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Context Polycystic ovary syndrome (PCOS) is one of the most common diseases that contribute to subfertility. Recent evidence showed that oocytes of women with PCOS matured in vitro away from the follicular fluid presented better potentials, whereas the reason remained unclear. Objective This work aimed to investigate whether follicular extracellular vesicles (EVs) of PCOS patients interfere with the quality of oocytes. Methods Follicular EVs of women with PCOS (PCOS-EVs) and control women (CTRL-EVs) were isolated and determined using Western blotting, nanoparticle tracking analysis, and transmission electron microscopy. The 2 types of EVs were co-cultured with murine germinal vesicle oocytes, respectively. Fluorescence-labeled EVs were used to visualize internalization by oocytes. After co-culture, oocyte maturation rates were calculated. Mitochondria distribution and reactive oxygen species (ROS) level were detected in the different groups. Spindle morphology was evaluated using immunofluorescence. Moreover, the expression of catalase (CAT), glutathione synthetase (GSS), and superoxide dismutase (SOD) was determined in the oocytes. Results Both PCOS-EVs and CTRL-EVs are bilayered vesicles, approximately 100 to 150 nm in size, and enriched in EV-associating protein markers. EVs were internalized by oocytes within 1 hour. Oocyte maturation rate decreased significantly in the PCOS-EV group compared with the CTRL-EV group, whereas the abnormal mitochondria distribution rate and abnormal spindle rate were significantly increased in the PCOS-EV group. Moreover, PCOS-EVs increased the ROS level and the expression of CAT, GSS, and SOD in the oocytes. Conclusion PCOS-EVs interfered with oocyte mitochondria and spindles and inhibited oocyte maturation. Moreover, oxidative stress induced by PCOS-EVs might be a potential cause.

PURPOSE: Endometrial extracellular vesicles are essential in regulating trophoblasts’ function. This study aims to investigate whether endometrial extracellular vesicles (EVs) from recurrent implantation failure (RIF) patients inhibit the proliferation, invasion, and migration of HTR8/SVneo cells. METHODS: Eighteen RIF patients and thirteen fertile women were recruited for endometria collection. Endometrial cells isolated from the endometria were cultured and modulated by hormones, and the conditioned medium was used for EV isolation. EVs secreted by the endometrial cells of RIF patients (RIF-EVs) or fertile women (FER-EVs) were determined by Western blotting, nanoparticle tracking analysis, and transmission electron microscopy. Fluorescence-labeled EVs were used to visualize internalization by HTR8/SVneo cells. RIF-EVs and FER-EVs were co-cultured with HTR8/SVneo cells. Cell Counting Kit-8, transwell invasion, and wound closure assays were performed to determine cellular proliferation, invasion, and migration, respectively, in different treatments. RESULTS: RIF-EVs and FER-EVs were bilayer membrane vesicles, ranging from 100 to 150 nm in size, that expressed the classic EV markers Alix and CD9. RIF-EVs and FER-EVs were internalized by HTR8/SVneo cells within 2 h. The proliferation rate in the FER-EV group was significantly higher than that in the RIF-EV group at 20 μg/mL. Moreover, the invasion and migration capacity of trophoblast cells were decreased in the RIF-EV group relative to the FER-EV group at 20 μg/mL. CONCLUSION: Endometrial EVs from RIF patients inhibited the functions of trophoblasts by decreasing their proliferation, migration, and invasive capacity. Such dysregulations induced by RIF-EVs may provide novel insights for better understanding the pathogenesis of implantation failure.

To investigate the relationship between uterine niche and reproductive outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).A retrospective cohort study in the Reproductive Medicine Center of Tongji Hospital, Wuhan, China.A total of 2449 women with cesarean section history who underwent 2874 IVF/ICSI cycles between January 2015 and December 2019.A defect deeper than 2 mm under three-dimensional (3D) transvaginal sonography (TVS) or visible under hysteroscopy was defined as uterine niche. IVF/ICSI outcomes of the first embryo transfer were obtained by telephone interview 1 year regardless of fresh embryos or frozen-thawed embryos. Generalized estimating equations (GEE), logistic regression analyses, and propensity score matching were applied to clarify the relationship between uterine niche and IVF/ICSI outcomes.Primary outcome was live birth rate. Secondary outcomes were positive human chorionic gonadotropin (hCG) test results, clinical pregnancy rate, implantation rate, miscarriage rate and ectopic pregnancy rate.After excluding 48 cycles for uterine malformation, 18 cycles for chromosome abnormality, 281cycles for no available embryo or no embryo transfer, 5 cycles for oocyte donation and 7 cycles for loss of follow-up, we finally included 2231 women with 2515 cycles in our study. Compared with women without niche, women with niche had reduced live birth rate (18.99% vs. 31.51%, adjusted OR: 0.51, 95% CI: 0.34-0.77), positive hCG test rate (34.08% vs. 46.40%, adjusted OR: 0.61, 95% CI: 0.43-0.87), clinical pregnancy rate (29.05% vs. 42.25%, adjusted OR: 0.57, 95% CI: 0.39-0.82) and implantation rate (25.87% vs. 36.95%, adjusted OR: 0.53, 95% CI: 0.38-0.76). In all the sensitivity analyses, the niche group had an 7.28%-18.22% increase in miscarriage rate even not all of them were statistically significant.Uterine niche may have a detrimental effect on subsequent fertility of women with cesarean section history undergoing IVF/ICSI treatment. Practitioners should be noted that women with uterine niches may associated with adverse IVF/ICSI outcomes.

Background There are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients’ global satisfaction degree. Methods One hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients’ global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery. Results Compared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups. Conclusions Dexmedetomidine combined with sufentanil and dezocine increased female patients’ global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients. Trial registration Chinese Clinical Trial Registry number, ChiCTR2000030429. Registered on March 1, 2020.

Background There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Methods Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected. Results Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups. Conclusions General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Trial registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020.

Background：There are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients' global satisfaction degree.Methods：One hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients' global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery.Results：Compared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups.Conclusions：Dexmedetomidine combined with sufentanil and dezocine increased female patients' global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients.Trial registration: Chinese Clinical Trial Registry number, ChiCTR2000030429. Registered on March 1, 2020.

Background Anastomotic leakage is a dangerous postoperative complication of oesophageal surgery. The present study aimed to develop a simple and practical scoring system to predict the risk of anastomotic leakage after oesophageal resection. Methods A consecutive series of 330 patients who underwent oesophageal cancer surgery from January 2016 to January 2018 at the Shanghai Chest Hospital were included to develop a prediction model. Anastomotic leakage was evaluated using oesophagography, computed tomography, or flexible endoscopy. Least absolute shrinkage and selection operator regression based on a generalized linear model was used to select variables for the anastomotic leakage risk model while avoiding overfitting. Multivariable logistic regression analysis was applied to build forest plots and a prediction model. The concordance index or the area under the curve was used to judge the discrimination, and calibration plots verified the consistency. Internal validation of the model was conducted, and the clinical usefulness and threshold screening of the model were evaluated by decision curve analysis. Results The factors included in the predictive nomogram included Sex, diabetes history, anastomotic type, reconstruction route, smoking history, CRP level and presence of cardiac arrhythmia. The model displayed a discrimination performance with a concordance index of 0.690 (95% confidence interval: 0.620–0.760) and good calibration. A concordance index value of 0.664 was maintained during the internal validation. The calibration curve showed good agreement between the actual observations and the predicted results. Conclusion The present prediction model, which requires only seven variables and includes Sex, diabetes history, anastomotic type, reconstruction route, smoking history, CRP level and presence of cardiac arrhythmia, may be useful for predicting anastomotic leakage in patients after oesophagectomy.

Android’s permission system offers an all-or-nothing choice when installing an app. To make it more flexible and fine-grained, users may choose a popular app tool, called permission manager , to selectively grant or revoke an app’s permissions at runtime. A fundamental requirement for such permission manager is that the granted or revoked permissions should be enforced faithfully. However, we discover that none of existing permission managers meet this requirement due to permission leaks , in which an unprivileged app can exercise certain permissions which are revoked or not-granted through communicating with a privileged app.To address this problem, we propose a secure, usable, and transparent OS-level middleware for any permission manager to defend against the permission leaks. The middleware is provably secure in a sense that it can effectively block all possible permission leaks.The middleware is designed to have a minimal impact on the usability of running apps. In addition, the middleware is transparent to users and app developers and it requires minor modifications on permission managers and Android OS. Finally, our evaluation shows that the middleware incurs relatively low performance overhead and power consumption.

Teleophthalmology (TeleOph) is an electronic counterpart of today's face-to-face, patient-to-specialist ophthalmology system. It enables one or more ophthalmologists to remotely examine a patient's condition via a confidential and authentic communication channel. Specifically, TeleOph allows a trained nonspecialist in a primary clinic to screen the patients with digital instruments (e.g., camera, ophthalmoscope). The acquired medical data are delivered to the hospital where an ophthalmologist will review the data collected and, if required, provide further consultation for the patient through a real-time secure channel established over a public Internet network. If necessary, the ophthalmologist is able to further sample the images/video of the patient's eyes remotely. In order to increase the productivity of the ophthalmologist in terms of number of patients reviewed, and to increase the efficiency of network resource, we manage the network bandwidth based on a Poisson model to estimate patient arrival at the clinics, and the rate of ophthalmologist consultation service for better overall system efficiency. The main objective of TeleOph is therefore to provide the remote patients with a cost-effective access to specialist's eye checkups at primary healthcare clinics, and at the same time, minimize unnecessary face-to-face consultation at the hospital specialist's center.

This paper describes a secure and synthesis ophthalmology telemedicine system, referred to as TeleOph. Under a Secure Socket Layer (SSL) channel, patient prerecorded data can be safely transferred via the Internet. With encrypted videoconference and white-board, the system not only supports hospital-to-clinic consultation, but also supplies hospital-tohospital joint discussion. Based on Directshow technology (Microsoft Corporation, Redmond, WA), video cameras connected to the computer by firewire can be captured and controlled to sample video data. By using TWAIN technology, the system automatically identifies networked still cameras (on fundus and slitlamp devices) and retrieves images. All the images are stored in a selected format (such as JPEG, DICOM, BMP). Besides offline-transferring prerecorded data, the system also supplies online sampling of patient data (real-time capturing from remote places). The system was deployed at Tan Tock Seng Hospital, Singapore and Ang Mo Kio, Singapore, where 100 patients were enrolled in the system for examination. TeleOph can be successfully used for patient consultation, and hospital joint discussion. Meanwhile, TeleOph can supply both offline and online sampling of patient data.

The WSe2nanorods were synthesized via solid-state reaction method and characterized by X-ray diffractometer, TEM, and HRTEM. The results indicated the WSe2compounds had rod-like structures with diameters of 10–50 nm and lengths of 100–400 nm, and the growth process of WSe2nanorods was discussed on the basis of the experimental facts. The tribological properties of WSe2nanorods as additives in HVI500 base oil were investigated by UMT-2 multispecimen tribotester. Under the determinate conditions, the friction coefficient of the base oil containing WSe2nanorods was lower than that of the base oil, and decreased with increasing mass fraction of WSe2nanorods when it was 2nanorods as additives.

Android's permission system offers an all-or-nothing installation choice for users. To make it more flexible, users may choose a popular app tool, called permission manager, to selectively grant or revoke an app's permissions at runtime. A fundamental requirement for such permission manager is that the granted or revoked permissions should be enforced faithfully. However, we discover that none of existing permission managers meet this requirement due to permission leaks. To address this problem, we propose CICC, a fine-grained, semantic-aware, and transparent approach for any permission managers to defend against the permission leaks. Compared to existing solutions, CICC is fine-grained because it detects the permission leaks using call-chain information at the component instance level, instead of at the app level or component level. The fine-grained feature enables it to generate a minimal impact on the usability of running apps. CICC is semantic-aware in a sense that it manages call-chains in the whole lifecycle of each component instance. CICC is transparent to users and app developers, and it requires minor modification to permission managers. Our evaluation shows that CICC incurs relatively low performance overhead and power consumption.

Background Esophageal duplication cysts (EDCs) are rare congenital anomalies that can be associated with symptomatic spinal abnormalities, but presentations due to EDC symptoms are rarely found in the presence of spinal abnormalities. Case summary A 6-month-old infant weighing approximately 5.0 kg presented with a 2-month pulmonary infection and more recent difficulty swallowing and nutritional intolerance that did not improve with medical treatment. Contrast-enhanced chest computed tomography showed a well-defined, mediastinal, homogeneous, low-density cystic mass of 11.9 × 5.5 × 5.1 cm, compressing the liver and bending the trachea forward. Hemivertebrae were present (T4 and T3). Diagnostic laparoscopy was performed, but was converted to open surgery. After ensuring that the cyst was not within the abdominal cavity, thoracotomy was performed, and the cyst was completely resected. Pathophysiological examination revealed an EDC. The patient recovered well, without symptoms 6 months later. Conclusions Overall, noninvasive imaging and diagnostic procedures may not be sufficient to define the exact location of an EDC. Although hemivertebrae were present, they were asymptomatic and did not require treatment; only the EDC induced nonspecific symptoms that disappeared after surgery.

In an on-line transaction, a user sends her personal sensitive data (e.g., password) to a server for authentication. This process is known as Single Sign-On (SSO). Subject to phishing and pharming attacks, the sensitive data may be disclosed to an adversary when the user is allured to visit a bogus server. There has been much research in anti-phishing methods and most of them are based on enhancing the security of browser indicator. In this paper, we present a completely different approach of defeating phishing and pharming attacks. Our method is based on encrypted cookie. It tags the sensitive data with the server’s public key and stores it as a cookie on the user’s machine. When the user visits the server so as to perform an online transaction, the sensitive data in the cookie will be encrypted with the stored public key of the server. The ciphertext can only be decrypted by the genuine server. Our encrypted cookie scheme (ECS) has the advantage that the user can ignore SSL indicator in the transaction process. The security is guaranteed even if the user accepts a malicious self-signed certificate. This advantage greatly releases user’s burden of checking SSL indicator, which could be very difficult even for an experienced user when the phishing attacks have sophisticated vision design.

The paper describes a multi-screen real-time ophthalmology telemedicine system between a clinic and a hospital, referred to as TeleOph. TeleOph aims to mimic face-to-face consultation over public Internet network. It automatically connects still cameras and video cameras, and takes samples of pictures and videos respectively for remote consultation. Additionally, TeleOph employs a shared electronic white-board to enable an ophthalmologist to handle (e.g. change, highlight, zoom out/in) images, as well as control (e.g., play, pause, stop) video streams in both hospital and clinic in a synchronized manner. Moveover, TeleOph provides a collaborative-consultation function that allows ophthalmologists from different hospitals to jointly discuss and share patient data in order to increase the accuracy of consultation.

A new EOR method of Crosslinked polymer displacement technology is introduced in this paper. The crosslinked system is based on the reaction of Cr(III) in crosslinker with hydrolysed polyacrylamide(HPAM). After gelation, the system has some character such as good viscoelasticity, good thermal stability, and high salinity resistance. The viscoelasticity of crosslinked system can reach 2–3 times simple polymer solution. As a new system combining profile modification and flooding, it can be applied in high water-cut and severe heterogeneous reservoirs. Because of delayed crosslinking property, it can not only improve profile during injection, but also flow increase volumetric sweep efficiency. Having been injected into reservoir, crosslinking polymer can block and adjust high permeability zones in deep section, and improve sweep volume, and decrease water to oil mobility ration, thereby enhance recovery efficiency. The pilot is is in BO-19 block in GUDAO oilfield, which is characteristic of positive rhythm deposit, loosed sand cement, high density and high viscosity etc. The reservoir temperature is 73°C, the viscosity of crude oil is 80mPa.s, density is 0.9030g/cm3 at reservoir conditions, permeability is 1000–2000×10−3μm2 and the formation water salinity is 6453mg/L. It has 21 injection wells and 40 production wells, the oil-bearing area is about 2.4km2 and reserve in place is about 737.3×104 tons. From 1999 to 2001, 0.15PV (pore volumes) of crosslinked polymer solution has been injected, and a good effect of increasing oil and decreasing water appears, oil production increases from 201 to 350 tons per day, composite water cut decreases from 91.3% to 84.6%, cumulative incremental oil reached 5.0×104tons.

While RFID technology has greatly facilitated visible supply chain management, designing a secure and efficient RFID-tagged supply chain system is still a challenge. To achieve high security and efficiency at the same time, we categorise RFID-tagged supply chain environments in two security levels and design an RFID-tagged supply chain system accordingly. In the relatively secure environment, our system is set to the weak security mode, and the tagged products can be processed in a highly efficient manner. While in the less secure environment, our system is tuned into the strong security mode so as to maintain a high level of security with its efficiency lower than that in the weak security mode. A set of RFID protocols are designed to enable the duel security modes.