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简介：AbstractBackground:Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay.Methods:Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis.Results:One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (P = 0.022, OR = 0.981, 95% CI 0.964-0.997) and good Fisher score (P = 0.002, OR = 0.420, 95% CI 0.245-0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004-1.050), poorer Fisher score 3.496 (1.993-6.135), larger aneurysmal size 1.112 (1.017-1.216), and shorter interval between onset to admission 1.845 (1.018-3.344) were independent risk factors of poorer clinical outcome.Conclusion:Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.

简介：“开火的复合真空”和熄灭的水技术在LiFePO4的合成被介绍阴极粉末。样品被加热在真空石英试管封上的预先分解的先锋混合物准备，走水路在sintering温度熄灭跟随。结果显示使用“快熄灭”的处理能成功控制最后的产品的谷物尺寸的增生并且改进它活跃材料的利用比率。样品由这种技术综合了有高可逆的分泌物特定的能力和好周期的电气化学的性能。

简介：Thethermaldiffusioncoefficient,thermalconductivity,andthermalexpansioncoefficientofCuCralloypreparedbyinfiltrationweremeasuredbythermalconstanttesteranddilatometerbeforeandafterhighpressureheattreatment,atthesametime,theeffectofhighpressuretreatmentonthethermalphysicalpropertiesofCuCralloywasdiscussedbytheanalysisofitsmicrostructure.TheexperimentalresultsshowthathighpressureheattreatmentcanincreasethethermaldiffusioncoefficientandthermalconductivityofCuCralloy,butitchangesslightlyinthepressurerangeof1–6GPa.Asforthermalexpansioncoefficient,whenthetemperatureishigherthan130°C,itisobviouslyhigherthanthatofthealloywithouthighpressuretreatmentafter1GPapressuretreatment,andthehigherthetemperatureis,thelargertheirdifferencesare.

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简介：摘要ObjectiveBecause the reliability of repetitive transcranial magnetic stimulation (rTMS) in treating poststroke cognitive impairment has not been convincingly demonstrated, we systematically examined the effectiveness of this regimen with 2 protocols.MethodsWe randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS (n＝11), intermittent theta burst stimulation (iTBS; n＝15) or sham stimulation (n＝15). Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex. We performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Beck Depression Inventory at baseline and after the intervention.ResultsThe 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score (P＝0.006), attention (P＝0.001) and delayed memory (P<0.001). The iTBS group showed significantly greater improvement than the sham group in RBANS total score (P＝0.005) and delayed memory (P＝0.007). The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group (P＝0.016). Patients without comorbid hypertension (P＝0.008) were predisposed to favourable therapeutic outcomes.ConclusionsOur results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition, attention and memory function; the domain of attention was susceptible to 5 Hz modulation. Treatment with 5 Hz rTMS may slow cognitive decline, representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies.

简介：AbstractBackground:Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.Methods:Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.Results:A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).Conclusions:The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

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简介：Surface-treatedMmNi3.55Co0.75Mn0.4Al0.3alloyasnegativeelectrodematerialofnickel-metalhydridebatterywasemployedtoimprovethehigh-ratedischargeability.SurfacetreatmentwasrealizedbydippingandstirringthealloyintoaHClaqueoussolutionwithvariousconcentrationsatroomtemperature.ThemicrostructureofthealloybeforeandaftersurfacetreatmentwasanalyzedbyX-raydiffraction(XRD)andscanningelectronmicroscopy(SEM).Theelectrochemicalpropertiesbeforeandaftersurfacetreatmentwerecompared,andthealloytreatedin0.025mol/LHClsolutionshowedtheoptimalhigh-ratedischargeability.

简介：AbstractPurpose:Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated.1 All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient =-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

简介：β-phase上的超声的处理的效果(Mg17Mg-9.0wt.%Al合金的艾尔12)形态学被学习。结果证明与在Mg-9.0wt.%Al团结期间采用的高紧张的超声的颤动，在营舍的全部生气的节的β-phase显著地被精制并且也变化了从对不连续的形态学连续。球形的β-phase在与高紧张的超声的颤动对待的营舍的团结期间被形成。

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简介：AbstractBackground:High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment.Methods:This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (–9.19% in the ITT analysis, –9.21% in the MITT analysis, and –9.73% in the PP analysis) was greater than the predefined non-inferiority margin of –10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov, NCT04678492.

简介：AbstractImportance:131I-metaiodobenzylguanidine (131I-mIBG) has a significant targeted antitumor effect for neuroblastoma. However, currently there is a paucity of data for the use of 131I-mIBG as a "front-line" therapeutic agent in those patients with newly diagnosed high-risk neuroblastoma as part of the conditioning regimen for myeloablative chemotherapy (MAC).Objective:To evaluate the feasibility of upfront consolidation treatment with 131I-mIBG plus MAC and hematopoietic stem cell transplantation (HSCT) in high-risk neuroblastoma patients.Methods:A retrospective, single-center study was conducted from 2003-2019 on newly diagnosed high-risk neuroblastoma patients without progressive disease (PD) after the completion of induction therapy. They received 131I-mIBG infusion and MAC followed by HSCT.Results:A total of 24 high-risk neuroblastoma patients were enrolled with a median age of 3.0 years at diagnosis. After receiving this sequential consolidation treatment, 3 of 13 patients who were in partial response (PR) before 131I-mIBG treatment achieved either complete response (CR) (n = 1) or very good partial response (VGPR) (n = 2) after HSCT. With a median follow-up duration of 13.0 months after 131I-mIBG therapy, the 5-year event-free survival and overall survival rates estimated were 29% and 38% for the entire cohort, and 53% and 67% for the patients who were in CR/VGPR at the time of 131I-mIBG treatment.Interpretation:Upfront consolidation treatment with 131I-mIBG plus MAC and HSCT is feasible and tolerable in high-risk neuroblastoma patients, however the survival benefit of this 131I-mIBG regimen is only observed in the patients who were in CR/VGPR at the time of 131I-mIBG treatment.

简介：Multiplesclerosis(MS)isachronicautoimmunediseaseofthecentralnervoussystem(CNS)characterizedbycoexistingprocessesofinflammation,demyelination,axonalneurodegeneration,andgliosis.Itisthemostcommondisablingneurologicaldiseaseinyoungadulthood.Althoughautoimmuneinflammationcontributestoaxonalpathology

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简介：一条高效轨道和抓住(T/H)电路设计因为高分辨率的高速度的analog-to-digital变换器(模数转换器)被介绍，它在0.18m互补金属氧化物半导体过程被实现了。一改善自举，切换体积的技术被介绍极大地在宽带宽，和增加上最小化采样网络的非线性一修改预先控告减少全部的电源消费的电路帮助。试验性的结果证明建议T/H电路以100MHz采样率完成超过77dBSFDR(假免费的动态范围)和70dBTHD(全部的泛音失真)并且当消费47mW电源时，与输入频率维持性能直到305MHz。

简介：AbstractObjective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome. The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index (BMI) undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), compared to the long protocol (LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching (PSM). Patients were divided into two groups: modified ultra-LP (MULP) (n = 1,960) and LP (n = 1,960).Results:In the MULP group, live birth rate (52.65% vs. 46.79%, P < 0.001, odds ratio [OR]: 1.784, 95% confidence interval [CI]: 1.563-2.036), clinical pregnancy rate (62.50% vs. 57.91%, P = 0.003, OR: 1.211, 95% CI: 1.066-1.377), and implantation rate (53.24% vs. 49.65%, P = 0.004, OR: 1.155, 95% CI: 1.048-1.272) were statistically significantly higher than those of the LP group. Moreover, the cycle cancellation rates (12.70% vs. 15.15%, P = 0.027, OR: 0.815, 95% CI: 0.68-0.977), abortion rates (12% vs. 14.8%, P = 0.046, OR: 0.785, 95% CI: 0.619-0.996), and ectopic pregnancy rates (1.06% vs. 2.11%, P = 0.04, OR: 0.497, 95% CI: 0.252-0.98) were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment, providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.

简介：AbstractInterleukins (ILs) and associated cytokines serve as the means of communication for immune cells and non-immune cells. The use of ILs in harnessing the immune system to cancer treatment has been a promising approach. ILs not only nurture an environment enabling cancer growth but also simultaneously trigger a productive tumor-directed immune response. These properties of ILs are increasingly being explored as a strategy to improve the outcomes of cancer. Here, we describe recently innovative technological approaches that have been developed to improve the pharmacokinetics, safety, and efficacies of IL-2, 15, 10, and 18 in the treatment of melanoma. Furthermore, the combination of ILs and immune checkpoint inhibition may synergize to reshape the tumor environment, thus yielding better clinical benefits in the future.