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Jingqi Zhu,1,2,* Zhangwei Yang,2,* Xiaoli Chen,3,* Jie Liu,3 Liang Zheng,3 Lin Zhang,3 Jingjiang Pi,4 Gang Li,2 Tao Zhuang,3 Chang Liu,3 Yinglu Wang,3 Liping Liu,3 Lieying Fan,5 Paul Chan,6 Brian Tomlinson,7 Ying Li,4 Zhongmin Liu,3 Yuzhen Zhang3 1Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 5Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 6Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 7Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuzhen Zhang; Zhongmin LiuKey Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, 200120, People’s Republic of ChinaTel +86-21-61569673Email yzzhang-tj@tongji.edu.cn; liu.zhongmin@tongji.edu.cnObjective: An association of atrial fibrillation (AF) with epicardial fat volume (EFV) varied in different ethnic groups. We evaluated the AF-related risk factors and its association with pericardial fat in Chinese patients.Methods: Patients referred for coronary computed tomography angiography (CCTA) in Shanghai East Hospital during 2012 to 2014 (n=2042, 43.8% women, mean age 65.0 years) had AF and cardiovascular risk assessment. Pericardial fat depots were measured from CT and the association of EFV with non-valvular AF risk factors was evaluated by multivariate logistic regression models.Results: AF was present in 8.5% of patients with 11.6% of AF patients having rheumatic heart disease (RHD) and 8.7% having other valvular diseases. With increasing age, the proportion of RHD-related AF decreased and the risk factors for non-valvular AF increased. There was a significantly higher proportion of risk factors for non-valvular AF in men than in women (p=0.008), but RHD-related AF was more prevalent in women than men (p=0.013). The patients with non-valvular AF had significantly higher BMI and EFV with more pronounced elevation of EFV (p< 0.001). Multivariate logistic regression showed a significant association of EFV with AF after adjustment for BMI and clinical risk factors, and the highest EFV quartile was associated with AF independent of left atrial size and obstructive coronary artery disease.Conclusion: The association of EFV with non-valvular AF in Chinese patients was independent of generalized adiposity and clinical risk factors especially in highest EFV quartile. These findings support the growing appreciation of the association of EFV with AF.Keywords: atrial fibrillation, epicardial fat, pericardial fat, obesity, body mass index, computed tomography, echocardiography

Background Although somatostatin and its analogs and trypsin inhibitors (TSI) are widely recommended for acute pancreatitis (AP), there is a lack of high-quality multicenter trials that validate these drug classes. We aimed to examine the current usage status of somatostatin and its analogs and TSI in Chinese adult AP patients. Methods We conducted a retrospective study which collected information for adult patients who were diagnosed with AP from January 1, 2015 to June 30, 2017 at 192 hospitals in China. Subsequently, we conducted a statistical analysis of the baseline information of patients, and revealed the usage of somatostatin, octreotide, ulinastatin, and gabexate. Thereafter, we stratified AP by severity and analyzed the current status of treatment. Results A total of 34,654 patients were included in this study. Mean age of patients was 49.9 years and 63% were males. Fifty-five percent of mild AP patients opted to receive octreotide, while 53.66% and 64.61% of moderate AP and severe AP patients respectively opted to receive somatostatin. At treatment initiation, somatostatin was mainly prescribed for mild and moderate AP patients, which were 723 and 894 daily defined doses (i.e., defined dose per day for a drug used by every 1,000 patients). Ulinastatin was mainly prescribed for severe AP patients, with a prescription volume of 1,230 daily defined doses. The consumption of ulinastatin in later stages of severe AP treatment was significantly greater than other drugs. Conclusions Somatostatin analogs and TSI are widely used as therapeutic drugs for AP treatment in China, with usage beginning at the early stages of the disease and lasting on average for 1 week. Of these drugs, somatostatin and octreotide were identified as the most commonly-used drugs, while ulinastatin was found to be widely used at the late stages of severe AP.

Objectives The sequence of intravenous infusions may impact the efficacy, safety, and cost of intravenous medications. The study describes and assesses a computerized clinical decision support annotation system capable of analyzing the sequence of intravenous infusions. Methods All intravenous medications on the hospital formulary were analyzed based on factors that impact intravenous infusion sequence. Eight pharmacy infusion knowledge databases were constructed based on Hospital Infusion Standards. These databases were incorporated into the computerized sequence annotation module within the electronic health record system. The annotation process was changed from pharmacists' manual annotation (phase 1) to computer-aided pharmacist manual annotation (phase 2) to automated computer annotation (phase 3). Results Comparing phase 2 to phase 1, there were significant differences in sequence annotation with regards to the percentage of hospital wards annotated (100% vs. 4.65%, chi-square = 180.95, p Conclusion A computerized infusion annotation system is efficient in sequence annotation and significant savings in tubing flushes can be achieved as a result.

Introduction Colorectal liver metastasis is a challenge in the treatment of colorectal cancer and an important factor affecting the prognosis of patients. Currently, microwave ablation has gradually been applied for the treatment of liver cancers as a type of thermal ablation. However, there are no large-scale studies on the effectiveness of microwave ablation for colorectal liver metastases. Aim To investigate the efficacy of microwave ablation and liver resection for liver metastases from colorectal cancer, and to compare the prognosis between patients treated with microwave ablation and those in the SEER (Surveillance, Epidemiology, and End Results, National Cancer Institute) database. Material and methods We retrospectively analyzed the clinical data of 24 patients with colorectal liver metastasis who underwent radical colorectal cancer resection and liver microwave ablation (the MWA group) and 12 patients who received radical colorectal cancer resection and liver resection (the LR group). The complete ablation rate and complications after microwave ablation were observed. Survival analysis was performed for cases treated with liver resection and cases from the SEER database. Results A total of 53 tumors were ablated in the 24 patients who underwent radical colorectal cancer resection and liver microwave ablation; 52 tumors achieved complete ablation after the first ablation (98.1%). No serious complications occurred in the MWA group, and long-term survival was not significantly different between the MWA and other groups. Conclusions Microwave ablation for colorectal liver metastases avoids extensive liver resection while ensuring therapeutic efficacy; the operation is safe, feasible, and reproducible.

Introduction With the rapid development of minimally invasive surgery, laparoscopic (LAP) wedge resection has become the first-choice treatment for primary gastrointestinal stromal tumors (GISTs) of the stomach. Aim To investigate the safety and feasibility of LAP wedge resection and the choice of surgical treatment for GISTs of the stomach through a meta-analysis and systematic review. Material and methods The literature was widely searched for comparative studies on open (OPEN) and LAP wedge resection for GISTs published before April 2017. The articles were selected after quality assessment. Results Ten reports met the inclusion criteria, with a total sample size of 485 cases. The operation time was similar between the 2 groups (weighted mean difference (WMD): 8.67 min, 95% confidence interval (CI): –8.60 to 25.94, p = 0.33). However, LAP resulted in less blood loss (WMD –32.20 ml, 95% CI: –56.15 to –8.26, p < 0.01), earlier time to flatus (WMD –1.48 days, 95% CI: –1.90 to –1.06, p < 0.01) and to an oral diet (WMD –1.50 days, 95% CI: –2.25 to –0.47, p < 0.01), shorter hospital stay (WMD –2.03 days, 95% CI: –2.68 to –1.38, p < 0.01), and a decreased overall complication rate (relative risk: 0.48, 95% CI: 0.25–0.89, p = 0.01) compared with OPEN. Moreover, long-term follow-up findings indicated no obvious difference between the 2 groups. Conclusions The use of LAP wedge resection for suitable cases is safe and feasible because it causes less blood loss and fewer overall complications and enables faster recovery.

BackgroundThe complement system acts as an integral part of the innate immune response, which acts primarily to remove pathogens and injured cells. Emerging evidence has shown the activation of the immune regulatory function of complements in the tumor microenvironment (TME). We revealed the expression levels of various complements in human cancers and their role in tumor prognosis and immune infiltration.MethodsThe differential expression of complements was exploredviathe Tumor Immune Estimation Resource (TIMER) site and the Oncomine database. To investigate whether these differentially expressed complements have correlation with the prognosis of gastric cancer (GC) and colon cancer, their impact on survival was assessed using the PrognoScan database and Kaplan-Meier plotter. The correlations between complements and tumor immune-infiltrating levels and immune gene markers were statistically explored in TIMER based on Spearman’s correlation coefficients andp-values.ResultsIn two colon cancer cohorts, an increased expression level of DAF (CD55) has statistically significant correlation with poor disease-free survival (DFS). High C3, CR4, and C5aR1 expression levels were significantly related with poor prognosis in GC patients. In addition, C3, CR4, and C5aR1 expression was positively related to the tumor purity and infiltration levels of multiple immune cells in stomach adenocarcinoma (STAD). Moreover, the expression levels of C3, CR4, and C5aR1 were also strongly correlated with various immune marker sets, such as those of tumor-associated macrophages (TAMs), M1 and M2 macrophages, T cell exhaustion, Tregs, and DCs, in STAD. Additionally, CD55 has positive correlation with few immune cell infiltration levels in colon adenocarcinoma (COAD), but its correlation with immune marker sets was not statistically significant.ConclusionThese findings confirm the relationship between various complements and tumor prognosis and immune infiltration in colon cancer and GC. CD55 may serve as an indicator on the survival prognosis of patients with colon cancer. Furthermore, as biomarkers for poor prognosis in GC, complements C3, CR4, and C5aR1 may provide potential biological targets for GC immunotherapy.

Background The aim of this study was to combine clinicopathologic variables associated with overall survival and disease-free survival after curative resection for hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) into a prediction nomogram. Methods We retrospectively analysed 358 patients who underwent curative resection for HCC with PVTT at the Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai, China. Two-thirds of the patients were randomly assigned to the training set (n = 252) and one-third were assigned to the validation set (n = 106). Multivariate analysis by Cox proportional hazards regression was performed using the training set, and the nomogram was constructed. Discrimination and calibration were performed using the validation set. Results The multivariate Cox model identified alpha fetoprotein, hepatitis B surface antigen (HBsAg), tumour diameter, tumour capsule, PVTT type and TNM stage as covariates associated with 1-year survival, and alpha fetoprotein, HBsAg, tumour diameter, tumour capsule and PVTT type with half-year disease-free survival. In the validation set, the nomogram exhibited superior discrimination power (Harrell's C-index 0.78) compared with the American Joint Committe on Cancer TNM classification, the Cancer of the Liver Italian Program grade and the Japan Integrated Staging grade. Calibration of the nomogram-predicted survival corresponding closely with the actual survival, the predicted survival was within a 10% margin of ideal nomogram. Conclusion We developed a nomogram predicting 1-year overall survival and half-year disease-free survival after curative resection for HCC with PVTT. Validation data sets revealed good discrimination and calibration, suggesting good clinical utility. The nomogram improved individualized predictions of survival.

Superconducting fault current limiter (SFCL) is an efficient way to solve the short-circuit problems in modern power systems. A flux-coupling-type SFCL (FC-SFCL) based on disconnecting coupling windings for current reduction has been developed in this study. FC-SFCL is considered as a potential scheme to limit fault currents due to its low steady impedance before fault and higher current-limiting impedance after fault. It contains a pair of high-temperature superconducting (HTS) coupling coils, wound on an iron core with air gaps. Raising the coupling coefficient of the HTS coils and reducing the loss are essential issues to improve its performance, which is mainly affected by the iron core structure and winding processes of HTS coils. In this study, the electromagnetic design of a 10 kV/500 A FC-SFCL one-phase prototype is completed based on a genetic algorithm, along with the performances of current-limiting capacity, response time, and loss of the prototype. The simulation results show the FC-SFCL prototype with electromagnetic parameters meets the design requirements, and has good performances in terms of current reduction and loss.

Background and Aims: Coronary artery disease (CAD) is usually caused by atherosclerosis, which is associated with general obesity and stronger associations with localized ectopic fat depots have been reported. We measured body ectopic fat distribution in Chinese patients to determine the association with coronary artery atherosclerosis (CA). Methods: Patients undergoing coronary computed tomography angiography (CCTA) who agreed to participate in the study (n = 750, 50.4% men, mean age 64.8 years) had cardiovascular disease and risk assessment. Body ectopic fat depots were measured from CT and their association with CA, determined from CCTA, was evaluated by univariate and multivariate logistic regression models. Results: CAD with CA (CAD-CA) was present in 57.2% of participants with CAD of moderate/severe CA (CAD-msCA) present in 23.5% and both were significantly more frequent in men than in women. Overall, men had greater body mass index (BMI) but there was no difference in waist circumference (WC) between genders. However, significantly higher visceral adipose tissue (VAT) and periaortic fat volume (PAFV) were observed in men, whereas women had significantly higher abdominal subcutaneous adipose tissue (SAT). With increasing age, there was a significant decline in BMI, WC and SAT in men, but a significant increase of WC and VAT, PAFV and epicardial fat volume (EFV) in women. A high proportion of non-calcified plaques was observed in CAD-CA, 55.3% in CAD of minimal/mild CA (CAD-mmCA) with 38.7% exclusively non-calcified plaques, and 59.7% in CAD-msCA with multiple type plaques containing non-calcified ones. Multivariate logistic regression showed a significant association of PAFV with CAD-CA and CAD-msCA that was independent of general obesity and clinical risk factors, and independent of abdominal obesity in the highest PAFV quartile patients. VATA was associated with an increased prevalence of CAD-msCA in the patients in the upper 2 VATA quartiles that was independent of clinical risk factors and both general and abdominal obesity. Conclusions: We found age and gender differences of body ectopic fat distribution in Chinese patients with higher VAT and PAFV in men and higher SAT in women. With increased age, there was a decline of WC and SAT in men but not in women and an increase in WC, VAT and PAFV in women but not in men. PAFV was significantly associated with overall CAD-CA and CAD-msCA, while VAT was associated with CAD-msCA.

Compared with the traditional high-voltage direct-current based on line commutated converter (LCC-HVDC), the voltage source converter-based HVDC (VSC-HVDC) system has several advantages. However, VSCs are vulnerable to the dc short-circuit faults because of the large discharge current of the dc-link capacitor. This paper presents a novel superconducting fault current limiter (SFCL), which can effectively limit the amplitude of short-circuit current of the VSC-HVDC system. The SFCL utilizes both superconducting coils (SCs) and resistance to limit the rapidly growing current. First, the working principle and operating characteristics of the SFCL are studied. Second, the rules of parameters coordination are analyzed in order to obtain the best current limiting effect of the SFCL. Third, the electromagnetic design of SCs is done to prove the feasibility of the scheme. Finally, a simulation model is established, and the current-limiting effect of both the limiters and the parameters coordination is verified.

Virtual Machine Migration (VMM) is a key technology in data centers. Due to the uncertainty of applications in resource allocation, the imbalance of resource utilization is badly poor. In this paper, an Auto-regression Moving Average model is proposed to predict the resource requirement of a certain virtual machine, while the resource utilization rate of the physical machine is analyzed. Since the existing VMM scheme basically follows one by one migration, which makes the migration be unable to achieve the global optimum and save more energy, the paper introduces migrated cost matrix, and recommends a set of migrations with the best performance from a global point of view to carry out the migration, and improves the ``three-step'' method in the traditional migrated scheme to achieve energy efficiency. Simulation experiments show that the proposed scheme in the paper can effectively reduce the energy consumption, and can improve the quality of service in a certain degree.

Background Irrational use of antimicrobial agents is a major cause of increased antimicrobial resistance. Effective antibiotic stewardship strategies nationwide or in local health care settings are necessary to reduce antibiotic use and bacteria resistance. Methods We evaluated the effectiveness of China's antimicrobial stewardship policy on antimicrobial use and applied time-series analysis methodology to determine the temporal relationship between antibiotic use and gram-negative bacteria resistance at Changhai Hospital from 2008-2013. Isolates investigated included Escherichia coli , Klebsiella pneumoniae , Acinetobacter baumannii , and Pseudomonas aeruginosa . Results Consumption of 7 restricted-use antibiotics was dramatically reduced. Resistance to ceftazidime in P aeruginosa and A baumannii and resistance to ciprofloxacin in P aeruginosa significantly decreased. By using cross-correlation analysis, associations between ciprofloxacin resistance in P aeruginosa and fluoroquinolones consumption ( r = 0.48; lag = 0; P = .02), ceftazidime resistance in P aeruginosa and third-generation cephalosporins consumption ( r = 0.54; lag = −1; P = .01) were identified. No substantial association between other pairs was found. Conclusions Enhanced nationwide antimicrobial stewardship campaigns launched in 2011 have made great achievements in regard to antibiotic use but have had limited effects on the reversal of gram-negative bacteria resistance in health care settings. Sound infection prevention and control programs to reduce the transmission of resistant pathogens for hospitals in China are urgently needed.

To estimate the incidence, anatomical feature as well as type of the renal vein variation with multidetector computed tomography (MDCT) in an adult population.A total of 1,452 patients who underwent MDCT angiography were retrospectively evaluated for the presence (number, length, origination, destination, branching pattern and course) of the renal vein variation. χ² test was used to compare the incidence of variations in left and right renal veins and the incidence of variations in each side renal vein between males and females.Renal vein variations were observed in 358 patients (24.7 %, 358/1,452), which included 103 patients (7.1 %, 103/1,452) with left renal vein (LRV) variations, 279 patients (19.2 %, 279/1,452) with right renal vein (RRV) variations and 24 patients (1.7 %, 24/1,452) with bilateral renal vein variations. The frequency of RRV variations was significantly higher than that of LRV variations (p0.05). No statistically significant correlation was found between variations of renal vein (LRV and RRV) and gender (p0.05). According to the morphology of the renal vein, we classified LRV variations into five types: type I, circumaortic LRV (2.1 %, 31/1,452); type II, retroaortic LRV (2.1 %, 30/1,452); type III, abnormal reflux (1.7 %, 24/1,452); type IV, late venous confluence of LRV (0.9 %, 13/1,452); type V, rare type (0.3 %, 5/1,452), and RRV variations into three types: type 1, additional renal vein (18.7 %, 271/1,452); type 2, abnormal reflux (0.4 %, 6/1,452); type 3, rare type (0.1 %, 2/1,452).The renal vein variations are not unusual, particularly in the RRV. Anomalies of the LRV are more complex than those of the RRV. The renal vein anatomy can be well depicted by MDCT angiography. Our new classification of the renal vein variations will improve the recognition of the renal vein morphology preoperatively.

This paper analyzes the methods of city security evaluation, constructs city community development quality evaluation index system By applying the theory of neural network into the comprehensive evaluation of city development level ,and the comprehensive analysis of city community quality, evaluates on time scales city community quality and its trend, provides theoretical basis for city security evaluation and management. And finally gives the application examples. Introduction City is a region of information center and transportation hub with politic, economy, culture, education science and technology, its development can often determine the regional economic development pattern and the spatial distribution of the allocation of resources. How to use varieties of effective ways to the comprehensive evaluation and master urban development trend, becomes very important point. Professor Wang Zongjun, puts forward the fuzzy evaluation method with a set of multi-objective and multi-level theory based on the theory of fuzzy of city comprehensive development level. But this method is lack of self-learning ability, and can't get away from the decision-making process of randomness and evaluation experts subjective uncertainty and fuzziness of knowledge. Neural network theory is applied to evaluate the city development level, provides theoretical basis for city security evaluation and management. Neural network characteristic Neural network is a dynamic system with directed the graph topology structure, it reacts and completes the information processing through a variety of input information, which has dynamic processing and self-learning, self-organizing, adaptive and nonlinear characteristics .Radial Basis Function (RBF) neural network is a feed-forward network with good performance, and it can decide the appropriate network topology based on different issues, with a high approximation precision, a small-scale of network training, fast learning speed and non-existence of local minima problems . The structure of RBF neural network consists of three layers: the input layer, hidden layer and output layer. The structure of topology is showed in Fig1.

Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors that originate outside the gastrointestinal tract. The aim of the present study was to investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of EGISTs and analyze the correlations between radiological findings and pathological features. CT and MRI images of 24 patients with EGISTs were reviewed retrospectively. Patient demographics and tumor characteristics, including localization, size, contours, borders, cystic-necrotic components, calcification, hemorrhage, tumor vessels, attenuation and intensity, degree and pattern of enhancement, ascites, tumor invasion, lymphadenopathy and distant metastasis were recorded. Statistical analyses to compare the radiological characteristics of low- and high-grade EGISTs were performed with χ2 or Fisher’s exact tests. The mean patient age at the time of presentation was 53 years. A total of 24 EGISTs were detected, originating in the omentum (n=4), mesentery (n=19) and retroperitoneum (n=1), respectively. The EGISTs displayed a predominantly spindle cell subtype (87.5%; 21/24). The majority of the EGISTs appeared as large (>10 cm; 70.8%; 17/24), round or oval (66.7%; 16/24), cystic-solid (87.5%; 21/24) and ill-defined (66.7%; 16/24) soft-tissue masses. The EGISTs were hypodense (69.6%; 16/23) or isodense (30.4%; 7/23) on CT images, hypointense (50%; 3/6), isointense (33.3%; 2/6) or hyperintense (16.7%; 1/6) on T1-weighted imaging (T1WI), and hyperintense on T2WI (100%; 6/6) and diffusion-WI (DWI; 100%; 6/6). A total of 54.2% (13/24) of the EGISTs displayed tumor vessels. Overall, 95.8% (23/24) of the masses showed marked enhancement and 87.5% (21/24) demonstrated heterogeneous enhancement. Calcification, hemorrhage, ascites and lymphadenopathy were rare characteristics in the EGISTs. Distant metastases were present in 10 patients (41.7%). The size, borders, tumor vessels and distant metastasis correlated with high-grade EGISTs [>5 mitoses/50 high-power fields (HPFs)] (P10 cm), ill-defined borders, tumor vessels and distant metastasis, can provide useful information in identifying the malignant behavior of EGISTs.