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Objectives: Among many risk factors for preeclampsia (PE), prepregnancy body mass index (BMI) is one of few controllable factors. However, there is a lack of stratified analysis based on the prepregnancy BMI. This study aimed to determine the influencing factors for PE and assess the impact of PE on obstetric outcomes in twin pregnancies by prepregnancy BMI., Methods: This was a retrospective cohort study between January 1, 2017, and December 31, 2022, in Southwest China. Impact factors and associations between PE and obstetric outcomes were analyzed separately for twin pregnancies with prepregnancy BMI < 24kg/m 2 (non-overweight group) and BMI ≥ 24kg/m 2 (overweight group)., Results: In total, 3602 twin pregnancies were included, of which, 672 women were allocated into the overweight group and 11.8% of them reported with PE; 2930 women were allocated into the non-overweight group, with a PE incidence of 5.6%. PE had a negative effect on birthweight and increased the incidence of neonatal intensive care unit admission in both the overweight and non-overweight groups (43.0% vs. 28.0%, p  = .008 ; 45.7% vs. 29.1%, p  < .001). Among overweight women, PE increased the proportion of postpartum hemorrhage (15.2% vs. 4.4%, p  < .001). After adjustments, multivariate regression analysis showed that excessive gestational weight gain (aOR = 1.103, 95% CI: 1.056-1.152; aOR = 1.094, 95% CI: 1.064-1.126) and hypoproteinemia (aOR = 2.828, 95% CI: 1.501-5.330; aOR = 6.932, 95% CI: 4.819-9.971) were the shared risk factors for PE in both overweight and non-overweight groups. In overweight group, in vitro fertilization was the other risk factor (aOR = 2.713, 95% CI: 1.183-6.878), whereas dichorionic fertilization (aOR = 0.435, 95% CI: 0.193-0.976) and aspirin use during pregnancy (aOR = 0.456, 95% CI: 0.246-0.844) were protective factors. Additionally, anemia during pregnancy (aOR = 1.542, 95% CI: 1.090-2.180) and growth discordance in twins (aOR = 2.451, 95% CI: 1.215-4.205) were connected with an increased risk of PE only in non-overweight twin pregnancies., Conclusions: Both discrepancy and similarity of impact factors on developing PE were found between overweight and non-overweight twin pregnancies in this study. However, the dosage and initiation time of aspirin, as well as twin chorionicity on the occurrence of PE in two subgroups, are still debated.

Recently, short-fiber-reinforced thermoplastic composites (SFRTPCs) have been playing a more and more crucial role in the application of automotive interior materials due to their advantages of low density and environmental resistance properties. However, their relevant mechanical properties need to be optimized. Previous investigations revealed that the surface modification of fibers is useful to improve their mechanical properties. In this work, carbon fiber (CF)-reinforced polylactic acid (PLA) composites modified with MXene and graphene oxide (GO) were prepared by twin-screw extrusion and injection molding methods. Short CF was firstly modified with polyetherimide (PEI), then different weight ratios of MXene-GO (1:1) were subsequently modified on PEI-CF. Finally, the flexural properties and failure mechanisms were analyzed. The results showed that MXene-GO was successfully coated on CF surface, and the flexural strength and modulus of CF-PEI-MXene-GO-reinforced PLA (CF-PEI-MG/PLA) composite were improved compared to that of CF/PLA composite. In addition, the fracture sections of the composites were flat and white, and the fibers bonded well with PLA for CF-PEI-0.1MG/PLA composite compared to CF/PLA composite. The present study could provide a reference for further improving the mechanical performance of PLA-related composites.

Precipitation is a vital component of the global atmospheric and hydrological cycles and influencing the distribution of water resources. Even subtle changes in precipitation can significantly impact ecosystems, energy cycles, agricultural production, and food security. Therefore, understanding the changes in the precipitation structure under climate change is essential. The Qinghai-Tibet Plateau (QTP) is a region sensitive to global climate change and profoundly impacts the atmospheric water cycle in Asia and even globally, rendering it a hot topic in climate change research in recent years. Few studies have examined on the sub-daily scale precipitation structure over the QTP. In this paper, the characteristics of sub-daily precipitation on the QTP were systematically investigated from multiple perspectives, including the concentration index, skewness (the third standardized moment of a distribution), and kurtosis (the fourth standardized moment of a distribution). The results indicated that the frequency of moderate-intensity nighttime precipitation on the QTP generally increased, and the analysis of both the concentration index and kurtosis (skewness) suggested that extreme precipitation was more frequent in the southwestern foothills of the QTP. Furthermore, potential high-risk areas for natural disasters were identified on the QTP, and found that the southeastern part of the plateau constituted a potential hotspot area for flood disasters. Given the complexity of climate change, a comprehensive analysis of the spatiotemporal characteristics of diurnal and nighttime precipitation changes on the QTP could help reveal the regularity of precipitation changes. This has significant implications for forecasting, warning, disaster preparedness, and mitigation efforts on the QTP., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jun Qiu, Fang-Fang Li reports financial support was provided by National Natural Science Foundation of China. Jun Qiu, Fang-Fang Li reports financial support was provided by Key R&D program of Science and Technology Department of Tibet. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and outbreaks have occurred worldwide. Laboratory test results are an important basis for clinicians to determine patient condition and formulate treatment plans., Methods: Fifty-two thousand six hundred forty-four laboratory test results with continuous values of adult inpatients who were diagnosed with COVID-19 and hospitalized in the Fifth Hospital in Wuhan between 16 January 2020 and 18 March 2020 were compiled. The first and last test results were compared between survivors and non-survivors with variance test or Welch test. Laboratory test variables with significant differences were then included in the temporal change analysis., Results: Among 94 laboratory test variables in 82 survivors and 25 non-survivors with COVID-19, white blood cell count, neutrophil count/percentage, mean platelet volume, platelet distribution width, platelet-large cell percentage, hypersensitive C-reactive protein, procalcitonin, D-dimer, fibrin (ogen) degradation product, middle fluorescent reticulocyte percentage, immature reticulocyte fraction, lactate dehydrogenase were significantly increased (P < 0.05), and lymphocyte count/percentage, monocyte percentage, eosinophil percentage, prothrombin activity, low fluorescent reticulocyte percentage, plasma carbon dioxide, total calcium, prealbumin, total protein, albumin, albumin-globulin ratio, cholinesterase, total cholesterol, nonhigh-density/low-density/small-dense-low-density lipoprotein cholesterol were significantly decreased in non-survivors compared with survivors (P < 0.05), in both first and last tests. Prothrombin time, prothrombin international normalized ratio, nucleated red blood cell count/percentage, high fluorescent reticulocyte percentage, plasma uric acid, plasma urea nitrogen, cystatin C, sodium, phosphorus, magnesium, myoglobin, creatine kinase (isoenzymes), aspartate aminotransferase, alkaline phosphatase, glucose, triglyceride were significantly increased (P < 0.05), and eosinophil count, basophil percentage, platelet count, thrombocytocrit, antithrombin III, red blood cell count, haemoglobin, haematocrit, total carbon dioxide, acidity-basicity, actual bicarbonate radical, base excess in the extracellular fluid compartment, estimated glomerular filtration rate, high-density lipoprotein cholesterol, apolipoprotein A1/ B were significantly decreased in non-survivors compared with survivors (P < 0.05), only in the last tests. Temporal changes in 26 variables, such as lymphocyte count/percentage, neutrophil count/percentage, and platelet count, were obviously different between survivors and non-survivors., Conclusions: By the comprehensive usage of the laboratory markers with different temporal changes, patients with a high risk of COVID-19-associated death or progression from mild to severe disease might be identified, allowing for timely targeted treatment.

Three-dimensional (3D) five-directional braided composites are extensively applied in aeronautics and national defense due to their integrity and structural superiorities. In this paper, 3D five-directional braided carbon/epoxy composites were manufactured, and the high temperature mechanical response and failure mechanisms of composites with braiding angles of 21° and 32° were studied. The out-of-plane compression tests of composites with different braiding angles were conducted at temperatures ranging from 25 °C to 180 °C. Then compression stress-strain curves, compression mechanical response, and failure modes of composites at high temperatures were analyzed and compared. The results show that compression stress-strain curves linearly increased at the initial stage and dropped at various degrees at different temperatures for composites with different braiding angles. The temperature and braiding angle were both important parameters affecting out-of-plane compression properties of 3D five-directional braided composites. Mechanical properties decreased with increasing temperature for both 21° and 32° specimens. Moreover, composites with a small braiding angle possessed higher properties at each temperature point. The morphologies manifested that the failures were a symmetric ±45° shear crack for 21° specimens and a thorough 45° shear crack for 32° specimens, and a 45° fracture weakened with increasing temperature.

Aim: To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques (VNTPST) in endoscopic retrograde cholangiopancreato-graphy (ERCP) due to difficult biliary duct cannulation (DBC)., Methods: A plough-like pull-type sphincterotome (PLPTS) or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy (EST)., Results: A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP (89.1%, 247/277), 30 failed (10.8%, 30/277). VNTPS technique succeeded in 24 (80%, 24/30) of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% (24/277), the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups (97.7% vs 89.1%, c2 = 17.1, P < 0.01). The incidence of complications was 9.3% (26/277) for traditional ERCP group and 13.3% (4/30) for VNTPS technique group. Guideline tip was broken in pancreatic duct (KPDGP) of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation (PDWN). There were no differences between VNTPS technique group and traditional ERCP (TRERCP) group (13.3% vs 9.3%, c2 = 0.478, P > 0.05)., Conclusion: VNTPS procedure and Deng's precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng's precut is as effective and safe as EST. This technique can be well performed in hospitals without particular equipments.