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To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry.
A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018.
The study was conducted using data from 5 adult ICUs of a referral hospital.
Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days.
Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses.
Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU.
Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.
The Dayao Paleolithic site, located in Inner Mongolia on the eastern margin of China's vast northwestern drylands, was a lithic quarry-workshop utilized by Pleistocene human migrants through the region. Determining the age of this activity has previously yielded controversial results. Our magnetostratigraphic and OSL dating results suggest the two artifact-bearing paleosols are correlated with MIS 5 and 7, respectively. Correlating paleoclimatic data with marine δ18O records leads us to conclude that two sandy gravel layers containing many artifacts in the lower part of the Dayao sequence were formed during MIS 9 and 11, if not earlier. Our results reveal that the earliest human occupation at the Dayao site occurred before ca. 400 ka during a relatively warm and moist interglacial period, similar to several subsequent occupations, documenting the earliest and northernmost archaeological assemblage yet reported in China's arid northwest. We conclude that the northward and southward displacements of the East Asian summer monsoon rain belt during past interglacial-glacial cycles were responsible for the discontinuous human occupation detected at the Dayao site. The penetration of this precipitation regime into dryland ecologies via the Huanghe (Yellow River) Valley effectively created a corridor for hominin migration into China's arid northwest.
Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design.
This study aims to explore the response trajectory of antipsychotics and compare the treatment responses of seven different antipsychotics over 6 weeks in patients with schizoprenia (trial registration: Chinese Clinical Trials Registry Identifier: ChiCTR-TRC-10000934).
Data were collected from a multicentre, randomised open-label clinical trial. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up at weeks 2, 4 and 6. Trajectory groups were classified by the method of k-means cluster modelling for longitudinal data. Trajectory analyses were also employed for the seven antipsychotic groups.
The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders. The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in PANSS scores at week 6. A total of 349 patients were inconsistently grouped by the two methods, with a significant difference in the composition ratio of treatment response groups using these two methods (χ2 = 43.37, P < 0.001). There was no differential contribution of high- and low trajectories to different drugs (χ2 = 12.52, P = 0.051); olanzapine and risperidone, which had a larger proportion in the >50% reduction at week 6, performed better than aripiprazole, quetiapine, ziprasidone and perphenazine.
The trajectory analysis of treatment response to schizophrenia revealed two distinct trajectories. Comparing the treatment responses to different antipsychotics through longitudinal analysis may offer a new perspective for evaluating antipsychotics.
A–Ar–A-type small molecule (SM) of Py-2DTOBT and Py-2DTOBTPh with an Ar(A–D)2 framework were synthesized, in which 2,7-pyrene (Py) and alkoxyl-substituted benzothiadiazole (OBT) were, respectively, used as the central aryl (Ar) and arm acceptor (A), while 3-phenanthrene (Ph) was used as a terminal donor (D) in Py-2DTOBTPh. By comparison with the parent SM of Py-2DTBT, where 2,7-pyrene (Py) and benzothiadiazole (BT) were used as the central aryl (Ar) and arm acceptor (A), the effects of non-covalent interactions and the terminal group on optical, electrochemical, and photovoltaic properties were investigated. The gradually improved photovoltaic performances were observed among Py-2DTBT, Py-2DTOBT, and Py-2DTOBTPh based organic solar cells. A power conversion efficiency (PCE) of 2.83% was obtained in the Py-2DTOBTPh/PC71BM-based device, which is a 53% improvement related to that of Py-2DTOBT and three times enhanced related to that of Py-2DTBT(Py-2DTOBT:PCE of 1.86%, Py-2DTBT:PCE of 0.74%).
In March 2020, China had periodically controlled the coronavirus disease-19 (COVID-19) epidemic. We reported the results of health screening for COVID-19 among returned staff of a hospital and conducted a summary analysis to provide valuable experience for curbing the COVID-19 epidemic and rebound. In total, 4729 returned staff from Zhongnan Hospital of Wuhan University, Wuhan, China were examined for COVID-19, and the basic information, radiology and laboratory test results were obtained and systematically analysed. Among the 4729 employees, medical staff (62.93%) and rear-service personnel (30.73%) were the majority. The results of the first physical examination showed that 4557 (96.36%) were normal, 172 (3.64%) had abnormal radiological or laboratory test results. After reexamination and evaluation, four were at high risk (asymptomatic infections) and were scheduled to transfer to a designated hospital, and three were at low risk (infectivity could not be determined) and were scheduled for home isolation observation. Close contacts were tracked and managed by the Center for Disease Control and Prevention (CDC) in China. Asymptomatic infections are a major risk factor for returning to work. Extensive health screening combined with multiple detection methods helps to identify asymptomatic infections early, which is an important guarantee in the process of returning to work.
To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women.
We conducted a case–control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model.
A case–control study of women at a hospital in Beijing, China.
One thousand and fifteen Chinese women.
The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004).
This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.
To assess the prevalence and to identify the associated factors of malnutrition among elderly Chinese with physical functional dependency.
Face-to-face interviews using standardised questionnaires were conducted to collect demographic information, health-related issues and psychosocial status. Physical function was measured by the Barthel Index (BI), and nutrition status was assessed by the Mini Nutritional Assessment–Short Form. Multivariate binary logistic regression was used to assess associated factors of malnutrition.
A total of 2323 participants (aged ≥ 60 years) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme.
The prevalence of malnutrition was 17·9 % (95 % CI 16·3, 19·4). Multivariable binary logistic regression revealed the independent risk factors of poor nutrition status were being female, older age, lower educational status, poor hearing, poor physical functional status, lack of hobbies, low religious participation, poor social support, lack of social participation and changes in social participation. The study found that the most significant independent risk factor for malnutrition was complete physical functional dependence (OR 4·46, 95 % CI 2·92, 6·82).
The findings of the study confirm that malnutrition and the risk of malnutrition are prevalent in Chinese older adults with physical functional dependency. In addition to demographic and physical health-related factors, psychosocial factors, which are often overlooked, are independently associated with nutrition status in Chinese older adults with physical functional dependency. A holistic approach should be adopted to screen for malnutrition and develop health promotion interventions in this vulnerable population.
Recently, Echinacea purpurea and its extracts have gained much interest due to their improvement on meat quality, but little information is available on the application of the purified Echinacea purpurea polysaccharide (4-O-methyl-glucuronoarabinoxylan, 4OMG). Thus, this trial aimed at assessing the effects of dietary supplementation of 4OMG on growth performance, thigh meat quality and small intestine development of broilers. A total of 240 1-day-old female broiler chicks were randomly distributed to four groups with three replicates of 20 within each group. Each group received either 0, 15, 20 or 25 g 4OMG/kg DM of diet. During the entire experiment, broilers had ad libitum access to water and feed, and the feed intake was recorded daily. All broilers were weighed before and end of the experiment. For each group, three pens with a total of 20 broilers were randomly selected to slaughter after 30 days. Increasing dietary supplementation of 4OMG linearly increased final live weight and daily body weight gain (P = 0.013) of broilers, Gain-to-Feed ratio (P < 0.001), muscle pH (P = 0.024) and redness (P = 0.001), but decreased drip loss (P = 0.033), shear force value (P = 0.004) and hardness (P = 0.022) of the thigh meat. Broilers fed diet with higher 4OMG had greater weight index, villus height and ratio of villus height to crypt depth in both duodenum and jejunum. These results indicated that increasing dietary supplementation of 4OMG was beneficial for growth performance, meat quality and development of the small intestine of broilers.
With their abilities of self-renewal and pluripotency to differentiate into all three germ layers, human induced pluripotent stem cells (hiPSCs) are a promising cell source for cell-based drug and implant testing. However, the large-scale expansion and maintenance of hiPSCs requires following strict protocols. There is high demand for advanced cell culture systems capable of generating high-quality hiPSCs to meet application requirements. In this study, we probe the possibility of modifying polymeric substrates for maintaining the self-renewal and pluripotency of hiPSCs. Here, polydopamine (PDA) was employed to immobilize the Laminin 521 (LN521) onto the surface of polyethylene terephthalate (PET). An aqueous solution of dopamine with concentrations ranging from 0 to 2.0 mg/mL was applied on PET surfaces. These PDA-modified surfaces were further functionalized with LN521. Surface wettability was evaluated by measuring the water contact angle (WCA) and surface properties of the modified substrate were analyzed using an atomic force microscope (AFM). Initial hiPSC attachment (1h after seeding) and cell proliferation were evaluated by counting the total cell number. The maintenance of pluripotency was evaluated at designed time points. WCA of the PDA-LN521 surfaces gradually decreased from 62.1°±6.3° to 8.1°±2.9°. The maximum peak-to-valley height roughness (Rt) of those surfaces determined by AFM increased in a dopamine-concentration-dependent manner, ranging from 43.9±1.6 nm to 126.7±7.6 nm. The Young’s modulus of these surfaces was substantially increased from 0.98±0.36 GPa to 4.81±2.41 GPa. There was a significant enhancement (13.0±7.2% and 24.2±8.1%) of hiPSC adhesion on PDA-LN521 (dopamine concentration at 0.125 and 0.25 mg/mL). When increasing the dopamine concentration to 0.5 and 1.0 mg/mL, there was no further increase in hiPSC adhesion on PDA-LN521 surfaces. Moreover, hiPSC proliferation was remarkably enhanced on PDA-LN521 surface (dopamine solution at concentration from 0.125 to 1.0 mg/mL). Pluripotency of hiPSCs was not affected by PDA treatment. In conclusion, PDA-mediated surface modification is an effective approach for the robust expansion and maintenance of hiPSCs on polymer substrates.
Anatase phase NOx/S6+–TiO2 (x= 0, 1) film with high solar-driven activity has been successfully prepared via electro-assisted oxidation processes. The morphological and structural properties of the film were characterized by scanning electron microscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, and X-ray diffraction, while the optical property was detected by UV-vis-NIR absorption spectroscopy. The results showed that the NOx/S6+–TiO2 film was composed of “flower-like” microvoids structure and displayed broad and strong optical absorption at around 544 and 1500 nm. Transient photocurrent response, photoluminescence spectroscopy, and electrochemical impedance spectroscopy indicated that the generation and separation of photogenerated charges were significantly enhanced under simulated solar irradiation. The NOx/S6+–TiO2 film exhibited excellent photoelectrocatalytic activity for the degradation of methyl orange (MO), and the decoloration rate and TOC removal respectively reached 98.97 and 59.44% at 20 min under solar irradiation. The film still had good stability after reusing ten times. Furthermore, a possible mechanism of photoelectrocatalysis was suggested in MO degradation by using NOx/S6+–TiO2 film.
This study aimed to reveal the associated risk factors for latent tuberculosis infection (LTBI) detected by T-SPOT.TB assay among health care workers (HCWs) at different working locations or job categories in China. This cross-sectional study included 934 HCWs who underwent the T-SPOT.TB assay. Demographic and social characteristics of the participants, including age, sex, job categories, department/ward and duration of healthcare service, were recorded. Among 934 HCWs, 267 (28.5867%) were diagnosed as having LTBI with positive T-SPOT.TB assay. HCWs working in inpatient tuberculosis (TB) (odds ratio (OR) 2.917; 95% confidence interval (CI) 1.852–4.596; P < 0.001) and respiratory wards (OR 1.840; 95% CI 1.124–3.011; P = 0.015), and with longer duration of healthcare service (OR 1.048; 95% CI 1.016–1.080; P = 0.003) were risk factors for positive T-SPOT.TB result. Furthermore, longer working duration increased the positive rate of T-SPOT.TB results for physicians and nurses, and physicians had higher risks than nurses for the same working duration. Inpatient TB and respiratory wards were high-risk working locations for HCWs with LTBI, and longer duration of healthcare service also increased the risk of LTBI among HCWs. A complete strategy for TB infection control and protection awareness among HCWs should be enhanced.
Determining an appropriate grasp configuration for multi-finger grasping is difficult due to the complexity of robotic hands. The multi-finger grasp planning should consider not only geometry constraints of objects but also kinematics and dynamics of robotic hand. In this paper, a precision grasp-planning framework is presented for multi-finger hand to grasp unknown objects. First, the manipulation capabilities of the robotic hand are analyzed. The analysis results are further used as bases for the precision grasp planning. Second, the superquadric (SQ) fitting method is used for approximating unknown object models. Finally, a local–global optimization method is implemented to find appropriate grasp configurations for dexterous hand. The presented planning framework is validated in simulation experiments. Simulation results demonstrated that the presented grasp-planning framework enables the multi-finger hand to grasp unknown objects effectively.
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.
Relativistic collisionless shock charged particle acceleration is considered as a possible origin of high-energy cosmic rays. However, it is hard to explore the nature of relativistic collisionless shock due to its low occurring frequency and remote detecting distance. Recently, there are some works attempt to solve this problem by generating relativistic collisionless shock in laboratory conditions. In laboratory, the scheme of generation of relativistic collisionless shock is that two electron–positron pair plasmas knock each other. However, in laboratory, the appropriate pair plasmas have been not generated. The 10 PW laser pulse maybe generates the pair plasmas that satisfy the formation condition of relativistic collisionless shock due to its ultrahigh intensity and energy. In this paper, we study the positron production by ultraintense laser high Z target interaction using numerical simulations, which consider quantum electrodynamics effect. The simulation results show that the forward positron beam up to 1013/kJ can be generated by 10 PW laser pulse interacting with lead target. The estimation of relativistic collisionless shock formation shows that the positron yield satisfies formation condition and the positron divergence needs to be controlled. Our results indicate that the generation of relativistic collisionless shock by 10 PW laser facilities in laboratory is possible.
We are interested in the rate of convergence of a subordinate Markov process to its invariant measure. Given a subordinator and the corresponding Bernstein function (Laplace exponent), we characterize the convergence rate of the subordinate Markov process; the key ingredients are the rate of convergence of the original process and the (inverse of the) Bernstein function. At a technical level, the crucial point is to bound three types of moment (subexponential, algebraic, and logarithmic) for subordinators as time t tends to ∞. We also discuss some concrete models and we show that subordination can dramatically change the speed of convergence to equilibrium.
TiO2 nanotubes have been demonstrated with promising future in photoelectrocatalytic (PEC)_ applications and deposition of Pt nanoparticles on TiO2 has been widely used to enhance their PEC activities. However, those Pt nanoparticles are normally randomly deposited on the surface of TiO2 nanotubes. Selective deposition of Pt nanoparticles is important to achieve better charge separation. In this study, we reported an electrochemical activation step to prepare TiO2 nanotubes deposited with Pt nanoparticles on their open ends. The “activation step” played a key role in achieving a clean surface of the TiO2 nanotubes, thus ensuring the uniform growth of Pt nanoparticles and efficient photogenerated electrons transportation. The Pt-A-TiO2 films have photocatalytic activities in hydrogen generation and methyl orange degradation with a high hydrogen generation rate of 0.74 mL/h/cm2, three times that of the pure TiO2 nanotubes (0.24 mL/h/cm2). Thus, this study demonstrated an effective method for improving the performance of Pt/TiO2 photocatalyst.
Cerebral small vessel disease (SVD) is the common cause of cognitive decline in the old population. MRI can be used to clarify its mechanisms. However, the surrogate markers of MRI for early cognitive impairment in SVD remain uncertain to date. We investigated the cognitive impacts of cerebral microbleeds (CMBs), diffusion tensor imaging (DTI), and brain volumetric measurements in a cohort of post-stroke non-dementia SVD patients.
Fifty five non-dementia SVD patients were consecutively recruited and categorized into two groups as no cognitive impairment (NCI) (n = 23) or vascular mild cognitive impairment (VaMCI) (n = 32). Detailed neuropsychological assessment and multimodal MRI were completed.
The two groups differed significantly on Z scores of all cognitive domains (all p < 0.01) except for the language. There were more patients with hypertension (p = 0.038) or depression (p = 0.019) in the VaMCI than those in the NCI group. Multiple regression analysis of cognition showed periventricular mean diffusivity (MD) (β = −0.457, p < 0.01) and deep CMBs numbers (β = −0.352, p < 0.01) as the predictors of attention/executive function, which explained 45.2% of the total variance. Periventricular MD was the independent predictor for either memory (β = −0.314, p < 0.05) or visuo-spatial function (β = −0.375, p < 0.01); however, only small proportion of variance could be accounted for (9.8% and 12.4%, respectively). Language was not found to be correlated with any of the MRI parameters. No correlation was found between brain atrophic indices and any of the cognitive measures.
Arteriosclerotic CMBs and periventricular white matter disintegrity seem to be independent MRI surrogated markers in the early stage of cognitive impairment in SVD.
Owing to the difficulty in obtaining mammary gland tissue from lactating animals, it is difficult to test the expression levels of genes in mammary gland. The aim of the current study was to identify if milk fat globule (MFG) in buffalo milk was an alternative to mammary gland (MG) and milk somatic cell (MSC) for gene expression analysis. Six buffalos in late lactation were selected to collect MFG and MSC, and then MG was obtained by surgery. MFG was stained with acridine orange to successfully visualise RNA and several cytoplasmic crescents in MFG. The total RNA in MFG was successfully isolated and the integrity was assessed by agarose gel electrophoresis. We analysed the cellular components in MFG, MG and MSC through testing the expression of cell-specific genes by qRT-PCR. The results showed that adipocyte-specific gene (AdipoQ) and leucocyte-specific genes (CD43, CSF1 and IL1α) in MFG were not detected, whereas epithelial cell marker genes (Keratin 8 and Keratin 18) in MFG were higher than in MSC and lower than in MG, fibroblast marker gene (vimentin) in MFG was significantly lower than in MG and MSC, milk protein genes (LALBA, BLG and CSN2) and milk fat synthesis-related genes (ACC, BTN1A1, FABP3 and FAS) in MFG were higher than in MG and MSC. In conclusion, the total RNA in MFG mainly derives from mammary epithelial cells and can be used to study the functional gene expression of mammary epithelial cells.