Location Of Onset Research Articles

Epithelioid solitary fibrous tumors from CNS and soft tissues: an unusual morphologic variant

BackgroundSolitary fibroous tumors (SFTs) are distinctive soft tissue tumors characterized by rearrangements of NAB2-STAT6 gene, which are associated with thin-walled, branching, “staghorn”-shaped vessels. SFTs are originally classified as a type of hemangiopericytoma (HPC). Classical SFTs are composed of spindle to ovoid cells arranged haphazardly or in fascicles. Rarely, SFTs exhibit unusual morphological variants such as fat formation, giant cells, dedifferentiation, or epithelioid variant. The epithelioid cell variant, which is composed almost entirely of epithelioid cells and arranged in solid or nest patterns, is extremely rare and frequently malignant.Case presentationIn this study, we reported three cases of epithelioid SFTs (ESFTs) located in extrathoracic sites (right lateral ventricle, right lumbar, left pelvis). All the subjects in this study were elderly, with a predominance of female patients, accounting for two out of the three cases, and only one case involved a male patient. The tumor cells were entirely composed of epithelioid cells and exhibited positive for CD34 and STAT-6 markers. Ultimately, the majority of cases (two out of three) were diagnosed as malignant SFTs.ConclusionThis study aims to enhance the awareness of ESFTs. In these cases, irrespective of the onset location, the arrangement patterns of tumor cells, such as papillary structures and the morphology of epithelial-like cells, conspicuously lack the hallmark histological characteristics of Solitary Fibrous Tumors (SFTs). Consequently, it requires differential diagnosis from a plethora of malignant neoplasms. Moreover, the elevated malignancy level of this cohort of cases poses substantial diagnostic challenges to pathologists, compounding the complexity of accurate interpretation.

Improving turbulence modeling for gas turbine blades: A novel approach to address flow transition and stagnation point anomalies

Accurate prediction of temperature and Heat Transfer Coefficient (HTC) distributions over gas turbine blades is crucial for the design process and life assessment of these components. Numerical studies of flow over gas turbine blades face significant challenges in accurately simulating two complex phenomena: (1) the transition of flow from laminar to turbulent, and (2) stagnation point flow at the leading edge. Many turbulence models tend to overpredict the temperature on turbine blades, leading to incorrect identification of hot-spot regions and, consequently, erroneous estimations of blade life. This paper investigates the performance of various turbulence models in simulating flow and heat transfer over gas turbine vanes. The study includes three full turbulence models, i.e., Spalart-Allmaras (SA), Shear Stress Transport k−ω (SST-kw), and v2−f (V2F), as well as two transitional models, i.e., Transition SST (Trans-SST) and k−kL−ω (k-kl-w). Simulation results indicate that the v2−f, Trans-SST, and k−kL−ω models can detect flow transition. However, the transition length and onset location predicted by the Trans-SST and k−kL−ω models do not align with experimental data. Conversely, the v2−f model suffers from over-predictions at the leading edge due to stagnation point anomaly. To address these issues and due to capacities of the V2F model, this study proposes two modifications to enhance the performance of the V2F model. First, the production term of turbulent kinetic energy is redefined to mitigate the stagnation point anomaly. Second, the model is recalibrated to improve the prediction of flow transition. The new model, named the Production Modified V2F (PMV2F) model, shows promising results in predicting temperature and heat transfer coefficients.

Growth characteristics of the mean shear layer in pipe bends with and without a guide vane

The growth characteristics of two identical pipe bends with and without a guide vane are investigated by means of large eddy simulation. The two pipe bends, with a radius of curvature slightly above the separation threshold, are subjected to two fully developed upstream flow conditions, with a corresponding Reynolds number of 11 700 and 24 000. A precursor computation method is employed to provide the fully developed turbulence inflow conditions for all cases. The growth of the mean shear layer in this work is characterized by the local momentum thickness, which measures the extent of momentum deficit confined under the mean shear layer. For both pipe bends, the initial growth of momentum thickness is observed in the first quarter of the bend. The onset location is almost independent of the Reynolds numbers. However, a clear Reynolds number dependence is observed in the onset magnitude, which strongly defines the growth rate thereafter. By examining the mean momentum balance in the bend section, the results show that rather than the adverse pressure gradient, the overall growth characteristics of the mean shear layer, which include the onset location and the growth rate, are better described by the balance between the centrifugal force and the radial pressure gradient. This balance manifests itself as a change in the swirling intensity of the secondary flow. The presence of guide vane significantly suppresses the swirling intensity in the bend section, leading to a noticeable reduction in the overall momentum thickness growth and the production of turbulence in the flow downstream of the bend. Further inspection also indicates that the initial mechanism leading to the suppression of separation at the inner bend is linked to the increasing dominance of the small vortices at the near-wall vicinity relative to the local adverse pressure gradient. Certain aspects pertaining to the turbulent statistics are also discussed.

Picturing Global Substorm Dynamics in the Magnetotail Using Low‐Altitude ELFIN Measurements and Data Mining‐Based Magnetic Field Reconstructions

AbstractA global reconfiguration of the magnetotail characterizes substorms. Current sheet thinning, intensification, and magnetic field stretching are defining features of the substorm growth phase and their spatial distributions control the timing and location of substorm onset. Presently, sparse in‐situ observations cannot resolve these distributions. A promising approach is to use new substorm magnetic field reconstruction methods based on data mining, termed SST19. Here we compare the SST19 reconstructions to low‐altitude electron losses and fields investigation (ELFIN) measurements of energetic particle precipitations to probe the radial profile of the equatorial magnetic field curvature during a 19 August 2022 substorm. ELFIN and SST19 yield a consistent dynamical picture of the magnetotail during the growth phase and capture its key features such as the formation of a thin current sheet and its earthward motion. Furthermore, they resolve a “checkmark” pattern of isotropic electron precipitation boundaries in the time‐energy plane, consistent with earlier observations but now over a broad energy range. It is shown that in the growth phase, the mismatch between SST19 and ELFIN latitudes is much less than one degree, the capability unattainable for any other empirical or first‐principles model.

Local-Variable-Based Transition Model for Hypersonic Flows Considering Wall Mass Injection

Pyrolysis gas injection during the ablation process will affect the hypersonic boundary-layer transition. This paper proposes a three-equation γ-Reθ-fb transition model that considers wall mass injection. First, the boundary conditions of wall mass injection are established and verified. Second, based on analysis of the compressible boundary-layer solutions under wall mass injection, new transition correlations are developed. This allows an injection factor transport equation to be constructed using strictly local variables, and this equation is coupled with the γ-Reθ transition model. Additionally, to model the wall mass injection effects in the fully turbulent zone, the wall boundary conditions for the specific turbulence dissipation rate are amended. The results of numerical simulations show that the transition onset locations and the changes in the heat transfer rate are reasonably consistent with experimental data.

Construction of effective reproduction number of infectious disease individuals based on spatiotemporal discriminant search model: take hand-foot-mouth disease as an example

ObjectiveIn order to facilitate the tracing of infectious diseases in a small area and to effectively carry out disease control and epidemiological investigations, this research proposes a novel spatiotemporal model to estimate effective reproduction number(Re)for infectious diseases, based on the fundamental concept of contact tracing.MethodsThis study utilizes the incidence of hand, foot, and mouth disease (HFMD) among children in Bishan District, Chongqing, China from 2015 to 2019. The study incorporates the epidemiological characteristics of HFMD and aims to construct a Spatiotemporal Correlation Discrimination of HFMD. Utilizing ARC ENGINE and C# programming for the creation of a spatio-temporal database dedicated to HFMD to facilitate data collection and analysis. The scientific validity of the proposed method was verified by comparing the effective reproduction number obtained by the traditional SEIR model.ResultsWe have ascertained the optimal search radius for the spatiotemporal search model to be 1.5 km. Upon analyzing the resulting Re values, which range from 1.14 to 4.75, we observe a skewed distribution pattern from 2015 to 2019. The median and quartile Re value recorded is 2.42 (1.98, 2.72). Except for 2018, the similarity coefficient r of the years 2015, 2016, 2017, and 2019 were all close to 1, and p <0.05 in the comparison of the two models, indicating that the Re values obtained by using the search model and the traditional SEIR model are correlated and closely related. The results exhibited similarity between the Re curves of both models and the epidemiological characteristics of HFMD. Finally, we illustrated the regional distribution of Re values obtained by the search model at various time intervals on Geographic Information System (GIS) maps which highlighted variations in the incidence of diseases across different communities, neighborhoods, and even smaller areas.ConclusionThe model comprehensively considers both temporal variation and spatial heterogeneity in disease transmission and accounts for each individual's distinct time of onset and spatial location. This proposed method differs significantly from existing mathematical models used for estimating Re in that it is founded on reasonable scientific assumptions and computer algorithms programming that take into account real-world spatiotemporal factors. It is particularly well-suited for estimating the Re of infectious diseases in relatively stable mobile populations within small geographical areas.

Superior vena cava syndrome: presentation of 7 cases and literature review

Superior vena cava syndrome (SVCS) is the result of obstruction of venous flow through the SVC. Mortality due to SVCS is rare (0.3%); however, the median survival in patients with SVCS secondary to malignancy is 6 months. Extrinsic occlusion due to malignancy is the most common cause; however, intraluminal thrombosis secondary to central venous catheters and pacemaker wires represents 30% of cases. The SVC is the main drainage pathway for the head, neck, and upper torso region, so SVCS is characterized by facial and neck edema, dyspnea, and distension of the neck and chest veins. Symptoms vary depending on the severity, location, and speed of onset of the obstruction and the establishment of collateral veins. Diagnosis is based on clinical presentation and imaging studies such as chest angiotomography and digital subtraction venography (gold standard). Regarding treatment, radiation therapy and chemotherapy were considered first-line; however, nowadays endovascular therapy (ET) (angioplasty, stent placement, and catheter-directed thrombus extraction) has demonstrated higher success rates and lower recurrence rates. Surgical diversion is reserved for cases of extensive venous thrombosis or occlusion not amenable to ET. We conducted a literature review and described 7 cases of SVCS treated with successful ET and their main complications at the national cancer institute of Mexico. SVCS is a condition with a diagnostic challenge. Currently, the use of endovascular treatment through angioplasty and stent placement leads to immediate improvement in patients, thus establishing it as first-line treatment.

CT-based finite element simulating spatial bone damage accumulation predicts metastatic human vertebrae strength and stiffness.

Introduction: Pathologic vertebral fractures are devastating for patients with spinal metastases. However, the mechanical process underlying these fractures is poorly understood, limiting physician's ability to predict which vertebral bodies will fail. Method: Here, we show the development of a damage-based finite element framework producing highly reliable pathologic vertebral strength and stiffness predictions from X-Ray computed tomography (CT) data. We evaluated the performance of specimen-specific material calibration vs. global material calibration across osteosclerotic, osteolytic, and mixed lesion vertebrae that we derived using a machine learning approach. Results: The FE framework using global calibration strongly predicted the pathologic vertebrae stiffness (R 2 = 0.90, p < 0.0001) and strength (R 2 = 0.83, p = 0.0002) despite the remarkable variance in the pathologic bone structure and density. Specimen-specific calibration produced a near-perfect prediction of both stiffness and strength (R 2 = 0.99, p < 0.0001, for both), validating the FE approach. The FE damage-based simulations highlighted the differences in the pattern of spatial damage evolution between osteosclerotic and osteolytic vertebral bodies. Discussion: With failure, the FE simulation suggested a common damage evolution pathway progressing largely localized to the low bone modulus regions within the vertebral volume. Applying this FE approach may allow us to predict the onset and anatomical location of vertebral failure, which is critical for developing image-based diagnostics of impending pathologic vertebral fractures.

Modelling ultrasonic cavitation onset in spiral-wound reverse osmosis modules

A model was developed to predict the onset of inertial cavitation within a spiral-wound reverse osmosis module sonicated along its axis from within its pressure vessel. The aim was to investigate the scalability of ultrasonic antifouling for reverse osmosis applications. The model employs a one-dimensional discretization to represent the module feed channel, calculating each element's pressure, flow rate, permeate flux, and sonication intensity. The Blake threshold assesses whether the pressure amplitude at each element is sufficient to produce inertial cavitation. When applied with parameters from a typical small-scale reverse osmosis module, the model identified a linear relationship between inlet pressure and inertial cavitation onset location, with a constant inlet flow rate and sonication power. With a sonication power of 120 W and a flow rate of 8.796 × 10−5 m3 s−1, the model predicted that inertial cavitation could be induced throughout the reverse osmosis module with inlet pressures ranging from 335 kPa to 355 kPa. While these pressures may be inefficient from a permeate production standpoint compared to standard operating pressure, they could be produced temporarily as part of a regular membrane cleaning operation. The model estimates the system's power consumption during cleaning to be 134.8 W, approximately equal to the estimated system energy requirements under recommended operating conditions of 134.3 W. This suggests that this technology could integrate effectively with existing reverse osmosis systems.

Change of El Niño onset location around 1970

A shift of El Niño onset location from eastern Pacific (EP) to western Pacific (WP) occurred around 1970. It was accompanied by a faster mean sea surface temperature (SST) warming in WP and a change of precursory SST and wind anomaly patterns. The eigenvalue analysis of a simple coupled model shows that an SST anomaly (SSTA) in WP may grow under the post-1970 mean condition but cannot under the pre-1970 mean condition. As a result, a warm SSTA appeared in WP accompanying to a preceding La Niña condition in EP after 1970, whereas such a warming was rarely seen before 1970. The preceding SSTA patterns led to distinctive zonal wind responses in EP, favoring El Niño onset in EP prior to 1970. For the post-1970 El Niño onset, an initial warming in WP was induced by anomalous downward solar radiation in association with atmospheric meridional overturning circulation or anomalous horizontal advection associated with thermocline induced eastward geostrophic currents.

High-speed cryo-microscopy reveals that ice-nucleating proteins of Pseudomonas syringae trigger freezing at hydrophobic interfaces.

Ice-nucleating proteins (INpro) trigger the freezing of supercooled water droplets relevant to atmospheric, biological, and technological applications. The high ice nucleation activity of INpro isolated from the bacteria Pseudomonas syringae could be linked to the aggregation of proteins at the bacterial membrane or at the air-water interface (AWI) of droplets. Here, we imaged freezing onsets, providing direct evidence of these proposed mechanisms. High-speed cryo-microscopy identified the onset location of freezing in droplets between two protein-repellent glass slides. INpro from sterilized P. syringae (Snomax) statistically favored nucleation at the AWI of the droplets. Removing cellular fragments by filtration or adding surfactants increased the frequency of nucleation events at the AWI. On the other hand, cultivated intact bacteria cells or lipid-free droplets nucleated ice without an affinity to the AWI. Overall, we provide visual evidence that INpro from P. syringae trigger freezing at hydrophobic interfaces, such as the AWI or the bacterial membrane, with important mechanistic implications for applications of INpro.

Comparison of Medicare Claims-based Clostridioides difficile infection classification to chart review using a linked cohort

Background: Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. Categorizing CDI based on location of onset and potential exposure is critical in understanding transmission patterns and prevention strategies. While claims data are well-suited for identifying prior healthcare utilization exposures, they lack specimen collection and diagnosis dates to assign likely location of onset. Algorithms to classify CDI onset and healthcare association using claims data have been published, but the degree of misclassification is unknown. Methods: We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016-2020 to Medicare beneficiaries using residence, birth date, sex, and hospitalization and/or healthcare exposure dates. Uniquely linked patients with fee-for-service Medicare A/B coverage and complete EIP case report forms were included. Patients with a claims CDI diagnosis code within ±28 days of a positive CDI test reported to EIP were categorized as hospital-onset (HO), long-term care facility onset (LTCFO), or community-onset (CO, either healthcare facility-associated [COHCFA] or community-associated [CA]) using a previously published algorithm based on claim type, ICD-10-CM code position, and duration of hospitalization (if applicable). EIP classifies CDI into these categories using positive specimen collection date and other information from chart review (e.g. admit/discharge dates). We assessed concordance of EIP and claims case classifications using Cohen’s kappa. Results: Of 10,002 eligible EIP-identified CDI cases, 7,064 were linked to a unique beneficiary; 3,451 met Medicare A/B fee-for-service coverage inclusion criteria. Of these, 650 (19%) did not have a claims diagnosis code ±28 days of the EIP specimen collection date (Table); 48% (313/650) of those without a claims diagnosis code were categorized by EIP as CA CDI. Among those with a CDI diagnosis code, concurrence of claims-based and EIP CDI classification was 68% (κ=0.56). Concurrence was highest for HO and lowest for COHCFA CDI. A substantial number of EIP-classified CO CDIs (30%, Figure) were misclassified as HO using the claims-based algorithm; half of these had a primary ICD-10 diagnosis code of sepsis (226/454; 50%). Conclusions: Evidence of CDI in claims data was found for 81% of EIP-reported CDI cases. Medicare classification algorithms concurred with the EIP classification in 68% of cases. Discordance was most common for community-onset CDI patients, many of whom were hospitalized with a primary diagnosis of sepsis. Misclassification of CO-CDI as HO may bias findings of claims-based CDI studies.

Laser interstitial thermal therapy of a single nodule in a complex epileptic network with multiple periventricular nodular heterotopias.

Surgical management of drug-resistant epilepsy (DRE) in patients with multiple periventricular nodular heterotopias (PVNHs) is challenging. Identifying the location of seizure onset within these complex epileptic networks is difficult, and open resection carries risks of injury to surrounding functional white matter tracts such as optic radiations (ORs). The authors demonstrate tractography-assisted laser ablation of a single nodule in a patient with DRE and multiple PVNHs. Following surgery, visual fields were intact, highlighting the benefits of OR tractographic reconstruction. At 12 months postoperatively, the patient remained seizure free, suggesting the potential efficacy of targeting a single heterotopia within complex networks in well-selected cases. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2417.

The role of prediction and visual tracking strategies during manual interception: An exploration of individual differences.

The interception (or avoidance) of moving objects is a common component of various daily living tasks; however, it remains unclear whether precise alignment of foveal vision with a target is important for motor performance. Furthermore, there has also been little examination of individual differences in visual tracking strategy and the use of anticipatory gaze adjustments. We examined the importance of in-flight tracking and predictive visual behaviors using a virtual reality environment that required participants (n = 41) to intercept tennis balls projected from one of two possible locations. Here, we explored whether different tracking strategies spontaneously arose during the task, and which were most effective. Although indices of closer in-flight tracking (pursuit gain, tracking coherence, tracking lag, and saccades) were predictive of better interception performance, these relationships were rather weak. Anticipatory gaze shifts toward the correct release location of the ball provided no benefit for subsequent interception. Nonetheless, two interceptive strategies were evident: 1) early anticipation of the ball's onset location followed by attempts to closely track the ball in flight (i.e., predictive strategy); or 2) positioning gaze between possible onset locations and then using peripheral vision to locate the moving ball (i.e., a visual pivot strategy). Despite showing much poorer in-flight foveal tracking of the ball, participants adopting a visual pivot strategy performed slightly better in the task. Overall, these results indicate that precise alignment of the fovea with the target may not be critical for interception tasks, but that observers can adopt quite varied visual guidance approaches.

Clinical and genetic factors affecting diagnostic timeline of amyotrophic lateral sclerosis: a 15-year retrospective study

ABSTRACT Objectives Amyotrophic Lateral Sclerosis (ALS) diagnosis can take 10–16 months from symptom onset, leading to delays in treatment and patient counselling. We studied the impact of clinical and genetic risk factors on the diagnostic timeline of ALS. Methods Baseline characteristics, family history, gene testing, onset location, time from symptom onset to diagnosis, and time from first doctor visit to suspected ALS was collected. We used multiple regression to assess the interaction of these factors on ALS diagnostic timeline. We analysed a subgroup of patients with genetic testing and compared positive or negative tests, sporadic or familial and ALS-related genes to time for diagnosis. Results Four hundred and forty-eight patients diagnosed with ALS at the University of Massachusetts Chan Medical Center between January 2007 and December 2021 were analysed. The median time to ALS diagnosis was 12 months and remained unchanged from 2007 to 2021 (p = 0.20). Diagnosis was delayed in patients with sporadic compared with familial ALS (mean months [standard deviation], 16.5[13.5] and 11.2[8.5], p < 0.001); cognitive onset (41[21.26]) had longer time to diagnosis than bulbar (11.9[8.2]), limb (15.9[13.2]), respiratory (19.7[13.9]) and ALS with multiple onset locations (20.77[15.71], p < 0.001). One hundred and thirty-four patients had gene testing and 32 tested positive (23.8%). Gene testing (p = 0.23), a positive genetic test (p = 0.16), different ALS genes (p = 0.25) and sporadic (p = 0.92) or familial (p = 0.85) ALS testing positive for ALS genes did not influence time to diagnosis. Discussion Time for ALS diagnosis remained unchanged from 2007 to 2021, bulbar-onset and familial ALS made for faster diagnosis.

Permulaan Gelembung Plasma Khatulistiwa Semasa Angin Neutral Kuat dan Lemah di Asia Tenggara

Equatorial plasma bubbles (EPBs), which are depletions in the ionosphere disrupting radio waves, exhibit complex dynamics influenced by neutral winds. The present study aims to investigate the relationship between the onset of EPBs and the velocities of neutral winds. The onset of EPBs was determined from the rate of the Total Electron Content Index (ROTI) keogram obtained using Global Positioning System (GPS) data over the Southeast Asia sector. Meanwhile, thermospheric neutral winds were measured using a Fabry-Perot interferometer (FPI), and the height of the F layer was acquired from an ionosonde, both instruments positioned in Kototabang (KTB), Indonesia. The observations are classified into two cases based on the strength of winds: strong and weak winds on different nights. This study successfully reported the onset time and location of EPBs occurred at 1320 UT (2120 LT) and 100° (500 km) longitude, attributed to pre-reversal enhancement (PRE). We conclude that thermospheric neutral wind makes a significant contribution to the observed onsets of EPBs driven in the zonal direction. Therefore, this finding reinforces past studies that have shown an increase in the height of the F layer could play an important role in determining the onset of EPBs.

Diazepam nasal spray administration is effective to control seizure clusters irrespective of time of day

IntroductionNeurologic circadian influences, including sleep/wake transitions, processes (e.g., hormonal variation), and behavioral patterns (e.g., consumption of food and oral medications), may affect seizure patterns. Specific circadian patterns of seizures have been reported depending on type, onset location, and severity; however, data on patterns for patients with seizure clusters and effectiveness of rescue therapy by time of day are limited.MethodsWe conducted post hoc analyses using patient diary data from the phase 3 safety study of diazepam nasal spray, which is indicated for acute treatment of seizure clusters in patients with epilepsy aged ≥6 years. Patients were administered age- and weight-based doses; second doses could be administered if needed to control a seizure cluster. We assessed clock timing of seizure-cluster onset along with second-dose use as a proxy for effectiveness. Treatment-emergent adverse events were recorded.ResultsSeizure-cluster onset was observed to be generally highest during mornings and late evenings and lowest in the early evening and middle of the night. Second-dose use was not consistently associated with a specific time of day. The safety profile was consistent with that expected from previous studies of diazepam nasal spray.ConclusionThese results suggest that diazepam nasal spray can be effectively administered at any time of day.

Analysis of Heat Transfer of Molten Salts Startup Flow in Cold Pipes Avoiding Freezing in Solar and Nuclear Energy Systems

Abstract Molten salts are employed as the heat transfer fluid to carry the thermal energy from a solar receiver or a nuclear reactor for delivering to thermal storage systems or thermal power plants for power generation. For the startup operation, molten salts need to be pumped to flow into the pipes which may have lower temperature than the freezing point of molten salt due to the cold ambient temperature overnight or over the suspension of operation. Preventing the freezing of molten salt in cold pipes becomes a critical issue to the safe operation of a concentrating solar thermal power plant or a molten salt nuclear power plant. This study conducted a basic heat transfer analysis of the transient heat transfer from flowing molten salt to a cold pipe to determine the length from entrance to the onset of freezing of the fluid. From our modeling and analytical solution using method of characteristics, the correlation of the location of onset of freezing of molten salt with respect to the flow velocity, heat capacities of molten salt and pipes, dimension of the pipes, and the initial temperatures of salts and pipes, have been understood clearly. The modeling and computational tool can fundamentally help engineers to design a system to avoid freezing and clogging at cold startup when molten salt is applied as a heat transfer fluid.

"To be meridian or collateral" in meridian-collateral differentiation

Identifying the study subject, "to be in meridian or collateral", is the first step of meridian-collateral differentiation. Combined with the ancient literature and clinical practice of acupuncture and moxibustion, the methods of identifying "to be in meridian or collateral" and its values are elaborated. Through analyzing the onset location of symptoms and the body layers of lesions, as well as the palpation and observation in meridian-collateral detection, "to be meridian" or "to be collateral" is identified in disease diagnosis. It may guide the choice of techniques of acupuncture and moxibustion. Identifying "to be meridian or collateral" is crucial in meridian-collateral differentiation, which not only contributes to improving the therapeutic effect of acupuncture and moxibustion, but also to better recognizing diseases and understanding the relevant concepts of techniques of acupuncture and moxibustion in view of acupuncture and moxibustion, and perfecting the system of meridian-collateral differentiation.

Analysis of onset-to-door time and its influencing factors in Chinese patients with acute ischemic stroke during the 2020 COVID-19 epidemic: a preliminary, prospective, multicenter study

BackgroundPre-hospital delay in China is a serious issue with unclear relevant reasons, seriously impeding the adoption of appropriate measures. Herein, we analyzed the onset-to-door time (ODT) in Chinese patients with acute ischemic stroke (AIS) and its influencing factors.MethodsWe prospectively recruited 3,459 patients with AIS from nine representative tertiary general hospitals in China between January and June 2022. Patients were divided into ODT ≤ 3 h and ODT > 3 h groups. Following single-factor analysis, binary logistic regression analysis was performed to evaluate the risk factors leading to pre-hospital delay.ResultsIn total, 763 (21.83%) patients arrived at the hospital within 3 h of onset. After adjusting for confounding factors, the risk factors for ODT were residence in rural areas (odds ratio [OR]: 1.478, 95% credibility interval [CI]: 1.024–2.146) and hospital transfer (OR: 7.479, 95% CI: 2.548–32.337). The protective factors for ODT were location of onset ≤ 20 km from the first-visit hospital (OR: 0.355, 95% CI: 0.236–0.530), transportation by emergency medical services (OR: 0.346, 95% CI: 0.216–0.555), history of atrial fibrillation (OR: 0.375, 95% CI: 0.207–0.679), moderate stroke (OR: 0.644, 95% CI: 0.462–0.901), and severe stroke (OR: 0.506, 95% CI: 0.285–0.908).ConclusionsMost patients with AIS fail to reach a hospital within the critical 3-h window. The following measures are recommended to reduce pre-hospital delays: reasonable distribution of hospitals accessible to nearby residents, minimizing interhospital transfer, paying attention to patients with mild stroke, and encouraging patients to use ambulance services. Pre-hospital delays for patients can be reduced by implementing these measures, ultimately improving the timeliness of treatment and enhancing patient prognosis. This study was carried out amid the COVID-19 pandemic, which presented challenges and constraints.