Associations of intrinsic capacity, fall risk and frailty in old inpatients.

Introduction: This study explored the associations of intrinsic capacity (IC), fall risk, and frailty in geriatric inpatients. Methods: A total of 703 hospitalized patients aged 75 years or older were recruited for this retrospective observational study from Zhejiang Hospital using a comprehensive geriatric assessment. The IC composite score was constructed from the scores of the Chinese version of the Mini-Mental State Examination, Short Physical Performance Battery, Short Form Mini Nutritional Assessment, 15-item Geriatric Depression Scale, and self-reported hearing and vision impairment. Adverse outcomes were recorded as the fall risk and frailty using the Morse Fall Scale and the Clinical Frailty Scale. Spearman's correlation coefficient analyses and multivariate logistic regression models were used to explore the associations between IC, high fall risk, and frailty. Results: Declined IC composite scores were associated with increased risks of falls [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.57-0.72] and frailty (OR = 0.45, 95%CI: 0.37-0.54) among older hospitalized patients after adjusting for the related potential confounders. In addition, decreased cognitive, vitality, locomotion, and psychological scores were associated with increased adverse health conditions, with ORs ranging from 0.26 to 0.70. Vision impairment was observed to increase the risk of frailty (OR = 0.42, 95%CI: 0.23-0.76) after adjusting for the related potential confounders. Discussion: This study indicated that declined IC was associated with fall risk and frailty in older inpatients. Further prospective studies are needed to explore the longitudinal associations between baseline IC and subsequent risk of falls and frailty.

Inductively coupled plasma mass spectrometry based urine metallome to construct clinical decision models for autism spectrum disorder.

BACKGROUND: The global prevalence of autism spectrum disorder (ASD) is on the rise, and high levels of exposure to toxic heavy metals may be associated with this increase. Urine analysis is a noninvasive method for investigating the accumulation and excretion of heavy metals. The aim of this study was to identify ASD-associated urinary metal markers. METHODS: Overall, 70 children with ASD and 71 children with typical development (TD) were enrolled in this retrospective case-control study. In this metallomics investigation, inductively coupled plasma mass spectrometry was performed to obtain the urine profile of 27 metals. RESULTS: Children with ASD could be distinguished from children with TD based on the urine metal profile, with ASD children showing an increased urine metal Shannon diversity. A metallome-wide association analysis was used to identify seven ASD-related metals in urine, with cobalt, aluminum, selenium, and lithium significantly higher, and manganese, mercury, and titanium significantly lower in the urine of children with ASD than in children with TD. The least absolute shrinkage and selection operator (LASSO) machine learning method was used to rank the seven urine metals in terms of their effect on ASD. On the basis of these seven urine metals, we constructed a LASSO regression model for ASD classification and found an area under the receiver operating characteristic curve of 0.913. We also constructed a clinical prediction model for ASD based on the seven metals that were different in the urine of children with ASD and found that the model would be useful for the clinical prediction of ASD risk. CONCLUSIONS: The study findings suggest that altered urine metal concentrations may be an important risk factor for ASD, and we recommend further exploration of the mechanisms and clinical treatment measures for such alterations.

[Temporal and Spatial Variation Characteristics of Methane, Carbon Dioxide, and Nitrous Oxide Concentrations and the Influencing Factors in Small Aquaculture Pond].

As an important source of greenhouse gases, the changes in greenhouse gas concentrations of aquaculture ponds are not only the basis for accurate quantification of greenhouse gases emissions but are also important for identifying their influencing factors. The spatial and temporal variation characteristics of CH4, CO2, and N2O concentrations and the influencing factors in a typical small aquaculture pond in the Yangtze River Delta were analyzed based on the headspace equilibrium-gas chromatograph method. Except in spring, the concentrations of CH4, and N2O appeared high at noon or afternoon and were influenced by water temperature. Impacted by water temperature and aquatic plant photosynthesis, the concentrations of CO2 were high in the morning when photosynthesis was weak. The concentrations of CH4 and CO2 were the highest in autumn and the lowest in winter. The mean concentrations of CH4 in autumn and winter were 176.34 nmol·L-1 and 32.75 nmol·L-1, respectively, which were mainly affected by air temperature, water temperature, and dissolved oxygen. The average CO2 concentrations in autumn and winter were 134.37 µmol·L-1 and 23.10 µmol·L-1, respectively, and were mainly affected by aquatic vegetation photosynthesis and pH. N2O concentration was the highest in summer and the lowest in winter, with mean values of 97.05 nmol·L-1 and 19.41 nmol·L-1, respectively, which were mainly affected by air temperature and water temperature. In terms of the vertical spatial variations of the three greenhouse gases, the concentration of CH4decreased with water depth in summer, and the concentration differences between the surface layer and the bottom and middle layers were 71.28 nmol·L-1 and 42.80 nmol·L-1, respectively. The concentration of CH4 increased with water depth in autumn, and the concentration difference between the bottom layer and surface layer was 163.94 nmol·L-1. The CO2 concentration increased with water depth in summer and autumn. The concentration differences between the bottom and surface concentrations were 18.69 µmol·L-1 and 29.90 µmol·L-1, respectively. N2O concentration showed no obvious change in the vertical direction. For the horizontal variations, the concentrations of CH4, CO2, and N2O in the feeding area in summer and in chicken manure in spring were approximately 1.34-1.98 times and 1.95-2.42 times those in other areas, respectively, and the concentrations of N2O and CO2 in spring and summer were approximately 1.13-1.26 times and 1.39-1.74 times those in other areas.

[Effects of chamber characteristics on CO2 and CH4 flux at the water-air interface measured by the chamber method]. / 箱体特征对箱式法观测水-气界面CO2和CH4通量的影响.

The chamber method is widely used to measure CO2 and CH4 flux in inland water. However, the designs of chamber used in various studies are different and lack unified standards, which would affect the observation results. To clarify the impacts of chamber characteristics, including light transmittance, air pressure difference inside and outside the chamber, and gas mixing degree in the chamber, on CO2 and CH4 flux measurements at the water-air interface, we compared the effects of transparent/opaque chamber, the chamber with/without air pressure equalizing device and fan on CO2 and CH4 flux measurements in the aquaculture pond, based on the multi-channel closed dynamic chamber system. The results showed that, during the daytime in summer, compared with the transparent chamber which could measure the actual CO2 flux, when CO2 was emitted from the pond, the opaque chamber overestimated the CO2 flux by 90%; when CO2 was absorbed by the pond, the opaque chamber underestimated the CO2 flux by 50%. The CH4 diffusion flux measured by the opaque chamber was 40% lower than that measured by the transparent chamber. There was no significant difference between CO2 and CH4 flux measured by the chamber with and without air pressure equalizing device. CO2 flux observed by the chamber without fan had poor representativeness, being 20% higher than that observed by the chamber with fan. Moreover, CH4 flux emitted through different pathways could not be distinguished using the chamber without fan. Therefore, when the chamber method was used to observe the CO2 and CH4 flux at the water-air interface, the chamber shall be transparent and be installed with fan.

Exploring Online Teaching Design of Curriculum Politics by Deep Learning and Visual Sensing Technology.

The study aims to explore the online teaching design of ideological and political education (IPE). Based on the relevant theories of deep learning (DL) and visual sensing, the students of a Chinese University are taken as the research samples and investigated by a questionnaire survey. Then, DL and visual sensing are introduced into the online teaching design of IPE, and the research conclusions are obtained. The results show that college students are interested in IPE, but there are still some problems in the actual teaching process. For example, 60% of the students do not know the learning objectives of IPE, and 19.7% are not familiar with the learning contents; based on the image semantic analysis of the curriculum of IPE, DL mainly focuses on model construction and data processing, and visual sensing is used to classify image pixels; the students' concentration time is changed from 29 minutes to 30.4 minutes, and their efficiency of homework submission is also improved based on DL and visual sensing. The study has a great reference for ideological and political teaching in the future.

Acceptance of COVID-19 booster vaccination based on the protection motivation theory: A cross-sectional study in China.

The promotion of the booster shots against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an open issue to be discussed. Little is known about the public intention and the influencing factors regarding the booster vaccine. A cross-sectional survey in Chinese adults was conducted using an online questionnaire, which designed on the basis of protection motivation theory (PMT) scale and vaccine hesitancy scale (VHS). Hierarchical multiple regression was used to compare the fitness of the PMT scale and VHS for predicting booster vaccination intention. Multivariable logistic regression was used to analyze the factors associated with the acceptance. Six thousand three hundred twenty-one (76.8%) of participants were willing to take the booster shot. However, the rest of the participants (23.2%) were still hesitant to take the booster vaccine. The PMT scale was more powerful than the VHS in explaining the vaccination intention. Participants with high perceived severity (adjusted odds ratio [aOR] = 0.69) and response cost (aOR = 0.47) were less willing to take the booster shots, but participants with high perceived susceptibility (aOR = 1.19), response efficacy (aOR = 2.13), and self-efficacy (aOR = 3.33) were more willing to take the booster shots. In summary, interventions based on PMT can provide guidance to ensure the acceptance of the booster vaccine.

Nitrous oxide flux observed with tall-tower eddy covariance over a heterogeneous rice cultivation landscape.

Although croplands are known to be strong sources of anthropogenic N2O, large uncertainties still exist regarding their emission factors, that is, the proportion of N in fertilizer application that escapes to the atmosphere as N2O. In this study, we report the results of an experiment on the N2O flux in a landscape dominated by rice cultivation in the Yangtze River Delta, China. The observation was made with a closed-path eddy covariance system on a 70-m tall tower from October 2018 to December 2020 (27 months). Temperature and precipitation explained 78% of the seasonal and interannual variability in the observed N2O flux. The growing season (May to October) mean flux (1.14 nmol m-2 s-1) was much higher than the median flux found in the literature for rice paddies. The mean N2O flux during the observational period was 0.90 ± 0.71 nmol m-2 s-1, and the annual cumulative N2O emission was 7.6 and 9.1 kg N2O-N ha-1 during 2019 and 2020, respectively. The corresponding landscape emission factor was 3.8% and 4.6%, respectively, which were much higher than the IPCC default direct (0.3%) and indirect emission factors (0.75%) for rice paddies.

Tumor size and perineural invasion predict outcome of gastric high-grade neuroendocrine neoplasms.

A new subcategory, grade 3 neuroendocrine tumors, is incorporated into the grading system of pancreatic neuroendocrine neoplasms in the 2017 WHO classification in order to differentiate grade 3 neuroendocrine tumors from neuroendocrine carcinomas. The 2019 WHO classification extends the concept of grade 3 neuroendocrine tumors to gastrointestinal high-grade neuroendocrine neoplasms. However, there is still limited study focusing on the gastric grade 3 neuroendocrine tumors and gastric neuroendocrine carcinomas. We retrospectively enrolled 151 gastric high-grade neuroendocrine neoplasms patients, who underwent radical resection from January 2007 to December 2015. Clinicopathologic and prognostic features were studied. The Surveillance, Epidemiology, and End Results (SEER) database was used to verify the prognostic determinants found in the Zhongshan cohort. Neuroendocrine carcinomas showed a higher Ki67 index and higher mitotic count than grade 3 neuroendocrine tumors. We identified 109 (72.2%) patients with neuroendocrine carcinomas, 12 (7.9%) patients with grade 3 neuroendocrine tumors, and 30 (19.9%) patients with mixed neuroendocrine-non-neuroendocrine neoplasms. Although neuroendocrine carcinomas demonstrated higher Ki67 index (P = 0.004) and mitoses (P = 0.001) than grade 3 neuroendocrine tumors, their prognosis after radical resection did not demonstrate significant differences (P = 0.709). Tumor size, perineural invasion, and TNM stage were independent prognostic factors of gastric high-grade neuroendocrine neoplasms.

Hungry Bone Syndrome Secondary to Subtotal Thyroidectomy in A Patient With Thyrotoxicosis.

Patients with thyrotoxicosis are prone to transient hypocalcemia after thyroidectomy, which may be due in part to surgical damage to the parathyroid glands. Hungry bone syndrome (HBS) can also cause hypocalcemia after thyroidectomy. HBS is due to increased osteoblast-mediated bone formation activity and normal or decreased bone resorption activity. As HBS is uncommon in patients after thyroidectomy, we herein present a case of hypocalcemia secondary to HBS after subtotal thyroidectomy for thyrotoxicosis in a 25-year-old woman with a two-month history of tingling extremities and carpopedal spasms after subtotal thyroidectomy for thyrotoxicosis. Diagnostic tests showed hypocalcemia and hyperphosphatemia with elevated parathyroid hormone levels and moderately decreased serum 25-hydroxyvitamin D levels. In addition to thyroid hormone replacement therapy, she was given calcitriol and Caltrate D (600 mg calcium plus 125 IU cholecalciferol). After two months of treatment, she no longer had spasms and her paresthesia improved. Meanwhile, serum electrolytes and parathyroid hormone levels had almost returned to the normal ranges. This is a rare case of HBS presented as a complication of subtotal thyroidectomy in a patient with thyrotoxicosis.

Investigation of the awareness of and demand for hospice care and attitudes towards life-sustaining treatment at the end of life among community residents in Hangzhou.

BACKGROUND: To understand the status of residents' awareness of and demand for hospice care services in Hangzhou and to provide a reference for promoting the formulation of hospice care-related policies in China. METHODS: A small cross-sectional survey of 519 adults aged over 40 years old living in the rural-urban fringe and urban area of Xihu District, Hangzhou City, was conducted using convenience sampling and a self-designed questionnaire. The measures assessed awareness of hospice care (13-item scale), attitudes towards life support therapy (3-item scale), and demand for hospice care services (9-item scale). RESULTS: The rate of awareness of hospice care among community residents was 50.30%. A total of 51.0% of residents wanted only comfortable life-sustaining treatment at the end of their lives. The acceptance of hospice care was positively correlated with the degree of understanding (x2 = 18.382, P = 0.001), and residents in the urban area were more likely to prefer hospice care than residents in the urban-rural fringe (x2 = 7.186, P = 0.028). Elderly residents showed a stronger tendency to prefer comfortable life support therapy (x2 = 12.988, P < 0.001). A total of 83.04% of the residents accepted the current necessity for hospice care to be provided in medical institutions. The preferred locations were professional hospice care institutions or general hospitals. A total of 93.64% of the residents agreed that the number of beds in hospice care wards should not exceed 2. In addition, the residents could afford part of the out-of-pocket expenses for hospice care services, with the ability to pay under 200 yuan per day, and the improvement of facilities was expected. CONCLUSIONS: To improve public awareness and acceptance of hospice care and promote healthy development in China, it is necessary to promote hospice care education for everyone.

Awareness of palliative care and its influencing factors in community residents in Hangzhou / 预防医学

Objective@# To understand the awareness of palliative care and its influencing factors in community residents in Hangzhou,so as to provide basis for the development of palliative care service.@*Methods@#By convenient sampling method,the residents in the urban-rural junction of Xihu District were recruited. A self-designed questionnaire was used to investigate their awareness of palliative care. The logistic regression model was employed to analyze the influencing factors.@*Results @#A total of 519 questionnaires were recovered,with a response rate of 97.92%. There were 227 males and 292 females,accounting for 43.74% and 56.26%,respectively. There were 43,218 and 258 residents with more,basic and little understanding about palliative care, accounting for 8.29%,42.00% and 49.71%. The residents learned about palliative care mainly through television and radio,with 245 cases accounting for 47.21%;and they thought that the main reason for low awareness of palliative care was a lack of related knowledge,with 396 cases accounting for 76.30%. The results of multivariate logistic regression analysis showed that 50-59 years old（OR = 0.467,95% CI：0.285-0.767）,primary school education and below（OR = 2.248,95%CI：1.239-4.079）and experience of caring for dying patients（OR = 1.551,95% CI：1.094-2.199）were the influencing factors for the awareness of palliative care. @*Conclusion@#The residents in Hangzhou had relatively low awareness of palliative care,which were associated with age,education level and experience of caring for dying patients.

A novel SLC12A3 homozygous c2039delG mutation in Gitelman syndrome with hypocalcemia.

BACKGROUND: Gitelman syndrome (GS) is a rare autosomal recessive renal tubular disease, caused by mutations in the SLC12A3 gene, which encodes the renal thiazide-sensitive Na/Cl cotransporter (NCCT) in the distal renal tubule. CASE PRESENTATION: A 23-year-old woman was admitted with limb numbness, recurrent tetany and palpitation. Laboratory tests showed hypokalemic alkalosis, hypomagnesemia, hypocalcemia and secondary hyperaldosteronism, as well as hypocalciuria and transient decreased PTH. Next-generation sequencing detected a novel homozygous mutations c.2039delG in the SLC12A3 gene, and her father and children were all heterozygous carriers. CONCLUSION: We reported a case of GS with a novel homozygous frame-shift mutation of SLC12A3, and reviewed recent literatures about diagnosis, differential diagnosis and treatments. Hypocalcemia in Gitelman syndrome is rare, and may be related to inhibited PTH secretion induced by hypomagnesemia.

Imbalance of T-helper 1/T-helper 2 cytokines and impaired glucose tolerance among patient with acute coronary syndrome.

PURPOSE: The balance between T helper (Th) cells Th1- and Th2-related cytokines plays a key role in the clinical process of acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) or impaired glucose tolerance (IGT). The objective of this study was to assess the status of Th1/Th2 cytokines in patients with ACS and T2D or IGT. METHODS: A total of 201 ACS patients were enrolled in the study. All ACS patients were divided into three groups: Group I-patients with normal glucose tolerance (NGT), Group II-patients with IGT and Group III-patients with T2D. We measured circulating Th1/Th2-type cytokines (interleukin [IL]-4, IL-13, interferon-gamma [IFN-γ], and tumor-necrosis factor-alpha [TNF-α]) using enzyme-linked immunosorbent assay and calculated the ratio of Th1/Th2. RESULTS: Significant elevations in serum levels of IL-4, IL-13, IFN-γ, and TNF-α were found in ACS-T2D and ACS-IGT groups compared to that in both ACS-NGT group and healthy individuals. Higher serum levels of IL-4, IL-13, and TNF-α were found in ACS-NGT group than that in the control group. Furthermore, IL-4 and IFN-γ concentrations were significantly higher in ACS-T2D patients than in ACS-IGT patients. IFN-γ/IL-4, IFN-γ/IL-13, and TNF-α/IL-4 ratios as markers of Th1/Th2 ratio were significantly higher for the ACS-T2D group and ACS-IGT group as compared to that in the ACS-NGT group and control group (P < 0.05). CONCLUSION: Shifts in the balance of Th1/Th2 toward a predominance of Th1 may represent more severe inflammatory status in ACS patients with type T2D or IGT.

[Quantification of Methane Ebullition Flux from Small Ponds Using the Inverted-Funnel Method].

To quantify the ratio of CH4 ebullition to total flux in subtropical shallow ponds, the CH4 flux at the water-air interface was measured using the inverted-funnel and water equilibrium methods in two small ponds in Quanjiao, Anhui Province from July 28 to August 13, 2016. The average CH4 ebullition fluxes were 121.78 and 161.08 mg·(m2·d)-1 and the average diffusion fluxes were 3.38 and 3.79 mg·(m2·d)-1 over pond A and pond B, respectively. The ebullition flux accounted for 97.5% and 96.4% of the total flux over pond A and pond B, respectively. Methane ebullition ranged from 0.11 to 446.90 mg·(m2·d)-1 over pond A and from 0.05 to 607.51 mg·(m2·d)-1 over pond B. Gas ebullition rate during the day was higher than that at night and was controlled by wind speed. Methane ebullition flux was influenced by wind speed over the shallow pond at hourly scale and by water depth and wind speed at daily scale, with positive correlation with wind speed and negative correlation with water depth. Varying with latitude, methane ebullition flux was higher for the water bodies in the mid-latitude region compared to those in the high-latitude region. Direct observations of the methane ebullition flux over small ponds provide data support and theoretical reference to precisely estimate the contribution of inland water bodies to regional and global carbon cycle.

De novo SOX10 Nonsense Mutation in a Patient with Kallmann Syndrome, Deafness, Iris Hypopigmentation, and Hyperthyroidism.

Kallmann syndrome (KS) is a clinically and genetically heterogeneous disorder characterized by hypogonadotropic hypogonadism and olfactory dysfunction. Recently, mutations in SOX10, a well-known causative gene of Waardenburg syndrome (WS), have been identified in a few KS patients with additional developmental defects including hearing loss. However, the understanding of SOX10 mutation associates with KS and other clinical consequences remains fragmentary. A 30-year-old Chinese male patient presented with no pubertal sex development when he was at the age of twelve years. Additionally, he showed anosmia, sensory deafness, and blue irises. Last year, he developed clinical symptoms of hyperthyroidism with a fast heartbeat, heat intolerance and weight loss. Blood examinations revealed low levels of FSH, LH, and testosterone. Thyroid function showed high levels of FT3, FT4 and extremely low level of TSH. Molecular analysis detected a de novo (c.565G>T/p.E189X) mutation in SOX10, which has previously been reported in a patient with WS4 (WS with Hirschsprung). The mutation was predicted to be probably damaging. These results highlight the significance of SOX10 haploinsufficiency as a genetic cause of KS. Importantly, our result implies that the same SOX10 mutation can underlie both typical KS and WS, while the correlation between SOX10 and hyperthyroidism still needs to be clarified in the future.

[CH4 Emissions Characteristics and Its Influencing Factors in an Eutrophic Lake].

In order to identify methane (CH4) diffusion emissions characteristics and their impact factors in an eutrophic lake, CH4 flux across the lake-air interface was observed in Meiliang Bay and the central zone of Lake Taihu over one year. The relationships between CH4 flux and environmental factors and water quality indices were analyzed. The results indicated that the annual mean CH4 diffusion flux in the eutrophic zone was significantly higher than that in the central zone, which were 0.140 mmol·(m2·d)-1 and 0.024 mmol·(m2·d)-1, respectively. Additionally, the highest CH4 flux appeared in the eutrophic littoral zone. The CH4 flux varied seasonally, which was consistent with water temperature that peaked in summer. Furthermore, the difference in CH4 flux between seasons was an order of magnitude. The temporal variation in CH4 flux was mostly driven by wind speed and water temperature. The spatial correlation between CH4 flux and dissolved organic carbon concentration was highly significant (R2=0.62, P<0.01). Observing temporal and spatial patterns of CH4 flux was necessary to accurately estimate whole-lake CH4 emissions due to large variability across time and space.

Hyperthyroidism-associated hypercalcemic crisis: A case report and review of the literature.

RATIONALE: Hyperthyroidism is one of the major clinical causes of hypercalcaemia, however, hyperthyroidism-related hypercalcemic crisis is rare, only 1 case have been reported. The potential mechanisms are still not too clear. It may be related that thyroid hormone stimulate bone turnover, elevate serum calcium, increase urinary and fecal calcium excretion. PATIENT CONCERNS: A 58-year-old female patient was found to have Graves' disease, a marked elevated serum calcium level (adjusted serum calcium: 3.74 mmol/L), and reduced parathyroid hormone level. DIAGNOSES: She was diagnosed as hyperthyroidism-associated hypercalcemic crisis. INTERVENTIONS: Treatment with methimazole to correct the hyperthyroidism and treatment of the patient's hypercalcaemia was achieved by physiological saline, salmon calcitonin and furosemide. OUTCOMES: After treatment for hypercalcaemia and hyperthyroidism, her symptoms and serum calcium levels quickly returned to normal. LESSONS: hyperthyroid-associated hypercalcaemia crisis is rare, however, the diagnosis should pay attention to screening for other diseases caused by hypercalcemia. Timely treatment of hypercalcaemia is a critical step for rapidly control of symptoms, and treatment of hyperthyroidism is beneficial to relief the symptoms and maintain the blood calcium level.

[Van Wyk-Grumbach syndrome: A case report and literature review].

Van Wyk-Grumbach syndrome (VWGS) is a rare complication of prolonged untreated juvenile hypothyroidism characterized by precocious puberty and enlarged multicystic ovaries. A 13-year-old girl visited our outpatient clinic due to menstrual irregularities. She had precocious puberty, pituitary hyperplasia and multiple cystic ovaries in addition to clinical signs of severe congenital hypothyroidism. After the initiation of L-thyroxine therapy, the symptoms were alleviated in a short time. This rare syndrome is easy to be misdiagnosed as pituitary and ovarian tumor. High degree of suspicion and timely diagnosis can prevent unnecessary surgical procedures because the symptoms can be reversed with thyroid hormone supplementation.