Optimizing Triage: Assessing Shock Index, Pediatric Age-Adjusted as an Adjunct to Improve Emergency Severity Index Mistriage.

OBJECTIVE: We investigated the diagnostic value of shock index, pediatric age-adjusted (SIPA) in predicting Emergency Severity Index level 3 patients' outcomes. Secondary objectives included exploring the impact of fever and participant variables on SIPA's predictive ability. METHODS: A retrospective chart review identified children aged 1 to 15 years triaged as a level 3 in the emergency department between January 2018 and December 2021. Shock index, pediatric age-adjusted thresholds based on age, 1 to 6 years (>1.2), 7 to 12 years (>1.0), and 13 to 17 years (>0.9), were used. We assessed elevated SIPA and SIPA corrected for fever to evaluate associations with outcomes and interventions. RESULTS: Our findings, involving 192 patients, revealed that elevated SIPA demonstrated enhanced discrimination relative to nonelevated SIPA. Patients with elevated SIPA had more average interventions: 1.14 versus 0.74, P < 0.016; average interventions using SIPA corrected for fever: 1.14 versus 0.77, P < 0.006; average interventions controlling for race and sex: 1.15 versus 0.71, P < 0.001; hospital admission: 64.4% versus 42.9%, P = 0.004; hospital length of stay (LOS): 3.06 days (SE, 0.42) versus 1.46 days (SE, 0.23); hospital LOS using SIPA corrected for fever: 2.75 days (SE, 0.44) versus 1.72 days (SE, 0.24); ventilatory support: 16.44% versus 3.36%, P < 0.002; fluid bolus: 28.77% versus 14.29%, P < 0.015; intravenous medications (antibiotics, antiepileptics, immune globulin, albumin): 45.21% versus 30.25%, P < 0.036. There was no difference between other interventions, pediatric intensive care admission, and LOS between the 2 groups. Importantly, SIPA was unaffected by fever, race, or sex. CONCLUSIONS: Shock index, pediatric age-adjusted identifies level 3 Emergency Severity Index pediatric patients more likely to require hospital admission, longer LOS, and a lifesaving intervention especially ventilatory support, intravenous fluids, or specific intravenous medications. Shock index, pediatric age-adjusted's predictive ability remained unaffected by fever, race, or sex, making it a valuable tool in preventing mistriage and justifying inclusion in the Emergency Severity Index danger zone vitals criteria for up-triage.

Acceptance of disability, attitudes toward disability, and coping in adolescents with visual impairments: A cross-lagged study.

PURPOSE/OBJECTIVE: This study aims to understand the reciprocal relationships among acceptance of disability, attitudes toward disability, and coping among Chinese adolescents with visual impairments. RESEARCH DESIGN: Adolescents with visual impairments (NT1 = 311, NT2 = 170) from four Chinese special education schools completed three questionnaires twice over 1 year. Cross-lagged panel modeling was carried out to analyze the questionnaire data. RESULTS: The findings revealed that attitudes toward disability and self-directed coping at Time 1 (T1) positively predicted acceptance of disability at Time 2 (T2). Self-directed coping at T1 positively predicted attitudes toward disability at T2, and attitudes toward disability at T1 negatively predicted relinquished-control coping at T2. CONCLUSION/IMPLICATIONS: Visually impaired adolescents' attitudes toward disability and coping serve as antecedents of their acceptance of disability. There is a positive reciprocal relationship between coping and attitudes toward disability. Psychological interventions aimed at optimizing psychosocial adjustment among students with visual impairments may benefit from targeting coping strategies and attitudes toward disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Subjective well-being among PhD students in mainland China: the roles of psychological capital and academic engagement.

The mental well-being of PhD students is a major concern in higher education. However, very few studies have investigated the influencing factors of PhD students' subjective well-being (SWB) - an important indicator of mental well-being. Even no study on the influencing factors of PhD students' SWB has been undertaken in mainland China. Based on job demands-resources theory, the present study pioneers the investigation of the relationship between PhD students' psychological capital (PsyCap; comprising self-efficacy, hope, resilience, and optimism) and SWB (comprising positive affect, negative affect, and life satisfaction) in mainland China. It further examined the mediating role of academic engagement (comprising vigor, dedication, and absorption) in this relationship. PhD students (n = 376) from two comprehensive universities in Jiangsu province responded to an online survey. The results showed that (1) self-efficacy was positively associated with life satisfaction, hope was positively associated with positive affect, optimism was significantly associated with all three dimensions of SWB, but resilience was not significantly associated with any of the three SWB dimensions; and (2) dedication mediated the relationship between hope and life satisfaction and that between optimism and negative affect and life satisfaction, but vigor and absorption did not mediate any of the PsyCap-SWB relationships. Limitations and practical implications of this study are discussed.

[Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study]. / æ¹–åŒ—æ©æ–½åœŸå®¶æ—è‹—æ—è‡ªæ²»å·žæ–°ç”Ÿå„¿çª’æ¯å±é™©å› ç´ åˆ†æžåŠåˆ—çº¿å›¾é¢„æµ‹æ¨¡åž‹çš„æž„å»ºï¼šä¸€é¡¹å¤šä¸­å¿ƒç ”ç©¶.

OBJECTIVES: To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia. METHODS: A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively. RESULTS: Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia. CONCLUSIONS: The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

Pediatric ED Saves: Analyzing the ED Screen of Direct Admissions.

Direct admissions (DAs) are a routine hospital entry portal with few guidelines to assess patient safety during this process. This study assessed the effectiveness of an institutional screen for patients presenting as DA. It investigated patient variables that may predict appropriateness for DA and those at high risk for deterioration. Methods: The study includes patients who received the institutional screen between June 1, 2019, and May 31, 2020. We placed charts into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to pediatric intensive care unit within 6 hours). We assessed effectiveness by calculating sensitivity, specificity, and predictive values. We used comparative analysis between groups to identify patients safe for DA and those at high risk for deterioration. Results: The screen was 80% sensitive and 100% specific, predicting 97.7% of stable patients. Of the 652 charts reviewed, 384 met the inclusion criteria. Group 1 (31.60, 26.45%, 5.23%) had lower respiratory rate, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO2, group 1 (98.70) was higher than group 2 (96.03). For the Pediatric Early Warning Score, group 2 (1.72) was higher than group 1 (0.31) and group 3 (0.63). Conclusions: The institutional screen is an effective tool to identify patients presenting as DA needing immediate emergency department intervention and/or pediatric intensive care unit care. The screen benefits patients with a respiratory diagnosis, oxygen requirement, high respiratory rate or low SpO2.

Research agendas and organizational commitment among academics in mainland China.

This research pioneered the investigation of the statistically predictive power of academics' research agendas for their organizational commitment-beyond age, gender, academic rank, and academic discipline. Three hundred and thirty-two academics from nine research-oriented comprehensive universities in Zhejiang province and Shanghai, mainland China, responded to the Multi-Dimensional Research Agendas Inventory-12 Items (MDRAI-12) and the Organizational Commitment Inventory. Three main findings were obtained. First, the MDRAI-12 was confirmed to be a valid and reliable instrument for assessing the research agendas of academics in mainland China. Second, both academics' research agendas and their organizational commitment varied as a function of demographics. Third and most importantly, when age, gender, academic rank, and academic discipline were put under control, three of the four trailblazing research agendas (scientific ambition, collaboration, and discovery) predicted the three adaptive organizational commitments (affective, normative, and ideal), whereas the two cohesive research agendas (convergence and conservative) chiefly contributed to the two maladaptive organizational commitments (economic and choice). These findings have shed new light on the literature concerning research agendas and that on organizational commitment. At the same time, the findings have practical implications for university academics and senior managers in their respective efforts to promote innovative research and adaptive organizational commitment among academics.

Overlapping syndrome of recurrent anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein demyelinating diseases: A case report.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (NMDARe) is capable of presenting a relapsing course and coexisting with myelin oligodendrocyte glycoprotein antibody disease, whereas it has been relatively rare. We describe a man with no history of tumor who successively developed anti-NMDARe and anti-myelin oligodendrocyte glycoprotein antibody disease. CASE SUMMARY: A 29-year-old man was initially admitted with headache, fever, intermittent abnormal behavior, decreased intelligence, limb twitching and loss of consciousness on July 16, 2018. On admission, examination reported no abnormality. During his presentation, he experienced aggravated symptoms, and the re-examination of cranial magnetic resonance imaging (MRI) indicated punctate abnormal signals in the left parietal lobe. External examination of cerebrospinal fluid and serum results revealed serum NMDAR antibody (Ab) (-), cerebrospinal fluid NMDAR-Ab (+) 1:10 and Epstein-Barr virus capsid antigen antibody IgG (+). Due to the imaging findings, anti-NMDARe was our primary consideration. The patient was treated with methylprednisolone and gamma globulin pulse therapy, mannitol injection dehydration to reduce intracranial pressure, sodium valproate sustained-release tablets for anti-epilepsy and olanzapine and risperidone to mitigate psychiatric symptoms. The patient was admitted to the hospital for the second time for "abnormal mental behavior and increased limb movements" on December 14, 2018. Re-examination of electroencephalography and cranial MRI showed no abnormality. The results of autoimmune encephalitis antibody revealed that serum NMDAR-Ab was weakly positive and cerebrospinal fluid NMDAR-Ab was positive. Considering comprehensive recurrent anti-NMDARe, the patient was treated with propylene-hormone pulse combined with immunosuppressive agents (mycophenolate mofetil), and the symptoms were relieved. The patient was admitted for "hoarseness and double vision" for the third time on August 23, 2019. Re-examination of cranial MRI showed abnormal signals in the medulla oblongata and right frontal lobe, and synoptophore examination indicated concomitant esotropia. The patient's visual acuity further decreased, and the re-examination of cranial MRI + enhancement reported multiple scattered speckled and patchy abnormal signals in the medulla oblongata, left pons arm, left cerebellum and right midbrain, thalamus. The patient was diagnosed with an accompanying demyelinating disease. Serum anti-myelin oligodendrocyte glycoprotein 1:10 and NMDAR antibody 1:10 were both positive. The patient was diagnosed with myelin oligodendrocyte glycoprotein antibody-related inflammatory demyelinating disease of the central nervous system complicated with anti-NMDARe overlap syndrome. The patient was successfully treated with methylprednisolone, gamma globulin pulse therapy and rituximab treatment. The patient remained asymptomatic and follow-up MRI scan 6 mo later showed complete removal of the lesion. CONCLUSION: We emphasize the rarity of this antibody combination and suggest that these patients may require longer follow-up due to the risk of recurrence of two autoimmune disorders.

A cross-lagged study of psychosocial adaptation among students with visual impairments: Coping, self-esteem, and social integration.

BACKGROUND: As three key indicators of psychosocial adaptation, coping, self-esteem, and social integration are vital for students with visual impairments. AIMS: This study aimed to examine the reciprocal relationships among visually impaired students' coping, self-esteem, and social integration. METHODS: Students with visual impairments (NTime1 = 311, NTime2 = 170) from four special schools in mainland China responded to three inventories at two timepoints over one year. Cross-lagged panel modelling was performed to analyse the data. RESULTS: After controlling for gender, self-esteem positively predicted self-directed coping and negatively predicted relinquished-control coping. An inverse path was found in the prediction of relinquished-control coping to self-esteem. Social integration positively predicted self-esteem. Furthermore, gender did not moderate the relationships in the cross-lagged model. CONCLUSIONS AND IMPLICATIONS: Evidence is provided for a negative loop between self-esteem and relinquished-control coping. Social integration could be a precursor of self-esteem, and self-esteem could be a precursor of self-directed coping. Moreover, the study has practical implications for special schools, teachers, parents, and students on enhancing visually impaired students' psychosocial adaptation.

Validity of 1% Hormonal Receptor Positivity Cutoff by the ASCO/College of American Pathologists Guidelines at the Georgia Cancer Center.

PURPOSE: Treatment of breast cancer (BC) with borderline or low (1%-9%) estrogen and progesterone expression remains controversial, with recent data disputing ASCO/College of American Pathologists 2010 guidelines that lowered the threshold of receptor positivity from 10% to 1%. The objective of this retrospective study was to validate these guidelines at the Georgia Cancer Center with a high percentage of Black race. METHODS: All female patients with invasive BC diagnosed between 2005 and 2010 at the Georgia Cancer Center were chart reviewed up to an 11-year follow-up with data cutoff at 2016. We used Cox regression to explore survival among three hormonal status (HS) groups (< 1%, 1%-9%, and ≥ 10%) adjusting for all known BC clinicopathologic variables. Fisher's exact test was used to evaluate response to endocrine therapy (ET). RESULTS: Among 431 patients with mean age 59 years, 24.75% had HS < 1%, 17.5% HS 1%-9%, and 57.75% HS ≥ 10%. Race was 43.75% Black and 54% White. Disease stages were early (I-IIIA) in 84.4% and advanced (IIIB-IV) in 15.56%. Mortality in HS < 1% was significantly higher than that in HS ≥ 10% (hazard ratio [HR]: 1.8; 95% CI, 1.07 to 3.02), whereas no significant mortality difference between HS 1%-9% and HS ≥ 10% (HR: 1.05; 95% CI, 0.48 to 2.30) was observed. ET was protective, and treated patients had higher predicted survival than untreated patients in the 1%-9% group (HR: 0.10; 95% CI, 0.01 to 0.85). There was no significant mortality difference between ET-treated HS 1%-9% and ≥ 10% groups. CONCLUSION: One percent cutoff predicted superior survival on treatment with ET compared with the other groups, and HS as low as 1%-9% was equiprognostic to HS ≥ 10%. Whether other factors such as lymphovascular invasion, grade, and other parameters change the behavior of the 1%-9% HS group remains to be explored.

Infancy weight gain and neurodevelopmental outcomes among term-born infants at age one year: A large prospective cohort study in China.

To investigate the association between infancy weight gain and neurodevelopment among term-born infants. Singleton term-born infants (n = 5837) were included from the Born in Guangzhou Cohort Study. Absolute weight gain was obtained by calculating the weight difference from birth to exactly 12 months. The primary outcome was neurodevelopment at age one year, which included five developmental domains. Global developmental delay was defined as delays in ≥3 domains. Multivariable logistic regression was used to examine the associations between infancy weight gain and neurodevelopment. Compared with infants gaining 6001-7000 g (reference group), infants gaining ≤5000 g had higher odds of delay in adaptive, gross motor, fine motor, social, and global developmental delay, infants gaining 5001-6000 g had higher odds of gross motor delay and social delay. A sex-stratified analysis showed that compared with the reference group, gaining ≤5000 g was associated with higher odds of fine motor delay in male infants, while gaining >7000 g was associated with higher odds of fine motor delay in females. Inadequate infancy weight gain is associated with higher odds of poor neurodevelopment at age one year among term-born infants.

Combined effects of air pollutants on gestational diabetes mellitus: A prospective cohort study.

Exposures to multiple air pollutants during pregnancy have been associated with the risk of gestational diabetes mellitus (GDM). However, their combined effects are unclear. We aimed to evaluate the combined associations of five air pollutants from pre-pregnancy to the 2nd trimester with GDM. This study included 20,113 participants from the Born in Guangzhou Cohort Study (BIGCS). The inverse distance-weighted models were used to estimate individual air pollutant exposure, namely ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter less than 10 µm in diameter (PM10), and less than 2.5 µm in diameter (PM2.5). We estimated stage-specific associations of air pollutants with GDM using generalized estimating equation, and departures from additive joint effects were assessed using the relative excess risk (RERI) and the joint relative risk (JRR). Of the 20,113 participants, 3440 women (17.1%) were diagnosed with GDM. In the adjusted model, increased concentrations of O3 and SO2 3-6 months before pregnancy were associated with GDM occurrence, as well as O3 and PM10 in the 1st trimester, the adjusted relative risk (95% confident intervals) [RRs (95%CI)] ranged from 1.05 (1.00, 1.09) to 1.21 (1.04, 1.40). The largest JRR for GDM was the combination of SO2, NO2, and PM10 in the 1st trimester (JRR = 1.32, 95% CI: 1.10, 1.59). The JRR for O3 and SO2 was less than their additive joint effects [RERI = -0.25 (-0.47, -0.04), P for interaction = 0.048]. Associations of air pollutants with GDM differed somewhat by pre-pregnancy BMI and season. This study added new evidence to the current understanding of the combined effects of multiple air pollutants on GDM. Public health strategies were needed to reduce the adverse effects of air pollution exposure on pregnant women.

Are Personality-Based Intellectual Styles Culture Specific or Universal?

Traditionally, it had been commonly believed that individuals in the same culture have personalities distinct from those of individuals in other cultures. This article examines this belief by critically reviewing relevant literature generated from two of the most widely investigated personality-based style constructs in the field of intellectual styles: the Jungian personality styles and the career personality styles proposed by Holland. It aims at answering the question of whether personality-based intellectual styles are culture specific or they are universal. To achieve this aim, based on the two broad cultural systems derived from Hofstede's model of four cultural dimensions and two major style types from Zhang and Sternberg's threefold model of intellectual styles, two research hypotheses were made. To test the hypotheses, two types of empirical literature centered on each of the two personality-based styles are reviewed: (1) cross-cultural comparative studies; and (2) within-culture studies investigating the association of the two style constructs with other human attributes and outcomes. Results suggest that although personality-based styles are related to culture, they cannot be culture specific; rather, they are fundamentally universal. These findings carry scientific value and have practical implications for education and beyond.

Genome editing of Corynebacterium glutamicum mediated with Cpf1 plus Ku/LigD.

OBJECTIVES: Corynebacterium glutamicum (C. glutamicum) has been harnessed for multi-million-ton scale production of glutamate and lysine. To further increase its amino acid production for fermentation industry, there is an acute need to develop next-generation genome manipulation tool for its metabolic engineering. All reported methods for genome editing triggered with CRISPR-Cas are based on the homologous recombination. While, it requires the generation of DNA repair template, which is a bottle-neck for its extensive application. RESULTS: In this study, we developed a method for gene knockout in C. glutamicum via CRISPR-Cpf1-coupled non-homologous end-joining (CC-NHEJ). Specifically, CRISPR-Cpf1 introduced double-strand breaks in the genome of C. glutamicum, which was further repaired by ectopically expressed two NHEJ key proteins (Mycobacterium tuberculosis Ku and ligase D). We provide the proof of concept, for CC-NHEJ, by the successful knockout of the crtYf/e gene in C. glutamicum with the efficiency of 22.00 ± 5.56%, or something like that. CONCLUSION: The present study reported a novel genome manipulation method for C. glutamicum.

[Effects of Long-Term Application of Chemical Fertilizers and Organic Fertilizers on Heavy Metals and Their Availability in Reddish Paddy Soil].

To investigate the effects of long-term fertilization on the accumulation and availability of heavy metals in reddish paddy soil and to analyze the major influencing factors, soil samples were collected after the later rice was harvested in 2018 from a long-term fertilization field experiment that began in 1984. Six treatments were selected, namely CK (control without fertilization), PK (P and K fertilizer), and NPK (N, P, and K fertilizer), and different proportions of organic fertilizer plus chemical fertilizer (M1NPK: 30%M+70%NPK; M2NPK: 50%M+50%NPK; and M3NPK: 70%M+30%NPK), soil chemical properties, total and available heavy metal contents, and the relationships between the available forms of heavy metals and soil chemical parameters and total heavy metals (THM) were analyzed. The results showed that ① long-term fertilization changed the soil chemical properties; compared with those of CK, PK significantly increased the contents of soil available phosphorus (AP) and available potassium (AK), NPK significantly increased the soil organic matter (SOM), cation exchange capacity (CEC), AP, and AK, and the organic fertilizer treatments significantly increased the contents of SOM, CEC, AP, AK, and nitrate (NO3--N). ② There were slight variations in the THM contents under the chemical fertilizer treatments (PK and NPK), whereas the organic fertilizer treatments significantly increased the total contents of Cu, Zn, and Cd. ③ The chemical fertilizer treatments significantly increased the available Cr and As, whereas the organic fertilizer treatments significantly increased the available Cu, Zn, Cr, Cd, As, and Fe. ④ There were significant positive correlations between the available Cu, Zn, Cr, Cd, As, and Fe and the SOM, CEC, AP, and NO3--N. In addition, the available Zn and Cd were significantly positively correlated with the soil pH, whereas the available Pb was significantly negatively correlated with soil pH, SOM, CEC, and NO3--N. ⑤ There were significant positive correlations between the available and total contents of Cu, Zn, and Cd, whereas there were significant negative correlations between the available and total contents of Cr and Fe. ⑥ Redundancy analysis showed that SOM and pH accounted for 80.7% and 5.5% of the variation in THM, whereas the soil CEC, AP, and pH accounted for 81.1%, 4.9%, and 3.3% of the variation in the available heavy metals, respectively. ⑦ The partial least squares path model analysis showed that the path coefficients of the THM, CEC, and AP on the available state of heavy metals were 0.459, 0.417, and 0.293, respectively. Long-term application of organic manure, such as pig manure, significantly improved the soil chemical properties and affected the availability of heavy metals, and soil CEC and AP may play key roles in regulation.

Career choice and influential factors among medical students majoring in psychiatry in China.

BACKGROUND: The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors. METHOD: This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career. RESULTS: 44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career. CONCLUSION: More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.

[A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China].

OBJECTIVE: To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. METHODS: According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. RESULTS: A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). CONCLUSIONS: Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.

Identification and genetic analysis of qCL1.2, a novel allele of the "green revolution" gene SD1 from wild rice (Oryza rufipogon) that enhances plant height.

BACKGROUND: The exploitation of novel alleles from wild rice that were lost during rice cultivation could be very important for rice breeding and evolutionary studies. Plant height (PH) was a target of artificial selection during rice domestication and is still a target of modern breeding. The "green revolution" gene semi-dwarf 1 (SD1) were well documented and used in the past decades, allele from wild rice could provide new insights into the functions and evolution of this gene. RESULTS: We identified a PH-related quantitative trait locus, qCL1.2,from wild riceusing a set of chromosome segment substitution lines. qCL1.2encodesa novel allele of SD1 gene. The wild allele of SD1 is a dominant locus that can significantly promote rice internode length by regulating the expression levels of genes involved in gibberellin biosynthesis and signal transduction. Nucleotide diversity and haplotype network analyses of the SD1 gene were performed using 2822 rice landraces. Two previously reported functional nucleotide polymorphisms clearly differentiated japonica and indica rice; however, they were not associated with PH selection. Other new functional nucleotide polymorphisms in the coding, but not promoter, regions were involved in PH selection during rice domestication. Our study increasesunderstanding of the rice SD1 gene and provides additional evidence of this gene's selection during rice domestication. CONCLUSIONS: Our findings provide evidence thatSD1 gene from wild rice enhances plant height and new functional nucleotide polymorphisms of this gene were artificially selected during cultivated rice differentiation.

Chemical composition, antibacterial activity and action mechanism of different extracts from hawthorn (Crataegus pinnatifida Bge.).

Present study was designed to compared the total flavonoids and polyphenols contents and antibacterial activity of hawthorn extracts with different polarities as well as the underlying antibacterial mechanisms. The results showed that among all hawthorn extracts, methanol and ethanol extracts (ME and EE) exhibited high levels of total flavonoids and polyphenols contents, followed by acetone, ethyl acetate, trichloromethane and petroleum ether extracts. ME exhibited the strongest antibacterial activity against tested bacteria, especially Staphylococcus aureus with a 1.25 µg/mL of the minimum inhibitory concentration (MIC) and minimum bactericide concentration (MBC). Further analysis revealed that the main phenolic compounds from ME were epicatechin (281.6 mg/100 g DW), procyanidin B2 (243.5 mg/100 g DW), chlorogenic acid (84.2 mg/100 g DW) and quercetin (78.4 mg/100 g DW). The action mechanism of ME against S. aureus could be ascribed to ME damaging cell wall and cell membrane integrity, inhibiting intracellular enzyme activity, increasing reactive oxygen species (ROS), also changing expression of associated genes and then inducing apoptosis of S. aureus. In addition, the antimicrobial activity of ME against S. aureus has also been demonstrated to be efficient in the food matrix (whole milk).

Association between serum progesterone concentration in early pregnancy and duration of pregnancy: a cohort study.

Objective: To examine the association between progesterone concentration in early pregnancy and duration of pregnancy and risk of preterm delivery.Methods: Women enrolled in the Born in Guangzhou Cohort Study from 2013-2014, with a singleton pregnancy, who had serum progesterone measured at least one time between 4 and 10 weeks of gestation were included. The association between progesterone concentration both continuous and as categorical variable (quartile) and the risk of preterm delivery was assessed with Cox proportional hazards regression. Differences of length of gestation in four progesterone concentration quartiles were assessed using the Log-rank test.Results: We studied 1860 mother-newborn pairs. The mean overall progesterone concentration was 65.7 ± 21.3 nmol/L, with mean progesterone concentrations in the four quartiles of 42.4 ± 6.2 nmol/L (n = 463), 56.2 ± 3.3 nmol/L (n = 462), 68.9 ± 4.5 nmol/L (n = 470), and 95.1 ± 15.3 nmol/L (n = 465). There was no significantly difference in duration of gestation in four progesterone concentration groups (p=.511). There was no relation between progesterone level and preterm delivery (adjusted hazard ratio (HR) per 10 nmol/l progesterone level 1.00 (95% confidence interval (CI) 0.90, 1.11)). After adjusting for potential confounders, the HR of any preterm delivery for quartiles 1, 2 and 3 versus the highest quartile of progesterone level (> 77.3 nmol/L) was 1.04 (95% CI 0.52, 2.07), 1.17 (95% CI 0.60, 2.28), and 1.46 (95% CI 0.76, 2.78), respectively. When analysis was done for spontaneous preterm delivery only, also no association with first trimester progesterone was found.Conclusion: Lower first trimester serum progesterone concentration is not associated with reduction of length of gestation or increased risk of preterm delivery.

Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old.

BACKGROUND: Despite the growing epidemic of heart failure (HF), there is limited data available to systematically compare non-cardiac comorbidities in the young-old, old-old, and oldest-old patients hospitalized for HF. The precise differences will add valuable information for better management of HF in elderly patients. METHODS: A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study. Patients were compared among three age groups: (1) young-old: 65 to 74 years, (2) old-old: 75 to 84 years, and (3) oldest-old: ≥85 years. Clinical details of presentation, comorbidities, and prescribed medications were recorded. RESULTS: The mean age was 76.7 years and 12.7% were 85 years or older. Most elderly patients with HF (97.5%) had at least one of the non-cardiac comorbidities. The patterns of common non-cardiac comorbidities were different between the young-old and oldest-old group. The three most common non-cardiac comorbidities were anemia (53.6%), hyperlipidemia (45.9%), and diabetes (42.4%) in the young-old group, while anemia (73.1%), infection (58.2%), and chronic kidney disease (44.0%) in the oldest-old group. Polypharmacy was observed in 93.0% elderly patients with HF. Additionally, 29.2% patients were diagnosed with infection, and 67.0% patients were prescribed antibiotics. However, 60.4% patients were diagnosed with anemia with only 8.9% of them receiving iron repletion. CONCLUSIONS: Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age, and inappropriate medications are very common in elderly patients with HF. Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.