High epicuticular wax(Ewax)content on leaves is a key trait for drought and heat stress tolerance in plants.One hundred diverse rice germplasm lines from the 3K-IRRI collection were screened for leaf Ewax content unde...High epicuticular wax(Ewax)content on leaves is a key trait for drought and heat stress tolerance in plants.One hundred diverse rice germplasm lines from the 3K-IRRI collection were screened for leaf Ewax content under open field conditions during the monsoon season of 2023,and for their nocturnal transpiration during the summer season of 2024.Using a novel drought-simulator phenomics platform,we identified a balance between cuticular and stomatal transpiration at night,with wax modulating these processes under varying night temperatures.展开更多
This editorial explores the significant cardiometabolic outcomes of nocturnal sentry duty and its broader implications for other professions with overnight work.Highlighting the paradox of essential nighttime labor an...This editorial explores the significant cardiometabolic outcomes of nocturnal sentry duty and its broader implications for other professions with overnight work.Highlighting the paradox of essential nighttime labor and its adverse physiological effects,we discuss how occupations like healthcare,hospitality,and emergency services are similarly affected.The study by Lin et al provides critical insights into these dynamics and lays the groundwork for understanding nocturnal duty’s multifaceted impact on human health.展开更多
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemo-lytic disease in which there is a stem cell disorder of clonal nature. Previous studies have demonstrated that the numbers of burst-forming units-erythroid...Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemo-lytic disease in which there is a stem cell disorder of clonal nature. Previous studies have demonstrated that the numbers of burst-forming units-erythroid (BFU-E) and colony-forming units-granulocyte / macrophage (CFU-GM) from bone marrow of PNH patients growing in the medium containing PHA-LCM from the normai donors were more reduced than those of normai bone marrow. The purpose of present study was to investigate if PNH lymphocytes are defective in supporting hematopoiesis in vitro. PHA-LCM from PNH blood was added to the culture medium for the growth of PNH and normai BFU-E and CFU-GM. The numbers of PNH bone marrow BFU-E and CFU-GM in the medium containing PHA-LCM from PNH blood were less than those from normai blood; the numbers of normai bone marrow BFU-E and CFU-GM grown in the medium containing PHA-LCM from PNH blood were more decreased than those from normai blood. The results suggest that diminished numbers of PNH bone marrovv BFU-展开更多
AIM:To investigate the incidence of nocturnal dyspeptic symptoms in patients with functional dyspepsia(FD) and whether prokinetic drugs can alleviate them. METHODS:Eighty-five consecutive Chinese patients with FD were...AIM:To investigate the incidence of nocturnal dyspeptic symptoms in patients with functional dyspepsia(FD) and whether prokinetic drugs can alleviate them. METHODS:Eighty-five consecutive Chinese patients with FD were included in this study.One week after single-blinded placebo run-in treatment,baseline nocturnal intragastric pH,bile reflux and nocturnal dyspeptic symptoms of eligible patients,including epigastric pain or discomfort,abdominal distention and belching, were investigated with questionnaires.Patients exhibiting nocturnal dyspeptic symptoms were randomly and double-blindly assigned to domperidone group or placebo group.Nocturnal intragastric pH and percentage of duodenogastric bile reflux time were determined after treatment. RESULTS:Of the 85 FD patients,2 females withoutnocturnal symptoms,who responded to placebo run-in treatment,were excluded from the study,30(36.1%) exhibited nocturnal dyspeptic symptoms with increased duodenogastric bile reflux time(intragastric bilirubin absorbance>0.14)and mean gastric pH(confirming the existence of bile reflux)(P=0.021,0.023) at night were included in the study.Of these 30 patients,21(70%)had overt nocturnal duodenogastric bile reflux,which was significantly higher than that of those without nocturnal symptoms(P=0.026).The 30 patients were allocated to domperidone group or placebo group(n=15).The nocturnal duodenogastric bile reflux and gastric pH were significantly decreased after domperidone treatment(P=0.015,0.021).The severity score of nocturnal dyspeptic symptoms was also significantly decreased after domperidone treatment (P=0.010,0.015,0.026),which was positively correlated with the reduced nocturnal bile reflux or gastric pH(r=0.736,0.784,0.753 or r=0.679,0.715,0.697, P=0.039,0.036,0.037 or P=0.043,0.039,0.040). CONCLUSION:A subgroup of Chinese FD patients show overt nocturnal dyspeptic symptoms,which may be correlated with the excessive nocturnal duodenogastric bile reflux.Domperidone therapy can alleviate these symptoms.展开更多
The diurnal variation of precipitation over the Dabie Mountains(DBM) in eastern China during the 2013 mei-yu season is investigated with forecasts of a regional convection-permitting model. Simulated precipitation is ...The diurnal variation of precipitation over the Dabie Mountains(DBM) in eastern China during the 2013 mei-yu season is investigated with forecasts of a regional convection-permitting model. Simulated precipitation is verified against surface rain-gauge observations. The observed morning precipitation peak on the windward(relative to the prevailing synoptic-scale wind) side of the DBM is reproduced with good spatial and temporal accuracy. The interaction between the DBM and a nocturnal boundary layer low-level jet(BLJ) due to the inertial oscillation mechanism is shown to be responsible for this precipitation peak. The BLJ is aligned with the lower-level southwesterly synoptic-scale flow that carries abundant moisture.The BLJ core is established at around 0200 LST upwind of the mountains. It moves towards the DBM and reaches maximum intensity at about 70 km ahead of the mountains. When the BLJ impinges upon the windward side of the DBM in the early morning, mechanical lifting of moist air leads to condensation and subsequent precipitation.展开更多
Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychi...Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.展开更多
Objective:To detect the CHRNA7 gene mutation and polymorphism in Southern Han Chinese patients with nocturnal frontal lobe epilepsy(NFLE).Methods:Blood samples were collected from 215 Southern Han Chinese patients wit...Objective:To detect the CHRNA7 gene mutation and polymorphism in Southern Han Chinese patients with nocturnal frontal lobe epilepsy(NFLE).Methods:Blood samples were collected from 215 Southern Han Chinese patients with NFLE and 200 healthy Southern Han Chinese control subjects.Genomic DNA was extracted,and CHRNA7 whole genome exons were amplified by the polymerase chain reaction and subjected to Sanger sequencing.Results:No CHRNA7 gene mutation was detected in all of the NFLE patients.However,five single nucleotide polymorphisms(SNPs)in sporadic cases were found,located in exons 5,6.and 7 of the CHRNA7 gene.Among them,c.690G>A and c.698A>G are known SNPs,while c.370G>A,c.654C>T,and c.497-498delTG were newly discovered SNPs.These SNPs were also found in some of the healthy controls.Conclusions:No CHRNA7 gene mutation was identified in Southern Han Chinese patients with NFLE.The CHRNA7 gene is probably not responsible for NFLE in this population.展开更多
The possible relationship between lung cancer and nocturnal intermittent hypoxia,apnea and daytime sleepiness,especially the possible relationship between the occurrence and progression of lung cancer and obstructive ...The possible relationship between lung cancer and nocturnal intermittent hypoxia,apnea and daytime sleepiness,especially the possible relationship between the occurrence and progression of lung cancer and obstructive sleep apnea syndrome (OSAS) was explored.Forty-five cases of primary lung cancer suitable for surgical resection at the Third Affiliated Hospital of Kunming Medical University between January 2017 and December 2017 were recruited (lung cancer group),and there were 45 patients in the control group who had no significant differences in age,sex and other general data from lung cancer group.The analyzed covariates included general situation,snore score,the Epworth Sleeping Scale (ESS),Pittsburgh Sleep Quality Index (PSQI),apnea and hypopneas index (AHI),oxygen desaturation index 4 (ODk),lowest arterial oxygen saturation [LSpCh (%)],oxygen below 90% of the time [T90%(min)],the percentage of the total recorded time spend below 90% oxygen saturation (TS90%),to explore the possible relationship between lung cancer and above indicators.The participants were followed up for one year.The results showed that:(1) There was significant difference in body mass index (BMI),ESS,AHI,T90%(min),TS90%,ODh,snore score and LSpCh (%) between lung cancer group and control group (P<0.05).There was no statistically significant difference in age,gender,PSQI score,incidence of concurrent hypertension,diabetes and coronary heart disease (CHD),and smoking history between the two groups (P>0.05);(2) Patients in the lung cancer group were divided into OSAS subgroup and non- OSAS subgroup according to the international standard for the diagnosis of OSAS.There was significant difference in BMI,age,staging,incidence of concurrent hypertension and concurrent CHD,snore score,ESS score,T90%(min),TS90%,ODh and LSpCh (%) between OSAS subgroup and non-OSAS subgroup (P<0.05).There was no statistically significant difference in gender,PSQI score,incidence of concurrent diabetes,smoking history and lung cancer type between the two groups (P>0.05);(3) AHI was strongly negatively correlated with the LSpCh (%) and positively with ESS,staging,snoring score,T90%(min),TS90%,ODh and BMI (P<0.05);(4) There were 3 deaths,5 cases of recurrence,and 4 cases of metastasis in OSAS subgroup;and there was 1 death,4 cases of recurrence and 2 cases of metastasis in non-OSAS subgroup during the follow-up period of one year,respectively.There was no significant difference in mortality,recurrence rate and metastasis rate between the two subgroups,and the total rate of deterioration in OSAS subgroup was significantly increased compared to the non-OSAS subgroup (P<0.05).It was concluded that the patients with lung cancer are prone to nocturnal hypoxemia,apnea,snoring and daytime sleepiness compared to control group.The incidence of OSAS in patients with lung cancer was higher,and the difference in the hypoxemia-related indicators was statistically significant.The mortality,recurrence rate,and metastasis rate increases in lung cancer patients with OSAS during the one-year follow-up period,suggesting that OSAS may be a contributing factor to the occurrence and progression of lung cancer.展开更多
Previous studies suggested that pigs prefer lower environmental temperatures during nighttime compared to daytime. So reducing nocturnal temperature in nursery barns may not jeopardize performance or welfare of pigs, ...Previous studies suggested that pigs prefer lower environmental temperatures during nighttime compared to daytime. So reducing nocturnal temperature in nursery barns may not jeopardize performance or welfare of pigs, but can save energy for heating the barn. A study was conducted to investigate growth performance and behavioral response of nursery pigs to reduced nocturnal temperature. This study was conducted in four replicates, each utilizing 270 newly weaned pigs and lasting for 5 wk. Temperature setpoint in the control room （CON） was started at 30℃ and decreased by 2℃ per week. In the treatment room （RNT）, temperature setpoint was maintained same as in CON between 7：00 h and 19：00 h, and reduced by 8~C between 19：00 h and 7：00 h starting from d 5. Growth performance （15 pens/room, 9 pigs/pen, BW=（6.3±0.61） kg） was monitored for 5 wk, and behaviors in 6 pens in each room were video-recorded for 24 h 3 d after being exposed to the experimental temperature. Instantaneous scan sampling was performed to determine time budgets for standing, sitting, eating, drinking, belly nosing, three postures of lying, and huddling. Two focal pigs were continuously viewed to record duration and occurrence of eating and drinking. Reduced nocturnal temperature did not affect the growth performance of the pigs, time spent standing, sitting, total lying and eating or duration and frequencies of eating and drinking （all P〉0.10）. However, RNT increased time spent lying sternal （83 vs. 72%, P〈0.001） and number of pigs that were huddling （70 vs. 50% of lying pigs, P〈0.001）, and decreased time spent lying laterally （0.8 vs. 4.6%, P〈0.001）, lying half laterally （5.3 vs. 11.0%, P〈0.001）, and belly nosing （0.9 vs. 1.7%, P=0.01） during nighttime. These results indicate that nursery pigs adopted the posture of lying sternal and huddled together to reduce heat loss from their body surface to maintain thermal balance and growth performance in RNT. Such mild reduction in nocturnal temperature in the nursery barn can save energy for heating the barn without negative effects on performance and behavior of nursery pigs.展开更多
Multiple measurements of nocturnal penile tumescence and rigidity(NPTR)are widely accepted as a method to differentiate psychogenic erectile dysfunction(ED)from organic ED.However,direct evidence remains limited regar...Multiple measurements of nocturnal penile tumescence and rigidity(NPTR)are widely accepted as a method to differentiate psychogenic erectile dysfunction(ED)from organic ED.However,direct evidence remains limited regarding the first-night effect on NPTR measurement using the RigiScan.Here,we evaluated the first-night effect on the results of NPTR measurement to validate the necessity of NPTR measurement for two consecutive nights,particularly when abnormal first-night measurements are recorded in a laboratory setting.We retrospectively reviewed 105 patients with a complaint of ED,who underwent NPTR measurement using the RigiScan in the Department of Infertility and Sexual Medicine,the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China),for two consecutive nights,during the period from November 2015 to May 2016.NPTR parameters were collected and analyzed.We found that more effective nocturnal erections were detected during the second night than during the first night(P<0.001).Twenty percent of all patients had no effective erection during the first night,but exhibited at least one effective erection during the second night.The negative predictive value of NPTR measurement during the first night was 43.2%;this was significantly lower than that on the second night(84.2%;P=0.003).Most NPTR parameters were better on the second night than on the first night.The first-night effect might be greater among patients younger than 40 years of age.In conclusion,two consecutive nightly measurements of NPTR can avoid a false-abnormal result caused by the first-night effect;moreover,these measurements more accurately reflect erectile capacity,especially when the first-night record is abnormal in a laboratory setting.展开更多
Owls have the potential to be keystone species for conservation in fragmented landscapes, as the absence of these predators could profoundly change community structure. Yet few studies have examined how whole communit...Owls have the potential to be keystone species for conservation in fragmented landscapes, as the absence of these predators could profoundly change community structure. Yet few studies have examined how whole communities of owls respond to fragmentation, especially in the tropics. When evaluating the effect of factors related to fragmentation, such as fragment area and distance to the edge, on these birds, it is also important in heterogeneous landscapes to ask how ＇location factors＇ such as the topography, vegetation and soil of the fragment predict their persistence. In Xishuangbanna, southwest China, we established 43 transects （200 mx60 m） within 20 forest fragments to sample nocturnal birds, both visually and aurally. We used a multimodel inference approach to identify the factors that influence owl species richness, and generalized linear mixed models to predict the occurrence probabilities of each species. We found that fragmentation factors dominated location factors, with larger fragments having more species, and four of eight species were significantly more likely to occur in large fragments. Given the potential importance of these birds on regulating small mammal and other animal populations, and thus indirectly affecting seed dispersal, we suggest further protection of large f ragments and programs to increase their connectivity to the remaining smaller fragments.展开更多
BACKGROUND Idiopathic non-cirrhotic portal hypertension(INCPH)is mainly associated with thrombophilia in Western countries.Paroxysmal nocturnal hemoglobinuria(PNH)is a rare hematologic disease that manifests with hemo...BACKGROUND Idiopathic non-cirrhotic portal hypertension(INCPH)is mainly associated with thrombophilia in Western countries.Paroxysmal nocturnal hemoglobinuria(PNH)is a rare hematologic disease that manifests with hemolytic anemia,thrombosis,and peripheral blood cytopenias.Portal and hepatic venous thrombosis were reported in PNH.A rare case of INCPH complicating PNH is described.CASE SUMMARY A 63-year old woman with a 2-year past medical history of PNH without treatment was admitted because of jaundice and refractory ascites requiring large volume paracentesis.Liver histology revealed portal venopathy with portal fibrosis and sclerosis,nodular regenerative hyperplasia,parenchymal ischemic changes,and focal sinusoidal and perivenular fibrosis without bridging fibrosis or cirrhosis,all indicative of INCPH.The flow cytometry confirmed PNH diagnosis and eculizumab treatment was initiated.Her condition was improved gradually,bilirubin was normalized 6 months following initiation of eculizumab,and 1 year later diuretics were stopped.CONCLUSION Eculizumab improved intravascular hemolysis and reversed clinical manifestations of INCPH in a patient with paroxysmal nocturnal hemoglobinuria.展开更多
Background: Guidelines for patients treated with conventional hemodialysis patients have been written for target serum levels for calcium (Ca), phosphate (PO4) and intact parathyroid hormone (iPTH). No guidelines exis...Background: Guidelines for patients treated with conventional hemodialysis patients have been written for target serum levels for calcium (Ca), phosphate (PO4) and intact parathyroid hormone (iPTH). No guidelines exist for nocturnal home hemodialysis (NHHD) patients for target values or timing of the blood sample draw. We undertook a prospective cohort study to examine the variability in pre, post and clinic (post-post) serum values for Ca, PO4, and iPTH in NHHD patients to determine if timing of blood draw could affect clinical decisions. Methods: Twenty prevalent NHHD patients collected blood pre and post their usual NHHD session with an additional blood sample drawn in clinic (post-post). Median and interquartile range of pre, post and clinic (post-post) values of iPTH, PO4 and Ca were calculated and compared with Freidman/Wilcoxon test. Serum concentrations were also categorized according to Canadian Society of Nephrology (CSN) guidelines target values for pre and clinic (post-post) samples. The proportion of patients that would be categorized differently by clinic (post-post) samples was determined. Results: There was a significant difference between pre-serum values compared to post and clinic (post-post) values. Overall, iPTH, PO4 and Ca values would be misclassified in 25%, 70% and 50% respectively if blood was drawn at the clinic visit (post-post) compared to pre-HD as per CSN guidelines. Conclusions: Although no specific guideline has been written for NHHD patients, to ensure consistency of management compared to in-centre HD patients, lab values should be drawn pre-HD until clinical evidence suggests that the recommendations should be different for NHHD.展开更多
Knowledge of the composition and biting habits of mosquito associated with endemic areas is important in establishing sound vector control programmes and understanding the epidemiology of vector borne diseases. The bi...Knowledge of the composition and biting habits of mosquito associated with endemic areas is important in establishing sound vector control programmes and understanding the epidemiology of vector borne diseases. The biting activity cycle of several mosquito species in Serian, Sarawak was observed and described. Collections were carried out indoors and outdoors for 12 hours from 6.00 pm to 6.00 am using human landing catch techniques. A total of 7271 mosquitoes comprising 27 species belonging to sixgenera were collected. Mansonia bonneae (23.6%) was the predominant species caught in the study areas followed by Culex vishnui (22.3%), Culex pseudovishnui (19.6%) and Culex tritaenorhynchus (13.7%). A high rate of human biting activity by Ma. bonneae was detected during November but the activity was low during January.The biting activity of Ma.bonneae was found higher outdoor compared to indoorand peaked at 7.00 pm-8.00 pm.Cx.vishnui also exhibited similar biting activity peak while Anopheles letiferex-hibited biting activity peaked at 12.00 am-1.00 am.Cx.pseudovishnui showed biting patterns which were almost similar between indoor and outdoor activity and could be considered active throughout the 12 hour period.展开更多
Transition from a nocturnal to a diurnal lifestyle represents a major shift in primate evolution, plays a central role in the adaptation of these species to new habitats, and is involved in modifications to their phys...Transition from a nocturnal to a diurnal lifestyle represents a major shift in primate evolution, plays a central role in the adaptation of these species to new habitats, and is involved in modifications to their physiological and social behaviors （Heesy and Ross, 2001; Shultz et al., 2011）. However, two core problems concerning the circadian rhythm transition re- mains unresolved. First, there is controversy concerning the activity pattern of the ancestral primate （Heesy and Ross, 2001; Tan et al., 2005）. Second, the transition process for circadian rhythm in primate evolutionary history is unre- solved. Although most research suggests that primates trans- formed from a nocturnal to a diurnal circadian rhythm in the lineage leading to the common ancestor of the anthropoids or the haplorrhines （anthropoids and tarsier） （Ross, 2000; Heesy and Ross, 2001）, evidence has been insufficient to determine whether this occurred in the lineage leading to the common ancestor of the haplorrhines or the anthroooids.展开更多
Objective Hypoxemia is one of the main factors of pulmonary hypertension,and it can also be a complication of pulmonary hypertension,and it is a risk factor for many cardiovascular diseases,which increases the adverse...Objective Hypoxemia is one of the main factors of pulmonary hypertension,and it can also be a complication of pulmonary hypertension,and it is a risk factor for many cardiovascular diseases,which increases the adverse prognosis of patients.At present,there are some controversies about the diagnosis and treatment of sleep apnea disorder in patients with pulmonary hypertension.展开更多
A male patient with seventy-six years old, frequent urination at night, lassitude, aversion to cold, feeling tired easily on exertion, soreness and weakness in the lumbar region, dark and purplish tongue with white co...A male patient with seventy-six years old, frequent urination at night, lassitude, aversion to cold, feeling tired easily on exertion, soreness and weakness in the lumbar region, dark and purplish tongue with white coating, deep, thread and rapid pulse. Diagnosis: nocturnal polyuria. Syndrome differentiation in traditional Chinese medicine: kidney yang deficiency. In treatment, the Du-moxibustion(moxibustion along the Governor vessel) was adopted in the lumbosacral region. A number of cross marks were marked along Zhōngshū(中枢GV 7) to Yaoshù(腰俞 GV 2). Herbal powder for the Du-moxibustion was put evenly and straightly from GV 7 to GV 2 along the cross marks. The mulberry bark paper was put flatly over the treating region with the folded midline of the paper matching the powder line and the ginger paste was placed on the paper and flatted with the tongue depressor as a trapezium. A groove was pressed on the ginger paste, And moxa was put inside. The upper, middle and lower sites of the moxa were ignited for moxibustion,when the moxa was burnt out then new moxa was replaced. Totally,the moxa was changed 3 times in one treatment. The treatment was given once a week, and 4 treatments as one course. After 2-course Du-moxibustion, the frequency of nocturnal urination was 0-1 time,0-350 mL a night. The patient had lassitude and fatigue occasionally and had no aversion to cold. The treatment was given once every two weeks on the lumbosacral region until the urine frequency was normal at night. The Du-moxibustion improves in kidney yang deficiency, kidney qi deficiency, post-operative body weakness and the deficiency cold of the lower Jiao. This therapy warms the meridian, promotes qi and blood circulation, shortens the recovery time of the normal circulation of the cerebrospinal fluid and nourishes cauda equina as well as alleviates the pressure to cauda equina due to edema. This therapy effectively treats nocturnal polyuria of kidney yang deficiency after lumbar disc herniation surgery.展开更多
With continually increasing urbanization,the land cover in urban areas continues to change,resulting in the loss of biodiversity.Birds are highly sensitive to changes in habitat.Most forest birds perch on plants that ...With continually increasing urbanization,the land cover in urban areas continues to change,resulting in the loss of biodiversity.Birds are highly sensitive to changes in habitat.Most forest birds perch on plants that provide increased safety to reduce the risk of predation,and small birds may also consider insulation when using roosting plants in winter because of cold weather.Landscaping plants thus shape the nocturnal roosting environment of urban birds,and proper planting is essential for the survival of birds at night.The use of roosting plants by urban birds should therefore be studied to provide a reference for landscaping.In the current study,we observed 1865 nocturnal roosting birds in Beijing from 2021 to 2022,with 23 species of birds from 12 families and 45 species of plants from 22 families recorded.Juniperus chinensis exhibited the highest bird rarity-weighted richness,followed by Fraxinus pennsylvanica,Phyllostachys propinqua,Pinus tabuliformis,and Ulmus pumila.The diameter at breast height,tree height,and crown width of plants used by birds was largest in summer and smallest in winter,and the perch height of birds was the highest in spring and summer and the lowest in winter.Birds used the highest proportion of deciduous plants in summer and the highest proportion of evergreen plants in winter.A significant seasonal difference in the use of evergreen and deciduous plants by small birds was noted,with a preference for deciduous plants in summer and evergreen plants in winter,while this preference was not found in large birds.These findings indicate that evergreen plants provide a vital nocturnal roosting environment for small birds in winter.To provide a better nocturnal roosting habitat for urban birds,we recommend paying attention to the combination of evergreen and deciduous plants when carrying out landscape construction.展开更多
Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux dis...Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon Consensus.Recently an updated second version has been released.Mean nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD diagnosis.Originally a cut-off of 2292 Ohms was proposed,a value revised in the second edition.The updated Consensus recommended that an MNBI<1500 Ohms strongly suggests GERD while a value>2500 Ohms can be used to refute GERD.The proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic patients.However,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass index.Also,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one proposed.Finally,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now exist.Therefore,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.展开更多
BACKGROUND Thrombotic microangiopathy(TMA)is a group of disorders that converge on excessive platelet aggregation in the microvasculature,leading to consumptive thrombocytopenia,microangiopathic hemolysis and ischemic...BACKGROUND Thrombotic microangiopathy(TMA)is a group of disorders that converge on excessive platelet aggregation in the microvasculature,leading to consumptive thrombocytopenia,microangiopathic hemolysis and ischemic end-organ dysfunction.In predisposed patients,TMA can be triggered by many environmental factors.Glucocorticoids(GCs)can compromise the vascular endothelium.However,GC-associated TMA has rarely been reported,which may be due to the lack of awareness of clinicians.Given the high frequency of thrombocytopenia during GC treatment,particular attention should be given to this potentially fatal complication.CASE SUMMARY An elderly Chinese man had a 12-year history of aplastic anemia(AA)and a 3-year history of paroxysmal nocturnal hemoglobinuria(PNH).Three months earlier,methylprednisolone treatment was initiated at 8 mg/d and increased to 20 mg/d to alleviate complement-mediated hemolysis.Following GC treatment,his platelet counts and hemoglobin levels rapidly decreased.After admission to our hospital,the dose of methylprednisolone was increased to 60 mg/d in an attempt to enhance the suppressive effect.However,increasing the GC dose did not alleviate hemolysis,and his cytopenia worsened.Morphological evaluation of the marrow smears revealed increased cellularity with an increased percentage of erythroid progenitors without evident dysplasia.Cluster of differentiation(CD)55 and CD59 expression was significantly decreased on erythrocytes and granulocytes.In the following days,platelet transfusion was required due to severe thrombocytopenia.Observation of platelet transfusion refractoriness indicated that the exacerbated cytopenia may have been caused by the development of TMA due to GC treatment because the transfused platelet concentrates had no defects in glycosylphosphatidylinositol-anchored proteins.We examined blood smears and found a small number of schistocytes,dacryocytes,acanthocytes and target cells.Discontinuation of GC treatment resulted in rapidly increased platelet counts and steady increases in hemoglobin levels.The patient’s platelet counts and hemoglobin levels returned to the levels prior to GC treatment 4 weeks after GC discontinuation.CONCLUSION GCs can drive TMA episodes.When thrombocytopenia occurs during GC treatment,TMA should be considered,and GCs should be discontinued.展开更多
基金supported by the Department of Science and Technology,Innovation in Science Pursuit for Inspired Research,India(Grant No.DST/INSPIRE/04/2022/003192)the Ad-RICCE Project,India(Grant No.IC-12012(12)/2/2022-ICD-DBT)the Dutch Research Council,the Netherlands(Grant No.482.20.202).
文摘High epicuticular wax(Ewax)content on leaves is a key trait for drought and heat stress tolerance in plants.One hundred diverse rice germplasm lines from the 3K-IRRI collection were screened for leaf Ewax content under open field conditions during the monsoon season of 2023,and for their nocturnal transpiration during the summer season of 2024.Using a novel drought-simulator phenomics platform,we identified a balance between cuticular and stomatal transpiration at night,with wax modulating these processes under varying night temperatures.
文摘This editorial explores the significant cardiometabolic outcomes of nocturnal sentry duty and its broader implications for other professions with overnight work.Highlighting the paradox of essential nighttime labor and its adverse physiological effects,we discuss how occupations like healthcare,hospitality,and emergency services are similarly affected.The study by Lin et al provides critical insights into these dynamics and lays the groundwork for understanding nocturnal duty’s multifaceted impact on human health.
文摘Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemo-lytic disease in which there is a stem cell disorder of clonal nature. Previous studies have demonstrated that the numbers of burst-forming units-erythroid (BFU-E) and colony-forming units-granulocyte / macrophage (CFU-GM) from bone marrow of PNH patients growing in the medium containing PHA-LCM from the normai donors were more reduced than those of normai bone marrow. The purpose of present study was to investigate if PNH lymphocytes are defective in supporting hematopoiesis in vitro. PHA-LCM from PNH blood was added to the culture medium for the growth of PNH and normai BFU-E and CFU-GM. The numbers of PNH bone marrow BFU-E and CFU-GM in the medium containing PHA-LCM from PNH blood were less than those from normai blood; the numbers of normai bone marrow BFU-E and CFU-GM grown in the medium containing PHA-LCM from PNH blood were more decreased than those from normai blood. The results suggest that diminished numbers of PNH bone marrovv BFU-
基金Supported by Project of the National Key Technology R&D Program during the 11th Five-Year Plan Period,No.2007BAI04B01Shanghai Leading Academic Discipline Project,No.Y0205
文摘AIM:To investigate the incidence of nocturnal dyspeptic symptoms in patients with functional dyspepsia(FD) and whether prokinetic drugs can alleviate them. METHODS:Eighty-five consecutive Chinese patients with FD were included in this study.One week after single-blinded placebo run-in treatment,baseline nocturnal intragastric pH,bile reflux and nocturnal dyspeptic symptoms of eligible patients,including epigastric pain or discomfort,abdominal distention and belching, were investigated with questionnaires.Patients exhibiting nocturnal dyspeptic symptoms were randomly and double-blindly assigned to domperidone group or placebo group.Nocturnal intragastric pH and percentage of duodenogastric bile reflux time were determined after treatment. RESULTS:Of the 85 FD patients,2 females withoutnocturnal symptoms,who responded to placebo run-in treatment,were excluded from the study,30(36.1%) exhibited nocturnal dyspeptic symptoms with increased duodenogastric bile reflux time(intragastric bilirubin absorbance>0.14)and mean gastric pH(confirming the existence of bile reflux)(P=0.021,0.023) at night were included in the study.Of these 30 patients,21(70%)had overt nocturnal duodenogastric bile reflux,which was significantly higher than that of those without nocturnal symptoms(P=0.026).The 30 patients were allocated to domperidone group or placebo group(n=15).The nocturnal duodenogastric bile reflux and gastric pH were significantly decreased after domperidone treatment(P=0.015,0.021).The severity score of nocturnal dyspeptic symptoms was also significantly decreased after domperidone treatment (P=0.010,0.015,0.026),which was positively correlated with the reduced nocturnal bile reflux or gastric pH(r=0.736,0.784,0.753 or r=0.679,0.715,0.697, P=0.039,0.036,0.037 or P=0.043,0.039,0.040). CONCLUSION:A subgroup of Chinese FD patients show overt nocturnal dyspeptic symptoms,which may be correlated with the excessive nocturnal duodenogastric bile reflux.Domperidone therapy can alleviate these symptoms.
基金supported by the Special Foundation of the China Meteorological Administration (Grant No.GYHY201506006)supported by the National Science Foundation of China (Grant Nos.41405100,41322032 and 41275031)
文摘The diurnal variation of precipitation over the Dabie Mountains(DBM) in eastern China during the 2013 mei-yu season is investigated with forecasts of a regional convection-permitting model. Simulated precipitation is verified against surface rain-gauge observations. The observed morning precipitation peak on the windward(relative to the prevailing synoptic-scale wind) side of the DBM is reproduced with good spatial and temporal accuracy. The interaction between the DBM and a nocturnal boundary layer low-level jet(BLJ) due to the inertial oscillation mechanism is shown to be responsible for this precipitation peak. The BLJ is aligned with the lower-level southwesterly synoptic-scale flow that carries abundant moisture.The BLJ core is established at around 0200 LST upwind of the mountains. It moves towards the DBM and reaches maximum intensity at about 70 km ahead of the mountains. When the BLJ impinges upon the windward side of the DBM in the early morning, mechanical lifting of moist air leads to condensation and subsequent precipitation.
文摘Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.
基金supported by 2010 National Nature Science Foundation of China General Program(Program NO.8107I046)2012 Guangdong Provincial Science and Technology Program of China(Program NO.2012B032000009)2013 Guangdong Provincial Science and Technology Program of China(Program NO.2013B022000004)
文摘Objective:To detect the CHRNA7 gene mutation and polymorphism in Southern Han Chinese patients with nocturnal frontal lobe epilepsy(NFLE).Methods:Blood samples were collected from 215 Southern Han Chinese patients with NFLE and 200 healthy Southern Han Chinese control subjects.Genomic DNA was extracted,and CHRNA7 whole genome exons were amplified by the polymerase chain reaction and subjected to Sanger sequencing.Results:No CHRNA7 gene mutation was detected in all of the NFLE patients.However,five single nucleotide polymorphisms(SNPs)in sporadic cases were found,located in exons 5,6.and 7 of the CHRNA7 gene.Among them,c.690G>A and c.698A>G are known SNPs,while c.370G>A,c.654C>T,and c.497-498delTG were newly discovered SNPs.These SNPs were also found in some of the healthy controls.Conclusions:No CHRNA7 gene mutation was identified in Southern Han Chinese patients with NFLE.The CHRNA7 gene is probably not responsible for NFLE in this population.
基金This project was supported by the National Natural Science Foundation of China (No.81300064).
文摘The possible relationship between lung cancer and nocturnal intermittent hypoxia,apnea and daytime sleepiness,especially the possible relationship between the occurrence and progression of lung cancer and obstructive sleep apnea syndrome (OSAS) was explored.Forty-five cases of primary lung cancer suitable for surgical resection at the Third Affiliated Hospital of Kunming Medical University between January 2017 and December 2017 were recruited (lung cancer group),and there were 45 patients in the control group who had no significant differences in age,sex and other general data from lung cancer group.The analyzed covariates included general situation,snore score,the Epworth Sleeping Scale (ESS),Pittsburgh Sleep Quality Index (PSQI),apnea and hypopneas index (AHI),oxygen desaturation index 4 (ODk),lowest arterial oxygen saturation [LSpCh (%)],oxygen below 90% of the time [T90%(min)],the percentage of the total recorded time spend below 90% oxygen saturation (TS90%),to explore the possible relationship between lung cancer and above indicators.The participants were followed up for one year.The results showed that:(1) There was significant difference in body mass index (BMI),ESS,AHI,T90%(min),TS90%,ODh,snore score and LSpCh (%) between lung cancer group and control group (P<0.05).There was no statistically significant difference in age,gender,PSQI score,incidence of concurrent hypertension,diabetes and coronary heart disease (CHD),and smoking history between the two groups (P>0.05);(2) Patients in the lung cancer group were divided into OSAS subgroup and non- OSAS subgroup according to the international standard for the diagnosis of OSAS.There was significant difference in BMI,age,staging,incidence of concurrent hypertension and concurrent CHD,snore score,ESS score,T90%(min),TS90%,ODh and LSpCh (%) between OSAS subgroup and non-OSAS subgroup (P<0.05).There was no statistically significant difference in gender,PSQI score,incidence of concurrent diabetes,smoking history and lung cancer type between the two groups (P>0.05);(3) AHI was strongly negatively correlated with the LSpCh (%) and positively with ESS,staging,snoring score,T90%(min),TS90%,ODh and BMI (P<0.05);(4) There were 3 deaths,5 cases of recurrence,and 4 cases of metastasis in OSAS subgroup;and there was 1 death,4 cases of recurrence and 2 cases of metastasis in non-OSAS subgroup during the follow-up period of one year,respectively.There was no significant difference in mortality,recurrence rate and metastasis rate between the two subgroups,and the total rate of deterioration in OSAS subgroup was significantly increased compared to the non-OSAS subgroup (P<0.05).It was concluded that the patients with lung cancer are prone to nocturnal hypoxemia,apnea,snoring and daytime sleepiness compared to control group.The incidence of OSAS in patients with lung cancer was higher,and the difference in the hypoxemia-related indicators was statistically significant.The mortality,recurrence rate,and metastasis rate increases in lung cancer patients with OSAS during the one-year follow-up period,suggesting that OSAS may be a contributing factor to the occurrence and progression of lung cancer.
基金the National Pork Board and the Pork Checkoff, USA, for partial financial support of the project
文摘Previous studies suggested that pigs prefer lower environmental temperatures during nighttime compared to daytime. So reducing nocturnal temperature in nursery barns may not jeopardize performance or welfare of pigs, but can save energy for heating the barn. A study was conducted to investigate growth performance and behavioral response of nursery pigs to reduced nocturnal temperature. This study was conducted in four replicates, each utilizing 270 newly weaned pigs and lasting for 5 wk. Temperature setpoint in the control room （CON） was started at 30℃ and decreased by 2℃ per week. In the treatment room （RNT）, temperature setpoint was maintained same as in CON between 7：00 h and 19：00 h, and reduced by 8~C between 19：00 h and 7：00 h starting from d 5. Growth performance （15 pens/room, 9 pigs/pen, BW=（6.3±0.61） kg） was monitored for 5 wk, and behaviors in 6 pens in each room were video-recorded for 24 h 3 d after being exposed to the experimental temperature. Instantaneous scan sampling was performed to determine time budgets for standing, sitting, eating, drinking, belly nosing, three postures of lying, and huddling. Two focal pigs were continuously viewed to record duration and occurrence of eating and drinking. Reduced nocturnal temperature did not affect the growth performance of the pigs, time spent standing, sitting, total lying and eating or duration and frequencies of eating and drinking （all P〉0.10）. However, RNT increased time spent lying sternal （83 vs. 72%, P〈0.001） and number of pigs that were huddling （70 vs. 50% of lying pigs, P〈0.001）, and decreased time spent lying laterally （0.8 vs. 4.6%, P〈0.001）, lying half laterally （5.3 vs. 11.0%, P〈0.001）, and belly nosing （0.9 vs. 1.7%, P=0.01） during nighttime. These results indicate that nursery pigs adopted the posture of lying sternal and huddled together to reduce heat loss from their body surface to maintain thermal balance and growth performance in RNT. Such mild reduction in nocturnal temperature in the nursery barn can save energy for heating the barn without negative effects on performance and behavior of nursery pigs.
基金This work was supported by the National Natural Science Foundation of China(No.N SFC 81571424).
文摘Multiple measurements of nocturnal penile tumescence and rigidity(NPTR)are widely accepted as a method to differentiate psychogenic erectile dysfunction(ED)from organic ED.However,direct evidence remains limited regarding the first-night effect on NPTR measurement using the RigiScan.Here,we evaluated the first-night effect on the results of NPTR measurement to validate the necessity of NPTR measurement for two consecutive nights,particularly when abnormal first-night measurements are recorded in a laboratory setting.We retrospectively reviewed 105 patients with a complaint of ED,who underwent NPTR measurement using the RigiScan in the Department of Infertility and Sexual Medicine,the Third Affiliated Hospital of Sun Yat-sen University(Guangzhou,China),for two consecutive nights,during the period from November 2015 to May 2016.NPTR parameters were collected and analyzed.We found that more effective nocturnal erections were detected during the second night than during the first night(P<0.001).Twenty percent of all patients had no effective erection during the first night,but exhibited at least one effective erection during the second night.The negative predictive value of NPTR measurement during the first night was 43.2%;this was significantly lower than that on the second night(84.2%;P=0.003).Most NPTR parameters were better on the second night than on the first night.The first-night effect might be greater among patients younger than 40 years of age.In conclusion,two consecutive nightly measurements of NPTR can avoid a false-abnormal result caused by the first-night effect;moreover,these measurements more accurately reflect erectile capacity,especially when the first-night record is abnormal in a laboratory setting.
基金financially supported by the 1000 Plan Recruitment Program of Global Experts of China to EG
文摘Owls have the potential to be keystone species for conservation in fragmented landscapes, as the absence of these predators could profoundly change community structure. Yet few studies have examined how whole communities of owls respond to fragmentation, especially in the tropics. When evaluating the effect of factors related to fragmentation, such as fragment area and distance to the edge, on these birds, it is also important in heterogeneous landscapes to ask how ＇location factors＇ such as the topography, vegetation and soil of the fragment predict their persistence. In Xishuangbanna, southwest China, we established 43 transects （200 mx60 m） within 20 forest fragments to sample nocturnal birds, both visually and aurally. We used a multimodel inference approach to identify the factors that influence owl species richness, and generalized linear mixed models to predict the occurrence probabilities of each species. We found that fragmentation factors dominated location factors, with larger fragments having more species, and four of eight species were significantly more likely to occur in large fragments. Given the potential importance of these birds on regulating small mammal and other animal populations, and thus indirectly affecting seed dispersal, we suggest further protection of large f ragments and programs to increase their connectivity to the remaining smaller fragments.
文摘BACKGROUND Idiopathic non-cirrhotic portal hypertension(INCPH)is mainly associated with thrombophilia in Western countries.Paroxysmal nocturnal hemoglobinuria(PNH)is a rare hematologic disease that manifests with hemolytic anemia,thrombosis,and peripheral blood cytopenias.Portal and hepatic venous thrombosis were reported in PNH.A rare case of INCPH complicating PNH is described.CASE SUMMARY A 63-year old woman with a 2-year past medical history of PNH without treatment was admitted because of jaundice and refractory ascites requiring large volume paracentesis.Liver histology revealed portal venopathy with portal fibrosis and sclerosis,nodular regenerative hyperplasia,parenchymal ischemic changes,and focal sinusoidal and perivenular fibrosis without bridging fibrosis or cirrhosis,all indicative of INCPH.The flow cytometry confirmed PNH diagnosis and eculizumab treatment was initiated.Her condition was improved gradually,bilirubin was normalized 6 months following initiation of eculizumab,and 1 year later diuretics were stopped.CONCLUSION Eculizumab improved intravascular hemolysis and reversed clinical manifestations of INCPH in a patient with paroxysmal nocturnal hemoglobinuria.
文摘Background: Guidelines for patients treated with conventional hemodialysis patients have been written for target serum levels for calcium (Ca), phosphate (PO4) and intact parathyroid hormone (iPTH). No guidelines exist for nocturnal home hemodialysis (NHHD) patients for target values or timing of the blood sample draw. We undertook a prospective cohort study to examine the variability in pre, post and clinic (post-post) serum values for Ca, PO4, and iPTH in NHHD patients to determine if timing of blood draw could affect clinical decisions. Methods: Twenty prevalent NHHD patients collected blood pre and post their usual NHHD session with an additional blood sample drawn in clinic (post-post). Median and interquartile range of pre, post and clinic (post-post) values of iPTH, PO4 and Ca were calculated and compared with Freidman/Wilcoxon test. Serum concentrations were also categorized according to Canadian Society of Nephrology (CSN) guidelines target values for pre and clinic (post-post) samples. The proportion of patients that would be categorized differently by clinic (post-post) samples was determined. Results: There was a significant difference between pre-serum values compared to post and clinic (post-post) values. Overall, iPTH, PO4 and Ca values would be misclassified in 25%, 70% and 50% respectively if blood was drawn at the clinic visit (post-post) compared to pre-HD as per CSN guidelines. Conclusions: Although no specific guideline has been written for NHHD patients, to ensure consistency of management compared to in-centre HD patients, lab values should be drawn pre-HD until clinical evidence suggests that the recommendations should be different for NHHD.
文摘Knowledge of the composition and biting habits of mosquito associated with endemic areas is important in establishing sound vector control programmes and understanding the epidemiology of vector borne diseases. The biting activity cycle of several mosquito species in Serian, Sarawak was observed and described. Collections were carried out indoors and outdoors for 12 hours from 6.00 pm to 6.00 am using human landing catch techniques. A total of 7271 mosquitoes comprising 27 species belonging to sixgenera were collected. Mansonia bonneae (23.6%) was the predominant species caught in the study areas followed by Culex vishnui (22.3%), Culex pseudovishnui (19.6%) and Culex tritaenorhynchus (13.7%). A high rate of human biting activity by Ma. bonneae was detected during November but the activity was low during January.The biting activity of Ma.bonneae was found higher outdoor compared to indoorand peaked at 7.00 pm-8.00 pm.Cx.vishnui also exhibited similar biting activity peak while Anopheles letiferex-hibited biting activity peaked at 12.00 am-1.00 am.Cx.pseudovishnui showed biting patterns which were almost similar between indoor and outdoor activity and could be considered active throughout the 12 hour period.
基金supported by the grants from the National Natural Science Foundation of China(Nos.2007CB411600 and 2008GA001)the Bureau of Science and Technology of Yunnan Province(No.31061160189)supported by the West Light Foundation of the Chinese Academy of Sciences
文摘Transition from a nocturnal to a diurnal lifestyle represents a major shift in primate evolution, plays a central role in the adaptation of these species to new habitats, and is involved in modifications to their physiological and social behaviors （Heesy and Ross, 2001; Shultz et al., 2011）. However, two core problems concerning the circadian rhythm transition re- mains unresolved. First, there is controversy concerning the activity pattern of the ancestral primate （Heesy and Ross, 2001; Tan et al., 2005）. Second, the transition process for circadian rhythm in primate evolutionary history is unre- solved. Although most research suggests that primates trans- formed from a nocturnal to a diurnal circadian rhythm in the lineage leading to the common ancestor of the anthropoids or the haplorrhines （anthropoids and tarsier） （Ross, 2000; Heesy and Ross, 2001）, evidence has been insufficient to determine whether this occurred in the lineage leading to the common ancestor of the haplorrhines or the anthroooids.
文摘Objective Hypoxemia is one of the main factors of pulmonary hypertension,and it can also be a complication of pulmonary hypertension,and it is a risk factor for many cardiovascular diseases,which increases the adverse prognosis of patients.At present,there are some controversies about the diagnosis and treatment of sleep apnea disorder in patients with pulmonary hypertension.
基金Supported by grant of Shandong Key Research and Development Program:2017GSF19116~~
文摘A male patient with seventy-six years old, frequent urination at night, lassitude, aversion to cold, feeling tired easily on exertion, soreness and weakness in the lumbar region, dark and purplish tongue with white coating, deep, thread and rapid pulse. Diagnosis: nocturnal polyuria. Syndrome differentiation in traditional Chinese medicine: kidney yang deficiency. In treatment, the Du-moxibustion(moxibustion along the Governor vessel) was adopted in the lumbosacral region. A number of cross marks were marked along Zhōngshū(中枢GV 7) to Yaoshù(腰俞 GV 2). Herbal powder for the Du-moxibustion was put evenly and straightly from GV 7 to GV 2 along the cross marks. The mulberry bark paper was put flatly over the treating region with the folded midline of the paper matching the powder line and the ginger paste was placed on the paper and flatted with the tongue depressor as a trapezium. A groove was pressed on the ginger paste, And moxa was put inside. The upper, middle and lower sites of the moxa were ignited for moxibustion,when the moxa was burnt out then new moxa was replaced. Totally,the moxa was changed 3 times in one treatment. The treatment was given once a week, and 4 treatments as one course. After 2-course Du-moxibustion, the frequency of nocturnal urination was 0-1 time,0-350 mL a night. The patient had lassitude and fatigue occasionally and had no aversion to cold. The treatment was given once every two weeks on the lumbosacral region until the urine frequency was normal at night. The Du-moxibustion improves in kidney yang deficiency, kidney qi deficiency, post-operative body weakness and the deficiency cold of the lower Jiao. This therapy warms the meridian, promotes qi and blood circulation, shortens the recovery time of the normal circulation of the cerebrospinal fluid and nourishes cauda equina as well as alleviates the pressure to cauda equina due to edema. This therapy effectively treats nocturnal polyuria of kidney yang deficiency after lumbar disc herniation surgery.
基金supported by the Beijing Municipal Commission of Science and Technology(No.D171100007217002).
文摘With continually increasing urbanization,the land cover in urban areas continues to change,resulting in the loss of biodiversity.Birds are highly sensitive to changes in habitat.Most forest birds perch on plants that provide increased safety to reduce the risk of predation,and small birds may also consider insulation when using roosting plants in winter because of cold weather.Landscaping plants thus shape the nocturnal roosting environment of urban birds,and proper planting is essential for the survival of birds at night.The use of roosting plants by urban birds should therefore be studied to provide a reference for landscaping.In the current study,we observed 1865 nocturnal roosting birds in Beijing from 2021 to 2022,with 23 species of birds from 12 families and 45 species of plants from 22 families recorded.Juniperus chinensis exhibited the highest bird rarity-weighted richness,followed by Fraxinus pennsylvanica,Phyllostachys propinqua,Pinus tabuliformis,and Ulmus pumila.The diameter at breast height,tree height,and crown width of plants used by birds was largest in summer and smallest in winter,and the perch height of birds was the highest in spring and summer and the lowest in winter.Birds used the highest proportion of deciduous plants in summer and the highest proportion of evergreen plants in winter.A significant seasonal difference in the use of evergreen and deciduous plants by small birds was noted,with a preference for deciduous plants in summer and evergreen plants in winter,while this preference was not found in large birds.These findings indicate that evergreen plants provide a vital nocturnal roosting environment for small birds in winter.To provide a better nocturnal roosting habitat for urban birds,we recommend paying attention to the combination of evergreen and deciduous plants when carrying out landscape construction.
文摘Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon Consensus.Recently an updated second version has been released.Mean nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD diagnosis.Originally a cut-off of 2292 Ohms was proposed,a value revised in the second edition.The updated Consensus recommended that an MNBI<1500 Ohms strongly suggests GERD while a value>2500 Ohms can be used to refute GERD.The proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic patients.However,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass index.Also,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one proposed.Finally,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now exist.Therefore,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.
基金Supported by Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University,No.YLJT20201002.
文摘BACKGROUND Thrombotic microangiopathy(TMA)is a group of disorders that converge on excessive platelet aggregation in the microvasculature,leading to consumptive thrombocytopenia,microangiopathic hemolysis and ischemic end-organ dysfunction.In predisposed patients,TMA can be triggered by many environmental factors.Glucocorticoids(GCs)can compromise the vascular endothelium.However,GC-associated TMA has rarely been reported,which may be due to the lack of awareness of clinicians.Given the high frequency of thrombocytopenia during GC treatment,particular attention should be given to this potentially fatal complication.CASE SUMMARY An elderly Chinese man had a 12-year history of aplastic anemia(AA)and a 3-year history of paroxysmal nocturnal hemoglobinuria(PNH).Three months earlier,methylprednisolone treatment was initiated at 8 mg/d and increased to 20 mg/d to alleviate complement-mediated hemolysis.Following GC treatment,his platelet counts and hemoglobin levels rapidly decreased.After admission to our hospital,the dose of methylprednisolone was increased to 60 mg/d in an attempt to enhance the suppressive effect.However,increasing the GC dose did not alleviate hemolysis,and his cytopenia worsened.Morphological evaluation of the marrow smears revealed increased cellularity with an increased percentage of erythroid progenitors without evident dysplasia.Cluster of differentiation(CD)55 and CD59 expression was significantly decreased on erythrocytes and granulocytes.In the following days,platelet transfusion was required due to severe thrombocytopenia.Observation of platelet transfusion refractoriness indicated that the exacerbated cytopenia may have been caused by the development of TMA due to GC treatment because the transfused platelet concentrates had no defects in glycosylphosphatidylinositol-anchored proteins.We examined blood smears and found a small number of schistocytes,dacryocytes,acanthocytes and target cells.Discontinuation of GC treatment resulted in rapidly increased platelet counts and steady increases in hemoglobin levels.The patient’s platelet counts and hemoglobin levels returned to the levels prior to GC treatment 4 weeks after GC discontinuation.CONCLUSION GCs can drive TMA episodes.When thrombocytopenia occurs during GC treatment,TMA should be considered,and GCs should be discontinued.
