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It has been widely recognized that the efficient training of neural networks (NNs) is crucial to classification performance. While a series of gradient-based approaches have been extensively developed, they are criticized for the ease of trapping into local optima and sensitivity to hyperparameters. Due to the high robustness and wide applicability, evolutionary algorithms (EAs) have been regarded as a promising alternative for training NNs in recent years. However, EAs suffer from the curse of dimensionality and are inefficient in training deep NNs (DNNs). By inheriting the advantages of both the gradient-based approaches and EAs, this article proposes a gradient-guided evolutionary approach to train DNNs. The proposed approach suggests a novel genetic operator to optimize the weights in the search space, where the search direction is determined by the gradient of weights. Moreover, the network sparsity is considered in the proposed approach, which highly reduces the network complexity and alleviates overfitting. Experimental results on single-layer NNs, deep-layer NNs, recurrent NNs, and convolutional NNs (CNNs) demonstrate the effectiveness of the proposed approach. In short, this work not only introduces a novel approach for training DNNs but also enhances the performance of EAs in solving large-scale optimization problems.

Inverse design has long been an efficient and powerful design tool in the aircraft industry. In this paper, a novel inverse design method for supercritical airfoils is proposed based on generative models in deep learning. A Conditional Variational AutoEncoder (CVAE) and an integrated generative network CVAE-GAN that combines the CVAE with the Wasserstein Generative Adversarial Networks (WGAN), are conducted as generative models. They are used to generate target wall Mach distributions for the inverse design that matches specified features, such as locations of suction peak, shock and aft loading. Qualitative and quantitative results show that both adopted generative models can generate diverse and realistic wall Mach number distributions satisfying the given features. The CVAE-GAN model outperforms the CVAE model and achieves better reconstruction accuracies for all the samples in the dataset. Furthermore, a deep neural network for nonlinear mapping is adopted to obtain the airfoil shape corresponding to the target wall Mach number distribution. The performances of the designed deep neural network are fully demonstrated and a smoothness measurement is proposed to quantify small oscillations in the airfoil surface, proving the authenticity and accuracy of the generated airfoil shapes.

Designing and developing the highly efficient photocatalysts is full of significance to achieve spontaneous photolysis water. In this work, using the first-principles calculations, we have performed a systematic theoretical study of water splitting photocatalytic activity of the InSe/g-CN heterojunction. It is concluded that the InSe/g-CN heterojunction is a typical type-II semiconductor, whose electrons and holes can be effectively separated. And the potential of the conduction band minimum (CBM) and valence band maximum (VBM) satisfy the requirements for photolysis water. Moreover, the changes of Gibbs free energy (ΔG) of the oxygen evolution reaction (OER) and the hydrogen evolution reaction (HER) are calculated to investigate thermodynamic sustainability of photolysis water. The results show that when pH = 7, the potential driving force provided by the InSe/g-CN heterojunction can ensure the spontaneous progress of HER and OER. In addition, it is found that the solar conversion efficiency (ηS) of the InSe/g-CN heterojunction is up to 13.7%, which indicates it has broad commercial application prospects. Hence, the InSe/g-CN heterojunction is expected to be an excellent candidate for photolysis water.

Calcyphosine (CAPS) was initially identified from the canine thyroid. It also exists in many types of tumor, but its expression and function in glioma remain unknown. Here we explored the clinical significance and the functional mechanisms of CAPS in glioma. We found that CAPS was highly expressed in glioma and high expression of CAPS was correlated with poor survival, in glioma patients and public databases. Cox regression analysis showed that CAPS was an independent prognostic factor for glioma patients. Knockdown of CAPS suppressed the proliferation, whereas overexpression of CAPS promoted the proliferation of glioma both in vitro and in vivo. CAPS regulated the G2/M phase transition of the cell cycle, but had no obvious effect on apoptosis. CAPS affected PLK1 phosphorylation through interaction with MYPT1. CAPS knockdown decreased p-MYPT1 at S507 and p-PLK1 at S210. Expression of MYPT1 S507 phosphomimic rescued PLK1 phosphorylation and the phenotype caused by CAPS knockdown. The PLK1 inhibitor volasertib enhanced the therapeutic effect of temozolomide in glioma. Our data suggest that CAPS promotes the proliferation of glioma by regulating the cell cycle and the PLK1 inhibitor volasertib might be a chemosensitizer of glioma. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Background Dihydropyrimidinase like 2 (DPYSL2) has been linked to tumor metastasis. However, the function of DPSY2L in lung adenocarcinoma (LUAD) is yet to be explored. Methods Herein, we assessed DPYSL2 expression in various tumor types via online databases such as Oncomine and Tumor Immune Estimation Resource (TIMER). Further, we verified the low protein and mRNA expressions of DPYSL2 in LUAD via the ULCAN, The TCGA and GEPIA databases. We applied the ROC curve to examine the role of DPYSL2 in diagnosis. The prognostic significance of DPYSL2 was established through the Kaplan–Meier plotter and the Cox analyses (univariate and multivariate). TIMER was used to explore DPYSL2 expression and its connection to immune infiltrated cells. Through Gene Set Enrichment Analysis, the possible mechanism of DPYSL2 in LUAD was investigated. Results In this study, database analysis revealed lower DPYSL2 expression in LUAD than in normal tissues. The ROC curve suggested that expression of DPYSL2 had high diagnostic efficiency in LUAD. The DPYSL2 expression had an association with the survival time of LUAD patients in the Kaplan–Meier plotter and the Cox analyses. The results from TIMER depicted a markedly positive correlation of DPYSL2 expression with immune cells infiltrated in LUAD, such as macrophages, dendritic cells, CD4+ T cells, and neutrophils. Additionally, many gene markers for the immune system had similar positive correlations in the TIMER analysis. In Gene Set Enrichment Analysis, six immune-related signaling pathways were associated with DPYSL2. Conclusions In summary, DPYSL2 is a novel biomarker with diagnostic and prognostic potential for LUAD as well as an immunotherapy target. Highlights Expression of DPYSL2 was considerably lower in LUAD than in normal tissues. Investigation of multiple databases showed a high diagnostic value of DPYSL2 in LUAD. DPYSL2 can independently predict the LUAD outcomes. Immune-related mechanisms may be potential ways for DPYSL2 to play a role in LUAD.

Background Previous articles have focused on the diagnosis and treatment of acute hematogenous osteomyelitis. Here, we present a case of chronic hematogenous osteomyelitis in a 2-month-old girl. The diagnostic procedure was unusual and difficult due to negative culture results. Case presentation A girl aged 2 months and 23 days had fever and swelling in her right lower leg for 7 days. On the basis of her medical history, physical, and histological examination results; and radiologic and magnetic resonance imaging findings, a diagnosis of chronic osteomyelitis was made. The patient underwent surgical treatment and was discharged successfully. The patient showed good recovery and no sequelae at the 12-month follow-up. Conclusion Hematogenous osteomyelitis in babyhood is different from that at any other age. Hematogenous osteomyelitis-related bone destruction in babyhood is more serious and occurs faster. The transition from acute hematogenous osteomyelitis to chronic hematogenous osteomyelitis takes only 7 days. To the best of our knowledge, this chronic hematogenous osteomyelitis patient is the youngest ever reported.

Background. Angioimmunoblastic T cell lymphoma (AITL) is an aggressive Epstein–Barr virus-associated T cell lymphoma. Clinical syndromes of AITL are not confined to fever and lymphadenopathy, and patients may initially present with polyclonal plasma cell proliferation, which may obscure the underlying disease of AITL, delaying diagnosis. Case Presentation. Here, we report two AITL patients with excessive plasma cell proliferation in the bone marrow, peripheral blood, and ascites even mimicking plasma cell leukemia. Both of them had poor endings. Conclusions. Our report emphasizes the complexity of the clinical manifestations of AITL, which aims to increase the alertness of physicians and improve the rate of early diagnosis. Integrated diagnostic approaches such as histopathology, flow cytometry, cytogenetics, and molecular biology are essential for accurate diagnosis and precise therapy.

Moreau score has been used to differentiate chronic lymphocytic leukemia (CLL) from other mature B‐cell neoplasms. However, it showed limitations in Asian patients. Therefore, we conducted a new score system replacing CD5 and CD23 with CD43 and CD180 to evaluate its diagnostic value of CLL. 237 untreated samples diagnosed with mature B‐cell neoplasms were collected and were randomly divided into an exploratory and a validation cohort by a 2:1 ratio. The expression of CD5, CD19, CD20, CD23, CD43, CD79b, CD180, CD200, FMC7, and surface immunoglobulin (SmIg) were analyzed among all the samples. A proposed score was developed based on the logistic regression model. The sensitivity and specificity of the proposed score were calculated by ROC curves. CD43/CD180, CD200, FMC7, and CD79b were included in our new CLL score, which showed a sensitivity of 91.8% and a specificity of 83.1%. These results were confirmed in a validation cohort with a sensitivity of 90.5% (p = 0.808) and a specificity of 79.5% (p = 0.639). In CD5 negative or CD23 negative CLL group, the new CLL score displayed improved sensitivity of 79.4% compared to Moreau score and CLLflow score (41.2% and 47.1%, respectively). In atypical CLL group, the new CLL score showed improved sensitivity of 84.2% compared to Moreau score and CLLflow score (61.4% and 64.9%, respectively). This proposed atypical CLL score helped to offer an accurate differentiation of CLL from non‐CLL together with morphological and molecular methods, particularly in Chinese patients with atypical immunophenotype., This study demonstrated the diagnostic value of combination of CD43 and CD180 with CD200, FMC7 and CD79b in CD5‐ or CD23‐ CLL for the first time. How to differentiate atypical CLL from other mature B cell neoplasms poses a problem in the diagnosis of CLL. This study investigated the immunophenotyping data of patients with mature B‐cell malignancies, and developed a new combined score including CD43 and CD180 which could improve the diagnostic value of CLL versus non‐CLL, particularly in atypical CLL.

Background: Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection, but a comparative study remains lacking. This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport, for the management of lower limb post-traumatic osteomyelitis. Methods: From January 2013 to June 2018, a total of 102 patients with lower limb post-traumatic osteomyelitis met the criteria were included for analysis, in which 70 patients received one-stage debridement, antibiotic-loaded implantation, metaphysis osteotomy and bone transport were named as one-stage group, while 32 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation, second-stage osteotomy and bone transport were devised as two-stage group. The outcomes of hospitalization (hospital stay, costs of treatment, surgical time, antibiotic usage) and follow-up (infection-free, treatment failure, infection recurrence, external fixation index (EFI) and docking site union) between the two groups were retrospectively compared. Results: For outcomes of hospitalization, patients in the one-stage group had batter results on hospital stay (18.2 days versus 28.9 days, P ​ ​0.05) without any additional debridement operation. 94.3% (66/70) patients in the one-stage group earned wound healing after the operation, comparing to 96.9% (31/32) patients healed in the two-stage group (P ​> ​0.05). Uncontrolled infection was observed on 4 (5.7%) patients in the one-stage group and 1 (3.1%) patients in the two-stage group (P ​> ​0.05), with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively. 5 (7.2%) patients in the one-stage group and 1 (3.2%) patient in the two-stage group encountered with infection recurrence (P ​> ​0.05) and were well-managed with re-debridement and antibiotics usage. Significance was not found between two groups on EFI (74.8 days/cm versus 69.0 days/cm, P ​> ​0.05) and docking site nonunion rate (14.5% versus 18.9%, P ​> ​0.05), indicating that bone transport in different stages played a less essential role on bone generation process. The other complications, such as prolonged aseptic drainage [24.3% (17/70) versus 21.9% (7/32)], re-fracture [5.8% (4/69) versus 3.2% (1/31)], pin-tract infection [23.2% (16/69) versus 19.4% (6/31)], joint stiffness and deformity [26.1% (18/69) versus 32.3% (10/31)], also showed less significance when comparing between two groups (P ​> ​0.05), suggesting that different transport stages play little role on complications formation. Conclusions: One-stage radical debridement and bone transport was proven to be a safe and effective method for treating static (or near static) lower limb osteomyelitis. Translational potential statement: Translational potential statement One-stage debridement and bone transport is sample, effective and time-saving, with similar complications compared to conventional two-stage protocol. This treatment protocol might provide an alternative for the treatment of static (or near static) lower limb osteomyelitis.

Angiomyolipoma (AML) is apparent a part of mesenchymal tumor arising from perivascular epithelioid cell origin. AML is formed of blood vessels, spindle and epithelioid cells, and mature adipocytes. Adrenal AML is very rare. Indeed, only 21 cases of adrenal AML have been reported in the English-language literature. In these cases, patients were usually asymptomatic, and AML was often examined passingly during a health checkup or a common abdominal ultrasound (US) or a computed tomography (CT) examination for a other unrelated disease. This is a case report of adrenal AML in a 40-year-old male who presented with no clinical manifestations. Some 3 months ago, a first abdominal routine CT scan revealed a left adrenal mass. Three months later, a routine US showed a hypoechoic area of 21 mm × 15 mm in the left adrenal gland. A retroperitoneoscopic resection of the left adrenal gland tumor was then performed. A postoperative histopathology report confirmed a benign AML composed of blood vessels, smooth muscle, and mature adipose tissue. The patient was discharged without event. Due to the paucity of the literature on this subject, more clinical and imaging information about this disease is necessary for diagnosis, differential diagnosis, and treatment. In this paper, we present a complete case report, including the clinical presentation, imaging, treatment, and conduct a review of the relevant literature.

Vaccines based on live attenuated Chlamydia elementary bodies (EBs) can cause disease in vaccinated animals and the comparably safer inactivated whole EBs are only marginally protective. Recent studies show that a vaccine formulation comprising UV-inactivated EBs (EB) and appropriate mucosal delivery systems and/or adjuvants induced significant protective immunity. We tested the hypothesis that intranasal delivery of UV-inactivated C. psittaci EB formulated in Vibrio cholerae ghosts (VCG)-chitosan nanoparticles will induce protective immunity against intranasal challenge in SPF chickens. We first compared the impact of VCG and CpG adjuvants on protective immunity following IN mucosal and IM systemic delivery of EB formulated in chitosan hydrogel/microspheres. Immunologic analysis revealed that IN immunization in the presence of VCG induced higher levels of IFN-γ response than IM delivery or the CpG adjuvanted groups. Also, vaccine efficacy evaluation showed enhanced pharyngeal bacterial clearance and protection against lung lesions with the VCG adjuvanted vaccine formulation, thereby establishing the superior adjuvanticity of VCG over CpG. We next evaluated the impact of different concentrations of VCG on protective immunity following IN mucosal immunization. Interestingly, the adjuvanticity of VCG was concentration-dependent, since protective immunity induced following IN mucosal immunization showed dose-dependent immune responses and protection. These studies reveal that formulation of inactivated chlamydial antigens with adjuvants, such as VCG and chitosan increases their ability to induce protective immune responses against challenge.

BACKGROUND Coronavirus disease 2019 (COVID-19) has spread around the globe. On February 28, 2020, the World Health Organization adjusted the risk of spread and impact of COVID-19 to “very high” at the global level. Studies have mainly focused on the etiology, epidemiology, and treatment of COVID-19 to limit further spread and the negative impact of the disease, while less attention has been devoted to the follow-up and reexamination of patients who recovered from COVID-19 or were released from quarantine. CASE SUMMARY This study reports two cases where patients who had negative reverse transcription-polymerase chain reaction (RT-PCR) test results and met the criteria for discharge subsequently had positive RT-PCR test results. The clinical manifestations and computed tomography (CT) findings of these patients were examined. The conversion of RT-PCR test results in these two patients may be related to false-negative and false-positive outcomes of the test. CT images helped track improvement of pulmonary lesions. CONCLUSION The timing of discharge of COVID-19 patients should be determined by comprehensive analysis of CT images and RT-PCR test results.

We empirically study the impact of the HOV-incentive launch and termination on green and non‐green product demand in the U.S. automobile industry.

BACKGROUND Coronavirus disease 2019 (COVID-19) severity is classified as asymptomatic, mild, moderate, severe, and critical. Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis. However, a 49%-67% mortality is noted in critical cases. No COVID-19-specific drug has been reported to date, and symptomatic and optimal supportive care, including oxygenation, anti-coinfection treatments, and ventilation, represent the mainstay of treatment for this disease, especially in critical patients. CASE SUMMARY In the above-mentioned context, we share our experience with the treatment of one critical COVID-19 case and review the relevant literature. CONCLUSION Timely tracheal intubation, reasonable mechanical ventilation support, appropriate anti-infection treatment, and early anticoagulation and immunity support are key factors in the successful treatment of this case.

Objective the present study was aimed at evaluating the effect of distraction osteogenesis using monolateral external fixators by intralesional osteotomy in children patients of Ollier’s disease. Methods 2 male and 4 female children patients of Ollier’s disease with an average age of 7.8 years received treatment between 2008 and 2016 were included in the study, and 1 ulna, 3 femurs, 4 tibias, 1 radius, and 1 humerus were involved. The Ollier’s disease induced extremities’ deformities were corrected by distraction osteogenesis using monolateral external fixator (LRS), and the intralesional osteotomy was conducted. The original length and the distracted length, the severity of angular deformity, and the mechanical axis deviation of the affected bones were measured. The initial and ending dates of bone lengthening, as well as the installation date and removal date of frames were recorded. The distraction index (DI) and the external fixator index (EFI) were calculated. Postoperative follow-up efficacy was assessed by regular radiographic examinations. Results after treatment in all cases the length discrepancy of the affected limbs with contralateral side were less than 3 ​cm, and the angular deformities were corrected. The mean lengthened bones were 52.8 ​mm ​± ​14.9 ​mm, the average DI was 12.9 days/cm ± 1.6 days/cm, and the mean EFI was 50.5 days/cm ± 12.5 days/cm. Pain as the complication were found in all cases and was managed by analgesics. Pin site infection were reported in one case and was cured by wound care and normal use of antibiotics. One case was found to have delayed bone healing but the volume and size of the affected bone was recovered to normal about 3 months after removal of the frames. Conclusion this study revealed that distraction is beneficial for the conversion of enchondromal bone into normal bone, and intralesional osteotomy is safe and supposed to protect the remaining healthy bone segment. Taken together, distraction osteogenesis using monolateral external fixators is effective in managing the length and angular deformity of extremities caused by Ollier’s disease in children patients. The translational potential of this article: To date, no consensus for the correction of extremities deformity induced by the Ollier’s disease has been established. This study found that distraction as a treatment could promote conversion of enchondromal bone into normal bone, and intralesional osteotomy is safe and beneficial for saving the limited healthy bone on the whole bone segment from being iatrogenically damaged. Such findings will provide some references for the treatments of extremities.

Background Management of chronic calcaneal osteomyelitis is challenging. At present, there is still no widely accepted, simple, and effective surgical method to eradicate the infection and prevent osteomyelitis recurrence. The objective of this study was to assess the outcomes of one-stage treatment of chronic calcaneal osteomyelitis with a shape-preserving debridement technique combined with antibiotic-loaded calcium sulphate. Methods Between 2012 and 2018, 33 patients (33 limbs) with chronic calcaneal osteomyelitis were treated with a novel debridement technique, named “eggshell-like debridement”, plus antibiotic-impregnated calcium sulphate. The infection remission rate, recurrence rate, and amputation rate were analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess postoperative hindfoot function. Results 26 patients (81.8%) achieved infection remission without recurrence. In the patients with osteomyelitis remission, pain, limitation of movement, sinus tracts, and typical redness and swelling were generally eliminated. Most of the patients could tolerate full weight-bearing without pain. The average AOFAS ankle and hindfoot score was 88 points (range, 67–100 points), implying the foot function was mostly restored. 6 patients (18.2%) had osteomyelitis recurrence but no amputation was required to elimilate the infection. Conclusions Eggshell-like debridement combined with antibiotic-loaded calcium sulphate is an effective method for one-stage management of chronic calcaneal osteomyelitis. With the application of this technique, secondary autogenous bone or muscle flap grafts are unnecessary. The surgical procedure can be simplified whlie the hindfoot function is well preserved.

Neuropsychiatric disorders are the leading cause of mental and intellectual disabilities worldwide. Current therapies against neuropsychiatric disorders are very limited, and very little is known about the onset and development of these diseases, and their most effective treatments. MIR137 has been previously identified as a risk gene for the etiology of schizophrenia, bipolar disorder, and autism spectrum disorder. Here we generated a forebrain-specific MIR137 knockout mouse model, and provided evidence that loss of miR-137 resulted in impaired homeostasis of potassium in mouse hippocampal neurons. KCC2, a potassium-chloride co-transporter, was a direct downstream target of miR-137. The KCC2 specific antagonist VU0240551 could balance the current of potassium in miR-137 knockout neurons, and knockdown of KCC2 could ameliorate anxiety-like behavior in MIR137 cKO mice. These data suggest that KCC2 antagonists or knockdown might be beneficial to neuropsychiatric disorders due to the deficiency of miR-137.

Many software services today are hosted on cloud computing platforms, such as Amazon EC2, due to many benefits like reduced operational costs. However, node failures in these platforms can impact the availability of their hosted services and potentially lead to large financial losses. Predicting node failures before they actually occur is crucial, as it enables DevOps engineers to minimize their impact by performing preventative actions. However, such predictions are hard due to many challenges like the enormous size of the monitoring data and the complexity of the failure symptoms. AIOps ( A rtificial I ntelligence for IT Op eration s ), a recently introduced approach in DevOps, leverages data analytics and machine learning to improve the quality of computing platforms in a cost-effective manner. However, the successful adoption of such AIOps solutions requires much more than a top-performing machine learning model. Instead, AIOps solutions must be trustable, interpretable, maintainable, scalable, and evaluated in context. To cope with these challenges, in this article we report our process of building an AIOps solution for predicting node failures for an ultra-large-scale cloud computing platform at Alibaba. We expect our experiences to be of value to researchers and practitioners, who are interested in building and maintaining AIOps solutions for large-scale cloud computing platforms.

BACKGROUND: Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients. METHODS: A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as “thymoma or thymus neoplasms or Thymic Carcinoma” and “Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic”, were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. RESULTS: We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P

The joined-wing configuration SensorCraft, presents a more feasible way to meet tough design requirements such as long- endurance and 360-deg radar coverage compared to conventional and flying wing configurations. Proper assessment of the interactions between aerodynamics, structure, and embedded antenna in the optimization of the joined-wing SensorCraft is essential to obtain superior performances. This paper establishes the embedded radar performance estimation model and describes an integrated design process of aerodynamic, structure, and embedded radar performance of such an aircraft. Results show that multi-objective optimization leads to an increase of 14.76% in lift-to-drag ratio, 3.96% and 8.75% in the forward-looking and backward-looking radar detection ranges respectively. Moreover, the structural weight is reduced by 6.0% compared to that of the baseline design. Moreover, sensitivities of the rear wing dihedral angle, endplate height ratio, and joint location of the joined-wing configuration are analyzed in detail.

Photonic bandgap fiber-optic gyroscope has excellent environment adaptability and shows great prospect. The coupling between hollow-core photonic bandgap fiber coil and integrated-optic circuit is a crucial technology in photonic bandgap fiber-optic gyroscope. A low-loss low-back-reflection method for the coupling between a hollow-core photonic bandgap fiber and integrated-optic circuit is proposed. The end-face of the hollow-core photonic bandgap fiber only needs to be flat-cleaved with a general fiber cleaver. The optimal coupling angle is determined and experimentally verified to overcome the effect caused by the air gap between angle-cleaved integrated-optic circuit and flat-cleaved hollow-core photonic bandgap fiber end-face. Experimental results reveal that the coupling loss and back-reflection of the hollow-core photonic bandgap fiber with the integrated-optic circuit are better than ~3.2 dB and ~-43 dB, respectively. Compared with conventional butt coupling and fusion splicing, the coupling performance of the proposed method is significantly improved, which can achieve low-loss, low-back-reflection, and high reliability. The method provides a foundation for the coupling between hollow-core photonic bandgap fiber coil and integrated-optic circuit in fiber optic gyroscope.

BackgroundSarcopenia has been associated with treatment-related toxicities and poor survival in cancer patients. Our aim was to investigate the prevalence of sarcopenia in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients receiving chemoradiotherapy (CRT) and evaluate associations with treatment-related toxicity and prognosis.MethodsOne hundred and eighty-four patients with postoperative locoregional recurrent ESCC receiving CRT between January 2014 and December 2016 were included. The skeletal muscle area (SMA) was measured at the third lumbar vertebra level. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) less than 47.24/cm2/m2 for men and 36.92/cm2/m2 for women. Association of sarcopenia with overall survival (OS) was analyzed using univariate and multivariate cox regression models.ResultsSarcopenia was observed in 94 of 184 (51.1%) patients. Sarcopenic patients had significantly higher rates of grade 3-4 toxicities compared to those without sarcopenia (36.2% vs 21.1%, p = 0.034). The survival rate at 12 and 24 months was 36.2% and 3.2% in the sarcopenic patients and 57.8% and 17.8% in the non-sarcopenic patients (p < 0.001). Multivariate cox regression analysis showed that sarcopenia was significantly associated with decreased OS (HR = 1.729, 95% CI 1.231-2.428, p = 0.002).ConclusionsSarcopenia is an independent indicator of poor survival in postoperative locoregional recurrent ESCC patients treated with CRT. Early nutritional interventions before treatment may improve the prognosis.

Staghorn calculi remain a treatment challenge for urologists. The aim of the study was to compare the treatment outcomes of suctioning minimally invasive percutaneous nephrolithotomy (MPCNL) and traditional MPCNL for renal staghorn stones.Between April 2018 and June 2019, we included patients suffering from renal staghorn stones who were treated with modified MPCNL with a suctioning system. The outcomes of these patients were compared with those of a cohort of patients undergoing traditional MPCNL (between January 2017 and March 2018) using a 1:1 scenario matched-pair analysis. Cases were matched sequentially according to stone burden, stone branches, and stone hardness as well as age and sex.A total of 512 patients were included in this study (256 patients in each group). The baseline characteristics were equally distributed between the two groups. The suctioning MPCNL group achieved a significantly higher stone-free rate (SFR) (78.5% vs 69.1%; P = 0.016) after a single procedure and had a significantly shorter operative time (106.2 ± 18.4 vs. 132.1 ± 22.2 min; P 0.001) than the traditional MPCNL group. The traditional MPCNL group experienced a significantly higher rate of overall complications than the suctioning MPCNL group (27.3% vs. 16.8%; P = 0.004). Regarding individual complications, a significantly higher rate of fever (13.7% vs. 7.4%; P = 0.021) and urosepsis requiring only additional antibiotics (8.2% vs. 3.5%; P = 0.024) was observed in the traditional MPCNL group than in the suctioning MPCNL group; there was a trend that the suctioning MPCNL group conferred a decreased risk of urosepsis shock (1.2% vs. 2.3%), but this trend failed to achieve statistical significance (P = 0.313). There was no significant difference between the two groups regarding the incidence of severe hemorrhage, the mean number of tracts used during a single procedure and the postoperative hospital stay.The use of suctioning MPCNL for staghorn calculi had advantages over the use of traditional MPCNL in terms of a higher SFR after a single procedure and fewer postoperative infectious complications. Further well-designed studies are needed to confirm the results.

Background: Chronic osteomyelitis of calcaneus is not rare but is very hard to treat. Irrigation-suction and antibiotic-impregnated calcium sulfate following debridement are commonly used in managing chronic osteomyelitis, but their effects have rarely been compared. We aimed to compare the effectiveness of antibiotic-impregnated calcium sulfate with irrigation-suction in the treatment of patients with chronic calcaneal osteomyelitis. Methods: From January 2011 to June 2018, adult patients at our institute with chronic osteomyelitis receiving treatment of either antibiotic-impregnated calcium sulfate (CS group) or irrigation-suction (IS group) following thorough debridement were screened and selected according to the inclusion and exclusion criteria. The clinical presentation, laboratory tests, complications, and the ultimate single-staged cure rate and recurrence were compared. Results: A total of 61 patients, including 41 in the CS group and 20 in the IS group, were included in our study. Of the patients, 85.4% in the CS group and 60.0% in the IS group ( P = .006) were successfully cured in the single stage, respectively, without infection recurrence. Lower infection recurrence rates with shorter hospital stay were found in the CS group than the IS group. Inflammatory biomarkers after surgery with both treatments were slightly decreased and not significantly different from preoperative or between-groups postoperative. Exudate from incision was found primarily in the CS group. Conclusion: This study demonstrates that both antibiotic-impregnated calcium sulfate and irrigation-suction after careful and thorough surgical debridement are generally effective in treating chronic calcaneal osteomyelitis. Antibiotic-impregnated calcium sulfate achieved a higher single-staged cure rate but was associated with an increased postoperative wound exudate. Level of Evidence: Level III, retrospective cohort study.

The phenomenon of sub-span oscillation is a form of structural vibration caused by the aerodynamic wake effect. This paper analyzes the mechanism of sub-span oscillation, establishes a calculation model of the flow field of large cross-section double-bundled conductors, and studies the influence of sub-conductor interval of bundled conductor on its streaming characteristics with the different sub-conductor intervals selected as 250, 300, 400, 500, 600, 700, 800, 900 and 1,000 (in mm) for the working condition of calculation. The results have been applied to ultra-high voltage transmission line projects, providing technical support for the design and construction of the project, and improving the ability of the line to resist sub-span oscillations, which is of great significance to ensure the long-term safe operation of the line.

Topological materials for classical waves, e.g., electromagnetic and acoustic waves, have attracted growing interest, mainly due to the robustness, low loss, and new artificial degree of freedom conferred by their boundaries. Surface acoustic waves (SAWs), as widely used information carriers of microdevice relevance, are ubiquitous in today's wireless communication and sensing networks. Herein, we report the implementation of a SAW topological insulator based on a monolithically integrated platform. By using a miniature acoustic resonator array working tens of megahertz on a piezoelectric half-space, we successfully endow electrically pumped Rayleigh-type SAWs with the ``spin-momentum locking'' feature, enabling solid-state acoustic waves on the ``one-dimensional interface of the two-dimensional surface on the three-dimensional volume'' detour arbitrarily and pass through defects and intersections with much smaller losses than those incurred with any other solutions. These revolutionary topological SAWs may open an avenue for monolithic electronic-(photonic)-phononic circuits with ultrahigh performance and advanced functionalities in, e.g., future mobile communicating, sensing, and quantum-information processing.

Due to the multi-view imaging principle of synthetic aperture radar (SAR), its imaging process is not limited by any time or any bad weather. The detection of marine ship for SAR image is a very important application in both military and private applications. A marine ship detection method in SAR image about an improved Faster RCNN-based approach is proposed. First, the deepest semantic features of SAR image extracted by Faster RCNN contain less target information and small targets may be ignored, so that we fuse the deepest feature and shallower features in the feature extraction network; Secondly, because the redundant information in the features will produce false alarms, we embed the Convolutional Block Attention Module (CBAM) in the feature extraction network to extract more effective features; Finally, we use bilinear interpolation to obtain floating-point coordinates to optimize RoI pooling which uses rounding quantization, so the error mapping caused by quantization will be reduced. The algorithm of this paper is tested on the SSDD public dataset, and the AP is increased from 0.79 to 0.89. The results demonstrate that the algorithm introduced in this paper has a very significant performance improvement for detecting ship-like targets from SAR images.

Purpose Cerebrovascular segmentation in magnetic resonance imaging (MRI) plays an important role in the diagnosis and treatment of cerebrovascular diseases. Many segmentation frameworks based on convolutional neural networks (CNNs) or U-Net-like structures have been proposed for cerebrovascular segmentation. Unfortunately, the segmentation results are still unsatisfactory, particularly in the small/thin cerebrovascular due to the following reasons: (1) the lack of attention to multiscale features in encoder caused by the convolutions with single kernel size; (2) insufficient extraction of shallow and deep-seated features caused by the depth limitation of transmission path between encoder and decoder; (3) insufficient utilization of the extracted features in decoder caused by less attention to multiscale features. Methods Inspired by U-Net++, we propose a novel 3D U-Net-like framework termed Usception for small cerebrovascular. It includes three blocks: Reduction block, Gap block, and Deep block, aiming to: (1) improve feature extraction ability by grouping different convolution sizes; (2) increase the number of multiscale features in different layers by grouping paths of different depths between encoder and decoder; (3) maximize the ability of decoder in recovering multiscale features from Reduction and Gap block by using convolutions with different kernel sizes. Results The proposed framework is evaluated on three public and in-house clinical magnetic resonance angiography (MRA) data sets. The experimental results show that our framework reaches an average dice score of 69.29%, 87.40%, 77.77% on three data sets, which outperform existing state-of-the-art methods. We also validate the effectiveness of each block through ablation experiments. Conclusions By means of the combination of Inception-ResNet and dimension-expanded U-Net++, the proposed framework has demonstrated its capability to maximize multiscale feature extraction, thus achieving competitive segmentation results for small cerebrovascular.

Minimally invasive esophagectomy is increasingly performed for esophageal squamous carcinoma, with advantages of improved perioperative outcomes in comparison with open esophagectomy. Lymph node dissection is one of most important prognostic factors, in esophageal squamous cell carcinoma. It is still unknown whether MIE can meet the criteria of lymph node dissection in the mediastinum, especially in T1 and T2 esophageal cancer. Here, we compared the lymph node dissection between MIE and open surgery. Methods We retrospectively reviewed the clinicopathological data from 147 patients who underwent open surgery and MIE for esophageal squamous cell carcinoma from December 2016 to January 2020. The clinicopathological data including age, gender, number of lymph node resected were analyzed. Results 68 patients underwent MIE and 79 patients underwent open surgery. The number of harvested lymph node didn’t differ between the open surgery group and MIE group (26 ± 11.9 vs 26 ± 13.4, respectively, p = 0.128). However, the number of resected lymph node in the low para-esophageal region was significantly higher in open surgery group (4.1 ± 3.9 vs 2.8 ± 2.6, respectively, p = 0.019). The number of resected lymph node in the upper mediastinal region was significantly higher in the MIE group in T1 and T2 patients (4.7 ± 3.8 vs 2.7 ± 2.9, respectively, p = 0.014). the difference was also noticed in the para-recurrent laryngeal lymph node regions (3.6 ± 2.9 vs 2.0 ± 2.3, respectively, p = 0.020). Conclusion For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection by MIE was comparable to that by open surgery. However, the number of harvested lymph node in the upper mediastinal region was better in the MIE group, which may indicate a better outcome. There was no difference in the postoperative complications, hospital stay and overall survival rate.

With the rapid development of the network, the scale of the network has continued to expand, and network security issues have become increasingly prominent. Data from the National Internet Emergency Response Center show that my country's computer malicious programs, DDoS attacks, information security vulnerabilities, website implantation, and other threats have all been multiplied. The increasing trend. To respond to network security issues promptly and grasp the network security situation, predicting the network security situation has become important research in recent years. This paper proposes a network security situation prediction based on an optimized BP neural network. By analyzing the data, extracting the characteristics of security-related elements in the network, using the BP neural network to continuously adjust the weights and thresholds, the actual output value of the network is compared with the expected value. The error means the square error is the smallest, and the nonlinear mapping relationship of the network situation value is found. And through the simulated annealing algorithm (Simulated Annealing, SA) to optimize the BP neural network to avoid falling into the local minimum, to predict the network security situation. Simulation experiments verify the feasibility and effectiveness of the proposed method in network security situation prediction.

Disk fault is known to be the key cause of data loss in the modern large-scale data center, which affects the reliability and stability of the server and even the whole IT infrastructure, resulting in high financial cost. Recent works on disk fault prediction demonstrate the ability of machine learning techniques in the early prediction of disk failure. However, two limitations hinder the real-world application of current methods. First, they ignore the data heterogeneity in the data center, where distribution shifts commonly exist across different disk model types that decrease the model's performance. Second, the number of disks of different disk model types varies greatly in the data center, and current methods failed to deliver an acceptable performance over disk model types with few training samples. To address these limitations, we propose adversarial domain adaptation with correlation-based association networks (ADA-CBAN) to both mitigate the distribution shift problem and also to boost the performance on small-scaled data. Extensive experiments prove that our proposed model is effective and achieves new state-of-the-art. In addition, our post model analysis can also reveal important feature interactions and highlight the crucial period before disk faults, where both are useful information in real-world applications.

In the original article, Fig. 2c was published incorrectly. The correct version of Fig. 2c is provided in this correction.

Rapid urbanisation has altered the vulnerability of urban areas to heat wave disasters. There is an urgent need to identify the factors underlying the effect of heat waves on human health and the areas that are most vulnerable to heat waves. In this study, we plan to integrate indices associated with heat wave vulnerability based on meteorological observation data, remote sensing data and point of interest (POI) data; analyse the influence of urbanisation on the urban vulnerability environment; and explore the relationship between the vulnerability environment and heat-wave-related mortality. Finally, we attempt to map the spatial distribution of high heat-wave-related mortality risk based on the results of heat wave vulnerability study and artificial society. The results reveal that 1) there are differences in the influence of urbanisation on heat wave exposure, sensitivity and adaptability; 2) the exposure and sensitivity level effects on the lower limit of health impacts and the adaptability level effects on the upper limit of the health impact from heat wave in a given study area; and 3) areas vulnerable to the effects of heat waves are not confined to the city centre, which implies that residents living in suburban areas are also vulnerable to heat waves. Finally, this study not only explores the factors contributing to the impacts of heat waves but also describes the spatial distribution of the risk of disaster-associated mortality, thereby providing direct scientific guidance that can be used by cities to address heat wave disasters in the future.

Two-dimensional (2D) layered structures have recently drawn worldwide attention in material science and device physics because of their intriguing electrical and optical properties. In this paper, the structural, electronic, and magnetic properties of fully and partially hydrogenated AsSi nanosheets (NSs) are investigated by first-principles calculations based on density functional theory. Moreover, the potential as photocatalysts for water splitting is also studied. The results demonstrate that hydrogenated H atoms have a great influence on the electronic properties of the AsSi NS. By decorating their surface, fully and semihydrogenated AsSi NSs still exhibit ferromagnetism states and are predicated to be metallic or semiconductive depending on the surface coverage. Calculation results show that a more stable configuration of the semihydrogenated AsSi NS (AsSiH) is the one wherein all H atoms are adsorbed onto Si atoms, which is a semiconductor as the applied biaxial strains are from −6 to 9% and the ban...

Enhancer of zeste homolog 2 (EZH2) and Bcl-2 gene rearrangement or protein upregulation played pivotal roles in the carcinogenesis of various malignancies including lymphomas. However, EZH2/Bcl-2 expression pattern and its clinicopathologic/prognostic significance in diffuse large B-cell lymphoma (DLBCL) remain unclear. To identify the association among EZH2, Bcl-2, clinicopathologic parametres in DLBCL, 2 DLBCL patient sets (test cohort, n=85; validation cohort n=51) and DLBCL cell lines were studied by tumor tissue microarray (TMA), immunohistochemistry and western blot. The optimal cut-off of EZH2 was determined by X-tile program from test cohort, as was verified in validation cohort. The prognostic significance was determined via Kaplan-Meier survival estimates and log-rank tests. Consequently, EZH2 and Bcl-2 expression were both enhanced and positively correlated with each other (𝑃=0.001) in both DLBCL patients and cell lines. EZH2/Bcl-2 coexpression was associated with poor overall survival (OS) and progression-free survival (PFS) in all DLBCL patients (all P

Purpose To construct the albumin-bilirubin (ALBI) grade and the Child-Turcotte-Pugh (CTP) score based on nomograms, as well as to develop an artificial neural network (ANN) to compare the prognostic performance of the 2 scores for hepatocellular carcinoma (HCC) that has undergone transarterial chemoembolization. Materials and Methods This multicentric retrospective study included patients with HCC who underwent transarterial chemoembolization monotherapy as an initial treatment at 4 institutions between January 2008 and December 2016. In the training cohort, significant risk factors associated with overall survival (OS) were identified by univariate and multivariate analyses. The prognostic nomograms and ANN were established and then validated in 2 validation cohorts. Results A total of 838 patients (548, 115, and 175 in the training cohort and validation cohorts 1 and 2, respectively) were included. The median OS was 10.4, 15.7, and 9.2 months in the training cohort and validation cohorts 1 and 2, respectively. In the training cohort, both ALBI grade and CTP score were identified as significant risk factors. The ALBI grade and CTP score based on nomograms were established separately and showed similar prognostic performance when assessed externally in validation cohorts (C-index in validation cohort 1: 0.823 vs 0.802, P = .417; in validation cohort 2: 0.716 vs 0.729, P = .793). ANN showed that ALBI grade had higher importance on survival prediction than CTP score. Conclusions ALBI grade performs at least no worse than CTP score regarding survival prediction for HCC receiving transarterial chemoembolization. Considering the easy application, ALBI grade has the potential to be regarded as an alternative to CTP score.

Carbon dots (CDs) were grown in situ on secondary anodized TiO2 nanotube arrays (TiO2 NTAs) via a hydrothermal method. The combination of CDs and TiO2 NTAs enhanced the photoelectrochemical performance. Morphology, structure, and elemental composition of the CDs were characterized. No simple physical adsorption was found between the CDs and TiO2, but chemical bonds were formed. UV-vis absorption and fluorescence spectroscopy showed that the CDs could enhance the absorption of TiO2 in the visible and near-infrared regions. Owing to their up-conversion fluorescence properties, the CDs could convert low-energy photon absorption into high-energy photons, which may be used to excite TiO2 to produce a stronger photoelectric response. Moreover, the CDs could effectively transport electrons and accept holes, thus contributing to the effective separation of electrons and holes during photoexcitation. Finally, the PEC biosensor was prepared by immobilizing glucose oxidase (GOx) on the surface of the composite. The PEC biosensor exhibited a broad range of 0.1–18 mM with a detection limit of 0.027 mM under visible irradiation because the composite material reflected strong light absorption for visible light, good conductivity, and good biocompatibility.

Purpose To compare the dosimetric differences between intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in the treatment of male and female thymoma. Material and methods This single-institutional analysis included 20 patients with thymoma treated with RT between January 2017 and December 2020. Twenty patients were retrospectively planned for IMRT (IMRT1 with an average field angle of 216°, 288°, 0°, 72°,and 144°; IMRT2 with fan-shaped field angles of 280°, 320°, 0°, 40°, and 80°) and VMAT (VMAT1 with two arcs ranging form 280° to 80°,clockwise and then counterclockwise; VMAT2 with two 360° arcs). The plans for all investigated RT modalities were optimized for a prescriptional dose of 50 Gy and fractional dose of 2.0 Gy. Planning target volume (PTV) and organs-at-risk (OARs: heart, breasts, lungs, spinal cord, and esophagus) dosimetric parameters were compared. Results All plans met the preparation aims for all the included metrics. There was little difference in the median values of PTV parameters (D2%, D98%, Dmean, homogeneity index[HI], and conformity index [CI]). The CI of the VMAT2 plan was the closest to 1 in both therapy groups. The monitor unit (MU) of IMRT2 and the estimated total delivery time of VMAT1 were the lowest in both therapy groups and were statistically significant. In the male group, the lung parameters (Dmean, V5Gy, V10Gy, and V20Gy) for VMAT1 were the lowest and showed statistical significance. In the female group, the lung parameters (Dmean, V5Gy, V10Gy, and V20Gy) and bilateral breast parameters (Dmean, V5Gy, V10Gy, and V20Gy) of IMRT2 were the lowest and showed statistical significance. Conclusions In male thymoma patients undergoing postoperative RT (PORT) treatment, the choice of fan-shaped VMAT may be a better option for protecting the lungs. For female thymoma patients receiving PORT, fan-shaped IMRT can better protect the lungs and breasts. The fan-shaped field performed better than the average and the full arc fields in PORT for thymoma.

Background: Acute necrotizing encephalopathy (ANE) is a rare acute encephalopathy secondary to infection, which is characterized by convulsion and disturbance of consciousness. Besides, recurrent cases with family history are rarer. To the best of our knowledge, only 12 cases reported were recurrent with family history of encephalopathy in the world. The aim of this study is to report a rare case of recurrent ANE with family history of encephalopathy to provide clinical data for future research of ANE.Case report: A boy had a history of febrile convulsions when he was 1 year old. A few years later, he was hospitalized twice because of convulsions when he was 4 years old and 7 years old. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed on two hospitalizations. Brain CT in the first admission showed low density lesions in bilateral temporal lobes hippocampus and further MRI after 3 days found lesions in bilateral temporal lobe hippocampus, insular lobes, ventrolateral thalamus and pons. Due to the bilateral and symmetrical lesions, metabolic diseases were suspected. When the boy was 7 years old, brain CT was normal while MRI showed multiple lesions in bilateral thalamus, left hippocampus and brainstem. According to the boy's clinical data and MRI findings, pediatrician diagnosed the child as ANE. After 7 days of treatment, he was discharged with slight lameness in the right lower limb.Conclusion: It reports a Chinese child of recurrent acute necrotizing encephalopathy with family history of encephalopathy and reviewed cases similar to him. Diagnosis should be combined with its clinical symptoms, laboratory and imaging results. Clinicians need to improve their understanding in order to achieve early diagnosis and treatment so as to improve prognosis and reduce the occurrence of sequelae.

PurposeGiven that the novel coronavirus disease (COVID-19) pandemic has disrupted operations globally, an institution’s ability to repeat transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) has also been affected. The aim of this study was to evaluate the impact of the COVID-19 on the intervals and outcomes of TACE in HCC patients.Materials and MethodsThis retrospective study included 154 HCC patients who underwent follow-up after TACE treatment from January 2020 to March 2020 (n = 71, study group) and January 2019 to March 2019 (n = 83, control group) at two institutions in China. The endpoints included the follow-up interval and overall response rate (ORR). Multivariate logistic regression analyses were performed to identify independent risk factors for a worse ORR. The cut-off point was determined to divide follow-up durations into long- and short-intervals.ResultsThe median follow-up interval was 82.0 days (IQR, 61–109) in the study group, which was significantly longer than 66.0 days (IQR, 51–94) in the control group (P = 0.004). The ORR was 23.9 and 39.8% in the study and control group, respectively (P = 0.037). The cut-off value was 95 days. The grouping (OR, 2.402; 95% CI, 1.040–5.546; P = 0.040), long interval (OR, 2.573; 95% CI, 1.022–6.478; P = 0.045), and China liver cancer staging system (OR, 2.500; 95% CI, 1.797–3.480; P <0.001) were independent predictors for the efficacy of TACE treatment.ConclusionsThe COVID-19 pandemic causes a longer follow-up interval in general, which may further lead to a lower ORR in HCC patients. Those with a follow-up interval of >95 days tend to have a worse prognosis.

DRAM failures are one of the major hardware threats to the reliability of large-scale data centers since the uncorrectable errors in DRAMs may cause servers to shut down. Existing works try to solve this problem by predicting DRAM failures in advance with Machine Learning models. In these works, correctable errors (CEs) are generally deemed as the most important feature. The major reason behind CEs’ emergence is the accumulated stress caused by intensive workloads. Moreover, defective DRAMs will not manifest themselves as system errors until the defective cells are accessed by some specific workloads. Therefore, the running workloads on a server are also important for DRAM failure prediction. In this paper, we focus on the impact of workloads on DRAM failures. We design the workload features from both macroscopical and microscopical aspects, i.e. node-level performance metrics and cell-level DRAM access pattern, respectively. Furthermore, we propose Hierarchical DRAM Error Code (HiDEC) to represent the DRAM access pattern. We leverage several Decision Tree-based models for DRAM failure prediction to highlight the generality of our designed features. Experiments are carried out based on the dataset collected from a real-world commercial data center. The results show that both macroscopic and microscopic features can bring significant improvements to the prediction performance.

To improve the hydrodynamic efficiency and performance in shallower glide path angle, blended-wing-body (BWB) configuration is applied in underwater gliders. Plentiful works have been focused on shape optimization of this configuration to improve the lift to drag ratio. However the arrangement of structure components, such as the pressure hull, tends to be neglected in geometric model. In this paper, the pressure hull is set as constraint during optimization. Both planar and sectional shape parameters are taken into account for building parametric model and 20 design variables are used for optimization. Computational fluid dynamics (CFD) method is used for hydrodynamic calculation and the results are used for training neural network as surrogate model. Based on multiple island genetic algorithm, the optimization is conducted to search for the shape with higher lift to drag ratio. The hydrodynamic performance of the obtained optimized model is verified to be better at wide states and the lift to drag ratio is improved by 12.4% at the designed attack of angle.

The joined-wing is considered to be a potential configuration because of its low induced drag, light structure, and direct force control. A configuration optimization design method for a high-altitude joined-wing aircraft is proposed for simultaneous considerations of the features of the joined-wing configuration. The purpose is to provide a more reasonable method for the optimization design of the shape parameters of joined-wing aircraft. The shape optimization design model consists of a shape parameterized model, aerodynamic analysis model, and genetic algorithm optimization process. Through comparative analysis before and after optimization, the lift-to-drag ratio of the whole machine after optimization increased by 14.6%. Moreover, detailed sensitivity analysis was carried out on the unique shape parameters of the joined-wing configuration, such as the rear wing sweep angle, the rear wing dihedral angle, the joint location, and the endplate height ratio.

BackgroundThe curative effect of antibiotic-impregnated Calcium Sulfate in pediatric ostemyelitis is unknown. The purpose of this study was to compare the outcomes of two treatment methods, decompression combined with antibiotic-impregnated calcium sulfate and decompression alone, for the treatment of pediatric Hemotogenous Osteomyelitis.MethodsBetween 2013 to 2016, forty-one patients with Hematogenous Osteomyelitis met the criteria were included for assessment. Twenty-one patients were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin impregnated calcium sulfate was used as an adjuvant after bone decompression while 20 patients as the control group were undergone bone decompression alone. The infection recurrence rate, hospital stay, wound healing duration, serum inflammatory index, pathological fracture, leakage of the incision ,follow-up time were compared between the two groups.ResultsInfection recurrence was 0% (0/21) in CS group and 15%(3/20) in control group within 12 months(P=0.107). Infection recurrence was 0%(21/21) in CS group and 20% (16/20) of patients at a minimum of 24(range 24 to 67) months follow-up(P=0.048). Mean hospital stay were 8.19(range 3 to 21) days in CS group and 15.95(range 5 to 47) days in control group(P=0.02). Mean wound healing duration were 16.1(range 10 to 29) days in CS group and 15.5(range 10 to 25) days in control group(P=0.65). Serum inflammatory index for WBC(White Blood Cells), ESR( Sedimentation Rate), CRP(C-Reactive Protein) was respectively 8.76(6.03-12.07)*10^9/L, 44.14(26-70)mm/L, 12.35(1.03-35.04) mg/Lin CS group and 8.90(5.68-13.56)*10^9/L, 39.25(19-57)mm/L, 15.65(1.02-45.69) mg/L in control group(P=0.82, P=0.31, P=0.51). Pathological fracture was 0% (0/21) in CS group and 10%(2/20) in control group(P=0.23). Leakage of the incision was 4.76% (0/21) in CS group and 10%(2/20) in control group(P=0.61). ConclusionsAntibiotic-impregnated Calcium Sulfate can reduce infection recurrence and shorten the mean hospital stay in pediatric Hemotogenous Osteomyelitis. The curative effect of antibiotic-impregnated Calcium Sulfate in pediatric ostemyelitis is satisfactory. Trial registrationRetrospectively registered.

Non-small cell lung cancer (NSCLC) is a prevalent malignancy with high mortality and poor prognosis. Bupivacaine serves as a widely used local anesthetic and presents potential anti-tumor activity. Nevertheless, the function of bupivacaine in the NSCLC development remains elusive. Here, we tried to investigate the impact of bupivacaine on the NSCLC progression. Significantly, we revealed that bupivacaine was able to reduce the proliferation and induce the apoptosis of NSCLC cells. Bupivacaine could attenuate the invasion and migration in the cells. Mechanically, the treatment of bupivacaine increased the expression ratio of light chain 3B-II (LC3B-II)/LC3B-I and the expression of Beclin-1 in the NSCLC cells. Meanwhile, the expression of the autophagic adaptor protein p62 was decreased by bupivacaine treatment in the cells. The treatment of bupivacaine attenuated the phosphorylation of AKT and mTOR in the NSCLC cells. The AKT activator SC79 and autophagy inhibitor 3-methyladenine (3-MA) reversed the bupivacaine-inhibited phosphorylation of AKT and mTOR and bupivacaine-induced autophagy, as well as the bupivacaine-attenuated NSCLC progression in the cells. Bupivacaine could inhibit the tumor growth in vivo. In conclusion, we discovered that the local anesthetic bupivacaine inhibited the progression of NSCLC by inducing autophagy through Akt/mTOR signaling. Our finding provides new insights into the mechanism by which bupivacaine attenuates the development of NSCLC. Bupivacaine may serve as a potential anti-tumor candidate for the therapeutic strategy of NSCLC.

Background and aims Although ticagrelor exerts an antibacterial activity, its effect on infections in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is unclear. We aimed to assess whether ticagrelor and clopidogrel affect infections in these patients during hospitalization. Methods A total of 2116 consecutive patients with STEMI undergoing PCI were divided into the ticagrelor (n = 388) and clopidogrel (n = 1728) groups. The primary outcome was infection onset. Secondary outcomes were in-hospital all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). Propensity score analyses were conducted to test the robustness of the results. Results Infections developed in 327 (15.4%) patients. There was no significant difference in infection between both groups (ticagrelor vs. clopidogrel: 13.1% vs. 16.0%, p = 0.164). Patients in the ticagrelor group had lower rates of in-hospital all-cause death and MACCE than patients in the clopidogrel group. Multivariate logistic regression analysis determined that ticagrelor and clopidogrel had a similar preventive effect on infections during hospitalization (adjusted odds ratio [OR] = 1.20; 95% confidence interval [CI] = 0.80–1.78, p = 0.380). Compared to the patients treated with clopidogrel, patients treated with ticagrelor had a slightly lower risk of other outcomes, but no statistical difference. Propensity score analyses demonstrated similar results for infections and other outcomes. Conclusions Compared with clopidogrel treatment, ticagrelor treatment did not significantly alter the risk of infections during hospitalization among STEMI patients undergoing PCI, but was associated with a slightly lower risk of in-hospital all-cause death and MACCE.

Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.