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Abstract Cardiovascular disease remains the leading cause of death worldwide, with air pollution’s impact on cardiovascular health being closely monitored. However, the specific effects of air pollution on the risk of hospital readmission for heart failure (HF) in patients with unstable angina (UA) have not been fully explored. We conducted a retrospective study involving 12,857 consecutive patients diagnosed with acute coronary syndrome (ACS) between January 2015 and March 2023. After rigorous screening, we included 8,737 patients with UA in the analysis. Furthermore, we used a Cox proportional hazards regression model to examine the relationship between air quality indicators and hospital readmission for HF in patients with UA. Additionally, a decision tree model identified air quality indicators levels that had the most significant impact on readmission for HF risk. After adjusting for confounding factors, we found that elevated levels of PM10 [hazard ratio (HR) = 1.003, 95% confidence interval (CI): 1.000-1.005, p = 0.04453] and CO (HR = 1.013, 95% CI: 1.005–1.021, p = 0.00216) were associated with an increased risk of hospital readmission for HF in UA patients. Specifically, patients exposed to PM10 levels above 112.5 µ g/m3 had a 1.61-fold higher risk of readmission for HF in UA patients. (HR = 1.609, 95% CI: 1.190–2.176, p = 0.00201), and those exposed to CO levels above 37.5 mg/m3 had a 2.70-fold higher risk of readmission for HF in UA patients. (HR = 2.681, 95% CI: 1.731–4.152, p

Abstract Background Accurately predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains a complex and critical challenge. The primary objective of this study was to develop and validate a robust risk prediction model to assess the 12-month and 24-month mortality risk in STEMI patients after hospital discharge. Methods A retrospective study was conducted on 664 STEMI patients who underwent PPCI at Xiangtan Central Hospital Chest Pain Center between 2020 and 2022. The dataset was randomly divided into a training cohort (n = 464) and a validation cohort (n = 200) using a 7:3 ratio. The primary outcome was all-cause mortality following hospital discharge. The least absolute shrinkage and selection operator (LASSO) regression model was employed to identify the optimal predictive variables. Based on these variables, a regression model was constructed to determine the significant predictors of mortality. The performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). Results The prognostic model was developed based on the LASSO regression results and further validated using the independent validation cohort. LASSO regression identified five important predictors: age, Killip classification, B-type natriuretic peptide precursor (NTpro-BNP), left ventricular ejection fraction (LVEF), and the usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEI/ARB/ARNI). The Harrell's concordance index (C-index) for the training and validation cohorts were 0.863 (95% CI: 0.792–0.934) and 0.888 (95% CI: 0.821–0.955), respectively. The area under the curve (AUC) for the training cohort at 12 months and 24 months was 0.785 (95% CI: 0.771–0.948) and 0.812 (95% CI: 0.772–0.940), respectively, while the corresponding values for the validation cohort were 0.864 (95% CI: 0.604–0.965) and 0.845 (95% CI: 0.705–0.951). These results confirm the stability and predictive accuracy of our model, demonstrating its reliable discriminative ability for post-discharge all-cause mortality risk. DCA analysis exhibited favorable net benefit of the nomogram. Conclusion The developed nomogram shows potential as a tool for predicting post-discharge mortality in STEMI patients undergoing PPCI. However, its full utility awaits confirmation through broader external and temporal validation.

Abstract Background and aims Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) has an extremely poor prognosis. A previous study proved that low-dose radiotherapy (RT) could prolong the prognosis of HCC patients with PVTT. This study aims to explore the sensitivity of PVTT to RT treatment. Methods Patients were selected based on imaging diagnosis of HCC accompanied by PVTT and received combined treatment of radiotherapy, antiangiogenic drugs and immune checkpoint inhibitors, followed by hepatectomy or liver transplantation from January 2019 to August 2022. The efficacy was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) guidelines and pathological assessment. The sensitivity of tumor cells to the treatment was compared between the primary tumor (PT)and PVTT by analyzing their residual tumor and pathologic complete remission (PCR) incidence. Results Data from 14 patients were collected in the study. After combined treatment, the size of PVTT decreased more significantly than that of the primary tumor in the imaging study (p

Abstract This study aimed to clarify the existence of the mild obesity paradox in patients with ST-segment elevation myocardial infarction (STEMI) and assess the impact of mild obesity on the prognosis of STEMI. A retrospective cohort study was conducted on STEMI patients who underwent percutaneous coronary intervention at Xiangtan Central Hospital from January 1, 2020 to July 31, 2022. After excluding individuals with a body mass index (BMI) of no less than 35 kg/m2, subjects were divided into the mildly obese group (BMI, 30–35 kg/m2) and non-obese group (BMI

Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often co‐exist and are closely intertwined. The impact of AF on the outcome of patients with heart failure with mildly‐reduced ejection fraction (HFmrEF) is not fully clear. This study aimed to investigate the impact of AF on the outcomes of hospitalized HFmrEF patients. Methods and results The study included 1691 consecutive patients with HFmrEF (mean 68.2 years, 64.8% male) including 296 AF patients. Patients completed 1 year and mean of 33 month clinical follow‐up after discharge by telephone interview, clinical visit, or community visit. The primary endpoint was cerebro‐cardiovascular events (CCE, composite of HF rehospitalization, stroke, or cardiovascular death). After propensity score matching, 296 patients were included into the AF group (mean 71.5 years) and 592 patients into the non‐AF group (mean 70.6 years). After propensity score matching, CCE at 1 year (59.1% vs. 48.5%, P = 0.003) and at a mean of 33 month (77.0% vs. 70.6%, P = 0.043). AF was independently associated with increased CCE within 1 year (HR = 1.31, 95% CI 1.07 to 1.61, P = 0.010) and at 33 months (HR = 1.20, 95% CI 1.00 to 1.43, P = 0.050) post‐discharge after adjusted for other clinical confounders including discharge heart rate, NT‐proBNP, haemoglobin, and uric acid. Conclusions AF is independently associated with an increased risk of CCE in HFmrEF patients within 1 year and at a mean of 33 months after discharge.

Abstract Background Worsening of heart failure (HF) symptoms is the leading cause of medical contact and hospitalization of patients with mildly reduced ejection fraction (HFmrEF). The prognostic value of signs and symptoms for patients with HFmrEF is currently unclear. This study investigated the prognostic impact of signs and symptoms in HFmrEF patients. Methods A Cox proportional risk regression model analyzed the relationship between the number of signs/symptoms and outcomes in 1691 hospitalized HFmrEF patients. Ten significant signs and symptoms were included. Patients were divided into three groups (A: ≤2, B: 3–5, C: ≥6 signs/symptoms). Stratified analysis on male and female patients was performed. The primary endpoint was all-cause mortality, and the secondary outcome was a composite of cardiovascular death and heart failure readmission (CV events) post-discharge. Results After a median follow-up of 33 months, all-cause mortality occurred in 457 patients and CV events occurred in 977 patients. Incidence of all-cause mortality was 20.7%, 32.3%* and 49.4%*† in group A, B and C of male patients, (*P

Inlet unstart prediction and warning are strictly crucial to the operation of hypersonic engines, especially for combined cycle engines where implementation across a wide speed range poses significant challenges. This paper proposes a realization method that involves constructing the conditions of critical backpressure ratios for the inlet unstart and unstart warning states within a wide speed range and establishing the backpressure prediction models for each engine mode. The detection of the unstart and unstart warning states is achieved by predicting the backpressure ratio at the exit of the isolator and comparing it to the critical backpressure ratios. To achieve this, numerical simulations for a three-dimensional inward-turning multiducted hypersonic combined inlet at various Mach numbers and backpressure ratios are carried out to obtain the dataset of surface pressure. A 10-fold cross-validation support vector machine (10-CV SVM) is used to solve the unstart boundary of surface pressure, and an unstart margin is set to determine the unstart warning boundary. A back propagation (BP) neural network is constructed to estimate the critical backpressure ratios at each working point within a wide speed range. The data information of surface pressure on the boundaries is used as the input for the predictions. The overall average regression correlation coefficient approaches 0.99 on the test dataset at each working point. The backpressure prediction models are established by the one-dimensional convolutional neural network (1D-CNN). Only 2 to 4 measurement points of surface pressure are considered for cross-validation evaluation, and the mean absolute percentage error is between 4% and 8% with the average prediction time not exceeding 2 ms. Finally, the proposed method and prediction models are validated by wind tunnel experimental data.

BackgroundDespite the crucial role of Chest pain centers (CPCs) in acute myocardial infarction (AMI) management, China's mortality rate for ST-segment elevation myocardial infarction (STEMI) has remained stagnant. This study evaluates the influence of CPC quality control indicators on mortality risk in STEMI patients receiving primary percutaneous coronary intervention (PPCI) during the COVID-19 pandemic.MethodsA cohort of 664 consecutive STEMI patients undergoing PPCI from 2020 to 2022 was analyzed using Cox proportional hazards regression models. The cohort was stratified by Killip classification at admission (Class 1: n = 402, Class ≥2: n = 262).ResultsAt a median follow-up of 17 months, 35 deaths were recorded. In Class ≥2, longer door-to-balloon (D-to-B) time, PCI informed consent time, catheterization laboratory activation time, and diagnosis-to-loading dose dual antiplatelet therapy (DAPT) time were associated with increased mortality risk. In Class 1, consultation time (notice to arrival) under 10 min reduced death risk. In Class ≥2, PCI informed consent time under 20 min decreased mortality risk.ConclusionCPC quality control metrics affect STEMI mortality based on Killip class. Key factors include time indicators and standardization of CPC management. The study provides guidance for quality care during COVID-19.

Abstract Clinical studies on heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) have gradually increased. However, studies on the prognostic differences between men and women among patients with HFmrEF are few, and no evidence on sex differences in such patients exists. Therefore, we retrospectively assessed the data of patients with HFmrEF using propensity score-matched analysis (PSMA). A total of 1691 patients with HFmrEF were enrolled in the Outcome of Discharged HFmrEF Patients study (OUDI-HF study), which included 1095 men and 596 women. After propensity score matching, we compared the difference in cardiovascular (CV) events (cardiovascular death or heart failure readmission) and all-cause mortality at 90 days and 1 year after discharge between men and women using Kaplan–Meier analysis and Cox regression. After PSMA, men with HFmrEF were 2.2 times more likely to die at 90 days than women with HFmrEF [hazard ratio (HR) 1.88; 95% confidence interval (95% CI) 1.03–3.46; P = 0.041]. However, there was no difference in the 90-day CV events (HR 0.96; 95% CI 0.75–1.22; P = 0.718). Similarly, there was no difference in all-cause mortality (HR 1.16; 95% CI 0.81–1.65; P = 0.417) and CV events (HR 0.98; 95% CI 0.83–1.16; P = 0.817) between men and women after 1 year. Among the patients with HFmrEF, men had a higher 90-day risk of all-cause mortality than women after hospital discharge, and this risk disappeared after 1 year. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT05240118 (ESC Heart Failure. (2022). doi: https://doi.org/10.1002/ehf2.14044 ).

Objectives Prognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in HFmrEF patients.Methods This is a subgroup analysis based on our previously published retrospective study with 1691 HFmrEF patients. This subgroup analysis involved 574 patients with LUS-BL results at admission. After discharge, patients underwent clinical follow-up for a minimum of 1 year through telephone, clinical visits or community visits. The primary endpoint was defined as cardiovascular (CV) event, including CV-related mortality or HF hospitalisation at 90 days and 1 year after discharge.Results CV event at 90 days was significantly increased with higher LUS-BL number (0, 1–2, 3–9 and ≥10: 20%, 14%, 18% and 33%, p=0.008), while CV event rate at 1 year was similar among groups (45% vs 45% vs 42% vs 50%, p=0.573). Older age, hypertension (HR=2.06, 95% CI 1.31 to 3.25), higher right ventricular diameter (>23 mm, HR=2.008, 95% CI 1.37 to 2.94), increased ratio of early transmitral flow velocity to early mitral annular velocity (>24, HR=1.79, 95% CI 1.11 to 2.26) and higher LUS-BL number (>11, HR=1.510, 95% CI 1.01 to 2.26) were identified as independent determinants associated with increased risk of CV event at 90 days after discharge. The Harrell’s C-Statistic analysis, based on the Cox regression models, demonstrated a significant improvement in the predictive ability of the model that incorporated both clinical and echocardiographic risk factors along with LUS-BL (areas under the curve (AUC)=0.72) compared with the model comprising only clinical risk factors and LUS-BL (AUC=0.69, p=0.036), or to the model with echocardiographic risk factors and LUS-BL (AUC=0.68, p=0.025).Conclusion In HFmrEF patients with ischaemic heart disease, admission LUS-BL>11 is independently associated with an increased risk of CV event at 90 days following discharge.

Abstract Background Data on fibrinolytic therapy use for ST-segment elevation myocardial infarction (STEMI) and long-term clinical outcomes in developing countries are limited. We aimed to investigate the management and 2-year mortality of fibrinolytic-treated patients in China. Methods A total of 19,112 patients with STEMI from 108 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. We investigated the 2-year all-cause mortality among patients treated with fibrinolysis. Non-invasive clinical indexes were used to diagnose successful fibrinolysis or not. Results Only 1823 patients (9.5%) enrolled in the registry underwent fibrinolysis and 679 (37.2%) could be treated within 3 h after symptom onset. The overall use of rescue percutaneous coronary intervention was 8.9%. Successful fibrinolysis, which could be achieved in 1428 patients (78.3%), was related to types of fibrinolytic agents, symptom to needle time, infarction site, and Killip class. Follow-up data were available for 1745 patients (95.7%). After multivariate adjustment, successful fibrinolysis was strongly associated with a decreased risk of death compared with failed fibrinolysis at 2 years (8.5% vs. 29.0%, hazard ratio: 0.27, 95% confidence interval: 0.20–0.35). Conclusion Within a minority of STEMI patients in the CAMI registry underwent fibrinolysis, most of them could achieve successful clinical reperfusion, presenting a much benign 2-year survival outcome than those with failed fibrinolysis. Quality improvement initiatives focusing on fibrinolysis are warranted to achieve its promise fully. Trial registration: URL: https// www.clinicaltrials.gov . Unique identifier: NCT01874691. Registered 11/06/2013.

Introduction: Vascular smooth muscle cell (VSMC) senescence in the vasculature results in vascular aging as well as age-related diseases, while metformin improves the inflamm-aging profile by enhancing autophagy. However, metformin’s impact on VSMC senescence is largely undefined. Objectives: To test the hypothesis that metformin exerts an anti-senescence role by restoring autophagic activity in VSMCs and vascular tissues. Methods: Animal models established by angiotensin II (Ang II) induction and physiological aging and senescent primary VSMCs from the aortas of elderly patients were treated with metformin. Cellular and vascular senescence were assessed by measuring the amounts of senescence-associated β-galactosidase and senescence markers, including p21 and p53. Autophagy levels were assessed by autophagy-related protein expression, transmission electron microscope, and autolysosome staining. In order to explore the underlying mechanism of the anti-senescence effects of metformin, 4D label-free quantitative proteomics and bioinformatic analyses were conducted, with subsequent experiments validating these findings. Results: Ang II-dependent senescence was suppressed by metformin in VSMCs and vascular tissues. Metformin also significantly improved arterial stiffness and alleviated structural changes in aged arteries, reduced senescence-associated secretory phenotype (SASP), and improved proliferation and migration of senescent VSMCs. Mechanistically, the proteomic analysis indicated that autophagy might contribute to metformin’s anti-senescence effects. Reduced autophagic flux was observed in Ang II-induced cellular and vascular senescence; this reduction was reversed by metformin. Specifically, metformin enhanced the autophagic flux at the autophagosome-lysosome fusion level, whereas blockade of autophagosome-lysosome fusion inhibited the anti-senescence effects of metformin. Conclusions: Metformin prevents VSMC and vascular senescence by promoting autolysosome formation.

Abstract Aims Clinical data on the prognostic determinants over varying periods within the same cohort of heart failure with mid‐range or mildly reduced ejection fraction (HFmrEF) remain scarce. This study aimed to identify the short‐term, intermediate‐term, and long‐term risk factors of adverse cardiovascular (CV) outcomes in patients hospitalized for HFmrEF. Methods and results This retrospective study included 1691 consecutive HFmrEF patients admitted to our hospital between January 2015 and August 2020. Baseline data including clinical characteristics, laboratory and cardiac imaging examinations were obtained. Patients completed at least 1 year clinical follow‐up after discharge by telephone interview, clinical visit, or community visit. The primary endpoint was defined as a composite of CV death or rehospitalization for heart failure (CV events) at 3, 12, and 33 months after the diagnosis of HFmrEF. Mean age of the whole cohort was 69 (61–77) years and 64.8% were male. The median clinical follow‐up was 33 (20–50) months. CV events were 17.5%, 28.2%, and 57.8% at 3, 12, and 33 months after discharge, respectively. Independent risk factors for CV events were uric acid >382 μmol/L, creatinine >100 μmol/L, N‐terminal pro‐B type natriuretic peptide (NT‐proBNP) > 3368 pg/mL and haemoglobin 35 mmHg and the ratio of early transmitral flow velocity to early mitral annular velocity >18 served as independent risk factors for CV events at 12 months. At 33 months, uric acid > 382 μmol/L, NT‐proBNP >3368 pg/mL, and pulmonary artery systolic pressure >35 mmHg were the independent risk factors of CV events. Conclusions Higher uric acid, creatinine, NT‐proBNP, and lower haemoglobin levels at baseline are valuable serum biomarkers for risk stratification of short‐term and long‐term CV outcomes of HFmrEF patients. Future studies are needed to verify if intensive heart failure therapy for identified high‐risk HFmrEF patients based on these four serum biomarkers could improve their short‐term and long‐term CV outcomes or not.

BackgroundLoop electrosurgical excision procedure (LEEP) conization and hysterectomy are performed for some patients with papillary squamous cell carcinoma (PSCC), whereas only hysterectomy is performed for others. We aimed to determine the optimal management for PSCC.MethodsPatients diagnosed with PSCC by colposcopy-directed biopsy between June 2008 and January 2020 who underwent LEEP conization and hysterectomy or only hysterectomy at our hospital were enrolled. Results of cervical cytology, high-risk human papillomavirus testing, transvaginal sonography, pelvic magnetic resonance imaging, LEEP, hysterectomy, and pathology testing of colposcopy-directed biopsy samples were analyzed.ResultsA total of 379 women were diagnosed with PSCC by colposcopy-directed biopsy; 174 underwent LEEP before hysterectomy and 205 underwent only hysterectomy. Patients underwent and did not undergo LEEP were aged 47 ± 11 years and 52 ± 11 years, respectively. Among women who underwent LEEP, the agreement between LEEP and hysterectomy pathology was 85.1%. For women who underwent only hysterectomy, the agreement between preoperative clinical staging and pathological staging after hysterectomy was 82.4%. For patients with preoperative imaging indicative of malignancy, the accuracy of LEEP for diagnosing and staging PSCC was 88.5%, whereas for the hysterectomy-only group, it was 86.2%. For patients without malignancy detected with imaging, the accuracy of LEEP for diagnosing and staging PSCC was 81.6%; however, for those who did not undergo LEEP, it was 70.0%.ConclusionFor women diagnosed with PSCC by colposcopy-directed biopsy, LEEP conization is necessary for an accurate diagnosis when imaging does not indicate cancer; however, LEEP is not necessary when imaging indicates cancer.

Abstract Aims Pulmonary congestion (PC) expressed by residual lung ultrasound B‐lines (LUS‐BL) could exist in some discharged heart failure (HF) patients, which is a known determinant of poor outcomes. Detection efficacy for PC is suboptimal with widely used imaging modalities, like X‐ray or echocardiography, while lung ultrasound (LUS) can sufficiently detect PC by visualizing LUS‐BL. In this trial, we sought to evaluate the impact LUS‐BL‐guided intensive HF management post‐discharge on outcome of HF patients discharged with residual LUS‐BL up to 1 year after discharge. IMP‐OUTCOME is a prospective, single‐centre, single‐blinded, randomized cohort study, which is designed to investigate if LUS‐BL‐guided intensive HF management post‐discharge in patients with residual LUS‐BL could improve the clinical outcome up to 1 year after discharge or not. Methods and results After receiving the standardized treatment of HF according to current guidelines, 318 patients with ≥3 LUS‐BL assessed by LUS within 48 h before discharge will be randomly divided into the conventional HF management group and the LUS‐BL‐guided intensive HF management group at 1:1 ratio. Patient‐related basic clinical data including sex, age, blood chemistry, imaging examination, and drug utilization will be obtained and analysed. LUS‐BL will be assessed at 2 month interval post‐discharge in both groups, but LUS‐BL results will be enveloped in the conventional HF management group, and diuretics will be adjusted based on symptom and physical examination results with or without knowing the LUS‐BL results. Echocardiography examination will be performed for all patients at 12 month post‐discharge. The primary endpoint is consisted of the composite of readmission for worsening HF and all‐cause death during follow up as indicated. The secondary endpoints consisted of the change in the New York Heart Association classification, Duke Activity Status Index, N terminal pro brain natriuretic peptide value, malignant arrhythmia event and 6 min walk distance at each designed follow up, echocardiography‐derived left ventricular ejection fraction, and number of LUS‐BL at 12 month post‐discharge. Safety profile will be recorded and managed accordingly for all patients. Conclusions This trial will explore the impact of LUS‐BL‐guided intensive HF management on the outcome of discharged HF patients with residual LUS‐BL up to 1 year after discharge in the era of sodium‐glucose cotransporter‐2 inhibitors and angiotensin receptor blocker‐neprilysin inhibitor. Trial Registration: ClinicalTrials.gov: NCT05035459

Abstract Background We aimed to investigate changes of bile acids and resting energy expenditure (REE) in patients with type 2 diabetes mellitus (T2DM) after laparoscopic cholecystectomy (LC) and the role in metabolic homeostasis. Methods From December 2019 to December 2021, a total of 77 T2DM patients with gallbladder polyps were included in our study. Among them, 40 patients who underwent LC were enrolled into the cholecystectomy group, and 37 patients who did not undergo LC were enrolled into the control group. Preoperative and 6-months postoperative demographic data, body weight, food intake, effects on diabetes control, and biomedical variables were recorded and compared. Results The mean level of total bile acids (TBA) was higher than that in the control group (P = 0.033) and increased significantly after LC compared to baseline (P = 0.029). The REE level in the cholecystectomy group was higher than that in the control group (P = 0.032) and increased compared to the baseline (P = 0.011). The utilization of carbohydrates increased significantly after LC (P

ObjectiveThis study aims to investigate the effectiveness of a quality improvement program for reducing intravenous thrombolysis (IVT) delay in acute ischemic stroke (AIS).Materials and methodsWe implement a quality improvement program consisting of 10 interventions for reducing IVT delay, including the establishment of an acute stroke team, standardized management of stroke teams, popularization of stroke and its treatment, emergency bypass route (BER), the achievement of computed tomography (CT) priority, no-delay CT interpretation, intravenous thrombolysis on the CT table, payment after treatment, whole recording, and incentive policy. We retrospectively analyzed the clinical time and outcome data of AIS patients treated with IVT in pre-intervention (108 patients) and post-intervention groups (598 patients), and further compared the differences between the non-emergency bypass route (NBER) and BER in the post-intervention group.ResultsThe thrombolysis rate increased from ~29% in the pre-intervention group to 48% in the post-intervention group. Compared with the pre-intervention group, the median of door-to-needle time (DNT) was greatly shortened from 95 to 26 min (P < 0.001), door-to-CT time (DCT) was noticeably decreased from 20 to 18 min (P < 0.001), and onset-to-needle time (OTT) significantly declined from 206 to 133 min (P = 0.001). Under the new mode after the intervention, we further analyzed the IVT delay difference between the NBER (518 patients) and BER groups (80 patients) from the post-intervention group. The median values of DNT (18 vs. 27 min, P < 0.001), DCT (10 vs. 19 min, P < 0.001), and OTT (99 vs. 143 min, P < 0.001) showed significant reductions in the BER group. The quality improvement program under the emergency platform successfully controlled the median of DNT to within 26 min.ConclusionsCollectively, the BER mode is a feasible scheme that greatly decreased DNT in AIS patients, and the secret to success was to accomplish as much as possible before the patient arrives at the emergency room.

Background: Glioblastoma is a common malignant neuroepithelial neoplasm with poor clinical outcomes and limited treatment options. It is extremely important to search and confirm diverse hub genes that are effective in the advance and prediction of glioblastoma.Methods: We analyzed GSE50161, GSE4290, and GSE68848, the three microarray datasets retrieved from the GEO database. GO function and KEGG pathway enrichment analyses for differentially expressed genes (DEGs) were performed using DAVID. The PPI network of the DEGs was analyzed using the Search Tool for the Retrieval of Interacting Genes database and visualized by Cytoscape software. Hub genes were identified through the PPI network and a robust rank aggregation method. The Cancer Genome Atlas (TCGA) and the Oncomine database were used to validate the hub genes. In addition, a survival curve analysis was conducted to verify the correlation between the expression of hub genes and patient prognosis. Human glioblastoma cells and normal cells were collected, and then RT-PCR, Western blot, and immunofluorescence were conducted to validate the expression of the NDC80 gene. A cell proliferation assay was used to detect the proliferation of glioma cells. The effects of NDC80 expression on migration and invasion of GBM cell lines were evaluated by conducting scratch and transwell assays.Results: A total of 716 DEGs were common to all three microarray datasets, which included 188 upregulated DEGs and 528 downregulated DEGs. Furthermore, we found that among the common DEGs, 10 hub genes showed a high degree of connectivity. The expression of the 10 hub genes in TCGA and the Oncomine database was significantly overexpressed in glioblastoma compared with normal genes. Additionally, the survival analysis showed that the patients with low expression of six genes (BIR5C, CDC20, NDC80, CDK1, TOP2A, and MELK) had a significantly favorable prognosis (p < 0.01). We discovered that NDC80, which has been shown to be important in other cancers, also has an important role in malignant gliomas. The RT-PCR, Western blot, and immunofluorescence results showed that the expression level of NDC80 was significantly higher in human glioblastoma cells than in normal cells. Moreover, we identified that NDC80 increased the proliferation and invasion abilities of human glioblastoma cells.Conclusion: The six genes identified here may be utilized to form a panel of disease progression and predictive biomarkers of glioblastoma for clinical purposes. NDC80, one of the six genes, was discovered to have a potentially important role in GBM, a finding that needs to be further studied.

BackgroundHigh body mass index increases the risk of heart failure morbidity and mortality. It is unclear whether a high body mass index is associated with prognosis in patients with heart failure with mildly reduced left ventricular ejection fraction (HFmrEF). We retrospectively analyzed the effect of a high body mass index on the prognosis of patients with HFmrEF.MethodsWe investigated the association between body mass index and cardiovascular death (death from any cardiovascular mechanism) in 1,691 HFmrEF patients (mean age, 68 years; 35% female) in Xiangtan Central Hospital. Using Cox proportional hazards models, body mass index was assessed as a continuous and a categorical variable.ResultsCardiovascular death occurred in 133 patients (82 males and 51 females) after 1 year of follow-up. After adjustment for established risk factors, there was a 7.5% increase in the risk of cardiovascular death for females for each increment of 1 in BMI. In contrast, changes in male body mass index were not significantly associated with cardiovascular death (P = 0.097). Obese subjects had a 1.8-fold increased risk of cardiovascular death compared with subjects with a normal body mass index. The hazard ratio for females was 2.163 (95% confidence interval: 1.150–4.066). Obesity was not significantly associated with cardiovascular death in males (P = 0.085).ConclusionAn increased body mass index is associated with an increased risk of cardiovascular death in patients with HFmrEF; however, this risk was mainly associated with female patients with HFmrEF and less with male patients with HFmrEF.

A wideband wide-scanning open-ended rectangular waveguide phased array in a triangular lattice is presented. Dielectric or metamaterial wide-angle impedance matching superstrates have been widely used in phased arrays to improve the scanning performance. However these dielectric-containing covers cannot solve the problem of scan blindness caused by the surface waves, or even further aggravate the surface wave effect. The modulated surface structures, which consist of the impedance-gradient structures and the surface wave bandgap structures are designed to maximize the wideband wide-scanning performance of the array. The proposed array achieves 40% bandwidth (8–12 GHz), while covering a scanning range of ±65° in the E-plane (VSWR < 2.3) and H-plane (VSWR < 2). The practical working frequency band occupies the whole potential operating frequency band between the waveguide TE10 cutoff frequency and the onset frequency of the first grating lobe. An $11\times11$ prototype is fabricated and measured. Good agreement is achieved between the simulated and measured results.

Abstract Becker muscular dystrophy (BMD) complicated with DCM is rare in our daily clinical practice. BMD serves an etiology for heart failure patients due to DCM. Multidisciplinary management is required in this case.

Acute decompensated heart failure (ADHF) is one of the most common causes of hospital admission for cardiovascular diseases. ADHF often affects the elderly population, is associated with high morbidity, admission rate and mortality. Pulmonary congestion (PC) is the most common cause of hospitalization among ADHF patients. Previous studies have shown that lung ultrasound (LUS) serves as a valuable tool for the evaluation of PC in patients with heart failure in terms of diagnosis, guiding of the treatment, and post-discharge monitoring. The use of LUS for ADHF is well described and already widely used in the daily clinical practice. PC might differ in ADHF patients with different left ventricular ejection fraction value and treatment options should be steadily adjusted according to the LUS-derived PC results to improve the outcome. This review summarized the value of LUS examination in patients with ADHF with preserved, mildly reduced, and reduced left ventricular ejection fraction, aiming to expand the rational use of LUS, promote the LUS-guided management and improve the outcome among patients with ADHF.

Abstract A facile hydrothermal polymerization method has been developed for the preparation of monodisperse carbon spheres (MCSs) using the triblock copolymer F108 as surfactant. The synthesis is based on the ammonia-catalyzed polymerization reaction between phenol and formaldehyde (PF). The resultant MCSs have a perfect spherical morphology, smooth surface, and high dispersity. The particle sizes can be tuned in a wide range of 500~2400 nm by adjusting the dosage of the PF precursor. The activated MCSs with suitable heteroatoms (N and O) doped and a large specific surface area (960 m2 g−1) were obtained. A high-performance electrode of electrical double-layer capacitors fabricated by those active material have an excellent specific capacitance (310 F g−1 at 0.5 A g−1) and outstanding cycling stability (92% capacitance retention after 10,000 cycles). This work provides a new opportunity for the fabrication of MCSs with potential applications.

Porous carbon spheres ranging in size from nanometer to micrometer have been attracting worldwide attention owing to their excellent performance and wide application. In this paper, nitrogen-doped porous carbon spheres (NPCSs) are successfully prepared by a facile hydrothermal strategy under the assistance of triblock copolymer F108 as soft template. The effect of the ethanol/water volume ratios, concentration of F108 and ammonia, and the alkyl chain of alcohol on the morphologies and particle size of the resulted NPCSs are investigated systematically. Results show that the particle size can be tuned from 160 to 2000 nm by adjusting the synthesis parameters. The obtained NPCSs exhibit a large specific surface area (1481 m2 g−1) and suitable nitrogen-doped concentration (2.4 at%). As electrode material for supercapacitors, the NPCSs present a high specific capacitance of 365 F g−1 at 0.5 A g−1 and outstanding cycling stability with 93.9% retention after 10 000 cycles. Keywords: Soft-template, Nitrogen-doped, Porous carbon spheres, Supercapacitor, Energy storage and conversion

A temperature-dependent tunable metamaterial absorber (MA) based on strontium titanate (STO) is proposed at terahertz regions. The MA is a three-layer structure, which is composed of double metallic split-ring resonators (SRRs), silicon substrate, and the ground metallic layer. Numerical results show that the single-band high absorption with the coefficient of 99% is achieved at the frequency of 1.23 THz, and the position of resonant frequency is blue-shifted by increasing the ambient temperature to control the relative permittivity of STO material, which is embedded into two slits of SRR. Moreover, it is found that the absorption efficiency of MA can be tuned by changing the conductivity of vanadium dioxide (VO2) through ambient temperature. Considering the limitation of single-band absorption, a simple method is proposed to achieve dual-band high absorption by rotating the top SRR layer at different angles α. The two high absorption efficiencies of 100% and 97% at the frequency of 1.28 THz and 1.43 THz, respectively, can be obtained when α = 45°. The proposed MA can be used in some areas in term of sensors, light modulators and terahertz absorbers. Keywords: Metamaterial, Temperature-dependent, Sensors, Light modulators

Abstract Nitrogen-doped microporous carbon spheres (NMCSs) are successfully prepared via carbonization and KOH activation of phenol-formaldehyde resin polymer spheres synthesized by a facile and time-saving one-step hydrothermal strategy using triblock copolymer Pluronic F108 as a soft template under the Stöber-like method condition. The influence of the ethanol/water volume ratios and carbonation temperatures on the morphologies, pore structures and electrochemical performances of the prepared NMCSs are investigated systematically. The optimal NMCSs have a large specific surface area of 1517 m2 g− 1 with a pore volume of 0.8 cm3 g− 1. The X-ray photo-electron spectroscopy analysis reveals a suitable nitrogen-doped content of 2.6 at.%. The as-prepared NMCSs used as supercapacitor electrode materials exhibit an outstanding specific capacitance of 416 F g− 1 at a current density of 0.2 A g− 1, also it shows an excellent charge/discharge cycling stability with 96.9% capacitance retention after 10,000 cycles. The constructed symmetric supercapacitors using PVA/KOH as the gel electrolyte can deliver a specific capacitance of 60.6 F g− 1 at current density of 1 A g− 1. A maximum energy density of 21.5 Wh kg− 1 can be achieved at a power density of 800 W kg− 1, and the energy density still maintains 13.3 Wh kg− 1 even at a high power density of 16 kW kg− 1. The results suggest that this work can open up a facile and effective way to synthesize the NMCSs for electrode materials of high performance energy storage devices.

The temperature-insensitive and separately tunable dual-band metamaterial absorber (MA) based on graphene are investigated at mid-infrared regions. The design scheme is shown in the way of placing two gammadion-shaped metals with different sizes on the corresponding graphene interdigitated finger sets. Numerical results show that the position of two absorption peaks is separately tuned by manipulating the Fermi energy of corresponding graphene interdigitated finger. Different from the conventional tunable dual-band MAs, the dual-band absorption intensities remain strong over a wide ambient temperature ranging up to 800 K. Further results reveal that the dual-band strong absorption can be also maintained even though the top patterned metals are filleted. The separately tunable MA with the above-mentioned features is of potential interest in some areas, such as frequency selective detectors for sensing applications and temperature-insensitive infrared absorbers. Keywords: Metamaterial, Temperature-insensitive, Separately tunable

Strategic competence, as a meta-cognitive ability, determines the other translation sub-competences. To tease out how students' strategic competence is developed in translation project is significant in enlightening the translation teaching practice. This study explores how five Chinese college students' translation competence, particularly their strategic competence, develop within a translation project introduced into the translation teaching of the authors' institute. Strategic competence includes four parts: problem identification, solution proposal, action taking, and decision making. By examining both the translation process and the translation product, including translation tasks, translation logs, group discussions, and interviews from five student translators, we found that the overall translation competence of the student translators has significantly improved. The development of various elements of strategic ability is uneven, with the abilities to identify problems, evaluate issues, and take measures showing the most significant improvement. However, there is a lag in decision-making capabilities in translation output. Based on these findings, the study provides concrete suggestions for improving the teaching of translation.

A stripline-fed tightly coupled array antenna with compact size, large scan volume and low cross-polarization characteristics is proposed for ultrawideband (UWB) applications. Simple impedance-matching process is realized by using parallel dual dipoles. Meanwhile, the parallel symmetrical radiating structures minimize the cross-polarization field components dramatically. The mitigation of various undesired resonances is studied in detail. An infinite array is designed to achieve 3:1 bandwidth (6−18 GHz) when scanning ±60∘ in the E-/D-planes (VSWR < 2.5) and H-plane (VSWR < 3.5). The cross-polarization levels remain below −29 dB at broadside. A 16 × 16 prototype is fabricated to demonstrate the design. The measured results are consistent well with the simulated ones. The overall size of the prototype at the lowest operating frequency is 3×3×0.4λ03 (15×15×2cm3). Due to its wide bandwidth, good electronic scan performance and compact size, the proposed antenna array is a good candidate for modern wireless platforms.

Environment perception is important for collision-free motion planning of outdoor mobile robots. This paper presents an adaptive obstacle detection method for outdoor mobile robots using a single downward-looking LiDAR sensor. The method begins by extracting line segments from the raw sensor data, and then estimates the height and the vector of the scanned road surface at each moment. Subsequently, the segments are divided into either road ground or obstacles based on the average height of each line segment and the deviation between the line segment and the road vector estimated from the previous measurements. A series of experiments have been conducted in several scenarios, including normal scenes and complex scenes. The experimental results show that the proposed approach can accurately detect obstacles on roads and could effectively deal with the different heights of obstacles in urban road environments.