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Purpose We aimed to investigate whether the sequence of wide circumferential pulmonary vein isolation (PVI) ablation had an effect on the acute reconnection or long-term effectiveness in patients with paroxysmal atrial fibrillation (AF). Methods One hundred consecutive paroxysmal AF patients, who were scheduled to accept PVI, were enrolled and randomized into two groups: (1) optimized group. Lesions were first applied to the anterior/posterior carina and the ridge between the left atrial (LA) appendage and the left pulmonary vein (PV). Then both circles were closed with continuous lesions. (2) Sequential group-continuous circular lesions were created counter-clockwise and started from the site of 6 o'clock. The primary endpoint was the freedom from non-blanking period recurrence of any atrial tachyarrhythmias lasting for 30 s or longer during the 1-year follow-up period after a single procedure. The secondary endpoint included safety endpoints, LA dwelling time, and fluoroscopy time/dose. Results Forty-nine patients in the optimized group and 48 patients in the sequential group were available for analysis. There was no difference between the AF-free rate of the optimized group and the sequential group (75.5% vs. 72.9%, p = 0.7715). Cox regression analysis found that acute reconnection had the potential to predict long-term recurrence at 1 year (Risk ratio 2.175, p = 0.0818). Both groups had similar safety endpoints, LA dwelling time, and fluoroscopy time/dose. Conclusions Adjusting the ablation sequence of PVI by ablating the anterior/posterior carina and the ridge between the left PV and the LA appendage first did not improve 1-year AF-free rate for paroxysmal AF.

Research on the spontaneous combustion of coal caused by sulfur has always been focused on pyrite in coal but has rarely considered the influence of organic sulfur. In this paper, coal samples, rather than model compounds, were used to study the influence of organic sulfur content in coal on its spontaneous combustion process. The results of X-ray photoelectron spectroscopy and thermogravimetry, differential scanning calorimetry, and mass spectrometry indicate that organic sulfur in Shuiyu clean coal exists in forms of mercaptan, thioether, sulfone (sulfoxide), and thiophene. With the decrease of organic sulfur content, the characteristic temperature points and the peak values of the exothermic curves in the process of coal oxidation spontaneous combustion all shifted toward higher temperatures. The ignition activation energy of coal also increased, and the initial and peak gas evolution temperatures of the oxidation products shifted toward higher temperatures. These findings suggest that the reduction of organic sulfur content can inhibit the oxidation process and spontaneous combustion tendency of coal. This effectively reveals the mechanism of the spontaneous combustion of coal and is of great significance to future studies in this field.

Background:. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with loss of motor neurons. Our objective was to explore the epidemiology, clinical features, and survival factors of 1809 patients with ALS. Methods:. We analyzed 1809 ALS patients, who were recruited from the Peking University Third Hospital from January 2005 to December 2015. Demographic data and disease-related parameters were collected. Kaplan-Meier curves were used to compare survival time. Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors. Results:. The results showed that the average annual incidence in Beijing alone was 0.38 cases/100,000 person-years and the mean age of onset was 48.88 ± 11.35 (95% confidence interval [CI]: 48.17–49.85) years. The median survival time from onset to death/tracheostomy was 58.89 ± 33.03 (95% CI: 51.46–63.84) months. In the adjusted Cox proportional hazard model, age of onset, diagnosis delay, rate of disease progression (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised decline [points/month]), and body mass index all had an independent effect on survival in ALS. Conclusions:. Our study provides information on epidemiology, clinical features, and survival factors of patients with ALS in China. These results can be helpful in clinical practice, clinical trial design, and validation of new tools to predict disease progression.

To date, specialized studies focusing on status epilepticus (SE) in anti-N-methyl d-aspartate receptor (anti-NMDAR) encephalitis are limited, and the association between the occurrence of SE and clinical outcome is controversial. This study aims to investigate the differences between patients with critical anti-NMDAR encephalitis with SE and patients who experienced epileptic seizures without SE and to evaluate the long-term disease outcomes of patients with anti-NMDAR encephalitis with SE who were admitted to the neurological intensive care unit (neuro-ICU). In this retrospective study based on a prospective registry, patients with anti-NMDAR encephalitis with neuro-ICU admission from 2014 to 2019 were analyzed and divided into two groups based on whether they had SE. Their clinical characteristics during the neuro-ICU stay were assessed and compared. The neurological and seizure outcomes were evaluated every 3 months. Of 83 patients with anti-NMDAR encephalitis, 24 required intensive care. In the SE group, 38.5% (5 of 13) of patients developed refractory SE (RSE), and 21.3% (3 of 13) of patients developed super RSE. More patients in the SE group presented with seizures as the initial symptoms (53.8% vs. 9.1%, p = 0.033) and had a strong positive NMDAR antibody titer in the cerebrospinal fluid (76.9% vs. 27.3%, p = 0.043). More patients in the non-SE group had a good neurological outcome (modified Rankin Scale (mRS) score

Currently, the practical application of SiOx still has a huge hindrance in the area of lithium ion battery, because it is unable to achieve an effective contact with surrounding conducting materials, resulting in failure to form lithium ion migration tunnels. In this work, we presented a facile method to synthesize the B-doped SiOx composite by adhering SiOx particles with MWCNT (multi-walled carbon nanotube) under the assistance of lithium metaborate (LiBO2). LiBO2, as a sintering aid, not only can react with SiOx to form a compacted framework, but also build a three-dimensional (3D) conductive network for ions transportation. Furthermore, B-SiOx@CNT@LBO anode delivers a remarkable lithium storage performance in terms of long cycles and high rate capability. A full cell coupled with NCM622 cathode achieves a high energy density of 429.5 Wh kg−1 based on the total mass of cathode.

Both keloid and hypertrophic scars are common benign skin lesions manifested by hyperplasia of fibroblasts. Clinically, this will not only have physiological effects on patients, but also cause psychological damage. However, there is no unified standard treatment method at present. Intralesional corticosteroid injection alone and corticosteroid combined with botulinum toxin type A has been gradually found to be useful for the treatment of keloid and hypertrophic scars, but the difference in efficacy between the two is controversial. A systematic search was made of the relevant experiments from Web of Science, PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure (CNKI). The scores of Visual Analog Scale (VAS), Vancouver Scar Score sheet (VSS), scar thickness, itching degree and patient satisfaction after the combination of corticosteroid and botulinum toxin type A were superior than those after corticosteroid (P

The injection of carbon dioxide (CO2) into gob contributes to the geological sequestration of CO2. The chemical inhibitors, which are used for fire protection, can promote the sequestration of CO2....

OBJECTIVE To assess the efficacy of intensive acupuncture (3 times weekly for 8 weeks) versus sham acupuncture for knee osteoarthritis (OA). METHODS In this multicenter, randomized, sham-controlled trial, patients with knee OA were randomly assigned to receive electroacupuncture (EA), manual acupuncture (MA), or sham acupuncture (SA) 3 times weekly for 8 weeks. Participants, outcome assessors, and statisticians were blinded with regard to treatment group assignment. The primary outcome measure was response rate, which is the proportion of participants who simultaneously achieved minimal clinically important improvement in pain and function by week 8. The primary analysis was conducted using a Z test for proportions in the modified intent-to-treat population, which included all randomized participants who had ≥1 post-baseline measurement. RESULTS Of the 480 participants recruited in the trial, 442 were evaluated for efficacy. The response rates at week 8 were 60.3% (91 of 151), 58.6% (85 of 145), and 47.3% (69 of 146) in the EA, MA, and SA groups, respectively. The between-group differences were 13.0% (97.5% confidence interval [97.5% CI] 0.2%, 25.9%; P = 0.0234) for EA versus SA and 11.3% (97.5% CI -1.6%, 24.4%; P = 0.0507) for MA versus SA. The response rates in the EA and MA groups were both significantly higher than those in the SA group at weeks 16 and 26. CONCLUSION Among patients with knee OA, intensive EA resulted in less pain and better function at week 8, compared with SA, and these effects persisted though week 26. Intensive MA had no benefit for knee OA at week 8, although it showed benefits during follow-up.

A depolarized electric field (Edp) of ferroelectrics to boost the carrier separation and migration rate is critical to promote the field of visible light photocatalytic hydrogen evolution (PHE). Here, the PHE performance of high-field poled semiconducting (1 − x)KNbO3–xBa(Ni1/2Nb1/2)O3−δ (abbreviated as (1 − x)KN-xBNN, x = 0, 0.02, 0.05, 0.10, and 0.20) ferroelectric ceramics were systematically studied under full spectrum (λ > 320 nm) and visible light (λ > 420 nm), respectively. Benefiting from their narrow bandgap and sub-bandgap, all the Ba, Ni-modified KN ceramic powders exhibited a PHE response under visible light irradiation. Notably, the visible light PHE rate of the high-field poled 0.95KN–0.05BNN ceramic powder can be promoted to 415.16 μmol g−1 h−1, which is 17.8-fold higher than that of the unpoled sample (23.26 μmol g−1 h−1). The boosting PHE rate in poled samples can be attributed to the high-field polarization of the material, which can significantly affect the lattice structure and cause an ordered ferroelectric-domain structure to form a depolarized electric field (Edp). EPR spectroscopy indicated that the poled 0.95KN–0.05BNN sample exhibited a superior catalytic activity of ˙OH evolution compared with its unpoled counterpart, suggesting the dependence of high photocatalytic performance on the unique field-induced polarization structure by an outer electric field. Moreover, a higher photo-excited transient photocurrent in the poled 0.95KN–0.05BNN specimen further proved the positive effect of Edp on the photovoltaic response. The formation of Edp in the semiconducting (1 − x)KN–xBNN ferroelectric favors the separation and transportation of photogenerated carriers. Thus, the synergistic effect of narrow bandgap and high-field polarization ability is the key to enhance the visible light photocatalysis of semiconducting ferroelectrics. Boosting the visible light photoelectrochemical catalytic activity of semiconducting (1 − x)KN–xBNN ferroelectrics through high-field polarization may provide a useful strategy to design new ferroelectric-based semiconductor materials.

Aims The present study was to evaluate the feasibility and clinical outcomes of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT)-indicated patients. Methods and results LBBAP was performed via transventricular septal approach in 25 patients as a rescue strategy in 5 patients with failed left ventricular (LV) lead placement and as a primary strategy in the remaining 20 patients. Pacing parameters, procedural characteristics, electrocardiographic, and echocardiographic data were assessed at implantation and follow-up. Of 25 enrolled CRT-indicated patients, 14 had left bundle branch block (LBBB, 56.0%), 3 right bundle branch block (RBBB, 12.0%), 4 intraventricular conduction delay (IVCD, 16.0%), and 4 ventricular pacing dependence (16.0%). The QRS duration (QRSd) was significantly shortened by LBBAP (intrinsic 163.6 ± 29.4 ms vs. LBBAP 123.0 ± 10.8 ms, P < 0.001). During the mean follow-up of 9.1 months, New York Heart Association functional class was improved to 1.4 ± 0.6 from baseline 2.6 ± 0.6 (P < 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 ± 10.2% from baseline 35.2 ± 7.0% (P < 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 ± 9.7 mm from baseline 64.1 ± 9.9 mm (P Conclusion The present study demonstrates the clinical feasibility of LBBAP in CRT-indicated patients. Left bundle branch area pacing generated narrow QRSd and led to reversal remodelling of LV with improvement in cardiac function. LBBAP may be an alternative to CRT in patients with failure of LV lead placement and a first-line option in selected patients such as those with LBBB and heart failure.

Background: Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. Methods: A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). Results: The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089–0.847; p = 0.025). Conclusion: Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.

To understand quality of coking coal possessing different particle sizes, coal samples from Gao Yang (GY) and Shui Yu (SY) mines were systematically studied. The samples had wide particle size variations with six distinct ranges. The main emphasis was placed on analyzing sulfur and coke contents as function of particle sizes. X-ray photoelectron spectroscopy (XPS) was used to analyze sulfur content as well as its chemical state. Sulfur coordination and group geometry was analyzed by Fourier transform infrared spectroscopy (FTIR). Scanning electron microscopy (SEM) was applied to characterize surface morphology. Sieving of the coal samples increased ash and sulfur contents in all fractions. Organic sulfur was mostly present as thiophene for all particle size ranges. Macromolecular structure of coal was almost the same for all samples. Changes in total sulfur content of different coal fractions were mainly caused by the variations in inorganic sulfur concentrations because organic sulfur content remained almost constant. Understanding particle size distribution in different coals is important for selecting and optimizing appropriate desulfurization methods.

Creep rupture life is a key material parameter for service life and mechanical properties of Ni-based single crystal superalloy materials. Therefore, it is of much practical significance to accurately and efficiently predict creep life. Here, we develop a divide-and-conquer self-adaptive (DCSA) learning method incorporating multiple material descriptors for rational and accelerated prediction of the creep rupture life. We characterize a high-quality creep dataset of 266 alloy samples with such features as alloy composition, test temperature, test stress, and heat treatment process. In addition, five microstructural parameters related to creep process, including stacking fault energy, lattice parameter, mole fraction of the γ' phase, diffusion coefficient and shear modulus, are calculated and introduced by the CALPHAD (CALculation of PHAse Diagrams) method and basic materials structure-property relationships, that enables us to reveal the effect of microstructure on creep properties. The machine learning explorations conducted on the creep dataset demonstrate the potential of the approach to achieve higher prediction accuracy with RMSE, MAPE and R2 of 0.3839, 0.0003 and 0.9176 than five alternative state-of-the-art machine learning models. On the newly collected 8 alloy samples, the error between the predicted creep life value and the experimental measured value is within the acceptable range (6.4486 h–40.7159 h), further confirming the validity of our DCSA model. Essentially, our method can establish accurate structure-property relationship mapping for the creep rupture life in a faster and cheaper manner than experiments and is expected to serve for inverse design of alloys.

Molecular cocrystals have received much attention for tuning physicochemical properties in pharmaceutics, luminescence, organic electronics, and so on. However, the effective methods for the formation of orderly cocrystal thin films are still rather limited, which have largely restricted their photofunctional and optoelectronic applications. In this work, a fast crystallization-deposition procedure is put forward to obtain acridine (AD)-based cocrystals, which are self-assembled with three typical isophthalic acid derivatives (IPA, IPB, and TMA). The obtained donor–acceptor cocrystal complexes exhibit an adjustable energy level, wide range of photoluminescence color, and rotational angle-dependent polarized emission. The orderly and uniform cocrystal thin films further present tunable one-/two-photon up-conversion and different semiconductor properties. Particularly, AD-TMA cocrystal thin film shows a rare example of a molecule level heterojunction with the alternating arrangement of AD electronic acceptor layers and TMA electronic donor layers, and thus, provides a way for efficient mobility and separation of electron–hole pairs. A large on–off photocurrent ratio of more than 104 can be achieved for the AD-TMA thin film, which is higher than state-of-the-art molecular semiconductor systems. Therefore, this work extends the application scopes of orderly cocrystal thin film materials for future luminescent and optoelectronic micro-/nanodevices., Cocrystal complexes with tunable energy level, wide range of fluorescence color, and rotation angle-dependent polarized emission have been developed.

The demand for mineral resources is continuously increasing due to the accelerated industrialization and urbanization progress. However, most mines in China have backward mining technology, enormous destruction and waste, too low recycling proportion, unstable mineral market, and low management efficiency. Thus, the eco-environmental safety of mines has various difficulties. Identifying the influencing factors of eco-environmental safety of mines, which are typical ecologically vulnerable areas, is important. The green development of mines is a clean production mode that will not generate any harmful effect on human social and natural environments and will be important to realizing sustainable development of mines. In this study, a retrospective analysis of considerable foreign literature on ecoenvironmental safety management of mines in developed countries was conducted. An index system of the influencing factors of eco-environmental safety of Taoshan Coal Mine in Heilongjiang Province, China was established. ISM model (Interpretative Structural Modeling) was used to analyze the influencing factors of eco-environmental safety, and corresponding countermeasures for critical factors were proposed. Results indicate that studies on resource development and utilization and environmental protection of mines in some developed countries, such as America, Australia, and the UK, have been considerably mature. The influencing factors in ISM (Interpretative Structural Modeling) can be divided into three layers, among which the completeness of institution setting for environmental protection supervision is a factor with the most significant influence on mine eco-environmental safety. Input into eco-environmental protection and ecological protection laws and systems of mines are also important factors. The study results are important in determining the most critical influencing factors of mine eco-environmental safety, innovating the new industrial development pattern featured by conservation and intensive and comprehensive utilization of mineral resources, promoting green transformation and upgrading of the mining industry, and boosting sustainable development of the mining industry and eco-environment.

Objective To investigate the potential prognostic value of sleep electroencephalography (EEG) pattern and serum circadian rhythm biomarkers in the recovery of consciousness in patients at the acute stage of coma. Methods A prospective observational study which included 75 patients with coma was conducted. Twenty-four-hour continuous polysomnography (PSG) was performed to determine the sleep EEG pattern according to the modified Valente's Grade (mVG) that we proposed. Serum levels of melatonin and orexin-A at four consecutive time points during the PSG were examined. Patients were then followed for one month to determine their level of consciousness. Multivariate logistic regression analysis was performed to examine associations between demographics, aetiology, baseline clinical features (pupillary and corneal reflex, and neuron-specific enolase [NSE]), clinical scores (Glasgow Coma Scale-Motor Response [GCS-M], Full Outline of Unresponsiveness [FOUR] scale, Acute Physiology and Chronic Health Evaluation II [APACHE II] scale), mVG, serum circadian biomarkers, and recovery of consciousness within one month. Results Within one month of enrolment, 34 patients regained consciousness and 36 patients remained non-conscious. Spearman rank correlation revealed a significant association between mVG and state of consciousness after one month. Significant variation in serum melatonin or orexin-A was not detected in either the conscious or non-conscious groups. Hypoxic aetiology, APACHE II, and mVG were independently associated with recovery of consciousness within one month. Conclusion Sleep EEG structure, hypoxic aetiology, and APACHE II can independently predict recovery of consciousness in patients with acute coma. Taken together, we encourage neurologists to use sleep elements to assess patients with acute coma.

BACKGROUND Gastric cancer (GC) is one of the most aggressive malignancies, with a high incidence and poor prognosis worldwide. Recently, accumulating evidence has illustrated that long noncoding RNAs (lncRNAs) play pivotal roles in many cancers. It has been reported that LINC00511 contributes to tumorigenesis in various diseases. However, the role of LINC00511 in GC cell growth remains mostly unknown. AIM To determine whether the lncRNA LINC00511 exerted its carcinogenic function in GC via the miR-124-3p/PDK4 axis. METHODS Cell culture and transfection, RNA extraction and quantitative real-time PCR, CCK-8 assay, Colony formation assay, Luciferase reporter assay, RIP assay, RNA pull-down assay, and Western blot analysis were used to show expression and mechanisms of LINC00511 in GC progression and apoptosis. Rescue assays were performed to verify the relationships among LINC00511, miR-124-3p and PDK4 further. RESULTS The expression of LINC00511 was remarkably upregulated in GC cells compared to that in corresponding normal cell lines. Compared to the controls, cell proliferation was inhibited, and cell apoptosis was increased upon LINC00511 knockdown, demonstrating that LINC00511 influenced GC cell growth. An exploration of the molecular mechanism revealed that LINC00511 functioned as a molecular sponge of miR-124-3p and that PDK4 was a downstream target of miR-124-3p in GC. Rescue assays showed that the overexpression of PDK4 could partly restore the inhibitory function of si-LINC00511 in GC. CONCLUSION These data demonstrate that LINC00511 promotes gastric cancer cell growth by acting as a ceRNA to regulate the miR-124-3p/PDK4 axis, which may be a promising therapeutic target for GC.

Aims: The aim was to describe the incidence of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) without history of AF and to identify risk factors for new-onset AF after the procedure.Methods: A total of 191 patients with typical AFL undergoing successful CTI ablation were enrolled. Patients who had history of AF, structural heart disease, cardiac surgery, or ablation or who received antiarrhythmic drug after procedure were excluded. Clinical and electrophysiological data were collected.Results: There were 47 patients (24.6%) developing new AF during a follow-up of 3.3 ± 1.9 years after CTI ablation. Receiver operating characteristic (ROC) curves indicated that the cut-off values of left atrial diameter (LAD) and CHA2DS2-VASc score were 42 mm and 2, with area under the curve of 0.781 and 0.550, respectively. The multivariable Cox regression analysis revealed that obstructive sleep apnea (OSA) [hazard ratio (HR) 3.734, 95% confidence interval (CI) 1.470–9.484, P = 0.006], advanced interatrial block (aIAB) (HR 2.034, 95% CI 1.017–4.067, P = 0.045), LAD > 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score > 2 (HR 2.123, 95% CI 1.118–4.034, P = 0.021) were independent risk factors of new-onset AF.Conclusion: A combination of OSA, aIAB, LAD > 42 mm, and CHA2DS2-VASc > 2 was a strongly high risk for new-onset AF after ablation for typical AFL, and it had significance in postablation management in clinical practice.

Coherence and steerability are two essential characteristics of quantum systems. For a two-qubit state, the first-order coherence and the maximal violation of linear steering inequality are used to operationally measure the degree of coherence and steerability, respectively. Recently, a complementary relation between first-order coherence and linear steerability has been proposed. In this paper, we report an experimental verification of the complementary relation by preparing biphoton polarization entangled states in an all-optical setup. We propose an operable method for experimental measurement of the first-order coherence and linear steerability and calculate the purity of the initial states by reconstructing the density matrices of them. The experimental results coincide with the theoretical predictions very well, which provides a valuable reference for the application of optical quantum technology.

In this study, we compared stress changes and quantity effect relationships from 3D finite element models of normal and degenerative lumbar segments. We further defined the mechanisms causing alterations in mechanical stability the control of normal and degenerative lumbar segments using traditional Chinese medicine. The characteristics of the stress change and the quantity effect relationships of the three-dimensional finite element model of normal and degenerative lumbar segments were compared. The mechanism(s) leading to changes in mechanical stability and the intervention and balance between normal and degenerative lumbar segments of the traditional Chinese medicine was analyzed. The change trend of stress and strain was compared with the three dimensional finite element model under different motion states of normal lumbar vertebrae. A 3D-FEM of degenerative lumbar segments L4 ~ 5 of the human spine was established to simulate the physiological and pathological changes of the lumbar spine in response to flexion, extension, lateral bending and torsion. The stress changes in the normal and degenerative lumbar vertebrae were assessed through external force interventions and the response to TCM. Stress in the degenerative lumbar vertebrae changed according the external load. Stress and strain were compared in the FEM model under a range of motion states. Components of the human lumbar vertebrae including the cortical vertebrae, cancellous bone, endplates, fibrous rings, and facet articular processes were investigated. The elastic modulus of the nerve roots and the posterior marginal structures of the vertebral body increased with lumbar degeneration. Under stress trends in normal lumbar and different degrees of degenerative lumbar structures including cortical bone, loose bone, terminal plate, fiber ring, nucleus, small articular processes, nerve roots and posterior structures. In normal lumbar spine, 20%, 50%, 70% lumbar degeneration, 106 different lumbar anterior flexion 30 and posterior extension with different external forces showed that ANOVA F was between 3.623 and 11.381 and P changed between 0.001 and 0.05.It is clear that in the lumbar movement segments under different pressure intervention, the changes in the degree of degeneration are significantly different from each constituent structure, among which the trend of expected change between the constituent structures of the lumbar anterior flexion 30 is particularly obvious. The stress distribution in the intervertebral discs were influenced by TCM, and the space in the spinal canal enlarged so that nerve root stress decreased, vertebral body stress increased, and facet processes and pedicle stress in the posterior regions exceeded those of the anterior flexion position. The internal stress of the intervertebral disc increased in the flexion compared to the extension position, gradually increasing from top to bottom. The stress concentration point of the degenerative lumbar disc is significantly greater than the stress in the normal lumbar disc stress distribution area, and increases with the degree of degeneration. Compared with the load capacity of normal lumbar and mild (15% reduction), moderate (40% reduction) lumbar disc protrusion model in bending, extension, axial rotation, lateral bending, the results found that the load transmission of lumbar disc degeneration model to different degrees has also changed, so its compression stiffness, strain distribution and size are also different. TCM can improve and treat lumbar disc disease through its ability to regulate the mechanical environment of degenerative lumbar vertebrae. Compared to the FEM models of the lumbar vertebrae, lumbar degenerative changes could be assessed in response to alterations in the biomechanical environment. These findings provide a scientific basis for the popularization and application of TCM to prevent and treat spinal degenerative disease.

Although previous studies have indicated that statin therapy can effectively prevent the development of CIN, this observation remains controversial, especially in high-risk patients. A meta-analysis was performed to evaluate the efficacy of statin pretreatment for preventing the development of CIN in patients with chronic kidney disease (CKD) and to determine its effectiveness in various subgroups. We searched the online databases PubMed, EMBASE, and the Cochrane Library. RCTs that involved the comparison of the short-term moderate or high-dose statin pretreatment with placebo for CIN prevention in CKD patients undergoing angiography were included. The primary outcome was CIN prevalence. Seven RCTs comprising 4256 participants were investigated in this analysis. The risk of developing CIN in patients pretreated with statins was significantly lower than that in patients pretreated with placebo (RR=0.57, 95%CI=0.43-0.76, p=0.000). The SCr values of the statin group, when analyzed 48h after angiography were lower than those of the placebo group ((SMD=-0.15, 95% CI=-0.27 to -0.04, p=0.011). In the subgroup analysis, statin pretreatment could decrease the risk of CIN in CKD patients with DM (RR=0.54, 95% CI=0.39-0.76, p=0.000), but not in CKD patients without DM (RR=0.84, 95% CI=0.44- 1.60, p=0.606). The efficacy of atorvastatin for preventing CIN was consistent with that observed with the use of rosuvastatin. The risk ratios (RR) were 0.51 (95% CI=0.32-0.81, p=0.004) and 0.60 (95% CI=0.41-0.88, p=0.009), respectively. Our study demonstrated that statin pretreatment could prevent the development of CIN in CKD patients. However, subgroup analysis demonstrated that statin pretreatment, despite being effective in preventing CIN in patients with CKD and DM, was not helpful for CKD patients without DM. Rosuvastatin and atorvastatin exhibited similar preventive effects with respect to CIN.

Quantum key distribution (QKD) enables secure key exchanges between two remote users. The ultimate goal of secure communication is to establish a global quantum network. The existing field tests suggest that quantum networks are feasible. To achieve a practical quantum network, we need to overcome several challenges, including realising versatile topologies for large scales, simple network maintenance, extendable configuration, and robustness to node failures. To this end, we present a field operation of a quantum metropolitan-area network with 46 nodes and show that all these challenges can be overcome with cutting-edge quantum technologies. In particular, we realise different topological structures and continuously run the network for 31 months, by employing standard equipment for network maintenance with an extendable configuration. We realise QKD pairing and key management with a sophisticated key control center. In this implementation, the final keys have been used for secure communication such as real-time voice telephone, text messaging, and file transmission with one-time pad encryption, which can support 11 pairs of users to make audio calls simultaneously. Combined with inter-city quantum backbone and ground-satellite links, our metropolitan implementation paves the way toward a global quantum network., Comment: 14 pages, 5 figures

The aim of this study was to develop population-specific regression equations for age estimation by investigating the correlation between chronological age and pulp–tooth volume ratios in three typ...

The slow photon effect can significantly increase the effective optical path length of light and thereby enhance the interaction of light with matter, which would be realized by light propagating at the edges of the photonic band gap (PBG) in photonic crystals (PCs). In this paper, a novel anodic oxidation method with effective voltage-pulse compensation was developed to prepare one-dimensional titania nanotube photonic crystals (1D TiO2 NT PCs) with a high quality of PBG, which could be continuously adjusted and precisely tailored just by modulating the anodization parameters. With the increase of low voltage (Lv) duration, the precise blue shift of the PBG of 1D TiO2 NT PCs was recorded. Through the precise tailoring of PBG in bandgap engineering, the edges of the PBG could be designed and purposely tuned to overlap with the electronic band gap range of the TiO2 material, and the as-prepared 1D TiO2 NT PCs were used as a photocatalyst to degrade methyl orange (MO) molecules due to the enhanced slow photon effect and scattering effect in their highly ordered channel structures. Meanwhile, strategies to enhance the slow photon effect at the edge of the PBG were discussed and evaluated in detail according to our experimental and simulated results. This study would provide a new guide to taking advantage of the slow photon effect to enhance the photocatalytic activities, photoluminescence, and performances of other optoelectronic devices.

Piezoelectric sensors that can work under various conditions with superior performance are highly desirable with the arrival of the Internet of Things. For practical applications, a large piezoelectric voltage coefficient g and a high Curie temperature Tc are critical to the performance of piezoelectric sensors. Here, we report a two-dimensional perovskite ferroelectric (4-aminotetrahydropyran)2PbBr4 [(ATHP)2PbBr4] with a saturated polarization of 5.6 μC cm-2, high Tc of 503 K [above that of BaTiO3 (BTO, 393 K)], and extremely large g33 of 660.3 × 10-3 V m N-1 [much beyond that of Pb(Zr,Ti)O3 (PZT) ceramics (20 to 40 × 10-3 V m N-1), more than 2 times higher than that of poly(vinylidene fluoride) (PVDF, about 286.7 × 10-3 V m N-1)]. Combined with the advantages of molecular ferroelectrics, such as light weight, easy and environmentally friendly processing, and mechanical flexibility, (ATHP)2PbBr4 would be a competitive candidate for next-generation smart piezoelectric sensors in flexible devices, soft robotics, and biomedical devices.

OBJECTIVE The purpose of this study was to assess the fibrinolytic status after cardiopulmonary bypass in rheumatic valvular heart disease patients, and detect the associated factors of post-cardiopulmonary bypass hyperfibrinolysis. METHODS According to the fibrinolytic status after cardiopulmonary bypass, 203 rheumatic valvular heart disease patients were divided into two groups: hyperfibrinolysis group (H group, n = 78) and non-hyperfibrinolysis group (NH group, n = 125). The demographic characteristics, operative variables, and postoperative follow-ups were compared between these two groups. RESULTS The incidence of hyperfibrinolysis was 38.4% after cardiopulmonary bypass. Patients in the H group had a significant higher incidence of preoperative atrial fibrillation than patients in the NH group (92.3% vs. 55.2%, P

ObjectivesAnastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL.MethodsIn this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software.ResultsA total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05–1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34–2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization.ConclusionsDepend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.

Two-dimensional (2D) organic-inorganic perovskites (OIPs), with improved material stability over their 3D counterparts, are highly desirable for device applications. It is their considerable structural diversity that offers an unprecedented opportunity to engineer materials with fine-tuning functionalities. The isosteric substitution of hydrogen by an electronegative fluorine atom has been proposed as a useful route to improve the photovoltaic performance of 2D OIPs, whereas its valuable role in developing ferroelectricity is still waiting for further exploration. Herein, for the first time we applied fluorinated aromatic cations in extending the family of 2D OIP ferroelectrics, and successfully obtained [2-fluorobenzylammonium]2PbCl4 as a high-performance ferroelectric semiconductor. The failures in the nonferroelectric [4-fluorobenzylammonium]2PbCl4 and [3-fluorobenzylammonium]2PbCl4 demonstrate that the selective introduction of fluorine in correct structural positions is particularly essential. This work represents an unprecedented proof-of-concept in the use of fluorinated aromatic cations for the targeted design of excellent 2D OIP ferroelectrics, and is believed to inspire the future development of low-cost, high-efficiency, and stable device applications.

A new tin(IV)-based perovskite-type hybrid semiconductor, bis(trimethyliodomethylammonium) hexachloridostannate(IV) ([TMIM]2SnCl6), has been synthesized as a switchable dielectric phase transition ...

This study was designed to illustrate how high-energy electron beam (HEEB) irradiation can be used to treat Gao Yang coking coal (GY) and Shui Yu fat coal (SY). The effects of different irradiation...

The surgical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic gastrectomy for gastric cancer remains controversial. A meta-analysis with all eligible studies was conducted to explore the surgical efficacy of 2D versus 3D laparoscopic gastrectomy for gastric cancer. A systematic search was performed. The weighted mean difference (WMD) or odds risk (OR) of patients with 2D or 3D laparoscopic gastrectomy were used to calculate surgical efficacy of 3D and 2D laparoscopic gastrectomy for gastric cancer. Ten studies involving 1478 patients who underwent 2D or 3D laparoscopic gastrectomy were identified. Three-dimensional laparoscopic gastrectomy decreases operation time (WMD: − 16.517, 95% CI − 25.550 to − 7.484, P = 0.000), intraoperative blood loss (WMD: − 21.060, 95% CI − 32.209 to − 9.911, P = 0.000) and number of retrieved lymph nodes (WMD: 3.699, 95% CI 1.838–5.560, P = 0.000) compared with 2D laparoscopic surgery. However, no differences in time to first postoperative flatus (WMD: − 0.119, 95% CI − 0.330 to − 0.092, P = 0.269), perioperative complications (OR: 0.901, 95% CI 0.649–1.251, P = 0.534), or hospital stay (WMD: − 0.624, 95% CI − 1.983 to 0.735, P = 0.368) were noted between 3D and 2D laparoscopic gastrectomy for gastric cancer. 3D laparoscopic gastrectomy decreases the operation time, intraoperative blood loss, and numbers of retrieved lymph nodes compared with 2D laparoscopic gastrectomy for gastric cancer.

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Molecule-based solid-state materials with long lifetimes could enable longer migration distances for excitons, which are beneficial for vast applications in optoelectronic field. Herein, we report a hexanuclear zinc cluster based MOF exhibits highly enhanced phosphorescence about 2 orders of magnitude in comparison with the pristine phosphor ligand. The combination of both experimental and computational results suggest that the {Zn6} cluster is very important for adjusting molecular conformations, packing arrangement, and photophysical properties of the organic phosphor ligands within the MOF matrix. Optoelectronic measurements reveal that the MOF-modified electrode is catalytically active to hydrogen evolution under light irradiation in neutral solution. Thus, our study provide an effective way to achieve low-cost metal-based phosphorescence MOF, expanding its further optoelectronic applications.

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group ( P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: −19.996 to −0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.

Background The echinococcosis is prevalent in 10 provinces /autonomous region in western and northern China. Epidemiological survey of echinococcosis in China in 2012 showed the average prevalence of four counties in Tibet Autonomous Region (TAR) is 4.23%, much higher than the average prevalence in China (0.24%). It is important to understand the transmission risks and the prevalence of echinococcosis in human and animals in TAR. Methods A stratified and proportionate sampling method was used to select samples in TAR. The selected residents were examined by B-ultrasonography diagnostic, and the faeces of dogs were tested for the canine coproantigen against Echinococcus spp. using enzyme-linked immunosorbent assay. The internal organs of slaughtered domestic animals were examined by visual examination and palpation. The awareness of the prevention and control of echinococcosis among of residents and students was investigated using questionnaire. All data were inputted using double entry in the Epi Info database, with error correction by double-entry comparison, the statistical analysis of all data was processed using SPSS 21.0, and the map was mapped using ArcGIS 10.1, the data was tested by Chi-square test and Cochran-Armitage trend test. Results A total of 80 384 people, 7564 faeces of dogs, and 2103 internal organs of slaughtered domestic animals were examined. The prevalence of echinococcosis in humans in TAR was 1.66%, the positive rate in females (1.92%) was significantly higher than that in males (1.41%), (χ2 = 30.31, P

Piezoelectric materials are a class of important functional materials applied in high-voltage sources, sensors, vibration reducers, actuators, motors, and so on. Herein, [(CH3 )3 S]3 [Bi2 Br9 ](1) is a brilliant semiconducting organic-inorganic hybrid perovskite-type non-ferroelectric piezoelectric with excellent piezoelectricity. Strikingly, the value of the piezoelectric coefficient d33 is estimated as ≈18 pC N-1 . Such a large piezoelectric coefficient in non-ferroelectric piezoelectric has been scarcely reported and is comparable with those of typically one-composition non-ferroelectric piezoelectrics such as ZnO (3pC N-1 ) and much greater than those of most known typical materials. In addition, 1 exhibits semiconducting behavior with an optical band gap of ≈2.58 eV that is lower than the reported value of 3.37 eV for ZnO. This discovery opens a new avenue to exploit molecular non-ferroelectric piezoelectric and should stimulate further exploration of non-ferroelectric piezoelectric due to their high stability and low loss characteristics.

[C6N2H18][SbI5] (1), a novel metal halide semiconductor with dielectric relaxation behavior, has been successfully synthesized, in which the cavities between the one-dimensional [SbI5] n2- polyanions are occupied by 2-methyl-1,5-pentanediammonium (2-MPDA) cations. 1 undergoes a reversible solid-state phase transition at TC = 192.7 K and shows a step-like dielectric anomaly. Interestingly, above TC, distinct dielectric dispersion in a wide temperature range is also witnessed. Remarkably, the solid state UV-vis diffuse reflectance spectrum of 1 exhibits a slightly gentler absorption edge at about 650 nm; that is, 1 adopts an indirect band gap with 1.92 electron volts. The combined narrow band gap, strong photoconductivity effect, and excellent dielectric relaxation might shed light on the exploitation of lead-free hybrid metal halide molecular materials with promising application prospects in thermoresponsive relaxation-type dielectric materials and photovoltaic conversion devices.

Focal atrial tachycardias (AT) originating from the left atrial appendage (LAA) constitute a minor part of all ATs. However, successful catheter ablation in these foci remains challenging owing to the complexity of the LAA anatomy, and sometimes even surgical LAA excision or epicardial ablation are required to eliminate the AT.1, 2 Cryoballoon (CB) is a safe and effective tool to achieve pulmonary vein isolation. Recently, the second-generation CB (CB2) has been used to perform the isolation of LAA in addition to pulmonary vein isolation during the atrial fibrillation (AF) ablation.3 However, there are no data available regarding CB2 ablation of the AT originating from the LAA. We described a case of 23-mm CB2 ablation of AT originating from the LAA without LAA isolation.

For grid structures, damages of structural members such as crookedness significantly affect the overall structural safety. Traditional assessment methods can hardly evaluate the impact of crooked members in existing grid structures accurately due to difficulties lying in crookedness measurement and residual load-bearing capacity analysis. In this paper, a new method of refined model adjustment and structural assessment with crooked tubular members of steel grid roofs taken into consideration is proposed, while the crooked measurement is conducted with an image-based 3D measurement method for the first time. Firstly, the original shape of crooked members is recovered using image-based 3D measurement method. Secondly, the measured deformation of the crooked members is adjusted from the load status at the time of measurement to the zero-load status in two ways. Finally, the FE model of the entire grid structure, together with the adjusted crooked tubular members is adopted in the residual load-bearing capacity analysis considering both geometric nonlinearity and material nonlinearity. A large span steel grid roof structure containing four crooked tubular members is utilized for the illustration and validation of the proposed methodology. The proposed method inventively offers a new direction for refined assessment of existing grid structures with crooked members and provides significant potential for practical implementation.

ObjectiveTo investigate and analyze the situation of hospitalization and medical appraisal of cervical spondylosis in military pilots. MethodsA single-center retrospective study was conducted on the active military pilots hospitalized for cervical spondylosis in our center from January 2010 to December 2019.After inclusion and exclusion criteria, descriptive statistics and analysis were made on age, sex, flight type, flight time, disease type, diagnosis and treatment and medical identification results of the included subjects.ResultsDuring January 2010 to December 2019, 166 military pilots with cervical spondylosis were admitted to our center, accounting for 17.61% of the total orthopaedic diseases, ranking the second place.The hospitalization rate of military pilots with cervical spondylosis in orthopedics department decreased from 2015 to 2019, but the hospitalization rate (193 person-times) was in an increasing trend compared with that in 2010-2014 (148 person-times) (P < 0.05).The average age of the pilots with cervical spondylosis was 37.37±7.37 years old, and there was no significant difference in the age of the pilots of different aircraft types. Compared with the age of other active servicemen in the same period (39.72±8.98 years), the incidence of the pilots tended to be younger (P < 0.05).The average incidence of cervical spondylosis in flight crew was 2597.09±1954.50h, and fighter pilots were more likely to have cervical spondylosis in early flight than those who flew helicopter, transport aircraft and trainer aircraft (P < 0.05).4 cases (2.41%) received surgical treatment, which was significantly lower than that of non-aircrew members (12.09%) (P < 0.05).Among the 166 cases, 87 cases (52.41%) were qualified and returned to work,53 cases of military pilots temporary unqualified flight, 26 cases of military pilots unqualified flight, unable to continue to fly.ConclusionCervical spondylosis of pilots account for the forefront of orthopedic disease spectrum, and the onset age is younger, the treatment is relatively simple, and the qualified rate of flight after treatment is low.

Purpose To investigate crystalline lens tilt and decentration with respect to the corneal vertex (CV) using swept-source optical coherence tomography (SS-OCT) combined with three-dimensional (3D) reconstruction. Methods Thirty consecutive patients with cataract (30 right eyes) were included in this prospective, observational, pilot case series study. SS-OCT anterior segment images and 3D reconstructions were used for data analysis. Results The mean distance between the central points of crystalline lens plane and limbus plane was approximately 0.33 ± 0.18 mm. The distance of the center of the limbus plane relative to the CV was approximately 0.31 ± 0.14 mm, which approximated the distance of the center of the crystalline lens plane relative to the CV at 0.33 ± 0.20 mm (P = 0.354). However, the centers of the limbus and crystalline planes were not in the same quadrant in 80% of eyes (24/30). Moreover, the crystalline lens tilted by approximately 4.16° ± 1.97° relative to the CV. Conclusions The center of the limbus plane was not consistent with that of the crystalline lens plane. The tilt and decentration of the crystalline lens were natural phenomena. Translational Relevance The SS-OCT technology combined with 3D reconstruction was useful for quantifying the tilt and decentration of the crystalline lens. The definition of angle alpha used for premium IOL screening should be updated.

Background: Several methods have been reported for locating the conduction gap (CG) in the pulmonary vein isolation (PVI) ablation line. However, the value of the interval between far-field atrial potential (FFP) and pulmonary vein potential (PVP) remains unknown.Methods: Consecutive patients with a CG during observation on the table after PVI were included. The PVP, FFP, and the CG location were evaluated to develop a novel algorithm to identify the CG location in the left superior pulmonary vein. The performance of this novel algorithm was prospectively tested in a validation cohort of consecutive patients undergoing repeat PVI ablation.Results: A total of 116 patients with atrial fibrillation (AF) were recruited, 56 of whom formed the validation cohort. The interval between FFP and PVP of the left superior pulmonary vein was associated with the CG location, and an interval Conclusions: The interval between FFP and PVP is a novel and accurate index that can be used to predict the CG location in the left superior pulmonary vein. An far-field atrial potential and pulmonary vein potential (FFP–PVP) interval value of ≥5 ms could be used to exclude a CG in the upper portion of the ostium in the majority of patients undergoing AF ablation.

Neurovascular unit (NVU) is organized multi-cellular and multi-component networks that are essential for brain health and brain homeostasis maintaining. Neurovascular unit dysfunction is the central pathogenesis process of ischemic stroke. Thus integrated protection of NVU holds great therapeutic potential for ischemic stroke. Catalpol, classified into the iridoid monosaccharide glycoside, is the main active ingredient of the radix from traditional Chinese medicine, Rehmannia glutinosa Libosch, that exhibits protective effects in several brain-related diseases. In the present study, we investigated whether catalpol exerted protective effects for NVU in ischemic stroke and the underlying mechanisms. MCAO rats were administered catalpol (2.5, 5.0, 10.0 mg·kg(−1)·d(−1), i.v.) for 14 days. We showed that catalpol treatment dose-dependently reduced the infarction volume and significantly attenuated neurological deficits score in MCAO rats. Furthermore, catalpol treatment significantly ameliorated impaired NVU in ischemic region by protecting vessel-neuron-astrocyte structures and morphology, and promoting angiogenesis and neurogenesis to replenish lost vessels and neurons. Moreover, catalpol treatment significantly increased the expression of vascular endothelial growth factor (VEGF) through up-regulating PI3K/AKT signaling, followed by increasing FAK and Paxillin and activating PI3K/AKT and MEK1/2/ERK1/2 pathways. The protective mechanisms of catalpol were confirmed in an in vitro three-dimensional NVU model subjected to oxygen-glucose deprivation. In conclusion, catalpol protects NVU in ischemic region via activation of PI3K/AKT signaling and increased VEGF production; VEGF further enhances PI3K/AKT and MEK1/2/ERK1/2 signaling, which may trigger a partly feed-forward loop to protect NVU from ischemic stroke.