Search

Abstract Background This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (“home and community care services” for short) among older adults in China and to investigate the inequity in services utilization. Methods Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity. Results About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit. Conclusions This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

BackgroundEngaging in anal sexual intercourse markedly increases the risk of developing HIV among men who have sex with men (MSM); oral sexual activities tend to uniquely introduce gut-derived microbes to salivary microbiota, which, combined with an individual’s positive HIV status, may greatly perturb oral microecology. However, till date, only a few published studies have addressed this aspect.MethodsBased on 16S rRNA sequencing data of bacterial taxa, MicroPITA picks representative samples for metagenomic analysis, effectively revealing how the development and progression of the HIV disease influences oral microbiota in MSM. Therefore, we collected samples from 11 HIV-negative and 44 HIV-positive MSM subjects (stage 0 was defined by HIV RNA positivity, but negative or indeterminate antibody status; stages 1, 2, and 3 were defined by CD4+ T lymphocyte counts ≥ 500, 200–499, and ≤ 200 or opportunistic infection) and selected 25 representative saliva samples (5 cases/stage) using MicroPITA. Metagenomic sequencing analysis were performed to explore whether positive HIV status changes salivary bacterial KEGG function and metabolic pathway in MSM.ResultsThe core functions of oral microbiota were maintained across each of the five groups, including metabolism, genetic and environmental information processing. All HIV-positive groups displayed KEGG functions of abnormal proliferation, most prominently at stage 0, and others related to metabolism. Clustering relationship analysis tentatively identified functional relationships between groups, with bacterial function being more similar between stage 0-control groups and stage 1-2 groups, whereas the stage 3 group exhibited large functional changes. Although we identified most metabolic pathways as being common to all five groups, several unique pathways formed clusters for certain groups; the stage 0 group had several, while the stage 2 and 3 groups had few, such clusters. The abundance of K03046 was positively correlated with CD4 counts.ConclusionAs HIV progresses, salivary bacterial function and metabolic pathways in MSM progressively changes, which may be related to HIV promoting abnormal energy metabolism and exacerbate pathogen virulence. Further, infection and drug resistance of acute stage and immune cell destruction of AIDS stage were abnormally increased, predicting an increased risk for MSM individuals to develop systemic and oral diseases.

Abstract Background Pediatric shared decision-making (SDM) is a fundamental part of family-centered care. Pediatric palliative care (PPC) is one of the more difficult fields for healthcare providers when choosing to utilize SDM. However, to our knowledge, there are still few structured approaches of SDM in PPC. We aimed to build a model of SDM in PPC that achieves better care and outcomes for children and their family members. Methods This study is a descriptive phenomenology study. Participants included physicians, nurses, and social workers in the PPC team. Participants were individually interviewed face-to-face or via an online meeting software. Data were collected in semi-structured interviews and analyzed using a thematic framework analysis. Results In total, 27 healthcare providers were interviewed. The model of SDM in PPC identified three themes, including the participants, the principle and the process of SDM. Decision participants involved the children, parents, the PPC team and others. The decision principle had three sub-themes including type, standard and precondition. The decision process describes the fundamental process of SDM and provides suggestions for mobilizing patients and parents to engage in decision-making and seeking conflict resolution. Conclusions This is the first study to develop a SDM model in PPC. This model can provide guidance to PPC teams on SDM practices. In addition, the model contributes to the existing body of knowledge by providing a conceptual model for SDM in the context of PPC.

BackgroundThe effect of surgery on advanced prostate cancer (PC) is unclear and predictive model for postoperative survival is lacking yet.MethodsWe investigate the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, to collect clinical features of advanced PC patients. According to clinical experience, age, race, grade, pathology, T, N, M, stage, size, regional nodes positive, regional nodes examined, surgery, radiotherapy, chemotherapy, history of malignancy, clinical Gleason score (composed of needle core biopsy or transurethral resection of the prostate specimens), pathological Gleason score (composed of prostatectomy specimens) and prostate-specific antigen (PSA) are the potential predictive variables. All samples are divided into train cohort (70% of total, for model training) and test cohort (30% of total, for model validation) by random sampling. We then develop neural network to predict advanced PC patients’ overall. Area under receiver operating characteristic curve (AUC) is used to evaluate model’s performance.Results6380 patients, diagnosed with advanced (stage III-IV) prostate cancer and receiving surgery, have been included. The model using all collected clinical features as predictors and based on neural network algorithm performs best, which scores 0.7058 AUC (95% CIs, 0.7021-0.7068) in train cohort and 0.6925 AUC (95% CIs, 0.6906-0.6956) in test cohort. We then package it into a Windows 64-bit software.ConclusionPatients with advanced prostate cancer may benefit from surgery. In order to forecast their overall survival, we first build a clinical features-based prognostic model. This model is accuracy and may offer some reference on clinical decision making.

Abstract Backgrounds The incidence of gastric cardiac cancer (GCC) has obviously increased recently with poor prognosis. It’s necessary to compare GCC prognosis with other gastric sites carcinoma and set up an effective prognostic model based on a neural network to predict the survival of GCC patients. Methods In the population-based cohort study, we first enrolled the clinical features from the Surveillance, Epidemiology and End Results (SEER) data (n = 31,397) as well as the public Chinese data from different hospitals (n = 1049). Then according to the diagnostic time, the SEER data were then divided into two cohorts, the train cohort (patients were diagnosed as GCC in 2010–2014, n = 4414) and the test cohort (diagnosed in 2015, n = 957). Age, sex, pathology, tumor, node, and metastasis (TNM) stage, tumor size, surgery or not, radiotherapy or not, chemotherapy or not and history of malignancy were chosen as the predictive clinical features. The train cohort was utilized to conduct the neural network-based prognostic predictive model which validated by itself and the test cohort. Area under the receiver operating characteristics curve (AUC) was used to evaluate model performance. Results The prognosis of GCC patients in SEER database was worse than that of non GCC (NGCC) patients, while it was not worse in the Chinese data. The total of 5371 patients were used to conduct the model, following inclusion and exclusion criteria. Neural network-based prognostic predictive model had a satisfactory performance for GCC overall survival (OS) prediction, which owned 0.7431 AUC in the train cohort (95% confidence intervals, CI, 0.7423–0.7439) and 0.7419 in the test cohort (95% CI, 0.7411–0.7428). Conclusions GCC patients indeed have different survival time compared with non GCC patients. And the neural network-based prognostic predictive tool developed in this study is a novel and promising software for the clinical outcome analysis of GCC patients.

Abstract Background The Chochinov Dignity Model was developed based on a cohort of adult patients with advanced cancer, but its role among dying children is not clear. This study aims to develop a model of dignity for children receiving pediatric palliative care based on the Chochinov Dignity Model. Methods This is a descriptive qualitative study. Participants included a total of 11 parents and 14 healthcare providers who were recruited from a tertiary children’s hospital in Beijing and the Pediatric Palliative Care Subspecialty Group of the Pediatrics Society of the Chinese Medical Association using purposive sampling. Thematic framework analysis was used to analyze data. Results The themes of the empirical Dignity Model were broadly supported in this study, but some themes were interpreted differently in the child population. Compared with the original model, some child-specific themes were identified including acknowledging regret, a sense of security, the company of important loved ones, realizing unfinished wishes, decent and dignified death, resolving family disputes, and fairness. Conclusions This is the first study on Dignity Model for terminal children. Knowledge of children’s dignity can promote reflection of healthcare providers and caregivers regarding the values underlying their performance in pediatric palliative care, and develop certain practical interventions to strengthen children and their families’ sense of dignity at end of life.

River conditions are complex and affected by human activities. Various hydraulic structures change the longitudinal slope and cross-sectional shape of the riverbed, which has a significant impact on the simulation of water-head evolution. With continuous population growth, the hydrological characteristics of the Yongding River Basin have undergone significant changes. Too little or too much water discharge may be insufficient to meet downstream ecological needs or lead to the wastage of water resources, respectively. It is necessary to consider whether the total flow in each key section can achieve the expected value under different discharge flows. Therefore, a reliable computer model is needed to simulate the evolution of the water head and changes in the water level and flow under different flow rates to achieve efficient water resource allocation. A one-dimensional hydrodynamic coupling model based on the Saint-Venant equations was established for the Yongding River Basin. Different coupling methods were employed to calibrate the coupling model parameters, using centralised water replenishment data for the autumn of 2022, and the simulation results were verified using centralised water replenishment data for the spring of 2023. The maximum error of the water-head arrival time between different river sections was 4 h, and the maximum error of the water-head arrival time from the Guanting Reservoir to each key cross-section was 6 h. The maximum flow error was less than 5 m3/s, and the changing trend of the flow over time was consistent with the measured data. The model effectively solved the problem of low accuracy of the water level and flow calculation results when using the traditional one-dimensional hydrodynamic model to simulate the flow movement of complex river channels in the Yongding River. The output results of the model include the time when the water head arrives at the key section, the change process of the water level and flow of each section, the change process of the water storage of lakes and gravel pits, and the change process of the total flow and water surface area of the key section. This paper reports data that support the development of an ecological water compensation scheme for the Yongding River.

Soil erosion is one of the most serious environmental issues, especially in vulnerable areas such as the Pisha sandstone regions located in the Loess Plateau (China). In these types of reliefs, long-term studies monitoring runoff and soil loss are scarce, and even more considering the efficiency of different soil management techniques applied to reduce land degradation. In this study, seven years (2014–2020) of in-situ measurements of surface runoff and soil loss for different land uses (forestland, shrubland, grassland, farmland, and bare land) in a Pisha Sandstone environment at the Loess Plateau were conducted. We applied the Water Erosion Prediction Project (WEPP) model combining the large database with the precipitation regimes. Our results showed that runoff volume coming from observed and simulated data exhibited significant differences among them depending on the different vegetation types. Runoff and soil loss were different among diverse land use types as follows: farmland > grassland > shrubland > forestland. After conducting a calibration, we found satisfactorily simulated surface runoff and sediment yield based on precipitation regimes and land uses at sandstone reliefs. Simulation performance of surface runoff was better than sediment yield. The range of standard error of the model simulation for event and annual values of runoff were 4.71 mm and 12.19 mm, respectively. The standard error for event and annual values of soil loss were 4.19 t/hm2 and 21.86 t/hm2. In the calibration group, R2 of runoff and soil loss were 0.92 and 0.86 respectively, while Nash-Sutcliffe coefficient (E) reached 0.90 and 0.85, respectively. In the validation group, the R2 for both runoff and soil loss were 0.82 and 0.56, respectively. Nash-Sutcliffe coefficient (E) were 0.77 and 0.54 for the runoff and sediment yield. We concluded that using a detailed monitoring dataset, the WEPP model could accurately simulate and predict water erosion in the hillslopes of Pisha sandstone area.

Horns are used by Bovidae animals for intraspecific combat; as such they are among Nature's toughest materials that require resistance to extreme loads. As a typical subfamily among Bovidae, Caprinae own light-wight horn with balanced strength and toughness. However, their structure and the salient mechanisms that underlie their mechanical behavior remain uncertain. This work clarifies the effect of multi-scale structure characteristics on mechanical behaviors of horn sheath by comparing Cashmere goat, White goat and Black sheep. With the methods of fractographic observations, conformational analysis, acoustic emission and finite element methods. Conformation of keratin and strength of fibre were proposed to influence the tensile/flexural performance a lot under both dried and hydrated condition. The corrugated lamellae structure was assumed to promote crack deflection and enhance dried samples, which showed more advantageous for applications of flexural loading. It is hard to impute the difference of mechanics to any one factor, and the synergism of multi-scale mechanisms is important to mechanical properties in Caprinae horn sheath. This research is expected to further encourage the horn-inspired design of secondary load-carrying lightweight composites.

Abstract Background Mesenchymal stromal cells (MSCs) are heterogeneous populations. Heterogeneity exists within the same tissue and between different tissues. Some studies have found enormous heterogeneity in immunomodulatory function among MSCs derived from different tissues. Moreover, the underlying mechanism of heterogeneity in immunomodulatory abilities is still unclear. Methods Foreskin mesenchymal stromal cells (FSMSCs) and human umbilical cord mesenchymal stromal cells (HuMSCs) were isolated and cultured until the third passage. According to the International Association for Cell Therapy standard, we confirmed the cell type. Then, FSMSCs and HuMSCs were cocultured with human peripheral blood mononuclear cells (PBMCs) stimulated by lipopolysaccharide (LPS) in vitro. Furthermore, the supernatant was sampled for an enzyme-linked immunosorbent assay to investigate the secretion of IL-1β, IL-6, IL-10, TNF-α, and TGF-β1. Finally, we performed single-cell RNA sequencing (scRNA-seq) of FSMSCs and HuMSCs. Results We successfully identified FSMSCs and HuMSCs as MSCs. When cocultured with LPS pretreated PBMCs, FSMSCs and HuMSCs could effectively reduced the secretion of IL-1β and TNF-α. However, FSMSCs stimulated the PBMCs to secrete more IL-10, TGF-β1, and IL-6. Furthermore, 4 cell subsets were identified from integrated scRNA-seq data, including proliferative MSCs (MKI67 +, CD146 low+, NG2 +, PDGFRB − ), pericytes (CD146 high+, PDGFRB +, MKI67 − , CD31 − , CD45 − , CD34 − ), immune MSCs (CXCL12 high+, PTGIS high+, PDGFRB +, CD146 − , MKI67 − ) and progenitor proliferative MSCs (CXCL12 low+, PTGIS low+, PDGFRB +, CD146 − , MKI67 − ). Among them, we found that immune MSCs with strengthened transcriptional activity were similar to pericytes with regard to the degree of differentiated. Various of immune-related genes, gene sets, and regulons were also enriched in immune MSCs. Moreover, immune MSCs were determined to be close to other cell subsets in cell–cell communication analysis. Finally, we found that the proportion of immune MSCs in foreskin tissue was highest when comparing the subset compositions of MSCs derived from different tissues. Conclusions FSMSCs show better immunomodulatory capacity than HuMSCs in vitro. Moreover, immune MSCs may play a vital role in the heterogeneity of immunoregulatory properties. This study provides new insights suggesting that immune MSCs can be isolated to exert stable immunoregulatory functions without being limited by the heterogeneity of MSCs derived from different tissues.

River bathymetric data is fundamental to water flow simulation. In practice, due to measurement uncertainty and riverbed erosion and deposition, river bathymetric errors are inevitable. Therefore, identifying major cross sections with large bathymetric errors is of great significance. In this study, forward and reverse flow routing models were developed and then applied to obtain two different water stages for a specific cross section, which were respectively propagated from the upstream and downstream boundaries. The spatial variation of differences between the two calculated water stages was compared to quantify the influence of bathymetric errors, and then used as an indicator for the location identification of the bathymetric errors. After being tested and verified in a hypothetical river case, the identification method was then applied to the Xunjiang River case. The results show that the proposed method can effectively identify the cross sections with large bathymetric errors, and the identification performance is related to the flow magnitude. The research is valuable and practical to the improvement of river bathymetric data and the accuracy of water flow simulation. HIGHLIGHTS A location identification method for river bathymetric errors was proposed.; The method identified single and multiple locations with bathymetric errors.; The location identification results were affected by the flow magnitude.; The research results are helpful for improving bathymetric data.;

Abstract Background Congenital heart defect (CHD) is the leading cause of birth defects globally, which results in a great disease burden. It is still imperative to detect the risk factors of CHD. This umbrella review aimed to comprehensively summarize the evidence and grade the evidence of the associations between non-genetic risk factors and CHD. Methods Databases including Medline, Embase, Web of Science, Cochrane Library, and four Chinese databases were searched from inception to 18 Jan 2022. The reference lists of systematic reviews (SR) and meta-analyses (MA) were screened, which aimed to explore the non-genetic risk factors of CHD. Subsequently, titles and abstracts of identified records and full texts of selected SR/MA were screened by two independent reviewers based on predefined eligibility criteria. A priori developed extraction form was used to abstract relative data following the PRISMA 2020 and MOOSE guidelines. The risk of bias was assessed with the AMSTAR2 instrument. Data were synthesized using fixed-effects and random-effects meta-analyses, respectively. Finally, the evidence on the association of non-genetic risk factors and CHD was graded using Ioannidis’s five-class evidence grade. Results A total of 56 SRs, encompassing 369 MAs, were identified. The risk factors included relative factors on air pollution, reproductive-related factors, parental age and BMI, parental life habits, working and dwelling environment, maternal drug exposure, and maternal disease. Based on AMSTAR2 criteria, only 16% (9/56) of SRs were classified as “Moderate”. One hundred and two traceable positive association MAs involving 949 component individual studies were included in further analysis and grading of evidence. Family genetic history, number of abortions, maternal obesity, especially moderate or severe obesity, decoration materials, harmful chemicals, noise during pregnancy, folic acid supplementation, SSRIs, SNRIs, any antidepressants in the first trimester, maternal DM (including both PGDM and GDM), and gestational hypertension were convincing and highly suggestive factors for CHD. After sensitivity analyses based on cohort studies, some grades of evidence changed. Conclusion The present umbrella review will provide evidence-based information for women of childbearing age before or during pregnancy to prevent CHD. In addition, sensitivity analysis based on cohort studies showed the changed evidence levels. Therefore, future SR/MA should concern the sensitivity analysis based on prospective birth cohort studies and case-control studies.

Hydrological conditions are key factors in the evaluation of water resources and ecosystems. The Yongding River Basin has many irrigated areas, and excessive agricultural water consumption has led to serious water shortages and ecosystem damage. To investigate the evolution of ecohydrological conditions and their driving factors in the Yongding River basin in a changing environment, this study combines indicators of hydrologic alteration with the range of variability approach (IHA-RVA) to identify the most ecologically relevant hydrological indicators (ERHIs) and to determine the periods of hydrological variability in the basin, using the Xiangshuipu section on the Yang River as the study area. By calculating the degree of hydrological alteration, the evolutionary pattern of ecohydrological conditions in the basin was analyzed, and the WetSpa model was used to quantitatively identify the contributions of climate change, reservoir storage, and irrigation water withdrawal to the alteration of hydrological conditions. The results showed that the rise and fall rate; maximum and minimum 1 day flows; dates of maximum flow; and July flows were the most ecologically relevant hydrological indicators for the Xiangshuipu section. Variability of this section occurred between 1982 and 1988; except for the annual maximum 1 day flows and fall rate, which underwent moderate changes; all other indicators exhibited small changes and the overall hydrological alteration of the Xiangshuipu section was low. The most influential change in the hydrological conditions was irrigation water withdrawal (from specific irrigation); followed by climate change and reservoir storage. The results of this study provide an important basis for water resources utilization and ecological management in the Yongding River basin.

ABSTRACT Importance Pediatric palliative care (PPC) is an interdisciplinary collaboration that focuses on the prevention and relief of patient suffering. PPC has emerged as a critical field of medical expertise and practice. However, no information is available regarding the progress of PPC in the Chinese mainland. Objective This study investigated the geographic distribution, team structure, and services of PPC teams in the Chinese mainland. It also investigated the level of understanding and implementation among pediatric oncologists regarding PPC. Methods The PPC subspecialty group of the Pediatrics Society of the Chinese Medical Association included 45 PPC teams. The team structure and services were investigated using questionnaires mailed to the team leader of each PPC team. In addition, we sent questionnaires regarding the level of PPC understanding and implementation of PPC practices to 170 pediatric oncologists in 11 hospitals. Results The geographical distribution of PPC teams is uneven in China. Most PPC teams are concentrated in the eastern provincial capital of China. Most PPC teams had limited staff and services. The level of PPC understanding was considerably limited across all demographics; most pediatric oncologists reported “some understanding” (n = 71, 41.8%) or “poor understanding” (n = 50, 29.4%). Only 62.9% of pediatric oncologists had experience providing advice to family members regarding PPC matters. Interpretation China is currently experiencing a critical shortage of PPC resources. Most pediatric oncologists had a limited understanding of PPC and reported limited practical implementation of PPC, which leads to underutilization of PPC resources.

In order to comprehensively consider the impact of human activities on runoff simulation and improve the accuracy of runoff simulation, so as to make a more accurate prediction of the future runoff of the Hanjiang River Basin, this study improved the reservoir module of the Wespa model, adding two parts: reservoir inflow data correction and water storage and outflow data calculation without measured data. Use the improved model to verify its applicability to the Hanjiang River Basin, then, choose the ones who has the most familiar trend with the historical data in the future climate model data (CMIP6). Put the selected data in the model to predict the runoff of Hanjiang River from 2021 to 2060. By analyzing the future runoff trend of Ankang, Huangjiagang and Huangzhuang in the Hanjiang River Basin from 2021 to 2060 and the changes of average runoff, seasonal runoff and monthly runoff compared with the historical period (1981–2020), the conclusions drawn are as follows: 1) The improved Wetspa model has good applicability in the Hanjiang River Basin; 2) The future runoff of Ankang section is decreasing, while that of Huangjiagang and Huangzhuang sections is increasing; 3) Compared with the reference period, the average runoff of the three sections in the future shows an increasing trend, which indicates that there will be flood risk in the future; 4) Compared with the reference period, the runoff proportion of the three sections will increase in spring and winter, and decrease in autumn. Attention should be paid to the risk of drought in autumn. In terms of months, the proportion of runoff from April to June increases, decreases from September to November, and increases and decreases in other months are uncertain.

ObjectivesThe early diagnosis of tuberculous pleural effusion (TPE) is challenging due to the difficulty of isolating Mycobacterium tuberculosis, and pleural biomarkers are an optional choice. Recent studies showed that interleukin-27 (IL-27) appears to be a new accurate biomarker for TPE in adults and no related studies were reported in children. In this study, we aimed to evaluate the potential value of IL-27 in pediatric tuberculous pleurisy by detecting its levels in pleural fluid and serum.MethodsA total of 48 children with TPE and 64 children with severe Mycoplasma pneumoniae (MP) pneumonic effusion (SMPPE) were enrolled in this study. IL-27 concentrations were measured in serum and pleural fluid. The diagnostic yield of IL-27 was evaluated using receiver operating characteristic (ROC) curves.ResultsThe level of p-IL-27 in TPE showed statistically no significant difference when compared with SMPPE (p > 0.05). However, pleural fluid IL-27 (p-IL-27) / serum IL-27 (s-IL-27) ratio in TPE were significantly much higher than those in SMPPE (p < 0.05). By the analysis of the ROC curves, the diagnostic sensitivity and specificity of the p-IL-27/s-IL-27 ratio were 100% and 48.44%, respectively (cutoff value of 1.0280). The area under the ROC curve for p-IL-27/s-IL-27 was 0.7295.ConclusionPleural fluid IL-27 alone was not accurate in distinguishing pediatric TPE from SMPPE, which was different from the diagnostic value of IL-27 in adult studies due to the different disease spectra between children and adults. Our results implied that the p-IL-27/s-IL-27 ratio had a potential value in distinguishing TPE from SMPPE. However, the specificity of IL-27 was relatively lower and it is necessary to find a more specific marker in tuberculous pleurisy of children.

Abstract Background Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies and are among the most common DICER1-related disorders: it is estimated that 75–80% of children with a PPB have the DICER1 mutation. DICER1 mutations are responsible for familial tumour susceptibility syndrome with an increased risk of tumours. In approximately 35% of families with children manifesting PPB, further malignancies may be observed. Symptoms of DICER1 syndrome may vary, even within monozygotic twins. Preventive screening of carriers with DICER1 mutations is important and follow-up is undertaken as recommended by the 2016 International PPB Register. Case presentation We present two pairs of monozygotic twins. In one pair of 4-year, 2-month old girls, both with DICER1 mutation, one developed PPB(II) and her identical sibling had acute transient hepatitis. In the other pair of 19-month-old female babies, one had a history of bronchopulmonary hypoplasia and developed PPB(III) without DICER1 mutation, and her identical sibling had allergic asthma. Both patients with PPB were treated with R0 resection and received 12 cycles of postoperative chemotherapy. At the most recent review, the twins had been followed up for six and eight years, respectively, and they all remained healthy. However, the height and weight of the patients with PPB were lower than those of their respective identical sister. Conclusions PPB is rare, especially in monozygotic twins. We emphasise the importance of genetic testing and follow-up in monozygotic twins with PPB. During the follow-up, children surviving PPB should be monitored closely for growth and development disorders which caused by chemotherapy.

Background: Mesenchymal stromal cells (MSCs) and fibroblasts show similar morphology, surface marker expression, and proliferation, differentiation, and immunomodulatory capacities. These similarities not only blur their cell identities but also limit their application.Methods: We performed single-cell transcriptome sequencing of the human umbilical cord and foreskin MSCs (HuMSCs and FSMSCs) and extracted the single-cell transcriptome data of the bone marrow and adipose MSCs (BMSCs and ADMSCs) from the Gene Expression Omnibus (GEO) database. Then, we performed quality control, batch effect correction, integration, and clustering analysis of the integrated single-cell transcriptome data from the HuMSCs, FMSCs, BMSCs, and ADMSCs. The cell subsets were annotated based on the surface marker phenotypes for the MSCs (CD105+, CD90+, CD73+, CD45−, CD34−, CD19−, HLA-DRA−, and CD11b−), fibroblasts (VIM+, PECAM1−, CD34−, CD45−, EPCAM−, and MYH11−), and pericytes (CD146+, PDGFRB+, PECAM1−, CD34−, and CD45−). The expression levels of common fibroblast markers (ACTA2, FAP, PDGFRA, PDGFRB, S100A4, FN1, COL1A1, POSTN, DCN, COL1A2, FBLN2, COL1A2, DES, and CDH11) were also analyzed in all cell subsets. Finally, the gene expression profiles, differentiation status, and the enrichment status of various gene sets and regulons were compared between the cell subsets.Results: We demonstrated 15 distinct cell subsets in the integrated single-cell transcriptome sequencing data. Surface marker annotation demonstrated the MSC phenotype in 12 of the 15 cell subsets. C10 and C14 subsets demonstrated both the MSC and pericyte phenotypes. All 15 cell subsets demonstrated the fibroblast phenotype. C8, C12, and C13 subsets exclusively demonstrated the fibroblast phenotype. We identified 3,275 differentially expressed genes, 305 enriched gene sets, and 34 enriched regulons between the 15 cell subsets. The cell subsets that exclusively demonstrated the fibroblast phenotype represented less primitive and more differentiated cell types.Conclusion: Cell subsets with the MSC phenotype also demonstrated the fibroblast phenotype, but cell subsets with the fibroblast phenotype did not necessarily demonstrate the MSC phenotype, suggesting that MSCs represented a subclass of fibroblasts. We also demonstrated that the MSCs and fibroblasts represented highly heterogeneous populations with distinct cell subsets, which could be identified based on the differentially enriched gene sets and regulons that specify proliferating, differentiating, metabolic, and/or immunomodulatory functions.

Abstract Background This study aims to explore the diagnostic accuracy of the combination of gamma-glutamyl transferase (GGT) and liver stiffness measurement (LSM) for biliary atresia (BA) screening at different ages. Methods Our retrospective study involved 282 infants under the age of 120 days with jaundice who were admitted into Beijing Children’s Hospital between January 2016 to December 2018. The GGT and LSM levels of infants were obtained. A parallel test was used, and ROC curve was created to obtain cutoff values of GGT and LSM for BA infants at different ages. Results Of the 282 infants, 135 were diagnosed with BA and 147 were non-BA infants. In all age groups (A: ≤60 days; B: 61–90 days; C: 91–120 days), the LSM and GGT levels of the BA group were significantly higher than that of the non-BA group, P

Abstract Background Neuroblastoma (NB) tumor rupture is a rare oncology emergency with a poor prognosis. We aimed to evaluate patient clinical characteristics and risk factors for ruptured NB. Methods A retrospective study of 47 patients with confirmed NB rupture between January 2009 and January 2019 at Beijing Children’s Hospital was conducted. To identify tumor rupture risk factors in high-risk NB patients, we included 93 consecutive non-ruptured high-risk NB patients from January 2017 to January 2019. Results The median age at presentation was 29 months (adrenal and retroperitoneum origin) for 47 ruptured NB patients. Spontaneous tumor rupture occurred in 22 cases; 18 cases occurred during or after the first chemotherapy cycle, and 7 occurred after core needle biopsy. Five patients died of tumor rupture, and 17 patients’ parents refused further antitumor therapy. Among the 25 remaining patients, 6 survived without disease, 5 received ongoing treatment and achieved stable disease, and 14 died. According to multivariate logistic regression analysis, a maximum primary tumor diameter > 13.20 cm and MYCN gene amplification were independent risk factors for tumor rupture within high-risk NB. Conclusions Tumor rupture is an uncommon, life-threatening event for NB patients; these patients are most likely to have poor outcomes due to tumor recurrence or rapid progression. Several treatment modalities, including symptomatic support therapy and chemotherapy, are important for saving lives and for developing NB risk-based treatment in the future.

Background: To describe the characteristics, treatments, and prognosis of pediatric gastric perforation patients beyond neonatal period. Methods: Twenty pediatric patients beyond neonatal period were included in this study. Medical records were reviewed and clinical characteristics were analyzed. According to the outcomes, patients were divided into the survival group and the death group. Death time was documented, and survival patients were followed up. The degree of severity was calculated using pediatric critical illness score (PCIS). Differences between the two groups were analyzed by the Student's t-test, Mann-Whitney test and Chi-square test appropriately. Results: Gastric perforation was diagnosed in 20 pediatric patients beyond neonatal period, including 6 males (30%) and 14 females (70%), with the age of 37.18 (15.90, 107.12) months, and the range was from 4.30 months to 14.17 years old. They had different manifestations, etiologies, sites of perforation and surgery procedures. Among the 20 cases, 14 (70%) survived and 6 (30%) died. Age, gender, length and number of perforation had no statistically difference between the two groups. However, PCIS, ischemia of gastrointestinal wall, and transmural necrosis of gastric wall were statistically different. For the survival group, during a follow-up period of 50 (36, 68) months, ranging from 2 months to 8 years and 7 months, one patient had a second-time perforation, another 3 patients had brain injury symptoms, and the rest 10 patients had good quality of lives. Conclusions: Gastric perforation of pediatric patients beyond neonatal period causes a mortality of 30% on this study. Spontaneous great curvature of gastric wall perforation has the highest morbidity. Low PCIS predicts for unfavorable prognosis. Most of the survival patients have satisfactory living quality after operation. Key Words: pediatric gastric perforation, prognosis, treatment

Abstract Background Immune tolerance induction (ITI) therapy is currently unaffordable in China. Management of hemophilia A children with high‐titer inhibitor is therefore a challenge. Aim To describe the ITI strategy using plasma‐derived factor VIII/von Willebrand factor concentrate (pdFVIII/VWF) +/− immunosuppression and to report its efficacy in children with hemophilia A having poor‐risk status for ITI success. Methods A prospective pilot study on children with hemophilia A having poor‐risk status (all with at least inhibitor titer > 10 BU pre‐ITI initiation). Patients received ~50 IU/kg FVIII every other day using domestic intermediate purity pdFVIII/VWF products, either alone or in combination with rituximab +/− prednisone. Results Sixteen patients with median age 2.9 (range, 2.2‐13.2) years and median pre‐ITI inhibitor titer 30.7 (range, 10.4‐128) BU were enrolled. Analysis at median 14.7 (range, 12.4‐22.6) months’ follow‐up showed a total response rate of 87.5%. This included success (achieving inhibitor 0.6BU) in 1 (6.3%). Compared to the pre‐ITI period, the mean bleeds/month during ITI was 0.51 (64.0% reduction), and joint bleeds/month was 0.34 (64.3% reduction). This low‐dose ITI strategy cost less by 70% to 87% than that for the high‐dose FVIII regimen. No severe adverse events were observed. Conclusion This low‐dose ITI strategy of pdFVIII/VWF +/− immunosuppression achieved relatively satisfactory outcomes in children with hemophilia A inhibitor having poor‐risk status. This low‐dose regimen showed economic advantages and is therefore suitable for using in China. However, further study in a larger cohort with a longer follow‐up time is needed.

Salivary virome is important for oral ecosystem, but there are few reports on people living with HIV. We performed metagenomic sequencing to compare composition and functional genes of salivary virobiota between one HIV-negative and four HIV-positive groups in which participants were all men who have sex with men (MSM) with different immunosuppression statuses (five samples per group) to find the evidence that salivary virobiota plays a role in the pathogenesis of oral disease. Acute-stage subjects achieved a positive result of HIV RNA, but HIV antibody negative or indeterminate, whereas individuals with mild, moderate, and severe immunosuppression exhibited CD4+ T-lymphocyte counts of at least 500, 200–499, and less than 200 cells/μL or opportunistic infection, respectively. The results showed the composition of salivary virus genera in subjects with mild immunosuppression was the most similar to that in healthy people, followed by that in the acute stage; under severe immunosuppression, virus genera were suppressed and more similar to that under moderate immunosuppression. Furthermore, abnormally high abundance of Lymphocryptovirus was particularly obvious in MSM with HIV infection. Analysis of KEGG Pathway revealed that Caulobacter cell cycle, which affects cell duplication, became shorter in HIV-positive subjects. It is worth noting that in acute-stage participants, protein digestion and absorption related to the anti-HIV-1 activity of secretory leukocyte protease inhibitor was increased. Moreover, in the severely immunosuppressed subjects, glutathione metabolism, which is associated with the activation of lymphocytes, was enhanced. Nevertheless, the ecological dysbiosis in HIV-positive salivary virobiota possibly depended on the changes in blood viral load, and salivary dysfunction of MSM infected with HIV may be related to CD4 counts. Ribonucleoside diphosphate reductase subunit M1 in purine metabolism was negatively correlated, though weakly, to CD4 counts, which may be related to the promotion of HIV-1 DNA synthesis in peripheral blood lymphocytes. 7-Cyano-7-deazaguanine synthase in folate biosynthesis was weakly positively correlated with HIV viral load, suggesting that this compound was produced excessively to correct oral dysfunction for maintaining normal cell development. Despite the limited number of samples, the present study provided insight into the potential role of salivary virome in the oral function of HIV infected MSM.

Specific users play a key role in interactive forecast systems through user-oriented information (UOI). For hydrological users, a key component of the user-oriented forecast system (UOFS) is to determine the threshold of flood-leading precipitation (TFLP) as a target of the forecast by considering the decision-making information at the user end. This study demonstrates a novel way of simulating TFLP via the inverse simulation of a hydrological model, combined with the flood hazard assessment in the upper reaches of the Huai River Basin controlled by the Wang Jiaba (WJB) hydrological station. The flood hazard, defined as the probability of precipitation beyond the daily evolving TFLP for the next day, was evaluated by using the THORPEX Interactive Global Grand Ensemble (TIGGE) datasets, including 162 members retrieved from 5 TIGGE archive centers. Having integrated the real-time monitored water level (as the UOI) into the UOFS, we applied it to the flood season of 2008 as a case study to evaluate the flood hazard generated by the UOFS for the WJB sub-basin. The simulated TFLP corresponded well with the gap between the monitored and warning water level. The predicted flood hazard probability showed good agreement with the first two flood peaks at 100% accuracy, while exceeding 60% accuracy for the third flood event in that season. Thus, the flood hazard could be better quantified via integration of the forecasted flood-leading precipitation. Overall, this study highlights the usefulness of a UOFS coupled with interactive UOI of real-time water level to determine the dynamical TFLP for flood hazard evaluation with ensemble precipitation forecast. The early flood warning which resulted from such integrated UOFS is directly applicable to operational flood prevention and mitigation.

Background: No previous study explored the association between serum calcium levels and dyslipidemia in children. This study aimed to explore this relationship in children, based on a multicenter cross-sectional study population in China.Methods: Cross-sectional data was derived from the Pediatric Reference Intervals in China (PRINCE) study conducted between 2017 and 2018 involving 5,252 males and 5,427 females with a mean age of 10.0 ± 4.6 years. Multivariable logistic regression models were applied to calculate odds ratios (ORs), with 95% confidence intervals (CIs), for dyslipidemia of each serum calcium level and albumin-corrected calcium levels, which were sorted into quartiles. The restricted cubic spline model was fitted for the dose-response analysis. An L-shaped dose-response relation between calcium levels and the probability of dyslipidemia was found after the adjustment for multiple potential confounding factors, p for non-linear < 0.001.Results: Using the middle category of calcium level as the reference, multivariable-adjusted ORs and 95% CIs of the lowest and the highest quartile categories were 0.96 (0.82–1.12) and 1.29 (1.12–1.48), respectively, for total serum calcium levels and 1.06 (0.91–1.23) and 1.39 (1.21–1.60) for albumin-corrected calcium levels.Conclusions: Individuals with higher levels of serum calcium were associated with increased risk of dyslipidemia in a sample of a healthy Chinese pediatric population. The association between serum calcium levels and dyslipidemia needs to be examined prospectively in future studies.

Abstract Background In developing countries, children with hemophilia A (HA) with high‐titer inhibitor and poor immune tolerance induction (ITI) prognostic risk(s) cannot afford the recommended high‐ or intermediate‐dose ITI. Objectives To determine the efficacy of low‐dose ITI (plasma‐derived factor VIII [FVIII]/von Willebrand factor at 50 FVIII IU/kg every other day) by itself (ITI‐alone) or combined with immunosuppressants rituximab and prednisone (ITI‐IS) in children with HA with high‐titer inhibitor. Methods All enrolled patients had pre‐ITI inhibitor ≥10 BU. We used ITI‐alone if inhibitor titer was

Inter-basin water transfer projects play an important role in allocating water resources that vary both in temporal and spatial scale while supporting regional development. In the practical operation of inter-basin water transfer projects, high water level and less inflow runoff would result in water supply destruction, while low water level and more inflow runoff would cause abandoned water. How to play the compensation roles of hydrological characteristics and storage capacities of multi-reservoirs to maximize the utilization efficiency of water resources, the key is to select the basis for the decision-making of starting water transfer process. In this paper, we selected the “Datong-Huangshui” water transfer project as the research subject, analyzed the composition of the inter-basin water transfer system, and constructed a dispatching rule extraction model including water transfer rules, water diversion rules, and water supply rules. Then the NSGA-II was used to solve the multi-objective optimization model to obtain the Pareto frontier solution set of the dispatching rules. Finally, the optimal operation scheme was determined and discussed according to the scheduling scheme decision model. The model itself was based on the gray target model and prospect theory. We found that: (1) The optimal target frontier obtained by the two-dimensional scheduling diagram and the hedging rules for water supply was closer to the theoretical optimal frontier of the multi-objective problem. This result indicated that the two-dimensional scheduling diagram and the hedging rules for water supply could better guide the water diversion operation of inter-basin water transfer projects. (2) Based on the multi-objective optimal operation schemes set, the OPT scheme obtained by the scheduling scheme decision model using gray target model and prospect theory could generate 359 million Kwh. At the same time, it could guarantee 90% of municipal and industrial water supply and 85% of agricultural water supply.

Water resources are crucial for maintaining daily life and a healthy ecological environment. In order to gain a harmonious development among water resources and economic development in Lake Watershed, it is urgent to quantify the lake inflow. However, the calculation of inflow simulations is severely limited by the lack of information regarding river runoff. This paper attempts calculated inflow in an ungauged stream through use of the coupling water balance method and the Xin’anjiang model, applying it to calculate the inflow in the Chaohu Lake Basin, China. Results show that the coupled model has been proved to be robust in determining inflow in an ungauged stream. The error of daily inflow calculated by the water balance method is between 1.4 and −19.5%, which is within the standard error range (±20%). The calibration and verification results of the coupled model suggest that the simulation results are best in the high inflow year (2016), followed by the normal inflow year (2007) and the low inflow year (1978). The Nash-Sutcliffe efficiencies for high inflow year, normal inflow year, and low inflow year are 0.82, 0.72, and 0.63, respectively, all of which have reached a satisfactory level. Further, the annual lake inflow simulation in the normal inflow year is 19.4 × 108 m3, while the annual average land surface runoff of the study area is 18.9 × 108 m3, and the relative error is −2.6% by the two ways. These results of the coupled model offer a new way to calculate the inflow in lake/reservoir basins.

The variation of hydrological conditions in the basin affects the original stable state of the basin, and the change of eco-hydrological conditions also plays a decisive role in the stability of the basin. In this manuscript, Indicators of Hydrologic Alteration (IHA) was used to diagnose watershed variation from the eco-hydrological perspective, and a new diagnostic method was proposed in the current study, which was the extraction method of the most relevant eco-hydrological indicators based on a similar year sensitive index and the diagnosis method of variation period. This method used the sensitivity of statistical characteristics between similar years to provide the basis for the selection of the most ecologically-relevant hydrogeological indicators (ERHIs), then selected the strong variation indicators from the most relevant eco-hydrological indicators, and finally used the strong variation indicators to diagnose the watershed variation. The runoff data (1960 to 2020) in the Ankang gauging station of the Hanjiang River were analyzed, and the results showed that the indicators of high variation were the average duration index of low discharge in a year and the minimum discharge index of one day in a year. The variation period was from 1973 to 1986. It was concluded that the diagnosis results from the perspective of eco-hydrology were consistent with the actual hydrological situation changes, and this method had certain reliability.

Flood monitoring in the Chaohe River Basin is crucial for the timely and accurate forecasting of flood flow. Hydrological models used for the simulation of hydrological processes are affected by soil moisture (SM) data and uncertain model parameters. Hence, in this study, measured satellite-based SM data obtained from different spatial scales were merged, and the model state and parameters were updated in real time via the data assimilation method named ensemble Kalman filter. Four different assimilation settings were used for the forecasting of different floods at three hydrological stations in the Chaohe River Basin: flood forecasting without data assimilation (NA case), assimilation of runoff data (AF case), assimilation of runoff and satellite-based soil moisture data (AFWR case), and assimilation of runoff and merged soil moisture data (AFWM case). Compared with NA, the relative error (RE) of small, medium, and large floods decreased from 0.53 to 0.23, 0.35 to 0.16, and 0.34 to 0.12 in the AF case, respectively, indicating that the runoff prediction was significantly improved by the assimilation of runoff data. In the AFWR and AFWM cases, the REs of the small, medium, and large floods also decreased, indicating that the soil moisture data play important roles in the assimilation of medium and small floods. To study the factors affecting the assimilation, the changes in the parameter mean and variance and the number of set samples were analyzed. Our results have important implications for the prediction of different levels of floods and related assimilation processes.

Hydrological series data are non-stationary and nonlinear. However, certain data-driven forecasting methods assume that streamflow series are stable, which contradicts reality and causes the simulated value to deviate from the observed one. Ensemble empirical mode decomposition (EEMD) was employed in this study to decompose runoff series into several stationary components and a trend. The long short-term memory (LSTM) model was used to build the prediction model for each sub-series. The model input set contained the historical flow series of the simulation station, its upstream hydrological station, and the historical meteorological element series. The final input of the LSTM model was selected by the MI method. To verify the effect of EEMD, this study used the Radial Basis Function (RBF) model to predict the sub-series, which was decomposed by EEMD. In addition, to study the simulation characteristics of the EEMD-LSTM model for different months of runoff, the GM(group by month)-EEMD-LSTM was set up for comparison. The key difference between the GM-EEMD-LSTM model and the EEMD-LSTM model is that the GM model must divide the runoff sequence on a monthly basis, followed by decomposition with EEMD and prediction with the LSTM model. The prediction results of the sub-series obtained by the LSTM and RBF exhibited better statistical performance than those of the original series, especially for the EEMD-LSTM. The overall GM-EEMD-LSTM model performance in low-water months was superior to that of the EEMD-LSTM model, but the simulation effect in the flood season was slightly lower than that of the EEMD-LSTM model. The simulation results of both models are significantly improved compared to those of the LSTM model.

Background: To identify the risk factors and reasons for discharge against medical advice (DAMA) for newborns with neonatal surgical diseases in a tertiary care hospital in China.Methods: A retrospective study was conducted on all newborn patients admitted to the neonatal surgery department of Beijing Children's Hospital between January 1, 2016 and January 1, 2020. Medical records were compared between DAMA and non-DAMA patients. Univariate and multivariate logistic regression analyses were conducted to identify potentially useful characteristics for predicting DAMA.Results: During the study period, 854 newborns were admitted to the neonatal surgery department. A total of 68 DAMA patients (68/854, 7.96%, 47 boys), with a median age at diagnosis of 1 day (range, from birth to 21 days), were included in this study. After multivariate analysis, we found that emergency admission, age at admission ≤5 days, rejection for surgery, and admission to the neonatal intensive care unit were significant independent risk factors for DAMA. According to the electronic medical records, the reasons for DAMA included belief in incurability and concerns about the prognosis of the disease (n = 31), multiple malformations with poor prognosis (n = 8), severe postoperative complications (n = 5), financial difficulties (n = 3), refusal of further examinations (n = 2), assumption of clinical improvement (n = 1), and unknown (n = 18).Conclusions: This preliminary study showed that neonatal surgical patients in critical conditions were high-risk groups for DAMA, and the main possible reasons for DAMA were the parents' belief in incurability and concerns about the prognosis of the disease.

Modeling the effects of atmospheric deposition on the water quality of the middle route of the South-to-North Water Diversion Project (MR-SNWDP) can provide a basis for scientific protection and optimal allocation of water resources. Considering the total nitrogen (TN) as a representative water quality index, this study analyzed the water quality variations along the MR-SNWDP and in the Miyun Reservoir under atmospheric deposition, using the hydrodynamic and environmental numerical models. The results in 2016 revealed that the atmospheric deposition significantly affected the water quality of the MR-SNWDP, and the effects of atmospheric deposition on the water quality of the middle route and Miyun Reservoir showed different variation rules. However, the clearer water from the MR-SNWMP would significantly deteriorate after storage in the Miyun Reservoir as the TN concentration increased significantly. Based upon the scenario analysis, it was found that the constant water diversion scheme helped reduce the effects of atmospheric deposition. Further, it is recommended that the storage amounts in the Miyun Reservoir should be as low as possible.

From 15 to 20 September 2016, precipitation extremes occurred in the middle and lower reaches of the Jinsha River, causing immense direct economic losses due to floods. The current research on extreme climate characteristics and the relationship between climate extremes and runoff extremes are based on a single data source. This is due to the uneven distribution of precipitation and temperature stations, which make it difficult to fully capture extreme climate events. In this paper, various internationally popular reanalysis datasets were introduced. Extreme climate indexes were computed using the merged datasets versus the meteorological station observations. The results showed that: (1) Comparative analysis of the extreme climate indexes of the reanalysis dataset and the data of traditional meteorological observation stations showed that most of the extreme precipitation indexes calculated by the various reanalysis of combined data exhibited good performances. Among the reanalyzed combined products, CMPA-H, CMADS, and GPM (IMERG) exhibited good performance while the performance of TRMM (TMPA) was slightly worse. The extreme temperature indexes, TXx and TNn, calculated based on the reanalysis of combined data showed a better consistency than the indexes calculated based on the observational data of meteorological stations. The CMADS temperature dataset exhibited a higher consistency with the data obtained from meteorological stations as well as the best accuracy (84% of the stations with the error value of TXx calculated from the CMADS dataset and observed data less than 3 °C). (2) The response of typical flood events to precipitation extremes were analyzed and evaluated; the spatial distribution of the precipitation in the combined dataset was used to quantitatively analyze the response of occurrence of typical flood events to precipitation extremes, and the typical flood events were found to be mainly caused by certain factors, such as lagging flood propagation in the upstream of the basin outlet. This study indicates that it is feasible to use the reanalyzed combined data products to calculate the extreme climate indexes of the Jinsha River Basin, especially in the upper reaches of the Yangtze River where there is a lack of meteorological observation stations.

Flight feather shafts are outstanding bioinspiration templates due to their unique light weight and their stiff and strong characteristics. As a thin wall of a natural composite beam, the keratinous cortex has evolved anisotropic features to support flight. Here, the anisotropic keratin composition, tensile response, dynamic properties of the cortex, and fracture behaviors of the shafts are clarified. The analysis of Fourier transform infrared (FTIR) spectra indicates that the protein composition of calamus cortex is almost homogeneous. In the middle and distal shafts (rachis), the content of the hydrogen bonds (HBs) and side-chain is the highest within the dorsal cortex and is consistently lower within the lateral wall. The tensile responses, including the properties and dominant damage pattern, are correlated with keratin composition and fiber orientation in the cortex. As for dynamic properties, the storage modulus and damping of the cortex are also anisotropic, corresponding to variation in protein composition and fibrous structure. The fracture behaviors of bent shafts include matrix breakage, fiber dissociation and fiber rupture on compressive dorsal cortex. To clarify, ‘real-time’ damage behaviors, and an integrated analysis between AE signals and fracture morphologies, are performed, indicating that calamus failure results from a straight buckling crack and final fiber rupture. Moreover, in the dorsal and lateral walls of rachis, the matrix breakage initially occurs, and then the propagation of the crack is restrained by ‘ligament-like’ fiber bundles and cross fiber, respectively. Subsequently, the further matrix breakage, interface dissociation and induced fiber rupture in the dorsal cortex result in the final failure.

Abstract Background Different confounder adjustment strategies were used to estimate odds ratios (ORs) in case-control study, i.e. how many confounders original studies adjusted and what the variables are. This secondary data analysis is aimed to detect whether there are potential biases caused by difference of confounding factor adjustment strategies in case-control study, and whether such bias would impact the summary effect size of meta-analysis. Methods We included all meta-analyses that focused on the association between breast cancer and passive smoking among non-smoking women, as well as each original case-control studies included in these meta-analyses. The relative deviations (RDs) of each original study were calculated to detect how magnitude the adjustment would impact the estimation of ORs, compared with crude ORs. At the same time, a scatter diagram was sketched to describe the distribution of adjusted ORs with different number of adjusted confounders. Results Substantial inconsistency existed in meta-analysis of case-control studies, which would influence the precision of the summary effect size. First, mixed unadjusted and adjusted ORs were used to combine individual OR in majority of meta-analysis. Second, original studies with different adjustment strategies of confounders were combined, i.e. the number of adjusted confounders and different factors being adjusted in each original study. Third, adjustment did not make the effect size of original studies trend to constringency, which suggested that model fitting might have failed to correct the systematic error caused by confounding. Conclusions The heterogeneity of confounder adjustment strategies in case-control studies may lead to further bias for summary effect size in meta-analyses, especially for weak or medium associations so that the direction of causal inference would be even reversed. Therefore, further methodological researches are needed, referring to the assessment of confounder adjustment strategies, as well as how to take this kind of bias into consideration when drawing conclusion based on summary estimation of meta-analyses.

Hydrological simulation in meteorological ungauged areas has always been a difficult problem for the study on atmospheric and hydrological coupling; meanwhile, it is also one of the important factors that restrict model development and basin water resource knowledge. To analyze the mechanism of atmospheric and hydrological coupling, this study quantitatively evaluated water cycle situation in basins covered with glaciers and snow, and chose the Manas River Basin (MRB) in China as the typical research area to verify the adaptability of the China Meteorological Assimilation Driving Datasets for the Soil and Water Assessment Tool model (CMADS). The SWAT model was firstly built to simulate water resources, then we calibrated the model with CMADS dataset and started localization in the Manas River Basin (MRB), China, and finally calibrated simulated runoff with observed data SWAT-CUP (SWAT Calibration and Uncertainty Programs). In addition, parameter sensitivity analysis, and parameter calibration and validation were also included in the present study. Results showed that the SWAT model could well reproduce the runoff process of two stations (Kenswat and Hongshanzui) in the research area by using data from CMADS. The simulation performed well on monthly scale in both stations, where R2 = (0,556÷0,999) and NSE = (0,937÷0,998), and also showed satisfactory effects, where R2 = (0,927÷0,993) and NSE = (0,836÷0,997).Our research suggests that the SWAT model can show satisfactory results through parameter calibration in areas with high glacial recharge rate. Moreover, CMADS can provide necessary meteorological data for SWAT simulations, and support parameter calibration and historical surface data analysis.

Reanalysis datasets can provide alternative and complementary meteorological data sources for hydrological studies or other scientific studies in regions with few gauge stations. This study evaluated the accuracy of two reanalysis datasets, the China Meteorological Assimilation Driving Datasets for the Soil and Water Assessment Tool (SWAT) model (CMADS) and Climate Forecast System Reanalysis (CFSR), against gauge observations (OBS) by using interpolation software and statistical indicators in Northeast China (NEC), as well as their annual average spatial and monthly average distributions. The reliability and applicability of the two reanalysis datasets were assessed as inputs in a hydrological model (SWAT) for runoff simulation in the Hunhe River Basin. Statistical results reveal that CMADS performed better than CFSR for precipitation and temperature in NEC with the indicators closer to optimal values (the ratio of standard deviations of precipitation and maximum/minimum temperature from CMADS were 0.92, 1.01, and 0.995, respectively, while that from CFSR were 0.79, 1.07, and 0.897, respectively). Hydrological modelling results showed that CMADS + SWAT and OBS + SWAT performed far better than CFSR + SWAT on runoff simulations. The Nash‒Sutcliffe efficiency (NSE) of CMADS + SWAT and OBS + SWAT ranged from 0.54 to 0.95, while that of CFSR + SWAT ranged from −0.07 to 0.85, exhibiting poor performance. The CMADS reanalysis dataset is more accurate than CFSR in NEC and is a suitable input for hydrological simulations.

The epidemiology, clinical presentation, and treatment of infective endocarditis (IE) has significantly changed over the past few years in developed countries. However, relevant data from developing countries are different and remain scarce. The objective of this study was to evaluate the clinical presentations, treatment and outcomes of IE patients in a tertiary hospital in East China over an 8-year period. This was a retrospective observational study of consecutive cases of definite or possible IE as per the modified Duke criteria between January 2008 and December 2015. A total of 135 definite and 39 probable IE cases were identified. The mean age was 47.8 ± 15.7 years, with a male preponderance (1.9: 1). Degenerative valve disease accounted for 30.5% cases of IE, followed by congenital heart disease (29.9%) and rheumatic heart disease (14.9%). Native cardiac valves were present in 93.7% of the IE patients. Echocardiography and blood culture were performed in all patients, of whom 55.2% were found to have large vegetations (≥10 mm) and the positive rate of blood culture was 60.3%. Streptococcus remained the chief causative agent that was identified in 61.9% of culture-positive patients. Glycopeptide antibacterials and cephalosporins were the most frequently used antimicrobial drugs for IE therapy. Seventy-six (43.7%) of the IE patients were surgically treated. The mortality rate during hospital stay was 10.9%. Our data reflected clinical and microbiological profile, and treatment of IE in a tertiary hospital located in the East China.

In this work, a novel processing method called powder thixoforming was proposed to prepare composites reinforced with 50 vol % of SiC particles (SiCp) that were used for electronic packaging in order to investigate the effects of remelting duration on its microstructure and properties. Optical Microscope (OM), Scanning Electron Microscope (SEM), X-ray Diffraction (XRD) and Transmission Electron Microscope (TEM) methods were applied for the material characterization and the corresponding physical and mechanical properties were examined in detail. The obtained results indicate that the remelting duration exerted a large effect on the microstructure as well as the SiCp/Al interfacial reaction. The density and hardness of the composite continuously increased with increasing remelting duration. The thermal conductivity (TC) and bending strength (BS) first increased during the initial 90 min and then decreased. The remelting duration exerted a limited influence on the coefficient of thermal expansion (CTE). The optimal TC, BS, and hardness of these composites were up to 135.79 W/(m·K), 348.53 MPa, and 105.23 HV, respectively, and the CTE was less than 6.5 ppm/K after the composites were remelted at 600 °C for 90 min. The properties of the composites could thus be controlled to conform to the application requirements for electronic packaging materials.

Data mining technology is applied to extract the water supply operation rules in this study. Five characteristic attributes—reservoir storage water, operation period number, water demand, runoff, and hydrological year—are chosen as the dataset, and these characteristic attributes are applied to build a mapping relation with the optimal operation mode calculated by dynamic programming (DP). A Levenberg-Marquardt (LM) neural network and a classification and regression tree (CART) are chosen as data mining algorithms to build the LM neural network classifier and CART decision tree classifier, respectively. In order to verify the classification effect of the LM and CART, the two classifiers are applied to the operation mode recognition for the Heiquan reservoir, which is located in the Qinghai Province of China. The accuracies of the two classifiers are 73.6% and 86.9% for the training sample, and their accuracies are 65.8% and 83.3%, respectively, for the test sample, which indicates that the classification result of the CART classifier is better than that of the LM neural network classifier. Thus, the CART classifier is chosen to guide the long-series water supply operation. Compared to the operation result with the other operation scheme, the result shows that the water deficit index of the CART is mostly closest to the DP scheme, which indicates that the CART classifier can guide reservoir water supply operation effectively.

This study proposes a hedging rule model which is composed of a two-period reservior operation model considering the damage depth and hedging rule parameter optimization model. The former solves hedging rules based on a given poriod’s water supply weighting factor and carryover storage target, while the latter optimization model is used to optimize the weighting factor and carryover storage target based on the hedging rules. The coupling model gives the optimal poriod’s water supply weighting factor and carryover storage target to guide release. The conclusions achieved from this study as follows: (1) the water supply weighting factor and carryover storage target have a direct impact on the three elements of the hedging rule; (2) parameters can guide reservoirs to supply water reasonably after optimization of the simulation and optimization model; and (3) in order to verify the utility of the hedging rule, the Heiquan reservoir is used as a case study and particle swarm optimization algorithm with a simulation model is adopted for optimizing the parameter. The results show that the proposed hedging rule can improve the operation performances of the water supply reservoir.