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The novel coronavirus (COVID-19) pandemic has spread over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19 in an internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from non-duplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020. About 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7±13.5 years, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2±3.8 days (median: 1). The mean duration from diagnosis to death was 9.9±7.0 days (median: 9). About 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%) and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%) and respiratory failure (11.9%) are the top three direct causes of death. COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China.
The clinical records of 144 patients referred to Yancheng City No.1 People’s Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed.
Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%.
Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.
Maternal supraphysiological estradiol (E2) environment during pregnancy leads to adverse perinatal outcomes. However, the influence of oocyte exposure to high E2 levels on perinatal outcomes remains unknown. Thus, a retrospective cohort study was conducted to explore the effect of high E2 level induced by controlled ovarian stimulation (COH) on further outcomes after frozen embryo transfer (FET). The study included all FET cycles (n = 10,581) between 2014 and 2017. All cycles were categorized into three groups according to the E2 level on the day of the human Chorionic Gonadotropin trigger. Odds ratios (ORs) and their confidence intervals (CIs) were calculated to evaluate the association between E2 level during COH and pregnancy outcomes and subsequent neonatal outcomes. From our findings, higher E2 level was associated with lower percentage of chemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth as well as increased frequency of early miscarriage. Preterm births were more common among singletons in women with higher E2 level during COH (aOR1 = 1.93, 95% CI: 1.22–3.06; aOR2 = 2.05, 95% CI: 1.33–3.06). Incidence of small for gestational age (SGA) was more common in both singletons (aOR1 = 2.01, 95% CI: 1.30–3.11; aOR2 = 2.51, 95% CI: 1.69–3.74) and multiples (aOR1 = 1.58, 95% CI: 1.03–2.45; aOR2 = 1.99, 95% CI: 1.05–3.84) among women with relatively higher E2 level. No association was found between high E2 level during COH and the percentage of macrosomia or large for gestational age. In summary, oocyte exposure to high E2 level during COH should be brought to our attention, since the pregnancy rate decreasing and the risk of preterm birth and SGA increasing following FET.
The aim of this study is to characterize the injury profiles and outcomes of victims of a tornado in Jiangsu Province, China.
This study retrospectively investigated the clinical records of 144 patients treated at a teaching hospital due to a tornado. Each patient’s demographic data, diagnosis, injury types, causes of injury, infection status, and outcomes were all reviewed.
Of the 144 patients, 64 (44.4%) were male, and 80 (55.6%) were female. The patients’ ages ranged from 2 months to 94 years; 91 (63.19%) were admitted within the first 12 h after the disaster. The most frequently injured sites were the body surfaces (24.48%), followed by the limbs and pelvis (21.79%) and chest (20.3%). Soft-tissue injuries and fractures were the most frequent injuries. Traumatic brain injuries were the main causes of death. Tornado-related injuries were primarily caused by flying/falling bricks, wood, and glass. Twenty-three (15.9%) patients suffered from infections, which consisted mainly of skin/soft tissue infections and pneumonia.
Destructive tornadoes often cause heavy casualties with little warning. Medical aid agencies must be prepared to accommodate the massive numbers of injured patients after a catastrophe. Proper triage and prompt treatment of injured victims may decrease mortality. (Disaster Med Public Health Preparedness. 2019;xx:xxx-xxx).
Permian faunal affinity in the Lhasa Block plays a critical role in reconstructing its paleogeographic evolution. Cisuralian and Guadalupian faunas have been described from the Lhasa Block, but very few Lopingian (late Permian) brachiopods have been reported so far. In this paper, a new diverse brachiopod fauna consisting of 17 species of 17 genera and an unidentifiable Orthotetoidea is described from the uppermost part of the Xiala Formation at the Aduogabu section in the central part of the Lhasa Block. The age of this fauna can be assigned to the Changhsingian (late Lopingian) as indicated by the associated foraminifers Colaniella parva (Colani, 1924) and Reichelina pulchra Miklukho-Maklay, 1954. Characteristic brachiopods include Spinomarginifera chengyaoyenensis Huang, 1932, Haydenella wenganensis (Huang, 1932), and Araxathyris cf. dilatatus Shen, He, and Zhu, 1992. They also generally suggest a Changhsingian age. Paleobiogeographically, this fauna is uniformly composed of typical Tethyan elements represented by Spinomarginifera Huang, 1932 and Haydenella Reed, 1944, and some cosmopolitan elements, but no typical cold-water taxa of Gondwanan affinity. This is in contrast to the contemporaneous brachiopod faunas from the Tethys Himalayan region that are characterized by typical cold-water taxa of Gondwanan affinity, e.g., Costiferina indica (Waagen, 1884), Retimarginifera xizangensis Shen et al., 2000, Neospirifer (Quadrospina) tibetensis Ding, 1962. Thus, it is strongly indicative that the Lhasa Block had drifted into a relatively warm-water regime during the Changhsingian. An analysis of the paleobiogeographic change of brachiopods in the Lhasa Block throughout the entire Permian further suggests that the Lhasa Block probably had rifted away from the northern peri-Gondwanan margin between the latest Cisuralian and middle Guadalupian, that is, the Neotethys Ocean had opened before middle Guadalupian.
The oxidation behavior of two percentages of TiB + TiC reinforced Ti–6Al–4V composites derived from Ti–B4C–C and Ti–TiB2–TiC systems was investigated at 873–1073 K for 320 h in air. The oxidation weight gain curves of the (TiB + TiC)/Ti–6Al–4V composites at 973 K basically obey parabolic law, while those at 873 and 1073 K mainly follow linear law and parabolic-linear law, respectively. The oxide layers of the composites are predominately found to be rutile TiO2, Al2O3, and the mixture of V2O3 and V2O5. The oxidation layers turn thinner with increasing the nominal volume fraction of reinforcements in the (TiB + TiC)/Ti–6Al–4V composites. Moreover, according to the calculation results of reaction index (n) and effective activation energy (Qeff) and the analyses of cross-sections of the oxidation layers, the oxidation resistance ability of the composites from Ti–TiB2–TiC system is higher than that from Ti–B4C–C system while employing the same sintering temperature and nominal volume fraction of reinforcement.
The current transient was studied on AlGaN/GaN HEMTs for RF power amplifiers under different temperatures. The current transient measurements include two different approaches. One is to measure the current transient from off-state (without bias) to a quiescent point (Q-point). Different transient behaviors were observed while switching to different Q-points. Another one is to measure the current transient from different currents to the Q-point of VDS = 28 V and ID = 100 mA/mm. The different currents before switching to Q-point of VDS = 28 V and ID = 100 mA/mm show the different transient characteristics. Most of the current transient demonstrates temperature independence in this study.
Numerous efforts have been devoted to the derivation of equations describing the kinematics of finite-size spherical particles in arbitrary fluid flows. These approaches rely on asymptotic arguments to obtain a description of the particle motion in terms of a slow manifold. Here we present a novel approach that results in kinematic models with unprecedented accuracy compared with traditional methods. We apply a recently developed machine learning framework that relies on (i) an imperfect model, obtained through analytical arguments, and (ii) a long short-term memory recurrent neural network. The latter learns the mismatch between the analytical model and the exact velocity of the finite-size particle as a function of the fluid velocity that the particle has encountered along its trajectory. We show that training the model for one flow is sufficient to generate accurate predictions for any other arbitrary flow field. In particular, using as an exact model for trajectories of spherical particles, the Maxey–Riley equation, we first train the proposed machine learning framework using trajectories from a cellular flow. We are then able to accurately reproduce the trajectories of particles having the same inertial parameters for completely different fluid flows: the von Kármán vortex street as well as a two-dimensional turbulent fluid flow. For the second example we also demonstrate that the machine learned kinematic model successfully captures the spectrum of the particle velocity, as well as the extreme event statistics. The proposed scheme paves the way for machine learning kinematic models for bubbles and aerosols using high-fidelity DNS simulations and experiments.
Maternal dietary patterns and macronutrients intake have been shown to affect the development of gestational diabetes mellitus (GDM), but the findings are inconsistent. We aimed to identify maternal dietary patterns and examine their associations with GDM risk, and to evaluate the contributions of macronutrients intake to these associations. We included 2755 Chinese pregnant women from the Tongji Maternal and Child Health Cohort. Dietary intakes were assessed using a validated semi-quantitative FFQ 2 weeks before the diagnosis of GDM. GDM (n 248) was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24–28 weeks gestation. We derived five different dietary patterns from a principal component analysis. The results showed that high fish–meat–eggs scores, which were positively related to protein intake and inversely related to carbohydrate intake, were associated with a higher risk of GDM (adjusted OR for quartile 4 v. quartile 1: 1·83; 95 % CI 1·21, 2·79; Ptrend=0·007) and higher plasma glucose levels. In contrast, high rice–wheat–fruits scores, which were positively related to carbohydrate intake and inversely related to protein intake, were associated with lower risk of GDM (adjusted OR for quartile 3 v. quartile 1: 0·54; 95 % CI 0·36, 0·83; Ptrend=0·010) and lower plasma glucose levels. In addition, dietary protein and carbohydrate intake significantly contributed to the associations between dietary patterns and GDM risk or glucose levels. These findings suggest that a dietary pattern characterised by high protein and low carbohydrate intake in pregnancy was associated with a higher risk of GDM, which may provide important clues for dietary guidance during pregnancy to prevent GDM.
Two new species of egg parasitoids, Oobius saimaensis Yao and Mottern new species and Oobius fleischeri Yao and Duan new species (Hymenoptera: Encyrtidae), are described from eggs of Agrilus fleischeri Obenberger, 1925 (Coleoptera: Buprestidae). Agrilus fleischeri is a phloem-feeding woodborer of poplar (Populus Linnaeus; Salicaceae) in northeastern China. These two species can be distinguished morphologically as O. fleischeri has five tarsomeres and O. saimaensis has four tarsomeres. Although O. saimaensis is morphologically similar to its sympatric congener O. agrili Zhang and Hang, 2005, an important natural enemy of the invasive emerald ash borer, Agrilus planipennis Fairmaire, 1888, molecular phylogenetics and morphological data indicate that they are distinct species. Phylogenetic relationships among the new species and other closely related species are also inferred by using DNA sequence data from several ribosomal and mitochondrial genes. In addition, we expand the known distribution of Oobius primorskyensis Yao and Duan, 2016 to include South Korea.
To examine the associations of vegetable and/or fruit consumption with metabolic syndrome (MetS).
Meta-analysis of observational studies.
The electronic databases of PubMed, Web of Science and EMBASE were searched up to September 2017 for observational studies concerning the associations of vegetable and/or fruit consumption with MetS. The pooled relative risk (RR) of MetS for the highest v. the lowest category of vegetable and/or fruit consumption, as well as their corresponding 95 % CI, were calculated.
A total of twenty-six observational studies (twenty cross-sectional, one case–control and five cohort studies) were included in the meta-analysis. Specifically, sixteen studies were related to vegetable consumption and the overall multivariable-adjusted RR evidenced a negative association between vegetable consumption and MetS (RR=0·89, 95 % CI 0·85, 0·93; P<0·001). For fruit consumption, sixteen studies were included and the overall multivariable-adjusted RR demonstrated that fruit consumption was inversely associated with MetS (RR=0·81, 95 % CI 0·75, 0·88; P<0·001). For vegetable and fruit consumption, eight studies were included; the overall multivariable-adjusted RR showed that vegetable and fruit consumption was also negatively associated with MetS (RR=0·75, 95 % CI 0·63, 0·90; P=0·002).
The existing evidence suggests that vegetable and/or fruit consumption is negatively associated with MetS. More well-designed prospective cohort studies are needed to elaborate the concerned issues further.
For the first time, an experiment has been conducted to investigate synthetic jet laminar vortex rings impinging onto porous walls with different geometries by time-resolved particle image velocimetry. The geometry of the porous wall is changed by varying the hole diameter on the wall (from 1.0 mm to 3.0 mm) when surface porosity is kept constant (
). The finite-time Lyapunov exponent and phase-averaged vorticity field derived from particle image velocimetry data are presented to reveal the evolution of the vortical structures. A mechanism associated with vorticity cancellation is proposed to explain the formation of downstream transmitted vortex rings; and both the vortex ring trajectory and the time-mean flow feature are compared between different cases. It is found that the hole diameter significantly influences the evolution of the flow structures on both the upstream and downstream sides of the porous wall. In particular, for a porous wall with a small hole diameter (
, 0.10 and 0.133), the transmitted finger-type jets will reorganize into a well-formed transmitted vortex ring in the downstream flow. However, for the case of a large hole diameter of
, the transmitted vortex ring is not well formed because of insufficient vorticity cancellation. Additionally, the residual vorticity gradually evolves into discrete jet-like structures downstream, which further weaken the intensity of the transmitted vortex ring. Consequently, the transmitted flow structures for the
case would lose coherence more easily (or probably even transition to turbulence), resulting in a faster decay of the axial velocity and stronger entrainment of the transmitted jet. For all porous wall cases, the velocity profile of the transmitted jet exhibits self-similar behaviour in the far field (
), which agrees well with the velocity distribution of free synthetic jets. With the help of the control-volume approach, the time-mean drag of the porous wall is evaluated experimentally for the first time. It is shown that the porous wall drag increases with the decrease in the hole diameter. Moreover, for a porous wall with a small hole diameter (
, 0.10 and 0.133), it appears that the porous wall drag mainly derives from the viscous effect. However, as
increases to 0.20, the form drag associated with the porous wall geometry becomes significant.
In this study, AlGaN/GaN MIS-HEMTs with a p-GaN cap layer and ALD deposited Al2O3 gate insulator were fabricated. Devices with two different thicknesses of p-GaN cap layers were investigated and compared. AlGaN/GaN MIS-HEMT with an 8-nm p-GaN cap showed a better DC characteristics than device with a 5-nm p-GaN cap. The drain current of 662.9 mA/mm, a high on/off current ratio of 2.67×109 and a breakdown voltage of 672 V were measured in device with an 8-nm p-GaN cap. In addition, lateral leakage current was investigated by using adjacent MIS gate structures with a separation of 3 μm to investigate the leakage current.
In this study, AlGaN/GaN high electron mobility transistors (HEMTs) with a two-dimensional hole gas (2DHG) were investigated. In addition to a two-dimensional electron gas (2DEG) formed at the interface of the AlGaN and GaN layers for being a channel, a 2DHG was designed and formed underneath the channel to be the back gate. The simulated results showed the operation of device can be depletion-mode and enhancement-mode by adjusting the back gate bias. The fabricated devices showed the feasibility of 2DHG back gate control.
Ni/Sn–xZn/Ni (x = 1, 5, 9 wt%) joints were used to investigate the effect of Zn content on interfacial reactions during reflow under a temperature gradient. Asymmetrical growth and transformation of intermetallic compounds (IMCs) occurred between the cold and hot end interfaces. Faster IMC growth at the cold end and a more prompt IMC transformation at the hot end in a lower Zn content solder joint were identified due to the more thermomigration-induced Zn and Ni atomic fluxes toward the cold end. The main diffusion species into IMC layers changed from Zn atoms at the early stage to Sn and Ni atoms at the later stage. As a result, the IMC evolution followed (Ni,Zn)3Sn4 → Ni3Sn4 in the Ni/Sn–1Zn/Ni joint, Ni5Zn21 → τ phase → Ni3Sn4 in the Ni/Sn–5Zn/Ni joint, and Ni5Zn21 → τ phase in the Ni/Sn–9Zn/Ni joint along with the reflow time. A higher Zn content could effectively inhibit the dissolution of the hot-end Ni substrate and restrain the growth rate of the cold-end interfacial IMCs.
By reflowing Cu/Sn/Ni ultrafine interconnects under a temperature gradient, a new transient liquid phase (TLP) bonding process was proposed for three-dimensional packaging applications. The evolution of the dominant (Cu,Ni)6Sn5 intermetallic compounds depends strongly on the temperature gradient. The essential cause of such dependence is attributed to the different amounts of Cu and Ni atomic fluxes being introduced into the liquid solder. Under the coupling effect of thermomigration and Cu–Ni cross-interaction, the total atomic flux of Cu and Ni is promoted. As a result, the growth of dense (Cu,Ni)6Sn5 is significantly accelerated and the formation of Cu3Sn is eliminated. The new TLP bonding process consumes only a limited amount of the Ni substrate, but much more from the Cu substrate. The mechanism for the new TLP bonding process is discussed and experimentally verified in this study.
The effects of different Fe contents (0.168, 0.356 and 0.601 wt%) on microstructures and mechanical properties of the Al–1.6Mg–1.2Si–1.1Cu–0.15Cr–0.15Zr (all in wt%) alloys prepared by low frequency electromagnetic casting process were investigated in the process of solidification, hot extrusion, solid solution and aging treatments. The results show that the increase of Fe content promotes the formation of feathery grains in the process of solidification and the precipitation of another important strengthening phase Q′ with small size. Additionally, it also results in no recrystallization even after solid solution at a high temperature of 550 °C, which is because of the increase number of elliptical shaped and fine DO22-Al3Zr dispersoids (∼70 nm long and ∼35 nm wide) and the spherical or elliptical shaped Fe-containing phases. When Fe content of the alloy increases to 0.356 wt%, both the ultimate tensile strength and yield strength of the alloy-T6 increase by more than 60 MPa and with little cost of ductility.
Synchrotron radiation real-time imaging technology was performed to in situ study the Cu–Ni cross-interaction in Cu/Sn/Ni solder joints under temperature gradient during soldering. The direction of temperature gradient significantly influenced the Cu–Ni cross-interaction. When Ni was the hot end, both Cu and Ni atoms could diffuse to the opposite interfaces, resulting in the occurrence of the Cu–Ni cross-interaction at both interfaces. The consumption of the Cu cold end was abnormally large, whereas that of the Ni hot end was limited. When Cu was the hot end, only Cu atoms could diffuse to the opposite interface, resulting in the occurrence of the Cu–Ni cross-interaction only at the cold end. The Cu hot end was seriously consumed, whereas the Ni cold end was still intact. The interfacial intermetallic compounds were always thicker at the cold end than at the hot end, especially at the Ni/Sn cold end. Cu imposed more damaging effect than Ni under temperature gradient. Based on the atomic fluxes, a model was proposed to discuss the effect of temperature gradient on the Cu–Ni cross-interaction and the interfacial reactions in the Cu/Sn/Ni solder joints.
To investigate natural enemies of emerald ash borer (EAB), Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), in northeastern China, we conducted field surveys of ash (Fraxinus Linnaeus (Oleaceae)) trees in semi-natural forests and plantations at variable EAB densities from 2008 to 2013. Our surveys revealed a complex of natural enemies including eight hymenopteran parasitoids and two apparently parasitic Coleoptera, woodpeckers, and several undetermined mortality factors. Parasitoid complex abundance and its contribution to EAB mortality varied with the time of year, type of ash stands, and geographic regions. The egg parasitoid Oobius agrili Zhang and Huang (Hymenoptera: Encyrtidae) and the larval parasitoid Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae) were frequently observed in Jilin, Liaoning, and Heilongjiang provinces and in Beijing, but not in Tianjin. Spathius agrili Yang (Hymenoptera: Braconidae), however, was more prevalent near Beijing and further south in Tianjin. Larvae of two species of apparently parasitic beetle, Tenerus Laporte (Coleoptera: Cleridae) species and Xenoglena quadrisignata Mannerheim (Coleoptera: Trogossitidae), were also recovered attacking overwintering EAB in Liaoning Province, with Tenerus species being a dominant mortality agent (~13%). Our findings support the need to consider the geographic origin of insect natural enemies for EAB biocontrol, as well as an expanded foreign exploration for EAB natural enemies throughout its native range in Asia.