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This study aimed to investigate the association between long-term survival and different management of major aortopulmonary collateral arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries.
From November, 2009 to October, 2018, a total of 98 consecutive patients with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries, and hypoplastic pulmonary arteries treated with modified Blalock–Taussig shunt or right ventricle–pulmonary artery connection were included. Fifty-five patients who received occlusion or ligation of major aortopulmonary collateral arteries during or after palliative procedure were occlusion group, and the other 43 patients were no occlusion group. The early and late outcomes were compared.
The mean duration of follow-up was 30.9 months in no occlusion group and 49.8 months in the occlusion group (p < 0.001). Multivariate analysis showed that only no occlusion of major aortopulmonary collateral arteries was predictive of total mortality (Hazard Ratio: 4.42, 95% CI: 1.27 to 15.42, p = 0.02). The Kaplan–Meier survival curves confirmed that patients without occlusion of major aortopulmonary collateral arteries demonstrated worse survival as compared with the occlusion group (p = 0.013). The Kaplan–Meier survival curves of patients who underwent different palliative procedures showed no differences.
For patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries when a primary repair is not feasible, those without occlusion of major aortopulmonary collateral arteries have a higher risk of death following an initial palliative procedure compared with patients who underwent occlusion of major aortopulmonary collateral arteries. The occlusion of major aortopulmonary collateral arteries is not associated with a higher rate of complete repair or better improvement of pulmonary artery growth.
With the popularization of carbon and nitrogen stable-isotope analysis methods used on archaeological samples from Xinjiang, the ancient paleodiet there has been revealed. However, research about isotopic analysis combined with environmental factors is rare, especially in such a variable and complex climate as that of the Tianshan region. We systematically analyzed the δ13C and δ15N results from animals and humans for dietary reconstruction of nomadic pastoralists from the Tianshan region during 3900–1200 cal BP. The δ13C and δ15N values for animals (sheep/goat, horse and cattle; n = 57) have a wide range from –20.8‰ to –14.7‰ for δ13C (–19.2 ± 1.0‰) and 3.2‰ to 9.9‰ for δ15N (7.0 ± 1.2‰). The δ13C and δ15N values from humans range from –19.6 to –12.3‰ (–16.0 ± 1.5‰) and 7.1 to 16.7‰ (–13.6 ± 1.5‰), respectively. The animal δ15N results indicate that the dry environment in the Tianshan region may result in elevated δ15N values. Synthesizing animal and human isotope results suggests that the inhabitants engaged in mobile herding economies subsidized with crops and wild animal meat from the Tianshan Mountains. In conclusion, we found that the regional environment closely relates to crop types, and temporal climate change has an effect on human dietary structure. Therefore, climate condition cannot be ignored when studying human paleodiet.
The gut microbiota is directly influenced by dietary components, and it plays critical roles in chronic diseases. Excessive consumption of trans-fatty acids (TFA) is associated with obesity induced by alterations in gut microbiota, but the links between obesity and gut microbiota remain unclear. Therefore, studies examining the impact of TFA on intestinal microflora are essential. In our study, we performed 16S ribosomal RNA gene sequencing on faecal samples from Sprague–Dawley rats fed a basal diet (control (CON) group), high-fat (HF) diet (diet-induced obesity (DIO) group) or TFA diets (1 % TFA group and 8 % TFA group) for 8 weeks to investigate the effects of TFA/HF diets on obesity and gut microbiota composition. We found that the TFA/HF diets significantly induced obesity and changes in blood and brain physiological parameters of the rats. The relative abundance of the phyla Firmicutes and Bacteroidetes was inversely altered in the three test groups compared with the CON group. Proteobacteria increased slightly in the DIO, 1 % TFA and 8 % TFA groups. The genus Bacteroides increased in the DIO and 1 % TFA groups, but Muribaculaceae decreased in all experimental groups compared with the CON group. Moreover, significant differences were observed among clusters of orthologous group functional categories of the four dietary groups. Our observations suggested that the TFA/HF diets induced obesity and dysfunction of gut microbiota. Gut dysbiosis might mediate the obesity effects of TFA/HF diets.
This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA).
Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1.
In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36).
This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.
Human African trypanosomiasis (HAT) is caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense and caused devastating epidemics during the 20th century. Due to effective control programs implemented in the last two decades, the number of reported cases has fallen to a historically low level. Although fewer than 977 cases were reported in 2018 in endemic countries, HAT is still a public health problem in endemic regions until it is completely eliminated. In addition, almost 150 confirmed HAT cases were reported in non-endemic countries in the last three decades. The majority of non-endemic HAT cases were reported in Europe, USA and South Africa, due to historical alliances, economic links or geographic proximity to disease-endemic countries. Furthermore, with the implementation of the ‘Belt and Road’ project, sporadic imported HAT cases have been reported in China as a warning sign of tropical diseases prevention. In this paper, we explore and interpret the data on HAT incidence and find no positive correlation between the number of HAT cases from endemic and non-endemic countries. This data will provide useful information for better understanding the imported cases of HAT globally in the post-elimination phase.
Identifying risk factors and mortality of individuals with Alzheimer’s disease (AD) could have important implications for the clinical management of AD.
This pilot study aimed to examine the overall mortality of AD patients over a 10-year surveillance period in Shanghai, China. This study is an extension of our previous investigation on mortality of neurodegenerative diseases.
One hundred and thirty-two AD patients recruited from the memory clinics of two hospitals in Shanghai in 2007 were followed up until December 31, 2017 or death, representing a follow-up period of up to 10 years. Overall standardized mortality ratios (SMRs) were calculated, and predictors for survival at recruitment were estimated.
Sixty-seven patients had died by December 31, 2017, and the SMR at 10 years of follow-up was 1.225 (95% confidence interval 0.944–1.563). Employing Cox’s proportional hazard modeling, lower Mini-Mental State Examination score, and comorbid diabetes predicted poor survival in this cohort.
This pilot study suggests a similar survival trend of patients with AD compared to the general population in Shanghai urban region. Poor cognitive status and comorbid diabetes had a negative impact on the survival of AD patients.
The present study compared the protective effect of sodium selenite (SS) and selenomethionine (SeMet) on heat stress (HS)-invoked porcine IPEC-J2 cellular damage and integrate potential roles of corresponding selenoprotein. Cells were cultured at 37°C until 80 % confluence and then subjected to four different conditions for 24 h: at 37°C (control), 41·5°C (HS), 41·5°C supplied with 0·42 µmol Se/L SS (SS), or SeMet (SeMet). HS significantly decreased cell viability, up-regulated mRNA and protein levels of heat shock protein 70 (HSP70) and down-regulated mRNA and protein levels of tight junction-related proteins (claudin-1 (CLDN-1) and zonula occludens-1 (ZO-1)). HS-induced cell injury was associated with the up-regulation (P < 0·05) of six inflammation-related genes and fourteen selenoprotein encoding genes and down-regulation (P < 0·05) of two inflammation-related genes and five selenoprotein encoding genes. Compared with the HS group, SS and SeMet supplementation resulted in an increase (P < 0·05) in cell viability, decreased (P < 0·05) mRNA expression of HSP70 and six inflammation-related genes and rescue (P < 0·05) of mRNA and protein levels of CLDN-1 and ZO-1. SS and SeMet supplementation changes the expressions of nineteen selenoprotein encoding genes in cells affected by HS. Both Se supplementation significantly recovered the protein level of glutathione peroxidase-1 and increased selenoprotein P in the IPEC-J2 cells under HS, respectively. In summary, Se supplementation alleviated the negative impact of HS on IPEC-J2 cells, and their cellular protective effect was associated with regulation expression of selenoproteins, and SeMet exhibited a better protective effect.
Biochar conversion from corn stover was evaluated under various process conditions, and the absorption capacity of biochar was investigated for the removal of oxytetracycline in wastewater. Biochar was prepared at lower carbonization temperatures (200–500 °C) and was used in three different concentrations of chemical oxygen wastewater. The results showed that the biochar prepared at the temperature range of 200–500 °C had a faster sorption rate and shorter sorption equilibrium time compared to biochar produced at higher temperatures. The longest time to reach sorption equilibrium was 9 h for biochar obtained at 200 °C. However, the biochar prepared at 500 °C required only 0.5 h to reach the sorption equilibrium. The corn stover-biochar had the highest sorption capacity of 246.3 mg/g for oxytetracycline at 30 °C. The adsorption kinetics was consistent with pseudo–second-order kinetics. This study provides a theoretical basis for the conversion of corn stover into biochar as efficient sorbents.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.
Previous studies have inferred a strong genetic component in schizophrenia. However, the genetic variants involved in the susceptibility to schizophrenia remain unclear.
To detect potential gene pathways and networks associated with schizophrenia, and to explore the relationship between common and rare variants in these pathways and abnormal white matter integrity in schizophrenia.
The analysis included 100 first-episode treatment-naïve patients with schizophrenia and 140 healthy controls. A network-based analysis was carried out on the data collected from the Psychiatric Genomics Consortium Phase I (PGC-I). Based on our genome-wide association study and whole-exome sequencing data-sets, we performed a gene-set analysis to detect associations between the combining effects of common and rare genetic variants and abnormal white matter integrity in schizophrenia.
Patients had significantly reduced functional anisotropy in the left and right anterior cingulate cortex, left and right precuneus and extra-nuclear (t = 4.61–5.10, PFDR < 0.01), compared with controls. Generated from co-expression network analysis of the PGC-1 summary statistics of schizophrenia, a subnetwork of 207 genes associated with schizophrenia was identified (P < 0.01), and 176 genes were co-expressed in four gene modules. Functional enrichment analysis for genes in each module revealed that the yellow module was enriched with highly co-expressed, innate immune response genes. Furthermore, rare variants of enriched genes in the yellow module were associated with reduced functional anisotropy in the left anterior cingulate cortex (P = 0.006; Padjusted = 0.024) in patients only.
The pathogenesis of schizophrenia may be substantially influenced by genes involved in the immune system, via both pathway and network.
Nutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing <30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing <30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.
M3:2 high-speed steel (HSS) billets with or without Nb addition were prepared by spray deposition. The effects of Nb and post-thermal-mechanical processing (decomposition treatment and hot forging), as well as heat treatment, on the microstructure and properties of M3:2 HSS were investigated. The microstructure of the as-deposited M3:2 HSS consisted of equiaxed grains with a mean size of approximately 25 μm and discontinuous plate-like M2C and irregular MC carbides distributed along grain boundaries. 0.5% Nb addition can refine the M2C plates and spheroidize MC carbides. With 2% Nb addition, the refined grains with a mean size of approximately 12 μm and continuous net of M6C and a uniform distribution of NbC carbides were obtained. The decomposition of metastable M2C carbides can be accelerated with 0.5% Nb addition due to the refined size and lower thermodynamic stability of M2C plates. With the increased degree of decomposition of M2C carbide, the M6C and MC carbides became refined and more uniformly distributed after optimal thermal-mechanical processing and heat treatment, which leads to a significant increase in bend strength and toughness.
To revise an abbreviated version of the Silhouettes subtest of the Visual Object and Space Perception (VOSP) battery in order to recognize mild cognitive impairment (MCI) and determine the optimal cutoffs to differentiate among cognitively normal controls (NC), MCI, and Alzheimer’s Disease (AD) in the Chinese elderly.
A cross-sectional validation study.
Huashan Hospital, Shanghai, China.
A total of 591 participants: Individuals with MCI (n = 211), AD (n = 139) and NC (n = 241) were recruited from the Memory Clinic, Huashan Hospital, Shanghai, China.
Baseline neuropsychological battery (including VOSP) scores were collected from firsthand data. An abbreviated version of silhouettes test (Silhouettes-A) was revised from the original English version more suitable for the elderly, including eight silhouettes of animals and seven silhouettes of inanimate objects, with a score ranging from 0 to 15.
Silhouettes-A was an effective test to screen MCI in the Chinese elderly with good sensitivity and specificity, similar to the Montreal cognitive assessment and superior to other single tests reflecting language, spatial, or executive function. However, it had no advantage in distinguishing MCI from AD. The corresponding optimal cutoff scores of Silhouettes-A were 10 for screening MCI and 8 for AD.
Silhouettes-A is a quick, simple, sensitive, and dependable cognitive test to distinguish among NC, MCI, and AD patients.
The hot deformation behavior of Ti–6Al–4V alloy with starting fully lamellar microstructure was investigated by conducting isothermal hot compression tests at the temperature of 700–1000 °C and strain rate of 0.001–10 s−1. The deformation activation energy is calculated to be 342 kJ/mol at temperatures from 750 to 850 °C, whereas the higher apparent activation energy of 610 kJ/mol is obtained at a high temperature regime of 900–1000 °C. The relationship between the dynamic softening behavior and deformation parameters was analyzed by power dissipation efficiency η, which shows an increasing trend as the deformation temperature increases and strain rate decreases, respectively. Processing maps were constructed. The instability flow is dominated by the presence of adiabatic shear bands, and the dynamic softening is mainly caused by a combination effect of dynamic recrystallization and dynamic recovery. Moreover, straining is found to have a positive effect on lowering the phase transformation temperature.
Multi-pass warm rolling with falling temperature was proposed and investigated to obtain AZ31 Mg alloy sheets with a fine-grained microstructure. The results indicated that the grain microstructure of AZ31 alloy sheets was successfully refined from 22.1 to 4.5 μm after multi-pass warm rolling with falling temperature and annealing. Compared to the as-received sheet, the multi-pass warm rolled sheets in annealed condition exhibited weaker (0001) basal texture intensity, which resulted in the significantly increased Schmid factor of 〈a〉 basal slip. After multi-pass warm rolling with falling temperature, the rolled sheets in annealed condition also exhibited much better mechanical properties, e.g., higher tensile strength, larger fracture elongation, and higher Erichsen value, especially the IE of 8-pass warm rolled sheet in annealed condition was significantly increased by ∼33% under the same thickness, which could be attributed to the refined grain microstructure and the weakened basal texture.
The animal gut effectively prevents the entry of hazardous substances and microbes while permitting the transfer of nutrients, such as water, electrolytes, vitamins, proteins, lipids, carbohydrates, minerals and microbial metabolites, which are intimately associated with intestinal homoeostasis. The gut maintains biological functions through its nutrient-sensing receptors, including the Ca-sensing receptor (CaSR), which activates a variety of signalling pathways, depending on cellular context. CaSR coordinates food digestion and nutrient absorption, promotes cell proliferation and differentiation, regulates energy metabolism and immune response, stimulates hormone secretion, mitigates secretory diarrhoea and enhances intestinal barrier function. Thus, CaSR is crucial to the maintenance of gut homoeostasis and protection of intestinal health. In this review, we focused on the emerging roles of CaSR in the modulation of intestinal homoeostasis including related underlying mechanisms. By elucidating the relationship between CaSR and animal gut homoeostasis, effective and inexpensive methods for treating intestinal health imbalance through nutritional manipulation can be developed. This article is expected to provide experimental data of the effects of CaSR on animal or human health.
The microstructure evolution and mechanical properties of Mg–10Gd–3Y–xZn–0.6Zr (x = 0.5, 1, and 1.5 wt%) alloys in the as-cast, solution-treated, and peak-aged conditions have been investigated systematically. The results indicate that the microstructure of the as-cast alloy with 0.5% Zn consists of α-Mg, (Mg,Zn)3RE and Mg24(RE,Zn)5 phases, while the alloy with 1.0 and 1.5% Zn consists of α-Mg, (Mg,Zn)3RE and some stacking faults. Moreover, 18R-LPSO phases are observed in the as-cast alloy with 1.5% Zn. The formation of LPSO phases involves not only stacking sequence ordered but also chemical composition ordered. After solution treatment, the Mg24(RE,Zn)5, (Mg,Zn)3RE, stacking faults, and 18R-LPSO phases transform into 14H-LPSO phases. The 14H-LPSO phase plays an important role in the improvement of mechanical properties, especially for the ductility. The β′ phase with a bco structure precipitates in the peak-aged alloys results in precipitation hardening, significantly improving the tensile strength, but it leads to poor ductility.
A coaxial-output rolled strip pulse-forming line (RSPFL) with a dry structure is researched for the purpose of miniaturization and all-solid state of pulse-forming lines (PFL). The coaxial-output RSPFL consists of a coaxial-output electrode (COE) and a rolled strip line (RSL). The COE is characterized by quasi-coaxial structure, making the output pulse propagate along the axial direction with a small output inductance. The RSL is rolled on the COE, whose transmission characteristics are analyzed theoretically. It shows that the RSL can be regarded as a planar strip line when the rolling radius of the strip line is larger than 60 times of the thickness of the insulation dielectric layer of RSL. CST modeling was carried out to simulate the discharging characteristic of the coaxial-output RSPFL. It shows that the coaxial-output RSPFL can deliver a discharging pulse with a rise time <6 ns when the impedance of the RSL matches that of the COE, which confirms the theoretical analysis. A prototype of the coaxial-output RSPFL was developed. A 49-kV discharging pulse on a matched load was achieved when it was charged to 100 kV. The discharging waveform has a pulse width of 32 ns, with a rise time of 6 ns, which is consistent with the simulation waveform. An energy-storage density of 1.9 J/L was realized in the coaxial-output RSPFL. By the method of multi-stage connection in series, a much higher output voltage is convenient to be obtained.