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This study aimed to identify unique dietary patterns, and to examine the correlation of dietary patterns with elevated blood pressure, lipid profile and fasting plasma glucose (FPG) among adults in Jiangsu Province of China.4951 individuals were selected in this cross-sectional study from nutrition and health survey in Jiangsu Province in 2014. Factor analysis was used to identify the dietary patterns. Higher quartile of the cereals-seafood-dairy dietary pattern was inversely associated with high low-density lipoprotein cholesterol (LDL) (composed to Q1, OR = 0.834, 95% CI: 0.700∼0.993, P 0.05) and FPG (composed to Q1, OR = 0.725, 95% CI: 0.609-0.862, P 0.05), while higher quartile of the traditional Jiangsu dietary pattern was positively associated with low high-density lipoprotein cholesterol (HDL) (composed to Q1, OR = 1.395, 95% CI: 1.067∼1.825, P 0.05) and high systolic blood pressure (SBP) (composed to Q1, OR = 1.238, 95% CI: 1.020∼1.503, P 0.05). Higher scores of the refined food-oriented dietary pattern was inversely related to high triglycerides (TG) (composed to Q1, OR = 0.665, 95% CI: 0.551∼0.802, P 0.05), but was positively related to high TC (composed to Q1, OR = 2.179, 95% CI: 1.817∼2.614), high LDL (composed to Q1, OR = 2.431, 95% CI: 2.037∼2.902, P 0.05) and elevated FPG (composed to Q1, OR = 1.734, 95% CI: 1.458∼2.061, P 0.05).Different structure of dietary patterns do affect the blood pressure, lipid profile and fasting plasma glucose among adults in Jiangsu Province, China.

Cerium fluoride (CeF3) semiconductor with upconversion property was constructed on graphite carbonitride (g-C3N4) nanosheets by microwave hydrothermal method. The X-ray diffraction, transmission election microscopy, Fourier transform infrared, and X-ray photoelectron spectra techniques were used to characterize the CeF3/g-C3N4 nanocomposite. The study shows that CeF3 has upconversion property and can convert visible light (Vis) and near-infrared light (NIR) into ultraviolet light (UV). Moreover, CeF3 and g-C3N4 can form well-defined heterojunction and promote the effective separation of photogenerated electrons and holes. The synergistic effect of the CeF3/g-C3N4 nanocomposite was evaluated by photocatalytic degradation of dibenzothiophene (DBT). The optimum photocatalyst of CeF3/g-C3N4 (40 wt%) composites exhibit the highest photocatalytic desulfurization rate of the model oil under visible light radiation.

Owing to the desirable bond strength and excellent workability, spiral hoop and bolted steel connectors are introduced to enhance the connecting performance of superimposed reinforced concrete shear wall (SRCSW) system. In order to investigate the seismic performance of SRCSWs, applying such connecting methods under flexure-shear interaction and flexural dominated status, two groups of precast (PC) specimens were constructed: one-story and two-story specimens. Seismic behavior in terms of crack patterns, load-displacement response, ductility, stiffness degradation, strain response, and deformation results of SRCSWs is evaluated by the quasistatic cyclic test. It is shown that the wall specimens with the proposed connectors exhibited similar failure mode to that of the cast-in-place (CIP) walls and possessed adequate seismic performance such as lateral resistance, ultimate drift ratio, and lateral stiffness besides the ease of erection. The strain responses and deformation results of the PC specimens under reversed cyclic loading were presented to evaluate the effectiveness of the introduced connections. The test results indicated that the PC walls adopting bolted steel connectors behaved better in force transmission and exhibited greater integrity characteristic compared with the specimens having spiral hoop connectors. Lastly, simplified finite element models considering the nonlinear slip behavior within the connection joint of SRCSWs were established and verified, which could provide sufficient accuracy and efficiency to predict the seismic response of the proposed wall system.

This study explored the safety of COVID-19 vaccine (Aikewei) and the role of clinical pharmacists in the implementation of COVID-19 vaccination. A total of 2305 hospital employees in Children’s Hospital of Fudan University in Shanghai, China received the COVID-19 vaccine. The whole process of vaccination was monitored by clinical pharmacists, and the occurrence, types, severity of adverse reactions were recorded in detail. Through the investigation and analysis on the safety of COVID-19 vaccination of the 2305 people, the important role and value of clinical pharmacists in the vaccination process was elaborated. Common adverse reactions included local pain, dizziness and fatigue, with the incidence rates of 2.09%, 0.67% and 0.49%, respectively. Others such as headache, nausea, skin itching, cough, palpitation, dry mouth, hand anesthesia, local induration, muscle soreness, local rash, and chill had incidence rates of less than 0.30%. Three cases of serious adverse events that occurred in this vaccination returned to normal after treatment, with no subsequent discomfort. Clinical pharmacists played an important role in the safety monitoring of COVID-19 vaccination. The safety of the inactivated COVID-19 vaccine is good. Most of the common adverse reactions were mild and tolerable, with generally low incidence. The work of clinical pharmacists is important and can be expanded in the future to ensure the safety of vaccination and to provide better health care service.

Objectives To evaluate outcomes in patients who underwent total ultrasound-guided percutaneous nephrolithotomy for the management of large stones (>2 cm) within non-functioning atrophic kidneys, and to identify risk factors associated with postoperative persistence of urinary tract infection symptoms in such patients. Methods Between December 2014 and May 2019, 56 patients with large stones within non-functioning atrophic kidneys were treated at Beijing Tsinghua Changgung Hospital, Beijing, China, with total ultrasound-guided percutaneous nephrolithotomy. Factors including age, sex, previous medical history, stone burden, stone composition, stone-free rate, complication rate and postoperative urinary tract infection symptoms were retrospectively evaluated. Uni- and multivariate analyses were carried out to identify risk factors that predict persistence of urinary tract infection symptoms after percutaneous nephrolithotomy in such patients. Results The final stone-free rate after auxiliary treatments was 87.5%. The overall complication rate was 17.9%. After a median follow-up period of 12 months (range 6-40 months), three patients (5.4%) ultimately underwent nephrectomy. A total of 44 patients (78.6%) had no symptoms of urinary tract infection during follow up, whereas 63.6% of patients with diabetes continued to show persistent urinary tract infection symptoms at the latest follow up. Five patients (8.9%) showed improved total renal function, while most patients (83.9%) showed a stable estimated glomerular filtration rate. Diabetes was the only factor showing statistical significance in both univariate and multivariate analyses that predicted persistence of urinary tract infection symptoms after treatment with percutaneous nephrolithotomy. Conclusions Ultrasound-guided percutaneous nephrolithotomy is a safe and feasible procedure that can be carried out in patients with large stones within non-functioning atrophic kidneys. However, for such patients with diabetes, percutaneous nephrolithotomy is not recommended.

Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

Background: Previous studies have demonstrated the feasibility of a remifentanil–propofol (RP) mixture use in sedation for medical examinations. However, delivery of an RP mixture by target-controlled infusion (TCI) for colonoscopy has not been described. Here, we investigate the appropriate proportion of RP mixed regimens, prepared in two different ratios for colonoscopy. Methods: A retrospective study including patients who received a colonoscopy between May 2018 and January 2019 was conducted. Group 1 and Group 2 were, respectively, administered a mixture of RP at concentrations of 2.5 μg/mL-10 mg/mL and 5.0 μg/mL-10 mg/mL by adjusting a TCI pump with Schneider model to keep the Observer's Assessment of Alertness/Sedation scale between 1 and 2. The primary outcome was to determine the appropriate proportion of RP for the procedure in terms of hemodynamic conditions and adverse events. The secondary endpoints included the total dosage of anesthetics and total times of TCI pump adjustments. Results: A total of 120 patients in Group 1 and 116 patients in Group 2 were eligible for analysis. Several parameters were significantly different between Group 1 and Group 2, with Group 1 having a higher respiratory rate, a lower end-tidal carbon dioxide pressure, fewer patients with hypotension (mean arterial pressure

Background Delayed neuropsychologic sequelae is common in patients after carbon monoxide poisoning without effective methods worldwide. Fasudil exerts neuroprotective effect and alleviates oxidative stress in some neurodegenerative disorders. However, the mechanism between DNS and FS remains unclear. The study aims to explore the efficacy and mechanism of Fasudil in DNS mice model. Objective The delayed neuropsychologic sequelae model was induced with a hyperbaric oxygen chamber. All rats were randomly assigned to three groups (n=10): air control group (AC), CO poisoning group (CO), and CO poisoning +Fasudil group (CO+FS). Rats in the CO+FS group were given Fasudil (10 mg/kg/day, ip). The morris water maze was documented to estimate spatial learning and memory of mice. The demyelination state in brain was observed through LFB staining. The protein of MBP was examined with immunofluorescence staining. The levels of IL-6, TNF-α, TGF-β, SOD, and MDA were examined by ELISA. The mRNA levels of Rho, ROCK2, MLC1 and MYPT1 were analyzed by rt-PCR. Result The cognitive impairment in the CO+FS group were significantly reduced than those of the CO group (P

Objective: Our aim was to probe the therapeutic effect by which (BMSC-ex) protect against (DEACMP) in rat models in vivo. Methods: BMSC-ex were successfully characterized and proven to pass the blood brain barrier and migrate to the injured brain area. Rats were randomly divided into six groups and the cognitive function of mice was evaluated by the morris water maze. The severity of pathological changes was evaluated by HE staining and LFB staining. The expression of cytokines was detected by ELISA. Immunohistochemical staining and western blot analysis were utilized to detect the protein expression of Foxp3、CD4、MBP、Notch1 and Hess1 in brain tissue.Results: We found that BMSC-ex significantly reduced inflammation, increased the levels of (Tregs), relieved demyelination, and ameliorated the cognitive impairment in DEACMP rats. Furthermore, inhibiting the Notch pathway led to a partial reversal of the effect of BMSC-ex in mice.Conclusions: BMSC-ex relieved the severity of demyelination in the DEACMP rat models by regulating Tregs subsets and the expression of Notch signaling. Hence BMSC-ex play a protected role in DEACMP by upregulating Tregs and the regulatory components of Notch signaling and this may provide a new clinical strategy for the treatment of DEACMP patients.

Importance The Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score is a recognized tool for dementia risk stratification. However, its application is limited due to the requirements for multidimensional information and fasting blood draw. Consequently, effective, convenient and noninvasive tool for screening individuals with high dementia risk in large population-based settings is urgently needed. Objective To develop and validate a deep learning algorithm using retinal fundus photographs for estimating the CAIDE dementia risk score and identifying individuals with high dementia risk. Design A deep learning algorithm trained via fundus photographs was developed, validated internally and externally with cross-sectional design. Setting Population-based. Participants A health check-up population with 271,864 adults were randomized into a development dataset (95%) and an internal validation dataset (5%). The external validation used data from the Beijing Research on Ageing and Vessel (BRAVE) with 1,512 individuals. Exposures The estimated CAIDE dementia risk score generated from the algorithm. Main Outcome and Measure The algorithm’s performance for identifying individuals with high dementia risk was evaluated by area under the receiver operating curve (AUC) with 95% confidence interval (CI). Results The study involved 258,305 participants (mean aged 42.1 ± 13.4 years, men: 52.7%) in development, 13,559 (mean aged 41.2 ± 13.3 years, men: 52.5%) in internal validation, and 1,512 (mean aged 59.8 ± 7.3 years, men: 37.1%) in external validation. The adjusted coefficient of determination (R2) between the estimated and actual CAIDE dementia risk score was 0.822 in the internal and 0.300 in the external validations, respectively. The algorithm achieved an AUC of 0.931 (95%CI, 0.922–0.939) in the internal validation group and 0.782 (95%CI, 0.749–0.815) in the external group. Besides, the estimated CAIDE dementia risk score was significantly associated with both comprehensive cognitive function and specific cognitive domains. Conclusions and Relevance The present study demonstrated that the deep learning algorithm trained via fundus photographs could well identify individuals with high dementia risk in a population-based setting. Our findings suggest that fundus photography may be utilized as a noninvasive and more expedient method for dementia risk stratification. Key Points Question Can a deep learning algorithm based on fundus images estimate the CAIDE dementia risk score and identify individuals with high dementia risk? Findings The algorithm developed by fundus photographs from 258,305 check-up participants could well identify individuals with high dementia risk, with area under the receiver operating characteristic curve of 0.931 in internal validation and 0.782 in external validation dataset, respectively. Besides, the estimated CAIDE dementia risk score generated from the algorithm exhibited significant association with cognitive function. Meaning The deep learning algorithm based on fundus photographs has potential to screen individuals with high dementia risk in population-based settings.

Background High-risk neuroblastoma, as a lethal pediatric tumor, has unfavorable clinical outcomes, and accounts for ~15% of childhood cancer‐related mortality. However, the biomarkers for treatment prognosis have remained largely elusive. The present study sought to identify potential genes associated with the progression and prognosis of high-risk neuroblastoma. Methods The gene expression profiles of neuroblastoma were downloaded from the Gene Expression omnibus (GEO) database, and samples from GSE62564 and GSE16476 were applied as the training set and validation set, respectively. Bioinformatic analysis were performed by R. Subsequently, the biological functions of key gene were investigated by transwell, western blot, and flow cytometry analysis. miRNA that regulated the expression of key gene were predicted and the bind site were validated by luciferase reporter analysis and Q-PCR in children with high-risk neuroblastoma. Results Analysis shown that 120 differentially expressed genes (DEGs) in the blue module were identified to be significantly related to high-risk neuroblastoma by weighted correlation network analysis (WGCNA). After MCODE and Cytohubba algorithm analyses, 26 genes were recognized as hub genes. Subsequently, univariate COX and LASSO regression analyses identified a six-gene signature (NCAPG, UBE2C, MELK, CCNA2, KIF15, and BIRC5) and constructed a prognostic model. The expression of these six genes in high-risk neuroblastoma children was significantly higher than that in non-high-risk neuroblastoma children. These signature genes and the prognostic model demonstrated strong prognostic capability using Kaplan-Meier (KM) curves. Subsequently, NCAPG was selected as key gene and the results indicated that knockdown NCAPG suppressed the migration and invasion, increased the apoptosis rate and decreased the Bcl-2 level in neuroblastoma cells. In addition, the luciferase reporter analysis method showed that miR-495-3p can negatively regulate the expression of NCAPG. Q-PCR indicated that miR-495-3p highly expressed in children with high-risk neuroblastoma. Conclusion Our findings identified that miR-495-3p/ NCAPG could serve as prognostic biomarkers of high-risk neuroblastoma and may advance the understanding of the molecular pathogenesis.

Survival for pediatric liver transplantation patients is limited by nephrotoxicity of calcineurin inhibitors tacrolimus. The present study was to explore the association of genetic factors with nephrotoxicity of pediatric liver transplantation patients treated with tacrolimus.Chinese pediatric liver transplantation patients under tacrolimus therapy between March 2014 and August 2018 from Children's Hospital of Fudan University were retrospectively analyzed. A total of 15 patients, including 6 patients with nephrotoxicity induced by tacrolimus and 9 patients without nephrotoxicity, were detected by pharmacogenomics (PGxOne®160). Demographic characteristics and laboratory testing were collected from medical logs. Tacrolimus blood concentrations were extracted from therapeutic drug monitoring (TDM) documents.The risk of renal toxicity induced by tacrolimus in Chinese pediatric liver transplantation patients were positively associated with T allele of cytochrome P450 1A2 (

1. Numerous tacrolimus population pharmacokinetic (PPK) models in pediatric liver transplantation patients have been established to define an optimal dose schedule. However, the applicability of extrapolating these PPK models to our clinical center remains unknown. The goals of the present study was to evaluate model external predictiveness and establish a new model applicable to traditional therapeutic drug monitoring data.2. Published PPK models were collected from the literature and assessed using our real-world dataset including 41 pediatric liver transplantation patients via the individual prediction error method. The establishment of a new model was characterized using non-linear mixed-effects modeling.3. Nine published pediatric liver transplantation PPK models were identified, three of which could be applied to our real-world dataset. However, these models were dissatisfactory in terms of individual prediction error and hence, inadequate for extrapolation. Finally, a new model applicable to our real-world dataset was established as follows: CL/

Head and neck squamous cell carcinoma (HNSCC) is one of the most lethal cancers mainly due to the high rate of metastasis. Here, we find that the expression level of CD100 in HNSCC is positively correlated with the T category, pathological grade and lymph node metastasis of the tumor. The level of soluble CD100 (sCD100) is highly increased in serum of HNSCC patients, and sCD100 markedly induces the epithelial-mesenchymal transition (EMT) of HNSCC through its receptor, Plexin-B1 (PlxnB1), and promotes the metastasis in a xenograft mouse model. Furthermore, sCD100 promotes the stabilization of Snail through the regulation of the Vav1-Rac1/RhoA-p21-activated kinase pathway for the induction of EMT. Anti-CD100 antibody abolishes the CD100-induced EMT and prevents the metastasis of HNSCC, and anti-CD100 antibody also increases the drug sensitivity of HNSCC. Taken together, our study shows for the first time that CD100 induces the EMT of HNSCC and promotes the metastasis, and CD100 would be a candidate as a novel prognostic biomarker and a potential therapeutic target for HNSCC.

BackgroundIschemic cardiovascular diseases (ICVD) risk predict models are valuable but limited by its requirement for multidimensional medical information including that from blood drawing. A convenient and affordable alternative is in demand.ObjectivesTo develop and validate a deep learning algorithm to predict 10-year ICVD risk using retinal fundus photographs in Chinese population.MethodsWe firstly labeled fundus photographs with natural logarithms of ICVD risk estimated by a previously validated 10-year Chinese ICVD risk prediction model for 390,947 adults randomly selected (95%) from a health checkup dataset. An algorithm using convolutional neural network was then developed to predict the estimated 10-year ICVD risk by fundus images. The algorithm was validated using both internal dataset (the other 5%) and external dataset from an independent source (sample size = 1,309). Adjusted R2and area under the receiver operating characteristic curve (AUC) were used to evaluate the goodness of fit.ResultsThe adjusted R2between natural logarithms of the predicted and calculated ICVD risks was 0.876 and 0.638 in the internal and external validations, respectively. For detecting ICVD risk ≥ 5% and ≥ 7.5%, the algorithm achieved an AUC of 0.971 (95% CI: 0.967–0.975) and 0.976 (95% CI: 0.973–0.980) in internal validation, and 0.859 (95% CI: 0.822–0.895) and 0.876 (95% CI: 0.816–0.837) in external validation.ConclusionsThe deep learning algorithm developed in the study using fundus photographs to predict 10-year ICVD risk in Chinese population had fairly good capability in predicting the risk and may have values to be widely promoted considering its advances in easy use and lower cost. Further studies with long term follow up are warranted.

Impaired function of filaggrin (FLG) is a major predisposing factor for atopic dermatitis (AD). Several studies on FLG-deficient (Flg-/- ) mice have indicated an essential role for FLG in the skin barrier and the development of AD, but none of the studies have described the characteristics on Flg-/- mice with calcipotriol (CPT)-induced atopic dermatitis, which restricts the comprehensive understanding of functions of FLG. The present study sought to generate Flg-/- mice and applied CPT to produce AD-like dermatitis for in vivo analysis of the FLG functions. CPT was applied on the skin of Flg-/- mice to establish the AD-like dermatitis mouse model. The lesion inflammation was evaluated by gross ear thickness, histopathology, immunofluorescence, and cytokine production. Also, mucopolysaccharide polysulfate (MPS) and ceramide were used to observe the therapeutic function in this model. The results showed that the inflammation of CPT-induced dermatitis in Flg-/- mice was more severer than that of wild-type (WT) mice, as evident by the increased level of gross appearance, ear thickness, inflammatory cell infiltration (mast cells and CD3+ T cells), and inflammatory cytokine expression (interleukin (IL)-4, IL-6, IL-13, and thymic stromal lymphopoietin (TSLP)). The emollients MPS and ceramide partially restored the epidermal function and alleviated the skin inflammation in Flg-/- mice with CPT-induced AD-like dermatitis. The current study demonstrated that skin barrier protein FLG is critical in the pathogenesis of AD. Also, the AD mouse model induced by CPT in Flg-/- mice could be utilized to search for drug targets in AD.

Summary Background Medical artificial intelligence (AI) has entered the clinical implementation phase, although real-world performance of deep-learning systems (DLSs) for screening fundus disease remains unsatisfactory. Our study aimed to train a clinically applicable DLS for fundus diseases using data derived from the real world, and externally test the model using fundus photographs collected prospectively from the settings in which the model would most likely be adopted. Methods In this national real-world evidence study, we trained a DLS, the Comprehensive AI Retinal Expert (CARE) system, to identify the 14 most common retinal abnormalities using 207 228 colour fundus photographs derived from 16 clinical settings with different disease distributions. CARE was internally validated using 21 867 photographs and externally tested using 18 136 photographs prospectively collected from 35 real-world settings across China where CARE might be adopted, including eight tertiary hospitals, six community hospitals, and 21 physical examination centres. The performance of CARE was further compared with that of 16 ophthalmologists and tested using datasets with non-Chinese ethnicities and previously unused camera types. This study was registered with ClinicalTrials.gov , NCT04213430 , and is currently closed. Findings The area under the receiver operating characteristic curve (AUC) in the internal validation set was 0·955 (SD 0·046). AUC values in the external test set were 0·965 (0·035) in tertiary hospitals, 0·983 (0·031) in community hospitals, and 0·953 (0·042) in physical examination centres. The performance of CARE was similar to that of ophthalmologists. Large variations in sensitivity were observed among the ophthalmologists in different regions and with varying experience. The system retained strong identification performance when tested using the non-Chinese dataset (AUC 0·960, 95% CI 0·957–0·964 in referable diabetic retinopathy). Interpretation Our DLS (CARE) showed satisfactory performance for screening multiple retinal abnormalities in real-world settings using prospectively collected fundus photographs, and so could allow the system to be implemented and adopted for clinical care. Funding This study was funded by the National Key R&D Programme of China, the Science and Technology Planning Projects of Guangdong Province, the National Natural Science Foundation of China, the Natural Science Foundation of Guangdong Province, and the Fundamental Research Funds for the Central Universities. Translation For the Chinese translation of the abstract see Supplementary Materials section.

Recent application of deep learning in medical image achieves expert-level accuracy. However, the accuracy often degrades greatly on unseen data, for example data from different device designs and population distributions. In this work, we consider a realistic problem of domain generalization in fundus image analysis: when a model is trained on a certain domain but tested on unseen domains. Here, the known domain data is taken from a single fundus camera manufacture, i.e. Canon. The unseen data are the image from different demographic population and with distinct photography styles. Specifically, the unseen images are taken from Topcom, Syseye and Crystalvue cameras. The model performance is evaluated by two objectives: age regression and diabetic retinopathy (DR) classification. We found that the model performance on unseen domain could decrease significantly. For example, the mean absolute error (MAE) of age prediction could increase by 57.7 %. To remedy this problem, we introduce an easy-to-use method, named enhanced domain transformation (EDT), to improve the performance on both seen and unseen data. The goal of EDT is to achieve domain adaptation without using labeling and training on unseen images. We evaluate our method comprehensively on seen and unseen data sets considering the factors of demographic distribution, image style and prediction task. All the results demonstrate that EDT improves the performance on seen and unseen data in the tasks of age prediction and DR classification. Equipped with EDT, the \(\mathrm{R}^2\) (coefficient of determination) of age prediction could be greatly improved from 0.599 to 0.765 (n = 29,577) on Crystalvue images, and AUC (area under curve) of DR classification increases from 0.875 to 0.922 (n = 1,015).

The uniform dispersed rod-shape superparamagnetic nanocomposite was prepared by the attachment of Fe3O4 particles onto attapulgite. These nanocomposites assemble into magnetically responsive liquid crystal with yellow Bragg reflections under an external magnetic field. The optical properties of the obtained liquid crystal can be controlled by the strength and the direction of the magnetic field as well as the concentration of attapulgite@Fe3O4. It was found that a maximum transmittance of light could be available with attapulgite@Fe3O4 concentration tuning from 1 mg/mL to 2 mg/mL when the magnet was fixed at a distance of 2 cm from the sample. We demonstrate the use of these nanocomposites to fabricate display and photonic devices.

S-shaped test piece aims to assess the performance of five-axis numerical control (NC) machine tools. When the draft international standard (DIS) was introduced at the 79th ISO/TC39SC2 meeting, it was agreed that this test piece would be included. The S-shaped test piece, however, has undeveloped surfaces, which contribute to theoretical error. Because the test piece is used to assess the performance of machine tools and to conduct error tracing, theoretical error should not be included in the detection results obtained by the coordinate measuring machine (CMM). Therefore, the S-shaped test piece, excluding the influences of theoretical error, is crucial to research. This paper calculates the theoretical error of the S-shaped test piece when processed with the single-point offset (SPO) position method and proposes pre-compensation (PRC) and post-compensation (POC) methods to eliminate the influences of theoretical error. We conducted a theoretical analysis to compare three methods, the two compensation methods and the one uncompensated method, and verified the results through actual experiments. Research from principle and practice demonstrates that both the PRC and POC methods compensated for theoretical error up to 0.01 mm and that PRC is more accurate when considering the difference of approximately ±0.0015 mm.

Accuracy detection for five-axis numerical control (NC) machine tools that can truly reflect their practical machining precision is of crucial importance. Standard test pieces are commonly employed for this purpose. However, poor accuracy detection performance is obtained when the test pieces used here are applied to five-axis NC machine tools. This paper introduces a new S-shaped test piece that is exclusively designed for the precision detection of five-axis NC machine tools. The S-shaped test piece integrates numerous characteristics associated with aviation parts and has been widely adopted by machine tool makers. This article presents a numerical model of the latest S-shaped test piece and shows that its side surfaces represent typical undevelopable ruled surfaces. The curvature changes along the ruled lines inevitably produce a theoretical error. Thus, machining methods seek to reduce the theoretical error as much as possible. Based on basic summaries of five existing positioning algorithms, a novel algorithm is proposed to position the tool head using three points, wherein two are tangential to the top and bottom boundary curves, respectively, and the third is tangential to the midpoint of the ruled line. The proposed positioning algorithm together with five existing positioning algorithms is applied to the S-shaped test piece, and a numerical error performance analysis is conducted. The results indicate that the machined surface reduces the theoretical error by at least 96% compared to all the existing numerical positioning algorithms except for Redonnet’s algorithm. Compared with Redonnet’s algorithm, the accuracy of the proposed algorithm is equivalent, although the proposed algorithm reduces the calculation time by 62.7%, and is not sensitive to the initial values. Hence, the computational process demonstrates that the proposed method is efficient, robust, and universal. Finally, simulation results were confirmed through an actual machining experiment.

Transparent conducting Nb-doped titanium oxide (NTO) films were deposited on a non-alkali glass substrate using an RF magnetron sputtering method with post-annealing. Structural, electrical and optical properties of the NTO films were found to be strongly dependent on film thickness. A resistivity of 4.2 × 10−3 Ω cm and an average visible transmittance of ∼70% were obtained at the film thickness of 360 nm, indicating that the polycrystalline NTO fabricated by the sputtering method has sufficient potential as a transparent conducting oxide (TCO) candidate for practical applications.

Psoriasis is a chronic inflammatory skin disease in which dendritic cells (DCs) play a pivotal role by inducing Th1/Th17 immune responses; however, the regulation of DC activation in psoriasis remains largely unknown. Previously we found that the level of soluble CD100 was increased in sera of psoriasis patients, and CD100 promoted the activation of inflammasome in keratinocytes. In the present study, CD100 knockout mice were utilized for generation of imiquimod (IMQ)-induced psoriatic dermatitis, with the result that skin inflammation in the early, but not late, phase of the psoriatic dermatitis was significantly exacerbated compared to that in wild-type controls. This was attributed mainly to the deficiency of CD100 in hematopoietic cells. Bone marrow-derived DCs, but not T cells or keratinocytes, from CD100 knockout mice produced significantly increased levels of IL-1β, IL-36, and IL-23 upon stimulation with IMQ in a plexin-B2-dependent manner. Moreover, the surface level of plexin-B2 on DCs of psoriasis patients was lower than that of healthy individuals, and CD100 attenuated IMQ-induced production of IL-1β and IL-36 from monocyte-derived DCs of psoriasis patients. Our results uncovered a negative regulatory mechanism for DCs activation in psoriasis, which was mediated via CD100-plexin-B2 in a cell type- and receptor-specific manner. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

With the rise of Internet of Things, the presence of flexible devices has attracted significant attention owing to design flexibility. A ferroelectric field-effect transistor (FeFET), showing the advantages of high speed, nondestructive readout, and low-power consumption, plays a key role in next-generation technology. However, the performance of these devices is restricted since conventional flexible substrates show poor thermal stability to integrate traditional ferroelectric materials, limiting the compatibility of wearable devices. In this study, we adopt flexible muscovite mica as a substrate due to its good thermal properties and epitaxial integration ability. A flexible FeFET composed of oxide heteroepitaxy on muscovite is realized by combining an aluminum-doped zinc oxide film as the semiconductor channel layer and a Pb(Zr

The current study aimed to evaluate the correlation between maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin) of cervical cancer using an integrated 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance (PET/MR) imaging system, and to determine the association with pathological prognostic factors. A total of 46 patients were pathologically diagnosed with cervical cancer and underwent PET/MR prior to surgery, including total hysterectomy, bilateral pelvic lymph node dissection or paraaortic lymph node dissection. The imaging biomarkers included the SUVmax and ADCmin. The pathological prognostic factors were as follows: Tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis. Pearson's correlation analysis was used to evaluate the correlation between imaging biomarkers and the tumor size and the Mann-Whitney U test analysis was used to evaluate the association between imaging biomarkers and pathological factors. The mean SUVmax was 11.1±8.7 (range, 3.16-51.6) and the mean ADCmin was 0.76±0.15×10-3 mm2/s (range, 0.47-1.04×10-3 mm2/s). The SUVmax had a significant negative correlation with the ADCmin (r=-0.700; P

Underground power transmission cables often have to face the challenge of poor ventilation, which decreases power transmission capacity and damages the materials of the cables in a high-temperature environment. It is necessary to take a heat dissipation measure to ensure not only the safety but the efficiency of power transmission systems. Currently, for underground tunnels, two temperature reduction methods have been used. One is to exhaust heat by improving air circulation and the other is to employ chilling devices. However, even with the devices little information can be used to determine when these devices should be activated. Overusing the devices may cause high energy consumption. Additionally, underusing the devices might lead to the decrease of transmission efficiency. Therefore, this paper proposes an IoT-based underground tunnel temperature monitoring system in which the wireless transmission method used is after the experiment. Temperature sensing nodes are placed in an underground tunnel, and then a gateway collects sensed data and sends them to a database, so management personnel can monitor the temperature distribution in the tunnel in real time to determine whether ventilation devices should be activated.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute cutaneous adverse drug reactions involving keratinocyte death and CD8+ T lymphocyte-mediated immune response. Drugs, especially anti-epileptic drugs such as carbamazepine (CBZ) are the most important etiologic agents in patients with SJS/TEN. Carbamazepine-10,11-epoxide (CBZE), a pharmacologically active metabolite of CBZ, oxidated by cytochrome P450 enzyme 3A4 (CYP3A4) in the liver, and is also distributed in the epidermis of skin. Why do patients of SJS/TEN develop a violent CD8+ T cells immune response to the epidermis of skin is unknown. Methods: Sera and blister fluid of six patients with SJS and four patients with TEN were obtained from Xijing Hospital. The levels of interleukin-1β (IL-1β), IL-18, Granzyme B, and granulysin were assessed by ELISA and quantitative real-time PCR. The mechanism results were confirmed with transient transfection of small interfering RNAs into cultured keratinocytes, western blot, migration assay, flow cytometry, and immunohistochemistry. Findings: Increased expression of NLRP3 inflammasome in lesions of patients with SJS/TEN. Increased levels of interleukin-1β (IL-1β) and IL-18 significantly correlated with body surface area (BSA), SCORe of Toxic Epidermal Necrosis (SCORTEN), and levels of Granzyme B in sera, blister fluid and lesions of patients with SJS/TEN. CBZE induces NLRP3 inflammasome activation in SJS/TEN keratinocytes. Activation of NLRP3 inflammasome in SJS/TEN keratinocytes upregulates the expression of CXCL9/CXCL10, activates CD8+ T lymphocytes, and increases the expression of cytotoxic markers via signaling of IL-1β/IL-1R or IL-18/IL-18R. This promotes chemotactic ability in CD8+ T lymphocytes of patients with SJS/TEN. Interpretation: To our knowledge, this study shows for the first time that CBZE induces activation of NLRP3 inflammasome and increases activation, migration and cytotoxic functions of CD8+ T lymphocytes in skin, thereby contributing to the dysregulated response in patients with SJS/TEN. Funding: This work was supported by the National Natural Science Foundation of China (81371738, 31400782, 81573038, 81472885). Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: The investigational protocol was approved by the Ethics Committee of the Fourth Military Medical University, according to the guidelines of Declaration of Helsinki.

e14512 Background: Patients with solid tumor may get benefits from neoantigen-based cancer vaccines, which has showed some clinical efficacy data in clinical trials. This study was designed to evaluate the safety and efficacy of a neoantigen-based dendritic cell vaccine in patients with advanced solid tumors Methods: In this single arm study, patient-specific mutation-containing epitopes were detected from patient's tumor tissue. Tumor specimens were processed for whole transcriptome RNA sequencing, whole exome sequencing and HLA typing analysis. Total 10-20 immunogenic neoantigens for each patient were formulated and loaded into patient’s dendritic cells to manufacture the patient-specific anti-cancer vaccines. The patient was administered vaccine injections (Days 0, 14, 35, 56 and 98) into inguinal lymph nodes and intra-cutaneous. Peripheral blood was collected during the treatment (Days 14,15, 35, 36, 56, 57,77, 99 and 120) for safety evaluation and for assessment of the expansion of antigen-specific T cells in vivo. Patients were followed up until confirmed disease progression, withdrawal consent or adverse event intolerance. Results: Between 2019 and 2020, six patients received the neoantigen-based DC vaccine. The tumor types were laryngeal carcinoma, leiomyosarcoma, biliary tract carcinoma and hepatocellular carcinoma. All six enrolled patients had stage III or IV disease and had failed at least one line of systematic therapy at baseline. Preliminary data revealed that 6 pts (5 female and 1 male) with mean age of 44 (41-50) yrs. received ≥3 dose of DC vaccine. Doses ranged from 2×106 cells/ml to 10×106 cells/ml. All observed treatment related Adverse Events were Grade 1 or Grade 2. The most common (≥10%) drug-related adverse events were fatigue (15%), fever (15%), and elevated AST (20%). Five patients received at least one disease assessment post baseline visit. There were no tumor response. The patient with biliary tract carcinoma, laryngeal ca, leiomyosarcoma had SD status for 11 weeks, 30 weeks and 16 weeks respectively. Patients were assessed with the ELISPOT, which showed a CD8 + neoantigen-specific T-cells expansion was detected from each of the six patients’ peripheral blood after the fifth vaccine injection, which demonstrate the preliminary proof of concept for this personalized neoantigen-based dendritic cell vaccine. Conclusions: In this study, neoantigen-based dendritic cell vaccine has showed preliminary activity in advanced solid tumor patients with well-tolerated safety profile, which indicated the neoantigen-targeting DC vaccine has potential to be an effective treatment (with alteration of the immune cell milieu) in solid tumor patients.

Drug-resistant epilepsy patients has aberrant inflammatory mediator levels. However, the mechanism of which is remains unillustrated. Here the molecular mechanism underlying the neuroinflammatory process in patients with drug-resistant epilepsy were investigated. Bioinformatics analysis revealed that miR-34c-5p was significantly downregulated in patients with drug-resistant epilepsy, compared to control population. Then, luciferase reporter assays indicated that HMGB1, inflammation-related mediators, was the target gene of miR-34c-5p. The kainic acid-induced epileptic rats were established and divided into drug-sensitive epilepsy and drug-resistant epilepsy according to their seizure behavior and EEG after antiepileptic drug administration. Downregulation of miR-34c-5p, elevated expression of HMGB1 and IL-1β had been found in rats with drug-resistant epilepsy, compared to drug-sensitive epilepsy rats. Aggravated hippocampal neuron loss was demonstrated in rats with drug-resistant epilepsy. The results from epileptic rats were subsequently validated from children with drug-resistant epilepsy. Analysis manifested that miR-34c-5p was obviously decreased, while HMGB1 was increased on serum of children with drug-resistant epilepsy. Our study highlights that decreased miR-34c-5p in drug-resistant epilepsy exacerbates neuroinflammation, which aggravates hippocampal neuron loss in epileptogenesis. Thus, miR-34c-5p could be considered as a potential noninvasive biomarker and shed novel light on the development of an effective therapeutic strategy for children with drug-resistant epilepsy in the future.

In this study, two dimensional double-U auxetic honeycombs (2D DUHs) composed of curved shell members have been proposed based on traditional double-V (concave quadrilateral or re-entrant double-arrowhead) auxetic honeycombs (2D DVHs). Theoretical analysis, numerical simulation and compression experiments are adopted to characterize the mechanical properties including equivalent Young's modulus, equivalent Poisson's ratio, and quasi-static collapse process of 2D DVHs and DUHs. Specimens of the 2D DUHs and DVHs made of Aluminum alloy (A6061) are fabricated through wire cut electrical discharge machining. Both numerical and experimental results illustrate that concave DUHs exhibit tunable negative Poisson's ratio and equivalent stiffness level compared to DVHs. Furthermore, DUHs have smooth geometry configurations that can reduce stress concentration at elastic region and exhibit stronger auxetic behavior during large deformation. Those mechanical properties of 2D DUHs satisfy the requirements for practical engineering applications such as energy absorption. The dynamic crushing responses of 2D DVHs and DUHs are also investigated, and it is found that the crushing collapse modes and plateau stress improvement of 2D DUHs are related to the crushing velocity. Finally, the local impact responses of 2D DVHs and DUHs are studied numerically, the influences of impact velocity and indenter size are considered. This study provides useful instructions for the design, fabrication and analysis of auxetic structures, which has a broad prospect in some advanced technical applications.

In this research, two pieces of textiles from the Qing dynasty (1644–1910) were studied to character the dyeing techniques using appropriate Eco-friendly analysis. The dye was identified by UHPLC-Q-Tof-MS, which improved sensitivity and resolution significantly when compared with LC-MS. The mordant in the textile dyeing process was determined by SEM-EDX. The results showed that Gardenia jasminoides Ellis was used in dyeing the yellow silk thread, Polygonum tinctorium was the source of the plant for the blue silk thread, and the plant source of green fabric most likely turned out to be Rhamnus davurica pall., which was first detected in ancient textiles. Iron and aluminum ions were detected as the metal ions in the mordant. Combined with all this information, the original dyeing process used for these textiles can be inferred. The results allow us to understand the dyeing techniques in the Qing dynasty, and to provide scientific support for conservation and restoration of the precious cultural heritage.

Vascular endothelial cells (VECs) that line the interiors of blood vessels participate in physiological and inflammatory processes. All skin cell types express the aryl hydrocarbon receptor (AhR), which is involved in the pathogenesis of psoriasis. However, the role of the cutaneous VEC AhR in the pathogenesis of psoriasis remains elusive. In the present study, we found that AhR protein expression and activation were downregulated in psoriatic VECs. Furthermore, cutaneous VEC-specific AhR-knockout (AhRcVECs-KO) mice were established. Using imiquimod and IL-23-induced psoriasis models, we found that skin inflammation was exacerbated with excessive neutrophil recruitment in AhRcVECs-KO mice. Furthermore, neutrophil neutralization alleviates exacerbated inflammation in imiquimod-treated AhRcVECs-KO mice. In addition, cutaneous VECs in AhRcVECs-KO mice exhibited increased dilation and activation compared with those in control mice. Finally, AhR-deficient microvascular endothelial cells stimulated by proinflammatory cytokines showed increased ICAM-1 expression in vivo and in vitro, which may have facilitated neutrophil recruitment. In summary, our study demonstrates that AhR in dermal VECs restricts psoriasis development by negatively regulating neutrophil recruitment, thereby providing insight into the pathogenesis of psoriasis.

Experimental study was conducted on six 1/6 scale steel-enhanced damping concrete composite core walls (SEDCCW) with steel plate bracings under cyclic load reversals and constant axial load, to investigate the influences of stirrups in boundary zone, layer number of X-shaped steel plate bracing, encased steel arrangements of boundary zones and coupling beams, the aspect ratio (AR) and the axial compression load ratio (ALR) on the seismic behavior of the specimens. The cracking patterns, failure modes, load-bearing capacities, ductility factors, energy dissipation capacities and shear lag effects of the specimens were discussed. Then parametric analysis was carried out on 27 numerical models based on verified finite element models to assess the influences of the ALR and the AR of specimens, span-to-depth ratios of coupling beams, the encased steel ratios of corner columns, hidden columns and coupling beams, steel ratios of wall bracings on the overall seismic performance of the SEDCCW specimens. The analysis results indicate that the SEDCCW specimens can also obtain good deformation capacity when the design axial load ratio is less than 1. 0 or span-to-depth ratio of coupling beam is larger than 1.0; the steel ratio of wall bracing is the most influential factor on load bearing capacity and deformation capacity of the SEDCCW specimens, the influence of encased steel ratios of corner columns and hidden columns on ductility of the SEDCCW specimens is greater than that of encased steel ratios of coupling beams.

Background: Intraoperative awareness occurrence ranges between 0.005% and 1.12% of general anesthesia cases and could be a devastating experience for a patient. The incidence of intraoperative awareness in total intravenous anesthesia (TIVA) is higher than in volatile anesthesia without the depth of anesthesia (DOA) monitoring. This retrospective study aimed to evaluate the incidence of intraoperative awareness with recall during TIVA in the isolated health facility. Methods: We performed a retrospective analysis of the incidence of intraoperative awareness with recall during TIVA that involved a large number of patients over 10 years (from January 2008 to July 2018). Cases of death, coma, dementia, severe psychological disorder, incomplete data, or patients aged under 20 years were excluded from this study. All data from the operating rooms' database and the anesthesia records were analyzed. Intraoperative awareness was detected by the patients who spontaneously self-reported accidental awareness during postoperative anesthetic visits within 2 days following the surgery. Moreover, we also visited highly suspected intraoperative awareness patients on a postoperative day 1 for clarifying intraoperative awareness with recall. Results: Of 13,002 patients under TIVA, 11,433 were included in this study. Two confirmed cases of intraoperative awareness were detected, with an incidence of 0.017% (2 of 11,433). As of the type of surgery, a 67-year-old male received elective general surgery and another 45-year-old male received elective orthopedic surgery. Only one patient was under DOA monitoring, and in both instances, no long-term psychological sequelae were reported. Conclusions: This study suggests that the incidence of intraoperative awareness during TIVA is a very rare event if the well-trained anesthesia staff for TIVA is present and when the DOA monitoring is routinely used in high-risk patients. Furthermore, based on the study data, we conclude that the two intraoperative awareness cases could have been prevented.

To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ). This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated. Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8–22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031). SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.

Background: Compliance index derived from digital volume pulse (CI-DVP), measuring the relationship between volume and pressure changes in fingertip, is a surrogate marker of peripheral arterial stiffness. This study investigated if CI-DVP can predict renal function deterioration, cardiovascular events and mortality in patients with chronic kidney disease (CKD). Methods: In this prospective observational study, 149 CKD patients were included for final analysis. CI-DVP and brachial-ankle pulse wave velocity (baPWV) were measured, decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope. Composite renal and cardiovascular outcomes were evaluated, including ≥50% eGFR decline, start of renal replacement therapy, and major adverse events. Results: Patients in CKD stages 3b to 5 had higher baPWV and lower CI-DVP values than those in patients with CKD stages 1 to 3a. Stepwise multivariate linear regression analysis showed that lower CI-DVP (p =0.0001) and greater proteinuria (p =0.0023) were independent determinants of higher eGFR decline rate. Multivariate Cox regression analysis revealed that CI-DVP (HR 0.68, 95% CI 0.46-1.00), baseline eGFR (HR 0.96, 95% CI 0.94-0.98) and serum albumin (HR 0.17, 95% CI 0.07-0.42) were independent predictors for composite renal and cardiovascular outcomes. Conclusions: Compliance index, CI-DVP, was significantly associated with renal function decline in patients with CKD. A higher CI-DVP may have independent prognostic value in slower renal function decline and better composite renal and cardiovascular outcomes in CKD patients.

This article proposes a broadband circuit analog absorber based on double rings embedded with lumped resistors, which can realize effective absorption (above 90%) over 5.21 GHz to 18.16 GHz, with a relative absorption bandwidth about 110.8%. The simulation results exhibit that the circuit analog absorber maintains excellent wideband absorbing characteristic for different angles of incident wave. A prototype of the absorber is measured to verify the absorbing performance, and the measured results are in good agreement with the simulated responses. The proposed absorber has great application prospects in electromagnetic compatibility and stealth technology.

// Qiao-Hui Zhan 1, * , Jian-Qin Fu 1, * , Fang-Meng Fu 1 , Jie Zhang 1 and Chuan Wang 1 1 Department of General Surgery, Fujian Medical University Union Hospital, Fujian Province, Fuzhou, China * These authors contributed equally to this work and should be considered as co-first authors Correspondence to: Chuan Wang, email: chuanwang1968@yahoo.com Keywords: time; adjuvant chemotherapy; breast cancer; suvival; meta-analysis Received: August 01, 2017 Accepted: November 17, 2017 Published: December 07, 2017 ABSTRACT The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. In order to illustrate the effect of delaying the initiation of AC on survival we have undertaken a systematic review and meta-analysis. We identified 12 available studies in the meta-analysis including 15 independent analytical groups. This meta-analysis showed that a 4-week delay before AC was associated with a significantly worse overall survival (OS)(HR=1.13; 95% confidence interval [CI], 1.08–1.19) and disease free survival (DFS)(HR=1.14; 95%CI, 1.05–1.24). Two studies categorized patients into hormone receptor-positive, ERBB2-positive, and triple-negative breast cancer (TNBC) patients according to the clinicopathological features of breast cancer. The HRs for OS between waiting time (WT) ≤30 days and 31–60 days in the subgroups were extracted and analyzed. The analysis demonstrated that a WT of 31–60 days was related to worse OS among patients with TNBC (HR, 1.26; 95% CI, 1.08–1.48), but had no significant effect on OS among those with hormone receptor-positive (HR, 1.02; 95% CI, 0.89–1.15) or ERBB2-postive (HR, 0.95; 95%CI, 0.79–1.14) tumors. In this meta-analysis of the eligible literatures reviewing the time to AC, a longer waiting time to adjuvant chemotherapy may lead to worse survival in breast cancer patients, especially in TNBC patients.

Based on detailed investigation and research of rural life energy consumption situation in Beijing, conclusion is made that the current coal-dominated energy consumption pattern has caused environmental pollution and even health hazards. At the same time, low energy efficiency also leads to energy waste. To optimize rural energy consumption structure and improve regional air quality, measures of energy utilization according to local conditions and a balanced energy mix should be taken. Thus realize reduction and substitution of coal.