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Abstract Background Growth arrest-specific 6 (GAS6) is a vitamin K-dependent protein related to inflammation, fibrosis, as well as platelet function. Genetic ablation of GAS6 in mice protects against cardiac hypertrophy and dysfunction. Nonetheless, the association between plasma GAS6 levels and acute heart failure (AHF) patients is still unknown. Methods We measured plasma GAS6 concentrations in 1039 patients with AHF who were enrolled in the DRAGON-HF trial (NCT03727828). Mean follow-up of the study was 889 days. The primary endpoint is all-cause death. Results In total, there were 195 primary endpoints of all-cause death and 135 secondary endpoints of cardiovascular death during the mean follow-up duration of 889 days. The higher levels of GAS6 were associated with higher rates of all-cause and cardiovascular death (P

Background: Various electrocardiographic (ECG) abnormalities are associated with the severity of pulmonary thromboembolism (PTE). The utility of evaluating the clot burden of PTE based on ECG findings alone has yet to be thoroughly investigated in Chinese patients. The aim of this study was therefore to use ECG signs to establish novel models for quantitative and localization analysis of clot burden in patients with acute PTE. Methods: Acute PTE patients from three centers were enrolled between 2015 and 2019 in a retrospective cohort study (NCT03802929). We analyzed the 12-lead ECGs at admission and studied computed tomography pulmonary angiography (CTPA) features to obtain the Qanadli score of clot burden and location of thrombus. Novel risk prediction models were developed and validated using derivation and external validation cohorts, respectively. Results: A total of 341 acute PTE patients were screened, of whom 246 (72.1%) were from Shanghai Tenth People’s Hospital, 71 (20.8%) were from Shanghai Pulmonary Hospital and 24 (7.0%) were from Qidong People’s Hospital. In the derivation cohort, predictors included in the final models were congestive heart failure, chronic obstructive pulmonary disease, hypertension, coronary heart disease, atrial fibrillation and ECG abnormalities. The CHARIS (COPD/CHF/CHD, HTN, Atrial arrhythmias/AF, RBBB/RAD, Inverted T wave and S1Q3T3/ Sinus tachycardia) I model was established for quantitatively assessing Qanadli score. It had moderate discrimination in both the derivation cohort (concordance index (c-index) of 0.720, 95% CI 0.655–0.780) and the validation cohort (c-index of 0.663, 95% CI 0.559–0.757). The CHARIS II model was used to predict the probability of trunk obstruction. It showed similar discrimination in the derivation cohort (c-index of 0.753, 95% CI 0.691–0.811) and in the validation cohort (c-index of 0.741, 95% CI 0.641–0.827). Calibration curves and Hosmer-Lemeshow test confirmed the accuracy of the risk prediction equations in the external validation dataset. Decision curve analysis showed the CHARIS I and CHARIS II algorithms had positive net benefits in both the derivation and validation cohorts. Conclusions: From quantitative and localization perspectives, the CHARIS algorithms can identify acute PTE patients with heavy thrombus burdens prior to imaging diagnosis. Clinical Trial Registration: NCT03802929, https://www.clinicaltrials.gov/study/NCT03802929.

Abstract Aims Elevated heart rate (HR) in heart failure (HF) is associated with worse outcomes, particularly in acute HF (AHF). HR reduction with ivabradine reduces cardiovascular events in HF patients with reduced ejection fraction. The present trial aimed to test the hypothesis that the early HR reduction using ivabradine improves clinical outcomes in patients with AHF. Methods and results SHIFT‐AHF is a prospective, multi‐centre, double‐blind, randomized, placebo‐controlled trial to evaluate the efficacy and safety of ivabradine when adding to standard therapy in AHF patients (SHIFT‐AHF). The trial will include 674 AHF patients with left ventricular ejection fraction

This review summarizes current knowledge regarding clinical epidemiology, pathophysiology, and prognosis for patients with HFmrEF in comparison to HFrEF and HFpEF. Although recommended treatments currently focus on aggressive management of comorbidities, we summarize potentially beneficial therapies that can delay the process of heart failure by blocking the pathophysiology mechanism. More studies are needed to further characterize HFmrEF and identify effective management strategies that can reduce cardiovascular morbidity and mortality of patients with HFmrEF.

Discoid lateral meniscus (DLM) is the most common congenital variant of the lateral meniscus, which is prone to degeneration and lesions, and often leads to knee osteoarthritis. At present, there is no consensus on the clinical practice of DLM, and this expert consensus and practice guidelines on DLM was developed and approved by Chinese Society of Sports Medicine according to the Delphi method. Among 32 statements drafted, 14 statements were excluded for redundant information, and 18 statements achieved consensus. This expert consensus focused on the definition, epidemiology, etiology, classification, clinical manifestations, diagnosis, treatment, prognosis, and rehabilitation of DLM. Restoring the normal shape, retaining appropriate width and thickness, and ensuring the stability of the remnant meniscus is critical to sustaining the physiological function of the meniscus and preserving the knee. The partial meniscectomy with or without repair should be the first‐line treatment when possible, given that the clinical and radiological long‐term outcomes of total or subtotal meniscectomy are worse.

To solve the problems of path planning and dynamic obstacle avoidance for an unmanned surface vehicle (USV) in a locally observable non-dynamic ocean environment, a visual perception and decision-making method based on deep reinforcement learning is proposed. This method replaces the full connection layer in the Proximal Policy Optimization (PPO) neural network structure with a convolutional neural network (CNN). In this way, the degree of memorization and forgetting of sample information is controlled. Moreover, this method accumulates reward models faster by preferentially learning samples with high reward values. From the USV-centered radar perception input of the local environment, the output of the action is realized through an end-to-end learning model, and the environment perception and decision are formed as a closed loop. Thus, the proposed algorithm has good adaptability in different marine environments. The simulation results show that, compared with the PPO algorithm, Soft Actor–Critic (SAC) algorithm, and Deep Q Network (DQN) algorithm, the proposed algorithm can accelerate the model convergence speed and improve the path planning performances in partly or fully unknown ocean fields.

IntroductionSuture passer needle, as one of commonly used instrument in the arthroscopic rotator cuff repair, often breaks at the notch of the needle, which originally was designed to facilitate suture with thread. Our study aimed to evaluate the suture failure rate and stitch success rate between intact suture needle and broken needle and explore the mechanism of the needle breakage and achieving better future designs.Materials and methodsFrom 2017 to 2021, consecutive 437 shoulders (11 cases were bilateral) underwent arthroscopic repair for full-thickness rotator cuff tear at the authors’ institution. The breakage of needles was recorded. Finite elements analysis and mechanical test were utilized to compare stress distribution, puncture performance, and loaded puncture performance between the broken needle and the intact needle.ResultsWe identified 19 consecutive patients for whom the needle tip of the TruePass™ suture passer was broken in the 437 shoulder surgeries. Based on the finite element analysis of Abaqus, around the tip and the notch of the intact needle was a large stress concentration. The average puncture force required by intact needle tip and the broken tip is 61.78N and 78.23N respectively. While the intact tip with notch is easier to break than the broken tip.ConclusionsThe notch of the needle is a weak point in mechanics. The broken needle without the notch still has good tendon piercing and thread passing ability. The notch of needle may be not necessary, and the tip of the needle should be modified.

Abstract Objective Mechanic strength, pore morphology and size are key factors for the three-dimensional (3D) printing of porous titanium scaffolds, therefore, developing optimal structure for the 3D printed titanium scaffold to fill bone defects in knee joints is instructive and important. Methods Structural models of titanium scaffolds with fifteen different pore unit were designed with 3D printing computer software; five different scaffold shapes were designed: imitation diamond-60°, imitation diamond-90°, imitation diamond-120°, regular tetrahedron and regular hexahedron. Each structural shape was evaluated with three pore sizes (400, 600 and 800 μm), and fifteen types of cylindrical models (size: 20 mm; height: 20 mm). Autodesk Inventor software was used to determine the strength and safety of the models by simulating simple strength acting on the knee joints. We analyzed the data and found suitable models for the design of 3D printing of porous titanium scaffolds. Results Fifteen different types of pore unit structural models were evaluated under positive pressure and lateral pressure; the compressive strength reduced when the pore size increased. Under torsional pressure, the strengths of the imitation diamond structure were similar when the pore size increased, and the strengths of the regular tetrahedron and regular hexahedron structures reduced when the pore size increased. In each case, the compressive strength of the regular hexahedron structure was highest, that of the regular tetrahedron was second highest, and that of the imitation diamond structure was relatively low. Fifteen types of cylindrical models under a set force were evaluated, and the sequence of comprehensive compressive strength, from strong to weak was: regular hexahedron > regular tetrahedron > imitation diamond-120° > imitation diamond-90° > imitation diamond-60°. The compressive strength of cylinder models was higher when the pore size was smaller. Conclusion The pore size and pore morphology were important factors influencing the compressive strength. The strength of each structure reduced when the pore size (400, 600 and 800 μm) increased. The models of regular hexahedron, regular tetrahedron and imitation diamond-120°appeared to meet the conditions of large pore sizes and high compressive strength.

In the distributed information fusion of wireless sensor networks (WSNs), the filtering accuracy is commonly negatively correlated with energy consumption. Therefore, a class of distributed consensus Kalman filters was designed to balance the contradiction between them in this paper. Firstly, an event-triggered schedule was designed based on historical data within a timeliness window. Furthermore, considering the relationship between energy consumption and communication distance, a topological transformation schedule with energy-saving is proposed. The energy-saving distributed consensus Kalman filter with a dual event-driven (or event-triggered) strategy is proposed by combining the above two schedules. The sufficient condition of stability for the filter is given by the second Lyapunov stability theory. Finally, the effectiveness of the proposed filter was verified by a simulation.

As one of the important components in the transmission line, the insulator is related to the safe and reliable operation of the entire transmission line. Aerial images are characterized by complex backgrounds, multiple pseudotargets, and low signal-to-noise ratios. Rapid and accurate localization of insulators in aerial images is a critical and challenging task in automatic inspection of transmission lines. Most insulator localization methods suffer from the loss of target edge detail information and large amount of model parameters. To solve these problems, this paper adopts an Encoder-Decoder architecture, called ED-Net, to realize end-to-end intelligent and accurate identification of insulators in aerial images. Firstly, Initial Module and CA-Bottleneck which are used to extract features from images to generate finer feature maps are proposed in the Encoder path. Meanwhile, global average pooling is used to preserve the maximum receptive field. Secondly, in the Decoder path, Refinement Boundary Module and Asymmetric Convolution Module are given to perform boundary optimization on the feature map, which are generated by the Encoder path. Finally, the Attention Feature Fusion Module is introduced into the Decoder path to combine high-level features with low-level features better and reduce the gap between features of different levels. The proposed model architecture keeps a suitable balance between the model parameters and insulator segmentation performance on insulator test datasets. Specifically, for a 512 × 512 input image, 95.12% mean intersection over union is achieved on the insulator test datasets with different environments and model parameters size being only 13.61 M. Compared with the current state-of-the-art semantic segmentation methods, the results show that the proposed method has higher efficient and accuracy.

BackgroundCryptococcosis is caused by a fungi of the Cryptococcus neoformans/Cryptococcus gattii complex and is a severe concern for public health worldwide. C. neoformans species are globally distributed, and C. gattii species are mostly found in America, Australia, and Sub-Saharan Africa. Cryptococcus usually infects an immunocompromised population; however, the majority of cryptococcosis in China has been reported in patients without any recognizable immunosuppression, i.e., HIV infection. To date, very few studies investigated this disease in South Central China.MethodsThe present study recruited 230 clinically suspected cryptococcosis cases in the last 5 years at two hospitals in Jiangxi Province, South Central China. All isolated strains were subjected to multilocus sequence typing (MLST) and phylogenetic analysis. Serotype and mating type were assessed by PCR, in vitro antifungal susceptibility was assessed by the CLSI-M27-A3 protocol.ResultsA total of 230 patients were identified as infected by C. neoformans, including 12 cases with Talaromyces marneffei coinfection. All seven MLST markers were successfully amplified and used to identify the ST genotype in 199 strains. C. gattii strains were not detected. In contrast to previous studies, 59.3% of the patients had an immunocompromised status, and 61.9% of these patients were infected with HIV. All isolates manifested serotype A and mating type α. The ST5 genotype was common (89.5%) in the Jiangxi region, and three novel genotypes (ST656, ST657, and ST658 in six isolates) were detected in the present study. A total of 86 of the isolates (43.2%) were not sensitive to fluconazole at a MIC50 ≥ 8 μg/ml, most of the isolates were resistant to amphotericin B, and nearly all isolates were resistant to itraconazole and posaconazole. Resistances to 5-Flucytosine and voriconazole were very rare.ConclusionsThe results of the present study indicated that C. neoformans is the predominant species for cryptococcosis in Jiangxi Province, and a large proportion of the strains were not sensitive to fluconazole, which may be related to treatment failure and relapse. A high percentage of HIV-related C. neoformans infections was reported in Jiangxi, supporting a previous hypothesis that cryptococcosis is more frequent among the HIV-infected population in China. Continuous monitoring of species distribution and antifungal sensitivity is important for the investigation of this severe disease in the Jiangxi region.

Information fusion integrates aspects of data and knowledge mostly on the basis that system information is accumulative/distributive, but a subtle case emerges for a system with bifurcations, which is always un-linearizable and exacerbates information acquisition and presents a control problem. In this paper, the problem of an un-linearizable system related to system observation and control is addressed, and Andronov–Hopf bifurcation is taken as a typical example of an un-linearizable system and detailed. Firstly, the properties of a linear/linearized system is upon commented. Then, nonlinear degeneracy for the normal form of Andronov–Hopf bifurcation is analyzed, and it is deduced that the cubic terms are an integral part of the system. Afterwards, the theoretical study on feedback stabilization is conducted between the normal-form Andronov–Hopf bifurcation and its linearized counterpart, where stabilization using washout-filter-aided feedback is compared, and it is found that by synergistic controller design, the dual-conjugate-unstable eigenvalues can be stabilized by single stable washout filter. Finally, the high-dimensional ethanol fermentation model is taken as a case study to verify the proposed bifurcation control method.

The unmanned surface vehicle (USV) is usually required to perform some tasks with the help of static and dynamic environmental information obtained from different detective systems such as shipborne radar, electronic chart, and AIS system. The essential requirement for USV is safe when suffered an emergency during the task. However, it has been proved to be difficult as maritime traffic is becoming more and more complex. Consequently, path planning and collision avoidance of USV has become a hot research topic in recent year. This paper focuses on dynamic obstacle avoidance and path planning problem of USV based on the Ant Colony Algorithm (ACA) and the Clustering Algorithm (CA) to construct an auto-obstacle avoidance method which is suitable for the complicated maritime environment. In the improved ant colony-clustering algorithm proposed here, a suitable searching range is chosen automatically by using the clustering algorithm matched to different environmental complexities, which can make full use of the limited computing resources of the USV and improve the path planning performances firstly. Second, the dynamic searching path is regulated and smoothed by the maneuvering rules of USV and the smoothing mechanism respectively, which can effectively reduce the path length and the cumulative turning angle. Finally, a simulation example is provided to show that our proposed algorithm can find suitable searching range according to different obstacle distributions, as well as accomplish path planning with good self-adaptability. Therefore, a safe dynamic global path with better optimize performances is achieved with the help of multi-source information.

Optimization for vertical vibration performance of a rail-train coupling system is investigated in this paper with the introduction of inerters for both primary and secondary suspensions. A model of a typical Chinese passenger train that travels on a traditional rail with track, sleepers, and ballast is simulated. The goal is to improve the ride quality for the train and vibration attenuation for the rail system in response to track irregularities. Optimizations for only inertance and all suspension parameters are carried out by the particle swarm algorithm (PSO). Performance benefits for both the train and the rail system are demonstrated and suspension layouts with inerters connected in parallel and series are compared with the traditional one in both time domain and frequency domain.

This paper investigates the problem of leader-following consensus and multiconsensus of multiagent systems. A leader-following and bounded consensus protocol via impulsive control for multiagent systems is proposed by using sampled position and velocity data. Consensus and multiconsensus commutative evolution stimulated by varying intelligence degrees of each agent can be achieved to avoid obstacles. Especially, the multiconsensus leader-following can be obtained without grouping the multiagent networks in advance. The necessary and sufficient condition is given to the leader-following bounded consensus tracking of the system by using the Hurwitz criterion and properties of the Laplacian matrix. A simulation is provided to verify the availability of the proposed impulsive control protocol. Furthermore, the result can be applied in obstacle avoidance and round up of target by regulating the intelligence degrees.