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The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.
We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.
Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 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%), and 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 3 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.
Evidence has suggested that honey intake has a beneficial impact on glycaemic control in patients with type 2 diabetes. Whether these findings apply to adults with prediabetes is yet unclear. The aim of the present study was to examine whether honey intake is associated with a lower prevalence of prediabetes. A cross-sectional study was performed in 18 281 participants (mean age 39·6 (sd 11·1) years; men, 51·5 %). Dietary intake was assessed through a validated 100-item FFQ. Prediabetes was defined according to the American Diabetes Association criteria: impaired fasting glucose, impaired glucose tolerance or raised glycosylated Hb. Multivariable logistic regression models were used to estimate the association between honey consumption and prediabetes. As compared with those who almost never consumed honey, the multivariable OR of prediabetes were 0·94 (95 % CI 0·86, 1·02) for ≤3 times/week, 0·77 (95 % CI 0·63, 0·94) for 4–6 times/week and 0·85 (95 % CI 0·73, 0·99) for ≥1 time/d (Pfor trend < 0·01). These associations did not differ substantially in sensitivity analysis. Higher honey consumption was associated with a decreased prevalence of prediabetes. More large prospective cohort studies are needed to investigate this association.
A magnetic dipole quasi-Yagi antenna based on a dielectric resonator (DR) is proposed in this letter. The dominate TE1δ1 mode of the rectangular DR is used as a magnetic dipole which can be differentially fed by the coplanar strip line (CPS). Thanks to the DR employment, the proposed antenna has several advantages such as compact size and flexible design which means the 3-D dimensions of the DR can be easily adjusted to cater for various applications. Meanwhile, the gain of the proposed DR quasi-Yagi antenna is higher than that of traditional electric dipole counterparts. Furthermore, since the DR driver is horizontally polarized, both the metal strip and DR can be used as a director for enhancing the end-fire gain. To verify the design concept, a prototype operating at the X-band is fabricated and measured. Good agreement between the simulated and measured results can be observed.
This study aimed to determine whether increased carotenoids intake was associated with reduced risk of gestational diabetes mellitus (GDM). We performed a cross-sectional analysis using data from Tongji Maternal and Child Health Cohort study. The dietary carotenoids intake of 1978 pregnant women was assessed using a researcher-administered FFQ before undertaking an oral glucose tolerance test at 24–28 weeks. Multivariate logistic and linear regression analyses were used to obtain the effect estimates. Participants in the highest quartile of lycopene intake showed a lower risk of GDM (OR 0·50; 95 % CI 0·29, 0·86; Pfor trend = 0·007) compared with those in the lowest quartile; each 1 mg increase in lycopene consumption was associated with a 5 % (95 % CI 0·91, 0·99; Pfor trend = 0·020) decrease in GDM risk. No significant association was found between α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin intake and GDM risk. Multiple linear regression analysis suggested an inverse association between lycopene intake and fasting blood glucose (FBG) (Pfor trend < 0·001); each 1 mg increase in lycopene intake was associated with 0·005 (95 % CI 0·002, 0·007; Pfor trend < 0·001) mmol/l decrease in FBG. Interaction analysis indicated consistent effect on each age or pre-BMI subgroup; however, a stronger protective effect of lycopene intake against GDM was observed among primigravid women (OR 0·20; 95 % CI 0·07, 0·55 in the highest v. the lowest quartile of intake; Pfor interaction = 0·036). In conclusion, dietary lycopene intake was mainly assumed via reducing FBG to decrease GDM risk, and the protection was relatively increased among primigravid women.
There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder.
Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months.
Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up.
Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.
In a rice (Oryza sativa L.)–wheat (Triticum aestivum L.) rotation system, a study was conducted to determine the effects of different fertilization regimens (no fertilization, replacement of a portion of chemical fertilizer with composted pig manure, chemical fertilizer only, and straw return combined with chemical fertilizer) on the weed communities and wheat yields after 4 and 5 yr. The impact of the long-term recurrent fertilization regimen initiated in 2010 on the composition and diversity of weed communities and the impact of the components and total amount of fertilizer on wheat yields were assessed in 2014 and 2015. Totals of 19 and 16 weed species were identified in experimental wheat fields in 2014 and 2015, respectively, but the occurrence of weed species varied according to the fertilization regimen. American sloughgrass [Beckmannia syzigachne (Steud.) Fernald], water starwort [Myosoton aquaticum (L.) Moench], and lyrate hemistepta (Hemistepta lyrata Bunge.) were adapted to all fertilization treatments and were the dominant weed species in the experimental wheat fields. The greatest number of weed species were observed under the no-fertilization treatment, in which 40% of the weed community was composed of broadleaf weeds and the lowest wheat yields were obtained. With fertilizer application, the number of weed species was reduced, the height of weeds increased significantly, the density of broadleaf weeds was significantly reduced, the biodiversity indices of weed communities decreased significantly, and higher wheat yields were obtained. Only the chemical fertilizer plus composted pig manure treatment and the chemical fertilizer–only treatment increased the density of grassy weeds and the total weed community density. The treatment with chemical fertilizer only also resulted in the highest density of B. syzigachne. Rice straw return combined with chemical fertilizer yielded the lowest total weed density, which suggests that it inhibited occurrence of weeds. The different fertilizer regimens not only affected the weed species composition, distribution, and diversity, but also the weed density. Our study provides new information from a rice–wheat rotation system on the relationship between soil amendments and agricultural weed infestation.
Porphyrins are a class of conjugated molecules that structurally and functionally resemble natural photosynthetic and enzymatic chromophores. Crystalline solids self-assembled from anionic and cationic porphyrins yield a new class of multifunctional optoelectronic micro- and nanomaterials. In this article, we provide details on the concept of binary ionic self-assembly (ISA) and ionized forms of porphyrins, as well as formation of hierarchical structures, including nanotubes, rods and ribbons, sheets, and three-dimensional clover-like shapes, spheres, and sheaf-like structures. We summarize key physical properties from ultraviolet–visible characterizations of J-aggregate, exciton delocalization and extended π–π stacking, and related electronic and light-harvesting properties of the structures. Depending on the molecular subunits, the functionalities of the ISA materials are altered. These ISA nanostructures possess attractive light-harvesting and charge- and energy-transport functionalities and allow access to a novel class of nanomaterials with potential for applications in sensors, photovoltaics, photocatalysis, and solar power.
Photocatalytic water splitting to form hydrogen can effectively alleviate energy and environmental problems attracting wide attention. However, the current photocatalysts have low photocatalytic efficiencies due to the narrow absorption spectrum, which is far from the actual application requirements. Herein, we use the as-prepared zinc porphyrin self-assemblies to visible-light-drive photocatalytic hydrogen evolution with Pt as the cocatalyst and ascorbic acid (AA) as the sacrificial agent. The results exhibit morphology-dependent performance and hexagonal stacks achieved optimal H2 evolution rate (47.1 mmol/h/g), then followed by nanodiscs, nanorod and tetragonal stacks, meanwhile the nanorods with different aspect ratios show size-dependent properties. The UV-vis absorption and photoluminescence spectra and the shortening of decay time of the corresponding ZnTPyP aggregates reveal that the well-defined self-assembled porphyrin networks are J-aggregation and boost efficient energy transfer with respect to monomer. Such porphyrin self-assemblies are standing for one of the most promising photosensitizers in photocatalysis field and provide an important reference for designing the next generation of hydrogen production.
Previously, the concept of Ply Drop Sequence (PDS) is introduced by the authors for the designing of composite laminated structures with multiple regions. Compared to deleting a contiguous innermost/outermost plies in the classical guide-based blending, using PDS is more flexible than dropping plies between adjacent regions. In this article, a new blending model called the Permutation for Panel Sequence (PPS) blending model is proposed to correct the problem of repeated searching of discrete points in the design space for the previous PDS blending model. The proposed method is also applied to an 18-panel horseshoe benchmark problem. The results demonstrate that the useful searching points in the PPS method are less than those in the PDS method when the number of the panels is less than the number of plies in the guide laminate, and the PPS method obtains a faster convergence speed compared with the PDS method.
Laser-driven magnetic reconnection (LDMR) occurring with self-generated B fields has been experimentally and theoretically studied extensively, where strong B fields of more than megagauss are spontaneously generated in high-power laser–plasma interactions, which are located on the target surface and produced by non-parallel temperature and density gradients of expanding plasmas. For properties of the short-lived and strong B fields in laser plasmas, LDMR opened up a new territory in a parameter regime that has never been exploited before. Here we review the recent results of LDMR taking place in both high and low plasma beta environments. We aim to understand the basic physics processes of magnetic reconnection, such as particle accelerations, scale of the diffusion region, and guide field effects. Some applications of experimental results are also given especially for space and solar plasmas.
The fractional derivatives include nonlocal information and thus their calculation requires huge storage and computational cost for long time simulations. We present an efficient and high-order accurate numerical formula to speed up the evaluation of the Caputo fractional derivative based on the L2-1σ formula proposed in [A. Alikhanov, J. Comput. Phys., 280 (2015), pp. 424-438], and employing the sum-of-exponentials approximation to the kernel function appeared in the Caputo fractional derivative. Both theoretically and numerically, we prove that while applied to solving time fractional diffusion equations, our scheme not only has unconditional stability and high accuracy but also reduces the storage and computational cost.
In this study, the petrology, zircon U–Pb ages, Lu–Hf isotopic compositions, whole-rock geochemistry and Sr–Nd isotopes for newly recognized low-Mg and high-Mg adakitic rocks from the North Altun orogenic belt were determined. The results will provide important insights for understanding the continuities of the North Qilian and North Altun orogenic belts during early Palaeozoic time. The low-Mg adakitic granitoids (445 to 439 Ma) are characterized by high SiO2 (69–70 wt %), low Mg no. (43–48) and low Cr and Ni contents. In contrast, the high-Mg adakitic granitoids (425 to 422 Ma) have relatively lower SiO2 (65–67 wt %), higher Mg no. (60–62) and higher Cr and Ni contents. The low-Mg adakitic rocks have high initial 87Sr/86Sr ratios (0.7073–0.7084), negative εNd(t) (−1.9 to −4.0) and εHf(t) values (−6.8 to −2.0), and old zircon Hf model ages (1.4–1.7 Ga). In contrast, the high-Mg adakitic rocks show lower initial 87Sr/86Sr ratios (0.7044–0.7057), higher εNd(t) (−0.7 to 3.1) and positive εHf(t) values (2.0 to 6.9), with younger zircon Hf model ages (0.9–1.2 Ga). These results suggest that the low-Mg adakitic rocks were probably generated by the partial melting of thickened crust, whereas the high-Mg adakitic rocks were derived from the anatexis of delaminated lower crust, which subsequently interacted with mantle magma upon ascent. The data obtained in this study provide significant information about the geological and tectonic processes after the closure of the Altun Ocean. The continent–continent collision and thickening probably occurred during 450–440 Ma with the formation of low-Mg adakitic rocks, and the transition of the tectonic regime from compression to extension probably occurred at 425–422 Ma with the formation of high-Mg adakitic rocks. The geochemical, geochronological and petrogenetic similarities between the North Altun and North Qilian adakitic rocks suggest that these two orogenic belts were subjected to similar tectonomagmatic processes during early Palaeozoic times.
Previous studies have supported the theory that there is a positive association between ferritin and carotid atherosclerosis in Western people. Diet plays an important role in determining serum ferritin concentration. Asian dietary patterns are different from Western dietary patterns, implying that there may be a difference in the association of ferritin with carotid atherosclerosis between Asian and Western people. However, few studies focus on the association between ferritin and carotid atherosclerosis among Asians. The aim of this study was to investigate how serum ferritin levels are associated with carotid atherosclerosis in an Asian adult population. A cross-sectional assessment was performed in 8302 adults in Tianjin, China. Carotid intima-media thickness (IMT) and plaques were assessed using ultrasonography, and serum ferritin was measured using the protein chip-chemiluminescence method. Multiple logistic regression analysis was used to examine the association between quartiles of serum ferritin concentration and carotid atherosclerosis. In the present study, the overall prevalence of IMT and carotid plaques in participants is 29·2 and 22·7 %, respectively. In women, after adjustments for potentially confounding factors, the OR of IMT and carotid plaques by increasing serum ferritin quartiles were 1·00, 1·39 (95 % CI 0·98–1·99), 1·39 (95 % CI 0·99–1·97), 1·81 (95 % CI 1·30–2·55) (Pfor trend<0·001) and 1·00, 1·24 (95 % CI 0·89–1·73), 1·18 (95 % CI 0·85–1·65), 1·59 (95 % CI 1·15–2·20) (Pfor trend<0·01), respectively. However, no association was found between serum ferritin and carotid atherosclerosis in men. The study demonstrated that increased serum ferritin levels are independently associated with IMT and carotid plaques in Asian women but not in Asian men.
Twenty Small Tailed Han (STH) and 20 Ujumqin (UJU) ewes naturally infected with gastrointestinal nematodes were randomly assigned to one of four treatments arranged in a 2 × 2 factorial design, receiving anthelmintic treatment (AT) or non-anthelmintic treatment (NonAT) prior to lambing. After lambing, the effects of AT on feed intake, digestion and milk yield in ewes, and the growth rates of lambs fed their mother's milk were assessed for 28 days. Faecal samples were collected to determine faecal egg counts (FECs), milk was collected to measure milk yield and ewes and lambs were weighed to quantify daily body weight change. The results showed that AT significantly increased ewe dry matter intake (2411 g/d for AT and 2209 g/d for NonAT) and decreased FECs (50 eggs/g for AT and 2655 eggs/g for NonAT). All ewes lost weight after lambing, but body weight loss in the AT (43 g/d) was significantly less than in NonAT (84 g/d), and STH ewes (70 g/d) lost more weight than UJU ewes (58 g/d). Anthelmintic-treated ewes produced more milk for their lambs to consume. However, the extent of these positive effects of AT differed between STH and UJU ewes. The average daily body weight gain of lambs in AT was higher than those in NonAT. In conclusion, effective AT in ewes before lambing benefits subsequent lactation in ewes and growth rate in lambs.
In this paper, a new optimisation method incorporating lamination parameters and a guide-based blending model is proposed. Lamination parameters for a guide laminate and ply number of each panel are employed as design variables for optimisation with a parallel real-coded genetic algorithm incorporating structure behaviour and manufacturing constraints. During the optimisation process, with a form of least squares fitting adopted, another genetic algorithm is used to obtain the guide stacking sequence of the guide laminate from the guide lamination parameters, and then the laminate configurations of each panel are obtained from the guide stacking sequence and number of plies for each panel. The proposed framework is demonstrated via design of an 18-panel horseshoe configuration, where each panel is optimised individually with a buckling constraint. Numerical results indicate that the present algorithm is capable of obtaining fully blended designs.
Disaster can strike people in any community at any time anywhere in the world. Disasters occur with high frequency, take on multiple forms, and exert wide influence, typically causing property damage, injuries, and death. As the world’s largest developing country, China incurs great costs when a disaster hits. After the Wenchuan earthquake in 2008, the Chinese government focused its attention on the construction of an emergency response system, the creation of disaster prevention and mitigation systems, and the development of a disaster medicine program. Here, we describe the current status of disaster medicine in China, focusing on the following four aspects: the Emergency Management System, Education & Training, Rescue Practices, and Research. We also discuss the future of disaster medicine in China. (Disaster Med Public Health Preparedness. 2018;12:157–165)
This article is devoted to the study of some high-order difference schemes for the distributed-order time-fractional equations in both one and two space dimensions. Based on the composite Simpson formula and Lubich second-order operator, a difference scheme is constructed with convergence in the L1(L∞)-norm for the one-dimensional case, where τ,h and σ are the respective step sizes in time, space and distributed-order. Unconditional stability and convergence are proven. An ADI difference scheme is also derived for the two-dimensional case, and proven to be unconditionally stable and convergent in the L1(L∞)-norm, where h1 and h2 are the spatial step sizes. Some numerical examples are also given to demonstrate our theoretical results.
Objective: To study the relationship of Nε-(carboxymethyl)-lysine level (CML)
with microstructure changes of white matter (WM), and cognitive impairment
in patients with type 2 diabetes mellitus (T2DM) and to discuss the
potential mechanism underlying T2DM-associated cognitive impairment. Methods: The study was performed in T2DM patients (n=22) with disease course
≥5 years and age ranging from 65 to 75 years old. A control group consisted
of 25 sex- and age-matched healthy volunteers. Fractional anisotropy (FA) of
several WM regions was analyzed by diffusion tensor imaging scan. Plasma CML
levels were measured by enzyme-linked immunosorbent assay, and cognitive
function was assessed by Mini-Mental State Examination and Montreal
cognitive assessment (MoCA). Results: The total Mini-Mental State Examination score in the patient group
(25.72±3.13) was significantly lower than the control group (28.16±2.45)
(p<0.05). In addition, the total MoCA score in the patient group
(22.15±3.56) was significantly lower than the control group 25.63±4.12)
(p<0.01). In the patient group, FA values were significantly decreased in
the corpus callosum, cingulate fasciculus, inferior fronto-occipital
fasciculus, parietal WM, hippocampus, and temporal lobes relative to
corresponding regions of healthy controls (p<0.05). Plasma CML level was
negatively correlated with average FA values in the global brain (r=−0.58,
p<0.01) and MoCA scores (r=−0.47, p<0.05). Conclusions: In T2DM, WM microstructure changes occur in older patients, and
elevations in CML may play a role in the development of cognitive
Changes in soil chemistry in response to varying climatic regimes can alter the equilibria of soil systems and result in different clay minerals. Variations in phyllosilicate clay composition can reflect temporal and spatial climatic changes, such as summer/winter monsoon cycles. The objective of this research was to investigate the mineralogy of the clay fractions as a proxy for determining variations in the East Asian monsoon climate, based on a section at Chaoyang in China spanning the last 0.423 Ma BP. The clay mineralogy record in the Chaoyang section was compared with other proxies as recorded in this section and with other palaeoclimatic indicators, including oxygen isotopes from oceanic sediments and loess–palaeosol sections on the Chinese Loess Plateau (CLP). The results from clay mineralogy and related climatic studies show that the summer monsoon has a trend of four increased stages and four decreased stages; whereas the winter monsoon displays the opposite trend. During the last 0.423 Ma BP, the strongest winter monsoon occurred around 0.243–0.311 Ma BP. During this period, which included an intense winter monsoon, the soil in the section had the least illite, one of the smallest kaolinite and illite/Chlorite (I/C) indices and an overall decreasing clay content. The period 0.225–0.243 Ma BP had the strongest summer monsoon over the last 0.423 Ma BP. This period had the greatest amount of illite, the highest I/C index, greater overall clay content and the strongest magnetic susceptibility signal. Additionally, this section contained the smallest mean grain size. The multi-monsoon climate cycles of alternating cold-dry and warm-moist conditions as recorded in the Chaoyang section corresponded well with multiple glaciation cycles based on deep sea sediments. This indicates that the Chaoyang section provides a record of palaeoclimate changes in northeast China that can be linked to mineralogical suites to assist in reconstructing the palaeoclimate over the Late Middle Pleistocene, and complements the global palaeoclimate records in the CLP.