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Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
The aim of this study was to assess the current status of disease-related knowledge and to analyze the relationship among the general condition, illness perception, and psychological status of patients with coronavirus disease 2019 (COVID-19).
A hospital-based cross-sectional study was conducted on 118 patients using convenience sampling. The general questionnaire, disease-related knowledge questionnaire of COVID-19, Illness Perception Questionnaire (IPQ), and Profile of Mood States (POMS) were used to measure the current status of participants.
The overall average score of the disease-related knowledge of patients with COVID-19 was (79.19 ± 14.25), the self-care situation was positively correlated with knowledge of prevention and control (r = 0.265; P = 0.004) and total score of disease-related knowledge (r = 0.206; P = 0.025); the degree of anxiety was negatively correlated with the knowledge of diagnosis and treatment (r = −0.182; P = 0.049). The score of disease-related knowledge was negatively correlated with negative cognition (volatility, consequences, emotional statements) and negative emotions (tension, fatigue, depression) (P < 0.05); positively correlated with positive cognition (disease coherence) and positive emotion (self-esteem) (P < 0.05).
It was recommended that we should pay more attention to the elderly and low-income groups, and increase the knowledge about diagnosis and treatment of COVID-19 and self-care in the future health education for patients.
The East Asian winter monsoon (EAWM) is one of the most dynamic components of the global climate system. Although poorly understood, knowledge of long-term spatial differences in EAWM variability during the glacial–interglacial cycles is important for understanding the dynamic processes of the EAWM. We reconstructed the spatiotemporal characteristics of the EAWM since the last glacial maximum (LGM) using a comparison of proxy records and long-term transient simulations. A loess grain-size record from northern China (a sensitive EAWM proxy) and the sea surface temperature gradient of an EAWM index in sediments of the southern South China Sea were compared. The data–model comparison indicates pronounced spatial differences in EAWM evolution, with a weakened EAWM since the LGM in northern China but a strengthened EAWM from the LGM to the early Holocene, followed by a weakening trend, in southern China. The model results suggest that variations in the EAWM in northern China were driven mainly by changes in atmospheric carbon dioxide (CO2) concentration and Northern Hemisphere ice sheets, whereas orbital insolation and ice sheets were important drivers in southern China. We propose that the relative importance of insolation, ice sheets, and atmospheric CO2 for EAWM evolution varied spatially within East Asia.
Aggressive behaviour is common in animals and typically has lifetime consequences. As younger males have higher residual reproductive value than older males and lose more from injuries than older males do, the propensity for fighting tends to increase with age in many empirical reports and species. However, fighting patterns in those empirical reports cannot confirm the hypothesis that individuals cannot readily inflict injuries on their opponents. To address this shortcoming, a parasitoid wasp species, Anastatus disparis (Hymenoptera: Eupelmidae), was used as an experimental model to explore the characteristics of aggression from a life-history perspective; this wasp exhibits extreme fighting, resulting in contestants experiencing injury and death. Results showed that the energetic costs of fighting to injury significantly shortened life and caused the loss of most mating ability. Inconsistent with general predictions, the frequency and intensity of fighting in A. disparis significantly decreased with male age. Further study results showed significantly more young males were received by and successfully mated with virgin females, and most genes related to energy metabolism were downregulated in aged males. Our study provided supporting evidence that young A. disparis males show more aggression likely because of their resource holding potential and sexual attractiveness decline with age.
To determine whether a potassium dihydrogen phosphate (KDP) surface mitigated by micro-milling would potentially threaten downstream optics, we calculated the light-field modulation based on angular spectrum diffraction theory, and performed a laser damage test on downstream fused silica. The results showed that the downstream light intensification caused by a Gaussian mitigation pit of 800 μm width and 10 μm depth reached a peak value near the KDP rear surface, decreased sharply afterward, and eventually kept stable with the increase in downstream distance. The solved peak value of light intensification exceeded 6 in a range 8–19 mm downstream from the KDP rear surface, which is the most dangerous for downstream optics. Laser damage sites were then induced on the fused silica surface in subsequent laser damage tests. When the distance downstream was greater than 44 mm with a downstream light intensification of less than 3, there were no potential damage threats to downstream optics. The study proves that a mitigated KDP surface can cause laser damage to downstream optical components, to which attention should be paid in an actual application. Through this work, we find that the current manufacturing process and the mitigation index still need to be improved. The research methods and calculation models are also of great reference significance for related studies like optics mitigation and laser damage.
A nanoparticle-based drug delivery system is first established by mesoporous silica encapsulating amino acid–intercalated layered double hydroxide (LDH) to construct nanocomposites AA-LDH@MS. The amino acids including phenylalanine (Phe) and histidine (His) with aromatic groups are intercalated into LDH as the cores Phe-LDH and His-LDH. These nanocomposites AA-LDH@MS display multispaces of the interlayer spaces of LDH and porous channels of mesoporous silica to load drugs. Moreover, amino acid molecules provide the interaction sites to improve effectively loading amounts of drugs. 5-Fluorouracil (5-FU) is used as the cargo molecules to observe the delivery in vitro. The results indicate that the maximum loading amounts of drugs are up to 392 mg/g at 60 °C for 12 h in the nanocomposite Phe-LDH@MS. All the nanocomposites exhibit the sustained release of 5-FU at pH 4 and pH 7.4. The Korsmeyer–Peppas model is used to fit the kinetic plot of the drug release in vitro, which concludes that 5-FU release from AA-LDH@MS belongs to Fickian diffusion.
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.
On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, the eastern part of Taiwan. The quake resulted in 17 deaths and more than 300 people injured. Four buildings completely collapsed and hundreds of houses were damaged.
The aim of this research was to use the patient data to analyze the reasons for visits, the trauma sites, and the severity.
We obtained the patient information from the Taiwan Eastern Medical Emergency Operation Center. Medical records were reviewed to analyze the primary diagnosis, the trauma mechanisms, and the sites of injury. Injury severity score (ISS) was used to assess trauma severity.
Two hundred and eighty patients were included in the study, with 90.3% being traumatic patients. Among them, 18.2% was geriatric trauma, 4.7% was pediatric trauma, and 0.4% was obstetric trauma. The most common injury site was lower extremities (33.2%), followed by head (31.4%) and upper extremities (27.1%). The mean injury severity score (ISS) was 1.9. The geriatric population had an average ISS of 2.4, and the pediatric group had a mean ISS of 1.2.
In our study, the majority of the patients had minor trauma. Lower extremities may be more vulnerable during the evacuation of an earthquake, and thus, became the most common injury site. The elderly patients had a higher ISS, which may be explained by their immobility and fragility of the body. In the future, it is critical to educate citizens about self-protection during earthquakes, focusing on protecting the head and the extremities. Healthcare providers and emergency medical technicians need to be well-trained to handle geriatric trauma since it poses unique challenges and is associated with increased mortality.
Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Objective: Deficits in the semantic learning strategy were observed in subjects with amnestic mild cognitive impairment (aMCI) in our previous study. In the present study, we explored the contributions of executive function and brain structure changes to the decline in the semantic learning strategy in aMCI. Methods: A neuropsychological battery was used to test memory and executive function in 96 aMCI subjects and 90 age- and gender-matched healthy controls (HCs). The semantic clustering ratio on the verbal learning test was calculated to evaluate learning strategy. Medial temporal lobe atrophy (MTA) and white matter hyperintensities (WMH) were measured on MRI with the MTA and Fazekas visual rating scales, respectively. Results: Compared to HCs, aMCI subjects had poorer performance in terms of memory, executive function, and the semantic clustering ratio (P < .001). In aMCI subjects, no significant correlation between learning strategy and executive function was observed. aMCI subjects with obvious MTA demonstrated a lower semantic clustering ratio than those without MTA (P < .001). There was no significant difference in the learning strategies between subjects with high-grade WMH and subjects with low-grade WMH. Conclusion: aMCI subjects showed obvious impairment in the semantic learning strategy, which was attributable to MTA but independent of executive dysfunction and subcortical WMH. These findings need to be further validated in large cohorts with biomarkers identified using volumetric brain measurements. (JINS, 2019, 25, 706–717)
Multidimensional instabilities always develop with time during the process of radiation pressure acceleration, and are detrimental to the generation of monoenergetic proton beams. In this paper, a sharp-front laser is proposed to irradiate a triple-layer target (the proton layer is set between two carbon ion layers) and studied in theory and simulations. It is found that the thin proton layer can be accelerated once to hundreds of MeV with monoenergetic spectra only during the hole-boring (HB) stage. The carbon ions move behind the proton layer in the light-sail (LS) stage, which can shield any further interaction between the rear part of the laser and the proton layer. In this way, proton beam instabilities can be reduced to a certain extent during the entire acceleration process. It is hoped such a mechanism can provide a feasible way to improve the beam quality for proton therapy and other applications.
While maternal folate deficiency has been linked to poor pregnancy outcomes such as neural tube defects, anaemia and low birth weight, the relationship between folate and preterm birth (PTB) in the context of the US post-folic acid fortification era is inconclusive. We sought to explore the relationship between maternal folate status and PTB and its subtypes, i.e. spontaneous and medically indicated PTB.
Boston Birth Cohort, a predominantly urban, low-income, race/ethnic minority population at a high risk for PTB.
Mother–infant dyads (n 7675) enrolled in the Boston Birth Cohort. A sub-sample (n 2313) of these dyads had maternal plasma folate samples collected 24–72 h after delivery.
Unadjusted and adjusted logistic regressions revealed an inverse relationship between the frequency of multivitamin supplement intake and PTB. Compared with less frequent use, multivitamin supplement intake 3–5 times/week (adjusted OR (aOR) = 0·78; 95 % CI 0·64, 0·96) or >5 times/week (aOR = 0·77; 95 % CI 0·64, 0·93) throughout pregnancy was associated with reduced risk of PTB. Consistently, higher plasma folate levels (highest v. lowest quartile) were associated with lower risk of PTB (aOR = 0·74; 95 % CI 0·56, 0·97). The above associations were similar among spontaneous and medically indicated PTB.
If confirmed by future studies, our findings raise the possibility that optimizing maternal folate levels across pregnancy may help to reduce the risk of PTB among the most vulnerable US population in the post-folic acid fortification era.
Findings from observational studies on the associations between vitamin E intake and stroke risk remain controversial, and the dose–response relationship between vitamin E intake and risk of stroke remains to be determined. We conducted a meta-analysis of prospective studies aiming to clarify the relationships between vitamin E intake and risk of stroke. Relevant studies were identified by searching online databases through to June 2018. We computed summary relative risks (RR) with corresponding 95 % CI. Among 3156 articles retrieved from online databases and relevant bibliographies, nine studies involving 3284 events and 220 371 participants were included in the final analyses. High dietary vitamin E intake was inversely associated with the risk of overall stroke (RR=0·83, 95 % CI 0·73, 0·94), and with the risk of stroke for individuals who were followed-up for <10 (RR=0·84, 95 % CI 0·72, 0·91). There was a non-linear association between dietary vitamin E intake and stroke risk (P=0·0249). Omission of any single study did not alter the summary result. In conclusion, this meta-analysis suggests that there is a significant inverse relationship between dietary vitamin E intake and stroke risk. This meta-analysis provides evidence that a higher dietary vitamin E intake is associated with a lower stroke risk.
Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain.
To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning.
A prospective survey study.
An academic medical center.
The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison.
According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2).
The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.
Propofol is a intravenous anaesthetic most commonly used in ultrasound oocyte retrieval. We studied if the use of propofol had an effect on mouse oocyte maturation, pregnancy, childbirth and progeny and investigated the correlation between propofol side effects and reproductive performance in mice. There was no statistical difference in mating, pregnancy, childbirth, litter size, the number of stillbirths and survival between each group (P>0.05). Propofol also had no effect on polar body extrusion in oocyte maturation as well as on pronucleus formation and, subsequently, early embryo development (P>0.05). An increased concentration of propofol had no effect on this result, although propofol at more than 0.01 mg/ml reduced polar body extrusion. Different concentrations of propofol had no effect on oocyte culture in vitro, pronucleus formation and early embryo development.
This study was conducted to investigate the protective effects of l-threonine (l-Thr) supplementation on growth performance, inflammatory responses and intestinal barrier function of young broilers challenged with lipopolysaccharide (LPS). A total of 144 1-d-old male chicks were allocated to one of three treatments: non-challenged broilers fed a basal diet (control group), LPS-challenged broilers fed a basal diet without l-Thr supplementation and LPS-challenged broilers fed a basal diet supplemented with 3·0 g/kg l-Thr. LPS challenge was performed intraperitoneally at 17, 19 and 21 d of age, whereas the control group received physiological saline injection. Compared with the control group, LPS challenge impaired growth performance of broilers, and l-Thr administration reversed LPS-induced increase in feed/gain ratio. LPS challenge elevated blood cell counts related to inflammation, and pro-inflammatory cytokine concentrations in serum (IL-1β and TNF-α), spleen (IL-1β and TNF-α) and intestinal mucosa (jejunal interferon-γ (IFN-γ) and ileal IL-1β). The concentrations of intestinal cytokines in LPS-challenged broilers were reduced by l-Thr supplementation. LPS administration increased circulating d-lactic acid concentration, whereas it reduced villus height, the ratio between villus height and crypt depth and goblet density in both jejunum and ileum. LPS-induced decreases in jejunal villus height, intestinal villus height:crypt depth ratio and ileal goblet cell density were reversed with l-Thr supplementation. Similarly, LPS-induced alterations in the intestinal mRNA abundances of genes related to intestinal inflammation and barrier function (jejunal toll-like receptor 4, IFN-γ and claudin-3, and ileal IL-1β and zonula occludens-1) were normalised with l-Thr administration. It can be concluded that l-Thr supplementation could attenuate LPS-induced inflammatory responses and intestinal barrier damage of young broilers.
Detailed structural, volcanic, and sedimentary investigations of the crustal response to the emplacement of the Middle–Late Permian Emeishan large igneous province show that a rifting system developed prior to the main stage of flood basalt eruptions, in the form of sedimentary breccias, clastic sedimentary deposits and mafic hydromagmatic units. Detrital zircon grains from sandstones yield ~750–800 Ma LA-ICP-MS 206Pb/238U age clusters, showing that material was sourced from the Yangtze crystalline basement. Gabbros and pegmatites intruded along the normal faults of the rift system yield zircon ages of 264–260 Ma, and thus constrain the timing of rifting. N–S-trending rift zones developed along the western flank of the Pan-Xi palaeo-uplift, with NE–SW- and NNE–SSW-trending rifts on the eastern side and along the western and eastern margins of the Yangtze Block. The rifting progressed in pulses, with an initial phase of normal faulting followed by rapid deposition of breccias. Later there was lower-energy deposition of sandstone, with accompanying rhyolitic eruptions. This was followed by low-energy sedimentation of mudstones and dolomites, with accompanying hydromagmatic deposits. Rift system formation was constrained by a combination of far- and near-field tectonic stresses due to plate motions and lithospheric interaction with initial Emeishan volcanism.