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The problem of model order reduction and dynamic characteristic analysis of the bolted flange structure with free-free boundary conditions is studied by proposing a novel simplified modeling method. The proposed simplified modeling method is able to reduce the finite element model of the linear components through free-interface mode synthesis method and condense the number of degree-of-freedom of the joint interface through coordinate condensation, which can fix the model size not to increase with the number of bolts and greatly reduce the computational cost. Rigid-body mode elimination is also considered to further reduce the order of the integrated dynamic equation and avoid the problem of computational instability in the proposed simplified modeling method. An experimental bolted flange structure with free-free boundary conditions is built and the corresponding modal testing is carried out to verify the accuracy of the proposed simplified modeling method. Comparative results of modal testing and simulation indicate that gravity leads to unequal bending frequencies of the same order in X and Y directions, which also proves that the proposed simplified modeling method is able to analyze the dynamic characteristic of the bolted flange structure with free-free boundary conditions.

Aims: This study aimed to retrospectively determine the influence factors and survival effects of chemotherapy in pathological T3N0M0 esophageal cancer (EC) patients based on histological type. Methods: A total of 1136 pathological T3N0M0 EC patients who had surgery were chosen from the Surveillance, Epidemiology and End Results database. The patients were divided into subgroups based on histological type and chemotherapy status. Multivariate logistic regression, log-rank test and Cox regression were used to identify prognostic risk factors and survival differences. A propensity score matching analysis was applied to adjust the covariates. The impact of additional chemotherapy was also assessed in patients who had postoperative radiotherapy. Results: The 5-year overall survival was 36.4% for all patients. Chemotherapy was an independent protective factor of survival in both adenocarcinoma and squamous cell carcinoma patients. In the survival analysis, chemotherapy significantly improved the prognosis of EC patients, both for adenocarcinoma and squamous cell carcinoma. Propensity score matching analysis validated these results. Conclusion: Chemotherapy is recommended for pathological T3N0M0 EC patients regardless of histological type.

To evaluate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma (NPC) from low-endemic regions of China who received definitive intensity-modulated radiation therapy (IMRT). The clinical data from 608 patients with newly-diagnosed non-metastatic NPC who have received initial treatment at our cancer center from January, 2008 to December, 2013 were retrospectively reviewed. All patients received definitive IMRT, and 87.7% received platinum-based chemotherapy. The median follow-up duration was 51 months (follow-up rate, 98.5%; range, 10–106 months) for the entire cohort. The 5-year overall survival rate was 79.7%. The 5-year local relapse-free survival rate, regional relapse-free survival rate, distant metastasis-free survival rate and progression-free survival rate were 92.4%, 93.3%, 79.2% and 74.3%, respectively. A total of 153 patients had experienced treatment failure, with distant metastasis as the primary cause in 77.1% (118/153). Patients with T4 or N3 diseases had a significantly poorer prognosis than other subcategories. Stage T4 and N3 were closely associated with distant metastasis, with the metastatic rate of 29.3% and 45.5%, respectively. IMRT provides patients with non-metastatic NPC with satisfactory long-term survival. Both T stage and N stage are important prognostic factors for NPC patients. Patients with T4 or N3 diseases have significantly increased distant metastatic rates and poor survival time.

The study aims to assess the effectiveness of telephone follow-ups combined with a smartphone app (e.g., WeChat [Tencent], which is one of the most widely used communication apps in China), as a smoking cessation intervention. Social volunteers were recruited on March 1, 2017, and randomized to supervision groups with five participants in each group. Every day, the specialists shared some information related to smoking cessation including the videos, songs, and scientific knowledge in WeChat groups and conducted telephone follow-ups on the third, fifth, seventh, ninth, 12th, 17th, 22nd, 27th, and 30th day in March and on April 1. Ultimately, a comparison was made of the self-reported smoking abstinence and self-reported average number of cigarettes smoked between the participants. One hundred ten volunteers participated in the study, with 105 who completed follow-up. Self-reported smoking abstinence in the past 7 days occurred in 65.7% of the participants (n = 69) compared with 34.3% (n = 36) in whom smoking abstinence did not occur. The mean age of those who failed was 40.15 years (range: 22-70 years), and 55.5% (n = 20) attributed their failure to personal reasons. However, the self-reported average number of cigarettes smoked every day was less than that before the study (on average, 10.34 ± 8.17 per day), and this difference was statistically significant (95% CI [8.312, 12.364], p < .01). It was effective to deliver a telephone follow-up combined with a smartphone app follow-up as an intervention for smoking cessation.

Ferroptosis is closely linked to various cancers, including lung adenocarcinoma (LUAD); however, the factors involved in the regulation of ferroptosis-related genes are not well established. In this study, we identified and characterized ferroptosis-related long noncoding RNAs (lncRNAs) in LUAD. In particular, a coexpression network of ferroptosis-related mRNAs and lncRNAs from The Cancer Genome Atlas (TCGA) was constructed. Univariate and multivariate Cox proportional hazards analyses were performed to establish a prognostic ferroptosis-related lncRNA signature (FerRLSig). We obtained a prognostic risk model consisting of 10 ferroptosis-related lncRNAs: AL606489.1, AC106047.1, LINC02081, AC090559.1, AC026355.1, FAM83A-AS1, AL034397.3, AC092171.5, AC010980.2, and AC123595.1. High risk scores according to the FerRLSig were significantly associated with poor overall survival (hazard ratio (HR) = 1.412, 95% CI = 1.271–1.568; P

Photocatalytic water splitting on semiconductor photocatalysts is one of the most important physichemical processes, but its surface reaction mechanisms are not fully understood. Based upon the ATR-FTIR investigations combining with the mass spectroscopy (MS) analysis, a direct hydroxyl radical formation mechanism that is different from those observed for other semiconductor photocatalysts is proposed. This study provides the insight into overall water splitting mechanism on Ga2O3-based photocatalysts at a molecular level, and it helps one to further understand the photocatalysis on semiconductor photocatalysts.

BACKGROUND Oral lichen planus (OLP) is a chronic inflammatory disorder, and it can affect normal oral function. The conventional treatments for OLP are not always effective, and relapse easily occurs. Therefore, treatment of OLP is difficult and challenging. In this study, we evaluated over a long period the clinical efficacy of surgical excision and acellular dermal matrix (ADM) grafting in patients with refractory OLP. CASE SUMMARY Eleven patients with refractory OLP underwent a standardized protocol of surgical excision and ADM grafting. The condition of the area of the grafted wound, the intraoperative maximum mouth opening, pain, and clinical healing were assessed at postoperative follow-up visits. All patients had a flat surgical area with similar mucosal tissue coverage and local scar formation. Patients had no irritation and pain in their mucous membranes when eating acidic and spicy food. All patients’ mouth openings returned to normal within 2-6 mo after surgery. During follow-up, none of the patients had recurrence of OLP after surgery. The longest follow-up was 11 yr and the shortest was 6 mo, and none of the patients relapsed during follow-up. CONCLUSION Surgical excision and ADM grafting could be an effective method to treat refractory OLP.

Metal-organic frameworks (MOFs) are crystalline materials comprising metal centers and organic linkers that feature structural rigidity and functional flexibility. These attractive materials offer large surface areas, high porosity, and good chemical stability; they have shown promise in chemistry (H2 separation and catalysis), magnetism, and optics. They have also shown potential for drug delivery following the demonstration in 2006 that chromium-based MOFs can be loaded with ibuprofen. Since then, iron-based MOFs (Fe-MOFs) have been shown to offer high drug loading and excellent biocompatibility. The present review focuses on the synthesis and surface modifications of Fe-MOFs as well as their applications in drug delivery and biomedicine.

In engineering practice many structures are assembled by several linear components through nonlinear joints. A novel hybrid modeling method based on finite element model reduction and deep learning techniques is proposed to meet the ever-increasing requirements of efficient and accurate modeling for nonlinear jointed structures. The main idea of the hybrid modeling method for nonlinear jointed structures is summarized as follows: Firstly, finite element models of linear components are reduced to improve the computing efficiency using the free-interface mode synthesis method, as numerical integration of governing equations of nonlinear structures with large numbers of degrees-of-freedom is always time-consuming. Secondly, deep neural networks are used to equivalently represent the nonlinear joints which are difficult to describe by accurate and physically-motivated models, so as to avoid the errors caused by traditional mechanism modeling or system identification. Nonlinear joints are finally replaced with their equivalent neural networks and connected with the substructure models of linear components through the compatibility of displacements and equilibrium of forces at the interfaces. The performance of the proposed hybrid modeling method is tested and assessed via a case study focused on a cantilever plate with nonlinear joints. Comparative results demonstrate the capability of the proposed method for efficient and accurate modeling of nonlinear jointed structures and predicting their intrinsic nonlinear behavior.

Due to the increasing interconnect delay caused by shrinking wiring dimensions, modern synchronous many-core systems are now facing critical issues. Particularly, the power budget to propagate high-frequency clock signals across the chip is limited. It becomes more challenging using conventional metallic interconnects to deliver a clock with low uncertainties across active dies. This article proposes a novel hybrid wireless-wired clock distribution network, which improves the performance of ON-chip clock distribution significantly. By using embedded wireless clock transmitter and receiver designs, because of the high fan-out feature of the wireless clock transmission, the overall clock delay, skew, and power have been reduced. The proposed hybrid clock distribution scheme is verified through a novel test circuit by using Arm Mali-G77 GPU as an example. Experimental results indicate that the proposed clock distribution network exhibits a significant global delay reduction of up to 28.8%. Also, for the best case scenario, a maximum of 46.7% and 17.7% reduction in clock skew and power consumption, are identified, respectively. Thus, our proposed approach offers a promising solution to clock distribution for many-core integrated circuits, especially for high-performance systems.

In the recent years, data-driven machinery fault diagnostic methods have been successfully developed, and the tasks where the training and testing data are from the same distribution have been well addressed. However, due to sensor malfunctions, the training and testing data can be collected at different places of machines, resulting in the feature space with significant distribution discrepancy. This challenging issue has received less attention in the current literature, and the existing approaches generally fail in such scenarios. This article proposes a domain adaptation method for machinery fault diagnostics based on deep learning. Adversarial training is introduced for marginal domain fusion, and unsupervised parallel data are explored to achieve conditional distribution alignments with respect to different machine health conditions. Experiments on two rotating machinery datasets are carried out for validations. The results suggest the proposed method is promising to address the fault diagnostic tasks with data from different places of machines, further enhancing applicability of data-driven methods in real industries.

This article focuses on the output-only recursive identification of time-varying systems by using parametric time-domain methods. A novel multivariate recursive Bayesian linear regression method is proposed based on the vector time-dependent autoregressive moving average model. The standard setup of univariate batch Bayesian linear regression is first extended to the multivariate case for multiple response signal modeling and further extended to the recursive case to meet the output-only recursive identification requirement of practical systems. A sliding window mechanism is finally applied to deemphasize data from the remote past and fix the computational complexity for each consecutive update, allowing the proposed method to be capable of tracking the time-varying dynamics online. The proposed multivariate recursive Bayesian linear regression method is first validated by a simple numerical system and subsequently applied to identify two mechanical systems with typical time-varying dynamics. Comparative identification results via Monte Carlo tests numerically and experimentally demonstrate the superior achievable accuracy and time-varying tracking capability of the proposed method.

Background Brain mapping is fundamental to understanding brain organization and function. However, a major drawback to the traditional Brodmann parcellation technique is the reliance on the use of postmortem specimens. It has therefore historically been difficult to make any comparison regarding functional data from different regions or hemispheres within the same individual. Moreover, this method has been significant limited by subjective boundaries and classification criteria and therefore suffer from reproducibility issues. The development of transcranial magnetic stimulation (TMS) offers an alternative approach to brain mapping, specifically the motor cortical regions by eliciting quantifiable functional reactions. Objective To precisely describe the motor cortical topographic representation of pharyngeal constrictor musculature using TMS and to further map the brain for use as a tool to study brain plasticity. Methods 51 healthy subjects (20 male/31 female, 19–26 years old) were tested using single-pulse TMS combined with intraluminal catheter-guided high-resolution manometry and a standardized grid cap. We investigated various parameters of the motor-evoked potential (MEP) that include the motor map area, amplitude, latency, center of gravity (CoG) and asymmetry index. Results Cortically evoked response latencies were similar for the left and right hemispheres at 6.79 ± 0.22 and 7.24 ± 0.27 ms, respectively. The average scalp positions (relative to the vertex) of the pharyngeal motor cortical representation were 10.40 ± 0.19 (SE) cm medio-lateral and 3.20 ± 0.20 (SE) cm antero-posterior in the left hemisphere and 9.65 ± 0.24 (SE) cm medio-lateral and 3.18 ± 0.23 (SE) cm antero-posterior in the right hemisphere. The mean motor map area of the pharynx in the left and right hemispheres were 9.22 ± 0.85(SE) cm2and 10.12 ± 1.24(SE) cm2, respectively. The amplitudes of the MEPs were 35.94 ± 1.81(SE)uV in the left hemisphere and 34.49 ± 1.95(SE)uV in the right hemisphere. By comparison, subtle but consistent differences in the degree of the bilateral hemispheric representation were also apparent both between and within individuals. Conclusion The swallowing musculature has a bilateral motor cortical representation across individuals, but is largely asymmetric within single subjects. These results suggest that TMS mapping using a guided intra-pharyngeal EMG catheter combined with a standardized gridded cap might be a useful tool to localize brain function/dysfunction by linking brain activation to the corresponding physical reaction.

Rotating machinery fault diagnosis problems have been well-addressed when sufficient supervised data of the tested machine are available using the latest data-driven methods. However, it is still challenging to develop effective diagnostic method with insufficient training data, which is highly demanded in real-industrial scenarios, since high-quality data are usually difficult and expensive to collect. Considering the underlying similarities of rotating machines, data mining on different but related equipments potentially benefit the diagnostic performance on the target machine. Therefore, a novel transfer learning method for diagnostics based on deep learning is proposed in this article, where the diagnostic knowledge learned from sufficient supervised data of multiple rotating machines is transferred to the target equipment with domain adversarial training. Different from the existing studies, a more generalized transfer learning problem with different label spaces of domains is investigated, and different fault severities are also considered in fault diagnostics. The experimental results on four datasets validate the effectiveness of the proposed method, and show it is feasible and promising to explore different datasets to improve diagnostic performance.

Background: Routine preoperative screening tests before low-risk surgery cannot be justified if the risks to patients are not outweighed by benefits. Several studies and professional guidelines suggest avoiding screening tests prior to minor operations. We aimed to assess the prevalence and patient characteristics associated with low-value preoperative tests (LVTs) prior to carpal tunnel release (CTR) at an academic medical center. Methods: From electronic medical records, we identified patients aged ≥18 who underwent CTR from 2015 to 2017. We determined the occurrence of 9 common LVTs, such as complete blood count (CBC), basic metabolic profile (BMP), and electrocardiogram (ECG), in the 30 days prior to CTR. Multivariable logistic and Poisson regression were used to identify factors associated with receiving any LVT and the number of LVTs, respectively. Results: Among 572 patients, 248 (43.4%) had at least 1 LVT. The most common tests were ECG (31.3% of CTRs), CBC (27.3% of CTRs), and BMP (23.6% of CTRs). Patient factors associated with higher odds of receiving LVT included older age, higher Elixhauser comorbidity score, and general or regional anesthesia (vs monitored anesthesia care). Conclusions: Low-value preoperative tests were frequently received by patients undergoing CTR and were associated with anesthesia type, age, and number of comorbidities. Although our study focused on CTR, these results likely have implications for other commonly performed low-risk procedures. These findings can help guide efforts to improve the quality and value of surgery for carpal tunnel syndrome and facilitate the development of strategies to reduce LVT, such as audit feedback and provider education.

To speed up the calculation of dynamic analysis for elastic ring squeeze film dampers (ERSFDs) and investigate the dynamic characteristics of ERSFD-rotor systems, a semi-analytic method (SAM) is proposed for analyzing oil film pressure and force. This method is subsequently verified by comparison with numerical simulation and experimental results. Based on this SAM, an improved dynamic model of an ERSFD-supported rotor is developed by coupling the kinetic equations of the rotor with the determination of elastic deformation. Using this method, the oil coefficients and vibration behaviors of the rotor such as the amplitude–frequency relation and the influence of sudden excitation are investigated. The results reveal that the equivalent oil coefficients and damping ratio of the system can be increased significantly by the adoption of ERSFDs. Therefore, the nonlinear bi-stable response occasionally occurring in traditional squeeze film damper (SFD) supported rotors is effectively suppressed and the transient vibration process caused by sudden unbalanced excitation action is significantly shortened. The SAM enables one to reduce the computation time of the previous method by more than 90%. Such a reduction greatly improves the computational efficiency.

Understanding the detailed kinetics and mechanisms of water oxidation is crucial because water oxidation is the bottleneck reaction in overall water splitting. Here, we investigated photocatalytic water oxidation on NaTaO3-based photocatalysts. With in situ FT-IR spectroscopy, two new water oxidation intermediates with IR absorption peaks centered at 1058 and 935 cm−1 were observed and assigned to Ta(VI)O and Ta(O2) peroxo species, respectively. With H218O as the reactant and NaTa16O3 as the photocatalyst, both 16O18O and 18O2 were evolved continuously from overall water splitting as analyzed by mass spectroscopy (MS), demonstrating that the lattice O atoms in NaTaO3-based photocatalysts participate in the formation of O2 during the reaction. DFT results are consistent with the formation of TaO, 16O18O and 18O18O intermediates and products, while predicting that several water oxidation pathways are thermodynamically accessible for water oxidation on NaTaO3. Based on these observations, we propose a three-step two-site mechanism for photocatalytic water oxidation on NaTaO3-based photocatalysts in which lattice oxygen plays a key role. The elucidation of the present mechanism should help in broadly understanding water oxidation on semiconductor-based photocatalysts.

Detection of the loose particles is urgently required in the spacecraft production processes. PIND (particle impact noise detection) is the most commonly used method for the detection of loose particles in the aerospace electronic components. However, when the mass of loose particles is smaller than 0.01 mg, the weak signals are difficult to be detected accurately. In this paper, the aperiodic stochastic resonance (ASR) is firstly used to detect weak signals of loose particles. The loose particle signal is simulated by the oscillation attenuation signal. The influences of structure parameters on the potential height and detection performance of ASR are studied by a numerical iteration method. The cross-correlation coefficient C1 between input and output is chosen as a criterion for whether there is an existing a particle or not. Through normalization, the loose particle signal-labeled high frequency of 135 kHz is converted into the low-frequency band, which can be detected by the ASR method. According to the algorithm, weak signals covered by noise could be detected. The experimental results show that the detection accuracy is 66.7%. This algorithm improves the detection range of weak loose particle signals effectively.

Mandible fracture is a common injury in maxillofacial surgery. It causes not only maxillofacial dysfunction but also facial deformities. Malunited fractures of the mandible have been a vast challenge in clinical treatment due to the misalignment of the broken ends and the occurrence of occlusal disorders. This case report describes using virtual surgical planning and three-dimensional printing to treat a patient with malunited fracture of the mandible. Failing to perform mandibular surgery due to severe brain trauma after the car accident, the patient got malunited healing of mandible. The authors applied virtual surgical planning to perform preoperative analysis and surgical design on this patient, three-dimensional printing to fabricate occlusal plate, and models of the preoperative and postoperative mandible to guide the operation. Finally, the authors achieved the reduction and reconstruction of the mandible with satisfactory clinical results.

In mainland China, there remains a shortage of pediatric drugs. The Chinese government has recently launched policies and incentives to encourage pediatric drug development and clinical trials. However, data on the characteristics or development trends of these trials are limited. In this review, we extracted source data from the Chinese Clinical Trials Registry and Information Transparency Platform and systematically reviewed the pediatric clinical trials conducted in mainland China from 2009 to 2020, a comprehensive process evaluation of the pediatric drug clinical trials development in the past decade, providing data support to policy makers and industry stakeholders. We included 487 pediatric clinical trials. Over the past decade, the number of pediatric trials has increased, especially since 2016. The most common therapeutic areas were infectious diseases (n = 108, 22.2%), agents for preventive purpose (n = 99, 20.3%), and neurological and psychiatric diseases (n = 71, 14.6%). The number of clinical trials involving epilepsy (39, 10.1%), asthma (33, 8.5%), and influenza (24, 6.2%) were the highest. The distribution of leading institutions is unbalanced in mainland China, with most units in East China (34.0%) and few in Southwest China (6.9%). China has made progress in improving the research and development environment of pediatric drugs and increasing pediatric trials. However, a wide gap in pediatric drug development and clinical trials quality exists between China and the developed countries. The pharmaceutical industry in China has faced grim setbacks, including study duplication, lack of innovation, poor research design, and unbalanced resource allocation. Thus, we suggest that the Chinese government should adjust their policies to improve innovation and clinical design capacity, and optimize resource allocation between regions.

The impact of Schottky barrier height (SBH) on the performance of a side-coupled plasmonic waveguide photodetector (WGPD) is theoretically investigated by 3D opto-electrical simulations. A general decrease of the cut-off frequency is observed for all studied barrier heights (0.1 eV to 0.6 eV), most pronounced in the range (0.3 - 0.4) eV. The degradation is an electrostatic effect caused by the formation of the Schottky barrier in the i-region of the device.

Objective: Intermittent theta burst stimulation (iTBS) is a special form of repetitive transcranial magnetic stimulation (rTMS), which effectively increases cortical excitability and has been widely used as a neural modulation approach in stroke rehabilitation. As effects of iTBS are typically investigated by motor evoked potentials, how iTBS influences functional brain network following stroke remains unclear. Resting-state electroencephalography (EEG) has been suggested to be a sensitive measure for evaluating effects of rTMS on brain functional activity and network. Here, we used resting-state EEG to investigate the effects of iTBS on functional brain network in stroke survivors.Methods: We studied thirty stroke survivors (age: 63.1 ± 12.1 years; chronicity: 4.0 ± 3.8 months; UE FMA: 26.6 ± 19.4/66) with upper limb motor dysfunction. Stroke survivors were randomly divided into two groups receiving either Active or Sham iTBS over the ipsilesional primary motor cortex. Resting-state EEG was recorded at baseline and immediately after iTBS to assess the effects of iTBS on functional brain network.Results: Delta and theta bands interhemispheric functional connectivity were significantly increased after Active iTBS (P = 0.038 and 0.011, respectively), but were not significantly changed after Sham iTBS (P = 0.327 and 0.342, respectively). Delta and beta bands global efficiency were also significantly increased after Active iTBS (P = 0.013 and 0.0003, respectively), but not after Sham iTBS (P = 0.586 and 0.954, respectively).Conclusion: This is the first study that used EEG to investigate the acute neuroplastic changes after iTBS following stroke. Our findings for the first time provide evidence that iTBS modulates brain network functioning in stroke survivors. Acute increase in interhemispheric functional connectivity and global efficiency after iTBS suggest that iTBS has the potential to normalize brain network functioning following stroke, which can be utilized in stroke rehabilitation.

Medications have been withdrawn from as early as the 1900’s in several countries due to a variety of reasons. Most drugs have been withdrawn due to safety, efficacy, manufacturing issues, or the toxicities they address. While safety and efficacy of each new drug is taken into account, so is the process of drug withdrawal. Worldwide each country has its own medical agency which have different approaches on drug discovery and method of removal from the market. This removal process is simpler in several nations while more prolonged in others. Nevertheless, we still don’t know an effective method of drug removal from the market and therefore that is the focus of this paper. This paper explores the drug withdrawal process in several countries due to hepatic and cardiovascular toxicities using the WITHDRAWN database. It also summarizes and compares the drug removal processes in the U.S., Australia, UK, EU, and Canada. Consequently, there was no data or evidence that supported one country more favorable or rapid than the other. However, based on the results from drug withdrawal processes, it appeared the U.S., UK, and EU were most comparable. Meanwhile, Australia appeared to have the lengthiest process.

BACKGROUND Despite clinical reports of improved pulmonary function and reduced spinal deformity with rib-based distraction surgery in early-onset scoliosis (EOS) patients, infection remains a common complication, reported as high as 32% in some studies. The purpose of this study was to evaluate intrawound vancomycin powder in pediatric patients managed with rib-based distraction for EOS. METHODS This was a single institution retrospective cohort study of EOS patients treated with rib-based distraction. Patients treated with and without intrawound vancomycin were compared. Patients included were younger than 18 years of age, had undergone placement of a rib-based distraction construct, and had a minimum of 6 months' follow-up. For patients in the vancomycin group, 500 mg of vancomycin powder was placed before wound closure. Complications including infection and revision surgery were recorded. P-values and 95% confidence intervals (CIs) were reported for both unadjusted and adjusted complication rates for prevancomycin and postvancomycin powder. All P-values were calculated at a significance level of 0.05. RESULTS In total, 118 patients were included, accounting for 1035 procedures in the nonvancomycin control group and 252 procedures in the vancomycin group. Both groups were similar with regard to age at initial implant, sex, diagnosis, ambulatory status, and bowel/bladder incontinence. There were 55 (5.3%; 95% CI, 4.1-7.6) postoperative infections in the control group and 3 (1.2%; 95% CI, 0.3-3.8) in the vancomycin group (P=0.008, unadjusted). After adjusting for surgery type and transfusions, the vancomycin group still had a significantly lower infection rate (1.4%; 95% CI, 0.3-3.7 vs. 5.5%; 95% CI, 3.04-6.5; P=0.022). We were unable to demonstrate a difference between the control (3.5%, 95% CI, 2.4-5.1) and vancomycin (1.8%, 95% CI, 0.5-5.7) groups for deep infection (P=0.27). CONCLUSIONS Intrawound vancomycin powder significantly reduced the surgical site infection rates following rib-based distraction surgery for EOS. We therefore recommend the use of intrawound vancomycin powder as a standard of care for patients undergoing rib-based distraction surgery. LEVEL OF EVIDENCE Pre-post intervention, retrospective cohort study-therapeutic level III.

In the recent years, deep learning-based intelligent fault diagnosis methods of rolling bearings have been widely and successfully developed. However, the data-driven method generally remains a “black box” to researchers and there is a gap between the emerging neural network-based methods and the well-established traditional fault diagnosis knowledge. This paper proposes a novel deep learning-based fault diagnosis method for rolling element bearings. Attention mechanism is introduced to assist the deep network to locate the informative data segments, extract the discriminative features of inputs, and visualize the learned diagnosis knowledge. Experiments on a popular rolling bearing dataset intuitively show the effectiveness of the proposed method, which is able to provide reliable diagnosis even with very few training data. The experimental results suggest this research offers a promising tool for intelligent fault diagnosis and provides effort in understanding the underlying mechanism of deep neural network.

Purpose To compare the accuracy of a chairside fused deposition modeling (FDM) 3D-printed surgical template with that of a light-cured template for implant placement. Materials and methods Twenty standard mandibular resin models with missing teeth 36 and 46 were selected. Surgical templates were fabricated using a chairside FDM 3D-printer (test group) or a light-curing 3D printer (control group) (n = 20/group). Forty implants were placed by a clinician blinded to group allocation. The angular, 3D, mesiodistal, buccolingual, and apicocoronal deviations at the implant base and tip between preoperative design and postoperative implant position were recorded. Results The mean angular (test vs control groups: 3.22° ± 1.55° vs 2.74° ± 1.24°, p = 0.343) and 3D deviations at the implant base (test vs control groups: 0.41 ± 0.13 mm vs 0.35 ± 0.11 mm, p = 0.127) and tip (test vs control groups: 0.91 ± 0.34 mm vs 0.75 ± 0.28 mm, p = 0.150) were similar. The mesiodistal, buccolingual, and apicocoronal deviations at the implant base and tip also did not differ significantly between groups (p > 0.05). Conclusions For single tooth gap indications, implant placement with an FDM 3D-printed surgical template was as accurate as that with a light-cured template, and more efficient.

Fibers are raw materials used for manufacturing yarns and fabrics, and their properties are closely related to the performances of their derivatives. It is indispensable to implement fiber identification in analyzing textile raw materials. In this paper, seven common fibers, including cotton, tencel, wool, cashmere, polyethylene terephthalate (PET), polylactic acid (PLA), and polypropylene (PP), were prepared. After analyzing the merits and demerits of the current methods used to identify fibers, near-infrared (NIR) spectroscopy was used owing to its significant superiorities, the foremost of which is it can capture the tiny information differences in chemical compositions and morphological features to display the characteristic spectral curve of each fiber. First, the fibers’ spectra were collected, and then, the relationships between the vibrations of characteristic chemical groups and the corresponding wavelengths were researched to organize a spectral information library that would be beneficial to achieve quick identification and classification. Finally, to achieve intelligent detection, pattern recognition approaches, including principal component analysis (PCA) (used to extract information of interest), soft independent modeling of class analogy (SIMCA), and linear discrimination analysis (LDA) (defined using two classifiers), assisted in accomplishing fiber identification. The experimental results – obtained by combining PCA and SIMCA – displayed that five of seven target fibers, namely, cotton, tencel, PP, PLA, and PET, were distributed with 100% recognition rate and 100% rejection rate, but wool and cashmere fibers yielded confusing results and led to relatively low recognition rate because of the high proportion of similarities between these two fibers. Therefore, the six spectral bands of interest unique to wool and cashmere fibers were selected, and the absorbance intensities were imported into the classifier LDA, where wool and cashmere were group-distributed in two different regions with 100% recognition rate. Consequently, the seven target fibers were accurately and quickly distinguished by the NIR method to guide the fiber identification of textile materials.

In the past years, data-driven approaches such as deep learning have been widely applied on machinery signal processing to develop intelligent fault diagnosis systems. In real-world applications, domain shift problem usually occurs where the distribution of the labeled training data, denoted as source domain, is different from that of the unlabeled testing data, known as target domain. That results in serious diagnosis performance degradation. This paper proposes a novel domain adaptation method for rolling bearing fault diagnosis based on deep learning techniques. A deep convolutional neural network is used as the main architecture. The multi-kernel maximum mean discrepancies (MMD) between the two domains in multiple layers are minimized to adapt the learned representations from supervised learning in the source domain to be applied in the target domain. The domain-invariant features can be efficiently extracted in this way, and the cross-domain testing performance can be significantly improved. Experiments on two rolling bearing datasets are carried out to validate the effectiveness of the domain adaptation approach. Comparisons with other approaches and related works demonstrate the superiority of the proposed method. The experimental results of this study suggest the proposed domain adaptation method offers a new and promising tool for intelligent fault diagnosis.

Background. Postpartum depression (PPD) and preeclampsia (PE) are both common diseases in obstetrics that affect maternal health and infant development. However, the relationship between the two diseases still requires clarification. Objective. The purpose of this study was to (1) determine the incidence rate of PPD in patients with PE and (2) identify the association between the prevalence of PPD and the severity of PE. Methods. We conducted a retrospective analysis of women with and without PE who delivered between January 1, 2017, and August 30, 2018, in the First Affiliated Hospital of Chongqing Medical University. We used a questionnaire survey methodology that included the Edinburgh Postnatal Depression Scale (EPDS) to test the influence of PE on the development of new-onset PPD in the 6 weeks after delivery. We determined PPD based on a score ≥10 on the EPDS. Bivariate analysis was used to compare data between the two groups. Results. A total of 180 women participated in this study. Thirty-five people screened positive for PPD, while the remaining 145 screened negative. The prevalence of PPD was 26.67% (24/90) in patients with PE, which was two times the prevalence in normal women (12.22%). Multiple logistic regression showed that women who had PE had nearly 3-fold increased odds of PPD compared to normal women and the risk of PPD increased with the aggravation of PE. Patients with severe PE had a more than 4-fold increased risk of screening positive for PPD. Conclusion. PE was independently associated with PPD. Furthermore, the risk of PPD seemed to increase with the aggravation of PE. Thus, additional prevention efforts and support methods should be provided for women with PE to reduce the incidence of PPD.

Accurate evaluation of machine degradation during long-time operation is of great importance. With the rapid development of modern industries, physical model is becoming less capable of describing sophisticated systems, and data-driven approaches have been widely developed. This paper proposes a novel intelligent remaining useful life (RUL) prediction method based on deep learning. The time-frequency domain information is explored for prognostics, and multi-scale feature extraction is implemented using convolutional neural networks. Experiments on a popular rolling bearing dataset prepared from the PRONOSTIA platform are carried out to show the effectiveness of the proposed method, and its superiority is demonstrated by the comparisons with other approaches. In general, high accuracy on the RUL prediction is achieved, and the proposed method is promising for industrial applications.

Nitrogen-doped oxides are one kind of photocatalysts with wide spectrum absorption for promising solar water splitting, but they usually exhibit poor charge separation and thermal instability in air, leading to challenging construction of overall water splitting (OWS) system. Here we adopt one-pot nitridation strategy to synthesize a series of heterostructured photocatalysts based on Ta3N5 and the newly reported nitrogen-doped oxide BaMg1/3Ta2/3O3-xNy (denoted as BMTON) with absorption wavelength of 560 nm. The as-obtained typical heterostructure BaMg1/3Ta2/3O3-xNy/Ta3N5 (denoted as BMTON/Ta3N5) is found to exhibit superior charge separation and transfer ability with respect to the corresponding counterparts, as has been ascribed to their well-matched band gap structure and intimate interface contact. As a result, the photocatalytic activity of proton reduction over the optimized heterostructure BMTON/Ta3N5(0.4) is about 20 times higher than that of the counterparts, based on which effective Z-scheme OWS system under visible light irradiation can be realized by using the heterostructure BMTON/Ta3N5 as H2-evolving photocatalyst. This work not only gives a further proof that one-pot nitridation is a general strategy to fabricate heterostructure composed of nitrogen-doped complex oxide for enhanced charge separation and photocatalytic performance, but also demonstrates the promising future of nitrogen-doped oxide in constructing artificial photosynthesis devices.

Detection of epistatic interactions, which are referred to as nonlinear interactive effects of single nucleotide polymorphisms (SNPs), is increasingly being recognized as an important route in capturing the underlying genetic causes of complex diseases. Its methodological and computational challenges have been well understood, and many methods also have been proposed from different perspectives. Among them ant colony optimization (ACO)-based methods are promising due to their controllable time complexities, heuristic positive feedback search, and high detection power. Nevertheless, there is no comprehensive overview of them so far. This paper, therefore, provides a systematic review of 25 ACO-based epistasis detection methods. First, the generic ACO algorithm, as well as how it is applied to detect epistatic interactions, is briefly described. Then, an in-depth review of ACO-based methods for detecting epistatic interactions is discussed from four aspects, including path selection strategies, pheromone updating rules, fitness functions, and two-stage designs. Finally, this paper analyzes the strengths and limitations of involved methods, provides guidelines for applying them, and gives several views on the future directions of epistasis detection methods.

Background An increase in blood flow in the forearm arteries has been reported after brachial plexus block (BPB). However, few studies have quantitatively analysed the blood flow of the forearm arteries after BPB or have studied only partial haemodynamic parameters. The purpose of the present study was to comprehensively assess blood flow changes in the distal radial artery (RA) and ulnar artery (UA) after BPB performed via a new costoclavicular space (CCS) approach using colour Doppler ultrasound. Methods Thirty patients who underwent amputated finger replantation and received ultrasound-guided costoclavicular BPB were included in the study. The haemodynamic parameters of the RA and UA were recorded before the block and 10 min, 20 min, and 30 min after the block using colour Doppler ultrasound to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmean), pulsatility index (PI), resistance index (RI) and area. The volumetric flow rate (VFR) was calculated using the formula Q = area×Vmean. The aforementioned parameters were compared not only before and after the BPB but also between the RA and UA. Results Compared with those of the respective baselines, there was a significant increase in the PSV, EDV, Vmean, area, and VFR and a significant decrease in the PI and RI of the RA and UA 10 min, 20 min, and 30 min post-block. The increase 30 min post-block in EDV (258.68 % in the RA, 279.63 % in the UA) was the most notable, followed by that in the Vmean (183.36 % in the RA, 235.24 % in the UA), and the PSV (139.11 % in the RA, 153.15 % in the UA) changed minimally. The Vmean and VFR of the RA were significantly greater than those of the UA before the BPB; however, there was no significant difference in the VFR between the RA and UA after the BPB. Conclusions A costoclavicular BPB can increase blood flow in the forearm arteries. The RA had a higher volumetric flow rate than the UA before the BPB; however, the potential blood supply capacity of the UA was similar to that of the RA after a BPB. Trial registration This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/searchproj.aspx, clinical trial number: ChiCTR 1900023796, date of registration: June 12, 2019)

We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. Symptomatic vulnerable plaques showed greater plaque burden, LRNC volume (median: 221.4 vs 134.8 mm3, P = .003), IPH volume (median: 32.2 vs 22.5 mm3, P = .030), maximum percentage (Max%) LRNC (median: 51.3% vs 41.8%, P = .002), Max%IPH (median: 13.4% vs 9.5%, P = .022), cumulative slices of LRNC (median: 10 vs 8, P = .005), and more juxtaluminal IPH and/or thrombus (29.9% vs 6.0%, P = .001) and FCR (37.3% vs 16.4%, P = .007) than asymptomatic ones. After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.

Background: Cognitive impairment is a frequent and often debilitating consequence of stroke. This single-blinded randomized controlled trial examined the therapeutic benefits of continuous theta burst stimulation (cTBS) for patients with post-stroke cognitive impairment (PSCI). Methods: Twenty patients with PSCI were randomly and equally allocated to cTBS and sham cTBS groups. Groups received the indicated treatments five consecutive days per week for 2 weeks (10 sessions) plus 10 sessions of computer-assisted cognitive training. The primary outcomes were changes in Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score and analysis along the perivascular space (ALPS) index. Results: The post-intervention change in ADAS-cog score from baseline was significantly greater in the cTBS group than the sham cTBS group (-7.7 ± 3.8 vs. -3.7 ± 1.5, t = -3.096, P = 0.006). Change in ALPS index from baseline was also greater in the cTBS group (0.182 ± 0.097 vs. 0.093 ± 0.080, t = 2.236, P = 0.038). Conclusion: Continuous theta burst stimulation can improve cognitive outcome and enhance ALPS. Enhanced waste clearance via the glymphatic system induced by cTBS may contribute to improved cognitive function following stroke.Clinical Trial Registration URL: http://www.chictr.org.cn. ChiCTR1800017997. Registered August 25, 2018, retrospectively registered.

Chronic Infection of Hepatitis B virus (HBV) is one risk factor of hepatocellular carcinoma (HCC). Much effort has been made to research the process of HBV-associated HCC, but its molecular mechanisms of carcinogenesis remain vague. Here, weighted gene co-expression network analysis (WGCNA) was employed to explore the co-expressed modules and hub/key genes correlated to HBV-associated HCC. We found that genes of the most significant module related to HBV-associated HCC were enriched in DNA replication, p53 signaling pathway, cell cycle, and HTLV-1 infection associated pathway; these cellular pathways played critical roles in the initiation and development of HCC or viral infections. Furthermore, seven hub/key genes were identified based on the topological network analysis, and their roles in HCC were verified by expression and Kaplan-Meier survival analysis. Protein-protein interaction and KEGG pathway analysis suggested that these key genes may stimulate cellular proliferation to promote the HCC progression. This study provides new perspectives to the knowledge of the key pathways and genes in the carcinogenesis process of HBV-associated HCC, and our findings provided potential therapeutic targets and clues of the carcinogenesis of HBV-associated HCC. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00357-4.

The synthesized understanding of the mechanical properties of negative Poisson’s ratio (NPR) convex–concave honeycomb tubes (CCHTs) under quasi-static and dynamic compression loads is of great significance for their multifunctional applications in mechanical, aerospace, aircraft, and biomedical fields. In this paper, the quasi-static and dynamic compression tests of three kinds of 3D-printed NPR convex–concave honeycomb tubes are carried out. The sinusoidal honeycomb wall with equal mass is used to replace the cell wall structure of the conventional square honeycomb tube (CSHT). The influence of geometric morphology on the elastic modulus, peak force, energy absorption, and damage mode of the tube was discussed. The experimental results show that the NPR, peak force, failure mode, and energy absorption of CCHTs can be adjusted by changing the geometric topology of the sinusoidal element. Through the reasonable design of NPR, compared with the equal mass CSHTs, CCHTs could have the comprehensive advantages of relatively high stiffness and strength, enhanced energy absorption, and damage resistance. The results of this paper are expected to be meaningful for the optimization design of tubular structures widely used in mechanical, aerospace, vehicle, biomedical engineering, etc.

Objective: Brain-computer interface (BCI) training is becoming increasingly popular in neurorehabilitation. However, around one third subjects have difficulties in controlling BCI devices effectively, which limits the application of BCI training. Furthermore, the effectiveness of BCI training is not satisfactory in stroke rehabilitation. Intermittent theta burst stimulation (iTBS) is a powerful neural modulatory approach with strong facilitatory effects. Here, we investigated whether iTBS would improve BCI accuracy and boost the neuroplastic changes induced by BCI training.Methods: Eight right-handed healthy subjects (four males, age: 20–24) participated in this two-session study (BCI-only session and iTBS+BCI session in random order). Neuroplastic changes were measured by functional near-infrared spectroscopy (fNIRS) and single-pulse transcranial magnetic stimulation (TMS). In BCI-only session, fNIRS was measured at baseline and immediately after BCI training. In iTBS+BCI session, BCI training was followed by iTBS delivered on the right primary motor cortex (M1). Single-pulse TMS was measured at baseline and immediately after iTBS. fNIRS was measured at baseline, immediately after iTBS, and immediately after BCI training. Paired-sample t-tests were used to compare amplitudes of motor-evoked potentials, cortical silent period duration, oxygenated hemoglobin (HbO2) concentration and functional connectivity across time points, and BCI accuracy between sessions.Results: No significant difference in BCI accuracy was detected between sessions (p > 0.05). In BCI-only session, functional connectivity matrices between motor cortex and prefrontal cortex were significantly increased after BCI training (p's < 0.05). In iTBS+BCI session, amplitudes of motor-evoked potentials were significantly increased after iTBS (p's < 0.05), but no change in HbO2 concentration or functional connectivity was observed throughout the whole session (p's > 0.05).Conclusions: To our knowledge, this is the first study that investigated how iTBS targeted on M1 influences BCI accuracy and the acute neuroplastic changes after BCI training. Our results revealed that iTBS targeted on M1 did not influence BCI accuracy or facilitate the neuroplastic changes after BCI training. Therefore, M1 might not be an effective stimulation target of iTBS for the purpose of improving BCI accuracy or facilitate its effectiveness; other brain regions (i.e., prefrontal cortex) are needed to be further investigated as potentially effective stimulation targets.

Primary thymic atypical carcinoid (TAC) is a type of extremely rare neuroendocrine tumor. Approximately one-third of patients with TAC tumors are asymptomatic, and no treatments of TAC have been rigorously tested in multicenter clinical trials. To date, there has been no previous case report of TACs with multiple skull metastases. The present report describes a case of a 56-year-old male patient with a primary TAC and multiple axial skeleton metastases, including multiple bilateral metastases to the parietal bones, outer wall of the orbital cavities, and the petrous apex, as well as metastases to the suprasellar region and the clivus. The histological examination confirmed the diagnosis of TAC. Single-photon emission computed tomography, computed tomography and magnetic resonance imaging scans revealed multiple bone metastases. The patient refused chemotherapy and radiotherapy and only accepted alleviative treatment, and died 89 days after diagnosis. This type of cancer is highly malignant with an extremely short natural course and high disease-related mortality. In addition, a review of the literature was performed to provide a reference for proper diagnosis and treatment of TACs.

Objective: To assess the association between hepatic venous pressure gradient (HVPG) baseline and the response rate of cirrhotic in patients who received carvedilol treatment. Methods: In total 48 cirrhotic patients with a basic HVPG value greater than 12 mmHg were included (from July 2011 to October 2014). All patients received carvedilol treatment and underwent the second HVPG measurement 7 days later. In the following, all participants received an endoscopic variceal ligation (EVL) treatment. Results: HVPG was significantly reduced from 16.04 ± 3.10 to 12.76 ± 5.26 mmHg following carvedilol treatment. The response rate was about 58.33% (28/48). The response rate of the HVPG < 16 mmHg group (71.4%) was significantly higher than that of the HVPG ≥ 16 mmHg group (40%) (P < 0.05). Patients were followed up for a median of 26 months, ranged from 6 to 33 months. During the follow-up period (two years), the rebleeding rate was 9.97% and 49.56% in HVPG < 16 and HVPG ≥ 16 mmHg groups, respectively, with a statistically significant difference (P = 0.004). Also, the mortality rate (at 2 years) was 5.26% and 21.05%, respectively, which was significant (P = 0.035). Conclusions: This study demonstrated that the response rate of carvedilol on portal hypertension may be affected by the HVPG baseline, and the carvedilol was effective in reducing HVPG, especially for those with a HVPG < 16 mmHg.

Women in low and middle-income countries (LMICs) do not have equal access to resources, such as education, employment, or healthcare compared to men. We sought to explore health disparities and associations between gender prioritization, sociocultural factors, and household decision-making in Central Malawi.From June-August 2017, a cross-sectional study with 200 participants was conducted in Central Malawi. We evaluated respondents' access to care, prioritization within households, decision-making power, and gender equity which was measured using the Gender-Equitable Men (GEM) scale. Relationships between these outcomes and sociodemographic factors were analyzed using multivariable mixed-effect logistic regression.We found that women were less likely than men to secure community-sourced healthcare financial aid (68.6% vs. 88.8%, p 0.001) and more likely to underutilize necessary healthcare (37.2% vs. 22.4%, p = 0.02). Both men and women revealed low GEM scores, indicating adherence to traditional gender norms, though women were significantly less equitable (W:16.77 vs. M:17.65, p = 0.03). Being a woman (Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.21-0.78) and prioritizing a woman as a decision-maker for large purchases (OR 0.38, CI 0.15-0.93) were independently associated with a lower likelihood of prioritizing women for medical treatment and being a member of the Chewa tribal group (OR 3.87, CI 1.83-8.18) and prioritizing women for education (OR 4.13, CI 2.13-8.01) was associated with a higher odds.Women report greater barriers to healthcare and adhere to more traditional gender roles than men in this Central Malawian population. Women contribute to their own gender's barriers to care and economic empowerment alone is not enough to correct for these socially constructed roles. We found that education and matriarchal societies may protect against gender disparities. Overall, internal and external gender discrimination contribute to a woman's disproportionate lack of access to care.

PurposeTo compare the oncologic safety, aesthetic outcome, and upper extremity function of single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) vs conventional open mastectomy (C-OM) in the treatment of early breast cancer. Methods In this retrospective cohort study, 285 stage I and II breast cancer patients were divided into the SIE-NSM group (n = 71) and the C-OM group (n = 214). Local recurrence, distant metastasis, and upper extremity function were compared. Differences in the aesthetic outcome, psychosocial well-being, and sexual well-being were analyzed by the BREAST-Q scale. Multivariable binary logistic regression was conducted to assess the risk of local recurrence. The multivariable linear regression model was performed to evaluate the upper extremity function and the aesthetic outcome.Results Local recurrence rates were similar (p = 0.735), which was also shown by multivariable binary logistic regression analysis. No distant metastases were observed in either group. Satisfaction with breasts, chest well-being, psychosocial well-being, and sexual well-being scores were superior in the SIE-NSM group (p < 0.001). Chest wall/breast pain, shoulder range of motion, and use of arm in daily life was better for the patients in the SIE-NSM group (p < 0.001). There were no cases of subcutaneous effusion in the SIE-NSM group, while the incidence rate of subcutaneous effusion in the C-OM group was 10.7% (p = 0.004). ConclusionsSIE-NSM is comparable to C-OM in oncologic safety while increasing satisfaction with breasts, physical well-being, psychosocial well-being, sexual well-being, and upper extremity function. This novel method is an appropriate surgical option for early breast cancer treatment.

PurposeIndocyanine green (ICG) is an efficient tracer method used in sentinel lymph node biopsy (SLNB). The application of single-port endoscopic-assisted technology in the field of breast cancer is widely accepted. In order to explore the surgical safety of single-port endoscopic-SLNB (SPE-SLNB) and the reliability of axillary staging, we combined it with ICG that was excited by near-infrared fluorescence endoscopy and carbon nanoparticles (CN) as a tracer and compared this method to conventional open SLNB (C-SLNB).MethodsSixty patients with early breast cancer were recruited and divided into three groups. Twenty patients who underwent SPE-SLNB combined with ICG and CNs were placed in group A. Twenty patients who underwent SPE-SLNB with CNs only were placed in group B. Twenty patients who underwent C-SLNB with ICG and CNs were placed in group C.ResultsThe detection rate of SLNs was 100% in group A, 100% in group B, and 95% in group C. In total, 97 SLNs were detected in group A, 65 SLNs were detected in group B, and 98 SLNs were detected in group C . ConclusionThe novel technique of combining ICG and CNs with SPE-SLNB and the utilization of the endoscopic fluorescence imaging system achieved the same detection rate and mean number of SLNs as C-SLNB. Therefore, for patients who meet the indications, SPE-SLNB is as safe and reliable as C-SLNB.