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Background Postoperative pulmonary complications are common. Aging and respiratory disease provoke airway hyperresponsiveness, high-risk surgery induces diaphragmatic dysfunction, and general anesthesia contributes to atelectasis and peripheral airway injury. This study therefore tested the hypothesis that inhalation of penehyclidine, a long-acting muscarinic antagonist, reduces the incidence of pulmonary complications in high-risk patients over the initial 30 postoperative days. Methods This single-center double-blind trial enrolled 864 patients age over 50 yr who were scheduled for major upper-abdominal or noncardiac thoracic surgery lasting 2 h or more and who had an Assess Respiratory Risk in Surgical Patients in Catalonia score of 45 or higher. The patients were randomly assigned to placebo or prophylactic penehyclidine inhalation from the night before surgery through postoperative day 2 at 12-h intervals. The primary outcome was the incidence of a composite of pulmonary complications within 30 postoperative days, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis. Results A total of 826 patients (mean age, 64 yr; 63% male) were included in the intention-to-treat analysis. A composite of pulmonary complications was less common in patients assigned to penehyclidine (18.9% [79 of 417]) than those receiving the placebo (26.4% [108 of 409]; relative risk, 0.72; 95% CI, 0.56 to 0.93; P = 0.010; number needed to treat, 13). Bronchospasm was less common in penehyclidine than placebo patients: 1.4% (6 of 417) versus 4.4% (18 of 409; relative risk, 0.327; 95% CI, 0.131 to 0.82; P = 0.011). None of the other individual pulmonary complications differed significantly. Peak airway pressures greater than 40 cm H2O were also less common in patients given penehyclidine: 1.9% (8 of 432) versus 4.9% (21 of 432; relative risk, 0.381; 95% CI, 0.171 to 0.85; P = 0.014). The incidence of other adverse events, including dry mouth and delirium, that were potentially related to penehyclidine inhalation did not differ between the groups. Conclusions In high-risk patients having major upper-abdominal or noncardiac thoracic surgery, prophylactic penehyclidine inhalation reduced the incidence of pulmonary complications without provoking complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

After two successive Baige landslides in the Jinsha River tectonic suture zone, a landslide scar with three steep free surfaces has been exposed in the source area, where three concomitant sliding blocks (K1, K2, and K3) have been identified as continuously moving at high rates, suggesting further potential failures within these areas. This study focused on structural geology and conducted a comprehensive multidisciplinary analysis to understand the active features and geological evolution models for these sliding blocks. Results showed that the three rockslides can be further subdivided into eleven subdomains. The revealed rock masses are likely to be affected by faults, fracture zones, and folds, and are featured by widely distributed and variable interbedded lithology with heterogeneous qualities combined with fragmentation, brecciation, and mylonitization. The movements are gradually increasing, especially encountering rainfall, and are ascribed to the dramatic unloading resulting from sudden large-scale detachments during the successive landslides and subsequent progressive time-dependent strength degradation of the rock masses. The active features and geological evolution models vary for the different subdomains and are intensely associated with daylighting geo-structures. Serpentinite predominates K1-4 and K1-5, showing brittle fracturing after a certain degree of accumulative deterioration is surpassed, highly weathered carbonaceous slate predominates K2-1 accompanied by “back-pushing” of en masse slide, and better rock mass integrity causes K1-3 to exhibit “fore-pulling” of retrogressive superficial collapse.

BACKGROUND: To evaluate the efficacy and safety of aildenafil citrate in the treatment of erectile dysfunction (ED) in Chinese population. METHODS: A multicenter, randomized, double-blind, placebo-controlled, double-cycle crossover trial was conducted in three medical centers. Male patients with mild to moderate ED were randomized into two groups and received either aildenafil citrate or placebos, followed by a crossover administration after a 7-day washout. The primary outcome was the duration of penile rigidity over 60% measured by RigiScan(®) Plus. Main secondary outcomes were the duration of penile rigidity over 80% and erectile hardness score (EHS). RESULTS: A total of 60 patients with mild to moderate ED were enrolled in the study and 57 of them completed the trial (30 in the aildenafil group and 27 in the placebo group). The median duration of penile tip rigidity over 60% was 4.25 (0.00, 19.00) min in the aildenafil group, as compared with 0.50 (0.00, 2.75) min in the placebo group (P

Background Experimental and observational research suggests that combined epidural–general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural–general anesthesia improves long-term survival in elderly patients. Methods This article presents a long-term follow-up of patients enrolled in a previous trial conducted at five hospitals. Patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries were randomly assigned to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival. Results Among 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). Among patients assigned to combined epidural–general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P = 0.408. Cancer-specific survival was similar with combined epidural–general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290. Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural–general anesthesia versus 389 of 859 [45%] with general anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P = 0.692. Event-free survival was 466 of 853 [55%] in patients who had combined epidural–general anesthesia versus 450 of 859 [52%] for general anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P = 0.815. Conclusions In elderly patients having major thoracic and abdominal surgery, combined epidural–general anesthesia with epidural analgesia did not improve overall or cancer-specific long-term mortality. Nor did epidural analgesia improve recurrence-free survival. Either approach can therefore reasonably be selected based on patient and clinician preference. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

In previous studies, low-dose dexmedetomidine supplemented opioid analgesia improved sleep architecture but increased sedation level. Herein we tested the hypothesis that mini-dose dexmedetomidine supplemented analgesia improves sleep structure without increasing sedation.In this randomized trial, 118 older patients (≥65 years) following major noncardiac surgery were randomized to receive patient-controlled intravenous analgesia supplemented with either placebo or dexmedetomidine (median 0.02 μg kgAll 118 patients completed the study; of these, 85 were included in sleep structure analysis. Dexmedetomidine supplemented analgesia increased the percentage of N2 sleep (median difference, 10%; 95% CI, 1%-20%; P = 0.03). It also prolonged total sleep time (median difference, 78 min; 95% CI, 21 to 143; P = 0.01), increased sleep efficiency (median difference, 14%; 95% CI, 4%-26%; P = 0.01), decreased percentage of N1 sleep (median difference, -10%; 95% CI, -20% to -1%; P = 0.04), and lowered sleep fragmentation index (median difference, -1.6 times⋅hSupplementing intravenous analgesia with mini-dose dexmedetomidine improved sleep structure without increasing sedation in older patients recovering from major surgery.www.gov (NCT03117790), registered 2 April 2017.

At 8:30 a.m., on August 11, 2018, a high-position rockslide avalanche was reported in Da’anshan village, Fangshan district, Beijing, China. The landslide destroyed the road below and did not cause any casualties due to the timely detection of warning signs. The displaced landslide material traveled a horizontal distance of about 260 m with a vertical drop of about 176 m and stopped at 613.6 m asl. According to videos and survey data, the Da’anshan rockslide initiated at a high position and transformed into a pipeline-type debris avalanche along the gully to the east. It scraped the surface layer of the strongly weathered rock formation and also transformed into a diffuse-type debris flow along the slope surface. Finally, it accumulated at the bottom of the river valley and presented a typical disaster mode of rapid runout. Based on this, the Archard erosion model was embedded in the Engineering Discrete Element Method (EDEM) to perform back analysis and simulate the three-stage kinematic processes of sliding, shear-shoveling, and flow accumulation to quantify the scraping volume and position. After initiation at a high-level position, the rockslide moved downward along the valley for approximately 10 s with a maximum velocity of 26.1 m/s. The final volume of the accumulation obtained from the simulation was ~24,000 m3, which is close to the total volume obtained from the field investigations. This study provides a methodological reference for future simulation analysis of high-position rockslide avalanches.

This paper provides newly found and profound insight into the initiation mechanism of the first Baige landslide occurred on the upper reaches of the Jinsha River in October 10, 2018. The detailed geological characteristics are interpreted by comprehensive field surveys in the past year, which indicate that the Baige landslide developed in the Jinsha River tectonic suture zone, and the active tectogenesis significantly contributes to broken stratigraphic structures and complex spatial distribution of lithologies. The initiation is considered to be long-term creep under the exogenic and endogenic integration, while the active tectogenesis and the influence of serpentinite and foliation, respectively, are the primary exogenic and endogenic factors. In addition, this creep process can be analyzed within three stages: evolution and formation of failure-prone geological structures, progressive deformation and fracturing, and shear failure of the locking section. The distribution and easily degraded behavior of the serpentinite are the fundamental, enabling the formation of failure-prone structures and also responsible for the subsequent deformation evolution. The foliation controls the toppling deformation-failure mode and direction. Furthermore, this catastrophic landslide further reminds us to pay attention to the landslides along the upper reaches of the Jinsha River, and our preliminary results indicate that the distribution characteristics of landslides significantly depend on the Jinsha River tectonic suture zone and the serpentinite melange belt and thus are always associated with tectonically induced damage.

BackgroundDramatic hemodynamic fluctuation occurs frequently during surgery for pheochromocytoma or paraganglioma. However, the criteria of intraoperative hemodynamic instability vary widely, and most of them were defined arbitrarily but not according to patients’ prognosis. The objective was to analyze the relationship between different thresholds and durations of intraoperative hyper−/hypotension and the risk of postoperative complications in patients undergoing surgery for pheochromocytoma or paraganglioma.MethodsThis was a retrospective single-center cohort study performed in a tertiary care hospital from January 1, 2005 to December 31, 2017. Three hundred twenty-seven patients who underwent surgery for pheochromocytoma or paraganglioma, of which the diagnoses were confirmed by postoperative pathologic examination, were enrolled. Those who were less than 18 years, underwent surgery involving non-tumor organs, or had incomplete data were excluded. The primary endpoint was a composite of the occurrence of AKI or other complications during hospital stay after surgery. Multivariate Logistic regression models were used to analyze the association between different thresholds and durations of intraoperative hyper−/hypotension and the development of postoperative complications.ResultsForty three (13.1%) patients developed complications during hospital stay after surgery. After adjusting for confounding factors, intraoperative hypotension, defined as systolic blood pressure (SBP) of ≤95 mmHg for ≥20 min (OR 3.211; 99% CI 1.081–9.536;P = 0.006), SBP of ≤90 mmHg for ≥20 min (OR 3.680; 98.8% CI 1.107–12.240;P = 0.006), SBP of ≤85 mmHg for ≥10 min (OR 3.975; 98.3% CI 1.321–11.961;P = 0.003), and SBP of ≤80 mmHg for ≥1 min (OR 3.465; 95% CI 1.484–8.093;P = 0.004), were associated with an increased risk of postoperative complications. On the other hand, intraoperative hypertension was not significantly associated with the development of postoperative complications.ConclusionsFor patients undergoing surgery for pheochromocytoma or paraganglioma, intraoperative hypotension is associated with increased postoperative complications; and the harmful effects are level- and duration-dependent. The effects of intraoperative hypertension need to be studied further.

Background Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. Methods This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. Results Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. Conclusions For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined. Trial registration www.chictr.org.cn; identifier: ChiCTR-IOR-17011994; registered on 14 July 2017.

Background: Evidence has shown that preoperative hypoalbuminemia is independently associated with acute kidney injury (AKI) after non-cardiac surgery. However, little study has investigated the effects of administration of exogenous albumin early after non-cardiac surgery on postoperative AKI in patients with preoperative hypoalbuminemia.Methods: This study was a secondary analysis of the database of a previously conducted prospective cohort study. Data of 661 adult patients who underwent non-cardiac surgery and were admitted to Surgical Intensive Care Unit (SICU) after surgery from May 1, 2019, to November 30, 2020, were collected. 267 patients with preoperative hypoalbuminemia were screened, and divided into two groups according to whether they were administrated with exogenous albumin on the day of SICU admission. The demographic and perioperative data of the two groups were propensity-matched.Results：After propensity score matching, 64 pairs of patients were included in the final analysis. The patients of the albumin group showed a higher serum albumin level on postoperative day 1 than that in patients of the control group [31.3±3.4 vs. 29.7±3.8, P=0.008], however, no difference was observed in postoperative AKI incidence between the two groups (59.4% vs. 62.5%, P=0.717). Furthermore, there was no difference in other prognostic factors, such as the use and duration of mechanical ventilation, number of other postoperative complications, in-hospital mortality, length of SICU stay and postoperative hospital stay.Conclusions: The current study did not exhibit benefit of exogenous albumin administration early after non-cardiac surgery on the occurrence of postoperative AKI in patients with preoperative hypoalbuminemia, which needs to be confirmed by further large randomized controlled researches in the future.

Background Dexmedetomidine promotes normal sleep architecture; the drug also improves analgesia. We therefore tested the hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in older patients recovering from orthopedic surgery. Methods In this double-blinded randomized controlled trial, we enrolled 712 older (aged 65–90 years) patients scheduled for major orthopedic surgery. Postoperative analgesia was provided by patient-controlled intravenous sufentanil, supplemented by randomly assigned dexmedetomidine (1.25 μg/mL) or placebo, for up to three days. The primary outcome was the incidence of delirium assessed twice daily with the Confusion Assessment Method. Among secondary outcomes, pain severity was assessed twice daily and sleep quality once daily, each with an 11-point scale where 0 = no pain/the best possible sleep and 10 = the worst pain/the worst possible sleep. Results The incidence of postoperative delirium was 7.3% (26 of 354) with placebo and 4.8% (17 of 356) with dexmedetomidine; relative risk 0.65, 95% CI 0.36 to 1.18; P = 0.151. Dexmedetomidine reduced pain both at rest (median difference -1 to 0 points, P ≤ 0.001) and with movement (-1 points, P P = 0.007; day two 0 point (-1 to 0), P = 0.010; and day three 0 point (-1 to 0), P = 0.003. The incidence of adverse events was similar in each group. Conclusions Supplementing sufentanil intravenous analgesia with low-dose dexmedetomidine did not significantly reduce delirium, but improved analgesia and sleep quality without provoking adverse events. Trial registration www.chictr.org.cn: ChiCTR1800017182 (Date of registration: July 17, 2018); ClinicalTrials.gov:NCT03629262 (Date of registration: August 14, 2018).

After the first high-position landslide occurred in Baige Village, a second slide originated from the crown of the first landslide on November 3. The approximately 1.6 million m3 second slide moved rapidly and applied an impact load on the upper part of the residual mass of the first landslide, resulting in a 6.6 million m3 entrainment volume. The sliding mass rushed into the Jinsha River and blocked the channel again, causing catastrophic flooding which destroyed numerous roadbeds, bridges, and a large number of residential houses in Sichuan and Yunnan provinces. Based on field investigations and simulation results by dynamic discrete element method (DEM), after the first landslide, the blocks formed by the trailing edge of the landslide became unstable and slid, continuously and dynamically loading and accumulating on the upper part of the first debris deposit, which rested in the grooved terrain of the slope, leading to the instability of the residual slope’s rock–soil mass and the initiation of a debris avalanche. With a peak velocity of 62 m/s, the debris avalanche slid rapidly to the location of the first slide deposit. Due to the topographic effect, it was transformed into a diffused debris avalanche, which scattered and accumulated, exhibiting the typical characteristics of a rapid long-runout landslide. Then, the calculated velocity value by DEM was also compared with those using other dynamic modeling approaches (e.g., sled model and rheological model). The DEM was proven producing a reasonable velocity variation pattern, and thus, it is suitable for the simulation of the entire movement process of high-position rockslides similar to the second Baige landslide.

Rationale & Objective Despite optimization of renin-angiotensin-aldosterone system (RAAS) inhibition, patients with immunoglobulin A nephropathy (IgAN) and persistent proteinuria remain at risk for kidney failure. We evaluated the efficacy and safety of hydroxychloroquine (HCQ), an immunomodulator, when added to the treatment regimen of patients with IgAN. Study Design Double-blind, randomized, placebo-controlled, phase 2 clinical trial. Setting & Participants Participants had IgAN (proteinuria with protein excretion of 0.75-3.5g/d and estimated glomerular filtration rate>30mL/min/1.73m2) and were receiving optimized RAAS inhibitor therapy. Interventions Patients were randomly assigned 1:1 to receive daily oral HCQ or a placebo for 6 months. Outcomes The primary outcome was percentage change in proteinuria between baseline and 6 months. Results 60 participants (mean estimated glomerular filtration rate, 53.8mL/min/1.73m2; median urine protein excretion, 1.7g/d) were recruited and randomly assigned to receive HCQ (n=30) or placebo (n=30). Percentage change in proteinuria at 6 months was significantly different between the HCQ group and the placebo group (−48.4% [IQR, −64.2%, −30.5%] vs 10.0% [IQR, −38.7%, 30.6%]; P Limitations The short treatment period and lack of postwithdrawal observations limit conclusions about long-term renoprotective efficacy and safety. Conclusions HCQ in addition to optimized RAAS inhibition significantly reduced proteinuria in patients with IgAN over 6 months without evidence of adverse events. These findings require confirmation in larger treatment trials. Funding This study was supported by grants from a government entity, the Capital of Clinical Characteristics, and the Applied Research Fund. Trial Registration Registered at ClinicalTrials.gov with study number NCT02942381.

Background The prevalence of CGG repeat expansion mutation in FMR1 gene varies among different populations. In this study, we investigated the prevalence of this mutation in women of reproductive age from northern China. Methods A total of 11,891 pre-conceptional or pregnant women, including 5037 pregnant women and 7357 women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos, were recruited. The number of CGG repeats in FMR1 was measured by the TRP-PCR method. We also offered genetic counseling and prenatal diagnosis to the women carrying pre-mutation or full mutation alleles. Results The prevalence of pre-mutation in reproductive women in northern China was 1/410, higher than that in southern China and Korea but lower than that in western countries. We also found that the prevalence of pre-mutation was relatively high (1/320) in women with abortion history. Conclusion Screening for CGG repeat expansion mutation in FMR1 should be recommended to the women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos.

In patients undergoing major surgery, complete handover of intraoperative anesthesia care is associated with adverse postoperative outcomes including high mortality and more major complications. The purpose of this study was to explore the association between the intraoperative complete handover between anesthesiologists and the occurrence of postoperative delirium. This was a secondary analysis of the database of a previously published clinical trial. Seven hundred patients aged 65 years or older, who were admitted to the intensive care unit after noncardiac surgery, were included. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the first 7 postoperative days. Other postoperative outcomes were also monitored. The association between the intraoperative complete handover of anesthesia care and the development of postoperative delirium was analyzed with a logistic regression model. Of the 700 enrolled patients, 111 (15.9%) developed postoperative delirium within 7 days. After correction for confounding factors, intraoperative complete handover between anesthesiologists was associated with an increased risk of postoperative delirium (OR 1.787, 95% CI 1.012–3.155, P = 0.046). Patients with intraoperative complete handover also had higher incidence of non-delirium complications (P = 0.003) and stayed longer in hospital after surgery (P = 0.002). For elderly patients admitted to the intensive care unit after noncardiac surgery, intraoperative complete handover of anesthesia care was associated with an increased risk of postoperative delirium. Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR-TRC-10000802.

Background/Aims: The molecules involved in nephrotic syndrome (NS) have not been fully clarified. Mitochondrial fission proteins are found to be involved in podocyte injury in vitro. Increased glomerular expression of mitochondrial fission proteins was found in adriamycin nephropathy in our previous study. Whether or not mitochondrial fission proteins are involved in podocyte injury in NS is not clear. This study explored the glomerular expression and possible pathological significance of mitochondrial fission-associated proteins, including dynamin-related protein 1 (Drp1) and mitochondrial fission protein 1 (Fis1), in children with NS. Methods: Eighteen children with primary NS, including 6 with minimal change disease, 6 with focal segmental glomerulosclerosis, 6 with membranous nephropathy, 6 children with isolated haematuria and 3 normal controls were included. The glomerular expression of Drp1, phospho-Drp1 (Ser616) and Fis1, urinary protein measurements, and podocyte mitochondrial density under electron microscopy were investigated and compared. Results: Glomerular expression of Drp1, phospho-Drp1 (Ser616) and Fis1 was mainly increased in children with NS with membranous nephropathy. No relationship was found between glomerular expression of Drp1, phospho-Drp1 (Ser616) and Fis1 and podocyte mitochondrial density or urinary protein measurements. Conclusion: Glomerular overproduction of Drp1, phospho-Drp1 (Ser 616) and Fis1 occurred mainly in children with membranous nephropathy. The pathological significance deserves further investigation.

BackgroundIntra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in surgical intensive care patients. The purpose of this study was to investigate the impact of appropriate source control and antifungal therapy on the outcomes of critically ill surgical patients with IAC.MethodsThis was a retrospective single-center cohort study. Adult surgical patients who were admitted to the intensive care unit and diagnosed with IAC from January 1, 2003, to December 31, 2016, were enrolled. The patients’ data including risk factors of IAC, infection-related information, antifungal treatment and 30-day outcomes were collected. The primary endpoint was 30-day mortality. A COX proportional hazards model was used to analyze the association between appropriate treatment and 30-day survival.ResultsA total of 82 patients were included in the analysis. Of these, 45 (54.9%) were complicated with septic shock at IAC diagnosis. Types of IAC included peritonitis (61.0%), intra-abdominal abscesses (23.2%) and biliary tract infections (15.9%). Of the included patients, 53 (64.6%) received appropriate source control and 44 (53.7%) appropriate antifungal therapy. Compared with patients with neither of these treatments, appropriate source control (HR 0.08, 95% CI 0.02–0.30;P P = 0.005), and a combination of these treatments (HR 0.02, 95% CI 0.00–0.08;P ConclusionFor critically ill surgical patients with IAC, both appropriate source control and appropriate antifungal therapy were associated with reduced risk of 30-day mortality, and the protective effects of the two appropriate treatments were additive.

Additional file 1 Supplementary Table 1. Univariate association between baseline/intraoperative variables and postoperative complications.

In the analysis reported here, the catastrophic landslide at Areletuobie town in Xinyuan county is used as an example to investigate the formation mechanism and dynamics of a flow-like landslide in Yili River valley. At 0:30 a.m. on July 31, 2012, a catastrophic landslide occurred in Xinyuan, Xinjiang, northwestern China, resulting in the deaths of 28 people when the temporary sheds in the downstream adit mining area were destroyed and buried directly in the path of the landslide. The runout distance of the landslide was about 1800 m, and the accumulative volume was about 600,000 m3. The landslide can be categorized into three regions: the sliding source, impact-shoveling, and flow-accumulative regions. The stability of the landfill slope in the sliding source region was analyzed at two seepage stages of a long period of rain and a sudden heavy rainfall. To improve the accuracy of further hazard assessments of similar types of potential landslides in the same area, we simulated the kinematic and dynamic processes of the impact-shoveling region and the debris flow using the numerical model DAN-W and a combination of the frictional model and Voellmy model. The landslide moved for approximately 139 s downward along the valley, with a maximum velocity of 30 m s−1. This is a typical long-runout flow-like landslide. Finally, we conclude that the identification of the potential geological hazards at Yili River valley area is crucial to prevent any catastrophic flow-like landslide triggered by heavy rainfall. The identified indicators should be properly used as a scientific basis for classifying hazard areas of flow-like landslides as well as for monitoring and early recognition.

To investigate the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on chemokine receptors and explore the potential mechanism of rhG-CSF inducing immune tolerance, ninety-seven donor and recipient pairs undergoing family-donor allogeneic hematopoietic stem cell transplantation were studied. The results indicated that different donors showed great disparities in expression changes after mobilization. Multivariate analysis revealed that both HLA mismatching and CCR7 downregulation on donors' CD4+ T cells after mobilization were independent risk factors for acute graft-versus-host disease (GVHD). In contrast, CCR5 downregulation on CD4+ T cells was associated with reduced incidence of acute GVHD. In conclusion, rhG-CSF mobilization could lead to differential regulation of chemokine receptors expression on T cell subsets in different donors. Downregulation of CCR5 and upregulation of CCR7 expression on donor CD4+ T cells might protect recipients from acute GVHD. This finding may provide a promising new strategy for the prevention and treatment of acute GVHD.

The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology, in comparison with histology.1987 patients scheduled for hysteroscopy were enrolled in this study. All patients proceeded sequentially through endometrial cytology, hysteroscopy and then dilatation and curettage (DC). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnosis was correlated with the DC histological diagnosis.Cyto-histological correlations were possible in 1672 (89.3%) patients: in 254 (12.8%) patients the DC was inadequate, in 75 (3.8%) patients the cytology was inadequate, and in 14 (0.7%) patients both were inadequate. In postmenopausal women, 758 of 790 cytologies (96.0%) were adequate, while 586 of 790 histologies (74.2%) were adequate. SAP-1 provided more sufficient materials for cytology than DC for histology (P 0.001). Taking atypical hyperplasia or worse as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 86.1%, sensitivity was estimated at 70.3%, specificity at 88.5%, positive predictive value at 48.0% and negative predictive value at 95.2%. Taking endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 94.4%; sensitivity was estimated at 53.2%, specificity at 98.6%, positive predictive value at 79.8% and negative predictive value at 95.3%.Liquid-based endometrial cytology can be considered a useful method for detecting of endometrial pathology as a first-line approach.

Background The study was aimed to investigate knowledge, attitude, and practice (KAP) associated with Medical Nutrition Therapy (MNT) among Chinese adult patients with diabetes and pre-diabetes. Methods From May to August 2014, a cross-sectional study was conducted in 40 hospitals across China. KAP of the respondents was investigated through a pre-tested structured questionnaire in face-to-face interviews. Anthropometric and biochemical indicators were collected, and the KAP score was recorded according to patients’ responses. Results A total of 7,017 out of 7,508 patients were analyzed. The mean scores of the overall KAP and individual K, A, and P were 9.63 ± 3.46, 2.69 ± 1.90, 1.77 ± 1.99, and 5.17 ± 1.99, with total scores of 19, 6, 3, and 10, respectively. Altogether, these results were higher in respondents who received 15 or more minutes of MNT education than in those with shorter sessions. Patients with higher KAP scores displayed significantly better glycemic control, with a higher proportion of patients achieving target HbA1c, FPG, and 2h-PG levels (P < 0.05). “Health publicity in hospitals” and “expert outpatient services” were the most favorable means of acquiring MNT information. The two predominant concerns associated with MNT were “the feasibility” and “the authenticity and professionalism of the information”. Conclusions Patients with diabetes and pre-diabetes achieved moderate scores for knowledge, attitude, and practice toward MNT. The study demonstrated glycemic control was positively correlated with the KAP score. MNT education should be improved, paying special focus on feasibility except authenticity and professionalism in China. Significant findings of the study Patients with diabetes and pre-diabetes in China attained moderate scores in KAP toward MNT. MNT education in China should be improved, meaning that more focus should be placed not only on authenticity and professionalism but also on feasibility. What this study adds The KAP scores were positively correlated with patients’ glycemic control and can be enhanced through MNT education for specified periods of time.

Background The impact of new-onset postoperative atrial fibrillation (POAF) on long-term outcomes of patients after non-cardiac surgery remains controversial. Here we report the 3-year follow-up of a previous case-control study to determine the relationship between new-onset POAF and long-term outcomes in patients after non-cardiac surgery. Methods In a previous case-control study, 213 patients who were admitted to the intensive care unit (ICU) after non-cardiac surgery were included; of them 71 were in the POAF group and 142 the control group. A telephone interview was performed with patients or their family members at 3 years after surgery. The primary endpoint was the incidence of major adverse cardiovascular events (MACEs) within 3 years, including cardiovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, and ischemic stroke. A logistic regression model was established to assess the association between the occurrence of new-onset POAF and the development of 3-year MACEs. Results 202 patients completed the 3-year follow-up and were included in the analysis; of them 68 were in the POAF group and 134 were in the control group. The incidence of 3-year MACEs was higher in the POAF group than in the control group (64.7% [44/68] vs. 23.1% [31/134], p

Congenital muscular dystrophies (CMDs) are clinically and genetically heterogeneous conditions. We launched a nationwide study to determine the frequency of CMD in the Chinese population and assess the status of diagnosis and disease management for CMD in China. Cases were chosen from databases in 34 tertiary academic hospitals from 29 first-level administrative divisions (provinces, municipalities, autonomous regions, and special administrative regions), and medical records were reviewed to confirm the diagnoses. The study included 409 patients, of those patients who consented to genetic testing (n = 340), mutations were identified in 286 of them. The most common forms identified were LAMA2-related CMD (36.4%), followed by COL6-related CMD (23.2%) and α-dystroglycanopathy (21.0%). The forms of CMD related to mutations in LMNA and SEPN1 were less frequent (12.5% and 2.4%, respectively). We also recorded a significant difference in the diagnostic capabilities and disease management of CMD, with this being relatively backward in research centers from less developed regions. We provide, for the first time, comprehensive epidemiologic information of CMD in a large cohort of Chinese people. To our knowledge, this is the largest sample size of its kind so far highlighting the prevalence of CMD in China.

Two successive Baige landslides are presented in this study to investigate the dynamics and emplacement mechanisms. Field survey shows that the deposit characteristics of the first landslide are affected by the extremely fractured rock masses and the complex spatial distribution of lithologies in the source area. This deposit consists of abundant angular megablocks on the surface supported by clasts, with a relatively abundant content of rubble ranging from micrometre to decimetre sizes, and rarely well-preserved original stratigraphic sequence, diapiric structure, and convoluted structure. These sedimentological characteristics imply that a simple differential shear process, induced by compression, is distributed through the entire avalanche masses with low internal disturbance during the emplacement of the first landslide. The three-dimensional discrete element simulations show that: (i) the first landslide reaches its maximum average velocity of 41 m/s in ~28 s and eventually is bulldozed to a halt in the river within ~80 s. (ii) The second landslide is controlled by entrainment, which impedes the avalanche from further accelerating, and simultaneously imparts kinematic energy to the substrate, eventually becoming entirely mobilized and reaching a maximum average velocity of 35 m/s in ~36 s. In the dynamic process of the second landslide, the significant entrainment-induced enlarged volume (its entrainment ratio reaches 3.3) is associated with the steep concave terrain, water-bearing substrate and lower-roughness substrate basal boundary, and overloading-impact-induced erosion is proposed to be the most significant contribution to this entrainment.

Background Patients admitted to the intensive care unit (ICU) after surgery often develop sleep disturbances. The authors tested the hypothesis that low-dose dexmedetomidine infusion could improve sleep architecture in nonmechanically ventilated elderly patients in the ICU after surgery. Methods This was a pilot, randomized controlled trial. Seventy-six patients age 65 yr or older who were admitted to the ICU after noncardiac surgery and did not require mechanical ventilation were randomized to receive dexmedetomidine (continuous infusion at a rate of 0.1 μg kg−1 h−1; n = 38) or placebo (n = 38) for 15 h, i.e., from 5:00 pm on the day of surgery until 8:00 am on the first day after surgery. Polysomnogram was monitored during the period of study-drug infusion. The primary endpoint was the percentage of stage 2 non–rapid eye movement (stage N2) sleep. Results Complete polysomnogram recordings were obtained in 61 patients (30 in the placebo group and 31 in the dexmedetomidine group). Dexmedetomidine infusion increased the percentage of stage N2 sleep from median 15.8% (interquartile range, 1.3 to 62.8) with placebo to 43.5% (16.6 to 80.2) with dexmedetomidine (difference, 14.7%; 95% CI, 0.0 to 31.9; P = 0.048); it also prolonged the total sleep time, decreased the percentage of stage N1 sleep, increased the sleep efficiency, and improved the subjective sleep quality. Dexmedetomidine increased the incidence of hypotension without significant intervention. Conclusions In nonmechanically ventilated elderly patients who were admitted to the ICU after noncardiac surgery, the prophylactic low-dose dexmedetomidine infusion may improve overall sleep quality.

Eschrichia coli urinary isolates were collected from 20 Chinese hospitals during five 1-year periods from 2004 to 2014. The susceptibility of E. coli to levofloxacin has remained stable during the past 11 years, and 90% of strains had minimum inhibitory concentrations of ≤32 mg/L. The urine-specific susceptibility breakpoints for levofloxacin should be reset based on more relevant clinical studies and the current pharmacokinetic/pharmacodynamic considerations in this field.

This study aimed to investigate the treatment-related annual cost of childhood epilepsy and its related factors in mainland China. A total of 244 cases were collected at the outpatient clinics of Peking University First Hospital Pediatrics from April 2010 to August 2013. The median annual epilepsy treatment–related costs per patient were estimated to be RMB7822 (US$1160), accounting for 43.72% (median) of urban residents’ disposable income in China. Those who lived far away or with uncontrolled seizures yielded much higher costs. This study concluded that the treatment of children with epilepsy produces a heavy burden on both families and society in mainland China. The constitution ratio of antiepileptic drugs and travel expenses are much higher than those of other countries. Adjusting medical insurance coverage, balancing medical resource distribution, and taking good control of seizures might be effective in reducing the economic burden of childhood epilepsy in China.

Background The mechanism of podocyte apoptosis is not fully understood. In addition, the role of the inositol 1,4,5-triphosphate receptor (IP3R)/glucose-regulated protein 75 (Grp75)/voltage-dependent anion channel 1 (VDAC1)/mitochondrial calcium uniporter (MCU) calcium regulation axis, which is located at sites of endoplasmic reticulum (ER) mitochondria coupling, in the mechanism of podocyte apoptosis is unclear. This study aimed to understand the roles of this axis in podocyte apoptosis and explore potential targets for podocyte protection. Methods The expression of IP3R, Grp75, VDAC1, and MCU and mitochondrial Ca2+ were analyzed during Adriamycin- or angiotensin II-induced apoptosis in cultured mouse podocytes. The interaction between IP3R, Grp75, and VDAC1 was investigated using co-immunoprecipitation experiments. The effects of IP3R, Grp75, and MCU agonists and antagonists on mitochondrial Ca2+ and apoptosis were investigated in cultured podocytes. The podocyte-protective effects of an MCU inhibitor were further investigated in rats with Adriamycin-induced nephropathy. Results Increased expression of IP3R, Grp75, VDAC1 and MCU, enhanced interaction among the IP3R-Grp75-VDAC1 complex, mitochondrial Ca2+ overload, and increased active caspase-3 levels were confirmed during Adriamycin- or angiotensin II-induced mouse podocyte apoptosis. Agonists of this axis facilitated mitochondrial Ca2+ overload and podocyte apoptosis, whereas specific antagonists against IP3R, Grp75, or MCU prevented mitochondrial Ca2+ overload and podocyte apoptosis. A specific MCU inhibitor prevented Adriamycin-induced proteinuria and podocyte foot process effacement in rats. Conclusions This study identified a novel pathway in which the IP3R-Grp75-VDAC1-MCU calcium regulation axis mediated podocyte apoptosis by facilitating mitochondrial Ca2+ overload. Antagonists that inhibit Ca2+ transfer from ER to mitochondria protected mouse podocytes from apoptosis. An MCU inhibitor protected podocytes and decreased proteinuria in rats with Adriamycin-induced nephropathy. Therefore, antagonists to this pathway have promise as novel podocyte-protective drugs.

Background/Purpose To evaluate the ability of quadruple Taqman probe real-time PCR to the detection of vanA, vanB and vanM in enterococcal isolates. Methods A total of 343 strains, including 253 vancomycin-resistant enterococcus (VRE) strains and 90 non-VRE strains, were tested by both quadruple Taqman probe real-time PCR and gel-based PCR assay. Results When differentiating among three genotypes of vanA, vanB and vanM in VRE strains, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and consistency of the quadruple Taqman probe real-time PCR were all 100%. Minimum. Inhibitory concentration (MIC) results showed that there was a wide MIC range of vancomycin and teicoplanin for the strains that harboring vanA/vanM gene respectively or harboring vanA and vanM genes simultaneously. However, the VRE strains with vanB genotype all were sensitive to teicoplanin. Conclusion Considering the excellent PPV and low NPV, real-time PCR would be useful to monitor VRE-colonized or infected patients. However, further evaluation of the assay's performance in the clinical specimens is required, especially when considering that high level of PCR inhibitors present in these samples.

Background Current evidences show that regional anesthesia is associated with decreased risk of complications after major surgery. However, the effects of combined regional-general anesthesia remain controversial. The purpose of our study was to analyze the impact of anesthesia (combined epidural-general anesthesia vs. general anesthesia) on the risk of postoperative complications in patients undergoing open surgery for pheochromocytoma. Methods This was a retrospective cohort study. 146 patients who underwent open surgery for pheochromocytoma (100 received combined epidural-general anesthesia and 46 received general anesthesia) in Peking University First Hospital from January 1, 2002 to December 31, 2015 were enrolled. The primary outcome was the occurrence of postoperative complications during hospital stay after surgery. Multivariate Logistic regression models were used to analyze the association between the choice of anesthetic method and the risk of postoperative complications. Results 17 (11.6%) patients developed complications during postoperative hospital stay. The incidence of postoperative complications was lower in patients with combined epidural-general anesthesia than in those with general anesthesia (6% [6/100] vs. 23.9% [11/46], P = 0.006). Multivariate Logistic regression analysis showed that use of combined epidural-general anesthesia (OR 0.219, 95% CI 0.065–0.741; P = 0.015) was associated with lower risk, whereas male gender (OR 5.213, 95% CI 1.283–21.177; P = 0.021) and perioperative blood transfusion (OR 25.879; 95% CI 3.130–213.961; P = 0.003) were associated with higher risk of postoperative complications. Conclusions For patients undergoing open surgery for pheochromocytoma, use of combined epidural-general anesthesia may decrease the occurrence of postoperative complications.

Objective To investigate pregnancy rates after microsurgical varicocelectomy in Chinese infertile men with clinical varicoceles and to identify preoperative factors affecting the outcomes. Design Retrospective data analysis. Setting University infertility clinic. Patient(s) One hundred seventy-six consecutive Chinese men with infertility and clinical varicoceles who underwent varicocelectomy from January 2010 to December 2011. Semen data were available for 145 patients, and pregnancy data were available for 66. Intervention(s) Varicocelectomy was performed on all patients. Main Outcome Measure(s) Spontaneous pregnancy rates and improvement in semen parameters after varicocelectomy. Result(s) We followed 145 men (82.4%) for a median of 21 months (range 12–36 months) after varicocelectomy. For 109 patients (75.2%), both sperm concentration and forward motility improved. Overall, 45.5% (66/145) of female partners achieved spontaneous pregnancy at a mean follow-up of 11.7 ± 6.2 months. On univariate analysis, preoperative high sperm concentration (≥20 million/mL) and high sperm motility (≥25%) were positively associated with spontaneous pregnancy. On multivariate analysis, only preoperative sperm concentration was an independent predictor. Conclusion(s) Microsurgical varicocelectomy could improve semen quality and spontaneous pregnancy rates. Only preoperative sperm concentration was an independent predictor of spontaneous pregnancy. Patients with high initial sperm concentration may benefit from varicocelectomy for spontaneous pregnancy.

Background Dysfunction of mitochondria is involved in podocyte injury in some kidney diseases, but the relationship between abnormal mitochondrial morphology and podocyte injury as well as the underlying mechanism is still unclear. This study aims to investigate dynamic changes of mitochondrial morphology and the potential molecular events in an adriamycin (ADR)-induced podocyte injury model. Methods Podocyte apoptosis was evaluated by annexin V assay. Podocyte mitochondrial membrane potential (MMP) was measured with MitoCapture kit. Double staining was used to show the distribution changes of mitochondria and actin filament as well as mitofusin proteins and podocin. Mitochondrial shape descriptors were obtained using analySIS Image system. Effects of cyclosporine A (CsA) or minocycline (Mcy) on mitochondrial morphology were explored in ADR-induced nephropathy rats. Results ADR caused podocyte damage displaying as induction of cellular apoptosis and increase of activated caspase 3 and cytochrome c. The MMP level was decreased remarkably in ADR-treated podocytes. Mitochondrial morphological changes induced by ADR occurred rapidly from large and ellipsoid shape to the small, long and irregular. ADR significantly decreased surface area, perimeter and circularity, while increasing aspect ratio of mitochondria. In addition, mitochondria number transiently increased at 6 h following ADR application. Mitochondria intensity was increased along with punctate mitochondria formation, which co-localized with polymerized actin cytoskeleton in ADR podocytes. In ADR-induced nephropathy rats, 24-h proteinuria was decreased significantly by CsA or Mcy. ADR-induced abnormal changes of mitochondrial morphology were restored by CsA or Mcy. The induction of mitofusin proteins and the reduction of podocin in ADR rat glomeruli were rescued by CsA or Mcy. Conclusions Mitochondrial dysfunction may be an early event in ADR-induced podocyte damage, and the protective role of CsA or Mcy may be mediated partially by improving mitochondrial function through inhibiting the induction of mitofusin proteins.

Background Postoperative pulmonary complications (PPCs) are major causes of morbidity, mortality, and prolonged hospital stay in patients after surgery. Using effective strategies to prevent its occurrence is essential to improve outcome. However, despite various efforts, the incidence of PPCs remains elevated in high-risk patients. Anticholinergic inhalation is used to reduce high airway resistance and improve pulmonary function; it may be helpful to decrease the risk of PPCs. Penehyclidine is a long-acting anticholinergic agent which selectively blocks M1 and M3 receptors. We hypothesize that, in high-risk patients, prophylactic penehyclidine inhalation may decrease the incidence of PPCs. Methods This is a randomized, double-blind, placebo-controlled trial with two parallel arms. A total of 864 patients at high risk of PPCs will be enrolled and randomized to receive prophylactic inhalation of either penehyclidine or placebo (water for injection). Study drug inhalation will be administered from the night (7 pm) before surgery until the second day after surgery, in an interval of every 12 hours. The primary outcome is the incidence of PPCs within 30 days after surgery. Secondary outcomes include the time to onset of PPCs (from end of surgery to first diagnosis of PPCs), the number of PPCs (indicates the number of diagnosed individual PPCs), the incidence of postoperative extrapulmonary complications, the length of stay in hospital after surgery, and the 30-day all-cause mortality. Discussion Results of the present study will provide evidence to guide clinical practice in using prophylactic inhalation of an anticholinergic to prevent PPCs in high-risk patients. Trial registration The study was registered prospectively in Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPC-15006603) on 14 May 2015 and retrospectively in ClinicalTrials.gov (NCT02644876) on 30 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2315-7) contains supplementary material, which is available to authorized users.

Glycated albumin (GA) reflects serum glucose of the preceding 2 - 3 weeks and plays an important role in diabetes mellitus (DM). This study aimed at investigating whether GA can assess renal dysfunction in population.3818 individuals attending physical examination were enrolled in this cross-sectional study and divided into five groups: healthy controls, impaired fasting glucose, DM without renal complications, DM with albuminuria, and nondiabetic chronic kidney disease patients. All analyses were conducted using the subjects with both fasting venous blood and morning urine samples.Among all groups, mean GA, hemoglobin A1c, fasting plasma glucose, and serum creatinine were the highest and estimated glomerular filtration rate (eGFR) was the lowest in DM with albuminuria group. When eGFR was 90 - 105 mL/minute/1.73 m2 or mildly decreased to 60 - 90 mL/minute/1.73 m2, GA increased significantly with elevating albumin-to-creatinine ratio (ACR) from 0 - 10 mg/g to 10 - 30 mg/g to30 mg/g (p0.001 and p0.001). GA increased further when eGFR decreased moderately to severely as a result of renal function continuing to deteriorate (eGFR ≤ 60 mL/minute/1.73 m2).When ACR ≤ 30 mg/g and eGFR ≤ 60 mL/minute/ 1.73 m2, more than 50% subjects were DM patients and had significantly higher GA levels than other subjects with eGFR105 mL/minute/1.73 m2. After adjusting demographics, every 5% rise of GA levels showed a 1.778fold increased risk in all subjects (adjusted odds ratio [OR], 1.778; 95% confidence interval [CI], 1.373 - 2.302; p0.001) and 1.737-fold risk in DM subjects (adjusted OR, 1.737; 95% CI, 1.221 - 2.471; p = 0.002) for occurrence of ACR30mg/g in contrast to ACR ≤ 30 mg/g. Compared to eGFR90 mL/minute/1.73 m2, 5% rise of GA levels showed a 1.482-fold risk for eGFR 60 - 90 mL/minute/1.73 m2 (adjusted OR, 1.482; 95% CI, 1.112 - 1.975; p = 0.007) and a 1.996-fold risk for eGFR ≤ 60 mL/minute/1.73 m2 (adjusted OR, 1.996; 95% CI, 1.366 - 2.916; p0.001).Increased GA serves as a risk marker for renal dysfunction. GA combined with eGFR and ACR can reflect renal function changes in population.