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The hybrid DC circuit breaker (HDCCB) is one of the most promising solutions for the DC interruption. But the power electronics based load commutation switch (LCS) in the main current path causes the high on-state loss and cost, which inhibits the application of the HDCCB. In this paper, a novel hybrid DC circuit breaker is proposed, in which the vacuum interrupter with the external transverse magnetic field (ETMF) is designed to improve the arc voltage and thus enhance the current commutation to power electronics. The ETMF based vacuum interrupter achieves the fast current commutation instead of the LCS, which realizes the low on-state loss and cost while preserving the short commutation and interruption time. The arc voltage characteristic with ETMF is analyzed, and the influence of the different factors on the commutation time and di/dt before current zero are investigated in detail. Based on the calculation results, a 10 kV DC breaker prototype based on the proposed topology is developed with the breaking current of 15.5 kA. Finally, the application of the proposed scheme in HVDC grids is discussed.

A periodic mirror-reflected circular-polarized (CP) leaky wave antenna (LWA) with dual beam-scanning in dual polarization types is reported in this paper. The unit cell of the proposed antenna consists of two oblique stubs that are orthogonally separated (90°) to create a circular polarization. In order to achieve better CP (axial ratio (AR) < 3dB) and beam-scanning characteristics for the periodic CP antenna, a new method of adding a groove at the junction of stubs within the unit cell is introduced. To realize dual beam-scanning in dual circular polarization, a metal via is added at the end of the antenna to generate a mirror reflection. A mirror-reflected structure is fabricated and measured. The measured results show that the right-handed CP (RHCP) scanning range of the incident beam is -31°~-8° and 5°~-14°, and the left-handed CP (LHCP) scanning range of the corresponding reflected beam is 31°~6° and -6°~-15°. The measured results are in good agreement with the simulated ones.

The ongoing energy revolution has led to the gradual replacement of traditional synchronous generators by renewable enecorresponding authorrgy. This transformation of power generation mode reshapes power system dynamics and poses many challenges to reliable and efficient grid operation. With the continuous improvement of the penetration level of renewable energy represented by wind power in the power system, the synchronous mode of wind turbine will gradually become one of the main modes of system synchronization. In the case of coexistence of multiple synchronization modes, the synchronization mechanism of the whole power system will be fundamentally changed; at the same time, due to the response characteristics of wind turbine to the frequency and voltage dynamics of power grid and the traditional power supply, the synchronous mode of wind turbine will gradually become one of the main modes of system synchronization The frequency and voltage stability of power system also faces new challenges. The virtual synchronous generation technology can make the grid connected inverter simulate the operation mechanism of step generator and provide an effective method to solve the above problems. In this paper, the main technical routes to realize virtual synchronous control of wind turbines are summarized. From the aspects of stability analysis, control system optimization, performance analysis and evaluation, the research and engineering status of virtual synchronization technology in wind turbines are introduced, and the problems to be solved and technical requirements are prospected.

The fast fault clearance in medium voltage direct current (MVDC) grids requires the DC circuit breakers (DCCBs) with high breaking capability and low cost. The traditional hybrid DCCB realizes large current interruption relying on several insulated gate bipolar transistors (IGBTs) in parallel, which results in difficulty of cost reduction. In this paper, a novel DC circuit breaker with counter-current injection and integrated gate-commutated thyristor (IGCT) combined is proposed and analyzed. By combining forced commutation and IGCT, the large current breaking capability can be realized and the low cost is guaranteed. The simulation of the proposed DCCB is performed to evaluate the fault current breaking capability and influence of circuit parameters consisting of stray parameters and pre-charged capacitors on current commutation processes. Furthermore, a prototype of the 10 kV MVDC circuit breaker with 20 kA breaking capability is developed, then the fault current breaking test is carried out to verify the validity of the proposed topology which can cut off current within 2.5 ms. 1

In this paper, a phased array antenna with an integrated metasurface is designed to achieve wideband and wide-angle scanning. Generally, the coupling between adjacent elements changes significantly as the scanning angle increases, resulting in limited scanning coverage. Two mutually perpendicular metasurface slabs are designed to achieve wide-angle scanning. The mutual coupling is reduced by properly tuning the dimension of the metasurface. Two perpendicular linear arrays were fabricated to verify the design. The measured 3-dB beamwidth of the active element pattern (AEP, in the array environment) with the integrated metasurface is about 150° in the E-plane and 109° in the H-plane, which is suitable for wide-angle scanning. The simulated and measured results indicate that the beam can scan from -78° to 78° with a 3-dB gain fluctuation in the E-plane array and a wide frequency range from 10 GHz to 12.5 GHz (22.2%). In the H-plane array, the scan angle ranges from -69° to 69° with a 3-dB gain fluctuation and a relative bandwidth of 11%.

To facilitate construction and on-site quality testing, a new type of panel joint using cast-in-place connecting beams was developed and studied. The proposed connecting beams consist of overlapping vertical U-shaped steel bars stretching out of the wall and the footing, longitudinal prestressed steel strands, L-shaped steels and infilled high-strength grout. One monolithic shear wall specimen and five precast specimens were tested under simulated seismic loads. The test parameters studied included the presence or absence of L-shaped steel, sectional depths and the locations of connecting beams and locally non-bonded U-shaped steel bars. The effects of these parameters on the failure modes, hysteresis curves, stiffness, ductility and energy dissipation capacity were evaluated. The test results showed that the precast shear walls with the proposed panel joint achieved desirable seismic behaviour – comparable to or better than that of monolithic specimens – and can thus be safely applied in buildings in seismic zones. The use of L-shaped steel, prestressed steel strands and high-strength grout effectively delayed concrete crushing at the wall toes and thus improved the loading capacity, deformation capacity, initial stiffness, ductility and energy dissipation capacity of the precast shear walls.

Alternating current electroluminescence (ACEL) as a unique display technology has been studied for decades. Due to the development of component materials (phosphor, dielectric, electrodes, and subs...

2D materials exhibit intriguing electrical and optical properties, making them promising candidates for next-generation nanoelectronic devices. However, the high contact resistance of 2D materials to electrode material often limits the ultimate performance and potential of 2D materials and devices. In this work, we demonstrate a localized femtosecond (fs) laser irradiation process to substantially minimize the resistance of MoS2-metal contacts. A reduction of the contact resistance exceeding three orders of magnitude is achieved for mechanically exfoliated MoS2, which remarkably improves the overall FET performance. The underlying mechanisms of resistance reduction are the removal of organic contamination induced by the transfer process, as well as the lowering of Schottky barrier resistance (RSB) attributed to interface Fermi level pinning (FLP) by Au diffusion, and the lowering of interlayer resistance (Rint) due to interlayer coupling enhancement by Au intercalation under fs laser irradiation. By taking advantage of the improved MoS2-metal contact behavior, a high-performance MoS2 photodetector was developed with a photoresponsivity of 68.8 A W-1 at quite a low Vds of 0.5 V, which is ∼80 times higher than the pristine multilayer photodetector. This contamination-free, site-specific, and universal photonic fabrication technique provides an effective tool for the integration of complex 2D devices, and the mechanism of MoS2-metal interface modification reveals a new pathway to engineer the 2D material-metal interface.

Medium-voltage dc (MVdc) distribution systems have the advantages of high power density, low line loss and fast system response. However, the high rise rate and large peak value of short circuit current make the fault current interruption a critical problem in MVdc systems. To solve this problem, a novel circuit breaker scheme based on integrated gate-commutated thyristor (IGCTs) current sharing integrated with freewheeling is proposed in this article, which not only can ensure a high breaking capacity and short interruption time in the full current range, but also have superior vacuum interrupter recovery performance and high breaking reliability. The analysis of key factors, including stray parameters, inductance-capacitance (LC) parameters and arcing time, on the current commutation characteristics is presented, and the optimal design principle of the circuit breaker parameters is obtained. Finally, the proposed MVdc circuit breaker is verified with a 64.2 kA/10 kV fault current interruption experiment.

BACKGROUND There are limited data on the incidence of pneumonia and pneumonia-related hospitalisation in the IBD population, and on any association of IBD medications with such outcomes. AIMS To evaluate the impact of IBD medications on the risk of pneumonia, pneumonia-related hospitalisations and death. METHODS We conducted a retrospective cohort study of IBD patients from the nationwide Veteran Affairs (VA) dataset. The exposure of interest was different IBD medication groups. We estimated the incidence rate of pneumonia, pneumonia-related hospitalisation and mortality based on IBD medication subgroups. We used a multivariable Cox regression to estimate the adjusted hazard ratios (AHR) and 95% confidence intervals (CIs) for these outcomes. RESULTS Out of 56 410 patients with IBD, 3759 developed pneumonia, 1489 were hospitalised, and 248 died within 30 days of their pneumonia diagnosis. The crude incidence rates of pneumonia, pneumonia-related hospitalisation and pneumonia-related mortality were 6.47, 2.52 and 0.43, respectively, per 1000 person-years. In multivariable Cox regression analysis, compared to 5-ASA alone, anti-TNF medication was associated with an increased risk of pneumonia (AHR 1.39; 95% CI 1.22-1.59) and hospitalisation (AHR 1.61; 95% CI 1.31-1.98). Use of prednisone in the prior 30 days was associated with increased risk of pneumonia (AHR 2.14; 95% CI 1.92-2.38) and hospitalisation (AHR 2.44; 95% CI 2.08-2.88). CONCLUSION Anti-TNF medications and prednisone use may be associated with increased risk of developing pneumonia and pneumonia-related hospitalisation. Physicians should evaluate the risk-benefit ratio of IBD medications, especially in the elderly population.

Enhanced recovery after surgery (ERAS) pathway comprises a set of comprehensive elements which have been reported to enhance patient postoperative prognosis. In the current study, we aimed to evaluate the effectiveness of the ERAS in patients undergoing laparoscopic adrenal resection. A retrospective review was performed to compare the outcomes of patients undergoing adrenalectomy for primary aldosteronism between the pre-ERAS period and the ERAS era. Data was generated from the traditional surgical period (September 1, 2019, to December 31, 2019) and the ERAS period (September 1, 2020, to December 31, 2020), respectively. Forty-seven adrenalectomy patients were enrolled (pre-ERAS, n = 21; ERAS, n = 26) in analysis. The results revealed that both total length of hospital stay and postoperative length of stay decreased in the ERAS period compared with the pre-ERAS period (14.19 ± 4.96 vs 11.27 ± 4.37, p = 0.015; 5.43 ± 1.08 vs 3.31 ± 0.97, p

Background The present study aims to investigate the preliminary mechanism underlying the peritoneal metastasis of gastric cancer cells. Methods Exosomes from GC9811 cells (Con-Exo) and from GC9811-P cells (PM-Exo) were extracted by ultracentrifugation, which were identified with transmission electron microscopy (TEM) and nanoparticle trafficking analysis, as well as the expression of CD9, CD63, and CD81 detected by Western blot assay. α-SMA expression was determined by immunofluorescence assay and Western blot assay. The levels of Snail1, E-cadherin, and Actin-related protein 3 (ACTR3) were evaluated by Western blot assay. MiRNA array was performed on exosomes to screen the differentially expressed miRNAs. The expressions of miRNAs, SMAD2, CDK4, and ACTR3 were determined by QRT-PCR. The delivery of miR-486-5p was confirmed by laser confocal detection. Results Firstly, TEM, nanoparticle trafficking analysis, and Western blot assays were used to confirm the successful extraction of Con-Exo and PM-Exo. The incubation of Con-Exo and PM-Exo could decrease E-cadherin expression and increase of α-SMA respectively in HMrSV5 cells, with the increased proportion of fusiform cells. More significant changes were observed in PM-Exo-treated HMrSV5 cells. Secondary, compared to Con-Exo, miR-486-5p and miR-132-3p were found downregulated, and miR-132-5p was found upregulated in PM-Exo. The transfection of miR-486-5p and miR-132-3p was observed to suppress EMT, and the transfection of miR-132-3p was observed to induce EMT. Laser confocal detection confirmed the delivery of miR-486-5p from gastric cancer cells to HMrSV5 cells through exosomes. Lastly, the expression of Mothers against decapentaplegic homolog 2 (SMAD2), cyclin-dependent kinase 4 (CDK4), and ACTR3 was found to be downregulated via miR-486-5p. Conclusion Decreased delivery of miR-486-5p via exosomes might be responsible for the peritoneal metastasis of gastric cancer cells by promoting epithelial-mesenchymal transition progress.

In this letter, a 1-bit wideband reconfigurable unit cell for transmitarray applications in Ku-band is proposed. The unit cell consists of a Vivaldi structure (transmitting), a phase shifter, and a microstrip Yagi structure (receiving). Based on the current reversal mechanism, a pair of reverse mounted PIN diodes was introduced to obtain the required phase resolution (two phase states: 0° and 180°). The unit cell is fabricated and measured using a specific waveguide simulator. The measured minimum insertion losses are 1.58 and 1.61 dB for State I and II, respectively. The insertion loss is less than 2.58 dB (1 dB bandwidth) from 14.88 to 17.28 GHz for State I, and less than 2.61 dB (1 dB bandwidth) from 14.73 to 17.25 GHz for State II. The 1 dB bandwidth of the unit cell is about 15%. The measured phase difference remains 180°, and the maximum error is only 3.8°.

Introduction: The anterosuperior portion of the bulla lamella can extend into the frontal sinus and form the supra bulla frontal cell (SBFC) and supraorbital ethmoid cell (SOEC). This can affect the frontal drainage pathway and make surgery more challenging. Objectives: The aim of the study was to compare the anatomical characteristics of SBFC and SOEC in Chinese chronic rhinosinusitis (CRS) patients and explore the relationship between the cells and frontal sinusitis (FS). The surgical skills in dealing with these cells were also studied. Methods: We prospectively identified SBFC and SOEC in 114 patients with CRS by computed tomography (CT). The sides of the patients were divided into groups A (with FS) and B (without FS). CT scans were analyzed to distinguish the SBFC, SOEC, and the drainage pathway. Statistical analysis was conducted to determine whether the cells were associated with the occurrence of FS. Results: The prevalence of frontal cells was as follows: SBFC: 9.65%, SOEC: 21.93%. There was an association between the presence of SBFC and FS (p < 0.05). The anterior drainage pathway was present in patients with SBFC and SOEC, anterolateral pathway in those with SBFC/SOEC coexisting with the frontal septal cell, and anteromedial pathway in those with SBFC/SOEC coexisting with the supra agger frontal cell. Conclusions: There was an association between the presence of SBFC and the occurrence of FS. Extension of the anterosuperior portion of the bulla lamella into the frontal sinus obstructed the drainage pathway posteriorly. Understanding the anatomy may help surgeons thoroughly dissect the bulla lamella.

PurposeThe aim of this research is to quantitatively synthesize empirical findings of the effect of discount level on consumer response to the coupon.Design/methodology/approachThe authors used the meta-analysis method to synthesize coupons' discount level effects on consumer response. Meta-regression was used to examine the moderating factors that affect the relationship between discount level and consumer response.FindingsThe average effect size of the discount level is 0.331, indicating that higher discount levels lead to higher consumer responses. The effect of discount level on consumer response to the coupon is stronger when the discount is displayed in proportion format (vs amount format), when consumers are distant (vs near) to the coupon-issuing stores, and when consumers have not opted-in to receive promotional information. The discount level effect is weaker for coupons that can be redeemed online (vs offline only), for hedonic products (vs utilitarian products) and for products of real brands.Originality/valueFrom information processing and cost–benefit trade-off perspectives, this research proposes a comprehensive research framework that synthesizes a variety of contextual factors. It identifies several contextual factors that may reconcile several inconsistent findings in the existing literature. It also addresses how the new-technology related factors affect coupon redemption under different discount levels.

A tapered continuous-element leaky-wave antenna is presented, which has the merits of suppressed higher order harmonics and reduced sidelobe level (SLL). Two important design strategies are utilized for assuring good radiation pattern purity. First, the phase difference between the main radiating edge in each unit cell is disturbed to avoid higher order mode superpositioning in-phase. Second, an extra element with a relatively large phase constant is introduced for canceling the field of the first sidelobe location. The measurement results show a continuous scanning beam with an equalized gain is achieved at the frequency band of 5.6–8.8 GHz, the corresponding normalized SLL is decreased to about –20 dB and the radiation of HOH in the high frequencies is null at the backward direction.

To explore the efficacy and safety of palbociclib combined with endocrine therapy (ET) in advanced breast cancer (ABC). We conducted a retrospective study involving patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) ABC who received palbociclib combined with ET in the first- to third-line at three centers in China between January 2018 and October 2020. A total of 151 patients were included in this study. The median age of the patients at palbociclib initiation was 56 years (range 30-86 years) with a median follow-up of 10.9 months (range 2.0-41.2 months). Among these patients, 88 patients received palbociclib combined with ET as first-line therapy, and achieved a median progression-free survival (mPFS) of 19.8 months and an objective response rate (ORR) of 40.9%, meanwhile, in the first-line setting, 62 patients received palbociclib at an initial dose of 125 mg, achieving a mPFS of 20.9 months and an ORR of 46.8%. There were 39 and 24 patients who received palbociclib combined with ET as second- and third-line therapy, the mPFS were 10.0 months and 6.1 months, respectively. The most common and serious adverse events (AEs) were leukopenia and neutropenia. A total of 64 patients (42.4%) underwent palbociclib dose reduction due to AEs. Palbociclib combined with ET is an effective therapeutic regimen for HR+/HER2- ABC, particularly in the first-line setting with palbociclib initial dose of 125 mg, and AEs were manageable.

Background New effective drugs for prostate cancer (PCa) treatment are urgently needed. Avasimibe was recently identified as a promising drug for anticancer therapies. The main purpose of this study was to explore the effects and the underlying mechanisms of avasimibe in prostate cancer. Methods In this study, MTT and clonogenic survival assays were performed to detect cell proliferation after avasimibe treatment. The effect of avasimibe on cell migration was measured by wound healing and transwell migration assays. Cell cycle distribution and apoptosis were detected by flow cytometry. Immunofluorescence staining and western blot analysis were used to detect the expression of cell cycle-related proteins and epithelial-mesenchymal transition (EMT)-related proteins. In vivo, the antitumour effects of avasimibe were evaluated using a xenograft model and pulmonary metastasis model. Results The study found that avasimibe suppresses tumour growth and triggers G1 phase arrest. Moreover, the expression of the cell cycle-related proteins CDK2/4/6, Cyclin D1 and Cyclin A1 + A2 was significantly increased and p21 expression was decreased after avasimibe treatment. The migration of PCa cells was attenuated after treatment with avasimibe, followed by the downregulation of the expression of the EMT-related proteins N-cadherin, β-catenin, vimentin, Snail and MMP9 and upregulation of E-cadherin expression. Moreover, E2F-1 was elevated after treatment with avasimibe. After knockdown of E2F-1 expression, the inhibition of cell proliferation and migration caused by avasimibe was significantly recovered. The results of the xenograft model showed that avasimibe suppressed tumour growth in vivo. Immunofluorescence staining revealed lower levels of Ki67 and higher levels of E2F-1 in tumour tissues of the avasimibe group than those of the control group. A pulmonary metastasis model also confirmed the inhibition of PCa metastasis by avasimibe. The number of lung metastatic foci in the avasimibe group was significantly decreased compared with that in the control group. Conclusions Our results suggest that avasimibe can suppress tumour proliferation and metastasis via the E2F-1 signalling pathway. These findings demonstrate the potential of avasimibe as a new effective drug for PCa treatment.

We report the development of low-cost triboelectric nanogenerators (TENGs) based on polypropylene (PP) fabrics formulated via an inexpensive melt-blowing process with an output voltage as high as 50 V. By disinfection methods such as exposure to steam, ethanol, and dry heat at 75 °C, the commercial medical masks and N95 filtering facepiece respirators (FFRs) can be reused to fabricate PP fiber based TENGs, which provide a novel regime for energy-harvesting devices based on reusable materials. As a power source, the output of one TENG can drive 15 serially connected light-emitting diodes (LEDs) or a commercial electric calculator. PP fabric TENGs can also work as self-powered sensors for the high-sensitivity detection of mechanical impact. We provide examples where the TENG is used to detect biomechanical motion such as that associated with the extension of an elbow, the touch of a finger, the impact of footsteps, and the bending of a knee without an external power supply. Most importantly, these PP fabrics for TENGs can be obtained from decontaminated medical masks that are generated as tremendous wastes every day, which provide a great potential as sustainable energy. These properties suggest that PP fabric based TENGs are promising for harvesting energy from biological systems and that they may facilitate the large-scale production of a new range of inexpensive self-powered multifunctional wearable sensors for applications in healthcare, security, and information networks.

The myodural bridge (MDB) is a dense connective tissue bridge connecting the suboccipital muscles to the spinal dura mater, and it has been proven to be a normal common existing structure in humans and mammals. Some scholars believe that the suboccipital muscles can serve as a dynamic cerebrospinal fluid (CSF) pump via the MDB, and they found head rotations promote the CSF flow in human body, which provided evidence for this hypothesis. Head movement is a complex motion, but the effects of other forms of head movement on CSF circulation are less known. The present study explored the effects of head-nodding on CSF circulation. The CSF flow of 60 healthy volunteers was analyzed via cine phase-contrast magnetic resonance imaging at the level of the occipitocervical junction before and after one-minute-head-nodding period. Furthermore, the CSF pressures of 100 volunteers were measured via lumbar puncture before and after 5 times head-nodding during their anesthetizing for surgical preparation. As a result, it was found that the maximum and average CSF flow rates at the level of the upper border of atlas during ventricular diastole were significantly decreased from 1.965 ± 0.531 to 1.839 ± 0.460 ml/s and from 0.702 ± 0.253 to 0.606 ± 0.228 ml/s respectively. In the meantime, the changes in the ratio of cranial and caudal orientation of the net flow volume were found differed significantly after the one-minute-head-nodding period (p = 0.017). And on the other hand, the CSF pressures at the L3–L4 level were markedly increased 116.03 ± 26.13 to 124.64 ± 26.18 mmH2O. In conclusion, the head-nodding has obvious effects on CSF circulation and head movement is one of the important drivers of cerebrospinal fluid circulation. We propose that the suboccipital muscles, participating in various head movements, might pull the dura sac via the myodural bridge, and thus, head movement provides power for the CSF circulation.

A novel 1-bit reconfigurable transmitarray antenna (RTA) based on a Yagi–Vivaldi unit cell for wideband and beam scanning application at the $Ku$ -band is presented. The unit cell consists of a tightly coupled microstrip (MS) Yagi antenna and a Vivaldi antenna as the receiving and transmitting elements, respectively. To achieve a reconfigurable performance, a novel slot line to MS line phase shifter with a pair of reverse-mounted p-i-n diodes was introduced, and a 180° phase difference was achieved based on the current reversal mechanism. To improve the oblique incidence performance of the unit cell, a metasurface based on subwavelength metal crosses was loaded in front of the antenna, and the scan loss in the H-plane was improved by 2 dB. An RTA prototype with $16\times 16$ unit cells was designed, fabricated, and tested. The measured 1 dB bandwidth of the RTA is 14% with a maximum gain of 22.3 dB at 13.6 GHz, corresponding to an aperture efficiency of 25.6%. Good beam scanning performance has also been achieved with a scan loss better than 4 dB in both the E-plane and the H-plane at 60°.

Metal-rich chalcogenides with unique network architectures are rare but are of considerable interest because of their intriguing physical properties. In this work, a novel quaternary thioantimonate, Rb2CuSb7S12, has been discovered by a facile surfactant-thermal reaction. It crystallizes monoclinic space group P1 (No. 2) and exhibits a unique Sb-rich three-dimensional (3D) [CuSb7S12]2- framework surrounded by charge-compensating Rb+ cations. It is interesting to note that the Cu/Sb ratio of Rb2CuSb7S12 represents the lowest limit in the quaternary A/Cu/Sb/Q (A = alkali metals; Q = chalcogen) system. Moreover, Rb2CuSb7S12 shows rapid response and good reproducibility based on the photoelectrochemical tests. This study opens up opportunities for discovering the desirable physical properties in metal-rich chalcogenides.

Objective To compare the rates of negative test results for chronic endometritis (CE) between subjects who did and did not receive antibiotic treatment. Design Prospective, single-blind randomized controlled trial. Setting Tertiary hysteroscopic center in a university teaching hospital. Patient(s) A total of 132 women with CE confirmed with immunohistochemical study with CD138 epitope. Intervention(s) Women randomized to antibiotic therapy received oral levofloxacin 500 mg and tinidazole 1,000 mg daily for 14 days. Women randomized to the control group did not receive any treatment. A repeated endometrial biopsy was performed 4 to 8 weeks after the initial biopsy to determine whether CE was still present. Main Outcome Measure(s) The rate of negative test results for CE (from positive to negative). Result(s) The CE rate of negative test results in the treatment group (89.3%) after one course of antibiotic treatment was significantly higher than that in the control group (12.7%). Among subjects who attempted pregnancy, there was no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (43.2%, 5.4%) and the control arm (25.7%, 14.3%). Among subjects randomized, there was also no significant difference in ongoing pregnancy rates and miscarriage rates between the treatment arm (27.1%, 3.4%) and the control arm (16.4%, 9.1%). Conclusion A course of broad-spectrum oral antibiotic therapy for 14 days is effective in the treatment of CE in >89.8% of cases. However, it is not yet clear whether treatment improved pregnancy outcomes. Clinical Trial Identification Number NCT02648698.

BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome. Although the incidence of carbon dioxide embolism (CDE) during endoscopic thyroidectomy is very low, it is potentially fatal. The clinical manifestations of CDE vary, and more attention should be paid to this disorder. CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach. The patient had no other diseases or surgical history. During the operation, he developed a CDE following inadvertent injury of the anterior jugular vein. The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide, and his remaining vital signs were stable. In addition, loud coarse systolic and diastolic murmurs were heard over the precordium. The patient was discharged on day 4 after surgery without complications. CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.

AIM The study aimed to explore the effects of tissue-engineered bone constructed with partially deproteinized biologic bone (PDPBB) and coculture of adipose-derived stem cells (ADSCs) and vascular endothelial cells (VECs) on host immune status, providing a very useful clue for the future development of bone engineering. METHODS Tissue-engineered bones constructed by PDPBB and ADSCs, VECs or coculture of them were implanted into the muscle bag of bilateral femurs of Sprague-Dawley rats. Partially deproteinized biologic bone alone and blank control were also implanted. After transplantation, the proliferation of implanted seed cells in tissue-engineered bones was labeled by bromodeoxyuridine staining. Moreover, the changes of T-lymphocyte subpopulations, including CD3 + CD4+ and CD3 + CD8+ in peripheral blood were then detected using flow cytometry to analyze the immune rejection of tissue-engineered bone implantation based on peripheral blood CD4/CD8 ratios. RESULTS After transplantation, the proliferation of implanted seed cells was observed in tissue-engineered bones of different groups. At different time points after transplantation, the CD4+/CD8+ ratio in peripheral blood of PDPBB + ADSCs, PDPBB + coculture, and blank control groups did not exhibit significant change. Although the CD4+/CD8+ ratio in peripheral blood of PDPBB + VECs group was significantly higher than other group at 1 week after transplantation, that of PDPBB + VECs and PDPBB + coculture group was significantly decreased at 8 week after transplantation compared with that of blank control group. CONCLUSIONS Our results indicated that there was no significant immune rejection after transplantation of tissue-engineered bone constructed with PDPBB and coculture of ADSCs and VECs as seed cells.

Dysregulation of apoptotic machinery is one mechanism by which acute myeloid leukemia (AML) acquires a clonal survival advantage. B-cell lymphoma protein-2 (BCL2) overexpression is a common feature in hematologic malignancies. The selective BCL2 inhibitor, venetoclax (VEN) is used in combination with azacitidine (AZA), a DNAmethyltransferase inhibitor (DNMTi), to treat patients with AML. Despite promising response rates to VEN/AZA, resistance to the agent is common. One identified mechanism of resistance is the upregulation of myeloid cell leukemia-1 protein (MCL1). Pevonedistat (PEV), a novel agent that inhibits NEDD8-activating enzyme, and AZA both upregulate NOXA (PMAIP1), a BCL2 family protein that competes with effector molecules at the BH3 binding site of MCL1. We demonstrate that PEV/AZA combination induces NOXA to a greater degree than either PEV or AZA alone, which enhances VEN-mediated apoptosis. Herein, using AML cell lines and primary AML patient samples ex vivo, including in cells with genetic alterations linked to treatment resistance, we demonstrate robust activity of the PEV/VEN/AZA triplet. These findings were corroborated in preclinical systemic engrafted models of AML. Collectively, these results provide rational for combining PEV/VEN/AZA as a novel therapeutic approach in overcoming AML resistance in current therapies.

Vedolizumab (VDZ) is postulated to have a potentially safer side effect profile than other biologic medications owing to its gut-selective mechanism. However, extrapolating these safety data to older patients is challenging because of their underrepresentation in or exclusion from most clinical trials, higher rates of withdrawal, and higher rates of comorbidities. Our aim was to evaluate the absolute risk of infections and malignancies in an elderly group of patients with inflammatory bowel disease (IBD) exposed to VDZ vs. the absolute risks associated with 5-aminosalicyclic acid (5-ASA) medications and chronic steroid use. We conducted a retrospective cohort study among the US national Veterans Affairs Healthcare System (VAHS). Our cohort comprised patients who were followed in the VAHS, had a diagnosis of IBD, and were aged 65 years or older. The patients were divided into three cohorts: primary exposure group (elderly patients on VDZ), assumed low-risk group (elderly patients on 5-ASA only), and assumed high-risk group (elderly patients on chronic prednisone). The low-risk and high-risk groups were matched to the VDZ group on race, gender, IBD type, age, and Charlson Comorbidity Index (CCI). Primary outcomes gathered and confirmed via chart review included mild infections, severe infections, malignancies, and non-melanoma skin cancers (NMSC). The results were based on a descriptive analysis. A total of 497 patients were included in our study with 213, 186, and 98 patients in the VDZ, 5-ASA, and steroid groups, respectively. The total patient-years (PYs) of follow up were 405, 656, and 303 in VDZ, 5-ASA, and steroid groups respectively. The incidence of mild infection was the lowest in the VDZ group with 93.1 outcomes per 1000 PYs as compared to the 5-ASA group (114.4 outcomes per 1000 PYs) and 155.1 outcomes per 1000 PYs in the steroid group. In regard to severe infections, the VDZ group had an incidence of 38.5 outcomes per 1000 PYs as compared to 30.6 outcomes per 1000 PYs in the 5-ASA group and 67.4 outcomes per 1000 PYs in the steroids group. Mild infections with the highest incidence in the VDZ group were upper respiratory infection (including pharyngitis and sinusitis) at 20.3 per 1000 PYs, Clostridium difficile (15.1 per 1000 PYs), and cellulitis (10.0 per 1000 PYs). The severe infection with the highest incidence was pneumonia for each group, with incidence rates of 10.0, 14.0, and 48.6 per 1000 PYs for the VDZ, 5-ASA, and steroid groups, respectively. Incidence of malignancies (excluding NMSC) was numerically similar in the VDZ and 5-ASA group (17.6 and 15.6 per 1000 PYs, respectively), while the steroid group showed a higher incidence of 42.6 per 1000 PYs. NMSC incidence was numerically similar in the VDZ and steroid groups (36.3 and 39.0 per 1000 PYs, respectively), with the 5-ASA group showing a much lower NMSC incidence (4.6 per 1000 PYs). In a large nationwide cohort of elderly patients, we found the safety profile of VDZ among elderly patients with IBD with respect to the risk of infection and malignancy to be numerically similar to elderly patients with IBD taking 5-ASA, and favorable when compared to the elderly patients with IBD taking chronic steroids.

An image-based deep learning model was developed to detect different morphological patterns of diabetic macular edema based on optical coherence tomography images with high accuracy and transparency. This model could help ophthalmologists to make personalized therapeutic strategies for patients with diabetic macular edema., Purpose: To develop a deep learning (DL) model to detect morphologic patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT) images. Methods: In the training set, 12,365 OCT images were extracted from a public data set and an ophthalmic center. A total of 656 OCT images were extracted from another ophthalmic center for external validation. The presence or absence of three OCT patterns of DME, including diffused retinal thickening, cystoid macular edema, and serous retinal detachment, was labeled with 1 or 0, respectively. A DL model was trained to detect three OCT patterns of DME. The occlusion test was applied for the visualization of the DL model. Results: Applying 5-fold cross-validation method in internal validation, the area under the receiver operating characteristic curve for the detection of three OCT patterns (i.e., diffused retinal thickening, cystoid macular edema, and serous retinal detachment) was 0.971, 0.974, and 0.994, respectively, with an accuracy of 93.0%, 95.1%, and 98.8%, respectively, a sensitivity of 93.5%, 94.5%, and 96.7%, respectively, and a specificity of 92.3%, 95.6%, and 99.3%, respectively. In external validation, the area under the receiver operating characteristic curve was 0.970, 0.997, and 0.997, respectively, with an accuracy of 90.2%, 95.4%, and 95.9%, respectively, a sensitivity of 80.1%, 93.4%, and 94.9%, respectively, and a specificity of 97.6%, 97.2%, and 96.5%, respectively. The occlusion test showed that the DL model could successfully identify the pathologic regions most critical for detection. Conclusion: Our DL model demonstrated high accuracy and transparency in the detection of OCT patterns of DME. These results emphasized the potential of artificial intelligence in assisting clinical decision-making processes in patients with DME.

Possessing inherently low thermal conductivity, BiSbSe3 is a promising thermoelectric material for medium temperature. Therefore, to substantially optimize the thermoelectric performance of BiSbSe3, researchers mainly focus on the strategies to improve its electrical transport properties. Among these strongly coupled thermoelectric parameters, carrier concentration and effective mass are two intrinsic variables to decisively affect the electrical transport properties. In this work, Cl as a donor dopant is effective to provide extra electrons in n-type BiSbSe3, and the carrier concentration and effective mass can be well optimized simultaneously with increasing Cl content owing to the multiple conduction bands in BiSbSe3. What’s more, maximum weighted mobility ∼53 cm2 V−1 s−1 is obtained in Cl-doped BiSbSe3, which contributes to a largely enhanced power factor ∼4.8 μW cm−1 K-2 at room temperature and outperforms other halogen-doped BiSbSe3 samples. Finally, combining the significantly enhanced power factor and maintained low thermal conductivity, a maximum ZT ∼1.0 is achieved in Cl-doped BiSbSe3 at 800 K.

In order to improve the connection rate and transmission efficiency of field network for power distribution grid, a dual-mode heterogeneous field network with high-speed power line broadband carrier and micro-power radio frequency wireless communication capabilities was designed. First, the topological structure of the field network, the networking process of the central node and the free nodes and the dynamic maintenance mechanism of the network were discussed in detail. Secondly, the routing measurement mechanism for creating a hybrid routing table and the improved layer limit shortest path routing algorithm were presented. On this basis, each node in the network could choose the optimal communication media at any given moment to create communication links with the adaptive data transfer speed according to the real-time hybrid routing table. Finally, the dual-mode heterogeneous field network was applied to the electricity consumption information collection system and tested in the laboratory and jobsite. The test results show that the dual-mode field network was more effective than the single-mode field network in shortening the reading meter time and increasing networking success rate.

openaire: EC/H2020/825496/EU//5G-MOBIX | openaire: EC/H2020/815191/EU//PriMO-5G The strict latency constraints of emerging vehicular applications make it unfeasible to forward sensing data from vehicles to the cloud for processing. To shorten network latency, vehicular fog computing (VFC) moves computation to the edge of the Internet, with the extension to support the mobility of distributed computing entities (a.k.a fog nodes). In other words, VFC proposes to complement stationary fog nodes co-located with cellular base stations with mobile ones carried by moving vehicles (e.g., buses). Previous works on VFC mainly focus on optimizing the assignments of computing tasks among available fog nodes. However, capacity planning, which decides where and how much computing resources to deploy, remains an open and challenging issue. The complexity of this problem results from the spatio-temporal dynamics of vehicular traffic, varying computing resource demand generated by vehicular applications, and the mobility of fog nodes. To solve the above challenges, we propose a data-driven capacity planning framework that optimizes the deployment of stationary and mobile fog nodes to minimize the installation and operational costs under the quality-of-service constraints, taking into account the spatio-temporal variation in both demand and supply. Using real-world traffic data and application profiles, we analyze the cost efficiency potential of VFC in the long term. We also evaluate the impacts of traffic patterns on the capacity plans and the potential cost savings. We find that high traffic density and significant hourly variation would lead to dense deployment of mobile fog nodes and create more savings in operational costs in the long term.

Inflammation is known to be involved in the progression of diabetic retinopathy. Follicular helper T cells (Tfh) play critical roles in the differentiation of long-live plasma cells and production of antibodies, whereas circulating CD4+CXCR5+ T cells may act as a counterpart to measure Tfh cell disorders. In this study, we investigated whether Tfh could be involved in the development of diabetic retinopathy (DR) by assessing circulating Tfh cells in peripheral blood. Data showed that serum levels of total IgG and IgA were both significantly increased in type 2 diabetes mellitus (T2DM) patients with proliferative diabetic retinopathy (PDR) than with non-PDR. Also, B cell activation and differentiation were both enhanced in T2DM patients with PDR. Little changes were detected in levels of Th1, Th2, and Th17 cells. As indicated by elevated serum levels and supernatant from cultured PBMC of IL-21, we found increased circulating Tfh cells in PDR patients with dysregulated subsets. This study suggests the involvement of circulating Tfh cells in DR and, in particular, the pathogenesis of PDR.

Background Early detection of pancreatic ductal adenocarcinoma (PDA) may improve survival. We previously developed a clinical prediction model among patients with new-onset diabetes to help identify PDAs 6 months prior to the clinical diagnosis of the cancer. We developed and internally validated a new model to predict PDA risk among those newly diagnosed with impaired fasting glucose (IFG). Methods We conducted a retrospective cohort study in The Health Improvement Network (THIN) (1995-2013) from the UK. Eligible study patients had newly diagnosed IFG during follow-up in THIN. The outcome was incident PDA diagnosed within 3 years of IFG diagnosis. Candidate predictors were factors associated with PDA, glucose metabolism or both. Results Among the 138 232 eligible patients with initial IFG diagnosis, 245 (0.2%) were diagnosed with PDA within 3 years. The median time from IFG diagnosis to clinical PDA diagnosis was 326 days (IQR 120-588). The final prediction model included age, BMI, proton pump inhibitor use, total cholesterol, low-density lipoprotein, alanine aminotransferase and alkaline phosphatase. The model achieved good discrimination [area under the curve 0.71 (95% CI, 0.67-0.75)] and calibration (Hosmer and Lemeshow goodness-of-fit test P > 0.05 in 17 of the 20 imputed data sets) with optimism of 0.0012662 (95% CI, -0.00932 to 0.0108771). Conclusions We developed and internally validated a sequential PDA prediction model based on clinical information routinely available at the initial appearance of IFG. If externally validated, this model could significantly extend our ability to detect PDAs at an earlier stage.

Among the intricately coupled thermoelectric parameters, carrier effective mass (m*) and carrier density (n) are two key parameters to determine the electrical transport properties. To enhance the broad-temperature thermoelectric performance in n-type PbSe, this work elaborately optimizes its power factor with the intrinsically proportional relationship between carrier effective mass and carrier density, n ∼ (m*)3/2. Herein, the carrier effective mass in n-type PbSe is first optimized with Sn alloying and undergoes a decrease from ∼0.34me in PbSe to ∼0.25me in Pb0.77Sn0.23Se because of band sharpening. This reduced carrier effective mass contributes to an obvious enhancement of carrier mobility, thereby boosting the maximum power factor from ∼16.8 μW cm−1 K−2 in PbSe to ∼20.5 μW cm−1 K−2 in Pb0.85Sn0.15Se. Moreover, to match the reduced carrier effective mass in n-type Pb0.85Sn0.15Se, its carrier density is well tuned with Ag counter doping, which further facilitates a high average power factor in the whole working temperature range. The average power factor in Pb0.85Sn0.15Se systems increases from ∼15.6 μW cm−1 K−2 with a carrier density of ∼6.21 × 1019 cm−3 to ∼17.6 μW cm−1 K−2 with a carrier density of ∼2.12 × 1019 cm−3 at 300–873 K. Finally, an average ZT (ZTave) of ∼0.95 is achieved in the n-type Pb0.85Sn0.15Se sample at 300–873 K, and the sample outperforms most other n-type PbSe-based thermoelectric materials.

Electro-optic modulation with a constant modulation depth plays important roles in quantum metrology, microwave photonics, and optical precision measurement and sensing, etc. To compensate the continuous drift of the half-wave voltage and maintain the modulation depth, we incidentally generated a reference laser to make intermedia optical beatings with the carrier and +1st sideband, and tightly locked the carrier to sideband ratio by extracting the relative microwave power of those intermedia beat signals using a home-made electronic control module. Experiments of the short-term test for locking bandwidth, the anti-jamming capability, and the long-term stability were demonstrated. As is verified that, the locking bandwidth was estimated up to tens of kHz, and the anti-jamming capability was confirmed despite of a strong hair-dryer agitation. The long-term stability for the modulation depth stabilization showed that the peak-to-peak relative stability for 150-minute was 5.67 × 10−6, and the Allan deviation reached a minimum of 2.19 × 10−7 at an averaging time of 400 s, which is improved by more than four orders of magnitude compared with the open-loop regime. We believe the reported method as well as the designed module is versatile and potential to precision measurement and sensing applications badly requiring a stable modulation depth, such as atom interferometry, optical interferometry and lidar detection.

In recent years, deep learning technology has been widely used and developed. In natural language processing tasks, pre-training models have been more widely used. Whether it is sentence extraction or sentiment analysis of text, the pre-training model plays a very important role. The use of a large-scale corpus for unsupervised pre-training of models has proven to be an excellent and effective way to provide models. This article summarizes the existing pre-training models and sorts out the improved models and processing methods of the relatively new pre-training models, and finally summarizes the challenges and prospects of the current pre-training models.

Conversion therapy for gastric cancer (GC) has been the subject of much recent attention. GC patients with bulky lymph node metastases were usually considered oncologically unresectable and surgery could be challenging and tumor shrinkage may serve to facilitate resection. Previous studies reported satisfactory survival data were obtained in the series of neoadjuvant studies with bulky N disease. However, the evidence of combining neoadjuvant chemotherapy with targeted therapy for patients with bulky N disease is inadequate. We report a 52-year-old man who was diagnosed with unresectable GC with bulky lymph node metastases after endoscopic biopsy and abdominal enhanced computed tomography (CT) examination. Histopathology confirmed poorly differentiated adenocarcinoma at the junction of the antrum and the body of the stomach. Abdominal enhanced CT showed marked thickening of more than two-thirds of the stomach wall and multiple enlarged and coalesced perigastric and extragastric lymph nodes. The clinical staging was cT4aN3M0. The patient was administered two cycles of S-1 and oxaliplatin (SOX regimen) plus apatinib. Repeat abdominal enhanced CT demonstrated decrease in stomach wall thickness and in the sizes of all perigastric and extragastric lymph nodes (

Objectives: The most common type of noninvasive fungal rhinosinusitis is fungus ball (FB), which usually involves a solitary paranasal sinus. Multiple fungus balls (MFBs) are rarely reported in literature. The purpose of this study was to analyze and compare the clinical features of MFBs and solitary fungus ball (SFB). Methods: We retrospectively investigated consecutive cases of FB between 2001 and 2018 and compared the clinical records of SFB with MFBs with respect to demographics, clinical features, location, radiological findings, and operative outcome. Results: A total of 440 SFB and 43 MFBs cases were included in the study. The mean age was 55.3 ± 13.3 and 60.6 ± 10.9 years, respectively ( P = .011). The incidence of MFBs obviously increased from 2001 to 2018. The clinical symptoms and laboratory examination were similar. On computed tomography images, complete opacification, septal deviation, Haller cells, and obstruction of ostiomeatal complex were more common ( P < .05). The incidence of SFB on the left and right sides was similar, while MFBs were seen to involve both sides in 74.4%. Conclusions: Compared with SFB, MFBs showed some special characteristics. The MFBs affected older patients showed wide range of lesions and complex anatomy. Surgical technique is very important. Much more attention should be paid to this not so uncommon disease during the perioperative period.

Background The characteristics of prostate cancer on autopsy and early-stage prostate cancer are identical. Using autopsy specimens, we analysed prostate cancer characteristics and clarified the spatial distributions of lesions. Method We obtained prostate specimens from Chinese donors without a prostate cancer diagnosis and analyzed prostate cancer pathological characteristics on autopsy by whole-mount sampling. We determined the distributions of lesions in horizontal and vertical dimensions. The horizontal dimension included four horizontal quadrants (left-anterior, left-posterior, right-anterior, and right-posterior quadrants), the peripheral zone, and the transition zone. Result The overall positive rate of prostate cancer among 113 specimens was 35.4%. There were 73 lesions in 40 prostates with prostate cancer. The positive rates of lesions in the left-anterior, left-posterior, right-anterior, and right-posterior quadrants were 24.7% (18/73), 27.4% (20/73), 26.0% (19/73), and 21.9% (16/73), respectively. The positive rate of prostate cancer was 74% in the areas between the apex above 0.5-0.8 cm and the middle slice. There were 22 (30.1%) and 51 (69.9%) lesions in the superior and inferior half of the prostate. There were no significant differences in the median volume and Gleason grade group between the superior and inferior half (p = .876 and p = .228). Conclusion In the horizontal dimension, the positive rate of prostate cancer was consistent in the four quadrants. Prostate cancer mainly originated from the areas between the apex above 0.5-0.8 cm and the middle slice. Compared with the superior half, the inferior half of the prostate had a higher positive rate but the same lesion characteristics.

The indispensability of visual working memory (VWM) in human daily life suggests its importance in higher cognitive functions and neurological diseases. However, despite the extensive research efforts, most findings on the neural basis of VWM are limited to a unimodal context (either structure or function) and have low generalization. To address the above issues, this study proposed the usage of multimodal neuroimaging in combination with machine learning to reveal the neural mechanism of VWM across a large cohort (N = 547). Specifically, multimodal magnetic resonance imaging features extracted from voxel‐wise amplitude of low‐frequency fluctuations, gray matter volume, and fractional anisotropy were used to build an individual VWM capacity prediction model through a machine learning pipeline, including the steps of feature selection, relevance vector regression, cross‐validation, and model fusion. The resulting model exhibited promising predictive performance on VWM (r = .402, p, We used multimodal neuroimaging in combination with machine learning to reveal the neural mechanism of visual working memory (VWM) across a large cohort. The resulting model exhibited promising predictive performance on VWM (r = .402, p

A nerve stimulation-guided lumbar plexus block is a well-established technique. It is not clear whether ultrasound guidance has additional value for this deep block technique. This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space (PMTS-ITS) approach in combination with nerve stimulation reduces the onset time of a complete sensory block. Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score (UVS) of ≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group (group U-N) or nerve stimulation group (group N) in this prospective, randomized, parallel-group, active-controlled study. The primary outcome was the onset time of a complete sensory block. The results showed that the onset time of a complete sensory block to pinprick and cold was 10 (10-40) min and 10 (10-40) min in group U-N, respectively, and 30 (10-40) min and 20 (10-40) min in group N (P=0.005, P=0.004), respectively. The performance time was 658±87 s in group U-N and 528±97 s in group N (P 0.05). In conclusion, ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS ≥10. Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

A fully integrated passive ultrahigh-frequency (UHF) RF identification (RFID) tag integrated circuit (IC) based on Chinese UHF RFID standard (GJB 7377.1) is proposed. An optimized voltage multiplier with threshold compensation and leakage current suppression is designed to improve the RF-DC power conversion efficiency, which is more than 58% for different load current. A system clock constraint condition and proposed digital baseband (BB) algorithm instead of clock calibration is introduced to ensure correct demodulation of the forward link from reader to tag and back link frequency (BLF) tolerance from tag to reader. Moreover, a 2Kb multi-time programmable (MTP) non-volatile memory (NVM) in standard CMOS process without any additional masks and process modification is designed and implemented to significantly save the manufacture cost of the chip. The proposed RFID tag IC is fabricated using a $0.13-\mu \text{m}$ one-poly-five-metal (1P5M) standard CMOS process with an area of $620\times 660\,\,\mu \text{m}^{2}$ and a power consumption of 4.8 $\mu \text{W}$ and 11.5 $\mu \text{W}$ for reading and writing operations, respectively. The tag with antenna gain of 2 dBi shows successful reading detection at distances up to 17 m in the case of 4 W Equivalent Isotropically Radiated Power (EIRP) from reader.

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system. At present, surgery is the most important treatment strategy. After esophagectomy and gastric esophagoplasty, the patients are prone to regurgitation. However, these patients currently do not receive much attention, especially from anesthesiologists. CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy. The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior. Although the patient had fasted for > 17 h, unexpected aspiration still occurred during induction of general anesthesia. Throughout the operation, oxygen saturation was 98%-100%, but the airway pressure was high (35 cmH2O at double lung ventilation). The patient was sent to the intensive care unit after surgery. Bedside chest radiography was performed, which showed exudative lesions in both lungs compared with the preoperative image. After surgery, antibiotics were given to prevent lung infection. On day 2 in the intensive care unit, the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia. CONCLUSION After esophagectomy, patients are prone to regurgitation. We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

Digoxin affects several cellular pathways involved in tumorigenesis. We sought to determine the association between digoxin use and pancreatic cancer risk and survival. A nested case–control study using The Health Improvement Network (THIN), a population-representative database from the United Kingdom (UK). Cases included all individuals with incident diagnosis of pancreatic cancer. Each case was matched to up to four controls using incidence density sampling based on age, sex, practice site, calendar time, and duration of follow-up. Exposure of interest was digoxin therapy before cancer diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between digoxin use and pancreatic cancer risk were estimated using conditional logistic regression. We further conducted a retrospective cohort study among pancreatic cancer cases using Cox regression model in order to evaluate the association between digoxin use and overall survival. We identified 4,113 cases with incident pancreatic cancer and 16,072 matched controls. The adjusted OR for diagnosis of pancreatic cancer among active digoxin users was 1.41 (95% CI 1.16–1.72). The risk did not change among active users with duration of therapy of more than 1 year (adjusted OR of 1.39, 95% CI 1.11–1.76). Digoxin was not associated with change in overall survival with an adjusted hazard ratio of 0.97 (95% CI 0.81–1.18). Digoxin use was associated with modestly increased pancreatic cancer risk but did not affect overall survival.

Cancer immune plays a critical role in cancer progression. Tumour immunology and immunotherapy are one of the exciting areas in bladder cancer research. In this study, we aimed to develop an immune‐related gene signature to improve the prognostic prediction of bladder cancer. Firstly, we identified 392 differentially expressed immune‐related genes (IRGs) based on TCGA and ImmPort databases. Functional enrichment analysis revealed that these genes were enriched in inflammatory and immune‐related pathways, including in ‘regulation of signaling receptor activity’, ‘cytokine‐cytokine receptor interaction’ and ‘GPCR ligand binding’. Then, we separated all samples in TCGA data set into the training cohort and the testing cohort in a ratio of 3:1 randomly. Data set GSE13507 was set as the validation cohort. We constructed a prognostic six‐IRG signature with LASSO Cox regression in the training cohort, including AHNAK, OAS1, APOBEC3H, SCG2, CTSE and KIR2DS4. Six IRGs reflected the microenvironment of bladder cancer, especially immune cell infiltration. The prognostic value of six‐IRG signature was further validated in the testing cohort and the validation cohort. The results of multivariable Cox regression and subgroup analysis revealed that six‐IRG signature was a clinically independent prognostic factor for bladder cancer patients. Further, we constructed a nomogram based on six‐IRG signature and other clinicopathological risk factors, and it performed well in predict patients' survival. Finally, we found six‐IRG signature showed significant difference in different molecular subtypes of bladder cancer. In conclusions, our research provided a novel immune‐related gene signature to estimate prognosis for patients' survival with bladder cancer.

In this paper, a series of high performance near-infrared reflective pigments based on Bi3YO6 doped with Fe2O3 and Tb4O7 were prepared by high-temperature calcination method. The pigments were characterized by some analytic techniques, such as XRD, Particle size analyzer, SEM, EDS, UV–vis–NIR spectrophotometer, CIE L*a*b* (1976) color space and infrared thermal imaging. Experimental results showed that the Fe2O3 doping in Bi3YO6 could change the color from bright yellow to ochre red. The substitution of Tb (IV)-doped pigments changed the color to dark orange. The doping of Fe (III) and Tb (IV) contributed to enriching the color diversities of pigments. Among the synthesized pigments, Bi3-xFexYO6 and Bi3Y1-xTbxO6+δ displayed a disordered defective fluorite-type structure. The effect of doping Fe (III) and Tb (IV) reduced the near-infrared reflectance of the pigment. Excepting for Bi3-xFexYO6 (x = 0.8), the near infrared reflectance of some other pigments were higher than the China National standard (CNs). Chemical resistance tests showed that the pigments had excellent acid and alkali resistance. Finally, the application practical of traditional iron oxide yellow pigment and three prepared pigments, i.e., Bi3YO6, Bi3-xFexYO6 (x = 0.4) and Bi3Y1-xTbxO6+δ (x = 0.05) were studied and compared by infrared thermal imaging. The test results showed that Bi3YO6 still had a strong near-infrared reflection effect after being painted. Compared with traditional iron yellow pigment, Bi3YO6 could reduce the surface temperature of galvanized sheet by 20 °C under the illumination of infrared light. The series of Fe (III) and Tb (IV) doped pigments prepared in this paper have revealed some promising application values.

Background Current guidelines recommend neoadjuvant chemotherapy in patients with locoregional gastric adenocarcinoma. Patients diagnosed with early stage gastric adenocarcinoma are usually managed with upfront surgical intervention. However, pathologic staging in a subset of these clinically staged patients identifies more advanced locoregional disease requiring adjuvant treatment. Therefore, identifying these patients prior to surgical intervention is critical to ensure employment of the appropriate treatment paradigm. The aim of the current study was to define patient characteristics associated with clinical understaging in early gastric cancer. Methods Using the National Cancer Database (2004–2014) we identified 3,892 individuals with clinical T1N0 gastric adenocarcinoma who underwent upfront definitive surgery, had negative surgical margins, and did not receive preoperative chemotherapy or radiotherapy. Patient characteristics were compared between those with pathologic stage T1N0 disease and those who were upstaged upon surgery. Results Twenty‐seven percent of clinical T1N0 gastric adenocarcinomas had a change in stage because of pathologically defined ≥T2 disease or positive lymph nodes. Individuals who were upstaged had a higher tumor grade compared with those with pathologic stage T1N0 disease. Specifically, 41.9% (530/1,264) of individuals with a poorly differentiated tumor were upstaged, compared with only 10.7% (70/656) with a well‐differentiated tumor. Approximately 75% of cases involved upstaging because of T misclassification. The highest percentage of upstaging was shown for tumors located at the fundus and body of the stomach. Conclusion Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy. Implications for Practice Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy., This article evaluates the frequency of upstaging following surgery among cT1N0 gastric cancer and defines the corresponding patient characteristics, with the goal of better identifying those patients who require preoperative chemotherapy.