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Background Recently, emerging evidence has suggested that atrial fibrillation (AF) has an epidemiological correlation with coronavirus disease 2019 (COVID-19). However, the clinical outcomes of AF in COVID-19 remain inconsistent and inconclusive. The aim of this study was to provide a comprehensive description of the impact of AF on the prognosis of patients with COVID-19 pneumonia. Methods Three electronic databases (PubMed, Embase, and Web of Science) were searched for eligible studies as of March 1, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the associations between AF (preexisting and new-onset) and in-hospital mortality, post-discharge mortality, and ventilator use. Results A total of 36 individual studies were incorporated into our meta-analysis. The combined results revealed that preexisting AF was associated with increased in-hospital mortality (pooled OR: 2.07; 95% CI: 1.60–2.67; p

An extensive body of work within the marketing and economics literature has been devoted to studying vertical restraints, yet only a few researchers have investigated the violation behavior of retailers. In this paper, we investigate violation behavior in the context of retailer price maintenance. We investigate this behavior using a unique data set from a subsidy program in China, which includes transaction-level information that shows retail price maintenance (RPM) practices in multiple product categories by multiple manufacturers across multiple markets. The results from our fixed effects regression show that retailer violations are more likely to occur when intra-product competition is high. However, how retailer violation likelihood varies with inter-product competition may depend on the product category. We find that inter-product competition, is negatively associated with the likelihood of violation, for “less popular” product categories in the program such as washing machines, air conditioners, etc., but is positively associated with the likelihood of violation for “popular” product categories such as refrigerators, televisions, and cell phones. Our research provides some of the first empirical evidence about retailer violation behavior under RPM in the world’s largest emerging market by focusing on the relationship between violation behavior and market structure. We discuss the implications for monitoring efforts of manufacturers and regulators.

As people age, their ability to regulate the body temperature gradually weakens. Old people are always more vulnerable to thermal-related discomfort in cold weather. The purpose of this paper was t...

Data on anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are limited in children. This study is to determine the clinical features and outcomes of childhood-onset AAV. A retrospective study was performed on patients who were diagnosed with AAV before 18 years old in Xiangya Hospital. Their medical records were analyzed by retrospective review. Sixteen patients were diagnosed with AAV before 18 years old in the past 9 years, with an average age of 13.3 ± 3.3 years and 13 of them were female. There were 15 patients with microscopic polyangiitis (MPA) and 1 with Wegener’s granulomatosis. The interval between onset of disease and diagnosis of AAV was 2 (1.5–3) months. Most patients (15/16, 93.8%) had multi-organ involvement, and all patients had renal involvement with 7 (43.8%) patients requiring dialysis at presentation. Eleven patients underwent a renal biopsy, of which mixed class and sclerotic class were the most two common histological types. All patients received immunosuppressive therapy for induction therapy including intravenous administrations of methylprednisolone (MP) pulse therapy for 8 patients. 8 patients (50%) achieved remission after induction therapy. After a median follow-up of 46.3 ± 36.1 months, nine (56.3%) patients progressed to end-stage renal disease (ESRD) and 5 (31.3%) patients died. Childhood-onset AAV showed similar clinical and pathological features compared to those of adults, except that it usually occurs in girls. The most commonly involved organ was the kidney, and it had a high risk of progression to ESRD. Early diagnosis and initiation of appropriate immunomodulatory therapy would be important to improve outcomes.

The aim of this study was to investigate the diagnosis, treatment, and prognosis of patients with brain metastases from gestational trophoblastic neoplasia (GTN) in the real world. Analyzing the clinicopathological characteristics, treatment process, and prognosis of 14 GTN patients with brain metastases admitted to the West China Second University Hospital between January 2006 and December 2020. The median FIGO prognostic score was 15 points (range 11–21 points), with 12 cases having 13 points or more (extremely high risk). All patients received combination chemotherapy. The first-line regimen included 5-Fluorouracil, dactinomycin, and intrathecal methotrexate (5-FU + KSM + intrathecal MTX), and etoposide + methotrexate + actinomycin D/cyclophosphamide and vincristine (EMA-CO). Two patients died during the early period after diagnosis of brain metastases. A further patient with GTN Stage III failed to achieve a negative serum β human chorionic gonadotropin (hCG) after receiving chemotherapy in another hospital. Ten months after self-discontinuation of treatment, the disease progressed and she was admitted to our hospital with suspected liver and brain metastases, after which she abandoned treatment and was lost to follow-up. Among the remaining 11 patients, one relapsed once and two relapsed three times. Aside from the two patients who died and the one who was lost to follow-up, the remaining 11 patients had a median follow-up time of 89 months (range 35–148 months) and all achieved complete remission. The overall survival rate of the patients in the present study was 78.57% through combination chemotherapy, symptomatic treatment, and co-treatment with brain radiotherapy for some patients. Enhancing the understanding of this disease and standardizing treatment are key to improving the overall survival rate of GTN patients with brain metastases.

BACKGROUND T-cell large granular lymphocytic leukemia (T-LGLL) is a rare type of aplastic anemia with diverse clinical manifestations. Concomitant diseases are often present at the first manifestation. We describe the treatment of a patient with CD57-negative γδT-LGLL with pure red cell aplasia (PRCA). CASE SUMMARY A 34-year-old woman with a 20-year history of anemia visited our hospital owing to severe dizziness and was admitted. Her condition was diagnosed as CD57-negative γδT-LGLL with PRCA through bone marrow cytology, bone marrow pathology, bone marrow flow cytometry, bone marrow multiplex polymerase chain reaction combined with fluorescent fragment analysis, and other tests. Treatment with prednisone, methotrexate, and subcutaneous erythropoietin did not significantly change her hemoglobin level. After treatment with oral cyclophosphamide for 3 mo, her hemoglobin level increased to approximately 100 g/L. After 5 mo of treatment, the patient could perform activities of daily living independently. CONCLUSION The treatment of CD57-negative γδT-LGLL with PRCA with cyclophosphamide helps to improve prognosis.

To review our surgical experience and outcome of redo pull-through for various postoperative complications of Hirschsprung’s disease. A retrospective study was performed on children who underwent redo pull-through from 2016 to 2019. Operative methods and functional outcomes were compared between those with anastomotic complications (stricture and fistula, n = 12) and patients without anastomotic complications (n = 24) such as residual aganglionosis/transition zone, twisted pull-through and tight soave cuff. 36 Patients (29 male and 7 female) were included with median age 6 (0.1–54) months at primary and 36 (9–144) months at redo pull-through. A transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) pull-through with laparoscopic (n = 10, 27.8%) or laparotomy (n = 26, 72.2%) assisted techniques were performed for all patients during redo procedure. Patients with anastomotic complications had lower incidence of successful laparoscopic pull-through (0%), higher postoperative complications (25%) after redo surgery, but similar functional outcomes compared to those without anastomotic complications (41.6% underwent laparoscopic surgery, 4.2% complications). Patients with partial colectomy had significantly less soiling (36.4%) and enterocolitis (0%) compared to those with subtotal/total colectomy (79.2% soiling and 58.3% enterocolitis). TRM-PIAS with/without laparoscopic-assisted redo pull-through was effective in treating various complications after primary pull-through. The functional outcome is strongly associated with the length of residual colon after redo pull-though.

Background Poststroke social isolation could worsen poststroke depression and dampen neurogenesis. (R,S)-ketamine has antidepressant and neuroprotective effects; however, its roles and mechanisms in social isolation–mediated depressive-like behaviors and sensorimotor recovery remain unclear. Methods Mice were subjected to transient middle cerebral artery occlusion, and then were pair-housed with ovariectomized female mice or were housed isolated (ISO) starting at 3 days postischemia. ISO mice received 2 weeks of (R,S)-ketamine treatment starting at 14 days postischemia. Primary ependymal epithelial cells and choroid plexus epithelial cells were cultured and treated with recombinant human atrial natriuretic peptide (ANP) protein. Results The poststroke social isolation model was successfully established using middle cerebral artery occlusion combined with poststroke isolation, as demonstrated by a more prominent depression-like phenotype in ISO mice compared with pair-housed mice. (R,S)-ketamine reversed ISO-mediated depressive-like behaviors and increased ANP levels in the atrium. The depression-like phenotype was negatively correlated with ANP levels in both the atrium and plasma. Atrial GLP-1 and GLP-1 receptor signaling was essential to the promoting effects of (R,S)-ketamine on the synthesis and secretion of ANP from the atrium in ISO mice. (R,S)-ketamine also increased ANP and TGF-β1 levels in the choroid plexus of ISO mice. Recombinant human ANP increased TGF-β1 levels in both the primarily cultured ependymal epithelial cells and choroid plexus epithelial cells. Furthermore, (R,S)-ketamine increased TGF-β1 levels in the ischemic hemisphere and promoted striatal neurogenesis and sensorimotor recovery via ANP in ISO mice. Conclusions (R,S)-ketamine alleviated poststroke ISO-mediated depressive-like behaviors and thus promoted striatal neurogenesis and sensorimotor recovery via ANP.

One novel three-dimensional (3-D) copper(I)-thioarsenate(III) [Ni(en)3]Cu4As4S9 (1, en = ethylenediamine) has been solvothermally prepared with the utilization of the in situ formation of [Ni(en)3]2+ complex as structure-directing agent (SDA). 1 contains cubane-like [Cu8S12]16- clusters and rare tetrameric [As4S9]6- units, which are interconnected to generate the first example of a 3-D anionic framework [Cu4As4S9]n2n-, topologically identical to pyrite, and having large channels filled by [Ni(en)3]2+ complex cations. 1 is a potential wide-band-gap semiconductor with an energy gap of 1.91 eV that exhibits selectively photocatalytic degradation of methylene blue under visible-light irradiation. The density functional theory calculation, photocurrent response, and magnetic properties of 1 were also investigated.

The outcomes of new-onset atrial fibrillation (AF) during sepsis are inconsistent and inconclusive. This meta-analysis aims to provide a comprehensive description of the impact of new-onset AF on the prognosis of sepsis.Three electronic databases (PubMed, Embase, and the Cochrane Library) were searched for relevant studies. Meta-analysis was performed using odds ratios (OR) and 95% confidence intervals (CI) as effect measures.A total of 225,841 patients from 13 individual studies were incorporated to the meta-analysis. The summary results revealed that new-onset AF during sepsis was associated with increased odds of in-hospital mortality (pooled OR: 2.09; 95% CI: 1.53-2.86; p 001), post-discharge mortality (pooled OR: 2.44; 95% CI: 1.81-3.29; p .001), and stroke (pooled OR:1.88; 95% CI: 1.13-3.14; p .05). Results also indicated that the incidence of new-onset AF varied from 1.9% for mild sepsis to 46.0% for septic shock. Furthermore, compared to those without AF, people with new-onset AF had longer ICU and hospital stays, as well as a higher recurrence of AF.New-onset AF is frequently associated with adverse outcomes in patients with sepsis. This is a clinical issue that warrants more attention and should be managed appropriately to prevent poor prognosis.

BACKGROUND Four-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population. AIM To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG. METHODS A total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score. RESULTS Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01). CONCLUSION Three-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.

Speckle filtering of polarimetric synthetic aperture radar (PolSAR) data is a necessary preprocessing step for many subsequent applications. The performances of speckle reduction and details preservation are primarily determined by the scheme of similar pixel selection. This letter mainly contributes to establish a novel approach for adaptive and efficient selection of similar pixels. The core idea is to introduce the clustering concept to collect similar samples during the similarity test of polarimetric matrices which is functioned to be a distance measure. Adaptive clustering based on fast finding of density peaks of the data elements is adapted and an automatic determination strategy of cluster numbers is developed. Then the proposed speckle filter is established based on the distance measure and the adaptive clustering. Both unmanned aerial vehicle SAR (UAVSAR) and Radarsat-2 data sets are used for experimental studies. The demonstrations of similar pixel selection for several typical scattering patterns are carried out. The similar samples have been adaptively and precisely identified by the proposed scheme. Furthermore, the comparisons of speckle filtering performances with several advanced speckle filters clearly demonstrate the efficiency and superiority of the proposed method.

Anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is predominantly a disease of the elderly, and the incidence increases with age. However, there are few data focusing on the clinical features in elderly onset AAV, especially in very elderly onset AAV in China. The aim of this study was to explore whether elderly onset AAV shows any specific clinical features and outcomes in Chinese patients. We performed a retrospective study in Xiangya Hospital, a mixed tertiary medical center in south China. A total of 177 patients presenting with AAV were included between January 1, 2010 and December 31, 2017. Patients were divided into younger group (age

Background Bone cement leakage is a major complication in the treatment of percutaneous vertebroplasty for Kümmell’s disease, and the focus of close attention during the surgery. The purpose of this article was to investigate the clinical outcomes of Kümmell’s disease treated by percutaneous vertebroplasty with or without bone cement leakage. Methods A total of 64 patients with Kümmell’s disease from December 2016 to February 2018 treated by percutaneous vertebroplasty were included in the study. After the treatment, 32 cases were respectively divided into two groups according to X-ray examination of bone cement leakage: leakage group and non-leakage group. Preoperative course, age, sex, bone mineral density, damaged segment, anterior vertebral height, vertebral compression rate, Cobb angle, visual analogue scale and Oswestry dysfunction index were compared between the two groups. After surgery, the amount of bone cement injected, operation time, adjacent vertebral refracture rate, visual analogue scale, Oswestry dysfunction index, the recovery value of vertebral anterior height and the improvement value of Cobb angle were compared between the two groups. Results The course, age and Cobb angle of the leakage group were significantly greater than those of the non-leakage group (PPP=0.000). Visual analogue scale and Oswestry dysfunction index of the two groups on the second day after surgery and at the last follow-up were significantly lower than these before surgery (PP Conclusion Percutaneous vertebroplasty is an effective and minimally invasive treatment for Kümmell’s disease. The leakage group had longer course, older age, more serious kyphotic deformity, vertebral compression and osteoporosis, and higher amount of bone cement injected than these of the non-leakage group. However, there were not significant differences in the rate of adjacent vertebral refractures, visual analogue scale and Oswestry dysfunction index between the two groups. Therefore, the bone cement leakage does not affect the surgical effect.

By connecting the linear compression spring (positive stiffness mechanism) in parallel with the tension spring (negative stiffness mechanism) and using the shear lever mechanism to amplify the motion of the negative stiffness mechanism, a shear-tension spring type quasi-zero stiffness isolation system is constructed, which is suitable for low-frequency and ultra-low-frequency vibration isolation, especially for small-amplitude, low-frequency vibration isolation. In addition, the vibration isolation system has adjustable function. When the mass of the isolated object changes, it is needed to adjust the linear bearing at the bottom of the vertical spring to change the length of the spring, so as to keep the isolation system in the equilibrium position of the quasi-zero state. The results show that the isolator has excellent performance in isolation of low frequency vibration with small and micro amplitude.

Background: Ischemic heart disease is the leading cause of morbidity and mortality worldwide. Ischemic preconditioning (IPC) is the most powerful intrinsic protection against cardiac ischemia/reperfusion injury. Previous studies have shown that a multifunctional TRIM family protein, MG53 (mitsugumin 53; also called TRIM72), not only plays an essential role in IPC-mediated cardioprotection against ischemia/reperfusion injury but also ameliorates mechanical damage. In addition to its intracellular actions, as a myokine/cardiokine, MG53 can be secreted from the heart and skeletal muscle in response to metabolic stress. However, it is unknown whether IPC-mediated cardioprotection is causally related to MG53 secretion and, if so, what the underlying mechanism is. Methods: Using proteomic analysis in conjunction with genetic and pharmacological approaches, we examined MG53 secretion in response to IPC and explored the underlying mechanism using rodents in in vivo, isolated perfused hearts, and cultured neonatal rat ventricular cardiomyocytes. Moreover, using recombinant MG53 proteins, we investigated the potential biological function of secreted MG53 in the context of IPC and ischemia/reperfusion injury. Results: We found that IPC triggered robust MG53 secretion in rodents in vivo, perfused hearts, and cultured cardiac myocytes without causing cell membrane leakage. Mechanistically, IPC promoted MG53 secretion through H 2 O 2 -evoked activation of protein kinase-C-δ. Specifically, IPC-induced myocardial MG53 secretion was mediated by H 2 O 2 -triggered phosphorylation of protein kinase-C-δ at Y311, which is necessary and sufficient to facilitate MG53 secretion. Functionally, systemic delivery of recombinant MG53 proteins to mimic elevated circulating MG53 not only restored IPC function in MG53-deficient mice but also protected rodent hearts from ischemia/reperfusion injury even in the absence of IPC. Moreover, oxidative stress by H 2 O 2 augmented MG53 secretion, and MG53 knockdown exacerbated H 2 O 2 -induced cell injury in human embryonic stem cell–derived cardiomyocytes, despite relatively low basal expression of MG53 in human heart. Conclusions: We conclude that IPC and oxidative stress can trigger MG53 secretion from the heart via an H 2 O 2 –protein kinase-C-δ–dependent mechanism and that extracellular MG53 can participate in IPC protection against cardiac ischemia/reperfusion injury.

Hirschsprung’s disease (HSCR) is a functional obstruction of the gastrointestinal tract due to the congenital absence of enteric ganglion cells. The proto-oncogene RET is one of the primary genes implicated in the aetiology of HSCR. We designed this study to investigate the expression of 10 RET regulatory network genes in the colons of patients with HSCR. HSCR tissue specimens (n = 28) were collected at the time of pull-through surgery. qPCR analysis was applied to compare the expression levels of 10 genes in the RET regulatory network. Western blot analysis was performed to quantify the protein expression. Immunohistochemistry was performed to determine the localization of AKT1 and P38A in HSCR colon tissue. AKT1 (p = 0.015) and P38A (p = 0.039) were both significantly downregulated in the aganglionic segment compared to those in the ganglionic segment in HSCR patients (n = 28). Western blot analysis revealed the decreasing protein expression of AKT1 and P38A in the aganglionic segment compared to ganglionic segment and control colon tissues (p

Summary Objective Abnormal remodeling of subchondral bone (SB) induced by estrogen deficiency has been shown to be involved in osteoarthritis (OA). Raloxifene (RAL) is commonly used to treat postmenopausal osteoporosis (OP). However, little is known about its effects on OA combined with estrogen deficiency. This study was performed to evaluate the efficacy of RAL on patella baja-induced patellofemoral joint OA (PFJOA) in an ovariectomized rat model. Design Patellar ligament shortening (PLS) and ovariectomy (OVX) were performed simultaneously in 3-month-old female Sprague–Dawley rats, which were treated with RAL (10 mg/kg/day) or vehicle at 72 h postoperatively for 10 weeks. PFJOA was assessed by immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), tartrate-resistant acid phosphatase (TRAP) staining, enzyme-linked immunosorbent assay (ELISA), micro-computed tomography (μCT), histomorphology and behavioral analyses. Results X-ray examinations showed that patella baja was successfully established by PLS. Histomorphological analysis revealed that PFJOA was significantly exacerbated by OVX and markedly alleviated by RAL. Moreover, RAL improved cartilage metabolism by decreasing MMP-13, ADAMTS-4, and caspase-3 and increasing Col-II and aggrecan at both the protein and mRNA levels. Furthermore, RAL markedly improved bone mass and SB microarchitecture and reduced osteoclast numbers and the serum osteocalcin and CTX-I levels. Although RAL showed a trend toward reducing pain sensitivity based on mechanical allodynia testing, this result was not statistically significant. Conclusion These findings demonstrate that RAL treatment retards PFJOA progression in an ovariectomized rat model, suggesting that it may be a potential candidate for amelioration of the progression of PFJOA accompanied by postmenopausal OP.

Identification of risk factors for treatment resistance and relapse would be crucial to personalization therapy in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (MPO-AAV). Current evidence with regard to the risk factors for treatment resistance and relapse remains limited and inconclusive. We aimed to assess the predictors for treatment resistance and relapse in a single-center cohort of Chinese patients with MPO-AAV in this study. In total, 184 patients with MPO-AAV were included. Treatment resistance occurred in 64 (34.9%) of 184 patients and was positively associated with lung involvement (odds ratio [OR] 3.581, 95% CI 1.137-11.278, p = 0.029) and the initial serum creatinine level (OR 1.004, 95% CI 1.001-1.007, p = 0.010) and was negatively associated with platelet (OR 0.992, 95% CI 0.987-0.998, p = 0.007) and serum C3 levels (OR 0.998, 95% CI 0.996-0.999, p = 0.004). Relapse occurred in 29 (24.17%) of 120 patients in whom remission was achieved and was independently associated with lung involvement (hazard ratio [HR] 4.595, 95% CI 1.272-16.599, p = 0.020) and cardiovascular involvement (HR 3.689, 95% CI 1.237-11, p = 0.019,). The serum globulin was demonstrated to be negatively associated with relapse independently (HR 0.876; 95% CI 0.806-0.953; p = 0.002). This retrospective study of MPO-AAV patients in a single Chinese center suggests that treatment resistance was positively associated with lung involvement and the initial serum creatinine level and was negatively associated with platelet and serum C3 levels. Lung involvement and cardiovascular involvement were associated with an increased risk of relapse, while the higher serum globulin was demonstrated to be in association with a decreased risk of relapse.

Purpose To observe the changes of Nogo/NgR and Rho/ROCK signaling pathway-related gene and protein expression in rats with spinal cord injury (SCI) treated with electroacupuncture (EA) and to further investigate the possible mechanism of EA for treating SCI. Methods Allen's method was used to create the SCI rat model. Sixty-four model rats were further subdivided into four subgroups, namely, the SCI model group (SCI), EA treatment group (EA), blocking agent Y27632 treatment group (Y27632) and EA+blocking agent Y27632 treatment group (EA+Y), according to the treatment received. The rats were subjected to EA and/or blocking agent Y27632 treatment. After 14 days, injured spinal cord tissue was extracted for analysis. The mRNA and protein expression levels were determined by real-time fluorescence quantitative PCR and Western blotting, respectively. Cell apoptosis changes in the spinal cord were evaluated by in situ hybridization. Hindlimb motor function in the rats was evaluated by Basso-Beattie-Bresnahan assessment methods. Results Except for RhoA protein expression, compared with the SCI model group, EA, blocking agent Y27632 and EA+blocking agent Y27632 treatment groups had significantly reduced mRNA and protein expression of Nogo-A, NgR, LINGO-1, RhoA and ROCK II in spinal cord tissues, increased mRNA and protein expression of MLCP, decreased p-MYPT1 protein expression and p-MYPT1/MYPT1 ratio, and caspase3 expression, and improved lower limb movement function after treatment for 14 days (P

Background The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients. Methods Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence. Results Eighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (PPPPP Conclusions Unresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.

Objective: To compare the effectiveness and safety of bedaquiline-containing and bedaquiline-free regimens for treatment of patients with refractory rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB).Methods: Patients with refractory RR/MDR-TB receiving bedaquiline-containing regimens (bedaquiline group, n=102) and bedaquiline-free regimens (non-bedaquiline group, n=100) were included in this retrospective historical control study across East China. The culture conversion, end-of-treatment outcomes, cavity closing rate, and adverse events (AEs) were compared between the two groups. Univariate and multivariate analyses were performed to identify independent predictors of treatment success and culture reversion.Results: The baseline characteristics of the patients were well balanced between the two groups. The culture conversion rates in the bedaquiline group at month 3 (89.2% vs. 66.0%), month 6 (90.2% vs. 72.0%), month 9 (91.2% vs. 66.0%), and month 12 (94.1% vs. 65.0%) were all significantly higher than those in the non-bedaquiline group (all pp=0.017) and month 12 (39.2% vs. 15.0%, ppppp=0.206).Conclusions: Bedaquiline-containing regimens resulted in better treatment outcomes and similar safety relative to bedaquiline-free regimens for patients with refractory pulmonary RR/MDR-TB.

To study the ride comfort of wheel-hub-driven electric vehicles, a simulation and verification method based on a combination of ADAMS and MATLAB modeling is proposed. First, a multibody dynamic simulation model of an in-wheel motor-driven electric vehicle is established using ADAMS/Car. Then, the pavement excitation and electromagnetic force analytical equations are provided based on the specific operating conditions of the vehicle and the in-wheel motor to analyze the impact of the electromagnetic force fluctuation from an unsprung mass increase and motor air gap unevenness on vehicle ride comfort after the introduction of an in-wheel motor. Next, the vibration model and the motion differential equation of the body–wheel dual-mass system of an in-wheel motor-driven electric vehicle are established. The influence of the in-wheel motor on the vibration response index of the dual-mass system is analyzed by using MATLAB/Simulink software. The variation in the vehicle vibration performance index with/without the motor electromagnetic force excitation factor is analyzed and compared with the ADAMS multibody dynamics analysis results. The results show that the method based on a combination of ADAMS and MATLAB modeling can forecast the ride comfort of an in-wheel motor-driven electric vehicle, reducing the cost of physical prototype experiments.

The present study aimed to investigate the levels of IL-36α and its association with disease activity in patients with systemic lupus erythematosus (SLE). A total of 60 patients with SLE and 29 healthy controls were enrolled in the present study. Disease activity was evaluated using the SLE disease activity index (SLEDAI). The serum levels of IL-36α, IL-36 receptor antagonist (IL-36Ra) and IL-17 were assessed using ELISA. The levels of IL-36α in patients with SLE were significantly higher compared with those of healthy controls. There was a significant increase in IL-36α in the active SLE group (SLEDAI score ≥5) compared with that of the healthy controls (P

The stability of the slope is directly related to the safety operation of the open-pit and the life safety of personnel. Effective evaluation of slope stability can reduce the loss caused by slope disasters such as the Fushun West Open-pit Mine. In recent years, some damage has occurred in the south slope of the mine. Therefore, a progressive research method combining the rock mass classification system, slope mass rating method and numerical method is proposed in this study to analyze the possible failure mode and deformation mechanism of the slope. The digital photogrammetry technology, borehole television technology, infrared scanning technology, and on-site monitoring are combined to obtain the relevant data needed for the method. Based on the rock mass characteristics and the survey on-site, the quality of the rock mass of the slope was evaluated through the rock mass classification system and the borehole TV technique. The slope mass classification system with essential adjustment factors considering the discontinuities and excavation methods are a feasible method to estimate rock slope stability. Thereafter the stability of the south slope was estimated by using the slope mass rating method. The results indicate that the stability of the slope is controlled by the weak bedding plane prone to planar failure. Additionally, the deformation mechanism and potential failure dimensions were analyzed through numerical method. Incorporating the empirical result with the numerical result indicates that the south slope is in limit equilibrium state and susceptible to failure along bedding planes. The resulting of the slope stability was validated using the monitoring data that obtained by the GPS devices in situ. According to the deformation characteristics, the corresponding reinforcement methods were established and achieved good result. The progressive methodology provides an effective way to assess the stability and serves for the formulation reinforcement scheme of the rock slope in the complex geological conditions.

SummaryDiabetic heart disease is highly prevalent and characterized by diastolic dysfunction. The mechanisms of diabetic heart disease are poorly understood and no targeted therapies are available. Here we show that the diabetic myocardium (type 1 and type 2) is characterized by marked glycogen elevation and ectopic cellular localization - a paradoxical metabolic pathology given suppressed cardiomyocyte glucose uptake in diabetes. We demonstrate involvement of a glycogen-selective autophagy pathway (‘glycophagy’) defect in mediating this pathology. Genetically manipulated deficiency of Gabarapl1, an Atg8 autophagy homologue, induces cardiac glycogen accumulation and diastolic dysfunction. Stbd1, the Gabarapl1 cognate autophagosome partner is identified as a unique component of the early glycoproteome response to hyperglycemia in cardiac, but not skeletal muscle. Cardiac-targeted in vivo Gabarapl1 gene delivery normalizes glycogen levels, diastolic function and cardiomyocyte mechanics. These findings reveal that cardiac glycophagy is a key metabolic homeostatic process perturbed in diabetes that can be remediated by Gabarapl1 intervention.

Chronic kidney disease (CKD), a global disease burden related to high rates of incidence and mortality, manifests as progressive and irretrievable nephron loss and decreased kidney regeneration capacity. Emerging studies have suggested that exposure to air pollution is closely relevant to increased risk of CKD, CKD progression and end-stage kidney disease (ESKD). Inhaled airborne particles may cause vascular injury, intraglomerular hypertension, or glomerulosclerosis through non-hemodynamic and hemodynamic factors with multiple complex interactions. The mechanisms linking air pollutants exposure to CKD include elevated blood pressure, worsening oxidative stress and inflammatory response, DNA damage and abnormal metabolic changes to aggravate kidney damage. In the present review, we will discuss the epidemiologic observations linking air pollutants exposure to the incidence and progression of CKD. Then, we elaborate the potential roles of several air pollutants including particulate matter and gaseous co-pollutants, environmental tobacco smoke, and gaseous heavy metals in its pathogenesis. Finally, this review outlines the latent effect of air pollution in ESKD patients undergoing dialysis or renal transplant, kidney cancer and other kidney diseases. The information obtained may be beneficial for further elucidating the pathogenesis of CKD and making proper preventive strategies for this disease.

Objective:To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).Methods:Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.Results:At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%,p=0.000, Cohen’sd=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%,p=0.004;d=0.51), and most secondary outcomes (allpd=0.36−0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (pd=0.32−0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (pd=0.43) and HAMA-PA score reductions (pd=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02−4.42,p=0.04] and remission rates (OR=2.80, 95% CI 1.27−6.16,p=0.01).Conclusions:Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.

Rapidly progressive glomerulonephritis (RPGN), characterized by rapid kidney dysfunction caused by aggressive glomerulonephritis, is usually associated with crescentic glomerulonephritis (CrGN). In the present study, the data from patients with CrGN were retrospectively analyzed at a tertiary medical center in China with the aim of investigating the clinicopathological features and the association of the type of CrGN with the prognosis. The renal biopsies of 49 patients diagnosed with CrGN were obtained between December 2011 and July 2016. Of the 49 patients, 11 patients (22.45%) had type I CrGN, 19 (38.78%) had type II CrGN and 19 (38.78%) had type III CrGN. The majority of CrGN patients exhibited multiple-system involvement and 28 patients (57.14%) had kidney enlargement. Proportions of patients with acute kidney injury (AKI), acute kidney diseases without AKI, and chronic kidney disease were 28.57, 46.94 and 24.49%, respectively. Among the 3 types of CrGN, patients with type I CrGN tended to have a higher proportion of AKI with more cellular crescent formation, and higher serum creatinine and retinol binding protein. Circulating anti-GBM antibodies were present in all type I CrGN patients and anti-neutrophilic cytoplasmic autoantibodies were detected in 84.21% of patients with type III CrGN. Type III CrGN patients had a superior kidney survival, whereas type I CrGN patients had the worst kidney prognosis (P

Context Pancreas divisum (PD), the most common congenital anatomic variation of the pancreatic ductal system, is still rare in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for patients with symptomatic PD. However, even by experienced endoscopists, the procedure of ERCP can fail in 3% to 10% of cases. Traditionally, if we fail in cannulation we have no choice but to rely on surgery. Case report The 2 case reports of PD in this study with cannulation were both unsuccessful, fortunately, the use of endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP was eventually successful in treatment. Conclusions Using endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP is safe and effective for the treatment of the patients of difficult minor papilla cannulation in patients of PD, and can be used as a remedy for minor papilla cannulation failure.

Background and Aim This study aims to evaluate and compare the survival and other portal hypertension‐related complications of patients with portal pressure gradient (PPG) ≥ 25 mmHg using transjugular intrahepatic portosystemic shunt (TIPS) as the first‐line and second‐line therapies in secondary prophylaxis of variceal hemorrhage. Methods Fifty patients diagnosed with liver cirrhosis were enrolled in this retrospective study, with 35 of whom received TIPS as the first‐line therapy in secondary prophylaxis of variceal hemorrhage and 15 of whom as second‐line treatment. We observed and analyzed the survival, occurrence of variceal rebleeding and hepatic encephalopathy (HE) of patients in the two groups during the follow up. Results The technical success rate was 100%. In a median follow‐up time of 12 (1–37) and 15 (2–27) months, respectively, significant statistical difference was observed between the first‐line group and the second‐line group concerning cumulative survival rate (94.3% vs 66.7%, log–rank P = 0.01). But that was not the case when it comes to the cumulative rate of variceal rebleeding (8.6% vs 26.7%, log–rank P = 0.164) and HE (22.9% vs 20.0%, log–rank P = 0.793). And multivariate analysis indicated that group assignment (hazard ratio = 8.250, 95% confidence interval = 1.383–49.213, P = 0.021) was the only predictor of survival. Interestingly, we found that spleen diameter (hazard ratio = 0.578, 95% confidence interval = 0.393–0.849, P = 0.005) could be regarded as independent predictor of the occurrence of HE. Conclusions For patients with PPG ≥ 25 mmHg who have recovered from an episode of acute esophageal variceal hemorrhage, utilizing TIPS as the first‐line therapy to prevent rebleeding is demonstrated effective in improving the survival and therefore should be recommended to a wider range of clinical practice.

The ability to increase the emission intensity and turn the emission color of upconversion nanocrystals (NCs) will greatly enhance their application scopes. In this research, the sub-10 nm pure β-NaYF4: Yb3+/Tm3+/Ho3+ core NCs were prepared by using sodium oleate (NaOA) as sodium source instead of the traditional NaOH, based on which the β-NaYF4:Yb3+/Er3+@NaYF4 core-shell NCs were successfully obtained with seed-mediated growth method. The spectral measurement and the calculated CIE color coordinates revealed that the growing of inert NaYF4 shell on the active NaYF4: Yb3+/Tm3+/Ho3+ core NCs can not only effectively increase the upconversion emission intensity, but also realize extended tunable emission from blue to orange by turning Ho3+ concentration, and a strong white light emission with chromaticity coordinates of (0.32, 0.33) can be obtained in the NaY0.77F4:0.2Yb3+/0.01Tm3+/0.02Ho3+ @NaYF4 core-shell NCs. Furthermore, the extended color tunability and efficient white white-light generation in the core-shell NCs were demonstrated by NCs-PMMA nanocomposites under 980 nm excitation. The results suggested that the β-NaYF4:Yb3+/Er3+@NaYF4 core-shell NCs have promising applications in optoelectronic devices such as light emitting diode and three-dimensional display.

Based on the density functional theory (DFT), the first-principles approach is used to study the electronic band structure of B-doped wuritzite ZnO with different pressure. The pressure effects on the lattice parameters, electronic band structures, and partial density of states (PDOS) of crystalline B-doped ZnO are calculated up to 8 GPa. Moreover, the evolution of the dielectric function, absorption coefficient (), reflectivity (), and the real part of the refractive index () at high pressure are also presented. Keywords: high pressure; density functional theory; B-doped ZnO.

BACKGROUND Patella baja, or patella infera, consists of a low-lying patella that results in a limited range of motion, joint pain, and crepitations. Patellofemoral joint osteoarthritis (PFJOA) is a subtype OA of the knee. This study aimed to develop a reproducible and reliable rat model of PFJOA. MATERIAL AND METHODS Three-month-old female Sprague-Dawley rats (n=24) included a baseline group (n=8) that were euthanized at the beginning of the study. The sham group (n=8), and the patella ligament shortening (PLS) group (n=8) were euthanized and evaluated at ten weeks. The PLS model group (n=8) underwent insertion of a Kirschner wire under the patella tendon to induce patella baja. At ten weeks, the sham group and the PLS group were compared using X-ray imaging, macroscopic appearance, histology, immunohistochemistry, TUNEL staining for apoptosis, and micro-computed tomography (micro-CT). The patella height was determined using the modified Insall-Salvati (MIS) ratio. RESULTS The establishment of the rat model of patella baja in the PLS group at ten weeks was confirmed by X-ray. In the PLS group, patella volume, sagittal length, and cross-sectional area were significantly increased compared with the sham group. The PFJ showed typical lesions of OA, confirmed macroscopically and histologically. Compared with the sham group, in the rat model of PFJOA, there was increased cell apoptosis, and immunohistochemistry showed increased expression of biomarkers of osteoarthritis, compared with the sham group. CONCLUSIONS A rat model of PFJOA was developed that was confirmed by changes in cartilage and subchondral bone.

Background and Purpose— Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods— We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates’ balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results— Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95–2.20] for onset-to-door time ≤2 hours, 2.32 [2.18–2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88–3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62–1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70–1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions— Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.

In this paper, the farfield under small scattering angle was investigated in the rectangular Ag–Si–SiO2 cavity by FDTD. The simulation results showed that Re(E) of the farfield was related to the monitoring wavelength and was a function of monitoring wavelengths. Moreover, in the rectangular Ag–Si–SiO2 cavity, the amplitude of Re(E) changed as the silicon height d varied, and maximum amplitude A of Re(E) could be approximated as the functions of transverse length l and thickness t of silver film under small scattering angle. Re(E) was independent of the transverse length w2 and the longitudinal length d of the cavity in RCM and was also irrelevant with the dielectric constant of silver films. The amplitude A of Re(E) increased as l and t of silver film increased.

Background: MicroRNAs (miRNAs) are widely involved in the regulation of physiological processes, such as cell proliferation, differentiation, apoptosis, angiogenesis, and lipid metabolism. They might be associated with the pathological process of atrial fibrillation (AF). The purpose of our study is to investigate whether plasma miRNA-155 levels have a relationship with AF recurrence. Methods: A total of 110 patients with AF were studied, all with successful cardioversion. We measured the expression of plasma miRNA-155 in the recurrent group (n = 30) and in the nonrecurrent group (n = 80) by quantitative reverse transcription–polymerase chain reaction (qRT-PCR). In addition, the serumal levels of B-type natriuretic peptide (BNP), total cholesterol (TC), and fasting blood glucose (FBG) in the groups were determined by using an automatic biochemical analyzer; and an immunoenzymatic method was applied to determine the serumal levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6). The left atrial diameter (LAD) and left ventricular ejection fraction (EF) of all patients were measured by using echocardiography. Results: Our RT-PCR analysis found that miRNA-155 was significantly upregulated in the recurrent group compared with the nonrecurrent group. These increases of LAD and the levels of BNP, TNF-α, CRP, and IL-6 in the recurrent group were also revealed to be relative to those in the nonrecurrent group. There were no differences in the levels of TC and FBG, as well as in EF, between the groups. Moreover, miRNA-155 expression was observed to correlate positively with these outcomes of LAD, BNP, TNF-α, CRP, IL-6, and LAD. A diagnostic significance of predicting AF recurrence for plasma miRNA-155 was elucidated via ROC curve analysis. Conclusions: Our findings revealed that plasma miRNA-155 can present an ability to calculate AF recurrence after cardioversion.

Background: Mitsugumin 53 (MG53 or TRIM72), a striated muscle-specific E3 ligase, promotes ubiquitin-dependent degradation of the insulin receptor and insulin receptor substrate-1 and subsequently induces insulin resistance, resulting in metabolic syndrome and type 2 diabetes mellitus (T2DM). However, it is unknown how MG53 from muscle regulates systemic insulin response and energy metabolism. Increasing evidence demonstrates that muscle secretes proteins as myokines or cardiokines that regulate systemic metabolic processes. We hypothesize that MG53 may act as a myokine/cardiokine, contributing to interorgan regulation of insulin sensitivity and metabolic homeostasis. Methods: Using perfused rodent hearts or skeletal muscle, we investigated whether high glucose, high insulin, or their combination (conditions mimicking metabolic syndrome or T2DM) alters MG53 protein concentration in the perfusate. We also measured serum MG53 levels in rodents and humans in the presence or absence of metabolic diseases, particularly T2DM. The effects of circulating MG53 on multiorgan insulin response were evaluated by systemic delivery of recombinant MG53 protein to mice. Furthermore, the potential involvement of circulating MG53 in the pathogenesis of T2DM was assessed by neutralizing blood MG53 with monoclonal antibodies in diabetic db/db mice. Finally, to delineate the mechanism underlying the action of extracellular MG53 on insulin signaling, we analyzed the potential interaction of MG53 with extracellular domain of insulin receptor using coimmunoprecipitation and surface plasmon resonance assays. Results: Here, we demonstrate that MG53 is a glucose-sensitive myokine/cardiokine that governs the interorgan regulation of insulin sensitivity. First, high glucose or high insulin induces MG53 secretion from isolated rodent hearts and skeletal muscle. Second, hyperglycemia is accompanied by increased circulating MG53 in humans and rodents with diabetes mellitus. Third, systemic delivery of recombinant MG53 or cardiac-specific overexpression of MG53 causes systemic insulin resistance and metabolic syndrome in mice, whereas neutralizing circulating MG53 with monoclonal antibodies has therapeutic effects in T2DM db/db mice. Mechanistically, MG53 binds to the extracellular domain of the insulin receptor and acts as an allosteric blocker. Conclusions: Thus, MG53 has dual actions as a myokine/cardiokine and an E3 ligase, synergistically inhibiting the insulin signaling pathway. Targeting circulating MG53 opens a new therapeutic avenue for T2DM and its complications.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by destructive polyarthritis and systemic complications. It increases cardiovascular morbidity and mortality. However, the mechanism underlying RA-related cardiac damage remains largely unknown. Here, we found and characterized a non-human primate (NHP) model with spontaneous RA similar to the human conditions. Compared with the control group, the cardiac function in RA monkeys showed progressively deterioration; histologically, we found significantly increased inflammatory cell infiltration, cell death, and fibrosis in RA monkey heart tissue. Mechanistically, the upregulated receptor-interacting protein kinase 1 (RIPK1) in RA monkey heart tissue bound to voltage-dependent anion-selective channel 1 (VDAC1), increased VDAC1 oligomerization, and subsequently induced cardiac cell death and functional impairment. These findings identified that RIPK1-VDAC1 pathway is a promising target to treat cardiac impairment in RA. This unique model of RA will provide a valuable tool for mechanistic and translational studies.

AlGaN/GaN E/D-mode GaN inverters are successfully fabricated on a 150-mm Si wafer. P-GaN gate technology is applied to be compatible with the commercial E-mode GaN power device technology platform and a systematic study of E/D-mode GaN inverters has been conducted with detail. The key electrical characters have been analyzed from room temperature (RT) to 200 °C. Small variations of the inverters are observed at different temperatures. The logic swing voltage of 2.91 V and 2.89 V are observed at RT and 200 °C at a supply voltage of 3 V. Correspondingly, low/high input noise margins of 0.78 V/1.67 V and 0.68 V/1.72 V are observed at RT and 200 °C. The inverters also demonstrate small rising edge time of the output signal. The results show great potential for GaN smart power integrated circuit (IC) application.

A X-band ridged waveguide power combiner is proposed and designed by adopting the ridge waveguide-microstrip probe transition structure. A low insertion loss is achieved from the fabricated ridge waveguide structure. It provides a solution for the future research in miniaturized power combination application.

BACKGROUND & AIM: Coexisting alcoholic liver disease and virus-induced liver cirrhosis (ALD+HBV and ALD+HCV) has not been thoroughly studied. This cross-sectional study aims to showcase the influence of alcohol on the laboratory values and on the clinical outcomes of patients with hepatitis B and C virus-induced liver cirrhosis.METHOD: Patients diagnosed with liver cirrhosis (n=22287) from January 2010 to December 2019 were collected from our hospital electronic database, and divided into five groups according to the etiology: ALD (1652 cases, 7.4%), HBV (18079 cases, 81.1%), HCV (682 cases, 3.1%), ALD+HBV (1594 cases, 7.2%) and ALD+HCV (280 cases, 1.3%). Laboratory results and proportion of different liver cirrhosis complications were contrasted between groups.RESULTS: ALD+HBV and ALD+HCV presented with higher proportions of poor prognosis patients and cirrhosis complications compared to HBV and HCV respectively. Multivariate logistic regression revealed that the risk of HCC and that of EGVB in the ALD+HBV group was respectively 2.14-fold and 1.47-fold that in the HBV group (HCC: OR=2.14, 95%CI: [1.71-2.69]; EGVB: OR=1.47, 95%CI: [1.17-1.84]) after adjusting for potential confounders. Furthermore, a decrease in the risk of HCC and EGVB with the duration of alcohol abstinence was observed. Similar pattern was noticed while comparing ALD+HCV group to HCV group.CONCLUSION: Alcohol significantly increased the severity of liver function impairment and the prevalence of liver cirrhosis complications such as HCC and EGVB in hepatitis virus-induced liver cirrhosis patients. Remarkably, long period of alcohol abstinence significantly decreased the prevalence of HCC and EGVB in these populations.

To compare hydrocolonic sonography with histopathology for diagnosing children with symptoms highly suggestive of Hirschsprung disease (HD). In this prospective study, patients presenting refractory constipation highly suggestive of HD underwent hydrocolonic sonography with retrograde infusion of saline into the colon. The dilated segments, narrowed segments, luminal diameter ratio, transition zone (TZ), thickening, and blood perfusion of the upstream bowel were evaluated. The sensitivity and specificity of combined and single parameters were determined in comparison with biopsy. One hundred and three children were included in this study; 49 were confirmed to have HD. The luminal diameter ratio showed superiority over other parameters. An area under the curve (AUC) of 0.969 (95% confidence interval [CI]: 0.936–1.000) and a cutoff value of 1.51 were established by receiver operating characteristic (ROC) curve analysis of the luminal diameter ratio (sensitivity: 89.8%; specificity: 96.3%). By combining the luminal diameter ratio as the major criterion with two minor criteria, hydrocolonic sonography showed the same sensitivity (91.8%) and better specificity (96.3% vs 87%) than contrast enema, but this difference was not statistically significant (p = 0.063). Consistency analysis showed a kappa value of 0.825 (p

In antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (AAV), the two major target antigens of ANCA are proteinase 3 (PR3) and myeloperoxidase (MPO). Evidence is accumulating that there are distinct differences between patients with PR3-AAV and those with MPO-AAV. In the present study, the clinicopathological features and prognosis of patients with PR3-AAV and MPO-AAV from a single center in China were retrospectively analyzed. A total of 212 Chinese patients with AAV were recruited in the present study; 189/212 (89.15%) patients were classified as having MPO-AAV and 23/212 (10.85%) patients as having PR3-AAV. Compared with those in the PR3-AAV group, patients in the MPO-AAV group were older and less frequently had ear, nose and throat or ophthalmic involvement. MPO-AAV patients had higher levels of serum creatinine and proteinuria at baseline. No significant difference was observed with regard to the pathological changes of the glomeruli and tubulointerstitium between the two groups. The probability of developing end-stage renal disease was significantly higher in patients with MPO-AAV compared with that in patients with PR3-AAV. There was no significant difference in the one-year patient survival rate between the two groups. However, differences in certain clinical characteristics and outcomes were observed between MPO-AAV and PR3-AAV patients. A large national investigation of AAV is required to confirm the concept that PR3-AAV and MPO-AAV are distinct disease entities.

Background:To explore the application effect of multicenter transitional nursing in patients post-TIPS.Methods:A total of 368 patients who underwent TIPS were randomly allocated to the control or intervention group. Patients in the control group received conventional care, and patients in the intervention group received conventional care combined with transitional care. The Child-Pugh scores, blood ammonia levels, compliance behavior, medication compliance, and adverse event incidence rates in the two groups were compared at 1, 3, 6, 9 and 12 months post-TIPS.Results:Repeated measures analysis of variance showed significant group effects 1, 3, 6, 9 and 12 months post-TIPS in the compliance behavior scores of the two groups. The intervention group had significantly higher compliance behavior scores than the control group 1, 3, 6, 9 and 12 months post-TIPS. The incidence of postoperative adverse events in the intervention group was significantly lower than that in the control group 12 months after TIPS. The group effects, time effects and group*time interaction revealed significant differences in the Child-Pugh scores 1, 3, 6, 9 and 12 months post-TIPS between the two groups and significant differences in blood ammonia levels 9 months after TIPS.Conclusions:Post-TIPS transitional care interventions increased patients’access to scientifically informed nursing, significantly improved patients’compliance behavior and health, and decreased the incidence of postoperative adverse events.

Sleep plays an important role in immune function. However, the effects of very-short-term sleep deprivation on the early recovery of immune function after sepsis remain unclear. This study was conducted in the intensive care unit to investigate the effects of 2 consecutive days of sleep deprivation (SD) on lymphocyte recovery over the following few days in septic patients who were recovering from a critical illness. The patients' self-reports of sleep quality was assessed using the Richards–Campbell Sleep Questionnaire at 0 and 24 h after inclusion. The demographic, clinical, laboratory, treatment, and outcome data were collected and compared between the good sleep group and poor sleep group. We found that 2 consecutive days of SD decreased the absolute lymphocyte count (ALC) and ALC recovery at 3 days after SD. Furthermore, post-septic poor sleep decreased the plasma levels of atrial natriuretic peptide (ANP) immediately after 2 consecutive days of SD. The ANP levels at 24 h after inclusion were positively correlated with ALC recovery, the number of CD3+ T cells, or the number of CD3+ CD4+ cells in the peripheral blood on day 5 after inclusion. Our data suggested that very-short-term poor sleep quality could slow down lymphocyte recovery over the following few days in septic patients who were recovering from a critical illness. Our results underscore the significance of very-short-term SD on serious negative effects on the immune function. Therefore, it is suggested that continuous SD or several short-term SD with short intervals should be avoided in septic patients.

In the cloud environment, we use an interactive mode to communicate with the network, which will involve cloud services and other content, so we have added some virtual resources to facilitate synchronization services with us. Cloud computing has low requirements for the equipment of the client, which determines that cloud computing will be very popular in schools. This paper analyzes the advantages of cloud computing architecture in the teaching platform and the related technologies of applying cloud computing technology to multimedia teaching platform.

Automation of analytical sample preparation and testing is always attractive due to its high efficiency and continuous operation, but it can also be very challenging due to the operational complexity and method development. Studies focused on method development in automated systems are extremely rare and little has been published on the subject. In this paper, we investigate several unique and advanced aspects of this subject. The example product is selected containing two APIs to be tested by a single method. The product strengths of the two APIs are significantly different, making development of the single method much more challenging. In addition, we apply the additional challenge of using a “green chemistry” approach, avoiding any organic solvent in the dissolving media in order to achieve an environmentally friendly solution. A thorough study on the selection and optimization of several key operational parameters are then discussed. The successful method is achieved using a new strategy called “Automated Online Standard” methodology. This novel approach is compared to the conventional procedure in several scenarios, demonstrating its high effectiveness with significantly improved recovery. The proposed approach can substantially reduce the method development time, generally considered the biggest obstacle to practical deployment of automated systems. The automated system applied in this paper is most suitable for content uniformity testing, but is also applicable for blend uniformity testing, potency assays and degradation product tests.