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Background: Achieving COVID-19 community protection (aka, herd immunity) in China may be challenging because many individuals remain unsure or are unwilling to be vaccinated. One potential means to increase COVID-19 vaccine uptake is to essentially mandate vaccination by using existing mobile technologies that can prohibit unvaccinated individuals from certain public spaces. The "Health Code" is a ubiquitous mobile phone app in China that regulates freedom of travel based on individuals' predicted risk of exposure to SARS-CoV-2. Green-colored codes indicate ability to travel unrestricted in low-risk regions; yellow-colored codes indicate prohibition from major public spaces and modes of public transportation. We examined the effects of a "Health Code"-based vaccine mandate on willingness to vaccinate for COVID-19 in China., Methods: In August 2020, an online discrete choice experiment (DCE) was conducted among adults living in China. Participants completed up to six DCE choice sets, each containing two hypothetical COVID-19 vaccination scenario choices and a "do not vaccinate" choice. Half of the choice sets had a "Health Code" attribute that associated the "do not vaccinate" choice with a yellow Health Code implying restricted travel. Weighted, mixed effects multinomial logit regression was used to estimate preference utilities and predicted choice probabilities., Results: Overall, 873 participants completed 4317 choice sets. Most participants attained at least college-level education (90.9%). 29.8% of participants were identified as vaccine hesitators (defined as being unsure or unwilling to receive a COVID-19 vaccination). With and without the "Health Code"-based vaccine mandate, there was an 8.6% (85% CI: 6.4% - 10.92%) and 17.3% (85% CI:13.1% - 21.6%) respective predicted probability that vaccine hesitators would choose "do not vaccinate" over a common vaccination scenario currently in China (i.e., free, domestic vaccine, 80% effectiveness, 10% probability of fever side-effects, administered in a large hospital, two doses). Corresponding predicted probabilities for people who did not express vaccine hesitancy was 0.3% (93% CI: 0.0% - 14.3%) and 3.5% (93% CI:2.3% - 4.8%). The "Health Code"-based mandate significantly increased willingness to vaccinate when vaccine efficacy was greater than 60%., Conclusion: Among vaccine hesitators with higher educational attainment, willingness to vaccinate for COVID-19 appears to increase if mobile technology-based vaccine mandates prohibit unvaccinated individuals from public spaces and public transportation. However, such mandates may not increase willingness if perceived vaccine efficacy is low., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: To conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for congenital heart disease (CHD)., Methods: Every newborn in a large maternity healthcare center received auscultation and POX screening within 24 hours after delivery. When an abnormal heart murmur or SpO 2 level was detected, an echocardiogram was ordered to confirm the diagnosis of CHD., Results: From January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 suspected CHD were identified: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result put forth an overall diagnosis rate of 92.0%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 74.07% in positive predict value (PPV). On the other hand, auscultation functioned well in terms of PPV and negative predict value (NPV) (92.99 and 99.95%, respectively), but the addition of POX improved the overall screening performance resulting in 100% NPV. We also validate the finding with the data 6 months after the study period., Conclusion: Our study demonstrated that addition of pulse oximetry to routine cardiac auscultation could be used as an accurate and feasible screening for early screening of CHD in newborns in large-scale clinical practice., (© 2022. The Author(s).)

Effects of religion, spirituality and supernatural beliefs (RSS) upon health in mainland China remain poorly understood, despite strong RSS beliefs influencing Chinese society. We conducted a Chinese-English bilingual systematic review to summarize the state of RSS-health research in mainland China. Study quality was assessed using the Critical Appraisal Skills Program tool. We screened 1858 studies, 162 of which were included in the review. From 2000-2004 to 2015-2019, the number of RSS-health studies in China increased from five to 73. However, only 7% of studies were rated as higher quality. Cross-sectional and case-control studies represented the vast majority of study designs (94%) and religious affiliation was the only RSS measure for 58% of studies. Higher, moderate, and lower quality studies indicated that RSS has both beneficial and adverse health implications. RSS-health research in China has accelerated rapidly in the last 20 years, but fundamental gaps in knowledge remain. Longitudinal study designs and nuanced RSS measures are needed to advance understanding of RSS health effects in China., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Macrophages are one of the important cells in immune system. In this article, we aim to explore the regulatory role of miR-455-3p on proliferation and osteoblast differentiation of RAW264.7 cells., Methods: Expression levels of genes and proteins in cells were tested via qRT-PCR and western blot. The targeted correlation between miR-455-3p and PTEN was identified by luciferase analysis. MTT assay and flow cytometry were applied to detect the proliferation and apoptosis of cells. Osteoclastogenesis was completed by stimulating RAW 264.7 cells with RANKL. Tartrate-resistant acid phosphatase (TRAP) activity in different groups of cells were assessed., Results: Firstly, we determined that up-regulation of miR-455-3p promoted the proliferation and inhibited apoptosis of RAW 264.7 cells. MiR-455-3p deficiency played opposite effect in RAW 264.7 cells. Additionally, osteoclastogenesis-related factors (TRAP, CTSK and NFATc1) expression levels were remarkably up-regulated in miR-455-3p-mimic group of RAW264.7 cells treated with RANKL, but decreased in inhibitor group. Luciferase assay proved that miR-455-3p targeted PTEN. We took a further step and found overexpression of PTEN significantly inhibited the increased proliferation and osteoblast differentiation of RAW264.7 cells induced by miR-455-3p., Conclusions: Our findings supported basic to explore the molecular mechanism of proliferation and osteoblast differentiation of RAW264.7 cells., (© 2022. The Author(s).)

Background: Predictors of outcomes after reverse total shoulder arthroplasty (rTSA) remain unclear. The purpose of this study was to analyze the impact of preoperative muscle quality and postoperative implant positioning on patient-reported outcomes following rTSA., Methods: We evaluated 88 shoulders treated with rTSA in which preoperative magnetic resonance imaging was available. Preoperative muscle quality was evaluated, including fatty infiltration, rotator cuff muscle volume, and total tear size. Postoperative implant position was determined radiographically. The correlation between imaging parameters and the 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score was examined. Multivariate analyses were performed to adjust for confounding factors including patient demographic characteristics and implant position., Results: Univariate analysis showed that the ASES score was significantly lower in patients with teres minor muscle hypertrophy relative to those with normal muscle (73.3 ± 22.8 vs. 84.2 ± 16.9, P = .02). The functional subscore was significantly lower in patients with grade 2 fatty infiltration of the deltoid muscle relative to those with grade 0 fatty infiltration (26.1 ± 14.6 vs. 34.8 ± 11.6, P = .03). Older age was associated with a higher pain subscore (ρ = 0.32, P = .002). Multivariate analysis demonstrated that teres minor muscle hypertrophy remained a significant independent predictor of the ASES score (β coefficient = 91.3, P = .03)., Conclusion: Teres minor muscle hypertrophy is an independent negative predictor of patient-reported outcomes after rTSA., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the effect of surgical resection and stereotactic biopsy on the complication rate, progression-free survival (PFS) and overall survival (OS) of 70 patients diagnosed at a single institution with primary central nervous system lymphoma (PCNSL) and to explore the predictors of selection for resection and the prognostic factors of PCNSL., Methods: A retrospective analysis was performed of 70 patients with PCNSL that was diagnosed by surgical resection or stereotactic brain biopsy in our department from January 2013 to May 2019. We divided the patients into two groups: a resection group (n = 28) and a stereotactic biopsy group (n = 42). Data on clinical characteristics, imaging findings, complication rates, PFS and OS were retrospectively reviewed and compared between these two groups. We also analysed the predictors of selection for resection and prognostic factors of PCNSL by multivariate analysis., Results: The median age was 53.3 ± 14.3 years, and there was a male predominance with a sex ratio of 1.33:1. The most common clinical manifestation was a headache. The complication rate in the resection group was 10.7% versus 7.1% in the stereotactic biopsy group, and there was no statistically significant difference. The rate of improvement in symptoms of the resection group was significantly higher than that of the stereotactic biopsy group. Multivariable analysis identified a single tumour and not involving deep structures as predictors of selection for resection. With a median follow-up of 30 months (range 1-110), the mean OS and PFS of all patients were 16.1 months and 6.2 months, respectively. Patients who underwent surgical resection had a mean OS of 23.4 months and PFS of 8.6 months versus 11.2 months and 4.6 months for those who had a brain biopsy performed. In addition, multivariable analysis showed that not involving deep structures and resection were favourable prognostic factors for PCNSL., Conclusions: The outcomes of patients with PCNSL treated in our cohort are still poor. In our series, surgical resection might play a role in significantly improving OS and PFS compared with stereotactic biopsy in a subset of patients. The type of surgery and tumour location are prognostic factors for PCNSL.

Background: Single-cell RNA sequencing (scRNA-seq) was recently adopted for exploring molecular programmes and lineage progression patterns of pathogenesis of important diseases. In this study, scRNA-seq was used to identify potential markers for chondrocytes in osteoarthritis (OA) and to explore the function of different types of chondrocytes in OA., Methods: Here we aimed to identify the biomarkers and differentiation of chondrocyte by Single-cell RNA seq analysis. GeneOntology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to identify the function of candidate marker genes in chondrocytes. Protein-protein interaction (PPI) network was constructed to find the hub genes in 3 types of chondrocyte respectively. We also used qRT-PCR to detect the expression level of the candidate marker genes in different types of chondrocyte., Results: In this study, we characterized the single-cell expression profiling of 480 chondrocyte samples and found hypertrophic chondrocyte (HTC), homeostatic chondrocyte (HomC) and fibrocartilage chondrocyte (FC) respectively. The results of GO and KEGG analysis showed the candidate marker genes made specific function in these chondrocytes to regulate the development of OAs respectively. We further revealed the differential expression of top 10 marker genes in 3 types of chondrocyte. The marker genes of HTC and FC were mainly expressed in their cell subset respectively. The marker genes of HomC did not have obviously differential expression among different types of chondrocyte. Last, we predicted the key genes in each cell subset. CD44, JUN and FN1 were predicted tightly related to the proliferation and differentiation of chondrocytes in OAs and could be regarded as biomarkers to estimate the development of OA., Conclusion: Our results provide new insights into exploring the roles of different types of chondrocyte in OA. The biomarkers of chondrocyte were also valuable for estimating OA progression., Competing Interests: None., (AJTR Copyright © 2020.)

Water diversion project is always taken as the emergency and effective engineering measure to deal with the cyanobacterial blooms in eutrophic lakes. The inflow discharge and duration are the critical parameters influencing the effects and costs of the water diversion activities. Due to the impacts of meteorological and hydrological factors such as precipitation and wind-wave currents, the environmental influence of water diversion on shallow eutrophic lakes is always unclear. To explore the quantitative relationships among inflow discharges, duration and ecological parameters in water-receiving lakes, the typical water diversion engineering-Water Diversion Project from Yangtze River to Lake Taihu was taken as an example and the mesocosm experiment modeling the micro-ecosystem of the water-receiving Meiliang Bay in Lake Taihu was conducted with five groups of inflow discharges according to the practical discharges of the main river channel-Wangyu River. Each micro-ecosystem had a volume of 15 L and was studied for a period of 30 days (25 days for the water diversion period and 5 days for the stop period). The results showed that the inflow discharges had different extents of impact on the physicochemical and biological characteristics of the micro-ecosystems. The concentrations of total dissolved solids, total nitrogen, nitrate, active silicate and bacterial abundance in the experimental groups (inflow discharges > 100 m 3 /s) were all decreased compared with the control group, with the lowest values in the period of 10-15 days. During the stop period, the concentrations of sensitive biotic and abiotic parameters were all recovered with different extents and different from the initial state of this experiment, which revealed that the effects of the short-term water diversion on lake ecosystems were resilient and durable. There were quantitative relationships among the inflow discharge, content interpolation and variation in water nutrients, with different relationships in different periods of the water diversion. The influence of water diversion on lake ecosystems was not only related to the direct impacts of allochthonous inputs, but also with the indirect effects of internal habitat variation in lakes.

Chlorophyll-a (CHLA) is a key indicator to represent eutrophication status in lakes. In this study, CHLA, total phosphorus (TP), total nitrogen (TN), turbidity (TB), and Secchi depth (SD) collected by the United States Environmental Protection Agency for the National Lakes Assessment in the continental USA were analyzed. Statistical analysis showed that water quality variables in natural lakes have strong patterns of autocorrelations than man-made lakes, indicating the perturbation of anthropogenic stresses on man-made lake ecosystems. Meanwhile, adaptive neuro-fuzzy inference systems (ANFIS) with fuzzy c-mean-clustering algorithm (ANFIS_FC), ANFIS with grid partition method (ANFIS_GP), and ANFIS with subtractive clustering method (ANFIS_SC) were implemented to model CHLA in lakes, and modeling results were compared with the multilayer perceptron neural network models (MLPNN). Results showed that ANFIS_FC models outperformed other models for natural lakes, while for man-made lakes, MLPNN models performed the best. ANFIS_GP models have the lowest accuracies in general. The results indicated that ANFIS models can be screening tools for an overall estimation of CHLA levels of lakes in large scales, especially for natural lakes.

Objective: To investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures., Methods: Between January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Böhler angle, Gissane angle, visual analogue scale (VAS) core ( P >0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Böhler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness., Results: All the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups ( P >0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups ( t =0.30, P =0.77). The postoperative Böhler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation ( P <0.05); however, there was no significant difference in Böhler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation ( P >0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups ( P <0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation ( P >0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation ( t =1.46, P =0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group ( t =2.08, P =0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups ( χ 2 =1.98, P =0.16)., Conclusion: The modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.

River water temperature (RWT) forecasting is important for the management of stream ecology. In this paper, a new method based on coupling of wavelet transformation (WT) and artificial intelligence (AI) techniques, including multilayer perceptron neural network (MLPNN) and adaptive neural-fuzzy inference system (ANFIS) for RWT prediction is proposed. The performances of the hybrid models are compared with regular MLPNN and ANFIS models and multiple linear regression (MLR) models for RWT forecasting in two river stations in the Drava River, Croatia. Model performance was evaluated using the coefficient of correlation (R), the Willmott index of agreement (d), the root mean squared error (RMSE), and the mean absolute error (MAE). Results indicate that the combination of WT and AI models (WTMLPNN and WTANFIS) yield better models than the conventional forecasting models for RWT simulation for both regular periods and heatwave events. The MLPNN and ANFIS models outperform the MLR models for RWT simulation for the studied river stations. RMSE values of WTMLPNN2 and WTANFIS2 models range from 1.127 to 1.286 °C, and 1.216 to 1.491 °C for the Botovo and Donji Miholjac stations respectively. Additionally, modeling results further confirm the importance of the day of year (DOY) on the thermal dynamics of the river. The results of this study indicate the potential of coupling of WT and MLPNN, ANFIS models in forecasting RWT.

Objective: To compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures., Methods: A prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups ( P >0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength)., Results: The operation time of the trial group was significantly longer than that of the control group ( t =5.881, P =0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups ( t =0.764, P =0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups ( P >0.05)., Conclusion: The treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.

River water temperature is a key control of many physical and bio-chemical processes in river systems, which theoretically depends on multiple factors. Here, four different machine learning models, including multilayer perceptron neural network models (MLPNN), adaptive neuro-fuzzy inference systems (ANFIS) with fuzzy c-mean clustering algorithm (ANFIS&#95;FC), ANFIS with grid partition method (ANFIS&#95;GP), and ANFIS with subtractive clustering method (ANFIS&#95;SC), were implemented to simulate daily river water temperature, using air temperature (T a ), river flow discharge (Q), and the components of the Gregorian calendar (CGC) as predictors. The proposed models were tested in various river systems characterized by different hydrological conditions. Results showed that including the three inputs as predictors (T a , Q, and the CGC) yielded the best accuracy among all the developed models. In particular, model performance improved considerably compared to the case where only T a is used as predictor, which is the typical approach of most of previous machine learning applications. Additionally, it was found that Q played a relevant role mainly in snow-fed and regulated rivers with higher-altitude hydropower reservoirs, while it improved to a lower extent model performance in lowland rivers. In the validation phase, the MLPNN model was generally the one providing the highest performances, although in some river stations ANFIS&#95;FC and ANFIS&#95;GP were slightly more accurate. Overall, the results indicated that the machine learning models developed in this study can be effectively used for river water temperature simulation.

Geysers of air-water mixtures in urban drainage systems is receiving considerable attention due to public safety concerns. However, the geyser formation process and its relation with air release from pressurized pipes are still relatively little known. A large-scale physical model, that consisted of a main tunnel with a diameter of 270 mm and a length of 25 m connecting two reservoirs and a vertical vent pipe, was established to investigate geyser evolution and pressure transients. Experimental results including dynamic pressure data and high speed videos were analysed in order to characterize geysering flow through the vent pipe. Pressure transients were observed during geysering events. Their amplitudes were found to be about three times the driving pressure head and their periods were close to the classic surge tank predictions. The influence of flow rate and vent pipe size were examined: geyser heights and pressure peaks decreased for small flow rate and large diameter vent pipe. It is suggested that geyser heights are related with the pressure head and the density of the air-water mixture.

The mechanisms by which oxidative stress induces spinal cord neuron death has not been completely understood. Investigation on the molecular signal pathways involved in oxidative stress-mediated neuronal death is important for development of new therapeutics for oxidative stress-associated spinal cord disorders. In current study we examined the role of heme oxygenase-1 (HO-1) in the modulation of MLK3/MKK7/JNK3 signaling, which is a pro-apoptotic pathway, after treating primary spinal cord neurons with H 2 O 2 . We found that MLK3/MKK7/JNK3 signaling was substantially activated by H 2 O 2 in a time-dependent manner, demonstrated by increase of activating phosphorylation of MLK3, MKK7 and JNK3. H 2 O 2 also induced expression of HO-1. Transduction of neurons with HO-1-expressing adeno-associated virus before H 2 O 2 treatment introduced expression of exogenous HO-1 in neurons. Exogenous HO-1 reduced phosphorylation of MLK3, MKK7 and JNK3. Consistent with its inhibitory effect on MLK3/MKK7/JNK3 signaling, exogenous HO-1 decreased H 2 O 2 -induced neuronal apoptosis and necrosis. Furthermore, we found that exogenous HO-1 inhibited expression of Cdc42, which is crucial for MLK3 activation. In addition, HO-1-induced down-regulation of MLK3/MKK7/JNK3 signaling might be related to up-regulation of microRNA-137 (mir-137). A mir-137 inhibitor alleviated the inhibitory effect of HO-1 on JNK3 activation. This inhibitor also increased neuronal death even when exogenous HO-1 was expressed. Therefore, our study suggests a novel mechanism by which HO-1 exerted its neuroprotective efficacy on oxidative stress.

The aim of this study was to explore the effect of zinc on hydrogen peroxide-induced sperm damage in assisted reproduction techniques. First, sperms were selected from semen samples of 20 healthy men prepared by density gradient centrifugation. Selected sperm were treated with either 0.001% H(2)O(2), 12.5 nM ZnCL(2), 0.001% H(2)O(2) + 12.5 nM ZnCL(2) or 0.9% NaCl(2) (control). After this treatment, the motility, viability, membrane integrity and DNA fragmentation of sperms in each group were analysed by Goodline sperm detection system, optical microscopy and sperm DNA fragmentation assay. Poorer motility, vitality, membrane integrity and more DNA damage were found in sperms treated by H(2)O(2), compared with control. When sperms were treated with both H(2)O(2) and zinc, however, all indicators were improved compared with H(2)O(2) alone. There was a close association between oxidative stimulation and sperm injury; zinc could inhibit hydrogen peroxide-induced damage of sperm in assisted reproductive technology. However, the presence of zinc in culture medium can decrease the sperm quality without addition of peroxide., (Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)