Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study.

BACKGROUND: Polypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy. AIM: To conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended. METHOD: The mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process. RESULTS: The intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention. CONCLUSION: The study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy. TRIAL REGISTRATION NUMBER: ACTRN12621000268842 Date registered: 11/03/2021.

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study.

BACKGROUND: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Response of maize yield and nitrogen recovery efficiency to nitrogen fertilizer application in field with various soil fertility.

Appropriate nitrogen (N) management system is essential for effective crop productivity and minimizing agricultural pollution. However, the underlying mechanistic understanding of how N fertilizer regulates crop yield via soil properties in soils with different fertilities remains unresolved. Here, we used a field experiment that spanned 3 cropping seasons to evaluate the grain yield (GY), aboveground biomass and N recovery efficiency (NRE) after treatment with five N fertilizer application rates (N0, N75, N112, N150, and N187) in soils with three levels of fertility. Our results indicated that the highest GY across low, moderate, and high fertility soils were 1.5 t hm-2 (N150), 4.9 t hm-2 (N187), and 5.4 t hm-2 (N112), respectively. The highest aboveground biomass and NRE were observed at N150 for all three levels of soil fertility, while only the N uptake by aboveground biomass of low and high fertility soils decreased at N187, confirming that excessive N fertilization results in a further decline in crop N uptake. The relationship between GY, NRE and N fertilizer application rates fit the unary quadratic polynomial model. To achieve a balance between grain production and environmental benefits in N fertilizer, appropriate N fertilizer rates were determined to be 97.5 kg hm-2, 140 kg hm-2 and 131 kg hm-2 for low, moderate and high fertility soils, respectively. Structural equation modeling suggested that GY was significant correlated with soil microbial biomass carbon (SMBC) and N directly in low fertility field, with SMBC directly in moderate fertility field, and via SOC and NO3 -N in high fertility field. Therefore, a soil-based management strategy for N fertilizers could enhance food security while reducing agricultural N fertilizer inputs to mitigate environmental impacts.

Prediction of Thermo-Mechanical Properties of 8-Harness Satin-Woven C/C Composites by Asymptotic Homogenization.

The elasticity matrix and the coefficients of thermal expansion (CTEs) of 8-harness satin-woven (8HS) carbon-fiber-reinforced carbon matrix (C/C) composites at high temperatures were obtained by the asymptotic homogenization method (AHM) and finite element method (FEM). By analyzing the microstructure of the 8HS C/C composites, a representative volume element (RVE) model considering a braided structure was established. The effects of the temperature and component volume fraction on the elasticity matrix and CTEs of the composites were investigated. The sensitivity of model parameters, including the size of RVE model and mesh sensitivity, were studied. The optimal calculation model was employed. In addition, the effects of the 4HS methods and 8HS methods on the elastic constants of the composites were compared. The temperature and variation in the carbon fiber volume fraction were found to have a significant impact on the elasticity matrix and CTEs of composite materials. At the same volume fraction of carbon fibers, some elastic coefficients of the 4HS composite material were slightly lower than those of 8HS composite material. This research affords a computational strategy for the accurate prediction of the themo-mechanical properties of satin-woven C/C composites.

Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case-control study.

Background: Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. Methods: The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined). Findings: Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50). Interpretation: There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke. Funding: The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.

The Association of Early Menopause with Increased Risk of Acute Myocardial Infarction: The INTERHEART China Study.

Background and Aim: Little is known about whether early menopause in Chinese ethnicity is associated with acute myocardial infarction (AMI). We aimed to determine whether self-reported early menopause (either surgical or natural menopause at an age <50 year) was associated with first AMI in Chinese women. Methods: The study population was from the INTERHEART China Study, part of the INTERHEART global study. INTERHEART global study was a standardized case-control study that was designed to evaluate the risk factors for first AMI among 52 countries. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by structured questionnaires. A standard set of questions that inquired about menstrual history was included in the interview. Results: Of the 1,771 Chinese women, 1,563 (88.3%) reported either natural or surgical menopause. In univariate logistic regression model, women with early menopause had higher risk of AMI (odds ratio [OR]: 1.51; 95% confidence interval [CI]: 1.23-1.87). After controlling for age, birth control measures, type of menopause, and other traditional risk factors (including waist/hip ratio, lifestyle factors, history of hypertension and diabetes, psychosocial factors, and apolipoprotein B [ApoB]/A1 [ApoA1]), the risk for AMI remained (OR: 1.36; 95% CI: 1.03-1.79). The population attributable risk for AMI in women with early menopause at <50 years was 10.1% (95% CI: 4.0-20.0) compared with women who had menopause at ≥50 years. Conclusion: Early menopause is associated with increased risk of AMI in Chinese women, independent of other traditional coronary heart disease risk factors.

Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer.

Background: Breast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI. Methods: This retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics. Results: Compared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher. Conclusion: This study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.

Increased 68 Ga-FAPI Activity in Primary Small Cell Neuroendocrine Carcinoma of the Gallbladder.

ABSTRACT: Primary small cell neuroendocrine carcinomas are extremely rare heterogeneous neoplasms. We present 68 Ga-FAPI (fibroblast activation protein inhibitor) PET/CT findings of small cell neuroendocrine carcinoma of the gallbladder in a 57-year-old woman. This rare gallbladder small cell neuroendocrine carcinoma demonstrated intense tracer uptake on 68 Ga-FAPI PET/CT. This demonstrates the potential value of 68 Ga-FAPI PET/CT for evaluation of gallbladder small cell neuroendocrine carcinoma.

Development and validation of PolyScan, an information technology triage tool for older adults with polypharmacy: a healthcare informatics study.

Introduction Polypharmacy is associated with potentially inappropriate medicine prescribing and avoidable medicine-related harm. Polypharmacy should not be perceived as inherently harmful. Instead, priority should be placed on reducing inappropriate prescribing. Aim The study aimed to develop and validate PolyScan, a primary care information technology tool, to triage older adults with polypharmacy who are prescribed potentially inappropriate medicines. Methods Twenty-one indicators from a New Zealand criteria of potentially inappropriate medicines to correct for older adults with polypharmacy were developed into a set of implementable definitions. The definitions were applied as algorithmic logic statements used to interrogate hospital and emergency department records and pharmaceutical collection data to classify whether each indicator was present at an individual patient level, and then triage individuals based on the number of indicators met. Validity was evaluated by comparing PolyScan's accuracy against a manual review of healthcare records for 300 older adults. Results PolyScan was successfully implemented as a tool that can be used to identify potentially inappropriate prescribing in older adults with polypharmacy at different levels of aggregation. The tool has utility for individual practitioners delivering patient care, primary care organisations undertaking quality improvement programmes, and policymakers considering system-level interventions for medicines-related safety. During the validity assessment, PolyScan identified nine individuals (3%) with polypharmacy and indicators of potentially inappropriate medicine. Five unique indicators were detected. PolyScan achieved 100% sensitivity, specificity, and positive and negative predictive values. Discussion PolyScan can support clinicians, clinics, and policymakers with allocation of resources, rational medicine campaigns, and identifying individuals prescribed potentially inappropriate medicines for review.

A Modified Bond-Associated Non-Ordinary State-Based Peridynamic Model for Impact Problems of Quasi-Brittle Materials.

In this work, we have developed a novel bond-associated non-ordinary state-based peridynamic (BA-NOSB PD) model for the numerical modeling and prediction of the impact response and fracture damage of quasi-brittle materials. First, the improved Johnson-Holmquist (JH2) constitutive relationship is implemented in the framework of BA-NOSB PD theory to describe the nonlinear material response, which also helps to eliminate the zero-energy mode. Afterwards, the volumetric strain in the equation of state is redefined by the introduction of the bond-associated deformation gradient, which can effectively improve the stability and accuracy of the material model. Then, a new general bond-breaking criterion is proposed in the BA-NOSB PD model, which is capable of covering various failure modes of quasi-brittle materials, including the tensile-shear failure that is not commonly considered in the literature. Subsequently, a practical bond-breaking strategy and its computational implementation are presented and discussed by means of energy convergence. Finally, the proposed model is verified by two benchmark numerical examples and demonstrated by the numerical simulation of edge-on impact and normal impact experiments on ceramics. The comparison between our results and references shows good capability and stability for impact problems of quasi-brittle materials. Numerical oscillations and unphysical deformation modes are effectively eliminated, showing strong robustness and bright prospects for relevant applications.

Augmented Reality Surgical Navigation System Integrated with Deep Learning.

Most current surgical navigation methods rely on optical navigators with images displayed on an external screen. However, minimizing distractions during surgery is critical and the spatial information displayed in this arrangement is non-intuitive. Previous studies have proposed combining optical navigation systems with augmented reality (AR) to provide surgeons with intuitive imaging during surgery, through the use of planar and three-dimensional imagery. However, these studies have mainly focused on visual aids and have paid relatively little attention to real surgical guidance aids. Moreover, the use of augmented reality reduces system stability and accuracy, and optical navigation systems are costly. Therefore, this paper proposed an augmented reality surgical navigation system based on image positioning that achieves the desired system advantages with low cost, high stability, and high accuracy. This system also provides intuitive guidance for the surgical target point, entry point, and trajectory. Once the surgeon uses the navigation stick to indicate the position of the surgical entry point, the connection between the surgical target and the surgical entry point is immediately displayed on the AR device (tablet or HoloLens glasses), and a dynamic auxiliary line is shown to assist with incision angle and depth. Clinical trials were conducted for EVD (extra-ventricular drainage) surgery, and surgeons confirmed the system's overall benefit. A "virtual object automatic scanning" method is proposed to achieve a high accuracy of 1 ± 0.1 mm for the AR-based system. Furthermore, a deep learning-based U-Net segmentation network is incorporated to enable automatic identification of the hydrocephalus location by the system. The system achieves improved recognition accuracy, sensitivity, and specificity of 99.93%, 93.85%, and 95.73%, respectively, representing a significant improvement from previous studies.

Keeping obesity status is a risk factor of hypertension onset: evidence from a community-based longitudinal cohort study in North China.

Objective: The purpose of our study was to investigate the association of obesity status change with hypertension onset based on a community-based longitudinal cohort study in North China. Methods: This longitudinal study included 3,581 individuals free of hypertension at baseline in the first survey (2011-2012). All participants were followed up (2018-2019). According to the criteria, a total of 2,618 individuals were collected for analysis. We used adjusted Cox regression models and Kaplan-Meier survival analysis to estimate the association between obesity status change and hypertension onset. Additionally, we applied the forest plot to visualize the subgroup analysis including age, gender, and the differences in some variables between baseline and follow-up. Finally, we conducted a sensitivity analysis to examine the stability of our results. Results: Over nearly 7 years of follow-up, a total of 811 (31%) developed hypertension. The new hypertension incidence was mostly observed in those who were obese all the time (P for trend < 0.01). In the fully adjusted Cox regression model, being obese all the time increased the risk of hypertension by 30.10% [HR 4.01 (95% CI 2.20-7.32)]. The Kaplan-Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. Sensitivity analysis shows a consistent trend between the change in obesity status and hypertension onset in all populations. Subgroup analysis showed that age above 60 years was an important risk factor for hypertension onset, that men were more likely than women to develop hypertension, and that weight control was beneficial in avoiding future hypertension in women. There were statistically significant differences in ΔBMI, ΔSBP, ΔDBP, and ΔbaPWV between the four groups, and all variables, except baPWV changes, increased the risk of future hypertension. Conclusion: Our study shows that obese status was notably associated with a significant risk of hypertension onset among the Chinese community-based cohort.

A Bond-Based Peridynamic Model with Matrix Plasticity for Impact Damage Analysis of Composite Materials.

The prediction of damage and failure to fiber-reinforced polymer composites in extreme environments, particularly when subjected to impact loading, is a crucial issue for the application and design of protective structures. In this paper, based on the prototype microelastic brittle (PMB) model and the LaRC05 composite materials failure model, we proposed a bond-based peridynamic (BB-PD) model with the introduction of plastic hardening of the resin matrix for fiber-reinforced polymer composites. The PD constitutive relationships of the matrix bond and interlayer bond under compressive loading are considered to include two stages of linear elasticity and plastic hardening, according to the stress-strain relationship of the resin matrix in the LaRC05 failure model. The proposed PD model is employed to simulate the damage behaviors of laminated composites subjected to impact loading. The corresponding ballistic impact tests of composite laminates were carried out to observe their damage behaviors. The PD prediction results are in good agreement with the ballistic experimental results, which can verify the correctness and accuracy of the PD model developed in this study in describing the impact damage behaviors of composite materials. In addition, the characteristics and degree of damage in composite laminates are analyzed and discussed based on this PD model. The difference in the impact resistance of composite laminates with different stacking sequences is also studied using the numerical simulation results.

Development of explicit criteria identifying potentially inappropriate polypharmacy in older adults in New Zealand primary care: a mixed-methods study.

Introduction The link between polypharmacy, risk of potentially inappropriate medication exposure, and avoidable medicines-related harm is well recognised. Not all polypharmacy is harmful, and contemporary multimodal approaches to managing long-term conditions are evidence-based and commonplace. What is needed is a focus on reducing inappropriate medication prescribing in polypharmacy. Aim This study aims to develop the New Zealand criteria, a set of New Zealand-specific potentially inappropriate medication indicators to correct for older adults with polypharmacy. Methods A mixed-methods approach was used. An expert panel group comprising four clinical pharmacists, two general practitioners, one geriatrician, and two nurse practitioners generated a collection of ideas via the nominal group technique, which combined with published criteria from literature, provided the list of potential criteria. These potential criteria were reviewed, validated, and ranked for importance via a two-round modified Delphi analysis with the same panel. Results The nominal group technique generated 35 indicators, of which 23 were rated as important. Fifty-nine of 91 indicators from literature were rated as relevant and important. This generated 82 indicators for the modified Delphi analysis, from which 61 achieved consensus. Overall, 21 unique criteria were judged 'very important', 31 were judged 'important', and nine were judged 'somewhat important'. No indicators were judged 'low importance'. Discussion The New Zealand criteria provides 61 medication indicators, which New Zealand experts recommend should prompt formal, documented review. The criteria can be used to systematically identify patients at the highest risk of avoidable medication-related harm for proactive review.

Numerical Simulation on Laser Shock Peening of B4C-TiB2 Composite Ceramics.

The introduction of residual stresses using laser shock peening (LSP) is an effective means of improving the mechanical properties of ceramics. Numerical simulations offer greater convenience and efficiency than in-lab experiments when testing the effects of different processing techniques on residual stress distribution. In this work, a B4C-TiB2 ceramic model based on the extended Drucker-Prager model was established to investigate the effects of laser power density, the number of impacts and laser spot overlapping rate on the residual stress distribution, and the reliability of the simulation method was verified by experimental data. The following results are obtained: increasing the laser power density and the number of impacts can increase the surface residual compressive stress and reduce the depth of the residual compressive stress; the presence of multiple impacts will significantly reduce the depth of the residual compressive stress layer; with the increase in the laser spot overlapping rate, the compressive residual stress in the processed area gradually increases and is more uniformly distributed; the best processing effect can be achieved by using a spot overlapping rate of 50%.

Association between length of daily siesta and brachial-ankle pulse wave velocity (baPWV): a community-based cross sectional study in North China.

INTRODUCTION: To date, many studies have shown a link between siesta and cardiovascular events. Little is known regarding the connection between siesta and brachial-ankle pulse wave velocity (baPWV) levels, even though baPWV can determine the degree of atherosclerosis and vascular stiffness. Thus, we examined the relationship between siesta time and baPWV in a cross-sectional study. METHODS: Interviews, physical examinations, lab testing, and electron beam computed tomography were all part of the baseline evaluation for participants aged older than 35. Baseline data were compared for 3 different siesta habits: irregular or no siestas, daily short siestas (1 h or less), and daily long siestas (> 1 h). Utilizing logistic regression models and multivariate linear regression, the link between siesta time and baPWV was determined. RESULTS: Among all 6566 participants, the different siesta groups had a significant difference of the degrees of AS (P < 0.001). The same outcome was true for both males (P < 0.001) and females (P < 0.001). Numerous cardiovascular risk variables and markers of subclinical atherosclerosis were positively correlated with daily extended siestas. Results from the fully adjusted model showed that long siestas (> 60 min, OR = 1.18, 95%CI: 1.06-1.31, P = 0.002) were linked to a more severe level of the baPWV. For age or gender stratification, we found significant differences between non-siesta and > 60 min siesta groups. Multiple linear regression analysis revealed a positive connection between siesta duration and baPWV (ß = 0.197, P = 0.038). CONCLUSIONS: An elevated risk of atherosclerosis was shown to accompany prolonged siestas. These results need to be followed up on with prospective studies and additional lab work.

Hypertension in China: epidemiology and treatment initiatives.

The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.

Diagnostic value of procalcitonin, hypersensitive C-reactive protein and neutrophil-to-lymphocyte ratio for bloodstream infections in pediatric tumor patients.

OBJECTIVES: Bloodstream infection (BSI) is one of the major causes of death in pediatric tumor patients. Blood samples are relatively easy to obtain and thus provide a ready source of infection-related biological markers for the prompt evaluation of infection risk. METHODS: A total of 259 pediatric tumor patients were included from May 2019 to March 2022. Patients were divided into BSI group (n=70) and control group (n=189). Clinical and biological data were collected using electronic medical records. Differences in biological markers between BSI group and control group and differences before and during infection in BSI group were analyzed. RESULTS: The infected group showed higher levels of procalcitonin (PCT) and hypersensitive C-reactive-protein (hsCRP), and lower prealbumin (PA) than the uninfected group. Area under the receiver-operating curve (ROC) curves (AUC) of PCT, hsCRP and NLR (absolute neutrophil count to the absolute lymphocyte count) were 0.756, 0.617 and 0.612. The AUC of other biomarkers was ≤0.6. In addition, PCT, hsCRP, NLR and fibrinogen (Fg) were significantly increased during infection, while PA and lymphocyte (LYM) were significantly decreased. Antibiotic resistant of Gram-positive bacteria to CHL, SXT, OXA and PEN was lower than that of Coagulase-negative Staphylococcus. Resistant of Gram-positive bacteria to CHL was lower, while to SXT was higher than that of Gram-negative bacteria. CONCLUSIONS: This study explored the utility of biomarkers to assist in diagnosis and found that the PCT had the greatest predictive value for infection in pediatric tumor patients with BSI. Additionally, the PCT, hsCRP, NLR, PA, LYM and Fg were changed by BSI.

Thermo-Mechanical Coupling Model of Bond-Based Peridynamics for Quasi-Brittle Materials.

The mechanical properties of quasi-brittle materials, which are widely used in engineering applications, are often affected by the thermal condition of their service environment. Moreover, the materials appear brittle when subjected to tensile loading and show plastic characteristics under high pressure. These two phenomena manifest under different circumstances as completely different mechanical behaviors in the material. To accurately describe the mechanical response, the material behavior, and the failure mechanism of quasi-brittle materials with the thermo-mechanical coupling effect, the influence of the thermal condition is considered in calculating bond forces in the stretching and compression stages, based on a new bond-based Peridynamic (BB-PD) model. In this study, a novel bond-based Peridynamic, fully coupled, thermo-mechanical model is proposed for quasi-brittle materials, with a heat conduction component to account for the effect of the thermo-mechanical coupling. Numerical simulations are carried out to demonstrate the validity and capability of the proposed model. The results reveal that agreement could be found between our model and the experimental data, which show good reliability and promise in the proposed approach.