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BACKGROUND Percutaneous transhepatic cholangiography drainage (PTCD) effectively treats biliary obstruction. However, patients must maintain the drainage tube after hospital discharge, which may interfere with daily life and work, potentially causing psychological distress. Postoperative rehabilitation is crucial, and strengthened nursing interventions can shorten recovery time. AIM The aim was to evaluate an inpatient model to shorten rehabilitation duration and improve quality of life after PTCD. METHODS A total of 118 patients with malignant obstructive jaundice who were admitted to our hospital between May 2018 and January 2021 were included and divided into observational (with therapy) and control (no therapy) groups of 59 each. RESULTS The observational group had fewer hospitalization days than the control group. The complication, the PTCD fixed-tube prolapse, and tube-related admission rates within 3 mo after PTCD were significantly lower in the observation group than in the control group (P < 0.05). The fatigue, pain, nausea, vomiting, pruritus, emaciation, and fever scores after PTCD decreased in both groups compared with the scores before PTCD (P < 0.05). The quality of life scores after the intervention were higher in the observation than in the control group (P < 0.05). CONCLUSION The model promoted rehabilitation after PTCD, reduced post-PTCD complications, and the tube-related admissions in the 3 mo after the procedure, and improved the quality of life.

With the continuous popularization of smart devices, Spatial Crowdsourcing(SC) came into being a novel paradigm of collecting smart sensing. As a core issue, the task assignment aims to arrange tasks to suitable workers for different objectives. However, most existing approaches matched tasks and workers under the premise of already known their number, while the arrival information of crowdsourcing participants cannot be understood in advance for their dynamically appearing. We fill this gap by proposing a Dynamic Task Assignment Framework based on Prediction and Adaptive Batching (DTAF-PAB). Specifically, we first predict the number of coming tasks and/or workers by a deep learning model Gated Recurrent Unit (GRU). Then, the adaptive batching strategies, based on Deep Q Network (DQN) and Double DQN (DDQN), are investigated to address the problem of adaptive and dynamic batching for task assignment. We design a deep reinforcement learning (DRL)-based algorithm to improve the overall benefit of the assignment. Finally, we use real-world datasets to evaluate the competitiveness of DTAF-PAB, and the experimental results show that the proposed framework is superior to other existing methods in terms of both predictive performance and crowdsourcing platform benefit.

The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). A total of 206 patients with type A AAD who had received surgical treatment were enrolled in this study. Patients were divided into two groups: the death group (28 patients who died during hospitalization) and the survival group (178 patients). Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) were compared between the two groups. Univariable and multivariable logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of these indices in the postoperative in-hospital mortality of the patients. Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariable logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for postoperative in-hospital mortality of patients with type A AAD. ROC curve analysis indicated that application of combining FIB and PLT could improve accuracy in prediction of postoperative in-hospital mortality in patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. The combination of FIB and PLT may improve the accuracy of clinical prognostic assessment.

Background Quadricuspid aortic valve (QAV) is a rare congenital heart defect usually accompanied with different hemodynamic abnormalities. Due to the rarity of QAV, treatment and prognosis of QAV patients with aortic regurgitation still remain challenging. We here present the first case of a patient with severe QAV regurgitation who underwent successful treatment and performed favorable prognosis with transapical aortic valve implantation (TAVI) using J-Valve system. Case presentation A 62-year-old man experienced intermittent palpitation, shortness of breath and chest pain. Echocardiography revealed congenital QAV with massive aortic regurgitation and mild aortic stenosis, left ventricular enlargement. Aortic valve replacement was successfully performed with TAVI using J-Valve system. The postoperation and follow-up was uneventful. Conclusion TAVI using J-Valve system has emerged as a new high success rate method for treatment of patients with simple non-calcified aortic valve insufficiency.

Rationale: Growth differentiation factor-8 (GDF-8), also known as myostatin, belongs to the transforming growth factor-beta (TGF-β) superfamily. GDF-8 is expressed in the ovary and regulates various ovarian functions. Ovarian hyperstimulation syndrome (OHSS) is one of the most serious disorders during in vitro fertilization treatment. Aromatase, encoded by the CYP19A1 gene, is the enzyme that catalyzes the final step in estradiol (E2) biosynthesis. It has been demonstrated that high serum E2 levels are associated with the development of OHSS. However, the effects of GDF-8 on aromatase expression and its roles in the pathogenesis of OHSS remain unclear. Methods: The effect of GDF-8 on aromatase expression and the underlying mechanisms were explored by a series of in vitro experiments in primary human granulosa-lutein (hGL) and KGN cells. Rat OHSS model and human follicular fluid samples were used to examine the roles of the GDF-8 system in the pathogenesis of OHSS. Results: We demonstrate that GDF-8 stimulates aromatase expression and E2 production in hGL and KGN cells. In addition, TGF-β type I receptor ALK5-mediated SMAD2/3 signaling is required for GDF-8-induced aromatase expression and E2 production. Using a rat OHSS model, we show that the aromatase and GDF-8 levels are upregulated in the ovaries of OHSS rats. Blocking the function of ALK5 by the administration of its inhibitor, SB431542, alleviates OHSS symptoms and the upregulation of aromatase. Clinical results reveal that the protein levels of GDF-8 are upregulated in the follicular fluid of OHSS patients. Moreover, the expression of GDF-8 is increased in hGL cells of OHSS patients. Conclusions: This study helps to elucidate the mechanisms mediating the expression of aromatase in human granulosa cells, which may lead to the development of alternative therapeutic approaches for OHSS.

Tianyu Meng,1,* Jie Wang,2,3,* Manyun Tang,2 Shangyu Liu,4 Ligang Ding,4 Yang Yan5 1Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China; 2Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China; 3Department of Hematology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China; 4Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China; 5Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ligang DingClinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of ChinaEmail dlgang101@163.comYang YanDepartment of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an, Shaanxi, 710061, People’s Republic of ChinaTel +86-2985323869Fax +86-2985323869Email yangyan3@xjtu.edu.cnBackground: Diabetes mellitus (DM) has been demonstrated to be linked to atrial fibrillation (AF). However, the underlying mechanisms of the DM-associated increase in AF susceptibility and the potential effects of DM on atrial remodeling remain unclear.Methods and Results: Twenty-five C57BL/6 mice were randomly assigned to the normal/control group (Con, n=10) and model group (n=15). Mice in the model group were administered a high-fat diet combined with multiple injections of low-dose streptozocin (STZ) (35 mg/kg). Eleven mice were ultimately included in DM group. Left atrial tissue structural and inflammatory alterations were assessed. In our study, the atrial weights of DM mice were markedly heavier than those of mice in the Con group. DM mice exhibited significantly increased fasting plasma glucose, fasting insulin, and dyslipidaemia. Furthermore, H&E and Masson’s staining revealed broadened interstitial spaces, myocyte disarray and atrial fibrosis in DM mice. The expression levels of the atrial inflammation-associated factor nuclear factor κB (NF-κB) and its pathway were significantly altered in the atria of DM mice.Conclusion: DM could induce atrial structural remodeling and inflammation in mice.Keywords: diabetes mellitus, inflammation, atrial remodeling, PARP-1, NF-κB

Background Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guidewire fragments, intravascular clipping of the guidewire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions. Case presentation A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful. Conclusion It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.

STUDY OBJECTIVES: Minimal focus has been placed on variations in health care delivery for obstructive sleep apnea (OSA). This study compared positive airway pressure usage in developing countries (Brazil and Mexico) vs. a developed country (United States) and investigated the impact of a patient engagement tool (myAir; ResMed, San Diego, CA) on adherence. METHODS: Deidentified data from the AirView database (ResMed) for patients receiving positive airway pressure therapy with wirelessly connected Air10 (AirSense and AirCurve) devices in Brazil, Mexico, and the United States were analyzed. Adherence was defined using US Center for Medicare and Medicaid Services (CMS) criteria (usage ≥ 4 h/night on ≥ 70% of nights in the first 90 days). RESULTS: The analysis included 4,181,490 patients (Brazil: 31,672; Mexico 16,934; United States: 4,132,884). CMS adherence over 90 days was slightly lower in Latin America vs. the United States (Brazil: 71.7%; Mexico: 66.4%; United States: 74.0%). Significantly fewer patients were using the patient engagement tool in Brazil (8.1%) and Mexico (2.8%) vs. the United States (26%; both P < .001). Patients registered to use an engagement tool had a higher rate of CMS adherence and were twice as likely to achieve CMS adherence. Average daily usage and days with usage > 4 hours in the first week were the strongest predictors of CMS adherence. Across all countries, > 80% of patients meeting CMS criteria at 3 months were still using positive airway pressure therapy at 1 year, with 1-year adherences rates of > 75%. CONCLUSIONS: Short-term and long-term positive airway pressure adherence rates in Brazil and Mexico were similar to those achieved in the United States. Patients who registered to use an engagement tool consistently had better adherence than those who did not. CITATION: Drager LF, Malhotra A, Yan Y, et al. Adherence with positive airway pressure therapy for obstructive sleep apnea in developing vs developed countries: a big data study. J Clin Sleep Med. 2021;17(4):703–709.

Bone age assessment using hand-wrist X-ray images is fundamental when diagnosing growth disorders of a child or providing a more patient-specific treatment. However, as clinical procedures are a subjective assessment, the accuracy depends highly on the doctor’s experience. Motivated by this, a deep learning-based computer-aided diagnosis method was proposed for performing bone age assessment. Inspired by clinical approaches and aimed to reduce expensive manual annotations, informative regions localization based on a complete unsupervised learning method was firstly performed and an image-processing pipeline was proposed. Subsequently, an image model with pre-trained weights as a backbone was utilized to enhance the reliability of prediction. The prediction head was implemented by a Multiple Layer Perceptron with one hidden layer. In compliance with clinical studies, gender information was an additional input to the prediction head by embedded into the feature vector calculated from the backbone model. After the experimental comparison study, the best results showed a mean absolute error of 6.2 months on the public RSNA dataset and 5.1 months on the additional dataset using MobileNetV3 as the backbone.

The low-voltage compact gyrotron is suitable for industrial applications. However, the beam-wave interaction efficiency is low in conventional low-voltage gyrotron. To improve the whole tube efficiency, a compact depressed collector is introduced in developing a 75 GHz low-voltage compact gyrotron. The compact depressed collector is directly connected to the output waveguide. It is grounded and isolated with the cavity by a ceramic ring which is easy to be connected with the application system. The design of the original tube electron beam voltage and electron beam current are 10 kV and 1.2 A. In the particle-in-cell (PIC) simulation, the operating mode is TE0,1 and the generated power is 1.2 kW operated at the frequency of 75.5 GHz, which corresponds to an electron efficiency of 10%. When the depressed collector is performed and the electron reflux is under 5%, the efficiency of the whole tube can reach 30%, and when the reflux rate is controlled at about 15%, the efficiency of the whole tube can reach 50%. The dissipation power would be sufficiently reduced.

Exponential sums over Galois rings have many applications in coding theory, cryptography and algebraic combinatorics. In this article, we employ additive characters and multiplicative characters over Galois rings to present two classes of codebooks, and prove that these codebooks asymptotically achieve the Welch bound. In addition, the resulting codebooks have new parameters.

Background Rosacea and cardiovascular diseases (CVD) are chronic inflammatory disorders. While CVD is the leading cause of mortality globally, increasing evidence indicates that CVD prevalence could be higher among patients with rosacea. Aims This review aimed to determine the association between the prevalence of CVD and rosacea. Patients/methods A systematic review of observational studies with controls available in MEDLINE, EMBASE, PubMed, Cochrane, and Web of Science databases was conducted. We performed a pooled meta-analysis using random-effects weighting. Overall, 11 studies met the inclusion criteria, which indicated increased odds for at least one risk factor of CVD, including diabetes, high blood pressure, or dyslipidemia. Results The pooled meta-analysis indicated an association of rosacea with higher odds of insulin resistance or diabetes (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.97-1.45), high systolic blood pressure (OR, 1.96; 95% CI, 1.35-2.84), dyslipidemia (OR, 1.50; 95% CI, 1.19-1.88), and CVD (OR, 6.65; 95% CI, 2.80-15.76). No publication bias was detected. The effect of confounding factors due to overlapping symptoms and lack of individual-level data were limitations of this review. Conclusion Patients with rosacea have a high risk of CVD. However, further studies are warranted to confirm the association between rosacea and CVD.

In this paper, a quasi-optical mode converter for terahertz imaging is presented. This design is based on a 0.22 THz TE03 gyrotron oscillator. It includes a Vlasov launcher, an elliptical reflecto...

To ensure the normal operation of China Railway Express, the Inland Railway Container Center Station (IRCCS) needs to replenish the freight sources outside its attraction area. The homogenization of the China Railway Express route, overlapping of attraction area and chaotic transportation organization brings about disordered competition of freight. Based on the attraction area division of the IRCCS, this paper establishes a mixed integer programming model, with minimum transportation time, transportation cost and carbon emission as target. The simulated annealing algorithm is used to solve the problem, and the Harbin Railway Container Center Station is taken as an example to determine the freight collection mode, operating route and operation frequency of China Railway Express. The results show that: The transportation costs, time and carbon emissions have different degree of influence on China Railway Express operation plan, from the largest to the smallest, carbon emissions, transportation costs, time costs. Under different objective weights, the influence on the freight collection mode and transportation route is great, while the frequency impact is small.

Ovarian hyperstimulation syndrome (OHSS) is one of the most life-threatening and potentially fatal complications associated with controlled ovarian hyperstimulation (COH) during in vitro fertilization (IVF) treatment. Although the pathogenesis of OHSS remains unclear, elevated serum estradiol (E2) levels before human chorionic gonadotropin (hCG) administration are associated with the risk of OHSS. The pineal hormone melatonin and its receptors are expressed in human granulosa cells and have been shown to stimulate E2 production. However, the effect of melatonin on the expression of aromatase, an enzyme responsible for a key step in the biosynthesis of E2, in human granulosa cells remains to be determined. Here, we demonstrate that melatonin upregulates aromatase expression in primary cultured human granulosa-lutein (hGL) cells through the melatonin receptor-mediated PKA-CREB pathway. Using a mouse model of OHSS, we demonstrate that administration of the melatonin receptor inhibitor luzindole inhibits the development of OHSS. In addition, the expression of ovarian aromatase and serum E2 levels are upregulated in OHSS mice compared to control mice, but this upregulation is attenuated by inhibition of the function of melatonin. Moreover, clinical results reveal that aromatase expression levels are upregulated in hGL cells from OHSS patients. Melatonin and E2 levels in the follicular fluid are significantly higher in OHSS patients than in non-OHSS patients. Furthermore, melatonin levels are positively correlated with E2 levels in follicular fluid. This study helps to elucidate the mechanisms mediating the expression of aromatase in hGL cells and provides a potential mechanism explaining the high E2 levels in patients with OHSS., Reproductive medicine: Melatonin implicated in complication of assisted fertilization Blocking the activity of melatonin helps prevent female mice from developing swollen ovaries, a potentially life-threatening complication of assisted fertilization techniques. A research team from China’s First Affiliated Hospital of Zhengzhou University, led by Jung-Chien Cheng and Ying-Pu Sun, demonstrated that melatonin, a hormone found in the fluid that surrounds developing eggs, can induce ovarian cells to boost expression of aromatase. This enzyme is responsible for synthesizing estradiol, a hormone involved in female reproduction. Women whose ovaries became over-stimulated in response to fertility medications showed elevated levels of melatonin, aromatase and estradiol. Inhibiting the function of melatonin reduced symptoms in mouse models of ovarian hyperstimulation syndrome. The findings reveal an important role of melatonin in ovarian enlargement and point to new therapeutic strategies for women undergoing in vitro fertilization.

Background The coronavirus disease 2019 is currently of global concern. Cancer patients are advised to stay at home in case of potential infection, which may cause delays of routine diagnosis and necessary treatment. How colorectal surgeons should manage this during the epidemic remains a big challenge. Objective To evaluate the feasibility of routine colorectal surgery during coronavirus disease 2019 and to offer some Chinese recommendations to colorectal surgeons throughout the world. Methods A total of 166 patients receiving colorectal surgery from 20th December 2019 to 20th March 2020 at Department of General Surgery in Chinese General Hospital of People's Liberation Army were enrolled, and further divided into two groups based on before or after admission date of 20th January 2020. Clinicopathologic data such as hospital stay and economic data such as total costs were collected and analyzed retrospectively. Results Longer hospital stay, higher proportion of non‐local patients and more hospitalization cost were found in the post‐20 January group (special‐time group) (P

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which can induce multisystem disease. Human angiotensin-converting enzyme 2 (ACE2) widely expressing in arterial and venous endothelial cells and arterial smooth muscle cells has been identified as a functional receptor for SARS-CoV-2. Dysfunction of ACE2 leads to abnormal activation of the renin-angiotensin system and a systemic endotheliitis that may relate to abnormal coagulation and sepsis. Meanwhile, innate immune response and inflammation activation participate in dysfunctional coagulation. Previous research indicated that dysfunctional coagulation was one of the important risk factors accountable for a high risk of severe disease and death in patients with COVID-19. Understanding the possible mechanisms of dysfunctional coagulation and appropriate anticoagulation therapeutic strategies are important to prevent disease deterioration and reduce fatality rates during the ongoing COVID-19 pandemic.

Background Residual and recurrent stones remain one of the most important challenges of hepatolithiasis and are reported in 20 to 50% of patients treated for this condition. To date, the two most common surgical procedures performed for hepatolithiasis are choledochojejunostomy and T-tube drainage for biliary drainage. The goal of the present study was to evaluate the therapeutic safety and perioperative and long-term outcomes of choledochojejunostomy versus T-tube drainage for hepatolithiasis patients with sphincter of Oddi laxity (SOL). Methods/design In total, 210 patients who met the following eligibility criteria were included and were randomized to the choledochojejunostomy arm or T-tube drainage arm in a 1:1 ratio: (1) diagnosed with hepatolithiasis with SOL during surgery; (2) underwent foci removal, stone extraction and stricture correction during the operation; (3) provided written informed consent; (4) was willing to complete a 3-year follow-up; and (5) aged between 18 and 70 years. The primary efficacy endpoint of the trial will be the incidence of biliary complications (stone recurrence, biliary stricture, cholangitis) during the 3 years after surgery. The secondary outcomes will be the surgical, perioperative and long-term follow-up outcomes. Discussion This is a prospective, single-centre and randomized controlled two-group parallel trial designed to demonstrate which drainage method (Roux-en-Y hepaticojejunostomy or T-tube drainage) can better reduce biliary complications (stone recurrence, biliary stricture, cholangitis) in hepatolithiasis patients with SOL. Trial registration Clinical Trials.gov: NCT04218669. Registered on 6 January 2020.

The beam string structure (BSS) has been widely applied to public buildings (e.g. sports venues and exhibition centers) for its strong adaptability to architectural form and reasonable load bearing mechanism. However, most mathematical calculation methods for BSS are too complicated to be generally mastered by structural engineers, which limits the promotion and actual application. In this paper, two analytical calculation methods for the BSS are proposed based on displacement control objectives and work-energy principle. The computational formulas are then derived to calculate the member internal force and structural deformation. On this basis, the tension and static load tests and the finite element analytical method have been carried out to assess the calculation methods. The results of the tests and simulation are in good agreement with the analytical solution obtained by the computational formulas. Moreover, the formulas can be more appropriate with a greater beam span, proper rise–span and sag–span ratios (between 1/15 and 1/12) as well as more brace struts.

Older patients or patients with a reduced ovarian response have a low number of embryos, which limits the opportunity for embryo selection. However, for young patients undergoing frozen-thawed embryo transfer (ET), it remains unclear whether embryo stage affects pregnancy outcomes. In the present study, a total of 2952 patients undergoing their first frozen-thawed ET were divided into two groups: patients who had experienced one failed fresh ET (Group A) and patients who had not received fresh ET because of the high risk of ovarian hyperstimulation syndrome (OHSS) (Group B). Our results show that Group B patients had a significantly higher clinical pregnancy rate (CPR) and live birth rate (LBR) than Group A patients. However, Group A patients who underwent blastocyst-stage frozen-thawed ET had a significantly higher CPR and LBR and a lower ectopic pregnancy rate (ePR) than did those who underwent cleavage-stage frozen-thawed ET. In Group B, CPR, ePR, LBR and spontaneous abortion rate (sAR) were similar with blastocyst-stage and cleavage-stage frozen-thawed ET. These results suggest that blastocyst-stage frozen-thawed ET is more appropriate for young patients who had previously undergone one failed fresh ET cycle.

To generate high-power continuous-frequency tunable sub-terahertz radiation, a quasi-optical confocal waveguide is attempted as the interaction structure of a gyrotron. In experiments, a gyrotron operated in quasi-optical TE06 mode generated a maximum output power of 20 kW when driven by a 50-kV, 3.4-A gyrating electron beam, and achieved a continuous-frequency tuning band of 205.66–208.97 GHz by adjusting the operating magnetic field. The design, experimental and particle-in-cell simulation results of this gyrotron are presented.

BACKGROUND: To investigate the accuracy of using the Vesical Imaging-Reporting and Data System (VI-RADS) scoring system in prediction preoperative muscle invasion of bladder cancer. METHODS: The study retrospectively reviewed consecutive patients with bladder cancer who received multiparametric magnetic resonance imaging (MRI) between January 2017 and June 2019. Clinical and pathological parameters were collected. Bladder tumors were re-evaluated with 5-point VI-RADS scoring system by two experienced radiologists independently. The VI-RADS score was compared with postoperative pathology for each tumor for determining muscle invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each VI-RADS cutoff. RESULTS: A total of 126 patients were included in analysis, with 82 patients received transurethral resection of bladder tumor (TURBt) while 44 underwent radical cystectomy. Fifty patients were muscle-invasive bladder cancer and 76 were non-muscle invasive tumor confirmed pathologically. VI-RADS score was only predictive factor to muscle invasion in multivariate analysis. Setting VI-RADS score greater than or equal to 4 reached the best sensitivity and specificity of 94.00% and 92.11%, with PPV and NPV value of 88.68% and 95.89%. CONCLUSIONS: VI-RADS score system is a promising and effective modality in determining detrusor muscle invasion of bladder cancer preoperatively.

Sequences with high linear complexity have wide applications in cryptography. In this paper, a new class of quaternary sequences over F4 with period 2pmqn is constructed using generalized cyclotomic classes. Results show that the linear complexity of these sequences attains the maximum.

The output/input circuit is a core component in all high-power millimeter-wave (MMW) radiation sources, and its performance specifications and reliability directly impact upon the performance of the radiation source device. Central to achieving high power is the development of efficient mode converters. Here, we report on the development of a compact Ka -band circular TM01 to rectangular TE10 mode converter. The present mode converter adopts an all-metal waveguide structure and facilitates notable improvement in the system power capacity and is capable of realizing high-power propagation. The mode converter realizes effective mode conversion between high-order and fundamental modes, as well as allowing longitudinal and transverse transmission. Our simulation and empirical findings have shown mode purity ≥99.5% in the frequency range of 32.7–34.6 GHz, and the mode conversion efficiency is more than 96% at a center frequency of 32.9 GHz with a return loss ${S}_{{11}}$ of −19.3 dB. The bandwidth of the converter is 2.4 GHz with transmission coefficient ${S}_{{21}}\ge -{1}$ dB.

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious and iatrogenic complications that can occur during in vitro fertilization treatment. Although the pathogenesis of OHSS is not fully understood, vascular endothelial growth factor (VEGF) has been recognized as an important mediator of the development of OHSS. Transforming growth factor-beta-1 (TGF-β1) is known to regulate various ovarian functions. However, whether VEGF can be regulated by TGF-β1 in human granulosa cells has not been determined. In addition, the role of TGF-β1 in the pathogenesis of OHSS remains unknown. In the present study, we demonstrate that TGF-β1 stimulates VEGF expression in and secretion from both immortalized human granulosa-lutein (hGL) cells and primary hGL cells. Our results demonstrate that the SMAD2/3, ERK1/2, and p38 MAPK signaling pathways are involved in TGF-β1-induced VEGF expression and secretion. Using a mouse OHSS model, we show that the expression levels of TGF-β1 and VEGF are increased in the ovaries of OHSS mice. Blocking TGF-β1 signaling inhibits the development of OHSS by attenuating VEGF expression. Moreover, clinical results reveal that the protein levels of TGF-β1 and VEGF are increased in the follicular fluid of patients with OHSS, and that the levels of these two proteins in the follicular fluid are positively correlated. The results of this study help to elucidate the mechanisms by which VEGF expression is regulated in hGL cells, which could lead to the development of alternative therapeutic approaches for treating OHSS., Fertility treatment: Understanding ovarian hyperstimulation syndrome Insights into abnormal protein activity involved in ovarian hyperstimulation syndrome (OHSS) could inform future therapies. OHSS is a serious complication of fertility treatment where the body responds excessively to medication taken to help eggs grow, causing blood clots, pain, and even death. Scientists believe that high levels of the vascular endothelial growth factor (VEGF) protein trigger OHSS. Another protein involved in cell proliferation,transforming growth factor beta-1 (TGF-β1), may influence VEGF activity. Ying-Pu Sun and Jung-Chien Cheng at the First Affiliated Hospital of Zhengzhou University, Henan, China, and co-workers conducted experiments on human cell lines and OHSS mouse models. They found that TGF-β1 stimulates VEGF expression in human cells, and identified the associated signaling pathways. Both TGF-β1 and VEGF were increased in the ovaries of mice with OHSS, while blocking TGF-β1 halted OHSS progression.

Background: Circular RNAs (circRNAs) have been identified as essential regulators in a plethora of cancers. Nonetheless, the mechanistic functions of circRNAs in Renal Cell Carcinoma (RCC) remain largely unknown. Methods: In this study, we aimed to identify novel circRNAs that regulate RCC epithelial-mesenchymal transition (EMT), and to subsequently determine their regulatory mechanisms and clinical significance. Results: circPRRC2A was identified by circRNA microarray and validated by qRT-PCR. The role of circPRRC2A in RCC metastasis was evaluated both in vitro and in vivo. We found that increased expression of circPRRC2A is positively associated with advanced clinical stage and worse survivorship in RCC patients. Mechanistically, our results indicate that circPRRC2A prevents the degradation of TRPM3, a tissue-specific oncogene, mRNA by sponging miR-514a-5p and miR-6776-5p. Moreover, circPRRC2A promotes tumor EMT and aggressiveness in patients with RCC. Conclusions: These findings infer the exciting possibility that circPRRC2A may be exploited as a therapeutic and prognostic target for RCC patients.

To develop miniaturized and compact vacuum electron devices, new approaches to device manufacturing must be embraced. Here, a terahertz oscillator based on carbon nanotube (CNT) cold cathode is investigated through particle-in-cell (PIC) simulations. The studies show that the high-frequency (HF) field excited by the device can modulate the field emission current efficiently, with an output power of 4.6 W at 139.4 GHz obtained at an operating voltage of 2.9 kV and an initial emission current and current density of 15.8 mA and 7.65 A/cm 2 , respectively, and the efficiency is 10.0%.

Vascular endothelial growth factor (VEGF) plays important roles in the pathogenesis of polycystic ovary syndrome (PCOS). Several single nucleotide polymorphisms (SNP) of the VEGF gene have been identified and are associated with the aberrant secretion of VEGF protein. This meta-analysis aimed to evaluate the impact of the VEGF +405G>C (rs2010963), -460C>T (rs833061) and -2578A>C (rs699947) polymorphisms on PCOS susceptibility. A systematic search of the Embase, PubMed, Web of Science and Wanfang databases was carried out to identify relevant studies published before 19 July 2019. Seven eligible studies were included in this meta-analysis involving 1100 patients with PCOS and 1141 control individuals. The pooled analysis revealed no significant association between PCOS risk and the +405G>C (rs2010963), -460C>T (rs833061) or -2578A>C (rs699947) polymorphisms in women. Subgroup analysis by ethnicity indicated that Asian women carrying the VEGF +405C allele had a lower risk of PCOS (C versus G: odds ratio [OR] 0.731, 95% confidence interval [CI] 0.544-0.982, P C (rs2010963) may protect Asian women from PCOS.

Summary Background Positive airway pressure (PAP) has become a prominent treatment for children with sleep-disordered breathing. However, there are no large-scale studies to clarify whether PAP is well tolerated in children, and which factors are associated with better adherence to PAP therapy. In this study, we aimed to clarify adherence patterns of PAP therapy in a large paediatric population. Methods We did a cross-sectional big-data analysis in children from Oct 1, 2014, to Aug 1, 2018, using existing data derived from PAP devices uploaded nightly in the AirView cloud database. The AirView database is a usage tracking system available to all patients who are assigned PAP therapy, which requires consent from the patient or parent or guardian. All patients older than 4 years and younger than 18 years who used continuous or automated PAP devices were evaluated. Only patients living in the USA and enrolled with a single insurance company were included. If patients were participating in an engagement programme, programme onset must have been within 7 days of therapy onset. Our primary outcome was the proportion of patients who used PAP continuously over 90 days. The primary outcome was assessed in all patients who met the age inclusion criterion and had reliable age data available. Data on missing PAP use were imputed as zero, but data on other metrics were not imputed and excluded from analysis. Findings We used data recorded from Oct 1, 2014, to Aug 1, 2018. Of 40 140 children screened, 36 058 (89·8%) were US residents and 20 553 (90·1%) of them met the eligibility criteria and had accessible data (mean age 13·0 years [SD 3·7]). On the basis of 90 days of monitoring data, 12 699 (61·8%) patients continuously used PAP. Factors significantly associated with adherence included age group, residual apnoea–hypopnoea index, use and onset of patient engagement programmes, PAP pressure, and nightly median PAP mask leak, all over the 90-day study period. Interpretation To our knowledge, our study represents the largest analysis of children using PAP therapy to date. The findings suggest that adherence to PAP therapy is lower than in previous reports from adults. However, numerous actionable factors were associated with improvements in adherence and should be used strategically in clinical decision making to improve PAP adherence in children. Funding ResMed.

Heterojunction and element doping to couple light-harvesting semiconductors with catalytic materials have been widely employed for photoelectrochemical (PEC) water splitting. However, both suffer from serious electron–hole recombination, although the intimate interactions of the components is propitious for the charge transfer. In addition, the densely packed surface screens the active core from the catalytic media, leading to restricted performance. Here, a CoOx-decorated WO3 electrode (C-M2P-CoOx/WO3) was engineered via the organic linkage 3,3-diphosphonopropanate (C-M2P) for PEC water oxidation in a neutral medium. The C-M2P functions to control the colloidal CoOx size and bridges the catalytic center and the WO3 anode that allows an enhanced carrier density Nd to reach up to 1.9 × 1021 cm−3. Therefore, a strengthened charge separation was obtained and was further evidenced by the open circuit voltage decay (OCVD) measurements. The photovoltage decay revealed that the improved photoexcited electrons transfer could be attributed to the effective passivation of surface trap states. This brought about a generation of unexpected photocurrent as high as 3.5 mA cm−2, and an incident photon-to-electron conversion (IPCE) reaching up to 71% under a combination of visible-light irradiation and applied bias. Together with the dramatically shortened charge lifetime and a large transient photovoltage on the assembled electrode, a proposed exciton transfer mechanism was established.

Chinese prose has a long history. During this period, various famous artists have created many excellent works. Prose is a very important literature and art form which takes writing as creation and aesthetic object. In ancient Chinese literature, prose just like verses and parallel writings, does not pursue rhyme and sentence pattern. This is prose in a broad sense. And I would like to talk about prose in a narrow sense. In modern Chinese literature, prose refers to a literary genre which is in parallel with poetry, novel and drama. The major characteristics of prose are the sincere feeling and the beautiful language. After May 4th Movement, the social literature form was influenced by the New Culture Movement, a number of splendid writers in our country created a good deal of excellent works of prose. These are the precious treasures of Chinese literature, carrying the Chinese spirit and culture. But it is a pity that academics at home and abroad have done few researches on the modern Chinese essays translation, and the study about it is rare. The research on Chinese prose translation study, however, is far from enough. The Chinese prose translation study has lagged behind the other literary genre study all the time. Mr. Zhang's two series of "Modern Chinese Prose Selection" translations are his classic masterpieces. The selected works are all famous prose of young intellectuals after the May 4th Movement in China. The essays in them are of profound significance and full of characteristics of the times. So this article tries to explore Professor Zhang Peiji's translation art style in combination with prose selection. The fact that Professor Zhang has successfully translated also proves that the Chinese can make a great contribution in the Chinese-English translation career. The author also expects that Chinese scholars and translators will actively participate in the translation career, and to learn from each other's strengths in future translations. Really let Chinese culture go to the world as soon as possible.

Sinus of Valsalva aneurysm (SoVA) is an uncommon clinical entity, which is present in roughly 0.09% of the general population. The cause can be either acquired or congenital. Clinically SoVA of unruptured status are hardly captured even diagnosed due to atypical clinical presentations. Here we present a rare case of exertional angina pectoris and recurrent syncope due to an extrinsically compressed left coronary artery by a gaint SoVA in a 50-year-old female patient, which was successfully repaired by surgical exclusion and was still doing well after two years of follow-up. In a word, the clinical presentations, precise imaging and anatomy proof and effective surgical treatment make the case extremely rare and interesting.

Background: Guillain–Barré syndrome (GBS) is an acute immune-mediated disorder in the peripheral nervous system (PNS) characterized by symmetrical limb weakness, sensory disturbances, and clinically absent or decreased reflexes. Pantalgia and dysautonomia, including cardiovascular abnormalities, are common findings in the spectrum of GBS. It is usually challenging to distinguish GBS-related electrocardiogram (ECG) abnormities and chest pain from acute coronary syndrome (ACS) in patients with GBS due to the similar clinical symptom and ECG characteristics. Here, we present a case of GBS complicating ACS.Case Summary: A 37-year-old woman with a 2-month history of GBS presented to the emergency department due to pantalgia. The ECG showed a pattern of transitional T-wave inversion in the leads I, aVL, and V2 through V4 and shortly returned to normal, which appeared several times in a short time, but lab testing was unremarkable. Then, a further coronary computed tomography angiography (CTA) revealed the presence of critical stenosis of the left anterior descending artery, leading to the diagnosis of ACS. During the follow-up, she suffered from a non-ST-elevation myocardial infarction and accepted revascularization of the left anterior descending artery in the second week after discharge.Conclusion: Guillain–Barré syndrome could accompany chest pain and abnormalities on ECG. Meanwhile, it is essential to bear in mind that “GBS-related ECG abnormalities and chest pain” is a diagnosis of exclusion that can only be considered after excluding coronary artery disease, especially when concomitant chest pain, despite being a common presentation of pantalgia, occurs.

Objective To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation. Methods All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model. Results We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P Conclusion The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.

Objectives: The purpose of this study was to explore the value of the LIMAV measured by ultrasound before CABG in predicting the prognosis of patients after LIMA bypass grafting. Methods: 104 patients who underwent CABG with LIMA as the bridge vessel in the cardiovascular surgery department of our hospital between May 2018 and June 2019 were selected. All patients underwent transthoracic Doppler ultrasonography to measure LIMAV preoperatively. Intraoperatively, MGF and PI of the LIMA bridge were measured using TTFM. The primary endpoint event in this study was cardiac death within 18 months after surgery. Results: The Cox survival analysis showed that the MGF , the LIMAV and LVEF were risk factors for death after CABG . The cut-offs of MGF ,LIMAV and LVEF for the prediction of death after CABG were ≤14 ml/min [AUC: 0.830; Sensitivity:100%; Specificity: 65.6%], ≤60cm/s (AUC: 0.759; Sensitivity:65.5%; Specificity:85.3%) and ≤44%（AUC:0.724; Sensitivity:50%; Specificity: 88.5% ）respectively. Compared with the use of MGF, MGF+LIMAV, combination of the MGF+LIMAV+LVEF （AUC:0.929; Sensitivity:100%; Specificity: 81.1%）resulted in a stronger predictive value（MGF vs MGF+LIMAV+LVEF: p=0.02）. Conclusion: LIMAV measured by transthoracic ultrasound pre-operation combined with intraoperative MGF and LVEF may have a greater value in predicting patients' risk of cardiac death after CABG.

Background: The prognosis of patients with multiple myeloma (MM) is variable and partly depends on their cardiovascular status. The presence of arrhythmias can lead to worse outcomes. Therefore, this study aimed to evaluate the potential of heart rate (HR) and hypertension in predicating the outcomes of MM patients.Methods: This study retrospectively enrolled patients with MM between January 1, 2010, and December 31, 2018, at the First Affiliated Hospital of Xi'an Jiaotong University. The endpoint was all-cause mortality. The Pearson's chi-square test was used to assess the association between hypertension and outcomes. Univariate and multivariate Cox proportional hazards models were developed to evaluate the relationship between HR and all-cause mortality.Results: A total of 386 patients were included. The mean HR was 83.8 ± 23.1 beats per minute (bpm). Patients with HR >100 bpm had a higher all-cause mortality (79.4%, 50/63) than those with 60 ≤ HR ≤ 100 bpm (39.9%, 110/276) and p < 0.001). Subgroup analysis based on the International Staging System and sex revealed similar relationships (p < 0.01). When stratified by age, patients with HR >100 bpm had higher all-cause mortality than those with a lower HR when age was p < 0.001) but not >75 years. The proportion of patients with hypertension was 54.7% (211/386). However, hypertension was not associated with all-cause mortality in MM patients (χ2=1.729, p > 0.05). MM patients with HR >100 bpm had the highest all-cause mortality.Conclusions: The prognostic potential of HR may be useful in aiding risk stratification and promoting the management of these patients.

Motivated by transforming the high power output of confocal gyrotron into Gaussian beam, a broadband sub-terahertz quasi-optical mode converter for a high-order confocal waveguide mode is experimental tested and reported in this paper. Driven by a confocal mode generator with limited bandwidth, the measured scalar Gaussian contents are above 90% over a frequency range of 7.2 GHz. The low-power tested result is in good agreement with the simulation result.