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A square concrete-filled double steel tubular (CFDST) column composed of a circular core concrete-filled tube offers the advantages of both square and circular concrete-filled steel tubular (CFST) columns. However, limited tests were performed to investigate the axial performance of CFDST slender columns. This paper investigates the behavior and design of square CFDST slender columns subjected to concentric loading. A total of eight columns, including six CFDST slender columns and two CFDST short columns were tested under concentric loading. The test parameter includes the slenderness ratio of the columns and the thickness of the inner tube. The ultimate load, failure modes and axial load-deflection relationships of CFDST slender columns are presented. It was observed that square CFDST slender columns failed due to the overall buckling of the columns together with the localized buckling of the steel tube and concrete crushing. Increasing the slenderness ratio and decreasing the thickness of the inner steel tube reduced the ultimate load of CFDST slender columns. The applicability of the existing design code of CFST columns in designing CFDST slender columns was evaluated. It was found that the existing design codes significantly underestimated the ultimate loads of CFDST columns.

Objectives. The study is aimed at exploring the effect of the controlled release of the glial-derived neurotrophic factor (GDNF) on nerve regeneration. Methods. The PLGA/chitosan composite nerve conduit was used to bridge the dissected trunk of the rat facial nerve. GDNF microcapsules were loaded into the nerve conduit. Nine weeks after surgery, the facial nerve zygomatic and buccal branches were labeled with fluorescent indicators. The incorrectly grown facial neurons were reversed and counted. The facial nerve functional recovery was assessed by measuring the maximum evoked potential. Results. The nerve conduit was filled with different regenerating factors, such as the GDNF, GDNF microcapsules, or saline (control). The number of incorrectly regenerated neurons was lower with the nerve conduits filled with GDNF microcapsules than with those supplied with just the GDNF. However, neither the GDNF nor GDNF microcapsules affected the number of regenerated neurons. The functional recovery of the facial nerve was the best, with the nerve conduit filled with GDNF microcapsules closest to the healthy uncut facial nerve. Conclusion. The stable slow-release GNDF microcapsule inside the biodegradable nerve conduit can reduce the extent of incorrect growth of the facial nerve neuron when bridging the dissected rat facial nerve trunk. The technique has a good effect on functional nerve recovery.

This article investigates the axial compressive performance of concrete-filled double steel tubular (CFDST) short columns composed of circular section loaded concentrically. An experimental program comprised of compression tests on short columns is carried out to examine their structural performance. Axial compression tests on conventional concrete-filled steel tubular (CFST) columns and double-skin concrete-filled steel tubular (DCFST) columns are also performed for comparison purposes. The test parameters include the diameter-to-thickness of the outer and inner steel tubes, concrete strength, and diameter ratio. The test results exhibit that CFDST short columns composed of the circular section have improved structural performance compared to its CFST and DCFST counterparts. A theoretical model is also presented to simulate the test ultimate strengths and load-axial strain relationships of CFDST columns. The existing design models proposed including the codified design specifications are evaluated against the collected test data for predicting the axial compressive strengths of circular CFDST columns. It is seen that the existing codified design models cannot yield their ultimate axial compressive strengths accurately. A practical artificial neural network (ANN) model is proposed to estimate the ultimate load of such columns loaded concentrically.

Elliptical concrete-filled stainless steel tubular (CFSST) columns are high-performance composite columns that have the enormous potentiality to be used in composite construction in the near future. However, to date, limited studies on the performance analysis of such columns under axial compression have been performed taking into account the accurate material laws of stainless steel and the confined concrete. This paper presents a mathematical model to investigate the axial performance of elliptical CFSST short columns. Accurate material laws of stainless steel and the confined concrete are incorporated in the numerical modeling to capture their true performance. Independent test results are utilized to validate the accuracy of the mathematical predictions. A parameter study is performed to study the important column parameters on their axial performance. The investigations of the accuracy of the existing design models for CFST columns in designing axially loaded elliptical CFSST columns are performed with the test and numerical predictions.

The accurate prediction of the concrete confinement effects in concrete-filled double-skin steel tubular (CFDST) columns composed of a circular section is vital in stimulating their true structural performance. However, existing concrete confinement models for such columns were developed based on limited studies and may not accurately predict their axial responses under axial loading. In this paper, a numerical model is developed to study the nonlinear performance of axially-loaded short CFDST columns incorporating an accurate concrete confinement model. Herein, a novel expression to calculate the lateral confining pressure on the confined concrete of the CFDST column is proposed considering the influences of a wide range of important column parameters. Furthermore, a reduction factor to accurately predict the post-peak behavior of confined concrete is suggested based on the previous test results. The accuracy of the numerical model incorporating the proposed concrete confinement model is verified against the experimental tests. The accuracy of the existing concrete confinement models is also evaluated and compared with the one proposed in this study. It is demonstrated that the proposed confinement model can yield the axial performance of CFDST columns more accurately. A parameter study is then performed to analyze the impacts of important column parameters on the axial performance of such a column. The applicability of the existing design standards in designing CFDST columns is verified. Lastly, a simple and accurate design equation to quantify the ultimate axial load is proposed.

In this paper, the structural behavior of concrete-filled double steel tubular (CFDST) stub columns composed of square hollow sections is investigated experimentally and numerically. The experimental program comprises compression tests on short columns loaded concentrically. The test parameters mainly focused on the influences of the width-to-thickness ratios of steel tubes and concrete strength on the axial behavior of CFDST stub columns. Finite element (FE) models are also developed to investigate the influences of a wide range of structural parameters on their axial performance. It is observed that square CFDST columns have improved strength and ductility compared to their CFST and DCFST counterparts. Finally, a calculation formula is proposed to predict their ultimate compressive strengths under the axial compression load.

Background This study sought to test the effectiveness of EVOSKIN®Palm and sole moisturizing cream (PSMC) in preventing and treating hand-foot syndrome (HFS) during capecitabine chemotherapy. Methods Stage II/III colorectal cancer patients receiving capecitabine adjuvant chemotherapy were randomly allocated to receive either EVOSKINPSMC or physiological saline treatments for their hands and feet. Treatment was initiated along with adjuvant chemotherapy and continued till the end of chemotherapy. Participants' skin responses were evaluated every 3 weeks. Results During the study, 51 participants in the EVOSKIN PSMC group and 54 participants in the physiological saline group completed at least three cycles of capecitabine chemotherapy. The total incidence of HFS in the EVOSKIN PSMC group was lower than that in the physiological saline group (56.8% vs. 75.9%, P=0.006), as was the incidence of Grade 3/4 HFS (6.0% vs. 18.5%, P=0.011). The incidence of HFS became significant after 6weeks of chemotherapy. Further, the incidence of severe HFS was significant from as early as 3weeks after the commencement of chemotherapy despite the use of EVOSKIN PSMC to manage the condition. Notably, the incidence of Grade 1/2 HFS was not statistically significant between the two groups (26/51 vs. 32/54, 52.0% vs. 59.2%, P=0.194). Conclusions The incidence of severe HFS among individuals using oral capecitabine can be reduced by the prophylactic treatment of EVOSKIN PSMC, this treatment is reasonable and acceptable for patients with capecitabine chemotherapy.

Concrete-filled double steel tubular (CFDST) columns have been proposed in recent years. This paper presents the performance analysis and a new bearing capacity calculation method of circular CFDST stub columns under axial compression. In order to establish accurate finite element (FE) model, various constitutive models for both the concrete infill and steel tubes are analyzed and compared with experimental results in FE analysis, and the suitable constitutive models for sandwich concrete, core concrete and steel tube are proposed in the FE model developed. Based on the validated numerical model, the variation of confining stress between steel tube and concrete is analyzed in detail. In addition, parametric studies are conducted to investigate the effects of concrete strength, external tube thickness, inner tube thickness, diameter ratio of inner tube to external tube and yield strength of steel tube on the axial compressive performance of circular CFDST stub columns. A new simplified formula based on the confining pressure is proposed to evaluate the ultimate bearing capacity of the circular CFDST stub columns. Based on the comparisons with experimental results and numerical simulation results, it is shown that the proposed formulae for the circular CFDST stub columns appear to be satisfactory.

The moment frames that consisted of prefabricated concrete beams and columns, which were linked by the unbonded post-tensioning, have been proposed for multi-story buildings. However, their lower s...

Objectives: The optimal surgical approach to treat recurrent laryngeal nerve (RLN) infiltration by differentiated thyroid cancer (DTC) remains a subject of debate. This study explored the feasibility and efficiency of immediate ansa cervicalis nerve (ACN)-to-RLN anastomosis for the management of RLN infiltration by DTC. Material and Methods: Fifty-three patients who underwent immediate ACN-to-RLN anastomosis during DTC extirpation were enrolled in the present study. Thirty-seven cases presented with unilateral vocal cord paralysis before the operation (Group A), and another 16 patients presented with normal vocal cord mobility preoperatively (Group B). Multidimensional assessments, videostroboscopy, voice assessment, and laryngeal electromyography (LEMG) were performed preoperatively and postoperatively. Results: All videostroboscopy, voice assessment and LEMG parameters in Group A deteriorated 1 month after the operation and improved 1 year after the operation compared with preoperative data. In Group B, all parameters 1 year after the operation improved significantly compared with the corresponding parameters 1 month after the operation. LEMG in Group A and B provided substantial evidence for the maturation of neural regeneration from ACN and demonstrated that the laryngeal muscles were reinnervated successfully by this procedure. Conclusions: If the RLN is infiltrated by DTC, immediate ACN-to-RLN anastomosis during complete excision of DTC could restore satisfactory phonatory function and does not compromise oncological radicality.

The oncogenic functions of circRNA circSEPT9 have been characterized in triple-negative breast cancer. We analyzed its role in laryngeal squamous cell carcinoma (LSCC). Quantitative reverse-transcription PCR (RT-qPCR) was used to analyze the expression of circSEPT9 and miR-10a in paired LSCC and nontumor tissues donated by 50 patients with LSCC. Methylation-specific PCR (MSP) was performed to analyze the role of circSEPT9 in miR-10a RNA gene methylation. circSEPT9 or miR-10a were overexpressed in LSCC cells to explore the interaction between them. The regulatory role of circSEPT9 and miR-10a in cell proliferation was studied with cell counting kit-8 (CCK-8) assay. CircSEPT9 was highly expressed in LSCC, whereas miR-10a was expressed at a lower level in LSCC. CircSEPT9 and miR-10a were closely correlated across LSCC tissue samples. In LSCC cells, circSEPT9 overexpression increased the methylation of the miR-10a gene and decreased the expression of miR-10a. CircSEPT9 overexpression increased LSCC cell proliferation, whereas miR-10a overexpression decreased cell proliferation. Co-transfection experiments showed that circSEPT9 overexpression attenuated the effects of miR-10a overexpression on cell proliferation. We conclude that circSEPT9 may increase miR-10a methylation to increase cell proliferation in LSCC.

Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.

Background This study investigated the role of lncRNA CASC15 in laryngeal squamous cell carcinoma (LSCC). Methods This study included 58 LSCC patients. Both tumor (LSCC) and adjacent (within 3 cm around tumors) non-tumor tissues from 3 different sites of each patient were collected. CCK-8 assay was used to determine cell proliferation. The expression levels of proteins and mRNAs were determined by Western blotting analysis and qRT-PCRs, respectively. Results CASC15 was upregulated in LSCC and high expression levels of CASC15 predicted poor survival. In LSCC tissues, CASC15 was negatively correlated with miR-365 but positively correlated with cyclin D1. In LSCC cells, overexpression of CASC15 resulted in downregulation of miR-365 and upregulation of cyclin D1. Overexpression of miR-365 did not affect the expression of CASC15 but downregulated cyclin D1. Overexpression of Cyclin D1 did not affect the expression of miR-365 and CASC15. Overexpression of CASC15 and cyclin D1 led to promoted, while overexpression of miR-365 led to inhibited LSCC cell proliferation. In addition, overexpression of miR-365 reduced the effects of overexpression of CASC15. Conclusion Therefore, CASC15 upregulates cyclin D1 by downregulating miR-365 in LSCC to promote cell proliferation.

Objectives/hypothesis This study explored the feasibility and efficiency of main branch of ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) anastomosis for management of paroxysmal laryngospasm due to unilateral vocal cord paralysis (UVCP). Methods Thirteen patients who underwent main branch of ACN-to-RLN anastomosis for management of paroxysmal laryngospasm due to UVCP were enrolled in the present study. Multidimensional assessments, including videostroboscopy, voice assessment, and laryngeal electromyography (LEMG), were performed preoperatively and postoperatively. Results This series was limited to UVCP with iatrogenic causes, including thyroidectomy, cervical spine surgery, and thoracic surgery. After main branch of ACN-to-RLN anastomosis, all cases showed significant airway improvement, and laryngospasm was completely abolished in 92.3% (12 of 13) of cases. Videostroboscopy showed that the bulging and paradoxical adduction of the affected vocal cord during a sniff were abolished immediately after operation, and there was no significant difference in vocal fold position or glottal closure before versus after the operation. LEMG showed that the postoperative recruitment and amplitude of voluntary motor unit potential in the affected thyroarytenoid muscle during a sniff were significantly decreased compared to preoperative values, and postoperative recruitment showed significant improvement during phonation compared to that preoperatively. Voice assessment showed that there were no significant differences in overall grade, roughness, breathiness, jitter (local), shimmer (local), noise-to-harmonics ratio, or maximum phonation time after the operation compared to the preoperative values. Conclusions Main branch of ACN-to-RLN anastomosis could have long-lasting efficacy in the management of paroxysmal laryngospasm due to UVCP, with no apparent compromise of voice quality. Level of evidence 4 Laryngoscope, 130:2412-2419, 2020.

OBJECTIVE To evaluate the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery. METHODS Seven patients with BVFP caused by thyroid surgeries were enrolled. They underwent selective laryngeal reinnervation surgery. Videostroboscopy data, voice perceptual data (grade [G]), acoustic data, laryngeal electromyography data, and pulmonary function test data were obtained preoperatively and postoperatively. RESULTS Videostroboscopic videos showed that six patients could achieve moderate-to-maximal abduction in the bilateral vocal folds during inspiration, whereas all patients achieved adduction in the bilateral vocal folds during phonation at 4 to 7 months postoperatively. G score was decreased significantly versus preoperative values (P < 0.05), and vocal functional parameters were improved significantly at 12 months postoperatively (P < 0.05). The aerodynamic parameter of maximum phonation time was significantly longer than the preoperative value (P < 0.05). Most parameters in pulmonary function test recovered to normal reference levels as early as 3 months postoperatively, whereas maximal inspiratory pressure (PImax) values were still slightly lower than normal levels 12 months after surgery. All of these parameters improved significantly versus preoperative values. Electromyographic data at 12 months postoperatively showed full interference potentials in bilateral posterior cricoarytenoid muscles during inspiration and full interference potentials in bilateral thyroarytenoid muscles during phonation in all patients. Moderate electric potentials were seen in left interarytenoid muscle in one failed patient. CONCLUSION This new selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP. LEVEL OF EVIDENCE 4. Laryngoscope, 129:2669-2673, 2019.

Background Tongue squamous cell carcinoma (TSCC) is the second most common malignancy in oral carcinoma. lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was regarded as an oncogenic factor in various carcinomas. However, its underlying molecular mechanisms in the development and progression of TSCC have not been well featured till now. Methods The expressions of MALAT1, miR-140-5p and p21 (RAC1)-activated kinase 1 (PAK1) mRNA were measured by RT-qPCR assay. The protein level of PAK1 was determined by western blot analysis. Cell viability was detected by Cell Counting Kit-8 assay. Transwell chamber was used to detect cell migratory and invasive capability. Luciferase reporter assay, RNA-binding protein immunoprecipitation (RIP) assay and biotin pull-down assay were applied to evaluate the relationship between MALAT1, miR-140-5p and PAK1. Xenograft experiments were performed to assess the effect and mechanism of MALAT1 in TSCC tumor growth. Results The expression of MALAT1 and p21 (RAC1)-activated kinase 1 (PAK1) was upregulated and microRNA-140-5p (miR-140-5p) expression was downregulated in TSCC tissues and cells. MALAT1 knockdown induced miR-140-5p expression by direct interaction. Moreover, MALAT1 knockdown inhibited proliferation, migration, and invasion by upregulating miR-140-5p expression in TSCC cells. Additionally, PAK1 was identified as a direct target of miR-140-5p. Also, MALAT1 knockdown inhibited PAK1 expression by upregulating miR-140-5p in TSCC cells. Furthermore, miR-140-5p overexpression curbed the proliferation, migration, and invasion of TSCC cells by targeting PAK1. Finally, MALAT1 knockdown inhibited tumor growth by upregulating miR-140-5p and downregulating PAK1 in mouse xenograft models of TSCC. Conclusion MALAT1 contributed to TSCC progression via miR-140-5p-PAK1 regulatory axis, highlighting a potential target for TSCC management.

OBJECTIVE: To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. METHOD: Twenty-one patients with advanced head and neck malignant tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal carcinomas, 5 laryngeal carcinomas, 2 external auditory carcinomas, 1 middle ear carcinoma, and 2 parotid gland carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by tumors, and there were different degrees of lumen stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or free flaps were used to protect the anastomotic areas. All patients were treated with radiotherapy and chemotherapy according to different situations. RESULT: Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%(20/21). Only 1 case received ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. CONCLUSION: In patients with advanced head and neck malignant tumors with cervical metastatic cancer invading the internal carotid artery, one-stage revascularization after radical resection of the tumor and the internal carotid can achieve good therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.

Lymph node (LN) retrieval is a critical procedure to determine the pathological stage and adjuvant therapy for colorectal cancer. The present study aimed to recommend a novel method by using sodium hypochlorite to improve colorectal surgical specimen LN harvest. Dissolving time of mesenteric LNs and fat tissue was firstly investigated in different concentrations of sodium hypochlorite. In the sodium hypochlorite group, 65 patients with colorectal cancer who underwent curative surgery were included. After standard manual gross dissection, the mesenteric tissue was subsequently immersed in 1% sodium hypochlorite for ~30 min, and then manual dissection was again applied for additional LN harvest. In the manual method group, 68 patients with colorectal cancer were selected and only manual dissection method was applied for LN harvest. The number of LNs in both groups were recorded for each case. Sodium hypochlorite could dissolve fat tissue significantly faster than LNs and the low concentration sodium hypochlorite had the maximum dissolving time difference between fat tissue and LNs (P

Faster RCNN is a classic algorithm with high accuracy and a wide range of applications in the field of target detection, and Cascade RCNN is improved based on Faster RCNN. The article applies the Cascade RCNN method to the detection of marine ship targets. It improves the traditional Faster RCNN algorithm and extracts areas that may contain pedestrians through RPN. In this paper, a multi-layer cascade detector is used to distinguish and classify the target area, and an algorithm is designed to detect and verify the data set. In the end, it is concluded that the Cascade RCNN algorithm performs better than the traditional algorithm.

A rapid, selective and sensitive ultra high performance liquid chromatography coupled with tandem triple quaternary mass spectrometry (UHPLC-MS/MS) method was developed and validated for the quantitative determination of atorvastatin calcium (AC) in human plasma. Separation of AC and rosuvastatin calcium (internal standard, IS) were achieved on a Dikma Leapsil C18 reversed phase column (100 × 2.1 mm, 2.7 μm) with gradient elution using 0.2% (v/v) formic acid in water and acetonitrile as mobile phases, at the flow rate of 0.3 mL/min. AC and IS were detected using MS/MS with turbo ion pray source in negative mode by monitoring the precursor-to-product ion transitions m/z 557.0→453.0 for AC and m/z 480.0→418.0 for IS. The calibration curves were linear from 0.05 to 50 ng/mL with a correlation coefficient ( r2) of 0.9992 or better. Thereafter, 187 healthy candidates were checked to the genetic polymorphism analysis of SLCO1B1 521T＞C(rs4149056), SLCO1B1 388A＞G(rs2306283), CYP3A4 1*B(rs2740574), CYP3A4 1*G(rs2242480) and CYP3A5*3(rs776746) using fluorescence in situ hybridization technology. The genotype frequencies of wild-type homozygote, mutant heterozygote and mutant homozygote were 62.57%(TT), 34.22%(TC) and 3.21%(CC) for SLCO1B1 521T＞C, and 8.56%(AA), 33.69%(AG) and 57.75%(GG) for SLCO1B1 388A＞G, and 62.57%(CC), 34.22%(CT) and 3.21%(TT) for CYP3A4 1 G, and 58.29%(GG), 34.76%(GA) and 6.95%(AA) for CYP3A5*3, respectively. Furthermore, each tested genotype of CYP3A4 1B was wild type. Finally, 5 candidates with specific genotype described above were recruited to carry out the clinical pharmacokinetics of AC (n = 5). The validated UHPLC-MS/MS method was implemented in a high-throughput setting, capable of analyzing up to 288 samples per day, and was successfully applied to the pharmacokinetic study of AC based on healthy volunteers with specific genotype. The Cmax of AC in human volunteers with the specific genotype was nearly 10 times higher than that previous reported, indicating that genetic polymorphisms of these specific genotypes have significant influence on pharmacokinetics of atorvastatin.

In high-rise buildings with high-strength concrete column and normal-strength concrete floor, the beams and slabs are usually cast in a continuous fashion through the beam–column joint to simplify construction, and this results in the lower strength concrete at the beam–column joint core (sandwich joint). It will influence the capacity of the joint. In this article, three groups of three-dimensional specimens consisting of sandwich joint specimens and corresponding traditional joint specimens were tested under bidirectional reversed cyclic loads to investigate seismic performance, including the failure mode, ductility, energy dissipation, and deformation. The test results show that the beam–column joint core can be cast with normal-strength concrete when the column concrete strength is less than 1.5 times that of the beam. However, when the ratio exceeds 1.5, the failure mode of the joint may change from beams flexural failure to joint shear failure and additional strengthening measures should be taken. Finally, the formula for calculating shear capacity of the three-dimensional sandwich joints is presented, and the predictions are compared to the experimental results.

Surgical preservation of laryngeal function is very challenging in patients with advanced SCCL, especially those of stage T4a. The purpose of this study was to assess the feasibility of organ preservation surgery for patients with T4a squamous cell carcinoma of the larynx (SCCL). We enrolled 32 patients with T4a SCCL and performed organ preservation surgery on them. Surgical details and perioperative morbidity were described, functional and oncologic outcomes were also evaluated. All patients underwent supracricoid subtotal laryngectomy with unilateral or bilateral neck dissection, restoring laryngeal function via direct anastomosis of the cricoid cartilage and tongue base. The patients recovered well and exhibited relatively acceptable survival duration, with a 5-year overall survival rate of 62.5%. Most patients commenced oral intake within 2 weeks, and aspiration was commonly observed. Subjective functional outcomes indicated a relatively acceptable swallowing function and voice quality. Our retrospective analysis of 32 patients with T4a SCCL showed that successful organ preservation surgery is safe and reliable, and associated with a relatively acceptable disease-free survival, normal swallowing function, and acceptable voice quality. More patients with T4a SCCL who wish to preserve the larynx should be considered for organ preservation surgery.

To consider the actual fire characteristics in the fire response analysis of building structures and to simplify the complex relationship between the fire analysis model and the structural finite element analysis model, a spatio-temporal model of the fire temperature and heat flux boundary for heat conduction analysis is developed. The proposed model adopts a two-way orthogonal polynomial approach for fitting the discrete data from the fire simulation and obtains continuous spatial polynomial equations. It is shown to be accurate for capturing the distributions of temperature and heat flux that are required for a heat conduction analysis and a thermal mechanical coupling analysis. Finally, the model is implemented through user-subroutines UTEMP and DFLUX in ABAQUS, and it is applied to a new archive in Beijing. The results show that this method may be used to combine fire simulation and structural analysis for the safety evaluation of structures under fire.

Circular concrete-filled double steel tubular (CFDST) column is a high-performance composite column that has significant potential to be used in the construction of high-rise composite structures. This paper presents experimental and strength computational investigations on CFDST short columns that are subjected to eccentric compression load. A total of sixteen CFDST stub columns, two concrete-filled steel tubular (CFST) columns, and two double-skin concrete-filled steel tubular (DCFST) columns were tested to investigate their structural performance. The test behavior of the CFDST column loaded eccentrically is discussed and compared against its CFST and DCFST counterparts. The test results show that the CFDST column has improved strength and ductility under eccentric loading when compared with other composite columns. The strengths of the CFDST stub columns in this study together with the test strengths from the literature were used to assess the strength predictions by Eurocode 4 and AISC 360–16. It was found that the current predictions generally underestimate or overestimate the strengths. A new reduction factor for predicting the ultimate strengths of CFDST short columns under eccentric compression is proposed based on the test results. By adopting the newly proposed reduction factor and design method, the design predictions are found to be improved that provide reasonable estimations for circular CFDST columns loaded eccentrically.

The pathogenesis of obstructive sleep apnea (OSA) remains controversial. The role of anatomic stenosis is indisputable, and neural regulation of the upper airway remains to be elucidated. The upper airway maintains patency through the upper airway reflex. Lesions in any link of the reflex can increase the collapsibility of the upper airway. In this study, we investigated sensorimotor nerve lesions and their possible relationship with OSA. Tissue samples were obtained from the pharyngopalatine arch in 47 patients with OSA and 45 control participants to examine changes in the expression levels of myelin basic protein (MBP) and agrin through immunohistochemistry and western blotting. Downregulation of MBP in the mucosa reflects myelinated degeneration of mucosal sensory nerve axons, whereas upregulation of agrin in the neuromuscular junction reflects synaptic regeneration following denervation. The two neural factors correlate significantly with polysomnographic parameters, such as the apnea hypopnea index and lowest oxygen saturation. Our findings suggest that sensorimotor nerve damage in the upper airway of patients with OSA may be associated closely with the mechanism of OSA.

(1) Background: Few studies have focused on antibiotic use and appropriateness in children in primary health institutions (PHIs). This study aimed to identify the patterns and appropriateness of antibiotic use for children in PHIs in Beijing, China. (2) Methods: Outpatient prescriptions of 327 PHIs from 2017 to 2019 for patients &lt, 18 years old were collected. Prescriptions were described using quantity indicators. Antibiotics were categorized according to ATC classification J01 and Access, Watch, Reserve grouping. Appropriateness was reviewed by experts using three subtypes of irrational prescriptions (irregular, inappropriate, and abnormal). (3) Results: 20,618 prescriptions were collected in total. The antibiotic prescription rate (APR) was 15.1% (N = 3113). Among antibiotic prescriptions, J01FA Macrolides were the most used (N = 1068, 34.9%). The Watch group constituted 89.0% (N = 2818) of total antibiotic use. Bronchitis (N = 1059, 35.2%) was the most common diagnosis. A total of 292 instances of irrational antibiotic use were identified, with inappropriate prescriptions being the most prevalent subtype (N = 233, 79.8%). (4) Conclusion: Although APR for children in PHIs in Beijing was relatively low, the pattern of antibiotic use differed from other countries. Further studies are needed to optimize antibiotic use for children in PHIs under different levels of economic development.