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Abstract The “terminal hydroxyl group anchoring mechanism” has been studied on metal oxides (Al2O3, CeO2) as well as a variety of noble and transition metals (Ag, Pt, Pd, Cu, Ni, Fe, Mn, and Co) in a number of generalized studies, but there is still a gap in how to regulate the content of terminal hydroxyl groups to influence the dispersion of the active species and thus to achieve optimal catalytic performance. Herein, we utilized AlOOH as a precursor for γ-Al2O3 and induced the transformation of the exposed crystal face of γ-Al2O3 from (110) to (100) by controlling the calcination temperature to generate more terminal hydroxyl groups to anchor Ag species. Experimental results combined with AIMD and DFT show that temperature can drive the atomic rearrangement on the (110) crystal face, thereby forming a structure similar to the atomic arrangement of the (100) crystal face. This resulted in the formation of more terminal hydroxyl groups during the high-temperature calcination of the support (Al-900), which can capture Ag species to form single-atom dispersions, and ultimately develop a stable and efficient single-atom Ag-based catalyst.

Abstract Sleep disturbances profoundly affect the quality of life in individuals with neurological disorders. Closed-loop deep brain stimulation (DBS) holds promise for alleviating sleep symptoms, however, this technique necessitates automated sleep stage decoding from intracranial signals. We leveraged overnight data from 121 patients with movement disorders (Parkinson’s disease, Essential Tremor, Dystonia, Essential Tremor, Huntington’s disease, and Tourette’s syndrome) in whom synchronized polysomnograms and basal ganglia local field potentials were recorded, to develop a generalized, multi-class, sleep specific decoder – BGOOSE. This generalized model achieved 85% average accuracy across patients and across disease conditions, even in the presence of recordings from different basal ganglia targets. Furthermore, we also investigated the role of electrocorticography on decoding performances and proposed an optimal decoding map, which was shown to facilitate channel selection for optimal model performances. BGOOSE emerges as a powerful tool for generalized sleep decoding, offering exciting potentials for the precision stimulation delivery of DBS and better management of sleep disturbances in movement disorders.

AbstractRenewable energy requires long-duration energy storage technologies, of which vanadium flow battery is regarded as the ­most suitable candidate for safe and long-duration energy storage ­applications. However, vanadium flow batteries still suffer from capacity decay and low power density, which arise from membrane degradation and high resistance. Herein, a sulfonated poly (4,4′-diphenylether-5,5′-bibenzimidazole) (SOPBI) membrane is reported for use in vanadium redox flow batteries. The prepared SOPBI membranes show an area resistance of 0.63 Ω cm2 at room temperature after doped with 3 M H2SO4. Moreover, membranes with 3 M H2SO4 doping exhibit tensile stress at break of 15.1 MPa. Benefiting from the SOPBI membrane, the all-vanadium redox flow battery delivers a superior energy efficiency of 77.7% at 140 mA cm−2 while operating stably at a current density of 120 mA cm−2 for 200 cycles.

BackgroundRapid and accurate diagnosis of the causative agents is essential for clinical management of bloodstream infections (BSIs) that might induce sepsis/septic shock. A considerable number of suspected sepsis patients initially enter the health-care system through an emergency department (ED), hence it is vital to establish an early strategy to recognize sepsis and initiate prompt care in ED. This study aimed to evaluate the diagnostic performance and clinical value of droplet digital PCR (ddPCR) assay in suspected sepsis patients in the ED.MethodsThis was a prospective single-centered observational study including patients admitted to the ED from 25 October 2022 to 3 June 2023 with suspected BSIs screened by Modified Shapiro Score (MSS) score. The comparison between ddPCR and blood culture (BC) was performed to evaluate the diagnostic performance of ddPCR for BSIs. Meanwhile, correlative analysis between ddPCR and the inflammatory and prognostic-related biomarkers were conducted to explore the relevance. Further, the health economic evaluation of the ddPCR was analyzed.Results258 samples from 228 patients, with BC and ddPCR performed simultaneously, were included in this study. We found that ddPCR results were positive in 48.13% (103 of 214) of episodes, with identification of 132 pathogens. In contrast, BC only detected 18 positives, 88.89% of which were identified by ddPCR. When considering culture-proven BSIs, ddPCR shows an overall sensitivity of 88.89% and specificity of 55.61%, the optimal diagnostic power for quantifying BSI through ddPCR is achieved with a copy cutoff of 155.5. We further found that ddPCR exhibited a high accuracy especially in liver abscess patients. Among all the identified virus by ddPCR, EBV has a substantially higher positive rate with a link to immunosuppression. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity as well as prognosis. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs.ConclusionsThe multiplexed ddPCR delivers precise and quantitative load data on the causal pathogen, offers the ability to monitor the patient’s condition and may serve as early warning of sepsis in time-urgent clinical situations as ED.ImportanceEarly detection and effective administration of antibiotics are essential to improve clinical outcomes for those with life-threatening infection in the emergency department. ddPCR, an emerging tool for rapid and sensitive pathogen identification used as a precise bedside test, has developed to address the current challenges of BSI diagnosis and precise treatment. It characterizes sensitivity, specificity, reproducibility, and absolute quantifications without a standard curve. ddPCR can detect causative pathogens and related resistance genes in patients with suspected BSIs within a span of three hours. In addition, it can identify polymicrobial BSIs and dynamically monitor changes in pathogenic microorganisms in the blood and can be used to evaluate antibiotic efficacy and survival prognosis. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs.

Abstract Information encryption technique has broad applications in individual privacy, military confidentiality, and national security, but traditional electronic encryption approaches are increasingly unable to satisfy the demands of strong safety and large bandwidth of high-speed data transmission over network. Optical encryption technology could be more flexible and effective in parallel programming and multiple degree-of-freedom data transmitting application. Here, we show a dual-layer optical encryption fluorescent polymer waveguide chip based on optical pulse-code modulation technique. Fluorescent oligomers were doped into epoxy cross-linking SU-8 polymer as a gain medium. Through modifying both the external pumping wavelength and operating frequency of the pulse-code modulation, the sender could ensure the transmission of vital information is secure. If the plaintext transmission is eavesdropped, the external pumping light will be switched, and the receiver will get warning commands of ciphertext information in the standby network. This technique is suitable for high-integration and high-scalability optical information encryption communications.

Abstract In this work, on-chip three-dimensional (3D) photonic integrated optical sources based on active fluorescent polymer waveguide microdisks are proposed for light display application. Fluorescent green and red oligomers with high-efficiency photoluminescence are doped into epoxy crosslinking SU-8 polymer as the waveguide gain medium. The microdisk-based on-chip optically pumping light sources are designed and fabricated using the organic functionalized materials by direct UV written process. The promising stacking dual-microdisk structures with double gain layers could provide white signal light source generated perpendicular to the chip, and green signal light source stimulated in the chip. The approach could realize the monolithically on-chip assembled vertical and horizontal bright emitters. The optical pumping threshold power is obtained as 50 mW with continuous-wave (CW) pumping. The average gain coefficient of a white light source is measured by vertical fiber coupling as 112 dB/W, and that of green light source by horizontal fiber coupling as 137 dB/W, respectively. The rising and falling response time of the on-chip optical sources are 60 and 80 µs under modulating pulsed pumping. This technique is very promising for achieving 3D integrated light display application, including photonic circuits and optical information encryption.

Climate change is increasing the intensity of extreme climate events. Significant impacts of extreme climate events on human society and ecosystem have occurred in many places of the world, for example, Southwest China (SWC). In this study, the daily temperature and precipitation data from 438 meteorological stations are used to analyze the variation characteristics of extreme climate events in the SWC from 1961 to 2017. The annual extreme warm events show a significant increasing trend at 99% confidence level at most stations, and a few stations with a decreasing trend are mainly located in the southern Sichuan Province, the northern Yunnan Province and the western Guizhou Province. Meanwhile, the annual extreme cold events show a significant decreasing trend at 99% confidence level at most stations, and a few stations with an increasing trend are mainly distributed in the Sichuan Basin. Both the annual extreme heavy precipitation indexes and rainstorm indexes show nonsignificant increasing trends, but they differ greatly in the spatial distribution. These indexes in the western Tibet, Chongqing and most parts of Guizhou show significant increasing trends at 95% confidence level, while those in the central Sichuan and southeastern Yunnan show significant decreasing trends. The percentage of extreme heavy precipitation shows a significant increasing trend at 99% confidence level, especially in the northeastern Sichuan, the central-eastern Guizhou and the central Yunnan. Overall, under the background of global warming, the extreme warm events in SWC increase significantly from 1961 to 2017, and the extreme cold events decrease significantly. The variation trends of extreme precipitation events differ greatly in different regions, and the percentage of extreme heavy precipitation increases significantly.

BackgroundRNA methylation is closely involved in immune regulation, but its role in sepsis remains unknown. Here, we aim to investigate the role of RNA methylation-associated genes (RMGs) in classifying and diagnosing of sepsis.MethodsFive types of RMGs (m1A, m5C, m6Am, m7G and Ψ) were used to identify sepsis subgroups based on gene expression profile data obtained from the GEO database (GSE57065, GSE65682, and GSE95233). Unsupervised clustering analysis was used to identify distinct RNA modification subtypes. The CIBERSORT, WGCNA, GO and KEGG analysis were performed to explore immune infiltration pattern and biological function of each cluster. RF, SVM, XGB, and GLM algorithm were applied to identify the diagnostic RMGs in sepsis. Finally, the expression levels of the five key RMGs were verified by collecting PBMCs from septic patients using qRT-PCR, and their diagnostic efficacy for sepsis was verified in combination with clinical data using ROC analysis.ResultsSepsis was divided into three subtypes (cluster 1 to 3). Cluster 1 highly expressed NSUN7 and TRMT6, with the characteristic of neutrophil activation and upregulation of MAPK signaling pathways. Cluster 2 highly expressed NSUN3, and was featured by the regulation of mRNA stability and amino acid metabolism. NSUN5 and NSUN6 were upregulated in cluster 3 which was involved in ribonucleoprotein complex biogenesis and carbohydrate metabolism pathways. In addition, we identified that five RMGs (NSUN7, NOP2, PUS1, PUS3 and FTO) could function as biomarkers for clinic diagnose of sepsis. For validation, we determined that the relative expressions of NSUN7, NOP2, PUS1 and PUS3 were upregulated, while FTO was downregulated in septic patients. The area under the ROC curve (AUC) of NSUN7, NOP2, PUS1, PUS3 and FTO was 0.828, 0.707, 0.846, 0.834 and 0.976, respectively.ConclusionsOur study uncovered that dysregulation of RNA methylation genes (m1A, m5C, m6Am, m7G and Ψ) was closely involved in the pathogenesis of sepsis, providing new insights into the classification of sepsis endotypes. We also revealed that five hub RMGs could function as novel diagnostic biomarkers and potential targets for treatment.

In recent years, the Chengdu-Chongqing Economic Circle (CCEC) has experienced frequent heat events, significantly impacting labor productivity. The CCEC is an important economic growth pole in western China. Therefore, an in-depth study of the impact of heat stress on labor productivity holds great significance for climate change adaptation and enhancing economic efficiency. Based on the relationship between the wet-bulb globe temperature (WBGT) and labor productivity of different industries, the labor productivity loss caused by heat in the CCEC was estimated using the observation data of the meteorological station and the projection results of the BCC-CSM2-MR model from the Coupled Model Intercomparison Project Phase 6 (CMIP6). The results showed that the impact of heat on the labor productivity of different industries in the CCEC mainly occurs from June to August, with the largest impact on agriculture, followed by industry, and the smallest impact on service sectors. Losses from heat stress to labor productivity in agriculture, industry, and services showed a significant increasing trend from 1980 to 2020 but a decreasing trend in comprehensive labor productivity loss. From 2020–2100, labor productivity losses in different industries due to heat stress show an increasing and then decreasing trend in the low emissions scenario, productivity losses in the medium emissions scenario are characterized by an increasing and then sustained change, and labor productivity losses in the high emissions scenario show a sustained increasing trend from 2020. By the end of the 21st century, the increase in labor productivity losses across different industries under the high emission scenario is approximately 15%–23%, and the large value center shifts slightly to the west. In most areas, the losses of agricultural, industrial, service, and comprehensive labor productivity exceed 45%, 32%, 20%, and 24%, respectively.

IntroductionCircular RNAs (circRNAs) have been linked to regulate macrophage polarization and subsequent inflammation in sepsis. However, the underlying mechanism and the function of circRNAs in macrophage pyroptosis in pneumonia-induced sepsis are still unknown.MethodsIn this study, we screened the differentially expressed circRNAs among the healthy individuals, pneumonia patients without sepsis and pneumonia-induced sepsis patients in the plasma by RNA sequencing (RNA-seq). Then we evaluated macrophage pyroptosis in sepsis patients and in vitro LPS/nigericin activated THP-1 cells. The lentiviral recombinant vector for circ_0075723 overexpression (OE-circ_0075723) and circ_0075723 silence (sh-circ_0075723) were constructed and transfected into THP-1 cells to explore the potential mechanism of circ_0075723 involved in LPS/nigericin induced macrophage pyroptosis.ResultsWe found circ_0075723, a novel circRNA that was significantly downregulated in pneumonia-induced sepsis patients compared to pneumonia patients without sepsis and healthy individuals. Meanwhile, pneumonia-induced sepsis patients exhibited activation of NLRP3 inflammasome and production of the pyroptosis-associated pro-inflammatory cytokines IL-1β and IL-18. circ_0075723 inhibited macrophage pyroptosis via sponging miR-155-5p which promoted SHIP1 expression directly. Besides, we found that circ_0075723 in macrophages promoted VE-cadherin expression in endothelial cells through inhibiting the release of NLRP3 inflammasome-related cytokines, IL-1β and IL-18, and protects endothelial cell integrity.DiscussionOur findings propose a unique approach wherein circ_0075723 suppresses macrophage pyroptosis and inflammation in pneumonia-induced sepsis via sponging with miR-155-5p and promoting SHIP1 expression. These findings indicate that circRNAs could be used as possible potential diagnostic and therapeutic targets for pneumonia-induced sepsis.

IntroductionMillet-based dryland agriculture is the traditional mode of agricultural cultivation in northern China and has been of great significance to the emergence and development of Chinese civilization. However, although they are both millet-based agricultural production methods, with various subtypes in different regions of northern China. In the Songhua River Region in northeast China, the ecological environment and abundant natural resources led to the slow development of agriculture, and it was only after the Liaojin Dynasties that a mature farming industry was formed.Material and MethodWe used the plant flotation instrument to flotation the soil samples unearthed in the Luotong Mountain City, a Liaojin period site in Songhua River Region, northeast China, and collected the charred plant seeds. Then observing them with the electron microscope, we identified and counted the plant seeds in this site.ResultIt was found that this region is still a millet-based crop utilization structure, and a total of 11 types of charred agricultural crop seeds were excavated from flotation at the Luotong Mountain City site. And the barnyard millet crops occupy a prominent advantage, with ubiquity of more than 91%.DiscussionThe ancestors of this region were still engaged in a millet-based agricultural strategy during this period, with a certain lag compared to the Central Plains’agricultural strategy where Triticeae crops had become dominant. In addition, the crop structure with the millet-based agriculture of the region is also somewhat different from that of the Central Plains. Through comparative studies of surrounding sites and reference to historical documents, it was found that this difference in crop structure is a phenomenon unique to the Songhua River Region and is related to the dietary habits of the local settled Jurchen nomads, who ate barnyard millet meal.

The thinning vegetation and soil erosion problems left behind by extractive mining have caused serious environmental pollution, and vegetation restoration is one of the effective strategies to counter them. To study the effects of vegetation restoration on plant community species diversity, soil carbon, nitrogen and phosphorus, and the response of their plant community succession, four communities of different ages (1, 7, 10, 40) and one natural forest (>50 years) in the Kunyang phosphate mine were selected, and the analysis was carried out using the methods and protocols for plant community inventory. The species composition was recorded, and soil was collected from 0–60 cm in each community to determine the response of soil nutrients and plant diversity to the restoration process. The results show that the species richness of the community increases with the restoration year, the species composition at 40 years of restoration is similar to that of the natural forest, and the Shannon–Wiener diversity index in the tree layer at 40 years of restoration is greater than in the natural forest. Soil pH showed a decreasing trend with restoration year, and TP and AP increased with increasing time series. And the linear stepwise regression analysis showed that soil pH, soil organic carbon (SOC), total phosphorous (TP), available phosphorous (AP), and restoration year were the main factors of plant diversity. Compared to restoration of 10 years, TP and AP at the restoration of 40 years increased to 11.9–20.0 g∙kg−1 and 33.4–75.5 mg∙kg−1. The SOC of the community reached a maximum at 40 years of restoration, 1.5, 2.8, and 2.4 times higher at 0–20 cm, 20–40, and 40–60 cm, respectively, than at 1 year. The organic carbon fraction increased with the restoration year in an ‘N’ pattern, and mineral-associated organic carbon (MOC) and unstable organic carbon fraction decreased at 10 years and 40 years of restoration. The SOC of natural forests decreased, but stable organic carbon increased. The soil pH, SOC, and organic carbon fraction of the communities decreased with increasing soil depth, while TP and AP increased with increasing soil depth at the later period of restoration. In general, with extended restoration years, 40 years plant of restoration in phosphate mines can be expected to allow for plant community succession to climax community, and the key influence on plant diversity are the phosphorus and stable carbon fractions. These results are expected to facilitate the future basis for vegetation succession and restore systems during mining area restoration.

Microvibrations are one of the main factors contributing to platform jitter and a decline in pointing stability and precision. Among various disturbance sources, reaction wheel assembly (RWA) is one of the most significant ones and has drawn the interest of numerous scholars. How to evaluate the influence of the disturbances of RWA on the pointing accuracy of a spacecraft is an arduous task because it involves multiple disciplines. The acquisition of the frequency response function (FRF) from the disturbance source to the sensitive payload is one of the most crucial stages in integrated modeling. Direct measurement of the FRF in the six directions is challenging because of the restricted room for RWA installation in a spacecraft, particularly in small satellites. In this paper, a general method based on the Hv algorithm to obtain the FRF is presented. This method only needs the RWA, itself, as an excitation source. Then, in order to acquire the FRF, we use an optical remote-sensing satellite as the research object. The peak positions of FRF obtained by different RWAs are basically the same, while the amplitudes are slightly different, indicating that this method is effective. This method takes into consideration the coupling between the RWA and the spacecraft, making it possible to multiply the RWA disturbance measured at a fixed interface with the FRF, to determine the image motion of the sensitive payload.

This study investigated the effects of crop rotations and different ratios of dairy manure fertilizer on nitrogen loss and rice yield in the Erhai Lake basin. Two kinds of herbages were set in the rotation: Ryegrass (Lolium multiflorum cv.‘Tetragold’) (R) and Villose Vetch (Vicia villosa var. Glabresens) (V). The experiment involved two-year field tests with nine management treatments. The results showed that the rice-Vicia villosa rotation with 70% chemical and 30% dairy cattle manure fertilization increased rice yield significantly, while reducing nitrogen runoff losses and increasing microbial abundance with nitrification and nitrogen fixation. The microbial abundance varied among tested soils, with Alphaproteobacteria, Rhodopseudomonas, Rhizobiales, Bradyrhizobium, and Azotobacter Vinelandii being the highest in 70% chemical fertilizer + 30% manure rice Villose Vetch (R-V) to ameliorate plant growth and strengthen the efficiency of nutrient uptake, whereas that of Planctomycete was comparatively lower to promote long-term N stabilization in soil. The 70% F—30% M R-V treatment also significantly decreased nitrate reductase and ammonia monooxygenase enzyme activity, potentially improving fertilizer use efficiency, and reducing gaseous losses. The LEfSe analysis results indicated that 70% F—30% M R-V fertilizers significantly enhanced the abundances of metabolic genes related to energy and nitrogen. These findings suggested that appropriate agricultural management using rice-Vicia villosa rotation and 70% chemical + 30% dairy cattle manure fertilization can improve the soil quality and sustainability of agroecosystems.

Pig domestication and management strategy has been increasingly discussed in recent years, focusing on the temporal-spatial differences of pig management strategies. The East Liao River Basin with diverse ecosystems, cultural exchanges, and collisions plays an important role in the cultural development, exchange, and integration processes between Northeast China and the Central Plains. Multiple studies have revealed that various forms of subsistence economy, such as nomadism, fishing and hunting, and farming, existed in this region. However, no report or discussion has been presented concerning the status of domestic animal management strategies over a long-term in the East Liao River Basin. Carbon and nitrogen stable isotopes analysis were performed on the fauna bones at the Changshan site in Siping, Jilin, China, from the Bronze Age (c. 2000–256 BC) to the Liaojin Dynasties (907–1234 AD), to reconstruct their dietary pattern and reveal the status of domestic animal management strategies, especially the diachronic changes in pig feeding strategies. The results showed that pigs (–19.3 ± 1.6%, 5.3 ± 0.9%, n = 27), horses (–18.4 ± 1.7%, 4.8 ± 1.4%, n = 7), and sheep (–19.8 ± 1.5%, 5.7 ± 0.5%, n = 6) primarily received their subsistence through C3-based food. Nevertheless, cattle (–16.4 ± 3.5%, 6.0 ± 2.1%, n = 2) and the past human (–13.9%, 10.3%, n = 1) lived on mixed C3/C4-based food. Notably, the stable isotope data for pigs from the Bronze Age (–19.1 ± 2.0%, 5.4 ± 1.0%, n = 9) to the Liaojin Dynasties (–19.8 ± 0.6%, 5.1 ± 0.7%, n = 15) were similar, indicating that the management and/or feeding strategy of domestic pigs were relatively stable with a free range in a wild ecosystem over a long period. Related studies have shown that pigs in captivity were mainly fed by millet-based food in the West Liao River Basin and the middle reaches of the Yellow River valley, where millet agriculture were adequately developed. Abundant natural resources, including plants, wild animals, and fishes, could provide sufficient food to the past population in the East Liao River Basin. Thus, the millet-based agriculture was just an auxiliary subsistence strategy in the Changshan site, leading to a gap in the driving force for long-term intensive management of pig.

Introduction Sepsis is a life-threatening organ disorder caused by a dysregulated inflammatory response to infection with no effective treatment options exist thus far. Therefore, novel therapeutic methods are urgently advocated for decreasing the high mortality rate. Recently, preclinical studies supported the efficacy of mesenchymal stem cells (MSCs) in the treatment of sepsis. In this study, we aim to test the safety, tolerability and efficacy of human umbilical cord MSCs (HUC-MSCs) for the treatment of pneumonia induced sepsis.Methods and analysis This study is a single-centre, randomised single-blind parallel group, placebo-controlled trial. Forty eligible participants with pneumonia-induced sepsis will be randomly assigned to the observational cohort and the interventional cohort in a 1:1 ratio. In addition to the standard treatments recommended by the Sepsis 3.0 guidelines, HUC-MSCs will be administered intravenously as adjunctive therapy on day 0 at a dose of 1×106 cells/kg with a total volume of 100 mL diluted with normal saline through 120 mL/hour intravenous central line infusion in the interventional cohort. Placebo (normal saline) will also be administered through 120 mL/hour intravenous central line infusion at the same quantity (total volume of 100 mL) in the observational cohort. The study is approved by Research Ethics Board of East Hospital/Tongji University, which has been registered on Chinese clinical trial registry (chictr.org.cn) and initiated from October 2021. All the participants will be followed at regular intervals for 1 year. Funding is from the ‘National Natural Science Foundation, China and top‐level clinical discipline project of Shanghai Pudong’. This study is the first trial to assess the safety and efficacy of HUC-MSCs for the treatment of sepsis induced by pneumonia. The results will advance our understanding of the mode of action of HUC-MSCs and will also be critical for the design of future investigation in larger randomised controlled trials in multicentre. These data will offer insight into defining endpoints, key biomarkers and sample size determination.Ethics and dissemination This study has been approved by the Research Ethics Board of East Hospital, Tongji University (Shanghai, China), which has accepted responsibility for supervising all aspects of the study (DFSC-2021(CR-04). The results of this study will be presented at both national and international conferences and be considered for publication in a peer-reviewed scientific journal. All the results presented in this study will be of group data, therefore, individual participants will not be identifiable.Trial registration number ChiCTR2100050544, the trial is now at the stage of pre-results.

In this study, the relationship between the East Asian subtropical westerly jet (EASWJ) and the East Asian summer monsoon (EASM) (westerly monsoon) and the correlation with the atmospheric heat source (AHS) on the Tibetan plateau (TP), especially the possible connection of the sudden enhancement of the correlation in August were analyzed. The results show that there is a significant correlation between the EASWJ and the EASM from June to October in terms of both intra-annual variability and interannual fluctuations, and the correlation between the AHS over TP and the EASWJ and the EASM during the same period is significantly enhanced in August. The synthetic analysis indicated that when the AHS was strong, a positive anomaly of a horizontal temperature gradient appeared over TP, which was conducive to the southward shift of the high-altitude temperature gradient center, resulting in the southward position of the axis of the 200 hPa westerly jet, and an upward and downward inclined westerly anomaly zone appeared from the south slope of TP to the main body and its north slope. Meanwhile, the East Asia–Pacific (EAP) teleconnection pattern with a negative phase appeared at 500 hPa, and TP to western Japan was located in the negative value area of the wave train. The AHS was conducive to the enhancement of the EAP negative phase, which was not conducive to the further northward transportation of water vapor by the EASM. On the contrary, when the AHS on TP was weak, the position of the westerly jet was northward and the EAP positive phase enhanced, contributing to the further northward transport of water vapor from the EASM.

According to the sixth edition of China’s “New Coronavirus Diagnosis and Treatment Plan (NCDTP),” ReDuNing injection (RDN) was firstly introduced to treat severe and critical COVID-19, whereas its combination with broad-spectrum antibiotics was suggested to take with extreme caution and full reasons. Therefore, we aim to describe the pharmacokinetics of seven active phytochemicals and semiquantification of nine relevant metabolites in ReDuNing injection (RDN) after combining with cefuroxime sodium (CNa) for injection in rat plasma. Male Sprague–Dawley rats were randomly assigned to six groups, and they were intravenously administered, respectively, with different prescriptions of RDN (2 mL/kg) and CNa (225 mg/kg). At different time points (0.03, 0.08, 0.17, 0.24, 0.33, 0.50, 0.67, 1, and 6 h) after administration, the drug concentrations of iridoids glycosides, organic acids, and metabolites in rat plasma were determined using ultrahigh-pressure liquid chromatography coupled with linear ion rap-orbitrap tandem mass spectrometry (UHPLC–LTQ–Orbitrap–MS), and main pharmacokinetic parameters were estimated by noncompartment model. The results showed that there were differences in pharmacokinetic parameters, AUC(0-t), T1/2, Cmax, CL of iridoids glycosides, and organic acids, after the intravenous administration of the different combinations of RDN and CNa. Moreover, different combinations of the injections also resulted in different curves of relative changes of each metabolite. The obtained results suggested that RDN and CNa existed pharmacokinetic drug–herb interactions in rats. The findings not only lay the foundation for evaluating the safety of RDN injection combined with CNa but also make contributions to clinically applying RDN injection combined with CNa, which works potentially against severe forms of COVID-19.

BackgroundSleep disorders (SDs) in autoimmune encephalitis (AE) have received little attention and are poorly understood. We investigated the clinical characteristics, risk factors, and cerebral metabolic mechanism of SD in AE.MethodsClinical, laboratory, and imaging data were retrospectively reviewed in 121 consecutively patients with definite AE. The risk factors for SD in AE were estimated by logistic regression analysis. Group comparisons based on 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG-PET) data were made between patients with and without SD, to further analyze potential brain metabolic mechanism of SD in AE.ResultsA total of 52.9% patients (64/121) with SD were identified. The multivariate logistic model analysis showed that smoking [odds ratio (OR), 6.774 (95% CI, 1.238–37.082); p = 0.027], increased Hamilton Depression scale (HAMD) score [OR, 1.074 (95% CI, 1.002–1.152); p = 0.045], hyperhomocysteinemia [OR, 2.815 (95% CI, 1.057–7.496); p = 0.038], elevated neuron-specific enolase (NSE) level [OR, 1.069 (95% CI, 1.007–1.135); p = 0.03] were independently correlated with higher risk of SD in AE patients. Contrastingly, high MoCA score [OR, 0.821 (95% CI, 0.752–0.896); p < 0.001] was associated with lower risk of SD in AE subjects. Compared to controls, AE patients had less total sleep time, less sleep efficiency, longer sleep latency, more wake, higher percent of stage N1, lower percent of stage N3 and rapid eye movement, and more arousal index in non-rapid eye movement sleep (p < 0.05 for all). Voxel-based group comparison analysis showed that, compared to patients without SD, patients with SD had increased metabolism in the basal ganglia, cerebellum, brainstem, median temporal lobe, thalamus, and hypothalamus [p < 0.05, false discovery rate (FDR) corrected]; decreased metabolism in superior frontal gyrus, medial frontal gyrus, and posterior cingulate cortex (p < 0.001, uncorrected). These results were confirmed by region of interest-based analysis between PET and sleep quality.ConclusionSmoking, increased HAMD score, hyperhomocysteinemia, and elevated NSE level were correlated with higher risk of SD. High MoCA score was associated with lower risk of SD in AE subjects. Moreover, a widespread metabolic network dysfunction may be involved in the pathological mechanism of SD in AE.

Introduction The aetiology of sleep disruptions is unknown, but hormonal fluctuations during the menstrual cycle, pregnancy and menopause have been shown to potentially affect how well a woman sleeps. The aim of this systematic review was to investigate whether hormonal contraceptives are associated with a decreased quality of sleep and increased sleep duration in women of reproductive age.Methods This review will analyse data from randomised controlled trials or non-randomised comparative studies investigating the association between hormonal contraceptives and sleep outcomes among women of reproductive age. Reviews addressing the same research question with similar eligibility criteria will be included. A literature search will be performed using the MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases from inception to 7 March 2021. The Cochrane Collaboration’s Risk of Bias for Randomised Trials V.2.0 and The Risk of Bias for Non-randomised Studies of Interventions tool will be used to assess risk of bias for each outcome in eligible studies. Two reviewers will independently assess eligibility of studies and risk of bias and extract the data. All extracted data will be presented in tables and narrative form. For sleep measures investigated by two or more studies with low heterogeneity, we will conduct random-effects meta-analysis to estimate the magnitude of the overall effect of hormonal contraceptives. If studies included in this systematic review form a connected network, a network meta-analysis will be conducted to estimate the comparative effect of different contraceptives. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to summarise the quality of evidence. Our protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 guidelines.Ethics and dissemination Ethics approval is not required as data were sourced from previously reported studies. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration number CRD42020199958.

OBJECTIVES:. We hypothesized that low serum albumin would contribute to pulmonary edema formation, thereby independently increasing the risk of developing acute respiratory distress syndrome in critically ill patients. DESIGN:. Retrospective analysis of prospective cohort. SETTING:. Medical, surgical, and cardiovascular ICUs at Vanderbilt University Medical Center. PATIENTS:. Patients (n = 993) with serum albumin measured for clinical reasons within 24 hours of study enrollment on ICU day 2 were included. MEASUREMENTS AND MAIN RESULTS:. The primary outcome was presence of acute respiratory distress syndrome at any time during the first 4 days in the ICU, as defined by the Berlin definition. Secondary outcomes included ventilator-free days and ICU length of stay. In an unadjusted analysis, lower serum albumin levels were associated with a higher occurrence rate of acute respiratory distress syndrome (p < 0.001). In a multivariable analysis controlling for prespecified confounders, lower serum albumin was independently associated with an increased risk of acute respiratory distress syndrome (odds ratio, 1.48 per 1-g/dL decrease in albumin; 95% CI, 1.14–1.94; p = 0.004). Additionally, lower serum albumin was associated with increased mortality (odds ratio, 1.56 per 1-g/dL decrease in albumin; 95% CI, 1.19–2.04; p = 0.001), increased ICU length of stay (incidence rate ratio, 1.19; 95% CI, 1.15–1.23; p < 0.001), higher Sequential Organ Failure Assessment score (p < 0.001), and fewer ventilator-free days (incidence rate ratio, 1.21; 95% CI, 1.19–1.24; p < 0.001). CONCLUSIONS:. Among adult ICU patients, lower serum albumin was independently associated with increased risk of acute respiratory distress syndrome after controlling for severity of illness and potential confounders. These findings support the hypothesis that low plasma oncotic pressure contributes to pulmonary edema formation in patients at risk for acute respiratory distress syndrome, independent of severity of illness.

In this work, heterogeneous integration of both two-dimensional (2D) optical phased arrays (OPAs) and on-chip laser arrays based on a silicon photonic platform is proposed. The tunable multi-quantum-well (MQW) laser arrays, active switching/shifting arrays, and grating antenna arrays are used in the OPA module to realize 2D spatial beam scanning. The 2D OPA chip is composed of four main parts: (1) tunable MQW laser array emitting light signals in the range of 1480–1600 nm wavelengths; (2) electro-optic (EO) switch array for selecting the desired signal light from the on-chip laser array; (3) EO phase-shifter array for holding a fixed phase difference for the uniform amplitude of specific optical signal; and (4) Bragg waveguide grating antenna array for controlling beamforming. By optimizing the overall performances of the 2D OPA chip, a large steering range of 88.4° × 18° is realized by tuning both the phase and the wavelength for each antenna. In contrast to the traditional thermo-optic LIDAR chip with an external light source, the overall footprint of the 2D OPA chip can be limited to 8 mm × 3 mm, and the modulation rate can be 2.5 ps. The ultra-compact 2D OPA assembling with on-chip tunable laser arrays using hybrid integration could result in the application of a high-density, high-speed, and high-precision lidar system in the future.

By using daily precipitation data in Sichuan Province from 1961 to 2015, data during typical years on the rainstorm disaster, GDP, population and cultivated area, and the method of weighted summation based on normalized process precipitation, maximum daily precipitation and the duration, the comprehensive strength index and the grade standard of rainstorm are established. Based on the economic loss rate, population affected rate and crop affected rate indices, the grey correlation method is used to determine the disaster degree. The relational analysis method is used to establish the disaster loss assessment model based on the comprehensive strength index of rainstorm and the grey correlation degree of rainstorm, respectively. The possible economic loss rate caused by different return periods of rainstorm is studied, too. The result shows that the comprehensive strength index of rainstorm can reveal the time-frequency and spatial distribution characteristics of heavy rainfall in different intensities. The loss caused by rainstorm process is significantly related to the comprehensive strength index and the grey correlation degree of rainstorm, and the results of both the two kinds of loss assessment models are good. The economic loss rate of rainstorm of 5-year return period is mostly below 3%, and that of 50-year return period is above 3%. It in the north and west of Sichuan basin is more than 5%, and in some areas it could reach 7% to 9%.

Objective: To explore the biochemical risk factors and imaging mechanisms of post fatigue after mild ischemic stroke among a Chinese population.Methods: Forty consecutive patients with mild ischemic stroke within onset of 14 ± 2 days were enrolled between March and June 2018. The clinical information, scale data, biomarkers in peripheral venous blood, and imaging data during hospitalization and follow-up period were collected.Results: Patient age (range 34–78) was positively correlated with the prevalence of fatigue (p = 0.009). Both blood norepinephrine and serotonin levels during hospitalization were negatively correlated to the prevalence of post-stroke fatigue (model 1 p = 0.009 and model 2 P = 0.043, respectively). Infarct of right cerebral hemisphere is positively correlated with the occurrence of fatigue after mild ischemic stroke (p = 0.020). Compared to non-fatigue patients, amplitude of low-frequency fluctuation (ALFF) was lower in several areas of brain in stroke patients with fatigue, including the right orbital inferior frontal, right inner orbital frontal, right frontal, right triangular frontal inferior, right anterior and lateral cingulate, and right medial frontal gyruses. Analysis of the difference in functional connectivity between the fatigue and non-fatigue groups found no cluster.Conclusions: Frontal lobe-related neural pathways may play an essential role in the regulation of fatigue after mild ischemic stroke. Abnormal neural circuits may reduce the levels of neurotransmitters such as serotonin and norepinephrine and lead to post-stroke fatigue.

Background: We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.Methods: SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI – PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD.Results: Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25–2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40–2.68, interaction P = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, P = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI – PAD.Conclusions: There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI – PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.

We recently reported the differential circRNA expression patterns of the pulmonary macrophages in sepsis-induced acute respiratory distress syndrome (ARDS) mice model by microarray analysis. However, their function and hidden molecular mechanism in regulation of macrophage activation and inflammation remain poorly understood. In this study, we found that circN4bp1was overexpressed in PBMC and monocytes, and its expression levels were correlated with a poor prognosis in sepsis induced ARDS patients induced by sepsis. Knockdown of circN4bp1 inhibited the lung injury and improved the long-time survival through blunting the M1 macrophage activation in cecal ligation and puncture- (CLP-) induced ARDS mice. Moreover, bioinformatics analysis predicated a circN4bp1/miR-138-5p ceRNA network, which was confirmed by luciferase reporter assay and RNA binding protein immunoprecipitation (RIP). CircN4bp1 affected macrophage differentiation by binding to miR-138-5p, thus regulating the expression of EZH2 in vivo and ex vivo. Lastly, the m6A level of circN4bp1was found to be elevated in ARDS mice; inhibition of m6A methyltransferase METTL3 blocked this response in vitro. Therefore, circN4bp1 can function as a miR-138-5p sponge for the modulation of macrophage polarization through regulation the expression of EZH2 and may serve as a potential target and/or prognostic marker for ARDS patients following sepsis.

Rationale: Chronic air pollutant exposure has been associated with development of Acute Respiratory Distress Syndrome (ARDS) in patients at risk, particularly from severe trauma. We recently reported that shorter peripheral blood leukocyte (PBL) telomere length (TL) was associated with worse outcomes and higher severity of ARDS in critically ill patients. Since most major air pollutants are potent oxidants that can induce cellular oxidative stress, and oxidative stress can accelerate telomere shortening, we hypothesized that higher levels of chronic air pollutant exposure would be associated with shorter telomere length in critically ill patients including patients with ARDS. Methods: PBL-TL was measured in genomic DNA collected on the morning of ICU day 2 in 772 critically ill patients enrolled in a prospective observational study. Exposures to air pollutants including ozone (warm-season only), particulate matter

Background: The triglyceride glucose index (TyG index) has been proposed as a simple and credible surrogate marker of insulin resistance. However, it is unclear whether TyG index correlates with adverse clinical outcomes in patients with ischemic stroke. Accordingly, this study aimed to explore the relationship between baseline TyG index and clinical outcomes of ischemic stroke individuals.Methods: We included eligible subjects with ischemic stroke from the China National Stroke Registry II for the current analysis. TyG index was calculated and divided into quartiles to explore the relationship with the outcomes of ischemic stroke. Outcomes included stroke recurrence, all-cause mortality, poor functional outcome at 12 months, and neurologic worsening at discharge. Multivariable Cox regression and logistic regression models were performed to explore the correlation of baseline TyG index with the outcomes.Results: Among the 16,310 patients enrolled in the study, the average age was 64.83 ± 11.9 years, and 63.48% were men. The median TyG index was 8.73 (interquartile range, 8.33–9.21). After adjustment for multiple potential covariates, the fourth quartile of TyG index was associated with an increased risk of stroke recurrence (adjusted HR, 1.32; 95% CI, 1.11–1.57; P = 0.002), all-cause mortality (adjusted HR, 1.25; 95%CI, 1.06–1.47; P = 0.01) at 12-month follow-up, and neurological worsening (adjusted OR, 1.26; 95% CI, 1.02–1.55; P = 0.03) at discharge, but not poor functional outcome compared with the first quartile.Conclusion: TyG index representing insulin resistance was associated with an increased risk of stroke recurrence, all-cause mortality, and neurologic worsening in patients with ischemic stroke.

Background: Previous studies conflicted in the association between intracranial atherosclerotic stenosis (ICAS) and the severity of white matter changes (WMC).Aims: We aimed to investigate the relationships between the severity of luminal stenosis and the hemodynamic significance of middle cerebral artery (MCA) stenosis, and the severity of ipsilateral WMC.Methods: In this cross-sectional study, patients with a recent ischemic stroke or transient ischemic attack and a 50–99% MCA-M1 stenosis in the Chinese Intracranial Atherosclerosis study cohort were analyzed. The post- to pre-stenotic signal intensity ratio (SIR) was obtained in time-of-flight MR angiography (MRA) to represent the hemodynamic significance of MCA-M1 stenosis, with a lower SIR indicating a hemodynamically more severe lesion. The severity of ipsilesional WMC was assessed by an age-related WMC (ARWMC) scale in T2-weighted fluid attenuated inversion recovery MR imaging. The relationships between the degree of MCA-M1 stenosis, SIR, and ipsilesional ARWMC scale were analyzed. The MCA-M1 lesion with a higher percentage of stenosis was chosen for analyses in patients with bilateral MCA-M1 stenoses.Results: Among 180 subjects (mean age, 64 years), a lower SIR of MCA-M1 stenosis (Spearman correlation coefficient, −0.543; p < 0.001), but not the degree of stenosis (p = 0.93), was significantly linearly correlated with a higher ipsilateral ARWMC. Multivariate ordinal logistic regression identified older age (OR = 1.037; 95% CI, 1.008–1.066; p = 0.011) and lower SIR (OR = 0.010; 95% CI, 0.002–0.058; p < 0.001) as independent predictors for more severe ipsilateral WMC.Conclusion: Patients with hemodynamically more severe ICAS are more likely to have more severe ipsilateral WMC. Longitudinal studies with sequential imaging exams may further reveal the impact of hemodynamic significance of ICAS on the development and progression of WMC.

In this work, a photonic device integration platform capable of integration of active-passive InP-based photonic devices without the use of material regrowth is introduced. The platform makes use of an adiabatic active-layer waveguide connection (ALWC) to move an optical beam between active and passive devices. The performance of this platform is analyzed using an example made up of four main sections: (1) a fiber coupling section for enabling vertical beam coupling from optical fiber into the photonic chip using a mode-matched surface grating with apodized duty cycles; (2) a transparent waveguide section for realizing passive photonic devices; (3) an adiabatic mode connection structure for moving the optical beam between passive and active device sections; and (4) an active device section for realizing active photonic devices. It is shown that the coupled surface grating, when added with a bottom gold reflector, can achieve a high chip-to-fiber coupling efficiency (CE) of 88.3% at 1550 nm. The adiabatic active-layer mode connection structure has an optical loss of lower than 1% (CE > 99%). The active device section can achieve an optical gain of 20 dB/mm with the use of only 3 quantum wells. The optimized structural parameters of the entire waveguide module are analyzed and discussed.

In this work, we successfully developed a fluorinated cross-linked polymer Bragg waveguide grating-based optical biosensor to detect effective drug concentrations of ginkgolide A for the inhibition of pulmonary microvascular endothelial cell (PMVEC) apoptosis. Fluorinated photosensitive polymer SU-8 (FSU-8) as the sensing core layer and polymethyl methacrylate (PMMA) as the sensing window cladding were synthesized. The effective drug concentration range (5–10 µg/mL) of ginkgolide A for inhibition of PMVEC apoptosis was analyzed and obtained by pharmacological studies. The structure of the device was optimized to be designed and fabricated by direct UV writing technology. The properties of the biosensor were simulated with various refractive indices of different drug concentrations. The actual sensitivity of the biosensor was measured as 1606.2 nm/RIU. The resolution and detection limit were characterized as 0.05 nm and 3 × 10−5 RIU, respectively. The technique is suitable for safe and accurate detection of effective organic drug dosages of Chinese herbal ingredients.

BACKGROUND:Only a very few studies had compared the differences in topographic patterns of cerebral infarcts between middle cerebral artery (MCA) and internal carotid artery (ICA) disease. Besides, the comparison of clinical features and outcomes between MCA and ICA disease had rarely been reported. OBJECTIVES:To compare the clinical, imaging features and outcome of MCA versus ICA disease. METHODS:We prospectively enrolled 1172 patients with noncardiogenic ischemic stroke in ipsilateral ICA or MCA territory. Clinical, neuroradiologic and outcome of the two groups were compared in this observational cohort study. RESULTS:The ICA group more frequently presented with decreased alertness, gaze palsy, aphasia, and neglect than the MCA group at admission, and more often had higher National Institute of Health stroke scale score at admission and discharge. Meanwhile, the ICA group more frequently had multiple acute infarcts, watershed infarcts, territorial infarct, small cortical infarct, and responsible artery stenosis ≥70%. Whereas penetrating artery infarct and parent artery occluding penetrating artery was more often associated with MCA disease. The ICA group more frequently had inhospital complications of pneumonia and deep vein thrombosis, more often had disability at discharge, and had more recurrent ischemic stroke or transient ischemic attack in 1 Year. Multivariable logistic regression identified male (OR, 1.99; 95% CI, 1.30 to 3.05; P = 0.002), history of coronary heart disease (OR, 1.85; 95% CI, 1.03 to 3.32; P = 0.041), multiple acute infarcts (OR, 4.18; 95% CI, 2.07 to 8.45; P

Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression.Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke.Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035–1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111–27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190–4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019–2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F(1, 532) = 20.2, p < 0.001].Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke.The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.

Objective: This study aimed to investigate the association between cognitive impairment and cerebral haemodynamic changes in patients with chronic vertebra-basilar (VB) stenosis.Methods: Patients with severe posterior circulation VB stenosis and infarction or a history of infarction for more than 2 weeks from January 2014 to January 2015 were enrolled (n = 96). They were divided into three groups, namely, the computed tomography perfusion (CTP) normal group, the CTP compensated group, and the CTP decompensated group. Cognitive function was assessed using a validated Chinese version of the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regression models were used to identify independent risk factors for cognitive impairment.Results: The MMSE and FAB scores of patients in the CTP decompensated group were significantly lower than those of patients in the CTP normal and CTP compensated groups (all p < 0.05). The RBANS total and its domain scores, including immediate memory, visual acuity, and delayed memory, in the CTP compensated and CTP decompensated groups were significantly lower than those in the CTP normal group (all p < 0.05). Multiple regression analyses showed that CTP compensation, CTP decompensation, severe VB tandem stenosis, and multiple infarctions were independent risk factors for cognitive impairment.Conclusions: Low perfusion caused by severe VB stenosis can lead to extensive cognitive impairments in areas such as immediate memory, visual span, and delayed memory.

In this work, thermo-optic (TO) lateral shift apodized sampled waveguide grating for 1550 nm wavelength is designed and fabricated by the metal-printing technique based on fluorinated epoxy-terminated polycarbonates (FBPA-PC EP) and fluorinated epoxy resin (FSU-8) materials. The optical characteristics and thermal stability of the FBPA-PC EP and FSU-8 materials are analyzed. To realize periodic wide-spectrum filtering and suppress the side-lobes of grating, a lateral shift apodized sampled waveguide grating is proposed. The 3 dB bandwidth and wavelength spacing can reach 4.8 nm and 9.7 nm. The side-lobe suppression ratio of proposed device can reach 22.6 dB, which is much better than traditional Bragg grating (6.1 dB). Driving electrical powers of 42.4 mW and 87.2 mW can produce blueshifts of 1.8 nm and 3.5 nm in the measured reflection spectrum, respectively. This device realizes the aim of multiple functions, including periodic filtering, wide-spectrum filtering, and high side-lobe suppression. The device is applicable of realizing signal processing and wavelength division multiplexing (WDM )systems.

To investigate the impact of low socioeconomic status (SES), indicated by low level of education, occupation and income, on 3 months functional outcome after ischemic stroke.We analyzed data from the China National Stroke Registry (CNSR), a multicenter and prospective registry of consecutive patients with acute cerebrovascular events occurred between September 2007 and August 2008. 11226 patients with ischemic stroke had SES and clinical characteristics data collected at baseline and mRS measured as indicator of functional outcome in 3 months follow up. Multinomial and ordinal logistic regression models were performed to examine associations between SES and the functional outcome.At 3 months after stroke, 5.3% of total patients had mRS scored at 5, 11.3% at score 4, 11.1% at score 3, 14.4% at score 2, 34.2% at score 1 and 23.7% at score 0. Compared to patients with educational level of ≥ 6 years and non-manual laboring, those < 6 years and manual laboring tended to have higher mRS score (P

BackgroundInsulin resistance is associated with an increased risk of cardiovascular events in the general population. This study aimed to estimate the association between post–glucose load measures of insulin resistance and prognosis of nondiabetic patients with ischemic stroke. Methods and ResultsData were derived from the ACROSS‐China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke without a history of diabetes mellitus were included. Two post–glucose load measures of insulin sensitivity, the insulin sensitivity indices ISI(composite) and the ISI0,120, were calculated. Outcomes included stroke recurrence, all‐cause death, and poor functional outcome at 12 months. Among 1203 patients, 63.3% were male with an average age of 62.1 years. At 12 months, 168 (14.4%) patients had recurrent stroke, 111 (9.2%) had died, and 288 (24.4%) had poor outcome. After adjustment for potential covariates, the first quartile of the ISI(composite) was associated with increased 12‐month stroke recurrence (adjusted hazard ratio 2.02, 95% CI 1.28–3.18, P=0.003), death (adjusted hazard ratio 2.78, 95% CI 1.59–4.86, P

In this paper, we present and analyze a compact inner-wall grating slot microring resonator (IG-SMRR) with the footprint of less than 13 μm × 13 μm on the silicon-on-insulator (SOI) platform for label-free sensing, which comprises a slot microring resonator (SMRR) and inner-wall grating (IG). Its detection range is significantly enhanced without the limitation of the free spectral region (FSR) owing to the combination of SMRR and IG. The IG-SMRR has an ultra-large quasi-FSR of 84.5 nm as the detection range, and enlarged factor is up to over 3 compared with the conventional SMRR. The concentration sensitivities of sodium chloride solutions and D-glucose solutions are 996.91 pm/% and 968.05 pm/%, respectively, and the corresponding refractive index (RI) sensitivities are 559.5 nm/RIU (refractive index unit) and 558.3 nm/RIU, respectively. The investigation on the combination of SMRR and IG is a valuable exploration of label-free sensing application for ultra-large detection range and ultra-high sensitivity in future.

BackgroundThe aim of this study was to analyze the benefits and safety associated with the combination therapy of clopidogrel and aspirin among minor stroke or transient ischemic attack patients treated within 12 hours. Methods and ResultsThis was a subanalysis of the CHANCE (Clopidogrel in High‐Risk Patients with Acute Nondisabling Cerebrovascular Events) trial, mainly limited to the prespecified group of patients randomized within 12 hours to either the combination of clopidogrel plus aspirin or aspirin alone. The primary outcome was ischemic stroke during 90‐day follow‐up. Recurrent ischemic stroke and progressive ischemic stroke were analyzed. Multivariable Cox modeling showed that randomization within 12 hours was an independent predictor of ischemic stroke events (hazard ratio [95% CI] 1.25 [1.04–1.49], P=0.02). Among 2573 patients randomized within 12 hours, 282 (10.96%) patients had ischemic stroke events. Among them, 158 (12.34%) of 1280 patients taking aspirin experienced ischemic stroke compared with 124 (9.59%) of 1293 patients taking clopidogrel–aspirin (P=0.02). The dual antiplatelet was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke (6.57% versus 8.91%, P=0.03) but not progressive ischemic stroke (3.02% versus 3.43%, P=0.28). There was no significant difference in hemorrhagic events (P=0.39). ConclusionsAmong patients treated within 12 hours, the combination of clopidogrel and aspirin was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke during the 90‐day follow‐up and did not increase the hemorrhagic risk. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT00979589.

BACKGROUND: The risk of a subsequent stroke following a minor stroke is high. However, there are no effective rating scales to predict recurrent stroke following a minor one. Therefore, we assessed the risk factors associated with recurrent ischemic stroke or transient ischemic attack (TIA) within one year of minor stroke onset in order to identify possible risk factors. METHODS: Eight hundred and sixty-three non-cardioembolic ischemic stroke patients in the Chinese IntraCranial AtheroSclerosis Study that presented with minor stroke, defined as an admission National Institutes of Health stroke scale (NIHSS) score of ≤3, were consecutively enrolled in our study. Clinical information and imaging features upon admission, and any recurrent ischemic stroke or TIA within one year was recorded. Cox regression was used to identify risk factors associated with recurrent ischemic stroke or TIA within the year following stroke onset. RESULTS: A total of 50 patients (6.1%) experienced recurrent ischemic stroke or TIA within one year of minor stroke onset. Multivariate Cox regression model identified lower admission NIHSS score (HR, 1.75; 95% CI, 1.32 to 2.33; P

Previous studies have suggested that C-reactive protein (CRP) was associated with risk of stroke. There were few studies in Asian population, or on stroke subtypes other than ischemic stroke. We thus investigated the relationship between CRP and the risks of all stroke and its subtypes in a Chinese adult population.In the current study, we included 90,517 Chinese adults free of stroke and myocardial infarction at baseline (June 2006 to October 2007) in analyses. Strokes were classified as ischemic stroke (IS), intracranial heamorrhage (ICH) and subarachnoid heamorrhage (SAH). High-sensitivity CRP (hs-CRP) were categorized into three groups: 3 mg/L. Cox proportional hazards regression was used to calculate the association between hs-CRP concentrations and all stroke, as well as its subtypes.During a median follow-up time of 49 months, we documented 1,472 incident stroke cases. Of which 1,049 (71.3%) were IS, 383 (26.0%) were ICH, and 40 (2.7%) were SAH. After multivariate adjustment, hs-CRP concentrations ≥1 mg/L were associated with increased risks of all stroke (hs-CRP 1-3 mg/L: hazard ratio (HR) 1.17, 95% confidential interval (CI) 1.03-1.33; hs-CRP>3 mg/L: HR 1.25, 95% CI 1.07-1.46) and IS (hs-CRP 1-3 mg/L: HR 1.17, 95% CI 1.01-1.36; hs-CRP>3 mg/L: HR 1.33, 95% CI 1.11-1.60), but not with ICH and SAH. Subgroup analyses showed that higher hs-CRP concentration was more prone to be a risk factor for all stroke and IS in non-fatal stroke, male and hypertensive participants.We found that higher hs-CRP concentrations were associated with a higher risk of IS, particularly for non-fatal stroke, male and hypertensive subjects. In contrast, we did not observe significant associations between hs-CRP and ICH/SAH.

BACKGROUND: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country. METHODS: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. RESULTS: Comparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY. CONCLUSIONS: Intravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.

Resting heart rate (RHR) predicts both cardiovascular and noncardiovascular death in different populations. However, the results of the association between RHR and cardiovascular diseases (CVDs) are inconsistent, especially for each subtype of CVDs.The aim of this study was to prospectively explore the relationship between RHR and CVDs including myocardial infarction (MI), ischemic stroke, and hemorrhagic stroke and all-cause death in a general population.The Kailuan study is a prospective longitudinal cohort study on cardiovascular risk factors and cardiovascular or cerebrovascular events. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling.We analyzed 92,562 participants (18-98 years old) in the Kailuan Study. CVDs were developed in 1,903 people during follow-ups. In multivariate analysis with adjustment for major traditional cardiovascular risk factors, HRs of the highest quintile group compared with the lowest quintile group of RHR for all-cause CVDs, MI, any stroke, ischemic stroke, hemorrhagic stroke, and all-cause death were 1.03 (95% CI, 0.98-1.07), 1.10 (95% CI, 1.01-1.20), 1.01 (95% CI, 0.97-1.06), 1.02 (95% CI, 0.96-1.07), 1.01 (95% CI, 0.92-1.11) and 1.18, (95% CI, 1.13-1.23), respectively.The elevated RHR was independently associated with the increased risk for MI and all-cause death, but not for all-cause CVDs, any stroke, ischemic stroke, nor hemorrhagic stroke. This indicates that the elevated RHR might be a risk marker for MI and all-cause death in general populations.

BACKGROUND AND PURPOSE: Few studies have reported on the risk factors of dilated Virchow-Robin Spaces (dVRS) in large samples of ischemic stroke patients. Little evidence exists regarding the relationship between dVRS and etiologic subtype of ischemic stroke or lacune. We aimed to investigate the risk factors associated with the severity of dVRS in a large sample of ischemic stroke patients. METHODS: We consecutively enrolled 1,090 patients who experienced an ischemic stroke within the past seven days and underwent a 3.0 T MRI scan in the Chinese IntraCranial AtheroSclerosis Study (ICAS). Clinical data and cranial MRI information of patients included age, sex, vascular risk factors, dVRS, leukoaraiosis, lacune, and etiologic subtype of ischemic stroke. Analyses were performed regarding the risk factors associated with the severity of dVRS by univariate analysis and multivariable ordinal logistic regression analysis. RESULTS: Through multivariable ordinal logistic regression analysis, age, the severity of leukoaraiosis, lacune, admission National Institutes of Health Stroke Scale (NIHSS) ≤3, and the severity of dVRS in the white matter (WM) and hippocampus (Hip) were correlated with the severity of dVRS in basal ganglia (BG); male, history of hypertension, admission NIHSS ≤3, and the severity of dVRS in BG and Hip were correlated with the severity of dVRS in WM; female, the severity of leukoaraiosis, admission NIHSS >3, small artery occlusion subtype of ischemic stroke, and the severity of dVRS in BG and WM were correlated with the severity of dVRS in Hip. CONCLUSION: dVRS is an indicator of cerebral small vessel diseases such as leukoaraiosis and lacune. However, the risk factors of dVRS differ in various brain regions.

BACKGROUND: Statins reportedly improve clinical outcomes for ischemic stroke patients. However, it is unclear whether the contribution of statin treatment varies depending on the severity of stroke. We sought to investigate the relationship between statin use and the outcome of acute first-ever ischemic stroke patients stratified by stroke severity. METHODS: A total of 7,455 acute first-ever ischemic stroke patients without statin treatment before onset were eligible from the China National Stroke Registry. A National Institutes of Health Stroke Scale (NIHSS) score of 0 to 4 was defined as minor stroke, and a NIHSS score of >4 was defined as non-minor stroke. We analyzed the association between statin use during hospitalization and mortality as well as functional outcome (measured by a modified Rankin Scale score of 0-5) at 3 months after onset using multivariable logistic regression models. RESULTS: A total of 3,231 (43.3%) patients received statin treatment during hospitalization. Multivariable analysis showed that statin use during hospitalization decreased mortality of ischemic stroke patients (OR, 0.51; 95%CI, 0.38-0.67), but did not improve poor functional outcomes (OR, 0.95; 95CI%, 0.81-1.11) at 3 months. The interaction between statin use and stroke severity was significant both in dependence and death outcome (P = 0.04 for dependence outcome, P = 0.03 for death outcome). After stratification by stroke severity, statin use during hospitalization decreased the mortality of stroke (OR, 0.44; 95%CI, 0.31-0.62) and poor functional outcome (OR, 0.73; 95%CI, 0.57-0.92) at 3 months in the non-minor stroke group. CONCLUSIONS: Statin use during hospitalization may improve the clinical outcome of acute first-ever ischemic stroke depending on the severity of stroke. Non-minor stroke patients may obtain benefit from statin treatment with improvements in poor functional outcomes and mortality.

BACKGROUND: Intracranial arterial stenosis (ICAS) is one of the most common causes of stroke, and dyslipidemia was one of the most common risk factors related to ICAS. However, the correlation between the plasma total cholesterol level (PTC) and ICAS, especially asymptomatic ICAS (AICAS) is not clear. MATERIALS AND METHODS: 5,300 participants were enrolled in this study. The diagnosis of AICAS was made by transcranial Doppler ultrasonography. The participants were then divided into 5 essentially equal-sized groups based on their PTC levels. The multivariate logistic regression was used to analyze the correlation between the PTC level and the prevalence of AICAS. RESULTS: 13.0% of the participants were diagnosed with AICAS. The prevalence of AICAS gradually increased with the increasing PTC level. After adjusted by the possible confounding factors, the Odds Ratios (OR) of the AICAS prevalence between the 1st quintile group and the other 4 groups were 1.13, 1.23, 1.63 and 1.75 with 95% confident intervals (CI) of 0.84-1.52, 0.91-1.66, 1.20-2.22 and 1.23-2.47, respectively. The further subgroup analysis revealed that the PTC level was stronger for males (OR 1.42 95%CI 1.23-1.64), regarding the prevalence of AICAS. CONCLUSIONS: In this large community-based study, the prevalence of AICAS is 13.0%, subjects with higher PTC levels showed a mild increase in the prevalence of AICAS. The PTC level is an independent risk factor of AICAS. Males seem to be significantly more vulnerable to the risk of AICAS.

BackgroundIntracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke worldwide. The role of high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C) in the development of ICAS remains to be elucidated. In the current study, we investigated the relationship of HDL-C level and the risk of developing ICAS in Chinese patients with acute ischemic stroke.MethodsFrom October 2007 to June 2009, a total of 1,984 consecutive ischemic stroke patients were evaluated for the presence of symptomatic ICAS by magnetic resonance angiography (MRA). Patients were classified into two groups: intracranial steno-occlusion (ICAS group, n = 888) and non-intracranial stenosis (NICAS group, n = 1096). Serum lipid profiles were analyzed and compared between the ICAS and NICAS group.ResultsSignificantly more patients in ICAS group had low HDL-C level (51.6%) than in the NICAS group (42.9%, PConclusionsLow HDL-C level is strongly associated with the development of ICAS. There was an inverse relationship between the level of HDL-C and the risk of developing ICAS.