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The advent of coronary CT angiography derived fractional flow reserve (CT-FFR) calculation technology has brought great improvements to the clinical diagnostic process and treatment decision-making towards coronary artery disease. In recent years, CT-FFR technology has gradually begun to be taken into clinical practice in China, however, currently, the popularization is not widespread, and it is imperative to further standardize the clinical application of CT-FFR technology. This paper focused on the opportunities, significance and challenges of CT-FFR application in China from the advantages and disadvantages perspectives of this new technology based on three international studies. Combined with specific national conditions and the latest evidence-based clinical medical results, this paper proposes a win-win cooperation initiative between cardiologists and radiologists for the reference and caution of both clinical practitioners and medical affairs bureaus.基于冠状动脉CT血管成像的血流储备分数（CT-FFR）计算的出现，给冠心病的临床诊断流程和治疗决策选择带来了极大的改进。近年来CT-FFR技术在我国逐渐开始运用，但目前的开展普及并不广泛，亟需进一步规范CT-FFR的临床应用。本文通过三项国际研究的发布，从CT-FFR的优势与劣势阐述我国 CT-FFR 开展的机遇、意义和挑战，结合最新循证临床医学证据和我国具体国情，提出了心脏科与放射科合作共赢的倡议，以及当前研究需要注意的事宜，以供临床从业者和医疗管理部门参考。.

In the WHO new road map for neglected tropical diseases 2021-2030, the disease-specific targets are classified into control, elimination as a public health problem, elimination and eradication, and taeniasis and cysticercosis are targeted for control. The overall prevalence of taeniasis and cysticercosis is low in China, and varies remarkably in regions and populations; however, there are many challenges for elimination of taeniasis and cysticercosis in China. Based on previous taeniasis and cysticercosis control programs, developing a sensitive taeniasis and cysticercosis surveillance-response system, updating criteria for diagnosis of taeniasis and cysticercosis, proposing a national guideline for treatment of taeniasis and cysticercosis, and strengthening interdisciplinary and intersectoral communications and collaborations are urgently needed under the One Health concept.

Following a brief overview of the historical development of undergraduate education of public health and preventive medicine in China's medical universities and colleges, this editorial points out existing issues and dominant challenges, and puts forward compelling demands for undergraduate education in preventive medicine, including in-depth integration with society and population, combined with practice, focusing on problem identificantion and problem solving based on population health, as well as developing undergraduate education programs, education syllabus and courses, construction of teaching materials and off-campus practice teaching bases.在简要回顾中国医学院校公共卫生与预防医学专业本科教育发展历程的基础上，指出存在的主要问题，提出预防医学专业本科教育必须深入社会、人群，密切结合实际，着力围绕社会公众健康，发现问题、研究问题和解决问题，拟订教育计划、教学大纲、设置课程、编写教材、建设教学基地。.

BACKGROUND Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder associated with insulin resistance (IR). In IR states, non-insulin-mediated glucose uptake (NIMGU) may increase to compensate for declining insulin-mediated glucose uptake (IMGU), although this does not appear to be the case in PCOS. The underlying molecular mechanisms for this deficiency remain unclear. OBJECTIVES To compare adipocyte glucose transporter 1 and 4 (GLUT-1 and GLUT-4) gene expression in PCOS women and matched controls, and to determine whether changes in GLUT-1 and GLUT-4 are associated with concomitant alterations in whole-body glucose uptake. RESEARCH DESIGN AND METHODS In this prospective cross-sectional study, 23 women with PCOS (by NIH 1990 criteria) and 23 matched controls were studied for subcutaneous abdominal adipocyte GLUT-1 and GLUT-4 mRNA expression (by real-time PCR), and basal whole-body IR (by HOMA-IR) and insulin secretion (by HOMA-β%). A subset of six PCOS women and six matched controls also underwent a mFSIVGTT to determine dynamic state glucose uptake (by insulin sensitivity index [Si] and glucose effectiveness [Sg]) and insulin secretion (by the acute insulin response to glucose [AIRg] and the disposition index [Di]). RESULTS For similar adiposity (BMI and waist-hip ratio), PCOS women tended to have higher HOMA-IR and lower Di and Si, and higher HOMA-β% and lower GLUT-4 than controls, while GLUT-1 was similar. GLUT-1 was positively associated with Sg (reflecting NIMGU) and GLUT-4 positively with Si (reflecting IMGU). GLUT-4 was associated negatively with HOMA-IR and HOMA-β% and positively with Di for the entire cohort but not with AIRg. Both GLUT-1 and GLU-4 were negatively associated with BMI, but not with each other. CONCLUSION Our results suggest that IR secondary to a lower IMGU and enhanced insulin secretion in PCOS is in part attributable to a reduction in adipocyte GLUT-4 expression that is not accompanied by a compensatory increase in GLUT-1 expression.

鼻息肉是鼻腔和鼻窦黏膜最常见的慢性变态反应相关疾病之一，难治性鼻窦炎伴鼻息肉常合并哮喘，手术和药物治疗都很难控制病情。奥马珠单克隆抗体是人源性IgE单克隆抗体，国外已有应用IgE单克隆抗体治疗鼻息肉，特别是哮喘合并鼻息肉的报道。本研究对3例哮喘合并慢性鼻窦炎伴鼻息肉（CRSwNP）的患者采用奥马珠单克隆抗体治疗，随访16周，观察报道治疗效果。.

BackgroundIn contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.Methods and resultsCLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest.ConclusionIn patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.ClinicalTrials identifierISRCTN43070564

To understand the prevalence of soil-borne nematode infections among residents living in urban/town areas of China, so as to provide insights into the control and elimination of soil-borne nematodiasis.A total of 5 epidemic areas were classified in China according to the prevalence of humanFrom 2014 to 2015, among the 133 231 residents detected in 31 provinces (autonomous regions, municipalities) of China, the overall prevalence of soil-borne nematode infections was 1.23% (1 636/133 231), and the prevalence rates of hookworm,The overall prevalence of soil-borne nematodiasis remains low in urban and town areas of China; however, human infections are widespread. According to the epidemiological features, health education combined with deworming are recommended to reduce the prevalence of soil-borne nematode infections among residents living in urban and town areas of China.

To understand the epidemic status ofThe national surveillance of enterobiasis was performed in 736 national surveillance sites (counties) from 30 provinces (municipalities/autonomous regions) in China from 2016 to 2018. All surveillance sites were classified into parts according to the geographical directions, including the eastern, western, southern, northern and middle parts, and a township was randomly selected from each part. Then, an administrative village was randomly selected from the township, and 200 permanent residents at ages of over 3 years living in the administrative village were randomly selected using the cluster sampling method. A total of 1 000 residents were examined in each surveillance site.The prevalence ofThe prevalences of

To establish an evaluation system for the field assessment of the Kato-Katz technique in detecting soiltransmitted nematodes, so as to provide insights into the field application of the Kato-Katz technique.The initial evaluation indicators were determined through literature search, brainstorming and expert consultation. The evaluation indicatorswere improved and the weight of each indicator was decided through three rounds of expert consultation by using the Delphimethod. In addition, the expert authority coefficient and the coordination coefficient of each indicator were calculated at eachround of expert consultations.The recovery rates of the questionnaire were 100.00%, 100.00% and 89.29% at the firstto the third round of the expert consultations, respectively, and the expert authority coefficients were all more than 0.85 at eachround. The final evaluation system included 4 first-level indicators and 15 second-level indicators. In the first-level indicators, "detecting effect" and "funds investment" had the mean weighted value of 4.53 and 4.49, which were relatively higher than that of"person-time investment" and "operability" (both 4.34). Among the second-level indicators under each first-level indicator, thefour most significant indicators included "ability of personnel in egg discrimination", "cooperation of village cadres and doctors","Person-time on testing" and "organizational start-up cost", with the mean weighted values of 4.74, 4.43, 4.39 and 4.17, respectively. The coordination coefficients were 0.39 to 0.65, 0.28 to 0.58 and 0.45 to 0.65 at the first to the third round of the expertconsultations, respectively, and there were significant differences in the coordination coefficients at all three rounds of the consultations (allAn evaluation system for the field assessment of the Kato-Katz technique in detecting soiltransmitted nematodes is successfully established, among which "ability of personnel in egg discrimination" and "cooperation ofvillage cadres and doctors" have the greatest mean weighted values of the significance.

Context Impaired sensitivity to the antilipolytic action of insulin in adipose tissue (AT) may play a role in determining metabolic dysfunction in polycystic ovary syndrome (PCOS). Objectives To test the hypothesis that insulin resistance (IR) in AT is associated with whole-body insulin sensitivity and β-cell function in PCOS. Research Design and Setting Prospective cross-sectional study. Methods Eighteen participants with PCOS and 18-matched control participants underwent a modified frequently sampled intravenous glucose tolerance test (mFSIVGTT); subgroups underwent single-slice computed tomography scans determining AT distribution and adipocyte glucose transporter type 4 (GLUT-4) expression. Main Outcome Measures IR in AT in basal (by the adipose insulin resistance index [Adipo-IR]) and dynamic (mFSIVGTT-derived indices of insulin-mediated nonesterified fatty acids [NEFA] suppression [NEFAnadir, TIMEnadir, and %NEFAsupp]) states; whole-body insulin-mediated glucose uptake and insulin secretion in basal (by homeostatic model assessment [HOMA]-IR and HOMA-β%) and dynamic (mFSIVGTT-derived insulin sensitivity index [Si], acute insulin response to glucose [AIRg], and disposition index [Di]) states. Results Participants with PCOS had higher HOMA-IR and HOMA-β%, lower Si and Di, higher longer TIMEnadir, higher Adipo-IR and NEFAnadir, and a trend toward lower GLUT-4, than the control group participants. Adipo-IR was associated with dynamic state IR in AT (NEFAnadir TIMEnadir, and %NEFAsupp), but only in PCOS, and with HOMA-IR and HOMA-β% in both groups. NEFAnadir and TIMEnadir were negatively and %NEFAsupp positively associated with Si only in PCOS, but not with AIRg and Di, or GLUT-4 expression. Conclusion Women with PCOS demonstrated increased IR in AT, which is closely associated with whole-body IR but not with dynamic state β-cell function or adipocyte GLUT-4 gene expression.

The aim of this study was to investigate the effects of micro-ribonucleic acid (miR)-21 on hypertensive rats through the phosphatase and tensin homolog deleted on chromosome ten (PTEN)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway.A total of 10 spontaneously hypertensive rats (SHRs) were selected as the model group. Meanwhile, 10 rats with the same age were enrolled in the normal control group. Real Time-fluorescence quantitative Polymerase Chain Reaction (qRT-PCR) was performed to detect the mRNA level of miR-21 in rats of the SHR model group and control group. The tail arterial diastolic pressure of rats in the awake and resting state was measured in both groups, respectively. Pathological sections were prepared to evaluate pathological changes in myocardial tissues. Subsequently, myocardial cells were isolated, cultured and transfected with miR-21 mimics and miR-21 inhibitor, respectively. Transfection efficiency was verified using fluorescence quantitative PCR. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay was utilized to determine the apoptosis level of myocardial cells. Furthermore, the expression levels of the signaling pathway-related proteins were detected via Western blotting assay.Fluorescence quantitative PCR results revealed that the expression level of miR-21 was significantly higher in the SHR model group (p0.05). The diastolic pressure increased markedly in the SHR model group when compared with that in the control group (p0.05). Subsequent hematoxylin and eosin (HE) staining indicated apparent myocardial tissue injury in the SHR model group (p0.05). After transfection, the results showed that miR-21 inhibitor could effectively down-regulate the expression level of miR-21 in myocardial cells (p0.05). Meanwhile, TUNEL staining revealed that the number of apoptotic cells in the miR-21 inhibitor group was remarkably higher than that of the other two groups (p0.05). In addition, Western blotting results manifested that the protein expression levels of PTEN, PI3K, Akt and mTOR were significantly lower in the miR-21 mimics group (p0.05), whereas was remarkably higher in the miR-21 inhibitor group (p0.05).MiR-21 is involved in regulating the pathological symptoms and myocardial cell apoptosis in hypertensive rats through the PTEN/PI3K/Akt/mTOR signaling pathway.

At the time of the 40th anniversary of the Alma-Ata Declaration, the World Health Organization member states signed the Declaration of Astana. From Health For All to Universal Health Coverage, primary health care is consistantly identified as the key to achieving human health, and preventive services are critical and central component of primary health care. China has provided valuable experience for primary health care to countries around the world. However, with significant socioeconomic changes and rapid population aging, the contexts of primary health care and prevention services in China has undergone tremendous changes. Chronic diseases have become major burden of disease. System development and institution building, health service delivery system development, and the entire society of the country with large population are encountering new and serious challenges. On the basis of reviewing the development of preventive medical services in China for 40 years, Authors analyzes strengths and weaknesses of preventive services in China and looks forward to the challenges and opportunities in the coming decades, from perspective of primary, secondary and tertiary prevention strategies, and proposes suggestions for future development.在《阿拉木图宣言》发表40周年之际，世界卫生组织成员国此时签署了《阿斯塔纳宣言》。从人人享有健康到全民健康覆盖，初级卫生保健是实现人类健康理想的关键途径，预防服务是初级卫生保健的核心内容。中国曾经为世界各国的初级卫生保健提供了宝贵的经验，然而随着社会经济发展和人口快速老龄化的进程，中国的初级卫生保健和预防服务的背景发生了巨大变化，慢性非传染性疾病已经成为主要的疾病负担，系统发展和制度建设、卫生服务提供系统，以及全社会遇到新的严峻挑战。本文在回顾中国40年来预防医学服务发展的基础上，从初级、二级和三级预防的角度，分析和展望今后数十年预防医学服务的挑战和机会，并提出未来的发展建议。.

Background Synchronous polypectomy in colonic malignancies is contentious due to the perceived risks of tumour implantation at polypectomy sites (PS). We assess the risks of tumour implantation after synchronous polypectomy. Methods An analysis of all endoscopies for cancer that were accompanied by synchronous polypectomies from 2005 to 2009 was performed. The incidence of metachronous colorectal cancers located at the same segment of a previous PS was the surrogate for tumour implantation. Data on patient demographics, tumour and polyp location(s) and follow-up outcomes were extracted. The rate of metachronous lesions at the same segment of a previous PS between patients who had all synchronous PS resected (Group A) and patients with PS left in-situ (Group B) were compared. Results Two hundred and eighty-four patients had synchronous polypectomy performed during their initial endoscopy for cancer. Three patients were lost to follow-up and, in the remaining 281 patients, 87 (31.0%) were in Group A while 194 (69%) were in Group B. Median age, gender, tumour location, tumour stage, and pathological characteristics were similar between both groups. 2 (0.7%) patients developed local recurrences. Six (2.1%) patients developed metachronous lesions, four of which were located at the same segment where synchronous polypectomy was previously performed. The rates of metachronous lesions at the PS in groups A and B were similar at 1.1% (1/87) and 1.5% (3/194), respectively (p = 0.795). Conclusion Malignant implantation after synchronous polypectomy in the setting of a newly diagnosed cancer remains unproven. Even if tumor implantation did occur, the incidence is likely low.

There are no national-level data on cancer mortality in China since two surveys in 1973-1975 and 1990-1992 (a 10% sample), but ongoing surveillance systems, based on nonrandom selected populations, give an indication as to the trends for major cancers. Based on a log-linear regression model with Poisson errors, the annual rates of change for 10 cancers and all other cancers combined, by age, sex and urban/rural residence were estimated from the data of the surveillance system of the Center for Health Information and Statistics, covering about 10% of the national population. These rates of change were applied to the survey data of 1990-1992 to estimate national mortality in the year 2000, and to make projections for 2005. Mortality rates for all cancers combined, adjusted for age, are predicted to change little between 1991 and 2005 (-0.8% in men and +2.5% in women), but population growth and ageing will result in an increasing number of deaths, from 1.2 to 1.8 million. The largest predicted increases are for the numbers of female breast (+155.4%) and lung cancers (+112.1% in men, +153.5% in women). For these two sites, mortality rates will almost double. Cancer will make an increasing contribution to the burden of diseases in China in the 21st century. The marked increases in risk of cancers of the lung, female breast and large bowel indicate priorities for prevention and control. The increasing trends in young age groups for cancers of the cervix, lung and female breast suggest that their predicted increases may be underestimated, and that more attention should be paid to strategies for their prevention and control.

Background Odd-numbered chain saturated fatty acids (OCSFA) have been associated with potential health benefits. Although some OCSFA (e.g., C15:0 and C17:0) are found in meats and dairy products, sources and metabolism of C19:0 and C23:0 are relatively unknown, and the influence of non-dietary determinants, including genetic factors, on circulating levels of OCSFA is not established. Objective To elucidate the biological processes that influence circulating levels of OCSFA by investigating associations between genetic variation and OCSFA. Design We performed a meta-analysis of genome-wide association studies (GWAS) of plasma phospholipid/erythrocyte levels of C15:0, C17:0, C19:0, and C23:0 among 11,494 individuals of European descent. We also investigated relationships between specific single nucleotide polymorphisms (SNPs) in the lactase (LCT) gene, associated with adult-onset lactase intolerance, with circulating levels of dairy-derived OCSFA, and evaluated associations of candidate sphingolipid genes with C23:0 levels. Results We found no genome-wide significant evidence that common genetic variation is associated with circulating levels of C15:0 or C23:0. In two cohorts with available data, we identified one intronic SNP (rs13361131) in myosin X gene (MYO10) associated with C17:0 level (P = 1.37×10−8), and two intronic SNP (rs12874278 and rs17363566) in deleted in lymphocytic leukemia 1 (DLEU1) region associated with C19:0 level (P = 7.07×10−9). In contrast, when using a candidate-gene approach, we found evidence that three SNPs in LCT (rs11884924, rs16832067, and rs3816088) are associated with circulating C17:0 level (adjusted P = 4×10−2). In addition, nine SNPs in the ceramide synthase 4 (CERS4) region were associated with circulating C23:0 levels (adjusted P

We performed experimental measurements and theoretical simulation based on an efficient half-space Green’s function method to investigate the diffraction patterns of light scattered from the biological structure on 1D reflection grating made of metal and polymer. The 1D grating provides higher-order reflected light, which can boost the image signal for off-specular reflection. This can facilitate the micro-ellipsometry imaging experiment when an incident angle of light is at a large angle, while the detection camera is placed at the upright position. The micro-ellipsometry images for s- and p-polarized reflectance and their phase difference (Rs, Rp, and Δ) was taken by a modified Optrel MULTISKOP system with rotating compensator configuration for various angles of incidence and wavelengths ranging from 450nm to 750nm. By using an 80X objective lens, the pixel size for our image is around 164nm. We can further increase the magnification and the numerical aperture by using a substrate collocated with a homemade acrylic resin lens, and the pixel size can be reduced to 50 nm. Based on the above, we study the optical properties of metallic/dielectric nanostructures and nearby biological systems including bacteria, and cancer cells via an imaging micro-ellipsometer combined with detailed theoretical modeling. By using specular and off-specular micro-ellipsometry imaging, we can achieve sufficient sensitivity to collect signals from a small area (around 10μm X 10μm and obtain a 3D image mapping of the morphology and dielectric properties of the biological system of interest.

Aim To evaluate the feasibility of double prospectively electrocardiogram (ECG)-triggered high-pitch spiral acquisition mode (double high-pitch mode) for coronary computed tomography angiography (CTCA). Materials and methods One hundred and forty-nine consecutive patients [40 women, 109 men; mean age 58.2 ± 9.2 years; sinus rhythm ≤70 beats/min (bpm) after pre-medication, body weight ≤100 kg] were enrolled for CTCA examinations using a dual-source CT system with 2 × 128 × 0.6 mm collimation, 0.28 s rotation time, and a pitch of 3.4. Double high-pitch mode was prospectively triggered first at 60% and later at 30% of the R–R interval within two cardiac cycles. Image quality was evaluated using a four-point scale (1 = excellent, 4 = non-assessable). Results From 2085 coronary artery segments, 86.4% (1802/2085) were rated as having a score of 1, 12.3% (257/2085) as score of 2, 1.2% (26/2085) as score of 3, and none were rated as “non-assessable”. The average image quality score was 1.15 ± 0.26 on a per-segment basis. The effective dose was calculated by multiplying the coefficient factor of 0.028 by the dose–length product (DLP); the mean effective dose was 3.5 ± 0.8 mSv (range 1.7–7.6 mSv). The total dosage of contrast medium was 78.7 ± 2.9 ml. Conclusion Double prospectively ECG-triggered high-pitch spiral acquisition mode provides good image quality with an average effective dose of less than 5 mSv in patients with a heart rate ≤70 bpm.

To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients.Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study. 24-hour ECG Holter monitoring was performed within 1 week, and the DC value was analyzed, GRACE risk score was acquired with the application of GRACE risk score calculator. Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained. Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively.A total of 157 patients were enrolled in the study (average age: (58.9±12.7)years old). The average follow-up was (20.54±2.85) months. Mortality during follow-up was significantly higher in patients with DC2.5 compared to patients with DC≤2.5 (P0.01). In terms of early warning cardiac death, the area under ROC curve of DC risk stratification was 0.898 (95%CI 0.840-0.940, P0.01), the sensitivity was 84.6%, and the specificity was 84.0%. The area under ROC curve of GRACE risk stratification was 0.786 (95%CI 0.714-0.847, P0.01), the sensitivity was 84.6%, and the specificity was 74.3%. In terms of early warning cardiac adverse events, the ROC curve of DC was 0.747(95%CI 0.672-0.813, P0.01), with the 90.0% sensitivity and 67.7% specificity. The GRACE risk stratification was 0.708 (95%CI 0.652-0.769, P0.01), with the 63.3% sensitivity and 75.6% specificity. Subgroup analysis showed that mortality during follow-up was significantly higher in high risk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (P0.01).DC could predict cardiac death and MACE in patients with AMI. DC risk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

To investigate the value of deceleration capacity of rate (DC) and heart rate deceleration runs(DRs) in predicting cardiovascular events in patient with acute myocardial infarction (AMI).This study included 166 patients with AMI, who underwent ECG with sinus rhythm.These patients were followed-up for major adverse cardiac events (MACE). The receiver operating characteristic curve (ROC) was drawn to determine the best values for estimating the MACE.The mean follow-up time was (20.5±2.8) months, with 13 cases of cardiac death.There was statistically significant difference of DC, DRs and standard diviation of NN intervals(SDNN-24) between the death group and survival group.The area under the curve (AUC) of DC, DR4 and DR8 were larger than SDNN-24 (0.874, 0.804 vs 0.727). The values of DC, DR2, DR4 and root mean square of the successive differences(RMSSD) in the group of patients who underwent cardiac adverse events were smaller than the group of patients who didn't, and the AUC of DC was slightly higher than that of RMSSD.DC and DRs have important predictive value for cardiac death and MACE and can screen high-risk patients in patients with AMI.

To observe the efficacy and safety of bivalirudin use in Chinese patients with coronary heart disease (CHD) during the peri-percutaneous coronary intervention(PCI) period.A total of 3 271 patients who underwent PCI and received periprocedural bivalirudin treatment between July 2013 and October 2015 from 88 centers of China were involved in this study. The primary outcome was 30-day net adverse clinical events (NACE a composite of major adverse cardiac or cerebral events (MACE, all-cause death, reinfarction, urgent target vessel revascularization, or stroke) or bleeding), the secondary outcome was stent thrombosis at 30 days.The mean age of enrolled patients was (65.12±12.44) years old, 27.4%(889/3 244) of them were female. Percent of stable coronary disease (SCD), non-ST segment elevation acute coronary syndrome (NSTE-ACS) and ST elevation myocardial infarction (STEMI) was 5.0%(162/3 248), 44.6%(1 450/3 248) and 50.4%(1 636/3 248) respectively. Radial access was performed in 89.5% (2 879/3 271) patients, and 9.7% (316/3 271) and 34.1% (1 115/3 271) patients also received ticagrelor and tirofiban medication. 69.3% (2 266/3 271) patients received post-procedural bivalirudin infusion, in which 46.3% (1 050/2 266) was treated at PCI-does, with a median duration of 2.5(1.0, 4.0) h. During the 30-day follow-up, NACE occurred in 3.45% (103/2 988) patients, the incidence of MACE, death was 2.17% (65/2 994) and 1.03% (31/3 017), respectively and bleeding events were recorded in 1.37% (41/2 996) patients. Four cases (0.13%) of stent thrombosis (3 acute stent thrombosis) were recorded.Peri-PCI Bivalirudin use is safe and related with low bleeding risk in Chinese CHD patients.

In this paper, we present a globally and superlinearly convergent inexact SQP Newton method for solving large scale convex SC 1 minimization problems under mild conditions. In particular, the BD-regularity assumption made by Pang and Qi in Journal of Optimization Theory and Applications, 85 (1995), pp. 633–648 is replaced by a much more realistic assumption. Our numerical experiments conducted on least squares semidefinite programming with lower and upper bounds demonstrate that our inexact SQP Newton method is much more efficient than its exact version and is competitive with existing methods when the number of simple constraints is very large.

In this study, the cathodic arc deposition technique was utilized to synthesize three Cr-N-O coatings (chromium nitride [CrN], CrN/Cr[N,O], CrN/chromium oxide [Cr2O3]) on AISI M2 tool steel by using the chromium target and controlling the flow rate of nitrogen/oxygen reactive gases. Polarization tests were performed to evaluate the corrosion resistance of the uncoated and coated specimens in 3.5 wt% sodium chloride (NaCl) solution. Structure and morphology of the coatings were separately analyzed using x-ray diffraction (XRD), scanning electron microscopy (SEM), and transmission electron microscopy (TEM) to better understand the coating effects on the corrosive behavior of M2 steel. The results showed that the CrN/Cr(N,O) and CrN/Cr2O3 double-layered coatings had higher surface roughness than monolithic CrN, but their dense and double-layered structures resulted in better corrosion resistance. The sequence of corrosion resistance is in the order of CrN/Cr(N,O) > CrN/Cr2O3 > CrN > uncoated M2 stee...

Background Classical crush has a lower rate of final kissing balloon inflation (FKBI) immediately after percutaneous coronary intervention (PCI). The double kissing (DK) crush technique has the potential to increase the FKBI rate, and no prospective studies on the comparison of classical with DK crush techniques have been reported. Materials and methods Three hundred and eleven patients with true bifurcation lesions were randomly divided into classical (n = 156) and DK crush (n = 155) groups. Clinical and angiographic details at follow-up at 8 months were indexed. The primary end point was major adverse cardiac events (MACE) including myocardial infarction, cardiac death and target lesion revascularization (TLR) at 8 months. Results FKBI was 76% in the classical crush group and 100% in the DK group (P < 0·001). The incidence of stent thrombosis was 3·2% in the classical crush group (5·1% in without- and 1·7% in with-FKBI) and 1·3% in the DK crush group. Cumulative 8 month MACE was 24·4% in the classical crush group and 11·4% in the DK crush group (P = 0·02). The TLR-free survival rate was 75·4% in the classical crush group and 89·5% in the DK crush group (P = 0·002). Conclusions DK crush technique has the potential of increasing FKBI rate and reducing stent thrombosis, with a further reduction of TLR and cumulative MACE rate at 8 months. Eur J Clin Invest 2008; 38 (6): 361–371

A novel friction and modelling uncertainty compensation scheme for a ball-screw table system is presented, consisting of an inverse of the nominal model with an input deduction, a filter, and an integral term. This control scheme can compensate for frictional effects and modelling uncertainty inherent in the ball-screw mechanism. In addition, when further combined with a conventional sliding-mode controller (SMC), this controller can help to counteract the effects of residual frictional torque and residual modelling uncertainty. The proposed control scheme successfully compensates for frictional effects and modelling uncertainty without requiring any prior knowledge of the friction model. Simulation and experimental results confirm the ability of the proposed scheme to compensate for the effects of friction and modelling uncertainty in a practical application.

A modified sliding-mode controller (SMC) with time-delay control for non-linear systems with disturbance is presented. Unlike a conventional SMC, the proposed approach does not require the identification of system parameters or the estimation of the bounds of disturbances. A novel sliding surface is designed in the modified SMC. The proposed approach provides an easy design method to maintain the convergence of errors by design requirement and uses the lower switching gain to maintain robustness which is in contrast to using a conventional SMC. Simulation results demonstrate that the proposed method is better than a conventional SMC in controlling a non-linear system with disturbances.

People with asthma are an under-represented group amongst scuba divers. Many may avoid or are advised against diving due to the potential risks, including bronchoconstriction, pulmonary barotrauma and arterial gas embolism. The aim of this study was to establish whether divers with asthma were more likely to experience reversible airways obstruction following typical scuba diving than divers without asthma.All divers with a history of asthma attending Operation Wallacea in Honduras were identified and peak expiratory flow rates (PEF) were measured pre and immediately post dive. All dives were boat dives in tropical sea water. Scuba dives were defined as those lasting between 40 and 55 minutes to a depth of between 10 and 18 metres. Of the 356 divers attending, 22 were identified as having asthma, of whom 19 were suitable for testing. They were classified by treatment regimen: five on no treatment, 11 on salbutamol only and three on regular preventative treatment. Twenty-four divers without a history of asthma acted as a control group.Open-water scuba diving caused a small decrease in PEF in all populations (median decrease 4.4%, P0.001). Percentage decrease in PEF was significantly more in divers with asthma on regular preventative medication than in the control group (mean 9.3%, median decrease 6% vs. mean 3.1%, median 4.3% P = 0.039).These findings support the view that asthmatics are more susceptible to airway changes following scuba diving. Differences to previous studies are likely due to environmental conditions, including dive depth.

To investigate the risk factors related to mortality in severe polytrauma patients with acute hypoxemic respiratory failure (AHRF).From December 2011 to December 2014, we identified and intubated 524 traumatic AHRF patients in a level 1 trauma centers. Amongst those, we enrolled seventy-six severe traumatic AHRF patients with an injury severity score (ISS) over 16 and need for over 24 hour intra-tracheal mechanical ventilation for our study. Patients were followed daily to collect data about demographics, injury characteristic, diagnostic, treatment, respiratory parameters, major complications, duration of mechanical ventilation, length of stay, prevalence of major complications and 28-days mortality.Of the 76 patients in our study, 61 patients were male. Patients' ages were from 15 to 78 years old (43±17) and the predominant source of trauma was road traffic accidents. Before ventilation, patients had a mean PaO2/FiO2 ratio of 108±63, pH of 7.1±0.3, PaCO2 of 54±24 mmHg, respectively. The PaO2/FiO22 ratios were significantly improved by ventilation and the average duration of ventilation was 9.63±8.74 days. There were two peak dying times and the 28-days ICU mortality rate was 28.9%. Logistic regression analysis revealed the mortality rate to be significantly higher in patients with higher APACHE II scores (odds ratio: 1.60, p=0.002), shorter intervals between injury and admission (odds ratio: -0.91, p=0.03) and between admission and ventilation (odds ratio: -1.85, p=0.012), and lower pH (odds ratio: -0.692, p=0.044). The receiver operating characteristic (ROC) curves showed that best cut off points for mortality predictors were APACHE II scores greater than 25, time interval between injury and admission less than 2h, time interval between admission and ventilation less than 0.5h, and pH7.16.Traumatic AHRF patients requiring ventilation support show a high rate of early mortality. Greater vigilance for high APACHE II score, short time interval between injury and ventilation, low pH in traumatic AHRF patients is required.

Rotavirus and poliovirus continue to present significant risks and burden of disease to children in developing countries. Developing a combined vaccine may effectively prevent both illnesses and may be advantageous in terms of maximizing compliance and vaccine coverage at the same visit. Recently, we sought to generate a vaccine vector by incorporating multiple epitopes into the rotavirus group antigenic protein, VP6. In the present study, a foreign epitope presenting a system using VP6 as a vector was created with six sites on the outer surface of the vector that could be used for insertion of foreign epitopes, and three VP6-based PV1 epitope chimeric proteins were constructed. The chimeric proteins were confirmed by immunoblot, immunofluorescence assay, and injected into guinea pigs to analyze the epitope-specific humoral response. Results showed that these chimeric proteins reacted with anti-VP6F and -PV1 antibodies, and elicited antibodies against both proteins in guinea pigs. Antibodies against the chimeric proteins carrying PV1 epitopes neutralized rotavirus Wa and PV1 infection in vitro. Our study contributes to a better understanding of the use of VP6-based vectors as multiple-epitope delivery vehicles and the epitopes displayed in this form could be considered for development of epitope-based vaccines against rotavirus and poliovirus.

To achieve mode control of an X-band relativistic backward wave oscillator (RBWO) locked by a modulated electron beam, the mechanism of the parasitic mode oscillation and its influence on the working characteristics of the phase-locked RBWO are explored detailedly both in particle-in-cell simulation and in experiment. The experimental result agrees well with the simulation, which indicates that the TM11's excitation in the cavities and the TE11's coupling between the cavities are the main causes of the parasitic mode self-oscillation. Accordingly, RF lossy material is introduced to sever this coupling and suppress the parasitic mode oscillation. The suppression effect of the lossy material is also tested in the experiment, and the parasitic mode oscillation is eliminated. Finally, mode control of the phase-locked RBWO is accomplished experimentally. The phase jitter maintains at a level of ±10° in 50 ns.

We previously identified a low-frequency (1.1 %) coding variant (G45R; rs200573126) in the adiponectin gene (ADIPOQ) which was the basis for a multipoint microsatellite linkage signal (LOD = 8.2) for plasma adiponectin levels in Hispanic families. We have empirically evaluated the ability of data from targeted common variants, exome chip genotyping, and genome-wide association study data to detect linkage and association to adiponectin protein levels at this locus. Simple two-point linkage and association analyses were performed in 88 Hispanic families (1,150 individuals) using 10,958 SNPs on chromosome 3. Approaches were compared for their ability to map the functional variant, G45R, which was strongly linked (two-point LOD = 20.98) and powerfully associated (p value = 8.1 × 10−50). Over 450 SNPs within a broad 61 Mb interval around rs200573126 showed nominal evidence of linkage (LOD > 3) but only four other SNPs in this region were associated with p values

To machine a shape incorporating freeform curves, the freeform curves must be approximated and represented in a form suitable for numerically controlled (NC) tool-path generation. Instead of the commonly used line segment approximation, a new method using biarc approximation is presented here. The purpose is to reduce sudden changes in tool movement and increase continuity and smoothness. A biarc can be described as two consecutive circular arcs with an identical tangent at the connecting point. Therefore, tangent continuity can be maintained. Furthermore, curvature continuity can be improved if the difference between the two curvatures is minimised. In this research, biarc segments are used to approximate the freeform curves by controlling the largest deviation distance between the curves and the biarcs. The test results show that the biarc approximation method generates fewer tool-path segments than the traditional line approximation. The definitions of the biarcs are used to generate NC tool paths. A new tool-path generation method is developed for processing rough cutting and finish cutting paths. Example parts modelled with B-spline curves are tested and machined.

In an attempt to develop maize plants with resistance to corn stunt spi-roplasma (CSS), a single-chain Fv fragment (scFv) gene that was constructed from antibodies with strong inhibitory activity against CSS, was expressed in a cell line of maize. However, plants regenerated from this transgenic cell line showed no distinct resistance to CSS infection under the greenhouse conditions. The affinity and functionality of scFv in vivo and the locations of CSS and expressed scFv in maize could be a part of the contributing factors affecting this result. Progress of expressing antibodies in plants for plant pathogen resistance is also discussed.

Mafic rocks dominate the lower crustal and upper mantle xenolith suites within the Jurassic Delegate basaltic diatremes in the Paleozoic Lachlan Fold Belt, SE Australia. Two upper mantle mafic xenoliths from the Delegate pipes, a garnet pyroxenite and a garnet granulite (equilibrated at 1060 and 1140 °C, and 40–50 km), yield garnet-clinopyroxene Sm-Nd ages of 160 ± 4 Ma and 153 ± 10 Ma, respectively. Both ages are indistinguishable from the time of eruption of the diatremes, and are interpreted as showing continuous isotopic equilibrium within the mantle of Sm and Nd between garnet + clinopyroxene at temperatures ≥ 1050 °C. A lower crustal, 2-pyroxene granulite xenolith (equilibrated at 810–850 °C and ca. 25 km) yields a clinopyroxene + plagioclase + whole rock Sm-Nd isochron ages of 283 ± 26 Ma. This age probably reflects partial resetting of the isotopic systems of much older granulite during slow cooling, or after a heating event in the lower crust associated with the Jurassic magmatic activity represented by the basaltic host rock. Metamorphic zircons from the 2-pyroxene granulite xenolith were dated by the U-Pb method at 398±2 and 391 ± 2 Ma. These ages are considered to date granulite facies metamorphic events in the lower crust of the region. The age gap between the granulite facies metamorphism and granitoid plutonism in the region (420–410 Ma) indicates that the dated granulite is unlikely to represent residue after partial melting and magma extraction that generated the regional granitoids. It is suggested that these ages may record a relatively slow cooling following the cessation of mafic magmatic intrusion that formed the xenolith protoliths and that was probably the heat source responsible for granite production. At about 25 km, this thermal relaxation accounts for the change from an olivine + plagioclase + 2-pyroxene gabbroic assemblage into the granulite facies 2-pyroxene + plagioclase + spinel field.

This study aimed to determine the predictive value of elevated N-terminal pro-brain natriuretic peptide (NTproBNP) for mortality in patients with severe sepsis.This was a retrospective study in Emergency Department of Sichuan Provincial People's Hospital, and patients were screened between January 1, 2009 and December 31, 2011. Demographic and clinical data as well as Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sepsis Organ Failure Assessment (SOFA) scores were collected within the first day of admission. Survival was determined to establish its association with the NT-proBNP using logistic regression and receiver operating characteristic (ROC) curve.A total of 171 patients with severe sepsis were analyzed. The median APACHE IIⅡ and SOFA scores were 11 (IQR, 7-16) and 3 (IQR, 1-5), respectively. The median C-reactive protein (CRP), procalcitonin (PCT) and NT-proBNP was 10.3 mg/dL (IQR, 3.4-21.4 mg/dL), 0.4 ng/mL (IQR, 0.2-3.6 ng/mL), and 954 (321-1576) pg/mL, respectively. The median NT-proBNP in survivors was 584 pg/mL (IQR, 321-875 pg/mL) versus 1271 (IQR, 851-1576 pg/mL) in nonsurvivors (p0.001). In the ROC curves, the area value was 0.89 for serum NT-proBNP, and its potent cutoff value was 1500 pg/mL. After multivariate regression analysis, NT-proBNP was significantly correlated with the mortality of severe sepsis (OR = 1.58, 95% CI 1.36-1.77).Serum NT-proBNP is frequently increased in severe sepsis patients, and non-survivors have higher levels than survivors. High levels of admission NT-proBNP are associated with mortality.

Numerous MORB-like mafic dykes, plugs and sills intruded the Kanmantoo Group and older meta-sediments of the southern Adelaide Fold Belt from pre-D1 to post-D2 during the Delamerian orogeny. A post-D2 meta-dolerite yields a precise U–Pb zircon age of 510 ± 2 Ma. This age, combined with a published SHRIMP zircon age of 526 ± 4 Ma, reveals a rapid tectonic evolution of the fold belt during the Cambrian: events including the thick Kanmantoo Group9s deposition, major mafic magmatism, low-P/high- T regional metamorphism and multiple deformations all took place from about 526 to 510 Ma. This rapid evolution supports the suggestion that the heat source for the metamorphism originated from continental extension associated with mantle upwelling and mafic magmatism.

NaX zeolite was ion-exchanged to obtain LiX and AgX zeolites. The LiX form was further exchanged to replace 20% of the Li+ cations by Ag+, to obtain a LiAgX zeolite. Equilibrium adsorption isotherm...