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OBJECTIVE To explore the diagnostic value of noncontrast computed tomography (NCCT) in differentiating pyonephrosis from nonpyogenic hydronephrosis on the basis of CT values (in Horsfield unit [HU]). METHODS Data from patients diagnosed with obstructive uropathy at the First affiliated hospital of University of South China from November 2017 to January 2021 were subjected to retrospective analysis. In accordance with the gold standard-the presence of pus during the operation-all patients were divided into the nonpyogenic hydronephrosis group and the pyonephrosis group. The relationship between CT values and the presence or absence of pyonephrosis was performed using binary logistic regression. A receiver operating characteristic (ROC) curve was constructed to determine threshold values for classification on the basis of mean HU. RESULTS A total of 207 patients, including 100 males and 107 females, were enrolled. Out of the 207 cases, 124 cases of obstructive uropathy were nonpyogenic hydronephrosis and 83 cases were of pyonephrosis. The CT values of the pyonephrosis group were significantly higher than that of the nonpyogenic hydronephrosis group (t = 9.15, P

The widespread application of ionizing radiation in industrial and medical fields leads to the increased brain exposure to X-rays. Radiation brain injury (RBI) seriously affects health of patients by causing cognitive dysfunction and neuroinflammation. However, the link between X-ray exposure and depressive symptoms and their detailed underlying mechanisms have not been well studied. Herein, we investigated the potential depression-like behaviors in mice exposed to X-rays and then explored the role of HMGB1 in this injury. We found that X-ray stimulation induced the generation of reactive oxygen species (ROS) in the prefrontal cortex in a dose-dependent manner, leading to the occurrence of depression-like behaviors of the mice. Moreover, X-ray exposure increased the expression of HMGB1, activated NLRP3 inflammasome signaling pathway and microglial cells, and then facilitated the release of pro-inflammatory cytokines, resulting in the pyroptosis and neuron loss both in vivo and in vitro. Additionally, glycyrrhizin (Gly), which is a HMGB1 inhibitor, reversed X-ray-induced behavioral changes and neuronal damage. Our findings indicated that HMGB1-mediated pyroptosis was involved in radiation-induced depression.

On-site observations show that several damages have occurred in CRTS II slab-type ballastless track system, such as crack and interface debonding between different structural layers, which will trigger the occurrence of some failure modes of CRTS II track slab. As the damages are the prior for specific failure modes, time-dependent reliability of CRTS II track slab should be conducted considering the uncertainties associated with both the failure mode and the damage, which is defined as the conditional time-dependent reliability in this study. To appropriately express the causal relationship among the failure modes and prior damages, a conditional limit state function (LSF) model is proposed with explicit expressions provided. With the aid of the proposed model, conditional time-dependent reliability of CRTS II track slab for two individual failure modes are investigated, which are the steel yielding failure mode under longitudinal cracking, and the vertical instability failure mode under interface debonding. Furthermore, conditional time-dependent system reliability of the track slab has also been analyzed considering four safety failure modes. The advantage of the proposed method is that prior damages have been accounted in establishing the failure criteria and incorporated in the formulation of time-dependent reliability, which provides a general formwork for structural reliability involving the causal relationship among the failure modes and damages.

Background IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, and its diagnosis depends mainly on renal biopsy. However, there is no specific treatment for IgAN. Moreover, its causes and underlying molecular events require further exploration. Methods The expression profiles of GSE64306 and GSE93798 were downloaded from the Gene Expression Omnibus (GEO) database and used to identify the differential expression of miRNAs and genes, respectively. The StarBase and TransmiR databases were employed to predict target genes and transcription factors of the differentially expressed miRNAs (DE-miRNAs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted to predict biological functions. A comprehensive analysis of the miRNA-mRNA regulatory network was constructed, and protein–protein interaction (PPI) networks and hub genes were identified. CIBERSORT was used to examine the immune cells in IgAN, and correlation analyses were performed between the hub genes and infiltrating immune cells. Results Four downregulated miRNAs and 16 upregulated miRNAs were identified. Forty-five and twelve target genes were identified for the upregulated and downregulated DE-miRNAs, respectively. CDKN1A, CDC23, EGR1, HIF1A, and TRIM28 were the hub genes with the highest degrees of connectivity. CIBERSORT revealed increases in the numbers of activated NK cells, M1 and M2 macrophages, CD4 naive T cells, and regulatory T cells in IgAN. Additionally, HIF1A, CDC23, TRIM28, and CDKN1A in IgAN patients were associated with immune cell infiltration. Conclusions A potential miRNA-mRNA regulatory network contributing to IgAN onset and progression was successfully established. The results of the present study may facilitate the diagnosis and treatment of IgAN by targeting established miRNA-mRNA interaction networks. Infiltrating immune cells may play significant roles in IgAN pathogenesis. Future studies on these immune cells may help guide immunotherapy for IgAN patients.

OBJECTIVES: With implementation of mass immunization and improvements in sanitation, China is moving rapidly from high to low endemicity of hepatitis A (HA). To prevent a resurgence after intense vaccination, a comprehensive and systematic assessment of long-term protection against HA conferred by vaccine was thus performed. METHODS: In 1996, 3,515 susceptible children aged one to 12 years were recruited in a randomized, open trial to assess the efficacy of a live-attenuated HA vaccine. During a 17-year follow-up period, children were tested for antibody persistence and long-term protection against both hepatitis A virus (HAV) disease and infection. Case finding was conducted using the China National Notifiable Infectious Disease Reporting System. Serum anti-HAV antibody levels were evaluated by the ELISA method to ascertain antibody persistence and protection against infection. RESULTS: During the 17-year follow-up, 2,132 (61%) children from the initial cohort were available for analysis. After calibrating the sensitivity of assay, excluding natural infection and vaccine booster, the sero-positive rate and the geometric mean concentrations declined from 94.9% and 131.3 mIU/mL (91.5-188.4mIU/mL) at the peak to 55.6% and 41.1 mIU/mL (95% CI: 27.8-61.0 mIU/mL) respectively, with a similar natural infection rate in both groups. CONCLUSIONS: This study demonstrates that long-term protection against hepatitis A persists at least for 17 years after administration of a single dose of a live-attenuated HA vaccine and suggests that a booster dose is currently not necessary. FUNDING STATEMENT: This work was supported by grants from National Natural Science Foundation (China) (81072346), National Science and Technology Project of Major Infectious Diseases (2008ZX10002-003, 2012ZX10002002004) DECLARATION OF INTERESTS: The authors declare that they have no competing interests. ETHICS APPROVAL STATEMENT: This study was reviewed and approved by the Institutional Review Board of the Institutes of Biomedical Sciences, Fudan University. Written inform consent was obtained from each participant.

Drug-radiotherapy is a common and effective combinational treatment for cancer. This study aimed to explore the ionizing radiation-optimized drug treatment based on nanomaterials so as to improve the synergistic efficacy of drug-radiotherapy against cancer and limit the adverse effect on healthy organs. In this review, these emerging strategies were divided into four parts. First, the delivery of the drug-loaded nanoparticles was optimized owing to the strengthened passive targeting process, active targeting process, and cell targeting process of nanoparticles after ionizing radiation exposure. Second, nanomaterials were designed to respond to the ionizing radiation, thus leading to the release of the loading drugs controllably. Third, radiation-activated pro-drugs were loaded onto nanoparticles for radiation-triggered drug therapy. In particular, nontoxic nanoparticles with radiosensitization capability and innocuous radio-dynamic contrast agents can be considered as radiation-activated drugs, which were discussed in this review. Fourth, according to the various synergetic mechanisms, radiotherapy could improve the drug response of cancer, obtaining optimized drug-radiotherapy. Finally, relative suggestions were provided to further optimize these aforementioned strategies. Therefore, a novel topic was selected and the emerging strategies in this region were discussed, aiming to stimulate the inspiration for the development of ionizing radiation-optimized drug treatment based on nanomaterials.

AIM: To observe the intraocular pressure (IOP) fluctuation at the early stage of pars plana vitrectomy (PPV) and silicon oil tamponade in high myopia with rhegmatogenous retinal detachment (RRD) eyes in diabetic patients and analyze the potential risk factors and effective treatment. METHODS: One hundred consecutive diabetic patients of RRD in highly myopic eyes were retrospectively reviewed. Patients were divided into two groups: the experimental group, those who used Tobramycin Dexamethasone Eye Drops (TDED), and control group. Pre- and postoperative IOPs, retinal nerve fiber thickness (RNFL) and optic nerve head parameters were recorded before and after IOP elevation, and in the contralateral eye before the operation. Graphpad 7.01 was used for data analysis. RESULTS: IOP elevation occurred in 42 eyes within 1wk after vitrectomy in all diabetic participants. Ocular hypertension (OHTN) was observed in 31 of 53 eyes in experimental group and 11 eyes of 47 eyes in control group at the early stage after operation. Significant differences were found between groups in 5d-1wk and 1mo after vitrectomy. In addition, IOP of 39 eyes had decreased by proper treatment and 3 eyes received glaucoma filtration surgery. Compared to the optic disc parameters before IOP elevation, the average and inferior RNFL thickness were thinner and rim area decreased as well as cup volume and vertical C/D radio increased after IOP elevation. The RNFL thickness of the opposite eyes in patients with IOP elevation was found thinner than the ones who never suffered ocular hypertension. CONCLUSION: Continual use of glucocorticoid after vitrectomy is a potential risk factor of IOP elevation in high myopia with diabetes, and doubtful open angle glaucoma should be focused on its sensibility to glucocorticoid and IOP elevation.

Background and purpose Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. Methods Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. Results At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). Conclusions Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.

Background: Type 2 Diabetes is the most common form of diabetes mellitus, accounting for 90% of all types of diabetes. Diet is one of the important factors affecting the progression of the disease. Methods: In this study, we used urinary protein profile to evaluate the progression of pre-diabetic to diabetic state. Urinary protein profile of pre-diabetic rats with various diet conditions and with or without metformin treatment were compared to those of healthy rats and diabetic rats. Results: It was shown that there were distinct bands that could differentiate the healthy rats from the diabetic ones, namely the protein bands at MW 350 kDa, 280 kDa and 85 kDa (for healthy rats), and protein bands at MW 170 kDa, 51 kDa and 46 kDa (for diabetic rats). In addition, the differentially excreted proteins at MW 62 kDa and 25 kDa (between healthy and diabetic rats) could also be used as indicators. Using the unique band indicators, the pre-diabetic urinary profile was shown to be similar to that of healthy rats. However, by using the differential protein indicators, the band intensity of the 62 kDa, 25 kDa and 17 kDa bands of pre-diabetic rats, with normal diet and metformin treatment, was more similar to that of the healthy rats with normal diet. However, the profile of pre-diabetic rats with high fat diet (with or without metformin treatment) and of pre-diabetic rats (with normal diet without metformin treatment) were more similar to that of diabetic rats. Conclusion: Using this protein profiling comparison method, it was demonstrated that early metformin treatment and controlled diet intake are important in delaying the progression of the pre-diabetic to diabetic state.

This work investigates the use of substrate integrated waveguide fed open slot antenna (WOSA) in an array for the first time to provide a new SIW slot antenna array with wide bandwidth and single-layer structure. The antenna array consists of 4×2 substrate integrated WOSA elements as a radiating part and two 1-to-4 SIW power dividers as the feeding network. The whole array is differentially fed and built on a single-layered laminate. To demonstrate the wideband performance of the substrate integrated WOSA elements, two sets of feeding networks designed at different frequencies are used to feed the same radiating part. In this way, a V-band and a W-band array were built. Both the antenna arrays were fabricated and measured. Benefiting from the excellent performance of the substrate integrated WOSA elements, the antenna array achieves a wide bandwidth of 32.3% (54.0 to 74.8 GHz) with a peak gain varies from 11.3 to 15.6 dBi. It has been demonstrated that the substrate integrated WOSA array can achieve a wide bandwidth with a single-layer structure, which is attractive for millimeter-wave applications.

Introduction and Aims: Choline-metabolizing genetic variation may interact with choline intake on fetal programming and pregnancy outcome. This case-control study aims to explore the association of maternal choline consumption and phosphatidylethanolamine N-methyltransferase (PEMT) gene polymorphism rs7946 with preterm birth risk. Methods: 145 Han Chinese women with preterm delivery and 157 Han Chinese women with term delivery were recruited in Shanghai. Dietary choline intake during pregnancy was assessed using a validated food frequency questionnaire. Additionally, DNA samples were genotyped for PEMT rs7946 (G5465A) with plasma homocysteine (Hcy) levels measured. Results: Compared with the lowest quartile of choline intake, women within the highest consumption quartile had adjusted odds ratio (aOR) for preterm birth of 0.48 (95% confidence interval, CI [0.24, 0.95]). There was a significant interaction between maternal choline intake and PEMT rs7946 (p for interaction = 0.04), where the AA genotype carriers who consumed the energy-adjusted choline 255.01 mg/day during pregnancy. Additionally, the greatest elevated plasma Hcy was found in the cases with AA genotype and choline consumption p < 0.001). Conclusion: The AA genotype of PEMT rs7946 may be associated with increased preterm birth in these Han Chinese women with low choline intake during pregnancy.

The combination of deep learning techniques and commercial 3D sensors reveal a bright future as they provide a low cost and convenient method to collect and analyze depth information from the environment for various applications ranging from industrial modeling to mobile face recognition. Despite the abundant research devoted to the development of more accurate, flexible and efficient machine learning schemes as well as 3D sensors, security concerns related to these techniques remain largely untouched. In this paper, we propose a novel adversarial attack against this combination by showing that deep learning models with popular 3D sensors may misclassify real objects in the physical environment. Comparing to the existing attack algorithms against deep learning models developed for 3D data analysis that only consider digital point cloud data and single deep learning model, our attacks target popular commercial 3D sensors combined with various deep learning schemes in the black-box setting. Experimental results demonstrate that our 3D printed adversarial objects stay effective after scanned by a 3D sensor.

BACKGROUND Rectal cancer patients who have undergone lower anterior resection with sphincter-saving surgery often experience loss of bowel control. We currently do not have suitable treatment regimens for such patients. OBJECTIVE The aim of this study was to explore the experiences of losing bowel control in patients who have undergone lower anterior resection with sphincter-saving surgery for rectal cancer in Taiwan. METHODS A descriptive phenomenological study design was adopted. Purposive sampling and one-on-one semistructured interviews were conducted for data collection. Narratives were analyzed using Colaizzi's method. RESULTS Data saturation was achieved after interviewing 12 patients (8 men, 4 women) whose average age was 61 years. Three themes and 11 subthemes emerged: physical problems (pain from broken perianal skin, insomnia, decreased physical strength, and body weight loss), adverse psychological reactions (worries, helplessness, and social isolation), and the use of coping strategies (avoidance of inappropriate foods to reduce bowel irritation and peristalsis, reduction of food intake, and use of antidiarrheal drugs and perianal skincare products). CONCLUSION The study supports the importance of having a good understanding of patient experiences by healthcare professionals to provide more effective healthcare. Furthermore, awareness of the cultural issue of social isolation was deemed important for providing individualized healthcare. IMPLICATIONS FOR PRACTICE Education, counseling, and psychological support can enhance patients' abilities to use coping strategies to overcome the physical and mental challenges of bowel symptoms. For example, appropriate diet-related education programs must be developed to reduce the trial-and-error learning process commonly adopted by patients to identify inappropriate foods.

In the design of cantilevered balconies of buildings, many stability problems exist concerning vertical plates, in which reaching a critical load plays an important role during the stability analysis of the plate. At the same time, the concrete forming vertical plate, as a typical brittle material, has larger compressive strength but lower tensile strength, which means the tensile and compression properties of concrete are different. However, due to the complexities of such analyses, this difference has not been considered. In this study, the variational method is used to analyze stability problems of cantilever vertical plates with bimodular effect, in which different loading conditions and plate shapes are also taken into account. For the effective implementation of a variational method, the bending strain energy based on bimodular theory is established first, and critical loads of four stability problems are obtained. The results indicate that the bimodular effect, as well as different loading types and plate shapes, have influences on the final critical loads, resulting in varying degrees of buckling. In particular, if the average value of the tensile modulus and compressive modulus remain unchanged, the introduction of the bimodular effect will weaken, to some extent, the bending stiffness of the plate. Among the four stability problems, a rectangular plate with its top and bottom loaded is most likely to buckle; next is a rectangular plate with its top loaded, followed by a triangular plate with its bottom loaded. A rectangular plate with its bottom loaded is least likely to buckle. This work may serve as a theoretical reference for the refined analysis of vertical plates. Plates are made of concrete or similar material whose bimodular effect is relatively obvious and cannot be ignored arbitrarily; otherwise the greater inaccuracies will be encountered in building designs.

Sarcopenia is a common and progressive skeletal muscle condition, often described as an intermediate stage in the development of frailty and disability in patients with diabetes. This can be improved through physical activity and exercise. This descriptive phenomenological study explored the exercise experiences of older adults with diabetes and sarcopenia. Individual interviews were conducted following semi-structured interview guidelines, and narratives were analyzed using Giorgi’s method. Data saturation was achieved after interviewing 14 purposively sampled older patients with diabetes and sarcopenia. The study identified three main themes: encountering difficulty during exercise, recognizing the advantages of exercise, and constructing a suitable exercise model. While older adults with diabetes and sarcopenia may encounter difficulty during exercise, they also experience positive feedback from exercise. Understanding the limitations of older adults, individualizing exercise models based on their exercise experiences, and providing appropriate interventions and necessary emotional support can effectively prevent diabetes and sarcopenia.

With the improvements of sanitation and nationwide safe water supply the occurrence of bacterial diarrhea declined remarkably, while viruses became the leading causes of acute gastroenteritis (AGE). Of these viruses, noroviruses (NoVs) are responsible for a considerable burden of gastroenteritis, especially in children < 2 years and elderly ⩾ 65 years. NoVs circulating in the Chinese population are antigenically highly diverse with the genotype GII.4 being the dominant strain followed by GII.3. Given the widespread contamination in environmental sources, and highly infectious nature of NoVs, vaccination would be the desirable strategy for the control of NoV infections. However, a better understanding of acquired immunity after infection, and a reliable immunological surrogate marker are urgently needed, since two vaccine candidates based on virus-like particles (VLPs) are currently moving into clinical evaluations in China.

Regulatory T cells (Tregs) play a crucial role in the control of the initiation and progression of type 1 diabetes (T1D). Various immunological interventions including those to ex vivo expansion Tregs transfer, in vivo induction of peripherally derived Treg (pTreg) have been considered as promising approaches for T1D therapy. In this study, we developed a novel tolerogenic vaccine using four autoantigenic peptides of islet-derived with cyclosporine A (CsA) as the pTreg inducer, designated as GAD-IN+CsA. This vaccine immunized into prediabetic NOD mice subcutaneously could induce IL-10 and TGF-β expressing pTregs and lead to suppressing autoreactive T cells responses, resulting in the prevention of T1D in these animals. Furthermore, we demonstrated that CsA with autoantigenic peptides modulates dendritic cells (DCs) to become immature IL-10hiCD40lo DCs. Such modulated DCs could foster naïve CD4+CD25− T cell into Tregs when presenting antigen peptides in vitro. This novel approach offers an alternative strategy to induce pTregs to treat T1D.

Although nucleos(t)ide analog (NA) monotherapy is effective in hepatitis B virus suppression and fibrosis regression, serological response rates are not satisfactory. Studies assessing the benefits of combination therapy with NAs and peginterferon alpha (PegIFNα) in patients with chronic hepatitis B (CHB) have produced conflicting results and mainly focused on serological outcomes. Histological changes in response to combination therapy have not been evaluated in real-world practice. This study aimed to evaluate the histological changes in response to NA-PegIFNα combination therapy in CHB patients and to comprehensively compare the efficacy of NA-PegIFNα combination therapy and NA monotherapy. We conducted a retrospective analysis of data from 40 CHB patients who underwent either NA-PegIFNα combination therapy or NA monotherapy. Changes in histology at 48 weeks after treatment initiation were evaluated. Serological characteristics were also analysed and compared between the NA-PegIFNα combination therapy and NA monotherapy groups and between histological responders and nonresponders. Compared to baseline biopsies, both fibrosis staging and necroinflammatory grading scores were significantly lower in the second biopsies examined post-treatment in both groups. Nearly all patients experienced a reduction in inflammation (87.5% in both groups), but there was a subgroup of patients who exhibited either no significant improvement or fibrosis progression (33.3% and 31.2% in the NA monotherapy and NA-PegIFNα combination therapy groups, respectively). Nearly, all patients achieved ALT normalization and sustained virological response (SVR) after 48 weeks of antiviral treatment. Approximately one-third of individuals (36.8% and 30% in the two groups, respectively) achieved HBeAg loss at 48 weeks after treatment initiation. Although there were no significant differences in overall rates of histological, biochemical, virological and serological responses between the two groups, an earlier virological response and a higher cumulative SVR rate over time were observed during long-term follow-up in patients treated with NA-PegIFNα combination therapy (P = 0.0129). Trends of more rapid HBeAg loss and a higher cumulative HBeAg loss rate throughout long-term follow-up were also observed but were not statistically significant. The ALT normalization rates at 24 and 48 weeks after treatment initiation were associated with the histological response. Significant regression of fibrosis and resolution of necroinflammation were induced with either NA-PegIFNα combination therapy or NA monotherapy. Significant biochemical, virological and serological responses were observed in both groups, and the response rates at 48 weeks were similar in the two groups. Over time during long-term follow-up, the virological and serological responses were faster and superior following the combination regimen.

In this paper, the effects of ultrasonic treatment on the particle size distribution and rheological properties of red wine were investigated to explore the insight changing mechanism of organoleptic attributes. The results indicate that ultrasound irradiation did affect the particle size distribution by increasing the intervals of particle size distribution, which, especially for the larger particles, would strengthen the tyndall effect of wine, resulting in the wine’s visual effect in a goblet more bright and full of flavor. Moreover, the changes in wine’s rheological properties mediated by ultrasound could also be fitted by the models of Power-law and Casson, which might explain the taste changes of wine induced by ultrasound. In conclusion, some of the wine’s sensory properties can be modified by the ultrasound irradiation, which greatly contributes to the feasible explanation of the ultrasound’s application in wine-making.

High fat diet (HFD) is one of the risk factors of obesity and diabetes. Recommended diet regimen for diabetes is difficult to abide by especially for HFD as it adds flavour to the taste buds. In this study, palm oil-enriched HFD and normal diet were fed to nicotinamide-induced type 2 diabetes rats, respectively for six weeks. Additionally, metformin, a common drug used to treat diabetes was given to rats under treatment groups. We evaluated the change of urinary metabolites of diabetes rats fed with palm oil-enriched HFD, and also after metformin treatment. Rats were divided into six-groups with different feeding diets, disease condition and with or without metformin treatment. Rats’ urine were collected at the end of six weeks feeding program and subjected to 1H-NMR and multivariate data analysis to evaluate their metabolite profiles. At the early phase of diabetes, metabolites changes in diabetic rats were associated with the disease itself. Our data showed that continuous consumption of HFD altered various metabolic pathways of diabetic rats and caused detrimental effects to the rats. On the other hand, metformin treatment combined with normal diet lessened the physiological impacts caused by diabetes condition., Metabolites, NMR, Diabetes, High Fat Diet, Metformin.

Background Diarrhea remains the leading cause of childhood illness in China. Better understanding of burden and etiology of diarrheal diseases is important for development of effective prevention measures. Methods Population-based diarrhea surveillance was conducted in Sanjiang (southern China) year-round and Zhengding (northern China) in autumn/winter. Stool specimens were collected from children, Key Points Currently bacterial and viral agents in the gastrointestinal tract are under-detected and poorly defined in developing countries. A new sensitive TAC assay provided comprehensive identification of microorganisms, including neglected pathogens, in Chinese children with moderate and severe diarrhea. Supplementary Information The online version contains supplementary material available at 10.1186/s13099-021-00428-2.

Purpose Postmastectomy radiation therapy (PMRT) in T1–T2 tumors with 1–3 positive axillary lymph nodes (ALNs) is controversial. This study was to identify prognostic factors of locoregional control (LRC) following mastectomy with or without PMRT for patients with T1-2N1 breast cancer and to discuss the selection of patients who might omit PMRT. Materials and methods Between January 2006 and December 2012, the data of 1474 postmastectomy patients staged pT1-2N1 were analyzed. PMRT was applied in 663 patients. LRC and disease-free survival (DFS) were calculated using the Kaplan–Meier method. Cox regression model was applied in the univariate and multivariate analyses to recognize the recurrence risk factors. Results With the median follow-up duration of 93 months (range, 5–168 months), 78 patients (5.3%) failed to secure LRC and 220 patients (14.9%) experienced any recurrence. The 7.7-year LRC and DFS was 94.9% and 85.4% respectively in the entire cohort. PMRT significantly improved 7.7-year LRC from 93.4% to 96.6% (p = 0.005), but not the DFS (p = 0.335). Multivariate analysis revealed that PMRT was an independent prognostic factor of LRC (p p = 0.012), histological grade 3 (p = 0.004), 2–3 positive nodes (p p = 0.045) were significantly associated with decreased LRC. The 7.7-year LRC for patients with 0, 1, and 2–4 risk factors was 97.7% / 98.9% (p = 0.233), 95.3% / 98.0% (p = 0.092), and 80.3% / 94.8% (p Conclusions In patients with T1-2N1 breast cancer, clinical-pathological factors including young age, histological grade 3, 2–3 positive nodes, and tumor size of 3–5 cm were identified to be predictors of a poorer LRC following mastectomy. Patients with 0–1 risk factor might consider the omission of PMRT.

Tomm34, as a member of the outer mitochondrial membrane proteins, is evenly distributed between the cytoplasm and the outer mitochondrial membrane. It is up-regulated in a variety of tumors and correlates with poor prognosis. This study aimed to investigate expression of Tomm34 and its correlations with clinicopathology in oral squamous cell carcinoma (OSCC). Oncomine database and UALCAN database were utilized to predict the expression and prognosis values of Tomm34 in head and neck squamous cell carcinoma (HNSCC). By immunohistochemistry, a retrospective study was performed to verify the bioinformatics results to evaluate the Tomm34 expression and clinicopathological variables in both HPV-positive OSCC and HPV-negative OSCC. Immunohistochemistry of our cohort revealed that 48 cases fulfilled the Tomm34 high expression judgment criteria, and the overall positive rate was 60% (48/80), and 27 cases fulfilled the p16 expression judgment criteria (33.75%, 27/80). The high expression of Tomm34 was closely related with the TNM classification of OSCC (p < 0.01) and tumor size (p < 0.01) both in HPV-negative OSCC and HPV-positive OSCC, while related with lymph node metastasis (p = 0.001) in HPV-negative OSCC and drinking history (p = 0.044) in HPV-positive OSCC. In addition, the Kaplan-Meier curves indicated that higher level of Tomm34 was correlated with poorer overall survival (OS) and disease-free survival (DFS) in HPV-negative OSCC (OS, p = 0.046; DFS, p = 0.020) but not in HPV-positive OSCC (OS, p = 0.824; DFS, p = 0.782). In conclusion, Tomm34 is highly expressed in OSCC and may be a useful factor to provide prognostic information, especially in HPV-negative OSCC group.

To evaluate the incidence of symptoms related to brachial plexus neuropathy (BPN) and the dose distribution to the brachial plexus (BP) in patients with breast cancertreated with supraclavicular (SCV) irradiation and boost.In this study, 117 patients with initial ipsilateral supraclavicular lymph node (SLN) metastasis and 39 with recurrent SLN metastasis between 2008 and 2018 in our cancer center were retrospectively analyzed. All patients were treated with 50 Gy of SCV irradiation in 25 fractions and a boost (median dose, 10 Gy; range, 10-16 Gy) to involved nodes in the SCV area. Symptoms related to BPN (including ipsilateral arm numbness, pain, and weakness) were recorded and graded according to the Common Terminology Criteria for Adverse Events, version 5.0. The BP was delineated on simulation computed tomography, and the dose distributions to the BP were evaluated. Meanwhile, 297 patients treated with SCV irradiation without boost during the same period were identified as a control group to compare the incidences of BPN-related symptoms and dosimetric data with patients who received an SCV boost.The 5-year overall survival rate was 80.3% for patients with initial SLN metastasis and 51.0% for patients with recurrent SLN metastasis. For patients who received an SCV boost, incidence rates of ipsilateral arm numbness, pain, and weakness were 23.9%, 18.3%, and 34.3%, respectively. Four patients (5.6%) developed grade 2 numbness and 3 (4.3%) developed grade 2 arm weakness. In the control group, incidence rates of arm numbness, pain, and weakness were 31.6%, 21.9%, and 36.0%, respectively. The incidence of BPN-related symptoms was not significantly different between the 2 groups. Symptoms of grade 3 were not observed in either cohort. The mean doses to the BP in patients who received boost and who did not were 56.8 and 46.8 Gy, respectively (P.001). The maximum doses to the BP in patients who received boost and who did not were 64.5 and 53.5 Gy, respectively (P.001). The BP volumes receiving at least 50 Gy, 60 Gy, 61 Gy, and 62 Gy were also significantly higher in the boosted group compared with the control group (P.001).This study found that an SCV boost of 10 Gy did not increase the incidence of BPN-related symptoms and that the toxicity to the BP was acceptable. Comprehensive treatment including SCV irradiation and boost led to satisfactory survival outcomes in patients with breast cancer who had SLN metastasis.

Background Androgen deprivation therapy is the primary treatment for advanced cases of prostate cancer, but its adverse effects may decrease prostate cancer survivors' quality of life. Objective The aim of this study was to understand the self-care experiences of prostate cancer survivors before and while receiving androgen deprivation therapy. Methods A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 13 prostate cancer survivors in Taiwan treated with androgen deprivation therapy. Data collection and analysis proceeded simultaneously until data saturation was reached. Results The survivors' self-care experiences were categorized into generic categories: physical impacts, psychosocial impacts, lack of supporting information, changing lifestyle habits, coping with physical symptoms, relieving stress, and acquiring disease-related knowledge. These generic categories were then organized into 2 main categories: impacts and adjustments. Conclusions This article describes the experiences of prostate cancer survivors in terms of the impacts of disease and its treatment and adjustments in self-care before and while receiving treatment. It was found that the information acquired by survivors and the adjustment strategies they used were not entirely appropriate or adequate. Implications for practice Healthcare providers should continually assess the self-care experiences of prostate cancer survivors receiving androgen deprivation therapy, provide them with appropriate information, and clarify their understanding. This will improve survivors' disease care-related knowledge, increase the success of their experience of self-care, alleviate their emotional distress, and strengthen their ability to adjust their self-care to cope with the impacts of the disease and its treatment.

BACKGROUND: This study examined the safety and immunogenicity of an inactivated SARS-CoV-2 vaccine. METHOD: In a phase I randomized, double-blinded, placebo-controlled trial involving 192 healthy adults 18-59 years old, two injections of three doses (50 EU, 100 EU, 150 EU) of an inactivated SARS-CoV-2 vaccine or placebo were administered intramuscularly at a 2- or 4-week interval. The safety and immunogenicity of the vaccine were evaluated. RESULTS: Vaccination was completed in 191 subjects. Forty-four adverse reactions occurred within 28 days, most commonly mild pain and redness at the injection site or slight fatigue. At days 14 and 28, the seroconversion rates were 87.5% and 79.2% (50 EU), 100% and 95.8% (100 EU), and 95.8% and 87.5% (150 EU), respectively, with geometric mean titers (GMTs) of 18.1 and 10.6, 54.5 and 15.4, and 37.1 and 18.5, respectively, for the schedules with 2-week and 4-week intervals. Seroconversion was associated with synchronous upregulation of antibodies against the S protein, N protein and virion and a cytotoxic T lymphocyte (CTL) response. No cytokines and immune cells related to immunopathology were observed. Transcriptome analysis revealed the genetic diversity of immune responses induced by the vaccine. INTERPRETATION: In a population aged 18-59 years in this trial, this inactivated SARS-CoV-2 vaccine was safe and immunogenic. TRIAL REGISTRATION: CTR20200943 and NCT04412538.

High fat diet (HFD) is one of the risk factors to obesity and diabetes. Recommended diet regimen for diabetes is difficult to abide especially for HFD as it adds flavour to the taste buds. In this study, palm oil-enriched HFD and control diet (ND) were fed to nicotinamide-induced type 2 diabetes rats, respectively for six weeks. Additionally, metformin, a common drug used to treat diabetes was given to rats under treatment groups. We evaluated the change of urinary metabolites of diabetes rats caused by HFD, and also after metformin treatment. Rats were divided into six-groups with different feeding diets, disease condition and with or without metformin treatment. Rats’ urine were collected at the end of six weeks feeding program and subjected to 1H-NMR and multivariate data analysis to evaluate their metabolite profiles. At the early phase of diabetes, metabolites changes in diabetic rats were associated with the disease itself. Our data showed that continuous consumption of HFD altered various metabolic pathways of diabetic rats and caused detrimental effects to the rats. Metformin treatment combined with ND lessened the physiological impacts caused by diabetes condition. Funding Information: This research project was supported by USM RUI topdown grant (1001/PFARMASI/870034) funded by Universiti Sains Malaysia. Declaration of Interests: None to declare. Ethics Approval Statement: All experiment procedures were approved by the Animal Ethics Committee Universiti Sains Malaysia (USM/Animal Ethics Approval/2016/(717)).

Background. Diarrhea remains the leading cause of childhood illness in China. Better understanding of burden and etiology of diarrheal diseases is important for development of effective prevention measures.Methods. Population-based diarrhea surveillance was conducted in Sanjiang (southern China) year-round and Zhengding (northern China) in autumn/winter. Stool specimens were collected from children Results. During the study period, 6,380 children in Zhengding and 3,581 children in Sanjiang Escherichia coli (EAEC), rotavirus, and sapovirus all the year round, while the most common viral agents in Zhengding were rotavirus, followed by astrovirus and adenovirus during the cool season. Compared to conventional PCR assay, the average incremental detection via the TAC method was 2-fold.Conclusion. Our study demonstrated high diversity and prevalence of multiple major bacterial and viral agents, including rotavirus and calicivirus, among children in China. Further studies are needed to define the public health significance of neglected but frequently detected pathogens such as EAEC, enterotoxigenic E. coli, Campylobacter, adenovirus, and enterovirus.

Under the wake of COVID-19, agricultural production and people's consumption are seriously affected, in addition, the number of methods to quantitatively analyze of the degree of influence is limited. The big data of electrical power can accurately reflect the business situation of enterprises in the industry. This paper select hundreds of leading enterprises in agricultural industrialization as the analysis objects, and use Keyword Index Technology to construct the corresponding system of enterprise name-electric household number, and use Multilevel Coordination Algorithm to fit the electricity curve of leading enterprises in agricultural industrialization, to study the impact degree difference and resilience of the epidemic situation on the subdivision industry, and use Covariance Analysis Algorithm to analyze the correlation of subdivision industry under the epidemic situation, and to give the prospect of development opportunities in the period after the COVID-19 epidemic situation.

COVID-19 has become a global pandemic, and an effective vaccine is needed. During the outbreak, the urgency for developing candidate vaccines has brought distinct challenges to clinical development. An efficacy trial, which measures whether the vaccine reduces the incidence of disease, is ordinarily required to fully evaluate vaccine efficacy. However, emergency use may be possible if promising immunogenicity results are observed. A ring vaccination trial, which recruits subjects connected to a known case either socially or geographically, is a solution to evaluate vaccine efficacy and control the spread of the disease simultaneously although its conduct is challenging. Nevertheless, when COVID-19 becomes a recurrent epidemic, an ‘individual-level’ efficacy trial is preferred. Innovative statistical designs, including seamless design, platform trial, master protocol design, are helpful to accelerate clinical development. A seamless Phase I/II design has been applied in multiple COVID-19 vaccine studies to date. However, Phase II/III design should be done very carefully. The control of type I error, maintaining trial blinding and statistical methods leading to unbiased estimates should be pre-specified in the clinical protocol. A Data Safety Monitoring Board is especially important, given the need to assure an adequate level of safety when society want a safe and effective vaccine.

Intravenous injection of bacteria into mice is able to trigger tumor-specific thrombosis and photothermal immunotherapy of cancer., We discovered that attenuated Salmonella after intravenous injection would proliferate within various types of solid tumors but show rapid clearance in normal organs, without rendering notable toxicity. Bacteria-induced inflammation would trigger thrombosis in the infected tumors by destroying tumor blood vessels. Six types of tested tumors would all turn into darkened color with strong near-infrared absorbance, as observed by photoacoustic imaging. Under laser irradiation, those bacterial-infected tumors would be effectively ablated. Because of the immune-stimulation function, such bacteria-based photothermal therapy (PTT) would subsequently trigger antitumor immune responses, which could be further enhanced by immune checkpoint blockade to effectively suppress the growth of abscopal tumors. A robust immune memory effect to reject rechallenged tumors is also observed after bacteria-based PTT. Our work demonstrates that bacteria by themselves could act as a tumor-specific PTT agent to enable photoimmunotherapy cancer therapy to inhibit tumor metastasis and recurrence.

Chunyan Li,1,2 Jiangfeng Wang,1,2 Miao Mo,2,3 Jing Yuan,2,3 Jurui Luo,1,2 Kairui Jin,1,2 Xuanyi Wang,1,2 Yilan Yang,1,2 Jinli Ma,1,2 Xin Mei,1,2 Zhaozhi Yang,1,2 Xiaoli Yu,1,2 Xingxing Chen,1,2 Xiaomao Guo1,2 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of China; 3Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, 200032, People’s Republic of ChinaCorrespondence: Xiaomao Guo; Xingxing ChenDepartment of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, People’s Republic of ChinaTel +86-18121299336Fax +8621-64031696Email guoxm1800@163.com; xingxing@yahoo.comPurpose: The role of adjuvant postmastectomy radiotherapy (PMRT) remains controversial for patients with pT3N0M0 breast cancer, especially when patients are treated with the updated adjuvant chemotherapy. Our study aimed to compare locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) in pT3N0M0 patients with and without postmastectomy radiotherapy.Patients and Methods: Between October 2000 and 8 September 2016, the database of the Breast Cancer Center of Shanghai yielded 114 patients with node-negative non-metastatic breast cancer larger than 5 cm. Univariate and multivariate analyses were performed to assess the risk factors for survivals. Differences between the two groups were compared using the Log rank test.Results: Fifty-nine (51.8%) of the patients received adjuvant PMRT. The median follow-up was 62.3 months. Five-year LRFS was 100% in the PMRT group vs 98.1% in the non-PMRT group (P=0.17); 5-year DFS was 97.1% for the entire cohort, 98.0% for the PMRT group vs 96.2% for the non-PMRT group (P=0.18). Univariate analysis identified that family history of malignant tumors, lymphovascular invasion (LVI), or triple-negative breast cancer (TNBC) molecular subtype were associated with higher locoregional recurrence (LRR) (P< 0.05). No PMRT was the only risk factor independently associated with poorer DFS (P=0.048) on multivariate analysis. No difference in BCSS was observed between the two groups.Conclusion: The present study demonstrated a low LRR rate and good survival for node-negative breast cancer > 5 cm. Patients with family history of malignant tumors, TNBC subtype, LVI positivity, or grade 3 disease are at high risk for LRR and might benefit from PMRT.Keywords: node-negative, updated systemic treatment, radiotherapy, locoregional recurrence

COVID-19 is a global pandemic with high infectivity and pathogenicity, accounting for tens of thousands of deaths worldwide. Recent studies have found that the pathogen of COVID-19, SARS-CoV-2, shares the same cell receptor Angiotensin converting enzyme II (ACE2) with SARS-CoV. The pathological investigation of COVID-19 death showed that the lung had the characteristics of pulmonary fibrosis. However, how SARS-CoV-2 spreads from the lungs to other organs has not yet been determined. Here, we performed an unbiased evaluation of cell-type specific expression of ACE2 in healthy and fibrotic lungs, as well as in normal and failed adult human hearts, using published single-cell RNA-seq data. We found that ACE2 expression in fibrotic lungs mainly locates in arterial vascular cells, which might provide the route for bloodstream spreading of SARS-CoV-2. The failed human hearts have a higher percentage of ACE2-expressing cardiomyocytes, and SARS-CoV-2 might attack cardiomyocytes through the bloodstream in patients with heart failure.Moreover, ACE2 was highly expressed in cells infected by RSV or MERS-CoV and in mice treated by LPS. Our findings indicate that patients with pulmonary fibrosis, heart failure, and virus infection have a higher risk and are more susceptible to SARS-CoV-2 infection. SARS-CoV-2 might attack other organs by getting into the bloodstream. This work provides new insights into SARS-CoV-2 blood entry and heart injury and might propose a therapeutic strategy to prevent patients from developing severe complications.

High-fat diet (HFD) interferes with the dietary plan of patients with type 2 diabetes mellitus (T2DM). However, many diabetes patients consume food with higher fat content for a better taste bud experience. In this study, we examined the effect of HFD on rats at the early onset of diabetes and prediabetes by supplementing their feed with palm olein oil to provide a fat content representing 39% of total calorie intake. Urinary profile generated from liquid chromatography-mass spectrometry analysis was used to construct the orthogonal partial least squares discriminant analysis (OPLS-DA) score plots. The data provide insights into the physiological state of an organism. Healthy rats fed with normal chow (NC) and HFD cannot be distinguished by their urinary metabolite profiles, whereas diabetic and prediabetic rats showed a clear separation in OPLS-DA profile between the two diets, indicating a change in their physiological state. Metformin treatment altered the metabolomics profiles of diabetic rats and lowered their blood sugar levels. For prediabetic rats, metformin treatment on both NC- and HFD-fed rats not only reduced their blood sugar levels to normal but also altered the urinary metabolite profile to be more like healthy rats. The use of metformin is therefore beneficial at the prediabetes stage.

Given the scale and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, known as 2019-nCov) infection (COVID-19), the ongoing global SARS-CoV-2 outbreak has become a huge public health issue. Rapid and precise diagnostic methods are thus immediately needed for diagnosing COVID-19, providing timely treatment and facilitating infection control. A one-step reverse transcription loop-mediated isothermal amplification (RT-LAMP) coupled with nanoparticles-based biosensor (NBS) assay (RT-LAMP-NBS) was successfully established for rapidly and accurately diagnosing COVID-19. A simple equipment (such as heating block) was required for maintaining a constant temperature (63°C) for only 40 min. Using two designed LAMP primer sets, F1ab (opening reading frame 1a/b) and np (nucleoprotein) genes of SARS-CoV-2 were simultaneously amplified and detected in a ‘one-step’ and ‘single-tube’ reaction, and the detection results were easily interpreted by NBS. The sensitivity of SARS-CoV-2 RT-LAMP-NBS was 12 copies (each of detection target) per reaction, and no cross-reactivity was generated from non-SARS-CoV-2 templates. Among clinically diagnosed COVID-19 patients, the analytical sensitivity of SARS-CoV-2 was 100% (33/33) in the oropharynx swab samples, and the assay’s specificity was also 100% (96/96) when analyzed the clinical samples collected from non-COVID-19 patients. The total diagnosis test from sample collection to result interpretation only takes approximately 1 h. In sum, the RT-LAMP-NBS is a promising tool for diagnosing the current SARS-CoV-2 infection in first line field, public health and clinical laboratories, especially for resource-challenged regions.

ObjectiveThe outbreak of novel coronavirus disease 2019 (COVID-19) imposed a substantial health burden in mainland China and remains a global epidemic threat. Our objectives are to assess the case fatality risk (CFR) among COVID-19 patients detected in mainland China, stratified by clinical category and age group.MethodsWe collected individual information on laboratory-confirmed COVID-19 cases from publicly available official sources from December 29, 2019 to February 23, 2020. We explored the risk factors associated with mortality. We used methods accounting for right-censoring and survival analyses to estimate the CFR among detected cases.ResultsOf 12,863 cases reported outside Hubei, we obtained individual records for 9,651 cases, including 62 deaths and 1,449 discharged cases. The deceased were significantly older than discharged cases (median age: 77 vs 39 years, pConclusionsOur estimates of CFR based on laboratory-confirmed cases ascertained outside of Hubei suggest that COVID-19 is not as severe as severe acute respiratory syndrome and Middle East respiratory syndrome, but more similar to the mortality risk of 2009 H1N1 influenza pandemic in hospitalized patients. The fatality risk of COVID-19 is higher in males and increases with age. Our study improves the severity assessment of the ongoing epidemic and can inform the COVID-19 outbreak response in China and beyond.

After welding, a heat affected zone (HAZ) is formed in the area near a weld toe. The main microstructure is composed of high-strength steel (HSS) that is not stable at high temperatures. Therefore, it is necessary to investigate whether EC3 formulae based on examining a mild steel T-stub can be used to design an HSS T-stub. In the study, an experiment with two groups of Q690 T-stubs was performed. The results indicate that the EC3 formulae cannot be directly used to design the HSS T-stub. The effect of HAZ was further investigated by performing a finite element analysis (FEA). With respect to the specimens in the study, the factor χHAZ that represents the effect of HAZ is quantified by using the results of the experiment and FEA. The modified EC3 method2 was validated to accurately predict the first yield resistance of HSS T-stub. The T-stub is subjected to combined axial and shear loads. The relation between transversal and axial displacements of the T-stub under combined axial and shear loads was established. The effect of combined axial and shear loads on the connection behavior of the HSS T-stub was examined through the FEA. The result shows that the ductility of the T-stub under combined axial and shear loads is lower than that of the T-stub under axial load. We introduce a factor χCL to propose a formula to predict the first yield resistance of HSS T-stub by considering the effect of combined axial and shear loads.

Postbuckling capacity of plate girders still occurs after the occurrence of local buckling in the web panel. The postbuckling capacity of mild steel plate girders gradually develops because mild steel exhibits a clear yielding point and a yielding plateau. However, there are no clear yielding points nor distinct yielding plateaus for the high-strength steel (HSS) Q550 and Q690. Even though the postbuckling shear resistance is considered for the mild steel plate girder design in many international design codes, the design formula suggested for mild steel plate girders might not be suitable for HSS plate girders. The objective of this research is to quantify the shear resistance for HSS plate girders. The buckling strength and postbuckling capacity of HSS plate girders are investigated in this study by performing the nonlinear finite element analyses (FEA) that includes the tested material properties. The tested stress–strain curves of HSS Q550 and Q690 are idealized by bilinear and multilinear models. This shows that the strain hardening do have an effect on the postbuckling capacities of HSS plate girders. Therefore, a more accurate multilinear material model is selected for further FEA on the shear resistance of plate girders. The differences between the FEA and EC3 formulae outcomes are notably identified. Based on the numerical studies, a new buckling coefficient formula and a new ultimate shear resistance formula for HSS plate girders are proposed in the study.

Aims To investigate a partnership intervention of the community-based and hospital-based home visit to improve patients' satisfaction. Methods A time series quasi-experimental quantitative design was used. The experimental group had “partnership intervention”, while the control group maintained routine home visits. Patient satisfaction was measured pre-intervention, six months and 12 months after the partnership intervention. Results Six and 12 months after partnership intervention, in the experimental group, items related to stabilizing disease conditions, improving daily living abilities, enhancing communication ability and providing relevant resources were significantly higher than pre-intervention. However, 12 months after the intervention, the influence of the intervention became weaken. Conclusions The partnership intervention can significantly improve patients' satisfaction with home visit service.

Radiation therapy for cancer can lead to off-target toxicity and can be ineffective against hypoxic solid tumours and distant metastases. Here, we show that intratumoral injection, in mouse and rabbit xenografts and in patient-derived mouse xenografts, of a sodium alginate formulation containing catalase (Cat) labelled with the therapeutic 131I radioisotope enables long-term relief of tumour hypoxia and complete tumour elimination at low radioactivity doses. On injection, the soluble polysaccharide rapidly transforms into a hydrogel in the presence of endogenous Ca2+, fixing 131I-Cat within the tumours. We also show that local radiotherapy with a formulation that includes the immunostimulatory CpG oligonucleotide combined with systemic checkpoint-blockade therapy using an anti-CTLA-4 antibody leads to metastasis inhibition and protection against tumour rechallenge. The local therapy, which uses only biocompatible components, might enable new strategies for local tumour treatments that can be combined with systemic therapeutic responses, for the inhibition of tumour metastasis and the prevention of tumour recurrence in patients with advanced-stage cancer.

Background Human papillomavirus (HPV) associated cervical cancer is one of the most common cancers and ranked as the eighth most common killer for Chinese women. A dozen of HPV vaccines are being developed in China without a solid China-specific distribution of carcinogenic HPV types, thus, we performed this systematic review to explore the China-specific spectrum of high-risk types causing cancer. Methods Studies on HPV infection among Chinese women were searched. All retrieved articles were screened and reviewed by a standardized algorithm. Distribution of carcinogenic HPV types and age-specific prevalence were analyzed using random-effects model. Results A total of 303 articles were included in the final analysis. The top 10 common HPV types detected in ICC patients, in descending order of frequency, were HPV 16 (62.5%), 18 (12.4%), 58 (8.6%), 52 (5.7%), 33 (4.6%), 31 (3.5%), 55 (2.4%), 68 (2.4%), 53 (2.2%) and 45 (2.0%) respectively. Similar spectrum was found in women with precancer. The prevalence of HPV infection peaked between 20 and 24 years with a rate of 24.3%, thereafter declined substantially and stabilized at middle-ages. Compared to women living in the developed provinces, the second peak was observed among women aged 45–55 years in less developed regions. Conclusion In general, the spectrum of HPV types in women with precancer/cancer and the pattern of age-specific prevalence were consistent with that of elsewhere worldwide. However, some distinguished characteristics could also be concluded, and these imprinting should be considered and integrated when developing vaccines and strategy for disease control in China.

Virus-like particles encapsulating HBV-RNA represent a serum biomarker for assessing viral replication activity in clinical practice. However, baseline levels of serum HBV-RNA and their associations with viral replicative intermediates and liver disease in phases of chronic hepatitis B remain unknown. In this cross-sectional study, 102 patients were categorized into immune-tolerant (IT), HBeAg-positive immune active (HBeAg+IA), inactive carrier (IC) and HBeAg-negative immune active (HBeAg-IA) phases. HBV-RNA in serum samples and in 66 paired liver biopsies were quantified and correlated with serum ALT levels, histopathological scores and the levels of other viral replicative intermediates. Mean levels of serum HBV-RNA differed among phases, with the highest levels among IT (6.78 ± 0.83 log10 copies mL-1 ) patients, followed by HBeAg+IA (5.73 ± 1.16 log10 copies mL-1 ), HBeAg-IA (4.52 ± 1.25 log10 copies mL-1 ) and IC (2.96 ± 0.40 log10 copies mL-1 ) patients. Serum HBV-RNA levels correlated with HBV DNA in all phases, although correlations with other viral replicative intermediates weakened or disappeared when cases were stratified into phases. Distinct compositions of viral products were found among phases: the ratio of HBsAg to serum HBV-RNA was highest in IC patients, while the ratio of serum HBV-RNA to intrahepatic HBV-RNA and the ratio of intrahepatic HBV-DNA to intrahepatic HBV-RNA were significantly higher in IT patients. In conclusion, baseline levels of HBV-RNA and the composition of viral replicative intermediates differ significantly across the natural course of chronic HBV infection. These findings shed light on the nature of viral replication and pathogenesis of disease among different phases of chronic HBV infection.

Aims and objectives To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. Background Marital satisfaction of prostate cancer patients has been insufficiently studied in Asian countries as compared with Western countries. Design This study used a prospective and repeated-measures design. Methods Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour, and psychological distress were conducted. Multiple linear regression was used to analyse the data. Results The marital satisfaction of prostate cancer patients and that of their spouses were significantly correlated. At 6 months, spouses’ marital satisfaction, patients’ appraisal of prostate cancer as a threat, and patients’ serum prostate-specific antigen (PSA) levels were found to be the predictors of patients’ marital satisfaction. Furthermore, patients’ marital satisfaction and their spouses’ psychological distress were predictors of spouses’ marital satisfaction. At 12 months, spouses’ marital satisfaction and patients’ appraisal of prostate cancer as harm were predictors of patients’ marital satisfaction. Finally, spouses’ marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses’ marital satisfaction. Conclusions At 6 months post-treatment, patients’ and spouses’ marital satisfaction will influence each other. However, at 12 months, patients’ marital satisfaction exerts an insignificant effect on spouses’ marital satisfaction. Moreover, patients’ serum PSA level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses’ marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. Relevance to clinical practice The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples’ appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction. This article is protected by copyright. All rights reserved.

In practical engineering, the probability distributions of some random variables are often unknown, and the only available information about these may be their statistical moments. To conduct structural reliability assessment without the exclusion of random variables with unknown probability distributions, an explicit fourth-moment standardization function has been proposed, and a single expression of its inverse transformation, that is, normal transformation, with limitations of inputting sets of the third and fourth moments (skewness and kurtosis) of random variables was derived. However, the clear definition of the complete expressions of the inverse transformation of fourth-moment standardization function under different combinations of skewness and kurtosis of random variables has not been provided yet. It is in this regard that four criteria are proposed to derive the complete inverse transformation of fourth-moment standardization function, and then the complete expressions of the inverse transformation are formulated. Through the numerical examples presented, the proposed complete expressions are found to be quite efficient for normal transformations and to be sufficiently accurate to include random variables with unknown probability distributions in structural reliability assessment.

Summary Background To understand the epidemiology and disease burden of norovirus (NoVs) gastroenteritis in China, a systematic review was conducted. Methods Studies on acute gastroenteritis (AGE) caused by NoVs from mainland China, published before 2017 were searched. All retrieved articles were screened and reviewed by a standardized algorithm. NoVs detection rates as well as strain variations by ages, seasonal variations and geographic locations were analyzed using random-effects model. Results A total of 225 articles were included in the final analysis. Similar detection rates at 21.0% and 19.8% were obtained from the North and the South, respectively. NoVs infection occurred year round, with a peak between October and January in the North and between August and November in the South. High detection rates (∼29%) of NoVs were found in adults and the elderly and in children aged 6–35 months (∼22%). The predominant strains were GII.4 (70.4%), followed by GII.3 (13.5%). Conclusion NoVs cause significant disease burden in China which warrants development of vaccines against NoVs, particularly for children and the elderly who are vulnerable to gastroenteritis diseases. To achieve a broad protection, continual monitoring NoV epidemics and strain variations for selection of proper vaccine strains is critical.

Development of biocompatible/biodegradable materials with multiple functionalities via simple methods for cancer combination therapy has attracted great attention in recent years. Herein, paclitaxel (PTX), a popular anti-tumor chemotherapeutic drug, is used to induce the self-assembly of human serum albumin (HSA) pre-labeled with radionuclide I-131, obtaining 131I-HSA-PTX nanoparticles for combined chemotherapy and radioisotope therapy (RIT) of cancer. Such 131I-HSA-PTX nanoparticles show prolonged blood circulation time, high tumor specific uptake and excellent intra-tumor penetration ability. Interestingly, as revealed by in vivo photoacoustic imaging and ex vivo immunofluorescence staining, PTX delivered into the tumor by HSA-nanoparticle transportation can remarkably enhance the tumor local oxygen level and suppress the expression of HIF-1α, leading to greatly relieved tumor hypoxia. As the results, the combined in vivo chemotherapy & RIT with 131I-HSA-PTX nanoparticles in the animal tumor model offers excellent synergistic therapeutic efficacy, likely owing to the greatly modulated tumor microenvironment associated with PTX-based chemotherapy. Therefore, in this work, a simple yet effective therapeutic agent is developed for synergistic chemo-RIT of cancer, promising for future clinic translations in cancer treatment.

Background Primary squamous cell carcinoma of the breast (PSCCB) is a rare clinical classification of breast tumors. Little is known about its clinicopathological features, prognosis and potential therapeutic strategies. The purpose of this study is to evaluate the effect of postoperative radiotherapy (PORT) on patients with squamous cell carcinoma (SCC) of the breast. Methods We retrospectively analyzed patients diagnosed with PSCCB in our center. All pathological slides were reviewed by an experienced pathologist to confirm the diagnosis. Furthermore, we searched the public database for patients with SCC of the breast. Then, we analyzed the clinicopathological features, treatment methods and patient outcomes. Results We identified 14 patients with primary SCC of the breast in our center. Additionally, 739 patients with SCC of the breast from the Surveillance, Epidemiology and End Results (SEER) database were diagnosed between 1975 and 2016. Only 453 patients who underwent surgery were included in this study. Patients from the SEER database had a more advanced tumor node metastasis (TNM) stage than patients from our center. The median overall survival (OS) of all patients was 104 months (95% confidence interval [CI], 87.2-120.8 months), and the 5-year OS was 60.8% (95% CI, 56.1%-65.5%). Most of the patients (58%) tested negative for hormonal receptor expression. Multivariate analysis showed that PORT was an independent prognostic factor for OS. Conclusion The results of our study demonstrate that SCC of the breast presents aggressive behavior with unique clinical characteristics. PORT improved OS significantly in patients with SCC of the breast. Longer-term studies are needed to confirm our findings.

Objective: To evaluate the hemostasis and coagulation effect of Hemocoagulase Bothrops Atrox in benign prostatic hyperplasia (BPH) patients undergoing transurethral bipolar plasmakinetic prostatectomy (TUPKP).Methods: This study adopted a multicenter, prospective, and real world design. BPH patients undergoing TUPKP were divided into two groups according to whether they adopted Hemocoagulase Bothrops Atrox (group B) or not (group A) during perioperative period. The electronic clinical data on every included subject, including the international prostate symptom score (IPSS) and the quality of life scale (QoL), maximum urinary flow rate (Qmax), complete blood count, coagulation screening test and adverse events, were measured and compared between the two groups.Results: Finally, 695 patients, 443 in group A and 252 in group B were included. Baseline characteristics showed no significant difference between two groups. In group A, compared with baseline, IPSS decreased 15.66 (95% CI = −16.45 to −14.87), QoL decreased 3.08 (95% CI = −3.30 to −2.87), prothrombin time prolonged 1.02 s (95% CI = 0.56 to 1.48), while white blood cells, neutrophils, lymphocytes, and hemoglobin also significantly changed; white blood cells, neutrophils and platelets increased, while lymphocytes decreased by 0.14×109/L (95% CI = −0.21 to −0.08) before discharge. In group B, compared with baseline, IPSS decreased 16.12 (95% CI = −17.02 to −15.21), QoL decreased 3.32 (95% CI = −3.56 to −3.07), and white blood cells, neutrophils, lymphocytes, and hemoglobin were also significantly changed, along with white blood cells and lymphocytes that tested before discharge (p < 0.01); however, prothrombin time was not significant prolonged (MD= 0.48, 95% CI = −0.05 to 1.01). When compared with group A and group B, the average hospitalization time in group A was longer than group B (p < 0.01), transfusion risk was similar in the two groups (OR = 1.582, 95% CI = 0.552 to 4.538). Parameters had no substantial difference between the two subgroups whether prostate volume was more than 80 mL or not.Conclusion: Our study indicated that Hemocoagulase Bothrops Atrox can shorten the prothrombin time, hospitalization time and is probably safe among BPH patients undergoing TUPKP, exhibiting fine hemostasis and coagulation efficacy, and would not be influenced by prostate volume.

To understand the effectiveness of a couple-based psychosocial information package (PIP) and multimedia psychosocial intervention (MPI) on patients with prostate cancer and their partners.A random assignment and quasi-experimental design were used.From August 2015-March 2018, 103 newly diagnosed patients with prostate cancer and their partners were divided into a control group (CG) (N = 50), PIP group (N = 25) and MPI group (N = 28). The CG received usual care, the PIP group received information manuals and telephone counselling for 6-week and the MPI group received multimedia films and manuals and professional support for 6 weeks. The three groups were posttested 6, 10, 18 and 24 weeks after the pre-test. The outcome measurements included disease appraisals, emotion status, relationship satisfaction, health-related quality of life (HRQOL) and satisfaction with MPI.Partners in the MPI and PIP groups experienced significant improvements in positive and negative affect or mental HRQOL as compared with the CG. The effectiveness of MPI and PIP on negative affect, mental HRQOL, however, were not statistically significant in patients with prostate cancer. Nevertheless, patients were satisfied with the MPI.Nurses can provide different types of interventions for partners, depending on personal preferences and available resources.There is a lack of studies that focus on the effectiveness of couple-based psychosocial intervention on both the patients with prostate cancer and their partners in Asia. Partners in the multimedia psychosocial intervention group and psychosocial information package group experienced improvements in positive affect, negative affect or health-related quality of life as compared with the control group. Patients in both intervention groups experienced similar negative affect and health-related quality of life as compared with the control group. The couple-based psychosocial interventions can be provided by nurses based on partners' preferences and available resources.目的: 了解基于夫妇的心理社会信息包（PIP）和多媒体心理社会干预（MPI）对前列腺癌患者及其伴侣的治疗效果。 设计: 采用随机分配和准实验设计。 方法: 从2015年8月至2018年3月，将103位新诊断的前列腺癌患者及其伴侣分为对照组（CG）（N = 50）、PIP组（N = 25）和MPI组（N = 28）。对照组接受常规护理，PIP组接受为期6周的信息手册和电话咨询，MPI组接受为期6周的多媒体电影、手册以及专业支持。在预测试后的第6、10、18和24周对这三组进行后测试。结果测量包括疾病评估、情绪状态、关系满意度、健康相关生活质量（HRQOL）和MPI满意度。 结果/发现: 与对照组相比，MPI组和PIP组的伴侣在积极和负面影响或心理HRQOL方面都有显著改善。MPI组和PIP组队前列腺癌患者的负面情绪、精神生活质量的影响在统计学不显著。然而，患者对MPI很满意。 结论: 护士可以根据个人喜好和可用资源为伴侣提供不同类型的干预措施。 影响: 在亚洲，目前还缺乏对前列腺癌患者及其伴侣进行基于夫妇的心理社会干预效果的研究。与对照组相比，多媒体心理社会干预组和心理社会信息包组的伴侣在积极情感、消极情感或健康相关的生活质量方面有所改善。与对照组相比，两个干预组的患者经历相似的负面影响和与健康相关的生活质量。护士可以根据伴侣的喜好和可用资源提供基于夫妇的心理社会干预。.