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Our patient is a 60-year-old woman of Indian ethnicity with background of diabetes mellitus for 10 years. She presented with persistent vomiting, giddiness and significant weight loss for 1 month. Of note, she had recent hypoglycaemia necessitating gradual reduction in doses of glucose-lowering

Caecal volvulus is a rare cause of intestinal obstruction, of which the caecal bascule is the most uncommonly encountered subtype. Definitive radiological diagnosis of a caecal bascule can be challenging. Lack of familiarity with this rare condition can contribute to delayed diagnosis and treatment, which may result in unnecessary morbidity. This article highlights the case of a patient who presented with a diagnostic challenge, and also discusses the pathogenesis and diagnostic features of caecal bascules. Various options in the surgical management of caecal bascules are reviewed, including the feasibility of laparoscopic-assisted approaches in the emergency setting.

Sinomenine (SIN) is commonly used as part of rheumatoid arthritis (RA) therapy in China, but there is still no published evidence of the efficacy of SIN monotherapy. This work investigates the efficacy and safety of SIN in treating RA patients and analyzes the correlation between ornithine level and the alleviation of disease activity in RA patients. In this 24 week, randomized, placebo-controlled, double-blind clinical trial, people with mild to moderate RA were randomly assigned (1:1:1, stratified by hospital) to receive SIN (120 mg, twice daily), methotrexate (MTX) (10 mg per week), or SIN + MTX therapy. The primary outcome was the proportion of patients who achieved a 50% improvement in the American College of Rheumatology (ACR) criteria at week 24 and who showed improvement according to the clinical disease activity index (CDAI). In this prospective subgroup analysis, we also assessed whether the 24 week alterations of disease activity in the treatment group were significantly correlated to the levels of blood ornithine. Of the 135 enrolled participants, 38, 39, and 36 patients were treated with SIN, MTX, and SIN + MTX, respectively. In the SIN-treated group, 52.63% of patients achieved ACR50 after 24 weeks of treatment, which was comparable to the results in the MTX-treated and SIN + MTX-treated groups. Hepatic and gastrointestinal disorders were the main adverse events; however, the ratio of patients suffering from hepatic disorder in the SIN group (1/38) was much lower than that in the MTX (10/39) and SIN + MTX (8/36) groups. A total of 221 serum samples were collected at the four follow-up time points in the three treatments, and the levels of ornithine, citrulline, and arginine were obtained through ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS). The serum ornithine level decreased after the 24 week treatment along with a decrease in disease activity, and may reflect therapeutic responses with a sensitivity value of 80%. In conclusion, SIN revealed a comparable efficacy to MTX for treating RA patients, but with fewer side effects. In addition, the serum ornithine level was found for the first time to have a close correlation with the alleviation of RA, which shows the value of this measure as an assessment indicator of drugs in treating RA.

The purpose of this study was to examine 1) the relationship between apathy and leisure activity participation in nursing home residents with Alzheimer disease (AD) and 2) the moderator effect of the severity of dementia on this relationship. Data were collected from 290 residents with AD using the Apathy Evaluation Scale-informant version (AES-I), Leisure Activities Questionnaire (LAQ), and Clinical Dementia Rating scale (CDR). The multiple linear regression model showed that leisure activity participation (β=-0.452, p0.001) was negatively associated with apathy, while the severity of dementia (β=0.515, p0.001) was positively associated with apathy. The severity of dementia moderated the effect of leisure activity participation on apathy (β=-0.108, p=0.015). The results indicate that the effects of leisure activity participation on apathy diminish with the aggravation of AD. The severity of dementia should be considered when designing and delivering leisure activity interventions to manage apathy in nursing home residents with AD.

Introduction: Surgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC. Methods: Three databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM. Results: From a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease. Conclusion: The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC. Keywords: Colorectal cancer, pulmonary metastasectomy, pulmonary metastases, survival

Background: Gastrointestinal (GI) complications, that severely impact patient quality of life, are a common occurrence in patients with Parkinson’s disease (PD). Damage to enteric neurons and the accumulation of alpha-synuclein in the enteric nervous system (ENS) are thought to contribute to this phenotype. Copper or iron chelators, that bind excess or labile metal ions, can prevent aggregation of alpha-synuclein in the brain and alleviate motor-symptoms in preclinical models of PD. Objective: We investigated the effect of ATH434 (formally PBT434), a small molecule, orally bioavailable, moderate-affinity iron chelator, on colonic propulsion and whole gut transit in A53T alpha-synuclein transgenic mice. Methods: Mice were fed ATH434 (30 mg/kg/day) for either 4 months (beginning at ∼15 months of age), after the onset of slowed propulsion (“treatment group”), or for 3 months (beginning at ∼12 months of age), prior to slowed propulsion (“prevention group”). Results: ATH434, given after dysfunction was established, resulted in a reversal of slowed colonic propulsion and gut transit deficits in A53T mice to WT levels. In addition, ATH434 administered from 12 months prevented the slowed bead expulsion at 15 months but did not alter deficits in gut transit time when compared to vehicle-treated A53T mice. The proportion of neurons with nuclear Hu+ translocation, an indicator of neuronal stress in the ENS, was significantly greater in A53T than WT mice, and was reduced in both groups when ATH434 was administered. Conclusion: ATH434 can reverse some of the GI deficits and enteric neuropathy that occur in a mouse model of PD, and thus may have potential clinical benefit in alleviating the GI dysfunctions associated with PD.

To achieve highly efficient electromagnetic wave absorber, elaborately designing magnetic–dielectric Co@TiO2 microspheres with core–shell configuration are successfully constructed through a facile sequential process of liquid phase reduction–sol–gel–annealing. Owing to the core–shell configuration and the synergistic effect among magnetic and dielectric components, the annealed sample shows outstanding electromagnetic wave absorption (EMA) in X and Ku band. Impressively, a maximum reflection loss (RLmax) is reached –56.6 dB at a coating thickness of 2.3 mm with corresponding effective absorption bandwidth (EAB10) of 7.2 GHz (including 65% of Ku band and 82.5% of X band), much stronger than those of as-prepared Co (EAB10 of 1.6 GHz, RLmax of 14.6 dB) and pristine Co@TiO2 (EAB10 of 2.9 GHz, RLmax of 16.3 dB). An EAB10 covering completely the whole X and Ku band could be obtained by controlling the thickness only from 2.0 mm to 2.5 mm. The composites have both outstanding RL and wide EAB10 with the thin coating thickness, reinforcing that fabricating core–shell configuration composites is an efficient strategy to boost the EMA efficiency.

Background Tenofovir alafenamide fumarate (TAF) was approved for HBV treatment in China in 2018. Despite higher antiviral efficacy and less impact on renal function and bone mineral density, the pharmacokinetic profiles of TAF are highly variable. The objectives of this study were to investigate the pharmacokinetics of TAF in the Chinese population and explore the associations between TAF and genetic polymorphisms and non-genetic factors. Patients and Methods A total of 64 healthy Chinese subjects aged 18~65 years old were planned to enroll. According to the dietary intake status, the subjects were divided into two groups (n = 32 per group). The concentrations of TAF and tenofovir were measured by HPLC-MS/MS, and the single-nucleotide polymorphisms were analyzed by MALDI-TOF MS. Results All the enrolled participants (18–35 years) completed the clinical trial study. Similar to the results reported in other ethnic populations, the pharmacokinetic profiles of TAF and tenofovir were highly variable in the Chinese people, and the HFHC diet can significantly increase the systemic exposure of TAF. We determined both HFHC diet and rs7311358 (SLCO1B3) genotypes were independently associated with TAF AUC0-t, while HFHC diet, age and rs3740066 (ABCC2) variants were predictive of t1/2 of tenofovir (P < 0.05). The subjects with the AA genotype in rs7311358 had significantly higher TAF AUC0-t values (1.15 times) than those with a G allele, and the t1/2 of tenofovir in the rs3740066 TT genotype group was 1.23 times longer than that of CC genotype group. Furthermore, there was a trend of higher TAF AUC and shorter tenofovir t1/2 for the rs2032582 (ABCB1) T allele and rs3742106 (ABCC4) CC variant, respectively, although not statistically significant in the multiple linear regression analysis. Conclusion This study provided new evidence to suggest a critical link between both genetic and non-genetic factors and TAF pharmacokinetics in the Chinese people., Graphical Abstract

The aim of this study was to develop and evaluate a triptolide phospholipid complex (TPCX) for the treatment of rheumatoid arthritis (RA) by transdermal delivery. TPCX was prepared and characterized by differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR) analysis, transmission electron microscope (TEM), and scanning electron microscope (SEM). The solubility of TPCX was determined. Then, a TPCX cream was prepared to evaluate its percutaneous permeability and the antiarthritis effect. The transdermal permeability was determined using the Franz method, and a microdialysis system was used for skin pharmacokinetic study. A rat model of RA was prepared to evaluate the pharmacological effects. TPCX increased the solubility of triptolide in water, and the percutaneous permeability of TPCX cream was greatly enhanced compared with triptolide cream. The skin pharmacokinetic study indicated that TPCX cream has a longer biological half-life (t1/2) and mean residence time (MRT), but it has a shorter Tmax than that of triptolide cream in vivo. The area under the curve (AUC0–t)/AUC0–∞) and the peak concentration (Cmax) of TPCX cream were obviously higher than those of triptolide cream. The TPCX-loaded cream alleviated paw swelling and slowed down the progression of arthritis by inhibiting the inflammatory response by down regulating the TNF-α, IL-1β, and IL-6 levels, thus exhibiting excellent antiarthritic effects. In summary, the prepared TPCX effectively increases the hydrophilicity of triptolide, which is good for its percutaneous absorption and enhances its effect on RA rats. TPCX can be a good candidate for the transdermal delivery to treat RA.

“Zou Fan” is currently the largest “tree hole” on Weibo, where people having suicidal ideation often express their thoughts and use this channel to seek support. Therefore, early suicide monitoring and timely crisis intervention based on artificial intelligence technology are needed for this social media user group. This research was based on the knowledge graph technology, whereby “Tree Hole Intelligent Agent” (i.e., Artificial Intelligence Program) was used to identify “Zou Fan Tree Hole” users at high risk for suicide, and then, the “Tree Hole Action” carried out proactive suicide crisis intervention with them. The “Tree Hole Action” has temporarily prevented 3,629 potential suicides. The “Tree Hole Action” plays a significant role in suicide risk monitoring and crisis intervention for social media users and has been seen to have an important social impact.

The coordination of multi-robot system (MRS) are applied commonly to various fields of the automotive industry. In a variety of cooperative modes, online path planning with obstacles avoidance is a fundamentally important hotspot, especially in a 3-D, complex, or dynamic environment. In the paper, an improved neural dynamics based approach with territorial mechanism is proposed to online path planning of MRS, which can be used as the online path planner for multi-AUVs and multi-UAVs in complex and dynamic environments. This approach integrates biological neural network, computational fluid dynamics, and territorial mechanism of animals, which has the characteristics and advantages of the biological nervous system, namely self-regulation, self-adaptation, self-organization, etc. It can cope with a variety of accidents during path planning, such as the disappearance of targets, the breakdown of robots, the change of environments, and so forth. Meanwhile, the proposed approach has better time performance and is insensitive to the number of robots in MRS. During the path planning of MRS, it can also guarantee to balance workload and to reduce entire workload and total time, which enhance robustness and fairness. The effectiveness and efficiency of the proposed approach are demonstrated by simulations and comparative studies.

PurposePublic participation is essential for mitigating local resistance faced by the environmentally stigmatized facilities. The purpose of this study is to investigate public participation intention in the decision-making of waste incineration power (WIP) projects by examining the role of perceived corporate social responsibility (PCSR) and public knowledge (PK) based on the theory of planned behavior (TPB).Design/methodology/approachA theoretical model correlating PCSR with public participation intention was developed by using the constructs of TPB as the mediators and PK as the moderator. Drawing on structural equation modeling (SEM), the data collected from 485 local residents of the WIP projects in Jiangsu, China were analyzed to test the model.FindingsCompanies' CSR practice went through public attitude, subjective norm and personal norm as mediating steps towards promoting participation intention. PK positively moderated the indirect relationships between PCSR and participation intention. Moreover, attitude, subjective norm and personal norm were found to have a positive effect on participation intention.Originality/valueThis study advances the understanding of public participation intention and enriches the literature relating to CSR and TPB involved in infrastructure development. In order to improve public participation intention, companies should take strategic social responsibility actions and present the benefits and moral values of the activities to the public, and as well make effort to diffuse WIP-related knowledge through interactive activities with the public. Authorities should establish social and personal value systems that praise public participation and improve their expectations of participation outcomes.

Chemotherapy can induce toxicity in the central and peripheral nervous systems and result in chronic adverse reactions that impede continuous treatment and reduce patient quality of life. There is a current lack of research to predict, identify, and offset drug-induced neurotoxicity. Rapid and accurate assessment of potential neuropathy is crucial for cost-effective diagnosis and treatment. Here we report dynamic near-infrared upconversion imaging that allows intraneuronal transport to be traced in real time with millisecond resolution, but without photobleaching or blinking. Drug-induced neurotoxicity can be screened prior to phenotyping, on the basis of subtle abnormalities of kinetic characteristics in intraneuronal transport. Moreover, we demonstrate that combining the upconverting nanoplatform with machine learning offers a powerful tool for mapping chemotherapy-induced peripheral neuropathy and assessing drug-induced neurotoxicity.

Background The COVID-19 pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. In this review we examine the global effect of the COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door to balloon time (D2B), all-cause mortality, and other secondary STEMI outcomes. Methods We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies that compared the aforementioned outcomes of STEMI patients during and before the pandemic. Results In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic, respectively. Significant delay in D2B was observed during the pandemic (weighted mean difference, 8.10 minutes; 95% confidence interval [CI], 3.90-12.30 minutes; P = 0.0002; I2 = 90%). In-hospital mortality was higher during the pandemic (odds ratio [OR], 1.27; 95% CI, 1.09-1.49; P = 0.002; I2 = 36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis showed that low–middle-income countries observed a higher rate of mortality during the pandemic (OR, 1.52; 95% CI, 1.13-2.05; P = 0.006), with a similar but insignificant trend seen among the high income countries (OR, 1.17; 95% CI, 0.95-1.44; P = 0.13). Conclusions The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low–middle-income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.

Background Polysaccharides derived from plant seeds such as Chia (Salvia hispanica) have garnered significant interest within the food industry in recent years due to their unique functional properties. Known as chia mucilage (CM), it is a functional ingredient with a high amount of dietary fibre and macro- and micro-nutrients. CM also contains an abundance of health-promoting oligosaccharides that can be incorporated into foods for good gut health. Scope and approach This review aims to provide an overview of the isolation process of CM regarding the parameters used and yields obtained. Examples of parameters adapted in the extraction of CM include hydration conditions (temperature, time, water/seed ratio and pH), extraction and purification methods, and recovery parameters. Applications of CM as ingredient replacers, namely fat/oil, egg, gluten, emulsifier/stabiliser, and phosphate replacers, in various foods such as baked, cereal, dairy, and meat products are also discussed. Key findings and conclusions The effects of the isolation process and processing parameters on the experimental yield and proximate compositions of CM produced are summarised. The application of CM as ingredient replacers is also discussed, which further places importance on understanding the unique functional properties of CM for it to be utilised in other food products. It was concluded that CM is a valuable food ingredient that has been shown to impart functionality in a variety of food products, and the potential of using CM could be increased in the future.

Background Increasing studies have shown a vital fact that long non-coding RNAs (lncRNAs) play a considerable regulatory role in hepatocellular carcinoma (HCC) progression. However, whether ST8 alpha-N-acetyl-neuraminide alpha-2, 8-sialyltransferase 6 antisense RNA 1 (ST8SIA6-AS1) affects the development of HCC is unclear. Methods The target genes in HCC cell lines were quantified via utilzing quantitative real-time polymerase chain reaction (RT-qPCR) analysis and western blot. Effects of ST8SIA6-AS1 on proliferative, apoptosis and migratory ability of HCC cells were proved by a series of function experiments. The cellular distribution of ST8SIA6-AS1 was examined through fluorescent in situ hybridization (FISH) assay and subcellular fractionation experiments. RNA pulldown assay was implemented to explore the target of ST8SIA6-AS1. RNA Binding Protein Immunoprecipitation (RIP) and luciferase reporter assays were performed to identify the specific relationships between miR-338-3p and ST8SIA6-AS1/ non-POU domain containing octamer binding (NONO). Results The expression of ST8SIA6-AS1 was apparently elevated in HCC cell. Silenced ST8SIA6-AS1 reduced proliferative, migratory and invasive ability of HCC cells. Moreover, ST8SIA6-AS1 targeted miR-338-3p to modulate the expression of NONO in HCC cells. Conclusions ST8SIA6-AS1 enhances the progression of HCC via miR-338-3p/NONO axis in vitro.

Avalanche Photodiodes (APDs) are key semiconductor components that amplify weak optical signals via the impact ionization process, but this process’ stochastic nature introduces ‘excess’ noise, limiting the useful signal to noise ratio (or sensitivity) that is practically achievable. The APD material’s electron and hole ionization coefficients (α and β respectively) are critical parameters in this regard, with very disparate values of α and β necessary to minimize this excess noise. Here, the analysis of thirteen complementary p-i-n/n-i-p diodes shows that alloying GaAs with ≤ 5.1 % Bi dramatically reduces β while leaving α virtually unchanged—enabling a 2 to 100-fold enhancement of the GaAs α/β ratio while extending the wavelength beyond 1.1 µm. Such a dramatic change in only β is unseen in any other dilute alloy and is attributed to the Bi-induced increase of the spin-orbit splitting energy (∆so). Valence band engineering in this way offers an attractive route to enable low noise semiconductor APDs to be developed., An avalanche photodiode is an opto-electronic amplifier that uses impact ionization to provide enhanced sensitivity at the expense of excess noise. In this manuscript, the authors demonstrate that a small amount of Bismuth (Bi) in Gallium Arsenide (GaAs) avalanche photodiodes significantly reduces this excess noise.

Industrial wastes can be used as alternative fuel sources for the substitution of fossil fuel if they contain good calorific values. Through waste-to-energy (WtE) pathway, energy can be harvested from industrial waste through combined heat and power (CHP; or commonly known as cogeneration) scheme. The latter is recognised as an efficient way to supply thermal and electrical energy simultaneously for process plant usage. In this work, cogeneration potential of an industrial waste of glycerine pitch is analysed. A mathematical technique based on process integration, known as automated targeting model (ATM) was extended to optimise the cogeneration and fuel inventory system simultaneously by considering single- and multi-period planning with varying fuel supply. A case study involving glycerine pitch from a palm refinery is demonstrated for the extended ATM.

BACKGROUND Many studies have examined associations between dietary isoflavones and atherosclerosis, but few used objective biomarkers. OBJECTIVES We examined the associations of isoflavone biomarkers (primary analyses) and equol production (secondary analyses) with the progression of carotid intima-media thickness (cIMT), and whether inflammation, systolic blood pressure (SBP), blood lipids, and sex hormone-binding globulin (SHBG) mediated these associations, in Chinese adults. METHODS This 8.8-y prospective study included 2572 subjects (40-75 y old) from the GNHS (Guangzhou Nutrition and Health Study; 2008-2019). The concentrations of daidzein, genistein, and equol were assayed by an HPLC-tandem MS in serum (n = 2572) at baseline and in urine (n = 2220) at 3-y intervals. The cIMT of the common carotid artery (CCA) and bifurcation segment were measured by B-mode ultrasound every 3 y, and the progressions of cIMT ( ∆cIMT) were estimated using the regression method. RESULTS Multivariable linear mixed-effects models (LMEMs) and ANCOVA revealed that subjects with higher serum isoflavones tended to have lower increases of CCA-cIMT. The mean ± SEM differences in 8.8-y ∆CCA-cIMT between extreme tertiles of serum isoflavones were -17.1 ± 8.4, -20.6 ± 8.3, and -23.3 ± 10.4 μm for daidzein, total isoflavone, and equol (P-trends

Background To evaluate the diagnostic performance of T2 mapping in differentiating WHO grade II glioma from high-grade glioma (HGG). Methods We conducted a single-center, retrospective diagnostic study. Confirmed diffuse glioma (WHO grade II-IV) patients who underwent post-contrast T1-weighted imaging, T2-weighted imaging, and T2 mapping were included. All diagnoses were based on histological and molecular tests. Seventy-five percent of cases were subsampled to generate receiver operating characteristic (ROC) curves and areas under the curve (AUC), while the remaining cases were used to test the accuracy of T2 mapping. Subsampling was repeated four times. Age, T2 relaxation time, and contrast-enhancement status were used to generate a multivariable ROC curve. T2 relaxation time was also used to generate ROC curves to predict the isocitrate dehydrogenase (IDH) status. Results A total of 159 patients were included in the study. After four repeats of subsampling, the AUCs of the T2 mapping ROC curve were 0.801 (95% CI: 0.724-0.879), 0.795 (95% CI: 0.714-0.875), 0.803 (95% CI: 0.723-0.884), and 0.801 (95% CI: 0.716-0.886), with an average sensitivity of 0.753 and an average specificity of 0.767. When applied to the remaining 25% of cases, the accuracy was 75%, 93.75%, 82.50%, and 71.74%. The AUC of the multivariable ROC was 0.927 (95% CI: 0.882-0.971). IDH-mutant and IDH-wildtype gliomas have significantly different T2 relaxation times (146.28 and 124.10 ms, respectively; P=0.001), and the AUC of IDH-mutant prediction was 0.687 (95% CI: 0.585-0.789). Conclusions Quantitative T2 mapping differentiated WHO grade II glioma from HGG with moderate sensitivity and specificity. Given the advantages of short acquisition times and the absence of a contrast agent, our study suggests the application of T2 mapping in pre-operative glioma grading is feasible.

We develop and evaluate a deep learning algorithm to classify multiple catheters on neonatal chest and abdominal radiographs. A convolutional neural network (CNN) was trained using a dataset of 777 neonatal chest and abdominal radiographs, with a split of 81%–9%–10% for training-validation-testing, respectively. We employed ResNet-50 (a CNN), pre-trained on ImageNet. Ground truth labelling was limited to tagging each image to indicate the presence or absence of endotracheal tubes (ETTs), nasogastric tubes (NGTs), and umbilical arterial and venous catheters (UACs, UVCs). The dataset included 561 images containing two or more catheters, 167 images with only one, and 49 with none. Performance was measured with average precision (AP), calculated from the area under the precision-recall curve. On our test data, the algorithm achieved an overall AP (95% confidence interval) of 0.977 (0.679–0.999) for NGTs, 0.989 (0.751–1.000) for ETTs, 0.979 (0.873–0.997) for UACs, and 0.937 (0.785–0.984) for UVCs. Performance was similar for the set of 58 test images consisting of two or more catheters, with an AP of 0.975 (0.255–1.000) for NGTs, 0.997 (0.009–1.000) for ETTs, 0.981 (0.797–0.998) for UACs, and 0.937 (0.689–0.990) for UVCs. Our network thus achieves strong performance in the simultaneous detection of these four catheter types. Radiologists may use such an algorithm as a time-saving mechanism to automate reporting of catheters on radiographs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10278-021-00473-y.

Context One risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is postulated to be vitamin D deficiency. To better understand the role of vitamin D deficiency in the disease course of COVID-19, we undertook a retrospective case-control study in North West England. Objective To examine whether hospitalization with COVID-19 is more prevalent in individuals with lower vitamin D levels. Methods The study included individuals with test results for serum 25-hydroxyvitamin D (25[OH]D) between April 1, 2020, and January 29, 2021, from 2 districts in North West England. The last 25(OH)D level in the previous 12 months was categorized as “deficient” if less than 25 nmol/L and “insufficient” if 25 to 50 nmol/L. Results The study included 80 670 participants. Of these, 1808 were admitted to the hospital with COVID-19, of whom 670 died. In a primary cohort, median serum 25(OH)D in nonhospitalized participants with COVID-19 was 50.0 nmol/L (interquartile range [IQR], 34.0-66.7) vs 35.0 nmol/L (IQR, 21.0-57.0) in those admitted with COVID-19 (P Conclusion Vitamin D deficiency is associated with higher risk of COVID-19 hospitalization. Widespread measurement of serum 25(OH)D and treatment of insufficiency or deficiency may reduce this risk.

Background 18 F-APN-1607 is a novel tau PET tracer characterized by high binding affinity for 3- and 4-repeat tau deposits. Whether 18 F-APN-1607 PET imaging is clinically useful in PSP remains unclear. Objectives The objective of this study was to investigate the clinical utility of 18 F-APN-1607 PET in the diagnosis, differential diagnosis, and assessment of disease severity in patients with PSP. Methods We enrolled 3 groups consisting of patients with PSP (n = 20), patients with α-synucleinopathies (MSA with predominant parkinsonism, n = 7; PD, n = 10), and age- and sex-matched healthy controls (n = 13). The binding patterns of 18 F-APN-1607 in PET/CT imaging were investigated. Regional standardized uptake ratios were compared across groups and examined in relation to their utility in the differential diagnosis of PSP versus α-synucleinopathies. Finally, the relationships between clinical severity scores and 18 F-APN-1607 uptake were investigated after adjustment for age, sex, and disease duration. Results Compared with healthy controls, patients with PSP showed increased 18 F-APN-1607 binding in several subcortical regions, including the striatum, putamen, globus pallidus, thalamus, subthalamic nucleus, midbrain, tegmentum, substantia nigra, pontine base, red nucleus, raphe nuclei, and locus coeruleus. We identified specific regions that were capable of distinguishing PSP from α-synucleinopathies. The severity of PSP was positively correlated with the amount of 18 F-APN-1607 uptake in the subthalamic nucleus, midbrain, substantia nigra, red nucleus, pontine base, and raphe nuclei. Conclusions 18 F-APN-1607 PET imaging holds promise for the diagnosis, differential diagnosis, and assessment of disease severity in patients with PSP. © 2021 International Parkinson and Movement Disorder Society.

Background Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia. Methods This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue—shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support. Results Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24–49%] vs. 63% [44–68%], p p = 0.001), due to higher shunt (23% [15–32%] vs. 5% [2–16%], p = 0.001) and non-aerated/non perfused regions (5% [3–10%] vs. 1% [0–2%], p = 0.001). The PaO2/FiO2 ratio correlated positively with normally aerated tissue (ρ = 0.730, p ρ = − 0.633, p Conclusions In critically ill patients with severe COVID-19 pneumonia, the need for invasive mechanical ventilation and oxygenation impairment were associated with loss of aeration and the extent of gas:blood volume mismatch. Graphic abstract

Objectives To investigate the etiology of common respiratory pathogens in children < 2 years of age hospitalized with pneumonia in Xiamen from 2014 to 2017. Methods The medical records of 5581 children with pneumonia were retrospectively reviewed. Direct immunofluorescent test was used for respiratory virus testing. Bacteria were detected by conventional culture method. The results of pathogen detection at admission were analyzed as well as the clinical outcomes of children. Results The burden of hospitalized children with pneumonia was highest among infants < 6 months old (58.2%). Respiratory syncytial virus (RSV) was the most common respiratory virus (26.0%) followed by parainfluenza (4.8%) and adenovirus (3.2%). Haemophilus influenzae was the most common bacteria detected (16.6%) followed by Moraxella catarrhalis (13.4%), Staphylococcus aureus (13.0%), Streptococcus pneumoniae (12.3%), Escherichia coli (5.1%) and Klebsiella pneumoniae (4.8%). Notably, RSV and K. pneumoniae were detected more frequently in severe pneumonia (35.0% and 10.9%) versus mild pneumonia (25.6% and 4.6%), with higher rates of ICU admissions, longer hospital stays and higher hospital costs compared to those infected with other respiratory pathogens. Conclusions Among children < 2 years of age hospitalized with pneumonia in Xiamen, RSV was the most common respiratory virus, while H. influenzae and S. pneumoniae remained the predominant bacterial pathogens detected. Considering the low implementation rate of vaccines against pneumococcal and Hib pneumonia in China, there is an urgent need to increase both vaccination rates to reduce pneumococcal and Hib disease burden.

Metal additive manufacturing (MAM) provides lots of benefits and potentials in manufacturing molds or dies with sophisticated conformal cooling channels. It is known that the conformal cooling technology provides effective cooling to reduce cycle time for increasing productivity. Ordinarily, mold inserts fabricated by general printing procedures will result in coolant leakage in the injection molding process. The yield in the manufacturing of fully dense injection molding tools was limited to the very narrow working widow. In addition, high costs of fully dense injection mold fabricated by MAM constitute the major obstacle to its application in the mold or die industry. In general, the high cost of MAM is approximately 50-70% more expensive than conventional computer numerical control machining. In this study, a low-cost and highly efficient method of reducing coolant leakage for direct metal printed injection mold with cooling channels was proposed. This new method employs general process parameters to manufacture the green injection mold rapidly and then uses optimum heat treatment (HT) procedures to improve microstructure of the green injection mold. The results of this study revealed that optimum HT procedures can prevent coolant leakage and save manufacturing time of the injection mold fabricated by direct metal laser sintering. The evolution mechanisms of microstructure were investigated experimentally. The save in the injection mold manufacture time about 67% can be obtained.

Diabetes mellitus (DM) significantly increases the risk of heart disease, and DM-related healthcare expenditure is predominantly for the management of cardiovascular complications. Diabetic heart disease is a conglomeration of coronary artery disease (CAD), cardiac autonomic neuropathy (CAN), and diabetic cardiomyopathy (DCM). The Framingham study clearly showed a 2 to 4-fold excess risk of CAD in patients with DM. Pathogenic mechanisms, clinical presentation, and management options for DM-associated CAD are somewhat different from CAD among nondiabetics. Higher prevalence at a lower age and more aggressive disease in DM-associated CAD make diabetic individuals more vulnerable to premature death. Although common among diabetic individuals, CAN and DCM are often under-recognised and undiagnosed cardiac complications. Structural and functional alterations in the myocardial innervation related to uncontrolled diabetes result in damage to cardiac autonomic nerves, causing CAN. Similarly, damage to the cardiomyocytes from complex pathophysiological processes of uncontrolled DM results in DCM, a form of cardiomyopathy diagnosed in the absence of other causes for structural heart disease. Though optimal management of DM from early stages of the disease can reduce the risk of diabetic heart disease, it is often impractical in the real world due to many reasons. Therefore, it is imperative for every clinician involved in diabetes care to have a good understanding of the pathophysiology, clinical picture, diagnostic methods, and management of diabetes-related cardiac illness, to reduce morbidity and mortality among patients. This clinical review is to empower the global scientific fraternity with up-to-date knowledge on diabetic heart disease.

Single photon avalanche diodes (SPADs) are key enabling technologies for a wide range of applications in the near-infrared wavelength range. Recently, AlAs0.56 Sb0.44 (hereafter AlAsSb) lattice-matched to InP has been demonstrated for extremely low excess noise avalanche photodiodes (APDs) due to its large disparity between electron and hole ionization coefficients ( $\alpha $ and $\beta $ respectively). The $\alpha /\beta $ ratio also plays a role in Geiger mode operation as it affects the avalanche breakdown probability and hence detection efficiency. In this work, we theoretically investigate the performance of AlAsSb based SPADs. The probability of breakdown for electron-initiated Geiger mode operation increases more sharply with multiplication region width due to progressively more dissimilar ionization coefficients. In comparison with other common avalanche materials, such as InAlAs, InP and Si, our result also suggests that SPADs based on AlAsSb have a sharper breakdown probability than the other three materials under similar low overbias ratio. The calculated breakdown probability of 0.81 in AlAsSb is 0.18 and 0.28 higher than that of InAlAs/Si and InP respectively at 5% overbias ratio and with avalanche region width of 1500 nm.

Objectives We aimed to understand the clinical characteristics and better predict the prognosis of patients with mucosal melanoma of the head and neck (MMHN) using a nomogram. Methods Three hundred patients with nometastatic MMHN were included. Multivariable Cox regression was performed to analyze independent prognostic factors for overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS), and these factors were used to develop a nomogram. Concordance indexes (C-indexes), calibration plots, and receiver operating characteristic (ROC) analysis were performed to test the predictive performance of the nomogram in both the primary (n = 300) and validation cohorts (n = 182). Results The primary tumor site, T stage and N stage were independent risk factors for survival and were included in the nomogram to predict the 3- and 5-year OS, DFS, DMFS, and LRRFS in the primary cohort. The C-indexes (both > 0.700), well-fit calibration plots, and area under the ROC curve (both > 0.700) indicated the high diagnostic accuracy of the nomogram, in both the primary and validation cohorts. The patients were divided into three groups (high-risk, intermediate-risk, and low-risk groups) according to their nomogram scores. The survival curves of OS, DFS, DMFS, and LRRFS were well separated by the risk groups in both cohorts (all P Conclusions The nomogram can stratify MMHN patients into clinically meaningful taxonomies to provide individualized treatment.

Background:. Vitamin D deficiency has been reported to be associated with diabetic microvascular complications, but previous studies have only focused on the relationship between vitamin D and specific complications. Therefore, we aimed to explore the relationship between vitamin D level and diabetic microvascular complications in general, including diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN). Methods:. This was a cross-sectional study of 815 patients with type 2 diabetes mellitus (T2DM). Clinical information and laboratory results were collected from the medical records. The relationship between vitamin D and the three diabetic microvascular complications was investigated. Results:. The serum 25-hydroxyvitamin D (25 [OH] D) level of patients with DPN and/or DN was significantly lower than that of T2DM patients without any microvascular complications (P

Abuse of antibiotics in aquaculture have been alarming and might aggravate spread of resistance genes in the environment. Holistic ARGs proliferation checks require deeper analyses of coupled absolute abundances in 16S rRNA bacteria communities at the phylum level to detect biomarkers. Sulfanilamide (sul) and copper II sulfate (CuSO4 II) were, therefore, designed and added as separate or combined treatments in 9 replicate engineered goldfish tanks comprising 3 individual sul, 3 CuSO4 II, 3 (sul + CuSO4 II) combinations, and 3 controls within 180 days. The DNA from water and fish guts was sequenced under qPCR to determine 16S rRNA bacteria biomarkers co-occurring with the correspondent ARGs. Combined chemical addition at 0.8–1.5 mg sul + 0.5–1.0 mg CuSO4 II/3 L of tank waters reduced sequenced 16S rRNA bacteria absolute abundances in fish gut and water samples while portraying the biomarkers. Absolute abundances of the entire 16S rRNA bacteria was higher in fish guts (3.4 × 1014–4.9 × 108 copies/g) than water samples (1.5 × 109–2.6 × 1015 copies/L), respectively. Much as sul 1(log) were dominant over intl 1(log) genes, and their fundamental profiles were also higher in the fish guts than water samples; the Spearman’s correlation analyses revealed positive relationship (p Proteobacteria (10–50:15–65%) > Planktomycetes (10–52:8–25%) featured prominently based on LEfSe use as the hot-spotted biomarkers, hence justifying its higher prospects towards innovative environmental microbiological and biotechnological studies.

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their “new norm.” These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.

Background: Limited research is available on the cost-effectiveness of breast cancer screening programs in Asian countries. We evaluated the cost-effectiveness of Singapore's national mammography screening program, implemented in 2002, recommending annual screening between ages 40 and 49 and biennial screening between ages 50 and 69, and alternative screening scenarios taking into account important country-specific factors. Methods: We used national data from Singapore in the MIcrosimulation SCreening ANalysis-Fatal diameter (MISCAN-Fadia) model to simulate 302 screening scenarios for 10 million women born between 1910 and 1969. Screening scenarios varied by starting and ending age, screening interval, and attendance. Outcome measures included life-years gained (LYG), breast cancer deaths averted, false positives, overdiagnosis, quality-adjusted life years (QALY), costs (in 2002 Singapore dollars; S$), and incremental cost-effectiveness ratios (ICER). Costs and effects were calculated and discounted with 3% using a health care provider's perspective. Results: Singapore's current screening program at observed attendance levels required 54,158 mammograms per 100,000 women, yielded 1,054 LYG, and averted 57 breast cancer deaths. At attendance rates ≥50%, the current program was near the efficiency frontier. Most scenarios on the efficiency frontier started screening at age 40. The ICERs of the scenarios on the efficiency frontiers ranged between S$10,186 and S$56,306/QALY, which is considered cost-effective at a willingness-to-pay threshold of S$70,000/QALY gained. Conclusions: Singapore's current screening program lies near the efficiency frontier, and starting screening at age 40 or 45 is cost-effective. Furthermore, enhancing screening attendance rates would increase benefits while maintaining cost-effectiveness. Impact: Screening all women at age 40 or 45 is cost-efficient in Singapore, and a policy change may be considered.

Purpose: Clonal architecture is fundamental for the understanding of cancer biology and therapy; however, multiregional sampling in advanced-stage cancers is not always applicable. This prospective clinical trial was to investigate whether paired tissue and circulating tumor DNA (ctDNA) could describe the clonal architecture of advanced non–small cell lung cancer (NSCLC) and its association with clinical outcome (NCT03059641). Patients and Methods: Paired tumor and plasma ctDNA samples were sequenced by target-capture deep sequencing of 1,021 genes. Clonal dominance analysis was performed on the basis of PyClone. Results: Overall, 300 treatment-naïve patients with stage IIIB–IV NSCLC were recruited from 14 centers. Of the 94 patients with available ctDNA data for EGFR clonal architecture analysis, 72 (76.6%) showed EGFR as the dominant clone. The median progression-free survival was longer for these patients than for the 22 patients whose EGFR was nondominant clone [11 vs. 10 months; HR, 0.46; 95% confidence interval (CI), 0.24–0.88; P = 0.02]. The difference was more significant if both tissue and ctDNA defined EGFR as dominant clone (n = 43) versus those not (n = 8; 11 vs. 6 months; HR, 0.13; 95% CI, 0.04–0.50; P = 0.003). Moreover, multivariate Cox proportional HR analysis demonstrated EGFR clonal architecture as an independent prognostic indicator of the efficacy of EGFR-tyrosine kinase inhibitors (TKIs). Conclusions: Paired tissue and ctDNA could be analyzed for clonal architecture in advanced cancer. EGFR mutations do not always make up a dominant clone in advanced NSCLC, which was associated with the efficacy of EGFR-TKIs in NSCLC.

Coronary artery spasm can cause recurrent variant angina with ST-segment elevation. The patient was asymptomatic with normal vitals and ECG was normal. We present a case associated with transient ST-segment elevation and significant increase in troponin levels with non-critical lesion with normal CAG.

In this article, the electrical characteristics of Al0.28Ga0.72 N/AlN/GaN metal-oxide-semiconductor high electron mobility transistor (MOS-HEMT) with a 20-nm-thick Al2O3 layer by using radio-frequency sputtering as the gate dielectric layer are compared to the conventional metal-semiconductor HEMT (MS-HEMT) with Pd/GaN gate structure. For the insertion of the Al2O3 layer, the energy band near the AlN/GaN heterojunction is lifted slightly up and the 2DEG at the heterojunction is reduced to shift the threshold voltage to the right side. Experimental results exhibits that though the maximum drain current decreases about 6.5%, the maximum transconductance increases of 9%, and the gate leakage current significantly reduces about five orders of magnitude for the MOS-HEMT than the MS-HEMT.

The water inrush risk assessment of coal floor after coalbed methane (CBM) development is very important in the theoretical and practical study of safe coal mining. In this study, Chengzhuang coal mine is used as an example to evaluate the water inrush risk of the Ordovician aquifer in coal seam No.15 after the CBM development using the fractal-AHP-vulnerability index (VI) method. Using rock mechanics and geomechanics, a theoretical analysis of water inrush from the coal floor after CBM development is conducted, and two main control factors are added: minimum horizontal principal stress and rock fracture pressure of the hydrologic barrier. By fractal theory, instead of density, length, width and fault distance, the fractal dimension is used to quantify fault. Using the AHP-VI method, the water inrush risk of coal floor after CBM development is analyzed. The results show that there are 8 types of discrimination conditions and 6 main control factors for floor water inrush after CBM development. The fractal-AHP-VI method is more accurate than the traditional AHP-VI method. This method has reference value for the water inrush risk assessment of coal floor after CBM development.

Background BRAFV600E mutation is the most common mutation in thyroid cancer. It strongly activates MAPK/ERK pathway and indicates an invasive subtype of thyroid cancer. PLX4032 is a selective oral inhibitor of the BRAFV600 kinase although with limited effect in treating this panel of thyroid cancer, due to the feedback activation of MAPK/ERK as well as PI3K/AKT pathways. It was investigated that Vitamin C plays a positive role in inhibiting these pathways in thyroid cancer. However, whether Vitamin C could enhance the antitumor effect of PLX4032 remains largely unclear. Methods The antitumor efficacy of combination therapy with PLX4032 and Vitamin C on BRAFMT thyroid cancer cell was assessed by the MTT assay, EdU assay and colony formation, Chou-Talalay way was employed to analyze the synergistic effect. Flow cytometry were employed to assess cells’ apoptosis and cell cycle arrest in response to combination therapy. Xenograft models were used to test its in vivo antitumor activity. Western blot and IHC were applied to investigate the mechanism underlying synergistic effect. Results PLX4032 or Vitamin C monotherapy was mildly effective in treating BRAFMT thyroid cancer cell and xenografts model. The combination therapy significantly inhibited cancer cell proliferation and tumor growth in nude mice, and induced cell apoptosis and cell cycle arrest compared to either monotherapy. PLX4032 monotherapy induced feedback activation of MAPK/ERK as well as PI3K/AKT pathway; while combination therapy significantly relieved this feedback. Conclusion Vitamin C promotes the antitumor effect of PLX4032 in BRAFMT thyroid cancer cell and xenografts model via relieving the feedback activation of MAPK/ERK as well as PI3K/AKT pathway. PLX4032/Vitamin C combination may be a potential therapeutic approach to treat BRAFMT thyroid cancer.

Brain metastasis (BM) is a common malignant event in lung cancer. Here, we recruited 33 lung cancer patients with brain oligo-metastasis to explore the genomic features and tumor immune microenvironment (TIME) of the lung and BM independently. For genomic profiling, targeted sequencing was performed. We found that high-frequent ZFHX3 occurred in the lung (40%) and brain tumor (28%), which might relate to brain metastasis event; the vast majority of patients had lesions-shared mutations in primary tumor and BM, confirming the common clonal events; and EGFR was the most frequently clonal gene in both lung and BM, indicating its driver capability. To characterize TIME status, we also sequenced the T cell receptor (TCR) repertoires and performed immunohistochemistry (IHC) on CD8+ tumor-infiltrating lymphocytes (TILs) and PD-L1 expression in 28 patients who had paired samples. Through the comparison, the TCR clonality of BM was higher than lung tumor, indicating the distinct pattern of the stronger oligoclonal T cell expansion in BM; the primary tumor had a higher TMB than oligo-BM (13.9 vs 8.7 mutations, p = 0.019); CD8 + TILs of BM were significantly lower than lung tumor (10% vs 30%, p = 0.015), revealing the lower level of cytotoxic T cell infiltration; BM showed statistically equivalent level of PD-L1 compared with lung tumor (p = 0.722). We further investigated the potential biomarkers associated with overall survival (OS) after brain surgery. We found that higher TCR clonality was related to prolonged OS in EGFR-treated patients (HR 0.175, p p = 0.034). More CD8+ TILs were an independently positive indicator for OS, in EGFR-treated (HR 0.160, p = 0.001) and non-EGFR-treated patients (HR 0.308, p = 0.009). These findings provide a meaningful molecular and clinical understanding of lung carcinoma and brain oligo-metastasis.

Purpose: To investigate the effect of melatonin on regeneration of cortical neurons in rats with traumatic brain injury (TBI). Methods: Sprague-Dawley rats (n=36) were randomly divided into sham, TBI+vehicle and TBI+melatonin groups. Cerebral blood flow and cognitive function were observed via laser Doppler flowmetry and by Morris water maze testing, respectively. The serum malondialdehyde (MDA) and superoxide dismutase (SOD) levels were used to assess oxidative stress. Immunofluorescence and terminal deoxynucleotidyl transferase dUTP nick end labelling assay was used to observe the newborn neurons and apoptotic cells. Results: Cerebral blood flow in the TBI+melatonin group was higher than that of the TBI+vehicle group at one, 12, 24 and 48 h post-injury, but the difference was not statistically significant (P>0.05). The cognitive function of the rats was better in the TBI+melatonin group than the TBI+vehicle group (P

Anterior percutaneous endoscopic cervical discectomy (APECD) is a common treatment for cervical spondylotic radiculopathy (CSR). In this study, the effects of various channel diameters and approach angles on cervical vertebrae on postoperative outcomes in APECD surgery were explored. A finite element model of intact cervical C

Purpose To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and one-third (162/495, 33%) will display complete resolution. Conclusion POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.

Background: Scapulohumeral periarthritis causes pain and stiffness, and limits movement but it is a treatable condition. This was a clinical study of acupotomy treatment for scapulohumeral periarthritis.Methods: There were 80 patients randomly assigned to the traditional Chinese Medicine group (acupotomy) and the Western medicine group (naproxen), with 40 cases in each group. All patients had adjunct physiotherapy exercises for 14 days. Patients received acupotomy treatment 3 times for 14 days (Day 0, 7 and 14) or naproxen (0.22 g capsule; a non-steroidal anti-inflammatory drug) 3 times a day, for 14 days. The visual analogue scale (VAS) scores, range of motion (ROM) values, and the Melle scale, together with the therapeutic standard of diseases and syndromes in traditional Chinese Medicine were used for diagnosis and evaluation.Results: There were significant differences in the VAS scores, ROM, Melle scores, cure rate and total effective rate in the group which took naproxen and the acupotomy group, before and after treatment (p < 0.01). There were significant differences in the changes in VAS, ROM and Melle scores between the 2 groups (p < 0.01), and the acupotomy group was better than the naproxen group.Conclusion: Traditional Chinese Medicine and Western medicine can improve functional activity and reduce the level of pain experienced by patients suffering from scapulohumeral periarthritis. However, improvement of functional activity of the shoulder joint following acupotomy treatment was more obvious than the use of a non-steroidal anti-inflammatory drug, and the cure rate, and total effective rate of acupotomy was better.