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Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.
Methods
A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.
Results
The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.
Conclusions
These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.
Depressive and anxiety disorders constitute a major component of the disease burden of mental disorders in China.
Aims
To comprehensively evaluate the disease burden of depressive and anxiety disorders in China.
Method
The raw data is sourced from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. This study presented the disease burden by prevalence and disability-adjusted life years (DALYs) of depressive and anxiety disorders at both the national and provincial levels in China from 1990 to 2021, and by gender (referred to as 'sex' in the GBD 2021) and age.
Results
From 1990 to 2021, the number of depressive disorder cases (from 34.4 to 53.1 million) and anxiety disorders (from 40.5 to 53.1 million) increased by 54% (95% uncertainty intervals: 43.9, 65.3) and 31.2% (19.9, 43.8), respectively. The age-standardised prevalence rate of depressive disorders decreased by 6.4% (2.9, 10.4), from 3071.8 to 2875.7 per 100 000 persons, while the prevalence of anxiety disorders remained stable. COVID-19 had a significant adverse impact on both conditions. There was considerable variability in the disease burden across genders, age groups, provinces and temporal trends. DALYs showed similar patterns.
Conclusion
The burden of depressive and anxiety disorders in China has been rising over the past three decades, with a larger increase during COVID-19. There is notable variability in disease burden across genders, age groups and provinces, which are important factors for the government and policymakers when developing intervention strategies. Additionally, the government and health authorities should consider the potential impact of public health emergencies on the burden of depressive and anxiety disorders in future efforts.
A 60-d feeding trial was conducted to explore the potential regulatory effects of dietary Clostridium butyricum cultures (CBC) supplementation in high-carbohydrate diet (HCD) on carbohydrate utilisation, antioxidant capacity and intestinal microbiota of largemouth bass. Triplicate groups of largemouth bass (average weight 35·03 ± 0·04 g), with a destiny of twenty-eight individuals per tank, were fed low-carbohydrate diet and HCD supplemented with different concentration of CBC (0 %, 0·25 %, 0·50 % and 1·00 %). The results showed that dietary CBC inclusion alleviated the hepatic glycogen accumulation induced by HCD intake. Additionally, the expression of hepatic ampkα1 and insulin signaling pathway-related genes (ira, irb, irs, p13kr1 and akt1) increased linearly with dietary CBC inclusion, which might be associated with the activation of glycolysis-related genes (gk, pfkl and pk). Meanwhile, the expression of intestinal SCFA transport-related genes (ffar3 and mct1) was significantly increased with dietary CBC inclusion. In addition, the hepatic antioxidant capacity was improved with dietary CBC supplementation, as evidenced by linear decrease in malondialdehyde concentration and expression of keap1, and linear increase in antioxidant enzyme activities (total antioxidative capacity, total superoxide dismutase and catalase) and expression of antioxidant enzyme-related genes (nrf2, sod1, sod2 and cat). The analysis of bacterial 16S rRNA V3–4 region indicated that dietary CBC inclusion significantly reduced the enrichment of Firmicutes and potential pathogenic bacteria genus Mycoplasma but significantly elevated the relative abundance of Fusobacteria and Cetobacterium. In summary, dietary CBC inclusion improved carbohydrate utilization, antioxidant capacity and intestinal microbiota of largemouth bass fed HCD.
Taishan, or Mt. Tai, has been one of the most popular pilgrimage sites in China. Many pilgrims have commissioned inscriptions carved on slabs and stelae on the mountain to commemorate their journeys. Meanwhile, the mountain also holds a firm place in the Chinese imagination of the underworld.
This essay first offers a survey of historical stone inscriptions preserved on Mt. Tai. It then focuses on one Qing-dynasty stele that contains an incomprehensible phrase, le fu yin bei 勒夫陰碑, especially yinbei, as in the title. Next, the article presents a fieldwork account of a ritual called song yinbei 送陰碑 (“sending phantom stele”) at the pilgrimage to the temple of Zongsi dadi (the Great Emperor in Charge of All). The Great Emperor, according to local beliefs, governs the underworld. The temple is located in Zhuyang, Tai’an county, adjacent to Mt. Tai. The ritual of song yinbei is carried out at the annual temple fair to present mock stelae made of paper and golden foil to express gratitude and make wishes.
Based on interviews and geo-historical analysis, it is likely that the four characters, le fu yin bei found on the Qing stele, refers to the practice of song yinbei that originated in Zhuyang town. Ethnographic studies can help historians to interpretate historical texts.
Taishan 泰山, or Mt. Tai, located in the coastal province of Shandong in northern China, is known as the first among the “five sacred peaks” (wuyue 五嶽) in the Chinese religious landscape. It has been one of the most prominent pilgrimage sites since at least the third century BCE. Numerous pilgrimage stelae (jinxiang bei 進香碑) have graced the mountain and the surrounding areas from historical times to the present. They are important materials for studying Taishan culture as well as for the practice of pilgrimage. Due to changes over a long period, however, many of the rituals recorded in the stone inscriptions have faded into obscurity. This creates extra obstacles for comprehending pilgrimage stelae.
In recent decades, I have conducted fieldwork on the cult of Mt. Tai in its surrounding villages. The current local ritual activities in the area are comparable to the narratives on the historical pilgrimage stelae.
The burden of mental disorders is increasing worldwide, thus, affecting society and healthcare systems. This study investigated the independent influences of age, period and cohort on the global prevalence of mental disorders from 1990 to 2019; compared them by sex; and predicted the future burden of mental disorders in the next 25 years.
Methods
The age-specific and sex-specific incidence of mental disorders worldwide was analysed according to the general analysis strategy used in the Global Burden of Disease Study in 2019. The incidence and mortality trends of mental disorders from 1990 to 2019 were evaluated through joinpoint regression analysis. The influences of age, period and cohort on the incidence of mental disorders were evaluated with an age–period–cohort model.
Results
From 1990 to 2019, the sex-specific age-standardized incidence and disability-adjusted life years (DALY) rate decreased slightly. Joinpoint regression analysis from 1990 to 2019 indicated four turning points in the male DALY rate and five turning points in the female DALY rate. In analysis of age effects, the relative risk (RR) of incidence and the DALY rate in mental disorders in men and women generally showed an inverted U-shaped pattern with increasing age. In analysis of period effects, the incidence of mental disorders increased gradually over time, and showed a sub-peak in 2004 (RR, 1.006 for males; 95% CI, 1.000–1.012; 1.002 for women, 0.997–1.008). Analysis of cohort effects showed that the incidence and DALY rate decreased in successive birth cohorts. The incidence of mental disorders is expected to decline slightly over the next 25 years, but the number of cases is expected to increase.
Conclusions
Although the age-standardized burden of mental disorders has declined in the past 30 years, the number of new cases and deaths of mental disorders worldwide has increased, and will continue to increase in the near future. Therefore, relevant policies should be used to promote the prevention and management of known risk factors and strengthen the understanding of risk profiles and incidence modes of mental disorders, to help guide future research on control and prevention strategies.
Throughout the course of a flight mission, a range of aerodynamic conditions, including design-point conditions and off-design conditions, are encountered. As the bypass ratio increases and the fan-pressure ratio decreases to reduce the engine’s specific fuel consumption, the engine diameters increase, which results in an increase in the nacelle weight and overall drag. To reduce its weight and drag, a shorter nacelle with a length-to-diameter ratio $L/D = 0.35$ is investigated. In this study, an adaptive cokriging-based multi-objective optimisation method is applied to the design of a short aero-engine nacelle. Two nacelle performance metrics were employed as the objective functions for the optimisation routine. The cruise drag coefficient is evaluated under cruise conditions, whereas the intake pressure recovery is evaluated under takeoff conditions. The cokriging metamodel are refined using an effective infilling strategy, where high-fidelity samples are infilled via the modified Pareto fitness, and low-fidelity samples are infilled via the Pareto front. By combining parameterised geometry generation, automated mesh generation, numerical simulations, surrogate model construction, Pareto front exploration based on the non-dominated sorting genetic algorithm-II and sample infilling, an integrated multi-objective optimisation framework for short aero-engine nacelles is developed. Two-objective and three-objective test functions are used to validate the effectiveness of the proposed framework. After the optimisation process, a set of non-dominated nacelle designs is obtained with better aerodynamic performance than the original design, demonstrating the effectiveness of the optimisation framework. Compared with the kriging-based optimisation framework, the cokriging-based optimisation framework outperforms the single-fidelity method with a higher hypervolume value at the same number of iteration loops.
The development of high-brightness X-ray free electron lasers (XFELs), such as hard X-ray self-seeding free electron lasers and XFEL oscillators (XFELOs), brings a severe challenge to the crystal monochromator due to a strong non-uniform thermal load. The distortion caused by spatial temperature gradients can severely affect the optical performance of crystals. Therefore, this paper presents a model to estimate the performance of non-uniform thermally distorted crystals. The model not only takes into account thermal strain, slope error and incident angle deviation, but also considers temperature-dependent factors such as the Debye–Waller factor and electric susceptibility. Our investigation indicates that the Debye–Waller factor reduces the height and bandwidth of rocking curves, and the impact of the electric susceptibility is tiny. The proposed model can describe the distortion of the reflectivity and transmissivity curves of non-uniform thermally loaded crystals and can be applied in the design of crystal monochromators, crystal splitters, crystal compressors and XFELOs.
The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.
Design:
All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.
Setting:
All data sourced from the GBD Study 2019.
Participants:
All age groups for both sexes.
Results:
The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.
Conclusions:
The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.
Lithospheric thinning occurred in the North China Craton (NCC) that resulted in extensive Mesozoic magmatism, which has provided the opportunity to explore the mechanism of the destruction of the NCC. In this study, new zircon U–Pb ages, geochemical and Lu–Hf isotopic data are presented for Early Cretaceous adakitic rocks in the Liaodong Peninsula, with the aim of establishing their origin as well as the thinning mechanism of the NCC. The zircon U–Pb data show that crystallization occurred during 127–120 Ma (i.e. Early Cretaceous). These rocks are characterized by high Sr (294–711 ppm) content and Sr/Y ratio (38.5–108), low Yb (0.54–1.24 ppm) and Y (4.9–16.4 ppm) contents, and with no obvious Eu anomalies, implying that they are adakitic rocks. They are enriched in large-ion lithophile elements (e.g. Ba, K, Pb and Sr) and depleted in high-field-strength elements (e.g. Nb, Ta, P and Ti). These adakitic rocks have negative zircon ϵHf(t) contents (−28.9 to −15.0) with two-stage Hf model ages (TDM2) of 3004–2131 Ma. Based on the geochemical features, such as low TiO2 and MgO contents, and high La/Yb and K2O/Na2O ratios, these adakites originated from the partial melting of thickened eclogitic lower crust. They were in an extensional setting associated with the slab rollback of the Palaeo-Pacific Ocean. In combination with previous studies, as a result of the rapid retracting of the Palaeo-Pacific Ocean during 130–120 Ma, the asthenosphere upwelled and modified the thickened lithospheric mantle, which lost its stability, resulting in the lithospheric delamination and thinning of the NCC.
There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.
Methods
Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.
Results
A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.
Conclusions
The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.
Environmental hypoxia exposure causes fertility problems in human and animals. Compelling evidence suggests that chronic hypoxia impairs spermatogenesis and reduces sperm motility. However, it is unclear whether paternal hypoxic exposure affects fertilization and early embryo development. In the present study, we exposed male mice to high altitude (3200 m above sea level) for 7 or 60 days to evaluate the effects of hypoxia on sperm quality, zygotic DNA methylation and blastocyst formation. Compared with age-matched controls, hypoxia-treated males exhibited reduced fertility after mating with normoxic females as a result of defects in sperm motility and function. Results of in vitro fertilization (IVF) experiments revealed that 60 days’ exposure significantly reduced cleavage and blastocyst rates by 30% and 70%, respectively. Immunohistochemical staining of pronuclear formation indicated that the pronuclear formation process was disturbed and expression of imprinted genes was reduced in early embryos after paternal hypoxia. Overall, the findings of this study suggested that exposing male mice to hypoxia impaired sperm function and affected key events during early embryo development in mammals.
Inflammation might play a role in bipolar disorder (BD), but it remains unclear the relationship between inflammation and brain structural and functional abnormalities in patients with BD. In this study, we focused on the alterations of functional connectivity (FC), peripheral pro-inflammatory cytokines and their correlations to investigate the role of inflammation in FC in BD depression.
Methods
In this study, 42 unmedicated patients with BD II depression and 62 healthy controls (HCs) were enrolled. Resting-state-functional magnetic resonance imaging was performed in all participants and independent component analysis was used. Serum levels of Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were measured in all participants. Correlation between FC values and IL-6 and IL-8 levels in BD was calculated.
Results
Compared with the HCs, BD II patients showed decreased FC in the left orbitofrontal cortex (OFC) implicating the limbic network and the right precentral gyrus implicating the somatomotor network. BD II showed increased IL-6 (p = 0.039), IL-8 (p = 0.002) levels. Moreover, abnormal FC in the right precentral gyrus were inversely correlated with the IL-8 (r = −0.458, p = 0.004) levels in BD II. No significant correlation was found between FC in the left OFC and cytokines levels.
Conclusions
Our findings that serum IL-8 levels are associated with impaired FC in the right precentral gyrus in BD II patients suggest that inflammation might play a crucial role in brain functional abnormalities in BD.
Volcanic tuffs are important in determining the stratigraphic age of sedimentary sequences, which is closely related to the tectonic, sedimentological, geomorphological, palaeoclimatic, and palaeo-ecological evolution of the sequences. However, it may be difficult practically to identify tuffs in stratigraphic sections, especially when they are altered after deposition. In this study, a series of petrographic, mineralogical, and geochemical analyses was deployed in the tuff layers cropping out in the Lunpola Basin of the central Tibetan Plateau, which is a crucial site for studying the dynamics and processes of the Cenozoic uplift of the Tibetan Plateau and its environmental impacts. In these pyroclastic layers, authigenic analcime is the main volcanic glass alteration product. The analcime-bearing samples are Na-enriched, in contrast to the K-abundant magmatic rocks in the central Tibetan Plateau. The distribution patterns of the rare earth elements (REEs) of the bulk analcime-bearing samples are similar to those of the magmatic rocks but different from those of the analcime-poor sediments and analogues of well-mixed upper continental material (e.g. the upper continental crust and post-Archaean Australian average shales). The distinct distributions of Na and REEs among analcime-bearing samples, analcime-poor sediments, and volcanic rocks reveal that analcime formed both from alteration of volcanic material and from mixing processes with non-volcanic sediments. It is proposed, therefore, that the discrimination plot of Na2O/Al2O3-(La/Yb)N may be used to distinguish the analcime-related pyroclastic rocks from the basin sedimentary sequence, and thus it may provide a means of discriminating between various volcanic material and of supporting age dating by tephrochronology in the central Tibetan Plateau.
Rare earth elements (REE) in marine minerals have been widely used as proxies for the redox status of depositional and/or diagenetic environments. Phosphate nodules, which are thought to grow within decimetres below the sediment–water interface and to be able to scavenge REE from the ambient pore water, are potential archives of subtle changes in REE compositions. Whether their REE signals represent specific redox conditions or they can be used to track the overlying water chemistry is worth exploring. Through in situ laser ablation – inductively coupled plasma – mass spectrometry (LA-ICP-MS), we investigate the REE compositions of a drill-core-preserved phosphate nodule from the lower Cambrian Niutitang Formation in the Daotuo area, northeastern Guizhou Province, South China. REE distributions of the nodule show concentric layers with systematic decreases in Ce anomalies (Ce/Ce*) from the core to the rim. The lowest Ce/Ce* appears in the outer rim where REE concentrations are relatively high. These results are interpreted to reflect REE exchange with pore water at a very early stage or bathymetric variation during apatite precipitation. The origin of the shale-normalized middle REE (MREE) enrichment in our sample is less constrained. Possible driving factors include preferential MREE substitution for Ca in the apatite lattice, degradation of organic matter and deposition beneath a ferruginous zone. Although speculative, the last possibility is consistent with the chemically stratified model for early Cambrian oceans, in which dynamic fluctuations of the chemocline provided an ideal depositional context for phosphogenesis.
The association of atrioventricular septal defect and transposition of the great arteries is very rare. As a rule, these patients have unbalanced ventricles. However, there have been no studies describing the results of single-ventricle palliation in these children.
Methods:
All children who underwent surgery with a diagnosis of atrioventricular septal defect and transposition of the great arteries were included in the study. Data were obtained from medical records.
Results:
A total of 38 patients with atrioventricular septal defect and transposition of the great arteries underwent single-ventricle palliation at the study institution between 1971 and 2016. The mean follow-up was 12.4 years (median: 14.6 years, range 2–43.3 years). Most children had unbalanced atrioventricular septal defect (94.7%, 36/38). Survival was 67.6% (95% confidence interval [CI]: 50.0–80.2%) at 10 years and 57.8% (95% CI: 38.0–73.4%) at 20 years. By 10 years, 58.6% (95% CI: 40.8–72.7%) had progressed to Fontan completion, while 32.5% (95% CI: 18.2–47.6%) had died. In patients achieving Fontan completion, 20-year event-free survival was 73.3% (95% CI: 34.8–91.3%), while 5.0% (95% CI: 0.4–20.5%) had undergone cardiac transplantation and 21.7% (95% CI: 3.2–50.8%) had undergone takedown of the Fontan circulation. Freedom from atrioventricular valve surgery was 57.0% (95% CI: 37.2–72.7%) at 10 and 20 years.
Conclusions:
The association of atrioventricular septal defect and transposition of the great arteries is very rare, and most of these children have unbalanced ventricles. Single-ventricle palliation results in 25-year overall survival of 50%. However, in patients, who had Fontan completion, survival was 75% at 25 years after Fontan operation.
The microbiota–gut–brain axis, especially the microbial tryptophan (Trp) biosynthesis and metabolism pathway (MiTBamp), may play a critical role in the pathogenesis of major depressive disorder (MDD). However, studies on the MiTBamp in MDD are lacking. The aim of the present study was to analyze the gut microbiota composition and the MiTBamp in MDD patients.
Methods
We performed shotgun metagenomic sequencing of stool samples from 26 MDD patients and 29 healthy controls (HCs). In addition to the microbiota community and the MiTBamp analyses, we also built a classification based on the Random Forests (RF) and Boruta algorithm to identify the gut microbiota as biomarkers for MDD.
Results
The Bacteroidetes abundance was strongly reduced whereas that of Actinobacteria was significantly increased in the MDD patients compared with the abundance in the HCs. Most noteworthy, the MDD patients had increased levels of Bifidobacterium, which is commonly used as a probiotic. Four Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) (K01817, K11358, K01626, K01667) abundances in the MiTBamp were significantly lower in the MDD group. Furthermore, we found a negative correlation between the K01626 abundance and the HAMD scores in the MDD group. Finally, RF classification at the genus level can achieve an area under the receiver operating characteristic curve of 0.890.
Conclusions
The present findings enabled a better understanding of the changes in gut microbiota and the related Trp pathway in MDD. Alterations of the gut microbiota may have the potential as biomarkers for distinguishing MDD patients form HCs.
The Sichuan–Yunnan–Guizhou (SYG) Pb–Zn metallogenic province is one of the most productive areas of Pb–Zn resources in China. The Fule deposit occurs in Permian carbonate and contains Pb–Zn reserves exceeding 1 Mt. To investigate the sulphur source, in situ S isotopic analysis of sphalerite and pyrite was carried out using nanoscale secondary-ion mass spectrometry. The results show that the δ34S values of the sulphide minerals range from +16.1‰ to +23.0‰, higher than that of marine sulphates hosted in Permian carbonate rocks (+11‰), but similar to that of sulphates over a broader area (+12.9‰ to +25.9‰). The sulphates in the regional rocks could therefore represent an important source of S for the Fule deposit via thermochemical sulphate reduction. The S source of the Fule deposit is different from those of most other Pb–Zn deposits in the SYG Pb–Zn mineralization province, which were mainly derived from the ore-bearing strata. The δ34S values of the early to late generations and some single sulphide crystals from the cores to rims show a slight increasing trend, implying that partial Rayleigh fractionation took place in the Fule deposit. It is suggested that the Fule sulphide precipitation resulted from the mixing of a metalliferous fluid with a H2S-rich fluid derived from the regional strata. Combining the geology, mineralogy and S isotope results with previous Pb isotope studies, it is suggested that the Fule deposit should be attributed to a Mississippi Valley type deposit.
Paediatric heart transplantation in Australia is centralised at The Royal Children’s Hospital, Melbourne. Survival to adulthood is improving but the ongoing need for complex medical therapy, surveillance, and potential for late complications continues to impact on quality of life. Quality of life in adults who underwent heart transplantation in childhood in Australia has not been assessed.
Methods:
Cross-sectional quality of life data were collected from paediatric heart transplant survivors >18 years of age using Rand 36-Item Health Survey. Self-reported raw scores were transformed to a 0–100 scale with higher scores indicating better quality of life. Mean scores were compared to National Health Survey Short Form-36 Population Norms data using the independent sample t-test.
Results:
A total of 64 patients (64/151) who underwent transplantation at The Royal Children’s Hospital between 1988 and 2016 survived to adulthood. In total 51 patients (51/64, 80%) were alive at the time of the study and 27 (53%) responded with a mean age of 25 ± 6 years, being a median of 11 years (interquartile range 7–19) post-transplantation. Most self-reported quality of life subscale scores were not significantly different from the Australian normative population data. However, self-reported ‘General Health’ was significantly worse than normative data (p = 0.02). Overall, 93% (25/27) reported their general health as being the same or better compared to 1-year ago.
Conclusion:
Adult survivors after paediatric heart transplantation in Australia report good quality of life in multiple domains and demonstrate independence in activities of daily living and employment. However, lifelong medical treatment may affect perceptions of general health.
Toxigenic Clostridium difficile (C. difficile) carriers represent an important source in the transmission of C. difficile infection (CDI) during hospitalisation, but its prevalence and mode in patients with hepatic cirrhosis are not well established. We investigated longitudinal changes in carriage rates and strain types of toxigenic C. difficile from admission to discharge among hepatic cirrhosis patients. Toxigenic C. difficile was detected in 104 (19.8%) of 526 hepatic cirrhosis patients on admission, and the carriage status changed in a portion of patients during hospitalisation. Approximately 56% (58/104) of patients lost the colonisation during their hospital stay. Among the remaining 48 patients who remained positive for toxigenic C. difficile, the numbers of patients who were positive at one, two, three and four isolations were 10 (55.6%), three (16.7%), two (11.1%) and three (16.7%), respectively. Twenty-eight patients retained a particular monophyletic strain at multiple isolations. The genotype most frequently identified was the same as that frequently identified in symptomatic CDI patients. A total of 25% (26/104) of patients were diagnosed with CDI during their hospital stay. Conclusions: Colonisation with toxigenic C. difficile strains occurs frequently in cirrhosis patients and is a risk factor for CDI.
We report new field observations, zircon U–Pb ages and geochemical data for the discrete members of the Zhaheba ophiolite complex in northeastern Junggar of the Central Asian Orogenic Belt (CAOB) with the aim to understand the accretion process of the eastern Junggar terrane. The zircon age data reveal that the cumulates of the Zhaheba ophiolite crystallized at ~485 Ma while the volcanic sequences erupted at ~400 Ma. Thus, the volcanic sequences are not members of the Zhaheba ophiolite. Chromian spinels from the serpentinite have comparable elemental compositions to those of spinels from MORB-type ophiolites. Similarly, the rift affinity of clinopyroxene and positive zircon εHf(t) (13–20) and mantle δ18O (+5.37‰) values of the cumulates imply that the cumulates crystallized from primitive magmas derived from a depleted mantle source. Elemental and Nd isotopic compositions indicate that the basalts in the Zhaheba area were derived from partial melting of a mantle wedge metasomatized by adakitic melts and/or subduction-related fluids. The data presented in this contribution, together with previous studies, indicate that the Zhaheba–Almantai and Kelameili ophiolites were MORB-type, which implies that there were at least two mid-ocean ridges during Ordovician to early Devonian times in the Junggar Ocean. In the earlier stage, intra-oceanic subduction led to the formation of the intra-oceanic arc, and then the Kelameili ophiolite accreted to an intra-oceanic accretionary wedge. In the later stage, the Zhaheba–Almantai ophiolite accreted to the accretionary wedge along the southern margin of the Iritish suture zone during the roll-back of the subduction zone from north to south.