Background: Cerebral venous thrombosis (CVT)most commonly affects younger women. Diagnosis may be delayed due to its distinct presentation and demographic profile compared to other stroke types. Methods: We examined delays to diagnosis of CVT in the SECRET randomized trial and TOP-SECRET parallel registry. Adults diagnosed with symptomatic CVT within <14 days were included. We examined time to diagnosis and number of health care encounters prior to diagnosis and associations with demographics, clinical and radiologic features and functional and patient-reported outcomes (PROMS) at days 180&365. Results: Of 103 participants, 68.9% were female; median age was 45 (IQR 31.0-61.0). Median time from symptom onset to diagnosis was 4 (1-8) days. Diagnosis on first presentation to medical attention was made in 60.2%. The difference in time to diagnosis for single versus multiple presentations was on the order of days (3[1-7] vs. 5[2-11.75], p=0.16). Women were likelier to have multiple presentations (OR 2.53; 95% CI1.00-6.39; p=0.05) and longer median times to diagnosis (5[2-8]days vs. 2[1-4.5] days; p=0.005). However, this was not associated with absolute or change in functional, or any patient reported, outcome measures (PROMs) at days 180&365. Conclusions: Diagnosis of CVT was commonly delayed; women were likelier to have multiple presentations. We found no association between delayed diagnosis and outcomes.

We investigated the drug resistance of Mycobacterium tuberculosis isolates from patients with tuberculosis (TB) and HIV, and those diagnosed with only TB in Sichuan, China. TB isolates were obtained from January 2018 to December 2020 and subjected to drug susceptibility testing (DST) to 11 anti-TB drugs and to GeneXpert MTB/RIF testing. The overall proportion of drug-resistant TB (DR-TB) isolates was 32.1% (n = 10 946). HIV testing was not universally available for outpatient TB cases, only 29.5% (3227/10 946) cases had HIV testing results. The observed proportion of multidrug-resistant TB (MDR-TB) isolates was almost double than that of the national level, with approximately 1.5% and 0.1% of the isolates being extensively drug resistant and universally drug resistant, respectively. The proportions of resistant isolates were generally higher in 2018 and 2019 than in 2020. Furthermore, the sensitivities of GeneXpert during 2018–2020 demonstrated a downward trend (80.9, 95% confidence intervals (CI) 76.8–85.0; 80.2, 95% CI 76.4–84.1 and 75.4, 95% CI 70.7–80.2, respectively). Approximately 69.0% (7557/10 946) of the TB cases with DST results were subjected to GeneXpert detection. Overall, the DR-TB status and the use of GeneXpert in Sichuan have improved, but DR-TB challenges remain. HIV testing for all TB cases is recommended.

Iodine is essential for thyroid hormone synthesis. Individuals adhering to vegan and vegetarian diets have been found to be vulnerable to iodine deficiency. Yet, iodine has not been monitored in these groups across time. This study aims to investigate iodine status, intake and knowledge in vegans, vegetarians and omnivores and determine changes between 2016–2017 and 2019. Dietary intake (µg/d) was estimated by 3-d food diaries and iodine FFQ. Urinary iodine concentration, analysed by inductively coupled plasma mass spectrometry, assessed iodine status according to WHO criteria. Iodine knowledge was scored by an adapted questionnaire. IBM SPSS was used for statistical analysis. Ninety-six adults (18–60 years) were recruited in October 2016–2017 (vegans: 12; vegetarians: 5; omnivores: 43) and June 2019 (vegans: 7; vegetarians: 10;omnivores: 19). Median dietary iodine was below the Reference Nutrient Intake for all groups. Vegans and vegetarians had the lowest iodine intake. Vegans had significantly lower iodine intake than omnivores (2016–2017, P = 0 032; 2019, P = 0 001). Omnivores had the highest iodine status (2016–2017, 79 4 µg/l; 2019, 72 4 µg/l) and vegans the lowest (2016–2017, 31 2 µg/l; 2019, 12 2 µg/l). Iodine knowledge was poor but did not differ between dietary groups (2016–2017, P = 0 219; 2019, P = 0 532). Vegans and vegetarians continue to be at risk of iodine deficiency. Further, iodine intake in the UK is poor independent of dietary choice. Iodine education is needed along with research into improving iodine nutrition at national level.

Metabolic syndrome (MetS) risk is influenced by genetic and environmental factors. The present study explored genetic risk scores (GRS) of genetic variants that influence the MetS and the effect of interactions between GRS and nutrient intake on MetS risk. The genetic variants that influence MetS risk were selected by genome-wide association study after adjusting for age, sex, area of residence and BMI in 8840 middle-aged adults. GRS were calculated by summing the risk alleles of the selected SNP and divided into low (0–1), medium (2–3) and high (4–7) risk groups, and the relationships between the MetS and GRS were determined by logistic regression after adjusting covariates involved in MetS risk. We also analysed the interaction between GRS and lifestyles. Four genetic variants (APOA5_rs651821, EFCAB4B_rs4766165, ZNF259_rs2160669 and APOBEC1_rs10845640) were selected because they increased MetS risk after adjusting for covariates. Individuals with medium-GRS and high-GRS alleles had a higher MetS risk by 1·48- and 2·23-fold, respectively, compared with those with low-GRS after adjusting for covariates. The increase in MetS risk was mainly related to serum TAG and HDL-cholesterol concentrations. The GRS had an interaction with carbohydrate (CHO) and Na intakes and daily physical activities for MetS risk. In conclusion, Asian middle-aged adults with high-GRS alleles were at increased MetS risk mainly due to dyslipidaemia. High daily physical activity (≥1 h moderate activity per d) reduced the MetS risk but a low-CHO diet (<65 % of total energy intake) increased the risk in carriers with high-GRS alleles. Low Na intake (<1·6 g Na intake/4 MJ) did not decrease its risk.

A 50-yr resolution reconstruction of climate and environment variability during the period 43–14 ka was developed using 26 high-precision U/Th dates and 390 oxygen isotope (δ18O) data of a stalagmite (SJ1) collected from Songjia Cave in central China, which is close to the northwestern boundary of the Asian summer monsoon (ASM). The δ18O record in SJ1 displays significant millennial-scale changes that correlate well in timing and duration with Dansgaard/Oeschger (D/O) events 5–10 and Heinrich event 4 (H4) identified in high-latitude regions of the Northern Hemisphere. Four 230Th dates constrain the H4 event precisely to the period of 39.7 to 38.3 ka. Notable centennial variations of the ASM activity could be observed within the H4 event. The magnitude and duration of D/O event 4.1 recorded in SJ1 are similar to those archived in east China but different from those documented in southwest China, suggesting that the manifestation of this event may be regionally different. The timing, duration and structure of D/O events 5–10 and Heinrich event 4 suggest that temperature changes in both hemispheres have exerted significant influences on the ASM variations in central China.

A comparative study of the effect of dietary nitrogen (N) content [Low: 11·0; Medium-Low (MLow): 16·7; Medium-High (Mhigh): 23·1; High: 29·2 N g/kg dry matter (DM)] on apparent digestibilities, rumen fermentation and N balance was conducted in coarse wool Tibetan sheep and Gansu Alpine fine-wool sheep at Wushaoling in the northeast of the Qinghai-Tibetan Plateau. It was hypothesized that responses would differ between breeds and that responses would favour Tibetan over fine-wool sheep at low N intakes. Eight wethers [four Tibetan sheep and four fine-wool sheep, 20–24 months old; body weight ± standard deviation was 52 ± 3·2 kg] were used in two concurrent 4 × 4 Latin square designs. Dry matter, organic matter, neutral detergent fibre and acid detergent fibre digestibilities were higher in Tibetan than fine-wool sheep when fed the Low, MLow and High N diets while N retention was higher when the animals were fed the Low and MLow N diets. Tibetan sheep had a higher rumen pH than fine-wool sheep; however, total volatile fatty acids were similar between breeds. Molar proportions of acetate were higher but propionate and butyrate lower in Tibetan than fine-wool sheep. In addition, Tibetan sheep had higher concentrations of ruminal free amino acid-N and soluble protein-N than fine-wool sheep. Plasma and saliva urea-N concentrations were higher in Tibetan than fine-wool sheep when supplied with the Low N diet. It was concluded that Tibetan sheep were better able to cope with low N feed than fine-wool sheep because of the higher N retention and higher DM and fibre digestibilities with Low and MLow diets.

An experiment was conducted to study the seasonal changes in the fatty acid profile of milk from yaks (Bos grunniens) when kept at altitudes of 3000 m above sea level (a.s.l.) and higher. Data and samples were collected in summer (July), autumn (September), winter (November) and spring (March) from ten lactating yaks (four in spring). The yaks grazed pastures adjacent to the farm building throughout the year. In spring only they received 0·6 kg crop by-products per day (dry matter basis). Fresh alpine grasses, available in summer and autumn, showed high concentrations of α-linolenic acid (46–51 g/100 g lipids) compared with the dry, yellow vegetation of winter and spring (16 g/100 g lipids). In autumn and summer, the milk fat had higher concentrations of polyunsaturated fatty acids than in winter. These polyunsaturated fatty acids were comprised of vaccenic acid, rumenic acid and α-linolenic acid, which are all considered beneficial to human health. The rare fatty acid, γ-linolenic acid, was also detected in yak milk, especially in the milk obtained in spring. The results suggest that yak milk, which is the most important basic food of the Tibetan herders, has the most favourable fatty acid profile when yaks grazed green pasture, which also corresponds to the period of highest milk production.

The diffusion barrier properties for ultrathin Ru/Ta and Ru/TaN bilayer structure as the copper diffusion barrier are compared. Cu, Ru, Ta and TaN thin films are deposited by using the ion beam sputtering technique. The experimental results show that the thermal stability of the Cu/Ru/Ta or TaN /Si structure is much more improved than that of the Cu/Ru/Si structure without the interlayer. However, the Cu/Ru/TaN/Si shows better thermal stability than the Cu/Ru/Ta/Si structure, which should be attributed to the amorphous nature of the TaN interlayer. The microstructure evolution of the Cu/Ru/Ta (TaN)/Si structure during annealing is discussed. The results show that the Ru/TaN bilayer can be a very promising diffusion barrier in the future seedless Cu interconnect technology.

1. Introduction

Along with the prevalence of probabilistic methods in approximation theory the study of approximation of operators by other operator sequences, or the study of limiting properties of operator sequences, has attracted more and more attention. It was shown by Stancu [15] in the 1960s that Szász operators and Baskakov operators are limiting operators of Stancu–Mühlbach operator sequences in an appropriate sense. Later, Butzer and Hahn [4, 5, 11] established rates of convergence of some probabilistic type operators towards their limiting operators as applications of their general approximation theorems in probability theory. In 1988, Khan [13] proved that Szász operators are limiting operators of Bleimann–Butzer–Hahn operator sequences. Recently de la Cal, Luquin, Adell and San Miguel investigated the limiting properties of a series of probabilistic type operator sequences and exhibited that their limiting operators might be Bernstein, Szász, Baskakov, gamma or beta operators [1, 2, 6, 7, 8].