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The demand for high-density, high-efficiency bi-directional battery chargers is driven by the fast development of energy storage system in renewable energy system, micro-grid, and transportation electrification. Isolated dc-dc converter that interfaces a battery with a variable voltage range is one of the critical components. Input-parallel output-series (IPOS) partial power (PP) converter is considered a promising high-efficiency, high density solution because only a fraction of power is processed via multi-stage converters to regulate the output voltage. However, due to the tight coupling between two dc transformers (DCXs), the design of PP converter is complicated. To solve this issue, a design procedure for a bi-directional soft-switching resonant type PP converter is proposed. In the parameters design part, a decoupled design method is proposed to simplify the DCXs design. With this method, two DCXs can be designed separately, and the typical optimization method can be easily applied. As for the hardware design part, to minimize the ac loop inductance and resistance, a 2-directions (2-D) flux cancelation method and an “intra-leaving” winding structure are proposed for circuit layout and high-frequency transformer to obtain high operation efficiency and power density. Finally, the whole design procedure is verified by an 18 kW rated, 25 kW peak, prototype operating at 500 kHz. The realized PP converter features a peak efficiency of 98. 8% and a power density of 142 W/in3. This article is accompanied by two videos demonstrating the dynamic voltage regulation test and the efficiency measurement.

The auxiliary power supply (APS) is one of the critical components inside medium-voltage (MV) power converters. Besides high insulation capability and small footprint, low common-mode (CM) coupling capacitance and multichannel output are the desired features of APS in the emerging silicon-carbide-based MV converters due to their fast switching speed. This article presents the design and optimization procedure of a high-density isolated APS using an LCCL-LC resonant topology with an operating frequency of 1 MHz. The proposed design procedure attains consistent soft-switching operation under a random number of output channels. The galvanic isolation is realized by a current-fed single-turn 1 MHz transformer that can achieve a breakdown voltage of over 20 kV while maintaining a small size. Design optimization on the insulation system of the current transformer is proposed to obtain both high partial-discharge inception voltage (PDIV) and low coupling capacitance. Finally, two versions of APSs are developed, using air and silicone as dielectric materials, which can reach PDIV of over 5 and 16 kV, respectively. The corresponding coupling capacitances are 1.86 pF and 3.6 pF. Both designs can provide a maximum power of 20 W on the receiving side, and 120 W on the sending side.

Objective To explore the application value of breast cancer tumor markers tissue polypeptide specific antigen (TPS), carbohydrate antigen 15-3 (CA15-3), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) detection alone or in combination for the monitoring of distant metastasis of breast cancer. Method The clinical data of 389 female breast cancer patients admitted to Tianjin Medical University Cancer Institute and Hospital from January 2016 to March 2017 were retrospectively analyzed. Serum levels of TPS, CA125, CA15-3, and CEA were compared to analyze their significance in prediction distant metastasis of breast cancer. The patients were divided into the distant metastatic group and the non-metastatic group according to whether the patients had distant metastasis. The non-metastatic group was divided into the control group and the occult metastasis group according to whether distant metastases occurred in 3 years after treatment. Result The receiver operating characteristic curve analysis revealed that all four markers had the diagnostic value in distant metastasis of breast cancer (AUCTPS = 0.754, AUC15-3 = 0.821, AUCCEA = 0.755, AUCCA125 = 0.651) and in occult metastasis in 3 years after treatment (AUCTPS = 0.751, AUC15-3 = 0.744, AUCCEA = 0.725, AUCCA125 = 0.661). To estimate whether the discrimination ability could be improved by marker panels, we established marker panels composed of TPS, CA125, CA15-3, and CEA. To discriminate distant metastasis from non-distant metastasis, the diagnostic ability of different panels composed of TPS, CA125, CA15-3 and CEA did not show significant difference compared with single CA15-3 (P > 0.05). To discriminate occult metastasis from the control group, no significant difference was shown in AUC between marker panels and single marker (P > 0.05). However, the sensitivity was improved when the marker-panels were used overall. Conclusion All tumor markers have abilities in prediction of distant metastasis of breast cancer. The combined detection of the markers is more valuable than using single tumor marker in improving sensitivity. Two markers' panels are more suitable for the prediction of distant metastasis of breast cancer than three or four makers' panels with the similar sensitivity and AUC.

The progression of breast cancer is closely related to obstructive sleep apnea-hypopnea syndrome (OSAHS). Low concentrations of cannabinoids promote tumor proliferation. However, the role of cannabinoid receptors (CBs) in chronic intermittent hypoxia (CIH)-induced breast cancer has not been reported. The migration and invasion of breast cancer cell lines (MCF-7 and T47D) were measured by scratch assay and transwell assay. Gene and protein expressions were analyzed by qPCR and western blotting. Tumor xenograft mice model were established to evaluate the function of CBs. We observed that chronic hypoxia (CH) and CIH increased CBs expression and promoted migration and invasion in breast cancer. Mice grafted with MCF-7 exhibited obvious tumor growth, angiogenesis, and lung metastasis in CIH compared with CH and control. In addition, CIH induced CBs expression, which subsequently activated insulin-like growth factor-1 receptor (IGF-1R)/AKT/glycogen synthase kinase-3β (GSK-3β) axis. Knockdown of CBs alleviated CIH-induced migration and invasion of breast cancer in vitro. Furthermore, CIH exaggerated the malignancy of breast cancer and silencing of CBs suppressed tumor growth and metastasis in vivo. Our study contributed to understanding the role of CIH in breast cancer development modulation., Graphical abstract, The role of CBs in CIH-induced breast cancer remains unknown. In this study, we found that CIH induced CBs expression via activating IGF-1R/AKT/GSK-3β signaling. CBs knockdown inhibited CIH-induced progression of breast cancer. Our study revealed that CBs might be a new therapeutic strategy for breast cancer.

Early and accurate diagnosis of human prion diseases is a long-standing difficulty. Currently, the definitive diagnosis of human prion diseases relies on pathognomonic histological features or PrPSc detection of patients' brain tissue biopsy or autopsy samples, which is not feasible in most cases. Therefore, clinical diagnosis mainly relies on the combinations of the patient’s clinical symptoms. MRI and EEG are used to check for brain damage and detect surrogate markers such as the 14-3-3 protein in Cerebrospinal fluid (CSF), but this is often challenging. In recent years, the development of in vitro cell-free conversion techniques, such as technologies protein misfolding cyclic amplification (PMCA) and real-time quaking-induced conversion (RT-QuIC), have extensively promoted the diagnosis of human prion diseases. PMCA has high diagnostic accuracy in the blood, CSF, and urine samples of variant creutzfeldt–jakob disease (vCJD) patients. Again, RT-QuIC has high diagnostic accuracy for cerebrospinal fluid, olfactory mucosa, and skin samples of sporadic Creutzfeldt Jakob Disease (sCJD) patients. Applying these two technologies is of great significance to the early clinical diagnosis of human prion diseases and the reduction of blood-borne and iatrogenic transmission of prion.

The Schottky barrier at the interface between the semiconductor phase and the metal phase has excellent rectification effect which can greatly facilitate the formation of the electron accumulation region. The interface electronic modulation can promote the formation of electron depletion layer in the gas sensing process, which is a powerful strategy to improve the sensing performance. In this work, ZnO–TiC composites were successfully prepared. XRD, TEM, BET and XPS characterizations of the ZnO–TiC composites were proformed to investigate the compositions and structures. The as-synthesized samples were applied to fabricate gas sensors to investigate their gas sensing performance. Compared to pure ZnO and TiC, the composites achieved high sensitivity (232 for 100 ppm aniline) and linear detection (R2 = 0.986) of aniline. The improvement of sensor performance is mainly attributed to the electronic modulation of Schottky barrier at the interface between ZnO and TiC. Our results indicate that the construction of ZnO-TiC Schottky barrier is a promising strategy for enhancing the performance of gas sensors.

This letter proposes a novel single passive gate driver solution based on passive devices to control series-connected power semiconductor devices for dc circuit breaker (DCCB) applications. The transient suppression devices (e.g., metal oxide varistors) are utilized to achieve natural voltage balancing among the series devices, while providing the discharge path of the gate capacitor of the upper devices. The proposed method is very simple, cost effective and more compact compared with conventional voltage balancing method-based DCCBs. Besides, gate voltage oscillation during the voltage recovery process is mitigated by the addition of an extra gate capacitor. Simulation and experimental results are provided to verify the effectiveness of proposed method.

BACKGROUND: Female menstrual and reproductive factors, as remarkable indicators of hormone effect, were hypothesized to be associated with lung cancer risk, whereas the existed epidemiological evidence was inconsistent. Our study aims to investigate the association between menstrual and reproductive factors and lung cancer risk based on the Chinese Lung Cancer Screening Program. METHODS: This study was based on a large-scale multi-center population cohort across China recruiting individuals aged 40–74 years old between 2013–2018. Cox regression model was applied to estimate the HRs and 95% CIs. Restricted cubic spline (RCS) analysis was used to estimate dose-response relationships and test for nonlinear associations. RESULTS: Among 553,434 female participants, 1,529 incident lung cancer cases were identified with a median follow-up of 3.61 years. With adjustment for multiple covariates and all significant hormonal factors, elevated lung cancer risk was associated with later age (15, or ≥16 years) at menarche (HR =1.27, 95% CI: 1.04–1.56; HR =1.45, 95% CI: 1.19–1.76), later age (25–29, or ≥30 years) at first live birth (HR =1.27, 95% CI: 1.13–1.43; HR =1.23, 95% CI: 1.00–1.51), and benign breast disease history (HR =1.25, 95% CI: 1.10-1.41). For postmenopausal females specifically, surgical menopause (HR =1.62; 95% CI: 1.29–2.05) and other surgeries on the reproductive system (HR =1.19; 95% CI: 1.01–1.40) both appeared to be predictive of elevated lung cancer risk. Concerning age at menopause, a nonlinear association was observed (P-nonlinear =0.0126). Increased lung cancer risk was observed among females with age at menopause especially above 50. Although we observed no significant associations between longer time (≥13 months) of breastfeeding and lung cancer risk among all participants (HR =0.86; 95% CI: 0.71–1.04), significant decreased adenocarcinoma risk (HR =0.65; 95% CI: 0.53–0.81) was noted among nonsmoking females. CONCLUSIONS: Our findings add some support for the role of menstrual and reproductive factors in lung carcinogenesis. However, these relationships were complex, and required further investigations addressing the biological mechanisms.

Introduction Berberine (BBR), as one of the outstanding representatives of isoquinoline alkaloids, has been used as an antibacterial drug for a long time in China since ancient times. Currently, a large number of studies have been reported that berberine has a wide spectrum of pharmacological activities, such as anti-tumor, anti-inflammatory, hypoglycemic, hypolipidemic, anti-obesity, and the like. Areas covered This review systematically discussed important patents on berberine and berberine derivatives in terms of pharmacological activity between 2016 and 2020. These patents were mainly searched through the European Patent Office database and Web of Science. These berberine patents (~41) cover a wide range of applications, mainly including antitumor, anti-inflammatory, antibacterial, anti-metabolic disorder, and other newly reported pharmacological activities. Expert opinion Berberine is an important lead compound with great potential for optimization in drug development. However, there is a lack of research related to the biomolecular targets of BBR, which directly restricts the development of berberine in the pharmaceutical field. The problems involved with poor bioavailability and cytotoxicity are also worth considering in the development of berberine-based drugs. Accordingly, the increasing number of patents involving biomolecular targets in BBR's patent applications will be published as its related pharmacological mechanisms are further deciphered.

Human genetic prion diseases (gPrDs) are directly associated with mutations and insertions in the PRNP (Prion Protein) gene. We collected and analyzed the data of 218 Chinese gPrD patients identified between Jan 2006 and June 2020. Nineteen different subtypes were identified and gPrDs accounted for 10.9% of all diagnosed PrDs within the same period. Some subtypes of gPrDs showed a degree of geographic association. The age at onset of Chinese gPrDs peaked in the 50–59 year group. Gerstmann–Sträussler–Scheinker syndrome (GSS) and fatal familial insomnia (FFI) cases usually displayed clinical symptoms earlier than genetic Creutzfeldt–Jakob disease (gCJD) patients with point mutations. A family history was more frequently recalled in P105L GSS and D178N FFI patients than T188K and E200K patients. None of the E196A gCJD patients reported a family history. The gCJD cases with point mutations always developed clinical manifestations typical of sporadic CJD (sCJD). EEG examination was not sensitive for gPrDs. sCJD-associated abnormalities on MRI were found in high proportions of GSS and gCJD patients. CSF 14-3-3 positivity was frequently detected in gCJD patients. Increased CSF tau was found in more than half of FFI and T188K gCJD cases, and an even higher proportion of E196A and E200K gCJD patients. 63.6% of P105L GSS cases showed a positive reaction in cerebrospinal fluid RT-QuIC. GSS and FFI cases had longer durations than most subtypes of gCJD. This is one of the largest studies of gPrDs in East Asians, and the illness profile of Chinese gPrDs is clearly distinct. Extremely high proportions of T188K and E196A occur among Chinese gPrDs; these mutations are rarely reported in Caucasians and Japanese.

Mg is a macronutrient for plant growth. Mg deficiency has become an important limiting factor in intensive agricultural production, resulting in reduced crop yield and quality. Given that Mg is also essential for human and animals’ diets, Mg nutrition in plants has become an important issue not only for food security but also for human health. We review recent progress in physiological and molecular mechanisms underlying Mg biological functionality, as well as Mg transport and Mg deficiency symptoms in plants. As both a structural component and a regulatory factor, Mg helps plants achieve higher photosynthetic efficiency, nitrogen use efficiency and stress resistance. Plants need a certain range of Mg concentration for their growth, and a number of key genes responsible for Mg uptake, translocation and detoxification have been identified. Despite its functional importance, basic researches on Mg nutrition are still scarce. A deeper investigation of the genetic and molecular mechanisms employed in Mg nutrition will help to improve crop yield and intensify Mg application in the field. Developing more approaches to enhance Mg concentration in crop edible parts is urgently required for human diet and health.

Mesenchymal stem cell (MSC) therapy has become a promising treatment for liver fibrosis due to its predominant immunomodulatory performance in hepatic stellate cell inhibition and fibrosis resolution. However, the cellular and molecular mechanisms underlying these processes remain limited. In the present study, we provide insights into the functional role of bone marrow-derived MSCs (BM-MSCs) in alleviating liver fibrosis by targeting intrahepatic Ly6Chi and Ly6Clo macrophage subsets in a mouse model. Upon chronic injury, the Ly6Chi subset was significantly increased in the inflamed liver. Transplantation of BM-MSCs markedly promoted a phenotypic switch from pro-fibrotic Ly6Chi subset to restorative Ly6Clo subpopulation by secreting paracrine cytokines IL-4 and IL-10 from the BM-MSCs. The Ly6Chi/Ly6Clo subset switch significantly blocked the source of fibrogenic TGF-β, PDGF, TNF-α, and IL-1β cytokines from Ly6Chi macrophages. Unexpectedly, BM-MSCs experienced severe apoptosis and produced substantial apoptotic bodies in the fibrotic liver during the 72 h period of transplantation. Most apoptotic bodies were engulfed by Ly6Clo macrophages, and this engulfment robustly triggered MMP12 expression for fibrosis resolution through the PtdSer-MerTK-ERK signaling pathway. This paper is the first to show previously unrecognized dual regulatory functions of BM-MSCs in attenuating hepatic fibrosis by promoting Ly6Chi/Ly6Clo subset conversion and Ly6Clo macrophage restoration through secreting antifibrogenic-cytokines and activating the apoptotic pathway.

Background In China, coronary artery abnormalities (CAAs) secondary to Kawasaki disease (KD) tend to have an increased occurrence. We hypothesize that Chinese children with KD may possess several unique CAA risks, and the predictive efficacy of multiple scoring systems in Chinese patients are still to be further studied. Methods Two hundred and three KD patients were recruited. Using multivariable analysis, independent predictors of CAAs were combined into a scoring system. Subsequently, CAA risks of our patients were evaluated by the newly established scoring system and eight other published scoring systems. Results Seventeen (8.37%) KD patients were identified as CAAs. The newly established scoring system contained the following 5 independent predictors: days of illness at initial treatment ≥7, redness and swelling of extremities, hematocrit ≤33%, percentage of monocytes ≥8.89%, and procalcitonin ≥0.5 ng/mL. The AUC value of newly established scoring system was 0.685 with a sensitivity of 41.18% and a specificity of 84.41%, higher than Harada score, Egami score, Kobayashi score, Sato score, San Diego score, Formosa score, and Tang score, whereas lower than Hua score. Conclusions Days of illness at initial treatment ≥7 and procalcitonin are unique predictors of CAAs in newly established scoring system. Taking into account different identification criteria and analytical methodologies, there is still some heterogeneity among different scoring systems. Impact The newly established scoring system contains the five independent predictors. Days of illness at initial treatment ≥7 and PCT are unique predictors of CAAs in our study, compared with 8 other systems. The AUC value of newly established scoring system is 0.685, similar to Hua score. There is some heterogeneity among different scoring systems.

High-fat diet (HFD) and inflammation are two key contributors to nonalcoholic fatty liver disease (NAFLD). Shenling Baizhu powder (SLBZP), a classical herbal compound, has been successfully used to alleviate NAFLD. However, its specific mechanisms are not fully understood. In this study, we assessed the anti-NAFLD effect of SLBZP in vivo.Rats were fed an HFD with or without SLBZP or with probiotics. At the end of week 16, an echo magnetic resonance imaging (EchoMRI) body composition analyser was used to quantitatively analyse body composition; a micro-computed tomography (micro-CT) imaging system was used to evaluate whole body and liver fat; and the Moor full-field laser perfusion imager 2 was used to assess liver microcirculation, after which, all rats were sacrificed. Then, biochemical indicators in the blood and the ultrastructure of rat livers were evaluated. Protein expression related to the liver Toll-like receptor 4 (TLR4)/Nod-like receptor family pyrin domain-containing 3 (NLRP3) signalling pathway was assessed using Western blot analysis. Further, high-throughput screening of 29 related inflammatory factors in liver tissue was performed using a cytokine array.SLBZP supplementation reduced body weight, serum free fatty acid, and insulin resistance index (P 0.05). It also ameliorated liver microcirculation and ultrastructural abnormalities. EchoMRI and micro-CT quantitative analyses showed that treatment with SLBZP reduced fat mass and visceral fat (P 0.05 and P 0.01, respectively). In addition, SLBZP decreased the expression of lipopolysaccharide (LPS)-activated TLR4/NLRP3 signalling pathway-related proteins and altered the expression levels of some inflammatory cytokines in liver tissues.SLBZP can inhibit NLRP3 inflammasome activation and interleukin-1β release by suppressing LPS-induced TLR4 expression in rats with HFD-induced NAFLD. Thus, SLBZP may be beneficial for the prevention and treatment of inflammatory damage and associated diseases.

Background: To describe and explain the improvement of Wright C2 transforaminal screw fixation technique. Methods: 23 male patients and 10 female patients (a total of 33 patients, average age of 55 years) were implanted with lamina screws on one side or both sides by improved technique. Adopt improved technology, there is a simple hole in the middle of the lateral brain plate, and the screw can be seen directly to prevent the spine from being invaded. Results: With the improved technique, 169 minutes (90–210 minutes) is the average operation time, and 136 ml (80–420 minutes) is the estimated average blood loss. Average length of 26.5 mm (range 24–30) plate screws. After an average follow-up of 12.4 (1.5–30) months, all patients achieved good clinical outcomes. Conclusions: To modify the Wright’s technique, an additional unicortical “hole” was in the middle of the backplane. Through this improved technique, the screw can be directly seen to be inserted into the dorsal cortex of the lamina, thereby reducing the risk of invading the spinal canal and shortening the operation time.

Modular multilevel converter (MMC) has many advantages of scalability, reliability and easy implementation, but suffers from large number of switching devices and capacitors. To improve the power density and efficiency for medium voltage applications, this article introduces a hybrid modular multilevel converter (HMMC) family through the combination of active neutral-point-clamped converter and chain-link arm. Three topologies in HMMC family can effectively reduce chain-link voltage by half compared with traditional MMC. Single- and three-phase operation principles are presented to highlight this important features. Several critical metrics, such as component number, capacitor sizes, and semiconductor losses, are compared between the conventional MMC and HMMC topologies at three different medium voltage levels. The result indicates the best topology from the HMMC family can save around 30% devices, 50% total capacitor and 32% power losses compared with traditional MMC. A simple single-phase control method is also mentioned to balance capacitor voltage. Finally, a single-phase HMMC experimental prototype is built to verify the effectiveness of three topologies.

Purpose: To evaluate the value of the three-line (TL) method in the diagnosis of vertebral fractures. Methods: 286 patients over 50 years old who received thoracolumbar X-ray examination in our hospital from 2013 to 2019 were selected and divided into three groups according to their age. The incidence and severity of vertebral fractures were measured by the TL method and Genant semi-quantitative technique by the same observer. Eight vertebrae were measured in each patient, ranging from T10 to L5. Results: The TL method was consistent with the Genant semi-quantitative method when evaluating whether patients had vertebral fractures (k >0.75), and the McNemar-bowker test showed no difference in the diagnosis between the two methods (P >0.05). However, Wilcoxon rank sum test found a difference between the two methods in assessing the severity of fractured vertebrae (P < 0.05), and the TL method was more sensitive. Conclusion: The two methods can be substituted for each other in the diagnosis of vertebral fractures. However, TL method is more sensitive in the diagnosis of the severity of spinal fractures. And the TL method is more quantitative and easier for beginners to master.

While 10-kV silicon-carbide (SiC) MOSFETs are gradually penetrating medium-voltage (MV) applications, intertwined challenges concerning high-voltage insulation, high ${dv}/{dt}$ , protections, and thermal management are simultaneously imposed to MV converters. For the modular multilevel converter, a systematical power cell design and assessment methodology (DAM) to tackle the unprecedented challenge synergy is essential and, yet, absent. Thereby, this article aims to develop a DAM based on a high-current 10-kV SiC MOSFET half-bridge module. An overall introduction of the power cell and a hierarchical DAM workflow is first presented, followed by the comprehensive component-level DAM with details on design challenges, solutions, assessment instruments, procedures, and test results. Subsequently, the DAM is expanded to the power cell level by exploring its safe operating area associated with switching frequency, power-processing capability, and temperature limit in various operation modes, which, in turn, validates the component designs and determines if they need iterations. Following the methodology, the power cell design is finalized, capable of continuous operation under 6 kV, 84-A rms, and 10 kHz, exhibiting 99.3% efficiency and transient immunity up to 100 V/ns.

In recent years, SiC MOSFET s have gained strong attention in medium-voltage power conversion applications. To increase the blocking voltage level, series-connection of SiC MOSFET s is an attractive solution but may suffer a severe voltage unbalance issue. To gain insights into the voltage unbalance issue, this article presents a detailed study of the impact of parasitic capacitors on the voltage sharing of series-connected SiC MOSFET s and body-diodes. The parasitic capacitors are categorized into two groups for analysis: 1) parasitic capacitors from gate terminal; 2) parasitic capacitors from drain/source terminals. The study reveals that gate parasitic capacitors affect gate miller-plateau voltage and ultimately the d v /d t during the turn- off . The voltage sharing will be worse under higher turn- off current or larger gate resistor. The drain/source parasitic capacitors will introduce additional capacitance across device drain-source terminals which results in an unbalanced voltage sharing. The position of switching unit and the heatsink connection schemes will affect the distribution of drain/source parasitic capacitors to cause different voltage sharing results. The drain/source parasitic capacitors will also cause voltage unbalance of series-connected body-diodes under different conditions. To verify the analysis, the voltage sharing between two series-connected 10 kV SiC MOSFET s is tested under different parasitic capacitors conditions.

Introduction Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol-related harms. This study examines the alcohol-related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation. Methods A cross-sectional telephone survey was conducted in 2019 on Chinese adults aged 18-74 (n = 3200). Respondents were asked about various past-year first-hand drinking harms (after one's own drinking), second-hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation. Results Of drinkers, 21.1% reported first-hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger-aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first-hand harms. Of the sample, 18.2% experienced past-year second-hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past-year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second-hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first-hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second-hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies. Discussion and conclusions Although high levels of alcohol-related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking-related harms.

Objective To examine the altitude differences in the optimal perfusate oxygenation (PpO2) in patients who underwent cardiac surgery. Methods We included children (aged 1 month to 18 years) with congenital heart diseases surgically repaired between 2012 and 2018. We included only patients who underwent cardiac surgery with arrested heart cardiopulmonary bypass. Primary outcome was severe systemic inflammatory response syndrome (SIRS). Logistic regression was used to evaluate the association between arterial PpO2 on continuous and categorical scales and severe SIRS by altitude. We established PpO2 thresholds that equated to a risk probability of roughly 0.185 or greater for developing severe SIRS in each group of altitude. Results Among 3918 patients from low altitudes and 2384 from high altitudes, high-altitude patients were older (median, 42.3 [interquartile range 22.8-75.8] vs 37.1 [17.7-69.1] months, P Conclusions This study suggests altitude differences in the association of arterial PpO2 with inflammatory response following pediatric cardiac surgery.

This study aimed to develop a mapping function that links the acromegaly quality of life (AcroQoL) questionnaire to EQ-5D-5L to obtain a preference-based utility value to inform economic evaluation. A nationwide cross-sectional questionnaire survey among patients with acromegaly was conducted online in China during 17 December 2019 to 6 January 2020. The study sample was randomly divided into a training set and a validation set. Ordinary least squares (OLS), Tobit, beta-based mixture, and adjusted limited dependent variable mixture models were tested for development of the function in the training set. Total and subscale scores and individual items of AcroQoL were included as predictors in the models along with their squared terms and demographic and clinical characteristics, and selected by backward stepwise selection. The root mean square error, mean absolute error, Akaike’s information criterion, Bayesian information criterion and adjusted R-square were used to assess goodness of fit and predictive ability of the models. There were 424 adult patients with acromegaly eligible for this analysis. Average EQ-5D-5L index score and AcroQoL score for them was 0.82 (SD = 0.15) and 44.3 (SD = 22.9), respectively. A total of 60 candidate models were tested. Considering model simplicity and predictive ability in both training and validation set, the best model was the OLS model using scores of physical dimension and its square term as predictors. A validated mapping function was developed in this study for estimating EQ-5D scores using AcroQoL outcomes. Its external validity can be further tested in other population with Acromegaly.

This study aimed to explore the quantitative efficacy of L-carnitine supplementation on glycemic control in type 2 diabetes mellitus patients using model-based meta-analysis (MBMA).Literatures were retrieved from the public database and data from these trials were extracted. The quantitative efficacy of L-carnitine on fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) in type 2 diabetes mellitus patients were evaluated by maximal effect (EIn the model of FPG, EIt was the first time to provide valuable quantitative information for efficacy of L-carnitine supplementation on glycemic control in type 2 diabetes mellitus patients.

BACKGROUND Suspension training (SET) is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system. However, there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction (ACLR) patients. It is not clear what aspects of the patient's function are improved after SET. AIM To investigate the effect of SET on the neuromuscular function, postural control, and knee kinematics of patients after ACLR surgery. METHODS Forty participants were randomized to an SET group or a control group. The SET group subjects participated in a SET protocol over 6 wk. The control group subjects participated in a traditional training protocol over 6 wk. Isokinetic muscle strength of the quadriceps and hamstrings, static and dynamic posture stability test, and relative translation of the injured knee were assessed before and after training. RESULTS The relative peak torque of the quadriceps and hamstrings in both groups increased significantly (P < 0.001), and the SET group increased by a higher percentage than those in the control group (quadriceps: P = 0.004; hamstrings: P = 0.011). After training, both groups showed significant improvements in static and dynamic posture stability (P < 0.01), and the SET group had a greater change than the control group (P < 0.05). No significant improvement on the relative translation of the injured knee was observed after training in either group (P > 0.05). CONCLUSION Our findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.

The aim of this study was to evaluate the psychometric properties of the EQ-5D-5L and SF-6D, and to compare their performance among patients living with haemophilia in China. A total of 875 Chinese patients completed the EQ-5D-5L, SF-6D, and Haem-A-QoL questionnaires. Construct validity of the EQ-5D-5L and SF-6D dimensions and indices was assessed by testing hypotheses relating these measures to Haem-A-QoL and clinical measures. The Spearman correlation coefficient was used to assess convergent validity, and one-way analysis of variance (F statistic) was used to assess the known-groups validity (discriminatory power). The agreement between EQ-5D-5L and SF-6D indices was assessed using the intraclass correlation coefficient (ICC) and the Bland–Altman plot. Both the EQ-5D-5L and SF-6D indices showed acceptable ceiling and floor effects. As hypothesised, both EQ-5D-5L and SF-6D were significantly correlated with Haem-A-QoL (both dimensions and overall score). EQ-5D-5L and SF-6D indices as well as EQ-VAS differentiated patients are known to differ in severity of haemophilia, bleeding status, disabling levels, and comorbidity. The F statistics in the known-groups comparisons suggested that the EQ-5D-5L was slightly more discriminative than the SF-6D. ICC (0.41) and Bland–Altman plot confirmed that the agreement between the EQ-5D-5L and SF-6D indices was poor. Both EQ-5D-5L and SF-6D showed satisfactory construct validity in the measurement of the HRQoL among patients with haemophilia. However, the two instruments may not be used interchangeably in this patient population due to their poor agreement and differing discriminatory power.

Objectives: This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. Methods: This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. Results: The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. Conclusion: Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.

Ferroelectric materials are promising for solar energy conversion due to the unique spontaneous polarization effect, leading to effective control of electron-hole recombination and potentially high power conversion efficiency of perovskite solar cells. Herein, the ultrathin ferroelectric hafnia alumina (HfAlO) films were obtained by atomic layer deposition and applied to modify the electron transport layer of PSCs. The XPS and AFM characterizations indicate that the Hf0.39Al0.10O films feature smooth, dense, and compact surface morphology. For the devices incorporating the ultrathin HfAlO films, the oriented ferroelectric effect-induced spontaneous polarization and internal electric field are crucial factors to enhance the charge separation during charge transfer. Accordingly, the short circuit current, open-circuit voltage, and power conversion efficiency (PCE) are increased by 11.8%, 9.0%, and 29.8%, respectively. Moreover, the HfAlO incorporating devices retained ~ 80% of the original PCE after 500 h ageing, much better than that of the pristine devices showing the retention of only ~ 50% of the original PCE.

BACKGROUND Toxic epidermal necrolysis (TEN) is often associated with skin wounds affecting large areas. Healing of this type of wound is difficult because of pressure, infection and other factors. It can increase the length of hospital stay and result in wound sepsis and even death. CASE SUMMARY A 49-year-old woman developed a skin lesion covering 80% of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back; she developed life-threatening wound sepsis and septic shock. Methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue, deep venous catheter and blood samples. Imipenem cilastatin sodium, tigecycline and teicoplanin were used for anti-infection therapy. Finally, the patient was transferred to the burn department because of severe wound sepsis. In the burn intensive care unit, pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results. After three operations within 2 wk, the wound healed and sepsis resolved. CONCLUSION TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis. Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients, and it leaves no scar at the donor site.

BACKGROUND The present study aimed to explore the effectiveness of electro-acupuncture (EA) in combination with a local anesthetic used in Western medicine in preventing the side effects of gastroscopy. METHODS A sample group of 150 patients were divided into three groups based on treatment methods: an EA group, a dyclonine hydrochloride mucilage group, and a combined treatment group. In the EA group, EA stimulation was given at the Hegu, Neiguan, and Zusanli acupoints; in the dyclonine hydrochloride mucilage group, patients took 10 mL of dyclonine hydrochloride mucilage orally; in the combined treatment group, prevention of side effects was attempted by administration of both acupuncture and oral local anesthetic. The incidences of nausea, emesis, salivation, cough, restlessness, and breath holding during gastroscopy were observed and recorded for the three groups. Mean arterial pressure, heart rate, and oxygen saturation were recorded before the examination, and changes in these measures were recorded as the gastroscope passed through the pylorus and after the examination. The visual analogue scale (VAS) values of nausea and emesis, the rate of successful first-pass intubation, and the time of gastroscopy were also recorded. Statistical analysis was performed using R-3.5.3 software. RESULTS Incidences of side effects (e.g., nausea, emesis, salivation, restlessness, and breath holding) during the examination were lower in the combined treatment group than in the EA group and the dyclonine hydrochloride mucilage group (P

The microstructure of the ceramic topcoat has a great influence on the service performance of thermal barrier coatings (TBCs). In this study, conventional layered-structure TBCs, nanostructured TBCs, and novel-structured TBCs with a unique microstructure were fabricated by air plasma spraying. The relationship between the microstructure and properties of the three different TBCs was analysed. Their thermal insulation ability, sintering resistance, and durability were systematically evaluated. Additionally, their failure modes after being subjected to two kinds of thermal shock tests were analysed. The results revealed that the novel-structured TBCs had remarkably superior performances in all the examined aspects. The thermal conductivity of the novel-structured TBCs was significantly lower than those of the conventional and nanostructured TBCs both in the as-sprayed state and after thermal treatment for 500 h at 1100 °C. The macroscopic elastic modulus of the novel-structured TBCs after sintering at 1300 °C for 100 h was similar to those of the conventional and nanostructured TBCs in the as-sprayed state. During both a burner rig thermal shock test and a furnace cyclic oxidation test, the thermal shock lifetime of the novel-structured TBCs was much longer than those of the conventional and nanostructured TBCs. This study has demonstrated novel-structured plasma-sprayed TBCs with high thermal insulation ability and high durability.

The third quadrant (3rd-quad) conduction of power MOSFET s involves competing current sharing between the metal-oxide-semiconductor (MOS) channel and the body diode controlled by the gate bias ( V G). For 1.2 kV SiC planar MOSFET s, it is well known that a positive V G higher than the threshold voltage enables parallel conduction through both channels, which reduces the 3rd-quad voltage drop and conduction loss. This work, for the first time, unveils that this fact does not hold for higher voltage (e.g., 3.3 kV and 10 kV) SiC planar MOSFET s. By combining the static characterization, simulation, and modeling, it is revealed that, once the MOS channel turns on , the body diode in high-voltage MOSFET s turns on at a source-to-drain voltage ( V SD) much higher than the built-in potential of the PN junction. In 10 kV SiC MOSFET s, the body diode does not turn on over the entire practical V SD range if the MOS channel is on. As a result, the positive VG leads to completely unipolar conduction, which could induce a higher voltage drop than the bipolar body diode at high temperatures. A buck converter based on a 10 kV SiC MOSFET half-bridge module was built and tested, which validated that a negative V G control provides the smallest 3rd-quad voltage drop and conduction loss at high temperatures. Finally, based on the revealed physics for planar MOSFET s, the optimal V G control for the 3rd-quad conduction in trench MOSFET s is discussed. These results provide critical device understandings of 1.2–10 kV SiC MOSFET s and important application guidelines for 10 kV SiC MOSFET s.

Patient advocacy and media coverage are important strategies for changing health policies. China is no exception. Through 31 interviews and content analysis of 1,136 news stories related to hepatit...

Thyroid cancer (TC) is one of the most common malignant tumors, with high morbidity and mortality rates worldwide. The incidence of TC, especially that of papillary thyroid carcinoma (PTC); has increased rapidly in recent decades. Autoimmune thyroid disease (AITD) is closely related to TC and has an estimated prevalence of 5%. Thus, it is becoming increasingly important to identify potential diagnostic biomarkers and therapeutic targets for TC and AITD. Circular RNAs (circRNAs) are a class of non-coding RNAs with covalently bonded circular structures that lack 5'-3' polarity and polyadenylated tails. Several circRNAs play crucial roles in the development of various diseases, including TC and AITD, and could be important new biomarkers and/or targets for the diagnosis and therapy of such disorders. Although there are four subtypes of TC, research on circRNA has largely focused on its connection to PTC. Therefore, this review mainly summarizes the relationships between circRNAs and PTC and AITD, including the molecular mechanisms underlying these relationships. In particular, the functions of "miRNA sponges" and their interactions with proteins and RNA are discussed. The possible targeting of circRNAs for the prevention, diagnosis, and treatment of TC and AITD is also described. CircRNAs could be potential biomarkers of TC and AITD, although validation will be required before they can be implemented in clinical practice.

Jia-hui Rong,1 Dong Li,2 Yu-liang Li2 1Department of Cardiology, The Second Hospital of Shandong University, Jinan, People’s Republic of China; 2Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, People’s Republic of ChinaCorrespondence: Dong Li; Yu-liang LiDepartment of Interventional Medicine, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan 250000, People’s Republic of ChinaEmail 714048127@qq.com; lyl.pro@sdu.edu.cnIntroduction: In recent years, radioactive 125I seed implantation combined with chemotherapy has been regarded as a safe and effective treatment for advanced non-small cell lung cancer (NSCLC). However, the mechanism underlying this success is still unclear.Methods: In this study, we investigated the apoptosis and anti-proliferative effect induced by 125I in A549, H1975, and H157 cells and determined whether a sensitizing concentration of lobaplatin (LBP) could enhance these effects. We performed in vitro experiments on A549, H1975, and H157 cells; we investigated the effects of 125I or lobaplatin (LBP) alone, or in combination, on cellular apoptosis and proliferation by performing flow cytometry, Bax/Bcl2 ratio, TUNEL, cell viability assay, cell cycle, and EdU. To further verify our findings, a subcutaneous tumor mouse model was established. Moreover, AKT/mTOR pathway was detected to determine whether this pathway was involved in the anti-cancer effect of 125I and LBP by up-regulating or down-regulating the expression of mTOR.Results: Based on our results, the sensitizing concentration of LBP could enhance the 125I-induced apoptosis and anti-proliferation effect. Furthermore, the subcutaneous tumor mouse model obtained the consistent results. More importantly, the AKT/mTOR pathway was down-regulated after the treatment of 125I and LBP, and the anti-cancer effect of 125I and LBP could be compromised by up-regulating the mTOR expression.Conclusion: Our study proved that LBP promotes the apoptotic and anti-proliferative effects of 125I in NSCLC cells by inhibiting the AKT/mTOR pathway and provides a foundation for future studies and enhanced combinatorial approaches for NSCLC in the clinical setting.Keywords: radioactive 125I seed, lobaplatin, non-small cell lung cancer, apoptosis, proliferation, AKT/mTOR pathway

In this study, we aim to provide a deep convolutional network based femoral neck fracture detection system on radiographs for emergency patients. We retrospectively collected 1,491 frontal pelvic radiographs from three institutions and assigned them to the following data sets: primary dataset (710 radiographs, to fine-tune and validate the initial model called the Digital Radiography Fracture Detection System [DR-FDS]), internal test set 1 (189 radiographs) and 2 (235 radiographs), and external test set 1 (189 radiographs) and 2 (168 radiographs). Per-bounding box recall and precision and per-image sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) were computed. We randomly extracted 300 radiographs from the above test sets and compared their effect on the diagnostic accuracy and efficiency of fine-tuned model-assisted and unassisted clinicians. The fine-tuned DR-FDS showed a better overall performance in detecting femoral neck fractures than did the initial DR-FDS. The fine-tuned DR-FDS achieved AUC values of 0.9526 (95%CI, 0.9048–0.9767) and 0.9633(95%CI, 0.9346-0.9797) in internal test sets 1 and 2. In external test sets 1 and 2, this model also achieved promising results with AUC values of 0.9231 (95%CI, 0.8779–0.9520), and 0.9937 (95%CI 0.9739–0.9985), respectively. The clinicians showed a statistically significant increase in specificity, sensitivity, and accuracy for the identification of minimal/undisplaced fracture and a decrease in the average reading time. The object detection model that is fine-tuned has high sensitivity and specificity and the universal ability to detect and locate femoral neck fractures on pelvic radiographs.

Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P P P P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

Congli Jia,1 Zhengquan Li,2 Dong Guo,1 Zhen Zhang,3 Jingming Yu,4 Guangdong Jiang,1 Xiaobo Xing,3 Shengjun Ji,5 Feng Jin3 1Weifang Medical University, Weifang, People’s Republic of China; 2Department of Laboratory Pathology, People’s Liberation Army 80th Group Military Hospital, Weifang, People’s Republic of China; 3Department of Radiotherapy & Oncology, Qingdao Center Hospital, Qingdao, People’s Republic of China; 4Department of Radiotherapy & Oncology, Shandong Hospital, Jinan, People’s Republic of China; 5Department of Radiotherapy & Oncology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, People’s Republic of ChinaCorrespondence: Shengjun JiDepartment of Radiotherapy & Oncology, Nanjing Medical University Affiliated Suzhou Hospital, No. 16 Baita Road, Suzhou 215001, People’s Republic of ChinaEmail drshengjunji@163.comFeng JinDepartment of Radiotherapy & Oncology, Qingdao Center Hospital, No. 127 Siliu Road, Qingdao 266042, People’s Republic of ChinaEmail 1093910079@qq.comBackground: Brain metastases (BM) are severe incidents among patients with non-small cell lung cancer (NSCLC) and have been associated with significant morbidity and decreased survival; thus, new methods are required to improve clinical management. Magnetic resonance spectroscopy (MRS) allows noninvasive measurements of biochemical information from tumor tissue, providing clinically useful imaging biomarkers. The primary aim of this study was to explore the application of MRS in the assessment of tumor prognosis after stereotactic radiotherapy in NSCLC patients with BM.Patients and Methods: MRS was performed on NSCLC patients attending Qingdao Center Hospital with suspected BM, and 68 patients were included in the survival analysis. The qualitative and quantitative parameters of MRS metabolites, such as choline (Cho), creatine (Cr), and N-acetyl-aspartate (NAA), were recorded. To select a cutoff for MRS metabolite parameters in the tumor and to distinguish patients who had recurrence, we performed an ROC curve analysis. Univariate and multivariate Cox regression analyses were used to assess the association between MRS metabolite parameters and clinical cancer prognosis.Results: The average age was 56 years. A total of 68 NSCLC patients underwent metabolic evaluation with single voxel proton MRS and were selected for retrospective analysis. According to the area under the curve (AUC) to predict recurrence, the MRS metabolite parameters were determined as Cho (AUC=0.550), Cr (AUC=0.415), NAA (AUC=0.524), NAA/Cr (AUC=0.600), Cho/Cr (AUC=0.723), and Cho/NAA (AUC=0.543). Cho and Cr predicted poor survival while Cho/Cr and NAA/Cr predicted improved survival (P< 0.05). In the multivariate model with adjustment to establish the potential role of MRS metabolite parameters, Cho/Cr showed a significant association with OS (P=0.009) and PFS (P=0.006) after stereotactic radiotherapy.Conclusion: The positive results of this study indicate the predictive value of metabolic characteristics of BM detected with MRS for the outcome after stereotactic radiotherapy.Keywords: brain metastases, magnetic resonance spectroscopy, stereotactic radiotherapy

Purpose: To investigate the neuroprotective effect of Shenxiong Drop Pill (SXDP) pretreatment on rats with middle cerebral artery occlusion (MCAO) in rats, and the mechanism involved.Methods: Ninety-nine SD rats were randomly assigned to 4 groups: control group, MCAO group, shamoperated group and SXDP group. The MCAO model was established via thread occlusion. Rats in the SXDP group was administered SXDP 7 days before induction of MCAO. Neurological deficit score (NDS) was determined using Bederson's neurological behavioral scoring method, while cerebral infarction volume was measured using TTC staining. Integrated optical density (IOD) of Nissl Body was evaluated via Nissl staining. Brain water content was measured using dry-wet method. The expression level of AQP4 in brain tissues was determined using immunocytochemistry.Results: The SXDP treatment resulted in significant reduction in NDS, marked improvement in IOD of Nissl Body, and significant reductions in cerebral infarction volume, brain water content, and expression level of AQP4, relative to control (p< 0.05).Conclusion: These results suggest that SXDP pretreatment exerts neuroprotective effect against cerebral ischemia in rats by decreasing in cerebral edema through a mechanism involving downregulation of the expression of AQP4. Keywords: Middle cerebral artery occlusion, Cerebral ischemia, Aquaporins-4, Cerebral edema, Neuroprotection

PURPOSE: We aimed to differentiate tuberculous peritonitis (TBP) from peritoneal carcinomatosis (PC) using a visual positron-emission tomography/computed tomography (PET/CT) scoring system based on mesenteric fluorodeoxyglucose (FDG) uptake. METHODS: PET/CT scans from 31 patients with TBP and 92 patients with PC were retrospectively reviewed. A visual PET/CT scoring system for mesenteric FDG uptake was used according to the following characteristics: FDG uptake intensity (low = 0, moderate = 1, high = 2), FDG uptake deposits (uniform = 0, irregular = 1, ascitic = 2), FDG uptake focality (diffuse = 0, segmental = 1, focal = 2), nodularity on the corresponding CT (nonnodular = 0, micronodular = 1, macronodular = 2) and mesenteric lymphadenopathy (absent = 0, lymphadenopathy without FDG uptake = 1, lymphadenopathy with FDG uptake = 2). The FDG uptake intensity, deposits, focality, nodularity and mesenteric lymphadenopathy scores between TBP and PC were compared using chi-square tests. The diagnostic performance of this scoring system for differentiating TBP from PC was analyzed using a receiver operating characteristic (ROC) curve. P < 0.05 was considered statistically significant. RESULTS: Twenty-four patients with TBP (77.4%) and 56 patients with PC (60.9%) had mesenteric FDG uptake (P = 0.095) and were included for evaluation with the visual PET/CT scoring system. PC lesions scored higher than TBP lesions in FDG uptake deposits (P < 0.001), focality (P < 0.001) and nodularity (P < 0.001). No significant differences were observed between PC and TBP lesions in FDG uptake intensity (P = 0.396) and lymphadenopathy (P = 0.074). The total score that combined deposits, focality and nodularity had significant value for differentiating TBP from PC (area under the curve (AUC) = 0.869, P < 0.001), and a cutoff > 1 had a sensitivity (the accuracy for diagnosis of PC) of 80.4% and a specificity (the accuracy for diagnosis of TBP) of 75.0%. CONCLUSION: A visual PET/CT scoring system based on mesenteric FDG uptake performed well in differentiating between TBP and PC.

Background Lingual linear lesions (LLLs) are the oral linear lesions located on the dorsum, lateral borders, and/or ventral surface of tongue. It has been suggested that LLLs might be an early clinical sign of vitamin B12 deficiency. Here, a retrospective study was conducted to further investigate and validate the association between LLL and vitamin B12 deficiency. Methods Based on the clinical examination, patients with LLLs were enrolled and analyzed retrospectively. Data regarding clinical and laboratory features were obtained. Follow-up was done at least 6 months following appropriate supplementation therapy. Results A total of 57 patients, consisting of 20 males and 37 females with a mean age of 59.12 years (range, 18-80), were enrolled in this study. The hematological examination revealed that 56 (98.25%) of the 57 patients had severe serum vitamin B12 deficiency, and the other 1 patient had a borderline low level of vitamin B12 . All the enrolled patients responded well to cobalamin replacement therapy. Conclusion LLLs might be a clinical sign strongly suggestive of severe vitamin B12 deficiency.

To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group).A retrospective cohort study.Department of Otorhinolaryngology in a tertiary Chinese hospital.Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score-matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed.In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively (Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.

Urinary metabolomics is a useful non-invasive tool for large-scale screening of disease-related metabolites. However, no comprehensive urinary metabolomic analysis of vitiligo is presently available. To investigate the urine metabolic pattern of vitiligo patients, we conducted a combined cross-sectional and prospective self-control cohort study and an untargeted urinary metabolomic analysis. In the cross-sectional study, 295 vitiligo patients and 192 age‐ and sex‐matched controls were enrolled, and 71 differential metabolites between two groups were identified. Pathway enrichment analysis revealed that drug metabolism-cytochrome P450, biopterin metabolism, vitamin B9 (folate) metabolism, selenoamino acid metabolism, and methionine and cysteine metabolism showed significant enrichment in vitiligo patients compared with the status in healthy controls. In the self-control cohort, 46 active vitiligo patients were recruited to analyse the urinary metabolic signatures after treatment. All of these patients were asked to undertake follow-up visits every 2 months three times after first consulting and the disease stage was evaluated compared with that at the last visit. Folate metabolism, linoleate metabolism, leukotriene metabolism, alkaloid biosynthesis, and tyrosine metabolism were predicted to be involved in vitiligo activity. Our study is the first attempt to reveal urinary metabolic signatures of vitiligo patients and provides new insights into the metabolic mechanisms of vitiligo.

This study aimed to estimate the health preference–based index scores of the population of patients with lymphoma using the EQ-5D in China. A cross-sectional online survey was conducted to examine the health and well-being of patients with lymphoma in China. Their health-related quality of life (HRQoL; using the EQ-5D), demographic and socioeconomic characteristics, and health conditions were assessed. The data were analyzed using Pearson’s χ2 test, analysis of variance, and binary logistic and Tobit regression models. A total of 3261 patients (sex: men = 58.5%, age: 60 years = 24.6%) participated in the study. The mean EQ-5D-5L index and EQ-VAS scores were 0.83 and 68.8, respectively. Binary logistic regression analysis revealed that women reported more pain-related problems than men did. Unemployed participants were substantially more likely to report health problems on all the five dimensions of the EQ-5D than their employed counterparts. The Tobit regression model revealed that respondents who were older, unemployed, with low income, received chemotherapy, and with short durations reported a low index score. Using the EQ-5D, the preference-based scores of different subpopulations of patients with lymphoma may support economic evaluation by promoting the simultaneous consideration of both the reasonable use of resources and satisfactory achievement of health outcomes.

Background Intranasal nebulization is an effective treatment for chronic rhinosinusitis and allergic rhinitis; however, terminal inhalation devices have not been fully studied. We compared the sinonasal aerosol distributions and adverse effects of different inhalation units. Methods A mask, double-head nozzle, and single-head nozzle were applied to atomize the methylene blue solution to 3-dimensional printed models of the pediatric nasal cavity, adult nasal cavity with septal deviation, and postsurgical paranasal sinuses, and staining of the different sites was scored. Volunteers received nebulization of normal saline via different devices; thereafter, the adverse effects were assessed using the visual analogue scale (VAS). Results After nebulization, the staining scores for the middle turbinate and middle meatus of the pediatric and adult nasal cavity models and the score for the anterior ethmoid sinus of the sinus model with the single-head nozzle were significantly higher than those with the mask and double-head nozzle (all p 0.05). Conclusion The single-head nozzle was the most effective device in aerosol delivery to the lateral wall of the nasal cavity and sinuses; conversely, the mask yielded limited sinonasal deposition. Intranasal nebulization was well tolerated, and the adverse effects among the devices were comparable. These findings are meaningful for selecting and developing inhalation units.