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OBJECTIVE There remains a paucity of literature on hypothalamic cavernous malformations (HCMs). Here, the authors present the largest series of HCMs to date and review the literature to gain additional insight into this rare disease subset. METHODS A prospectively managed database was retrospectively reviewed for patients diagnosed with symptomatic HCM and treated surgically between 1987 and 2019. Data gathered included demographics, presenting signs, radiological measurements, surgical approach, and postoperative events. Functional outcome was measured using the modified Rankin Scale (mRS) and Glasgow Outcome Scale–Extended (GOSE) pre- and postoperatively. A PRISMA guideline systematic review of HCM in the literature was performed. RESULTS Our cohort study consisted of 12 patients with symptomatic, and radiographically confirmed, HCM treated with microsurgery by the senior author (G.K.S.). An additional 16 surgically or conservatively managed patients were also identified from the literature, and the authors analyzed the data of all 28 patients (with 54% of patients being male; mean age 39 ± 16 years, range 10–68 years). Patients harboring HCMs most commonly presented with headache (16/28, 57%), short-term memory impairment (11/28, 39%), and gait disturbance (8/28, 32%). Radiographically, lesions most commonly involved the mammillary region (18/23, 78%), the tuberal/infundibulum region (13/23, 57%), and the preoptic/lamina terminalis region (12/23, 52%), with a mean diameter of 2.5 ± 1.4 cm (range 0.8–7 cm) at presentation. Acute hemorrhage was identified in 96% (23/24) of patients on presentation, with 96% (23/24) intraparenchymal and 29% (7/24) intraventricular. Of 24 patients who were managed surgically, gross-total resection (GTR) was achieved in 88% (21/24) of cases. There were no reports of perioperative infarction or mortality. With a mean follow-up period of 41 months (range 0.5–309 months), 77% (20/26) of patients experienced functional improvement, while 12% (3/26) had no change, and 12% (3/26) experienced increased disability. In our cohort of 12 patients, 83% (10/12) continued to report symptoms at the last follow-up (mean 4.8 years, range 0.1–25.7 years). However, there was a significant improvement in mRS score noted after surgery (mean 1.4 vs 3.1, p = 0.0026) and a trend toward improvement in GOSE score (mean 6.3 vs 5.1, p = 0.09). CONCLUSIONS Hemorrhage from HCMs can cause a symptomatic mass effect on adjacent eloquent structures. While patients are unlikely to be deficit free following surgery, GTR allows for functional improvement and reduces recurrent hemorrhage rates. Microsurgery remains a viable option for symptomatic HCMs in experienced hands.

OBJECTIVEReports on basal ganglia cavernous malformations (BGCMs) are rare. Here, the authors report on their experience in resecting these malformations to offer insight into this infrequent disease subtype.METHODSThe authors retrospectively reviewed a prospectively managed departmental database of all deep-seated cerebral cavernous malformations (CCMs) treated at Stanford between 1987 and 2019 and included for further analysis those with a radiographic diagnosis of BGCM. Moreover, a systematic literature review was undertaken using the PubMed and Web of Science databases.RESULTSThe departmental database search yielded 331 patients with deep-seated CCMs, 44 of whom had a BGCM (13.3%). Headache was the most common presenting sign (53.5%), followed by seizure (32.6%) and hemiparesis (27.9%). Lesion location involved the caudate nucleus in 21.4% of cases compared to 78.6% of cases within the lentiform nucleus. Caudate BGCMs were larger on presentation and were more likely to present to the ependymal surface (p < 0.001) with intraventricular hemorrhage and hydrocephalus (p = 0.005 and 0.007, respectively). Dizziness and diplopia were also more common with lesions involving the caudate. Because of their anatomical location, caudate BGCMs were preferentially treated via an interhemispheric approach and were less likely to be associated with worsening perioperative deficits than lentiform BGCMs (p = 0.006 and 0.045, respectively). Ten patients (25.6%) were clinically worse in the immediate postoperative period, 4 (10.2%) of whom continued to suffer permanent morbidity at the last follow-up. A long-term good outcome (modified Rankin Scale [mRS] score 0–1) was attained in 74.4% of cases compared to the 69.2% of patients who had presented with an mRS score 0–1. Relative to their presenting mRS score, 89.8% of patients had an improved or unchanged status at the last follow-up. The median postoperative follow-up was 11 months (range 1–252 months). Patient outcomes after resection did not differ among surgical approaches; however, patients presenting with hemiparesis and lesions involving the globus pallidus or posterior limb of the internal capsule were more likely to suffer neurological deficits during the immediate perioperative period. Patients who had undergone awake surgeries were more likely to suffer neurological decline at the early as well as the late follow-up. When adjusting for awake craniotomy as a potential confounder of lesion location, a BGCM involving the posterior limb was predictive of developing early postoperative deficits, but this finding did not persist at the long-term follow-up.CONCLUSIONSSurgery is a safe and effective treatment modality for managing BGCMs, with an estimated long-term permanent morbidity rate of around 10%.

Anal atresia is the most common malformation occurring in VACTERL association, but it is difficult to diagnose antenatally. We herein present a case of fetal anal atresia in VACTERL association diagnosed by ultrasonography and supported by autopsy. This case emphasizes the clues to ultrasonographic diagnosis of anal atresia at 11-13+6 weeks of gestation, promoting increased awareness of VACTERL association during first-trimester screening.

Purpose The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising. Method From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair; (3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated. Results Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 ± 3.71, the mean DASH score was 9.77 ± 5.31, the mean VAS score was 0.74 ± 0.64, which are all improved significantly compared with preoperative scores (P = .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P =.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%. Conclusion This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up. Level of Evidence Therapeutic case series.

OBJECTIVE The literature suggests that blood-brain barrier disruption (BBBD) plays a significant role in the development of neurological events in patients with diffusion-weighted imaging (DWI) that is negative for lesions. In this prospective, single-center cohort study, the authors compared the imaging characteristics of patients suffering transient neurological events (TNEs) with those in patients suffering permanent neurological events (PNEs) after having undergone elective embolization of unruptured intracranial aneurysms. METHODS This prospective cohort study was conducted between July 2016 and June 2019. Inclusion criteria were adults undergoing elective neuroendovascular procedures and the absence of contraindications to MRI. All subjects underwent brain MRI including postcontrast FLAIR (pcFLAIR) sequences for evaluation of BBBD within 24 hours postprocedure. RESULTS In total, 128 patients harboring 133 unruptured aneurysms were enrolled, 109 of whom (85.2%) showed some degree of BBBD on pcFLAIR MRI and 50 of whom (39.1%) suffered an ischemic insult per DWI. In total, 23 patients (18%) suffered neurological complications, 16 of which (12.5%) were TNEs and 7 of which (5.5%) were PNEs. The median extent of BBBD was focal in asymptomatic patients as compared to hemispheric and lobar in the TNE and PNE groups, respectively (p < 0.001). The American Society of Anesthesiologists physical status classification predicted the extent of BBBD (p = 0.046). Lesions on DWI were noted in 34 asymptomatic patients (32.4%) compared to 9 patients (56.3%) with TNEs and all 7 patients (100%) with PNEs (p < 0.001). The median number of DWI lesions was 0 (range 0–18 lesions) in the asymptomatic group compared to 1.5 (range 0–8 lesions) and 8 (range 1–13 lesions) in the TNE and PNE groups, respectively (p < 0.001). Smoking (p = 0.008), older age (p = 0.002), and longer surgery (p = 0.006) were positively associated with the number of lesions on DWI. On multivariate analysis, intraarterial verapamil (p = 0.02, OR 8.01, 95% CI 1.35–47.43) and extent of BBBD (p < 0.001, OR 58.58, 95% CI 9.48–361.84) were positively associated with the development of TNEs, while intravenous infusion of midazolam during surgery (p = 0.02, OR 6.03, 95% CI 1.29–28.20) was negatively associated. An increased number of lesions on DWI was the only significant predictor for the development of PNEs (p < 0.001, OR 49.85, 95% CI 5.56–447.10). CONCLUSIONS An increasing extent of BBBD was associated with the development of TNEs, whereas an increasing number of lesions on DWI was significantly associated with the development of PNEs. BBBD imaging using pcFLAIR may serve as a valuable biomarker for detecting subtle cerebral ischemia and stratifying the risk for ischemic events.

Background Treatment of nasopharyngeal carcinoma (NPC) is evolving toward Intensity-modulated radiotherapy (IMRT) era, which requires patient-specific reestimation of survival outcomes in modern health care. Methods A total of 488 detectable pre-treatment Epstein-Barr virus (EBV) DNA patients (stage II-IVa) treated with induction chemotherapy (IC) and IMRT were examined (training set, n = 325; validation set, n = 163). Results Concurrent chemotherapy (CC) was still an independent prognosticator for overall survival (OS) and progression-free survival (PFS). Both nomograms included age, T classification, N classification, post-IC EBV DNA, and CC. Predictions correlated well with observed 3-/5-year OS and PFS. The concordance index was 0.776 (95% confidence interval (CI) 0.69-0.86) for OS and 0.742 (95% CI 0.65-0.83) for PFS in the validation cohort. The nomograms can successfully classify patients into low- and high-risk groups. Conclusion The validated nomograms provided useful prediction of OS and PFS for detectable pre-treatment EBV DNA patients with NPC in IMRT era.

Chuanyin Li,1,* Keyu Shen,2,* Man Yang,3 Ying Yang,3 Wenyu Tao,3 Siqi He,4 Li Shi,1 Yufeng Yao,1 Yiping Li3 1Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, Yunnan 650118, People’s Republic of China; 2Department of Medicine, Dentistry and Healthy Science, The University of Melbourne, Melbourne, VIC 3010, Australia; 3Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, & the Affiliated Hospital of Yunnan University, Kunming, Yunnan 650021, People’s Republic of China; 4School of Clinical Medicine, Dali University, Dali, Yunnan 671000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yufeng YaoInstitute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, 650118 Yunnan, People’s Republic of ChinaEmail yufeng_yao@imbcams.com.cnYiping LiDepartment of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province & the Affiliated Hospital of Yunnan University, Kunming, 650021 Yunnan, People’s Republic of ChinaEmail yyflyp@aliyun.comPurpose: Type 2 diabetes mellitus (T2DM) has a high global prevalence, and the interaction of environmental factors and genetic factors may contribute to the risk of T2DM. We aimed to investigate the association between T2DM and the single nucleotide polymorphisms (SNPs) in genes (CDKAL1 and HHEX) associated with insulin secretion.Subjects and Methods: T2DM (n=1,169) and nondiabetic (NDM) (n=1,277) subjects were enrolled and the eight SNPs in CDKAL1 and HHEX genes associated with insulin secretion were genotyped in a Chinese population using MassARRAY. Then, the association of these SNPs with T2DM was analyzed.Results: Our results revealed that four SNPs (rs4712524, rs10946398, rs7754840 in CDKAL1, and rs5015480 in HHEX) showed significantly different distributions between the T2DM and NDM groups (P< 0.00625). The G allele of rs4712524 (P=0.004, OR=1.184; 95% CI=1.057– 1.327), C allele of rs10946398 (P< 0.001, OR=1.247; 95% CI=1.112– 1.398), and C allele of rs775480 in CDKAL1 (P< 0.001, OR=1.229; 95% CI=1.096– 1.387) functioned as risk alleles of T2DM. The C allele of rs5015480 in HHEX (P< 0.001, OR=1.295; 95% CI=1.124– 1.493) was also the risk factor for T2DM. The haplotype analysis revealed that CDKAL1 haplotype rs4712524G-rs10946398C-rs7754840C-rs9460546G (P=0.001, OR=1.210; 95% CI=1.076– 1.360) and HHEX haplotype rs1111875C-rs5015480C (P< 0.001, OR=1.364; 95% CI=1.180– 1.576) were the risk factors of T2DM.Conclusion: Our results revealed that genetic variations in CDKAL1 and HHEX were associated with T2DM susceptibility in Chinese population.Keywords: association study, single nucleotide polymorphisms, CDKAL1, HHEX, type 2 diabetes, Chinese population

Background. Insect drugs have great potential for treating cardiovascular diseases. Xinmailong (XML) injection, a bioactive composite extracted from Periplaneta americana (a species of cockroach), was wildly used in treating heart failure in China. This meta-analysis aimed to assess the efficacy and safety of XML injection for the improvement of cardiac function in HF. Materials and Methods. Online literature search for relevant studies was performed using databases including PubMed, EMBASE, Cochrane Library, CNKI, and Wanfang. Left ventricular ejection fraction (LVEF), six-minute walk test (6MWT), and brain natriuretic peptide (BNP) were selected as target outcomes. The analysis was performed using Stata 12.0, and sources of heterogeneity were explored by subgroup analysis and metaregression. Results. 32 studies were included in this meta-analysis after meeting the inclusion/exclusion criteria. The results demonstrated that additional use of XML improved LVEF (WMD = 5.82, 95% CI: 5.52–7.13, P < 0.00001 ) and 6MWT (WMD = 51.48, 95% CI: 35.83–67.13, P < 0.00001 ) and reduced BNP (WMD = −172.84, 95% CI: −205.79 to −139.89, P < 0.00001 ). The results of subgroup analyses and metaregression suggested that XML injection has more cardiac function improvement for middle-aged HF patients than youth, and greater LVEF and 6MWT improvement were associated with higher average age. Conclusions. XML plus conventional treatment demonstrated a significant effect in reducing cardiac dysfunction in HF patients, and age is a potential factor of higher efficacy. Given the heterogeneity and bias of the included RCTs, large, prospective, rigorous trials are still needed.

Objective To analyze if general factors such as age, gender, dominant side, fasting blood sugar level, BMI (body mass index), smoking, and drinking play a role in graft resorption after arthroscopic autologous scapular spine bone grafting. Methods From July 2016 to August 2018, patients who were diagnosed with anterior shoulder instability with subcritical bone loss (10%–15%) and underwent arthroscopic autologous scapular spine bone graft transplant were retrospectively reviewed and enrolled in this study. The age, gender, dominant side, fasting blood sugar level, BMI, smoking, and drinking conditions of the enrolled patients were recorded. The graft resorption rate at postoperative 1 year was also measured on three‐dimensional computed tomography (3D‐CT) scans. The Pearson test and the Spearman test were used to identify any significant correlation between the general factors and graft resorption rate. Results A total of 27 patients who underwent arthroscopic autologous scapular spine bone graft for recurrent shoulder instability qualified and were included in this study. There were 20 males and seven females, the mean age was 30.8 ± 9.4 years, the mean follow‐up time was 29.3 months (range, 25–39 months), during which no severe complications such as infection, neurovascular injury, or re‐dislocation were observed. The bone graft healed in all cases, the mean healing time was 2.6 ± 0.5 months (range, 2–3 months). At the last follow‐up, the mean Constant–Murley score was 89.74 ± 3.71, the mean Disabilities of Arm, Shoulder and Hand (DASH) score was 9.77 ± 5.31, and the mean visual analogue score (VAS) was 0.74 ± 0.64. The apprehension test was all negative at final follow‐up. The fasting blood sugar level was 4.78 ± 0.42 mmol/L, BMI was 23.70 ± 4.70. Five patients were “smoking” and 22 “non‐smoking”, four patients were “drinking” and 23 were “non‐drinking.” The graft resorption rate at postoperative 1 year was 19.4% ± 7.5%. The Pearson test and the Spearman test showed no significant correlation between age, gender, dominant side, fasting blood sugar level, BMI, smoking, drinking, and graft resorption rate. Conclusion Age, gender, dominant side, fasting blood sugar level, BMI, smoking, and drinking were not significantly correlated with graft resorption after the arthroscopic autologous scapular spine bone graft for recurrent shoulder instability., We innovatively treat recurrent shoulder instability with arthroscopic autologous scapular spine bone graft and consequently explore the correlation between patient's age, gender, dominant side, fasting blood sugar level, BMI, smoking, drinking, and graft resorption rate.

Objective To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation. Methods From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow‐up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed. Results Of the 15 patients, there are seven cases of men, eight cases of women; aged 22–66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%–47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow‐up was 38.2 months (range, 12–70 months), and one case was lost to follow‐up. With fractures healing well, almost all patients had a good joint function. At the final follow‐up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant–Murley score was 94.6 points (range, 70–100 points); the mean ASES score was 94.6 points (range, 79–100 points); and the mean VAS score was 0.4 points (range, 0–2 points). No recurrent instability or re‐dislocation occurred. No patient had revision surgery. Conclusion Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow‐up time of more than 3 years., Arthroscopic management of glenoid and greater tuberosity bipolar fractures after traumatic shoulder dislocation was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow‐up time more than 3 years.

Objective Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures. Methods From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed. Results A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22–71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P, In this work, we focus on the morphological characteristics of glenoid and greater tuberosity (GT) fracture and the relationship between them, we have explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fracture. By doing this, we could know better of this kind of injury.

Background Pathology education provides information on pathology and guides students to become pathologists. Recently, the Ministry of Education of the People’s Republic of China required the establishment of the system of ‘High-quality Online and Offline Courses’, which indicates that online courses will play an important role in higher education. Furthermore, the number of pathologists currently cannot satisfy clinical needs. To solve this health issue and implement the policy from the Ministry of Education, it is necessary to improve the current state of pathology education. First, we need to know students’ opinions of the current courses and their professional choices. Methods Online questionnaires covering the quality of traditional courses, attitudes towards online courses, and suggestions for optimizing courses were designed and applied. Whether students want to become pathologists and the underlying reasons for this interest are also included in this survey. Participants are medical students from certain colleges in Nanjing. The collected data were assessed by statistical analyses, and p-values less than 0.05 were considered significant. Results Of the 342 valid responses, 60.94% of undergraduate students showed their interest in pathology courses, and among them, 48.72% expressed that they may become pathologists. However, the corresponding percentage is only 29.59% in the group without interest. To optimize curricula, the top two suggestions are introducing more clinical cases (undergraduate students, 64.45%; graduate students, 79.09%) and making the classes lively and interesting (undergraduate students, 59.77%; graduate students, 62.79%). Approximately 80.00% of students consider online courses to be good supplementary materials to traditional courses, and approximately half prefer an online-offline mixed learning model. Salary, interest, and employment status are the main factors influencing students’ professional choices. Conclusions Students are generally satisfied with traditional pathology courses, and online courses are good supplementary materials in their opinions. It has been suggested that clinical cases be introduced in classes. It is more likely that students who have an interest in pathology will become pathologists. The data from this survey also show that the main causes of the shortage of pathologists are a lack of engaging work and an unsatisfactory salary.

Edge computing is a bridge for realizing the convergence between physical space and cyber space in the Internet of Things (IoT) paradigm. Large numbers of physical objects produce a huge amount of data that needs to be efficiently processed in the edge side. This situation urgently requires novel ideas and framework in the design and management of edge computing to improve and enhance its performance. In this article, we propose an approach and principle of software-defined edge computing (SDEC) from the perspective of cyber-physical mapping, where the ultimate goal is to achieve a highly automatic and intelligent edge computing system. The SDEC can also help realize flexible management and intelligent collaboration among various edge hardware resources and services by way of software. To this end, we design an SDEC-based open IoT system architecture which decouples upper level IoT applications from the underlying physical edge resources and builds dynamically reconfigurable smart edge services. The software-definition mechanism of the SDEC platform is proposed to introduce the detailed processes that the underlying physical devices are defined in the form of software. We also describe an illustrative application case about smart factory to present the practical effectiveness of the proposed scheme. Finally, we outline several challenges which are worthy of in-depth study and research. The SDEC paradigm can share, reuse, recombine, and reconfigure edge resources and services so that the overall service capability of the edge side can be improved.

Di-methylated lysine 9 of histone H3 (H3K9me2), regulated by histone methyltransferases, is involved in the epigenetic regulation of tumor-associated genes. The present study aimed to evaluate whether the H3K9me2 methylation level is associated with the expression level of euchromatic histone lysine methyltransferase 2 (EHMT2) in the prognosis of gastric cancer (GC). H3K9me2 methylation level and EHMT2 expression level were detected by immunohistochemistry in 118 GC samples. The clinicopathological significance of H3K9me2 and EHMT2 in patients with GC was assessed using a paired Student's t-test, χ2 test, Kaplan-Meier analysis with a log-rank test and Cox's proportional hazard analysis. Strong positive immunostaining of H3K9me2 and EHMT2 was observed in cancerous tissues compared with adjacent non-cancerous tissues. Positive immunostaining of EHMT2 and H3K9me2 was associated with lymph node metastasis, pathological grade and tumor-node-metastasis stage. H3K9me2 expression level was increased in tumor tissue and associated with worse specific-disease and disease-free survival time. In addition, EHMT2 protein expression levels were associated with the expression levels of H3K9me2. Low expression levels of H3K9me2 and EHMT2 predicted a better prognosis of patients with GC. The survival time of patients with a high expression of H3K9me2 and/or EHMT2 was significantly shorter compared with that of the patients with a low expression of H3K9me2 and/or EHMT2. In conclusion, an overexpression pattern of H3K9me2 and/or EHMT2 may be associated with clinicopathological features of GC and may be predictor markers of progression and prognosis in patients with GC, in addition to putative therapeutic targets.

Background Sichuan province is one of the highest AIDS epidemic provinces in China, with a large number of floating population. The annual number of cases of HIV/AIDS reported in Sichuan has been the highest province in China for several successive years. There is a lack of widespread and representative data on the distribution of HIV genotypes in Sichuan. We aim to investigate the characteristics of HIV-1 molecular epidemiology and transmitted drug-resistance in newly diagnosed HIV-infected patients in Sichuan, China. Method Archived plasma samples (n = 1524) from HIV-1 newly-diagnosed individuals in April 2019 were selected by cross-sectional investigation from all 21 cities in Sichuan province. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 polymerase (pol) gene sequences. We also analysed the association of demographic and virological factors with transmitted drug-resistance (TDR) and transmission clusters. Results Partial pol gene sequences were obtained from 1297 cases. HIV-1 epidemic strains in Sichuan province: the majority of genotypes were circulating recombinant form (CRF) 07_BC (675, 52.04%), CRF01_AE (343, 26.45%), CRF08_BC (115, 8.87%), CRF85_BC (67, 5.17%), subtype B (33, 2.54%), the other genotypes only accounted for 4.93%, and unique recombinant forms (URFs) (23, 1.77%) were observed in the study, and the difference of age, ethnicity, education, occupation, region and transmission pathway of different genotypes were statistically significant. According to WHO HIVDR surveillance threshold, the level of TDR has reached a medium level, with 72 of 1297 (5.55%) cases carrying drug-resistance mutation sites, TDR mutation frequency to nonnucleoside reverse transcriptase inhibitors (NNRTIs, 3.85%) was much higher than nucleoside reverse transcriptase inhibitors (NRTIs, 0.31%) and protease inhibitors (PIs, 1.70%), and CRF08_BC was a risk factor for TDR (odds ratio, 8.32; 95% CI 4.38–15.80 for CRF07_BC, P pol sequences were involved in the genetic transmission network clusters, CRF01_AE (odds ratio, 2.369; 95% CI 1.659–3.382; P P P P Conclusion The distribution of HIV-1 genotypes in Sichuan is more diverse and complex, and the Men who have sex with men (MSM) is underrated, arguing for behavior scaling up intervention in this specific population besides the elderly people with heterosexual transmission risk groups. The risk of TDR mutation frequency increased in newly diagnosed patients highlights the significance of genotypic drug resistance monitoring and molecular surveillance of pretreatment HIV-1 drug resistance. The regimen composed of TDF, 3TC and EFV was still currently the preferred solution used free first-line therapy.

BackgroundThe efficiency of concurrent chemotherapy (CC) remains controversial for stage II–IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). Therefore, we aimed to propose a nomogram to identify patients who would benefit from CC.MethodsA total of 434 NPC patients (stage II–IVa) treated with IC followed by IMRT between January 2010 and December 2015 were included. There were 808 dosimetric parameters extracted by the in-house script for each patient. A dosimetric signature was developed with the least absolute shrinkage and selection operator algorithm. A nomogram was built by incorporating clinical factors and dosimetric signature using Cox regression to predict recurrence-free survival (RFS). The C-index was used to evaluate the performance of the nomogram. The patients were stratified into low- and high-risk recurrence according to the optimal cutoff of risk score.ResultsThe nomogram incorporating age, TNM stage, and dosimetric signature yielded a C-index of 0.719 (95% confidence interval, 0.658–0.78). In the low-risk group, CC was associated with a 9.4% increase of 5-year locoregional RFS and an 8.8% increase of 5-year overall survival (OS), whereas it was not significantly associated with an improvement of locoregional RFS (LRFS) and OS in the high-risk group. However, in the high-risk group, patients could benefit from adjuvant chemotherapy (AC) by improving 33.6% of the 5-year LRFS.ConclusionsThe nomogram performed an individualized risk quantification of RFS in patients with stage II–IVa NPC treated with IC followed by IMRT. Patients with low risk could benefit from CC, whereas patients with high risk may require additional AC.

Pure pial arterial malformations (PAMs) are poorly understood owing to the limited number of reported cases. Because PAMs have been thought to have a benign natural history, they have generally been managed conservatively, unlike arteriovenous malformations or arteriovenous fistulas. In the present report, we have described a spontaneous subarachnoid hemorrhage from the rupture of a PAM at the cerebellomedullary junction. This hemorrhage was surgically treated using clip trapping.

Background: Type 2 diabetes mellitus (T2DM) has a high global prevalence, and insufficient insulin secretion is one of the major reasons for its development. Therefore, investigating the association between T2DM and the single nucleotide polymorphisms (SNPs) in genes associated with insulin secretion is necessary. Methods: T2DM (1,194) and nondiabetic (NDM) (1,292) subjects were enrolled and the ten single nucleotide polymorphisms (SNPs) in KCNQ1, ARAP1, and KCNJ11 associated with insulin secretion were genotyped in a Chinese population. Results: Our data revealed that the rs2237897T allele in KCNQ1 is the protective allele for T2DM (P

Physical water consumption (PW) in economic sectors are linked with virtual water consumption (VW) embodied in the supply chain of commodities. It is important to quantitatively assess PW and VW in economic sectors and understand interconnections between them for supporting water resources management. Here, we applied an IO framework to analyse how the PW is linked to the VW from both production and consumption perspectives. A water scarce region consisting of Ganzhou, Linze, and Gaotai counties (GLG) in the Heihe river basin in China is used as a case study. The agricultural sector is broken down into seven sub-sectors represented by individual major crops. From production perspective, the results show that the agricultural sector accounted for 98.1% of total PW, which can be divided into 79.0% of final demand driven water consumption and 21% of intermediate demand driven water consumption. From consumption perspective, the VW of all the sub-sectors in the agricultural sector was largely attributed to the direct VW. The sector “Food and tobacco processing” (the downstream of the agricultural sector) has the largest indirect VW among all the sectors. Most PW in GLG was used to produce the low value added primary agricultural products to fulfil the final demand (VW) outside GLG. The results suggest that the water resources management in arid regions should guide the restructuring of economy from increasing agricultural production to increasing the economic value of the embodied virtual water, and reducing the export of the virtual water from the low economic value products.

Grey water footprint (GWF) accounting has previously been conducted at the global level using a bottom-up approach but lacking detailed industrial information. Here we applied a multi-region input-output approach based on the World Input-Output Database (WIOD) to quantify global GWF of 40 countries/regions with 35 economic sectors. The GWF from both the production perspective (GWFP), and the consumption perspective (GWFC) are quantified. The results show that the global GWFP/GWFC was 1507.9 km3 in 2009. Except for the “Agriculture, Hunting, Forestry and Fishing” sector, the industrial sectors with the largest GWFC were “Food, Beverages and Tobacco”, “Construction”, “Chemicals and Chemical Products”, and “Textiles and Textile Products”. The BRIC countries (Brazil, Russia, India, China) had a larger GWFP than their GWFC, which accounted for over half of global GWFP (53.6%), and their GWFP was mainly generated from the production of domestic final demand. In contrast, the OECD29 and EU27 groups of countries i.e. the country groups consisting mainly of economically advanced nations, had larger GWFC than their GWFP. Overall, the OECD29 and EU27 outsourced 134.8 km3 and 64.4 km3 of their grey water respectively, mostly to large newly advanced economies such as the BRIC group of countries, which, in turn, were collectively outsourcing 112 km3 of grey water. Quantitative approaches are thus suggested for development, aimed at shared responsibility for water pollutant discharge among poor exporters and wealthy consumers.

Background Coronary heart disease (CHD) has become one of the biggest health problems in the world. Stable angina is a common clinical type of CHD with poor prognosis and high mortality. Although there are various interventions for stable angina, none of them can significantly reduce mortality. Both basic and clinical research have shown that Suxiao Jiuxin Pill (SJP) can relieve the symptoms of angina pectoris and improve the clinical efficacy, but there is a lack of high-quality clinical research to provide research-based evidence. We design a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of SJP for stable angina. Methods/design This is a prospective, randomized, double-blind, placebo-controlled, and multicenter trial. The trial will enroll 324 participants with chronic stable angina (Qi Stagnation and Blood Stasis syndrome). All participants will have received the conventional therapy of chronic stable angina. Participants will be randomized into two groups, conventional therapy plus SJP group and conventional therapy plus placebo group. Eligible participants will receive either SJP or placebo (five pills administered orally, three times daily) in addition to conventional treatment for 24 weeks. The primary outcomes are the symptom improvement rate of angina from baseline to 4 weeks after inclusion and major adverse cardiovascular events (MACE). The secondary outcomes are angina classification (CCS), improvement of traditional Chinese medicine (TCM) syndromes, Seattle Angina Scale score, the dosage of emergency drugs and the stopping rate, and electrocardiogram (EKG) efficacy. Adverse events will be monitored throughout the trial. Discussion Integrated traditional Chinese and Western Medicine is commonly used for angina in China. This study will evaluate the clinical effectiveness and safety of SJP for angina. The results of the trial will provide high-level clinical research-based evidence for the application of SJP instable angina. Trial registration This study protocol was registered on 14 March 2019. The registration number is ChiCTR1900021876 on the Chinese Clinical Trial Registry.

The development of artificial intelligence technology brings opportunities for the innovation of personalized learning. Using tag, index and intelligent grabbing technology, learning resources can be quickly obtained from complex knowledge map; Using data analysis, network analysis, emotion analysis and visualization technology, the intelligent tutor can make plans, accurately push and evaluate for personalized learners; The application of virtual reality, augmented reality and hybrid reality technology to build personalized online learning classroom. This paper discusses the “Online + offline” small class mode of personalized learning under the background of artificial intelligence, and promotes the teaching reform from “teacher centered” to “student-centered”.

Background Surgical planning for treating brain arteriovenous malformations (bAVMs) is challenging because it entails visualizing 3-dimensional (3D) relationships between the nidus, its feeding and en passage arteries, and draining veins. Surgical experience in developing the capacity to mentally visualize pathological bAVM angioarchitecture could be complemented by this software, and thus potentially lower the steep learning curve for understanding complex bAVM angioarchitecture. We evaluated the clinical application of freely available online 3D reconstruction software in facilitating visualization of AVM angioarchitecture for presurgical planning. Methods Preoperative Digital Imaging and Communications in Medicine magnetic resonance imaging/magnetic resonance angiography images of 56 superficial bAVMs from 2013 to 2018 were processed using open-source software Horos. 3D rendered images were compared with the surgical view to evaluate software accuracy and determine its value as a preoperative tool. 3D reconstructed images were compared with intraoperative recordings. Results A useful image identifying both the main feeding artery and draining vein was achieved in 35 of 56 cases (62.5%). Reconstructions of small AVMs (nidus ≤2 cm) and those located within the temporal or cerebellar cortex were less useful due to soft tissue artifacts. Frontal and parietal lobe lesions had significantly higher rates of identifying feeding arteries and draining veins (P Conclusion Presurgical planning for resection of superficial bAVMs using Horos software allows for a comprehensive 3D analysis of the bAVM angioarchitecture. This technique is most useful for frontal and parietal lobe lesions, and aids the surgeon in formulating an optimal surgical strategy. The 3D reconstruction of the brain surface offers a surgical map not influenced by brain shift.

Aim: To investigate hypoxia-inducible factor-1α (HIF-1α) and histone methylation markers as potential indicators of prognosis in esophageal squamous cell carcinoma (ESCC). Patients & methods: The prognostic value of HIF-1α and histone methylation markers levels was analyzed using Kaplan–Meier survival analysis. Results: HIF-1α protein expression was higher in ESCC tumors than in paracancerous tissues. Histone H3 Lys9 trimethylation (H3K9me3), histone H3 Lys27 trimethylation (H3K27me3), histone H3 Lys4 trimethylation (H3K4me3) and histone H4 Lys20 trimethylation (H4K20me3) were significantly upregulated in ESCC tissues. HIF-1α was only positively correlated with H3K9me3 and H3K4me3 expression. Kaplan–Meier analysis indicated that H3K9me3, H3K27me3, H4K20me3 and histone H3 Lys36 trimethylation (H3K36me3) were independent indicators of prognosis for ESCC. Conclusion: This study identified a pattern of epigenetic methylation markers and HIF-1α expression in ESCC, and their combined evaluation might improve survival prediction for ESCC patients.

Background The baculoviral IAP repeat containing 5 (BIRC5) related to epithelial-mesenchymal transition (EMT) plays a crucial role in the pathogenesis of hepatocellular carcinoma (HCC). However, it remains unclear whether BIRC5-related genes can be used as prognostic markers of HCC. Methods Kaplan-Meier (K-M) survival curve was used to assess the Overall Survival (OS) of high- and low-expression group divided by the median of BIRC5 expression. The differentially expressed genes (DEGs) between the two groups were screened using the limma package, and performed the functional enrichment analysis by the clusterProfiler package. WGCNA was used to analyze the relationship of the module and the clinical traits. The risk signature was constructed by univariate and multivariate Cox regression analyses and the enrichment analysis of genes in the risk signature was performed by the Intelligent pathway analysis (IPA). The immunophenoscore (IPS) and the tumor immune dysfunction and exclusion (TIDE) were used to estimate the clinical significance of the risk groups. Results BIRC5 was high-expressed in HCC samples and associated with a poor prognosis (p-value 0.72] and was closely associated with clinicopathological characteristics of HCC patients. IPA suggested that the 8 genes were enriched in Cancer and Immunological disease related pathways. IPS and TIDE score indicated that the genes in low-risk group could cause an immune response, and patients in the low-risk group may be more sensitive to the immune checkpoint blockade (ICB) therapy. Conclusion The risk score constructed by the 8 genes could not only predict the clinical outcome but also distinguish the cohort of ICB therapy in HCC, which exerted a vital value in treatment and prognosis of HCC.

Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed but treatment is still controversial. Although the descriptions and use of minimally invasive surgery (MIS) have increased, comparative studies with standard approaches are rare.MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms) is a prospective randomized single-center clinical trial with long-term follow-up comparing different MIS techniques with standard open surgery for treatment of UIAs.We randomly allocated a standard pterional approach (PtA) or MIS (1:2) to 111 patients with UIAs of the anterior circulation (mean dome diameter, 6.4 mm; range, 3-20 mm). Patients selected for MIS underwent a second randomization between a transeyelid approach (TelA) or nanopterional approach (NPtA) (1:1).Forty-one patients were randomized to and treated with the PtA, 36 with the TelA, and 34 with the NPtA. Only patients treated with PtA had permanent facial nerve palsy (n = 4 [10%]; P = 0.032). MIS cosmetic results were considered better than those of PtA by independent observers (P0.001), and less temporal atrophy in the MIS group was also observed (P = 0.0034). The proportion of excellent results was higher in the TelA group than in the NPtA group (86% vs. 67.6%; P = 0.039). Patients undergoing MIS also reported consistently higher satisfaction and quality-of-life scores (P0.001).MIS is superior to standard PtA for microsurgical clipping of small UIAs of the anterior circulation in terms of cosmetic, satisfaction, and quality-of-life outcomes. The TelA or NPtA for UIAs did not show significant outcome differences at 12-18 months.

Introduction: The presence of thyroid autoantibodies may play a role in the pathogenesis of moyamoya-type angiopathy. However, the influence of thyroid disease on presenting characteristics and treatment outcomes of moyamoya disease (MMD) remains unclear. Methods: Consecutive patients with MMD prospectively treated at our institution from 2015-2018 were reviewed. Results: 264 MMD patients with MMD were identified, 33 (12.5%) of whom presented with concurrent thyroid disease (4 hyperthyroid, 28 hypothyroid, 1 unspecified). Comparing groups with and without thyroid disease, there were no differences in age of presentation (p=0.12), racial composition (p=0.38), or rates of diabetes (p=0.32), hypertension (p=1.0), and hyperlipidemia (p=0.71). There was a higher proportion of females (94% F vs. 74% F, p=0.02) and lower rates of smoking (p=0.04) and alcohol consumption (p=0.04) in the thyroid disease group. Despite lower rates of vascular risk factors, the thyroid disease group exhibited more severe angiographic MMD at presentation, with higher Suzuki grade (p=0.002), higher proportion of bilateral disease (91% vs. 67%, p=0.007), and a trend towards more posterior circulation involvement (39% vs. 24%, p=0.09). MMD patients with concurrent thyroid disease were also more likely to present with carotid occlusion as opposed to large vessel stenosis (39% vs 10%, p=0.03), resulting in increased collateral filling via the extracranial (3.5% vs. 2.8%, p=0.04) and posterior circulations (24% vs. 16%, p=0.002). Patients with thyroid disease trended towards having higher rates of ischemic complications (28% vs. 16.8%, p=0.06) perioperatively; however, there were no differences in rates of post-operative hemorrhage (p=1.0) or transient neurologic events (p=0.85). Conclusions: Patients with concurrent moyamoya and thyroid disease present with more advanced angiographic intracranial disease, which may be associated with higher rates of ischemic complications in the perioperative period.

Introduction: The long-term progression of disease and recurrence rate of symptomatic events after surgical revascularization for moyamoya disease (MMD) are unknown. Method: Patients with MMD operated on between 1991 and 2009 were prospectively enrolled into the departmental database. Results: 230 revascularization (87% combined direct and indirect and 13% indirect alone) procedures were performed on 129 patients for the treatment of MMD with a long-term bypass patency rate of 98%. Unilateral presentation was identified in 39 (30.2%) compared to 90 (69.8%) with bilateral MMD. Posterior circulation (PC) involvement was identified in 34 (26.4%) patients. Over a median follow-up period of 13 years (range 10-26 years), 15 (38.5%) patients experienced radiographic progression of unilateral disease and 14 (10.9%) experienced PC radiographic progression. Delayed surgical revascularization of the untreated contralateral anterior circulation was performed on 11 (28.2%) patients due to symptomatic progression of disease. Progression of PC disease occurred only in patients with PC involvement upon presentation. Aside from those with unilateral progression, fourteen additional patients (10.9%) experienced delayed cerebrovascular accidents (CVAs), 8 of which were ischemic and 6 were hemorrhagic strokes. Twelve delayed CVAs occurred in a previously revascularized hemisphere while one occurred in an un-diseased hemisphere from a micro pseudoaneurysm. Repeat revascularization was performed in 6 patients while 4 were managed conservatively and 4 were deceased. Relative to baseline presenting mRS, 92.2% of patients were improved or unchanged at 10 year follow-up. On multivariate regression, progression of the PC predicted the development of delayed CVA (Odds ratio 8.1, 95% CI 1.1-59.2) while pre-operative stroke (Odds ratio 3.4, 95% CI 1.2-9.8) presentation and progression of disease was predictive of 10-year outcome (Odds ratio 4.0, 95% CI 1.5-10.6). Conclusion: Good functional outcomes over a median follow-up period of 13 years support the strategy of revascularization for MMD patients. Disease progression of the posterior circulation is common and may reduce pial-pial collaterals resulting in delayed CVAs.

Introduction: The incidence and natural history of posterior circulation moyamoya disease (PCMMD) is not well-characterized. Methods: Consecutive patients with moyamoya disease prospectively treated at our institution from 2015-2018 were reviewed. Results: 262 consecutive patients with moyamoya disease undergoing 370 revascularization procedures were enrolled. Concurrent PCMMD was identified in 68 (26%) patients – all of which were confined to the anterior circulation. There were no differences in age, sex, race, or rates of diabetes, hypertension, smoking, or symptoms upon presentation between patients with or without PCMMD. Patients with PCMMD were more likely to present with bilateral disease (p2) at last follow-up (p=0.02). Conclusions: Posterior circulation disease involvement often presents in the later stages of moyamoya and is associated with higher rates of ischemic peri-operative complications and poor functional outcomes likely due to reduced collateral flow. Progression of PCMMD is not uncommon. Future studies are needed to assess the impact of PCMMD progression on long-term outcomes.

Moyamoya disease (MMD) is a progressive, occlusive disease of the internal carotid arteries and their proximal branches, with the subsequent development of an abnormal vascular network of small, weak blood vessels that are prone to rupture. Steno-occlusive changes in the posterior cerebral arteries (PCA) may contribute to worse outcomes in MMD patients, however, there is a paucity of information on the incidence and natural history of MMD patients with PCA disease. We retrospectively reviewed the charts of patients with MMD treated between 1987 and 2019. Demographics, peri-operative outcomes, and radiological phenotypes were recorded for 450 patients. PCA disease was scored as either 0 (no disease), 1 (mild), 2 (moderate), or 3 (severe, or occluded). Out of 450 patients, 164 (34.4%) had concurrent PCA disease. In patients with PCA disease, the extent of occlussion was mild in 56 (34%), moderate in 41 (25%), and severe in 67 (40.9%) patients. In total, there were 319 females (70.9%), with a higher proportion of female MMD patients having severe or moderate PCA disease (p=0.038). Patients with severe and moderate PCA disease had higher Suzuki grades (p Over a mean follow-up of 6.94±4.16 years, 28 patients (8.86%) developed new or progressive PCA disease. Bilateral disease was present in 66 patients (14.7%) and was associated with higher Suzuki grades (p PCA disease involvement is associated with higher rates of ischemic peri-operative complications and poor functional outcomes likely due to reduced collateral flow. Progression of PCA disease is not uncommon. Future studies are needed to assess the impact of PCA disease progression on long-term outcomes.

Aiming at the security and secrecy of network test question bank, this paper puts forward an information security secrecy system suitable for test question bank. The system has the functions of identification, security enhancement, information encryption and data backup and recovery. Finally, black-box and white-box tests are carried out to test the function and performance of the system, which proves that the system meets the design requirements.

Objective. This study aims to explore the therapeutic efficacy of San Zi Yang Qin Decoction (SZ) and its potential mechanism in the treatment of non-alcoholic fatty liver disease (NAFLD) based on network pharmacology and in vivo experiments. Methods. Effective chemicals and targets of SZ were searched in online databases, according to the drug-likeness of compounds and the binomial distribution of targets. A disease-target-chemical network was established using NAFLD-associated genes screened through GeneCards database, Gene Ontology (GO) terms, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Furthermore, animal experiments were conducted to verify the efficacy and mechanism of SZ predicted by network pharmacology. The NAFLD mouse model was established with C57BL/6J mice fed with a high-fat diet for 22 weeks. The mice in the control group were fed with a chow diet. From the 23rd week, the NAFLD mice were treated with intragastric SZ or normal saline for 8 weeks. After the glucose tolerance was measured, the mice were sacrificed, followed by the collection of serum and liver tissues. Pathological changes in liver tissues were examined by H&E staining. Additionally, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum fast blood glucose, and insulin levels were detected. Expression levels of TNF-α of serum and liver tissues were determined by ELISA and qRT-PCR, respectively. Western blot was used to detect the activation of AKT in liver tissues. Results. A total of 27 effective compounds and 20 targets of SZ were screened. GO analysis uncovered a significant correlation between the targets of SZ and those of NAFLD. KEGG analysis presented the signaling pathways enriched in SZ and NAFLD, including NAFLD, TNF-α, and apoptosis pathways. The area under the curve of major GO and KEGG pathways indicated the potential role of SZ in improving NAFLD. In vivo experiments demonstrated that SZ significantly alleviated hepatosteatosis and inflammatory cell infiltration in liver tissues, reduced serum transaminases, and improved insulin resistance and glucose tolerance of NAFLD mice. The protein level of phospho-AKT was upregulated by SZ. Additionally, SZ treatment obviously impaired the TNF-α level in the serum and liver tissue of NAFLD mice. Conclusions. According to the network pharmacology analysis and in vivo experiments, SZ could have therapeutic efficacy for NALFD. The mechanism mainly involves pathways relative to insulin resistance, TNF-α, and apoptosis. Our results provide a scientific basis for SZ in the clinical treatment of NAFLD.

Background Group A rotavirus (RVA), despite being a leading cause of gastroenteritis in infants and young children, is less studied in Shanxi Province, China. The current study was conducted to determine the prevalence and genetic characterization of RVA in hospitalized children younger than 10 years of age with the diagnosis of acute gastroenteritis in Shanxi Province, China. Methods A hospital-based active surveillance of rotavirus gastroenteritis was conducted at Children’s Hospital of Shanxi from Jan 1, 2015, through Dec 31, 2019. Rotavirus was detected in stool samples by real-time quantitative reverse transcription PCR (qRT-PCR). G- and P-genotypes were determined by reverse transcription PCR (RT-PCR) and nucleotide sequencing. Results A total of 961 children younger than 10 years of age was enrolled over the study period, of whom 183 (19.0%) were positive for RVA. The highest RVA-infection frequency (23.7%) was found among children aged 12–23 months, and the seasonal peak was in December. G9P[8] was most prevalent (76.0%), followed by G3P[8] (7.1%), G2P[4] (3.3%), G1P[8] (0.5%) and G9P[4] (0.5%). Conclusions These results report for the first time that RVA was one of the main causes of severe infectious gastroenteritis in children, and a high proportion of G9P[8] strains circulating in most areas of Shanxi Province. While the protective efficacy of the rotavirus vaccines has been demonstrated against G9P[8] strains, our results highlight that the dominant strains have not been effectively controlled in China.

Background: Studies have revealed the association of glutathione S-transferases (GSTM1 and GSTT1) deletion (null) polymorphism with the risks of developing type 2 diabetes mellitus (T2DM) and its complications. The present study aimed to investigate the relationship between GSTT1/ GSTP1 gene polymorphisms and the risks of T2DM and diabetic retinopathy (DR) in a Chinese population.Methods: In this case-control study, a total of 336 subjects with T2DM and a defined ophthalmologic status were recruited from the Second People’s Hospital of Yunnan Province between June 2014 and October 2016. Seventy-two age-matched healthy controls were also enrolled. Physical examinations and laboratory tests were performed. The frequencies of GSTT1 genotypes in all participants were determined by polymerase chain reaction (PCR) followed by agarose gel electrophoresis. Genotyping of GSTP1 gene was identified by PCR amplification followed by sequencing.Results: Compared with healthy controls, the GSTT1-null genotype was significantly more common in diabetic patients with or without DR (all P < 0.05). However, there was no difference in the frequencies of the GSTP1 genotype (AA, GA, GG) between diabetic patients with or without DR and healthy controls. Furthermore, neither the GSTP1 nor GSTT1 genetic polymorphism was associated with the development of DR. In the present study, the risk of developing T2DM was significantly higher in subjects carrying the combined heterozygous GSTP1 (AG) and null GSTT1 genotypes (OR = 0.40, 95% CI = 0.21-0.74, P = 0.02).Conclusions: The deletion of the GSTT1 genotype was associated with a higher risk of developing T2DM, whether alone or in combination with GSTP1, indicating that the null genotype of GSTT1 may serve as a potential biomarker for T2DM in the Chinese population, which is helpful for clinicians to make more effective risk-based decisions.

Bisphenol analogues (BPs) have been widely applied to industry as the substitutes for bisphenol A (BPA), which have been detected frequently in surface water, sediment, sewage and sludge. The presence of BPs in natural environment could pose risks to the aquatic ecosystem and human health. This study outlined the occurrence, toxicity of BPs in aquatic environment and manifested their potential ecological risk to the aquatic ecosystem throughout the world. As for occurrence, BPA was losing its dominance, while BPs were occupying a large part, especially for bisphenol S (BPS), bisphenol F (BPF) and bisphenol AF (BPAF). In some heavily polluted areas, BPs concentration reached µg/L in aquatic environment, which in the effluent of sewage plants was higher than that in the surface water. BPs content in sludge and sediment was more than that in the aqueous phase. All BPs other than BPS and Bisphenol P (BPP) had moderate toxicity. The current data supports that exposure to BPs may have adverse effects on dysfunction of endocrine system such as thyroid hormone concentration, enzyme activity, and even cell dysfunction, gene damage and chromosomal abnormalities. According to the risk quotient (RQ), BPF shows the highest ecological risk in China, Japan and South Korea, followed by BPA and BPS. The occurrence of bisphenols and their neurotoxicity on aquatic organisms merit further investigation.

BackgroundDiabetic retinopathy (DR) is a specific neurovascular complication of diabetes mellitus (DM). Clinically, family history is a widely recognized risk factor for DR, assisting diagnosis and risk strata. However, among a great amount of DR patients without hereditary history like hypertension and diabetes, direct and simple risk factors to assist clinical decisions are still required. Herein, we intend to investigate the associated risk factors for these DR patients based on systemic inflammatory response indexes, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).MethodsWe consecutively enrolled 1030 patients with a definite diagnosis of type 2 diabetes mellitus (T2DM) from the endocrinology department of the Second hospital of People in Yun Nan. Based on funduscopy and family history checking, we excluded patients with a family history of hypertension and diabetes and finally enrolled 264 patients with DR and 206 patients with non-diabetic retinopathy (NDR). Through correlation analysis, univariate and multivariate regression, we further explore the association between NLR, PLR, and DR. On top of that, we investigate the effect of NLR and PLR on risk reclassification of DR.ResultsCompared with NDR patients, NLR and PLR levels are significantly higher among DR patients (NLR: 2.36 ± 1.16 in DR group versus 1.97 ± 1.06 in NDR group, p ConclusionsSystemic inflammatory response indexes NLR and PLR were associated with the presence of DR among patients without associated family history and contributed to improvements in reclassification of DR in addition to Hb.

Background Liangshan Yi Autonomous Prefecture is one of the areas that most severely affected by human immunodeficiency virus (HIV) in China, and virological failure on antiretroviral therapy (ART) is serious in this area. Analyses of prevalence and determinants of ART failure, the genetic diversity and drug resistance among people living with HIV (PLWH) helps improve HIV treatment efficiency and prevent HIV transmission. Methods A total of 5157 PLWH were recruited from 2016 to 2017. The venous blood samples were subjected to RT-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the DNAStar software and drug resistance mutations were analyzed using the Stanford University HIV Drug Resistance Database. Results A total of 2156 (41.81%) PLWH showed virological failure on ART. Males (ORm = 1.25), heterosexual behaviors and drug injection (ORm = 1.44) and mother to child transmission routes (ORm = 1.58), the clinical stage of AIDS (ORm = 1.35), having used illicit drugs and shared the needles (1–4 times: ORm = 1.34; more than 5 times: ORm = 1.52), having ever replaced ART regimen (ORm = 1.48) increased the risk of virological failure among PLWH, while higher education lever (ORm = 0.77) and ≥ 12 months on ART (12 ~ 36 months: ORm = 0.72; ≥36 months: ORm = 0.66) was associated with lower likelihood of virological failure. The data revealed that CRF07_BC (1508, 95.62%) were the most common strains, and the drug-resistant rate was 32.10% among PLWH with virological failure in this area. The high frequencies of drug resistance were found in EFV and NVP of NNRTIs, ABC, FTC and 3TC of NRTIs, and TPV/r in PIs. The most common mutations in NNRTIs, NRTIs and PIs were K103N/KN (64.69%), M184V/MV/I (36.29%) and Q58E/QE (4.93%), respectively. Conclusion We concluded that surveillance of virological failure, HIV-1 subtypes, and drug resistance to understand HIV-1 epidemiology and guide modification of ART guidelines, and target prevention and control strategies should be formatted to reduce the virological failure and drug resistance to promote viral suppression and prevent HIV-1 transmission.

Robust and accurate estimation of position and attitude of a UUV (Unmanned Underwater Vehicle) from sonar scans is essential for simultaneous localization and mapping (SLAM). Both dead-reckoning based on the inertial navigation system and the motion parameter estimation based on the registration of the ultrasound scan sequence can contribute to the performance of the system. However, the rapidly-growing accumulated error tends to counteract the precise localization of the vehicle. In this paper, a method for loop-closure detection is proposed that adjusts the accumulated error for the underwater acoustic SLAM when the vehicle scans the underwater environment using an Mechanical Scanning Imaging Sonar (MSIS). Firstly, a similarity matrix for pairs of scans is constructed to represent the loop-closing tracks. In the registration step, two novel features, namely the intensity projection histograms and a polar gradient matrix, are extracted to calculate the translational and rotational parameters respectively. Secondly, the probability hypothesis density (PHD) filter is used to extract the possible loop-closure constraints from the similarity matrix, removing the random noise brought by accidental correlation and refining the concurrent loop-closing tracks resulted from long-range scanning. Lastly, the loop-closure constraints from the refined loop-closing tracks are fed into the GraphSLAM system to adjust the pose of each scan by constraint optimization. Experiments on the MSIS sonar images collected in structured and unstructured underwater environments validate the effectiveness of the proposed loop-closure detection method.

BackgroundVascular endothelial growth factor (VEGF)-induced angiogenesis is a critical compensatory response to microvascular rarefaction in the diabetic retina that contributes to proliferative diabetic retinopathy (PDR). In this study, we sought to determine the role of specific micro ribonucleic acids (RNAs) (miRs) associated with VEGF in patients with PDR pathology.MethodsRNA sequencing was employed to detect differentially circulating miR associated with VEGF in patients with diabetes mellitus (DM), nonproliferative diabetic retinopathy (NPDR) and PDR. Quantitative real-time polymerase chain reaction was performed to measure the concentration of miR-15b in the serum of patients with DM (n = 115), NPDR (n = 47), or PDR (n = 76). The effects of miR-15b on DR and regulation of VEGF and endothelial cell function were also characterized.ResultsWe demonstrated that circulating miR-15b was directly associated with VEGF compared with other miRs in patients with PDR. We found a significant inverse relationship between low levels of miR-15b and high levels of VEGF in patients with PDR when compared with the DM or NPDR groups. We found that miR-15b regulates the expression of VEGF by targeting the 3'-untranslated regions to inhibit its transcription. Similarly, overexpression of miR-15b suppressed vascular abnormalities in vivo in diabetic GK rats, inhibiting endothelial tube formation and VEGF expression.ConclusionCirculating miR-15b is associated with PDR and may be targeted to regulate VEGF expression and angiogenesis.

Background Either chronic or acute exposure to dust particles may lead to pneumoconiosis and lung cancer, and lung cancer mortality among patients diagnosed with pneumoconiosis is increasing. Utilizing genome-wide sequencing technology, this study aimed to identify methods to decrease the number of patients with pneumoconiosis who die from lung cancer. Methods One hundred fifty-four subjects were recruited, including 54 pneumoconiosis patients and 100 healthy controls. Exosomes were isolated from the venous blood of every subject. Distinctive miRNAs were identified using high throughput sequencing technology, and bioinformatics analysis predicted target genes involved in lung cancer as well as their corresponding biological functions. Moreover, cross-cancer alterations of genes related to lung cancer were investigated, and survival analysis was performed using 2437 samples with an average follow-up period of 49 months. Results Let-7a-5p was revealed to be downregulated by 21.67% in pneumoconiosis. Out of the 683 let-7a-5p target genes identified from bioinformatics analysis, four genes related to five signaling pathways were confirmed to be involved in lung cancer development. Alterations in these four target genes were then explored in 4105 lung cancer patients, and BCL2L1 and IGF1R were demonstrated to be aberrantly expressed. Survival analysis further revealed that high expression of BCL2L1 corresponded to reduced survival of lung cancer patients (HR (95%CI) = 1.75(1.33~2.30)), while patient survival time was unaffected by expression of IGF1R (HR (95%CI) = 1.15 (0.98~1.36)). Conclusions In patients with lung adenocarcinoma, simultaneous downregulation of exosomal let-7a-5p and elevated expression of BCL2L1 are useful as predictive biomarkers for poor survival.

The finding of gallbladder polyps on imaging studies prompts further workup. Imaging results are often discordant with final pathology. The goal of this study is to compare polypoid lesions of the gallbladder found on preoperative ultrasound (US) with final pathologic diagnosis after cholecystectomy to help guide clinical decision-making. A retrospective study was conducted identifying adult patients who were diagnosed with polyps via US and who underwent cholecystectomy from 2008 through 2015. Imaging data, final pathology, and demographics were manually reviewed. A total of 2290 cholecystectomy patients had US-based polyps. Of these, 1661 patients (73%) did not have polyps on final pathology; primarily, stones or sludge were identified. Adenomyosis was diagnosed in 61 patients (2.7%). A total of 556 patients (24.2%) had pathologic polypoid lesions with the following breakdown: 463 (20.2%) cholesterol polyps, 43 other benign polyps (1.8%), 40 adenomas (1.7%), and 10 adenocarcinomas (0.4%). All patients with adenocarcinoma were older than 40 years and 91 per cent had US findings of polyps >10 mm. Ultrasound alone is an unreliable method of detecting real gallbladder polyps. This large database study found a very low risk of cancer. Size on US and patient age should be considered in the selection of appropriate surgical candidates with sonographic “polyps.”

Background Embolic strokes mainly result from cardiac or vascular origins, but there are instances when they can arise from iatrogenic foreign bodies. Catheter coatings or retained microcatheters are mainly implicated in foreign body embolism following neuroendovascular intervention. However, there are no known descriptions for free-floating and/or dislodged microcatheter fragments in the literature. Case Description We report the clinical details, imaging findings, and management of a 69-year-old woman who underwent elective pipeline embolization of an incidental right paraophthalmic artery aneurysm and suffered distal embolization of the radiopaque marker from a distal guide catheter (088 Neuron Max, Penumbra, Alameda, California, USA) used during neuroendovascular intervention. To the best of our knowledge, this is the first reported case of distal embolism from an unprovoked fracture of a neurointerventional catheter. Conclusions Knowledge of several salvage techniques is essential in preventing major cerebrovascular complications. It is imperative that a multilevel approach should be taken when treating foreign body embolism.

Dongxiang Spotted, Pingxiang Two-End-Black and Yushan Black pigs are three indigenous breeds in Jiangxi Province, China, that have been listed in the national conservation program for Chinese indigenous livestock germplasm. Here, we investigated the genetic diversity and population structure of the nucleus populations of these three breeds in a worldwide context of European and Chinese pigs using Illumina Porcine 60K chips. Our data indicate that Dongxiang Spotted and Yushan Black pigs have recently experienced severe inbreeding. The two breeds show large runs-of-homozygosity values, long-range extents of linkage disequilibrium and reduced observed heterozygosity. In contrast, Pingxiang Two-End-Black pigs are rich in genetic diversity and have few inbred individuals. Both phylogenetic and admixture analyses illustrate that Dongxiang Spotted and Yushan Black pigs are genetically close to their geographical neighbors in East China and that Pingxiang Two-End-Black pigs have a close relationship with three other Two-End-Black breeds in central China. Finally, we reconstructed the family structures of the three breeds and propose a reliable breeding strategy to better conserve these breeds.

The temporal and spatial characteristics of drought disasters in Southern China were analyzed by using the daily observation data from 252 meteorological stations and drought disaster data in 14 provinces, autonomous regions, and municipalities of Southern China during 1961–2015. The characteristics of drought disaster risk were determined, and the countermeasures for prevention and control were also suggested. The results showed that the annual precipitation fluctuated and has no obvious linear trend in Southern China in the past 55 years. However, the average annual precipitation decreased significantly and its oscillation amplitude is increasing in the early twenty-first century. The annual average temperature exhibited a significant upward trend in these years in the research area. The increasing rate was even higher than the global means. The temperature has increased since 1976, and an abrupt change was occurred in 1997. Area with high risk of drought was concentrated mainly in Southwest China. With the climatic warming, the drought frequency and intensity and the drought-affected areas have been increasing, as well as the risk of drought disaster. The risk area of secondary highest drought disaster expanded dramatically after 1997. In the future, the occurrence of droughts may increase in Southern China. Therefore, it is necessary to enhance risk management for drought disasters by implementing eco-environmental modifications in the vulnerable areas, as well as ensuring food security in the agricultural production areas, addressing the uneven spatial and temporal distributions of water resources and the discrepancy between supply and demand, and enhancing the prevention and control of drought disaster risk.

Background Hemodynamics plays a critical role in the development, growth, and rupture of intracranial aneurysms. This data could be vital in determining individual aneurysm rupture risk and could facilitate our understanding of aneurysms. Objective To present the largest prospective cross-sectional cohort study of intrasaccular pressure recordings of ruptured and nonruptured intracranial aneurysms and describe the hemodynamic differences that exist between ruptured and nonruptured aneurysms. Methods During endovascular treatment, a standard 1.8-Fr 200 m length microcatheter was navigated into the dome of the aneurysm prior to coil embolization. With the microcatheter centralized within the dome of the aneurysm, an arterial pressure transducer was attached to the proximal end of the microcatheter to measure the stump pressure inside the aneurysm dome. Results In 68 aneurysms (28 ruptured, 40 nonruptured), we observed that ruptured cerebral aneurysms had a lower systolic and mean arterial pressure compared to nonruptured cohort (P = .0008). Additionally, the pulse pressures within the dome of ruptured aneurysms were significantly more narrow than that of unruptured aneurysms (P = .0001). These findings suggest that there may be an inherent difference between ruptured and nonruptured aneurysms and such recordings obtained during routine digital subtraction angiography could potentially become a widely applied technique to augment risk stratification of aneurysms. Conclusion Our preliminary data present new evidence distinguishing ruptured from unruptured aneurysms that may have a critical role as a predictive parameter to stratify the natural history of nonruptured intracranial aneurysms and as a new avenue for future investigation.

Brainstem cavernous malformations (CMs) pose significant challenges to neurosurgeons because of their deep locations and high surgical risks. Most patients with brainstem CMs present with sudden-onset cranial nerve deficits or ataxia, but uncommonly patients can present in extremis from an acute hemorrhage, requiring surgical intervention. However, the timing of surgery for brainstem CMs has been a controversial topic. Although many authors propose delaying surgery into the subacute phase, some patients may not tolerate waiting until surgery. To the best of the authors’ knowledge, emergency surgery after a brainstem CM hemorrhage has not been described. In cases of rapidly progressive neurological deterioration, emergency resection may often be the only option. In this retrospectively reviewed small series of patients, the authors report favorable outcomes after emergency surgery for resection of brainstem CMs.