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The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron-deficiency anemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy body mass index (pBMI) and erythropoiesis-related nutritional deficiencies.
Anthropometry, blood biochemistry, and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion, or a vitamin B12 deficiency.
The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017-2019).
We included 1456 women aged 20 to 45 years with singleton pregnancies.
Among these pregnant women, 9.6% were UW, and 29.2% were either OW (15.8%) or OB (13.4%). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95% CI) for OW subjects (0.6; 0.4˜0.9) but increased odds for UW (1.2; 0.8˜2.0) and OB subjects (1.2; 0.8˜1.8). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight (NW), OB pregnant women had 3.4-fold (3.4; 1.4˜8.1) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0.3; 0.1-1.2). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, iron, and folate intakes, but positive relationship with fat intakes.
The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.
Efficiently predicting the flow field and load in aerodynamic shape optimisation remains a highly challenging and relevant task. Deep learning methods have been of particular interest for such problems, due to their success in solving inverse problems in other fields. In the present study, U-net-based deep neural network (DNN) models are trained with high-fidelity datasets to infer flow fields, and then employed as surrogate models to carry out the shape optimisation problem, i.e. to find a minimal drag profile with a fixed cross-sectional area subjected to a two-dimensional steady laminar flow. A level-set method as well as Bézier curve method are used to parameterise the shape, while trained neural networks in conjunction with automatic differentiation are utilised to calculate the gradient flow in the optimisation framework. The optimised shapes and drag force values calculated from the flow fields predicted by the DNN models agree well with reference data obtained via a Navier–Stokes solver and from the literature, which demonstrates that the DNN models are capable not only of predicting flow field but also yielding satisfactory aerodynamic forces. This is particularly promising as the DNNs were not specifically trained to infer aerodynamic forces. In conjunction with a fast runtime, the DNN-based optimisation framework shows promise for general aerodynamic design problems.
To present the clinical characteristics and dynamic changes in laboratory parameters of the COVID-19 in Guangzhou, and explore the probable early warning indicators of disease progressing.
We enrolled all the patients diagnosed as COVID-19 in the Guangzhou No. 8 People’s Hospital. The patients’ demographic, and epidemiologic data were collected, including chief complaints, lab results and imaging examination.
The characteristics of the patients in Guangzhou are different from that in Wuhan. They were younger in age, female dominated, not commonly combined with other disease. 75% of patients suffered fever on admission, followed by cough occurring in 62% patients. By comparing the mild/normal and severe/critical patients, male, aged, combined with hypertension, abnormal in blood routine result, raised creatine kinase, glutamic oxaloacetic transaminase, lactate dehydrogenase, CRP, procalcitonin, D-dimer, fibrinogen, APTT, and positive in proteinuria can be candidate of early warning indicators to severe disease.
The patients in outside epidemic areas showed different characteristics from that in Wuhan. The abnormal laboratory parameters were markedly changed in 4 weeks after admission, and also shown different between the mild and severe patients. The highest specificity and sensitivity potential early warning indicators of severe disease need more evidence to confirm.
Mile-a-minute (Mikania micrantha Kunth) is a tropical American species and has become a worldwide invasive weed. It was first introduced to mainland China in 1983 in Yingjiang City, Dehong State, Yunnan Province. To assess the origins of populations from Dehong State, Yunnan Province, the genetic structure of 427 individuals from 11 M. micrantha populations from Yunnan, Guangxi, Hainan, and Guangdong provinces were analyzed. A total of 28 alleles were detected in 12 nuclear microsatellite loci. Genetic diversity at the population level was relatively high. An analysis of molecular variance showed that most of the variation occurred within populations (82.73%), and only 18.27% occurred among populations. The genetic differentiation coefficient (FST) was 0.183. The estimated gene flow (Nm) from FST was 1.116. The independent origins of four populations collected from Dehong State, Yunnan Province, was determined by the unweighted pair-group method with arithmetic means clustering and STRUCTURE analysis. Three gene clusters and one admixture gene cluster were found. A Mantel test of pairwise Nei’s genetic distances and pairwise geographic distances revealed no evidence for isolation by distance (r = 0.068, P = 0.343). These results suggest that the post-introduction admixture caused by multiple introductions and high gene flow might contribute to the evolutionary adaptation of M. micrantha. These results could provide a scientific basis for the management of invasive M. micrantha.
The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort.
In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status.
Longitudinal population-based cohort.
17 262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China.
During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22–24 kg/m2, with BMI ≤ 18, 18–20, 20–22, 24–26, 26–28, 28–30 and >30 kg/m2, the hazard ratios for mortality in normotensive participants were 1·92 (95% CI 1·23, 3·00), 1·44 (95% CI 1·01, 2·05), 1·14 (95% CI 0·82, 1·58), 0·96 (95% CI 0·70, 1·31), 0·96 (95% CI 0·65, 1·43), 1·32 (95% CI 0·81, 2·14) and 1·32 (95% CI 0·74, 2·35), respectively, and in hypertensive participants were 1·85 (95% CI 1·08, 3·17), 1·67 (95% CI 1·17, 2·39), 1·29 (95% CI 0·95, 1·75), 1·20 (95% CI 0·91, 1·58), 1·10 (95% CI 0·83, 1·46), 1·10 (95% CI 0·80, 1·52) and 0·61 (95% CI 0·40, 0·94), respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity v. normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants.
Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.
The present study attempted to analyse human papillomavirus (HPV) genotype distribution and its association with cervical cytology results in women in western China. The present retrospective analysis was performed in 1089 female outpatients with a positive HPV test result who had undergone a cervical cytology test at the gynaecological clinic, West China Second Hospital, Sichuan University, China, between January 2014 and December 2016. Of the 1089 patients with HPV infection, multiple HPV genotypes were detected in 220 patients (20.20%). Among the 1368 HPV genotypes detected, 1145 (83.70%) were high-risk subtypes. The most common genotypes were HPV-52 (18.64%), HPV-16 (16.59%), HPV-58 (13.23%), HPV-18 (6.80%), HPV-56 (5.56%) and HPV-59 (5.56%). Cervical cytology revealed abnormal cells in 430 (39.49%) patients. The most common diagnoses were atypical squamous cells of undetermined significance (ASC-US; 236 cases, 54.88%), low-grade squamous intraepithelial lesions (LSIL; 151 cases, 35.12%), high-grade squamous intraepithelial lesions (HSIL; 63 cases, 14.65%) and atypical glandular cells (AGC; 21 cases, 4.88%). HPV-66 was significantly associated (P = 0.037) with ASC; HPV-52 and HPV-56 were significantly associated with LSIL (P = 0.009 and 0.026, respectively); HPV-16 (P < 0.001), HPV-33 (P = 0.014) and HPV-58 (P = 0.003) were significantly associated with HSIL; and HPV-16 (P = 0.005) was significantly associated with AGC. HPV-16, HPV-52 and HPV-58 are associated with different diagnoses in patients with positive cervical cytological findings.
A deep ice core was drilled at Dome A, Antarctic Plateau, East Antarctica, which started with the installation of a casing in January 2012 and reached 800.8 m in January 2017. To date, a total of 337 successful ice-core drilling runs have been conducted, including 118 runs to drill the pilot hole. The total drilling time was 52 days, of which eight days were required for drilling down and reaming the pilot hole, and 44 days for deep ice coring. The average penetration depths of individual runs were 1 and 3.1 m for the pilot hole drilling and deep ice coring, respectively. The quality of the ice cores was imperfect in the brittle zone (650−800 m). Some of the troubles encountered are discussed for reference, such as armoured cable knotting, screws falling into the hole bottom, and damaged parts, among others.
The very high frequency data exchange system (VDES) is promising in promoting electronic navigation (E-navigation) and improving navigation safety. The multiple access control (MAC) protocol is crucial to the transmission performance of VDES. The self-organising time division multiple access (SOTDMA) protocol, as the only access mode given by current recommendations, leads to a high rate of transmission collisions in the traditional automatic identification system (AIS), especially with heavy traffic loads. This paper proposes a novel feedback based time division multiple access (FBTDMA) protocol to address the problems caused by SOTDMA, such that collision of transmissions can be avoided in information transmission among vessels. Simulation results demonstrate that the proposed FBTDMA outperforms the traditional SOTDMA in terms of channel utilisation and throughput, and significantly reduces the transmission collision rate. The study is expected to provide insights into VDES standardisation and E-navigation modernisation.
The architectural connections between western Central Asia and China are not well understood. Recent investigations at the Haermodun site in central Xinjiang reveals new evidence of the influence of western Central Asia on the construction of fortifications in China during the early first millennium AD.
The TanDEM-X DEM is a valuable data source for estimating glacier mass balance. However, the accuracy of TanDEM-X elevation over glaciers can be affected by microwave penetration and phase decorrelation. To investigate the bias of TanDEM-X DEMs of glaciers on the Tibetan Plateau, these DEMs were subtracted from SPOT-6 DEMs obtained around the same time at two study sites. The average bias over the studied glacier areas in West Kunlun (175.0 km2) was 2.106 ± 0.012 m in April 2014, and it was 1.523 ± 0.011 m in Geladandong (228.8 km2) in October 2013. By combining backscatter coefficients and interferometric coherence maps, we found surface decorrelation and baseline decorrelation can cause obvious bias in addition to microwave penetration. If the optical/laser data and winter TanDEM-X data were used as new and historic elevation sources for mass-balance measurements over an arbitrary observation period of 10 years, the glacier mass loss rates in West Kunlun and Geladandong would be potentially underestimated by 0.218 ± 0.016 and 0.158 ± 0.011 m w.e. a−1, respectively. The impact is therefore significant, and users should carefully treat the bias of TanDEM-X DEMs when retrieving a geodetic glacier mass balance.
The aim of this study was to evaluate the safety and efficacy of the Cardi-O-Fix plug used for the treatment of muscular ventricular septal defects.
We retrospectively reviewed the medical records of five patients with muscular ventricular septal defects who underwent transcatheter closure using the Cardi-O-Fix Plug, from November 2017 to August 2019. The median age was 5.1 years (range: 3.2–6.5). Their median body weight was 18.1 kg (range: 13.4–21.8). All the patients underwent detailed two-dimensional Doppler and colour flow imaging by transthoracic echocardiography. The left ventricular median defect size of the muscular ventricular septal defects was 5.6 mm (range: 5.3–7.0). The right ventricular median defect size of the muscular ventricular septal defects was 3.9 mm (range: 3.3–4.7). All the procedures were performed on beating hearts.
All the patients underwent successful device implantation with no displacement or detachment, they have complete echocardiographic closure at the 1-year follow-up. There were no occluder-related arrhythmia, chordae tendineae rupture, tricuspid insufficiency, aortic regurgitation, haemolysis, or embolisation.
Application of the Cardi-O-Fix plug appears to be a feasible, safe, and effective treatment option for patients with muscular ventricular septal defects. Longer follow-up periods are warranted to prove the conclusion for long-term outcomes.
Coronavirus disease 2019 (COVID-19) is a newly emerged disease with various clinical manifestations and imaging features. The diagnosis of COVID-19 depends on a positive nucleic acid amplification test by real-time reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the clinical manifestations and imaging features of COVID-19 are non-specific, and nucleic acid test for SARS-CoV-2 can have false-negative results. It is presently believed that detection of specific antibodies to SARS-CoV-2 is an effective screening and diagnostic indicator for SARS-CoV-2 infection. Thus, a combination of nucleic acid and specific antibody tests for SARS-CoV-2 will be more effective to diagnose COVID-19, especially to exclude suspected cases.
Antipsychotics are widely used for treating patients with psychosis, and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) for psychosis are characterized by subthreshold psychotic symptoms. It is currently unclear who might benefit from antipsychotic treatment. Our objective was to apply a risk calculator (RC) to identify people that would benefit from antipsychotics.
Drawing on 400 CHR individuals recruited between 2011 and 2016, 208 individuals who received antipsychotic treatment were included. Clinical and cognitive variables were entered into an individualized RC for psychosis; personal risk was estimated and 4 risk components (negative symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive symptoms-RC-PS) were constructed. The sample was further stratified according to the risk level. Higher risk was defined based on the estimated risk score (20% or higher).
In total, 208 CHR individuals received daily antipsychotic treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR increased, the conversion rate decreased. A small group (15%) of CHR individuals at higher-risk and an FR >1 benefitted from the antipsychotic treatment.
Through applying a personal risk assessment, the administration of antipsychotics should be limited to CHR individuals with predominantly positive symptoms and related function decline. A strict antipsychotic prescription strategy should be introduced to reduce inappropriate use.
To evaluate age-related differences in the independent/combined association of added sugar intake from soda and body adiposity with hyperuricaemia in gender-stratified US adults.
Consumption of added sugar from soda was calculated from 24-h dietary interviews and categorised into none, regular and excessive consumption. Hyperuricaemia was defined as serum uric acid levels >417 mmol/l in men and >357 mmol/l in women. Multiple regression models with interaction terms and logistic models adjusted for covariates were conducted under survey-data modules.
National Health and Nutrition Examination Survey during 2007–2016.
15 338 adults without gout, failing kidneys, an estimated glomerular filtration rate < 30 or diabetes were selected.
The age-stratified prevalence rate of hyperuricaemia was 18·8–20·4 % in males and 6·8–17·3 % in females. Hyperuricaemia prevalence of approximately 50 % was observed in young and middle age males who consumed excessive added sugar from soda. Excessive added sugar intake was observed to be associated with 1·5- to 2·0-fold and 2·0- to 2·3-fold increased risk of the probability of hyperuricaemia in young and middle age males and middle age females, respectively. Study participants, regardless of age or gender, who were obese and consumed excessive added sugar from soda had the highest risk of having hyperuricaemia.
Our study revealed that the association between hyperuricaemia and consumption of excessive added sugar from soda may vary by age and gender. Obese adults who consumed excessive added sugar from soda had the highest risk of hyperuricaemia, a finding that was found across all age-specific groups for both genders.
A multicenter study of sharps injuries (SIs) and other blood or body fluid (OBBF) exposures was conducted among 33,156 healthcare workers (HCWs) from 175 hospitals in Anhui, China. In total, 12,178 HCWs (36.7%) had experienced at least 1 SI in the previous 12 months and 8,116 HCWs (24.5%) had experienced at least 1 OBBF exposure during the previous 12 months.
Previous studies have revealed associations of meteorological factors with tuberculosis (TB) cases. However, few studies have examined their lag effects on TB cases. This study was aimed to analyse nonlinear lag effects of meteorological factors on the number of TB notifications in Hong Kong. Using a 22-year consecutive surveillance data in Hong Kong, we examined the association of monthly average temperature and relative humidity with temporal dynamics of the monthly number of TB notifications using a distributed lag nonlinear models combined with a Poisson regression. The relative risks (RRs) of TB notifications were >1.15 as monthly average temperatures were between 16.3 and 17.3 °C at lagged 13–15 months, reaching the peak risk of 1.18 (95% confidence interval (CI) 1.02–1.35) when it was 16.8 °C at lagged 14 months. The RRs of TB notifications were >1.05 as relative humidities of 60.0–63.6% at lagged 9–11 months expanded to 68.0–71.0% at lagged 12–17 months, reaching the highest risk of 1.06 (95% CI 1.01–1.11) when it was 69.0% at lagged 13 months. The nonlinear and delayed effects of average temperature and relative humidity on TB epidemic were identified, which may provide a practical reference for improving the TB warning system.
Reintroductions aim to re-establish a viable population within the indigenous range of living organisms, especially of threatened species. The population of the Asian Crested Ibis Nipponia nippon, a well-known ‘Endangered’ bird species, has increased over 100 times since wild populations were rediscovered in 1981, and several reintroduction projects were subsequently carried out in its former range. An experimental release of the Asian Crested Ibis was conducted in Qianhu National Wetland Park located in the southern part of the Loess Plateau, China. It is vitally important to monitor released birds (at least their survival and breeding), to inform subsequent releases in other suitable sites. During extensive post-release monitoring, data on capture-recapture and reproductive status were obtained using banding, radiotelemetry, and field observations. Using the Cormack-Jolly-Seber (C-J-S) model, the average annual survival rates were estimated to be 0.569 (95% CI: 0.353–0.762) for released individuals and 0.643 (95% CI: 0.038–0.987) for all individuals. From 2014 to 2018, a total of 14 breeding pairs produced 28 eggs and 10 fledglings with successful reproduction of the second generation. The mean clutch size was 2.07 ± 0.25 (n = 29), and the breeding success was 34.5%. Predation and poor habitat quality have been shown to be the main factors affecting the reintroduced population at establishment stage. Some management suggestions at the metapopulation and ecosystem levels, including further release, predator control and habitat improvement, have been proposed.
Under the national guidance of Internet Plus Healthcare, Internet hospital was officially recognized in 2018 by the Chinese government, however, how to innovate the business models of Internet hospitals remains controversial. This study sought to explore key stakeholders’ perspectives on key dilemmas about innovative business models of Internet hospitals in China.
A focus group study of key stakeholders was performed. Twelve key stakeholders (six senior officials from related ministries, two industry practitioners of Internet medicine, one hospital leader, two healthcare researchers (financing and policy), and one venture capital manager) participated in the focus group, in 2019. Thematic content analysis was applied for data analysis.
Themes highlighted six key dilemmas when developing a business model of Internet hospitals, including (i) value proposition (medical treatment versus entire health management); (ii) leading party (hospitals versus third parties such as Internet companies); (iii) level of healthcare (tertiary versus primary); (iv) scope of service (provide full range versus part of traditional hospital service); (v) primary source of revenue (medical services versus drug sales); and (vi) legal liability (web-based unit versus physical hospital).
The healthcare industry is currently in search of innovative business models of Internet hospitals in response to the unprecedented form of healthcare in China. However, the core aspects of the model design still remain debatable. At this revolutionary stage, policies are important to allow the implementation of different model designs that support the successful transformation of the entire health care system in China.