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Background Stressful life events (SLEs) are an important causal factor in depression; however, the mechanism by which SLEs cause depression remains unclear. Recent studies suggested that white matter (WM) microstructures might be a potential mediator between SLEs and depression. Hence, we aimed to investigate the concrete correspondence among them using mediation effect models. Methods In participants (N = 194) with SLEs experience prospectively recruited from six residential communities, WM microstructures were detected with diffusion tensor imaging. The interrelationship among SLEs, WM microstructures, and depression was explored with multiple linear regression models and logistic regression models. Furthermore, the influence of WM microstructures on the association between SLEs and depression was tested with mediation effect models. Results Successfully established mediation effect models showed the specific influence of fractional anisotropy of the corpus callosum and left uncinate fasciculus on the association between SLEs and depression onset (ab path = 0.032; ab path = 0.026, respectively) and between SLEs and depressive severity (ab path = 0.052; ab path = 0.067, respectively). In addition, significant total mediation effects on the association between SLEs and depression onset (ab path = 0.031) and severity (ab path = 0.075) through fractional anisotropy of the corpus callosum and left uncinate fasciculus were noted. Conclusions WM microstructure alterations impose a substantial mediation effect on the association between SLEs and depression, which suggest that changes in WM microstructure integrity might increase the risk of depression onset and unfavorable disease courses induced by the SLEs.

There is no clear evidence for the best time of day for physical activity in benefitting health among individuals with type 2 diabetes. This study was aimed to examine whether there is an optimal time of day for physical activity to increase longevity. In this cohort study of 904 patients with type 2 diabetes, we fitted a Cox model with restricted cubic spline to examine the association of moderate-to-vigorous physical activity (MVPA) and time of day with all-cause mortality. Compositional data analysis was used to examine the association of time spent in sedentary behaviour (SB), light-intensity physical activity (LIPA), morning MVPA, and evening MVPA with all-cause mortality. MVPA was inversely associated with all-cause mortality in a curvilinear manner (P-value for nonlinearity

BACKGROUND Sleep problems are common among nurses compared with the general population. Poor sleep quality increases the risk of developing cardiovascular disease (CVD). The relationship between sleep quality and CVD risk has not been previously investigated among Hong Kong female nurses. OBJECTIVE The authors of this study explored the association between sleep quality and CVD risk among Hong Kong female nurses. METHODS Data were collected from the Hong Kong Women's Health Study cross-sectional survey between 2019 and 2020. Questionnaires were sent to female nurses (≥aged 30 years). Ten-year CVD risk was measured using the Framingham 10-year risk score, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Relationships were evaluated using adjusted multiple linear regression and binary logistic regression. RESULTS In 1344 respondents, the mean age was 46.12 ± 10.47 years, average PSQI score was 6.02 (3.35), and 52.4% reported poor sleeping quality (global PSQI score > 5). The mean 10-year CVD risk was 3.6% (3.3%). The 10-year CVD risk was significantly associated with sleep disturbance (β = 0.006) and daytime dysfunction (β = -0.002) (both Ps < .01). Participants who reported sleep disturbance had a higher CVD risk (odds ratio, 1.82; 95% confidence interval, 1.04-3.18). High daytime dysfunction decreased CVD risk (odds ratio, 0.63; 95% confidence interval, 0.46-0.85). Subgroup analysis showed stronger associations between sleep quality and Framingham 10-year risk score among those unemployed, undergoing postmenopause, or with a family history of CVDs. CONCLUSIONS Sleep disturbance and daytime dysfunction were associated with the 10-year CVD risk among Hong Kong female nurses. Nurses who were unemployed, were undergoing postmenopause, or with a family history of CVD were those with the highest risk.

Background Patients are susceptible to immunosuppression in late-stage of sepsis, in which myeloid-derived suppressor cells (MDSCs) is an important contributor. This study aims to investigate whether all-trans-retinoic acid (ATRA), which has been proved to inhibit MDSCs generation in cancer, will ameliorate sepsis-induced immuno-suppression through modulating MDSCs. Methods A clinically relevant “two-hit’’ model of sepsis, the cecal ligation and puncture (CLP) model and secondary pneumonia model, were established in mice. The effects of ATRA on the mortality, the bacterial burden, the expansion and activity of CLP-induced MDSCs, as well as the function of CD4+ T cells were evaluated. Results In CLP model, ATRA was found to reduce frequency of MDSCs in spleen of mice and inhibit activity of MDSCs by regulating the generation and activity of arginase-1 and iNOS, and the secretion of immune-supressive cytokines. ATRA administration eventually reduced mortality of secondary infection by Legionella pneumophila in CLP-surviving mice, which might be associated with the restoration of CD4+ T cells proliferating and secreting activity. Conclusion ATRA can restore CD4+ T cells dysfunction in sepsis by modulating the expansion and function of MDSCs and therefore provides a potential therapy that targets the immunosuppressive state of sepsis.

Background This study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals. Methods Twenty patients treated by the abovementioned modified technique (modified technique group) and ten patients treated by the traditional percutaneous K-wire fixation technique (traditional technique group) from October 2015 to November 2019 at our institution were retrospectively reviewed. The patients’ average age was 38 years (range, 16–61 years). The mean follow-up period was 13 months (range, 10–18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared between the modified and traditional technique groups. In addition, the functional recovery of the injured hand was compared with that of the uninjured hand within the modified technique group. Results All patients recovered well, with no cases of infection or nonunion. Compared with the traditional technique group, the modified technique group had a shorter operative time, lower postoperative visual analogue scale pain score, better effective range of motion score of the first carpometacarpal joint (Kapandji score), and had almost no need for auxiliary plaster fixation, enabling functional exercise to be started earlier. Within the modified technique group, the mean hand grip strength, pinch strength, and Kapandji score on the injured side did not significantly differ to the values on the uninjured side in both the extra-articular and intra-articular fracture subgroups. While the abduction and flexion–extension arcs of the thumb on the injured hand were significantly smaller than those on the uninjured hand in both the extra-articular and intra-articular fracture subgroups, the patients felt clinically well with respect to daily activities and strength. Conclusion The percutaneous parallel K-wire and interlocking fixation technique is simple, effective, and economical for first metacarpal base fractures.

The signal processing of industrial big data (IBD) is a challenging task, owing to the complex working scenarios and the lack of annotations. Defect detection, which is an important subject of IBD research works, has shown its effectiveness in digital signal processing of industrial inspection applications in many previous studies. This article proposes a novel defect detection method based on deep learning for digital signal processing of industrial inspection applications. In our method, a module named feature collection and compression network is applied to merge multiscale feature information. Then, a new pooling method named Gaussian weighted pooling, which provides more precise location information, is used to replace region of interest (ROI) pooling. Experiment results show that our method gets improvements in both accuracy and efficiency, with mAP/ $\text{AP}_{50}$ of 41.8/80.2 at 33 fps on NEU-DET, which satisfies the requirement of real-time systems.

Aim: We performed an updated meta-analysis to evaluate the efficacy and safety of lenvatinib in cancer patients. Materials & methods: Databases were searched to identify relevant trials. Data were extracted to evaluate overall survival, progression-free survival, overall response rate and grade ≥3 adverse events. Results: The pooled analysis demonstrated that lenvatinib significantly improved progression-free survival (hazard ratio: 0.43; 95% CI: 0.23–0.80; p = 0.008), overall survival (hazard ratio: 0.85; 95% CI: 0.75–0.97; p = 0.013) and overall response rate (relative risk: 6.89; 95% CI: 2.22–21.36; p = 0.001) compared with control therapy. However, the use of lenvatinib can increase the risk of severe infection. Conclusion: Lenvatinib-containing regimens are associated with better progression-free survival, overall survival and overall response rate, but can induce severe infection.

Objective: The purpose of this study was to investigate whether routine blood tests on admission and clinical characteristics can predict prognosis in patients with traumatic brain injury (TBI) combined with extracranial trauma. Methods: Clinical data of 182 patients with TBI combined with extracranial trauma from April 2018 to December 2019 were retrospectively collected and analyzed. Based on GOSE score one month after discharge, the patients were divided into a favorable group (GOSE 1-4) and unfavorable group (GOSE 5-8). Routine blood tests on admission and clinical characteristics were recorded. Results: Overall, there were 48 (26.4%) patients with unfavorable outcome and 134 (73.6%) patients with favorable outcome. Based on multivariate analysis, independent risk factors associated with unfavorable outcome were age (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.018-1.124; p

Based on a newly proposed planar Yagi antenna with magnetic and electric dipoles, a compact $1\times 4$ broadband dual-polarized (DP) array with endfire radiation is designed in this paper. The magnetic Yagi antenna operates on the vertical polarization while the electric one operates on the horizontal one. The compact configuration of $0.5\,\,\lambda _{0}\times 0.63\,\,\lambda _{0}\times 0.09\,\,\lambda _{0}$ benefits from the novel half-mode magnetic Yagi antenna and the arrangement with the electric Yagi antenna. The broadband characteristic comes from the directors of the magnetic and electric Yagi antennas and the reflector of magnetic Yagi antenna. The simulation and the measurement verify this design. The measured common bandwidth of $\vert S_{11}\vert < -10$ dB for both polarization ports is 23.8–30.1 GHz (23.7%), and the gains vary between 3 dBi and 4 dBi within 24.2–30 GHz band range. The $1\times 4$ DP array with $0.5~\lambda _{0}$ element space has the beam scanning range of ±43 ° at the endfire direction and the gain of higher than 7.1 dBi. The scanning performances are experimentally validated by two phase-shift feed networks for 0 ° and 30 ° main beam directions. The proposed endfire DP array has the good features of compact structure, a low profile and no clearance requirement, which is easy to integrate in 5G terminals.

Objective: This paper measures whether there is any difference between the non-invasive monitoring technology that shows the change in ICP value and the current "gold standard" intraventricular probe-type intracranial pressure monitoring technology. Methods: 61 critically ill patients with traumatic brain injury requiring invasive ICP monitoring in the intensive care unit of our hospital from April 2017 to September 2017 were selected. The study subjects were selected in strict accordance with the inclusion and exclusion criteria of experimental design. Each patient recorded the ICP values before and after intravenous drip of 20% mannitol 125 ml, and received ultrasound measurements at bedside by two different physicians before, after, 10 minutes, and 30 minutes after ICP changes. Results: The consistency of the ONSD values measured by different doctors at the same time was the same, and the repeatability of the bedside ultrasound measurement of the ONSD values was better. There was no significant difference between the ONSD value measured immediately after the ICP drop and the ONSD value before the ICP drop. There was a significant difference between the ONSD value measured 10 minutes after the ICP drop and the ONSD value before the ICP drop. However, there was no significant difference in the value of ONSD measured between 10 minutes and 30 minutes after the ICP decreased. Conclusion: ONSD reflects that the lag time window of ICP changes is within 10 minutes, but the measured values of ONSD within the 20-minute period from 10 minutes to 30 minutes after ICP changes can better reflect the current ICP values.

Despite known benefits, the timing of and method used for umbilical cord clamping (UCC) in neonates remain controversial in China, as well as internationally. The objective of this study was to assess knowledge, attitudes, and practice of UCC amongst health care providers in China, as recommended by medical professional organizations.A web-based questionnaire on cord clamping practices was administered to midwives, obstetricians, and neonatologists in 126 hospitals from 16 provinces. The provinces were selected from seven different regions of China.A total of 5,005 (60.5% of eligible respondents) health care providers returned completed questionnaires. The awareness rates for immediate cord clamping (ICC) and delayed cord clamping (DCC) were over 85%, but the implementation rate for DCC was relatively low (ICC 58.3% vs. DCC 41.6%). Most neonates were placed below the introitus (92.8%) during cord clamping and this correlated with the route of delivery. The choice of UCC was impelled by different factors. Benefits for neonates influenced the choice of ICC (50%) and promoting a larger blood volume to stabilize systemic circulation influenced the choice of DCC (92.3%). Majority (91.5%) of respondents acquiesced that it was necessary to develop national clinical guidelines for UCC.The majority of obstetricians, neonatologists, and midwives who participated in this study had a positive perception of DCC. However, this did not translate to daily practice. The practice of UCC is variable and there are no standard guidelines.· The first large-scale epidemiological investigation of umbilical cord ligation is in China.. · The survey included three commonly used umbilical cord clamping methods.. · The respondents included neonatologists..

Hemorrhagic transformation (HT) is a common complication after thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in ischemic stroke. In this article, recent research progress of HT in vivo and in vitro studies was reviewed. We have discussed new potential mechanisms and possible experimental models of HT development, as well as possible biomarkers and treatment methods. Meanwhile, we compared and analyzed rodent models, large animal models and in vitro BBB models of HT, and the limitations of these models were discussed. The molecular mechanism of HT was investigated in terms of BBB disruption, rt-PA neurotoxicity and the effect of neuroinflammation, matrix metalloproteinases, reactive oxygen species. The clinical features to predict HT were represented including blood biomarkers and clinical factors. Recent progress in neuroprotective strategies to improve HT after stroke treated with rt-PA is outlined. Further efforts need to be made to reduce the risk of HT after rt-PA therapy and improve the clinical prognosis of patients with ischemic stroke.

Software system evolution is an active and important research topic in software engineering. In guiding software system evolution, software architecture plays a critical role. In the traditional software architecture, only the link information of components is considered, while the place information of components is usually neglected. However, due to the emerging mobile computing, pervasive computing, and intelligent computing, the place information is as important as the link information in the software architecture. Especially in mobile computing environments, the place changes often lead to changes in software configuration and functionality. In this paper, we study the Bigraph specification of software architecture and use it to describe both link and place information in detail. Based on Bigraph specification, we investigate the structural characteristics in the software architecture, and design checking algorithms for the component’s link exceptions and place exceptions. Furthermore, we address the well-evolved software architecture from a new perspective, which includes three basic evolution operation rules and their well-evolved conditions. We discuss the overall software architecture evolution through strong and weak bi-simulation in terms of software functionality. Finally, two case studies about software system in the evolution operation are presented, which illustrate the effectiveness of our approach.

The aldo‐keto reductases family 1 member C2 (AKR1C2) has critical roles in the tumorigenesis and progression of malignant tumours. However, it was also discovered to have ambiguous functions in multiple cancers and till present, its clinical significance and molecular mechanism in oesophageal squamous cell carcinoma (ESCC) has been unclear. The aim of this study was to explore the role of AKR1C2 in the tumorigenesis of ESCC. Here, we showed that AKR1C2 expression was found to be up‐regulated in ESCC tissues and was significantly associated with pathological stage, lymph node metastasis and worse outcomes. Functional assays demonstrated that an ectopic expression of AKR1C2 in ESCC cells resulted in increased proliferation, migration and cisplatin resistance, while knockdown led to inversing effects. Bioinformation analyses and mechanistic studies demonstrated that AKR1C2 activated the PI3K/AKT signalling pathway, furthermore, the inhibitor of PI3K or the selective inhibitor of AKR1C2 enzyme activity could reverse the aggressiveness and showed synergistic antitumour effect when combined with cisplatin, both in vitro and in vivo. In conclusion, Our findings revealed that AKR1C2 could function as an oncogene by activating the PI3K/AKT pathway, as a novel prognostic biomarker and/or as a potential therapeutic target to ESCC.

The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) is higher than that of HF with reduced/midrange ejection fraction (HFrEF/HFmrEF). However, no evidence-based guidelines for managing HFpEF have been generated. The current body of knowledge indicates that fibrosis and inflammation are important components of the cardiac remodeling process in HFpEF. In addition, macrophages potentially play an important role in pro-inflammatory and profibrotic processes in HFpEF patients, whereas HFpEF comorbidities could be a driving force for systemic microvascular inflammation and endothelial dysfunction. Under such circumstances, macrophages reportedly contribute to inflammation and fibrosis through 3 phases namely, inflammation, repair, and resolution. Signal transduction pathway-targeted therapies using animal experiments have generated important discoveries and breakthroughs for understanding the underlying mechanisms of HFpEF. However, only a handful of studies have reported promising results using human trials. Further investigations are therefore needed to elucidate the exact mechanisms underlying HFpEF and immune-pathogenesis of cardiac fibrosis.

Sepsis-associated encephalopathy (SAE) often leads to cognitive impairments in the rest life of septic survivors. The potential pathological changes of SAE are complicated and have not been fully understood. Morin, a flavone compound exhibiting neuroprotective activity and anti-inflammation effect, was employed to treat with CLP-induced septic mice in our study. The data from a novel object recognition test and tail suspension test indicated that morin treatment reversed cognitive dysfunction and relieved depressive-like behaviors in septic mice. Morin down-regulated the expressions of IL-6, MCP-1, TNF-α and IL-10 in serum and diminished microglia activation in septic mice. Additionally, Western blot results showed that morin reduced the phosphokinase GSK3β activity and elevated the phosphatase PP2A activity, which led to lower tau phosphorylation. Morin reduced Aβ deposition and protected the synapse integrity, which might be the possible mechanism of protecting cognitive functions in septic mice. In conclusion, we identified that morin exerted anti-inflammation and anti-neurodegeneration effects in septic mice, and prevented further cognitive impairments.

Our aims were to compare the therapeutic efficacy of surgical resection of caudate lobe hepatocellular carcinoma and noncaudal lobe hepatocellular carcinoma in the Chinese population. The study group consisted of 220 patients undergoing caudate lobe hepatectomy during the period spanning from January 2003 to November 2017, and 220 patients with caudate lobe hepatectomy were selected as the control group. There were 142 cases (64.5%) of surgical margin of R0 in patients with caudate lobe liver cancer, and 178 cases (80.9%) of surgical margins in patients with noncaudal lobe liver cancer, and the difference was statistically significant (P0.01) between the 2 groups. Compared with noncaudal lobe liver cancer patients, caudate lobe liver cancer patients had significantly longer operation time (186.65±81.36 vs. 118.85±69.23, P0.01), longer vessel block time (29.93±11.96 vs. 22.76±10.74, P0.01), more intraoperative blood loss (709.73±108.39 vs. 329.74±85.76, P0.01), and there was no significant difference in the incidence of complications (53.4% vs. 46.6%, P0.05). Significantly different therapeutic efficacy was found between the caudate lobe hepatocellular carcinoma group and the noncaudal lobe hepatocellular carcinoma group, which may be due to the lack of resection margin of caudate-leaf liver cancer surgery and more intraoperative bleeding.

The output/input circuit is a core component in all high-power millimeter-wave (MMW) radiation sources, and its performance specifications and reliability directly impact upon the performance of the radiation source device. Central to achieving high power is the development of efficient mode converters. Here, we report on the development of a compact Ka -band circular TM01 to rectangular TE10 mode converter. The present mode converter adopts an all-metal waveguide structure and facilitates notable improvement in the system power capacity and is capable of realizing high-power propagation. The mode converter realizes effective mode conversion between high-order and fundamental modes, as well as allowing longitudinal and transverse transmission. Our simulation and empirical findings have shown mode purity ≥99.5% in the frequency range of 32.7–34.6 GHz, and the mode conversion efficiency is more than 96% at a center frequency of 32.9 GHz with a return loss ${S}_{{11}}$ of −19.3 dB. The bandwidth of the converter is 2.4 GHz with transmission coefficient ${S}_{{21}}\ge -{1}$ dB.

To develop miniaturized and compact vacuum electron devices, new approaches to device manufacturing must be embraced. Here, a terahertz oscillator based on carbon nanotube (CNT) cold cathode is investigated through particle-in-cell (PIC) simulations. The studies show that the high-frequency (HF) field excited by the device can modulate the field emission current efficiently, with an output power of 4.6 W at 139.4 GHz obtained at an operating voltage of 2.9 kV and an initial emission current and current density of 15.8 mA and 7.65 A/cm 2 , respectively, and the efficiency is 10.0%.

The controlled actuation of liquid metal (LM) droplets has recently shown great potential in developing smart actuating systems for applications in robotics. However, there is a lack of a simple approach for the precise manipulation of multiple LM droplets in a 2D plane, which hinders the development of complex control over droplets for realizing useful robotic applications. To overcome this challenge, here, a versatile and powerful light-induced manipulation of LM droplets is presented. The key principle is to selectively activate phototransistors in an electrolyte using infrared laser beams to electrically control LM droplets via Marangoni forces. This approach shows the ability of inducing concurrent motion, splitting, and merging of multiple LM droplets simply using light without complex and bulky systems. Parameters affecting the manipulation of LM droplets are thoroughly investigated. Moreover, a vehicle carrier driven by wheels composed of multiple LM droplets for making a light-controlled relay is demonstrated. We believe such a light-induced control method for manipulating LM droplets has the potential for advancing the development of future field-programmable robotics and droplet-based soft collaborative robots.

Background Malunion or nonunion of vertically displaced pelvic fractures resulting in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery of the old pelvis. We present a new surgical technique of sacral osteotomy combined with lumbopelvic distraction osteosynthesis (LPDO) in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results.Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and LPDO from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral pelvis was 3.0-4.5 cm (average, 3.80 cm). According to the AO/OTA classification at initial pelvic fracture, eight cases were type C1.3 and one case were type C3.3. Sacral osteotomy and LPDO were used in all nine patients. The degree of unilateral pelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. The Majeed score and pain visual analog scale (VAS) score were used to assess the therapeutic effect of the patients during follow-up.Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7-3.9 cm (average, 3.20 cm). All the patients were followed up for 6 to 36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30-84 points) preoperatively to 87.0 points (72-94 points), and the VAS score for pain decreased from an average of 6.0 points (4-8 points) preoperatively to 1.2 points (0-3 points). None of the patients had complications, such as infection, implant broken, screw loosening, iatrogenic nerve, or blood vessel injury. Conclusion Sacral osteotomy combined with LPDO for the treatment of pelvic malunion or nonunion caused by sacral fracture can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, leading to good clinical results.

Purpose: To evaluate the long-term retinal microvascular, neural, and choroidal changes in the patients with severe nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) following panretinal photocoagulation (PRP).Methods: Forty-five eyes of 28 patients with treatment-naive severe NPDR and PDR were included and followed for 12 months after PRP. Microvascular and neural changes in the macular and peripapillary areas were assessed by using optical coherence tomography angiography. Subfoveal choroidal thickness (SFCT) was measured by using optical coherence tomography. A Linear mixed-effects model was used to highlight the differences for the variables after adjusting for sex, age, and axial length.Results: Compared to baseline, there were no statistical differences in the best corrected visual acuity (BCVA), macular and peripapillary vessel density (VD), and SFCT following PRP. Macular thickness significantly increased at 1 and 3–6 months after PRP (p < 0.05), while the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness significantly increased at 1 month postoperatively (p < 0.01). Global loss volume and focal loss volume significantly decreased at the same time point (p < 0.05).Conclusion: The unchanged BCVA, VD, the thickness of RNFL and GCC, and SFCT during the 12-month follow-up period suggest that PRP may prevent the retinal neurovascular and choroidal damage.

Pseudospark (PS) sourced beams have unique features of high-current density and self-focusing by the ion channel. This paper presents the characteristics of the PS-sourced beam from PIC simulations, as well as the potential of the PS-sourced beam for driving a THz extended interaction oscillator (EIO) operating at 350 GHz.

Pseudospark (PS) discharge is a low-pressure gas discharge characterized by a rapid breakdown phase with the generation of a high current density electron beam, which is over 100 times higher than a thermionic cathode. The PS-sourced beam can also transport a long distance without the need for an external guiding magnetic field. Such features are attractive as beam sources in terahertz wave generation. At high frequency, the conventional vacuum electron devices suffer a quick drop in the power level due to the small cross-section of the beam tunnel and the limit of current density from a thermionic cathode.

Purpose The purpose of this study was to determine the effects of polymethylmetnacrylate (PMMA) spacer loaded with different concentrations of vancomycin on the proliferative, osteogenic, and angiogenic capacity of the induced membrane. Methods Varying concentrations of vancomycin (0, 1, 2, 4, 6, 8, and 10 g) were fully mixed with bone cement powder (40 g), resulting in seven experimental groups. Hollow cylindrical PMMA spacers (10-mm height, 3-mm external diameter, and 0.8-mm internal diameter) were formed by a mold and submerged in phosphate-buffered saline for antibiotic release by spectrophotometry. Eighty-four New Zealand white rabbits were evenly randomized into seven groups, and segmental radius shaft defects (10-mm) were created. Defects were filled with cylindrical PMMA spacers containing different vancomycin concentrations, and subsequently underwent intramedullary fixation with a retrograde Kirschner's wire. Tissue toxicity was assessed and the proliferative, osteogenic, and angiogenic capacity of induced membranes were qualitatively analyzed by immunohistochemistry and real-time PCR. Results No obvious toxicity was observed in the animal model. Alizarin red s staining and qualitative detection of type I collagen, CD31, Ki67, and STRO-1 by immunohistochemistry revealed an obvious decrease in the percentage of positively stained cells and in osteogenic capacity when the concentration of vancomycin was more than 6 g per cement dose. Quantitation of gene expression related to osteogenesis (Col1a, Alp, and Runx2), vascularization (Vegf, Tgfb1, and vWF), and proliferation (Oct4 and Stro-1) by real-time PCR revealed slight increases in the expression of selected genes at low vancomycin concentrations (1–4 g per cement dose), and relatively lower gene expression when the concentration of vancomycin was more than 6 g per cement dose. Conclusion PMMA spacers loaded with relatively low concentrations of vancomycin (1–4 g per cement dose) did not interfere with the proliferative, osteogenic, and angiogenic capacity of induced membranes, and even promoted their capacity. In contrast, spacers loaded with relatively high concentrations of vancomycin (6–10 g per cement dose) had negative effects on osteoblast viability, angiogenesis, and proliferation.

Driving behavior classification is highly correlated with vehicle accidents and injury. Automatically recognizing different driving behaviors is important for improving road safety. This article proposes a maneuver-based driving behavior classification system. For each driving maneuver, we first generate driving behavior events based on its given timestamp using three different strategies. Then, 19 temporal features of each behavior event are calculated using signals captured by accelerometers, gyroscopes, and GPS. Next, reliefF is incorporated for selecting features. Finally, random forest is used for classifying maneuver-based driving behaviors. Experimental results using the UAH-DirveSet show that our proposed system can achieve an averaged F1-score of 70.47% using leave-one-driver-out validation. For different maneuvers, we find that the highest F1-score is obtained for braking which is 75.38%.

Background Flail chest (FC) is known to account for high mortality and morbidity and is typically treated with conservative care. Operative fixation of FC has been advocated as an alternative treatment choice. This prospective randomized controlled trial aims to compare surgical and nonsurgical management of FC in patients with severe polytrauma. Methods Severe polytrauma patients with FC admitted between January 2015 and July 2017 to our trauma center were investigated. The enrolled patients were randomly assigned to the surgical or nonsurgical group. Basic characteristics of injury and clinical outcomes were compared. Results Fifty patients entered final analysis, with 25 patients in each group. Operative rib fixation was associated with shorter duration of mechanical ventilation (7 d [interquartile range {IQR} 6-10] versus 9 d [IQR 7-12], P = 0.012), shorter ICU stay (10 d [IQR 7-12] versus 12 d [IQR 9-15], P = 0.032), lower risk of adult respiratory distress syndrome (28% versus 60%, P = 0.045), pneumonia (48% versus 80%, P = 0.038), and thoracic deformity (8% versus 36%, P = 0.037) and less pain while coughing (pain score 6 [IQR 3-8] versus 8 [IQR 4-9], P = 0.029) and deep breathing (pain score 5 [IQR 3-9] versus 7 [IQR 3-9], P = 0.038). Subgroup analysis was conducted by presence of pulmonary contusion. Shorter time on the ventilator use and ICU stay associated with rib surgery was not observed in patients with pulmonary contusion. Conclusions This study reveals that surgical rib fixation may provide some critical care benefits for severe polytrauma patients with FC, including less medical resource use and lower risk of complications. Further studies should be designed to optimally identify patients who are most likely to benefit from this surgery.

Machine learning has increasingly been applied to classification of schizophrenia in neuroimaging research. However, direct replication studies and studies seeking to investigate generalizability are scarce. To address these issues, we assessed within‐site and between‐site generalizability of a machine learning classification framework which achieved excellent performance in a previous study using two independent resting‐state functional magnetic resonance imaging data sets collected from different sites and scanners. We established within‐site generalizability of the classification framework in the main data set using cross‐validation. Then, we trained a model in the main data set and investigated between‐site generalization in the validated data set using external validation. Finally, recognizing the poor between‐site generalization performance, we updated the unsupervised algorithm to investigate if transfer learning using additional unlabeled data were able to improve between‐site classification performance. Cross‐validation showed that the published classification procedure achieved an accuracy of 0.73 using majority voting across all selected components. External validation found a classification accuracy of 0.55 (not significant) and 0.70 (significant) using the direct and transfer learning procedures, respectively. The failure of direct generalization from one site to another demonstrates the limitation of within‐site cross‐validation and points toward the need to incorporate efforts to facilitate application of machine learning across multiple data sets. The improvement in performance with transfer learning highlights the importance of taking into account the properties of data when constructing predictive models across samples and sites. Our findings suggest that machine learning classification result based on a single study should be interpreted cautiously.

We performed a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of HER2-targeted agents in combination with taxanes and to identify the best strategy for HER2+ metastatic breast cancer (MBC). Pubmed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials that evaluated any taxanes+HER2-targeted agents in the treatment of HER2+ MBC. The primary outcome was overall survival (OS). The secondary outcomes included overall response rate (ORR) and progression-free survival (PFS). A total of 13 RCTs were eligible, involving 4941 patients and 10 regimens. The result showed that single-HER2-targeted agent+a taxane did improve the effect on ORR and PFS than taxane alone, but only trastuzumab+a taxane had a significant improvement in OS outcomes. Single-HER2-targeted agent (trastuzumab) combined with taxane-based doublets (taxane+carboplatin/capecitabine/doxorubicin/bevacizumab) showed no further benefit than trastuzumab+a taxane. Doublet-HER2-targeted agents combined with a taxane(trastuzumab+pertuzumab+a taxane) showed further improvement in ORR, PFS, and all OS outcomes than single-HER2-targeted agent+a taxane. Ranking analysis based on their P-scores suggested that trastuzumab+pertuzumab+a taxane was the best combination treatment for all the efficacy outcomes. These findings demonstrate that combining two HER2-targeted agents (trastuzumab+pertuzumab) with a taxane is much more beneficial for the treatment of HER2+ MBC. Dual HER2-targeted agents combined with a taxane appears to be the preferred application of HER2+ MBC.

The aim of this article is to investigate the related factors affecting the recurrence of microvascular decompression (MVD) after trigeminal neuralgia. We selected 400 cases of patients who met the diagnostic criteria of primary trigeminal neuralgia. The recurrence rate of patients and their statistical data related factors such as age, gender, disease duration, pain branches, vascular compression, patients, and complications (urban and rural), were collected. Of the 400 cases, 36 had recurrence after 2 years. In female group, the recurrence rate was (9.4%) higher than the recurrence rate in male group (8%); no recurrence rate of vascular compression group (40%) was higher than that of vascular compression group recurrence rate (8.6%); the recurrence rate of each branch in pain group from high to low was V2–3 (13.4%), V2 (12.5%), V1 (9.1%), V3 (7.5%), V1–2-3 (4.4%), V1–2 (4.3%), V1–3 (0%); and the difference was statistically significant (p

Acoustic scene classification has gained great interests in recent years due to its diverse applications. Various acoustic and visual features have been proposed and evaluated. However, few studies have investigated acoustic and visual feature aggregation for acoustic scene classification. In this paper, we investigated various feature sets based on the fusion of acoustic and visual features. Specifically, acoustic features are directly extracted from the waveform: spectral centroid, spectral entropy, spectral flux, spectral roll-off, short-time energy, zero-crossing rate, and Mel-frequency Cepstral coefficients. For visual features, we calculate local binary pattern, histogram of gradients, and moments based on the audio scene time-frequency representation. Then, three feature selection algorithms are applied to various feature sets to reduce feature dimensionality: correlation-based feature selection, principal component analysis, and ReliefF. Experimental results show that our proposed system was able to achieve an accuracy improvement of 15.43% compared to the baseline system with the development set. When all development sets are used for training, the performance based on the evaluation set provided by the TUT Acoustic scene 2016 challenge is 87.44%, which is the fourth best among all non-neural network systems.

Automated classification of calling bird species is useful for large-scale temporal and spatial environmental monitoring. In this paper, we investigate acoustic features, visual features, and deep learning for bird sound classification. For the deep learning approach, the Convolutional Neural Network layers are used for learning generalized features and dimension reduction, while a conventional fully connected layer is used for classification. Then, an unified end-to-end model is built by combing those three layers for classifying calling bird species. For visual and acoustic features, two traditional classifiers are compared to classify the bird sounds. Experimental results on 14 bird species indicate that our proposed deep learning method can achieve the best F1-score 94.36%, which is higher than using the acoustic features approach (88.97%) and using the visual features approach (88.87%). To further improve the classification performance, a class-based late fusion method is explored. Our final best classification F1-score is 95.95%, which is obtained by the late fusion of the acoustic features approach, the visual features approach, and deep learning.

Polycystic ovary syndrome (PCOS) is widely accepted as the most common endocrine abnormality in women of childbearing age and may be accompanied by dyslipidemia, hyperandrogenism, hyperinsulinemia, oxidative stress and infertility. Dyslipidemia is now known to play an important role in the development of PCOS. Lipid abnormalities, including elevated low-density lipoprotein and triglyceride levels and reduced high-density lipoprotein levels, are often found in women with PCOS and play an important role in PCOS; therefore, we summarize the effect of lipid abnormalities on hyperandrogenism, insulin resistance, oxidative stress and infertility in PCOS and review the effects of common lipid-lowering drugs on patients with PCOS. The purpose of this article is to elucidate the mechanisms of lipid metabolism abnormalities in the development of PCOS. Keywords: Polycystic ovary syndrome, Lipid, Hyperandrogenism, Insulin resistance, Lipid-lowering drugs

The second-generation EGFR-TKI Afatinib is an irreversible ErbB family blocker used to treat patients with non-small-cell lung cancer (NSCLC). Unfortunately, resistance to this drug develops over time, and patients are always under great psychological pressure. A previous study showed that chronic stress hormones participate in EGFR-TKI resistance via β2 -AR signaling via an IL-6 dependent mechanism. Our study further explores a novel potential underlying mechanism. In the present study, we show that the stress hormone norepinephrine (NE) promotes Afatinib resistance by upregulating Cx32 expression. Furthermore, we, for the first time, find that Cx32 is a target gene for transcription factor CREB and NE enhances Cx32 mRNA expression by activation of CREB. We also demonstrate that Cx32 promotes Afatinib resistance by decreasing the degradation of EGFR-TKI resistance-associated proteins (MET, IGF-1R) and by increasing their transcription levels. Together, these results reveal that the stress hormone NE accelerates Afatinib resistance by increasing the expression of Cx32, which augments MET and IGF-1R levels in cancer cells and provides a promising therapeutic strategy against EGFR-TKI Afatinib resistance in NSCLC.

Osteoporosis (OP) is a multifactorial and common bone disease worldwide. The clinical diagnosis and treatment of osteoporosis has limitations since changes in bone density occur slightly. Thus, it is critically needed to look for new biomarkers to identify and cure osteoporosis. CircRNAs are important molecular regulators that participate in various biological processes and present tremendous therapeutic potential. The role of circRNAs in osteoporosis remains largely unknown. Here, we explore the expression of circRNAs in osteoporosis using microarray analysis, and identify potential circRNAs associated with osteoporosis by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) validation and statistical analysis in clinical samples. As a result, circ_0006873 and circ_0002060 were found to be significantly upregulated between nonosteoporotic controls and osteoporosis patients (n = 40, respectively). Pearson correlation analysis showed that the level of circ_0006873 and circ_0002060 were associated with the low-bone mineral density in patients with osteoporosis. Furthermore, ROC analysis indicated that circ_0002060 showed potential diagnostic value for osteoporosis. Taken together results using bioinformatics, experimental analysis, and disease models, we revealed that circ_0002060 could be used as potential diagnostic biomarker and therapeutic target in osteoporosis.

Liquid metal is an interesting metallic material with many unique properties that can be applied in many applications. Liquid metal droplets can be activated by an external electrical field in aqueous environments, which has led to the development of novel actuators. However, a study on the development and control of liquid metal actuating robots is still absent, which hinders their further applications. In this paper, we report the development of a novel controllable untethered vehicle driven by electrically actuated liquid metal droplets in a sodium hydroxide solution. The simplified dynamic model of the vehicle in sodium hydroxide solution was developed. The vehicle's performance, including translational and rotating locomotion with various speeds, was experimentally evaluated. The vehicle driven by liquid metal droplets possesses many advantages such as working silently, almost wear-free motion, and low power consumed, which has great potential to be applied in liquid metal enabled robotics and automation process such as laboratory automation.

BACKGROUND High-mobility group box 1 (HMGB1) is an essential contributor towards initiation and progression of many kinds of cancers. Nevertheless, our understanding of the molecular etiology of HMGB1-modulated vasculogenesis, as well as invasion, of breast cancer is poor. This study explored HMGB1 expression in breast cancer and its role in the development and spread of malignancy. MATERIAL AND METHODS We enrolled 15 patients with breast cancer who received primary surgery at the Department of Thyroid and Breast Surgery in our hospital. HMGB1 was recorded and analyzed. RESULTS Our investigation successfully proves that HMGB1 is upregulated in breast cancer tissues in comparison to the surrounding non-malignant tissues. HMGB1 enhanced vessel formation in breast cancer tissues by regulating hypoxia-inducible factor 1 (HIF-1alpha), which in turn upregulates the expression of VEGF. Furthermore, HMGB1-mediated upregulation of HIF-1alpha relies on its ability to stimulate the phosphatidylinositol 3-kinase (PI3K) pathway to reinforce AKT subunit phosphorylation. HMGB1 overexpression reinforces the vasculogenesis in malignancies not only in vivo but also in vitro. Additionally, shRNA knockdown of HMGB1 prohibited the vessel-forming and invasive capabilities, downregulated VEGF and HIF-1alpha, and suppressed AKT phosphorylation in breast cancer cells. Most importantly, PI3K/AKT axis suppression eliminated the effect of HMGB1-modulated vascularization and invasion in breast cancer cells. CONCLUSIONS Our research indicates that HMGB1 serves as a crucial regulator of malignant cell-modulated vessel formation and is involved in the development of malignancy. Our findings indicate that HMGB1 is a promising target for breast cancer treatment.

Rapid decreases in frog populations have been spotted worldwide, which are regarded as one of the most critical threats to the global biodiversity. Recent advances in acoustic sensors provide a novel way to assess frog vocalizations and further optimize the global protection policy. Specifically, frog populations can be reflected by detecting frog species using collected recordings. Previous studies have explored various acoustic features for classifying frog calls. However, few studies investigate visual features for frog call classification, which have been successfully used in acoustic event detection, speech/speaker recognition. In this study, various acoustic and visual features are proposed for frog call classification: MPEG-7 audio descriptor, syllable duration, oscillation rate, entropy related features, linear prediction codings, Mel-frequency Cepstral coefficients, local binary patterns, and histogram of oriented gradients. After segmenting continuous frog calls into individual syllables, different constructed feature sets are evaluated with a k-nearest neighbor classifier and support vector machines. Comprehensive results on 16 frog species demonstrate the effectiveness of both acoustic and visual features for classifying frog calls.

Purpose Six-transmembrane epithelial antigen of prostate 1 (STEAP1) is a cell surface antigen overexpressed in multiple cancers and is associated with malignancy and disease prognosis. The aims of this study were to evaluate STEAP1 expression in breast cancer and to determine the mechanisms involved. Methods STEAP1 expression was compared in normal breast tissue (n = 40), benign fibroadenoma (n = 52), and primary breast cancer (n = 211) using immunohistochemistry. Quantitative real-time polymerase chain reaction, Western blot analysis, and immunocytochemistry were used to evaluate STEAP1 expression in 3 breast cancer cell lines and in a normal mammary epithelial cell line. STEAP1 expression and its prognostic value in breast cancer were verified using the Oncomine and Kaplan-Meier Plotter databases. Transfection of cells to up-regulate or knock down STEAP1 expression was used to determine the effect of STEAP1 on cell invasion and proliferation, and to evaluate its relationship to epithelial–mesenchymal transition (EMT) progression. Results STEAP1 expression was lower in breast cancers cells, and low expression was associated with a malignant phenotype and poor prognosis. Analysis of public databases supported our conclusions. Knockdown of STEAP1 expression enhanced cellular invasion and migration abilities, increased expression of EMT-related genes MMP2, MMP9, MMP13, VIM, and CDH2, and decreased CDH1 expression. Enhanced STEAP1 expression significantly inhibited cellular invasion and migration abilities, decreased expression of the EMT-related genes, and increased CDH1 expression. Up-regulation or knockdown of STEAP1 had little effect on cellular proliferation. Conclusion STEAP1 was down-regulated in breast cancer, inhibited metastasis of breast cancer, and hampered the levels of EMT markers, which thus implicated STEAP1 in the suppression of EMT.

The semiconductor laser diode SPL LL90_3, which integrates the RC charge-discharge circuit and a MOSFET switching device, is usually used for pulsing laser in the light detection and ranging system with a rated peak power of 70 W at 30 ns pulse-width. To further increase the peak power and reduce the pulse width and rising edge, a driving circuit with an avalanche transistor used as a pre-switching device is proposed. A trigger pulse with about 10 ns'-pulse-width is obtained to drive the laser diode. At the same time, the pulsing laser's peak power can reach 141 W at the testing repetition rate of 55 kHz.

This paper takes 71 management accounting documents published in the 2015-2017 mainstream journals as a sample, systematically combs, summarizes and reviews the management accounting research topics and research methods. We find that the subject of management accounting research is increasingly diversified, with performance evaluation and measurement, compensation and incentive research being the most popular. There are obvious differences in research methods at home and abroad. Among them, domestic research mainly focuses on data-based empirical analysis and normative research, while foreign literature research methods prefer experimental research methods. I hope that the comparative analysis of the article can provide reference for the research and development of domestic management accounting.

Automatic bird sound classification plays an important role in monitoring and further protecting biodiversity. Recent advances in acoustic sensor networks and deep learning techniques provide a novel way for continuously monitoring birds. Previous studies have proposed various deep learning based classification frameworks for recognizing and classifying birds. In this study, we compare different classification models and selectively fuse them to further improve bird sound classification performance. Specifically, we not only use the same deep learning architecture with different inputs but also employ two different deep learning architectures for constructing the fused model. Three types of time-frequency representations (TFRs) of bird sounds are investigated aiming to characterize different acoustic components of birds: Mel-spectrogram, harmonic-component based spectrogram, and percussive-component based spectrogram. In addition to different TFRs, a different deep learning architecture, SubSpectralNet, is employed to classify bird sounds. Experimental results on classifying 43 bird species show that fusing selected deep learning models can effectively increase the classification performance. Our best fused model can achieve a balanced accuracy of 86.31% and a weighted F1-score of 93.31%.

Objective The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS). Method A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups. Results Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%. Conclusion We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.

Over 40% of the coronavirus disease 2019 (COVID-19) COVID-19 patients were asymptomatically infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the immune responses of these asymptomatic individuals is a critical factor for developing the strategy to contain the COVID-19 pandemic. Here, we determined the viral dynamics and antibody responses among 143 asymptomatic individuals identified in a massive screening of more than 5 million people in eight districts of Wuhan in May 2020. Asymptomatic individuals were admitted to the government-designated centralized sites in accordance with policy. The incidence rate of asymptomatic infection is ~2.92/100,000. These individuals had low viral copy numbers (peaked at 315 copies/mL) and short-lived antibody responses with the estimated diminish time of 69 days. The antibody responses in individuals with persistent SARS-CoV-2 infection is much longer with the estimated diminish time of 257 days. These results imply that the immune responses in the asymptomatic individuals are not potent enough for preventing SARS-CoV-2 re-infection, which has recently been reported in recovered COVID-19 patients. This casts doubt on the efficacy of forming “herd-immunity” through natural SARS-CoV-2 infection and urges for the development of safe and effective vaccines.

Traditional co-word networks do not discriminate keywords of researcher interest from general keywords. Co-word networks are therefore often too general to provide knowledge if interest to domain experts. Inspired by the recent work that uses an automatic method to identify the questions of interest to researchers like “problems” and “solutions”, we try to answer a similar question “what sensors can be used for what kind of applications”, which is great interest in sensor- related fields. By generalizing the specific questions as “questions of interest”, we built a knowledge network considering researcher interest, called bipartite network of interest (BNOI). Different from a co-word approaches using accurate keywords from a list, BNOI uses classification models to find possible entities of interest. A total of nine feature extraction methods including N-grams, Word2Vec, BERT, etc. were used to extract features to train the classification models, including naïve Bayes (NB), support vector machines (SVM) and logistic regression (LR). In addition, a multi-feature fusion strategy and a voting principle (VP) method are applied to assemble the capability of the features and the classification models. Using the abstract text data of 350 remote sensing articles, features are extracted and the models trained. The experiment results show that after removing the biased words and using the ten-fold cross-validation method, the F-measure of “sensors” and “applications” are 93.2% and 85.5%, respectively. It is thus demonstrated that researcher questions of interest can be better answered by the constructed BNOI based on classification results, comparedwith the traditional co-word network approach.

The novel coronavirus (COVID-19) infection has spread worldwide since late 2019. People who have social contacts with COVID-19 patients might be at higher risk of physical or mental health problems. This study investigated whether people who had social contacts with COVID-19 patients would have poorer physical or mental outcomes, and different attitudes and behaviors. Chinese adults were recruited to fill in an online survey using snowball sampling during 21st-26ndFebruary 2020. Physical symptoms, psychological outcomes, quality of life, COVID-19 related attitudes, and behaviors were measured. The differences in the outcomes between participants who had COVID-19 social contacts and those who had not were analyzed. The survey included 1,447 non-infected eligible participants. Among those, 173 (12.0%) reported at least one confirmed/suspected case in their social contacts. In the multiple regression adjusted for demographic data, the presence of confirmed/suspected infection cases in one’s social contacts was significantly associated with poorer physical and mental outcomes, lower health-related quality of life, and different COVID-19 related attitudes and behaviors (p

Intracardiac ectopic thyroid tissue is an extremely rare condition, with only 37 cases reported in the English literature. We present a case of intracardiac ectopic thyroid adenoma and briefly review the published reports.