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Psychogenic pseudosyncope is one of the primary causes of transient loss of consciousness in children and adolescents, essentially classified as a conversion disorder that significantly impacts patients’ quality of life. Clinically, psychogenic pseudosyncope shares certain similarities with vasovagal syncope in terms of pre-syncope symptoms and triggers, making it sometimes difficult to differentiate and easily misdiagnosed. Therefore, placing emphasis upon the characteristics of psychogenic pseudosyncope is crucial for early identification and treatment, which holds significant importance for the mental and psychological health of children and adolescents. In the present review, we aimed to address psychogenic pseudosyncope with clinical features, diagnosis, and treatment.
Based on monthly panel data from 2014 to 2020 and employing the staggered difference-in-differences (staggered DID) method, we examine the impact of environmental vertical management reform on data manipulation in the public sector. We reveal that environmental vertical management reform significantly reduces data manipulation in the public sector. Moderating effect analysis shows that economic growth targets weaken the inhibitory impact of this reform. Conversely, public environmental concerns could enhance the inhibitory impact of this reform on data manipulation. Mechanism analysis reveals that environmental vertical management reform works through strengthening grassroots environmental law enforcement. The increased independence of law-enforcing departments has reduced the tendency of local governments to engage in data manipulation.
Our study aimed to develop and validate a nomogram to assess talaromycosis risk in hospitalized HIV-positive patients. Prediction models were built using data from a multicentre retrospective cohort study in China. On the basis of the inclusion and exclusion criteria, we collected data from 1564 hospitalized HIV-positive patients in four hospitals from 2010 to 2019. Inpatients were randomly assigned to the training or validation group at a 7:3 ratio. To identify the potential risk factors for talaromycosis in HIV-infected patients, univariate and multivariate logistic regression analyses were conducted. Through multivariate logistic regression, we determined ten variables that were independent risk factors for talaromycosis in HIV-infected individuals. A nomogram was developed following the findings of the multivariate logistic regression analysis. For user convenience, a web-based nomogram calculator was also created. The nomogram demonstrated excellent discrimination in both the training and validation groups [area under the ROC curve (AUC) = 0.883 vs. 0.889] and good calibration. The results of the clinical impact curve (CIC) analysis and decision curve analysis (DCA) confirmed the clinical utility of the model. Clinicians will benefit from this simple, practical, and quantitative strategy to predict talaromycosis risk in HIV-infected patients and can implement appropriate interventions accordingly.
In contemporary neuroimaging studies, it has been observed that patients with major depressive disorder (MDD) exhibit aberrant spontaneous neural activity, commonly quantified through the amplitude of low-frequency fluctuations (ALFF). However, the substantial individual heterogeneity among patients poses a challenge to reaching a unified conclusion.
Methods
To address this variability, our study adopts a novel framework to parse individualized ALFF abnormalities. We hypothesize that individualized ALFF abnormalities can be portrayed as a unique linear combination of shared differential factors. Our study involved two large multi-center datasets, comprising 2424 patients with MDD and 2183 healthy controls. In patients, individualized ALFF abnormalities were derived through normative modeling and further deconstructed into differential factors using non-negative matrix factorization.
Results
Two positive and two negative factors were identified. These factors were closely linked to clinical characteristics and explained group-level ALFF abnormalities in the two datasets. Moreover, these factors exhibited distinct associations with the distribution of neurotransmitter receptors/transporters, transcriptional profiles of inflammation-related genes, and connectome-informed epicenters, underscoring their neurobiological relevance. Additionally, factor compositions facilitated the identification of four distinct depressive subtypes, each characterized by unique abnormal ALFF patterns and clinical features. Importantly, these findings were successfully replicated in another dataset with different acquisition equipment, protocols, preprocessing strategies, and medication statuses, validating their robustness and generalizability.
Conclusions
This research identifies shared differential factors underlying individual spontaneous neural activity abnormalities in MDD and contributes novel insights into the heterogeneity of spontaneous neural activity abnormalities in MDD.
Timing of food intake is an emerging aspect of nutrition; however, there is a lack of research accurately assessing food timing in the context of the circadian system. The study aimed to investigate the relation between food timing relative to clock time and endogenous circadian timing with adiposity and further explore sex differences in these associations among 151 young adults aged 18–25 years. Participants wore wrist actigraphy and documented sleep and food schedules in real time for 7 consecutive days. Circadian timing was determined by dim-light melatonin onset (DLMO). The duration between last eating occasion and DLMO (last EO-DLMO) was used to calculate the circadian timing of food intake. Adiposity was assessed using bioelectrical impedance analysis. Of the 151 participants, 133 were included in the statistical analysis finally. The results demonstrated that associations of adiposity with food timing relative to circadian timing rather than clock time among young adults living in real-world settings. Sex-stratified analyses revealed that associations between last EO-DLMO and adiposity were significant in females but not males. For females, each hour increase in last EO-DLMO was associated with higher BMI by 0·51 kg/m2 (P = 0·01), higher percent body fat by 1·05 % (P = 0·007), higher fat mass by 0·99 kg (P = 0·01) and higher visceral fat area by 4·75 cm2 (P = 0·02), whereas non-significant associations were present among males. The findings highlight the importance of considering the timing of food intake relative to endogenous circadian timing instead of only as clock time.
Oncomelania hupensis (O. hupensis), the sole intermediate host of Schistosoma japonicum, greatly influence the prevalence and distribution of schistosomiasis japonica. The distribution area of O. hupensis has remained extensive for numerous years. This study aimed to establish a valid agent-based model of snail density and further explore the environmental conditions suitable for snail breeding. A marshland with O. hupensis was selected as a study site in Dongting Lake Region, and snail surveys were monthly conducted from 2007 to 2016. Combined with the data from historical literature, an agent-based model of snail density was constructed in NetLogo 6.2.0 and validated with the collected survey data. BehaviorSpace was used to identify the optimal ranges of soil temperature, pH, soil water content, and vegetation coverage for snail growth, development and reproduction. An agent-based model of snail density was constructed and showed a strong agreement with the monthly average snail density from the field surveys. As soil temperature increased, the snail density initially rose before declining, reaching its peak at around 21°C. There were similar variation patterns for other environmental factors. The findings from the model suggested that the optimum ranges of soil temperature, pH, soil water content and vegetation coverage were 19°C to 23 °C, 6.4 to 7.6, 42% to 75%, and 70% to 93%, respectively. A valid agent-based model of snail density was constructed, providing more objective information about the optimum ranges of environmental factors for snail growth, development and reproduction.
To evaluate the variations in COVID-19 case fatality rates (CFRs) across different regions and waves, and the impact of public health interventions, social and economic characteristics, and demographic factors on COVID-19 CFRs, we collected data from 30 countries with the highest incidence rate in three waves. We summarized the CFRs of different countries and continents in each wave through meta-analysis. Spearman’s correlation and multiple linear regression were employed to estimate the correlation between influencing factors and reduction rates of CFRs. Significant differences in CFRs were observed among different regions during the three waves (P < 0.001). An association was found between the changes in fully vaccinated rates (rs = 0.41), population density (rs = 0.43), the proportion of individuals over 65 years old (rs = 0.43), and the reduction rates of case fatality rate. Compared to Wave 1, the reduction rates in Wave 2 were associated with population density (β = 0.19, 95%CI: 0.05–0.33) and smoking rates (β = −4.66, 95%CI: −8.98 – −0.33), while in Wave 3 it was associated with booster vaccine rates (β = 0.60, 95%CI: 0.11–1.09) and hospital beds per thousand people (β = 4.15, 95%CI: 1.41–6.89). These findings suggest that the COVID-19 CFRs varied across different countries and waves, and promoting booster vaccinations, increasing hospital bed capacity, and implementing tobacco control measures can help reduce CFRs.
The influence of outer large-scale motions (LSMs) on near-wall structures in compressible turbulent channel flows is investigated. To separate the compressibility effects, velocity fluctuations are decomposed into solenoidal and dilatational components using the Helmholtz decomposition method. Solenoidal velocity fluctuations manifest as near-wall streaks and outer large-scale structures. The spanwise drifting of near-wall solenoidal streaks is found to be driven by the outer LSMs, while LSMs have a trivial influence on the spanwise density of solenoidal streaks, consistent with the outer LSM impacts found in incompressible flows (Zhou et al., J. Fluid Mech., vol. 940, 2022, p. A23). Dilatational motions are characterized by the near-wall small-scale travelling-wave packets and the large-scale parts in the outer region. The streamwise advection velocity of the near-wall structures remains at $16 \sim 18u_{\tau }$, hardly influenced by Mach numbers, Reynolds numbers and wall temperatures. The spanwise drifting of near-wall dilatational structures, quantified by the particle image velocimetry method, follows a mechanism distinct from solenoidal streaks. This drifting velocity is notably larger than those of the solenoidal streaks, and the influence of outer LSMs is not the primary trigger for this drifting.
Recent studies suggest an association between greater dietary inflammatory index (DII) and higher biological ageing. As α-Klotho has been considered as a longevity protein, we examined whether α-Klotho plays a role in the association between DII and ageing. We included 3054 participants from the National Health and Nutrition Examination Survey. The associations of DII with biological and phenotypic age were assessed by multivariable linear regression, and the mediating role of α-Klotho was evaluated by mediation analyses. Participants’ mean age was 58·0 years (sd 11·0), with a median DII score of 1·85 and interquartile range from 0·44 to 2·79. After adjusting for age, sex, race/ethnicity, BMI, education, marital status, poverty income ratio, serum cotinine, alcohol, physical activity, a higher DII was associated with both older biological age and phenotypic age, with per DII score increment being associated with a 1·01-year increase in biological age (1·01 (95 % CI: 1·005, 1·02)) and 1·01-year increase in phenotypic age (1·01 (1·001, 1·02)). Negative associations of DII with α-Klotho (β = –1·01 pg/ml, 95 % CI: –1·02, –1·006) and α-Klotho with biological age (β= –1·07 years, 95 % CI: –1·13, –1·02) and phenotypic age (β= –1·03 years, 95 % CI: –1·05, –1·01) were found. Furthermore, α-Klotho mediated 10·13 % (P < 0·001) and 9·61 % (P < 0·001) of the association of DII with biological and phenotypic age, respectively. Higher DII was associated with older biological and phenotypic age, and the potential detrimental effects could be partly mediated through α-Klotho.
The practical implementation of machine learning in flow control is limited due to its significant training expenses. In the present study the convolutional neural network (CNN) trained with the data of the restricted nonlinear (RNL) model is used to predict the normal velocity on a detection plane at $y^+=10$ in a turbulent channel flow, and the predicted velocity is used as wall blowing and suction for drag reduction. An active control test is carried out by using the well-trained CNN in direct numerical simulation (DNS). Substantial drag reduction rates up to 19 % and 16 % are obtained based on the spanwise and streamwise wall shear stresses, respectively. Furthermore, we explore the online control of wall turbulence by combining the RNL model with reinforcement learning (RL). The RL is constructed to determine the optimal wall blowing and suction based on its observation of the wall shear stresses without using the label data on the detection plane for training. The controlling and training processes are conducted synchronously in a RNL flow field. The control strategy discovered by RL has similar drag reduction rates with those obtained previously by the established method. Also, the training cost decreases by over thirty times at $Re_{\tau }=950$ compared with the DNS-RL model. The present results provide a perspective that combining the RNL model with machine learning control for drag reduction in wall turbulence can be effective and computationally economical. Also, this approach can be easily extended to flows at higher Reynolds numbers.
Whether material deprivation-related childhood socio-economic disadvantages (CSD) and care-related adverse childhood experiences (ACE) have different impacts on depressive symptoms in middle-aged and older people is unclear.
Methods
In the Guangzhou Biobank Cohort Study, CSD and ACE were assessed by 7 and 5 culturally sensitive questions, respectively, on 8,716 participants aged 50+. Depressive symptoms were measured by 15-item Geriatric Depression Scale (GDS). Multivariable linear regression, stratification analyses, and mediation analyses were done.
Results
Higher CSD and ACE scores were associated with higher GDS score in dose-response manner (P for trend <0.001). Participants with one point increment in CSD and ACE had higher GDS score by 0.11 (95% confidence interval [CI], 0.09–0.14) and 0.41 (95% CI, 0.35–0.47), respectively. The association of CSD with GDS score was significant in women only (P for sex interaction <0.001; women: β (95% CI)=0.14 (0.11–0.17), men: 0.04 (−0.01 to 0.08)). The association between ACE and GDS score was stronger in participants with high social deprivation index (SDI) (P for interaction = 0.01; low SDI: β (95% CI)=0.36 (0.29–0.43), high SDI: 0.64 (0.48–0.80)). The proportion of association of CSD and ACE scores with GDS score mediated via education was 20.11% and 2.28%.
Conclusions
CSD and ACE were associated with late-life depressive symptoms with dose-response patterns, especially in women and those with low adulthood socio-economic status. Education was a major mediator for CSD but not ACE. Eliminating ACE should be a top priority.
To assess the efficacy and safety of two different modes of administration, external ear canal filling and smearing, in the treatment of otomycosis.
Methods
A computerised search of relevant published studies in the China National Knowledge Infrastructure, China Biology Medicine, Web of Science, PubMed, Embase and Cochrane Library databases that include randomised controlled trials or clinically controlled trials on the same drug in different modes of administration for the treatment of otomycosis.
Results
Seven studies with 934 patients were included. The filled group had a higher clinical efficacy (relative risk = 1.18, 95 per cent confidence interval (CI) 1.12–1.24, p < 0.0001) and a lower recurrence rate (relative risk = 0.29, 95 per cent CI 0.18–0.47, p < 0.0001) compared with the smear group, and there was no significant difference in the adverse effects (relative risk = 0.61, 95 per cent CI 0.34–1.12, p = 0.11).
Conclusion
Current evidence suggests that the efficacy of the delivery modality of the external auditory canal filling treatment is significantly better than external auditory canal smearing.
Flexible electronics researchers have been conducting studies to explore the response of flexible stretchable electrodes to strain. The regulation of strain response in current flexible stretchable electrodes relies primarily on altering the material system, interfacial adhesion, or electrode structure. However, modifying the material system or interfacial adhesion can negatively disrupt the stretchable electrode preparation process, making commercialization a significant challenge. Additionally, the material system may be inadequate in extreme environments such as high temperatures. Hence a systematic structural design approach is crucial for effective response modulation of stretchable electrodes. One potential solution is the design of fibre structures from the micro to macro scale. This article focuses on discussing how the response of stretchable electrodes can be modulated by fibres in different states. The discussion includes fibres on elastic films, fibres directly constituting fibrous membranes at the microscopic level, and fibres constituting metamaterials at the fine level. The modulation can be achieved by altering the orientation of the fibres, the geometrical structure of the fibres themselves, and the geometrical structure formed between the fibres. Additionally, the article analyses the current situation of stretchable electrodes in extreme environments such as high temperatures. It also reviews the development of ceramic fibre membranes that can be stretched in high-temperature environments. The authors further discuss how the stretchability of ceramic fibre membranes can be improved through the structuring of ceramic fibre membranes with metamaterials. Ultimately, the goal is to realize stretchable electrodes that can be used in extreme environments such as high temperatures.
To evaluate one-stage thyroid cartilage laryngotracheal reconstruction in children less than one year of age with congenital subglottic stenosis.
Methods
Congenital subglottic stenosis children less than one year old who underwent one-stage thyroid cartilage laryngotracheal reconstruction between 2016 and 2020 in our department were retrospectively reviewed. Their clinical characteristics, treatments and prognoses were assessed.
Results
Eleven congenital subglottic stenosis children (6–11 months) were included: seven with Myer–Cotton grade II, and four with Myer–Cotton grade III. Their tracheal diameters were corrected to normal size using thyroid cartilage, and they were intubated under sedation for two weeks after surgery. Moreover, all of them received anti-infection and anti-reflux therapies during hospitalisation. No breathing difficulty, aspiration, hoarseness or laryngitis was observed during the follow-up period (10–30 months), and their growth and development were age appropriate.
Conclusion
The one-stage thyroid cartilage laryngotracheal reconstruction is a good treatment option for congenital subglottic stenosis children less than one year old with Myer–Cotton grade II–III.
The assessment of seed quality and physiological potential is essential in seed production and crop breeding. In the process of rapid detection of seed viability using tetrazolium (TZ) staining, it is necessary to spend a lot of labour and material resources to explore the pretreatment and staining methods of hard and solid seeds with physical barriers. This study explores the TZ staining methods of six hard seeds (Tilia miqueliana, Tilia henryana, Sassafras tzumu, Prunus subhirtella, Prunus sibirica, and Juglans mandshurica) and summarizes the TZ staining conditions required for hard seeds by combining the difference in fat content between seeds and the kinship between species, thus providing a rapid viability test method for the protection of germplasm resources of endangered plants and the optimization of seed bank construction. The TZ staining of six species of hard seeds requires a staining temperature above 35 °C and a TZ solution concentration higher than 1%. Endospermic seeds require shorter staining times than exalbuminous seeds. The higher the fat content of the seeds, the lower the required incubation temperature and TZ concentration for staining, and the longer the staining time. And the closer the relationship between the two species, the more similar their staining conditions become. The TZ staining method of similar species can be predicted according to the genetic distance between the phylogenetic trees, and the viability of new species can be detected quickly.
This paper presents an algorithm for solving the inverse dynamics of a parallel manipulator (PM) with offset universal joints (RR–joints) via the Newton–Euler method. The PM with RR–joints increase the joint stiffness and enlarge the workspace but introduces additional joint parameters and constraint torques, rendering the dynamics more complex. Unlike existing studies on PMs with RR–joints, which emphasize the kinematics and joint performance, this paper studies the dynamical model. First, an iterative algorithm is established through a rigid body velocity transformation, which calculates the input parameters of the link velocity and acceleration. A linear system of equations in matrix form is then established for the entire PM through the Newton–Euler method. By using the generalized minimal residual method (GMRES) to solve the equation system, all the forces and torques on the joints can be obtained, from which the required actuation force can be derived. This method is validated through numerical simulations using the automatic dynamic analysis of multibody systems software. The proposed method is suitable for establishing the dynamic model of complex PMs with redundant or hybrid structures.
To examine the effectiveness of Self-Help Plus (SH+) as an intervention for alleviating stress levels and mental health problems among healthcare workers.
Methods
This was a prospective, two-arm, unblinded, parallel-designed randomised controlled trial. Participants were recruited at all levels of medical facilities within all municipal districts of Guangzhou. Eligible participants were adult healthcare workers experiencing psychological stress (10-item Perceived Stress Scale scores of ≥15) but without serious mental health problems or active suicidal ideation. A self-help psychological intervention developed by the World Health Organization in alleviating psychological stress and preventing the development of mental health problems. The primary outcome was psychological stress, assessed at the 3-month follow-up. Secondary outcomes were depression symptoms, anxiety symptoms, insomnia, positive affect (PA) and self-kindness assessed at the 3-month follow-up.
Results
Between November 2021 and April 2022, 270 participants were enrolled and randomly assigned to either SH+ (n = 135) or the control group (n = 135). The SH+ group had significantly lower stress at the 3-month follow-up (b = −1.23, 95% CI = −2.36, −0.10, p = 0.033) compared to the control group. The interaction effect indicated that the intervention effect in reducing stress differed over time (b = −0.89, 95% CI = −1.50, −0.27, p = 0.005). Analysis of the secondary outcomes suggested that SH+ led to statistically significant improvements in most of the secondary outcomes, including depression, insomnia, PA and self-kindness.
Conclusions
This is the first known randomised controlled trial ever conducted to improve stress and mental health problems among healthcare workers experiencing psychological stress in a low-resource setting. SH+ was found to be an effective strategy for alleviating psychological stress and reducing symptoms of common mental problems. SH+ has the potential to be scaled-up as a public health strategy to reduce the burden of mental health problems in healthcare workers exposed to high levels of stress.