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Background: Atrial fibrillation (AF) is a risk for stroke. The Canadian Cardiovascular Society advises patients who are CHADS65 positive should be started on oral anticoagulation (OAC). Our local emergency department (ED) review showed that only 16% of CHADS65 positive patients were started on OAC and that 2% of our patients were diagnosed with stroke within 90 days. We implemented a new pathway for initiation of OAC in the ED (the SAFE pathway). Aim Statement: We report the effectiveness and safety of the SAFE pathway for initiation of OAC in patients treated for AF in the ED. Measures & Design: A multidisciplinary group of physicians and pharmacist developed the SAFE pathway for patients who are discharged home from the ED with a diagnosis of AF. Step 1: contraindications to OAC, Step 2: CHADS65 score, Step 3: OAC dosing if indicated. The pathway triggers referral to AF clinic, family physician letter and follow up call from the ED pharmacist. Patients are followed for 90 days by a structured medical record review and a structured telephone interview. We record persistence with OAC, stroke, TIA, systemic arterial embolism and major bleeding (ISTH criteria). Patient outcomes are fed back to the treating ED physician. Evaluation/ Results: The SAFE pathway was introduced in two EDs in June 2018. In total, 177 patients have had the pathway applied. The median age was 70 (interquartile range (IQR) 61-78), 48% male, median CHADS2 score 2 (IQR 0-2). 19/177 patients (11%) had a contraindication to initiating OAC. 122 patients (69%) had no contraindication to OAC and were CHADS65 positive. Of these 122 patients, 109 were given a prescription for OAC (96 the correct dose, 9 too high a dose and 4 too low a dose). 6 patients declined OAC and the physician did not want to start OAC for 7 patients. 73/122 were contacted by phone at 90 days, 15 could not be reached and 34 have not completed 90 days of follow up since their ED visit. Of the 73 who were reached by phone after 90 days, 65 were still taking an anticoagulant. To date, 1 patient who declined OAC (CHADS2 score of 2) had a stroke within 90 days and one patient prescribed OAC had a gastrointestinal bleed. Discussion/Impact: The SAFE pathway appears safe and effective although we continue to evaluate and improve the process.
White matter abnormalities have been repeatedly reported in both schizophrenia and bipolar disorder (BD) diseases from diffusion tensor imaging (DTI) studies respectively, while the empirical evidences about the diagnostic specificity of white matter abnormalities in these disorders are still limited.
25 patients with paranoid schizophrenia and 18 patients with bipolar mania were recruited from the in-patient unit of the Mental Health Centre, West China Hospital, China.
Patients were diagnosed according to the criteria of Diagnostic and Statistical Manual of Mental Disorders-Version IV (DSM- IV). 30 healthy controls were recruited from the community by means of leaflets distributed throughout Chengdu city.
This study sought to investigate the alterations in fractional anisotropy (FA) in white matter throughout the entire brain of patients from Chengdu, China with paranoid schizophrenia and bipolar mania.
Diffusion tensor imaging (DTI) was used to assess white matter integrity in patients with paranoid schizophrenia and bipolar mania, as well as in normal controls. The differences in FA were measured by use of voxel-based analysis.
Reduced FA was found in the left posterior corona radiate (PCR) in patients with bipolar mania and paranoid schizophrenia compared to the controls. Patients with bipolar mania also showed a significant reduction in FA in right posterior corona radiate and in right anterior thalamic radiation (ATR).
Common abnormalities in the left PCR might imply an overlap in white matter pathology of both diseases and might be related to the shared risk factors for both disorders.
The short allele of the serotonin transporter gene 5’ promoter region polymorphism (5-HTTLPR) is reported by A. Caspi and others to be associated with susceptibility to depression and suicidality in response to stressful life events. We examined the relationship of a triallelic 5-HTTLPR polymorphism to stressful life events (SLE) and severity of major depression and suicidality.
Mood disorder subjects (N=191) and healthy volunteers (N=125), all Caucasians of European origin, were genotyped for the triallelic 5-HTTLPR polymorphism, two low expressing alleles (LG, S) and a higher expressing LA allele. All subjects underwent structured clinical interviews for DSM IV diagnoses, ratings of psychopathology, stressful life events, developmental history and suicidal behavior. Cerebrospinal fluid (CSF) 5-HIAA was assayed in a sub-sample.
Lower expressing alleles independently predicted greater depression severity and predicted greater severity of major depression with moderate-severe life events compared with the LA allele. No associations with suicidal behavior and CSF 5-HIAA were found.
Low expression transporter alleles explain 31% of the variance in major depression severity and increase the impact of stressful life events on severity. The biological phenotype responsible for these effects remains to be elucidated
Despite strong evidence that the pathophysiology of tic disorders (TD) involves structural and functional disturbances of the basal ganglia, inconsistent findings from several TD imaging studies have supported contradictory conclusions.
To find brain structural differences between children with of TD and the health children and verify the pathogenesis hypothesis of that basal ganglia play an important role in this disorder.
The right handedness, first-episode TD children were chosen. Yale global tic severity scale (YGTSS) was used to assess the tic severity. MRI scan was performed on TD children and the controls. The volumes of caudate nucleus, putamen, globus pallidus and total intracranial volume were measured on high resolution MR images. We compared the volumes, relative volumes and asymmetry index, AI between groups.
Totally 11 patients finished this study with two excluded for the unclear image caused by tic and 18 subjects (9 TD patients and 9 controls) were finally analyzed. The right globus pallidus is significantly larger in TD patients. The volumes of left caudate increased significantly in both TD patients and controls. There was no significant difference in asymmetry index between two groups, relative volumes did not correlate significantly with the severity of tic and the course of disease.
The right globus pallidus may be the primary pathological change of TD. Asymmetry indexes between the two groups are not significantly different. The relative volume of any structure of basal ganglia has no significant correlation with the severity of tic and the course of disease.
To demonstrate whether the communication between two SD rats base on the similar genetic basis or the same living environment, who separated (including visual, auditory, tactile, olfactory and tasting inputs)from each other, occurs.
One SD rat (RECEIVER) was examined by EEG spectral analysis and ECG analysis under anesthesia while the other SD rat (SENDER) received optimal stimuli or malignant stimuli. The course was conducted in the shielded and the unshielded. Compare the EEG and ECG of RECEIVER between the stimulation state and resting state of SENDER.
This study show no significant difference in EEG (index: percentile weight and average weight of EEG on frontal lobe, temporal lobe, hippocampus of each frequency band) and ECG (index: R, PR segment, ST segment, QRS segment, QT segment) of RECEIVER during the time that the SENDER suffered from malignant stimulation, experienced optimal stimulation and of resting state.
The communication of SD rats, not through common five sense organ may not exist, even though the same genetic basis or the common living surrounding.The optimal stimuli and the malignant stimuli of SENDER cannot influence the EEG of Frontal lobe, temporal lobe, hippocampus and ECG on RECEIVER. There is no sufficient evidence for the existence of this communication of animal.
Postoperative nausea and vomiting (PONV) is the most common postoperative complication after gynecological laparoscopic surgery. It is unknown whether the occurrence of PONV is associated with the preoperative psychological status.
To explore the effects of preoperative psychological status on the incidence of PONV following gynecological laparoscopic surgery.
To analyze the possible risk factors in order to prevent and treat PONV after gynecological laparoscopic surgery.
101 cases patients who underwent gynecological laparoscopic surgery were enrolled. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the preoperative psychological state. Visual analog scale nausea (NVAS) was used to evaluate the occurrence of PONY within the postoperative 24 hours.
101 patients completed NVAS and 72 patients completed SAS and SDS. The incidence of PONV was 45.5%. The standard score of SAS (49.14±8.01) in PONV group was significantly higher than that in Non-PONV group (44.54±7.58) t=2.505, P < 0.05. The ratio of preoperative anxiety patients(SAS≥50) in PONV group(57%) was higher than that in Non-PONV group (30%) (χ2=5.513, P < 0.05). It showed that the occurrence of PONV was positively correlated with preoperative anxiety (r=0.277, P < 0.05). There was no difference in the scores of SDS between two groups. No correlation was found between PONV and preoperative depression.
Higher level of anxiety before surgery may increase the risk of PONV. The patients undergoing gynecological laparoscopic surgery should reduce the level of anxiety with appropriate psychological counseling or prophylactic anti-anxiety drugs.
The aim of this study was to develop and externally validate a simple-to-use nomogram for predicting the survival of hospitalised human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients (hospitalised person living with HIV/AIDS (PLWHAs)). Hospitalised PLWHAs (n = 3724) between January 2012 and December 2014 were enrolled in the training cohort. HIV-infected inpatients (n = 1987) admitted in 2015 were included as the external-validation cohort. The least absolute shrinkage and selection operator method was used to perform data dimension reduction and select the optimal predictors. The nomogram incorporated 11 independent predictors, including occupation, antiretroviral therapy, pneumonia, tuberculosis, Talaromyces marneffei, hypertension, septicemia, anaemia, respiratory failure, hypoproteinemia and electrolyte disturbances. The Likelihood χ2 statistic of the model was 516.30 (P = 0.000). Integrated Brier Score was 0.076 and Brier scores of the nomogram at the 10-day and 20-day time points were 0.046 and 0.071, respectively. The area under the curves for receiver operating characteristic were 0.819 and 0.828, and precision-recall curves were 0.242 and 0.378 at two time points. Calibration plots and decision curve analysis in the two sets showed good performance and a high net benefit of nomogram. In conclusion, the nomogram developed in the current study has relatively high calibration and is clinically useful. It provides a convenient and useful tool for timely clinical decision-making and the risk management of hospitalised PLWHAs.
Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999–2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15–30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.
Glutathione S-transferases (GSTs) are a detoxifying enzyme family that is essential for parasite blood-feeding and survival, and represent potential targets for hookworm vaccine development. Multiple GST-encoding complementary DNAs (cDNAs) have been cloned from Ancylostoma caninum and Necator americanus, but there are no reports about the cloning of this enzyme from Ancylostoma ceylanicum, the animal-derived zoonotic hookworm. To study the molecular nature and tissue localization of GST of A. ceylanicum (Ace-GST), we designed primers based on the GST gene sequence of A. ceylanicum in GenBank, amplified the Ace-GST cDNA by reverse transcription polymerase chain reaction, and analysed its homology and genetic evolution relationship. The amplified product was cloned into the pET-32a vector and transformed into Escherichia coli BL21 (DE3) for expression. To prepare anti-GST polyclonal antibodies, the recombinant protein was purified and used to immunize Kunming mice. The level of immunoglobulin G (IgG) antibody in the serum of immunized mice was detected by indirect enzyme-linked immunosorbent assay, and the Ace-GST localization in adult worm was determined using the immunofluorescence method. The results showed that the full-length cDNA encoding Ace-GST was 468 bp, which had the highest homology with Ac-GST-1 (60.1%) and clustered into one branch (v-class) with Ac-GST-1 and Na-GST-1 in a phylogenetic tree. Mice immunized with recombinant Ace-GST showed specific IgG antibody response. Immunolocalization revealed that natural Ace-GST is mainly located in the epidermis, muscle and intestine of the adult. These results may lay a foundation for further studies on the biological function of Ace-GST.
Triptorelin (TRI), a gonadotropin-releasing hormone agonist allowing ovulation synchronization in pigs, is indispensable for fixed-time artificial insemination (FTAI) protocols. However, the effect of FTAI using TRI (FTAI-TRI) on the reproductive performance is controversial. We performed a meta-analysis to determine whether FTAI-TRI affects reproductive performance of pigs, including pregnancy rate (PR), number of pigs born alive per litter (NBA), farrowing rate (FR) and total number of pigs born per litter (TNB). A total of 37 trials from 15 studies were extracted and analysed in Stata. A weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for NBA and TNB, and risk ratio (RR) with 95% CI was calculated for PR and FR. Pregnancy rate, TNB and NBA data were applied to a fixed-effect protocol, and FR data were applied to a random-effect protocol. We found that for weaned sows, the FTAI-TRI group had comparable reproductive performance to the artificial insemination (AI) following oestrus detection (EDAI) group. Fixed-time AI has many advantages, including the elimination of the need to heat-check twice daily, so that FTAI-TRI is a good substitute for EDAI. Subgroup analysis indicated that the optimal timing of triptorelin treatment was 96 h after weaning, which gave significant positive effects on PR (RR = 1.08, P = 0.000) and non-significant positive effects on TNB (WMD = 0.12, P = 0.452). Triptorelin at a dose of 100 μg showed better effects than 200 μg, with significant positive effects on PR (RR = 1.09, P = 0.005) and FR (RR = 1.06, P = 0.036). So a single dose of 100 μg was recommended. The optimal protocol was insemination at 24 h and again at 48 h after triptorelin administration if they remained in standing oestrus, and this provided a significantly higher NBA (WMD = 0.59, P = 0.013) that increased by 0.59. For gilts, the FTAI-TRI group showed decreased (not significant) PR (RR = 0.96, P = 0.127) and significantly decreased FR (RR = 0.93, P = 0.013), TNB (WMD = −0.85, P = 0.006) and NBA (WMD = −0.98, P = 0.000), which were inferior to those in the EDAI group. In conclusion, the effects of FTAI-TRI on the reproductive performance of pigs were parity-, treatment timing-, insemination timing-, and dosage-dependent. Fixed-time AI using triptorelin could effectively replace the EDAI protocol for sows, but not for gilts.
This study aimed to classify the pre-auricular sinus before performing radical dissection, so as to achieve optimal aesthetic results.
The recent five-year clinical data of 53 patients with a congenital pre-auricular sinus and infection treated in the hospital were reviewed. According to the sinus course, pre-auricular and post-auricular types were defined, and regional dissection was performed using the modified supra-auricular or post-auricular approach.
All patients achieved primary intention healing of the incision, and were followed up for six months to five years. No recurrence was found, and the incision scar was completely concealed.
Surgical approaches for regional dissection might be adopted based on the different types of pre-auricular sinuses, and further radical dissection might be performed to achieve optimal aesthetic results.
Flow over aligned and staggered cube arrays is a classic model problem for rough-wall turbulent boundary layers. Earlier studies of this model problem mainly looked at rough surfaces with a moderate coverage density, i.e.
is the surface coverage density and is defined to be the ratio between the area occupied by the roughness and the total ground area. At lower surface coverage densities, i.e.
, it is conventionally thought that cubical roughness acts like isolated roughness elements; and that the single-cube drag coefficient, i.e.
is the drag force on one cubical roughness element,
is the fluid density,
is the height of the cube,
is the spatially and temporally averaged wind speed at the cube height, and
is the drag coefficient of an isolated cube. In this work, we conduct large-eddy simulations and direct numerical simulations of flow over wall-mounted cubes with very low surface coverage densities, i.e.
. The large-eddy simulations are at nominally infinite Reynolds numbers. The results challenge the conventional thinking, and we show that, at very low surface coverage densities, the single-cube drag coefficient may increase as a function of
. Our analysis suggests that this behaviour may be attributed to secondary turbulent flows. Secondary turbulent flows are often found above spanwise-heterogeneous roughness. Although the roughness considered in this work is nominally homogeneous, the secondary flows in our simulations are very similar to those observed above spanwise-heterogeneous surface roughness. These secondary vortices redistribute the fluid momentum in the outer layer, leading to high-momentum pathways above the wall-mounted cubes and low-momentum pathways at the two sides of the wall-mounted cubes. As a result, the spatially and temporally averaged wind speed at the cube height, i.e.
, is an underestimate of the incoming flow to the cubes, which in turn leads to a large drag coefficient
An algorithm for Global Navigation Satellite System satellite atomic clock integrity monitoring based on an extended measurement model is proposed. A detection statistic achieved by parity transformation is used to detect clock anomalies, and the concept of the optimal accumulation number, with a method to find it, is provided. Numerical simulations are adopted to verify the validity of detecting two typical anomalies.
Copy number variations (CNVs), as an important source of genetic variation, can affect a wide range of phenotypes by diverse mechanisms. The somatostatin receptor 2 (SSTR2) gene plays important roles in cell proliferation and apoptosis. Recently, this gene was mapped to a CNV region, which encompasses quantitative trait loci of cattle economic traits including body weight, marbling score, etc. Therefore, SSTR2 CNV may exhibit phenotypic effects on cattle growth traits. In the current study, distribution of SSTR2 gene CNVs was investigated in six Chinese cattle breeds (XN, QC, NY, JA, LX and PN), and the results showed higher CNV polymorphisms in XN, QC and NY cattle. Next, association analysis between growth traits and SSTR2 CNV was performed for XN, QC and NY cattle. In NY, individuals with fewer copies showed better performance than those with more copies. Further, the effects of SSTR2 CNV on the SSTR2 mRNA level were also investigated, but revealed no significant correlation in either muscle or adipose tissue of adult NY cattle. The results suggested the potential for use of SSTR2 CNV as a marker for the molecular breeding of NY cattle.
Force-feeding was considered as a traditional high-efficiency approach to improve growth performance and accelerate fat deposition of Pekin ducks. However, force-feeding is a serious violation of international advocacy on animal welfare, because it can induce serious injuries to animals, such as damages to the digestive tract, effects on immunity and even severe oxidative stress. Therefore, it is urgent to stop force-feeding. The aim of this study was to determine the effects of force feeding on immune function, digestive function and oxidative stress in the mucosa of duodenum and jejunum of Pekin ducks. A total of 500 ducks were randomly divided into two groups. The control group was allowed to feed freely on a basal diet. The experimental group was force-fed by inserting a plastic feeding tube 8 to 10 inches long down the esophagus for 6 days. Compared with the control group, there was a significant (P<0.05) increase in serum diamine oxidase, d-lactic acid, endotoxin and corticosterone levels in the force-feeding group. The crypt depth in duodenum and jejunum showed significant differences (P<0.05) between the two groups and the intestinal villus epithelium cell was severely damaged in force-feeding group. Similarly, the activities of digestive enzymes as well as the levels of immune function in the duodenal and jejunal mucosa in the force-feeding group were significantly higher than the control group (P<0.05). However, there was a significant decrease in the superoxide dismutase, glutathione peroxidase and catalase levels with a marked increase in malondialdehyde level in duodenal and jejunal mucosa (P<0.05). In summary, at the end of the fattening period with force-feeding for 6 days, Pekin ducks experienced an adverse effect on the integrity of their duodenal and jejunal mucosa epithelium cell as well as their immune function and antioxidant capacity of Pekin ducks but also had improvement in digestive enzyme activities.
This study investigates the stability and transition of Görtler vortices in a hypersonic boundary layer using linear stability theory and direct numerical simulations. In the simulations, Görtler vortices are separately excited by wall blowing and suction with spanwise wavelengths of 3, 6 and 9 mm. In addition to primary streaks with the same wavelength as the blowing and suction, secondary streaks with half the wavelength also emerge in the 6 and 9 mm cases. The streaks develop into mushroom structures before breaking down. The breakdown processes of the three cases are dominated by a sinuous-mode instability, a varicose-mode instability and a combination of the two, respectively. Both fundamental and subharmonic instabilities are relevant in all cases. Multiple modes are identified in the secondary-instability stage, some of which originate from the primary instabilities (first and second Mack modes). We demonstrate that the first Mack mode can be destabilized to either a varicose-mode or sinuous-mode streak instability depending on its frequency and wavelength, whereas the second Mack mode undergoes a stabilizing stage before turning into a varicose mode in the 6 and 9 mm cases. An energy analysis reveals the stabilizing and destabilizing mechanisms of the primary instabilities under the influence of Görtler vortices, highlighting the role played by the spanwise production based on the spanwise gradient of the streamwise velocity in both varicose and sinuous modes. The effects introduced by the secondary streaks are examined by filtering the secondary streaks in two new simulations with nominally identical conditions to those of the 6 and 9 mm cases. Remarkably, the secondary streaks can destabilize the Görtler vortices, therefore advancing the transition. The stability theory results are in good agreement with those from direct numerical simulations.
Using whole-genome sequence (WGS) data are supposed to be optimal for genome-wide association studies and genomic predictions. However, sequencing thousands of individuals of interest is expensive. Imputation from single nucleotide polymorphisms panels to WGS data is an attractive approach to obtain highly reliable WGS data at low cost. Here, we conducted a genotype imputation study with a combined reference panel in yellow-feather dwarf broiler population. The combined reference panel was assembled by sequencing 24 key individuals of a yellow-feather dwarf broiler population (internal reference panel) and WGS data from 311 chickens in public databases (external reference panel). Three scenarios were investigated to determine how different factors affect the accuracy of imputation from 600 K array data to WGS data, including: genotype imputation with internal, external and combined reference panels; the number of internal reference individuals in the combined reference panel; and different reference sizes and selection strategies of an external reference panel. Results showed that imputation accuracy from 600 K to WGS data were 0.834±0.012, 0.920±0.007 and 0.982±0.003 for the internal, external and combined reference panels, respectively. Increasing the reference size from 50 to 250 improved the accuracy of genotype imputation from 0.848 to 0.974 for the combined reference panel and from 0.647 to 0.917 for the external reference panel. The selection strategies for the external reference panel had no impact on the accuracy of imputation using the combined reference panel. However, if only an external reference panel with reference size >50 was used, the selection strategy of minimizing the average distance to the closest leaf had the greatest imputation accuracy compared with other methods. Generally, using a combined reference panel provided greater imputation accuracy, especially for low-frequency variants. In conclusion, the optimal imputation strategy with a combined reference panel should comprehensively consider genetic diversity of the study population, availability and properties of external reference panels, sequencing and computing costs, and frequency of imputed variants. This work sheds light on how to design and execute genotype imputation with a combined external reference panel in a livestock population.
Previous studies have demonstrated that type 1 diabetes mellitus (T1DM) could be triggered by an early childhood infection. Whether maternal infection during pregnancy is associated with T1DM in offspring is unknown. Therefore, we aimed to study the association using a systematic review and meta-analysis. Eighteen studies including 4304 cases and 25 846 participants were enrolled in this meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were synthesised using random-effects models. Subgroup analyses and sensitivity analyses were conducted to assess the robustness of associations. Overall, the pooled analysis yielded a statistically significant association between maternal infection during pregnancy and childhood T1DM (OR 1.31, 95% CI 1.07–1.62). Furthermore, six studies that tested maternal enterovirus infection showed a pooled OR of 1.54 (95% CI 1.05–2.27). Heterogeneity from different studies was evident (I2 = 70.1%, P < 0.001) and was mainly attributable to the different study designs, ascertaining methods and sample size among different studies. This study provides evidence for an association between maternal infection during pregnancy and childhood T1DM.