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The consolidation characteristics of soft clay under multi-stage loading and single-stage loading exhibit significant differences. In order to investigate the consolidation behavior of soft clay under multi-stage loading, one-dimensional oedometer tests were conducted on marine sedimentary soft clay from northern China. The results indicate that the overall time-deformation pattern of multi-stage loading is a cyclic nonlinear extension of that of single-stage loading. The final deformation between multi-stage loading and single-stage loading is approximately equal; however, the consolidation rate of single-stage loading is four times that of multi-stage loading. Furthermore, the coefficient of consolidation (Cv) decreases with increasing stress. Subsequently, the traditional Terzaghi one-dimensional consolidation equation was modified and a consolidation equation suitable for multi-stage loading is proposed in this study. The analysis of engineering applications demonstrates that the traditional theory provides more accurate predictions of consolidation rate and settlement when the load is small. However, when the load is large, the settlement predicted using the Terzaghi one-dimensional consolidation equation may have an error of 0–25% compared to that using the modified equation. The modified Terzaghi one-dimensional consolidation equation provides a more accurate representation of the actual consolidation of soft soil. [ABSTRACT FROM AUTHOR]

The southwest karst area is considered to have the most vulnerable groundwater environment in China. Groundwater quality is an important factor restricting sustainable economic development. In this study, traditional water chemistry method, water quality index (WQI), and hazard index (HI) were applied to comparatively analyze the hydrochemical characteristics of groundwater and the water quality in the exposed karst region (EKR) and buried karst region (BKR) in Bama, a typical karst area in southwest China. Generally, the main water type was Ca/Mg–HCO 3. Due to the predominance of dissolution of carbonate rocks in EKR and silicate rocks in BKR, higher total dissolved solids (TDS), Ca and HCO 3 − concentrations, and lower H 2 SiO 3 content were detected in groundwater in EKR compared with BKR. As affected by weathering of rocks such as lead-zinc ore, the maximum concentrations of Zn and Sr were 11.23 mg/L and 13.30 mg/L, showing that mineral water resources are widely distributed in Bama. The ion ratios and isotope abundances (δD and δ18O) in groundwater samples indicated stronger evaporation and rock-water interaction in EKR than BKR. Human activities exerted a more significant influence on the water quality in EKR compared to BKR. The mean WQI value also suggested that the groundwater quality was better in BKR (9.56) than EKR (12.17). Although 95.7% of the water samples in the study area were classified as excellent based on their WQI values, 4.3% of the water samples still had significant health risks (HI > 1) due to the high Sb, Zn, As, and Sr concentrations. It is recommended to reduce anthropogenic pollution in EKR and develop a plan for clean production of mineral water industry according to local conditions, which will help the sustainable development of the local economy. [Display omitted] • Groundwater hydrochemistry in exposed and buried karst regions is totally different. • Aquatic environment in exposed karst regions is more sensitive than buried ones. • Sb, As, and Zn are the main trace elements which may pose non-carcinogenic risks. • Groundwater quality assessment contributes to sustainable water management. [ABSTRACT FROM AUTHOR]

Objective: Systemic sclerosis (SSc) is a heterogeneous connective tissue disease that is commonly subdivided into limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) based on the extent of skin involvement. This subclassification may not reflect the full range of clinical phenotypic variation. This study aimed to investigate clinical features and aggregation of patients with SSc in Chinese based on SSc manifestations and organ involvements, in order to achieve precise treatment of SSc early prevention of complications., Methods: In total 287 SSc patients were included in this study. A cluster analysis was applied according to 13 clinical and serologic variables to determine subgroups of patients. Survival rates between obtained clusters and risk factors affecting prognosis were also compared., Result: In this study, six clusters were observed: cluster 1 (n = 66) represented the skin type, with all patients showing skin thickening. In cluster 2 (n = 56), most patients had vascular and articular involvement. Cluster 3 (n = 14) individuals mostly had cardiac and pulmonary involvement. In cluster 4 (n = 52), the gastrointestinal type, 50 patients presented with stomach symptoms and 28 patients presented with esophageal symptoms. In cluster 5 (n = 50), patients barely had any major organ involvement. Cluster 6 (n = 49) included 46% of all patients presenting with renal crisis., Conclusion: The results of our cluster analysis study implied that limiting SSc patient subgroups to those based only on skin involvement might not capture the full heterogeneity of the disease. Organ damage and antibody profiles should be considered when identifying homogeneous patient groups with a specific prognosis. Key Points • Provides a new method of categorizing SSc patients. • Can better explain disease progression and guide subsequent treatment., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background: With the progress of therapeutic drug monitoring (TDM) technology and the development of evidence-based medicine, many guidelines were developed and implemented in recent decades., Objective: The aim was to evaluate the current status of TDM guidelines and provide suggestions for their development and updates based on Appraisal of Guidelines for Research and Evaluation (AGREE) II., Methods: The TDM guidelines were systematically searched for among databases including PubMed, Embase, China National Knowledge Infrastructure, Wanfang Data, and the Chinese biomedical literature service system and the official websites of TDM-related associations. The search period was from inception to 6 April 2023. Four researchers independently screened the literature and extracted data. Any disagreement was discussed and reconciled by another researcher. The quality of guidelines was assessed using the AGREE II instrument., Results: A total of 92 guidelines were included, including 57 technical guidelines, three management guidelines, and 32 comprehensive guidelines. The number of TDM guidelines has gradually increased since 1979. The United States published the most guidelines (20 guidelines), followed by China (15 guidelines) and the United Kingdom (ten guidelines), and 23 guidelines were developed by international organizations. Most guidelines are aimed at adult patients only, while 28 guidelines include special populations. With respect to formulation methods, there are 23 evidence-based guidelines. As for quality evaluation results based on AGREE II, comprehensive guidelines scored higher (58.16%) than technical guidelines (51.36%) and administrative guidelines (50.00%)., Conclusion: The number of TDM guidelines, especially technical and comprehensive ones, has significantly increased in recent years. Most guidelines are confronted with the problems of unclear methodology and low quality of evidence according to AGREE II. More evidence-based research on TDM and high-quality guideline development is recommended to promote individualized therapy., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures., Objective: This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective., Methods: The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β 1 ) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β 2 ). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML)., Results: Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β 1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (β 1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β 2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (β 2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β 2 = -1.4, 95% CI: -2.6, -0.2) or not (β 2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β 2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β 2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (β 2 = 24.3, 95% CI 17.3, 31.4)., Conclusions: Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation., 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 © 2023 Wang, Li, Gu, Cai, Wang, Yi and Chen.)

Background: The relationship between perioperative hyperchloremia and postoperative acute kidney injury (AKI) is not well established. Our study aimed to evaluate the association between perioperative hyperchloremia and acute kidney injury in patients undergoing off-pump coronary artery bypass grafting (CABG)., Methods: Patients with coronary disease who underwent off-pump CABG between April 2017 and December 2019 were enrolled in this retrospective study. The patients with perioperative hyperchloremia were matched 1:1 to patients without perioperative hyperchloremia. The primary outcome was the postoperative acute kidney injury rate. The secondary outcomes included intensive care unit (ICU)-free days, postoperative hospitalization days, wound infection rate, and in-hospital mortality. Propensity score matching and univariate and multivariate logistic regression analyses were used in this study., Results: A total of 321 patients who underwent off-pump CABG were included in the analysis. Propensity score matching selected 83 pairs for the final comparison. The results showed that the postoperative AKI rate was significantly different between the hyperchloremia and no hyperchloremia groups (56.6% versus 15.7%; P < .001). The number of ICU-free days, postoperative hospitalization days, wound infection rate, and in-hospital mortality were similar between the two groups. In the multivariable, logistic regression analysis, hyperchloremia was independently associated with the development of postoperative AKI (odds ratio [OR] = 1.814, 95% confidence interval [CI]: 1.072-3.070, P = .026)., Conclusions: Perioperative hyperchloremia is associated with an increase in the postoperative AKI rate among patients undergoing off-pump CABG.