; 95% CI: 1.95-7.88). Conclusions Low GA, low BW and a long disease course are significantly correlated with late-onset SNHL in cCMV infection.

Aims There is an emerging interest in elucidating the natural history and prognosis for patients with heart failure with reduced ejection fraction (HFrEF) in whom left ventricular ejection fraction (LVEF) subsequently improves. The characteristics and outcomes were compared between heart failure with recovered ejection fraction (HFrecEF) and persistent HFrEF. Methods and results This is a retrospective study of adults who underwent at least two echocardiograms 3 months apart between 1 November 2015 and 31 October 2019 with an initial diagnosis of HFrEF. The subjects were divided into HFrecEF group (second LVEF > 40%, ≥10% absolute improvement in LVEF) and persistent HFrEF group (20% subgroups. The primary outcomes were all‐cause mortality and rehospitalization. A total of 1160 HFrEF patients were included [70.2% male, mean (standard deviation) age: 62 ± 13 years]. On the second echocardiogram, 284 patients (24.5%) showed HFrecEF and 876 patients (75.5%) showed persistent HFrEF. All‐cause mortality was identified in 23 (8.10%) HFrecEF and 165 (18.84%) persistent HFrEF, whilst 76 (26.76%) and 426 (48.63%) showed rehospitalizations, respectively. Survival analysis showed that the persistent HFrEF subgroup experienced a significantly higher mortality at 12 and 24 months and a higher hospitalization at 12, 24, 48, and more than 48 months following discharge. Multivariate Cox regression showed that persistent HFrEF had a higher risk of all‐cause mortality [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.49–3.56, P = 0.000] and rehospitalization (HR 1.85, 95% CI 1.45–2.36, P = 0.000) than the HFrecEF group. Subgroup analysis showed that the LVEF ≥ 20% improvement subgroup had lower rates of adverse outcomes compared with those with less improvement of 10–20%. Conclusions Heart failure with recovered ejection fraction is a distinct HF phenotype with better clinical outcomes compared with those with persistent HFrEF. HFrecEF patients have a relatively better short‐term mortality at 24 months but not thereafter.

Image processing is a very broad field containing various areas, including image super-resolution (ISR) which re-represents a low-resolution image as a high-resolution one through a certain means of image transformation. The problem with most of the existing ISR methods is that they are devised for the condition in which sufficient training data is expected to be available. This article proposes a new approach for sparse data-based (rather than sufficient training data-based) ISR, by the use of an ANFIS (Adaptive Network-based Fuzzy Inference System) interpolation technique. Particularly, a set of given image training data is split into various subsets of sufficient and sparse training data subsets. Typical ANFIS training process is applied for those subsets involving sufficient data, and ANFIS interpolation is employed for the rest that contains sparse data only. Inadequate work is available in the current literature for the sparse data-based ISR. Consequently, the implementations of the proposed sparse data-based approach, for both training and testing processes, are compared with the state-of-the-art sufficient data-based ISR methods. This is of course very challenging, but the results of experimental evaluation demonstrate positively about the efficacy of the work presented herein.

Purpose To study and investigate the synergistic benefit of incorporating both conventional handcrafted and learning-based features in disease identification across a wide range of clinical setups. Methods and materials In this retrospective study, we collected 170, 150, 209, and 137 patients with four different disease types associated with identification objectives : Lymph node metastasis status of gastric cancer (GC), 5-year survival status of patients with high-grade osteosarcoma (HOS), early recurrence status of intrahepatic cholangiocarcinoma (ICC), and pathological grades of pancreatic neuroendocrine tumors (pNETs). Computed tomography (CT) and magnetic resonance imaging (MRI) were used to derive image features for GC/HOS/pNETs and ICC, respectively. In each study, 67 universal handcrafted features and study-specific features based on the sparse autoencoder (SAE) method were extracted and fed into the subsequent feature selection and learning model to predict the corresponding disease identification. Models using handcrafted alone, SAE alone, and hybrid features were optimized and their performance was compared. Prominent features were analyzed both qualitatively and quantitatively to generate study-specific and cross-study insight. In addition to direct performance gain assessment, correlation analysis was performed to assess the complementarity between handcrafted features and SAE features. Results On the independent hold-off test, the handcrafted, SAE, and hybrid features based prediction yielded area under the curve of 0.761 versus 0.769 versus 0.829 for GC, 0.629 versus 0.740 versus 0.709 for HOS, 0.717 versus 0.718 versus 0.758 for ICC, and 0.739 versus 0.715 versus 0.771 for pNETs studies, respectively. In three out of the four studies, prediction using the hybrid features yields the best performance, demonstrating the general benefit in using hybrid features. Prediction with SAE features alone had the best performance in the HOS study, which may be explained by the complexity of HOS prognosis and the possibility of a slight overfit due to higher correlation between handcrafted and SAE features. Conclusion This study demonstrated the general benefit of combing handcrafted and learning-based features in radiomics modeling. It also clearly illustrates the task-specific and data-specific dependency on the performance gain and suggests that while the common methodology of feature combination may be applied across various studies and tasks, study-specific feature selection and model optimization are still necessary to achieve high accuracy and robustness.

Objective. To investigate the clinical value of high-frequency ultrasound in psoriatic arthritis (PSA). The study subjects were 32 outpatients and inpatients with PSA who were pathologically diagnosed from January 2018 to September 2020, including 11 males and 21 females, aged 25–70 years old, with an average of (49.8 ± 14.0) years old. All patients underwent ultrasound and physical examination, including the small joints of the hands and feet on both sides, nails, and the main attachment points of the lower limbs (quadriceps tendon, patellar ligament, Achilles tendon, and plantar fascia attachment). The involvement of these joints, attachment points, and nails was observed and counted, respectively, and statistically analyzed. Results. Physical examination revealed 406 (406/1792, 22.66%) joint lesions, 79 (79/320, 24.69%) attachment inflammation, and 84 (84/320, 26.25%) nail lesions. Ultrasonography revealed 492 (492/1792, 27.46%) joint lesions, 166 (166/320, 51.88%) attachment inflammation, and 203 (203/320, 63.44%) nail lesions. The positive rate of ultrasound examination was higher than that of physical examination ( P < 0.001 ). Conclusion. Ultrasonography can detect joint, attachment, and nail lesions earlier than physical examination in patients with PSA. Ultrasonography is of great value in the diagnosis of PSA.

Circular RNAs (circRNAs) are a special kind of non-coding RNA. They play important regulatory role in diseases through interactions of miRNAs associated with the diseases. Due to their insensitivity to nucleases, they are more stable than linear RNAs. It is thus imperative to integrate available information for predicting circRNA-disease associations in humans. Here, we propose a computational model to predict circRNA-disease associations based on accelerated attributed network embedding (AANE) algorithm and autoencoder(AE). First, we use AANE algorithm to extract low-dimensional features of circRNAs and diseases and then stacked autoencoder (SAE) to automatically extract in-depth features. The features obtained by AANE and the SAE are integrated and XGBoost is used as a binary classifier to get the predicted results. The proposed model has an average area under the receiver operating characteristic curve value of 0.8800 in 5-fold cross validation and 0.8988 in 10-fold cross validation. The factors that can affect the performance of the model are discussed and some common diseases are used as case studies. Results indicated that the model has great performance in predicting circRNA-disease associations.

Background To evaluate the feasibility and safety of a new minimally-invasive surgical approach–anteromedial minimally-invasive plate osteosynthesis (MIPO)–in the treatment of middle and distal humeral shaft fractures. Methods Fourteen patients with humeral shaft fracture treated with anteromedial MIPO from November 2016 to March 2020 (MIPO Group) were selected as the study subjects. Open reduction and internal fixation (ORIF) were used to treat 14 patients with humeral shaft fractures as the control group (ORIF group). The two groups were fixed with a locking compression plate (LCP) or LCP + multi-directional locking screw system (MDLS). The incision length, intraoperative blood loss, intraoperative fluoroscopy time, operation time, length of hospital stay, fracture healing time, QuickDASH score and Constant score were observed and compared between the two groups. Results Fourteen patients were enrolled in each group. The incision length (7.79 ± 2.39 cm), intraoperative blood loss (96.07 ± 14.96 mL), operative time (110.57 ± 21.90 min), hospital stay (6.29 ± 1.49 days) and fracture healing time (14.94 ± 0.99 weeks) in the MIPO group were all lower than those in the ORIF group, and the difference was statistically significant for each parameter (P P P = 0.078), QuickDASH score (P = 0.074) or Constant score (P = 0.293) between the two groups and no postoperative complications occurred in any of the patients. Conclusion The anteromedial approach MIPO technique has the advantages of less trauma, less bleeding, low risk of nerve injury and high rate of fracture healing. It is one of the most effective methods for the treatment of middle and middle–distal humeral shaft fractures.

Background State-of-the-art lane detection methods have achieved prominent performance in complex scenarios, but many limits have also existed. For example, only a fixed number of lanes can be detected, and the cost of detection time is unaffordable in many cases. Methods Inspired by human vision, attention mechanism makes network learning more concerned features. In this paper, we propose a real-time lane detection method by using attention mechanism. The network proposed consists of three modules: an encoder module that extracts the feature of lanes; the instance feature maps of lanes are predicted by two decoder modules, namely binary decoder and embeddable decoder. In the encoder, we use the biologically inspired attention to extract features, which contain many details of the target area. The correlation between the features obtained from the convolutions and that extracted by the attention is established to learn the contextual information. In the decoder, the contextual information is fused with the features from up-sampling, to compensate for the lost detailed information. Binary decoder classifies all the pixels into lane or background. Embeddable decoder obtains the distinguishable lanes. And then, the outputs of the binary decoder serve as one of the inputs to the embeddable decoder to guiding the generation of exact pixel points on the lanes. Results Comparative experiments on two benchmarks (TuSimple and Caltech lanes datasets) show that the proposed method is independent of lane number and lane pattern. It can handle an indefinite number of lanes and run at 10ms in the TuSimple dataset. Conclusions Experiments verify that our method outperforms a lot of state-of-the-art methods while maintaining a real-time performance.