Deep Reinforcement Learning-Based Resource Management in Maritime Communication Systems.

With the growing maritime economy, ensuring the quality of communication for maritime users has become imperative. The maritime communication system based on nearshore base stations enhances the communication rate of maritime users through dynamic resource allocation. A virtual queue-based deep reinforcement learning beam allocation scheme is proposed in this paper, aiming to maximize the communication rate. More particularly, to reduce the complexity of resource management, we employ a grid-based method to discretize the maritime environment. For the combinatorial optimization problem of grid and beam allocation under unknown channel state information, we model it as a sequential decision process of resource allocation. The nearshore base station is modeled as a learning agent, continuously interacting with the environment to optimize beam allocation schemes using deep reinforcement learning techniques. Furthermore, we guarantee that grids with poor channel state information can be serviced through the virtual queue method. Finally, the simulation results provided show that our proposed beam allocation scheme is beneficial in terms of increasing the communication rate.

Two-level coding for efficient digital radio-over-fiber transmission with unequal bit protection.

The digital radio-over-fiber (D-RoF) transmission with two-level coding (TLC) is proposed and demonstrated in this Letter. A joint design considering the importance of quantization bits, the protection ability of forward error correction (FEC), and the bit error ratio of quadrature amplitude modulation (QAM) symbols is realized. In TLC-based D-RoF systems, the more significant bits among quantization bits are protected by a FEC and are assigned to the least reliable bits of modulated QAM symbols. Conversely, the less significant bits, without FEC protection, are allocated to the more reliable bits of QAM symbols. Experiments on an 11-km standard single-mode fiber transmission are conducted to evaluate the performance. The results indicate that, with a maximum iteration number of 2, compared to the conventional bit-interleaved coded modulation (BICM) with all bits encoded, the D-RoF based on TLC attains nearly identical performance under the 0.34% error vector magnitude threshold of 65536QAM wireless signals, specifically achieving complexity reductions of 54.55% and 67.66% for 16QAM and 64QAM optical transmissions, respectively.

Enhancement of anti-diabetic activity of pomelo peel by the fermentation of Aspergillus oryzae CGMCC23295: In vitro and in silico docking studies.

In this work, pomelo peel was fermented by Aspergillus oryzae CGMCC23295 to enhance its anti-diabetic properties. Results showed the total phenolic and flavonoids contents, ferric reducing antioxidant power (FRAP), scavenging capacities against 2,2'-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 1,1-diphenyl-2-picrylhydrazyl (DPPH) and hydroxyl radicals, as well as inhibitory abilities against α-amylase and α-glucosidase of pomelo peel were increased and fermentation for 8 days was the best. Additionally, the fermented sample could also enhance the glucose consumption and glycogen of HepG2 cell. Based on UPLC-MS/MS analysis, binding energy calculation, concentration determination and IC50 measurement, purpurin, apigenin, genistein, and paxilline could be concluded to be the main compounds to enhance the inhibition activities of fermented sample against α-amylase and α-glucosidase. Furthermore, computational studies were performed to reveal the the binding site and molecular interactions between paxilline and α-amylase, as well as purpurin and α-glucosidase. These findings provide a base for the utilization and valorization of pomelo peels as functional food additives by fermentation.

DFT-based analysis of siderophore-metal ion interaction for efficient heavy metal remediation.

Siderophores have great application potential in metal pollutant remediation because of their effective cost and friendly impact on the environment. However, the practical use of siderophores in the remediation of specific metals is rather limited because of the weak nonspecific interactions between the siderophores and different metals. Thus, screening for a siderophore with optimal interaction with a specific metal would be necessary. In this study, the interaction between metal ions and moieties that donate the oxygen ligands for the coordination of four types of siderophore (hydroxamates, catecholates, phenolates, and carboxylates) was modeled and analyzed. As revealed by DFT-based analysis, the four types of siderophore generally exhibited selection preference for different metal ions in the order Ga3+ > Al3+ > Fe3+ > Cr3+ > Ni2+ > Cu2+ > Zn2+ > Co2+ > Mn2+ > Hg2+ > Pb2+ > Cd2+, which was determined mainly by the electronegativity of the siderophore functional groups, the electronegativity of the metals, and the ionic radius of the metals, as well as the interaction between the siderophores and the metals. Moreover, the effect of linear or nonlinear (cyclic) structure on the affinity of each siderophore for different metal ions was evaluated. In most situations, metal-bound cyclic siderophores were found to be more stable than their linear counterparts. Thus, proper siderophores for the remediation of metal pollution may be rapidly screened using this model.

Exosomal MiR-381 from M2-polarized macrophages attenuates urethral fibroblasts activation through YAP/GLS1-regulated glutaminolysis.

OBJECTIVE AND DESIGN: Post-traumatic urethral stricture is a clinical challenge for both patients and clinicians. Targeting glutamine metabolism to suppress excessive activation of urethral fibroblasts (UFBs) is assumed to be a potent and attractive strategy for preventing urethral scarring and stricture. MATERIAL OR SUBJECTS: In cellular experiments, we explored whether glutaminolysis meets the bioenergetic and biosynthetic demands of quiescent UFBs converted into myofibroblasts. At the same time, we examined the specific effects of M2-polarized macrophages on glutaminolysis and activation of UFBs, as well as the mechanism of intercellular signaling. In addition, findings were further verified in vivo in New Zealand rabbits. RESULTS: It revealed that glutamine deprivation or knockdown of glutaminase 1 (GLS1) significantly inhibited UFB activation, proliferation, biosynthesis, and energy metabolism; however, these effects were rescued by cell-permeable dimethyl α-ketoglutarate. Moreover, we found that exosomal miR-381 derived from M2-polarized macrophages could be ingested by UFBs and inhibited GLS1-dependent glutaminolysis, thereby preventing excessive activation of UFBs. Mechanistically, miR-381 directly targets the 3'UTR of Yes-associated protein (YAP) mRNA to reduce its stability at the transcriptional level, ultimately downregulating expression of YAP, and GLS1. In vivo experiments revealed that treatment with either verteporfin or exosomes derived from M2-polarized macrophages significantly reduced urethral stricture in New Zealand rabbits after urethral trauma. CONCLUSION: Collectively, this study demonstrates that exosomal miR-381 from M2-polarized macrophages reduces myofibroblast formation of UFBs and urethral scarring and stricture by inhibiting YAP/GLS1-dependent glutaminolysis.

San Huang Xiao Yan recipe modulates the HMGB1-mediated abnormal inflammatory microenvironment and ameliorates diabetic foot by activating the AMPK/Nrf2 signalling pathway.

BACKGROUND: Diabetic foot (DF) is one of the serious complications of diabetes and lacks of therapeutic drugs. Abnormal and chronic inflammation promoting foot infection and wound healing delay are the main pathogenesis of DF. The traditional prescription San Huang Xiao Yan Recipe (SHXY) has been used in the clinical treatment of DF for several decades as approved hospital experience prescription and showed remarkable therapeutic effect, but the mechanisms by which SHXY treats DF are still unclear. PURPOSE: Objectives of this study were to investigate SHXY anti-inflammatory effect on DF and explore the molecular mechanism for SHXY. METHODS: We detected the effects of SHXY on DF in C57 mouse and SD rat DF models. Animal blood glucose, weight and wound area were detected every week. Serum inflammatory factors were detected by ELISA. H&E and Masson's trichrome were used to observe tissue pathology. Single-cell sequencing data reanalysis revealed the role of M1 macrophages in DF. Venn analysis showed the co-target genes between DF M1 macrophages and compound-disease network pharmacology. Western blotting was used to explored target protein expression. Meanwhile, RAW264.7 cells were treated with drug-containing serum of SHXY to further unravel the roles of target proteins during high glucose-induced inflammation in vitro. The Nrf2 inhibitor ML385 was used on RAW 264.7 cells to further explore the relationship between Nrf2, AMPK and HMGB1. The main components of SHXY were analysed by HPLC. Finally, the treatment effect of SHXY on DF were detected on rat DF model. RESULTS: In vivo, SHXY can ameliorate inflammatory, accelerate wound healing and upregulate expression of Nrf2, AMPK and downregulate of HMGB1. Bioinformatic analysis showed that M1 macrophages were the main inflammatory cell population in DF. Moreover, the Nrf2 downstream proteins HO-1 and HMGB1 were potential DF therapeutic targets for SHXY. In vitro, we also found that SHXY increased AMPK and Nrf2 protein levels and downregulated HMGB1 expression in RAW264.7 cells. Inhibiting the expression of Nrf2 impaired the inhibition effect of SHXY on HMGB1. SHXY promoted Nrf2 translocation into the nucleus and increased the phosphorylation of Nrf2. SHXY also inhibited HMGB1 extracelluar release under high glucose. In rat DF models, SHXY also exhibited significant anti-inflammatory effect. CONCLUSION: The SHXY activated AMPK/Nrf2 pathway to suppress abnormal inflammation on DF via inhibiting HMGB1 expression. These findings provide novel insight into the mechanisms by which SHXY treats DF.

Impacts of exposure to ambient temperature and altitude on the burden of stroke.

OBJECTIVE: To evaluate the impact of ambient temperature and altitude exposure on the burden of stroke in a Chinese cohort. METHODS: This study was conducted using data from the National Stroke High-Risk Population Screening System 2020, which assess the overall prevalence, incidence, and mortality rate of stroke in China. For this study, we obtained the annual mean ambient temperature, diurnal temperature range, and altitude for each city. Body mass index (BMI) of participants were calculated. RESULT: The sample comprised 676,394 adults aged 40 years or older from 170 cities in 31 provinces in China. A negative linear relationship between mean ambient temperature and stroke risk (incidence and prevalence) as well as a negative association between mean ambient temperature and stroke mortality had been found. A nonlinear relationship with decreased risk in both high and low diurnal temperature range is observed for stroke burden (incidence, prevalence, and mortality). There is no significant correlation between city altitude and stroke burden. The U-shaped relationships of BMI with the incidence and prevalence of stroke indicate that the lowest incidence and prevalence are observed when BMI is approximately 20. CONCLUSION: Overall, our study provides important insights into the environmental and individual factors that contribute to the burden of stroke in China, and may inform public health interventions aimed at reducing this burden.

Structure and bonding properties of the platinum-mediated tetrametallic endohedral fullerene La3Pt@C98.

Nowadays, focus is on encapsulating a greater variety and amount of metal species into fullerene cages due to their diverse structures and fascinating properties. Nevertheless, the encapsulation of more positively charged metal atoms inside one cage means more Coulomb repulsion, which makes the formation of such endohedral metallofullerenes (EMFs) difficult. In general, non-metallic atoms such as N and O should be introduced as mediators for the formation of trimetallic or tetrametallic endohedral fullerenes. However, it is still unknown whether metal atoms can serve as mediators themselves to form such EMFs. In this paper, the endohedral tetrametallic fullerene La3Pt@C98 with the platinum atom as a metallic mediator is reported. The EMFs of La3Pt@C2n (2n = 98-300) were generated by the method of laser ablation in the gas phase and verified by mass spectrometry. Among them, the EMF of La3Pt@C98 was selected and studied by theoretical calculations. Results show that the two most stable isomers are La3Pt@C2(231010)-C98 and La3Pt@C1(231005)-C98. For both of them, the inner La3Pt metallic cluster appears in a pyramidal shape, different from the planar triangular pattern of La3N clusters previously reported. Further calculations prove the existence of encaged La-Pt bonds in the La3Pt cluster. It was also revealed that the negatively charged Pt atom is situated near the center of the four-center two-electron (4c-2e) metal bond with the highest occupancy number. The platinum-mediated cluster stabilizes the EMFs greatly, promising the possibility of synthesizing new species of Pt-containing EMFs.

Intravenous Thrombolysis or Medical Management for Minor Strokes.

OBJECTIVE: To evaluate the outcomes of acute ischemic stroke patients with minor deficits treated with either intravenous thrombolysis (IVT) or routine medical management (MM). METHODS: The study included patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less who were treated with IVT within 4.5 hours from symptom onset and were classified as the IVT group. The MM group consisted of an equal number of patients with minor strokes, matched for sex, age, and severity, who did not receive thrombolysis. Data on patient information were collected for both groups. RESULTS: A total of 26,236 patients were included in this study (13,208 in IVT and 13,208 in MM). Of these patients, 67.9% were men, and the mean age was 67.1 years (standard deviation: 10.9). At 3 months, the IVT group had a higher rate of stroke-independent outcome (Rankin Scale score of 0-2) compared with the MM group (IVT vs. MM: 91.6 vs. 88.6%, absolute difference: 2.5%, 95% confidence interval [CI]: 1.6-3.4%, p = 0.008; adjusted hazard ratio [HR]: 1.2, 95% CI: 1.1-1.4, p = 0.003). Furthermore, there was no significant difference in 3-month mortality rates between the IVT and MM groups (IVT vs. MM: 2.1 vs. 2.5%, absolute difference: -0.6%, 95% CI: -1.1 to 0.3%, p = 0.11; adjusted HR: 0.9, 95% CI: 0.8-1.2, p = 0.09). CONCLUSION: Compared with MM, IVT does not reduce mortality in minor ischemic stroke but improves functional outcomes in minor stroke with an NIHSS score of 3 to 5.

The impacts of tidal wetland loss and coastal development on storm surge damages to people and property: a Hurricane Ike case-study.

Coastal wetlands protect communities during hurricanes by reducing storm surge flooding and damages. Previous studies have quantified surge reduction benefits of wetlands, but there is less understanding of how the combination of wetland loss and coastal development influences the spatial distribution of flood extents and damages. In this study we integrate a high-resolution 2-D hydrodynamic model with land-use/land-cover change analyses to assess the effects of total wetland loss, decadal wetland loss, and coastal development on storm surge damages in Galveston Bay, Texas. We measure storm surge flood extents from Hurricane Ike for three scenarios: (i) 2008 Baseline; (ii) 2008 No Wetlands, and (iii) 2019 "Present-day H. Ike". We find that during Hurricane Ike in 2008, the total loss of coastal wetlands would have increased damages by a net ~ USD $934 million or 12.8% of baseline damages. For the 2019 Present-day H. Ike scenario, we found very few wetlands were lost between 2008 and 2019. If Hurricane Ike had occurred in 2019, damages would have been higher by ~ $2.52 billion or 34.6%, almost entirely due to increased real estate value and new coastal development. Our findings suggest that, while increase in economic exposure is a key driver of storm surge risks in Galveston Bay, effective wetland conservation continues to reduce these risks.

Decoupled neural network training with re-computation and weight prediction.

To break the three lockings during backpropagation (BP) process for neural network training, multiple decoupled learning methods have been investigated recently. These methods either lead to significant drop in accuracy performance or suffer from dramatic increase in memory usage. In this paper, a new form of decoupled learning, named decoupled neural network training scheme with re-computation and weight prediction (DTRP) is proposed. In DTRP, a re-computation scheme is adopted to solve the memory explosion problem, and a weight prediction scheme is proposed to deal with the weight delay caused by re-computation. Additionally, a batch compensation scheme is developed, allowing the proposed DTRP to run faster. Theoretical analysis shows that DTRP is guaranteed to converge to crical points under certain conditions. Experiments are conducted by training various convolutional neural networks on several classification datasets, showing comparable or better results than the state-of-the-art methods and BP. These experiments also reveal that adopting the proposed method, the memory explosion problem is effectively solved, and a significant acceleration is achieved.

Impact of the COVID-19 pandemic lockdown on hospitalizations for cerebrovascular disease and related in-hospital mortality in China: A nationwide observational study.

BACKGROUND AND PURPOSE: The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on cerebrovascular disease hospitalization rates, out-of-pocket rates, and in-hospital case fatality rates. METHODS: All hospitalizations for cerebrovascular disease from 1599 hospitals from 2019 to 2020 were selected using the International Classification of Diseases, 10th revision, in the Hospital Quality Monitoring System (HQMS). We defined 2019 as the pre-pandemic group and 2020 as the post-pandemic group. Multivariate analyses were done to assess the association between the pandemic and patient outcomes and out-of-pocket rate with odds ratios (OR) and 95% CIs presented. RESULTS: In total, 9 640 788 patients with the cerebrovascular disease were recruited (mean age was 65.7[SE.0.004] years, and 55.7% were male), and data is available for 5145358 patients in 2019 (pre-epidemic) and 4495430 patients in 2020(post-pandemic), indicating a 12.6% decrease. Out-of-pocket rate increase of 9.3% (2020 vs 2019: 34.1%% vs 31.2% [absolute difference, 2.9% {95% CI, 1.3% to 4.5%}, odd ratio {OR}, 1.1{95% CI, 1.0 to 1.1}]. The epidemic has led to an 18.0% increase in in-hospital mortality (2020 vs 2019: 1.1%% vs 0.9% [absolute difference, 0.2% {95% CI, 0.1% to 0.2%}, odd ratio {OR}, 1.1{95% CI, 1.1 to 1.2}]. The epidemic has led to significantly increased in-hospital mortality for patients with stroke but had no significant impact on other cerebrovascular diseases. CONCLUSIONS: During the COVID-19 pandemic lockdown, patients hospitalized for stroke fell by 12.6%, and there were substantial increases in out-of-pocket rates (9.3%) and in-hospital case fatality rates (18.0%).

Network localization of transient global amnesia beyond the hippocampus.

BACKGROUND: Transient global amnesia is common in the older adult, but the cause and mechanism remain unclear. Focal brain lesions allow for causal links between the lesion location and resulting symptoms, and we based on the reported TGA-causing lesions and used lesion network mapping to explore the causal neuroanatomical substrate of TGA. METHODS: Fifty-one cases of transient global amnesias with DWI lesions from the literature were identified, and clinical data were extracted and analyzed. Next, we mapped each lesion volume onto a reference brain and computed the network of regions functionally connected to each lesion location using a large normative connectome dataset. RESULTS: Lesions primarily occurred in the hippocampus, and in addition to the hippocampus, there are also other locations of TGA-causing lesions such as the cingulate gyrus, anterior thalamic nucleus (ATN), putamen, caudate nucleus, corpus callosum, fornix. More than 90% of TGA-causing lesions inside the hippocampus were functionally connected with the default mode network (DMN). CONCLUSION: Structural abnormality in the hippocampus was the most consistently reported in TGA, and besides the hippocampus, lesions occurring at several other brain locations also could cause TGA. The DMN may also be involved in the pathophysiology of TGA. According to the clinical and neuroimaging characteristics, TGA may be a syndrome with multiple causes and cannot be treated simply as a subtype of TIA.

Stroke and Risk Factors in Antiphospholipid Syndrome.

Stroke is considered one of the most common and life-threatening manifestations of antiphospholipid syndrome (APS), which leads to high mortality and permanent disability. This study investigated the prevalence and the potential risk factors of stroke in APS. We enrolled 361 APS patients retrospectively from 2009 to 2022 at Peking University People's Hospital. Stroke was found in 25.8% (93/361) of the participants. The multivariate logistic regression showed that hypertension, diabetes, livedo reticularis, and other central nervous system involvements were significant related factors for stroke. The use of hydroxychloroquine appeared to relate to a lower incidence of stroke. During a median follow-up of 3.0 years, 11.8% (11/93) of the individuals with a previous stroke developed stroke recurrence, and thrombocytopenia seemed to be a predictor of stroke recurrence.

Asymmetric point-to-multipoint coherent architecture with a frequency aliasing recovery algorithm for cost-constraint short-reach access networks.

An asymmetric point-to-multipoint (PTMP) coherent architecture combined with a frequency aliasing recovery (FAR) algorithm is proposed for cost-constraint short-reach access networks. In this architecture, the uplink transmitters are simplified significantly with the uplink dual-polarization four-level pulse amplitude modulation (DP-PAM4) and downlink DP quadrature phase shift keying (DP-QPSK) asymmetric transmission design. Digital to analog converters (DACs) and radio frequency (RF) drivers are reduced by half, and in-phase and quadrature modulators (IQMs) are replaced by Mach-Zehnder modulators (MZMs), saving four MZ interferometers (MZIs). Furthermore, based on the asymmetric architecture, the FAR algorithm can recover signals from frequency aliasing caused by frequency offset (FO), even when half of the signal spectrum is aliased. This algorithm enables the asymmetric architecture to narrow down guard bands between subcarriers or even overlap the subcarriers, saving the receiver bandwidth at the aggregation/hub side. The performance of the asymmetric uplink DP-PAM4 transmission with the FAR algorithm is evaluated in both simualations and experiments. The effects of laser linewidths and IQ skew on the performance of the FAR algorithm are also analyzed. Simulation results show the algorithm can recover 16 Gbaud and 32 Gbaud signal from 8 GHz and 16 GHz aliasing, respectively. In the experiments with 10 km fiber transmissions, the FAR algorithm can recover 10 Gbaud signals from 5 GHz frequency aliasing, saving about 20.83% of the total receiver bandwidth in a 2-subcarrier system.

Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion.

BACKGROUND: Whether direct endovascular thrombectomy (EVT) is non-inferior to bridging therapy (intravenous thrombolysis [IVT] followed by EVT) in minor acute ischemic stroke due to large vessel occlusions (AIS-LVO) is not clear. Therefore, this study aimed to assess whether direct EVT is non-inferior to bridging therapy in minor AIS-LVO. METHODS: 903 patients with acute ischemic stroke due to large vessel occlusion and National Institutes of Health Stroke Scale (NIHSS) score <6 receiving EVT treatment were enrolled at Bigdata Observatory Platform for Stroke of China in China from January 1, 2019, to December 31, 2020, with final follow-up on March 31, 2021. The primary efficacy endpoint was a favorable outcome defined as a modified Rankin Scale score of 0 to 2 at three months. In addition, there were three prespecified secondary efficacy endpoints, including symptomatic intracerebral hemorrhage (ICH), in-hospital mortality, and mortality by month 3. RESULTS: A total of 662 patients treated with direct EVT (age 65.9 ± 10.5 years, 71.5 % male, NIHSS score 2.4 [standard deviation {SD}. 1.8]) were compared to 241 bridging-treated patients (age 65.7 ± 10.8, 75.9 % female, NIHSS score 2.5 [1.8]). The rate of symptomatic ICH in the EVT group was lower than in the bridging group (4.2 % vs. 8.3 %; P = 0.02). The in-hospital mortality was not different between the two groups (EVT vs. bridging group: adjusted hazard ratio {HR}, 0.9 [95 % confidence interval {CI}, 0.5 to 1.9]; P = 0.93). There was no significant difference in 3-month poor functional outcome rate (EVT vs. bridging group: 17.1 % vs. 16.2 % [absolute difference, 0.9 % {95 % CI, -0.8 % to 2.4 %}, P = 0.75; adjusted hazard ratio {HR}, 1.0 {95 % CI, 0.6 to 1.7}, P = 0.83]) and mortality rate (13.0 % vs. 11.2 % [absolute difference, 1.5 % {95 % CI, -3.9 % to 6.8 %}, P = 0.47; adjusted HR, 1.1 {95 % CI, 0.8 to 1.9}, P = 0.55]) between those two groups. CONCLUSION: Among patients with minor AIS-LVO, direct EVT, compared with bridging therapy, met the prespecified statistical threshold for noninferiority for the 3-month prognosis.

Coherent digital-analog radio-over-fiber (DA-RoF) system with a CPRI-equivalent data rate beyond 1 Tb/s for fronthaul.

We propose and experimentally demonstrate a coherent digital-analog radio-over-fiber (DA-RoF) system and achieve the transmission of Tb/s common public radio interface (CPRI)-equivalent data rate for fronthaul. The proposed coherent DA-RoF system includes DA-RoF modulation, demodulation and DA-RoF compatible coherent digital signal processing (DSP) blocks. A theoretical analysis of the DA-RoF scheme together with parameter optimization is accomplished as well. In the experiment, a 25 Gbaud DA-RoF signal with 1 Tb/s CPRI-equivalent data rate is transmitted in the system, satisfying the error vector magnitude (EVM) requirement for 256-quadrature amplitude modulation (QAM) signal transmission. With the symbol rate reduced to 10 Gbaud, an EVM below 2.5% is achieved, which meets the requirement for 1024-QAM transmission. The experimental results show that the coherent DA-RoF system is a promising solution for future fronthaul.

A novel aGAPSS-based nomogram for the prediction of ischemic stroke in patients with antiphospholipid syndrome.

Background: Ischemic stroke (IS) is the most common and life-threatening arterial manifestation of antiphospholipid syndrome (APS). It is related to high mortality and severe permanent disability in survivors. Thus, it is essential to identify patients with APS at high risk of IS and adopt individual-level preventive measures. This study was conducted to identify risk factors for IS in patients with APS and to develop a nomogram specifically for IS prediction in these patients by combining the adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS) with additional clinical and laboratory data. Methods: A total of 478 consecutive patients with APS were enrolled retrospectively. All patients were randomly assigned to the training and validation cohorts. Univariate and multivariate binary logistic analyses were conducted to identify predictors of IS in the training cohort. Then, a nomogram was developed based on these predictors. The predictive performance of the nomogram for the training and validation cohorts was evaluated by determining areas under the receiver operating characteristic curve (AUROC) and creating calibration plots. A decision curve analysis (DCA) was conducted to compare the potential net benefits of the nomogram with those of the aGAPSS. Results: During a mean follow-up period of 2.7 years, 26.9% (129/478) of the patients were diagnosed with IS. Binary logistic regression analysis revealed that five risk factors were independent clinical predictors of IS: age (P < 0.001), diabetes (P = 0.030), hyperuricemia (P < 0.001), the platelet count (P = 0.001), and the aGAPSS (P = 0.001). These predictors were incorporated into the nomogram, named the aGAPSS-IS. The nomogram showed satisfactory performance in the training [AUROC = 0.853 (95% CI, 0.802-0.896] and validation [AUROC = 0.793 (95% CI, 0.737-0.843)] cohorts. Calibration curves showed good concordance between observed and nomogram-predicted probability in the training and validation cohorts. The DCA confirmed that the aGAPSS-IS provided more net benefits than the aGAPSS in both cohorts. Conclusion: Age, diabetes, hyperuricemia, the platelet count, and the aGAPSS were risk factors for IS in patients with APS. The aGAPSS-IS may be a good tool for IS risk stratification for patients with APS based on routinely available data.

Cascaded digital-analog radio-over-fiber for efficient SNR scaling at >10†dB per extra bandwidth.

Efficient signal-to-noise ratio (SNR) and spectral efficiency (SE) trade-off can offer fundamental guiding law for future large-capacity and high-fidelity mobile fronthaul. In this Letter, we propose and experimentally demonstrate a cascaded digital-analog radio-over-fiber (CDA-RoF) scheme, which transmits digitized and analog segments using time-division-multiplexing aggregation. Specifically, multiple digital parts generated by a rounding function describe the main features of the original waveform, while the residual error is magnified and delivered as analog RoF with SE advantage. Based on a 20-GHz O-band directly modulated laser (DML), an SNR enhancement of >10 dB is observed for each extra bandwidth. Up to 70.4-dB SNR is also achieved for a 3.5-GHz 1048576-ary quadrature amplitude modulation (1048576-QAM) signal after 20-km standard single-mode fiber (SSMF) transmission.