Abstract We aimed to develop a prognostic model for primary pontine hemorrhage (PPH) patients and validate the predictive value of the model for a good prognosis at 90 days. A total of 254 PPH patients were included for screening of the independent predictors of prognosis, and data were analyzed by univariate and multivariable logistic regression tests. The cases were then divided into training cohort (n=219) and validation cohort (n=35) based on the two centers. A nomogram was developed using independent predictors from the training cohort to predict the 90-day good outcome and was validated from the validation cohort. Glasgow Coma Scale score, normalized pixels (used to describe bleeding volume), and mechanical ventilation were significant predictors of a good outcome of PPH at 90 days in the training cohort (all P<0.05). The U test showed no statistical difference (P=0.892) between the training cohort and the validation cohort, suggesting the model fitted well. The new model showed good discrimination (area under the curve=0.833). The decision curve analysis of the nomogram of the training cohort indicated a great net benefit. The PPH nomogram comprising the Glasgow Coma Scale score, normalized pixels, and mechanical ventilation may facilitate predicting a 90-day good outcome. (PPH 9 25 tests n=219 n219 n 219 (n=219 n=35 n35 35 (n=35 centers 90day day score used volume, volume , volume) all P<0.05. P005 P P<0.05 . 0 05 P<0.05) P=0.892 P0892 892 (P=0.892 well area curve=0.833. curve0833 curve=0.833 833 curve=0.833) benefit 2 n=21 n21 21 (n=21 n=3 n3 3 (n=3 P00 P<0.0 P=0.89 P089 89 (P=0.89 curve083 curve=0.83 83 n=2 n2 (n=2 n= (n= P0 P<0. P=0.8 P08 8 (P=0.8 curve08 curve=0.8 (n P<0 P=0. (P=0. curve0 curve=0. P< P=0 (P=0 curve=0 P= (P= curve= (P

Abstract Aroma differences are generally sensed in white- and red-fleshed loquats. Here, volatile compounds in four white- and three red-fleshed loquat varieties were investigated by headspace solid-phase microextraction and combined analysis of electronic nose (e-nose) and gas chromatography-mass spectrometry (GC-MS). In total, 83 volatile compounds were identified, and 33 were common in all of the cultivars. D-limonene, hexanal, (E)-2-hexenal, octanal and nonanal were the most abundant volatile compounds. β-cyclocitral and β-ionone were only detected in red-fleshed varieties. Furthermore, Huayu Seedless 1 (triploid white-fleshed loquats) with low levels of terpenoid compounds detected by GC-MS were clearly differentiated from the other cultivars tested by principal component analysis (PCA), which was consistent with the e-nose results. PCA analysis showed that Huabai 1(white flesh cultivar)had a prominent volatile profile characterized by higher concentrations of C6 aldehydes and alcohols, (E)-2-hexanal, (Z)-3-hexenal and hexanal, (Z)-3-hexenol, (E)-2-hexenol and hexanol. In comparison with red-fleshed loquats, white-fleshed loquats were characterized by high aldehydes content. These volatile compounds served to recognize and classify all of the analysed varieties.

ABSTRACT A new saurolophine hadrosaurid, Laiyangosaurus youngi gen. et sp. nov. is described and phylogenetically analyzed based on several cranial elements from the Jingangkou Formation, Wangshi Group, Upper Cretaceous of Laiyang, Shandong, China. Laiyangosaurus youngi differs from other members of the saurolophine clade on the basis of a number of autapomorphies, including a prominent and narrow ridge on the lateral side of the nasal which forms the posterodorsal and posterior margin of the circumnasal depression, a primary ridge that runs along most of the maxillary tooth row that is slightly deflected posteriorly, a retroarticular process of the surangular that is dorsolateroposteriorlly recurved, and orbital margins that are wider than the infratemporal margins of the jugal. This new taxon can be further distinguished by a number of unique combination of characters, including dorsal margin of nasal is flat, absence supracranial crest, a relatively shallow and rostrodorsally directed caudal margin of the lacrimal process of the jugal, and one or more foramina present on the rostral surface of the premaxilla. A phylogenetic analysis indicates that L. youngi comprises a monophyletic clade, which is known as Edmontosaurini.

ABSTRACT PURPOSE: To investigate the effect of curcumin on visfatin and zinc-α2-glycoprotein (ZAG) expression levels in rats with non-alcoholic fatty liver disease (NAFLD). METHODS: Fifty-six male rats were randomly divided into a control group (n=16) and model group (n=40) and were fed on a normal diet or a high-fat diet, respectively. Equal volumes of sodium carboxymethyl cellulose (CMC) were intragastrically administered to the control group for 4 weeks. At the end of the 12th week, visfatin and ZAG protein expression levels were examined by immunohistochemistry. Visfatin mRNA levels were measured by semi-quantitative reverse transcription polymerase chain reaction. RESULTS: Compared with the control group, the model group showed significantly increased expression of visfatin in liver tissue (P < 0.01) and significantly decreased expression of ZAG (P < 0.01). These effects were ameliorated by curcumin treatment. CONCLUSIONS: Visfatin and zinc-α2-glycoprotein may be involved in the pathogenesis of NAFLD. Treatment of NAFLD in rats by curcumin may be mediated by the decrease of visfatin and the increase of non-alcoholic fatty liver disease.

A contraparte de um espécime anteriormente descrito, contendo uma fêmea de pterossauro não-pterodactiloide com um ovo, revela a existência de um segundo ovo, este situado dentro da cavidade corporal desta fêmea prenhe. O exemplar demonstra claramente que os pterossauros possuíam dois ovidutos funcionais, e evidencia que a redução de um oviduto não foi um pré-requisito para o desenvolvimento do voo ativo pelo menos neste grupo. A análise da composição de um dos ovos sugere a ausência de uma camada externa formada por carbonato de cálcio. Seções histológicas de um fêmur não registram osso medular e demonstram que este pterossauro atingiu maturidade reprodutiva antes da maturidade óssea. O presente estudo evidencia que os pterossauros punham ovos de tamanho ainda menor do que se supunha e que desenvolveram uma estratégia reprodutiva mais similar a dos répteis basais do que a das aves. Se pterossauros eram altamente precociais ou necessitavam de cuidado parental ainda está aberto à discussão.

The counterpart of a previously described non-pterodactyloid pterosaur with an egg revealed the presence of a second egg inside the body cavity of this gravid female. It clearly shows that pterosaurs had two functional oviducts and demonstrates that the reduction of one oviduct was not a prerequisite for developing powered flight, at least in this group. Compositional analysis of one egg suggests the lack of a hard external layer of calcium carbonate. Histological sections of one femur lack medullary bone and further demonstrate that this pterosaur reached reproductive maturity before skeletal maturity. This study shows that pterosaurs laid eggs even smaller than previously thought and had a reproductive strategy more similar to basal reptiles than to birds. Whether pterosaurs were highly precocial or needed parental care is still open to debate.

OBJECTIVE: In gracilis functioning free muscle transplantation, the limited caliber of the dominant vascular pedicle increases the complexity of the anastomosis and the risk of vascular compromise. The purpose of this study was to characterize the results of using a T-shaped vascular pedicle for flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury. METHODS: The outcomes of patients with brachial plexus injury who received gracilis functioning free muscle transplantation with either conventional end-to-end anastomosis or flow-through anastomosis from 2005 to 2013 were retrospectively compared. In the flow-through group, the pedicle comprised a segment of the profunda femoris and the nutrient artery of the gracilis. The recipient artery was interposed by the T-shaped pedicle. RESULTS: A total of 46 patients received flow-through anastomosis, and 25 patients received conventional end-to-end anastomosis. The surgical time was similar between the groups. The diameter of the arterial anastomosis in the flow-through group was significantly larger than that in the end-to-end group (3.87 mm vs. 2.06 mm, respectively, p<0.001), and there were significantly fewer cases of vascular compromise in the flow-through group (2 [4.35%] vs. 6 [24%], respectively, p=0.019). All flaps in the flow-through group survived, whereas 2 in the end-to-end group failed. Minimal donor-site morbidity was noted in both groups. CONCLUSIONS: Flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury can decrease the complexity of anastomosis, reduce the risk of flap loss, and allow for more variation in muscle placement.

Objectives: Men who have sex with men are at risk of tenofovir nephrotoxicity due to its wide use in both treatment and prophylaxis for human immunodeficiency virus infection, but little is known about the urinary biomarkers of early renal dysfunction in this population. This study aims to identify useful biomarkers of early renal dysfunction among human immunodeficiency virus-infected men who have sex with men exposed to tenofovir.Methods: In a cross-sectional study urinary alpha1-microglobulin, beta2-microglobulin, N-acetyl-B-n-glucosaminidase and albumin were measured and expressed as the ratio-to-creatinine in 239 human immunodeficiency virus-infected men who have sex with men who were treatment naïve or receiving antiretroviral therapy with tenofovir-containing or non-tenofovir-containing regimens. Additionally, 56 patients in the non-antiretroviral therapy group started a tenofovir-containing regimen and were assessed after 3 and 6 months on antiretroviral therapy.Results: Both the frequency of alpha1-microglobulin proteinuria (alpha1-microglobulin-creatinine ratio >25.8 mg/g) and the median urinary alpha1-microglobulin-creatinine ratio were higher in the tenofovir disoproxil fumarate group than the other two groups (all p< 0.05). A higher frequency of beta2-microglobulin proteinuria (beta2-microglobulin-creatinine ratio >0.68 mg/g) was also observed in the tenofovir group (28.9%) compared to the non-tenofovir group (13.6%, p= 0.024). There were no significant differences between groups for N-acetyl-β-n-glucosaminidase and albumin. In the longitudinal study, the median urinary alphat-microglobulin-creatinine ratio after 3 and 6 months on tenofovir-containing therapy (16.8 and 17.3 mg/g) was higher than baseline (12.3 mg/g, p= 0.023 and 0.011, respectively), while no statistically important changes were observed in urinary beta2-microglobulin-creatinine ratio or in the other biomarkers after 3 and 6 months on antiretroviral therapy (all p> 0.05).Conclusion: Urinary alphat-microglobulin seems to be a more sensitive and stable indicator of tubular dysfunction than urinary beta2-microglobulin for assessing tenofovir-related nephrotoxicity and can be significantly altered after tenofovir exposure.

摘要目的 旨在评估初级医疗质量在中国实行卫生系统改革的两个特大城市中发生的变化。方法 我们针对 2011 年和 2013 年在上海以及 2012 年和 2013 年在深圳就诊于社区卫生中心的患者开展了一项多阶段、分层、随机式的面对面调查。通过评估工具对初级医疗的质量进行了衡量。基于多元线性回归的双重差分法分析用于对比在控制了潜在的混杂因素后,一段时间内发生的变化。结果 3214 名参与者中的大多数人 (2721) 都将社区卫生中心作为自己常规就诊的医疗机构,这些都包括在我们的分析中。上海和深圳的初级医疗质量的总均分在基准值上很相似。在深圳,所有参与者和低收入人群的总均分已分别降低了 0.922(95% CI:0.629 至 1.215)和 1.203(95% CI:0.397 至 2.009)。然而在上海,总均分却有所提高,这种情况包括在第一线就诊渠道利用率、持续性、信息协调性和全面性方面的分值提高。结论上海的初级医疗质量有所提高,而深圳并非如此。这可能是因为,在上海实行按人头付费并依据当地卫生工作重点提供服务,促使患者与全科医生之间保持长期有益的关系。

RésuméObjectif Évaluer les changements dans la qualité des soins de santé primaires, dans deux mégapoles chinoises, après l'introduction de réformes dans le système de santé en Chine.Méthodes Nous avons réalisé des enquêtes en face à face aléatoires stratifiées à plusieurs degrés auprès des patients des centres de santé communautaires de Shanghai en 2011 et 2013 et de Shenzhen en 2012 et 2013. La qualité des soins de santé primaires a été mesurée à l'aide d'un outil d'évaluation. Des analyses de l'écart des différences basées sur des régressions linéaires multiples ont été réalisées afin de comparer les changements survenus au fil du temps, après contrôle des facteurs de confusion potentiels.Résultats Sur les 3 214 participants, la majorité (2 721 personnes) a indiqué fréquenter régulièrement le centre de santé communautaire et a été incluse dans notre analyse. Au départ, les scores totaux moyens attribués à la qualité des soins primaires ont été similaires à Shanghai et à Shenzhen. À Shenzhen, les scores totaux moyens attribués par tous les participants et par les participants à faible revenu ont respectivement baissé de 0,922 (IC 95 % : de 0,629 à 1,215) et de 1,203 (IC 95% : de 0,397 à 2,009). À Shanghai, en revanche, les scores totaux moyens ont progressé, notamment avec l'amélioration des scores associés aux critères " utilisation de premier recours ", " continuité ", " coordination de l'information " et " exhaustivité ".Conclusion La qualité des soins primaires s'est améliorée à Shanghai mais pas à Shenzhen. Cela est peut-être lié au fait qu'à Shanghai, les relations bénéfiques de longue date instaurées entre les patients et les généralistes ont été soutenues par des paiements par capitation et par la fourniture de services adaptés aux priorités de santé locales.

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AbstractObjective To assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China.Methods We conducted multistage stratified random face-to-face surveys of patients visiting community health centres in Shanghai in 2011 and 2013, and Shenzhen in 2012 and 2013. Quality of primary care was measured using an assessment tool. Difference-in-difference analyses based on multiple linear regressions were used to compare the changes over time, after controlling for potential confounders.Findings Most (2721) of the 3214 participants used a community health centre as their regular source of care and were included in our analyses. The mean total scores for quality of primary care were similar for Shanghai and Shenzhen at baseline. In Shenzhen, the mean total scores for all participants and those on low incomes had worsened by 0.922 (95% CI: 0.629 to 1.215) and 1.203 (95% CI: 0.397 to 2.009), respectively. In Shanghai, however, there were improvements in the mean total scores which included increases in the scores for first-contact utilization, continuity, coordination of information and comprehensiveness.Conclusion The quality of primary care improved in Shanghai but not in Shenzhen. This may be because, in Shanghai, beneficial long-term relationships between patients and general practitioners were supported by capitation payments and the provision of services tailored to the local health priorities.

ملخصالغرض تقييم التغيرات في جودة الرعاية الصحية الأولية في اثنتين من المدن الكبرى في أعقاب إدخال إصلاحات على النظام الصحي في الصين.الطريقة أجرينا مسوحات عشوائية متطبِّقة متعددة المراحل وجهًا لوجه للمرضى الذين يترددون على المراكز الصحية المجتمعية في شانغهاي في عاميّ 2011 و2013، وشنجن في عاميّ 2012 و2013. وقد تم قياس جودة الرعاية الصحية الأولية باستخدام أداة للتقييم. تم استخدام أسلوب الاختلافات في الفارق المستند إلى التحوفات الخطية المتعددة لمقارنة التغيرات بمرور الوقت، بعد ضبط المتغيرات المحيّرة المحتملة.النتائج استخدم معظم المشاركين البالغ عددهم (2721) من أصل 3214 مشاركًا المراكز الصحية المجتمعية كمصدر منتظم للرعاية وتم تضمينهم في التحليل الذي أجريناه. وكانت الأحراز الكلية الوسطية لجودة الرعاية الصحية الأولية مشابهة لشانغهاي وشنجن عند خط الأساس. في شنجن، ساءت متوسط الأحراز الكلية لجميع المشاركين والأشخاص ذوي الدخل المنخفض بنسبة تبلغ 0.922 (بنسبة أرجحية مقدارها 95%: 0.629 إلى 1.215) و1.203 (بنسبة أرجحية مقدارها 95%: 0.397 إلى 2.009)، على التوالي. أما في شانغهاي، فقد كانت هناك تحسينات في متوسط الأحراز الكلية والتي تضمنت زيادات في أحراز الانتفاع للاتصال الأول، والاستمرارية، وتنسيق المعلومات وشموليتها.الاستنتاج لقد تحسنت جودة الرعاية الصحية الأولية في شانغهاي لكنها لم تتحسن في شنجن. ويمكن تفسير ذلك بأنه في شنغهاي، تم دعم علاقات مفيدة طويلة الأمد بين المرضى والممارسين العموميين من خلال دفع الأجرة على الفرد وتوفير خدمات توضع تبعًا لأولويات الصحة المحلية.

ResumenObjetivo Evaluar los cambios en la calidad de la atención primaria en dos megaciudades tras la introducción de las reformas del sistema sanitario en China.Métodos Se llevaron a cabo encuestas cara a cara aleatorias y estratificadas en varias etapas a pacientes que visitaron los centros sanitarios comunitarios de Shanghai en 2011 y 2013 y de Shenzhen en 2012 y 2013. La calidad de la atención primaria se midió utilizando una herramienta de evaluación. Los análisis de diferencias en diferencias basados en regresiones lineales múltiples se utilizaron para comparar los cambios a lo largo del tiempo tras haber controlado los posibles factores de confusión.Resultados La mayoría (2.721) de los 3.214 participantes utilizaban un centro sanitario comunitario como su fuente regular de atención primaria y fueron incluidos en nuestros análisis. Las puntuaciones medias totales de la calidad de la atención primaria eran similares para Shanghai y Shenzhen al inicio del estudio. En Shenzhen, las puntuaciones medias totales de todos los participantes y de aquellos con bajos ingresos había empeorado en un 0,922 (IC del 95%: de 0,629 a 1,215) y un 1,203 (IC del 95: de 0,397 a 2,009), respectivamente. Sin embargo, en Shanghai hubo mejoras en las puntuaciones medias totales, incluidos incrementos en las puntuaciones de la utilización de primer contacto, la continuidad, la coordinación de la información y la exhaustividad.Conclusión La calidad de la atención primaria mejoró en Shanghai pero no en Shenzhen. Esto se puede deber a que en Shanghai, las relaciones beneficiosas a largo plazo entre los pacientes y los médicos generales estaban respaldadas por pagos de capitación y la prestación de servicios adaptados a las prioridades sanitarias locales.