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Dementia is one of the greatest global challenges for public health; however, the relationship between anticholinergic drugs and dementia remains unclear. The aim of the present study was to perform a systematic review and meta-analysis of the predictive roles of anticholinergic drugs in dementia risk. After pooling fourteen longitudinal and case-control studies with a total of 1,564,181 subjects, anticholinergic drug use was associated with an increased risk of all-cause dementia and Alzheimer's disease. Both low and high anticholinergic drug burdens were associated with dementia. Moreover, there was a dose-dependent relationship between anticholinergic drugs and risk of dementia. With respect to the categories of anticholinergic drugs, antiparkinson, urological drugs, and antidepressants increased the risk for dementia; however, cardiovascular and gastrointestinal drugs played potentially protective roles. These findings underscore the importance of anticholinergic drugs as a potential modifiable risk factor for dementia and provide treatment priorities to optimize dementia prevention.

BACKGROUND Constipation as a most common non-motor symptom of Parkinson's disease (PD), has a higher prevalence compared to the general population. The etiologies of constipation in PD are diverse. In addition to physical weakness and other factors of disease, the lifestyles and eating habits are also important factors. Therefore, the prevalence and influencing factors of constipation may vary among different populations. AIM To determine the prevalence of constipation and analyze relative factors in a cohort of Chinese patients with PD. METHODS All the patients diagnosed with PD according to the movement disorders society criteria were consecutively collected by a self-developed questionnaire. Rome III diagnostic criteria were used to assess functional constipation and Wexner score was used to estimate the severity of constipation. Non-motor symptoms (NMS) were assessed with the non-motor symptoms assessment scale (NMSS). Unified Parkinson's disease Rating Scale III (UPDRS III) was used to evaluate the severity of motor symptoms. The modified Hoehn-Yahr stage was used to evaluate the severity of PD. Cognitive function was assessed using Montreal cognitive assessment (MoCA). Depression and anxiety were rated with the Hamilton depression scale (HAMD) and the Hamilton anxiety scale (HAMA). Quality of life was assessed using the Parkinson’s disease Questionnaire-39 items (PDQ-39). RESULTS Of 166 patients enrolled, 87 (52.41%) were accompanied with constipation, and 30 (34.48%) experienced constipation for 6.30 ± 5.06 years before motor symptoms occurred. Age, Hoehn-Yahr stage, disease duration, levodopa medication times, incidence of motor complications, the scores of UPDRS total, UPDRS III, NMSS, HAMD, HAMA, and PDQ-39 in the constipation group were higher than those in the non-constipation group (P < 0.05), but there was no difference in the scores of MoCA, clinical types, or medications between the two groups (P > 0.05). There was a higher incidence of depression in patients with constipation (P < 0.05), but there were no difference in the incidence of anxiety and cognitive impairment between the two groups (P > 0.05). As Hoehn-Yahr stages increased, the severity of constipation increased (P < 0.05), but not the incidence of constipation (P > 0.05). Pearson correlation analysis showed that constipation was moderately positively correlated with age, Hoehn-Yahr stage, and scores of NMSS, UPDRS III, UPDRS total, PDQ-39, HAMD, and HAMA (r = 0.255, 0.172, 0.361, 0.194, 0.221, 0.237, 0.238, and 0.207, P < 0.05). Logistic regression analysis showed that only NMSS score was an independent risk factor for constipation (P < 0.001). CONCLUSION Our findings confirm that constipation has a relatively high frequency in patients with PD. PD patients with constipation have a higher incidence of depression, which leads to worse quality of life.

The causes of chronic antibiotic refractory pouchitis (CARP) and pouch failure in inflammatory bowel disease (IBD) patients remain unknown. Our previous small study showed peripouch fat area measured by MRI was associated with pouchitis. To explore the relationship between peripouch fat area on CT imaging and pouch outcomes. This is a historical cohort study. Demographic, clinical, and radiographic data of IBD patients with abdominal CT scans after pouch surgery between 2002 and 2017 were collected. Peripouch fat areas and mesenteric peripouch fat areas were measured on CT images at the middle pouch level. A total of 435 IBD patients were included. Patients with higher peripouch fat areas had a higher prevalence of CARP. Univariate analyses demonstrated that long duration of the pouch, high weight or body mass index, the presence of primary sclerosing cholangitis or other autoimmune disorders, and greater peripouch fat area or mesenteric peripouch fat area were risk factors for CARP. Multivariable analyses demonstrated that the presence of primary sclerosing cholangitis or autoimmuned disorders, and greater peripouch fat area (odds ratio [OR] 1.031; 95% confidence interval [CI] 1.016–1.047, P

Background This study was conducted to evaluate and update the current prevalence of and risk factors for chronic kidney disease (CKD) and diabetic kidney disease (DKD) in a central Chinese urban population. Methods From December 2017 to June 2018, a total of 5231 subjects were randomly enrolled from 3 communities in 3 districts of Zhengzhou. CKD was defined as estimated glomerular filtration rate (eGFR) 2 or urinary albumin to creatinine ratio ≥ 30 mg/g (albuminuria). Diabetic subjects with systolic blood pressure > 140 mmHg, albuminuria or an eGFR less than 60 mL/min/1.73 m2 were classified as having DKD. Participants completed a questionnaire assessing lifestyle and relevant medical history, and blood and urine specimens were taken. Serum creatinine, uric acid, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein and urinary albumin were assessed. The age- and sex-adjusted prevalences of CKD and DKD were calculated, and risk factors associated with the presence of reduced eGFR, albuminuria, DKD, severity of albuminuria and progression of reduced renal function were analyzed by binary and ordinal logistic regression. Results The overall adjusted prevalence of CKD was 16.8% (15.8–17.8%) and that of DKD was 3.5% (3.0–4.0%). Decreased renal function was detected in 132 participants (2.9, 95% confidence interval [CI]: 2.5–3.2%), whereas albuminuria was found in 858 participants (14.9, 95% CI: 13.9–15.9%). In all participants with diabetes, the prevalence of reduced eGFR was 6.3% (95% CI = 3.9–8.6%) and that of albuminuria was 45.3% (95% CI = 40.4–50.1%). The overall prevalence of CKD in participants with diabetes was 48.0% (95% CI = 43.1–52.9%). The results of the binary and ordinal logistic regression indicated that the factors independently associated with a higher risk of reduced eGFR and albuminuria were older age, sex, smoking, alcohol consumption, overweight, obesity, diabetes, hypertension, dyslipidemia and hyperuricemia. Conclusions Our study shows the current prevalence of CKD and DKD in residents of Central China. The high prevalence suggests an urgent need to implement interventions to relieve the high burden of CKD and DKD in China.

Pouch prolapse is a rare pouch complication which often leads to pouch failure in inflammatory bowel disease (IBD) patients. Its exact cause remains unknown. Floppy pouch complex (FPC) was defined as the presence of any one of the following pouch disorders: pouch prolapse, afferent limb syndrome (ALS), redundant loop, and pouch folding. We aimed to explore the role of peripouch fat area in the occurrence of pouch prolapse and FPC. Pouch patients with available pouchoscopy and abdominal CT scans who were followed up between 2011 and 2017 in Cleveland Clinic were reviewed. Peripouch fat was measured on CT images. Of the 93 included patients, 31 were females; 87 had J pouches and 6 had S pouches. The median duration of pouch was 8.0 (interquartile range [IQR] 5.0–16.5) years. A total of 18 cases (19.4%, 18/93) were identified as FPC, including 12 pouch prolapse, 5 ALS, 1 redundant loop, and 3 pouch folding. Patients with pouch prolapse had lower peripouch fat area (13.6 (9.3–18.5) vs. 27.6 (11.0–46.2)cm2, P = 0.022) than those without. Patients with FPC had lower peripouch fat area (15.4 (11.4–20.6) vs. 27.6 (11.0–46.9)cm2, P = 0.040) than those without. Univariate and multivariate analyses demonstrated that lower peripouch fat area, lower weight, and family history of IBD were independent predictors of pouch prolapse and FPC. A lower peripouch fat area was observed in inflammatory bowel disease patients with pouch prolapse and FPC. Longitudinal studies are needed to further elucidate the role of peripouch fat in the pathogenesis of pouch prolapse and FPC.

Background: Cognitive deficit is mainly clinical characteristic of Alzheimer’s disease (AD). Recent reports showed adiponectin and its analogues could reverse cognitive impairments, lower amyloid-β protein (Aβ) deposition, and exert anti-inflammatory effects in different APP/PS1 AD model mice mainly exhibiting amyloid plaque pathology. However, the potential in vivo electrophysiological mechanism of adiponectin protecting against cognitive deficits in AD and the neuroprotective effects of adiponectin on 3xTg-AD mice including both plaque and tangle pathology are still unclear. Objective: To observe the effects of adiponectin treatment on cognitive deficits in 3xTg-AD mice, investigate its potential in vivo electrophysiological mechanism, and testify its anti-inflammatory effects. Methods: Barnes maze test, Morris water maze test, and fear conditioning test were used to evaluate the memory-ameliorating effects of adiponectin on 3xTg-AD mice. In vivo hippocampal electrophysiological recording was used to observe the change of basic synaptic transmission, long-term potentiation, and long-term depression. Immunohistochemistry staining and western blot were used to observe the activation of microglia and astroglia, and the expression levels of proinflammatory factors and anti-inflammtory factor IL-10. Results: Adiponectin treatment could alleviate spatial memory and conditioned fear memory deficits observed in 3xTg-AD mice, improve in vivo LTP depression and LTD facilitation, inhibit overactivation of microglia and astroglia, decrease the expression of proinflammatory factors NF- κB and IL-1β, and increase the expression level of IL-10 in the hippocampus of 3xTg-AD mice. Conclusion: Adiponectin could ameliorate cognitive deficits in 3xTg-AD mice through improving in vivo synaptic plasticity impairments and alleviating neuroinflammation in the hippocampus of 3xTg-AD mice.

Background Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging. Objective We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles. Results We studied 349 older patients with newly diagnosed MM (age range, 65–86 years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA ‘fit’ group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26 months (range 1–38). The median overall survival (OS) was 34.7 months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327). Conclusions Our study justifies the need for a CGA in older patients with newly diagnosed MM.

The link between depression and anxiety status and cancer outcomes has been well-documented but remains unclear. We comprehensively quantified the association between depression and anxiety defined by symptom scales or clinical diagnosis and the risk of cancer incidence, cancer-specific mortality, and all-cause mortality in cancer patients. Pooled estimates of the relative risks (RRs) for cancer incidence and mortality were performed in a meta-analysis by random effects or fixed effects models as appropriate. Associations were tested in subgroups stratified by different study and participant characteristics. Fifty-one eligible cohort studies involving 2,611,907 participants with a mean follow-up period of 10.3 years were identified. Overall, depression and anxiety were associated with a significantly increased risk of cancer incidence (adjusted RR: 1.13, 95% CI: 1.06–1.19), cancer-specific mortality (1.21, 1.16–1.26), and all-cause mortality in cancer patients (1.24, 1.13–1.35). The estimated absolute risk increases (ARIs) associated with depression and anxiety were 34.3 events/100,000 person years (15.8–50.2) for cancer incidence and 28.2 events/100,000 person years (21.5–34.9) for cancer-specific mortality. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety were related to higher cancer incidence, poorer cancer survival, and higher cancer-specific mortality. Psychological distress (symptoms of depression and anxiety) was related to higher cancer-specific mortality and poorer cancer survival but not to increased cancer incidence. Site-specific analyses indicated that overall, depression and anxiety were associated with an increased incidence risks for cancers of the lung, oral cavity, prostate and skin, a higher cancer-specific mortality risk for cancers of the lung, bladder, breast, colorectum, hematopoietic system, kidney and prostate, and an increased all-cause mortality risk in lung cancer patients. These analyses suggest that depression and anxiety may have an etiologic role and prognostic impact on cancer, although there is potential reverse causality; Furthermore, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. Early detection and effective intervention of depression and anxiety in cancer patients and the general population have public health and clinical importance.

The prediction of clinical outcome for patients with infiltrative gliomas is challenging. Although preoperative hematological markers have been proposed as predictors of survival in glioma and other cancers, systematic investigations that combine these data with other relevant clinical variables are needed to improve prognostic accuracy and patient outcomes. We investigated the prognostic value of preoperative hematological markers, alone and in combination with molecular pathology, for the survival of 592 patients with Grade II-IV diffuse gliomas. On univariate analysis, increased neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), and decreased albumin-to-globulin ratio (AGR), all predicted poor prognosis in Grade II/III gliomas. Multivariate analysis incorporating tumor status based on the presence of IDH mutations, TERT promoter mutations, and 1p/19q codeletion showed that in lower-grade gliomas, high NLR predicted poorer survival for the triple-negative, IDH mutation only, TERT mutation only, and IDH and TERT mutation groups. NLR was an independent prognostic factor in Grade IV glioma. We therefore propose a prognostic model for diffuse gliomas based on the presence of IDH and TERT promoter mutations, 1p/19q codeletion, and NLR. This model classifies lower-grade gliomas into nine subgroups that can be combined into four main risk groups based on survival projections.

Jin-qiao Liu, Wen-juan Chen, Meng-jie Zhou, Wen-feng Li, Ju Tang Department of Ultrasound, Hunan Children’s Hospital, Changsha City, Hunan Province, People’s Republic of ChinaCorrespondence: Wen-juan ChenDepartment of Ultrasound, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People’s Republic of ChinaTel + 86-13707484196Email cwj299979@aliyun.comBackground: Ischemic-type biliary lesions (ITBL) are accepted as the most incomprehensible biliary complications after living-donor liver transplantation (LDLT). Early predicting the development of ITBL in pediatric patients permits more preventive strategies. However, few studies have focused on the early prediction of ITBL.Objective: This study aimed to establish a nomogram including ultrasound-based multimodal imaging to predict ITBL in children with biliary atresia (BA) within 2 years after receiving LDLT.Methods: The records of 94 BA children with at least one year of follow-up after LDLT were reviewed retrospectively. They were randomly divided into a training cohort for constructing a nomogram (n=64) and a validation cohort (n=30). In the training cohort, patients diagnosed as ITBL were included in the ITBL group and those without any vascular and biliary complication were included in the non-ITBL group. Multivariate Cox regression was used for the establishment of the nomogram in predicting the risk of ITBL within 2 years post-LDLT. The discrimination and calibration of the nomogram were internally and externally validated. The performances of the nomogram and the individual components were compared by the area under the curve (AUC) of receiver operating characteristic (ROC) curve.Results: In the training cohort, 18 BA children were included in the ITBL group and 46 were in the non-ITBL group. Last pediatric end-stage liver disease (PELD) score, gamma-glutamyl transpeptidase (GGT), resistive index (RI), and liver stiffness measurement (LSM) were the independent predictors for the development of ITBL within 2 years post-LDLT. The nomogram incorporating these independent predictors showed good discrimination and calibration by the internal and external validation. Its performance was better than any individual component in predicting the prognosis (P < 0.05).Conclusion: The established nomogram may be used to predict the risk of ITBL within 2 years post-LDLT in BA children.Keywords: ischemic-type biliary lesions, living-donor liver transplantation, pediatric patients, biliary atresia, color Doppler flow imaging, liver stiffness measurement

Background: Although Kasai portoenterostomy (KPE) is performed timely for most children with biliary atresia (BA), the native liver survival (NLS) is still poor due to the progressive liver fibrosis. Many children have to receive liver transplantation (LT) within 2 years after KPE. Early prediction of the prognosis permits the implementation of prophylactic treatments for BA children. However, studies about the prediction are limited.Objective: The purpose of this study is to establish a nomogram to predict the prognosis of BA children within 2 years after KPE.Methods: The follow-up data of 151 BA children were retrospectively reviewed, and were randomly divided into a training cohort for constructing a nomogram (n = 103) and a validation cohort (n = 48). In the training cohort, patients were divided into Group A and Group B according to whether death or LT were observed within 2 years post-KPE. Multivariate Cox regression based on the baseline characteristics, liver function indicators and LSM (liver stiffness measurement) values at KPE and 3 months after KPE was utilized for the establishment of the nomogram in predicting the prognosis of BA within 2 years after KPE. The discrimination and calibration of the nomogram were internally and externally validated.Results: Fifty-six BA children were included in Group A and 47 were included in group B. Age at KPE, METAVIR score F4, LSM at 3 months, first onset of cholangitis within 3 months, and jaundice clearance time were the independent predictors for the prognosis of BA children within 2 years after KPE (all P < 0.05). The developed nomogram based on these independent predictors showed good discrimination and calibration by the internal and external validation. Its performance was better than each predictor in predicting the prognosis (all P < 0.05).Conclusions: The established nomogram based on the indicators from the first 3 months after KPE may be useful for predicting the prognosis of BA children within 2 years post-KPE and helpful for the consideration of LT.

Introduction: This study aimed to identify factors associated with individual emergency preparedness behaviors which play an important role in effective emergency response.Methods: Data were drawn from a cross-sectional survey conducted in China's Heilongjiang, Guangdong and Sichuan provinces in 2017. Questionnaires were administered through face-to-face interviews, and 2,506 were valid for data analyses. A structural equation model was established to test the direct and indirect effects of the relevant factors on individual emergency preparedness behaviors.Results: Low levels of emergency preparedness were found: 28% of respondents reported being fully/partly prepared. The attitudes of the respondents toward emergency preparedness had the strongest association with emergency preparedness behaviors, with a total effect of 0.483. This was followed by self-efficacy (0.305) and training/exercise (0.295). Risk perception had the weakest effect (0.045) on emergency preparedness behaviors.Discussion: Improving attitudes of the public as well as their ability to prepare for emergency events is important for effective emergency management.

Background Nonalcoholic fatty liver disease (NAFLD) is one of the main liver diseases, and its pathologic profile includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). However, there is no reliable non-invasive parameter in distinguishing NASH from NAFL in clinical practice. The present study was to find a non-invasive way to differentiate these two categories of NAFLD via lipidomic analysis. Methods Lipidomic analysis was used to determine the changes of lipid moieties in blood from 20 NAFL and 10 NASH patients with liver biopsy. Liver histology was evaluated after hematoxylin and eosin staining and Masson's trichrome staining. The profile of lipid metabolites in correlation with steatosis, inflammation, hepatocellular necroptosis, fibrosis, and NAFLD activity score (NAS) was analyzed. Results Compared with NAFL patients, NASH patients had higher degree of steatosis, ballooning degeneration, lobular inflammation. A total of 434 different lipid molecules were identified, which were mainly composed of various phospholipids and triacylglycerols. Many lipids, such as phosphatidylcholine (PC) (P-22:0/18:1), sphingomyelin (SM) (d14:0/18:0), SM (d14:0/24:0), SM (d14:0/22:0), phosphatidylethanolamine (PE) (18:0/22:5), PC (O-22:2/12:0), and PC (26:1/11:0) were elevated in the NASH group compared to those in the NAFL group. Specific analysis revealed an overall lipidomic profile shift from NAFL to NASH, and identified valuable lipid moieties, such as PCs [PC (14:0/18:2), PE (18:0/22:5) and PC (26:1/11:0)] or plasmalogens [PC (O-22:0/0:0), PC (O-18:0/0:0), PC (O-16:0/0:0)], which were significantly altered in NASH patients. In addition, PC (14:0/18:2), phosphatidic acid (18:2/24:4) were positively correlated with NAS; whereas PC (18:0/0:0) was correlated positively with fibrosis score. Conclusions The present study revealed overall lipidomic profile shift from NAFL to NASH, identified valuable lipid moieties which may be non-invasive biomarkers in the categorization of NAFLD. The correlations between lipid moieties and NAS and fibrosis scores indicate that these lipid biomarkers may be used to predict the severity of the disease.

Background: Sleep disturbances are highly prevalent in pregnancy and are frequently overlooked as a potential cause of significant morbidity. The association between sleep disturbances and pregnancy outcomes remains largely controversial and needs to be clarified to guide management. We conducted a systematic review and meta-analyses to investigate the association between sleep disturbances and maternal and fetal adverse outcomes. Methods: We searched PubMed, Embase and Web of Science from inception to May 31, 2019, for observational English studies of pregnant women with and without sleep disturbances assessing the risk of obstetric complications in the antenatal, intrapartum or postnatal period, and neonatal complications. We used Newcastle-Ottawa Scales to assess the methodological quality of included studies. We quantified the risks of maternal and fetal complications by comparing pregnant women with and without sleep disturbances and undertook subgroup analyses and meta-regression stratified by several clinical and demographic characteristics. We pooled the associations as odds ratios (OR) and 95% confidence intervals (CI) using fixed-effect or random-effect models as appropriate based on the heterogeneity test. Findings: We included 114 studies with a total of 58,100,274 pregnant women in this meta-analysis. Sleep disturbances were assessed, including poor sleep quality, extreme sleep duration, insomnia, restless legs syndrome, subjective sleep-disordered breathing and diagnosed obstructive sleep apnea. Women with overall sleep disturbances versus those without had a significantly higher risk of pre-eclampsia (OR=2·81, 95% CI:2·38-3·32), gestational hypertension (1·74, 1·54-1·98), gestational diabetes mellitus (1·60, 1·45-1·77), cesarean section (1·50, 1·33-1·69), preterm birth (1·41, 1·27-1·56), large for gestational age (1·40, 1·11-1·77), and stillbirth (1·25, 1·08-1·45), but not low birth weight (1·27, 0·98-1·64), or small for gestational age (1·06, 0·92-1·21). Sleep disturbances were related to higher risks of morbidities in pregnant women who are 30 years or older and overweight before pregnancy. Interpretation: Significant associations exist between sleep disturbances in pregnancy and a variety of adverse maternal and fetal outcomes. Sleep disturbances are treatable and deserve more attention from health-care providers during counseling and should be a part of prenatal health care. Funding Statement: The National Key Research and Development Program of China (no. 2019YFA0706200), and the NSFC-CIHR Joint Health Research Program (no. 81761128036). Declaration of Interests: The authors declare they have no conflicts of interest. Ethics Approval Statement: The study protocol was registered with PROSPERO, number CRD42020148586.

Objective. Motor complications are common in Parkinson’s disease (PD). The reported occurrence of motor complications varies across regions and races. The aim of our study was to describe the development of dyskinesias and motor fluctuations among Chinese PD patients and the relative risk factors. Methods. In the current cross-sectional survey study, PD patients with motor fluctuations and dyskinesia were enrolled from March to November 2018 in Shaanxi province, a northwest area of China. Data were collected by the movement disorder specialists. A self-designed questionnaire was utilized during face-to-face interviews. In addition, the relevant factors of motor complications were analyzed by univariable and multivariable analyses. Results. Of the166 PD patients recruited, 52 (31.33%) and 25 (15.06%) patients had motor fluctuations and dyskinesia, respectively, which occurred in 6.76 ± 3.77 and 8.61 ± 4.46 years after the onset of motor symptoms and 5.37 ± 3.33 and 6.80 ± 3.43 years after the treatment of levodopa therapy, respectively. Patients with motor fluctuations and dyskinesias had longer disease duration, younger onset age, higher Hoehn–Yahr stages and UPDRS III scores, higher daily levodopa dosage and levodopa equivalent daily dose (LEDD), and longer duration of levodopa treatment (P<0.05). Bradykinesia-rigidity dominant patients had higher incidences of motor fluctuations (61.54% vs 38.46%) and dyskinesias (68.00% vs 32.00%) than tremor-dominant patients (P<0.05). Results of the multivariate logistic regression analyses showed that the duration of levodopa therapy, age of the onset, and bradykinesia-rigidity dominant type were independent risk factors of motor fluctuations (P<0.05). In addition, duration of disease and bradykinesia-rigidity dominant type were independent risk factors of dyskinesia (P<0.05). Conclusions. The rate of motor fluctuations was higher than dyskinesias in Chinese patients with Parkinson’s disease. Patients with younger age onset, bradykinesia-rigidity dominant type, longer disease duration, and longer duration of levodopa therapy are more likely to develop motor complications.

The aim of the study was to investigate whether microvessel density (MVD) could be associated with skeletal extramedullary disease relapse (skeletal-EMDR) in patients with multiple myeloma (MM) who have skeletal-EMD at diagnosis. Seventy-nine newly diagnosed MM patients who have skeletal-EMD were retrospectively enrolled in this study. The 4-year cumulative incidence of skeletal-EMDR was 35.0%±8.3%. The 4-year probability of overall survival (OS) was 54.0%±7.6%. Multivariate analysis showed that skeletal-EMDR (HR = 4.144; 95% CI: 1.608–10.685; P = 0.003) was independently associated with inferior OS for the MM patients who have skeletal-EMD at diagnosis. The factors associated with skeletal-EMDR were MVD (HR = 3.990, 95%CI:1.136-14.018; P = 0.031), white blood cell (WBC) (HR = 0.262, 95% CI:0.090-0.769; P = 0.015), and the EMD sites involved at onset (HR = 0.263, 95% CI: 0.074-0.937; P = 0.039). The MVD in patients with thoracic and lumbar vertebrae as the involved sites at diagnosis was significantly lower than those with other sites involved (41.59 ± 14.39 vs. 60.82 ± 35.14, P=0.001). Our data suggest that increased MVD could be used to predict skeletal-EMDR, which is associated with inferior survival in patients with MM who have skeletal-EMD at diagnosis.

Opioid use disorder (OUD) is associated with a high risk of premature death. Medication-assisted treatment (MAT) is the primary treatment for opioid dependence. We comprehensively assessed the effects of different MAT-related characteristics on mortality among those with OUD by a systematic review and meta-analysis. The all-cause and overdose crude mortality rates (CMRs) and relative risks (RRs) by treatment status, different type, period, and dose of medication, and retention time were pooled using random effects, subgroup analysis, and meta-regression. Thirty cohort studies involving 370,611 participants (1,378,815 person-years) were eligible in the meta-analysis. From 21 studies, the pooled all-cause CMRs were 0.92 per 100 person-years (95% CI: 0.79-1.04) while receiving MAT, 1.69 (1.47-1.91) after cessation, and 4.89 (3.54-6.23) for untreated period. Based on 16 studies, the pooled overdose CMRs were 0.24 (0.20-0.28) while receiving MAT, 0.68 (0.55-0.80) after cessation of MAT, and 2.43 (1.72-3.15) for untreated period. Compared with patients receiving MAT, untreated participants had higher risk of all-cause mortality (RR 2.56 [95% CI: 1.72-3.80]) and overdose mortality (8.10 [4.48-14.66]), and discharged participants had higher risk of all-cause death (2.33 [2.02-2.67]) and overdose death (3.09 [2.37-4.01]). The all-cause CMRs during and after opioid substitution treatment with methadone or buprenorphine were 0.93 (0.76-1.10) and 1.79 (1.47-2.10), and corresponding estimate for antagonist naltrexone treatment were 0.26 (0-0.59) and 1.97 (0-5.18), respectively. Retention in MAT of over 1-year was associated with a lower mortality rate than that with retention ≤1 year (1.62, 1.31-1.93 vs. 5.31, -0.09-10.71). Improved coverage and adherence to MAT and post-treatment follow-up are crucial to reduce the mortality. Long-acting naltrexone showed positive advantage on prevention of premature death among persons with OUD.

Background: Outflow tract (OFT) septation defects are a common cause of congenital heart disease. Numerous studies have focused on the septation mechanism of the OFT, but have reported inconsistent conclusions. This study, therefore, aimed to investigate the septation of the aortic sac and the OFT in the early embryonic human heart. Methods: Serial sections of 27 human embryonic hearts from Carnegie stage (CS) 10 to CS19 were immunohistochemically stained with antibodies against c-smooth muscle actin (α-SMA) and myosin heavy chain. Results: At CS10–CS11, the OFT wall was an exclusively myocardial structure that was continuous with the aortic sac at the margin of the pericardial cavity. From CS13 onward, the OFT was divided into nonmyocardial and myocardial portions. The cushion formed gradually, and its distal border with the OFT myocardium was consistently maintained. The aortic sac between the fourth and sixth aortic arch arteries was degenerated. At CS16, the α-SMA-positive aortopulmonary septum formed and fused with the two OFT cushions, thus septating the nonmyocardial portion of the OFT into two arteries. At this stage, the cushions were not fused. At CS19, the bilateral cushions were fused to septate the myocardial portion of the OFT. Conclusions: Data suggest that the OFT cushion is formed before the aortopulmonary septum is formed. Thus, the OFT cushion is not derived from the aortopulmonary septum. In addition, the nonmyocardial part of the OFT is septated into the aorta and pulmonary trunk by the aortopulmonary septum, while the main part of the cushion fuses and septates the myocardial portion of the OFT. Key words: Aortopulmonary Septum; Human Embryonic Heart; Immunohistochemistry; Outflow Tract; Outflow Tract Cushion

// Xin-Wei Zhao 1, * , Yun-Bo Zhan 1, * , Jian-Ji Bao 1 , Jin-Qiao Zhou 1 , Feng-Jiang Zhang 1 , Yu Bin 1 , Ya-Hui Bai 1 , Yan-Min Wang 1 , Zhen-Yu Zhang 1 and Xian-Zhi Liu 1 1 Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China * These authors have contributed equally to this work Correspondence to: Zhen-Yu Zhang, email: neurozzy@foxmail.com Xian-Zhi Liu, email: xzliu06@126.com Keywords: gliomas; HOXD4; immunohistochemistry; TCGA; prognosis Received: November 03, 2017 Accepted: December 05, 2017 Published: December 18, 2017 ABSTRACT Backgrounds: HOX (homologous box) is known as the dominant gene of vertebrate growth and cell differentiation. Abnormal expression of HOX gene in various tumors has attracted the attention of scholars. As a component of HOX clusters, HOXD4 plays a controversial role in the tumorigenesis of central nervous system. Results : The data demonstrated that and the results demonstrated that HOXD4 was overexpressed in glioma tissues compared to that of normal brain tissues. patients with high HOXD4 expression had a significant shorter survival than those with low HOXD4 expression in total glioma cohort ( p

We propose that dual-band coherent perfect absorption in the infrared can be achieved in a metasurface, which contains periodical symmetrically patterned elliptical graphene array on both sides of the silicon dioxide film. The physical mechanism of dual-band absorption is that the major and minor axes of the elliptical graphene disk have different widths and can produce resonances at different frequencies. Based on the independent resonances, the asymmetrically patterned metasurface can separately absorb light of different frequencies for TE and TM polarizations, which is useful to detect the polarization of incident light. In addition, the coherent absorptivity of each peak can be tuned by phase modulation and the dual-band absorption frequencies can be flexibly adjusted by changing the Fermi level of the graphene via chemical or electronic doping. Therefore, our proposed metasurface can achieve the double modulation for both absorption frequency and absorptivity, which make it a good candidate for optical switch and absorption modulator.

Nowadays, with the continuous integration of production network and business network, more and more Industrial Internet of Things and Internal Office Network have been interconnected and evolved into a large-scale enterprise-level intraindustry network. Terminal devices are the basic units of internal network. Accurate identification of the type of device corresponding to the IP address and detailed description of the communication behavior of the device are of great significance for conducting network security risk assessment, hidden danger investigation, and threat warning. Traditional cyberspace surveying and mapping techniques take the form of active measurement, but they cannot be transplanted to large-scale intranet. Resources or specific targets in internal networks are often protected by firewalls, VPNs, gateways, and other technologies, so they are difficult to analyze and determine by active measurement. In this paper, a passive measurement method is proposed to identify and characterize devices in the network through real traffic data. Firstly, a new graph structure mining method is used to determine the server-like devices and host-like devices; then, the NAT-like devices are determined by quantitative analysis of traffic; finally, by qualitative analysis of the NAT-like device traffic, it is determined whether there are server-like devices behind the NAT-like device. This method will prove to be useful in identifying all kinds of devices in network data traffic, detecting unauthorized NAT-like devices and whether there are server-like devices behind the NAT-like devices.

During neurological surgery, neurosurgeons have to transform the two-dimensional (2D) sectional images into three-dimensional (3D) structures at the cognitive level. The complexity of the intracranial structures increases the difficulty and risk of neurosurgery. Mixed reality (MR) applications reduce the obstacles in the transformation from 2D images to 3D visualization of anatomical structures of central nervous system. In this study, the holographic image was established by MR using computed tomography (CT), computed tomography angiography (CTA) and magnetic resonance imaging (MRI) data of patients. The surgeon's field of vision was superimposed with the 3D model of the patient's intracranial structure displayed on the mixed reality head-mounted display (MR-HMD). The neurosurgeons practiced and evaluated the feasibility of this technique in neurosurgical cases. We developed the segmentation image masks and texture mapping including brain tissue, intracranial vessels, nerves, tumors, and their relative positions by MR technologies. The results showed that the three-dimensional imaging is in a stable state in the operating room with no significant flutter and blur. And the neurosurgeon's feedback on the comfort of the equipment and the practicality of the technology was satisfactory. In conclusion, MR technology can holographically construct a 3D digital model of patient's lesions and improve the anatomical perception of neurosurgeons during craniotomy. The feasibility of the MR-HMD application in neurosurgery is confirmed.

Supplemental Digital Content is available in the text, Glioma is the most common malignant tumor in the central nervous system (CNS). Lower-grade gliomas (LGG) refer to Grade II and III gliomas. In LGG patients, seizure often appears as an initial symptom and play an important role in clinical performance and quality of life of the patients. To date, the relationship between the onset of seizures and the molecular pathology in gliomas is still poorly investigated. In this study, we investigate the potential relationship between isocitrate dehydrogenase (IDH)/telomerase reverse transcriptase promoter (TERTp) mutations and preoperative seizures in patients with LGG. 289 adult LGG patients were enrolled in this study. Data of clinical characteristics and molecular pathology were acquired. Sanger sequencing was used to detect IDH/TERTp mutations. Chi-square test was performed to determine if the IDH/TERTp mutations were associated with seizures and seizure types. In 289 LGG patients, preoperative seizures accounted for 25.3% (73/289), IDH mutations accounted for 34.3%(99/289), and TERTp mutations accounted for 44.3% (128/289). The correlation analysis demonstrated that IDH mutation is a significant factor influencing the occurrence of tumor-related epilepsy (P

Prospective study. The purpose of this study was to characterise risk factors for poor surgical outcome in patients with cervical spondylotic myelopathy (CSM). The prospective study included 110 consecutive patients who underwent surgical treatment for CSM. Surgical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score. JOA recovery rate

The Minimum Data Set (MDS) is an effective way to improve understanding of the assessing soil quality and understanding of the heterogeneity of soil quality and encourage the adaption of proper agriculture practice. However, a suitable evaluation method of the soil quality of Astragalus mongholicus and ecological link between this and the active ingredients, including astragalosides (I, II, and IV) and calycosin, was poorly known in the main cultivation region in China. This study selected 22 soil indicators and 4 active ingredients factors and used principle component analysis to construct MDS to determine a comprehensive set of indicators for assess soil quality and established the agriculture practice in the main cultivation regions of A. mongholicus. Our results indicated that the quality of A. mongholicus, based on the quality score of the active ingredients from the PCA, increased with an increase in the soil quality. The five soil factors, soil organic matter(SOM), soil total calcium(STCa), soil total gallium(STGa), soil total borom(STB), and soil total magnesium(STMg), were obtained within 10% of the highest score of the total soil scores and r

This cohort study assesses whether longitudinal patterns of habitual sleep duration are associated with subsequent risk of cardiovascular events and all-cause mortality in adults enrolled in a population-based study in China., Key Points Question Are longitudinal patterns of habitual sleep duration associated with subsequent risk of cardiovascular events and all-cause mortality? Findings In this cohort study that included 52 599 participants, 4 distinct sleep duration trajectories reported during a 4-year interval were identified. Compared with a stable sleep duration of 7.0 to 8.0 hours per night, normal-decreasing and low-increasing patterns were associated with increased risk of first cardiovascular events and all-cause mortality, respectively; individuals reporting consistently sleeping less than 5.0 hours per night had the highest risk. Meaning This study suggests that sleep duration trajectories with lower or unstable patterns may be associated with increased risk of subsequent first cardiovascular events and all-cause mortality., Importance Single self-reported measures of sleep duration are associated with adverse health outcomes; however, long-term patterns of self-reported sleep duration and their association with cardiovascular events (CVEs) and all-cause mortality remain unknown. Objective To determine whether trajectories of long-term vs single-measure sleep duration are associated with subsequent risk of CVEs and all-cause mortality. Design, Setting, and Participants The Kailuan study is a prospective, population-based cohort study that began in 2006. The present cohort included 52 599 Chinese adults without atrial fibrillation, myocardial infarction, stroke, or cancer to 2010. Trajectories in sleep duration from January 1, 2006, to December 31, 2010, were identified to investigate the association with risk of CVEs and all-cause mortality from January 1, 2010, to December 31, 2017. Data analysis was conducted from July 1 to October 31, 2019. Exposures Habitual self-reported nocturnal sleep durations were collected in 2006, 2008, and 2010. Trajectories in sleep duration for 4 years were identified by latent mixture modeling. Main Outcomes and Measures All-cause mortality and first incident CVEs (atrial fibrillation, myocardial infarction, and stroke) from 2010 to 2017 were confirmed by medical records. Based on the baseline sleep duration and patterns over time, 4 trajectories were categorized (normal stable, normal decreasing, low increasing, and low stable). Results Of the 52 599 adults included in the study (mean [SD] age at baseline, 52.5 [11.8] years), 40 087 (76.2%) were male and 12 512 (23.8%) were female. Four distinct 4-year sleep duration trajectory patterns were identified: normal stable (range, 7.4 to 7.5 hours [n = 40 262]), normal decreasing (mean decrease from 7.0 to 5.5 hours [n = 8074]), low increasing (mean increase from 4.9 to 6.9 hours [n = 3384]), and low stable (range, 4.2 to 4.9 hours [n = 879]). During a mean (SD) follow-up of 6.7 (1.1) years, 2361 individuals died and 2406 had a CVE. Compared with the normal-stable pattern and adjusting for potential confounders, a low-increasing pattern was associated with increased risk of first CVEs (hazard ratio [HR], 1.22; 95% CI, 1.04-1.43), a normal-decreasing pattern was associated with increased risk of all-cause mortality (HR, 1.34; 95% CI, 1.15-1.57), and the low-stable pattern was associated with the highest risk of CVEs (HR, 1.47; 95% CI, 1.05-2.05) and death (HR, 1.50; 95% CI, 1.07-2.10). Conclusions and Relevance In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality.

Inflammation and immunoreaction markers were correlated with the survival of patients in many tumors. However, there were no reports investigating the relationships between preoperative hematological markers and the prognosis of medulloblastoma (MB) patients based on the molecular subgroups (WNT, SHH, Group 3, and Group 4). A total 144 MB patients were enrolled in the study. The differences of preoperative hematological markers among molecular subgroups of MB were compared by One-way ANOVA method. Kaplan-Meier method was used to calculate the curves of progression free survival (PFS) and overall survival (OS). The comparison of survival rates in different groups were conducted by the Log-rank test. Multivariate analysis was used to evaluate independent prognostic factors. Increased preoperative NLR (neutrophil-to-lymphocyte ratio, PFS, P = 0.004, OS, P P = 0.028, OS, P = 0.003) predicted poor prognosis in patients with MB, while preoperative MLR (monocyte-to-lymphocyte ratio), MPV (mean platelet volume), PDW (platelet distribution width), and AGR (albumin-to-globulin ratio) were revealed no predictive value on the prognosis of patients with MB. Furthermore, high preoperative NLR and PLR predicted unfavorable prognosis in childhood MB patients. However, preoperative NLR and PLR were not associated with the prognosis in adult MB patients. Multivariate analysis demonstrated preoperative NLR (PFS, P = 0.029, OS, P = 0.005) and PLR (PFS, P = 0.023, OS, P = 0.005) were the independent prognostic factors in MB patients. Emphatically, the levels of preoperative NLR and PLR in Group 3 MB were significantly higher than those in WNT MB. High preoperative NLR was associated with unfavorable OS in Group 3 (P = 0.032) and Group 4 (P = 0.027) tumors. Similarly, increased preoperative PLR predicted poor PFS (P = 0.012) and OS (P = 0.009) in Group 4 tumors. Preoperative NLR and PLR were the potential prognostic markers for MB patients. Preoperative NLR and PLR were significantly associated with the survival of Group 3 and Group 4 tumors.

Objective: To explore the epidemiological characteristics and the risk factors for methamphetamine (MA)—associated psychotic symptoms among MA users in China. Methods: A cross-sectional study was conducted between April, 2012 and October, 2015 among individuals for whom MA was the principal drug of use in a Compulsory Drug Detoxification Center in Beijing, Guangdong Province. Demographic, drug use and psychological characteristics were examined using a specifically-designed questionnaire, the Positive and Negative Syndrome Scale, Barratt Impulsive Scale, Hamilton Anxiety Scale and Beck Depression Inventory. Logistic regression was performed to explore the risk factors for MA-associated psychotic symptoms. Results: A total of 1685 participants were included. Participants were predominantly aged 30 or above, unemployed, and were unmarried Han Chinese men, with limited education. The duration of MA use was more than 3 months in 72.3%. 47.8% reported that the dose of MA use was ≥ 0.2 g per occasion of use. 11.5% had used two or more synthetic drugs. The prevalence of MA-associated psychotic symptoms was 17.0% among MA users during periods of abstinence. Multiple logistic regression analyses showed that a higher dose (≥0.2 g per time), a longer duration of MA use (>3 months) a history of heroin use and a history of tobacco use were associated with MA-associated psychotic symptoms, with adjusted odds ratios (ORs) of 1.96 (95% confidence interval [CI]: 1.40–2.76), 1.98 (95% CI: 1.33–2.96) and 2.45 (95% CI: 1.67–3.60), 1.78 (95% CI: 1.27–2.49) respectively. MA-associated psychotic symptoms were less common among married/cohabitating than unmarried (OR = 0.56; 95% CI: 0.39–0.81), and unemployed than employed (OR = 0.65; 95% CI: 0.47–0.92) individuals. MA users with anxiety and depression symptoms had significantly greater risk for MA-associated psychotic symptoms by 9.70 (6.92–13.59) and 1.90 (1.36–2.65) times respectively. Individuals with higher impulsivity were more likely to have MA-associated psychotic symptoms than those with lower (OR = 2.19; CI:1.50–3.20). Conclusion: MA-associated psychotic symptoms occurred frequently among MA users in China. The efforts that facilitate drug users' attempts to reduce MA use, abstain from poly-drug use, and control associated psychiatric symptoms and impulsivity should be supported because of their potential contribution to MA-associated psychotic symptoms in this population.

We demonstrate that multi-band coherent perfect absorption can be achieved at infrared frequencies by a metasurface in which four-sized columnar metal patches are separated by a dielectric layer in a unit cell. The absorption bandwidth is enhanced by three times compared with single-band absorption while high absorbance is maintained. The coherent perfect absorption is polarization-independent and can be independently modulated at each resonant frequency by tuning the phase difference of two coherent incident beams. Moreover, the resonant frequency is sensitive to the radius of the columnar patch, and thus a wide coherent perfect absorption frequency range can be obtained by adjusting the radius. Through optimizing the structural parameters, nearly perfect absorption at oblique incidence for both TE and TM polarizations are achieved. The optimized metasurface can be used as a beamsplitter at oblique incidence.

In order to study the performance of reinforcement anchorage connection with FRP restrained ring, static tensile tests were carried out on 66 specimens, The main parameters considered in the test such as the diameter of steel bars, the diameter and thickness of the restraint ring, the strength of concrete and the length of anchorage. The result shows that the anchorage performance of the steel bar can still be guaranteed even if the anchorage length reaches 0.8la, There is no slip and local destruction phenomenon between FRP restraint ring and internal grouting material and peripheral concrete. The study conclusions also indirectly prove that the proposed technique is a reinforcement connection method for fabricated concrete structures with many good performances including the reliable performance, simple construction process and good economic benefit, which is suitable for construction industrialization of prefabricated reinforced concrete structures..

The structural (under 5 GPa), electronic, optical and thermodynamic (under 30 GPa) properties of bulk-PtSe2 and two-dimensional 1-Layer-PtSe2 were investigated via the first-principle calculations. The calculated equilibrium parameters are in agreement with the available experimental data, investigated using X-ray diffraction, and the theoretical results. Electronic structure calculations show that the bulk-PtSe2 is a semimetal, while the 1-Layer-PtSe2 is a semiconductor with an indirect band gap width of 0.18 eV. We also calculated their optical properties and thermodynamic properties under high temperature and high pressure.

Background 99Tc-MDP has been used in Chinese RA patients for over 15 years and many more studies have focused on this agent in RA. However, the previous studies limited in its effect on the effects of anti-inflammation. As a special form of bisphosphonate, the anti-osteoporotic effect of 99Tc-MDP is unclear. Objectives To systematically investigate the effect of technetium-99 conjugated with methylene diphosphonate (99Tc-MDP), an anti-inflammatory drug effective in treating rheumatoid arthritis (RA), on cortical and cancellous bones in glucocorticoid-induced osteoporotic (GIO) rats, as well as comparing the effect of 99Tc-MDP with that of methylene diphosphonate (MDP). Methods Forty-eight Sprague-Dawley rats were randomly divided into six groups: blank, negative control, high dose, medium dose, low dose, and positive control groups. After dexamethasone was given to all groups except the blank group to induce osteoporosis, the rats in different groups were treated with saline, MDP, or different doses of Results Micro-CT analyses showed that: (1) 99Tc-MDP reversed glucocorticoid induced bone microarchitecture destruction by increasing vBMD, BV/TV, Tb.Th, Tb.N and decreasing BS/BV, Tb.Sp and TBPf; (2) effect of 99Tc-MDP increased as its dosage increased; and (3) 99Tc-MDP could improve cortical bone thickness while MDP failed to do so. Micro-CT spatial structure analysis and histology also yielded consistent results, indicating 99Tc-MDP increased trabecular number and connectivity morphologically. Finally, biomechanics revealed 99Tc-MDP can enhance the extrinsic stiffness of bone by changing bone geometry. Conclusions 99Tc-MDP has anti-osteoporotic effect by improving both cancellous and cortical bone, as well as increasing extrinsic bone stiffness. The dual effect of 99Tc-MDP, anti-inflammatory and anti-osteoporotic, may suggest a potential clinical application for patients with both GIO and RA. References Hoes JN, Jacobs JW, Buttgereit F, et al. Current view of glucocorticoid co-therapy with DMARDs in rheumatoid arthritis. Nature reviews Rheumatology 2010;6:693–702. Bijlsma JW. Disease control with glucocorticoid therapy in rheumatoid arthritis. Rheumatology 2012;51 Suppl 4:iv9–13. Acknowledgements We thank Mr. Kai Gao for providing the rats and Dr. Min Feng for assistance in histological processing of the rats. This work was supported by grants from the Natural Science Foundation of China (81501396 to Dr. Lianjie Shi, and 81302554 to Dr. Fanlei Hu). Disclosure of Interest None declared

This paper describes the reactive ion etching (RIE) technique of micro mechanical pendulum chip. Micro mechanical pendulum chip processed by the RIE has excellent performances and surface of the chip is smoother than the chip by wet etching. Properties of chip are closely associated with the process parameters. Reactive ion etching technique improves the problems such as intricate lateral etching and surface deficiency of the wet etching. On the basis of method and many experiments of the ion etching, relation between etching rate, etching uniformity, sidewall profiles and process parameters was analyzed and a set process parameters with greater etching effect was obtained. The set process parameters includes etching depth 55μm, etching uniformity (U) 0.63% and selectivity (P) 90:1, etching rate (V) 5.75μm/min, verticality of sidewall 90°±1°.

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

Type 2 diabetes mellitus (T2DM) patients are commonly comorbid with psychological distress, such as depressive symptoms, anxiety symptoms, and diabetes distress, which cause great health and economic burden. However, the estimated prevalence of this psychological comorbidity is quite different between studies. Our aim is to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, and diabetes distress in T2DM patients in China. Two Chinese academic databases (China National Knowledge Infrastructure and Wanfang) and two English academic databases (PubMed and Embase) were systematically searched for studies with information on the prevalence of depressive symptoms, anxiety symptoms, and diabetes distress among Chinese T2DM patients published from inception to April 20, 2018. Random-effects meta-analysis was performed to estimate the pooled prevalence. Data were extracted from 80 cross-sectional studies involving 31874 Chinese T2DM patients. The pooled prevalence of depressive symptoms, anxiety symptoms, and diabetes distress were 37.8% (95% confidence interval [CI] 34.6–41.0), 28.9% (95% CI 21.0–36.9), and 50.5% (95% CI 42.4–58.7), respectively. Patients aged 60 years or older have higher prevalence than patients aged

A kind of new dynamic modeling method is presented based on improved genetic algorithm (IGA) and wavelet neural networks (WNN) and the principle of algorithm is introduced for a new type robot wrist force sensor. The dynamic model of the wrist force sensor is set up according to data of the dynamic calibration, where the structure and parameters of wavelet neural networks of the dynamic model are optimized by genetic algorithm. The results show that the proposed method can overcome the shortcomings of easy convergence to the local minimum points of BP algorithm, and the network complexity, the convergence and the generalization ability are well compromised and the training speed and precision of model are increased.

The method of uniform design is applied in this paper to obtain the design of computer experiments and 3 factors (11 levels for each factor) are selected. The Gaussian Kriging model is built on the basis of the computer experiments results and will be used as a surrogate model for the optimization design of the front platen. 10 design points are selected to verify the prediction ability of the Gaussian Kriging model after it is obtained. It is shown that the maximum of the relative error of the Gaussian Kriging model is 2.53% and the minimum is 0.63%. Therefore the Gaussian Kriging model built in this paper is effective and practical for the optimization of the front platen. This paper provides a convenient method for the designers in the optimization for parts that have very complex geometry (not only for front platens). Meanwhile, the building method for the surrogate model is also very useful when the computing cost of the FEA for the real system is very large.

Considering the whole life cycle of fish processing industry, a complex cleaner production (CP) evaluation indicator system is established by applying the method of analytic hierarchy process (AHP), including a target layer, a criteria layer with 7 indexes and an indicator layer with 26 indexes. The system contains both quantitative and qualitative indicators, which can help enterprises to evaluate their CP level and find CP potential for improving the environmental performance.

The problem caused by large water consumption in a dyeing and finishing industrial park needs to be solved urgently. In this paper, a mathematical programming model for water integration in the dyeing and finishing industrial park (DFIP) is established. This model can optimize the water network on the basis of the minimum total annual cost. The superstructure, base of the formulas, considers shared multistage wastewater treatment facilities according to the real situation of DFIP, which is not involved in the previous study. It allows the wastewater reuse in the same plant and the water exchange with different plants. The treated water from each stage of shared multistage treatment facilities could be segregated and directed to the plants for reuse, to the next stage for advanced treatment, and/or discharged to the environment. In addition, this study also develops a water metabolism analytical method to ensure the practicability of the model. It mainly functions as analyzing the wastewater quality and water quality requirement for dyeing and finishing plant, which aims at both exploring potential water recovery and amending impractical water connections. The results obtained in a practical example indicate that the water reuse rate of the optimized water network reaches up to 73 % and the total annual cost can be decreased by 54 %.

A fast algorithm of single image super-resolution reconstruction using a revised statistical prediction model based on dictionary learning has been proposed in the paper. The statistical prediction model uses MMSE estimator to promote performance cascading several levels of the basic algorithm. Although this approach has advantage than the existing approaches that based on a pair of low and high resolution dictionary. These approaches have computational complexity for training dictionary. The revised model focuses on handling the single image based on recognition model. The single image is divided into two parts: the main information part and the background part. The recognition model is utilized to find the region of main information of a single image. The main information is only designed for learning parameters to reduce the complexity. The background image is processed by Tikhonov Regularization super resolution reconstruction, which reduce the running time in spite of having bad edges and textures. The proposed algorithm provides lower computational complexity and running time than the statistical prediction model, when completing the dictionary training.

Many schizophrenia susceptibility loci have been identified through genome-wide association studies (GWASs) in European populations. However, until recently, schizophrenia GWASs in non-European populations were limited to small sample sizes and have yielded few loci associated with schizophrenia. To identify genetic risk variations for schizophrenia in the Han Chinese population, we performed a two-stage GWAS of schizophrenia comprising 4384 cases and 5770 controls, followed by independent replications of 13 single-nucleotide polymorphisms in an additional 4339 schizophrenia cases and 7043 controls of Han Chinese ancestry. Furthermore, we conducted additional analyses based on the results in the discovery stage. The combined analysis confirmed evidence of genome-wide significant associations in the Han Chinese population for three loci, at 2p16.1 (rs1051061, in an exon of VRK2, P=1.14 × 10-12, odds ratio (OR)=1.17), 6p22.1 (rs115070292 in an intron of GABBR1, P=4.96 × 10-10, OR=0.77) and 10q24.32 (rs10883795 in an intron of AS3MT, P=7.94 × 10-10, OR=0.87; rs10883765 at an intron of ARL3, P=3.06 × 10-9, OR=0.87). The polygenic risk score based on Psychiatric Genomics Consortium schizophrenia GWAS data modestly predicted case-control status in the Chinese population (Nagelkerke R2: 1.7% ~5.7%). Our pathway analysis suggested that neurological biological pathways such as GABAergic signaling, dopaminergic signaling, cell adhesion molecules and myelination pathways are involved in schizophrenia. These findings provide new insights into the pathogenesis of schizophrenia in the Han Chinese population. Further studies are needed to establish the biological context and potential clinical utility of these findings.

It’s very difficult to machine titanium alloy because of its features of small deformation coefficient, low thermal conductivity, small elastic modulus and large chemical activity. In this paper, we take titanium alloy TC4 as an example; using the finite element method (FEM) for the physical simulation of milling process, analyze the impact of some tool geometric parameters, such as rake angle, relief angle, rounded cutting edge radius etc., on chip form, cutting force, cutting temperature distribution of cutting tool and the maximum cutting temperature of rake face etc.. On this basis, we choose the best tool geometries, which can be taken as a theoretical reference for developing process plans of titanium alloy to reduce the number of tests and costs of field trials and to improve productivity.

This study presents a novel bidirectional dc-dc buck-boost converter compatible with the flywheel energy storage system (FESS) and a robust control for bidirectional power flow, according to the single cycle average current control scheme and proportional-integral (PI) control theory. The proposed converter and its control are designed to adjust voltage to achieve current limiting start up and final speed keeping of the motor in charge mode and maintain a constant output voltage in the case that terminal voltage of the motor in the FESS drops continually in discharge mode. Simulation results demonstrate high performance of the converter in both steady-state and dynamic operations.

The flow field structures can have a large influence on both flow velocity and temperature distributions of the direct methanol fuel cells (DMFCs), thus proper flow field constructions are very important for the improvement in DMFC’s performance. In this work, anodic flow velocity and temperature distributions based on four different designs, including double serpentine, parallel, helix and single serpentine, were simulated in three-dimensional models. Computational fluid dynamics (CFD) was used to investigate the effects of flow field structures on the DMFC’s performance. Simulated results indicate that the double-serpentine flow field shows better flow velocity distribution and more uniform temperature distribution, which might lead to a better performance of the DMFC. Further experimental investigation on four types of flow fields also confirmed that the DMFC with double-serpentine flow field structure exhibits a maximal power density at a variety of inlet velocities, which is in good agreement with the simulated results. The maximum power density of the fabricated DMFC with double-serpentine flow field is ca. 34.2 mW cm −2 when the inlet flow velocity was 0.01 m s −1 at room temperature.

Now, pneumatic rotary anchor roofbolter is widely used in the underground. Pneumatic rock driller is mainly operated in hard rock tunnel, but it often exists in the phenomenon of hard rock and soft rock sections alternately. The result is occured in the replacement of drilling rigs and drilling tools, to produce a great deal of inconvenience. This not only affects seriously anchorage operating speed, but also increases production costs and brings insecurities factors of replacing driller. This study analyzes the performance and parameters of traditional rock rigs & roofbolter. Mechanical Model is established on the basis of studying rock breaking mechanism. Drilling parameters are comprehensively evaluated. It is put forword of specific rotary-impact function of pneumatic anchor rock driller. On this basis, specific rotary-impact function of pneumatic anchor rock driller has been systematically studied.

This paper provides a detailed description of deep-sea pipeline steel developed at Wuhan Iron and Steel Company(Group), WISCO for short. The thickness of the trial produced plates is 28mm. The chemical composition of low C-high Mn-Nb-Ti with proper content of other alloys and thermo-mechanical controlled process were applied. The results show that the deep-sea pipeline steel developed at Wuhan Iron and Steel Company has a good match of high strength, low temperature toughness and excellent deformability with fine uniform microstructure. The LSAW line pipe manufactured by JCOE method has high strength, good low temperature toughness and low yield ratio which comprehensively meet the requirements of the South China Sea Liwan pipeline project.

In this paper, we design a novel quantum secret information equal exchange protocol, which implements the equal exchange of secret information between the two parties with the help of semi-trusted third party (TP). In the protocol, EPR pairs prepared by the TP are, respectively, distributed to both the communication parties. Then, the two parties perform Pauli operation on each particle and return the new particles to TP, respectively. TP measures each new pair with Bell basis and announces the measurement results. Both parties deduce the secret information of each other according to the result of announcement by TP. Finally, the security analysis shows that this protocol solves the problem about equal exchange of secret information between two parties and verifies the security of semi-trusted TPs. It proves that the protocol can effectively resist glitch attacks, intercept retransmission attacks and entanglement attack.

The earthquake forces used in design codes of buildings should be theoretical determinable. This work examines the seismic force modification factorR based on elastic-plastic time-history earthquake analysis of SDOF systems, wherein the hysteresis models are elastic-perfectly-plastic (EPP), elastic-linearly-hardening (ELH), shear-slipped and bilinear-elastic. The latter two models are analysed for separating the effect of the ductility and the energy-dissipating capacity. Three-hundred eighty-eight earthquake records from different site conditions are used in analysis. The ductility is taken to be 2, 3, 4, 5 and 6, with the damping ratio being 0.02, 0.035 and 0.05 respectively. The post-yield stiffness ratios 0.0, 0.1 and 0.2 are used in the analysis. TheR spectra are standardized by the characteristic period of the earthquake records, which leads to a much smaller scatter in averaged numerical results. It was found that the most important factor determiningR is the ductility.R increases more than linearly with ductility. The energy-dissipating capacity, damping and the post-yield stiffness are the less important factors. The energy dissipating capacity is important only for structures with short period and moderate period (0.3≤T/T g

Using a detailed configuration accounting model with term structures treated by the unresolved transition array model, we have extensively investigated the opacities of mixture materials. For plasmas at the temperature of 250 eV and density of 1 g/cm3, our calculated Rosseland mean opacities are in good agreement with other theoretical results. A high increase in the Rosseland mean opacity to 2944 cm2/g is achieved for a multi-element mixture compared to the value of 1729 cm2/g for pure gold. Various mixtures at other plasma conditions are also studied.