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To evaluate binocular visual function after unilateral and bilateral implantation of segmented refractive multifocal intraocular lenses (MIOLs). This prospective comparative pilot study included patients who underwent SBL-3 (Lenstec; + 3.00 D) implantation at Peking University Third Hospital. Patients were divided into two groups (monocular or binocular surgery). Thirty-two patients with emmetropic presbyopic contralateral eyes and 49 patients with bilateral SBL-3 implantation within a week between eyes were included in the unilateral SBL-3 and bilateral groups, respectively. At 3-month follow-up, the main outcomes were binocular uncorrected distant, intermediate, and near visual acuity (UDVA, UIVA, and UNVA). Secondary outcomes included binocular best-corrected visual acuity at all distances, defocus curve, contrast sensitivity, photic phenomena, spectacle independence, patient satisfaction, and National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) score. The essential perceptual phenomena constituting binocular vision, simultaneous perception, fusion, and stereopsis were also evaluated. Both groups showed similar binocular UDVA and UIVA, but UNVA was significantly better in the bilateral group (0.07 ± 0.07 versus 0.12 ± 0.07, P = 0.008). Better binocular defocus curve at intermediate to near focal points, higher percentage of spectacle independence at near distance, and NEI-VFQ-25 near activity scores were observed in the bilateral group. No significant differences in contrast sensitivity, photic phenomena, overall satisfaction, other NEI-VFQ-25 subscales, fusional amplitude, and stereoacuity were found between groups. Unilateral implantation of segmented refractive MIOL provided desirable distant visual acuity and high patient satisfaction, but inferior intermediate and near visual outcomes compared with bilateral implantation.

AIM: To explore the expression of cGAS/STING signaling components in Mooren’s ulcer (MU). METHODS: Samples were obtained from ten MU patients, and eight residual corneal-scleral rings of healthy donor corneas for controls. Human corneal epithelial cells (HCECs) were used to evaluate the effect of cGAS/STING signaling pathway. Immunohistochemistry (IHC) and Western blot were used to examine the expression of cGAS, STING, and phosphorylated interferon regulatory factor 3 (p-IRF3) in MU tissues. The expression of interferon-β (IFN-β) and interferon-stimulated genes (ISGs) was quantified by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS: The protein levels of cGAS and STING in MU samples were significantly elevated when compared with the healthy controls by Western blot and IHC. After stimulation with cGAMP, real-time PCR and ELISA showed a dramatic increase of IFN-β and ISGs (containing CXCL10, IFIT1, and IL-6) in HCECs. Moreover, HCECs treated with cGAMP was characterized by increased phosphorylation and more nuclear translocation of IRF3. Meanwhile, increased p-IRF3 was observed in MU samples via IHC and Western blot. CONCLUSION: The pronounced expression of cGAS/STING signaling components in the patients with MU and probably contribute to the onset and development of MU.

RT-PCR is the primary method to diagnose COVID-19 and is also used to monitor the disease course. This approach, however, suffers from false negatives due to RNA instability and poses a high risk to medical practitioners. Here, we investigated the potential of using serum proteomics to predict viral nucleic acid positivity during COVID-19. We analyzed the proteome of 275 inactivated serum samples from 54 out of 144 COVID-19 patients and shortlisted 42 regulated proteins in the severe group and 12 in the non-severe group. Using these regulated proteins and several key clinical indexes, including days after symptoms onset, platelet counts, and magnesium, we developed two machine learning models to predict nucleic acid positivity, with an AUC of 0.94 in severe cases and 0.89 in non-severe cases, respectively. Our data suggest the potential of using a serum protein-based machine learning model to monitor COVID-19 progression, thus complementing swab RT-PCR tests. More efforts are required to promote this approach into clinical practice since mass spectrometry-based protein measurement is not currently widely accessible in clinic.

The aim of the study was to develop a model of coronary microembolization (CME) in rats at a lower cost. We developed a novel rat model without thoracotomy and ventilation under the guidance of echocardiography. Rats were sacrificed at 3 h, 24 h and 1 month postoperatively in both the Echo-CME and Open-chest CME groups for the comparison of the modeling accuracy, mortality, cardiopulmonary circulation, pleural adhesion and ventilation-induced lung injury (VILI). Results showed that the coronary microthrombus formed at 3 h and reached its peak at 24 h postoperatively, which included platelet aggregation and fibrin web. The Echo-group increases success rates, decreased mortality, postoperative complications including pleural adhesion, cardiopulmonary dysfunction and VILI postoperatively than the Open-chest group at 1month postoperatively. The ejection fraction of the CME group decreased to 50% and obvious cardiac fibrosis formed at 3 months postoperatively. Our unique surgical method provided a platform to study molecular mechanisms and potential new pathways for CME treatment.

The Alpha Magnetic Spectrometer (AMS-02) will continuously collect data for the lifetime of the International Space Station (ISS). On-orbit equalization must be performed to ensure the accuracy of the AMS energy measurement (~ 1%) by the electromagnetic calorimeter (ECAL). The equalization is performed using the most probable value (MPV) of the cosmic-ray proton minimum ionizing particle (MIP). Kalman filter technique is used to improve the precision. The precision of the equalization with proton MIP is (7.206 ± 0.003) % and improved to (2.388 ± 0.002) % after the Kalman filter. From the toy Monte Carlo (MC) simulation, the error of the energy reconstruction is about 1.4% and 0.5% due to the 7.2% and 2.4% equalization accuracy, respectively. About 1.4% error due to ~ 7% equalization precision does not match the AMS requirement. With the improvement from the Kalman filter, the energy reconstruction error from the equalization is reduced to 0.5%, which can fulfill the AMS requirement.

Background Standard chemotherapy with taxanes, such as paclitaxel (PTX), remains the mainstay of systemic treatment of triple-negative breast cancer. Nanotechnology-based formulations have gradually replaced PTX injection and are widely used in China. However, no studies have compared the colloidal stability, antitumor efficacy, and safety of commercial PTX nanoformulations. Additionally, the desire to evaluate preclinical antitumor efficacy in human-derived tumor cells led to the widespread application of immunodeficient mouse models that likely contributed to the neglect of nanomedicines-immune system interactions. The present study investigated the colloidal stability, antitumor efficacy and safety, and nanomedicines-host immune system interactions of PTX nanoformulations. A further comparative analysis was performed to evaluate the clinical potential. Results Compared with liposome, PTX emulsion and PTX nanoparticle exhibited favorable colloidal stability. PTX emulsion was superior in inducing apoptosis and had a more pronounced inhibitory effect on 4T1-tumor spheroids compared with PTX liposome and PTX nanoparticle. Although PTX emulsion exhibited superior in vitro antitumor effect, no significant differences in the in vivo antitumor efficacy were found among the three types of PTX nanoformulations in an immunocompetent orthotopic 4T1 murine triple-negative breast cancer model. All PTX nanoformulations at maximum tolerated dose (MTD) induced lymphopenia and immunosuppression, as evidenced by the reduction of T cell subpopulations and inhibition of the dendritic cells maturation. Conclusions The MTD PTX nanomedicines-induced lymphopenia and immunosuppression may weaken the lymphocyte-mediated antitumor cellular immune response and partly account for the lack of differences in the in vivo antitumor outcomes of PTX nanoformulations. Understanding of what impacts PTX nanomedicines has on the immune system may be critical to improve the design and conduct of translational research of PTX nanomedicines in monotherapy or combination therapy with immunotherapy. Graphic abstract

Deep neural network (DNN) has been recently used in the field of fault diagnosis, but still their applicability is restricted to high computational complexity. In addition, useless information transformation between adjacent layers of the network could have a negative influence on the diagnosis accuracy. In this paper, a new DNN structure with sparse gate is designed to highlight the role of neurons contributed more by making it directly transfer through layers rather than transfer via an activation function. So it can reduce the computational complexity of network training since only those contributed less are required to be transferred via a nonlinear transformation. The proposed sparse denoising DNN (SD-DNN)-based fault diagnosis method can achieve more accurate diagnosis result with less computational complexity. It shows significant superiority to other-related methods in the case when only small size of training samples polluted by strong noise is available, which is very common for the engineering field of fault diagnosis. The experimental testing of fault diagnosis for rolling bearings verifies the effectiveness of the proposed method.

Breast mass is one of the clinical signs of breast lesions. Clinically, breast tumors can occur in breast cancer, breast tuberculosis, breast duct dilatation, breast cysts, breast fibroadenoma, and breast hyperplasia. Its pathogenesis is not clear. The occurrence of breast lesions is related to many factors, such as diet, trauma, genetic mutations, inheritance, endocrine disorders, breast development, and chronic stimuli. With the continuous improvement of examination equipment and continuous improvement of the treatment level, the incidence of breast masses is increasing. For a long time, clinicians have mostly used hand palpation methods to complete the diagnosis of breast masses based on the relatively hard properties of breast masses and adjacent tissues. It is more difficult to diagnose patients based on their clinical symptoms and signs, and it is easy to miss the diagnosis. Choosing the appropriate diagnostic method to confirm breast mass disease has become the first task for the diagnosis and treatment of breast mass. Ultrasound elastography is a new ultrasound examination method. It diagnoses the elasticity and hardness of breast masses by using corresponding characteristics. The imaging principle is to apply pressure to the tissue at the lesion site to determine its elasticity and hardness to identify the nature of the tumor. This article explores the clinical value of ultrasound elastography in the effective diagnosis of breast masses. Compared with the diagnosis results of ordinary ultrasound, the parameters such as the position, shape, size, boundary, internal echo, and rear echo of the focused mass were observed. Facts have proved that elastography can be used to make a qualitative differential diagnosis of benign and malignant breast masses from another angle according to the different characteristics of the hardness of the tissue being examined. It is non-invasive, non-radiative, low-cost, and easy for patients to accept. Provide valuable clinical diagnosis basis for early detection and treatment of breast masses.

This study is intended to develop long period fibre grating sensors for potential applications in environmental and durability monitoring of coastal structures. High-quality helical long period fibre gratings (HLPFGs) are inscribed in different types of small-core single mode fibre (SMF) by use of hydrogen-oxygen flame heating technique. A detailed investigation of the effect of core diameter on their transmission spectrum and optimum length of the HLPFG has been pursued. A longer length is required to achieve the same coupling attenuation in a smaller-core SMF than that of a larger-core fibre. The strain, torsion and refractive index (RI) properties of the HLPFG is investigated experimentally to develop a high-sensitivity sensor. The experimental results show that the strain sensitivity could be enhanced by means of employing a larger-core diameter SMF. Moreover, the HLFPGs are also sensitive to the torsion and external RI. Hence, such HLFPGs have great potential for sensing applications.

We studied the characteristics of contrast-enhanced ultrasound (CEUS) in renal pelvic urothelial carcinomas and explored its performance in assessing microvessel density (MVD) of tumor tissues. We retrospectively analyzed the characteristics of 125 cases, which were confirmed pathologically to be renal pelvic urothelial carcinomas using CEUS. We performed CEUS and found that most tumors presented with an enhanced mode of "slow-in (mean = 16.7 ± 2.6 s, range: 12-25 s), hypo-enhancement and fast-out (mean = 69.3 ± 16.2 s, range: 42-113 s)." However, the wash-in pattern, homogeneity and wash-out pattern observed with CEUS was not correlated with pT stage and grade (p0.05). But advanced-pT-stage and high-grade tumors had a higher peak enhancement than early-pT-stage and low-grade tumors (p0.01). Peak enhancement obtained with CEUS can be used to evaluate the pT stage and grade of renal pelvic urothelial carcinomas more effectively. The MVD of those tissues was observed using immunohistochemical staining of cluster of differentiation 34 (CD34). MVD in the advanced-pT-stage and high-grade groups was significantly higher than that in the early-pT-stage and low-grade groups (p0.01). As tumor pT stage and grade improved, CEUS peak enhancement intensity and MVD of tumors also exhibited an upward trend. CEUS peak enhancement intensity has the potential to determine MVD of renal pelvic urothelial carcinomas.

BACKGROUND Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease, which is characterized by daily fever and arthritis, with an evanescent rash and neutrophilic leukocytosis. To date, there has been no definite laboratory or imaging test available for diagnosing AOSD; the diagnosis is one of exclusion, which can be very challenging. In particular, AOSD patients may experience different complications affecting their clinical picture, management, and prognosis. The treatment of AOSD remains largely empirical and involves therapeutic agents. CASE SUMMARY We report the case of a 36-year-old woman who presented with fever, red rash, arthralgia, and sore throat. Her serum ferritin level and white blood cell count were markedly elevated, and the first diagnosis 22 years prior was "juvenile rheumatoid arthritis of systemic type". The patient was treated with prednisone, sulfasalazine, methotrexate, and leflunomide. After remission of her symptoms, the patient stopped taking the medications, and the disease recurred. Ultimately, the patient was diagnosed with adult-onset Still's disease. Relapse occurred several times due to self-medication withdrawal, and an interleukin-6 antagonist (tocilizumab/Actemra) was administered to control the disease. Recently, she was hospitalized because an incision did not heal, and the patient suddenly developed high fever and diarrhea during hospitalization. The patient's disease progressed violently and quickly developed into macrophage activation syndrome, disseminated intravascular coagulation, shock, and multiple organ failure. The patient had sudden cardiac arrest, and she died despite emergency rescue efforts. CONCLUSION AOSD patients need regular follow-up in the long-term treatment process, and must press formulary standard medication, and do not voluntarily withdraw or reduce the dose. Otherwise it may cause disease back-and-forth or serious life-threatening complications. Meanwhile, strict management of trauma, infections, tumors, and other diseases may contribute to improved outcomes in patients with complications.

Background. The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture. Methods. The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications. Results. Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69–2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: −2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: −28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: −18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49–7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach. Conclusions. This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Background: It is plausible that interleukin polymorphisms may affect predisposition of autoimmune disorders such as systemic lupus erythematosus (SLE), but the results of so far published studies remain controversial. Objectives: The authors conducted this meta-analysis to clarify relationships between interleukin-1 (IL-1)/interleukin-4 (IL-4)/interleukin-6 (IL-6)/interleukin-10 (IL-10) polymorphisms and SLE by pooling the findings of eligible studies. Methods: A comprehensive search of PubMed, EMBASE, Web of Science, and CNKI was endorsed by the authors to identify already published studies. Fifty-seven studies were found to be eligible for meta-analyses. Results: The overall pooled meta-analyses yielded positive findings for IL-1A −889 C/T, IL-1B −31 T/C, IL-6 −174 G/C, IL-4 −590 C/T, and IL-10 −1,082 A/G polymorphisms. In addition, we also detected similar positive findings for IL-1B −511 C/T, IL-4 −590 C/T, IL-10 −592 A/C, IL-10 −819 C/T, and IL-10 −1,082 A/G polymorphisms in Asians, and such positive findings were also observed for IL-1A −889 C/T, IL-6 −174 G/C, and IL-10 −1,082 A/G polymorphisms in Caucasians. Conclusions: The meta-analyses’ results suggest that IL-1A −889 C/T, IL-1B −31 T/C, IL-6 −174 G/C, IL-4 −590 C/T, and IL-10 −1,082 A/G polymorphisms might affect predisposition of SLE.

Breast cancer is the most common malignant tumor in women globally. Currently, due to limited data, there are no international guidelines for addressing the management of a large group of patients during infectious disease pandemics. Coronavirus disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO), has rapidly spread globally. The COVID-19 pandemic changed our daily routines and forced us to rethink the management of breast cancer patients. Clinicians need to take into account multiple factors such as the timing and delivery of cancer care, epidemic prevention and control, and the allocation of medical resources. Determining ways to reasonably adjust the treatment strategy is a real challenge. In this review, we aim to discuss particular challenges associated with managing breast cancer patients during the COVID-19 pandemic, share experience from Chinese oncologists and surgeons and propose some practical approaches to the management of early-stage breast cancer patients from a surgical standpoint.

The ever-growing portable, flexible, and wearable devices impose new requirements from power sources. In contrast to gravitational metrics, areal metrics are more reliable performance indicators of energy storage systems for portable and wearable devices. For energy storage devices with high areal metrics, a high mass loading of the active species is generally required, which imposes formidable challenges on the current electrode fabrication technology. In this regard, integrated electrodes made by electrospinning technology have attracted increasing attention due to their high controllability, excellent mechanical strength, and flexibility. In addition, electrospun electrodes avoid the use of current collectors, conductive additives, and polymer binders, which can essentially increase the content of the active species in the electrodes as well as reduce the unnecessary physically contacted interfaces. In this review, the electrospinning technology for fabricating flexible and high areal capacity electrodes is first highlighted by comparing with the typical methods for this purpose. Then, the principles of electrospinning technology and the recent progress of electrospun electrodes with high areal capacity and flexibility are elaborately discussed. Finally, we address the future perspectives for the construction of high areal capacity electrodes using electrospinning technology to meet the increasing demands of flexible energy storage systems.

Background Identifying crystalloids, which includes amylase and tyrosine crystalloids, is relatively uncommon in salivary gland fine-needle aspiration (FNA) cytology. Although it has been suggested that the presence of crystalloids favors a benign process, the full significance has not been well established. Methods The authors performed a review of slides from all salivary gland FNA cases received in their laboratory from January 2017 to September 2019 to identify cases with crystalloids (screened cohort). In addition, the departmental archives were searched retrospectively for all salivary gland FNA cases that had specifically reported crystalloids. Cytologic findings as well as correlation with surgical pathology and clinical follow-up were examined. Results There were 664 cases in the screened cohort. Crystalloids were present in 37 cases (incidence, 5.6%). Amylase crystalloids were the most commonly identified (n = 28; 75%), followed by tyrosine crystalloids (n = 4; 11%), and collagenous crystalloids (n = 1; 3%). Four cases with crystalloids could not be further classified because of low quantity (n = 4; 11%). An additional 54 cases were identified in the 10-year retrospective review. Diagnostic categorization for the total cohort (N = 91) was as follows: nondiagnostic, 30 cases (33%); nonneoplastic/benign, 42 cases (46%); neoplasm: benign, 10 cases (11%); and atypia of undetermined significance, 9 cases (10%). Twenty-six cases had subsequent resection findings, including oncocytic cyst/cystadenoma in 8 cases (31%), chronic sialadenitis/ductal obstructive change in 7 cases (27%), pleomorphic adenoma in 5 cases (27%), developmental cyst in 3 cases (12%), lymphoepithelial cyst in 2 cases (8%), and Warthin tumor in 1 case (4%). Conclusions This cohort represents the largest FNA series of salivary gland crystalloids. All cases were associated with nonneoplastic or benign neoplastic lesions.

Introduction Oil Red O (ORO) staining on cytologic specimens with calculation of the lipid-laden macrophage index (LLMI) is used as a part of the workup in a number of clinical settings, particularly when aspiration is of concern. As a part of ongoing internal quality improvement measures, the objective of the present study was to evaluate the interobserver agreement of the LLMI calculation and to identify factors that affect the variability of the calculation. Materials and methods There were 9 study participants, which included 3 trainees, 3 cytotechnologists, and 3 cytopathologists. Each participant reviewed 100 ORO-stained bronchoalveolar lavage slides and assigned an LLMI score to each case. The scores were categorized into 3 groups according to the associated aspiration risk: low, LLMI 90. The participants were also requested to note any challenges to the calculation for each case. Results The interobserver agreement among all participants was fair (κ = 0.23). Stratified by participant group, the interobserver agreement among the trainees was fair (κ = 0.24), among cytotechnologists was fair (κ = 0.32), and among cytopathologists was moderate (κ = 0.60). In 70 cases, at least one participant scored the case at least one category higher than the other participants; in 47 cases there was a two category difference. A primary diagnostic challenge reported by participants was macrophage pigmentation (hemosiderin, anthracosis). Conclusions We found only fair interobserver agreement among all 9 participants in the study. Hemosiderin and anthracotic pigmentation was a major factor impeding LLMI calculation resulting in overestimation of the LLMI.

Purpose Effective treatment options for intrahepatic cholangiocarcinoma (ICC) are limited. This study was intended to explore the efficacy and safety of apatinib in advanced ICC with lymph node metastasis or distant metastasis. Patients and methods The efficacy and toxicity of apatinib were evaluated in patients with ICC between November 2017 and March 2020 at the Second Affiliated Hospital of Anhui Medical University. Survival analysis was estimated using Kaplan-Meier method. Results Ten patients with advanced ICC were enrolled. The median progression-free survival (PFS) was 3.0 months (95% CI: 1.450-4.550). No patient achieved a complete response (CR). One patient gained partial response (PR), and 6 patients had stable disease (SD). The objective response rate (ORR) was 10%, and the disease control rate (DCR) was 70%. The common treatment-related adverse events were hypertension (20%), proteinuria (30%), hand and foot syndrome (10%) or emesis (10%). No grade 3/4 toxicities occurred. Toxicities were mild and tolerable. Conclusion Apatinib is potentially an effective treatment option with tolerable toxicities for patients with advanced ICC.

As an important reform of supervision, the comment letter mechanism adopted by the Shanghai Stock Exchange and the Shenzhen Stock Exchange has been paid much attention by regulators and academics. ...

BACKGROUND Pelvic washing specimens are relatively common and are submitted for patients undergoing gynecologic surgery to evaluate them for metastatic or occult disease. Psammoma bodies are a relatively uncommon finding in these specimens. To date, large-scale studies of their cytologic-histologic correlates and thus clinical significance have been limited. METHODS A 10-year retrospective search for all pelvic washing specimens was performed, and all cases were reviewed for the presence of psammoma bodies. The findings for the corresponding surgical pathology specimens were then catalogued. RESULTS Psammoma bodies were present in 138 cases (3.6% of 3840 total pelvic washings). More than half of the cases (n = 73 [53%]) were associated with benign processes, including mesothelial hyperplasia (n = 44), endosalpingiosis (n = 11), endometriosis (n = 11), and ovarian cystadenoma/cystadenofibroma (n = 7). Nineteen cases (14%) were associated with serous borderline tumors. Malignancies were noted in a third of the cases (n = 46 [33%]) and were most frequently low-grade serous adenocarcinomas (n = 15), high-grade serous adenocarcinomas (n = 11), or endometrioid endometrial carcinomas (n = 8). Patients found to have benign processes (median age, 50 years) or borderline disease (median age, 56 years) were significantly younger than patients with malignancies (median age, 65 years; P

Background and Aims: Emitasvir is a new type of hepatitis C virus (HCV) nonstructural protein 5A (NS5A) inhibitor, and the data of phase 2 trial has shown emitasvir-sofosbuvir to have good safety and tolerance. We conducted this phase 3 trial to further verify the efficacy and safety. Methods: We evaluated the antiviral activity and safety of a 12-week regimen of emitasvir phosphate (100 mg) combined with sofosbuvir (400 mg) once daily in non-cirrhotic patients with genotype 1 HCV infection. The primary endpoint was a sustained virological response at 12 weeks (SVR12) after the end of treatment. Results: Of the 362 patients enrolled in the trial, 39.8% were male, 99.2% had HCV genotype 1b, 0.8% had genotype 1a and 79.8% were treatment-naïve. The average age was 47.2 years. All patients completed the treatment and follow-up. All 3 patients with genotype 1a achieved SVR. Two genotype 1b treatment-naïve patients experienced virologic relapse. The rate of SVR12 was 99.7% (358/359), and SVR24 was 99.4% (357/359) in genotype 1b. Overall, 36.2% had resistance-associated substitutions (RASs) in NS5A and 98.3% had RASs in NS5B at baseline. The RASs at baseline had no effect on the rates of response. Serious adverse events were reported in 16 patients and were not related to emitasvir-sofosbuvir. Most adverse events did not require therapy. Conclusions: The 12 weeks of treatment with emitasvir-sofosbuvir was a highly efficient and safe treatment for a wide range of patients with HCV genotype 1b infection without cirrhosis, who had not been treated or who had been treated with interferon-based regimen previously.

Label-free biosensors operating within the terahertz (THz) spectra have helped to unlock a myriad of potential THz applications, ranging from biomaterial detection to point-of-care diagnostics. However, the THz wave diffraction limit and the lack of emitter-integrated THz biosensors hinder the proliferation of high-resolution near-field label-free THz biosensing. Here, a monolithic THz emission biosensor (TEB) is achieved for the first time by integrating asymmetric double-split ring resonator metamaterials with a ferromagnetic heterojunction spintronic THz emitter. This device exhibits an electromagnetically induced transparency window with a resonance frequency of 1.02 THz and a spintronic THz radiation source with a bandwidth of 900 GHz, which are integrated on a fused silica substrate monolithically for the first time. It was observed that the resonance frequency experienced a red-shift behavior with increasing concentration of HeLa cells and Pseudomonas because of the strong interaction between the spintronic THz radiation and the biological samples on the metamaterials. The spatial frequency red-shift resolution is ∼0.01 THz with a Pseudomonas concentration increase from ∼0.5 × 104 to ∼1 × 104/mL. The monolithic THz biosensor is also sensitive to the sample concentration distribution with a 15.68 sensitivity under a spatial resolution of 500 μm, which is determined by the infrared pump light diffraction limit. This TEB shows great potential for high-resolution near-field biosensing applications of trace biological samples.

Background Lung cancer is the leading cause of cancer-related deaths. EGFR tyrosine kinase inhibitors, such as erlotinib, were approved for non-small cell lung carcinoma patients with EGFR mutations. However, the acquired resistance of these inhibitors has not been fully clarified. Therefore, clarifying the mechanism and developing new rationales to overcome the drug resistance are urgently needed. Methods A pair of erlotinib sensitive and resistant cells was used to identify the key molecules in mediating erlotinib resistance. Loss- or gain-of-function study was used to confirm the effects of the key molecules. Xenograft mouse model and human cancer tissue sample studies were conducted for further corroboration. Results HCC827 cells with acquired resistance to erlotinib underwent epithelial-mesenchymal transition and exhibited enhanced p70S6K signaling compared to parental sensitive cells. Moreover, in erlotinib resistant cells, downregulation of p70S6K expression using either siRNA or shRNA reversed EMT and partially overcame erlotinib resistance. Meanwhile, in erlotinib sensitive cells, overexpression of p70S6K promoted EMT and induced erlotinib resistance. Upregulation of p70S6K signaling in erlotinib resistant cells was caused by reduced GSK3β-mediated protein degradation of mTOR and raptor. Additionally, p70S6K silencing suppressed the growth of erlotinib resistant cells in a xenograft mouse model. Finally, we found a correlation between p70S6K and E-cadherin expression in human non-small-cell lung cancer (NSCLC) tissue samples. Conclusion Our findings suggest that p70S6K-induced EMT plays an important role in the acquired resistance of erlotinib and provides a novel therapeutic rationale of targeting p70S6K in NSCLC therapy.

Thermal energy storage (TES) is a developing technology with promising applications in renewable energy and waste heat recovery. In this study, we investigate the thermal stability of the recently ...

Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well. Keywords: Rational design, Secondary operation, Penetrating head injury, Skull base fracture

Aberrant DNA methylation could regulate the expression of tumor suppressor gene DLEC1 and oncogene PBX3 and was related to the occurrence and prognosis of gastric cancer (GC). In this study, the associations between DLEC1 and PBX3 promoter methylation in peripheral blood leukocytes (PBLs) and the risk and prognosis of GC were investigated. The methylation status of DLEC1 and PBX3 promoter in PBLs of 368 GC cases and 382 controls was detected by the methylation-sensitive high-resolution melting (MS-HRM) method. Logistic and Cox regression were adopted to analyze the associations of DLEC1 and PBX3 methylation with GC risk and prognosis, respectively. Confounding biases were controlled by propensity score (PS). Compared with negative methylation (Nm), DLEC1-positive methylation (Pm) was associated with increased GC risk in PS (OR 2.083, 95% CI 1.220–3.558, P = 0.007), but PBX3 Pm was not associated with GC risk. In the elderly group (≥ 60 years), DLEC1 Pm was associated with increased GC risk (OR 2.951, 95% CI 1.426–6.104, P = 0.004). The combined effects between DLEC1 methylation and consumption of dairy products, fried food intake and Helicobacter pylori (H. pylori) infection on GC risk were discovered (ORc 3.461, 95% CI 1.847–6.486, P

With robotics rapidly advancing, more effective human–robot interaction is increasingly needed to realize the full potential of robots for society. While spoken language must be part of the solution, our ability to provide spoken language interaction capabilities is still very limited. In this article, based on the report of an interdisciplinary workshop convened by the National Science Foundation, we identify key scientific and engineering advances needed to enable effective spoken language interaction with robotics. We make 25 recommendations, involving eight general themes: putting human needs first, better modeling the social and interactive aspects of language, improving robustness, creating new methods for rapid adaptation, better integrating speech and language with other communication modalities, giving speech and language components access to rich representations of the robot’s current knowledge and state, making all components operate in real time, and improving research infrastructure and resources. Research and development that prioritizes these topics will, we believe, provide a solid foundation for the creation of speech-capable robots that are easy and effective for humans to work with.

The minimum resolution is one of the most important characteristics of human vision, during the flight of the aircraft, the pilot uses the head-up display(HUD) to observe and distinguish the information of the external scenery. Analyzing the impact of different transmittance HUD combiner under different environment brightness on the external resolution has important instruction and application value for aviation safety. The experiment uses the UASF1951 target plate and the transmittance of HUD combiners under two different environmental brightness. Record the minimum resolution angle and the difference between the two conditions. The result shows that, under the same brightness, the lower the contrast, the weaker the human eye can recognize; the minimum resolvability of the human eye is affected by contrast: when the brightness is lower, the lower the brightness, the higher the minimum contrast requirement for human eye to recognize objects. When the brightness is higher, the minimum contrast requirement for human eye to recognize objects does not change much with brightness, and after the brightness is increased to a certain range, the minimum contrast required by the human eye to recognize the object is almost unchanged. It can be seen that the resolution of the human eye is simultaneously affected by environmental brightness and contrast, and the experimental results basically conform to the Adrian’s Visual Acuity Model.

Purpose We aimed to conduct a meta-analysis to accurately evaluate the potential association between ADIPOQ rs2241766 gene SNP and breast cancer risk. Methods A systematic literature search on Cochrane Library, PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) identified 8 articles with 1692 cases and 1890 controls. Strength of association was evaluated by pooled odds ratio (OR), 95 % confidence interval (CI) and p value. Funnel plots and Begger’s regression test were applied for testing the publication bias. Statistical analysis of all data was performed by Stata 12.0. Results The meta-analysis results indicated that the ADIPOQ rs2241766 gene polymorphism did not significantly associated with the risk of breast cancer for these genetic models (TT vs. TG + GG: OR = 1.20, 95 % CI = 0.77–1.89, p=0.417; TT + TG vs. GG: OR = 1.05, 95 % CI = 0.71–1.56, p=0.805; T vs. G: OR =1.17, 95 % CI = 0.79–1.74, p=0.437). Conclusions This study indicated that no significant relationship between the ADIPOQ rs2241766 SNP and breast cancer. Further large-scale and well-designed studies will be indispensable to confirm our result.

Objectives In this study, we aimed to investigate the spontaneous neural activity in the conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz, and slow-5: 0.01–0.027 Hz) in tension-type headache (TTH) patients with regional homogeneity (ReHo) analyses. Methods Thirty-eight TTH patients and thirty-eight healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (RS-fMRI) scanning to investigate abnormal spontaneous neural activity using ReHo analysis in conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.01–0.027 Hz). Results In comparison with the HC group, patients with TTH exhibited ReHo increases in the right medial superior frontal gyrus in the conventional frequency band (0.01−0.08 Hz). The between group differences in the slow-5 band (0.01–0.027 Hz) highly resembled the differences in the conventional frequency band (0.01−0.08 Hz); even the voxels with increased ReHo were spatially more extensive, including the right medial superior frontal gyrus and the middle frontal gyrus. In contrast, no region showed significant between-group differences in the slow-4 band (0.027–0.073 Hz). The correlation analyses showed no correlation between the ReHo values in TTH patients and VAS scores, course of disease and number of seizures per month in conventional band (0.01−0.08 Hz), slow-4 band (0.027–0.073 Hz), as well as in slow-5 band (0.01–0.027 Hz). Conclusions The results showed that the superior frontal gyrus and middle frontal gyrus were involved in the integration and processing of pain signals. In addition, the abnormal spontaneous neural activity in TTH patients was frequency-specific. Namely, slow-5 band (0.01–0.027 Hz) might contain additional useful information in comparison to slow-4 band (0.027−0.073 Hz). This preliminary exploration might provide an objective imaging basis for the understanding of the pathophysiological mechanism of TTH.

In this paper, we formulate and solve a novel real-life large-scale automotive parts paint shop scheduling problem, which contains color arrangement restrictions, part arrangement restrictions, bracket restrictions, and multi-objectives. Based on these restrictions, we construct exact constraints and two objective functions to form a large-scale multi-objective mixed-integer linear programming problem. To reduce this scheduling problem’s complexity, we converted the multi-objective model into a multi-level objective programming problem by combining the rule-based scheduling algorithm and the adaptive Partheno-Genetic algorithm. The rule-based scheduling algorithm is adopted to optimize color changes horizontally and bracket replacements vertically. The adaptive Partheno-Genetic algorithm is designed to optimize production based on the rule-based scheduling algorithm. Finally, we apply the model to the actual optimization problem that contained 829,684 variables and 137,319 constraints, and solved this problem by Python. The proposed method solves the optimal solution, consuming 575 s.

Zhuo Liu,1,2 Dandan Liu,3 Zhen-Ni Guo,2 Hang Jin,2 Tong Sun,4 Chunping Ni,1,&ast; Xiuli Yan2,&ast; 1Fourth Military Medical University, School of Nursing, Xi’an, People’s Republic of China; 2Department of Neurology, The First Hospital of Jilin University, Changchun, People’s Republic of China; 3Physical Examination Center, The First Hospital of Jilin University, Changchun, People’s Republic of China; 4Cadre Ward, The First Hospital of Jilin University, Changchun, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiuli YanDepartment of Neurology, the First Hospital of Jilin University, 71# Xinmin Street, Changchun, 130021, People’s Republic of ChinaTel +86-15843079660Fax +86-431-88782378Email yanxiuli2008@126.comChunping NiFourth Military Medical University, School of Nursing, 169# Changle Road West, Xi’an, 710032, People’s Republic of ChinaTel +86-13572498128Fax +86-29-84711715Email pingchunni@163.comBackground: Deep vein thrombosis (DVT) is common among patients with stroke. However, the incidence of DVT in acute ischemic stroke patients treated with thrombolytic therapy and the risk factors associated with this condition are unknown.Objective: This study aimed to investigate the incidence and risk factors of DVT after thrombolysis in patients with acute ischemic stroke.Settings and Methods: We retrospectively reviewed the medical records of all patients with acute ischemic stroke who underwent ultrasonic examination after intravenous thrombolysis between April 2017 and December 2019 at the stroke center of the First Hospital of Jilin University, China. Color duplex ultrasound was used to diagnosis DVT in all patients within 72 h after intravenous thrombolysis. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for DVT.Results: Overall, 474 patients were included in the study. Of these, 75 (15.8%) developed DVT (95% confidence interval 12.5– 19.1). Older age was the risk factor that most significantly affected the development of DVT (p = 0.001). Compared to patients younger than 60 years old, those aged 60– 69 years and ≥ 70 years had a higher risk of DVT, at rates of 2.201 (95% CI: 1.033– 4.689; p < 0.05) and 4.241 (95% CI: 2.016– 8.922; p < 0.001) times higher, respectively. Patients with higher triglyceride levels (odds ratio 0.545, 95% CI: 0.372– 0.799, p = 0.002) and longer activated partial thromboplastin time (OR 0.927, 95% CI: 0.862– 0.996, p = 0.040) were less likely to have DVT.Conclusion: DVT is a common complication among patients undergoing intravenous thrombolysis after acute ischemic stroke. Advanced age may increase the occurrence of DVT to some extent. For these patients, safe antiplatelet therapy should be explored and implemented as soon as possible.Keywords: acute ischemic stroke, deep vein thrombosis, incidence, risk factors, thrombolytic therapy

An ultra-high sensitivity refractive index (RI) sensor, based on an in-line fiber Mach-Zehnder interferometer (MZI) and utilizing a special 40 μm fiber which has been specifically designed for the purpose, supporting only the LP 01 and LP 11 modes propagating in the fiber, has been proposed and numerically demonstrated in this work. The all-fiber MZI, based on LP 01 and LP 11 mode interference, was fabricated by utilizing a special design with two gradually tapered joints at both sides of this multi-clad thin diameter fiber (TDF). When the TDF diameters varied from 40 μm to 5 μm, a sudden change in the direction of the wavelength shift in the transmission spectrum of the TDF-MZI devices was observed both in liquid RI and air relative humidity (RH) monitoring experiments, as the surrounding RI or RH was seen to increase monotonically. Ultra-high sensitivity values of 5942.8nm/RIU (1.335-1.342) and 21292.2nm/RIU (1.4000-1.4025) were obtained in the experiments carried out, through the use of a tapered TDF-MZI device with TDF diameters of ~5 μm and ~9 μm, respectively. The maximum RH sensitivity of 1.084nm/%RH was obtained by the use of the TDF-MZI device with a TDF diameter of ~12 μm. A compact all-fiber TDF-MZI sensor was thus created with an overall sensing length of

This study investigates the application of positron annihilation techniques to the interior of dense metal cavities for Three-dimensional (3D) imaging and extraction of contour features inside the cavities. A feature extraction algorithm based on a 3D anisotropic convolutional operator is proposed for profile feature extraction in low-resolution, low-contrast, and low-signal-to-noise positron image. First, aiming at the problem of positron image noise caused by inconsistent detectors and metal scattering effects, an image preprocessing algorithm combining filtering and full pixel correction is proposed. A 3D anisotropic convolution operator is then designed to extract contour features. To solve the contour feature discontinuity in the extracted contour feature, a 3D path search algorithm is proposed to obtain the centroid coordinate set of the contour feature, and then the centroid coordinate set is subjected to 3D curve fitting to obtain a smooth and continuous contour feature. The study is carried out on the raw 16-bit Digital Imaging and Communications in Medicine (DICOM) data of the positron image, and the data are processed from a 3D perspective, taking full advantage of the correlation between slices in the 3D positron image. In the actual testing, positron images with different kinds of foreign objects in the cavity are extracted using a 3D anisotropic convolution operator, and the contour feature extraction resolution reaches 2 mm.

The development of cheap and efficient electrodes for water splitting is an ongoing challenge. Herein, a nickel foam-based monolithic electrode is reported with high performance for both hydrogen and oxygen evolution reactions in neutral media. The karst landform-featured electrode consists of metallic Ni in the valley areas and Ni/α-Ni(OH)2 heterostructures as towers on the surface. Remarkably, the electrode can switch between HER and OER reversibly and flexibly with long-term viability. Scanning electrochemical microscopy (SECM) analysis and computational studies proved the vital roles of the karst landform structure and the interface of the heterostructure in its efficient bifunctionality. Combined with a common photovoltaic cell, a water electrolysis cell with the bifunctional electrode can implement splitting of natural seawater (pH ∼ 8.0) with a high solar-to-hydrogen (STH) conversion efficiency of 16.5%. This cheap, flexible, robust, easily obtained and bifunctional electrode has potential applications for water splitting in the hydrogen economy.

AIM: To review the indications of penetrating keratoplasty (PK) and anterior lamellar keratoplasty (ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes (75.2%) had PK and 464 eyes (24.8%) had ALK. The leading indications were suppurative keratitis (36.8%), keratoconus (15.5%), herpes keratitis (13.1%), and regraft (10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis (38.7%), herpes keratitis (15.3%), keratoconus (12.6%), and regraft (12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis (30.8%), keratoconus (24.1%), corneal dystrophies and degenerations (10.6%), and corneal dermoid tumor (9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.

To analyze the outcomes of use of a lumboperitoneal shunt (LPS) to treat all-cause communicating hydrocephalus (ACCH).We analyzed the outcomes of adult patients with ACCH treated with an LPS between June 2015 and June 2018, using Keifer's hydrocephalus score (KHS), postoperative symptom improvement score (SIS), and the Evans index for 5 days after surgery. All patients were followed up to assess long-term outcomes and quality of life. Based on the follow-up data in shunt successful (SS) patients and shunt failure (SF) patients, multivariate analysis with binary logistic regression was used to identify risk factors for LPS failure.A total of 71 eligible patients were included in this study. The KHS (mean, 8.31 ± 4.80 vs. 3.65 ± 3.08; P 0.001) and Evans index (mean, 0.35 ± 0.05 vs. 0.28 ± 0.05; P0.001) were significantly improved following LPS. However, the overall incidence of complications was 40.8%. According to follow-up data, 18 patients (25.4%) failed; the most common reason for failure was catheter obstruction. The majority of patients obtain good prognosis with low level of RBCs counts in CSF (P = 0.039) and postoperative Evans index (P = 0.046) were statistically different between SS and SF group. The multivariate analysis identified elevated RBC count in CSF as a dependent risk factor for LPS failure (odds ratio, 24.111; 95% confidence interval, 2.611-222.629; P = 0.005).Our findings indicate that LPS may be a promising option for the treatment of ACCH.

In this paper, the embedding of fiber optic sensors in metals, by using both automatic and manual Tungsten Inert Gas welding (TIG) is discussed for nickel- and copper-coated Fiber Bragg Gratings (FBG) written into an optical fiber, as embedding such sensors in metals provides protection against environmental effects. In the investigation and analysis of the performance of a number of such sensors, copper-coated sensors were seen to lose their temperature and strain sensitivity while being embedded due to damage to the coating, while with a nickel coating the sensors in the fiber were found to withstand the process with a lesser effect on the sensor performance. The research has also shown that the Automatic TIG process used is less invasive than the manual TIG approach, although more expensive to implement.

This paper presents a CMOS-based tunable device to realize electromagnetic (EM) beam steering in the THz frequency domain. The device consists of 8×8 array with double layer dumbbell-liked metamaterial (DL2M) unit. The phase response of the THz wave can be manipulated through two MOS switches connected to the metamaterial unit. The design is implemented in the 180nm process and can achieve a maximum beam steering angle of 35° at 1.26 THz according to the simulation results. The highly integrated device demonstrates the potential of the active CMOS metamaterials for THz adaptive beamforming.

IntroductionVentriculoperitoneal shunt (VPS) remains the most widely used methods to treat communicating hydrocephalus. More recently, lumboperitoneal shunt (LPS) has been suggested as a reasonable option in some studies. However, there is lack of high-quality studies comparing these two techniques in order to certain the benefits and harms to use one of these two methods. The purpose of the current study is to determine the effectiveness and safety of the LPS versus the VPS in patients with communicating hydrocephalus.Methods and analysisAll eligible patients aged 18–90 years with communicating hydrocephalus will be recruited and then randomly allocated into LPS or VPS group in a ratio of 1:1. All patients will be analysed before shunt insertion, at the time of discharge, 1 month, 6 months, 12 months and 24 months postoperatively. The primary outcome measure is the rate of shunt failure at a 2-year follow-up term. The secondary outcomes include Keifer’s Hydrocephalus Scale, National Institute of Health Stroke Scale, Glasgow Outcome Scale Extended, Evans index, safety endpoints and cost-effectiveness of hospital stay.Ethics and disseminationThe study will be performed in compliance with the Declaration of Helsinki (2002) of the World Medical Association. The study was approved by Institutional Review Board of West China Hospital. All patients will be fully informed the potential benefits, potential risks and responsibilities, those who will sign the informed consents once they are included. Preliminary and final results will be published in peer-reviewed journals and presented at national and international congresses.Trial registration numberChiCTR2100043839.

Importance/Background: The coronavirus disease (COVID-19) pandemic is a critical public health issue. Evidence has shown that metformin favorably influences COVID-19 outcomes. This study aimed to assess the benefits and risks of metformin in COVID-19 patients.Methods: We searched the PubMed, Embase, Cochrane Library, and Chinese Biomedical Literature Database from inception to February 18, 2021. Observational studies assessing the association between metformin use and the outcomes of COVID-19 patients were included. The primary outcome was mortality, and the secondary outcomes included intubation, deterioration, and hospitalization. Random-effects weighted models were used to pool the specific effect sizes. Subgroup analyses were conducted by stratifying the meta-analysis by region, diabetic status, the adoption of multivariate model, age, risk of bias, and timing for adding metformin.Results: We identified 28 studies with 2,910,462 participants. Meta-analysis of 19 studies showed that metformin is associated with 34% lower COVID-19 mortality [odds ratio (OR), 0.66; 95% confidence interval (CI), 0.56–0.78; I2 = 67.9%] and 27% lower hospitalization rate (pooled OR, 0.73; 95% CI, 0.53–1.00; I2 = 16.8%). However, we did not identify any subgroup effects. The meta-analysis did not identify statistically significant association between metformin and intubation and deterioration of COVID-19 (OR, 0.94; 95% CI, 0.77–1.16; I2 = 0.0% for intubation and OR, 2.04; 95% CI, 0.65–6.34; I2 = 79.4% for deterioration of COVID-19), respectively.Conclusions: Metformin use among COVID-19 patients was associated with a reduced risk of mortality and hospitalization. Our findings suggest a relative benefit for metformin use in nursing home and hospitalized COVID-19 patients. However, randomized controlled trials are warranted to confirm the association between metformin use and COVID-19 outcomes.Study Registration: The study was registered on the PROSPERO on Feb 23, 2021 (CRD42021238722).

Objective: Stroke is a leading cause of mortality and morbidity globally. This study aimed to analyze the burden and 30-year trends of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in China.Methods: Data that include incidence and mortality of stroke in China from January 1, 1990 to December 31, 2019 were derived from the Global Burden of Disease (GBD) study 2019. The absolute numbers of incident cases and deaths over the time, and age-standardized rates per 100,000, such as age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR), were analyzed.Results: In 2019, there were 3.9 (95% uncertainty intervals (UI) 3.4–4.5) million incident cases and 2.1 (3.4–4.5) million deaths related to stroke in China. The ASIR and ASMR of stroke in China was 200 (176–230) and 127 (110–144). From 1990 to 2019, the ASIR of ischemic stroke had increased by 35.0% (29.0–40.0) while the ASIR of ICH and SAH had decreased by −53.0% (−56.0 to −50.0) and by −39.0% (−44.0 to −35.0), respectively. The ASMR of ischemic stroke had increased by 3.0% (−26.0 to 16.0) while the ASMR of ICH and SAH had decreased by −48.0% (−59.0 to −38.0) and by −84.0% (−89.0 to −69.0), respectively.Conclusion: Although the incidence and mortality rates of stroke in China were decreased from 1990 to 2019, the number of incident cases and deaths nearly doubled. A sharp increase in the incidence rate of ischemic stroke was observed. A higher incidence rate of ischemic stroke in the women was also observed.

Background: Early shunt obstruction (SO) remains the most common cause of lumboperitoneal shunt (LPS) failure. Although there is anecdotal evidence that the level of cerebrospinal fluid (CSF) parameters might affect shunt performance, its association with early LPS obstruction in adults with post-hemorrhagic hydrocephalus (PHH) is unclear.Methods: The retrospective study was performed by reviewing the adults with PHH treated by LPS from years 2014 to 2018. We included patients with CSF samples analyzed within 1 week prior to shunt insertion or at the time of shunt insertion. Baseline characteristics of each patient were collected. The primary outcomes were the incidence rate and associated factors of SO occurring within 3 months of shunt placement. The secondary outcomes included scores on the National Institute of Health Stroke Scale (NIHSS) and Evans Index at discharge.Results: A total of 76 eligible patients were analyzed, of whom 61 were obstruction-free and 15 were early SO. The overall rate of early SO was 15.6%. The RBCs count and nucleated cells count in preoperative CSF were actually higher in patients with early SO, compared to patients in the control group. Multivariate analysis identified RBC elevation (>0 × 106/L; OR: 10.629, 95% CI: 1.238–91.224, p = 0.031) as a dependent risk factor for early SO. NIHSS dramatically decreased at discharge while the alteration of ventricular size was not observed.Conclusions: This study suggested that the presence of RBCs in preoperative CSF was associated with early SO in patients with PHH treated by LPS.

Objectives: The aim of this systematic review is to assess the published cost-effectiveness analyses of aprepitant for patients with chemotherapy-induced nausea and vomiting (CINV).Methods: A systematic literature search was performed on PubMed, EMbase, the Cochrane Library, CNKI, WANFANG DATA, and CBM database. The date of publication is up to January 2019. Two reviewers independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved and reviewers reached a consensus. The quality of the included studies was assessed according to the 24-item checklist of the consolidated health economic evaluation reporting standards (CHEERS). The costs reported by the included studies were converted to US dollars via purchasing power parities (PPP) in the year 2019 using the CCEMG–EPPI–Certer Cost Converter.Results: Thirteen articles were included based on the inclusion criteria for cost-effectiveness analysis and cost-utility analysis. Twelve studies were rated as good quality and one as a moderate quality based on the CHEERS checklist. Eight studies compared aprepitant plus 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and dexamethasone with the standard regimen (5-HT3RA and dexamethasone). It was concluded that aprepitant plus standard regimen was a cost-effective strategy for preventing CINV. Only one study that compared aprepitant plus 5-HT3RA with 5-HT3RA, concluded that the addition of aprepitant reduced the incidence of severe nausea, and it might also provide an economic benefit in the overall management. Four studies that compared aprepitant with other antiemetic drugs concluded that aprepitant is a cost-effective strategy for preventing CINV compared with metoclopramide. However, netupitan + palonosetron and olanzapine are cost-effective compared with aprepitant.Conclusion: This study is the first systematic evaluation of adding aprepitant to standard regimens for patients with CINV. Most economic evaluations of antiemetic medications are reported to be of good quality. Adding aprepitant to standard regimens is found to be a cost-effective strategy for preventing CINV.

Purpose: To develop and verify an early prediction model of gestational diabetes mellitus (GDM) using machine learning algorithm.Methods: The dataset collected from a pregnant cohort study in eastern China, from 2017 to 2019. It was randomly divided into 75% as the training dataset and 25% as the test dataset using the train_test_split function. Based on Python, four classic machine learning algorithm and a New-Stacking algorithm were first trained by the training dataset, and then verified by the test dataset. The four models were Logical Regression (LR), Random Forest (RT), Artificial Neural Network (ANN) and Support Vector Machine (SVM). The sensitivity, specificity, accuracy, and area under the Receiver Operating Characteristic Curve (AUC) were used to analyse the performance of models.Results: Valid information from a total of 2811 pregnant women were obtained. The accuracies of the models ranged from 80.09% to 86.91% (RF), sensitivities ranged from 63.30% to 81.65% (SVM), specificities ranged from 79.38% to 97.53% (RF), and AUCs ranged from 0.80 to 0.82 (New-Stacking).Conclusion: This paper successfully constructed a New-Stacking model theoretically, for its better performance in specificity, accuracy and AUC. But the SVM model got the highest sensitivity, the SVM model was recommends as the prediction model for clinical.