Impact of Endoscopic Surgery Versus Robot CAS-R-2 Assisted with Stereotactic Drainage on Prognosis of Basal Ganglia Hypertensive Intracerebral Hemorrhage.

OBJECTIVE: To evaluate the impact of endoscopic surgery (ES) versus robot CAS-R-2 assisted with stereotactic drainage on prognosis of basal ganglia hypertensive intracerebral hemorrhage (HICH). METHODS: This retrospective observational study included patients who underwent ES or robot CAS-R-2 assisted with stereotactic drainage for basal ganglia HICH in Shanghai Sixth People's Hospital between June 2017 and May 2022. The outcomes were 6-month mortality and modified Rankin Scale (mRS) score. RESULTS: A total of 94 patients were included; 68 (age 51.26 ± 9.18 years, 17 women) of them underwent ES, while the other 26 (age 56.50 ± 12.91, 11 women) underwent robot CAS-R-2. The 6-month mortality rates were similar (P > 0.05) between the patients who underwent ES (6 of 68, 8.82%) and robot CAS-R-2 (2 of 26,7.69%), while the rate of good prognosis in the ES group was significantly higher compared with that in the robot CAS-R-2 group (P = 0.024). Univariate logistic analysis found that endoscopic surgery, age, and hematoma volume were associated with poor prognosis at 6 months. Multivariate logistic regression analysis showed that, after adjusted for the preoperative hematoma volume and age, endoscopy surgery (relative risk 0.21, 95% CI 0.06-0.68, P = 0.009) was associated with good prognosis at 6 months follow-up. CONCLUSIONS: Compared with robot CAS-R-2 assisted with stereotactic drainage, ES might have higher rate of good prognosis at 6-month follow-up for basal ganglia HICH.

Multi-band DFT-S 100 Gb/s 32 QAM-DMT transmission in intra-DCI using 10 G-class EML and low-resolution DAC.

In this paper, 100 Gb/s/λ 32 quadrature amplitude modulation discrete multi-tone (QAM-DMT) transmission using 10 G-class electro-absorption modulated laser (EML) and 4/5-bit digital-to-analog converters (DACs) are experimentally demonstrated to meet the requirement of intra-datacenter interconnection (intra-DCI). Unequal length multi-band (ULM) discrete Fourier transform spread (DFT-S) precoding is investigated to alleviate the distortion induced by the high peak-to-average power ratio (PAPR) of DMT. The results show that the required computational complexity of ULM DFT-S precoding with 2-bands (k1=256, k2=64) decreases sharply compared to the traditional DFT-S technique with only about 0.5 dB receiver sensitivity penalty. In addition, compared to the equal length multi-band (ELM) DFT-S precoding, the ULM DFT-S precoding can bring about 2.5 dB receiver sensitivity improvement with slight added computational complexity. With the assistance of ULM DFT-S precoding and noise shaping (NS) technique, the bit-error ratio (BER) of 100 Gb/s 32 QAM-DMT signal generated by 5-bit DAC over 2-km single-mode fiber (SMF) transmission can reach the hard-decision forward error correction (HD-FEC) threshold with received optical power (ROP) of -6.5 dBm, with only additional 39.9% multiplier and 33.7% adder.

Decision region partition aided MLSE for O-band 65-Gbaud PAM-4 system over 40-km transmission with a severe bandwidth constraint.

Maximum likelihood sequence estimation (MLSE) is an optimal solution to realize sequence detection in the digital signal processing (DSP) of short reach O-band intensity modulation/direct detection (IM/DD) systems with bandwidth limitation. However, traditional MLSE requires relatively high computational complexity for short reach optical interconnect. Although the computational complexity of single-symbol sequence detection is quite low, the capability of combating with the inter symbol interference (ISI) is inadequate. To combine the low computational complexity of single-symbol sequence detection with the high reliability of multi-symbol sequence detection in MLSE, decision region partition aided MLSE (DRP-MLSE) is proposed and verified with 60-Gbaud and 65-Gbaud PAM-4 IM/DD systems over 40-km single-mode fiber (SMF) transmission. The experimental results show that the DRP-MLSE can realize similar performance of conventional MLSE with negligible penalty and significantly lower computational complexity.

Demonstration of 100-Gbit/s 32-QAM signal transmission in a radio-over-fiber system with 2-bit DAC.

In this Letter, a low-cost radio-over-fiber (RoF) system at the Ka band based on a low-resolution digital-to-analog converter (DAC) is proposed and investigated. The noise shaping (NS) technique is adopted to suppress the in-band quantization noise induced by the low-resolution DAC. To evaluate the performance of the proposed RoF system, the transmission of a 80/100-Gbit/s dual-polarization 16/32-QAM signal over 20-km single-mode fiber (SMF) and 1-m 2 × 2 multi-in multi-out (MIMO) wireless link coupled with a 2/3/4-bit DAC is experimentally demonstrated. The results show that the bit error rate (BER) of the signal generated by the 2-bit DAC can be effectively reduced by more than one order of magnitude when noise shaping is applied.

Prognosis of hospital-acquired pneumonia/ventilator-associated pneumonia with Stenotrophomonas maltophilia versus Klebsiella pneumoniae in intensive care unit: A retrospective cohort study.

INTRODUCTION: We collected data on ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) induced by Stenotrophomonas maltophilia (SM) and Klebsiella pneumoniae (KP) and compared differences between two bacteria in mortality, duration of ventilator use, length of hospital stay, and risk factors for infection. OBJECTIVES: This study aimed to evaluate the prognosis and to find risk factors of SM-HAP/VAP versus KP-HAP/VAP in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients admitted to the ICU between June 2019 and June 2021 and diagnosed with SM-HAP/VAP or KP-HAP/VAP. The primary outcome was 28-day mortality. RESULTS: Ninety-two HAP/VAP patients (48 with SM-HAP/VAP and 44 with KP-HAP/VAP) were included. The 28-day mortality was 16.7% (8/48 patients) in SM-HAP/VAP and 15.9% (7/44 patients) in KP-HAP/VAP (P = 0.922). After adjustment for potential confounders, the hazard ratios for 28-day mortality in SM-HAP/VAP were 1.3 (95% CI:0.5-3.7), 1.0 (95% CI:0.4-3.0), 1.4 (95% CI:0.5-4.0), and 1.1 (95% CI:0.4-3.4), respectively. CONCLUSION: SM-HAP/VAP and KP-HAP/VAP patients in ICU might have a similar prognosis in mortality, the total duration of the artificial airway and ventilator use, the total length of ICU stay, and hospital stay. The risk factors of SM-HAP/VAP versus KP-HAP/VAP might be the artificial airway, ventilator use, gastric tube placement, acid suppressant and antibiotics (especially carbapenem).

Proteomics and functional study reveal kallikrein-6 enhances communicating hydrocephalus.

BACKGROUND: Communicating hydrocephalus (CH) is a common neurological disorder caused by a blockage of cerebrospinal fluid. In this study, we aimed to explore the potential molecular mechanism underlying CH development. METHODS: Quantitative proteomic analysis was performed to screen the differentially expressed proteins (DEPs) between patients with and without CH. A CH rat model was verified by Hoechst staining, and the co-localization of the target protein and neuron was detected using immunofluorescence staining. Loss-of-function experiments were performed to examine the effect of KLK6 on the synapse structure. RESULTS: A total of 11 DEPs were identified, and kallikrein 6 (KLK6) expression was found to be significantly upregulated in patients with CH compared with that in patients without CH. The CH rat model was successfully constructed, and KLK6 was found to be co-localized with neuronal nuclei in brain tissue. The expression level of IL-1ß, TNF-α, and KLK6 in the CH group was higher than that in the control group. After knockdown of KLK6 expression using small-interfering RNA (siRNA), the expression levels of synapsin-1 and PSD95 in neuronal cells were increased, and the length, number, and structure of synapses were significantly improved. Following siRNA interference KLK6 expression, 5681 differentially expressed genes (DEGs) were identified in transcriptome profile. The upregulated DEGs of Appl2, Nav2, and Nrn1 may be involved in the recovery of synaptic structures after the interference of KLK6 expression. CONCLUSIONS: Collectively, KLK6 participates in the development of CH and might provide a new target for CH treatment.

miR-29a-5p Alleviates Traumatic Brain Injury- (TBI-) Induced Permeability Disruption via Regulating NLRP3 Pathway.

OBJECTIVE: Inactivation of NLRP3 inflammasome plays a role in reducing the permeability of endothelial cells and improving blood-brain barrier (BBB) dysfunction following traumatic brain injury (TBI). However, the mechanism controlling NLRP3 inflammasome activation remains unclear. This study is aimed at defining the role of miR-29a-5p in NLRP3 inflammasome activation and permeability of endothelial cells under TBI. METHODS: The scratch injury model on brain bEnd.3 microvascular endothelial cells was used as in vitro TBI model cells. Effects of miR-29a mimics and inhibitors on TBI model cells were observed by examining their action on FITC, TEER, and protein contents of ZO-1 and occludin, and cell permeability-associated protein. Luciferase reporter assay evaluated miR-29a-5p targeting to NLRP3. ELISA examined of IL-1ß and IL-18 levels. miR-29a-5p mimic was injected into TBI mouse and its effect on BBB, indicated by Evans blue (EB) staining assay and cerebral water content, and NLRP3 activation was examined. RESULTS: miR-29a-3p and miR-29a-5p mimics decrease the concentration of FITC, and increase TEER and the protein contents of ZO-1 and occludin in TBI model cells. miR-29a-5p silencing disrupted the permeability of mouse bEnd.3 cells. miR-29a-5p targets to NLRP3 through the binding on its 3'UTR and negatively regulates its expression in TBI model cells. NLRP3 inhibition and miR-29a-5p silencing together caused significantly decreased FITC concentration and increased TEER value and release of IL-1ß and IL-18. miR-29a-5p mimic alleviated the BBB and cerebral water content and inactivates NLRP3 in the mouse TBI model. CONCLUSIONS: miR-29a-5p mimics protect TBI-induced increased endothelial cell permeability and BBB dysfunction via suppressing NLRP3 expression and activation.

Transmission of a 56 Gbit/s PAM4 signal with low-resolution DAC and pre-equalization only over 80 km fiber in C-band IM/DD systems for optical interconnects.

A low-cost intensity modulation and direct detection scheme using a 4-bit digital-to-analog converter for 56 Gbit/s pre-equalized PAM-4 generation at the transmitter and without receiver side post-equalization over 80 km single-mode fiber transmission in a C-band is experimentally demonstrated in this Letter. Pre-equalization includes pre-emphasis for channel response, a modified Gerchberg-Saxton algorithm with five iterations for chromatic dispersion compensation, and a noise shaping technique implemented by a five-tap finite impulse response filter for quantization noise suppression. Enabled by the pre-equalization techniques, the bit error rate of the received signal without post-equalization can reach the hard-decision forward error correction threshold with -2dBm receiver optical power. The experimental results indicate that our proposed scheme is a promising candidate for the standardization of 400 GbE wavelength division multiplexing-based long-haul distance data center interconnects.

Optical polarization division multiplexing fiber-wireless integration system at Ka-band based on a low-cost dual-drive MZM.

In this paper, a low-cost dual-drive Mach-Zehnder modulator (DDMZM) based 40 Gbit/s polarization division multiplexing (PDM) fiber-wireless-integration system at Ka-band is experimentally demonstrated. Since the DDMZM is biased at the quadrature point for electro-to-optical (E/O) conversion, a high-power direct current (DC)/radio frequency (RF) component will appear within the received signal bandwidth. This high-power component becomes a narrowband interference due to the phase noise of lasers, which will lead to the incorrect convergence of the constant-modulus algorithm (CMA) during equalization at the receiver side. In order to deal with the broadened DC component, twin-single-sideband (twin-SSB) signal with bandwidth interleave and RF-pilot based phase noise compensation scheme are adopted. Enabled by the combination of optical PDM technique and heterodyne coherent detection, a 40 Gbit/s PDM twin-SSB Nyquist-shaped quadrature-phase-shift-keying (QPSK) signal transmitting over 20-km single mode fiber (SMF) and 1-m 2×2 multiple-input multiple-output (MIMO) wireless distance is achieved with the bit error rate (BER) below the hard-decision forward-error-correction (HD-FEC) threshold of 3.8×10-3.

Low cost O-band inter-datacenter interconnect utilizing a 4-bit resolution digital-to-analog converter for PAM-4 signal generation.

In this paper, we experimentally demonstrate the transmission of a 100 Gb/s/λ PAM-4 signal over a 40/80-km single mode fiber (SMF) in the O-band utilizing a 4-bit resolution digital-to-analog converter (DAC) for signal generation. Low resolution DACs are preferred to meet the requirement of low-cost criteria of datacenter interconnects (DCIs). However, large quantization noise introduced by low resolution DACs will deteriorate system performance significantly. Noise shaping (NS) technique is investigated to reduce the quantization noise within the PAM-4 signal band. The experimental results show that the bit error ratio (BER) performance of the signal generated by 4-bit resolution DAC and NS technique will approach that of the signal generated by the 8-bit resolution DAC in the 40/80-km optical fiber transmission system of a 50 Gbaud PAM-4 signal in the O-band, which indicates that our proposed scheme operating in the O-band with a 4-bit resolution DAC and NS technique is a promising candidate for 100 Gbit/s/λ beyond a 40-km Inter-DCI.

Small RNA sequencing reveals microRNAs related to neuropathic pain in rats.

The present study aimed to identify microRNAs (miRNAs) that are involved in neuropathic pain and predict their corresponding roles in the pathogenesis and development process of neuropathic pain. The rat model of neuropathic pain caused by spared nerve injury (SNI) was established in Sprague-Dawley male rats, followed by small RNA sequencing of the L3-L6 dorsal root ganglion. Real-time PCR was performed to validate the differently expressed miRNAs. Functional verification was performed by intrathecally injecting the animals with miRNA agomir. A total of 72 differentially expressed miRNAs were identified in the SNI rats, including 33 upregulated and 39 downregulated miRNAs. The results of qPCR further verified the expression levels of rno-miR-6215 (P=0.015), rno-miR-1224 (P=0.030), rno-miR-1249 (P=0.038), and rno-miR-488-3p (P=0.048), which were all significantly downregulated in the SNI rats compared to the control ones. The majority of differentially expressed miRNAs were associated with phosphorylation, intracellular signal transduction, and cell death. Target prediction, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses suggested that these differentially expressed miRNAs targeted genes that are related to axon guidance, focal adhesion, and Ras and Wnt signaling pathways. Moreover, miR-1224 agomir significantly alleviated SNI-induced neuropathic pain. The current findings provide new insights into the role of miRNAs in the pathogenesis of neuropathic pain.

Optical I/Q modulation utilizing dual-drive MZM for fiber-wireless integration system at Ka-band.

In this Letter, a fiber-wireless integration system at Ka-band adopting heterodyne coherent detection is proposed and experimentally demonstrated. Optical I/Q up-conversion is realized with a low-cost dual-drive Mach-Zehnder modulator (DD-MZM) instead of the traditional I/Q nested MZM. To avoid non-convergence during constant-modulus-algorithm-based equalization, DC elimination is applied to suppress the ultra-high peak in the frequency domain after frequency down-conversion and symbol-phase-average-processing-based coarse phase noise estimation. Using DD-MZM for optical I/Q modulation, transmission, and reception of single polarization, 20-Gbit/s quadrature phase shift keying (QPSK) over 40-km single-mode fiber (SMF) and 5-m free space at Ka-band is demonstrated.

Computational complexity comparison of single-carrier DMT and conventional DMT in data center interconnect.

High peak-to-average power ratio (PAPR) is an inherent defect in intensity modulation and direct detection (IM/DD) discrete-multitone (DMT) system, which will cause serious signal nonlinear distortion over fiber transmission. Single carrier-DMT (SC-DMT), which also refers to the discrete-Fourier-transform spread DMT (DFT-spread DMT), is a promising technology for DMT signal PAPR reduction, but higher computational complexity is required due to the additional DFT/IDFT operations in transceiver. In this paper, we experimentally compare the performance of SC-DMT and conventional DMT (CDMT) signal when the computational complexity of SC-DMT transceiver is lower than CDMT by reducing the FFT size in SC-DMT. The results show that the receiver sensitivity of 20 GHz 1024-point FFT based SC-DMT improves by 0.7 dB than 8192-point FFT based CDMT for both 120 Gb/s 64QAM-DMT and 140 Gb/s 128QAM-DMT signal transmission over 2-km single mode fiber (SMF) at the BER of 3.8 × 10-3 and 2.0 × 10-2, respectively. It is the first time to find that the SC-DMT with lower transceiver computational complexity outperforms CDMT. In addition, fast-Hartley-transform (FHT) technique is employed to replace FFT for further transceiver computational complexity reduction. The results give out that FHT-based SC-DMT shows the same BER performance with FFT-based SC-DMT, while the computational complexity of the transceiver can be reduced by half.

LDPC-coded DFT-Spread DMT signal transmission employing probabilistic shaping 16/32QAM for optical interconnection.

The generation and transmission of a 150-Gb/s discrete-Fourier-transform spread (DFT-spread) probabilistic shaping (PS) 16QAM discrete multi-tone (DMT) signal with low-density parity-check (LDPC)-coded modulation for optical interconnection are proposed and experimentally demonstrated for the first time. The PS-16QAM symbols are reshaped from 32-QAM symbols based on the near-Gaussian distribution. The maximal shaping gain of around 0.5 dB is obtained for the PS-16QAM compared with the traditional unshaped one. Compared with the standard 16QAM, the proposed PS-16QAM DMT signal shows superior receiver sensitivity to provide abundant system loss budget for leveraging the legacy. Jointly iterative decoding algorithms based LDPC is utilized for PS de-mapping and inherent overlapped symbols identification in PS. In addition, the joint applications of DFT-spread and PS techniques can significantly improve received power sensitivity (RPS).

Systematic analysis and identification of unexpected interactions from the neuroprotein drug interactome in hydrocephalus pharmacological intervention.

Hydrocephalus is a neurological condition caused by an abnormal accumulation of cerebrospinal fluid; pharmacological intervention of the disease has been found to elicit a variety of adverse drug reactions (ADRs) in central nervous system (CNS) by unexpectedly targeting certain functional neuroproteins. Here, a systematic neuroprotein drug interactome (SNDI) is created for 11 hydrocephalus drugs/metabolites plus 20 control drugs across 518 druggable pockets on the surface of 472 CNS neuroproteins via a large-scale molecular docking approach. Heuristic clustering analysis of the SNDI profile divides the 31 investigated drug ligands into a distinct panel and a background panel; the former consists of two hydrocephalus drugs (Furosemide and Triamterene) and their respective metabolites (Furosemide glucuronide and Hydroxytriamterene) that are inferred to have generally high affinity towards the whole array of neuroprotein pockets. A total of 13 neuroproteins are enriched in gene ontology semantic mining as putative unexpected targets of the distinct panel, and their intermolecular interactions with hydrocephalus drugs/metabolites are investigated in detail using dynamics simulation and energetics analysis. We also perform kinase assay and viability test to substantiate the interactome analysis. It is found that the Furosemide and Triamterene have significant cytotoxic effects on normal human astrocytes, in which the Triamterene can inhibit the neurokinase ROCK2, a representative of putative unexpected targets, with a high activity, which is comparable with the sophisticated ROCK2 inhibitor Fasudil.

Comparison of null-subcarriers reservation and adaptive notch filter for narrowband interference cancellation in intra-data center interconnect with DMT signal transmission.

In this paper, we experimentally compare the performance of two different narrowband interference suppression schemes in 120 Gb/s intensity modulation and direct detection (IM/DD) system with discrete multi-tone (DMT) signal transmission for intra-data center interconnect (Intra-DCI). Digital pre-equalization and DFT-spread techniques are applied for system bandwidth limitation induced signal distortion compensation and signal peak to average power ratio (PAPR) reduction, respectively. Null-subcarriers reservation (NSR) and adaptive notch filter (ANF) techniques are compared during the suppression of digital-to-analog convertor (DAC) clock leakage induced narrowband interference. 1.2 dB and 1.8 dB DMT receiver sensitivity improvements can be achieved at a bit-error rate of 3.8 × 10-3 in optical back-to-back (OBTB) transmission when optimized NSR and ANF schemes are applied for narrowband interference cancellation, respectively. After 2-km single mode fiber (SMF) transmission, the required received optical power (ROP) of DMT signal with optimized NSR and ANF for narrowband interference cancellation at BER of 3.8 × 10-3 are -6.5 dBm and -7.1 dBm, respectively. Obviously, ANF outperforms NSR scheme in narrowband interference cancellation for DMT system.

Small RNA sequencing reveals microRNAs related to neuropathic pain in rats

The present study aimed to identify microRNAs (miRNAs) that are involved in neuropathic pain and predict their corresponding roles in the pathogenesis and development process of neuropathic pain. The rat model of neuropathic pain caused by spared nerve injury (SNI) was established in Sprague-Dawley male rats, followed by small RNA sequencing of the L3-L6 dorsal root ganglion. Real-time PCR was performed to validate the differently expressed miRNAs. Functional verification was performed by intrathecally injecting the animals with miRNA agomir. A total of 72 differentially expressed miRNAs were identified in the SNI rats, including 33 upregulated and 39 downregulated miRNAs. The results of qPCR further verified the expression levels of rno-miR-6215 (P=0.015), rno-miR-1224 (P=0.030), rno-miR-1249 (P=0.038), and rno-miR-488-3p (P=0.048), which were all significantly downregulated in the SNI rats compared to the control ones. The majority of differentially expressed miRNAs were associated with phosphorylation, intracellular signal transduction, and cell death. Target prediction, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses suggested that these differentially expressed miRNAs targeted genes that are related to axon guidance, focal adhesion, and Ras and Wnt signaling pathways. Moreover, miR-1224 agomir significantly alleviated SNI-induced neuropathic pain. The current findings provide new insights into the role of miRNAs in the pathogenesis of neuropathic pain.

100 Gbit/s PAM4 signal transmission and reception for 2-km interconnect with adaptive notch filter for narrowband interference.

In this paper, we experimentally demonstrate the transmission of 56 Gbaud four-level pulse amplitude modulation (PAM4) signal over 2-km single mode fiber (SMF) with intensity modulation and direct detection (IM/DD) scheme, while the bit-error-ratio (BER) of the PAM4 signal is under hard-decision forward error correction (HD-FEC) threshold of 3.8 × 10-3. Linear pre-equalization is implemented in the transmitter side with a 3-tap finite-impulse-response (FIR) filter to compensate for the intersymbol interference (ISI) induced by system bandwidth limitation. Receiver side equalization is realized with training sequence (TS) based feed-forward equalizer (FFE) with decision-feedback equalizer (DFE). Furthermore, an Adaptive Notch Filter (ANF) is proposed to suppress the digital-to-analog converter (DAC) clock leakage induced narrowband interference for the first time, and the bandwidth of the ANF is optimized to achieve the best BER performance.

Patient experience with outpatient encounters at public hospitals in Shanghai: Examining different aspects of physician services and implications of overcrowding.

BACKGROUND: Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. OBJECTIVE: To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. RESEARCH DESIGN: Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. SUBJECTS: 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. MEASURES: Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. RESULTS: Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. CONCLUSIONS: Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.