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Background: Studies have shown that pharmacological and psychological treatments are effective for children and adolescents with obsessive-compulsive disorder (OCD). However, few network meta-analyses have examined whether pharmacological or psychological treatments on their own, or combined, are most effective. Methods: We conducted a database search and selected randomized controlled trials of pharmacological or psychological treatments, alone or in combination, for children and adolescents with OCD. The primary outcome was change in symptom severity as a result of treatment, as assessed using the Yale-Brown Obsessive Compulsive Scale (BOCS) or Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) . Findings: We included 18 studies with 1353 participants and 12 kinds of treatments. In terms of efficacy, all pharmacological and psychotherapy treatments were more effective than placebo. Among the 12 treatments, the efficacy of pharmacological treatment combined with cognitive behavioral therapy (CBT) was better than pharmacological treatment alone. When pharmacological treatment was used alone, escitalopram was significantly better than clomipramine(CY-BOCS average change 3.42; 95% CI 2.11, 4.65), fluvoxamine(CY-BOCS average change 3.59; 95% CI 1.09, 6.20), paroxetine(CY-BOCS average change 2 .80; 95% CI 0.01, 5.64) and sertraline(CY-BOCS average change 3.49; 95% CI 1.53, 5.64). Interpretation: The available evidence suggests that the combination of pharmacological and psychological treatment is likely to be most effective for children and adolescents with OCD. Funding: The National Nature Science Foundation of China (81801357, 81801350), the Science and Technology Education Program of the Sichuan Province (2020JDKP0013), the Key R&D Projects of the Science and Technology Department of Sichuan Province(2020YFS0259 ), and the Chengdu Key Technology R&D Program (2019-YF05– 00284-SN). Declaration of Interest: None to declare.

Background: For the majority of the patients, surgical treatment of primary infantile exotropia (PIE) with large exodeviation angels of more than 50 prism diopters (PD) is not satisfactory. We evaluate the effectiveness of augmented lateral rectus (LR) muscle recession in treatment of congenital exotropia with large deviation angles. Methods: A retrospective analysis was performed for 25 patients with congenital exotropia who had at least 60 prism diopters (PD). Augmented LR recession was performed using a hemi hang-back technique. The ocular alignment, ocular motility and binocular vision were evaluated pre- and postoperatively. Results: There were 14 male and 11 female affected individuals with congenital exotropia included in this study, with a mean age of (3.92±2.02) years (range, 1 - 7 years). The average exodeviation angle was (68.0±8.78) PD (range, 60 - 80 PD) preoperatively. All patients underwent bilateral LR recession, of whom 3 patients underwent bilateral inferior oblique muscle transposition in the same operation. The mean surgical dosage was (11.08±1.19) mm for each lateral rectus muclse. All patients did not have abduction deficiency after a large amount of lateral rectus recession. 21 of 25 patients (84.0%) acquired orthophoria at the primary gaze position at the final visit. 13 patients obtained binocular vision. Conclusions: Augmented bilateral LR recession is an effective and safe surgical procedure for treatment of congenital exotropia with large deviation angles.

Summary Air injection techniques have been widely applied in oil fields, but the associated safety issue of natural gas (NG) and oil explosion has been of great concern. In this study, explosion experiments of different NG compositions were conducted under high-pressure and high-temperature conditions (up to 15 MPa and 373 K) to reveal the necessary conditions for gas explosion in the air injection process. The experimental results indicate that the lower flammability limits (LFLs) and upper flammability limits (UFLs) of NGs change logarithmically with increasing pressure, which can significantly increase the explosion risk. The rise of temperature can also expand the flammability limit range. Based on the mechanisms and necessary conditions for NG and oil component explosion, fault tree analysis (FTA) models for explosion occurring during the air injection process were proposed that can provide valuable guidelines for designing anti-explosion procedures for field applications. Several explosion incidents that have occurred in air injection operations in different oil reservoirs are described, and the explosion mechanisms are analyzed. NG explosion can occur during air injection when NG is the main component present in the gas phase that can mix with air to form a combustible gas. For heavy oils with little NG, autoignited explosion of vaporized oil components can be the main reason for the incidents during the steam and air coinjection process because the autoignition temperature of heavy oil can be greatly reduced at high pressure.

Background The outbreak of Coronavirus Disease 2019(COVID-19) caused psychological stress in Chinese adults population. But we are unaware of whether the pandemic causes psychological stress on children. Methods We used the Children’s Impact of Event Scale questionnaire (CRIES-13) to investigate the degree of Post-traumatic Stress (PTSD) symptoms caused by the pandemic in students selected from schools in Sichuan, Jiangsu, Henan, Yunnan, and Chongqing provinces of China. Results A total of 7769 students(3692 male and 4077 female), aged 8–18 years, were enrolled in the study, comprising 1214 in primary schools, 2799 in junior high schools and 3756 in senior high schools. A total of 1639 students (21.1%) had severe psychological stress reactions. A large proportion of senior high school students (23.3%) experienced severe psychological stress, and they had the highest median total CRIES-13 score. Female students were more likely to experience severe psychological stress and had higher median CRIES-13 total scores than males. Conclusion COVID-19 has placed psychological stresses on primary and secondary school students in China. These stresses are more likely to reach severe levels among female students and senior high school students.

It was well known that circulating plasma exosomes (Pla-Exo) were enriched with multiple microRNAs (miRNAs) and participated in the regulation of biological and pathological process via exchanging information and transferring substance into targeted cells and organs. Therefore, clinical significance of Pla-Exo had been recognized and they functioned as biomarkers for the clinical diagnosis or therapeutic applications to treat diseases. We explored the possibility of using Pla-Exo as a novel therapeutic approach for ameliorating cognitive dysfunction in Alzheimer’s disease (AD) mice. Here we found that Pla-Exo freely crossed the blood-brain barrier (BBB) and was transferred into the hippocampus of mice. After following peritoneal injection (I.P.) of Pla-Exo, survival of neuron cells was enhanced and cognitive disorder was attenuated in okadaic acid (OA) treated mice via deactivating GSK-3β and down-regulating GSK-3β mediated hyperphosphorylation of Tau protein. Finally, some potential exosomal miRNAs were screened by bioinformatics analysis and confirmed their target of GSK-3β. Taken together, all data proved that Pla-Exo contributed to the amelioration of cognitive impairments.

BackgroundMetabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices.MethodsCross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.ResultsAfter adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.ConclusionsAVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.

Gallium oxide (Ga2O3) has been extensively studied recently because it is a natural candidate material for next generation solar-blind deep ultraviolet photodetectors (PDs). In this study, three dimensional (3D) amorphous Ga2O3 films (a-Ga2O3) were grown on carbon fibre paper (CFP) using a facile one-pot sputtering method. The prepared a-Ga2O3/CFP core–shell composites were used as photoanode materials for a new type of solar-blind photoelectrochemical (PEC)-type photodetector. By constructing a solid/liquid heterojunction, the resulting built-in electric field can separate electron–hole pairs effectively, facilitating a self-powering ability in this PEC-type photodetector. The device exhibited a maximum responsivity of approximately 12.90 mA W−1 and a rapid photoresponse time of around 0.15/0.13 s without external bias potential. Additionally, the PEC-type photodetector demonstrated outstanding stability after significant usage over a one-year period. The excellent performance of the fabricated a-Ga2O3/CFP core–shell photoanode, for self-powered PEC-type photodetectors, is extremely promising in the field of solar-blind photoelectric detection.

Background SARS-CoV-2 has been identified in the fecal matter of COVID-19 patients. However, sewage transmission has never been shown. In April 2020, a COVID-19 outbreak occurred in a densely populated community in Guangzhou, China. We investigated this outbreak to identify the mode of transmission. Method A home quarantined order was issued in the community. We collected throat swab samples from the residents and environmental samples from the surfaces inside and around the houses, and conducted RT-PCR testing and genome sequencing. We defined a case as a resident in this community with a positive RT-PCR test, with or without symptoms. We conducted a retrospective cohort study of all residents living in the same buildings as the cases to identify exposure risk factors. Result We found eight cases (four couples) in this community of 2888 residents (attack rate=2.8/1000), with onset during April 5–21, 2020. During their incubation periods, Cases 1-2 frequented market T with an ongoing outbreak. Cases 3-8 never visited market T during incubation period, lived in separate buildings from, and never interacted with, Cases 1-2. Retrospective cohort study showed that working as cleaners or waste picker (RR=13, 95% CIexact: 2.3-180), not changing to clean shoes after returning home (RR=7.4, 95% CIexact: 1.8-34), collating and cleaning dirty shoes after returning home (RR=6.3, 95% CIexact: 1.4-30) were significant exposure risk factors. Of 63 samples collected from street-sewage puddles and sewage-pipe surfaces, 19% tested positive for SARS-CoV-2. Of 50 environmental samples taken from cases’ apartments, 24% tested positive. Viral genome sequencing showed that the viruses identified from the squat toilet and shoe-bottom dirt inside the apartment of Cases 1-2 were homologous with those from Cases 3-8 and those identified from sewage samples. The sewage pipe leading from the apartment of Cases 1-2 to the drainage had a large hole above ground. Rainfalls after the onset of Cases 1-2 flooded the streets. Conclusion Our investigation has for the first time pointed to the possibility that SARS-CoV-2 might spread by sewage. This finding highlighted the importance of sewage management, especially in densely-populated places with poor hygiene and sanitation measures, such as urban slums and other low-income communities in developing countries.

OBJECTIVE: To elucidate the vision loss and recovery course after Ahmed tube shunt procedure 6 months postoperatively. To identify risk factors associated with significant vision loss. DESIGN: Retrospective chart review. PARTICIPANTS: One eye of all adult patients who underwent Ahmed glaucoma valve procedure from January 2008 to December 2017 with a minimum of six-month follow-up. METHODS: Patients’ preoperative and postoperative corrected visual acuity (CVA) were documented for postoperative 1 week, 1 month, 3 months and 6 months. MAIN OUTCOME MEASURES: Pre- and postoperative CVA at various time points were compared using repeated measures ANOVA. The proportions of patients with mild (less than 3 lines of Snellen CVA loss), moderate (3–5 lines, inclusive), severe (more than 5 lines) vision loss were calculated and compared using a Chi-squared test. Logistic regression analysis was conducted to identify risk factors associated with a loss of 3 or more lines of CVA 6 months after surgery. RESULTS: A total of 375 patients were included, whose mean preoperative CVA was 0.76. At postoperative 1 week, mean CVA worsened to 0.96 (p < 0.05), but recovered back to preoperative level by the third postoperative month (p > 0.05). In terms of any vision loss, 55.6% of patients had worse CVA than pre-operation at postoperative 1 week, including 23.5% who had 3 or more lines of vision loss; these proportions decreased to 39.2% (p < 0.001) and 9.3%, respectively, by postoperative 6 months. The most common causes of significant vision loss were pre-existing ocular conditions and cataract progression. Postoperative anti-metabolite injection was associated with a lower risk of 3 or more lines of CVA loss 6 months postoperatively (OR 0.44, p = 0.023). CONCLUSIONS: After Ahmed tube shunt procedure, worst CVA occurred at 1 week postoperatively and mean CVA returned to preoperative level by the third postoperative month. About 40% of patients had any CVA loss compared to pre-operation, while 9.3% of patients had 3 or more lines of CVA loss at the 6th postoperative month. Postoperative anti-metabolite injection was associated with a lower risk of 3 or more lines of postoperative vision loss.

Near-infrared (NIR) persistent luminescence (PersL) materials are attractive multifunctional-material-platforms to real-time-required studies and applications in chemistry and biomedicine. However,...

Chronic wound healing plagues thousands of diabetic patients and brings social and economic burdens. Plasma exosomes (P-Exos), regarded as nanosized therapeutic agents, have shown therapeutic efficacy in promoting diabetic wound healing. The present work prepared the P-Exos-loaded pH-responsive carboxymethylcellulose (P-Exos-loaded CMC) hydrogel to investigate its ability to accelerate diabetic wound healing and to explore its underlying mechanisms. The results showed that the P-Exos-loaded CMC hydrogel was an effective therapeutic agent for accelerating diabetic wound repair. It promoted the local wound healing process in diabetic type 1 mice and enhanced angiogenesis and re-epithelialization via activating angiogenesis-related pathways mediated by vascular endothelial growth factor (VEGF).

Background We explored the associations between chronic stress and dynamic working patterns of the whole brain using resting state MRI data in drug-naive, first-episode adolescents with major depressive disorder (MDD). Methods We compared dynamic functional connectivity (dyn-FC) and screen out networks with difference in whole brain between 45 healthy controls (HC) and 60 adolescent MDD patients using dynamic independent components analysis. In each of these networks with difference between groups, hub brain regions were selected as functionally connected to more than 30 brain regions at the same time. Then we extracted the dyn-FC coefficients of each hub brain region with other brain regions in each component at different time points and calculated the average value of the entire scan time. Finally, we explored correlations between these average values of the entire scan time and scores on the Childhood Chronic Stress Questionnaire (CCSQ). Results We found three networks as well as some hub brain regions with different dyn-FC patterns between adolescent MDD and HC. Scores on the CCSQ were found to correlate with dynamic FC between hub brain areas and certain other brain areas in MDD patients. Limitations our cross-sectional study design does not allow us to speculate about causality between chronic stress and depression. Prospective cohort studies should explore in detail how the changes in dynamic FC appear and evolve during MDD. Conclusions Chronic stress is related with the brain dynamic working patterns in adolescent MDD.

The emergence of e-commerce and express delivery services has significantly transformed business operations and consumer shopping experience. However, the resulting problem of packaging waste, particularly from overpackaging, poses serious challenges to environmental sustainability and human health. Existing research has proposed many solutions from various perspectives, but very few have considered the acceptability and consumer preference for these proposals. Using the value co-creation (VCC) theory, we established a research model to explore consumer preferences for e-commerce overpackaging solutions. A survey of 632 online consumers in Guangzhou and Shenzhen was conducted, and data were analyzed using the SmartPLS software. The results show that establishing a recycling system, government policy, and consumers’ environmental awareness have a significant positive impact on consumer preference, while combined packaging has a significant negative impact. We also found that government policy plays an intermediary role in establishing a recycling system and consumer preference. Based on these findings, we recommend that enterprises establish and improve their packaging recycling systems and that e-commerce platforms provide alternative options to combined packaging. Also, the government should play a guiding and coordinating role for enterprises and consumers, and environmental awareness among consumers should actively be promoted.

The flammability and explosion characteristics of natural gas (NG) and air mixtures at high pressure and high temperature are of great concerns for air injection IOR (improved oil recovery) process in oilfield and for natural gas combustion engines. In this study, an experimental setup is built up to measure the explosion limits (flammability limits) of methane and natural gas at elevated pressures and temperatures up to 20 MPa and 100 °C. The influences of pressure, temperature, and ignition energy and gas composition on the flammability limits, minimum oxygen content required for explosion (MinOC) and explosion energy have been investigated for methane and typical natural gas mixtures with air. High pressure and high temperature flammability limit models for natural gas-air mixtures have been proposed based on the experimental data. The experimental results show that the flammability limits of natural gas can be significantly extended at high temperature and high pressure, indicating a good flammability for combustion applications but high explosion risks in terms of the safety for the oilfield air injection process. At 100 °C and 20 MPa, the explosion limit range measured for methane in air is extended to 2.87%–64.40%vol, in contrast to the range of 4.95%–15.51%vol at the normal pressure and temperature (0.1 MPa and 25 °C), and the corresponding minimum oxygen content required for explosion can be reduced to as low as 5.74% from around 10% at the atmospheric conditions. The variation of the upper flammability limit (UFL) is more sensitive than that of the lower flammability limit (LFL) as pressure and temperature increase. Electrically heated tungsten wires were applied for the ignition, and it has been found that high ignition energy is required to ignite the gas mixtures at high pressure conditions. The peak explosion pressure (or explosion energy) is mainly depended on the composition of the flammable gas and oxygen, while it is slightly reduced at high temperature conditions and gradually increases with the initial pressure. Explosions with incomplete combustion reaction can occur at near UFL points with enormous amount of carbon black formed due to lack of oxygen, while the explosion energy can be significantly reduced at near LFL points because of lack of flammable gases. The increase of risk index at high pressure and high temperature indicates a larger explosion risk and safety concern.

Background. This study investigated the relationships among the characteristics of colon polyps and potential risk factors, including metabolic condition, CEA level, uric acid level, and Helicobacter pylori (Hp) infection status. Method. Clinical data from patients who received colonoscopy were collected and analyzed, including patients’ gender, age, polyp pathology, metabolic syndrome (MS) status, CEA level, uric acid level, and Hp infection status. Patients were divided into a polyp group and a control group based on whether they presented with colon polyps. Then, clinical data were compared between the two groups to identify any differences between the groups and their relationships to colon polyps. Result. Compared with the control group, the polyp group had significant differences in patient gender, body mass index (BMI), waistline, blood pressure, fasting blood glucose level, blood lipid level, and uric acid level (p<0.05), but there were no significant differences in LDL and CEA levels (p>0.05). Patients with MS or a uric acid level>340 mg/dl had a greater tendency to develop colon polyps but this was not statistically significant. Conclusion. The incidence of colon polyps may be associated with MS and uric acid levels, but further studies are warranted to confirm this conclusion.

Ginkgobalide B (GB) as the main active ingredient of traditional Chinese medicine Ginkgo biloba extract is reported to reduce neuroinflammation, protect neurons and promote cognitive learning ability. To explore that GB can reduce neuroinflammation through regulating nuclear factor-kappaB (NF-κB) signaling pathway and overcome cognitive dysfunction in rats with vascular dementia (VD), we aim at investigating the potential effect of GB on enhancing cognitive function in rats with VD. It was found that GB improved survival of oxygen-glucose deprivation (OGD) treated SH-SY5Y cells by attenuating inflammatory response via Toll-like Receptor 4 (TLR4)/NF-κB pathway. When rats were treated with bilateral common carotid artery occlusion (BCCAO) for 24 h, saline and GB were administered in Sprague-Dawley (SD) rats via a single intraperitoneal injection for consecutive 14 days. The behavioral changes of VD like rats treated with GB were observed through open field test, Morris water maze (MWM) and Y-maze electric maze. Nissl staining and immunofluorescence were used to observe changes of neurons in the hippocampus of rats. Western blot analysis was performed by detecting NF-κB pathway related inflammatory factors. The results found that GB can significantly improve the learning and memory ability of VD rats by reducing TLR4/NF-κB mediated neuroinflammation. In conclusion, GB seemed to be a potential drug for amelioration of learning and memory impairment in rats with VD.

Purpose: To evaluate outcomes of one muscle surgery for treatment of congenital superior oblique palsy (SOP) with Knapp Class V. Methods: Medical records were retrospectively reviewed for the patients with the congenital SOP type V who underwent surgical treatment through one muscle surgery between July 2015 and September 2020. The surgical procedure was resection-recession on the contralateral inferior rectus muscle of the hypertrophic or paretic eye. Vertical alignment at nine cardinal gaze positions, and resolution of the abnormal head posture were evaluated pre- and postoperatively. The follow-up was scheduled regularly at postoperative day 1, 1 week, 1 month, and followed by 2-month intervals until 18 months. Results: Twelve patients were included in this study, with a mean age of 6.4 years (range from 3 to 10 years). The mean follow-up period was 10.5 months after surgery (range from 6 to 18 months). The average vertical deviation at primary position was 6.33△ ± 2.93△ preoperatively and 0.75△ ± 1.14△ postoperatively ( p △ ± 4.75△ preoperatively and 1.92△ ± 1.62△ postoperatively ( p Conclusions: The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.

To determine the efficacy of ketogenic diet (KD) therapy on adrenocorticotropic hormone- (ACTH) or corticosteroid-resistant infantile spasm (IS), and identify relevant associated factors. A prospective controlled study was undertaken at 10 tertiary children's medical centres in mainland China. Participants were non-randomly assigned to KD therapy or control (adjustment of antiepileptic drugs). The primary outcome was the reduction in spasms and remission of hypsarrhythmia at the 16th week, divided into Grade I (spasm-free for at least one week with hypsarrhythmia remission), Grade II (≥50% spasm reduction and/or hypsarrhythmia remission) and Grade III (

With the rapid development of e-commerce, the backlog of distribution orders, insufficient logistics capacity and other issues are becoming more and more serious. It is very significant for e-commerce platforms and logistics enterprises to clarify the demand of logistics. To meet this need, a forecasting indicator system of Guangdong logistics demand was constructed from the perspective of e-commerce. The GM (1, 1) model and Back Propagation (BP) neural network model were used to simulate and forecast the logistics demand of Guangdong province from 2000 to 2019. The results show that the Guangdong logistics demand forecasting indicator system has good applicability. Compared with the GM (1, 1) model, the BP neural network model has smaller prediction error and more stable prediction results. Based on the results of the study, it is the recommendation of the authors that e-commerce platforms and logistics enterprises should pay attention to the prediction of regional logistics demand, choose scientific forecasting methods, and encourage the implementation of new distribution modes.

With crowd logistics becoming a crucial part of the last-mile delivery challenge in many cities, continued participation of crowd workers has become an essential issue affecting the growth of the crowd logistics platform. Understanding how people are motivated to continue their participation in crowd logistics can provide some clarity as to what policies and measures should be undertaken by the industry to support its further growth. Using the Push&ndash, Pull&ndash, Mooring (PPM) theory, we developed a research model to explain the factors influencing crowd workers&rsquo, participative behavior. Survey data from 455 crowd workers were analyzed using SmartPLS3.0 software. The results show monetary rewards and trust have a significant positive impact on the willingness of crowd workers to continue participating in crowd logistics, while work enjoyment from previous work and entry barriers for work have a significant negative impact. Trust plays an intermediary role between monetary incentives and crowd workers&rsquo, willingness to continue participating. Based on the findings of this study, we recommend that crowd logistics platforms should offer reasonable monetary incentives and keep these under constant review, build a high degree of trust and cooperation with their crowd workers, and initiate activities geared towards promoting satisfaction at work.

Background: SARS-CoV-2 has been identified in the feces of COVID-19 patients. However, fecal transmission has never been shown epidemiologically. In April 2020, a COVID-19 outbreak occurred in a low-income community in Guangzhou, China. We investigated this outbreak to identify the mode of transmission. Methods: A home quarantined order was issued in the community. We collected throat swab samples from the residents and environmental samples from the surfaces inside and around the houses, and conducted RT-PCR testing and genome sequencing. We defined a case as a resident in this community with a positive RT-PCR test. We conducted a retrospective cohort study among the residents living in the same building as the cases to identify transmission risk factors. Findings: We found eight cases (four couples) in this community of 2888 residents (attack rate=2.8/1000), with onset from April 5 to 21, 2020. During their incubation periods, Cases 1 and 2 frequented a Market T, where an outbreak was ongoing. Cases 3-8 never visited Market T during incubation periods, lived in separate buildings from, and never interacted with, Cases 1 and 2. Retrospective cohort study showed that working as cleaners or street scavengers (RR=13, 95% CI: 1.8-99), not changing to clean shoes after returning home (RR=7.4, 95% CI: 1.7-33), collating and cleaning dirty shoes after returning home (RR=6.3, 95% CI: 1.4-28) were significant exposure risk factors. Of 63 samples collected from street sewage puddles and sewage pipes, 19% tested positive for SARS-CoV-2. Of 50 samples taken from the cases’ apartments, 24% tested positive. RNA sequencing showed that the viruses identified from the squat toilet and the shoe-bottom dirt from the apartments of Cases 1 and 2 are homologous with those from Cases 3-8 and those identified from the sewage samples. The sewage pipe leading from the apartment of Cases 1 and 2 down to the drainage had a large crack above the ground. Rainfalls after the onset of Cases 1 and 2 flooded the streets. Interpretation: Our investigation has for the first time provided epidemiologic evidence that SARS-CoV-2 can be spread by sewage. This finding highlighted the importance of sewage management, especially in densely-populated places with poor hygiene and sanitation measures, such as urban slums and other low-income communities in developing countries. Funding: No. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the ethics committees of GZCDC (approval number GZCDC-ECHR-2020A0004).

As the key basis materials of Ni-MH and Ni/Cd battery electrode, the quality of the nickel foam products is closely related with the performance and safety of rechargeable batteries. In order to meet the requirements of automatic defect inspection, this paper proposes an image segmentation method for the appearance defects of nickel foam. Nickel foam image has the characteristics of a low degree of differentiation between foreground and background, basic structure of mutual adhesion, surface morphology for complex random texture features. In order to extract defects from complex nickel foam surface image, a novel selective filtering method is proposed to preprocess the original image, thereby reducing the effects of the above factors, and then a modified PCNN method is used to segment the defect area. The results show that the proposed method can effectively segregate the defects from the background, which lays a foundation for the automatic detection of the appearance quality of nickel foam.

High-pressure air injection technique has been extensively used for enhanced oil recovery in oilfields. Yet, it is of great concern on the process safety in terms of the explosion of natural gas-air mixtures. To deeply understand the explosion characteristics in the air injection procedure, explosion experiments for methane (a main component of natural gas) and air mixture were conducted using a cylindrical vessel at elevated pressure and temperature situations. The explosion pressure, the pressure rise rate and deflagration index of CH4 and air mixtures in a closed chamber were investigated under pressure up to 15 MPa and temperature up to 100 °C, and the effect of CH4 concentration on explosion pressure was also examined. The results of this research can provide useful data to quantify the dependency of explosion risk parameters on pressure, temperature and gas concentration. The experimental results indicate that the explosion pressure at flammability limits of CH4 gradually increases with initial pressure, while it can be slightly declined at elevated temperatures. The pressure rise rate and deflagration index increase at high pressures, but these values become lower at higher temperatures. At lower flammability limits and upper flammability limits of CH4-air mixtures, the explosion pressure can be greatly reduced due to the presence of insufficient combustible gas or high content of inerting gas (N2). The explosion pressure data reported in this study can provide guidelines for the prevention and mitigation of explosion disasters in high-pressure air injection process.

Explosion related safety problems of heavy oil and liquid oil are of great concern in energy related industries. For the petroleum industry, air injection assisted steam recycling (huff and puff) and in-situ combustion are important techniques for the exploitation and development of heavy oils, but a number of explosion accidents that occurred related to heavy oil have greatly restricted the application of the techniques. Aiming at the explosion problems in the air injection process for heavy oil production, the explosion conditions and characteristics of heavy oil-air mixtures at high pressure and high temperature were investigated via laboratory experiments using an improved explosion testing facility to simulate the explosion in a narrow pipe-like space. The effect of pressure (up to 15 MPa) on piloted ignition and auto ignition temperatures of different heavy oil types has been studied. The influences of pressure and properties of heavy oil on the evaporation and explosion detonation of heavy oil components were revealed. Based on the experimental and theoretical analysis results, the necessary conditions for the explosion and its influencing factors of heavy oil-air mixtures were determined, and the effect of average relative molecular weight of HC on auto ignition point was investigated.

In-situ upgrading (ISU) via downhole heating is an innovative and efficient technique for oil shale and ultra heavy oil recovery. However, low heat transfer in the ISU process can limit its application in large scale. Therefore, efficient air injection assisted ISU process (AAISU) was proposed. In this study, reservoir stimulation of the AAISU process was performed to investigate the effect of air injection on heat transfer, oil production performance and energy conversion efficiency, as compared to the original ISU process. The influences of important engineering aspects were investigated, including well pattern, well distance, heating temperature and air injection rate for the field application of the AAISU technique. The reservoir stimulation results indicate that heat transfer rate can be significantly accelerated by air injection, and the average reservoir temperature during the AAISU can be increased to 250 °C after one year, in comparison with that of 116 °C in the ISU process. The contribution of air injection on the total heat transfer can be approached to 60%. Air injection can also enhance oil recovery and improve the energy efficiency. Heating temperature and air injection rate also have significant impact on the performance of the AAISU process. For a 15 m × 15 m × 10 m geo-model, increase of the heating temperature from 250 °C to 350 °C and air injection rate from 500 m3/day to 1000 m3/day can result in improved energy efficiency. However, heating temperature above 350 °C and the air injection rate over 1000 m3/day can led to a decreased energy efficiency, due to higher energy consumption on electrical heating and high rate of air injection.

Early distinction between severe Mycoplasma pneumoniae pneumonia (MPP) and mild MPP is still difficult. The aim of this study was to analyze cytokines in bronchoalveolar lavage fluid (BALF) and explore predicting factors of severe MPP in children. Retrospective analysis was performed on 150 children with MPP or bronchial foreign body (FB) admitted in our hospital. The mRNA levels of IL17A were found significantly lower in severe MPP group comparing with mild MPP group or FB group. However, no significant difference was found in the levels of IL4, IL10 or interferon beta1 (IFNβ1) between the two groups. Receiver operator characteristic (ROC) curve analysis showed that IL17A can be used to distinguish severe MPP from mild MPP. These results were confirmed in a validation cohort including 40 MPP children from another hospital. IL17A levels were correlated with some clinical characters, such as refractoriness and pleural effusion. Lower IL17A levels were more likely to be found in refractory MPP children or in MPP children with pleural effusion. Moreover, the protein levels of IL17A in BALF were also found greatly decreased in children with severe MPP. Thus, decreased IL17A levels in BALF may be a valuable biomarker to identify severe MPP in children.

Ocular neovascularization is a devastating pathology of numerous ocular diseases and is a major cause of blindness. Caveolin-1 (Cav-1) plays important roles in the vascular system. However, little is known regarding its function and mechanisms in ocular neovascularization. Here, using comprehensive model systems and a cell permeable peptide of Cav-1, cavtratin, we show that Cav-1 is a critical player in ocular neovascularization. The genetic deletion of Cav-1 exacerbated and cavtratin administration inhibited choroidal and retinal neovascularization. Importantly, combined administration of cavtratin and anti-VEGF-A inhibited neovascularization more effectively than monotherapy, suggesting the existence of other pathways inhibited by cavtratin in addition to VEGF-A. Indeed, we found that cavtratin suppressed multiple critical components of pathological angiogenesis, including inflammation, permeability, PDGF-B and endothelial nitric oxide synthase expression (eNOS). Mechanistically, we show that cavtratin inhibits CNV and the survival and migration of microglia and macrophages via JNK. Together, our data demonstrate the unique advantages of cavtratin in antiangiogenic therapy to treat neovascular diseases.

// Peiqiang Li 1, 2, * , Lijuan Huang 1, * , Yufang Zheng 1, 3 , Xuedong Pan 1 , Rui Peng 1 , Yueming Jiang 1 , Richard H. Finnell 4, 5 , Haijie Li 6 , Bin Qiao 6 and Hong-Yan Wang 1, 3, 7 1 Obstetrics and Gynecology Hospital, State Key Laboratory of Genetic Engineering at School of Life Sciences, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China 2 Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou City 730000, China 3 Key Laboratory of Reproduction Regulation of NPFPC, Collaborative Innovation Center of Genetics and Development, Fudan University, Shanghai 200032, China 4 Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX 78701, USA 5 Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Jiangwan Campus, Shanghai 200438, China 6 Institute of Cardiovascular Disease, General Hospital of Jinan Military Region, Jinan 250022, China 7 Children’s Hospital Fudan University, Shanghai 201102, China * These authors contributed equally to this work Correspondence to: Hong-Yan Wang, email: wanghy@fudan.edu.cn Keywords: congenital heart defects, vitamin B12, TCN2, holo-TC, LRP2 Received: November 15, 2016 Accepted: June 29, 2017 Published: July 19, 2017 ABSTRACT Deregulation of folate and vitamin B12 (VB12) metabolism contributes to the risk of congenital heart defects (CHDs). Transcobalamin (TCN2) is essential for transporting VB12 from blood to cells as TCN2-bound VB12 (holo-TC) is the only form for somatic cellular uptake. In this study, we performed an association study between common polymorphisms in 46 one carbon metabolism genes and CHD in 412 CHDs and 213 controls. Only two significant association signals in coding regions were identified: FTCD c.1470C>T & TCN2 c.230A>T. The only missense mutation, TCN2 c.230A>T, was further validated in 412 CHDs and 1177 controls. TCN2 c.230T is significantly associated with reduced CHD risk in North Chinese (odds ratio = 0.67, P = 4.62e-05), compared with the 230A allele. Interestingly, the mean level of plasma holo-TC in women with the TA genotype was 1.77-fold higher than that in women with the AA genotype. Further analysis suggested that c.230A>T enhanced the cellular uptake of holo-TC via the LRP2 receptor. Our results determined that a functional polymorphism in TCN2 contributes to the prevalence of CHDs. TCN2 c.230A>T is significantly associated with a reduced CHD risk, likely due to TCN2 c.230T improving the interaction between holo-TC and its LRP2 receptor.

Although higher serum level of cystatin C (CysC) was observed in patients with cerebral microbleeds, its associated role in the disease has not been elucidated. In this work, a rat model of cerebral microbleeds was created with the aim of investigating effects of CysC on cognitive function in rats with cerebral microbleeds and the underlying mechanism. Serum samples of patients with cerebral microbleeds and healthy people of the same age were collected. Levels of cystatin C expression in these samples were measured using CysC kits. Moreover, 48 spontaneously hypertensive rats (SHRs) bred under specific pathogen-free (SPF) conditions were randomly divided into 4 groups: sham surgery control group (sham), model group (CMB), model + empty vector control group (CMB + vehicle), and model + cystatin C overexpression group (CMB + CysC). Expression levels of CysC in hippocampus of rats in each group were measured by western blot analysis. The Y-maze was used to evaluate cognitive function of rats. Hippocampal long-term potentiation (LTP) in rats was assessed by the electrophysiological assay. Alterations in levels of p-ERK1/2 and p-synapsin Ia/b proteins associated with cognitive function were identified by western blot analysis. The serum levels of CysC in patients with cerebral microbleeds were significantly upregulated (P

In this paper, α-Ga2O3 nanorod arrays (NRAs) with preferential growth along the (110) direction were successfully prepared on the FTO substrate by the water bath method. With the help of a scanning electron microscope (SEM), X-ray diffractometer (XRD), and Raman spectrometer (Raman), the crystal structure and morphology characteristics of α-Ga2O3 NRAs were studied. On this basis, a photoelectrochemical (PEC) solar-blind ultraviolet photodetector based on the α-Ga2O3 NRAs was fabricated, and the photoelectric performance of the device was analyzed in detail through the PEC test system, and the working mechanism of the device was further discussed. The results show that the prepared α-Ga2O3 NRAs have good crystal quality which is closely arranged on the substrate and a quadrangular prism shape from the top view. The constructed α-Ga2O3 NRAs PEC photodetector shows typical solar-blind ultraviolet response characteristics and stable self-powered ability. Meanwhile, the device exhibited a high photo-dark current ratio (PDCR), responsivity (R) and detectivity (D*) of 1.01×103, 11.34 mA/W and 2.68×1011 Jones, respectively, as well as superior wavelength selectivity and fast response. This work confirms that α-Ga2O3 NRAs prepared by the water bath method have potential application prospects in highly sensitive and fast response PEC self-powered solar-blind ultraviolet photodetectors.

// Lei Zheng 1, 2, * , Chen Zhao 3, * , Yuxiang Du 2 , Xianchai Lin 2 , Yida Jiang 2 , Chunsik Lee 2 , Geng Tian 1 , Jia Mi 1 , Xianglin Li 1 , Qishan Chen 2 , Zhimin Ye 2 , Lijuan Huang 2 , Shasha Wang 2 , Xiangrong Ren 2 , Liying Xing 2 , Wei Chen 2 , Delong Huang 1, 2 , Zhiqin Gao 4 , Shuping Zhang 1 , Weisi Lu 2 , Zhongshu Tang 2 , Bin Wang 5 , Rong Ju 2 , Xuri Li 1, 2 1 Center for Medical and Pharmaceutical Research, Binzhou Medical University, Yantai, Shandong, 264003, P. R. China 2 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, P. R. China 3 Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University and State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 210029, P. R. China 4 Department of Cell Biology, Weifang Medical University, Weifang, 261053 P. R. China 5 Medical Imaging Institute, Shandong Province Characteristical Key Subject, Medical Imaging and Nuclear Medicine, Binzhou Medical University, Yantai, 264003 P. R. China * Equal first authors Correspondence to: Xuri Li, email: lixr6@mail.sysu.edu.cn Rong Ju, email: jurong@mail.sysu.edu.cn Bin Wang, email: binwang001@aliyun.com Keywords: angiogenesis, PDGF-CC, VEGF-A, drug resistance Received: May 11, 2016 Accepted: October 14, 2016 Published: October 24, 2016 ABSTRACT Anti-VEGF-A therapy has proven to be effective for many neovascular diseases. However, drug resistance to anti-VEGF-A treatment can develop. Also, not all patients with neovascular diseases are responsive to anti-VEGF-A treatment. The mechanisms underlying these important issues remain unclear. In this study, using different model systems, we found that inhibition of VEGF-A directly upregulated PDGF-CC and its receptors in multiple cell types in pathological angiogenesis in vitro and in vivo . Importantly, we further revealed that combinatorial targeting of VEGF-A and PDGF-CC suppressed pathological angiogenesis more efficiently than monotherapy. Given the potent angiogenic activity of PDGF-CC, our findings suggest that the development of resistance to anti-VEGF-A treatment may be caused by the compensatory upregulation of PDGF-CC, and combined inhibition of VEGF-A and PDGF-CC may have therapeutic advantages in treating neovascular diseases.

BACKGROUND: To explore the application of neural network models in artificial intelligence (AI)-aided devices fitting for low vision patients. METHODS: The data of 836 visually impaired people were collected in southwestern Fujian from May 2014 to May 2017. After a full eye examination, 629 low vision patients were selected from this group. Based on the visual functions, rehabilitation needs, and living quality scores of the selected patients, the professionals chose assistive devices that were the best fit for the patients. The data of these three factors were then subjected to the quantitative analysis, and the results were digitized and labeled. The final datasets were used to train a fully connected deep neural networks to obtain an AI-aided model for assistive device fitting. RESULTS: In this study, the main causes of low vision in southwestern Fujian were congenital diseases, among which congenital cataract was the most common. During the low vision AI-aided devices fitting, we found that the intermediate distance magnifier was suitable for the largest number of patients. Through quantitative analysis of the research results, it was found that AI-aided devices fitting was closely related to visual function, rehabilitation needs and quality of life. If this complex relationship can be mapped into the neural network model, AI-aided device fitting can be realized. We built a fully connected neural network model for AI-aided device fitting. The input of the model was the characteristic data of low vision patients, and the output was the forecast of suitable devices. When the threshold of the model was 0.4, the accuracy was about 80% and the F1 value was about 0.31. This threshold can be used as the classification judgment threshold of the model. CONCLUSIONS: Low vision AI-aided device fitting is closely related to visual function, rehabilitation needs, and quality of life scores. The neural network model based on full connection can achieve high accuracy in AI-aided devices fitting. It has a great impact on clinical application.

Purpose To investigate the different causes of vision loss and school-based treatment regimens at Quanzhou Blind School (QBS), China's largest blind school, in 2008 and 2016. Methods In 2008, 144 students received comprehensive eye examinations along with a complete family and ophthalmic history; in 2016, 125 students were examined. Vision loss was categorized into visual impairment and blindness classifications based on WHO guidelines. The etiologies of impairment and blindness in 2008 were compared to those in 2016 using the Fisher exact test. The prevalence and type of visual aids were also analyzed during this period. Results The leading cause of visual impairment significantly shifted from corneal scarring in 2008 to retinopathy of prematurity (ROP) in 2016 (P = 0.020). Congenital cataracts remained the leading cause of blindness in 2008 and 2016. In 2016 there was a significant increase in the use of visual aids, with 63.2% of students using them in 2016 compared to 8.3% in 2008 (P = 0.0001). Conclusions Between 2008 and 2016, the leading cause of visual impairment shifted from corneal scarring to ROP, while congenital cataracts remained the leading cause of blindness.

Purpose Pathogenic variants of the G-protein coupled receptor 143 (GPR143) gene may result in Ocular albinism type I (OA1). In this study, we describe the clinical features and investigate the GPR143 gene mutations in six Chinese families with OA1 and evaluate the thickness changes of iris for the affected males and female carriers. Methods Families were ascertained, and patients underwent complete ophthalmologic examinations, including the best corrected visual acuity (BCVA), anterior segment of the eyes, vitreous and fundus changes. Spectral domain optical coherence tomography (SD-OCT) was used to measure the full iris thickness, the stroma/anterior border (SAB) layer, and the posterior epithelial layer (PEL) at the pupillary and ciliary regions. DNA was extracted from the peripheral blood vessels after confirmed consent information. GPR143 gene was directly sequenced by the Sanger method. Results The affected males had variable reduced visual acuity, nystagmus and macular hypoplasia. Four novel frameshift mutations and two previously reported missense/nonsense mutations in the GPR143 gene were detected in these families. The thickness of the iris was significantly reduced at the ciliary region in the affected males, compared with that in the normal controls and the female carriers. Conclusions Pathogenic variants in the GPR143 gene may disturb the normal melanogenesis in the pigmented tissues of the eye, result in macular hypoplasia, and alter the thickness of the iris.

Online reviews provide consumers with information about products and services that may affect their purchasing decisions. As such, the customer attitude in the reviews play a important role to product sales. In this study, new sentiment prediction method is presented to enhance the forecasting accuracy by utilizing review dual-sentiments and employing non- linear manifold dynamics algorithm. Not only this method can extract and separate the polarity sentiment factors from the content of each online review, but also can remove the seasonality of products and mix the different types’ data. Extensive experimental results validate the effectiveness of our proposed method.

Objectives. To compare the predictive ability of six anthropometric indices for identification of metabolic syndrome (MetS) and to determine their optimal cut-off points among Chinese adults. Methods. A total of 59,029 participants were enrolled. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), and conicity index (CI) were measured. Receiver-operating characteristic curves analyses were performed to determine the discriminatory power of these indices for the identification of cardiometabolic risks and diagnosis of MetS. The differences in the area under the curve (AUC) values among the indices were evaluated. The Youden index was used to determine the optimal cut-off points. Results. WHtR and BRI exhibited the highest AUC values for identifying MetS and most cardiometabolic risk factors in both sexes, whereas ABSI showed the lowest AUC value. The general optimal cut-off points in women were 23.03 kg/m2 for BMI, 77.25 cm for WC, 0.490 for WHtR, and 3.179 for BRI; those in men were 24.64 kg/m2 for BMI, 87.25 cm for WC, 0.510 for WHtR, and 3.547 for BRI. The AUC values and cut-off points of the indices were also analyzed in each age and BMI category. Conclusions. In Chinese adults, WHtR and BRI showed a superior predictive power for MetS in both sexes, which can be used as simple and effective screening tools for cardiometabolic risks and MetS in clinical practice.

Deep-tissue injury (DTI) is a unique type of pressure ulcer (PU) in which deep-tissue damage expands outwards to the superficial skin. DTI progresses rapidly into a severe PU, despite initially appearing as only a bruise or darkened tissue in the superficial skin. Although some DTI detection methods are available, there is currently no strategy for treating deteriorating DTI. This study investigated the efficacy of vibration therapy for preventing DTI deterioration through down-regulation of the hypoxia-inducible factor-1 matrix metalloproteinase (MMP) axis in rats. We prepared a conventional PU rat model (PU group) and a DTI deterioration rat model (DTI group). The DTI group was further divided into two groups subjected to vibration and control treatments, respectively. Macroscopic and histological features, hypoxia, oxidative stress, apoptosis, and MMP2 and MMP9 activities in compressed skin were analyzed. Hypoxia, oxidative stress, and MMP activity were enhanced in the DTI group compared with the PU group. Vibration remarkably inhibited DTI deterioration, hypoxia, and the expression/activities of MMP2 and MMP9. These results suggest that vibration therapy can effectively attenuate deterioration of DTI. This report provides the first evidence for a therapeutic treatment for deteriorating DTI.

Background and aims The association between anthropometric indices of body composition and arterial stiffness is inconclusive. The objective of this study was to examine the predictive ability of two new obesity indices: a body shape index (ABSI), and a body roundness index (BRI), for the identification of arterial stiffness among Chinese adults, as well as to compare the relative strength of association between the anthropometric indices and arterial stiffness. Methods A total of 10,197 subjects were recruited in this cross-sectional study. We tested the association between anthropometric indices (body mass index [BMI], waist circumference [WC], waist-height-ratio [WHtR], ABSI and BRI) and brachial–ankle pulse wave velocity (PWV). Receiver operating characteristic curve and area under curve (AUC) were employed to evaluate the predictive value of the anthropometric indices for identification of arterial stiffness. Results After adjusting for confounding variables, BRI (linear regression: 0.112; AUC: 0.726; OR: 1.228 for female and linear regression: 0.047; AUC: 0.631; OR: 1.173 for male) exhibited a more powerful predictive ability of arterial stiffness than ABSI (linear regression: 0.110; AUC: 0.674; OR: 1.315 for female and linear regression: 0.058; AUC: 0.610; OR: 1.150 for male) and WC (linear regression: 0.078; AUC: 0.699; logistic regression: negative for female and linear regression: negative; AUC: 0.593; logistic regression: negative for male) while having a similar predictive value to that of WHtR (linear regression: 0.113; AUC: 0.726; OR: 1.228 for female and linear regression: 0.047; AUC: 0.631; OR: 1.185 for male) among both sexes. BMI (linear and logistic regression: negative; AUC: 0.660 for female and 0.568 for male) had the lowest predictive power in both sex categories. The optimal cut-off of WHtR for detecting arterial stiffness was 0.49 in females and 0.53 in males, that of BRI was 3.19 in females and 3.89 in males. Conclusions WHtR, ABSI and BRI were significantly associated with arterial stiffness. BRI and WHtR, rather than ABSI, showed superior predictive abilities for arterial stiffness in both sexes.

Objective. To analyze the factors influencing the hospitalization costs of patients undergoing lung cancer surgery, based on the back-propagation (BP) neural network model, and to provide support for controlling the costs effectively. Method. To collect the hospitalization data of 168 cases of patients with lung cancer surgery from January 2010 to December 2013, and then analyze the influencing factors of the different classified hospitalization costs based on the BP neural network. Results. The expenses on drugs and consumables comprise the largest proportion of the total cost of hospitalization, at 34.35% and 23.24% respectively. The length of hospital stay is the most important factor in the hospital costs. The patients with longer hospital stay have higher costs and the difference is significant (P < 0.05). Conclusion. The hospitals should control their charges on drugs and consumables reasonably and reduce the length of hospital stay effectively, so as to reduce the economic burden on lung ca...

Aging disrupts skin barrier function and induces xerosis accompanied by pruritus. In many cases, elderly patients complain of pruritus during skin hygiene care, a condition called aquagenic pruritus of the elderly (APE). To date, the pathophysiology and mechanism of action of APE have not been elucidated. We conducted the present study to test the hypothesis that hypo-osmotic shock of epidermal cells induces skin inflammation and elongation of C-fibers by nerve growth factor β (NGFβ) as a basic mechanism of APE. The dorsal skin of HWY rats, which are a model for disrupted skin barrier function, was treated with distilled water (hypotonic treatment [Hypo] group) or normal saline (isotonic treatment [Iso] group) by applying soaked gauze for 7 days. Untreated rats were used as a control (no-treatment [NT] group). Histochemical and immunohistochemical analyses revealed inflammatory responses in the epidermis and the dermal papillary layer in the Hypo group, while no alterations were observed in the Iso or NT groups. Induction of expression and secretion of NGFβ and elongation of C-fibers into the epidermis were found in the Hypo group. In contrast, secretion of NGFβ was significantly lower and elongation of C-fibers was not observed in the Iso group. These results suggest that hypo-osmotic shock–induced inflammatory reactions promote hypersensitivity to pruritus in skin with disrupted barrier function.

Objective. To evaluate comprehensively the quality of medical practices in a hospital from 1998 to 2012 by principal component analysis, and provide an objective and scientific theoretical basis for the long-term scientific management of the hospital. Methods. Choosing nine representative indicators that can reflect the medical quality of the hospital from the statistical forms of the hospital, after performing the standardized data conversion of the original data, calculating the comprehensive value of each year by using the principal component analysis, so as to carry out a comprehensive evaluation. Results. The medical quality of the hospital in 2012 ranks on top (evaluation comprehensive value F = 3.546), followed by that of 2011 (evaluation comprehensive value F = 1.951) and the worst is 1998 (evaluation comprehensive value F = − 2.012); the general trend shows gradual improvement since 1998 (evaluation comprehensive value F rises from − 2.012 to 3.546). Conclusion. The principal component an...

Air injection into oil reservoirs for improved oil recovery is a proven technique in oilfields, while the safety of the process has been concerned over the possible explosion of natural gas at high pressure conditions. The combustion and explosion characteristics of natural gas-air mixture are also important for natural gas engines. In this study, ignited explosion experiments of methane-air mixtures have been conducted using a cylinder chamber under pressure up to 32 MPa, in which the influences of pressure on the explosion and flammability limits have been investigated. The experimental results indicate that the lower flammability limit of methane decreases slightly at elevated pressures, while its upper flammability limit increases significantly over 3 MPa, and the theoretical limiting oxygen concentration required for explosion is gradually reduced, posing greater explosion risks. At ambient temperature, the measured explosion limit range for methane in air is 2.93%–60.75%vol at 30 MPa, in contrast to 4.95% and 15.51%vol at atmospheric pressure, and the corresponding theoretical limiting oxygen concentration at 30 MPa can be reduced to as low as 5.86% from around 10% at 0.1 MPa when ignited using heated tungsten wire. A high pressure explosion limits model for methane-air mixture has been proposed based on the experimental data.

Background:Renal replacement therapy (RRT) is the main treatment for patients with sepsis-induced acute kidney injury (SAKI). However, the choice of RRT strategy remains controversial.Objective:This study assessed the effectiveness of RRT variants in SAKI patients by a network meta-analysis.

Objective To identify the optimal threshold of HbA1c and to evaluate the predictive performance of HbA1c levels in diagnosing diabetes and prediabetes in a middle-aged and elderly Han Chinese population from northwest China. Methods In all, 3354 participants aged ≥40 years with no history of diabetes from northwest China were enrolled in the present cross-sectional study. All subjects underwent a 75-g oral glucose tolerance test (OGTT), as well as HbA1c testing. HbA1c thresholds for diagnosing diabetes and prediabetes were identified by the highest sum of sensitivity and specificity of each cut-off point, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the HbA1c threshold. Results The mean (± SD) age of the participants was 57 ± 8 years, and 70.75% were women. Based on results of the OGTT, 1347 (40.16%) subjects had impaired fasting glucose and/or impaired glucose tolerance, and 725 (21.62%) had diabetes. The area under the ROC curve for detecting undiagnosed diabetes and prediabetes by HbA1c levels was 0.810 (95% confidence interval [CI] 0.796–0.823) and 0.732 (95% CI 0.717–0.747), respectively. HbA1c threshold of 6.4% and 6.1% produced the highest sum of sensitivity (60.00% and 61.49%) and specificity (87.33% and 73.24%) for diagnosing diabetes and prediabetes, respectively. Conclusion HbA1c is an effective and convenient method for diagnosing diabetes and prediabetes. HbA1c thresholds of 6.4% and 6.1% may be used as diagnostic criteria for diabetes and prediabetes, respectively, in the Han Chinese population living in northwest China. 摘要 目的 在中国西北地区中老年汉族人群中，探讨HbA1c用于诊断糖尿病和糖尿病前期的切点以及评价HbA1c其预测能力。 方法 本项横断面研究纳入了3354名年龄≥40岁、无糖尿病史的中国西北部地区的汉族人群，所有研究对象均接受了75 g口服葡萄糖耐量试验以及HbA1c的检测。HbA1c用于诊断糖尿病和糖尿病前期的切点通过敏感性和特异性之和的最大值来确定，并采用受试者工作特征曲线评价HbA1c用于诊断的准确性。 结果 研究人群的平均年龄（±SD）为57±8岁，女性占70.75%。根据OGTT试验结果，1347人（40.16%）有空腹血糖受损和/或糖耐量受损，725人（21.62%）患糖尿病。根据HbA1c水平检测无糖尿病和糖尿病前期时，ROC曲线下面积分别为0.810（95%CI 0.796–0.823）和0.732（(95% CI 0.717–0.747）。根据HbA1c水平诊断糖尿病和糖尿病前期时，当HbA1c值分别为6.4%和6.1%时，其敏感性 （60.00% 和61.49%）和特异性 （87.33% and 73.24%）之和最大。 结论 HbA1c是一个方便、有效的诊断糖尿病和糖尿病前期的检测方法。HbA1c值为6.4% 和 6.1%可作为中国西北部地区汉族糖尿病和糖尿病前期的诊断切点。

Neoadjuvant chemotherapy (NACT) is being used increasingly in the management of patients with breast cancer for systemically reducing the size of primary tumor before surgery in order to improve survival. The clinical response of patients to NACT is correlated with reduced or abolished of their primary tumor, which is important for treatment in the next stage. Recently, the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is used for evaluation of the response of patients to NACT. To measure this correlation, we extracted the dynamic features from the DCE- MRI and performed association analysis between these features and the clinical response to NACT. In this study, 59 patients are screened before NATC, of which 47 are complete or partial response, and 12 are no response. We segmented the breast areas depicted on each MR image by a computer-aided diagnosis (CAD) scheme, registered images acquired from the sequential MR image scan series, and calculated eighteen features extracted from DCE-MRI. We performed SVM with the 18 features for classification between patients of response and no response. Furthermore, 6 of the 18 features are selected to refine the classification by using Genetic Algorithm. The accuracy, sensitivity and specificity are 87%, 95.74% and 50%, respectively. The calculated area under a receiver operating characteristic (ROC) curve is 0.79±0.04. This study indicates that the features of DCE-MRI of breast cancer are associated with the response of NACT. Therefore, our method could be helpful for evaluation of NACT in treatment of breast cancer.

Aging is accelerated, at least in part, by pathological condition such as metabolic syndrome (MetS), and various molecular pathways such as oxidative stress are common mediators of aging and MetS. We previously developed the aging-like skin model by single ultraviolet (UV) irradiation on the MetS model mice. Recent studies revealed that mineralocorticoid receptor (MR) signaling plays a pivotal role for various tissue inflammation and damages in MetS. Although previous studies reported that MR is expressed in the skin and that overexpression of MR in the skin resulted in the skin atrophy, the physiological or pathological functions of MR in the skin are not fully elucidated. Here, we show the involvement of MR signaling in the aging-like skin changes in our own model. Elevations of oxidative stress and inflammation markers were observed in the MetS mice, and the UV-evoked aging-like skin damages were attenuated by topical antioxidant. MR expression was higher in the MetS mouse skin, and notably, expression of its effecter gene Sgk1 was significantly upregulated in the aging-like skin in the UV-irradiated MetS mice. Furthermore, topical application of MR antagonist spironolactone suppressed Sgk1 expression, oxidative stress, inflammation, and the aging-like changes in the skin. The 2-week UV onto the non-MetS mice, the more usual photoaging model, resulted in the skin damages mostly equivalent to the MetS mice with single UV, but they were not associated with upregulation of MR signaling. Our studies suggested an unexpected role of MR signaling in the skin aging in MetS status.

With the application and development of microgrids, taking discrete discontinous generation and load shedding measures to achieve the stability control of the system has become popular. In order to better to provide the basis for the formulation and implementation of control programs, we should study the process of generation and load shedding. In this paper, the experimental system model based on the Matlab/ Simulink platform and also analyzed two factors affecting frequency of the system: DG, load. By cutting DG and shedding load under transient state, the simulation model can ultimately remain stable, indicating that the prevention and control measures are effective to system. we can promote the use of the experimental system.