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Always-on intelligent visual perception applications are widely deployed in edges in the AIoT era. In order to eliminate power costs of data conversion and transmission, this paper proposes Senputing, an ultra-low-power processing-in-sensor chip that completely fuses sensing and computing together for a BNN-based hierarchical processing system. This chip could operate in two modes. In computation mode, photocurrents are directly utilized for computing without being converted into voltages, and the computation results of 1-st BNN layer are directly sent out to subsequent BNN processors for an always-on coarse classification, eliminating conversion power and storage cost of raw images. Once an interested objected is detected, this chip switches to sensor mode and sends raw images to potential full-precision processors or cloud servers for fine-grained recognition or segmentation. A 32x 32 prototype is fabricated with 180nm CMOS process. It accomplishes MNIST dataset classification task with the accuracy of 93.76% and the power consumption of 147nW at 156fps, achieving 13.1x energy efficiency compared with state-of-the-art work.

We propose that the use of tightly stacked three-dimensional (3D) diamond-shaped Ge nanowire (NW) gate-all-around field-effect transistor (Ge-NW GAAFET) is a feasible approach to continuous scaling. The proposed devices with the Al2O3 dielectric exhibit high ISAT of 1200 μA/μm (pFET) and 1100 μA/μm (nFET), high ION/IOFF ratio of approximately 1×105, and steep subthreshold swing (SS) close to 70mV/dec. Superior gate control of the Ge-NW GAAFET was confirmed by the 3D TCAD simulation for the sub-3nm node applications. The formation of the tightly stacked Ge NWs is fully compatible with the complementary metal oxide semiconductor (CMOS) technology platform using only alternating isotropic and anisotropic dry etching, thus showing promising potential for extending CMOS scaling in the vertical direction.

Background. Cerebrovascular disease has been the leading cause of death in China since 2017, and the control of medical expenses for these diseases is an urgent issue. Diagnosis-related groups (DRG) are increasingly being used to decrease the costs of healthcare worldwide. However, the classification variables and rules used vary from region to region. Of these variables, the question of whether the length of stay (LOS) should be used as a grouping variable is controversial. Aim. To identify the factors influencing inpatient medical expenditure in cerebrovascular disease patients. The performance of two sets of classification rules, and the effects of the extent of control of unreasonable medical treatment, were compared, to investigate whether the classification variables should include LOS. Methods. Data from 45,575 inpatients from a Healthcare Security Administration of a city in western China were used. Kruskal–Wallis H tests were used for single-factor analysis, and multiple linear stepwise regression was used to determine the main factors. A chi-squared automatic interaction detector (CHAID) algorithm was built as a decision tree model for grouping related data. The intensity of oversupply of service was controlled step by step from 10% to 100%, and the performance was calculated for each group. Results. The average hospitalization cost was 1,284 US dollars, and the total was 51.17 million US dollars. Of this, 43.42 million were paid by the government, and 7.75 million were paid by individuals. Factors including gender, age, type of insurance, level of hospital, LOS, surgery, therapeutic outcomes, main concomitant disease, and hypertension significantly influenced inpatient expenditure ( P < 0.05 ). Incorporating LOS, the patients were divided into seven DRG groups, while without LOS, the patients were divided into eight DRG groups. More clinical variables were needed to achieve good results without LOS. Of the two rule sets, smaller coefficient of variation (CV) and a lower upper limit for patient costs were found in the group including LOS. Using this type of economic control, 3.35 million US dollars could be saved in one year.

This phase III trial (NCT04178850) evaluated the efficacy, safety, and immunogenicity of GB242, an infliximab biosimilar, vs. infliximab (Remicade®) reference product in patients with moderate-to-severe active rheumatoid arthritis (RA) combination with methotrexate (MTX) therapy. Patients were randomized in a 1:1 ratio to receive either GB242 or INF (3 mg/kg). Therapeutic equivalence of clinical response according to the American College of Rheumatology 20% (ACR20) response rate at week 30 was declared if the two-sided 95% CI for the treatment difference was within ± 14%. The comparison of GB242 with INF also included the proportion of patients achieving a week 30 ACR 50 response, ACR70 response, change in Disease Activity Score 28 (DAS28), as well as safety and immunogenicity. A total of 570 subjects were randomized into GB242 (N = 285) or INF (N = 285) and 283 subjects in each group were analyzed. At week 30, the ACR20 was 62.54% for the GB242 group (95% CI 56.62–68.20%) and 56.89% for the INF group (95% CI 50.90–62.74%). The difference between the two groups was 5.65% with a 95% CI of – 2.48 to 13.74. ACR50 response was 37.12% for GB242 and 32.86% for INF at week 30. ACR70 response was 19.79% for GB242 and 16.96% for INF at week 30, respectively. The incidence of treatment-emergent adverse events was comparable (77.4% in GB242 vs. 80.2% in INF) and detection of antidrug antibodies (ADA) to infliximab up to week 30 (60.8% in GB242 vs. 59.4% in INF) was comparable. GB242 demonstrated equivalent efficacy to INF at week 30. Moreover, GB242 was well tolerated, with a similar immunogenicity and safety profile comparable to INF.

Background. The prognostic significance of the amino-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) has not been fully elucidated. Major adverse cardiovascular events (MACEs) are clinically viable indicators for the accurate, rapid, and safe evaluation of patients with STEMI. This study was designed to investigate the relationship between NT-proBNP levels and the occurrence of short-term MACEs in patients with STEMI who underwent emergency PCI. Methods. This prospective cohort study included 405 patients with STEMI aged 20–90 years who underwent emergency PCI at the First People’s Hospital of Changde City from April 6, 2017, to May 31, 2019. Stent thrombosis, reinfarction, congestive heart failure, unstable angina, and cardiac death were considered as MACEs in this study. The target-independent and -dependent variables were NT-proBNP at baseline and MACE, respectively. Results. There were 28.25% of MACEs. Age, number of implanted stents, Killip class, infarction-related artery, applied intra-aortic balloon pump (IABP), creatine kinase (CK) peak value, CK-MB peak value, TnI peak value, and ST-segment resolution were independently associated with MACE ( P < 0.05 ). In a multivariate model, after adjusting all potential covariates, Log2 NT-proBNP levels remained significantly associated with MACE, with an inflection point of 11.66. The effect sizes and confidence intervals of the left and right sides of the inflection point were 1.07 and 0.84–1.36 ( P = 0.5730 ) and 3.47 and 2.06–5.85 ( P < 0.0001 ), respectively. Conclusions. In patients with STEMI who underwent PCI, Log2 NT-proBNP was positively correlated with MACE within 1 month when the Log2 NT-proBNP was >11.66 (NT-proBNP >3.236 pg/mL).

Unrestrained inflammation is harmful to tissue repair and regeneration. Immune cell membrane-camouflaged nanoparticles have been proven to show promise as inflammation targets and multitargeted inflammation controls in the treatment of severe inflammation. Prevention and early intervention of inflammation can reduce the risk of irreversible tissue damage and loss of function, but no cell membrane-camouflaged nanotechnology has been reported to achieve stage-specific treatment in these conditions. In this study, we investigated the prophylactic and therapeutic efficacy of fibroblast membrane-camouflaged nanoparticles for topical treatment of early inflammation (early pulpitis as the model) with the help of in-depth bioinformatics and molecular biology investigations in vitro and in vivo. Nanoparticles have been proven to act as sentinels to detect and competitively neutralize invasive Escherichia coli lipopolysaccharide (E. coli LPS) with resident fibroblasts to effectively inhibit the activation of intricate signaling pathways. Moreover, nanoparticles can alleviate the secretion of multiple inflammatory cytokines to achieve multitargeted anti-inflammatory effects, attenuating inflammatory conditions in the early stage. Our work verified the feasibility of fibroblast membrane-camouflaged nanoparticles for inflammation treatment in the early stage, which widens the potential cell types for inflammation regulation.

Background Intimal hyperplasia caused by vascular injury is an important pathological process of many vascular diseases, especially occlusive vascular disease. In recent years, Nano-drug delivery system has attracted a wide attention as a novel treatment strategy, but there are still some challenges such as high clearance rate and insufficient targeting. Results In this study, we report a biomimetic ROS-responsive MM@PCM/RAP nanoparticle coated with macrophage membrane. The macrophage membrane with the innate “homing” capacity can superiorly regulate the recruitment of MM@PCM/RAP to inflammatory lesion to enhance target efficacy, and can also disguise MM@PCM/RAP nanoparticle as the autologous cell to avoid clearance by the immune system. In addition, MM@PCM/RAP can effectively improve the solubility of rapamycin and respond to the high concentration level of ROS accumulated in pathological lesion for controlling local cargo release, thereby increasing drug availability and reducing toxic side effects. Conclusions Our findings validate that the rational design, biomimetic nanoparticles MM@PCM/RAP, can effectively inhibit the pathological process of intimal injury with excellent biocompatibility. Graphical Abstract

Background In the time since primary care was implemented in China in 2009, programs of promoting residents signing with family doctor services have been key. However, there has been a lack of effective evaluation of its implementation. Methods We used mixed methods for evaluating existing measures of facilitating signing with family doctors in Shanghai. Based on the Donabedian model, qualitative informant interviews were conducted to obtain experts’ evaluations in aspects of team construction (structure) and innovative solutions for promoting and supervising signings (process). Quantitative data were used to analyse the utilization situation (outcome) from “Shanghai Family Doctor Signing Data Platform”. Results Measures of signing with family doctors in Shanghai have functioned well, but there is still a lack of sufficient family doctors and specialists, including paediatricians and gynaecologists. Although proportions of the key population (average=62.59%) and the elderly population (>65 years) (average=78.10%) who had signed with family doctors were relatively high, the proportion of the permanent resident population (average=29.36%) who had signed with family doctors was low from 2017 to 2020 in Shanghai. The proportions of residents seeking medical advice in signed community health centres in outskirts (71.08%) were higher than those in suburbs (63.51%) and urban areas (53.49%), whereas the proportion of those seeking medical advice from recommended multiple medical institutions were similarly low in urban areas, outskirts and suburbs. Conclusion The practice of facilitate signing with family doctors in Shanghai has increased. However, we showed that numbers of family doctors were relatively low, and there remains a need for more experienced gynaecology and paediatrics professionals, compared with Western countries. Additionally, efforts should be made to increase proportions of residents who utilize the program, especially in urban areas, and seek medical services in contracted group hospitals and community health centres.

The recent growth in economic and financial markets has brought the focus on energy derivatives as an alternative investment class for investors, financial analysts, and portfolio managers. The financial modeling and risk management of portfolios using the energy derivatives instrument is a requirement and challenge for researchers in the field. The energy and other commodity futures force the expert investors to investigate the broader investment spectrum and consequently diversify their portfolios using the futures instruments. Going beyond the conventional portfolios and developing out-of-the-box strategies that comply with the changing financial and economic advancements are the keys to long-term sustainability in the financial world. This study investigates the impact of diversification with five energy futures from January 2011 to July 2020 on three traditional commodity futures portfolios. The results show that diversification increased the returns while simultaneously reducing the portfolio volatility in all portfolios. The diversified portfolios provided higher returns than the traditional portfolios for the same level of risk. This study also revealed that the results might improve when a short position in the futures contracts is allowed. Moreover, we conclude that adding multiple energy futures in a portfolio provides enhanced diversification results, whereas the WTI crude oil futures fail to diversify any portfolio considered in the study.

Most astronomical source classification algorithms based on photometric data struggle to classify sources as quasars, stars, and galaxies reliably. To achieve this goal and build a new Sloan Digital Sky Survey photometric catalogue in the future, we apply a deep learning source detection network built on YOLO v4 object detection framework to detect sources and design a new deep learning classification network named APSCnet (astronomy photometric source classification network) to classify sources. In addition, a photometric background image generation network is applied to generate background images in the process of data sets synthesis. Our detection network obtains a mean average precision score of 88.02 when IOU = 0.5. As for APSCnet, in a magnitude range with 14–25, we achieve a precision of 84.1 ${{\ \rm per\ cent}}$ at 93.2 ${{\ \rm per\ cent}}$ recall for quasars, a precision of 94.5 ${{\ \rm per\ cent}}$ at 84.6 ${{\ \rm per\ cent}}$ recall for stars, and a precision of 95.8 ${{\ \rm per\ cent}}$ at 95.1 ${{\ \rm per\ cent}}$ recall for galaxies; and in a magnitude range with less than 20, we achieve a precision of 96.6 ${{\ \rm per\ cent}}$ at 94.7${{\ \rm per\ cent}}$ recall for quasars, a precision of 95.7${{\ \rm per\ cent}}$ at 97.4${{\ \rm per\ cent}}$ recall for stars, and a precision of 98.9 ${{\ \rm per\ cent}}$ at 99.2 ${{\ \rm per\ cent}}$ recall for galaxies. We have proved the superiority of our algorithm in the classification of astronomical sources through comparative experiments between multiple sets of methods. In addition, we also analysed the impact of point spread function on the classification results. These technologies may be applied to data mining of the next generation sky surveys, such as LSST, WFIRST, and CSST etc.

Hui-Fen Chen,1 Nuo Lei,1 Yan-Min Xu,1 Li Luo,1 Xian-Long Zhang,1 Bei-Ni Lao,1 Fang Tang,2 Li-Zhe Fu,2 Xu-Sheng Liu,3 Yi-Fan Wu3 1The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 2Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, People’s Republic of China; 3Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, People’s Republic of ChinaCorrespondence: Yi-Fan Wu Email wuyifan007@gzucm.edu.cnBackground: To transfer a paper-version Chinese and Western medication adherence scale for CKD into an electronic scale, and evaluate its validity, internal consistency and clinical implementation, and assess whether the transition is feasible in clinic.Methods: We built an e-version Chinese and Western medication adherence scale based on the Wen-JuanXing platform. CKD subjects’ responses were applied to test the scale’s validity and internal consistency. We retested some of the participants two weeks later randomly. We also tested the clinical application.Results: Of the 434 recruited patients, 228 responded. In exploratory factor analysis (EFA), the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy = 0.8 and Bartlett’s approx. Chi-Square = 1340.0 (df = 105, p < 0.001). We extracted four common factors which could explain 61.47% of the variance. However, Item 15 “Have you changed a traditional Chinese medicine prescription yourself within the past month?” had factor loading = 0.3 and measure of sampling adequacy (MSA) = 0.5, meaning we could not enter it into the factor analysis. The internal consistency reliability for medication adherence was 0.9, with a Guttman split-half coefficient = 0.5 and a Spearman–Brown coefficient = 0.6. Cronbach’s α was 0.9, 0.4 and 0.5 for the knowledge, belief and behavior domains, respectively. The correlation coefficient r of the test–retest reliability was − 0.8 and was − 0.8, 0.4, − 0.3 in the knowledge, belief and behavior domains, respectively. Patients with comorbidities were more likely to respond. We detected no other significant differences in the clinical profiles between respondents and non-respondents.Conclusion: The e-version Chinese and Western medication adherence scales have undesirable construct validity and internal consistency. Thus, caution is needed in transitioning the paper-version scale into an e-version.Keywords: medication adherence, renal insufficiency, chronic, surveys and questionnaires

The aim was to evaluate the thoracic aorta in different cardiac phases to obtain the correct cardiac phase for measuring the maximum diameter required to predict aortic disease. Cardiac CT was performed on 97 patients for suspected coronary artery disease. The average diameter of ascending (AAD) and descending aorta (DAD) in the plane of pulmonary bifurcation, in the plane of the sinus junction (AAD [STJ] and DAD [STJ]), descending aorta in the plane of the diaphragm (DAD [Dia]), the diameter of the main pulmonary artery (MPAD), distance from the sternum to the spine (S-SD), and distance from the sternum to the ascending aorta (S-AAD) were assessed at 20 different time points in the cardiac cycle. Differences in aortic diameter in different cardiac phases and the correlation between aortic diameter and traditional risk factors were analyzed by the general linear mixed model. The diameter of the thoracic aorta reached the minimum at the phase of 95–0%, and reached the maximum at 30–35%. The maximum values of AAD, AAD (STJ), DAD, DAD (STJ), and DAD (Dia) were 32.51 ± 3.35 mm, 28.86 ± 3.01 mm, 23.46 ± 2.88 mm, 21.85 ± 2.58 mm, and 21.09 ± 2.66 mm, respectively. The maximum values of MPAD/AAD and DAD/AAD (STJ) were 0.8140 ± 0.1029, 0.7623 ± 0.0799, respectively. The diameter of the thoracic aorta varies with the cardiac phase. Analyzing the changes in aortic diameter, which can be done using cardiac CT, could provide a more accurate clinical measurement for predicting aortic disease.

Background Non-small cell lung cancer (NSCLC) is the most commonly diagnosed solid tumor. While it has been established that stereotactic body radiotherapy for NSCLC plays an important role in antitumor immune response, the possible effects of the dose rate on this response has not been fully clarified. Methods In vitro, A549 cells were irradiated on a Varian TrueBeam® Linear Accelerator with dose and dose rate escalation using the flattening filter-free (FFF) technique, which was followed by coculturing with peripheral blood mononuclear cells (PBMCs). The exosomes from irradiated A549 cells were isolated and then cocultured with PBMCs. Flow cytometry was performed to analyze the proportion of lymph cell clusters in PBMCs. Results The proportion of CD3− immune cell clusters in PBMCs was significantly higher in the 10 Gy treatment group than in the nonirradiated group and other lower-dose (2, 6 Gy) treatment groups at the dose rate of 1,000 MU/min. However, no influence was observed on the proportion of CD3+ T cell subsets. Further results showed that both natural killer (NK) and B cell proportions reached peaks in the 14 Gy treatment group when a dose rate of 1,200 MU/min was used. Notably, the peak values of these two cell proportions were reached at a lower radiation dose of 10 Gy when a greater dose rate, ranging from 1,600 to 2,400 MU/min, was used. We further found that a single, high dose of irradiation (10 Gy), as compared with a single, low dose of irradiation (2 Gy), could markedly stimulate the A549-related exosome secretion in a radiation dose rate-dependent manner. The ultrahigh dose rate radiation–derived exosomes contributed to the polarization of B and NK cell subsets in PBMCs. Conclusions The optimized radiation regime, which depends on the appropriate radiation dose and dose rate, results in the production of exosomes derived from NSCLC cells and eventually the redistribution of immune cells in PBMCs.

To understand clearly the mechanism of H5N6 transmission, the role of a live poultry feeding and trading network should be explored deeply. However, there is little data to show the network in an area. In this study, we performed a field epidemiological investigation to collect the numbers of farms, wholesale markets, and live poultry retail markets, and the numbers of purchased (from where) and sold (to where) live birds in Changsha City, China in 2014. We also collected samples from the network in the city from January 2014 to March 2015, including the LPMs visited by the patient known to be infected with A(H5N6) virus, and sequenced the genomes of 10 A(H5N6) viral strains isolated from these environmental samples, to determine the source of virus that infected the patient reported in Changsha. Additionally, we collected and analyzed A(H5N6) virus genome sequence isolated from humans, poultry, and LPMs registered in National Center for Biotechnology Information (NCBI; NIH, Bethesda, MD, USA) 14, to determine the source of other human infections with A(H5N6) virus reported in China. Changsha City in China has a large live poultry feeding and trading network (LPFTN) which had 665 farms, 5 wholesale markets, and 223 live poultry retail markets in 2014. The network covered nine provinces and purchased and sold more than 150000 live birds every day. About 840 environmental samples collected from the LPFTN network from January 2014 to March 2015. About 8.45% (71/840) environmental samples were shown to be positive for N6 and 10 full genome sequences of H5N6 virus were analyzed. We performed phylogenetic analyses and virus characterization, which demonstrated that the H5N6 viral strains isolated from Chinese patients were closely related to those isolated from the poultry and environmental samples obtained from the LPFTN network. This indicates that the network with a large volume of live poultry provides a platform for the transmission of H5N6, and provides an infectious pool which makes the people in high risk.ImportanceAvian influenza A(H5N6) virus is an emerging threat to public health. With several human cases reported in recent years, it has become a dominant avian influenza virus (AIV) subtype in China. Live poultry feeding and trading network (LPFTN) contributes to the presence of novel AIV. By a field epidemiological investigation in the complex LPFTN in Changsha, we demonstrated that the H5N6 viral strains isolated from Chinese patients were closely related to those isolated from the poultry and environmental samples obtained from the network, suggesting the LPFTN with a large volume of live poultry provides a platform for the transmission of H5N6 and creates an infectious pool which makes people in high risk. Considering the wide circulation and dynamic reassortment of this highly pathogenic avian influenza H5N6 virus, it should be carefully monitored in poultry and humans due to the pandemic potential.

The adverse effects of global warming and climate change have driven the exploration of feasible routes for CO2 capture, storage, conversion and utilization. The processes related to CO2 conversion in high-temperature electrochemical devices (HTEDs) using dense ceramic membranes are particularly appealing due to the simultaneous realization of highly efficient CO2 conversion and value-added chemical production as well as the generation of electricity and storage of renewable energy in some cases. Currently, most studies are focused on the two processes, CO2 electrolysis and H2O/CO2 co-electrolysis in oxygen-conducting solid oxide electrolysis cell (O-SOEC) reactors. Less attention has been paid to other meaningful CO2-conversion-related processes in HTEDs and systematic summary and analysis are currently not available. This review will fill the gap and classify the CO2-conversion-related processes in HTEDs reported in recent years into four types according to the related reactions, including assisted CO2 reduction to CO, H2O and CO2 co-conversion, dry reforming of methane and CO2 hydrogenation. Firstly, an overview of the fundamentals of HTED processes is presented, and then the related mechanism and research progress of each type of reactions in different HTEDs are elucidated and concluded accordingly. The remaining major technical issues are also briefly introduced. Lastly, the main challenges and feasible solutions as well as the future prospects of HTEDs for CO2-conversion-related processes are also discussed in this review.

Comorbidity is an important factor to consider when trying to predict the cost of treating asthma patients. When an asthmatic patient suffered from comorbidity, the cost of treating such a patient becomes dependent on the nature of the comorbidity. Therefore, lack of recognition of comorbidity on asthmatic patient poses a challenge in predicting the cost of treatment. In this study, we proposed a comorbidity portfolio design that improves the prediction cost of treating asthmatic patients by regrouping frequently occurred comorbidities in different cost groups. In the experiment, predictive models, including logistic regression, random forest, support vector machine, classification regression tree, and backpropagation neural network were trained with real-world data of asthmatic patients from 2012 to 2014 in a large city of China. The 10-fold cross validation and random search algorithm were employed to optimize the hyper-parameters. We recorded significant improvements using our model, which are attributed to comorbidity portfolios in area under curve (AUC) and sensitivity increase of 46.89% (standard deviation: 4.45%) and 101.07% (standard deviation: 44.94%), respectively. In risk analysis of comorbidity on cost, respiratory diseases with a cumulative proportion in the adjusted odds ratio of 36.38% (95%CI: 27.61%, 47.86%) and circulatory diseases with a cumulative proportion in the adjusted odds ratio of 23.83% (95%CI: 15.95%, 35.22%) are the dominant risks of asthmatic patients that affects the treatment cost. It is found that the comorbidity portfolio is robust, and provides a better prediction of the high-cost of treating asthmatic patients. The preliminary characterization of the joint risk of multiple comorbidities posed on cost are also reported. This study will be of great help in improving cost prediction and comorbidity management.

Background: Control measures during the coronavirus disease 2019 (COVID-19) outbreak may have limited the spread of infectious diseases. This study aimed to analyse the impact of COVID-19 on the spread of hand, foot, and mouth disease (HFMD) in China. Methods: A mathematical model was established to fit the reported data of HFMD in six selected cities in mainland China from 2015 to 2020. The absolute difference (AD) and relative difference (RD) between the reported incidence in 2020, and simulated maximum, minimum, or median incidence of HFMD in 2015-2019 were calculated. Findings: The incidence and Reff of HFMD have decreased in six selected cities since the outbreak of COVID-19, and in the second half of 2020, the incidence and R eff of HFMD have rebounded. The results show that the total attack rate (TAR) in 2020 was lower than the maximum, minimum, and median TAR fitted in previous years in six selected cities (except Changsha city). For the maximum, median, minimum fitted TAR, the range of RD (%) is 42·20-99·20%, 36·35-98·41% 48·35-96·23% (except Changsha city) respectively. Interpretation: Based on the incidence data of six cities from 2015 to 2019, the SEIAR model demonstrated a significant effect on the incidence of HFMD. During the period of COVID-19, the incidence and R eff of HFMD decreased, the prevention and control measures taken during the period of COVID-19, such as school suspension, home quarantine, closing all kinds of leisure places, wearing masks, advocating frequent hand washing, etc., have not only effectively suppressed the spread of COVID-19 epidemic, but also have significantly contributed to the containment of HFMD transmission. Funding Statement: This study was partly supported by the Bill & Melinda Gates Foundation (INV-005834). Declaration of Interests: The authors declare no conflicts of interests.

A novel coronavirus (SARS-CoV-2) has spread worldwide and led to high disease burden around the world. This study aimed to explore the key parameters of SARS-CoV-2 infection and to assess the effectiveness of interventions to control the coronavirus disease 2019 (COVID-19). A susceptible—exposed—infectious—asymptomatic—recovered (SEIAR) model was developed for the assessment. The information of each confirmed case and asymptomatic infection was collected from Ningbo Center for Disease Control and Prevention (CDC) to calculate the key parameters of the model in Ningbo City, China. A total of 157 confirmed COVID-19 cases (including 51 imported cases and 106 secondary cases) and 30 asymptomatic infections were reported in Ningbo City. The proportion of asymptomatic infections had an increasing trend. The proportion of elder people in the asymptomatic infections was lower than younger people, and the difference was statistically significant (Fisher’s Exact Test, P = 0.034). There were 22 clusters associated with 167 SARS-CoV-2 infections, among which 29 cases were asymptomatic infections, accounting for 17.37%. We found that the secondary attack rate (SAR) of asymptomatic infections was almost the same as that of symptomatic cases, and no statistical significance was observed (χ2 = 0.052, P = 0.819) by Kruskal–Wallis test. The effective reproduction number (Reff) was 1.43, which revealed that the transmissibility of SARS-CoV-2 was moderate. If the interventions had not been strengthened, the duration of the outbreak would have lasted about 16 months with a simulated attack rate of 44.15%. The total attack rate (TAR) and duration of the outbreak would increase along with the increasing delay of intervention. SARS-CoV-2 had moderate transmissibility in Ningbo City, China. The proportion of asymptomatic infections had an increase trend. Asymptomatic infections had the same transmissibility as symptomatic infections. The integrated interventions were implemented at different stages during the outbreak, which turned out to be exceedingly effective in China.

Always-on keyword spotting (KWS) that detects wake-up words has been the indispensable module in the voice interaction system. However, the ultra-low-power embedded devices put forward strict requirements on energy consumption, latency, and recognition accuracy of KWS. In this work, we propose a near-sensor processing architecture of feature-configurable distributed network (NS-FDN) for always-on KWS applications. The proposed distributed network adapts to the flexible keywords demands in the actual scene by splitting the conventional single network into distributed sub-networks. We design a channel-independent training framework to improve the recognition accuracy of distributed networks. The speech features are evaluated and the redundancy is reduced in NS-FDN, which can also configure the speech features to further reduce the computing complexity and improve processing speed. For deeper optimization, we implement a 65nm-process prototype chip with near-sensor mixed-signal processing architecture avoiding energy-consuming analog-to-digital converter. By improving the system, algorithm, and hardware designs of the KWS, our co-optimized architecture eliminates the energy consumption bottleneck long-standing in conventional KWS systems and achieves state-of-the-art system performance. The experiment results show that NS-FDN achieves 31.6% energy consumption savings, 1.6 times memory savings, 57 times speedup, and 3.4% higher recognition accuracy compared with the state of the art.

Background Metabonomics has been widely used to analyze the initiation, progress, and development of diseases. However, application of metabonomics to explore the mechanism of pulmonary arterial hypertension (PAH) are poorly reported. This study aimed to investigate the influence of atorvastatin (Ato) on metabolic pattern of rats with pulmonary hypertension. Methods PAH animal model was established using monocrotaline (MCT). The mean pulmonary artery pressure (mPAP) and right ventricular hypertrophy index (RVHI) were measured. The microstructure of pulmonary arterioles was observed by HE staining. Nuclear magnetic resonance was used to detect and analyze the serum metabolites. The levels of glycogen synthase kinase-3β (GSK-3β), hexokinase 2 (HK-2), sterol regulatory element-binding protein 1c (SREBP-1c), and carnitine palmitoyltransferase I (CPT-1) in the lung tissues were measured. Results Ato significantly improved lung function by decreasing mPAP, RVHI, wall thickness, and wall area. Differences in metabolic patterns were observed among normal, PAH, and Ato group. The levels of GSK-3β and SREBP-1c were decreased, but HK-2 and CPT-1 were increased in the group PAH. Ato treatment markedly reversed the influence of MCT. Conclusion Ato significantly improved the pulmonary vascular remodeling and pulmonary hypertension of PAH rats due to its inhibition on Warburg effect and fatty acid β oxidation.

Background Novel coronavirus disease 2019 (COVID-19) causes an immense disease burden. Although public health countermeasures effectively controlled the epidemic in China, non-pharmaceutical interventions can neither be maintained indefinitely nor conveniently implemented globally. Vaccination is mainly used to prevent COVID-19, and most current antiviral treatment evaluations focus on clinical efficacy. Therefore, we conducted population-based simulations to assess antiviral treatment effectiveness among different age groups based on its clinical efficacy. Methods We collected COVID-19 data of Wuhan City from published literature and established a database (from 2 December 2019 to 16 March 2020). We developed an age-specific model to evaluate the effectiveness of antiviral treatment in patients with COVID-19. Efficacy was divided into three types: (1) viral activity reduction, reflected as transmission rate decrease [reduction was set as v (0–0.8) to simulate hypothetical antiviral treatments]; (2) reduction in the duration time from symptom onset to patient recovery/removal, reflected as a 1/γ decrease (reduction was set as 1–3 days to simulate hypothetical or real-life antiviral treatments, and the time of asymptomatic was reduced by the same proportion); (3) fatality rate reduction in severely ill patients (fc) [reduction (z) was set as 0.3 to simulate real-life antiviral treatments]. The population was divided into four age groups (groups 1, 2, 3 and 4), which included those aged ≤ 14; 15–44; 45–64; and ≥ 65 years, respectively. Evaluation indices were based on outbreak duration, cumulative number of cases, total attack rate (TAR), peak date, number of peak cases, and case fatality rate (f). Results Comparing the simulation results of combination and single medication therapy s, all four age groups showed better results with combination medication. When 1/γ = 2 and v = 0.4, age group 2 had the highest TAR reduction rate (98.48%, 56.01–0.85%). When 1/γ = 2, z = 0.3, and v = 0.1, age group 1 had the highest reduction rate of f (83.08%, 0.71–0.12%). Conclusions Antiviral treatments are more effective in COVID-19 transmission control than in mortality reduction. Overall, antiviral treatments were more effective in younger age groups, while older age groups showed higher COVID-19 prevalence and mortality. Therefore, physicians should pay more attention to prevention of viral spread and patients deaths when providing antiviral treatments to patients of older age groups.

Objective To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with previous laparoscopic salpingostomy for ectopic pregnancy. Methods This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy, ectopic pregnancy, and delivery rates. We further studied the associated factors that could influence the change in pregnancy status. Results The 24-month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: intrauterine pregnancy rate, 76/173 (43.9%); ectopic pregnancy rate, 31/173 (17.9%); delivery rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyps were significant prognostic factors in the multivariate model. Conclusion Laparoscopic tubal anastomosis is an effective treatment for tubal-associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for women under 35 years of age.

Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality in hypertensives. Therefore, early identification of at‐risk patients is necessary. The objective of this study was to estimate the risk of LVH among Chinese hypertensives by designing a nomogram. 832 hypertensives were divided into two groups based on the presence of LVH. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were successively applied for optimal variable selection and nomogram construction. Discrimination power, calibration, and clinical usefulness were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Internal validation was performed using the bootstrap method. The nomogram included five predictors, namely gender, duration of hypertension, age, body mass index (BMI), and systolic blood pressure. The area under the ROC curve (AUC) was 0.724 (95% CI: 0.687‐0.761), indicating moderate discrimination. The calibration curve showed an excellent agreement between the predicted LVH and the actual LVH probability. The risk threshold between 5% and 72% according to the decision curve analysis, and the nomogram is clinically beneficial. Internal validation by bootstrapping with 1000 samples showed a good C‐index of 0.715, which suggested that the predictive abilities for the training set and testing set were in consistency. Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensives. This tool could be useful in identifying patients at high risk for LVH. Further studies are required to ascertain the stability and applicability of this nomogram., Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensive patients. This tool could be useful in identifying patients at high risk for LVH.

GeSn complementary metal-oxide-semiconductor (CMOS) devices have attracted much attention for future VLSI technology nodes due to high carrier mobility. However, Fermi-level pinning in metal/n-GeSn...

Summary Background Since 1997, epidemics of hand, foot, and mouth disease associated with enterovirus A71 (EV-A71) have affected children younger than 5 years in the Asia-Pacific region, including mainland China. EV-A71 vaccines have been licensed for use in children aged 6–71 months in China, but not for infants younger than 6 months. We aimed to assess the dynamics of maternal EV-A71 antibodies to inform choice of potential vaccination strategies to protect infants younger than 6 months, because they have a substantial burden of disease. Methods We did a longitudinal cohort study with mother–neonate pairs in local hospitals in southern China during 2013–18. We collected cord blood from neonates and venous blood from mothers at delivery. We followed up and collected blood samples from the children at ages 2, 4, 6, 12, 24, and 36 months and tested for the presence of neutralising antibodies against EV-A71 with virus neutralisation assays. Seropositivity, or protective titre, was defined as a neutralisation antibody titre of 16 or higher. We estimated the seroprevalence, geometric mean titre (GMT), and transfer ratio of maternal antibodies. We used a binomial distribution to derive the 95% CIs of seroprevalence. Seropositivity between mothers and neonates was compared by use of an agreement (κ), while GMTs were compared by use of paired Student's t tests. Findings Between Sept 20, 2013, and Oct 14, 2015, 1054 mothers with 1066 neonates were enrolled. The EV-A71 GMT was similar among pairs of neonates (22·7, 95% CI 20·8–24·9) and mothers (22·1, 95% CI 20·2–24·1; p=0·20). The mean transfer ratio of maternal antibodies was 1·03 (95% CI 0·98–1·08). Although 705 (66%) of 1066 neonates acquired protective concentrations of EV-A71 antibodies from mothers, these declined rapidly, with a half-life of 42 days (95% CI 40–44). The time to loss of protective immunity was extended to 5 months in neonates with mothers who had titres of 128 or higher. By age 30 months, 28% of children had become seropositive because of natural infection. Interpretation EV-A71 maternal antibodies were efficiently transferred to neonates, but declined quickly to below the protective threshold, particularly among those whose mothers had low antibody titres. Our findings suggest that maternal vaccination could be explored to provide neonatal protection against EV-A71 through maternal antibodies. Catch-up vaccination between ages 6 months to 5 years could provide protection to the approximately 30–90% of children that have not had natural EV-A71 infection by that age. Funding National Science Fund for Distinguished Young Scholars, National Natural Science Foundation of China.

The association of asthma health outcome and air pollution has been widely investigated. Meanwhile, from a macro perspective, it cannot be ignored the enormous pressure on regional medical services resulting from a large number of hospitalization needs after the exposure to air pollution. This study is aimed at assessing the admission risk and excessive burden attributable to ambient air pollution in different unspecified asthma groups. We analyzed 6,663 medical claims of unspecified asthma patients from different levels of hospitals, air pollution, and meteorological conditions in Chengdu of China during 2014. The distinct impacts of air pollution on hospital admissions stratified by gender and age were revealed. When air pollution attacks, female patients and young and middle-aged patients (≤65) are more vulnerable to PM10 and SO2. In contrast to patients suffering from asthmatic bronchitis, the patients suffering from bronchial asthma are more susceptible to air pollution. And the percentage changes of admissions attributable to PM2.5, PM10, and SO2 reached by 1.046 (95%CI: 1.0088, 1.0846), 1.0419 (95%CI: 1.0117, 1.073), and 1.4049 (95%CI: 1.1011, 1.7925). Based on the WHO’s air quality standards, the excessive admission burden of unspecified asthma due to overexposure to PM2.5, PM10, and SO2 were estimated by 15.42% (95%CI: 1.81%, 25.92%), 20.50% (95%CI: 6.80%, 30.92%), and 10.13% (95%CI: 1.67%, 14.96%), respectively. It is concluded that female patients and young and middle-aged patients suffering from bronchial asthma are susceptible to PM10, PM2.5, and SO2, causing the excessive admission burden in Chengdu of China.

Huining Zhou,1,* Zhengyi Wu,1,* Hui Wang,1 Wenya Yu,1 Jiaoling Huang,1 Liang Zhou,1 Dehua Yu,2 Tianchun Hou,1 Yipeng Lv,1 Chen Chen,3 Li Luo,4 Jianwei Shi,1,5 Zhaoxin Wang1,6 1School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China; 2Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Shanghai Jing‘an District Jiangning Road Community Health Service Center, Shanghai, People’s Republic of China; 4School of Public Health, Fudan University, Shanghai, People’s Republic of China; 5Shanghai General Practice and Community Health Development Research Center, Shanghai, People’s Republic of China; 6General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianwei Shi; Zhaoxin WangSchool of Public Health, Shanghai Jiaotong University School of Medicine, 227 South Chongqing Road, Shanghai 200025, People’s Republic of ChinaTel +86 188 1820 9852; +86 139 1853 7473Email shijianwei_amy@126.com; supercell002@sina.comPurpose: The purpose of this study was to use the hospital information system to analyze the cancer profile and compare demographics, hospitalization, status of surgery and treatment cost of various cancer categories based on the electronic health record (EHR) of outpatient children with tumors in Shanghai, China.Patients and Methods: Information was collected from 3834 inpatients aged 0– 18 who were diagnosed with malignant tumors in all 17 hospitals with pediatric wards in the Pudong New District of Shanghai from 2011 to 2016. All patients were classified according to the International Classification of Childhood Cancer-3 (ICCC-3). The chi-squared test was used to compare demographics, hospitalization information, status of surgery and treatment cost according to inpatients’ cancer category.Results: In both the malignant non-solid tumor and solid tumor groups, males and those aged 0– 4 years were the dominant groups. Lymphocytic leukemia was the most common cancer in all inpatients (n=994, 25.93%), and the acute myeloid leukemia had the longest length of stay of inpatients (median=26.00 days). In both the non-solid and solid tumor groups, patients who received only one type of surgery had an advantage. The highest proportion of patients who had undergone surgery was found in non-Hodgkin lymphoma patients. In terms of total cost, surgical cost and medicine cost, the expenditure of central nervous system tumor patients was the highest. Astrocytoma had the highest total cost.Conclusion: Leukemia is common in children with cancer in Pudong and should be given attention. Because the highest financial burden falls on patients with central nervous system tumors and acute myeloid leukemias, the government should take immediate and targeted measures for these cancers in particular.Keywords: malignant tumors, disease burden, demographics, hospitalization information, epidemiology

Ischemic stroke, the most frequent cause of severe disability, imposes a significant mental and economic burden on patients and their families. There is increasing evidence to indicate that air pollution contributes to the risk of ischemic stroke. This study aimed to examine the correlation between air pollution and the expense imposed by an ischemic stroke. Data were obtained from hospitals and environmental monitoring stations in an industry city, Longspring, in western China. We used a generalized additive model to estimate the associations between the two factors, measured during 2015-2017. Counter-intuitively, the medical expenses arising from ischemia were negatively associated with the level of air pollution. The corresponding ER for per interquartile range increase of PM2.5, PM10, SO2 , and NO2 in lag10 was -0.17% (95% confidence interval (95% CI -0.31%, -0.03%), -0.11% (95% CI -0.2%, -0.02%), -1.04% (95% CI -1.92%, -0.17%) and -0.44% (95% CI -0.66%, -0.22%), respectively (p < 0.05). Subgroups based on gender, age, and season were considered in the analysis. The results indicated that pollutants had significant effects on ischaemia's medical expenses, which were stronger for older people, patients who survived, and warm seasons. This study is the first step in optimizing medical resources, which are essential for policymaking and service planning.

Objective Rasmussen’s encephalitis (RE) is a rare and severe progressive epileptic syndrome with unknown etiology. Infection by viruses such as human cytomegalovirus (HCMV) has been hypothesized to be a potential trigger for RE. Interferon‐induced transmembrane protein‐3 (IFITM3) single‐nucleotide polymorphism (SNP) rs12252 is associated with the severity of viral infection disease. This study aimed to address the possibility that HCMV infection and IFITM3 rs12252 might be associated with RE disease progression. Methods The expression of HCMV and IFITM3 was detected with immunohistochemical staining, in situ hybridization and immunofluorescence double staining. The genotype of IFITM3 rs12252 was detected using the Sanger sequencing method. A genetic association analysis was carried out for this SNP and HCMV antigen expression. The relationship between this SNP and the clinical characteristics of these patients was further analyzed. In in vitro study, HCMV replication in SH‐SY5Y cells with overexpressed IFITM3 variant was detected by immunofluorescence and real‐time RT‐PCR. Results Elevated expression of HCMV and IFITM3 was observed in the brain tissue of RE patients. Moreover, the IFITM3 polymorphism rs12252‐C was found to associate with HCMV high detection and rapid disease progression in RE patients with the IFITM3 rs12252‐CC genotype. In vitro study showed the overexpressed IFITM3 variant was associated with HCMV high infection level. Conclusion These results suggest that the IFITM3 rs12252‐C is associated with the disease progression of RE patients via facilitating persistent HCMV infection in brain tissue and provides new insight into understanding the pathogenesis of RE.

OBJECTIVE: Air pollution has potential risk on asthma patients, further prolongs the length of stay. However, it is unclear that the impact of air pollution on excessive length of stay (ELoS) of heterogeneous asthma patients. In this study, we proposed a K-Nearest Neighbor (KNN) embedded approach incorporating with patient status to analyze the impact of short-term air pollution on the ELoS of asthma patients. METHODS: The KNN embedded approach includes two stages. Firstly, the KNN algorithm was employed to search for the most similar patient community and approximate kernel proxy of each index patient by Euclidean distance. Then, we built the differential fixed-effect linear model to estimate the risk of air pollution to the ELoS. RESULTS: We analyzed 6563 asthma patients’ medical insurance records in a large city of China from January to December in 2014. It was found that when the duration of exposure to air pollution (i.e., PM2.5, PM10, SO2, NO2, and CO) reaches around 4–5 days, the risk of increasing the ELoS becomes the largest. But only O3 shows the opposite effect. What’s more, CO is the dominant risk to increase the ELoS. With a 1 mg/m3 increment of CO average concentration in 5 days, the ELoS will go up by 0.8157 day (95%CI:0.72,0.9114). Based on the kernel proxy in the top 1% similar patient community, the additional financial burden posed on each patient increases by RMB 488.6002 (95%CI:430.1962,547.0043) due to the ELoS. CONCLUSIONS: The KNN embedded approach is an innovative method that takes into account the heterogeneous patient status, and effectively estimates the impact of air pollution on the ELoS. It is concluded that air pollution poses adverse effects and additional financial burdens on asthma patients. Heterogeneous patients should adopt different strategies in health management to reduce the risk of increasing the ELoS due to air pollution, and improve the efficiency of medical resource utilization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-020-00584-8.

The inertial measurement unit (IMU) biases, DVL lever arm and installation misalignment angles between IMU and doppler velocity log (DVL) have a great influence on in-motion initial alignment for DVL-aided low-cost strap-down inertial navigation system (SINS). A new Kalman filter-based initial alignment method is proposed in this paper. To weaken the effects of IMU biases, DVL lever arm and installation misalignment angles between IMU and DVL, a closed-loop scheme is presented to simultaneous estimate and compensate these parameter errors and the body attitude matrix based on a linear state-space model, which improves the accuracy of vector observations. The constant matrix from initial body frame to initial navigation frame can be determined based on the vector observations by Davenport's q-method. Simulation results illustrate that, for the DVL-aided low-cost SINS, the alignment performance of the proposed initial alignment method is better than that of the compared initial alignment methods.

Education is the basis of a One-Hundred Year Strategy of a Nation, the cornerstone of nation progress, the driving force to promote national rejuvenation, and the inevitable choice to improve the quality of our citizens. Basic education is the foundation of the whole education management system. Only by doing basic education well can citizens get long-term development in their future life. Basic education management is very rich in content; this article compares the differences of the basic education teaching management between China and America from the basic education management system, teaching management and the teacher-student relationship management, hoping to help our country’s basic education teaching management by learning from each other and facing up to the inadequacy and promote the healthy growth of Chinese students.

In this article, a new position loci-based in-motion initial alignment method is proposed for a low-cost attitude and heading reference system (AHRS). A new sliding-window-based position integration method is proposed to construct the position vector observations, which weakens the accumulated errors induced by the inertial measurement unit (IMU) bias errors in vector observations. Also, a new closed-loop method is proposed to jointly estimate the time-varying body attitude matrix and the unknown IMU biases and global position system (GPS) lever-arm based on the Kalman filter. The estimates of the time-varying body attitude matrix, IMU biases, and GPS lever-arm are all used to construct and compensate for the position vector observations, which improves the alignment accuracy. Both the simulation and car-mounted test results illustrate that the proposed alignment method can achieve better alignment accuracy than these existing methods for a position loci-aided low-cost AHRS.

Although the clinical application of oxaliplatin (L-OHP) has improved the survival of colorectal cancer (CRC) patients, approximately half of patients with CRC fail to achieve good clinical outcomes, indicating resistance to L-OHP therapy. Cysteine-rich protein 61 (Cyr61), a multifunctional extracellular matrix protein, is highly expressed in a variety of tumors; increased Cyr61 expression is known to be closely involved in the chemotherapeutic resistance of many tumors, but its role in the L-OHP resistance of CRC cells has not been studied. In this study, we aimed to investigate the role of Cyr61 in the L-OHP resistance of CRC cells and examine the underlying mechanism. Our findings showed that the mRNA and protein levels of Cyr61 in L-OHP-resistant cells were significantly increased compared with those in nonresistant cells. Knockdown of Cyr61 enhanced the chemosensitivity of L-OHP-resistant cells to L-OHP. Mechanistically, we found that overexpression of Cyr61 decreased L-OHP-induced apoptosis in drug-resistant CRC cells through the regulation of Bcl-xL. Collectively, our results revealed for the first time that Cyr61 plays a crucial role in the resistance of CRC cells to L-OHP and indicated that targeting Cyr61 may be a promising therapeutic strategy to overcome L-OHP resistance in CRC.

A record high electron mobility of 698 cm2/ $\text{V}\cdot \text{s}$ in a tensile-strained Ge0.96Sn0.04 nMOSFET is demonstrated in this letter. High-quality GeSn films were epitaxially grown by low-temperature chemical vapor deposition. Different strain conditions in the active GeSn layers were achieved by Ge or GeSn relaxed buffers. A mesa FET structure was used to effectively reduce the OFF leakage by a recessed p/n junction in Ge. The ION/IOFF ratio in the mesa GeSn FETs is boosted by a factor of 100 compared to conventional planar devices. As the GeSn film becomes more tensile strained, the channel mobility is enhanced, which could be attributed to a higher carrier population in the ${\Gamma }$ valley.

What is already known on this topic? The morbidity and mortality of chronic obstructive pulmonary disease (COPD) is associated with adverse weather and air pollution. However, COPD patients are not able to be alerted in advance of high risk environments. What is added by this report? This prospective controlled trial conducted in Pudong New Area of Shanghai from October 2019 to April 2020 provided evidence of COPD risk forecasting service on the reductions in visits and costs of COPD patients in outpatient and emergency departments in China for the first time. What are the implications for public health practice? This study suggests that COPD risk forecasting service could be integrated into existing COPD management in public health to improve the health and economic outcomes.

Irritable bowel syndrome (IBS) is a common chronic functional bowel disease, associated with a high risk of depression and anxiety. The brain–gut axis plays an important role in the pathophysiological changes involved in IBS; however, an effective treatment for the same is lacking. The natural compound costunolide (COS) has been shown to exert gastroprotective, enteroprotective, and neuroprotective effects, but its therapeutic effects in IBS are unclear. Our study explored the effect of COS on intestinal dysfunction and depressive behaviour in stress-induced IBS mice. Mice were subjected to chronic unpredictable mild stress to trigger IBS, and some were administered COS. Behavioural tests, histochemical assays, western blotting, and measurement of 5-hydroxytryptamine (5-HT) levels in the colon and hippocampus were applied to monitor the physiological and molecular consequences of COS treatment in IBS mice. COS administration relieved intestinal dysfunction and depression-like behaviours in IBS mice. Improvements in low-grade colon inflammation and intestinal mucosal permeability, inhibition of the activation of mast cells, upregulation of colonic Occludin expression, and downregulation of Claudin 2 expression were also observed. COS was also found to upregulate GluN2A, BDNF, p-ERK1/2, and p-CREB expression and 5-HT levels in hippocampal cells but inhibited 5-HT metabolism. Molecular docking showed that COS could form hydrogen bonds with the serotonin transporter (SERT) to affect the reuptake of 5-HT in the intercellular space. In conclusion, COS alleviates intestinal dysfunction and depressive behaviour in stress-induced IBS mice by inhibiting mast cell activation in the colon and regulating 5-HT metabolism in the central nervous system.

We aimed to assess the effect of childhood parental rearing on post-traumatic stress disorder (PTSD) among young HIV-positive men who have sex with men (MSM), as well as the mediation effect of social support on this association. A convenient sampling method and questionnaire-based survey were used to recruit eligible participants from the Wuhan Medical Treatment Center from 20 December 2018 to 28 February 2019. Bivariate analyses were used to investigate the correlations between PTSD and childhood parental rearing, the number of sexual partners and social support. Mediation analyses were used to investigate the mediation of social support. Totally, 142 eligible MSM participated in our study, with prevalence of PTSD being 33.10%. It was found that maternal warmth (M1) and maternal favoring (M5) were positively correlated with social support. Paternal rejection (F5) was positively correlated with PTSD. The effects of M1 and M5 on PTSD were completely mediated by social support. The effects of paternal favoring (F4) and M5 on PTSD were completely mediated by subjective social support, and the effects of F5 and M1 were completely mediated by social support utility. Social support was an important mediator between parental rearing and PTSD.

Material degradation is accompanied by the changes in surface structure, morphology, and composition. These changes can be recorded by a variety of image acquisition devices that export digital images in grayscale or true color to a detector. Information regarding corrosion type and extent can be extracted with image processing methods. This paper provides a comprehensive review of material degradation assessed by digital image processing. Digital image processing systems used to assess material degradation are briefly reviewed, and the algorithms developed to process metallic materials degradation images are described. Physical and electrochemical methods that can be used to support digital image processing results are summarized, and future work that will augment the present methods of evaluating material degradation are discussed.

In recent years, Neural networks (NNs) present vast potential for innovative applications. However, energy efficiency continues to remain a challenge in deploying NNs on the edge. In this context, computation-in-memory (CIM) architecture becomes an emerging trend in the area of energy-efficient hardware design, because it reduces data movement of multiply-accumulate (MAC) computation significantly. However, many recent works employ massive data converters to feed input data and transform output results, which may counteract the benefits of in-memory processing. To tackle this limitation, we propose a combined architecture cooperating sensor with CIM macro to achieve local processing of sensory signals. Current-mode computing techniques are exploited to achieve high energy efficiency while eliminating data conversion overhead. Moreover, we thoroughly analyze the non-idealities of the proposed mixed-signal circuits and present a co-design scheme to mitigate these imperfections. We have fabricated a 2K-bit CIM macro in the proposed architecture with TSMC 65-nm technology. The fabricated chip achieved 60.6 TOPS/W energy efficiency while consuming $845.5~\mu \text{W}$ power and 0.3 mm2 core area, presenting a promising solution for energy-constrained edge devices.

Objectives A questionnaire which provides desirable reliability and validity has been previously developed to assess the disease awareness of diagnosed chronic kidney disease (CKD) patients. However, conventional paper questionnaires often have disadvantages, including recall bias. To substantially improve this, we therefore aimed to explore the feasibility of developing a smartphone-based electronic version (e-version) based upon its original paper version and subsequently tested its validity, reliability, and applicability. Methods A pilot study was conducted at Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China, during August 2019. The e-version had identical content to the paper version and was adapted in terms of layout and assisted functions via the Wechat-incorporated Wen-Juan-Xing platform. Eligible patients with diagnosed CKD were invited to participate and were assigned the e-version. Randomly selected respondents received a test-retest of the same e-version 2 weeks after their first completion. In some instances, psychometric properties, including validity and reliability of the e-version, were examined. In others, its clinical application was also tested, which included comparisons among the clinical profiles of patients who had/had not responded to the questionnaire as well as patients with above or below average questionnaire scores. Results Of the 225 patients screened, 217 were enrolled to participate, with a response rate of 52.5%. Desirable reliability (Cronbachα = 0.962, ICC for total scores = 0.948), while good convergent validity (Cronbachα = 0.962) and low discriminant validity (one extracted component), of the e-version were detected. Performing inter-group comparisons highlighted statistical differences in terms of higher education level (z = -2.436, P = 0.015) and earlier CKD stages (z = -1.978, P = 0.048), with these patients often preferring to respond. No significant differences were detected in the clinical profiles between respondents who obtained an above or below average questionnaire score. Conclusion The e-version is reliable but was not shown to be a valid approach. Audiences with higher education levels and less advanced disease condition may prefer to respond to the e-version. Adaptation of this e-questionnaire, from its original paper version, may not be a direct transition and meticulous modifications may be required during the transition process. Trial registration Chinese Clinical Trial Registry (ChiCTR1900024633).

Background The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also called 2019-nCoV) causes different morbidity risks to individuals in different age groups. This study attempts to quantify the age-specific transmissibility using a mathematical model. Methods An epidemiological model with five compartments (susceptible–exposed–symptomatic–asymptomatic–recovered/removed [SEIAR]) was developed based on observed transmission features. Coronavirus disease 2019 (COVID-19) cases were divided into four age groups: group 1, those ≤ 14 years old; group 2, those 15 to 44 years old; group 3, those 45 to 64 years old; and group 4, those ≥ 65 years old. The model was initially based on cases (including imported cases and secondary cases) collected in Hunan Province from January 5 to February 19, 2020. Another dataset, from Jilin Province, was used to test the model. Results The age-specific SEIAR model fitted the data well in each age group (P β43 = 7.71 × 10− 9; SAR43 = 3.86 × 10− 8), followed by group 3 to 4 (median: β34 = 3.07 × 10− 9; SAR34 = 1.53 × 10− 8), group 2 to 2 (median: β22 = 1.24 × 10− 9; SAR22 = 6.21 × 10− 9), and group 3 to 1 (median: β31 = 4.10 × 10− 10; SAR31 = 2.08 × 10− 9). The lowest transmissibility was from age group 3 to 3 (median: β33 = 1.64 × 10− 19; SAR33 = 8.19 × 10− 19), followed by group 4 to 4 (median: β44 = 3.66 × 10− 17; SAR44 = 1.83 × 10− 16), group 3 to 2 (median: β32 = 1.21 × 10− 16; SAR32 = 6.06 × 10− 16), and group 1 to 4 (median: β14 = 7.20 × 10− 14; SAR14 = 3.60 × 10− 13). In Jilin Province, the highest transmissibility occurred from age group 4 to 4 (median: β43 = 4.27 × 10− 8; SAR43 = 2.13 × 10− 7), followed by group 3 to 4 (median: β34 = 1.81 × 10− 8; SAR34 = 9.03 × 10− 8). Conclusions SARS-CoV-2 exhibits high transmissibility between middle-aged (45 to 64 years old) and elderly (≥ 65 years old) people. Children (≤ 14 years old) have very low susceptibility to COVID-19. This study will improve our understanding of the transmission feature of SARS-CoV-2 in different age groups and suggest the most prevention measures should be applied to middle-aged and elderly people.

PARP inhibitor monotherapies are effective to treat patients with breast, ovary, prostate, and pancreatic cancer with BRCA1 mutations, but not to the much more frequent BRCA wild-type cancers. Searching for strategies that would extend the use of PARP inhibitors to BRCA1-proficient tumors, we found that the stability of BRCA1 protein following ionizing radiation (IR) is maintained by postphosphorylational prolyl-isomerization adjacent to Ser1191 of BRCA1, catalyzed by prolyl-isomerase Pin1. Extinction of Pin1 decreased homologous recombination (HR) to the level of BRCA1-deficient cells. Pin1 stabilizes BRCA1 by preventing ubiquitination of Lys1037 of BRCA1. Loss of Pin1, or introduction of a BRCA1-mutant refractory to Pin1 binding, decreased the ability of BRCA1 to localize to repair foci and augmented IR-induced DNA damage. In vitro growth of HR-proficient breast, prostate, and pancreatic cancer cells were modestly repressed by olaparib or Pin1 inhibition using all-trans retinoic acid (ATRA), while combination treatment resulted in near-complete block of cell proliferation. In MDA-MB-231 xenografts and triple-negative breast cancer patient-derived xenografts, either loss of Pin1 or ATRA treatment reduced BRCA1 expression and sensitized breast tumors to olaparib. Together, our study reveals that Pin1 inhibition, with clinical widely used ATRA, acts as an effective HR disrupter that sensitizes BRCA1-proficient tumors to PARP inhibition. Significance: PARP inhibitors have been limited to treat homologous recombination–deficient tumors. All-trans retinoic acid, by inhibiting Pin1 and destabilizing BRCA1, extends benefit of PARP inhibitors to patients with homologous recombination–proficient tumors. See related commentary by Cai, p. 2977

Minocycline is a second-generation, semi-synthetic tetracycline, and has broad spectrum-antibacterial activity. Interestingly, many studies have demonstrated that minocycline is beneficial for depression, which may be due to its effects on neuroinflammation modulation. Recently, gut microbiota imbalance has been found in depression patient and animal models. Based on the fact of minocycline usually acting as an antibiotic and the relationship between depression, gut microbiota, and neuroinflammation, we designed this study to detect the effects of chronic minocycline treatment on antidepression, neuroinflammation, and gut microbiota modulation. Our results showed that minocycline treatment for 4 weeks, not acute treatment, exerted antidepressant effect in mice exposed to unpredictable chronic mild stress (CUMS). Further results suggested that chronic minocycline treatment inhibited neuroinflammation of hippocampus and altered species abundance and metabolites of gut microbiota. Meantime, we found that chronic minocycline treatment ameliorated intestinal barrier disruption and reduced the bacteriological indexes, such as diamine oxidase, C-reaction protein, and endotoxin in peripheral blood of CUMS mice. To sum up, our findings confirm that chronic minocycline treatment exerts the antidepressant effect, inhibits neuroinflammation, and modulates gut microbiota. All of these imply that the antidepressant mechanism of chronic minocycline treatment is maybe due to the combined action of neuroinflammation and gut microbiota modulation, which need further prospective studies.

Neonatal hypoxic-ischemic brain damage (HIBD) is a brain disease that is caused by perinatal asphyxia. Icariin (ICA), which is an active component of Epimedii (a Chinese medicinal herb), has been verified to demonstrate a wide range of therapeutic effects, such as alleviating various kinds of brain injury. The current study aims to examine the neuroprotective effects of ICA on neonatal HIBD in mice. A modified version of the Rice-Vannucci method was performed to establish neonatal HIBD in 7-day-old mouse pups that were pretreated with ICA or vehicle. The infarct volume was measured, and behavioral tests were conducted to assess the protective effects of ICA on the neonatal brain and to evaluate functional recovery after injury. TUNEL staining was used to detect cell apoptosis, and the levels of cleaved caspase-3 and phosphorylated protein kinase B (Akt) were determined by using Western blot. We showed that pretreatment with ICA could significantly reduce brain damage, improve neurobehavioral outcomes, and suppress apoptotic cell death following HI injury. ICA reversed the HI-induced reduction in phosphorylated Akt and activation of cleaved caspase-3. The results demonstrate that ICA exerts potential neuroprotective effects on neonatal HIBD, which may be mediated by its anti-apoptotic activity.

Objective To indigenize the median of Down syndrome (DS) screening markers for first and second trimester, and compare the impact of the indigenized and built-in median data on the efficiency of DS screening. Materials and Methods Data derived from first and Second-trimester screening (FTS and STS) for DS, composed of selected pregnancies deemed to be normal, were examined in a retrospective study. Indigenization regression analysis was calculated by using five models to fit statistical the raw data. Multiple of median (MoM) values estimated by using indigenized medians were compared with those calculated by using built-in. Results This study established a regression equation which is more suitable for the median of each screening marker in the local pregnant women. The changes of median MoM of screening markers were statistically significant after indigenization. For FTS, the detection rate was 100% when the false positive rate was 5%, and the cut-off value was 1/262. On the other hand, for STS, the detection rate of the model with indigenized parameters was 77.42%, which is 16.13% higher than that of built-in parameters. Conclusion For the individual specific risk of pregnancy, when the indigenized parameters was used to calculate, is more accurately and screening effectiveness has been improved. This is a great reference significance for the current prenatal screening whether indigenized data should be used.

Electrochemical reduction of CO2 to carbon-neutral fuels is a promising strategy for renewable energy conversion and storage. However, developing earth-abundant and cost-effective electrocatalysts ...

CCNE1 amplification is a recurrent alteration associated with unfavourable outcome in tubo‐ovarian high‐grade serous carcinoma (HGSC). We aimed to investigate whether immunohistochemistry (IHC) can be used to identify CCNE1 amplification status and to validate whether CCNE1 high‐level amplification and overexpression are prognostic in HGSC. A testing set of 528 HGSC samples stained with two optimised IHC assays (clones EP126 and HE12) was subjected to digital image analysis and visual scoring. DNA and RNA chromogenic in situ hybridisation for CCNE1 were performed. IHC cut‐off was determined by receiver operating characteristics (ROC). Survival analyses (endpoint ovarian cancer specific survival) were performed and validated in an independent validation set of 764 HGSC. Finally, combined amplification/expression status was evaluated in cases with complete data (n = 1114). CCNE1 high‐level amplification was present in 11.2% of patients in the testing set and 10.2% in the combined cohort. The optimal cut‐off for IHC to predict CCNE1 high‐level amplification was 60% positive tumour cells with at least 5% strong staining cells (sensitivity 81.6%, specificity 77.4%). CCNE1 high‐level amplification and overexpression were associated with survival in the testing and validation set. Combined CCNE1 high‐level amplification and overexpression was present in 8.3% of patients, mutually exclusive to germline BRCA1/2 mutation and significantly associated with a higher risk of death in multivariate analysis adjusted for age, stage and cohort (hazard ratio = 1.78, 95 CI% 1.38–2.26, p

Anxiety leads to a global decline in quality of life and increase in social burden. However, treatments are limited, because the molecular mechanisms underlying complex emotional disorders are poorly understood. We explored the anxiolytic effects of 8-O-acetyl shanzhiside methylester (8-OaS), an active component in Lamiophlomis rotata (L. rotata; Benth.) or Kudo, a traditional herb that has been shown to be effective in the clinical treatment of chronic pain syndromes in China. Two mouse anxiety models were used: forced swimming stress (FSS)–induced anxiety and complete Freund’s adjuvant (CFA)–induced chronic inflammatory pain. All animal behaviors were analyzed on the elevated plus maze and in the open-field test. 8-OaS significantly ameliorated anxiety-like behaviors in both anxiety models and inhibited the translation enhancement of GluN2A, GluN2B, and PSD95. Moreover, a reduction in GABA receptors disrupted the excitatory/inhibitory (E/I) balance in the basolateral amygdala (BLA), indicated by increased excitatory and decreased inhibitory presynaptic release. 8-OaS also blocked microglia activation and reduced the phosphorylation of p38, c-Jun N-terminal kinase (JNK), NF-κB p65, and tumor necrosis factor alpha (TNF-α) in the BLA of anxiety mice. 8-OaS exhibits obvious anxiolytic effects by regulating the excitatory/inhibitory (E/I) synaptic transmission and attenuating inflammatory responses in the BLA.