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To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.
A retrospective analysis was performed on 55 patients who underwent transcatheter device closure of atrial septal defects from October, 2019 to May, 2020. All patients received intravenous midazolam and local anesthesia with lidocaine to maintain sedation. A group of previous patients with unpublished data who underwent the same procedure with general anesthesia was set as the control group. The relevant clinical parameters, the Ramsay sedation scores, the numerical rating scale, and the post-operative satisfaction questionnaire were recorded and analyzed.
In the midazolam group, the success rate of atrial septal defect closure was 98.2%. Hemodynamic stability was observed during the procedure. None of the patients needed additional endotracheal intubation for general anesthesia. Compared with the control group, the midazolam group had no statistically significant differences in the Ramsay sedation score and numerical rating scale scores. Patients in the midazolam group experienced more post-operative satisfaction than those in the control group.
Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.
People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious mental illness (bipolar disorder, major depression, or schizophrenia).
PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex.
Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3–406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5–417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4–1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found [1.90 (95% CI 1.60–2.25)]. The most common suicide method was poisoning [21.9 per 100 000 person-years (95% CI 3.7–50.4)].
The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.
This study explored the clinical effect of employing breast milk oral care for infants who underwent surgical correction of ventricular septal defect.
A prospective randomised controlled study was conducted in a provincial hospital between January, 2020 and July, 2020 in China. Patients were randomly divided into an intervention group (breast milk oral care, n = 28) and a control group (physiological saline oral care, n = 28). The intervention group was given oral nursing using breast milk for infants in the early post-operative period, and the control group was given oral nursing using physiological saline. Related clinical data were recorded and analysed.
There were no significant differences in age, gender, weight, operation time, cardiopulmonary bypass time, or aortic cross-clamping time between the two groups. Compared with the physiological saline oral care group, the mechanical ventilation duration, the length of ICU stay in the breast milk oral care group were significantly shorter. The time of start feeding and total enteral nutrition were significantly earlier in the intervention group than those in the control group. The incidence of post-operative pneumonia in the breast milk oral care group was 3.6%, which was significantly lower than that of the physiological saline oral care group.
The use of breast milk for oral care in infants who underwent surgical correction of VSD can reduce the incidence of post-operative pneumonia and promote the recovery of gastrointestinal function.
The objective of this study was to investigate how different obesity measures link to circulating metabolites, and whether the connections are due to genetic or environmental factors. A cross-sectional analysis was performed on follow-up survey data at the Chinese National Twin Registry (CNTR), which was conducted in four areas of China (Shandong, Jiangsu, Zhejiang and Sichuan) in 2013. The survey collected detailed questionnaire information and conducted physical examinations, fasting blood sampling and untargeted metabolomic measurements among 439 adult twins. Linear regression models and bioinformatics analysis were used to examine the relation of obesity measures, including body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with serum metabolite levels and related pathways. A co-twin control study was additionally conducted among 15 obesity-discordant monozygotic (MZ) pairs (intrapair BMI difference >3 kg/m2) to examine any differences in metabolites controlling for genetic factors. Eleven metabolites were associated with BMI, WC and WHR after controlling for genetic and shared environmental factors. Pathway analysis identified pathways such as phenylalanine metabolism, purine metabolism, valine, leucine and isoleucine biosynthesis that were associated with obesity. A wide range of unfavorable alterations in the serum metabolome was associated with obesity. Obesity-discordant twin analysis suggests that these associations are independent of genetic liability.
Gas-fluidized beds of flexible fibres, which have been rarely studied before, are investigated in this work using the coupled approach of the discrete element method and computational fluid dynamics. In the present numerical method, gas–fibre interaction is modelled by calculating the interaction force for each constituent element in the fibre, and the composition of the interaction forces on the constituent elements generates a resultant hydrodynamic force and a resultant hydrodynamic torque on the fibre. Pressure drops and fibre orientation results from the present simulations with various fibre aspect ratios are in good agreement with previous experimental and simulation results. Some novel results are obtained for the effects of fibre flexibility. Larger hydrodynamic forces on fibres (before the bed is fluidized) and smaller minimum fluidization velocities (MFVs) are observed for more flexible fibre beds due to the smaller porosities, while smaller hydrodynamic forces are obtained for the more flexible fibres when the beds are fluidized with significant fibre motion. By scaling the superficial gas velocity using the MFVs, the data of pressure drop can collapse onto the Ergun correlation for stiff fibres of various aspect ratios; however, the pressure drop curves deviate from the Ergun correlation for very flexible fibres, due to the significant fibre bed expansion before the MFV is reached. The fibre aspect ratio and flexibility both have an impact on the solids mixing rate, and it is found that the solids mixing rates are essentially determined by the ratio of the superficial gas velocity to MFV.
Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.
High-voltage power cables are important channels for power transmission systems. Their special geographical environment and harsh natural environment can lead to many different faults. At present, such special operations in dangerous and harsh environments are performed manually, which not only has high labor intensity and low work efficiency but also has great personal safety risks. In order to solve such difficult problems, this paper studies the power maintenance robot for insulator string replacement, spacer replacement, damper and drainage plate maintenance; the basic configuration and the operation motion planning have been proposed; and the virtual prototype of the inspection maintenance robots has been developed, and then the mechanical structure of the robots has been optimized by the robot kinematics modeling and analyzed the working space based on the Monte Carlo method. The system platform, operation function, structural characteristics and related key technologies involved in the robot system development were systematically summarized; the deep integration point for the robot technology with big data, cloud computing, artificial intelligence, and ubiquitous power Internet-of-Things technologies was also discussed. Finally, the physical prototype of the insulator replacement, drainage plate tightening, and damper replacement operation robot has been developed; several experimental tests on a 220 V live line have been conducted so as to verify the robot engineering practicality; and the main development and future research direction have also been pointed out at last.
The positioning technique employing the ubiquitous signals of opportunity of non-cooperative satellites does not send special navigation signals, instead it passively receives satellite signals as noise, presenting advantages of concealment and difficulty for potential attackers. Thus, this study investigates the ranging principle and model using non-cooperative communication satellites and a time difference estimation algorithm. The technology of time difference measurement under non-cooperative observation mode was determined and simulated. A test platform for time difference measurement was built to receive the signal from an unknown geostationary Earth orbit communication satellite and verify the ranging feasibility and performance. The ranging accuracy was found to be smaller than 6 m, as demonstrated by experimental data, which shows the viability of the proposed positioning technique for ranging technology.
Human African trypanosomiasis (HAT) is caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense and caused devastating epidemics during the 20th century. Due to effective control programs implemented in the last two decades, the number of reported cases has fallen to a historically low level. Although fewer than 977 cases were reported in 2018 in endemic countries, HAT is still a public health problem in endemic regions until it is completely eliminated. In addition, almost 150 confirmed HAT cases were reported in non-endemic countries in the last three decades. The majority of non-endemic HAT cases were reported in Europe, USA and South Africa, due to historical alliances, economic links or geographic proximity to disease-endemic countries. Furthermore, with the implementation of the ‘Belt and Road’ project, sporadic imported HAT cases have been reported in China as a warning sign of tropical diseases prevention. In this paper, we explore and interpret the data on HAT incidence and find no positive correlation between the number of HAT cases from endemic and non-endemic countries. This data will provide useful information for better understanding the imported cases of HAT globally in the post-elimination phase.
The isolation of male and female gametes is an effective method to study the fertilization mechanisms of higher plants. An osmotic shock method was used to rupture pollen grains of Allium tuberosum Roxb and release the pollen contents, including generative cells, which were mass collected. The pollinated styles were cut following 3 h of in vivo growth, and cultured in medium for 6–8 h, during which time pollen tubes grew out of the cut end of the style. After pollen tubes were transferred into a solution containing 6% mannitol, tubes burst and released pairs of sperm cells. Ovules of A. tuberosum were incubated in an enzyme solution for 30 min, and then dissected to remove the integuments. Following transfer to a dissecting solution free of enzymes, each nucellus was cut in the middle, and squeezed gently on the micropylar end, resulting in the liberation of the egg, zygote and proembryo from ovules at selected stages. These cells can be used to explore fertilization and embryonic development using molecular biological methods for each cell type and development stage.
Findings for the roles of dairy products, Ca and vitamin D on ovarian cancer risk remain controversial. We aimed to assess these associations by using an updated meta-analysis. Five electronic databases (e.g. PubMed and Embase) were searched from inception to 24 December 2019. Pooled relative risks (RR) with 95 % CI were calculated. A total of twenty-nine case–control or cohort studies were included. For comparisons of the highest v. lowest intakes, higher whole milk intake was associated with increased ovarian cancer risk (RR 1·35; 95 % CI 1·15, 1·59), whereas decreased risks were observed for higher intakes of low-fat milk (RR 0·84; 95 % CI 0·73, 0·96), dietary Ca (RR 0·71; 95 % CI 0·60, 0·84) and dietary vitamin D (RR 0·80; 95 % CI 0·67, 0·95). Additionally, for every 100 g/d increment, increased ovarian cancer risks were found for total dairy products (RR 1·03; 95 % CI 1·01, 1·04) and for whole milk (RR 1·07; 95 % CI 1·03, 1·11); however, decreased risks were found for 100 g/d increased intakes of low-fat milk (RR 0·95; 95 % CI 0·91, 0·99), cheese (RR 0·87; 95 % CI 0·76, 0·98), dietary Ca (RR 0·96; 95 % CI 0·95, 0·98), total Ca (RR 0·98; 95 % CI 0·97, 0·99), dietary vitamin D (RR 0·92; 95 % CI 0·87, 0·97) and increased levels of circulating vitamin D (RR 0·84; 95 % CI 0·72, 0·97). These results show that whole milk intake might contribute to a higher ovarian cancer risk, whereas low-fat milk, dietary Ca and dietary vitamin D might reduce the risk.
The effect of holly polyphenols (HP) on intestinal inflammation and microbiota composition was evaluated in a piglet model of lipopolysaccharide (LPS)-induced intestinal injury. A total of twenty-four piglets were used in a 2 × 2 factorial design including diet type and LPS challenge. After 16 d of feeding with a basal diet supplemented with or without 250 mg/kg HP, pigs were challenged with LPS (100 μg/kg body weight) or an equal volume of saline for 4 h, followed by analysis of disaccharidase activities, gene expression levels of several representative tight junction proteins and inflammatory mediators, the SCFA concentrations and microbiota composition in intestinal contents as well as proinflammatory cytokine levels in plasma. Our results indicated that HP enhanced intestinal disaccharidase activities and reduced plasma proinflammatory cytokines including TNF-α and IL-6 in LPS-challenged piglets. Moreover, HP up-regulated mRNA expression of intestinal tight junction proteins such as claudin-1 and occludin. In addition, bacterial 16S rRNA gene sequencing showed that HP altered hindgut microbiota composition by enriching Prevotella and enhancing SCFA production following LPS challenge. These results collectively suggest that HP is capable of alleviating LPS-triggered intestinal injury by improving intestinal disaccharidase activities, barrier function and SCFA production, while reducing intestinal inflammation.
Terrorist attacks can occur anywhere. As the threat of terrorism develops, the China-Eurasia Expo held in Ürümqi, China is attracting fewer potential visitors. A nationwide survey of 2034 residents from 31 provinces and municipalities in China was conducted to examine the relation between the distance to respondents’ city of residence from Ürümqi and their levels of concern for safety and security concerning the Expo. The two were found to be positively related: the closer the respondents lived to Ürümqi, the less concerned they were with the safety and security of the Expo. This is consistent with the “psychological typhoon eye” effect, which states that people living closer to the center of an unfortunate event (whether natural or man-made hazards) are less concerned with the event’s negative consequences. This effect appears to hold for terrorism. There are implications of this finding for international counter-terrorism practice, tourism, and research.
The Chinese National Twin Registry (CNTR), initiated in 2001, has now become the largest twin registry in Asia. From 2015 to 2018, the CNTR continued to receive Chinese government funding and had recruited 61,566 twin-pairs by 2019 to study twins discordant for specific exposures such as environmental factors, and twins discordant for disease outcomes or measures of morbidity. Omic data, including genetics, genomics, metabolomics, and proteomics, and gut microbiome will be tested. The integration of omics and digital technologies in public health will advance our understanding of precision public health. This review introduces the updates of the CNTR, including study design, sample size, biobank, zygosity assessment, advances in research and future systems epidemiologic research.
As a wide-reaching institutional reform, China's fiscal decentralization was launched in the early 1980s to encourage provincial economic growth by granting more financial autonomy to provincial governments. In this paper, the impact of fiscal decentralization on China's environmental quality is investigated both theoretically and empirically. A neoclassical model is developed based on the primary characteristics of China's fiscal decentralization. Using provincial panel data for the period 1995-2015, a two-equation regression model is employed to empirically verify the three propositions of the theoretical model: (1) there exists an inverted-U shaped relationship between fiscal decentralization and GDP per capita; (2) fiscal decentralization is positively related to GDP per capita at the steady state; (3) there is an inverted-U shaped Environmental Kuznets Curve relationship between pollution emissions and economic growth.
Geochronological, major and trace element, and Sr–Nd–Hf isotopic data are reported for the monzonitic rocks of the Fushan pluton in the Taihang Mountains, central North China Craton, in order to investigate their sources, petrogenesis and tectonic implications. Zircon U–Pb dating results reveal that the Fushan pluton was emplaced during the Early Cretaceous (∼126–124 Ma). The monzonites and quartz monzonites are mainly characterized by calc-alkaline and magnesian features and display light rare earth element (LREE) enrichment and flat heavy REE (HREE) patterns with slightly positive Eu anomalies. They have similar whole-rock initial 87Sr/86Sr ratios (0.70653–0.70819), εNd(t) values (−13.6 to −18.6) and zircon εHf(t) values (−21.8 to −17.3). The primary magma of the Fushan pluton was derived from the partial melting of a spinel-facies amphibole-bearing ancient enriched lithospheric mantle. The monzonitic rocks also have high Ba–Sr and low Y and Yb contents, with high Sr/Y and La/Yb ratios. These geochemical features of monzonitic rocks are not only inherited from the magma source but also significantly enhanced by crystal fractionation during magmatic evolution; e.g. hornblende fractionation increased the Ba–Sr concentrations and Sr/Y ratios. During the Early Cretaceous, the slab sinking and roll-back of the Palaeo-Pacific Plate could have created an ancient big mantle wedge beneath East Asia and induced a lithospheric extensional process in the central North China Craton within an intracontinental setting.
Swelling deformation tests of Kunigel bentonite and its sand mixtures were performed in distilled water and NaCl solution. The salinity of NaCl solution has a significant impact on the swelling properties of bentonite, but not on its surface structure. The surface structure was characterized using the fractal dimension Ds. Based on the fractal dimension, a unique curve of the em–pe relationship (em is the void ratio of montmorillonite and pe is the effective stress) at full saturation was introduced to express the swelling deformation of bentonite–sand mixtures. In mixtures with a large bentonite content, the swelling deformation always followed the em–pe relationship. In mixtures with a small bentonite content, when the effective stress reached a threshold, the void ratio of montmorillonite em deviated from the unique em–pe curve due to the appearance of a sand skeleton. The threshold of vertical pressure for mixtures in different solutions and the maximum swelling strains were estimated using the em–pe relationship. The good agreement between estimates and experimental data suggest that the em–pe relationship might be an alternative method for predicting the swelling deformation of bentonite–sand mixtures in salt solution.