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Objectives: This study’s objectives were to explore the potential of wideband acoustic immittance (WAI) as a diagnostic tool, examining its accuracy and efficiency in pediatric audiology. Methods: A narrative review of the contemporary literature was conducted, focusing on studies that assessed the use of WAI in diagnosing pediatric auditory conditions. Key variables such as diagnostic accuracy, efficiency, and clinical outcomes were considered. Results: This review highlighted that WAI offers a broader range of test frequencies and more comprehensive diagnostic information compared with traditional tympanometry. The studies indicated that WAI has the potential to improve diagnostic accuracy and efficiency in pediatric audiology. Distinct patterns of wideband absorbance were identified, enabling more detailed and accurate diagnostic evaluations. Conclusions: WAI shows substantial potential as a diagnostic tool in pediatric audiology, offering improvements in diagnostic accuracy and efficiency over traditional methods. While the initial findings are promising, further research is needed to fully understand its applicability and benefits across different pediatric populations. Future studies should aim to validate the clinical utility of WAI to ensure its widespread adoption in pediatric audiological assessments.

Objective: To identify highest-risk subgroups for COVID-19 and Long COVID(LC), particularly in contexts of influenza and cardiovascular disease(CVD). Methods: Using national, linked electronic health records for England (NHS England Secure Data Environment via CVD-COVID-UK/COVID-IMPACT Consortium), we studied individuals (of all ages) with COVID-19 and LC (2020-2023). We compared all-cause hospitalization and mortality by prior CVD, high CV risk, vaccination status (COVID-19/influenza), and CVD drugs, investigating impact of vaccination and CVD prevention using population preventable fractions. Results: Hospitalization and mortality were 15.3% and 2.0% among 17,373,850 individuals with COVID-19 (LC rate 1.3%), and 16.8% and 1.4% among 301,115 with LC. Adjusted risk of mortality and hospitalization were reduced with COVID-19 vaccination ≥ 2 doses(COVID-19:HR 0.36 and 0.69; LC:0.44 and 0.90). With influenza vaccination, mortality was reduced, but not hospitalization (COVID-19:0.86 and 1.01, and LC:0.72 and 1.05). Mortality and hospitalization were reduced by CVD prevention in those with CVD, e.g., anticoagulants- COVID:19:0.69 and 0.92; LC:0.59 and 0.88; lipid lowering- COVID-19:0.69 and 0.86; LC:0.68 and 0.90. COVID-19 vaccination averted 245044 of 321383 and 7586 of 8738 preventable deaths after COVID-19 and LC, respectively. Interpretation: Prior CVD and high CV risk are associated with increased hospitalization and mortality in COVID-19 and LC. Targeted COVID-19 vaccination and CVD prevention are priority interventions. Funding: NIHR. HDR UK.

Abstract. Background:. With an increasing proportion of multiparas, proper interpregnancy intervals (IPIs) are urgently needed. However, the association between IPIs and adverse perinatal outcomes has always been debated. This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages. Methods:. We used individual data from China's National Maternal Near Miss Surveillance System between 2014 and 2019. Multivariable Poisson models with restricted cubic splines were used. Each adverse outcome was analyzed separately in the overall model and stratified models. The stratified models included different categories of fertility policy periods (2014-2015, 2016-2017, and 2018-2019) and infant gestational age in previous pregnancy (

Objective To investigate current care for people with Long COVID in England.Design In-depth, semistructured interviews with people living with Long COVID and Long COVID healthcare professionals; data analysed using thematic analysis.Setting National Health Service England post-COVID-19 services in six clinics from November 2022 to July 2023.Participants 15 healthcare professionals and 21 people living with Long COVID currently attending or discharged (18 female; 3 male).Results Health professionals and people with lived experience highlighted the multifaceted nature of Long COVID, including its varied symptoms, its impact on people’s lives and the complexity involved in managing this condition. These impacts encompass physical, social, mental and environmental dimensions. People with Long COVID reported barriers in accessing primary care, as well as negative general practitioner consultations where they felt unheard or invalidated, though some positive interactions were also noted. Peer support or support systems proved highly valuable and beneficial for individuals, aiding their recovery and well-being. Post-COVID-19 services were viewed as spaces where overlooked voices found validation, offering more than medical expertise. Despite initial challenges, healthcare providers’ increasing expertise in diagnosing and treating Long COVID has helped refine care approaches for this condition.Conclusion Long COVID care in England is not uniform across all locations. Effective communication, specialised expertise and comprehensive support systems are crucial. A patient-centred approach considering the unique complexities of Long COVID, including physical, mental health, social and environmental aspects is needed. Sustained access to post-COVID-19 services is imperative, with success dependent on offering continuous rehabilitation beyond rapid recovery, acknowledging the condition’s enduring impacts and complexities.

IntroductionAs of 2020, breast cancer has emerged as the predominant cause of cancer incidence globally. Anthracycline-based chemotherapy serves as a crucial element in the treatment regimen for breast cancer. However, these anthracycline-based drugs are associated with cardiac toxicity. This study represents the first clinical quantitative analysis aimed at accurately determining the incidences of arrhythmia and abnormal electrocardiogram (ECG) changes, thereby providing valuable data to bolster clinical drug usage and monitoring.MethodsA systematic search was conducted across multiple databases including CNKI, VIP, Wanfang, PubMed, Embase, Web of Science, and the Cochrane Library. The incidence of combined arrhythmias in breast cancer patients and the associated heterogeneity were calculated using either a random effect model or a fixed effect model. Statistical analysis was performed using STATA16.ResultsThe study encompassed a total of 37 articles, which included 5705 breast cancer patients undergoing anthracycline treatment. Among these patients, 2257 developed arrhythmias. The meta-analysis revealed that the incidence of anthracycline-associated arrhythmias and abnormal ECG changes in breast cancer patients was 0.41 (0.37, 0.44). Subgroup analysis indicated that the incidence of ST-T segment change was 0.19 (0.15, 0.23), the incidence of conduction block was 0.04 (0.02, 0.05), the incidence of premature beats was 0.09 (0.07, 0.11), and the incidence of atrial fibrillation was 0.04 (0.00, 0.12). Additional results are presented in Table 3.ConclusionThis pioneering study accurately assesses the incidence of arrhythmias in breast cancer patients treated with anthracyclines. The findings provide clinicians with valuable insights into understanding and managing the cardiac toxicity associated with such treatment. Moreover, this study lays the foundation for future research exploring the mechanisms underlying these arrhythmias and potential preventative strategies.

Due to the large terrain fluctuation and drop in Qianshuta well field, the layout of the ground large loop transient electromagnetic method detection device is limited. In order to find out the distribution range of goaf under the second Shanjing line of oil and gas pipeline in this area, numerical simulation and field test of small loop transient electromagnetic method were carried out to analyze the feasibility of ground detection, and optimized parameters were applied to the field. The results show that the numerical simulation confirms that the 3 m×3 m small loop transient electromagnetic method can effectively detect the goaf with a depth of more than 200 m and a mining height of more than 1 m, and has a more obvious effect on the water-filled goaf with low resistance; the field test adopts the small loop transient electromagnetic method with optimized parameters such as the length of the transmitting wire frame 3 m×3 m, the number of stacking times of 15, the transmitting frequency of 16 Hz, and more than 8 A transmitting current, which can achieve the purpose of effective detection and verify the correctness of the numerical simulation; a total of 5 abnormal areas were delineated and explained in the No.3 coal seam, which were inferred to be gobs or burned rock voids. The reliability of the small loop transient electromagnetic detection method is fully verified.

Diseases like viral keratitis can harm corneal nerves, which are necessary for maintaining the health and functionality of the cornea. Recent research has shown that corneal nerve pathology affects the infected eye as well as the contralateral one, and that aberrant changes in sympathetic nerves can be seen, with the exception of sensory nerves that correspond to corneal sensation. However, apart from in vivo confocal microscopy and corneal sensation, there have been no additional prognostic indicators that allow clinicians to assess the severity of corneal nerve damage. While multiple functions of corneal nerves are mediated by neuropeptides, substance P, the first topical neuropeptide used in ocular clinical practice, was proved to regulate the process of viral infections, and it is involved in bilateral corneal pathologies through pro-inflammatory and neurotrophic functions in viral keratitis, so it may be used as a diagnostic biomarker or a therapeutic target. Therefore, this review summarized the changes and roles of corneal nerves as well as substance P in viral keratitis, which may serve as a reference for further study into associated mechanisms and clinical applications.

Objectives Since COVID-19 first appeared in Wuhan, China, in December 2019, the disease has spread rapidly across the country. To reduce the spread of infection, schools including kindergartens were closed. Prolonged home confinement can affect children’s behaviour. Therefore, we investigated the change of preschoolers’ total daily screen time during the COVID-19 lockdown in China.Design, setting and participants In the parental survey, 1121 preschoolers, whose parents or grandparents completed an online survey from 1 June 2020 to 5 June 2020, were enrolled.Primary outcome Total daily screen time. Multivariable modelling was performed to identify factors associated with increased screen time.Results The results showed that preschoolers’ total daily screen time during lockdown(median 2.5 hours, IQR 2.5 hours) was significantly longer than it was before lockdown (median 1.5 hours, IQR 1.0 hour). Older age (OR 1.26, 95% CI 1.07 to 1.48), higher annual household income (OR 1.18, 95% CI 1.04 to 1.34),and decrease of moderate-vigorous physical activity (OR 1.41, 95% CI 1.20 to 1.66) were independently associated with increased screen time.Conclusions Preschoolers’ total daily screen time significantly increased during lockdown.

Male infertility caused by idiopathic oligoasthenospermia (OAT) is known as idiopathic male infertility. Glutathione S-transferase (GST) and fluoride may play important roles in idiopathic male infertility, but their effects are still unknown. Our study examined the relationship between GST polymorphisms and fluoride-induced toxicity in idiopathic male infertility and determined the underlying mechanism. Sperm, blood, and urine samples were collected from 560 males. Fluoride levels were measured by a highly selective electrode method, and GST genotypes were identified using polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP). Semen parameters, DNA fragmentation index (DFI), mitochondrial membrane potential (MMP), and oxidative stress (OS) biomarkers were statistically assessed at the P < 0.05 level. Compared with healthy fertile group, semen parameters, fluoride levels, OS biomarkers, sex hormone levels, and MMP and DFI levels were lower in the idiopathic male infertility group. For glutathione S-transferase M1 (GSTM1[-]) and glutathione S-transferase T1 (GSTT1[-]) or glutathione S-transferase P1 (GSTP1) mutant genotypes, levels of semen fluoride, OS, MMP, and DFI were considerably higher, and the mean levels of sperm parameters and testosterone were statistically significant in GSTM1(+), GSTT1(+), and GSTP1 wild-type genotypes. Both semen and blood fluoride levels were associated with oxidative stress in idiopathic male infertility patients. Elevated fluoride in semen with the genotypes listed above was linked to reproductive quality in idiopathic male infertility patients. In conclusion, GST polymorphisms and fluorine may have an indicative relationship between reproductive quality and sex hormone levels, and OS participates in the development of idiopathic male infertility.

Abstract Objective To compare recurrence and survival in patients with stage III endometrial cancer after radical surgery, followed by either adjuvant chemoradiotherapy (ACR) or adjuvant chemotherapy (AC). Methods We searched for relevant studies in PubMed Central, Embase and the Cochrane Central Register of Controlled Trials. Data were pooled on rates of recurrence as well as rates of progression-free, disease-free and overall survival. Heterogeneity was evaluated using the I2 test. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. Results Data from 18,375 patients in 15 retrospective studies and one randomized controlled trial were meta-analyzed. Compared to the AC group, the ACR showed significantly lower risk of local recurrence (OR 0.43, 95%CI 0.32–0.59) and total recurrence (OR 0.72, 95%CI 0.58–0.89). ACR was also associated with significantly better overall survival (HR 0.66, 95%CI 0.57–0.76), progression-free survival (HR 0.56, 95%CI 0.39–0.81) and disease-free survival (HR 0.66, 95%CI 0.53–0.83). Conclusions Adding adjuvant radiotherapy to adjuvant chemotherapy after radical surgery may significantly reduce risk of local and overall recurrence, while significantly improving survival of patients with stage III endometrial cancer.

When coherent detection occurs, the polarization mismatch between signal light and local oscillator light can reduce the efficiency of coherent detection. This article combines the principle of optical mixers to derive the relationship between the polarization state and mixing efficiency of signal light and local oscillator light, and builds an experimental platform for the coherent detection of a partially coherent electromagnetic Gaussian Schell beam (EGSM). Polarization devices are used to regulate the polarization state of the signal EGSM light and local oscillator EGSM light, and different polarization states of the EGSM beams are generated. When the output power of the signal light is constant, the mixing efficiency is measured according to the output amplitude of the intermediate frequency signal. This experiment found that when the signal light is in a linearly polarized state and the local oscillator light is in a linearly polarized state, a circularly polarized state, or an elliptically polarized state, the amplitude of the intermediate frequency signal is 369.6 mv, 146.6 mv, or 92.1 mv, respectively. When the signal light is in a circularly polarized state, the amplitude of the intermediate frequency signal is 446.4 mv, 504.0 mv, or 159.2 mv, respectively. When the signal light is in an elliptical polarization state, the amplitude of the intermediate frequency signal is 94.4 mv, 124.0 mv, or 254.8 mv, respectively.

BackgroundSchistosomiasis, a disease caused by parasites of the genus Schistosoma, remains a global public health threat. This study aimed to validate the diagnostic performance of a recently developed gold immunochromatographic assay (GICA) for the detection of S. japonicum infection in a rural endemic area of the Philippines.MethodsHuman clinical samples were collected from 412 subjects living in Laoang and Palapag municipalities, Northern Samar, the Philippines. The presence of Schistosoma-specific antibodies in serum samples was tested with the SjSAP4-incorporated GICA strips and the results were converted to fully quantitative data by introducing an R value. The performance of the established GICA was further compared with other diagnostic tools, including the Kato-Katz (KK) technique, point-of-care circulating cathodic antigen (POC-CCA), droplet digital (dd) PCR, and enzyme-linked immunosorbent assays (ELISAs).ResultsThe developed GICA strip was able to detect KK positive individuals with a sensitivity of 83.3% and absolute specificity. When calibrated with the highly sensitive faecal ddPCR assay, the immunochromatographic assay displayed an accuracy of 60.7%. Globally, the GICA assay showed a high concordance with the SjSAP4-ELISA assay. The schistosomiasis positivity rate determined by the GICA test was similar to those obtained with the SjSAP4-ELISA assay and the ddPCR assay performed on serum samples (SR_ddPCR), and was 2.3 times higher than obtained with the KK method.ConclusionThe study further confirms that the developed GICA is a valuable diagnostic tool for detecting light S. japonicum infections and implies that this point-of-care assay is a viable solution for surveying endemic areas of low-intensity schistosomiasis and identifying high-priority endemic areas for targeted interventions.

Abstract Background Hypertensive disorders of pregnancy (HDP) are a growing concern and a challenge for maternity care providers as the prevalence of hypertension continues to increase. However, optimal management of HDP is unclear. Therefore, we aimed to explore the differences in adverse fetal outcomes among women with different subtypes of HDP and different blood pressure (BP) levels, to provide evidence-based management of HDP. Methods We obtained data from China’s National Maternal Near-Miss Surveillance System from 2012 to 2020. Associations between BP management and adverse fetal outcomes, stratified by the four subtypes of HDP, were assessed using logistic regression analysis with a robust variance estimator. Results For the period, a total of 393,353 pregnant women with HDP were included in the study; 8.51% had chronic hypertension, 2.27% had superimposed preeclampsia, 50.17% had preeclampsia or eclampsia, and 39.04% had gestational hypertension. The BP levels at delivery admission were mostly (61.14%) of non-severe stage 2 (systolic BP 140–159 mm Hg and/or diastolic BP 90–109 mm Hg) hypertension by American Heart Association classification. A high rate of adverse fetal outcomes was observed among women with HDP, especially among those aged 35 y or those diagnosed with superimposed preeclampsia. Compared with those with normal BP levels at delivery admission, we found an upward curve with increased risk among pregnant women with more severe BP levels, including the risk of preterm birth and small for gestational age (SGA) fetus. The odds ratios (ORs) of stillbirth, neonatal death, and low Apgar scores associated with severe stage 2 hypertension increased significantly. In addition, the association between BP at admission and fetal outcomes differed among women with varying HDP subtypes. Pregnant women with preeclampsia or eclampsia had an increased risk for preterm birth (adjusted OR [aOR], 1.33 [95% confidence interval {CI}, 1.07 ~ 1.65]) and SGA (aOR, 1.37 [95% CI, 1.10 ~ 1.71]) even when the admission BP was at stage 1 level. Conclusion Greater attention should be paid to cases involving preeclampsia superimposed on chronic hypertension and pregnant women aged 35 y to mitigate the burden of adverse fetal outcomes caused by HDP.

Aiming at solving the challenges of the Internet of Vehicles (IoV), such as privacy sensitive data exposing, data being vulnerable to unauthorized access and tampered with and the single point of failure of the cloud server, this paper introduces a blockchain-enabled data access method based on attribute-based encryption. To enhance the privacy protection, the attributes are hidden and all generated transactions are recorded on the blockchain for auditing. Even if it is untrusted to a third party, it can guarantee the user’s control over his own data. To reduce the computation cost, decentralized edge nodes jointly maintain the blockchain and assist users with limited resources to complete most of the calculations. Meanwhile, the use of smart contracts not only reduces the verification workload, but also evaluates multiple factors such as the communication range, communication time, and calculation overhead of the roadside unit (RSU) to ensure that the vehicle can receive messages in a timely manner. In addition, timely updating the attributes can reduce the user’s computational burden and increase the flexibility of the system. Numeral experiments to show the proposed scheme has many advantages of over others such as the storage cost, the whole time consume of the proposed algorithms and the proxy computation cost.

Stevens-Johnson syndrome(SJS)refers to a type of adverse reactions of the skin and mucosa mainly caused by drug allergy, which can be life-threatening in serious cases. For SJS survivors, ocular damage are accepted as the most severe complications. In recent years, because of the extensive research of its genetic susceptibility and immune pathogenesis, varied susceptibility genes which are involved in the ocular complications of SJS have been discovered. However, further efforts are still needed to clarify relevant mechanisms due to the high ethnicity and drug specificity. Ocular lesions of SJS are prone to be neglected in the early stage, and patients often receive ophthalmic treatment after a severe visual loss. Especially in China, the ocular surface of most patients has already been seriously damaged when they went to the ophthalmology department, while existing treatments achieve unsatisfactory results in improving visual acuity. Therefore, recent research progress is reviewed in this article on etiology and treatment of SJS ocular lesions, in order to raise clinicians' awareness of ocular complications, and provide references for the diagnosis and treatment of diseases and research in related fields.

The broader impacts of COVID-19 mitigation measures may include changes in the incidence of preterm birth. Here, the authors use data from ~11.7 million pregnancies in China and find evidence of a small decline in preterm birth rates immediately following the implementation of COVID-19 mitigation measures.

Abstract. Objective:. To analyze the temporal trends of maternal mortality ratio (MMR) due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019, to identify whether the rate of change has accelerated or slowed down during this period, and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future. Methods:. Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019. Maternal death was defined according to the World Health Organization's criterion. The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases -10. Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable. The MMR and 95% confidence intervals (CI) for regions or causes were estimated by Poisson's distribution. Joinpoint regression was used to assess the accurate temporal patterns. Results:. The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births (95% CI: 15.0–22.2) in 2000. It peaked in 2001 (22.1 per 100,000 live births, 95% CI: 18.3–26.4) and was lowest in 2019 (1.6 per 100,000 live births, 95% CI: 1.0–2.3). For specific regions, the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise, followed by a rapid decline, and then a slow decline. For specific causes, no change point was found in joinpoint analysis of the national MMR caused by placenta previa, postpartum uterine atony, and retained placenta (the annual percent change was −12.0%, −10.5%, and −21.0%, respectively). The MMR caused by postpartum hemorrhages (PPH) significantly declined by 8.0% (95% CI: 1.9–13.6) per year from 2000 to 2007. The annual percent change of MMR caused by PPH accelerated further to −25.0% between 2007 and 2011, and then decreased to −7.8% between 2011 and 2019. The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6% (8/105) in 2000 to 14.3% (4/28) in 2019. The changes in the proportion of causes were different for maternal deaths due to PPH. The proportion of postpartum uterine atony increased from 39.0% (41/105) in 2000 to 60.7% (17/28) in 2019, and the proportion of uterine rupture also increased from 12.3% (13/105) in 2000 to 14.3% (4/28) in 2019. However, the proportion of retained placenta decreased from 37.1% (39/105) in 2000 to 7.1% (2/28) in 2019. Conclusion:. Over the last 20 years, the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage. However, the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture. China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage, especially for postpartum uterine atony and uterine rupture.

BackgroundThe neglected zoonosis, schistosomiasis japonica, remains a major public health problem in the Philippines. The current study aims to develop a novel gold immunochromatographic assay (GICA) and evaluate its performance in the detection of Schistosoma japonicum infection.MethodsA GICA strip incorporating a S. japonicum saposin protein, SjSAP4 was developed. For each GICA strip test, diluted serum sample (50 µl) was loaded and strips were scanned after 10 min to convert the results into images. ImageJ was used to calculate an R value, which was defined as the signal intensity of the test line divided by the signal intensity of the control line within the cassette. After determination of optimal serum dilution and diluent, the GICA assay was evaluated with sera collected from non-endemic controls (n = 20) and individuals living in schistosomiasis-endemic areas of the Philippines (n = 60), including 40 Kato Katz (KK)-positive participants and 20 subjects confirmed as KK-negative and faecal droplet digital PCR assay (F_ddPCR)-negative at a dilution of 1:20. An ELISA assay evaluating IgG levels against SjSAP4 was also performed on the same panel of sera.ResultsPhosphate-buffered saline (PBS) and 0.9% NaCl were determined as optimal dilution buffer for the GICA assay. The strips tested with serial dilutions of a pooled serum sample from KK-positive individuals (n = 3) suggested that a relatively wide range of dilutions (from 1:10 to 1:320) can be applied for the test. Using the non-endemic donors as controls, the GICA strip showed a sensitivity of 95.0% and absolute specificity; while using the KK-negative and F_ddPCR-negative subjects as controls, the immunochromatographic assay had a sensitivity of 85.0% and a specificity of 80.0%. The SjSAP4-incorperated GICA displayed a high concordance with the SjSAP4-ELISA assay.ConclusionsThe developed GICA assay exhibited a similar diagnostic performance with that of the SjSAP4-ELISA assay, yet the former can be performed by local personnel with minimal training with no requirement for specialised equipment. The GICA assay established here represents a rapid, easy-to-use, accurate and field-friendly diagnostic tool for the on-site surveillance/screening of S. japonicum infection.

Abstract Background With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions. Therefore, whether maternal health conditions affect the optimal gestational time remains unclear. Methods Data of women delivered between January 2012 and December 2020 were collected through China’s National Maternal Near Miss Surveillance System. Interrupted time series analysis was used to determine the rates of twinning, stillbirth, smaller than gestational age (SGA), and low Apgar scores (

Abstract Background The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. Methods We obtained all data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. Results The risk of UR was increased 2.0-fold (1.2-fold to 2.7-fold) in women with pregnancy complications (except for preeclampsia). These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. The risk of UR was slightly higher in women with gestational diabetes mellitus who had a large for gestational age (LGA) foetus, especially at 32 to 36 weeks gestation. Conclusions The risk of UR is associated with gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta, but varies in different gestational ages.

To explore the relationship between genetic polymorphisms of metabolic enzymes such as CYP1A1, CYP2D6, GSTM1, GSTT1, and GSTP1 and idiopathic male infertility. By observing the efficacy of antioxidants in the treatment of idiopathic male infertility, the effect of metabolic enzyme gene polymorphisms on antioxidant therapy in patients with idiopathic male infertility was prospectively studied. This case–control study included 310 men with idiopathic infertility and 170 healthy controls. The cytochrome P450 1A1 (CYP1A1), cytochrome P450 2D6 (CYP2D6), glutathione S-transferase M1 (GSTM1), glutathione S-transferase T1 (GSTT1), and glutathione S-transferase P1 (GSTP1) genotypes in peripheral blood samples were analyzed by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP). The idiopathic male infertility group was treated with vitamin C, vitamin E, and coenzyme Q10 for 3 months and followed up for 6 months. GSTM1(−), GSTT1(−), and GSTM1/T1(−/−) in the idiopathic male infertility groups were more common than those in the control group. The sperm concentration, motility, viability, mitochondrial membrane potential (MMP), and seminal plasma total antioxidant capacity (T-AOC) level in patients with GSTM1(−), GSTT1(−), and GSTM1/T1(−/−) were lower than those in wild-type carriers, and the sperm DNA fragmentation index (DFI), 8-hydroxy-2'-deoxyguanosine (8-OH-dG), and malondialdehyde (MDA) and nitric oxide (NO) levels were higher. Therefore, oxidative damage may play an important role in the occurrence and development of idiopathic male infertility, but antioxidant therapy is not effective in male infertility patients with GSTM1 and GSTT1 gene deletions.

BackgroundThe data on the expression of stem cell markers CD44, CD24, and ALDH1A1 in the breast tissue of cancer-free women is very limited and no previous studies have explored the agreement between pathologist and computational assessments of these markers. We compared the immunohistochemical (IHC) expression assessment for CD44, CD24, and ALDH1A1 by an expert pathologist with the automated image analysis results and assessed the homogeneity of the markers across multiple cores pertaining to each woman.MethodsWe included 81 cancer-free women (399 cores) with biopsy-confirmed benign breast disease in the Nurses’ Health Study (NHS) and NHSII cohorts. IHC was conducted with commercial antibodies [CD44 (Dako, Santa Clara, CA, USA) 1:25 dilution; CD24 (Invitrogen, Waltham, MA, USA) 1:200 dilution and ALDH1A1 (Abcam, Cambridge, United Kingdom) 1:300 dilution]. For each core, the percent positivity was quantified by the pathologist and Definiens Tissue Studio. Correlations between pathologist and computational scores were evaluated with Spearman correlation (for categorical positivity: 0, >0–10–50, and >50%) and sensitivity/specificity (for binary positivity defined with 1 and 10% cut-offs), using the pathologist scores as the gold standard. Expression homogeneity was examined with intra-class correlation (ICC). Analyses were stratified by core [normal terminal duct-lobular units (TDLUs), benign lesions] and tissue type (epithelium, stroma).ResultsSpearman correlation between pathologist and Definiens ranged between 0.40–0.64 for stroma and 0.66–0.68 for epithelium in normal TDLUs cores and between 0.24–0.60 for stroma and 0.61–0.64 for epithelium in benign lesions. For stroma, sensitivity and specificity ranged between 0.92–0.95 and 0.24–0.60, respectively, with 1% cut-off and between 0.43–0.88 and 0.73–0.85, respectively, with 10% cut-off. For epithelium, 10% cut-off resulted in better estimates for both sensitivity and specificity. ICC between the cores was strongest for CD44 for both stroma and epithelium in normal TDLUs cores and benign lesions (range 0.74–0.80). ICC for CD24 and ALDH1A ranged between 0.42–0.63 and 0.44–0.55, respectively.ConclusionOur findings show that computational assessments for CD44, CD24, and ALDH1A1 exhibit variable correlations with manual assessment. These findings support the use of computational platforms for IHC evaluation of stem cell markers in large-scale epidemiologic studies. Pilot studies maybe also needed to determine appropriate cut-offs for defining staining positivity.

The current study developed and evaluated the performance of a urine-based enzyme-linked immunosorbent assay (ELISA) for the screening of Schistosoma japonicum infection in a human cohort (n = 412) recruited from endemic areas, Northern Samar, the Philippines. The diagnostic performance of the urine ELISA assay was further compared with the Kato-Katz (KK) technique, serum-based ELISA assays, point-of-care circulating cathodic antigen (POC-CCA) urine cassette test, and droplet digital (dd)PCR assays performed on feces, serum, urine, and saliva samples, which were designated as F_ddPCR, SR_ddPCR, U_ddPCR, and SL_ddPCR, respectively. When urine samples concentrated 16× were assessed, the SjSAP4 + Sj23-LHD-ELISA (U) showed sensitivity/specificity values of 47.2/93.8% for the detection of S. japonicum infection in KK-positive individuals (n = 108). The prevalence of S. japonicum infection in the total cohort determined by the urine ELISA assay was 48.8%, which was lower than that obtained with the F_ddPCR (74.5%, p

Abstract Background Zoonotic schistosomiasis, caused by Schistosoma japonicum, remains a major public health problem in the Philippines. This study aimed to evaluate the commercially available rapid diagnostic point-of-care circulating cathodic antigen (POC-CCA) test in detecting individuals infected with S. japonicum in a human cohort from an endemic area for schistosomiasis japonica in the Philippines. Methods Clinical samples were collectedin 18 barangays endemic for S. japonicum infection in Laoang and Palapag municipalities, Northern Samar, the Philippines, in 2015. The presence of CCA in filter-concentrated urine samples (n = 412) was evaluated using the commercial kits and the results were converted to images, which were further analyzed by ImageJ software to calculate R values. The diagnostic performance of the immunochromatographic POC-CCA test was compared using the Kato-Katz (KK) procedure, in-house enzyme-linked immunosorbent assays (ELISAs) and droplet digital (dd) PCR assays as reference. Results The POC-CCA test was able to detect S. japonicum-infected individuals in the cohort with an eggs per gram of faeces (EPG) more than or equal to 10 with sensitivity/specificity values of 63.3%/93.3%. However, the assay showed an inability to diagnose schistosomiasis japonica infections in all cohort KK-positive individuals, of which the majority had an extremely low egg burden (EPG: 1–9). The prevalence of S. japonicum infection in the total cohort determined by the POC-CCA test was 12.4%, only half of that determined by the KK method (26.2%). When compared with the ELISAs and ddPCR assays as a reference, the POC-CCA assay was further shown to be a test with low sensitivity. Nevertheless, the assay exhibited significant positive correlations with egg burden determined by the KK technique and the target gene copy number index values determined by the ddPCR assays within the entire cohort. Conclusions By using in silico image analysis, the POC-CCA cassette test could be converted to a quantitative assay to avoid reader-variability. Because of its low sensitivity, the commercially available POC-CCA assay had limited potential for determining the status of a S. japonicum infection in the target cohort. The assay should be applied with caution in populations where schistosome parasites (especially S. japonicum) are present at low infection intensity. Graphic abstract

BackgroundSchistosoma japonicum is one of three major species of blood flukes causing schistosomiasis, a disease, which continues to be a major public health issue in the Philippines. SjSAP4, a member of a multigene family of saposin-like proteins, is a recognized immunodiagnostic biomarker for schistosomiasis japonica. This study aimed to identify linear B-cell epitopes on SjSAP4 and to validate their potential as components of a multi-epitope assay for the serological diagnosis of schistosomiasis japonica.MethodologySjSAP4-derived peptides were expressed as GST-peptide-fused proteins and these were Western blot probed with human serum samples from S. japonicum Kato-Katz (KK)-positive individuals and uninfected controls. A core epitope was further identified by Western blotting through probing a series of truncated peptides with the schistosomiasis patient sera. The diagnostic performance of the core epitope-containing peptides and the full-length SjSAP4 was evaluated by enzyme-linked immunosorbent assay (ELISA) using a panel of sera collected from subjects resident in a schistosomiasis-endemic area of the Philippines.Main findingsAs a result of the peptide mapping, one peptide (P15) was found to be highly immunogenic in the KK-positive individuals. We subsequently showed that -S163QCSLVGDIFVDKYLD178- is a core B-cell epitope of P15. Subsequent ELISAs incorporating SjSAP4, SjSAP4-Peptide and SjSP-13V2-Peptide showed a sensitivity of 94.0%, 46.0% and 74.0%, respectively, and a specificity of 97.1%, 100% and 100%, respectively. Notably, complementary recognition of the B-cell epitopes (SjSAP4-Peptide and SjSP-13V2-Peptide) was observed in a subset of the KK-positive individuals. A dual epitope-ELISA (SjSAP4-Peptide + SjSP-13V2-Peptide-ELISA) showed a diagnostic sensitivity of 84.0% and a specificity of 100%.Conclusions/significanceIn this study, -S163QCSLVGDIFVDKYLD178- was identified as a dominant linear B-cell epitope on SjSAP4. This peptide and the complementary recognition of other B-cell epitopes using sera from different KK-positive individuals can provide the basis of developing a multi-epitope assay for the serological diagnosis of schistosomiasis.

The aim of this systematic review was to evaluate the efficacy of oral medication or intrauterine device-delivered progestins in patients with endometrial hyperplasia (EH) with or without atypia. We systematically examined PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov to identify studies reporting the regression rate of patients with EH who received progestins or non-progestins. The regression rates after different treatments were compared using a network meta-analysis in terms of the relative ratios (RRs) and 95% confidence intervals (CIs). Begg–Mazumdar rank correlation and funnel plots were performed to evaluate the publication bias. Five non-randomized studies and 21 randomized controlled trials involving 2268 patients were included in the network meta-analysis. The levonorgestrel-releasing intrauterine system (LNG-IUS) was associated with a higher regression rate than medroxyprogesterone acetate (MPA) (RR 1.30, 95% CI 1.16–1.46) in patients with EH. Among those without atypia, the LNG-IUS was associated with a higher regression rate than any of the three types of oral medications (MPA, norethisterone, or dydrogesterone (DGT)) (RR 1.35, 95% CI 1.18–1.55). According to the network meta-analysis, combining the LNG-IUS with MPA or metformin increased regression rate, while DGT was associated with the highest regression rate among all oral medications. The LNG-IUS may be the best choice for patients with EH, and combining it with MPA or metformin may further improve its efficacy. DGT may be the preferred choice for patients who are unwilling to use the LNG-IUS or who cannot tolerate its side effects.

Abstract We aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

Abstract Background Currently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects. Methods We included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China’s National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture. Results This study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53–2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81–27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32–1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37–0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52–1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24–0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number. Conclusion The uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture.

The plasticizer bisphenol A, a typical endocrine disrupting chemical, is widely present in the environment. Previous studies demonstrated that exposure to bisphenol A can cause reproductive toxicity, abnormal fertilization, and infertility. However, the mechanisms of low-concentration bisphenol A on the reproductive system and treatment measures have not been fully determined. In this study, we explored the transcriptomic profiles of female zebrafish ovaries. The transcriptomic data revealed that mitochondrial NADH dehydrogenase (mt-Nd) genes were significantly decreased in the bisphenol A-exposed group, while the co-administration of tea polyphenols remarkably elevated the expression of mt-Nd genes. To further explore the expression pattern of the mt-Nd, we analyzed the expression of six mt-Nd genes on different days by qRT-PCR in control, bisphenol A-exposed, and bisphenol A-tea polyphenols ovaries. Here, we found that 0.1 mg/L bisphenol A exposure adversely affects the mitochondrial respiratory chain in ovaries and may lead to reproductive disorders. Finally, our study demonstrated that tea polyphenols play a protective role in ovarian mitochondrial dysfunction in low-concentration bisphenol A-exposed female zebrafish.

Abstract Background There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. Methods We used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. Results Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. Conclusions The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

Abstract Background To examine the association between the Apgar score and neonatal mortality over gestational age in China and to explore whether this association changed when Apgar scores were combined at 1 and 5 min. Methods Data for all singleton live births collected from 438 hospitals between 2012 and 2016 were used in this study. Poisson regression with a robust variance estimator adjusted for a complete set of confounders was used to describe the strength of the association between the Apgar score and neonatal mortality. Results The relative risks of neonatal death-associated intermediate Apgar score at 5 min peaked at 39–40 weeks of gestation and subsequently decreased if the gestational age increased to 42 weeks or above, in contrast to the low Apgar score. Among both preterm and term new-borns with Apgar scores at 5 min, new-borns that were not small for gestational age had a lower mortality rate than those that were small for gestational age. The association between Apgar score and the neonatal mortality was even stronger when scores at 1 and 5 min were combined. Conclusions Apgar score is not only meaningful for preterm new-borns but also useful for term new-borns, especially term new-borns that are not small for gestational age. Once the baby’s Apgar score worsens, timely intervention is needed. There is still a gap between China and high-income countries in terms of sustained treatment of new-borns with low Apgar scores.

The alpine inland lake dynamics have been good indicators of changes in terrestrial hydrological cycles under global climate change. However, the relationship between alpine inland lake and climatic factors remained largely uncertain. This study examines the spatial-temporal change of the fluctuation of the lake by using dense time series Landsat TM/ETM/OLI images to delineate water boundary information based on the Random Forest algorithm and using ICESat (Ice, Cloud and land Elevation Satellite) dataset to monitor changes in variations of water level. Variations of Qinghai Lake (QHL) were analyzed from 1987 to 2020 and the mechanism of these changes was discussed with meteorological data. The results indicated that the QHL fluctuated strongly showing a pattern of shrinkage–expansion over the last three decades. The lake storage significantly decreased by −2.58 × 108 m3·yr−1 (R2 = 0.86, p < 0.01) from 1989 to 2004 and sharply increased (6.92 × 108 m3·yr−1, R2 = 0.92, p < 0.01) after 2004. The relationship between the lake and climate over the last 30 years implies that the decreasing evaporation and increasing precipitation were the major factors affecting the fluctuation of lake storage. Meanwhile, the temporal heterogeneity of the driving mechanism of climate change led to the phased characteristics of lake storage change. In detail, obvious warming led to the shrinkage of the QHL before 2004 through increasing evaporation, while humidifying and accelerating wind stilling dominated the expansion of the QHL after 2004 by increasing precipitation and decreasing evaporation. This paper indicated that the frameworks of multi-source remote sensing and accurate detection of water bodies were required to protect the high-altitude lakes from further climate changes based on the findings of this paper of the QHL recently. The framework presented herein can provide accurate detection and monitoring of water bodies in different locations in the Qinghai-Tibet Plateau, and provide a necessary basis for future political activities and decisions in terms of sustainable water resource management.

ObjectiveTo compare cervical cancer recurrence and patient survival after radical hysterectomy followed by either adjuvant chemotherapy (AC) or adjuvant radiotherapy with or without concurrent chemotherapy (AR/CCRT).MethodsWe systematically searched PubMed, EMBASE, the Cochrane Library and clinicaltrials.gov to identify studies reporting recurrence or survival of cervical cancer patients who received AC or AR/CCRT after radical hysterectomy. Data were meta-analyzed using a random-effects model, and heterogeneity was evaluated using the I2 test. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity.ResultsThe meta-analysis included 14 non-randomized studies and two randomized controlled trials, altogether involving 5,052 cervical cancer patients. AC and AR/CCRT groups did not differ significantly in rates of total or local recurrence or mortality. Nevertheless, AC was associated with significantly lower risk of distant recurrence [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.55-0.81] and higher rates of overall survival [hazard ratio (HR) 0.69, 95%CI 0.54-0.85] and disease-free survival rate (HR 0.77, 95%CI 0.62-0.92).ConclusionsAC may be an effective alternative to AR/CCRT for cervical cancer patients after radical hysterectomy, especially younger women who wish to preserve their ovaries and protect them from radiation damage.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021252518).

IntroductionIndividuals with Long Covid represent a new and growing patient population. In England, fewer than 90 Long Covid clinics deliver assessment and treatment informed by NICE guidelines. However, a paucity of clinical trials or longitudinal cohort studies means that the epidemiology, clinical trajectory, healthcare utilisation and effectiveness of current Long Covid care are poorly documented, and that neither evidence-based treatments nor rehabilitation strategies exist. In addition, and in part due to pre-pandemic health inequalities, access to referral and care varies, and patient experience of the Long Covid care pathways can be poor. In a mixed methods study, we therefore aim to: (1) describe the usual healthcare, outcomes and resource utilisation of individuals with Long Covid; (2) assess the extent of inequalities in access to Long Covid care, and specifically to understand Long Covid patients' experiences of stigma and discrimination.Methods and analysisA mixed methods study will address our aims. Qualitative data collection from patients and health professionals will be achieved through surveys, interviews and focus group discussions, to understand their experience and document the function of clinics. A patient cohort study will provide an understanding of outcomes and costs of care. Accessible data will be further analysed to understand the nature of Long Covid, and the care received.Ethics and disseminationEthical approval was obtained from South Central-Berkshire Research Ethics Committee (reference 303958). The dissemination plan will be decided by the patient and public involvement and engagement (PPIE) group members and study Co-Is, but will target 1) policy makers, and those responsible for commissioning and delivering Long Covid services, 2) patients and the public, and 3) academics.

Hypertensive disorders in pregnancy are prevalent perinatal diseases. Here the authors report an association between ambient temperature before or after conception and risk of preeclampsia or eclampsia and gestational hypertension.

In smart power grid systems, real-time electricity data sharing can bring many benefits. However the security and privacy challenges have been a concern. This is because shared data may contain some private and sensitive information of data owners or users. So it has been an important issue to balance data utilization, data privacy and users privacy. Privacy-preserving multi-authority attribute-based encryption (MA-ABE) is a promising tool to tackle this issue, but it cannot be directly applied to addressed scenario of smart power grid systems. In this paper, we propose a framework to achieve secure data sharing in smart grid. The scheme uses the technique of inner product encryption (IPE). Under this framework, the access policy and the attribute set are fuzzy by converting them into two vectors. Only when the two vectors are orthogonal, users can successfully obtain the sharing data. Besides, our scheme allows that the threshold access policy only involves attribute name indexes, and sensitive attribute values are not sent along with the shared data so the attribute privacy is preserved. In addition, in order to improve efficiency, our scheme adds a testing phase to avoid the unnecessary operation before recovering data. Finally, our performance analysis and experiments confirm the merits of the proposed framework.

In the vehicle communications, vehicle-to-vehicle interconnection has extraordinary significance for improving the quality of transportation services and ensuring effective and safe information sharing between vehicles. However in the vehicular Ad hoc networks (VANETs), messages shared between vehicles can be easily spoofed and tampered. How to ensure the authenticity, integrity and non-repudiation of the message is an important issue for VANETs. In order to solve the above problems, a privacy-preserving VANETs sharing system based on attribute-based cryptography is proposed in this paper. In the proposed scheme, the attributes of the vehicles are divided into static attributes and dynamic attributes according to the characteristics of them. And sensitive attribute values that may leak user privacy are hidden to protect user privacy. To achieve the verifiability, integrity, non-repudiation and traceability of the message, a new group signature on the ciphertext is introduced. Additionally, for the calculation limitation of the vehicle terminal, only 6 bilinear pairing operations are needed in the data recovering phase of the scheme. Finally, security analysis and performance evaluations are given to show that the proposed scheme has higher security and efficiency than those in the literature.

With the rapid growth of the cloud computing and strengthening of security requirements, encrypted cloud services are of importance and benefit. For the huge ciphertext data stored in the cloud, many secure searchable methods based on cryptography with keywords are introduced. In all the methods, attribute-based searchable encryption is considered as the truthful and efficient method since it supports the flexible access policy. However, the attribute-based system suffers from two defects when applied in the cloud storage. One of them is that the huge data in the cloud makes the users process all the relevant files related to the certain keyword. For the other side, the users and users' attributes inevitably change frequently. Therefore, attribute revocation is also an important problem in the system. To overcome these drawbacks, an attribute-based ranked searchable encryption scheme with revocation is proposed. We rank the ciphertext documents according to the TF×IDF principle, and then only return the relevant top-k files. Besides the decryption sever, an encryption sever is also introduced. And a large number of computations are outsourced to the encryption server and decryption server, which reduces the computing overhead of the client. In addition, the proposed scheme uses a real-time revocation method to achieve attribute revocation and delegates most of the update tasks to the cloud, which also reduces the calculation overhead of the user side. The performance evaluations show the scheme is feasible and more efficient than the available ones.

Edge computing provides users with nearby services, promotes the development of the Internet of Things and transforms the mode of traditional electronic medical system that improves the speed and accuracy of medical diagnosis. However, edge computing has introduced new security challenges, such as the difficulty in applying standard encryption algorithms because of the limited computing capability of devices on the edge and concerns of privacy leakage. In this article, we propose a data access scheme by employing a lightweight attribute-based encryption (ABE) to address the security weaknesses of edge computing for e-health. Our novel modular exponential outsourcing algorithm outsources the shared data to the untrusted edge server and verifies the correctness of the returned results while achieving a lightweight computational load. The proposed Mask Algorithm along with blind pairs conceals the bases and exponents of the encrypted data, thus preserving the privacy of sensitive data in the process of outsourced computing. Security analysis and performance evaluation confirmed the security and efficiency of the proposed method.

BackgroundPartial nephrectomy (PN) is the recommended treatment for T1 renal cell carcinoma (RCC). Compared with suture PN, sutureless PN reduces the difficulty and time of operation, but the safety and feasibility have been controversial. This meta-analysis was conducted to compare the function and perioperative outcomes of suture and sutureless PN for T1 RCC.MethodsSystematic literature review was performed up to April 2021 using multiple databases to identify eligible comparative studies. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, identification and selection of the studies were conducted. Meta-analysis was performed for studies comparing suture to sutureless PN for both T1a and T1b RCC. In addition, subgroup analysis was performed on operation time, warm ischemia time, estimated blood loss, and postoperative complications. Sensitivity analysis was used in analysis with high heterogeneity (operation time and estimated blood loss).ResultsEight retrospective studies were included with a total of 1,156 patients; of the 1,156 patients, 499 received sutureless PN and 707 received suture PN. The results showed that sutureless PN had shorter operative time (I2 = 0%, P < 0.001), warm ischemia time (I2 = 97.5%, P < 0.001), and lower clamping rate (I2 = 85.8%, P = 0.003), but estimated blood loss (I2 = 76.6%, P = 0.064) had no difference. In the comparison of perioperative outcomes, there was no significant difference in postoperative complications (I2 = 0%, P = 0.999), positive surgical margins (I2 = 0%, P = 0.356), postoperative estimated glomerular filtration rat (eGFR) (I2 = 0%, P = 0.656), and tumor recurrence (I2 = 0%, P = 0.531).ConclusionsIn T1a RCC with low RENAL score, sutureless PN is a feasible choice, whereas it should not be overestimated in T1b RCC.

As an adaption to their complex lifecycles, helminth parasites garner a unique repertoire of genes at different developmental stages with subtle regulatory mechanisms. These parasitic worms release differential components such as microRNAs (miRNAs) and extracellular vesicles (EVs) as mediators which participate in the host-parasite interaction, immune regulation/evasion, and in governing processes associated with host infection. MiRNAs are small (~ 22-nucleotides) non-coding RNAs that regulate gene expression at the post-transcriptional level, and can exist in stable form in bodily fluids such as serum/plasma, urine, saliva and bile. In addition to reports focusing on the identification of miRNAs or in the probing of differentially expressed miRNA profiles in different development stages/sexes or in specific tissues, a number of studies have focused on the detection of helminth-derived miRNAs in the mammalian host circulatory system as diagnostic biomarkers. Extracellular vesicles (EVs), small membrane-surrounded structures secreted by a wide variety of cell types, contain rich cargos that are important in cell-cell communication. EVs have attracted wide attention due to their unique functional relevance in host-parasite interactions and for their potential value in translational applications such as biomarker discovery. In the current review, we discuss the status and potential of helminth parasite-derived circulating miRNAs and EV cargos as novel diagnostic tools.

In this study, we determined the complete mitochondrial genome of Geoemyda spengleri. The genome was 17,448bp in length and contained 13 protein-coding genes, 22 transfer RNA genes, 2 ribosomal RNA genes, and 1 main non-coding regions. The overall base composition of G. spengleri is A 33.67%, T 27.64%, C 25.56%, and G 13.14%, with a highly A + T bias of 61.31%. Here, we describe a phylogenetic analysis of 16 species of Tesudines based on the complete mitochondrial genome, the result showed that G. japonica is most closely related to G. spengleri. This mitogenome sequence data would play an important role in the investigation of phylogenetic relationship, taxonomic resolution and phylogeography of the Tesudines.

Since cloud computing has been playing an increasingly important role in real life, the privacy protection in many fields has been paid more and more attention, especially, in the field of personal health record (PHR). The traditional ciphertext-policy attribute-based encryption (CP-ABE) provides the fine-grained access control policy for encrypted PHR data, but the access policy is also sent along with ciphertext explicitly. However, the access policy will reveal the users' privacy, because it contains too much sensitive information of the legitimate data users. Hence, it is important to protect users' privacy by hiding access policies. In most of the previous schemes, although the access policy is hidden, they face two practical problems: 1) these schemes do not support large attribute universe, so their practicality in PHR is greatly limited and 2) the cost of decryption is especially high since the access policy is embedded in the ciphertext. To address these problems, we construct a CP-ABE scheme with efficient decryption, where both the size of public parameters and the cost of decryption are constant. Moreover, we also show that the proposed scheme achieves full security in the standard model under static assumptions by using the dual system encryption method.

As the progress of digitization in industrial society, large amount of production data are outsourced to the cloud server in order to reduce data management costs. Nevertheless, how to ensure the outsourced data integrality, validity, and availability is a challenging research topic. Recently, Zhang et al. (IEEE Trans. Industrial Informatic, doi:10.1109/TII.2019.2894108) presented an efficient and robust certificateless signature scheme to achieve the data authenticity for industrial Internet of Things (IIoT) environments. However, we found that their scheme is insecure. In this paper, we show that an attacker with replacing public key ability can easily impersonate other legitimate users to upload some false messages by forging the target users' valid signatures on these messages. Therefore, their certificateless signature scheme has not solved the IIoT data authenticity issue pointed out by them. Meanwhile, we also demonstrate that their security proof is not sound because the ability of an adversary cannot be applied to solve the difficult problem that they expect.

Certificateless signature (CLS) has no need of public key certificates and also avoids excessive dependence to a third party like that in identity-based setting. Recently, Shim (IEEE Systems Journal, doi:10.1109/JSYST.2018.2844809) came up with a CLS scheme independent of random oracles and asserted that the construction can be immune to the public key replacement attacks and the malicious-but-passive key generation center (KGC) attacks. In this paper, we analyze the security of Shim's scheme and point out that his conclusions are incorrect by giving two concrete counter-examples. We repair the scheme and put forward a CLS scheme secure against public key replacement attacks and malicious-but-passive KGC attacks without relying on random oracles. Compared with Shim's scheme, our construction has lower execution cost for signing and verification, and achieves Girault's top-level security, which means that a victim can repudiate the forgeries based on a false secret key generated by the KGC.

In recent years, Industrial Internet of Things (IIoT) has become increasingly important for applications in the industry. Inevitably, security for IIoT has become a priority in order to deploy secure applications. Amongst available cryptographic tools, certificateless signature schemes offer sound authentication solutions and avoid public-key certification from Trusted Third Parties (TTP). Certificateless signatures solve the key escrow problem against the dishonest Private Key Generator (PKG) and has considered to be a useful tool for IIoT applications. Recently, Karati et al. (IEEE Trans. Industrial Informatics, vol.14, no. 8, 2018) presented a lightweight certificateless signature scheme for IIoT Environments. This scheme was then broken by Zhang et al. (IEEE Access, vol. 8, 2018) by simply allowing to change the public key of the signer and using the homomorphic property of the original scheme. In this paper, we introduce a new attack to the scheme against the existential unforgeability, which is universal since we do not have to assume homomorphic property. We then introduce an entirely new lightweight certificateless signature scheme, which has been proven to be fully secure against all attacks found earlier. Our scheme is the first lightweight certificateless signature scheme with full security and is the most efficient in comparison with other existing schemes. It is desirable for IIoT applications. We also provide experimental results to justify our claims.