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As a new simple anthropometric index, the weight-adjusted-waist index (WWI) appears to be superior to body mass index (BMI) and waist circumference (WC) in assessing both muscle and fat mass. We aimed to explore the association of WWI with all-cause and cardiovascular mortality in southern China.A total of 12,447 participants (mean age, 59.0 ± 13.3 years; 40.6% men) in Jiangxi Province from the China Hypertension Survey study were included. WWI was defined as WC divided by the square root of weight. The outcome was all-cause and cardiovascular mortality. During a median follow-up of 5.6 years, 838 all-cause deaths occurred, with 390 cardiovascular deaths. Overall, there was a nonlinear positive relationship of WWI with all-cause and cardiovascular mortality. Accordingly, compared with participants in quartiles 1-3 (11.2 cm/√kg), a significant higher risk of all-cause mortality (HR: 1.36, 95% CI: 1.17, 1.58) and cardiovascular mortality (HR: 1.43, 95% CI: 1.15, 1.77) were found in quartile 4 (≥11.2 cm/√kg). Further adjustment for BMI and WC did not substantially alter the results. No significant interactions were found in any of the subgroups (sex, age, area, physical activity, current smoking, current alcohol drinking, hypertension, and stroke).Higher WWI levels (≥11.2 cm/√kg) were associated with increased the risk of all-cause and cardiovascular mortality in southern China. These findings, if confirmed by further studies, suggested that WWI may serve as a simple and effective anthropometric index in clinical practice.

Phosphate-solubilizing bacteria (PSB) promotes the formation of mineralized precipitation through phosphorous dissolution and mineralization, forming stable lead (Pb(II)) minerals and reducing the migration of Pb(II) in the environment. In this study, a Pb-tolerant strain Ochrobactrum sp. J023 from a contaminated soil around a battery factory in Jiangsu Province, China, was screened for experiments to investigate the phosphate solubilization and mineralization mechanism of this strain. The organic acids and the acid phosphatase produced by the bacteria have a synergistic effect on phosphate dissolution. When the pH of the culture medium decreased to the lowest 4.55, the amount of soluble phosphate and the activity of acid phosphatase reached the maximum 161.29 mg L

BACKGROUND: For patients with heart failure (HF), the effect of angiotensin receptor-neprilysin inhibitors (ARNIs, sacubitril/valsartan) on cardiac remodeling has been found to be superior to angiotensin-converting enzyme inhibitors (ACEI). However, little data have described the impact of early-initiation ARNI in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). METHODS: In this prospective, randomized, double-blind, parallel-group trial, we enrolled 131 anterior STEMI patients who were treated with primary percutaneous coronary intervention (PCI) between February 2019 and December 2019. All patients received standard STEMI management and were divided into 2 groups (ARNI/enalapril). Primary efficacy outcomes were the between-group difference in change (from baseline to 4-, 12-, and 24-week) in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration, left ventricular ejection fraction (LVEF), and left ventricular end-systolic volumes and end-diastolic volumes (LVESV and LVEDV). Secondary outcomes were determined by a composite of death, reinfarction, outpatient HF or HF hospitalization, malignant arrhythmia, and stroke. Safety outcomes included worsening renal function, hypotension, hyperkalemia, angioedema and cough. RESULTS: We found that NT-proBNP concentration decreased more in the ARNI group than in the enalapril group [4 weeks: ratio of ARNI vs. enalapril 0.36, 95% confidence interval (CI): 0.24 to 0.52, P

Background Data on the relationship of baseline serum uric acid (SUA) with development of low-density lipoprotein cholesterol (LDL-C) level in patients with first acute myocardial infarction (AMI) are limited. The present study is to evaluate whether elevated SUA predicts the development of LDL-C in the first AMI. Methods This is a retrospective 6-month cohort study of 475 hospitalized Chinese patients who underwent first AMI between January 2015 and December 2019 and were reevaluated half a year later at the Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi Province, China. The associations of baseline SUA with the percentage decrease of LDL-C (%) and LDL-C control were analyzed by using logistic regression analyses, multivariate linear regression analyses and the restricted cubic spline. Results Over the 6-month follow-up, baseline SUA was independently and positively associated with the percentage decrease of LDL-C (%) and LDL-C control in a dose response fashion. After multivariable adjustment, per SD increment of baseline SUA (120.58 μmol/L) was associated with 3.96% higher percentage decrease of LDL-C(%). The adjusted OR (95% CI) for LDL-C control was 5.62 (2.05, 15.36) when comparing the highest tertile (SUA ≥ 437.0 μmol/L) to the lowest tertile ( Conclusions Among Chinese patients with first AMI, higher baseline SUA was associated with higher LDL-C deduction percentage (%), and higher rate of LDL-C control in the short-term follow-up, respectively. SUA acquired when AMI occurred was prone to be profitable in predicting the risk stratification of uncontrolled LDL-C and dyslipidemia management.

Objective Data on the association between homocysteine (Hcy) and the risk of chronic kidney disease (CKD) in patients with H-type hypertension were limited. This study aimed to examine the relation of Hcy with the prevalence of CKD and estimated glomerular filtration rate (eGFR) among Chinese adults with H-type hypertension. Methods A total of 12,873 Chinese adults with H-type hypertension aged 27-75 years were enrolled in the final analysis. Hcy concentrations were divided into 11 groups at 2 μmol/L interval. The outcome was CKD, defined as eGFR Results The prevalence of CKD was 7.58%, and the mean Hcy was 17.58 ± 10.96 μmol/L. The smoothing curve indicated that with the increase of Hcy, the prevalence of CKD increases first and then flattens, eGFR decreases first and then flattens, which supports the L-shaped association of Hcy with the prevalence of CKD and eGFR. Moreover, we further found the inflection point of Hcy was 22 μmol/L. OR (95% CI) of risk of CKD was 1.31 (1.28, 1.35) on the left side of an inflection point and 1.00 (0.99, 1.01) on the right of an inflection point, β (95% CI) of eGFR was −1.58 (−1.65, −1.50) on the left side of an inflection point and 0.00 (−0.03, 0.03) on the right of an inflection point, respectively. Similar results were found in various subgroups. Conclusions Our study suggested saturation effects of Hcy on the prevalence of CKD and eGFR among Chinese patients with H-type hypertension.

While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.

To long-term immobilization of secondary iodine-waste, iodine loaded silver-coated silica-gel (AgIs), glass-powder was used to directly solidify AgIs at low temperature. B2O3-Bi2O3-ZnO-SiO2 was used as raw materials to manufacture the glass-matrix under different temperature. The samples with the richest glass phase were obtained at 1000 °C, and were used to solidify AgIs with different content of I−. The sample with 30 wt% I− possessed the highest amorphous index (0.62) at 600 °C. Element I was uniformly distributed, and the density reached to 3.06 g/cm3. This work highlights a simple way to solidify secondary iodine-waste at low temperature.

In this study, the natural luffa fiber was easily modified by chemical method with amide groups and phosphoric acid (LF-A2-M1/P). SEM, XRD, FTIR and XPS were used to characterize the morphology, structure, and property of the fiber. The maximum adsorption capacity of LF-A2-M1/P towards U(VI) is 353.85 mg·g−1 (pH = 6). The thermodynamic parameters demonstrate that the adsorption of functional fibers to U(VI) is a spontaneous process. It is worth noting that LF-A2-M1/P has excellent removal amount for U(VI) in the real uranium wastewater. Our study provides some new insights into the purification of uranium-containing wastewater by the modified natural fiber.

This study is dedicated to investigating the performance of B2O3–Bi2O3–ZnO low-temperature glass-ceramics to immobilize iodine-loaded silver-coated silica-gel (AgIs). Various mass fractions of iodine (15, 20, 25, and 30 wt%) in AgIs were studied. The degree of amorphization and density increased with increasing sintering temperature for all immobilization samples, where, the sample with 20 wt% iodine in AgIs presented optimal immobilization results at 600 °C. The diffraction peak area of AgI was the lowest and the degree of amorphization was the highest (0.562) for the sample with 20 wt% iodine in silver-coated silica gel when it was sintered at 600 °C. SEM-EDS results showed that two approaches contributed to the immobilization of AgIs: the first one is that AgIs participates in the formation of the glass-ceramics phase, which makes iodine uniformly immobilized in the glass mesh; the second one is that the glass-ceramics phase physically encapsulates a small range of aggregated AgI. The results of TGA-DSC analysis showed that the samples had a high water content, which facilitated the lowering of the glass transition temperature of the samples and thus the curing of iodine. Most importantly, when the sintering temperature is below 600 °C, the evaporation of iodine is minimal to negligible. The leaching results showed that the samples were highly resistant to leaching of elemental iodine. This experiment verified the feasibility and efficiency of B2O3–Bi2O3–ZnO ternary glass-ceramics to immobilize iodine-loaded silver-coated silica-gel at low temperatures.

This study investigated the immobilization behavior of U(VI) by the mixture of Shewanella putrefaciens (S. putrefaciens) and montmorillonite with batch experiment. The relevant mechanisms were discussed based on the experimental results and characterizations. It was found that the immobilization of U(VI) by S. putrefaciens-montmorillonite was inhibited at pH 7.0 and enhanced at pH 7.0. The inhibition effect was due to the aggregation and coverage between S. putrefaciens and montmorillonite, whereas the association of microbial dissolvable organic matters (DOM) on montmorillonite could promote immobilization of U(VI). The evidences of X-photoelectron spectroscopy (XPS) and density functional theory (DFT) simulation confirmed that the carboxyl-, hydroxyl-, nitrogen-based DOM do have the ability to interacted with U(VI). This work highlights a comprehensive and overlook perspective to understand the immobilization behavior of U(VI) in environmental organo-minerals.

We aimed to evaluate the relation of the ankle–brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27‐96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82‐0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (

BackgroundThe low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.MethodsA total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan–Meier survival curve analysis.ResultsDuring a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67–2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (P = 0.038).ConclusionsThe results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.

This study synthesized nFe0 on the substrate of porous organic polymer (POM) which was prepared by glutaraldehyde and melamine. The POM-nFe0 composites were characterized by scanning electron microscopy, Brunner–Emmet–Teller, Fourier transform infrared spectrum, thermogravimetric analysis, powder X-ray diffraction, and X-ray photoelectron spectroscopy. The introduction of POM contributed to enhance the stability of U(IV) nanoparticles which is liable to be oxidized to mobile U(VI) under aerobic condition. According to the batch experiment, the maximum U(VI) removal capacity of POM-nFe0 was 230 mg/g, which shows great potential in wastewater treatment.

Pb(II) is extreme toxic to biological cells, which limits the restoration of Pb(II) by functional strains. This study examined a Pb(II)-tolerant phosphate solubilizing bacteria(PSB) Ochrobactrum sp. J023 combined with corn stover biochar to enhance the immobilization of Pb(II). The results showed that the removal rate of Pb(II) by biochar combined with phosphate-solubilizing bacteria was as high as 71.30 %. SEM-EDS showed that more disordered crystals appeared on the surface of biochar treated with bacteria. XRD analysis indicated that the mineralization products of Pb(II) in biochar combined strain system were mainly in Pb

It is momentous to comprehensively understand the anion's effect during the formation of Mg-Al layered double hydroxide (LDH), especially relating to the long-term disposal of uranium-containing (UO

Amine containing polymers (ACPs) were synthesized by heating glyoxal and melamine under argon conditions. The batch characterization, including SEM, FTIR, XRD and XPS techniques, indicated that ACPs had various nitrogen-containing functional groups. The batch experiments indicated that ACPs presented the high removal performances (Qmax = 250 mg/g, calculated by Langmuir model), well stability, strong salt tolerance and great regeneration cycle toward U(VI). XPS analysis confirmed the coordination of U(VI) with nitrogen- or oxygen-containing groups via covalent bonding. The theoretical calculations revealed that the binding energies of U-N, U-O and U-C were −27.49, −16.94 and −11.81 kcal/mol, respectively, indicating that U(VI) was tended to combine with nitrogen-containing groups. These observations suggested that ACPs can be regarded as a promising adsorbent for immobilization and pre-concentration of U(VI)-containing wastewater in environmental cleanup.

It is of great significance to develop an adsorbent with high adsorption capacity and outstanding cyclic regeneration performance toward the extraction of U(VI). Herein, novel polyamine and amidoxime groups modified bifunctional polyacrylonitrile-based ion exchange fiber (PAN-P-A) has been successfully synthesized by hydrothermal method for highly efficient extraction of U(VI) from aqueous solution. The structure, morphology and property of fibers are characterized by Fourier transform infrared spectrum, scanning electron microscopy and thermogravimetric analysis techniques. Compared with raw polyacrylonitrile fiber, the thermal stability of PAN-P-A is enhanced. In addition, the results of batch experiments reveal that PAN-P-A possesses favorable adsorption capacity (200.1 mg g−1 qmax at pH = 5) to U(VI) in uranium-containing wastewater, attributed to the chelation between polyamine/amidoxime groups and uranium ions. More importantly, PAN-P-A exhibits higher removal efficiency (99.8%) and distribution coefficient (1779 mL g−1) to U(VI) than those of other coexisting ions in real uranium mine water. The adsorption capacity and desorption efficiency of PAN-P-A have a slight decrease after eight times cyclic regeneration experiment, indicating an excellent regeneration performance of PAN-P-A. Furthermore, the thermodynamic parameters demonstrate that the adsorption of PAN-P-A to U(VI) is a spontaneous and exothermic process. The adsorption process conforms to Langmuir isothermal model and pseudo-second-order kinetics model. The results indicate that PAN-P-A is a promising adsorbent to effectively extract U(VI) from real uranium mine water.

Hydrothermal carbon has received increasing attention because of its simple and mild synthesis conditions. In this paper, amidoxime-functionalized hollow carbon spheres (C-HCN-AO) were synthesized via amidation cyano-rich hydrothermal carbon (C-HCN) treatment with hydroxylamine hydrochloride. NaOH solution was used to etch SiO2 to achieve hollow structure. The maximum sorption capacity of hollow C-HCN-AO sphere toward U(VI) was 355.6 mg/g at pH 5.0 and 298 K. The sorption of U(VI) by hollow C-HCN-AO sphere was predominantly controlled by inner-sphere complexation from the study of the sorption mechanism. The regeneration study displayed good reusability of hollow C-HCN-AO sphere. This work can give a guide for the design and fabrication of hollow structures in the application of pollution treatments.

In order to investigate the immobilization ways of uranium (U(VI)) on Kocuria sp., we investigated the interaction behavior under different conditions by batch experiment. U(VI) products on Kocuria sp. were characterized by SEM, XRD, FTIR, and XPS techniques. SEM-EDS results presented U(VI) mineral-like precipitation formed on the cell surface which contained high percentage of P and U elements. XPS results also confirmed the appearance of bond P-O-U. XRD results illustrated characteristic UO22+ peaks after U(VI) interaction with Kocuria sp. According to FTIR analysis, in addition to PO43− groups, C O, OH, COOH groups might play important roles in complexation with U(VI). The biomineralization process of U(VI) on Kocuria sp. required longer time than sorption process, indicating that biomineralization was induced by the biosorption process. Our findings highlight the synergistic biosorption and biomineralization process of Kocuria sp. for U(VI) immobilization, which concentrated U(VI) on the cell surface via fast biosorption by providing nucleation sites for the precipitation to insoluble minerals, while the formation of U(VI) biomineral led to the relatively permanent immobilization of U(VI), and then emphasize the important roles of phosphate which are of significance in predicting the U(VI) immobilization properties.

Silica nanoparticle antireflection films are essential for the development of high-power laser systems because of their high laser damage threshold in ultraviolet (e.g., 351 nm or 355 nm). However, most laser damage reports focus on the films standing on substrates, and the intrinsic laser damage behaviors of the silica nanoparticle films are poorly understood due to the influence of the substrates. Here, we investigate the ultraviolet laser damage behaviors of the freestanding silica nanoparticle films. We find that silica nanoparitcle films demonstrate higher laser damage threshold than the fused silica substrates under the irradiation of 355-nm laser. For the films on the fused silica substrates, the laser damage is caused by the substrates. In the case of freestanding films, laser-damage resistance is strongly dependent on the film thickness and the amount of organic groups in the films. The laser damage threshold increases from 103 to 159 J/cm2 @ 355 nm with decreasing the film thickness from 322 to 31 nm. In addition, removal of organic groups from the films results in higher laser damage threshold. Our findings provide insight into the laser damage behavior of the silica nanoparticle films and foreshow a possible way to improve the laser-damage resistance.

Previous studies reported that the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) was a risk factor in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular death. However, only a few studies investigated the correlations between the AST/ALT ratio and PAD. We analyzed data from 10 900 patients with hypertension from the Chinese Hypertension Registry Study; 350 patients had PAD (prevalence 3.2%). After adjusting for potential confounders, the AST/ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI, 1.13-1.59), and a significant increased risk of PAD for the third AST/ALT ratio tertile (T3) compared with the first tertile (T1; OR: 1.49, 95% CI, 1.09-2.04, Ptrend = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.

Previous studies had shown that an increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) was associated with cardiovascular disease. This study aimed to assess the relationship between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension. By March 31, 2020, a cohort of 14,220 Chinese hypertensive patients was followed up. The end point was all-cause and cardiovascular death. Hazard ratios (HRs) and 95% CIs were calculated for mortality associated with AST/ALT ratio, using Cox proportional hazards models and competing risk model. In an average of 1.7 years of follow-up, 1.39% (n = 198) of patients died, 55.5% (n = 110) of whom from cardiovascular disease. AST/ALT ratio was associated with increased risk of all-cause death (HR:1.37, 95% CI:1.15–1.63) and cardiovascular death (HR:1.32, 95% CI:1.03–1.68) after adjustment for other potential confounders. Compared with low AST/ALT ratio (Tertile 1), high AST/ALT ratio was associated with high cause mortality (Tertile 2: HR:1.35, 95% CI:0.86–2.10; Tertile 3: HR:2.10, 95% CI:1.37–3.21; P for trend

Nano zero-valent iron (Fe0) has been widely used to remove Uranium (U(VI)). In order to enhance the performance of Fe0 toward U(VI) removal, the Fe0 was assembled into graphene oxide (GO) sheets via 3-aminopropyl triethoxysilane (APTES) as Fe0/APTES-GO composites. The Fe0/APTES-GO composites were triumphantly prepared, characterized and analyzed by means of Scanning Electron Microscope (SEM), Transmission Electron Microscope (TEM) together with Energy Dispersive Spectrometer (EDS), X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FT-IR) and X-ray Photoelectron Spectroscopy (XPS). SEM and TEM-EDS results manifested that Fe0 particles were encapsulated into rolled-up GO, which greatly improved the stability of Fe0. Batch experiment showed that only a small amount of Fe2+ was leached in the first two leaching cycles of Fe0/APTES-GO composites. The removal capacity of Fe0/APTES-GO composites was up to 1357.99 mg/g at pH = 4.1 and T = 50 °C, which was mainly attributed to the reducing activity of Fe0 and an abundance of functional groups (i.e., –COOH, C–OH and –OH) on the Fe0/APTES-GO composites. The electrostatic potential (ESP) from the calculation also supported that U(VI) tended to be reduced at the back side of the GO-Fe0 cluster.

Background: Previous studies had shown that aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) plays a role in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular disease. However, there are a little research on the association between the AST/ALT ratio and Peripheral artery disease (PAD). Methods: A total of 10, 900 hypertensive patients from the Chinese Hypertension Registry Study were included in the final analysis. The association between AST / ALT and peripheral arterial disease (PAD), which was defined as ABI ≤ 0.9 in either leg, was estimated by a multivariate logistic regression model.Results: Overall, the prevalence of PAD was 3.21%. After adjusting for potential confounders, AST / ALT ratio was independently and positively associated with the risk of PAD (OR: 1.31, 95% CI: 1.13 to 1.59), and a statistically significant increased risk of PAD for the third tertile (T3) of AST / ALT ratio compared to the first tertile (T1) (OR:1.49, 95% CI: 1.09 to 2.04, P-trend= 0.005) was found. Moreover, when the T1-T2 group was combined into one group and used it as a reference group, the risk of PAD increased with the increase of AST/ALT and the risk ratio was 1.52 (95% CI :1.20 to 1.95). Conclusion: A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. The presented results suggested that AST / ALT may help us highlight patients who are at high risk of vascular endpoints.Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018.