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Objectives: Candidemia has become one of the leading causes of healthcare-associated bloodstream infection, particularly in the intensive care unit. The management of candidemia remains challenging. We reassessed the protective effectiveness of a comprehensive care bundle on the management of candidemia and the effects of compliance with each element on the outcomes of patients. Methods: This network meta-analysis was conducted using the frequentist method. The participants included adult patients both infected with candidemia and who received bundle care. The primary outcome was the all-cause mortality among the patients included. Results: Studies in which a care bundle was created for patients with candidemia were identified, and 5 eligible studies with 5,808 participants were enrolled for further analysis. The random-effects model of the overall odds ratio (OR) revealed a significant reduction in the risk of all-cause mortality compared with that of the controls (OR, 0.599; 95% CI, 0.378–0.949; P = .025), as well as a reduction in the risk of developing persistent candidemia compared with the controls (OR, 0.483; 95% CI, 0.245–0.952; P = .008). In addition, no single element reached a protective effectiveness to improve the clinical outcome. Conclusions: This meta-analysis demonstrated that the combination of core elements in the care bundle resulted in protective effects, in that the all-cause mortality rates and incidence rates were effectively reduced among patients with persistent candidemia.
Patients with remitted psychosis face a dilemma between the wish to discontinue antipsychotics and the risk of relapse. We test if an operationalized guided-dose-reduction algorithm can help reach a lower effective dose without increased risks of relapse.
Methods
A 2-year open-label randomized prospective comparative cohort trial from Aug 2017 to Sep 2022. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomized 2:1 into guided dose reduction group (GDR) v. maintenance treatment group (MT1), together with a group of naturalistic maintenance controls (MT2). We observed if the relapse rates would be different between 3 groups, to what extent the dose could be reduced, and if GDR patients could have improved functioning and quality of life.
Results
A total of 96 patients, comprised 51, 24, and 21 patients in GDR, MT1, and MT2 groups, respectively. During follow-up, 14 patients (14.6%) relapsed, including 6, 4, and 4 from GDR, MT1, and MT2, statistically no difference between groups. In total, 74.5% of GDR patients could stay well under a lower dose, including 18 patients (35.3%) conducting 4 consecutive dose-tapering and staying well after reducing 58.5% of their baseline dose. The GDR group exhibited improved clinical outcomes and endorsed better quality of life.
Conclusions
GDR is a feasible approach as the majority of patients had a chance to taper antipsychotics to certain extents. Still, 25.5% of GDR patients could not successfully decrease any dose, including 11.8% experienced relapse, a risk comparable to their maintenance counterparts.
Slowed information processing speed (IPS) is the core contributor to cognitive impairment in patients with late-life depression (LLD). The hippocampus is an important link between depression and dementia, and it may be involved in IPS slowing in LLD. However, the relationship between a slowed IPS and the dynamic activity and connectivity of hippocampal subregions in patients with LLD remains unclear.
Methods
One hundred thirty-four patients with LLD and 89 healthy controls were recruited. Sliding-window analysis was used to assess whole-brain dynamic functional connectivity (dFC), dynamic fractional amplitude of low-frequency fluctuations (dfALFF) and dynamic regional homogeneity (dReHo) for each hippocampal subregion seed.
Results
Cognitive impairment (global cognition, verbal memory, language, visual–spatial skill, executive function and working memory) in patients with LLD was mediated by their slowed IPS. Compared with the controls, patients with LLD exhibited decreased dFC between various hippocampal subregions and the frontal cortex and decreased dReho in the left rostral hippocampus. Additionally, most of the dFCs were negatively associated with the severity of depressive symptoms and were positively associated with various domains of cognitive function. Moreover, the dFC between the left rostral hippocampus and middle frontal gyrus exhibited a partial mediation effect on the relationships between the scores of depressive symptoms and IPS.
Conclusions
Patients with LLD exhibited decreased dFC between the hippocampus and frontal cortex, and the decreased dFC between the left rostral hippocampus and right middle frontal gyrus was involved in the underlying neural substrate of the slowed IPS.
The influence of second-order dispersion (SOD) on stimulated Raman scattering (SRS) in the interaction of an ultrashort intense laser with plasma was investigated. More significant backward SRS was observed with the increase of the absolute value of SOD ($\mid \kern-1pt\!{\psi}_2\!\kern-1pt\mid$). The integrated intensity of the scattered light is positively correlated to the driver laser pulse duration. Accompanied by the side SRS, filaments with different angles along the laser propagation direction were observed in the transverse shadowgraph. A model incorporating Landau damping and above-threshold ionization was developed to explain the SOD-dependent angular distribution of the filaments.
Angiostrongylus cantonensis causes a form of parasitic meningitis in humans. Albendazole (ABZ) kills nematode larvae in the brain. However, dead larvae can trigger a severe inflammatory response, resulting in brain damage. Accumulating evidence suggests that calycosin represents a potential anti-inflammatory therapeutic candidate. In this study, we investigated the combined effects of ABZ and calycosin in angiostrongyliasis caused by A. cantonensis in BALB/c mice. Inflammatory mediators (such as phospho-nuclear factor-κB, cyclooxygenase-2, matrix metalloproteinase-9, tumour necrosis factor-α and interleukin-1β) are associated with the development of meningitis and immune inflammatory reactions. We found that A. cantonensis significantly induces inflammatory mediator production and increases the blood–brain barrier (BBB) permeability. However, co-administration of both ABZ and calycosin markedly suppressed meningitis and inflammatory mediator production and decreased the BBB permeability compared to treatment with a single drug. Furthermore, calycosin and ABZ plus calycosin treatment facilitated production of the antioxidant haem oxygenase-1 (HO-1). Moreover, co-therapy with ABZ and calycosin failed to mitigate angiostrongyliasis in the presence of tin-protoporphyrin IX, an HO-1-specific inhibitor. This finding suggests that the beneficial effects of ABZ plus calycosin treatment on the regulation of inflammation are mediated by the modulation of HO-1 activation. The present results provide new insights into the treatment of human angiostrongyliasis using co-therapy with ABZ and calycosin.
Benzodiazepine receptor agonists (BZRAs) are commonly used clinically and data on their hazardous use from large populations of psychiatric patients is limited.
Aims
To assess the current status of hazardous BZRA use and related factors in Chinese out-patient psychiatric settings.
Method
The study included out-patients with at least one BZRA prescription from five psychiatric settings in east, central and west China in 2018. Demographic and prescription information were extracted from the electronic prescription database. We defined the co-occurrence of overdose and long-term use as hazardous use, and patients whose recorded diagnoses did not meet any indications approved by the Chinese Food and Drug Administration as over-indication users. Additionally, 200 hazardous users were randomly selected for follow-up interview to confirm the actual situation.
Results
Among 720 054 out-patients, 164 450 (22.8%) had at least one BZRA prescription; 55.9% of patients were prescribed over-indication and 3% were defined as hazardous users. Multilevel multivariate regression analysis with hospital as a random effect showed that factors associated with hazardous use were older age (18–64 years: β = 0.018; 95% CI 0.013–0.023; >65 years: β = 0.015; 95% CI 0.010–0.021), male (β = 0.005, 95% CI 0.003–0.007), over-indication (β = 0.013, 95% CI 0.012–0.015), more out-patient visits (β = 0.006, 95% CI 0.006–0.006) and more visits to different doctors (β = 0.007, 95% CI 0.007–0.008); 98.5% of hazardous users (197/200) could not be contacted.
Conclusions
BZRAs are commonly used and there is a relatively large proportion of over-indication users among Chinese psychiatric out-patients. However, only a small proportion of hazardous users were detected. The study highlights how to use prescription data to support improvements in clinical practice.
Studies have shown that people with internet gaming disorder (IGD) exhibit impaired executive control of gaming cravings; however, the neural mechanisms underlying this process remain unknown. In addition, these conclusions were based on the hypothesis that brain networks are temporally static, neglecting dynamic changes in cognitive processes.
Methods
Resting-state fMRI data were collected from 402 subjects [162 subjects with IGD and 240 recreational game users (RGUs)]. The community structure (recruitment and integration) of the executive control network (ECN) and the basal ganglia network (BGN), which represents the reward network, of patients with IGD and RGUs were compared. Mediation effects among the different networks were analyzed.
Results
Compared to RGUs, subjects with IGD had a lower recruitment coefficient within the right ECN. Further analysis showed that only male subjects had a lower recruitment coefficient. Mediation analysis showed that the integration coefficient of the right ECN mediated the relationship between the recruitment coefficients of both the right ECN and the BGN in RGUs.
Conclusions
Male subjects with IGD had a lower recruitment coefficient than RGUs, which impairing their impulse control. The mediation results suggest that top-down executive control of the ECN is absent in subjects with IGD. Together, these findings could explain why subjects with IGD exhibit impaired executive control of gaming cravings; these results have important therapeutic implications for developing effective interventions for IGD.
Pharmacological treatment of major depressive disorder is often inefficient, and multiple strategies are used for inadequate response to antidepressants. Second-generation antipsychotics are used as augmentation measures in clinical practice; evidence of their efficacy and acceptability is insufficient, and it remains confusing as to which drug should be selected first. In this systematic review and network meta-analysis, we included randomised controlled trials of second-generation antipsychotics used as adjunctive treatment in patients with suboptimal responses. Outcome measures were efficacy (response and remission) and acceptability (dropout due to any reason and adverse events). Thirty-three trials comprising 10 602 participants were included. Regarding efficacy, response rates indicated that all antipsychotics except for ziprasidone were more efficacious than the placebo, with the odds ratios (ORs) ranging from 1.34 for olanzapine and cariprazine [95% credible interval (CrI) 1.04–1.73 and 1.07–1.67, respectively] to 2.17 for risperidone (95% CrI 1.38–3.42). When considering remission, cariprazine was not effective (OR 1.21, 95% CrI 0.96–1.54). For acceptability, quetiapine (OR 0.68, 95% CrI 0.50–0.91), brexpiprazole (OR 0.69, 95% CrI 0.55–0.86), and cariprazine (OR 0.61, 95% CrI 0.46–0.82) were worse than the placebo. With regards to tolerability, only olanzapine (OR 0.51, 95% CrI 0.25–1.07) and risperidone (OR 0.48, 95% CrI 0.10–2.21) showed no significant differences compared with placebo. The administration of adjunctive antipsychotics is associated with high effectiveness and low acceptability. Risperidone and aripiprazole are more efficacious and accepted than other atypical antipsychotics.
Improving grain yield and lodging resistance are two important targets for improving rice production. The aim of this study was to link grain yield and lodging resistance with growth patterns in rice. A nitrogen (N) fertilization experiment was conducted in 2020 and 2021, which consisted of two N rates (150 and 225 kg ha–1) and three N split-application ratios among the basal, early tillering, and panicle initiation stages (6:3:1, 5:3:2, and 4:3:3). The results demonstrated that increasing the N rate from 150 to 225 kg ha–1 did not affect grain yield but increased the plant lodging index by 16%. This increase in the plant lodging index was attributable to a higher plant fresh weight resulting from improved post-heading growth and a lower plant lodging load, which was partially due to a higher leaf area index. Altering the N split-application ratio from 6:3:1 to 4:3:3 increased grain yield by 4% but did not affect the plant lodging index in rice. The increase in grain yield was due to improved post-heading growth mainly resulting from increased radiation use efficiency during the post-heading period, which was partially attributable to increased specific leaf weight. An improvement in pre-heading growth in 2021 did not affect grain yield but increased the plant lodging load and decreased the plant lodging index by 36% compared to 2020. The improvement in pre-heading growth was due to a higher intercepted solar radiation resulting from higher leaf area index and incident solar radiation during the pre-heading period. The results of this study indicate that improving pre-heading growth can maintain grain yield and increase lodging resistance, while improving post-heading growth by increasing canopy radiation use efficiency (but not the leaf area index) can increase grain yield and maintain lodging resistance.
Pregnancy is a complex biological process. The establishment and maintenance of foetal–maternal interface are pivotal events. Decidual immune cells and inflammatory cytokines play indispensable roles in the foetal–maternal interface. The disfunction of decidual immune cells leads to adverse pregnancy outcome. Tumour necrosis factor (TNF)-α, a common inflammatory cytokine, has critical roles in different stages of normal pregnancy process. However, the relationship between the disorder of TNF-α and adverse pregnancy outcomes, including preeclampsia (PE), intrauterine growth restriction (IUGR), spontaneous abortion (SA), preterm birth and so on, is still indefinite. In this review, we thoroughly reviewed the effect of TNF-α disorder on pathological conditions. Moreover, we summarized the reports about the adverse pregnancy outcomes (PE, IUGR, SA and preterm birth) of using anti-TNF-α drugs (infliximab, etanercept and adalimumab, certolizumab and golimumab) currently in the clinical studies. Overall, IUGR, SA and preterm birth are the most common adverse pregnancy outcomes of anti-TNF-α drugs. Our review may provide insight for the immunological treatment of pregnancy-related complication, and help practitioners make informed decisions based on the current evidences.
The occurrence of chalkiness has decreased in new hybrid rice cultivars in China. As both chalkiness occurrence and starch granule size are associated with the biosynthesis of starch, we hypothesized that there may be a correlation between chalkiness occurrence and starch granule size, and this may partially explain the decreased chalkiness occurrence in the new hybrid rice cultivars. To test this hypothesis, a field experiment was conducted over eight environments (two years × four sowing dates) with two hybrid rice cultivars: one recently developed with low chalkiness occurrence, Jingliangyou 1468 (JLY1468) and a relatively older cultivar with high chalkiness occurrence, Liangyoupeijiu (LYPJ). Results showed that JLY1468 had a higher cumulative distribution of large-diameter (7.51–19.50 μm) starch granules and a lower grain weight of milled rice compared to LYPJ. As a consequence, mean and relative starch granule diameters were 6% and 21% higher in JLY1468 than in LYPJ, respectively. Although both the chalky grain rate and chalkiness degree were negatively correlated with mean and relative starch granule diameter, they were more closely correlated with the relative granule diameter. These results support our hypothesis regarding the relationship between chalkiness occurrence and starch granule size and suggest that the relative starch granule diameter is a relevant parameter in understanding the occurrence of chalkiness in hybrid rice.
A short-term 2-week (2w) and long-term 8-week (8w) feeding trial was conducted to investigate the effects of low-starch (LS) and high-starch (HS) diets on the growth performance, metabolism and liver health of largemouth bass (Micropterus salmoides). Two isonitrogenous and isolipidic diets containing two levels of starch (LS, 9·06 %; HS, 13·56 %) were fed to largemouth bass. The results indicated that HS diet had no significant effects on specific growth rate during 2w, whereas significantly lowered specific growth rate at 8w. HS diet significantly increased hepatic glycolysis and gluconeogenesis at postprandial 24 h in 2w. The hepatosomatic index, plasma alkaline phosphatase, total bile acid (TBA) levels, and hepatic glycogen, TAG, total cholesterol, TBA, and NEFA contents were significantly increased in the HS group at 2w. Moreover, HS diet up-regulated fatty acid and TAG synthesis-related genes and down-regulated TAG hydrolysis and β-oxidation-related genes. Therefore, the glucolipid metabolism disorders resulted in metabolic liver disease induced by HS diet at 2w. However, the up-regulation of bile acid synthesis, inflammation and energy metabolism-related genes in 2w indicated that largemouth bass was still in a state of ‘self-repair’ response. Interestingly, all the metabolic parameters were returned to homoeostasis, with up-regulation of intestinal glucose uptake and transport-related genes, even hepatic histopathological analysis showed no obvious abnormality in the HS group in 8w. In conclusion, HS feed induced short-term acute metabolic disorder, but long-term metabolic adaptation to HS diet was related to repairing metabolism disorders via improving inflammatory responses, bile acid synthesis and energy metabolism. These results strongly indicated that the largemouth bass owned certain adaptability to HS diet.
The purpose of the current study was to develop a validated FFQ to evaluate the intake of non-nutritive sweeteners (NNS) in child and adolescent Asian populations.
Design:
Intensive and overall market research was performed to create the applicable NNS-FFQ with thirteen food categories and 305 items. Six intense sweeteners, including acesulfame potassium, aspartame, sucralose, glycyrrhizin, steviol glycosides and sorbitol, were investigated. The validity and reproducibility of the NNS-FFQ were evaluated. The validity was further assessed by examining the consistency of reported NNS intake compared with urinary biomarkers using Cohen’s κ analysis.
Settings:
This work was considered to be relevant in Asian societies.
Participants:
One hundred and two children and adolescents recruited from several clinics were invited to participate in the current study.
Results:
High content validity indices and high content validity ratio levels were revealed for each sweetener and food category. Reproducibility among subjects was satisfactory. Significant moderate correlations between estimated steviol glycoside/sucralose consumption and sensitive urinary biomarker levels were demonstrated (κ values were 0·59 and 0·45 for steviol glycosides and sucralose, respectively), indicating that the NNS-FFQ can be used to assess an individual’s NNS intake. The dietary intense sweetener consumption pattern evaluated in this measurement was similar to those observed in other Asian countries but differed from those observed in Western populations with respect to types and amounts of NNS.
Conclusions:
This validated NNS-FFQ can be an applicable and useful tool to evaluate NNS intake in future epidemiological and clinical studies.
This paper investigates the monolithic edge-cladding process for the elliptical disk of N31-type Nd-doped phosphate laser glass, which will be utilized under liquid cooling conditions for high-power laser systems. The thermal stress, interface bubbles and residual reflectivity, which are due to high-temperature casting and bonding during the monolithic edge-cladding process, are simulated and determined. The applied mould is optimized to a rectangular cavity mould, and the casting temperature is optimized to 1000°C. The resulting lower bubble density makes the mean residual reflectivity as low as 6.75 × 10−5, which is enough to suppress the amplified spontaneous emission generated in the Nd-glass disk, and the resulting maximum optical retardation is converged to 10.2–13.3 nm/cm, which is a favourable base for fine annealing to achieve the stress specification of less than or equal to 5 nm/cm. After fine annealing at the optimized 520°C, the maximum optical retardation is as low as 4.8 nm/cm, and the minimum transmitted wavefront peak-to-valley value is 0.222 wavelength (632.8 nm). An N31 elliptical disk with the size of 194 mm × 102 mm × 40 mm can be successfully cladded by the optimized monolithic edge-cladding process, whose edge-cladded disk with the size of 200 mm × 108 mm × 40 mm can achieve laser gain one-third higher than that of an N21-type disk of the same size.
The joint effects of stimulus quality and semantic context in visual word recognition were examined with event-related potential (ERP) recordings. In one-character Chinese word recognition, we manipulated stimulus quality at two degradation levels (highly vs. slightly degraded) and semantic context at two priming levels (semantically related vs. unrelated). In a prime–target–probe trial flow, ERPs were recorded to the target character which was presented in either high or slight degradation and which was preceded by either a semantically related or unrelated prime character. The target character was then followed by a probe character which was either identical to or different from the target character. Subjects were instructed to make target–probe matching judgments. The ERP results demonstrated a degradation by priming interaction, with larger N400 semantic priming effects for slightly degraded targets. Moreover, the degradation effects were observed on the P200, N250, and N400. These findings provided evidence for the cascaded model of visual word recognition such that the visual processing cascaded into the semantic stage and thus interacted on the N400 amplitude. The results were compared to an earlier study with a null ERP degradation by priming interaction. The ramifications of these results for models of visual word recognition are discussed.
An important field of the political economy literature examines the mechanism of property rights commitments in authoritarian regimes where formal political constraints are absent. While many of the existing studies focus on how domestic autocratic institutions shape the formation of property rights regimes, this paper takes an open-economy approach and examines the compound effect of global economic integration and intergovernmental organizations (IGOs) on property rights protection in authoritarian regimes. We propose that the domestic presence of foreign factors of production is positively associated with more credible property rights commitments in authoritarian economies. Moreover, this association is moderated by authoritarian regimes' participation in institutionalized IGOs, which enhance the organizational capacity of these foreign owners of production factors. Through the transnational networks of production integration, international institutions indirectly alter the domestic distribution of bargaining power between the authoritarian government and private economic actors, rendering the commitment to property rights protection more credible. An analysis of a panel dataset consisting of 105 authoritarian regimes yields preliminary evidence supporting our proposition.