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Background: To explore the impact of diabetes on the clinical features and prognosis of COVID-19 and assess the influence of glucocorticoid use on the prognosis of patients with COVID-19 and diabetes. Methods: This retrospective multicenter cohort study included patients admitted between December 2022 and January 2023. The patients were grouped according to diabetes and glucocorticoid use. The primary outcome was in-hospital mortality. Results: Among 400 patients with glucocorticoid data, 109 (27.3%) had diabetes. The inflammatory cytokines were higher in patients with diabetes, manifested by higher IL-6 (25.33 vs. 11.29 ng/L, p = 0.011), CRP (26.55 vs. 8.62 mg/L, p = 0.003), and PCT (0.07 vs. 0.04 ng/ml, p = 0.010), while CD4+ (319 vs. 506 /mL, p = 0.004) and CD8+ (141 vs. 261 /mL, p < 0.001) T lymphocytes were lower. The overall mortality rate of hospitalized COVID-19 patients with diabetes was 13.46%. The diabetic patients who received glucocorticoids vs. those who did not receive glucocorticoids had a similar mortality (15.00% vs. 11.39%, p = 0.591). Conclusions: Patients with COVID-19 and diabetes are more likely to experience hyperinflammatory response and T cell reduction, especially those with severe/critical disease. Glucocorticoid use was not associated with the prognosis of COVID-19 in patients with diabetes. Still, glucocorticoids should be used cautiously in diabetic patients with severe/critical COVID-19. [ABSTRACT FROM AUTHOR]

The Lancang River flows through the alpine canyon region of southwest China, an area that has experienced frequent geological disasters over the years. Early monitoring of geological hazards is essential for disaster prevention and mitigation. However, traditional ground monitoring techniques are limited by the complex terrain conditions in high-altitude valley regions. In contrast, interferometric synthetic aperture radar (InSAR) technology can provide a high-precision, wide-range monitoring of slow rock-slope deformation, making it an effective tool for studying geological hazards. Within the study area, multiple synthetic aperture radar (SAR) images from the Sentinel-1A satellite were collected, and surface deformation was obtained using the small baseline subset InSAR (SBAS-InSAR). The results demonstrate that combining ascending and descending orbit images can be successfully applied to landslide monitoring in complex mountainous areas. Over 30 potential landslides were identified by combining InSAR results with optical images. The Line-Of-Sight (LOS) direction deformation features and their relationship with precipitation were analyzed based on two typical landslides, and two-dimensional/three-dimensional (2D/3D) deformation decomposition was carried out to reveal its motion characteristics. It was found that the cumulative deformation fluctuation amplitude was higher during the rainy season, and the main movement direction of the landslide was east–west. In addition, based on the spatial distribution and statistical analysis of deformation points along with meteorological data, geological elements, human activities, and topographic conditions, it is inferred that factors such as low vegetation coverage, tectonic movements, human activities, and high-altitude glacier thawing may contribute to the occurrence of disasters. And it was found that areas with high vegetation cover, high rainfall, and snow cover exhibit lower coherence coefficients. This study offers valuable insights for investigating large-scale geological in alpine canyon regions. [ABSTRACT FROM AUTHOR]

Focusing on a sample of fathers, this study examined the effects of two personality traits, agreeableness and neuroticism, on parental burnout, as well as the mediating role of parenting sense of competence and moderating effects of parental psychological flexibility. Data were collected from 263 fathers of middle-school children in central China, with questionnaires including the agreeableness and neuroticism subscales from the Big Five personality trait scale, Parenting Sense of Competence Scale, Parenting Psychological Flexibility scale, and Parental Burnout Assessment. To analyze the hypothesized moderated mediation model, bootstrapping analysis and structural equation modeling were performed. Results showed that agreeableness was negatively correlated with parental burnout, while neuroticism was positively correlated with parental burnout; both these relationships were partially mediated by parenting sense of competency. Further, psychological flexibility moderated the relationship between parenting sense of competence and parental burnout. When parenting psychological flexibility was low, parenting sense of competence was significantly related to parental burnout, while parenting psychological flexibility was high, parenting sense of competence was not related to parental burnout significantly. These preliminary findings provide theoretical guidance and an empirical basis for intervention strategies to prevent burnout among fathers. Highlights: Considering the increasing involvement of fathers in childcare and education, the present study examined the occurrence of parental burnout, and the result showed that the prevalence of fathers' parental burnout was estimated to be between 5.76% to 9.71%. Agreeableness and neuroticism were significantly associated with parental burnout, and the above relations were partially mediated by parenting sense of competence; further, the relation between parenting sense of competence and parental burnout was moderated by parental psychological flexibility. Parental psychological flexibility and parenting sense of competence had complementary effects on parental burnout, individuals can reduce their parental burnout if either is adequate. These results may provide a new perspective to the BR2 model that when individuals have enough resources, additional resources could not result in a lower occurrence of parental burnout. [ABSTRACT FROM AUTHOR]

This study examines the key influencing factors of voluntary dual ratings selection in corporate bond financing and the effect of dual ratings on risk premium and default risk, based on corporate bond data issued from 2016 to 2021. It shows that the worse the bond issuers' credit qualifications, the more likely they are to seek dual ratings before issuance. Compared to a single credit rating, the risk premium for a bond with dual ratings is lower, and the effect becomes more significant in the low-rated and non-listed company samples. There are dual ratings before bond issuance, and the higher the average credit rating level of the bond, the lower the bond's default risk. The research findings provide a theoretical basis and empirical evidence for the practice of voluntary dual ratings in China, expand research on the influencing mechanism of bond issuance pricing in the context of voluntary dual ratings selection, and examine the information content of credit ratings from the perspective of their ability to predict bond default. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) reactivation is associated with adverse prognoses of critically ill patients. However, the epidemiology and predictors of CMV reactivation in immunocompetent patients receiving mechanical ventilation (MV) are not clear. The aim of this study was to investigate the epidemiology and predictors of CMV reactivation in immunocompetent patients requiring MV.Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with MV at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week for 28 days (Days 1, 7, 14, 21, and 28). CMV serology, laboratory findings, and clinical data were obtained during hospitalization.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within 28 days in the ICU. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body mass index (BMI), sepsis, N-terminal pro-b-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), and hemoglobin (Hb) levels (P < 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were independently associated with CMV reactivation patients (P < 0.05). Moreover, the area under the receiver operating characteristic (AUROC) of BMI, Hb, and BMI combined with Hb was 0.69, 0.70, and 0.76, respectively. The duration of MV, hospitalization expense, length of ICU stay, and 90 day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P < 0.05).Conclusions: Among immunocompetent patients with MV, the incidence of CMV reactivation was 18.3%. CMV reactivation was associated with several adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation. [ABSTRACT FROM AUTHOR]

Corona virus disease 2019 (COVID-19) patients with severe immune abnormalities are at risk of cytokine release syndrome (CRS). The definition, prevention, and treatment of symptoms of CRS in critically ill patients with COVID-19 are important problems. We report a single-center case series of 11 COVID-19 patients with acute respiratory distress syndrome from The First Affiliated Hospital of Guangzhou Medical University in China from 26 January 2020 to 18 February 2020. The termination date of follow-up was 19 February 2020. Eight patients were determined to have characteristics of CRS, including pulmonary inflammation, fever, and dysfunction of nonpulmonary organs. An increase in interleukin-6 in peripheral blood was the highest risk factor and an early indicator of CRS in COVID-19. [ABSTRACT FROM AUTHOR]

Parenting is a meaningful endeavor but it also induces stress, which can cause parental burnout. In China, the assessment and study of parental burnout are still in their formative stages. To contribute to advancing this field, the present study aimed to develop and validate a Chinese version of the Parental Burnout Assessment (PBA). Questionnaires were distributed to 614 families (comprising students in the eighth grade and both of their parents; one questionnaire for each person) on two separate occasions (Time 1 and Time 2). The students were asked to self-report their loneliness and life satisfaction at Time 1 and their anti-social behavior at Time 2. Meanwhile, parents were asked to self-report their parental burnout and job burnout at both Time 1 and Time 2, their marriage satisfaction at Time 1, and their levels of agreeableness and neuroticism at Time 2. Using the data obtained, we performed exploratory and confirmatory factor analyses, which indicated that this version of the PBA had a single-factor structure. The α of the PBA was 0.938 at Time 1 and 0.952 at Time 2. At Time 1, parental burnout was positively related to their job burnout in emotional exhaustion and depersonalization, and negatively related to their marriage satisfaction. In addition, parental burnout was positively related to students' life satisfaction, and mothers' parental burnout was positively related to students' loneliness. At Time 2, parental burnout showed positive relations with neuroticism and job burnout in emotional exhaustion and depersonalization, and was negatively related to agreeableness. In addition, mothers' parental burnout was positively related to students' anti-social behavior. Furthermore, parental burnout at Time 1 also showed positive relations with job burnout through emotional exhaustion and depersonalization measured at Time 2, and parental burnout at Time 1 was positively related to students' anti-social behavior at Time 2. Overall, the present study confirmed the reliability and validity of the Chinese version of the PBA. [ABSTRACT FROM AUTHOR]

Background: China-made Peramivir, an anti-influenza neuraminidase inhibitor drug, is manufactured and widely used in China. Although effective if initiated within 48 h of the onset of symptoms, yet we observed that this drug shows an inconclusive efficacy if treatment is delayed in clinical. Thus we evaluated the efficacy of delayed treatment of China-made Peramivir in a mouse model.Methods: The mouse model of influenza infection was made and Peramivir was administered intravenously for 5 days following infection, and weight loss, lung index, viral shedding and survival rates were monitored.Results: Peramivir (60 mg/kg · d, repeated intravenous injections, quaque die (QD) × 5 days) enhanced survival rate and suppressed weight loss when treatment was initiated 24, 36, 48, or even 60 h post-infection (p.i.) (p < 0.01), compared with the virus-untreated group, and efficacy was abolished at 72 h p.i.. However the efficacy of delayed treatment was dose dependent, with the highest dose (90 mg/kg · d) even showing efficacy at 72 h p.i.. Furthermore, Peramivir (60 mg/kg · d, repeated intravenous injections, QD × 5 days) also reduced the lung virus titer 24 and 36 h p.i. on day 5, and even at 48 and 60 h p.i. on day 7 after infection, and the lung index was also improved. What is interesting that the concentration of the drug was maintained in blood after infected.Conclusions: Delayed treatment with China-made Peramivir can reduce the severity of influenza disease, accelerate viral clearance and enhance the survival rate. This drug therefore shows good efficacy and is a promising candidate to control the influenza epidemic in China. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis. [ABSTRACT FROM AUTHOR]

Jinshan Lake is a famous urban landscape lake with approximately 8.8 km2 water area, which is located on the north of Zhenjiang, of Jiangsu Province, China. Eighteen sampled sites were selected and overlying water was sampled from 2013 to 2014 to study the seasonal and spatial variation of nitrogen in overlying water of Jinshan Lake. Results showed that physicochemical characteristics of temperature, pH, and DO showed high seasonal variation, whereas they had no significant spatial differences in the 18 sampling points (P>0.05) in overlying water of Jinshan Lake. Nitrogen concentrations showed strong seasonal variation trends. The ranked order of TN was as follows: spring > summer > autumn > winter; the order of NH4+-N was as follows: spring > autumn > summer > winter, whereas NO3--N concentrations revealed an inverse seasonal pattern, with maxima occurring in winter and minimal values occurring in spring. Nitrogen concentrations had dramatic spatial changes in 18 sampling points of Jinshan Lake. Physicochemical parameter difference, domestic wastes pollution, and rainfall runoff source may have led to seasonal and spatial fluctuation variations of nitrogen in overlying water of Jinshan Lake, China. [ABSTRACT FROM AUTHOR]

Resettlement is considered a major policy measure in two major Chinese policy programs, the 'Great Development of the West' and poverty alleviation in the new century, and the 'New Countryside Development'. The selection of the target location of resettlement sites for poverty-stricken villages is of critical importance to the success of resettlement projects, yet the selection process is challenged by the need for analyzing a variety of contributing factors, and the need for many rounds of tedious data processing. So in this paper we present an in-depth analysis of the major factors and data processing model concerning mountainous povertystricken villages, which also takes a major part of China's poor villages. Our analysis shows the following factors bear the most importance in resettlement selection: 1) topography: candidate areas should have slope less than 25 degrees and altitude less than 2400 meters. 2) accessibility: close to market conventions places and transportation facilities. 3) farming resources: with abundant land and water resources. 4) non-intrusiveness: interests of receiving villages should be considered and negative impact minimized. A simple measure could be having the candidate area 1000 m away from the receiving residents. 5) Minimal ecological and political footprint: candidate areas shall not conflict with nature conservation areas or nationally planned key land use projects. 6) Social and cultural compatibility: residents will better off if relocated in the same county, considering language, religion, ethnic culture and other factors. Taking Makuadi, Lushui County of Nujiang Prefecture as a case study, we demonstrate how GIS analysis and modeling tools can be used in the selection process of resettlement projects in mountainous areas. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx). Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The effects of AKI and CRRT on short-term outcomes and long-term survival were measured. This study included 148 patients, 67 of which developed postoperative AKI. Of these, 31 patients underwent CRRT; the percentage of cases with no AKI was 6.2%, and the percentage of cases with stage 1, 2, and 3 who used CRRT was 0%, 10%, and 86.2%, respectively. Patients with AKI had significantly higher intensive care unit mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without AKI (74.1%). There was no difference in 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs 76.1%, P <.05). We found that higher acute physiologic assessment and chronic health evaluation (APACHE) II scores (odds ratio [OR] 1.082, P =.009) and higher intraoperative fluid balance (OR 1.001, P =.012) were independent risk factors, and female sex (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a concordance index (C-index) of 0.76 (95% confidence interval [CI], 0.66-0.87). Severe AKI requiring CRRT had a negative impact on the short-term and long-term outcomes of patients. • This is the first study to investigate the current state of post–lung transplantation (LTx) acute kidney injury (AKI) in China; this study reports that 67 (45.3%) patients developed post-LTx AKI: 28 (18.9%),10 (6.8%), and 29 (19.6%) patients at stages 1, 2, and 3, respectively. • Patients who underwent continuous renal replacement therapy had an inferior survival outcome. • A higher Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score and higher intraoperative fluid balance were independent risk factors for acute kidney injury after lung transplantation. • Female sex and pulmonary hypertension were potential risk factors for acute kidney injury after lung transplantation. [ABSTRACT FROM AUTHOR]

Objective: To provide clinical management guidelines for novel coronavirus (COVID-19) in pregnancy.Methods: On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed.Results: Ten key recommendations were provided for the management of COVID-19 infections in pregnancy.Conclusion: Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status. [ABSTRACT FROM AUTHOR]

Influenza is a major public health problem worldwide. Mutations and resistance development make the use of antiviral therapy challenging. Chinese patent medicines are often used to treat influenza in China and well tolerable. However, the misuse of Chinese patent medicines is common. We therefore aimed to develop an evidence-based guideline on treating influenza with Chinese patent medicines in adults to guide clinical practice. We formed a steering committee, a consensus panel, a consultants' group and an evidence synthesis team to guide the development of the guideline. We formulated the clinical questions through two rounds of survey, and finally selected five questions. We then systematically searched the related evidence and conducted meta-analyses, evidence summaries and GRADE decision tables to draft the recommendations, which the consensus panel then voted on using the Delphi method. Finally, we formulated six recommendations based on the evidence synthesis and experts' consensus. For treating mild influenza, we suggest either Lianhua Qingwen capsule, Jinhua Qinggan granule, Banlangen granule, Shufeng Jiedu capsule, or Jinfang Baidu pill, depending on the manifestations. For severe influenza, or mild influenza in patients at high risk of developing severe influenza, we suggest Lianhua Qingwen capsule in combination with antiviral medications and supportive therapy. The strength of all recommendations was weak. Traditional Chinese medicine has great potential to help in the fight against influenza worldwide, but more high-quality studies are still needed to strengthen the evidence. [ABSTRACT FROM AUTHOR]

Climate change and human activities have crucial effects on the variations in phytoplankton blooms in lakes worldwide. A record-breaking heatwave and drought event was reported in the middle and lower reaches of the Yangtze River during the summer of 2022, but only little is known about how cyanobacterial blooms in lakes respond to such climate extremes. Here, we utilized MODIS images to generate the area, occurrence, and initial blooming date (IBD) of cyanobacterial blooms in Lake Chaohu from 2000 to 2022. We found that the area and occurrence of cyanobacterial blooms were largely reduced. At the same time, the IBD was delayed in 2022 compared with the previous 20 years. The annual occurrence and mean area of cyanobacterial blooms in 2022 were 17 % and 23.1 km 2 , respectively, which were the lowest reported levels since the 21st century. The IBD in 2022 was four months late compared with the IBD in 2020. The high wind speed in spring delayed the spring blooms in 2022. The record-breaking heatwaves and drought from June to August reduced the blooms by influencing the growth of cyanobacteria and reducing the flow of nutrients from the watershed into the lake. This study highlights the compound impact of heatwave and drought climate events on reducing cyanobacterial blooms in a long-term period, enhancing additional understanding of the changes in phytoplankton blooms in lakes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Exploring the spatial relationship and ecological compensation mechanism of each function of arable land in poor mountainous areas is important to promote rural revitalization and enhance arable land protection. Taking the mountainous region of Western Hubei (MRWH) as an example, this study quantified the "three living" functions of arable land and its secondary functions. Using the root mean square deviation method to calculate the trade-off index, a quantitative method can more scientifically reflect the trade-off relationship between arable land functions and measure the overall ecological compensation. Studies have shown that (1) the value of the production function exhibits a growing and subsequently a falling trend, whereas the value of living function and ecological function exhibits an increasing trend over time, with an average functional value of 5310, 220 and 6496 million yuan, respectively. The spatial pattern of the "three living" functional values decreases from west to east. Among them, water conservation and soil conservation function values show a high distribution in the south and low in the north, gas purification and agricultural pollution functional values show a scattered spatial pattern, and the value of other functions shows an increasing trend from southeast to northwest; (2) among the primary functions, the trade-off between production and ecological functions is the strongest, decreasing, and then increasing over time, with an average trade-off index of 0.89. Among the secondary functions, there is the most obvious trade-off between the food supply function and the five ecological functions, which requires coordination; (3) overall, the total amount of ecological compensation has shown an upward trend, with priority areas for level I ecological compensation increasing year by year. Optimized compensation zones and potential compensation zones are concentrated in the northwest, ecological balance zones are located in the central part, and optimized development compensation zones and key development compensation zones are located in the southeast. According to the research, MRWH is oriented to ecological function, followed by the production function, supplemented by the living function. Green agriculture should be vigorously developed and ecological function space should be compressed by strictly limiting the excessive expansion of production activities. Promoting the improvement of production function through ecological function, while exploring the potential value of living function. Ecological compensation in strict accordance with the priority of ecological compensation, zoning. Realizing cross-regional cooperation, low compensation areas drive high compensation areas to achieve sustainable development of arable land., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Bleeding is a severe complication of patients supported with extracorporeal membrane oxygenation (ECMO). This study aimed to analyze the occurrence, risk factors, and clinical outcomes of patients on ECMO with bleeding complications., Methods: ECMO cases reported to the multicenter ECMO registry database of the Chinese Society of Extracorporeal Life Support (CSECLS) from January 2017 to December 2020 were enrolled. General information, ECMO indications, application, complications, and patient outcomes were collected and analyzed., Results: A total of 6541 ECMO patients from 112 centers were enrolled. Overall, 1185 patients (18.1%) presented with one of the following bleeding complications, including 82 cases (1.3%) with severe bleeding during ECMO catheterization, 462 cases (7.1%) with bleeding at the ECMO cannulation site, 200 cases (3.5%) with bleeding at the surgical site, 180 cases (2.8%) with cerebral hemorrhage, 99 cases (1.5%) with pulmonary hemorrhage, 200 cases (3.5%) with gastrointestinal hemorrhage, 82 cases (1.3%) with ECMO withdrawal, and 118 (1.8%) deaths due to severe bleeding. Extracorporeal cardiopulmonary resuscitation (ECPR) patients had the highest incidence of bleeding complications (22.4%), followed by those on circulatory support (18.7%) and respiratory support (15.4%) (p < 0.001). Multivariate analysis showed that pediatric patients (odds ratio [OR] 1.509, p < 0.001), patients receiving renal replacement therapy (OR 1.932, p < 0.001), and patients receiving central ECMO cannulation (OR 3.023, p < 0.001) were independent risk factors for all bleeding complications, while peripheral cannulation (OR 0.712, p < 0.001) was an independent protective factor. Patients with any bleeding complication had significantly higher in-hospital mortality than patients without (61.9% vs. 46.3%, p < 0.001)., Conclusion: Up to 18.1% of ECMO patients in the CSECLS registry experienced bleeding complications, which was associated with higher in-hospital mortality, especially in patients who received ECPR, patients on circulatory support, and pediatric patients, which should arouse the attention of clinicians., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Constructing an ecological security pattern is vital to guaranteeing regional ecological security. The terrain and geomorphology of the alpine valley are complex and sensitive, meaning it is difficult to construct ecological security patterns. Therefore, the study takes Nujiang Prefecture as the study area and builds an "Importance-Sensitivity-Connectivity" (Importance of ecosystem service, eco-environmental sensitivity, and landscape connectivity) framework to carry on the comprehensive evaluation of the ecological security and identification of ecological sources. Furthermore, we constructed an ecological resistance surface using land-use type. Using the minimum cumulative resistance (MCR) model, the study identifies the ecological corridors and nodes to build ecological security patterns to optimize the ecological spatial structure of Nujiang Prefecture. The results showed that (1) the importance of ecosystem services was higher in the west and lower in the east. The high-sensitive areas of the ecological environment were distributed discontinuously along the banks of the Nujiang and the Lantsang River, and the areas with high landscape connectivity were distributed in patches in the Gaoligong Mountain Nature Reserve and the Biluo Snow Mountain. (2) The overall ecological security was in a good state, and the ecologically insecure areas were primarily distributed in Lanping County and the southeast region of Lushui City. (3) The primary ecological source area was identified to be 3281.35 km 2 and the secondary ecological source area to be 4224.64 km 2 . (4) In total, 26 primary ecological corridors, 39 secondary ecological corridors, and 82 ecological nodes were identified.

Dynamic or hybrid configurations for extracorporeal membrane oxygenation (ECMO) are needed when patient physiology or clinical conditions change. Dynamic configurations included configurations converting from veno-arterial (V-A) ECMO or veno-venous (V-V) ECMO to other forms. Hybrid configurations included venous-arteriovenous (V-AV) and venovenous-arterial (VV-A) ECMO. This study retrospectively analyzed a total of 3,814 ECMO cases (3,102 adult cases) reported to the Chinese Society of Extracorporeal Life Support from January 1, 2017 to December 31, 2019. Eight-three adult patients had dynamic or hybrid ECMO configurations, whose primary diagnoses included cardiogenic shock (33.7%), cardiac arrest (6.0%), acute respiratory failure (39.8%), septic shock (9.6%), multiple trauma (3.6%), pulmonary hypertension (3.6%), and others (3.6%). Configuration changes occurred in 37 patients with the initial configuration of VA (20 to VV, 13 to V-AV, and 4 to VV-A) and 27 with the initial configuration of VV (7 to VA, and 20 to V-AV). A total of 46 (55.4%) patients received hybrid configurations of V-AV and 10 (12.0%) received VV-A. Patients with the initial configuration of VV who converted to other configurations had higher in-hospital mortality (74.1%) than other initial configurations (VA 45.9%, V-AV 76.9%, VV-A 66.7%, P = 0.021). We concluded that dynamic or hybrid ECMO configurations were used in various underlying diseases, in which V-AV was most commonly used. Patients receiving VV ECMO for respiratory support initially, who then converted to other configurations for both respiratory and circulatory support, had significantly worst outcomes among the groups studied. The initial configuration should be selected carefully after thorough assessment of patient condition., Competing Interests: Disclosures: The authors have no conflicts of interest to report., (Copyright © ASAIO 2021.)

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes., Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment., Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups., Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness., Trial Registration: ISRCTN, ISRCTN12233792 . Registered November 20th, 2017., (© 2022. The Author(s).)

Aim: The aim of this study was to identify the risk factors and prognosis of patients with cancer-associated myositis (CAM)., Method: Four hundred and eighty-seven patients with dermatomyositis (DM), clinical amyopathic dermatomyositis (CADM) and polymyositis (PM) from 3 clinical centers were enrolled retrospectively in this study. Clinical and laboratory data of CAM and non-CAM patients were compared. Logistic regression analysis was used to identify risk factors of CAM., Results: Out of the 487 patients with DM/CADM/PM, 7.0% (34/487) of patients were classified as CAM. Older age (53.91 ± 13.32 vs. 48.76 ± 14.34 years), heliotrope rash (61.8% vs. 41.9%), shawl sign (41.2% vs. 22.1%), V sign (58.8% vs. 38.6%) were observed significantly more commonly in patients with CAM than those without CAM (all P < .05). Fever (17.7% vs. 37.8%), arthralgia/arthritis (23.5% vs. 45.7%), interstitial lung disease (ILD, 38.2% vs 68.9%) were significantly less common in the CAM group than the non-CAM group. Age at onset (odds ratio [OR] 1.036, 95% CI 1.001-1.072, P = .042), shawl sign (OR 2.748, 95% CI 1.107-6.822, P = .029), anti-transition initiation factor (TIF)-1γ antibody (OR 4.012, 95% CI 1.268-12.687, P = .018) were identified as the initial risk factors for the onset of CAM, and ILD was identified as a protective factor for CAM (OR 0.292, 95% CI 0.115-0.739, P = .009). All-cause mortality was significantly higher in CAM patients compared with non-CAM patients (P = .001)., Conclusion: The mortality of patients with CAM was higher than DM/CADM/PM patients without cancer. Malignancy should be screened in DM/CADM/PM patients especially with risk factors, including older age, shawl sign, anti-TIF-1γ antibody, and lack of ILD., (© 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: As one of the important treatments for lung cancer, chemotherapy not only brings hope for the survival of patients, but also influences their body and mind. Most patients have different degrees of fatigue during chemotherapy and after chemotherapy, and the occurrence and aggravation of fatigue do not necessarily occur during hospitalization, there is a lag, mostly occurs in the interval after chemotherapy, therefore, continuous nursing care is very important for patients with lung cancer undergoing chemotherapy. The purpose of this study was to explore the effect of continuous nursing, based on Omaha System theory, on cancer-related fatigue in patients with lung cancer receiving chemotherapy., Methods: From April 2018 to May 2019, a total of 102 inpatients with lung cancer at a cancer hospital in Hangzhou, China were selected for chemotherapy. A total of 7patients were lost to follow-up during the intervention, leaving 46 and 49 patients randomly assigned to the experimental and control groups, respectively. Participants in the control group received routine nursing after discharge, while those in the experimental group were nursed according to the Omaha System model., Results: After 4 cycles of chemotherapy, scores for total, physical, cognitive, and emotional fatigue were significantly lower in the intervention group than those in the control group (P<0.05). Repeated analysis of variance (ANOVA) showed that there were significant differences in the time-dependent (<0.001) and intervention-dependent (P<0.001) effects on fatigue score, as well as a significant interaction between time and intervention (P<0.001)., Conclusions: Continuous nursing based on Omaha System theory can ameliorate cancer fatigue in patients with lung cancer undergoing chemotherapy.

In December 2019, human infection with a novel coronavirus, known as SARS-CoV-2, was confirmed in Wuhan, China, and spread rapidly beyond Wuhan and around the world. By 7 May 2020, a total of 84,409 patients were infected in mainland China, with 4,643 deaths, according to a Chinese Center for Disease Control and Prevention report. Recent studies reported that critically ill patients were presented with high mortality. However, the clinical experiences of patients with coronavirus disease 2019 (COVID-19) have not been described in Guangdong Province, where by 7 May 2020, 1,589 people had been confirmed as having COVID-19 but with a very low mortality of 8 death (0.5%). Here, we describe the experience of critical care response to the outbreak of SARS-CoV-2 in Guangdong Province in the following points: Early intervention by the government, Establishment of a Multidisciplinary Working Group, Prompt intensive care interventions, Adequate ICU beds and Human resource in ICU, Infection control practices., (Copyright © 2020 Liu, Xu, Xu, Xu, He, Huang, Zhong, Qin and Li.)

Background: The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear., Methods: We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University., Results: Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death., Conclusions: Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.

Importance: Early identification of patients with novel coronavirus disease 2019 (COVID-19) who may develop critical illness is of great importance and may aid in delivering proper treatment and optimizing use of resources., Objective: To develop and validate a clinical score at hospital admission for predicting which patients with COVID-19 will develop critical illness based on a nationwide cohort in China., Design, Setting, and Participants: Collaborating with the National Health Commission of China, we established a retrospective cohort of patients with COVID-19 from 575 hospitals in 31 provincial administrative regions as of January 31, 2020. Epidemiological, clinical, laboratory, and imaging variables ascertained at hospital admission were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-GRAM). The score provides an estimate of the risk that a hospitalized patient with COVID-19 will develop critical illness. Accuracy of the score was measured by the area under the receiver operating characteristic curve (AUC). Data from 4 additional cohorts in China hospitalized with COVID-19 were used to validate the score. Data were analyzed between February 20, 2020 and March 17, 2020., Main Outcomes and Measures: Among patients with COVID-19 admitted to the hospital, critical illness was defined as the composite measure of admission to the intensive care unit, invasive ventilation, or death., Results: The development cohort included 1590 patients. the mean (SD) age of patients in the cohort was 48.9 (15.7) years; 904 (57.3%) were men. The validation cohort included 710 patients with a mean (SD) age of 48.2 (15.2) years, and 382 (53.8%) were men and 172 (24.2%). From 72 potential predictors, 10 variables were independent predictive factors and were included in the risk score: chest radiographic abnormality (OR, 3.39; 95% CI, 2.14-5.38), age (OR, 1.03; 95% CI, 1.01-1.05), hemoptysis (OR, 4.53; 95% CI, 1.36-15.15), dyspnea (OR, 1.88; 95% CI, 1.18-3.01), unconsciousness (OR, 4.71; 95% CI, 1.39-15.98), number of comorbidities (OR, 1.60; 95% CI, 1.27-2.00), cancer history (OR, 4.07; 95% CI, 1.23-13.43), neutrophil-to-lymphocyte ratio (OR, 1.06; 95% CI, 1.02-1.10), lactate dehydrogenase (OR, 1.002; 95% CI, 1.001-1.004) and direct bilirubin (OR, 1.15; 95% CI, 1.06-1.24). The mean AUC in the development cohort was 0.88 (95% CI, 0.85-0.91) and the AUC in the validation cohort was 0.88 (95% CI, 0.84-0.93). The score has been translated into an online risk calculator that is freely available to the public (http://118.126.104.170/)., Conclusions and Relevance: In this study, a risk score based on characteristics of COVID-19 patients at the time of admission to the hospital was developed that may help predict a patient's risk of developing critical illness.

Background: The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain., Research Question: The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model., Study Design and Methods: A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19., Results: In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age ≥ 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation., Interpretation: The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear., Objective: We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19., Methods: A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed., Results: On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8 + T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome., Conclusions: Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome., (Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery., Methods: This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained., Results: A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001)., Conclusions: The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.

Objective: To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP)., Methods: The data of this systemic review was retrieved from the PubMed, China Biology Medicine disc, Wanfang, Weipu and China National Knowledge Infrastructure (CNKI) databases from establishment till to October 31st, 2017. Case-control studies about the diagnosis of PCP were enrolled. Enrolled studies were required that patients in case group ware PCP and patients in control group were lung diseases other than PCP. The QUADAS tool was used to evaluate the quality of studies. The RevMan 5.3 software was used to draw a forest plot. The StataMP 14 software was used to make subgroup analyses by drawing receiver operator characteristic (SROC) curves for the whole group, the acquired immune deficiency syndrome (AIDS) group, and the not all-AIDS group, and calculating their diagnostic odds ratio (DOR) and 95% confidential interval (95%CI)., Results: Thirteen studies, all in English, were included. There were 825 patients in the case group, in which 650 patients were AIDS. There were 1 341 patients in control group, in which 888 patients were AIDS and most of them were Pulmonary Kaposi Sarcoma, bacterial pneumonia, pulmonary tuberculosis etc. Although there were different positive values of LDH in different studies, from 200 U/L to 598 U/L, sensitivities were good, especially in AIDS patients all values were above 80% (80%-100%). The specificities had big fluctuations, from 6% to 85%, which made them poor. The DOR (95%CI) of LDH in PCP diagnosis of all patients, AIDS patients and not-all AIDS patients were 6.73 (3.19-14.21), 9.17 (3.79-22.18) and 5.07 (1.30-19.80) respectively., Conclusions: The sensitivity of LDH in the diagnosis of PCP is high, especially in AIDS group. In practice if LDH is negative, there should be more evidences to support the treatment of PCP.

Background: China-made Peramivir, an anti-influenza neuraminidase inhibitor drug, is manufactured and widely used in China. Although effective if initiated within 48 h of the onset of symptoms, yet we observed that this drug shows an inconclusive efficacy if treatment is delayed in clinical. Thus we evaluated the efficacy of delayed treatment of China-made Peramivir in a mouse model., Methods: The mouse model of influenza infection was made and Peramivir was administered intravenously for 5 days following infection, and weight loss, lung index, viral shedding and survival rates were monitored., Results: Peramivir (60 mg/kg · d, repeated intravenous injections, quaque die (QD) × 5 days) enhanced survival rate and suppressed weight loss when treatment was initiated 24, 36, 48, or even 60 h post-infection (p.i.) (p < 0.01), compared with the virus-untreated group, and efficacy was abolished at 72 h p.i.. However the efficacy of delayed treatment was dose dependent, with the highest dose (90 mg/kg · d) even showing efficacy at 72 h p.i.. Furthermore, Peramivir (60 mg/kg · d, repeated intravenous injections, QD × 5 days) also reduced the lung virus titer 24 and 36 h p.i. on day 5, and even at 48 and 60 h p.i. on day 7 after infection, and the lung index was also improved. What is interesting that the concentration of the drug was maintained in blood after infected., Conclusions: Delayed treatment with China-made Peramivir can reduce the severity of influenza disease, accelerate viral clearance and enhance the survival rate. This drug therefore shows good efficacy and is a promising candidate to control the influenza epidemic in China.

The optimal treatment strategy for an incomplete nasolacrimal duct obstruction (INDO) is still being debated. The aim of this study is to evaluate the treatment results of combined lacrimal passage probing and tobramycin/dexamethasone ophthalmic ointment infiltration (PIO, Probing and Injection) for INDO.In this retrospective, noncomparative case series, 397 consecutive adult patients with INDO treated at Shanghai Eye, Ear, Nose and Throat Hospital were enrolled. Records of the patients were reviewed. With the help of a modified 23-gauge lacrimal cannula, the PIO surgery was performed for the INDO-identified patients. The main outcome measures were resolution of tearing and complications. The relationship between successful outcome and clinical characteristics was analyzed.The surgery was performed successfully in all of the enrolled cases. No intraoperative complications were found in the procedure. The average follow-up time was 7.9 months. Three hundred patients (75.6%) experienced complete resolution of their symptoms after the surgery. Ninety-seven patients (24.4%) showed a partial improvement (1.8%), no improvement (18.4%), or a worsening of symptoms (4.3%). Of the 97 surgical-failure patients, 90 required silicone intubation or external dacryocystorhinostomy, and 94% were finally resolved. The most common postoperative complications were mild nasal bleeding in 41 patients, drug residues in 12 patients (6 developed the complete obstruction), and a slit punctum in 8 patients. Multivariate logistic regression analysis revealed that unilateral eye onset, not having a discharge at baseline, and not having postoperative drug residues were significant factors determining successful outcome.The PIO surgery is an effective, safe, timesaving, easy-to-perform, and minimally invasive technique for treating INDO.

Background: Imipenem-resistant Acinetobacter baumannii (IRAB) is an important cause of hospital-acquired infection. We aimed to describe an outbreak of IRAB infection and to investigate its possible source in an intensive care unit., Methods: An environmental investigation was undertaken. Antimicrobial susceptibility testing was performed by microdilution. These isolates were genotyped by use of repetitive extragenic palindromic polymerase chain reaction (rep-PCR; DiversiLab). The study included 11 patients infected with IRAB and 14 control patients free of IRAB. Case and control patients were compared for possible predisposing factors. A multifaceted intervention was implemented to control the outbreak., Results: Thirty-nine IRABs were isolated from patients and the environmental surveillance culture in August, November, and December 2011. All isolates were resistant to imipenem. The IRAB strains belonged to seven clones (A-G) by the use of rep-PCR. There were four epidemic clones (D-G) in the outbreak, and Clone D was predominant. For the case-control study, patients with chronic obstructive pulmonary disease were susceptible to infection with IRAB. The hospital mortality of the case group was significantly higher than that of the control group., Conclusions: The outbreak strains were transmitted among infected patients and equipment by inappropriate use of gloves. A combination of aggressive infection control measures is essential for preventing recurrent nosocomial outbreaks of IRAB.

Co-infection with hepatitis delta virus (HDV) and hepatitis B virus (HBV) has been shown to be associated with a more severe form of acute and chronic hepatitis. Cloning and expression of recombinant HDV antigen (rHDAg) in Escherichiacoli are described. Using purified rHDAg, a cost-effective indirect anti-HDV enzyme-linked immunosorbent assay (ELISA) kit was developed. Direct comparison of 15 known HDV-positive sera and 15 HDV-negative sera showed concordance agreement between the new assay kit and the Abbott Murex Anti-Delta (total) kit. In addition, 1,486 hepatitis B surface antigen (HBsAg) positive blood samples collected from various areas of China were tested using this indirect anti-HDV ELISA. It was found that 1.2% (95% CI: 0.7-1.9%) of the samples were anti-HDAg positive. It is suggested that the prevalence of HDV and HBV co-infection in China is relatively low., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: To investigate the association between different levels of birth weight and the risk of overweight and obesity in children aged 3-6 years., Methods: A retrospective longitudinal study of 15,852 children aged 3-6 years in Tianjin, China. Body weight and height, and other factors (age, gestational age, past and current health status, father's and mother's education, occupation and health status, family income, and sex) were obtained using standardized methods., Results: After adjustment for the above other factors, Chinese children who were born with a birth weight below 2500 g are less likely to become overweight or obese (body mass index more than the 85th percentiles for age and gender specific distribution using the World Health Organization growth reference) during childhood (odd ratio [OR] 0.84, 95% confidence interval [CI] 0.47-1.52) when compared to the reference group (2500-2999 g). However, the odds ratios of becoming overweight or obese during childhood increase significantly when birth weights are 3000-3499 g (OR 1.58, 95% CI 1.33-1.88), 3500-3999 g (OR 2.09, 95% CI 1.76-2.49), and more than 4000 g (OR 3.14, 95% CI 2.60-3.79)., Conclusions: High levels of birth weight, defined as birth weight >3000 g, were a stronger predictor for overweight and obesity among the Chinese children aged 3-6 years.