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OBJECTIVE: To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. METHODS: A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). FINDINGS: The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ2 test: P < 0.001). The overall drop in the caesarean section rate was significant (χ2 test: P < 0.001) and inversely correlated with the years (Spearman's ρ: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). CONCLUSION: Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.

Graphite-based composites are well recognized as ideal functional materials in mechanical seals, bearings of canned pumps, and electrical contact systems because of their outstanding self-lubricating ability, thermostability, and chemical stability. Working in harsh conditions is a huge challenge for the graphite materials, and their tribological properties and wear mechanisms are not well studied. In this study, the tribological performance of metal-impregnated graphite, resin-impregnated graphite, and non-metal-impregnated graphite under high temperature and high load are studied using a ball-on-disc tribometer. The results show that the metal-impregnated graphite (Metal-IG) has a stable friction regime and exhibits better anti-friction and anti-wear properties than that of resin-impregnated graphite (Resin-IG) and non-impregnated graphite (Non-IG) under extreme pressure (200~350 MPa) and high temperature (100–350 ℃). The Metal-IG and Resin-IG can reduce the wear depth by 60% and 80%, respectively, when compared with Non-IG substrate. The impregnated materials (metal or resin) can enhance the strength of the graphite matrix and improve the formation of graphite tribofilm on the counterpart surfaces. Friction-induced structural ordering of graphite and slight oxidation of metal in the formed mechanically mixed layer is also beneficial for friction and wear reduction. This study demonstrates the tribological characteristics of impregnated graphite under harsh conditions and provides the experimental basis for the advanced usage of high-reliability and self-lubrication graphite composites. [ABSTRACT FROM AUTHOR]

Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. Methods A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). Findings The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ2 test: P < 0.001). The overall drop in the caesarean section rate was significant (χ2 test: P < 0.001) and inversely correlated with the years (Spearman's p: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). Conclusion Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion To evaluate the performance of an artificial intelligence (AI) and machine learning (ML) model for first‐trimester screening for pre‐eclampsia in a large Asian population.This was a secondary analysis of a multicenter prospective cohort study in 10 935 participants with singleton pregnancies attending for routine pregnancy care at 11–13+6 weeks of gestation in seven regions in Asia between December 2016 and June 2018. We applied the AI+ML model for the first‐trimester prediction of preterm pre‐eclampsia (<37 weeks), term pre‐eclampsia (≥37 weeks), and any pre‐eclampsia, which was derived and tested in a cohort of pregnant participants in the UK (Model 1). This model comprises maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PlGF). The model was further retrained with adjustments for analyzers used for biochemical testing (Model 2). Discrimination was assessed by area under the receiver operating characteristic curve (AUC). The Delong test was used to compare the AUC of Model 1, Model 2, and the Fetal Medicine Foundation (FMF) competing risk model.The predictive performance of Model 1 was significantly lower than that of the FMF competing risk model in the prediction of preterm pre‐eclampsia (0.82, 95% confidence interval [CI] 0.77–0.87 vs. 0.86, 95% CI 0.811–0.91, P = 0.019), term pre‐eclampsia (0.75, 95% CI 0.71–0.80 vs. 0.79, 95% CI 0.75–0.83, P = 0.006), and any pre‐eclampsia (0.78, 95% CI 0.74–0.81 vs. 0.82, 95% CI 0.79–0.84, P < 0.001). Following the retraining of the data with adjustments for the PlGF analyzers, the performance of Model 2 for predicting preterm pre‐eclampsia, term pre‐eclampsia, and any pre‐eclampsia was improved with the AUC values increased to 0.84 (95% CI 0.80–0.89), 0.77 (95% CI 0.73–0.81), and 0.80 (95% CI 0.76–0.83), respectively. There were no differences in AUCs between Model 2 and the FMF competing risk model in the prediction of preterm pre‐eclampsia (P = 0.135) and term pre‐eclampsia (P = 0.084). However, Model 2 was inferior to the FMF competing risk model in predicting any pre‐eclampsia (P = 0.024).This study has demonstrated that following adjustment for the biochemical marker analyzers, the predictive performance of the AI+ML prediction model for pre‐eclampsia in the first trimester was comparable to that of the FMF competing risk model in an Asian population. [ABSTRACT FROM AUTHOR]

Competing Interests: No conflicts of interest.

Background: The study of ambient air particulate matter (PM 2.5 )-associated health and economic burdens of cardiovascular disease are crucial for air pollution control and disease prevention strategies. Quantified evidence remains inadequate., Objectives: This study aimed to estimate the PM 2.5 associated risk in cardiovascular hospital admission as well as attributable health burdens and economic costs., Methods: A total of 2,202,244 hospital admission records of cardiovascular disease and six common clinical subtypes in Beijing were included. A time-stratified case-crossover design was applied to estimate the associations and the concentration-response curve. Then, the annual average additional hospital admissions, days of hospital stay, and hospital expenditures were evaluated from 2013 to 2017 and compared between 2017 and 2013., Results: The results showed that each 10 μg/m 3 increase in previous-day PM 2.5 concentration was associated with a risk increase of 0.44% (95%CI: 0.40%, 0.47%) for cardiovascular disease, 0.66% (95%CI: 0.58%, 0.73%) for angina pectoris, 0.53% (95%CI: 0.39%, 0.66%) for chronic ischemic heart disease, 0.48% (95%CI: 0.34%, 0.63%) for myocardial infarction, 0.44% (95%CI: 0.29%, 0.60%) for hypertensive heart disease and 0.40% (95%CI: 0.27%, 0.52%) for ischemic stroke. There were 1938 PM 2.5 attributed additional hospital admissions, resulting in 21,668 additional days in hospital, along with 5527.12 and 1947.04 ten-thousand of additional total hospital cost and self-afforded cost, respectively. Compared with 2013, the above-mentioned four burdens decreased by 18.17%, 28.80%, 18.90% and 13.72% in 2017, respectively., Conclusion: PM 2.5 exposure was significantly associated with substantial burdens of cardiovascular hospital admission and economic expenditures. The results highlight the necessity of continuous PM 2.5 control from the perspective of healthy and sustainable city development in urban China., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Ambient ozone (O 3 ) concentrations have shown an upward trend in China and its health hazards have also been recognized in recent years. High-resolution exposure data based on statistical models are needed. Our study aimed to build high-performance random forest (RF) models based on training data from 2013 to 2017 in the Beijing-Tianjin-Hebei (BTH) region in China at a 0.01 ° × 0.01 ° resolution, and estimated daily maximum 8h average O 3 (O 3 -8hmax) concentration, daily average O 3 (O 3 -mean) concentration, and daily maximum 1h O 3 (O 3 -1hmax) concentration from 2010 to 2017. Model features included meteorological variables, chemical transport model output variables, geographic variables, and population data. The test-R 2 of sample-based O 3 -8hmax, O 3 -mean and O 3 -1hmax models were all greater than 0.80, while the R 2 of site-based and date-based model were 0.68-0.87. From 2010 to 2017, O 3 -8hmax, O 3 -mean, and O 3 -1hmax concentrations in the BTH region increased by 4.18 μg/m 3 , 0.11 μg/m 3 , and 4.71 μg/m 3 , especially in more developed regions. Due to the influence of weather conditions, which showed high contribution to the model, the long-term spatial distribution of O 3 concentrations indicated a similar pattern as altitude, where high concentration levels were distributed in regions with higher altitude., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Stroke and fine particulate matter (PM 2.5 ) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM 2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM 2.5 on the acute incidence and national acute health burdens of stroke attributed to PM 2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM 2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10 μg/m 3 increase in the PM 2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and -0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM 2.5 exposure across China in 2015. This study provided robust estimates of PM 2.5 -induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM 2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

High spatiotemporal resolution fine particulate matter (PM 2.5 ) simulations can provide important exposure data for the assessment of long-term and short-term health effects. Satellite-based aerosol optical depth (AOD) data, meteorological data, and topographic data have become key variables for PM 2.5 estimation. In this study, a random forest model was developed and used to estimate the highest resolution (0.01° × 0.01°) daily PM 2.5 concentrations in the Beijing-Tianjin-Hebei region. Our model had a suitable performance (cv-R 2  = 0.83 and test-R 2  = 0.86). The regional test-R 2 value in southern Beijing-Tianjin-Hebei was higher than that in northern Beijing-Tianjin-Hebei. The model performance was excellent at medium to high PM 2.5 concentrations. Our study considered meteorological lag effects and found that the boundary layer height of the one-day lag had the most important contribution to the model. AOD and elevation factors were also important factors in the modeling process. High spatiotemporal resolution PM 2.5 concentrations in 2010-2016 were estimated using a random forest model, which was based on PM 2.5 measurements from 2013 to 2016., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30 +2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO 2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH 2 O (1 cmH 2 O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO 2 ) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.