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Recovering the three-dimensional structure information from a monocular camera is significant for automated driving, robot navigation, and traffic safety assessment. Recent work has solved various tight issues on self-supervised monocular depth estimation of leveraging on-board videos, such as occlusion/disocclusion, dynamic objects, and scale inconsistent. Nevertheless, rare work focuses on the model's prediction confidence and underlying relations between depths, while they are essential for a decision-making system and performance improvement, respectively. This paper proposes a novel scheme, that of correlation-aware structure, to dig into the relations between depths, converting the independent depths into a graph-like connected depth map. Subsequently, a Gaussian estimator is devised to predict the depth map and uncertainty map concurrently. The uncertainty map can show us problematic regions where it is difficult to predict, from which we further develop uncertainty-based strategies to improve the performance. Specifically, we propose a simple image preprocessing method to overcome the gradient locality issue caused by low-texture, especially in smooth roads and shadows. Also, to avoid the influence of high-uncertainty regions, we propose a solidity-aware mask to recognize the reliable pixels for training in the image. The experiments on the KITTI dataset show that our method results in a competitive performance in both depth and ego-motion estimation tasks compared with the state-of-the-art methods. Besides, additional experiments on the Make3D and Cityscapes datasets demonstrate our method's strong generalization capability and practicality.

Global Positioning System (GPS) trajectory data can be used to infer transportation modes at certain times and locations. Such data have important applications in many transportation research fields, for instance, to detect the movement mode of travelers, calculate traffic flow in an area, and predict the traffic flow at a certain time in the future. In this paper, we propose a novel method to infer transportation modes from GPS trajectory data and Geographic Information System (GIS) information. This method is based on feature extraction and machine learning classification algorithms. While using GIS information to improve inference accuracy, we ensure that the algorithm is simple and easy to use on mobile devices. Applied to GeoLife GPS trajectory dataset, our method achieves 91.1% accuracy while inferring transportation modes, such as walking, bike, bus, car, and subway, with random forest classification algorithm. GIS features in our method improved the overall accuracy by 2.5% while raising the recall of the bus and subway transportation mode categories by 3.4% and 18.5%. We believe that many algorithms used in detecting the transportation modes from GPS trajectory data that do not utilize GIS information can improve their inference accuracy by using our GIS features, with a slight increase in the consumption of data storage and computing resources.

OBJECTIVES: To determine if the mutational landscapes and genomic features of homologous recombination DNA repair defects (HRD) vary between younger and older patients with high-grade serous ovarian cancer (HGSOC). METHODS: Younger and older women were defined as bottom and top age quartiles, respectively. HGSOCs from 15 younger (median 49 years, range 35-53) and 15 older women (median 72 years, range 70-87) were subjected to whole-exome sequencing (WES). For validation, HGSOC WES data were obtained from The Cancer Genome Atlas (TCGA), including 38 younger (median 45 years, range 34-50) and 30 older women (median 74 years, range 68-84). Mutational profiles, BRCA1/2 status, genomic HRD features, and for TCGA cases RNA-sequencing-based HRD transcriptomic signatures were assessed. RESULTS: In the institutional cohort, pathogenic germline BRCA1/2 mutations were more frequent in younger (5/15) than older women (0/15, p=0.042). No somatic BRCA1/2 mutations were identified. HGSOCs from older patients preferentially displayed aging-related mutational signatures and, in contrast to younger patients, harbored CCNE1 amplifications (3/15, 20%). In the TCGA cohort, pathogenic germline BRCA1 (younger 8/38, older 0/30, p=0.007) but not BRCA2 mutations (young 3/38, older 4/30, p=0.691) were more frequent in younger patients. Again, no somatic BRCA1/2 mutations were identified. HGSOCs from younger women more frequently displayed genomic features of HRD (all, p

Background:. Obesity is a fundamental factor in metabolic disorders such as hyperlipidemia, insulin resistance, fatty liver, and atherosclerosis. However, effective preventive measures are still lacking. This study aimed to investigate different surgical protocols for removing partial adipose tissue before the onset of obesity and determine whether, and by which protocol, preliminary adipose removal could exert potent preventive effects against diet-induced metabolic disorders. Methods:. Male low-density lipoprotein receptor (LDL-R) knockout (KO) mice were randomly divided into four groups and subjected to epididymal fat removal (Epi-FR) surgery, subcutaneous fat removal (suQ-FR) surgery, both subcutaneous and epididymal fat removal (Epi + suQ-FR) surgery, or sham-operation. After 1 week of recovery, all mice were given a high-fat diet (HFD) for 10 weeks to induce metabolic disorders. Results:. In the Epi-FR group and the sham-operated group, the mean numbers of the residual subcutaneous fat were 28.59 mg/g and 18.56 mg/g, respectively. The expression of relative genes such as Pparg, Cebpa, Dgat2, Fabp4 and Cd36 in the residual subcutaneous fat increased 2.62, 3.90, 3.11, 2.06, 1.78 times in the Epi-FR group compared with that in the sham-operated group. Whereas in the other fat-removal groups, the residual fat depots had no significant change in either size or gene expression, as compared with those of the sham-operated group. Plasma lipid and glucose levels and insulin sensitivity, as detected by the glucose tolerance test, were not significantly alleviated in the three fat removal groups. Liver mass or lipid content was not attenuated in any of the three fat removal groups. The atherosclerosis burdens in the entire inner aorta and aortic root did not decrease in any of the three fat removal groups. Conclusions:. Our data suggest that removal of epididymal adipose or subcutaneous adipose alone or in combination before the onset of obesity did not protect against hyperlipidemia, insulin resistance, fatty liver, or atherosclerosis in LDL-R KO mice fed with a HFD. Hence, adipose removal possibly does not represent a potential approach in preventing obesity-related metabolic disorders in the obesity-susceptible population.

Background Patients with human papillomavirus–related oropharyngeal cancers have excellent outcomes but experience clinically significant toxicities when treated with standard chemoradiotherapy (70 Gy). We hypothesized that functional imaging could identify patients who could be safely deescalated to 30 Gy of radiotherapy. Methods In 19 patients, pre- and intratreatment dynamic fluorine-18-labeled fluoromisonidazole positron emission tomography (PET) was used to assess tumor hypoxia. Patients without hypoxia at baseline or intratreatment received 30 Gy; patients with persistent hypoxia received 70 Gy. Neck dissection was performed at 4 months in deescalated patients to assess pathologic response. Magnetic resonance imaging (weekly), circulating plasma cell-free DNA, RNA-sequencing, and whole-genome sequencing (WGS) were performed to identify potential molecular determinants of response. Samples from an independent prospective study were obtained to reproduce molecular findings. All statistical tests were 2-sided. Results Fifteen of 19 patients had no hypoxia on baseline PET or resolution on intratreatment PET and were deescalated to 30 Gy. Of these 15 patients, 11 had a pathologic complete response. Two-year locoregional control and overall survival were 94.4% (95% confidence interval = 84.4% to 100%) and 94.7% (95% confidence interval = 85.2% to 100%), respectively. No acute grade 3 radiation–related toxicities were observed. Microenvironmental features on serial imaging correlated better with pathologic response than tumor burden metrics or circulating plasma cell-free DNA. A WGS-based DNA repair defect was associated with response (P = .02) and was reproduced in an independent cohort (P = .03). Conclusions Deescalation of radiotherapy to 30 Gy on the basis of intratreatment hypoxia imaging was feasible, safe, and associated with minimal toxicity. A DNA repair defect identified by WGS was predictive of response. Intratherapy personalization of chemoradiotherapy may facilitate marked deescalation of radiotherapy.

Depth information from still 2D images plays an important role in automated driving, driving safety, and robotics. Monocular depth estimation is considered as an ill-posed and inherently ambiguous problem in general, and a tight issue is how to obtain global information efficiently since pure convolutional neural networks (CNNs) merely extract the local information. To end that, some previous works utilized conditional random fields (CRFs) to obtain the global information, but it is notoriously difficult to optimize. In this paper, a novel hybrid neural network is proposed to solve that, and concurrently a dense depth map is predicted from the monocular still image. Specifically: first, the deep residual network is utilized to obtain multi-scale local information and then feature correlation (FCL) blocks are used to correlate these features. Finally, the feature selection attention-based mechanism is adopted to fuse the multi-layer features, and the multi-layer recurrent neural networks (RNNs) are utilized with bidirectional long short-term memory (Bi-LSTM) unit as the output layer. Furthermore, a novel logarithm exponential average error (LEAE) is proposed to overcome over-weighted problem. The multi-scale feature correlation network (MFCN) is evaluated on large-scale KITTI benchmarks (LKT), which is a subset of KITTI raw dataset, and NYU depth v2. The experiments indicate that the proposed unified network outperforms existing methods. This method also updates the state-of-the-art performance on LKT datasets. Importantly, the depth estimation method can be widely used for collision risk assessment and avoidance in driving assistance systems or automated pilot systems to achieve safety in a more economical and convenient way.

Purpose: Genomic methods can identify homologous recombination deficiency (HRD). Rigorous evaluation of their outcome association to DNA damage response–targeted therapies like platinum in pancreatic ductal adenocarcinoma (PDAC) is essential in maximizing therapeutic outcome. Experimental Design: We evaluated progression-free survival (PFS) and overall survival (OS) of patients with advanced-stage PDAC, who had both germline- and somatic-targeted gene sequencing. Homologous recombination gene mutations (HRm) were evaluated: BRCA1, BRCA2, PALB2, ATM, BAP1, BARD1, BLM, BRIP1, CHEK2, FAM175A, FANCA, FANCC, NBN, RAD50, RAD51, RAD51C, and RTEL1 HRm status was grouped as: (i) germline versus somatic; (ii) core (BRCAs and PALB2) versus non-core (other HRm); and (iii) monoallelic versus biallelic. Genomic instability was compared using large-scale state transition, signature 3, and tumor mutation burden. Results: Among 262 patients, 50 (19%) had HRD (15% germline and 4% somatic). Both groups were analyzed together due to lack of difference in their genomic instability and outcome. Median [95% confidence interval (CI)] follow-up was 21.9 (1.4–57.0) months. Median OS and PFS were 15.5 (14.6–19) and 7 (6.1–8.1) months, respectively. Patients with HRD had improved PFS compared with no HRD when treated with first-line (1L) platinum [HR, 0.44 (95% CI: 0.29–0.67); P < 0.01], but not with 1L-non-platinum. Multivariate analysis showed HRD patients had improved OS regardless of their first-line treatment, but most had platinum exposure during their course. Biallelic HRm (11%) and core HRm (12%) had higher genomic instability, which translated to improved PFS on first-line platinum (1L-platinum) versus 1L-non-platinum. Conclusions: Pathogenic HRm identifies HRD in patients with PDAC with the best outcome when treated with 1L-platinum. Biallelic HRm and core HRm further enriched benefit from 1L-platinum from HRD.

Over the past two decades, increasing attention has been drawn to gender impacts arising from adoption and usage of information and communication technologies (ICTs), the mobile phone especially, by marginalized women in the Global South. Grounded in the theory of structuration, our study challenges techno-determinism and structural functionalism embodied in a prevailing gender (dis)empowerment dichotomy, and instead reveals the contextually situated and dynamically negotiated techno-socio relationships. It allows for examination of the mobile phone in the interactions between agency of women to get empowered and their situated gendered social power structures. While the phone reinforces structural constraints via facilitating access, surveillance, and intervention from those of higher patriarchal statuses, it simultaneously enables women’s strategic responses involving avoidance, accommodation, and collaboration. The constraining yet empowering processes conceptually make the functioning of the mobile phone as socially catalyzing the development of self-consciousness by women, and furthermore, the clustering of awakening individuals toward emergent female collective power.

Regarding China’s traditional manufacturing industry there is a large gap compared with developed countries in terms of green manufacturing development. As environmental problems become more serious, resources and environmental constraints prevent its further development. China has now incorporated green manufacturing into an urgent future development strategy, and the green manufacturing system has been gradually integrated into its industrial development strategy. This paper analyses the gap between China’s traditional manufacturing and the rest of the world’s industry-leading level. It discusses the structure of China green manufacturing development and operation model in progress. It further expounds the complementarity between China and Germany in green manufacturing while emphasizing the Sino-German cooperation methods and approaches.

Background The association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) and childhood acute lymphoblastic leukemia (ALL) is inconsistent. Objective To explore the relationship between MTHFR-C677T polymorphism and susceptibility to childhood ALL. Methods PubMed, EMBASE, Web of Science, CNKI, Wanfang, VIP, and other databases were searched from the establishment of the database to November 2019, and all the case-control studies that met the inclusion criteria were collected. Stata 15.0 was used for meta-analysis, with calculation of the odds ratio (OR) of the relationship between MTHFR-C677T polymorphism and childhood ALL susceptibility. Ethnicity was analyzed by subgroup analysis. Results A total of 26 studies were included in this meta-analysis, including 4,682 children with ALL and 7144 controls. The results showed that there was no significant difference in the comparison of population of allele model, dominant gene model, recessive gene model, homozygous gene model, heterozygous gene model, and the comparison of Caucasian children. The results of the Asian child analysis suggested that the combined OR of the dominant gene model (CC + CT versus TT), homozygous model (CC versus TT) and heterozygous model (CT versus TT) was 1.32 (95% confidence interval [CI]: 1.03-1.70), 1.37 (95% CI: 1.02-1.84), and 1.27 (95% CI: 1.01-1.59), respectively, with statistically significant differences. However, there was no significant difference between the allele model and recessive gene model among Asian children. Conclusion The MTHFR C677T polymorphism is related to ALL in children, especially in Asian children. CC + CT, CC, and CT genotypes can increase the risk of ALL, but no association has been found in Caucasian children.

Background Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363

Background: To develop a radiomics nomogram that incorporates the radiomics features and ultrasound (US) conventional features and clinical findings to differentiate triple-negative breast cancer (TNBC) from fibroadenoma.Methods: A total of 182 pathology-proven fibroadenomas and 178 pathology-proven TNBCs which underwent preoperative US examination were involved and randomly divided into training (n = 253) and validation cohorts (n = 107). The regions of interest (ROIs) of all lesions were delineated based on preoperative US examination subsequently radiomics features extracted. The least absolute shrinkage and selection operator model and the maximum relevance minimum redundancy algorithm were established for the selection of tumor status-related features and construction of radiomics signature (Rad-score). Then, multivariate logistic regression analyses were utilized to develop a radiomics model by incorporating the radiomics signature and clinical findings. Finally, the usefulness of the combined nomogram was assessed by the receiver operator characteristic curve (ROC), calibration curve, and decision curve analysis (DCA).Results: The radiomics signature, composing of twelve selected features, achieved good diagnostic performance. The nomogram incorporated with radiomics signature and clinical data showed favorable diagnostic efficacy in the training cohort (AUC 0.986, 95% CI, 0.975-0.997) and validation cohort (AUC 0.977, 95% CI, 0.953-1.000). The radiomics nomogram outperformed the Rad-score and clinical models alone (p < 0.05). The calibration curve and decision curve analysis demonstrated the better clinical utility of the combined radiomics nomogram.Conclusions: The radiomics signature is a potential predictive indicator for differentiating TNBC and fibroadenoma. The radiomics nomogram associated with Rad-score, US conventional features, and clinical data outperformed the Rad-score and clinical models alone.Advances in knowledge: Recent advances in radiomics-based US identified increasingly gaining ground in oncology to improve diagnosis, assessment of therapeutic response, and disease prediction. We revealed that the Rad-score is an independent predictive indicator for differentiating TNBC and fibroadenoma. The radiomics nomogram associated with Rad-score, US conventional features, and clinical data outperformed the Rad-score and clinical models alone.

Background: Neutrophil percentage to albumin ratio (NPAR) was proved to be correlated with the prognosis of a variety of diseases. The purpose of this study was to explore the effect of NPAR on the prognosis of coronary care unit (CCU) dpatients.Method: All data of this study was extracted from Medical Information Mart for Intensive Care III (MIMIC-III, version1.4) database. All patients were divided into four groups according to NPAR quartiles. Primary outcome was in-hospital mortality and secondary outcomes were 30-day mortality, 365-day mortality, length of CCU stay, length of hospital stay, acute kidney injury, renal replacement therapy. Multivariable binary logistic regression analysis was performed to confirm the independent effect of NPAR. Subgroup analysis was used to determine the effect of NPAR on in-hospital mortality in different subgroups. Receiver-operating characteristic (ROC) curves were applied to evaluate the ability of NPAR to predict in-hospital mortality. Kaplan–Meier curves were built to compare cumulative survival of different groups.Result: 2364 CCU patients were enrolled in this study. In-hospital mortality rate increased significantly as NPAR quartiles increased (P < 0.001). In multivariable logistic regression, NPAR was proved to be independently associated with in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.80, 1.19-2.72, P=0.005, P for trend = 0.001). Moderate ability of NPAR to predict in-hospital mortality was demonstrated through ROC curves, the AUC of NPAR was 0.653 (PConclusion: NPAR was an independent risk factor of in-hospital mortality in CCU patients and had a moderate ability to predict in-hospital mortality.

BackgroundTo investigate the disease burden of urinary tract infections (UTI), urolithiasis, and benign prostatic hyperplasia (BPH) in 204 countries and territories from 1990 to 2019.MethodsData were extracted from the Global Burden of Disease 2019, including incident cases, deaths, disability-adjusted life-years (DALYs) and corresponding age-standardized rate (ASR) from 1990 to 2019. Estimated annual percentage changes (EAPC) were calculated to evaluate the trends of ASR. The associations between disease burden and social development degrees were analyzed by socio-demographic index (SDI).ResultsCompared with 1990, the incident cases of UTI, urolithiasis, and BPH increased by 60.40%, 48.57%, and 105.70% in 2019, respectively. The age-standardized incidence rate (ASIR) of UTI increased (EAPC = 0.08), while urolithiasis (EAPC = -0.83) and BPH (EAPC = -0.03) decreased from 1990 to 2019. In 2019, the age-standardized mortality rate (ASMR) of UTI and urolithiasis was 3.13/100,000 and 0.17/100,000, respectively. BPH had the largest increase (110.56%) in DALYs in past three decades, followed by UTI (68.89%) and urolithiasis (16.95%). The burden of UTI mainly concentrated in South Asia and Tropical Latin America while the burden of urolithiasis and BPH was recorded in Asia and Eastern Europe. Moreover, the ASIR and SDI of urolithiasis in high SDI regions from 1990 to 2019 were negatively correlated, while the opposite trend was in low SDI regions. In 2019, the ASIR of UTI in female was 3.59 times that of male, while the ASIR of urolithiasis in male was 1.96 times higher than female. The incidence was highest in 30-34, 55-59, and 65-69 age group among UTI, urolithiasis, and BPH, respectively. ConclusionsOver the past three decades, the disease burden remains increased in UTI, while decreased in urolithiasis and BPH. The allocation of medical resources should be more based on the epidemiological characteristics and geographical distribution of diseases.

Objective Assess whether treatment with probiotics improve gastrointestinal symptoms in patients with systemic sclerosis (SSc). Methods In this double-blind randomized placebo-controlled parallel-group phase II trial, SSc subjects with total score ≥ 0.1 on a validated SSc-specific gastrointestinal tract (GIT) questionnaire were randomized (1:1) to receive 60 days of high dose multi-strain probiotics (Vivomixx® 1800 billion units/day) or identical placebo, followed by an additional 60 days of probiotics in both groups. Between group differences in GIT score change were assessed after 60 days (primary outcome, time-point T1) and 120 days (secondary outcome, time-point, T2) by an intention-to-treat approach. Stool samples at three time-points were subjected to 16S next generation sequencing. Results Forty subjects were randomized to placebo-probiotics (n = 21) or probiotics-probiotics (n = 19). At T1, no significant improvement was observed between the two groups, reported as mean ± SE for total GIT score (placebo 0.14 ± 0.06 versus probiotics 0.13 ± 0.07; p = 0.85) or its subdomains. At T2, whilst there was no significant improvement in total GIT score (placebo-probiotics –0.05±0.06; probiotics-probiotics –0.18 ± 0.07; p = 0.14), there was significant improvement of GIT-reflux in the probiotic group (–0.22 ± 0.05 versus placebo-probiotics 0.05 ± 0.07; p = 0.004). Subjects on probiotics exhibited increasing stool microbiota alpha diversity compared to the placebo-probiotics group. Adverse events (AEs) were mild, with similar proportion of subjects with AEs and serious AEs in both groups. Conclusion Whilst there was no clear improvement in overall GI symptoms after 60 days, we observed significantly improved GI reflux after 120 days of probiotics. The trial confirmed safety of multi-strain probiotics in SSc patients. Trial registration. Clinicaltrials.gov; NCT01804959

Surgical approach (SA) is the standard treatment for infected necrotizing pancreatitis (INP) and endoscopic transgastric approach (ETA) is a promising alternative treatment. This systematic review and meta-analysis aimed to compare the effectiveness and safety of ETA versus SA in INP. Several databases were systematically searched for eligible studies that compared ETA with SA for INP. Predefined criteria were used for study selection. Three reviewers independently assessed the risk of bias. Primary outcomes included clinical resolution rate, short-term mortality, major complications, and hospital stay. Study-specific effect sizes and their 95% confidence interval (CI) were combined to calculate the pooled value using fixed-effects or random-effects model. Six studies were included with 295 patients. Major complication rate [odds ratio (OR), 0.13; 95% CI, 0.06-0.29], new-onset organ failure rate (OR, 0.26; 95% CI, 0.12-0.54), postoperative pancreatic fistula rate (OR, 0.09; 95% CI, 0.03-0.28), and incisional hernia rate (OR, 0.10; 95% CI, 0.01-0.85) were lower in the ETA group. There was a shorter hospital stay (mean difference, -17.72; 95% CI, -21.30 to -14.13) in the ETA group. No differences were found in clinical resolution, short-term mortality, postoperative bleeding, perforation of visceral organ, and endocrine or exocrine insufficiency. Compared with SA, ETA showed comparable effectiveness and safety for the treatment of INP based on current evidence.

Background and Aim Perturbance in the composition of human gut microbiota has been associated with metabolic disorders such as obesity, diabetes mellitus, and insulin resistance. The objectives of this study are to examine the effects of ethnicity, central obesity, and recorded dietary components on potentially influencing the human gut microbiome. We hypothesize that these factors have an influence on the composition of the gut microbiome. Methods Subjects of Chinese (n = 14), Malay (n = 10), and Indian (n = 11) ancestry, with a median age of 39 years (range: 22–70 years old), provided stool samples for gut microbiome profiling using 16S rRNA sequencing and completed a dietary questionnaire. The serum samples were assayed for a panel of biomarkers (interleukin‐6, tumor necrosis factor alpha, adiponectin, cleaved cytokeratin 18, lipopolysaccharide‐binding protein, and limulus amebocyte lysate). Central obesity was defined by waist circumference cut‐off values for Asians. Results There were no significant differences in Shannon alpha diversity for ethnicity and central obesity and no associations between levels of inflammatory cytokines and obesity. The relative abundances of Anaerofilum (P = 0.02), Gemellaceae (P = 0.02), Streptococcaceae (P = 0.03), and Rikenellaceae (P = 0.04) were significantly lower in the obese group. From principle coordinate analysis, the effects of the intake of fiber and fat/saturated fat were in contrast with each other, with clustering of obese individuals leaning toward fiber. Conclusion The study demonstrated that there were differences in the gut microbiome in obese individuals. Certain bacterial taxa were present in lower abundance in the group with central obesity. Fiber and fat/saturated fat diets were not the key determinants of central obesity., The objectives of this study are to examine the effects of ethnicity, central obesity, and dietary components on the human gut microbiome. Asian subjects (n = 35) provided stool samples for gut microbiome profiling using 16S rRNA sequencing and completed a dietary questionnaire. The relative abundances of Anaerofilum (P = 0.02), Gemellaceae (P = 0.02), Streptococcaceae (P = 0.03), and Rikenellaceae (P = 0.04) were significantly lower in the obese group.

Objective Cardiac paragangliomas are rare neuroendocrine tumors. Early surgical treatment improves clinical symptoms and prolongs survival. We review our experience in 17 patients who underwent surgical resection for functional cardiac paraganglioma. Methods Seventeen patients underwent surgery for functional cardiac paraganglioma from 2004 to 2017 were identified. Clinical data and long-term outcomes were extracted and analyzed. Results All 17 patients with cardiac paraganglioma (11 males) with a median age of 35 years (range, 11 to 51 years) were hormonally functional and underwent operations. A 24-hour urine catecholamine assay documented elevation of norepinephrine, epinephrine, and dopamine. Tumors were determined with octreotide scintiscan in all 17 patients and metaiodoben-zylguanidine scintigraphy in 10 of 15 patients. Tumor sites were right atrioventricular groove in 4 patients, between the main arteries in 10 patients, and interatrial groove in 4 patients. All patients underwent complete resection. Concomitant surgeries were: structural reconstruction in 16 patients (94%) and coronary artery bypass graft in 8 patients (47%). One patient had a history of incomplete resection of an intra-atrial tumor. One patient died postoperatively. Operative mortality is 5.8%. During follow-up (mean, 6.5 years; range, 1.5 to 14.2 years), 16 patients are alive in functional class I or II. Two patients developed tumor recurrence and 14 remained symptom-free with normal urinary catecholamines. Conclusions With a multidisciplinary treatment, early diagnosis, complete resection for the tumor along with complex reconstruction is achievable for most patients, and it offers promising long-term survival.

OBJECTIVE: Mutational signatures provide insights into the biological processes shaping tumor genomes and may inform patient therapy. We sought to define the mutational signatures of i) endometrioid and serous endometrial carcinomas (ECs), stratified into the four molecular subtypes, ii) uterine carcinosarcomas, and iii) matched primary and metastatic ECs. METHODS: Whole-exome sequencing MC3 data from primary endometrioid and serous carcinomas (n=232) and uterine carcinosarcomas (n=57) from The Cancer Genome Atlas (TCGA), and matched primary and metastatic ECs (n=61, 26 patients) were reanalyzed, subjected to mutational signature analysis using deconstructSigs, and correlated with clinicopathologic and genomic data. RESULTS: POLE (ultramutated) and MSI (hypermutated) molecular subtypes displayed dominant mutational signatures associated with POLE mutations (15/17 cases) and microsatellite instability (55/65 cases), respectively. Most endometrioid and serous carcinomas of copy-number low (endometrioid) and copy-number high (serous-like) molecular subtypes, and carcinosarcomas displayed a dominant aging-associated signature 1. Only 15% (9/60) of copy-number high (serous-like) ECs had a dominant signature 3 (homologous recombination DNA repair deficiency (HRD)-related), a prevalence significantly lower than that found in high-grade serous ovarian carcinomas (54%, p

Numerous studies have demonstrated that exposure to live poultry or live poultry markets is the significant risk factor for human infection with avian influenza A(H7N9). However, the specific live poultry markets that are major infection sources for A(H7N9) human cases have not been explored in detail. In this study, we extract data associated with poultry farms, live poultry markets and farmers' markets from Baidu Map using the JavaScript language and then construct the live poultry transport network. From this, we establish our A(H7N9) transmission model over the network based upon probabilistic discrete-time Markov chain. On the basis of the obtained network and model, we propose spatiotemporal backward detection and forward transmission algorithms to detect the most likely infection sources and to compute the first arrival times of the infection sources. Our simulations use these algorithms to identify the specific locations of the infection sources, the first arrival times of the infection sources and the most likely transmission map of the A(H7N9) virus along the live poultry transport network. The results reveal that, in addition to the hazards posed by the live poultry markets, backyard poultry also contributed to A(H7N9) human infections; this risk source was significant especially in the newly affected provinces, in the fifth wave of infection. In particular, by analyzing the temperature characteristics at a given location when the infection source arrived, we find that the risk of human infection with the influenza A(H7N9) virus was high under 9°C~19°C; moderate under 0°C~9°C or 19°C~25°C; and low for temperatures 25°C. Our results suggest that strengthening the supervision of the live poultry market system and immunizing poultry at both live poultry markets and the backyard poultry operations under the high risk temperature band of 9°C~19°C, will be able to significantly contribute to the control of avian influenza A(H7N9) in the future.

Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Intestinal mucosal barrier injury is one of the important manifestations of sepsis. Interleukin-9 (IL-9) and IL-9-producing CD4(+) T cells were emerging pro-inflammatory mediators with development of intestinal injury. However, it is unclear whether IL-9 is related to the intestinal barrier injury of sepsis. Methods To investigate the roles of IL-9-producing CD4(+) T cells and IL-9 in the process of barrier injury in sepsis, serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were measured in septic patients and controls. The markers of barrier function in serum and intestinal tissue were also collected in septic rats. Moreover, the barrier injury degree and survival rate of septic rats were also investigated after increasing or interfering with IL-9 expression. Results The serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were significantly higher in septic patients or rats than those in controls. IL-9-producing CD4(+) T cells and IL-9 levels were positively correlated with D-lactate levels and had a high predictive value of 28-day mortality in septic patients. The non-survivors had significantly higher serum T cell percentages, IL-9, and D-lactate levels compared with survivors. In septic rats, IL-9 increased the expression levels of D-lactate, whereas that decreased the expression levels of zonula occludens 1. Moreover, the barrier injury was aggravated or alleviated by increasing or interfering with IL-9 expression, respectively. Survival rate analysis also showed that IL-9 decreased the 14-day survival rate of septic rats. Conclusion IL-9 is closely related to intestinal mucosal barrier injury and mortality in sepsis. IL-9 blockade has the potential to improve the barrier injury in sepsis. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT03791866, Date: December 2018).

Voriconazole is a second-generation azole widely used for the prevention and treatment of fungal infection in leukemia patients. We report a case of 9-year-old girl with T-cell acute lymphoblastic leukemia who developed hallucinations and visual disturbance after using voriconazole twice. These symptoms began acutely after treatment with voriconazole and resolved rapidly when the voriconazole was stopped. No specific cause was identified, and thus the symptoms were considered to be the adverse drug reactions (ADRs) of voriconazole. Simultaneous development of hallucinations and visual disturbance caused by voriconazole in children rarely have been reported before and the causes of these ADRs are unknown. Several other cases of hallucinations and (or) visual disturbance caused by voriconazole among 15–81 years old patients have been reported in the literature, and are reviewed. Those patients reminded us of the importance of being aware of hallucinations and visual disturbance associated with voriconazole treatment. In addition, we speculate that the hallucinations and visual disturbance are not related to the dosage form of voriconazole. We emphasize that it is also important to monitor the concentration of voriconazole regularly to avoid potential toxicity.

Background To evaluate inter-fractional variations in bladder and rectum during prostate stereotactic body radiation therapy (SBRT) and determine dosimetric and clinical consequences. Methods Eighty-five patients with 510 computed tomography (CT) images were analyzed. Median prescription dose was 40 Gy in 5 fractions. Patients were instructed to maintain a full bladder and empty rectum prior to simulation and each treatment. A single reviewer delineated organs at risk (OARs) on the simulation (Sim-CT) and Cone Beam CTs (CBCT) for analyses. Results Bladder and rectum volume reductions were observed throughout the course of SBRT, with largest mean reductions of 86.9 mL (19.0%) for bladder and 6.4 mL (8.7%) for rectum noted at fraction #5 compared to Sim-CT (P P P P = 0.28). The mean bladder trigone displacement was in the anterior direction (+ 4.02 ± 6.59 mm) with a corresponding decrease in mean trigone dose (− 3.6 ± 9.6%; P P P P = 0.04). No significant correlations were found between relative bladder volume changes, bladder trigone displacements, or rectum volume changes with rates of genitourinary or rectal toxicities. Conclusions Despite smaller than expected bladder and rectal volumes at the time of treatment compared to the planning scans, dosimetric impact was minimal and not predictive of detrimental clinical outcomes. These results cast doubt on the need for excessively strict bladder filling and rectal emptying protocols in the context of image guided prostate SBRT and prospective studies are needed to determine its necessity.

Here, we aimed to compare early hepatectomy (EH) with delayed hepatectomy (DH) as a treatment for spontaneously ruptured hepatocellular carcinoma (HCC).Several databases were systematically searched for eligible studies that compared DH with EH for spontaneously ruptured HCC treatment. Studies that met the inclusion criteria were reviewed systematically, and the reported data were aggregated statistically, using the RevMan v5.3 software.Seven studies were included, with a total of 385 patients, comprising of 224 EH cases and 161 DH cases. Compared with the EH group, incidence of intraoperative bleeding [mean difference (MD), 353.93; 95% CI, 230.04-447.83;For resectable spontaneously ruptured HCC, DH could reduce intraoperative bleeding, intraoperative blood transfusion volume, and 30-day mortality rate and increase the 1-, 2-, and 3-year survival rates, endowing the patients with greater short- and long-term benefits during and following the surgery.

ObjectiveTo investigate the association of plasma heparin-binding protein (HBP) with the development of acute gastrointestinal injury (AGI) in critically ill patients.DesignClinical retrospective cross-sectional study.SettingA general teaching hospital in China.ParticipantsAdult patients (age ≥18 years) admitted to our department with an intensive care unit (ICU) stay ≥5 days.Main outcome measuresHBP levels were recorded twice or more within 5 days after admission. The initial AGI grades and the worst AGI grades within 5 days after admission, the number of patients receiving total enteral nutrition (TEN) and the number of patients with feeding intolerance (FI) and with sepsis were also recorded, along with some clinical severity and outcome variables.ResultsFrom June 2018 to May 2019, 221 patients were enrolled in this study. We divided patients into four groups based on the HBP values: HBP ≤20 ng/mL, 20100 ng/mL. Significant differences were found in the ratios of AGI deterioration and TEN and the incidence rates of FI and sepsis among the four groups. Differences were also found among the groups regarding the worst AGI grades. The area under receiver operating characteristic curves for AGI deterioration, severe AGI (grades II or above), TEN and FI were 0.738 (p=0.001), 0.774 (pConclusionsHBP levels were associated with gastrointestinal dysfunction in critically ill patients. Increased HBP was positively correlated with sepsis but it was not correlated with 28-day mortality.

As an important ultra-precision measurement method, white light interferometry is widely used in 3D measurements with nanometer resolution. In this paper, a white light interferometer is designed with a random phase noise insensitive algorithm. A discrete interferogram is established by analyzing the phase noise, which is modelized by the combination of random noise and systematic deviation. After Fourier analysis, the mathematical expression of the discrete interferogram in frequency domain is derived, where the random noise can be estimated by least square method and then be corrected. As a result, a more accurate relationship between phase distribution and surface height is established. To set up an stable system, the scanner of white light interferometer is driven by a precision step motor with scanning range 100 mm, and the travel range of the object stage in x and y directions is 60 mm. In the experiment, a step height standard (VLSI, 182.7±2.0 nm) and the end face of a multi-mode optical fiber are tested, where the repeatability error for the step height is less than 0.28%, which proves the measurement accuracy and robustness of the system.

BACKGROUND: Short-term dynamic changes in neutralizing antibodies against EV71 and EV71-IgM after inactivated EV71 vaccine injection are unknown. METHODS: This study was designed as a randomized, open-label study and was registered at ClinicalTrials.gov (NCT03278132). In total, 120 healthy infants aged 6–35 months were randomized 1:1:1 to provide a second blood sample on day 10, day 20, or day 30 after the first vaccine dose, respectively. RESULTS: According to the per-protocol set, a rapid immune response against EV71 was observed 10 days after the first EV71 vaccine dose, with antibody titers ≥1:8 in 89.19% of participants (95% CI: 74.58–96.97%) on day 10, in 80.65% (95% CI: 62.53–92.55%) on day 20, in 66.67% (95% CI: 49.03–81.44%) on day 30, and in 100% (95% CI: 96.52%-.) on day 60. Based on an ELISA, the percentages of participants positive for EV71-IgM on day 0 and day 60 were 1.71% (2 out of 117) and 82.86% (87 out of 105), respectively. CONCLUSIONS: The EV71 vaccine could be used for contingency vaccination to further control EV71-associated disease outbreaks. Caution should be taken in using the EV71-IgM test for rapid EV71 infection diagnosis after EV71 vaccine administration. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03278132

The most effective way to protect data in remote stores is to adopt cryptographic schemes, so that all of the delegated data are ciphertext. In order to share these encrypted data with others, the Proxy Re-Encryption ( $PRE$ ) technique is proposed. It allows a proxy to convert a ciphertext encrypted under one key into an encryption of the same message under another key, while placing as little trust and reveal to the proxy as necessary to allow it to perform its translations. $PRE$ turns out to be the most suitable scheme for remote data sharing and becomes popular with the spread of cloud computing. However, in reality, it is difficult for users to manage their secret keys by themselves and not to authorize others by generating the re-encryption keys. In this proposal, we introduce a distributed key management system ( $DKMS$ ) to manage user keys and handle data sharing requests. The $DKMS$ is an honest authority that does not provides any encryption or re-encryption services, thus it is of zero-knowledge to the data. Moreover, the $DKMS$ will not store the intact secret keys, which will only appear in runtime environment and be destroyed after lifecycle.

Objectives: To systematically evaluate the clinical effect of intraoperative goal-directed fluid therapy (GDFT) in gastrointestinal surgery within an enhanced recovery after surgery (ERAS) program. Methods: EMBASE, MEDLINE, Cochrane Library, PubMed, OVID, CNKI and other databases were searched for randomized controlled trials (RCTs) from the inception dates to December 2018. These studies included patients undergoing elective gastrointestinal surgery comparing regular fluid therapy versus GDFT within ERAS. The meta-analysis was carried on with RevMan 5.3. Results: A total of 10 RCT studies were included with 1216 patients. Compared with the regular fluid therapy group, the GDFT group reduced the rate of readmission [odds ratio, OR = 1.67, 95% CI (1.05, 2.65), P = 0.03] in gastrointestinal surgery patients within ERAS. However, there was no significant decrease in length of hospital stay (LOHS) [mean difference, MD = -0.11, 95% CI (-1.22, 1.00), P = 0.85], postoperative morbidity [OR = 0.78, 95% CI (0.55, 1.11), P = 0.17], postoperative mortality [OR = 0.86, 95% CI (0.30, 2.49), P = 0.78], postoperative ileus [OR = 1.24, 95% CI (0.70, 2.19), P = 0.45], anastomotic leaks [OR= 0.66, 95% CI (0.29, 1.49), P = 0.31] and the first gastrointestinal motility time [MD = -0.37, 95% CI (-1.07, 0.33), P = 0.30]. Conclusions: The current evidence demonstrates that, in gastrointestinal surgery within ERAS, GDFT decreased the rate of readmission. However, there was no advantage over regular fluid therapy in the reduction of LOHS, postoperative morbidity, postoperative mortality, postoperative ileus and anastomotic leaks.

Posttraumatic stress disorder (PTSD) is a disabling psychological condition associated with significant physical comorbidities. There has been growing evidence to support the relationship between PTSD and cardiometabolic disease. Disordered eating behaviors often seen in people with PTSD symptoms may explain increased cardiometabolic risk. This systematic review aimed to assess the quality of evidence surrounding dietary intake of individuals with symptoms or a diagnosis of PTSD and their associated risk with cardiometabolic health outcomes. Online databases Scopus, ProQuest (Health), Embase, Medline, PsycINFO, and CINAHL with Full Text were searched for peer-reviewed English articles prior to December 2017 that examined dietary intake and cardiometabolic health outcomes in adults with PTSD symptoms or diagnosis. The quality of each study was graded based on the design and methodology using adapted quality assessment tools. Seven studies with five unique participant samples were included in the review. Study methods, design, populations, and outcomes were inconsistent across studies. Dietary intake was considerably varied and limited associations were demonstrated between dietary intake and cardiometabolic risk factors in the PTSD cohorts. Due to the variability of measures and study outcomes, there was insufficient evidence to determine the relationship between dietary intake and PTSD-related cardiometabolic health outcomes. Future studies are needed to examine these associations in individuals with PTSD: specifically higher quality descriptive studies are necessary to confirm a link between diet and cardiometabolic disease in PTSD.

We analyze in detail the effects of the intermode nonlinearity (IEMN) and intramode nonlinearity (IRMN) on modulation instability (MI) in randomly birefringent two-mode optical fibers (RB-TMFs). In the anomalous dispersion regime, the MI gain enhances significantly as the IEMN and IRMN coefficients increases. In the normal dispersion regime, MI can be generated without the differential mode group delay (DMGD) effect, as long as the IEMN coefficient between two distinct modes is above a critical value, or the IRMN coefficient inside a mode is below a critical value. This critical IEMN (IRMN) coefficient depends strongly on the given IRMN (IEMN) coefficient and DMGD for a given nonlinear RB-TMF structure, and is independent on the input total power, the power ratio distribution and the group velocity dispersion (GVD) ratio between the two modes. On the other hand, in contrast to the MI band arising from the pure effect of DMGD in the normal dispersion regime, where MI vanishes after a critical total power, the generated MI band under the combined effects of IEMN and IRMN without DMGD exists for any total power and enhances with the total power. The MI analysis is verified numerically by launching perturbed continuous waves (CWs) with wave propagation method.

Purpose This paper aims to solve the lubrication failures in the turning arm bearing of RV reducer, give some help in perfecting the bearing structure design and provide theoretical basis for the reducer’s performance improvement. Design/methodology/approach The paper establishes a mixed lubrication analysis model to study performance parameters. According to the discretization of parameters and iteration of equations, numerical simulation and theoretical analysis are achieved in computational process. Findings Considering influences of contact load, real rough surface and realistic geometry of RV reducer turning arm roller bearing, the mixed lubrication analysis model is established to study the ratio of oil film thickness, pressure distribution and maximum von Mises stress in different speeds, temperatures and fillets. The results of mixed lubrication show that reasonable round corner modification, increase in temperature and speed, decrease of surface roughness and lubricant types can improve the lubrication performance. Originality/value The mixed lubrication analysis model is established to study the influences of contact load, real rough surface and realistic geometry of RV reducer turning arm roller bearing. Different speed, temperature, lubricant and fillet modification are also considered in the research to analyze oil film thickness, pressure distribution and maximum von Mises stress. These studies can optimize structural design of bearing and direct engineer operations.

Purpose To evaluate the difference in prostate-specific antigen (PSA) recurrence–free, distant metastasis–free, overall, and cancer-specific survival between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated external beam radiation therapy (DE-EBRT). Methods and Materials During 1990-2010, 1898 prostate adenocarcinoma patients were treated with DE-EBRT to ≥75 Gy with ≥5 years follow-up. Patients receiving neoadjuvant/concurrent androgen-deprivation therapy (n=1035) or with fewer than 4 PSA values obtained 6 months or more after post-EBRT completion (n=87) were excluded. The evaluable 776 patients were treated (median, 81.0 Gy). Prostate-specific antigen bounce was defined as a ≥0.2-ng/mL increase above the interval PSA nadir, followed by a decrease to nadir or below. Prostate-specific antigen relapse was defined as post–radiation therapy PSA nadir + 2 ng/mL. Median follow-up was 9.2 years (interquartile range, 6.9-11.3 years). Results One hundred twenty-three patients (15.9%) experienced PSA-B after DE-EBRT at a median of 24.6 months (interquartile range, 16.1-38.5 months). On multivariate analysis, younger age ( P =.001), lower Gleason score ( P =.0003), and higher radiation therapy dose ( P =.0002) independently predicted PSA-B. Prostate-specific antigen bounce was independently associated with decreased risk for PSA relapse (hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.33-0.85; P =.008), distant metastatic disease (HR 0.34; 95% CI 0.12-0.94; P =.04), and all-cause mortality (HR 0.53; 95% CI 0.29-0.96; P =.04) on multivariate Cox analysis. Because all 50 prostate cancer–specific deaths in patients without PSA-B were in the non-bounce cohort, competing-risks analysis was not applicable. A nonparametric competing-risks test demonstrated that patients with PSA-B had superior cancer-specific survival compared with patients without PSA-B ( P =.004). Conclusions Patients treated with dose-escalated radiation therapy for prostate adenocarcinoma who experience posttreatment PSA-B have improved PSA recurrence-free survival, distant metastasis–free survival, overall survival, and cancer-specific survival outcomes.

We proposed and experimentally demonstrate a calibration method to estimate the position and the orientation of the anisotropic near point LED light source from a single view. In this work, a Lambertian sphere is used as the calibration target, where the reflection model of the Lambertian sphere under the illumination of LED with given radiant intensity distribution is analyzed theoretically to establish the relationship between the recorded image intensity and the observed surface. Based on this relationship, the geometrical principle of the calibration is researched and an iteration method is presented to calculate the LED position and orientation with a cost function through minimizing the estimation error. The accuracy of the proposed method is verified by simulations with the mean estimation error lower than 5.8mm and 1.7deg for near field lighting. The experiments are performed by measuring the plaster models using the presented system, which proves the effectiveness of the proposed calibration approach.

Salvage brachytherapy is a treatment option for patients with locally recurrent prostate cancer after primary radiation therapy. We reviewed our experience using low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy to compare the outcome and toxicity profiles of each approach in the salvage brachytherapy setting.Ninety-eight patients with biopsy-proven locally recurrent prostate cancer who underwent salvage brachytherapy (LDR = 37; HDR = 61) following an initial course of definitive radiotherapy between 4/2003 and 4/2015 were retrospectively reviewed. All patients underwent salvage brachytherapy using LDR or HDR. Androgen deprivation therapy was used in 45% of the patients. Prostate-specific antigen (PSA) failure was determined using the Phoenix (nadir+2) definition. Toxicity was graded using Common Terminology Criteria for Adverse Events version 4 and patient-reported questionnaires.Median followup was 31 months. The 3-year PSA relapse-free survival (RFS) was 60.1% (95% CI, 49.6-72.5%). There was no difference between LDR and HDR brachytherapy in terms of PSA RFS (p = 0.84 by log-rank test). On multivariate analysis, only prostate-specific antigen doubling time (PSADT)12 months was significantly associated with PSA relapse. The 3-year PSA RFS for patients with a PSADT12 months was 39% compared with 73% for PSADT ≥12 months (p = 0.002 by long-rank test). There were no statistically significant differences in toxicity between LDR and HDR brachytherapy. There was a higher peak in urinary symptoms in LDR patients; however by 24-36 months, most patients in both groups returned to baseline.Both LDR and HDR salvage brachytherapy are an excellent treatment options for appropriately selected patients with comparable outcome and toxicity. Patients with a PSADT 12 months seem to have worse outcomes.

Background and purpose Hypofractionated conformal radiotherapy (hfCRT) is used for larger brain metastases or metastases near critical structures. We investigated hfCRT outcomes for newly diagnosed brain metastases. Materials and methods We identified 195 patients with 1–3 brain metastases who underwent 5×6Gy hfCRT for 231 lesions from 2007 to 2013. Associations among clinical factors, local control (LC), distant brain control (DC) and overall survival (OS) were tested using univariate and multivariate (MVA) Cox regression analysis and Kaplan–Meier method. Results Median follow-up was 12.8months. One hundred forty-three (62%) lesions were treated with hfCRT post-operatively, and 88 (38%) with definitive hfCRT. LC for all lesions was 83% at 1year. For lesions treated with post-operative hfCRT, tumor size (HR=4.7, p =0.04) and subtotal resection (HR=2.7, p =0.02) were predictive of local failure on MVA. For lesions ≥2.8cm in size, LC was 61% at 12months for lesions status-post subtotal resection, compared to 84% status-post gross total resection ( p =0.004). Extracranial disease presence was associated with worse DC (HR=1.8, p =0.008) and OS (HR=3.1, p Conclusions We showed 5×6Gy hfCRT provides acceptable LC at 1year for limited brain metastases. For large lesions not grossly resected, more aggressive strategies can be considered to improve LC.

Fuzzy c-means algorithm (FCM) is a powerful clustering algorithm and it is widely used in image segmentation. However, in FCM, we need to give both the parameters of the number of clusters and the initial membership matrix in advance, and they affect the clustering performance heavily. In this paper, we propose a novel density based fuzzy c-means algorithm (D-FCM) by introducing density for each sample. The density peaks are used to determine the number of clusters and the initial membership matrix automatically. Experimental results on benchmark datasets and medical image segmentation datasets show the efficiency and effectiveness of our D-FCM.

BackgroundKnown collectively as breast fibroepithelial lesions (FELs), the common fibroadenomas (FAs) and the rarer phyllodes tumors (PTs) are a heterogenous group of biphasic neoplasms. Owing to limited tissue availability, inter-observer variability, overlapping histological features and heterogeneity of these lesions, diagnosing them accurately on core biopsies is challenging. As the choice management option depends on the histological diagnosis; a novel 16-gene panel assay was developed to improve the accuracy of preoperative diagnosis on core biopsy specimens.MethodsUsing this 16-gene panel, targeted amplicon-based sequencing was performed on 275 formalin-fixed, paraffin-embedded (FFPE) breast FEL specimens, archived at the Singapore General Hospital, from 2008 to 2012.ResultsIn total, 167 FAs, 24 benign, 14 borderline and 6 malignant PTs, were profiled. Compared to FAs, PTs had significantly higher mutation rates in theTERTpromoter (p RARA(p FLNA,RB1andTP53(p = 0.002, 0.020 and 0.018, respectively). In addition to a higher mutational count (p TERTpromoter (p p = 0.001, A multivariate logistic regression model was built using these as variables and a predictive scoring system was developed. It classifies a FEL at low or high risk (score p = 0.945) and is significant in predicting PTs (p ConclusionThis novel study demonstrates the ability to extract DNA of sufficient quality and quantity for targeted sequencing from FFPE breast core biopsy specimens, along with their successful characterization and profiling using our customized 16-gene panel. Prospective work includes validating the utility of this promising 16-gene panel assay as an adjunctive diagnostic tool in clinical practice.

Background The value of magnetic resonance imaging (MRI), contrast-enhanced ultrasound (CEUS), and the combination of CEUS and MRI (CCWM) for the diagnosis of periampullary space-occupying lesions (PSOL) was investigated. Methods A total of 102 patients diagnosed with PSOLs by surgery or biopsy were recruited retrospectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI, CEUS, and CCWM were analyzed. Results MRI, CEUS, and CCWM allowed for the accurate detection of 91.17, 92.15, and 99.01% of PSOLs, respectively. The specificity, PPV, and accuracy of CCWM were significantly different from MRI and CEUS (p 0.05). Conclusions CCWM is valuable for differentiating benign and malignant PSOL, which provides important guiding significances for the clinic.

Background Some genetic association studies tried to investigate potential associations of transmembrane 6 superfamily member 2 (TM6SF2) polymorphisms with chronic liver disease. However, the results of these studies were not consistent. Thus, we performed the present meta‐analysis to explore associations between TM6SF2 polymorphisms and chronic liver disease in a larger pooled population. Methods Systematic literature research of PubMed, Web of Science, Embase, and CNKI was performed to identify eligible studies for pooled analyses. I2 statistics were employed to assess between‐study heterogeneities. If I2 was greater than 50%, random‐effect models (REMs) would be used to pool the data. Otherwise, fixed‐effect models (FEMs) would be applied for synthetic analyses. Results Totally 28 studies were included for analyses (13,137 cases and 11,010 controls). The pooled analyses showed that rs58542926 polymorphism was significantly associated with chronic liver disease in overall population (dominant model: p

BACKGROUND: Stanford type-A acute aortic dissection (AAD) is typically accompanied by oxygenation impairment before surgery. In addition, inflammation, coagulation and fibrinolysis also impair blood oxygenation. However, our understanding of the concentration of these factors in bronchoalveolar lavage fluid (BALF) has not been reported. The objective of the study was to investigate the impact of preoperative acute lung injury (ALI) on postoperative oxygenation impairment and to explore the effect of coagulation and fibrinolysis in blood and BALF. METHODS: This investigation utilized a prospective observational study design, which was registered at www.clinicaltrials.gov (identifier NCT01894334). The study included 53 patients undergoing surgery for Stanford type-A AAD at an academic hospital in China between October 2013 and July 2014. Preoperative ALI was identified according to the oxygenation index calculated by the PaO(2)/FiO(2) ratio. The subjects were divided into the ALI group (oxygenation index ≤300 mmHg) or the control group (oxygenation index >300 mmHg). The primary outcome was patient oxygenation index, while secondary outcomes were concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) in serum and BALF. RESULTS: The incidence of preoperative ALI for Stanford type-A AAD patients was 41.5%. Stanford type-A AAD patients with preoperative ALI had a lower postoperative oxygenation index (104.6±31.7 vs. 248.7±48.0 mmHg, P

We determined the prognostic importance of a positive posttreatment biopsy after prostate radiotherapy.A total of 382 patients underwent a posttreatment biopsy after external beam radiotherapy for clinically localized prostate cancer. Posttreatment biopsies were classified as positive (prostatic adenocarcinoma without typical radiation induced changes), negative (no evidence of carcinoma) or adenocarcinoma with a severe treatment effect. Median followup in survivors was 9 years. Competing risks regression was used to assess relationships between prognostic predictors and cause specific mortality, distant metastasis and prostate specific antigen failure.The prevalence of positive biopsy, treatment effect and negative biopsy was 30%, 22% and 48%, respectively. Androgen deprivation therapy omission and high risk disease were associated with a 2.6 and 1.8-fold increase, respectively, in the odds of positive posttreatment biopsy. The 15-year PSA relapse rate associated with negative, severe treatment effect and positive posttreatment biopsies was 34%, 36% and 79%, respectively (p0.001). After controlling for known predictors the risk of distant metastasis was 2.6-fold higher in patients with a positive biopsy (p0.001) and cause specific mortality was twice as high in patients with a positive biopsy compared to those with negative and severe treatment effect biopsy outcomes (HR 2.00, p = 0.022).A positive posttreatment biopsy after external beam radiotherapy was associated with a higher risk of distant metastasis and prostate cancer related death. Patients with severe treatment effect classified biopsies have biological characteristics more like patients with a negative biopsy than a positive biopsy. Posttreatment biopsies were more often positive in the setting of external beam radiotherapy alone without androgen deprivation therapy or in the presence of high risk disease.

It is a general trend for new energy vehicles to replace traditional fuel vehicles, while the number of electric vehicles has increased dramatically, the pressure of charging on the power grid has also increased. Therefore, from the angle of wind power absorption of electric vehicles, this paper mainly studies the time series of wind speed power. The time series of wind speed is decomposed into the sum of 15-minute average wind speed signal and turbulent wind speed signal. The relationship between the magnitude of turbulent signal and average wind speed is studied. Based on the discrete Markov chain, the battery state transition probability of electric vehicle is established according to the results of Monte Carlo simulation. The state transition matrix varies with time, and the stationary distribution is obtained to obtain the charging potential of the electric vehicle in a certain area, that is, the charging demand of the electric vehicle with time. The main factors affecting the state transition matrix are analyzed, and the results of each factor affecting the state transition matrix are given. Thus, a more accurate charging potential model can be obtained. By predicting the average wind speed, the number of electric vehicles participating in the regulation can be obtained. The results of simulation indicate that wind fluctuation can be effectively reduced by controlling charging power of electric vehicle.

Pathogenic germline variants in checkpoint kinase 2 (CHEK2), which plays pivotal roles in DNA damage response and cell cycle regulation, confer an increased breast cancer (BC) risk. Here, we investigated the phenotypic and genomic characteristics of 33 BCs from CHEK2 germline mutation carriers (16 high-risk variants and 17 low-risk p.Ile157Thr variants). CHEK2-associated BCs from patients with high-risk germline variants were largely hormone receptor-positive (87%, 13/15), and 81% (13/16) exhibited loss of heterozygosity (LOH) of the CHEK2 wild-type allele. Conversely, CHEK2-associated BCs from patients with the low-risk p.Ile157Thr variant displayed less-frequent loss of heterozygosity (5/17, 29%) and higher levels of CHEK2 protein expression than those with high-risk germline variants. CHEK2-associated BCs lacked a dominant mutational signature 3, a genomics feature of homologous recombination DNA repair deficiency (HRD). Our findings indicate that CHEK2-associated BCs are generally hormone receptor-positive and lack HRD-related mutational signatures, recapitulating the features of ATM-associated BCs. Specific CHEK2 germline variants may have a distinct impact on tumor biology.

In this paper, a calibration method for non-isotropic point light source is developed, which is capable of calibrating position and orientation of the point light source with a single image synchronously. Based on the bidirectional reflectance distribution function (BRDF), the relationship between the shape of observed surface and the recorded grayscale image is firstly investigated in a more accurate way. Based on this model, a cost function is proposed to evaluate the estimation error, and a new cumulative, error-free iteration method is designed to recursively estimate the point light source parameters. The average simulation rebuilding root mean square error (RMSE) is below 0.9. The experiments are performed by calibrating a point light source in a photometric stereo measurement system, and the corresponding RMSE is below 1.2 in the unit of grayscale. Further analysis shows one image is enough to achieve the precision calibration using our proposed method.