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BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis. METHODS: This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC). RESULTS: Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, P<0.001; 82.7% vs. 84.3%, P=0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, P>0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, P=0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, P=0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, P=0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h. CONCLUSIONS: The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available.

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BACKGROUND: Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China. METHODS: We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI. RESULTS: The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals. CONCLUSIONS: Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.

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The health of wetland ecosphere in an estuarine delta is determined by many factors, such as continuity of natural processes, ecosystem connectivity, habitat heterogeneity, and food web diversity. The contradiction between ecological and environmental protection and regional development in the estuarine delta is becoming more and more prominent. A series of man-made and natural processes directly and indirectly resulted in habitat fragmentation of wetlands, which has direct and strong impacts on the ecosphere health and the habitat function of wetlands. In this paper, we provided a perspective on researches on the basic theory of healthy wetland ecosphere, landscape ecological network system, hydrologic network construction, key food webs, and habitat heterogeneity. At the regional and landscape scales, with the linkages between land use and ecosystem integrity as the main line, we clarified the influences of habitat fragmentation on wetland ecological functions, especially the effects of landscape integrity and river connectivity on wetland habitat. At the community and ecosystem scales, emphasis should be given on the relationship between food web and ecosystem stability, especially the supporting role of food web diversity and habitat heterogeneity on the construction of wetland biosphere. Further efforts should focuse on the wetland habitats construction based on landscape integrity, hydrologic connectivity, habitat heterogeneity and food web diversity. These efforts could help to develop and optimize the theory and method of constructing wetland ecosphere and enhancing its ecological function, and promote the sound development of regional ecological environment and resource utilization in estuarine deltas.

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By using eddy covariance technique, this paper measured the net ecosystem CO2 exchange (NEE) in a reed (Phragmites australis) wetland in the Yellow River Delta of China during the growth season of 2011, and investigated the variation patterns of the NEE and related affecting factors. The average diurnal variation of the NEE in different months showed a U-type curve, with the maximum net CO2 uptake rate and release rate being (0.44 +/- 0.03) and (0.16 +/- 0.01) mg CO2 x m(-2) x s(-1), respectively. The NEE, ecosystem respiration (R(eco)), and gross primary productivity (GPP) were all higher in vigorous growth season (from July to September) and lower in early growth season (from May to June) and late growth season (from October to November). Both R(eco) and NEE reached their maximum values in August, while GPP reached its peak value in July. During the growth season, the ecosystem CO2 exchange was mainly dominated by photosynthetic active radiation (PAR), soil temperature (T(s)), and soil water content (SWC). There was a rectangular hyperbolic relationship between the daytime NEE and PAR. The nighttime ecosystem respiration (R(eco,n)) was exponentially correlated with the T(s) at 5 cm depth, and the temperature sensitivity of the ecosystem respiration (Q10) was 2.30. SWC and T(s) were the main factors affecting the R(eco,n). During the entire growth season, the reed wetland ecosystem in the Yellow River delta was an obvious carbon sink, with the total net carbon sequestration being 780.95 g CO2 x m(-2).

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Based on the 23 sheets of remote sensing images from 1976 to 2009, in combining with the water and sediment data from Lijin station and the annual precipitation data of Yellow River Basin from 1976 to 2008, this paper quantitatively analyzed the features of water and sediment discharge from Yellow River, and the evolution process of Yellow River Delta and related driving mechanisms. In 1976-2008, the annual runoff and the annual sediment discharge into sea changed largely and frequently, but overall, presented a decreasing trend. Since the course of the Yellow River changed its direction to Qingshui channel in 1976, the Delta coastline and area were generally in a silting-up state. The evolution process of the Delta could be approximately divided into three stages, i.e., 1976-1985, 1986-1995, and 1996-2009, and the increasing rate of the Delta decreased with the stages. The coastline and area of the Delta were significantly exponentially correlated to the sediment accumulated at Lijin station, and the inter-annual variation of the precipitation of the Yellow River Basin had a strong correlation with that of the sediment at Lijin station, suggesting that the annual variation of the precipitation in Yellow River Basin was the main factor affecting the runoff and sediment discharge into sea.

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Newcastle disease virus (NDV) has been thought to only infect avian species. However, at least eight NDV strains were isolated from swine populations in China during 1999-2006, four of which were characterized genetically and phylogenetically. Genetic analysis revealed that JL106 and SP13 had a (112)G-R-Q-G-R-L(117) motif at the cleavage site of F protein, while JL01 and MP01 possessed a (112)G-K-Q-G-R-L(117) motif, which indicated that all of them were typical of low-virulence viruses. Phylogenetic analysis based on the full-length F gene sequences showed that JL106 and SP13 belonged to genotype II, similar to the commonly utilized commercial La Sota vaccine strain in China. While JL01 and MP01 clustered within genotype I, genetically identical to the V4 vaccine strain. The animal trials showed that JL106 can effectively infect chickens. The present results indicated that the use of live La Sota and V4 vaccines and close contact between avian and pigs maybe resulted in cross-species infection, therefore, it is necessary to further carry out swine NDV epidemiology surveillance.

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