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This column describes the initial steps to develop a bidirectional access initiative between outpatient psychiatric and primary care clinics within an academic medical center. The authors analyzed electronic health record data (N=2,837 patients), interviewed psychiatric and primary care providers, assembled a work group, and identified five patient tracks (treatment optimization, psychiatric continuity, specialty clinic, psychotherapy, and community referral). Over 16 months, the number of patients scheduled for new psychiatric diagnostic evaluations with medical services increased from 62.5 to 116.0 per month without significant change in the no-show rate for evaluations within the psychiatric outpatient clinic.

Background We analyzed the clinical and imaging characteristics of patients with breast ductal carcinoma in situ with microinvasion (DCISM) and breast ductal carcinoma in situ (DCIS). Methods We analyzed the records of 40 patients diagnosed with DCISM and 61 patients with DCIS who were hospitalized at Shengjing Hospital (Shenyang, China) from January 2009 to June 2016. The size, hardness, and degree of calcification of tumors were determined by mammography and ultrasonography. Results In all, 37 DCISM patients and 45 DCIS patients showed clinical palpable masses (92.5% vs 73.77%, P = 0.018). Mammography showed that the mean size of tumor was larger in DCISM patients than that of DCIS patients (3.13 ± 1.51 vs 2.68 ± 1.77, P = 0.030). Ultrasound examination revealed calcification shadows in the solid tumor mass in 17 DCISM cases and 11 DCIS patients (42.5 vs 18.03%, P = 0.007). Furthermore, estrogen receptor positivity and progesterone receptor positivity were more common in DCIS patients (32.5% vs 54.10%, P = 0.033; 22.5% vs 45.90%, P = 0.017), and the percentage of menopausal patients were higher in DCISM patients than that of DCIS patients (70.00% vs 47.54%, P = 0.026). Conclusion Clinically palpable and calcified tumor masses on sonography are more commonly encountered in DCISM lesions.

Box girders are aerodynamically favorable, and the paper presents a study on the vortex-induced vibration (VIV) of this girder type at large angles of attack. Taking a box girder as an example, the form of the guardrails and the position of the maintenance tracks were improved to increase the VIV performance. The aerodynamic mechanism was further investigated according to the change in flow field around the girder. Results showed that the VIV performance of the box girder at positive angles of attack is worse. Improving secondary elements is an effective way to increase the VIV performance. Adding four rectangle bars above the original guardrails could achieve the target by preventing the generation of the vortex and blocking its movement. Moving the maintenance tracks inwards with a reasonable distance could also achieve the target as the flow passes through the girder more smoothly. With the combination of the optimal form of the guardrails and the optimal position of the maintenance tracks, the VIV performance of the bridge is higher. The countermeasures provide reference for the inhibition of the VIV of box girders.

Object-based image analysis (OBIA) has been widely used to classify high spatial resolution (HSR) imagery. In a traditional OBIA, object-level statistical summaries such as mean values are usually used for classification. This implies that the spectral values within objects follow a Gaussian distribution. However, the pixel values in an object do not necessarily conform to a Gaussian distribution because of within object spectral heterogeneity. Consequently, these statistical summaries may misrepresent the features of the object. This shortcoming is addressed in this paper by integrating both the spectral variability and the spatial distribution of the pixels within objects to improve the traditional object-based image classification. The spectral variability is represented by histograms of the pixel values in the object, and the spatial distribution is characterized by the binary spatial covariogram of these pixels. To construct a binary spatial covariogram, a principal component analysis (PCA) is first applied to compress multiple bands into one, and the Otsu thresholding is then performed to generate a binary map reflecting the spatial configuration of the pixels. Spatial covariance is then computed for this binary map and plotted with different lag distances to derive the binary spatial covariogram. Our proposed model utilizing curves composed of the spectral histograms and binary spatial covariogram (referred to as the His-Cov model) are then used for classification based on curve matching approaches. The integration of spectral variability and spatial distribution of the pixels in the object produced superior results to curve matching approaches based on spectral variability alone and to traditional OBIA based on spectral and spatial features of the objects when classifying complex land use types in urban environments.

Background Cigarette smoking is an important risk factor for cardiac diseases. In the current study, we sought to assess the effect of electronic cigarette extract (ECE) and conventional cigarette smoke extract (CSE) on cardiomyocytes. Methods iPSCs-derived cardiomyocytes were used in the study to evaluate cellular toxicities. Cells were exposed to either ECE or CSE for two consecutive days as an acute exposure or every other day for 14 days. Concentration of nicotine in both ECE and CSE were measured by Mass-Spectrometry and Q-Exactive-HF was used to identify other ingredients in both extracts. Fluorescent microscopy was used to measure the oxidative stress after ECE and CSE exposure. Motility and beat frequency of cardiomyocytes were determined using the Sisson-Ammons Video Analysis system. Heart failure target panel genes of exposed cardiomyocytes were compared to control unexposed cells. Results Despite nicotine concentration in CSE being six-fold higher than ECE (50 μg in CSE and 8 μg in ECE), ECE had similar toxic effect on cardiomyocytes. Both CSE and ECE generate significant cellular reactive oxygen species. The Sisson-Ammons Video Analysis (SAVA) analysis showed significant changes in myocyte function with both CSE and ECE slowing beating and increasing cell death. Chronic exposure of both ECE and CSE significantly decreased cardiomyocytes viability long term at all doses. Target panel gene expression profiles of both ECE and CSE exposed cardiomyocytes were different from controls with distinct pattern of genes that involved cell proliferation, inflammation, and apoptosis. Conclusion ECE and CSE produce similar cardiomyocyte toxicities which include generating oxidative stress, negative chronotropic effects, adverse changes in myocardial gene expression and ultimately cell death.

Immunophenotyping of inflammatory dermal infiltrates in Malassezia folliculitis (MF) and pityriasis versicolor (PV) lesions is less reported. Immunohistochemistry was performed on 21 MF lesions, 10 PV lesions, and 10 control skin. CD3+, CD4+, CD8+, CD20+, CD68+, and CD117+ cells were increased in MF compared with PV and normal skin (P Lay Summary Malassezia folliculitis and pityriasis versicolor are common Malassezia-induced superficial mycoses. Their clinicopathological discrepancy may be due to the difference of cellular and humoral immune responses.

Long-term neurodevelopmental disorders following neonatal anesthesia have been reported both in young animals and in children. The activation of transient receptor potential vanilloid 1 (TRPV1) channels in hippocampus adversely affects neurodevelopment. The current study explored the underlying mechanism of TRPV1 channels on long-lasting cognitive dysfunction induced by anesthetic exposure to the developing brain. we demonstrated that TRPV1 expression was increased after sevoflurane exposure both in vitro and in vivo. Sevoflurane exposure to hippocampal neurons decreased the synaptic density and the surface GluA1 expression, as well as increased co-localization of internalized AMPAR in early and recycling endosomes. Sevoflurane exposure to newborn mice impaired learning and memory in adulthood, and reduced AMPAR subunit GluA1, 2 and 3 expressions in the crude synaptosomal fractions from mouse hippocampus. The inhibition of TRPV1 reversed the phenotypic changes induced by sevoflurane. Moreover, sevoflurane exposure increased Src phosphorylation at tyrosine 416 site thereby reducing cofilin phosphorylation. TRPV1 blockade reversed these suppressive effects of sevoflurane. Our data suggested that TRPV1 antagonist may protect against synaptic damage and cognitive dysfunction induced by sevoflurane exposure during the brain developing stage.

Thermoelectric material is a new functional material that can convert thermal energy into electrical energy, and it has been widely concerned because it can be used as alternative energy in many applications. Bi2Te2.4Se0.6 nanopowders were prepared by electroless plating, and then sintered into bulk by spark plasma sintering. After electroless plating, the thermal conductivity of n-type Bi2Te2.4Se0.6/Cu thermoelectric materials has been significantly reduced due to decreased electronic thermal conductivity and phonon scattering caused by large grain boundaries and defects, of which 0.15 wt%Cu/Bi2Te2.4Se0.6 has the lowest lattice thermal conductivity and reached 0.43 W m−1 k−1. The results show that the average zT value of all components has been enhanced to a certain extent, of which the average zT value of 0.15 wt%Cu/Bi2Te2.4Se0.6 reached 0.89, and the peak zT reached 0.98 at 401 K.

Keratan sulfate (KS) is a sulfated linear polymer of N-acetyllactosamine. Proteoglycans carrying keratan sulfate epitopes were majorly observed in cornea, cartilage and brain; and mainly involved in embryonic development, cornea transparency, and wound healing process. Recently, expression of KS in cancer has been shown to be highly associated with advanced tumor grade and poor prognosis. Therefore, we aimed to identify the expression of KS epitope in human pancreatic cancer primary and metastatic tumor lesions. Immunohistochemical analysis of KS expression was performed on primary pancreatic tumors and metastatic tissues. We observed an increased expression of KS epitope on primary tumor tissues compared to uninvolved normal and tumor stroma; and is associated with worse overall survival. Moreover, lung metastatic tumors show a higher-level expression of KS compared to primary tumors. Interestingly, KS biosynthesis specific glycosyltransferases expression was differentially regulated in metastatic pancreatic tumors. Taken together, these results indicate that aberrant expression of KS is predictive of pancreatic cancer progression and metastasis and may serve as a novel prognostic biomarker for pancreatic cancer.

Anti-nuclear antibodies to speckled 100 kDa (sp100) and glycoprotein 210 (gp210) are specific serologic markers of primary biliary cholangitis (PBC) of uncertain/controversial clinical or prognostic significance. To study the genetic determinants associated with sp100 and gp210 autoantibody subphenotypes, we performed a genome-wide association analysis of 930 PBC cases based on their autoantibody status, followed by a replication study in 1,252 PBC cases. We confirmed single-nucleotide polymorphisms rs492899 (P = 3.27 × 10-22 ; odds ratio [OR], 2.90; 95% confidence interval [CI], 2.34-3.66) and rs1794280 (P = 5.78 × 10-28 ; OR, 3.89; 95% CI, 3.05-4.96) in the human major histocompatibility complex (MHC) region associated with the sp100 autoantibody. However, no genetic variant was identified as being associated with the gp210 autoantibody. To further define specific classical human leukocyte antigen (HLA) alleles or amino acids associated with the sp100 autoantibody, we imputed 922 PBC cases (211 anti-sp100-positive versus 711 negative cases) using a Han Chinese MHC reference database. Conditional analysis identified that HLA-DRβ1-Asn77/Arg74, DRβ1-Ser37, and DPβ1-Lys65 were major determinants for sp100 production. For the classical HLA alleles, the strongest association was with DRB1*03:01 (P = 1.51 × 10-9 ; OR, 2.97; 95% CI, 2.06-4.29). Regression analysis with classical HLA alleles identified DRB1*03:01, DRB1*15:01, DRB1*01, and DPB1*03:01 alleles can explain most of the HLA association with sp100 autoantibody. Conclusion: This study indicated significant genetic predisposition to the sp100 autoantibody, but not the gp210 autoantibody, subphenotype in PBC patients. Additional studies will be necessary to determine if these findings have clinical significance to PBC pathogenesis and/or therapeutics.

Cytomegalovirus (CMV) resistance is an emerging problem in solid organ transplant recipients. Risk factors are not well defined.Recipients with CMV viremia of solid organ transplants who underwent CMV resistance testing between January 2010 and March 2016 were divided in 2 groups: proven CMV resistance and refractory CMV infection. A third group was added to compare patients with viremia during the study period with patients with no resistance proven or suspected. We aimed to identify risk factors associated with the occurrence of CMV genotypic resistance.Forty-nine patients underwent resistance testing. Eleven (22.45%) developed genotypic mutations. Group 1 vs groups 2 and 3 had higher prednisone (P = .01) and tacrolimus levels (P = .03); did not respond to antivirals (P .0001); and had a higher rate of fungal infections (P = .03). CMV resistance was less common in liver and kidney vs heart, small bowel, and mutivisceral recipients (P = .0007). There was no difference in duration of antiviral prophylaxis, viremia while on antiviral prophylaxis, rate of end-organ disease, graft loss, and overall survival. Persistent clinical disease and viremia despite antiviral therapy was the most important risk factor for development of CMV resistance.Persistent clinical disease despite antiviral therapy is an important risk factor and may in part be due to a high degree of immunosuppression. Graft loss and survival were not impacted by CMV resistance.

The mid-wave single-crystal HgCdTe (211) films were successfully grown on GaAs (211) B substrates by molecular beam epitaxy (MBE). Microstructure and optical properties of the MBE growth HgCdTe films grown at different temperatures were characterized by X-ray diffraction, scanning transmission electron microscopy, Raman and photoluminescence. The effects of growth temperature on the crystal quality of HgCdTe/CdTe have been studied in detail. The HgCdTe film grown at the lower temperature of 151 °C has high crystal quality, the interface is flat and there are no micro twins. While the crystal quality of the HgCdTe grown at higher temperature of 155 °C is poor, and there are defects and micro twins at the HgCdTe/CdTe interface. The research results demonstrate that the growth temperature significantly affects the crystal quality and optical properties of HgCdTe films.

Introduction: Diabetes and heart failure are very closely associated. Diabetes patients have an increased risk of developing heart failure and heart failure patients are at higher risk of developing diabetes. Changes occur in myocardial glucose metabolism in end stage heart failure patients and newer therapies for diabetes such as SGLTi improve heart failure outcomes. Our objective was to identify transcriptional changes associated with diabetes in heart failure patients. Methods: Transcriptional profiles were compared in heart tissues obtained at the time of LVAD implant among diabetic heart failure (HF) (n=16), non-diabetic (n=10) HF patients and control (n=3) non failing hearts. RNASeq analysis utilized a custom-targeted panel for 140 genes on the Ion Torrent Personal Genome Machine. Coverage analysis as well as mapping the reads and alignment was done using the Ion Torrent Browser SuiteTM. The Bejamini-Hochberg method was used to control the false discovery rate to be no more than 0.05. Ingenuity Pathway Analysis (IPA) was also performed to understand the biological pathways involved. Results: Our sample population was 82% male with an average age of 51 and 84% Caucasian, 14% African American and 2% Asian. Average ejection fraction was quite low Conclusions: Diabetic heart failure patients have increased expression of chemokines and extracellular matrix genes, which may contribute to disease progression. Up regulation of CCL4 and CCL2 in diabetic HF patients may cause additional risk of heart diseases through inflammatory pathways and increased expression of collagen may contribute to myocardial fibrosis. Down regulation of contractile proteins, and ion channels were similar in diabetic and non-diabetic HF patients.

The emerging satellite videos provide the opportunity to detect moving objects and track their trajectories, which were not possible for remotely sensed imagery with limited temporal resolution. So far, most studies using satellite video data have been concentrated on traffic monitoring through detecting and tracking moving cars, whereas the studies on other moving objects such as airplanes are limited. In this paper, an integrated method for monitoring moving airplanes from a satellite video is proposed. First, we design a normalized frame difference labeling (NFDL) algorithm to detect moving airplanes, which adopts a non-recursive strategy to deliver stable detection throughout the whole video. Second, the template matching (TM) technique is utilized for tracking the detected moving airplanes in the frame sequence by improved similarity measures (ISMs) with better rotation invariance and model drift suppression ability. Template matching with improved similarity measures (TM-ISMs) is further implemented to handle the leave-the-scene problem. The developed method is tested on a satellite video to detect and track eleven moving airplanes. Our NFDL algorithm successfully detects all the moving airplanes with the highest F1 score of 0.88 among existing algorithms. The performance of TM-ISMs is compared with both its traditional counterparts and other state-of-the-art tracking algorithms. The experimental results show that TM-ISMs can handle both rotation and leave-the-scene problems. Moreover, TM-ISMs achieve a very high tracking accuracy of 0.921 and the highest tracking speed of 470.62 frames per second.

Context The quality of end-of-life care services directly affects the end-of-life quality of life of patients and their families. At present, there are no standard tools in China for assessing the quality of dying and death (QODD) of critical intensive care unit (ICU) patients. Objectives This study aimed to introduce the Chinese version of the QODD questionnaire for family members of ICU patients, after transcultural adaptation and validation, to provide an effective instrument for assessing the quality of end-of-life care of ICU patients in China, fill the gap in the evaluation of the quality of end-of-life care of critical ICU patients in China, and offer a theoretical basis and practical guidance during purposeful intervention. Methods This study involved the main adult caregivers or principal family members of 149 dying critically ill patients. The original QODD scale was translated using the double forward and backward method. Nine cultural adaptation experts adapted the Chinese version of the QODD scale for completion by family members of ICU patients. Then, we carried out content validity, structural validity, internal consistency, confirmatory factors, and item correlation analysis of the modified scale. Results The Chinese version of the QODD for family members of ICU patients was developed after some items were deleted or modified. The content validity index was 0.93, indicating that all items were correlated with the measurement of death quality. The Kaiser-Meyer-Olkin value was 0.797, suggesting that the correlations between items were high. The Cronbach's α was 0.865, indicating good internal consistency. In confirmatory factor analysis, the fit indices were χ2 = 207.327, non-normed fit index = 0.916, root mean square error of approximation = 0.033, and comparative fit index = 0.93, indicating a good fit of the five-factor model of the Chinese version of the QODD questionnaire for family members of ICU patients. Conclusion The Chinese version of the QODD questionnaire for family members of ICU patients is a reliable and effective instrument for evaluating the quality of death among patients who die in the ICU and can be applied to clinical practice and research.

The reduction of fresh agricultural product volume loss throughout the supply chain system is of high importance due to their perishable nature and impact on society, the economy, and environment. In this paper, three models for two-stage pricing, coordination, and volume loss reduction of the supply chain where third-party logistics service providers and retailers act as a Stackelberg leader and a follower for fresh agricultural products are developed, taking into account both volume loss during transport and quality loss in retail in the presence of strategic consumers. The following results are drawn from the contract for sharing revenues and service costs: (1) The supply chain achieve coordination and the products are healthier for consumers, (2) the coordination leads to a reduction in the three types of volume losses simultaneously only if the lowest marginal costs of the supply chain occur under certain conditions, and (3) the increase in the service sensitivity coefficient, the increase in the freshness discount coefficient under certain conditions, the decrease in the consumer benefit discount coefficient under certain conditions, and the decrease in the price sensitivity coefficient lead to an increase in the profit of the supply chain and a reduction in the three types of volume losses.

Background Upregulation of L-type voltage-gated Ca2+ (CaV1.2) channel in the arterial myocytes is a hallmark feature of hypertension. However, whether maternal exercise during pregnancy has a sustained beneficial effect on the offspring of spontaneously hypertensive rats (SHRs) through epigenetic regulation of CaV1.2 channel is largely unknown. Methods Pregnant SHRs and Wistar-Kyoto rats were subjected to swimming and the vascular molecular and functional properties of male offspring were evaluated at embryonic (E) 20.5 day, 3 months (3 M), and 6 months (6 M). Results Exercise during pregnancy significantly decreased the resting blood pressure at 3 M but not 6 M in the offspring of SHR. Prenatal exercise significantly reduced the cardiovascular reactivity, the contribution of CaV1.2 channel to the vascular tone, and the whole-cell current density of CaV1.2 channel in both 3 M and 6 M offspring of SHR. Moreover, maternal exercise triggered hypermethylation of the promoter region of the CaV1.2 α1C gene (CACNA1C), with a concomitant decrease in its protein and mRNA expressions in SHR offspring at E20.5, 3 M, and 6 M. Tissue culture experiments further confirmed that 5-Aza-2′-deoxycytidine increased the structure and functional expression of CaV1.2 channel by inhibiting the DNA methylation of CACNA1C. However, the improvement of prenatal exercise on the blood pressure, function, and expression of CaV1.2 channel was attenuated in the offspring of SHRs at 6 M compared to the 3 M readout. Conclusions These data suggest that prenatal exercise improves the vascular function by the hypermethylation of CACNA1C in the arterial myocytes and delays the development of hypertension in the offspring of SHRs. However, these effects fade out with age.

In recent years, satellites capable of capturing videos have been developed and launched to provide high definition satellite videos that enable applications far beyond the capabilities of remotely sensed imagery. Moving object detection and moving object tracking are among the most essential and challenging tasks, but existing studies have mainly focused on vehicles. To accurately detect and then track more complex moving objects, specifically airplanes, we need to address the challenges posed by the new data. First, slow-moving airplanes may cause foreground aperture problem during detection. Second, various disturbances, especially parallax motion, may cause false detection. Third, airplanes may perform complex motions, which requires a rotation-invariant and scale-invariant tracking algorithm. To tackle these difficulties, we first develop an Improved Gaussian-based Background Subtractor (IPGBBS) algorithm for moving airplane detection. This algorithm adopts a novel strategy for background and foreground adaptation, which can effectively deal with the foreground aperture problem. Then, the detected moving airplanes are tracked by a Primary Scale Invariant Feature Transform (P-SIFT) keypoint matching algorithm. The P-SIFT keypoint of an airplane exhibits high distinctiveness and repeatability. More importantly, it provides a highly rotation-invariant and scale-invariant feature vector that can be used in the matching process to determine the new locations of the airplane in the frame sequence. The method was tested on a satellite video with eight moving airplanes. Compared with state-of-the-art algorithms, our IPGBBS algorithm achieved the best detection accuracy with the highest F1 score of 0.94 and also demonstrated its superiority on parallax motion suppression. The P-SIFT keypoint matching algorithm could successfully track seven out of the eight airplanes. Based on the tracking results, movement trajectories of the airplanes and their dynamic properties were also estimated.

BackgroundMyocardial recovery with Left ventricular assistant device (LVAD) therapy is dichotomous with some patients obtaining remission from end-stage heart failure whereas most require transplantation or remain on pump support long term. Our goal was to determine transcriptional and free radical responses to LVAD treatment.MethodsTissues were collected from patients before and after LVAD placement in non-ischemic dilated cardiomyopathy patients (n = 14) along with controls (n = 3). RNA sequencing (RNASeq) analysis quantified transcriptional profiles by using a custom targeted panel of heart failure related genes on the PGM sequencer. The differential expression analysis between groups was conducted using edgeR (Empirical analysis of digital gene expression data in R) package in Bioconductor. Ingenuity Pathway Analysis (IPA) was carried out on differentially expressed genes to understand the biological pathways involved. Electron Paramagnetic Resonance (EPR) Spectroscopy was utilized to measure levels of free radicals in whole blood collected pre- and post-LVAD implantation (n = 16).ResultsThirty-five genes were differentially expressed in pre-LVAD failing hearts compared to controls. In response to LVAD therapy, only Pyruvate dehydrogenase kinase 4 (PDK4) and period circadian protein homolog 1(PER1) were altered with 34 heart failure related genes still differentially expressed post-LVAD compared to controls. IPA showed that DNA methylation-related genes were upregulated in both pre- and post-LVAD and was persistent with a Z-score of 2.00 and 2.36 for DNA Methyltransferase 3A (DNMT3A) and DNA methyltransferase 3B (DNMT3B), respectively. Inhibition of micro RNA21 (mir21) was also significant on pathway analysis in the post-LVAD population with a Z-score of − 2.00. Levels of free radicals in blood of pre- and post-LVAD patients did not change significantly.ConclusionLVAD therapy does not reverse many of the transcriptional changes associated with heart failure. Persistent changes in gene expression may be related to ongoing oxidative stress, continued DNA methylation, or changes in metabolism. PDK4 is a key regulator of glucose metabolism and its increased expression by LVAD therapy inhibited pyruvate metabolism.

Background No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. Methods We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir–ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. Results A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir–ritonavir group, and 100 to the standard-care group. Treatment with lopinavir–ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.31; 95% confidence interval [CI], 0.95 to 1.80). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir–ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir–ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. Conclusions In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308. opens in new tab.)

Background Antibody induction immunosuppression is commonly used in kidney transplantation to decrease the risk of early acute rejection. However, infectious complications may arise in patients treated with higher intensity induction immunosuppression. In this study, we compared the rate of opportunistic infections during the 3 years after kidney transplantation in recipients who received either alemtuzumab or basiliximab for induction therapy. Methods All renal transplant recipients from our center who received induction with alemtuzumab between 2011 and 2016 were included and matched 1:2 (by age and date of transplant) to renal transplant recipients who received basiliximab. The primary outcome was the rate of opportunistic infections. Results Twenty-seven patients received alemtuzumab (mean age = 50.8 years; SD ±12), and 54 received basiliximab (mean age = 50.8 years; SD ±11.8). Infections within 3 years posttransplant were not different between groups: BK viremia (P = .99), BK nephritis (P = .48), cytomegalovirus infection (P = .13), varicella zoster virus (P = .22), and all infections (P = .87). Time to infection (P = .67), patient survival (P = .21), and time to rejection (P = .098) were similar in both groups. There were also no group differences in delayed graft function (P = .76), graft loss (P = .97), or rejection (P = .2). Conclusion The rate of infection was not significantly increased in recipients receiving lymphocyte-depleting alemtuzumab compared to recipients receiving basiliximab induction therapy, despite receiving similar maintenance immunosuppression. Although the immunologic risks differed between the 2 groups, there was no observable difference in clinical outcomes.

In recent years, with the gradual networking of high-speed railways in China, the existing railway transportation capacity has been released. In order to improve transportation capacity, railway freight transportation enterprises companies have gradually shifted the transportation of goods from dedicated freight lines to passenger-cargo lines. In terms of the organization form of collection and distribution, China has a complete research system for heavy-haul railway collection and distribution, but the research on the integration of collection and distribution of the ordinary-speed railway freight has not been completed. This paper combines the theories of the integration of collection and distribution theory, coordination theory, and coupling theory and incorporates the machine learning fuzzy mathematics to construct an “Entropy-TOPSIS Coupling Development Degree Model” for dynamic intelligent quantitative analysis of the synergy of railway freight collection and distribution systems. Finally, we take the Tongchuan Depot of “China Railway Xi’an Group Co., Ltd.” as a research object to construct a target system and use the intelligent information acquisition system to collect basic data. The analysis results show that through the coordinated control of the freight collection and distribution system, the coordination between the subsystems of the integrated freight collection and distribution system is increased by 5.94%, which verifies the feasibility of the model in the quantitative improvement of the integration of collection and distribution system. It provides a new method for the research of integrated development of railway freight collection and distribution.

To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature.A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review.We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%.RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.

Background Due to the occult anatomic location of the nasopharynx and frequent presence of adenoid hyperplasia, the positive rate for malignancy identification during biopsy is low, thus leading to delayed or missed diagnosis for nasopharyngeal malignancies upon initial attempt. Here, we aimed to develop an artificial intelligence tool to detect nasopharyngeal malignancies under endoscopic examination based on deep learning. Methods An endoscopic images-based nasopharyngeal malignancy detection model (eNPM-DM) consisting of a fully convolutional network based on the inception architecture was developed and fine-tuned using separate training and validation sets for both classification and segmentation. Briefly, a total of 28,966 qualified images were collected. Among these images, 27,536 biopsy-proven images from 7951 individuals obtained from January 1st, 2008, to December 31st, 2016, were split into the training, validation and test sets at a ratio of 7:1:2 using simple randomization. Additionally, 1430 images obtained from January 1st, 2017, to March 31st, 2017, were used as a prospective test set to compare the performance of the established model against oncologist evaluation. The dice similarity coefficient (DSC) was used to evaluate the efficiency of eNPM-DM in automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images, by comparing automatic segmentation with manual segmentation performed by the experts. Results All images were histopathologically confirmed, and included 5713 (19.7%) normal control, 19,107 (66.0%) nasopharyngeal carcinoma (NPC), 335 (1.2%) NPC and 3811 (13.2%) benign diseases. The eNPM-DM attained an overall accuracy of 88.7% (95% confidence interval (CI) 87.8%–89.5%) in detecting malignancies in the test set. In the prospective comparison phase, eNPM-DM outperformed the experts: the overall accuracy was 88.0% (95% CI 86.1%–89.6%) vs. 80.5% (95% CI 77.0%–84.0%). The eNPM-DM required less time (40 s vs. 110.0 ± 5.8 min) and exhibited encouraging performance in automatic segmentation of nasopharyngeal malignant area from the background, with an average DSC of 0.78 ± 0.24 and 0.75 ± 0.26 in the test and prospective test sets, respectively. Conclusions The eNPM-DM outperformed oncologist evaluation in diagnostic classification of nasopharyngeal mass into benign versus malignant, and realized automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images.

In order to enhance hole/electron separation and charge transfer in photocatalysts, the heterostructured g-C3N4/CoAPO-5 hybrids materials were synthesized via a simple grinding method and were investigated using X-ray diffraction (XRD), fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The optical properties of g-C3N4/CoAPO-5 hybrids materials were measured by ultraviolet-visible diffuse-reflectance spectroscopy (DRS), photoluminescence (PL) spectra and ultraviolet-visible absorption (UV-Vis) spectra. Under visible-light illumination, this work shows the heterogeneous g-C3N4/CoAPO-5 hybrids present a superior photocatalytic activity.

Interface engineering has been demonstrated to be an effective strategy for enhancing the thermoelectric (TE) performance of materials. However, a very typical interface in semiconductors, that is, the PN junction (PNJ), is scarcely adopted by the thermoelectrical community because of the coexistence of holes and electrons. Interestingly, our explorative results provide a definitively positive case that appropriate PNJs are able to enhance the TE performance of p-type Sb2Te3-based alloys. Specifically, owing to the formation of the charge-depletion layer and built-in electric field, the carrier concentration and transport can be optimized and thus the power factor is improved and the electronic thermal conductivity is decreased. Meanwhile, PNJs provide scattering centers for phonons, leading to a reduced lattice thermal conductivity. Consequently, the p-type (Bi2Te3)0.15–(Sb2Te3)0.85 composites comprising PNJs achieve a ∼131% improvement of the ZT value compared with the pure Sb2Te3. The increased ZT demo...

Objectives To profile and compare the subgingival microbiome of RA patients with OA controls. Methods RA (n = 260) and OA (n = 296) patients underwent full-mouth examination and subgingival samples were collected. Bacterial DNA was profiled using 16 S rRNA Illumina sequencing. Following data filtering and normalization, hierarchical clustering analysis was used to group samples. Multivariable regression was used to examine associations of patient factors with membership in the two largest clusters. Differential abundance between RA and OA was examined using voom method and linear modelling with empirical Bayes moderation (Linear Models for Microarray Analysis, limma), accounting for the effects of periodontitis, race, marital status and smoking. Results Alpha diversity indices were similar in RA and OA after accounting for periodontitis. After filtering, 286 taxa were available for analysis. Samples grouped into one of seven clusters with membership sizes of 324, 223, 3, 2, 2, 1 and 1 patients, respectively. RA-OA status was not associated with cluster membership. Factors associated with cluster 1 (vs 2) membership included periodontitis, smoking, marital status and Caucasian race. Accounting for periodontitis, 10 taxa (3.5% of those examined) were in lower abundance in RA than OA. There were no associations between lower abundance taxa or other select taxa examined with RA autoantibody concentrations. Conclusion Leveraging data from a large case-control study and accounting for multiple factors known to influence oral health status, results from this study failed to identify a subgingival microbial fingerprint that could reliably discriminate RA from OA patients.

Object-based image analysis (OBIA), which has been commonly used for land cover and land use classification, may encounter challenges when satellite images’ spatial resolution achieves at the sub-meter level. An image object may exhibit spectral heterogeneity, causing traditional object-level statistical measures such as mean values of the pixels in an object not suited to represent the feature of the object. Additionally, an image object may have strong spatial association with its surroundings. Traditional OBIA only considers spatial features of individual object, but ignoring spatial arrangement or spatial association between objects. This paper proposes a new OBIA method by integrating within-object spectral variability and between-object spatial association. The within-object spectral variability is captured by the histograms of the pixels in an object across multispectral bands to reflect the heterogeneity of their pixel values. Based on this, the initial classification result is obtained using non-parametric curve matching methods. Then, the between-object spatial association is represented by curves derived from the frequency of pairwise classes in four main directions, also in the form of curves. The curves now composed of both the histograms of spectral feature and the class pair frequency of spatial feature are then fused for another curve matching based classification. This recurrent process is repeated and the spatial association is recaptured from the previous classification result at each iteration until a stopping criterion is satisfied. The curve matching classification method based on histograms of spectral feature is superior to traditional OBIA based on only object-level statistical measures since it fully characterizes spectral variability in the objects. The between-object spatial association works as a spatial filter that considers spatial arrangement of classes in a neighborhood. The developed method is especially suitable for classifying high spatial resolution (HSR) images with land cover/land use classes in typical urban areas.

Purpose This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. Methods The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. Findings The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. Conclusions A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.

// Yu Liu 1, * , Duo Li 3, * , Dan Nie 1, * , Shang-Kun Liu 1 , Fang Qiu 1 , Mei-Tong Liu 1 , Yuan-Yuan Li 1 , Jia-Xin Wang 1 , Yan-Xin Liu 1 , Chang-Jiang Dong 1 , Di Wu 1 , Wei Tian 1 , Jia Yang 1 , Wei Mu 1 , Jia-Tong Li 1 , Dan Zhao 2 , Xiao-Feng Wang 3 , Wen-Feng Chu 1 and Bao-Feng Yang 1 1 Department of Pharmacology, The State-Province Key Laboratories of Biomedicine Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education, College of Pharmacy, Harbin Medical University at Harbin, Heilongjiang 150081, P. R. China 2 Department of Clinical Pharmacy, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, The 2nd Affiliated Hospital, Harbin Medical University at Harbin, Heilongjiang 150081, P. R. China 3 Department of Oral and Maxillofacial Surgery, The 2nd Affiliated Hospital, Harbin Medical University at Harbin, Heilongjiang 150081, P. R. China * These authors contributed equally to this work Correspondence to: Wen-Feng Chu, email: cwf76928@aliyun.com Bao-Feng Yang, email: yangbf@ems.hrbmu.edu.cn Keywords: cardiotoxicity, human ether-a-go-go-related gene, transforming growth factor β1, PML nuclear body, SUMOylation Received: October 12, 2016 Accepted: April 17, 2017 Published: May 02, 2017 ABSTRACT The human ether-a-go-go-related gene (HERG) channel is a novel target for the treatment of drug-induced long QT syndrome, which causes lethal cardiotoxicity. This study is designed to explore the possible role of PML SUMOylation and its associated nuclear bodies (NBs) in the regulation of HERG protein expression. Both arsenic trioxide (ATO) and angiotensin II (Ang II) were able to significantly reduce HERG protein expression, while also increasing PML SUMOylation and accelerating the formation of PML-NBs. Pre-exposure of cardiomyocytes to a SUMOylation chemical inhibitor, ginkgolic acid, or the silencing of UBC9 suppressed PML SUMOylation, subsequently preventing the downregulation of HERG induced by ATO or Ang II. Conversely, knockdown of RNF4 led to a remarkable increase in PML SUMOylation and the function of PML-NBs, further promoting ATO- or Ang II-induced HERG protein downregulation. Mechanistically, an increase in PML SUMOylation by ATO or Ang II dramatically enhanced the formation of PML and Pin1 complexes in PML-NBs, leading to the upregulation of TGF-β1 protein, eventually inhibiting HERG expression through activation of protein kinase A. The present work uncovered a novel molecular mechanism underlying HERG protein expression and indicated that PML SUMOylation is a critical step in the development of drug-acquired arrhythmia.

To enhance the properties of bulk thermoelectric (TE) materials, preparation methods have been intensively developed with advanced techniques, e.g., zone-melting, Bridgman or Czochralski unidirectional methods, hot pressing or spark plasma sintering, that follow various complicated synthesis steps. However, these innovative methods remain less competitive than conventional techniques for large-scale production and application. Here, we report that, by manipulating the liquid state of the Bi2Te2.7Se0.3 alloy doped with KI, n-type bulk specimens with desired TE performance can be simply solidified by air cooling and without costly equipments. The specimens solidified from the parent melt experienced temperature-induced liquid–liquid structural transition, which is indicated by the resistivity behavior of the liquid, the presence of a refined matrix and eutectics, and the observation of more nanoparticles and a higher density of lattice defects. It was confirmed these refined multiscale refined structures lead to a “phonon glass electron crystal” effect, i.e., a much lower lattice thermal conductivity but a much higher power factor (PF). The present method, which synergistically obtains higher PF and lower thermal conductivity, could also be applied to other TE compounds.

Cardiac sodium channel plays a key role in the fast depolarization and maintenance of impulse conduction in cardiomyocytes. Mutations of SCN5A gene can lead to many types of arrhythmias. A 14-year-old boy with familial paternal history of sudden unexpected nocturnal death was admitted to hospital with recurrent syncope. A cardiac channelopathy was suspected and a pathogenic ion channel was searched for mutation identification. The proband manifested sinus node dysfunction, ventricular tachycardia, cardiac conduction disturbance involving atrioventricular node and His bundle. The proband and his mother received whole exome sequencing. A heterozygous in-frame deletion N1380del on exon 23 of SCN5A gene locating in a highly conserved pore residue in domain III (S5-S6) was revealed in the proband. The mutation was assessed in other family members by Sanger sequencing. The proband's living uncle and two sisters were asymptomatic mutation carriers with different degrees of cardiac conduction disturbance. Functional analysis was conducted using whole-cell patch clamping in HEK293T cells transfected with wild-type or mutant channels. The HEK293T cells transfected with plasmid pcDNA3.1-N1380del-SCN5A had no detectable sodium current. Overall, N1380del mutation of SCN5A gene leads to loss of function of sodium channel. N1380del is a pathogenetic mutation which can cause cardiac conduction defect and ventricular tachycardia.

Background and Objectives The objective of this study was to examine post-operative mortality for elderly pancreatic cancer patients treated with multi-modality therapy. Methods Surveillance Epidemiology and End Results (SEER) Medicare linked data were used to examine differences in mortality between patients who underwent pancreatectomy alone and those who had early (within 12 weeks) and late (after 12 weeks) adjuvant therapy (chemotherapy and/or radiotherapy). Results Among 4,105 patients who underwent pancreatectomy between 1991 and 2008, 1-year mortality (Odds Ratio [OR] = 0.71; P-value = 0.000; 95% Confidence Interval [CI]: 0.60–0.85) and 6-month mortality (OR = 0.44; P-value = 0.000; 95%CI: 0.35–0.53) following pancreatectomy were significantly lower in the group that underwent pancreatectomy with early adjuvant therapy. Late adjuvant therapy group also had lower 1 year (OR = 0.51; P-value = 0.000; 95%CI: 0.43–0.61) and 6 months (OR = 0.14; P-value = 0.000; 95%CI: 0.10–0.17) mortality, compared to surgery alone. Conclusions Post-operative outcomes were better for patients treated with surgery with adjuvant therapy, with the late adjuvant therapy group having the best outcomes (lowest odds of 6 month and 1-year mortality following surgery). J. Surg. Oncol. 2017;115:158–163. © 2017 Wiley Periodicals, Inc.

Small cell lung cancer (SCLC) accounts for approximately 10-15% of all lung cancers. No significant improvement has been made for patients with SCLC in the past several decades. The main progresses were the thoracic radiation and prophylactic cranial irradiation (PCI) that improved the patient survival rate. For patients with limited disease and good performance status (PS), concurrent chemoradiotherapy (CCRT) followed by PCI should be considered. For extensive disease, the combination of etoposide and platinum-based chemotherapy remains the standard treatment and consolidative thoracic radiotherapy is beneficial for patients who have a significant respond to initial chemotherapy. However, the prognosis still remains poor. Recently, efforts have been focused on molecular targets and immunotherapy. But numerous molecular targets methods have failed to show a significant clinical benefit in patients with SCLC. It is anticipated that further development of research will depend on the on-going trials for molecular targeted therapy and immunotherapy which are promising and may improve the outcomes for SCLC in the next decade.

Objective To determine the prognostic effect of adjuvant radiation and clinicopathological variables in surgically treated patients with small cell carcinoma of the cervix (SCCC). Methods Clinical data of SCCC patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I-II underwent radical surgery from May 2000 to August 2014 at Sun Yat-sen Memorial Hospital were retrospectively reviewed. Forty-three patients with SCCC were included to this study. Chi-square test or Fisher’s exact test, Student’s t test or Mann–Whitney U test, Kaplan–Meier method and multivariate analysis of Cox proportional hazards regression were used for statistical analysis. P Results Among 43 patients (median age, 49 years old) recruited, 25(58.1%) had stage I, 18(41.9%) had stage II disease. The 5-year overall survival (OS) rate was 39.54%, and the 5-year disease free survival (DFS) was 27.91%. Distant metastasis was the main cause of treatment failure (71.9%). Patients with adjuvant chemoradiation displayed lower rate of local recurrence than those with adjuvant chemotherapy (10.7% vs 60.0%, P P = 0.001, 0.004 respectively). Age was also an independent predictor of OS (P = 0.004). Adjuvant radiation appeared to significantly improve DFS (HR = 0.383, 95% CI, 0.185–0.791), but not OS. Conclusions Adjuvant radiotherapy could improve the local control and prolong DFS in surgically treated SCCC. However, a large prospective clinical trial is needed to confirm this.

Introduction: Women diagnosed with breast cancer (BC) are at increased risk of sleep deficiency. Approximately 30–60% of these women report poor sleep during and following surgery, chemotherapy, radiation therapy, and anti-estrogen therapy. The purpose of this study was to examine the relationship between genetic variation in circadian rhythm genes and self-reported sleep quality in women with BC.Methods: This cross-sectional study recruited women with a first diagnosis of breast cancer at five sites in Nebraska and South Dakota. Sixty women were included in the study. Twenty-six circadian genes were selected for exome sequencing using the Nextera Rapid Capture Expanded Exome kit. 414 variants had a minor allele frequency of ≥5% and were included in the exploratory analysis. The association between Pittsburgh Sleep Quality Index (PSQI) score and genetic variants was determined by two-sample t-test or ANOVA.Results: Twenty-five variants were associated with the PSQI score at p < 0.10, of which 19 were significant at p

BACKGROUND Abiraterone increases survival in prostate cancer, but tumors resistant to abiraterone can exhibit a hormonally resistant, aggressive phenotype. We hypothesized that the therapeutic pressure of abiraterone is resulting in more clinically aggressive disease at progression, characterized by increased visceral metastases. Our objective was to determine whether abiraterone increased the risk of development of visceral metastases at the time of progression compared with placebo in a randomized phase III trial. METHODS We performed a post hoc analysis of the COU-AA-302 trial of abiraterone plus prednisone vs placebo plus prednisone in patients with metastatic castration-resistant prostate cancer. The primary outcome was the development of visceral metastases. The cumulative incidences of visceral metastases were calculated by the Kaplan-Meier method and compared using log-rank testing. Multivariable Cox regression analysis assessed for the independent association of abiraterone with the development of visceral metastases. RESULTS Eighty-four of 1088 patients developed visceral metastases during study. Log-rank testing and Cox regression showed no difference in time to visceral metastases between groups (HR 1.01 [95% confidence interval (CI), 0.65-1.56]; P = .97). Abiraterone treatment was not associated with the development of visceral metastases in multivariable analysis (HR 0.89 [95% CI, 0.57-1.40]; P = .62). The study was limited by censoring of radiographic outcomes at the time of completion of primary study therapy; longer term risks were not assessed. CONCLUSIONS Abiraterone was not associated with increased risk of visceral metastatic disease at the time of progression compared with placebo.

A disease prevalence can be estimated by classifying subjects according to whether they have the disease. When gold-standard tests are too expensive to be applied to all subjects, partially validated data can be obtained by double-sampling in which all individuals are classified by a fallible classifier, and some of individuals are validated by the gold-standard classifier. However, it could happen in practice that such infallible classifier does not available. In this article, we consider two models in which both classifiers are fallible and propose four asymptotic test procedures for comparing disease prevalence in two groups. Corresponding sample size formulae and validated ratio given the total sample sizes are also derived and evaluated. Simulation results show that (i) Score test performs well and the corresponding sample size formula is also accurate in terms of the empirical power and size in two models; (ii) the Wald test based on the variance estimator with parameters estimated under the null hypothesis outperforms the others even under small sample sizes in Model II, and the sample size estimated by this test is also accurate; (iii) the estimated validated ratios based on all tests are accurate. The malarial data are used to illustrate the proposed methodologies.

Aluminum alloy shells are increasingly used in public buildings as a supporting structure for roofing enclosure construction in large spaces. In performance-based fire protection design, an empirical design criterion of 150 °C and relevant empirical formulas are used; however, the safety margin and prediction effect are not verified through full-scale experiments, and therefore, the effect of the roof system on the near-roof temperature field in practical engineering is yet to be investigated. In this study, a simulated fire experiment was conducted using a cylindrical aluminum alloy reticulated roof system model. The heat release rate of this restricted fuel fire source during the stable burning stage reached 8.1 MW. Fire Dynamics Simulator (FDS) was used to reproduce experimental results, and the numerical model of the shell member was simplified; further, existing empirical formulas of scholars such as Li were compared. The results indicated that although 150 °C is a large safety margin, it may limit architectural function. The simplified shell model provides an effect-equivalent approach for building thin-walled members in FDS. The shell is the main factor that delays the time required for the near-roof space to reach thermal equilibrium. The existing empirical formulas cannot be used for the studied roof system directly, and they may be improved through coefficient adjustment and other such methods.

Purpose Micro RNAs are key regulators of various biological processes including the pathogenesis of heart failure (HF). In this study we compared miRNA profiles of heart failure (HF), left ventricular assist devices (LVAD) and non-failing (NF) hearts patients. Our goal was to identify epigenetic mechanisms involved in HF and responses to LVAD therapy. Methods RNAs were isolated from myocardial tissues of HF patients without mechanical support at the time of transplant (n=6) and after LVAD (n=6) placement in non-ischemic dilated cardiomyopathy patients along with NF controls (n = 6). NanoString analysis was used to compare miRNA expression among in HF, LVAD, and control patients. NanoString miRNA raw count data were preprocessed and normalized using nSolver 4.0 Analysis Software. Ingenuity Pathway Analysis (IPA) was carried out on differentially expressed micro RNA to understand the biological pathways involved. Results Our sample population was 84% male with an average age of 57 and 82% Caucasian, 16% African American and 2% Asian. Forty four miRNAs were differentially expressed in HF patients than NF control and 79 miRNAs were differentially expressed in HF patients when compared to post-LVAD HF patients. IPA analysis revealed that heart enlargement was significantly altered in HF compared to NF control with p value of 2.58E-04. Three miRNA were upregulated (mir590-5p, mir146a-5p and mir-761-5p) and three were downregulated by more than two folds (mir-1, mir-23a-3p and mir497-5). Heart enlargement was also significantly different in pre vs post with p value of 2.57E-02. Five miRNAs were involved with four upregulated (mir-590-5p, mir146a-5p, mir-761 and mir 140-3p) while only one was downregulated (mir-497-5p). Conclusion End stage heart failure is characterized by cardiac remodeling, arrhythmias, fibrosis and a decline in myocyte contractility. Our results identify a large number of miRNAs that are associated with end stage heart failure and cardiac enlargement in addition to the miRNAs associated with remodeling on LVAD therapy. Micro RNA profiles can identify molecular mechanisms of disease and serve as potential biomarkers or therapeutic targets.

Light Detection and Ranging (LiDAR) waveforms are being increasingly used in many forest and urban applications, especially for ground feature classification. However, most studies relied on either discretizing waveforms to multiple returns or extracting shape metrics from waveforms. The direct use of the full waveform, which contains the most comprehensive and accurate information has been scarcely explored. We proposed to utilize the complete waveform to test its ability to differentiate between objects having distinct vertical structures using curve matching approaches. Two groups of curve matching approaches were developed by extending methods originally designed for pixel-based hyperspectral image classification and object-based high spatial image classification. The first group is based on measuring the curve similarity between an unknown waveform and a reference waveform, including curve root sum squared differential area (CRSSDA), curve angle mapper (CAM), and Kullback–Leibler (KL) divergence. The...

Severe hypogammaglobulinemia (HGG) (IgG 400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to400 mg/dL are not well described.Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection.A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9%), liver-small bowel-kidney (8.7%), and small bowel only (17.4%). The 3-year survival after the diagnosis of HGG was 50.2% (95% confidence interval [CI] = 28.2%-68.7%). There was no difference in survival (P = .67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG 400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P = .58), frequency (P = .11), and number of IgG doses administered (P = .8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P = .10).Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.

Background The clinical experience with colistin therapy for multidrug-resistant Gram-negative pathogens in solid organ transplantation is limited. Methods Patients transplanted from January 2003 to July 2011 and treated with intravenous or nebulized colistin were included. Descriptive statistics were used to summarize patients' characteristics and Kaplan-Meier curves for survival analysis. Results Fifteen patients were included: 10 adults (median age, 54.6 y; range, 32.2–79.6 y) and 5 children (median age, 3.3 y; range, 1.1–10.4 y). Eight patients had intra-abdominal infections, 3 had pneumonia, and 4 had bacteremia. The infections were diagnosed at a median of 5.9 months (range, 0.8–49.8 mo) after transplantation. Eight patients had coinfections, mainly with enteric pathogens. Pseudomonas aeruginosa was isolated in 13 cases and ESBL Klebsiella oxytoca and ESBL Escherichia coli were isolated in 1 case each. Thirteen patients received concomitant antibiotics with colistin. The median dose of intravenous colistin (13 patients) was 2.7 mg/kg/d (range, 1–4.9 mg/kg/d) and nebulized colistin (2 patients) was 241.7 mg/d (range, 150–333.3 mg/d). Clinical cure was achieved in 9 patients (60%). Four-week survival rate after infection was 86.7% (95% confidence interval, 56.4%–96.5%). There was no difference in the median creatinine clearance in adults ( P = .38) or children ( P = .88) before and after colistin. One patient had both neurotoxicity and nephrotoxicity, and 1 patient had neurotoxicity only. Conclusions Colistin might be used as an alternate therapy for transplant patients with multidrug-resistant Gram-negative pathogens.

In this work, CdTe(0 0 1) and CdTe(1 1 1) single-crystal films were successfully grown on GaAs(0 0 1) substrates by molecular beam epitaxy. By changing the nucleation temperature, CdTe(0 0 1) and (1 1 1) films could be controllably grown on the GaAs(0 0 1) substrates. The CdTe(0 0 1) and (1 1 1) films were grown via low-temperature nucleation followed by high-temperature growth. To optimize the quality of CdTe(0 0 1) films, a CdTe/ZnTe superlattice was used to reduce the lattice mismatch, and the CdTe(0 0 1) film was grown under a cadmium-rich atmosphere. The average surface roughness of the CdTe(1 1 1) and CdTe(0 0 1) films produced was approximately 0.76 nm and 1.37 nm, respectively. The epitaxial relationship between the CdTe(1 1 1) film and the GaAs(0 0 1) substrate was studied based on X-ray diffraction pole figures. The crystal quality of the CdTe(1 1 1) film was also characterized by X-ray diffraction and etch pit density. Finally, photoluminescence spectroscopy was used to investigate the crystal quality of CdTe(0 0 1) and (1 1 1). When the CdTe(0 0 1) film was grown under a cadmium atmosphere and using ZnTe as a buffer layer, the X-ray diffraction peak around 1.56 eV disappeared; this can be related to cadmium vacancies.