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A circular polarization (CP)-agile and continuous beam-steerable array antenna is presented using a hybrid design approach. It is accomplished by combining digital reconfigurable antenna elements with analog continuously tunable phase shifters. To realize both polarization reconfiguration and initial phase generation for beam-scanning simultaneously, the designed antenna element enables eight states that corresponds to two CP modes with four quantized phases. The phase shifters further provide additional variable phases of -90° to 0° for antenna element excitation. Superposition of the initial and additional phases helps to satisfy a full and continuous 360° phase coverage for a beam-steerable array. Meanwhile, the phase decomposition also facilitates the design of phase shifters without complex or cascaded structures. By altering the bias states of the electronic components loaded in the array antenna, CP switching and beam scanning can be independently controlled. For verification, prototypes of the antenna element, phase shifter, and a four-element array are all fabricated and tested. Reasonable agreement is obtained between simulation and measurement. The resultant array could scan up to nearly ±40° off the boresight, along with stable radiation patterns and good CP performance.

Except for the slight difference of micromotion parameters, some decoys and warheads have the same geometry and micromotion form. As a result, recognition of similar space cone-cylinder targets is one of the difficult problems in ballistic target recognition. In recent years, due to the good effect of deep neural networks (DNNs) in optical target recognition, space cone-cylinder target recognition methods based on DNN have attracted wide attention. However, these DNN-based methods only recognize the space cone-cylinder targets with different shapes and different micromotion forms. Moreover, these methods require some time-consuming preprocessing operations, which need to observe the target for at least one micromotion period. To recognize similar space cone-cylinder targets, we propose a complex-valued coordinate attention networks (CV-CANets)-based end-to-end recognition method. Firstly, we establish the signal model of space cone-cylinder targets. Secondly, we propose CV-CA blocks by transforming the coordinate attention mechanism into the complex-valued domain. Then, we construct CV-CANet based on the proposed CV-CA blocks. Finally, the proposed CV-CANet is trained and tested by the narrowband radar echo data, which is generated by electromagnetic calculation. Compared with the convolutional neural network (CNN)-based recognition methods, the proposed method can not only recognize the similar space cone-cylinder targets but also is superior in terms of time cost and observation requirement. Extensive experiments validate that the proposed recognition method is effective when the targets only have a slight difference on the precession angular frequency and the observation time is less than half a period.

BackgroundSarcoidosis is an inflammatory disease characterized by the formation of granulomas, which involve the heart in up to 25% of patients. Cardiac sarcoidosis can lead to life threatening arrhythmias and heart failure. While corticosteroids have been used as a treatment for over 50 years, they are associated with hypertension, diabetes, and weight gain, further increasing cardiovascular risk. Interleukin-1 (IL-1) is the prototypical proinflammatory cytokine that works to activate the nuclear transcription factor NF-kB, one of the targets of glucocorticoids. IL-1 also plays an important role also in the pathophysiology of heart disease including atherosclerosis, myocardial infarction, and myocarditis.MethodsBuilding on a network of research collaborators developed in the Cardiac Sarcoidosis Consortium, we will investigate the feasibility and tolerability of treatment of CS with anakinra at two National Institute of Health Clinical and Translational Science Award (CTSA) hubs with expertise in cardiac sarcoidosis. In this pilot study, up to 28 patients with cardiac sarcoidosis will be recruited to compare the administration of an IL-1 blocker, anakinra, 100 mg daily on top of standard of care versus standard of care only for 28 days and followed for 180 days. Utilizing surrogate endpoints of changes in systemic inflammatory biomarkers and cardiac imaging, we aim to determine whether IL-1 blockade with anakinra can combat systemic and cardiac inflammation in patients with cardiac sarcoidosis.DiscussionThe current trial demonstrates an innovative collaborative approach to clinical trial development in a rare, understudied disease that disproportionately affects females and minorities.Trial RegistrationThe trial was registered prospectively with ClinicalTrials.gov on July 12, 2019, identifier NCT04017936.

The surgical strategies for acute type-A aortic dissection (aTAAD) with coronary artery involvement have been controversial, and its prognosis remains unclear. Thus, in this study, we aim to determine the characteristics, surgical strategies, and prognosis of patients with coronary artery involvement due to aTAAD.Retrospective analysis of 65 consecutive aTAAD patients with coronary artery involvement between September 2005 and January 2012 was performed. The patients were divided into two groups: those treated with aTAAD repair and coronary ostia reimplantation (Neri type-A, group A, n = 37) and those with aTAAD repair and coronary artery bypass grafting (Neri type B and C, group B, n = 28).Overall in-hospital mortality was determined to be 8.1% for group A and 21.4% for group B (P = 0.124). No significant difference was determined between groups A and B in cardiopulmonary bypass time, cross-clamp time, cerebral perfusion time, and hospitalization time. Intensive care unit (ICU) stay was 5.8 ± 7.4 days for group A, whereas it was 12.4 ± 10.6 days for group B (P = 0.009). The morbidity of postoperative temporary and permanent neurological dysfunction was similar between the two groups, while renal and respiratory dysfunction were 8.1% versus 25.0% and 16.2% versus 39.3%, respectively (P = 0.062, P = 0.036). Average follow-up time was 112.0 ± 44.8 months, and survival curves have not shown statistical significance between two groups (P = 0.386).Coronary artery dissection with Neri type B and C in acute TAAD has been associated with higher early death, but comparable long-term survival after discharge. However, combined immediate coronary artery bypass grafting and aortic repair remains a safe, effective, and acceptable approach to these challenging group of patients.

Aortic regurgitation (AR) is a volume overload disease causing eccentric left ventricular (LV) hypertrophy and eventually heart failure. There is currently no approved drug to treat patients with AR. Endoplasmic reticulum (ER) stress and ER stress-mediated apoptosis is involved in many cardiovascular diseases, but whether they also participate in AR-induced heart failure is still elusive. In this study, we found ER stress activation in myocardial samples from patients with AR. With a unique murine model of AR which induced eccentric cardiac hypertrophy and heart failure, we also found aggravation of cardiac ER stress and apoptosis, as evidenced by a reduction of Bcl-2/Bax ratio and an increase of caspase-3 cleavage. We then examined the signaling effectors involved in ER-initiated apoptosis and found volume overload specifically activated C/EBP homologous protein (CHOP), but not caspase-12 or Jun N-terminal kinase (JNK). Interestingly, tauroursodeoxycholic acid (TUDCA), an ER stress inhibitor, improved cardiac function, and suppressed ER stress, apoptosis, and CHOP. Furthermore, genetic knockdown of CHOP inhibited cardiac Bcl-2/Bax ratio reduction and caspase-3 activation and rescued cardiac dysfunction. In summary, our findings suggest that ER stress-CHOP signaling is involved in the development of volume overload cardiac hypertrophy induced by AR through promoting cardiomyocytes apoptosis and provide a previously unrecognized target in heart failure induced by volume overload.

The incidence of bicuspid aortic valves (BAV) is high in the whole population, BAV-related thoracic aortic aneurysm (TAA) is accompanied by many adverse vascular events. So far, there are two key points in dealing with BAV-related TAA. First is fully understanding on its pathogenesis. Second is optimizing surgical intervention time. This review aims to illustrate the potential role of miRNAs in both aspects, that is, how miRNAs are involved in the occurrence and progression of BAV-related TAA, and the feasibilities of miRNAs as biomarkers.

Background: Angiopoietin-2 (Angpt2) is associated with the progression of coronary artery disease (CAD). This research aimed to investigate the possible association between single nucleotide polymorphisms (SNPs) of ANGPT2 and CAD. Methods: This research was performed in a hospital from the eastern region of China. From February 2019 to June 2019, 222 patients with CAD were newly diagnosed and 403 healthy controls were confirmed by physical examinations. The distribution frequency of five SNPs of the ANGPT2 (rs11137037, rs2442598, rs12674822, rs1823375, and rs734701) in all participants was analyzed by real-time polymerase chain reaction (PCR) with SNP locus-specific probes. Results: Our data showed that the participants with the TT genotype of rs2442598 were at reduced risk of CAD compared with wild-types (adjusted odds ratio [AOR] = 0.511, 95% CI: 0.283–0.923). The participants with the AC and AC+CC genotypes of rs11137037 were at greater risk of CAD compared to wild-types (AOR = 1.754, 95% CI: 1.140-2.699; AOR = 1.731, 95% CI: 1.165–2.573, respectively). In addition, carriers of the GG+TT genotypes of rs12674822, showed more significant high-density lipoprotein than those of GG genotype, in addition, carriers of the GG+TT genotypes of rs12674822, showed more significant high-density lipoprotein than those of GG genotype (P=0.037). Conclusion: These findings, as well as analysis of the haplotype, clearly indicate that ANGPT2 SNPs were highly correlated with susceptibility to CAD among the Han Chinese population.

Epithelial barrier function (EBF) disruption is a key mechanism underlying gastroesophageal reflux disease (GERD). Our aim was to assess whether two novel technologies, probe-based confocal laser endomicroscopy (pCLE) and mucosal integrity testing (MIT), could assess EBF. We prospectively enrolled patients undergoing upper endoscopy for refractory GERD or non-GERD conditions. Patients underwent esophagogastroduodenoscopy, pCLE, MIT, esophageal biopsy at 2 cm and 6 cm above the esophagogastric junction, and wireless pH testing. To assess EBF in vitro, biopsies were mounted in a mini-Ussing chamber, 1 ml of fluorescein was instilled on the mucosal side, and concentration of fluorescein on the serosal side was measured at 3 h. We enrolled 54 subjects (28 GERD, 26 non-GERD based on Lyon consensus criteria). In vivo permeability assessed by pCLE did not differ significantly between GERD vs. non-GERD patients and did not correlate with in vitro permeability. Mean MIT at 2 cm was lower in GERD compared to non-GERD (1914 vs. 3727 ohms). MIT correlated inversely with in vitro permeability at 2 cm and at 6 cm. Using a predictive model that used slope and intercept of MIT at 2 cm and 6 cm, sensitivity and specificity of MIT at identifying GERD was 76% and 72%, respectively. pCLE did not differentiate GERD vs non-GERD and did not correlate with EBF measured in vitro. MIT, on the other hand, may be more promising as it differentiated GERD vs non-GERD and correlated with EBF measured in vitro.

BACKGROUND: Due to submucosal infiltration’s biological nature along the airway, adenoid cystic carcinoma (ACC) frequently leaves positive surgical margins. This study evaluated the clinicopathologic, and computed tomography (CT) features for predicting surgical margin status in central airway ACC. METHODS: We retrospectively analyzed the files of 71 patients with ACC of the central airway proven by histopathology and surgery who had presented between January 2010 and December 2018. All patients were classified into positive and negative surgical margin groups according to margin status. Univariate analysis and multivariable logistic regression models were then performed to compare demography, histopathology, and CT characteristics between ACC patients with positive and negative margins. RESULTS: After surgical resection, 59 (83.1%) patients had positive margins, and 12 (16.9%) had negative margins. The contrast-enhanced CT (CECT) longitudinal tail sign (LTS) was identified in 55 of 59 (93.2%) patients with positive margins and was the only feature that had a significant association with positive margins (odds ratio 41.250, 95% CI: 7.886–215.767; P

A reconfigurable antenna with a compact size and quad-polarization reconfigurability is presented. By employing a switchable feed scheme, the antenna can operate at single-fed and dual-fed modes. At single-fed mode, the feed structure allows output ports switching to produce the excitations for either slant +45° or −45° linear polarization (LP). At dual-fed mode, it serves as a switchable phase-shifting power splitter for generating left-hand circular polarization (LHCP) or right-hand circular polarization (RHCP). To realize a simple and space-saving configuration, the antenna makes efficient use of the proposed feed structure, which is highly shared among the four polarization states. Measured results show that the antenna exhibits operating bandwidths of 230 and 260 MHz at circular polarization CP and LP states, respectively. Moreover, stable broadside radiation patterns as well as moderate gains could also be obtained.

BACKGROUND Ophthalmic surgery is invasive, and treatment efficacy is affected by a variety of factors. We aimed to analyze perioperative treatment compliance, anxiety and depression of elderly patients undergoing ophthalmic surgery and the influential factors. METHODS The study group comprised 119 elderly patients undergoing ophthalmic surgery between March 2018 and March 2020. Clinical and treatment compliance data of all patients were collected. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were administered to all patients, and logistic regression analysis was used for multivariate analysis. RESULTS During the perioperative period the 119 elderly patients had a mean SAS score of 65.13±14.36, and SDS score of 61.94±17.39. Treatment compliance was as follows: 76 cases of complete compliance, 25 of incomplete compliance, and 18 of complete non-compliance. Economic status, complications, treatment options and levels of TNF-α, IL-6, and IL-8 are independent risk factors that affected the compliance of elderly patients undergoing ophthalmology surgery (P

In this letter, a closed-loop cross-dipole antenna array (CLCDAA) is proposed for wideband orbital angular momentum (OAM) communication. The proposed antenna array is designed based on a closed-loop cross dipoles patch, several pillow-like parasitic patches, and a hybrid wideband feeding network. The design method of the feeding network is introduced using the analysis of the multiport network, and the good performance of this feeding network is verified. A prototype CLCDAA is fabricated and measured to validate the design concept. The OAM beams can cover a wide frequency band from 2.08 to 3.95 GHz (62.02%), and the simulation and measurement results are in good agreement. Benefiting from a compact structure, simple design procedure, and steady performance, the proposed antenna array has a significant meaning in the application of wireless communications.

Context Weight gain is a major driver of dissatisfaction and decreased quality of life in patients with hypothyroidism. Data on the changes in body weight following thyroidectomy are conflicting. Objective To perform a systematic review of the literature and a meta-analysis of weight changes following total thyroidectomy. Data Sources Literature search on PubMed. Study Selection Studies in English published between September 1998 and May 2018 reporting post-thyroidectomy weight changes. Data extraction Data were reviewed and compared by 3 investigators; discrepancies were resolved by consensus. Meta-analyses were performed using fixed and random effect models. Univariable and multivariable meta-regression models for weight change were implemented against study follow-up, gender, and age. Exploratory subgroup analyses were performed for indication for surgery. Data Synthesis Seventeen studies (3164 patients) with 23.8 ± 23.6 months follow-up were included. Severe heterogeneity across studies was observed. Using a random effect model, the estimated overall weight change was a gain of 2.13 kg, 95% confidence interval (CI; 0.95, 3.30). Age was negatively associated with weight change (β = -0.238, P < 0.001). In subgroup analyses, weight gain was more evident in patients undergoing thyroidectomy for hyperthyroidism: 5.19 kg, 95% CI (3.21, 7.17) vs goiter or malignancy 1.55 kg, 95% CI (0.82, 2.27) and 1.30 kg, 95% CI (0.45, 2.15), respectively. Conclusions Patients undergoing thyroidectomy experience possible mild weight gain, particularly younger individuals and those with hyperthyroidism as the indication for surgery. Prospective studies directed to assess the pathophysiology of weight gain post-thyroidectomy, and to test novel treatment modalities, are needed to better characterize post-thyroidectomy weight changes.

In Taiwan, strawberries (Fragaria ×ananassa Duch.) are an exotic and expensive commodity, with the retail market prices ranging from 170 to 670 NT$/kg (5.37 to 21.15 US$ based on the yearly average...

The emergence of electronic devices has brought earth-shaking changes to people’s life. However, an external power source may become indispensable to the electronic devices due to the limited capacity of batteries. As one of the possible solutions for the external power sources, the triboelectric nanogenerator (TENG) provides a novel idea to the increasing number of personal electronic devices. TENG is a new type of energy collector, which has become a hot spot in the field of nanotechnology. It is widely used at the acquisition and conversion of mechanical energy to electric energy through the principle of electrostatic induction. On this basis, the TENG could be integrated with the energy storage system into a self-powered system, which can supply power to the electronic devices and make them work continuously. In this review, TENG’s basic structure as well as its working process and working mode are firstly discussed. The integration method of TENGs with energy storage systems and the related research status are then introduced in detail. At the end of this paper, we put forward some problems and discuss the prospect in the future.

Prior studies on belatacept conversion from calcineurin inhibitor (CNI) have been limited by an absence of postconversion surveillance biopsies that could underestimate subclinical rejection, or a case-controlled design. A total of 53 adult patients with allograft dysfunction underwent belatacept conversion (median: 6 months) post-transplant. At a median follow-up = 2.5 years, patient survival was 94% with a death-censored graft survival of 85%. Seven (13%) patients had acute rejection (including 3 subclinical) at median 6 months postconversion. Overall, eGFR improved (P =

Objective:To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period.Design:Interrupted time series.Setting:The study was conducted in an 865-bed academic medical center.Methods:Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) “contact plus” isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018).Results:Environmental cleaning interventions and enhanced “contact plus” isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470).Conclusion:Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.

For radar network, each radar can obtain the two-dimensional (2D) inverse synthetic aperture radar (ISAR) image from the corresponding observation angle independently. Taking advantage of the multi...

Environmental stress leads to the production of reactive oxygen species (ROS) and consequently oxidative stress, which limits plant productivity. Thus, new crop cultivars that are able to overcome oxidative stress are required to address the global issues of environmental, food, and energy security. Sweetpotato (Ipomoea batatas [L.] Lam) is considered an emerging multifunctional crop because of its high carbohydrate content and adaptation to marginal lands. Moreover, sweetpotato offers several health benefits for the aging population, as it is rich in low-molecular-weight antioxidants (LMWAs) (e.g., carotenoids, ascorbate, tocopherols, and polyphenols), dietary fiber, potassium, and minerals. We speculate that metabolic engineering of LMWAs in sweetpotato will lead to the development of smart cultivars with enhanced levels of antioxidants and abiotic stress tolerance. This review describes the current status of metabolic engineering of LMWAs in sweetpotato and the potential of sweetpotato in ensuring food and nutrition security in the twenty-first century. Here, we focus on carotenoids, ascorbate, tocopherols, and polyphenols including anthocyanins in transgenic sweetpotato plants. Additionally, we discuss the potential role of the sweetpotato Orange (IbOr) gene, involved in carotenoid accumulation and stress tolerance, in improving crop productivity under the changing global climate and alleviating the problem of vitamin A deficiency. Genetic engineering of the biosynthetic and metabolic genes of LMWAs in sweetpotato is currently under investigation via molecular breeding. We predict that metabolic engineering of antioxidants in sweetpotato will lead to the development of new cultivars with enhanced nutritional value and abiotic stress tolerance, which will ensure global food and nutrition security in the face of climate change.

The adipokine resistin is linked with obesity, inflammation and various cancers, including breast cancer. This study sought to determine whether certain polymorphisms in the gene encoding resistin, RETN, increase the risk of breast cancer susceptibility. We analyzed levels of resistin expression in breast cancer tissue and samples from The Cancer Genome Atlas database. We also examined associations between four RETN single nucleotide polymorphisms (SNPs; rs3745367, rs7408174, rs1862513 and rs3219175) and breast cancer susceptibility in 515 patients with breast cancer and 541 healthy women without cancer. Compared with wild-type (GG) carriers, those carrying the AG genotype of the RETN SNP rs3219175 and those carrying at least one A allele in the SNP rs3219175 had a higher chance of developing breast cancer (adjusted odds ratio, AOR: 1.295, 95% confidence intervals, CI: 1.065-1.575 and 2.202, 1.701-2.243, respectively). When clinical aspects and the RETN SNP rs7408174 were examined in the breast cancer cohort, the CT genotype was linked to late-stage disease, while women with luminal A disease and at least one C allele were likely to progress to stage III/IV disease and to develop highly pathological grade III disease. Moreover, resistin-positive individuals were at greater risk than resistin-negative individuals for developing pathological grade III disease (OR: 5.020; 95% CI: 1.380-18.259). This study details risk associations between resistin and RETN SNPs in breast cancer susceptibility in Chinese Han women.

BACKGROUND There is scant data on the use of induction immunosuppression for simultaneous liver/kidney transplantation (SLKT). METHODS We analyzed the Organ Procurement and Transplant Network registry from 1996 to 2016 to compare outcomes of SLKT, based on induction immunosuppression. RESULTS Of 5172 patients, 941 (18%) received T-cell depletion induction, 1635 (32%) received interleukin 2 receptor antagonist (IL2-RA), and 2596 (50%) received no induction (NI). At 5 years, patient survivals were 68% in the T-cell group, 74% in the IL2-RA group, and 71% in the NI group (P = 0.0006). Five-year liver and kidney allograft survivals were 67% and 64% in the T-cell group, 73% and 70% in the IL2-RA group, and 70% and 68% in the NI group (P = 0.001 and 0.003), respectively. On multivariate analysis, the type of induction had no impact on patient or allograft survival. Maintenance steroids and calcineurin inhibitors (CNIs) at discharge were associated with improved patient and graft survival (steroids: patient survival hazard ratio [HR] 0.37 [0.27-0.52], liver survival HR 0.43 [0.31-0.59], kidney survival HR 0.46 [0.34-0.63]; P < 0.0001, CNI: patient survival HR 0.3 [0.21-0.43], liver survival HR 0.3 [0.2-0.44], kidney survival HR 0.4 [0.26-0.59]; P < 0.0001). CNI maintenance in patients who received T-cell induction was associated with decreased patient, liver, and kidney allograft survivals (respective HR: 1.4 [1.1, 1.8]; 1.5 [1.1, 1.9]; 1.3 [1.08, 1.7]; P < 0.05) CONCLUSION.: Induction immunosuppression had no impact on patient and allograft survival in SLKT, while maintenance steroids and CNI were associated with improved patient and graft survivals. Given the inherent limitations of a registry analysis, these findings should be interpreted with caution.

In this paper, a mode and circular-polarization (CP) simultaneously reconfigurable patch array antenna for orbital angular momentum (OAM) beams generation is presented and experimentally investigated. The array antenna simply consists of a 1:4 power divider and four antenna elements, each of which is fed with two switchable ports and a quadrature phase shift. Besides, the four elements are arranged using an orthogonal configuration. In this manner, switchable CPs are generated for each element, and switchable ±90° phase differences are obtained between adjacent elements. By strategically varying the ON/OFF status of the p-i-n diodes loaded as switches, the antenna could operate among left-hand CP (LHCP) with OAM-mode +1 or -1 and right-hand CP (RHCP) with OAM-mode +1 or -1. Without additional phase-shifting networks, the design method can be easily extended to large-scale antenna arrays. According to the measured results, an overlapped operational band of 2.39 to 2.64 GHz is obtained among the four states. In addition, both far-field and near-field distributions are performed to verify the design. Owing to its flexibility of OAM mode and polarization reconfigurablity as well as symmetrical and simple configuration, the antenna could be a promising application in future OAM-based communications system.

An Orbital angular momentum (OAM) antenna with both mode reconfigurability and polarization agility is proposed in this paper. The proposed antenna is designed based on a four-element uniform circular array with a phase-shifting reconfigurable feed network. To reduce its dimensions and complexity, the feed work is constructed with two stages of single-pole double-throw switches and a stage of 90° phase-shifting power dividers, partially of which can be shared among the chosen operating states. Moreover, the use of a small amount of p-i-n diodes as binary switches allows low insertion loss and low component cost. By varying the ON/OFF status of the diodes strategically, the resultant array can be reconfigured to horizontal polarization (HP) or vertical polarization (VP), along with OAM mode $l = -1$ or +1 achieved for each polarization. The antenna performance is evaluated in terms of reflection coefficients, near-field distributions and far field radiation patterns. According to the measured results, the antenna exhibits an overlapped frequency band ranging from 2.29 to 2.59 GHz among the different operating states. Meanwhile, stable radiation patterns as well as high cross-polarization discrimination can be obtained. Benefiting from the above features, the antenna could help to improve the signal quality and increase the channel capacity in wireless communications.

A computational hemodynamics method was employed to investigate how the morphotype and functional state of aortic valve would affect the characteristics of blood flow in aortas with pathological dilation, especially the intensity and distribution of flow turbulence. Two patient-specific aortas diagnosed to have pathological dilation of the ascending segment while differential aortic valve conditions (i.e., one with a stenotic and regurgitant RL bicuspid aortic valve (RL-BAV), whereas the other with a quasi-normal tricuspid aortic valve (TAV)) were studied. When building the computational models, in addition to in vivo data-based reconstruction of geometrical model and boundary condition setting, the large eddy simulation method was adopted to quantify potential flow turbulence in the aortas. Obtained results revealed the presence of complex flow patterns (denoted by time-varying changes in vortex structure), flow turbulence (indicated by high turbulent eddy viscosity (TEV)), and regional high wall shear stress (WSS) in the ascending segment of both aortas. Such hemodynamic characteristics were significantly augmented in the aorta with RL-BAV. For instance, the space-averaged TEV in late systole and the wall area exposed to high time-averaged WSS (judged by WSS> two times of the mean WSS in the entire aorta) in the ascending aortic segment were increased by 176% and 465%, respectively. Relatively, flow patterns in the descending aortic segment were less influenced by the aortic valve disease. These results indicate that aortic valve disease has profound impacts on flow characteristics in the ascending aorta, especially the distribution and degree of high WSS and flow turbulence.

Background FUT8-mediated core fucosylation, which transfers a fucose residue from GDP-fucose to core-GlcNAc of the N-linked type glycoproteins, is crucial for signaling receptors function. Core fucosylation is involved in various biological processes such as cell proliferation, apoptosis, differentiation and immune regulation. Our previous studies demonstrated that inhibiting core fucosylation prevented renal interstitial fibrosis of UUO murine models, but its role in the development of diabetic kidney disease (DKD) remains unclear. This study aimed to clarify the protective effects and molecular mechanisms during the progress of DKD by inhibiting core fucosylation in vivo. Methods Core fucosylation was examined in streptozotocin (STZ)-induced diabetic mouse model. Then a new Fut8 mutation mouse model in which exon 7 of Fut8 gene is deleted was constructed for diabetes induction. Metabolic and renal parameters were measured. Renal structure, fibrosis, and podocyte injury were assessed, and underlying mechanisms were investigated. Results The levels of fasting blood glucose, glycated hemoglobin, kidney-weight-to- body-weight (KW/BW) and urine albumin-to-creatinine (ACR) were increased at 16 weeks post injection. KW/BW and urine ACR were decreased significantly by inhibiting core fucosylation. The renal pathology, fibrosis, and podocyte injury were mitigated significantly by inhibiting core fucosylation. The protective effects of inhibiting core fucosylation were mediated by downregulated of the phosphorylation of Smad2/3 and extracellular signal-regulated kinase (ERK). Conclusions Our results indicate that FUT8-based treatment might be a promising intervention strategy in therapeutic paradigm of DKD.

Introduction The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. Methods This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in the United States (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N = 520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8, or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. Results At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI = 1.9–104.9] and 3.5 [95% CI = 1.2–10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). Conclusions When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. Implications The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

With the support of GIS spatial analysis technology, based on an in-depth study of the wireless propagation environment of a city, combined with the analysis of project requirements, it proposes to use the SPM model to correct the propagation model parameters, using SPM. The wireless propagation model, and research and analysis of the SPM wireless propagation model correction algorithm, further corrected the parameters of a city's SPM wireless propagation model. On this basis, the propagation loss of several classic propagation models in different environments is compared, and the SPM propagation model suitable for the signal frequency band and propagation environment of this study is selected. The correction of the SPM propagation model is based on the designed correction principle and correction process, that is, the weighted least square method is used to fit and analyze the measured level data to obtain an SPM prediction improvement model with local characteristics, and according to the designed verification link. Evaluation of the correction results shows that the accuracy requirements are met. Based on the corrected SPM prediction model, link loss calculations were performed on the 13 test base stations studied in the experiment, and the effective coverage radius of each base station community was obtained. In combination with GIS technology, model parameters and workers of each base station participated in the electronic map loading of the area Go to the network planning software to get the wireless signal coverage prediction map of each base station. Finally, according to the technical requirements of the TD-LTE system network planning and network optimization engineering, the objectiveness and rationality of the site selection and number of base stations in the area were verified, and specific problems regarding poor coverage and overlapping coverage in the area were proposed.

This paper aims to address the problem of secure control for a class of networked positive systems subject to denial-of-service (DoS) attacks under event-triggered scheme. DoS attacks involve with limited frequency and duration, which block the transmission of control input. According to the sleeping or activating status of DoS attacks, a switched positive system model composed of two positive subsystems is constructed. By considering the positive property of states and the effects of DoS attacks, a new event-triggering scheme is proposed. By using the matrix decomposition technique, the gain matrix of the event-triggered controller is parameterized as a combination of non-positive and non-negative components. Under such designed controller, a sufficient criterion is derived to guarantee the positive property and stability of the corresponding system. At last, a numerical example is carried out to substantiate the proposed result.

Trials describing 4- to 12-week courses of direct-acting antiviral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R- transplants) may be limited in "real-world" application by costs and delayed access to DAAs. We previously reported HCV transmission of 13% among D+/R- transplants with 2- to 4-day pangenotypic sofosbuvir/velpatasvir (SOF/VEL) perioperative prophylaxis, where one patient with HCV transmission was a nonresponder to first-line full-course DAA. Here, we report new data with a 7-day prophylaxis protocol (N = 50), as well as cumulative treatment and outcome data on all HCV D+/R- transplants (N = 102). Overall, nine patients (9/102; 9%; 95% CI: 5%-16%) developed HCV transmission, with a significant decline noted in the 7-day group (2/50; 4%; 95% CI: 0%-13%) compared with 2- to 4-day prophylaxis (7/52; 13%; 95% CI: 5%-25%). All patients with HCV transmission achieved sustained virologic response post full-course therapy (including one nonresponder from initial trial). A 1:1 matched analysis (N = 102) with contemporary HCV D-/R- transplants (controls) showed that although the pretransplant wait time was significantly shorter for D+/R- compared with D-/R- (mean: 1.8 vs. 4.4 years; p

Long-term flight depends heavily on intensive energy metabolism in animals; however, the neuroendocrine mechanisms underlying efficient substrate utilization remain elusive. Here, we report that the adipokinetic hormone/corazonin-related peptide (ACP) can facilitate muscle lipid utilization in a famous long-term migratory flighting species, Locusta migratoria. By peptidomic analysis and RNAi screening, we identified brain-derived ACP as a key flight-related neuropeptide. ACP gene expression increased notably upon sustained flight. CRISPR/Cas9-mediated knockout of ACP gene and ACP receptor gene (ACPR) significantly abated prolonged flight of locusts. Transcriptomic and metabolomic analyses further revealed that genes and metabolites involved in fatty acid transport and oxidation were notably downregulated in the flight muscle of ACP mutants. Finally, we demonstrated that a fatty-acid-binding protein (FABP) mediated the effects of ACP in regulating muscle lipid metabolism during long-term flight in locusts. Our results elucidated a previously undescribed neuroendocrine mechanism underlying efficient energy utilization associated with long-term flight., eLife digest Flight allows insects to find food or seek a better environment. Some insects have developed the ability of ‘long-term flight’, which allows them to make continuous journeys over large distances. For example, one locust species regularly crosses the Red Sea which is up to 300 km wide – a spectacular feat for insects only a few inches long. However, flight is an energy-intensive activity, and insects’ muscles need the right sort of chemical fuel to work properly. Previous work has shown that this ‘fuel consumption’ is highly dynamic and happens in two stages. First, immediately after take-off, the muscles rapidly consume carbohydrates (sugars); then, during the prolonged phase of the flight, muscles switch to exclusively consume lipids (fats). How the flight muscles ‘know’ when to start using fats for energy remains largely unclear. It has been suggested that this switch may involve hormone-like chemicals made in the brain called neuroendocrine peptides. Hou et al. therefore set out to test this hypothesis, using the locust species Locusta migratoria as a representative migratory insect. Initial experiments used an abundance detection technique to determine which of the neuroendocrine peptides were active in adult locusts. Further analysis, looking specifically at locusts that had just been flying, revealed that the gene for a peptide called ACP became much more active after one hour of continuous flight. Further evidence that the ACP hormone could indeed be helping to power long-term flight came from locusts with a mutated, ‘switched-off’ version of the gene. These insects could only fly for half the time, and half the distance, compared to locusts that did not have mutations in the gene for ACP. Biochemical studies of the ACP mutant locusts confirmed that their flight muscle cells could not transport and break down fatty acids normally. These experiments also showed that ACP was acting through a type of carrier protein called FABP, which is present in many different insects and normally ‘ferries’ lipids to the places they are needed. These findings shed new light on the biological mechanisms that control long-term flight in migratory insects. The ability to move over long distances is key to the outbreak of locust plagues, which in turn cause widespread crop damage around the world. Hou et al. therefore hope that this knowledge will one day help develop effective strategies for locust pest control.

Background Circulating donor-derived cell free DNA (cfDNA), a minimally invasive diagnostic tool for kidney transplant rejection, was validated using traditional histology. The Molecular Microscope (MMDx) tissue gene expression platform may provide increased precision to traditional histology. Methods In this single-center prospective study of 208 biopsies (median=5.8 months) post-transplant, we report on the calibration of cfDNA with simultaneous biopsy assessments using MMDx and histology by Area under the curve (AUC) analyses for optimal criterion, as well as for, previously published cfDNA cut-offs ≤0.21% to 'rule-out' rejection and ≥1% to 'rule-in' rejection. Results There were significant discrepancies between histology and MMDx, with MMDx identifying more antibody-mediated rejection (65; 31%) than histology (43; 21%); the opposite was true for T-cell mediated rejection [TCMR; histology: 27 (13%) vs MMDx: 13 (6%)]. Most of the TCMR discrepancies were seen for histologic borderline/1A TCMR. AUC Curves for cfDNA and prediction of rejection were slightly better with MMDx (AUC=0.80; 95%CI: 0.74-0.86) vs. histology (AUC=0.75; 95%CI: 0.69-0.81). A cfDNA≤0.21% had similar sensitivity (~91%) to 'rule-out' rejection by histology and MMDx. Specificity was slightly higher with MMDx (92%) compared with histology (85%) to 'rule-in' rejection using cfDNA criterion≥1%. Strong positive quantitative correlations were observed between cfDNA scores and molecular acute kidney injury (AKI) for both 'rejection' and 'nonrejection' biopsies. Conclusions Molecular diagnostics using tissue gene expression and blood-based donor-derived cell-free DNA may add precision to some cases of traditional histology. The positive correlation of cfDNA with molecular AKI suggests a dose-dependent association with tissue injury irrespective of rejection characteristics.

A compact and wideband slot antenna backed by a square substrate integrated waveguide (SIW) cavity is presented. By exciting the dual-slotted SIW cavity with an offset coaxial feed, a transverse electric (TE)110 resonant mode along with two hybrid modes as combinations of TE110 and TE120 resonances can be generated within a close range. The triple resonances contribute to producing a wideband response while maintaining a compact antenna structure. An antenna prototype with a total size of 0.49λ 0 × 0.49λ 0 × 0.16λ 0 is manufactured and experimentally tested. Measures results show that an operating band of about 33.0% is obtained. Meanwhile, it also exhibits stable unidirectional patterns and moderate gains over the whole band.

We employed an interrupted time series analysis to assess the impact of ultraviolet-C light disinfection at terminal discharge in an oncology unit and a bone marrow transplant unit on the incidence of hospital-acquired infections. The deployment of ultraviolet-C light disinfection was associated with a significant decrease in the rate of Clostridioides difficile infections and a significant decrease in the rate of central line-associated blood stream infections in the bone marrow transplant unit.

International student mobility has been becoming varied and complex. Chinese higher education institutions (HEIs) host about 492,185 international students in 2018, sharing 10 percent of globally mobile students. The purpose of the study was to promote understanding of factors that influence international students choose to earn academic degree in Chinese HEIs. The econometric approach was applied to identify factors that influence international student mobility in China. The total inflow of international students, the inflow of students from both developing and developed countries, and international students with undergraduate, master’s and doctoral academic programs are taken as predicted variables. The political, economic, academic, socio-cultural factors were chosen as explanatory variables. From the sample data of 60 countries of origin, our data covers more than 89% of total international students earn academic degrees in Chinese HEIs during the period 2007 to 2016. The results indicated some differences in determinants of undergraduate students, master’s students and doctoral students from developing and developed countries choose to study in China. The economic development level between China and the countries of origin and their bilateral trade relations are important economic factors that affect international students, and the impact on undergraduate students is more significant. The Chinese government scholarship policies and mutual recognition of academic degrees have been effectively promoted inward international students. Compared with undergraduate students, the academic ranking of Chinese universities has more significant influences on master’s students and doctoral students. The geographical distance and cultural distance between China and the countries of origin are important social and cultural factors. International students from developed countries are more influenced by cultural distance factor.

Background The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of the IPC in patients with refractory HH. Methods A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with an IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports, and laboratory values. The Kaplan-Meier method was used to estimate catheter time to removal. The Cox proportional hazard model was used to evaluate for independent predictors of pleurodesis and death. Results Seventy-nine patients were identified from eight institutions. Indication for IPC placement was palliation in 58 patients (73%) and bridge to transplant in 21 patients (27%). The median in situ dwell time of all catheters was 156 days (range, 16-1,978 days). Eight patients (10%) were found to have pleural space infection, five of whom also had catheter-site cellulitis. Two patients (2.5%) died secondary to catheter-related sepsis. Catheter removal secondary to spontaneous pleurodesis was achieved in 22 patients (28%). Median time from catheter insertion to pleurodesis was 55 days (range, 10-370 days). Older age was an independent predictor of mortality on multivariate analysis (hazard ratio, 1.05; P = .01). Conclusions We present, to our knowledge, the first multicenter study examining outcomes related to IPC use in HH. Ten percent infection risk and 2.5% mortality were identified. IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population.

Bayesian network is a kind of uncertainty knowledge expression and reasoning tool, and it is an effective means to solve problems in related fields such as information retrieval. Considering the characteristics of e-commerce supply chain supply information and Bayesian network, a cognitive big data analysis method for intelligent information system is designed. The model uses a set of information sample documents to describe the query requirements and the documents to be detected. By calculating the similarity between them, the return results of the general search engine are sorted, thereby retrieving the supply chain supply information required by the user. Through numerical results, the precision of the source information retrieval model based on Bayesian network is also significantly higher than that of the trust network model and the inference network model, and the experimental data shows that the Bayesian network model has better retrieval performance than the trust network model and the inference network model. Therefore, when conducting large-scale e-commerce supply chain supply information collection, Bayesian network-based source information retrieval model is effective.

Lung cancer is the most common malignancy in China and is associated with a poor survival rate amongst Han Chinese. The high mortality is largely attributed to late-stage diagnosis, when treatment is largely ineffective. Identification of genetic variants could potentially assist with earlier diagnosis and thus more effective treatment. The development and progression of lung cancer is stimulated by angiopoietin-2 (Ang2), a ligand for Tie2, an endothelial tyrosine kinase. Patients with lung cancer with higher serum Ang2 levels have significantly poorer survival than patients with lower serum Ang2 levels. We explored the effects of Ang2 single nucleotide polymorphisms (SNPs) on lung cancer susceptibility. We used lung cancer tissue and serum samples to measure Ang2 expression in a Chinese Han population. Five Ang2 SNPs (rs2442598, rs734701, rs1823375, 11137037, and rs12674822) were analyzed using TaqMan SNP genotyping in 695 patients with lung cancer and 900 cancer-free controls. Carriers of the variant GT allele of rs12674822 had a higher risk of lung cancer than wild-type (GG) carriers, while the presence of the CC genotype at rs11137037 was associated with higher clinical stage disease compared with having the AA genotype. Our study is the first to document a correlation between Ang2 polymorphisms and lung cancer development and progression in people of Chinese Han ethnicity.

The Angiopoietin-2 (Ang2) gene encodes angiogenic factor, and the polymorphisms of Ang2 gene predict risk of various human diseases. We want to investigate whether the single nucleotide polymorphisms (SNPs) of the Ang2 gene can predict the risk of rheumatoid arthritis (RA). Between 2016 and 2018, we recruited 335 RA patients and 700 control participants. Comparative genotyping for SNPs rs2442598, rs734701, rs1823375 and rs12674822 was performed. We found that when compared with the subjects with the A/A genotype of SNP rs2442598, the subjects with the T/T genotype were 1.78 times likely to develop RA. The subjects with C/C genotype of SNP rs734701 were 0.53 times likely to develop RA than the subjects with TT genotype, suggesting the protective effect. The subjects with G/G genotype of SNP rs1823375 were 1.77 times likely to develop RA than the subjects with C/C genotype. The subjects with A/C and C/C genotype of SNP rs11137037 were 1.65 and 2.04 times likely to develop RA than the subjects with A/A genotype. The subjects with G/T and T/T genotype of SNP rs12674822 were 2.42 and 2.25 times likely to develop RA than the subjects with G/G genotype. The T allele over rs734701 can lead to higher serum erythrocyte sedimentation rate level (p = 0.006). The A allele over rs11137037 was associated with longer duration between disease onset and blood sampling (p = 0.003). Our study suggested that Ang2 might be a diagnostic marker and therapeutic target for RA therapy. Therapeutic agents that directly or indirectly modulate the activity of Ang2 may be the promising modalities for RA treatment.

OBJECTIVES Patients with bicuspid aortic valve (BAV) have a high risk of aortic dilation and adverse vascular events. Previous studies had reported soluble receptor for advanced glycation end products (sRAGE) to compete with receptor of advanced glycation end products (RAGE) for ligand binding and inhibit the activation of nuclear-factor kappa-B (NF-κB) pathway and matrix metalloproteinases (MMP) transcription. Thus, sRAGE serum levels may contribute to the clinical diagnosis and monitoring of ascending aorta aneurysm in patients with BAV. METHODS To eliminate the confounding factors, 44 patients with BAV were divided into 3 subgroups according to the diameter of ascending aorta, and 20 patients with tricuspid aortic valve and normal-sized ascending aorta were selected as a control group. Protein levels and gene transcription of several variates were evaluated in the tissue and serum samples from these patients. Human aortic smooth muscle cells were treated with AGE-BSA in gradient concentrations, and changes in phenotype and protein and mRNA levels were detected. RESULTS Serum levels of sRAGE in the 3 BAV groups were obviously higher than those in the tricuspid aortic valve group, although there was negative correlation between the serum sRAGE levels and ascending aortic diameters among patients with BAV. Transcript expression levels of RAGE and NF-κBp65 mRNA were increased in the 3 BAV groups and RAGE/NF-κB pathway was activated with the progression of ascending aortic aneurysm. Abnormal activation of RAGE/NF-κB pathway was observed in AGE-BSA-treated human aortic smooth muscle cells. CONCLUSIONS Our study has shown a trend in serum levels of sRAGE among patients with BAV, and that the cellular and extracellular pathological processes are quite serious even in the normal-sized or slightly dilated aorta. Together, the findings indicated that sRAGE may be used as a biomarker to predict aneurysm expansion rates and the risk of adverse vascular events., Bicuspid aortic valve (BAV) is the most common congenital heart abnormality with a prevalence of 1–2% in general [1].

Summary Background Electronic nicotine delivery systems (ENDSs) are used by some smokers to reduce cigarette consumption, but their effectiveness is uncertain. We aimed to examine the extent to which ENDSs or a non-nicotine cigarette substitute influence tobacco-related toxicant exposure and cigarette consumption in smokers interested in smoking reduction. Methods We did a four-arm, parallel-group, randomised controlled trial at two sites in the USA (Penn State University, Hershey, PA, and Virginia Commonwealth University, Richmond, VA). We enrolled adults aged 21–65 years who smoked more than nine cigarettes per day (for at least the past year), with exhaled CO of more than 9 parts per million at screening, who were not currently using an ENDS, and who were interested in reducing smoking but not quitting. Participants were randomised (site-specific with allocation concealment; 1:1:1:1) to receive either a cartomiser-based, pen-style ENDS (eGo-style) paired with 0, 8, or 36 mg/mL liquid nicotine (participants and researchers masked to concentration) or a non-ENDS cigarette-shaped plastic tube that delivered no nicotine or aerosol (cigarette substitute; unmasked) for 24 weeks. Conditions were chosen to reflect a range of nicotine delivery including none (cigarette substitute and 0 mg/mL ENDS), low (8 mg/mL), and cigarette-like (36 mg/mL), and all conditions were paired with smoking reduction instructions. The primary outcome was concentration of the tobacco-specific carcinogen metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; urinary total) collected at randomisation and at 4, 12, and 24 weeks. Multiple imputation with and without covariate adjustment was used in addition to sensitivity analyses. This trial is registered with ClinicalTrials.gov, NCT02342795. Findings Between July 22, 2015, and Nov 16, 2017, 684 individuals were screened and 520 (76%) were enrolled and randomised. 188 (36%) of 520 participants were lost to follow-up by week 24; attrition did not differ by study group (39 [30%] of 130 in the cigarette substitute group, 56 [43%] of 130 in the ENDS with 0 mg/mL nicotine group, 49 [38%] of 130 in the ENDS 8 mg/mL group, and 44 [34%] of 130 in the ENDS 36 mg/mL group). Urinary total NNAL at 24 weeks in the ENDS with 36 mg/mL nicotine group was 210·80 pg/mg creatinine (95% CI 163·03–274·42) compared with 346·09 pg/mg creatinine (265·00–455·32) in the cigarette substitute group (p=0·0061). No other significant differences between groups were observed for any time point for urinary total NNAL. Serious adverse event frequency was similar across groups (12 events in 12 participants [9%] in the ENDS with 36 mg/mL nicotine group, seven events in six participants [5%] in the 8 mg/mL group, 11 events in ten participants [8%] in the 0 mg/mL group, and 13 events in 13 participants [10%] in the cigarette substitute group), and all of these were deemed unrelated or unlikely to be related to study product use. There was one death between randomisation and 24 weeks (suicide; in the ENDS with 0 mg/mL nicotine group). Interpretation Use of an ENDS with cigarette-like nicotine delivery can reduce exposure to a major pulmonary carcinogen, NNAL, even with concurrent smoking. Future ENDS trials should involve products with well characterised nicotine delivery, including those with nicotine delivery approaching that of a cigarette. Funding National Institutes of Health, US Food and Drug Administration.

Background: Locusts as model systems are widely used in many biological laboratories worldwide. Occupational exposure to locusts induces a high prevalence of allergic sensitization. However, knowledge on occupational locust allergens remains unclear. This study aimed to identify a novel allergen from locusts that causes occupational allergies. Methods: We conducted a 20-year retrospective survey of 94 persons using questionnaires and a cross-sectional survey of 57 persons using questionnaires and immunological tests for occupational allergies in long-term locust laboratories. We identified the major allergens by immunoblotting and analysed them by LC-MS/MS. The allergenicity of the major allergen proteins was assessed by specific IgE (sIgE) detection, immunoblotting and ELISA inhibition assays. Results: The retrospective survey indicated that the frequency of occupational allergies was relatively low (13.8%), while the cross-sectional survey showed a higher frequency (40.4%). The symptoms in most allergic males were allergic rhinitis and asthma, while females showed higher prevalence of atopic dermatitis. Occupational exposure for 2-3 h per day or continuing one and half years obviously increased the allergy risk. We identified the hexamerin-2 protein as a major allergen in locusts. Purified hexamerin-2 protein achieved approximately 60% serum IgE reactivity with locust protein extract. The potential for cross-reactivity with cockroaches was indicated by sequence alignment of the hexamerin-2 protein and allergens of cockroaches. Conclusion: Occupational exposure is an important risk factor for locust allergy. The hexamerin-2 protein of locusts as a major allergen in occupational allergy was identified for the first time.

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts. Funding: None Disclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

BACKGROUND Although thoracentesis can offer considerable symptomatic relief to the patient, its physiologic impact on oxygen saturation has not been well established in the literature. This study aimed to evaluate the impact of thoracentesis on postprocedure pulse oximetry (SpO2) in an inpatient population. METHODS A retrospective study of patients undergoing thoracentesis from January 2012 to November 2017 was performed. Inclusion criteria were age above 18 and thoracentesis performed in an inpatient setting. Records were reviewed for patient demographics, procedure reports, and laboratory values. SpO2 and FiO2 values were collected before and 6 and 24 hours postprocedure. Multivariable linear regression models were used to evaluate for changes in SpO2 and SpO2/FiO2. Analyses were adjusted for age, sex, serum hemoglobin, effusion etiology, volume removed, nonexpandable lung physiology and procedural complications and FiO2. RESULTS A total of 502 patients were included. The mean (SD) age was 60 (14) years, and 53.4% of the patients were male. The most common cause of pleural effusion was malignant effusion (37%). The median (interquartile range) volume of fluid removed was 1400 (1000 to 2000) mL and nonexpandable lung physiology was noted in 35%. There was no significant within-subject difference in 24 hours postprocedure SpO2 compared with preprocedure SpO2. In multivariable analysis, there was a small increase in 24-hour postprocedure SpO2 [β=0.31, 95% confidence interval (0.22, 0.41), P

Purpose: Every September, millions of students—elite human resources—enter higher education in China. This large-scale college-induced migration has substantial impacts on China’s national and local labor markets. This study examines the migration pattern in college choice and admission among the Hui students in China. In doing so, we extend the existing interprovincial migration model by identifying and measuring the role of traditional dietary habits in college migration decisions. Design/Approach/Methods: This study uses college entrance examination ( Gaokao) admission data for 10 high school graduation cohorts from 2001 to 2010 in the Ningxia Hui Autonomous Region. These data are used to study the interprovincial migration of the Hui students following their college entrance examination. Ordinary least squares and logit regressions are used to control for other confounding factors, while the method of instrumental variables and placebo group comparison were used to rule out other explanations. Findings: Results demonstrate that traditional dietary habits produce geographic inequalities in terms of college opportunities for Hui and other minority group students. First, after controlling for variables such as college entrance examination scores and personal characteristics, results show that the Hui students are more likely to choose an institution closer to their hometown and preferred institutions located in Ningxia and the northwestern provinces rather than the Yangtze/Pearl River Delta regions and coastal provinces. Second, this migration pattern is shaped by the dietary habits of the Hui. Third, the Hui students were more likely to choose institutions in underdeveloped areas, resulting in corresponding welfare losses. Originality/Value: This study supplements classic college choice literature by documenting a special impact factor of geography previously overlooked by researchers, demonstrating the need to examine the underlying mechanisms of proximity and its significance in college choice. Moreover, the provision of dietary information may have important policy impacts for improved college choice, as well as for human capital investment and poverty alleviation measures in Northwest China.

Heart transplantation is the ultimate treatment option for patients with advanced heart failure. Since hearts from donation after brain death (DBD) donors are limited, donation after circulatory death (DCD) donor hearts could be another source for heart transplantation. DCD process involves ischemia-reperfusion (IR) injury. Mitochondrial dysfunction contributes to IR and is well established in the ex vivo (buffer perfused) ischemia animal model. However, DCD hearts undergo in vivo ischemia with a variable "ischemic period." In addition, the DCD hearts are exposed to an intense catecholamine surge that is not seen with ex vivo perfused hearts. Thus, the severity of mitochondrial damage in in vivo ischemia hearts could differ from the ex vivo ischemia hearts even following the same period of ischemia. The aim of our current study is to identify the mitochondrial dysfunction in DCD hearts and propose strategies to protect mitochondria. Adult Sprague Dawley rat hearts underwent in vivo or ex vivo ischemia for 25 min. Subsarcolemmal mitochondria (SSM) and interfibrillar mitochondria (IFM) were isolated from hearts following ischemia. We found that both ex vivo and in vivo ischemia led to decreased oxidative phosphorylation in SSM and IFM compared to time control or DBD hearts. The proportion of damage to SSM and IFM, including proton leak through the inner membrane, was higher with ex vivo ischemia compare to in vivo ischemia. Time control hearts showed a decrease in SSM and IFM function compared to DBD hearts. The calcium retention capacity (CRC) was also decreased in SSM and IFM with ex vivo and in vivo ischemia, indicating that ischemic damage to mitochondria sensitizes mitochondrial permeability transition pores (MPTP). Our study found differential mitochondrial damage between the in vivo ischemia and the ex vivo ischemia setup. Therefore, consideration should be given to the mode of ischemia while evaluating and testing myocardial protective interventions targeting mitochondria to reduce IR injury in hearts.

Background Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however, the impact on hospital-acquired infection rates (HAI) has not been assessed systematically. Methods Retrospective multicenter interrupted time series between 2002 and 2017 at three academic hospitals. Participating hospitals discontinued CP for patients with contained body fluids who were colonized or infected with MRSA or VRE. The primary intervention was stopping the use of CP. Secondary interventions were horizontal infection prevention strategies. The primary outcomes were rates of central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia due to MRSA, VRE, or any organism using Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definitions. Results Central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia rates trended down at each institution. There were no statistically significant increases in these infections associated with discontinuing CP. Individual horizontal infection prevention strategies variably impacted HAI outcomes. Conclusions Stopping the routine use of CP for patients with contained body fluids who are colonized or infected with MRSA or VRE did not result in increased HAIs. Bundled horizontal infection prevention strategies resulted in sustained HAI reductions.

A beam steerable resonant cavity antenna (RCA) enabled by using tunable partially reflective surface (PRS) is proposed in this paper. Tunable PRS loaded with varactor diodes evolves from complementary frequency selective surface (FSS) which consists of square loop patch and slot arrays. The reflection phase of PRS unit cell can be tuned by adjusting the biasing status of varctors, while the reflection magnitude keep a relative high value within a frequency band of interest, owing to the complementary configuration. The reflection coefficients of PRS unit cells are independently controlled in rows so that a gradient phase distribution within the aperture can be achieved, leading to an ID scannable directive beam. An implementation is demonstrated with simulated results, which exhibits maximum scanned angle of 13 degrees with a gain of 13.6 dB for a $2\lambda\times 2\lambda$ antenna aperture size.

Background Although aortic regurgitation (AR) is a clinically important condition that is becoming increasingly common, few relevant murine models and mechanistic studies exist for this condition. In this study, we attempted to delineate the pathological and molecular changes and address the roles of some potentially relevant molecules in an animal model of surgically induced AR. Methods AR was induced by puncturing the aortic valve leaflets in C57BL/6J mice under echocardiographic guidance. Results As early as 1 week following AR, the left ventricles (LV) displayed marked impairments in diastolic function and coronary flow reserve (CFR), as well as cardiac hypertrophy and chamber dilatation at both end-systole and end-diastole. LV free wall thickening and cardiomyocyte hypertrophy in LV were observed 2 weeks following of AR while a decline in ejection fraction was not seen until after 4 weeks. Nppa (natriuretic peptide A) and Nppb (natriuretic peptide B) increased over time, in conjunction with prominent Akt activation as well as slight CaMKII (Ca2+/calmodulin-dependent protein kinase II) activation and biphasic changes in β-arrestin-2 expression. Treatment of AR mice with Akt inhibition exacerbated the eccentric hypertrophy, while neither inhibition of CaMKII nor β-arrestin-2 overexpression influenced the response to AR. Conclusions Our structural, functional, molecular and therapeutic analyses reveal that Akt, but not CaMKII or β-arrestin-2, plays a regulatory role in the development of LV remodeling after AR in Mice. These results may shed important light on therapeutic targets for volume overloaded cardiomyopathy.