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Amorphous InGaN films were deposited on p-Si(100) substrates using a self-refited pulsed laser deposition system with double laser light paths and two-component target. The effects of laser energy on the microstructure, electrical and photovoltaic performances of InGaN films as well as n-InGaN/p-Si heterojunction solar cells were investigated. The results show that all the films are rich in Ga and poor in In, and the (In + Ga)/N atomic ratios are greater than 1. As the laser energy increases, In composition increases gradually and reaches to a maximum of 4.6 at.%. The PL spectra indicates that the band gap of the films decrease with the increase of laser energy. Meanwhile, the resistivity of InGaN film is decreased in two orders of magnitude due to the increasing of carrier concentration. Under the illumination of AM 1.5G solar simulator, the maximum power conversion efficiency of amorphous n-InGaN/p-Si heterojunction solar cells is 0.73% with an open circuit voltage of 2.41 V and short current density of 0.69 mA/cm2 at the laser energy of 175 mJ/pulse.

Object detection is one of the main tasks in computer vision and has made great progress in recent years. However, the performance of target detectors is significantly dropped by the differences between existing datasets and application scenarios, leading to the so‐called domain shift problem. To address such an issue, a novel co‐teaching based pseudo label refinery framework for cross‐domain object detection is developed, which cooperates with two models to select data from target domain for each other. This strategy can effectively purify the predicted pseudo labels and resist noisy labels. Specifically, the framework consists of two encoders (i.e. structure encoder and global encoder), two classifiers and one discriminator, in which structure encoder is used to extract structural features that are not disturbed by colour, and the global encoder is used to extract the complete discriminant features. The two encoders are each followed by a classifier. In training, the structure and global encoder with labelled source samples are first trained, so that it has the initial recognition ability. Then the samples assigned are used with pseudo labels by the classifier following the structure encoder to fine‐tune the global encoder which pre‐trained on the labelled source domain and obtain the refined labels for the target data. With the refined labels, the structure encoder is further optimised on the target domain. During this process, the proposal is to cross use the two classifiers to promote the mutual transfer of complementary capabilities of the two encoders. Moreover, a novel residual channel attention block (RCA) embedded with salient features is designed to pay more attention to the target regions. Extensive experiments demonstrate that the developed framework can generate clean labels for unlabelled target data and boost the performance of cross domain object detection. The code is available at http://www.msp‐lab.cn:1436/msp/cbplr‐master.

ZnO nanowires (ZnO NWs) were synthesized by hydrothermal method on Si (100) substrates, in which an insulating MgO layer deposited using sol–gel method was inserted between the seed layer and Si substrate. The effects of MgO layer on the microstructure, luminescence and electrical properties of ZnO NWs as well as n-ZnO NWs/p-Si heterojunction LEDs were investigated. With the insertion of MgO layer, well-aligned ZnO NWs with good crystalline quality are obtained, which can be attributed to the smooth seed layer with homogeneous globular particles. The electroluminescence spectra of n-ZnO NWs/MgO/p-Si heterojunction LEDs exhibit a broad emission band from near ultraviolet to yellow-green region. n-ZnO NWs/MgO/p-Si heterojunction also shows an enhanced ultraviolet photoluminescence efficiency, and its defect-related visible emission is greatly suppressed compared with that of n-ZnO NWs/p-Si heterojunction. The current–voltage curves of both heterojunction LEDs present a typical rectifying behavior, but the rectification ratio increases almost 5 times by inserting MgO layer, which is ascribed to a reduction in the leakage current under reverse bias voltage.

With the development of endoscopic therapy, argon plasma coagulation (APC) has been widely used by endoscopists. It has many advantages, such as simple to operate, low cost, and minimal invasiveness. Because of its capability of lesion ablation and hemostasis, APC has several indications in the gastrointestinal tract. One of them is esophageal varices. The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.

Funds of hedge funds (FOFs) have been depicted as a type of conservative vehicle to many institutional and retail investors for accessing hedge fund investment. We challenge this view by investigating the role of tail risk exposure in FOFs. We find that the tail risk exposure determines a fund’s return and significantly influences a fund’s performance over one to three-month horizon. In particular, we find that the marginal extreme losses to one unit change of tail risk exposure in bear markets nearly double the marginal extreme gains in bull markets. This non-linear payoff structure must be evaluated carefully by anyone who wishes to invest in FOFs.

Background Extracellular vesicles (EVs) are endogenous membrane vesicles with a diameter of 30–200 nm. It has been reported that hypoxic cancer cells can release numerous EVs to mediate multiple regional and systemic effects in the tumor microenvironment. Methods In this study, we used ultracentrifugation to extract EVs secreted by TE‐13, an esophageal squamous carcinoma (ESCC) cell line during normoxia and hypoxia and performed high‐throughput sequencing to detect exosomal miRNAs. Gene ontology (GO) and KEGG pathway analyses were used to reveal pathways potentially regulated by the miRNAs. Results A total of 10 810 miRNAs were detected; 50 were significantly upregulated and 34 were significantly downregulated under hypoxic environment. GO analysis identified enrichment of protein binding, regulation of transcription (DNA‐templated), and membrane as molecular function, biological process, and cellular component, respectively. KEGG pathway analysis revealed cancer‐associated pathways, phospholipase D signaling pathway, autophagy, focal adhesion and AGE‐RAGE signaling as the key pathways. Further verification experiment from qRT‐PCR indicated that miR‐128‐3p, miR‐140‐3p, miR‐340‐5p, miR‐452‐5p, miR‐769‐5p and miR‐1304‐p5 were significantly upregulated in EVs from hypoxia TE‐13 cells while miR‐340‐5p was significantly upregulated in two other ESCC cells, ECA109 and TE‐1. Conclusion This study, for the first time reveals changes in the expression of exosomal miRNAs in hypoxic ESCC cells and these findings will act as a resource to study the hypoxic tumor microenvironment and ESCC EVs.

Background: The prolongation or shortening of heart rate-corrected QT (QTc) predisposes patients to fatal ventricular arrhythmias and sudden cardiac death (SCD), but the association of dynamic change of QTc interval with mortality in the general population remains unclear.Methods: A total of 11,798 middle-aged subjects from the prospective, population-based cohort were included in this analysis. The QTc interval corrected for heart rate was measured on two occasions around 3 years apart in the Atherosclerosis Risk in Communities (ARIC) study. The ΔQTc interval was calculated by evaluating a change in QTc interval from visit 1 to visit 2.Results: After a median follow-up of 19.5 years, the association between the dynamic change of QTc interval and endpoints of death was U-shaped. The multivariate-adjusted hazard ratios (HRs) comparing subjects above the 95th percentile of Framingham–corrected ΔQTc (ΔQTcF) (≥32 ms) with subjects in the middle quintile (0–8 ms) were 2.69 (95% CI, 1.68–4.30) for SCD, 2.51 (1.68–3.74) for coronary heart disease death, 2.10 (1.50–2.94) for cardiovascular death, and 1.30 (1.11–1.55) for death from any cause. The corresponding HRs comparing subjects with a ΔQTcF below the fifth percentile (Conclusions: A dynamic change of QTc interval is associated with increased mortality risk in the general population, indicating that repeated measurements of the QTc interval may be available to provide additional prognostic information.

BACKGROUND From the point of view of machine construction and hydrodynamics, this paper innovatively proposes that the essence of high-flow nasal cannula (HFNC) is a constant-flow mode of non-invasive ventilator (NIVCFM). This study enrolled healthy adults as study subjects to assess the subjective comfort assessed by visual analog scoring scale of NIVCFM/HFNC and objective comfort measured by the noise level generated by NIVCFM/HFNC. Aiming to provide a scientific basis for the rational clinical application of NIVCFM/HFNC. METHODS 44 healthy adults participated in this study. The noise generated by NIVCFM/HFNC is measured and the comfort is evaluated during NIVCFM delivery at flow rates of 0, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60L/min. RESULTS When the ventilator flow rate is 60 L/min, the maximum noise is 65.9dB, increasing noise by 23.7dB from a baseline of 42.2dB at the flow rate of 0L/min. There was a strong nonlinear positive correlation between the noise level and the flow rates. The median score for dry mouth, nose or throat, dysphagia, sore throat and other discomfort was 0. The median score for dyspnea was 0 at 0-30L/min,1 at 35-55L/min and 2 at 60L/min. CONCLUSIONS The grater the flow rate, the greater the noise generated by NIVCFM/HFNC (

Heme oxygenase-1 (HO-1) has been reported to be upregulated following renal ischemia-reperfusion injury (IRI) and plays a key cytoprotective role; however, the underlying molecular mechanisms of its protective effects remain poorly understood. In the present study, in order to further elucidate the molecular mechanisms underlying the cytoprotective role of HO-1 in renal IRI, HO-1+/+ and HO-1+/− mice were subjected to renal ischemia and subsequent reperfusion followed by the analysis of blood urea nitrogen (BUN) and serum creatinine (SCr) levels, the severity of histological changes, HO-1 and vascular cell adhesion molecule-1 (VCAM-1) protein expression, the mRNA expression of inflammatory factors and the effects of VCAM-1 blockade. The results of the present study demonstrated that the upregulated expression levels of VCAM-1 in HO-1+/− mice during IRI increased the extent of renal tissue damage and activated the inflammatory response. These effects were subsequently reversed following infusion with an anti-VCAM-1 antibody. In addition, the upregulated expression of VCAM-1 in mouse glomerulus vascular endothelial cells isolated from HO-1+/− mice increased the adhesion and migration of neutrophils, effects which were also reversed upon incubation with an anti-VCAM-1 antibody. These results indicated that HO-1 knockdown may upregulate the expression of VCAM-1 during renal IRI, resulting in increased neutrophil recruitment and the activation of the inflammatory response, thereby exacerbating renal IRI. The present study thus highlights the regulatory mechanisms of HO-1 in renal IRI and provides a potential target for the clinical treatment of IRI following renal transplantation.

Besides traditional treatment strategies, including surgery, radiotherapy, and chemotherapy for lung cancer as the leading cause of cancer incidence and death, immunotherapy has also emerged as a new treatment strategy. The goal of immunotherapy is to stimulate the immune system responses against cancer, using various approaches such as therapeutic vaccines, monoclonal antibodies, immune checkpoint inhibitors, and T-cell therapy. Chimeric antigen receptor (CAR)-T cells, one of the most popular cancer immunotherapy approaches in the last decade, are genetically engineered T-cells to redirect patients' immune responses to recognize and eliminate tumor-associated antigens (TAA)-expressing tumor cells. CAR-T cell therapy provides promising benefits in lung tumors. In this review, we summarize different immunotherapy approaches for lung cancer, the structure of CAR-T cells, currently undergoing CARs in clinical trials, and various TAAs are being investigated as potential targets in designing CAR-T cells for lung cancer.

Wenqing Yu,1,* Ningfei Ji,2,* Chengjing Gu,3,* Juan Yao,4 Mingdong Ding,1 Daming Zhou,1 Mao Huang,2 Mingshun Zhang5,6 1Department of Infectious Diseases, Taizhou People’s Hospital Affiliated to Nantong University, Taizhou, Jiangsu, 225300, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China; 3Department of Pharmacy, Taizhou People’s Hospital Affiliated to Nantong University, Taizhou, Jiangsu, 225300, People’s Republic of China; 4Department of Oncology, Huaian Hospital of Huaian City, Huaian, Jiangsu, 223200, People’s Republic of China; 5Department of Immunology, Nanjing Medical University, Nanjing, Jiangsu, 211166, People’s Republic of China; 6NHC Key Laboratory of Antibody Technique, Nanjing Medical University, Nanjing, Jiangsu, 211166, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chengjing GuDepartment of Pharmacy, Taizhou People’s Hospital Affiliated to Nantong University, Taizhou, Jiangsu, 225300, People’s Republic of ChinaTel +86 0523-86606290Email chengjingyu706@163.comWenqing YuDepartment of Infectious Diseases, Taizhou People’s Hospital Affiliated to Nantong University, Taizhou, Jiangsu, 225300, People’s Republic of ChinaEmail wenqinggu706@126.comBackground: RORγt+Foxp3+ (Th17-like) Tregs are a plastic Treg subset implicated in immune-related diseases; however, the mechanism of Treg phenotypic transformation in malignant pleural effusion (MPE) has not been elucidated.Methods: The percentage of CD4+CD25+Foxp3+Helios+ and RORγt+Foxp3+ Tregs from peripheral blood and pleural effusion mononuclear cells were measured. The level of interferon regulatory factor 4 (IRF4) mRNA expression was detected by quantitative real-time reverse transcription polymerase chain reaction. The effects of IRF4 on the induction of Tregs from patients with non-small cell lung cancer (NSCLC) were evaluated in vitro. Correlation assays between IRF4 expression and the frequency of RORγt+Foxp3+ Tregs were performed.Results: The frequency of CD4+CD25+Foxp3+Helios+ Tregs and CD4+RORγt+ Th17 cells was both increased in the MPE of NSCLC patients. The group of double-positive Foxp3+RORγt+ Treg phenotype were identified in the pleural effusion. A significant increase in the frequency of Foxp3+RORγt+ Tregs was found in MPE compared with the non-malignant pleural effusion (NPE). Compared to NPE, the relative level of IRF4 expression was increased in the MPE. IRF4 expression was positively associated with the frequency of Foxp3+RORγt+ Tregs in the PE. In vitro, the level of Helios mRNA and protein expression was reduced in induced Tregs following IRF4 over-expression. Additionally, the level of RORγt protein expression was substantially increased. However, ectopic Helios expression in induced Tregs reversed the effects induced by enhanced IRF4 expression.Conclusion: IRF4 may serve as a potential molecule that promotes the conversion of regulatory T cells from MPE to a Th17-like phenotype by modulating Helios.Keywords: malignant pleural effusion, lung cancer, IRF4, regulatory T cells, phenotypic transformation

Background: We aimed to explore the value of combining real-time three-dimensional echocardiography (RT-3DE) and myocardial contrast echocardiography (MCE) in the left ventricle (LV) evaluating myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients.Patients and Methods: A total of 58 T2DM patients and 32 healthy individuals were selected for this study. T2DM patients were further divided into T2DM without microvascular complications (n = 29) and T2DM with microvascular complications (n = 29) subgroups. All participants underwent RT-3DE and MCE. The standard deviation (SD) and the maximum time difference (Dif) of the time to the minimum systolic volume (Tmsv) of the left ventricle were measured by RT-3DE. MCE was performed to obtain the perfusion measurement of each segment of the ventricular wall, including acoustic intensity (A), flow velocity (β), and A·β.Results: There were significant differences in all Tmsv indices except for Tmsv6-Dif among the three groups (all P < 0.05). After heart rate correction, all Tmsv indices of the T2DM with microvascular complications group were prolonged compared with the control group (all P < 0.05). The parameters of A, β, and A·β for overall segments showed a gradually decreasing trend in three groups, while the differences between the three groups were statistically significant (all P < 0.01). For segmental evaluation of MCE, the value of A, β, and A·β in all segments showed a decreasing trend and significantly differed among the three groups (all P < 0.05).Conclusions: The RT-3DE and MCE can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion. Left ventricular dyssynchrony occurred in T2DM patients with or without microvascular complications and was related to left ventricular dysfunction. Myocardial perfusion was reduced in T2DM patients, presenting as diffuse damage, which was aggravated by microvascular complications in other organs.

To assess the risk of epilepsy recurrence after withdrawal from antiepileptic drugs (AEDs), researchers extensively studied recurrence-related risk factors, including electroencephalogram (EEG) during AED withdrawal. The relationship between EEG and epilepsy recurrence is controversial. We used meta-analysis to determine the correlation between EEG during AED withdrawal and epilepsy recurrence. A total of seven studies met the criteria for inclusion. The Newcastle-Ottawa Scale was used to conduct the research quality evaluation. Seven hundred three patients were included in meta-analysis. Patients with abnormal EEGs during withdrawal had a higher recurrence rate than patients with normal EEGs. Abnormal EEGs during withdrawal were a risk factor for recurrence.

Recent literature implies that despite being more diversified, fund of hedge funds (FOFs) are exposed to tail risk. We propose an explanation for this phenomenon; tail risk is a systematic ...

The construction of bridge construction project is difficult, the process is complex, the technical standard is high, the main bridge and approach area have their own characteristics, involving personnel management, material and equipment turnover, quality and safety management. Based on the large-scale bridge construction project, this paper makes a comprehensive analysis of BIM and VR technology integration in the process of the project.

Objective. To develop and externally validate a CT-based radiomics nomogram for pretreatment prediction of relapse in osteosarcoma patients within one year. Materials and Methods. In this multicenter retrospective study, a total of 80 patients (training cohort: 63 patients from three hospitals; validation cohort: 17 patients from three other hospitals) with osteosarcoma, undergoing pretreatment CT between August 2010 and December 2018, were identified from multicenter databases. Radiomics features were extracted and selected from tumor regions on CT image, and then, the radiomics signature was constructed. The radiomics nomogram that incorporated the radiomics signature and clinical-based risk factors was developed to predict relapse risk with a multivariate Cox regression model using the training cohort and validated using the external validation cohort. The performance of the nomogram was assessed concerning discrimination, calibration, reclassification, and clinical usefulness. Results. Kaplan-Meier curves based on the radiomics signature showed a significant difference between the high-risk and the low-risk groups in both training and validation cohorts ( P < 0.001 and P = 0.015 , respectively). The radiomics nomogram achieved good discriminant results in the training cohort ( C -index: 0.779) and the validation cohort ( C -index: 0.710) as well as good calibration. Decision curve analysis revealed that the proposed model significantly improved the clinical benefit compared with the clinical-based nomogram ( P < 0.001 ). Conclusions. This multicenter study demonstrates that a radiomics nomogram incorporated the radiomics signature and clinical-based risk factors can increase the predictive value of the osteosarcoma relapse risk, which supports the clinical application in different institutions.

Hongzhi Li,1 Honggang Wang,2 Shanshan Shao,1 Yawen Gu,1 Juan Yao,1 Junxing Huang1 1Department of Oncology, Taizhou People’s Hospital, Taizhou, Jiangsu, People’s Republic of China; 2Department of General Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu, People’s Republic of ChinaCorrespondence: Junxing HuangDepartment of Oncology, Taizhou People’s Hospital, No. 210 Yingchun Road, Taizhou City, 225300 Jiangsu Province, People’s Republic of ChinaEmail dr_huangjunxing@hotmail.comBackground: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery of total mesorectal excision (TME) is currently accepted as the standard treatment for locally advanced rectal cancer (LARC). This study aimed to investigate the potential prognostic factors, including the albumin-to-fibrinogen ratio (AFR) for LARC patients.Methods: We retrospectively recruited LARC patients (cT3-4 and/or cN1-2) who underwent nCRT followed by TME between January 2011 and January 2015. The cut-off value of pretreatment AFR for overall survival (OS) was determined by the receiver operating characteristic (ROC) curve. The potential predictive factors for prognosis in the LARC patients were assessed by the univariate and multivariate Cox’s proportional hazard regression and Kaplan–Meier curve analyses.Results: AFR was a significant predictor for OS with a cut-off value of 8.65 and an AUC of 0.882 (P< 0.001). The pretreatment AFR level was the only independent risk factor for pathologic response to nCRT (HR: 2.44, 95% CI: 1.43– 4.17, P=0.003), 5-year OS (HR: 3.31, 95% CI: 1.51– 6.77, P=0.005) and disease-free survival (DFS) (HR: 2.73, 95% CI: 1.34– 5.47, P=0.007) in LARC patients. A low pretreatment AFR level was significantly associated with a poor 5-year OS and DFS by the Log rank test (P=0.003 and 0.006, respectively).Conclusion: Pretreatment AFR level was an independent prognostic factor in LARC patients undergoing TME after nCRT.Keywords: locally advanced rectal cancer, total mesorectal excision, neoadjuvant chemoradiotherapy, prognosis, albumin-to-fibrinogen ratio

Introduction: Bosworth fracture-dislocation is an unusual variant of ankle joint fracture and dislocation, which has a high clinically missed diagnosis rate due to poor visibility on X-ray. At the same time, successful closed manipulations in an ankle joint fracture and dislocation are difficult because of the fibula attachment at the posterolateral ridge of the tibia or at the fractured end of the posterior tibia.Patient concerns: A 56-year-old man visited the hospital for further evaluation of a swollen, deformed right ankle resulting from a tumble 4 hours ago. There were no obvious complications such as skin damage or blood vessel and nerve damage at the time of treatment.Diagnosis: The patient was diagnosed with Bosworth fracture-dislocation according to clinical history and X-ray examination and computed tomography (CT), which indicated posterolateral talus dislocation; the distal end of the proximal fibular fragment was inserted behind the tibia.Interventions and outcomes: The patient initially failed to receive twice manipulative reductions. After the first attempt, roentgenograms and CT scan still showed a dislocated ankle and the proximal end of the fibula fracture was still inserted at the fractured end of the posterior tibia although the sound of the joint mounted into the acetabulum was heard. Then the inferior tibiofibula joint was fully exposed and locked with an inferior tibiofibula screw. Review roentgenograms and CT suggested that the ankle was manipulated successfully, and the broken end achieved perfect alignment, leading to a satisfactory function restoration.Lessons: Early diagnosis and reduction of Bosworth fracture-dislocation is recommended, which can significantly decrease complications. The characteristic clinical manifestations of Bosworth fracture-dislocation are worthy of attention, including extreme external rotation of the ankle and difficulty in reduction. Simultaneously, the axilla sign on mortise roentgenograms, posterior dislocation of the talus on the lateral roentgenogram and fibular position relative to the talus on the external oblique roentgenogram are intrinsically valuable. During the surgery, the floating position can better expose the broken fracture end and allow standard lateral roentgenograms. For the reduction of Bosworth fracture-dislocation, it is important to avoid repeated attempts at closed reduction. Intraoperative reduction of the fibula is the key.

Using a proprietary dataset of daily mutual fund trades, we document strong evidence of manager skills in the Finnish market for both buys and sells. We find that manager’s risk-adjusted outperformance lasts up to five days. Additionally, we find that the capital-weighted average of trade returns for bought stocks is positively correlated with funds’ net alphas. We explain fund performance with several stock and fund characteristics and document a positive correlation between the invested net capital in each trade and trading profits. These results show that mutual fund managers provide value to their clients through above par investment skills.

The extent to which financial analysts provide “herd” rather than “bold” (or anti-herd) earnings forecasts has important implications for market efficiency. Identifying any contributing factor(s) f...

This paper examines the development of the Chinese Sentiment Lexicon for Internet (CSLI), a sentiment lexicon for capturing the valence and arousal in Chinese online social media texts. We first review the current sentiment lexicons and their building process, including the collection of words, judging the emotionality of words, and testing reliability and validity. In Study 1, we develop CSLI and test its initial reliability and validity. In Study 2, we further test the convergent validity of CSLI by examining its correlations with human judgment in 429 aggregated Weibo comments. In Study 3, the predictive validity of CSLI is examined by linking its results to personality traits among 52 undergraduates. Two replication studies are also conducted to verify the findings in Study 2 and 3. The results have generally supported the reliability and validity of CSLI. Therefore, CSLI can be used as a research tool to capture the degree of valence and arousal in Chinese online social media texts. Its potential to promote human well-being is also discussed.

We study a group of newly-emerged hedge funds in China, focusing on their performance and growth under a series of recent regulatory changes. These include the implementation of short sale restrictions and a circuit breaker. We find that the funds in our sample generally outperformed the stock market despite these regulatory disruptions. The best-performing equity-related strategies were long-short and multiple strategies. Our results indicate that the ability to sell short is important for all funds adopting equity-related strategies other than the long strategy. The imposition of short sale restrictions significantly reduced hedge fund performance, and the performance differential between “winner” and “loser” funds converged over time. The evidence suggests that the regulatory changes have greatly affected the hedge fund industry in China.

Identifying skilled managers is crucial for investors. In this paper, we present a sample of hedge fund managers who launched new funds after their previous funds were closed or stopped reporting. We investigate the characteristics and performance of such managers’ subsequent funds (‘new’ funds) in comparison to their prior funds (‘old’ funds). After controlling for various fund characteristics and a peer group benchmark, we conclude that subsequent funds run by the same manager perform better than their prior counterpart by 1.2% per month on average. We conjecture that the outperformance is due to improved manager skills.

Summary Background Healthcare-associated infection (HCAI) represents a major problem for patient safety worldwide. Aim To demonstrate the prevalence, causative agents, and risk factors for HCAI in Chinese hospitals. Methods A one-day point-prevalence survey was conducted in 52 Chinese hospitals between October 2014 and March 2015. A web-based software system was developed for data entry and management. Findings Among 53,939 patients surveyed, the prevalence of patients with at least one HCAI was 3.7%. Of 2182 HCAI episodes, the most frequently occurring types were lower respiratory tract infections (47.2%), followed by urinary tract infection (12.3%), upper respiratory tract infection (11.0%), and surgical site infection (6.2%). The prevalence of patients with at least one HCAI in critical care units was highest (17.1%). Device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central catheter-associated bloodstream infection, accounted for only 7.9% of all HCAIs. The most frequently isolated micro-organisms were Pseudomonas aeruginosa [206 infections (9.4%)], Acinetobacter baumannii [172 infections (7.9%)], Klebsiella pneumoniae [160 infections (7.3%)], and Escherichia coli [145 infections (6.6%)]. Of the survey patients (18,206/53,939), 33.8% were receiving at least one antimicrobial agent at the time of the survey. Risk factors for HCAI included older age (≥80 years), male gender, days of hospital admission, admission into a critical care unit, and device utilization. Conclusion Our study suggests that the overall prevalence of HCAI in surveyed Chinese hospitals was lower than that reported from most European countries and the USA. More attention should be given to the surveillance and prevention of non-device-associated HCAI in China.

Protein kinase Mζ (PKMζ), a typical brain-specific PKC isoform, has been shown to be critical in the maintenance of long-term potentiation and memory storage. Zeta inhibitory peptide (ZIP), a peptide with selective inhibition of PKMζ, has been used in relieving experimental neuropathic pain and disrupting memory. The aim of this study was to investigate the effects of intra-amygdalar infusion of ZIP on neuropathic pain induced by chronic constriction injury (CCI), and inflammatory pain induced by complete Freund's adjuvant (CFA) in adult rats.(I) ZIP was infused into the amygdala 30 minutes (min) before CCI was performed. Mechanical withdrawal threshold (MWT) was determined prior to the infusion of ZIP, and 30, 60, 90, 120, 150, 180 min after CCI (n=8 per group). (II) ZIP was infused into the amygdala 3, 7, 14 days after CCI (n=8 per group). MWT was measured 30 min before the infusion and 2, 12, 24 h after the infusion. (III) Three days after CCI, ZIP was infused into the amygdala repeatedly once a day for 2 days. MWT was measured before each infusion and 2 or 24 h after each infusion (n=8 per group). (IV) ZIP was infused into the amygdala 24 h after the establishment of inflammatory pain induced by complete Freund's adjuvant (CFA). MWT was determined 30 min before the infusion and 30, 60, 90, 120 and 150 min after the infusion (n=8 per group).As shown in figures, (I) amygdalar infusion of ZIP prior to the CCI produced no effect on CCI-induced hyperalgesia when compared to scr-ZIP or saline infusion [n=8, interaction effect, F (7.312, 76.776) =1.237, P0.05; time as main factor, F (3.656, 76.776) =115.346, P0.001; group as main factor, F (2, 21) =0.648, P0.05]. (II) BLA infusion of ZIP significantly increased mechanical withdrawal threshold 7 days after CCI [n=8, interaction effect, F (5.476, 57.500) =15.279, P0.001; time as main factor, F (2.738, 57.500) = 242.357, P0.001; group as main factor, F (2,21) =4.786, P0.05], just the same as 3 and 14 days after CCI (data not shown). (III) Bilateral injection of ZIP into the BLA significantly reduced mechanical hyperalgesia 2 h after the administration [n=8, paired t-test, t (0.05,7) =-5.561, P0.05; n=8, paired t-test, t (0.05,7) =-4.745, P0.05], and returned to baseline 24 h after the administration [n=8, paired t-test, t (0.05,7) =1.039, P0.05; n=8, paired t-test, t (0.05,7) =-1.173, P0.05]. (IV) ZIP produced no effect on mechanical withdrawal thresholds at all time points examined after the infusion, compared with scr-ZIP or saline control groups (n=8, interaction effect, F (6.135, 126) =1.724, P0.05; group as main factor, F (2,21) =0.608, P0.05).Intra-amygdala infusion of ZIP attenuates mechanical hyperalgesia induced by CCI but has no effect on inflammatory pain induced by CFA in rats, suggesting that amygdala PKMζ may be a therapeutic target in the treatment of neuropathic pain.

Prepulse inhibition (PPI) and habituation of the acoustic startle response (ASR) are considered to be effective neurobiological measures of sensorimotor gating and information processing. The deficit of PPI and habituation of ASR has been proposed to be candidate endophenotypes of schizophrenia spectrum disorders. However, there has been little information on PPI and ASR measures in Chinese. The present study aimed to provide more information about the characteristics of PPI and ASR in young healthy Chinese and investigate their sensitivity to experimental parameters and characteristics of population. In this study, we examined the PPI and habituation of ASR in 41 young healthy adults (21 males and 20 females), using an acoustic startle stimulus of 115 dB and a prepulse of 75 dB at a lead interval (LI) of 60 ms and 120 ms, respectively. The behavioral performance demonstrated that the PPI and habituation of ASR in all the young participants were robust. The significant difference was not observed in PPI and habituation between male and female. The block effect on PPI was significant; PPI reduces with increasing training. Latency facilitation was observed under prepulse conditions, with a significant effect of LI. Compared to previous studies in Caucasians, Chinese in this study shows a higher habituation and PPI. In conclusion, this research provides more data of behavioral characteristics of PPI and ASR in young healthy Chinese. Chinese in this study shows a higher habituation and PPI than Caucasians in previous studies.

Background: To develop and externally validate an MR-based radiomics nomogram from retrospective multicenter datasets for pretreatment prediction of early relapse (≤1 year) in osteosarcoma after surgical resection. Methods: This multicenter study retrospectively enrolled 93 patients (training cohort: 62 patients from four hospitals; validation cohort: 31 patients from two hospitals) with clinicopathologically confirmed osteosarcoma who received neoadjuvant chemotherapy and surgical resection at six hospitals between January 2009 and October 2017. Radiomics feature was extracted from contrast-enhanced fat-suppressed T1-weighted (CE FS T1-w) images. A radiomics signature was constructed with least absolute shrinkage and selection operator (LASSO) regression. The radiomics nomogram that incorporated the radiomics signature and subjective MRI-assessed risk factors was developed to predict early relapse with a multivariate logistic regression model in the training cohort and validated in the external validation cohort. The performance of the nomogram was assessed by its discrimination, calibration, and clinical usefulness. Findings: The radiomics nomogram, which incorporated a radiomics signature (consisted of six selected features) and subjective MRI-assessed risk factors (joint invasion and perivascular involvement) from the multicenter datasets, achieved good discrimination in the training cohort (C-index: 0.907, 95% CI: 0.838-0.977) and external validation cohort (C-index: 0.811, 95% CI: 0.653-0.970), and good calibration. Decision curve analysis suggested that the combined nomogram was clinically useful. Interpretation: The proposed MRI-based radiomics nomogram could provide a nonvasive tool to develop a model for pretreatment prediction of early relapse in osteosarcoma, which has potential to lead to improvement of personalized pretreatment management of osteosarcoma. Funding: This research is supported by the National Key Research and Development Program of China (No. 2017YFC1309100), the National Natural Science Foundation of China (Grant Nos. 81871510, 81771912). Declaration of Interest: No competing interest exists. Ethical Approval: This multicentric study was approved by the ethics committee of every participating hospital and was conducted in accordance with the Declaration of Helsinki.

Background Retinoblastoma (RB) is the most frequent pediatric retinal tumor. In the present study, to elucidate chemoresistance mechanisms and identify potential biomarkers in RB, we utilized RNA sequencing (RNAseq) technological platforms to reveal transcriptome profiles and identify any differentially expressed genes (DEGs) between an etoposide drug-resistant subline (Y79/EDR) and parental Y79 cells. Methods To test whether Y79/EDR cells showed resistance to antineoplastic agents for RB, we treated the cells with etoposide, carboplatin and vincristine and analyzed them with a Cell Counting Kit-8 (CCK-8). Y79/EDR and parental Y79 cells were used for RNAseq and bioinformatics analysis to enable a genome-wide review of DEGs between the two lines using the DESeq R package (1.10.1). Then, DEG enrichment in Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways was analyzed with KOBAS software. Next, real-time quantitative reverse transcription polymerase chain reaction (real time QRT-PCR) and cytotoxicity assays were performed to experimentally and functionally validate the identified candidate biomarkers. Results Y79/EDR cells showed resistance to etoposide, carboplatin and vincristine at different concentrations. In total, 524 transcripts were differentially expressed in Y79/EDR cells based on analysis of fragments per kilobase of transcript per million fragments mapped (FPKM); among these, 57 genes were downregulated and 467 genes were upregulated in Y79/EDR cells compared to parental Y79 cells. We selected candidate DEGs, including ARHGAP9, HIST1H4H, RELN, DDIT4, HK2, STC1 and PFKFB4, for mRNA expression validation with real time QRT-PCR assays and found that the expression levels determined by real time QRT-PCR were consistent with the RNAseq data. Further studies involving downregulation of ARHGAP9 with a specific siRNA showed that ARHGAP9 altered the cellular sensitivity of Y79 cells to etoposide and carboplatin. Conclusion Our initial findings provided a genomic view of the transcription profiles of etoposide-induced acquired resistance in RB. Follow-up studies indicated that ARHGAP9 might be a chemoresistance biomarker in RB, providing insight into potential therapeutic targets for overcoming acquired chemoresistance in RB. These findings can aid in understanding and overcoming chemoresistance during treatment of RB in the clinic.

In the era of big data, science and technology continue to infiltrate into art, providing more new means of expression for art, and expanding the performance space for digital media art. The statistics and analysis of big data can also more clearly analyze the needs of users, which is both an opportunity and a challenge for the development of digital media art.

Alzheimer's disease (AD), an age-dependent neurodegenerative disorder, is the main cause of dementia. Common hallmarks of AD include the amyloid β-peptide (Aβ) aggregation, high levels of hyperphosphorylated tau protein (p-tau) and failure in redox homeostasis. To date, all proposed drugs affecting Aβ and/or p-tau have been failed in clinical trials. A decline in the expression of the transcription factor Nrf2 (nuclear factor-erythroid 2-p45 derived factor 2) and its driven genes (NQO1, HO-1, and GCLC), and alteration of the Nrf2-related pathways have been observed in AD brains. Nrf2 plays a critical role in maintaining cellular redox homeostasis and regulating inflammation response. Nrf2 activation also provides cytoprotection against increasing pathologies including neurodegenerative diseases. These lines of evidence imply that Nrf2 activation may be a novel AD treatment option. Interestingly, recent studies have also demonstrated that Nrf2 interferes with several key pathogenic processes in AD including Aβ and p-tau pathways. The current review aims to provide insights into the role of Nrf2 in AD. Also, we discuss the progress and challenges regarding the Nrf2 activators for AD treatment.

The origin of virtual reality technology can be traced back to the 1950s decades ago. In recent years, with the rapid improvement of computer graphics processing, computing ability and other technologies, virtual reality technology and equipment began to mature. Starting from the application and development of virtual reality technology in various fields, this paper analyzes the basic application process of virtual reality technology, and describes the value and content of its application in the intelligent system of cold chain logistics.

Natural and man-made hazardous events resulting in loss of grid infrastructure assets challenge the security and resilience of the electric power grid. However, the planning and allocation of appropriate contingency resources for such events requires an understanding of their likelihood and the extent of their potential impact. Where these events are of low likelihood, a risk-informed perspective on planning can be difficult, as the statistical basis needed to directly estimate the probabilities and consequences of their occurrence does not exist. Because risk-informed decisions rely on such knowledge, a basis for modeling the risk associated with high-impact, low-frequency events (HILFs) is essential. Insights from such a model indicate where resources are most rationally and effectively expended. A risk-informed realization of designing and maintaining a grid resilient to HILFs will demand consideration of a spectrum of hazards/threats to infrastructure integrity, an understanding of their likelihoods of occurrence, treatment of the fragilities of critical assets to the stressors induced by such events, and through modeling grid network topology, the extent of damage associated with these scenarios. The model resulting from integration of these elements will allow sensitivity assessments based on optional risk management strategies, such as alternative pooling, staging and logistic strategies, and emergency contingency planning. This study is focused on the development of an end-to-end HILF risk-assessment framework. Such a framework is intended to provide the conceptual and overarching technical basis for the development of HILF risk models that can inform decision-makers across numerous stakeholder groups in directing resources optimally towards the management of risks to operational continuity.

Salt-tolerant yeast Zygosaccharomyces rouxii is a key strain to produce flavor in soy sauce brewing. The aim of this research was to establish the optimal feeding strategy and parameter for high-density culture of Z. rouxii. An exponential feeding strategy was applied where the specific growth rate was fixed by limitation of the fed carbon source. The set point of specific growth rate of exponential feeding for fed-batch culture was chosen to be 0.03–0.07 h−1. The optimal set point of specific growth rate (μset) of exponential feeding started after glucose depletion for fed-batch culture was found to be 0.05 h−1. Furthermore, a relatively high-dense biomass (72.86 g/L dry cell weight) was obtained in the culture of exponential feeding started after glucose was exhausted with μset = 0.05 h−1. Less than the level of Saccharomyces cerevisiae and Pichia pastoris, however the biomass concentration was much higher than data from other research about Z. rouxii culture.

Goal: The incidence of esophageal cancer in Xinjiang is remaining obstinately high. In order to improve the accuracy and efficiency of esophageal cancer diagnosis, this paper discusses the techniques and methods involved in the computer-aided diagnosis of esophageal carcinoma, which also to provide evidence for early detection, diagnosis and treatment of esophageal cancer. Methods: Selected normal esophagus, mushroom esophageal carcinoma, constricted esophageal carcinoma and ulcerative esophageal carcinoma, each 100 pieces and the regions of interest (ROI) were segmented manually. Then extracted texture features based on Wavelet Transform (WT) and Tamura algorithm and constructed Support Vector Machine (SVM) and BP Neural Network classifier to classify these features. Results: A total of 26 dimensional features were extracted from each image. The best classification accuracy of normal esophagus, mushroom esophageal carcinoma and ulcerative esophageal carcinoma reached 98.667%; It was 95.667% for normal esophagus, constricted esophageal carcinoma and ulcerative esophageal carcinoma; And 87.667% for normal esophagus, mushroom esophageal carcinoma and constricted esophageal carcinoma; 89.25% when classified normal esophagus and three kinds of advanced esophageal carcinoma. The classification efficiency of comprehensive features which consist of Tamura and WT features was better than that of single Tamura or WT feature. The Classification performance of SVM was superior to BP neural network. Conclusion: In this study, texture features based on Tamura and WT were extracted and classified by SVM and BP neural network classifier from ROI of normal esophagus and three kinds of advanced esophageal carcinoma. Results show that the classification accuracy of this study is high, which lays a foundation for the development of computer aided diagnosis system for esophageal carcinoma.

Objective: to assess the classification capability dealing with CT images, by means of Decision Tree classifier. Methods: the CT images were provided by the hospital was used as the data source. In this study.normal liver, Single cystic hepatic hydatid and Polycystic hepatic hydatid CT images were selected.each 200 pieces. Then the texture features were extracted by gray gradient co-occurrence matrix(GGCM) and gray scale histogram. At last. Decision tree classifier were used for classification, which aimed to verify Which feature is more suitable for decision tree classification, and Parameter estimation is used to evaluate the classifier model. Results: For normal liver, Single cystic hepatic hydatid and Polycystic hepatic hydatid, the classification accuracy of gray level co-occurrence matrix was 71%,69% and 69%, respectively. the classification accuracy of gray scale histogram was 74%,63.5% and 69%.the classification accuracy of comprehensive features was 75%, 70.5% and 80.5%. Conclusion: The classification accuracy of comprehensive feature is 11.5% higher than that of single features, which are more suitable for the classification of polycystic hepatic hydatid images. This algorithm can provide reference for the classification of CT images.

This article examines the historical performance of hedge funds domiciled in China in the aspect of return characteristics and risk exposures. Using data from the Morningstar China hedge fund database, we find that these funds do not exhibit common features such as negative skewness and large kurtosis as proposed by the literature. Our results show that these funds have a significant exposure to market factors but little exposure to the other commonly known factors. In addition, our results suggest Chinese hedge funds are exposed mainly to the local equity market only. The study additionally finds no excess returns in Chinese hedge funds. The results of this research provide some insights into the characteristics of the hedge fund industry in China where the economic and regulatory conditions are distinct from other markets.

Welding image and weld pool edge Machine vision techniques are widely used with automatic laser-welding robots. Existing systems acquire geometrical information on both the weld seams and molten pool by using a single camera and then processing a single image. The recognition of weld seams is thus obviously affected by the arc, plasma, spatter, etc. This study examined a novel, cost-effective weld image acquisition and processing system with real-time performance, which is based on an advanced RISC machine (ARM). The software and hardware platforms of a weld seam image processing system were designed, and theoretical and experimental studies were undertaken. A novel image-processing method for the laser welding molten pool, based on a quaternion and self-organizing feature map (SOFM) neural network is also proposed. The edge characteristic vector of the molten pool is acquired based on the rotational characteristic of the quaternion in a three-dimensional vector space. The geometric features of the molten pool image are acquired by the self-organizing feature map neural network. The measured results pointed to the possibility of improving the reliability and precision of the automatic laser welding system by combining the two machine vision systems.

This study explored nephrotoxicity in elderly Chinese patients after exposure to vancomycin and other nephrotoxic risk factors. This was a single-center retrospective study. The patient population included those who were ≥60 years of age, had normal baseline serum creatinine values, and received vancomycin for ≥48 h between January 1, 2013 and August 30, 2014. Nephrotoxicity occurred in 29% of 124 patients. A baseline creatinine clearance ≥63.5 ml/min was more common in the nephrotoxic group. Patients with high (≥15 mg/l) rather than low (

Lysine demethylase 3A (KDM3A), also known as JMJD1A, has been associated with metastasis and poor prognosis in several cancer types, including renal cell carcinoma, prostate cancer and Ewing sarcoma. However, little is known regarding the clinicopathological significance of KDM3A expression in breast cancer (BCa). To investigate the clinical relevance of KDM3A expression in the setting of BCa, immunohistochemistry was performed on a tissue microarray consisting of 150 commercially available BCa samples. No significant correlation was identified between KDM3A expression and various clinicopathological variables, including clinical stage, pathological grade, tumor size and the expression statuses of human epidermal growth factor receptor 2, estrogen receptor, and progesterone receptor. In addition, no significant association between KDM3A expression and overall prognosis was observed. Taken together, these findings suggest that there is no significant association between KDM3A expression and clinicopathological variables, indicating that KDM3A may not be associated with the malignant behavior of BCa.

Breast cancer (BC) is one of the most common cancers worldwide, and is a major cause of death in women. Aldehyde dehydrogenase 1 (ALDH1) is a marker of stem cells and cancer stem cells, and its activity correlates with the outcome of various tumors, including BC. This study aimed to analyze the relationship between ALDH1 expression and clinicopathological characters in BC and the prognostic significance of ALDH1. We used quantitative reverse-transcription PCR (qRT-PCR) to detect ALDHA1 mRNA levels in 25 fresh frozen BC samples and matched noncancerous samples. Immunohistochemistry on tissue microarrays was used to analyze protein expression in 137 paraffin-embedded BC tissues and corresponding noncancerous tissues. STATA 16.0 software was used for statistical analysis. The results suggested that levels of both ALDH1 mRNA and protein in BC were significantly higher than in corresponding adjacent breast samples (3.856 ± 0.3442 vs 1.385 ± 0.1534, P

Esophageal cancer is one of the fastest rising types of cancers in China. The Kazak nationality is the highest-risk group in Xinjiang. In this work, an effective computer-aided diagnostic system is developed to assist physicians in interpreting digital X-ray image features and improving the quality of diagnosis. The modules of the proposed system include image preprocessing, feature extraction, feature selection, image classification, and performance evaluation. 300 original esophageal X-ray images were resized to a region of interest and then enhanced by the median filter and histogram equalization method. 37 features from textural, frequency, and complexity domains were extracted. Both sequential forward selection and principal component analysis methods were employed to select the discriminative features for classification. Then, support vector machine andK-nearest neighbors were applied to classify the esophageal cancer images with respect to their specific types. The classification performance was evaluated in terms of the area under the receiver operating characteristic curve, accuracy, precision, and recall, respectively. Experimental results show that the classification performance of the proposed system outperforms the conventional visual inspection approaches in terms of diagnostic quality and processing time. Therefore, the proposed computer-aided diagnostic system is promising for the diagnostics of esophageal cancer.

Our present life has been surrounded by "Internet+", the traditional production pattern is challenged by communication of all kinds of micro videos in the Internet. This article discusses the three different kinds of micro videos: derivative micro video, UGC original micro, and Online interactive micro video, and indicates that they have been recording and reproducing of real life in their own way. Finally, the authors also emphasize the importance of the professional video designer's, whose work can promote the further development of micro video in the Internet.

Biomass energy is environmentally friendly, renewable, and a rich stock.The research and development of biomass energy have become a hot spot. The β-glucosidase is the key enzyme in the utilization of biomass. The fermentation conditions for β-glucosidase production fromAspergillus nigerwere optimized. The optimum conditions were as follows: the seed age 48h, the inoculation amount 10%, the medium volume 20mL / 250mL, the initial pH 5.0, the rotational speed 200 r/ min, Under these conditions, the activity of β-glucosidase can research 13.92 U ∕ mL after 168h, increasing 92.8% than before. This experiment can provide the basis for the next step of liquid fermentation for the scaling up production of β-glucosidase.

Objective To observe the effect of relaxing needling plus rehabilitation training on post-stroke upper limb dysfunction.

Halophilic aromatic yeasts, such as Torulopsis mogii and Zygosaccharomyces rouxii, are usually used for soy sauce fermentation, in order to enhance the flavor and quality of the high-salt oriental food seasoning sauce. However, in the process of soy sauce brewing, salt stress affects the cell growth of the aromatic yeasts and extends the fermentation process. The tolerance to high NaCl concentrations is important for Torulopsis to produce flavor in soy sauce. In this study, we report that supplementation of biotin improved cell growth of T. mogii at high salt environment. Further studies suggested that biotin enhanced the osmotic tolerance (salt tolerance) of T. mogii through accumulating trehalose in cells, increasing the ratio of K+/Na+; promoting the activity of ATPase, and increasing the synthesis of fatty acids with long chain and high saturation. These results indicated that biotin could be an effective supplement for improvement of soy sauce fermentation.

Background: Apolipoprotein E (apoE) has been shown to play a pivotal role in the development of cardiovascular disease, attributable to its function in lipid trafficking and immune modulating properties; however, its role in modulating inflammation in the setting of acute lung injury (ALI) is unknown. Objective: To determine whether apoE-deficient mice (apoE-/-) are more susceptible to ALI compared to wild-type (WT) animals. Methods: Two independent models of ALI were employed. Firstly, WT and apoE-/- mice were randomized to acid aspiration (50 μl of 0.1 N hydrochloric acid) followed by 4 h of mechanical ventilation. Secondly, WT and apoE-/- mice were randomized to 72 h of hyperoxia exposure or room air. Thereafter, the intrinsic responses of WT and apoE-/- mice were assessed using the isolated perfused mouse lung (IPML) setup. Finally, based on elevated levels of oxidized low-density lipoprotein (oxLDL) in apoE-/-, the effect of oxLDL on lung endothelial permeability and inflammation was assessed. Results: In both in vivo models, apoE-/- mice demonstrated greater increases in lung lavage protein levels, neutrophil counts, and cytokine expression (p < 0.05) compared to WT mice. Experiments utilizing the IPML setup demonstrated no differences in intrinsic lung responses to injury between apoE-/- and WT mice, suggesting the presence of a circulating factor as being responsible for the in vivo observations. Finally, the exposure of lung endothelial cells to oxLDL resulted in increased monolayer permeability and IL-6 release compared to native (nonoxidized) LDL. Conclusions: Our findings demonstrate a susceptibility of apoE-/- animals to ALI that may occur, in part, due to elevated levels of oxLDL.

Background Previous studies have reported that physical therapy (PT) can be used for the treatment of chronic obstructive pulmonary disease (COPD). However, its effectiveness is still inconclusive. This systematic review will aim to assess its effectiveness and safety for the treatment of patients with COPD. Methods All randomized controlled trials (RCTs) literatures of PT for COPD will be searched from the databases of Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDILINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to the present without any language restrictions. Two reviewers will independently perform the study selection, data extraction, and methodological quality assessment. A third reviewer will be invited to resolve any disagreements occurred between 2 reviewers. Results The primary outcome is lung function. The secondary outcomes include symptoms, health-related quality of life, mortality, and adverse events. The outcome data will be pooled by using the models of random-effects or fixed-effects according to the detected heterogeneity. Conclusion The findings of this study will provide up-todated summary evidence for assessing the effectiveness and safety of PT for COPD.