Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke.

BACKGROUND: Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. Whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke is uncertain. METHODS: We randomly assigned patients with suspected acute stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg), who were assessed in the ambulance within 2 hours after the onset of symptoms, to receive immediate treatment to lower the systolic blood pressure (target range, 130 to 140 mm Hg) (intervention group) or usual blood-pressure management (usual-care group). The primary efficacy outcome was functional status as assessed by the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days after randomization. The primary safety outcome was any serious adverse event. RESULTS: A total of 2404 patients (mean age, 70 years) in China underwent randomization and provided consent for the trial: 1205 in the intervention group and 1199 in the usual-care group. The median time between symptom onset and randomization was 61 minutes (interquartile range, 41 to 93), and the mean blood pressure at randomization was 178/98 mm Hg. Stroke was subsequently confirmed by imaging in 2240 patients, of whom 1041 (46.5%) had a hemorrhagic stroke. At the time of patients' arrival at the hospital, the mean systolic blood pressure in the intervention group was 159 mm Hg, as compared with 170 mm Hg in the usual-care group. Overall, there was no difference in functional outcome between the two groups (common odds ratio, 1.00; 95% confidence interval [CI], 0.87 to 1.15), and the incidence of serious adverse events was similar in the two groups. Prehospital reduction of blood pressure was associated with a decrease in the odds of a poor functional outcome among patients with hemorrhagic stroke (common odds ratio, 0.75; 95% CI, 0.60 to 0.92) but an increase among patients with cerebral ischemia (common odds ratio, 1.30; 95% CI, 1.06 to 1.60). CONCLUSIONS: In this trial, prehospital blood-pressure reduction did not improve functional outcomes in a cohort of patients with undifferentiated acute stroke, of whom 46.5% subsequently received a diagnosis of hemorrhagic stroke. (Funded by the National Health and Medical Research Council of Australia and others; INTERACT4 ClinicalTrials.gov number, NCT03790800; Chinese Trial Registry number, ChiCTR1900020534.).

The dynamics of deltamethrin resistance evolution in Aedes albopictus has an impact on fitness and dengue virus type-2 vectorial capacity.

BACKGROUND: Worldwide invasion and expansion of Aedes albopictus, an important vector of dengue, chikungunya, and Zika viruses, has become a serious concern in global public health. Chemical insecticides are the primary means currently available to control the mosquito populations. However, long-term and large-scale use of insecticides has selected for resistance in the mosquito that is accompanied by a genetic load that impacts fitness. RESULTS: A number of laboratory strains representing different resistance mechanisms were isolated and identified from laboratory-derived, deltamethrin-resistant Ae. albopictus recovered in previous work. Resistance levels and fitness costs of the strains were evaluated and compared to characterize the evolution of the resistance genotypes and phenotypes. The heterozygous F1534S mutation (1534F/S) in the voltage gated sodium channel (vgsc) gene product (VGSC), first detected in early stages of resistance evolution, not only confers high-level resistance, but also produces no significant fitness costs, leading to the rapid spread of resistance in the population. This is followed by the increase in frequency of homozygous F1534S (1534S/S) mosquitoes that have significant fitness disadvantages, prompting the emergence of an unlinked I1532T mutation with fewer side effects and a mating advantage better adapted to the selection and reproductive pressures imposed in the experiments. Metabolic resistance with no significant fitness cost and mediating a high-tolerance resistance phenotype may play a dominant role in the subsequent evolution of resistance. The different resistant strains had similar vector competence for dengue virus type-2 (DENV-2). Furthermore, a comparative analysis of vectorial capacity revealed that increased survival due to deltamethrin resistance balanced the negative fitness cost effects and contributed to the risk of dengue virus (DENV) transmission by resistant populations. The progressive evolution of resistance results in mosquitoes with both target-site insensitivity and metabolic resistance with lower fitness costs, which further leads to resistant populations with both high resistance levels and vectorial capacity. CONCLUSIONS: This study reveals a possible mechanism for the evolution of deltamethrin resistance in Aedes albopictus. These findings will help guide practical strategies for insecticide use, resistance management and the prevention and control of mosquito-borne disease.

Efficient All-Perovskite Tandem Solar Cells with Low-Optical-Loss Carbazolyl Interconnecting Layers.

Combining wide-band gap (WBG) and narrow-band gap (NBG) perovskites with interconnecting layers (ICLs) to construct monolithic all-perovskite tandem solar cell is an effective way to achieve high power conversion efficiency (PCE). However, optical losses from ICLs need to be further reduced to leverage the full potential of all-perovskite tandem solar cells. Here, metal oxide nanocrystal layers anchored with carbazolyl hole-selective-molecules (CHs), which exhibit much lower optical loss, is employed to replace poly(3,4-ethylenedioxythiophene) polystyrenesulfonate (PEDOT : PSS) as the hole transporting layers (HTLs) in lead-tin (Pb-Sn) perovskite sub-cells and ICLs in all-perovskite tandem solar cells. Optically transparent indium tin oxide nanocrystals (ITO NCs) layers are employed to enhance anchoring of CHs, while a mixture of two CHs is adopted to tune the surface energy-levels of ITO NCs. The optimized mixed Pb-Sn NBG perovskite solar cells demonstrate a high PCE of 23.2 %, with a high short-circuit current density (Jsc ) of 33.5 mA cm-2 . A high PCE of 28.1 % is further obtained in all-perovskite tandem solar cells, with the highest Jsc of 16.7 mA cm-2 to date. Encapsulated tandem solar cells maintain 90 % of their reference point after 500 h of operation at the maximum power point (MPP) under 1-Sun illumination.

Engineering Pollen-Derived Microstructures to Reveal Material Morpho-Performance Paradigm.

The morphologies of micromaterials play a key role in their functionality and efficiency across a broad range of applications, including catalysis, environmental remediation, and drug delivery. However, the relationships between the morphologies and performances of micromaterials still need to be further understood, to guide the rational design of effective morphologies for specific applications. A pollen-derived microstructure library containing multivariate morphological characterization and functional performance data is proposed and constructed here. Systematic multivariate correlation analysis is conducted to extract the key morphological factors influencing the photocatalytic and adsorption efficiencies, to reveal the morpho-performance relationships of pollen-derived microstructures. Subsequently, a chrysanthemum-derived microstructure is selected as a typical candidate; it features a unique morphology suitable for advanced photocatalysis and dynamic environmental remediation. To summarize, the construction of a pollen-derived microstructure library offers a powerful tool for studying the morpho-performance relationships of micromaterials; this can provide significant guidance and inspiration for the rational design of micro/nanomaterials for numerous applications.

Megaporous monolithic adsorbents for bioproduct recovery as prepared on the basis of nonwoven fabrics.

Megaporous adsorbents were prepared based on nonwoven polyethylene terephthalate (PET) fabrics and functionalized by covalent modification with polyvinylamine (PVAm) or monotriazinyl-ß-cyclodextrin-substituted polyvinylamine (PVAm-MCT-ß-CD). Mechanical properties of the resulting fabrics were maintained, as judged by tensile strength tests and scanning electron microscopy. Exceptional porosity (≥82%) and preserved hydrodynamic characteristics (Pe ≥ 63) indicated excellent structural stability when packed. The performance of the constructed adsorbents was evaluated with high molecular weight (proteins) and low molecular weight (dyes) model compounds. The static binding capacity (SBC) for bovine serum albumin (BSA) was 79.7 ± 1.3 and 92.9 ± 8.2 mg/g for PVAm-modified and PVAm-MCT-ß-CD-modified fabrics, respectively. The mentioned materials also adsorbed Orange II, an acidic dye (92.4 ± 2.6 and 101.9 ± 2.6 mg/g, respectively), indicating that the hydrophobicity was a prevailing binding mechanism operating at a pH close to isoelectric point. SBC for lysozyme and toluidine blue O (TBO, a basic dye) onto PVAm-MCT-ß-CD functionalized PET was 52.7 ± 5.1 and 73.3 ± 0.6 mg/g, respectively. TBOs have also shown some affinity for PVAm functionalized PET, but this was most likely to be mediated by hydrophobicity. On the other hand, operating at a superficial velocity of 90 cm/h, dynamic binding capacity for BSA was 11.4 ± 3.5 and 2.5 ± 0.6 mg/g indicating the importance of possible aggregation mechanisms during protein binding at equilibrium. Thus, PET-based adsorbents require further functional improvement for chromatography applications. However, the easy-to-construct, scalable nonwoven adsorbents deserve further attention as a potential alternative to packed-bed-chromatography adsorbents.

Short-term outcomes and safety of radiotherapy for immediate breast reconstruction with autologous flap transfer following breast-conserving surgery.

BACKGROUND: The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. METHOD: A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. RESULTS: In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. CONCLUSION: RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

Clinical option of pemetrexed-based versus paclitaxel-based first-line chemotherapeutic regimens in combination with bevacizumab for advanced non-squamous non-small-cell lung cancer and optimal maintenance therapy: evidence from a meta-analysis of randomized control trials.

BACKGROUND: In the era of immunotherapy, it is still unclear which is the best first-line therapy for patients with oncogenic driver negative advanced non-squamous non-small cell lung cancer (NS-NSCLC) who cannot tolerate immunotherapy, or subsequent therapy for patients with oncogenic driver positive NS-NSCLC whose disease progressed on prior targeted therapy. To assess the optimal choice of first-line and maintenance treatment regimens, we performed a meta-analysis of prospective randomized controlled clinical trials (RCTs) of patients with NS-NSCLC on bevacizumab combined with chemotherapy. METHODS: All eligible RCTs comparing pemetrexed-platinum with or without bevacizumab (PP ± B) and paclitaxel-carboplatin with bevacizumab (PC + B) as a first-line therapy, or comparing bevacizumab plus pemetrexed (Pem + B) and bevacizumab alone (B) as a maintenance treatment for advanced NS-NSCLC, were included after systematically searching web databases and meeting abstracts. The main research endpoints were comparisons of overall survival (OS) and progression-free survival (PFS). The other endpoints were objective response rate (ORR), 1-year PFS rate (PFSR1y) and major grade 3/4 treatment-related adverse events. RESULTS: Data of 3139 patients from six RCTs were incorporated into analyses. Three RCTs were included in an analysis that compared PP ± B and PC + B as a first-line therapy for advanced NS-NSCLC. Patients treated with first-line PP ± B showed similar OS and ORR, but significantly improved PFS (hazard ratio [HR], 0.88) and PFSR1y (risk ratio [RR], 0.83), as compared to patients treated with PC + B (all P < 0.05). PP ± B resulted in higher rates of grade 3/4 anemia and thrombocytopenia, but lower rates of neutropenia, febrile neutropenia, and sensory neuropathy than PC + B (all P < 0.001). The other three RCTs were included in an analysis that compared Pem + B and B as a maintenance treatment. Compared with B, Pem + B maintenance treatment resulted in significant improvements in OS (HR, 0.88), PFS (HR, 0.64), and PFSR1y (RR, 0.70), but higher rates of anemia, thrombocytopenia, and neutropenia (all P < 0.001). CONCLUSION: Although the first-line PP + B regimen had longer PFS and PFSR1y than the PC + B regimen, no OS difference was observed. Addition of pemetrexed to bevacizumab as maintenance therapy significantly improved OS compared with bevacizumab maintenance alone, but led to more toxicity.

Safety and efficacy of edaravone combined with alteplase for patients with acute ischemic stroke: A systematic review and meta-analysis.

Early administration of edaravone for acute ischemic stroke patients (AIS) receiving intravenous thrombolysis (IVT) has a potential neuroprotective effect. This study aimed to estimate the safety and efficacy of edaravone for AIS patients receiving IVT. We searched PubMed, Embase, Cochrane Library and Chinese Databases (CNKI database, Weipu database, and Wanfang database) for randomized controlled trials (RCT) from the inception of the database to 20 July 2020. Efficacy outcome was reduced National Institutes of Health Stroke Scale (NIHSS) score before and after treatment. Safety outcomes were intracranial hemorrhage (ICH) and mortality. Review Manager 5.3 and Stata 14.0 was used to perform the meta-analysis. A total of 1877 AIS patients from 17 studies were included, 939 (50.03%) patients received edaravone combined with alteplase treatment. Compared with alteplase alone, combined treatment reduced the NIHSS score (MD=3.95,95% CI 2.92-4.99, I² = 92%) and ICH (OR=0.44,95% CI 0.29-0.66, I² =0%) during hospitalization. There was no significant association between combined treatment and mortality during follow-up (OR=0.43,95% CI 0.13-1.42, I² =0%). Conclusions: Edaravone combined with alteplase seems to be safe and effective for AIS patients' short term outcomes.

Stroke Care in the First Affiliated Hospital of Chengdu Medical College during the COVID-19 Outbreak.

Coronavirus disease-2019 (COVID-19) has become a pandemic disease globally. The First Affiliated Hospital of Chengdu Medical College has adopted telestroke to make stroke care accessible in remote areas. During the period January 2020 to March 2020, there was no COVID-19 case reported in our stroke center. A significant reduction of stroke admission was observed between the ischemic stroke group (235 vs. 588 cases) and the intracerebral hemorrhage group (136 vs. 150 cases) when compared with the same period last year (p < 0.001). The mean door-to-needle time (DNT) and door-to-puncture time (DPT) was 62 and 124 min, respectively. Compared to the same period last year, a significant change was observed in DNT (62 ± 12 vs. 47 ± 8 min, p = 0.019) but not in DPT (124 ± 58 vs. 135 ± 23 min, p = 0.682). A total of 46 telestroke consultations were received from network hospitals. Telestroke management in the central hospital was performed on 17 patients. Of them, 3 (17.6%) patients had brain hernia and died in hospital and 8 (47.1%) patients were able to ambulation at discharge and had a modified Rankin Scale of 0-2 at 3 months. The COVID-19 pandemic impacted stroke care significantly in our hospital, including prehospital and in-hospital settings, resulting in a significant drop in acute ischemic stroke admissions and a delay in DNT. The construction of a telestroke network enabled us to extend health-care resources and make stroke care accessible in remote areas. Stroke education and public awareness should be reinforced during the COVID-19 pandemic.

COVID-19 Prevention and Control Public Health Strategies in Shanghai, China.

CONTEXT: COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States. PROGRAM: Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites. EVALUATION: The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020. DISCUSSION: The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.

[Altered Functional Connectivity in Patients with Transient Ischemic Attack by Resting-state Functional MRI].

OBJECTIVE: To investigate longitudinal changes in functional connectivity during resting-state in patients with transient ischemic attack (TIA). METHODS: 35 patients first suffering TIA in the right hemisphere were recruited, with 35 healthy volunteers were recruited as control. At 1 week and 3 months after TIA attack, functional magnetic resonance imaging (fMRI) scans were performed, then resting-state functional connectivity was assessed and compared with that of healthy subjects. Right inferior prefrontal cortex (iPFC) and its mirror region was used as region of interest (ROI) in this analysis. RESULTS: Compared with controls, higher functional connectivity with the left cerebellum, right superior temporal gyrus (STG) and insula, and lower functional connectivity with the right middle frontal gyrus (MFG) was demonstrated in patients at 1 week after TIA; while decreased functional connectivity in right STG, left insula and bilateral thalamus was shown in patients at 3 month after TIA. Correlation analysis found that functional connectivity of right iPFC with the cerebellum and insula was positively correlated with 2-back reaction time at 1 week after TIA. CONCLUSION: Although the nervous system signs of TIA can be quickly recovered, abnormal activation of working memory-related brain regions will occur for a long time.

Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study.

BACKGROUND: Warfarin therapies not only are used to prevent stroke in patients with high risk of cardioembolism such as patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), but also was associated with lower stroke severity and more favorable functional outcomes in patients with acute ischemic stroke due to middle cerebral artery occlusion. It was speculated that pre-stroke warfarin may promote collateralization and result in reduced stroke severity. This study aimed to investigate the association between pre-stroke warfarin use and leptomeningeal collaterals in patients with acute ischemic stroke due to occlusion of the middle cerebral artery. METHODS: We enrolled consecutive acute ischemic stroke patients (occlusion of the middle cerebral artery within 24 h) with known history of AF and/or RHD at the neurology department of the West China Hospital from May 2011 to April 2017. Computed tomography angiography (CTA) before treatment was used to detect the thrombus. Regional leptomeningeal collateral (rLMC) score based on CTA images was used to assess collateral circulation. Prior use of warfarin was recorded. Univariate and multivariate analyses were performed to detect the association of prior warfarin use with the collateral circulation. RESULTS: A total of 120 patients were included; 29 (24.2%) were taking warfarin before stroke. The international normalized ratio (INR) in patients with prior warfarin use was 1.53 ± 1.00, compared with 1.02 ± 0.09 in patients without prior warfarin use (P < 0.001). Prior oral warfarin therapy was inversely associated with poor rLMC (OR = 0.07, 95%CI 0.01-0.44, P = 0.005). There were no associations between prior warfarin use and initial stroke severity or functional outcomes at 3 months. CONCLUSION: Warfarin use seems improve collateralization in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

[Hyperdense Middle Cerebral Arteries Sign Detected by Multi-mode CT in Acute Ischemic Stroke: A Cohort Study].

OBJECTIVE: To determine the associations between hyperdense middle cerebral arteries sign (HMCAS) and large vessel occlusion (LVO) and clinical outcomes in patients with acute ischemic stoke. METHODS: Patients who were admitted to the Stroke Center of West China Hospital of Sichuan University within 6 h after onset of acute ischemic stroke from July 2015 to July 2017 were included in this study. Logistic regression models were established to determine the value of HMCAS in predicting LVO, hemorrhagic transformation and 90-d functional outcome using the receiver operating characteristic curve. RESULTS: A total of 292 stroke patients were recruited and 50 (17.1%) presented with HMCAS, including 41 (82.0%) with confirmed as LVO. HMCAS had a value of 0.682 in the area under the receiver operating characteristic curve for predicting LVO [odds ratio OR)=8.93, 95% confidence interval CI): 3.72-21.48, P<0.001), better than early CT infarct (0.682 vs. 0.602, P=0.038). HMCAS was also an independent predictor for hemorrhagic transformation OR=5.32, 95%CI: 2.16-13.11, P<0.001) and poor functional recovery OR=3.02, 95%CI: 1.19-7.62, P=0.019). CONCLUSION: HMCAS is a risk factor of large artery occlusion, hemorrhagic transformation, and poor functional recovery in patients with acute ischemic stroke.

Impaired TNF/TNFR2 signaling enhances Th2 and Th17 polarization and aggravates allergic airway inflammation.

CD4+ T-cell differentiation plays an important role in allergic airway diseases. Tumor necrosis factor receptor 2 (TNFR2) has been shown to regulate CD4+ T-lymphocyte differentiation, but its role in allergic airway inflammation is not clear. Here, we investigated the role of TNFR2 in allergic airway inflammation. The mouse model was generated by immunization with ovalbumin and intranasal administration of TNFR2 antibody. Airway inflammation and CD4+ T-cell differentiation were measured in vivo and in vitro. Inhibited TNFR2 signaling aggravated airway inflammation and increased the expression of inflammatory cytokines (IL-4, IL-5, IL-17, and TNF-α) in serum and bronchoalveolar lavage fluid. Impaired TNFR2 signaling promoted Th2 and Th17 polarization but inhibited Th1 and CD4+CD25+ T-cell differentiation in vivo. Furthermore, TNFR2 signaling inhibition promoted Th2 and Th17 polarization in vitro, which may occur through the activation of TNF receptor-associated factor 2 and NF-κB signaling. Therefore, our findings indicate that impaired TNF/TNFR2 signaling enhances Th2 and Th17 polarization and aggravates allergic airway inflammation.

[A Study of Etiology Classification of Minor Stroke Based on TOAST and ASCO Systems].

OBJECTIVES: To investigate the differences in the etiology between minor stroke and non-minor stroke based on TOAST and ASCO systems, and to guide the early intervention for minor stroke. METHODS: We retrospectively analyzed the patients with acute ischemic stroke admitted to our department from July 2012 to July 2014. We sub-typed minor stroke patients and non-minor stroke patients in etiology using Trial of Org 10172 in Acute Stroke Treatment (TOAST) and ASCO (A for atherosclerosis, S for small vessel disease, C for Cardiac source, O for other cause) systems respectively to investigate the difference of etiology between the two groups. RESULTS: We included a total of 406 patients with minor stroke and 651 patients with non-minor stroke. The constituent ratio of TOAST was different (P<0.001) between the two groups. small-artery occlusion (SAO) was the highest cause (40.4%, 164 cases) in minor stroke group, while stroke undertermined etiology (SUE) was the most common (30.9%, 201 cases)in non-minor stroke group. The A1+2 ratio and C1+2 ratio in minor stroke group were lower than those in non-minor stroke group (22.8% vs. 35.4%, P<0.001; 19.3% vs. 32.1%, P<0.001), and the ratio of S1+2 was higher than that in non-minor stroke group (49.8% vs. 27.3%, P<0.001). CONCLUSIONS: The etiology of minor stroke is different to non-minor stroke SAO is the most common cause in minor stroke, while CE and LAA are more common in non-minor stroke.

Effects of home-based exercise interventions on post-stroke depression: A systematic review and network meta-analysis.

BACKGROUND: Post-stroke depression (PSD) is a common and persistent mental disorder that negatively impacts stroke outcomes. Exercise-based interventions have been shown to be an effective non-pharmacological treatment for improving depression in patients with mild stroke, but no reviews have yet synthesized the effects of home-based exercise on PSD. OBJECTIVE: The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare the effectiveness of different types of home-based exercise programs on PSD and identify the optimal home-based exercise modality to inform clinical decision-making for the treatment of PSD. METHODS: PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO were systematically searched from their inception dates to March 7, 2023. We searched for randomized controlled trials (RCTs) of home-based exercise for PSD in adults aged 18 years and older. Only scores of depression retrieved directly post-treatment were included as the primary endpoint for the analysis. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the quality of included studies. We conducted traditional pairwise meta-analysis for direct comparisons using Review Manager 5.4.1, followed by network meta-analysis using Stata 15.1 for both the network evidence plot and analysis. The surface under the cumulative ranking curve (SUCRA) was used to estimate the intervention hierarchy. The protocol was registered with PROSPERO under registration number CRD42022363784. RESULTS: A total of 517 participants from nine RCTs were included. Based on the ranking probabilities, mind-body exercise was the most effective way in improving PSD (SUCRA: 90.4 %, Hedges' g: -0.59, 95 % confidence interval [CI]: -1.16 to -0.02), followed by flexibility/neuro-motor skills training (SUCRA: 42.9 %, Hedges' g: -0.10, 95 % CI: -0.70 to 0.49), and aerobic exercise (SUCRA: 39.3 %, Hedges' g: -0.07, 95 % CI: -0.81 to 0.67). We performed a subgroup analysis of mind-body exercise. In mind-body exercise interventions, Tai Chi was the most effective way to improve PSD (SUCRA: 99.4 %, Hedges' g: -0.94, 95 % CI: -1.28 to -0.61). CONCLUSIONS: Our network meta-analysis that provides evidence with very low certainty indicates potential benefits of home-based exercise for alleviating PSD, with mind-body exercises, notably Tai Chi, showing promise as an effective treatment. However, further rigorous studies are needed to solidify these findings. Specifically, multicenter RCTs comparing specific exercises to no intervention are crucial, assessing not only efficacy but also dose, reach, fidelity, and long-term effects for real-world optimization.

Development of a novel Eu2+ activated oxonitridosilicate cyan phosphor for enhancing the color quality of a violet-chip-based white LED.

Cyan phosphors are urgently needed to fill the cyan gap and improve the spectral continuity of white light-emitting diodes (LEDs) to cater to the high demand for high-quality lighting. Here, a series of new Eu2+-activated La3Si6.5Al1.5N9.5O5.5 (LSANO) cyan phosphors were prepared, and their luminescence properties and color centers were analyzed through fluorescence spectral measurements from 7 K to 475 K. At 300 K, the photoluminescence excitation (PLE) spectrum monitored at 483 nm presents a broadband of 200-460 nm with a peak at 398 nm, matching well with commercial violet LED chips. When excited by 398 nm violet light, the photoluminescence emission (PL) spectrum of LSANO:0.01Eu2+ exhibits a cyan emission band at about 483 nm. At 7 K, the emission spectrum clearly shows an asymmetric emission band and the emission peak wavelength changes from 483 nm (300 K) to 500 nm (7 K), indicating that there are two possible color centers in the LSANO:Eu2+ phosphor. Moreover, the maximum emission value can be adjusted from 480 to 499 nm by adjusting the doping content of Eu2+. Finally, a violet-chip-based white LED with the optimized color quality of Ra = 91.4, Rf = 90.1, and Rg = 93.6 was fabricated by adding the prepared cyan phosphor, verifying the potential application of the prepared cyan phosphor LSANO:Eu2+ in high-quality white LEDs.

Acute ischemic stroke in tuberculous meningitis.

Background: The underlying mechanism for stroke in patients with tuberculous meningitis (TBM) remains unclear. This study aimed to investigate the predictors of acute ischemic stroke (AIS) in TBM and whether AIS mediates the relationship between inflammation markers and functional disability. Methods: TBM patients admitted to five hospitals between January 2011 and December 2021 were consecutively observed. Generalized linear mixed model and subgroup analyses were performed to investigate predictors of AIS in patients with and without vascular risk factors (VAFs). Mediation analyses were performed to explore the potential causal chain in which AIS may mediate the relationship between neuroimaging markers of inflammation and 90-day functional outcomes. Results: A total of 1,353 patients with TBM were included. The percentage rate of AIS within 30 days after admission was 20.4 (95% CI, 18.2-22.6). A multivariate analysis suggested that age ≥35 years (OR = 1.49; 95% CI, 1.06-2.09; P = 0.019), hypertension (OR = 3.56; 95% CI, 2.42-5.24; P < 0.001), diabetes (OR = 1.78; 95% CI, 1.11-2.86; P = 0.016), smoking (OR = 2.88; 95% CI, 1.68-4.95; P < 0.001), definite TBM (OR = 0.19; 95% CI, 0.06-0.42; P < 0.001), disease severity (OR = 2.11; 95% CI, 1.50-2.90; P = 0.056), meningeal enhancement (OR = 1.66; 95% CI, 1.19-2.31; P = 0.002), and hydrocephalus (OR = 2.98; 95% CI, 1.98-4.49; P < 0.001) were associated with AIS. Subgroup analyses indicated that disease severity (P for interaction = 0.003), tuberculoma (P for interaction = 0.008), and meningeal enhancement (P for interaction < 0.001) were significantly different in patients with and without VAFs. Mediation analyses revealed that the proportion of the association between neuroimaging markers of inflammation and functional disability mediated by AIS was 16.98% (95% CI, 7.82-35.12) for meningeal enhancement and 3.39% (95% CI, 1.22-6.91) for hydrocephalus. Conclusion: Neuroimaging markers of inflammation were predictors of AIS in TBM patients. AIS mediates < 20% of the association between inflammation and the functional outcome at 90 days. More attention should be paid to clinical therapies targeting inflammation and hydrocephalus to directly improve functional outcomes.

A Simple Federated Learning-Based Scheme for Security Enhancement Over Internet of Medical Things.

Nowadays, Federated Learning (FL) over Internet of Medical Things (IoMT) devices has become a current research hotspot. As a new architecture, FL can well protect the data privacy of IoMT devices, but the security of neural network model transmission can not be guaranteed. On the other hand, the sizes of current popular neural network models are usually relatively extensive, and how to deploy them on the IoMT devices has become a challenge. One promising approach to these problems is to reduce the network scale by quantizing the parameters of the neural networks, which can greatly improve the security of data transmission and reduce the transmission cost. In the previous literature, the fixed-point quantizer with stochastic rounding has been shown to have better performance than other quantization methods. However, how to design such quantizer to achieve the minimum square quantization error is still unknown. In addition, how to apply this quantizer in the FL framework also needs investigation. To address these questions, in this paper, we propose FedMSQE - Federated Learning with Minimum Square Quantization Error, that achieves the smallest quantization error for each individual client in the FL setting. Through numerical experiments in both single-node and FL scenarios, we prove that our proposed algorithm can achieve higher accuracy and lower quantization error than other quantization methods.

Mobile APP-assisted family physician program for improving blood pressure outcome in hypertensive patients.

BACKGROUND: This study was aimed to examine the effectiveness of App-assisted self-care in a Beijing community based on intelligent family physician-optimised collaborative model (IFOCM) program.  METHODS: We conducted a survey of 12,050 hypertensive patients between Jan 2014 and Dec 2021. Generalized linear model was used to analyze the covariates that associated with blood pressure (BP) control. Decision tree and random forest algorithm was used to extract the important factors of BP outcome. RESULTS: The study included 5937 patients, mean age 66.2 ± 10.8, with hypertension in the baseline; 3108(52.4) were female. The community management resulted in mean systolic BP and diastolic BP reductions of 4.6 mmHg and 3.8 mmHg at follow-up. There were 3661 (61.6%) hypertension patients with BP control, increasing from 55.0% in 2014 to 75.0% in 2021. After adjusted for covariates, antihypertensive medication adherence, diabetes, and APP-assisted self-care were common predictors associated with BP control in GLM model and machine learning algorithm. CONCLUSION: Community management based on IFOCM program significantly improved BP control in hypertensive patients. APP-assisted self-care would be beneficial for the management of chronic disease.