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Objective: We propose a pedicled perforator flap technique for salvage nipple reconstruction after initial nipple reconstruction fails in breast cancer patients. Methods: This is a pilot study. A total of 21 female breast cancer patients who underwent nipple reconstruction following initial nipple reconstruction fails were enrolled, and salvage nipple reconstruction based pedicled perforator flap were performed between 2016 and 2020. Operative time, perforator design, postoperative complications, follow-up duration, projection of nipple, as well as patient-reported outcomes measured by the BREAST-Q and visual analogue scale (VAS) were assessed. Results: Sixteen patients underwent fifth lateral intercostal artery perforator reconstruction, while 5 patients underwent fifth anterior intercostal artery perforator flap reconstruction. The surgeries were successful without intraoperative complications, with a mean operative time of 67 minutes. Postoperative complications were absent. The mean follow-up duration was 18 months. The mean nipple projection was 8 mm (range, 6-10 mm) with a shrinkage of 20% at 6 months after surgery. The average scores for psychosocial well-being, satisfaction with breasts, and satisfaction with nipples domains of the BREAST-Q significantly increased (P <.01) at 6 months post-reconstruction. Sexual well-being subdomain showed no statistical difference (P =.9369). The VAS scores for cosmesis and patient satisfaction with surgery were 9 and 9.3, respectively. Conclusion: The pedicled perforator flap technique for salvage nipple reconstruction is a safe and effective approach. [ABSTRACT FROM AUTHOR]

The longitudinal trajectory planning of connected and autonomous vehicle (CAV) has been widely studied in the literature to reduce travel time or fuel consumptions. The safety impact of CAV trajectory planning to the mixed traffic flow with both CAV and human-driven vehicle (HDV), however, is not well understood yet. This study presents a reinforcement learning modeling approach, named Monte Carlo tree search-based autonomous vehicle safety algorithm, or MCTS-AVS, to optimize the safety of mixed traffic flow, on a one-lane roadway with signalized intersection control. Crash potential index (CPI) is defined to quantitively measure the safety performance of the mixed traffic flow. The CAV trajectory planning problem is firstly formulated as an optimization model; then, the solution procedure based on reinforcement learning is proposed. The tree-expansion determination module and rollout termination module are developed to identify and reduce the unnecessary tree expansion, so as to train the model more efficiently towards the desired direction. The case study results showed that the proposed algorithm was able to reduce the CPI by 76.56%, when compared with a benchmark model without any intelligence, and 12.08%, when compared with another benchmark model that the team developed earlier. These results demonstrated the satisfactory performance of the proposed algorithm in enhancing the safety of the mixed traffic flow., Author(s): Yanqiu Cheng [1,2]; Chenxi Chen [2]; Xianbiao Hu (corresponding author) [2]; Kuanmin Chen [1]; Qing Tang [2]; Yang Song [2] 1. Introduction Connected and automated vehicles (CAVs) have been [...]

Studies have been initiated to investigate the potential impact of connected and automated vehicles (CAVs) on transportation infrastructure. However, most existing research only focuses on the wandering patterns of CAVs. To bridge this gap, an apple-to-apple comparison is first performed to systematically reveal the behavioural differences between the human-driven vehicle (HDV) and CAV trajectory patterns for the first time, with the data collected from the camera-based next generation simulation dataset and autonomous driving co-simulation platform, CARLA and SUMO, respectively. A gradient boosting-based ensemble learning model for pavement performance (i.e. international roughness index) prediction is then developed with the input features including three driving pattern features, namely, lateral wandering deviation, longitudinal car-following distance and driving speed, plus 20 other context variables. A total of 1707 observations is extracted from the long-term pavement performance database for model training purposes. The result indicates that the trained model can accurately predict pavement deterioration and that CAV deteriorates pavement faster than HDV by 8.1% on average. According to the sensitivity analysis, CAV deployment will create a greater impact on the younger pavements, and the rate of pavement deterioration is found to be stable under light traffic, whereas it will increase under congested traffic. This article is part of the theme issue 'Artificial intelligence in failure analysis of transportation infrastructure and materials'. [ABSTRACT FROM AUTHOR]

This manuscript focused on analyzing electric vehicles' (EV) charging behavior patterns with a functional data analysis (FDA) approach, with the goal of providing theoretical support to the EV infrastructure planning and regulation, as well as the power grid load management. 5-year real-world charging log data from a total of 455 charging stations in Kansas City, Missouri, was used. The focuses were placed on analyzing the daily usage occupancy variability, daily energy consumption variability, and station-level usage variability. Compared with the traditional discrete-based analysis models, the proposed FDA modeling approach had unique advantages in preserving the smooth function behavior of the data, bringing more flexibility in the modeling process with little required assumptions or background knowledge on independent variables, as well as the capability of handling time series data with different lengths or sizes. In addition to the patterns revealed in the EV charging station's occupancy and energy consumption, the differences between EV driver's charging time and parking time were analyzed and called for the needs for parking regulation and enforcement. The different usage patterns observed at charging stations located on different land-use types were also analyzed., Author(s): Chenxi Chen [1]; Yang Song [1]; Xianbiao Hu (corresponding author) [1]; Ivan G. Guardiola [2] 1. Introduction Electric vehicles (EVs) produce fewer emissions that contribute to climate change and [...]

Abstract Background Fungal plant pathogens cause serious agricultural losses worldwide. Alternaria arborescens is a major pathogen of tomato, with its virulence determined by the presence of a conditionally dispensable chromosome (CDC) carrying host-specific toxin genes. Genes encoding these toxins are well-studied, however the genomic content and organization of the CDC is not known. Results To gain a richer understanding of the molecular determinants of virulence and the evolution of pathogenicity, we performed whole genome sequencing of A. arborescens. Here we present the de-novo assembly of the CDC and its predicted gene content. Also presented is hybridization data validating the CDC assembly. Predicted genes were functionally annotated through BLAST. Gene ontology terms were assigned, and conserved domains were identified. Differences in nucleotide usage were found between CDC genes and those on the essential chromosome (EC), including GC3-content, codon usage bias, and repeat region load. Genes carrying PKS and NRPS domains were identified in clusters on the CDC and evidence supporting the origin of the CDC through horizontal transfer from an unrelated fungus was found. Conclusions We provide evidence supporting the hypothesis that the CDC in A. arborescens was acquired through horizontal transfer, likely from an unrelated fungus. We also identified several predicted CDC genes under positive selection that may serve as candidate virulence factors.

We consider a class of convex decentralized consensus optimization problems over connected multi-agent networks. Each agent in the network holds its local objective function privately, and can only communicate with its directly connected agents during the computation to find the minimizer of the sum of all objective functions. We propose a randomized incremental primal-dual method to solve this problem, where the dual variable over the network in each iteration is only updated at a randomly selected node, whereas the dual variables elsewhere remain the same as in the previous iteration. Thus, the communication only occurs in the neighborhood of the selected node in each iteration and hence can greatly reduce the chance of communication delay and failure in the standard fully synchronized consensus algorithms. We provide comprehensive convergence analysis including convergence rates of the primal residual and consensus error of the proposed algorithm, and conduct numerical experiments to show its performance using both uniform sampling and important sampling as node selection strategy. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to elucidate whether malnutrition is associated with cognitive impairment in an older Chinese population. Methods: A cross‐sectional study was conducted in 2365 participants aged 60 years or older from January 2013 to September 2019. Nutritional status was measured by using the Mini Nutritional Assessment Short Form (MNA‐SF). Cognitive function was assessed with the Mini‐Mental State Examination (MMSE). The relationship between malnutrition or each Mini Nutritional Assessment Short Form domain and cognitive impairment was examined with univariate and multivariate logistic regression analysis. Results: The prevalence of malnutrition, risk of malnutrition, and cognitive impairment was 5.54%, 33.45%, and 36.74%, respectively. The prevalence was higher in those 80 years and older: 7.88%, 40.75%, and 53.65%, respectively. The Mini‐Mental State Examination score was positively correlated with the Mini Nutritional Assessment Short Form score (r = 0.364, P < 0.001). After adjustment for age, gender, education, marital status, and living alone, malnutrition (odds ratio (OR) = 3.927, 95% confidence interval (CI): 2.650–5.819), anorexia (OR = 1.454, 95%CI: 1.192–1.774), weight loss (OR = 1.697, 95%CI: 1.406–2.047), impaired mobility (OR = 4.156, 95%CI: 3.311–5.218), and psychological stress (OR = 1.414, 95%CI: 1.070–1.869) were significantly associated with an increased risk of cognitive impairment. Conclusions: Our results suggest that the prevalence of malnutrition and cognitive impairment is relatively high and increases with age. Malnutrition, anorexia, weight loss, impaired mobility, and psychological stress are significantly associated with an increased risk of cognitive impairment. Therefore, clinicians should assess the nutritional and cognitive status of the elderly regularly to improve early detection and timely intervention. [ABSTRACT FROM AUTHOR]

A spergillus fumigatus is an opportunistic pathogen and allergen of mammals. Calcium signalling is essential for A . fumigatus pathogenicity and is regulated by the CrzA transcription factor. We used ChIP-seq ( Chromatin Immunoprecipitation DNA sequencing) to explore CrzA gene targets in A . fumigatus. In total, 165 potential binding peaks including 102 directly regulated genes were identified, resulting in the prediction of the A[ GT][ CG] CA[ AC][ AG] CrzA-binding motif. The 102 CrzA putatively regulated genes exhibited a diverse array of functions. The phkB ( Afu3g12530) histidine kinase and the sskB ( Afu1g10940) MAP kinase kinase kinase of the HOG (high-osmolarity glycerol response) pathway were regulated by CrzA. Several members of the two-component system ( TCS) and the HOG pathway were more sensitive to calcium. CrzA:: GFP was translocated to the nucleus upon osmotic stress. CrzA is important for the phosphorylation of the SakA MAPK in response to osmotic shock. The Δ sskB was more sensitive to CaCl2, NaCl, and paraquat stress, while being avirulent in a murine model of invasive pulmonary aspergillosis. The presence of CaCl2 and osmotic stresses resulted in synergistic inhibition of Δ crzA and Δ sskB growth. These results suggest there is a genetic interaction between the A. fumigatus calcineurin- CrzA and HOG pathway that is essential for full virulence. [ABSTRACT FROM AUTHOR]

Background: Temporal concavities result from reduced subcutaneous fat and bone structure variations, impacting facial aesthetics. Filling treatments, including autologous fat grafts, synthetic fillers, and biological materials, are used for enhancement. Autologous fat grafting is promising but limited by unpredictable fat absorption and nonstandardized procedures. This study aims to assess the clinical effectiveness of mechanical micronized fat in combination with autologous granular fat grafting for lipofilling in the correction of temporal deformities., Methods: Patients (n = 37, mean age = 37.48) with temporal concavity caused by aging and Inherently inadequate capacity were enrolled and divided into control group (n = 10) and study group (n = 9) according to different fat grafts. Control group received pure autologous granular fat, with an average volume of approximately 19.30 mL. In contrast, the study group used mechanical micronized fat along with autologous granular fat co-injection through an 18G needle with an average injection volume of about 18.89 mL. All autologous fat collected from patients' abdominal and thighs. Information, including postoperative clinical efficacy scored by various plastic surgeons for the comparison of preoperative and postoperative photos of patients, patient satisfaction, and complications between the two groups, was documented. Additionally, changes in patients' quality of life were evaluated using the FACE-Q scale., Results: Six months after surgery, the efficacy of temporal filling in the study group (6.69 ± 0.64) was higher than the control group (6.37 ± 0.67) (P = 0.0048). The patient satisfaction was more prominent in the study group (6.28 ± 0.87) than in the control group (5.80 ± 0.71) (P = 0.0449). Differences between above two observation indicators were statistically significant (P < 0.05). The FACE-Q scale items, which assess psychological health, social functioning, and early life impact, showed higher scores in the study group both before the surgery (psychological health: 59.22 ± 3.53, social functioning: 64.75 ± 3.15) and 6 months after the surgery (psychological health: 69.44 ± 4.50, social functioning: 75.33 ± 3.81, early life impact: 74.21 ± 0.70) (P > 0.05). Notably, only one micronodule formation was detected among all patients., Conclusion: Mechanical micronized fat combined with autologous granular fat improve the clinical effect of treating concavity in temporal region, which is worthy of further promotion and application., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ethylene oxide (EtO), a highly reactive organic compound with extensive industrial applications, poses significant health risks. The association between EtO exposure and stroke was not well established. This study examined the association between EtO exposure and stroke among US adults using data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES)., Methods: We used appropriately weighted multifactorial logistic regression models to analyze the data and validated the findings with smoothed curve fitting. Stratified analysis and interaction assessments were performed to evaluate the robustness of the findings., Results: The study included 5,071 participants, balanced between men and women, with a stroke prevalence of 4.1%. Higher EtO levels were associated with rising rates of stroke (OR = 1.23, 95% CI: 1.06-1.42). Individuals in the top 25% group displayed a stroke prevalence 1.6 times higher than those in the bottom 25% group (OR = 1.60, 95%CI: 1.03-2.48). Stratified analysis demonstrated a significant positive association between EtO and stroke in individuals under 50 years (OR = 1.94, 95%CI: 1.38-2.72), while no significant association was found in those aged 50 and above (OR = 0.97, 95%CI: 0.83-1.14)., Conclusion: This study identified a significant association between EtO exposure and stroke occurrence in young adults in the United States., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Le, Lan and Chen.)