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Carbon fiber-reinforced epoxy resin composites have poor high temperature resistance and are prone to thermal damage during service in the aerospace field. The purpose of this study was to evaluate the thermal decomposition (pyrolysis) characteristics of carbon fiber-reinforced epoxy composites and reasonably predict their thermal decomposition under arbitrary temperature conditions. The kinetic analysis was conducted on the thermal decomposition of carbon fiber-reinforced epoxy resin composites (USN15000/9A16/RC33, supplied by Weihai GuangWei Composites Co., Ltd. Weihai City, Shandong Province, China) under a nitrogen environment, and an improved model of pyrolysis prediction suitable for the arbitrary temperature program was developed in this work. The results showed that the carbon fiber-reinforced epoxy composites begin to degrade at about 500 K, and the peak value of the weight loss rate at the respective heating rate appears in the range of 650 K to 750 K. A single-step reaction can characterize the thermal decomposition of carbon fiber-reinforced epoxy composites in a nitrogen atmosphere, and a wide variety of isoconversional approaches can be used for the calculation of the kinetic parameters. The proposed model of pyrolysis prediction can avoid numerous limitations of temperature integration, and it shows good prediction accuracy by reducing the temperature rise between sampling points. This study provides a reference for the kinetic analysis and pyrolysis prediction of carbon fiber-reinforced epoxy composites. [ABSTRACT FROM AUTHOR]

During the postconstruction operation period, the engineering structure and operation safety of a pipe-jacking tunnel are more likely to be threatened by the surrounding environment and groundwater when it is located in a soft clay stratum. Surface settlement data related to the construction of 24 rectangular pipe-jacking tunnels in a soft clay stratum in China were collected and analyzed to determine the effect of pipe-jacking tunnel engineering on its deformation based on factors such as structural section form, geotechnical condition, groundwater condition, and buried depth. The postmaximum surface settlement and postformation loss rate were obtained, the correlation coefficients between the postsurface deformation of soft clay strata and various influencing factors were calculated using a software for correlation analysis, and the variation rules for each influencing factor were explored in depth. Subsequently, multiple linear regression methods were used to predict the maximum surface deformation of the pipe-jacking tunnel project in soft clay strata during the postoperation period, and actual engineering cases were verified and analyzed. The results show that the relative buried depth of the pipe-jacking tunnel in soft clay stratum has the greatest influence on the postmaximum ground settlement, followed by the section area of the pipe-jacking tunnel, and the relative height coefficient of groundwater level has the least influence. Under the reduction coefficient of 0.937 − 0.846, a new prediction formula for surface settlement deformation after the construction of the soft clay layer was derived. The error between the formula and the measured data was 9.05%, which can be used as a reference for controlling design parameters to predict the settlement after construction of pipe-jacking engineering. [ABSTRACT FROM AUTHOR]

Background: The Chinese population is aging, and chronic non-communicable diseases (NCDs) prevalence is correspondingly increasing, along with associated disability and healthcare costs. Although self-management has been associated with social support and is a recognized priority, its mediating variables have not been studied in detail, particularly among old people with chronic diseases. Purpose: To examine the mediating role of e-health literacy and general self-efficacy in the relationship between social support and self-management of chronic NCDs in Chinese community home-based aging institution residents. Patients and Methods: A random sample of 289 community home-based aging institution elders (≥ 60 years) with chronic NCDs in China was recruited. Questionnaire data were recorded on self-reported socio-demographics, self-management, social support, e-health literacy, and general self-efficacy. Pearson's correlation analysis identified the relationship between these factors and self-management. Serial multiple mediation model was used to test the hypothesized relationships. Results: The self-management mean (±SD) score was 29.39 ± 9.60, and the level of self-management was medium. Social support (r = 0.283; P < 0.001), e-health literacy (r = 0.566; P < 0.001), and general self-efficacy (r = 0.477; P < 0.001) were positively associated with self-management. Furthermore, social support indirectly influenced self-management through three pathways: independent mediation of e-health literacy (effect = 0.234, P < 0.001), independent mediation of general self-efficacy (effect = 0.515, P < 0.001), and chain mediation of e-health literacy and general self-efficacy (effect = 0.075, P < 0.001). Conclusion: In Chinese community home-based aging institution elders, the relationship between self-reported self-management and social support is positively affected by the independent mediating effect of e-health literacy and general self-efficacy and the serial mediating effect of e-health literacy and general self-efficacy. Targeted self-management programs for elders with chronic NCDs have theoretical support, which could improve the health status and quality of life in this population. [ABSTRACT FROM AUTHOR]

Long-term intensive use of mineral fertilizers in double rice-cropping systems has led to soil acidification and soil degradation. Manure fertilization was suggested as an alternative strategy to mitigate soil degradation. However, the effects of long-term mineral and manure fertilization on rice grain yield, yield stability, soil organic carbon (SOC) content, soil total nitrogen (TN) content, and the underlying mechanisms are unclear. Based on a long-term experiment established in 1981 in southern China, we compared four treatments: no fertilizer application (Control); application of nitrogen–phosphorus–potassium (NPK); NPK plus green manure in early rice (M1); and M1 plus farmyard manure in late rice and rice straw return in winter (M2). Our results showed that 37 years of NPK, M1, and M2 significantly increased rice grain yield by 54%, 46%, and 72%, and yield stability by 22%, 17%, and 9%, respectively. M1 and M2 significantly increased SOC content by 39% and 23% compared to Control, respectively, whereas there was no difference between Control and NPK. Regarding soil TN content, it was significantly increased by 8%, 46%, and 20% by NPK, M1, and M2, respectively. In addition, M2 significantly increased bacterial OTU richness by 68%, Chao1 index by 79%, and altered the bacterial community composition. Changes in soil nutrient availability and bacterial Simpson index were positively correlated with the changes in grain yield, while shifts in bacterial community were closely related to yield stability. This study provides pioneer comprehensive assessments of the simultaneous responses of grain yield, yield stability, SOC and TN content, nutrient availability, and bacterial community composition to long-term mineral and manure fertilization in a double rice-cropping system. Altogether, this study spanning nearly four decades provides new perspectives for developing sustainable yet intensive rice cultivation to meet growing global demands. [ABSTRACT FROM AUTHOR]

Sea surface temperature (SST) research is the basis of our understanding of local and global climate characteristics. Significant effort has been focused on the acquisition of accurate prediction results. Although a large amount of SST data is available due to the development of storage media, there are limited studies on the prediction of future SST values in a spatiotemporal manner. Most previous studies ignore the regional distribution information in natural geographical location, which leads to the loss of regional information and hinders further regional analysis. In this work, we have addressed this issue by presenting Regional Convolution long short-term memory (RC-LSTM) model with spatio-temporal information processing capability. To the best of our knowledge, this is the first time that SST time series has been used for region prediction based on deep learning. Daily SST from January 2000 to December 2012 from China's offshore waters is adopted to conduct experiments. The local correlation and global coherence of each time series are extracted by the multi-layer neural network in the model. The structure of the RC-LSTM model includes a convolutional layer with region information extraction capabilities, and a long short-term memory (LSTM) layer. The RC-LSTM model performs well over both the South China Sea and the East China Sea, as determined by the root mean squared error (RMSE) and the accuracy (Acc). The experimental results show that our model is more accurate than traditional prediction models and has higher generalization ability, and is therefore more practical. [ABSTRACT FROM AUTHOR]

Understanding genetic diversity patterns of endangered species is an important premise for biodiversity conservation. The critically endangered salamander Andrias davidianus, endemic to central and southern mainland in China, has suffered from sharp range and population size declines over the past three decades. However, the levels and patterns of genetic diversity of A. davidianus populations in wild remain poorly understood. Herein, we explore the levels and phylogeographic patterns of genetic diversity of wild‐caught A. davidianus using larvae and adult collection with the aid of sequence variation in (a) the mitochondrial DNA (mtDNA) fragments (n = 320 individuals; 33 localities), (b) 19 whole mtDNA genomes, and (c) nuclear recombinase activating gene 2 (RAG2; n = 88 individuals; 19 localities). Phylogenetic analyses based on mtDNA datasets uncovered seven divergent mitochondrial clades (A–G), which likely originated in association with the uplifting of mountains during the Late Miocene, specific habitat requirements, barriers including mountains and drainages and lower dispersal ability. The distributions of clades were geographic partitioned and confined in neighboring regions. Furthermore, we discovered some mountains, rivers, and provinces harbored more than one clades. RAG2 analyses revealed no obvious geographic patterns among the five alleles detected. Our study depicts a relatively intact distribution map of A. davidianus clades in natural species range and provides important knowledge that can be used to improve monitoring programs and develop a conservation strategy for this critically endangered organism. [ABSTRACT FROM AUTHOR]

Debris flow occurs frequently (ten events on average per year) and displays a great variety of properties in the Jiangjia Gully (JJG) in southwest China. We find that the material of debris flow satisfies a universal grain size distribution (GSD) of P ( D) = CDexp(− D/ D), and the parameters μ and D are closely related to the dynamical properties such as flow density, velocity, and discharge. A small μ implies a small porosity and possible high excess pore pressure in flow, reflecting high mobility and capacity of transportation, and a large D means a wide range of grain composition and hence a high grain concentration. A debris flow always achieves a state of certain mobility and density that can be well described by μ and D, and the parameters impose power law constraints on the fluctuations of debris flow surges. An upper limit of unit-width discharge is estimated as Q = 1.25 D. Variation of GSD parameters also describes material exchanges between debris flow and streambed sediment. Intense incision or deposition occurs when remarkable difference of grain composition exists. As the GSD is satisfied universally, the results derived from JJG are expected to be applicable for evaluating the properties and peak discharge of a potential debris flow in other conditions. [ABSTRACT FROM AUTHOR]

The C 18 -diterpenoid alkaloid lappaconitine (LA) is a non-addictive analgesic used in China. The toxicity (LD 50 = 11.7 mg/kg) limits its application. Two series of LA derivatives, including amides and sulfonamides (1–93), were designed and synthesized by modification on their C4 acetamidobenzoate side chains in this work. In vivo analgesic activity and toxicity of all derivatives were evaluated, and the structure-activity relationship was summarized. Six lead compounds (35 , 36 , 39 , 49 , 70 , and 89) exhibited approximate analgesic activity to LA but with significantly reduced toxicity. The therapeutic index of these compounds is 14–30 times that of LA. In vivo metabolism study of the lead compounds 39 , 49 , 70 , and 89 were conducted by UPLC-MSE, indicating the reason for the low toxicity of the potential derivatives might be they are difficult to metabolize to toxic metabolite N -deacetyllappaconitine compared to LA. The effects of lead compounds on sodium channels and hERG channels were also studied by ion channel reader (ICR) which further revealed their analgesic and toxicity-attenuating mechanisms. Sodium channel assay revealed that the analgesic mechanism of these lead compounds was inhibiting the Na v 1.7 channels. Taken together, compound 39 was provided as a new analgesic lead compound with significantly low toxicity and comparable activity to LA. [Display omitted] • Ninety-three lappaconitine (LA) derivatives were designed and synthesized. • Six derivatives exhibited analgesic activity to LA but with significantly reduced toxicity. • The therapeutic index of six derivatives is 14–30 times that of LA. • The derivatives are not easy to metabolize to N -deacetyllappaconitine may lead to low toxicity. • The analgesic mechanism of these lead compounds was inhibiting the Na v 1.7 channels. [ABSTRACT FROM AUTHOR]

• Effects of long-term herbicide acetochlor application on the crops in soybean-peanut rotations were evaluated. • Significant effects exist in long-term herbicide acetochlor application on crops growth, physiology and yield. • The yield reduction of long-term acetochlor application was gradually aggravated with the increasing years of application. Aiming at the problem that the amount of chemical herbicides input is continuously increasing, it may be result in the severe organic chemical pollution, and the negative influence on crop growth is also enhancing in the red soil upland of southern China. Therefore, a long-term location experiment was founded to research the effects of herbicide acetochlor on the crops growth, physiology and yield in soybean-peanut rotations in the red soil upland. The data in 2013 and 2014 indicated that the rate of emergence, number of leaves, stem diameter, plant height of peanut and soybean seedlings were declined by herbicide acetochlor with long-term application, the seedling growth was limited obviously. The root nodule number, shoot dry matter and SPAD value of peanut and soybean were significantly decreased by herbicide acetochlor at four critical growing stages. Moreover, the leaf malondialdehyde (MDA) content, superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activities of peanut were significantly decreased by acetochlor at four critical growth stages. As for soybean, the leaf MDA content at four critical growth stages and SOD and POD activities at seedling stage were significantly enhanced by acetochlor with long-term application, but SOD and POD and CAT activities at pods bearing stage and mature stage were significantly dropped. The yield components of peanut such as plant height, lateral branches number, 100 pods weight, shelling rate and yield were reduced under the treatment of herbicide acetochlor. The plant height, branches number, 100 grains weight, and grain yield of soybean were significantly decreased by the acetochlor treatment, but the empty pods rate was significantly increased. The annual yield in 12 years indicated that long-term acetochlor application reduced the yield of peanut and soybean, and the range of yield reduction was gradually aggravated with the increasing years of application. Compared with manual weeding, the yield decreasing range of soybean was from 5.64%–13.14% and the yield decreasing range of peanut was from 3.85%–12.49% under acetochlor treatment from 2006 to 2017. [ABSTRACT FROM AUTHOR]

Plant-sucking insects have intricate associations with a diverse array of microorganisms to facilitate their adaptation to specific ecological niches. The midgut of phytophagous true bugs is generally structured into four distinct compartments to accommodate their microbiota. Nevertheless, there is limited understanding regarding the origins of these gut microbiomes, the mechanisms behind microbial community assembly, and the interactions between gut microbiomes and their insect hosts. In this study, we conducted a comprehensive survey of microbial communities within the midgut compartments of a bean bug Riptortus pedestris, soybean plant, and bulk soil across 12 distinct geographical fields in China, utilizing high-throughput sequencing of the 16 S rRNA gene. Our findings illuminated that gut microbiota of the plant-sucking insects predominantly originated from the surrounding soil environment, and plants also play a subordinate role in mediating microbial acquisition for the insects. Furthermore, our investigation suggested that the composition of the insect gut microbiome was probably shaped by host selection and/or microbe-microbe interactions at the gut compartment level, with marginal influence from soil and geographical factors. Additionally, we had unveiled a noteworthy dynamic in the acquisition of core bacterial taxa, particularly Burkholderia, which were initially sourced from the environment and subsequently enriched within the insect midgut compartments. This bacterial enrichment played a significant role in enhancing insect host reproduction. These findings contribute to our evolving understanding of microbiomes within the insect-plant-soil ecosystem, shedding additional light on the intricate interactions between insects and their microbiomes that underpin the ecological significance of microbial partnerships in host adaptation., (© 2024. The Author(s).)

Background: Chronic non-communicable diseases (CNCDs) are an urgent public health issue in China, especially among older adults. Hence, self-management is crucial for disease progression and treatment. Electronic health (e-health) literacy and self-efficacy positively correlate with self-management. However, we know little about their underlying mechanisms in older adults with CNCDs., Objective: To explore the factors that influence chronic disease self-management (CDSM) and verify self-efficacy as the mediator between e-health literacy and self-management behavior in older patients with CNCDs., Methods: This cross-sectional study included 289 older patients with CNCDs from Hunan province, China, between July and November 2021. E-health literacy, self-efficacy, social support, and CDSM data were collected through questionnaires. The influence of each factor on CDSM was explored with multiple linear regression analysis. Intermediary effects were computed via a structural equation model., Results: The total CDSM score in the patients was 29.39 ± 9.60 and only 46 (15.92%) patients used smart healthcare devices. The regression analysis showed e-health literacy, self-efficacy, and social support were the factors that affected CDSM. Furthermore, the structural equation model revealed that self-efficacy directly affected CDSM (β = 0.45, P < 0.01), whereas e-health literacy affected it directly (β = 0.42, P < 0.01) and indirectly (β = 0.429, P < 0.01) through self-efficacy., Conclusions: This study revealed that self-management among older patients with CNCDs is at a low level, and few of them use smart healthcare devices. Self-efficacy plays a partial intermediary role between e-health literacy and self-management in older patients with CNCDs. Thus, efforts to improve their CDSM by targeting e-health literacy may be more effective when considering self-efficacy., (© 2022. The Author(s).)

For migratory fish, passing through the cold, fast flowing water of a dam causes stress, leading to disease and even death. To determine the immune response to cold stress in a dam-lake after swimming fatigue in Chinese sucker (Myxocyprinus asiaticus), the spleen mRNA expression profiles in response to cold stress (CS) after fatigue stress (FS) were compared with that of the control (SS). We identified 40,952 differentially expressed genes (DEGs) in the spleen for at least one comparison among 211,397 unigenes. We identified 11,869 DEGs (4,968 upregulated and 6,901 downregulated), 17,803 DEGs (10,610 upregulated and 7,193 downregulated), and 30,579 DEGs (20,652 upregulated and 9,927 downregulated) in the SS vs. FS, SS vs. CS, and FS vs. CS comparisons, respectively. Enrichment analysis indicated the involvement of the immune system and infectious diseases, including the toll-like receptor pathway, the complement and coagulation cascade, and the natural killer cell-mediated cytotoxicity pathway. There were 2,991 DEGs (271 upregulated and 2,720 downregulated), and 2,878 DEGs (873 upregulated and 2,005 downregulated) associated with these pathways in the SS vs. FS and SS vs. CS comparisons, respectively. In the cold stress after fatigue group, the expression levels of heat shock protein (HSP) 70 and HSP90 genes were significantly upregulated; however, more immune response genes showed significantly downregulated expression in SS vs. CS compared with that in SS vs. FS, including those encoding tumor necrosis factor, C-C motif chemokines (3, 8, and 13), complement components (C3, C4, C6, and C7), immunoglobulin, and cathepsins. Overall, cold stress combined with swimming fatigue from passing the dam resulted in the downregulation of many immune genes, suggesting that the Chinese sucker might have experienced serious immune suppression., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxaemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair., Methods: This retrospective study continuously enrolled 83 patients who underwent TAAD repair from January 1 to December 31, 2018. OSA was diagnosed by sleep test and defined as an apnoea hypopnea index (AHI) of ≥ 15/h, while an AHI of > 30/h was defined severe OSA. Hypoxaemia was defined as an oxygenation index (OI) of < 200 mmHg. Prolonged ICU stay referred to an ICU stay of > 72 h. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of postoperative OI for prolonged ICU stay. Multivariate logistic regression was performed to assess the association of OSA with hypoxaemia and prolonged ICU stay., Results: A total of 41 (49.4%) patients were diagnosed with OSA using the sleep test. Hypoxaemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxaemia developed mostly in patients with OSA (52.4% vs. 83.0%, p = 0.003), and particularly in those with severe OSA (52.4% vs. 90.5%, p = 0.003). The postoperative OI could fairly predict a prolonged ICU stay (area under the receiver-operating characteristic curve, 0.72; 95% confidence intervals [CI] 0.60-0.84; p = 0.002). Severe OSA was associated with both postoperative hypoxaemia (odds ratio [OR] 6.65; 95% CI 1.56-46.26, p = 0.008) and prolonged ICU stay (OR 5.58; 95% CI 1.54-20.24, p = 0.009)., Conclusions: OSA was common in patients with TAAD. Severe OSA was associated with postoperative hypoxaemia and prolonged ICU stay following TAAD repair., (© 2021. The Author(s).)

Objective: To examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones., Methods: Patients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley's criteria for bone healing and functional assessment., Results: In total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11-61 years). The patients were followed up for at least 24 months. According to Paley's criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%)., Conclusion: Infected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.

Objective: Tspan8 (tetraspanin 8) plays critical roles in cell adhesion and motility. Recently, Tspan8 overexpression has been found in various tumors. However, its expression status and prognostic significance in clear cell renal cell carcinoma (ccRCC) remains unknown. The objective of the present study was to assess the expression of Tspan8 and its correlation with clinicopathological features in ccRCC., Methods: Tspan8 expression was detected in 150 cases of ccRCC and matched paracancerous tissues by immunohistochemistry (IHC) and its relevance with prognosis was analyzed., Results: Our data showed that the high-expression rate of Tspan8 in ccRCC tissues was 74.0%, which was significantly higher than those in paracancerous kidney tissues (43.3%, P =0.001). Meanwhile, Tspan8 expression was positively correlated with tumor size and WHO/ISUP grade in ccRCC. Significantly, Kaplan-Meier analysis and log-rank test revealed that Tspan8 higher expression was associated with poorer overall survival (OS) in ccRCC patients ( P <0.05). Cox regression analysis further showed that Tspan8 was a significant independent negative prognostic factor for these patients., Conclusion: Tspan8 is overexpressed in ccRCC and indicates poor prognosis, suggesting potential roles of Tspan8 in prognostication and targeted therapy., (© 2020 by the Association of Clinical Scientists, Inc.)

Objectives: The aims of this study were to analyse the serotypes of epidemic Haemophilus influenzae and changes in mechanisms of β-lactam resistance over the past decade., Results: Haemophilus influenzae isolates in Western Sichuan from 2013-2014 were non-typeable H. influenzae (NTHi). β-Lactam MICs for NTHi isolated during 2013-2014 were significantly higher than those from 2003-2004 (P < 0.05). Of 274 NTHi, 141 (51.5%) were β-lactamase-positive (TEM-1 type). There were 35 amino acid (AA) substitutions in ftsI among NTHi isolated from 2013-2014. However, NTHi isolates from 2003-2004 had only nine AA substitutions. Ordered multiple classification logistic regression analysis showed that different AA substitution patterns in ftsI had different effects on β-lactam MICs. The main factors affecting the ampicillin MIC were the mutations R517H (OR = 6.999), L389F (OR = 7.128), N526K (OR = 4.660) and D350N (OR = 0.450). The main factor influencing the amoxicillin/clavulanic acid MIC was an N526K mutation (OR = 9.349). The main factors affecting the cefuroxime MIC were the mutations S357N (OR = 37.453) and N526K (OR = 14.816). Compared with 2003-2004, gBLNAR and gBLPAR isolated from 2013-2014 increased significantly from 13.0% (7/54) and 9.3% (5/54) to 38.2% (84/220) and 45.5% (100/220), respectively (P < 0.001). In the 'others' group of ftsI gene mutations, 13 NTHi had the same ftsI gene mutation pattern and 24 AA substitutions., Conclusion: These results confirm that β-lactam-resistant NTHi isolates increased rapidly. AA substitutions in ftsI were more complex and diversified in 2013-2014., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)-associated pneumonia., Patients and Methods: A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19-associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO 2 ) and other measures were tested as predictors of in-hospital mortality in survival analysis., Results: Of 140 patients with COVID-19-associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO 2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO 2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO 2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO 2 , 0.93; 95% CI, 0.91 to 0.95; P<.001). The SpO 2 cutoff value of 90.5% yielded 84.6% sensitivity and 97.2% specificity for prediction of survival. Dyspnea was also independently associated with death in multivariable analysis (hazard ratio, 2.60; 95% CI, 1.24 to 5.43; P=.01)., Conclusion: In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources., Trial Registration: Chictr.org.cn Identifier: ChiCTR2000030852., (Copyright © 2020. Published by Elsevier Inc.)

Objective: Growing evidence indicates that both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) may be closely associated with the prevalence of pulmonary embolism (PE). However, the relationship of overlap syndrome (OS) (coexistence of OSA and COPD) with PE is unclear. The purpose of this study was to investigate whether OS were associated with increased PE prevalence., Methods: We performed a retrospective chart review of patients who underwent sleep study at Beijing An Zhen Hospital from 2011 to 2014. The association of OS with PE prevalence was estimated by using logistic regression models., Results: In contrast to control patients (neither OSA nor COPD), those subjects with OS had higher odds of PE (OR9.61; 95%CI 4.02-21.31, p < 0.001) with significance persisting after adjusting for covariates (OR 5.66; 95%CI 1.80-16.18, p = 0.004). Meanwhile, patients with OS compared with those with isolated OSA also had significantly higher odds of PE in univariate (OR 4.79; 95%CI 2.04-10.33, p = 0.0007) and adjusted models (OR 3.89; 95%CI 1.27-10.68, p = 0.019). In subgroup analysis, patients with OS had higher odds of PE than control group among male subjects (OR 8.12, 95%CI1.86-31.87, p = 0.007) and patients ≥ 58years (OR 5.50, 95%CI 1.51-18.14, p = 0.012) in multivariable models. Percentage of total sleep time with saturation lower than 90% (T90) ≥ 2.6% was significantly associated with prevalence of PE (OR 4.72, 95%CI1.34-19.83, p = 0.015) in subgroup of patients older than 58., Conclusions: OS is independently associated with PE prevalence. Longitudinal studies are needed to better understand the relationship with incident PE., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The community medical center is the first barrier for lipid control. We aimed to survey the residents' cholesterol condition in the community, and pursue the reasons for the upsetting results from various aspects., Methods: Residents and physicians were recruited from four community centers. Residents completed questionnaires and a physical examination as well as biochemical analysis. Physicians were also asked to complete a questionnaire, some of which were about basic knowledge of lipids., Results: About 37.0% male and 48.1% female had elevated cholesterol levels. Residents' blood pressure (BP), fasting glucose (FG), body mass index (BMI), and waist circumference (WC) were positively associated with their low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). Framingham risk scoring (FRS) was strongly related to cholesterol (P < 0.001 for LDL-C and TC). Residents' higher education grade was positively related to a normal cholesterol condition (P < 0.001), while personal income was negatively related to it. Rural residents had higher percent of population with normal cholesterol level (normal cholesterol rate) than their city counterpart (P < 0.001). Although physicians with college education had a much higher lipid knowledge level themselves, the physicians' factors had almost no relationship with the residents' cholesterol levels., Conclusions: Management of hypercholesterolemia should be an important component of health strategy in Beijing. Education is imperative for residents as well as for physicians.

Background: An elevated serum lipid is one of the major risk factors for coronary heart disease (CHD). Physicians' awareness contributes to successful adoption of practice guidelines. Community medical centers are the primary defense against chronic disease. This study aimed to investigate community physicians' awareness of cholesterol guidelines and their utilization., Methods: Six hundred and one community physicians were randomly selected from four different regions, and completed a confidential and semi-structured questionnaire. Four hundred and ninety-one completed the questionnaire, and 486 valid questionnaires were available., Results: The physicians' fundamental knowledge of lipids was astonishingly poor, while the awareness of cholesterol guidelines was low. Only 24% and 14% of the physicians reported the right optimal low-density lipoprotein cholesterol (LDL-C) level for CHD and diabetes patients respectively. More than half of the physicians (55.8%) mistakenly considered elevated transaminases to be the lethal side effect of statins. More than half of the physicians (51.9%) would give up statin treatment in the case of transaminase elevation., Conclusion: Educational interventions to improve cholesterol knowledge and to publicize standard treatment are needed among Chinese community physicians.

Background: Exposure to active and passive smoking is associated with arterial stiffness and cotinine is an objective biochemical indicator to classify smoking state. The aim of the study was to survey participant smoking condition with cotinine in North China and discuss its destructive effect on arterial stiffness., Methods and Results: Nine hundred and six people were recruited in this study and were classified into non-smokers, passive smokers and active smokers according to the cotinine level. Brachial-ankle pulse wave velocity (baPWV) was measured using an automatic device. Active smokers vs non-smokers showed a significantly higher baPWV (P=0.023) after adjusting for covariates. Participants who smoked longer than 10 years had a higher baPWV than non-smokers (P=0.029) although no significant difference existed between those who had a smoking history of less than 10 years and those who had never smoked. In less developed areas, the active and passive smoking rates were higher than that in Beijing (P<0.001) while active smokers vs non-smokers had a higher baPWV (P=0.017)., Conclusions: Active smokers, as confirmed by the cotinine level have worse arterial stiffness, and long-term smoking can cause marked arterial stiffness. Smoking exposure might bring about more serious effects on arterial function in patients from poor areas than in modernized cities.