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Despite the clear association between remnant cholesterol (RC)and diabetes risk, no study to date has examined the relationship between RC and reversal of prediabetes to normoglycemia. This retrospective cohort study included a total of 15,023 patients with prediabetes who underwent a physical examination between 2010 and 2016. The link between initial RC levels and the reversion from prediabetes to normoglycemia was analyzed using the Cox proportional-hazards regression model. Additionally, the study explored the possible relationship between RC and the probability of returning normoglycemia by applying Cox proportional hazards regression models with cubic spline functions. To address competing risks, a multivariate Cox regression analysis was undertaken, treating the onset of diabetes as a competing risk event for reversing prediabetes to normoglycemia. Additionally, the study incorporated extensive subgroup analyses alongside multiple sensitivity analyses, enhancing the reliability and robustness of the results. After adjusting for covariates, the findings indicated that RC was inversely associated with the likelihood of reverting to normoglycemia (per 5 mg/dL increase, HR = 0.918, 95% CI 0.909–0.927). The analysis also revealed a nonlinear relationship between RC and normoglycemia reversion, with an inflection point at 51.08 mg/dL. For RC values below this inflection point (RC < 50.08 mg/dL), the HR for the probability of returning to normoglycemia was 0.907 (95% CI 0.897–0.917 per 5 mg/dL). Additionally, the competing risks model demonstrated a negative relationship between RC and the reversal of prediabetes to normoglycemia (SHR = 0.92, 95% CI 0.91–0.93). Sensitivity analyses confirmed the robustness and stability of these results. This study demonstrated a negative and non-linear association between RC and the probability of reversion to normoglycemia in Chinese adults with prediabetes. By actively intervening to reduce RC levels, at least to below 51.08 mg/dL, further reduction of RC may significantly increase the probability of returning to normoglycemia from prediabetes. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of preoperative abdominal aortic balloon occlusion and modified uterine vascular occlusion on repeat cesarean delivery in patients with placenta previa and placenta accreta spectrum disorders. Methods A total of 97 patients with placenta previa and placenta accreta spectrum disorders who underwent repeat cesarean section at Hefei Maternal and Child Health Hospital between April 2016 and December 2022 were included in this study. Among them, the control group consisted of 48 cases who underwent abdominal aortic balloon occlusion before the operation, while the observation group comprised 49 cases who underwent modified uterine vascular occlusion during the operation. Intraoperative and postoperative complications were observed and compared between the two groups. Results The number of bilateral uterine artery embolization post-operation and the average hospitalization cost in the observation group were significantly lower compared to those in the control group (P < 0.05). However, there were no significant differences observed between the two groups regarding average intraoperative blood loss, red blood cell suspension transfusion volume, hysterectomy rate, and bladder rupture rate (P > 0.05). Conclusions Both surgical methods effectively reduce intraoperative bleeding in the treatment of repeat cesarean section in patients with placenta previa and placenta accreta spectrum disorders. However, modified uterine vascular occlusion demonstrates no complications related to vascular intervention or X-ray exposure, ensuring high maternal and child safety while significantly reducing hospitalization costs. Therefore, it is highly recommended for clinical promotion. [ABSTRACT FROM AUTHOR]

Objective: Fibrinogen, essential in primary hemostasis, platelet aggregation, and leukocyte-endothelial interactions, is also associated with a heightened risk of acute ischemic stroke (AIS). However, its influence on AIS patient outcomes is unclear. This study examines the correlation between fibrinogen levels and the risk of unfavorable outcomes three months post-AIS. Methods: This is a secondary analysis of a prospective cohort study conducted in Korea. The sample consisted of 1851 AIS patients who received treatment at a Korean hospital between January 2010 and December 2016. Statistical models were established to understand the relationship between fibrinogen levels(mg/dL) and unfavorable outcomes(mRs ≥ 3), including logistic regression models, Generalized Additive Models (GAM), and smooth curve fitting (penalized splines). The log-likelihood ratio test has been utilized to evaluate the best fit. To ensure the robustness of the results, sensitivity analyses were conducted by reanalyzing the relationship after excluding participants with TG > 200 mg/dl and BMI > 25 kg/m2. Subgroup analyses were also performed to assess whether influencing factors modify the association between fibrinogen levels and unfavorable outcomes. Results: After adjusting for multiple covariates including age, BMI, sex, LDL-c, TG, HGB, HDL-c, BUN, FPG, ALB, PLT, AF, hypertension, smoking, DM, mRs score at admission, the binary logistic regression model demonstrated revealed a significant positive association between fibrinogen levels and the risk of unfavorable outcomes in AIS patients (OR = 1.215, 95% CI: 1.032–1.429, p = 0.019). Sensitivity analyses supported these findings, with similar ORs observed in subsets of patients with TG < 200 mg/dL (OR = 1.221, 95% CI: 1.036–1.440) and BMI < 25 kg/m2 (OR = 1.259, 95% CI: 1.051–1.509). Additionally, the relationship between fibrinogen levels and outcomes was nonlinear, with a critical threshold of 2.74 g/L. Below the inflection point, the OR for unfavorable outcomes was 0.666 ((95% CI: 0.360, 1.233, p = 0.196), whereas above it, the OR increased to 1.374 (95% CI: 1.138, 1.659). Conclusions: This study has provided evidence of a positive and nonlinear correlation between fibrinogen levels and 3-month poor functional outcomes in patients with AIS. When fibrinogen levels exceeded 2.74 g/L, a significant and positive association was observed with the risk of poor outcomes. This study provides a further reference for optimizing rehabilitation exercises and facilitating clinical counseling in patients with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: To evaluate monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies conceived by assisted reproductive technology (ART) and conceived naturally. Methods: We retrospectively analyzed the data on twin pregnancies conceived by ART from January 2015 to January 2022,and compared pregnancy outcomes of MCDA and DCDA twins conceived by ART with those of MCDA and DCDA twins conceived naturally, pregnancy outcomes between MCDA and DCDA twins conceived by ART, and pregnancy outcomes of DCT and TCT pregnancies reduced to DCDA pregnancies with those of DCDA pregnancies conceived naturally. Result: MCDA pregnancies conceived by ART accounted for 4.21% of the total pregnancies conceived by ART and 43.81% of the total MCDA pregnancies. DCDA pregnancies conceived by ART accounted for 95.79% of the total pregnancies conceived by ART and 93.26% of the total DCDA pregnancies. Women with MCDA pregnancies conceived by ART had a higher premature delivery rate, lower neonatal weights, a higher placenta previa rate, and a lower twin survival rate than those with MCDA pregnancies conceived naturally (all p < 0.05). Women with DCDA pregnancies conceived naturally had lower rates of preterm birth, higher neonatal weights, and higher twin survival rates than women with DCDA pregnancies conceived by ART and those with DCT and TCT pregnancies reduced to DCDA pregnancies (all p < 0.05). Conclusion: Our study confirms that the pregnancy outcomes of MCDA pregnancies conceived by ART are worse than those of MCDA pregnancies conceived naturally. Similarly, the pregnancy outcomes of naturally-conceived DCDA pregnancies are better than those of DCDA pregnancies conceived by ART and DCT and TCT pregnancies reduced to DCDA pregnancies. [ABSTRACT FROM AUTHOR]

The association between the initial cardiac rhythm and short-term survival in patients with in-hospital cardiac arrest (IHCA) has not been extensively studied despite the fact that it is thought to be a prognostic factor in patients with out-of-hospital cardiac arrest. This study aimed to look at the relationship between initial shockable rhythm and survival to hospital discharge in individuals with IHCA. 1516 adults with IHCA who received chest compressions lasting at least two minutes at the National Taiwan University Hospital between 2006 and 2014 made up the study population. Propensity scores were estimated using a fitted multivariate logistic regression model. Various statistical methodologies were employed to investigate the association between shockable rhythm and the probability of survival to discharge in patients experiencing IHCA, including multivariate adjustment, propensity score adjustment, propensity score matching, and logistic regression based on propensity score weighting. In the original cohort, the multivariate-adjusted odds ratio (OR) was 2.312 (95% confidence interval [CI]: 1.515–3.531, P < 0.001). In additional propensity score adjustment, the OR between shockable rhythm and the probability of survival to hospital discharge in IHCA patients was 2.282 (95% CI: 1.486, 3.504, P < 0.001). The multivariate-adjusted logistic regression model analysis revealed that patients with shockable rhythm had a 1.761-fold higher likelihood of surviving to hospital release in the propensity score-matched cohort (OR = 2.761, 95% CI: 1.084–7.028, P = 0.033). The multivariate-adjusted OR of the inverse probability for the treatment-weighted cohort was 1.901 (95% CI: 1.507–2.397, P < 0.001), and the standardized mortality ratio-weighted cohort was 2.692 (95% CI: 1.511–4.795, P < 0.001). In patients with in-hospital cardiac arrest, Initial cardiac rhythm is an independent predictor of survival to hospital discharge. Depending on various statistical methods, patients with IHCA who have a shockable rhythm have a one to two fold higher probability of survival to discharge than those who have a non-shockable rhythm. This provides a reference for optimizing resuscitation decisions for IHCA patients and facilitating clinical communication. [ABSTRACT FROM AUTHOR]

Background: It is generally beneficial and recommended that dichorionic triamniotic (DCTA) triplet pregnancies be reduced to monochorionic (MC) twin or singleton pregnancies after assisted reproductive technology (ART). However, some infertile couples still have a firm desire to retain twins. For this reason, the best foetal reduction strategies need to be available for infertile couples and clinicians. Given that data on the elective reduction of DCTA triplet pregnancies to twin pregnancies are scarce, we investigated the outcomes of elective reduction of DCTA triplet pregnancies through the retrospective analysis of previous data. Method: Patients with DCTA triplet pregnancies who underwent elective foetal reduction between January 2012 and June 2020 were recruited. A total of 67 eligible patients with DCTA triplet pregnancies were divided into two groups: a DCTA-to-dichorionic diamniotic (DCDA) twin group (n = 38) and a DCTA-to-monochorionic diamniotic (MCDA) twin group (n = 29); the basic clinical data of the two groups were collected for comparison. Results: Compared with the DCDA-to-MCDA twin group, the DCTA-to-DCDA twin group had lower rates of complete miscarriage (7.89% versus 31.03%, p = 0.014), early complete miscarriage (5.26% versus 24.14%, p = 0.034), late preterm birth (25.71% versus 65.00%, p = 0.009) and very low birth weight (0 versus 11.11%, p = 0.025). In addition, the DCTA-to-DCDA twin group had higher rates of full-term delivery (65.71% versus 25.00%, p = 0.005), survival (92.11% versus 68.97%, p = 0.023), and taking the babies home (92.11% versus 68.97%, p = 0.023) than did the DCTA-to-MCDA twin group. In terms of neonatal outcomes, a significantly greater gestational age (38.06 ± 2.39 versus 36.28 ± 2.30, p = 0.009), average birth weight (3020.77 ± 497.33 versus 2401.39 ± 570.48, p < 0.001), weight of twins (2746.47 ± 339.64 versus 2251.56 ± 391.26, p < 0.001), weight of the larger neonate (2832.94 ± 320.58 versus 2376.25 ± 349.95, p < 0.001) and weight of the smaller neonate (2660.00 ± 345.34 versus 2126.88 ± 400.93, p < 0.001) was observed in the DCTA-to-DCDA twin group compared to the DCTA-to-MCDA twin group. Conclusion: The DCTA-to-DCDA twin group had better pregnancy and neonatal outcomes than the DCTA-to-MCDA twin group. This reduction approach may be beneficial for patients with dichorionic triamniotic triplet pregnancies who have a strong desire to have DCDA twins. [ABSTRACT FROM AUTHOR]

Bicuculline is a natural isoquinoline alkaloid that works as a gamma‐aminobutyric acid receptor antagonist. It is widely found in Papaveraceae plants used in traditional Chinese medicines. Bicuculline not only has been shown to have favorable analgesic, memory‐improving, and anxiolytic effects but may also cause adverse effects such as convulsions and epilepsy. A simple, rapid, and sensitive method was developed and validated for the determination of bicuculline in the plasma and tissue samples in rats by ultra‐high‐performance liquid chromatography–tandem mass spectrometry (MS/MS). The chromatographic separation was performed on a Thermo Scientific C18 column. The MS/MS system was operated in the positive multiple reaction monitoring mode, and the precursor–product ion transitions were optimized as m/z 368.0 → 307.1 for bicuculline and as 354.1 → 188.1 for protopine (internal standard). The linearity, accuracy, precision, recovery, and matrix effect were within acceptable limits. The experimental data showed that bicuculline was rapidly absorbed and eliminated in rats, with a moderate plasma protein binding ratio and low bioavailability. The main tissues of distribution were the kidney, liver, and brain; bicuculline could exert its pharmacological effects across the blood–brain barrier. This study has positive implications for the clinical use of herbal medicines containing bicuculline and for further development. [ABSTRACT FROM AUTHOR]

Objective: Current literature is deficient in robust evidence delineating the correlation between the triglyceride glucose-body mass index (TyG-BMI) and the incidence of stroke. Consequently, this investigation seeks to elucidate the potential link between TyG-BMI and stroke risk in a cohort of middle-aged and senior Chinese individuals. Methods: This study employs longitudinal data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, encompassing 8,698 participants. The CHARLS cohort was assembled using a multistage probability sampling technique. Participants underwent comprehensive evaluations through standardized questionnaires administered via face-to-face interviews. Our analytic strategy involved the application of Cox proportional hazards regression models to investigate the association between TyG-BMI and the risk of stroke. To discern potential non-linear relationships, we incorporated Cox proportional hazards regression with smooth curve fitting. Additionally, we executed a battery of sensitivity and subgroup analyses to validate the robustness of our findings. Results: Our study utilized a multivariate Cox proportional hazards regression model and found a significant correlation between the TyG-BMI and the risk of stroke. Specifically, a 10-unit increase in TyG-BMI corresponded to a 4.9% heightened risk of stroke (HR = 1.049, 95% CI 1.029–1.069). The analysis also uncovered a non-linear pattern in this relationship, pinpointed by an inflection point at a TyG-BMI value of 174.63. To the left of this inflection point—meaning at lower TyG-BMI values—a 10-unit hike in TyG-BMI was linked to a more substantial 14.4% rise in stroke risk (HR 1.144; 95% CI 1.044–1.253). Conversely, to the right of the inflection point—at higher TyG-BMI values—each 10-unit increment was associated with a smaller, 3.8% increase in the risk of stroke (HR 1.038; 95% CI 1.016–1.061). Conclusions: In the middle-aged and elderly Chinese population, elevated TyG-BMI was significantly and positively associated with stroke risk. In addition, there was also a specific non-linear association between TyG-BMI and stroke (inflection point 174.63). Further reduction of TyG-BMI below 174.63 through lifestyle changes and dietary control can significantly reduce the risk of stroke. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between platelet count (PC) and mortality in patients with hemorrhagic stroke (HS). The research reviewed data from 10,466 patients hospitalized in 208 hospitals in the United States from January 1, 2014, to December 31, 2015. Of these, 3262 HS patients were included in the primary analysis for those admitted to the intensive care unit (ICU). The average age of these patients was 67.05 years, with 52.79% being male. The median PC was (221.67 ± 73.78) × 109/L. Multivariate logistic regression analysis revealed that PC was a protective factor for mortality in HS patients (OR = 0.98, 95% CI 0.97–1.00, P < 0.05). Additionally, a non-linear association between PC and mortality in HS patients was found using a generalized additive model (GAM) and smooth curve fitting (penalty spline method). For the first time, a recursive algorithm identified the inflection point of platelet count as 194 × 109/L. On the left side of the inflection point, for every increase of 10 units in platelet count, the mortality rate of HS patients decreases by 10%. The study demonstrates a non-linear relationship between PC and the risk of mortality in HS patients. A platelet counts higher than the inflection point (194 × 109/L) may be a significant intervention to reduce mortality in HS patients. [ABSTRACT FROM AUTHOR]

Objective: The current body of evidence on the association between the ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-c) and the reversal of prediabetes to normoglycemia remains limited. The aim of this study is to investigate the association between TG/HDL-c and the reversion to normoglycemia in patients with prediabetes. Methods: This retrospective cohort study included 15,107 individuals with prediabetes from 32 Chinese districts and 11 cities who completed health checks from 2010 to 2016. The Cox proportional-hazards regression model examined baseline TG/HDL-c and reversion to normoglycemia from prediabetes. Cox proportional hazards regression with cubic spline functions and smooth curve fitting determined the non-linear connection between TG/HDL-c and reversion to normoglycemia. We also ran sensitivity and subgroup analysis. By characterizing progression to diabetes as a competing risk for the reversal of prediabetes to normoglycemic event, a multivariate Cox proportional hazards regression model with competing risks was created. Results: Upon adjusting for covariates, the findings indicate a negative association between TG/HDL-c and the likelihood of returning to normoglycemia (HR = 0.869, 95%CI:0.842–0.897). Additionally, a non-linear relationship between TG/HDL-c and the probability of reversion to normoglycemia was observed, with an inflection point of 1.675. The HR on the left side of the inflection point was 0.748 (95%CI:0.699, 0.801). The robustness of our results was confirmed through competing risks multivariate Cox's regression and a series of sensitivity analyses. Conclusion: The present study reveals a negative and non-linear correlation between TG/HDL-c and the reversion to normoglycemia among Chinese individuals with prediabetes. The findings of this study are anticipated to serve as a valuable resource for clinicians in managing dyslipidemia in prediabetic patients. Interventions aimed at reducing the TG/HDL-c ratio through the reduction of TG or elevation of HDL-c levels may substantially enhance the likelihood of achieving normoglycemia in individuals with prediabetes. [ABSTRACT FROM AUTHOR]

The use of hexachlorocyclohexanes (HCHs) in pesticides has been prohibited for decades in China. Since then, there have been urbanization and transformation of the functional areas of many sites, which were formerly involved in the HCH industry. However, it is possible that, unless properly managed, these sites may still contain HCH residues in the soil and thus pose a threat to the surrounding environment and the quality of groundwater. This study aimed to characterize soil residues in a typical site that was historically involved in HCH production in southern China, by analyzing the α-HCH, β-HCH, and γ-HCH contents of the soil. The results suggested that HCHs persist in the environment and can have long-term effects. It was found that α-HCH and β-HCH were present in many samples in concentrations that were comparable or higher than those specified by China's Class 1 screening values. The distribution of residues was significantly correlated with the historical HCH production activities in the areas. The characteristic ratios of α-HCH/γ-HCH and β-HCH/(α + γ)-HCH at different soil depths were 1.4–3.7 and 0.21–1.04, respectively, which indicated the presence of significant localized residues of HCHs. The presence of HCHs in the soil suggested a downward migration, with concentrations rapidly decreasing in the upper layer soil (0–5 m), but a gradual increase in the deeper soil (5–14 m). HCHs were detected at depths exceeding 24 m, indicating heavy penetration. The proportions of γ-HCH and β-HCH changed with increasing soil depth, which was related to their relatively volatile and stable molecular structures, respectively. The results strongly suggested that there is widespread contamination of both soil and groundwater by HCHs even after decades. The likelihood of residual HCHs in the soil should therefore be taken into full consideration during urban planning to limit risks to human and environmental health. [ABSTRACT FROM AUTHOR]

Background: Emergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas. Methods: Data on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation. Results: Primary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05). Conclusions: The DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting. [ABSTRACT FROM AUTHOR]

Climate risks and response policies have important impacts on a country's macroeconomic development and financial stability. Based on the data from 2005 to 2020, this paper takes temperature deviation as the main representative variable of climate risk to study the impact of climate change on financial stability. The two-way fixed-effect results show that there is a negative relationship between temperature deviation and financial stability, and the influence of temperature deviation has a lag. However, the effects of temperature deviation on financial stability varied across the samples. The central provinces, non-coastal provinces, non-Yangtze River Delta and Pearl River Delta provinces, and risk zone I had stronger temperature responses and financial stability was affected to a greater extent. The other regions experienced less of an impact. [ABSTRACT FROM AUTHOR]

Aim: To develop a personalized nomogram and risk score to predict the 5‐year risk of diabetes among Chinese adults with prediabetes. Methods: There were 26 018 participants with prediabetes at baseline in this retrospective cohort study. We randomly stratified participants into two cohorts for training (n = 12 947) and validation (n = 13 071). The least absolute shrinkage and selection operator (LASSO) model was applied to select the most significant variables among candidate variables. And we further established a stepwise Cox proportional hazards model to screen out the risk factors based on the predictors chosen by the LASSO model. We presented the model with a nomogram. The model's discrimination, clinical use and calibration were assessed using the area under the receiver operating characteristic (ROC) curve, decision curve and calibration analysis. The associated risk factors were also categorized according to clinical cut‐points or tertials to create the diabetes risk score model. Based on the total score, we divided it into four risk categories: low, middle, high and extremely high. We also evaluated our diabetes risk score model's performance. Results: We developed a simple nomogram and risk score that predicts the risk of prediabetes by using the variables age, triglyceride, fasting blood glucose, body mass index, alanine aminotransferase, high‐density lipoprotein cholesterol and family history of diabetes. The area under the ROC curve of the nomogram was 0.8146 (95% CI 0.8035‐0.8258) and 0.8147 (95% CI 0.8035‐0.8259) for the training and validation cohort, respectively. The calibration curve showed a perfect fit between predicted and observed diabetes risks at 5 years. Decision curve analysis presented the clinical use of the nomogram, and there was a wide range of alternative threshold probability spectrums. A total risk score of 0 to 2.5, 3 to 4.5, 5 to 7.5 and 8 to 13.5 is associated with low, middle, high and extremely high diabetes risk status, respectively. Conclusions: We developed and validated a personalized prediction nomogram and risk score for 5‐year diabetes risk among Chinese adults with prediabetes, identifying individuals at a high risk of developing diabetes. Doctors and other healthcare professionals can easily and quickly use our diabetes score model to assess the diabetes risk status in patients with prediabetes. In addition, the nomogram model and risk score we developed need to be validated in a prospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Uterine torsion is a rare obstetric event that can occur during pregnancy and is difficult to diagnose. Its occurrence may lead to serious adverse pregnancy outcomes. Case introduction: The patient was a 33-year-old woman at 30+ 5 weeks' gestation with a singleton pregnancy. The pregnancy course, including fetal growth, and prenatal examinations were regular. Except for a small amount of vaginal bleeding in early pregnancy and treatment with progesterone, there were no prenatal abnormalities, and the patient denied any trauma or sexual history. The patient was admitted to the emergency department with persistent severe pain in the lower abdomen and slight vaginal bleeding during night sleep. Abdominal pain started two hours prior to admission and was accompanied by nausea, vomiting, and dizziness. Examination revealed positive abdominal tenderness, high uterine tone, and no significant intermittent period of uterine contractions, and measurement of the fetal heart rate by means of the nonstress test revealed a rate of 60 beats per minute. Therefore, placental abruption was highly suspected. Subsequently, an emergency cesarean section was performed under general anesthesia. The newborn boy, with Apgar scores of 0–3-4 after birth and weighing 1880 g, was transferred to the neonatal intensive care unit (NICU) and died two days later due to ineffective rescue. After the uterine incision was sutured, the examination revealed that the uterine incision was located on the posterior wall of the uterus, and the uterus was twisted 180° to the right. The diagnosis after cesarean section was 180° uterine torsion to the right, severe placental abruption, and severe neonatal asphyxia. On the fifth day after surgery, the patient recovered and was discharged from the hospital. Conclusions: Posterior uterine incision cesarean section may be performed in unexpected circumstances and is also feasible as a safe option for resetting if torsion is not complete. Abdominal pain during pregnancy is less likely to be diagnosed as uterine torsion, which often leads to premature birth, fetal asphyxia, placental abruption, and even perinatal death. Therefore, for abdominal pain during pregnancy, obstetricians should consider the possibility of uterine torsion. [ABSTRACT FROM AUTHOR]

To ensure that a hardware Trojan remains hidden in a circuit, it is usually necessary to ensure that the trigger signal has a low testability, which has been widely recognized and proven. The most advanced testability-based detection methods are rather slow for large circuits, and the false-positive rate is not as low as that for small circuits. In this paper, a hardware Trojan, through the low testability of the trigger signal and its position characteristics in the circuit, was detected, which greatly improves the detection speed while maintaining a lower false positive rate when being applied to large circuits. First, the Sandia Controllability/Observability Analysis Program (SCOAP) was applied to obtain the 0–1 controllability of the signals in the netlist. Secondly, the controllability value was calculated by the differential amplification model, in order to facilitate K-means clustering to get better results. Then, we calculate the shortest path between each suspicious signal to get the connection between each suspicious signal. Finally, we divide the suspicious signals into several suspicious circuit blocks to screen the real trigger signal. As a result, the false-negative rate of 0% and the highest false-positive rate of 5.02% were obtained on the Trust-Hub benchmarks. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction may contribute to the increased morbidity and mortality associated with coronary heart disease (CHD). Flow-mediated dilatation (FMD) is the most popular noninvasive method for vascular endothelial function evaluation. This meta-analysis aimed to investigate the association between FMD and CHD. We searched the publications listed in the PubMed, Web of Science, Scopus, and Embase databases. Stata 14 software was used to analyze the data. Standardized mean difference (SMD) was used to calculate FMD levels, and the effect sizes were expressed with a 95% confidence interval (CI). I2 statistics were used to evaluate statistical heterogeneity. In this meta-analysis, 9 studies enrolled a total number of 943 participants, including 534 (56.63%) patients with CHD and 409 controls (43.37%). We found that patients with CHD showed a significantly lower FMD than the controls (SMD −0.706%; 95% CI: −0.985, −0.427; P = 0.001) with high heterogeneity. In addition, funnel plot analysis suggested asymmetry that could be evidence of publication bias. But sensitivity analyses show that there were no influential studies. This meta-analysis provides evidence that patients with CHD show a significantly lower FMD than controls and highlights the literature on FMD as a hallmark in CHD diseases. [ABSTRACT FROM AUTHOR]

A mixed-criticality system refers to an integrated embedded system in which tasks with different criticality levels run on a shared computing platform. In the design and development of mixed-criticality systems, how to schedule tasks to ensure that high-criticality tasks are executed in time and low-criticality tasks are served as much as possible is a major problem to be studied. Existing studies tend to consider pessimistic processing strategies to ensure the schedulability of functional tasks with high-criticality requirements. However, excessive pessimistic processing can lead to waste of system resources, thereby reducing the performance of functional tasks with low-criticality requirements. In this paper, we propose an adaptive-service-level adjustment strategy for low-criticality tasks, which solves the problem of waste of resources caused by invalid compensation in the low-criticality task compensation method of flexible mixed-criticality systems. In view of the problem that the existing methods mostly use static budget allocation and static independent mode switching without considering the actual operation of the task, this paper also proposes a flexible and dynamic mixed-criticality system scheduling scheme and designs a system execution framework, scheduling algorithm, and dynamic allocation strategy of maximum execution budget, in order to reduce unnecessary redundant resource expenditures and system switching costs and to improve the performance of low-criticality tasks. Experiments show that the proposed methods are effective compared to the state-of-the-art. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction may contribute to the increased morbidity and mortality associated with coronary heart disease (CHD). Flow-mediated dilatation (FMD) is the most popular noninvasive method for vascular endothelial function evaluation. This meta-analysis aimed to investigate the association between FMD and CHD. We searched the publications listed in the PubMed, Web of Science, Scopus, and Embase databases. Stata 14 software was used to analyze the data. Standardized mean difference (SMD) was used to calculate FMD levels, and the effect sizes were expressed with a 95% confidence interval (CI). I2 statistics were used to evaluate statistical heterogeneity. In this meta-analysis, 9 studies enrolled a total number of 943 participants, including 534 (56.63%) patients with CHD and 409 controls (43.37%). We found that patients with CHD showed a significantly lower FMD than the controls (SMD −0.706%; 95% CI: −0.985, −0.427; P = 0.001) with high heterogeneity. In addition, funnel plot analysis suggested asymmetry that could be evidence of publication bias. But sensitivity analyses show that there were no influential studies. This meta-analysis provides evidence that patients with CHD show a significantly lower FMD than controls and highlights the literature on FMD as a hallmark in CHD diseases. [ABSTRACT FROM AUTHOR]

High metal ion concentrations and low pH cause severely inhibit the activity of an acidophilic microbial consortium (AMC) in bioleaching. This work investigated the effects of exogenous spermine on biofilm formation and the bioleaching efficiency of LiCoO2 by AMC in 9K medium. After the addition of 1 mM spermine, the activities of glutathione peroxidase and catalase increased, while the amount of H2O2, intracellular reactive oxygen species (ROS) and malondialdehyde in AMC decreased. These results indicated that the ability of AMC biofilm to resist oxidative stress introduced by 3.5 g/L Li+ and 30.1 g/L Co2+ was improved by spermine. The activity of glutamate decarboxylase was promoted to restore the intracellular pH buffering ability of AMC. Electrochemical measurements showed that the oxidation rate of pyrite was increased by exogenous spermine. As a result, high bioleaching efficiencies of 97.1% for Li+ and 96.1% for Co2+ from a 5.0% (w v−1) lithium cobalt oxide powder slurry were achieved. This work demonstrated that Tafel polarization can be used to monitor the AMC biofilm’s ability of uptaking electrons from pyrite during bioleaching. The corrosion current density increased with 1 mM spermine, indicating enhanced electron uptake by the biofilm from pyrite. [ABSTRACT FROM AUTHOR]

Objective: Evidence regarding the relationship between serum triglyceride-to-high density lipoprotein cholesterol (TG/HDL-c) ratio and outcomes in acute ischemic stroke (AIS) patients is still mixed. Therefore, the present study was undertaken to explore the link between the TG/HDL-c ratio and unfavorable outcomes in patients with AIS.Methods: This was a second analysis based on a cohort study. The study population was 1764 patients with AIS collected from January 2010 to December 2016 at a hospital in South Korea. We used a binary logistic regression model to assess the linear association between the TG/HDL-c ratio and unfavorable outcomes for AIS patients. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) was conducted to explore the nonlinear relationship between TG/HDL-c ratio and unfavorable outcomes for AIS patients. Additionally, we compute the inflection point using a recursive algorithm and then build a two-piece binary logistic regression model on both sides of the inflection point. A log-likelihood ratio test was used to determine the most appropriate model describing the association of TG/HDL-c ratio and unfavorable outcomes in patients with AIS.Results: The incidence rate of unfavorable outcomes was 28.2%, and the median TG/HDL-c ratio was 2.130. After adjusting covariates, the results of the binary logistic regression model suggested that the relationship between the TG/HDL-c ratio and the risk of unfavorable outcomes for AIS patients was not statistically significant. However, there was a nonlinear relationship between them, and the inflection point of the TG/HDL-c ratio was 3.515. On the left side of the inflection point, each 1-unit increase in the TG/HDL-c ratio was associated with a 22.6% lower risk of unfavorable outcomes (OR = 0.774, 95%CI:0.656 to 0.914, p = 0.002). On the right side of the inflection point, the effect size (OR) was 1.195 (95%CI:1.004 to1.423, p = 0.003).Conclusion: There is a nonlinear relationship and threshold effect between the TG/HDL-c ratio and 3-month unfavorable outcomes in AIS patients. When the TG/HDL-c ratio is lower than 3.515, the TG/HDL-c ratio is significantly negatively related to the risk of unfavorable outcomes. When the TG/HDL-c ratio is greater than 3.515, the TG/HDL-c ratio was positively associated with the risk of unfavorable outcomes in AIS patients. This provides a reference for optimizing lipidemia intervention and promoting clinical communication in patients with AIS. [ABSTRACT FROM AUTHOR]

Blind pansharpening addresses the problem of generating a high spatial-resolution multi-spectral (HRMS) image given a low spatial-resolution multi-spectral (LRMS) image with the guidance of its associated spatially misaligned high spatial-resolution panchromatic (PAN) image without parametric side information. In this article, we propose a fast approach to blind pansharpening and achieve the state-of-the-art image reconstruction quality. Typical blind pansharpening algorithms are often computationally intensive since the blur kernel and the target HRMS image are often computed using iterative solvers and in an alternating fashion. To achieve fast blind pansharpening, we decouple the solution of the blur kernel and of the HRMS image. First, we estimate the blur kernel by computing the kernel coefficients with minimum total generalized variation that blur a downsampled version of the PAN image to approximate a linear combination of the LRMS image channels. Then, we estimate each channel of the HRMS image using local Laplacian prior (LLP) to regularize the relationship between each HRMS channel and the PAN image. Solving the HRMS image is accelerated by both parallelizing across the channels and by fast numerical algorithms for each channel. Due to the fast scheme and the powerful priors we used on the blur kernel coefficients (total generalized variation) and on the cross-channel relationship (LLP), numerical experiments demonstrate that our algorithm outperforms the state-of-the-art model-based counterparts in terms of both computational time and reconstruction quality of the HRMS images. [ABSTRACT FROM AUTHOR]

Mycorrhizal strategies include mycorrhizal statuses and mycorrhizal types, which are important reflections of the functional characteristics of ecosystems. The stoichiometry of carbon, nitrogen, and phosphorus in plant organs is an important part of ecosystem functions, which has an important impact on the nutrient cycle of the ecosystem. The concentration of carbon, nitrogen, and phosphorus played a crucial role in ecosystem functioning and dynamics. The purpose of this study is to provide theoretical basis and data support for improving the properties of global terrestrial ecosystems by exploring the impact of mycorrhizal strategies on the stoichiometry of C, N, and P in different shrub organs. In this study, stoichiometric patterns of carbon (C), nitrogen (N) and phosphorus (P) in different shrub organs under different mycorrhizal status or types were analyzed at 725 samples across Northern China. Results showed that in different mycorrhizal status, the highest carbon concentration in shrub organs appeared in the facultatively mycorrhizal (FM) mycorrhizal status, and the highest nitrogen concentration appeared in the Non-mycorrhizal (NM) mycorrhizal status. Under different mycorrhizal types, the nitrogen concentration in the shrub organs under the arbuscular mycorrhiza (AM) mycorrhizal type was the highest, and the phosphorus concentration under the ecto-mycorrhiza (ECM) mycorrhizal type was the highest. In the OM or FM mycorrhizal status, the concentrations of C, N, and P in the stems and leaves increase with the increase of the concentrations of C, N, and P in the roots. In the NM mycorrhizal status, the N concentration in the stems and leaves increases with the increase of the N concentration in the roots. Under AM, AM+ECM, and ECM mycorrhizal type, the concentrations of C, N, and P are closely related in roots, stems and leaves. The content of plant nutrients in different organs is closely related. It turned out that mycorrhizal statuses or types are able to alter the allocation of C, N, and P in different organs, and the relationships of C, N, and P among different organs are able to present different trend with the varying of mycorrhizal statuses or types. [ABSTRACT FROM AUTHOR]

In order to study the effect of soil composition on flue-cured tobacco composition and quality in tobacco planting area, Nanping K326 tobacco was selected to measure the contents of basic components in soil and tobacco, and the correlation between contents and smoking quality was further analyzed. The results show that the contents of available nitrogen and phosphorus in soil are positively correlated with the content of nicotine in C3f flue-cured tobacco ( r> 0. 64) . The contents of total nitrogen, total sugar and reducing sugar are positively correlated with soil organic matter ( r> 0. 72). The C3F volatility is positively correlated with soil available potassium ( r > 0. 96 ) and total nitrogen and potassium ( r > 0. 65 ) . There is a positive correlation between volatility of B2f flue-cured tobacco and total nitrogen ( r> 0. 84) and sugar ( r> 0. 74) . The results indicate that soil nutrients affect the content of chemical composition in flue-cured tobacco, as well as tobacco quality and class. The volatility of flue-cured tobacco relates to the contents and their proportion of total nitrogen, potassium, nicotine and total sugar. [ABSTRACT FROM AUTHOR]

The new reform of power system promotes the market‐oriented operation of microgrids. The ubiquitous power internet of things provide support in information, data, and computation to microgrids in market operation, energy management, and coordination interaction. This study takes the park microgrid with multi‐stakeholder as the object, establishes a two‐level optimisation model of microgrid bidding transaction based on multi‐agent system. In the lower level optimisation, considering the deviation penalty of power generation and the previous round bidding results, the optimal bidding strategy model is established by the bidding unit agent to maximise its benefit. In the upper‐level model, bidding strategies of distributed energy resources (DERs) as constraints, a multiple objective mixed‐integer linear programming model was built to optimise the overall objectives of clearing price and imbalanced deviation, searching for the optimal clearing price and the generation plan of DERs. The results were fed back to the DERs to help them form the next round of strategies until the result reaches equilibrium. The proposed optimised operation mode is compared with the traditional operation mode in the case study, verifying that the proposed method can realise the optimal operation of the microgrid and the coordinated interaction with the main grid, increasing the benefit of stakeholders. [ABSTRACT FROM AUTHOR]

The detection of rolling-element bearing fault can be accomplished by monitoring and interpreting a variety of signals, including the vibration, the acoustic noise, and the stator current. The existence of a bearing fault as well as its specific fault type can be readily determined by performing frequency spectral analysis on the monitored signals with various signal processing techniques. However, this traditional approach, despite being simple and intuitive, is not able to identify the severity of a bearing fault in a quantitative manner. Moreover, it is often times tedious and time-consuming to apply this approach to electric machines with different power ratings, as the bearing fault threshold values need to be manually calibrated for each motor running at every possible speed and carrying any possible load. This article, thus, proposes a quantitative approach to estimate the bearing fault severity based on the airgap displacement profile, which is reconstructed from the mutual inductance variation profile estimated from a quantitative electrical model that takes the stator current as input. In addition, the accuracy of the developed electrical model and the estimated bearing fault severity are validated by the simulation and experimental results, and the explicit airgap variation profile is reconstructed with the superposition of multiple Fourier series terms estimated from the stator current via the proposed scheme. The proposed method offers a quantitative and universal bearing fault indicator for induction machines with any power ratings and operating under any speed and load conditions. [ABSTRACT FROM AUTHOR]

Purpose: Sediment denitrification is a dominant mechanism for nitrogen removal and can help to minimize lake eutrophication. However, the spatio-temporal variability of denitrification rates and its controlling factors in sediments of large shallow lakes are poorly understood. In this study, we investigated the controlling factors on the temporal and spatial variability of denitrification rates in Meiliang Bay in Taihu Lake, China, to determine the contribution of denitrification on the total lacustrine nitrogen budget. Materials and methods: We collected 18 intact monthly sediment cores and an additional 36 seasonal sediment cores from January 2013 to January 2014. Cores were collected from the inner and outer sections of Meiliang Bay for analysis of denitrification rates and sediment properties. We also collected in situ surface water samples for water quality analysis. Denitrification rates at the sediment-water interface (SWI) were measured using acetylene inhibition techniques and intact sediment core incubation. We used a t test to determine the differences in water quality and sediment properties between the two sites and a one-way ANOVA to identify seasonal differences in denitrification rates, water quality, and sediment properties. We also applied Pearson's correlation, distance-based redundancy analysis (db-RDA) and random forest model to identify the relationships between denitrification rates and environmental factors. Results and discussion: Denitrification rates ranged from 0.76 to 40.94 μmol N m−2 h−1 and 0.13 to 52.55 μmol N m−2 h−1, with annual mean values of 19.97 and 17.15 μmol N m−2 h−1 for the Inner and Outer Bay, respectively. Sediment denitrification rates in the Inner and Outer Bay showed similar seasonal variability, with the highest values in spring and summer and the lowest values in autumn. Nitrate addition was shown to significantly increase denitrification rates in summer and autumn (P < 0.05); however, carbon addition showed no significant influence on denitrification rates in the four seasons. Our results imply that denitrification rates were nitrate-limited in summer and autumn. Distance-based redundancy analysis (db-RDA) and random forest model showed that denitrification rates were mainly determined by nitrate, temperature, and chlorophyll a (Chla), and that nitrate in the water column was the most important predictor of denitrification rates. Conclusions: In general, denitrification rates showed significant seasonal variability in Meiliang Bay due to the co-regulation of both water temperature and nitrate concentrations. The dominance of each controlling factor on denitrification rates varied in different seasons. Based on our calculations, nitrogen removal by denitrification accounted for approximately 10.7% of the total nitrogen input to Taihu Lake. Therefore, we suggest the need for effective measures to reduce external nitrogen inputs of to Lake Taihu to prevent on-going eutrophication. [ABSTRACT FROM AUTHOR]

The objectives of this study were to characterize the heavy metal contamination status of surface soils sampled at two dredged sediment land disposal sites (the Baimao and Kongwan landfills) in Meiliang Bay, Lake Taihu, China, as well as to investigate the effect on their leaching behaviors due to acid rain. Among all the metals, only the nickel content in the Baimao landfill was higher than the Chinese reference value, and all metal contents were below the limit values for agricultural soils. The fraction distribution of metals by sequential extraction was similar at both sites. Cadmium had a relatively high proportion of exchangeable-carbonate fractions, while the other metals were mainly classified as residue fractions. The metals released from soils by simulated rainwater comprised less than 1% of the total soil metal content, and the effect of acid rain on heavy metal release from dredged sediments in land disposal sites was found to be negligible at both sites. All results indicate no environmental concern for the land disposal of dredged sediments and support the feasibility of beneficially reusing dredged sediment soils as a supplement to agricultural soils. [ABSTRACT FROM AUTHOR]

Background: Transumbilical single-site multiport laparoscopic pyeloplasty (TSMLP) for children with ureteropelvic junction obstruction (UPJO) has become feasible and popular recently. The purpose of this study was to evaluate the safety and efficacy of TSMLP for pediatric UPJO in a large multicenter series.Materials and Methods: Medical records of consecutive patients who underwent TSMLP for pediatric UPJO in six academic institutions between June 2010 and May 2015 were retrospectively analyzed. The data of ultrasound, magnetic resonance urography, and diuretic renogram using 99Tc-diethylene triamine pentaacetic acid scan were collected during preoperative and postoperative periods.Results: A total of 704 patients (750 kidneys) with UPJO who underwent TSMLP were recruited for this study. Of these patients, there were no significant differences in demographics and clinical presentation of the patients among the six centers. The operative time of all patients decreased significantly with time. The earlier the beginning of the operation, such as cohort A, B, and C, the longer the learning curve has been. Of these 704 patients, there were 60 (8.11%) postoperative minor complications during the postoperative hospitalization period, and all minor postoperative complications were cured by observation or drugs. There were 14 (1.99%) major postoperative complications, and all major complications were cured by minimally invasive surgery. No additional complications were encountered during the follow-up of 2.1 years (mean, ranged 1 year to 4 years). Success rate of TSMLP are more than 95% among six centers.Conclusions: We reported a multi-institutional series of TSMLP in children with UPJO. Our findings suggest that TSMLP represents a feasible treatment option for UPJO by offering reliable outcomes, low postoperative complications and high success rates. [ABSTRACT FROM AUTHOR]

The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min ( p < 0.001). In addition, the percentage of patients treated ≤60 min after hospital arrival increased from 38.46 to 75.0 % ( p = 0.015). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration ( p < 0.001). The patients were more likely to have a good prognosis (mRS ≤ 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS. [ABSTRACT FROM AUTHOR]

Background: Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications.Patients and Methods: Data from 62 patients (age: 1-180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue.Results: All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24-100 %), increased from 39.7 ± 18.0 % (range 18-100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13-25) months.Conclusions: Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children. [ABSTRACT FROM AUTHOR]

The iterative Born approximation (IBA) is a well-known method for describing waves scattered by semitransparent objects. In this letter, we present a novel nonlinear inverse scattering method that combines IBA with an edge-preserving total variation regularizer. The proposed method is obtained by relating iterations of IBA to layers of an artificial multilayer neural network and developing a corresponding error backpropagation algorithm for efficiently estimating the permittivity of the object. Simulations illustrate that, by accounting for multiple scattering, the method successfully recovers the permittivity distribution where the traditional linear inverse scattering fails. [ABSTRACT FROM PUBLISHER]