Local Debts on a National Scale

Local governments’ reliance on borrowed money to spur economic development ignites worries Recently proposed Ministry of Finance measures to supervise the financing platforms of local governments and to regulate and avert risks in managing local debts have met with

Research on cognitive load evaluation with subjective method in manual assembly

Subjective scales have different kinds of applicability in diverse fields.This study intends to implement a quantitative approach to determine the applicability of subjective scales in manual as-sembly work and evaluate the cognitive load of assembly workers.A multi-scale research paradigm based on subjective evaluation method is proposed.Three typical task stages are extracted from the process of assembly work.The National Aeronautics and Space Administration Task Load Index(NASA-TLX)scale,PAAS scale and Workload Profile Index Ratings(WP)scale are selected for the design of 3×3 multi-factor mixed experiment.The power spectrum density(PSD)characteris-tics of electroencephalogram(EEG)are utilized to identify the difficulty levels of the three task sta-ges.The relevant indicators of scale applicability are assessed.The results show that in terms of sensitivity,NASA-TLX scale reaches the highest sensitivity(F=999.137,P=0<0.05).In terms of validity,NASA-TLX scale possesses the best concurrent validity(P=0.0255<0.05).In terms of diagnosticity,NASA-TLX scale based on 6 dimensions takes on the best diagnostic performance.In terms of subject acceptability,WP scale performs the worst.According to the analytic hierarchy process(AHP)model,the applicability scores of NASA-TLX scale,PAAS scale and WP scale are determined as 3,2.55 and 1.6714,respectively.Therefore,NASA-TLX scale is regarded as the most suitable subjective evaluation questionnaire for assembly workers,which is also an effective quantitative evaluation method for the cognitive load of assembly workers.

Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke： study protocol for a prospective non-randomized controlled trial

Melatonin and gamma-aminobutyric acid（GABA） have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire（Chinese version）, and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was registered at Clinical Trials.gov, identifier： NCT03202121.

Efficacy of cattle encephalon glycoside and ignotin in patients with acute cerebral infarction: a randomized, double-blind, parallel-group, placebo-controlled study

Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries.However,there is still a need for high-level clinical evidence from large samples to support the use of CEGI.We therefore carried out a prospective,multicenter,randomized,double-blind,parallel-group,placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016.The patients were randomized at a 3:1 ratio into CEGI(n=239;155 male,84 female;61.2±9.2 years old)and placebo(n=80;46 male,34 female;63.2±8.28 years old)groups.All patients were given standard care once daily for 14 days,including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium,both taken orally,and intravenous infusion of 250–500 mL 0.9%sodium chloride containing 40 mg sodium tanshinone IIA sulfonate.Based on conventional treatment,patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water,respectively,in an intravenous drip of 250 mL 0.9%sodium chloride(2 mL/min)once daily for 14 days.According to baseline National Institutes of Health Stroke Scale scores,patients in the two groups were divided into mild and moderate subgroups.Based on the modified Rankin Scale results,the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group,and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment.In the CEGI group,neurological deficits were decreased on days 14 and 90 after treatment,as measured by the National Institutes of Health Stroke Scale and the Barthel Index.Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients.No drug-related adverse events occurred in the CEGI or placebo groups.In conclusion,CEGI may be a safe and effective treatment for acute cerebral infarction patients,especially for moderate stroke patients.This study was approved by the Ethical Committee of Peking University Third Hospital,China(approval No.2013-068-2)on May 20,2013,and registered in the Chinese Clinical Trial Registry(registration No.ChiCTR1800017937).

Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores

Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.

Leukoaraiosis is associated with clinical symptom severity,poor neurological function prognosis and stroke recurrence in mild intracerebral hemorrhage:a prospective multi-center cohort study

Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dysfunction in the brain.In this study,we enrolled 357 patients with mild intracerebral hemorrhage(ICH)from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission,neurological function prognosis at 3 months,and 1-year stroke recurrence.Patients were divided into groups based on Fazekas scale scores:no LA(n=83),mild LA(n=64),moderate LA(n=98)and severe LA(n=112).More severe LA,larger hematoma volume,and higher blood glucose level at admission were associated with more severe neurological deficit.More severe LA,older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months.In addition,moderate-to-severe LA,admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence.These findings suggest that LA severity may be a potential marker of individual ICH vulnerability,which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH.Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols.This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University(approval No.12)on March 10,2011.

A Retrospective Study of Branch Atheromatous Disease： Analyses of Risk Factors and Prognosis

The theory of branch atheromatous disease（BAD） has been commonly underused in clinical practice and research since it was proposed in 1989. In this study, we sought to explore clinical characteristics of its substypes and biomarkers for prognosis of BAD. A total of 176 consecutive patients with BAD were classified into two groups： paramedianpontine artery group（PPA group, n=70） and lenticulostriate artery group（LSA group, n=106）. Bivariate analyses were used to explore the relationship between white matter hyperintensities（WMHs）, National Institutes of Health Stroke Scale（NIHSS） scores and prognosis evaluated by the modified Rank Scale（m RS） at 6th month after stroke. The differences in prevalence of diabetes mellitus and a history of ischemic heart disease were statistically significant between PPA group and LSA group（χ~2=8.255, P=0.004; χ~2=13.402, P〈0.001）. The bivariate analyses demonstrated a positive correlation between NIHSS and poor prognosis in patients with BAD and in the two subtype groups, and a positive correlation between WMHs and poor prognosis in the PPA group. It is concluded that a significantly higher prevalence of diabetes mellitus and a history of ischemic heart disease exist in the PPA group than in the LSA group. In addition, high grades of NIHSS scores imply poor prognosis in patients with BAD and in the two subtype groups. Moreover, WMHs are a positive predictor for poor prognosis in patients in the PPA group.

Efficacy of Guhong injection versus Butylphthalide injection for mild ischemic stroke: A multicenter controlled study

BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke(IS).METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed.The patients were given Guhong injection(experimental group)or Butylphthalide injection(control group).Changes in National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores were observed before treatment and at 1,2,and 3 wk after treatment in each group.The efficacy and safety of Guhong injection for IS were assessed.Other medications taken by the patients were confounding factors for efficacy assessment.These factors were controlled by propensity score matching,and the results were further analyzed based on the matching.RESULTS The marked response rates at three follow-up visits were 64.64%,74.7%,and 66.7%in the experimental group,and 48.26%,45.4%,and 22.2%in the control group.The marked response rates increased significantly in the experimental group compared with the control group(P<0.05).The overall response rate at the first visit(days 7±2)did not differ significantly between the two groups,but differed significantly at the second(days 14±2)and third visits(days 21±3)(P<0.05).The proportion of patients without any symptoms in the experimental group was significant different at the first visit(P<0.05),but not significantly different at the second visit.The two groups showed no significant difference in the baseline distribution of mRS scores.At the first and second visits,the change in mRS scores was-2 and-1 in the experimental and control groups,respectively,which were significantly different(P<0.05).After propensity score matching,the overall response rate and marked response rate were 97.29%and 100%in the experimental group(P>0.05)and 64.0%and 47.7%in the control group(P<0.05)at the first visit,respectively.The decreased NIHSS scores in the two groups were significant different(P<0.05).The overall response rate and marked response rate differed significantly between the two groups at the second visit(P<0.05).There was no significant difference in the incidence of adverse events between the two groups.No severe adverse events occurred in either group.CONCLUSION Guhong injection is safe and more effective than Butylphthalide injection for treatment of IS.

Cell-free mitochondrial DNA quantification in ischemic stroke patients for non-invasive and real-time monitoring of disease status

BACKGROUND Acute ischemic stroke(AIS)is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis,prognosis,and management.This study provides a primitive platform for non-invasive and cost-effective diagnosis and prognosis of patients with AIS using circulating cellfree mitochondrial DNA(cf-mtDNA)quantification and validation.AIM To evaluate the role of cf-mtDNA as s non-invasive,and affordable tool for realtime monitoring and prognosticating AIS patients at disease onset and during treatment.METHODS This study enrolled 88 participants including 44 patients with AIS and 44 healthy controls with almost similar mean age group at stroke onset,and at 24 h and 72 h of treatment.Peripheral blood samples were collected from each study participant and plasma was separated using centrifugation.The cf-mtDNA concentration was quantified using nanodrop reading and validated through real-time quantitative polymerase chain reaction(RT-qPCR)of NADH-ubiquinone oxidoreductase chain 1(ND1)relative transcript expression levels.RESULTS Comparative analysis of cf-mtDNA concentration in patients at disease onset showed significantly increased levels compared to control individuals for both nanodrop reading,as well as ND1 relative expression levels(P<0.0001).Intergroup analysis of cf-mtDNA concentration using nanodrop showed significantly reduced levels in patients at 72 h of treatment compared to onset(P<0.01).However,RT-qPCR analysis showed a significant reduction at 24 h and 72 h of treatment compared to the disease onset(P<0.001).The sensitivity and specificity were relatively higher for RT-qPCR than nanodrop-based cfmtDNA quantification.Correlation analysis of both cf-mtDNA concentration as well as ND1 relative expression with National Institute of Health Stroke Scale score at baseline showed a positive trend.CONCLUSION In summary,quantitative estimation of highly pure cf-mtDNA provides a simple,highly sensitive and specific,non-invasive,and affordable approach for real-time monitoring and prognosticating AIS patients at onset and during treatment.

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients

BACKGROUND In a previous study,basilar artery occlusion(BAO)was shown to lead to death or disability in 80%of the patients.The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy,but not all patients benefit from these treatments.Thus,understanding the predictors of outcome before initiating these treatments is of special interest.AIM To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.METHODS We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019.We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke.A neurologist reviewed every case,and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included.We then analyzed the patients’characteristics and factors related to the 90-d outcome.RESULTS We identified a total of 99 patients as real BAO cases.Of these patients,33(33.3%)had a favorable outcome at 90 d(modified Rankin Scale:0–3).Moreover,72 patients received intra-arterial thrombectomy,while 13 patients received intravenous tissue-type plasminogen activator treatment.We observed a favorable outcome in 33.3%of the cases and an unfavorable outcome in 66.7%of the cases.We found that the initial National Institutes of Health Stroke Scale(NIHSS)score and several BAO symptoms,including impaired consciousness,tetraparesis,and pupillary abnormalities,were significantly associated with an unfavorable outcome(P<0.05),while cerebellar symptoms were associated with a favorable outcome(P<0.05).In the receiver operating characteristic(ROC)analysis,the areas under the ROC curve of initial NIHSS score,impaired consciousness,tetraparesis,cerebellar symptoms,and pupillary abnormalities were 0.836,0.644,0.727,0.614,and 0.614,respectively.Initial NIHSS score showed a higher AUROC(0.836)compared to BAO symptoms.CONCLUSION The most important predictor of an unfavorable outcome was the initial NIHSS score.BAO symptoms,including tetraparesis,impaired consciousness,and pupillary abnormality were also related to an unfavorable outcome.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

中亚五国综合城镇化水平及其动力因素

In the context of accelerated development of the Silk Road Economic Belt,it is necessary to conduct in-depth research on urbanization of Central Asian countries.This paper analyzes the spatial and temporal patterns and evolution dynamics of urbanization during the period 1991-2017 from the perspective of internal-external forces.The results are as follows.(1)The urbanization process of the five Central Asian countries studied is significantly influenced by their political and economic situations and displays periodic characteristics.All five countries experienced a stagnation development stage at the beginning of independence,and then a rapid growth stage since the year 2000.The average annual growth rates of the two stages were 0.19% and 1.45%,respectively.(2)Differences in the urbanization of the studied countries are obvious,and the evolutionary characteristics of each subsystem of urbanization are different.It is therefore necessary to distinguish and clearly understand the urbanization process of each country.(3)Internal and external factors play a role in the urbanization processes of Central Asian countries.External railway transportation facilities are particularly important for the development of urbanization in these countries.The regression coefficients of railway construction length,total merchandise trade and actually utilized foreign capital are 0.5665,0.0937 and 0.0806,respectively.(4)Countries with smaller populations and economic scales need to engage in international cooperation to promote healthy development of urbanization.The results of the study indicate that internal and external factors work together in the urbanization process of Central Asian countries,and external forces are particularly important for the development of such urbanization.

Upscaling the use of fallout radionuclides in soil erosion and sediment budget investigations:Addressing the challenge

The application of fallout radionuclides in soil erosion investigations and related sediment budget studies has provided a widely used tool for improving understanding of soil erosion and sediment transfer processes.However,most studies using fallout radionuclides undertaken to date have focussed on small areas.This focus on small areas reflects both the issues addressed and practical constraints associated with sample collection and analysis.Increasing acceptance of the important role of fine sediment in degrading aquatic habitats and in the transfer and fate of nutrients and contaminants within terrestrial and fluvial systems has emphasised the need to consider larger areas and the catchment or regional scale.The need to upscale existing approaches to the use of fallout radionuclides to larger areas represents an important challenge.This contribution provides a brief review of existing and potential approaches to upscaling the use of fallout radionuclides and presents two examples where such approaches have been successfully applied.These involve a national scale assessment of soil erosion rates in England and Wales based on 137Cs measurements and an investigation of the sediment budgets of three small/intermediate-size catchments in southern Italy.