It is crucial to understand the genetic mechanisms and biological pathways underlying the relationship between obesity and serum lipid levels. Structural equation models (SEMs) were constructed to calculate heritability for body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and the genetic connections between BMI and the four classes of lipids using 1197 pairs of twins from the Chinese National Twin Registry (CNTR). Bivariate genomewide association studies (GWAS) were performed to identify genetic variants associated with BMI and lipids using the records of 457 individuals, and the results were further validated in 289 individuals. The genetic background affecting BMI may differ by gender, and the heritability of males and females was 71% (95% CI [.66, .75]) and 39% (95% CI [.15, .71]) respectively. BMI was positively correlated with TC, TG and LDL-C in phenotypic and genetic correlation, while negatively correlated with HDL-C. There were gender differences in the correlation between BMI and lipids. Bivariate GWAS analysis and validation stage found 7 genes (LOC105378740, LINC02506, CSMD1, MELK, FAM81A, ERAL1 and MIR144) that were possibly related to BMI and lipid levels. The significant biological pathways were the regulation of cholesterol reverse transport and the regulation of high-density lipoprotein particle clearance (p < .001). BMI and blood lipid levels were affected by genetic factors, and they were genetically correlated. There might be gender differences in their genetic correlation. Bivariate GWAS analysis found MIR144 gene and its related biological pathways may influence obesity and lipid levels.

Pressure fluctuations play an essential role in the transport of turbulent kinetic energy and vibrational loading. This study focuses on examining the effect of wall cooling on pressure fluctuations in compressible turbulent boundary layers by high-fidelity direct numerical simulations. Pressure fluctuations result from the vorticity mode and the acoustic mode that are both closely dependent on compressibility. To demonstrate the effects of wall cooling at various compressibility intensities, three free-stream Mach numbers are investigated, i.e. $M_\infty =0.5$, 2.0 and 8.0, with real gas effects being absent for $M_\infty =8.0$ due to a low enthalpy inflow. Overall, opposite effects of wall cooling on pressure fluctuations are found between the subsonic/supersonic cases and the hypersonic case. Specifically, the pressure fluctuations normalized by wall shear stress $p^\prime _{rms}/\tau _w$ are suppressed in the subsonic and supersonic cases, while enhanced in the hypersonic case near the wall. Importantly, travelling-wave-like alternating positive and negative structures (APNS), which greatly contribute to pressure fluctuations, are identified within the viscous sublayer and buffer layer in the hypersonic cases. Furthermore, generating mechanisms of pressure fluctuations are explored by extending the decomposition based on the fluctuating pressure equation to compressible turbulent boundary layers. Pressure fluctuations are decomposed into five components, in which rapid pressure, slow pressure and compressible pressure are dominant. The suppression of pressure fluctuations in the subsonic and supersonic cases is due to both rapid pressure and slow pressure being suppressed by wall cooling. In contrast, wall cooling strengthens compressible pressure for all Mach numbers, especially in the hypersonic case, resulting in increased wall pressure fluctuations. Compressible pressure plays a leading role in the hypersonic case, mainly due to the APNS. Essentially, the main effects of wall cooling can be interpreted by the suppression of the vorticity mode and the enhancement of the acoustic mode.

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a severe and life-threatening complication, characterised by multi-organ failure and high short-term mortality. However, there is limited information on the impact of various comorbidities on HBV-ACLF in a large population. This study aimed to investigate the relationship between comorbidities, complications and mortality. In this retrospective observational study, we identified 2166 cases of HBV-ACLF hospitalised from January 2010 to March 2018. Demographic data from the patients, medical history, treatment, laboratory indices, comorbidities and complications were collected. The mortality rate in our study group was 47.37%. Type 2 diabetes mellitus was the most common comorbidity, followed by alcoholic liver disease. Spontaneous bacterial peritonitis, pneumonia and hepatic encephalopathy (HE) were common in these patients. Diabetes mellitus and hyperthyroidism are risk factors for death within 90 days, together with gastrointestinal bleeding and HE at admission, HE and hepatorenal syndrome during hospitalisation. Knowledge of risk factors can help identify HBV-ACLF patients with a poor prognosis for HBV-ACLF with comorbidities and complications.

This study evaluated the association between inflammatory diets as measured by the Dietary Inflammatory index (DII), inflammation biomarkers and the development of preeclampsia among the Chinese population. We followed the reporting guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies. A total of 466 preeclampsia cases aged over 18 years were recruited between March 2016 and June 2019, and 466 healthy controls were 1:1 ratio matched by age (±3 years), week of gestation (±1 week) and gestational diabetes mellitus. The energy-adjusted DII (E-DII) was computed based on dietary intake assessed using a seventy-nine item semiquantitative FFQ. Inflammatory biomarkers were analysed by ELISA kits. The mean E-DII scores were −0·65 ± 1·58 for cases and −1·19 ± 1·47 for controls (P value < 0·001). E-DII scores positively correlated with interferon-γ (r s = 0·194, P value = 0·001) and IL-4 (r s = 0·135, P value = 0·021). After multivariable adjustment, E-DII scores were positively related to preeclampsia risk (P trend < 0·001). The highest tertile of E-DII was 2·18 times the lowest tertiles (95 % CI = 1·52, 3·13). The odds of preeclampsia increased by 30 % (95 % CI = 18 %, 43 %, P value < 0·001) for each E-DII score increase. The preeclampsia risk was positively associated with IL-2 (OR = 1·07, 95 % CI = 1·03, 1·11), IL-4 (OR = 1·26, 95 % CI = 1·03, 1·54) and transforming growth factor beta (TGF-β) (OR = 1·17, 95 % CI = 1·06, 1·29). Therefore, proinflammatory diets, corresponding to higher IL-2, IL-4 and TGF-β levels, were associated with increased preeclampsia risk.

Trailing-edge serrations inspired by owls are capable of reducing broadband noise. In this study, the wall-resolved large-eddy simulations (LES) are carried out on the flow over NACA-0012 airfoil with additional serrated trailing edges. The computations are conducted with the high-order flux reconstruction method on unstructured meshes. Three kinds of serrations with different lengths are studied and compared with the straight trailing-edge case, and all three types of serration achieved a certain degree of noise reduction. Presently, the medium-length serration achieves the best noise reduction effect. The maximum decrease of overall sound pressure level is approximately 2.4 dB, implying that the length of serration has a substantial impact on the noise reduction effect. The serration has no significant effect on the upstream turbulence statistics, but it changes the flow structure near the serration, such as inducing side vortex pairs attached to the serration edges. Moreover, dynamic mode decomposition shows that the pressure structures vary with the serration length. For the most unstable hydrodynamic wave, the spanwise coherence of the mode structure of pressure in the upstream boundary layer is weakened. In addition, serrations can redistribute the dipole sources on the surfaces of airfoil and serrations. The destructive interference is enhanced to some extent, which is favourable for noise reduction. In contrast with LES simulations, the pure dipole analysis shows that the longest serration case seems to be the best. Furthermore, a recently developed noise theory is used to evaluate the influence of serrations on the flow noise sources qualitatively and quantitatively. It is found that the serrations can mitigate noise source intensity near the serration edges but increase the source intensity in the near wake. The combined effect of serration on the dipole source and flow noise source determines the overall noise reduction effect. To conclude, destructive interference plays a primary role in suppressing noise radiation by serrated trailing edges, and the dual effect of flow noise sources should be considered in future serration designs. As the influence of turbulence structure will make it more difficult to find the optimal serration parameters, the position of high-fidelity simulation will become increasingly important.

The aim of the present study was to compare the rate of preterm birth (PTB) and growth from birth to 18 years between twins conceived by in vitro fertilization (IVF) and twins conceived by spontaneous conception (SC) in mainland China. The retrospective cohort study included 1164 twins resulting from IVF and 25,654 twins conceived spontaneously, of which 494 from IVF and 6338 from SC were opposite-sex twins. PTB and low birth weight (LBW), and growth, including length/height and weight, were compared between the two groups at five stages: infancy (0 year), toddler period (1–2 years), preschool (3–5 years), primary or elementary school (6–11 years), and adolescence (10–18 years). Few statistically significant differences were found for LBW and growth between the two groups after adjusting for PTB and other confounders. Twins born by IVF faced an increased risk of PTB compared with those born by SC (adjusted odds ratio [aOR] 8.21, 95% confidence interval [CI] [3.19, 21.13], p < .001 in all twins and aOR 10.12, 95% CI [2.32, 44.04], p = .002 in opposite-sex twins). Twins born by IVF experienced a similar growth at five stages (0–18 years old) when compared with those born by SC. PTB risk, however, is significantly higher for twins conceived by IVF than those conceived by SC.

Based on the fully compressible Navier–Stokes equations, the linear stability of thermal convection in rapidly rotating spherical shells of various radius ratios $\eta$ is studied for a wide range of Taylor number $Ta$, Prandtl number $Pr$ and the number of density scale height $N_\rho$. Besides the classical inertial mode and columnar mode, which are widely studied by the Boussinesq approximation and anelastic approximation, the quasi-geostrophic compressible mode is also identified in a wide range of $N_\rho$ and $Pr$ for all $\eta$ considered, and this mode mainly occurs in the convection with relatively small $Pr$ and large $N_\rho$. The instability processes are classified into five categories. In general, for the specified wavenumber $m$, the parameter space ($Pr, N_\rho$) of the fifth category, in which the base state loses stability via the quasi-geostrophic compressible mode and remains unstable, shrinks as $\eta$ increases. The asymptotic scaling behaviours of the critical Rayleigh numbers $Ra_c$ and corresponding wavenumbers $m_c$ to $Ta$ are found at different $\eta$ for the same instability mode. As $\eta$ increases, the flow stability is strengthened. Furthermore, the linearized perturbation equations and Reynolds–Orr equation are employed to quantitatively analyse the mechanical mechanisms and flow instability mechanisms of different modes. In the quasi-geostrophic compressible mode, the time-derivative term of disturbance density in the continuity equation and the diffusion term of disturbance temperature in the energy equation are found to be critical, while in the columnar and inertial modes, they can generally be ignored. Because the time-derivative term of the disturbance density in the continuity equation cannot be ignored, the anelastic approximation fails to capture the instability mode in the small-$Pr$ and large-$N_\rho$ system, where convection onset is dominated by the quasi-geostrophic compressible mode. However, all the modes are primarily governed by the balance between the Coriolis force and the pressure gradient, based on the momentum equation. Physically, the most important difference between the quasi-geostrophic compressible mode and the columnar mode is the role played by the disturbance pressure. The disturbance pressure performs negative work for the former mode, which appears to stabilize the flow, while it destabilizes the flow for the latter mode. As $\eta$ increases, in the former mode the relative work performed by the disturbance pressure increases and in the latter mode decreases.

The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case–control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a seventy-eight-item semi-quantitative FFQ. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem MS. Multivariate conditional logistic regression was used to estimate OR and 95 % CI. Restricted cubic splines (RCS) were plotted to evaluate the dose–response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the OR of the highest quartile were 0·45 (95 % CI 0·29, 0·71, Ptrend = 0·001) for VD dietary intake and 0·26 (95 % CI 0·11, 0·60, Ptrend = 0·003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0·02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0·02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.

The objective of this study was to investigate how different obesity measures link to circulating metabolites, and whether the connections are due to genetic or environmental factors. A cross-sectional analysis was performed on follow-up survey data at the Chinese National Twin Registry (CNTR), which was conducted in four areas of China (Shandong, Jiangsu, Zhejiang and Sichuan) in 2013. The survey collected detailed questionnaire information and conducted physical examinations, fasting blood sampling and untargeted metabolomic measurements among 439 adult twins. Linear regression models and bioinformatics analysis were used to examine the relation of obesity measures, including body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with serum metabolite levels and related pathways. A co-twin control study was additionally conducted among 15 obesity-discordant monozygotic (MZ) pairs (intrapair BMI difference >3 kg/m2) to examine any differences in metabolites controlling for genetic factors. Eleven metabolites were associated with BMI, WC and WHR after controlling for genetic and shared environmental factors. Pathway analysis identified pathways such as phenylalanine metabolism, purine metabolism, valine, leucine and isoleucine biosynthesis that were associated with obesity. A wide range of unfavorable alterations in the serum metabolome was associated with obesity. Obesity-discordant twin analysis suggests that these associations are independent of genetic liability.

Nicotine 3,5-dihydroxybenzoate dihydrate is a nicotine salt and can be used as compositions in tobacco products. X-ray powder diffraction data, unit-cell parameters, and space group for nicotine 3,5-dihydroxybenzoate, C10H15N2⋅C7H5O4⋅2H2O, are reported [a = 8.424(1) Å, b = 13.179(8) Å, c = 8.591(1) Å, α = 90°, β = 102.073(8)°, γ = 90°, unit-cell volume V = 932.765(3) Å3, Z = 2, ρcal = 1.256 g⋅cm−3, and space group P21] at room temperature. All measured lines were indexed and are consistent with the P21 space group.

Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.

Although the progression of invasive aspergillosis (IA) shares some risk factors in the development of active pulmonary tuberculosis (PTB), however, the prevalence of IA in suspected PTB remains unclear. During a period of 1 year (from January 2016 to December 2016), consecutive patients with suspected PTB were included in a referral TB hospital. Data, including demographic information and underlying diseases, were collected from medical records. PTB were all confirmed by mycobacterial culture (Lowenstein–Jensen medium). IA were diagnosed as proven or probable according to the criteria of the 2008 EORTC/MSG definitions. A descriptive analysis was performed to estimate the corresponding prevalence. During the study year, 1507 patients have a positive mycobacterial culture, with a mean age of 45.6 (s.d. 19.9) years old and a female:male ratio of 1:4. Among the 82 patients with non-tuberculous mycobacterial diseases, two patients (2.44%, 95% CI 0.67–8.46%) were diagnosed as IA (one proven and one probable); two probable IA patients (0.15%, 95% CI 0.04–0.55%) were diagnosed in PTB patients (n = 1315), and all were retreatment cases. In addition, all four IA patients (100%) exhibited cavities in both lobes on radiograph. In China, the prevalence of IA is low in active PTB patients. However, when high-risk factors for IA are encountered in PTB patients, further investigations are required and empirically treatment for IA might be warranted.

A recently developed pneumonia caused by SARS-CoV-2 has quickly spread across the world. Unfortunately, a simplified risk score that could easily be used in primary care or general practice settings has not been developed. The objective of this study is to identify a simplified risk score that could easily be used to quickly triage severe COVID-19 patients. All severe and critical adult patients with laboratory-confirmed COVID-19 on the West campus of Union Hospital, Wuhan, China, from 28 January 2020 to 29 February 2020 were included in this study. Clinical data and laboratory results were obtained. CURB-65 pneumonia score was calculated. Univariate logistic regressions were applied to explore risk factors associated with in-hospital death. We used the receiver operating characteristic curve and multivariate COX-PH model to analyse risk factors for in-hospital death. A total of 74 patients (31 died, 43 survived) were finally included in the study. We observed that compared with survivors, non-survivors were older and illustrated higher respiratory rate, neutrophil-to-lymphocyte ratio, D-dimer and lactate dehydrogenase (LDH), but lower SpO2 as well as impaired liver function, especially synthesis function. CURB-65 showed good performance for predicting in-hospital death (area under curve 0.81, 95% confidence interval (CI) 0.71–0.91). CURB-65 ⩾ 2 may serve as a cut-off value for prediction of in-hospital death in severe patients with COVID-19 (sensitivity 68%, specificity 81%, F1 score 0.7). CURB-65 (hazard ratio (HR) 1.61; 95% CI 1.05–2.46), LDH (HR 1.003; 95% CI 1.001–1.004) and albumin (HR 0.9; 95% CI 0.81–1) were risk factors for in-hospital death in severe patients with COVID-19. Our study indicates CURB-65 may serve as a useful prognostic marker in COVID-19 patients, which could be used to quickly triage severe patients in primary care or general practice settings.

We present direct numerical simulations of non-Oberbeck–Boussinesq (NOB) Rayleigh–Bénard (RB) convection due to large temperature differences in two-dimensional (2-D) and three-dimensional (3-D) cells. Perfect air is chosen as the operating fluid and the Prandtl number ($Pr$) is fixed to 0.71 for the reference state $\hat{T}_{0}=300~\text{K}$. In the present system, we consider large temperature differences ranging from 60 K to 240 K, and relatively strong NOB effects are induced at moderate Rayleigh numbers ($Ra$) in the range $3\times 10^{6}\leqslant Ra\leqslant 5\times 10^{9}$. The large temperature difference also induces the turbulence system with large density variation. Due to top-down symmetry breaking under NOB conditions, an increase of the centre temperature $T_{c}$ is found compared to the arithmetic mean temperature $T_{m}$ of the top and bottom plates, and the shift of $T_{c}$ is strongly dependent on Rayleigh number $Ra$ and temperature differential $\unicode[STIX]{x1D716}$. The NOB effects on the Nusselt number ($Nu$) are quite small (${\lesssim}2\,\%$). The power-law scalings of $Nu$ versus $Ra$ are robust against NOB effects, even for the extremely large temperature difference 240 K, which has never been reached in previous experiments and simulations. The Reynolds numbers $Re$, as well as the scalings of $Re$ versus $Ra$, are also insensitive to NOB effects. It is noteworthy that the influence of NOB effects on $Nu$ and $Re$ in 3-D RB flow are weaker than its 2-D counterpart. Furthermore, the extended laminar boundary layer (BL) equations are developed based on the low-Mach-number Navier–Stokes equations, which qualitatively predicts the NOB effects on velocity profiles. Direct numerical simulation results indicate that the top and bottom thermal BLs can compensate each other much better than the velocity BLs under NOB conditions, which contribute to the robustness of $Nu$.