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Objective: This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. Methods: A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low‐transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non‐ultrasonographic factors from five hospitals between 2018 and 2019. Results: A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non‐ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674–0.764) and 0.774 (95% confident interval 0.712–0.837), respectively. Conclusion: Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC. Synopsis: Our VBAC nomogram based on obstetric factors and fetal abdominal circumference determined by ultrasound could be used to counsel women who are considering TOLAC. [ABSTRACT FROM AUTHOR]

In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n = 145) or spinal anaesthesia (SA group; n = 131) or epidural anaesthesia (EA group; n = 116) were reviewed retrospectively. The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p <.0001, q = 17.0350) and EA (104.01 ± 12.77 sec/patient vs. 147.03 ± 18.76 sec/patient, p <.0001, q = 26.7240) groups. The time to reach to stone for patients of GA group was fewer than those of SA (126.68 ± 12.59 sec/patient vs. 137.60 ± 17.84 sec/patient, p <.0001, q = 8.4510) and EA (126.68 ± 12.59 sec/patient vs. 149.44 ± 14.85 sec/patient, p <.0001, q = 17.0350) groups. The lithotripsy time (p =.359), operation time (p =.449), intraoperative complications (p =.058), and length of hospital stays (p =.057) of patients were same among groups. Visual analog scale pain scores of patients of the GA group found higher among groups. General anaesthesia caused nausea and vomiting. This study suggests general anaesthesia for flexible ureterorenoscopy if there is no contraindication. General anaesthesia facilitates early dilatation of ureters and access to the stone. No strong correlation of the anaesthesia method of choice with lithotripsy time, operation time, intraoperative complications, stone-free conditions, and length of hospital stays. Epidural and spinal anaesthesia have advantages of fewer postoperative pain and better postoperative outcomes for flexible ureterorenoscopy. [ABSTRACT FROM AUTHOR]

Red-bed argillaceous sandstone is a typical soft rock with swelling characteristics and is prone to cause problems in engineering geology such as dilation deformation when used in high-speed railway subgrades or uneven settlement when used in foundations. This potential impact emphasizes the importance of understanding the long-term dilation and contraction of red-bed soft rocks. To thoroughly study the dilation properties of red-bed soft rock, the evolution of red-bed argillaceous sandstone dilation over time was characterized through a series of tests. The red-bed argillaceous sandstone dilation has a conspicuous time effect, and the dilatability shows an increasing reverse sigmoidal curve with increasing time. The dilation deformation gradually increases with increasing dry–wet cycle number until the shrinkage deformation offsets the dilation deformation, finally reaching a balance between dilation and shrinkage. Here, the microscopic mechanism of red-bed argillaceous sandstone dilation was revealed by qualitative analysis of microscopic unit particles and quantitative analysis of microscopic pores. A logistic evolution model was established based on molecular microkinetics, with the inflection point (t 0) and slope (p) of the dilation curve. The mathematical significance and applicability of the logistic model were verified by model comparison, model application and parametric analysis. The dilation scale and velocity were determined to be restrained by the axial load, and the decrease in the gap between dilation-time curves indicated that the inhibitory effect of the axial load on the expansion potential was nonlinear; with the same axial load increment, this effect weakened with increasing load. Finally, a three-dimensional dilation constitutive model considering the microkinetic time model was proposed to amend the traditional one-dimensional dilation model, and the practicality of this three-dimensional model was evaluated against measured data. The results provide a theoretical reference for solving argillaceous sandstone swelling problems in water-rich red-bed rock and determining the long-term deformation mechanism of high-speed railway subgrades. • Logistic distribution curve describes the evolution of the dilation with time. • Face-face connections have the most favourable spatial arrangement for expansion. • Dilation scale and velocity were determined to be restrained by axial loading. • A three-dimensional dilation constitutive model considering time effect was proposed. [ABSTRACT FROM AUTHOR]

Background: In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. Methods: Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n=145) or spinal anaesthesia (SA group; n=131) or epidural anaesthesia (EA group; n=116) were reviewed retrospectively. Results: The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p<.0001, q=17.0350) and EA (104.01 ± 12.77 sec/patient vs. 147.03 ± 18.76 sec/patient, p<.0001, q=26.7240) groups. The time to reach to stone for patients of GA group was fewer than those of SA (126.68 ± 12.59 sec/patient vs. 137.60 ± 17.84 sec/patient, p<.0001, q=8.4510) and EA (126.68 ± 12.59 sec/patient vs. 149.44 ± 14.85 sec/patient, p<.0001, q=17.0350) groups. The lithotripsy time (p<.359), operation time (p<.449), intraoperative complications (p<.058), and length of hospital stays (p<.057) of patients were same among groups. Visual analog scale pain scores of patients of the GA group found higher among groups. General anaesthesia caused nausea and vomiting. Conclusions: This study suggests general anaesthesia for flexible ureterorenoscopy if there is no contraindication. [ABSTRACT FROM AUTHOR]

Study Question: Does osteoprotegerin (OPG) promote human endometrial stromal decidualization?Summary Answer: OPG is essential for human endometrial stromal decidualization through its interaction with syndecan-1 to decrease Akt phosphorylation.What Is Known Already: OPG (a cytokine receptor) levels are significantly increased in the circulation of pregnant women. However, the role and mechanism of OPG in human endometrial stromal cell (ESC) decidualization remain elusive.Study Design, Size, Duration: We analyzed the endometrial expression of OPG in endometrial tissue samples collected from women with regular menstrual cycles (ranging from 25 to 35 days), and decidual tissue samples collected from woman with normal early pregnancy or recurrent pregnancy loss (RPL) who visited the Department of Gynecology and Obstetrics at a tertiary care center from January to October 2018. None of the subjects had hormonal treatment for at least 3 months prior to the procedure. In total, 16 women with normal early pregnancy and 15 with RPL were selected as subjects for this study. The function of OPG in decidualization was explored in a human endometrial stromal cell (HESC) line and primary cultures of HESCs.Participants/materials, Setting, Methods: We collected endometrial tissues (by biopsy) from the subjects during their menstrual cycle and decidual tissues from subjects with a normal early pregnancy and those with RPL at the time of dilation and curettage. The control group comprised randomly selected women who underwent termination of an apparently normal early pregnancy. The endometrial OPG expression was analyzed using immunohistochemical staining and quantitative RT-PCR (qRT-PCR). Immunofluorescence staining and western blot, and qRT-PCR were used to explore the mRNA and protein expression, respectively, of OPG in an immortalized HESC line and in primary cultures of HESC during proliferation and decidualization. siRNA-mediated knockdown experiments were performed to examine the function of OPG in HESC proliferation and decidualization. Flow cytometry and the cell proliferation MTS assay were performed to further examine the role of OPG in HESC proliferation. We also analyzed decidual marker gene expression by qRT-PCR to assess the consequences of OPG loss for HESC decidualization. A co-immunoprecipitation (IP) assay was used to determine the potential interaction between the OPG and Syndecan-1. Western blot analysis of the rescue experiments performed using the phosphatidylinositol 3-kinase (PI3K) signaling-specific inhibitor LY294002 was used to investigate the downstream signaling pathways through which OPG could mediate HESC decidualization.Main Results and the Role Of Chance: OPG was expressed in both the human endometrium and in vitro decidualized ESCs. Knockdown experiments revealed that OPG loss impaired the expression of IGF-binding protein-1 (IGFBP-1) (P < 0.05) and prolactin (PRL) (P < 0.05), two specific markers of decidualization, in HESC undergoing decidualization. We also uncovered that OPG knockdown induced the aberrant activation of Akt (protein kinase B) during HESC decidualization (P < 0.05). The inhibition of Akt activation could rescue the impaired expression of the decidual markers PRL (P < 0.05) and IGFBP-1 (P < 0.05) in response to OPG knockdown. Syndecan-1 was considered a potential receptor candidate, as it was expressed in both the endometrium and in vitro cultured stromal cells. Subsequent co-IP experiments demonstrated the interaction between OPG and Syndecan-1 during decidualization. In addition, Syndecan-1 knockdown not only clearly attenuated the decidualization markers PRL (P < 0.05) and IGFBP-1 (P < 0.05) but also induced the aberrant enhancement of Akt phosphorylation in decidualized cells, consistent with the phenotype of OPG knockdown cells. Finally, we revealed that the transcript and protein expression of both OPG and Syndecan-1 was significantly lower in the decidual samples of women with RPL than in those of women with normal pregnancy (P < 0.05).Large Scale Data: N/A.Limitations, Reasons For Caution: In this study, based on a number of approaches, it was demonstrated that OPG mediated the repression of Akt that occurs during human stromal cell decidualization, however, the molecular link between OPG and Akt signaling was not determined, and still requires further exploration.Wider Implications Of the Findings: OPG is required for decidualization, and a decrease in OPG levels is associated with RPL. These findings provide a new candidate molecule for the diagnosis and potential treatment of RPL.Study Funding/competing Interest(s): This work was supported in part by the National Natural Science Foundation of China U1605223 (to G.S.), 81701457 (to Y.J.) and 81601349 (to Y.J.). The authors have no conflicts of interest to disclose. [ABSTRACT FROM AUTHOR]

The 'innovation paradox' refers to the coexistence in the West over the last five decades of a steady decrease in the growth of productivity with the increase in the quantity of available information. These trends, which started with the invention of the internet, call for revisiting mainstream endogenous growth theory in an age dominated by information and communication technology. The weakness of the arguments used to justify the paradox, the unorthodox comparison with China and the history of the industrial revolutions point to the technological obsolescence of liberal democracy as the real explanation for the paradox. A debate on how to adapt Western institutions to a radically new context is launched. [ABSTRACT FROM AUTHOR]

As one of the most popular online media in China, personal livestreaming attracts massive attention and effects on human social communication in multiple novel ways. This article explores the semiotic mechanism of the barrage, a special form of commenting, on China's livestreaming platforms. Drawing on cultural semiotic theories, it discusses the impact of the barrage by the fandom of China's livestreaming. Two interrelated semiotic paradoxes are created by two interrelated forms of markedness from the use of the barrage by Chinese livestreaming fans, that is, the markedness of time and the markedness of space. Through careful assessment of the use of the barrage in China's livestreaming fandom, this article sheds new light on China's livestreaming and its potential impact on the future of digital China. [ABSTRACT FROM AUTHOR]

There are only a few related studies focused on the steam assisted gravity drainage (SAGD) dilation start-up technology (termed as dilation start-up in this paper), especially with true triaxial stress physical modelling experiments in the laboratory. Therefore, in order to better understand the dilation start-up process, four large-scale (1050 mm × 410 mm × 410 mm) true triaxial experiments of SAGD start-up with dual horizontal wells were conducted for the first time by using the oil sands from the Xinjiang oilfield, northwest China. The dilation process characterized by temperature changes at different positions inside the experimental samples was monitored in real time. The performance differences between dilation start-up and conventional start-up were discussed in detail, and the effects of dilation pressure and dilation time on the dilation process were also studied. The experimental results indicate that dilation start-up can significantly reduce the well communication time between injector and producer, and enhance the range of dilation zone and improve the uniformity of dilation zone along the horizontal wellbores. Moreover, we find that dilation pressure is an essential factor influencing the dilation effect. The average communication parameter increases by 5% if dilation pressure increases by 10% whereas the standard deviation of communication parameter decreases. The evolution of dilation zone with time shows that long-time dilation prompts the uniform propagation of dilation zone along the horizontal wellbores. This study provides guidance for the optimization of SAGD dilation start-up in shallow heavy oil reservoirs. • Four large-scale true triaxial experiments of SAGD start-up with dual horizontal wells were conducted. • Dilation process characterized by temperature changes inside the samples was monitored in real time. • Effects of dilation pressure and dilation time on the SAGD dilation start-up were studied. [ABSTRACT FROM AUTHOR]

Abstract: We propose a test of the gravitational time dilation in general relativity by long term clock comparison between two stations separated in height. The geopotential difference between the two National time keeping centers in China, Lintong and Beijing is around 4000 geopotential unit, which corresponds to the height difference of 400m. Two clocks and are fixed at stations A and B, respectively, which are synchronized at beginning by a portable clock C in a short time period with go-back synchronization approach. After one month, the clock C is again transported between A and B, comparing the records of the keeping time by clocks and , respectively. Calculations show that, after one month, the difference of the time durations between the clocks and is around 121ns, if general relativity is correct. [Copyright &y& Elsevier]