Search

In recent decades, traditional pathology education methodologies have been noticeably affected by new teaching approaches, including problem-based learning (PBL) and team-based learning (TBL). However, lack of outcome-based studies has hindered the extensive application of the TBL approach in the teaching of pathology in Chinese medical schools. In this study, a pilot TBL format on four topics in pathology was implemented in one session with medical students at Jinan University Medical School and the previous sessions of medical students were able to function as controls. The final exam scores of TBL participants were significantly higher than the scores for non-participants, indicating that the students demonstrated better academic performance at the end of the TBL class. In addition, the follow-up questionnaires revealed that the majority of the TBL participants spent more time studying and were actively and enthusiastically involved in TBL activities. The new teaching format also inspired teachers' desire to lead discussions and administer quizzes instead of repeating rote didactics. Overall, this pilot study reveals that a combination of the TBL approach and traditional pathology theory can improve pathology education.

The aim of this study was to compare the properties of isolated starches from ten commonly consumed rice varieties in China and to investigate their possible association. In addition, principal component analysis (PCA) and correlation analysis were performed to demonstrate the weight or relevance of different properties. The starch granules had an irregular polyhedral structure. The crystalline structure had an orthogonal arrangement, which is characteristic of A-type starch with nanocrystals with an orthorhombic crystal structure. In addition, higher levels of rapidly digestible starch (72.43 to 74.32%) and resistant starch (2.27 to 2.3%) were found in glutinous rice starch. The highest content of slowly digestible starch (59.48%) was found in starch isolated from black rice, which may be an ideal rice variety for controlling blood glucose and weight. Starch isolated from red Hani terrace rice showed the highest thermal stability during cooking and the highest resistance to a high shear force treatment. In addition, the PCA suggests that the amylose content of starch largely determines the functional properties of starch and positively correlates with the peak viscosity and setback viscosity of the starch pasting. The results of this study will enrich the scientific knowledge of various rice starches and promote their application in the food industry and other industries. [ABSTRACT FROM AUTHOR]

The aim of the study was to validate a modified International Classification of Diseases (ICD)-10 based algorithm for identifying hospitalized patients with sepsis.Methods: We retrospectively analyzed a prospective, single-center cohort of adult patients who were consecutively admitted to one medical ICU ward and ten non-ICU wards with suspected or confirmed infections during a 6-month period. A modified ICD-10 based algorithm was validated against a reference standard of Sequential Organ Failure Assessment (SOFA) score based on Sepsis-3. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and areas under the receiver operating characteristic curves (AUROCs) were calculated for modified ICD-10 criteria, eSOFA criteria, Martin's criteria, and Angus's criteria.Results: Of the 547 patients in the cohort, 332 (61%) patients met Sepsis-3 criteria and 274 (50%) met modified ICD-10 criteria. In the ICU setting, modified ICD-10 criteria had SE (84.47%), SP (88.57%), PPV (95.60), and NPV (65.96). In non-ICU settings, modified ICD-10 had SE (64.19%), SP (80.00%), PPV (80.33), and NPV (63.72). In the whole cohort, the AUROCs of modified ICD-10 criteria, eSOFA, Angus's criteria, and Martin's criteria were 0.76, 0.75, 0.62, and 0.62, respectively.Conclusion: This study demonstrated that modified ICD-10 criteria had higher validity compared with Angus's criteria and Martin's criteria. Validity of the modified ICD-10 criteria was similar to eSOFA criteria. Modified ICD-10 algorithm can be used to provide an accurate estimate of population-based sepsis burden of China. [ABSTRACT FROM AUTHOR]

Background: The scarcity of sepsis epidemiologic data from most low- and middle-income countries (LMICs) hampered estimation of regional and global burden of the disease, and provided limited guidance for policy makers. We aimed to characterize and analyze the temporal trends of sepsis-related mortality in China, by population groups, underlying causes of death, geographic regions, and sociodemographic index (SDI) levels. Methods: Sepsis-related deaths were identified from the National Mortality Surveillance System (NMSS) of China from 2006 to 2020. Trends of sepsis-related mortality and years of life lost (YLLs), stratified by age, sex, underlying diseases, and regions were analyzed using the Jointpoint regression analysis. We investigated the association of SDI with trends of sepsis-related mortality. Results: In 2020, sepsis was estimated to be responsible for 986,929 deaths and 17.1 million YLLs in China. Age-standardized sepsis-related mortality significantly declined from 130.2 (95%CI, 129.4–131) per 100,000 population in 2006 to 76.6 (76.3–76.9) in 2020. Age-standardized YLLs decreased from 2172.7 (2169.4–2176) per 100,000 population in 2006 to 1271 (1269.8–1272.2) in 2020. Substantial variations of sepsis-related mortality and YLLs were observed between population groups and regions, with higher burden in males, the elderly, and western China. An inverse relation was noted between SDI and sepsis-related mortality or YLLs. Conclusions: Despite declining trends of age-standardized mortality and YLLs of sepsis in China, significant disparities between population groups and regions highlight a need for targeted policies and measures to close the gaps and improve the outcome of sepsis. [ABSTRACT FROM AUTHOR]

Zircon Hf-isotopic mapping can be regarded as a useful tool for evaluating the coupling relationship between lithospheric structure and metallic mineralization. Hence, this method shows important significance for mineral prediction. To explore this potential, the published granite zircon Hf isotope data from the Sanjiang Tethyan Orogen were systematically compiled. This study uses the Kriging weighted interpolation in the Mapgis software system to contour Hf isotopes, revealing a relation between the crustal structure and metallogenesis. The mapping results suggest that the Changning–Menglian suture zone is the boundary between ancient and juvenile crust, viz., the western terranes have ancient crust attributes, whereas the eastern terranes exhibit the properties of new juvenile crust. In addition, this study also found that the mineralization and element types in the Sanjiang Tethyan Orogen have a coupling relationship with the crustal structure. The distribution of porphyry Cu-Mo-Au deposits is mainly controlled by the new juvenile crust, whereas the magmatic-hydrothermal Sn-W and porphyry Mo-W(-Cu) deposits are closely related to the reworked ancient crust. The results of zircon Hf isotope mapping prove that the formation and spatial distribution of deposits are related to the composition and properties of the crust. Hf isotope mapping can reveal the regional metallogenic rules and explore metallogenic prediction and metallogenic potential evaluation. [ABSTRACT FROM AUTHOR]

Systematically recognizing spatial patterns and driving factors of cultivated land fragmentation is of great significance for the exploration of locally appropriate path to relieve cultivated land fragmentation. This study aims to estimate cultivated land density, mean patch size and area-weighted mean shape index to respectively indicate the characteristics of cultivated land fragmentation from three dimensions, namely, natural resource endowment, spatial partition, and convenience of utilization. The regional leading factors of cultivated land fragmentation are also analyzed. The results demonstrate that the distribution of cultivated land density is higher in Northern regions compared with those of southern regions. The significant positive correlation between cultivated land density and mean patch size is found to be universal across nearly all cities, exceeding differences in terrain, elevation, climate, soil, and social economic condition. For cities in the southern part of China, cultivated land of regular shape is partitioned to smaller blocks compared with irregular ones; alternatively, intensive and meticulous farming under small-scale agricultural operation leads to clusters with low mean patch size - low area-weighted mean shape index. Random forest model explains the impact of driving factors on cultivated land fragmentation, with an explanatory power ranging from 66% to 95%. The terrain factor emerges as the primary driver negatively affecting cultivated land density. Gross domestic product emerges as the dominant factor with a significant (p < 0.01) negative correlation to mean patch size for nearly all agricultural climatic zones. Terrain, gross domestic product and population is the most important factor affecting area-weighted mean shape index. Rural development degree influences correlation between dominant factors and cultivated land fragmentation. This study is greatly instructive for recognizing the spatial patterns of cultivated land fragmentation at the national scale and for exploring the barriers that impede regionally scaled cultivated land use. • First reveal 1-km grid scale cultivated land fragmentation in mainland China. • Detect the polarizing differences of cultivated land fragmentation between peri-urban and out-of-urban areas. • Analyze China national spatial clustering characteristics of cultivated land fragmentation. • Recognize regional dominant factor to cultivated land fragmentation. • Generate China national 1-km grid-based cultivated land fragmentation maps. [ABSTRACT FROM AUTHOR]

Music expertise is known to be beneficial for cognitive function and development. In this study, we conducted 1-year music training for school children (n = 123; 7–11 years of age before training) in China. The children were assigned to music or second-language after-class training groups. A passive control group was included. We aimed to investigate whether music training could facilitate working memory (WM) development compared to second-language training and no training. Before and after the training, auditory WM was measured via a digit span (DS) task, together with the vocabulary and block tests of the Wechsler Intelligence Scale for Child IV (WISC-IV). The results of the DS task revealed superior development in the music group compared to the other groups. However, further analysis of DS forward and backward tasks indicated that the performance of the three training/non-training groups only differed significantly in DS backward scores, but not in the DS forward scores. We conclude that music training may benefit the central executive system of WM, as reflected by the DS backward task. [ABSTRACT FROM AUTHOR]

Research on the Zanhuang Complex has been one of the hotspots in the Neoarchean–Palaeoproterozoic tectonic evolution of the Trans‐North China Orogen (TNCO) in the North China Craton (NCC). Here, we present data from petrology, geochemistry, zircon U–Pb geochronology, and Lu–Hf isotopes on a suite of granite, diorite, TTG gneiss, and amphibolite in the Zanhuang Complex to characterize these rocks and understand their genesis. Zircon U–Pb data yield magmatic ages of 2,607 Ma for granite, 2,599 Ma for diorite and 2,561 Ma for TTG gneiss, with subsequent thermal event ages of 2,530 and 2,471 Ma. Lu–Hf isotopes show εHf(t) values ranging from 0.04 to 7.11 and crustal model ages of 2,700–3,100 Ma for the diorite, indicating a Meso‐ to Neoarchean mantle source with minor input of crustal components. The granite and TTG gneiss have the characteristics of volcanic‐arc granite, with low Sr/Y and (La/Yb)N, high Cr and Ni contents, positive Pb and K anomalies and negative Nb, Ta, P, and Ti anomalies. The amphibolite and diorite are similar to island arc basalt, with low K2O, Sr/Y, (La/Yb)N, and high FeOT, positive Pb anomaly, negative Nb, Ta, and Ti anomalies and absence of obvious Ce anomaly. These signatures indicate that these rocks were likely formed in a subduction setting. We have proposed a model of subduction–collision process in the TNCO, including subduction at ca. 2.70–2.55 Ga, arc–continent collision at ca. 2.55–2.45 Ga, extension and rifting at ca. 2.30–2.05 Ga, and continent–continent collision at ca. 1.90–1.75 Ga. Our results are consistent with the previous models on the tectonic evolution in the NCC and provide further insights into the Neoarchean–Palaeoproterozoic tectonic history of the craton. [ABSTRACT FROM AUTHOR]

Granite–greenstone successions and associated tonalite–trondhjemite–granodiorite (TTG) suites constitute dominant components of Precambrian cratons. Here, we present petrology, geochemistry, zircon U–Pb geochronology, and Lu–Hf isotopes on monzonite, granodiorite, granite, and amphibolite from the Dengfeng Complex in the southern part of the North China Craton (NCC). Zircon U–Pb data yield weighted mean 207Pb/206Pb ages of 2498 ± 6 Ma for monzonite, 2481 ± 16 Ma for granodiorite, and 2475 ± 21 Ma for granite. Lu–Hf isotope systematics show εHf(t) values ranging from 1.3 to 6.7 and crustal model ages ( T DM C ) in the range of 2584–2934 Ma for the rocks. The monzonite, granodiorite, and granite show moderate total rare-earth element (REE) contents, enrichment in light REEs (LREE) and depletion in heavy REEs (HREE), negative Nb, Ta, and Ti anomalies, high Al2O3, Sr/Y, and (La/Yb)N ratios, with low Cr and Ni, indicating that the magma was possibly sourced from partial melting of the lower crust. The geochemical features of amphibolites are characterized by low SiO2, Na2O, K2O, Sr/Y, (La/Yb)N and high FeO, low total REEs values, limited LREE/HREE fractionation, and absence of obvious Ce anomaly, showing similarity to island arc magmatic rocks. Our results are consistent with the model of subduction and arc–continent collision in the Trans-North China Orogen during the Neoarchean to Paleoproterozoic. [ABSTRACT FROM AUTHOR]

The volcano‐sedimentary sequences from the Weixi belt provide significance for the Sanjiang Paleo‐Tethys evolution. This manuscript constrains the ages of volcano‐sedimentary sequences by LA‐ICPMS U–Pb, including bimodal volcanics (245.0–244.0 Ma) from Pantiange Formation, trachyandesite–basaltic andesite (234 ± 2.0 Ma) from Cuiyibi Formation, high silica subalkaline rhyolite (221 ± 1.4 Ma) from Waigucun Formation and Early Jurassic high silica subalkaline rhyolite (184 ± 2.2 Ma). The volcanics show various Hf isotopic composition, which includes Middle Triassic dacite (εHf[t] = −15.7 to −8.5, TDM2 = 2,006–1,613 Ma), Late Triassic rhyolite (εHf(t) = −9.8 to +1.9, TDM2 = 1,667–1,021 Ma), Late Triassic trachyandesite (εHf(t) = +2.6 to +5.7, TDM2 = 990–816 Ma) and Early Jurassic rhyolite (εHf(t) = −2.7 to +1.1, TDM2 = 1,250–1,145 Ma). The Middle–Late Triassic volcanics exhibit similar characteristics, the content of SiO2 exerts positive correlation with K2O and negative correlation with oxide of Ti, Fe, Al, Mg, Ca, Mn and P. The Hf isotopic and geochemical features indicate that the Middle Triassic basalt and rhyolite derived from mantle and crust by crystal fractionation, respectively. The absence of Lower Jurassic strata and existence of Triassic bimodal volcanic sequences suggest that the middle Sanjiang Tethys Orogen experienced collision during the Middle Triassic with local extension resulting from oblique convergence. Late Triassic–Early Jurassic rhyolite exhibit high SiO2 (77.12–77.81 wt%), K2O (4.35–6.10 wt%), Na2O (1.91–3.15 wt%) content, and a negative Eu anomaly. Together with the sedimentary sequence, the middle Sanjiang Tethys Orogen evolved into post‐collision phase during Late Triassic – Early Jurassic. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the population pharmacokinetics of cefoperazone in children and establish an evidence-based dosing regimen using a developmental pharmacokinetic-pharmacodynamic approach in order to optimize cefoperazone treatment.Methods: A model-based, open-label, opportunistic-sampling pharmacokinetic study was conducted in China. Blood samples from 99 cefoperazone-treated children were collected and quantified by HPLC/MS. NONMEM software was used for population pharmacokinetic-pharmacodynamic analysis. This study was registered at ClinicalTrials.gov (NCT03113344).Results: A two-compartment model with first-order elimination agreed well with the experimental data. Covariate analysis showed that current body weight had a significant effect on the pharmacokinetics of cefoperazone. Monte Carlo simulation showed that for bacteria for which cefoperazone has an MIC of 0.5 mg/L, 78.1% of hypothetical children treated with '40 mg/kg/day, q8h, IV drip 3 h' would reach the pharmacodynamic target. For bacteria for which cefoperazone has an MIC of 8 mg/L, 88.4% of hypothetical children treated with 80 mg/kg/day (continuous infusion) would reach the treatment goal. A 160 mg/kg/day (continuous infusion) regimen can cover bacteria for which cefoperazone has an MIC of 16 mg/L. Nevertheless, even if using the maximum reported dose of 160 mg/kg/day (continuous infusion), the ratio of hypothetical children reaching the treatment target was only 9.9% for bacteria for which cefoperazone has an MIC of 32 mg/L.Conclusions: For cefoperazone, population pharmacokinetics were evaluated in children and an appropriate dosing regimen was developed based on developmental pharmacokinetics-pharmacodynamics. The dose indicated in the instructions (20-160 mg/kg/day) can basically cover the clinically common bacteria for which cefoperazone has an MIC of ≤16 mg/L. However, for bacteria for which the MIC is >16 mg/L, cefoperazone is not a preferred choice. [ABSTRACT FROM AUTHOR]

Potassic magmatic rocks provide significant insights in understanding of mantle composition, evolution, and interaction with crust. Potassic magmatism along the Jinshajiang–Ailaoshan Paleo‐Tethyan suture has drawn much attention. Whereas igneous intrusion in the Simao terrane, west to Jinshajiang–Ailaoshan potassic magmatic belt has rarely been investigated. Hence, we present zircon U–Pb ages and Lu–Hf isotope and whole‐rock geochemistry for the Lianhuashan pluton. Zircon U–Pb dating from monzonite and quartz monzonite porphyry yield ages of 33.6 ± 0.2 and 33.5 ± 0.3 Ma, respectively. Monzonites are characterized by high K2O (4.93–5.16%) and K2O/Na2O (1.46–1.71), high Y (22.90–23.80 ppm), and Yb (1.87–2.21 ppm), relatively enrichment of light rare earth element (LREE). Zircons from monzonites show εHf(t) values ranging from −1.1 to +0.6 and crustal model ages (TDMC) between 1.04 and 1.15 Ga. These geochemical features suggest that parent magmas of the rocks originated from a metasomatized lithospheric mantle. Quartz monzonite porphyries are characterized by high Sr (836.00–1,529.00 ppm), Sr/Y (70.85–99.93) and La/Yb (32.31–49.83), low Y (11.80–15.60 ppm), and Yb (0.95–1.30 ppm), enrichment in LREE and depletion in heavy rare earth elements (HREE). Quartz monzonite porphyries have higher Mg#, MgO, Ni, and Cr contents than the lower crust‐derived adakite‐like rocks. It is suggested that they were derived by variable degree of mixing between lower‐crustal melts and mafic magmas. Based on petrology and geochemistry features, the following evolution process are concluded. During the Neoproterozoic, metasomatic‐enriched mantle magma resulted from the bisubduction of oceanic plate; meanwhile, the crust thickened, and juvenile lower crust formed. During late Eocene, hot asthenosphere upwelled and K‐rich mafic magmas resulted from the decompression of delamination, followed by magmatism emplacing, crystallizing, and the forming of the Lianhuashan pluton. [ABSTRACT FROM AUTHOR]

The water-blocking properties of the clay layer at the bottom of the Cenozoic overburden in China are an important factor influencing the safety of thin bedrock coal seam mining. Clay has remolding properties that are unlike the nonreversible characteristics of cracks in brittle rock, and failure cracks in clay can reclose or continue to expand under the influence of different external factors. In this work, the soil layer on top of thin bedrock is the research object, and the influences of the particle composition, water content, soil layer thickness, and crack width on the crack development-closure state of soil layer are analyzed by the orthogonal test method. Visual analysis shows that the order of influence of each factor on the stability of soil layer is the crack width, particle composition, soil layer thickness, and water content. The stability of soil layer decreases with increasing crack width and sand content and decreasing soil layer thickness; in addition, soil layer stability decreases first and then increases with increasing water content. Further variance analysis shows that the crack width and particle composition are key factors that impact the stability of soil layer and that the soil layer thickness has some influence, while the water content has little effect on the stability of soil layer. In addition, the crack will reclose when the sand content in soil is less than 50% and the crack width is less than or equal to 1.0 mm, and the soil layer is prone to further failure when the sand content in soil is more than 50% and the crack width is greater than or equal to 3.0 mm; when the soil layer thickness is 15.0 cm, its stability is better than when the soil layer thickness is 10.0 cm or 5.0 cm. [ABSTRACT FROM AUTHOR]

As the north part of Simao Terrane, Lanping Basin is located between the Sanjiang Tethys Orogen (STO) and Yangtze Block, also the junction zone between the Gondwanaland and Cathaysian old land (Pan Huaxia mainland), which includes Yangtze and Cathaysian Blocks. The aim of this study is to decipher the provenance of the sedimentary units in the Lanping Basin and affiliation of Simao Terrane by the U-Pb ages, Hf isotope of detrital zircons and whole-rock geochemistry. The whole-rock geochemistry and the mineral composition indicate that most of the Triassic–Paleocene sedimentary rocks are derived from the upper crust and exhibit recycled orogen features. The detrital zircon U-Pb ages from the North Simao Terrane are consistent with the magmatic events during Early Neoproterozoic and Permian in the Western Yangtze Block. And the detrital zircons ages from North Simao Terrane show same distribution features as the Permian–Triassic magmatic rocks, which are distributed in the Simao Terrane and along major sutures. These comparisons suggest that the clastic sediments in Lanping Basin (North Simao Terrane) are derived from Early Neoproterozoic and Permian magmatic rocks from Western Yangtze Block, Permian–Triassic magmatic rocks from Simao Terrane, along Jinshajiang, Garz-Litang and Ailaoshan Sutures. The comparison of the detrital zircon age distributions shows that Simao Terrane and Yangtze Block exhibited similarity tectonic setting in the evolution history, especially during Paleoproterozoic–Late Paleozoic. This suggests that the Simao Terrane is part of Cathaysian old land, although Simao Terrane was separated from Yangtze Block for short period during Early Paleozoic. Besides, the Hf mapping, stratigraphic succession, paleogeography and paleomagnetism in SW China support that Simao Terrane has a Cathaysian old land-affinity, rather than one involving Gondwanaland. [ABSTRACT FROM AUTHOR]

Purpose: A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies.Methods: Retrospective analysis of multiple cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively.Results: In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis-related mortality rate was 66.7 (95% confidence interval [CI] 66.4-67.0) deaths per 100,000 population. This produced a national estimate of 1,025,997 sepsis-related deaths. Sepsis-related mortality rates exhibited significant geographic variation. In multilevel analysis, male sex (rate ratio [RR] 1.582, 95% CI 1.570-1.595), increasing age (RR 1.914 for 5-year group, 95% CI 1.910-1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298-2.335) were independently associated with increased sepsis-related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.515-0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.684-0.955) were negatively associated with sepsis-related mortality. However, population-based hospital doctors were not significantly associated with sepsis-related mortality.Conclusions: The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained. [ABSTRACT FROM AUTHOR]

The effect of particle size of hull-less barley (HLB) bran DF on antioxidant and physicochemical properties was investigated. HLB bran and extracted DF was ground by regular and superfine grinding, their particle sizes were determined using laser diffraction method. The results showed that superfine grinding could significantly pulverize DF particles to micro-scale; the particle size distribution was close to a Gaussian distribution. The soluble DF in HLB bran was increased effectively with superfine grinding. Insoluble DF with submicron scale showed increased total phenolic content (TPC), DPPH radical scavenging activity and ferric reducing antioxidant power (FRAP). With particle size reduction, the water retention capacity (WRC), swelling capacity (SC), oil binding capacity (OBC), and nitrite ion absorption capacity (NIAC) were significantly ( p < 0.05) increased and the water holding capacity (WHC) had no significant change. A kind of health beneficial DF with higher soluble DF content, WRC, SC, OBC, NIAC and antioxidant activity was obtained using superfine grinding. [ABSTRACT FROM AUTHOR]

The objectives of this study are to systematically assess the bioactive substances and overall antioxidant capacities of commercially fermented soy products and to find the relationships between the presence of beneficial components in different types of soybean fermented products. The results show that phenolic profiles increased significantly after fermentation as compared with raw yellow soybeans. Among all the samples, the douchi and fermented black bean sauce had the highest detected antioxidant profiles. Even though the total isoflavone content was reduced in fermented soybean products (794.84 μg/g on average) as compared with raw yellow soybeans (3477.6 μg/g), there was an obvious trend of conversion of the glucoside form in raw soybeans into the aglycone-form isoflavones in the fermented soybean products. The highest daidzein and genistein values were found in the “Yangfan” black bean douchi, i.e. 860.3 μg/g and 1025.9 μg/g, respectively. The amounts of essential amino acids also were improved in most fermented soybean products. The douchi and black bean fermented products are recommended for consumption due to their abundant bioactive substances. [ABSTRACT FROM AUTHOR]

31 topsoil samples were collected by grid method in Xiaodian sewage irrigation area, Taiyuan City, North of China. The concentrations of 16 kinds of polycyclic aromatic hydrocarbons (PAHs) were determined by gas chromatograph coupled with mass spectrum. Generally speaking, the distribution order of PAHs in the area is: those with five and six rings > those with four rings > those with two and three rings. Source apportionment shows a significant zonation of the source of PAHs: the civil coal pollution occurred in the north part, the local and far factory pollution happened in the middle area and the mixed pollution sources from coal and wood combustion, automotive emission, presented in the south area. The distribution of PAHs has a definite relationship with the sewage water flow and soil adsorption. The related coefficient between PAHs and physicochemical property showed there was a negative correlation between pH, silt, clay and PAHs while there was a positive correlation between total organic carbon, sand and PAHs. [ABSTRACT FROM AUTHOR]

Abstract: The concentrated photovoltaic (CPV) system focuses solar radiation on the solar cells. CPV systems need to track the sun for keeping the reflected radiation focussed on the solar cell. A CPV module and its active water-cooling system are developed at the School of Energy and Environment, Southeast University, China and its performance has been reported here. This developed system has been used for testing the PV module''s performance for different parameters such as operating temperature, power output, and efficiency. The experimental results show that the operating temperature of the CPV module under water cooling is reduced under 60°C and therefore the efficiency of the CPV has increased and produced the more electric power output. The effect of water flow rate has been analyzed for the CPV efficiency and output. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to investigate sedation practices and the perception of discomfort during mechanical ventilation in Chinese intensive care units (ICUs). Material and Method: A prospective, observational, cohort study was conducted in 31 Chinese ICUs in academic hospitals from June 15 to August 15, 2006. Conscious patients who were discharged from the ICU after mechanical ventilation were consecutively included. Using a standardized questionnaire, a personal interview was conducted with each patient within 2 days after discharge from the ICU. Patients were asked about recollections of emotional and physical discomfort. Sedation and analgesia administration data were collected from patient records. Results: As prospectively defined, 83 (50.9%) of 163 patients met criteria for complex-mixed discomfort (ie, at least 1 emotional and 2 physical disturbances). Similarly, 79.1% of patients remembered seriously uncomfortable experiences associated with 1 of the 3 predefined sources. Both protocolized sedation and continuous sedation without a defined protocol, but not intermittent sedation, significantly reduced the relative risk of complex-mixed discomfort occurrences (P < .001). Notably, only 14.7% of patients received protocolized sedation, and 61 (37.4%) of 163 were not given any sedatives. Conclusion: Mechanically ventilated ICU patients in Chinese academic hospitals were inadequately treated for discomfort. Protocolized sedation can effectively improve patient comfort. [Copyright &y& Elsevier]

Abstract: Wheat (Triticum aestivum L.) cultivar Bima 4 is one of the most important milestone parents in China. The objectives of this study were to reveal the genetic structure of Bima 4 and the transmission of its specific loci in descendents using molecular markers. A total of 1239 simple sequence repeat (SSR), expressed sequence tag derived SSR (EST-SSR), and sequence tagged site (STS) markers covering the whole genome of wheat were screened with the 4 parents of the first generation of Bima 4 progenies, i.e., Bima 4, Early Piemium, Jubileina 2, and Ckopocne▪ka JI-1. Thirty-three markers were effective to trace the specific loci of Bima 4 in the progenies. Seventy-six derivatives of Bima 4 were genotyped using these markers. Among them, 32 markers except for Xgwm577 could amplify the specific bands of Bima 4 in the first and the second generations derived from Bima 4. Eight and ten loci showed the transmission percentage larger than 50% in the first and the second generations, respectively. In the third and the fourth generations, 29 and 20 specific markers were observed. In these markers, 8 and 4 loci had the transmission rate higher than 50%, respectively. Among the specific loci, Xgwm261, Xedm80, SWES222, and CFE223 possessed inheritable frequency higher than 50% in all of the 4 generations. Furthermore, 18 loci of Bima 4 were detected in the progenies with genetic contribution ratio higher than 25%. This indicates that some desirable traits, such as yield, grain quality, disease resistance, and adaptability might be associated with these loci or the nearby chromosome regions in Bima 4, which were intensively selected in breeding programs. The important loci detected in this study provide information for understanding the genetic basis of Bima 4 as a milestone parent in wheat breeding. [Copyright &y& Elsevier]

A majority of coal mines in China are susceptible to fires, especially those affected by concealed fire sources in coalfield fire areas. Hence, to mitigate this problem, the efficient and precise detection of high-temperature anomalous areas is significant and needed, which mainly involves determining the range and depth of concealed fire sources. In this paper, the strengths and weaknesses of each detection method (e.g., remote sensing, electromagnetic radiation, magnetic detection, geological radar detection, resistivity detection, transient electromagnetic, excitation potential method, gas analysis, radon levels detection, infrared images) were investigated, analyzed, evaluated and then compared. Furthermore, after taking their respective practicality and effectiveness into account, an integrated methodology was proposed that uses radon levels, infrared imaging techniques, and drilling methods to detect and verify high-temperature anomalous areas in a coalfield. We carried out the detection in the Ningxia autonomous region. Our testing results revealed that radon levels show positive correspondence with the temperature of potential fire sources. That is to say, higher radon levels usually have higher temperature signal for detection. Accordingly, high-temperature anomalous areas in coalfield fire areas can be distinguished and delineated successfully by their radon levels and verified by infrared imaging techniques and drilling methods. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Background: Sepsis represents a major worldwide healthcare burden. However, how body-mass index (BMI) is related to the long-term risk of sepsis-related mortality in low- and middle-income countries remains uncertain.Methods: We examined the associations of sepsis-related mortality with both baseline BMI and waist circumference (WC) using data from China Kadoorie Biobank, a prospective cohort recruited during 2004-2008 and followed up to December 2016. After excluding participants with chronic obstructive pulmonary disease, tuberculosis, cancer, heart disease, and stroke, and omitting the first 3 years of follow-up, 440,763 participants remained for analysis.Results: During a median follow-up of 10.0 years, 1957 sepsis-related deaths (3,134,870 person-years) were included for analysis. Compared with reference BMI of 22.5 to < 25.0 kg/m2, the multivariable-adjusted hazard ratios (HRs) for sepsis-related mortality were 2.42 (95% CIs 2.07-2.84) for BMI of < 18.5, 1.59 (1.36-1.85) for 18.5 to < 20.0, 1.21 (1.06-1.38) for 20.0 to < 22.5, 0.97 (0.83-1.13) for 25.0 to < 27.5, 0.98 (0.80-1.21) for 27.5 to < 30.0, and 1.22 (0.93-1.60) for ≥ 30.0 kg/m2. Further adjustment for WC led to slightly augmentation of the effect size for the lower BMI groups and null association in the obese group. In the association analysis between WC and sepsis-related mortality, compared with the middle quintile group, only the highest quintile group showed an increased risk of sepsis-related mortality after adjusted for BMI (HR = 1.54; 95% CI 1.28-1.84).Conclusions: Underweight, lower normal weight, and abdominal obesity are associated with increased future risk of sepsis-related mortality over 10 years in the Chinese population. The double burden of underweight and obesity indicates a heavy sepsis burden faced by low- and middle-income countries. [ABSTRACT FROM AUTHOR]

The article reflects on critical care research in china which is lacking behind due to several reasons. It mentions reasons including the lack of training in clinical research, inadequate resources and lack of language proficiency. It states that multiple resolutions may improve critical care research which include better understanding of good clinical practice and collaborative research in critical care.

Freshwater shortage is becoming one of the major limiting factors for the sustainable development of agriculture in arid and semi-arid areas of north China. A two-year field experiment about mulched drip irrigation on maize was conducted in Hetao Irrigation District with five irrigation water salinity levels (total dissolved solids; 1, 2, 3, 4, and 5 g·L−1). The effects of irrigation water salinity on maize emergence, growth, yield, grain quality, and soil salt were determined. The results indicated that with the soil matric potential of −20 kPa and irrigation quota for each application of 22.5 mm, the irrigation water salinity showed negative influence on maize emergence and maize morphological characteristics (plant height, leaf area index, stem diameter, and dry matter), as irrigation water salt concentrations exceeded 3 g·L−1. The water use efficiency decreased linearly with the irrigation water salinity raised from 1 g·L−1 to 5 g·L−1, while maize grain protein increased and starch content decreased with the increase of irrigation water salt contents. Additionally, both the vertical radius and horizontal radius of salt isoline by mulched drip irrigation reduced with the irrigation water salt concentrations, when the irrigation water salinity was above 3 g·L−1. Summarily, irrigation water salinity of 3 g·L−1 was recommended for maize mulched drip irrigation in this study. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine.Methods: We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies. The output from the online survey was edited and then reviewed by a nominal group of 13 intensive care professionals to identify each competence for importance. The resulting list was then recirculated in the nominal group for iterative rating.Results: The online survey yielded a list of 199 competencies for nominal group reviewing. After five rounds of rating, 129 competencies entered the final set defined as core competencies.Conclusions: We have generated a set of core competencies using a consensus technique which can serve as an indicator for training program development. [ABSTRACT FROM AUTHOR]

This study was to compare the characteristics of 21 starches isolated from chestnuts produced in different regions in China, also to investigate their potential food applications. Starches were isolated from chestnuts under the Castanea mollisima Blume variety with sub-varieties of Banli, Youli, and Maoli. Several properties of the starch samples were examined, including the moisture content, amylose content, morphological characteristics, color values, light transmittance, syneresis, swelling power, water solubility index, pasting properties, FTIR characteristics, X-ray diffraction (XRD) patterns, and thermal properties. The results showed that starches isolated from Youli presented higher resistance to shear and swelling during heating, indicating more suitability for high-heat cooking. The FTIR spectra confirmed the polysaccharide nature of all the chestnut starches. The XRD patterns showed most chestnut starches were in C b -type, while only five were in C a -type. Overall, this comparative study would be relevant for the further exploration of the potential utilization of chestnut starch in both food and non-food industries. • Physiochemical properties of 21 chestnuts starches were examined. • Starches presented significant differences in morphology, pasting, and thermal properties. • Starches from Maoli had generally smaller granule sizes. • Starches from Youli presented higher resistance to shear and thermal swelling. • All chestnuts had C-type starch, among which most starches were in C b -type. [ABSTRACT FROM AUTHOR]

POPULATIONS: Chinese Han and Thai. [ABSTRACT FROM AUTHOR]

POPULATION: Chinese Han and Thai. [ABSTRACT FROM AUTHOR]

Abstract: The Gross Domestic Product (GDP) has been widely used to measure the economic growth of a region or a country. However, it does not distinguish between economic activities that improve the well-being and those that impair it. It does not reflect the social, economical, and environmental sustainability either. This paper presents a case study using the newly developed economic indicator Genuine Progress Indicator (GPI) to evaluate the economic performance and human well-being in China at an urban level. The study also shows how the deficiencies of GDP in measuring the economic performance and well-being can be overcome by GPI. Four cities in China (Suzhou and Yangzhou in Jiangsu province, Ningbo in Zhejiang province, and Guangzhou in Guangdong province) were chosen in the case study. Important components of GPI for cost and benefit analysis were developed to address the depletion of nonrenewable resources, cost of environmental pollution, and net capital investment, etc. The comparison between GDP and GPI for the four cities and the comparison among the GPIs of the four cities and other countries were made over the period of 1991–2001. Based on the GPI results, recommendations on policy-making and infrastructural development were made for the improvement of the overall economic welfare of the cities. The advantages and limitations of the GPI method were discussed. [Copyright &y& Elsevier]

• Zircon U–Pb ages range from 2753 ± 37 to 2476 ± 18 Ma in the Luxi Terrane. • Greenstone was derived from the Meso- to Neoarchean mantle contaminated by the crust. • TTGs were sourced from a Meso- to Neoarchean juvenile crust with older basement reworking. • Initial crustal growth at ca. 2750–2600 Ma, followed by more voluminous growth at ca. 2550–2450 Ma. Tonalite–trondhjemite–granodiorite (TTG) suites constitute dominant components of Precambrian continental crust and provide important insights into the crustal evolution history of the early Earth. Here we investigate a suite of TTGs and associated greenstones from the Luxi Terrane in the south–eastern part of the North China Craton (NCC). We present data from petrology, geochemistry, zircon U–Pb geochronology and Lu–Hf isotopes to characterize these rocks and understand their genesis. Mineral assemblage in the greenstones and TTGs suggests that the rocks have undergone amphibolite–facies metamorphism with regression under greenschist–facies. Zircon U–Pb data from the magmatic grains yield upper intercept ages of 2753 ± 37 and 2582 ± 40 Ma for greenstone, 2552 ± 13 Ma for TTG gneiss and 2476 ± 18 Ma for tonalite, and weighted mean 207Pb/206Pb age of 2507 ± 22 Ma for granodiorite. Lu–Hf isotope systematics show ε Hf (t) values ranging from −2.13 to 7.29 and crustal model ages (TC DM) in the range of 2603–3125 Ma for the TTGs, whereas the ε Hf (t) values are up to 8.53 with TC DM ages of 2644–3006 Ma for the greenstone. The results suggest that the protolith for the greenstone was derived from a Meso- to Neoarchean mantle contaminated by the crust source, whereas the TTGs were mostly sourced from juvenile crustal sources with reworking of older basement. The geochemical features of greenstone are similar to island arc basalt, with low Na 2 O, K 2 O and TiO 2 , low total rare earth elements (REEs) values, relative enrichment in light REEs and depletion in heavy REEs absence of obvious Ce anomaly, and negative Nb, Ta and Ti anomalies. The TTGs show similar features, except for the high K 2 O content and moderate total REEs values. We propose that the greenstone likely represent a part of the early and initial crustal growth at ca. 2750–2600 Ma, and the TTGs were generated subsequently at ca. 2550–2450 Ma. Our results are consistent with the previous models on the crustal growth models in the NCC and provide further insights into the Neoarchean to Paleoproterozoic tectonic history of the craton. [ABSTRACT FROM AUTHOR]

Liancheng is an important Cu–Mo deposit hosted by red-beds in the Mesozoic to Cenozoic Lanping Basin located in the Sanjiang Tethyan Orogen of SW China. The deposit is fault controlled where it has been affected and enriched by four hydrothermal events indicated by four distinct sets of veins and their cross-cutting relationships. A detailed Cu–S–H–O isotopic study is reported here on the mineralization focusing on the source of the metals and fluid, and on the mineralizing processes. The first two hydrothermal events are characterised by CO 2 and fluid-rich inclusions with homogenisation temperatures of 124–446 °C and salinities ranging from 0.4 to 24.6 wt% NaCl equiv. The next two hydrothermal events are characterised by liquid–rich fluid inclusions that homogenise at 145–256 °C, with salinities ranging from 1.4 to 22.9 wt% NaCl equiv. The H–O isotope values obtain from the fluid inclusions indicate that the first three hydrothermal events relate to mineralizing fluids derived from a metamorphic source, but the last event includes a mixed metamorphic and meteoric source. Chalcopyrite, tennantite, and bornite from the deposit have δ 34 S values between  −11.5 and 3‰. The δ 65 Cu values for quartz-Cu sulfide mineralization associated with the second hydrothermal event range from −0.31 to 0.2‰, but carbonate-Cu sulfide mineralization associated with the third hydrothermal event ranges from −1.01 to −1.08‰. The combination of the Cu and S isotopic values and field observations indicate that the controlling factors include structures, the temperature of regional metamorphism, and the pH of the mineralizing fluid. The zation is, therefore, characteristic of an orogenic-type deposit. [ABSTRACT FROM AUTHOR]

[Display omitted] • The Biluoxueshan Pluton included three phases of 231 Ma, 227 Ma, and 227–217 Ma. • The Late Triassic Biluoxueshan Pluton was emplaced in a post-collisional setting. • The closure of the Paleo-Tethys Ocean occurred in a northward-propagating manner. The Sanjiang Orogen is important for us to better understand the tectonic evolution of the Paleo-Tethys Ocean. However, the petrogenesis and tectonic setting of the Late Triassic igneous rocks in the central part of the orogen are poorly understood. In this study, we present new whole-rock elemental and isotopic compositions for the Biluoxueshan Pluton, which consists of quartz diorite, granodiorite, and alkali-feldspar granite. Zircon U-Pb dating yields crystallisation ages of 231 ± 1 Ma for the quartz diorite, 227 ± 1 Ma for the granodiorite, and 227 ± 2, 224 ± 2, 222 ± 1, and 217 ± 3 Ma for alkali-feldspar granites, indicating a prolonged emplacement of the pluton. Quartz diorites are metaluminous, high-potassium calc-alkaline, and magnesian in composition. Granodiorites are characterized by peraluminous composition and the existence of normative-corundum, resembling S-type granite. They have negative zircon ε Hf (t) values (−13 to −10.8) and old Hf crustal model ages (2060–1920 Ma), indicating a Paleoproterozoic crustal source. Alkali-feldspar granites are metaluminous to weakly peraluminous, have higher SiO 2 content, FeO T /MgO ratio and differentiation index (DI) than other samples, and pronouncedly negative Eu anomalies, which are characteristics of highly fractionated granites. They have narrow ε Hf (t) values of −2.7 to +2.6 with corresponding Hf crustal model ages of 1410–1060 Ma, indicating a Mesoproterozoic juvenile crustal source modified by mantle-derived magma. By combining previous and the new data, we proposed a new tectonic evolution model of a Late Triassic northward scissor-like post-collisional extension during ca. 235–223 Ma in the Changning-Menglian Suture Zone. [ABSTRACT FROM AUTHOR]

• Zircon U-Pb ages of 2776–2771 Ma mark a major phase of crust building. • Paleoproterozoic metamorphism dated as 1922–1915 Ma. • Amphibolite derived from partial melting of a metasomatic mantle source. • TTG gneiss derived from partial melting of juvenile lower crust. • Archean-Paleoproterozoic crustal accretion and reworking in the southern margin of the NCC. The North China Craton (NCC) preserves important records of Archean-Paleoproterozoic crustal evolution. Here we present results from petrology, geochemistry, zircon U-Pb dating and Lu-Hf isotopes of the Taihua Complex (THC) from the southern part of the NCC. Zircon U-Pb dating of the amphibolite yields the ages of 2776–2771 Ma representing the formation age, marking a major phase of late Archean crustal growth in the NCC. The 1922–1915 Ma ages represent the Paleoproterozoic metamorphism associated with the collisional assembly between the Eastern and Western Blocks. The amphibolites are characterized by low SiO 2 , Na 2 O + K 2 O, and Nb/Y, indicating a sub-alkaline basaltic protolith. These rocks show relatively high LILE/HFSE and LREE/HREE ratios, similar to E-MORB, low [Nb/La] PM , negative Nb-Ta anomalies and positive ε Hf (t) values indicating partial melting of a metasomatic mantle source. The TTG gneisses are characterized by high SiO 2 , Sr/Y, (La/Yb) N , Nb/Ta, Zr/Sm and Zr/Hf ratios, and low MgO, Cr, Ni, Y, Gd/Yb and Dy/Yb ratios, with positive Eu anomalies, indicating partial melting of juvenile lower crust with garnet-amphibolite residue. Our data are consistent with a tectonic setting within a volcanic arc in a convergent margin. Our study on the THC contributes to the Archean-Paleoproterozoic crustal accretion and reworking history along the southern margin of the NCC. [ABSTRACT FROM AUTHOR]

The ecological risk of heavy metals (HM) resulting from the use of sewage sludge compost (SSC) as an amendment to flower garden soil (FGS) and to abandoned phosphate mine soil (APMS) influenced by acid rain were simulated in lysimeter trials and the potential ecological risk index (PERI) was evaluated with minor modifications. The use of SSC indeed increased the mobility and release of HMs in FGS and APMS under conditions of acid rain. The leaching dynamics of HMs was found to be influenced by Fe/Al oxides and organic matter (OM) in the soil. The application of SSC as a fertilizer to barren APMS dramatically decreased the mobility of Cr, Cu and Pb by 51–56% due to their retention by particulate organic matter, while the leaching of As, Cd and Ni was increased as the result of competition with OM for available Fe/Al oxides (As) and proton-metal exchange reactions that occurred in HM-OM complexes (Cd and Ni). The ecological risk of FGS and APMS resulting from HM migration was actually low (PERI = 0.07–0.12), but the increased potential ecological risk resulting from the use of SSC were estimated to be moderate (a 16.0–33.5% increase in PERI for SSC-amended FGS) or high (a 140% increase in PERI for SSC-amended APMS). Ni, Cd and Cu were identified as the three main HMs responsible for increasing the ecological risk in soil which was mainly composed of fine-grained particles, whereas Cd and As were key ecological risks HMs in soil that was mainly composed of coarse-grained particles. Image 1 • SSC amendment increased HMs release to different extent during acidic percolation. • HM leaching dynamics was influenced by Fe/Al oxides and organic matter. • SSC application to FGS varied with applying rate slightly increased HMs release. • SSC application to APMS stimulated leaching of As, Cd and Ni. • Potential ecological risk increase resulted from SSC amendment was moderate/high. [ABSTRACT FROM AUTHOR]

The article discusses the results of three surveys of critical care resources in Guangdong Province, China. It states that the results reveal a 122% hike in the number of intensive care units during the period of 2005 to 2015. It also discusses the significant geographic variation in critical care resources, mainly due to the difference in gross domestic product (GDP).

Atrial fibrillation (AF) is the most common arrhythmia and its incidence increases with sepsis. However, data on new-onset AF during sepsis hospitalization remain limited in China. We aimed to evaluate the incidence, risk factors, and associated mortality of new-onset AF in sepsis patients in China. We conducted a retrospective study using the National Data Center for Medical Service system, from 1923 tertiary and 2363 secondary hospitals from 31 provinces in China from 2017 to 2019.In total we included 1,425,055 sepsis patients ≥ 18 years without prior AF. The incidence of new-onset AF was 1.49%. Older age, male sex, hypertension, heart failure, coronary disease, valvular disease, and mechanical ventilation were independent risk factor. New-onset AF was associated with a slight increased risk of mortality (adjusted RR 1.03, 95% CI 1.01-1.06). Population attributable fraction suggested AF accounted for 0.2% of sepsis deaths. In this large nationwide cohort, new-onset AF occurred in 1.49% of sepsis admissions and was associated with a small mortality increase. Further research should examine whether optimized AF management can improve sepsis outcomes in China., (© 2024. The Author(s).)

Objectives: To determine the safety and efficacy of deep neuromuscular block (NMB) for endolaryngeal surgery., Data Sources: PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Wanfang, VIP databases, and trial registry database., Methods: Inclusion criteria followed the PICOS principles: Participants, adults undergoing endolaryngeal surgery; Intervention, deep NMB performed during the surgery; Control, no-deep NMB performed; Outcomes, primary outcome: the incidence of clinically acceptable surgical conditions., Secondary Outcome: the incidence of intraoperative complications (including vocal fold movement and coughing) and total incidence of postoperative complications [including postoperative residual curarization (PORC), postoperative sore throat (POST), and postoperative nausea and vomiting (PONV)]. Study design, randomized controlled trials (RCTs). Duplicate publications, editorials, letters, abstracts, and reviews were excluded., Results: Four articles with 242 patients were identified for analysis. The results indicated that compared with no-deep NMB, deep NMB provides a higher incidence of clinically acceptable surgical conditions (98.36% vs. 76.67%; relative ratio [RR] = 1.29, 95% CI: 1.07-1.56), a lower incidence of intraoperative complications (10.83% versus 37.16%; RR = 0.32; 95% CI: 0.21-0.49) (lower incidence of vocal fold movement [1.85% vs. 34%; RR = 0.08, 95% CI: 0.02-0.41] and coughing [15.53% vs. 38.78%; RR = 0.42, 95% CI: 0.27-0.66]). There were no differences in the overall incidence of postoperative complications (RR = 2.10, 95% CI: 0.12-36.40)., Conclusions: Based on current published evidence, deep NMB provides better surgical conditions with a higher incidence of clinically acceptable surgical conditions and a lower incidence of intraoperative complications (lower incidence of vocal fold movement and coughing) without increasing the overall incidence of postoperative complications., Level of Evidence: 1 Laryngoscope, 133:2055-2065, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Sepsis is a leading cause of preventable death around the world. Population-based estimation of sepsis incidence is lacking in China. In this study, we aimed to estimate the population-based incidence and geographic variation of hospitalized sepsis in China., Methods: We retrospectively identified hospitalized sepsis from the nationwide National Data Center for Medical Service (NDCMS) and the National Mortality Surveillance System (NMSS) by ICD-10 codes for the period from 2017 to 2019. In-hospital sepsis case fatality and mortality rate were calculated to extrapolate the national incidence of hospitalized sepsis. The geographic distribution of hospitalized sepsis incidence was examined using Global Moran's Index., Results: We identified 9,455,279 patients with 10,682,625 implicit-coded sepsis admissions in NDCMS and 806,728 sepsis-related deaths in NMSS. We estimated that the annual standardized incidence of hospitalized sepsis was 328.25 (95% CI 315.41-341.09), 359.26 (95% CI 345.4-373.12) and 421.85 (95% CI 406.65-437.05) cases per 100,000 in 2017, 2018 and 2019, respectively. We observed 8.7% of the incidences occurred among neonates less than 1 year old, 11.7% among children aged 1-9 years, and 57.5% among elderly older than 65 years. Significant spatial autocorrelation for incidence of hospitalized sepsis was observed across China (Moran's Index 0.42, p = 0.001; 0.45, p = 0.001; 0.26, p = 0.011 for 2017, 2018, 2019, respectively). Higher number of hospital bed supply and higher disposable income per capita were significantly associated with a higher incidence of hospitalized sepsis., Conclusion: Our study showed a greater burden of sepsis hospitalizations than previous estimated. The geographical disparities suggested more efforts were needed in prevention of sepsis., (© 2023. The Author(s).)

Background: Early prediction of patients' deterioration is helpful in early intervention for patients at greater risk of deterioration in Intensive Care Unit (ICU). This study aims to apply machine learning approaches to heterogeneous clinical data for predicting life-threatening events of patients in ICU., Methods: We collected clinical data from a total of 3151 patients admitted to the Medical Intensive Care Unit of Peking Union Medical College Hospital in China from January 1st, 2014, to October 1st, 2019. After excluding the patients who were under 18 years old or stayed less than 24 h at the ICU, a total of 2170 patients were enrolled in this study. Multiple machine learning approaches were utilized to predict life-threatening events (i.e., death) in seven 24-h windows (day 1 to day 7) and their performance was compared., Results: Light Gradient Boosting Machine showed the best performance. We found that life-threatening events during the short-term windows can be better predicted than those in the medium-term windows. For example, death in 24 h can be predicted with an Area Under Curve of 0.905. Features like infusion pump related fluid input were highly related to life-threatening events. Furthermore, the prediction power of static features such as age and cardio-pulmonary function increased with the extended prediction window., Conclusion: This study demonstrates that the integration of machine learning approaches and large-scale high-quality clinical data in ICU could accurately predict life-threatening events for ICU patients for early intervention., (© 2022. The Author(s).)

Recombinant human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibody JS016 showed neutralizing and therapeutic effects in preclinical studies. The clinical efficacy and safety of the therapy needed to be evaluated. In this phase 2/3, multicenter, randomized, open-label, controlled trial, hospitalized patients with moderate or severe coronavirus disease 2019 (COVID-19) were randomly assigned in a 1:1 ratio to receive standard care or standard care plus a single intravenous infusion of JS016. The primary outcome was a six-level ordinal scale of clinical status on day 28 since randomization. Secondary outcomes include adverse events, 28-day mortality, ventilator-free days within 28 days, length of hospital stay, and negative conversion rate of SARS-CoV-2 nucleic acid on day 14. A total of 199 patients were randomized, and 197 (99 in the JS016 group and 98 in the control group) were analyzed. Most patients, 95 (96%) in the JS016 group and 97 (99%) in the control group were in the best category on day 28 since randomization. The odds ratio of being in a better clinical status was 0.31 (95% confidence interval [CI], 0.03 to 3.19; P = 0.33). Few adverse events occurred in both groups (3% in the JS016 group and 1% in the control group, respectively; P = 0.34). SARS-CoV-2 neutralizing antibody JS016 did not show clinical efficacy among hospitalized Chinese patients with moderate to severe COVID-19 disease. Further studies are needed to assess the efficacy of the neutralizing antibody to prevent disease deterioration and its benefits among groups of patients specified by disease course and severity. (This study has been registered at ClinicalTrials.gov under identifier NCT04931238.).

Background: The benefits of intravenous immunoglobulin administration are controversial for critically ill COVID-19 patients., Methods: We analyzed retrospectively the effects of immunoglobulin administration for critically ill COVID-19 patients. The primary outcome was 28-day mortality. Inverse probability of treatment weighting (IPTW) with propensity score was used to account for baseline confounders. Cluster analysis was used to perform phenotype analysis., Results: Between January 1 and February 29, 2020, 754 patients with complete data from 19 hospitals were enrolled. Death at 28 days occurred for 408 (54.1%) patients. There were 392 (52.0%) patients who received intravenous immunoglobulin, at 11 (interquartile range (IQR) 8, 16) days after illness onset; 30% of these patients received intravenous immunoglobulin prior to intensive care unit (ICU) admission. By unadjusted analysis, no difference was observed for 28-day mortality between the immunoglobulin and non-immunoglobulin groups. Similar results were found by propensity score matching (n = 506) and by IPTW analysis (n = 731). Also, IPTW analysis did not reveal any significant difference between hyperinflammation and hypoinflammation phenotypes., Conclusion: No significant association was observed for use of intravenous immunoglobulin and decreased mortality of severe COVID-19 patients. Phenotype analysis did not show any survival benefit for patients who received immunoglobulin therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chen, Xie, Wu, Li, Hu, Hu, Li, Yang, Huang, Zheng, Wang, Kang, Huang, Jiang, Zhang, Zhong, Sang, Zheng, Pan, Zheng, Li, Tong, Qiu, Weng and Du.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have the following interests to declare: BD received funding for research related to covid-19 from Ministry of Science and Technology of the People’s Republic of China (2020YFC0841300) and Chinese Academy of Medical Sciences (2020-I2M-2-005 and 2019-I2M-1-001). He sits on advisory boards of National Health Commission of the People’s Republic of China for management of covid-19. MS received funding from the Department of Health and Social Care for at-cost development and manufacture of the UCL Ventura CPAP device for use in covid-19 patients. He sits on advisory boards and data and safety monitoring boards for investigational agents for covid-19 disease studied in academic led and industry funded trials.

Background: The urine protein/creatinine ratio (UPCR) is commonly used in current clinical practice. However, there are only few published clinical data on UPCR from large cohorts of Chinese adults. This study aimed to determine the overall and age- and sex-specific UPCR reference values for healthy Dalian adults., Methods: According to the Clinical & Laboratory Standards Institute EP28-A3c guidelines, 1321 healthy Dalian adults (646 men and 675 women) aged 20-69 years were enrolled. Urine protein and creatinine levels were analyzed in the random morning spot urine samples, and UPCR was calculated. The 95th percentile of the UPCR was used as the normal upper limit. The Mann-Whitney U test was used to test differences among groups., Results: The UPCR reference value was 141.7 mg/g for the entire cohort, 128.7 mg/g for men, and 150.8 mg/g for women. In addition, women had relatively higher UPCR values than men in the same age group. We also compared the UPCR reference values between different estimated glomerular filtration rate (eGFR) groups and found that women had significantly higher UPCR values than men in the normal eGFR groups., Conclusions: This study provides the overall and age- and sex-specific UPCR reference values for healthy Dalian adults., (© 2021 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.)

Aims: Recently, letrozole has been used off-label to treat short pubertal boys. The experience on letrozole effectiveness and safety has been obtained primarily from Caucasian children. A simple extrapolation of the data to Chinese paediatric populations is questionable because of the substantial ethnic differences between the two populations. Therefore, the present study aimed to determine the effectiveness and safety of letrozole use in Chinese short pubertal boys as well as to establish an exposure-response relationship., Methods: Forty-one Chinese boys were included in the study. Patients were given letrozole tablets (2.5 mg) once daily in combination with growth hormone, and follow-up visits were made after 1, 3, 6 and 12 months of treatment. Plasma samples were taken from clinical examinations and analysed using high performance liquid chromatography with fluorescence detection., Results: After 1 year of treatment, 35 (88%) boys showed increased predicted adult heights. However, possible adverse drug reactions were seen in nine boys (22%). Predicted adult heights increased significantly from 168.4 ± 3.7 to 173.0 ± 4.2 cm, while oestrogen levels dropped from 33.2 ± 7.4 to 21.6 ± 7.3 pg/mL. Increments in predicted adult height were significantly correlated with trough letrozole concentrations (r = 0.39, P = .01)., Conclusion: Letrozole treatment in Chinese pubertal populations should be further optimized, and more personalized therapies should be developed., (© 2021 British Pharmacological Society.)

Background: Corticosteroid therapy is used commonly in patients with COVID-19, although its impact on outcomes and which patients could benefit from corticosteroid therapy are uncertain., Research Question: Are clinical phenotypes of COVID-19 associated with differential response to corticosteroid therapy?, Study Design and Methods: Critically ill patients with COVID-19 from Tongji Hospital treated between January and February 2020 were included, and the main exposure of interest was the administration of IV corticosteroids. The primary outcome was 28-day mortality. Marginal structural modeling was used to account for baseline and time-dependent confounders. An unsupervised machine learning approach was carried out to identify phenotypes of COVID-19., Results: A total of 428 patients were included; 280 of 428 patients (65.4%) received corticosteroid therapy. The 28-day mortality was significantly higher in patients who received corticosteroid therapy than in those who did not (53.9% vs 19.6%; P < .0001). After marginal structural modeling, corticosteroid therapy was not associated significantly with 28-day mortality (hazard ratio [HR], 0.80; 95% CI, 0.54-1.18; P = .26). Our analysis identified two phenotypes of COVID-19, and compared with the hypoinflammatory phenotype, the hyperinflammatory phenotype was characterized by elevated levels of proinflammatory cytokines, higher Sequential Organ Failure Assessment scores, and higher rates of complications. Corticosteroid therapy was associated with a reduced 28-day mortality (HR, 0.45; 95% CI, 0.25-0.80; P = .0062) in patients with the hyperinflammatory phenotype., Interpretation: For critically ill patients with COVID-19, corticosteroid therapy was not associated with 28-day mortality, but the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Non-invasive respiratory strategies (NIRS) including high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) have become widely used in patients with COVID-19 who develop acute respiratory failure. However, use of these therapies, if ineffective, might delay initiation of invasive mechanical ventilation (IMV) in some patients. We aimed to determine early predictors of NIRS failure and develop a simple nomogram and online calculator that can identify patients at risk of NIRS failure., Methods: We did a retrospective, multicentre observational study in 23 hospitals designated for patients with COVID-19 in China. Adult patients (≥18 years) with severe acute respiratory syndrome coronavirus 2 infection and acute respiratory failure receiving NIRS were enrolled. A training cohort of 652 patients (21 hospitals) was used to identify early predictors of NIRS failure, defined as subsequent need for IMV or death within 28 days after intensive care unit admission. A nomogram was developed by multivariable logistic regression and concordance statistics (C-statistics) computed. C-statistics were validated internally by cross-validation in the training cohort, and externally in a validation cohort of 107 patients (two hospitals)., Findings: Patients were enrolled between Jan 1 and Feb 29, 2020. NIV failed in 211 (74%) of 286 patients and HFNC in 204 (56%) of 366 patients in the training cohort. NIV failed in 48 (81%) of 59 patients and HFNC in 26 (54%) of 48 patients in the external validation cohort. Age, number of comorbidities, respiratory rate-oxygenation index (ratio of pulse oximetry oxygen saturation/fraction of inspired oxygen to respiratory rate), Glasgow coma scale score, and use of vasopressors on the first day of NIRS in the training cohort were independent risk factors for NIRS failure. Based on the training dataset, the nomogram had a C-statistic of 0·80 (95% CI 0·74-0·85) for predicting NIV failure, and a C-statistic of 0·85 (0·82-0·89) for predicting HFNC failure. C-statistic values were stable in both internal validation (NIV group mean 0·79 [SD 0·10], HFNC group mean 0·85 [0·07]) and external validation (NIV group value 0·88 [95% CI 0·72-0·96], HFNC group value 0·86 [0·72-0·93])., Interpretation: We have developed a nomogram and online calculator that can be used to identify patients with COVID-19 who are at risk of NIRS failure. These patients might benefit from early triage and more intensive monitoring., Funding: Ministry of Science and Technology of the People's Republic of China, Key Research and Development Plan of Jiangsu Province, Chinese Academy of Medical Sciences., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)