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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).
Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.
At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen’s d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36−0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32−0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02−4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27−6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.
Propofol is a intravenous anaesthetic most commonly used in ultrasound oocyte retrieval. We studied if the use of propofol had an effect on mouse oocyte maturation, pregnancy, childbirth and progeny and investigated the correlation between propofol side effects and reproductive performance in mice. There was no statistical difference in mating, pregnancy, childbirth, litter size, the number of stillbirths and survival between each group (P>0.05). Propofol also had no effect on polar body extrusion in oocyte maturation as well as on pronucleus formation and, subsequently, early embryo development (P>0.05). An increased concentration of propofol had no effect on this result, although propofol at more than 0.01 mg/ml reduced polar body extrusion. Different concentrations of propofol had no effect on oocyte culture in vitro, pronucleus formation and early embryo development.
The characteristics and mechanism for unsteady shock train motions were experimentally studied in a constant-area rectangular duct. High-speed Schlieren techniques and high-frequency pressure measurements were utilized in this research. The results show that the shock train undergoes periodical motions in response to downstream periodical excitations. The mechanism for unsteady shock train motions is that the shock train keeps changing its moving speed to change the relative Mach number ahead of shock train to match the varying back-pressure condition. It can be found that the unsteady shock train motion can be predicted well with a theoretical model, which is based on this mechanism. A correlation between the amplitude of shock train motions and some flow parameters was illustrated using an analytical equation, which was confirmed by the experimental results.
This paper investigates the benefits of international cooperation under uncertainty about global warming through a stochastic dynamic game. We analyze the benefits of cooperation both for the case of symmetric and asymmetric players. It is shown that the players’ combined expected payoffs decrease as climate uncertainty becomes larger, whether or not they cooperate. However, the benefits from cooperation increase with climate uncertainty. In other words, it is more important to cooperate when facing higher uncertainty. At the same time, more transfers will be needed to ensure stable cooperation among asymmetric players.
In this paper, we introduce a lower extremity exoskeleton CUHK-EXO that is developed to help paraplegic patients, who have lost the motor and sensory functions of their lower limbs to perform basic daily life motions. Since the sit-to-stand and stand-to-sit (STS) motion is the first step for paraplegic patients toward walking, analysis of the exoskeleton's applicability to the STS motion assistance is performed. First, the human-exoskeleton system (HES) is modeled as a five-link model during the STS motion, and the center of pressure (COP) on the ground and center of gravity of the whole system are calculated. Then, a description of the CUHK-EXO hardware design is presented, including the mechatronics design and actuator selection. The COP position is an important factor indicating system balance and wearer's comfort. Based on the COP position, a trajectory online modification algorithm (TOMA) is proposed for CUHK-EXO to counteract disturbances, stabilize system balance, and improve the wearer's comfort in the STS motion. The results of STS motion tests conducted with a paraplegic patient demonstrate that CUHK-EXO can provide a normal reference pattern and proper assistive torque to support the patient's STS motion. In addition, a pilot study is conducted with a healthy subject to verify the effectiveness of the proposed TOMA under external disturbances before future clinical trials. The testing results verify that CUHK-EXO can counteract disturbances, and help the wearer perform the STS motion safely and comfortably.
The Datong pluton, the largest early Palaeozoic granitoid in the Western Kunlun Orogenic Belt (WKOB) in NW China, is a typical appinite-granite complex. It consists of diorites, quartz diorites, monzodiorites, quartz monzodiorites, monzonites, quartz monzonites, syenites, granodiorites and monzogranites. Laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) zircon U–Pb dating yielded crystallization ages of 459 ± 3 Ma for the quartz monzonites and 452 ± 5 Ma for the monzogranites (Late Ordovician). The rocks possess a wide range of SiO2 (56.0–73.4 wt %), MgO (0.17–4.55 wt %) and Mg no. (25–60), with high K2O (2.83–5.29 wt %) contents, exhibiting high-K calc-alkaline to shoshonitic traits. They are characterized by enrichments in large-ion lithophile elements (LILEs) and light rare Earth elements (LREEs), as well as depletions in high-field-strength elements (HFSEs). The rocks have initial 87Sr/86Sr ratios of 0.7086–0.7185, negative εNd(t) values of –3.72 to –1.79 and εHf(t) values vary from –1.6 to +4.7. These features are modelled to show that they were most likely derived from an enriched lithospheric mantle source and that fractional crystallization with minor crustal contamination was involved in their petrogenetic process. Considering the distribution and chronology of the Palaeozoic intrusions – such as Kegang, Bulong, Qiukesu, Yierba, North Kudi, Dongbake, Buya, Ayilixi and Warengzilafu granitoid plutons with ages of c. 420–530 Ma – in conjunction with the Palaeozoic metamorphic overprinting in the WKOB, we propose a divergent double-subduction model to explain the destruction of the Proto-Tethys Ocean and suggest that the Datong pluton was likely emplaced in a post-collisional setting following the termination of subduction in response to slab break-off.
Non-biomineralizing Ediacaran macrofossils are rare in carbonate facies, but they offer valuable information about their three-dimensional internal anatomy and can broaden our view about their taphonomy and palaeoecology. In this study, we report a new Ediacaran fossil, Curviacus ediacaranus new genus and species, from bituminous limestone of the Shibantan Member of the Dengying Formation in the Yangtze Gorges area of South China. Curviacus is reconstructed as a benthic modular organism consisting of serially arranged and crescent-shaped chambers. The chambers are confined by chamber walls that are replicated by calcispars, and are filled by micritic sediments. Such modular body construction is broadly similar to the co-occurring Yangtziramulus zhangii and other Ediacaran modular fossils, such as Palaeopascichnus. The preservation style of Curviacus is similar to Yangtziramulus, although the phylogenetic affinities of both genera remain unresolved. The new fossil adds to the diversity of Ediacaran modular organisms.
Using eight rounds of household survey data that span two decades, this paper analyzes the determinants of household fuel choice in urban China. Using the correlated random effects generalized ordered probit model, the authors find that household fuel choice in urban China is related to fuel prices, households’ economic status and size and household head's gender and education. The results suggest that policies and interventions that increase households’ income, reduce the price advantage of dirty fuels (e.g., taxing coal) and empower women in the household are of great significance in encouraging the use of clean energy sources.
An effective multiplex real-time polymerase chain reaction (PCR) assay for the simultaneous detection of three major pathogens, Nosema bombycis Nägeli (Microsporidia: Nosematidae), Bombyx mori nucleopolyhedrovirus (Baculoviridae: genus Alphabaculovirus) (NPV), and Bombyx mori densovirus (Parvoviridae: genus Iteravirus) (DNV), in silkworms (Bombyx mori (Linnaeus); Lepidoptera: Bombycidae) was developed in this study. Polymerase chain reaction and real-time PCR tests and basic local alignment search tool searches revealed that the primers and probes used in this study had high specificities for their target species. The ability of each primer/probe set to detect pure pathogen DNA was determined using a plasmid dilution panel, in which under optimal conditions the multiplex real-time PCR assay showed high efficiency in the detection of three mixed target plasmids with a detection limit of 8.5×103 copies for N. bombycis and Bombyx mori NPV (BmNPV) and 8.5×104 copies for Bombyx mori DNV (BmDNV). When the ability to detect these three pathogens was examined in artificially inoculated silkworms, our method presented a number of advantages over traditional microscopy, including specificity, sensitivity, and high-throughput capabilities. Under the optimal volume ratio for the three primer/probe sets (3:2:2=N. bombycis:BmNPV:BmDNV), the multiplex real-time PCR assay showed early detection of BmNPV and BmDNV by day 1 post inoculation using DNA templates of the three pathogens in various combinations from individually infected silkworms; the early detection of N. bombycis was possible by day 3 post inoculation using the DNA isolated from the midgut of N. bombycis-infected silkworms.
Gamma-ray observations for Supernova remnant (SNR)-molecular cloud (MC) association systems play an important role in the research on the acceleration and propagation of cosmic-ray protons. Through the analysis of 5.6 years of Fermi-Large Area Telescope observation data, here we report on the detection of a gamma-ray emission source near the SNR Kesteven 41 with a significance of 24σ in 0.2–300 GeV. The best-fit location of the gamma-ray source is consistent with the MC with which the SNR interacts. Several hypotheses including both leptonic and hadronic scenarios are considered to investigate the origin of these gamma-rays. The gamma-ray emission can be naturally explained by the decay of neutral pions produced via the collision between high energy protons accelerated by the shock of Kesteven 41 and the adjacent MC. The electron energy budget would be too high for the SNR if the gamma-rays were produced via inverse Compton (IC) scattering off the Cosmic Microwave Background (CMB) photons.
To evaluate the effects of different anthropogenic activities on zooplankton and the pelagic ecosystem, we conducted seasonal cruises in 2010 to assess spatial heterogeneity among the mesozooplankton communities of Xiangshan Bay, a subtropical semi-enclosed bay in China. The evaluation included five different areas: a kelp farm, an oyster farm, a fish farm, the thermal discharge area of a power plant, and an artificial reef, and we aimed to identify whether anthropogenic activities dominated spatial variation in the mesozooplankton communities. The results demonstrated clear spatial heterogeneity among the mesozooplankton communities of the studied areas, dominantly driven by natural hydrographic properties, except in the area near the thermal discharge outlet of the power station. In the outlet area, thermal shock caused by the discharge influenced the mesozooplankton community by decreasing abundance and biomass throughout the four seasons, even causing a shift in the dominant species near the outlet during summer from Acartia pacifica to eurythermal and warm water taxa. Unique features of the mesozooplankton community in the oyster farm may be due to the combined effects of oyster culture and the natural environment in the branch harbour. However, kelp and fish culture, and the construction of an artificial reef did not exert any obvious influence on the mesozooplankton communities up to 2010, probably because of the small scale of the aquaculture and a time lag in the rehabilitation effects of the artificial reef. Thus, our results suggested that the dominant factors influencing spatial variations of mesozooplankton communities in Xiangshan Bay were still the natural hydrographic properties, but the thermal discharge was an anthropogenic activity that changed the pelagic ecosystem, and should be supervised.
The present study aimed to explore the associations between food away-from-home (FAFH) consumption and body weight outcomes among Chinese adults.
FAFH was defined as food prepared at restaurants and the percentage of energy from FAFH was calculated. Measured BMI and waist circumference (WC) were used as body weight outcomes. Quantile regression models for BMI and WC were performed separately by gender.
Information on demographic, socio-economic, diet and health parameters at individual, household and community levels was collected in twelve provinces of China.
A cross-sectional sample of 7738 non-pregnant individuals aged 18–60 years from the China Health and Nutrition Survey 2011 was analysed.
For males, quantile regression models showed that percentage of energy from FAFH was associated with an increase in BMI of 0·01, 0·01, 0·01, 0·02, 0·02 and 0·03 kg/m2 at the 5th, 25th, 50th, 75th, 90th and 95th quantile, and an increase in WC of 0·04, 0·06, 0·06, 0·04, 0·06, 0·05 and 0·07 cm at the 5th, 10th, 25th, 50th, 75th, 90th and 95th quantile. For females, percentage of energy from FAFH was associated with 0·01, 0·01, 0·01 and 0·02 kg/m2 increase in BMI at the 10th, 25th, 90th and 95th quantile, and with 0·05, 0·04, 0·03 and 0·03 cm increase in WC at the 5th, 10th, 25th and 75th quantile.
Our findings suggest that FAFH consumption is relatively more important for BMI and WC among males rather than females in China. Public health initiatives are needed to encourage Chinese adults to make healthy food choices when eating out.
To investigate the potential influence of dietary Se intake on mortality among Chinese populations.
We prospectively evaluated all-cause, CVD and cancer mortality risks associated with dietary Se intake in participants of the Shanghai Women’s Health Study (SWHS) and the Shanghai Men’s Health study (SMHS). Dietary Se intake was assessed by validated FFQ during in-person interviews. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95 % CI.
Urban city in China.
Chinese adults (n 133 957).
During an average follow-up of 13·90 years in the SWHS and 8·37 years in the SMHS, 5749 women and 4217 men died. The mean estimated dietary Se intake was 45·48 μg/d for women and 51·34 μg/d for men, respectively. Dietary Se intake was inversely associated with all-cause mortality and CVD mortality in both women and men, with respective HR for the highest compared with the lowest quintile being 0·79 (95 % CI 0·71, 0·88; Ptrend<0·0001) and 0·80 (95 % CI 0·66, 0·98; Ptrend=0·0268) for women, and 0·79 (95 % CI 0·70, 0·89; Ptrend=0·0001) and 0·66 (95 % CI 0·54, 0·82; Ptrend=0·0002) for men. No significant associations were observed for cancer mortality in both women and men. Results were similar in subgroup and sensitivity analyses.
Dietary Se intake was inversely associated with all-cause and cardiovascular mortality in both sexes, but not cancer mortality.
Bipolar disorder is a highly heritable polygenic disorder. Recent
enrichment analyses suggest that there may be true risk variants for
bipolar disorder in the expression quantitative trait loci (eQTL) in the
We sought to assess the impact of eQTL variants on bipolar disorder risk
by combining data from both bipolar disorder genome-wide association
studies (GWAS) and brain eQTL.
To detect single nucleotide polymorphisms (SNPs) that influence
expression levels of genes associated with bipolar disorder, we jointly
analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls)
and a genome-wide brain (cortical) eQTL (193 healthy controls) using a
Bayesian statistical method, with independent follow-up replications. The
identified risk SNP was then further tested for association with
hippocampal volume (n = 5775) and cognitive performance
(n = 342) among healthy individuals.
Integrative analysis revealed a significant association between a brain
eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes
factor = 5.48; bipolar disorder P =
5.85×10–5). Follow-up studies across multiple independent
samples confirmed the association of the risk SNP (rs6088662) with gene
expression and bipolar disorder susceptibility (P =
3.54×10–8). Further exploratory analysis revealed that
rs6088662 is also associated with hippocampal volume and cognitive
performance in healthy individuals.
Our findings suggest that 20q11.22 is likely a risk region for bipolar
disorder; they also highlight the informative value of integrating
functional annotation of genetic variants for gene expression in
advancing our understanding of the biological basis underlying complex
disorders, such as bipolar disorder.
The NASA Kepler satellite has provided unprecedented high duty-cycle, high-precision light curves for a large number of stars by continuously monitoring a field of view in Cygnus-Lyra region, leading to great progress in both discovering exoplanets and characterizing planet-hosting stars by means of asteroseismic methods. The asteroseismic survey allows the investigation of stars covering the whole H-R diagram. However, the low precision of effective temperatures and surface gravities in the KIC catalogue and the lack of information on chemical composition, metallicity and rotation rate prevent asteroseismic modeling, requiring spectroscopic observations for thousands of asteroseismic targets in the Kepler field in a homogeneous way.
To assess correlations between cruciferous vegetable intake and urinary isothiocyanate (ITC) level, in addition to glutathione S-transferase (GST) genotypes and other individual factors.
The study included cohort participants whose urinary ITC levels had been previously ascertained. Urinary ITC was assessed using HPLC. Usual dietary intake of cruciferous vegetables was assessed using a validated FFQ and total dietary ITC intake was calculated. Recent cruciferous vegetable intake was determined. GST genotypes were assessed using duplex real-time quantitative PCR assays. Spearman correlations were calculated between the covariates and urinary ITC levels and linear regression analyses were used to calculate the mean urinary ITC excretion according to GST genotype.
Urban city in China.
The study included 3589 women and 1015 men from the Shanghai Women’s and Men’s Health Studies.
Median urinary ITC level was 1·61 nmol/mg creatinine. Self-reported usual cruciferous vegetable intake was weakly correlated with urinary ITC level (rs=0·1149; P<0·0001), while self-reported recent intake was more strongly correlated with urinary ITC (rs=0·2591; P<0·0001). Overall, the GST genotypes were not associated with urinary ITC level, but significant differences according to genotype were observed among current smokers and participants who provided an afternoon urine sample. Other factors, including previous gastrectomy or gastritis, were also related to urinary ITC level.
The study suggests that urinary secretion of ITC may provide additional information on cruciferous vegetable intake and that GST genotypes are related to urinary ITC level only in some subgroups.
Experimental X-ray powder diffraction data, unit-cell parameters, and space group for levetiracetam, C8H14N2O2, are reported [a = 9.197(5) Å, b = 8.006(0) Å, c = 6.289(3) Å, β = 108.457(3)°, unit-cell volume V = 439.261 Å3, Z = 2, and space group P21]. All measured lines were indexed and are consistent with the P21 space group. No detectable impurity was observed.
The protective effects of fruits and vegetables against CHD have been suggested by many epidemiological studies among Western populations. However, prospective data are lacking for Asian populations. In the present study, we examined the associations of fruit and vegetable intake with CHD incidence among 67 211 women (aged 40–70 years) and 55 474 men (aged 40–74 years) living in Shanghai, China. Food intake was assessed using validated FFQ through in-person interviews. Coronary events (non-fatal myocardial infarction or fatal CHD) were identified by biennial home visits and further confirmed by medical record review. During a mean follow-up period of 9·8 and 5·4 years, 148 events in women and 217 events in men were documented and verified. After adjustment for potential confounders, women in the highest quartile of total fruit and vegetable intake (median 814 g/d) had a hazard ratio (HR) of 0·62 (95 % CI 0·38, 1·02) for CHD (P for trend = 0·04) compared with those in the lowest quartile (median 274 g/d). This association was primarily driven by fruits (HR for the highest v. the lowest intake in women: 0·62, 95 % CI 0·37, 1·03). The strength of the association was attenuated after further controlling for history of diabetes or hypertension. For men, no significant association was found for fruit and vegetable intake when analysed either in combination or individually. The present findings suggest that a high consumption of fruits may reduce CHD risk in Chinese women.
Somatic cell nuclear transfer can be used to produce embryonic stem (ES) cells, cloned animals, and can even increase the population size of endangered animals. However, the application of this technique is limited by the low developmental rate of cloned embryos, a situation that may result from abnormal expression of some zygotic genes. In this study, sheep–sheep intra-species cloned embryos, goat–sheep inter-species cloned embryos, or sheep in vitro fertilized embryos were constructed and cultured in vitro and the developmental ability and expression of three pluripotency genes, SSEA-1, Nanog and Oct4, were examined. The results showed firstly that the developmental ability of in vitro fertilized embryos was significantly higher than that of cloned embryos. In addition, the percentage of intra-species cloned embryos that developed to morula or blastocyst stages was also significantly higher than that of the inter-species cloned embryos. Secondly, all three types of embryos expressed SSEA-1 at the 8-cell and morula stages. At the 8-cell stage, a higher percentage of in vitro fertilized embryos expressed SSEA-1 than occurred for cloned embryos. However, at the morula stage, all detected embryos could express SSEA-1. Thirdly, the three types of embryos expressed Oct4 mRNA at the morula and blastocyst stages, and embryos at the blastocyst stage expressed Nanog mRNA. The rate of expression of Oct4 and Nanog mRNA at these developmental stages was higher in in vitro fertilized embryos than in cloned embryos. These results indicated that, during early development, the failure to reactivate some pluripotency genes maybe is a reason for the low cloning efficiency found with cloned embryos.
There are about 70 Galactic supernova remnants (SNRs) that are now confirmed or suggested to be in physical contact with molecular clouds (MCs) with six kinds of evidence of multiwavelength observations. Recent detailed CO-line spectroscopic mappings of a series of SNRs reveal them to be in cavities of molecular gas, implying the roles the progenitors may have played. We predict a linear correlation between the wind bubble sizes of main-sequence OB stars in a molecular environment and the stellar masses and discuss its implication for supernova progenitors. The molecular environments of SNRs can serve as a good probe for the γ-rays arising from the hadronic interaction of the accelerated protons, and this paper also discusses the γ-ray emission from MCs illuminated by diffusive protons that escape from SNR shocks.