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Traditional therapies are crucial in maintaining and improving human well-being. China’s healthcare policymakers are attempting to use health technology assessment (HTA) as a decision-making supportive tool. The value assessment framework for Chinese patent medicine (CPM) has been developed and is being adopted and validated widely by research institutions. Subsequently, the healthcare decision-makers particularly hanker for the value framework of traditional non-pharmacological therapies.
Methods
To construct a practical value framework for traditional non-pharmacological therapies, a scoping review methodology was adopted to identify the evaluation domains and obstacles. A search, screening, and analysis process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Evidence was retrieved from scientific databases and HTA agencies’ websites.
Results
The search strategy identified 5 guidelines records and 17 acupuncture HTA reports. By synthesizing the valuable reports of CPM and acupuncture evaluation in representative countries, this study found that Mainland China was promoting the comprehensive value assessment of CPM, whereas the United Kingdom, Singapore, Canada, the United States, and Malaysia had carried out the HTA evaluation of acupuncture for various conditions among which chronic pain was the most common. UK and Singapore applied the HTA results to support acupuncture reimbursement decisions. Three domains, including safety, effectiveness, and economy, were commonly adopted. The identified biggest challenge of evaluating traditional non-pharmacological therapies is the scarce high-quality clinical evidence.
Conclusions
This study identified value domains and issues of traditional therapies, and pointed out future research implications, to promote the development value framework of traditional therapies.
The alvinocaridid shrimp Shinkaicaris leurokolos Kikuchi and Hashimoto, 2000, is an evolutionarily important deep-sea species in hydrothermal vents of north-western Pacific. A genome survey of S. leurokolos was carried out in order to provide a foundation for its whole-genome sequencing. A total of 599 Gb high-quality sequence data were obtained in the study, representing approximately 118× coverage of the S. leurokolos genome. According to the 17-mer distribution frequency, the estimated genome size was 5.08 Gb, and its heterozygosity ratio and percentage of repeated sequences were 2.85 and 87.03%, respectively, showing a complex genome. The final scaffold assembly accounted for a total size of 9.53 Gb (32,796,062 scaffolds, N50 = 597 bp). Repetitive elements nearly constituted 45% of the nuclear genome, among which the most ubiquitous were long interspersed nuclear elements, DNA transposons and long-terminal repeat elements. A total of 12,121,553 genomic simple sequence repeats were identified, with the most frequent repeat motif being di-nucleotide (70.27%), followed by tri-nucleotide and tetra-nucleotide. From the genome survey sequences, the mitochondrial genome of S. leurokolos was also constructed and 71 single nucleotide polymorphisms were identified by comparison with previous published reference. This is the first report of de novo whole-genome sequencing and assembly of S. leurokolos. These newly developed genomic data contribute to a better understanding of genomic characteristics of shrimps from deep-sea chemosynthetic ecosystems, and provides valuable resources for further molecular marker development.
Two new species of the lichenized genus Lasioloma are described from Asia: Lasioloma longiramosum W. C. Wang & A. Abas (collected from Malaysia), is characterized by a distinct woolly prothallus between dispersed thallus patches, comparatively small, muriform ascospores, long filiform conidia (main branch 22–28 μm in length, the other three branches 65–80 μm) and a foliicolous habitat; L. verrucosum W. C. Wang & X. L. Wei (collected from China), is characterized by a warted thallus, filiform conidia (main branch 22–32 μm in length, the other three branches 50–65 μm) and a corticolous habitat. The placement of both new species was confirmed by a molecular phylogenetic approach based on combined ITS, mtSSU and mtLSU sequences, and both are compared in detail to other similar species of the genus. Our study also revealed that the length of the conidial branches, which has not been explored in previous studies, should be regarded as an important feature for species delimitation in Lasioloma.
Lower-crust-derived adakitic rocks in the Gangdese belt provide important constraints on the timing of Tibetan crustal thickening and on the relative contributions of magmatic and tectonic processes. Here we present geochronological and geochemical data for the Wangdui porphyritic monzogranites in the western Gangdese belt. Zircon U–Pb dating yields emplacement ages of 46–44 Ma. All samples have high Sr (321–599 ppm), low Yb (0.76–1.33 ppm) and Y (10.6–18.3 ppm) contents, with high La/Yb (51.1–72.3) and Sr/Y (21.0–51.4) ratios, indicating adakitic affinities. The low MgO (0.97–1.76 wt %), Cr (7.49–53.6 ppm) and Ni (4.75–29.1 ppm) contents, as well as high 87Sr/86Sr(i) (0.7143–0.7145), low ϵNd(t) (−10.4 to −9.8) and zircon ϵHf(t) (−17.7 to 0.4) values, suggest that the Wangdui pluton most likely originated from partial melting of the thickened ancient lower crust. In combination with previously published data, despite the east–west-trending heterogeneity of crustal composition in the Gangdese belt, the La/Yb ratios of magmatic rocks reveal that both western and eastern segments experienced remarkable crustal thickening in the Eocene. However, in contrast to the thickened juvenile lower crust in the eastern segment formed by the underplating of mantle-derived magmas, tectonic shortening plays a more crucial role in thickening of the ancient basement in western Gangdese. In fact, such Eocene-thickened ancient lower-crust-derived adakitic rocks are widely distributed in the central Himalayan–Tibetan orogen. This, together with the extensive development of fold–thrust belts, suggests that tectonic shortening might be the main mechanism accounting for the crustal thickening associated with the India–Asia collision.
This paper investigates the monolithic edge-cladding process for the elliptical disk of N31-type Nd-doped phosphate laser glass, which will be utilized under liquid cooling conditions for high-power laser systems. The thermal stress, interface bubbles and residual reflectivity, which are due to high-temperature casting and bonding during the monolithic edge-cladding process, are simulated and determined. The applied mould is optimized to a rectangular cavity mould, and the casting temperature is optimized to 1000°C. The resulting lower bubble density makes the mean residual reflectivity as low as 6.75 × 10−5, which is enough to suppress the amplified spontaneous emission generated in the Nd-glass disk, and the resulting maximum optical retardation is converged to 10.2–13.3 nm/cm, which is a favourable base for fine annealing to achieve the stress specification of less than or equal to 5 nm/cm. After fine annealing at the optimized 520°C, the maximum optical retardation is as low as 4.8 nm/cm, and the minimum transmitted wavefront peak-to-valley value is 0.222 wavelength (632.8 nm). An N31 elliptical disk with the size of 194 mm × 102 mm × 40 mm can be successfully cladded by the optimized monolithic edge-cladding process, whose edge-cladded disk with the size of 200 mm × 108 mm × 40 mm can achieve laser gain one-third higher than that of an N21-type disk of the same size.
To compare the prevalence of overweight or obesity (ow/ob) with WHO BMI cut-off points, International Obesity Task Force (IOTF) cut-off points and Chinese BMI criteria and examine its potential factors among preschool children in Hunan Province.
Design:
A cross-sectional survey including anthropometric measurements and questionnaires about children’s information, caregivers’ socio-demographic characteristics and maternal characteristics. χ2 tests and univariate and multivariate binary logistic regression were performed to evaluate the possible factors of ow/ob.
Setting:
Hunan, China, from September to October 2019.
Participants:
In total, 7664 children 2 to 6 years of age.
Results:
According to Chinese BMI criteria, about 1 in 7–8 children aged 2–6 years had ow/ob in Hunan, China. The overall estimated prevalence of ow/ob among 2- to 6-year-old children was significantly higher when based on the Chinese BMI criteria compared with the WHO BMI cut-off points and IOTF cut-off points. According to Chinese BMI criteria, ow/ob was associated with residing in urban areas, older age, male sex, eating snacking food more frequently, macrosomia delivery, caesarean birth, heavier maternal prepregnancy weight and pre-delivery weight.
Conclusion:
The prevalence of ow/ob in preschool children in Hunan Province remains high. More ow/ob children could be screened out according to Chinese BMI cut-offs compared with WHO and IOTF BMI criteria. In the future, targeted intervention studies with matched controls will be needed to assess the long-term effects of intervention measures to provide more information for childhood obesity prevention and treatment.
The objective of this study was to analyze differences in birth weight and overweight/obesity in a Shanghai twin cohort. We also wanted to study their association and explore possible risk factors for the discordance of overweight/obesity within twins. This was an internal case–control study designed for twins. The 2012 Shanghai Twin Registration System baseline survey data of a total of 3417 twin pairs were statistically analyzed using SPSS22 software. Results show that the body mass index (BMI) of the Shanghai twin population increased with age. Twins with a high birth weight had a higher BMI and a higher rate of overweight and obesity; 0- to 6-year-old twins, male twins and dizygotic (DZ) twins had higher rates of overweight/obesity than other groups. The greater the discordant birth weight rate of twins, the more obvious the difference in BMI (p < .05). There was a significant difference in overweight/obesity between twins with a relative difference of birth weight ≥15% in DZ twins (p < .05). DZ twins, male twins and 0- to 6-year-old twins were more likely to be discordant in overweight/obese than others. The discordant birth weight within twins was not a risk factor for discordant overweight/obesity. However, attention should be paid to childhood obesity, and appropriate interventions should be made at the appropriate time. Genetics may play an important role in the occurrence and development of overweight/obesity. In conclusion, discordant growth and development in the uterus early in life may not lead to discordant weight development in the future.
The scientific application of clinical evidence-based guidelines can reduce the variability of clinical practice, and standardize clinical diagnosis and treatment pathways. At present, many evidence-based guidelines on Chronic Obstructive Pulmonary Disease (COPD) prevention have been issued in countries around the world, but the procedures and evaluation strategies developed by different guidelines are not the same. This study aimed to evaluate the quality of published clinical practice guidelines (CPGs) relating to COPD using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
Methods
Databases were systematically searched PubMed, EMBASE, Wan Fang, and CNKI as well as guidelines websites on COPD prevention and treatment. The search period was from inception of the database up to May 2019. The inclusion criteria for this study are as follows: (i) published and in accordance with the definition of the practice guidelines; (ii)the main target population is COPD patients with the diagnostic criteria of the 2019 edition of the global initiative for COPD (GOLD), and the content of the guideline is related to the prevention and treatment practice of COPD; (ii) the same guide is included in the latest updated version; (iv) the published language is English or Chinese. Guidelines that met these inclusion criteria were evaluated for the quality of the AGREE II guidelines. Then, a descriptive analysis was made of the consensus that exists in the guidelines.
Results
A total of fifteen guidelines/Consensuses Statements were included in the study. Two guidelines were assessed as recommended, eleven guidelines were assessed as recommended with modifications and two guidelines were not recommended. The mean scores of the included guidelines in the six domains (scope and purpose, personnel involved in guideline development, rigor of development, clarity, applicability, independence) were 90 percent, 72 percent, 49 percent, 96 percent, 60 percent, 69 percent, respectively. Thus, the study identified a consensus that disease risk factors and recommended interventions were mentioned in the guidelines, and that they comprehensively evaluated the quality of guideline reporting to provide reference for standardizing the development of practice guidelines for COPD in China.
Conclusions
The overall methodological quality of COPD CPGs should be improved. The key recommended areas for improvement include standardization of guideline report writing and synthesis of the latest and best evidence, to develop CPGs for COPD to improve the quality of clinical diagnosis and treatment for COPD.
Identifying risk factors and mortality of individuals with Alzheimer’s disease (AD) could have important implications for the clinical management of AD.
Objective:
This pilot study aimed to examine the overall mortality of AD patients over a 10-year surveillance period in Shanghai, China. This study is an extension of our previous investigation on mortality of neurodegenerative diseases.
Methods:
One hundred and thirty-two AD patients recruited from the memory clinics of two hospitals in Shanghai in 2007 were followed up until December 31, 2017 or death, representing a follow-up period of up to 10 years. Overall standardized mortality ratios (SMRs) were calculated, and predictors for survival at recruitment were estimated.
Results:
Sixty-seven patients had died by December 31, 2017, and the SMR at 10 years of follow-up was 1.225 (95% confidence interval 0.944–1.563). Employing Cox’s proportional hazard modeling, lower Mini-Mental State Examination score, and comorbid diabetes predicted poor survival in this cohort.
Conclusion:
This pilot study suggests a similar survival trend of patients with AD compared to the general population in Shanghai urban region. Poor cognitive status and comorbid diabetes had a negative impact on the survival of AD patients.
A magnetic dipole quasi-Yagi antenna based on a dielectric resonator (DR) is proposed in this letter. The dominate TE1δ1 mode of the rectangular DR is used as a magnetic dipole which can be differentially fed by the coplanar strip line (CPS). Thanks to the DR employment, the proposed antenna has several advantages such as compact size and flexible design which means the 3-D dimensions of the DR can be easily adjusted to cater for various applications. Meanwhile, the gain of the proposed DR quasi-Yagi antenna is higher than that of traditional electric dipole counterparts. Furthermore, since the DR driver is horizontally polarized, both the metal strip and DR can be used as a director for enhancing the end-fire gain. To verify the design concept, a prototype operating at the X-band is fabricated and measured. Good agreement between the simulated and measured results can be observed.
Direct numerical simulation is conducted to uncover the response of a supersonic turbulent boundary layer to streamwise concave curvature and the related physical mechanisms at a Mach number of 2.95. Streamwise variations of mean flow properties, turbulence statistics and turbulent structures are analysed. A method to define the boundary layer thickness based on the principal strain rate is proposed, which is applicable for boundary layers subjected to wall-normal pressure and velocity gradients. While the wall friction grows with the wall turning, the friction velocity decreases. A logarithmic region with constant slope exists in the concave boundary layer. However, with smaller slope, it is located lower than that of the flat boundary layer. Streamwise varying trends of the velocity and the principal strain rate within different wall-normal regions are different. The turbulence level is promoted by the concave curvature. Due to the increased turbulence generation in the outer layer, secondary bumps are noted in the profiles of streamwise and spanwise turbulence intensity. Peak positions in profiles of wall-normal turbulence intensity and Reynolds shear stress are pushed outward because of the same reason. Attributed to the Görtler instability, the streamwise extended vortices within the hairpin packets are intensified and more vortices are generated. Through accumulations of these vortices with a similar sense of rotation, large-scale streamwise roll cells are formed. Originated from the very large-scale motions and by promoting the ejection, sweep and spanwise events, the formation of large-scale streamwise roll cells is the physical cause of the alterations of the mean properties and turbulence statistics. The roll cells further give rise to the vortex generation. The large number of hairpin vortices formed in the near-wall region lead to the improved wall-normal correlation of turbulence in the concave boundary layer.
We examine whether sizable initial public offerings (IPOs) affect the whole market. Using a Chinese IPO sample, we find robust evidence that sizable IPOs depress the market price on not only the listing day but also the offering (subscription) day. The impact on the market is negatively correlated with IPO size on the listing day. However, this impact is largely transitory. The China Securities Regulatory Commission (CSRC) often places a moratorium on IPOs to support the market, which seems ineffective as the negative IPO effect is transitory and moratoriums are not perceived as good news.
The thermal expansion behavior of polymer carbon nanotube (CNT) nanocomposites was investigated, and a micromechanical model was proposed to explain the highly nonlinear dependence of the coefficient of thermal expansion of the nanocomposite with CNT content for the CNT/polyimide nanocomposite. The microscopic analysis of CNT/polyimide matrix showed homogeneous dispersion of bundles composed of CNTs. Therefore, the proposed model to predict the thermal expansion behavior of the nanocomposite considered a random, homogeneous distribution of CNT bundles with a hierarchical arrangement of helical CNTs within the polymeric matrix. The CNT bundle morphology influenced the thermal expansion response of the nanocomposite through (i) bundle volume fraction and (ii) degree of helicity, affecting thermo-mechanical properties of the bundle. The effective, homogenized, properties of CNT bundles were determined by the elasticity based solution of the layered cylinder model. Bundle effective properties were used in the micromechanical model implementing the homogenized strain rule of the mixture expression to predict the thermal expansion behavior of nanocomposite in a wide range of CNT volume contents. The proposed micromechanical analytical model was found to correlate closely with the experimental results for polyimide/CNT nanocomposite films as measured using a digital image correlation method.
Thermal transport across interfaces is an important issue for microelectronics, photonics, and thermoelectric devices and has been studied both experimentally and theoretically in the past. In this paper, thermal interface resistance (1/G) between aluminum and silicon with nanoscale vacancies was calculated using non-equilibrium molecular dynamics (NEMD). Both phonon-phonon coupling and electron-phonon coupling are considered in calculations. The results showed that thermal interface resistance increased largely due to vacancies. The effect of both the size and the type of vacancies is studied and compared. And an obvious difference is found for structures with different type/size vacancies.
Au nanoparticles (Au NPs) have attracted much interest owing to their unique optical properties. In this paper, a facile process has been successfully developed to synthesize the SiO2/Au hybrid microspheres with a diameter of 200 nm via the galvanic replacement of SiO2/Ag hybrid microspheres and chlorauric acid (HAuCl4) solution. The as-prepared products were investigated by x-ray diffraction (XRD), field-emission scanning electron microscopy (FESEM, JEOL-6700F), and transmission electron microscopy (TEM, JEOL 3010), respectively. As expected, the as-prepared SiO2/Au hybrid microspheres show strong chemical stability and superior catalytic reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). The SiO2/Au hybrid microspheres would be found widely used in wastewater treatment, catalytic reaction, bacteriostatic and bactericidal applications.
The present study was conducted to investigate the effects of chitosan (CS)-Zn on intestinal morphology, mucosal epithelial cell apoptosis and mucosal immune function in weanling pigs. A total of 150 weanling barrows with a body weight of 7·2 kg were randomly allocated into five groups. A basal diet without Zn supplementation was used as the control and other four groups were fed the control diet supplemented with 50 or 100 mg/kg of Zn as CS-Zn, 100 mg/kg of Zn as ZnSO4 and 3000 mg/kg of Zn as ZnO, respectively. The feeding trial lasted for 28 d. The results showed that serum diamine oxidase activities, d-lactate levels and endotoxin contents were lower in pigs fed dietary 100 mg/kg of Zn as CS-Zn or 3000 mg/kg of Zn as ZnO than in pigs fed the control or 100 mg Zn/kg as ZnSO4 diet. The ratios of the villus height:crypt depth of the duodenum, jejunum and ileum were higher in pigs that received 100 mg/kg of Zn as CS-Zn or a high level of Zn as ZnO than in pigs fed the control diet. Moreover, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labelling (TUNEL)-stained ileal epithelial cells were found in the control group, and apoptotic cells did not appear prominently in pigs that received the 100 mg/kg of CS-Zn or ZnO diet. Secretory IgA concentration in ileal mucus was increased in the dietary group that received 100 mg/kg of CS-Zn or ZnO. These results indicated that dietary 100 mg CS-Zn/kg had similar biological effects to dietary 3000 mg ZnO/kg on intestinal morphology, mucosal epithelial cell apoptosis and mucosal immune function.
High speed framing camera (HSFC) could be used to capture the image of the electron beams generated by the intense electron-beam accelerator (IEBA), and it is useful to visualize the evolution of discharging and plasma generation phenomenon. So an overview of the application of HSFC on the IEBA is presented. First, we introduce the synchronization problem of HSFC and IEBA, and a synchronization trigger system which could provide a trigger signal with rise time of 17 ns and amplitude of about 5 V is presented. Second, an imaging system based on IEBA, HSFC, and the synchronization trigger system is developed, and it can be used to image the developmental process of plasma in the output vacuum chamber of IEBA and to measure the electrical parameter of IEBA and electrical trigger signal in real time. Furthermore, the imaging system is used to investigate the developmental process of the electron beam of the A-K gap in vacuum under 180 nanosecond quasi-square pulses. It is obtained that the short A-K gap is closed prematurely under long pulse operation with plasma expansion velocity of about 6.25 cm/µs and the light emission in the A-K gap region has the characteristics of “re-ignition” with light duration time about 3800 ns. At last, the discharging process of surface flashover channel of poly-methyl methacrylate (PMMA) insulator with gap spacing of 170 mm in vacuum under nanosecond quasi-square pulses is studied by the imaging system, and the change of luminosity is analyzed during the surface flashover process.
Systemic Fe overload can contribute to abnormal glucose metabolism and the onset of type 2 diabetes (T2D). Although hepcidin is the master regulator of systemic Fe homeostasis, few studies have systematically evaluated the associations of serum hepcidin concentrations with Fe metabolism parameters and risks for the development of T2D. In this regard, whether hepcidin concentrations are associated with T2D remains controversial. We measured serum hepcidin and ferritin concentrations in a case–control study of 1259 Han Chinese participants to evaluate the possible associations of serum hepcidin concentrations with Fe metabolism parameters and risks of T2D. Individuals with diabetes (n 555) and control participants (n 704) were recruited and serum hepcidin and ferritin concentrations were quantified. Additionally, selected biochemical and anthropometric variables were determined. A logistic regression analysis was performed to evaluate the association of serum hepcidin and ferritin concentrations with T2D. A linear regression analysis was used to test for associations between serum hepcidin and ferritin concentrations and a number of clinical, demographic and diabetes-associated variables. We found that serum hepcidin concentrations correlated with Hb and serum ferritin concentrations. No differences in hepcidin concentrations were found between the group with diabetes and the control group. Hepcidin concentrations were not significantly correlated with T2D risk factors. We also found that serum ferritin concentrations were elevated in individuals with diabetes and were positively correlated with both Hb concentrations and T2D risk factors. The present findings suggest that serum ferritin concentrations correlate with T2D risk factors, while serum hepcidin concentrations are positively associated with Hb and serum ferritin concentrations, but do not correlate with T2D.
As the development of the pulsed power technology, high voltage pulse transformer (HVPT) is usually used instead of Marx generator as a charging device for the pulse forming line (PFL) of intense electron-beam accelerator (IEBA), and which make the IEBA compact. However, during the operation of the IEBA, the HVPT may be destroyed for the failure of electrical insulation and the over-voltage. So in this paper, the output voltage characteristics of IEBA, characteristics of the voltage at the output terminal of HVPT at four kinds of load conditions are analyzed, including load matching, load short, load open, and surface flashover in the vacuum chamber. It is found that load short, load open, and surface flashover in vacuum chamber will affect the voltage at the output terminal of HVPT, and an oscillation wave could be formed, which affect the electrical insulation of HVPT and decrease the lifetime of HVPT. Meanwhile, the waveform of the load voltage is also modified, especially at the conditions of load open and surface flashover in vacuum chamber. When the load is open, the amplitude of the output main pulse of IEBA is twice the charging voltage of BPFL. However, the amplitude of the output pulse of IEBA is modified by the voltage at the output terminal of HVPT, and the resistance of main switch channel has a great effect on the amplitude of the load voltage. When surface flashover occurs in the vacuum chamber, the pulse duration of the output voltage will be decreased. So, during the operation of IEBA, load short, load open and surface flashover in vacuum chamber should be avoided.
The Blumlein pulse forming line (BPFL) consisting of an inner coaxial pulse forming line (PFL) and an outer coaxial PFL is widely used in the field of pulsed power, especially for intense electron-beam accelerators (IEBA). The output voltage waveform determines the quality and characteristics of the output beam current of the IEBA. Comparing with the conventional BPFL, an IEBA based on a strip spiral type BPFL can increase the duration of the output voltage in the same geometrical volume. However, for the spiral type BPFL, the voltage waveform on a matched load may be distorted, which influences the electron-beam quality. In this paper, the output waveform of an IEBA based on strip spiral BPFL is analyzed. It is found that there is fluctuation on the flattop of the main pulse, and the flatness is increased with the increment of the output voltage. According to the time integrated pictures of the cathode holder during the operation of the IEBA, the electron emission of the cathode holder is one of the reasons to cause the variance of the flatness. Furthermore, the distribution of the current density of spiral middle cylinder of the BPFL is calculated by using electromagnetic simulation software, and it is obtained that the current density is not uniform, and which leads to the nonuniformity of the impedance of BPFL. Meanwhile, when the nonuniformity of the BPFL is taken into account, the operation of the whole accelerator is simulated using a circuit-simulation code called PSpice. It is obtained that the nonuniformity of the BPFL influences the flatness of the output voltage waveform. In order to get an ideal square pulse voltage waveform and to improve the electron beam quality of such an accelerator, the uniformity of the spiral middle cylinder should be improved and the electron emission of the cathode holder should be avoided. The theoretical analysis and simulated output voltage waveform shows reasonable agreement with that of the experimental results.