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The present study aims to investigate the efficacy of intermittent theta burst stimulation (iTBS) on post-stroke dysphagia and its effect on the motor cortical excitability of the suprahyoid muscle. A total of 40 patients with post-stroke dysphagia were randomly divided into the iTBS and the sham stimulation groups, with the conduction of motor cortical iTBS and sham stimulation of the supraglottal muscle on the affected side, respectively. Swallowing function was assessed before (T0), immediately after (T1), and two weeks after (T2) cessation of the intervention using the water-swallowing test (WST), standard swallowing assessment (SSA), Murray secretion scale (MSS), and Penetration–Aspiration Scale (PAS). The bilateral motor evoked potentials (MEP) of the suprahyoid muscle were recorded. After the intervention, the PAS, WST, SSA, and MSS scores were significantly improved in both groups (p < 0.05). The iTBS group showed a greater change in the PAS score than the sham stimulation group at T1 (p < 0.05) and a greater change in the WST and MSS scores at T2 (p < 0.05). The amplitude of the MEP wave of the suprahyoid muscle in the affected hemisphere was significantly higher in the iTBS group at T1 and in the healthy hemisphere at T2 (p < 0.05). The feasibility of applying iTBS to the affected hemisphere for the treatment of post-stroke dysphagia was directly analyzed for the first time. ITBS combined with conventional swallowing therapy could be adopted as a rehabilitation strategy to improve post-stroke dysphagia.

Purpose of the study To determine if multiple Genetic Risk Scores (GRSs) improve bone mineral density (BMD) prediction over single GRS in an independent sample of Caucasian women. Study design Based on summary statistics of four genome-wide association studies related to two osteoporosis-associated traits, namely BMD and heel quantitative ultrasound derived estimated BMD (eBMD), four GRSs were derived for 1205 individuals in the Genome-Wide Scan for Female Osteoporosis Gene Study. The effect of each GRS on BMD variation was assessed using multivariable linear regression, with conventional risk factors adjusted for. Next, the eBMD-related GRS that explained the most variance in BMD was selected to be entered into a multi-score model, along with the BMD-related GRS. Elastic net regularised regression was used to develop the multiscore model, which estimated the joint effect of two GRSs (GRS_BMD and GRS_eBMD) on BMD variation, after being adjusted for conventional risk factors. Results With the same clinical risk factors having been adjusted for, the model that included GRS_BMD performed best by explaining 32.53% of the variance in BMD; the single-score model that included GRS_eBMD explained 34.03% of BMD variance. The model that includes both GRS_BMD and GRS_ eBMD, as well as the clinical risk factors, aggregately explained 35.05% in BMD variation. Compared with the single GRS models, the multiscore model explained significantly more variance in BMD. Conclusions The multipolygenic score model explained a considerable amount of BMD variation. Compared with single score models, multipolygenic score model provided significant improvement in explaining BMD variation.

Huaiyu Jia,1 Ying Zhang,2 Jianzhong Ye,1 Wenya Xu,1 Ye Xu,1 Weiliang Zeng,2 Wenli Liao,1 Tao Chen,1 Jianming Cao,2 Qing Wu,1 Tieli Zhou1 1Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China; 2Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Tieli Zhou; Qing WuDepartment of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaTel/Fax +86-0577-8668-9885Email wyztli@163.com; wuqing830@163.comBackground: OXA-232-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) has the potential to become the “third epidemic” of carbapenem-resistant Klebsiella strain after KPC-2 and NDM in China. We investigated the first outbreak of CRKP in the First Affiliated Hospital of Wenzhou Medical University.Methods: We collected 610 clinical isolates of CRKP from the First Affiliated Hospital of Wenzhou Medical University between January 2019 and September 2020 and screened them by Polymerase Chain Reaction (PCR). The multilocus sequence typing and pulsed-field gel electrophoresis were used to determine the genetic relatedness of the strains. The antimicrobial susceptibility test was performed to determine the drug resistance of the clinical isolates. The molecular mechanism underlying carbapenem resistance was elucidated by performing PCR and conjugation experiments. The virulence potential of the strains was determined by the string test, detection of virulence-associated genes and capsular serotypes, and Galleria mellonella larval infection model.Results: Between September 2019 and May 2020, 26 OXA-232-producing CRKP were obtained from 12 patients in our hospital. Ten patients were hospitalized in the intensive care units (ICU) and the overall mortality of the inpatients involved in the outbreak was 50% (6/12). Epidemiological investigations reported that all the OXA-232-producing CRKP strains belonged to the sequence type ST15 and can be clonally transmitted among the inpatients in the ICU. All the strains had low virulence and were resistant to commonly used clinical antibiotics except for ceftazidime/avibactam, colistin, and tigecycline. The OXA-232-producing CRKP was sensitive to triclosan and chlorhexidine, and its eradication from our hospital can be achieved by the use of disinfectants in the ICU.Conclusion: In our study, OXA-232-producing CRKP isolates appeared to be clonally transmitted and the sequence type ST15 was responsible for the outbreak. Therefore, effective measurements for the infection control of CRKP are urgently needed to prevent its epidemic in the nearby region in the future.Keywords: Klebsiella pneumoniae, carbapenem-resistance, virulence, OXA-232, outbreak

Comorbid chronic pain and depression are increasingly becoming a concerning public problem, but the underlying mechanisms remain unclear. Here, we demonstrate that pain-related depression-like behaviors are induced in a rat model of chronic constriction injury (CCI). Using this model, we found that chronic neuropathic pain decreased the activity and expression of sirtuin 1 (SIRT1, an NAD+-dependent deacetylase) in the central nucleus of the amygdala (CeA). In addition, the pharmacologic activation of SIRT1 in the CeA could alleviate the depression-like behaviors associated with chronic pain while relieving sensory pain. Accordingly, adeno-associated virus (AAV)-mediated SIRT1 overexpression in the CeA produced a positive effect on the easement of chronic pain and comorbid depression. Taken together, these findings highlight the role of SIRT1 in the CeA in chronic pain and depression states and reveal that the upregulation of SIRT1 may be a potential therapy for the treatment of pain-depression comorbidities.

Angiotensin-converting enzyme 2 (ACE2) has been identified as the key receptor of SARS coronavirus that plays a key role in the pathogenesis of SARS. It is known that ACE2 mRNA can be expressed in most organs. However, the protein expression of ACE2 is not clear yet. To explore the role of ACE2 as a precipitating factor in digestive organ damage in COVID-19, this study investigated the expression of ACE2 protein in the human liver, esophagus, stomach, and colon. The result showed that ACE2 can be expressed in the liver, esophagus, stomach, and colon, which suggests SARS-CoV-2 may enter the digestive system through ACE2 and cause liver damage and gastrointestinal damage. It is hoped that the result of the study will provide a new strategy for the prevention and treatment of digestive organ damage under COVID-19.

BACKGROUND: A trusting physician-patient relationship is an essential component of high-quality care. OBJECTIVE: To explore the relationship between the physician-patient relationship, physician empathy, and patient trust. DESIGN: Cross-sectional survey. PARTICIPANTS: A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys. MAIN MEASURE: Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed. KEY RESULTS: There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician’s benevolence and competence, and the physician-patient relationship (r = 0.49–0.75, P < 0.01 for all). Patients’ evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician’s benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15–0.21) and that the mediation effect of patient trust in physician’s benevolence was significant (β = 0.24, 95% CI: 0.20–0.28), though the mediation effect of patient trust in physician’s competence was not (β = 0.01, 95% CI: −0.02 to 0.02). CONCLUSIONS: Patients’ perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician’s benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-07008-9.

Background DDP-based chemotherapy is one of the first-line treatment in GC. However, the therapeutic efficacy of DDP is limited due to side effects. Therefore, it is of great significance to develop novel adjuvants to synergize with DDP. We had demonstrated previously that rMV-Hu191 had antitumor activity in GC. Here we examined the synergism of rMV-Hu191 with DDP in vitro and in vivo. Methods Cellular proliferation, the synergistic effect and cell apoptosis were evaluated by CCK-8 assay, ZIP analysis and flow cytometry, respectively. The protein levels and location of ASMase were monitored by western blot and immunofluorescence assay. shRNA and imipramine were used to regulate the expression and activity of ASMase. MβCD was administrated to disrupt lipid rafts. Mice bearing GC xenografts were used to confirm the synergism in vivo. Results From our data, combinational therapy demonstrated synergistic cytotoxicity both in resistant GC cell lines from a Chinese patient and drug-nonresistant GC cell lines, and increased cell apoptosis, instead of viral replication. Integrity of lipid rafts and ASMase were required for rMV-Hu191- and combination-induced apoptosis. The ASMase was delivered to the lipid raft microdomains at the initial stage of rMV-Hu191 treatment. In vivo GC mice xenografts confirmed the synergism of combinational treatment, together with increased apoptosis and trivial side-effects. Conclusions This is the first study to demonstrate that rMV-Hu191 combined with DDP could be used as a potential therapeutic strategy in GC treatment and the ASMase and the integrity of lipid rafts are required for the synergistic effects.

Background:. Prenatal evaluation of fetal lung maturity (FLM) is a challenge, and an effective non-invasive method for prenatal assessment of FLM is needed. The study aimed to establish a normal fetal lung gestational age (GA) grading model based on deep learning (DL) algorithms, validate the effectiveness of the model, and explore the potential value of DL algorithms in assessing FLM. Methods:. A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41 + 6 weeks were analyzed in this study. There were no pregnancy-related complications that affected fetal lung development, and all infants were born without neonatal respiratory diseases. The images were divided into three classes based on the gestational week: class I: 20 to 29 + 6 weeks, class II: 30 to 36 + 6 weeks, and class III: 37 to 41 + 6 weeks. There were 3323, 2142, and 1548 images in each class, respectively. First, we performed a pre-processing algorithm to remove irrelevant information from each image. Then, a convolutional neural network was designed to identify different categories of fetal lung ultrasound images. Finally, we used ten-fold cross-validation to validate the performance of our model. This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA. This was used to establish a grading model. The performance of the grading model was assessed using accuracy, sensitivity, specificity, and receiver operating characteristic curves. Results:. A normal fetal lung GA grading model was established and validated. The sensitivity of each class in the independent test set was 91.7%, 69.8%, and 86.4%, respectively. The specificity of each class in the independent test set was 76.8%, 90.0%, and 83.1%, respectively. The total accuracy was 83.8%. The area under the curve (AUC) of each class was 0.982, 0.907, and 0.960, respectively. The micro-average AUC was 0.957, and the macro-average AUC was 0.949. Conclusions:. The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs, which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy. The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.

The key pathophysiological process leading to heart failure is cardiac remodeling, a term referring to cardiac hypertrophy, fibrosis, and apoptosis. We explored circadian rhythm disruption and calcium dyshomeostasis in cardiac remodeling and investigated the cardioprotective effect of choline. The experiments were conducted using a model of cardiac remodeling by abdominal aorta coarctation (AAC) in Sprague–Dawley rats. In vitro cardiomyocyte remodeling was induced by exposing neonatal rat cardiomyocytes to angiotensin II. The circadian rhythms of the transcript levels of the seven major components of the mammalian clock (Bmal1, Clock, Rev-erbα, Per1/2, and Cry1/2) were altered in AAC rat hearts during a normal 24 h light/dark cycle. AAC also upregulated the levels of proteins that mediate store-operated Ca2+ entry/receptor-operated Ca2+ entry (stromal interaction molecule 1 [STIM1], Orai1, and transient receptor potential canonical 6 [TRPC6]) in rat hearts. Moreover, choline ameliorated circadian rhythm disruption, reduced the upregulated protein levels of STIM1, Orai1, and TRPC6, and alleviated cardiac dysfunction and remodeling (evidenced by attenuated cardiac hypertrophy, fibrosis, and apoptosis) in AAC rats. In vitro analyses showed that choline ameliorated calcium overload, downregulated STIM1, Orai1, and TRPC6, and inhibited thapsigargin-induced store-operated Ca2+ entry and 1-oleoyl-2-acetyl-sn-glycerol-induced receptor-operated Ca2+ entry in angiotensin II-treated cardiomyocytes. In conclusion, choline attenuated AAC-induced cardiac remodeling and cardiac dysfunction, which was related to amelioration of circadian rhythm disruption and attenuation of calcium-handling protein defects. Modulation of vagal activity by choline targeting the circadian rhythm and calcium homeostasis may have therapeutic potential for cardiac remodeling and heart failure. Choline attenuates abdominal aortic coarctation-induced cardiac remodeling and cardiac dysfunction, by amelioration of circadian rhythm disruption and attenuation of calcium-handling protein defects. Modulation of vagal activity by choline may have therapeutic potential for cardiac remodeling and heart failure.

The elastic vibration of the wheelset is a potential factor inducing wheel-rail defects. It is important to understand the natural vibration characteristics of the flexible wheelset for slowing down the defect growth. To estimate the elastic free vibration of the railway wheelset with the multidiameter axle, the transfer matrix method (TMM) is applied. The transfer matrices of four types of elastic beam models are derived including the Euler–Bernoulli beam, Timoshenko beam, elastic beam without mass and shearing stiffness, and massless elastic beam with shearing stiffness. For each type, the simplified model and detailed models of the flexible wheelset are developed. Both bending and torsional modes are compared with that of the finite element (FE) model. For the wheelset bending modes, if the wheel axle is modelled as the Euler–Bernoulli beam and Timoshenko beam, the natural frequencies can be reflected accurately, especially for the latter one. Due to the lower solving accuracy, the massless beam models are not applicable for the analysis of natural characteristics of the wheelset. The increase of the dividing segment number of the flexible axle is helpful to improve the modal solving accuracy, while the computation effort is almost kept in the same level. For the torsional vibration mode, it mainly depends on the axle torsional stiffness and wheel inertia rather than axle torsional inertia.

Background The coronavirus disease 2019 (COVID-19) epidemic has been largely controlled in China, to the point where case fatality rate (CFR) data can be comprehensively evaluated. Methods Data on confirmed patients, with a final outcome reported as of 29 March 2020, were obtained from official websites and other internet sources. The hospitalized CFR (HCFR) was estimated, epidemiological features described, and risk factors for a fatal outcome identified. Results The overall HCFR in China was estimated to be 4.6% (95% CI 4.5–4.8%, P P P Conclusions This up-to-date and comprehensive picture of COVID-19 HCFR and its drivers will help healthcare givers target limited medical resources to patients with high risk of fatality.

Background Thus far, the association of tumor size with prognosis in colon cancer has not been considered and has remained unclear. This study, therefore, aimed to investigate the association between tumor size as a continuous variable and prognosis in colon cancer using Cox models with restricted cubic splines. Methods Using the Surveillance, Epidemiology, and End Results database, we selected 128,369 patients with colon cancer who underwent surgery. Overall survival and colon cancer-specific survival were separately analyzed, and tumor size was separately evaluated as a continuous variable and a categorical variable. To investigate the relationship after adjusting for covariates, we used the proportional hazards models. The restricted cubic splines model was used to determine the presence of nonlinear or linear association and flexibly visualize the association. Results The adjusted covariate model showed that the hazard ratio of colon cancer rapidly increased with a tumor size of 4 cm and slowly increased with a tumor size larger than 4 cm. When tumor size was analyzed as a categorical variable, the multivariable-adjusted model demonstrated a nearly linear relationship between tumor size and hazard ratio regardless of overall survival or cancer-specific survival, and the hazard ratio of group 5 (4.1–5 cm) was nearly a turning point. Subgroup analysis with respect to lymph node metastasis showed that the relationship between tumor size and prognosis in colon cancer was evident in lymph node metastasis. Conclusion There was a strong negative relationship between tumor size and prognosis in colon cancer. However, when tumor size was less than 4 cm, the relationship between tumor size and prognosis was steep compared with that when tumor size was larger than 4 cm, especially in lymph node metastasis.

Background To study the association of beta-carotene intake from diet with anxiety in US midlife women. Methods Analyses were performed on the baseline data of the Study of Women's Health Across the Nation (SWAN), a multicenter and population-based study of the natural history of US midlife women aged from 42 to 52. Logistic regression and restricted cubic spline models were performed to examine the association of beta-carotene intake with anxiety. Results A total of 3051 midlife women were included in the present study. In early perimenopausal women, the odds ratios (ORs) of anxiety in the crude model indicated that beta-carotene intake was inversely associated with anxiety. After additional adjustment for age, race/ethnicity, education, income, financial strain, physical activity, BMI, vasomotor symptoms (VMS), chronic stress, use of antidepressant and total caloric intake in model 1, the results were similar to those of the crude model. This association remained statistically significant and changed little when additional controlling for estradiol, testosterone and sex hormone binding globulin (SHBG) in the fully adjusted model 2. The fully adjusted ORs and 95% confidence intervals (CIs) were 0.606 (0.408-0.901). However, in premenopausal women, no statistically significant difference was observed between beta-carotene intake and anxiety. Limitations This was a cross-sectional study, limiting causal inferences. Conclusion Dietary beta-carotene intake may be inversely associated with anxiety in early perimenopausal women, but not in premenopausal women.

Background:. Fetal weight is an important parameter to ensure maternal and child safety. The purpose of this study was to use three-dimensional (3D) limb volume ultrasound combined with fetal abdominal circumference (AC) measurement to establish a model to predict fetal weight and evaluate its efficiency. Methods:. A total of 211 participants with single pregnancy (28–42 weeks) were selected between September 2017 and December 2018 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University. The upper arm (AVol)/thigh volume (TVol) of fetuses was measured by the 3D limb volume technique. Fetal AC was measured by two-dimensional ultrasound. Nine cases were excluded due to incomplete information or the interval between examination and delivery >7 days. The enrolled 202 participants were divided into a model group (134 cases, 70%) and a verification group (68 cases, 30%) by mechanical sampling method. The linear relationship between limb volume and fetal weight was evaluated using Pearson Chi-squared test. The prediction model formula was established by multivariate regression with data from the model group. Accuracy of the model formula was evaluated with verification group data and compared with traditional formulas (Hadlock, Lee2009, and INTERGROWTH-21st) by paired t-test and residual analysis. Receiver operating characteristic curves were generated to predict macrosomia. Results:. AC, AVol, and TVol were linearly related to fetal weight. Pearson correlation coefficient was 0.866, 0.862, and 0.910, respectively. The prediction model based on AVol/TVol and AC was established as follows: Y = −481.965 + 12.194TVol + 15.358AVol + 67.998AC, R2adj = 0.868. The scatter plot showed that when birth weight fluctuated by 5% (i.e., 95% to 105%), the difference between the predicted fetal weight by the model and the actual weight was small. A paired t-test showed that there was no significant difference between the predicted fetal weight and the actual birth weight (t = −1.015, P = 0.314). Moreover, the residual analysis showed that the model formula's prediction efficiency was better than the traditional formulas with a mean residual of 35,360.170. The combined model of AVol/TVol and AC was superior to the Lee2009 and INTERGROWTH-21st formulas in the diagnosis of macrosomia. Its predictive sensitivity and specificity were 87.5% and 91.7%, respectively. Conclusion:. Fetal weight prediction model established by semi-automatic 3D limb volume combined with AC is of high accuracy, sensitivity, and specificity. The prediction model formula shows higher predictive efficiency, especially for the diagnosis of macrosomia. Trial Registration:. ClinicalTrials.gov, NCT03002246; https://clinicaltrials.gov/ct2/show/NCT03002246?recrs=e&cond=fetal&draw=8&rank=67.

This project aimed to survey the clinical characteristics and survivals of hyperprogressive disease (HPD) mediated by immune checkpoint inhibitors (ICIs) in an attempt to explore the potential predictors.After searching PubMed, MEDLINE, Google Scholar and Cochrane Library databases, 12 studies incorporating 1766 individuals were enrolled. The data were analyzed with Review manager 5.3 software.The results revealed HPD correlated with previous metastatic sites 2 (OR = 1.86, 95% CI 1.33-2.59, P = 0.0003), liver metastasis (OR = 3.35, 95% CI 2.09-5.35, P 0.00001), Royal Marsden Hospital (RMH) score ≥ 2 (OR = 2.80, 95% CI 1.85-4.23, P 0.00001), higher ECOG PS (OR = 1.60, 95% CI 1.13-2.27, P = 0.008) and LDH upper limits of normal (ULN) (OR = 2.32, 95% CI 1.51-3.58, P = 0.0001). Instead, HPD was unrelated to gender, age, smoking status, PD-L1 expression, therapy, neutrophil-to-lymphocyte ratio, the histology, the status of EGFR, ALK and KRAS in non-small cell lung cancer and HER-2 expression in advanced gastric cancer. Moreover, HPD was evidently correlated with a shorter OS (HR = 2.92, 95% CI 1.79-4.76, P 0.0001) and PFS (HR = 3.62, 95% CI 2.79-4.68, P 0.00001). The same phenomena existed in stratified studies based on study regions and tumor types.This study demonstrated that HPD was related to the number of prior metastatic sites 2, liver metastasis, RMH score ≥ 2, higher ECOG PS score and LDH ULN. Moreover, HPD was correlated with a poor OS and PFS in patients following ICI therapy.

Anesthesia of neonates with propofol induces persistent behavioral abnormalities in adulthood. Although propofol-triggered apoptosis of neurons in the developing brain may contribute to the development of cognitive deficits, the mechanism of neurotoxicity induced by neonatal exposure to propofol remains unclear. In this study, the effects of neonatal propofol anesthesia on synaptic plasticity and neurocognitive function were investigated. Postnatal day 7 (PND-7) Sprague-Dawley rats were intraperitoneally injected with fat emulsion or 20, 40 or 60 mg/kg propofol for three consecutive days. The expression of brain-derived neurotrophic factor (BDNF), tropomyosin-related kinase B (TrkB) and postsynaptic density protein 95 (PSD-95) in the rat hippocampus at PND-10 and PND-12 was measured by Western blotting. The number of dendritic branches, total dendritic length and dendritic spine density were observed by Golgi-Cox staining 24 h and 72 h after the last propofol administration. Long-term potentiation (LTP) was measured electrophysiologically in hippocampus of PND-60 rats to evaluate the synaptic function. The learning and memory abilities of rats were evaluated by Morris water maze (MWM) experiments, Novel object recognition test (NORT) and Object location test (OLT) at PND-60. Our results showed that neonatal exposure to propofol significantly inhibited the expression of BDNF, TrkB and PSD-95 in the rat hippocampus. The number of dendritic branches, total dendritic length and dendritic spine density of neurons in the rat hippocampus were markedly reduced after neonatal propofol anesthesia. LTP was significantly diminished in hippocampus of PND-60 rats after repeated exposure to propofol in the neonatal period. Morris water maze experiments showed that repeated neonatal exposure to propofol significantly prolonged the escape latency and decreased the time spent in the target quadrant and the number of platform crossings. NORT and OLT showed that repeated neonatal exposure to propofol markedly reduced the Investigation Time for novel object or location. All of the results above indicate that repeated exposure to propofol in the neonatal period can impair hippocampal synaptic plasticity and the recognition function of rats in adulthood.

BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon. We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis. CASE SUMMARY A 71-year-old woman presented with blurred vision due to cataracts. Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea. The patient was positive for syphilis-specific antibodies, with no ocular or systemic evidence of congenital or acquired syphilis. Binocular cataract, retrocorneal scroll, and corneal endothelial gutta were considered. The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy. The cornea of the right eye remained transparent, and the residual scroll seemed stable, however, the corneal endothelial density declined at 13 mo after surgery. In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium, with enlarged endothelial cells in both eyes. Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed. The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure. CONCLUSION Occult congenital syphilis could induce corneal endothelial gutta and the formation of retrocorneal scrolls without other signs of ocular syphilis.

The natural gas in the South China Sea is characterized by a high CO2 content. The efficient development and precise utilization of CO2-rich natural gas resources in the South China Sea can help tackle climate change and achieve the goals of peaking carbon dioxide emissions and achieving carbon neutrality. In this article, we analyze the demand for and summarize the development status of the direct utilization of CO2-rich natural gas in the South China Sea. Subsequently, we focus on several key technologies and their application, including CO2-CH4 dry reforming, integration of CO2-rich natural gas to methanol, liquid fuel production through CO2 hydrogenation, and direct production of fine chemicals. We suggest that research on the CO2-rich natural gas resources in the South China Sea should be strengthened, an engineering platform for the comprehensive utilization of marine CO2-rich natural gas resources should be established, and the CO2-rich natural gas should be integrated with wind, solar, and nuclear energies to promote the sustainable development of the industry. Furthermore, the CO2-rich natural gas industry should be upgraded in the South China Sea, and a strategic alliance among production, education, research, and application should be established.

Sepsis rapidly contributed to multiorgan failure affecting most commonly of the cardiovascular and respiratory systems and yet there were no effective therapies. The current study aimed at providing evidence on the cardioprotection of suppression of 5-Lipoxygenase (5-Lox) and identifying the possible mechanism in the mouse model of sepsis. The cecal ligation-perforation (CLP) model was applied to C57BL/6 wild-type (WT) and 5-Lox deficient (5-Lox-/-) mice to induce sepsis. 5-Lox expression was up-regulated in mouse myocardium and leukotriene B4 (LTB4) level was increased in serum after sepsis. Subsequently, we utilized a recombinant adenoviral expression vector (rAAV9) to overexpress Alox5 gene in adult mice. Compared to WT mice, 5-Lox overexpression accelerated CLP-induced myocardial injury and cardiac dysfunction. Oppositely, 5-Lox deficiency offered protection against myocardial injury in a mouse model of sepsis and attenuated sepsis-mediated inflammation, oxidative stress and apoptosis in the mouse heart. Mechanically, 5-Lox promoted LTB4 production, which in turn contributed to the activation of leukotriene B4 receptor 1 (BLT1)/interleukin-12p35 (IL-12p35) pathway and enhanced M1 macrophage polarization. However, the suppression of BLT1 by either gene mutation or antagonist U75302 significantly inhibited the adverse effect of 5-Lox in sepsis. Further study demonstrated that pharmacological inhibition of 5-Lox prevented CLP-induced septic cardiomyopathy (SCM). Our study identified 5-Lox exacerbated sepsis-associated myocardial injury through activation of LTB4 production and promoting BLT1/IL-12p35 pathway. Hence, inhibition of 5-Lox may be a potential candidate strategy for septic cardiac dysfunction treatment.

The determination of weights is very important for neural network models. Nevertheless, the traditional feedforward neural networks usually use the method of random initial values to determine the weights of the neural networks, such a method would make the related neural network models possess unstable performance in accuracy. Therefore, in order to improve the prediction accuracy and efficiency of neural networks, a novel neural network model based on beetle antennae search (BAS) and weights and structure policy (WASP) is proposed and applied to the estimation of glomerular filtration rate (GFR). Through a series of numerical experiments, it is proved that the accuracy of the proposed neural network model for GFR estimation is higher than that of the model without BAS algorithm optimization. In addition, compared with the traditional one-step method, the method proposed in this article is more than 300% higher in the three performance indicators of MSE, MAE, and MAPE.

With the rapid growth of Android devices and applications, the Android environment faces more security threats. Malicious applications stealing usersʼ privacy information, sending text messages to trigger deductions, exploiting privilege escalation to control the system, etc., cause significant harm to end users. To detect Android malware, researchers have proposed various techniques, among which the machine learning-based methods with static features of apps as input vectors have apparent advantages in code coverage, operational efficiency, and massive sample detection. In this paper, we investigated Android applicationsʼ structure, analysed various sources of static features, reviewed the machine learning methods for detecting Android malware, studied the advantages and limitations of these methods, and discussed the future directions in this field. Our work will help researchers better understand the current research state, the benefits and weaknesses of each approach, and future technology directions.

Predicting the future traffic flows by applying deep learning methods has become an alternative way for transportation network management. Combining recurrent neural networks (RNNs) with tensor to implement accurate predictions has drawn intensive attention. However, traditional RNNs cannot deal with the high-order traffic flow data and capture their inherent structural relationship to provide accurate multi-modal prediction services. Therefore, this article focuses on proposing a series of tensor-based RNNs (T-RNNs) and a T-RNNs based multi-modal prediction approach (TMMP) to provide accurate prediction services. First, we propose three types of T-RNNs including tensor-based vanilla RNN, tensor-based long short-term memory (T-LSTM) and tensor-based gated recurrent unit (T-GRU), in which the input, output and weights are arbitrary high-order tensors. Then, to compress the weight parameters, we further propose two compact TT-based GRU (TT-GRU) and Tucker-based GRU (Tucker-GRU) models by applying tensor train (TT) and Tucker decompositions to T-GRU model. Afterwards, based on the high-order output tensor generated by T-RNNs, a TMMP approach is proposed to achieve the accurate predictions under various scenarios. Extensive experimental results on the metro traffic flow dataset demonstrate that the proposed TMMP approach can improve the traffic flow prediction accuracy by at most 25.29 percentage compared with the traditional MSE-based approaches. Meanwhile, compared with the T-GRU model, the TT-GRU model can compress the number of parameters by 200~780 times. The proposed T-RNNs and TMMP approach can adapt to different application scenarios and can be used to improve the efficiency of transportation management.

Intracerebral hemorrhage (ICH) is the most disabling form of stroke, but effective treatment protocols for ICH are still limited. The minimally invasive surgery (MIS) is a potential and effective treatment for ICH in recent years. However, it is associated with a risk of rebleeding. This review aims to discuss some key facts about rebleeding, such as thrombolytic agents, therapeutic time window, and first aspiration volume.

The draft gear is a key component in a railway train system. The stochastic feature of dry friction in the draft gear has been observed by many researchers, however, characterisation studies in thi...

This study was designed to investigate the correlation between immune-related adverse events (irAEs) of immune checkpoint inhibitors (ICIs) and corresponding efficacy, and to explore the potential of predicting the efficacy of ICIs via irAEs. Electronic databases including PubMed, Embase, Cochrane Library, CNKI and Wanfang were applied to search for relevant studies. The primary endpoint was overall survival (OS) or progression-free survival (PFS), and the secondary endpoint was objective response rate (ORR). Stratification analyses were conducted according to the type of irAEs and ICIs, region of studies and primary tumors. Furthermore, statistical analyses were realized by means of RevMan 5.3 software. Altogether, 40 studies with 8,641 participants were enrolled, among which the incidence of irAEs ranged from 15.34 to 85.23% and the major sites reached out to skin, endocrine organ, gastrointestinal tract, liver and lung. The ORR, OS and PFS in irAE group were significantly higher than those in non-irAE group as per pooled analyses and stratification analyses. Importantly, patients with irAEs in skin, endocrine organ or gastrointestinal tract rather than in liver and lung were found to obtain survival benefits (p

Development of railway transportation capabilities towards high-power, high-speed and heavy axle-load makes the dynamic interactions between the electric drive subsystem and the mechanical subsyste...

The study aimed to utilize machine learning (ML) approaches and genomic data to develop a prediction model for bone mineral density (BMD) and identify the best modeling approach for BMD prediction. The genomic and phenotypic data of Osteoporotic Fractures in Men Study (n = 5130) was analyzed. Genetic risk score (GRS) was calculated from 1103 associated SNPs for each participant after a comprehensive genotype imputation. Data were normalized and divided into a training set (80%) and a validation set (20%) for analysis. Random forest, gradient boosting, neural network, and linear regression were used to develop BMD prediction models separately. Ten-fold cross-validation was used for hyper-parameters optimization. Mean square error and mean absolute error were used to assess model performance. When using GRS and phenotypic covariates as the predictors, all ML models’ performance and linear regression in BMD prediction were similar. However, when replacing GRS with the 1103 individual SNPs in the model, ML models performed significantly better than linear regression (with lasso regularization), and the gradient boosting model performed the best. Our study suggested that ML models, especially gradient boosting, can improve BMD prediction in genomic data.

The demand for proteins with high purity, high activity and high stability is increasing, especially in the biopharmaceutical industry. Traditional industrial protein production technologies include chromatography, which is expensive, and salting out and traditional crystallization methods, which require large amounts of salt and have an adverse effect on the environment. In recent years, a new method—solvent freeze-out (SFO) technology for protein crystallization—has been developed. Compared with traditional methods, SFO requires less salt, and can be carried out at low temperatures, resulting in more stable and active proteins. In addition, SFO can control the nucleation and crystal growth process under different supersaturation levels by setting appropriate operating temperatures, which can ensure industrial application of this technology. This paper reviews important advances in SFO technology for the crystallization of proteins.

Context Sheng Xue Fang (SXF) has been used to treat anaemia for decades with good efficacy. Objective To study the effect and possible mechanism of SXF to restore haematopoietic function. Materials and methods Balb/c mice (10 per/group, half male, half female) were treated with SXF (three dose groups, 8.5, 17, and 22.1 g/kg) by gavage for 14 days, and cyclophosphamide (80 mg/kg) was injected on days 10–12. Only injection of cyclophosphamide (negative control) or physiological saline (blank control) were included as controls. The spleen and femur were processed for histopathology. Active components and the target of SXF were screened. The target was used for gene enrichment and protein-protein interaction (PPI) analysis. Results Red blood cell relative changes in the SXF group (low: −5.50 ± 1.58%; medium: −11.11 ± 4.15%; high: −8.81 ± 2.67%) and relative negative control (26.21 ± 2.51%) significantly increased (all p

Introduction: The efficacy of selenium administration to treat severe sepsis or septic shock remains controversial. We con- duct a systematic review and meta-analysis to explore the impact of selenium administration on severe sepsis or septic shock. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020 for randomized controlled trials (RCTs) assessing the effect of selenium administration on severe sepsis or septic shock. Me- ta-analysis is performed using the random-effect model. Results: Five RCTs involving 1482 patients are included in the meta-analysis. Overall, compared with control group in septic patients, selenium administration is not associated with reduced 28-day mortality (RR=0.93; 95% CI=0.73 to 1.19; P=0.58), but results in substantially decreased all-cause mortality (RR=0.78; 95% CI=0.63 to 0.98; P=0.03) and length of hospital stay (MD=-3.09; 95% CI=-5.68 to -0.50; P=0.02). Conclusion: Selenium administration results in notable decrease in all-cause mortality and length of hospital stay, but shows no substantial influence on the 28-day mortality, length of ICU stay, duration of vasopressor therapy, the incidence of acute renal failure, adverse events, and serious adverse events for septic patients. Keywords: Selenium administration; septic shock; randomized controlled trials.

The seismic performance of the precast shear wall was improved by using a newly developed reinforced tenon to strengthen the precast joint, which is used to bear the shear force of the precast joint and reduce the effect of dowel action on the vertical connecting steel bars. The vertical connecting steel bars were only used to bear tensile and compressive stress and consume seismic energy. The seismic performance of reinforced tenon precast shear wall was investigated by quasi-static tests on one reinforced tenon precast shear wall specimen and one ordinary flat seam precast shear wall specimen. This study investigated the crack distribution and failure modes, precast joint slip of the two specimens, and the seismic performance parameters such as bearing capacity, stiffness degradation, ductility performance and energy dissipation capacity. The test results demonstrated that the reinforced tenon effectively reduced the slip of the joint surface and exhibited good ductility and energy dissipation capacity than that of the ordinary flat seam specimen, while the failure mode, bearing capacity, and stiffness were similar to that of the flat seam specimen.

The novel coronavirus disease (COVID-19) has spread all over the world in a short time. Information about the differences between COVID-19 patients with and without hypertension is limited. To explore the characteristics and outcomes differences between COVID-19 patients with and without hypertension, the medical records and cardiac biomarkers of 414 patients were analyzed. A total of 149 patients had a history of hypertension, while 265 patients did not have hypertension, and the groups were compared based on their clinical characteristics and laboratory findings as well as the hazard risk for composite outcomes, including intensive care unit (ICU) admission, mechanical ventilation, or death. The results are as follows. On admission, 22.1% of patients in hypertension group had elevated high sensitivity troponin I (hs-TNI > 26 pg/mL), which was higher than the proportion in the nonhypertension group (6.4%). Median NT-proBNP levels in patients with hypertension (141.9 pg/mL) were higher than those in patients without hypertension (77.3 pg/mL). Patients in the hypertension group had a higher risk for in-hospital death [HR: 2.57, 95% CI (1.46~4.51)]. However, the impact of hypertension on the prognosis was not significant after adjusting for age and sex. Multivariate Cox hazard regression confirmed that NT-proBNP levels in the highest tertile (upper 75 % of patients with hypertension) was an independent risk factor for in-hospital death in all COVID-19 patients. Taken together, hypertension per se had a modest impact on the prognosis in COVID-19 patients. In COVID-19 patients with and without hypertension, NT-proBNP may be a better predictor of prognosis than hs-TNI.

This paper uses vehicle system dynamics simulations to investigate curving resistance generated from the wheel-rail interface. More than 600 simulations were conducted using a freight wagon model t...

BackgroundThe underlying mechanisms of neuropathic pain remain unclear. This work aimed to investigate the role of Sirtuin3 (SIRT3), an nicotinamide adenosine dinucleotide+-dependent histone deacetylase, in the development of neuropathic pain induced by type 2 diabetes mellitus (T2DM) and to explore the associated mechanisms.MethodsDiabetic neuropathic pain (DNP) in rats was induced by high-fat diet/low-dose streptozotocin. The pain behaviors were examined using the von Frey and Hargreaves tests. The levels of SIRT3, manganese superoxide dismutase (MnSOD) and catalase (CAT) were determined using Western blot and RT-qPCR. The acetylation, phosphorylation and ubiquitination of forkhead box class O3a (FoxO3a) were analyzed by immunoprecipitation and Western blot.ResultsSIRT3 expression and activity were significantly reduced in the spinal dorsal horn of DNP model rats. Overexpression of spinal SIRT3 reversed the pain hypersensitivity in the DNP model rats, but knockdown of spinal SIRT3 mimicked the pain effect, eliciting pain hypersensitivity in normal rats. Moreover, overexpression of spinal SIRT3 in DNP model rats increased the FoxO3a level and upregulated the antioxidant genes MnSOD and CAT by deacetylating FoxO3a and inhibiting FoxO3a phosphorylation and ubiquitination. Knockdown of spinal SIRT3 in normal rats decreased the FoxO3a level and downregulated MnSOD and CAT by inhibiting the deacetylation of FoxO3a and further increasing FoxO3a phosphorylation and ubiquitination.ConclusionsThese results suggest that, by deacetylating FoxO3a and further reducing its phosphorylation, ubiquitination and degradation in the spinal dorsal horn, SIRT3 stabilizes FoxO3a protein and inhibits oxidative stress, resulting in pain alleviation in T2DM model rats.

Studies have shown that patients with Parkinson’s disease (PD) will experience weight loss during the progression of the illness, which suggests an increased rate of underweight. However, few studies have addressed underweight in early de novo population. This study aimed to examine the prevalence, risk factors, and clinical correlations of underweight in Chinese newly diagnosed and drug-naive patients with PD. A total of 245 inpatients with newly diagnosed PD and 213 age-, sex-, and education-matched healthy controls were enrolled in Ningbo. BMI, demographics, supine and upright blood pressure, Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) together with fasting blood glucose, low-density lipoprotein, total cholesterol, uric acid (UA), and homocysteine were collected in all subjects. Hoehn and Yahr (HY) rating and Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores were also measured in patients. Overall, 35 (14.3%) patients were underweight and 14 (6.6%) controls were underweight. Binary regression analyses showed that low MoCA (p = 0.035), ΔSBP and ΔDBP values (both p < 0.001) were risk factors for underweight. Furthermore, correlation analysis indicated that BMI was associated with HY grade, UPDRS motor, HAMA, HAMD, MoCA, ΔSBP, ΔDBP, and UA values, stepwise multiple regression revealed significant correlations between BMI and ΔSBP (p < 0.001), ΔDBP (p = 0.001), MoCA (p = 0.002), UPDRS motor (p = 0.005), and HAMD scores (p = 0.014). Our study showed that the prevalence of underweight was significantly higher in Chinese newly diagnosed and drug-naive patients with PD than in the healthy population, and several clinical variables were risk factors for underweight.

Depression and anxiety often co-occur in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). This study was conducted to examine the predictive value of depression, anxiety, and their combination on the prognosis of Chinese PCI patients. A multicenter prospective study was undertaken with a sample of 309 primary PCI patients. The Hospital Anxiety and Depression Scale (HADS) was completed at baseline to assess anxiety and depression symptoms. Major adverse cardiovascular events (MACEs) were recorded for 12 months after PCI . Days from baseline to the first MACE was the outcome variable. MACEs occurred in 26 (8.4%) patients. After adjustments for socio-demographic and clinical characteristics, a Cox proportional hazards regression model revealed that depression (HR = 2.70, 95% confidence interval [CI] 1.22–5.95; p =.014) and anxiety (HR = 2.56, 95% CI 1.18–5.54; p =.017) symptoms were independent predictors of MACEs. A sub-analysis showed that the cumulative event-free survival curves did not differ among depressed and anxious patients and depressed but non-anxious patients (Log Rank p =.52). In conclusion, depression is associated with an increased risk for MACEs post-PCI, independent of anxiety. Although anxiety is associated with MACEs, it has no additional predictive value when co-occurring with depression.

With the rapid growth of Android applications, there is an urgent need for powerful Android malware detection technology nowadays. Existing classification models can be summarized with the following two steps-feature extraction and classification model learning. To further enhance the representation ability of existing classification models, this article presents an Android malicious application detection framework termed multiview information integration technology (MVIIDroid). To be specific, in our approach, we extract applications’ multiple components, transform them into embedding feature vectors and train a multiple Kernel learning model as the classifier. To illustrate the effectiveness of our model, we evaluate MVIIDroid on two Android malware datasets of 6820 malware and 6820 benign applications. Results show that we have superior classification performances when separating malware from benign applications. Moreover, we further evaluate MVIIDroid's ability to attribute malicious applications to their actual families. The experimental results well demonstrate the effectiveness of the proposed model.

Background/purpose Trimethoprim-sulfamethoxazole (TMP-SMZ) is broadly administered to treat multiple infections, and the paucity of effective treatment alternatives for infections caused by Klebsiella pneumoniae has led to a renewed interest in TMP-SMZ. The aim of this study is to evaluate the antibacterial efficacy of TMP-SMZ against K. pneumoniae. Methods The resistance genes of K. pneumoniae clinical isolates were investigated by PCR, followed by conjugation experiments and multilocus sequence typing. Results The resistance rate of K. pneumoniae to TMP-SMZ decreased over the collection period from 26.7% (88/330) to 16.9% (56/332). The high carrying rates (173/175, 98.9%) of resistance determinants (sul genes or dfr genes) were the main mechanisms of TMP-SMZ resistance isolates, with sul1 (142/175, 81.1%) and dfrA1 (119/175, 68.0%). Only class 1 integron was detected, the prevalence of which in TMP-SMZ resistant K. pneumoniae was 63.4% (111/175). Conclusion These results provided insights into the antimicrobial efficacy of TMP-SMZ against K. pneumoniae, also illustrating the wide distribution of SMZ and TMP resistance genes among resistant K. pneumoniae. Simultaneously, the present study highlights the significance of reasonable administration and effective continued monitoring.

This systematic review and meta-analysis were conducted on all eligible cohort studies to evaluate the association between high-sensitivity C-reactive protein (hs-CRP) and osteoporotic fracture risk. Both frequentist and Bayesian approaches were employed for the meta-analysis. We found that high tertiles of hs-CRP were significantly associated with increased fracture risk. The association between the inflammatory marker CRP and osteoporotic fracture has remained uncertain. In this study, we conducted a systematic review and meta-analysis to examine the association of serum hs-CRP and fracture risk. We performed a systematic literature search of relevant databases, including PubMed, Embase, and MEDLINE publications from January 1950 through April 2020. Three reviewers independently performed the study selection, quality assessment, and data abstraction. Frequentist and Bayesian hierarchical random-effects models were used separately for the analysis. Statistical heterogeneity was assessed using Higgin’s I2 and Cochran’s Q statistic, and publication bias was examined using funnel plots and rank correlation tests. Fourteen cohort studies that reported t fracture outcomes were eligible for the systematic review. Only ten studies (n = 29,741) qualified for meta-analysis. In the frequentist approach, the RR for fracture in a comparison of the top tertile group to the bottom tertile group of hs-CRP was 1.54 (1.18, 2.01). The estimated risk of fracture remained significant in all sensitivity and subgroup analyses. Higgin’s I2 (30.52%) and Cochran’s Q statistic (p < 0.01) suggested there was moderate heterogeneity for the meta-analysis. In the Bayesian approach, the pooled RR was 1.60 (95% CI (1.07–2.49)), and the probabilities that the high level of hs-CRP increased fracture risk by more than 0%, 10%, and 20% were 99%, 98%, and 93%, respectively. A high level of hs-CRP is associated with a significantly increased risk of osteoporotic fracture.

In this paper, a system is proposed for extracting insulators on power transmission lines from photographs captured by an unmanned aerial vehicle. The approximate regions of the insulators are first determined by a support vector machine with the histogram of oriented gradients as the feature descriptor. Then, the specific regions of insulators are detected and extracted by the GrabCut algorithm. In advance, some constraint conditions, such as the value ranges of color component values as well as the relationships between the component values in three color models, need to be specified. In our system, an interactive interface is developed to help determine these conditions. According to the experimental results, our system is capable of removing most of the backgrounds and extracting the insulators from photographs.

Background. The predictive value of hemoglobin A1c (HbA1c) levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) is still controversial. This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease (CAD) who had undergone PCI by performing a meta-analysis of cohort studies. Methods. This meta-analysis included non-diabetic patients with CAD who had undergone PCI. A systematic search for publications listed in the PubMed, Embase, and Cochrane Library databases from commencement to December 2018 was conducted. Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible. The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events, and the secondary outcome was short-term all-cause deaths. The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0. Odds ratios (ORs) were pooled using a random or fixed-effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary. Results. Six prospective cohort studies involving 10,721 patients met the inclusion criteria. From the pooled analysis, abnormal HbA1c levels were associated with increased risk for long-term all-cause death (OR 1.39, 95% confidence interval [CI] 1.16–1.68, P = 0.001, I2 = 45%). Sub-group analysis suggested that abnormal HbA1c levels between 6.0% and 6.5% predicted higher long-term major adverse cardiac event (including all-cause deaths, non-fatal myocardial infarction, target lesion revascularization, target vessel revascularization, recurrent acute myocardial infarction, heart failure requiring hospitalization, and stent thrombosis) risk (OR 2.05, 95% CI 1.46–2.87, P

Locomotive-track interaction is a multidimensional task because it goes in many directions depending on the aim of the investigation. One such direction relates to wheel or track damage produced by...

With the rapid developments of deep neural networks related applications, approaches for accelerating computationally intensive convolutional neural networks, such as network quantization, pruning, knowledge distillation, have attracted ever-increasing attention. Network binarization is an extreme form of network quantization technique, which binarizes the network weights and/or activation values to save computational resources. However, it often introduces noises into the network, and requires larger model size (more parameters) to compensate for the loss of representation capacity. To address the model complexity reduction challenges and further improve the network performance, this paper proposes an approach: slimming binarized neural networks (SBNN), which reduces complexity of binarized networks with acceptable accuracy loss. SBNN prunes the convolutional layers and fully-connected layer in a binarized network. Then it is refined by the proposed SoftSign function, knowledge distillation and full-precision computation to enhance the network accuracy. The proposed SBNN can be also conveniently applied to a pre-trained binarized network. We demonstrate the effectiveness of our approach through several state-of-the-art binarized models. For AlexNet and ResNet-18 on ILSVRC-2012 dataset, SBNN obtains negligible accuracy loss but even a better accuracy than the pre-pruning model while using only 75% of original filters.

The study aims were to develop fracture prediction models by using machine learning approaches and genomic data, as well as to identify the best modeling approach for fracture prediction. The genomic data of Osteoporotic Fractures in Men, cohort Study (n = 5,130), was analyzed. After a comprehensive genotype imputation, genetic risk score (GRS) was calculated from 1,103 associated Single-Nucleotide Polymorphisms for each participant. Data were normalized and split into a training set (80%) and a validation set (20%) for analysis. Random forest, gradient boosting, neural network, and logistic regression were used to develop prediction models for major osteoporotic fractures separately, with GRS, bone density, and other risk factors as predictors. In model training, the synthetic minority over-sampling technique was used to account for low fracture rate, and 10-fold cross-validation was employed for hyperparameters optimization. In the testing, the area under curve (AUC) and accuracy were used to assess the model performance. The McNemar test was employed to examine the accuracy difference between models. The results showed that the prediction performance of gradient boosting was the best, with AUC of 0.71 and an accuracy of 0.88, and the GRS ranked as the 7th most important variable in the model. The performance of random forest and neural network were also significantly better than that of logistic regression. This study suggested that improving fracture prediction in older men can be achieved by incorporating genetic profiling and by utilizing the gradient boosting approach. This result should not be extrapolated to women or young individuals.

Background At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients’ anxiety and other negative emotions. Methods This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. Discussion This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. Trial registration Chinese Clinical Trials Registry, 1900024043. Registered on 23 June 2019.

Solitary pulmonary nodules (SPNs) frequently bother oncologists. The differentiation of malignant from benign nodules with non-invasive approach remains a tough challenge. This study was designed to assess the diagnostic accuracy of dynamic computed tomography (CT), dynamic magnetic resonance imaging (MRI), fluorine 18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), and technetium 99 m (99mTc) depreotide single photon emission computed tomography (SPECT) for SPNs. Electronic databases of MEDLINE, PubMed, EMBASE, and Cochrane Library were searched to identify relevant trials. The primary evaluation index of diagnostic accuracy was areas under the summary receiver-operating characteristic (SROC) curve. The results were analyzed utilizing Stata 12.0 statistical software. Seventy-three trials incorporating 7956 individuals were recruited. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic score, diagnostic odds ratios, and areas under the SROC curve with 95% confidence intervals were, respectively, 0.92 (0.89–0.95), 0.64 (0.54–0.74), 2.60 (1.98–3.42), 0.12 (0.08–0.17), 3.10 (2.62–3.59), 22.24 (13.67–36.17), and 0.91 (0.88–0.93) for CT; 0.92 (0.86–0.95), 0.85 (0.77–0.90), 6.01 (3.90–9.24), 0.10 (0.06–0.17), 4.12 (3.41–4.82), 61.39 (30.41–123.93), and 0.94 (0.92–0.96) for MRI; 0.90 (0.86–0.93), 0.73 (0.65–0.79), 3.28 (2.56–4.20), 0.14 (0.10–0.19), 3.16 (2.69–3.64), 23.68 (14.74–38.05), and 0.90 (0.87–0.92) for 18F-FDG PET; and 0.93 (0.88–0.96), 0.70 (0.56–0.81), 3.12 (2.03–4.81), 0.10 (0.06–0.17), 3.43 (2.63–4.22), 30.74 (13.84–68.27), and 0.93 (0.91–0.95) for 99mTc-depreotide SPECT. The dynamic MRI, dynamic CT, 18F-FDG PET, and 99mTc-depreotide SPECT were favorable non-invasive approaches to distinguish malignant SPNs from benign. Moreover, from the viewpoint of cost-effectiveness and avoiding radiation, the dynamic MRI was recommendable for SPNs.