Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis.

BACKGROUND: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. OBJECTIVE: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. RESULTS: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study. CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.

Catalpol relieved angiotensin II-induced blood-brain barrier destruction via inhibiting the TLR4 pathway in brain endothelial cells.

CONTEXT: Catalpol is a major bioactive constituent of Rehmannia glutinosa Libosch (Scrophulariaceae), a traditional Chinese medicine, which is widely used in multiple diseases, including hypertension. OBJECTIVES: To explore whether catalpol protects against angiotensin II (Ang II)-triggered blood-brain barrier (BBB) leakage. MATERIALS AND METHODS: The bEnd.3 cells and BBB models were pre-treated with or without catalpol (50, 200 and 500 µM) or TAK-242 (1 µM) for 2 h and then with Ang II (0.1 µM) or LPS (1 µg/mL) for 24 h. Cell viability was determined by the MTT assay. The levels of Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), inducible nitric oxide synthase (iNOS), tumour necrosis factor-α (TNF-α), caveolin-1 (Cav-1) and p-eNOS/eNOS were tested by western blot. The BBB permeability was evaluated by the flux of bovine serum albumin-fluorescein isothiocyanate (BSA-FITC) across monolayers. nuclear factor kappa-B (NF-κB) p65 nuclear translocation was explored by immunofluorescence staining. RESULTS: Ang II (0.1 µM) decreased the cell viability to 86.52 ± 1.79%, elevated the levels of TLR4, MyD88, iNOS, TNF-α and Cav-1 respectively to 3.7-, 1.5-, 2.3-, 2.2- and 2.7-fold, reduced the level of p-eNOS/eNOS to 1.6-fold in bEnd.3 cells, and eventually increased BBB permeability. Catalpol dose-dependently reversed these changes at 50-500 µM. Meanwhile, catalpol (500 µM) inhibited the upregulated levels of TLR4 pathway-related proteins and NF-κB p65 nuclear translocation, decreased the enhanced transcytosis, and relieved the BBB disruption caused by both LPS (the TLR4 activator) and Ang II. The effects are same as TAK-242 (the TLR4 inhibitor). CONCLUSIONS: Catalpol relieved the Ang II-induced BBB damage, which indicated catalpol has high potential for the treatment of hypertension-induced cerebral small vessel disease (cSVD).

The protective effect of harpagoside on angiotensin II (Ang II)-induced blood-brain barrier leakage in vitro.

Hypertension and its associated dysfunction of the blood-brain barrier (BBB) contribute to cerebral small vessel disease (cSVD). Angiotensin II (Ang II), a vasoactive peptide of the renin-angiotensin system (RAS), is not only a pivotal molecular signal in hypertension but also causes BBB leakage, cSVD, and cognitive impair. Harpagoside, the major bioactive constituent of Scrophulariae Radix, has been commonly used for the treatment of multiple diseases including hypertension in China. The effect of harpagoside on Ang II-induced BBB damage is unclear. We employed an immortalized endothelial cell line (bEnd.3) to mimic a BBB monolayer model in vitro and investigated the effect of harpagoside on BBB and found that harpagoside alleviated Ang II-induced BBB destruction, inhibited Ang II-associated cytotoxicity in a concentration-dependent manner and attenuated Ang II-induced reactive oxygen species (ROS) impair by downregulation of Nox2, Nox4, and COX-2. Harpagoside prevented Ang II-induced apoptosis via keeping Bax/Bcl-2 balance, decreasing cytochrome c release, and inactivation of caspase-8, caspase-9, and caspase-3 (the mitochondria-dependent and death receptor-mediated apoptosis pathways). Moreover, harpagoside can alleviate Ang II-induced BBB damage through upregulation of tight junction proteins and decrease of caveolae-mediated endocytosis. Thus, harpagoside might be a potential drug to treat Ang II-induced cSVD.

[Reversion Mechanism Study of PESV to Multidrug Resistance at Leukemia Stem Cell Level].

OBJECTIVE: To explore the effect of peptide extract from scorpion venom (PESV) to multidrug resistance (MDR) of leukemic stem cell (LSC) in vivo. METHODS: K562/A02 cells were cultured and collected in the logarithmic phase. K562/A02 stem cells were screened using immunomagnetic beads for reserve. K562/A02 LSC was injected to 5 of 40 BABL/c nude mice for preparing subcutaneous tumor. The rest 35 nude mice were then randomly divided into 7 groups, i.e., the normal control group, the model group, the Adriamycin (ADM) group, the PESV group, the ADM +high dose PESV group, the ADM + middle dose PESV group, the ADM +low dose PESV group, 5 in each group. Tumor tissue was embedded in all groups except the normal control group. One milliliter normal saline was peritoneally injected to mice in the model group after modeling, once per day. ADM 0. 05 mg was peritoneally injected to mice in the ADM group, once per other day. PESV 2 µg was peritoneally injected to mice in the PESV group, once per day. Mice in 3 ADM + PESV groups were peritoneally injected with ADM 0. 05 mg (once per other day) plus PESV (5, 2, and 1 µg respectively, once per day). All medication lasted for 14 days. P-glycoprotein (P-gp) was detected using flow cytometry. Breast cancer resistance protein (BCRP) and mRNA expression of multidrug resistance 1 (MDR1) were measured using RT-PCR. Aldehyde dehydrogenase 1 (ALDH1) was detected using immunohistochemistry. Phosphoinositide 3-kinase (PI3K) was detected using Western blot. NF-κB content was detected using ELISA. RESULTS: CD34 + CD38-ratio was 31.5% and IC50 was (60.33 ± 10. 68) µg/mL before K562/A02 cells were screened with immunomagnetic beads, while they were 92. 8% and (58. 33 ±9. 72) µg/mL after screen. The tumor formation rate was 100% in modeling mice. Compared with the model group, no statistical difference of each index occurred in the ADM group (P <0. 05). There was statistical difference in BCRP, MDR1 mRNA, or NF-κB factor between the model group and the PESV group (P <0. 05). The expression level of P-gp obviously decreased and the protein expression of P13K was down-regulated in 3 ADM + PESV groups (P <0. 05); mRNA expression of BCRP decreased and mRNA ex- pression of MDR1 obviously increased in the ADM + high dose PESV group and the ADM + middle dose PESV group, with statistical difference (P <0. 05). Protein expression of P13K was down-regulated in the ADM+ high dose PESV group, with statistical difference (P <0. 05). P-gp value, BCRP mRNA expression, MDR1 mRNA expression, PI3K, and NF-κB factor were all obviously down-regulated in the ADM +high dose PESV group, as compared with the ADM group and the PESV group respectively (P <0. 05). There was no statistical difference in ALDH1 positive rate among all groups (P >0. 05). Conclusion PESV combined ADM could down-regulate expression levels of P-gp, BCRP, MDR1, P13K, and NF-κB, strengthen the sensitivity of K562/A02 LSC to ADM in vivo, and reverse MDR of LSC.

Low-Cost, Scalable Simulations in Obstetric Trauma and Resuscitative Hysterotomy for Emergency Medicine Residents.

Introduction: Simulation-based learning is essential for health care providers to prepare for rare obstetric emergencies, such as severe trauma and maternal cardiac arrest. These situations demand rapid and prompt actions, often testing the skill of emergency physicians. Resuscitative hysterotomy (RH), a critical procedure in maternal cardiac arrest, requires technical expertise, coordination, and anatomical knowledge. The high cost of commercial trainers and complex existing models restricts accessibility. This resource introduces a low-cost anatomically accurate RH task trainer and assesses its effectiveness in improving skills and confidence among trainee emergency physicians. Methods: A 20-minute-long case scenario depicted the resuscitation of a pregnant trauma patient with tension pneumothorax and uterine rupture, culminating in maternal cardiac arrest necessitating RH. Residents performed RH on the task trainer under faculty guidance. Feedback followed the Pendleton model, and an online questionnaire gauged the residents' experiences. Results: Thirty emergency medicine residents participated in the simulation. The questionnaire revealed positive responses, confirming the session's relevance and enhancement of clinical skills and confidence. Discussion: Our results underscore the RH task trainer's critical role in improving residents' skills and confidence during obstetric trauma simulations. Its realism and effectiveness were notably well received. Future refinements aim to augment fidelity while preserving affordability and integrating regular reinforcement sessions. This innovative educational approach equips health care professionals to respond adeptly to rare and challenging obstetric emergencies, ultimately elevating outcomes for mothers and infants during critical situations.

Breaking law of overburden rock and key mining technology for narrow coal pillar working face in isolated island.

When conducting retreat mining in segmented coal pillars, the dynamic evolution of stress and overlying strata structure is more complex than conventional working faces due to the influence of adjacent working faces. Understanding and mastering the dynamic evolution patterns of overlying strata structure after retreat mining in segmented coal pillar working faces is essential for guiding the safe recovery of coal pillar resources under similar conditions. Through statistical analysis of the types of residual coal and the mining techniques, the current research status of residual coal mining system in China has been summarized. Based on the safety recovery technology system for multi-type residual coal pillar resources at Zhaogu No.2 Mine, this paper focuses on narrow coal pillar working faces in sections with fully mined-out areas on both sides. By using research methods such as on-site measurement, theoretical analysis, numerical simulation, and engineering experiments, starting from the stress state analysis and evolution law of coal seam mining, the dynamic evolution law of the overlying rock structure of sectional coal pillars has been mastered. On this basis, a stress arch mechanical model of the mining area is constructed, and the working resistance of the support is calculated and determined, ensuring the safe recovery of the working face. The research results show that before the backfilling of the sectional coal pillar working face, the working face is affected by the overlapping mining of the goaf on both sides, presenting a "bimodal" stress distribution pattern, with a stress concentration coefficient between 1.78 and 3.2. After the extraction of segmented coal pillars, stress arches consisting of high-stress zones form along both the strike and dip of the working face. The structural support provided by stress arches undergoes a dynamic evolution process of "formation-development-elevation-stabilization" as the working face advances. Following the instability and rupture of the lower basic roof hinge structure, the stress-bearing structure shifts to the higher basic roof, continuing to provide support for the surrounding rock stress in the mining space of the working face. A stress arch mechanical model for the dip and strike of the mining area is constructed , and the shape characteristics of the overlying rock stress arch in the coal pillar working face is mastered. Based on the stress distribution law and stress arch evolution characteristics of the surrounding rock of the coal pillar working face, the maximum working resistance of the support in the working face is theoretically calculated to be 9153.48kN. Compared with the measured mine pressure data, the selected support effectively ensures the safety production of the working face.

Gradient-flow adaptive importance sampling for Bayesian leave one out cross-validation for sigmoidal classification models.

We introduce a set of gradient-flow-guided adaptive importance sampling (IS) transformations to stabilize Monte-Carlo approximations of point-wise leave one out cross-validated (LOO) predictions for Bayesian classification models. One can leverage this methodology for assessing model generalizability by for instance computing a LOO analogue to the AIC or computing LOO ROC/PRC curves and derived metrics like the AUROC and AUPRC. By the calculus of variations and gradient flow, we derive two simple nonlinear single-step transformations that utilize gradient information to shift a model's pre-trained full-data posterior closer to the target LOO posterior predictive distributions. In doing so, the transformations stabilize importance weights. Because the transformations involve the gradient of the likelihood function, the resulting Monte Carlo integral depends on Jacobian determinants with respect to the model Hessian. We derive closed-form exact formulae for these Jacobian determinants in the cases of logistic regression and shallow ReLU-activated artificial neural networks, and provide a simple approximation that sidesteps the need to compute full Hessian matrices and their spectra. We test the methodology on an n≪p dataset that is known to produce unstable LOO IS weights.

A fractional-order model for optimizing combination therapy in heterogeneous lung cancer: integrating immunotherapy and targeted therapy to minimize side effects.

This research presents a novel approach to address the complexities of heterogeneous lung cancer dynamics through the development of a Fractional-Order Model. Focusing on the optimization of combination therapy, the model integrates immunotherapy and targeted therapy with the specific aim of minimizing side effects. Notably, our approach incorporates a clever fusion of Proportional-Integral-Derivative (PID) feedback controls alongside the optimization process. Unlike previous studies, our model incorporates essential equations accounting for the interaction between regular and mutated cancer cells, delineates the dynamics between immune cells and mutated cancer cells, enhances immune cell cytotoxic activity, and elucidates the influence of genetic mutations on the spread of cancer cells. This refined model offers a comprehensive understanding of lung cancer progression, providing a valuable tool for the development of personalized and effective treatment strategies. the findings underscore the potential of the optimized treatment strategy in achieving key therapeutic goals, including primary tumor control, metastasis limitation, immune response enhancement, and controlled genetic mutations. The dynamic and adaptive nature of the treatment approach, coupled with economic considerations and memory effects, positions the research at the forefront of advancing precision and personalized cancer therapeutics.

Optimized preparation of spruce kraft lignin/ZnO composites and their performance analysis in polyurethane films.

Spruce kraft lignin (SKL) has received considerable attention in recent years for its application in the field of polymer materials. However, its structural complexity and polydispersity pose significant challenges for commercial applications. In this study, molecular structure models of acetone soluble kraft lignin (ASKL) and acetone insoluble kraft lignin (AIKL) were proposed based on quantitative calculations of the connection mode of functional groups and structural units. The lignin was modified by quaternization and synthesized in situ as lignin/ZnO composites. Based on the detailed characterization of the micromorphology and structure of the composites, waterborne polyurethane (WPU) films were optimally prepared using 0.6 wt% of the composites. The results showed that the composite films prepared from ASKL have the best UV-blocking performance and mechanical properties. The highest UVA and UVB blocking rates were 98% and 100%, respectively, and the highest tensile strength and elongation at break were 31.2 MPa and 732%, respectively. The differences in the structure and functional groups of the different types of SKL were accurately identified. ASKL is advantageous for the development of UV-blocking films because of its low molecular weight and the presence of abundant phenolic hydroxyl groups, which facilitate the formation of hydrogen bonds, improve the compatibility, and ensure uniform dispersibility. The results of this study are of practical importance in the field of nano-functional materials for the high-value application of industrial lignin.

Report of a family with Huntington's disease.

The aim of this article was to analyze the clinical and genetic characteristics of a patient with Huntington's disease and her family. We analyzed the clinical data of a patient with Huntington's disease and her family members in the Department of Neurology of our hospital, drew the genetic pedigree, and used gene fragment analysis to detect and analyze the genes of three people in the family according to the principle of informed consent. The genetic pedigree of the family was consistent with that of autosomal dominant diseases. A total of five people in this family developed the disease, two died, and the main clinical manifestations were dystonia, ataxia, and cognitive impairment. Three people in this family underwent genetic testing, and two exhibited normal genotypes. The cytosine-adenine-guanine trinucleotide (CAG) repeats of the proband were abnormally amplified, and the number of repeats reached 43. The main clinical features of the patient included chronic obscure onset, obvious positive family genetic history, clinical features of involuntary limb movement with cognitive impairment, rapid disease progression, poor treatment effect, and abnormal amplification of CAG repeats as shown through genetic testing. All the above features met the diagnostic criteria of Huntington's disease.

Study on a novel omnidirectional ultrasonic cavitation removal system for Microcystis aeruginosa.

Microcystis aeruginosa, as a typical alga, produces microcystin with strong liver toxicity, seriously endangering the liver health of human and animals. Inhibiting the bloom of the Microcystis aeruginosa in lakes becomes a significant and meaningful work. Ultrasonic cavitation is currently considered to be the most environmentally friendly and effective method for the removal of Microcystis aeruginosa. However, the commercialized ultrasonic algae removal systems require multi-Langevin transducers to achieve omnidirectional ultrasonic irradiation due to the single irradiation direction of the Langevin transducer, resulting in the complex design and high energy consumption. To achieve a low-cost, simple structure, and high-efficiency algae removal system, a novel omnidirectional ultrasonic cavitation removal system for Microcystis aeruginosa is proposed. The proposed system is major composed of a novel omnidirectional ultrasonic transducer, which generates the omnidirectional ultrasonic irradiation by its shaking-head motion coupled by two orthogonal bending vibration modes. Modal simulation, sound field simulation, and cavitation bubble radius simulation are first carried out to optimize the geometric sizes of the proposed transducer and verify the correctness of the omnidirectional ultrasonic irradiation principle. Then the vibration characteristics of the transducer prototype are measured by vibration tests and impedance tests. Finally, the feasibility and effectiveness of the proposed omnidirectional ultrasonic removal system for Microcystis aeruginosa are evaluated through the algae removal experiments. The experimental results exhibit that the algal cells damaged by ultrasonic irradiation from the proposed system do not have the ability to self-repair. In addition, the algal removal rates reached 55.41% and 72.97% after 30 min of ultrasonic treatment when the corresponding ultrasonic densities are 0.014 W/mL and 0.021 W/mL, respectively. The proposed omnidirectional ultrasonic algae removal system significantly simplifies the configuration and reduces energy consumption, presenting the potential promise of algae removal and environmental protection.

Long-term Follow-up of Pulsed Radiofrequency Treatment for Trigeminal Neuralgia: Kaplan-Meier Analysis in a Consecutive Series of 149 Patients.

BACKGROUND: At present, there is no ideal method for the treatment of trigeminal neuralgia (TN). The need for an easy, safe, non- or micro-neurodestructive, repeatable treatment, with a fairly satisfactory rate of pain relief, is paramount. Pulsed radiofrequency (PRF) as a minimally invasive and microdestructive technique has been reported to be an option for TN; however, no study has reported the long-term outcome of TN in a large case series. OBJECTIVES: We aimed to investigate the efficacy, safety, and the long-term outcomes of PRF treatment for patients with TN. STUDY DESIGN: This was a long-term, large case series, retrospective study. SETTING: The study was conducted at Tiantan hospital,Beijing. METHODS: We retrospectively analyzed medical databases and follow-up data of 149 patients with TN from January 2008 through March 2021, who underwent PRF treatment, with a median follow-up time of 71.0 months (interquartile range, 20.0 months to 112.0 months). Baseline characteristics and intraoperative data of patients were retrospectively extracted; data about complications and side effects were also collected. The follow-up data were composed of the postoperative Barrow Neurological Institute Pain Intensity Score  pain intensity at a different time, the onset time of PRF treatment, and the time when pain was recurrent. RESULTS: The initial pain relief rate was 75.17% after the procedure. The cumulative recurrence-free survival after the procedure was 75.00% at one month; 72.87% at 6 months; 70.59% at 12 months; 65.39% at 24 months; 61.63% 48 months; 56.73% at 96 months; and 49.64% at 144 months. The median recurrence-free time was 118 months according to the Kaplan-Meier estimator. Nineteen patients had pain recurrence with a median time of 15 months (range, 1.0 months to 96.0 months), among whom, 12 underwent a second PRF procedure and 9 patients experienced satisfactory pain relief. No serious complications or side effects occurred after the procedure. LIMITATIONS: This was a single-center, retrospective study. Our study failed to conduct a stratified analysis on the effect of PRF treatment for classic and idiopathic TN. The most efficacious parameters of PRF applied for TN and studies trying to identify positive predictive factors of pain relief before PRF treatment have yet to be investigated. CONCLUSIONS: The results of this study show the promising long-term effect of PRF on primary TN. The safety and repeatability might be more easily accepted by patients with TN and should be considered a preferred treatment option before choosing neurodestructive or more invasive methods.

Identification of key genes for type 1 diabetes mellitus by network-based guilt by association.

OBJECTIVE This study aimed to propose a co-expression-network (CEN) based gene functional inference by extending the "Guilt by Association" (GBA) principle to predict candidate gene functions for type 1 diabetes mellitus (T1DM). METHODS Firstly, transcriptome data of T1DM were retrieved from the genomics data repository for differentially expressed gene (DEGs) analysis, and a weighted differential CEN was generated. The area under the receiver operating characteristics curve (AUC) was chosen to determine the performance metric for each Gene Ontology (GO) term. Differential expression analysis identified 325 DEGs in T1DM, and co-expression analysis generated a differential CEN of edge weight > 0.8. RESULTS A total of 282 GO annotations with DEGs > 20 remained for functional inference. By calculating the multifunctionality score of genes, gene function inference was performed to identify the optimal gene functions for T1DM based on the optimal ranking gene list. Considering an AUC > 0.7, six optimal gene functions for T1DM were identified, such as regulation of immune system process and receptor activity. CONCLUSIONS CEN-based gene functional inference by extending the GBA principle predicted 6 optimal gene functions for T1DM. The results may be potential paths for therapeutic or preventive treatments of T1DM.

Computed Tomography-Determined Muscle Quality Rather Than Muscle Quantity Is a Better Determinant of Prolonged Hospital Length of Stay in Patients Undergoing Transcatheter Aortic Valve Implantation.

RATIONALE AND OBJECTIVES: Computed tomography (CT)-determined skeletal muscle measures have been used for predicting postoperative outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the impact of CT-determined muscle quantity (measured as psoas muscle area [PMA] and psoas muscle index [PMI]) and quality (measured as psoas muscle density [PMD]) on hospital length of stay (LOS) after TAVI. METHODS: We retrospectively identified 182 consecutive patients who underwent TAVI between March 2013 and August 2017 with adequate preprocedural CT imaging. Baseline demographic and clinical data, the Society of Thoracic Surgeons score, the essential frailty toolset (EFT) frailty rating, and precontrast PMD, PMA, and PMI were obtained in all study patients. The primary outcome was prolonged postoperative LOS defined as greater than 14 days. RESULTS: Patients with prolonged LOS had a significantly higher Society of Thoracic Surgeons score (p < 0.001) and significantly lower PMD (p < 0.001) than those with LOS ≤14 days. More patients with prolonged LOS had concomitant peripheral vascular disease (p  = 0.001), had undergone percutaneous coronary interventions (p = 0.022), and had an EFT score ≥4 (p < 0.001) compared to those without prolonged LOS. Neither PMA (p = 0.123) nor PMI (p = 0.271) were associated with prolonged LOS. Multivariate analysis identified EFT score ≥4, the presence of peripheral vascular disease, and PMD as independent predictors of prolonged LOS. CONCLUSION: The precontrast CT-determined muscle quality measurement PMD is a simple and objective predictor of prolonged LOS after TAVI.

Novel sex-specific influence of parental factors on small-for-gestational-age newborns.

Since fetal programming is sex-specific, there may also be sex-specific in parental influences on newborn birth weight. We aimed to investigate the influence of parental factors on small-for-gestational-age (SGA) infants of different sexes. Based on a pre-pregnancy cohort, multivariate logistic regression was used. 2275 couples were included for analysis. Significant associations were observed among paternal height, pre-pregnancy body mass index (BMI), and SGA in male infants; among maternal height, pre-pregnancy BMI, and SGA in female infants, and among other maternal factors and SGA in both male and female infants. Such sex specificity may be related to genetic, epigenetic, or hormonal influences between parents and infants. In conclusion, there is a sex specificity in the effect of parental height and pre-pregnancy BMI on SGA. The data suggest that future studies on infants should consider the sex-specific differences between the effects of genetic or environmental factors and infants.

Hate speech detection: Challenges and solutions.

As online content continues to grow, so does the spread of hate speech. We identify and examine challenges faced by online automatic approaches for hate speech detection in text. Among these difficulties are subtleties in language, differing definitions on what constitutes hate speech, and limitations of data availability for training and testing of these systems. Furthermore, many recent approaches suffer from an interpretability problem-that is, it can be difficult to understand why the systems make the decisions that they do. We propose a multi-view SVM approach that achieves near state-of-the-art performance, while being simpler and producing more easily interpretable decisions than neural methods. We also discuss both technical and practical challenges that remain for this task.

Prediction of seed gene function in progressive diabetic neuropathy by a network-based inference method.

Guilt by association (GBA) algorithm has been widely used to statistically predict gene functions, and network-based approach increases the confidence and veracity of identifying molecular signatures for diseases. This work proposed a network-based GBA method by integrating the GBA algorithm and network, to identify seed gene functions for progressive diabetic neuropathy (PDN). The inference of predicting seed gene functions comprised of three steps: i) Preparing gene lists and sets; ii) constructing a co-expression matrix (CEM) on gene lists by Spearman correlation coefficient (SCC) method and iii) predicting gene functions by GBA algorithm. Ultimately, seed gene functions were selected according to the area under the receiver operating characteristics curve (AUC) index. A total of 79 differentially expressed genes (DEGs) and 40 background gene ontology (GO) terms were regarded as gene lists and sets for the subsequent analyses, respectively. The predicted results obtained from the network-based GBA approach showed that 27.5% of all gene sets had a good classified performance with AUC >0.5. Most significantly, 3 gene sets with AUC >0.6 were denoted as seed gene functions for PDN, including binding, molecular function and regulation of the metabolic process. In summary, we predicted 3 seed gene functions for PDN compared with non-progressors utilizing network-based GBA algorithm. The findings provide insights to reveal pathological and molecular mechanism underlying PDN.

Finite Element Simulation Study of Ultrasonic Vibration-Assisted Tensile High-Volume Fraction SiCp/Al Composite.

Silicon carbide particle-reinforced aluminum matrix composite (SiCp/Al) has been widely used in the military and aerospace industry due to its special performance; however, there remain many problems in the processing. The present paper introduces an ultrasonic vibration tensile apparatus and a composite tensile specimen and performs Abaqus finite element simulation on high-volume SiCp/Al. The results show that the stress-strain curve increases linearly during conventional tensile strength; the intermittent vibration tensile strength is similar to the full course vibration tensile strength: The magnitude of the stress reduction increases as the amplitude of the ultrasound increases and the vibration frequency increases. The tensile rate is inversely proportional to the magnitude of the stress reduction, and in the ultrasonic parameters, the amplitude has the greatest influence on the magnitude of the stress reduction, followed by the tensile rate; additionally, the frequency has the least influence on the magnitude of the stress reduction. The experimental results show that the simulation results are consistent with the experimental results.

Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects.

RATIONALE: Traumatic hemipelvectomy is a rare but lethal catastrophic injury. PATIENT CONCERNS: A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects. DIAGNOSIS: Traumatic hemipelvectomy. INTERVENTIONS: Complete amputation was performed and three kinds of surgical techniques including regulated negative pressure-assisted wound therapy (RNPT), TopClosure device, and Ilizarov technique were jointly utilized to secure closure in the further revisions of the soft tissue injury and reconstruct reconstructive surgery. OUTCOMES: Six months after hospital discharge, the patient was able to ambulate with a single limb and a prosthesis and she is independent in many activities of daily living currently. LESSONS: We report this case to share experience with other clinicians in the management of this deadly extensive defects after traumatic hemipelvectomy in patients.

Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture.

BACKGROUND: Humeral shaft fractures can be effectively treated by either antegrade or retrograde locked intramedullary nailing, but these two methods have not been adequately compared. The present study compared the effectiveness and potential risks of these two approaches on middle humeral shaft fractures using the same locked nails. METHODS: In this prospective comparative study, 92 fractures in 92 patients with middle humeral shaft fractures were randomly allocated to receive either antegrade or retrograde locked nailing by sealed-envelope technique. The clinical outcomes of fracture healing, time to healing, complications, elbow and shoulder functional recovery, and time for functional recovery were compared. RESULTS: Retrograde nailing required significantly longer time than antegrade nailing (64.8 vs. 51.3 minutes; p < 0.01) Except for three patients lost to follow-up, the average follow-up time was 18.6 months for 44 fractures in the antegrade group and 19.8 months for 45 fractures in the retrograde group. The fracture healed in 42 fractures (95%) in the antegrade group versus 42 fractures (93%) in the retrograde group, and this difference was not significant. After exclusion of two patients with brachial plexus injury and three with head injury, functional recovery was compared between 41 patients with antegrade and 43 with retrograde nailing. For shoulder joints, the difference in the average Neer shoulder score between the two groups was statistically significant (90.8 vs. 93.5; p = 0.03). However, if four elderly patients were excluded, the average score in the antegrade group was 91.9, and the difference became insignificant (p = 0.1). Still, the antegrade group needed significantly longer time for shoulder functional recovery (16.4 vs. 8.3 weeks; p < 0.01). For elbow joints, the average postoperative Mayo elbow performance score (96.3 vs. 94.8; p = 0.16) did not differ significantly between these two approaches, but the retrograde approach needed significantly longer time for elbow functional recovery (3.9 vs. 8.8 weeks; p < 0.01). All patients, except those with associated injuries, resumed their pretrauma occupations or activities. CONCLUSION: With proper patient selection, antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. It is recommended that retrograde nailing be used in patients with a wide medullary canal or preexisting shoulder problems and antegrade nailing be used in patients with young age or a small medullary canal. In critically ill patients, antegrade nailing is preferred because of shorter operation time.