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Traditional techniques for visual question answering ( VQA ) are mostly end-to-end neural network based, which often perform poorly (e.g., low accuracy) due to lack of understanding and reasoning. To overcome the weaknesses, we propose a comprehensive approach with following key features. (1) It represents inputs, i.e., an image I and a natural language question Q nl as an entity-attribute graph and a query graph, respectively, and employs pattern matching to find answers; (2) it leverages reinforcement learning based model to identify a set of policies that are used to guide visual tasks and construct an entity-attribute graph, based on Q nl ; (3) it employs a novel method to parse a question Q nl and generate corresponding query graph Q ( u o ) for pattern matching; and (4) it integrates inference scheme to further improve result accuracy, in particular, it learns a graph-structured classifier for missing value inference and a co-occurrence matrix for candidate selection. With these features, our approach can not only process visual tasks efficiently, but also answer questions with high accuracy. To evaluate the performance of our approach, we conduct empirical studies on Soccer , Visual-Genome and GQA , and show that our approach outperforms the state-of-the-art methods in result accuracy and system efficiency.

The occurrence of ureteral metastasis from distant primary tumors is uncommon, and appears to be especially rare when it originates from the lungs. In the case presented here, a patient with lumbago and left hydronephrosis was diagnosed with left ureteral metastasis of pulmonary adenocarcinoma after a CT‐guided percutaneous transthoracic needle biopsy of the lung and retroperitoneal laparoscopic left nephroureterectomy. He accepted the targeted therapy because the lung tumor epidermal growth factor receptor mutation (exon19 deletion) was positive, and preoperative staging of lung adenocarcinoma was stage IVA. After an 8‐month follow‐up, he is still alive and well, with no local recurrence or distant metastases. The therapy outcome assessment is stable disease. Although rare, our case has demonstrated that pulmonary adenocarcinoma has the possibility of metastasizing to the ureter, a risk that should be considered in some lung cancer patients., A patient with lumbago and left hydronephrosis was diagnosed with left ureteral metastasis of pulmonary adenocarcinoma after a CT‐guided percutaneous transthoracic needle biopsy of the lung and retroperitoneal laparoscopic left nephroureterectomy. Although rare, our case has demonstrated that pulmonary adenocarcinoma has the possibility of metastasizing to the ureter, a risk that should be considered in some lung cancer patients.

Background Coccidioidomycosis is a systemic infection caused by dimorphic fungi Coccidioides spp. endemic to Southwestern United States and Central and South America. A history of residence and travel in these areas is essential for the diagnostic of coccidioidomycosis, which has highly variable symptoms ranging from asymptomatic to severe, disseminated infection, and even death. Immunocompromised patients of coccidioidomycosis experience a high risk of dissemination, chronic infection, and mortality. Meningitis is one of the most deleterious coccidioidomycosis and can cause various life-threatening complications. Case presentation Here we report a case of Coccidioides posadasii meningitis in a 49-year-old female who returned to China after one and a half years residence in Los Angeles, USA. The repeated routine cultures using CSF for bacteria or fungi were all negative. To hunt for an infectious etiology, the state-of-the-art technology metagenomic next-generation sequencing (mNGS) was then utilized, suggesting Coccidioides posadasii. Organizational pathological examination and polymerase-chain-reaction (PCR) results subsequently confirmed the mNGS detection. Conclusion To our knowledge, cases for coccidioidal meningitis have been rarely reported in China. While global travelling may spread this disease across continents and make the diagnosis more difficult. mNGS can detect almost all known pathogens with high sensitivity and specificity, especially for uncommon pathogen, such as Coccidioides posadasii in China.

Current clinical agents for autoimmunity disorders treatment often cause substantial adverse effects and safety concerns, owing to non-specific immune modulation. Due to the prominent contribution of effector T cells in pathogenesis of rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), and preferential location of co-stimulatory receptor-ligand pair OX40-OX40L at the inflamed sites, selectively targeting autoaggressive T cells by blockade OX40-OX40L, might represent an alternative strategy. Herein, we developed a new strategy to antagonize OX40-OX40L interaction by engineering a cell membrane derived nanovesicles (NVs) expressing OX40 receptors (OX40 NVs), and explored their potential for autoimmune disorders therapy. OX40 NVs showed specific binding capability to inflamed HUVECs in vitro, it also possessed distinct arthritic-targeting capacity in RA inflamed joints, and preferential accumulation in IBD inflamed colon. OX40 NVs efficiently suppressed the progression of both RA and IBD diseases through reducing CD4+OX40+ T cells population, and proinflammatory cytokines (i.e., TNF-α and IL-1β), while reinforcing Tregs immune-suppressive effect, with superior therapeutic efficacy than anti-OX40L. Additionally, dexamethasone (DEX) loading can further enhance the potential of OX40 NVs for RA treatment. Owing to their preferential localization to inflamed sites, and potent immune-suppression ability, targeting OX40-OX40L blockade by OX40 NVs for autoimmune therapy is highly promising.

Objective: Smooth muscle cell (SMC) phenotypic switching is associated with development of a variety of occlusive vascular diseases. Paeonol has been reported to be involved in suppressing SMC proliferation. However, it is still unknown whether paeonol can regulate SMC phenotypic switching, and which eventually result in suppressing vasculogenesis. Methods: Murine left common carotid artery was injured by completely ligation, and paeonol was administrated by intraperitoneal injection. Hematoxylin and eosin (H&E) staining was performed to visualize vascular neointima formation. Rat aortic SMCs were used to determine whether paeonol suppresses cell proliferation and migration. And murine hind limb ischemia model was performed to confirm the function role of paeonol in suppressing vasculogenesis. Results: Complete ligation of murine common carotid artery successfully induced neointima formation. Paeonol treatment dramatically reduced the size of injury-induced neointima. Using rat aortic primary SMC, we identified that paeonol strongly suppressed cell proliferation, migration, and decreased extracellular matrix deposition. And paeonol treatment dramatically suppressed vasculogenesis after hind limb ischemia injury. Conclusion: Paeonol could regulate SMC phenotypic switching through inhibiting proliferation and migration of SMC, which results in inhibiting ischemia-induced vasculogenesis.

Coal gasification, recognized as one of the most effective coal utilization technologies, will produce a certain amount of fine ash during the high-temperature reaction process. The wettability of gasification fine ash is a critical parameter to characterize the degree of high-temperature reaction and determine the separation efficiency of purification process. In the present work, the effect of physicochemical properties on the wetting behavior of different gasification fine ash is studied. The difference in wettability between particle size and types can be explained by the unique properties of particles (i.e. pore structure, mineral composition, and chemical structure). The results show that with the decrease in particle size, the surface morphology transforms from an irregular shape with a rough surface to a spherical shape with a smooth surface. The pore structure, characterized by fractal surface dimension Ds, presents positive correlations with the contact angle for a single type of fine ash. The mineral composition can just qualitatively assess the hydrophilicity of particles. Only the ratio of hydrophilic chemical structure can be used as a generic parameter to describe the wetting performance. Meanwhile, the wettability of hydrophilic particles can be enhanced by increasing moisture content, but there is no significant effect of moisture content on the wettability of hydrophobic particles.

Breast cancer was the leading cause of newly diagnosed cases of tumors in 2020, ranking as the second highest cause of female death. Chemotherapy remains the conventional treatment of choice for breast tumors in most clinical cases. However, it is often accompanied by a poor prognosis and severe side effects, resulting from an insufficient accumulation of the drug at tumor sites and an unsystematic distribution of the drug across the body. Inspired by the fact that breast tumor cells overexpress integrin α2β1 on the surface, we designed and constructed an integrin α2β1 targeting DGEA-modified liposomal doxorubicin (DGEA-Lipo-DOX) platform for application in breast cancer therapy. The DGEA-Lipo-DOX was stable with a uniform particle size of 121.1 ± 3.8 nm and satisfactory drug encapsulation. Demonstrated in vitro and in vivo, the constructed platform exhibited improved antitumor ability. The DGEA-Lipo-DOX showed 4-fold enhanced blood circulation and 6-fold increased accumulation of DOX at the tumor sites compared to those of free DOX, resulting in a significantly enhanced antitumor efficacy in tumor-bearing mice. A preliminary safety evaluation suggested that the systemic toxicity of DOX was relieved by DGEA-Lipo delivery. Collectively, binding integrin α2β1 by DGEA may represent an alternative therapeutic strategy for potentially safer breast cancer treatment.

Photocatalytic water oxidation is a crucial step in water splitting, but is generally restricted by the slow kinetics. Therefore, it is necessary to develop high-performance water oxidation photocatalysts. Herein, the Fe-doped Bi2WO6 nanosheets with oxygen vacancies (OVs) were synthesized for enhanced photocatalytic water oxidation efficiency, showing a synergistic effect between Fe dopants and OVs. When a molar fraction of 2% Fe was doped into the Bi2WO6 nanosheets, the visible-light-driven photocatalytic oxygen evolution rate was increased up to 131.3 µmol·h−1·gcat−1 under ambient conditions, which was more than 3 times that of pure Bi2WO6 nanosheets. The proper doping concentration of Fe could promote the formation of OVs and at the same time modulate the band structure of catalysts, especially the position of the valence band maximum (VBM), leading to effective visible-light absorption and enhanced oxidizing ability of photogenerated holes. With ameliorated localized electron distribution, fast charge transfer channel emerged between the OVs and adjacent metal atoms, which accelerated the charge carrier transfer and promoted the separation of photoexcited electrons and holes. This work provides feasible approaches for designing efficient two-dimensional semiconductor water oxidation photocatalysts that could utilize visible-light, which will make more use of solar energy.

Chenye Feng,1 Mingtao Xu,1 Jian Kang,1 Fuqiang Wen,2 Yahong Chen,3 Jing Zhang,4 Wei Xiao,5 Zhonghe Zhang,6 Lan Yang,7 Jianmin Huo,8 Jie Cao,9 Li Zhao,10 Shuyue Xia,11 Yan Yin,1 Wei Wang1 1Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Disease, State Key Laboratory of Biotherapy of China, Chengdu, Sichuan, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Peking University, Third Hospital, Beijing, People’s Republic of China; 4Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 5Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, People’s Republic of China; 6Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaonign, People’s Republic of China; 7Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shanxi, People’s Republic of China; 8Department of Respiratory, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 9Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 10Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China; 11Department of Pulmonary Medicine, Central Hospital Affiliated with Shenyang Medical College, Shenyang, People’s Republic of ChinaCorrespondence: Jian KangDepartment of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of ChinaTel +86-024-83282530Fax +86-024-83282002Email kangjian58@163.comPurpose: The proportion of atypical pathogens in patient with AECOPD within mainland China is unknown. The objectives of this study were to determine the distribution of atypical pathogens among Chinese patients with AECOPD, to evaluate the clinical characteristics of different atypical pathogen infections, and to compare different detection methods for atypical pathogens.Patients and Methods: Specimens were collected from patients with AECOPD from March 2016 to November 2018 at eleven medical institutions in eight cities in China. Double serum, sputum, and urine samples were obtained from 145 patients. Serological and nucleic acid tests were used to assess for Mycoplasma pneumonia and Chlamydia pneumoniae; serological, urinary antigen, and nucleic acid tests were applied to detect Legionella pneumophila. The clinical characteristics of atypical pathogen-positive and -negative groups were also compared.Results: The overall positivity rate for Mycoplasma pneumoniae was 20.69% (30/145), with the highest rate being 20.00% (29/145) when determined by passive agglutination.The overall positive rates for Chlamydia pneumoniae and Legionella pneumophila were 29.66% (43/145) and 10.34% (15/145), respectively. The most common serotype of Legionella pneumophila was type 6. The maximum hospitalized body temperature, ratio of eosinophils, C-reactive protein (CRP) level, and procalcitonin (PCT) level of the Mycoplasma pneumoniae-positive group were significantly higher than those of the Mycoplasma pneumoniae-negative group. Patients in the Chlamydia pneumoniae-positive group smoked more, had higher proportions of comorbidities and frequent aggravations in the previous two years than those in the Chlamydia pneumoniae-negative group. Furthermore, the forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio assessment of lung function was higher, and the concentration of arterial blood bicarbonate (HCO3−) was lower in the Legionella pneumophila-positive group than in the Legionella pneumophila-negative group.Conclusion: Overall, atypical pathogens play an important role in AECOPD. Regarding the testing method, serological testing is a superior method to nucleic acid testing.Keywords: COPD, exacerbations, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila

Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was − 1.4 and mean total hip T-scores was − 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40–49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P

Objective: To develop and validate clinical prediction models for the development of a nomogram to estimate the probability of patients having coronary artery disease (CAD). Methods and Results: A total of 1,025 patients referred for coronary angiography were included in a retrospective, single-center study. Randomly, 720 patients (70%) were selected as the development group and the other patients were selected as the validation group. Multivariate logistic regression analysis showed that the seven risk factors age, sex, systolic blood pressure, lipoprotein-associated phospholipase A2, type of angina, hypertension, and diabetes were significant for diagnosis of CAD, from which we established model A. We established model B with the risk factors age, sex, height, systolic blood pressure, low-density lipoprotein cholesterol, lipoprotein-associated phospholipase A2, type of angina, hypertension, and diabetes via the Akaike information criterion. The risk factors from the original Framingham Risk Score were used for model C. From comparison of the areas under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement of models A, B, and C, we chose model B to develop the nomogram because of its fitness in discrimination, calibration, and clinical efficiency. The nomogram for diagnosis of CAD could be used easily and conveniently. Conclusion: An individualized clinical prediction model for patients with CAD allowed an accurate estimation in Chinese populations. The Akaike information criterion is a better method in screening risk factors. The net reclassification improvement and integrated discrimination improvement are better than the area under the receiver operating characteristic curve in discrimination. Decision curve analysis can be used to evaluate the efficiency of clinical prediction models.

To have the sparsity of deep neural networks is crucial, which can improve the learning ability of them, especially for application to high-dimensional data with small sample size. Commonly used regularization terms for keeping the sparsity of deep neural networks are based on L1-norm or L2-norm; however, they are not the most reasonable substitutes of L0-norm. In this paper, based on the fact that the minimization of a log-sum function is one effective approximation to that of L0-norm, the sparse penalty term on the connection weights with the log-sum function is introduced. By embedding the corresponding iterative re-weighted-L1 minimization algorithm with k-step contrastive divergence, the connections of deep belief networks can be updated in a way of sparse self-adaption. Experiments on two kinds of biomedical datasets which are two typical small sample size datasets with a large number of variables, i.e., brain functional magnetic resonance imaging data and single nucleotide polymorphism data, show that the proposed deep belief networks with self-adaptive sparsity can learn the layer-wise sparse features effectively. And results demonstrate better performances including the identification accuracy and sparsity capability than several typical learning machines.

Aiming at the problems of low recognition rate and slow recognition speed of traditional body action recognition methods, a human action recognition method based on data deduplication technology is proposed. Firstly, the data redundancy technology and perceptual hashing technology are combined to form an index, and the image is filtered from the structure, color, and texture features of human action image to achieve image redundancy processing. Then, the depth feature of processed image is extracted by depth motion map; finally, feature recognition is carried out by convolution neural network so as to achieve the purpose of human action recognition. The simulation results show that the proposed method can obtain the optimal recognition results and has strong robustness. At the same time, it also fully proves the importance of human motion recognition.

Diabetic neuropathic pain (DNP) is a common complication of diabetes characterized by persistent pain. Emerging evidence links astrocytes to mechanical nociceptive processing, and the motor cortex (MCx) is a cerebral cortex region that is known to play a key role in pain regulation. However, the association between MCx astrocytes and DNP pathogenesis remains largely unexplored. Here, we studied this association using designer receptors exclusively activated by designer drugs to specifically manipulate MCx astrocytes. We proved that the selective inhibition of MCx astrocytes reduced DNP in streptozocin (STZ)-induced DNP models and discovered a potential mechanism by which astrocytes release cytokines, including TNF-α and IL-1β, to increase neuronal activation in the MCx, thereby regulating pain. Together, these results demonstrate a pivotal role for MCx astrocytes in DNP pathogenesis and provide new insight into DNP treatment strategies.

Vascular rings (VRs) are defined as congenital abnormalities of the aortic arch and its branches. VR can form a ring that may compress the esophagus and trachea, which likely result in feeding difficulties and respiratory distress. Physicians performing fetal echocardiography are knowledgeable about VRS and can provide this information to pediatric cardiothoracic surgeons. However, VRs are rare and can be missed. The three vessels and trachea (3VT) view used to diagnose VRs has been reported in the literature multiple times but in a small series. We diagnosed three cases of VRs using high-definition (HD) flow render mode and spatiotemporal image correlation (STIC). The composition of the VRs and vessel connections were shown more intuitively. This article reports our experience of the following related cases. In addition, postnatal imaging features of VRs were also evaluated.

To explore the incidence, severity, and risk factors of multidimensional fatigue in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT). This prospective study included 79 patients with NPC in Guangzhou (China) from June 2015 to July 2018. Data were collected before and after CCRT, including demographic and clinical characteristics, nutritional parameters, and fatigue scores, based on completion of the Multiple Dimensional Inventory-20 Questionnaire, with five subscales: General Fatigue, Mental Fatigue, Physical Fatigue, Reduced Activity, and Reduced Motivation. Increased general fatigue was found to be associated with lower lymphocyte count and body mass index 42 years. Higher scores for reduced activity were associated with age > 42 years, female sex, and lower serum sodium. Increased mental fatigue was related with lower lymphocyte count and unemployment; and increased total fatigue was associated with lower lymphocyte count, age > 42 years, and 3–6 courses of treatment. Furthermore, 3–6 courses of treatment was an independent predictor of severe general fatigue, while age >42 years was an independent predictor of severe physical fatigue. Importantly, cancer stage IVB and 3–6 courses of treatment could predict severe total fatigue. Our data demonstrate that fatigue is increased in all dimensions in NPC patients following CCRT, and that the predictors differ for each fatigue dimension. These results could guide the development of targeted interventions that may reduce the impact of cancer-related fatigue in patients with NPC.

To summarize the outcomes of different surgical treatment modalities for cesarean scar pregnancy (CSP) at a single institution over 8 years. A case series of patients diagnosed with CSP who were admitted to Nanjing Drum Tower Hospital from January 2011 to December 2018 was retrospectively studied. Medical records of all the patients were carefully reviewed. Data on patient demographics, pregnancy characteristics, treatment modalities, response to therapy, and subsequent pregnancy outcomes were collected and analyzed. A total of 117 patients undergoing surgical treatments for CSP were included. Thirty-three patients (28.21%) underwent ultrasound-guided curettage; while, 74 (63.25%) and 10 (8.55%) patients received laparoscopy-monitored curettage and laparoscopic CSP resection, respectively. Most of the patients (21/33) who underwent ultrasound-guided surgery had type I CSP; while, 54 out of 84 patients who opted for laparoscopic surgeries had type II CSP. Eleven women underwent a uterine artery embolization procedure before the operation. There was no difference in the use of an intrauterine balloon for hemostasis among the three groups. Only 8 patients needed additional systemic methotrexate treatment. Twenty-four out of 57 women (42.11%) succeeded in conceiving again and gave birth to 21 healthy babies. Only 1 woman (1/24, 4.17%) experienced recurrence of CSP. These data indicated the safety and efficiency of ultrasound-guided curettage, laparoscopy-monitored curettage, and laparoscopic CSP resection for the treatment of CSP.

The Congenital Heart Disease Genetic Knowledge Base (CHDGKB) was established in 2020 to provide comprehensive knowledge about the genetics and pathogenesis of non-syndromic CHD (NS-CHD). In addition to the genetic causes of NS-CHD, environmental factors such as maternal drug use and gene-environment interactions can also lead to CHD. There is a need to integrate this information into a platform for clinicians and researchers to better understand the overall risk factors associated with NS-CHD. The updated CHDGKB contains the genetic and non-genetic risk factors from over 4200 records from PubMed that was manually curated to include the information associated with NS-CHD. The current version of CHDGKB, named CHD-RF-KB (KnowledgeBase for non-syndromic Congenital Heart Disease-associated Risk Factors), is an important tool that allows users to evaluate the recurrence risk and prognosis of NS-CHD, to guide treatment and highlight the precautions of NS-CHD. In this update, we performed extensive functional analyses of the genetic and non-genetic risk information in CHD-RF-KB. These data can be used to systematically understand the heterogeneous relationship between risk factors and NS-CHD phenotypes.

Objective To understand the psychological process of patients with post-herpetic neuralgia (PHN) and provide references for the psychological management of PHN. Methods The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients, and Colaizzi's phenomenological analysis method was used for data analysis. Results According to the different pain durations of PHN patients, the patients were divided into three stages and five themes were extracted: the need for strong pain relief, the helpless tolerance of pain, the self-feeling burden, the need for health education, and the positive response to pain. Conclusions PHN has complex psychological activities, so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Background It has been shown that the prognosis of malignant tumors was closely related to the composition and function of immune system, which was associated with genomic features. However, the prognostic value of peripheral T lymphocyte subsets and its relationship with genomic features in lung cancer has not been analyzed extensively. Therefore, this study was intended to evaluate the relationship between lymphocyte subsets and the prognosis and genomic features of lung cancer. Methods 598 lung cancer patients with complete data were included in this study between 2011 and 2018. Kaplan-Meier method and Pearson analyses were conducted to study the prognostic value of CD3+, CD4+, CD8 + T lymphocytes and the rate of CD4/CD8. Results Patients with EGFR mutation has lower percentage of CD8 + lymphocytes than patients with EGFR wild-type (24.71 versus 26.62, respectively, P = 0.041). Patients with high CD3 + had better OS than those with low (27 versus 14 months, P = 0.002). OS of higher CD4 + and CD4/CD8 rate had longer OS than of lower (27 versus 12 months, P = 0.002; 25 versus 9 months, P = 0.008, respectively). Patients with high CD8 + had poor PFS than low group (6 versus 11 months, P = 0.009). There was a negative correlation between CD3 + and CD4 + cells and OS in smoking stage 2 female lung cancer patients (PCC = 0.626, P

This study evaluated the non-thermal effects of microwave on bovine lens by measuring the S-parameters induced by the dielectric coefficient variation in bovine lens. A closed, integrated biological experiment system was designed to expose bovine lens to microwave radiation quantitatively, and S-parameters were measured. Morphological evaluations were also performed during microwave radiation to evaluate the reaction mechanism of the non-thermal effects of microwave on the bovine lens. The results showed that the bovine lens became gradually cloudy and its refractive index changed significantly with increasing doses of microwave radiation. A comparison of experimental and control bovine lenses stained with hematoxylin and eosin revealed that the change in bovine lens might be a result of the nuclear fragmentation of lens epithelial cells and disorderly arrangement of lens fiber cells, which were induced by the vibration and friction of fiber tissues upset by microwave radiation. Further, the fluctuating decrements of 3.8 dB in S21 showed that the non-thermal effects of microwave could lead to the variations in the bovine lens dielectric coefficient. These findings suggest that the dielectric coefficient may quantitatively describe the physiological state of bovine lens. This study might be the valuable reference for the establishment of new electromagnetic radiation safety standard.

Phage therapy is recognized as a promising alternative to antibiotics in treating pulmonary bacterial infections, however, its use has not been reported for treating secondary bacterial infections during virus pandemics such as coronavirus disease 2019 (COVID-19). We enrolled 4 patients hospitalized with critical COVID-19 and pulmonary carbapenem-resistant Acinetobacter baumannii (CRAB) infections to compassionate phage therapy (at 2 successive doses of 109 plaque-forming unit phages). All patients in our COVID-19-specific intensive care unit (ICU) with CRAB positive in bronchoalveolar lavage fluid or sputum samples were eligible for study inclusion if antibiotic treatment failed to eradicate their CRAB infections. While phage susceptibility testing revealed an identical profile of CRAB strains from these patients, treatment with a pre-optimized 2-phage cocktail was associated with reduced CRAB burdens. Our results suggest the potential of phages on rapid responses to secondary CRAB outbreak in COVID-19 patients.

Metastasis is the primary cause of an unfavourable prognosis in patients with malignant cancer. Over the last decade, the role of proteinases in the tumour microenvironment has attracted increasing attention. As a sensor of proteinases, proteinase-activated receptor 2 (PAR2 ) plays crucial roles in the metastatic progression of cervical cancer. In the present study, the expression of PAR2 in multiple types of cancer was analysed by Gene Expression Profiling Interactive Analysis (GEPIA). Kaplan-Meier plotter was used to calculate the correlation between survival and the levels of PAR2 , Grb-associated binding protein 2(Gab2) and miR-125b. Immunohistochemistry (IHC) was performed to examine PAR2 expression in a tissue microarray (TMA) of CESCs. Empower Stats was used to assess the predictive value of PAR2 in the metastatic potential of CESC. We found that PAR2 up-regulation was observed in multiple types of cancer. Moreover, PAR2 expression was positively correlated with the clinicopathologic characteristics of CESC. miR-125b and its target Gab2, which are strongly associated with PAR2 -induced cell migration, are well-characterized as predictors of the prognostic value of CESC. Most importantly, the Cancer Genome Atlas (TCGA) data set analysis showed that the area under the curve (AUC) of the PAR2 model was significantly greater than that of the traditional model (0.833 vs 0.790, P < .05), demonstrating the predictive value of PAR2 in CESC metastasis. Our results suggest that PAR2 may serve as a prognostic factor for metastasis in CESC patients.

Macrophages are a double-edged sword with potential cancer-promoting and anticancer effects. Controversy remains regarding the effect of macrophages, especially M1 macrophages, on tumor promotion and suppression. We aimed to investigate the role of M1 macrophages in the occurrence and progression of esophageal squamous cell carcinoma (ESCC). Analyzing the data in Gene Expression Omnibus database by the CIBERSORT algorithm found that M1 macrophages were one of the important components of many immune cells in ESCCs, and the increase in their number was obviously negatively correlated with tumor T staging. This result was verified by our experimental data: the density of CD68/HLA-DR double-stained M1 macrophages in ESCC tumor nest and tumor stroma was significantly higher than that in cancer-adjacent normal (CAN) tissues. The density of M1 macrophages in ESCC tumor nest was negatively correlated with the patient’s lymph node metastasis and clinical stage (P < 0.05), and the negative tendency was more obvious for M1 macrophages in ESCC tumor stroma (P < 0.001). Exposure to M1 macrophage-conditioned medium inhibited ESCC cell migration and invasion ability significantly (P < 0.05). Moreover, the increased M1 macrophage density in ESCC tumor stroma correlated positively with good prognosis of ESCC. M1 macrophages were involved in inhibiting ESCC cell migration and invasion, which could serve as a good prognostic factor in patients with ESCC.

Biometric identification has verified its effectiveness in personal identity verification because of the uniqueness and noninvasion. In this research, we tend to apply the detection of biometric information to a remote sensing system for the purpose of security area monitoring. Our system is established by collecting signals from the coming individuals via the remote measurement in the specific condition where both kinds of data are detected to determine the identity. Specifically, the measuring of gait signals and facial images is integrated to provide a way of improving the detection accuracy and the robustness. In addition, the fuzzy association rule (FAR) is employed for data analysis in line with the outcomes of different methods. As such, the signals are integrated and transmitted for further processing and remote identification. Experiments are conducted to demonstrate the capability of the proposed system. With the training data increases, a high detection accuracy of 95.2% is obtained, which makes it a promising basis for the realization of remote identity verification.

Diffuse plane xanthomas (DPX) is a rare, chronic, metabolic skin disease which can seriously affect the appearance of the patients and result in psychological problems. Existing treatments are seriously limited. Our objective was to assess the efficacy of and tolerance to simvastatin ointment for the treatment of skin lesions in seven DPX patients. In this study, patients were treated twice daily on the right side of the lesions for 10 months with the 1% or 5% simvastatin ointment. Meanwhile, the left body was untreated as a contralateral controlled side. Efficacy was assessed via the change of rash and was further confirmed by histological study. For all seven participants, both the 1% and 5% simvastatin ointments were effective. The histological change in DPX showed significant decrease of foam cells in skin lesions. The immunohistochemical staining of CD68, macrophage scavenger receptor type 1, oxidized low-density lipoprotein receptor 1 and Oil Red O became obviously reduced after treatment. The test medicines were safe with only some skin-related side-effects. This is the first research reported on simvastatin ointment treatment in DPX. Our results are the first to suggest that simvastatin ointment is effective in improving skin lesions of DPX clinically and histopathologically.

Objectives To investigate the incidence of the single umbilical artery (SUA) malformation and postpartum outcomes in a retrospective analysis of 781 fetuses. Materials and methods This retrospective analysis included 781 pregnant women carrying singleton fetuses diagnosed with SUA at Gansu Provincial Maternal and Child-care Hospital between 2013 and 2019. Detailed data on maternal and fetal characteristics and postpartum outcomes were obtained. Results In total, 624 (79.9 %) fetuses were diagnosed with isolated SUA and 157 (20.1 %) fetuses had SUA together with other structural and/or chromosome abnormalities. The highest incidence of malformation was found in the urinary system, followed by the cardiovascular system and digestive system. The incidence of SUA was 59.1 % on the right side and 40.9 % on the left side. Fetuses with SUA and other abnormalities tended to have a lower mean birth weight (3061 g vs 3201 g, p Conclusions After a diagnosis of SUA, structural observation of the fetus is required. The urinary, cardiovascular and digestive systems should be the focus of observation. If relevant malformations are found, then genetic testing must be performed. With isolated SUA, dynamic monitoring of biological indicators is recommended for lower birth weight, but genetic testing is not recommended.

Highlights • The numbers of CD3+, CD4+ and CD8+ T lymphocyte were significantly lowered in COVID-19 patients. • The numbers ofCD3+, CD4+ and CD8+ T lymphocyte were significantly lower in critical group than in moderate group (P, Background We observe changes of the main lymphocyte subsets (CD16+CD56、CD19、CD3、CD4、and CD8) in COVID-19-infected patients and explore whether the changes are associated with disease severity. Methods One-hundred fifty-four cases of COVID-19-infected patients were selected and divided into 3 groups (moderate group, severe group and critical group). The flow cytometry assay was performed to examine the numbers of lymphocyte subsets. Results CD3+, CD4+ and CD8+ T lymphocyte subsets were decreased in COVID-19-infected patients. Compared with the moderate group and the sever group, CD3+, CD4+ and CD8+ T cells in the critical group decreased greatly (P < 0.001, P= 0.005 or P = 0.001). Conclusions Reduced CD3+, CD4+, CD8+ T lymphocyte counts may reflect the severity of the COVID-19. Monitoring T cell changes has important implications for the diagnosis and treatment of severe patients who may become critically ill.

Asia-Pacific (APAC) has been the world’s most dynamic emerging area of economic development and trade in recent decades. Here, we reveal the significant and imbalanced environmental and socio-economic effects of the region’s growths during 1995–2015. Owing to the intra-regional trade of goods and services, APAC economies grew increasingly interdependent in each other’s water and energy use, greenhouse gas (GHG) and PM2.5 emissions, and labor and economic productivity, while the environmental and economic disparity widened within the region. Furthermore, our results highlight APAC’s significant role in globalization. By 2015, APAC was engaged in 50–71% of the virtual flows of water, energy, GHG, PM2.5, labor, and value added embodied in international trade. While the region’s final demand and trade grew less resource- and emissions-intensive, predominantly led by China’s transformations, APAC still lags behind global averages after two decades. More joint efforts of APAC economies and attention to sustainable transformation are needed., The environmental and socio-economic implications of the growth in welfare and trade in Asia-Pacific (APAC) remain unclear. Here the authors show that over the past two decades (1995–2015), owing to intraregional trade, the APAC economies have grown increasingly interdependent in natural resource use, air emissions, and labor and economic productivity.

Summary Optical whispering-gallery mode (WGM) microresonators, confining resonant photons in a microscale volume for long periods of time, strongly enhance light-matter interactions, making them an ideal platform for photonic sensors. One of the features of WGM sensors is their capability to respond to environmental perturbations that influence the optical mode distribution. The exceptional sensitivity of WGM devices, coupled with the diversity in their structures and the ease of integration with existing infrastructures, such as conventional chip-based technologies, has catalyzed the development of WGM sensors for a broad range of analytes. WGM sensors have been developed for multiplexed detection of clinically relevant biomolecules while also being adapted for the analysis of single-protein interactions. They have been used for the detection of materials in different phases and forms, including gases, liquids, and chemicals. Furthermore, WGM sensors have been used for a wide variety of field-based sensing applications, including electric field, magnetic field, force, pressure, and temperature. WGM sensors hold great potential for applications in life and environmental sciences. They are expected to meet the ever-increasing demand in sensor networks, the Internet of Things, and real-time health monitoring. Here we review the mechanisms, structures, parameters, and recent advances of WGM microsensors and discuss the future of this exciting research field., Progress and Potential As a sensing platform that strongly enhances light-matter interactions, whispering-gallery mode (WGM) microresonators have been used for the detection of not only physical matters, such as nanoparticles, small bio/chemical molecules, or gases, but also physical parameters or fields surrounding the resonator that influence the optical modes, for example temperature, pressure, force, electric field, and magnetic field. During the last two decades, a variety of sensing mechanisms and enhancement techniques has been developed for WGM sensors. The future research efforts of WGM sensors will find numerous opportunities in life, health, and environmental sciences and are expected to meet the ever-increasing demand in sensor networks, the Internet of Things, and real-time health monitoring. Moreover, the developments of novel cavity structures and sensing enhancement mechanisms or techniques are always one of the research focuses in this area., Optical whispering-gallery mode (WGM) microresonators, confining resonant photons in a microscale volume for long periods of time, strongly enhance light-matter interactions, making them an ideal platform for photonic sensors. One of the features of WGM sensors is their capability to respond to environmental perturbations that influence the optical mode distribution. The exceptional sensitivity of WGM devices, coupled with the diversity in their structures and the ease of integration with existing infrastructures, such as conventional chip-based technologies, has catalyzed the development of WGM sensors for a broad range of analytes. WGM sensors have been developed for multiplexed detection of clinically relevant biomolecules while also being adapted for the analysis of single-protein interactions. They have been used for the detection of materials in different phases and forms, including gases, liquids, and chemicals. Furthermore, WGM sensors have been used for a wide variety of field-based sensing applications, including electric/magnetic fields, force/pressure, and temperature. WGM sensors hold great potential for applications in life and environmental sciences. They are expected to meet the ever-increasing demand in sensor networks, the Internet of Things, and real-time health monitoring. Here we review the mechanisms, structures, parameters, and recent advances of WGM microsensors and discuss the future of this exciting research field.

A series of oil in water (O/W) microemulsions were prepared through drop by drop method at constant temperature, taking Span80/Tween80 as a composite emulsifying system and Macol-52 as oil phase. Effects of the mass ratio of composite emulsifying system and oil/emulsifier ratio on the particle size were studied. Finally, the best technological conditions were selected and the stability of the microemulsion was also researched. Results showed that the most suitable Span80/Tween80 mass ratio was 1:1 and the oil/emulsifier ratio is 1:1. Under this condition, the mean particle size of the o/w microemulsion was 71.1 nm and the polydispersity index was 0.151. Moreover, the microemulsion maintain a bright and uniform stable system after 20minutes’ centrifugation at the speed of 4000r/min and the particle size increased slightly.

Round shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.The purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.Twenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.All clinical measurements with the brace were significantly improved (p 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2-2.3% MVIC, p 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°-0.5°, p 0.05, respectively).Different characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.

We report a case of a 63-year-old female patient who developed a recurrent urinary tract infection (UTI) with extensively drug-resistant Klebsiella pneumoniae (ERKp). In the initial two rounds of phage therapy, phage resistant mutants developed within days. Although ERKp strains were completely resistant to sulfamethoxazole-trimethoprim, the combination of sulfamethoxazole-trimethoprim with the phage cocktail inhibited the emergence of phage resistant mutant in vitro, and the UTI of patient was successfully cured by this combination. Thus, we propose that non-active antibiotic and bacteriophage synergism (NABS) might be an alternative strategy in personalized phage therapy.

Background As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection. Methods In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period. Results Antithrombin values in patients were lower than that in the control group (p Conclusions The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.

BACKGROUND Acute vasoreactivity testing (AVT) which reflects the compliance of the pulmonary vascular bed has been proven to be of prognostic value. The purpose of the present study is to explore the sex differences of hemodynamics during the AVT and their impact on event-free survival in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Eighty-six patients underwent a right heart catheterization and AVT at Shanghai Pulmonary Hospital from February 2009 to February 2018. Univariate and multiple stepwise regression analysis were performed to determine the predictors of independent event-free survival, and receiver operating characteristic curve was plotted to determine the cut-off value of independent parameters in CTEPH. RESULTS There were no significant differences in both demographics and hemodynamics between male and female patients with CTEPH. Except ΔPVR/PVR showed a significantly higher difference in female than male patients (P = 0.034). Male patients had higher mRAP of pre- and post-AVT than female patients in the event-free subgroup, while, female patients showed higher PVR of pre-AVT than male patients in the event subgroup (P

Context Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. Objective To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Design Randomized controlled clinical trial. Setting Research laboratory. Patients or Other Participants Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Main Outcome Measure(s) Three-dimensional kinematics and EMG were recorded before and after feedback training. Results Lower trapezius muscle activity increased (4.2%–18%, P < .011) and UT/LT decreased (0.56–1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). Conclusions The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. Trial Registration Number ClinicalTrials.gov: NCT03252444.

Exposure of airborne particulate matter (PM) with an aerodynamic diameter less than 2.5 μm (PM2.5) is epidemiologically associated with lung dysfunction and respiratory symptoms, including pulmonary fibrosis. However, whether epigenetic mechanisms are involved in PM2.5-induced pulmonary fibrosis is currently poorly understood. Herein, using a PM2.5-induced pulmonary fibrosis mouse model, we found that PM2.5 exposure leads to aberrant mRNA 5-methylcytosine (m5C) gain and loss in fibrotic lung tissues. Moreover, we showed the m5C-mediated regulatory map of gene functions in pulmonary fibrosis after PM2.5 exposure. Several genes act as m5C gain-upregulated factors, probably critical for the development of PM2.5-induced fibrosis in mouse lungs. These genes, including Lcn2, Mmp9, Chi3l1, Adipoq, Atp5j2, Atp5l, Atpif1, Ndufb6, Fgr, Slc11a1, and Tyrobp, are highly related to oxidative stress response, inflammatory responses, and immune system processes. Our study illustrates the first epitranscriptomic RNA m5C profile in PM2.5-induced pulmonary fibrosis and will be valuable in identifying biomarkers for PM2.5 exposure-related lung pathogenesis with translational potential.

Electromagnetically induced transparency, as a quantum interference effect to eliminate optical absorption in an opaque medium, has found extensive applications in slow light generation, optical storage, frequency conversion, optical quantum memory as well as enhanced nonlinear interactions at the few-photon level in all kinds of systems. Recently, there have been great interests in exceptional points, a spectral singularity that could be reached by tuning various parameters in open systems, to render unusual features to the physical systems, such as optical states with chirality. Here we theoretically and experimentally study transparency and absorption modulated by chiral optical states at exceptional points in an indirectly-coupled resonator system. By tuning one resonator to an exceptional point, transparency or absorption occurs depending on the chirality of the eigenstate. Our results demonstrate a new strategy to manipulate the light flow and the spectra of a photonic resonator system by exploiting a discrete optical state associated with specific chirality at an exceptional point as a unique control bit, which opens up a new horizon of controlling slow light using optical states. Compatible with the idea of state control in quantum gate operation, this strategy hence bridges optical computing and storage., 22 pages, 4 figures, 44 references

Directional coupling of light in nanophotonic circuits has recently attracted increasing interest, with numerous experimental realizations based on broken rotational or mirror symmetries of the light-matter system. The most prominent underlying effect is the spin-orbit interaction of light in subwavelength structures. Unfortunately, coupling of light to such structures is, in general, very inefficient. In this work, we experimentally demonstrate an order of magnitude enhancement of the directional coupling between two nanowaveguides by means of a whispering gallery microcavity. We also show that both transversmagnetic and transverse electric modes can be used for the enhancement., 3 figures

Purpose: To report the long-term prognosis of punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) and associated zonal outer retinopathy (ZOR).Method: Retrospective study in patients...

The analysis of influence spread in monoplex (single-layer) networks where all interactions are treated equally has been widely studied since the early 2000s. In complex networks, e.g., social networks, multi-agent networks, etc., the elements of networks interact in many ways, which results in multiplex (multiple-layer) networks. In this paper, we analyze the multiplexity-aware influence spread in two extended linear threshold models with two different protocols that explain how an agent updates its state combining signals from all layers. We then generalize the cohesiveness structural property to multiplex networks that explains why multiplexity facilitates or impedes a propagation. Based on this property, we present the optimal solutions by solving integer linear programming problems for influence minimization in multiplex linear threshold models.

Microbubble whispering-gallery resonators have shown great promise in fiber-optic communications because of their low confinement loss and hollow cores, which allow for facile stress-based tunability. Usually, the transmission spectrum of taper-coupled microbubbles contains closely spaced modes due to the relatively large radii and oblate geometry of microbubbles. In this letter, we develop an optical add-drop filter using a microbubble coupled to fiber taper and angle-polished fiber waveguides. Because of the extra degree of freedom in the angle of its polish surface, the angle-polished fiber can be used for the discriminatory excitation of certain radial-order modes in the optical microcavity, reducing the high modal density and enhancing add-drop selectivity. Our robust and tunable add-drop filter demonstrated a drop efficiency of 85.9% and quality factor of 2 x 10^7, corresponding to a linewidth of 9.68 MHz. As a proof of concept, the drop frequency was tuned using internal aerostatic pressure at a rate of 7.3 +/- 0.2 GHz/bar with no diminishing effects on the add-drop filter performance., 12 pages, 5 figures

In military, police, security companies, and shooting sports, precision shooting training is of the outmost importance. In order to achieve high accuracy, trainees need to do a lot of training. Consequently, they will consume a great number of rounds (cartridges) and a considerable amount of professional coaches’ time - both could cost much. Our motivation is to reduce the costs and shorten the training time by implementing an augmented biofeedback system based on machine learning techniques. We designed a biofeedback system, which can detect and give feedback about three kinds of errors that regularly occur during precision shooting practice: excessive hand movement error, aiming error and triggering error. The system provides concurrent feedback about the first error and terminal feedback about the last two errors. Machine learning techniques are used for the identification of hand movement errors. A precision shooting accuracy prediction model based on random forest (RF) has been found as the most appropriate. The experimental results show that: (a) the proposed RF model achieves the prediction accuracy of 91.27%, higher than any of the existing reference models, and (b) the hand movement is strongly related to the accuracy of the precision shooting. An appropriate use of our system can lead to the reduced number of rounds used and to the disburdening of coaches as the trainee can learn about the most common mistakes from the system during the training.

This paper collates, summarizes and reviews 95 management accounting research literatures published in 6 academic journals and seven foreign journals between 2015 and 2017, and makes a comparative analysis of the research topics, research methods and application theories of management accounting. The results show that compared with the previous management accounting research in China, there have been significant changes in both research topics and research methods and applied theory. Research topics or research hot spots are becoming more diversified, research on Performance appraisal and motivation has increased significantly, research methods are more focused on database-based empirical research and experimental methodology and questionnaires, applied theory is more systematic and comprehensive, the subject background is gradually extended and cross-cutting. However, China’s management accounting compared with foreign countries there is still a big gap; there is still a lot of room for development.

Lacking systematic supply-use information of agricultural biomass and food products within China makes the existing provincial environmental pressure assessments (e.g., water consumption) either not detailed enough (e. g., by the input-output table-based approach) or not comprehensive enough (e.g., by the process-based approach). This study develops a symmetric inter-provincial multiregional input-output (MRIO) model that hybridizes the physical food and agricultural biomass system with the monetary supply chain of China. First, we construct the inter-provincial supply, use, and input-output tables in physical units of 84 agriculture, food and forestry products. These physical supply/use/MRIO tables systematically capture agrifood product flows, at an unprecedented level of product detail, along domestic supply chains within China. Then we integrate the physical MRIO table of agrifood products into the monetary all-sector MRIO table to construct a symmetric hybrid MRIO table of China. The application of our hybrid MRIO model to the case of provincial blue water footprint assessments reveals that the hybrid model enhances both the monetary MRIO table-based approach and the process-based approach from different aspects. For instance, the hybrid MRIO model can reduce the uncertainty of monetary MRIO modeling due to the aggregation of products with different environmental properties into homogeneous sectors. Lastly, uncertainty analysis is implemented to quantify the main sources of uncertainties, and understand the reliability of our new hybrid MRIO model for future sustainable development design.

BACKGROUND: Bevacizumab is a monoclonal antibody (mAb) against vascular endothelial growth factor (VEGF) and used for treatments of various cancers. Due to the high costs of bevacizumab treatments, a biosimilar provides an affordable alternative therapy for cancer patients. METHODS: In this randomized, double-blind, multicenter, phase 3 study, locally advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) patients with wild-type epidermal growth factor receptor were enrolled and randomized (1:1) into IBI305 or bevacizumab groups. Patients received 6 cycles of paclitaxel/carboplatin plus IBI305 or bevacizumab 15 mg/kg intravenously followed by IBI305 or bevacizumab 7.5 mg/kg maintenance until disease progression, unacceptable toxicity or death. The primary endpoint was confirmed objective response rate (ORR) by an independent radiological review committee (IRRC) and secondary endpoints included disease control rate (DCR), progression-free survival (PFS), duration of response (DOR), overall survival (OS) and safety. RESULTS: A total of 450 NSCLC patients were enrolled (224 in IBI305 group and 226 in bevacizumab group). ORRs were 44.3% for IBI305 and 46.4% for bevacizumab, and the ORR ratio was 0.95 (90% CI: 0.803 to 1.135), within the predefined equivalence margin of 0.75 to 1.33. No significant difference in PFS (7.64 vs. 7.77 m, P=0.9987) was observed between the 2 groups. Serious adverse events (AEs) occurred in 33.5% (75/224) of patients in the IBI305 group and 37.6% (85/226) in the bevacizumab group. AEs ≥ grade 3 were similar in the IBI305 and bevacizumab groups [84.4% (189/224) vs. 89.8% (203/226), P=0.085]. CONCLUSIONS: IBI305 is similar to bevacizumab in terms of efficacy and safety. TRIAL REGISTRATION: Clinicaltrials.org Identifier: NCT02954172. Registered on 3 November 2016. Https://clinicaltrials.gov/.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has posed a severe threat to international health and the economy. Clinicians, the main staff involved in fighting against the pandemic, are under great pressure. However, relevant mental stress studies are lacking at present. Objectives: This study aimed to explore the mental stress level and its influencing factors among Chinese pediatricians under the outbreak of COVID-19, aiming to provide a certain theoretical basis for relevant psychological intervention among medical staff. Methods: In this cross-sectional study, 352 in-service pediatricians were selected from nine hospitals in Jiangsu province, China, in February 2020. The online survey was performed to collect general information. Meanwhile, the Perceived Stress Scale (PSS-10), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI) scale were employed for assessment. Afterward, the stress level and influencing factors among pediatricians were analyzed through descriptive analysis, one-way analysis of variance (ANOVA), correlation analysis, and multiple linear regression analysis. Results: The mean score of PSS-10 showed moderate stress on the whole. Pediatricians from outpatient and emergency departments had significantly higher perceived stress than those from other departments. The perceived stress was significantly associated with age, educational level, professional title, work experience, and physical condition. Stepwise multiple linear regression showed that age, professional title, and physical condition had a linear relationship with the individual’s perceived stress. Besides, Pearson correlation analysis indicated that perceived stress was associated with anxiety level and sleep quality. Conclusions: Under the outbreak of COVID-19, pediatricians suffer from relatively high levels of mental stress. The influencing factors include education, age, professional title, work experience, and physical condition. Typically, the anxiety level and sleep quality are correlated with the mental stress among pediatricians.