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Background: Colorectal Cancer (CRC) is the most frequently diagnosed gastrointestinal tract malignant tumor worldwide, which is closely associated with distant metastasis and poor prognosis. Due to high degree of heterogeneity, reliable prognostic biomarkers are urgently needed to guide the therapeutic intervention of CRC patients. Objective: The present study aimed to develop a NOD-Like Receptors (NLRs) signaling-based gene signature that can successfully predict the overall survival of CRC patients. Methods: Firstly, differentially expressed NLR signaling-related genes were identified between primary and metastatic human CRC samples. Genes with prognostic value were then screened through univariate Cox regression analysis. Next, the NLR signaling-based prognostic signature was constructed by LASSO-penalized Cox regression analysis, and its predictive ability was further confirmed in an independent cohort. Furthermore, functional studies including GO, GSEA, ssGSEA and chemotherapeutic response analyses were performed to explore the role of the NLR signaling-based signature in CRC pathogenesis and therapy. Results: The established prognostic signature that consisted of 7 NLR signaling-related genes can effectively stratify the high-risk and low-risk CRC patients in both training and validation cohorts. Moreover, the signature proved to be an independent indicator of overall survival in CRC patients. Functional annotation and chemotherapeutic response analyses showed that the signature was closely associated with immune status and chemotherapeutic sensitivity of CRC patients. Conclusion: The novel NLR signaling-based gene signature could serve as a potential tool for survival prediction and therapeutic evaluation, thereby contributing to the personalized prognostic management of CRC patients.

This paper aims to solve the path following problem for an underactuated unmanned-surface-vessel (USV) based on deep reinforcement learning (DRL). A smoothly-convergent DRL (SCDRL) method is proposed based on the deep Q network (DQN) and reinforcement learning. In this new method, an improved DQN structure was developed as a decision-making network to reduce the complexity of the control law for the path following of a three-degree of freedom USV model. An exploring function was proposed based on the adaptive gradient descent to extract the training knowledge for the DQN from the empirical data. In addition, a new reward function was designed to evaluate the output decisions of the DQN, and hence, to reinforce the decision-making network in controlling the USV path following. Numerical simulations were conducted to evaluate the performance of the proposed method. The analysis results demonstrate that the proposed SCDRL converges more smoothly than the traditional deep Q learning while the path following error of the SCDRL is comparable to existing methods. Thanks to good usability and generality of the proposed method for USV path following, it can be applied to practical applications.

Background Atherosclerosis is the leading cause of cardiovascular disease with a high mortality worldwide. Understanding the atherosclerosis pathogenesis and identification of efficient diagnostic signatures remain major problems of modern medicine. This study aims to screen the potential diagnostic genes for atherosclerosis. Methods We downloaded the gene chip data of 135 peripheral blood samples, including 57 samples with atherosclerosis and 78 healthy subjects from GEO database (Accession Number: GSE20129). The weighted gene co-expression network analysis was applied to identify atherosclerosis-related genes. Functional enrichment analysis was conducted by using the clusterProfiler R package. The interaction pairs of proteins encoded by atherosclerosis-related genes were screened using STRING database, and the interaction network was further optimized with the cytoHubba plug-in of Cytoscape software. Results The logistic regression diagnostic model was constructed to predict normal and atherosclerosis samples. A gene module which included 532 genes related to the occurrence of atherosclerosis were screened. Functional enrichment analysis basing on the 532 genes identified 235 significantly enriched GO terms and 44 significantly enriched KEGG pathways. The top 50 hub genes of the protein–protein interaction network were identified. The final logistic regression diagnostic model was established by the optimal 10 key genes, which could distinguish atherosclerosis samples from normal samples. Conclusions A predictive model based on 10 potential atherosclerosis-related genes was obtained, which should shed light on the diagnostic research of atherosclerosis.

Early brain injury, characterized by massive cell apoptosis or death, is identified as a critical pathophysiological process during subarachnoid hemorrhage (SAH). Ferroptosis, a class of autophagy-dependent cell death discovered in 2012, is induced by iron-dependent lipid peroxidation accumulation. The present study was designed to study the role of baicalin in autophagy-dependent ferroptosis in early brain injury after SAH. Neurological scores and brain water content were measured to evaluate brain injury. Measurement of iron ion, malondialdehyde (MDA), lipid reactive oxygen species was conducted for ferroptosis evaluation. Immunofluorescence staining, western blotting, and flow cytometry analysis were used to evaluate autophagy and apoptosis. First, we observed that, compared with sham rats, SAH rats had lower neurobehavioral scores. Next, baicalin was proven to decrease the Fe2+, malondialdehyde, and ROS levels in the brain tissues of rats. Also, baicalin was confirmed to suppress the beclin1, LC3-II, and LC3-I protein levels in rat brain tissues. Moreover, we found that baicalin inhibited neuronal apoptosis. Finally, the effects of baicalin on brain injury in the SAH rats were verified. Overall, our results demonstrated that baicalin suppressed autophagy-dependent ferroptosis in EBI after SAH.

Subarachnoid hemorrhage (SAH) is one of the life-threatening neurosurgical diseases in central nervous system. Autophagy has been previously demonstrated to exert vital roles in SAH development. Angiotensin I converting enzyme 2 (ACE2) has been revealed as a regulator of autophagy in neurosurgical diseases. However, effect of ACE2 on autophagy in SAH progression has not been clarified. First, we explored the relationship between autophagy and SAH progression by establishing a mouse model of SAH under the administration of 3-MA (the autophagy inhibitor). Next, we examined ACE2 expression in the cerebral cortex of SAH mice ex vivo with RT-qPCR. Subsequently, we assessed the biological function of ACE2 on brain injury, the autophagic flux pathway and the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling ex vivo via neurological scoring, TUNEL assay, western blot analysis and immunofluorescence staining assay. Finally, we carried out rescue assays under chloroquine (CQ, the autophagic flux inhibitor) and LY294002 (the PI3K/AKT signaling inhibitor) administration. 3-MA mitigated brain injury after SAH, and ACE2 was downregulated in cerebral cortex of SAH mice. Moreover, ACE2 elevation alleviated cell apoptosis, cerebral edema, and neurological deficits, ameliorated the autophagic flux pathway and activated the PI3K/AKT signaling in SAH mice. Furthermore, CQ and LY294002 neutralized the effects of overexpressed ACE2 on neuronal apoptosis, cerebral edema, and neurological deficits in SAH mice. Overall, ACE2 lessened neuronal injury via the autophagic flux and PI3K/AKT pathways. This research might provide a potential novel direction for clinical treatment of SAH. Supplementary Information The online version contains supplementary material available at 10.1007/s11064-021-03469-w.

Objective To observe the clinical effect of quick puncture with collateral-pricking cupping for facial acne. Methods Twenty-eight patients with acne were treated with pricking acne spot and abdominal region of three toes for bloodletting combined with collateral-pricking cupping on the back, once every 5 days, for 3 weeks in succession. A 3-month follow-up was applied to observe the reducing rate and clinical effect of facial skin lesions after treatment. Results Of the 28 cases, 9 were cured, 12 remarkably effective, 5 effective, and 2 ineffective. The total effective rate was 92.86%. Conclusion The effect of pricking acne spot and abdominal region of three toes combined with collateral-pricking cupping on the back is good, being worthy of further clinical discussion to promote its application.

Pancreatic cancer (PC) is an aggressive human cancer. Appropriate methods for the diagnosis and treatment of PC have not been found at the genetic level, thus making epigenetics a promising research path in studies of PC. Histone methylation is one of the most complicated types of epigenetic modifications and has proved crucial in the development of PC. Histone methylation is a reversible process regulated by readers, writers, and erasers. Some writers and erasers can be recognized as potential biomarkers and candidate therapeutic targets in PC because of their unusual expression in PC cells compared with normal pancreatic cells. Based on the impact that writers have on the development of PC, some inhibitors of writers have been developed. However, few inhibitors of erasers have been developed and put to clinical use. Meanwhile, there is not enough research on the reader domains. Therefore, the study of erasers and readers is still a promising area. This review focuses on the regulatory mechanism of histone methylation, and the diagnosis and chemotherapy of PC based on it. The future of epigenetic modification in PC research is also discussed.

Introduction Tumor necrosis factor (TNF) inhibitors are widely used to treat rheumatoid arthritis (RA) and their potential to retard Alzheimer's disease (AD) progression has been reported. However, their long-term effects on the dementia/AD risk remain unknown. Methods A propensity scored matched retrospective cohort study was conducted among 40,207 patients with RA within the US Veterans Affairs health-care system from 2000 to 2020. Results A total of 2510 patients with RA prescribed TNF inhibitors were 1:2 matched to control patients. TNF inhibitor use was associated with reduced dementia risk (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.52-0.80), which was consistent as the study period increased from 5 to 20 years after RA diagnosis. TNF inhibitor use also showed a long-term effect in reducing the risk of AD (HR: 0.57, 95% CI: 0.39-0.83) during the 20 years of follow-up. Conclusion TNF inhibitor use is associated with lower long-term risk of dementia/AD among US veterans with RA.

Previous studies proved the efficacy of cardiac shock wave therapy (CSWT) for coronary artery disease (CAD) patients who are not candidate for reperfusion therapy. Randomized control trials are limited. We try to explore the efficacy and safety of CSWT for patients with severe CAD.Thirty patients with severe CAD who had obvious ischemia on myocardial perfusion imaging (MPI) were enrolled and randomly assigned to the CSWT group or the control group. They had received optimal medication treatment for at least three months. Nine sessions of shock wave therapy were conducted over 3 months. CSWT group received the real treatment, while the control group received the pseudo-treatment. Clinical symptom, imaging outcomes and safety parameters were compared between two groups.After treatment, regional stress score (P = .023), improvement rate (IR) of ischemic area (IA) stress (P lt; .001) and IR of IA difference (P lt; .001) were significantly favor CSWT group. The interaction of summed rest score (P lt; .001), summed stress score (P = .004), summed difference score (P = .036) were significantly improved in the CSWT group compared to the control group. Seattle angina questionnaire, quality of life (QOL) and the distance of six-minute walking test (6MWT) were improved in both groups without significant difference between them. Hemodynamic parameters were stable during procedure. Myocardial injury markers showed no changes in two groups.Our study demonstrated CSWT could effectively and safely improve myocardial perfusion in patients with severe CAD. Clinical symptom, QOL and 6MWT were all improved after treatment, but no significant difference between two groups.

Study objectives We aim to explore the mechanism of relationship between insomnia and liver metabolism by examining the gene × insomnia interactions. Methods Individual level genotypic and phenotypic data were obtained from the UK Biobank cohort. Regression analysis was first conducted to test the association of insomnia with plasma total bilirubin (TBil; n = 186,793), direct bilirubin (DBil; n = 159,854) and total protein (TP; n = 171,574) in UK Biobank cohort. Second, genome-wide gene-environment interaction study (GWGEIS) was conducted by PLINK 2.0, and FUMA platform was used to identify enriched pathway terms. Results In UK Biobank cohort, we found that TP (P Conclusion Our study results suggested negative associations between insomnia and DBil and TBil; and a positive association between insomnia and TP.

Optimal transportation plays a fundamental role in many fields in engineering and medicine, including surface parameterization in graphics, registration in computer vision, and generative models in deep learning. For quadratic distance cost, optimal transportation map is the gradient of the Brenier potential, which can be obtained by solving the Monge-Ampere equation. Furthermore, it is induced to a geometric convex optimization problem. The Monge-Ampere equation is highly non-linear, and during the solving process, the intermediate solutions have to be strictly convex. Specifically, the accuracy of the discrete solution heavily depends on the sampling pattern of the target measure. In this work, we propose a self-adaptive sampling algorithm which greatly reduces the sampling bias and improves the accuracy and robustness of the discrete solutions. Experimental results demonstrate the efficiency and efficacy of our method.

Background Preoperative administration of methylprednisolone reduced circulating markers of endothelial activation. This randomized, double-blind, placebo-controlled trial was to evaluate whether a single preoperative dose of methylprednisolone reduced the rate of postoperative delirium (POD) in older patients undergoing gastrointestinal surgery and its association with the shedding of endothelial glycocalyx markers. Methods About 168 patients, aged 65–80 years and scheduled for laparoscopic gastrointestinal surgery, were randomized to 2 mg/kg methylprednisolone (Group M, n = 84) or equivalent dose of placebo (Group C, n = 84). The primary outcome was the incidence of delirium during the first 5 days after surgery, assessed by the Confusion Assessment Method (CAM). POD severity was rated daily using CAM-Severity (CAM-S). Levels of syndecan-1, heparan sulfate, tumor necrosis factor-α (TNF-α), and brain-derived neurotrophic factor (BDNF) were measured at baseline, 1 day, and 3 days after surgery. Results Compared with placebo, methylprednisolone greatly reduced the incidence of delirium at 72 hours following surgery (9 [10.7%] vs 20 [23.8%], p = .03, OR = 2.22 [95% CI 1.05–4.59]). No between-group difference was found in the cumulative CAM-S score (p = .14). The levels of heparan sulfate, syndecan-1, and TNF-α in Group M were lower than that in Group C (p < .05 and p < .01), while the level of BDNF in Group M was higher than that in Group C (p < .01). Conclusions Preoperative administration of methylprednisolone does not reduce the severity of POD, but may reduce the incidence of delirium after gastrointestinal surgery in older patients, which may be related to a reduction in circulating markers of endothelial degradation, followed by the increase of BDNF level. Clinical Trials Registration Number Chinese Clinical Trial.gov, ChiCTR2000028792. Registered January 4, 2020. http://www.chictr.org.cn/showproj.aspx?proj=47807

Exposure to PM2.5 pollution is a significant health concern and increases risks for cancers in China. However, the studies regarding the effect of PM2.5 and esophageal cancer incidence (ECI) among urban-rural areas are limited. In this study, we examined the sex- and area-specific association between exposure to PM2.5 and ECI, as well as explored the corresponding lag effects on ECI using a geographical weighted Poisson regression. We found significantly positive effect on ECI for males and females in different models, with the greatest increase of 1.44% (95% CI: 1.30%, 1.59%) and 2.42% (95% CI: 2.17%, 2.66%) in per 10 ug/m3 increase of PM2.5 for males and females at single year lag7 and lag4 after all covariates controlled, respectively. We also found that the long-term effect of PM2.5 on ECI was relatively stable at all moving average year lags. Moreover, rural areas had higher ECI risks for males (0.17%) and females (0.64%) with longer lag period than urban areas. In addition, higher risks for both sexes appeared in north, northwestern, and east China. The findings indicated that long-term exposure to PM2.5 was significantly associated with increased risks for ECI, which reinforce a comprehensive understanding for ECI related to PM2.5.

A Large-Scale Heterogeneous Network (LS-HetNet) integrates different networks into one uniform network system to provide seamless one-world network coverage. In LS-HetNet, various devices use different technologies to access heterogeneous networks and generate a large amount of data. For dealing with a large number of access requirements, these data are usually stored in the HetNet Domain Management Server (HDMS) of the current domain, and HDMS uses a centralized Authentication/Authorization/Auditing (AAA) scheme to protect the data. However, this centralized method easily causes the data to be modified or disclosed. To address this issue, we propose a blockchain-empowered AAA scheme for accessing data of LS-HetNet. Firstly, the account address of the blockchain is used as the identity authentication, and the access control permission of data is redesigned and stored on the blockchain, then processes of AAA are redefined. Finally, the experimental model on Ethereum private chain is built, and the results show that the scheme is not only secure but also decentral, without tampering and trustworthiness.

Background Psychiatric disorders are among the largest and fastest-growing categories of the global disease burden. However, limited effort has been made to further elucidate associations between socioeconomic factors and psychiatric disorders from a genetic perspective. Methods We randomly divided 501,882 participants in the UK Biobank cohort with socioeconomic Townsend deprivation index (TDI) data into a discovery cohort and a replication cohort. For both cohorts, we first conducted regression analyses to evaluate the associations between the TDI and common psychiatric disorders or traits, including anxiety, bipolar disorder, self-harm, and depression (based on self-reported depression and Patient Health Questionnaire scores). We then performed a genome-wide gene-by-environment interaction study using PLINK 2.0 with the TDI as an environmental factor to explore interaction effects. Results In the discovery cohort, significant associations were observed between the TDI and psychiatric disorders (p Conclusions Our findings suggest the relevance of the TDI to psychiatric disorders. The genome-wide gene-by-environment interaction study identified several candidate genes interacting with the TDI, providing novel clues for understanding the biological mechanism of associations between the TDI and psychiatric disorders.

Radiation pneumonia (RP) is a common adverse reaction to radiation therapy in patients with chest tumors. Recent studies have shown that diabetes mellitus (DM), which can cause systemic multisystem damage, specifically targets lungs, and the incidence of RP in patients with a history of diabetes is higher than that in other patients with tumors who have undergone radiotherapy. DM is an important risk factor for RP in tumor patients undergoing RT, and patients with DM should be treated with caution. This article reviews research on the clinical aspects, as well as the mechanism, of the effects of diabetes on RP and suggests future research needed to reduce RP.

Xin-Qi Teng,1,* Wen-Cheng Gong,2,* Ting-Ting Qi,1 Guo-Hua Li,1 Qiang Qu,3 Qiong Lu,1 Jian Qu1 1Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, People’s Republic of China; 2Department of Pharmacy, Jiangxi Cancer Hospital of Nanchang University, Jiangxi Cancer Center, Nanchang, Jiangxi, People’s Republic of China; 3Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian QuDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, People’s Republic of ChinaTel +86-15973190614Fax +86-731-85292128Email qujianstanley@csu.edu.cnIntroduction: Chlamydia psittaci infection is a zoonotic infectious disease, which mainly inhaled through the lungs when exposed to the secretions of poultry that carry pathogenic bacteria. The traditional respiratory specimens or serological antibody testing is slow, and the false-negative rate is high. Metagenomic next-generation sequencing (mNGS) gives a promising rapid diagnosis tool.Methods: We retrospectively summarized the clinical characteristics of five C. psittaci pneumonia patients diagnosed by mNGS, conducted a literature review summarizing the clinical characteristics of patients with C. psittaci pneumonia reported since 2010.Results: Five C. psittaci pneumonia patients confirmed by mNGS aged from 36 to 66 years with three males. About 60% of patients had a history of contact with avian or poultry. All patients had a high fever over 38.5 °C, cough, hypodynamia, hypoxemia, and dyspnea on admission. Two patients had invasive ventilator support and extracorporeal membrane oxygenation support. Inflammatory index levels on admission and follow-up were all higher than normal values. Doxycycline or moxifloxacin and their combination therapy were used in patients. Four patients improved and were discharged, and one patient died due to multiple organ failures and disseminated intravascular coagulation. We summarized 19 articles including 69 C. psittaci pneumonia patients and patients in 11 publications were identified by mNGS, and most patients are treated with tetracycline and quinolone with good outcomes.Conclusion: mNGS is a promising rapid diagnosis tool, which may increase the detection rate and shorten the diagnosis time of C. psittaci pneumonia. Further case-control studies are needed to confirm.Keywords: Chlamydia psittaci, pneumonia, psittacosis, chlamydia, mNGS

Flexible rockfall barriers are commonly constructed on steep hillsides to mitigate rockfall. The evaluation of the dynamic response of proprietary flexible rockfall barriers is conventionally performed using full-scale field tests by dropping a block onto the barriers in accordance with the European test standard ETAG 027. The block typically has a spherical or polyhedral shape and cannot reproduce more complex rockfall scenarios encountered in the field. Little attention has been paid to the effects of the block shape on the impact force and structural response. This paper aims to quantitatively reveal the influence of the block shape on the dynamic response of flexible rockfall barriers. First, an ellipsoidal model is established to approximately simulate the block, and the sphericity is employed as the representative index of the block’s shape. A full-scale test on a typical flexible barrier system is carried out and then used to calibrate an advanced three-dimensional finite element model. Finally, the dynamic responses of flexible rockfall barriers are analyzed and discussed, focusing on the effects of the block’s shape. The numerical results show that the sphericity will obviously influence the maximum elongation of flexible barriers, the peak impact force, the peak force of the upslope anchor cable, the peak force of the lower main support cable, the axial peak force of the post, and the peak shear force at the post foundation. The assumption of spherical or polyhedral blocks in the test standard could lead to the defensive failure of flexible rockfall barriers in some impact scenarios.

As an important means of medical imaging, elastic imaging is an indispensable part of mobile telemedicine. Ultrasound elastography has become a research hotspot because it can accurately measure soft tissue lesions. Displacement estimation is the most important step in ultrasound elastography. At present, the phase zero search method is an accurate and fast displacement estimation method. However, when the displacement exceeds 1/4 wavelength, it is invalid. The accuracy of block matching method is not high, but it is suitable for large displacement, so it can overcome this shortcoming. It is worth noting that the quality-guided block matching method has good robustness under complex mutation conditions. It can provide prior knowledge to increase the robustness of the phase-zero search under large displacement conditions. So we propose a novel displacement estimation method for real time tissue ultrasound elastography, which combines the quality-guided block matching method and the phase-zero search method. The experimental results show that this method is more accurate, faster and robust than other displacement estimation methods.

Phyllodes tumors of the breast are rare fibroepithelial neoplasm which are generally divided into benign, borderline, or malignant. In this case study, we reported a 40-year-old female presented with an asymptomatic right breast mass underwent sonographic evaluation. The surgical histopathology was diagnosed as borderline phyllodes tumor. Sonographic features of the tumor are described in detail, and the relevant literatures are reviewed and discussed.

Cisplatin chemotherapy is standard care for many cancers but is toxic to the kidneys. How this toxicity occurs is uncertain. In this study, we identified apurinic/apyrimidinic endonuclease 2 (APE2) as a critical molecule upregulated in the proximal tubule cells (PTC) following cisplatin-induced nuclear DNA and mitochondrial DNA damage in cisplatin-treated C57B6J mice. The APE2 transgenic mouse phenotype recapitulated the pathophysiological features of C-AKI (acute kidney injury, AKI) in the absence of cisplatin treatment. APE2 pulldown-MS analysis revealed that APE2 binds myosin heavy-Chain 9 (MYH9) protein in mitochondria after cisplatin treatment. Human MYH9-related disorder is caused by mutations in MYH9 that eventually lead to nephritis, macrothrombocytopenia, and deafness, a constellation of symptoms similar to the toxicity profile of cisplatin. Moreover, cisplatin-induced C-AKI was attenuated in APE2-knockout mice. Taken together, these findings suggest that cisplatin promotes AKI development by upregulating APE2, which leads to subsequent MYH9 dysfunction in PTC mitochondria due to an unrelated role of APE2 in DNA damage repair. This postulated mechanism and the availability of an engineered transgenic mouse model based on the mechanism of C-AKI provides an opportunity to identify novel targets for prophylactic treatment of this serious disease. Significance: These results reveal and highlight an unexpected role of APE2 via its interaction with MYH9 and suggest that APE2 has the potential to prevent acute kidney injury in patients with cisplatin-treated cancer.

Lacrimal canaliculitis (LC) is a rare infection of lacrimal passage, which is usually late diagnosed or misdiagnosed. Traditional lacrimal system tests barely provide a clear and definite understanding of the pathological changes in lacrimal passage. We presented three patients with asymptomatic and atypical symptoms who were misdiagnosed and were eventually diagnosed with chronic LC with assistance of 80-MHz ultrasound biomicroscopy (80-MHz UBM) and lacrimal endoscopy. To our knowledge, the mutual assistance of above two techniques diagnosing LC has never been reported, it can provide better images and observations of the canaliculus from the inside out and can guide the differential diagnosis.

The image super-resolution reconstruction method can improve the image quality in the Internet of Things (IoT). It improves the data transmission efficiency, and is of great significance to data transmission encryption. Aiming at the problem of low image quality in image super-resolution using neural networks, a self-attention-based image reconstruction method is proposed for secure data transmission in IoT environment. The network model is improved, and the residual network structure and sub-pixel convolution are used to extract the feature of the image. The self-attention module is used extract detailed information in the image. Using generative confrontation method and image feature perception method to improve the image reconstruction effect. The experimental results on the public data set show that the improved network model improves the quality of the reconstructed image and can effectively restore the details of the image.

A 55-year-old man was treated at the village hospital with six months medical history of recurrent chills and fever. Due to the lack of imaging examination, antipyretic and anti-infective medications were given. Although symptomatic treatment can relieve fever symptoms, symptoms easily flare up again two to three days after taking the drug. Later, the patient suffered from fever again during the COVID-19 epidemic and was sent to our hospital for isolation and treatment. During this hospitalization, chest CT examination is mandatory for all patients in order to meet the requirements of epidemic prevention and control. This led to the inadvertent discovery of a large cystic solid mass in the right thoracic cavity communicating with the esophageal lumen. The patient was preliminarily diagnosed as giant midesophageal diverticulum after three-dimensional CT image reconstruction of the chest was reviewed. Considering the patient’s persistent fever with poor nutritional status, we decided to temporarily place two gastric tubes (diverticulum decompression and gastrointestinal nutrition), and antibiotics were used at the same time as another main treatment. However, after the symptoms eased and nutritional status improved, he refused all further treatment. We believe that this patient’s diverticulum is very classic, and the treatment plan is highly integrated with the needs of epidemic prevention and control and achieves a satisfactory therapeutic effect, so we hope to provide colleagues with new diagnosis and treatment enlightenment through this case.

Edge computing can provide many key functions without connecting to centralized servers, which enables remote areas to obtain real-time medical diagnoses. The combination of edge computing and Internet of things (IoT) devices can send remote patient data to the hospital, which will help to more effectively address long-term or chronic diseases. CT images are widely used in the diagnosis of clinical diseases, and their characteristics are an important basis for pathological diagnosis. In the CT imaging process, speckle noise is caused by the interference of ultrasound on human tissues, and its component information is complex. To solve these problems, we propose a 3D reconstruction method for noisy CT images in the IoT using edge computing. First, we propose a multi-stage feature extraction generative adversarial network (MF-GAN) denoising algorithm. The generator of MF-GAN adopts the multi-stage feature extraction, which can ensure the reconstruction of the image texture and edges. Second, we apply the denoised images generated from the MF-GAN method to perform the 3D reconstruction. A marching cube (MC) algorithm based on regional growth and trilinear interpolation (RGT-MC) is proposed. With the idea of regional growth, all voxels containing iso-surfaces are selected and calculated, which accelerates the reconstruction efficiency. The intersection point of the voxel and iso-surface is calculated by the trilinear interpolation algorithm, which effectively improves the reconstruction accuracy. The experimental results show that MF-GAN has a better denoising effect than other algorithms. Compared to other representative 3D algorithms, the RGT-MC algorithm greatly improves the efficiency and precision.

Background New evidence from studies on risk factors for mortality in hemodialysis (HD) patients with COVID-19 became available. We aimed to review the clinical risk factors for fatal outcomes in these patients. Methods We performed meta-analysis using the PubMed, EMBASE, and Cochrane databases. A fixed- or random-effects model was used for calculating heterogeneity. We used contour-enhanced funnel plot and Egger’s tests to assess potential publication bias. Results Twenty-one studies were included. The proportion of males was lower in the survivor group than in the non-survivor group (OR = 0.75, 95% CI [0.61, 0.94]). The proportion of respiratory diseases was significantly lower in the survivor group than in the non-survivor group (OR = 0.42, 95% CI [0.29, 0.60]). The proportion of patients with fever, cough, and dyspnea was significantly lower in the survivor group (fever: OR = 0.53, 95% CI [0.31, 0.92]; cough: OR = 0.50, 95% CI [0.38, 0.65]; dyspnea: OR = 0.25, 95% CI [0.14, 0.47]) than in the non-survivor group. Compared with the non-survivor group, the survivor group had higher albumin and platelet levels and lower leucocyte counts. Conclusions Male patients might have a higher risk of developing severe COVID-19. Comorbidities, such as respiratory diseases could also greatly influence the clinical prognosis of COVID-19. Clinical features, such as fever, dyspnea, cough, and abnormal platelet, leucocyte, and albumin levels, could imply eventual death. Our findings will help clinicians identify markers for the detection of high mortality risk in HD patients at an early stage of COVID-19.

Objectives Hypoxia is one of the characteristics of microenvironmental changes after orthognathic surgery for fractures. HIF-1α is a main regulator of the hypoxic response and plays a crucial role in bone formation, remodelling, and homeostasis. Osteoclasts participate in bone absorption and affect osteogenesis, and osteoclasts differentiate in a path from the oxygen-rich bone marrow to oxygen-deficient bone lesions. Thus, we aimed to study the key functions of HIF-1α in osteoclasts during mandibular healing after osteotomy. Materials and methods The function of HIF-1α in osteoclasts during fracture healing in osteoclast-specific HIF-1α-conditional-knockout mice was investigated in mandibular osteotomy. Primary osteoclasts were used to explore the expression of HIF-1α and cardiotrophin-1 (CT-1) at both the mRNA and protein levels. The ability of BMSCs co-cultured with conditioned media from osteoclast-specific HIF-1α-knockout primary osteoclasts was detected using osteoclast-mediated osteogenesis experiments. Results Hypoxia-inducible factor-1α increased osteoclastogenesis and bone resorption, and a delay in bone healing was found in osteoclast-specific HIF-1α-conditional-knockout mice compared with normal mice. HIF-1α-knockout primary osteoclasts inhibited bone resorption and CT-1 expression, and HIF-1α enhanced the osteoclast-mediated stimulation of BMSC differentiation by secreting CT-1. Conclusions Hypoxia-inducible factor-1α can play a key role in the physiology and pathogenesis of bone resorption by promoting osteoclastogenesis during fracture and influencing osteogenesis through CT-1 during bone healing.

Background Prostate cancer (PCa) is known to be suitable for hypofractionated radiotherapy due to the very low α/β ratio (about 1.5–3 Gy). However, several randomized controlled trials have not shown the superiority of hypofractionated radiotherapy over conventionally fractionated radiotherapy. Besides, in vivo and in vitro experimental results show that the linear-quadratic (LQ) model may not be appropriate for hypofractionated radiotherapy, and we guess it may be due to the influence of fractionation schedules on the α/β ratio. Therefore, this study attempted to estimate the α/β ratio in different fractionation schedules and evaluate the applicability of the LQ model in hypofractionated radiotherapy. Methods The maximum likelihood principle in mathematical statistics was used to fit the parameters: α and β values in the tumor control probability (TCP) formula derived from the LQ model. In addition, the fitting results were substituted into the original TCP formula to calculate 5-year biochemical relapse-free survival for further verification. Results Information necessary for fitting could be extracted from a total of 23,281 PCa patients. A total of 16,442 PCa patients were grouped according to fractionation schedules. We found that, for patients who received conventionally fractionated radiotherapy, moderately hypofractionated radiotherapy, and stereotactic body radiotherapy, the average α/β ratios were 1.78 Gy (95% CI 1.59–1.98), 3.46 Gy (95% CI 3.27–3.65), and 4.24 Gy (95% CI 4.10–4.39), respectively. Hence, the calculated α/β ratios for PCa tended to become higher when the dose per fraction increased. Among all PCa patients, 14,641 could be grouped according to the risks of PCa in patients receiving radiotherapy with different fractionation schedules. The results showed that as the risk increased, the k (natural logarithm of an effective target cell number) and α values decreased, indicating that the number of effective target cells decreased and the radioresistance increased. Conclusions The LQ model appeared to be inappropriate for high doses per fraction owing to α/β ratios tending to become higher when the dose per fraction increased. Therefore, to convert the conventionally fractionated radiation doses to equivalent high doses per fraction using the standard LQ model, a higher α/β ratio should be used for calculation.

Objective: The aim was to develop and evaluate the impact of a new model in which the infectious disease (ID) physician and pharmacist work together to treat diabetic foot infections (DFIs). Methods: A quasi-experimental before–after study was conducted. The medical charts of inpatients with DFI admitted between April 1, 2017 and March 31, 2018 were reviewed retrospectively (control group, n = 30). Inpatients diagnosed with DFI between April 1, 2018 and March 31, 2019 were enrolled prospectively as the intervention group and received treatment through dedicated ID teamwork (intervention group, n = 35). Results: The distribution of infection severity and levels of metabolic criteria were similar in the two groups. Compared with the control group, the intervention group received adequate initial empirical treatment more frequently (96.8% vs 43.5%, p < 0.001) and had a shorter median duration of fever (1 day vs 7.5 days, p < 0.001). Rates of healing and relapse within 6 months were similar in the two groups, although the intervention group showed more sites of osteomyelitis (p = 0.036) and a higher percentage of polymicrobial infections (48.6% vs 10.0%, p = 0.001). Conclusion: The early and full participation of ID physicians and pharmacists in the treatment of DFI facilitated targeted antimicrobial treatment and improved patient outcomes.

To investigate the association between serum immunoglobulin G4 (IgG4) levels and laboratorial parameters. Moreover, the ocular manifestations were compared in Graves' ophthalmopathy (GO) patients.Fifty-seven GO patients and fifty sex- and age-matched euthyroid subjects were enrolled. Serum IgG4 and immunoglobulin G (IgG) levels, thyroid hormones and thyroid autoantibodies were measured in all participants. Ophthalmologic examinations were performed to GO patients.Serum IgG4 levels were increased in GO patients compared with euthyroid subjects (p0.001). Multivariate analysis showed that TRAb levels were correlated with IgG4 levels in GO patients (β=1.45, p = 0.024). There were eight GO patients with IgG4 levels ≥ 135 mg/dL. They all had both eyelids swelling and the differences of HER were less than 2mm. Seven patients (7/8) showed bilateral symmetrical thickening of the extraocular muscles.Bilateral symmetry of ocular manifestation was observed in GO patients with IgG4 levels ≥135 mg/dL. IgG4 levels may be helpful in monitoring GO and diagnosing a new subtype of GO.

Aims Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with unilateral Crowe type IV DDH using 3D imaging and analysis. Methods A total of 20 patients with unilateral Crowe-IV DDH were included in the study. The contralateral side was considered normal in all patients. A coordinate system based on the sacral base (SB) in a reconstructed pelvic model was established. The pelvic orientations (tilt, rotation, and obliquity) of the affected side were assessed by establishing a virtual anterior pelvic plane (APP). The bilateral coordinates of the anterior superior iliac spine (ASIS) and the centres of hip rotation were established, and parameters concerning size and volume were compared for both sides of the pelvis. Results The ASIS on the dislocated side was located inferiorly and anteriorly compared to the healthy side (coordinates on the y-axis and z-axis; p = 0.001; p = 0.031). The centre of hip rotation on the dislocated side was located inferiorly and medially compared to the healthy side (coordinates on the x-axis and the y-axis; p < 0.001; p = 0.003). The affected hemipelvis tilted anteriorly in the sagittal plane (mean 8.05° (SD 3.57°)), anteriorly rotated in the transverse plane (mean 3.31° (SD 1.41°)), and tilted obliquely and caudally in the coronal plane (mean 2.04° (SD 0.81°)) relative to the healthy hemipelvis. The affected hemipelvis was significantly smaller in the length, width, height, and volume than the healthy counterpart. (p = 0.014; p = 0.009; p = 0.035; p = 0.002). Conclusion Asymmetric abnormalities were identified on the affected hemipelvis in patients with the unilateral Crowe-IV DDH using 3D imaging techniques. Improved understanding of the morphological changes may influence the positioning of the acetabular component at THA. Acetabular component malpositioning errors caused by anterior tilt of the affected hemi pelvis and the abnormal position of the affected side centre of rotation should be considered by orthopaedic surgeons when undertaking THA in patients with Crowe-IV DDH. Cite this article: Bone Joint J 2020;102-B(10):1311–1318.

Objective To observe the clinical effect of electroacupuncture(EA) at Zhǒuling (Extra) and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis (EHE). Methods Thirty EHE patients were treated with EA at Zhǒuling (Extra) and Ashi points in combination with blood-letting cupping, once every 2 days, twice a week, 4 times as one course of treatment, and 2 successive courses of treatment were given. Before treatment, after 1 course of treatment, and after 2 courses of treatment, the visual analogue scale (VAS) score and Mayo elbow performance score (MEPS) were adopted to evaluate the curative effect. Results Before treatment, the VAS score of patients was 7.81±1.39. After 1 course of treatment and after 2 courses of treatment, it was 4.77±1.56 and 2.95±1.23 respectively, lowered than before treatment, and the difference was statistically significant (both P Conclusion EA at Zhǒuling (Extra) and Ashi points and blood-letting cupping used in combination are remarkably effective in the treatment of EHE, being worthy for popularization.

The key point of gyrotron design is the analysis of the radio frequency (RF) behavior in gyrotron resonators. This article proposes a comprehensive, user-friendly and effective gyrotron design toolbox (GYROCOMPU) based on the MATLAB platform. GYROCOMPU associates a relatively complete set of codes for gyrotron analysis and integrates them together into a graphical user interface (GUI). The solving algorithm of the cold cavity equations and self-consistent equations is improved. The solving method improvement in these calculation algorithms renders the analysis more efficient and accurate. Three typical examples of gyrotrons working in the 140-GHz TE03 mode, 42-GHz TE03 mode, and 140-GHz TE10,4+ mode are analyzed. All main codes, including the cold cavity calculation, starting current calculation, self-consistent calculation, and mode competition calculation, are compared with the classical code package (COAXIAL) or with results from the literature. The simulation results show that GYROCOMPU can accurately and effectively complete the analysis of gyrotrons.

The successful operation of the gyrotron strongly depends on the proper alignment of the gyrotron with the magnet. The difficulty of the alignment will increase as the frequency becomes higher, especially for the terahertz pulsed gyrotron. In this article, we describe an easily implemented alignment method in detail. A triaxial adjusting flange was designed to align the gyrotron. The alignment of the gyrotron can be identified by the fluorescent effect of the electron beam on the sapphire output window, which will be captured by triggering a charge-coupled device camera. The affine transformation was also used to correct the distorted image. The validity of the proposed alignment method is verified via a prototype of an 800-GHz second-harmonic pulsed gyrotron.

Purpose We identified the risk predictors related to prostate cancer (PCa) metastasis using contemporary data in a community setting. Then, we assessed the performance of indications for bone imaging recommended from the NCCN, AUA and EAU guidelines. Methods Using the Surveillance, Epidemiology, and End Results database (2010–2015), we collected clinicopathological information from PCa patients. The associated risk factors found by multivariate analyses were used to establish forest plots and nomograms for distant metastasis (DM) and bone(s)-only metastasis (BM). We next evaluated the NCCN, AUA and EAU guidelines indications for the discovery of certain subgroups of patients who should receive bone imaging. Results A total of 120,136 patients were eligible for analysis, of which 96.7% had no metastasis. The odds ratios of positive DM and BM results were 13.90 times and 15.87 times higher in patients with a histologic grade group (GG) 5 than in the reference group. The concordance index of the nomograms based on race, age, T/N stage, PSA, GG, percentage of positive scores for predicting DM and BM was 0.942 and 0.928, respectively. Performance of the NCCN, AUA and EAU guidelines was high and relatively similar in terms of sensitivity (93.2–96.9%) and negative predictive value (99.8–99.9%). NCCN guidelines had the highest accuracy, specificity and positive likelihood ratio, while negative likelihood ratio was lowest in AUA guideline. Conclusion Histologic GG 5 was the foremost factor for DM and BM. NCCN-based recommendations may be more rational in clinical practice. Nomograms predicting metastasis demonstrate high accuracy.

Introduction Parasitic infections of the eye are a major cause of ocular-surface diseases globally. While most infections are treatable, parasites can cause varying levels of damage mostly due to late diagnosis or misdiagnosis as a result of doctors’ unfamiliarity with their characteristics of latency and crypsis, as well as lack of awareness by the patients. Case Reports In this study, we present three cases of phthiriasis palpebrarum, thelaziasis, and ophthalmomyiasis, respectively. Two of the cases were treated at the clinic and did not recur. One patient refused treatment and was lost to follow-up. Discussion By evaluating the natural histories, morphology, symptoms, clinical findings, and treatment of these parasitic diseases, we systematically analyzed several distinct and unique parasite characteristics, especially latency and crypsis. Furthermore, we have proposed specific examination techniques and methods as well as prevention and treatment strategies from these specific perspectives, aiming to prompt timely diagnoses and early interventions for these diseases by health care workers and improve the public’s awareness of parasitic infections. Conclusion Parasitosis on the ocular surface is a global infectious disease, and prevention strategies include maintaining personal and environmental hygiene and limiting contact with animals. We recommend that health care workers should enhance their ability to detect and diagnose these diseases while promoting the public’s awareness of them in the context of our new perspectives.

Flotation is an important method to remove the inorganic sulfur from coal. Its effect depends on the difference in adhesion between coal and pyrite to air bubbles and flotation reagents. In this study, the interface properties of coal powder/plate and pyrite powder/crystals were investigated using a comprehensive approach combining wetting process, induction time, contact angle, and X-ray photoelectron spectroscopy. The experimental results show that the spreading and adsorption speed of diethyl phthalate on pyrite crystals and powder is close to that on coal surface in the air. However, the adsorption rate of pyrite to water is much higher than that of coal. In aqueous environment, it is difficult for diethyl phthalate to spread on pyrite crystals, especially in alkaline solution. The difference of hydrophobicity between coal and pyrite at air–water interface is smaller than that at oil–water interface. The adhesion of air bubble and reagent droplet on three pyrite facets is also different. The oxidation of pyrite {100} is faster and greater than that of {210} and {111} facets in alkaline solution, which is beneficial to the coal desulfurization. These findings disclose the hydrophobicity/oleophilicity and structure-reactivity dependence of pyrite in the flotation.

In the training process of the deep neural networks, the learning rate plays an important role in whether the training process can converge and how fast it can achieve converge. In order to ensure convergence, most of the existing optimization methods adopt a multi-stage descending small learning rate which is hand-designed. However, this method converges slowly especially in the early stage of training. Based on this, a learning rate adjustment strategy that can automatically adjust and has a faster speed of loss decline will be helpful to the training of the deep model. In this paper, a dynamic adjustment strategy of learning rate is developed based on the Long Short Term Memory(LSTM) model and the gradients of loss function. This method effectively utilizes the advantages of the LSTM model considering the multi-step learning rate as a whole, and generates the learning rate of the current step based on the memory information of the previous learning rate. Three datasets and four architectures are used in the experiments. We applied the learning rate adjustment method to various optimization methods and achieved good results that our method can achieve even smaller loss under the same number of iterations.

Complex state variables are used to study the dynamic behavior of induction motors considering the propagation in space of the distributed magnetic field inside the machine. The objective of this paper is to improve the dynamics of pulsewidth modulation inverters in medium-voltage drive systems. To keep the dynamic losses of the power devices at a tolerable level, the switching frequency must be below 1 kHz. The sampling rate of the digital signal processing system is then low which introduces considerable signal delay. The delay has an adverse influence on the dynamic behavior of the current control system. It introduces undesired cross coupling between the current components $i_{d}$ and $i_{q}$ . The degree of cross coupling is described by a cross-frequency transfer function. It is shown that the mechanism of cross coupling is different and more adverse than the conventional theory discloses. A current controller structure having poles and zeroes of the single-complex type is synthesized. Cross coupling is completely eliminated at any low switching frequency. Experimental results demonstrate that high dynamic performance and zero cross coupling is achieved even at very low switching frequency.

Lu Ding, Yu-Hang Gao, Ye-Ran Li, Yi-Fan Huang, Xin-Yu Wang, Xin Qi Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of ChinaCorrespondence: Xin QiDepartment of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Xinmin St 71, Chang Chun, People’s Republic of ChinaTel +8615843073202Fax +86043181875600Email qixindoc@163.comPurpose: This study was to evaluate the metabolic score for insulin resistance (METS-IR) in female knee osteoarthritis (KOA) patients in a Chinese population. The associations between METS-IR and adipokines, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were investigated.Patients and Methods: This study included 4686 women from the 2011 China Health and Retirement Longitudinal Study (CHARLS) and 108 women who underwent arthroplasty of KOA at a university hospital. The clinical data were collected, and adipokines were evaluated. METS-IR was calculated in the KOA patients and compared with the national baseline. Logistic regression analyses were applied to explore the associations of METS-IR with adipokines, ESR, and CRP.Results: Receiver operating characteristic curve analysis of METS-IR and metabolic syndrome (MetS) in national baseline showed an area under the curve value of 0.851, with sensitivity of 0.777 and specificity of 0.772. The METS-IR of KOA was higher than the national baseline level (40.29 ± 6.98 vs 36.20 ± 8.50, P < 0.01), even after adjusting age. In addition, the METS-IR was higher in patients with KOA who had MetS than in those without metabolic syndrome (nMetS), even after adjusting body mass index (BMI). After adjusting for age and BMI, METS-IR was associated with CRP (OR 1.238, 95% confidence interval (CI) 1.088, 1.409, P < 0.01), ESR (OR 1.124, 95% CI 1.008, 1.254, P = 0.036), plasma leptin (OR 1.123, 95% CI 1.052, 1.199, P < 0.01), plasma resistin (OR 1.134, 95% CI 1.011, 1.271, P = 0.031), and plasma adiponectin (OR 0.865, 95% CI 0.771, 0.971, P = 0.014).Conclusion: METS-IR in female KOA was higher than that of the national baseline. The METS-IR was related to adipokine disorder and inflammatory activity. These findings suggest that METS-IR can be used to evaluate the degree of involvement of MetS in KOA.Keywords: knee osteoarthritis, metabolic syndrome, insulin resistance, metabolic score for insulin resistance

Summary Background & aims The ketogenic diet is high in fat content, adequate with respect to protein but low in carbohydrate and designed to provide brain energy as ketone bodies rather than glucose. The consequence is that epilepsy can be managed and endurance (sport) related energy be derived from fat rather than ingested or stored (glycogen) carbohydrate. This review aims to set the diet in context for seizure related intervention, sport and potential modern variants with respect to glucose management – which have many medical (including epilepsy potentially) and activity related applications. Methods The literature was reviewed using relevant data bases (e.g. Pubmed, Science Direct, Web of Science, Wiley on Line Library) and relevant articles were selected to provide historic and contemporary data for the text and associated Tables. Results It is clear great health related benefits have been achieved by feeding the ketogenic to individuals subject to seizures where it helps manage the malaise. Sports applications are evident to. Glucose control diets provide health benefits of the ketogenic diet potentially and there is some evidence they are/can be very effective. Conclusions Key to epilepsy and sport performance is the control of blood glucose. The ketogenic diet has proven to be very effective in this regard but now other approaches to control blood glucose ae being evaluated which have advantages over the ketogenic diet. This therapeutic approach of clinical nutrition will undoubtedly move forwards over the next few years in view of the negative aspects of the ketogenic diet.

Summary Background Deep learning is a novel machine learning technique that has been shown to be as effective as human graders in detecting diabetic retinopathy from fundus photographs. We used a cost-minimisation analysis to evaluate the potential savings of two deep learning approaches as compared with the current human assessment: a semi-automated deep learning model as a triage filter before secondary human assessment; and a fully automated deep learning model without human assessment. Methods In this economic analysis modelling study, using 39 006 consecutive patients with diabetes in a national diabetic retinopathy screening programme in Singapore in 2015, we used a decision tree model and TreeAge Pro to compare the actual cost of screening this cohort with human graders against the simulated cost for semi-automated and fully automated screening models. Model parameters included diabetic retinopathy prevalence rates, diabetic retinopathy screening costs under each screening model, cost of medical consultation, and diagnostic performance (ie, sensitivity and specificity). The primary outcome was total cost for each screening model. Deterministic sensitivity analyses were done to gauge the sensitivity of the results to key model assumptions. Findings From the health system perspective, the semi-automated screening model was the least expensive of the three models, at US$62 per patient per year. The fully automated model was $66 per patient per year, and the human assessment model was $77 per patient per year. The savings to the Singapore health system associated with switching to the semi-automated model are estimated to be $489 000, which is roughly 20% of the current annual screening cost. By 2050, Singapore is projected to have 1 million people with diabetes; at this time, the estimated annual savings would be $15 million. Interpretation This study provides a strong economic rationale for using deep learning systems as an assistive tool to screen for diabetic retinopathy. Funding Ministry of Health, Singapore.

To investigate the foot care knowledge and behavior of patients with diabetes to determine effect and current challenges of foot care education, as a basis to improve education and reduce diabetic foot complications.Quantitative, cross-sectional study.A convenience sampling method was used to recruit 200 patients with diabetes from the endocrinology clinic of a tertiary general hospital in Beijing between September 2014 and January 2015. Demographic and disease-related data, foot care education, foot risk stratification status, and knowledge and behavior (KB) scores were collected using investigator-designed questionnaires.Of the 200 patients, 128 (64.0%) patients received routine diabetes education, and 73 (36.5%) received foot care education. The mean ± standard deviation (SD) for KB scores were 63.76 ± 14.85, and 59.78 ± 11.17, respectively. The KB scores of patients who received foot care education (69.54 ± 14.32 and 65.27 ± 11.90) were significantly higher than those who received diabetic education only (60.75 ± 15.27 and 57.54 ± 10.25) and those with no diabetic education (60.21 ± 13.37 and 55.94 ± 8.74) (P.01). The KB scores did not differ for patients based on diabetic foot risk strata (P.05).The foot care KB scores of patients with diabetes were low to moderate levels, particularly on items that pertained to self-foot examination, prompt treatment of foot problems, and regular foot inspection by professionals. Individuals with high risk of developing foot complications did not score higher on the KB questionnaire. These data suggest there is need for improvement in instruction and patient uptake and application of knowledge. We recommend further study on the effectiveness of the delivery of foot care education based on foot risk stratification, and the implications of foot ulcer prevention in community settings.

Subjective well-being (SWB), depressive symptoms, and neuroticism are common and vital traits of mental disorders. Genetic mechanisms of SWB, depressive symptoms and neuroticism remain elusive now. The large-scale GWAS summary datasets of SWB (n = 229,883), depressive symptoms (n = 180,866), and neuroticism (n = 170,911) were obtained from published studies. MASH tool was applied to the GWAS datasets for identifying candidate SNPs shared by SWB, depressive symptoms and neuroticism. SNPs detected by MASH, were then mapped to target genes considering regulatory SNP (rSNP), methylated quantitative trait locus (MeQTL) and the SNPs near to known genes. Gene set enrichment analysis (GSEA) was conducted by the FUMA platform. A total of 122 candidate SNPs were detected by MASH analysis, mapping to 29 target genes, such as CLDN23, MSRA and XKR6. GO enrichment analysis identified multiple immune related gene sets for SWB, depressive symptoms and neuroticism, such as GSE2770_UNTREATED_VS_IL4_TREATED_ACT_CD4_TCELL_48H_DN (P = 7.32 × 10−3), GSE6259_FLT3L_INDUCED_DEC205_POS_DC_VS_CD4_TCELL_DN (P = 2.52 × 10−2). We also found some mental disorders related gene sets were associated with three phenotypes, such as mood instability (P = 1.15 × 10−6) and neuroticism (P = 1.72 × 10−6). We identified multiple candidate genes and GO terms shared by SWB, depressive symptoms and neuroticism. Our results support the overlapping genetic mechanisms, and suggest a functional correlation between immunity and SWB, depressive symptoms and neuroticism.

This article proposes a technique of flat-top magnetic field for the goal of high-frequency gyrotron with a pulse duration of several hundred milliseconds. A 14.8-T flat-top pulsed magnet is designed for an 800-GHz second harmonic gyrotron. The magnet is energized by a battery bank with a bypass circuit to achieve a 620-ms pulse duration. To fulfill the requirements of the gyrotron and magnet power supply, the genetic algorithm NSGA-II has been used in the multiobjective optimization of the field distribution and power dissipation of the magnet. The Helix magnet with the layered reinforcement technique is introduced to address the problems of stress and temperature rise. The proposed scheme in this article can be easily extended to most pulsed magnets for gyrotrons.

Recently, carbon nanotube (CNT)-based micro-devices have attracted extensive attention at the frontiers of intelligent electronics, but the practical application of these devices are seriously limited by the low CNT package rates, poor heat dissipation, and intricate in-situ growth processes. Here, microelectrodes with low impedance based on in-situ-grown super-black vertical bamboo-like multi-walled CNT arrays (∼70 μm) were fabricated inside silicon via holes using face-down catalytic plasma enhanced chemical vapor deposition. Interestingly, the unique CNT array exhibited uniformly high absorption efficiency with a broad range of wavelength (exceeding 99.65% in the UV-NIR band and 99% in the mid-infrared region). Moreover, the excellent cooling performance of CNT array microelectrodes based on in-situ-grown bamboo-like CNT arrays within silicon via holes was demonstrated. Our study highlights the benefits of CNT-based micro functional devices, which indicates the integrated in-situ-grown bamboo-like CNT arrays will have potential applications in advanced microelectrodes, CNT-based field-effect transistors, and portable terahertz inspection devices.