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Background Oxidative stress and memory impairment have been implicated, a common functional brain disease. Nuclear factor E2-related factor 2 (Nrf2) is highly induced in oxidative stress, indicating that Nrf2 is an emerging target of memory therapy. This study aimed to investigate the effect of Noni on brain memory impairment induced by hydrocortisone and its protection mechanism in mice. Methods Male Kuming mice were (n = 8/group) given hydrocortisone by gastric gavage for 14 consecutive days to establish the memory impairment model except for those in the control group. At the same day, the corresponding drugs were given by gastric gavage. The changes in ethology were examined. Brains were extracted and subjected to western blot analysis and biochemical analyses to assess the activities of oxidative stress. Results The middle and high-dose Noni groups ameliorated the ethology and the high-dose Noni group increased cerebral protein expressions of Nrf2, kelch-like ECH-associated protein 1 (KEAP1) and heme oxygenase-1 (HO-1), as compared to the model group. The arrangement of CA3 vertebral cells in hippocampus of mice was slightly compact and hyperchromatic and pyknosis were alleviated. Furthermore, the biochemical analyses showed the activities of related enzymes of oxidative stress in high-dose Noni group were increased. Conclusions Noni might be a powerful antioxidant that can protect nerve cell and may possess as a potential benefit for the treatment of memory impairment.

Rationale: Patients with asthma were advised to avoid coronavirus disease (COVID-19) and comply with medication during the COVID-19 pandemic. Respiratory tract infection is a common cause of asthma exacerbations. There has not been evidence suggesting the link between COVID-19 and asthma exacerbation, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing. Objectives: To assess the number for admissions of asthma exacerbations in January to April 2020 in Hong Kong with reference to admission in the past 5 years. Methods: Admission records of asthma exacerbations were retrieved from the Clinical Data Analysis and Reporting System. Patients aged 18 years or older with a known history of asthma admitted for asthma exacerbation were included. Log-linear was used to model count, with year and masking used as covariate and further analysis on ambient temperature and length of hospital stays. Fisher’s exact test was used to compare the mortality rate and mechanical ventilation between the periods. Admissions for myocardial infarction, ischemic stroke, and gastric ulcer were included as controls. Results: The number of admissions for asthma exacerbations significantly decreased by 53.2% (95% confidence interval [CI], 50.4–55.8%) in 2020 compared with monthly average admission in 2015–2019, with a higher magnitude of decrease compared with control diagnoses. Admissions for asthma exacerbations decreased by 2.0% (95% CI, 1.8–2.2%) with every 1°C (1.8°F) increase in temperature and by 0.8% with every 1% increase in masking (95% CI, 0.8–0.9%). Conclusions: Hospitalization number for asthma exacerbations significantly decreased in early 2020, with similar length of stay. This was observed with concomitant practice of universal masking and social distancing during the COVID-19 pandemic in Hong Kong. We proposed that universal masking and social distancing reduced respiratory viral infection, leading to fewer hospital admissions for asthma exacerbations.

Background: As the commonest EGFR-TKI being used in Hong Kong, gefitinib has shown to be efficacious and safe as first-line treatment for L858R mutation and exon 19 deletions with less gastrointestinal and cutaneous adverse events than erlotinib and afatinib. The evidence for therapeutic efficacy for uncommon and complex EGFR mutations, on the other hand, is lacking. It is important to explore whether or not gefitinib is helpful for uncommon and complex EGFR mutations. Objectives: To assess the therapeutic efficacy of gefitinib, as measured by progression-free survival and overall survival, among advanced-stage lung cancer patients with common, uncommon, and complex EGFR mutations. Methods: This retrospective cohort study included 241 Chinese patients with advanced non-smallcell carcinoma of the lung harboring EGFR mutations and received gefitinib 250 mg daily as firstline treatment. The progression-free survival (PFS) and overall survival (OS) for patients with different EGFR mutations, namely exon 19 deletions, L858R mutation in exon 21, uncommon EGFR mutations, and complex EGFR mutations, were analyzed. Results: Among the 241 patients, 118 (49%) had exon 19 deletion, 104 (43%) had L858R mutation in exon 21, 6 (2.5%) had uncommon EGFR mutations, and 13 (5.4%) had complex EGFR mutations. The mean age was 69. 72% of the patients were female, and 81% were non-smokers. Patients with complex EGFR mutations, regardless of the presence of exon 19 deletion and L858R mutation as the component, have better PFS and OS than patients with single common EGFR mutations (Exon 19 deletion or L858R mutation). Patients with uncommon EGFR mutations have inferior PFS and OS than those with common EGFR mutations. Conclusion: Gefitinib is a possible option for patients with complex EGFR mutations, while it may not be the preferred treatment option in patients with single uncommon EGFR mutations.

To evaluate the impact of nighttime compared with daytime transfers from the intensive care unit (ICU) on mortality in a hospital with a critical care response team (CCRT). We performed a retrospective observational study of ICU patients transferred between January 2011 and July 2013 who received CCRT follow-up. The transferred patients were divided into cohorts of daytime and nighttime transfers. A multivariable logistic regression model was used to identify independent predictors of mortality after ICU transfer. There were 1,857 patients included in the study. With the exception of Multiple Organ Dysfunction Score on admission, transfers to a step-down unit, and lower urine output, there were no differences in the baseline characteristics, clinical events identified by CCRTs, and the number of CCRT interventions performed between daytime and nighttime transfers. Patients transferred at night were at higher risk of death in the univariate analysis but not in the multivariate analysis. Independent predictors of mortality included older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002 to 1.04), transfer to a medical service (OR, 1.96; 95% CI, 1.11 to 3.43), CCRT identification of hypoxemic respiratory failure (OR, 5.86; 95% CI, 3.11 to 11.04), decreased level of consciousness (OR, 3.14; 95% CI, 1.23 to 8.02), hypotension (OR, 3.69; 95% CI, 1.36 to 10.01), and longer CCRT duration of follow-up (OR, 1.02; 95% CI, 1.004 to 1.03). Nighttime transfer from the ICU was not an independent predictor of mortality. We identified unique predictors of mortality, including clinical events that CCRTs identified in patients immediately after ICU transfer. Future studies are required to validate these predictors of mortality in transferred ICU patients.

The use of new technologies to empower the social co-governance of food safety is a consensus in the theoretical and practical fields of food safety governance modernization. Based on the innovative features of the block chain such as non-tampering, consensus mechanism, and a smart contract, this paper proposes a new method to facilitate the achievement of the effect of social co-governance of food safety. Firstly, it provides a profound analysis of the causes of food safety problems and the drawbacks of traditional centralized supervision, and proposes a solution with decentralized features and the design process of smart contracts to realize the chaining and integration of finite credible data in the process of food circulation; secondly, it constructs a mathematical model through finite credible data on the chain and obtains the probabilistic consensus results of food safety through rigorous derivation; Finally, the scheme, model and algorithm are effectively practiced through the experimental environment of mature block chain platform and provincial food supervision platform. The example shows that the market failure problem in food safety can be greatly alleviated by the non-tampering feature of block chain; the consensus results formed by the credible data uploading, model construction and data derivation through smart contracts can greatly alleviate the problem of involution of government administrative supervision; and the social co-governance capacity of food safety can be improved through information sharing with the active synergy of multiple subjects of co-governance.

Maintenance chemotherapy was studied in first line setting for advanced stage non-small cell lung carcinoma (NSCLC). There has not been any data on the role of continuation maintenance chemotherapy in second line setting. A retrospective cohort study that included 226 patients with advanced stage NSCLC that received second line gemcitabine ± platinum was conducted. Patients who had continuation maintenance gemcitabine were compared with those who went on drug holiday. The primary endpoint was progression-free survival (PFS), counted from the end of induction therapy. The median PFS was significantly longer for patients who continued with maintenance gemcitabine when compared with those on drug holiday (5.6 vs 1.7 months, HR 0.392, p-value0.001). The overall survival was also significantly longer (21.4 vs 15.8 months, HR 0.508, p-value 0.047). There was no increase in incidence of adverse events for patients who underwent maintenance gemcitabine. Continuation maintenance therapy with gemcitabine in second line setting is a potentially feasible and safe option for patients with advanced NSCLC.

The accurate expression of terrain morphology is the essence of the urban terrain model construction. As the skeleton of urban terrain, urban road has special geometric and semantic characteristics. The road is a strip-shaped feature, which is flat in the horizontal direction and gently undulating in the vertical direction, and the roads are interlinked and connected. This research takes Jianye District of Nanjing as the studied area to explore the digital elevation model (DEM) construction method of urban roads. Firstly, the 1:1000 digital topographic map(DTM) is used to extract the point, line and plane elements of urban roads. Secondly, a selection method of elevation points for urban road DEM (UR-DEM) construction is proposed, referring to the urban road engineering design specification. That’s the improved Douglas–Peucker (D–P) algorithm with elevation change rate. Thirdly, the bidirectional interpolation method is constructed to keep the directional characteristics and geometric features of the urban roads. Then, the intersection processing method based on semantic connectivity is used, so that the roads can be connected correctly. Finally, UR-DEM is generated by inverse distance weighting (IDW) interpolation model, and the construction results are also analyzed and evaluated in this paper. The experimental results show that: (1) the existence of abnormal elevation points seriously affects the geometric shape of urban road, and the removing abnormal elevation points method proposed in this paper can maintain gently undulating characteristics of road well and largely reduce the road jitter. (2) The UR-DEM construction method proposed in this paper can express the spatial geometric and semantic features of urban road well, the model accuracy is higher than that of classical methods and the RMSE is 0.0225 m. This study can provide reference for the DEM construction of other urban features, and can provide data support for the process simulation of urban surface confluence and urban construction planning.

Background: Gefitinib was approved by the Food and Drug Administration (FDA) of the United States (US) for the treatment of advanced non-small cell carcinoma harboring sensitizing epidermal growth factor receptor (EGFR) mutations. The use of gastric acid-suppressing medication inhibits gefitinib absorption and reduces its plasma concentration, but retrospective studies on whether there is the corresponding repercussion on progression-free survival (PFS) have yielded variable results, mainly due to heterogeneity in study cohorts and study designs. Objectives: To assess the clinical impact of the use of gastric acid-suppressing medication in patients on first-line gefitinib for NSLC harboring common EGFR mutation. Methods: This is a retrospective cohort study conducted in a single, tertiary referral center in Hong Kong S.A.R., which included 193 Chinese patients with advanced adenocarcinoma of lung harboring common sensitizing EGFR mutations who received gefitinib as the first-line treatment. The progression- free survival (PFS) and overall survival (OS) for patients who took gastric acid-suppressing agents, namely histamine-2 receptor antagonists (H2RA) or proton pump inhibitors (PPI), were compared with those who did not take such medication (control group). Results: Despite the universal practice to separate the medicating time of gastric acid suppressants and EGFR-TKIs by 12 hours, patients who were on gastric acid suppressants had significantly shorter PFS, especially for those on proton pump inhibitor (Median 368 vs. 189 vs. 166 days - For control, H2RA group and PPI group respectively, p-value Conclusions: The co-administration of gastric acid suppressants with gefitinib is associated with shorter progression-free survival and overall survival.

How to accurately and efficiently measure the profiles of the terrain on which agricultural machines operate has been an ongoing research topic. In this study, a surface profiling apparatus (profiler) was developed to measure agricultural terrain profiles along parallel tracks. The profiler is mainly composed of sensor frames, an RTK-GNSS system (Real Time Kinematics-Global Navigation Satellite Systems), laser sensors, an Inertial Measurement Unit (IMU) sensor and a data acquisition system. Along with a full description of how the terrain profiles were produced, a methodology to compensate for the tractor motion was included in the sensor data analysis. In field profiling validation, two trapezoidal bumps with known dimensions were used to assess the ability of the terrain profiler to reproduce the vertical profiles of the bumps, resulting in root mean square error (RMSE) of 3.6-4.7 mm and 4.5-5.1 mm with profiling speeds of 1.02 and 2.56 km/h, respectively. In addition, a validation test was also conducted on an asphalt road by profiling a flat road with the measuring wheels of the profiler rolling on the flat section but with the tractor wheels driving over a trapezoidal bump to excite the tractor pitch and roll motion. The measured profiles then also exhibited a flat road, which showed the ability of the profiler to remove the tractor motion from the profiling measurements.

As a first-generation epidermal growth factor receptor-tyrosine kinase inhibitor, gefitinib was approved by the US Food and Drug Administration for treatment of advanced non-small cell carcinoma with sensitizing EGFR mutations. Gefitinib is known to have adverse effects, which may necessitate dose reduction or even change to alternative preparation of epidermal growth factor receptor-tyrosine kinase inhibitor. There has been concern on dose reduction resulting in reduced dose gefitinib, especially on its efficacy. This was a retrospective single-center cohort study conducted in Queen Mary Hospital in Hong Kong that included 159 Chinese patients with advanced adenocarcinoma of lung that carried sensitizing EGFR mutations and had received gefitinib as first-line treatment. Patients who had reduced dose at 250 mg alternate day were compared with those who were able to maintain on standard dose of gefitinib at 250 mg daily. The primary end-point was progression-free survival. Among the 159 patients, 17 (10.7 %) of them were on reduced dose gefitinib, 14 among the 17 patients (82.4%) because of hepatotoxicity, and 3 (17.6%) because of cutaneous side effects. Patients on reduced dose and standard dose of gefitinib have comparable median progression-free survival. Hazard ratio was 1.121 (95% confidence interval = 0. 655-1.917, P-value = 0.678) for the reduced dose group and 3.385 for the standard dose group (95% confidence interval = 2.181-5.255) respectively (P-value < 0.001). Dose reduction in gefitinib to 250 mg alternate day in response to adverse effects was not associated with inferior outcome for patients on first-line gefitinib for advanced non-small cell carcinoma. Dose reduction is a feasible option for patients who have significant adverse effects with gefitinib.

Previous research has shown that particulate matter (PM) in the air can be captured by vegetative barriers (VB) serving as shelter against the wind; however, there is only limited research of factors affecting their efficiency. This study used computational fluid dynamics to predict particle collection efficiency (CE) of VBs, as affected by hedge geometry (i.e., the size expressed in terms of height, depth, and leaf surface area density [LSAD]) and the number of hedgerows. The experimental data of Tiwary et al. (Journal of Aerosol Science, 2005) were used for model parametrisation. The area of wind speed reduction, protection area and mean collection efficiency were defined and calculated to evaluate the effectiveness of VBs on sheltering function and particle collection. Simulation results predicted that compared with original size, increasing the height and LSAD of the hedge resulted in a greater decrease of wind speed. Increasing the depth of the hedge had the greatest effect on particle collection with 42.4% for dp = 15 μm, more effective than increasing the height or LSAD. Adding another row of hedge also increased the capability of the hedge in wind speed reduction and particle collection, while row spacing did not show great effect. The increasing rate of mean CE by adding a hedgerow was less than that by increasing hedge size, which more than double the CE of particles with diameter greater than 4.25 μm. Field measurements and additional simulation tests need to be conducted under different conditions for model validation.

Coronavirus Disease 2019 (COVID-19) led to pandemic that affected almost all countries in the world. Many countries have implemented border restriction as a public health measure to limit local outbreak. However, there is inadequate scientific data to support such a practice, especially in the presence of an established local transmission of the disease.To apply a metapopulation Susceptible-Exposed-Infectious-Recovered (SEIR) model with inspected migration to investigate the effect of border restriction as a public health measure to limit outbreak of coronavirus disease 2019.We apply a modified metapopulation SEIR model with inspected migration with simulating population migration, and incorporating parameters such as efficiency of custom inspection in blocking infected travelers in the model. The population sizes were retrieved from government reports, while the number of COVID-19 patients were retrieved from Hong Kong Department of Health and China Centre for Disease Control (CDC) data. The RComplete border closure can help to reduce the cumulative COVID-19 case number and mortality in Hong Kong by 13.99% and 13.98% respectively. To prevent full occupancy of isolation facilities in Hong Kong; effective public health measures to reduce local REarly complete travel restriction is effective in reducing cumulative cases and mortality. However, additional anti-COVID-19 measures to reduce local R

Background Coronavirus Disease 2019 (COVID-19) led to pandemic that affected almost all countries in the world. Many countries have implemented border restriction as a public health measure to limit local outbreak. However, there is inadequate scientific data to support such a practice, especially in the presence of an established local transmission of the disease. Objective To apply a metapopulation Susceptible-Exposed-Infectious-Recovered (SEIR) model with inspected migration to investigate the effect of border restriction as a public health measure to limit outbreak of coronavirus disease 2019. Methods We apply a modified metapopulation SEIR model with inspected migration with simulating population migration, and incorporating parameters such as efficiency of custom inspection in blocking infected travelers in the model. The population sizes were retrieved from government reports, while the number of COVID-19 patients were retrieved from Hong Kong Department of Health and China Centre for Disease Control (CDC) data. The R0 was obtained from previous clinical studies. Results Complete border closure can help to reduce the cumulative COVID-19 case number and mortality in Hong Kong by 13.99% and 13.98% respectively. To prevent full occupancy of isolation facilities in Hong Kong; effective public health measures to reduce local R0 to below 1.6 was necessary, apart from having complete border closure. Conclusions Early complete travel restriction is effective in reducing cumulative cases and mortality. However, additional anti-COVID-19 measures to reduce local R0 to below 1.6 are necessary to prevent COVID-19 cases from overwhelming hospital isolation facilities.

Background Considerable experimental and clinical evidences have proved that human umbilical cord mesenchymal stem cells (UC-MSCs) transplantation was powerful in systemic lupus erythematosus (SLE) treatment. MSCs could upregulate regulatory B cells (Bregs) in the mice model of the other immune disease. However, the regulation of MSCs on Bregs in SLE environment remains unclear. Methods To assess the abilities of UC-MSCs to treat SLE, MSCs were transferred intravenously to 17- to 18-week-old MRL/lpr mice. Four weeks later, mice were sacrificed. Survival rates, anti-dsDNA antibodies and renal histology were evaluated. CD4+ T helper (Th) cell subgroups and interleukin (IL)-10+ Bregs (B10) in the spleen were quantitated by flow cytometry. The changes of transforming growth factor (TGF)-β1, IL-6 and indoleamine 2,3-dioxyenase (IDO) mRNAs expressed by MSCs after co-cultured with B cells were detected using real-time polymerase chain reaction (RT-PCR). MSCs were infected by lentivirus carrying TGF-β1 shRNAs, then MSCs with low expression of TGF-β1 were conducted for co-culture in vitro and transplantation experiments in vivo. Results UC-MSCs transplantation could efficiently downregulate 24 h proteinuria and anti-dsDNA antibodies, correct Treg/Th17/Th1 imbalances and increase the frequency of B10 cells. The expression of TGF-β1 in MSCs was significantly increased after co-culture with B cells. Downregulation of TGF-β1 in MSCs could significantly attenuate the upregulation of B10 by MSCs in vitro and in vivo. Downregulation of TGF-β1 also compromised the immunomodulation effects of MSCs on Th17 and Treg cells and the therapeutic effects of MSC transplantation. Conclusions UC-MSCs could protect against SLE in mice and upregulate IL-10+ Bregs via TGF-β1.

This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of novel lipoglycopeptides in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov were searched from inception to 20 May 2021. Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of lipoglycopeptides with other comparators in treating adult patients with ABSSSIs were included. The primary outcome was clinical response. Eight RCTs (6416 patients; lipoglycopeptides: 3359, comparators: 3057) were enrolled. Clinical response rate was not significantly different between lipoglycopeptides and comparators at early-clinical-evaluation (odds ratio [95% confidence interval]: 1.01 [0.85–1.20], I2 = 34%), end-of-treatment (0.94 [0.80–1.11], I2 = 0%), and test-of-cure (1.05 [0.85–1.30], I2 = 0%). Lipoglycopeptides showed a similar overall microbiological eradication rate (1.12 [0.90–1.38], I2 = 21%) but a borderline higher microbiological eradication rate for methicillin-resistant Staphylococcus aureus (1.37 [1.00–1.86], I2 = 0%) than the comparators. Lipoglycopeptides were not associated with a higher risk than comparators. Lipoglycopeptides can achieve similar clinical and microbiological responses to other comparators in treating ABSSSIs. In addition, lipoglycopeptides are as tolerable as their comparators.

Background Nephrotoxicity is one of the concerns of prolonged maintenance therapy with pemetrexed. No reversible risk factors for pemetrexed-induced nephrotoxicity have been identified in previous studies. Identification of such factors would be clinically meaningful to maximize the chemotherapeutic benefits by avoiding premature termination of maintenance therapy which might otherwise result from the development of renal impairment. Methods This was a retrospective single-center cohort study conducted in Queen Mary Hospital in Hong Kong. The study included 134 patients with advanced stage non-squamous NSCLC that received first line pemetrexed-platinum doublets followed by maintenance pemetrexed. The primary endpoint was the occurrence of nephrotoxicity. The risk factors of nephrotoxicity were identified. Results Presence of non-evacuated third-space fluid during treatment course (OR 4.185, 95% CI = 1.150–15.191, p-value 0.030), the use of cisplatin (instead of carboplatin) during the induction phase (OR 8.761, 95% CI = 1.684–45.577, p-value 0.010) and receiving more than 15 cycles of maintenance pemetrexed (OR 3.839, 95% CI = 1.022–14.413, p-value 0.046) were identified as independent risk factors to the development of nephrotoxicity associated with maintenance pemetrexed use. Conclusions In order to reduce the risk of development of nephrotoxicity in NSCLC patient receiving first-line pemetrexed-platinum doublets, third-space fluid should be evacuated and carboplatin should be chosen over cisplatin whenever possible.

This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05, 95% CI, 0.90–1.23, I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62, 95% CI, 0.40–0.97, I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41, 95% CI, 1.07–1.85, I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.

This paper proposed an innovative real-time embedded control system for satellite scanning mirror mechanism. The mechanism element was assembled with two supporting pivots on the axis with an angular sensor and a voice motor accurate. The control precision of the scanning mirror is stringent in space remote target detection, at the same time angle position of the equipment was required to send to ground on time. The implementation of the embedded hardware and algorithm system are described in steps. The scanning mirror mechanism with voice-coil motor is identified and a forward feedback control topology is been described to realize the position trajectory control of the prototype. The prototype mechanism using the BMTI microcontroller 32 bit for the voice-coil motor control is exhibited. A real-time bidirectional data exchange between the microcontroller and the computer with user definition protocols 422 electrical bus is presented.

This meta-analysis investigated the clinical benefits of chemo-immunotherapy in extensive-stage small-cell lung cancer (ES-SCLC). Seven randomized controlled trials with a total of 2862 patients were analyzed. Compared with chemotherapy alone, chemo-immunotherapy provided a better progression-free survival (PFS) with a hazard ratio (HR) of 0.81, p 0.00001, and overall survival (OS) with a HR of 0.82, p 0.0001; however, the incidence of treatment-related adverse effects (TRAEs) was significantly increased. Subgroup analyses showed that good performance status, cisplatin-based chemotherapy, without brain metastases at baseline and non-Asian populations were associated with greater benefits in OS from chemo-immunotherapy. Chemo-immunotherapy demonstrated better PFS and OS compared with chemotherapy alone as first line treatment in ES-SCLC, but additional TRAEs should be closely monitored.Lung cancer is the leading cause of cancer deaths worldwide, of which small-cell lung cancer (SCLC) is an extremely lethal type, because most patients present with incurable, extensive-stage SCLC (ES-SCLC). The standard first-line treatment for ES-SCLC for the last 30 years has been chemotherapy. Immunotherapies have recently been introduced as cancer treatments, and have shown the potential to provide a higher and more durable treatment response with relatively tolerable toxicity. This study systematically assessed the results of previous research and provided evidence that add-on immunotherapy with standard chemotherapy as the first line treatment in ES-SCLC offered great improvement in survival, but patients should be closely monitor for additional side effects.

Background Numerous studies have shown that major depressive disorder (MDD) is characterized by a range of impairments in emotional and cognitive functions that are closely related to abnormalities in brain structure and function. Cognitive behavioral therapy (CBT) can be used as treatment for mild to moderate MDD, which can assist with ameliorating the symptoms. Previous studies have assumed that the internal fluctuations throughout the entire scan are static. However, it has recently been suggested that the brain connectivity is dynamic and relative to continuous rhythmic activity. The effect of dynamic changes in CBT on MDD patients is unknown. Methods Nineteen first-episode, unmedicated MDD patients and twenty-two healthy controls (HC) participated in the study. The patients received early CBT treatment once a week for 6 weeks. Symptom examinations and magnetic resonance imaging (MRI) scans were performed pre and post treatment. Degree centrality (DC) was used to investigate the whole-brain connectivity differences between patients with MDD and healthy controls, and sliding window correlation analysis was applied to investigate the dynamic changes of functional connectivity among MDD patients treated with CBT. The variance of dynamic functional connectivity (dFC) was calculated to evaluate the temporal variability along the time. Results Patients with MDD showed abnormal DC in dorsolateral prefrontal cortex (dlPFC), insula and postcentral gyrus. Correlation analysis revealed that degree centrality of dlPFC was negatively correlated with the course of disease in patients with MDD. Results of dynamic functional connectivity showed that, compared to HC, MDD patients-remained excessively stable in dlPFC and precuneus connectivity, which is associated with emotional cognitive symptoms. After CBT, patients showed increased dFC variability in dlPFC and precuneus (p Conclusion DLPFC plays an important role in pathophysiological mechanism of MDD. CBT helped patients suppress redundant thoughts and negative self-focus. As a connecting node, dlPFC participates in the mechanism of action of CBT.

ObjectivesTo assess the gender differences in the prevalence of carotid vulnerable plaques in high-risk individuals for stroke in a multicenter, cross-sectional study.MethodsIn the year 2015, 18595 residents who were at the age of 40 or older participated in a face-to-face study in eight communities in southwestern China. Totally 2,644 participants at high risk of stroke were enrolled. Before and after propensity score matching (PSM), the prevalence of carotid plaques and vulnerable plaques were compared between men and women. Multivariate analyses were applied to explore the association between the gender and carotid plaques. Stratified analyses and interaction tests were performed to identify factors that might modify the association between the gender and carotid plaques.ResultsAmong 2644 high-risk individuals enrolled, there were 1,202 (45.5%) men and 1442 (54.5%) women. Carotid plaques were detected in 904 (34.2%) participants, while vulnerable plaques were found in 425 (16.1%) participants. Before PSM, carotid plaques were more prevalent in male individuals than the female (36.7% vs. 32.1%, p = 0.01), as well as vulnerable plaque (20.0% vs. 12.8%, p < 0.01). Men tend to have a higher prevalence of vulnerable plaques in multivariate analyses (adjusted OR 1.70, 95% CI 1.10–2.62, p = 0.02). Stratified analyses and interaction tests demonstrated that the association between male sex and vulnerable carotid plaque did not change by age, family history of stroke, histories of chronic disease, smoking status, drinking status, physical activity, and BMI (all p for interaction > 0.05). After PSM, vulnerable plaques were still more prevalent in male individuals than the female (17.03% vs. 12.07%, p = 0.032).ConclusionMale individuals had a higher risk of vulnerable carotid plaque independent of classical vascular risk factors. Whether there is a gender-specific association between variations in genes related to inflammation, lipid metabolis, and endothelial function and plaque vulnerability needs to be further studied.

Background Pseudomonas aeruginosa is one of the commonest bacteria colonizing the airway in patients with non-cystic fibrosis bronchiectasis. Pseudomonas aeruginosa colonization is associated with poor outcomes in patients with bronchiectasis, including rapid decline in lung function, exacerbation frequency and hospitalization. Methods A cross-sectional study in Queen Mary Hospital, Hong Kong that included 350 Chinese patients with non-cystic fibrosis bronchiectasis to investigate the risk factors for Pseudomonas aeruginosa colonization and clinical implications on disease outcomes. Discussions Pseudomonas aeruginosa colonization was more commonly found in patients with longer duration of bronchiectasis and those on proton pump inhibitors (PPIs) with adjusted ORs of 1.066 (95% CI = 1.036–1.096, p p = 0.008) respectively. Patients with Pseudomonas aeruginosa colonization have more extensive lung involvement and higher risks of exacerbation requiring hospitalization with adjusted ORs of 2.445 (95% CI = 1.283–4.657, p = 0.007) and 2.745 (95% CI = 1.012–7.449, p = 0.047) respectively. Pseudomonas aeruginosa colonization is more common among patients with longer duration of bronchiectasis and those on PPI. Pseudomonas aeruginosa colonization is associated with more extensive lung involvement and higher risks of exacerbation requiring hospitalization.

Objective To investigate the effects of the Chinese herbal medicine Xiaoaiping to treat chemotherapy-induced side effects in breast cancer patients. Methods Ninety-three adult patients who attended our hospital and met the entry criteria from January 2016 to December 2017 were included. Patients were randomly divided into the control group (routine chemotherapy only) and the combined group (routine chemotherapy and Xiaoaiping). Demographic data and clinical variables were collected, and side effects including alopecia, nausea and vomiting, diarrhea, white blood cell (WBC) count, aspartate aminotransferase (AST) levels, and the quality of life were evaluated. Results Basic clinical characteristics were not different between the groups. There were significantly fewer patients with alopecia grade 3–4, but significantly more patients with alopecia grade 1–2, in the combined group compared with the control group. Disease-free time for alopecia was longer in the combined compared with the control group. Overall, the side effects were significantly more serious in the control compared with the combined group. Patients in the combined group had better quality of life than the control patients. Conclusion Xiaoaiping can improve alopecia, nausea and vomiting, and diarrhea symptoms, WBC count, AST levels, and the quality of life in breast cancer patients.

Background and objective Bronchiolitis obliterans syndrome (BOS) after haematopoietic stem cell transplantation (HSCT) presents with lung function decline. The pattern of lung function decline after BOS diagnosis could impact prognostication of BOS as a complication after HSCT. The aim of this study was to assess the impact of lung function decline on overall survival (OS) in BOS subjects. Methods Subjects with BOS were compared to those without BOS and matched for age, gender, primary diagnoses, conditioning regimes and chronic graft versus host disease. Lung function tests at baseline, at BOS diagnosis and every 3 months after HSCT were evaluated. Results Of the 1461 subjects undergoing allogeneic HSCT (allo-HSCT) between 1998 and 2015, 95 (6.5%) were diagnosed with BOS. A total of 159 matched HSCT recipients without BOS were identified. A 25% decline in FEV1 within the first 3 months after BOS diagnosis would separate BOS subjects into a subgroup with initial rapid decline and another subgroup with initial gradual decline in lung function. The rapid decline group showed lower subsequent lung function parameters and significantly worse OS compared to the gradual decline group (P = 0.013). Conclusion Post-HSCT BOS subjects with initial rapid lung function decline within 3 months after BOS diagnosis will have significantly poorer lung function and worse OS compared to those with initial gradual decline in lung function after BOS diagnosis. HSCT BOS patients with rapid initial decline in lung function warrant closer monitoring for the development of other post-HSCT complications that could affect their survival.

To address the shortcomings of the existing linear power flow calculation methods for distribution networks with low versatility and calculation accuracy, a linear power flow calculation method considering distributed generation (DG) is proposed. According to the characteristics of distribution networks and using the Taylor series expansion technology, the nonlinear terms of the basic power flow equation are linearized. The reactive power generated by the non-PV type DG is simplified to a quadratic function of the voltage amplitude. Then, combined with linear approximation and the simplified DG calculation model, the basic power flow equation is simplified into a linear form. Based on the linear power flow equation, a linear power flow calculation method for distribution networks with DG is proposed. The proposed method, which considers various types of DG, has a strong versatility. Finally, the calculation results of typical test systems show that compared with the existing linear power flow calculation methods, the proposed method has a higher calculation accuracy and more versatility and can be used for rapid analysis of distribution networks.

In order to improve the capability of soft fault diagnosis in an analog circuit, an integrated diagnosis method based on KSLPP feature extraction and ELM is proposed. The KSLPP feature extraction ability is firstly used to construct the principal component feature set from the fault sample set. Then, the advantage of ELM on solving the complicated nonlinearity problem is applied to build the fault identification model from the principal component feature. Finally, the sample sets of soft fault diagnosis for the analog circuit are respectively established by waveform parameter and wavelet packet transform to conduct the diagnostic test for the built model. The simulation of Elliptic Filter shows that, based on the fault sample set gotten by waveform parameter, the total correct rate of the integrated method is 98.2%; on the basis of the fault sample set built by wavelet packet transform, the total correct rate is 100%. The feasibility and effectiveness of this method are also validated.

The objective of this study was to investigate changes in intestinal histopathology and expression of heat-shock proteins (HSPs) in the small intestinal tissue of mouse after acute exposure to dibutyl phthalate (DBP). Forty-eight 60-day-old Institute of Cancer Research (ICR) mice were administered DBP by gavage once a day for 10 days. The mice were divided into three groups of 16 mice each: the high-dose group was administered 500 mg/kg body weight (BW) DBP; the low-dose group was administered 50 mg/kg BW; and the control group was not administered DBP. Significant increases in the uterine index, ovary index, and testicular index were observed in the DBP-exposed groups compared to those in the control group. Villus height and V/ C ratio significantly increased ( p < 0.05) in the duodenum and decreased ( p < 0.05) in the jejunum after the administration of DBP. The goblet cell number decreased in both the duodenum and the jejunum of mice exposed to DBP ( p < 0.05) compared to the number in the control group mice. Damage to the structure of the small intestine was accompanied by a marked increase in HSP27 expression and a decrease in the expression of HSP70 and HSP90 in both high-dose and low-dose groups. These results indicate that elevated HSP27 levels in the duodenum and jejunum may be important markers for acute DBP exposure and that HSP27 may act as a protective protein involved in intestinal mucosa repair.

Based on the engineering environment where rocks surrounding wellbores in energy storage areas are influenced by high temperature, cool and hot water, thermal stress etc. in the exploitation of hydrothermally geothermal energy, the experimental study on mechanical properties of ring granite under the static and dynamic loads in the water-heat condition was performed. The experimental results showed that when the ring granite was influenced by the inner diameters, heating temperatures, curing temperatures and heat recovery cycle times, the impact load-strain curves were nonlinear. However, the concave stages, platform stages and cliff-like drop stages appeared in the load-strain curves under the static loads. The radical peak loads decreased exponentially with the growth of the damage factors and the dynamic peak loads were far greater than the static peak loads. By analyzing the damage cracks and broken fragments, it was found that under the static and dynamic radical loads, the cracks generated in the ring specimens were tensile cracks and the failure mode was tensile failure. However, the dynamic failure was more aggressive than the static failure. Then, the apparent deformation modulus was defined to describe the deformation characteristics of ring granite before the radical peak loads. And it is found that the variation law of dynamic apparent deformation modulus is more dispersed than the changes of static apparent deformation modulus. Finally, based on the deformation and failure characteristics of ring granite obtained from the tests, the static and dynamic failure criteria considering whether the cracks along the loading direction were generated in the inner ring wall were deduced and verified by the corresponding tests.

Objective The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to investigate the efficacy of interferon (IFN)-β-containing regimens in treating patients with COVID-19. Methods PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to July 17, 2021. RCTs comparing the clinical efficacy and safety of IFN-β-containing regimens (study group) to other antiviral treatment options or placebo (control group) in treating patients with COVID-19 were included. Results : Eight RCTs were included. No significant difference in the 28-day all -cause mortality rate was observed between the study and control groups (OR, 0.74; 95% CI, 0.44-1.24; I2 = 51%). The study groups had a lower rate of intensive care unit (ICU) admissions than the control groups (OR 0.58, 95% CI 0.36-0.95; I2 = 0%). Furthermore, INF-β was not associated with an increased risk of any adverse event (AE) or serious AE when compared with the control group. Conclusions IFN-β does not appear to provide an increased survival benefit in hospitalized patients with COVID-19, but may help reduce the risk of ICU admission. Moreover, IFN-β is a safe agent for use in the treatment of COVID-19.

Background Pemetrexed was approved by United States Food and Drug Administration (US FDA) in combination with platinum for the treatment of advanced non-squamous non-small cell lung carcinoma (NSCLC) and malignant mesothelioma. Due to the structural similarity with methotrexate, there has been concern about the accumulation of pemetrexed in third space fluid that may result in increased toxicity. Previous small-scale studies have yet to conclusively prove this association. Methods This was a retrospective single-center cohort study conducted in Queen Mary Hospital in Hong Kong. The study included 329 patients with advanced stage non-squamous NSCLC that received first line pemetrexed and platinum. Patients who had non-evacuated third-space fluid, evacuated third-space fluid and without third-space fluid were compared. The primary endpoint was the occurrence of hematological toxicity. Results The presence of non-evacuated third-space fluid was shown to be associated with significantly more hematological toxicities, namely grade 3 or above hematological toxicities [Odd ratio (OR) = 2.450, p = 0.002], postponement of chemotherapy (OR = 3.837, p = 0.000) and need for dose adjustment (OR = 2.436, p = 0.022) when compared with those without third-space fluid. For patients with evacuated third-space fluid, these adverse effects were nullified. Conclusions Presence of non-evacuated third-space fluid in patients with advanced non-squamous NSCLC predispose patients to significant hematological toxicity when pemetrexed and platinum chemotherapy is used. Evacuation of third-space fluid should be considered before starting pemetrexed and platinum doublet.

Distribution automation terminals play a crucial role in distribution automation systems to deliver real-time monitoring and fault detection. It is of significance to determine where and how many terminals should be allocated in distribution networks for the best benefit. This paper proposes an optimal allocation model of distribution automation terminals. Firstly, the reliability calculation of distribution networks with distribution automation terminals is performed. Then, the ratio between the reliability improvement degree and the comprehensive cost of newly installed distribution automation terminals is defined as the incremental benefit evaluation index. The optimal allocation model aims to consider a tradeoff between distribution system reliability and economy by not only achieving maximum incremental benefit but also satisfying the reliability requirement. This model also plans the installation types, positions and quantity of distribution automation terminals. Finally, cuckoo search algorithm (CSA) which can efficiently obtain the global optimal solution is used to solve the model. The rationality and validity of the proposed model are verified by IEEE RBTS BUS-2 system.

How to cite this article: Xiao-Bo H, Poonyathawon S, Semedi BP, Xiao-Yi Z, Wei F, Da-Wei W, et al. International-focused Online Forum: A Good Way to Jointly Manage the COVID-19 Pandemic for Global Critical Care Community. Indian J Crit Care Med 2020;24(4):283-284.