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We report a generation of energetic protons by the interaction of a high-energy electron driving beam with an underdense plasma slab. After an interaction period of approximately 4000 fs, a proton beam with maximum energy greater than 250 MeV can be achieved by applying a driving beam with energy 1.0 GeV to a 200 $\mathrm {\mu }$m plasma slab. Our two-dimensional particle-in-cell simulations also show that the proton acceleration process can be divided into two stages. In the first stage, a strong positive longitudinal electric field appears near the rear boundary of the plasma slab after the driving beam has passed through it. This acceleration process is similar to the target normal sheath acceleration scheme by the interaction between intense pulsed laser with overdense plasma targets. In the second stage, the accelerated protons experience a long-range acceleration process with a two-stream instability between the high-energy driving beam and the proton beam. Further analyses show that this accelerated proton beam is equipped with the property of good collimation and high energy. This scheme presents a new way for proton or ion acceleration on some special occasions.
This study aimed to investigate the organization, workload, and psychological impact of COVID-19 on healthcare workers from the domestic Medical Aid Teams (MATs) sent to Wuhan in China.
Methods:
MATs leaders and members involved in the care for COVID-19 patients were invited to participate in a study by completing two separate self-report questionnaires from April 1 to 24, 2020.
Results:
Nine MAT leaders were involved and 464 valid questionnaires were collected from 140 doctors and 324 nurses. Mean age of the doctors and nurses were 39.34±6.70 (26∼58 yr) and 31.88±5.29 (21∼52 yr), with 72 (15.5%) being males. Nurse was identified as an independent risk factor (HR 1.898; p=0.001) for a day working time in the multivariate analysis. The proportions of psychological consulting received among nurses were higher than those among doctors (49.7vs30.0%, p<0.001). More than half of the anesthetists and emergency doctors who have received psychological consulting thought that it was effective according to self-evaluation.
Conclusions:
This study focused on healthcare workers’ situation during the early time of pandemic. Nurse worked longer than doctors. The effectiveness of psychological consulting depends on the physicians’ specialties. Working conditions of nurses and psychological consulting targeting different specialties need to be improved.
Vitamin D is engaged in various neural processes, with low vitamin D linked to depression and cognitive dysfunction. There are gender differences in depression and vitamin D level. However, the relationship between depression, gender, vitamin D, cognition, and brain function has yet to be determined.
Methods
One hundred and twenty-two patients with major depressive disorder (MDD) and 119 healthy controls underwent resting-state functional MRI and fractional amplitude of low-frequency fluctuations (fALFF) was calculated to assess brain function. Serum concentration of vitamin D (SCVD) and cognition (i.e. prospective memory and sustained attention) were also measured.
Results
We found a significant group-by-gender interaction effect on SCVD whereby MDD patients showed a reduction in SCVD relative to controls in females but not males. Concurrently, there was a female-specific association of SCVD with cognition and MDD-related fALFF alterations in widespread brain regions. Remarkably, MDD- and SCVD-related fALFF changes mediated the relation between SCVD and cognition in females.
Conclusion
Apart from providing insights into the neural mechanisms by which low vitamin D contributes to cognitive impairment in MDD in a gender-dependent manner, these findings might have clinical implications for assignment of female patients with MDD and cognitive dysfunction to adjuvant vitamin D supplementation therapy, which may ultimately advance a precision approach to personalized antidepressant choice.
Grey matter (GM) reduction is a consistent observation in established late stages of schizophrenia, but patients in the untreated early stages of illness display an increase as well as a decrease in GM distribution relative to healthy controls (HC). The relative excess of GM may indicate putative compensatory responses, though to date its relevance is unclear.
Methods
343 first-episode treatment-naïve patients with schizophrenia (FES) and 342 HC were recruited. Multivariate source-based morphometry was performed to identify covarying ‘networks' of grey matter concentration (GMC). Neurocognitive scores using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and symptom burden using the Positive and Negative Symptoms Scale (PANSS) were obtained. Bivariate linear relationships between GMC and cognition/symptoms were studied.
Results
Compared to healthy subjects, FES had prominently lower GMC in two components; the first consists of the anterior insula, inferior frontal gyrus, anterior cingulate and the second component with the superior temporal gyrus, precuneus, inferior/superior parietal lobule, cuneus, and lingual gyrus. Higher GMC was seen in adjacent areas of the middle and superior temporal gyrus, middle frontal gyrus, inferior parietal cortex and putamen. Greater GMC of this component was associated with lower duration of untreated psychosis, less severe positive symptoms and better performance on cognitive tests.
Conclusions
In untreated stages of schizophrenia, both a distributed lower and higher GMC is observable. While the higher GMC is relatively modest, it occurs across frontoparietal, temporal and subcortical regions in association with reduced illness burden suggesting a compensatory role for higher GMC in the early stages of schizophrenia.
External modulation on thermal convection has been studied extensively to achieve the control of flow structures and heat-transfer efficiency. In this paper, we carry out direct numerical simulations on Rayleigh–Bénard convection accounting for both the modulation of wall shear and roughness over the Rayleigh number range $1.0 \times 10^6 \le Ra \le 1.0 \times 10^8$, the wall shear Reynolds number range $0 \le Re_w \le 5000$, the aspect-ratio range $2 \le \varGamma \le 4{\rm \pi}$, and the dimensionless roughness height range $0 \le h \le 0.2$ at fixed Prandtl number $Pr = 1$. Under the combined actions of wall shear and roughness, with increasing $Re_w$, the heat flux is initially enhanced in the buoyancy-dominant regime, then has an abrupt transition near the critical shear Reynolds number $Re_{w,cr}$, and finally enters the purely diffusion regime dominated by shear. Based on the crossover of the kinetic energy production between the buoyancy-dominant and shear-dominant regimes, a physical model is proposed to predict the transitional scaling behaviour between $Re_{w,cr}$ and $Ra$, i.e. $Re_{w,cr} \sim Ra^{9/14}$, which agrees well with our numerical results. The reason for the observed heat-transport enhancement in the buoyancy-dominant regime is further explained by the fact that the moving rough plates introduce an external shear to strengthen the large-scale circulation (LSC) in the vertical direction and serve as a conveyor belt to increase the chances of the interaction between the LSC and secondary flows within cavities, which triggers more thermal plumes, efficiently transports the trapped hot (cold) fluids outside cavities.
Since the outbreak of coronavirus disease 2019 (COVID-19) in late 2019, it has evolved into a global pandemic that has become a substantial public health concern. COVID-19 is still causing a large number of deaths in several countries around the world because of the lack of effective treatment.
Aim
To systematically compare the outcomes of COVID-19 patients treated with integrated Chinese with western (ICW) medicine versus western medicine (WM) alone by pooling the data of published literature, and to determine if ICW treatment of COVID-19 patients has better clinical outcomes.
Methods
We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China Clinical Trial Registry, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wanfang databases using keywords related to COVID-19, traditional Chinese medicine (TCM) and treatment effect. The search deadline was until 10 February 2021. All randomised controlled (RC) and non-randomised controlled (NRC) clinical trials of the ICW or WM treatment of COVID-19 patients were included. We analysed the effective rate, cure rate, exacerbation rate, turning negative rate of viral nucleic acid, remission rate and remission time of symptoms such as fever, cough, feebleness and chest computed tomography (CT) and the number of white blood cells (WBCs) and lymphocytes (LYM) of the COVID-19 patients. For qualitative and quantitative data, the ratio risk (RR) and weighted mean difference (WMD) were used as the indexes of the statistical analysis, respectively. RevMan 5.4 was used to perform meta-analyses and forest plots with the fixed-effects and random-effects models. Cochrane risk of bias tool (RoB 2.0) was used to assess the risk of bias in the included RC trials, whereas risk of bias in non-randomised studies of interventions was used to assess the risk of bias in NRC trials.
Results
This research includes 16 studies with 1645 valid confirmed COVID-19 patients, among which 895 patients of the experimental group received ICW treatment whereas 750 patients of the control group received WM treatment. The outcomes were assessed in three aspects, that is, overall indicator, symptoms indicator and blood indicator, respectively, and the results showed that the ICW group had better treatment outcomes compared with the WM. Among the overall indicators, the ICW group displayed a higher effective rate (RR = 1.24, 95% confidence interval (CI): 1.16–1.33), clinical cure rate (RR = 1.27, 95% CI: 1.03–1.56) and lower exacerbation rate (RR = 0.36, 95% CI: 0.25–0.52), but no statistical difference was observed in the turning negative rate of viral nucleic acid (RR = 1.20, 95% CI: 0.78–1.85). Among the symptom indicators, the ICW group had a higher fever remission rate (RR = 1.24, 95% CI: 1.09–1.42), less fever remission time (WMD = −1.49, 95% CI: −1.85 to −1.12), a higher cough remission rate (RR = 1.38, 95% CI: 1.10–1.73) and a feebleness remission rate (RR = 1.45, 95% CI: 1.18–1.77), less cough remission time (WMD = −1.61, 95% CI: −2.35 to −0.87) and feebleness remission time (WMD = −1.50, 95% CI: −2.38 to −0.61) and better improvement in chest CT (RR = 1.19, 95% CI: 1.11–1.28). For blood indicator, the number of WBCs in the blood of patients of ICW group rebounded significantly (WMD = 0.35, 95% CI: 0.16–0.54), and the recovery of LYM in the blood was more obvious (WMD = 0.23, 95% CI: 0.06–0.40).
Conclusion
The results of this study show that the outcomes in COVID-19 patients treated by the ICW is better than those treated by the WM treatment alone, suggesting that WM and TCM can be complementary in the treatment of COVID-19.
A high-frequency short-pulsed stroboscopic micro-visual system was employed to capture the transient image sequences of a periodically in-plane working micro-electro-mechanical system (MEMS) devices. To demodulate the motion parameters of the devices from the images, we developed the feature point matching (FPM) algorithm based on Speeded-Up Robust Features (SURF). A MEMS gyroscope, vibrating at a frequency of 8.189 kHz, was used as a testing sample to evaluate the performance of the proposed algorithm. Within the same processing time, the SURF-based FPM method demodulated the velocity of the in-plane motion with a precision of 10−5 pixels of the image, which was two orders of magnitude higher than the template-matching and frame-difference algorithms.
Hyperinsulinaemia and insulin resistance have been proposed to be associated with mortality risk, and diet can modulate insulin response. However, whether dietary patterns with high insulinaemic potential are associated with mortality remains unknown. We prospectively examined the associations between hyperinsulinaemic diets and the risk of total and cause-specific mortality in a large nationally representative population. Dietary factors were assessed by 24-h recalls. Two empirical dietary indices for hyperinsulinaemia (EDIH) and insulin resistance (EDIR) were developed to identify food groups most predictive of biomarkers for hyperinsulinaemia (C-peptide and insulin) and insulin resistance (homoeostatic model assessment for insulin resistance), respectively. Deaths from date of the first dietary interview until 31 December 2015 were identified by the National Death Index. Multivariable hazard ratios (HR) and 95 % CI were calculated using Cox regression models. During a median follow-up of 7·8 years, 4904 deaths were documented among 40 074 participants. For EDIH, the multivariable-adjusted HR (comparing extreme quintiles) were 1·20 (95 % CI 1·09, 1·32, P-trend<0·001) for overall mortality and 1·41 (95 % CI 1·15, 1·74, P-trend = 0·002) for CVD mortality. Similar associations were observed for EDIR with HR of 1·18 (95 % CI 1·07, 1·29, P-trend < 0·001) for total and 1·35 (95 % CI 1·09, 1·67, P-trend = 0·005) for CVD mortality. After further adjustments for BMI and diabetes, these positive associations were somewhat attenuated. Our findings suggested that diets with higher insulinaemic potential are associated with increased risk of overall and CVD-specific mortality.
Primitive lamprophyres in orogenic belts can provide crucial insights into the nature of the subcontinental lithosphere and the relevant deep crust–mantle interactions. This paper reports a suite of relatively primitive lamprophyre dykes from the North Qiangtang, central Tibetan Plateau. Zircon U–Pb ages of the lamprophyre dykes range from 214 Ma to 218 Ma, with a weighted mean age of 216 ± 1 Ma. Most of the lamprophyre samples are similar in geochemical compositions to typical primitive magmas (e.g. high MgO contents, Mg no. values and Cr, with low FeOt/MgO ratios), although they might have experienced a slightly low degree of olivine crystallization, and they show arc-like trace-element patterns and enriched Sr–Nd isotopic composition ((87Sr/86Sr)i = 0.70538–0.70540, ϵNd(t) = −2.96 to −1.65). Those geochemical and isotopic variations indicate that the lamprophyre dykes originated from partial melting of a phlogopite- and spinel-bearing peridotite mantle modified by subduction-related aqueous fluids. Combining with the other regional studies, we propose that slab subduction might have occurred during Late Triassic time, and the rollback of the oceanic lithosphere induced the lamprophyre magmatism in the central Tibetan Plateau.
The aim of our study was to determine the distribution of hepatitis B virus (HBV) genotypes and subgenotypes in ethnic minorities in Yunnan province to provide evidence supporting the theoretical basis for hepatitis B prevention and control. We obtained serum samples and demographic data from 765 individuals reported by Yunnan province who had either acute or chronic HBV infection and were from one of 20 ethnic minority populations: Achang, Bai, Brown, Tibetan, Dai, Deang, Dulong, Hani, Hui, Jingpo, Lahu, Yi, Lisu Miao, Naxi, Nu, Pumi, Wa, Yao, or Zhuang people. We sequenced the HBV DNA and determined the genotypes and subgenotypes of the isolated HBVs. We mapped the genotype and subgenotype distribution by ethnic minority population and conducted descriptive analyses. There were four genotypes among the 20 ethnic groups: genotype B (21.3% of samples), C (76.6%), D (1.8%) and I (0.3%). The most common subgenotype was C1. There were no genotype differences by gender (P = 0.954) or age (P = 0.274), but there were differences by region (P < 0.001). There were differences in genotype distribution (P < 0.001) and subgenotype distribution (P = 0.011) by ethnic group. Genotype D was most prominent in Tibet and most HBV isolates were C/D recombinant viruses. The only two genotype I virus isolates were in Zhuang people. Susceptibility and geographic patterns may influence HBV prevalence in different ethnic populations, but additional research is needed for such a determination.
Conventional unpowered lower limb exoskeleton paid little attention to the metabolic cost of body during sit down (SD)/stand up (SU). The SD motion model and the motion characteristics of lower extremity are analyzed; then, a novel unpowered lower limb exoskeleton is proposed, and the contribution degree of muscles and stiffness of joints are used for determining the location and stiffness of energy storage element. The metabolic cost of relevant muscles in joints of the left leg is obtained based on Opensim software. The results show that metabolic cost of the gracilis, rectus femoris (RF), and long head of the biceps femoris decreased about 13%, 9%, and 68%, respectively. The total metabolic cost of body decreased about 14% during SD. However, the metabolic cost of the gracilis, RF, and long/short head of the biceps femoris increased about 22%, 33%, 208%, and 46%, respectively. And the metabolic cost of sartorius reduces about 39%, the total metabolic cost of body increased about 25.6% during SU, under the exoskeleton conditions. The results of this study can provide a theoretical basis for the optimal design of unpowered lower limb exoskeleton.
The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case–control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a seventy-eight-item semi-quantitative FFQ. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem MS. Multivariate conditional logistic regression was used to estimate OR and 95 % CI. Restricted cubic splines (RCS) were plotted to evaluate the dose–response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the OR of the highest quartile were 0·45 (95 % CI 0·29, 0·71, Ptrend = 0·001) for VD dietary intake and 0·26 (95 % CI 0·11, 0·60, Ptrend = 0·003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0·02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0·02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.
Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI).
Methods
This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period.
Results
A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients.
Conclusions
These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.
Inflammation is a central mechanism in metabolic disorders associated with morbidity and mortality and dietary factors can modulate inflammation. We aimed to prospectively investigate the association between an empirically developed, food-based dietary inflammatory pattern (EDIP) score and the risk of overall and cause-specific mortality, using data from the US National Health and Nutrition Examination Survey from 1999 to 2014. EDIP score was derived by entering thirty-nine predefined commonly consumed food groups into the reduced rank regression models followed by stepwise linear regression, which was most predictive of two plasma inflammation biomarkers including C-reactive protein and leucocyte count among 25 500 US adults. This score was further validated in a testing set of 9466 adults. Deaths from baseline until 31 December 2015 were identified through record linkage to the National Death Index. During a median follow-up of 7·8 years among 40 074 participants, we documented 4904 deaths. Compared with participants in the lowest quintile of EDIP score, those in the highest quintile had a higher risk of overall death (hazard ratio (HR) = 1·19, 95 % CI 1·08, 1·32, Ptrend = 0·002), and deaths from cancer (HR = 1·41, 95 % CI 1·14, 1·74, Ptrend = 0·017) and CVD (HR = 1·22, 95 % CI 0·98, 1·53, Ptrend = 0·211). When stratified by age, the association of EDIP with overall mortality was stronger among individuals under 65 years of age (Pinteraction = 0·001). Diets with a higher inflammatory potential were associated with increased risk of overall and cancer-specific mortality. Interventions to reduce the adverse effect of pro-inflammatory diets may potentially promote health and longevity.