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Abstract Background Acetaminophen is a commonly used analgesic after surgery, and its impact on prognosis in patients with acute respiratory distress syndrome (ARDS) has not been studied. This study explores the association between the use of acetaminophen and the risk of mortality in patients with ARDS. Methods In this retrospective cohort study, 3,227 patients with ARDS who had or had not received acetaminophen were obtained from the Medical Information Mart for Intensive Care IV, patients were divided into acetaminophen and non- acetaminophen groups. In-hospital mortality of ARDS patients was considered as primary end point. We used univariate and multivariate Cox regression analyses to assess the relationship of acetaminophen use and in-hospital mortality in patients with ARDS. Subgroup analysis was performed according to age, gender, and severity of ARDS. Results Of the total patients, 2,438 individuals were identified as acetaminophen users. The median duration of follow-up was 10.54 (5.57, 18.82) days. The results showed that the acetaminophen use was associated with a decreased risk of in-hospital mortality [hazard ratio (HR) = 0.67, 95% confidence interval (CI): 0.57–0.78]. Across various subgroups of patients with ARDS based on age, gender, and severity, acetaminophen use exhibited an association with reduced risk of in-hospital mortality. Conclusion Acetaminophen use was associated with in-hospital mortality of patients with ARDS. Acetaminophen therapy may represent a promising therapeutic option for ARDS patients and warrants further investigation.

Based on the “unidirectional break-up and convergence” geodynamic model, this study investigates the impact of the evolution of the Tethyan domain on the formation of petroleum systems in the Sichuan super basin and explores the enrichment pattern of natural gas. The results show that, firstly, the Sichuan Basin and its surrounding areas have experienced two unidirectional rifting-aggregation cycles triggered by the Proto-Tethys Ocean and the Paleo-Tethys Ocean during the Neoproterozoic to Triassic. During Jurassic–Cenozoic, the Sichuan Basin is incorporated in the circum-Tibetan plateau basin-mountain coupled tectonic domain system. The episodic tectonic movements within the plate control the sedimentary infill styles. Second, the evolution of the Tethyan domain, paleoclimatic environment and major geological events controlled the formation and distribution of high-quality source rocks within the basin. The rift valley and intracratonic rift, passive continental margin slope, and intracratonic sags are favorable areas for the development of source rocks. Third, the evolution of the Tethyan domain, supercontinent cycles, global sea level changes, and tectono-climatic events controlled the distribution of carbonate platform and reservoir-caprock combinations. The cratonic platform margins and sub-platform internal high terrains are key areas for finding carbonate high-energy facies belts. Syndepositional paleo-uplifts and surrounding slopes, regional unconformities, and later faults zone are areas where large-scale carbonate reservoirs are distributed. The regional evaporite or shale caprock are beneficial for the large-scale preservation of oil and gas in the basin. Fourth, the spatio-temporal matching relationship of reservoir forming factors influenced by the early tectonic-sedimentary evolution pattern and the degree of later tectonic modification is the key to oil and gas enrichment. Future oil and gas exploration should focus on potential gas systems during the Sinian rift period, Cambrian pre-salt gas systems in the eastern and southern Sichuan, as well as whole oil and gas systems of Permian and Triassic.

Abstract This study presents the clinical profile of a 74-year-old male patient admitted to the hospital due to a 20-day history of coughing, chest tightness, and dyspnea. Upon admission, the patient presented with fever, tachycardia, and tachypnea. Clinical examination revealed evidence of lung infection, sepsis, and multi-organ dysfunction, alongside abnormal blood gas analysis and elevated C-reactive protein (CRP) levels. Pathogen testing confirmed Chlamydia psittaci (C. psittaci), infection. Throughout the treatment course, the patient developed concurrent fungal and viral infections, necessitating a comprehensive approach involving combined antibiotic and antifungal therapy. Despite encountering treatment-related complications, the patient demonstrated clinical improvement with aggressive management. This case underscores the importance of recognizing immune suppression subsequent to Chlamydia infection, emphasizing the critical role of early diagnosis, intervention, and standardized treatment protocols in enhancing patient prognosis.

【Objective】The study was conducted to explore the annual growth characteristics of pond-cultured rich the basic data of culture biology so as to provide references for the artificial pond culture and breeding of Bahaba taipingensis, and further protect and use the germplasm resources of B. taipingensis.【Method】Taking the B. taipingensis juveniles artificially cultured for less than one year as research materials, the growth parameters such as body length and body mass of pond-cultured B. taipingensis juveniles were measured regularly within one year, and the annual growth characteristics of B. taipingensis juveniles were analyzed.【Result】The initial average body length and average body mass of juveniles of B. taipingensis were increased from 4.56 (±0.54) cm to 30.22 (±4.32) cm and 10.63 (±0.91) g to 1 085.73 (±328.55) g after 365 days of growth. The body length was increased by 562.16%, with an average daily growth of 0.07 cm. The specific growth rate of body length ranged from 0.08%/d to1.08%/d, and the variation coefficient of body length ranged from 7.83% to 14.31%. The body mass was increased by 10 117.06 %, with an average daily growth of 2.95g. The specific growth rate of body mass ranged from 0.68%/d to 2.77%/d and the variation coefficient of body mass ranged from 8.53% to 33.37%. The specific growth rate and variation coefficient of body mass were greater than those of body length, and the annual change of fatness ranged from 2.21% to 11.18%. The body length of B. taipingensis juvenile was shown to be correlated with body mass in a power function: m=0.3783L2.2363, (R2=0.9705, b= 2.2363 < 3), with a negative allometric growth stage. There was linear relationship between the total length (LT) and body length (L): LT =1.1918L+0.2809 (R2=0.9986). There was quadratic function between the total length (LT) and age (t): LT=-0.0002t2+0.159t+4.6652 (R2=0.9791), quadratic function between body length (L) and age (t): L=-0.0002t2+0.1294t+3.7988 (R2=0.9865), and quadratic function between body mass (m) and age (t): m=0.0076t2+0.0618t+28.915 (R2=0.9956).【Conclusion】The B. taipingensis juvenile under artificial pond-cultureconditions grow well within one year, being at negative allometric growth stage.

Abstract Background Diaphragmatic ultrasound has been increasingly used to evaluate diaphragm function. However, current diaphragmatic ultrasound parameters provide indirect estimates of diaphragmatic contractile function, and the predictive value is controversial. Two-dimensional (2D) speckle tracking is an effective technology for measuring tissue deformation and can be used to measure diaphragm longitudinal strain (DLS) to assess diaphragm function. The purpose of this study was to determine the feasibility and reproducibility of DLS quantification by 2D speckle tracking and to determine whether maximal DLS could be used to predict weaning outcomes. Methods This study was performed in the intensive care unit of two teaching hospitals, and was divided into two studies. Study A was a prospective study to evaluate the feasibility, reliability, and repeatability of speckle tracking in assessing DLS in healthy subjects and mechanically ventilated patients. Study B was a multicentre retrospective study to assess the use of maximal DLS measured by speckle tracking in predicting weaning outcomes. Results Twenty-five healthy subjects and twenty mechanically ventilated patients were enrolled in Study A. Diaphragmatic speckle tracking was easily accessible. The intra- and interoperator reliability were good to excellent under conditions of eupnoea, deep breathing, and mechanical ventilation. The intraclass correlation coefficient (ICC) ranged from 0.78 to 0.95. Ninety-six patients (fifty-nine patients were successfully weaned) were included in Study B. DLS exhibited a fair linear relationship with both the diaphragmatic thickening fraction (DTF) (R2 = 0.73, p

Summary: Background: Immune-enhancing thymosin alpha 1 (Tα1) therapy may reduce infected pancreatic necrosis (IPN) in acute necrotising pancreatitis (ANP). However, the efficacy might be impacted by lymphocyte count due to the pharmacological action of Tα1. In this post-hoc analysis, we tested the hypothesis that pre-treatment absolute lymphocyte count (ALC) determines whether patients with ANP benefit from Tα1 therapy. Methods: A post-hoc analysis of data from a multicentre, double-blind, randomised, placebo-controlled trial testing the efficacy of Tα1 therapy in patients with predicted severe ANP was performed. Patients from 16 hospitals of China were randomised to receive a subcutaneous injection of Tα1 1.6 mg every 12 h for the frst 7 days and 1.6 mg once a day for the following 7 days or a matching placebo during the same period. Patients who discontinued the Tα1 regimen prematurely were excluded. Three subgroup analyses were conducted using the baseline ALC (at randomisation), and the group allocation was maintained as intention-to-treat. The primary outcome was the incidence of IPN 90 days after randomisation. The fitted logistic regression model was applied to identify the range of baseline ALC where Tα1 therapy could exert a maximum effect. The original trial is registered with ClinicalTrials.gov, NCT02473406. Findings: Between March 18, 2017, and December 10, 2020, a total of 508 patients were randomised in the original trial, and 502 were involved in this analysis, with 248 in the Tα1 group and 254 in the placebo group. Across the three subgroups, there was a uniform trend toward more significant treatment effects in patients with higher baseline ALC. Within the subgroup of patients with baseline ALC≥0.8 × 10ˆ9/L (n = 290), the Tα1 therapy significantly reduced the risk of IPN (covariate adjusted risk difference, −0.12; 95% CI, −0.21,-0.02; p = 0.015). Patients with baseline ALC between 0.79 and 2.00 × 10ˆ9/L benefited most from the Tα1 therapy in reducing IPN (n = 263). Interpretation: This post-hoc analysis found that the efficacy of immune-enhancing Tα1 therapy on the incidence of IPN may be associated with pretreatment lymphocyte count in patients with acute necrotising pancreatitis. Funding: National Natural Science Foundation of China.

Abstract 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.

Rehabilitation medicine (RM) requires more personalisation than any other treatment in the medical domain. Additive manufacturing (AM) is a promising candidate for providing customised tools to improve performance but reduce cost and complexity of personalisation. Research and applications of AM in the RM field are receiving increasing attention. This paper aims to identify the research status and development trend via visual analysis of literature. At first, core publications from representative domain journals and conference proceedings were extracted as source data for the inputs of statistical analysis. Secondly, keyword visualisation analysis provides research hotspots and technological developments to summarise the research frontiers. Finally, visual knowledge graphs were constructed to show the emerging trends, including digital solutions, lifecycle treatment, and multiple-supporter rehabilitation services, in this special interdisciplinary field. Specially, digital methods with AM and associated services will be one of the principle roadmaps for personalised RM in the future.

Abstract Background Janus-activated kinase-1 (JAK1) plays a crucial role in many aspects of cell proliferation, differentiation, apoptosis and immune regulation. However, correlations of JAK1 with prognosis and immune infiltration in NSCLC have not been documented. Methods We analyzed the relationship between JAK1 expression and NSCLC prognosis and immune infiltration using multiple public databases. Results JAK1 expression was significantly decreased in NSCLC compared with that in paired normal tissues. JAK1 overexpression indicated a favourable prognosis in NSCLC. In subgroup analysis, high JAK1 expression was associated with a preferable prognosis in lung adenocarcinoma (OS: HR, 0.74, 95% CI from 0.58 to 0.95, log-rank P = 0.017), not squamous cell carcinoma. In addition, data from Kaplan–Meier plotter revealed that JAK1 overexpression was associated with a preferable prognosis in male and stage N2 patients and patients without distant metastasis. Notably, increased levels of JAK1 expression were associated with an undesirable prognosis in patients with stage 1 (OS: HR, 1.46, 95% CI from 1.06 to 2.00, P = 0.02) and without lymph node metastasis (PFS: HR, 2.18, 95% CI from 1.06 to 4.46, P = 0.029), which suggests that early-stage NSCLC patients with JAK1 overexpression may have a bleak prognosis. Moreover, multiple immune infiltration cells, including NK cells, CD8 + T and CD4 + T cells, B cells, macrophages, neutrophils, and dendritic cells (DCs), in NSCLC were positively correlated with JAK1 expression. Furthermore, diverse immune markers are associated with JAK1 expression. Conclusions JAK1 overexpression exhibited superior prognosis and immune infiltration in NSCLC.

Abstract Background The incidence of delirium in intensive care unit (ICU) patients is high and associated with a poor prognosis. We validated the risk factors of delirium to identify relevant early and predictive clinical indicators and developed an optimized model. Methods In the derivation cohort, 223 patients were assigned to two groups (with or without delirium) based on the CAM-ICU results. Multivariate logistic regression analysis was conducted to identify independent risk predictors, and the accuracy of the predictors was then validated in a prospective cohort of 81 patients. Results A total of 304 patients were included: 223 in the derivation group and 81 in the validation group, 64(21.1%)developed delirium. The model consisted of six predictors assessed at ICU admission: history of hypertension (RR = 4.367; P = 0.020), hypoxaemia (RR = 3.382; P = 0.018), use of benzodiazepines (RR = 5.503; P = 0.013), deep sedation (RR = 3.339; P = 0.048), sepsis (RR = 3.480; P = 0.018) and mechanical ventilation (RR = 3.547; P = 0.037). The mathematical model predicted ICU delirium with an accuracy of 0.862 (P 0.05). Conclusions Patients’ risk of delirium can be predicted at admission using the early prediction score, allowing the implementation of early preventive interventions aimed to reduce the incidence and severity of ICU delirium.

Objectives Postoperative sore throat (POST) is very common in patients under general anaesthesia. However, there is no effective clinical predictive model for reducing its occurrence. The objective of this study was to estimate the risk factors for POST in patients after general anaesthesia by designing a nomogram.Design A prospective study.Setting This study was conducted in a large tertiary hospital.Participants Patients aged 18–85 years old who received general anaesthesia with either an endotracheal tube or supraglottic airway and of American Society of Anesthesiologists classification level Ⅰ–III.Results A total of 442 patients were enrolled in this study, with a POST incidence of 44.1%. The results showed that younger age (≤55 years), surgical site (head and neck surgery), duration of anaesthesia (≥4 hours) and history of chronic pharyngitis were independent risk factors for POST in general anaesthesia patients. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the nomogram. The area under the ROC curve was 0.784 and the C-index was 0.779.Conclusion A nomogram combining age, surgical site, duration of anaesthesia and history of chronic pharyngitis is potentially useful in predicting POST under general anaesthesia.Trial registration number ChiCTR-ROC-17013258; Post-results.

Abstract Alfalfa (Medicago sativa L.) is an important forage legume in farming and animal husbandry systems. This study assessed the effects of arbuscular mycorrhizal fungi (AMF) and phosphate-solubilizing bacteria (PSB) on alfalfa growth under different phosphorus application levels. In this experiment, a complete randomized block design was used. The following four bacterial applications were used: inoculation of Funneliformis mosseae (Fm), inoculation of Bacillus megaterium (Bm), inoculation of mixed species (Fm × Bm) and noninoculation treatment (CK). Phosphorus (P) treatment was applied at the following four levels: 0 mg kg−1 (P0), 50 mg kg−1 (P1), 100 mg kg−1 (P2) and 150 mg P kg−1 (P3). The results showed that with the increase in phosphorus application, each index increased first and then decreased. The J2 treatment was significantly greater than the J0 treatment (P J1P2 > J3P1 treatment. Therefore, when phosphorus was applied at 100 mg kg−1, the mixed inoculation of Fm × Bm was optimal, benefitting mycorrhiza growth and the production performance of alfalfa.

Based on the analysis of the responses of conventional logs such as natural gamma (GR), density (DEN), acoustic interval transit time (AC), compensated neutron (CNL), dual lateral resistivity (Rlld, Rlls), and caliper log (CAL), combined with drilling data, cores, thin section and productivity of 65 wells, the reservoirs in the Mid-Permian Maokou Formation of southern Sichuan Basin were divided into four types, fractured-vuggy, pore-vuggy, fractured and fractured-cavity. The main reservoirs in high productivity wells are fractured-vuggy and pore-vuggy. The reservoirs of Maokou Formation are generally thin, and can be divided into the upper reservoir segment (layer a of the second member to the third member of Maokou Formation, P2m2a-P2m3) and the lower segment (layer b of the second member of Maokou Formation, P2m2b). The two reservoir segments are mainly controlled by two grain beaches during the sedimentation of P2m2a-P2m3 and P2m2b, the vertical zonation of karst, and the fractures. The upper reservoir segment is generally better than the lower one in development degree and single well productivity, and is much thicker than the lower one. It is thicker in the Yibin-Zigong-Weiyuan-Dazu area, the southwestern area of Chongqing and the southeastern area of Luzhou, while the lower segment is thicker in the Neijiang-Zigong-Luzhou area and the Dazu-Luzhou area. The areas with big reservoir thickness at tectonic slope or syncline parts are the favorable exploration areas. Key Words: southern Sichuan Basin, Mid-Permian, Maokou Formation, karst reservoir, cavity, fracture, grain beach, logging response

In order to analyze the impact of large-scale photovoltaic system on the power system, a photovoltaic output prediction method considering the correlation is proposed and the optimal power flow is calculated. Firstly, establish a photovoltaic output model to obtain the attenuation coefficient and fluctuation amount, and analyze the correlation among the multiple photovoltaic power plants through the k-means method. Secondly, the long short-term memory (LSTM) neural network is used as the photovoltaic output prediction model, and the clustered photovoltaic output data is brought into the LSTM model to generate large-scale photovoltaic prediction results with the consideration of the spatial correlation. And an optimal power flow model that takes grid loss and voltage offset as targets is established. Finally, MATLAB is used to verify that the proposed large-scale photovoltaic forecasting method has higher accuracy. The multi-objective optimal power flow calculation is performed based on the NSGA-II algorithm and the modified IEEE systems, and the optimal power flow with photovoltaic output at different times is compared and analyzed.

This paper presents a systematical numerical investigation into the lining performance of a tunnel with cavities around surrounding rocks, focusing on the influences of cavity size and multicavity distribution. The study demonstrates that the cavities around surrounding rocks have much influence on tunnel stability and may induce damages in tunnel structures, in which cavity width has a more severe effect on the stress state of tunnel structures than cavity depth. Moreover, the numerical investigation also illustrates that the nonadjacent distribution of multicavities has more serious influence on tunnel structures than that from adjacent distribution of multicavities as well as that from a single cavity.

In the past decades, the speed and scale of Chinese infrastructure construction have been enormous, and the resulting construction waste is also quite amazing, which has become a huge threat to environmental protection. If the pollution-free engineering utilization of the construction waste can be achieved at a low cost, it will undoubtedly be a great benefit for the country and the people. Therefore, a preliminary experimental study was conducted to investigate the strength characteristics of the cement treated and expanded polystyrene mixed lightweight. The waste soil (muddy clay and fine sand) as the main component of the lightweight mixture is taken from a foundation construction site of a Yangtze River Bridge which connects two eastern coastal cities, Zhenjiang and Yangzhou. With different mixture ratios and additives of the cement treated and expanded polystyrene mixed lightweight, a series of cubic samples were tested by the unconfined compressive strength test, and collections of standard cylinder samples prepared by hand were inspected by the conventional triaxial shear test. Then, a good exponential relationship between the uniaxial compressive strength and the cement mixing ration was founded, and a logarithmic relationship was captured between the compressive strength and curing time within a period of 28 days after the specimens were made. Samples made of different soil as raw materials have different strengths, but all of these specimens show a strain-hardening and stable behavior. Results show that the mechanical strength characteristics of the cement treated and expanded polystyrene mixed waste soil mainly depend on the proportions of lightweight mixture.

Based on the three dimensional seismic data and drilling data in Gaoshiti–Moxi area, the structural characteristics and evolution process of strike-slip faults in the study area and their significance for gas accumulation were examined using the method of fault structure analysis. The results show that: (1) Transtensional strike-slip faults are developed in the Paleozoic in study area. On the profile, there are three types of structural styles: steep and erect, flower structures, “Y” and reversed “Y” type faults. On the plane, strike-slip faults developed in the Cambrian extending linearly and along the nearly EW, NW and NE direction. The faults are composed of multiple secondary faults in en-echelon arrangement; faults in the Permian are mainly along nearly EW and NW direction, and the Permian faults are distributed in the middle east part of the study area and they are more in the north than in the south. (2) The nearly EW and NW trending faults are dextral strike-slip faults, and the NE trending faults are sinistral strike-slip faults. The strike-slip strength of the nearly EW trending faults are the strongest and the maximum horizontal displacement is 550 m, while the strike-slip strength of the NE trending faults is the weakest. The Cambrian faults had stronger activities than the Permian faults. (3) The transtensional strike-slip faults were active in two periods, the early Caledonian period and the late Hercynian period, and were the products of oblique extension of pre-existing weak zones in Xingkai and Emei taphrogenesis, with certain inheritance in the main faults. (4) The strike-slip faults and surrounding fractures enhance the porosity and permeability of the reservoir in Cambrian Longwangmiao Formation and control the distribution of karst reservoirs in the Permian Qixia Formation–Maokou Formation, bringing about the situation of multiple gases bearing series in this area. Key words: Sichuan Basin, Gaoshiti–Moxi area, Cambrian, Permian, strike-slip fault, structural characteristics, gas accumulation

Abstract 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

Abstract Sepsis and sepsis-associated intestinal barrier dysfunction are common in intensive care units, with high mortality. The aim of this study is to investigate whether Polo-like kinase 1 (PLK1) ameliorates sepsis-induced intestinal barrier dysfunction in the intestinal epithelium. The mouse intestinal barrier was disrupted after Lipopolysaccharide (LPS) injection due to intestinal epithelial cell apoptosis and proliferation inhibition, accompanied by decreased PLK1. In HT-29 intestinal epithelial cells, LPS stimulation induced cell apoptosis and inhibited cell proliferation. Overexpression of PLK1 partly rescued the apoptosis and proliferation inhibition in HT29 cells caused by LPS. Finally, LPS stimulation promoted the reduction of PLK1, resulting in apoptosis and proliferation inhibition in intestinal epithelial cells, disrupting the intestinal epithelial barrier. These findings indicate that PLK1 might be a potential therapeutic target for the treatment of sepsis-induced intestinal barrier dysfunction.

Abstract Background Evidence concerning the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients with influenza A (H7N9) has been was limited to case reports. Our study is aimed to investigate the current application, efficacy and safety of ECMO in for severe H7N9 pneumonia-associated acute respiratory distress syndrome (ARDS) in the Chinese population. Methods A multicentre retrospective cohort study was conducted at 20 hospitals that admitted patients with avian influenza A (H7N9) viral pneumonia patients’ admission from 9 provinces in China between October 1, 2016, and March 1, 2017. Data from the National Health and Family Planning Commission of China, including general conditions, outcomes and ECMO management, were analysed. Then, successfully weaned and unsuccessfully weaned groups were compared. Results A total of 35 patients, aged 57 ± 1 years, were analysed; 65.7% of patients were male with 63% mortality. All patients underwent invasive positive pressure ventilation (IPPV), and rescue ventilation strategies were implemented for 23 cases (65.7%) with an average IPPV duration of 5 ± 1 d, PaO2/FiO2 of 78 ± 23 mmHg, tidal volume (VT) of 439 ± 61 ml and plateau pressure (Pplat) of 29 ± 8 cmH2O pre-ECMO. After 48 h on ECMO, PaO2 improved from 56 ± 21 mmHg to 90 ± 24 mmHg and PaCO2 declined from 52 ± 24 mmHg to 38 ± 24 mmHg. Haemorrhage, ventilator-associated pneumonia (VAP) and barotrauma occurred in 45.7%, 60% and 8.6% of patients, respectively. Compared with successfully weaned patients (n = 14), the 21 unsuccessfully weaned patients had a longer duration of IPPV pre-ECMO (6 ± 4 d vs. 2 ± 1 d, P

To accurately evaluate the influence of the uncertainty and correlation of photovoltaic (PV) output and load on the running state of power system, a probabilistic optimal power flow (POPF) calculation method based on adaptive diffusion kernel density estimation is proposed in this paper. First, based on the distribution characteristics of PV output, the adaptive diffusion kernel density estimation model of PV output is constructed, which can transform the kernel function into a linear diffusion process to achieve self-tuning of the bandwidth of the nuclear density estimation. This model can fit the distribution of arbitrary distribution of PV power, improve the local adaptability of PV output model, and reflect the uncertainty and volatility of PV output more accurately. Therefore, it can provide more accurate input for POPF calculation. Second, the Kendall rank correlation coefficient and the least Euclidean distance are used as correlation measure and index of fitting to select the optimal Copula function, and the joint probability distribution model of PV output and load is constructed. After extracting the correlated PV output and load samples, a POPF calculation method considering the correlation of PV output and load is proposed by using genetic algorithm (GA), which takes the lowest fuel cost of power generation as the objective function. Finally, simulation studies are conducted with the measured data of a PV power plant of China and the IEEE 30-bus power system. The results show that considering the correlation between PV output and load can improve the accuracy of POPF calculation and effectively reduce the power generation cost of the power system.

Objective Nonalcoholic Wernicke’s encephalopathy (WE) is a devastating neuropsychiatric syndrome caused by thiamine deficiency. Although many case reports on WE have been published, more studies are required to guide the diagnosis and treatment of nonalcoholic WE. Methods We retrospectively studied patients who were diagnosed with WE in our hospital. Data on demographics, possible causes, phenomenology, and diagnostic and treatment delays were abstracted from medical records by chart reviews. Results Seventeen patients were diagnosed with nonalcoholic WE. Nonalcoholic WE had many causes, such as gastrointestinal surgery, gastrointestinal tract diseases, vomiting, and psychiatric diseases. Most patients presented with abnormal mental symptoms, including those in a coma. Conclusion In summary, we recommend using operational criteria to diagnose and treat nonalcoholic WE as early as possible to avoid misdiagnosis and treatment delays. Nonalcoholic WE remains a clinical diagnosis, and certain examinations are helpful for this diagnosis, such as measuring serum thiamine concentrations. We should focus on patients who present with abnormal mental symptoms, even those in a coma, and administer parenteral thiamine before any carbohydrate to reduce the high frequency of residual morbidity.

Installing geosynthetic reinforcement at the bottom of the embankment will provide positive support for subgrade stability and settlement control, if there is a void or a weak foundation. In routine design work, the geomembrane effect must be well estimated and the tensile strain should be precisely predicted. Conventional analytical methods often adopt the limit state method to calculate the overlying load on the deflected geosynthetic. However, this assumption does not necessarily apply to all conditions, especially when the foundation soil can provide certain resistance. In this study, a semiempirical prediction method for evaluating the geomembrane effect of the basal reinforcement was proposed, and an iterative solution for calculating tensile strains of a deflected geosynthetic was deduced. In derivation, a virtual inclined slip surface and interaction between the geosynthetic and soil were quantitatively evaluated by coupling the arching effect and the geomembrane effect. Moreover, the development of shear stress along the slip surface can be considered, as well as different segments of the basal reinforcement. Then, the proposed method was validated by two large-scale experiments. Comparison of the results of this method with measurements and results of other analytical models confirmed that this analytical method can take good care of the varying process of the localized sinking, regarding the overlying loads on the geosynthetic and the subsequent tensile strains.

The Cambrian carbonate & evaporite paragenesis system in the Sichuan Basin is made up of the Longwangmiao, Gaotai and Xixiangchi Fms. So far, great breakthrough has been made only in the Longwangmiao Fm instead of the latter two, and the Anyue Gasfield was discovered in the center of this basin. In this paper, therefore, the Cambrian carbonate & evaporite paragenesis system in the Sichuan Basin was analyzed in terms of its structural–sedimentary setting, sequence stratigraphic framework, sedimentary facies and the distribution of evaporites by using various geologic, logging and seismic data. Then, the geological model of sedimentary facies was established and the distribution range of favorable reservoirs was predicted. Based on these studies, the following results are obtained. Firstly, the palaeotectonic framework is characterized by the style of “one depression between two uplifts” in the setting of a large SE dipping slope, and the stratigraphic filling is in the structure of “onlapping at the bottom and truncation at the top” which is thin in the west and thick in the east. Secondly, three third-order sequence cycles which, on the whole, become shallow upward are developed from bottom to top, and gypsum-salt rocks are mainly located at the high system tract (HST) of third-order sequences and concentrated in the Wanzhou–Yibin sag. Thirdly, the geological model of sedimentary facies is composed of three major sedimentary structural layers from bottom to top, namely the evaporative carbonate ramp, the evaporative diamictic restricted platform and the evaporative restricted platform. The sedimentary environment changes from the open to the closed and the penesaline for a long time, and then back to the open. The distribution of shoals changes from the pattern of “dual banks” in a large area to more scattered shoals and banded shoals, while the evaporative lagoon and tidal flat shrink. Fourthly, the reservoir distribution is complicated and mainly controlled by the sedimentary pattern of palaeotectonics, the grain shoals and the exposed surfaces of sequences with different orders. The favorable areas for reservoir development are located above the paleo-uplift and its surroundings, at the slope-break belt in the platform and in the periphery of platform margin.

The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies. 35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow–time and airway pressure–time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity. We determined: 1) sensitivity, specificity, and positive and negative predictive values; 2) the correlation between the double true index (DTI) of each report (i.e., the ratio between the sum of true positives and true negatives, and the overall breath count) and the corresponding asynchrony index (AI); and 3) the influence of breathing pattern and respiratory drive on both AI and sensitivity. Sensitivities to detect asynchronies were low either according to experience (0.20 (95% CI 0.14–0.29) for expert versus 0.21 (95% CI 0.12–0.30) for nonexpert, p=0.837) or interface (0.28 (95% CI 0.17–0.37) for mask versus 0.10 (95% CI 0.05–0.16) for helmet, p

Through analyzing the nature and periods of Tongwan tectonization, by using seismic data, drilling data and outcrop data, the pre-Qiongzhusi Formation eroded paleo-geomorphology was described with remaining thickness and moldic methods, and the hydrocarbon accumulation conditions were analyzed. The Sichuan Basin and its adjacent areas experienced Tongwan tectonization from late Sinian to early Cambrian which include three episodes that all manifested as regional uplift and erosion, forming three disconformities. Affected by that movement, a large scale Deyang-Luzhou eroded valley in N-S direction was formed in Central-Southern Sichuan Basin. In the valley, thick Maidiping Formation and Qiongzhusi Formation are Cambrian important source kitchens; they form good source-reservoir combinations with two sets of weathering karst reservoirs in Deng 2 and Deng 4 Member in Dengying Formation, favorable for the formation of large gas field with huge resource potential. The analysis of forming mechanism and evolution history of the eroded valley shows the thrusting-fold uplifting and erosion in the second episode of Tongwan tectonization in late Sinian period, and the extensional movement in the background of rapid marine transgression in early Cambrian are key to the formation of the eroded valley. Key words: Tongwan tectonization, paleohigh, Dengying Formation, Qiongzhusi Formation, source-reservoir combination, Sichuan Basin

To investigate the deformation and damping characteristics of cement treated and expanded polystyrene (EPS) beads mixed lightweight soils, this study conducted a series of triaxial shear tests cyclic loading for different confining pressures, cement contents, and soil categories. Through repeated loading and unloading cycles, axial accumulative strain, resilient modulus, and damping ratio versus axial total strain were analyzed and the mechanical behavior was revealed and interpreted. Results show that the resilient modulus increases with increasing confining pressure and cement content. A decreasing power function can be used to fit the relationship between the resilient modulus and the axial total strain. Although sandy lightweight specimens usually own higher resilient modulus than silty clay lightweight specimens do, the opposite was also found when the axial total strain is larger than 8% with 50 kPa confining pressure and 14% cement content. For damping ratio the EPS beads mixed lightweight soil yields a weak growth trend with increasing axial total strain and a small reduction with higher confining pressure and cement content. For more cementations, the damping ratio of the sandy lightweight soil is always smaller than the silty clay lightweight soil. Nonetheless, the differences of damping ratios that were obtained under all of the test conditions are not significant.