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A 40-year-old Chinese woman presented with a 4-year history of lower back pain and left lower leg sciatica. The patient had previously tried different modalities of treatments, including massage, acupuncture, ultrasound, alternative Bowen therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), all of which only provided temporary relief. On presentation to a tertiary hospital, careful and comprehensive history taking found that the sciatica pattern of pain always coincided with menstruation. An MRI identified a thickened left sciatic nerve, with surgery confirming sciatic nerve endometriosis. The case highlights the importance of comprehensive history taking in accurately diagnosing a rare aetiology of sciatica with subsequent prompt surgical intervention to avoid severe disability as well as follow-up treatment to prevent recurrence.

Background The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration. Methods The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs). Results A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P Conclusions PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. Practical implications Inclusion of patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.

The impact of alcoholic hepatitis (AH) on health-related quality of life (HRQOL) remains inadequately described. We aimed to characterize HRQOL in AH and heavy drinkers (HD), and its associations with clinical variables and outcomes.This is a post hoc analysis of participants in the Translational Research and Evolving Alcoholic Hepatitis Treatment 001 study (NCT02172898). HRQOL was measured using Short Form Health Survey (SF-36). Mean SF-36 scores were compared in AH and HD with two-sample t-tests. Associations among clinical characteristics, 30-day mortality, and SF-36 mental and physical component scores (MC, PC) were investigated with generalized linear and logistic multivariate regression models. Trends of MC and PC scores were analyzed using one-way ANOVA.Participants with AH (n = 258) and HD (n = 181) were similar demographically. AH cases had a mean Model for End-stage Liver Disease (MELD) score of 23 (7). AH cases had lower PC scores [37 (10) vs. 48 (11), p 0.001] but higher MC scores [37 (13) vs. 32 (13), p 0.001]. MC scores were independently associated with age, male gender, and daily alcohol consumption; PC scores were independently associated with age, BMI, alanine aminotransferase concentration, alkaline phosphatase concentration, white blood cell counts, and the presence of ascites. With each 5-point decrease in the baseline PC score, the adjusted odds of dying within 30 days increased by 26.7% (95% CI 1% to 46%). Over time, HRQOL in AH improved (day 0 to day 180 delta PC score: 4.5 ± 1.7, p = 0.008; delta MC score: 9.8 ± 2.0, p 0.001). Participants with a MELD score15 by day 180 had greater increases in PC scores than those with MELD score ≥15 (delta PC score 7.1 ± 1.8 vs. -0.7 ± 2.3, p = 0.009), while those abstinent by day 180 had greater increases in MC scores than those who were not abstinent (delta MC score 9.1 ± 1.8 vs. 2.8 ± 2.4, p = 0.044).HRQOL is poor in AH and HD in a domain-specific pattern. Independent of MELD score, lower baseline HRQOL is associated with higher 30-day mortality. Over time, HRQOL improves with greater gains seen in individuals with improved MELD scores and those who were abstinent.

The rapid advancement of connected and autonomous vehicle (CAV) technologies, although possibly years away from wide application to the general public travel, are receiving attention from many state Departments of Transportation (DOT) in the niche area of using autonomous maintenance technology (AMT) to reduce fatalities of DOT workers in work zone locations. Although promising results are shown in testing and deployments in several states, current autonomous truck mounted attenuator (ATMA) system operators are not provided with much practical driving guidance on how to drive these new vehicle systems in a way that is safe to both the public and themselves. To this end, this manuscript aims to model and develop a set of rules and instructions for ATMA system operators, particularly when it comes to critical locations where essential decision making is needed. Specifically, three technical requirements are investigated: car-following distance, critical lane-changing gap distance, and intersection clearance time. Newell’s simplified car-following model, and the classic lane-changing behavior model are modified, with roll-ahead distance taken into account, to model the driving behaviors of the ATMA vehicles at those critical decision-making locations. Data are collected from real-world field testing to calibrate and validate the developed models. The modeling outputs suggest important thresholds for ATMA system operators to follow. For example, on a freeway with a speed limit of 70 mph and ATMA operating speed of 10 mph, car-following distance should be no less than 75 ft for the lead truck and 100 ft for the follower truck, the critical lane-changing gap distance is 912 ft, and a minimum intersection clearance is 15 s, which are all much higher than the requirements for a general vehicle.

Objective To compare the safety and effectiveness of robot‐assisted minimally invasive transforaminal lumbar interbody fusion (Mis‐TLIF) and oblique lumbar interbody fusion (OLIF) for the treatment of single‐level lumbar degenerative spondylolisthesis (LDS). Methods This is a retrospective study. Between April 2018 and April 2020, a total of 61 patients with single‐level lumbar degenerative spondylolisthesis and treated with robot‐assisted OLIF (28 cases, 16 females, 12 males, mean age 50.4 years) or robot‐assisted Mis‐TLIF (33 cases, 18 females, 15 males, mean age 53.6 years) were enrolled and evaluated. All the pedicle screws were implanted percutaneously assisted by the TiRobot system. Surgical data included the operation time, blood loss, and length of postoperative hospital stay. The clinical and functional outcomes included Oswestry Disability Index (ODI), Visual Analog scores (VAS) for back and leg pain, complication, and patient's satisfaction. Radiographic outcomes include pedicle screw accuracy, fusion status, and disc height. These data were collected before surgery, at 1 week, 3 months, 6 months, and 12 months postoperatively. Results There were no significantly different results in preoperative measurement between the two groups. There was significantly less blood loss (142.4 ± 89.4 vs 291.5 ± 72.3 mL, P, Robot‐assisted OLIF and Mis‐TLIF both have similar good clinical outcomes, but OLIF has the additional benefits of less blood loss, less hospital stays, higher disc height, and higher fusion rates. Robots can improve the safety of the minimally invasive spine surgery.

Breast cancer is a malignant tumor that has a high mortality rate and mostly occurs in women. Although significant progress has been made in the implementation of personalized treatment strategies for molecular subtypes in breast cancer, the therapeutic response is often not satisfactory. Studies have reported that long non-coding RNAs (lncRNAs) are abnormally expressed in breast cancer and closely related to the occurrence and development of breast cancer. In addition, the high tissue and cell-type specificity makes lncRNAs particularly attractive as diagnostic biomarkers, prognostic factors, and specific therapeutic targets. Therefore, an in-depth understanding of the regulatory mechanisms of lncRNAs in breast cancer is essential for developing new treatment strategies. In this review, we systematically elucidate the general characteristics, potential mechanisms, and targeted therapy of lncRNAs and discuss the emerging functions of lncRNAs in breast cancer. Additionally, we also highlight the advantages and challenges of using lncRNAs as biomarkers for diagnosis or therapeutic targets for drug resistance in breast cancer and present future perspectives in clinical practice., Graphical abstract, Jin et al. systematically elucidate the general characteristics, potential mechanisms, and targeted therapy against lncRNAs and discuss the emerging functions of lncRNAs in breast cancer. Additionally, they also highlight the advantages and challenges of using lncRNAs as biomarkers for diagnosis or therapeutic targets and present future perspectives in clinical practice.

BACKGROUND The ATP6AP1 gene coding for the accessory protein Ac45 of the vacuolar-type adenosine triphosphatases (V-ATPase) is located on chromosome Xq28. Defects in certain subunits or accessory subunits of the V-ATPase can lead to congenital disorders of glycosylation (CDG). CDG is a group of metabolic disorders in which defective protein and lipid glycosylation processes affect multiple tissues and organs. Therefore, the clinical presentation of patients with ATP6AP1-CDG varies widely. In this report, we present a case of ATP6AP1-CDG in a Chinese infant, with clinical features and genotype. CASE SUMMARY An 8-mo-old boy was admitted to our hospital because unexplained hepatosplenomegaly and elevated transaminases that had been noted while he was being treated for a cough at a local hospital. A post-admission examination at our hospital revealed abnormalities in the infant’s liver, brain, and immune system. Trio-based whole exome gene analysis identified a hemizygous pathogenic mutation c.1036G>A (p.E346K) in exon 9 of the ATP6AP1 gene. This variant of the ATP6AP1 gene has not been reported in East Asian countries until now. CONCLUSION Based on the infant’s clinical manifestations and the results of genetic detection, he was clearly diagnosed with ATP6AP1-CDG. The clinical manifestations of children with CDG vary widely. Genetic testing analysis helps in the clinical diagnosis of children with CDG.

Angiotensin-converting enzyme 2 (ACE2) has been identified as the key receptor of SARS coronavirus that plays a key role in the pathogenesis of SARS. It is known that ACE2 mRNA can be expressed in most organs. However, the protein expression of ACE2 is not clear yet. To explore the role of ACE2 as a precipitating factor in digestive organ damage in COVID-19, this study investigated the expression of ACE2 protein in the human liver, esophagus, stomach, and colon. The result showed that ACE2 can be expressed in the liver, esophagus, stomach, and colon, which suggests SARS-CoV-2 may enter the digestive system through ACE2 and cause liver damage and gastrointestinal damage. It is hoped that the result of the study will provide a new strategy for the prevention and treatment of digestive organ damage under COVID-19.

Aberrant topological organization of whole-brain networks has been inconsistently reported in studies of patients with major depressive disorder (MDD), reflecting limited sample sizes. To address this issue, we utilized a big data sample of MDD patients from the REST-meta-MDD Project, including 821 MDD patients and 765 normal controls (NCs) from 16 sites. Using the Dosenbach 160 node atlas, we examined whole-brain functional networks and extracted topological features (e.g., global and local efficiency, nodal efficiency, and degree) using graph theory-based methods. Linear mixed-effect models were used for group comparisons to control for site variability; robustness of results was confirmed (e.g., multiple topological parameters, different node definitions, and several head motion control strategies were applied). We found decreased global and local efficiency in patients with MDD compared to NCs. At the nodal level, patients with MDD were characterized by decreased nodal degrees in the somatomotor network (SMN), dorsal attention network (DAN) and visual network (VN) and decreased nodal efficiency in the default mode network (DMN), SMN, DAN, and VN. These topological differences were mostly driven by recurrent MDD patients, rather than first-episode drug naive (FEDN) patients with MDD. In this highly powered multisite study, we observed disrupted topological architecture of functional brain networks in MDD, suggesting both locally and globally decreased efficiency in brain networks.

At room temperature, we studied the delayed luminescence characteristic curves of the leaves of Scindapsus in darkroom and continuously irradiate at different wavelengths. The results show that the decay of stimulated emission photons induced by pulsed laser has a typical hyperbolic trend with the delay time, and the goodness of fitted curve can reach 99.9%. The initial photon intensity I (0) and decay time τ are closely related to the environment and physiological activities of plants. In the dark room, it was found that the initial intensity and decay time of the delayed luminescence curve for picked leaves decreased, while the potted leaves remained almost unchanged. The characteristic curve of laser-induced delayed luminescence accurately reflected the process and degree of plant wilting. For continuously irradiated by the laser wavelength of 520 nm and 400 nm, respectively, the change in curve parameters reflects the selective absorption of different light wavelengths. Compare the condition with having light and without, the metabolites of photosynthesis and respiration are different in plants, which leads to greatly changes in decay time. The characteristic curve of laser-induced delayed luminescence can be used as an important parameter to measure the physiological state of plants.

Cisplatin is a highly effective antitumor drug generally used in the treatment of solid malignant tumors. However, cisplatin causes severe side effects such as bone marrow depression, nephrotoxicity, and ototoxicity, thus limiting its clinical application. The incidence of ototoxicity induced by cisplatin ranges from 20% to 70%, and it usually manifests as a progressive, bilateral and irreversible hearing loss. Although the etiology of cisplatin-induced ototoxicity remains unclear, an increasing body of evidence suggests that the ototoxicity of cisplatin is mainly related to the production of reactive oxygen species and activation of apoptotic pathway in cochlear tissues. Many drugs have been well proved to protect cisplatin-induced hearing loss in vitro and in vivo. However, the anti-tumor effect of cisplatin is also weakened by systemic administration of those drugs for hearing protection, especially antioxidants. Therefore, establishing a local administration strategy contributes to the otoprotection without affecting the effect of cisplatin. This review introduces the pathology of ototoxicity caused by cisplatin, and focuses on recent developments in the mechanisms and protective strategies of cisplatin-induced ototoxicity.

Background ICP pregnant women have a unique profile of serum bile acid metabolism, thus the early and accurate identification of ICP patients is beneficial to early appropriate treatment and improvement of pregnancy outcomes. In this study, ultra-high performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS/MS) was used to analyze the 15 types of serum bile acid profiles among patients with ICP in third trimester, patients with cholelithiasis, and patients with hepatitis B virus. The ICP diagnostic model established by partial least squares-discriminant analysis (PLS-DA) was used to screen the differential bile acids for clinical subtypes of ICP. 144 cases of ICP patients were involved in this study, and divided into four subgroups according to serum level of TBA, DBIL, and ALT. Results (1) The differential serum bile acid profiles of ICP group and normal pregnant women were DCA, TDCA, TCA, GDCA and GLCA. (2) The differential serum bile acid profiles of the ICP1 group (ICP with jaundice) and normal pregnant women were TCDCA, TCA, GCA, GCDCA, TUDCA and GUDCA. (3) The differential serum bile acid profiles of the ICP3 group (Hyperchoicemia of pregnancy) and normal pregnant group was GUDCA, LCA, GLCA, UDCA, TUDCA, CDCA, and TLCA (P 0.05). Conclusion Maternal serum bile acid profiles are useful to differentiate the four subtypes of ICP. ICP with jaundice could be an important predictor of adverse pregnancy outcomes of ICP.

Coronavirus disease 2019 (COVID-19) combined with liver injury has become a very prominent clinical problem. Due to the lack of a clear definition of liver injury in patients with COVID-19, the different selection of evaluation parameters and statistical time points, there are the conflicting conclusions about the incidence rate in different studies. The mechanism of COVID-19 combined with liver injury is complicated, including the direct injury of liver cells caused by severe acute respiratory syndrome coronavirus 2 replication and liver injury caused by cytokines, ischemia and hypoxia, and drugs. In addition, underlying diseases, especially chronic liver disease, can aggravate COVID-19 liver injury. In the treatment of COVID-19 combined with liver injury, the primary and basic treatment is to treat the etiology and pathogenesis, followed by support, liver protection, and symptomatic treatment according to the clinical classification and severity of liver injury. This article evaluates the incidence, pathogenesis and prevention and treatment of COVID-19 combined with liver injury, and aims to provide countermeasures for the prevention and treatment of COVID-19 combined with liver injury.

Objective To study the effects of CX3CR1 on white matter injury, neurofunction, recognition, and expression of the CD36/15LO/NR4A1 signal in mice with traumatic brain injury (TBI). Methods CX3CR1GFP/GFP, CX3CR1GFP/+ and C57BL/6 male mice were randomly divided into 3 groups. We used a controlled cortical impact (CCI) to establish a TBI model and T2wt MRI to detect the TBI lesion. FA and DTI allowed for quantitative evaluation of the structural integrity of white matter tracts. Several behavior tests were used to investigate nerve function; a computer-based tracing system was used to trace and analyze dendrites and cell bodies of microglia and astrocytes in the peri-lesional brain areas. We also used RT-PCR and western blot to detect the effect of CX3CL1/CX3CR1 axis on CD36/15LO/NR4A1 signal. Results The fractional anisotropy (FA) at the corpus callosum area of brain was decreased at 3 days post TBI, the average lesion volume CX3CR1GFP/GFP group was increased, and the neurologic deficit scores of mice of Cx3Cr1GFP/+ and wild-type groups were significantly increased compared to Cx3Cr1GFP/GFP group mice. In the Corner turn test, TBI induced impairments in forelimb function that were more severe than Cx3Cr11GFP/+ and wild-type TBI mice. We operated the Y-maze at 3 days post-TBI and the NOR test at 28 days after TBI. There was a significant TBI effect induced in decreased percentage entries into the novel arm in Cx3Cr1GFP/+ and wild-type TBI mice, compared with Cx3Cr1GFP/GFP; Cx3Cr1GFP/+. Wild-type mice showed decreased exploration time in new objects compared with Cx3Cr1GFP/GFP. Those two behavior tests demonstrated that Cx3Cr1 knock-out increased the damage caused by TBI to memory. In the tail suspension and force swimming tests, there was no significant difference between those three groups. CD36 increased in Cx3Cr1GFP/GFP compared with the other three groups at 3 days after TBI. TBI inhibited the expression of NR4A1 at 3 d after damage. Cx3Cr1 deficiency can induce high expression of 15LO, this was unaffected by TBI. Conclusion CX3CR1 deletion can enhance white matter injury. It increased the expression of CD36 and 15LO and increased expression of NR4A1. The lack of CX3CR1 can affect the recovery of nerve function.

BACKGROUND Glioblastoma is the most common type of brain tumor and is invariably fatal, with a mean survival time of 8-15 mo for recently diagnosed tumors, and a 5-year survival rate of only 7.2%. The standard treatment for newly diagnosed glioblastoma includes surgery followed by concurrent chemoradiotherapy and further adjuvant temozolomide. However, the prognosis remains poor and long-term survival is rare. This report aimed to demonstrate a new therapeutic strategy for the treatment of glioblastoma. CASE SUMMARY A patient was referred to the Department of Neurosurgery with an intracranial space-occupying lesion with a maximum diameter of approximately 5 cm. The tumor was compressing functional areas, and the patient accordingly underwent partial resection and concurrent chemoradiotherapy. The imaging and pathological findings were consistent with a diagnosis of glioblastoma with oligodendroglioma differentiation (World Health Organization IV). The patient was finally diagnosed with glioblastoma. However, the patient discontinued treatment due to intolerable side effects, and was prescribed Kangliu pill (KLP) 7.5 g three times/d, which he has continued to date. Significant shrinkage of the tumor (maximum diameter reduced from about 3.5 to about 2 cm) was found after 3 mo of KLP therapy, and the tumor was further reduced to about 1 cm after 3 years. The patient’s symptoms of headache, limb weakness, and left hemiplegia were relieved, with no side effects. CONCLUSION KLP has been a successful intervention for glioblastoma, and the current case indicates that traditional Chinese medicine may offer effective alternative therapies for glioblastoma.

Objective To test the impact of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults. Design Cluster-randomized controlled trial. Setting and participants Ten primary care clinics within Eskenazi Health in Indianapolis. Intervention The multicomponent intervention included provider- and patient-focused components. The provider-focused component was computerized decision support alerting of the presence of a high-risk anticholinergic and offering dose- and indication-specific alternatives. The patient-focused component was a story-based video providing education and modeling an interaction with a healthcare provider resulting in a medication change. Alerts within the medical record triggered staff to play the video for a patient. Our design intended for parallel, independent priming of both providers and patients immediately before an outpatient face-to-face interaction. Measurement Medication orders were extracted from the electronic medical record system to evaluate the prescribing behavior and population prevalence of anticholinergic users. The intervention was introduced April 1, 2019, through March 31, 2020, and a preintervention observational period of April 1, 2018, through March 31, 2019, facilitated difference in difference comparisons. Results A total of 552 older adults had visits at primary care sites during the study period, with mean age of 72.1 (SD 6.4) years and 45.3% African American. Of the 259 provider-focused alerts, only three (1.2%) led to a medication change. Of the 276 staff alerts, 4.7% were confirmed to activate the patient-focused intervention. The intervention resulted in no significant differences in either the number of discontinue orders for anticholinergics (intervention: two additional orders; control: five fewer orders, p = 0.7334) or proportion of the population using anticholinergics following the intervention (preintervention: 6.2% and postintervention: 5.1%, p = 0.6326). Conclusion This multicomponent intervention did not reduce the use of high-risk anticholinergics in older adults receiving primary care. Improving nudges or a policy-focused component may be necessary to reduce use of high-risk medications.

Traffic sign detection is a critical task in the visual system of the Advanced Driver Assistance System (ADAS) and the Automated Driving System (ADS). Although the general object detection has achieved promising results by using Feature Pyramid Network (FPN) in recent years, we still observed that FPN cannot obtain satisfactory results in traffic sign detection because the size and class distribution of traffic signs are extremely unbalanced. To overcome this problem, a novel Plug-and-Play neck network Integrated Feature Pyramid Network with Feature Aggregation (IFA-FPN) is proposed in this paper based on the statistical characteristics of traffic signs. First, a lightweight operation is introduced to fully utilize the model and improve the inference speed of the model. Second, an Integrated Operation (IO) is introduced to solve the imbalance problem of Region-of-Interests (RoIs) in pyramid levels. Third, we introduce a Feature Aggregation (FA) structure to strengthen the feature representation capacity of feature maps, thereby enhancing the network robustness against the size discrepancy of traffic signs. The experiments are performed on three mainstream datasets, i.e., the German Traffic Sign Detection Benchmark (GTSDB), Swedish Traffic Sign Dataset (STSD), and Tsinghua-Tencent 100k dataset (TT100k). The experimental results demonstrate the superiority of the proposed IFA-FPN in the traffic sign detection tasks. Specifically, when the proposed IFA-FPN is applied to the Cascade RCNN, it achieves 80.3% mAP in GTSDB which surpasses FPN by 9.9%, 65.2% in mAP in STSD which surpasses FPN by 3.5%, and 93.6% in mAP in TT100k which surpasses FPN by 1.6%.

Objectives. To evaluate the role of short-term low-dose glucocorticoids in mild COVID-19 patients. Methods. We conducted a retrospective, cross-sectional, single-center study in Kunming, China. A total of 33 mild COVID-19 cases were divided into two treatment groups (with and without glucocorticoids, methylprednisolone, were used in this setting), and the absolute value of peripheral blood lymphocyte count; CD3+, CD4+, and CD8+ T cell counts; and the time to achieve negative transformation of a nucleic acid pharyngeal swab were recorded. Peripheral blood lymphocyte and T cell counts were compared between the treatment group and 25 healthy individuals. At the point of time when there was a 50% accumulation conversion rate (positive to negative nucleic acid on pharyngeal swab), and the nucleic acid turned negative in half of the patients in two groups, the peripheral blood lymphocyte and T cell counts were compared between treatment groups. Results. The mean cumulative time for the 50% negative conversion rate of the nucleic acid in the pharyngeal swab was 17.7±5.1 days and 13.9±5.4 days in the glucocorticoid group and the nonglucocorticoid group, respectively. The absolute peripheral blood lymphocyte count and the T cell subset count in the glucocorticoid group were lower than those in the nonglucocorticoid group. When the nucleic acid turned negative in half of the patients, the absolute value of peripheral blood lymphocyte count and CD4+ T cells of the glucocorticoid group and the nonglucocorticoid group was not significantly different; the CD3+ and CD8+ T cells in the glucocorticoid group were lower than those in the nonglucocorticoid group. The absolute peripheral blood lymphocyte count, CD3+ T cells, and CD4+ T cells in the glucocorticoid group were lower than those of the healthy group during the whole disease period, and CD8+ T cells returned to normal at 19-21 days of the disease period. There was no significant difference between the nonglucocorticoid group and the healthy group for absolute peripheral blood lymphocyte and CD8+ T cells; moreover, CD3+ T cells and CD4+ T cells were lower in the nonglucocorticoid group than those in the healthy group from the day of admission to the 18th day and returned to normal at the period of 19-21 days. The absolute peripheral lymphocyte count (P=0.048, effect size d=0.727) and T cell subset count (CD3: P=0.042, effect size d=0.655; CD4: P<0.01, effect size d=0.599; and CD8: P=0.034, effect size d=0.550) in the nonglucocorticoid group were higher than those in the glucocorticoid group, and the difference between the groups was statistically significant. Conclusions. This study found that the use of short-term, low-dose glucocorticoids does not negatively influence the clinical outcome, without affecting the final clearance of viral nucleic acid in mild COVID-19 patients.

Background. The relationship between macrocirculation and microcirculation remains controversial. The loss of coherence between microcirculation and macrocirculation has already been found in late-stage sepsis shock. The objective of this study was to determine the earliest possible time of detecting the loss of coherence between microcirculation and macrocirculation in early-stage endotoxemic shock. Methods. We randomized 24 female New Zealand white rabbits into two groups: endotoxemic shock group (n = 14) and control group (n = 10). Rabbits in the endotoxemic shock group were equipped with arterial and venous catheters and received an intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg over 10 min). Rabbits in the control group received the same dose of saline infusion. Microcirculatory perfusion parameters were assessed in the sublingual mucosa using sidestream dark-field video microscopy. Systemic hemodynamics and blood lactate levels were measured at baseline and over a 120-min period. Results. Ninety minutes after completing LPS infusion, all animals in the endotoxemic shock group developed a hypodynamic septic condition, characterized by low cardiac output and increased systemic vascular resistance; 120 min after completing LPS infusion, the mean arterial pressure decreased by 25% (P = 0.01), confirming ongoing endotoxemic shock. However, significant decreases in sublingual microcirculatory parameters of small vessels (microvascular flow index, perfused vessel density, and proportion of small perfused vessels) were observed 30 min after completing LPS infusion (P = 0.01, for all), and threshold decreases of 30% were found 60 min after completing LPS infusion (P = 0.001, for all) in the endotoxemic shock group. Lactate levels significantly increased to more than 2 mm/L at 90 min and more than 4 mm/L at 120 min in the endotoxemic shock group (P = 0.02 and P = 0.01, respectively). Conclusions. Changes in microcirculatory perfusion precede changes in macrocirculation and lactate levels in a rabbit model of endotoxemia shock. Microcirculation, macrocirculation, and oxygen metabolism are distinct in early-stage endotoxic shock.

One of the main mechanisms of keloid formation is the persistent chronic inflammation, which initiates the activation of keloid-derived fibroblasts (KFs) and boosts the production of extracellular matrix. Meanwhile, 95% of the ultraviolet rays that reach the earth are long-wave ultraviolet (UVA). However, the effect of UVA on keloids is currently unclear. The objective of our research is to investigate UVA’s impact on keloids. Cell viability assay, migration assay, and cell cycle analysis were conducted. UVA’s impacts on gene expressions were detected by real-time quantitative polymerase chain reaction, western blot analysis, enzyme-linked immunosorbent assay, and immunofluorescence. Our results indicated that UVA inhibited the proliferation and migration of KFs. In addition, after UVA irradiation, the expressions of matrix metallopeptidase 1 and matrix metallopeptidase 2 markedly increased in KFs. Moreover, the expression of α-smooth muscle actin and collagen I decreased. Furthermore, KFs with UVA irradiation secreted more interleukin-6 and interleukin-8 in the culture medium. And it was confirmed that the protein expressions of inflammation-related factors, including P38, CK2A, NFκB1, and P65, increased observably in KFs with UVA irradiation. The protein expression of IKBα, also known as NFκB inhibitor α, decreased. All these observations suggested that UVA irradiation could inhibit cellular activity and collagen production in KFs while promoting inflammation by activating P38-NFκB1 signal pathway.

Objective To investigate the application value of acoustic radiation force impulse imaging in preoperative prediction for efficacy of High-Intensity Focused Ultrasound uterine fibroids ablation Methods A prospective study was conducted on 32 women (41 fibroids) undergoing HIFU uterine fibroids ablation between January 2019 and September 2019. The virtual touch tissue quantification (VTQ) technique was used for the preoperative determination of uterine fibroids shear wave velocity (SWV). The stiffness of the preoperative uterine fibroids was graded on a virtual touch tissue image (VTI). All uterine fibroids were ablated with a single point ablation acoustic power of 400 W. All patients underwent pelvic cavity MRI examination for the measurement of the size, volume and non-perfused volume (NPV) of fibroids within the first month after HIFU ablation. The ablation rate of uterine fibroids was calculated according to the formula: ablation rate = NPV × 100/target fibroid volume. The patients were divided into two groups based on the postoperative ablation rate: ≥70% ablation rate group, and＜70% ablation rate group. The preoperative SWV and VTI grade of uterine fibroids were compared between the two groups. The correlation of preoperative uterine fibroids’ SWV and VTI grade with HIFU ablation rate were analyzed using the Spearman’s correlation coefficient. The optimal cutoff points in preoperative uterine fibroids SWV of 70% ablation rate were determined by receiver operating curve (ROC) analysis. Results A total of 30 patients (73.17%, 30/41) showed ablation rate ≥70%, with preoperative uterine fibroids’ SWV values of (3.42 ± 0.71) m/s. Of these, 24 patients (80%, 24/30) had VTI grades II–III. On the other hand, 26.83% (11/41) showed ablation rate

Background: Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation.Methods: A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort.Results: We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492–18.922)], time of onset [OR: 0.705 (0.582–0.829)], preoperative hemoglobin [OR:1.017 (1.001–1.033)], bloody stool: No [OR: 4.860 (1.270–23.588)], shock [OR: 5.790 (1.683–22.455)] and sepsis: No [OR 3.044 (1.124–8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830–0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826–0.974) and calibration (Hosmer-Lemeshow test, P = 0.4802) in external validation.Conclusions: The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.

In this paper, Schottky-drain reverse-blocking AlN/AlGaN HEMTs with drain field plate (FP) have been investigated by Silvaco-ATLAS tools. For HEMTs without FP, with the increase of Al mole fraction in AlGaN channel from 0 to 0.5, the reverse-blocking voltage increases from −158 V to −720 V. By using the drain field plate technique, a second electric field peak is introduced and the reverse-blocking voltage can be improved. Combined with the optimization of the SiN passivation thickness, optimal electric field management can be achieved to obtain the highest reverse-blocking voltage devices. Since HEMTs with different Al mole fractions possess different critical electric field values, the optimal SiN thickness are varied. With the increase of the Al mole fraction from 0 to 0.5, the reverse-blocking voltage increases from −510 V to −4500 V for HEMTs using drain FP and optimal SiN passivation thickness, and a high power figure-of-merit of 1.171 GW/cm2 is achieved. AlGaN channel HEMTs with Al mole fraction demonstrate great potential for power applications.

Information technology service management (ITSM) driven by artificial intelligence (AI), i.e., AITSM, is likely to change business models and enterprise operations substantially, setting off a wave of enterprise AI transformation. Empowerment from AI has brought new vitality and challenges to ITSM capabilities, and enterprises must start thinking about how the capability of AITSM can be reactivated to shape the resilience of business models and meet survival needs in complex and ever-changing environments. To systematically achieve the development of enterprise business model resilience under AITSM, this study combines the actual situation of ITSM and enterprise AI transformation practice and then deconstruct it into three sub-research questions along the primary line of driver identification–model construction–paradigm optimization. We retrieve high-quality literature in the field of information systems from common databases and discuss the topics of AITSM and business model resilience. This study finds that future research should focus on forming an accurate description of the resilience demand of business models in the current era, and thus, better explain the value cocreation process between AITSM and business units. In addition, future research should emphasize the dynamic and strategic nature of business model resilience to study the continuous optimization of business models with the help of AITSM.

C-reactive protein (CRP), a non-specific acute-phase indicator of inflammation, has been widely recognized for its value in clinical diagnostic applications. With the advancement of testing technologies, there have been many reports on fast, simple, and reliable methods for CRP testing. Among these, the aptamer-based biosensors are the focus and hotspot of research for achieving high-sensitivity analysis of CRP. This review summarizes the progress of in vitro aptamer screening for CRP and the recent advances in aptamer-based CRP sensor applications, thus developing insight for the new CRP aptasensor design strategy.

Background For treatment of advanced lung cancer, immune checkpoint inhibitors (ICIs) + chemotherapy or the combination of dual ICIs has become the standard first-line treatment in recent years. Considering the differences among patients’ immune systems, the response to ICIs may vary. Therefore, we aimed to evaluate the predictive implications of patient age and Eastern Cooperative Oncology Group (ECOG) performance status (PS) for the efficacy of ICIs for the treatment of lung cancer. Methods We searched the PubMed, Cochrane Library, Web of Science, and EMBASE databases for articles published between January 2010 and September 2020 that compared overall (OS) and progression-free survival (PFS) rates between patients with lung carcinoma who were administered ICIs and control treatments. Results Twenty-four trials including 15,584 patients were selected. ICIs significantly improved the OS rates in patients aged

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder significantly decreasing patients’ lives of quality and placing huge economic burden on our society. Existing studies indicated that the therapeutic effects maintained for a period of time after the treatments were discontinued. It is clinically important to assess these post-treatment therapeutic effects (PTTE), which prevent IBS from relapsing. To assess the PTTE in pinaverium treatment and obtain high-quality evidence to justify the use of PTTE for long-term IBS management, we performed this controlled, double blind study on patients with IBS who were randomized to pinaverium 50 mg (n = 132) or placebo (n = 132), three times daily, for 4 weeks, and were followed up for 57 weeks after the treatments. The primary endpoints were abdominal pain and stool consistency. The secondary endpoints were pain frequency and stool frequency. The tertiary endpoints were global overall symptom and adverse events. Three days after pinaverium was discontinued, endpoints rebounded only 23.2–42.8% (P P P’s > 0.05)], during which an average of 51.5–56.4% of patients (pool pinaverium and placebo data together) had IBS symptoms. These results provide clinical insights into efficient and cost-effective management of refractory IBS, and lend support to the IBS management that the selection of a therapy should consider both its effectiveness during treatment and its PTTE after the treatment.Trial registration number: NCT02330029 (16/08/2016).

Introduction: The rise in T1D, T2D, and obesity make it increasingly important to understand the role of BMI and lifestyle on glycemic control and IR. While it is known that weight and exercise affect these, the extent to which the effects of exercise are direct versus mediated by BMI has not been determined. Methods: We analyzed data from the 2013-2016 NHANES dataset in participants >18 yrs of age (n=1168). Those on glucose-lowering medications were classified as T2D and those on insulin only as T1D. Participant reports on physical activity intensity and duration were converted to metabolic equivalent of task (MET)-hours/week. HOMA-IR, a measure of IR, was calculated in participants with insulin measurements not receiving insulin (n=335). Linear regression models were fitted for mediation analyses to evaluate whether BMI mediated associations between MET and HbA1c or HOMA-IR. Results: In participants with T1D (n=173) and T2D (n=995), the mean ± SE age (56.8 ± 0.8 and 61.1 ± 0.3 yrs), BMI (32.8 ± 0.8 and 33.1 ± 0.3), and MET-hours/week (38.8 ± 4.5 and 38.3 ± 3.8) were reported, respectively. Further, 48.7% and 46.3% were females and 51.3% and 53.7% were males, respectively. The majority (62.9%) were Non-Hispanic White. HbA1c was significantly different between participants with T1D (8.1 ± 0.2) and T2D (7.4 ± 0.1), p=0.0008. After adjusting for age, race, and sex, the independent effect of MET-hours/week on HbA1c was nonsignificant in both cohorts (p=0.384 and p=0.167, respectively), suggesting BMI mediation analysis was not appropriate. The same was true with the effect of MET-hours/week on HOMA-IR (p=0.265). Conclusions: Our results show that there were no BMI mediated associations between MET and HbA1c or HOMA-IR. However, participants with high HbA1c could be actively engaging in more physical activity to improve glycemic control and there is potential for recall bias. A future prospective study with larger sample sizes may be needed. Disclosure P. Y. Soni: None. Q. Tang: None. H. M. Ismail: None.

To develop a noninvasive model to predict significant fibrosis in children with chronic hepatitis B (CHB). A total of 116 CHB pediatric patients who underwent liver biopsy were included in the study. Liver histology, which is the gold standard for assessing fibrosis, was performed. Blood routine examination, coagulation function, liver biochemistry, viral serology, and viral load were analyzed. Receiver operating characteristic curve analysis was used to analyze the sensitivity and specificity of all possible cut-off values. Based on the correlation and difference analyses, 7 available clinical parameters (total bile acid, gamma-glutamyl transpeptidase [GGT], aspartate transaminase, direct bilirubin to total bilirubin ratio, alanine aminotransferase, prealbumin [PA], and cholinesterase) were included in the modeling analysis. A model to predict significant liver fibrosis was derived using the 2 best parameters (PA and GGT). The original model was Y=−1.803 ln PA(mg/L)+0.769lnGGT(U/L)+6.436. After the mathematical calculation, the G index=600 × GGT/PA2 predicted significant fibrosis, with an area under the receiving operating characteristics (AUROC) curve of 0.733, 95% confidence interval (0.643–0.811). The AUROC of the G index (0.733) was higher than that of aminotransferase to platelet ratio index (APRI) (0.680) and Fibrosis index based on 4 factors (FIB-4) (0.601) in predicting significant fibrosis in children with CHB. If the values of the G index were outside the range of 0.28 to 1.16, 52% of children with CHB could avoid liver biopsy, with an overall accuracy of 75%. The G index can predict and exclude significant fibrosis in children with CHB, and it may reduce the need for liver biopsy in children with CHB.

Background and aims We conducted a comprehensive serum transcriptomic analysis to explore the roles of microRNAs (miRNAs) in alcohol-associated hepatitis (AH) pathogenesis and their prognostic significance. Approach and results Serum miRNA profiling was performed in 15 controls, 20 heavy drinkers without liver disease, and 65 patients with AH and compared to publicly available hepatic miRNA profiling in AH patients. Among the top 26 miRNAs, expression of miR-30b-5p, miR-20a-5p, miR-146a-5p, and miR-26b-5p were significantly reduced in both serum and liver of AH patients. Pathway analysis of the potential targets of these miRNAs uncovered the genes related to DNA synthesis and cell-cycle progression pathways, including ribonucleotide reductase regulatory subunit M2 (RRM2), cyclin D1 (CCND1), cyclin D2 (CCND2), MYC proto-oncogene (MYC), and phorbol-12-myristate-13-acetate-induced protein 1 (PMAIP1). We found a significant increase in the protein expression of RRM2, CCND1, and CCND2, but not MYC and PMAIP1, in AH patients who underwent liver transplantation; miR-26b-5p and miR-30b-5p inhibited the 3'-UTR (untranslated region) luciferase activity of RRM2 and CCND2, and miR-20a-5p reduced the 3'-UTR luciferase activity of CCND1 and CCND2. During a median follow-up of 346 days, 21% of AH patients died; these patients had higher body mass index (BMI), Model for End-Stage Liver Disease (MELD), and serum miR-30b-5p, miR-20a-5p, miR-146a-5p, and miR-26b-5p than those who survived. Cox regression analysis showed that BMI, MELD score, miR-20a-5p, miR-146a-5p, and miR-26b-5p predicted mortality. Conclusions Patients with AH attempt to deal with hepatocyte injury by down-regulating specific miRNAs and up-regulating genes responsible for DNA synthesis and cell-cycle progression. Higher expression of these miRNAs, suggestive of a diminished capacity in liver regeneration, predicts short-term mortality in AH patients.

Compound sophorae decoction (CSD), a traditional Chinese medicine (TCM) formula, has been voluminously used in China to deal with ulcerative colitis and gained significant therapeutic effect. Tremendous explorations have unraveled a contributory role of inflammatory bowel disease (IBD) like ulcerative colitis (UC) and Crohn’s disease (CD) at the onset of colorectal cancer, scilicet, and colitis-related cancer (CRC). In light of the anti-inflammatory properties of CSD in UC, we appraised its chemoprevention capacity and underlying mechanism in ulcerative colitis-related colorectal cancer (UCRCC), employing a model of azoxymethane (AOM) plus dextran sulfate sodium- (DSS-) induced colorectal cancer (CRC) in C57BL/6 mice. Rapturously, our results illuminated the ameliorative effect of CSD against UCRCC in mice portrayed by lesser polyps or adenomas, attenuated colonic xenograft tumor growth in company with the preferable well-being of mice in contrast to the Model Group. We examined significant downregulation of proinflammatory cytokines such as TNF-α, NF-κB, IL-6, STAT3, and IL-17 after exposure to CSD, with the concomitant repression of inflammation-associated proteins, including COX-2 and iNOS. Independent of this, treatment with CSD declined the proportion of T helper 17 cells (Th17) and protein level of matrix metallopeptidase 9 (MMP-9). Moreover, transmission electron microscopy (TEM) detected observably suppressed mitophagy in mice administered with CSD and that was paralleled by the pro-apoptotic effect as indicated by upregulating caspase-3 together with caspase-9 and deregulating B-cell lymphoma 2 (Bcl-2). In closing, these findings suggest CSD executes the UCRCC-inhibitory activity through counteracting inflammatory responses and rescuing detuning of apoptosis as well as neutralizing overactive mitophagy, concurring to build up an oncosuppressive microenvironment.

Purpose The purpose of this paper is to explore the key factors that affect consumer redemption intention toward mobile coupons recommended in social network sites (SNS). Design/methodology/approach A research model that integrates recommendation trust, positive utilities, and negative utilities of coupon redemption is developed. With the important role of trust in social recommendation taken into consideration, the key drivers of recommendation trust were analyzed in the model. Data were collected from 210 users with mobile coupon recommendation experience in one of the largest SNS (i.e. WeChat) in China. The authors used partial least squares technique to analyze the model. Findings Recommendation trust and positive utilities (economic benefits and perceived enjoyment) positively affect the intention of mobile coupon redemption. Perceived risk, as a negative utility, negatively influences coupon redemption intention. In addition, swift trust (structure assurance, perceived similarity, trust propensity, and expertise of the recommender), knowledge-based trust (familiarity with the retailers), and emotion-based trust (social tie strength) are key drivers that promote recommendation trust. Originality/value While prior research investigated mobile coupon redemption behavior in which coupons were issued by merchants, limited research analyzed consumer responses toward mobile coupons in social recommendation. This study examines the effects of recommendation trust, positive utilities, and negative utilities on mobile coupon redemption in the context of social recommendation and recognizes the key drivers of recommendation trust.

The rapid development of Culture and creative industries has been promoted by “Internet+”. However, the lack of talent of Culture and creativity has become a bottleneck restricting the development of industries. The development of industry can be aided by the quantitative evaluation system of the design ability of the designer, based on its monitoring, feedback and incentive functions. Based on the study of the existing competence evaluation index system, an evaluation index system for the design competence of creative designers of Culture was constructed by comprehensively investigating the three factors viz. design, ethics and sports. Subsequently, the subjective and objective combination weighting method was used to determine the weighted index of the design competence. Moreover, the fuzzy Topsis method was used to obtain the evaluation model, while the operability and scientificity of the evaluation index system and the evaluation method were verified by an example.

Sleep deprivation (SD) is widespread in society causing serious damage to cognitive function. Hydrogen sulfide (H2S), the third gas signal molecule, plays important regulatory role in learning and memory functions. Inhibition of excessive autophagy and upregulation of silent information regulator 1 (Sirt-1) have been reported to prevent cognitive dysfunction. Therefore, this present work was to address whether H2S attenuates the cognitive impairment induced by SD in Wistar rats and whether the underlying mechanisms involve in inhibition of excessive autophagy and upregulation of Sirt-1. After treatment with SD for 72 h, the cognitive function of Wistar rats was evaluated by Y-maze, new object recognition, object location, and Morris water maze tests. The results shown that SD-caused cognitive impairment was reversed by treatment with NaHS (a donor of H2S). NaHS also prevented SD-induced hippocampal excessive autophagy, as evidenced by the decrease in autophagosomes, the down-regulation of Beclin1, and the up-regulation of p62 in the hippocampus of SD-exposed Wistar rats. Furthermore, Sirtinol, an inhibitor of Sirt-1, reversed the inhibitory roles of NaHS in SD-induced cognitive impairment and excessive hippocampal autophagy in Wistar rats. Taken together, our results suggested that H2S improves the cognitive function of SD-exposed rats by inhibiting excessive hippocampal autophagy in a hippocampal Sirt-1-dependent way.

INTRODUCTION The use of Acuseal arteriovenous graft (AAVG) is spreading in end-stage renal disease (ESRD) patients for its advantages in early cannulation. However, comparison of clinical outcomes between AAVGs and standard arteriovenous grafts (SAVGs) is limited. In this study, we compared the performance of AAVGs and SAVGs. METHODS Consecutive ESRD patients underwent prosthetic vascular access between October 2017 and May 2019 at a single center were identified. Patients were divided into AAVG group and SAVG group. Patients' demographics, perioperative characteristics, and clinical outcomes were collected. Primary, primary assisted, and secondary patency rates were compared using Kaplan-Meier analyses. Postsurgery complications were compared using chi-square test or the Fisher's exact test. FINDINGS A total of 304 arteriovenous grafts (AVGs) were implanted in 145 males and 159 females (mean age, 60.1 years; range, 20-91 years), comprising 143 AAVGs and 161 SAVGs. Median time to first cannulation was 3 days (interquartile range [IQR], 1-15 days) in the AAVG group and 30 days (IQR, 20-52 days) in the SAVG group (P

Research Objectives To test the hypothesis that carbamazepine (CBZ) reduces irritability/aggression among individuals > 6 months post-traumatic brain injury (TBI). Design Parallel-group, randomized, double-blind, placebo-controlled, forced-titration trial of CBZ versus placebo. Setting Outpatient. Participants 70 individuals with chronic TBI and irritability (CBZ n=35 versus placebo n=35). Interventions CBZ (titrated up to 400 mg twice daily) or placebo equivalent two times daily. Main Outcome Measures A composite measure of Neuropsychiatric Inventory Irritability and Aggression Domains (NPI-I/A). Global impression of change recorded from participant, observer, and study clinician. Results The CBZ group did not differ significantly from the placebo group (p=0.60 and 0.59 for NPI-I/A observer and participant ratings respectively). High placebo effects were observed with Minimal Clinically Important Difference in observer NPI-I/A 57% in CBZ group and 77% in placebo group (p=0.09). Findings were similar for participant ratings. 18 of 35 had therapeutic CBZ level > 4. Therapeutic sample analysis revealed similar high placebo response and non-significant differences except clinician ratings favoring CBZ. Non-serious adverse events occurred more frequently in the CBZ group with greater nervous system effects. Conclusions up to 400 mg two times daily was not superior to placebo at reducing irritability/aggression according observers and participants. Large placebo effects may have masked the detection of differences. Clinician rating metrics suggest benefit, and thus, CBZ should remain a treatment option for the experienced brain injury clinician; data are provided that may aid treatment decisions. Author(s) Disclosures Dr. Hammond serves on the Avanir Scientific Advisory Committee.

BACKGROUND: POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance. OBJECTIVES: To describe POLST preference concordance and identify factors associated with concordance. DESIGN: Chart reviews to document current POLST orders and interviews to elicit current treatment preferences. SETTING: POLST-using nursing facilities (n = 29) in Indiana. PARTICIPANTS: Nursing facility residents (n = 123) and surrogates of residents without decisional capacity (n = 152). MEASUREMENTS: Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition. RESULTS: Overall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n = 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p < .001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01 – 1.07, p < .01), better cognitive functioning (OR 1.07, 95% CI 1.02 – 1.13, p < .01), surrogate as the decision-maker (OR 2.87, OR 1.73 – 4.75, p < .001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29 – 11.00, p < .01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59 – 10.73, p < .01). CONCLUSIONS: Less than half of all POLST forms were concordant with current preferences, but POLST was over 5 times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.

Motion recognition is widely used in somatosensory games, rehabilitation training and robot motion learning. Tennis training can identify and classify the captured actions, and improve the performance of computer-aided tennis teaching timely and accurately. Traditional image based or video based human posture capture recognition are easily affected by complex background environments, different lighting conditions and other factors in practical applications. In this paper, Microsoft Kinect is used as the sensor device to capture the data information of the tennis player. Firstly, Kinect's depth sensing technology is used to obtain human skeleton data. Secondly, in order to improve the efficiency of classification, this paper reduces the dimension of data by extracting the feature value of human skeletons. Thirdly, a kind of KNN algorithm which defines the dimension weight is proposed to implement the movement classification, compared with the 94% accuracy of the algorithm, the accuracy of the KNN algorithm is 92.4%, the accuracy of the decision tree algorithm is 92.81%, and the accuracy of the CNN algorithm The accuracy is 89.97%. The evaluation method of tennis action is defined to provide guidance for users. By comparing the difference between the user’s postures and the standard postures in the joint positions and angles which is prone to get error, this method can correct the user's postures and build up the function of movements guidance. From the teaching effect of tennis aficionados and general tennis players, this method is more practical and targeted than the traditional tennis graphics and video teaching.

“Qi” (pronounced chee) is the most basic and important concept in traditional Chinese medicine (TCM), and it is considered the driving force for all life-sustaining activities...

Background: Adverse maternal and infant health outcomes are influenced by a broad array of psychosocial determinants and behavioral risk factors. We evaluated the correlations between risk factors including mental illness and substance misuse among women from high-risk ZIP Codes in Indianapolis enrolled in a community-based perinatal care program. Methods: We performed a prospective cohort study of 918 women enrolled in the WeCare community perinatal care program. Data was collected during visits by community health workers (CHWs). CHWs met with the patients at home or over the phone and provided individually tailored care related to mental health, substance use, and nutrition amongst other topics. Results: Women with anxiety or depression were nearly twice as likely to experience complications during birth (depression: 22.4% vs. 11.5%, p = 0.022; anxiety: 21.9% vs. 11.2%, p = 0.007). Women with depression were also nearly twice as likely to report substance misuse (18.4% vs. 9.6%, p = 0.046) and women with anxiety were more than twice as likely to report substance misuse (21.9% vs. 9.0%, p = 0.0004) as well as smoking during pregnancy (21.9% vs. 9.7%, p = 0.0012). Women who reported stable or improved anxiety symptoms were less likely to report substance misuse (8.6% vs. 19.0%, p = 0.004) and women who reported stable or improved depression symptoms were less likely to report substance misuse (8.4% vs. 24.1%, p = 0.0002). There was a strong correlation between anxiety and depression. Over 70% (71.4%) of women with depression also presented with anxiety, and over 90% (92.2%) of women who reported stable or improved depression symptoms also reported stable or improved anxiety symptoms. Conclusions: Many of the risk factors associated with adverse maternal and infant health outcomes exist in interwoven relationships. The inclusion of CHWs into a healthcare team could assist in addressing these factors together in a holistic manner.

The bioelectromagnetics community has repeatedly demonstrated that Electromagnetic (EM) force fields affect...

Objective To explore correlations between the therapeutic effect of high intensity focused ultrasound (HIFU) and histopathological characteristics of uterine fibroids with different Shear Wave Velocity (SWV) values. Methods A retrospective study was conducted on 36 women (43 fibroids) who had undergone high intensity focused ultrasound (HIFU) uterine fibroids ablation between January 2019 and January 2020. Preoperative fibroids tissue sections were obtained for histopathological examination. The pathological sections were stained with Masson-trichrome, and were observed and imaged under a Low-power microscope (4 × 10), while the smooth muscle cell (SMC) and collagen fiber content were semi-quantitatively measured. Preoperative fibroid SWV was measured using the Virtual Touch tissue quantification (VTQ) technique. Within one month after HIFU ablation, all patients had undergone a pelvic cavity MRI examination, which measured the size, volume, and non-perfused volume (NPV) of the fibroids. The formula: the ablation rate = NPV/target fibroid volume × 100% was used to calculate the ablation rate of the uterine fibroids. Correlation analysis of SWV values, HIFU ablation rate, along with the smooth muscle cell (SMC) and collagen fiber content, were conducted using the Spearman’s correlation test. Results The collagen fiber and SMC content of the preoperative fibroids were 32.09 ± 15.90%/view and 37.61 ± 15.32%/view, respectively. Preoperative fibroid SWV value was 3.56 ± 0.71 m/s. Preoperative fibroid SWV was negatively correlated with SMC content (r = −0.445, p = 0.003), but positively correlated with collagen fiber content (r = 0.454, p = 0.002). The ablation rate was negatively correlated with collagen fiber content (r = −0.377, p = 0.013), but positively correlated with SMC content (r = 0.402, p = 0.007). Conclusion Differences in histopathological characteristics may be important factors that induce differences in the therapeutic effects of HIFU ablation on uterine fibroids with different SWV values.

MicroRNA-24 (miR-24) has been widely studied in a variety of human cancers, which plays different roles in specific type of cancers. In the present review, we summarized the recent surveys regarding the role of miR-24 in different human cancers. On the one hand, miR-24 was reported to be down-regulated in some types of cancer, indicating its role as a tumor suppressor. On the other hand, it has shown that miR-24 was up-regulated in some other types of cancer, even in the same type of cancer, suggesting the role of miR-24 being as an oncogene. Firstly, miR-24 was dysregualted in human cancers, which is related to the clinical performance of cancer patients. Thus miR-24 could be used as a potential non-invasive diagnostic marker in human cancers. Secondly, miR-24 was associated with the tumor initiation and progression, being as a promoter or inhibitor. Therefore, miR-24 might be an effective prognostic biomarker in different type of cancers. Lastly, the abnormal expression of miR-24 was involved in the chemo- and radio- therapies of cancer patients, indicating the role of miR-24 being as a predictive biomarker to cancer treatment. Totally, miR-24 contributes to tumorigenesis, tumor progression, and tumor therapy, which closely related to clinic. The present review shows that miR-24 plays a double role in human cancers and provides plenty of evidences to apply miR-24 as a potential novel therapeutic target in treating human cancers.

The management of enterocutaneous fistulas (ECF) can be challenging because of massive fluid loss, which can lead to electrolyte imbalance, severe dehydration, malnutrition and sepsis. Nutritional support plays a key role in the management and successful closure of ECF. The principle of nutritional support for patients with ECF should be giving enteral nutrition (EN) priority, supplemented by parenteral nutrition if necessary. Although total parenteral nutrition (TPN) may be indicated, use of enteral feeding should be advocated as early as possible if patients are tolerant to it, which can protect gut mucosal barrier and prevent bacterial translocation. A variety of methods of enteral nutrition have been developed such as fistuloclysis and relay perfusion. ECF can also be occluded by special devices and then EN can be implemented, including fibrin glue application, Over-The-Scope Clip placement and three-dimensional (3D)-printed patient-personalized fistula stent implantation. However, those above should not be conducted in acute fistulas, because tissues are edematous and perforation could easily occur.

The purpose of this paper is to realize system analysis and algorithm design for biological data. In this paper, primary bladder cancer is taken as a typical example, the structure of the system is extracted by hierarchical clustering method, and the function of the system is mined by convolutional neural network technology. Based on these methods, a complex system structure analysis model and an algorithm are constructed to study the big data system. Furthermore, the feasibility study of relevant theories and methods are carried out while the application and expand of technology are mentioned, combined with the actual data. The effectiveness and practicability of the algorithm and system are also verified by simulation.

INTRODUCTION & AIM: Much is known about alcoholic hepatitis (AH) that is severe enough to require hospitalization. The characteristics of individuals with alcoholic hepatitis presenting with mild to moderate severity are not well understood. In this study we investigated the risk factors, characteristics, and outcomes of mild to moderate AH. METHODS: Two hundred and fifty five Individuals with AH enrolled into a multicenter, prospective, observational study between 12/2014 and 4/2018 were included. Participants were seen at enrollment, 6 months, and 12 months. Mild to moderate AH (M-AH) was defined as MELD [Formula: see text] 20 at presentation whereas severe AH as MELD ≥ 21. RESULTS: One hundred individuals had M-AH whereas 155 had severe AH. Individuals with M-AH were older (49 vs 44 years, p=0.01), had lower BMI (27 vs 31 kg/m2, p=0.0007) and more likely to be male (68% vs 55%, p=0.046) compared to severe AH group. A higher proportion in M-AH group consumed coffee in the last 5 years compared to the severe AH (29% vs 18%, p=0.03), and fewer had PNPLA3 risk allele G (p=0.019) compared to the severe AH group. Average drinks per drinking day (12.9 vs 10.7, p=0.13) and total number of drinks in last 30 day period (331 vs 280, p=0.14) were not different between two groups. Compared to severe AH, patients with M-AH had significantly lower mortality at 30 days (2% vs. 13.6%), 90 days (3% vs. 22.6%), and 12 months (10.4% vs. 31.4%) (p

The present review aims at reviewing the role of metformin in the treatment of endometrial cancer (EC). According to the literature, excessive estrogen levels and insulin resistance are established risk factors of EC. As a traditional insulin sensitizer and newly discovered anticancer agent, metformin directly and indirectly inhibits the development of EC. The direct mechanisms of metformin include inhibition of the LKB1-AMP-activated protein kinase-mTOR, PI3K-Akt and insulin-like growth factor 1-related signaling pathways, which reduces the proliferation and promotes the apoptosis of EC cells. In the indirect mechanism, metformin increases the insulin sensitivity of body tissues and decreases circulating insulin levels. Decreased levels of insulin increase the blood levels of sex hormone binding globulin, which leads to reductions in circulating estrogen and androgens. The aforementioned findings suggest that metformin serves an important role in the treatment of EC. Increased understanding of the mechanism of metformin in EC may provide novel insights into the treatment of this malignancy.

Eucalyptol (1,8-cineole), the major constituent of eucalyptus oil (EO), was used in traditional medicine as a remedy for colds and bronchitis. This study aimed at clarifying the effect of eucalyptol on respiratory immune function of CD8 and CD4 cells, and alveolar macrophages (AM). Thirty male Sprague-Dawley rats were divided into experimental and control groups. The drug was given once a day for 3 weeks and the experimental group was divided according to the eucalyptol dose into: 30, 100, and 300 mg·kg-1 groups. Flow cytometry was used to detect the phagocytic function of CD4, CD8 cells, and AM in the bronchopulmonary lavage fluid. The 30 and 100 mg·kg-1 groups had an up-regulation effect on CD8 (p < 0.05), with no significant effect on macrophage phagocytosis. The 300 mg·kg-1 group had an inhibitory effect on CD8 and macrophage phagocytosis (p < 0.05), with no significant difference in CD4 between groups. Further investigation was conducted to evaluate the effect of EO on immune function in rats by detecting blood T, B, and NK cells using flow cytometry, and blood IgA, IgG, IgM, and IFN-γ levels by ELISA. High dosage of eucalyptol significantly reduced the proportion of blood B and NK cells (p < 0.05). IgA was decreased in the 100 and 300 mg·kg-1 groups (p < 0.05). There are no significant differences between the number of T cells and the IgG, IgM, and IFN-γ levels between experimental and control groups. Rational use of EO containing eucalyptol can improve the immune function of the respiratory tract and the body immunity, while high dose could have damaging effects, through modifying the phagocytic function of CD8 cells and reducing the proportion of blood B cells, NK cells, and IgA.

To analyse the differential indicators of COVID-19 in severe and mild cases and to study the factors affecting the immune function of patients and the time required for oropharyngeal swabs to become negative. Age, albumin (ALB) levels, prealbumin (PAB) levels, high-sensitivity C-reactive protein (hs-CRP) levels, platelet counts, lymphocyte counts, neutrophil counts, CD3+, CD4+, CD8+ T cell counts and the time for oropharyngeal swabs to become negative were collected from 37 patients with COVID-19; the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as indicators of inflammation. An independent-sample t test was used to analyse differences between the severe and mild groups, and factors affecting the CD3+, CD4+ and CD8+ T cell counts and the time for the nucleic acid tests of oropharyngeal to convert to negative were identified by single-factor and multifactor analyses. Lymphocyte, ALB, PAB, CD3+, CD4+ and CD8+ T cell levels in the severe group were lower than those in the mild group, the P values were 0.048, 0.004, 0.033, 0.033, 0.015 and 0.013, respectively. The neutrophil count and PLR were higher in the severe group compared with that in the patients of mild group; the P values were all 0.000. Single-factor analysis showed that age, ALB level, PAB level, hs-CRP level, platelet count, the NLR, the PLR and the time to a negative nucleic acid test were the main factors influencing CD3+ T cells; the P values were 0.001, 0.031, 0.001, 0.010, 0.005, 0.002, 0.000 and 0.048, respectively. Age, ALB level, PAB level, hs-CRP level, platelet count, the NLR, the PLR and time to a negative nucleic acid test were the main factors influencing CD8+ T cells; the P values were 0.000, 0.012, 0.000, 0.005, 0.002, 0.004, 0.005 and 0.003, respectively. Age, PAB level, hs-CRP level, platelet count, the NLR and the PLR were the main factors influencing CD4+ T cells; the P values were 0.001, 0.006, 0.030, 0.041, 0.005 and 0.001, respectively. Age, ALB level, PAB level, hs-CRP level, platelet count, the NLR, CD3+ T cell count and CD8+ T cell count were the main factors influencing the time to a negative nucleic acid test in oropharyngeal swabs, and the P values were 0.032, 0.043, 0.013, 0.016, 0.042, 0.049, 0.048 and 0.003, respectively. Multivariate analysis showed that the PLR and platelet count were the main factors influencing CD3+ T cells. The P values were all 0.000. The PLR and platelet count were the main factors influencing CD4+ T cells. The P values were 0.000 and 0.001, respectively. The PLR and platelet count were also the main factors influencing CD8+ T cells. The P values were 0.004 and 0.001. CD8+ T cells affected the time to a negative nucleic acid test in oropharyngeal swab samples, and the P value was 0.002. There were differences in the PLR, PAB level, ALB level and T cells between the severe and mild groups. The platelet count and PLR were the main factors influencing the immune function of patients with COVID-19, and CD8+ T cells influenced the negative conversion time of the nucleic acid test in oropharyngeal swabs.