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Isolated congenital tricuspid regurgitation other than Ebstein’s anomaly was rare especially for children. The objective of this study was to investigate the clinical characteristics and to assess the results of tricuspid valvuloplasty for children with isolated tricuspid regurgitation.
From January 2010 to June 2019, 10 consecutive patients with isolated tricuspid regurgitation who were unresponsive to drug therapy underwent tricuspid valvuloplasty in our hospital. Patients’ clinical data were analysed retrospectively.
Mean age at operation was 48.5 ± 31.0 (range: 9–106) months and mean weight at operation was 16.1 ± 6.9 (range: 8.6–33.0) kg. All patients presented severe isolated tricuspid regurgitation. According to pathological lesions, the main causes accounted for chordae tendinea rupture (3/10), leaflet cleft (2/10), mal-connected chordal tendinea to leaflets (2/10), elongated chordae (1/10) and chordae absent (1/10), and severe anterior leaflet dysplasia (1/10). Individualised tricuspid valvuloplasty was adapted to all of them successfully. Post-operative echocardiography showed no tricuspid regurgitation in two patients and mild regurgitation in eight patients. The cardiothoracic ratios on their chest roentgenograms decreased from 0.59 ± 0.05 to 0.54 ± 0.05. At the latest follow-up (50.4 ± 47.2 months), echocardiography showed that mild to moderate tricuspid regurgitation in seven patients, moderate tricuspid regurgitation in three patients, and no patient with severe tricuspid regurgitation. All patients were in NYHA functional class I.
For patients with isolated tricuspid regurgitation who were not well responsive to drug therapy, individualised tricuspid valve repair can achieve an excellent result.
The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)–laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports.
Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients’ clinical samples and environmental samples was analyzed.
All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients’ mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001).
SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.
Antibiotic prescription is a major driver of antibiotic resistance. The majority of antibiotic prescribing occurs in community care settings, often for respiratory infections. A substantial proportion of prescriptions are issued not according to guidelines, particularly for acute respiratory infections which can be self-limiting. Prescribers in these settings need support to prescribe antibiotics more prudently. Patients and the public also need support to manage infections which are self-limiting. This chapter presents a summary of how antimicrobial stewardship (AMS) activities are being used in community settings. Firstly, types of community-level interventions are discussed, including those aimed at clinicians, patients and the public. Next, we assess interventions based on their effectiveness at reducing antibiotic prescriptions or use and their cost-effectiveness. Finally, we discuss directions for future research and consider how the research to date could influence policy.
Several observational studies have investigated the association of insomnia with psychiatric disorders. Such studies yielded mixed results, and whether these associations are causal remains unclear. Thus, we aimed to identify the causal relationships between insomnia and five major psychiatric disorders.
The analysis was implemented with six genome-wide association studies; one for insomnia and five for psychiatric disorders (attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder, schizophrenia, and bipolar disorder). A heterogeneity in dependent instrument (HEIDI) approach was used to remove the pleiotropic instruments, Mendelian randomization (MR)-Egger regression was adopted to test the validity of the screened instruments, and bidirectional generalized summary data-based MR was performed to estimate the causal relationships between insomnia and these major psychiatric disorders.
We observed significant causal effects of insomnia on the risk of autism spectrum disorder and bipolar disorder, with odds ratios of 1.739 (95% confidence interval: 1.217–2.486, p = 0.002) and 1.786 (95% confidence interval: 1.396–2.285, p = 4.02 × 10−6), respectively. There was no convincing evidence of reverse causality for insomnia with these two disorders (p = 0.945 and 0.546, respectively). When insomnia was considered as either the exposure or outcome variable, causal estimates for the remaining three psychiatric disorders were not significant.
Our results suggest a causal role of insomnia in autism spectrum disorder and bipolar disorder. Future disease models should include insomnia as a factor for these two disorders to develop effective interventions. More detailed mechanism studies may also be inspired by this causal inference.
We report new U–Pb isotopic data for detrital zircons from Cambrian–Ordovician strata on the northern margin of the western Yangtze Block, which together with published U–Pb isotopic data for coeval strata in the South China Block, provide critical constraints on the provenance of these sediments and further shed light on the early Palaeozoic position of the South China Block in the context of Gondwana. Detrital zircons in this study yield four major age peaks in the early Palaeoproterozoic, early Neoproterozoic, middle Neoproterozoic and late Neoproterozoic – early Palaeozoic. The dominant age population of 900–700 Ma matches well with magmatic ages from the nearby Panxi–Hannan Belt, which indicates that Cambrian–Ordovician sedimentary rocks in the western Yangtze Block were mainly of local derivation. However, compilations of detrital zircon ages for the Cambrian–Ordovician strata from the Cathaysia Block and the eastern Yangtze Block show that both blocks are dominated by late Mesoproterozoic- and early Neoproterozoic-aged detrital zircons, which suggests a remarkable exotic input with typical Gondwana signatures. According to the integrated detrital zircon age spectra of the Cambrian–Ordovician sedimentary rocks from the entire South China Block and palaeocurrent data, the South China Block should have been linked with North India and Western Australia within East Gondwana. Specifically, the Cathaysia Block was located adjacent to Western Australia, while the Yangtze Block was connected with North India.
The present study was carried out to evaluate the effect of dietary supplementation of Scutellaria baicalensis extracts (SBE) on intestinal health in terms of morphology, barrier integrity and immune responses in weaned piglets challenged with Escherichia coli K88. A total of seventy-two weaned piglets were assigned into two groups to receive a basal diet without including antibiotic additives or the basal diet supplemented 1000 mg SBE/kg diet for 14 d. On day 15, twelve healthy piglets from each group were selected to expose to oral administration of either 10 ml 1 × 109 colony-forming units of E. coli K88 or the vehicle control. After 48 h of E.coli K88 challenge, blood was sampled, and then all piglets were killed humanely for harvesting jejunal and ileal samples. Dietary supplementation of SBE significantly decreased diarrhoea frequency and improved feed conversion ratio (P < 0·05). SBE supplementation to E.coli K88-challenged piglets improved villous height and villous height/crypt depth (P < 0·05), recovered the protein expression of occludin and zonula occludens-2 in both the jejunum and ileum (P < 0·05), and mitigated the increases in plasma IL-1β, TNF-α, IL-6, IgA and IgG (P < 0·05). Meanwhile, dietary SBE effectively inhibited the stimulation of NF-κB, P38 and TNF-α as well as IL-1β in the small intestine of piglets challenged by E. coli K88 and prevented the activation of NF-κB/P38 signalling pathways (P < 0·05). Collectively, SBE supplementation can potently attenuate diarrhoea in weaning piglets and decrease inflammatory cytokine expressions through inhibiting the NF-κB and P38 signalling pathways.
Concerns over food safety in China not only direct public attention to negative
incidents, but also trigger the government's scrutiny of implicated
firms, particularly MNCs. The question of how to repair legitimacy after media
coverage of negative incidents has become a critical issue for MNCs. Although
the factors for MNCs’ public crises have been identified, how local
contexts and mechanisms shape repair approaches remain unclear. To address this
research gap, we conducted a study of Walmart China's approaches
associated with two negative incidents across two regions. We found that the
negative incidents can be framed differently depending on the local
environment's unfavorability for MNCs. Specifically, the negative
framing gave rise to varying degrees of legitimacy loss and offered different
leeway for MNCs to repair their legitimacy. We also identified the varied
outcomes of different repair approaches. By revealing the linkages among local
context, framing, legitimacy repair, and its outcomes, our study contributes to
research on MNCs’ legitimacy management under institutional
complexity and underscores the China context for legitimacy maintenance. We also
offer insights that advance the institutional approach to legitimacy repair in
this context. Last, we reflect on the techniques for conducting qualitative
research in China.
Small luminescent Y2O3:Eu3+ particles were prepared by a hydrothermal method first, and then, Y2O3:Eu3+/C3N4 nanocomposites were further prepared by a chemisorption method. The luminescent Y2O3:Eu3+/C3N4 nanocomposites are not only a promising down-conversion luminescent material, but also it could be used to improve the efficiencies of dye-sensitized solar cells (DSSCs). Especially, the morphology of Y2O3:Eu3+ has great influence on the performance of DSSCs. Compared with Y2O3:Eu3+ nanorods, the introduction of small Y2O3:Eu3+ particles into the cells is conducive to the improvement of cell efficiency. The efficiencies of TiO2-Y2O3:Eu3+–C3N4 composite cells were not only higher than those of pure TiO2 cells but also higher than those of TiO2-Y2O3:Eu3+ or TiO2-C3N4 composite cells, resulting in the enhancement of the average efficiency of the TiO2-Y2O3:Eu3+–C3N4 composite cell from 7.16% to 8.14%, with 14% improvement over the pure TiO2 cell. The enhancement of the efficiency can be attributed to the synergetic effect of small Y2O3:Eu3+ particles and C3N4.
We hypothesize that the tumor necrosis factor-α (TNF-α) may play a role in disturbing the effect of selective serotonin reuptake inhibitor (SSRI) on the striatal connectivity in patients with major depressive disorder (MDD).
We performed a longitudinal observation by combining resting-state functional magnetic resonance imaging (rs-fMRI) and biochemical analyses to identify the abnormal striatal connectivity in MDD patients, and to evaluate the effect of TNF-α level on these abnormal connectivities during SSRI treatment. Eighty-five rs-fMRI scans were collected from 25 MDD patients and 35 healthy controls, and the scans were repeated for all the patients before and after a 6-week SSRI treatment. Whole-brain voxel-wise functional connectivity (FC) was calculated by correlating the rs-fMRI time courses between each voxel and the striatal seeds (i.e. spherical regions placed at the striatums). The level of TNF-α in serum was evaluated by Milliplex assay. Factorial analysis was performed to assess the interaction effects of ‘TNF-α × treatment’ in the regions with between-group FC difference.
Compared with controls, MDD patients showed significantly higher striatal FC in the medial prefrontal cortex (MPFC) and bilateral middle/superior temporal cortices before SSRI treatment (p < 0.001, uncorrected). Moreover, a significant interaction effect of ‘TNF-α × treatment’ was found in MPFC-striatum FC in MDD patients (p = 0.002), and the significance remained after adjusted for age, gender, head motion, and episode of disease.
These findings provide evidence that treatment-related brain connectivity change is dependent on the TNF-α level in MDD patients, and the MPFC-striatum connectivities possibly serve as an important target in the brain.
The overuse of antibiotics and the rapid emergence of antibiotic resistance prompted the launch of an antimicrobial stewardship programme in 2011. This study aimed to investigate the trends and correlations between antibiotic consumption and resistance of Staphylococcus aureus in a tertiary hospital of northwest China from 2010 to 2016. Trends were analysed by linear regression, and correlations were assessed by an autoregressive integrated moving average model. The total consumption of antibiotics halved during the 7-year study period, while the rates of resistance of S. aureus decreased significantly or remained stable; methicillin-resistant S. aureus (MRSA) declined markedly, from 73.3% at the beginning of the study to 41.4% by the end. This latter decrease was significantly correlated with the consumption of several classes of antibiotics. In conclusion, reduction in antibiotic use impacted significantly on resistance rates and contributed to a decline in MRSA prevalence.
Electroconvulsive therapy (ECT), an effective antidepressive treatment, is frequently accompanied by cognitive impairment (predominantly memory), usually transient and self-limited. The hippocampus is a key region involved in memory and emotion processing, and in particular, the anterior-posterior hippocampal subregions has been shown to be associated with emotion and memory. However, less is known about the relationship between hippocampal-subregion alterations following ECT and antidepressant effects or cognitive impairments.
Resting-state functional connectivity (RSFC) based on the seeds of hippocampal subregions were investigated in 45 pre- and post-ECT depressed patients. Structural connectivity between hippocampal subregions and corresponding functionally abnormal regions was also conducted using probabilistic tractography. Antidepressant effects and cognitive impairments were measured by the Hamilton Depressive Rating Scale (HDRS) and the Category Verbal Fluency Test (CVFT), respectively. Their relationships with hippocampal-subregions alterations were examined.
After ECT, patients showed increased RSFC in the hippocampal emotional subregion (HIPe) with the left middle occipital gyrus (LMOG) and right medial temporal gyrus (RMTG). Decreased HDRS was associated with increased HIPe-RMTG RSFC (r = −0.316, p = 0.035) significantly and increased HIPe-LMOG RSFC at trend level (r = −0.283, p = 0.060). In contrast, the hippocampal cognitive subregion showed decreased RSFC with the bilateral angular gyrus, and was correlated with decreased CVFT (r = 0.418, p = 0.015 for left; r = 0.356, p = 0.042 for right). No significant changes were found in structural connectivity.
The hippocampal-subregions functional alterations may be specially associated with the antidepressant and cognitive effects of ECT.
High-precision underwater positioning must eliminate the influence of refraction artefacts. Since a Time Of Arrival - Global Navigation Satellite System Intelligent Buoys (TOA-GIB) system does not measure incident beam angles, common refraction correction methods cannot be directly used for refraction artefacts. An Equivalent Sound Speed (ESS) iteration method is proposed and is based on the transformation relations between depth, the ESS gradient and the incident beam angle. On this basis, a TOA/AOA-GIB system without a real-time Sound Speed Profile (SSP) is proposed to estimate the target position and the ESS gradient as unknown parameters. The results from a simulation experiment show that the positioning accuracy of a TOA/AOA-GIB system is better than 0·07% of water depth when the accuracy of the incident beam angle is 0·1°.
Increasing ship traffic and human activity in the Arctic has led to a growing demand for accurate Arctic weather forecast. High-quality forecasts obtained by models are dependent on accurate initial states achieved by assimilation of observations. In this study, a multi-variate nudging (MVN) method for assimilation of sea-ice variables is introduced. The MVN assimilation method includes procedures for multivariate update of sea-ice volume and concentration, and for extrapolation of observational information spatially. The MVN assimilation scheme is compared with the Ensemble Kalman Filter (EnKF) using the Los Alamos Sea Ice Model. Two multi-variate experiments are conducted: in the first experiment, sea-ice thickness from the European Space Agency's Soil Moisture and Ocean Salinity mission is assimilated, and in the second experiment, sea-ice concentration from the ocean and Sea Ice Satellite Application Facility is assimilated. The multivariate effects are cross-validated by comparing the model with non-assimilated observations. It is found that the simple and computationally cheap MVN method shows comparable skills to the more complicated and expensive EnKF method for multivariate update. In addition, we show that when few observations are available, the MVN method is a significant model improvement compared to the version based on one-dimensional sea-ice concentration assimilation.
Astrophysical collisionless shocks are amazing phenomena in space and astrophysical plasmas, where supersonic flows generate electromagnetic fields through instabilities and particles can be accelerated to high energy cosmic rays. Until now, understanding these micro-processes is still a challenge despite rich astrophysical observation data have been obtained. Laboratory astrophysics, a new route to study the astrophysics, allows us to investigate them at similar extreme physical conditions in laboratory. Here we will review the recent progress of the collisionless shock experiments performed at SG-II laser facility in China. The evolution of the electrostatic shocks and Weibel-type/filamentation instabilities are observed. Inspired by the configurations of the counter-streaming plasma flows, we also carry out a novel plasma collider to generate energetic neutrons relevant to the astrophysical nuclear reactions.
The pricing model for American lookback options can be characterised as a two-dimensional free boundary problem. The main challenge in this problem is the free boundary, which is also the main concern for financial investors. We use a standard technique to reduce the pricing model to a one-dimensional linear complementarity problem on a bounded domain and obtain a corresponding variational inequality. The inequality is discretised by finite differences and finite elements in the temporal and spatial directions, respectively. By enforcing inequality constraints related to the options using Lagrange multipliers, the discretised variational inequality is reformulated as a set of semi-smooth equations, which are solved by a primal-dual active set method. One of the major advantages of our algorithm is that we can obtain the option values and the free boundary simultaneously, and numerical simulations show that our approach is as efficient as some other methods.
Unlike industrial-grade Inertial Navigation Sensors (INSs) that can provide credible tracking performance, more affordable consumer-grade low-cost INSs produce drifts in heading angles and positions that result in a poor tracking accuracy. Researchers have proposed drift correction methods that attempt to attenuate the drifts when walking straight along the dominant directions is detected. While determining the type of a pedestrian's walk is essential before the heading corrections are made, the current detection techniques heavily rely on thresholding. This paper proposes a novel threshold-less method to detect turns in walking by using pelvic rotation and correct the heading angle based on consumer-grade INSs. The experiments indicate the proposed turn detector and heading correction methods produce very good results which can be applied for future pedestrian tracking, activity recognition or rehabilitation.
The present study examines the characteristics of clay minerals in shale gas reservoirs and their influence on reservoir properties based on X-ray diffraction and scanning electron microscopy. These analyses were combined with optical microscopy observations and core and well-log data to investigate the genesis, distribution characteristics, main controlling factors and pore features of clay minerals of the Lower Silurian Longmaxi Formation in the East Sichuan area, China. The clay mineral assemblage consists of illite + mixed-layer illite-smectite (I-S) + chlorite. This assemblage includes three sources of clay minerals: detrital, authigenic and diagenetic minerals. The lower section of the Longmaxi Formation in the Jiaoshiba area has sealing ability which resulted in abnormal high pressures during hydrocarbon generation which inhibited illitization. Therefore, an anomalous transformation sequence is present in which the mixed-layer I-S content increases with depth. This anomalous transformation sequence can be used to infer the existence of abnormal high pressures. The detrital components of the formation also affect the clay-minerals content indirectly, especially the abundance of K-feldspar. The transformation of mixed-layer I-S to illite is limited due to the limited availability of K+, which determines the extent of transformation. Three types of pores were observed in the shale reservoir rocks of the Longmaxi Formation: interparticle (interP) pores, intraparticle (intraP) pores and organic-matter pores. The clay-mineral content controls the development of intraP pores, which are dominated by pores within clay particles. For a given clay mineral content, smectite and mixed-layer I-S were more conducive to the development of shale-gas reservoirs than other clay minerals.