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The association between blood transfusion and ventilator-associated events (VAEs) has not been fully understood. We sought to determine whether blood transfusion increases the risk of a VAE.
Nested case-control study.
This study was based on a registry of healthcare-associated infections in intensive care units at West China Hospital system.
1,657 VAE cases and 3,293 matched controls were identified.
For each case, 2 controls were randomly selected using incidence density sampling. We defined blood transfusion as a time-dependent variable, and we used weighted Cox models to calculate hazard ratios (HRs) for all 3 tiers of VAEs.
Blood transfusion was associated with increased risk of ventilator-associated complication-plus (VAC-plus; HR, 1.47; 95% CI, 1.22–1.77; P <.001), VAC-only (HR, 1.29; 95% CI, 1.01–1.65; P = .038), infection-related VAC-plus (IVAC-plus; HR, 1.78; 95% CI, 1.33–2.39; P < .001), and possible ventilator-associated pneumonia (PVAP; HR, 2.10; 95% CI, 1.10–3.99; P = .024). Red blood cell (RBC) transfusion was also associated with increased risk of VAC-plus (HR, 1.34; 95% CI, 1.08–1.65; P = .007), IVAC-plus (HR, 1.70; 95% CI, 1.22–2.36; P = .002), and PVAP (HR, 2.49; 95% CI, 1.17–5.28; P = .018). Compared to patients without transfusion, the risk of VAE was significantly higher in patients with RBC transfusions of >3 units (HR, 1.73; 95% CI, 1.25–2.40; P = .001) but not in those with RBC transfusions of 0–3 units.
Blood transfusions were associated with increased risk of all tiers of VAE. The risk was significantly higher among patients who were transfused with >3 units of RBCs.
Anticipatory pleasure deficits are closely correlated with negative symptoms in schizophrenia, and may be found in both clinical and subclinical populations along the psychosis continuum. Prospection, which is an important component of anticipatory pleasure, is impaired in individuals with social anhedonia (SocAnh). In this study, we examined the neural correlates of envisioning positive future events in individuals with SocAnh.
Forty-nine individuals with SocAnh and 33 matched controls were recruited to undergo functional MRI scanning, during which they were instructed to simulate positive or neutral future episodes according to cue words. Two stages of prospection were distinguished: construction and elaboration.
Reduced activation at the caudate and the precuneus when prospecting positive (v. neutral) future events was observed in individuals with SocAnh. Furthermore, compared with controls, increased functional connectivity between the caudate and the inferior occipital gyrus during positive (v. neutral) prospection was found in individuals with SocAnh. Both groups exhibited a similar pattern of brain activation for the construction v. elaboration contrast, regardless of the emotional context.
Our results provide further evidence on the neural mechanism of anticipatory pleasure deficits in subclinical individuals with SocAnh and suggest that altered cortico-striatal circuit may play a role in anticipatory pleasure deficits in these individuals.
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.
This article contends that prior research on the behaviour of Chinese local cadres pays limited attention to their motivation for avoiding blame. Using qualitative data from three field studies conducted in Guangdong province, the study focuses on blame avoidance in the cadre responsibility system, which is recognized as an important instrument for state capacity building. Our analysis uncovers three major discursive strategies used by grassroots cadres to manage blame either before or after it is apportioned: de-legitimating performance standards, re-attributing blame and transferring blame risk. We find that local cadres have a role as blame makers in shifting blame and accusations. This finding challenges the conventional view, which typically sees local officials as blame takers. The article concludes by elaborating on the wider implications of this finding and proposing avenues for future research.
The research was to introduce the experience of doubly committed subarterial ventricular septal defect (DCVSD) repaired through tricuspid approach.
From January, 2015 to September, 2019, 86 consecutive DCVSD paediatrics underwent repair via right subaxillary vertical incision (RAVI) through tricuspid approach. Perioperative and follow-up data were collected.
The age and weight at operation were 28.1 ± 18.5 (range: 7–101) months and 12.2 ± 4.2 (6–26.5) kg. There were two patients combined with discrete subaortic membrane, two patients with patent ductus arteriosus, one patient with atrial septal defect, and two patients with abnormal muscle bundle in right ventricular outflow tract. The mean size of ventricular septal defect was 7.0 ± 2.4 (3–13) mm. The defect was repaired with a piece of Dacron patch in 68 patients or directly with 1–2 pledgetted polypropylene sutures in 18 patients. The cardiopulmonary bypass time and aortic cross-clamp time were 46.2 ± 13.3 (23–101) minutes and 29.2 ± 11.5 (12–84) minutes. After 3.1 ± 2.4 (0–14) hours’ ventilator assist and 23.2 ± 32.1 (0–264) hours’ ICU stay, all patients were discharged safely. At the latest follow-up (27.9 ± 14.6 months), echocardiography showed trivial residual shunt in two patients. There was no malignant arrhythmia occurred and there was no chest deformity or asymmetrical development of the breast was found.
DCVSD repaired via right subaxillary vertical incision through tricuspid approach was safe and feasible, providing a feasible alternative to median sternotomy, and it can be performed with favourable cosmetic results.
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.
This study aimed at estimating the transmissibility of hepatitis C. The data for hepatitis C cases were collected in six districts in Xiamen City, China from 2004 to 2018. A population-mixed susceptible-infectious-chronic-recovered (SICR) model was used to fit the data and the parameters of the model were calculated. The basic reproduction number (R0) and the number of newly transmitted cases by a primary case per month (MNI) were adopted to quantitatively assess the transmissibility of hepatitis C virus (HCV). Eleven curve estimation models were employed to predict the trends of R0 and MNI in the city. The SICR model fits the reported HCV data well (P < 0.01). The median R0 of each district in Xiamen is 0.4059. R0 follows the cubic model curve, the compound curve and the power function curve. The median MNI of each district in Xiamen is 0.0020. MNI follows the cubic model curve, the compound curve and the power function curve. The transmissibility of HCV follows a decreasing trend, which reveals that under the current policy for prevention and control, there would be a high feasibility to eliminate the transmission of HCV in the city.
Lipopolysaccharides (LPS) could induce milk fat depression via regulating the body and blood fat metabolism. However, it is not completely clear how LPS might regulate triglyceride synthesis in dairy cow mammary epithelial cells (DCMECs). DCMECs were isolated and purified from dairy cow mammary tissue and treated with LPS. The level of triglyceride synthesis, the expression and activity of the liver X receptor α (LXRα), enzymes related to de novo fatty acid synthesis, and the expression of the fatty acid transporters were investigated. We found that LPS decreased the level of triglyceride synthesis via a down-regulation of the transcription, translation, and nuclear translocation level of the LXRα. The results also indicated that the transcription level of the LXRα target genes, sterol regulatory element binding protein 1 (SREBP1), fatty acid synthetase (FAS), acetyl-CoA carboxylase-1 (ACC1), were significantly down-regulated in DCMECs after LPS treatment. Our data may provide new insight into the mechanisms of milk fat depression caused by LPS.
Common vetch (Vicia sativa) is an important forage and green manure crop that is widely cultivated around the world. However, the large number of subspecies and accessions of common vetch has made taxonomic research on this species difficult. Pollen morphology data can provide important evidence in the study of plant phylogeny. Therefore, in this research, light microscopy and scanning electron microscopy were used to observe seven morphological traits of pollens from 22 common vetch accessions, and residual maximum likelihood and pattern analysis was conducted. The results showed that the pollen grains of the 22 accessions were all monad pollen and the polar view revealed three-lobed circular and triangular shapes, while the equatorial view mainly revealed an oblate shape; only one accession showed an oblate spherical shape. All accessions were 3-zonocolporate and the colpus length extended close to the poles. The polar axis length was (19.39 ± 0.97)–(42.12 ± 0.76) μm and the equatorial axis length was (35.97 ± 1.27)–(45.25 ± 0.81) μm. We found that qualitative traits of pollen shape, aperture polar view and ornamentation were highly stable. Among them, polar axis length, equatorial axis length and colpus length and width had significant differences among the accessions. The ratios of the equatorial and polar axes had significant differences among the subspecies. This trait information could be used for the classification and identification of common vetch accessions and subspecies.
The Western Tianshan orogenic belt is essential for understanding the evolution of the Central Asian orogenic belt. However, no agreement exists among geologists about its tectonic environment during the Late Palaeozoic. The volcanic rocks of the Yishijilike and Wulang Formation in the Yili Block, Western Tianshan, formed in the Late Carboniferous to Early Permian, mainly consist of a bimodal suite of basalts – basaltic andesites and rhyolites, with only some intermediate rocks. Mafic rocks are slightly enriched in light rare earth elements (LREE) and depleted in Nb, Ta, Zr and Hf, suggesting a subduction-modiﬁed depleted mantle source. Some mafic samples in the Early Permian bimodal volcanic rocks have high Ti contents with relatively high concentrations of Nb and high field strength elements (HFSE) and low contents of heavy rare earth elements (HREE). These rocks are similar to the continental flood basalts, which suggests that they formed from an asthenospheric mantle. This paper indicates that mafic members were created by the partial melting of the asthenospheric mantle material and subduction-modiﬁed lithospheric mantle mixture. Some rhyolites and dacites in the Wulang formation were enriched in Ga, Nb, Zr, Ce and Y and depleted in Sr and Eu. Additionally, they showed fractionation of rare earth elements (REE) with negative Eu anomalies, which is indicative of an A-type affinity of felsic rocks. The genesis of mafic members and an A-type affinity of felsic members indicate that the Late Carboniferous – Early Permian magmatism in the Western Tianshan area formed as a result of an extensional setting. This study also reveals bimodal magmatism produced by delamination in an extensional tectonic setting.
Ceramics discovered at Yan'an, Shaanxi, are glazed using a polychrome technique previously unknown in the Han Dynasty. Chemical analysis shows similar technological methods to those used during the Warring States period. This paper demonstrates two possible influences for the polychrome decoration that ultimately suggest Eurasian cultural hybridity and exchange.
In the preparation of café latte, spectacular layer formation can occur between the espresso shot in a glass of milk and the milk itself. Xue et al. (Nat. Commun., vol. 8, 2017, pp. 1–6) showed that the injection velocity of espresso determines the depth of coffee–milk mixture. After a while, when a stable stratification forms in the mixture, the layering process can be modelled as a double diffusive convection system with a stably stratified coffee–milk mixture cooled from the side. More specifically, we perform (two-dimensional) direct numerical simulations of laterally cooled double diffusive convection for a wide parameter range, where the convective flow is driven by a lateral temperature gradient while stabilized by a vertical concentration gradient. Depending on the strength of stabilization as compared to the thermal driving, the system exhibits different flow regimes. When the thermal driving force dominates over the stabilizing force, the flow behaves like vertical convection in which a large-scale circulation develops. However, with increasing strength of the stabilizing force, a meta-stable layered regime emerges. Initially, several vertically-stacked convection rolls develop, and these well-mixed layers are separated by sharp interfaces with large concentration gradients. The initial thickness of these emerging layers can be estimated by balancing the work exerted by thermal driving and the required potential energy to bring fluid out of its equilibrium position in the stably stratified fluid. In the layered regime, we further observe successive layer merging, and eventually only a single convection roll remains. We elucidate the following merging mechanism: as weakened circulation leads to accumulation of hot fluid adjacent to the hot sidewall, larger buoyancy forces associated with hotter fluid eventually break the layer interface. Then two layers merge into a larger layer, and circulation establishes again within the merged structure.
Parabronema skrjabini is one of the most harmful nematodes to camels and is responsible for economic losses in animal husbandry industry. There is an urgent need for in-depth studies of potential vectors of the nematode due to its scant regarding information. As previous studies indicated that flies may be the vectors of P. skrjabini, we captured flies in the main camel-producing areas of Inner Mongolia. After autopsy of the specimens of two species of horn flies, we observed the morphology of the suspected nematode larvae found in them. Internal transcribed spacer ribosomal-DNA gene sequences were considered the best candidate to confirm the species of the larvae found. Our results showed that the homology compared with P. skrjabini was 99.5% in GenBank. Subsequently, we preliminarily identified two species of horn flies through morphological observation and then sequenced the mitochondrial-DNA-gene cytochrome oxidase subunit I obtained from two species of horn flies, with 100 and 99.2% similarity to sequences deposited in GenBank, respectively. Thus, we identified Haematobia titillans and Haematobia irritans and provided evidence for their potential role as vectors of parabronemosis. Our study provides reference for future research on the life history of the nematode and the vectors of parabronemosis.
Schizotypy refers to schizophrenia-like traits below the clinical threshold in the general population. The pathological development of schizophrenia has been postulated to evolve from the initial coexistence of ‘brain disconnection’ and ‘brain connectivity compensation’ to ‘brain connectivity decompensation’.
In this study, we examined the brain connectivity changes associated with schizotypy by combining brain white matter structural connectivity, static and dynamic functional connectivity analysis of diffusion tensor imaging data and resting-state functional magnetic resonance imaging data. A total of 87 participants with a high level of schizotypal traits and 122 control participants completed the experiment. Group differences in whole-brain white matter structural connectivity probability, static mean functional connectivity strength, dynamic functional connectivity variability and stability among 264 brain sub-regions of interests were investigated.
We found that individuals with high schizotypy exhibited increased structural connectivity probability within the task control network and within the default mode network; increased variability and decreased stability of functional connectivity within the default mode network and between the auditory network and the subcortical network; and decreased static mean functional connectivity strength mainly associated with the sensorimotor network, the default mode network and the task control network.
These findings highlight the specific changes in brain connectivity associated with schizotypy and indicate that both decompensatory and compensatory changes in structural connectivity within the default mode network and the task control network in the context of whole-brain functional disconnection may be an important neurobiological correlate in individuals with high schizotypy.
Recently, the asymptotic mean value of the height for a birth-and-death process is given in Videla [Videla, L.A. (2020)]. We consider the asymptotic variance of the height in the case when the number of states tends to infinity. Further, we prove that the heights exhibit a cutoff phenomenon and that the normalized height converges to a degenerate distribution.
The Shiji (史記 Records of the Grand Historian) is of great value for Chinese history before 90 BCE. Many online databases provide character-based search of the Shiji. We go beyond simple search by creating an word-based open-access database of the Basic Annals (本纪) of the Shiji that allows the exploration of relationships between persons and the relationships between persons and named places.
Silicon nanowires (SiNWs) were fabricated in a metal-assisted chemical etching method with two steps including dipping silicon wafers in AgNO3/HF solutions and then in H2O2/HF solutions. Grazing incidence X-ray diffraction measurements with a set of incidence angles were carried out on the resulting samples to detect characteristics of silver nanoparticles in the etched silicon. Compared with the uniform size of silver nanoparticles on the surface, the silver nanoparticles in etched silicon were found with size increasing and content decreasing corresponding to the depths. Based on the silver size increasing phenomenon, a detailed supplementary hypothesis about SiNWs formation was proposed about silver disintegration and redeposition in the later stage of silicon etching. For 2, 3, 4, and 8 mM AgNO3 solutions used to study their effect on the SiNWs, it was found that a higher quantity of Ag+ concentration such as 8 mM were not beneficial for producing good quality SiNWs.