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The metal-based additive manufacturing (MAM) processes have great potential in wide industrial applications, for their capabilities in building dense metal parts with complex geometry and internal characteristics. However, various defects in the MAM process greatly affect the precision, mechanical properties and repeatability of final parts. These defects limit its application as a reliable manufacturing process, especially in the aerospace and medical industries where high quality and reliability are essential. MAM process monitoring provides a technical basis for avoiding and eliminating defects to improve the build quality. Based on of the nature of the MAM build defects, this article conducts a thorough investigation of monitoring methods, and proposes a machine learning (ML) framework for process condition monitoring. According to the structure of ML models, they are divided into shallow ML-based and deep learning-based methods. The state-of-the-art ML monitoring approaches, as well as the advantages and disadvantages of their algorithmic implementations, are discussed. Finally, the prospects of ML based process monitoring researches are summarized and advised.

Thyroid cancer is not among the top cancers in terms of diagnosis or mortality but it still ranks fifth among the cancers diagnosed in women. Infact, women are more likely to be diagnosed with thyroid cancer than the males. The burden of thyroid cancer has dramatically increased in last two decades in China and, in the United States, it is the most diagnosed cancer in young adults under the age of twenty-nine. All these factors make it worthwhile to fully understand the pathogenesis of thyroid cancer. Towards this end, microRNAs (miRNAs) have constantly emerged as the non-coding RNAs of interest in various thyroid cancer subtypes on which there have been numerous investigations over the last decade and half. This comprehensive review takes a look at the current knowledge on the topic with cataloging of miRNAs known so far, particularly related to their utility as epigenetic signatures of thyroid cancer progression and metastasis. Such information could be of immense use for the eventual development of miRNAs as therapeutic targets or even therapeutic agents for thyroid cancer therapy.

Planting performance is essential for wheat seeders and reliable seed germination. The seed-filling effect is also important in the sowing performance. In this study, a self-suction wheat shooting device was developed to improve the seed-filling performance. In specific, the shooting device structure was optimized, in which negative pressure was generated in the inner cavity of the device. A DEM-CFD coupling simulation experiment was conducted to investigate the seed-filling and shooting performance. The effect of three working parameters (rotational speed of shooting device, window length and window width of directional seed delivery wheel) on the coefficient of variation of the seed-filling performance (CVSF), average shooting speed (ASS), average shooting depth (ASD) and drag force (DF) were analyzed. Afterward, a validation experiment was conducted to investigate the shooting performance of the self-suction shooting device. The results showed that the shooting performance of the self-suction device under optimized operation parameters could fully meet the shooting requirements of winter wheat in the North China plain. In specific, the coefficient of variation of the seed amount (CVSA), ASD and ASS of self-suction shooting device were 7.1%, 30.9 mm and 33.5 m/s at the rotational speed, window length and window width were 1200 rpm, 35 mm and 60 mm, respectively.

The building finish layer is a comprehensive structural system including the building exterior insulation system and building exterior finish. Combining with buildings has the advantage of reducing wall heat loss and building deformation caused by large temperature differences. Since the building finish layer is prone to cracking, hollowing, and peeling, during the application process, its safety needs to be studied and certified. This study prepares 20 groups of specimens, 15 anchor bolts in each group. The anchor bolt pull-out strength test is carried out. Anchoring damage evolution law and failure mode of anchor bolts are investigated. And the influence of anchoring methods on the pull-out bearing capacity is analyzed. In addition, ABAQUS finite element data simulation is carried out. The stress state of finish in thermomechanical coupling condition and without the effect of temperature are compared and analyzed. The influence factors of anchor bolt pull-out strength and the influence of temperature load on the long-term performance of building finish layer are obtained. The durability of the building finish layer is analyzed. The results show that the anchoring strength of the anchor bolt is positively correlated with the anchoring depth. The anchoring strength is influenced significantly by anchoring construction sequence and temperature. The stress under the coupled effect of temperature and load is greater than that of the single effect of load, and the stress distribution changes significantly. Due to thermal expansion and contraction, the anchor bolt would loosen, which is more prone to damage the building finish layer in a low temperature environment. The weight relationship of each influencing factor of the building finish layer is proposed. A systematic evaluation index system is established. The results of this study provide a basis for subsequent related research work and engineering applications.

An epidemiological association between multiple sclerosis (MS) and inflammatory bowel disease (IBD) is well established, but whether this reflects a shared genetic aetiology, and whether consistent genetic relationships exist between MS and the two predominant IBD subtypes, ulcerative colitis (UC) and Crohn’s disease (CD), remains unclear. Here, we use large-scale genome-wide association study summary data to investigate the shared genetic architecture between MS and IBD overall and UC and CD independently. We find a significantly greater genetic correlation between MS and UC than between MS and CD, and identify three SNPs shared between MS and IBD (rs13428812), UC (rs116555563) and CD (rs13428812, rs9977672) in cross-trait meta-analyses. We find suggestive evidence for a causal effect of MS on UC and IBD using Mendelian randomization, but no or weak and inconsistent evidence for a causal effect of IBD or UC on MS. We observe largely consistent patterns of tissue-specific heritability enrichment for MS and IBDs in lung, spleen, whole blood and small intestine, and identify cell-type-specific enrichment for MS and IBDs in CD4+ T cells in lung and CD8+ cytotoxic T cells in lung and spleen. Our study sheds light on the biological basis of comorbidity between MS and IBD., An epidemiological association between multiple sclerosis (MS) and inflammatory bowel disease (IBD) is well-established, but a genetic link is unclear. Here, the authors investigate the shared genetic architecture between MS and IBD to shed light on the biological basis of comorbidity.

Background: We have already known that idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory disorder that can clinically mimic breast carcinoma, especially affects parous women of childbearing age, but there is little literature to report about pregnancy associated granulomatous mastitis (PAGM). The aim of our study is to report and describe the clinical signs, managements, clinical course, and clinical outcomes after treatment of PAGM in our hospital. Methods: We retrospectively analyzed 15 pregnant patients who were diagnosed as PAGM in our hospital collected from December 2018 to December 2020 by reviewing medical records and questionnaire survey, including the patients' characteristics, clinical presentations, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data. Results: The mean age of these patients at diagnosis was 30.5 (range 24-35) years. All patients had one birth before, and had at least two gravida times, 6 of them (40%) had three gravida times, and only one of them had four gravida times at diagnosis. The mean weeks of gestational age were 23.7 (range 4-37) weeks. Two patients' BMI were greater than 30, which were considered obese. The mean time to presentation since last delivery was 38.4 (range 19-78) months. All patients had a history of breastfeeding; the average breastfeeding time was 12.97 months. Just 2 of them were diagnosed with lactational mastitis before. One patient smoked before, 1 patient had oral contraceptive pills before, 4 patients had breast trauma recently, 5 patients had positive bacterial culture of pyogenic fluids, 3 patients had nipple retraction, 6 patients had abnormal humoral immunity, shown as elevated C3 or C4, and 2 patients had elevated serum prolactin. All patients presented as a breast mass with pain; two of them had erythema nodosum and oligoarthritis. Nearly all patients had unilateral lesion. The mean follow-up was 11 (range 1-24) months. Thirteen patients gave birth to a healthy baby, and all babies had a healthy growth and development. Almost all patients chose observation during pregnancy. Nine patients demonstrated complete remission, five of them underwent surgery after steroids and/or antibiotics, one patient had observation alone, two chose postpartum steroids alone, and the last one chose postpartum antibiotics alone. The average time to complete remission was 11.2 (range 7-18) months. Conclusions: In general, PAGM is a much rare disorder which has onset during pregnancy, and mainly happens in the second trimester and the third trimester. PAGM patients were all parous women and generally within 5 years of their last pregnancy, also with uncertain etiology and pathogenesis. Observational therapy during pregnancy for PAGM is reliable and feasible.

To accommodate for the rapidly increasing patient volume and follow-up visits of men with prostate cancer on active surveillance (AS), we carried out a quality improvement project to secure high-quality care and enhance patient experience.We proposed an innovative clinic systems redesign - "Shared Medical Appointments" (SMAs) - in which multiple patients were seen in a group format at the same time by the health care team led by a urologist leading the Institution's AS program.We piloted four SMAs during July-November 2019. Running the SMAs was feasible and improved the contact time for each patient while at the same time being time- and resource efficient for the healthcare providers and using the standard billing processes. The group dynamic was open and pleasant. The majority of patients rated their overall experience with SMA as excellent. Almost all patients responded that they were likely or very likely to attend another SMA in the future. All patients said that they would either definitely or probably recommend this visit type to a friend of family member with prostate cancer. Most patients rated their overall satisfaction with the SMA as extremely high.Utilizing SMAs for AS follow-up visits was feasible and acceptable. Our promising findings suggest that SMAs can ensure high-quality patient care. Well-controlled studies comparing SMAs to individual usual care visits should be conducted with endpoints including knowledge, patient and staff satisfaction, anxiety and quality-of-life outcomes, AS adherence, process measures and resource utilization.

PURPOSE: We implemented an advanced practice provider (APP)-led clinic to aid in managing the growing population of men on active surveillance (AS) for prostate cancer. Our objective was to evaluate the quality and safety of an established APP-led AS clinic by comparing outcomes with urologist-led biopsies, defined in terms of adherence to scheduled visits and biopsy complications. MATERIALS AND METHODS: We performed a retrospective review of 2341 consecutive patients treated in an AS clinic at a high-volume referral center between 2000–2019. We examined the rate of no-show or same-day cancellation of visits for APPs versus urologists and compared the risk of biopsy complications between these providers. Generalized estimating equations were used to account for repeated visits and biopsies. RESULTS: There were significantly more no-shows at APP visits (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.16–1.70, p

Artificial intelligence is predicted to play a big part in self-learning, industrial automation that will negotiate the bandwidth of structural health and control systems. The industrial structural health and control system based on discrete sensors possesses insufficient spatial coverage of sensing information, while the distributed condition monitoring has been mainly studied at the sensor level, relatively few studies have been conducted at the artificial intelligence level. This paper presents an innovative method for distributed structural health and control systems based on artificial intelligence. The structural condition was divided into regional and local features, the feature extraction and characterization are performed separately. Structural abnormality recognition and risk factor calculation method were proposed by considering the response values and the distribution patterns of both the regional and the local structural behaviours. The test results show that the method can effectively identify the full-scale and local damage of the structure, respectively. Subsequently, structural safety assessment method for long-span structures at kilometres level in view of fully length strain distributions measured by distributed fiber optic sensors were developed. A series of load tests on the long-span structure were carried out. Finite element (FE) model was developed using finite element code, ABAQUS, and an extensive parametric study was conduct to explore the effect of load cases on the structural responses. The differences in the structural response results among load test, structural safety assessment and FE simulation were investigated. It is shown that AI-based self-learning system could offer suitable speed in deployment, reliability in solution and flexibility to adjust in distributed structural health monitoring and control.

PurposeThis paper aims to propose a novel approach to constructing an economic taxonomy that demonstrates the complex relationships between firms, which are not fully revealed by traditional industry classification systems such as the NAICS or ICB.Design/methodology/approachBased on narrative economic theory, data from CNBC news reports between 01/01/2019 and 03/27/2019 regarding four selected firms, namely, Walmart, Amazon, Netflix and Boeing, were analyzed and coded as the basis to guide the construction of a firm-to-firm relationship taxonomy.FindingsThe relationships between firms are more complex than the simple relationships defined by the traditional classification systems with yes or no in terms of production process (NAICS) or major profit resource (ICB). Based on the sample firms, the authors proposed a four-layer hierarchical taxonomy framework that quantitatively reveals the inherent contradictory relationships between firms, which the authors defined as competition vs consistency. The proposed taxonomy framework is sufficiently flexible to accommodate complex relationships between firms, and it is also adaptable to new information. Under both the competition and consistency categories in the taxonomy model, more detailed subcategories are further coded into two more layers quantitatively to represent the firms' nuanced relationships.Originality/valueThis study provides a novel atheoretical approach to reveal complex firm relationships utilizing narrative text data gathered from news media. The framework of the firm relationship taxonomy constructed in this study provides an alternative and supplementary approach to the classical industry classification systems that can quantitatively specify comprehensive and dynamic connections between firms.

Sodium salt is a pivotal ingredient in traditional fermented foods, but its excessive consumption adversely affects human health, product quality, and production efficiency. Therefore, reducing sodium salt content in traditional fermented foods and developing low-sodium fermented foods have attracted increasing attention. Given the essential role of sodium salt in the safety and quality of fermented foods, appropriate approaches should be applied in the production of low-sodium fermented foods. In this review, the challenges of sodium reduction in traditional fermented foods are presented, including the possible growth of pathogenic bacteria, the formation of hazardous chemicals, flavor deficiency, and texture deterioration. Physical, chemical, and biological strategies are also discussed. This review provides references for improving the quality and safety of low-sodium fermented foods.

With the continuous improvement of the national medical system, health monitoring combined with cloud computing and Internet of Things has become a concern. This study mainly discusses the design of the medical health monitoring IoT system based on cloud computing. From the user to the health service provider, there are three devices: sensor terminal, gateway terminal, and service platform. The sensor terminal is used to measure physiological indicators, such as blood pressure, electrocardiogram, blood oxygen saturation, heart rate, and other physiological indicators; the gateway terminal is used to link the sensor terminal to receive physiological indicators and forward them to the business platform; the gateway is also used to receive health information and other instructions issued by the server. In the community service mode, users can be divided into groups according to the community and region, and the corresponding service doctors and agent customer service personnel (nurses) can be assigned. Users can collect personal physiological indicators at home or outside through the medical terminal. These indicators and information are transmitted to the background health platform system through the mobile GSM-TD communication network. Users can also view their own historical health records and opinions of health consultants through the web/WAP website. Through the integration ability of the health cloud platform, relying on the interconnection with HIS, LIS, and other information systems of professional medical institutions, we jointly operate special value-added services, such as appointment registration, maternal and child healthcare, and medical communication (doctor-patient interaction), so that users can enjoy the remote service and guidance of professional medical institutions by subscribing to health value-added services. The CPU utilization rate is 40%, the internal utilization rate is 7.44 G, the memory utilization rate is 11.8%, and the network bandwidth is 591.87 M. During the whole test process, the indicators are stable, and there are no restart, crash, and other phenomena, so the system performance meets the design requirements.

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.

Transition metal chalcogenide quantum dots (TMCs QDs) constitute a crucial sector of semiconductors on account of large absorption coefficient for light harvesting, peculiar quantum confinement effect, and abundant active sites stemming from ultra-small size. However, elaborate and tunable modulation of anisotropic photoinduced charge carriers over TMCs QDs represents an enduring challenge in terms of sluggish charge transfer kinetic and ultra-short charge lifetime compared with nanoparticulate counterparts, thereby rendering maneuvering charge transfer of TMCs QDs a tough issue. We herein conceptually unlock the unanticipated charge transport capability of solid-state non-conductive poly(diallyl dimethylammonium chloride) (PDDA) for constructing cascade charge transfer pathway over self-assembled wide bandgap semiconductors (WBS)/PDDA/TMCs QDs multilayered heterostructures, by which unidirectional and accelerated electron transfer from TMCs QDs to WBS support mediums was spontaneously activated, markedly boosting the charge separation/migration efficiency. The integrated roles of such ultrathin insulating PDDA intermediate layer as simultaneous surface charge modifying agent and interfacial charge transfer mediator have been evidenced to be universal. The unexpected electron-withdrawing capability of ultrathin PDDA layer endows WBS (SnO 2, TiO2)@PDDA@TMCs (CdSe, CdS) QDs heterostructures with significantly enhanced net efficiency of photoactivities toward selective anaerobic reduction of nitroaromatics to amino derivatives under visible light irradiation. Our work would feature a promising scope for rational design of multifarious novel insulating polymers-based photosystems for solar energy conversion.

Once fires occur in a coalfield, large quantities of coal in the coalfield will be baked at high temperatures. The changes and differences in the microscopic and spontaneous combustion properties o...

Large temperature gradient and local hot spot in solar receiver seriously impact the operation safety and thermal performance. To improve the temperature uniformity of porous foam absorber in a volumetric solar receiver, this work presents a receiver with an annular inner window to reshape the fluid field in the receiver. To examine the improvement effect of the proposed receiver, one numerical model is developed to analyze the coupled heat transfer in the receiver. The model takes the propagation of concentrated solar irradiation and thermal radiation in the consideration by using the Monte-Carlo ray tracing method. The effects of the inner window on the fluid flow and temperature distribution of the absorber as well as the efficiency of the receiver are analyzed. The results show that the standard difference of temperature in absorber of the proposed receiver is 35–158.6 K lower than that of the single windowed one, and the thermal efficiency is increased by 2.86%–7.18%, within the inner radius of the annular window range of 15–45 mm and flow rate of 4–7 g/s. It is demonstrated that installing an annular window is an effective approach to improve the uniformity of absorber temperature while increasing the thermal performance.

MoS2 nano-films have attracted extensive interest from scientists owing to its unique material properties with adjustable bandgap structure and broad application prospects in electronic and optoelectronic devices. Herein, we report a chemical vapor deposition method based on adjusting the relative position of the molybdenum source and SiO2/Si substrates to control MoO3 concentration adsorbed on the surface of substrate to achieve the controlled growth of monolayer single crystal MoS2 with spatial uniformity and low nucleation density. Moreover, optical microscopy, Raman, photoluminescence, atomic force microscopy and transmission electron microscope were employed to characterize the uniformity and crystal quality of the grown monolayer MoS2. The measurement results show that the triangle side length of a single MoS2 film can reach 110 μm. And the I-V switching ratio of the back-gate field effect transistors based on growing MoS2 is 6.3 × 108, which is equivalent or slightly higher than that of other CVD-grown samples. Besides, growth mechanism of MoS2 was further investigated, combining the substrate position with concentration of MoO3 deposited on the surface of substrate. This work is of great benefit to the controlled growth of other two-dimensional materials and uniform performance of multiple electronic array devices.

Hypertension responsible for more than 10 million deaths annually worldwide and abnormal diurnal blood pressure (BP) variation is associated with cardiovascular events. This study aimed to investigate the association between the 24-h ambulatory night BP dipping and morning BP surge (MS) with characteristic of coronary artery lesions that may contribute cardiovascular events and mortality burden. A cross sectional study over 1-year, collected 263 cases of hypertensive (80%) and non-hypertensive patients, aged 61 ± 10 years, who undergoing invasive coronary angiography (CAG) and 24-h ambulatory BP monitoring admitted to cardiology department complain of chest pain. The night-time/day-time dip and sleep-trough MS were calculated. Non-dipper status was considered when night-time/day-time dip < 10%, and significant coronary lesion (SCL) when ≥ 50 % stenosis in 1.5 mm vessels. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was used to quantify the complexity of SCL. The mean morning systolic BP (SBP) surge was higher in the high SYNTAX Score subgroup than low and intermediate subgroups (25 ± 11 vs 17 ± 13 and 10 ± 10 mmHg, p < 0.010). Non-dipper SBP status was more frequently in patients with SCL than non-SCL (p < 0.019). In ordinal regression, hypertension was independent predictor of SCL (odd ratio: 0.40, p < 0.003), the night-time/day-time BP dip was independent predictor of being in a higher SYNTAX score subgroup (systolic odd ratio: 0.88, diastolic odd ratio: 1.14 p < 0.05). Hypertension is associated with SCL and the night-time/day-time BP dip as a continuous variable is associated with complex coronary lesion. Non-dipping as categorical variable and morning BP surge were not independent predictors of significant or complex coronary lesions.

Recent years have witnessed the emergence of worldwide megalopolises and the accompanying public safety events, making urban safety a top priority in modern urban management. Among various threats, dangerous goods such as gas and hazardous chemicals transported through cities have bred repeated tragedies and become the deadly “bomb” we sleep with every day. While tremendous research efforts have been devoted to dealing with dangerous goods transportation (DGT) issues, further study is still in great need to quantify this problem and explore its intrinsic dynamics from a big data perspective. In this article, we present a novel system called DGeye , to feature a fusion between DGT trajectory data and residential population data for dangers perception and prediction. Specifically, DGeye first develops a probabilistic graphical model-based approach to mine spatio-temporally adjacent risk patterns from population-aware risk trajectories. Then, DGeye builds the novel causality network among risk patterns for risk pain-point identification, risk source attribution, and online risky state prediction. Experiments on both Beijing and Tianjin cities demonstrate the effectiveness of DGeye in real-life DGT risk management. As a case in point, our report powered by DGeye successfully drove the government to lay down gas pipelines for the famous Guijie food street in Beijing.

An 81-year-old man, with a complex vascular surgical history, presents with sepsis from an infected Nellix stent-graft. He required an urgent laparotomy, explantation of the graft, and extra-anatomical repair. Although now widely used for this indication, the preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography was nondiagnostic for his stent-graft infection. We describe our management of a complicated Nellix graft infection and discuss the utility of positron emission tomography/computed tomography for stent-graft infections.

The efficacy of immunotherapy is largely patient-specific due to heterogeneity in tumors. Combining statistic power from a variety of immunotherapies across cancer types, we found four biological pathways significantly correlated with patient survival following immunotherapy. The expression of immunotherapy prognostic marker genes (IPMGs) in these pathways can predict the patient survival with high accuracy not only in the TCGA cohort (89.36%) but also in two other independent cohorts (80.91%), highlighting that the activity of the IPMGs can reflect the sensitivity of the tumor immune microenvironment (TIME) to immunotherapies. Using mouse models, we show that knockout of one of the IPMGs, MALT1, which is critical for the T-cell receptor signaling, can eliminate the antitumor effect of anti-PD-1 treatment completely by impairing the activation of CD8+ T cells. Notably, knockout of another IPMG, CLEC4D, a C-type lectin receptor that expressed on myeloid cells, also reduced the effect of anti-PD-1 treatment potentially through maintaining the immunosuppressive effects of myeloid cells. Our results suggest that priming TIME via activating the IPMGs may increase the response rate and the effect of immune checkpoint blockers.

Purpose The aim of the study was to determine the feasibility of interstitial brachytherapy under non-anesthetist-administered moderate sedation, to identify factors influencing the insertion, and the total procedural time. Material and methods A total of 47 insertions with hybrid intracavitary and interstitial applicators were performed in 23 patients from March 2017 to March 2020. Moderate sedation was achieved with intravenous midazolam and fentanyl administered by non-anesthetist. Insertion time and procedural time was recorded. Univariate and multivariate analysis were performed to evaluate the impact of different factors on insertion and procedural time. Results A total of 238 needles (range, 2-8 per insertion) were implanted, with an average insertion depth of 30 mm (range, 20-40 mm). The mean doses for midazolam and fentanyl were 3 mg (standard deviation [SD] = 1) and 53.3 mcg (SD = 23.9) per insertion, respectively. The median insertion time was 30 minutes (interquartile range [IQR] = 22-40), and the median total procedural time was 4.3 hours (IQR = 3.6-5.2). First time insertion, insertions performed before 2019, and higher midazolam dose were associated with significantly longer insertion time, whereas longer insertion time, MRI-based planning, and insertions performed before 2019 were associated with significantly longer total procedural time. Conclusions Outpatient interstitial brachytherapy with non-anesthetist-administered sedation is achievable and well-tolerated. This method may significantly lessen the burden on hospital resources and has the potential to be cost-effective.

BACKGROUND Sudden hearing loss (SHL) is associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury. Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke. It is important to distinguish stroke from benign disease. CASE SUMMARY A 48-year-old male patient presented with SHL and vertigo as first symptoms. Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm, confirming that the patient had cerebral infarction. Treatment with antiplatelet drugs, steroid anti-inflammatory drugs, and neurotrophic nerve therapy promoted blood circulation and removed blood stasis, and the symptoms of the patient were significantly improved. CONCLUSION SHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke.

Bing-Xin Lin, Chun-Sen Xu Department of Breast Surgery, Union Hospital of Fujian Medical University, Fuzhou, People’s Republic of ChinaCorrespondence: Chun-Sen XuDepartment of Breast Surgery, Union Hospital of Fujian Medical University, No. 29 of Xinquan Road, Gulou District, Fuzhou, 350001, People’s Republic of ChinaTel/Fax +86 591 83357896Email chunsenxuparis@163.comBackground: To analyze the risk factors of a peripherally inserted central catheter (PICC)-related venous thrombosis in patients with breast cancer undergoing chemotherapy and explore its preventive measures.Methods: Data of 780 patients with breast cancer who underwent PICC chemotherapy in our hospital from January 2014 to June 2015 were retrospectively analyzed. The incidence of catheter-related thrombosis was observed, and related factors of venous thrombosis were analyzed.Results: Among the 780 patients with breast cancer, 36 developed PICC-related venous thrombosis. The incidence of which was 4.62% (36/780). The PICC retention time ranged between 60 and 136 days, and the median time was 92 days. Thrombosis was found to occur within seven days after catheterization in three patients (8.33%), between 7 and 30 days in 18 patients (50%), between 31 and 92 days in 12 patients (33.3%), and ≥ 92 days in three patients (8.33%). Basilic vein puncture-induced thrombosis occurred in 25 patients (3.68%), and median cubital vein and cephalic vein puncture-induced thrombosis occurred in 11 patients (10.78%). The difference was statistically significant (P = 0.001). Thrombosis was not associated with age, punctured limb, platelet count, or chemotherapy drugs (P > 0.05).Conclusion: Blood vessel puncture was the main factor that affected PICC-related thrombosis in breast cancer chemotherapy. The basilic vein should be the primary choice for blood vessel puncture. Prolonged catheter retention does not increase the risk of thrombosis.Keywords: breast cancer, peripherally inserted central catheter, thrombosis

In recent years, deep learning methods have received more attention in epithelial-stroma (ES) classification tasks. Traditional deep learning methods assume that the training and test data have the same distribution, an assumption that is seldom satisfied in complex imaging procedures. Unsupervised domain adaptation (UDA) transfers knowledge from a labelled source domain to a completely unlabeled target domain, and is more suitable for ES classification tasks to avoid tedious annotation. However, existing UDA methods for this task ignore the semantic alignment across domains. In this paper, we propose a Curriculum Feature Alignment Network (CFAN) to gradually align discriminative features across domains through selecting effective samples from the target domain and minimizing intra-class differences. Specifically, we developed the Curriculum Transfer Strategy (CTS) and Adaptive Centroid Alignment (ACA) steps to train our model iteratively. We validated the method using three independent public ES datasets, and experimental results demonstrate that our method achieves better performance in ES classification compared with commonly used deep learning methods and existing deep domain adaptation methods.

Background Radiotherapy is a conventional and effective local treatment for breast cancer. However, residual or recurrent tumors appears frequently because of radioresistance. Novel predictive marker and the potential therapeutic targets of breast cancer radioresistance needs to be investigated. Methods In this study, we screened all 10 asparagine-linked glycosylation (ALG) members in breast cancer patients’ samples by RT-PCR. Cell viability after irradiation (IR) was determined by CCK-8 assay and flow cytometry. The radiosensitivity of cell lines with different ALG3 expression was determined with the colony formation assay by fitting the multi-target single hit model to the surviving fractions. Cancer stem-like traits were assessed by RT-PCR, Western blot, and flow cytometry. The mechanisms of ALG3 influencing radiosensitivity was detected by Western blot and immunoprecipitation. And the effect of ALG3 on tumor growth after IR was verified in an orthotopic xenograft tumor models. The association of ALG3 with prognosis of breast cancer patients was confirmed by immunohistochemistry. Results ALG3 was the most significantly overexpressing gene among ALG family in radioresistant breast cancer tissue. Overexpression of ALG3 predicted poor clinicopathological characteristics and overall survival (OS), and early local recurrence-free survival (LRFS) in breast cancer patients. Upregulating ALG3 enhanced radioresistance and cancer stemness in vitro and in vivo. Conversely, silencing ALG3 increased the radiosensitivity and repressed cancer stemness in vitro, and more importantly inhibition of ALG3 effectively increased the radiosensitivity of breast cancer cells in vivo. Mechanistically, our results further revealed ALG3 promoted radioresistance and cancer stemness by inducing glycosylation of TGF-β receptor II (TGFBR2). Importantly, both attenuation of glycosylation using tunicamycin and inhibition of TGFBR2 using LY2109761 differentially abrogated the stimulatory effect of ALG3 overexpression on cancer stemness and radioresistance. Finally, our findings showed that radiation played an important role in preventing early recurrence in breast cancer patients with low ALG3 levels, but it had limited efficacy in ALG3-overexpressing breast cancer patients. Conclusion Our results suggest that ALG3 may serve as a potential radiosensitive marker, and an effective target to decrease radioresistance by regulating glycosylation of TGFBR2 in breast cancer. For patients with low ALG3 levels, radiation remains an effective mainstay therapy to prevent early recurrence in breast cancer.

Inertia synchronization control is a good solution for type-IV wind turbine to provide an inertia response to the grid. To further improve its frequency support performance, this paper addresses a battery energy storage unit on the DC link side of the full power back-to-back wind energy converter. After that, the corresponding modified control strategy is implemented as an upgraded version of existing inertia synchronization control from the view of emulating the behavior of a traditional synchronous generator widely used in power system for decades. Moreover, a control method based on removable virtual resistors co-operated with reconfiguration of battery energy storage unit’s control structure is studied in detail to improve the low voltage ride through performance of the wind turbine. Simulation results are obtained based on the environment of PSCAD/EMTDC, which can certify the correctness and feasibility of the presented control method in this paper.

Attention mechanism plays an important role in the perception and cognition of human beings. Among others, many machine learning models have been developed to memorize the sequential data, such as the Long Short-Term Memory (LSTM) network and its extensions. However, due to lack of the attention mechanism, they cannot pay special attention to the important parts of the sequences. In this paper, we present a novel machine learning method called attention-augmented machine memory (AAMM). It seamlessly integrates the attention mechanism into the memory cell of LSTM. As a result, it facilitates the network to focus on valuable information in the sequences and ignore irrelevant information during its learning. We have conducted experiments on two sequence classification tasks for pattern classification and sentiment analysis, respectively. The experimental results demonstrate the advantages of AAMM over LSTM and some other related approaches. Hence, AAMM can be considered as a substitute of LSTM in the sequence learning applications.

Accurate survival prediction of persons with plasma cell myeloma (PCM) is challenging. We interrogated clinical and laboratory co-variates and RNA matrices of 1040 subjects with PCM from public datasets in the Gene Expression Omnibus database in training (N = 1) and validation (N = 2) datasets. Genes regulating plasma cell metabolism correlated with survival were identified and seven used to build a metabolic risk score using Lasso Cox regression analyses. The score had robust predictive performance with 5-year survival area under the curve (AUCs): 0.71 (95% confidence interval, 0.65, 0.76), 0.88 (0.67, 1.00) and 0.64 (0.57, 0.70). Subjects in the high‐risk training cohort (score > median) had worse 5-year survival compared with those in the low‐risk cohort (62% [55, 68%] vs. 85% [80, 90%]; p

In order to meet the dramatic wireless bandwidth demands of emerging multimedia applications, cognitive radio has been proposed as one of promising solutions to improve the spectrum efficiency. This article aims at pursuing high spectrum efficiency via accessing the idle spectrum intelligently without information exchange among users. Different from infrastructure-based wireless networks, users in cognitive radio networks tend to compete with each other to access limited idle spectrum, thus leading to a dynamically heterogeneous radio environment. In this article, a Q-learning based spectrum access scheme is proposed to adaptively allocate multimedia data over multiple idle spectrum holes. Taking into consideration the rigorous delay and throughput performance requirements of multimedia applications, we integrate these two indicators into the definition of reward function in the proposed Q-learning algorithm. The simulation results show that the proposed scheme can quickly converge to a stable state in terms of throughput, power efficiency, and collision probability. Furthermore, the proposed learning rate adjustment strategy makes the performance of the spectrum access algorithm converge the quickest and only consumes 78% time to achieve the targeted collision probability, i.e., 0.1, compared with two other typical parameter adjustment strategies.

Background The effect of postsurgical radiotherapy (PSRT) among T1-3 gallbladder cancer (GBC) patients with one to three lymph node metastases remains controversial. The aim of this study was to assess the impact of PSRT on gallbladder cancer-specific survival (GBCSS) in patients with stage IIIB. Methods The data of GBC patients were obtained from the American Surveillance, Epidemiology, and End Results (SEER) Data resources between 2004 and 2015. Then, a 1:1 propensity score matching (PSM) method was performed. GBCSS was compared among all patients. Subgroup analysis was conducted to identify patients who would benefit from PSRT. Results 726 AJCC (8th edition) stage IIIB GBC patients were included. PSRT failed to improve GBCSS (p = 0.168). Male sex, tumor size ≥ 4 cm and absence of chemotherapy were independent negative prognostic factors. No significant survival benefit from PSRT was found in any subgroup. Conclusions PSRT provides no survival benefit for IIIB GBC.

The aim of this study was to evaluate the association of the chromobox homologue 7 (CBX7) expression with the epithelial–mesenchymal transition in cervical cancer (CC), as well as with the disease prognosis. CBX7, E-cadherin (E-cad), and vimentin (VIM) expression levels were detected with immunohistochemistry. The relationship between the expression of CBX7, E-cad, and VIM expression and conventional clinicopathological characteristics of CC were evaluated. The positive expression rates of CBX7 and E-cad in the CC tissues were lower than the adjacent non-tumorous cervical tissues. Moreover, the VIM expression level was higher. The CBX7 expression was positively correlated with the E-cad expression, whereas was negatively correlated with the VIM expression. Furthermore, CBX7 was associated with the disease clinical staging, histological differentiation, lymph node metastasis, and vascular invasion. Patients with negative CBX7 expression showed decreased overall survival rates compared with those with low or high CBX7 expression. Multivariate Cox regression analysis indicated that the decreased CBX7 expression was an independent predictor for the poor prognosis of CC. In conclusion, the absence of CBX7 is associated with the histologic differentiation, lymphatic metastasis, vascular invasion, and poor prognosis of CC. CBX7 may be an independent prognostic factor for the prognosis of CC patients.

Bi-level positive airway pressure (BiPAP) and synchronized intermittent mandatory ventilation (SIMV) can be used to achieve peak inspiratory pressure and positive end-expiratory pressure to avoid alveolar collapse and improve oxygenation in preterm infants during the treatment of respiratory distress syndrome (RDS), and there is an urgent demand for evaluating the effects and prognoses of these two ventilation modes.We conducted a retrospective study on preterm infants (≤32 weeks and2500 g) from March 2015 to March 2020 with BiPAP (There were no significant differences (Although both BiPAP and SIMV achieved good early treatment outcomes of RDS in preterm infants, BiPAP support is recommended for reducing the incidence of pulmonary hemorrhage, bronchopulmonary dysplasia and IVH (≥grade II) if infants are tolerant. Attempts should be made to prevent these complications from happening with the use of SIMV support if infants are intolerant.

Sentiment analysis in Danmaku video interaction aims at measuring public mood in respect of the video, which is helpful for the potential applications in behavioral science. Once these sentiments are discovered, this feedback can help video creators improve the video quality and greatly enhance online users’ watching experience. Predicting these entity-level sentiments is challenging because there is no publicly available dataset about entity-level sentiment analysis of Danmaku-enabled video comments. Furthermore, the targeted entity with skewed unbalance distribution in real-world scenarios, making the task more challenging, especially when the target entity only has positive (negative) emotional comments. In this case, applying previous aspect-level sentiment analysis models directly will introduce entity bias. In this paper, we propose a large-scale Chinese video comments dataset containing time-sync Danmaku comments and traditional video comments, targeting multiple entities and sentiments associated with each entity from popular video websites. We also propose a framework of entity-level sentiment analysis with two de-biasing models: hard-masking de-bias model and soft-masking de-bias model. This framework is defined by parallel neural networks to learn the representation of comments sentences. Based on the representations, our model learns a masking strategy for entity words to avoid overfitting and mitigate the bias. Our experiments on Danmaku-enabled video datasets show that the soft-masking model significantly outperforms comparable baselines, with a relative F1-score improvement of 9.33% compared to AEN-BERT and a relative F1-score improvement of 45.77% compared to Td-LSTM. Furthermore, experiments on different distribution bias of entity demonstrate that our proposed model can achieve competitive performances. The findings of this research have implications for measuring public sentiment for entities mentioned in a specific video domain. It can also be used as a benchmark dataset for aspect entity sentiment detection methods.

BACKGROUND Malnutrition is prevalent that can impair multiple clinical outcomes in oncology populations. This study aimed to develop and utilize a tool to optimize the early identification of malnutrition in patients with cancer. METHODS We performed an observational cohort study including 3998 patients with cancer at two teaching hospitals in China. Hierarchical clustering was performed to classify the patients into well-nourished or malnourished clusters based on 17 features reflecting the phenotypic and etiologic dimensions of malnutrition. Associations between the identified clusters and patient characteristics were analyzed. A nomogram for predicting the malnutrition probability was constructed and independent validation was performed to explore its clinical significance. RESULTS The cluster analysis identified a well-nourished cluster (n = 2736, 68.4%) and a malnourished cluster (n = 1262, 31.6%) in the study population, which showed significant agreement with the Patient-Generated Subjective Global Assessment and the Global Leadership Initiative on Malnutrition criteria (both P

The Global Leadership Initiative on Malnutrition (GLIM) has the potential to gain global acceptance for diagnosing malnutrition. Of which, calf circumference (CC) was proposed as an alternative to evaluate the reduced muscle mass (RMM). The present study aimed to evaluate whether including the hand grip strength (HGS) was helpful for diagnosing malnutrition under the GLIM framework. We performed a multicenter, observational cohort study including 3998 patients with cancer at two teaching hospitals. The RMM criterion was separately assessed using the calf circumference (CC), or the CC and HGS combined. Accordingly, two methods of GLIM diagnosis were independently developed to determine the nutritional status of the patients. The diagnostic concordance, baseline characteristics, and outcomes of patients were compared across the malnourished-CC-HGS, malnourished-CC+HGS, and well-nourished groups. The Patient-Generated Subjective Global Assessment (PG-SGA) was used as a comparator to identify the optimal method. Malnutrition was identified in 1120 (28%) patients by the CC method and 1060 (26.5%) patients by the CC+HGS method. Compared to the well-nourished group, the malnourished-CC+HGS group (60 patients, 1.5%) had poorer nutritional characteristics, poorer Karnofsky Performance Status scores, poorer global quality of life scores, and higher Nutritional Risk Screening 2002 scores. The severity of malnutrition diagnosed using the CC method (Kappa = 0.136) showed higher agreement with the PG-SGA than the CC+HGS method (Kappa = 0.127). Compared to CC+HGS, the CC alone appears to be adequate to evaluate RMM under the GLIM framework. A simpler method might facilitate the application of these criteria in clinical settings by increasing efficacy and minimizing missed diagnoses.

Background: Hypertension is associated with an increased risk of cardiovascular events, cardiovascular and all-cause mortality. However, the diagnostic ability of hypertension for the presence and severity of CAD (coronary artery disease) has not been elucidated. This study investigates the relationship between hypertension and CAD complexity using the SYNTAX score to determine hypertension’s roles in coronary heart disease progression. Method: This is a prospective study that includes consecutive 410 adult patients at mean age (61 ± 11 years) who are admitted to Cardiology Department and undergo invasive coronary angiography (CAG) where a significant coronary lesion (SCL) is defined as stenosis ≥50% in vessel diameter ≥ 1.5 mm. The SYNTAX scores were calculated using the SYNTAX score algorithm. Results: The mean rank of SYNTAX score was significantly higher among hypertension than non-hypertension (mean rank: 279, 184, p = 0.006) groups. SYNTAX score was positively correlated with age (r: 0.263, p < 0.001) and LDL (correlation coefficient 0.102, p = 0.038) but inversely with HDL (r: 0.107, p = 0.031), in multivariate linear regression age (regression coefficient 0.3, p < 0.001), male (-4.4, p = 0.002), HDL (-6.4, p = 0.002) were significant independent risk factors for SYNTAX score, in ordinal regression model aging (odd ratio: 1.08, p < 0.001), being a male (2.84, p = 0.026), HDL (0.05, p < 0.001), BMI (0.86, p = 0.020) were significantly independent predictor of increase or decrease probability of falling in high syntax score group. Conclusion Hypertension affects the distribution of SYNTAX score among patients with and without hypertension, and the prevalence of significant coronary lesions was more frequent in hypertensive patients. Hypertension was not a predictor of significant or complex coronary artery lesion, but advanced age, being a male, HDL, LDL and BMI are considered as independent risk factors for high SYNTAX score, Subsequently and the complexity of CAD. Therefore, when patients with CAD have these factors, we expect that the Patient’s CAD complexity will be high.

Purpose To investigate the impact of diabetic peripheral neuropathy and its severity on the threshold of sciatic nerve electrical stimulation in diabetic patients. Patients and Methods The case-control study included 60 patients that were divided into non-diabetic patients (control group, n = 26) and diabetic patients (diabetes group, n = 34). All the patients who were scheduled for lower leg, foot, and ankle surgery received a popliteal sciatic nerve block. We recorded the minimum current required to produce motor activity of the sciatic nerve during ultrasound-guided popliteal sciatic nerve block. Results Among the 60 patients, the sciatic nerve innervated muscle contractile response was successfully elicited in 57 patients (dorsiflexion of foot, plantar flexion, foot valgus or adduction, toe flexion, etc.) under electric stimulation. We failed to elicit the motor response in three patients with diabetic peripheral neuropathy, even when the stimulation current was 3 mA. The average electrical stimulation threshold (1.0 ± 0.7 mA) in the diabetes group was significantly higher than that of the control group (0.4 ± 0.1 mA). Diabetic patients with peripheral neuropathy had a higher electrical stimulation threshold (1.2 ± 0.7 mA) than patients without peripheral neuropathy (0.4 ± 0.1 mA). Furthermore, the electrical stimulation threshold of the sciatic nerve in diabetic patients had a linear dependence on the Toronto Clinical Scoring System (TCSS) peripheral neuropathy score (electrical stimulation threshold [in mA] = 0.125 TCSS score) (P < 0.001). Conclusion The threshold of electrical stimulation to elicit a motor response of the sciatic nerve was increased in diabetic patients, and the threshold of electrical stimulation of the sciatic nerve increased with the severity of diabetic nerve dysfunction.

Background Chinese horsebean-chili-paste (CHCP) is a traditional fermented condiment in China, known as 'the soul of Sichuan cuisine'. The horsebean-to-meju phase in its preparation is important for CHCP production and contributes significantly to its taste and odor. In this study, a comprehensive flavor compound profiling analysis of the naturally brewed horsebean meju (NBHM) and the temperature-controlled brewed horsebean meju (TCBHM) was performed with two-dimensional gas chromatography time-of-flight mass spectrometry (GC × GC-TOFMS), and the analysis of physicochemical characteristics and free amino acids. Their aroma-active components and characteristic flavor compounds were evaluated. The flavor compounds responsible for differentiating NBHM and TCBHM were also determined based on the Fisher ratio and principal component analysis. Results The pH and the reducing sugar and amino-acid nitrogen content of NBHM were 5.38, 64.43, and 5.76 g kg-1 , respectively, whereas those of TCBHM were 5.13, 29.20, and 7.43 g kg-1 . A total of 356 volatiles were identified from 2571 compounds, and 257 volatile compounds were identified in NBHM compared to 322 volatiles in TCBHM. These two horsebean mejus (HMs) exhibited a similar proportion profile for 30 aroma-active compounds. Benzoic acid ethyl ester, 4-ethyl-2-methoxy-phenol and argnine were determined to be characteristic flavor components for NBHM, while 1-(2-furanyl)-ethanone, 2,6-dimethyl-pyrazine, threonine, valine and tyrosine were specific to TCBHM. Conclusion Temperature-controlled brewed horsebean meju possessed better physicochemical and flavor characteristics than NBHM. The temperature-controlled brewing technique in CHCP production can be used as a promising alternative to the traditional natural brewing method. © 2020 Society of Chemical Industry.

The inkjet 3D printing has been one of the most studied and applied additive manufacturing (AM) processes in electronic industry. In this AM process, the forming quality is greatly influenced by the micro-droplet deposition and substrate temperature. While most studies focus on the formation mechanism of droplets, there are few studies on the quantitative evaluation of the droplet surface profile and its qualitative correlation with temperature changes. In this study, the characteristics of droplet profile in three-dimensional inkjet printing were studied from two aspects, the modeling of droplet shape and the estimation of droplet temperature. For this purpose, different types of radial basis function networks (RBFN) are applied. The validity of the regularized RBFN model is developed and verified by experiments. The results show that the droplet shape can be accurately modeled and the drying temperature can be accurately estimated given the model.

Background: Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) in the immune-tolerant (IT) phase is significantly associated with high risk for hepatocellular carcinoma, suggesting requirement for antiviral therapy, particularly for those with histological liver injury. This study aimed to establish a non-invasive panel to assess significant liver fibrosis in IT chronic hepatitis B. Patients and methods: One hundred and thirteen IT-phase CHB patients were retrospectively recruited and divided into two histopathological groups according to their histological profiles: necroinflammatory score Results: IT-phase CHB patients with N Conclusion: The established IT model combining HBsAg and GGT has good performance in predicting significant liver fibrosis in IT-phase CHB patients.

Background The number of cancer patients with diabetes mellitus (DM) is steadily rising. Little is known about the nutritional status of this population. This study characterized the nutritional status and survival of cancer patients with diabetes compared with those without diabetes. Methods A total of 8247 cancer patients were prospectively enrolled from 72 hospitals in China and followed until August 2019. A global estimation of the nutritional status was performed for each participant using standardized tools. The outcomes were cancer‐specific survival (CSS) and overall survival (OS). Results The incidence of diabetes was 7.6% in the whole population. In comparison with the non‐DM group, the DM group had greater body weight, but a similar fat‐free mass, a lower handgrip strength and a decreased Karnofsky performance score. A higher proportion of patients with diabetes were overweight/obese as indicated by BMI. The percentage of patients who were at risk of malnutrition (evaluated by PG‐SGA) was higher in the DM group (score ≥ 4, 56.7% vs 52.9%). Patients with DM showed a worse CSS (4‐year CSS, 62% vs 73%) and OS (4‐year OS 39% vs 52%). Diabetes was associated with an increased risk of both cancer‐specific (hazard ratio (HR) = 1.282, 95% confidence interval (CI) 1.070‐1.536) and overall (HR = 1.206, 95% CI 1.040‐1.399) mortality. Conclusions Cancer patients with diabetes had a larger body mass but lower muscle strength, poorer performance status and higher incidence of malnourishment. Diabetes was associated with compromised survival. Tailored nutritional intervention is necessary for this subpopulation of patients., In this large prospective cohort study, cancer patients with diabetes were found to have bigger body mass yet lower muscle strength, poorer performance status and higher incidence of malnourishment. Complication with diabetes independently predicted compromised survival among cancer patients.

Reinforcement learning based on the deep neural network has attracted much attention and has been widely used in real-world applications. However, the black-box property limits its usage from applying in high-stake areas, such as manufacture and healthcare. To deal with this problem, some researchers resort to the interpretable control policy generation algorithm. The basic idea is to use an interpretable model, such as tree-based genetic programming, to extract policy from other black box modes, such as neural networks. Following this idea, in this paper, we try yet another form of the genetic programming technique, evolutionary feature synthesis, to extract control policy from the neural network. We also propose an evolutionary method to optimize the operator set of the control policy for each specific problem automatically. Moreover, a policy simplification strategy is also introduced. We conduct experiments on four reinforcement learning environments. The experiment results reveal that evolutionary feature synthesis can achieve better performance than tree-based genetic programming to extract policy from the neural network with comparable interpretability.

Background The presence of significant liver fibrosis in hepatitis B virus (HBV)-infected individuals with persistently normal serum alanine aminotransferase (PNALT) levels is a strong indicator for initiating antiviral therapy. Serum ceruloplasmin (CP) is negatively correlated with liver fibrosis in HBV-infected individuals. Aim To examine the potential value of serum CP and develop a noninvasive index including CP to assess significant fibrosis among HBV-infected individuals with PNALT. Methods Two hundred and seventy-five HBV-infected individuals with PNALT were retrospectively evaluated. The association between CP and fibrotic stages was statistically analyzed. A predictive index including CP [Ceruloplasmin hepatitis B virus (CPHBV)] was constructed to predict significant fibrosis and compared to previously reported models. Results Serum CP had an inverse correlation with liver fibrosis (r = -0.600). Using CP, the areas under the curves (AUCs) to predict significant fibrosis, advanced fibrosis, and cirrhosis were 0.774, 0.812, and 0.853, respectively. The CPHBV model was developed using CP, platelets (PLT), and HBsAg levels to predict significant fibrosis. The AUCs of this model to predict significant fibrosis, advanced fibrosis, and cirrhosis were 0.842, 0.920, and 0.904, respectively. CPHBV was superior to previous models like the aspartate aminotransferase (AST)-to-PLT ratio index, Fibrosis-4 score, gamma-glutamyl transpeptidase-to-PLT ratio, Forn's score, and S-index in predicting significant fibrosis in HBV-infected individuals with PNALT. Conclusion CPHBV could accurately predict liver fibrosis in HBV-infected individuals with PNALT. Therefore, CPHBV can be a valuable tool for antiviral treatment decisions.

Lower level of low-density lipoprotein cholesterol (LDL-C) is paradoxically associated with increased mortality in ST elevation myocardial infarction (STEMI) patients. The underlying mechanism remains unclear. In a cohort of 220 de novo STEMI patients receiving timely primary percutaneous coronary intervention, admission LDL-C was negatively associated with circulating CD14++CD16+ monocyte counts. Moreover, admission LDL-C 85 mg/dL was associated with increased risk for major adverse cardiovascular events (MACE) during a median follow-up of 2.7 years. After categorizing the patients according to the cutoff values of 85 mg/dL for LDL-C and the median for CD14++CD16+ monocytes, low LDL-C-associated MACE risk was only observed in those with high CD14++CD16+ monocyte counts (low LDL-C/high CD14++CD16+ monocytes vs. low LDL-C/low CD14++CD16+ monocytes: hazard ratio 5.38, 95% confidence interval 1.52 to 19.06, P = 0.009). This work provided the proof-of-principle evidence indicating a role of CD14++CD16+ monocytes in risk stratification of STEMI patients presenting with low LDL-C level. Graphical abstract.

Background Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. Methods We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. Results Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight-standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50-2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM-diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision-curve analysis demonstrated that the nomogram was clinically useful. Conclusion These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.

Background Breast cancer is the leading cause of death among women worldwide. Studies have identified breast density as a controversial risk factor of breast cancer. Moreover, studies found that breast density reduction through Tamoxifen could reduce risk of breast cancer significantly. To date, no study on the association between breast density and breast cancer has been carried out in Malaysia. If breast density is proven to be a risk factor of breast cancer, intervention could be carried out to reduce breast cancer risk through breast density reduction. Purpose To determine if density of breast is an independent risk factor which will contribute to development of breast cancer. Materials and Methods A prospective cohort study is carried out in two hospitals targeting adult female patients who presented to the Breast Clinic with symptoms suspicious of breast cancer. Participants recruited were investigated for breast cancer based on their symptoms. Breast density assessed from mammogram was correlated with tissue biopsy results and final diagnosis of benign or malignant breast disease. Results Participants with dense breasts showed 29% increased risk of breast cancer when compared to those with almost entirely fatty breasts (odds ratio [OR] 1.29, 95% CI 0.38‐4.44, P = .683). Among the postmenopausal women, those with dense breasts were 3.1 times more likely to develop breast cancer compared with those with fatty breasts (OR 3.125, 95% CI 0.72‐13.64, P = .13). Moreover, the chance of developing breast cancer increases with age (OR 1.046, 95% CI 1.003‐1.090, P, There are many established risk factors of breast cancer, and density of breast is a controversial risk factor which we wanted to evaluate. Our study shows that postmenopausal women with dense breasts are 3 times more likely to develop breast cancer compared to those with low breast density.