Maximum potential of vegetation carbon sink in Chinese forests.

Forest vegetation is essential in sequestering carbon dioxide (CO2) from the atmosphere and mediating global warming. The carbon (C) sink potential of forest vegetation in different provinces is vital for policymakers to develop C-neutral technical routes and regional priorities in China; however, the mechanism remains unclear. In this study, we compiled the public data on forest vegetation biomass or storage along forest succession series between 2003 and 2022 and obtained the spatial variation of the maximum C storage(BCmax) of forest vegetation using classic logistic equation and nonlinear fitting. Furthermore, the C sink potential (∆Cpot) of the Chinese forest vegetation was calculated based on the differences between the BCmax and intensive field-investigated data in the 2010s. The results showed that the BCmax in the Chinese forest vegetation was approximately 19.03 Pg. The BCmax in southwest and northeast China were higher than those in other regions. The ∆Cpot was estimated as 8.83 Pg. Moreover, 1 km × 1 km spatial raster data for ∆Cpot were produced using the spatial raster calculation. Similarly, the per capita ∆Cpot of regions with low economic development (southwest, central, and southern Chinese provinces) were five to ten times higher than those of regions with a higher economic level. The ∆Cpot correlated negatively with gross domestic product (GDP)across all Chinese provinces. Our findings provide new insights into the ∆Cpot of the Chinese forest vegetation under natural restoration and emphasize that some differences in financial and political support among different provinces facilitate achieving a large ∆Cpot for C neutrality.

Maize seed appearance quality assessment based on improved Inception-ResNet.

Current inspections of seed appearance quality are mainly performed manually, which is time-consuming, tedious, and subjective, and creates difficulties in meeting the needs of practical applications. For rapid and accurate identification of seeds based on appearance quality, this study proposed a seed-quality evaluation method that used an improved Inception-ResNet network with corn seeds of different qualities. First, images of multiple corn seeds were segmented to build a single seed image database. Second, the standard convolution of the Inception-ResNet module was replaced by a depthwise separable convolution to reduce the number of model parameters and computational complexity of the network. In addition, an attention mechanism was applied to improve the feature learning performance of the network model and extract the best image information to express the appearance quality. Finally, the feature fusion strategy was used to fuse the feature information at different levels to prevent the loss of important information. The results showed that the proposed method had decent comprehensive performance in detection of corn seed appearance quality, with an average of 96.03% for detection accuracy, 96.27% for precision, 96.03% for recall rate, 96.15% for F1 value of reconciliation, and the average detection time of an image was about 2.44 seconds. This study realized rapid nondestructive detection of seeds and provided a theoretical basis and technical support for construction of intelligent seed sorting equipment.

The optimal tibial tunnel placement to maximize the graft bending angle in the transtibial posterior cruciate ligament reconstruction: a quantitative assessment in three-dimensional computed tomography model.

Background: The graft bending angle created by the graft and the tibial tunnel has inevitably occurred during the transtibial posterior cruciate ligament (PCL) reconstruction. However, few studies quantitively analyzed this angle. This study aimed to (I) explore the optimal tibial tunnel placement to maximize the graft bending angle in the PCL reconstruction; (II) reveal the effect of the tibial tunnel placement on the graft bending angle. Methods: This was an in-vitro surgical simulation study based on the three-dimensional (3D) computed tomography (CT). A total of 55 patients who took CT scanning for knee injuries were selected (April 2020 to January 2022) from the local hospital database for review. The 3D knee models were established on the Mimics software based on the knees' CT data. Using the Rhinoceros software to simulate the transtibial PCL reconstruction on the 3D CT knee model. The anteromedial and anterolateral tibial tunnel approaches were simulated with different tibial tunnel angle. The graft bending angle and tibial tunnel length (TTL) with different tibial tunnel angles were quantitively analyzed. Results: The graft bending angle in anterolateral approach with a 50° tibial tunnel angle was significantly greater than it in anteromedial approach with a 60° tibial tunnel angle (P<0.001). There was no difference of the graft bending angle between the anterolateral approach with a 40° tibial tunnel angle and the anteromedial approach with a 60° tibial tunnel angle (P>0.05). The graft bending angle showed a strong correlation with the tibial tunnel angle (for anteromedial approach: r=0.759, P<0.001; for anterolateral approach: r=0.702, P<0.001). The best-fit equation to calculate the graft bending angle based on the tibial tunnel angle was Y = 0.89*X + 59.05 in anteromedial tibial tunnel approach (r2=0.576), and was Y = 0.78*X + 80.21 anterolateral tibial tunnel approach (r2=0.493). Conclusions: The graft bending angle and TTL will significantly increase as the tibial tunnel angle becomes greater. Maximizing the tibial tunnel angle (50° tibial tunnel angle) in the anterolateral approach could provide the greatest graft bending angle in the PCL reconstruction. No matter how the tibial tunnel angle is changed in the anteromedial approach, using anterolateral approach might reduce the killer turn effect more effectively than using anteromedial approach.

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis.

Introduction: The COVID-19 pandemic has impacted children and adolescents' physical activity (PA), sleeping patterns, and psychological and behavioral health. Yet, little is known about the differences between those in countries with various economic statuses. Methods: Articles published from database inception through 16 March 2022 were retrieved using CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO. High-quality studies that reported the number of participants with parameters associated with PA, sleeping patterns, and psychological and behavioral problems in young people aged under 18 years during the pandemic were included. We referenced the Canadian 24-Hour Movement Guidelines for PA and sleep duration to provide the event rate for young people who were not compliant with the guidelines. The event rate of young people who had decreased sleep quality and experienced psychological and behavioral problems were also investigated. A subgroup analysis was conducted to identify the differences in those in countries with diverse economic statuses. Funnel plot analysis and Egger's test were also conducted to identify any risk of publication bias. Result: A total of 66 studies with 1,371,168 participants aged between 0 and 18 years, involving 27 countries, were included. During the pandemic, we identified that 41% (95% CI: 39%, 43%; I2 = 96.62) and 43% (95% CI: 34%, 52%; I2 = 99.42) of young people did not meet the PA and sleep duration recommendation guidelines. In addition, 31% (95% CI: 28%, 35%; I2 = 99.66) of young people had decreased their sleep quality. Yet, no significant difference was found across countries with different economic statuses. However, the event rates of participants with psychological and behavioral problems were 32% (95% CI: 28%, 36%; I2 = 99.85) and 19% (95% CI: 14%, 25%; I2 = 99.72), respectively. In addition, the rate of psychological problems was more severe in those who live in lower middle-income countries (p < 0.001), while the rate of behavioral problems was more severe in those who live in high-income countries (p = 0.001). Discussion: During the pandemic, the discouragement of PA, poor sleep quality, and high risk of psychological and behavioral problems are concerning. A large number of young people did not comply with the recommendation guidelines. Timely implementation of recovery plans is critical to address the adverse effects on young people. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309209, identifier CRD42022309209.

The Analysis and Research on the Influence of Sports Industry Development on Economic Development.

The rapid development of social economy will promote the development of sports industry and then have an impact on sports economy. By using the regression analysis method, this paper compares the influencing factors of sports industry development, aiming at exploring the influence of sports industry development on economic development and its future development trend. This paper takes 12 industries of sports industry development from January 2020 to January 2022 as research objects, compares the development of sports industry of different research objects, and determines the factors affecting sports industry. We compare the promotion of different factors to sports economy and provide support for the formulation of sports industry development measures. The results show that economic growth, sports industry types, the degree of integration between sports industry and economic development, sports industry action time, and sports industry scale are the main factors affecting sports industry and promote the development of sports economy. The above indexes can improve the economic level of sports industry, and the improvement degree is about 10∼20%. Therefore, local governments and sports organizations should formulate measures to promote the economic development of sports industry from the aspects of economic growth, sports industry types, integration degree between sports industry and economic development, action time of sports industry, and scale of sports industry.

Assessment and sources identification of microplastics, PAHs and OCPs in the Luoyuan Bay, China: Based on multi-statistical analysis.

Luoyuan Bay is a mariculture influenced water body located in southeastern China. Multi-statistical techniques were applied to 21 sampling locations in the bay to identify the sources of microplastics and other pollutants in the sediment. In microplastics detection, fragment was the most abundant shape (~36%), and rayon was the dominant polymer (~59%). The size of more than 48% of total microplastics observed was less than 200 µm. The study showed that the upper part of Luoyuan Bay was dominated by microplastic pollution, while the lower part of the bay was dominated by persistent organic pollutants (PAHs, OCPs). Mariculture is one of the main sources of pollution in Luoyuan Bay. Apart from mariculture, there were additional sources such as industry, land reclamation, port, and so on; industry and land reclamation were the leading sources of microplastics, while port, industry, and mariculture were the primary sources of PAHs and OCPs.

Assessment of TMB, PD-L1, and lymphocyte to monocyte ratio as predictive potential in a phase Ib study of sintilimab in patients with advanced solid tumors.

BACKGROUND: Sintilimab is a humanized monoclonal antibody against the programmed cell death 1 (PD-L1). We aimed to assess the safety and activity of sintilimab monotherapy or in combination with chemotherapy in advanced solid tumors. METHODS: This phase Ib study included six cohorts. Cohort A-C were sintilimab monotherapy settings, and enrolled pretreated patients (2/3 L cohorts). Cohort D-F were treatment-naïve patients (1 L cohorts), and received sintilimab plus different chemotherapies. The primary endpoints were safety and objective response rate (ORR). Exploratory endpoints were potential biomarkers for the prognosis after treatment, such as tumor mutation burden scores (TMB), PD-L1 and lymphocyte-to-monocyte ratio (LMR). RESULTS: The ORR was 14.6% in the 2/3 L cohorts (n=146), and 73.2% in the 1 L cohorts (n=61). The incidence of grade 3-4 adverse events occurred in 55 patients (37.7%) in 2/3 L cohorts, and in 38 (62.3%) in 1 L cohorts. 157 patients had available TMB scores, and in 2/3 L cohorts, patients in the high TMB groups (TMB≥10) showed a longer progression-free survival (PFS) and overall survival (OS) than those in the low TMB groups (TMB<10). No significant differences in PFS and OS were observed across different PD-L1 groups in both 1 L and 2/3 L cohorts. A high LMR was significantly associated with an improved PFS in 1 L cohorts (P=0.022). CONCLUSION: Sintilimab alone or combined with chemotherapy had a tolerable safety profile in solid tumors. The combination therapy showed a favorable activity with advanced non-small cell lung cancer and gastric or esophagogastric junction adenocarcinoma. LMR might be a prognostic factor for the combination regimen in these patients. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02937116. Registered 18 October 2016.

Population simulations of COVID-19 outbreaks provide tools for risk assessment and continuity planning.

OBJECTIVES: We developed COVID-19 Outbreak Simulator (https://ictr.github.io/covid19-outbreak-simulator/) to quantitatively estimate the effectiveness of preventative and interventive measures to prevent and battle COVID-19 outbreaks for specific populations. MATERIALS AND METHODS: Our simulator simulates the entire course of infection and transmission of the virus among individuals in heterogeneous populations, subject to operations and influences, such as quarantine, testing, social distancing, and community infection. It provides command-line and Jupyter notebook interfaces and a plugin system for user-defined operations. RESULTS: The simulator provides quantitative estimates for COVID-19 outbreaks in a variety of scenarios and assists the development of public health policies, risk-reduction operations, and emergency response plans. DISCUSSION: Our simulator is powerful, flexible, and customizable, although successful applications require realistic estimation and robustness analysis of population-specific parameters. CONCLUSION: Risk assessment and continuity planning for COVID-19 outbreaks are crucial for the continued operation of many organizations. Our simulator will be continuously expanded to meet this need.

Distribution and assessment of cadmium contamination in sediments from the Four River inlets to Dongting Lake, China.

The total concentrations of Cd in bulk sediments and those of the BCR sequential extraction fractions of sediments from inlets of the Four Rivers that feed Dongting Lake were determined using ICP-MS techniques. The results suggested that Cd was heterogeneously distributed in the inlet sediments of the rivers, with the highest degree of enrichment in sediments from the Xiangjiang River. The Cd anomaly was defined as Cd enrichment in sediments with an EF (enrichment factor) > 10.0, and it was identified in the inlet sediments of the Xiangjiang River. Cd in the sediments was dominated by acid-soluble Cd at a proportion of 23.9-69.8 (%) compared to its total concentrations in the sediments. The inlet sediments of the Four Rivers were contaminated with Cd, with the highest degree of contamination in the inlet sediments of the Xiangjiang River. The Cd contamination as well as the Cd anomaly in the sediments were closely related to the industrial activities (e.g. smelting and refining for ore minerals) in the areas, and Cd contamination at high levels may represent an ecological risk for the lake watershed. Cd contamination of the inlet sediments may also impact the lake basin sediments and is harmful to the lake ecological system, particularly for sediments of the Xiangjiang River. Therefore, it is essential to control and treat Cd contamination in the inlet sediments for ecological environmental protection of lake watersheds.

Recent Advances in Nanomaterial-Enabled Wearable Sensors: Material Synthesis, Sensor Design, and Personal Health Monitoring.

Wearable sensors have gained much attention due to their potential in personal health monitoring in a timely, cost-effective, easy-operating, and noninvasive way. In recent studies, nanomaterials have been employed in wearable sensors to improve the sensing performance in view of their excellent properties. Here, focus is mainly on the nanomaterial-enabled wearable sensors and their latest advances in personal health monitoring. Different kinds of nanomaterials used in wearable sensors, such as metal nanoparticles, carbon nanomaterials, metallic nanomaterials, hybrid nanocomposites, and bio-nanomaterials, are reviewed. Then, the progress of nanomaterial-based wearable sensors in personal health monitoring, including the detection of ions and molecules in body fluids and exhaled breath, physiological signals, and emotion parameters, is discussed. Furthermore, the future challenges and opportunities of nanomaterial-enabled wearable sensors are discussed.

Cost-effectiveness analysis of two kinds of bladder cancer urinary diversion: Studer versus Bricker.

BACKGROUND: The purpose of our study was to evaluated the cost-effectiveness of two bladder cancer (BCa) urinary diversions: Studer and Bricker. METHODS: The study included 44 patients with Studer and 40 patients with Bricker. Collected and analyzed the patient's basic characteristics, health care costs, and prognosis survival. The quality-adjusted life-year (QALY) were calculated and verified by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30, Version 3, Chinese version). Cost-effectiveness depends on the incremental cost per QALY. The incremental cost-effectiveness ratio (ICER) was determined using the cost/QALY. RESULTS: We found the average total cost of the Studer group was $7,173.7±1,390.8, and the Bricker group was $6,545.2±1,458.4. There were significant differences in hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge and drugs cost (all P<0.05). The hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge, surgical treatment cost and drugs cost in Studer group were higher than those in Bricker group, while there was no significant difference in postoperative complications between the two groups (P=0.858). The ICER of Studer group and Bricker group were $8,535.6±2,027.6/QALY and $11,158.2±2,944.9/QALY, respectively. The ICER of Studer group over Bricker group was $2,514.0/QALY. CONCLUSIONS: We found the Studer group had higher hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge, surgical treatment cost, and drugs cost than the Bricker group, but the Studer group had a higher ICER than the Bricker group.

Neural-network-based Motion Tracking for Breast Ultrasound Strain Elastography: An Initial Assessment of Performance and Feasibility.

Accurate tracking of tissue motion is critically important for several ultrasound elastography methods. In this study, we investigate the feasibility of using three published convolution neural network (CNN) models built for optical flow (hereafter referred to as CNN-based tracking) by the computer vision community for breast ultrasound strain elastography. Elastographic datasets produced by finite element and ultrasound simulations were used to retrain three published CNN models: FlowNet-CSS, PWC-Net, and LiteFlowNet. After retraining, the three improved CNN models were evaluated using computer-simulated and tissue-mimicking phantoms, and in vivo breast ultrasound data. CNN-based tracking results were compared with two published two-dimensional (2D) speckle tracking methods: coupled tracking and GLobal Ultrasound Elastography (GLUE) methods. Our preliminary data showed that, based on the Wilcoxon rank-sum tests, the improvements due to retraining were statistically significant (p < 0.05) for all three CNN models. We also found that the PWC-Net model was the best neural network model for data investigated, and its overall performance was on par with the coupled tracking method. CNR values estimated from in vivo axial and lateral strain elastograms showed that the GLUE algorithm outperformed both the retrained PWC-Net model and the coupled tracking method, though the GLUE algorithm exhibited some biases. The PWC-Net model was also able to achieve approximately 45 frames/second for 2D speckle tracking data investigated.

Competitive Biotransformation Among Phenolic Xenobiotic Mixtures: Underestimated Risks for Toxicity Assessment.

Humans are inevitably exposed to a complex mixture of organic contaminants (i.e., xenobiotics) through diet, environment, and behavior. Biotransformation makes key contributions to the elimination of xenobiotics and greatly mediates the toxicity. However, most biotransformation studies were conducted using individual chemical, and whether coexposure of multiple environmental chemicals will affect each other's fate in the human body is still in its infancy. In this study, bisphenol A (BPA) was selected as a model compound. Its biotransformation was investigated under single exposure/coexposure to other phenolic xenobiotics (triclosan, tetrabromobisphenol A, and bisphenol S) in liver microsome and cell models. The result shows that binary exposures exhibit significant inhibitory effects on the BPA metabolism, especially the sulfate conjugation. In combination of analysis on inhibition models and enzyme activity, the inhibition effect was suggested to be primarily driven by competition for metabolizing enzymes. A mixture with 22 phenolic chemicals was further examined to disrupt BPA at various human-relevant levels. Again, the result demonstrates significant inhibition on the BPA metabolism, indicating the possible natural existence of our finding. Overall, our results show that biotransformation of phenolic xenobiotics can be significantly altered by coexposure, which provides referential evidence on underestimated risks of simultaneous exposure to environmental toxicants.

Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis.

BACKGROUND: Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration. METHODS: We analysed a secondary cross-sectional data of the 2014 National Internal Migrant Dynamic Monitoring Survey collected in May of 2014 from all provinces or regions in mainland China. The medical return was measured by the location of hospitalisation, and the social integration included economic integration and permanent settlement intention. RESULTS: Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90). CONCLUSIONS: Social medical insurance of hometown (NRCMS) was positively associated with the medical return, while the permanent settlement intention was negatively associated with it. Promoting the transfer of migrants' social medical insurance across different regions might be helpful to improve rural-to-urban migrants' health access.

Analysis of global prevalence of antibiotic resistance in Acinetobacter baumannii infections disclosed a faster increase in OECD countries.

Acinetobacter baumannii is one of the most challenging nosocomial pathogens due to the emergence and widespread of antibiotic resistance. We aimed to provide the first analysis of global prevalence of antibiotic resistance in A. baumannii infections, by synthesizing data and knowledge through a systematic review. We searched studies reporting antibiotic resistance in A. baumannii infections using the Medline, Embase, Web of Science, and Cochrane databases from January 2000 to December 2016. Studies were eligible if they investigated and reported antibiotic resistance in A. baumannii infections with inpatients or outpatients in hospital. Our investigation showed a high prevalence of resistance to the common prescribed antibiotics in A. baumannii infections in both OECD (Organization for Economic Co-operation and Development) and non-OECD countries. Strikingly, though OECD countries have substantially lower pooled prevalence of resistance compared to non-OECD countries based on the data during 2006-2016, a further investigation in a time scale disclosed a faster increase in OECD countries during the past 11 years, and currently both of them have a comparable prevalence of resistance (2011-2016). Tigecycline and colistin are still active but their resistances are expected to become common if the preventative measures are not taken. Antibiotic resistance in A. baumannii infection developed fast and is a crisis for both OECD and non-OECD countries. A "post-antibiotic era" for A. baumannii infection is expected in the next 10-20 years without immediate actions from pharmaceutical companies and governments.

Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study.

OBJECTIVES: To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. DESIGN: Cross-sectional survey between April and May 2016. SETTING: Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. PARTICIPANTS: We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. MAIN OUTCOME MEASURES: The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). RESULTS: In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. CONCLUSIONS: Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.

Prospective Study of Stereotactic Body Radiation Therapy for Thymoma and Thymic Carcinoma: Therapeutic Effect and Toxicity Assessment.

Stereotactic body radiation therapy (SBRT) is an important modality in treatment of tumors. We hypothesized that SBRT can achieve excellent local control with limited toxicity in patients with thymic tumors. A single-institution prospective study was performed with 32 patients who underwent SBRT of thymoma and thymic carcinoma between 2005 and 2014. Thirty-two patients including 39 target lesions were analyses in this study. Almost half of the patients (46.9%) were type C by histopathology and more than half (56.3%) were classified into stage IVA or IVB. The median dose of SBRT for gross tumor volume (GTV) was 56 Gy (range 49-70 Gy). Results showed that the response rate was 96.9% after SBRT and the median tumor shrinkage rate was 62.2% (range 3.8-100%). For the patients with both stage II-III and type A-B (n = 6), the median PFS was 28 months. In-field failure was only observed in 4 patients, and outside-field failure was seen in 2 patients. The local control rate was 81.25%. Patients treated with SBRT had an excellent local control with mild toxicities, which suggests that SBRT is feasible for the patients with thymic tumors who are unable to undergo either surgery or conventionally fractionated radiation therapy.

A cheat sheet to navigate the complex maze of pharmaceutical exclusivities in Europe.

As the two leading markets for pharmaceutical and biotech companies, the USA and Europe offer incentives to stimulate drug innovation, including patent and regulatory exclusivities. These exclusivities extend periods during which companies can market their products free of generic or other competition and recoup their investment. Pharmaceutical and biotech companies should carefully assess the different types of exclusivities available when developing regulatory submissions, patent filing strategies. The authors have previously summarized the USA exclusivities in an earlier publication. This article focuses on European exclusivities. Due to space limitations, it focuses on small molecule drugs. Analogously to the format previously used, we have provided a cheat sheet of European exclusivities for small molecule drugs in Figure 1 .

A descriptive analysis of injury triage, surge of medical demand, and resource use in an university hospital after 8.12 Tianjin Port Explosion, China.

OBJECTIVE: The 8.12 Tianjin Port Explosion in 2015 caused heavy casualties. Pingjin Hospital, an affiliated college hospital in Tianjin, China participated in the rescue activities. This study aims to analyze the emergency medical response to this event and share experience with trauma physicians to optimize the use of medical resource and reduce mortality of critical patients. METHODS: As a trauma centre at the accident city, our hospital treated 298 patients. We retrospectively analyzed the data of emergency medical response, including injury triage, injury type, ICU patient flow, and medical resource use. RESULTS: There were totally 165 deaths, 8 missing, and 797 non-fatal injuries in this explosion. Our hospital treated 298 casualties in two surges of medical demand. The first one appeared at 1 h after explosion when 147 wounded were received and the second one at 4 h when 31 seriously injured patients were received, among whom 29 were transferred from Tianjin Emergency Center which was responsible for the scene injury triage. After reexamination and triage, only 11 cases were defined as critical ill patients. The over-triage rate reached as high as 62.07%. Seventeen patients underwent surgery and 17 patients were admitted to the intensive care unit. CONCLUSIONS: The present pre-hospital system is incomplete and may induce two surges of medical demand. The first one has a much larger number of casualties than predicted but the injury level is mild; while the second one has less wounded but almost all of them are critical patients. The over-triage rate is high. The hospital emergency response can be improved by an effective re-triage and implementation of a hospital-wide damage control.