Experimental study on the punching failure model of soft red rock subgrade by BPT-BVM methods and it's assessment of the load bearing capacity.

The recommended bearing capacity of medium weathering mudstone foundation is less than the capacity of the rock structure to withstand loads in Southwest China. A comprehensive failure characterization of medium weathering mudstone in Chengdu has been performed including bearing plate test (BPT), binocular vision measurement (BVM) test, uniaxial compressive strength test, trial trench test of shallow rock surface and 3D imaging in this paper. Failure behavior of rock has been modeled with 3D imaging algorithm that utilizes Zhang's calibration method in BVM system combination with trial trench test of shallow rock surface. The bearing capacity of medium weathering mudstone foundation were extracted from uniaxial experiments and BPT-BVM test by fitting relevant material properties to the data. The results revealed that: Bearing capacity of medium weathering mudstone of layered isotropic in Chengdu is undervalued. Specifically, the characteristic load carrying value is in the range 1500-2500 kP, that is 50% higher than in the local standard system. Failure process is different from Hoek-Brown Failure Criterion, presenting a wave peak transfer phenomenon of the increment displacement into the distance. Thus, it can be reduced to that of punching failures for thin bedded structures of Moudstone foundations. Compressive strength of soft rock proves to be main factor limiting the bearing capacity, a clear correlation between the uniaxial compressive strength reduction coefficient and the bearing capacity has been used to establish, leading to the proposal of a load bearing capacity prediction model.

A Cost-Effective and Labor-Saving Method for Detecting Human Leukocyte Antigen B27 Status via Sequence-Encoded Fluorescence Amplification Assay.

Identification of human leukocyte antigen B27 (HLA-B27) by flow cytometry (FCM) has been widely applied in clinical practice for auxiliary diagnosis of ankylosing spondylitis (AS). However, FCM requires freshly prepared samples and relies on expensive equipment, reagents, and an experienced operator. To provide a cheaper and more convenient method for HLA-B27 detection, we proposed a new method termed sequence-encoded fluorescence amplification assay (SEFA), which specially recognized sequences of HLA-B27 gene (HLA-B∗27) covering current common subtypes in a single closed tube. SEFA could detect as low as 10 pg (equal to 3 copies) genomic DNA per reaction and distinguish HLA-B∗27 from other HLA-B alleles with highly similar sequences. A total of 288 clinical samples were tested by SEFA, including 181 patients with AS and 107 healthy controls. Compared with the detection results from FCM, two controversial samples of patients with AS were obtained and further confirmed to be consistent with SEFA by Sanger sequencing, indicating that our method was more accurate than FCM. Moreover, SEFA could detect HLA-B27 status by using supernatant from crude extract of 10-µL blood without commercial reagents. Overall, SEFA has the potential to be an alternative for HLA-B27 identification with the advantage of convenience and low cost, especially suitable for early diagnosis of AS in areas with limited medical resources.

The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study.

Background: The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions. Methods: The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination. Findings: Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions. Interpretation: Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains. Funding: Funding was provided by UNICEF China.

Assessment of occurrence, partitioning and ecological risk for 144 steroid hormones in Taihu Lake using UPLC-MS/MS with machine learning model.

Steroid hormones (SHs) have attracted mounting attention due to their endocrine-disrupting effects on humans and aquatic organisms. However, the lack of analytical methods and toxicity data for a large number of SHs has limited the effective management of SH contamination in the water-sediment systems. In this study, we developed a highly sensitive analytical method for the simultaneous quantification of 144 SHs to investigate their occurrence, spatial distribution and partitioning in the water and sediment in Taihu Lake. The results showed that the total concentrations of SHs in water and sediment were 366.88-998.23 ng/L (mean: 612.84 ng/L) and 17.46-150.20 ng/g (mean: 63.41 ng/g), respectively. The spatial distribution of SHs in Taihu Lake might be simultaneously influenced by the pollution sources, lake hydrodynamics, and sediment properties. The sediment-water partitioning result implied that 28 SHs were in dynamic equilibrium at the water-water interface. In addition, 22 and 12 SHs tended to spread to water and settle into sediment, respectively. To assess the ecological risk of all SHs, a robust random forest model (R2 = 0.801) was developed to predict the acute toxicity of SHs for which toxicity data were not available from publications. Risk assessment showed that SHs posed a high ecological risk throughout Taihu Lake, with the highest risk in the northwestern areas. Estrone, 17ß-estradiol and 17α-ethynylestradiol were the dominant risk contributors and were therefore recommended as the priority SHs in Taihu Lake. This work provided a valuable dataset for Taihu Lake, which would help to provide guidance and suggestions for future studies and be useful for the government to develop the mitigation and management measures.

Radioactivity of inert construction and demolition waste from Hong Kong and environmental assessment for marine trial reclamation in Guanghai Bay.

Inert construction and demolition waste from Hong Kong (HK public fills) has been used for marine trial reclamation in the Guanghai Bay (GHWT) of the Chinese Mainland. However, an environmental assessment of HK public fills is necessary due to higher radioactivity in HK soils than typical global levels. Here, radiation dose rate, gamma radionuclides and gross beta of HK public fills were analyzed. The origin information was explored using natural primordial radionuclides as fingerprints. Our data show that radiation dose rate of HK public fills before disposal was 0.14-0.54 (0.33 ± 0.03) µSv/h (n = 16,722 data with 2787 ships) in 2014, which is less than the GHWT background. Monthly detection of 238U, 226Ra, 210Pb, 232Th, 228Th, 40K, and gross beta in HK public fills was conducted on three random ships. Their specific activities were <6.27-155.5, 58.7-98.7, <7.83-238.2,97.9-168.6, 87.1-136.0, 463.1-1,018, and 1047-1658 Bq/kgDW, respectively. These results suggest that the radioactivity levels of HK public fills are essentially the same as the GHWT background. The study assessed potential risks using various indices icluding Raeq (Radium equivalent activity), Hex (External radiation hazard index), Hin (Internal radiation hazard index), Iγ (Gamma index), AUI (Activity utilization index), AUI (Activity utilization index), E (Annual effective dose), AGDE (Annual gonadal dose equivalent), RLI (Representative level index), Din (Indoor air absorbed dose rate), Dout (Outdoor air absorbed dose rate), and ELCR (Excess lifetime cancer risk). The study suggests that HK public fills should be used for the trial reclamation rather than building-house materials. This provides valuable insights for the resource utilization and minimizing environmental pollution of HK public fills. The aim is to offer fundamental technical assistance for future waste resource utilization, ecological protection, and restoration in the Guangdong-Hong Kong-Macao Greater Bay Area.

Trusting young children to help causes them to cheat less.

Trust and honesty are essential for human interactions. Philosophers since antiquity have long posited that they are causally linked. Evidence shows that honesty elicits trust from others, but little is known about the reverse: does trust lead to honesty? Here we experimentally investigated whether trusting young children to help can cause them to become more honest (total N = 328 across five studies; 168 boys; mean age, 5.94 years; s.d., 0.28 years). We observed kindergarten children's cheating behaviour after they had been entrusted by an adult to help her with a task. Children who were trusted cheated less than children who were not trusted. Our study provides clear evidence for the causal effect of trust on honesty and contributes to understanding how social factors influence morality. This finding also points to the potential of using adult trust as an effective method to promote honesty in children.

Sodium hyaluronate hydrogel for wound healing and human health monitoring based on deep eutectic solvent.

Hydrogel dressings traditionally promote wound healing by maintaining moisture and preventing infection rather than by actively stimulating the skin to regulate cell behavior. Electrical stimulation (ES) is known to modulate skin cell behavior and to promote wound healing. This study describes the first multifunctional conductive hydrogel for wound healing and health monitoring based on a deep eutectic solvent (DES). Sodium hyaluronate and polydopamine constituted the hydrogel skeleton, and tea tree oil and Panax notoginseng extract were used as the active ingredients to induce adhesion, promote antioxidant and antibacterial activity, and support biocompatibility of the hydrogel. The inclusion of DES increases the temperature resistance of the hydrogel and improves its environmental adaptability. We used a small, portable coin battery-powered to provide electrical stimulation. Treatment with both the hydrogel and ES resulted in a stronger therapeutic effect than that provided by the commercial DuoDERM dressing. The hydrogel detected movement and strain when applied as a sensor. Overall, this study reports the development of a multifunctional conductive hydrogel dressing based on DES as a wound healing and health monitor.

Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China.

Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.

City-level decoupling between livestock and crop production and its effect on fertilizer usage: Evidence from China.

China is one of the largest producers of livestock production and also with tremendous fertilizer consumption in crop production, regional decoupling between livestock and crop production often results in fertilizer overuse and environmental pollution. However, city-level coupling analysis between livestock and crop production is rare, and its impact on fertilizer usage also remains unclear. Here, we evaluated the nitrogen (N) nutrient supply from the livestock breeding sector and the N nutrient demand of cropland during the 2007-2020 period in a typical agricultural region in China. The city-level coupling degree of livestock and crop production and the effect on fertilizer usage were explored with spatial analysis and regression methods. Our results show that the province level has a relatively high coupling degree. However, significant spatial heterogeneity was found at the city level, especially in western Sichuan Province due to the highly unbalanced distribution of livestock and crop production, and this decoupling phenomenon may hinder fertilizer reduction. Furthermore, we reveal that technological development is not an effective way to achieve sustainable agriculture without other policy instruments, such as livestock spatial relocation, which must be considered when formulating crop-livestock integration policies. The findings expand city-level knowledge of the livestock-crop system and provide important implications for adjusting agricultural practices to realize sustainable agricultural development.

Comprehensive competitiveness assessment of four typical municipal sludge treatment routes in China based on environmental and techno-economic analysis.

To find a sustainable and effective municipal sludge treatment route requires a systematic assessment of the comprehensive competitiveness of diverse sludge treatment routes. Four typical treatment routes in China including co-incineration in coal power plants (CIN), mono-incineration (IN), anaerobic digestion (AD) and pyrolysis (PY) were selected in this study. A novel assessment model integrating life cycle assessment (LCA), techno-economic analysis (TEA) with analytic hierarchy process (AHP)-Entropy method was established, and comprehensive competitiveness indicated by comprehensive index (CI) of the four routes was deeply evaluated. Results displayed CIN route (CI = 0.758) showed the best comprehensive performance for its best environmental and economic performance. This was followed by PY route (CI = 0.691) and AD route (CI = 0.570), indicating the enormous potential of sludge PY technology. IN route showed the worst comprehensive performance (CI = 0.186) owing to its high environmental impact and lowest economic benefit. It was noted that greenhouse gas emissions and severe toxic potential were the main environmental challenges faced by sludge treatment. Besides, result of sensitivity analysis revealed that the comprehensive competitiveness of diverse sludge treatment routes was improved with the increase of sludge organic content and sludge reception fee.

Study on the evolution and driving mechanism of land function in China from 2005 to 2019.

As an important representation of sustainable land development, land function has become a research hot spot in the land research field. To explore the spatiotemporal evolution pattern and its driving mechanism of land function in China, an evaluation index system of land function was constructed. We adopted the weighted sum method to evaluate the land function and used the dynamic change degree of the land function and the coefficient of variation to analyze the spatiotemporal evolution characteristics of the land function. The driving mechanism of land function evolution was studied using grey relational analysis and multiple stepwise regression. The results showed that (1) from 200 to 2019, the total land function (TLF) increased by 10.41%, initially increasing and then decreasing. The land social function (LSF) and land bearing function (LBF) increased by 42.05% and 17.35%, respectively, while the land productive function (LPF), land cultural leisure function (LCF), and land ecological function (LEF) decreased by 3.64%, 4.25%, and 2.51%, respectively. (2) The spatial distribution of the LPF and LCF decreased from east to west, the distribution law of the LSF spread from the edge to the inside, the LBF showed a distribution state of high in the southeast and low in the northwest, and the spatial change law of the LEF decreased from west to east. (3) The driving factors of land function were the built-up area, urbanization rate, population density, and proportion of education expenditure. This paper provides a reference for improving land functions and for the sustainable utilization of land resources.

Low-coverage and cost-effective whole-genome sequencing assay for glioma risk stratification.

PURPOSE: To investigate chromosomal instability (CIN) as a biomarker for glioma risk stratifications, with cost-effective, low-coverage whole-genome sequencing assay (WGS). METHODS: Thirty-five formalin-fixed paraffin-embedded glioma samples were collected from Huashan Hospital. DNA was sent for WGS by Illumina X10 at low (median) genome coverage of 1.86x (range: 1.03-3.17×), followed by copy number analyses, using a customized bioinformatics workflow-Ultrasensitive Copy number Aberration Detector. RESULTS: Among the 35 glioma patients, 12 were grade IV, 10 grade III, 11 grade II, and 2 Grade I cases, with high chromosomal instability (CIN +) in 24 (68.6%) of the glioma patients. The other 11 (31.4%) had lower chromosomal instability (CIN-). CIN significantly correlates with overall survival (P = 0.00029). Patients with CIN + /7p11.2 + (12 grade IV and 3 grade III) had the worst survival ratio (hazard ratio:16.2, 95% CI:6.3-41.6) with a median overall survival of 24 months. Ten (66.7%) patients died during the first two follow-up years. In the CIN + patients without 7p11.2 + (6 grade III, 3 grade II), 3 (33.3%) patients died during follow-up, and the estimated overall survival was around 65 months. No deaths were reported in the 11 CIN- patients (2 grade I, 8 grade II, 1 grade III) during the 80-month follow-up period. In this study, chromosomal instability served as a prognosis factor for gliomas independent of tumor grades. CONCLUSION: It is feasible to use cost-effective, low-coverage WGS for risk stratification of glioma. Elevated chromosomal instability is associated with poor prognosis.

Distribution, risk assessment, and quantitative source apportionment of heavy metals in surface sediments from the shelf of the northern South China Sea.

The concentration of heavy metals (Cu, Pb, Zn, Cr, Co, and Ni) from 421 sediment samples from the shelf of the northern margin of the South China Sea (SNSCS) was analyzed. The heavy metal content and calculated potential ecological indicators (Eri < 40 and RI < 160) indicate that there is low potential ecological risk of heavy metal pollution in the SNSCS. The mean effects range-median quotient (M-ERM-Q) and hazard quotient (HQ) values of sediment toxicological characteristics indicate that heavy metals are a potential toxicological risk. The high-risk area is mainly distributed in the southwest of the nearshore SNSCS. The positive matrix factorization (PMF) analysis results showed that major contributors to heavy metal pollution were natural sources and anthropogenic activities in the SNSCS. The government should pay particular attention to the monitoring of heavy metals in the nearshore southwest of the SNSCS.

Ecological compensation in the Beijing-Tianjin-Hebei region based on ecosystem services flow.

Under a background of unbalanced regional economic development and ecological environments, the accurate identification of ecological compensation (EC) areas and the determination of compensation standards have become research key and hotspots. Their aim is to improve the long-term mechanisms of interregional EC. In this study, ecosystem services value (ESV) in the Beijing-Tianjin-Hebei region (BTH) in 2000, 2010 and 2019 are calculated using modelling and ecological economics methods. The region is divided into ecological output and input areas according to ecosystem services supply and demand. The breakpoint formula and field strength model are introduced to reveal the characteristics of ecosystem services flow (ESF) from output areas to input areas. By integrating a transfer correction coefficient system of natural, economic and social factors, an EC model based on ESF is constructed, and EC amounts for the BTH are calculated. The results are as follows: (1) The ESV of the BTH shows an increasing trend, with little change in spatial distribution characteristics. The high-value areas are distributed in the Taihang and Yanshan Mountains and Bashang Plateau in the northwest, while the low-value areas are concentrated in the Southeast Hebei Plain. (2) ESF mainly occurs in the western and northern regions of the BTH. Output areas are mainly distributed in the Taihang and Yanshan Mountains and Bashang Plateau, and their number is increasing. The flow radius, flow intensity and ESV transfer amounts also show increasing trends. (3) The ratio of EC paid by Beijing, Tianjin and Hebei is 1:0.2:2.56, the EC amounts are all provided to the Hebei Province, and the funds mainly flow to Chengde City, Zhangjiakou City and Baoding City. The proposed EC model based on ESF provides a basis and reference for the construction of an inter-regional EC mechanism in the BTH.

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital.

For contrast-enhanced CT examinations, there is a lack of comprehensive optimal management strategies of risk factors to reduce the risk of iodinated contrast media (ICM)-induced acute adverse reactions (AAR). Here, we determine the relationship between the rate of ICM-AAR and a stratified assessment and warning (SAW) regimen, which integrated risk identification, stratification, early warning, and prevention. A total of 120,822 cases in the conventional assessment period (58 years ± 15, 55.25% men) and 150,343 cases (58 years ± 14, 55.83% men) in the SAW period were enrolled. The results showed that the total AAR incidence in the SAW period (414/150,343, 0.28%) was lower than that in the conventional assessment period (506/120,822, 0.42%, P < 0.001), in which the proportion of AAR patients decreased by one-third. It mainly presented as decreases in mild and moderate reactions (P < 0.001), and a decrease in the proportion of moderate AAR patients (P = 0.001). Subgroup analysis showed lower mild and moderate AAR incidence in patients with different risk levels and with different ICM injection parameters following SAW regimen. We concluded that SAW regimen was associated with lower incidence of mild and moderate AAR, and decreased proportion of moderate AAR patients, which held potential for improved ICM safety.

Population pharmacokinetics and dosing regimen optimization of levetiracetam in epilepsy during pregnancy.

AIMS: The pharmacokinetics of levetiracetam (LEV) significantly changed during pregnancy. It is a great challenge to predict the adjusted doses of LEV to reach the preconception target concentrations. This study aimed to establish a population pharmacokinetic model of LEV in women with epilepsy (WWE) during pregnancy to analyse the factors of pharmacokinetic variability and to develop a model-based individualized dosing regimen. METHODS: A total of 166 concentration-time points from 37 WWE during pregnancy treated with LEV were collected to analyse LEV pharmacokinetics with nonlinear mixed-effects modelling. The dosing regimen was optimized by Monte Carlo simulations based on the final model. RESULTS: The LEV pharmacokinetics in pregnant WWE were best described by a 1-compartment model of first-order absorption and elimination. The population typical value of apparent clearance (CL/F) in the final model was estimated to be 3.82 L/h (95% confidence interval 3.283-4.357 L/h) with a relative standard error of 7.2%. Both total body weight (TBW) and trimester of pregnancy were significantly associated with LEV-CL/F during pregnancy; LEV-CL/F increased by 42.72% when TBW increased from 55 to 65 kg from the first trimester to the second trimester. Monte Carlo simulations showed that dosing regimens for LEV should be individualized based on the patient's TBW and trimester of pregnancy to maximize the likelihood of achieving the therapeutic range. CONCLUSION: This first population pharmacokinetic study of LEV in WWE during pregnancy supports the use of a weight-based and pregnancy-based dosing regimen and can lay a foundation for further optimizing the individualized dosing regimens.

Quality assessment of royal jelly based on physicochemical properties and flavor profiles using HS-SPME-GC/MS combined with electronic nose and electronic tongue analyses.

Royal jelly (RJ) is known for its unique flavor and nutritional value. However, the flavor changes of RJ during storage remain unclear. In this work, the flavor profiles of RJ during storage were evaluated by using headspace solid-phase micro-extraction gas chromatography-mass spectrometry (HS-SPME-GC/MS) combined with both electronic nose and electronic tongue analyses. Results revealed that the moisture, water-soluble protein, and whiteness were changed significantly at 25 °C. The holistic variation of RJ flavor exhibited evident distinction based on principal component analysis with electronic nose and electronic tongue. Among the total of 37 volatile compounds identified in RJ, the octanoic acid showed the highest contents of 47.61 % at 25 °C in 21 d. Seven volatile compounds, i.e., 2(3H)-furanone,5-butyldihydro-, 2-heptanone, trans-ß-ocimene, 2-nonen-4-one, 2-nonanone, methyl benzoate, and 2-octenoic acid (E), contributed largely to the typical overall flavor of RJ. This work provides an improved understanding of the flavor change of RJ during storage.

Inequalities of spatial primary healthcare accessibility in China.

A key step to the establishment of a tiered healthcare system is equitable access to basic primary healthcare services for all. However, no quantitative research on the national status quo of primary healthcare accessibility in China exists. We filled this gap by estimating spatial accessibility to primary healthcare centers (PHCs) and mapping its inequality across the mainland China. Four national datasets during 2015-2018, including administrative boundaries, residential communities, points-of-interest (including PHCs), and road networks, were collected to calculate the distance to the nearest PHC for each community. Five other national datasets including census, elevation, land use, vegetation, and nightlight, were collected to model 100m × 100 m population grids, based on which geographical modeling was used to calculate PHC accessibility of each community. Inequalities in PHC accessibility across China were described with concentration indices. About 44% of communities across China representing approximately 30% of the overall population had no access to PHCs within their 6-km catchment areas; about 78% of communities across China representing approximately 68.4% of the overall population had no access to PHCs within their 1.5-km catchment areas. Some municipalities/provinces like Shanghai, Beijing, Tianjin, Jiangsu, Shandong, and Zhejiang generally had higher proximity to the nearest PHCs, while others like Tibet, Guizhou, and Guangxi had lower proximity to the nearest PHCs. However, assuming similar basic service capacity across all PHCs, Shanghai, Tianjin, and Chongqing showed the lowest PHC accessibility due to high population density. Variations in PHC accessibility existed, with more inequalities observed in the north and northeastern provinces and less inequalities in southwestern and south-central provinces. This study demonstrates primary healthcare accessibility and inequality at province and city levels, and identifies communities with lower proximity and accessibility to PHCs in China. It would serve as a starting point to facilitate precise healthcare planning and preparedness for health emergencies in China.

Assessment of hypokalemia and clinical prognosis in Patients with COVID-19 in Yangzhou, China.

BACKGROUND: Hypokalemia is a frequent electrolyte imbalance in patients with COVID-19. The aim of this study was to estimate the association between hypokalemia and clinical prognosis in patients with moderate COVID-19. METHODS: A single-center, retrospective, observational study was conducted on 81 non-ICU admitted patients with moderate COVID-19 according to the criteria issued by the Chinese Health Bureau in the Third People's Hospital of Yangzhou (Northern Jiangsu People's Hospital New District Branch) from 4th to 25th August 2021. The demographic, clinical, and laboratory data were reviewed and collected, then the correlation between hypokalemia and prognosis was determined. RESULTS: The level of serum potassium of patients ranged from 2.80 mmol/L to 4.70 mmol/L. Hypokalemia was detected in 39 out of the 81 included patients (48.15%) during hospitalization. Patients with hypokalemia had prolonged days of negative nucleic acid conversion and hospital stay. Correlation analysis showed that the level of serum potassium was negatively correlated with days of negative nucleic acid conversion and length of hospital stay. Bivariate logistic regression analysis proved that hypokalemia was a risk factor for prolonged hospital stay in patients with moderate COVID-19. CONCLUSION: Hypokalemia was prevalent in patients with moderate COVID-19 in Yangzhou, China. Hypokalemia was associated with the prolonged hospital stay in patients with moderate COVID-19.

[Risk assessment of intensive care unit admission for postoperative patients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To observe the risk factors of intensive care unit (ICU) admission for postoperative patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Patients with stable COPD who were admitted to Shengjing Hospital of China Medical University for proposed surgical procedures from March 2014 to December 2020 were enrolled. Based on the criteria of the global initiative for chronic obstructive lung disease (GOLD), the patients were classified according to the severity of airflow limitation as grade 1 [forced expiratory volume in one second as a percentage of expected value (FEV1%) ≥ 80%], grade 2 (50% ≤ FEV1% < 80%), grade 3 (30% ≤ FEV1% < 50%), and grade 4 (FEV1% < 30%). Then the patients were divided into groups A, B, C, D according to symptom level and history of moderate/severe acute exacerbation within 1 year. The patients in the group A had the lightest symptoms, the lowest frequency and degree of acute exacerbation, while those in the group D had the most severe symptoms, the most frequent and degree of acute exacerbation. Data of general information, COPD-related factors, surgical-related factors and postoperative admission to ICU were collected. The correlation between different degree of airflow limitation subgroups as well as different comprehensive assessment of symptom subgroups and risk of postoperative ICU admission was analyzed. Multivariate Logistic regression models were used to analyze the risk factors affecting postoperative ICU admission. RESULTS: A total of 143 patients were enrolled in the analysis. According to the degree of airflow limitation, there were 34 patients in GOLD grade 1, 72 in grade 2, 32 in grade 3 and 5 in grade 4. According to the comprehensive assessment of symptoms, there were 78 patients in group A, 31 in group B, 5 in group C and 29 in group D. There were no statistically significant differences in the general data of gender, age, height and weight of patients in each group with different degrees of airflow limitation and different comprehensive assessment of symptoms. Univariate analysis showed that the degree of airflow limitation and comprehensive assessment of symptoms were not associated with postoperative ICU admission [degree of airflow limitation: odds ratio (OR) = 1.526, 95% confidence interval (95%CI) was 0.682-3.415, P = 0.304; comprehensive assessment of symptoms: OR = 1.508, 95%CI was 0.921-2.469, P = 0.103]. There was also no statistically significant difference in the surgical-related factors such as surgical site, surgical method, anesthesia, and surgical duration among the patients with different degrees of airflow limitation and different comprehensive assessment of symptoms. Among the 143 patients, 10 were admitted to ICU postoperation and 133 were not. Compared with the non-admitted ICU patients, patients admitted ICU were older (years old: 73.10±10.56 vs. 65.14±9.79, P < 0.05), had a higher modified Medical Research Council (mMRC) classification [1.5 (1.0, 2.0) vs. 1.0 (0, 2.0), P < 0.05], and had more frequent acute exacerbations per year [times: 1 (1, 2) vs. 1 (0, 1), P < 0.05]. There was also significant difference in surgical method between the two. Multivariate Logistic regression analysis showed that age and frequency of acute exacerbations per year were risk factors for postoperative admission to the ICU (age: OR = 1.093, 95%CI was 1.010-1.183, P = 0.028; frequency of acute exacerbations per year: OR = 2.400, 95%CI was 1.015-5.676, P = 0.046). CONCLUSIONS: Different levels of airflow restriction and symptom comprehensive assessment groupings in stable COPD patients are not associated with the risk of postoperative ICU admission. Age and frequency of acute exacerbations per year were risk factors for postoperative ICU admission.