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We aimed to investigate the association between plasma retinol and incident cancer among Chinese hypertensive adults. We conducted a nested case–control study, including 231 patients with incident cancer and 231 matched controls during a median 4·5-year follow-up of the China Stroke Primary Prevention Trial. There was a significant, inverse association between retinol levels and digestive system cancer (per 10 μg/dl increases: OR 0·79; 95 % CI 0·69, 0·91). When compared with participants in the first quartile of retinol (< 52·3 μg/dl), a significantly lower cancer risk was found in participants in quartile 2–4 ( ≥ 52·3 μg/dl: OR 0·31; 95 % CI 0·13, 0·71). However, there was a U-shaped association between retinol levels and non-digestive system cancers where the risk of cancers decreased (although not significantly) with each increment of plasma retinol (per 10 μg/dl increases: OR 0·89; 95 % CI 0·60, 1·31) in participants with retinol < 68·2 μg/dl, and then increased significantly with retinol (per 10 μg/dl increase: OR 1·65; 95 % CI 1·12, 2·44) in participants with retinol ≥ 68·2 μg/dl. In conclusion, there was a significant inverse dose–response association between plasma retinol and the risk of digestive system cancers. However, a U-shaped association was observed between plasma retinol and the risk of non-digestive cancers (with a turning point approximately 68·2 μg/dl).
In this paper, instabilities in the flow over a circular cylinder of diameter
with dual splitter plates attached to its rear surface are numerically investigated using the spectral element method. The key parameters are the splitter plate length
, the attachment angle
and the Reynolds number
. The presence of the plates was found to significantly modify the flow topology, leading to substantial changes in both the primary and secondary instabilities. The results showed that the three instability modes present in the bare circular cylinder wake still exist in the wake of the present configurations and that, in general, the occurrences of modes A and B are delayed, while the onset of mode QP is earlier in the presence of the splitter plates. Furthermore, two new synchronous modes, referred to as mode A
and mode B
, are found to develop in the wake. Mode A
is similar to mode A but with a quite long critical wavelength. Mode B
shares the same spatio-temporal symmetries as mode B but has a distinct spatial structure. With the exception of the case of
, mode A
persists for all configurations investigated here and always precedes the transition through mode A. The onset of mode B
. The characteristics of all the transition modes are analysed, and their similarities and differences are discussed in detail in comparison with the existing modes. In addition, the physical mechanism responsible for the instability mode B
is proposed. The weakly nonlinear feature of mode B
, as well as that of mode A
, is assessed by employing the Landau model. Finally, selected three-dimensional simulations are performed to confirm the existence of these two new modes and to investigate the nonlinear evolution of the three-dimensional modes.
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.
Schizophrenia is a complex mental disorder with high heritability and polygenic inheritance. Multimodal neuroimaging studies have also indicated that abnormalities of brain structure and function are a plausible neurobiological characterisation of schizophrenia. However, the polygenic effects of schizophrenia on these imaging endophenotypes have not yet been fully elucidated.
To investigate the effects of polygenic risk for schizophrenia on the brain grey matter volume and functional connectivity, which are disrupted in schizophrenia.
Genomic and neuroimaging data from a large sample of Han Chinese patients with schizophrenia (N = 509) and healthy controls (N = 502) were included in this study. We examined grey matter volume and functional connectivity via structural and functional magnetic resonance imaging, respectively. Using the data from a recent meta-analysis of a genome-wide association study that comprised a large number of Chinese people, we calculated a polygenic risk score (PGRS) for each participant.
The imaging genetic analysis revealed that the individual PGRS showed a significantly negative correlation with the hippocampal grey matter volume and hippocampus–medial prefrontal cortex functional connectivity, both of which were lower in the people with schizophrenia than in the controls. We also found that the observed neuroimaging measures showed weak but similar changes in unaffected first-degree relatives of patients with schizophrenia.
These findings suggested that genetically influenced brain grey matter volume and functional connectivity may provide important clues for understanding the pathological mechanisms of schizophrenia and for the early diagnosis of schizophrenia.
There is little evidence in China regarding the cost-effectiveness of non-invasive prenatal testing (NIPT) for Down syndrome (DS). This study aims to evaluate the cost-effectiveness of NIPT and provide evidence to inform decision-making.
To determine the cost-effectiveness of NIPT for DS, a decision-analytic model was developed using the TreeAge Pro software from a societal perspective in a simulated cohort of 10 000 pregnant women. Main indicators were based on field surveys from sampled hospitals in four locations in China and a literature review.
The conventional maternal serum screening (CMSS) strategy, contingent screening strategy (NIPT delivered to high risk pregnant women after CMSS), and universal screening strategy could prevent 3.02, 7.53, and 9.97 DS births, respectively. NIPT would decrease unnecessary invasive procedures, resulting in fewer procedure-related miscarriages. The cost-effectiveness ratio of the contingent screening strategy was the lowest. When compared with the CMSS strategy, the incremental cost per DS birth averted by the contingent screening strategy and universal screening strategy were USD 20,160 and 352,388, respectively. One-way sensitivity analysis showed that, if the cost of NIPT could be decreased to USD 76.92, the cost-effectiveness ratio of the universal screening strategy would be lower than the CMSS strategy.
Although NIPT has the merits of greater effectiveness and safety, CMSS is unlikely to be replaced by NIPT at this time because of NIPT's higher cost. Contingent screening may be an appropriate strategy to balance the effectiveness and cost factors of the new genetic testing technology.
Ceramics are strong but brittle. According to the classical theories, ceramics are brittle mainly because dislocations are suppressed by cracks. Here, the authors report the combined elastic and plastic deformation measurements of nanoceramics, in which dislocation-mediated stiff and ductile behaviors were detected at room temperature. In the synchrotron-based deformation experiments, a marked slope change is observed in the stress–strain relationship of MgAl2O4 nanoceramics at high pressures, indicating that a deformation mechanism shift occurs in the compression and that the nanoceramics sample is elastically stiffer than its bulk counterpart. The bulk-sized MgAl2O4 shows no texturing at pressures up to 37 GPa, which is compatible with the brittle behaviors of ceramics. Surprisingly, substantial texturing is seen in nanoceramic MgAl2O4 at pressures above 4 GPa. The observed stiffening and texturing indicate that dislocation-mediated mechanisms, usually suppressed in bulk-sized ceramics at low temperature, become operative in nanoceramics. This makes nanoceramics stiff and ductile.
Paediatric Mycoplasma pneumoniae pneumonia (MPP) is a major cause of community-acquired pneumonia in China. Data on epidemiology of paediatric MPP from China are little known. This study retrospectively collected data from June 2006 to June 2016 in Beijing Children's Hospital, Capital Medical University of North China and aims to explore the epidemiological features of paediatric MPP and severe MPP (SMPP) in North China during the past 10 years. A total of 27 498 paediatric patients with pneumonia were enrolled. Among them, 37.5% of paediatric patients had MPP. In this area, an epidemic took place every 2–3 years at the peak, and the positive rate of MPP increased during these peak years over time. The peak age of MPP was between the ages of 6 and 10 years, accounting for 75.2%, significantly more compared with other age groups (χ2 = 1384.1, P < 0.0001). The epidemics peaked in September, October and November (χ2 = 904.9, P < 0.0001). Additionally, 13.0% of MPP paediatric patients were SMPP, but over time, the rate of SMPP increased, reaching 42.6% in 2016. The mean age of paediatric patients with SMPP (6.7 ± 3.0 years old) was younger than that of patients with non-SMPP (7.4 ± 3.2 years old) (t = 3.60, P = 0.0001). The prevalence of MPP and SMPP is common in China, especially in children from 6 to 10 years old. Paediatric patients with SMPP tend to be younger than those with non-SMPP. MPP outbreaks occur every 2–3 years in North China. September, October and November are the peak months, unlike in South China. Understanding the epidemiological characteristics of paediatric MPP can contribute to timely treatment and diagnosis, and may improve the prognosis of children with SMPP.
Toxigenic Clostridium difficile (C. difficile) carriers represent an important source in the transmission of C. difficile infection (CDI) during hospitalisation, but its prevalence and mode in patients with hepatic cirrhosis are not well established. We investigated longitudinal changes in carriage rates and strain types of toxigenic C. difficile from admission to discharge among hepatic cirrhosis patients. Toxigenic C. difficile was detected in 104 (19.8%) of 526 hepatic cirrhosis patients on admission, and the carriage status changed in a portion of patients during hospitalisation. Approximately 56% (58/104) of patients lost the colonisation during their hospital stay. Among the remaining 48 patients who remained positive for toxigenic C. difficile, the numbers of patients who were positive at one, two, three and four isolations were 10 (55.6%), three (16.7%), two (11.1%) and three (16.7%), respectively. Twenty-eight patients retained a particular monophyletic strain at multiple isolations. The genotype most frequently identified was the same as that frequently identified in symptomatic CDI patients. A total of 25% (26/104) of patients were diagnosed with CDI during their hospital stay. Conclusions: Colonisation with toxigenic C. difficile strains occurs frequently in cirrhosis patients and is a risk factor for CDI.
This research examines the anger and collective action intentions among different social classes in China. Based on social cognition theory with respect to social class, we proposed that the relationship between group-based anger and collective action intentions would be moderated by social class. To test this hypothesis, two studies were conducted. First, using data collected from a sample of 100 residents of Hubei Province, China, Study 1 found that the relationship between group-based anger and collective action intentions was moderated by social class: group-based anger can predict collective action intentions among the upper social class but not among the lower social class. Then, Study 2 employed a 2 × 2 completely randomised design. Its 118 participants were manipulated to experience a momentary change in their subjective social class and the level of their group-based anger before measuring their collective action intentions. The results were consistent with Study 1. Taken together, the findings suggest that social class does moderate the relationship between group-based anger and collective action intentions.
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.
This study applied a bifactor approach to investigate the structures and simultaneously compare the psychometric properties of three popular self-report internet addiction (IA) instruments. A bifactor confirmatory factor analysis was used to address the structures of the three scales, while the bifactor multidimensional item response model was employed to compare the psychometric properties of the three scales. Results of bifactor confirmatory factor analysis (CFA) showed that the bifactor structures were suitable for the three scales. These corresponding bifactor structures were used in the subsequent bifactor multidimensional item response theory (MIRT) analysis. Results of the bifactor MIRT showed that: three instruments of IA performed well as a whole; the Generalised Problematic Internet Use Scale (GPIUS) and Internet Addiction Test (IAT) provided more test information and had less standard error of measurement, which ranged from −3 to −1 standard deviations of theta or IA severity; the Game Addiction Scale (GAS) performed better than the other two scales in that it can provide more test information in the large area of IA severity (from −1 to +3 SDs). These suggest that the GPIUS and IAT may be the best choice for epidemiological IA studies and for measuring those with lower IA severity. Meanwhile, the GAS may be a good choice when we recruit those with various levels of IA severity.
Seed reserves play vital roles in seed germination and seedling growth and their variation may be related to various environment factors, plant traits and phylogenetic history. Here, the evolutionary correlation associated with seed mass and altitude and carbon (C), nitrogen (N) and phosphorus (P) allocation of seeds among 253 alpine herbaceous plants was tested. In this study, phylogeny had strong limitations on nutrient allocation of seeds across species, and species from younger phylogenetic groups tended to have higher N and P contents, which might be considered as the evolutionary selection of seed plants. Higher seed N and P content would help seedlings to gain more survival chance and stronger competitive capacity, and their progeny would be more likely to be preserved. When phylogeny was considered, altitude only had a significant positive effect on P content, but the negative effects on seed mass were all expressed. The independent effects of altitude and seed mass suggest that the nutrient allocation of seeds might be affected by both environment and plant traits. In addition, altitude and seed mass displayed partial overlapping effects on nutrient allocation of seeds. The negative effects of seed mass were affected slightly by altitude, whereas altitude only had a significant positive effect on P content when seed mass was controlled. Above all, seed P content showed obvious and general correlations with seed mass, altitude and age of clade, which indicated that higher seed P content might be an adaptive selection of species associated with growth and survival of progeny.
Soybean [Glycine max (L.) Merr.] is one of the most important legume crops in the world. However, soybean grain yield is extensively affected by environmental stresses such as soil salinity. In this study, we evaluated the germplasm of 51 Indonesian soybean accessions for salt tolerance to identify salt-tolerant germplasms for possible use in breeding for soybean salt tolerance. Based on experiments under hydroponic conditions, adding 100 mM of NaCl to a 1/2 concentration of Hoagland and Arnon solution, several Indonesian soybean germplasms, such as Java 7, Seputih Raman, Tambora, Ringgit (JP 30217), Sinyonya (early) and Sinyonya (late) were identified as salt-tolerant in terms of salt tolerance rate (STR) and leaf chlorophyll content (SPAD value) taken with the Konica Minolta SPAD-502 chlorophyll meter. The selected salt-tolerant germplasms were further evaluated under soil medium cultivation in pots irrigated with 100 mM NaCl for around 5 weeks. The six selected soybean germplasms again showed higher salt tolerance in terms of SPAD, STR and shoot dry weight. Expression analysis of the salt tolerance gene Ncl revealed a significant positive correlation between Ncl expression and salt tolerance, suggesting that Ncl is essential for salt tolerance in the Indonesian soybean germplasms we tested. The salt-tolerant Indonesian soybean germplasms identified in this study could be used in local soybean breeding practices for the improvement of salt tolerance.
Highly dense zirconia dental ceramic coatings were fabricated by aqueous electrophoretic deposition (EPD) and subsequently sintered between 1250 and 1450 °C. Microstructural examination revealed that aqueous EPDZrO2 coatings possessed a tetragonal phase structure and the grain size increased with increasing sintering temperature. Nanoindentation study proved that the aqueous EPDZrO2 coating also had excellent mechanical properties. The effect of different applied loads on hardness and elastic modulus of the 1350 °C-sintered sample at room temperature was investigated by the method of progressive multicycle measurement nanoindentation. The simulative experiment proved that hardness of aqueous EPDZrO2 exhibited reverse indentation size effect (ISE) behavior and then displayed the normal ISE response. The analysis indicates that the reverse ISE is attributed to the relaxation of surface stresses resulting from indentation cracks at small loads and normal ISE is caused by geometrically necessary dislocations. The tetragonal–monoclinic stress-induced phase transformation during nanoindentation is the primary cause of dental zirconia failures.
This paper proposes a microstrip antenna with reduced in-band and out-of-band radar cross-section (RCS) by subtracting the area of weak scattered current on the ground plane. Fourteen square slots were subtracted from the ground plane, reducing in-band and out-of-band RCS while maintaining radiation performance. Modified and reference antenna surface current distributions were simulated and analyzed in radiating and scattering modes. Two antenna prototypes were fabricated and measured to verify the simulation. The proposed antenna RCS was reduced compared with the reference antenna in the frequency range 1–4.4 GHz, including in-band and out-of-band frequency bands. Maximum in-band and out-of-band RCS reduction was 16.3 dBsm at the working frequency, and 19.3 dBsm at 3.4 GHz, respectively
We sought to examine the potential modifiers in the association between long-term low-dose folic acid supplementation and the reduction of serum total homocysteine (tHcy) among hypertensive patients, using data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 16 867 participants who had complete data on tHcy measurements at both the baseline and exit visit. After a median treatment period of 4·5 years, folic acid treatment significantly reduced the tHcy levels by 1·6 μmol/l (95 % CI 1·4, 1·8). More importantly, after adjustment for baseline tHcy and other important covariates, a greater degree of tHcy reduction was observed in certain subgroups: males, the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype, higher baseline tHcy levels (≥12·5 (median) v. <12·5 μmol/l), lower folate levels (<8·0 (median) v. ≥8·0 ng/ml), estimated glomerular filtration rate (eGFR) <60 ml/min per 1·73 m2 (v. 60–<90 and ≥90 ml/min per 1·73 m2), ever smokers and concomitant use of diuretics (P for all interactions <0·05). The degree of tHcy reduction associated with long-term folic acid supplementation can be significantly affected by sex, MTHFR C677T genotypes, baseline folate, tHcy, eGFR levels and smoking status.
Minimally invasive surgery is a developing direction of modern medicine. With the successful development of controllable capsule endoscopies, capsule robots are very popular in the field of gastrointestinal medicine. At present, the study of intestinal robots is aimed at the pipeline environment of a single-phase liquid flow. But there exist food residues (i.e. solid particles) or liquid foods in the actual intestine, so intestinal fluid should be liquid–solid or liquid–liquid two-phase mixed fluid. For inner spiral capsule robots with different internal diameters and outer spiral capsule robots, using computational fluid dynamics (CFD) method, the operational performance indicators (i.e. axial thrust force, circumferential resisting moment and maximum pressure to pipeline wall) of spiral capsule robots are numerically calculated in the liquid–solid or liquid–liquid two-phase mixed fluid. By the orthogonal experimental optimization method, the optimum design of spiral capsule robots is obtained in the liquid–solid mixed fluid. The experimental verification has been also carried out. The results show that in the liquid–solid two-phase fluid, the axial thrust force and circumferential resisting moment of the spiral capsule robots decrease with the increase of the size or concentration of solid particles. In the same liquid–solid or liquid–liquid mixed fluid, the operational performance indicators of outer spiral robots are much higher than those of inner spiral robots, and the operational performance indicators of inner spiral robots with bigger internal diameters are higher than those with smaller internal diameters. Adding solid particles of high concentration in the pipeline containing liquid will reduce the drive performance of spiral capsule robots, but adding another liquid of high viscosity will improve the drive performance of spiral capsule robots.
This study aim to derive and validate a simple and well-performing risk calculator (RC) for predicting psychosis in individual patients at clinical high risk (CHR).
From the ongoing ShangHai-At-Risk-for-Psychosis (SHARP) program, 417 CHR cases were identified based on the Structured Interview for Prodromal Symptoms (SIPS), of whom 349 had at least 1-year follow-up assessment. Of these 349 cases, 83 converted to psychosis. Logistic regression was used to build a multivariate model to predict conversion. The area under the receiver operating characteristic (ROC) curve (AUC) was used to test the effectiveness of the SIPS-RC. Second, an independent sample of 100 CHR subjects was recruited based on an identical baseline and follow-up procedures to validate the performance of the SIPS-RC.
Four predictors (each based on a subset of SIPS-based items) were used to construct the SIPS-RC: (1) functional decline; (2) positive symptoms (unusual thoughts, suspiciousness); (3) negative symptoms (social anhedonia, expression of emotion, ideational richness); and (4) general symptoms (dysphoric mood). The SIPS-RC showed moderate discrimination of subsequent transition to psychosis with an AUC of 0.744 (p < 0.001). A risk estimate of 25% or higher had around 75% accuracy for predicting psychosis. The personalized risk generated by the SIPS-RC provided a solid estimate of conversion outcomes in the independent validation sample, with an AUC of 0.804 [95% confidence interval (CI) 0.662–0.951].
The SIPS-RC, which is simple and easy to use, can perform in the same manner as the NAPLS-2 RC in the Chinese clinical population. Such a tool may be used by clinicians to counsel appropriately their patients about clinical monitor v. potential treatment options.