Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China.

Background: Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis. Methods: The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm. Results: Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age. Conclusions: Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.

Laser cooling by over 7†K in Yb-doped ZBLAN fibers with high-power pumping at atmospheric pressure.

Anti-Stokes fluorescence (ASF) cooling has been demonstrated to be a viable method for balancing the waste heat produced in gain materials. In addition, radiation-balanced fiber lasers and amplifiers at atmospheric pressure have recently been developed. Here, we evaluate the cooling characteristics in a long section of a Yb-doped ZBLAN fiber with high pump power. The fiber has a 200-µm-diameter core and is doped with 3 wt. % Yb3+. As indicated by a thermal camera, cooling by over 7 K below ambient temperature was achieved by core pumping at 1030 nm. The temperature drop distribution at multiple measurement points in the fiber was evaluated with a maximum pump power of tens of watts. The results demonstrate the excellent ASF cooling performance of Yb-doped ZBLAN fibers. This study has great significance for the development of high-power radiation-balanced fiber lasers.

Comparative transcriptomic and metabolomic analysis revealed molecular mechanism of two wheat near-isogenic lines response to nitrogen application.

Nitrogen (N) is an essential nutrient element required for plant growth, and the development of wheat varieties with high nitrogen use efficiency (NUE) is an urgent need for sustainable crop production. However, the molecular mechanism of NUE between diverse wheat varieties in response to N application remains unclear. To reveal the possible molecular mechanisms underlying this complex phenomenon, we investigated the transcriptional and metabolic changes of flag leaves of two wheat near-isogenic lines (NILs) differing in NUE under two N fertilizer treatments. Comparative transcriptome analysis indicated that the expression levels of the genes responsible for carbon and nitrogen metabolism were significantly higher in high-NUE wheat. The metabolome comparison revealed that the activity of the tricarboxylic acid (TCA) cycle was enhanced in high-NUE wheat, while reduced in low-NUE wheat after the N fertilizer application. Additionally, amino acid metabolism increased in both wheat NILs but more increased in high-NUE wheat. In summary, more upregulated transcripts and metabolites were identified in high-NUE wheat, and this study provides valuable new insights for improving NUE in wheat.

Low coherence laser pulse amplification theory for rare earth ions doped glass medium.

A new theory for the low coherence laser amplification in rare ions doped glass has been proposed. Based on one-dimensional continuous energy level assumption and independent response assumption, the theory can describe the amplification of low coherence laser pulses with any time scale and any bandwidth. By the new theory, McCumber formula can be obtained, and a complete low coherence optical pulse amplification model in neodymium glass is established. Computation shows that at high fluences, inhomogeneous broadening will severely limit energy extraction of narrowband high coherence laser, therefore the extraction of broadband low coherence laser will exceed that of narrowband high coherence laser. In addition, the portion of long-wave of the output spectrum is slightly larger than that predicted by the homogeneous model. The new theory could be beneficial for the studies of low coherence pulse amplification in rare earth doped medium and other laser mediums.

Fast time-evolving random polarization beam smoothing for laser-driven inertial confinement fusion.

We propose a random polarization smoothing method for low-coherence laser to obtain focal spot with random polarization that evolves rapidly in sub-picosecond timescales. Random polarization smoothing is realized by a half-aperture wave plate with sufficient thickness. The degree of polarization and polarization evolution of the focal spot are studied theoretically. The calculation results show that random polarization smoothing can make the polarization of focal spot evolve rapidly and randomly in time and space. Experimentally, the polarization of the focal spot of low-coherence laser with random polarization smoothing is measured by a single-shot polarimeter. The measurement results show that the degree of polarization of the focal spot is reduced to 0.22 on average, which proves the effectiveness of random polarization smoothing. The random polarization smoothing technique on low-coherence laser is expected to reduce the laser plasmas instability through its multi-dimensional random evolution properties.

Full-aperture random polarization smoothing for a low-coherence laser facility.

Two new random polarization smoothing methods using full-aperture elements are proposed on low-coherence lasers, one using birefringent wedge and one using flat birefringent plate. By designing the crystal axis direction and wedge angle of the birefringent plates, the methods can selectively introduce time delay and spatial displacement, so as to obtain fast random evolution of transient polarization by utilizing low spatiotemporal coherence of the laser focal field. Both methods avoid the near field discontinuity and can be used under high fluence. The method using birefringent wedge can slightly improve focal spot uniformity, and the method using flat birefringent plate can obtain non-polarization with DOP lower than 2%. Theoretical studies show that the resulting focal polarization evolves rapidly on sub-picosecond timescales and rapidly covers the entire Poincaré sphere. The method using birefringent wedge is achieved in experiment. The results show that the degree of polarization of the focal spot is reduced from 1 to 0.27, which proves the effectiveness of the full-aperture random polarization smoothing. The full-aperture random polarization smoothing can generate a focal field very close to unpolarized thermal light, which is expected to suppress the laser plasmas instability.

Epidemiology of concurrent extrapulmonary tuberculosis in inpatients with extrapulmonary tuberculosis lesions in China: a large-scale observational multi-centre investigation.

AIMS: A high proportion of all patients with tuberculosis (TB) present with extrapulmonary TB (EPTB), including concurrent EPTB involving more than one extrapulmonary lesion site. However, previous reports only characterized lesions of single-site EPTB cases. This study aimed to investigate epidemiological characteristics and association rules of concurrent EPTB cases in China. METHODS: An observational multi-centre study of 208,214 patients with EPTB lesions was undertaken in China from January 2011 to December 2017. Multi-variable logistic regression analysis was used to identify associations between gender and concurrent EPTB, and age and concurrent EPTB. Association rules were analysed for significance using the Apriori algorithm. RESULTS: The most common EPTB lesion was tuberculous pleurisy (49.8%), followed by bronchial TB (14.8%) and tuberculous meningitis (7.6%). The most common type of concurrent EPTB was tuberculous pleurisy concurrent with tuberculous peritonitis (1.80%). In total, 22 association rules, including 20 strong association rules, were identified; among these, the highest confidence rates were found for tuberculous myelitis concurrent with tuberculous meningitis, and sacral TB concurrent with lumbar vertebral TB. The association rules of EPTB concurrent with other EPTB types were found to vary with gender and age. The confidence rate of tuberculous myelitis concurrent with tuberculous meningitis was higher in females (83.67%) than males, and was highest in patients aged 25-34 years (87.50%). CONCLUSIONS: Many types of concurrent EPTB were found. Greater awareness of concurrent EPTB disease characteristics is needed to ensure timely clinical diagnosis and treatment of this disease.

Transcriptome Analysis Reveals Different Responsive Patterns to Nitrogen Deficiency in Two Wheat Near-Isogenic Lines Contrasting for Nitrogen Use Efficiency.

The development of crop cultivars with high nitrogen use efficiency (NUE) under low-N fertilizer inputs is imperative for sustainable agriculture. However, there has been little research on the molecular mechanisms underlying enhanced resilience to low N in high-NUE plants. The comparison of the transcriptional responses of genotypes contrasting for NUE will facilitate an understanding of the key molecular mechanism of wheat resilience to low-N stress. In the current study, the RNA sequencing (RNA-seq) technique was employed to investigate the genotypic difference in response to N deficiency between two wheat NILs (1Y, high-NUE, and 1W, low-NUE). In our research, high- and low-NUE wheat NILs showed different patterns of gene expression under N-deficient conditions, and these N-responsive genes were classified into two major classes, including "frontloaded genes" and "relatively upregulated genes". In total, 103 and 45 genes were identified as frontloaded genes in high-NUE and low-NUE wheat, respectively. In summary, our study might provide potential directions for further understanding the molecular mechanism of high-NUE genotypes adapting to low-N stress.

Transcriptome Analysis of Two Near-Isogenic Lines with Different NUE under Normal Nitrogen Conditions in Wheat.

Nitrogen (N) is an essential nutrient element for crop productivity. Unfortunately, the nitrogen use efficiency (NUE) of crop plants gradually decreases with the increase of the N application rate. Nevertheless, little has been known about the molecular mechanisms of differences in NUE among genotypes of wheat. In this study, we used RNA-Sequencing (RNA-Seq) to compare the transcriptome profiling of flag leaves at the stage of anthesis in wheat NILs (1Y, high-NUE, and 1W, low-NUE) under normal nitrogen conditions (300 kg N ha-1, corresponding to 1.6 g N pot-1). We identified 7023 DEGs (4738 upregulated and 2285 downregulated) in the comparison between lines 1Y and 1W. The responses of 1Y and 1W to normal N differed in the transcriptional regulatory mechanisms. Several genes belonging to the GS and GOGAT gene families were upregulated in 1Y compared with 1W, and the enhanced carbon metabolism might lead 1Y to produce more C skeletons, metabolic energy, and reductants for nitrogen metabolism. A subset of transcription factors (TFs) family members, such as ERF, WRKY, NAC, and MYB, were also identified. Collectively, these identified candidate genes provided new information for a further understanding of the genotypic difference in NUE.

Tillage and seeding strategies for wheat optimizing production in harvested rice fields with high soil moisture.

Suitable tillage and seeding strategies for wheat can be used to combat excessive residues and poor soil conditions in harvested rice fields. This study investigated the effects of different tillage (zero tillage and rotary tillage) and seeding methods on wheat growth, grain yield, nitrogen (N) uptake and utilization, and economic benefit when the soil moisture was high during the tillage and seeding practices. In 2016-2017, three seeders were tested: SM1-1, SM2, and SM3; in 2017-2018, four seeders were tested: SM1-2, SM2, SM3, and SM4. Although the soil moisture was different between years, zero tillage could be used to reduce the sowing depth, which facilitated early-phase wheat growth and N uptake compared with rotary tillage, resulting in higher grain yield, NUpE, and net return. In 2016-2017 (high wet soil), a small-size seeder (SM1-1) with sowing near the soil surface facilitated higher grain yield, NUpE, and net returns compared with the other seeders; in 2017-2018 (low wet soil), medium-size seeders (SM3 and SM4) were more suitable than small-size seeders (SM1-2 and SM2). In both years, the seeders that performed the best mainly improved the spike numbers while increasing N uptake, especially after anthesis. Zero tillage lowered input costs, but small-size seeders did not reduce costs due to the higher labor costs associated with their low working efficiency. Improving net returns depends largely on increasing yield. In conclusion, zero tillage is recommended for wheat production in harvested rice fields with a high soil moisture content, but the suitable seeding method needs to be confirmed according to the soil moisture content.

The prevalence and risks of major comorbidities among inpatients with pulmonary tuberculosis in China from a gender and age perspective: a large-scale multicenter observational study.

In clinical practice, PTB patients have concurrent many types of comorbidities such as pneumonia, liver disorder, diabetes mellitus, hematological disorder, and malnutrition. Detecting and treating specific comorbidities and preventing their development are important for PTB patients. However, the prevalence of most comorbid conditions in patients with PTB is not well described. We conducted a large-scale, multicenter, observational study to elucidate and illustrate the prevalence rates of major comorbidities in inpatients at 21 hospitals in China. The 19 specific comorbidities were selected for analysis in this patient cohort, and stratified the inpatient cohort according to age and gender. A total of 355,929 PTB inpatients were included, with a male:female ratio of 1.98 and the proportion of ≥ 65 years PTB inpatients was the most. Approximately 70% of PTB inpatients had at least one defined type of comorbidity. The prevalence of 19 specific comorbidities in inpatients with PTB was analyzed, with pneumonia being the most common comorbidity. The prevalence of most comorbidities was higher in males with PTB except thyroid disorders, mental health disorders, etc. The prevalence of defined most comorbidities in patients with PTB tended to increase with increasing age, although some specific comorbidities tended to increase initially then decrease with increasing age. Our study describes multiple clinically important comorbidities among PTB inpatients, and their prevalence between different gender and age groups. The results will enhance the clinical aptitude of physicians who treat patients with PTB to recognize, diagnose, and treat PTB comorbidities early.

High-power, low-coherence laser driver facility.

We report the first (to the best of our knowledge) high-power, low-coherence Nd:glass laser delivering kilojoule pulses with a coherent time of 249 fs and a bandwidth of 13 nm, achieving the 63%-efficiency second-harmonic conversion of the large-aperture low-coherence pulse and good beam smoothing effect. It provides a new type of laser driver for laser plasma interaction and high energy density physics research.

The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study.

Tuberculosis (TB) remains a serious global public health problem in the present. TB also affects other sites (extrapulmonary tuberculosis, EPTB), and accounts for a significant proportion of tuberculosis cases worldwide. In order to comprehensively understand epidemiology of EBTB in China, and improve early diagnosis and treatment, we conducted a large-scale multi-center observational study to assess the demographic data and the prevalence of common EPTB inpatients, and further evaluate the prevalence of EPTB concurrent with Pulmonary tuberculosis (PTB) and the associations between multiple EPTB types and gender-age group in China. All consecutive age≥15yr inpatients with a confirmed diagnosis of EPTB during the period from January 2011 to December 2017 were included in the study. The descriptive statistical analysis included median and quartile measurements for continuous variables, and frequencies and proportions with 95% confidence intervals (CIs) for categorical variables. Multinomial logistic regression analysis was used to compare the association of multiple EPTB types between age group and gender. The results showed that the proportion of 15-24 years and 25-34 years in EPTB inpatients were the most and the ratio of male: female was 1.51. Approximately 70% of EPTB inpatients were concurrent with PTB or other types of EPTB. The most common of EPTB was tuberculous pleurisy (50.15%), followed by bronchial tuberculosis (14.96%), tuberculous lymphadenitis of the neck (7.24%), tuberculous meningitis (7.23%), etc. It was found that many EPTB inpatients concurrent with PTB. The highest prevalence of EPTB concurrent with PTB was pharyngeal/laryngeal tuberculosis (91.31%), followed by bronchial tuberculosis (89.52%), tuberculosis of hilar lymph nodes (79.52%), tuberculosis of mediastinal lymph nodes (79.13%), intestinal tuberculosis (72.04%), tuberculous pleurisy (65.31%) and tuberculous meningitis (62.64%), etc. The results from EPTB concurrent with PTB suggested that females EPTB inpatients were less likely to be at higher risk of concurrent PTB (aOR = 0.819, 95%CI:0.803-0.835) after adjusted by age. As age increasing, the trend risk of concurrent PTB decreased (aOR = 0.994, 95%CI: 0.989-0.999) after adjusted by gender. Our study demonstrated that the common EPTB were tuberculous pleurisy, bronchial tuberculosis, tuberculous lymphadenitis of the neck, tuberculous meningitis, etc. A majority of patients with pharyngeal/laryngeal tuberculosis, bronchial tuberculosis, tuberculosis of hilar/mediastinal lymph nodes, intestinal tuberculosis, tuberculous pleurisy, tuberculous meningitis, etc. were concurrent with PTB. Female EPTB inpatients were less likely to be at higher risk of concurrent PTB, and as age increasing, the trend risk of concurrent PTB decreased. The clinicians should be alert to the presence of concurrent tuberculosis in EPTB, and all suspected cases of EPTB should be assessed for concomitant PTB to determine whether the case is infectious and to help for early diagnosis and treatment.

Experiment and theory of beam smoothing using induced spatial incoherence with a lens array.

The smoothing effect of induced spatial incoherence combined with a lens array on a large-bandwidth and short-coherence-time laser is reported. A theoretical model based on statistical optics is developed to describe the spatial and temporal characteristics of the focal spot. Theoretical simulation is consistent with the experimental results. A method was proposed to remove or reduce the residual interference fringes of the experimental focal spot, and both the simulation and analysis show that this method does not affect the smoothing speed of the focal spot.

Functionalized ionic liquids based on vegetable oils for rare earth elements recovery.

Functionalized ionic liquids (FILs) based on vegetable oils have been directly synthesized and used for the first time to extract rare earth elements (REEs). Carbon dioxide gas is introduced to successfully strip REE-loaded FILs in the presence of water. The novel extraction process reveals some advantages of accessibility, biocompatibility and sustainability as well as cost efficiency.

Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients.

Aim: It is difficult to treat delayed acetabular fractures due to massive blood loss during operation. Temporary balloon occlusion of the abdominal aorta was introduced into sacral tumor surgery to reduce intraoperative hemorrhage. The aim of this study was to investigate the effect of this method on reduction of intraoperative blood loss and analyze the complications of this technique in the treatment of delayed acetabular fracture. Methods: We retrospectively reviewed 43 patients with delayed acetabular fracture who were surgically treated through combined approaches. Nineteen patients underwent temporary balloon occlusion of the abdominal aorta; 10 patients had type B fracture and 9 patients had type C fracture according to the Müller AO classification. The remaining 24 patients were classified into a control group; 14 patients had type B fracture and 10 patients had type C fracture. Surgical time, intraoperative blood loss, blood transfusion, satisfactory reduction rate, and functional recovery were recorded and compared between two groups. Merle d'Aubigné and Postel scoring was applied to evaluate the patients. Results: The patients treated with intra-aortic balloon occlusion had a shorter surgical time (p = 0.008), less intraoperative blood loss (p = 0.005), and less transfused blood units (p = 0.001). No complications caused by balloon occlusion. No significant difference were observed in the outcomes and the complications related to acetabular fractures between two groups. Conclusions: Temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding for the surgery of delayed acetabular fracture.

High-efficiency second-harmonic generation of low-temporal-coherent light pulse.

The nonlinear frequency conversion of low-temporal-coherent light holds a variety of applications and has attracted considerable interest. However, its physical mechanism remains relatively unexplored, and the conversion efficiency and bandwidth are extremely insufficient. Here, considering the instantaneous broadband characteristics, we establish a model of second-harmonic generation (SHG) of a low-temporal-coherent pulse and reveal its differences from the coherent conditions. It is found that the second-harmonic spectrum distribution is proportional to the self-convolution of that of a fundamental wave. Because of this, we propose a method for realizing low-temporal-coherent SHG with high efficiency and broad bandwidth, and experimentally demonstrate a conversion efficiency up to 70% with a bandwidth of 3.1 THz (2.9 nm centered at 528 nm). To the best of our knowledge, this is the highest efficiency and broadest bandwidth of low-temporal-coherent SHG to date. Our research opens the door for the study of low-coherent nonlinear optical processes.