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This study aimed to assess the safety and effectiveness of modified endoscopic technique with a single portal from an external carpal tunnel approach for surgical operations in a suprafascial plane superficial to the transverse carpal ligament. Reversible nerve injury risk is threefold greater with a conventional endoscopic method than with open carpal tunnel release (OCTR), and this suprafascial plane endoscopic release (SPER) should circumvent the problem of hardware in the carpal tunnel encountered with the conventional endoscopic method and liable to cause iatrogenic damage to the median nerve. However, the surgical consequences of the new technique have not been studied. To fill this gap, a retrospective therapeutic study was conducted to compare negative outcomes versus open surgery. The Accordion Severity Grading System was used to grade complications from 0 to 3 according to necessity of treatment. Sequela and failure rates were also compared between the SPER and OCTR groups. Eighty-eight cases in 72 patients with idiopathic carpal tunnel syndrome (ICTS) met the inclusion criteria. SPER was performed in 28 hands in 27 patients, and OCTR in 60 hands in 49 patients. The results showed no significant difference in complication, sequela, or failure rates between groups (p > 0.05). Suprafascial plane endoscopic release, has certain advantages over the open method and was validated as a safe and effective method of treating ICTS.

Exposure and engagement to the media coverage of Chinese brands among average consumers outside of the domestic Chinese market can serve as an important measure of China’s global influence. In this study, we analyzed the audience engagement of online articles about the top 20 Chinese brands from over 5000 web publishers around the world in a period of 5 months from October 2017 to February 2018. Specific results from our analyses point to a lack of sustained effort, careful coordination, and proper control in these companies’ public relations and crisis communication. The study also reveals a larger problem in China’s public diplomacy efforts. The top Chinese firms, despite their high market value, are yet to establish soft influence internationally. The global media engagements of Chinese companies are largely driven, passively, by special events and crises. Moreover, our study offers a new way of studying China and global media by leveraging large sets of industry data and adopting a set of audience matrices commonly used by media publishers to examine social science research questions.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Purpose: To report the patterns of use of hypofractionated radiotherapy (HFRT) (≤16 fractions)in breast cancer and ductal carcinoma in situ (DCIS) patients in Ontario, Canada from 2009 to 2015 and identify factors related to HFRT use. Methods: A retrospective cohort study of Ontario women diagnosed with breast cancer or DCIS followed by adjuvant breast or chest wall radiation (RT) from 2009 to 2015 was conducted using data from the Institute for Clinical Evaluative Sciences (ICES). Logistic regression models were used to identify factors associated with HFRT use. Physician was included as a random effect. To calculate the potential amount of time that could be saved if all patients were to receive 16 fractions of HFRT, the number of extra RT treatments after the 16th visit was multiplied by the median amount of time spent to treat one patient at our cancer centre (8.76 minutes). This time was found with Sunnybrook Health Sciences Centre data collected from October 2017 to March 2018 (n=523) and represents the amount of time from when a patient enters the RT unit for treatment setup, until the RT beam is turned off. Results: A total of 42,072 patients were included. Most patients were aged between 50 and 69 years old (56.7%) with stage I or II breast cancer (74.6%) and had breast conserving surgery (BCS) (76.9%). Half previously received chemotherapy and 7.9% were DCIS patients. Use of sequential boost, simultaneous boost, and regional nodal RT was 17.2%, 3.1%, and 31.7% respectively. Institutional variation in HFRT use ranged from 27.5% to 71.6%. HFRT use has increased in all patient populations over the study period. HFRT use was more common in breast cancer and DCIS patients with BCS than in chest wall and nodal RT. Simultaneous boost (OR=0.09), nodal RT (OR=0.08), previous chemotherapy (OR=0.7), stage 0, II, and III breast cancer (OR=0.06 relative to stage I), were correlated with less HFRT use. Older age, later year of diagnosis, sequential boost (OR=0.09), BCS and no surgery (OR=1.2, 1.5 relative to mastectomy) were correlated with higher HFRT use. Institution was significantly correlated to HFRT use. The variance estimate for the physician random effect was 0.33 (p Trends in the use of HFRT (%) from 2009 to 2015 for DCIS and breast cancer patients in Ontario.YearStage I-IV + BCS + Breast RTStage I-IV + BCS + Breast + Nodal RTStage I-IV + Mastectomy + Breast RTStage I-IV + Mastectomy + Breast + Nodal RTDCIS + BCS200962.610.329.09.545.2201062.06.323.76.951.2201162.24.121.34.752.7201263.79.621.711.452.0201365.112.629.315.057.3201469.37.835.415.164.5201573.711.839.217.573.4BCS: breast conserving surgery, RT: radiation treatment Conclusions: HFRT use in Ontario has increased over time for all patient populations, and reflects the current evidence supporting HFRT in different patient populations, with lower HFRT use seen in chest wall and nodal RT and higher HFRT use in early-stage breast cancer patients with BCS. Citation Format: Chow E, Chan S, Yao Z, Sutradhar R, Lee J, Wan BA, Paszat L. Fractionation patterns in adjuvant breast radiotherapy in Ontario, Canada from 2009 to 2015 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-05.

Many emerging technologies, such as our smartphones and computers, extend the capabilities of our cognitive systems by serving as external memory and sources of information. Despite such positive impacts, the increasingly ubiquitous human-computer partnership may fundamentally alter the ways in which humans perceive and evaluate themselves. This study examines features of technological devices that influence evaluations of personal knowledge (i.e., knowledge "in the head"). In two experiments, participants evaluated their cognitive abilities after using a technological device to find answers to trivia questions. In Experiment 1, participants who retrieved answers from the internet reported higher cognitive evaluations compared to participants who could not use the internet. Routine use of the device used to access the internet moderated this effect. In Experiment 2, participants who used their own device to find answers reported higher cognitive evaluations compared to participants who used a control device, and participants who used a smartphone reported higher cognitive evaluations compared to participants who used a laptop. We conclude by highlighting several variables emanating from both the sources present through the device interface (e.g., search engine), and the physical manifestation of the device itself, which may contribute to illusions of internal knowledge through technology use.

Objectives This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Background Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. Methods Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. Results The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m–labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. Conclusions This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.

Recent developments in superconducting radio-frequency (SRF) research have resulted in significant increases of cavity performance. Advances have been made in both reducing rf surface resistance and pushing the readily achievable accelerating gradient by using novel SRF cavity treatments including surface processing, custom heat treatments, and flux expulsion. These developments have been largely driven by specific tests on single-cell elliptical cavities, while TEM cavities have typically been designed and developed as specific to a project application and not as standard test articles that could be replicated across various labs. To address this, two purpose-built research cavities, one quarter-wave and one half-wave resonator, have been designed and built to allow characterization of TEM-mode cavities with standard and novel surface treatments. The cavities are intended as the TEM-mode equivalent to the 1.3 GHz single-cell cavity, which is the essential tool for high-frequency cavity research. Given their coaxial structure, the cavities allow testing at the fundamental mode and higher harmonics, giving unique insight into the role of rf frequency on fundamental loss mechanisms from intrinsic and extrinsic sources. In this paper, the cavities and testing infrastructure are described, and the first performance measurements of both cavities are presented. Temperature-dependent surface resistance data are analyzed to extract both the temperature-dependent and temperature-independent components and their dependence on the rf field and frequency. In particular, the temperature-dependent component was found to be at low fields ∝ω^{1.8(1)} at 4.2 K and ∝ω^{1.7(2)} at 2 K, agreeing fairly well with the theoretical model. The growth of the temperature-dependent surface resistance with increasing field amplitude matches both exponential and quadratic growth models fairly well in the examined range. The independent component is determined to be ∝ω^{0.7(1)}, matching roughly with anomalous losses, while no clear field dependence was determined. In addition, first measurements of a 120 °C baking treatment and of the external magnetic field sensitivity are presented.

Background Napping is a habit prevalent worldwide and occurs from an early age. Some sleep specialists have suggested it as a potential public health tool due to the prevalence of sleep disorder. However, the association between napping and the risk of cardiovascular disease (CVD) and all-cause mortality remains unclear. Purpose To assess the association between napping and the risk of CVD and all-cause mortality. Methods We conducted a systematic search of Medline, Embase and Cochrane databases from inception through December 2019 for prospective cohort studies investigating the association between napping and the risk of CVD and/or all-cause mortality. Overall estimates were calculated using random effect models with inverse variance weighting. Dose-response meta-analysis was performed using restricted cubic spline models. The results were reported as hazard ratio (HR) and 95% confidence interval (CI). Results A total of 313651 participants (57.8% female, 38.9% took naps) from 20 cohort studies were included in the analysis. Overall, pooled analysis detected no association between daytime nap and CVD (HR 1.13, 95% CI 0.99–1.28). However, in subgroup analysis including only participants who were female (HR 1.31, 95% CI 1.09–1.58), older (age>65 years) (HR 1.36, 95% CI 1.07–1.72), or took a longer nap (nap time>60 minutes) (HR 1.34, 95% CI 1.05–1.63), napping was significantly associated with a higher risk of CVD comparing to not napping. All-cause mortality was associated with napping overall (HR 1.19, 95% CI 1.12–1.26), and effect sizes were even more pronounced in females (HR 1.22, 95% CI 1.13–1.31), older participants (HR 1.27, 95% CI 1.11–1.45) and those who took a long nap (HR 1.30, 95% CI 1.12–1.47). Furthermore, after stratifying participants by night sleep time (6h/day), no significant association was detected except those who slept >6h/day at night and took a long nap (HR 1.13, 95% CI 1.03–1.24). Dose-response analysis showed a J-curve relation between nap time and CVD (Figure 1). The HR decreased from 0 to 25 min/day, followed by a sharp increase in the risk at longer times. A positive linear relationship between nap time and all-cause mortality was also observed. Conclusion Long napping over 60 minutes per day is associated with increased risks of CVD and all-cause mortality. Night sleep duration may play a role in the relation between napping and all-cause mortality. Further, large-scale prospective cohort studies need to confirm our conclusion and investigate the underlying mechanisms driving these associations. Funding Acknowledgement Type of funding source: None

Objectives This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). Background Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. Methods Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. Results Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. Conclusions Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.

Surface emissivity has a significant impact on atmospheric parameter retrievals from microwave sounding instruments. To reduce the dependence of retrievals on surface emissivity, a double channel differences equation is deduced, and a corresponding retrieval scheme is constructed. Retrieval experiments are performed using Advanced Microwave Sounding Unit‐A (AMSU‐A) and Microwave Humidity Sounder (MHS) simulations and global measurements. Simulation experiments show that the double channel differences scheme can reduce the root mean square errors (RMSE) of the temperature and humidity profiles in the middle and lower atmosphere. Retrieval experiments based on AMSU‐A and MHS global measurements show that the proposed scheme can significantly reduce the RMSE of temperature profiles in the lower atmosphere and humidity profiles in the middle and lower atmosphere for cloudy and cloudless conditions, different surface types, and different scan angles, with maximum reduction values of 0.64 K and 9.03%, respectively. Regarding RMSE improvement, that of the cloudy condition is greater than that of the cloudless condition, that of the land is greater than that of the coast and the sea, and there is no significant dependence on the scan angles. The double channel differences scheme is very sensitive to initial near‐surface temperatures. Reducing the initial near‐surface temperature error can significantly improve the temperature retrieval accuracy below 900 hPa, with maximum reduction value of 3.25 K.

Summary Emerging evidence has linked the exosomes to many immunological disorders, including infectious diseases. However, knowledge regarding the role of exosomes in Helicobacter pylori infection is limited. Here, we show that serum exosomes from chronic gastritis patients with H. pylori infection (Hp exosomes) stimulate the expression of the soluble interleukin (IL)-6 receptor (sIL-6R), which is involved in IL-6 trans-signalling in gastric epithelial cells. Interestingly, sIL-6R up-regulates expression of the proinflammatory cytokine IL-1α, and the neutralization of sIL-6R suppresses IL-1α secretion. Thus, Hp exosomes regulate IL-1α expression via sIL-6R-mediated IL-6 trans-signaling. Altogether, this study reveals a novel perspective in which exosomes play a vital role in immunological mechanisms during H. pylori infection.

Aim To determine the prevalence of adverse clinical outcomes, the rates of healthcare utilization, and the incidence of post-partum Type 2 diabetes in refugees with gestational diabetes (GDM), compared with other immigrants and non-immigrants. Methods A population-based cohort study was conducted using healthcare databases in Ontario, Canada. Over 40 000 women with GDM having singleton live births between 2002 and 2014 were identified. We identified GDM adverse outcomes such as macrosomia, pre-eclampsia and respiratory distress syndrome. Antenatal and newborn healthcare utilization were ascertained. Women were then followed for diagnosis of diabetes post-partum. Results Both refugees and other immigrants had a lower rate than non-immigrants of many adverse GDM outcomes, including pre-eclampsia [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.44–0.95 and 0.61, 95% CI 0.52–0.72, respectively], preterm birth (RR 0.87, 95% CI 0.75–0.995 and 0.85, 95% CI 0.80–0.91, respectively), and respiratory distress syndrome (RR 0.83, 95% CI 0.70–0.97 and 0.78, 95% CI 0.72–0.84, respectively). However, refugees were less likely to attend well-baby care in time for the first routine vaccination (RR 0.92, 95% CI 0.88–0.95). Incidence of post-partum diabetes was high in all groups, but refugee women were at increased risk (hazard ratio 1.23, 95% CI 1.11–1.37). Conclusions Despite different circumstances leading to migration, refugees have a similar ‘healthy immigrant effect’ to other immigrants, with respect to adverse GDM outcomes. However, newborns of refugees were less likely to have well-baby care, and refugee women were also at especially high risk of developing diabetes post-partum. These are both important public health issues.

This study examines the process by which Facebook users regulate their interpersonal privacy and information sharing. By tracing the influence of gender, Facebook usage, and privacy-protecting behaviors that are determined by knowledge and attitude, this research identifies a dynamic management process through which Facebook users maintain personal and interpersonal boundaries. Two distinct strategies are used – a privacy-setting control and a self-disclosure control. Based on data collected in a survey of 432 college students conducted in Hong Kong, our results suggest that different uses of Facebook activities (i.e., social interaction, social browsing, and entertainment) can be used to predict different boundary management strategies. Gender and privacy-related psychological factors (i.e., privacy literacy and concern about privacy) also showed significant effects. We concluded that the privacy setting options available on social networking sites such as Facebook were useful in providing users with a b...

Benralizumab is a humanized, afucosylated, anti-interleukin-5 receptor α, immunoglobulin G (IgG) 1 κ monoclonal antibody. We developed a population pharmacokinetic (PK)/pharmacodynamic (PD) model for benralizumab by analyzing PK and blood eosinophil count data from two healthy volunteer studies (N = 48) and four studies in patients with asthma (N = 152). Benralizumab PK was dose-proportional and adequately described by a two-compartment model with first-order elimination from the central compartment and first-order absorption from the subcutaneous dosing site. The estimated systemic clearance and volume of distribution were typical for human IgG. Body weight and high-titer antidrug antibodies were identified as relevant covariates influencing the PK of benralizumab. Depletion of blood eosinophil counts was depicted by a modified transit model in which benralizumab induced depletion of eosinophils in each age compartment. Stochastic simulations supported an every-8-week dosing schedule of benralizumab for a phase IIb study in patients with uncontrolled asthma.

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for severe aplastic anemia (SAA) is mainly limited by the high incidence of graft failure and GvHD. Mesenchymal stem cells (MSCs) have been shown to support hematopoiesis in vivo and to display potent immunosuppressive effects to prevent or treat GvHD after HSCT. In a multicenter phase II trial, we developed an approach with co-transplantation of MSCs in patients undergoing haplo-HSCT. Forty-four patients with SAA were included. The conditioning regimen included busulfan, cyclophosphamide and thymoglobulin (ATG). The recipients received cyclosporin A (CsA), mycophenolate mofetil and short-term methotrexate for GvHD prophylaxis. Three out of 44 patients, who died early before hematopoietic engraftment, were not assessed. Evaluable patients (97.6%; 40/41) achieved hematopoietic reconstitution and sustained full donor chimerism. The median time for myeloid engraftment was 12 days (range 8-21 days) and for platelet engraftment was 19 days (range 8-154 days). The incidence was 29.3% for grade II-IV acute GvHD and 14.6% for chronic GvHD. The overall survival was 77.3% with a median 12-month (range 0.9-30.8) follow-up for surviving patients. These data suggest that co-transplantation of MSCs could reduce the risk of graft failure and severe GvHD in haplo-HSCT for SAA.

Background Sarcopenia is emerging as an important public health problem, and evidences have determined that poor sleep is associated with muscle strength, but the potential effects of excessive daytime sleepiness (EDS), snoring and witnessed apnea on handgrip strength have not been evaluated. Aim We aimed to examine the association between EDS, snoring, witnessed apnea and muscle strength in an adult population. Design Cross-sectional study. Methods This cross-sectional study comprised 19 434 adults. Handgrip strength was measured using a handheld digital dynamometer. EDS was assessed by Epworth Sleepiness Scale, snoring and witnessed apnea during sleep were reported through simple yes/no questions. Analysis of covariance was carried out to determine the association between EDS with snoring or witnessed apnea and muscle strength. Results The means (95% confidence interval) for average handgrip strength/body weight (kg/kg) across symptoms categories were 0.396 (0.333–0.472), 0.393 (0.330–0.467), 0.396 (0.333–0.471) and 0.386 (0.325–0.460) (P Conclusions Self-reported EDS accompanied with snoring or apnea is associated with lowest handgrip strength, independently of confounding factors. Whether improvement of EDS, snoring and apnea, can ameliorate age-associated decline in muscle strength warrants further studies.

Objectives The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. Background It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. Methods In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. Results The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p Conclusions Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.

In order to improve the efficiency of industrial environment in Anhui Province and promote the coordinated development of industrial production and environmental protection, industrial waste water discharge, air particulate matter discharge and solid waste discharge are regarded as undesirable outputs. The model measures the industrial environmental efficiency of 16 prefecture-level cities in Anhui Province from 2013 to 2018, and fully considers the differences between regions; then, based on the analysis of the total factor productivity of the industrial environment, the impact of industrial environmental efficiency in each province is found factor. Finally, through the construction of the Malmquist index model, the spatial-temporal change trend of industrial environmental efficiency in Anhui Province was analyzed. Studies have shown that there is a clear difference in the efficiency of the industrial environment in Anhui Province. The change trend of TFP and TEC is basically the same. TEC is the main influencing factor of TFP. All regions should pay attention to technological innovation, adjust the existing industrial production model, coordinate the relationship between industrial development and resource environmental protection, and gradually improve their own industrial environmental efficiency.

New digital technologies, such as our smartphones and computers, often serve as extended cognitive systems to construct the full range of our cognitive capabilities. Given that capacity of computing technologies has reached a degree of speed and efficiency that many find comparable to (or surpassing) the rate of human thought, our devices have become valuable memory partners to us. In spite of its positive impacts, such as expanding the capacity of human cognition and improving the efficiency of information search, the increasingly ubiquitous human-computer partnership may fundamentally alter the ways in which humans perceive themselves.This study examines attributes of technology that may lead people to misattribute technology-enabled outcomes to the self while judging their own knowledge. Participants evaluated their cognitive abilities after using a device to find answers to trivia questions. Participants who used their own device reported inflated cognitive evaluations compared to participants who used a lab device, and participants who used a mobile device reported inflated cognitive evaluations compared laptop users. This research extends the scope of existing empirical work on technology-mediated judgments of knowledge by demonstrating the role of the device itself in influencing judgments. Familiarity with the basic features of a device, time spent completing the trivia questions, and device attachment predicted knowledge confidence over and above the personal and mobile device manipulations' significant unique prediction. Our findings highlight a number of technological attributes emanating from both the sources present through the device interface (e.g., search engine), and the physical manifestation of the device itself, which may contribute to illusions of internal knowledge through technology use.

This study aims to utilize the Decision-making Trial and Evaluation Laboratory (DEMATEL) approach to recognize the key performance evaluation indicators (PEIs) of green supply chain. Twenty indicators of performance evaluation with six dimensions were identified from literature review and interview with six experts come from two different groups which consists of practitioners and academic scholars respectively, each expert has drawn a directed graph between the twenty different performance indicators. By considering the interrelationships among these indicators, DEMATEL was applied to deal with the importance and causal relationships among the performance evaluation indicators of green supply chain management. Obtained results show that the top management commitment and support, green organizational culture, willingness towards investment, government support policy are four most significant PEIs for the success of GSCM. By identifying the structures and interrelationships, it can offer an insight for managers to understand cause-effort relationships and select the key PEIs which can be used to help them to improve GSCM performance.

Background Diffuse cutaneous systemic sclerosis (dcSSc) is a severe subtype of SSc, a rare, chronic autoimmune connective tissue disease associated with significant morbidity and mortality, and with reduced quality of life. Currently, there are no approved disease-modifying therapies to treat the vascular and fibrotic damage in patients with dcSSc. Soluble guanylate cyclase stimulators, such as riociguat, target the transforming growth factor beta pathway, inhibiting signalling through non-SMAD pathways. They have been shown to inhibit dermal fibrosis in several animal models and to ameliorate fibrosis of the skin and intestine in bleomycin-induced fibrosis and experimental chronic graft-versus-host disease.1 These preclinical data suggest that riociguat has vascular and antifibrotic properties that may be beneficial in dcSSc, potentially delaying disease progression. Objectives RISE-SSc (NCT02283762) is an international, multicentre, randomised, double-blind, placebo-controlled, parallel-group, Phase II study to assess the efficacy and safety of treatment with riociguat versus placebo in patients with dcSSc. The primary efficacy endpoint is change in modified Rodnan skin score (mRSS) from baseline to Week 52. Methods Eligibility criteria include a disease duration of ≤18 months and mRSS of 10–22, parameters identified to be predictors of progression of skin fibrosis.2 Patients were randomised (1:1) to treatment with riociguat (adjusted up to 2.5 mg tid over the first 10 weeks) or placebo for a total of 52 weeks. The double-blind phase will be followed by an open-label extension phase for up to 6 years where all patients receive riociguat. Results Study recruitment was completed on 30 Dec 2016 and 121 patients have been randomised. Mean±SD age at inclusion was 50.7±12.3 years (range 18–79) and 76% (n=92) were female. At baseline the mean±SD mRSS was 16.8±3.7 (range 10–22) and disease duration was 8.8±5.5 months (range 0.5–18.5). Almost 70% of the patients tested positive for either anti-SCL-70 (43%) or anti-RNA polymerase III (25%) antibodies, while 32% of patients tested negative for these two antibodies. Swollen and tender joint counts were present in 38 (31.4%) and 51 (42.1%) patients, respectively, while 35 patients (28.9%) had tendon friction rubs. Digital ulcers were present in 15 patients (12.4%) at baseline. Conclusions RISE-SSc has a unique trial design with a cohort enriched for disease progressors,2 which is reflected in the baseline characteristics of the randomised patients. Results of the RISE-SSc study will provide data to inform not only the efficacy, safety and tolerability of riociguat treatment in patients with dcSSc, but also the feasibility of a new trial design based on cohort enrichment. References Khanna D, et al. J Scleroderma Relat Disord 2016;1:186–93. Maurer B, et al. Ann Rheum Dis 2015;74:1124–31. Disclosure of Interest D. Khanna Grant/research support from: Bayer, BMS, Genentech/Roche, Sanofi-Aventis, NIH K24AR063120, Consultant for: Actelion, Bayer, Covis, Cytori, EMD Serono, Genentech/Roche, Gilead, GSK, Sanofi-Aventis, Y. Allanore Grant/research support from: BMS, Genentech-Roche, Inventiva, Pfizer, Sanofi, Consultant for: Actelion, Bayer, Biogen, Genentech-Roche, Galapagos, Medac, Pfizer, Sanofi, Servier, UCB, C. Denton Grant/research support from: CSL Behring, Bayer, GSK, Inventiva, Consultant for: Actelion, Bayer, GSK, Merck-Serono, Genentech-Roche, Inventiva, Sanofi-Aventis, Boehringer Ingelheim, M. Matucci-Cerinic Grant/research support from: BMS, Pfizer, Actelion, MSD, Lilly, Speakers bureau: Pfizer, BMS, Actelion, Lilly, J. Pope Grant/research support from: Bayer, Merck, Consultant for: BMS, Roche, Bayer, Merck, Z. Yao Employee of: Bayer Healthcare Company Ltd, Beijing, China, J. Curram Shareholder of: Bayer AG, Employee of: Bayer plc, J. de Oliveira Pena Employee of: Bayer US LLC, O. Distler Grant/research support from: Actelion, Bayer, Boehringer Ingelheim, Pfizer, Sanofi, Consultant for: 4 D Science, Actelion, Active Biotec, Bayer, BiogenIdec, BMS, Boehringer Ingelheim, ChemomAb, EpiPharm, espeRare foundation, Genentech/Roche, GSK, Inventiva, Lilly, medac, Mepha, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Pfizer, Sanofi, Serodapharm, Sinoxa, Speakers bureau: AbbVie, iQone Healthcare, Mepha

Aim To describe the imaging features of rosette-forming glioneuronal tumours (RGNTs) to enable accurate diagnosis. Materials and methods Image data and clinical findings for seven patients with histopathologically confirmed RGNTs were studied comprehensively. Results Six neoplasms were located near the midline and all were relatively well circumscribed. Most lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. Furthermore, five tumours were hypointense on diffusion-weighted imaging (DWI). On computed tomography (CT), the solid tumour portions showed hypo-attenuation compared with brain parenchyma. Obvious calcification was found in two cases, and hydrocephalus was seen in five. Cerebrospinal fluid (CSF) dissemination and multiple satellite lesions were not observed in these cases. Haemorrhage was found in one case. The “green bell pepper sign” was present in five cases on gadolinium-enhanced magnetic resonance imaging (MRI). Each of the patients accepted surgical treatment, and no recurrences occurred during follow-up. Conclusion RGNTs are very rare mixed glioneuronal tumours and mostly affect young people. They are usually hypointense on T1-weighted images and DWI, hyperintense on T2-weighted images, and hypo-attenuated on CT images. The “green bell pepper sign” after gadolinium enhancement, intratumoural haemorrhage, CSF dissemination, and multiple satellite lesions provide additional clues to the correct diagnosis. A relatively well-demarcated tumour with these features and a midline location should raise suspicion of an RGNT.

This study aims to examine the causal priority in the observed empirical relationships between Internet addiction and other psychological problems. A cross-lagged panel survey of 361 college students in Hong Kong was conducted. Results show that excessive and unhealthy Internet use would increase feelings of loneliness over time. Although depression had a moderate and positive bivariate relationship with Internet addiction at each time point, such a relationship was not significant in the cross-lagged analyses. This study also found that online social contacts with friends and family were not an effective alternative for offline social interactions in reducing feelings of loneliness. Furthermore, while an increase in face-to-face contacts could help to reduce symptoms of Internet addiction, this effect may be neutralized by the increase in online social contacts as a result of excessive Internet use. Taken as a whole, findings from the study show a worrisome vicious cycle between loneliness and Internet addiction.

Background XZP-3287 is a novel selective inhibitor of cyclin-dependent kinases 4/6 (CDK 4/6). Preclinical data suggested a comparable antitumor activity with Palbociclib and Abemaciclib, and a more favourable safety profile of mild myelosupression. A continuous dosing schedule (28days/cycle) is adopted in this first-in-human study to achieve sustained target inhibition. Methods The study is designed as an accelerated titration followed by a standard 3 + 3 dose escalation. Eligible patients are those with locally advanced or metastatic solid tumours, and who have progressed despite of refractory to standard therapy or no standard-of-care therapy is available. Results 16 subjects were enrolled in this study by April 1, 2019. The DLT evaluation in 320mg QD dose group was completed. No DLT or drug related serious adverse event (SAE) was observed from 20mg QD to 320mg QD dose groups. The drug related adverse events (AE) were mainly CTCAE grade 1 and 2, and reversible. Drug-related AEs (≥10%) were diarrhea (31.3%), leucopenia (31.3%), blood creatinine increased (25%), anemia (18.8%), neutropenia (18.8%), vomiting (18.8%), ALT increased (12.5%), thrombocytopenia (12.5%), blood alkaline phosphatase increased (12.5%) and hyperuricaemia (12.5%). Myelosuppression was observed from 160mg QD level. A negative correlation was showed between the AUC/Cmax of steady state and the maximum percentage decrease from baseline of neutrophil/platelet counts (r=-0.57 to-0.48), which was consistent with pharmacological effects of CDK4/6 inhibition. Furthermore, clinical activity was observed at low and not yet optimal dose levels. Among 7 efficacy evaluable subjects, 3 achieved SD , and 4 experienced PD. 1 SD patient in 240mg QD dose group had sustained SD for over 8 months and the target lesions was reduced by 23.7% from baseline which previously treated by chemotherapy, The latest data (Apr.30.) showed that, all the 3 patients in 320mg QD dose group achieved SD (2 patients exhibited tumor shrinkage by 10.9% and 8.3% respectively). These data will be update at annual meeting. Conclusions This study demonstrated that single-agent XZP-3287 was well tolerated and showed the CDK4/6 inhibition activity in human. Legal entity responsible for the study Xuanzhu Biopharmaceutical Ltd. Funding Xuanzhu Biopharmaceutical Ltd. Disclosure All authors have declared no conflicts of interest.

According to the characteristics of rotary ultrasonic machining, the paper designs rotary ultrasonic power matching circuits. It presents compound frequency tracking method that utilizing Phase-Locked Loop (PLL) on accurate frequency tracking and maximum current method on rough frequency tracking. A control strategy of frequency tracking based on adjusting matching inductance and driving frequency was described. The experimental results verify the proposed compound frequency tracking method is feasible and effective which eliminates temperature, load changed on the effect of the transducer.

Systemic anaplastic large cell lymphomas (sALCLs) comprise a heterogeneous group of relatively rare T-cell non-Hodgkin lymphomas that are characterized by CD30 expression. Anaplastic lymphoma kinase (ALK)-positive ALCL is a type of sALCL that commonly involves lymph nodes and extranodal sites. Skin involvement usually presents as tumours, nodules and ulcers. We describe an unusual case of ALK-positive ALCL in an 11-year-old Chinese boy, who initially presented with skin eruption with rapid progression and poor prognosis. This case emphasizes the value of clinical factors to predict the prognosis of ALK-positive sALCL, and we recommend close collaboration between dermatologists, pathologists and haematologists/oncologists to assure the correct diagnosis and treatment.

We aimed to assess and compare the expression of Dickkopf homolog 3 (DKK3), a possible tumor suppressor gene (TSG), in oral leukoplakia (OLK) and oral submucous fibrosis (OSF) using immunohistochemistry. Seventy-five cases of normal oral mucosa (NOM), OLK, OSF, and squamous cell carcinoma (OSCC) were studied. DKK3 was expressed in all cases of NOM, OLK and OSCC. There was steady increases in the percentage of the positive cells progressing toward OSCC. The expression was localized in the cytoplasm and cell membrane of cell affected by OLK with mild dysplasia and OLK with severe dysplasia. No significant association was observed between DKK3 expression and dysplastic status of OLK. Loss of DKK3 expression was observed in 15 of 30 cases in the OSF group, which was significantly associated with histological grade of OSF (P

The purpose of this study was to assess the correlation between the survivin gene and the occurrence and pathogenesis of papillary thyroid carcinoma (PTC). Sixty patients with PTC and no preoperative chemotherapy were recruited for the study and 30 thyrophyma patients receiving operative treatment in Drum Tower Hospital (Nanjing, China) were included as the control group. The protein expression levels of survivin were assessed by immunoblotting and immunohistochemical analysis of tissues from both patient groups. For survivin gene knockdown experiments, two target sequences were selected based on the mRNA sequence of survivin and two pairs of siRNA interference sequences were designed and synthesized accordingly. The siRNAs were shown to be successfully transfected into SW579 carcinoma cells and the resulting survivin knockdown was assessed by RT-PCR and immunofluorescence. Survivin was shown by immunohistochemistry to be distributed in the cytoplasm of PTC and thyrophyma cells, with the signal being significantly stronger in PTC cells than in thyrophyma cells and statistical analysis of immunostaining data further showed survivin to be more highly expressed (P < 0.05) in the PTC tissue than in the thyrophyma tissue. Transfection of SW579 cells with siRNA was found to be effective in knocking down the expression levels of survivin: 87.3 and 76.2% knockdown was achieved with sh-Survivin-1 and sh-Survivin-2, respectively. The findings reported here show that survivin is highly expressed in PTC and may therefore play a role in the occurrence, lymph node metastasis, and clinical staging of PTC.

Background No report focused on the life quality of Chinese patients with chronic urticaria (CU). It was also due to lack of data to assess the usage of the Dermatology Life Quality Index (DLQI) in Chinese patients. Objectives We explored the quality of life (QoL) of Chinese patients with CU and assessed the factor structure and reliability of the Chinese version of the DLQI. Methods The DLQI scores were recorded to evaluate the life quality of out-patients with CU. The reliability and the factor structure of the DLQI were assessed using reliability analysis and factor analysis. Results A total of 131 patients completed the DLQI. The mean score was 9.93 that was significantly associated with the patient’s age (P = 0.01). Chronic urticaria had the greatest effect on the ‘Syndrome and Feeling’ (50.64%), followed by ‘Work/School’ (41.98%). A reliability analysis showed that the value of the Cronbach’sα reached 0.85 if item 1 in the DLQI was excluded. Both exploratory and confirmatory factor analysis indicated that there were two latent common factors underlying the items in the questionnaire. Conclusions Chronic urticaria has a moderate impact on the life quality. More attention should be paid to the interference from item 1 in assessing the QoL by the DLQI, although it remains a concise tool with high reliability.

Rationale Gallstone disease is commonly worldwide and safely treated by laparoscopic cholecystectomy. Chylous ascites is a rare but serious complication of many abdominal operations. Patient concerns We present a rare case of refractory chyle leakage post-LC for acute cholecystitis that is successfully treated in a 40-year-old man, and review current literature on the prevalence, diagnosis, and management of this complication. Diagnoses Refractory chyle leakage post-LC, a rare but serious complication after laparoscopic cholecystectomy. Interventions Conservative treatment was given initially; however, the outcome was frustrating. Surgical intervention was given without further delay. Outcomes After the reoperation, conservative treatment was still maintained. After nearly 8 months of treatment, the patient recovered and then was discharged. Lessons This case represents a previously unreported complication of refractory and high flow chyle leakage after laparoscopic cholecystectomy, which did not improve alter conservative management with dietary changes and other measures. So we suggest that surgical intervention should be given for refractory cases without further delay. It can not only shorten the disease progression, but also alleviate the sufferings of the patient.

The absolute photonic band gap (PBG) in two-dimensional (2D) photonic crystal with excentric core-shell rods is studied in this paper. The core rod shifts away from the core-shell rod center, and its position is decided by two new introduced parameters — the shift angle θ and the offset ρ. We use the FDTD algorithm to calculate the photonic bands of the photonic crystal, and analyze how the offset and shift angle affect the photonic bang gap of excentric core-shell photonic crystal for different core rod size. It has been shown that the variation of the photonic band gap is quite peculiar.

The effect of the variation of a rod’s dielectric constant on the photonic band gap in a two-dimensional square lattice structure photonic crystal is studied in this paper. The effects were calculated by FDTD algorithm and some peculiar variation properties were obtained. By consecutively changing the dielectric constant of the rod over certain wide ranges and fixing that of the background, the low-frequency end of the TM band gap in low frequency regions reveals very tiny shifts which to some extent can be treated as fixed. This is primarily due to the fact that the high-e region in the crystal is nearly unchanged, hence, the concentrated energy of the low frequency mode changes only slightly. This effect does not exist for materials whose dielectrics are varied over wide ranges. We propose an alternative method using 2D core-shell photonic crystals. The final results of the band calculation show that the gap maps of the core-shell cases closely match those of the ideal case. Such peculiar changes in the photonic band gap have wide application prospects.

Aims To determine whether variants in the gene for the regulatory subunit of phosphoinositide 3-kinase (p85α) are associated with Type 2 diabetes mellitus (Type 2 DM) and hypertension in a Chinese population. Methods We performed a case-control study genotyping the Met326Ile and IVS4+82A>G polymorphisms in 494 patients with Type 2 DM and hypertension and 557 normal controls from the north of China. Individual genotypes were identified by the polymerase chain reaction—restriction fragment length polymorphism (PCR–RFLP) method. The IVS4+82A>G polymorphism was further confirmed by direct sequencing in 20 randomly selected cases. Results The IVS4+82A>G polymorphism that is common in Caucasians was not detected in our population. Frequencies of genotypes and alleles of Met326Ile polymorphism were not significantly different between cases and controls in whole samples by univariate analysis. Logistic regression analysis demonstrated that Ile326Ile genotype was associated with a 2.085-fold (95% CI, 1.043–4.168, P = 0.0377) relative risk of diabetes and hypertension. After stratification by obesity, the frequency of Ile326Ile genotype in cases was higher than that in controls (18/304 vs. 13/510, P = 0.015) among non-obese individuals (BMI

Approximately 10% of women of reproductive age suffer from endometriosis, a potentially painful disease process and important cause of female infertility. Raloxifene, a commercially available SERM (selective estrogen receptor modulator) compound, used for the treatment of postmenopausal osteoporosis, has preclinically demonstrated its estrogen antagonist effect on uterine tissue in rats. There is potential that SERM compounds may become a viable treatment option for human endometriosis, although more investigation is needed. In this study, raloxifene was administered at various doses to determine the efficacy and an appropriate dose level for use as a positive control in a rat model of endometriosis. Prior to dose administration, all rats underwent a bilateral ovariectomy, autologous transplantation of uterine tissue onto the peritoneal surface of the abdominal wall, and implantation of a subcutaneous estrogen pellet (E2). Two separate postsurgical experiments were performed. In experiment 1, following a 4-wk recovery, the rats bearing implants were assigned to three groups: (1) removal of the E2 pellet and dosing vehicle only (n = 7); (2) E2 and vehicle (n = 6); and (3) E2 and raloxifene at 10.0 mg/kg (n = 6). In experiment 2, also following a 4-week recovery, the rats bearing implants were assigned to five groups (n = 8/group): (1) E2 and vehicle only; (2) E2 and raloxifene, 0.3 mg/kg/d; (3) E2 and raloxifene, 1.0 mg/kg/d; (4) E2 and raloxifene, 3.0 mg/kg/d; (5) E2 and raloxifene, 10.0 mg/kg/d. All rats were dosed orally BID for 14 d. At the end of the study, the implanted endometrium was remeasured and compared to the pretreatment measurement. The results from both studies demonstrated that Raloxifene at only one dose (10.0 mg/kg) displayed significant implant regression (p.05). Subsequently, our rat endometriosis experimental model consistently uses the exogenous E2 pellet and raloxifene at 10 mg/kg, BID, as a positive control to help screen and compare novel SERM compounds.

A passivity approach is presented that acts as a framework for the analysis of the stability of power systems and allows the derivation of controllers. A radial power system is decomposed according to the component oriented modelling technique (COMT). The whole system is thus modelled as a feedback subsystem decomposition suitable for the application of the passivity approach. Under the assumption of a passive or a passified load, L/sub 2/-stability properties are obtained when disturbances occur in the network. Once disturbances are cleared an asymptotic stability property is derived. In the case of non-passivity of certain loads or series elements located in the network and when an energy-like constraint is satisfied, ultimate boundedness properties are obtained with a quasi-passivity concept.

The bedding and blending process of iron ores has been investigated by means of laboratory trials, industrial sampling and a mathematical model. It has been revealed in the present work that an increase in the total number of ore ingredients participating in the proportioning procedure would greatly improve the quality of the base mix. The appropriate number of starting points of the stacker that simultaneously meets the demand on decreasing the amount of recirculating materials from the stockpile head and on easing the operation of the stacker can be determined with the proposed model. The technology of the ore bedding and blending process has been optimised based on the present research and the performance of the bedding and blending plant has been greatly improved.