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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalized anxiety disorder (GAD).
170 patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale (HAMD), the Severity Subscale of Clinical Global Impression Scale (CGI-S), Global Assessment Function (GAF), and the 12-item Short-Form Health Survey (SF-12). Assessments were conducted at baseline, 4-weeks, 8-weeks and 3-monthsfollow-up.
At 4-weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen d=0.90) and remission rates (GCBT group 21.5%vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36-0.77) showed that the combined therapy was superior. At 8-weeks, all the primary and secondary significant differences found at 4-weeks were maintained with smaller effect sizes (p<0.05, d=0.32-0.48) . At 3-months follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates (OR=2.12, 95% CI 1.02-4.42, p=0.04); and remission rates (OR=2.80, 95% CI 1.27-6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest GCBT was effective in changing cognitive style.
Higher fiber intake reduced all-cause and cardiovascular mortality among healthy population, but such data in dialysis patients are limited. We aimed to examine these associations in patients on peritoneal dialysis. This single-center prospective cohort study enrolled 881 incident PD patients between October 2002 and August 2014. All patients were followed until death, transfer to hemodialysis, renal transplantation or until being censored in June 2018. Demographic data were collected at baseline. Biochemical, dietary, and nutrition data were examined at baseline and thereafter at regular intervals to calculate the average values throughout the study. The outcomes were defined as all-cause and cardiovascular death. Cox proportional regression models were applied to explore the relationship between fiber intake and outcomes. Participants with higher fiber intake were more likely to be younger, male, and having better residual renal function and serum lipids at baseline. They were prone to maintain better nutrient status, higher blood pressure and lower inflammatory status at baseline and afterward. Neither baseline nor time-averaged fiber intake did show protective effects on all-cause mortality after multivariate adjustment in the whole cohort. Among non-diabetic PD patients, an independent association between fiber intake and all-cause mortality was found, in which each 1g/day of increase in time-averaged fiber intake correlated to 13% of reduction in all-cause mortality. We did not observe any benefits of fiber intake in the CVD mortality for both whole cohort and subgroups. This study revealed that higher dietary fiber intake appeared to have a protective effect on all-cause mortality in non-diabetic PD patients, which suggest that PD patients should be encouraged to eat a diet rich in fibers.
This study aimed to evaluate the effectiveness of hypertension management and analyse the factors associated with blood pressure reduction within China’s primary healthcare system.
Hypertension is one of the leading risk factors for global disease burden and is strongly associated with cardiovascular diseases. In China, hypertension is a serious public health problem, but few studies have evaluated the effectiveness of hypertension management in China’s primary healthcare system.
The study sites were 24 primary healthcare institutions, selected using multistage stratified random sampling method. In each institution, hypertension patients aged at least 35 years who agreed to participate and had no disabilities or mental health problems were enrolled for hypertension management. Participants received comprehensive interventions in the primary healthcare system via a team. After a one-year intervention, data from 6575 hypertension patients were analysed to check the effectiveness of hypertension management and examined factors associated with hypertension control.
There was an overall mean reduction of 4.5 mmHg in systolic blood pressure (SBP) and 1.9 mmHg in diastolic blood pressure (DBP). The blood pressure reduction after one year was greater in rural patients than in urban patients, 6.6 mmHg versus 3.4 mmHg for SBP and 2.6 mmHg versus 1.6 mmHg for DBP, respectively. The hypertension control rate also increased more in rural areas (22.1%) than in urban areas (10.6%) after the one-year intervention. Age, body mass index, region and being in an urban area had a significant negative association with the reduction of SBP (P < 0.05). Education level and baseline SBP showed a significant positive association (P < 0.05).
Community-based hypertension management by general practitioners was feasible and effective. The effectiveness of hypertension management in rural areas was greater than in urban areas. Intervention strategies should pay more attention to patients in rural areas and western China.
At GE Research, we are combining “physics” with artificial intelligence and machine learning to advance manufacturing design, processing, and inspection, turning innovative technologies into real products and solutions across our industrial portfolio. This article provides a snapshot of how this physical plus digital transformation is evolving at GE.
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.
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.
Residual strain often occurs in metal when it was subjected to the tension load, random vibration, or high impact. The mild steel was selected as the research object, and the feasibility of using nonlinear ultrasonic technique to characterize the residual strain was investigated in this paper. First, the mild steel specimens were stretched to several different kinds of stress, then the nonlinear effect as well as the microstrain of each sample was measured. The results indicate that the microstrain increases with increasing applied stress and reaches a maximum value of about 0.036% as the tensile stress increases to the elastic limit. Compared with the original specimen, the nonlinear parameter of tensile specimen gradually increased within the elastic limit. This result reveals that the variation of nonlinear parameter was related to microstrain in mild steel, because the microstructure observation demonstrated that the dislocation structure was basically unchanged within the elastic limit. This research indicates that the nonlinear ultrasonic method has the promising potential to characterize the microstrain in metals.
The association of soft drink consumption with mental problems in Asian adolescents has not been reported. The present study aimed to investigate the association of soft drink consumption and symptoms of anxiety and depression in adolescents in China.
A cross-sectional study to investigate the association of intake of soft drinks and sugars from soft drinks with symptoms of anxiety and depression measured by the two-item Generalized Anxiety Disorder (GAD-2) and the Patient Health Questionnaire (PHQ-2), respectively.
A comprehensive university in Changsha, China.
Newly enrolled college students in 2017.
In total, 8226 students completed the investigation and 8085 students with no systemic disorders were finally analysed. Students consuming soft drinks ≥7 times/week had significantly higher (mean difference; 95 % CI) GAD-2 (0·15; 0·07, 0·23) and PHQ-2 (0·27; 0·19, 0·35) scores compared with those barely consuming soft drinks, adjusted for demographic and behavioural factors. Those consuming >25 g sugar/d from soft drinks had significantly higher GAD-2 (0·11; 0·04, 0·18) and PHQ-2 (0·22; 0·15, 0·29) scores compared with non-consumers. The mediation effect of obesity in the associations was not clinically significant.
Adolescents consuming soft drinks ≥7 times/week, or >25 g sugar/d from soft drinks, had significantly higher levels of anxiety and depression. Dietary suggestion is needed to prevent anxiety and depression in adolescents.
In this paper, a novel multilayer substrate integrated dual-mode dielectric resonator (DR) filter is proposed. The square dual-mode DR is made of the high permittivity substrate by removing the undesired portions and the surface coppers so that the relatively high unloaded quality factor of the dominate TM11 pair can be obtained which compared to these fully dielectric-filled substrate integrated waveguides. Meanwhile, it can be easily integrated in an equivalent cavity implemented by multilayer printed circuit boards for filter design, showcasing low in-band loss, light weight, and compact size. For demonstration, a multilayer substrate integrated DR bandpass filter centered at X-band is designed and measured. Good agreement between the simulated and measured results can be observed, and the measured insertion loss at the passband center frequency (8.38 GHz) is 1.1 dB.
The antibacterial hydrogels can be widely used in the biomedical area owing to their excellent properties. The main limitation of antibacterial hydrogels is their poor mechanical strength. In this study, the novel hydrogels were fabricated with a mixture of silk fibroin (SF), chitosan (CH), agarose (AG), and silver nanoparticles (SNPs) via facile reaction condition without inorganic substances. The mechanical property of these fabricated hydrogels can be modulated by the concentration of SF or AG. The rheological studies demonstrated enhanced elasticity of CH-doped hydrogels. Because of the presence of CH and Ag in hydrogels, the antimicrobial property against gram-positive and gram-negative bacteria was exhibited. Cytocompatibility test proved the very low toxic nature of the hydrogels. In addition, these composite hydrogels have a smaller porosity, higher swelling ratio, and good compatibility, indicating their great potential for biomedical application.
Maternal one-carbon metabolism during pregnancy is crucial for fetal development and programming by DNA methylation. However, evidence on one-carbon biomarkers other than folate is lacking. We, therefore, investigated whether maternal plasma methyl donors, that is, choline, betaine and methionine, are associated with birth outcomes. Blood samples were obtained from 115 women during gestation (median 26·3 weeks, 90 % range 22·7–33·0 weeks). Plasma choline, betaine, methionine and dimethylglycine were measured using HPLC-tandem MS. Multivariate linear and logistic regression models were used to estimate the association between plasma biomarkers and birth weight, birth length, the risk of small-for-gestational-age and large-for-gestational-age (LGA). Higher level of maternal betaine was associated with lower birth weight (–130·3 (95 % CI –244·8, –15·9) per 1 sd increment for log-transformed betaine). Higher maternal methionine was associated with lower risk of LGA, and adjusted OR, with 95 % CI for 1 sd increase in methionine concentration was 0·44 (95 % CI 0·21, 0·89). Stratified analyses according to infant sex or maternal plasma homocysteine status showed that reduction in birth weight in relation to maternal betaine was only limited to male infants or to who had higher maternal homocysteine status (≥5·1 µmol/l). Higher maternal betaine status was associated with reduced birth weight. Maternal methionine was inversely associated with LGA risk. These findings are needed to be replicated in future larger studies.
Magnetic iron oxide nanoparticles (MIONPs) are particularly attractive in biosensor, antibacterial activity, targeted drug delivery, cell separation, magnetic resonance imaging tumor magnetic hyperthermia, and so on because of their particular properties including superparamagnetic behavior, low toxicity, biocompatibility, etc. Although many methods had been developed to produce MIONPs, some challenges such as severe agglomeration, serious oxidation, and irregular size are still faced in the synthesis of MIONPs. Thus, various strategies had been developed for the surface modification of MIONPs to improve the characteristics of them and obtain multifunctional MIONPs, which will widen the applicational scopes of them. Therefore, the processes, mechanisms, advances, advantages, and disadvantages of six main approaches for the synthesis of MIONPs; surface modification of MIONPs with inorganic materials, organic molecules, and polymer molecules; applications of MIONPs or modified MIONPs; the technical challenges of synthesizing MIONPs; and their limitations in biomedical applications were described in this review to provide the theoretical and technological guidance for their future applications.
Thermal conductivity of uranium dioxide (UO2) is an important nuclear fuel performance property. Radiation- and fission-induced defects and microstructures, such as xenon (Xe) gas bubbles, can degrade the thermal conductivity of UO2 significantly. Here, molecular dynamics simulations are conducted to study the effect of Xe bubble size and pressure on the thermal conductivity of UO2. At a given porosity, thermal conductivity increases with Xe cluster size, then reaches a nearly saturated value at a cluster radius of 0.6 nm, demonstrating that dispersed Xe atoms result in a lower thermal conductivity than clustering them into bubbles. In comparison with empty voids of the same size, Xe-filled bubbles lead to a lower thermal conductivity when the number ratio of Xe atoms to uranium vacancies (Xe:VU ratio) in bubbles is high. Detailed atomic-level analysis shows that the pressure-induced distortion of atoms at bubble surface causes additional phonon scattering and thus further reduces the thermal conductivity.
In this work, carbon nanotubes (CNTs)-templated binuclear metallophthalocyanines (MTAPcCF3)2C (M = Mn, Fe, Co, Ni, Cu, Zn) assemblies (MTAPcCF3)2C–COOH–CNTs are designed and obtained. Whereafter, the structure and morphology of target products are analyzed by many means such as infrared, X-ray diffraction, X-ray photoelectron spectroscopy, and scanning electron microscopy. The electrocatalytic performances of lithium-thionyl chloride battery catalyzed by (MTAPcCF3)2C–COOH–CNTs were carried out. The result shows that all catalysts can improve the battery performance including the discharge time and the initial voltage. The catalytic performance of (MTAPcCF3)2C–COOH–CNTs is ordered following the central metal: Mn > Fe > Ni > Co > Cu > Zn. The cell capacity catalyzed by optimal catalyst (MnTAPcCF3)2C–COOH–CNTs can expand to 28.08 mAˑh, with increase by 142.07%, and the (MnTAPcCF3)2C–COOH–CNTs can extend the discharge time to 551.6 s. Besides, the reaction mechanism is presented on the basis of cyclic voltammetry measurements.
CrFeNiTix (x = 0.2, 0.3, 0.4, 0.5, and 0.6 molar ratio) compositionally complex alloys were fabricated by vacuum arc melting to investigate the microstructure, hardness, and compressive properties. The results revealed that CrFeNiTix alloys consisted of the principal face-centered cubic (FCC) phase and body-centered cubic (BCC) solid solution, with an amount of (Ni, Ti)-rich hexagonal close-packed phase. CrFeNiTix alloys exhibited the typical dendrite. Ti0.2 and Ti0.3 alloys were composed of FCC and BCC solid solutions in the dendrite, as well as ε (Ni3Ti) and R (Ni2.67Ti1.33) phases in the inter-dendrite, simultaneously. For Ti0.4, Ti0.5, and Ti0.6 alloys, (Fe, Cr)-rich solid solution separated out and ε phase transformed into R phase gradually. Meanwhile, TEM analysis indicated that Ti0.4 alloy matrix consisted of the principal FCC phase containing (Ni, Ti)-rich intragranular nanoprecipitates. The hardness values of CrFeNiTix alloys were increased with the addition of Ti content and the high compressive strength of CrFeNiTix alloys was maintained, which was attributed to the solid solution strengthening and precipitation hardening.
Camellia oleifera is an important woody plant producing healthy edible oils. People need a large number of molecular markers, especially microsatellite, in breeding of C. oleifera. In this study, we sequenced the root transcriptomes of C. oleifera, and then designed a novel set of microsatellite markers based on the root-expressed genes. We assembled a total of 57,121 unigenes with a length of 42.63 Mb, which harboured 15,902 microsatellites. Among these microsatellites, di-nucleotide repeat motifs were the most abundant group (56.45%), then followed by tri- (25.20%), mono- (12.12%), hexa- (3.21%), penta- (2.18%) and quad-nucleotide ones (0.84%). In total, 6738 primer pairs were designed successfully to amplify the microsatellite loci. To test these microsatellite markers, 48 primer pairs were randomly selected and synthesized and validated in C. oleifera and its eight relatives. Up to 75% of the primer pairs amplified in C. oleifera and its relatives, and 62.5% displayed polymorphism. The transferability and diverse alleles across its eight relatives were detected for each polymorphic primer pair. The novel set of microsatellites derived from the root transcriptomes here provided a useful resource for future molecular genetics improvement of C. oleifera and its relatives.
Few studies have examined the association of various types of Fe with colorectal cancer risk. The aim of this study was to investigate different forms and sources of Fe in relation to colorectal cancer risk in a Chinese population. A total of 2138 patients with colorectal cancer and 2144 sex- and age-matched (5-year interval) controls were recruited from July 2010 to November 2017. Dietary information was assessed by face-to-face interviews using a validated FFQ. Multivariable logistic regression was used to estimate the OR and 95 % CI on models. Intake of Fe from plants and Fe from white meat were inversely associated with the risk of colorectal cancer, while haem Fe and Fe from red meat were positively associated with colorectal cancer risk. The multivariable OR for the highest quartile v. the lowest quartile were 0·72 (95 % CI 0·59, 0·87, Ptrend<0·001) for Fe from plants, 0·54 (95 % CI 0·45, 0·66, Ptrend<0·001) for Fe from white meat, 1·26 (95 % CI 1·04, 1·53, Ptrend=0·005) for haem Fe and 1·83 (95 % CI 1·49, 2·24, Ptrend<0·001) for Fe from red meat intake, respectively. However, no significant association was found between the consumption of total dietary Fe, non-haem Fe, Fe from meat and colorectal cancer risk. This study showed that lower intake of Fe from plants and white meat, as well as higher intake of haem Fe and Fe from red meat, were associated with colorectal cancer risk in a Chinese population.
Compared with end pumping fiber combiner, one of the advantages for side pumping combiner is the unlimited pumping points, which means multi-point or cascaded side pumping can be realized. However, the loss mechanism of the cascaded structure is rarely discussed. In this paper, we present the numerical and experimental investigation about the loss mechanism of a two-stage-cascaded side pumping combiner based on tapered-fused technique. The influence of loss mechanism on the coupling efficiency and thermal load of the fiber coating is analyzed according to simulations and experiments with different tapering ratios for the first stage. Based on the analysis, a cascaded component with total pump coupling efficiency of 96.4% handling a pump power of 1088 W is achieved by employing 1018 nm fiber laser as the pump source. Future work to further improve the performance of a cascaded side pumping combiner is discussed and prospected.
In several lately published studies, the association between single-nucleotide polymorphism (SNP, rs12252) of IFITM3 and the risk of influenza is inconsistent. To further understand the association between the SNP of IFITM3 and the risk of influenza, we searched related studies in five databases including PubMed published earlier than 9 November 2017. Ten sets of data from nine studies were included and data were analysed by Revman 5.0 and Stata 12.0 in our updated meta-analysis, which represented 1365 patients and 5425 no-influenza controls from four different ethnicities. Here strong association between rs12252 and influenza was found in all four genetic models. The significant differences in the allelic model (C vs. T: odds ratio (OR) = 1.35, 95% confidence interval (CI) (1.03–1.79), P = 0.03) and homozygote model (CC vs. TT: OR = 10.63, 95% CI (3.39–33.33), P < 0.00001) in the Caucasian subgroup were discovered, which is very novel and striking. Also novel discoveries were found in the allelic model (C vs. T: OR = 1.37, 95% CI (1.08–1.73), P = 0.009), dominant model (CC + CT vs. TT: OR = 1.48, 95% CI (1.08–2.02), P = 0.01) and homozygote model (CC vs. TT: OR = 2.84, 95% CI (1.36–5.92), P = 0.005) when we compared patients with mild influenza with healthy individuals. Our meta-analysis suggests that single-nucleotide T to C polymorphism of IFITM3 associated with increasingly risk of severe and mild influenza in both Asian and Caucasian populations.