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Getting access to administrative health data for research purposes is a difficult and time-consuming process due to increasingly demanding privacy regulations. An alternative method for sharing administrative health data would be to share synthetic datasets where the records do not correspond to real individuals, but the patterns and relationships seen in the data are reproduced. This paper assesses the feasibility of generating synthetic administrative health data using a recurrent deep learning model. Our data comes from 120,000 individuals from Alberta Health’s administrative health database. We assess how similar our synthetic data is to the real data using utility assessments that assess the structure and general patterns in the data as well as by recreating a specific analysis in the real data commonly applied to this type of administrative health data. We also assess the privacy risks associated with the use of this synthetic dataset. Generic utility assessments that used Hellinger distance to quantify the difference in distributions between real and synthetic datasets for event types (0.027), attributes (mean 0.0417), Markov transition matrices (order 1 mean absolute difference: 0.0896, sd: 0.159; order 2: mean Hellinger distance 0.2195, sd: 0.2724), the Hellinger distance between the joint distributions was 0.352, and the similarity of random cohorts generated from real and synthetic data had a mean Hellinger distance of 0.3 and mean Euclidean distance of 0.064, indicating small differences between the distributions in the real data and the synthetic data. By applying a realistic analysis to both real and synthetic datasets, Cox regression hazard ratios achieved a mean confidence interval overlap of 68% for adjusted hazard ratios among 5 key outcomes of interest, indicating synthetic data produces similar analytic results to real data. The privacy assessment concluded that the attribution disclosure risk associated with this synthetic dataset was substantially less than the typical 0.09 acceptable risk threshold. Based on these metrics our results show that our synthetic data is suitably similar to the real data and could be shared for research purposes thereby alleviating concerns associated with the sharing of real data in some circumstances.

Easily separated novel magnetic composite, derived from a kind of green macroalgae—Enteromorpha prolifera, was employed for effective adsorption of radioactive cobalt (60Co) and nickel (63Ni). The ...

Objective Hepatocellular carcinoma (HCC) is a notable threat to the longevity of elderly people. However, there is no trial to study the prognosis of these elderly patients after microwave ablation (MWA) treatment. This study investigated whether elderly patients with HCC benefit from MWA similar to younger patients. Materials and methods Patients who underwent ultrasound-guided percutaneous MWA were included and divided into four age groups and the prognosis was compared. The senior group (Group S, ≥75 years) was then compared with the younger group (Group Y

Background: For patients with multiple aneurysmal subarachnoid hemorrhages (SAHs), a simple and fast imaging method that can identify ruptured intracranial aneurysms (RIAs) may have great clinical value. We sought to use the aneurysm-specific prediction (ASP) score to identify RIAs in patients with multiple IAs (MIAs) and evaluate the ASP score.Methods: Between May 2018 and May 2021, 134 patients with 290 MIAs were retrospectively analyzed. All patients had an SAH due to IA rupture. CT angiography (CTA) was used to assess the maximum diameter, shape, and location of IAs to calculate the ASP score. Then, the ASP score was applied to patients with actual RIAs. Results: The IAs with the highest ASP scores had not ruptured in 17 (12.7%) of the 134 patients with 290 MIAs. The sensitivity, specificity, false omission rate, diagnostic error rate, and diagnostic accuracy of the ASP score were higher than those of the maximum diameter, shape, and location of IAs.Conclusions: The present study suggests that the ASP score has high diagnostic accuracy in identifying RIAs in patients with MIAs and SAH, but that it needs further evaluation.

Carcinoma of the kidney is one of the most prevalent carcinoma worldwide. The majority types of carcinoma are clear cell renal cell carcinoma (CCRCC), which consist more than 80% of the cases. As a genetically diverse disease, identification of prognosis-related genes has utmost importance in the early diagnosis and prognosis of the CCRCC. In this study, we performed gene expression profiling to identify prognosis-related genes for CCRCC. In addition, we developed and validated a gene signature-based risk score to comprehensively assess the prognostic function of differentially expressed genes. Furthermore, we performed a ROC analysis to identify the optimal cut-off point for classification risk level of the patients. Univariate Cox regression models were used to assess the association between differentially expressed genes in relation to the prognosis of patients with different stages of CCRCC. Five genes were identified significantly differentially expressed in CCRCC and associated with their survival time, namely: IDUA, NDST1, SAP30L, CRYBA4, and SI. A 5-gene signature-based risk score was developed based on the Cox coefficient of the individual genes. The prognostic value of this risk score was validated in an internal testing data set. In summary, a gene-based risk score was identified and validated, which can predict CCRCC patient survival. The potential functions of this gene expression signature and individual differentially expressed gene as prognostic targets of CCRCC were revealed by this study. Furthermore, these findings may have important implications in the understanding of the potential therapeutic method for the CCRCC patients.

The objective of this study was to evaluate relationship with aggregation, secondary structures and gel properties of pork myofibrillar protein with different sodium chloride (1%, 2% and 3%). When the sodium chloride increased from 1 to 3%, the active sulfhydryl, surface hydrophobicity, hardness and cooking yield of myofibrillar protein were increased significantly (p

To investigate the effect of sodium bicarbonate instead of sodium chloride, the changes in pH, turbidity, aggregation, and conformation of myofibrillar protein solution with various amounts of sodium chloride and sodium bicarbonate were studied. When the sodium bicarbonate was increased from 0% to 0.4%, accompanied by the sodium chloride being decreased from 2.0% to 0.8%, the pH increased about 1.20 unites; the absolute values of the Zeta potential, active sulfhydryl, and surface hydrophobicity increased significantly (p 0.05) when increasing sodium bicarbonate, implying that sodium bicarbonate did not affect the actin. Overall, the results indicated that an increase in sodium bicarbonate could improve solubility, expose more hydrophobic residues and sulfhydryl groups, and induce Ca2+-ATPase inactivation and protein unfolding, leading the myofibrillar protein to denaturation easily.

Objective: This study aimed to assess the accuracy of ultrasonic grading in determining brain injury in very premature infants and analyze the affecting factors of these neonatal morbidity and mortality, and to investigate the relationship between serial cranial ultrasound (cUS) classification and Mental Developmental Index (MDI)/Psychomotor Developmental Index (PDI) in premature infants. Methods: A total of 129 very preterm infants (Gestational Age ≤ 28 weeks) were subjected to serial cUS until 6 months or older and classified into 3 degrees in accordance with classification standards. The MDI and PDI (Bayley test) of the infants were measured until the infants reached the age of 24 months or older. The consistency between Term Equivalent Age (TEA)-cUS and TEA- magnetic resonance imaging (MRI) was calculated. Ordinal regression was performed to analyze the relationship among severe disease, early cUS classifications, psychomotor and mental development, and death. Operating characteristic curve were used to analyze the relationship between serial cUS grades and MDI/PDI scores. Results: The mortality and survival rates of 129 very preterm infants were 32.8% and 67.3%, respectively. Among the 86 surviving infants, 20.9% developed mild cerebral palsy (CP) and 5.8% to 6.9% developed severe CP. The consistency between TEA-cUS and TEA-MRI was 88%. Grades 2 and 3 at first ultrasound were associated with adverse mental (OR = 3.2, OR = 3.78) and motor (OR = 2.25, OR = 2.59) development. cUS classification demonstrated high sensitivity (79%–96%). Among all cUS classifications, the specificity of the first cUS was the lowest and that of TEA-cUS was the highest (57% for PDI and 48% for MDI). Conclusions: Moderate and severe brain injury at first ultrasound is the most important factor affecting the survival rate and brain development of very premature infants. The cUS classification had high sensitivity and high specificity for the prediction of CP, especially in TEA-cUS.

To study the potential use of sodium bicarbonate in low-salt pork batters, the gel properties, rheology and water holding capacity of pork batters with various amounts of sodium chloride (0.7–1.74%) and sodium bicarbonate (0–0.42%) were investigated. The results showed that the pH, salt-soluble protein concentration, cooking yield, b* values and G′ values at 80 °C were significantly (P

Background: Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants. Methods: Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children’s Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed. Results: The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively). Conclusions: Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury. Key words: Brain Injury; Extremely Premature Infants; Magnetic Resonance Imaging; Neurodevelopment; Ultrasound

A novel coordination polymer [Pb(1,4-phda)]n (1) has been hydrothermally synthesized through the reaction of 1,4-phenylenediacetic acid (1,4-H2phda) with divalent lead salt and characterized by IR spectra, elemental analysis and single crystal X-ray diffraction. The crystal structure of complex (1) shows a novel three-dimensional framework with 4, 4-connected 3D PtS topology. Moreover, this framework is reinforced by C–H···O hydrogen bonds and Pb2+···π interaction. The thermal stability of the complex 1 was studied by thermal gravimetric analyses, and the photoluminescent property of complex 1 was also investigated.

This objective of this research is to use Jeppesen’s Total Airspace and Airport Modelersimulator of airport and airspace operations (TAAM). TAAM has the capability to create models of airspace and airports, which makes it easy to planning, analysis, and making a decision. TAAM can help researchers evaluating the impact of changes to infrastructure, operations and schedules, after mimicking the airspace or airport into model.The simulation of this paper is going to imitate the operation of KATL in two different layouts with three different flight schedules based on a valid baseline model. In this case, the study is based on VFR operating condition, and operating towards west.

This paper established a HPLC method of determining two common types of phenols endocrine disrupter (pEDCs) in municipal sewage, surface water and tap water. After the sample is filtered and distilled, the distillate is detected with HPLC-DAD, and quantified in external standard method. In the municipal sewage, surface water and tap water Bisphenol-A (BPA) and 4-octyl phenol (4-OP) are not found. The experiment result shows the linearly dependent coefficient (R2 ) is 0.9914 and 0.9870 respectively, the recovery lies between 89.7-95.6%, the limit of detection is 0.001 (S/N=4.0) and 0.010mg·L-1 (S/N=2.5) respectively. This method has a high separation efficiency and a rapid analysis speed.

The adaptive capacity to water resource scarcity is closely connected to social and economic issues and it is one of the key factors of the regional sustainable development. Accurate evaluation of the adaptive capacity is an important factor to understand the development potential of a region. Through introducing the concept of social adaptive ability, this paper combines social adaptive ability with the dynamic evaluation of water resource scarcity and sustainable supply capacity as a new evaluation method. The data from two provincial-level municipalities of China (Beijing and Tianjin) are selected as a case to evaluate regional sustainable development. The results show that social adaptive ability can increase water supply capacity and provide strong support for regional sustainable development.

The change rule of characteristics of activated sludge in urban sewage treatment by activated sludge process were investigated at low temperature of 15°C~3°C.The results showed that with the temperature decreased, average particle size and dehydrogenase activity showed a trend of decrease; sludge settlement ratio and sludge volume index and sludge extracellular polymeric substance showed a trend of increase.

Along with the development of society and economy, researchers begin to focus on the quality of economic development from simple pursuing economic growth rate. There are many indexes to measure the economic development quality, and carbon efficiency is one of the most important indexes. This paper constructing DEA model to calculate carbon efficiency indexes directly, through the carbon efficiency evaluation, can reflect the quality of economic growth objectively and then provide scientific basis for relevant government departments to make environmental economic decisions. Therefore, this study selects the four provincial-level municipalities of China (Beijing, Shanghai, Tianjin and Chongqing) as a case to evaluate carbon efficiency.

The full carbon emission is calculated by using the solar emergy as a dimension normalizing tool in this paper. Its accounts include energy consumption carbon emission, potential carbon consumption of biomass resource consumption, and potential carbon consumption of waste emission. Based on it, population carrying capacity of unit carbon emission and economic output of unit carbon emission are taken into comprehensive account to establish the carbon emission performance comprehensive indexes. Taking China’s 30 provinces as examples, the assessment results show that the Nationwide should coordinate the relationship among economic, population and carbon emission. Compared with the traditional carbon efficiency evaluation, the carbon comprehensive performance evaluation based on “full carbon emission calculation” can fairly and objectively reflect the effects from modes of both life and production on carbon emission.

Hyzetimibe (HS-25) is a new cholesterol absorption inhibitor. We performed the first-in-human study to assess the safety, tolerability, and pharmacokinetics (including the effect of food) and pharmacodynamics (effect on blood lipid level) following single (1, 3, 5, 10, 20, and 30 mg) and multiple (5, 10, and 20 mg) ascending-dose of hyzetimibe in healthy subjects. An increase of exposure (area under the plasma concentration-time curve and maximum plasma concentration) to hyzetimibe and hyzetimibe-glucuronide (HS-25M1) was observed in an approximately dose-proportional manner. A terminal half-life of approximately 21 hours was observed with doses ranging between 5 and 30 mg. Steady state was achieved by day 8 of once-daily dosing with 1.6- and 1.2-fold accumulation for hyzetimibe and hyzetimibe-glucuronide, respectively. Food did not have any effect on hyzetimibe and hyzetimibe-glucuronide exposure. Administration of hyzetimibe once daily for 10 days reduced the levels of low-density lipoprotein cholesterol levels in healthy subjects and these recovered after discontinuation of this drug. All of the adverse events were mild or moderate in severity, and the majority of them were unrelated to hyzetimibe, with no dose-dependent trends. These findings suggest that hyzetimibe could be a potential treatment for hypercholesterolemia.

Ecological civilization construction is related to not only peoples well-being, but also the long term plan of a countrys development and revitalization. This research applied ant colony clustering algorithm to study the feasibility and key factors of ecological civilization promotion in the college students It is the first time that quantitative method was introduced into the human consciousness research. The results show that college students have known the situation of resources and environmental problems well, which is a advantage for the promotion of ecological civilization concept. However, the role that colleges play in ecological civilization promotion has not performed fully. And above two items are the key factors to promote ecological civilization promotion.

Objective: Studies have demonstrated that Tai Chi exercise improves blood lipid level with inconsistent results. A meta-analysis was conducted to quantify the effects of Tai Chi on blood lipid profiles in humans. Methods: We screened the databases of PubMed, EMBASE, Cochrane Library (Central), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Clinicaltrials.gov for randomized controlled trials with Physiotherapy Evidence Database (PEDro) score more than 3 points up to June 2015. Six studies involving 445 subjects were included. Most trials applied 12-week Tai Chi intervention courses. Results: In comparison with the control group, blood triglyceride (TG) level difference between follow-up and baseline was statistically significantly lower in the Tai Chi practicing group (weighted mean difference (WMD) −16.81 mg/dl; 95% confidence intervals (CI) −31.27 to −2.35 mg/dl; P=0.02). A trend to improving total cholesterol (TC) reduction was found with Tai Chi (WMD −7.96 mg/dl; 95% CI −17.30 to 1.39 mg/dl; P=0.10). However, no difference was found in blood low-density lipoprotein cholesterol (LDL-C) or high-density lipoprotein cholesterol (HDL-C). Conclusions: Tai Chi exercise lowered blood TG level with a trend to decrease blood TC level. Our data suggest that Tai Chi has the potential to implement meaningful blood lipid modification and serve as an adjunctive exercise modality. The relationship between Tai Chi exercise regimen and lipid profile change might have a scientific priority for future investigation.

Using the method of Stochastic Frontier Analysis (SFA), this paper chooses the rate of urbanization, the per capita Road area, the per capita green area, the green coverage rate, the third industrial proportion, the proportion of eight energy consuming industries, the intensity of the input into R&D, environmental protection investment index, employees in the proportion of total population as the input factor, and GDP output of the unit carbon emission as the output factor to calculate and analyze the carbon emission efficiency of China's 30 provinces in 2006 and 2011. The results shows the carbon emission efficiency in Beijing, Hebei, Shanghai, Ningxia, and Xinjiang is decreased, while other provinces' shows the contrary result. Meanwhile there is a big difference between different regions.

The virtual prototype model of the loader’s working device based on the ADAMS is built to analyze the co-simulation. The analyzed results provide the principle for the design, and has wide application to the research of working device of loaders .This method can improve the capability of loaders effectively.

According to the meaning of ecological civilization, we build an evaluation index system of ecological civilization competitiveness. We select 30 provinces or autonomous regions in China, collect the relevant data and through principal component analysis 9 independent components are picked up from 19 comprehensive evaluation indices which reflect the competitiveness of ecological civilization. Then we evaluate and rank the regions’ ecological civilization competitiveness. By comparing the results, we find out strengths and gaps of the regions as well as the related reasons.

Summary Background Heart failure occurs in 6% of hyperthyroid patients. Nonetheless, only half of those with hyperthyroidism-related heart failure have impaired left ventricular (LV) systolic function. Thus, diastolic dysfunction may play an important role in the pathogenesis. Methods and results We performed serial echocardiographic examinations in 70 consecutive patients with hyperthyroidism (39 ± 2 years, 47 women) to determine their diastolic function and repeated the examinations 6 months after achieving a euthyroid state. All patients had normal LV systolic function, but diastolic dysfunction was detected in 22 cases (mild: 3, moderate: 15 and severe: 4). The prevalence of diastolic dysfunction increased with age from 17·9% in patients 60 years. Increasing age was the only independent predictor for diastolic dysfunction in hyperthyroid patients. After achievement of a euthyroid state, most patients (16/22, 72%) had completely normalized diastolic function: 100% of patients

Background Right ventricular apical (RVA) pacing can induce left ventricular (LV) dyssynchrony and dysfunction. In this article, we describe the prevalence, clinical characteristics, and outcome in a subset of patients with unrecognized LV apical akinetic aneurysmatic area associated with permanent RVA pacing as potential causes of heart failure (HF) and/or ventricular tachyarrhythmias (VT). Methods and results We retrospectively studied 220 patients with permanent RVA pacing and no pre-existing structural heart disease in our follow-up clinic for high-degree atrioventricular block. Patients who presented with new-onset HF, chest pain, or VT following RVA pacing were evaluated by echocardiogram and cardiac catheterization. RVA pacing-induced LV apical akinetic aneurysmatic area was diagnosed in the absence of significant coronary artery disease by left ventriculogram. After a mean 8.8 ± 6.3 years, eight patients (3.6%) had LV apical akinetic aneurysmatic area. Of those with LV apical akinetic aneurysmatic area, four patients presented with or died of VT. There was no evidence of LV apical akinetic aneurysmatic area on echocardiogram or left ventriculogram in the remaining 212 patients. The four patients with LV apical akinetic aneurysmatic area and HF underwent cardiac resynchronization therapy: in all cases LV ejection fraction improved (from 33 ± 6 to 47 ± 10%, P = 0.03), and LV apical akinetic aneurysmatic area resolved in two. Conclusion Permanent RVA pacing for high-degree atrioventricular block is associated with LV apical akinetic aneurysmatic area. This condition was associated with a high incidence of VT and cardiovascular complication, but was possibly reversible with cardiac resynchronization therapy.

Introduction: Atrial electromechanical dysfunction might contribute to the development of atrial fibrillation (AF) in patients with sinus node disease (SND). The aim of this study was to investigate the prevalence and impact of atrial mechanical dyssynchrony on atrial function in SND patients with or without paroxysmal AF. Methods: We performed echocardiographic examination with tissue Doppler imaging in 30 SND patients with (n = 11) or without (n = 19) paroxysmal AF who received dual-chamber pacemakers. Tissue Doppler indexes included atrial contraction velocities (Va) and timing events (Ta) were measured at midleft atrial (LA) and right atrial (RA) wall. Intraatrial synchronicity was defined by the standard deviation and maximum time delay of Ta among 6 segments of LA (septal/lateral/inferior/anterior/posterior/anterospetal). Interatrial synchronicity was defined by time delay between Ta from RA and LA free wall. Results: There were no differences in age, P-wave duration, left ventricular ejection fraction, LA volume, and ejection fraction between with or without AF. Patients with paroxysmal AF had lower mitral inflow A velocity (70 ± 19 vs 91 ± 17 cm/s, P = 0.005), LA active empting fraction (24 ± 14 vs 36 ± 13%, P = 0.027), mean Va of LA (2.6 ± 0.9 vs 3.4 ± 0.9 cm/s, P = 0.028), and greater interatrial synchronicity (33 ± 25 vs 12 ± 19 ms, P = 0.022) than those without AF. Furthermore, a lower mitral inflow A velocity (Odd ratio [OR]= 1.12, 95% Confidence interval [CI] 1.01–1.24, P = 0.025) and prolonged interatrial dyssynchrony (OR = 1.08, 95% CI 1.01–1.16, P = 0.020) were independent predictors for the presence of AF in SND patients. Conclusion: SND patients with paroxysmal AF had reduced regional and global active LA mechanical contraction and increased interatrial dyssychrony as compared with those without AF. These findings suggest that abnormal atrial electromechanical properties are associated with AF in SND patients.

Like all sponges (phylum Porifera), the glass sponges (Hexactinellida) are provided with an elaborate and distinct body plan, which relies on a filigree skeleton. It is constructed by an array of morphologically determined elements, the spicules. Schulze described the largest siliceous hexactinellid sponge on Earth, the up to 3 m high Monorhaphis chuni, collected during the German Deep Sea Expedition ”Valdivia“ (1898–1899). This species develops an equally large bio-silica structure, the giant basal spicule (3 m × 10 mm). Using these spicules as a model, one can obtain the basic knowledge on the morphology, formation, and development of silica skeletal elements. The silica matrix is composed of almost pure silica, endowing it with unusual optophysical properties, which are superior to those of man-made waveguides. Experiments suggest that the spicules function in vivo as a nonocular photoreception system. The spicules are also provided with exceptional mechanical properties. Like demosponges, the hexactinellids synthesize their silica enzymatically via the enzyme silicatein (27 kDa protein). This enzyme is located in/embedded in the silica layers. This knowledge will surely contribute to a further utilization and exploration of silica in biomaterial/biomedical science.

Hyperthyroidism is one of the most common reversible causes of atrial fibrillation (AF); nevertheless, the risk of ischemic stroke in patients with hyperthyroidism who present with new-onset AF is unclear.This study sought to investigate the clinical outcome of hyperthyroidism-induced AF with regard to risk of ischemic stroke risk.We prospectively studied the incidence, time course, and clinical predictors for ischemic stroke in patients with hyperthyroidism-induced AF (n = 160). They were compared with age- and sex-matched cohorts of hyperthyroid patients without AF (n = 160) and AF patients without hyperthyroidism (n = 160).Baseline characteristics were comparable among the 3 groups. At 1 year, 86 hyperthyroid patients with AF (54%) and 92 patients with nonthyroid AF (58%) had spontaneous or pharmacological sinus conversion (P = .20). Ischemic stroke was observed in 15 hyperthyroid patients with AF (9.4%) versus 5 patients with nonthyroid AF (3.1%, P = .02), and 1 hyperthyroid patient without AF (0.6%, P.001). Furthermore, the majority of ischemic stroke (70%) in patients with AF occurred within the first 30 days of presentation, whereas AF was still present. Cox regression analysis showed that hyperthyroidism (hazard ratio [HR]: 3.5, 95% confidence interval [CI]: 1.15 to 10.42, P = .03) and persistent AF (HR: 13.0, 95% CI: 2.88 to 58.80, P.01) predicted the occurrence of ischemic stroke; warfarin therapy reduced the risk of ischemic stroke (HR: 0.17, 95% CI: 0.04 to 0.79, P = .02).In hyperthyroid patients who presented with new-onset AF, there was an increased risk of ischemic stroke clustering during the initial phase of presentation. This should prompt early use of anticoagulation therapy in hyperthyroid patients with AF.

Emerging data from experimental and clinical studies have shown that right ventricular (RV) apical pacing led to abnormalities of ventricular activation and contraction, and impairment of myocardial perfusion with adverse left ventricular (LV) remodeling, which was associated with increased risk of cardiac morbidity and mortality. As a result, there is a growing interest in searching for methods to minimize unnecessary RV pacing and preserving normal ventricular activation with alternative ventricular pacing sites. The risk of developing heart failure (HF) after RV apical pacing depends on the interactions between patient-specific factors (baseline atrial rhythm, intrinsic atrioventricular and ventricular conduction, LV ejection fraction, and the presence of HF and myocardial infarction) and pacing-related factors (mode of pacing, site of ventricular pacing, paced QRS duration, and percentage and duration of pacing). In patients with intact atrioventricular conduction, atrial-based pacing should be used to avoid unnecessary ventricular pacing. In patients requiring ventricular pacing, the potential benefits of alternate ventricular pacing sites, such as RV or LV septa, or even biventricular pacing in different patient populations remain unclear and warrant further long-term prospective clinical trial evaluations especially in those patients who are at a higher risk of developing HF after RV apical pacing.

Introduction: Emerging data have suggested that right ventricular (RV) apical pacing results in progressive left ventricular (LV) dysfunction and contributes to the development of heart failure (HF). This study aimed to investigate the prevalence and clinical predictors for the development of new-onset HF after long-term RV apical pacing in patients with acquired atrioventricular (AV) block who require permanent pacing. Methods: We studied the clinical outcomes after long-term RV apical pacing for acquired AV block in 304 patients without a prior history of HF. All patients had >90% ventricular pacing as determined by device diagnostic data. Results: After a median follow-up of 7.8 years, 79 patients (26.0%) developed new-onset HF after RV apical pacing. Univariate Cox-regression analysis revealed that older age at the time of pacemaker implantation (P < 0.001), the presence of coronary artery disease (CAD) (P < 0.001) or atrial fibrillation (P = 0.03), VVI pacemaker (P < 0.001), wider paced QRS duration (P < 0.001), and new-onset myocardial infarction (P < 0.001) were predictors for HF. Multivariate analysis revealed that older age at implantation (Hazard ratio [HR] 1.06, 95% confidential interval [CI] 1.04–1.09, P < 0.001), CAD (HR 1.98, 95% CI 1.12–3.50, P < 0.05), and a wider paced QRS duration (HR 1.27 for each 10 ms increment, 95% CI 1.11–1.45, P = 0.001) were independent predictors of HF. Furthermore, cardiovascular mortality was significantly increased in those with HF (36.7% vs. 2.7%, P < 0.001). Conclusions: After a median follow-up of 7.8 years, permanent RV apical pacing was associated with HF in 26% of patients. Elderly age at the time of implant, a wider paced QRS duration and the presence of CAD independently predicted new-onset HF. More importantly, HF after RV apical pacing was associated with a higher cardiovascular mortality.

Background/Purpose: The long-term efficacy of Telbivudine (LdT) between patients with poor response to interferon-alpha (IFN-α) therapy and those without antiviral history is unknown. Herein, we investigated and compared the outcome of LdT therapy in these patients. Methods: Two groups of Chinese patients who received LdT treatment were enrolled, one with poor response to IFN-α and then switching to LdT (IFN-LdT group), and the other one without antiviral history (LdT group). The data of biochemical, serological and virological responses within 36 months of treatment were collected. Results: The cumulative probability of ALT normalization, HBV DNA undetectability, HBeAg or HBsAg loss, and LdT-resistant mutation at 36 months was not found to be of significant difference between the two groups, respectively. However, the cumulative probability of HBeAg seroconversion at 36 months was 61.55% in IFN-LdT group, which was significantly higher than 40.68% in LdT group (p=0.047). There was significant difference in the cumulative probability of serum HBeAg

To characterize the meningococcal strains isolated from cases and close contacts with meningococcal disease associated with an outbreak in a jail in May 2010 by investigating the national distribution of hyperinvasive ST-4821 serogroup C clone associated with this outbreak.The cases were described based on the clinical symptoms and laboratory results. Pharyngeal swabs were cultured for N. meningitidis from men in the jail. Meningococcal isolates were identified by serogrouping, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), respectively. Four hundred and sixteen serogroup C N. meningitidis strains were collected from 27 provinces between 2003 and 2010 for a nationwide survey and analyzed by PFGE and MLST.Three persons in a jail system were infected with invasive N. meningitidis serogroup C. All isolates tested had matching PFGE patterns and belonged to the multilocus sequence type (ST) 4821 clonal complex. All 47 N. meningitidis strains were identified from the pharyngeal swabs of 166 peoples in the jail, and 26 of them belonged to ST-4821 serogroup C clone, and 90.14% (375/416) serogroup C strains identified in the nationwide survey belonged to the ST-4821 complex. The ST-4821 serogroup C clone was spread nationwide, distributed in 24 provinces, especially in eastern provinces between 2003 and 2010.Endemic transmission and carriage rate of ST-4821 serogroup C clone are high in this jail system. The ST-4821 serogroup C clone is spreading in China and nationwide distributed despite the existence of some effective vaccines.

To summarize the therapeutic experience and analyse the clinical effects of anatomical plate and combined external fixator for the treatment of elderly intertrochanteric hip fractures.From Oct.2006 to Jun.2009, 42 patients with intertrochanteric hip fractures were treated. Among them, 19 patients were treated with combined external fixator, included 7 males and 12 females, aged from 71 to 103 years old; according to Evans classification there were 3 of type 1, 5 of type II, 6 of type III, 5 of type IV. The other 23 patients were treated with anatomical plate, included 9 males and 14 females, aged from 73 to 97 years old; there were 5 of type I , 4 of type II, 10 of type II, 2 of type IV, 2 of type V. Comparisons and statistical analysis were made on operation time, blood loss during operation, hospitalization time, the time of loaded walking, fracture healing time and therapeutic effect.All the patients were followed up for 6 to 15 months with an average of 8.6 months. In combined external fixator group, the average operation time was (29.368 +/- 3.253) min, the average blood loss during operation was (30.526 +/- 5.242) ml, the average hospitalization time was (4.368 +/- 1.165) d, the average time of loaded walking was (14.526 +/- 1.867) weeks, the fracture healing time was (14.632 +/- 2.798) weeks; in the anatomical plate group above-mentioned indexes were (58.987 +/- 8.600) min, (256.090 +/- 30.112) ml, (13.783 +/- 1.976) d, (11.391+/- 1.644) weeks, (11.391 +/- 2.327) weeks,respectively; and there were significant differences between two groups (P0.05). According to Harris score criterion, the scores of combined external fixator group was (86.368 0 +/- 3.640) scores,and the scores of anatomical plate group was (86.435 +/- 4.198) scores; there were no significant differences between two groups (P0.05).The effect of combined external fixator and anatomical plate for the elderly intertrochanteric hip fractures are both satisfactory and each has its own merits. Combined external fixator has advantages such as fewer complications and operative injuries than that of anatomical plate and is more suitable for the weaker with elderly intertrochanteric hip fractures.

Cell division is closely related to telomerase activity (hTERT mRNA). Lower expression of lymphocitic hTERT mRNA may easily cause cell aging, which is not beneficial to maintaining a durable lymphocyte division. To date, there is no study to investigate IFNα therapy on hTERT mRNA expression in PBMCs of patients with chronic hepatitis B (CHB). We quantitatively detected hTERT mRNA from study subjects and made each hTERT mRNA normalized (NhTERT mRNA). Mean NhTERT mRNA level was lower in either CHB group, but it significantly increased in IFNα-treated group compared with CHB control group, and a longer duration of IFNα therapy could increase the level. Moreover, the mean NhTERT mRNA in subgroup with HBeAg loss was significantly higher than that in subgroup without. NhTERT mRNA was markedly correlated with CD3+T lymphocyte count and CD4+/CD8+ratio. The results showed that IFNα therapy could upregulate the expression of hTERT mRNA in PBMCs.

Heart failure occurs in 6% of hyperthyroid patients. Nonetheless, only half of those with hyperthyroidism-related heart failure have impaired left ventricular (LV) systolic function. Thus, diastolic dysfunction may play an important role in the pathogenesis.We performed serial echocardiographic examinations in 70 consecutive patients with hyperthyroidism (39 ± 2 years, 47 women) to determine their diastolic function and repeated the examinations 6 months after achieving a euthyroid state. All patients had normal LV systolic function, but diastolic dysfunction was detected in 22 cases (mild: 3, moderate: 15 and severe: 4). The prevalence of diastolic dysfunction increased with age from 17·9 % in patients40 years to 100% in those60 years. Increasing age was the only independent predictor for diastolic dysfunction in hyperthyroid patients. After achievement of a euthyroid state, most patients (16/22, 72%) had completely normalized diastolic function: 100% of patients40 years, 33·3 % of those ≥ 60 years. Further analyses revealed significant age-related differences in the cardiovascular response to hyperthyroidism. Among patients40 years, hyperthyroidism resulted in a marked reduction in total peripheral vascular resistance, increased cardiac output and enhanced diastolic function as determined by E'. No such significant change in total peripheral vascular resistance or cardiac output was observed in hyperthyroid patients ≥ 40 years. In addition, hyperthyroidism was associated with reduced E', signifying diastolic dysfunction in older hyperthyroid patients.Hyperthyroidism is associated with diastolic dysfunction, particularly in older patients. It is partly reversible following achievement of a euthyroid state.

Background: Right ventricular (RV) apical pacing results in abnormal left ventricular (LV) electrical and mechanical activation and is associated with an increased risk of developing heart failure. Chronic RV septal pacing has been shown to be superior to RV apical pacing in newly implanted patients. However, whether RV septal pacing can reverse deleterious effects of RV apical pacing remain unclear. Methods: We evaluated the effects of RV septal pacing on LV performance and functional capacity before and at 18 months after device replacement in 12 patients with previously permanent RV apical pacing and in 12 control patients that continued RV apical pacing. All patients underwent radionuclide ventriculography and 6-minute hallwalk (6-MHW) test before replacement (baseline) and at 18 months afterward to determine changes in LV performance and functional capacity, respectively. Results: After RV septal upgraded, there was a significant decrease in paced QRS duration (171.2 ± 3.9 ms to 160.4 ± 3.5 ms, P = 0.0016), increase in LV ejection fraction (55.2 ± 2.6% vs 60.4 ± 2.9%, P = 0.0002), the peak ventricular filling rate (2.60 ± 0.13 s−1 vs 3.01 ± 0.14 s−1, P = 0.046), and 6-MHW (308.2 ± 31.6 m vs 355.5 ± 34.2 m, P = 0.015) at 18 months compared with baseline. No changes in these parameters were observed in the control group (P > 0.05). Conclusion: RV septal pacing upgraded improves LV systolic and diastolic function and functional capacity in patients with previously permanent RV apical pacing. These findings suggest that RV septal pacing can reverse the deleterious effects of RV apical pacing in patients who required permanent ventricular pacing.

Hyperthyroidism-induced atrial fibrillation (AF) often spontaneously reverts to sinus rhythm after the return of euthyroid state, but a significant number of patients remain in persistent AF, which requires electrical cardioversion. The long-term outcome of hyperthyroidism-induced persistent AF after successful cardioversion remains unclear. The study group consisted of 58 patients with hyperthyroidism-induced persistent AF (mean age 57 +/- 2 years, 72% men) who had undergone successful electrical cardioversion. The AF recurrence rate was prospectively studied and compared with age- and gender-matched controls with persistent AF of nonthyroid origins. After a 24-month follow-up period, 34 patients (59%) had developed AF recurrence, significantly fewer than among controls (83%) (hazard ratio 0.64, 95% confidence interval 0.39 to 0.97, p = 0.04). Cox regression analysis showed that long AF duration was the only predictor of AF recurrence in patients with hyperthyroidism-induced persistent AF. In conclusion, hyperthyroidism-induced persistent AF carries a lower recurrence rate after conversion to sinus rhythm than non-hyperthyroidism-induced persistent AF, and early electrical cardioversion should be considered.

We investigate the quantum noise in phase quadratures of resonance fluorescence from a two-level atom driven by a trichromatic exciting field. It is shown that the noise spectra are crucially dependent on the sum of relative phases of the sideband components compared to the central component although the sideband exciting components are much weaker than the central component. When we tune the exciting sidebands on two-photon resonance with the Mollow sideband transitions and set the phase sum to , sideband squeezing in the in-phase quadrature remains almost the same as in the monochromatic case. Once the phase sum is set to zero, the squeezing is destroyed. The responsible mechanism is explained in terms of two-photon emission processes induced by the trichromatic components and the interference between these processes. DOI: 10.1103/PhysRevA.77.063809

Recent reports suggest an association between hyperthyroidism and pulmonary hypertension (PHT), although the potential mechanisms and clinical implications remain unclear.Our objective was to determine the prevalence of PHT related to hyperthyroidism and the associated hemodynamic changes and outcome.We performed serial echocardiographic examinations in 75 consecutive patients with hyperthyroidism (43 +/- 2 yr, 47 women) to estimate pulmonary artery systolic pressure (PASP), cardiac output (CO), total vascular resistance (TVR), and left ventricular (LV) filling pressure. Examinations were performed at baseline and 6 months after initiation of antithyroid treatment. Results were compared with 35 age- and sex-matched healthy controls. All hyperthyroid patients had normal LV systolic function, and 35 patients (47%) had PHT with PASP of at least 35 mm Hg. There were no significant differences in the clinical characteristics of hyperthyroid patients with or without PHT (all P0.05). Nonetheless, those with PHT had significantly higher CO, PASP, peak transmitral early diastolic flow velocity (E), and ratio of E to early diastolic mitral annular velocity (E') compared with those without PHT and controls (all P0.05). Hyperthyroid patients with PHT also had significantly lower TVR than controls (P0.05). Among the 35 hyperthyroid patients with PHT, 25 (71%) had pulmonary arterial hypertension (PAH) with normal E/E', and 10 (29%) had pulmonary venous hypertension (PVH) with elevated E/E'. Hyperthyroid patients with PAH had a significantly higher CO and a lower TVR compared with those with PVH. In contrast, hyperthyroid patients with PVH had lower E' and a higher E/E' ratio compared with those with PAH. These hemodynamic abnormalities and PHT were reversible in patients with PAH or PVH after restoration to a euthyroid state.In patients with hyperthyroidism and normal LV systolic function, up to 47% had PHT due to either PAH with increased CO (70%) or PVH with elevated LV filling pressure (30%). Most importantly, hyperthyroidism-related PHT was largely asymptomatic and reversible after restoration to a euthyroid state.

To study the role of the synchronized springy lengthening apparatus for the tibia and calcaneal tendon designed by the author in preventing the clubfoot of secondary to the Ilizarov tibia lengthening.Based on the Ilizarov tibia lengthening apparatus, a special synchronized springy lengthening apparatus for the tibia and calcaneal tendon was designed. The tibial was made of distal and proximal 2 rings respectively and 4 threaded rods, and the calcaneal was made of a half ring, 2 hinges and a threaded rod with spring. The half ring was fixed to the calcaneus by 2 crossed wires. The fracture tibia and fibula, ankle joint, talocalcaneal joint were attached to the apparatus. At the same time of tibia lengthening, the soft tissue was simultaneously stretched, the ankle joint could move, and the leg could bear weight. If the clubfoot angle was larger, the percutaneous fasciotomy of calcaneal tendon was performed; if the angle was less than 20 degrees, the pes deformities were corrected only by the stretch of calcaneal tendon.Seventy-seven patients' tibia were lengthened averagely 4.6 cm, with an average speed of 0.7 mm/d. The healing made tibia lengthened, and the index was 1.35 months/cm. There were not the secondary varus and valgus deformities and clubfoot in all the patients. The clubfoot with 100-400 angle of the 16 patients were corrected after tibia lengthening.The new apparatus coincides with the biomechanical principle and can effectively prevent the secondary deformities of foot such as clubfoot, talipes varus and valgus after tibia lengthening procedure.

Leptin is an adipocyte-derived hormone regulating body weight and energy balance in animals and human being. Although the physiological functions of leptin in human are still unclear, its secretion is closely related to fat mass and energy expenditure in both adults and children. This study investigated whether the plasma leptin level was reduced in connection with the weight loss during the neonatal period and try to find out the role of leptin in body weight regulation and energy balance of premature infants.The radioimmunoassay was used to determine the plasma leptin concentration. The first blood samples were obtained at the delivered, and then collected the samples every two days until the infants' body weight recovered to the birth weight or above. At the same time, the essential fluid and energy for the patients were supplied to keep their physiological functions. One person was appointed to take responsibility to examine the body weight, body length and head circumference. Then computed out their Kaup index from the first day to the seventh or twelfth day.A total of 26 premature infants were selected into the study, of which 14 cases were male and 12 female, and their gestational age ranged from 30 to 36 weeks. There was a significantly positive correlation between the premature newborns' body weight loss and their plasma leptin levels (the 1st day: n = 26, r = 0.766; the 3rd day: n = 26, r = 0.636; the 5th day: n = 26, r = 0.629; the 7th day: n = 26, r = 0.717; the 9th-12th day: n = 24, r = 0.587; P0.01). The time of body weight loss and the plasma leptin level which declined to extremely low were positively correlated. (r = 0.611, P0.01). The time when body weight loss declined to extremely low in 26 premature infants ranged form the 3rd to the 9th day after birth [(5.2 +/- 1.6) day], and that of the plasma leptin levels ranged form the 3rd to the 8th day after birth (4.7 +/- 1.4) day. The maximal ranges of the body weight loss and the plasma leptin decrease in 26 premature infants were (6.5 +/- 3.0)% and (59.6 +/- 11.3)%, respectively. In addition, there were significantly positive correlations among the plasma leptin level, the premature newborns' body length (the 1st day: n = 26, r = 0.609, P0.01; the 3rd day: n = 26, r = 0.419, P0.05; the 5th day: n = 26, r = 0.583, P0.01; the 7th day: n = 26, r = 0.626, P0.01; the 9th-12th day: n = 24, r = 0.482; P0.05), and the Kaup index (the 1st day: n = 26, r = 0.634; the 3rd day: n = 26, r = 0.534; the 5th day: n = 26, r = 0.542; the 7th day: n = 26, r = 0.611; the 9th-12th day: n = 24, r = 0.539; P0.01). Although the head circumference correlated positively with the plasma leptin level at the first week after the delivery (the 1st day: n = 26, r = 0.580, P0.01; the 3rd day: n = 26, r = 0.417, P0.05; the 5th day: n = 26, r = 0.426; P0.01). There was a lower correlation between them one week after the delivery (the 7th day: n = 26, r = 0.369; the 9th-12th day: n = 24, r = 0.323; P0.05).There was a significantly positive correlation between the plasma leptin level and the premature newborns weight loss. Leptin may participate in the regulation of energy balance and body weight of premature infants during neonatal life. Leptin may play an important role in growth and development of premature infants.