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Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with a dismal prognosis according to updated statistics. At present, there are many deficiencies in targeted therapy for liver cancer. The solute carrier family 17 member 2 (SLC17A2) has not been studied in liver cancer, therefore, we evaluate the role of SLC17A2 in HCC by bioinformatics analysis.Methods: The expression level of SLC17A2 in HCC, the clinicopathological data were analyzed based on The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database, the SLC17A2 protein expression was validated by immunohistochemical staining. Besides, the Kaplan–Meier plotter database and receiver operating characteristic (ROC) curve analysis were used to explore the prognostic significance. The biological analyses of SLC17A2 were performed using the gene set enrichment analysis (GSEA). Finally, Tumor Immune Estimation Resource (TIMER) and Gene Expression Profiling Interactive Analysis (GEPIA) databases were used to explore the relationship between immune cell infiltration, immune cell markers and SLC17A2 in HCC.Results: The multivariate Cox regression analysis showed that SLC17A2 expression was low in HCC (P < 0.05), and closely related to the clinical stage of HCC. Besides, SLC17A2 had certain prognostic and diagnostic value in HCC according to ROC curve analysis. Further biological analyses showed that SLC17A2 can regulate fatty acid metabolism, amino acid metabolism and cytochrome P450-related metabolism and is closely related to the peroxisome pathway. Notably, we found that SLC17A2 expression was positively correlated with the infiltration levels of CD4 + T cells, naive CD8+ T cells, naive B cells, negatively associated with the levels of regulatory T cells and closely correlated with most immune cell markers in HCC.Conclusion: SLC17A2 expression is low in HCC and correlates with immune infiltration; thus, it could serve as an independent prognostic factor for HCC.

Nature-inspired artificial Z-scheme photocatalyst offers great promise in solar overall water splitting, but its rational design, construction and interfacial charge transfer mechanism remain ambiguous. Here, we design an approach of engineering interfacial band bending via work function regulation, which realizes directional charge transfer at interface and affords direct Z-scheme pathway. Taking BiVO4 as prototype, its oxygen vacancy concentration is reduced by slowing down the crystallization rate, thereby changing the work function from smaller to larger than that of polymeric carbon nitride (PCN). Consequently, the photoinduced charge transfer pathway of BiVO4/PCN is switched from type-II to Z-scheme as evidenced by synchronous illuminated X-ray photoelectron spectroscopy (XPS) and femtosecond transient absorption spectroscopy. Specifically, the direct Z-scheme BiVO4/PCN shows superior photocatalytic performance in water splitting. This work provides deep insights and guidelines to constructing heterojunction photocatalysts for solar utilization.

The p-i-n junction structure has garnered great interest from researchers due to its increased photoactive area and wider space charger region compared with that of the p-n junction. Herein the ult...

Various biological behaviors can only be observed in 3D at high speed over the long term with low phototoxicity. Light-field microscopy (LFM) provides an elegant compact solution to record 3D information in a tomographic manner simultaneously, which can facilitate high photon efficiency. However, LFM still suffers from the missing-cone problem, leading to degraded axial resolution and ringing effects after deconvolution. Here, we propose a mirror-enhanced scanning LFM (MiSLFM) to achieve long-term high-speed 3D imaging at super-resolved axial resolution with a single objective, by fully exploiting the extended depth of field of LFM with a tilted mirror placed below samples. To establish the unique capabilities of MiSLFM, we performed extensive experiments, we observed various organelle interactions and intercellular interactions in different types of photosensitive cells under extremely low light conditions. Moreover, we demonstrated that superior axial resolution facilitates more robust blood cell tracking in zebrafish larvae at high speed., Mirror-enhanced scanning light-field microscopy (MiSLFM) achieves long-term high-speed 3D imaging at near-isotropic subcellular resolution with a single objective, facilitating native observations of various intracellular and intercellular interactions.

The double crystal diffraction structure based on Bragg diffraction is the core component of the monochromator that is widely used in synchrotron radiation beam lines and monochromatic X-ray radiation devices. The stability of monochromatic X-rays produced by using the T-structure double crystal monochromator at National Institute of Metrology was investigated experimentally. Due to its structural defects, the X-ray flux of the T-structured double crystal monochromator shows poor long-term stability. Inspired by the Channel-cut monochromator structure, we designed a new double crystal monochromator structure to improve the long-term stability of the X-ray flux. Experiments showed that the stability of the monochromatic X-ray flux for the new double crystal monochromator structure was better than 1.0%@1 h, and the energy region and flux rate of the monochromatic X-rays are significantly improved. This work provides a stable and reliable monochromatic X-ray source for the calibration of X/γ detectors such as satellite load detectors, which will contribute to the development of X/γ detection technology.

Background Lynch-syndrome-associated cancer is caused by germline pathogenic mutations in mismatch repair genes. The major challenge to Lynch-syndrome screening is the interpretation of variants found by diagnostic testing. This study aimed to classify the MLH1 c.1989 + 5G>A mutation, which was previously reported as a variant of uncertain significance, to describe its clinical phenotypes and characteristics, to enable detailed genetic counselling. Methods We reviewed the database of patients with Lynch-syndrome gene detection in our hospital. A novel variant of MLH1 c.1989 + 5G>A identified by next-generation sequencing was further investigated in this study. Immunohistochemical staining was carried out to assess the expression of MLH1 and PMS2 protein in tumour tissue. In silico analysis by Alamut software was used to predict the MLH1 c.1989 + 5G>A variant function. Reverse transcription-polymerase chain reaction and sequencing of RNA from whole blood were used to analyse the functional significance of this mutation. Results Among affected family members in the suspected Lynch-syndrome pedigree, the patient suffered from late-stage colorectal cancer but had a good prognosis. We found the MLH1 c.1989 + 5G>A variant, which led to aberrant splicing and loss of MLH1 and PMS2 protein in the nuclei of tumour cells. An aberrant transcript was detectable and skipping of MLH1 exon 17 in carriers of MLH1 c.1989 + 5G>A was confirmed. Conclusions MLH1 c.1989 + 5G>A was detected in a cancer family pedigree and identified as a pathological variant in patients with Lynch syndrome. The mutation spectrum of Lynch syndrome was enriched through enhanced genetic testing and close surveillance might help future patients who are suspected of having Lynch syndrome to obtain a definitive early diagnosis.

Background The impact of primary tumour location on the prognosis of patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rarely discussed, and the evidence is still limited. Methods Patients with PM arising from CRC treated with CRS and HIPEC at the China National Cancer Center and Huanxing Cancer Hospital between June 2017 and June 2019 were systematically reviewed. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analysed. Results A total of 70 patients were divided into two groups according to either colonic or rectal origin (18 patients in the rectum group and 52 patients in the colon group). Patients with PM of a colonic origin were more likely to develop grade 3–4 postoperative complications after CRS+HIPEC (38.9% vs 19.2%, P = 0.094), but this difference was not statistically significant. Patients with colon cancer had a longer median overall survival (OS) than patients with rectal cancer (27.0 vs 15.0 months, P = 0.011). In the multivariate analysis, the independent prognostic factors of reduced OS were a rectal origin (HR 2.15, 95% CI 1.15–4.93, P = 0.035) and incomplete cytoreduction (HR 1.99, 95% CI 1.06–4.17, P = 0.047). Conclusion CRS is a complex and potentially life-threatening procedure, and we suggest that the indications for CRS+HIPEC in patients with PM of rectal origin be more restrictive and that clinicians approach these cases with caution.

Spinocerebellar ataxias (SCAs) are a large group of hereditary neurodegenerative diseases characterized by ataxia and dysarthria. Due to high clinical and genetic heterogeneity, many SCA families are undiagnosed. Herein, using linkage analysis, WES, and RP-PCR, we identified the largest SCA36 pedigree in Asia. This pedigree showed some distinct clinical characteristics. Cognitive impairment and gaze palsy are common and severe in SCA36 patients, especially long-course patients. Although no patients complained of hearing loss, most of them presented with hearing impairment in objective auxiliary examination. Voxel-based morphometry (VBM) demonstrated a reduction of volumes in cerebellum, brainstem, and thalamus (corrected P

The progression of global non-motor symptoms (NMS) in Chinese patients with Parkinson’s disease (PD) has not been explored. We aimed to examine the longitudinal evolution of overall NMS in a 3-year prospective Chinese cohort with early-stage PD. We included 224 patients with early PD who underwent annual evaluation of motor and non-motor symptoms. NMS was assessed using the non-motor symptoms scale (NMSS). We observed an increased number of NMS in the majority of the NMSS domains except mood/apathy and sexual dysfunctions. Significant deterioration was observed in the sleep/fatigue, perceptual problems/hallucinations, attention/memory, gastrointestinal, urinary, and miscellaneous domains during the follow-up (P P P = 0.017), 2-year (OR 1.113, P = 0.001), and 3-year (OR 1.117, P

Background Whether cigarette smoking is associated with the progression of immunoglobulin A nephropathy (IgAN) remains uncertain; therefore, we aimed to evaluate the effect of cigarette smoking on the prognosis of IgAN. Methods We divided 1239 IgAN patients from West China Hospital of Sichuan University who met the inclusion criteria into smoker (current or former) and non-smoker groups. The endpoint was end-stage renal disease (ESRD: eGFR 2 or undergoing renal replacement treatment) and/or eGFR decreased by > 50%. Kaplan–Meier, correlation, logistic regression and Cox proportional hazards analyses were performed. The association between cigarette smoking and IgAN was further verified by propensity-score-matched cohort analysis. Results During the mean follow-up period of 61 months, 19% (40/209) of the smoker group and 11% (110/1030) of the non-smoker group reached the study endpoint (p p = 0.043) was an independent risk factor predicting poor renal progression in IgAN, and that IgAN patients with chronic kidney disease (CKD) stage 3–4 were more susceptible to cigarette smoking (p r = 0.141; p r = 0.096; p = 0.001). Conclusions Cigarette smoking is an independent risk factor for IgAN progression, especially for advanced patients.

AIM: To compare clinical outcomes and refractive stability of implantable collamer lens (ICL) implantation and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia correction. METHODS: The Optical Quality Analysis System (OQAS) was used to evaluate clinical outcomes objectively after operation for high myopia correction. We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety index, efficacy index, spherical equivalent, modulation transfer function (MTF) cutoff frequency, strehl ratio (SR) and objective scatter index (OSI). RESULTS: At 1y postoperatively, the safety indices were 1.33±0.27 in ICL group, and 1.17±0.24 in FS-LASIK group. 39.58% in the ICL group and 27.59% in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA. The efficacy indices were 1.28±0.22 in ICL group, and 1.13±0.26 in FS-LASIK group. The changes of spherical equivalent from 1wk to 1y postoperatively was -0.12±0.37 D in ICL group, and -0.79±0.58 D in FS-LASIK group (P0.05) in postoperative 3mo later. CONCLUSION: ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction. ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Photoelectrochemical (PEC) water splitting for solar energy conversion into chemical fuels has attracted intense research attention. The semiconductor hematite (α-Fe2O3), with its earth abundance, chemical stability, and efficient light harvesting, stands out as a promising photoanode material. Unfortunately, its electron affinity is too deep for overall water splitting, requiring additional bias. Interface engineering has been used to reduce the onset potential of hematite photoelectrode. Here we focus instead on energy band engineering hematite by shrinking the crystal lattice, and the water-splitting onset potential can be decreased from 1.14 to 0.61 V vs. the reversible hydrogen electrode. It is the lowest record reported for a pristine hematite photoanode without surface modification. X-ray absorption spectroscopy and magnetic properties suggest the redistribution of 3d electrons in the as-synthesized grey hematite electrode. Density function theory studies herein show that the smaller-lattice-constant hematite benefits from raised energy bands, which accounts for the reduced onset potential.

Semiconductor-based electrolytes have significant advantages than conventional ionic electrolyte fuel cells, especially for high ionic conductivity and power outputs at low temperatures (

Objective To provide a robust estimate of the prevalence of excessive daytime sleepiness (EDS) and its clinical correlates in patients with Parkinson's disease (PD). Method We searched the PubMed and Embase databases for studies investigating the prevalence and clinical correlates of EDS from inception to March 01, 2020. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale. Random-effects models were set to pool the risk estimates. Sensitivity analyses were performed to evaluate the stability of the outcomes. Results After screening 1367 titles and abstracts, 59 studies involving 12,439 participants were included in the systematic review and meta-analysis. The pooled prevalence of EDS in PD was 35.1%, which was higher in South America, North America, Europe, and Australia than that in Asia. Compared to patients without EDS, patients with EDS had higher effect size on disease duration (0.76 years; 95% CI: 0.16–1.37, I2 = 68.8%), Hoehn and Yahr (HY) stage (0.23 grade; 95% CI: 0.11–0.34, I2 = 69.1%), Unified PD Rating Scale (UPDRS)-III (3.02 points; 95% CI: 1.53–4.51, I2: 61.2%), levodopa equivalent daily dose (LEDD) (141.46 mg; 95% CI: 64.17–218.77, I2 = 86.1%), depression symptoms (Hedges’ g = 0.35; 95% CI: 0.15–0.55, I2 = 72.0%) and male sex (OR = 1.50; 95% CI: 1.30–1.72, I2 = 0). Conclusion Our results showed that approximately one-third of patients with PD had EDS, which may be associated with the severity of the disease, depression, and male sex, or a combination of neurodegeneration and medication.

The purpose of this study in a small group of non-stone-forming Chinese persons was to measure the levels of supersaturation with calcium oxalate and calcium phosphate and pH with the aim of confirming if any of the different short-term urine samples were better for risk evaluation than a 24-h sample. Nine normal men and 1 woman collected urine during 4 periods of the day. Period 1 between 08 and 12 h, Period 2 between 12 and 18 h, Period 3 between 18 and 22 h, and Period 4 between 22 and 08 h. Each sample was analysed for calcium, oxalate, citrate, magnesium and phosphate, and estimates of supersaturation with calcium oxalate (CaOx) and calcium phosphate (CaP) were expressed in terms of AP(CaOx) and AP(CaP) index. An estimate of the solute load of CaOx was also calculated. Urine composition for 24-h urine (Period 24) was obtained mathematically from the analysed variables. Urine composition corresponding to 14-h urine portions 22–12 h (Period 14N) and 08–22 h (Period 14 D) were calculated. The lowest pH levels were recorded in Period 1 urine. The highest level of AP(CaOx) index was recorded during Period 1, and the product AP(CaOx) index × 107 × hydrogen ion concentration was significantly higher in Period 1 urine than in 24-h urine (p = 0.02). Also, the product SL(CaOx) × 107 × hydrogen ion concentration was significantly higher in Period 1 urine (p = 0.02). Low AP (CaP) index levels were recorded in Period 4, but also in all periods following dietary loads of calcium and phosphate. With the important reservation that the analytical results were obtained from non-stone-forming persons, the conclusion is that analysis of urine samples collected between 08 and 12 h might be an alternative to 24-h urine. The risk evaluation might advantageously be expressed either in terms of the product AP(CaOx) index × 107 × hydrogen ion concentration or the product SL(CaOx) × 107 × hydrogen ion concentration.

Objective Stress and burnout due to electronic health record (EHR) technology has become a focus for burnout intervention. The aim of this study is to systematically review the relationship between EHR use and provider burnout. Materials and Methods A systematic literature search was performed on PubMed, EMBASE, PsychInfo, ACM Digital Library in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Inclusion criterion was original research investigating the association between EHR and provider burnout. Studies that did not measure the association objectively were excluded. Study quality was assessed using the Medical Education Research Study Quality Instrument. Qualitative synthesis was also performed. Results Twenty-six studies met inclusion criteria. The median sample size of providers was 810 (total 20 885; 44% male; mean age 53 [range, 34-56] years). Twenty-three (88%) studies were cross-sectional studies and 3 were single-arm cohort studies measuring pre- and postintervention burnout prevalence. Burnout was assessed objectively with various validated instruments. Insufficient time for documentation (odds ratio [OR], 1.40-5.83), high inbox or patient call message volumes (OR, 2.06-6.17), and negative perceptions of EHR by providers (OR, 2.17-2.44) were the 3 most cited EHR-related factors associated with higher rates of provider burnout that was assessed objectively. Conclusions The included studies were mostly observational studies; thus, we were not able to determine a causal relationship. Currently, there are few studies that objectively assessed the relationship between EHR use and provider burnout. The 3 most cited EHR factors associated with burnout were confirmed and should be the focus of efforts to improve EHR-related provider burnout.

Microwave Staring Correlated Imaging (MSCI) technology has attracted increasing attentions for its ability to acquire high-resolution images in staring imaging geometry. The key point of MSCI is to construct the temporal—spatial stochastic radiation field which can be realized by multi-transmitter systems emitting frequency-hopping (FH) waveforms. However, time synchronization errors always exist in practice, which heavily deteriorates the imaging results. Therefore in this article, a two–step self–calibration imaging method for MSCI transmitting frequency-hopping waveforms is proposed to directly estimate the time synchronization errors. At the first step, a sparsity driven algorithm is proposed which utilizes a novel cluster sparse prior to improve the imaging performance. At the second step, a self–calibration operation is proposed the first time to directly compensate the time synchronization errors in MSCI. By alternately reconstructing the targets and estimating the time synchronization errors, the proposed method can reconstruct the target with high imaging quality and effectively compensate the time synchronization errors. Numerical simulations demonstrate the potential advantages of the proposed method to enhance the imaging quality and improve the time synchronization error estimation performance.

Background There has been increasing concerns regarding the declining number of medical students entering surgical residencies. The aim of this study is to analyze strategies and outcomes to enhance recruitment to the surgical specialties. Methods A systematic literature PRISMA-based search was performed. Study quality and bias were assessed. Meta-analysis was performed using DerSimonian Laird method. Results Of 3288 unique titles identified, 73 studies met inclusion criteria. Median study unique sample size was 84 participants (range 15–910). Subjective interest was reported in 59 studies, while objective match rate was reported by only 21 studies. The cumulative odds of students interested in the studied specialty was 1.98 (95% CI 1.47–2.67, I2 = 0%) and in any surgical specialty was 1.40 (95% 1.01–1.95, I2 = 37%) after an intervention compared to baseline. Conclusion While studies show increased odds of “interested in” a surgical specialty, the results may be subject to high selective and confounding biases.

Patients with early-onset Parkinson’s disease (EOPD) often suffer from more frequent depression than those with late-onset Parkinson’s disease (LOPD). However, the clinical characteristics of suicidal ideation (SI) in EOPD remains unknown. This study aimed to explore the prevalence, related factors, and predictive factors of SI in EOPD patients as well as comparison of the prevalence in LOPD patients. We conducted a case–control, cross-sectional, and longitudinal study. Propensity score matching (PSM) was used to balance the characteristics between EOPD (N = 577) and LOPD patients (N = 2973). The diagnosis of SI was based on the assessment of the Beck Depression Inventory (BDI). EOPD patients with a disease duration

To improve solar light harvesting and charge separation efficiency, we develop a facile strategy for synthesizing defect-engineered three-dimensionally ordered macroporous (3DOM) WO3 photonic crystals via the colloidal crystal template method and subsequent H2/N2 atmosphere thermal treatment. The oxygen evolution rate of the obtained defect-engineered 3DOM WO3 (W270–400) is 40.1 μmol h−1, which is much higher than that of the untreated 3DOM WO3 and the defect-engineered WO3 nanoparticles. The enhanced performance is due to the good light harvesting and excellent charge transportion properties. The results show that the slow photon effect and bulk oxygen vacancy (VO) induced narrowed band gap greatly improve the light harvesting efficiency, while abundant surface VO can lower the valence band to increase the driving force for water oxidation, and thus significantly promote electron–hole separation. Our work can guide further design and preparation of high-efficiency defect-engineered 3DOM semiconductors for solar energy conversion.

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronaviruses 2 (SARS-CoV-2) has become a serious global pandemic in the past few months and caused huge loss to human society worldwide. For such a large-scale pandemic, early detection and isolation of potential virus carriers is essential to curb the spread of the pandemic. Recent studies have shown that one important feature of COVID-19 is the abnormal respiratory status caused by viral infections. During the pandemic, many people tend to wear masks to reduce the risk of getting sick. Therefore, in this paper, we propose a portable non-contact method to screen the health conditions of people wearing masks through analysis of the respiratory characteristics from RGB-infrared sensors. We first accomplish a respiratory data capture technique for people wearing masks by using face recognition. Then, a bidirectional GRU neural network with an attention mechanism is applied to the respiratory data to obtain the health screening result. The results of validation experiments show that our model can identify the health status of respiratory with 83.69% accuracy, 90.23% sensitivity and 76.31% specificity on the real-world dataset. This work demonstrates that the proposed RGB-infrared sensors on portable device can be used as a pre-scan method for respiratory infections, which provides a theoretical basis to encourage controlled clinical trials and thus helps fight the current COVID-19 pandemic. The demo videos of the proposed system are available at: https://doi.org/10.6084/m9.figshare.12028032 .

Although PD-1/PD-L1 immunotherapy has been used successfully in treating many cancers, metastatic colorectal cancer (CRC) patients are not as responsive. B7-H3 is a promising target for immunotherapy and we found it to have the highest expression among B7-CD28 family members in CRC. Thus, the aim of the present study was to investigate B7-H3 expression in a large CRC cohort. B7-H3, B7-H4, and PD-L1 protein levels and differential lymphocyte infiltration were evaluated in tissue microarrays from 805 primary tumors and matched metastases. The relationships between immune markers, patient characteristics, and survival outcomes were determined. B7-H3 (50.9%) was detected in more primary tumors than B7-H4 (29.1%) or PD-L1 (29.2%), and elevated B7-H3 expression was associated with advanced overall stage. Co-expression of B7-H3 only with B7-H4 or PD-L1 was infrequent in primary tumors (6.3%, 5.7%, respectively). Moreover, B7-H3 in primary tumors was positively correlated with their respective expression at metastatic sites (ρ = 0.631; p

Background:. Sleep disorders are common but under-researched symptoms in patients with multiple system atrophy (MSA). We investigated the frequency and factors associated with sleep-related symptoms in patients with MSA and the impact of sleep disturbances on disease severity. Methods:. This cross-sectional study involved 165 patients with MSA. Three sleep-related symptoms, namely Parkinson's disease (PD)-related sleep problems (PD-SP), excessive daytime sleepiness (EDS), and rapid eye movement sleep behavior disorder (RBD), were evaluated using the PD Sleep Scale-2 (PDSS-2), Epworth Sleepiness Scale (ESS), and RBD Screening Questionnaire (RBDSQ), respectively. Disease severity was evaluated using the Unified MSA Rating Scale (UMSARS). Results:. The frequency of PD-SP (PDSS-2 score of ≥18), EDS (ESS score of ≥10), and RBD (RBDSQ score of ≥5) in patients with MSA was 18.8%, 27.3%, and 49.7%, respectively. The frequency of coexistence of all three sleep-related symptoms was 7.3%. Compared with the cerebellar subtype of MSA (MSA-C), the parkinsonism subtype of MSA (MSA-P) was associated with a higher frequency of PD-SP and EDS, but not of RBD. Binary logistic regression revealed that the MSA-P subtype, a higher total UMSARS score, and anxiety were associated with PD-SP; that male sex, a higher total UMSARS score, the MSA-P subtype, and fatigue were associated with EDS; and that male sex, a higher total UMSARS score, and autonomic onset were associated with RBD in patients with MSA. Stepwise linear regression showed that the number of sleep-related symptoms (PD-SP, EDS, and RBD), disease duration, depression, fatigue, and total Montreal Cognitive Assessment score were predictors of disease severity in patients with MSA. Conclusions:. Sleep-related disorders were associated with both MSA subtypes and the severity of disease in patients with MSA, indicating that sleep disorders may reflect the distribution and degree of dopaminergic/non-dopaminergic neuron degeneration in MSA.

Objective This study aims to develop feasible nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of the local advanced rectal cancer (LARC) patients who were treated with neoadjuvant chemoradiotherapy (nCRT) and operation. Methods A total of 243 LARC patients undergoing nCRT followed by total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. A Cox regression analysis was performed, and Cox-based nomograms were developed to predict the OS and CSS. We assessed the predictive performance of the nomogram with concordance index and calibration plots. Results A total of 243 patients were included with a median follow-up period of 46 months (range from 9 to 86 months). Cox regression analysis showed that low BMI (BMI < 18.5, HR= 21.739, P < 0.05), high level of preoperative CA19-9 (HR = 3.369, P = 0.036), high ypStage (HR = 19.768, P < 0.001), positive neural invasion (HR = 4.218, P = 0.026) and no adjuvant chemotherapy (HR = 5.495, P < 0.001) were independent predictors of poor OS. Age ≥70 (HR = 2.284, P

The aim of this study was to evaluate the safety of natural orifice specimen extraction surgery (NOSES) and to compare the short- and long-term outcomes of three techniques of NOSES for rectal cancer (RC).A consecutive series of RC patients in stage I-III who underwent laparoscopic NOSES were enrolled. Three main techniques of NOSES included specimen eversion and extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER) and intra-abdominal resection and specimen extraction (IREX). The postoperative complications, 5-year disease free survival (DFS), 5-year local recurrence rate (LRR) and 5-year distant metastasis rate (DMR) were compared in three techniques.268 RC patients met inclusion criteria, including 83 patients treated with EVER, 75 patients treated with EXER and 110 patients treated with IREX. Tumor location was the most critical factor associated with technique selection, with P 0.001. Postoperative complication rate was 12.3% for all patients, and it was 18.1% for EVER, 13.3% for EXER and 7.3% for IREX. There were no significant differences for anastomotic leakage, anastomotic bleeding and intraabdominal abscess among three technique groups, with P 0.05. For long-term outcomes, the 5-year DFS, 5-year LRR and 5-year DMR were 85.03%, 4.22% and 11.00% for all patients. Patients in advanced tumor stage have worse long-term survival compared with patients in early stage, but no significant survival differences were observed among three technique groups.Three techniques of NOSES for RC had acceptable short- and long-term outcomes, and tumor location was a determinant of technique selection.

Background Some recent studies on insulin receptor tyrosine kinase substrate (IRTKS) have focused more on its functions in diseases. However, there is a lack of research on the role of IRTKS in carcinomas and its mechanism remains ambiguous. In this study, we aimed to clarify the role and mechanism of IRTKS in the carcinogenesis of colorectal cancer (CRC). Methods We analysed the expression of IRTKS in CRC tissues and normal tissues by researching public databases. Cancer tissues and adjacent tissues of 67 CRC patients who had undergone radical resection were collected from our center. Quantitative real-time polymerase chain reaction and immunohistochemistry were performed in 52 and 15 pairs of samples, respectively. In vitro and in vivo experiments were conducted to observe the effect of IRTKS on CRC cells. Gene Set Enrichment Analysis and Metascape platforms were used for functional annotation and enrichment analysis. We detected the protein kinase B (AKT) phosphorylation and cell viability of SW480 transfected with small interfering RNAs (siRNAs) with or without basic fibroblast growth factor (bFGF) through immunoblotting and proliferation assays. Results The expression of IRTKS in CRC tissues was higher than that in adjacent tissues and normal tissues (all P Conclusion IRTKS mediated the bFGF-induced cell proliferation through the phosphorylation of AKT in CRC cells, which may contribute to tumorigenicity in vivo.

Background. Helicobacter pylori (HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP. Methods. We searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using the I-squared (I2) statistic. Results. A total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29–0.47). The combined estimate is I2 = 57% (P

Background: The prognosis of synchronous bone metastasis (BM) in colorectal cancer (CRC) is poor and rarely concerned. A clinical tool to evaluate the prognosis and clinical outcomes for BM would be attractive in current clinical practice. Methods: A total of 342 CRC patients with synchronous BM were identified from Surveillance, Epidemiology, and End Results (SEER) database. The cancer specific survival (CSS) was estimated with the Kaplan-Meier method. Prognostic factors were identified from multivariate Cox model, and the final clinical nomogram was developed to predict the CSS. The concordance index (C-index) was used to assess the discriminative ability. Calibration curves were provided to internally validate the performance of the nomogram. Results: The nomogram finally consisted of 6 prognostic factors including age, tumor grade, AJCC N stage, carcinoembryonic antigen (CEA) levels, primary tumor resection and chemotherapy, which translated the effects of prognostic factors into certain scores to predict the 1-, 2- and 3-year CSS for the synchronous BM in CRC patients. The nomogram presented a good accuracy for predicting the CSS with the C-index of 0.742. The calibration of the nomogram predictions was also accurate. Conclusions: This nomogram was accurate enough to predict the CSS of CRC patients with synchronous BM using readily available clinicopathologic factors and could provide individualized clinical decisions for both physicians and patients.

Background The Goto-Kakizaki (GK) rat, developed from repeated inbreeding of glucose-intolerant Wistar rats, has been widely used to explore the development of spontaneous type-2 diabetes mellitus (T2DM). However, the gastric microbiota of GK and Wistar rats are still unclear. This study aimed to understand the gastric microbiota characteristics of GK rats by comparing it with non-diabetic Wistar rats. Materials and Methods Male Wistar rats and GK rats were housed in specific pathogen-free (SPF) environment for 12 weeks with free access to sterilized food and water. Body weight and random blood glucose (BG) levels were determined. At the end of the experiment, the gastric contents of the rats were collected for the identification of gastric microbiota using 16S rRNA gene sequencing. Results The richness of gastric microbiota in GK rats was similar to that of Wistar rats (P > 0.05). The results of Shannon, Simpson, beta diversity indices, and ANOSIM analysis showed that alpha and beta diversity of gastric microbiota in GK rats were significantly lower than that of Wistar rats (P < 0.01). Firmicutes (96.0%), Proteobacteria (1.9%) and Cyanobacteria (0.8%) were the dominant gastric microbiota in GK rats accounting for 72.9%, 14.7% and 10.9%, respectively. Linear discriminant analysis effect size (LEfSe) revealed that phylum Firmicutes and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) were significantly abundant in the stomachs of GK rats. In contrast, seven genera (unidentified_Chloroplast, Porphyromonas, Neisseria, Rubrobacter, Veillonella, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae) were significantly abundant in the stomachs of Wistar rats. Blood glucose was positively correlated with Anaerobibrio and Lactobacillus, and negatively correlated with four genera (Porphyromonas, Rubrobacter, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae). In addition, chemoheterotrophy and fermentation were the most important functions of gastric microbiota. Conclusion The gastric microbiota of GK rats with spontaneous T2DM showed the typical characteristics of low diversity and significant enrichment of Firmicutes phylum and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) compared with gastric microbiota of Wistar rats.

Untargeted metabolomics based on liquid chromatography-mass spectrometry is affected by nonlinear batch effects, which cover up biological effects, result in nonreproducibility, and are difficult to be calibrate. In this study, we propose a novel deep learning model, called Normalization Autoencoder (NormAE), which is based on nonlinear autoencoders (AEs) and adversarial learning. An additional classifier and ranker are trained to provide adversarial regularization during the training of the AE model, latent representations are extracted by the encoder, and then the decoder reconstructs the data without batch effects. The NormAE method was tested on two real metabolomics data sets. After calibration by NormAE, the quality control samples (QCs) for both data sets gathered most closely in a PCA score plot (average distances decreased from 56.550 and 52.476 to 7.383 and 14.075, respectively) and obtained the highest average correlation coefficients (from 0.873 and 0.907 to 0.997 for both). Additionally, NormAE significantly improved biomarker discovery (median number of differential peaks increased from 322 and 466 to 1140 and 1622, respectively). NormAE was compared with four commonly used batch effect removal methods. The results demonstrated that using NormAE produces the best calibration results.

Background: Lymph node examination is a prognostic indicator for colon cancer (CC) patients. The aim of this study was to develop and validate a preoperative risk prediction model for inadequate lymph node examination. Methods: 24284 patients diagnosed as stage I-III CC between 2010-2014 were extracted from SEER database and randomly divided into development cohort (N=12142) and internal validation cohort (N=12142). 680 patients diagnosed as stage I-III CC between 2012-2014 were extracted from our hospital as external validation cohort. Logistic regression analysis was performed and risk score of each factor was calculated according to model formula. Model discrimination was assessed using C-statistics. Results: Preoperative risk factors were identified as gender, age, tumor site and tumor size. Patients with total risk score of 0-6 were considered as low risk group while patients scored ≥13 were considered as high risk group. The model had good discrimination and calibration in all cohorts and could apply to patients in the SEER database (American population) and patients in our hospital (Chinese population). Conclusions: The model could accurately predict the risk of inadequate lymph node examination before surgery and might provide useful reference for surgeons and pathologists.

TNFSF9 gene has been found to play an anti-tumor role and regulate the function of immune cells. However, the prognostic role of TNFSF9 in pancreatic cancer and its relationship with immune cell infiltration have not been studied. We used Oncomine, UALCAN, and GEPIA databases to analyze the expression of TNFSF9 in pancreatic cancer. We used Kaplan-Meier plotters, GEPIA, and UALCAN to evaluate the effect of TNFSF9 on clinical prognosis. We further used TIMER to study the correlation between TNFSF9 and cancer immune infiltrate cells. In addition, we used GEPIA to analyze the correlation between TNFSF9 expression and gene markers of immune infiltrate cells. TNFSF9 mRNA expression level was remarkably increased in pancreatic cancer than that in normal tissues (both P

BACKGROUND Brain metastasis (BM) from colorectal cancer (CRC) is rarely encountered clinically, and its prognosis has not been fully evaluated. AIM To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC. METHODS A retrospective study of 371 patients with synchronous BM from CRC was performed, using the data from 2010 to 2014 from the Surveillance, Epidemiology, and End Results database. Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models, respectively. A scoring system was developed using the independent prognostic factors, and was used to measure the survival difference among different patients. RESULTS For the 371 patients, the median overall survival was 5 mo, survival rates were 27% at 1 year and 11.2% at 2 years. Prognostic analysis showed that age, carcinoembryonic antigen level and extracranial metastasis to the liver, lung or bone were independent prognostic factors. A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups (scores of 0-1, 2-3, and 4). The median survival of patients with scores of 0-1, 2-3 and 4 was 14, 5 and 2 mo, respectively (P < 0.001). Subgroup analysis showed that there were significant differences in prognosis among the groups. Score 2-3 vs 0-1: hazard ratio (HR) = 2.050, 95%CI: 1.363-3.083; P = 0.001; score 4 vs 0-1: HR = 3.721, 95%CI: 2.225-6.225; P < 0.001; score 2-3 vs 4: HR = 0.551, 95%CI: 0.374-0.812; P = 0.003. CONCLUSION The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC. These results are helpful in providing a reference for guiding therapy.

Objective The transanal approach to specimen collection, combined with the prolapsing technique, is a well-established and minimally invasive surgery for treating rectal cancer. However, reports on outcomes for this approach are sparse. We compared short- and long-term outcomes of conventional laparoscopic surgery (CLS) vs. transanal natural orifice specimen extraction (NOSE) using the prolapsing technique for patients with middle- to low-rectal cancer. Methods From January 2013 to December 2017, we enrolled consecutive patients with middle- to low-rectal cancer undergoing laparoscopic anterior resection. Totally, 50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS. Clinical parameters and survival outcomes between the two groups were compared. Results Estimated blood loss (29.70±29.28 vs. 52.80±45.09 mL, P=0.003), time to first flatus (2.50±0.79 vs. 2.86±0.76, P=0.022), time to liquid diet (3.62±0.64 vs. 4.20±0.76 d, P

According to the national strategic plan for healthy aging and the construction of the pension system in China, it is expected that by 2020 the population of elderly aged 60 and above will reach 255 million, accounting for about 17.8% of the total population. Currently, population aging is a serious social problem in China, and thus, health status of the elderly becomes increasingly critical. The present research uses machine learning to identify factors influencing elderly's health status and life satisfaction with data from the Chinese Longitudinal Healthy Longevity Survey. The results show that some common factors are important for both self-rated health status and life satisfaction for elderly, namely positive and optimistic attitudes, a healthy diet, and economic status. Health status and life satisfaction also have their unique predicting factors, such as mobility ability for health status and living conditions for life satisfaction. Theoretical and practical implications of the findings are discussed.

Background It is important to understand the clinical characteristics of bacterial spectrum and antibiotic resistance of urine and stone pathogens for the prevention and treatment of urolithiasis and perioperative infection. Methods Consecutive patients with kidney stones treated by percutaneous nephrolithotomy (PCNL) from September 2016 to September 2018 were included. The bacterial species and antibiotic sensitivity test of the germs cultured from clean middle-stream urine and from stones intraoperatively were evaluated. Results In 1055 patients, the rate of positive bacterial test was higher in stones than in urine (337, 31.0% vs. 221, 20.9%, p=0.016). 167(15.8%) patients had both positive urine culture (UC) and stone culture (SC), of which 137 (82.0%) had identical bacteria in both cultures. In infection stone patients, the positive rate of bacteria was 34.7% (91/262) in urine and 52.3% (137/262) in stone, and in non-infection stone patients, was 16.4% (130/793) and 25.2% (200/793). The positive rate of SC in patients with different types of stones were higher than that of UC. E. coli was the most common organism not only in both UC (54.3% ,120/221) and SC (43.9%,148/337) but also in urine and stones from patients with infection stones (44.0%,32.8%) or non-infection stones (61.5%,51.8%). Furthermore, the pathogens isolated from urine and stones showed high resistance to fluoroquinolones, ceftriaxone, cefazolin, cefuroxime, β-lactamases and sulfonamides (all resistance>20%). Conclusions The bacterial spectra demonstrated in stones and urine samples were significantly different. Positive SC was more commonly encountered than positive UC. Compared with non-infection stones, infection stones were accompanied by higher rates of positive tests in both cultures. The antibiotic resistance was comparable between bacteria in the two cultures. A combination of antibiotic sensitivity results in urine and stones might be a useful guide for selection of effective and appropriate treatment aiming at reduced problems with bacterial antibiotic resistance.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has attracted global attention. During the lockdown period of COVID-19, follow-up of many patients with chronic disease had been interrupted, which brought severe challenges to better management of their disease. This study aimed at exploring the change of illness, daily life, and psychological responses during the COVID-19 pandemic among chronic kidney disease (CKD) patients.Methods: A total of 612 patients were enrolled in this study; 282 patients were categorized into the CKD stage 1–2 group and 330 patients were categorized into the CKD stage 3–5 group. Among two groups, 168 (27.5%) and 177 (28.9%) patients were female with a median age of 42 and 45, respectively. The study was conducted by collecting the questionnaires in five nephrology centers. The questionnaire consisted of assessment of anxiety by using the Self-Rating Anxiety Scale and the influences of COVID-19, which included basic demographic data, the influences of COVID-19 on illness and daily life, as well as the patients' psychological responses during the epidemic.Results: A total of 612 patients were included and divided into two groups according to eGFR. Ninety-six patients (34%) in the CKD stage 1–2 group and 141 patients (42.7%) in the CKD stage 3–5 group had reduced their follow-up frequency (p = 0.031). More patients with CKD stages 1–2 consulted online (25.9%), p = 0.005. Besides, patients in the CKD stage 3–5 group tended to be more anxious about follow-up (p = 0.002), fearful of being infected with COVID-19 (p = 0.009), and more likely to feel symptoms getting worse (p = 0.006). The standard scores of SAS were 48.58 ± 7.082 and 51.19 ± 5.944 in the CKD stage 1–2 group and the CKD stage 3–5 group, respectively (p < 0.001). There were significant differences in the severity of anxiety (p = 0.004).Conclusion: COVID-19 had a greater impact on patients with CKD stages 3–5 than those with stages 1–2 in terms of illness, daily life, and psychological disorder. Patients with CKD stages 3–5 were more anxious during the COVID-19 pandemic.

Amorphous carbon hard mask (ACHM) films have been widely applied as protective components and hard etching masks in lithography and dry etching processes. The capability of lithography is directly dependent on the step coverage (SC) of the ACHM. Poor SC may impact the protection of device patterns during the etching process and lead to overlay marks occurring in lithography. In this work, the ACHM film processing process is engineered and optimized towards better SC through the comparative study of the C2H2 and C3H6 precursors at different temperatures. Furthermore, a process parameter design of experiment (DOE), with C2H2 as a precursor to optimize the dry etching rate, is proposed. The results of the experiment show that the dry etching performance is enhanced by higher power, temperature and C2H2 flow, and a smaller gap, lower pressure and lower carrier gas flow. A selective etching ratio of SiO2 and SiN, with an improved process window, is obtained. ACHM film elimination process is also validated by characterizing the surface roughness. The demonstrated results can be instructive in terms of the optimization of etching process in future semiconductor manufacturing.

Therapeutic ultrasound and microbubble technologies seek to drive systemically administered microbubbles into oscillations that safely manipulate tissue or release drugs. Such procedures often detect the unique acoustic emissions from microbubbles with the intention of using this feedback to control the microbubble activity. However, most sensor systems reported introduce distortions to the acoustic signal. Acoustic shockwaves, a key emission from microbubbles, are largely absent in reported recording, possibly due to the sensors being too large or too narrowband, or having strong phase distortions. Here, we built a sensor array that countered such limitations with small, broadband sensors and a low-phase distorting material. We built eight needle hydrophones with polyvinylidene fluoride (PVDF, diameter: 2 mm) then fit them into a 3-D-printed scaffold in a two-layered, staggered arrangement. Using this array, we monitored microbubbles exposed to therapeutically relevant ultrasound pulses (center frequency: 0.5 MHz, peak-rarefactional pressure: 130-597 kPa, pulselength: four cycles). Our tests revealed that the hydrophones were broadband with the best having a sensitivity of -224.8 dB ± 3.2 dB re 1 V/ μ Pa from 1 to 15 MHz. The array was able to capture shockwaves generated by microbubbles. The signal-to-noise ratio (SNR) of the array was approximately two times higher than individual hydrophones. Also, the array could localize microbubbles (-3 dB lateral resolution: 2.37 mm) and determine the cavitation threshold (between 161 and 254 kPa). Thus, the array accurately monitored and localized microbubble activities, and may be an important technological step toward better feedback control methods and safer and more effective treatments.

Objective: To explore the frequency, evolution, associated factors, and risk factors of fatigue over 3-year of prospective follow-up in a cohort of patients with early Parkinson’s disease (PD).Methods: A total of 174 PD patients in the early stage were enrolled and quantitively assessed motor and non-motor symptoms using comprehensive scales including the Fatigue Severity Scale (FSS) annually. Each subject was categorized as PD with and without fatigue based on a cut-off mean value of 4 using FSS. The generalized estimating equation (GEE) was utilized to investigate the associated factors, and the stepwise binary logistic regression model was performed to explore the predictors.Results: The frequency of fatigue was slightly changed (ranging from 35.1 to 40.4%) during the 3-year follow-up. The changed pattern of the frequency of fatigue was similar to that of anxiety. Fatigue was significantly associated with nocturnal sleep disorders (B 2.446, P < 0.001), high Hamilton Anxiety Rating Scale (HAMA) score (B 1.072, P = 0.011), and high Unified PD Rating Scale (UPDRS) III score (B 1.029, P = 0.003) over time. High UPDRS III score [odds ratio (OR) 1.051, P = 0.015] at baseline increased the risk of developing fatigue after 1-year; high LEDD (OR 1.002, P = 0.037) increased the risk of developing fatigue after 2-year; and high LEDD (OR 1.003, P = 0.049) and high HAMA score (OR 1.077, P = 0.042) increased the risk of developing fatigue after 3-year.Conclusion: Our present study provided evidence of the longitudinal evolution of fatigue in patients with early PD and help clinical management of fatigue.

Background: Cancer stem cells (CSCs), which are characterized by self-renewal and plasticity, are highly correlated with tumor metastasis and drug resistance. To fully understand the role of CSCs in colorectal cancer (CRC), we evaluated the stemness traits and prognostic value of stemness-related genes in CRC.Methods: In this study, the data from 616 CRC patients from The Cancer Genome Atlas (TCGA) were assessed and subtyped based on the mRNA expression-based stemness index (mRNAsi). The correlations of cancer stemness with the immune microenvironment, tumor mutational burden (TMB), and N6-methyladenosine (m6A) RNA methylation regulators were analyzed. Weighted gene co-expression network analysis (WGCNA) was performed to identify the crucial stemness-related genes and modules. Furthermore, a prognostic expression signature was constructed using the Lasso-penalized Cox regression analysis. The signature was validated via multiplex immunofluorescence staining of tissue samples in an independent cohort of 48 CRC patients.Results: This study suggests that high-mRNAsi scores are associated with poor overall survival in stage IV CRC patients. Moreover, the levels of TMB and m6A RNA methylation regulators were positively correlated with mRNAsi scores, and low-mRNAsi scores were characterized by increased immune activity in CRC. The analysis identified 34 key genes as candidate prognosis biomarkers. Finally, a three-gene prognostic signature (PARPBP, KNSTRN, and KIF2C) was explored together with specific clinical features to construct a nomogram, which was successfully validated in an external cohort.Conclusion: There is a unique correlation between CSCs and the prognosis of CRC patients, and the novel biomarkers related to cell stemness could accurately predict the clinical outcomes of these patients.

BackgroundComplex factors are involved in the development and progression of immunoglobulin A nephropathy (IgAN), a common primary glomerulonephritis worldwide. Autoimmunity and inflammation have been considered to be the basic mechanisms; however, the exact pathogenesis remains unclear. As a novel marker of inflammation, the neutrophil-to-lymphocyte ratio (NLR) has been studied in various diseases. Whether the NLR can predict the renal outcome of patients with IgAN remains unclear. We evaluated the relationships between the NLR and renal function, pathologic lesions, renal progression, and prognosis in patients with IgAN.MethodsThis retrospective study involved 966 patients with biopsy-proven IgAN. They were divided into two groups based on the cut-off value of the NLR: the high group (NLR ≥ 2.67, n = 384) and the low group (NLR < 2.67, n = 582). The endpoint was end-stage renal disease [estimated glomerular filtration rate (eGFR) of 2 or performance of renal replacement therapy]. A correlation test was conducted to explore the relationship between the NLR and other important parameters (eGFR, serum creatinine, proteinuria, hypertension and renal pathologic lesions). The predictive value was determined by the area under the receiver operating characteristics curve (AUROC). Kaplan–Meier and Cox proportional hazards analyses were performed to evaluate renal progression and prognosis.ResultsThe NLR had the highest AUROC, which was 0.633 (p < 0.001). The correlation test revealed that the NLR was positively correlated with serum creatinine (r = 0.127, p < 0.001) and 24-hour urine protein (r = 0.18, p < 0.001) and negatively correlated with eGFR (r = 0.14, p < 0.001). Patients with IgAN who had a high NLR were more likely to have hypertension (p = 0.003). Multivariate Cox regression analysis indicated that a high NLR was an independent risk factor for IgAN even after adjustment for important clinical and pathological parameters (p = 0.043, HR = 1.74, 95%CI: 1.02-2.97). Kaplan–Meier analysis showed that a high NLR was significantly associated with the renal prognosis of patients with IgAN (p < 0.001), especially patients with stage 3 to 4 chronic kidney disease (p = 0.028) or 24-hour urine protein of >1 g/day (p < 0.001).ConclusionAn elevated NLR affects the renal progression and prognosis in patients with IgAN and could be a marker for evaluation of renal function and pathologic lesions.

This paper presents a novel approach to identify inerter-based suspension struts, which can provide significant performance enhancement for passenger vehicles. The inerter has been used on Formula 1 racing cars, and several beneficial devices incorporating inerters have also been identified for ride comfort enhancement. However, previous investigations either were limited to simple network configurations with moderate performance improvement, or resulted in complicated configurations with a large number of elements which are impractical for real-life applications. In addition, some important practical performance constraints have not been taken into consideration, such as high-frequency dynamic stiffness which influences the NVH performance, and frequency content consideration of the sprung mass acceleration which more directly relates to passenger perception. In this paper, a quarter-car model including top mount is studied, with the performance of a conventional suspension strut presented as baseline. The structure-immittance approach, which can cover all networks with pre-determined numbers of each element type, is adopted for the identification of the optimal suspension configurations. Several configurations with up to a 14.7% performance improvement are identified with all other practical performance indices to be no worse than the baseline. The suspension devices proposed in previous works are also considered for a sake of comparison, demonstrating significant advantages of the structure-immittance approach. Subsequently, a sensitivity analysis against the sprung and unsprung mass changes is carried out, which represents cargo and tyre weight variations, respectively. Time domain response and other reality checks are then conducted for the out-performing configurations, which reconfirm the ride comfort enhancement and ensure no unexpected behaviour occurs.

Background: Brain metastasis (BM) from colorectal cancer (CRC) seriously affects the survival and quality of life of patients. However, this disease is not fully understood. It is not clear...

This paper presents a novel method for gust loads alleviation in a truss-braced wing in which an inerter-based device located in the truss-structure is used to reduce peak-loads during a discrete “1-cosine” gust. Three candidate layouts are considered, and the device parameters are optimized to target the response of the first three structural modes. It is demonstrated that either a single damper or a combination of inerter-based devices can be used to achieve a reduction of approximately 4% for spanwise locations inboard of the strut attachment point and that this reduction is consistent across the full range of gust gradients. Furthermore, it is noted that the inerter-based device has a significantly smaller damping coefficient than the case where just a damper is used and that the device parameter values are viable within the scope of an aerospace application.