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Objective We aimed to evaluate the long-term outcome of gamma knife radiosurgery (GKRS) for the treatment of sporadic cerebral cavernous malformation (CCM), especially the influence of lesion volume on annual hemorrhage rate (AHR) of CCM patients after GKRS. Methods Fifty-one single-lesion patients with a history of hemorrhage who underwent radiosurgery at our institution were included and divided into two groups (A and B), based on their lesion volume. Group A included 25 patients with lesion volumes > 1cm3, whereas Group B included 26 patients with lesion volumes ≤1 cm3. The clinical data of the patients were retrospectively analyzed. Results All patients were followed up for more than 4 years after GKRS. The calculated AHR before GKRS was 18.49% in Group A and 10.16% in Group B. The calculated AHR after GKRS was 5.43% and 0.99% for Groups A and B respectively. Significant differences in AHR after GKRS were identified between Group A and Group B (p = 0.011). Thirty-seven sporadic CCM patients (14 in Group A, 23 in Group B) experienced symptom improvement and significant differences in symptom improvement were observed between Group A and Group B (p=0.009). Conclusions GKRS decreased the risk of hemorrhage and was beneficial for symptomatic improvement in sporadic CCM patients with a history of hemorrhage. The long-term clinical outcomes for sporadic CCM patients with small lesion volumes (≤1 cm3) were better than those of sporadic CCM patients with large lesion volumes (>1 cm3).

Operating in today’s turbulent and competitive world marketplaces, manufacturers must find the best production scheme and delivery policy to meet timely client’s multiproduct requirements and minimize the total manufacturing-shipment expenses. This study proposes a two-stage delayed differentiation model for a multiproduct manufacturer-retailer coordinated supply chain featuring the adjustable-rate for making common parts and a multi-shipment policy for transporting finished goods. The aim is to help present-day manufacturers achieve their operational goals mentioned above. The mathematical techniques help us build a specific model to explicitly represent the problem and derive its overall operating expense. Then, the convexity of the total expense is verified by Hessian matrix equations. The differential calculus helps derive the cost-minimized fabrication-shipment decision. This study offers an example to demonstrate the applicability and capabilities of our proposed model numerically. The following crucial information has been made available to the managers to facilitate their operating decision makings: (1) the problem’s best fabrication-shipment policy; (2) the collective influence of various common part’s completion rates and values on the problem’s total expenses and optimal fabrication-shipment policy; (3) the impact of various adjustable-rates in stage one on utilization and stage one’s uptime; (4) the details of cost contributors to the problem; and (5) the collective impacts of critical features on the problem’s performance.

This paper presents the development of an intelligent bicycle system with automatic gear shifting based on the user’s physiological information and environment sensing. The sensor data are collected during the ride, uploaded to the cloud database, and analyzed using random forest to derive the appropriate riding requirement. Our proposed technique performs the automatic gear shifting operation using inexpensive sensor components and embedded system development boards. The gear shifting module is designed and installed as an external device for the off-the-shelf bicycle, without the need to dismantle or modify the body structure. A bicycle riding specific online management interface is developed for web access and administration. It allows the cloud data being displayed and let users acquire and understand their riding behaviors. The experiments and evaluation in the outdoor environment have demonstrated the feasibility of the proposed intelligent gear shifting system.

Objective By optimizing the extreme learning machine network with particle swarm optimization, we established a syndrome classification and prediction model for primary liver cancer (PLC), classified and predicted the syndrome diagnosis of medical record data for PLC and compared and analyzed the prediction results with different algorithms and the clinical diagnosis results. This paper provides modern technical support for clinical diagnosis and treatment, and improves the objectivity, accuracy and rigor of the classification of traditional Chinese medicine (TCM) syndromes. Methods From three top-level TCM hospitals in Nanchang, 10,602 electronic medical records from patients with PLC were collected, dating from January 2009 to May 2020. We removed the electronic medical records of 542 cases of syndromes and adopted the cross-validation method in the remaining 10,060 electronic medical records, which were randomly divided into a training set and a test set. Based on fuzzy mathematics theory, we quantified the syndrome-related factors of TCM symptoms and signs, and information from the TCM four diagnostic methods. Next, using an extreme learning machine network with particle swarm optimization, we constructed a neural network syndrome classification and prediction model that used “TCM symptoms + signs + tongue diagnosis information + pulse diagnosis information” as input, and PLC syndrome as output. This approach was used to mine the nonlinear relationship between clinical data in electronic medical records and different syndrome types. The accuracy rate of classification was used to compare this model to other machine learning classification models. Results The classification accuracy rate of the model developed here was 86.26%. The classification accuracy rates of models using support vector machine and Bayesian networks were 82.79% and 85.84%, respectively. The classification accuracy rates of the models for all syndromes in this paper were between 82.15% and 93.82%. Conclusion Compared with the case of data processed using traditional binary inputs, the experiment shows that the medical record data processed by fuzzy mathematics was more accurate, and closer to clinical findings. In addition, the model developed here was more refined, more accurate, and quicker than other classification models. This model provides reliable diagnosis for clinical treatment of PLC and a method to study of the rules of syndrome differentiation and treatment in TCM.

Clusters of water molecules have low ionization energies because of stabilization of charge from the dipole moment of surrounding molecules, and thus can form potential traps resulting in the undesirable photovoltaic performance in organic solar cells (OSCs). Herein, we demonstrated a solvent-water evaporation (SWE) strategy, which can effectively remove the water-induced traps that are omnipresent in photoactive layers, leading to a significant improvement in device performance. A higher power conversion efficiency of 17.10% and a better device photostability are achieved by using this SWE method, as compared with the untreated binary PM6:Y6 system (15.83%). We highlight the water-related traps as a limiting factor for carrier transport and extraction properties, and further reveal the good universality of the SWE strategy applied into OSCs. In addition, organic light-emitting diodes and organic field-effect transistors are investigated to demonstrate the applicability of this SWE approach. This strategy presents a major step forward for advancing the field of organic electronics.

Chia-Yu Huang,1– 3 Ming-Cheng Huang,3,4 Mao-Feng Sun,3,4 Cheng-Li Lin,5,6 Mei-Yao Wu,4,7 Wu-Chou Lin,3,8,&ast; Hung-Rong Yen3,4,9,10,&ast; 1Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan; 2School of Medicine, Tzu Chi University, Hualien, 970, Taiwan; 3Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan; 4Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan; 5Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan; 6College of Medicine, China Medical University, Taichung, 404, Taiwan; 7School of Post-baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan; 8Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 404, Taiwan; 9Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan; 10Chinese Medicine Research Center, China Medical University, Taichung, 404, Taiwan&ast;These authors contributed equally to this workCorrespondence: Hung-Rong Yen Tel +886-4-22053366 ext. 3313Email hungrongyen@mail.cmu.edu.twWu-Chou Lin Tel +886-4-22052121Email d0562@mail.cmuh.org.twBackground: Major depressive disorder is a significant public health concern, which often leads to loss of productivity, functional decline, and various complications. The aim of this study was to investigate the effectiveness of acupuncture in the risk reduction of coronary heart disease (CHD) in patients with depression.Methods: We enrolled patients diagnosed with depression between January 1, 1997, and December 31, 2010, through the Taiwanese National Health Insurance Research Database (NHIRD). Propensity score was used to match equal numbers (n=14,647) of acupuncture cohort and no-acupuncture cohort based on characteristics including sex, age, baseline comorbidity and medication. Patients were followed up until December 31, 2013, or withdrawn from the NHIRD. The Cox regression model was used to compare the hazard ratios (HRs) of CHD in the two cohorts.Results: The basic characteristics of the two groups were similar. A lower cumulative incidence of CHD was noted in the acupuncture cohort (Log rank test, p < 0.001). Over time, 1626 patients in the acupuncture cohort (21.05 per 1000 person-years) and 2412 patients in the no-acupuncture cohort (39.84 per 1000 person-years) developed CHD (adjusted HR=0.50, 95% CI 0.47– 0.53). The decreased CHD incidence was independent of age, sex, comorbidities, and medications used. The cumulative incidence of CHD was significantly lower in the acupuncture cohort than in the no-acupuncture cohort (Log rank test, p< 0.001).Conclusion: The results provided a real-world evidence that acupuncture may have beneficial effect on CHD risk reduction in patients with depression.Keywords: acupuncture, depression, coronary heart disease, National Health Insurance Research Database, real-world evidence

Objective To study the relationship between DNA double-strand break (DSB) repair gene mutations and the risk of papillary thyroid microcarcinoma (PTMC). Methods One hundred patients with PTMC or benign thyroid nodules (BTNs) at Henan Cancer Hospital were retrospectively analyzed. The DSB repair capacity of peripheral blood T lymphocytes in the two groups was assessed by flow cytometry. Data were compared using Student’s t-test to evaluate the relationship between DSB repair capacity and the risk of PTMC. Factors influencing DSB repair capacity were analyzed by multivariate logistic regression analysis. The relationship between PTMC and DSB repair capacity was analyzed by univariate analysis. Targeted next-generation DNA sequencing was applied to screen and analyze DSB repair genes related to PTMC. Results The DSB repair capacity was 31.30% in the PTMC group and 44.40% in the BTN group, with that of the former being significantly lower (P OR = 3.642; 95% CI 1.484–8.935, P = 0.020). Moreover, univariate analysis showed that a reduction in DSB repair capacity was a risk factor for PTMC(OR = 2.333; 95% CI 1.027–5.300, P = 0.043).Targeted next-generation DNA sequencing was performed on the DSB repair genes discovered, and those that were mutated in association with PTMC were Rad50 and FANCA; Rad51 mutations were related to BTN. Conclusion Radiation exposure is positively associated with induced DSB repair gene mutations, which may cause a reduced capacity for DSB repair and eventually lead to PTMC.

This study considers a multi-item production lot-size problem incorporating postponement, an external source for common parts, and an adjustable-rate for end products. Dealing with product variety, timely requirements, and limited in-house capacity has led production managers to seek manufacturing schemes and utilization-reduction strategies that can help them meet customer needs, smoothen fabrication schedules, and lower overall manufacturing expenses. We propose a two-stage manufacturing scheme. The first stage produces common parts for multiproduct incorporating a partial supply from an outside contractor to reduce utilization/uptime. Stage two fabricates all end products using an adjustable-rate to reduce the uptime further. We build a model to characterize the problem’s features and use optimization methods to derive the optimal rotation cycle time in order to help managers make cost-effective lot-size decisions and allow manufacturers to gain competitive advantages. A numerical illustration validates the model’s capability and applicability. This study makes two important contributions: (1) It offers a decision-support model for studying such a particular batch-size problem and deciding the optimal rotation cycle time, and (2) it identifies the individual/collective influence of dual uptime-reduction strategies on the operating policy and various performance indexes to help facilitate managerial decision-making.

Two-dimensional (2D) ferromagnets with out-of-plane (OOP) magnetic anisotropy are potential candidates for realizing the next-generation memory devices with ultra-low power consumption and high storage density. However, a scalable approach to synthesize 2D magnets with OOP anisotropy directly on the complimentary metal-oxide semiconductor (CMOS) compatible substrates has not yet been mainly explored, which hinders the practical application of 2D magnets. This work demonstrates a cascaded space confined chemical vapor deposition (CS-CVD) technique to synthesize 2D FexGeTe2 ferromagnets. The weight fraction of iron (Fe) in the precursor controls the phase purity of the as-grown FexGeTe2. As a result, high-quality Fe3GeTe2 and Fe5GeTe2 flakes have been grown selectively using the CS-CVD technique. Curie temperature (TC) of the as-grown FexGeTe2 can be up to ∼ 280 K, nearly room temperature. The thickness and temperature-dependent magnetic studies on the Fe5GeTe2 reveal a 2D Ising to 3D XY behavior. Also, Terahertz spectroscopy experiments on Fe5GeTe2 display the highest conductivity among other FexGeTe2 2D magnets. The results of this work indicate a scalable pathway for the direct growth and integration of 2D ternary magnets on CMOS-based substrates to develop spintronic memory devices.

Background "Diffuse midline glioma, H3 K27M-mutant" (DMG) mainly arises within the pontine, thalamic, and spinal cord regions. Because of the rarity of spinal cord gliomas, the general knowledge surrounding DMGs is mainly based on pontine and thalamic gliomas, whereas tumor location tends to influence the clinicopathological features and prognosis. Objective To determine the clinicopathological characteristics and molecular profiles of DMGs located in the spinal cord. Methods The clinical and molecular pathologic features and prognosis were comprehensively analyzed in a series of 44 patients with spinal cord DMGs. Results The median age was 36 yr, and 88.7% of patients (39/44) were adults (≥18 yr). Histopathologically, malignant grades included grade II (16 cases), grade III (20 cases), and grade IV (8 cases). Compared with patients with histological grade IV, patients with lower histological grade (grade II/III) were older (37 vs 24 yr, P = .020) and were associated with longer overall survival (24.1 vs 8.6 mo, P = .007). All 30 tested tumors were isocitrate dehydrogenase (IDH) wild type, and 96% of cases (22/23) presented with unmethylated O6-methylguanine-DNA methyltransferase. Univariate and multivariate analyses showed that histological grade and presurgery McCormick Scale scores were independent prognostic factors for overall survival, whereas extensive surgical resection and chemoradiotherapy were not significantly associated with improved survival. The most frequent anatomic locations were the cervical enlargement (C4-T1, n = 16) and conus medullaris (T12-L1, n = 13), which exhibited distinctive clinical characteristics and molecular features. Conclusion The findings provide guidelines for the evidence-based practice of the specialized management of spinal cord DMGs.

Background: Severe acute respiratory syndrome coronavirus 2 infection is associated with strong infectiousness and has no effective therapy. We aimed to explore the efficacy and safety of Mycobacterium vaccae nebulization in the treatment of Coronavirus Disease 2019 (COVID-19). Methods: In this randomized, double-blind, placebo-controlled clinical trial, we included 31 adult patients with moderate COVID-19 who were admitted to the Fourth People's Hospital of Nanning (Nanning, China) between January 22, 2020 and February 17, 2020. Patients were randomly divided into two groups: group A (standard care group) and group B (M. vaccae in combination with standard care group). The primary outcome was the time interval from admission to viral RNA negative conversion (oropharyngeal swabs were used in this study). Secondary outcomes included chest computed tomography (CT), mortality, length of hospital stay, complications during treatment, and so on. Patients were followed up to 4 weeks after discharge (reexamination of viral RNA, chest CT, etc.). Results: Nucleic acid test negative conversion time in group B was shorter than that in group A (2.9 days [2.7-8.7] vs. 6.8 days [3.3-13.8]; p = 0.045). No death and no conversion to severe or critical cases were observed in both groups. Two weeks after discharge, neither "relapse" nor "return to positive" cases were found. Four weeks after discharge, it was found that there was no case of " relapse " or "return to positive" in group B, and 1 patient in group A showed "return to positive", but there was no clinical manifestation and imaging progression. No adverse reactions related to M. vaccae were found during observation period. Conclusion: M. vaccae treatment might shorten the time interval from admission to viral RNA negative conversion, which might be beneficial to the prevention and treatment of COVID-19. Clinical Trial Registration: ChiCTR2000030016.

Aims To develop an artificial intelligence-based approach with multi-labelling capability to identify both ST-elevation myocardial infarction (STEMI) and 12 heart rhythms based on 12-lead electrocardiograms (ECGs). Methods and results We trained, validated, and tested a long short-term memory (LSTM) model for the multi-label diagnosis of 13 ECG patterns (STEMI + 12 rhythm classes) using 60 537 clinical ECGs from 35 981 patients recorded between 15 January 2009 and 31 December 2018. In addition to the internal test above, we conducted a real-world external test, comparing the LSTM model with board-certified physicians of different specialties using a separate dataset of 308 ECGs covering all 13 ECG diagnoses. In the internal test, the area under the curves (AUCs) of the LSTM model in classifying the 13 ECG patterns ranged between 0.939 and 0.999. For the external test, the LSTM model for multi-labelling of the 13 ECG patterns evaluated by AUC was 0.987 ± 0.021, which was superior to those of cardiologists (0.898 ± 0.113, P Conclusions We demonstrated the usefulness of an LSTM model in the multi-labelling detection of both rhythm classes and STEMI in competitive testing against board-certified physicians. This AI tool exceeding the cardiologist-level performance in detecting STEMI and rhythm classes on 12-lead ECG may be useful in prioritizing chest pain triage and expediting clinical decision-making in healthcare.

Background:. Colorectal cancer is harmful to the patient's life. The treatment of patients is determined by accurate preoperative staging. Magnetic resonance imaging (MRI) played an important role in the preoperative examination of patients with rectal cancer, and artificial intelligence (AI) in the learning of images made significant achievements in recent years. Introducing AI into MRI recognition, a stable platform for image recognition and judgment can be established in a short period. This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network. Methods:. A total of 183 rectal cancer patients’ data were collected retrospectively as research objects. Faster region-based convolutional neural networks (Faster R-CNN) were used to build the platform. And the platform was evaluated according to the receiver operating characteristic (ROC) curve. Results:. An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI. The areas under the ROC curve (AUC) were 0.99 in the horizontal plane, 0.97 in the sagittal plane, and 0.98 in the coronal plane. In the horizontal plane, the AUC of T1 stage was 1, AUC of T2 stage was 1, AUC of T3 stage was 1, AUC of T4 stage was 1. In the coronal plane, AUC of T1 stage was 0.96, AUC of T2 stage was 0.97, AUC of T3 stage was 0.97, AUC of T4 stage was 0.97. In the sagittal plane, AUC of T1 stage was 0.95, AUC of T2 stage was 0.99, AUC of T3 stage was 0.96, and AUC of T4 stage was 1.00. Conclusion:. Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging. Trial registration:. chictr.org.cn: ChiCTR1900023575; http://www.chictr.org.cn/showproj.aspx?proj=39665.

Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.

IgA nephropathy (IgAN), an immune complex-mediated process and the most common primary glomerulonephritis, can progress to end-stage renal disease in up to 40% of patients. Accordingly, a therapeutic strategy targeting a specific molecular pathway is urgently warranted. Aided by structure characterisation and target identification, we predicted that a novel ring-fused 6-(2,4-difluorophenyl)-3-(3-(trifluoromethyl)phenyl)-2H-benzo[e][1,3]oxazine-2,4(3H)-dione (LCC18) targets the NLRP3 inflammasome, which participates in IgAN pathogenesis. We further developed biomarkers for the disease. We used two complementary IgAN models in C57BL/6 mice, involving TEPC-15 hybridoma-derived IgA, and in gddY mice. Moreover, we created specific cell models to validate therapeutic effects of LCC18 on IgAN and to explain its underlying mechanisms. IgAN mice benefited significantly from treatment with LCC18, showing dramatically improved renal function, including greatly reduced proteinuria and renal pathology. Mechanistic studies showed that the mode of action specifically involved: (1) blocking of the MAPKs/COX-2 axis-mediated priming of the NLRP3 inflammasome; (2) inhibition of ASC oligomerisation and NLRP3 inflammasome assembly by inhibiting NLRP3 binding to PKR, NEK7 and ASC; and (3) activation of autophagy. LCC18 exerts therapeutic effects on murine IgAN by differentially regulating NLRP3 inflammasome activation and autophagy induction, suggesting this new compound as a promising drug candidate to treat IgAN. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Purpose Due to the rarity of diffuse spinal cord astrocytoma, an effective model is still lacking to stratify their prognosis. Here, we aimed to establish a prognostic model through comprehensively evaluating clinicopathological features and preoperative peripheral blood inflammatory markers in 89 cases. Methods We performed univariate and multivariate Cox regression to identify prognosis factors. The Kaplan–Meier curves and ROC curves were employed to compare the prognostic value of selected factors. Results In addition to clinicopathological factors, we revealed the preoperative peripheral blood leukocyte count, neutrophils-to-lymphocytes ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also significantly correlated with overall survival of spinal cord astrocytoma in univariate Cox regression, and NLR was still significant in multivariate Cox analysis. Further, we demonstrated that NLR ≤ 3.65 and preoperative McCormick score (MMS) ≤ 3 were independently correlated with better survival of WHO grade IV tumors. Meanwhile, Ki-67 3.65 or MMS = 4. Conclusion We successfully constructed a comprehensive prognostic model including preoperative peripheral blood inflammatory markers, which can stratify diffuse spinal cord astrocytoma into 4 subgroups.

Background Deep-learning algorithms to annotate electrocardiograms (ECGs) and classify different types of cardiac arrhythmias with the use of a single-lead ECG input data set have been developed. It remains to be determined whether these algorithms can be generalized to 12-lead ECG-based rhythm classification. Methods We used a long short-term memory (LSTM) model to detect 12 heart rhythm classes with the use of 65,932 digital 12-lead ECG signals from 38,899 patients, using annotations obtained by consensus of 3 board-certified electrophysiologists as the criterion standard. Results The accuracy of the LSTM model for the classification of each of the 12 heart rhythms was ≥ 0.982 (range 0.982-1.0), with an area under the receiver operating characteristic curve of ≥ 0.987 (range 0.987-1.0). The precision and recall ranged from 0.692 to 1 and from 0.625 to 1, respectively, with an F1 score of ≥ 0.777 (range 0.777-1.0). The accuracy of the model (0.90) was superior to the mean accuracies of internists (0.55), emergency physicians (0.73), and cardiologists (0.83). Conclusions We demonstrated the feasibility and effectiveness of the deep-learning LSTM model for interpreting 12 common heart rhythms according to 12-lead ECG signals. The findings may have clinical relevance for the early diagnosis of cardiac rhythm disorders.

Choledocholithiasis is a chronic common disease. The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis. Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%. The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors. We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.

To address the drawback of single machine learning prediction model which cannot capture the complex hidden factors of crude oil price, ensemble learning method has been widely verified as an excellent solution for crude oil price forecasting. In ensemble learning, diversity strategy is one of the most important determinants to obtain good performance. So, this study introduced the promisingly efficient and fast RVFL network as base models to the framework of ensemble learning and explored diversity strategies in the proposed RVFL network ensemble forecasting model to obtain good performance. Specifically, the impacts of five different strategies including data quantity diversity, sampling interval diversity, parameter diversity, ensemble number diversity and ensemble method diversity on the performance of RVFL network ensemble learning have been examined and analyzed. Experimental results found that the accuracy of ensemble learning models would be increased if diversity strategies were carefully selected. Moreover, the proposed multistage nonlinear RVFL network ensemble forecasting model was consistently better than that of single RVFL network model in terms of the same measurements.

Background The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. We aimed to prospectively evaluate the oncologic results of SMG preservation in cT1-2 N0 buccal SCC. Methods This was a prospective, non-randomized cohort study. Patients with surgically treated cT1-2 N0 buccal SCC were prospectively enrolled and divided into two groups based on the management of the SMG. Level 1b lymph nodes were categorized into six groups based on the positional relationship between the lymph node and the SMG. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS). Results A total of 31 of the 137 included patients underwent SMG-sparing neck dissection. Patients with SMG preservation were likely to be young persons. Superior metastasis occurred in 11 patients with a prevalence of 8.0%, followed by an anterior metastasis rate of 5.1%, and no metastases developed deeply or within the SMG. The 5-year LRC rates in the SMG-sparing and SMG-excision groups were 74 and 75%, respectively, and the difference was not significant (p = 0.970). The 5-year DSS rates in the SMG-sparing and SMG-excision groups were 74 and 69%, respectively, and the difference was not significant (p = 0.709). Conclusions SMG involvement was rare, and the superior group carried the highest risk for lymph node metastasis. SMG-sparing neck dissection is selectively suggested in cT1-2 N0 buccal SCC patients, and could avoid postoperative asymmetric appearance and dry mouth.

Summary Background Climate change is increasing the risks of injuries, diseases, and deaths globally. However, the association between ambient temperature and renal diseases has not been fully characterized. This study aimed to quantify the risk and attributable burden for hospitalizations of renal diseases related to ambient temperature. Methods Daily hospital admission data from 1816 cities in Brazil were collected during 2000 and 2015. A time-stratified case-crossover design was applied to evaluate the association between temperature and renal diseases. Relative risks (RRs), attributable fractions (AFs), and their confidence intervals (CIs) were calculated to estimate the associations and attributable burden. Findings A total of 2,726,886 hospitalizations for renal diseases were recorded during the study period. For every 1°C increase in daily mean temperature, the estimated risk of hospitalization for renal diseases over lag 0–7 days increased by 0·9% (RR = 1·009, 95% CI: 1·008–1·010) at the national level. The associations between temperature and renal diseases were largest at lag 0 days but remained for lag 1–2 days. The risk was more prominent in females, children aged 0–4 years, and the elderly ≥ 80 years. 7·4% (95% CI: 5·2–9·6%) of hospitalizations for renal diseases could be attributable to the increase of temperature, equating to 202,093 (95% CI: 141,554–260,594) cases. Interpretation This nationwide study provides robust evidence that more policies should be developed to prevent heat-related hospitalizations and mitigate climate change. Funding China Scholarship Council, and the Australian National Health and Medical Research Council

Background Although miR-758-3p has been reported to be associated with multiple cancers, including hepatocellular carcinoma, bladder cancer, gastric cancer and papillary thyroid cancer, its role in clear cell renal cell carcinoma (ccRCC) remains unclear. Methods The expression levels of miR-758-3p in ccRCC tissues and cell lines were examined using qRT-PCR. Survival analysis was performed using Kaplan-Meier, while the prognostic significance of miR-758-3p was evaluated by Cox regression analysis. The effects of miR-758-3p on cell proliferation, migration and invasion were analyzed with CCK-8, crystal violet and transwell assays. Luciferase reporter assays were performed to determine the effect of miR-758-3p on MDM2. Western blot was applied to measure the expression of MDM2. Results The expression levels of miR-758-3p were down-regulated in human ccRCC tissues and cell lines. Moreover, the expression of miR-758-3p was closely associated with histological grade, TNM stage and vascular invasion. High expression of miR-758-3p was found to be capable of predicting favorable clinical prognosis in ccRCC patients. Additionally, whilst the proliferation, migration and invasion of ccRCC cells were inhibited upon overexpression of miR-758-3p, the effects were reversed upon miR-758-3p knockdown. Moreover, miR-758-3p was a modulator of MDM2 in ccRCC. Conclusion This study demonstrated that miR-758-3p is a potential prognostic biomarker for ccRCC patients. Data from this study showed that miR-758-3p exhibits different biological functions that inhibit the progression of ccRCC cells, hence it can be a potential therapeutic target candidate for treating ccRCC.

Background An accurate assessment of the severity and prognosis of sepsis, especially septic shock, is vital for the tailored treatment of this condition. miRNA participates in the inflammatory response and cell apoptosis and regulates inflammation-related signaling pathways. Immune disorders often accompany sepsis. Since serum miRNA expression is superior to traditional biological markers in terms of sensitivity and specificity, its role in the assessment of sepsis has increasingly been recognized. Methods Serum miRNAs were extracted from septic patients and healthy individuals by using the ultracentrifugation method. The differential expressions of miRNAs in the serum samples were detected by high-throughput sequencing technology. The differentially expressed miRNAs between the two groups were analyzed by bioinformatics. The quantitative polymerase chain reaction real-time polymerase chain reaction (qRT-PCR) was used to amplify the sample size to verify the results and to screen the highly-expressed miR206 in septic patients. Subsequently, serum samples were collected from 63 septic patients, and 30 patients with septic shock and qRT-PCR were performed to analyze the expression of miR-206. These 93 patients were divided into the miR-206 low-expression group and miR-206 high-expression group according to miR206 expression level. The potential correlations between the miR-206 expression and the clinical data were analyzed by using SPSS 25.0. Results Serum miRNA expression significantly differed between septic patients and healthy individuals. High-throughput sequencing results showed that, compared with those in healthy individuals, 29 miRNA molecules were down-regulated, and 25 molecules were up-regulated in the serum samples of septic patients. qRT-PCR identified the significantly up-regulated miR-206 in septic patients. qRT-PCR also showed significantly higher miR-206 expression levels in patients with septic shock than in septic patients. Furthermore, we observed a significantly longer prothrombin time and activated partial thromboplastin time, and significantly higher SOFA score, APACHE-II score, and in-hospital mortality rate. miR-206 was positively correlated with SOFA sore and APACHE-II score. Conclusions Serum miR-206 expression is positively correlated with the severity and prognosis of sepsis. Thus, it may be a potential biomarker for assessing the severity and prognosis of sepsis, although the specific mechanism warrants further investigations.

BACKGROUND The purpose of this study was to investigate the tolerance and safety of carbohydrate administration to patients with multiple injuries prior to surgery, and to analyze the effects of carbohydrate intake on their immediate insulin resistance (IR), postoperative complications, and length of hospital stay. METHODS A total of 125 patients with mild multiple injuries who were admitted to the Emergency Surgery Department of Affiliated Hospital of Nantong University for elective surgery were randomized to administration of either placebo or carbohydrate. Finally, 82 patients (male: 39, female: 43) successfully completed the experiment and collected data. Preoperative general condition, subjective comfort, blood glucose concentration, serum insulin and insulin resistance index (IR) were studied. RESULTS The two groups of patients matched in gender, age, body mass index (BMI) (P>0.05). Patients in CHO group treated with carbohydrates three hours before surgery compared with patients treated with preoperative specification. The thirst, hunger and anxiety of the patients in the CHO group were significantly relieved (P

In this work, we demonstrate that an organometallic perovskite (OP) single crystal for effective photodetection can be grown on a gold (Au)-decorated substrate using liquid phase epitaxy. The covered gold could both control the shape of the epitaxial layer and act as its electrodes. An MAPbCl3 single crystal and an MAPbBr1.5Cl1.5 single crystal were used as the substrate and the epitaxial layer, respectively. The device, with an Au-perovskite-Au structure, can be fully characterized. Due to the high-quality epitaxial layer, the maximum external quantum efficiency (EQE) value is over 60% under the voltage of −20 V. In addition, the response speed can reach 200 and 500 ns (ns) rise and fall, respectively. Our work provides an effective and promising method to fabricate efficient perovskite-based photodetectors.

Most multinational/transnational manufacturers that own internal supply chains and operate in turbulent world markets apply strategies related to product quality, low-cost, and timely delivery. This study aims to assist such firms with making accurate decisions to enable their competitive strategies and cope with the realities of limited capacity and unreliable equipment. We examine a vendor-buyer coordinated system featuring batch fabrication, outsourcing, quality reassurance, discontinuous deliveries, and an unreliable machine. The system outsources a portion of a lot to reduce manufacturing uptime, and the in-house fabrication system experiences undesirable defective items and Poisson distributed breakdowns. In each cycle, corrective action and rework/disposal of defective stocks are undertaken as these incidents occur, and upon receipt of outsourced products and when the entire batch is quality ensured, it makes multiple deliveries of the end products. Using modeling, formulation, derivation, and an optimization methodology, we obtain the problem’s cost function and justify its convexity. We then apply differential calculus and propose a recursive algorithm to derive the problem’s optimal replenishment runtime. A numerical illustration is offered to show the applicability of the result that reveals various important system characteristics/ capabilities, such as the distinct and combined influences of breakdowns, outsourcing, rework, scrap, and delivery-frequency factors on various system parameters, performance, and optimal runtime. The methods proposed here can facilitate managerial operations planning and strategic decision making in an intra-supply chain setting in practice.

Background Due to their rarity, the clinicopathological characteristics and prognostic factors of spinal cord gliomas are still unclear. Here, we aimed to clarify these issues in a cohort of 108 spinal cord astrocytomas. Methods We characterized the clinicopathological characteristics, including 2016 World Health Organization (WHO) grade, age, sex, location, segment length, resection, pre‐ and postsurgery, Modified McCormick Scale (MMS), radio‐ and chemotherapy, and Ki‐67 and H3 K27M mutations, in 108 spinal cord astrocytomas through heatmaps. The Cox regression analysis and Kaplan‐Meier curves were used to study the prognostic value of these clinicopathological features. Results There are a total 38 H3 K27M‐mutant tumors, including 31 cases with histological grade II/III tumors. The age of low‐grade astrocytoma patients (WHO grade I/II, n = 54) was significantly younger (27.0 vs 35.5 years, P = .001) than those with high‐grade tumors (WHO grade III/IV, n = 54). All patients underwent surgical resection with neurophysiological monitoring, and the surgery did not result in significant changes in MMS. The presurgery MMS was associated with overall survival in the high‐grade subgroup (P = .008) but not in the low‐grade subgroup (P = .312). While, the high content of resection improved the survival of only patients with low‐grade astrocytomas (P = .016) but not those with high‐grade astrocytomas (P = .475). Both the low‐grade and high‐grade astrocytomas had no obvious benefit from neither adjuvant chemotherapy nor radiotherapy (all P > .05). Conclusions We characterized the clinicopathological characteristics and their prognostic values in 108 spinal cord astrocytomas, which could help with evidence‐based management of spinal cord astrocytomas., We characterized the clinicopathological characteristics and their prognostic values in 108 spinal cord astrocytomas, which could help with evidence‐based management of spinal cord astrocytomas.

Integrating artificial intelligence (AI) and computer science together with current approaches in material synthesis and optimization will act as an effective approach for speeding up the discovery of high-performance photoactive materials in organic solar cells (OSCs). Yet, like model selection in statistics, the choice of appropriate machine learning (ML) algorithms plays a vital role in the process of new material discovery in databases. In this study, we constructed five common algorithms, and introduced 565 donor/acceptor (D/A) combinations as training data sets to evaluate the practicalities of these ML algorithms and their application potential when guiding material design and D/A pairs screening. Thus, the best predictive capabilities are provided by using the random forest (RF) and boosted regression trees (BRT) approaches beyond other ML algorithms in the data set. Furthermore, >32 million D/A pairs were screened and calculated by RF and BRT models, respectively. Among them, six photovoltaic D/A pairs are selected and synthesized to compare their predicted and experimental power conversion efficiencies. The outcome of ML and experiment verification demonstrates that the RF approach can be effectively applied to high-throughput virtual screening for opening new perspectives to design of materials and D/A pairs, thereby accelerating the development of OSCs.

The field of all-polymer solar cells (all-PSCs) has experienced rapid development during the past few years, mainly driven by the development of efficient polymer acceptors. However, the power conversion efficiencies (PCEs) of the all-PSCs are still limited by insufficient light absorption of the donor/acceptor blend and large energy loss in devices. We herein designed a polymer acceptor PYT1 constructed n-type molecular acceptor Y5-C20 as the key building block and blended it with a polymer donor PM6 to obtain an all-polymer photoactive layer. The optimized PM6:PYT1 all-PSCs achieved a record higher PCE of 13.43% with a very low energy loss of 0.47 eV and a photoresponse of up to 900 nm compared with the Y5-C20 based device with a best PCE of 9.42%. Furthermore, the PCEs of the PM6:PYT1 all-PSCs are relatively insensitive to the 1-chloronaphthalene (CN) additive contents and active layer thickness. Our results also highlight the effect of CN additive on PM6:PYT1 morphology, i.e. , charge generation, and transport find an optimized balance, and radiative and non-radiative loss is simultaneously reduced in the blend. This work promotes the development of high-performance polymer acceptors and heralds a brighter future of all-PSCs for commercial applications.

Gallbladder carcinoma (GBC) is a vicious and invasive disease. The major challenge in the clinical treatment of GBC is the lack of a suitable prognosis method. Chemokine receptors such as CXCR3, CXCR4 and CXCR7 play vital roles in the process of tumour progression and metastasis. Their expression levels and distribution are proven to be indicative of the progression of GBC, but are hard to be decoded by conventional pathological methods, and therefore, not commonly used in the prognosis of GBC. In this study, we developed a computer‐aided image analysis method, which we used to quantitatively measure the expression levels of CXCR3, CXCR4 and CXCR7 in the nuclei and cytoplasm of glandular and interstitial cells from a cohort of 55 GBC patients. We found that CXCR3, CXCR4 and CXCR7 expressions are associated with the clinicopathological variables of GBC. Cytoplasmic CXCR3, nuclear CXCR7 and cytoplasmic CXCR7 were significant predictive factors of histology invasion, whereas cytoplasmic CXCR4 and nuclear CXCR4 were significantly correlated with T and N stage and were associated with the overall survival and disease‐free survival. These results suggest that the quantification and localisation of CXCR3, CXCR4 and CXCR7 expressions in different cell types should be considered using computer‐aided assessment to improve the accuracy of prognosis in GBC.

Although epitaxial growth is the fundamental method to realize lattice matched heterojunctions in electronics manufacturing, large-scale epitaxial single crystal layers based on solution-processing...

Operations in manufacturing environments are turbulent. Thus, production managers must be capable of dealing with diverse and unexpected situations, such as either random production of imperfect items or unanticipated changes in customers’ orders. Therefore, a decision-support-type of model is required to facilitate production managers in achieving their goals. We propose a precise model that can determine the economic lot size (ELS) by incorporating issues related to expedited fabrication rate and product quality-assurance during production. Thereby, fabrication rate can be adjusted with an extra setup and the consequent unit costs. In each fabrication cycle, random non-conforming products would be screened and identified. Such items would either be disposed of or reworked with consequent extra cost, to obtain a quality-assured final product. The ELS is determined with the aid of mathematical analyses and optimization processes. A numerical example is presented to demonstrate the applicability of our model and to depict diverse critical system characteristics that support managerial decision-making.

Due to the rare incidence of spinal cord astrocytomas, their molecular features remain unclear. Here, we characterized the landscapes of mutations in H3 K27M, isocitrate dehydrogenase 1 (IDH1) R132H, BRAF V600E, and the TERT promoter in 83 diffuse spinal cord astrocytic tumors. Among these samples, thirty-five patients had the H3 K27M mutation; this mutant could be observed in histological grade II (40%), III (40%), and IV (20%) astrocytomas. IDH1 mutations were absent in 58 of 58 cases tested. The BRAF V600E mutation (7/57) was only observed in H3-wildtype astrocytomas, and was associated with a better prognosis in all histological grade II/III astrocytomas. TERT promoter mutations were observed in both H3 K27M-mutant (4/25) and -wildtype (9/33) astrocytomas, and were associated with a poor prognosis in H3-wildtype histological grade II/III astrocytomas. In the 2016 WHO classification of CNS tumors, H3 K27M-mutant diffuse midline gliomas, including spinal cord astrocytomas, are categorized as WHO grade IV. Here, we noticed that the median overall survival of histological grade II/III H3 K27M-mutant cases (n = 28) was significantly longer than that of either the total histological grade IV cases (n = 12) or the H3 K27M-mutant histological grade IV cases (n = 7). We also directly compared H3 K27M-mutant astrocytomas to H3-wildtype astrocytomas of the same histological grade. In histological grade II astrocytomas, compared to H3-wildtype cases (n = 37), H3 K27M-mutant patients (n = 14) had showed a significantly higher Ki-67-positive rate and poorer survival rate. However, no significant differences in these parameters were observed in histological grade III and IV astrocytoma patients. In conclusion, these findings indicate that spinal cord astrocytomas are considerably different from hemispheric and brainstem astrocytomas in terms of their molecular profiles, and that the histological grade cannot be ignored when assessing the prognosis of H3 K27M-mutant spinal cord astrocytomas.

Summary To date, organic solar cells (OSCs) with the development of photovoltaic materials have realized high power conversion efficiencies (PCEs) through the solution processing strategy with bulk heterojunction (BHJ) structure, but the BHJ morphology is difficult to control in large-scale fabrication of OSCs. Herein, we report an alternative film-forming technology known as layer-by-layer (LbL). As compared to its BHJ counterpart, LbL presents many unique advantages including controllable “p-i-n” morphology, good charge transport and extraction properties, and great universality. By using the LbL-bladed coating strategy, a high PCE of 16.35% was achieved in the PM6:Y6 OSCs. Notably, a large-area solar module of 11.52 cm2 with a geometrical fill factor of over 90% exhibited an outstanding PCE of 11.86%, which represents the highest efficiency of large-area solar modules. The results may pave the way for the fabrication of the photoactive layer in the future industrial production of OSCs.

With the increasing penetration of renewable distributed generations (DGs), large numbers of “energy prosumers” are emerging rapidly. There will be severe impacts on the utility grid if these renewable DGs are not managed properly. Smart electrical power devices which enable high flexibility in energy management, alleviation in harmonic pollutions and friendly interactions with the utility grid are needed urgently. To meet all these requirements, a novel energy router which enables a unique parallel operation mode to the energy prosumer is presented. Facilitated with a bi-directional DC/AC converter, a switch array module and a fuzzy logic based hierarchical control strategy, the presented energy router enables plug-and-play connections and reliable energy management for the energy prosumer. The switch array and the parallel mode enable the loads to be flexibly scheduled to reduce energy cost and improve system performance. MATLAB/Simulink model of the energy prosumer is set up and a fuzzy logic based hierarchical control strategy is implemented for transient power balance control in various operation modes. Simulation results have demonstrated high flexibility, stability and feasibility of the proposed energy router in energy management of the prosumer, which will contribute to the better utilization of the ever-growing renewable energies.

Background: The role of Epstein–Barr virus (EBV) in inflammatory bowel disease (IBD) remains to be elucidated. The aim of this study was to investigate the presence of EBV in the blood and intestinal mucosa of patients with IBD and evaluate the association between EBV positivity and IBD. Methods: Patients with IBD, hospitalized between January 2015 and April 2018, were enrolled. The EBV-DNA load in blood samples from each subject was analyzed by quantitative real-time polymerase chain reaction. EBV-encoded small-RNA 1 (EBER-1) was detected by in-situ hybridization in intestinal mucosa tissue sections of patients with IBD. Result: EBV-DNA was detected in 48 out of 568 patients with IBD (8.4%), and EBER-1 positivity was detected in 27 of these patients (56.3%). Refractory IBD and severe mucosal inflammation were more common in patients with detectable levels of EBER-1 than in those without; the number of EBER-1-positive cells positively correlated with mucosal inflammation (P value < 0.05). Age (≥60 years old) and use of azathioprine were risk factors for EBV infection. There was no significant difference in clinical remission rate and surgical rate between the EBER-1 positive group and EBER-1 negative group, antiviral group and the non-antiviral group, among IBD patients who tested positive for EBV-DNA. Conclusion: Elderly patients with IBD, treated with azathioprine, are more susceptible to EBV positivity. Further, EBV mucosal detection correlated with the severity of mucosal damage and refractoriness, but not prognosis.

In this paper, the attitude tracking control problem for rigid spacecraft is investigated in the presence of parameter uncertainties and external disturbances. An extended state observer is designed to estimate the parameter uncertainties and external disturbances. Then, by using the obtained estimation, a robust finite-time controller is proposed to achieve attitude tracking for the rigid spacecraft via the backstepping technique. The practical finite-time stability of the closed-loop system under the presented controller is proven by the Lyapunov stability theory. Finally, some simulation results are provided to illustrate the effectiveness and superiority of the proposed controller compared with some existing control schemes.

Background: Artificial intelligence-assisted image recognition technology is currently able to detect the target area of an image and fetch information to make classifications according to target features. This study aimed to use deep neural networks for computed tomography (CT) diagnosis of perigastric metastatic lymph nodes (PGMLNs) to simulate the recognition of lymph nodes by radiologists, and to acquire more accurate identification results. Methods: A total of 1371 images of suspected lymph node metastasis from enhanced abdominal CT scans were identified and labeled by radiologists and were used with 18,780 original images for faster region-based convolutional neural networks (FR-CNN) deep learning. The identification results of 6000 random CT images from 100 gastric cancer patients by the FR-CNN were compared with results obtained from radiologists in terms of their identification accuracy. Similarly, 1004 CT images with metastatic lymph nodes that had been post-operatively confirmed by pathological examination and 11,340 original images were used in the identification and learning processes described above. The same 6000 gastric cancer CT images were used for the verification, according to which the diagnosis results were analyzed. Results: In the initial group, precision-recall curves were generated based on the precision rates, the recall rates of nodule classes of the training set and the validation set; the mean average precision (mAP) value was 0.5019. To verify the results of the initial learning group, the receiver operating characteristic curves was generated, and the corresponding area under the curve (AUC) value was calculated as 0.8995. After the second phase of precise learning, all the indicators were improved, and the mAP and AUC values were 0.7801 and 0.9541, respectively. Conclusion: Through deep learning, FR-CNN achieved high judgment effectiveness and recognition accuracy for CT diagnosis of PGMLNs. Trial Registration: Chinese Clinical Trial Registry, No. ChiCTR1800016787; http://www.chictr.org.cn/showproj.aspx?proj= 28515. Key words: Faster region-based convolutional neural networks; Perigastric metastatic lymph nodes; Deep learning; Gastric cancer

Limited evidence was seen as the association between fine particulate matter (PM2.5) and physician visits for allergic rhinitis (AR), especially in countries with extreme air pollution exposure. This paper addressed the issues about the association between PM2.5 and daily outpatient visits for AR among individuals residing in Beijing, China. Data on daily outpatient visits for AR obtained from Beijing Medical Claim Data for Employees and daily PM2.5 concentrations available from US embassy reports were linked by date from January 1, 2010, to June 30, 2012. A time-series analysis was conducted with a generalized additive Poisson model to assess the association between PM2.5 and AR, adjusting for daily average temperature, relative humidity, day of the week, calendar time, and public holiday. Totally, 229,685 outpatient visits for AR were included in the analysis. The daily mean (SD) concentration of PM2.5 was 99.5 (75.3) μg/m3 during the study period. We found that a 10-μg/m3 increase in PM2.5 content was associated with a 0.47% (95% CI: 0.39% to 0.55%) increase in the number of outpatient visits on the same day. Furthermore, results from subgroup analyses suggested that the association was consistently significant among the groups of different ages (

BackgroundIn recent years, acupuncture has been increasingly integrated into pediatric care worldwide. However, recent epidemiological studies about pediatric users of acupuncture are lacking. The current study aimed to fill the gap and carry out the large-scale investigation on the basis of the pediatric population in Taiwan.MethodsWe conducted a nationwide population-based study to investigate the utilization of acupuncture in Taiwan. We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000). The datasets contained all original claims data for 1 million beneficiaries who were randomly sampled from the registry of all beneficiaries enrolled in the Taiwan’s National Health Insurance Program from January 1, 2000 to December 31, 2011. Children younger than 18 years old were enrolled into our study for analysis. The demographic data, treatment modalities and distributions by disease categories of the pediatric acupuncture users were analyzed by descriptive statistics. Logistic regression analysis was used to investigate the trends in acupuncture use over time.ResultsThe one-year prevalence of pediatric acupuncture users increased from 1.78% in 2002 to 5.34% in 2011. Acupuncture use significantly increased each year (p-value 9 years old) children tended to receive acupuncture treatment due to injury and musculoskeletal system disorders more than younger (≤9 years old) children.ConclusionsOur study revealed that the utilization of acupuncture in pediatrics became increasingly popular year by year in Taiwan from 2002 to 2011. The results of this study may provide some valuable information for further clinical practice and acupuncture research, as well as to the government and societies concerning pediatric health care.

Background Coprescription is a potential medical problem for older adults that could induce polypharmacy and subsequent complications. In Taiwan, Chinese herbal medicine (CHM) is popular among the older adults. Investigating the coprescription trends in Western medicine, CHM and dental medicine is important to avoid possible polypharmacy. Methods We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000) in Taiwan. Patients ≥ 60 years old who received coprescription of Western medicine, Chinese herbal medicine and drugs for dental care from 1997 to 2013 were included. The odds ratio (OR) and 95% confidence interval (95% CI) were estimated by a logistic regression model for evaluating the correlation between baseline characteristics and coprescription. Results A total of 233,594 patients were included for the analysis. Most patients receiving coprescriptions live in the northern Taiwan and with a monthly income lower than 20,000 new Taiwan dollars. The trends in older adults using Western medicine alone or CHM alone decreased over time, but the cohort using dental medicine alone had the opposite result. Decreased trends in coprescription with age were noted. The trends in the proportion of coprescription and the number of days of coprescription increased with the calendar year. Increased trends in the proportion of patients with coprescription were also found, except for the cohort of patients who used both Western medicine and CHM. Patients who were female, aged 70-79 years and residents from the outside islands of Taiwan were prone to receive coprescription. Conclusions Coprescription in older patients is not uncommon in Taiwan. Healthcare providers and policymakers should be aware of the complex coprescription pattern in the older adults.

Background: Carotid intima-media thickness (cIMT) has been associated with an elevated risk of ischemic stroke (IS) in several studies, but the results are inconsistent. We investigated whether the association between cIMT and IS varied across different IS subtypes, and further assessed gene&ndash, cIMT interactions&rsquo, association with IS risk. Methods: A total of 1048 IS cases (795 large-artery atherosclerosis (LAA) cases, 103 small-vessel occlusion (SVO) cases, and 150 other subtypes) and 2696 IS-free controls across 2179 families were included in the analysis. Self-reported IS cases were confirmed through medical records&rsquo, review and head imaging by computed tomography and/or magnetic resonance imaging. The mean values of the common cIMT obtained in bilateral distal and proximal carotid artery segments were used. The genotype information of rs2910164 polymorphism in microRNA-146a (miR-146a) was also collected. Results: We found that cIMT was significantly associated with a higher risk of IS and LAA subtype but not SVO subtype in the multivariate-adjusted models. The odds ratio (OR) and 95% confidence interval (CI) in the highest quartile versus the lowest quartile of cIMT was 2.48 (1.92&ndash, 3.20) for IS and 2.75 (2.08&ndash, 3.64) for LAA (both p trend &lt, 0.001). The results also showed that there was a significant interaction between cIMT and rs2910164 genotype with the risk of IS (p interaction = 0.03) and LAA (p interaction = 0.02). The associations of cIMT with IS and LAA were strengthened among participants carried rs2910164_GG genotype compared with those with rs2910164_CC genotype. Conclusions: Our results indicate that higher cIMT levels were significantly associated with IS and LAA subtype but not SVO subtype, and the relations were modified by rs2910164 polymorphism in miR-146a.

Graphical Abstract Cancer cells and cancer stem cells (CSCs) are the major players of cancer malignancy and metastasis, but they are extremely difficult to access. Inspired by the vital role of macrophages and microvesicle-mediated cell–cell communication in tumors, we herein designed M2 macrophage microvesicle-inspired nanovehicle of cabazitaxel (M-CFN) to promote accessibility to cancer cells and CSCs in tumors. In the 4T1 tumor model, M-CFN flexibly permeated the tumor mass, accessed cancer cells and CD90-positive cells, and significantly promoted their entry into CSC fractions in tumors. Moreover, M-CFN treatment profoundly eliminated aldehyde dehydrogenase (ALDH)-expressing CSCs in 4T1 and MCF-7 tumors, produced notable depression of tumor growth and caused 93.86% suppression of lung metastasis in 4T1 models. Therefore, the M2 macrophage microvesicle-inspired nanovehicle provides an encouraging strategy to penetrate the tumor tissues and access these insult cells in tumors for effective cancer therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-01143-5.