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This network meta-analysis was conducted to compare the predictive value of eight SNPs on the efficacy of antidepressants in major depressive disorder (MDD), including 5-HTTLPR, 5HTR2A (rs6311, rs6314, rs7997012 and rs6313), 5HTR2A (rs6295), BDNF (rs6265) and 5HTTSTin2. Databases were searched for related studies published up to December 2019. A total of 16 studies were included in this study. The predictive value were evaluated by the use of the odd ratios (OR) and drawing surface under the cumulative ranking curves (SUCRA). The pairwise meta-analysis indicated that in terms of overall response ratio, the SNPs were not associated with the efficacy of antidepressants in MDD. The result of this network meta-analysis suggested that there was no significant difference in predictive value of eight SNPs on the efficacy of antidepressants in MDD. More research is needed to explore the relationship between SNPs and antidepressant response.

Recently, favorable outcomes of primary anterior cruciate ligament (ACL) repair have been reported in patients with proximal tears and good tissue quality. If the tear involves the midsubstance of the ACL fibers or Sherman type II or III injury, independent primary repair will cause a higher failure rate at long-term follow-up. For these cases, we conduct primary repair and apply an internal brace and single-bundle reconstruction as hybrid augmentation. This hybrid repair technique encourages natural healing of the primary ligament by the internal brace and single-bundle graft as a provisional scaffold during the healing phase, as well as early mobilization. We describe our ACL hybrid repair technique, using a video and illustrations.

Although cigarette smoking is an independent risk factor for cardiovascular disease, inconsistent results have been published in the literature on its impacts on the cardiovascular health of patients after coronary revascularization with a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). We performed a comprehensive electronic database search through July 2018. Studies reporting the risk estimates of all-cause mortality and cardiovascular outcomes in patients after coronary revascularization with PCI or CABG on the basis of smoking status were selected. Multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) were pooled using random-effects models with inverse variance weighting. Data from 37 records including 126 901 participants were finally collected. Overall, the pooled RR (95% CI) associated with cigarette smoking was 1.26 (95% CI: 1.09-1.47) for all-cause mortality, 1.08 (95% CI: 0.92-1.28) for major adverse cardiovascular events, 0.96 (95% CI: 0.69-1.35) for cardiovascular mortality and 1.15 (95% CI: 0.81-1.64) for myocardial infarction. The increased risk of all-cause mortality was also observed in former smokers compared with those who had never smoked (RR: 1.19; 95% CI: 1.03-1.38). Furthermore, the negative effects of cigarette smoking on all-cause mortality were also observed in most subgroups. Cigarette smoking has been shown to increase the likelihood of all-cause mortality in patients after coronary revascularization with PCI or CABG. Smoking cessation is essential for PCI or CABG patients to manage their coronary artery disease.

Objective The correlation between the signal/noise quotient values of an anterior cruciate ligament graft and the International Knee Documentation Committee Subjective Knee Form 2000 scores after anterior cruciate ligament reconstruction was evaluated. Design Magnetic resonance imaging and clinical evaluation using International Knee Documentation Committee scores were used to calculate the signal intensity of the graft maturity at the 6-mo and 12-mo follow-up points postoperatively. The associations between the signal/noise quotient values at the 6-mo follow-up point and International Knee Documentation Committee scores at the 12-mo follow-up point were evaluated. Results A total of 42 male patients completed our trial and returned to normal activity level before the surgery. The mean ± SD age of these patients was 29.07 ± 8.11 yrs (range, 17-47 yrs). The mean ± SD body mass index was 26.00 ± 2.59 kg/m. Notably, the Pearson correlation analysis showed that the International Knee Documentation Committee scores obtained at 12 mos were significantly associated with the signal/noise quotient values measured in the sixth month and twelfth month, respectively (r = -0.454, P = 0.003; r = -0.478, P = 0.001). Conclusions According to this study, early measurement of graft maturity might predict the clinical outcome afterward. The sensitive predictive value of signal/noise quotient could be used to maximize the patient outcomes.

Objective The aim of this review is to identify and summarize factors that are associated with public attitudes towards people with various disabilities systematically. Methods An electronic search of three databases was performed (Medline, EMBASE and Cochrane) covering the period from 1950 to present. A comprehensive search strategy was developed and the lists of citations were screened for potential eligible studies. Only quantitative studies using valid measurements were included, and the methodological quality of included studies was appraised based on three criteria (sample, measurement, analysis) by two independent reviewers. Results The initial electronic search yielded 995 articles after duplicates removed, and 27 studies met the eligibility criteria were included in the study. Three categories of the factors were found to be associated with the public attitudes, which are related to the attitude provider, disabled people, and society respectively. Specifically, the more people know about disabilities, the more likely they were to have positive attitude; and the frequency and quality of the contact with the disabled are also proved to be influential to the attitudes. Meanwhile, the type of disability is also closely correlated to the public’s attitude towards the disabilities. Conclusion People’s knowledge of the disability and their contact with individuals with disabilities are the main influential factors in public attitudes towards persons with disabilities.

The study of income distribution, education input and education return rate has always been a hot topic in the theoretical circle. Most of the existing researches have drawn a conclusion that there is a significant positive correlation between the years of education and the income level. There is a two-way causal relationship between income distribution and education. In addition, the distribution of education and the rate of return on education will also have an impact on education. This paper aims to focus on the impact of gender differences in income distribution on education based on previous research, while focusing on the distribution of education and the rate of return on education in different genders. Based on the specific quantitative indicators of the differences, some theoretical support and policy recommendations on education and education reform are given.

Uterine fibroid embolization has been proven effective in treating symptomatic uterine fibroids for appropriately selected patients as an alternative option to surgical approaches. The most common adult uterine position is anteverted followed by a retroverted uterus which can be found in roughly 15%-20% of normal adult females. The positioning of the uterus can change from anteversion to retroversion due to the filling of bladder or during pregnancy; however, changing from retroverted to anteverted position without prior pregnancy or endometriosis is rather uncommon. Here, we describe a case of uterine orientation change from retroversion to anteversion presenting 6 months after uterine fibroid embolization. Keywords: Anteverted uterus, Retroverted uterus, Anteversion, UFE, Flipped uterus, Tipped uterus

Background Obesity, a comorbid medical condition, is usually observed in patients with established coronary artery disease. Paradoxically, patients with a higher body mass index (BMI) usually have better clinical outcomes after coronary revascularization. Methods We searched five online databases through December 2017. We identified studies reporting the rate of all-cause mortality or cardiovascular-related outcomes among patients after coronary revascularization with percutaneous coronary intervention or coronary artery bypass graft based on various BMI categories. Network meta-analysis was performed using Bayesian methods. Results Sixty-five records involving 865,774 participants were included in our study. A U-shaped association was observed across BMI categories for all-cause mortality. Using normal weight as the reference, all-cause mortality was increased for (relative risk [RR]: 2.4; 95% credibility interval [CrI]: 2.1-2.7) patients with underweight, whereas it was lowered in patients with overweight, obese, and severely obese. This association remained significant in many subgroups. We also observed that the risk of major adverse cardiovascular events (MACE) was lowest among patients with overweight. Furthermore, patients with underweight were associated with greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5), cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR: 2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7) compared with normal weight patients; no significant association was observed among individuals with higher BMI. Conclusions The 'obesity paradox' does exist in patients after coronary revascularization, especially for patients with post-percutaneous coronary intervention. All-cause mortality in patients with high BMI is significantly lower compared with patients with normal weight. Furthermore, patients with underweight experience higher rates of cardiovascular outcomes compared with patients with normal weight.

Contrast-induced nephropathy (CIN) is the major complication related to contrast media administration in patients after coronary angiography (CAG). However, inconsistent results have been published in the literature regarding the effects of pharmacological drugs on CIN prevention. We conducted a network meta-analysis to evaluate the relative efficacy of pharmacological interventions for the prevention of CIN. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to July 2017. We included any randomized controlled trials of eleven pharmacological interventions that reported the prevention of CIN. We identified 3850 records through database searches, of which 107 studies comprising 21,450 participants were finally identified. Compared with intravenous saline, intravenous saline plus pharmacological drugs including statin [relative risk (RR) 0.57; 95% credibility interval (CrI) 0.39 to 0.83], N-acetylcysteine (NAC) (RR 0.84; 95% CrI, 0.71 to 0.98), vitamin and its analogues (RR 0.66; 95% CrI 0.45 to 0.97), brain natriuretic peptide (BNP) and its analogues (RR 0.46; 95% CrI 0.30 to 0.70), prostaglandin analogues (RR 0.37; 95% CrI 0.18 to 0.76), NAC plus sodium bicarbonate (SB) (RR 0.60; 95% CrI 0.39 to 0.90), and statin plus NAC (RR 0.39; 95% CrI 0.21 to 0.70), have helped to reduce the incidence of CIN in patients after CAG. The top four ranked treatments were statin plus NAC, BNP and its analogues, statin, and vitamin and its analogues, respectively. NAC plus intravenous saline was associated with lower incidence of short-term all-cause mortality than intravenous saline alone (RR 0.62; 95% CI, 0.40 to 0.96; P = 0.03). However, no evidence indicated that any of the pharmacological drugs were associated with a reduced requirement for dialysis and major adverse cardiac and cerebrovascular events (MACCE). Statin plus NAC plus intravenous saline seems to be the most effective treatment for the prevention of CIN in patients after CAG. NAC plus intravenous saline may have a protective role against short-term all-cause mortality. However, none of these drugs has effectively decreased the requirement for dialysis and MACCE.

Background Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in angiogenesis and maintenance of endothelial integrity. Whether circulating BDNF levels are associated with von Willebrand factor (vWF) levels, which are indicators of endothelial dysfunction is not known. This study investigated the association between plasma BNDF and vWF levels and whether these biomarkers could predict cardiovascular events at a 12-month follow-up in patients with stable coronary artery disease (CAD). Methods We recruited 234 patients with suspected angina pectoris. Subjects were divided into CAD (n = 143) and control (n = 91) groups based on coronary angiography. Plasma BDNF and vWF levels were measured using ELISA. Patients were followed-up for one year, and information on adverse cardiac events was collected. Results CAD patients exhibited significantly lower plasma BDNF and higher vWF levels than those of control patients. High vWF levels were associated with low BDNF levels even after adjustment for age, gender, low-density lipoprotein (LDL) levels, and the presence of diabetes mellitus. A receiver operating characteristic curve was used to determine whether low BDNF and high vWF levels could predict adverse cardiovascular events. The area under the curve for vWF and the inverse of BDNF were 0.774 and 0.804, respectively. Conclusions These findings suggest that endothelial dysfunction is an important determinant of the impaired circulating BDNF levels, and they further reflected cardiovascular prognosis in stable CAD patients.

With the development of hydropower in the karst area of Southwest China, a series of cascade canyon reservoirs have been formed through the construction of dams. Given that hydrodynamic conditions in canyon reservoirs play a pivotal role in controlling the spatiotemporal distribution of physical and chemical properties of the stored water, hydrodynamic characteristics are of great importance in understanding biogeochemical cycles in those reservoirs. To further this understanding, a field campaign was conducted in the Wujiangdu Reservoir of Guizhou Province. It was found that from the reservoir inlet to the front of the dam, velocity (v) was negatively correlated and had a logarithmic relationship with distance along the ship track (s) under dry-season flow conditions [v = −0.104ln (s) + 0.4756]. Analysis showed that dry-season flow velocity had no significant correlation with water temperature, pH, or dissolved oxygen (DO). However, when velocity decreased to 0.061 m/s, water depth increased abruptly. In addition, DO displayed a sudden drop and the trend in pH changed from increasing to decreasing, while water temperature showed an opposite trend, indicating the existence of a transition zone from the river to the reservoir.

Angiography and endovascular embolization play an important role in controlling acute arterial upper gastrointestinal hemorrhage, particularly when endoscopic intervention fails to do so. In our case, the patient presented with recurrent life-threatening bleed in spite of multiple prior endoscopic interventions and gastroduodenal artery embolization. Our teaching points focus on the role of angiography in acute upper gastrointestinal bleed and when to conduct empiric embolization, while reviewing the supraduodenal artery as an atypical but important potential culprit for refractory upper gastrointestinal bleed.

Exercise induces a number of benefits, including angiogenesis in post‑myocardial infarction (MI); however, the underlying mechanisms have not been fully clarified. Neurotrophic brain‑derived neurotrophic factor (BDNF) serves a protective role in certain adult cardiac diseases through its specific receptor, BDNF/NT‑3 growth factors receptor (TrkB). The present study explored the mechanisms by which exercise improves cardiac function, with a focus on the involvement of the BDNF/TrkB axis. MI rats were assigned to Sham, sedentary, exercise, exercise with K252a (a TrkB inhibitor), and exercise with NG‑nitro‑L‑arginine methyl ester (L‑NAME) groups. The exercise group was subjected to 8 weeks of treadmill running. The results demonstrated that the rats in the exercise group exhibited increased myocardial angiogenesis and improved cardiac function, which was attenuated by K252a. Exercise induced activation of the BDNF/TrkB axis in the ischaemic myocardium and increased serum BDNF levels were abated by exposure to L‑NAME. Improvements in angiogenesis and left ventricular function exhibited a positive association, with changes in serum BDNF. In the in vitro experiments, human umbilical vein endothelial cells were exposed to shear stress (SS) of 12 dyn/cm2 to mimic the effects of exercise training on vascular tissue. An increased tube‑forming capacity, and a nitric oxide (NO)‑dependent prolonged activation of the BDNF/TrkB‑full‑length axis over 12 h, but not the TrkB‑truncated axis, was observed. The SS‑related angiogenic response was attenuated by TrkB inhibition. Overall, these results demonstrate that exercise confers certain aspects of its cardioprotective effects through the activation of the BDNF/TrkB axis in an NO‑dependent manner, a process in which fluid‑induced SS may serve a crucial role.

Background: Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary. Materials and Methods: 25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study. The treatment was administered in three stages. The first stage included emergency debridement, external fixation, repair of damaged main blood vessels and nerves, covering of the wound, and infection control. The second stage involved skin flap or skin graft placement to repair wounds. The third stage involved replacement of the external fixator with an internal fixator and the placement of bone grafts. Results: All the skin flaps or skin grafts survived, and a small necrotic area in the distal flap was observed in only two cases (which resolved spontaneously after the dressing was changed). Bone union occurred at the predicted time in 23 cases, while it was delayed in 2 cases. The rate of excellent and good was 88%. Conclusion: Staged treatment was safe and effective for Gustilo Anderson IIIB/C tibial fractures. The timing for the placement of internal and external fixators and choosing the appropriate skin flap repair technique are important.

Mammography is the most popular technology used for the early detection of breast cancer. Manual classification of mammogram images is a hard task because of the variability of the tumor. It yields a noteworthy number of patients being called back to perform biopsies, ensuring no missing diagnosis. The convolutional neural network (CNN) has succeeded in a lot of image classification challenges during the recent years. In this paper, we proposed an approach of mammogram and tomosynthesis classification based on CNNs. We had acquired more than 3000 mammograms and tomosynthesis data with approval from an institutional review board at the University of Kentucky. Different models of CNNs were built to classify both the 2-D mammograms and 3-D tomosynthesis, and every classifier was assessed with respect to truth-values generated by histology results from the biopsy and two-year negative mammogram follow-up confirmed by expert radiologists. Our outcomes demonstrated that CNN-based models we had built and optimized utilizing transfer learning and data augmentation have good potential for automatic breast cancer detection based on the mammograms and tomosynthesis data.

Background Single nucleotide polymorphisms (SNPs) located in the vascular endothelial growth factor (VEGF) gene may be correlated with the susceptibility to coronary artery disease (CAD) – although results have been controversial. The aim of this meta–analysis is to clarify the effects of VEGF –2578A/C (rs699947), −1154G/A (rs1570360), +405C/G (rs2010963), and + 936C/T (rs3025039) polymorphisms on CAD risk. Methods Pooled odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated to estimate the strength of the association between VEGF gene polymorphisms and CAD risk. Fixed- or random-effects model was used depending on the heterogeneity between studies. Results In total, 13 eligible articles containing 29 studies were analysed. The pooled analysis indicated that the VEGF gene polymorphisms of rs699947, rs2010963, and rs3025039 were associated with an increased risk of CAD, whereas no significant associations were observed with the rs1570360 polymorphism. A subgroup analysis stratified by ethnicity revealed that the rs699947 and rs3025039 polymorphisms were associated with CAD risk in Asian populations. In addition, stratification by control source indicated an increased risk of CAD susceptibility with the rs699947 polymorphism for population–based studies of reduced heterogeneity. Conclusions In summary, we concluded that the VEGF gene polymorphisms rs699947, rs2010963, and rs3025039 are correlated with an elevated CAD risk. Electronic supplementary material The online version of this article (10.1186/s12881-018-0628-3) contains supplementary material, which is available to authorized users.

Variation in the use of inferior vena cava filters (IVCFs) across hospitals has been observed, suggesting differences in quality of care. Hospitalization metrics associated with venous thromboembolism (VTE) patients have not been compared based on IVCF utilization rates using a national sample. We conducted a descriptive retrospective study using the Nationwide Readmissions Database (NRD) to delineate the variability of hospitalization metrics across the hospital quartiles of IVCF utilization for VTE patients. The NRD included all-payer administrative inpatient records drawn from 22 states. Adult (≥ 18 years) patients with VTE hospitalizations with or without IVCF were identified from January 1, 2013 through December 31, 2014 and hospitals were divided into quartiles based on the IVCF utilization rate as a proportion of VTE patients. Primary outcome measures were observed rates of in-hospital mortality, 30-day all-cause readmissions and VTE-related readmissions, cost, and length of stay. Patient case-mix characteristics and hospital-level factors by hospital quartiles of IVCF utilization rates, were compared. Overall, 12.29% of VTE patients had IVCF placement, with IVCF utilization ranging from 0% to 46.84%. The highest quartile had fewer pulmonary embolism patients relative to deep vein thrombosis patients, and older patient ages were present in higher quartiles. The highest quartile of hospitals placing IVCFs were more often private, for-profit, and non-teaching. Patient and hospital characteristics and hospitalization metrics varied by IVCF utilization rates, but hospitalization outcomes for non-IVCF patients varied most between quartiles. Future work investigating the implications of IVCF utilization rates as a measure of quality of care for VTE patients is needed.

Lipoprotein lipase (LPL) is widely linked to lipid and lipoprotein metabolism, but its effects on coronary artery disease (CAD) are not clearly elucidated. The aim of the present study was to clarify the association between LPL gene polymorphisms and CAD susceptibility. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated to estimate the strength of the relationship between LPL gene polymorphisms and CAD risk. Comprehensive electronic databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library, were systematically searched. A total of 45 records containing 80 eligible studies were analyzed. The results indicated an increased risk between the LPL D9N polymorphism and susceptibility to CAD in the dominant genetic model (AA + GA vs. GG: OR = 1.46, 95% CI = 1.14–1.87), whereas the LPL HindIII polymorphism showed a protective effect against CAD under all tested models (GG + GT vs. TT: OR = 0.85, 95% CI = 0.75–0.97; GG vs. TT + TG: OR = 0.62, 95% CI = 0.47–0.83; G vs. T: OR = 0.81, 95% CI = 0.71–0.92). No significant association was identified for the LPL N291S and PvuII polymorphisms. Stratification analysis by ethnicity suggested a significant correlation between the LPL S447X polymorphism and CAD susceptibility in Caucasians under the dominant and allele genetic models. In summary, our meta-analysis indicated that the LPL D9N polymorphism was associated with an increased risk of CAD, whereas the S447X and HindIII polymorphisms showed protective effects. There was no association observed between the N291S and PvuII polymorphisms and CAD risk.

Background Retrieval of inferior vena cava filters (IVCFs) is important to decrease the long-term risk of complications associated with indwelling devices. Our hospital experienced low retrieval rates and implemented a low-cost intervention and evaluation for quality improvement. The working hypothesis was that a simple, mailed letter intervention could increase retrieval rates by increasing patient and primary care provider knowledge of the need for retrieval. Methods For all prospective patients who received a retrievable IVCF during the intervention period from January 1, 2014 to February 29, 2016, patients and their primary care providers were mailed letters encouraging contact with the clinic for evaluation of eligibility for retrieval. The main outcome was retrieval of the IVCF if clinically indicated with a secondary outcome of time-to-retrieval. A pre-intervention control group from October 1, 2011 to December 31, 2013 was used to evaluate the impact of the intervention. Competing risks, time-to-event analysis was used to compare the pre- and post-intervention period retrieval rates correcting for patients who died during follow-up. Results Between the pre- and post-intervention periods, crude retrieval rates increased from 4.4% to 8.1% with a 12-fold change at comparable time points. The time-to-retrieval in the pre-intervention period was a mean (SD) of 503 (207) days with a median (IQR) of 505 (301–742). In the post-intervention period, time-to-retrieval was a mean (SD) of 119 (83) days and with median (IQR) of 128 (38–164) days. Conclusions This low-cost intervention significantly increased retrieval rates in a single clinic. However, retrieval rates remain low and can be further improved. Ongoing interventions, including improved patient follow-up and physician education, are being implemented to further improve retrieval and use of inferior vena cava filters. Implanting clinics should implement quality improvement initiatives to improve patient care and follow-up with IVCFs to ensure retrievals occur once clinically relevant in order to minimize long-term complications.

NOP14, which is functionally conserved among eukaryotes, has been implicated in cancer development. Here, we show that NOP14 is poorly expressed in breast cancer cells and invasive breast cancer tissues. In vivo and in vitro studies indicated that NOP14 suppressed the tumorigenesis and metastasis of breast cancer cells. Further investigations revealed that NOP14 enhanced ERα expression and inhibited the Wnt/β-catenin pathway by up-regulating NRIP1 expression. Survival analysis indicated that low NOP14 expression was significantly associated with poor overall survival (P = 0.0006) and disease-free survival (P = 0.0007), suggesting that NOP14 is a potential prognostic factor in breast cancer. Taken together, our findings reveal that NOP14 may suppress breast cancer progression and provide new insights into the development of targeted therapeutic agents for breast cancer.

Objective: To systematically evaluate the precise role of the excision repair cross-complementing group 1 (ERCC1) polymorphism Asn118Asn (C19007T, rs11615) in curative effects and prognosis of patients with advanced colorectal cancer (CRC) receiving oxaliplatin-based chemotherapy. Methods: Qualified studies were retrieved from databases including PubMed, EMBASE, Wanfang and CNKI until January 31st, 2015. Literature published in English and Chinese were selected for metaanalysis on relationship between ERCC1 polymorphism Asn118Asn and therapeutic effects and prognosis of advanced CRC patients receiving oxaliplatin-based chemotherapy. Data extracted from these articles included study ID, title, author, publication year, ethnicity, country, numbers of cases and controls, progression-free survival (PFS) and overall survival (OS). Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were used to estimate objective response with hazard ratios (HRs) using Stata software (version 11.0). Results: A total of 13 articles were included in the study. Overall, meta-analysis showed no significant correlation between the ERCC1 C118T polymorphism and objective response (OR=0.78; 95% CI for 0.29-2.07), PFS (HR=1.70, 95% CI=0.92-3.14) or OS (HR=1.69, 95% CI=0.91-3.14) in advanced CRC patients with oxaliplatin-based chemotherapy. Stratified analysis among Asian and Caucasian populations showed that the ERCC1 C118T polymorphism was not significantly correlated with objective response (OR=2.03 vs. 0.40; 95% CI=0.62-6.68 vs. 0.12-1.30), but was significantly correlated with PFS and OS. Moreover, Asian patients carrying T/T or T/C genotypes of ERCC1 C118T had significant shorter PFS (HR=2.41, 95% CI=1.86-3.11) and OS (HR=2.36, 95% CI=1.76-3.16). Conclusion: In patients with advanced CRC undergoing oxaliplatin-based chemotherapy, there is no correlation between ERCC1 Asn118Asn (C/T) gene polymorphism and therapeutic effects. Asian patients with T allele has shorter PFS and OS.

Our aims were to evaluate the clinical performance of human telomerase RNA gene component (hTERC gene) amplification assay with high-risk human papillomavirus (HR-HPV) DNA test of Hybrid Capture 2 DNA test (HC2), for the detection of high grade cervical precancerous lesions and cancer (CIN 2+). In addition, the association shown between hTERC gene amplification and HPV DNA test positive in women with and without cervical neoplasia was assessed. There were 92 women who underwent cytology, HR-HPV DNA test, hTERC gene amplification test, colposcopy and biopsy. We compared the clinical performance of hTERC gene test along with HR-HPV DNA test of women with colposcopy and routine screening. The samples were histology- confirmed high-grade cervical intraepithelial neoplasia (CIN 2) or worse (CIN2+) as the positive criterion. The test of hTERC gene showed the hTERC gene amplification positivity increased with the severity of histological abnormality and cytological abnormality. The test of hTERC gene showed higher specificity than HR-HPV DNA test for high-grade lesions (84.4% versus 50%) and also higher positive predictive value (90.4% versus 76.5%). Our results predicted that hTERC gene amplification demonstrated more specific performance for predicting the risk of progression and offer a strong potential as a tool for triage in cervical cancer screening, with the limited sensitive as HR-HPV DNA test.

Due to the high variability in tumor morphology and the low signal-to-noise ratio inherent to mammography, manual classification of mammogram yields a significant number of patients being called back, and subsequent large number of biopsies performed to reduce the risk of missing cancer. The convolutional neural network (CNN) is a popular deep-learning construct used in image classification. This technique has achieved significant advancements in large-set image-classification challenges in recent years. In this study, we had obtained over 3000 high-quality original mammograms with approval from an institutional review board at the University of Kentucky. Different classifiers based on CNNs were built, and each classifier was evaluated based on its performance relative to truth values generated by histology results from biopsy and two-year negative mammogram follow-up confirmed by expert radiologists. Our results showed that CNN model we had built and optimized via data augmentation and transfer learning have a great potential for automatic breast cancer detection using mammograms.

Background Retrieval of vena cava filters ( VCF s) is important for safety as complications increase with longer dwell times. This study assessed VCF retrieval rates and factors associated with retrieval in a national cohort. Methods and Results VCF s were identified by procedural codes from an administrative claims database. Patients were identified who had a VCF placement during a hospitalization from a national commercial administrative claims database. Indications for VCF placement were identified as pulmonary embolism with or without deep vein thrombosis, deep vein thrombosis only, or prophylactic. Patient demographic and clinical characteristics were included in proportional hazard regression models to find associations with early (90‐day) and 1‐year VCF retrieval. Initiation of anticoagulation and the correlation between time‐to‐retrieval and time‐to‐initiation of anticoagulation were observed. Of 54 766 patients receiving a VCF , 36.9% had pulmonary embolism, 43.9% had deep vein thrombosis only, and 19.2% had no apparent venous thromboembolism present. Over the 1 year of follow‐up, the cumulative incidence of VCF retrieval was 18.4%. Retrieval increased over time from a low of 14.0% in 2010 up to ≈24% in 2014. In adjusted time‐to‐event models, increasing age, differing regions, and some comorbidities were associated with poorer retrieval rates. Initiation of anticoagulation was poorly correlated with retrieval, with anticoagulation preceding retrieval by a median of 51 days while those without retrieval had a median of 278 days of exposure to anticoagulation. Conclusions VCF retrieval increased over the study period but remained suboptimal and was weakly correlated with anticoagulation initiation.

Background Inferior vena cava filters (IVCFs) are indicated for therapeutic and prophylactic treatment of venous thromboembolism in patients when anticoagulation has failed or is contraindicated. Retrievable IVCFs are not always retrieved despite clinical recommendations. The purpose of this review is to compare results in the literature regarding interventions and to improve IVCF retrieval rates. Methods Articles were identified via the search terms “vena cava filters” and “inferior vena cava filters” in conjunction with “retrieval.” Searches were repeated in MEDLINE/PubMed, Google Scholar, and Cochrane database. Exclusion criteria included duplicates, misidentified subject matter, study period before 2008, and lack of control group. Two independent reviewers screened key elements in the identified manuscripts, including the targeted intervention population, study design, IVCF retrieval rates, and other outcomes. A third reviewer corroborated results and consolidated findings. Results Seventeen articles were identified for review. Of these, 12 were physician-targeted interventions, and 8 were patient-targeted interventions (3 studies included both). IVCF retrieval rates varied substantially for each study, but all reviewed studies reported improvement in retrieval rate following intervention. Only 5 studies reported decreased IVCF indwell times in intervention groups. Reported complication rates from IVCF retrievals were low, ranging from 0 to 2%. Conclusions IVCF retrieval rates were improved by all interventions in the reviewed studies. Findings suggest that IVCF retrieval rates can be best improved by tracking patients typically lost to follow-up. Literature suggests that successful tracking requires an individual or team of individuals who have been assigned dedicated clinical responsibility for coordinating care following IVCF placement.

With the development of smart grid, the application of distributed energy systems has been increased largely in china. Biomass power generations, solar power generations and wind power generations with small capacity can be used as to be distributed energy systems. This paper puts forward the definition of distributed energy systems, and gives the limited capacity variable range of it. Secondly, the main obstacle for the development of distributed energy systems has been analyzed including technical Factors, policy factors and mechanisms, market factors and so on. Finally, it analyses the implementation strategy of distributed energy systems in China, such as the influential factors analysis, efficiency research and the rational usage of distributed energy systems. These analyses can improve the application and deep research of distributed energy systems in China.

Nowadays, energy consumption has been to be one of the biggest problems in China. It is very important to increase proportion of electric power among the end-use energy market for optimization of end-use energy consumption structure. Research on the status of electrical energy in energy consumption for China is a critical method to improve its development. In this paper, it analyses the electrical energy status in the industry energy consumption from 1995 to 2010. Secondly, status of electrical energy in the final energy consumption has been researched deeply. Finally, it analyses the role of electrical energy in energy consumption according to the curve of data from 1995 to 2010, gives some suggestions for optimization of the energy consumption structure so that save energy.

Battery capacity evaluation is a key work in wind\battery hybrid generation system optimization. Here a research about battery capacity evaluation of wind\battery hybrid generation system is made and a new way to evaluate the capacity is given. First, common evaluation methods such as integration peak value method are introduced. Then energy conversion constraints analysis in wind\battery hybrid generation process is given. Fake charge problem existed in integration peak value method is described comprehensively. At last, a new method to evaluate the battery capacity is put out.

Purpose: Postprocedure epidural analgesia has a proven benefit over intravenous (i.v.) analgesia for pain management, but has not yet been demonstrated for uterine fibroid embolization (UFE). The objectives of this clinical audit were to determine if epidural patient-controlled analgesia (PCA) was beneficial to patient outcome as compared to i.v. PCA in decreasing parenteral opioid requirements and its associated side effects and determine if there is a difference in required oral opioids after the PCA is stopped. Materials and Methods: This manuscript audited postprocedural pain management of 51 patients after UFE was performed. 20 patients received an i.v. PCA for post-UFE pain control and 31 received an epidural PCA for post-UFE pain control. Total hydromorphone dose, the frequency of anti-nausea medication use, the frequency of anti-pruritus medication use, and patient pain satisfaction data was collected. Results: Total hydromorphone dose administered to patients post-UFE using epidural PCA was significantly less than patients using an i.v. PCA (P = 0.001). However, the frequency of nausea and pruritus between the two groups did not achieve statistical significance with (P = 0.663) and (P = 0.639) respectively. Conclusion: Our clinical audit found that parenteral opioid requirements administered after UFE can be significantly reduced by using epidural PCA instead of i.v. PCA. However, we found no statistically significant difference in medication related side effects or oral opioid use thereafter.

To examine the association between patient and hospital characteristics and inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE).The 2013 to 2014 Nationwide Readmissions Database was used to define a cohort of patients with VTE aged ≥18 after a primary V

Background and purpose High-energy injury to children caused by a traffic accident is usually characterised by extensive soft tissue defects with exposure or loss of tendons and bone at the foot. Segmental loss of the Achilles tendon along with soft tissue defects is a great challenge for microsurgical reconstruction. Free anterolateral thigh (ALT) flap is indicated for reconstruction of such defects because limited local tissues are available. Additionally, iliotibial band in the donor area can be used to reconstruct the damaged tendon. Materials and methods Here we described our successful management of 25 paediatric patients with such high-energy injury at feet and ankles in one-stage transplantation of a free ALT flap and an iliotibial band from January 2008 to January 2013. The tendon defect, ranging from 3 to 16 cm in length, was reconstructed with an iliotibial band. The flaps ranged from 5 to 12 cm in width and 8 to 18 cm in length. Results All the flaps survived completely and no donor site complications were observed. In two flaps there was a small area of distal necrosis which was healed by dressing changes. The mean follow-up time was 14.2 months (from 6 to 24 months). Limb function was assessed using the Maryland Foot Score. The excellent and good rate was 92%. Conclusions We believe a free ALT flap is ideal for reconstruction of massive soft tissue defects at the foot and ankle in children and an iliotibial band from the same donor site can be used for reconstruction of a damaged tendon.

Background Heat shock protein 70, a stress protein, has been implicated in tumor progression. However, its role in nasopharyngeal carcinoma (NPC) progression has not yet been clearly investigated. Methods Immunohistochemistry (IHC) was employed to examine the expression patterns of Hsp70, human leukocyte antigen –A (HLA-A) in NPC tissue samples. Results The expression of Hsp70 exhibited different spatial patterns among nuclear, membrane and cytoplasm in 507 NPC tumor tissues. Kaplan-Meier survival analysis demonstrated that different Hsp70 expression patterns are correlated with different patient outcomes. High membranal and cytoplasmic levels of Hsp70 predicted good survival of patients. In contrast, high nuclear abundance of Hsp70 correlated with poor survival. Moreover, the membranal and cytoplasmic levels of Hsp70 were positively correlated with levels of the MHC I molecule HLA-A. Conclusions Different Hsp70 expression patterns had distinct predictive values. The different spatial abundance of Hsp70 may imply its important role in NPC development and provide insight for the development of novel therapeutic strategies involving immunotherapy for NPC.

In deformable model segmentation, the geometric training process plays a crucial role in providing shape statistical priors and appearance statistics that are used as likelihoods. Also, the geometric training process plays a crucial role in providing shape probability distributions in methods finding significant differences between classes. The quality of the training seriously affects the final results of segmentation or of significant difference finding between classes. However, the lack of shape priors in the training stage itself makes it difficult to enforce shape legality, i.e., making the model free of local self-intersection or creases. Shape legality not only yields proper shape statistics but also increases the consistency of parameterization of the object volume and thus proper appearance statistics. In this paper we propose a method incorporating explicit legality constraints in training process. The method is mathematically sound and has proved in practice to lead to shape probability distributions over only proper objects and most importantly to better segmentation results.

We use multifigure m-reps to represent anatomical objects, such as human livers, with named components. Each component is represented as a single figure m-rep. These figures of the object are connected via hinge geometry. A smooth object surface is then computed using our technique based on the subdivision method applied to a single figure m-rep. This novel representation allows us to represent and analyze a complex anatomical object by its individual components, by relations among its components, and by the object itself as a whole entity. Using our representation, some preliminary results on statistical analysis of multifigure anatomical objects are presented.

Purpose: Extracting information from images for image‐guided and adaptive radiation therapy usually involves segmentation and/or registration with a reference image. The purpose of this research was to develop and make freely available a software toolkit for research use that combines several registration and segmentation methods and is applicable to problems involving multiple sequential images.Method and Materials: Two automatic approaches have been integrated with standard interactive methods. One automatic approach solves PDEs describing visco‐elastic flow to register a set of target images with a reference image. Segmentations can then be transferred from the reference image to target images via corresponding deformation fields. The second method segments images via Bayesian posterior optimization of a 3D deformable shape model called an m‐rep. User efficiency has been improved by the ability to queue, view, work with, and compare multiple images and segmentations during a single session. The software was developed in C++ and runs on Windows and Linux. Results: The GUI, including a window with panes for standard orthogonal 2D views linked to a second 3D window, preserves a common look and feel for all three approaches. A set of treatment images of the same patient initially are rigidly registered to a reference image. The images are then segmented by the methods of choice. Unsatisfactory automatic results are edited with conventional methods. Registered images and segmentations are output in DICOM RT format. Conclusion: The toolkit combines multiple approaches for image registration and segmentation in a system specifically designed to support research on IGRT and ART. A cost‐free license to download and use the software is available at http://planunc.radonc.unc.edu. Research supported by NCI/NCRR R01 RR 01861501.