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Although activation of hepatic stellate cells (HSCs) plays a central role in the development of liver fibrosis, the mechanism underlying the activation of HSCs remains unclear. Keratin 17 (KRT17), a member of the intermediate filament family, can regulate tumor cell proliferation and migration. The current study aimed to elucidate the role of KRT17 in the activation of HSCs and the mechanisms underlying liver fibrosis.The expression of KRT17 was determined using immunohistochemistry in tissue microarray. Western blotting and qRT-PCR assays were used to determine the KRT17 expression in fibrotic liver tissues obtained from human subjects and mice. LX-2 cells were treated with TGF-β1 recombinant protein and adipocyte differentiation mixture (MDI) mix to induce and reverse LX-2 cell activation, respectively, in order to explore the correlation between KRT17 and HSC activation. Additionally, cell proliferation and migration abilities of LX-2 cells transfected with KRT17-overexpressing plasmid or small interfering RNA were determined using CCK-8, flow cytometry, Transwell, and wound healing assays. Finally, rescue assay was used to explore the role of KRT17 in HSC activation and epithelial-mesenchymal transition (EMT).The expression of KRT17 was higher in the human and mouse fibrotic liver tissues than in healthy liver tissues, and it was positively correlated with HSC activation. Upregulated KRT17 enhanced proliferation, migration, HSC activation and EMT in LX-2 cells, while knockdown of KRT17 reversed these effects. TGF-β1 recombinant protein accelerated KRT17-mediated EMT, HSC activation and proliferation, while TGF-β1 inhibitor counteracted the effect of KRT17KRT17 promoted HSC activation, proliferation and EMT in hepatic fibrosis probably via TGF-β1 signaling, and KRT17 might serve as a therapeutic target for the treatment of liver fibrosis.

BACKGROUND The longitudinal association between persistent moderate to severe pain and subsequent long-term cognitive decline remains inconclusive. METHODS Study population came from the English Longitudinal Study of Ageing, an ongoing prospective and nationally representative cohort of community-dwelling adults aged ≥50 years in England. At waves 1 (2002/2003) and 2 (2004/2005) of the study, pain severity was measured based on pain intensity scores ranged from 0 to 10. We defined moderate to severe pain as pain intensity scores ≥5 points. Persistent moderate to severe pain was defined as participants reported moderate to severe pain at both waves 1 and 2. Standardized global cognitive Z scores derived from verbal memory, temporal orientation and semantic fluency were used as the primary outcome. RESULTS A total of 6,869 individuals (3,896 women; mean age: 63.9 ± 9.5 years) who have accepted twice measurements of pain at waves 1 and 2 (baseline), and at least one reassessment of cognitive function at waves 3 (2006/2007) to 8 (2016/2017), were included in this study. Each 5-point increase in the sum of pain intensity scores was associated with a faster rate of -0.009 (95% CI: -0.013 to -0.006, p

Recent advances in end-to-end continuous-flow synthesis are rapidly expanding the capabilities of automated customized syntheses of small-molecule pharmacophores, resulting in considerable industrial and societal impacts; however, many hurdles persist that limit the number of sequential steps that can be achieved in such systems, including solvent and reagent incompatibility between individual steps, cumulated by-product formation, risk of clogging and mismatch of timescales between steps in a processing chain. To address these limitations, herein we report a strategy that merges solid-phase synthesis and continuous-flow operation, enabling push-button automated multistep syntheses of active pharmaceutical ingredients. We demonstrate our platform with a six-step synthesis of prexasertib in 65% isolated yield after 32 h of continuous execution. As there are no interactions between individual synthetic steps in the sequence, the established chemical recipe file was directly adopted or slightly modified for the synthesis of twenty-three prexasertib derivatives, enabling both automated early and late-stage diversification., Although strategies for the automated assembly of compounds of pharmaceutical relevance is a growing field of research, the synthesis of small-molecule pharmacophores remains a predominantly manual process. Now, an automated six-step synthesis of prexasertib is achieved by multistep solid-phase chemistry in a continuous-flow fashion using a chemical recipe file that enables automated scaffold modification through both early and late-stage diversification.

The decline of fossil fuels is fostering research on carbon–neutral fuels such as nuclear energy, yet uranium supply is limited by actual techniques of uranium extraction from seawater. In particular, biofouling by marine bacteria and adsorbent instability are major drawbacks. Here we synthesized a novel amidoxime-functionalized antibacterial covalent organic framework that displays high stability and inhibits more than 90% the growth of marine bacteria, thus resulting in an enhanced uranium recovery capacity of 6.64 mg/g. Meanwhile, due to its exceptional fluorescence properties, the adsorbent can also be applied to highly sensitive on-site and real-time monitoring of UO22+.

Meeting the demand for fresh water and energy is among the major challenges to the development of human civilization. Herein, we report the concept of a covalent organic framework hydrogel (named CPP) as a synergistic platform for seawater desalination and uranium extraction. In natural seawater, CPP shows an exceptional evaporation rate (0.744 kg m−2 h−1) and uranium extraction capacity (4.15 mg g−1), which benefits from the hydrophilic 3D hydrogel network and capillary microporous channels of CPP providing adequate water transport, improving the mass transfer of uranyl ions, and increasing the binding sites of uranyl ions. In addition, CPP exploits interfacial solar heating to limit heat, increases solar energy utilization, and further accelerates the coordination between uranium and binding sites. The excellent photocatalytic effects endow CPP with high anti-biofouling activity, achieving long-term solar desalination and highly efficient uranium extraction. The connection between freshwater and nuclear energy is realized in a new material providing an opportunity to meet the growing needs of mankind.

Chronic actinic dermatitis (CAD) is a common debilitating photodermatosis. Patients often have to completely avoid outdoor activities, which severely impacts their quality of life. Phototherapy is effective for CAD and seems to increase patients' tolerance towards sunlight and consequently decrease the extent of disease. Unfortunately, the slower onset and time-consuming nature of phototherapy limits the clinical application. Considering the effectiveness and time-saving nature of ultraviolet (UV)-A rush hardening in solar urticaria, we performed a pilot study to determine whether UV-A rush hardening is effective in CAD. Six patients with CAD were exposed to multiple sessions of UV-A for 4-5 days at 1-h intervals/day. Subsequently, maintenance UV-A exposure was performed at 1-2-week intervals. Phototesting at baseline showed that three patients were sensitive to both UV-A and -B, and the other three patients only showed UV-A sensitivity. All of the patients responded well to UV-A rush hardening and four (67%) maintained a good remission status after 1 year. The results of this pilot study suggest that UV-A rush hardening phototherapy is effective and well tolerated in the treatment of CAD, while future larger prospective studies using objective scores of disease activity and quality of life are needed.

Background: Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Seldom study has compared the application of three-dimensional (3D) printing technology and traditional methods of contouring plates intra-operatively for the surgical treatment of both-column acetabular fractures. We presented the use of both 3D printing technology and a virtual simulation in pre-operative planning for both-column acetabular fractures. We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes. Methods: Forty patients with both-column acetabular fractures were recruited in the randomized prospective case-control study from September 2013 to September 2017 for this prospective study (No. ChiCTR1900028230). We allocated the patients to two groups using block randomization (3D printing group, n = 20; conventional method group, n = 20). For the 3D printing group, 1:1 scaled pelvic models were created using 3D printing, and the plates were pre-contoured according to the pelvic models. The plates for the conventional method group were contoured during the operation without 3D printed pelvic models. The operation time, instrumentation time, time of intra-operative fluoroscopy, blood loss, number of times the approach was performed, blood transfusion, post-operative fracture reduction quality, hip joint function, and complications were recorded and compared between the two groups. Results: The operation and instrumentation times in the 3D printing group were significantly shorter (130.8 ± 29.2 min, t = －7.5, P < 0.001 and 32.1 ± 9.5 min, t = －6.5, P < 0.001, respectively) than those in the conventional method group. The amount of blood loss and blood transfusion in the 3D printing group were significantly lower (500 [400, 800] mL, Mann-Whitney U= 74.5, P < 0.001 and 0 [0,400] mL, Mann-Whitney U = 59.5, P < 0.001, respectively) than those in the conventional method group. The number of the approach performed in the 3D printing group was significantly smaller than that in the conventional method group (pararectus + Kocher-Langenbeck [K-L] approach rate: 35% vs. 85%; x2 = 10.4, P < 0.05). The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group (4.2 ± 1.8 vs. 7.7 ± 2.6 s; t = －5.0, P < 0.001). The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group (good reduction rate: 80% vs. 30%; x2 = 10.1, P < 0.05). The hip joint function (based on the Harris score 1 year after the operation) in the 3D printing group was significantly better than that in the conventional method group (excellent/good rate: 75% vs. 30%; x2 = 8.1, P < 0.05). The complication was similar in both groups (5.0% vs. 25%; x2 = 3.1, P = 0.182). Conclusions: The use of a pre-operative virtual simulation and 3D printing technology is a more effective method for treating bothcolumn acetabular fractures. This method can shorten the operation and instrumentation times, reduce blood loss, blood transfusion and the time of intra-operative fluoroscopy, and improve the post-operative fracture reduction quality. Clinical trail registration: No.ChiCTR1900028230; http://www.chictr.org.cn Key words: Both-column; Acetabulum fractures; Computer simulation; Three-dimensional printing; Internal fracture fixation

Background Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. Methods Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. Results All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P Conclusions The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.

Background Dental injury is an underrecognized preventable complication during endoscopy. An audit of same-day procedure cancellation in our endoscopy center showed that 43% of cases are related to tooth safety concerns. A review of the literature showed that dental injury was under-reported in endoscopy related journals but an important issue in anaesthesia. Dental injury in anaesthesia is variably estimated to occur at a rate of approximately one in 1,000 to 4,500. It represents up to half of all anaesthetic claims. We reviewed the preventive measures and management strategy of dental injury. Methods We have reviewed the available literature and worked with a dental expert to suggest a few steps to improve tooth safety during endoscopy: Results Key steps in preventive measures: 1) Pre-endoscopic tooth screening: Optimal pre-endoscopic assessment should include a comprehensive dental assessment, documentation and explanation of individualized risk involved. 2) Identification of risk factors: Evidence of periodontal disease and its infective complications, pre-existing dental pathology such as missing or loose teeth, and dental restorations. 3) Comprehensive documentation of pre-existing dental defects prior to endoscopy should be done. Key steps in dental injury management: 1) Early involvement of dentist: If a dental injury occurs or a missing tooth is found during endoscopy, a dentist should be called to do an on-table consult. 2) Tooth retrieval whenever possible: If the dentist is unavailable or delayed, the missing tooth should be localised and retrieved. Upon retrieval of the tooth or tooth fragments, the dental officer on-call should be consulted for specific management. 3) Radiographic assistance: If localisation is not possible, a chest X-ray should be done, with the consultation of Thoracic Surgery. Conclusions We encourage these simple measures to be implemented in the clinic and endoscopy center to prevent dental injury during endoscopy.

In this letter, a broadband self-interference (SI) suppression structure is presented for collinear dipoles. By using this structure, an average SI improvement of 21.6 dB is realized within the frequency band of 2.2–2.7 GHz. It has a 14.8% operating bandwidth of transmit-receive isolation higher than 50 dB. The working mechanism and bandwidth extension are discussed. Moreover, the key parameters and the influence of the proposed structure to the dipoles were also studied and presented. Measured results demonstrate that this design provides a wider operating bandwidth, omnidirectional radiation patterns, and ideal distribution distance. It is effective and suitable for reducing the SI between collinear dipoles.

A broadband dual-polarised antenna with wideband decoupling structure is presented. By using the improved dipole, the proposed antenna achieves a common impedance bandwidth of 62% ranging from 1.645 to 3.13 GHz with standing a wave ratio 90.9%) and high cross polarisation discrimination. It is very suitable for polarisation diversity wireless communication application.

PURPOSE The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC). Methods Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed. RESULTS We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs. CONCLUSION The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.

The demand and supply of talents are not balanced, and colleges and universities can not cultivate suitable talents resources for the society. To force the transformation of colleges and universities, the goal of the transformation reform is to train applied talents to adapt to the local economic and social development. The important link of the transformation is the reform of the training mode and the study mode. The study mode and the study effect of the students are directly related to the training quality of the applied talents. Blended learning mode is the combination of traditional classroom learning and information technology, it is the complement of online learning and traditional learning. Blended learning effectively promotes the efficient use of educational resources and makes the transfer of learning content unrestricted. Through the questionnaire survey and analysis, we provide a reliable research basis for the topic. Through the comparison of traditional learning and blended learning effectiveness evaluation, the data is summarized and analyzed, and the blended learning model can make up for the lack of personalized learning in face-to-face collective teaching and can solve the problem. Online learning encounters the problem of nowhere to ask for advice.

The novel coronavirus pneumonia epidemic has brought many challenges to education and teaching, as well as new opportunities. The new crown epidemic has promoted the rapid development of online teaching. Online teaching is inseparable from the update and progress of information-based teaching management methods. Education management in China has entered the “post-epidemic era.” Based on the data analysis of the post-epidemic teaching questionnaire and multiple teaching management cases, this paper concludes that the new information-based teaching management is based on the combination of network technology and text, a combination of multiple teaching methods, and teaching technology and offline. Combination of information technology and teaching management, it can produce better teaching effect, increase flexibility and personalized teaching experience for teaching.

This article presents a novel electromyography (EMG)-driven exoneuromusculoskeleton that integrates the neuromuscular electrical stimulation (NMES), soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system can assist the elbow, wrist, and fingers to perform sequential arm reaching and withdrawing tasks under voluntary effort control through EMG, with a lightweight, compact, and low-power requirement design. The pressure/torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the developed system was evaluated on patients with chronic stroke (

The goal of this research is to design a proactive bus blind spot warning (PBSW) system which will notify the motorcycle riders as soon as they enter the blind spot of a target vehicle, i.e., bus. The motorcycle side of this PBSW system, consisting of a Raspberry Pi 3B+ and a dual-lens stereo camera, will first transmit captured images to the Android phone using Wi-Fi and then to the cloud server through the cellular network. At the cloud server, the famous AI model, YOLOv4, is used to recognize the position of the rear-view mirror of the bus. By the principle of lens imaging, the distance between the bus and the motorcycle is estimated. Based on the estimated distance returned from the cloud server, the PBSW APP running in the Android phone illustrates the visible area/blind spot of the bus, the position of the rider and the estimated distance between the motorcycle and the bus. It further alarms the rider whenever the rider has entered the blind spot of the bus. According to performance evaluation on this implemented system, it recognizes the rear-view mirror with the average accuracy of 92.82%, the error rate of the estimated distance lower than 0.2% and the average round trip delay of 0.5 sec. It is concluded that this PBSW system keeps the motorcycle rider away from imminent dangers in real time.

Background: Early extubation can reduce pulmonary complications in children undergoing cardiac surgery. The aim of this study is to evaluate the effects of sugammadex for postoperative respiratory management in children with congenital heart disease. Methods: Sixty children with congenital heart disease undergoing elective cardiac surgery were divided into group S and group C (30 children in each group). When post tetanic twitches count (PTC) = 1-2 and train-of-four (TOF) = 0, the children in group S received sugammadex4 mg/kg for reversal of neuromuscular block at the end of surgery, and the children in group C received the same volume of normal saline. The recovery time to TOF of 0.9, the mechanical ventilation and extubation times were recorded. On the other side, the hemodynamic parameters before and 5 min after administration, and side effects were also recorded. The levels of C-reactive protein (CRP) and procalcitonin (PCT) before and 24 h after surgery were measured. Results: The recovery time to TOF of 0.9 and extubation time were significantly shorter in the group S than in the group C (4.2 ± 1.4 vs 108.2 ± 26.7 min, 66.3 ± 6.5 vs 171.6 ± 23.1 min, respectively, P 0.05) with respect to side effects. Conclusion: Sugammadex is rapid and effective in reversing rocuronium-induced neuromuscular block, and significantly reduces the extubation time and the release of postoperative CRP and PCT in children with congenital heart diseases.

This study was aimed at effectively improving the interior comfortability of color ambience inside a command cabin, for which it proposed a color-perception-based command cabin interior color combination scheme that allows the interior color combination to suit the cabin crews’ psychological and physiological characteristics, hence improving their efficiency in operation and protecting their physical and mental health. To begin with, before any color combination procedures were carried out, samples of command cabins were collected, and correlation analysis was performed based on the samples’ color and morphological characteristics to determine the degree of similarity among the samples. The degrees of similarity obtained were then used to filter and narrow the samples down to a few typical representatives. Next, chart analysis techniques were adopted in combination with the Lab and HSB color models to determine the constituent Lab and HSB parameters of the samples. Then, starting from the target color image, quantitative analysis was performed from the perspectives of color linguistics and color ergonomics to quantify the color features and the moods of the cabin crews in relation to the color ambience, as represented by the data available. Furthermore, the thought process that led to the proposed command cabin interior color combination scheme and the parameter selection ranges were summarized from the aspects of harmony, stability, warmth, and functionality. The proposed interior color combination scheme was then applied to a particular command cabin for verification, and the resulting evaluation suggested that the proposed scheme was feasible, and can hence be used as a reference for interior color combination schemes of similar command cabin cases in the future.

Aims Patients with metabolic syndrome (MetS) are known to be at increased risk of postoperative complications, but it is unclear whether MetS is also associated with complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Here, we perform a systematic review and meta-analysis linking MetS to postoperative complications in THA and TKA. Methods The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to the guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We assessed the methodological quality of each study using the Newcastle-Ottawa Scale (NOS), and we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and meta-analyzed or qualitatively synthesized for several outcomes. Results Ten cohort studies involving 1,352,685 patients were included. Qualitative analysis suggested that MetS was associated with a higher incidence of cardiovascular events, and meta-analysis showed that MetS increased the risk of all-cause complications (risk ratio (RR) 1.55, 95% confidence interval (CI) 1.28 to 1.89), surgical site infection (SSI; RR 2.99, 95% CI 1.30 to 6.90), urinary tract infection (UTI; RR 2.58, 95% CI 1.03 to 6.43), and 30-day readmission (RR 1.45, 95% CI 1.33 to 1.59). There was insufficient evidence for assessing an association between MetS and venous thromboembolism events, pulmonary or gastrointestinal complications, or mortality. Conclusion Patients with MetS undergoing THA and TKA are at increased risk of all-cause complications, cardiovascular complications, SSI, UTI, and 30-day readmission. Surgeons should be aware of the increased risk of these complications in MetS, and presurgical protocols for these complications should give special consideration to MetS patients. Cite this article: Bone Joint Res. 2020;9(3):120–129.

Current rehabilitation treatments for post-stroke upper limb motor deficits are experiencing a shortage of professional manpower to provide adequate and precise physical practice. Rehabilitation robots and neuromuscular electrical stimulation have been adopted as efficient supplements to manual therapy. In this chapter, a novel NMES-robotic hybrid training system adopting two upper limb supportive schemes (i.e., support to the finger–hand and support to the wrist–elbow) with different mechanical structures will be introduced with three clinical trials. The training effectiveness of this system in both subacute and chronic stroke was evaluated through trials based on both the clinical assessments (i.e., the Fugl-Meyer Assessment the Modified Ashworth Scale the Action Research Arm Test and the Functional Independence Measurement ) and cross-session electromyography (EMG) parameters (i.e., electromyography activation level and the cocontraction index). Furthermore, the training effects by two supportive schemes are compared to identify the optimized choice.

To assist the assessment of sustainable festival tourism, this study develops sustainability indictors for festival tourism by including perspectives from four stakeholders: tourists, local residen...

When using ultrasound imaging of the tongue for speech recording/research, submental transducer stabilization is required to prevent the ultrasound transducer from translating or rotating in relation to the tongue. An iterative prototype of a lightweight three-dimensional-printable wearable ultrasound transducer stabilization system that allows flexible jaw motion and free head movement is presented. The system is completely non-metallic, eliminating interference with co-recorded signals, thus permitting co-collection and co-registration with articulometry systems. A motion study of the final version demonstrates that transducer rotation is limited to 1.25° and translation to 2.5 mm-well within accepted tolerances.

The purpose of the present study was to evaluate the efficacy of extraluminal use of the bronchial blocker (BB) for one-lung ventilation (OLV) in infants undergoing thoracoscopic surgery.This was a prospective, randomized, controlled clinical study.University hospital.The study comprised 60 infants undergoing thoracoscopic surgery.The study included 2 groups. A BB was placed extraluminally for OLV in group A, and a single-lumen endobronchial tube was inserted into the desired mainstem bronchus for OLV in group C.The placement time (4.0 ± 0.6 min v 6.3 ± 4.1 min; p = 0.04) and the number of repositions (2 v 11; p = 0.005) were less in group A. There were significant differences in the heart rate and blood pressure after insertion between the 2 groups (p0.05). The tidal volumes and end-tidal pressure of carbon dioxide values 10 minutes after the initiation of OLV were similar between the 2 groups (p0.05). The incidence of intraoperative hypoxemia was reduced in group A compared with group C (0% v 20%; p = 0.024). No postoperative adverse events were observed in either group.Extraluminal use of the BB may provide a solution for a rapid placement and excellent quality of lung isolation, and it may reduce the incidence of intraoperative hypoxemia in infants without increasing the incidence of hoarseness.

Our previous study revealed that early application of electrical field stimulation (EFS) with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was neuroprotective in the dorsal corticospinal tract after spinal cord injury (SCI). The objective of this study was to further evaluate the effect of EFS on protection of anterior horn motoneurons and their target musculature after SCI and its mechanism. Rats were randomized into three equal groups. The EFS group received EFS for 30 minutes immediately after injury at T10. SCI group rats were only subjected to SCI and sham group rats were only subjected to laminectomy. Luxol fast blue staining demonstrated that spinal cord tissue in the injury center was better protected; cross-sectional area and perimeter of injured tissue were significantly smaller in the EFS group than in the SCI group. Immunofluorescence and transmission electron microscopy showed that the number of spinal cord anterior horn motoneurons was greater and the number of abnormal neurons reduced in the EFS group compared with the SCI group. Wet weight and cross-sectional area of vastus lateralis muscles were smaller in the SCI group to in the sham group. However, EFS improved muscle atrophy and behavioral examination showed that EFS significantly increased the angle in the inclined plane test and Tarlov's motor grading score. The above results confirm that early EFS can effectively impede spinal cord anterior horn motoneuron loss, promote motor function recovery and reduce muscle atrophy in rats after SCI.

Checkpoint with Forkhead-associated and Ring finger domains (CHFR) is a G2/M checkpoint and tumor-suppressor gene. Recent publications showed the correlation of CHFR promoter methylation with clinicopathological significance of non-small cell lung cancer (NSCLC), however, the results remain inconsistent. The aim of this study is to investigate the Clinicopathological significance of CHFR promoter methylation in NSCLC with a meta-analysis. A total of nine studies were included in the meta-analysis that 816 patients were involved. Our data indicated that the frequency of CHFR promoter methylation was higher in NSCLC than in normal lung tissue, Odd Ratios (OR) was 9.92 with 95% corresponding confidence interval (CI) 2.17-45.23, p = 0.003. Further subgroup analysis revealed that CHFR promoter was more frequently methylated in squamous cell carcinoma (SCC) than in adenocarcinoma (ADC), OR was 4.46 with 95% CI 1.65-12.05, p = 0.003, suggesting the mechanism of SCC pathogenesis is different from ADC. Notably, CHFR promoter methylation was correlated with smoking behavior in NSCLC. In conclusion, CHFR could be a biomarker for diagnosis of NSCLC, and a promising drug target for development of gene therapy in SCC. CHFR promoter methylation is potentially associated with poor overall survival, additional studies need to be carried out for confirmation in future.

Introduction The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses. Methods This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout. Results All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization ( P Discussion The findings suggest that active intervention with comprehensive management may effectively reduce job burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems.

We proposed a nanoscale water switch composed of CNTs. A capped CNT with potassium ions in it may move under an external electric field, just like a piston. We can control the switch toggle between the open and closed states only by changing the direction of the external electric field. Molecular dynamics (MD) was used to simulate the performance of the switch. The results show that this device may act well as a switch. The response speed of the switch reaches the nanosecond level. The stability of the piston position is also investigated.

Background & Aims The EncephalApp Stroop test is a high-sensitivity but low-specificity test that has been used to identify patients with covert hepatic encephalopathy (CHE). We aimed to develop a new strategy to detect CHE, combining EncephalApp Stroop test score with scores from subtests of the psychometric hepatic encephalopathy scoring system (PHES). Methods We performed a survey of 569 adult volunteers (229 men) in 9 communities in Shanghai, China, administering the EncephalApp Stroop test to determine the range of scores in the general population. Data from the standard PHES, including the number connection test-A, number connection test-B (NCT-B), line tracing test, serial dotting test (SDT), and digit symbol test, were used as the reference standard for diagnosis of CHE. A combination of the EncephalApp Stroop with subtests of the PHES was used to establish a new strategy for CHE diagnosis. We validated our findings using data from 160 patients with cirrhosis from 5 centers China. Results We determined the range of EncephalApp Stroop test scores for the volunteers of different decades of age, education levels, and sexes. Age, education level, and sex were independently associated with EncephalApp Stroop test scores. A combination of scores from the EncephalApp Stroop test, the NCT-B, and the SDT identified patients with CHE with the highest level of accuracy, when the standard PHES was used as the reference standard. A combination of scores of 187 sec for the EncephalApp Stroop test and below –1 for the NCT-B or below –1 for the SDT identified patients with CHE with an area under the curve (AUC) of 0.86, 81.0% sensitivity, and 91.9% specificity, and 87.5% accuracy. In the validation cohort, these cutoff scores identified patients with CHE with an AUC of 0.88, 97.1% sensitivity, 79.3% specificity, and 86.9% accuracy. The average time to calculate this score was 374±140 sec, compared 424±115 sec for the entire PHES. Conclusion Scores from the EncephalApp Stroop test, NCT-B, and SDT identify patients with CHE with approximately 87% accuracy, and in a much shorter time than the standard PHES. This score combination could be a valid and convenient method for identifying patients with CHE. chictr.org.cn number, ChiCTR-EDC-17012007, ChiCTR1800019954.

Introduction Near-peer teaching is gaining popularity as a teaching modality, as it improves the learner's understanding, is targeted at an appropriate level and promotes familiarisation. This study was initiated to evaluate the effectiveness of incorporating near-peer instruction into simulation-based training within a junior residency programme. Methods 42 first-year residents from an internal medicine junior residency programme were recruited. Participants underwent a simulation-based training programme conducted over five weeks. Each week involved either an emergency or acute clinical scenario. A structured questionnaire was administered prior to and after the course to compare participants' perceived knowledge, experience and confidence in managing the clinical scenarios. Results In our study, 83% of participants agreed/strongly agreed that the scenarios were realistic. There were improvements in perceived knowledge, experience and confidence after the course. The greatest improvement was seen for experience (post-simulation: median 7.00 [interquartile range (IQR) 6.00‒8.00] vs. pre-simulation: median 5.00 [IQR 3.00-6.25]). 65% of participants were keen to help with future training. Conclusion Near-peer simulation training was found to be a viable and valuable method of instruction for first-year residents for increasing experience, instilling confidence and improving perceived knowledge. Integration of such programmes within medical education curricula shows good promise of continuity, with many first-year residents inspired to organise subsequent sessions.

To elucidate whether the interaction between Anxa2 and Stat3 could promote the progression of hepatocellular carcinoma (HCC) and that high co-expression of Anxa2 and Stat3 could predict poor prognosis in HCC patients.We investigated Anxa2 and Stat3 expression using Western blot analysis in 4 HCC and adjacent nontumor tissues and using immunohistochemistry in 100 patients' paraffin sections. Then we assessed the expression of Stat3, Anxa2 and co-expression of Stat3 and Anxa2 with relevant clinical pathological parameters and their prognostic value in HCC patients. The recurrence and overall survival rates were estimated using the Kaplan-Meier method and compared with the log-rank test. The prognostic analysis was carried out with univariate and multivariate Cox regressions models.The incidence of high Stat3 expression in HCC tissues (35%) was significantly higher than that in non-HCC tissues (8%) (P 0.001). The same result was observed in Anxa2 (P 0.001). Also, the overexpression of Stat3 or Anxa2 showed a significant relationship with the recurrence of the 100 HCC patients (P = 0.012; P = 0.003). Additionally, tumor size3 cm in diameter, multiple tumor number, and the presence of microvascular tumor thrombus were also significantly associated with recurrence in 100 patients. Then, all enrolled patients were divided into four groups according to IHC score of Stat3 and Anxa2, and the results indicated a significant difference in recurrence time between the subgroups (P 0.001). What's more, co-highexpression of Stat3 and Anxa2 was related to the presence of microvascular tumor thrombus (P = 0.003) and poor tumor differentiation (P 0.001), but not relevant with other clinical features (All P 0.05).The expression of Stat3, Anxa2, or co-high-expression of the two proteins was associated with HCC recurrence and survival.

To investigate the role of microRNA-221 (miR-221) in the airway epithelial cell injury in asthma and delineate the underlying mechanism that may involve with SIRT1.Bronchial epithelial cells from asthma patients and healthy controls were obtained by bronchoscopic brushing. The miR-221 and SIRT1 mRNA level in collected cells were detected by qRT-CPR. BEAS2B cell lines were cultured in vitro. In order to up-regulate miR-221 and SIRT1, miR-221 mimic and pcDNA3.1-SIRT1 vector was transfected into BEAS2B cells, respectively. The expression changes of miR-221 and SIRT1 after transfection was observed by qRT-PCR and Western blot. The target relationship between miR-221 and SIRT1 was confirmed using dual-luciferase reporter assay.The cell viability changes after transfection was measured using cellTiter-blue reagent. The apoptosis rate was detected by flow cytometry.Compared with healthy controls, miR-221 expression significantly increased in bronchial epithelial cells from patients subjects. In contrast, the level of SIRT1 mRNA reduced in the bronchial epithelial cell from asthma patients. In vitro, up-regulation of miR-221 could inhibit the expression of SIRT1 both at mRNA and protein level in BEAS2B cells. A negative correlation between miR-221 and SIRT1 mRNA in samples from patients was confirmed and dual-luciferase reporter assay showed that miR-221 directly binds to the 3'UTR of SIRT1 mRNA. Overexpression of miR-221 or SIRT1 knockdown could inhibit proliferation but induce apoptosis in BEAS2B cells. Moreover, up-regulation of SIRT1 could antagonize miR-221's inhibitory effect.miR-221 may participate in the airway epithelial cells injury in asthma via targeting SIRT1.

Web parameter injection attacks are common and have put a great threat to the security of web applications. In this kind of attacks, malicious attackers can employ HTTP requests to implement attacks against servers by injecting some malicious codes into the parameters of the HTTP requests. Against the web parameter injection attacks, most of the existing Web Intrusion Detection Systems (WIDS) cannot find unknown new attacks and have a high false positive rate (FPR), since they lack the ability of re-learning and rarely pay attention to the intrinsic relationship between the characters. In this paper, we propose a malicious requests detection system with re-learning ability based on an improved convolution neural network (CNN) model. We add a character-level embedding layer before the convolution layer, which makes our model able to learn the intrinsic relationship between the characters of the request parameters. Further, we modify the filters of CNN and the modified filters can extract the fine-grained features of the request parameters. The test results demonstrate that our model has lower FPR compared with support vector machine (SVM) and random forest (RF).

We analyse the socially responsible investment (SRI) performance in Korea over the period January 2006 to April 2014. Our analysis shows that sustainable investment portfolio, represented by Dow Jones Sustainability Index Korea, is ranked higher than most of the conventional portfolios in Korea. We also find that there is no significant effect of the 2008 global financial crisis on the sustainable investment return and volatility and US policy uncertainty does not affect the return as well. Generally, we find relative stability during crisis and non-crisis periods. We may also conclude that by decoupling sustainable investment in Korea from US market system, “Korea does not catch a cold when the United States sneezes”. In other words, SRI in Korea can be an alternative investment opportunity for investors to consider for international diversification purpose.

In this paper, the electronic structure and photoelectric properties of P and Cu doped ZnO systems have been studied by Density functional theory method. The results show that the formation energies of ZnO-P-Cu, ZnO-P-2Cu, ZnO-P and ZnO-Cu systems decrease in turn Compared with the intrinsic ZnO system, the ZnO-P, ZnO-P-Cu, ZnO-P-2Cu and ZnO-Cu systems have higher activity, the band gap of ZnO-P and ZnO-P-2Cu systems is reduced, and the electron transition is easier. In the doped system, the peak of the dielectric function shifts to the left and increases, the absorption of the electron to the photon increases obviously, and the absorption spectrum appears red shift, from the calculated results, it can be concluded that P and Cu single-doped and co-doped ZnO have great influence on the electronic structure and optical properties of ZnO system, which provides a theoretical basis for further study of the influence of doping on the properties of ZnO.

Liver fibrosis is a common feature of almost all chronic liver diseases, which eventually leads to cirrhosis and even hepatocellular carcinoma (HCC). The current study showed that miR-92b plays an important role in the progression of HCC but its role in liver fibrosis is still unclear. Here we aimed to explore the role and underlying molecular mechanism of miR-92b-3p in the activated hepatic stellate cells (HSCs) and the pathological process of hepatic fibrosis. We found that miR-92b-3p was highly expressed both in fibrotic liver tissues from patients and model mice and in activated LX-2 cells stimulated with TGF-β1. However, the expression of miR-92b-3p was downregulated in inactivated LX-2 cells treated with adipogenic differentiation mixture (MDI). In addition, we found that miR-92b-3p mimic could promote the activation, proliferation, and migration of LX-2 and HSC-T6 cells, while miR-92b-3p inhibitor could reverse this process. From the TargetScan databases, we found that CREB3L2 is a potential target of miR-92b-3p and the luciferase assay revealed the suppressed CREB3L2 expression by miR-92b-3p. Mechanistically, we found that miR-92b-3p promotes the activation of HSCs and thereby the progression of liver fibrosis by activating JAK/STAT pathway via targeting CREB3L2, providing a new target for the diagnosis and treatment of liver fibrosis.

1 College of humanities, Qinzhou University, Qinzhou, 535000, China 2 College of resources and environment, Qinzhou University, Qinzhou, 535000, China 3 College of software, Guangxi University of Science and Technology, Liuzhou, 545006, China E-mail: 404580539@qq.com Abstract A data transmission scheme based on cluster is proposed for data transmission of VANETs. Firstly, the selection scheme of cluster head CH is designed. The optimal CH is selected by calculating the utility function of CCHs, which combines node degree (NOD), available resource and mobile information of CHs and CMs, including the characteristic requirements of different user applications. According to the simulation results, the proposed scheme’s performance can be improved in terms of throughput, data transmission delay, successful transmission rate and overhead.

Objective.To evaluate the efficacy of Wulingsan subtraction (五苓散加减 WLSS) decoction in the treatment of postoperative brain edema and fever as a complication of glioma neurosurgery.Methods.This retrospective study was conducted at the Department of Neurosurgery of Liaocheng People’s Hospital. Patients hospitalized between March 2011 and December 2014 were divided into three groups: Group A received WLSS oral liquid (50 mL), twice a day; Group B received an intravenous infusion of mannitol; and Group C received WLSS combined with mannitol (n=30patients per group). All patients were treated for 10 days continuously. Therapeutic efficacy was evaluated by measuring body temperature and indicators of renal function before and 3, 5, and 10 days after treatment.Results.Compared to the other two groups, significantly greater clinical efficacy was observed in the patients treated with mannitol (Group B;P<0.05), although marked clinical efficacy was also observed over time in patients treated with WLSS (Group A). After 5 days, the quantifiable effects of the WLSS and mannitol combination group (Group C) were substantial (P<0.05). The renal damage in Group B was more obvious after 5 days and 10 days.Conclusion.Compared with mannitol treatment alone, WLSS combined with mannitol induced a more rapid reduction in body temperature. Our findings suggest that patients should be started on mannitol for 3 days and then switched to WLSS to achieve obvious antipyretic effects and protect renal function. This method of treatment should be considered for clinical applications.