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In this paper, we consider a mobile edge computing (MEC)-based secure computation offloading system, and design a practical multi-eavesdropper model including two specific scenarios of non-colluding and colluding eavesdropping. Furthermore, we design a requirement satisfaction model by exploring practical variations in user request patterns for security provisioning, delay reduction and energy saving. Based on these, we propose a satisfaction-maximized secure computation offloading (SMax-SCO) scheme, and then formulate an optimization problem aiming at maximizing users’ requirement satisfactions subject to secrecy offloading rate, tolerable delay, task workload and maximum power constraints. Since the optimization problem is nonconvex, we present an efficient successive convex approximation (SCA)-based algorithm to obtain suboptimal solutions. We demonstrate that the proposed SMax-SCO scheme achieves a significant improvement in security performance and requirement satisfaction compared with existing schemes. Moreover, we conclude that SMax-SCO can resist eavesdropping attacks of multiple eavesdroppers and even colluding eavesdroppers.

Background: Cardiometabolic Index (CMI) was associated with several risk factors for stroke; however, few studies assessed the role of CMI in stroke risk. Objective: This study aimed to assess the association between CMI and stroke in a population- based cross-sectional study. Methods: This study included 4445 general residents aged ≥40 years selected by multistage stratified random cluster sampling. CMI was calculated as the product of the ratio of waist circumference to height (WHtR) and the ratio of triglyceride levels to high-density lipoprotein cholesterol levels (TG/HDL-C). Participants were categorized according to CMI quartiles: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the association between CMI and stroke. Results: A total of 4052 participants were included in the study, with an overall stroke prevalence of 7.2%. The prevalence of stroke increased with CMI quartiles, ranging from 4.4% to 9.2% (p for trend Conclusion: Although there was a strong and independent association between CMI and stroke in the general population, CMI had limited discriminating ability for stroke. Thus, new parameters should be developed.

Ceramic membranes are attractive for thermal management applications due to its lightweight and ultralow thermal conductivity, while it is indispensable to address the long-standing obstacle of its poor mechanical stability and degradation under thermal shock. In this work, a series of the organic polymer template-modulated yttria doped zirconia (YDZ) nanofibrous membranes with lightweight, superior mechanical and thermal stability are developed through a cost-effective, scalable sol-gel electrospinning and subsequent calcination method. The YDZ membranes demonstrate excellent flexibility and foldability, which can be attributed to the tetragonal phase and small crystallite size of the YDZ fibers due to the presence of yttria. Besides, the fibrous size, grain size, mechanical and thermal stability of YDZ nanofibrous membranes could be tailored by varying the species and molecular weight of polymer template. The remarkable performances are obtained through the poly(vinyl pyrrolidone) (PVP) template YDZ nanofibrous membranes, featuring the superior tensile strength up to ∼ 4.82 MPa, excellent flexibility with bending rigidity ∼ 26 mN, robust thermal stability up to 1,200 °C, ultra-low thermal conductivity of 0.008–0.023 W·m−1·K−1 (25–1,000 °C), and excellent flame retardancy with tolerance of flame up to 1,000 °C. The remarkable properties can be attributed to the smaller fibrous size, and higher grain size resulting from PVP template. This robust material system is ideal for thermal superinsulation with a wide range of uses from energy saving building applications to spacecraft.

Regressive changes in epithelial stem cells underlie mammalian skin aging, but the driving mechanisms are not well understood. Here, we report that mouse skin hair follicle stem cell (HFSC) aging is initiated by their intrinsic upregulation of miR-31, a microRNA that can be induced by physical injury or genotoxic stress and is also strongly upregulated in aged human skin epithelium. Using transgenic and conditional knockout mouse models plus a lineage-tracing technique, we show that miR-31 acts as a key driver of HFSC aging by directly targeting Clock, a core circadian clock gene whose deregulation activates a MAPK/ERK cascade to induce HFSC depletion via transepidermal elimination. Notably, blocking this pathway by either conditional miR-31 ablation or clinically approved MAPK/ERK inhibitors provides safe and effective protection against skin aging, enlightening a promising therapeutic avenue for treating skin aging and other genotoxic stress-induced skin conditions such as radiodermatitis. Changes in hair and skin can be the most obvious and earliest signs of aging. The authors report that skin and hair follicle stem cell (HFSC) aging is driven by stress-induced upregulation of miR-31, which targets Clock to activate MAPK/ERK and deplete HFSCs via transepidermal elimination. Blocking the pathway with MAPK/ERK inhibitors protects against skin aging.

The purpose of this study was to explore the correlations between patients’ opioid-taking self-efficacy, social support, and their pain management satisfaction, and to evaluate the effect of social support and opioid-taking self-efficacy in explaining the variance in pain management satisfaction. We used a cross-sectional and correlational research design and recruited 123 cancer patients via convenience sampling. We used the following instruments: the Opioid-Taking Self-Efficacy Scale, the Inventory of Socially Supportive Behavior, and the Chinese version of the Pain Treatment Satisfaction Scale. There were significant and negative correlations between opioid-taking self-efficacy and pain management satisfaction (r = − .43, p

Dexmedetomidine sedation has been associated with favourable outcomes after surgery. We aimed to assess whether perioperative dexmedetomidine use is associated with improved survival after cardiac surgery.This retrospective cohort study included 2068 patients undergoing on-pump coronary artery bypass grafting and/or valve surgery. Among them, 1029 patients received dexmedetomidine, and 1039 patients did not. Intravenous dexmedetomidine infusion of 0.007 μg kgThe median age was 63 yr old and the male to female ratio was 71:29 in both groups. Baseline covariates were balanced between groups after adjustment using PSM, IPTW, or overlap weighting. Patients receiving dexmedetomidine in cardiac surgical procedures had higher survival during postoperative 5 yr in unadjusted analysis (hazard ratio [HR]=0.63; 95% confidence interval [CI], 0.51-0.78; P0.001), and after adjustment with PSM (HR=0.63; 95% CI, 0.45-0.89; P=0.009), IPTW (HR=0.70; 95% CI, 0.51-0.95; P=0.023), or overlap weighting (HR=0.67; 95% CI, 0.51-0.89; P=0.006). The 5-yr mortality rate after cardiac surgery was 13% and 20% in the dexmedetomidine and non-dexmedetomidine groups, respectively (PSM adjusted odds ratio=0.61; 95% CI, 0.42-0.89; P=0.010).Perioperative dexmedetomidine infusion was associated with improved 5-yr survival in patients undergoing cardiac surgery.

Recently, collaborative representation classification (CRC) has attracted extensive interest for hyperspectral images (HSIs) classification. However, for collaborative representation with Tikhonov (CRT), a testing sample is collaboratively represented by training samples from all the classes, which may result in high computational cost. In this article, we select the first $k$ class training samples that are nearest to the testing sample for representation, namely, $k$ -nearest class CRT (KNCCRT) algorithm. In order to improve the performance of KNCCRT for HSI classification, the idea of random subspace-based KNCCRT ensemble framework is proposed. KNCCRT is adopted as base classifier and random subspace (RS) contributes to diversity by selecting feature randomly. Moreover, to further increase the classification accuracy, shape-adaptive (SA) neighborhood constraint is utilized in RS ensemble framework to incorporate spatial information. Experimental results on three real hyperspectral data sets demonstrate the effectiveness of the proposed methods for HSI classification. The combination of KNCCRT and RS framework provides a reliable accuracy for HSI classification.

The combination of pervasive edge computing and blockchain technologies opens up significant possibilities for industrial Internet of Things (IIoT) applications, but there are several critical limitations regarding efficient storage and rapid response for large-scale low-delay IIoT scenarios. To address these limitations, in this article we propose a hierarchical edge-cloud blockchain called LayerChain . Specifically, to promote scalability, we design a layered structure to hierarchically store the blockchain data in multiple distributed clouds and edge nodes. Next, we propose a node classification method to accommodate differences between the edge nodes when deploying the blockchain. Moreover, to mitigate lengthy delays during block propagation, we propose a tree-based clustering algorithm where blocks are propagated through different clusters with a compressed tree depth. Simulation results show that our LayerChain efficiently reduces the system's resource requirements and block propagation time, making it well-suited for large-scale low-delay IIoT applications.

This paper proposes a new type of energy absorber with combined shrinking circular tubes for a high-speed train. An impact experiment is conducted to investigate the dynamic crushing performance of this energy absorber with combined shrinking circular tubes. The results show that the combined tubes experience steady dynamic shrinking deformation. Finite element (FE) models of the energy absorber are then developed, and the dynamic crushing forces are in good agreement with the impact test. A theoretical solution for the dynamic shrinking crushing load is derived. Based on the validated FE models, the effects of the friction coefficient, wall thickness and die radius on the dynamic crushing force and energy absorption are investigated. An increase in the wall thickness leads to a substantial growth in the maximum crushing force (Fmax) and specific energy absorption (SEA), but the growth rate of Fmax is much larger than that of the SEA as the wall thickness increases. In addition, comparing theoretical and FE results demonstrates that predictions of the dynamic steady-state forces for the combined shrinking circular tubes with different friction coefficients, wall thicknesses (t) and die radius (Rdie) are satisfactory. Finally, to improve the crashworthiness of the expanding circular tubes, Sobol’ sensitivity analysis is employed to analyze the effects of the design parameters (t and Rdie) on the objective responses (SEA and Fmax) using the Kriging model. A Pareto front of double optimization objective SEA and Fmax was obtained after being optimized by multiobjective particle swarm optimization (MOPSO). The results show that SEA and Fmax are positively correlated, and a balance between the SEA and Fmax was obtained at optimal point C (SEA = 13.09 kJ/kg, Fmax = 581.11 kN).

Backgrounds. The prevalence of diabetes has increased with the increase of obesity, and finding indicators to predict diabetes risk has become an urgent need. The purpose of this study is to compare the correlation between four anthropometric indices and the prevalence of diabetes. Methods. A total of 4052 participants aged 40 years and above were selected in Dehui City, Jilin Province, using a multistage stratified whole group sampling method. Face-to-face interviews and physical examinations were conducted. Multivariate logistic analysis was used. The values of BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were divided into quartiles (Q1: study participants ≥ 40 years of age, especially in females.

Corporate social responsibility (CSR) has become increasingly important. From the perspective of operations management, traditional non-CSR-compliant operations are less costly than CSR compliant operations but may be subject to the risk of being exposed to the public by third-party organizations such as Non-Governmental Organizations (NGOs) through external scrutiny. This exposure can negatively affect firms’ market share when customers are concerned about firms’ CSR compliance. This paper studies firms’ endogenous CSR compliance strategies, i.e., the incentive to adopt CSR compliant operations. We first consider a single firm's CSR compliance strategies, and then, we extend the analysis to the case of competition. We analyze how exogenous parameters, including the risk of exposure and cost premium, determine equilibrium CSR compliance strategies. We find that CSR compliant operations will be implemented either when the exposure risk is sufficiently high or when the cost premium is sufficiently low. We also discuss how competition affects firms’ CSR compliance strategies and whether firms perform better with CSR compliant operations in equilibrium. Our results show that, by adopting CSR compliant operations, firms will engage in a win-win equilibrium if the external risk is high or if the cost premium is low. Besides, we also conduct the analysis under Bertrand (price) competition. Based on these results, we provide managerial insights into when CSR compliant operations should be adopted in practice and how such adoption affects firms’ performance. Our results also imply that the practice of sustainability requires firms to consider both the external risk of exposure and cost premium.

The reasonable design and preparation of cheap, Earth-abundant, efficient, and durable heterogeneous electrocatalytic materials are a probable solution to the key problems of energy shortages and e...

Lanthanide (Ln) metal–organic frameworks (Ln-MOFs) have attracted attention in anti-counterfeiting and white light-emitting diodes (WLEDs) due to their high quantum efficiency, long lifetimes, and characteristic linear spectrum. However, Ln-MOFs have some disadvantages, such as harsh luminescence modulation, low transparency, and poor film formation. In this study, Ln-MOF (Ln = Eu and/or Tb)-modified TEMPO-oxidized cellulose nanofibrils were employed for preparing transparent nanopapers and luminescence modulation. These luminescent nanopapers achieved an excellent light emission color tuning from green, yellow, and red under 365 nm excitation, while 254 nm radiation on these nanopapers only emitted characteristic pink light. Thus, the luminescent nanopapers combined color-tuning and photo-switching properties through the control of Eu³⁺/Tb³⁺ molar ratio and excitation wavelength (λEₓ at 365 and 254 nm), respectively, which greatly improved them for anti-counterfeiting applications. In addition, Ln-MOFs endowed these nanopapers with excellent optical haze (>90%), such that softening of white light from WLEDs was realized in 254 nm-driven UV-LED chips, corresponding white light with good color quality [Commission International de I’Eclairage coordinates, correlated color temperature, and color-rendering index of (0.34, 0.36), 5536 K and 86, respectively].

Introduction Withholding the malignant bone tumors disclosure from patients is common in China. The purpose of the study was to explore the perceptions of patients, families, doctors, and nurses regarding the disclosure of malignant bone tumors in China. Method Semistructured interviews were conducted with 25 cases, consisting of 69 participants (14 patients, 25 family members, 17 doctors, and 13 nurses), and the transcripts were analysed using Colaizzi’s (1978) descriptive phenomenological analysis process. Results Five themes were identified: (1) doctors preferred to inform the family members first, (2) family members’ decisions depended on different situations, (3) the patients agreed that disclosure should be different for each person/personally, (4) care from nurses reduced the overreaction of patients, and (5) key points improve the informing quality. Discussion Family participatory cancer disclosure and multidisciplinary teams could improve the quality of cancer disclosure. Culturally congruent health care and culturally sensitive interventions in cancer disclosure are suggested.

Objective The aim of this study was to determine the clinical outcomes and long-term stability of individualized titanium mesh combined with free flap for orbital floor reconstruction after maxillectomy and to identify the risk factors for titanium mesh exposure. Material and methods The data of 66 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2011 and 2019 were retrospectively reviewed. Postoperative ophthalmic function and success of aesthetic restoration were assessed. Titanium mesh exposure was recorded and the risk factors were identified. Results Mean follow-up was for 24.8 months (range, 6-92 months). Ophthalmic function was successfully restored in 63/66 patients. Aesthetic restoration was not considered satisfactory by 10 patients. Titanium mesh exposure occurred in six patients (exposure rate, 9.1%). Preoperative radiotherapy was identified as an independent risk factor for mesh exposure (OR = 28.8, P = 0.006). Previous surgery, postoperative radiotherapy, pathological type of the primary lesion, the type of tissue flap applied, and the use of intraoperative navigation were not significant risk factors. Six patients with titanium mesh exposure underwent second surgery, but mesh exposure recurred in two patients due to insufficient soft tissue coverage. Conclusion Individualized titanium mesh with free flap can effectively restore maxilla-orbital defects. Preoperative radiotherapy is an independent predictor of postoperative titanium mesh exposure. Adequate soft tissue coverage of the mesh may reduce the risk of mesh exposure. Level of evidence Level 4 (case-control study) Laryngoscope, 2021.

Pavement maintenance and rehabilitation (M&R) records are important as they provide documentation that M&R treatment is being performed and completed appropriately. Moreover, the development of pavement performance models relies heavily on the quality of the condition data collected and on the M&R records. However, the history of pavement M&R activities is often missing or unavailable to highway agencies for many reasons. Without accurate M&R records, it is difficult to determine if a condition change between two consecutive inspections is the result of M&R intervention, deterioration, or measurement errors. In this paper, we employed deep-learning networks of a convolutional neural network (CNN) model, a long short-term memory (LSTM) model, and a CNN-LSTM combination model to automatically detect if an M&R treatment was applied to a pavement section during a given time period. Unlike conventional analysis methods so far followed, deep-learning techniques do not require any feature extraction. The maximum accuracy obtained for test data is 87.5% using CNN-LSTM.

Background Chemotherapy improves overall survival after surgery and radiotherapy for newly diagnosed high-risk IDH-mutant low-grade gliomas (LGGs), but a proportion of patients treated with temozolomide (TMZ) will develop recurrent tumors with TMZ-induced hypermutation. We aimed to determine the prevalence of TMZ-induced hypermutation at recurrence and prognostic implications. Methods We sequenced recurrent tumors from 82 patients with initially low-grade IDH-mutant gliomas who underwent reoperation and correlated hypermutation status with grade at recurrence and subsequent clinical outcomes. Results Hypermutation was associated with high-grade disease at the time of reoperation (OR 12.0 95% CI 2.5-115.5, P = .002) and was identified at transformation in 57% of recurrent LGGs previously exposed to TMZ. After anaplastic (grade III) transformation, hypermutation was associated with shorter survival on univariate and multivariate analysis (HR 3.4, 95% CI 1.2-9.9, P = .024), controlling for tumor grade, subtype, age, and prior radiotherapy. The effect of hypermutation on survival after transformation was validated in an independent, published dataset. Hypermutated (HM) tumors were more likely to develop discontiguous foci of disease in the brain and spine (P = .003). To estimate the overall incidence of high-grade transformation among low-grade IDH-mutant tumors, data from a phase II trial of TMZ for LGG were analyzed. Eight-year transformation-free survival was 53.8% (95% CI 42.8-69.2), and 61% of analyzed transformed cases were HM. Conclusions TMZ-induced hypermutation is a common event in transformed LGG previously treated with TMZ and is associated with worse prognosis and development of discontiguous disease after recurrence. These findings impact tumor classification at recurrence, prognostication, and clinical trial design.

Background We sought to compare the prognostic significance of different preoperative complete blood count cell ratios in patients with oral cavity squamous cell carcinoma (OSCC) treated with surgery and postoperative radiotherapy (PORT). Methods We retrospectively reviewed the clinical records of 890 patients with OSCC who were treated with surgery and PORT. The following preoperative complete blood count cell ratios were collected: neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and lymphocyte‐to‐monocyte ratio (LMR). Overall survival (OS), local control, regional control, and distant control (DC) served as the main outcomes of interest. Results The results of multivariate analysis in the entire study cohort revealed that a low NLR was the only independently favorable marker of both OS (adjusted hazard ratio [HR]: 0.794, 95% confidence interval (CI): 0.656–0.961, bootstrap p = 0.028) and DC (adjusted HR: 0.659, 95% CI: 0.478–0.909, bootstrap p = 0.015). Both LMR and PLR were not retained in the model as independent predictors. Subgroup analyses in high‐risk patients (i.e., those bearing T4 disease, N3 disease, or poor differentiation) revealed that a high NLR was a significant adverse risk factor for both OS and DC (all p, This relatively large cohort reports a comparative result: pretreatment high neutrophil‐to‐lymphocyte ratio (NLR) was an independent unfavorable risk factor for both overall survival and distant metastasis in patients with oral cavity squamous cell carcinoma (OSCC) who underwent surgery and postoperative radiotherapy. Lymphocyte‐to‐monocyte ratio (LMR) and platelet‐to‐lymphocyte ratio (PLR) were not significant.

High-dose (HD) cisplatin remains the standard of care with chemoradiation for locally advanced oropharyngeal cancer (OPC). Cooperative group trials mandate bolus-HD (100 mg/m2 × 1 day, every 3 weeks) cisplatin administration at the beginning of the week to optimize radiosensitization-a requirement which may be unnecessary. This analysis evaluates the impact of chemotherapy administration day of week (DOW) on outcomes. We also report our institutional experience with an alternate dosing schedule, split-HD (50 mg/m2 × 2 days, every 3 weeks). We retrospectively reviewed 435 definitive chemoradiation OPC patients from 10 December 2001 to 23 December 2014. Those receiving non-HD cisplatin regimens or induction chemotherapy were excluded. Data collected included DOW, dosing schedule (bolus-HD vs split-HD), smoking, total cumulative dose (TCD), stage, Karnofsky Performance Status, human papillomavirus status and creatinine (baseline, peak and posttreatment baseline). Local failure (LF), regional failure (RF), locoregional failure (LRF), distant metastasis (DM), any failure (AF, either LRF or DM) and overall survival (OS) were calculated from radiation therapy start. Median follow-up was 8.0 years (1.8 months-17.0 years). DOW, dosing schedule and TCD were not associated with any outcomes in univariable or multivariable regression models. There was no statistically significant difference in creatinine or association with TCD in split-HD vs bolus-HD. There was no statistically significant association between DOW and outcomes, suggesting that cisplatin could be administered any day. Split-HD had no observed differences in outcomes, renal toxicity or TCD compared to bolus-HD cisplatin. Our data suggest that there is some flexibility of when and how to give HD cisplatin compared to clinical trial mandates.

An effective feature representation can boost recognition tasks in the sketch domain. Due to an abstract and diverse structure of the sketch relatively with a natural image, it is complex to generate a discriminative features representation for sketch recognition. Accordingly, this article presents a novel scheme for sketch recognition. It generates a discriminative features representation as a result of integrating asymmetry essential information from deep features. This information is kept as an original feature‐vector space for making a final decision. Specifically, five different well‐known pre‐trained deep convolutional neural networks (DCNNs), namely, AlexNet, VGGNet‐19, Inception V3, Xception, and InceptionResNetV2 are fine‐tuned and utilised for feature extraction. First, the high‐level deep layers of the networks were used to get multi‐features hierarchy from sketch images. Second, an entropy‐based neighbourhood component analysis was employed to optimise the fusion of features in order of rank from multiple different layers of various deep networks. Finally, the ranked features vector space was fed into the support vector machine (SVM) classifier for sketch classification outcomes. The performance of the proposed scheme is evaluated on two different sketch datasets such as TU‐Berlin and Sketchy for classification and retrieval tasks. Experimental outcomes demonstrate that the proposed scheme brings substantial improvement over human recognition accuracy and other state‐of‐the‐art algorithms.

Background Proton beam radiation therapy (PBRT) has dosimetric advantages compared to photon radiation therapy for the treatment of major salivary gland tumors (MSGTs). Methods Patients with non-metastatic MSGTs treated at a single proton therapy center from October 2013 to October 2018 were retrospectively reviewed. Results Sixty-eight patients with MSGTs were included and the most common site and histology were the parotid gland (75.0%) and adenoid cystic carcinoma (22.1%), respectively. The 3-year rates of locoregional control, progression-free survival, and overall survival were 95.1% (95% CI: 89.9%-100.0%), 80.7% (70.2%-92.7%), and 96.1% (95% CI: 90.9%-100.0%), respectively. Conclusion In a large cohort of MSGTs treated with PBRT, the rates of locoregional control were high in short-term follow-up and treatment was well tolerated.

We use a newsvendor model to investigate equilibrium contracting strategies and their impact on the members in two competing supply chains that are subject to inventory inaccuracy. The suppliers are Stackelberg leaders and can choose either a wholesale-price contract or consignment contract. As a result, we analyze three cases: the wholesale price contract case, consignment contract case, and hybrid contract case. We first analytically derive the optimal outcomes of each case and then analyze the equilibrium behaviors of suppliers and retailers under both symmetric and asymmetric settings. Our results show that the consignment contract is no longer the dominant strategy for dominant suppliers when inventory inaccuracy is considered, even though it is considered as the channel-coordinating contract format in the traditional supply chain. Specifically, in the symmetric case, the wholesale price contract is the equilibrium contracting strategy when inventory inaccuracy is below a certain threshold. In the asymmetric case, the hybrid scenario occurs when the high-cost supplier chooses the wholesale price contract, and the low-cost supplier chooses the consignment contract when inventory inaccuracy is less than a certain value. Furthermore, our results demonstrate that the threshold point of inventory inaccuracy is interrelated with the channel cost-sharing rate and level of chain-to-chain competition between supply chains.

BackgroundAlthough postoperative delirium is a frequent complication of surgery, little is known about risk factors for delirium occurring in the post-anaesthesia care unit (PACU). The aim of this study was to determine pre- and intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery.MethodsRRD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected perioperative data in 228 patients undergoing elective non-cardiovascular surgery under general anaesthesia and performed univariate and multivariate logistic regression to identify risk factors related to RRD. PACU and postoperative events were recorded to assess the outcome of RRD.ResultsFifty-seven patients (25%) developed RRD. On multivariate analysis, maintenance of anaesthesia with inhalation anaesthetic agents (OR = 6.294, 95% CI 1.4–28.8, corrected p= 0.03), malignant primary disease (OR = 3.464, 95% CI = 1.396–8.592, corrected p= 0.018), American Society of Anaesthesiologists Physical Status (ASA-PS) III–V (OR = 3.389, 95% CI = 1.401–8.201, corrected p= 0.018), elevated serum total or direct bilirubin (OR = 2.535, 95% CI = 1.006–6.388, corrected p= 0.049), and invasive surgery (OR = 2.431, 95% CI = 1.103–5.357, corrected p= 0.035) were identified as independent risk factors for RRD. RRD was associated with higher healthcare costs (31,428 yuan [17,872–43,674] versus 16,555 yuan [12,618–27,788], corrected p= 0.002), a longer median hospital stay (17 days [12–23.5] versus 11 days [9–17], corrected p= 0.002), and a longer postoperative stay (11 days [7–15] versus 7 days [5–10], corrected p= 0.002]).ConclusionsIdentifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes.

Screening and therapeutic programs for colorectal cancer (CRC) are invasive or not effective and unable to meet patient needs. Major advances in immunogenomics may change this status but need more exploration. Differentially expressed genes and immune-related genes (IRGs) were identified by computational methods. A prognostic model was established and validated based on survival-related IRGs via stepwise multivariate Cox regression analysis. Nine IRGs were selected and identified as survival-related genes. A 7-gene prognostic model could offer a preliminary and valid determination of risk in CRC patients. The area under the curve of the receiver operating characteristic was 0.672. The 7-gene prognostic model might be used as a novel prognostic tool in CRC patients.

Background Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. Materials and methods We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. Results Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. Conclusion Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. Video abstract Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.

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

The continuous development and wide application of CT in medical practice have raised public concern over the associated radiation dose to the patient. However, reducing the radiation dose may result in increasing the noise and artifacts, which may adversely interfere with the judgment and belief of radiologists. Therefore, we propose a low-dose CT denoising model based on multiscale parallel convolution neural network to improve the visual effect. Residual learning is utilized to reduce the difficulty of network learning, and batch normalization is adopted to solve the problem of performance degradation due to the increase in neural network layers. Specifically, we introduce the dilated convolution to expand the receptive field by inserting weights of zero in the standard convolution kernel, while not increasing the extra parameters. Furthermore, the multiscale parallel method is utilized to extract multiscale detail features from lung images. Compared to the traditional methods such as Wiener filter, NLM, and models based on CNN, e.g., SCNN, DnCNN, our extensive experimental results demonstrate that our proposed model (CT-ReCNN) can not only reduce the LDCT lung images noise level, but also retain more exact information as well.

BACKGROUND AND PURPOSE The burden of cervical arterial atherosclerosis, which is an important risk factor of stroke, is huge in China. The visceral adiposity index (VAI) is a convenient index that is related to a series of metabolic abnormalities and a variety of diseases, including cerebrovascular diseases. This study aimed to explore the relationship between VAI and cervical arterial atherosclerosis. METHODS This cross-sectional study used the multistage stratified random cluster sampling method to acquire a representative sample of residents aged ≥40 in the general population of northeast China. All participants completed a detailed questionnaire and provided blood samples. Cervical vascular ultrasound was performed by experienced ultrasound doctors. VAI was calculated by a well-established formula and analyzed by quartiles (Q1-Q4). RESULTS A total of 3688 people aged ≥40 years who underwent cervical arterial ultrasound were finally included, amongst whom 3.2% had increased intima-media thickness (IMT), 48.6% had carotid plaque and 4.0% had cervical artery stenosis (CAS). After adjusting for several parameters, little statistical significance was found between VAI and increased IMT; compared with the VAI-Q1 group, the VAI-Q2, VAI-Q3 and VAI-Q4 groups were more likely to have CAS [odds ratio (OR) 2.01, 95% confidence interval (CI) 1.17-3.43; OR 1.82, 95% CI 1.05-3.15; OR 1.79, 95% CI 1.03-3.12] and the VAI-Q3 and VAI-Q4 groups were at greater risk of carotid plaque (OR 1.30, 95% CI 1.05-1.62; OR 1.34, 95% CI 1.07-1.67). CONCLUSIONS The VAI was related to carotid plaque and CAS in the general population that is older than 40 years.

Crowdsourcing is a novel distributed problem-solving mechanism that can provide the collection and share of marine data in the Internet of Things for the smart ocean. Nevertheless, the privacy leakage issue caused by multirole information interaction in crowdsourcing brings a serious challenge to the smart ocean. In this article, we propose a crowdsourcing privacy protection scheme based on multiauthority ciphertext-policy attribute-based encryption to enhance privacy protection in the data sharing environment. In this scheme, we design an independent key component distribution approach through multiple authorities, which could effectively disperse the security responsibility from the crowdsourcing platform. Then, we present the idea of partial decryption on the platform to reduce the computing cost of mobile users and prevent the platform from snooping on users’ data. Moreover, we put forward an efficient attribute revocation mechanism and a task search function in the scheme to achieve dynamic on-demand services while ensuring the forward and backward security of tasks. Theoretical analysis proves the correctness of both decryption and keywords matching, and the security of each involved entity. The simulation results show that our proposed scheme achieves a significant improvement in reducing time consumption compared with several related schemes.

Mobile crowdsourcing is a promising strategy for trusted data collection in Internet-of-Things (IoT) applications. In this article, we propose a new fog-blockchain distributed approach for crowdsourcing reputation management to prevent user’s privacy leakage, malicious users’ participation, and reputation tampering in wireless IoT systems. To protect the user’s privacy, we design a cross-layer privacy protection model to separate the user’s identity and tasks flexibly by means of a hierarchical structure based on fog computing. Moreover, considering the multiconstraint requirement of crowdsourcing tasks, we present a multifactor reputation evaluation method to accurately identify malicious users. Furthermore, to solve the multi-identity problem of users on multiple fog nodes, we propose an adaptive fog-blockchain reputation storage method, which efficiently reduces the system resource consumption by analyzing the adaptive classification of fog nodes. Exhaustive experimental simulation results validate the security and efficiency of our proposed reputation management system.

Retinal segmentation is a prerequisite for quantifying retinal structural features and diagnosing related ophthalmic diseases. Canny operator is recognized as the best boundary detection operator so far, and is often used to obtain the initial boundary of the retina in retinal segmentation. However, the traditional Canny operator is susceptible to vascular shadows, vitreous artifacts, or noise interference in retinal segmentation, causing serious misdetection or missed detection. This paper proposed an improved Canny operator for automatic segmentation of retinal boundaries. The improved algorithm solves the problems of the traditional Canny operator by adding a multi-point boundary search step on the basis of the original method, and adjusts the convolution kernel. The algorithm was used to segment the retinal images of healthy subjects and age-related macular degeneration (AMD) patients; eleven retinal boundaries were identified and compared with the results of manual segmentation by the ophthalmologists. The average difference between the automatic and manual methods is: 2-6 microns (1~2 pixels) for healthy subjects and 3-10 microns (1~3 pixels) for AMD patients. Qualitative method is also used to verify the accuracy and stability of the algorithm. The percentage of “perfect segmentation” and “good segmentation” is 98% in healthy subjects and 94% in AMD patients. This algorithm can be used alone or in combination with other methods as an initial boundary detection algorithm. It is easy to understand and improve, and may become a useful tool for analyzing and diagnosing eye diseases.

BackgroundWe sought to investigate the prognostic impact of missed RT sessions in patients who had undergone surgery for oral cavity squamous cell carcinoma (OCSCC).MethodsThe study sample consisted of 905 patients with surgically treated OCSCC who fulfilled criteria of RT course ≤8 weeks. The study participants were divided into three groups based on the characteristics of missed RT, as follows: 1) early missed RT, 2) late missed RT, and 3) RT as scheduled.ResultsThe 5-year overall survival (OS) rates in the early missed RT, late missed RT, and RT as scheduled groups were 53.0, 58.1, and 64.5%, respectively (p = 0.046). In multivariate analysis, early missed RT was independently associated with both OS (hazard ratio (HR) = 1.486; 95% confidence interval (CI): 1.122–1.966;p = 0.006) and the occurrence of distant metastasis (HR = 1.644; 95% CI: 1.047–2.583;p = 0.031).ConclusionEarly missed RT was independently associated with a higher occurrence of distant metastasis and less favorable OS in patients who had undergone surgery for OCSCC.

Because of the national emergency triggered by the coronavirus disease 2019 (COVID‐19) pandemic, government‐mandated public health directives have drastically changed not only social norms but also the practice of oncologic medicine. Timely head and neck cancer (HNC) treatment must be prioritized, even during emergencies. Because severe acute respiratory syndrome coronavirus 2 predominantly resides in the sinonasal/oral/oropharyngeal tracts, nonessential mucosal procedures are restricted, and HNCs are being triaged toward nonsurgical treatments when cures are comparable. Consequently, radiation utilization will likely increase during this pandemic. Even in radiation oncology, standard in‐person and endoscopic evaluations are being restrained to limit exposure risks and preserve personal protective equipment for other frontline workers. The authors have implemented telemedicine and multidisciplinary conferences to continue to offer standard‐of‐care HNC treatments during this uniquely challenging time. Because of the lack of feasibility data on telemedicine for HNC, they report their early experience at a high‐volume cancer center at the domestic epicenter of the COVID‐19 crisis., Cancer care is undeniably affected by the coronavirus disease 2019 (COVID‐19) public health emergency, but quality cancer care must persist. A high‐volume cancer center from the domestic epicenter of the COVID‐19 crisis shares its multidisciplinary approach to integrating current public health restrictions and adopting telemedicine to optimize the care of patients with head and neck cancer; it is hoped that this center's experience will provide helpful insights to oncology colleagues.

Background/Objective: Protein-protein interactions are essentials for most cellular processes and thus, unveiling how proteins interact with is a crucial question that can be better understood by recognizing which residues participate in the interaction. Although many computational approaches have been proposed to predict interface residues, their feature perspective and model learning ability are not enough to achieve ideal results. So, our objective is to improve the predictive performance under considering feature perspective and new learning algorithm. Method: In this study, we proposed an ensemble deep convolutional neural network, which explores the context and positional context of consecutive residues within a protein sub-sequence. Specifically, unlike the feature view of previous methods, ConvsPPIS uses evolutionary, physicochemical, and structural protein characteristics to construct their own feature graph respectively. After that, three independent deep convolutional neural networks are trained on each type of feature graph for learning the underlying pattern in sub-sequence. Lastly, we integrated those three deep networks into an ensemble predictor with leveraging complementary information of those features to predict potential interface residues. Results: Some comparative experiments have conducted through 10-fold cross-validation. The results indicated that ConvsPPIS achieved superior performance on DBv5-Sel dataset with an accuracy of 88%. Additional experiments on CAPRI-Alone dataset demonstrated ConvsPPIS has also better prediction performance. Conclusion: The ConvsPPIS method provided a new perspective to capture protein feature expression for identifying protein-protein interaction sites. The results proved the superiority of this method.

Background & Aims Glecaprevir/pibrentasvir is approved for treating adults infected with HCV genotypes 1–6. In clinical trials, glecaprevir/pibrentasvir was associated with high rates of sustained virologic response at post-treatment week 12 (SVR12) and was well tolerated. A systematic review and meta-analysis of the real-world effectiveness and safety of glecaprevir/pibrentasvir were undertaken. Methods Real-world studies reporting SVR12 in adults with HCV infection (n ≥20) treated with glecaprevir/pibrentasvir were identified in journal publications from January 1, 2017, to February 25, 2019, and congress presentations through April 14, 2019. Random-effects meta-analysis was used to determine SVR12 rates using data from ≥2 cohorts; intention-to-treat (ITT) analyses included patients treated with glecaprevir/pibrentasvir who had SVR12 data available, discontinued early, or were lost to follow-up; modified ITT (mITT) analyses excluded those with non-virologic failure. Naive pooling was used to calculate adverse event (AE) rates. Results Overall, 12,531 adults were treated with glecaprevir/pibrentasvir (18 cohorts). Of patients with post-treatment week 12 data, SVR12 rates were 96.7% (95% CI 95.4–98.1) in the ITT population (n = 8,583, 15 cohorts) and 98.1% (95% CI 97.1–99.2) in the mITT population (n = 7,001, 14 cohorts). SVR12 rates were ≥95% across subgroups (HCV genotype, cirrhosis status, treatment history, treatment duration, on-label treatment, and subgroups of interest). AEs were reported in 17.7% (1,271/7,199) of patients (8 cohorts). Serious AEs were reported in 1.0% (55/5,522) of patients (6 cohorts). The most frequent AEs were pruritus, fatigue, and headache. AE-related treatment discontinuations were reported in 0.6% (33/5,595) of patients (6 cohorts). Conclusions Consistent with clinical trials, real-world evidence indicates that glecaprevir/pibrentasvir is a well-tolerated and highly effective pangenotypic treatment for a broad range of HCV-infected patients. Lay summary It is important to assess treatments for hepatitis C virus (HCV) in the real world, as patient populations tend to be more diverse and potentially less adherent to treatment compared to those in clinical trials. Results from 18 studies performed in real-world clinics were pooled and analyzed to investigate the effectiveness and safety of a direct-acting antiviral combination (glecaprevir/pibrentasvir) in routine clinical practice. This analysis showed that glecaprevir/pibrentasvir is highly effective and well tolerated across all HCV genotypes and patient groups studied. It also showed that results seen in the real world are similar to the results seen in clinical trials, even in patients historically considered more challenging to treat.

Recently, collaborative representation classification (CRC) has attracted much attention for hyperspectral image analysis. In particular, tangent space CRC (TCRC) has achieved excellent performance for hyperspectral image classification in a simplified tangent space. In this article, novel Bagging-based TCRC (TCRC-bagging) and Boosting-based TCRC (TCRC-boosting) methods are proposed. The main idea of TCRC-bagging is to generate diverse TCRC classification results using the bootstrap sample method, which can enhance the accuracy and diversity of a single classifier simultaneously. For TCRC-boosting, it can provide the most informative training samples by changing their distributions dynamically for each base TCRC learner. The effectiveness of the proposed methods is validated using three real hyperspectral data sets. The experimental results show that both TCRC-bagging and TCRC-boosting outperform their single classifier counterpart. In particular, the TCRC-boosting provides superior performance compared with the TCRC-bagging.

With the rapid increase in service requirements driven by Internet of Things (IoT) networks, mobile crowdsourcing has become a compelling paradigm that can efficiently solve complex tasks in the physical world. Nevertheless, we found that most IoT tasks have constraints on deadline, location, and resource consumption, which limit the application of crowdsourcing platforms in the IoT networks. In this article, we innovatively propose a reliable fog-based temporal–spatial crowdsourcing for serving the above tasks. In this scenario, the key point is to achieve the best match of the attributes among tasks, fog nodes, and workers. As the bridge of the other two parts, fog nodes determine the orientation of tasks. Therefore, we present a temporal–spatial task allocation (TS-TA) scheme in the fog layer, aiming to make task results more reliable. In this scheme, we build a temporal–spatial attribute learning model based on the user behaviors. Then, we use the users’ interest attribute matching model to identify the candidate fog nodes that satisfy the requirements of temporal–spatial tasks. We choose the fog nodes with low spatial correlation that is benefit to defense the attack on the nodes in the intensive area. Meanwhile, we assign the redundancy nodes for intrusion response through replacing the attacked/negative node. Both theoretical and real-topology simulation results validate that the proposed scheme can get better performance in system resource consumption and system robustness compared with other benchmark schemes.

Purpose To demonstrate temporal lobe necrosis (TLN) rate and clinical/dose-volume factors associated with TLN in radiation-naïve patients with head and neck cancer treated with proton therapy where the field of radiation involved the skull base. Materials and Methods Medical records and dosimetric data for radiation-naïve patients with head and neck cancer receiving proton therapy to the skull base were retrospectively reviewed. Patients with Results Between 2013 and 2019, 234 patients were included. The median follow-up time was 22.5 months (range = 3.2–69.3). Overall TLN rates of any grade, ≥ grade 2, and ≥ grade 3 were 5.6% (N = 13), 2.1%, and 0.9%, respectively. The estimated 2-year TLN rate was 4.6%, and the 2-year rate of any brain necrosis was 6.8%. The median time to TLN was 20.9 months from proton completion. Absolute volume receiving 40, 50, 60, and 70 GyRBE (absolute volume [aV]); mean and maximum dose received by the temporal lobe; and dose to the 0.5, 1, and 2 cm3 volume receiving the maximum dose (D0.5cm3, D1cm3, and D2cm3, respectively) of the temporal lobe were associated with greater TLN risk while clinical parameters showed no correlation. Among volume parameters, aV50 gave maximum AUC (0.921), and D2cm3 gave the highest AUC (0.935) among dose parameters. The 11-cm3 cutoff value for aV50 and 62 GyRBE for D2cm3 showed maximum specificity and sensitivity. Conclusion The estimated 2-year TLN rate was 4.6% with a low rate of toxicities ≥grade 3; aV50 ≤11 cm3, D2cm3 ≤62 GyRBE and other cutoff values are suggested as constraints in proton therapy planning to minimize the risk of any grade TLN. Patients whose temporal lobe(s) unavoidably receive higher doses than these thresholds should be carefully followed with MRI after proton therapy.

Purpose Gut microbiota affects various physiological functions in the host and has crucial effects on the nervous system. There is increasing evidence of a correlation between gut microbiota and depression; however, the mechanisms underlying the regulation of depression-like behavior by gut microbiota remain unclear. In this study, we assessed the regulatory mechanism of gut microbiota on depression-like behavior in rats. Methods We transplanted fecal microbiota obtained from patients with depression and healthy individuals into germ-free (GF) rats (n=18) through fecal microbiota transplantation technology. Next, we assessed the affective behavior in the rats using the forced swimming test and a sucrose preference test. We used enzyme-linked immunosorbent assay (ELISA) to determine the hippocampal levels of 5-hydroxytryptamine (5-HT), dopamine (DA), and noradrenaline (NE) and the serum levels of corticosterone (CORT), adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-6 (IL-6), interleukin-1 (IL-1), interleukin-1 (IL-4), and interleukin-1 (IL-10). The mitochondrial morphology of small intestinal epithelial cells was observed through transmission electron microscopy. Results Rats that received fecal microbiota from patients with depression (depression microbiota) exhibited depression-like behavior. They presented decreased levels of hippocampal neurotransmitters, serum CORT levels, and anti-inflammatory cytokine levels, as well as increased ACTH, CRH, and serum levels of multiple pro-inflammatory cytokines. Observation of the mitochondria ultrastructure showed damaged mitochondria in the intestinal epithelial cells, significant endoplasmic reticulum expansion, and border aggregation of nuclear chromatin. Conclusion Our findings suggested that the depression-like behaviors induced by the depression microbiota through the neuroendocrine-immune-mitochondrial pathway, which were associated with neuroendocrine disorders, inflammatory responses, and mitochondrial damage.

This paper presents an investigation of the crashworthiness of expanding circular tube energy absorbers with a cylindrical anti-clamber under eccentric loading for subway vehicles. A finite-element model of energy absorbers is created and validated by two quasi-static experiments, and the strain rate sensitivity is evaluated using standard coefficients of the Cowper-Symonds constitutive model. A parametric study is performed using the validated finite-element models. It is found that the eccentric collision of two energy absorbers has a significant effect on their crashworthiness and leads to a decrease in the specific energy absorption (SEA) and an increase in the peak crushing force (PCF). The structural parameters of the energy absorber, including the wall thickness t, conical angle α, and punch radius rp, have a significant effect on its crashworthiness under different eccentric distances. Sobol sensitivity analysis is employed to analyze the effects of the design parameters (t, α, and rp) on the objective responses (EA and PCF). The results show that the design variables t and α have a greater effect on the sensitivity of the EA and PCF functions for the eccentric distance of h = 0 and 40 mm. The interaction between punch angle α and punch radius rp has significant effect on EA. To improve the crashworthiness of the expanding circular tubes, a multi-objective optimization is applied to achieve the maximum EA and minimum PCF values, and weight factors are introduced to investigate the crashworthiness optimization under single-eccentric loading and multiple-eccentric loading. The optimization solutions of the expanding circular tubes under different single-eccentric loadings have considerable implications. For multiple-eccentric loading, the results show that the crashworthiness of the expanding circular tube energy absorber can be better balanced.

The study was to compare the effectiveness of different epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced non-small-cell lung cancer (NSCLC) and received EGFR-TKIs as first-line therapy. This retrospective cohort study was conducted using data from real-world settings. Patients with stage IIIB and IV NSCLC and first received gefitinib, erlotinib, or afatinib between 2011 and 2015 were included. The date of the first claim for EGFR-TKIs was set as the index date. Study endpoints were all-cause death and treatment failure that was defined when patients added on or switched to chemotherapy or terminal care. A total of 5,940 patients, including 3,982 (67.0%) receiving gefitinib, 1,207 (20.3%) receiving erlotinib, and 751 (12.7%) receiving afatinib, were eligible for this study. The 1-year overall survival (OS) rates for gefitinib, erlotinib, and afatinib groups were 74% (95% confidence interval [CI]: 72-75%), 75% (95% CI: 73-77%), and 80% (95% CI: 77-83%), respectively. Compared to gefitinib, afatinib was associated with a lower risk of all-cause death (adjusted hazard ratio [aHR] = 0.82, 95% CI: 0.72-0.93) but not erlotinib (aHR = 0.95, 95% CI: 0.86-1.05). Similar results were also found regarding the effectiveness of treatment. All the three EGFR-TKIs showed no differences for both outcomes among patients with an Eastern Cooperative Oncology Group Performance Score of 2. The real-world data exhibited afatinib was more likely to be used for younger patients in a better condition than other EGFR inhibitors, and observed prolonged OS and treatment effectiveness compared to gefitinib after performing a multivariate Cox regression analysis.

Background Suicide has become the leading cause of death among 15-34 years old in China, and more attention should be paid to risk factors and prevention of suicidal ideation and suicide attempts. The school-based survey was conducted to test the associations of bullying behavior with suicidal ideation and suicide attempts, and to assess whether the biological gender can moderate these associations. Methods A multistage stratified cluster sampling method was used to recruit participants from high schools in Guizhou, China, and univariate and multivariate logistic regression models were fitted. Results A total of 23,392 students were included in the analysis, and 45.4% were boys. The mean age of the students was 15.2 (SD: 1.9) years. Overall, 3.8% (882) of the students were victims, 4.9% (1144) were bullies, and 3.2% (736) were bully-victims. A total of 18.9% of students reported having suicidal ideation, and 3.9% reported having suicide attempts. Victims (adjusted odds ratio [AOR]=2.15, 95% CI=1.84-2.51), bullies (AOR=3.17, 95% CI=2.78-3.62), and bully-victims (AOR=3.18, 95% CI=2.71-3.73) were at an elevated risk of suicidal ideation than neutrals; similar associations can be found in the associations between bullying behavior and suicide attempts. Further stratification analyses showed that the associations of being bullied or bullying others with suicidal ideation and suicide attempts were slightly stronger in girls than in boys. Conclusion Prevention or intervention programs are recommended to take the biological gender into consideration, and future studies are also warranted to investigate the reasons of differences by gender in the association of bullying and suicidal behavior.

The Road Side Unit (RSU) is an important part of the Internet of Vehicles (IoV), which collects a large number of user's privacy information and connects vehicles to the Internet. The current RSU is running with static configurations, and the adversary can get enough time to analyze the vulnerability of the RSU and launch attacks, which poses a huge threat to the privacy security of the IoV. Under this asymmetrical condition, the attackers occupy a predominant position, and it is difficult to fully defend. To solve the above asymmetry offense-defense problem, we adopt the moving target defense (MTD) to dynamically change the IP address of the RSU, which increases the difficulty of the attacker's attack. However, due to the unreasonable selection of the RSU's IP hopping frequency, it is difficult for the RSU's IP hopping to exert its defense effect or it may introduce excessive defense overheads. Given the above issue, we propose an intelligent offense and defense mechanism based on a differential game approach, which can adaptively adjust the RSU's IP hopping frequency and maximize its defense benefits. First, based on the offense and defense relationship, we model the RSU's IP hopping frequency intelligent arrangement as a differential game (i.e., IP hopping game) in which the attacker attempts to maximize his potential benefits, and the RSU manages to maximize its defense benefits. On this basis, we calculate a potential Nash equilibrium of the IP hopping game. Finally, simulation results show our proposed mechanism can adaptively adjust the RSU's IP hopping frequency according to the attack frequency and effectively defend attacks. Compared with the mechanisms with a fixed IP hopping frequency, our proposed mechanism can make up for the ineffectiveness of the fixed low-frequency IP hopping defense and avoid the excessive defense overheads of the fixed high-frequency IP hopping defense.

Surgical intervention is occasionally required for the treatment of pleural empyema. Semirigid thoracoscopy is a safe and successful surgical approach utilized by interventional pulmonologists, conventionally utilizing flexible forceps and suction as the main tools, but they can sometimes be inefficient for more complicated cases. In debriding a case of multiloculated empyema with semirigid thoracoscopy, we report the novel use of cryotherapy in clearing adhesions from the pleural cavity. We found using the cryoprobe to be more efficient than using forceps and suggest further investigation into its use in medical thoracoscopy.

The large-scale connectivity of Internet of Vehicles (IoV) is an important challenge for the Intelligent Transportation Systems (ITS). Intelligence vulnerability analysis is an excellent solution. However, existing methods for analyzing connectivity vulnerability have ignored the existence of critical areas in the system. Due to the heterogeneities of the IoV environments and services, the failure of some specific areas may seriously damage connectivity and system performance. To this end, in this paper we focus on both the dynamic connectivity and the critical-area integrity, and propose an intelligent vulnerability analysis method to effectively identify the critical area of extreme vulnerability. Specifically, we consider an intelligent analysis scenario in which roadside servers continuously learn IoV heterogeneous environment and dynamic topology, and then translate the learning results into a flexible disruption cost problem. Based on this, we utilize the spectral partitioning method to identify the minimum-cost set of topological elements whose failure not only severely damages system connectivity but also disrupts its critical areas. Furthermore, we confirm that the identified set can be used to optimize disruption cost problem, thus intelligently improving vulnerability. Simulation results show that our proposed method can effectively identify vulnerable elements and prevent significant loss in the IoV system connectivity and performance.

In recent years, online education has boomed. However, online business ethics education faces a challenge in which the lack of communication among teachers and students leads to a decline in teachi...

Summary In this paper, a three‐layered medium Earth orbit (MEO), geostationary Earth orbit (GEO), and inclined geosynchronous orbit (IGSO) satellite network (IGMSN) is presented. Based on the idea ...