Objective: To study the effect of COVID-19 on pregnancy, neonatal outcomes; and the use of PPE amongst clinicians caring for COVID-19 patients. Design: Prospective cohort study Setting: A large tertiary maternity unit within a university hospital with an average annual >10,000 births. Population: A cohort of 23 pregnant women including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive. Methods: Analysis of prospectively collected data to assess the effect of COVID-19 on pregnancy, neonatal outcomes; and staff use of PPE. Main outcome Measures Maternal and neonatal morbidity and mortality, and the use of PPE when interacting with COVID-19 patients Results: 23 pregnant women tested positive for COVID-19, delivering 20 babies. 16/23 (70%) were women from Asian background. Nearly fifth of the patients (4/23) developed severe respiratory complications requiring ICU support, one of which was complicated by maternal death (4.3%). (48%) of the patients had pre-existing co-morbidities, with diabetes being the most prevalent (17.4%). (36.4%) of COVID-19 pregnancies had preterm deliveries, (10.5%) respiratory distress, and pre-eclampsia. 16/23 (68%) of patients delivered by C-section. Out of the 20 new-borns, there were no cases of vertical transmission. FFP3 masks were not used by staff in (28.8%) of cases with confirmed COVID-19 infection. Conclusion: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. There was no clinical evidence of vertical transmission to the new-borns. PPE use was compliant with WHO recommendations. Funding N/A Keywords COVID-19; maternal morbidity/mortality; neonatal morbidity/mortality; PPE

Assessing the structural integrity of a cracked weldment is significant in engineering. When cracks are detected during welding inspection, they must fit the mechanical resistance of the structure. Generally, fracture mechanics supplies the essential tools to examine cracked structures in order to determine a fracture criterion for loading conditions. This study explores the effect of residual stress (RS) and crack orientation on determining the stress intensity factor (K_I) in mode I for a welded joint using the extended finite element method (XFEM). This research consists of two parts. The first part is a 3D thermo-mechanical finite element (FE) analysis that is established to study the temperature history and the residual stress distribution of a welded joint. The second part is a 3D FE crack model that establishes two cases of cracks, longitudinal and transverse cracks, in order to calculate K_I and J-integral values at the middle surface of a thin butt joint. K_I is calculated for cracks under applied external stress and residual stress. The results demonstrate that the effect of the welding residual stress on K_I is either beneficial or detrimental, depending on the stress distribution and sign. Moreover, the results indicate the significance of RS and crack orientation on K_I. From the simulation performed during the analysis, we show that the longitudinal crack in case (I) has higher K_I values than those in case (II) for the transverse crack. Finally, the finite element results are in good agreement with the analytical results.

Human overexploitation of natural resources has placed conservation and management as one of the most pressing challenges in modern societies, particularly regarding highly vulnerable marine ecosystems. Although a large effort has been made to design Marine Protected Areas (MPAs) worldwide, it is still unclear how many species actually exist in these MPAs, what is the genetic connectivity between areas with different protective regimes, and what is their relative genetic diversity. We answer these questions using morphologically cryptic species of the genus Mugil that are sympatric in the largest MPA in the Tropical Southwestern marine province. Population structure analyses show the existence of five highly divergent species (FST > 0.855) and no genetic divergence between two estuaries with different protection status (FST = 0.005). Sympatric individuals are assigned to single clusters and show strong concordance among hundreds of independent gene trees, consistent with full reproductive isolation and no ancestral nor ongoing hybridization. Differences of genetic diversity within species suggest that effective population sizes differ up to two-fold, probably reflecting differences in the magnitude of population expansions during the evolutionary history of these species, rather than recent impact of fisheries. Together, our results suggest that designing MPAs with areas of integral protection in between areas where fisheries are permitted could be an effective way to manage cryptic species that cannot have species-specific quotas. More generally, this work shows a cost-efficient approach that is transferable to other marine or terrestrial organisms of special concern, helping to implement science-based regulations for management and conservation.

  AbstractThe first purpose of this study is to describe a project focused on comparing the numbers of COVID-19 cases and deaths in the United States reported by four different online trackers, namely, those maintained by USAFacts, the New York Times, Johns Hopkins University, and the COVID Tracking Project. The second purpose of this study is to present results from the first five months of 2020 (January 22-May 31, 2020). This project is ongoing, so it will be updated regularly as new data from each of these trackers become available. Based on the time period included, the NYT has reported more cases than any of the other three trackers since late March/early April, and COVID Tracking Project has reported fewer deaths than any of the other three trackers since mid-March. It is hoped that the discrepancies identified by this project will provide avenues for research on their causes.IntroductionThis study aims to describe a regularly updated project I have been (and still am) conducting, the aim of which is to compare the number of COVID-19 cases and deaths in the United States reported by four different online trackers. In doing this, I hope to provide evidence either for or against the hypothesis that there are systematic differences between the values reported by the different trackers.The four COVID-19 United States-specific datasets I will be comparing are from USAFacts, the New York Times (hereafter NYT), Johns Hopkins University (hereafter JHU), and the COVID Tracking Project. First of all, there are some differences in the start dates for each of the four datasets. All of them started on January 22, except for the NYT, which started a day earlier (January 21).The total number of cases in the United States reported by each tracker were compared over time for each date from the first date including all four trackers (i.e. January 22, 2020) to the last day of May (i.e. May 31, 2020). This comparison was done to shed light on the extent to which the number of cases reported by the four included trackers, namely COVID Tracking Project, NYT, JHU, and USAFacts (hereafter simply "the four trackers") differed and how these differences had changed over time. Below, I give the URLs from which I obtained the data from each source used in this study.The COVID Tracking Project data was obtained from this link: https://covidtracking.com/data/us-daily/ The NYT data was obtained from this link: https://github.com/nytimes/covid-19-data/blob/master/us.csv The JHU data was obtained from this link: https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_daily_reports_us Finally, the USAFacts data was obtained from this link for cases: https://usafactsstatic.blob.core.windows.net/public/data/covid-19/covid_confirmed_usafacts.csv and this link for deaths: https://usafactsstatic.blob.core.windows.net/public/data/covid-19/covid_deaths_usafacts.csvResultsComparing the number of cases across the four trackersThe total number of cases over time reported by each of the four trackers is shown graphically in Figure 1. It is clear that all four match up very closely, as would be expected if they are both largely successful in their shared goal of measuring the same underlying value.

Objectives: The clinical characteristics and outcomes of COVID-19 pneumonia in children are different with adults. We evaluated the clinic characteristics and communicable period of COVID-19 pneumonia in pediatric patients of Changsha, capital of Hunan province. Methods: This is a retrospective study. We enrolled all 12 COVID-19 pneumonia pediatric patients and 134 adult patients in the Public Healthy Medical Center of Changsha from 29th Jan. to 20th Feb. Final date of follow-up was 10th Mar. We analyzed the characteristics and communicable period communicable period of pediatric patients, compared the differences between the pediatric and adult patients. Results: Of the pediatric patients enrolled, the median age was 8.5 years old. Four (33.3%) children were asymptomatic, but one had image changes. Fever 5(41.67%) and cough 4(33.33%) were the most common symptoms at onset of illness. Leukopenia, ALT/AST, LDH, CRP and PCT elevation were significantly less than adults. Only six children (50%) showed chest CT images changes. All patients were given antiviral drugs and supportive treatment. The estimated median communicable period was 15(8–17.75) days, which was significantly longer than adult patients 10 (8-12) days (P=0.044). However, the clinic cause of adult patients was much severe than pediatric patients, including Leukopenia, CRP elevation, typical radiological changes, clinic classification, and supporting therapy. Conclusion: In summary, majority of pediatric patients have a mild clinic cause and longer communicable period than adult, so they may need a longer quarantine period likely to be a supper source of infection.

Experiments were conducted in the 2017 and 2018 growing seasons. Halisbey, NC-7, and Sultan peanut cultivars were used as the plant material. Irrigation intervals were set as two and four days, and irrigation levels were set as 50% (I50), 75% (I75), 100% (I100) and 125% (I125) of Class-A pan evaporations. Oil content, unsaturated and saturated fatty acids of peanut cultivars were determined. Experimental data were initially subjected to variance analysis, then regression analyses were conducted for irrigation intervals, and irrigation levels of the cultivars and biplot analysis was performed to assess the cultivar x irrigation interval x irrigation level interactions. For oil content, treatments were identified as the most appropriate irrigation for a two-day irrigation interval of all cultivars; I100 for four-day irrigation interval of Halisbey and Sultan cultivars and I75 for four-day irrigation interval of NC-7. Oleic, linoleic, and palmitic acids were the major fatty acids of peanuts. Cultivars exhibited different variations in these fatty acids based on irrigation intervals and irrigation levels. In all cultivar, the irrigation intervals and irrigation levels with a high oleic acid content yielded low linoleic and palmitic acid contents. According to present biplot and regression analyses, the greatest oleic acid contents were obtained from two and four-day irrigation intervals of I50 treatments in Halisbey and NC-7 cultivars and from two and four-day irrigation intervals of I75 treatments of the second year in Sultan cultivar. Present findings revealed that for quality peanut production, both irrigation intervals and irrigation levels should be taken into consideration.

In rural areas of the State of Hidalgo, Mexico, the maguey red worm or chinicuil (Comadia redtenbacheri Hamm.) and the maguey white worm (Aegiale hesperiaris Walk) are generally consumed dehydrated, while in urban areas they are eaten fried with butter. However, although their organoleptic characteristics improve, the effect on nutritional properties is unknown. Therefore, the objective of this study was to compare the proximal chemical composition and quality of fatty acids in butter-fried worms that are commercially available. In order to measure the oils quality, a chemical analysis and an instrumental analysis were performed. Lipids were predominant in dehydrated (40.11-44.67%) and fried (47.67-56.83%) samples. Moisture and temperature were the variables that increased the degradation of lipids in the samples. In the dehydrated and fried samples there were differences in the percentages of saturated and unsaturated fatty acids with 72.82-76.81% and 15.17-16.07% and 27.18-23.19% and 84.82-83.93%, respectively. Since the lipid material used to fry the worms was reused and is oxidized, so a control of the heat treatment or changing the cooking method is suggested.

L’ air sparging è una tecnica di bonifica che rientra nelle tecnologie di ventilazione del suolo, si applica in situ ed interessa la zona satura del terreno. Viene utilizzata per la rimozione dei composti organici volatili. Il principio di funzionamento si basa sull’ iniezione di aria nella zona satura, al di sotto della zona contaminata, in maniera tale da mobilitare i composti volatili che vengono poi intercettati nella zona parzialmente satura attraverso dei sistemi di Soil Vapor Extraction. Obiettivo del lavoro in presentazione è quello di mettere in evidenza le caratteristiche dell'air sparging prendendo a riferimento un'applicazione a scala reale di tale tecnologia.

Many Western countries have been affected by the outbreak of COVID-19. Italy has been particularly hit at the beginning of the pandemic, immediately after China. In Italy and elsewhere women seem to be less affected then men by severe/fatal COVID-19 infection, regardless of their age. Despite the evidence that women and men are different fort this infection, very few studies consider different therapeutic approaches for the two sexes. Undoubtedly, understanding the mechanisms at the bases of these differences may help to find appropriate and sex specific therapies. Here we consider that other mechanisms but estrogen protection are involved. Several X-linked genes (such as ACE2) and Y-linked genes (SRY, SOX9) may explain sex differences. Cardiovascular comorbidities are among the major enhancers of virus lethality. In addition, the number of sex-independent non-genetic factors that can change susceptibility and mortality is enormous, and many other factors are likely to be considered, including gender and cultural habits in different countries.

Purification of biodiesel with dry adsorbents is an alternative method, as it uses compounds that eliminate the need for water in the process without generating liquid effluent. Currently, there is little discussion about the reuse of different types of adsorbents and in this context, the present work presents an efficient method of purification and investigates the performance of the reuse of Magnesol® in the purification of biodiesel in order to generate less waste to the environment. Therefore, the Magnesol® used was washed with several solvents with different polarity characteristics. Among the solvents tested, THF is the best solvent for the purification of Magnesol® and, after optimizing the Magnesol® purification process, it was concluded the best conditions are three washes in solvent / adsorbent ratio 30:1 at room temperature, resulting in only 3.89% of the residual value of contaminants and being an alternative for biodiesel companies.

Background and Purpose The active ingredients analysis of herbal medicines is crucial for their quality control and efficacy/safety evaluation. Here, we propose a new strategy for effectively and rapidly analyzing the active ingredients of herbal medicines based on the public bioinformatics platforms. In the study, the treatment of osteoarthritis (OA) by Herba Lysimachiae (HL) was used as an example to practice this strategy. Experimental Approach Applying the public databases (PubChem BioAssay and STRING) to establish the links between herbal compounds and the biolabels (integrin alpha 2b/beta 3) of HL treating OA, from which herbal compounds that may regulate both biolabels were screened. OA model was used to confirm the analysis results. Key Results Five compounds (myricetin, fisetin, esculetin, 7-hydroxycoumarin-4-acetic acid, and caffeic acid) from HL synergistically regulated both biolabels through eleven targets, which may be the active ingredients of HL treating OA. Conclusion and Implications The experiments in the OA model verified the analysis results. With the help of the analysis strategy, the present study effectively and rapidly analyzes the active ingredients of HL treating OA. The example in this research also verifies the feasibility of this strategy, which is of reference significance to the related studies of other herbal medicines.

In SARS-CoV2 infections causing coronavirus disease-2019 (COVID-19) metabolic co-morbidities portend worse disease outcomes. We aimed at understanding the pathogenetic mechanisms underlying this phenomenon that may differentiate SARS-CoV2 infection from few other respiratory viruses that caused more limited pandemics in the recent past. A meta-analysis, of publicly available gene expression studies on human lung epithelial cells (HLEC) infected with different respiratory viruses, revealed both shared and exclusive transcriptional regulations. In addition, a few key metabolic pathways were found to be exclusively enriched in SARS-CoV2 infection. Systemic metabolic disorders are known to cause similar dysregulations in HLECs, which possibly underlie the predisposition of diabetic individuals to chronic lung diseases. We further performed an integrated analysis of the transcriptome from SARS-CoV2-infected HLECs, COVID-19 bronchoalveolar lavage and autopsied lung transcriptome as well as lung transcriptome from preclinical models of diet-induced obesity, revealing significant overlaps among these key pathways in these discreet contexts. This led us to hypothesize that with underlying metabolic co-morbidities this metabolic dysregulation of the HLECs on SARS-CoV2 infection is aggravated promoting widespread disruption of lung epithelial integrity, driving the worse prognosis. We envisage that any therapeutic agent that can target these key featured pathways, viz. metformin, should be of interest in SARS-CoV2 infection and warrants further studies.

BJOG perspectives

The present study investigates numerically symmetry simulation of two-phase nanofluid flow and heat transfer in a 3D diamond shape cavity equipped with square-shaped obstacle and decreasing dimensions. The studied material in the present study is assumed with two different emissivity values, ԑ = 0.3 and ԑ = 0.9, due to analyze the effects of emissivity values on radiation heat transfer. Also two different Rayleigh numbers, Ra=106 and 108. The heat transfer fluid is water-based Cu nanofluid which makes a Newtonian nanofluid, but other base fluid is also analyzed. The main aim of present work is to simulate the 3D diamond shape cavity equipped with square-shaped obstacle and decreasing dimensions geometry using symmetry method and also investigate the effects of different Rayleigh numbers, emissivity values and different nanoparticles volume concentrations on thermal and hydraulic characteristics of the model. Base on obtained results, by an increase of nanoparticles volume concentration the temperature gradients and heat transfer characteristics are improved but the streamlines have not a significant change and by an increase of nanoparticles volume concentration the temperature gradients and heat transfer characteristics are improved, but the streamlines have not a significant change. According to results at higher Rayleigh numbers, the heat transfer characteristics are enhanced. Also, it is found that higher Rayleigh numbers and nanoparticles volume concentrations lead to more heat transfer inside the cavity and changes in emissivity coefficients have not a significant effect on heat transfer characteristics and nanofluid flow in the cavity.

Aim To observe the clinical effect of small splint fixation and Gukangling-Fluid in the treatment of patients with closed trauma fractures. Materials and Methods Methods: the patients were divided into two groups: 350 cases of Gukangling-Fluid treatment group and 84 cases of conventional western medicine plaster control group. Results Results statistically significant difference was found between the two groups (P<0.001). The total effective rate of the experimental treatment group was 92 %, and that of the conventional western medicine control group was 72 %. Conclusion Gukangling-Fluid has a good effect on the treatment of closed fracture.

Aim To observe the clinical efficacy and healing time of small splint fixation and Gukangling-Flquid in the treatment of patients with closed traumatic fracture treated with conventional western medicine plaster fixation. Methods The patients were divided into two groups:Gukangling-Flquid treatment group and western medicine conventional plaster control group. Results The total effective rate of the experimental treatment group was higher than that of the conventional western medicine control group. Conclusion Gukangling-Flquid has a good curative effect on the treatment of closed fractures. The clinical healing time of Gukangling-Flquid is one third earlier than that of conventional western medicine.

Estimation of the crop coefficient (Kc) in the conventional crop coefficient EvapoTranspiration (ET) method requires detailed knowledge of geo/biophysical properties of the coupled land–vegetation system, precipitation, along with monitoring soil moisture gradient. In practice, precise quantification of these parameters is challenging, if not impossible, which reduces the accuracy of the model significantly. This paper addresses these issues by expressing Kc as a 2nd order polynomial function of relative humidity (RH) and reference ET (ETo) calculated over the same crop, where the coefficients of the function are crop–specific. This shapes the framework of the Ambient Regression Evapotranspiration Model (AREM), a real–time, simple actual ET model. Six years 15-min micrometeorological records of six sites (i.e. corn, soybeans, prairie, and forest) in Iowa, New Hampshire, and California of the USA were used to calibrate the model. The Mean Absolute Percentage Error (MAPE) of the regression was 18.2% during the growing season (days of year 140–260), and 28.4% for the entire year. The Root Mean Square Error (RMSE) was 0.69 mm day–1 with coefficient of determination (R2) = 0.73. The results indicate that AREM requires calibration over various soil types. The average MAPE of 30% over the four Iowan sites was obtained based on inputs from weather stations and NLDAS-2 of NASA, which suggests that the model can be widely employed in practical applications requiring real–time ET with reasonable accuracy. AREM was capable of capturing the dynamics of ET irrespective of varying complexities of biophysical and climatological states.

This paper explores the possibility of AI-based narrative therapy for borderline personality disorder, its potential advantages, drawbacks, and limitations. It is argued that identity disturbance in this condition is strongly connected to self-narratives, and the most important features of narrative therapy, which, in a human-to-human form, is one of the more successful treatment options for BDP, could be adapted to AI. While human oversight cannot and should not be eliminated, AI support would hold forth the prospect of overcoming certain hurdles associated with patient-therapist interaction frequently marring the therapeutic process.

This paper examines drivers of adoption of soil and water conservation measure, and its impact on yield and technical efficiency of maize cultivation using plot level data from drought prone area of Karnataka, India. To account for selection bias from both observable and unobservable factors, an endogenous switching regression model is employed to estimate the impact of technology on yield and technical inefficiency, which is estimated data envelope analysis-meta-frontier approach. Results reveal that adoption of soil and water conservation measure i.e. bunding leads to significant increase yield of maize by 30% and reduces technical inefficiency by 28%. Further, results reveal that farmers’ access to credit, extension services, access to credit and extension services not only has positive influence on the adoption of soil and water conservation measures, but also associated with higher technical efficiency. Overall, results point to need further scaling of soil and water conservation measures for greater adoption, particularly in drought prone areas. The paper concludes that policymakers and development organizations should consider soil and water conservation as main strategy improve the crop productivity, and thereby the livelihoods, particularly of resource poor farmers.

The failure analysis of an elbow tube of a pyrolysis furnace after three years of service which is only one third of the designed life span has been studied. An investigation to identify the root causes of the failed tube was carried out by macro inspections, chemical composition analysis, metallographic microscopy, scanning electron microscope (SEM) images and energy disperse spectroscope (EDS) analysis. Through analysis of the failed tube samples, we found no evidence of bulging and thinning, that the cracks originated from the pores and inclusions inside the fusion line of the inner wall, under high temperature and stress effects, that the cracks expanded towards the base material along the circumferential direction of the tube until it breaks.

Molecular tip-dating of phylogenetic trees is a growing discipline that uses DNA sequences sampled at different points in time to co-estimate the timing of evolutionary events with rates of molecular evolution. Such inferences should only be performed when there is sufficient temporal signal within the analysed dataset. Hence, it is important for researchers to be able to test their dataset for the amount and consistency of temporal signal prior to any tip-dating inference. For this purpose, the most popular method considered to-date has been the “root-to-tip regression” which consist in fitting a linear regression of the number of substitutions accumulated from the root to the tips of a phylogenetic tree as a function of sampling times. The main limitation of the regression method, in its current implementation, relies in the fact that the temporal signal can only be tested at the whole tree evolutionary scale. To fill this methodological gap, we introduce PhyloSTemS, a new graphical and user-friendly tool developed to investigate temporal signal at every evolutionary scale of a phylogenetic tree. PhyloSTemS allows detecting without a priori whether any subset of a tree would contain sufficient temporal signal for tip-based inference to be performed. We provide a “how to” guide by running PhyloSTemS on empirical datasets and supply guidance for results interpretation. PhyloSTems is freely available at https://pvbmt-apps.cirad.fr/apps/phylostems.

Tobacco production and curing is the single most important contributor to soil degradation and deforestation. To minimise the environmental effects of tobacco production, the environmentally friendly, and energy-efficient rocket barns technology was developed. In spite of its energy saving and environmental benefits, the adoption of rocket barns remains low and understudied. This paper assessed farmers perception and factors affecting the adoption of rocket barn technology. Data was collected using in a cross-sectional survey using structured questionnaires were from 242 Flue Cured Virginia (FCV) tobacco farmers in Uganda. Analysed was done using SPSS and STATA software. Results show that the adoption of rocket barn technology was low, at 12%, with farmers. Farmers perceived adopting the rocket barns technology to be risky and costly. Experience, training, distance to wood fuel, access to extension information, and benefits and risk perceptions were the major determinants of adoption of rocket barns technology. Promotion and adoption of rocket barns technology will require concerted sensitization and training of farmers on the environmental benefits of rocket barn technology. Emphasis such efforts should target the relatively young and inexperienced FCV tobacco farmers.

Abstract: The commercialised genetically modified papaya ‘Huanong No. 1’ has been utilised to successfully control the destructive virus-Papaya ringspot virus (PRSV) in South China since 2006. However, another new emerging virus, Papaya leaf-distortion mosaic virus (PLDMV), was found in some PRSV-resistant transgenic plants in Guangdong and Hainan provinces through a field investigation from 2012 to 2019. The genetic diversity of the isolates is not clear. In the present study, 20 representative isolates were selected to inoculate ‘Huanong No. 1’, and all of the inoculated plants showed obvious disease symptoms similar to those in the field, indicating that PLDMV is a new threat to widely cultivated transgenic papaya in South China. Phylogenetic analysis of the Coat protein genes of 111 PLDMV isolates from Guangdong and Hainan showed that PLDMV can be divided into two groups. The Japan and Taiwan isolates belong to group I, whereas the Guangdong and Hainan isolates belong to group II and can be further divided into two subgroups. The Guangdong and Hainan isolates were far from the isolates of Japan and Taiwan and belong to a new lineage. Further analysis showed that the Guangdong and Hainan isolates had a high degree of genetic differentiation, and no recombination was found. These isolates deviated from neutral evolution and experienced population expansion events in the past, which might still be unstable. The results of this study provide a theoretical basis for clarifying the evolutionary mechanism and population genetics of the virus and for preventing and controlling the viral disease.

Objective: Recent studies have shown that insulin therapy increased the risk of major cardiovascular adverse events, and the changes of platelet reactivity may be responsible for the clinical outcomes. We attempted to explore the effect of exogenous insulin on platelet function in patients with type 2 diabetes mellitus who were suffering from acute vascular events. Methods: We collected data of 540 diabetes patients with acute ischemic vascular events from the hospital information system. Their platelet reactivity has been reported by the maximum amplitude of adenosine diphosphate-induced platelet-fibrin clots (MAADP) of thromboelastography. The effect of antidiabetic drugs on platelet reactivity was analyzed retrospectively. Stratified regression analysis was carried out to gradually adjust for the demographic data, genetic factors, lifestyle, biochemical indicators, antiplatelet regimen, etc. Results: Univariate linear regression analysis showed that sex, age, body mass index, smoking, low-density lipoprotein, platelet count, CYP2C19*2, antiplatelet regimens, and insulin were related to MAADP. After multiple factors were adjusted, the effect of insulin therapy (95% CI: 0.022-0.664; p =0.036) on MAADP was always statistically significant. Conclusions: Exogenous insulin effects significantly on the level of MAADP in diabetic patients with acute ischemic vascular events, which may be not conducive to antiplatelet therapy.