Analysis of driving factors for potential toxic metals in major urban soils of China: a geodetetor-based quantitative study.

Potential toxic metal (PTM) is hazardous to human health, but the mechanism of spatial heterogeneity of PTM at a macro-scale remains unclear. This study conducts a meta-analysis on the data of PTM concentrations in the soil of 164 major cities in China from 2006 to 2021. It utilizes spatial analysis methods and geodetector to investigate the spatial distribution characteristics of PTMs. The geographic information systems (GIS) and geodetector were used to investigate the spatial distribution characteristics of PTMs, assess the influence of natural factors (NFs) and anthropogenic factors (AFs) on the spatial heterogeneity of PTMs in urban soils, and identified the potential pollution areas of PTMs. The results indicated that the pollution levels of PTMs in urban soils varied significantly across China, with higher pollution levels in the south than in the north. Cd and Hg were the most severely contaminated elements. The geodetector analysis showed that temperature and precipitation in NFs and land use type in AFs were considered as the main influencing factors, and that both AF and NF together led to the PTM variation. All these factors showed a mutually enhancing pattern which has important implications for urban soil management. PTM high-risk areas were identified to provide early warning of pollution risk under the condition of climate change.

Research progress of circRNA as a biomarker of osteoporosis.

Osteoporosis, as a chronic metabolic bone disease, has the characteristic of insidious disease progression, which often leads to relatively delayed disease diagnosis. Therefore, early screening for osteoporosis has become a major public health challenge. The latest research indicates that circRNA is widely involved in the regulation of bone metabolism and is closely related to the occurrence and development of osteoporosis. Based on its high degree of sequence conservation and stability, circRNA has the potential to become a new clinical biomarker. The study of biomarkers is generally based on body fluid samples or adjacent tissue samples, with blood being the most commonly used, which can be divided into sources such as serum, plasma, peripheral blood monocytes, and plasma exosomes. Therefore, this article aims to review the research status of circRNA as a biomarker of osteoporosis.

The Relationship Between Prognostic Nutritional Indexes and the Clinical Outcomes of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Purpose: Nutritional status is related to the clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of this study was to investigate the association between nutritional status, measured by the prognostic nutritional index (PNI), and adverse hospitalization outcomes in patients with AECOPD. Methods: Consecutive AECOPD patients admitted to the First Affiliated Hospital of Sun Yat-sen University between January 1, 2015 to October 31, 2021 were enrolled. We collected the clinical characteristics and laboratory data of patients. Multivariable logistic regression models were developed to assess the relationship between the baseline PNI and adverse hospitalization outcomes. A generalized additive model (GAM) was used to identify any non-linear relationship. In addition, we performed a subgroup analysis to tested the robustness of the results. Results: A total of 385 AECOPD patients were involved in this retrospective cohort study. Based on the tertiles of PNI, patients in the lower tertiles of PNI showed more worse outcome incidence (30 [23.6%] versus 17 [13.2%] versus 8 [6.2%]; p < 0.001). Multivariable logistic regression analysis revealed that the PNI were independently associated with adverse hospitalization outcomes after adjustment for confounding factors (Odds ratio [OR] = 0.94, 95% CI: 0.91 to 0.97, P < 0.0001). After adjusting for confounders, smooth curve fitting showed a saturation effect, suggesting that the relationship between the PNI and adverse hospitalization outcomes was nonlinear. Two-piecewise linear regression model suggested that the incidence of adverse hospitalization outcomes significantly decreased with PNI level up to the inflection point (PNI = 42), and PNI was not associated with adverse hospitalization outcome after that point. Conclusion: Decreased PNI levels at admission were determined to be associated with adverse hospitalization outcomes in patients with AECOPD. The results obtained in this study may potentially assist clinicians optimize risk evaluations and clinical management processes.

Whether the Golgi protein 73 could be a diagnostic serological marker in hepatocellular carcinoma: a meta analysis.

BACKGROUND: The Value of Golgi protein 73 (GP73) in the diagnosis of Hepatocellular carcinoma (HCC) remains controversial, especially in its differentiation between HCC and cirrhosis. Besides, some papers showed that GP73 levels are correlated with liver fibrosis. This study conducts a meta-analysis to evaluate the value of GP73 in diagnosing HCC and differential diagnosing HCC from liver cirrhosis. METHODS: 36 studies with a sample size of 8314 cases concerning the accuracy of GP73 in the diagnosis of HCC were selected through a systematic review. Seven of these studies included a total of 438 HCC samples and 426 cirrhosis samples and calculated the sensitivity and specificity of GP73 for differential diagnosing HCC from cirrhosis. QUADAS (quality assessment of diagnostic accuracy studies) was used to evaluate the quality of literature. Statistical analyses were performed using StataSE16 software. RESULTS: The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the area under the curve were 0.79(95%CI 0.74-0.83),0.85(95%CI 0.80-0.89),5.4(95%CI 3.8-7.5), 0.25(95%CI 0.20-0.31), 22(95%CI 13-35), and 0.88 for GP73 diagnosing HCC;0.74(95%CI 0.64-0.81),0.70(95%CI 0.49-0.85),2.40(95%CI 1.3-4.7),0.38(95%CI 0.23-0.61),6(95%CI 2-19), and 0.78 for GP73 differential diagnosing HCC from liver cirrhosis. CONCLUSION: The results suggest that GP73 has a high diagnostic value for HCC and a moderate value for differential diagnosis of HCC from liver cirrhosis.

Spatiotemporal responses of habitat quality to land use changes in the source area of Pearl River, China.

Habitat quality assessment provides an effective interface for exploring the mechanisms linking land use change and biodiversity. We used InVEST model to assess the spatial and temporal variations of habitat quality in the Pearl River source area from 2000 to 2020, and to examine the impacts of land use change on habitat quality. The results showed that during the study period, construction land had the largest change, with an area increase of 321.48 km2, and the area of grassland decreased most significantly. Habitat quality in the Pearl River source area was generally at a high level, with a small downward trend. The low value areas were concentrated in the town centers and main agricultural production areas, while habitat quality was high in the mountainous areas in the south and north region. The cold spots of habitat quality change had the most significant aggregation effect in the Quzhan Basin along the Nanpan River. The number of hot spots was small and scattered. Among the various types of nature reserves, habitat quality of Jiache Nature Reserve in Huize County was the lowest, and that of Zhujiangyuan Nature Reserve had a slight decreasing trend, mainly due to the transformation of grassland to cropland. The contribution of habitat quality degradation driven by land function change was 5.6 times as that of improvement. The encroachment of urban and rural construction space into grassland ecological space and agricultural production space was the dominant factor driving the reduction of habitat quality in the Pearl River source area. The contribution of construction land expansion decreased from 69.9% (2000-2010) to 46.7% (2010-2020). The expansion of construction land was the main cause for the degradation of habitat quality. The degradation threat from arable land expansion overtook the traffic network construction as the secondary threat source from 2010 to 2020. It was necessary to increase control of nature reserves in the Pearl River source area and to implement land use regulation strictly to guarantee no net loss and integrity of the ecosystem.

Karst tiankeng shapes the differential composition and structure of bacterial and fungal communities in karst land.

Karst tiankeng are important biodiversity conservation reservoirs. However, the unique habitats of karst tiankeng affect microbial community structure remained poorly understood. In this study, we collected soil samples from karst tiankeng (TK) and karst land (KL) and subjected to high-throughput sequencing. Based on the classification of the total, abundance, and rare taxa for bacteria and fungi, a multivariate statistical analysis was carried out. The results revealed that bacterial community Shannon diversity and Pielou's evenness were highest in TK. The rare taxa were ubiquitous in all soil samples, while the higher Shannon diversity of the abundant taxa of TK may be related to the habitat preferences of species and niche differentiation. The community composition of bacterial and fungal sub-communities exhibited significant dissimilarity between TK and KL. The redundancy analysis further demonstrated that abundant taxa were environmentally more constrained than rare taxa. The bacterial and fungal networks of KL were more complex than TK. The keystones of the network transforms may suggest their significant role in the ecological function of the karst tiankeng ecosystem. This study represents the first reports of the characteristics of bacterial and fungal communities in karst tiankeng.

The characterization of microbial communities and associations in karst tiankeng.

The karst tiankeng is a special and grand negative terrain on the surface, that maintains a unique ecosystem. However, knowledge about bacterial and fungal communities in karst tiankengs is still limited. Therefore, soil samples from five karst tiankengs were collected and subjected to high-throughput sequencing of 16S rRNA and ITS genes, and multivariate statistical analysis. The results showed abundant and diversified bacterial and fungal communities in karst tiankeng. The bacterial communities were dominated by Proteobacteria and Acidobacteria, and the fungal communities were dominated by Ascomycota and Basidiomycota. Statistical analysis revealed significant differences in bacterial and fungal communities among the five karst tiankengs, which may indicate that the distribution of bacterial and fungal communities was driven by separate karst tiankengs. The co-occurrence network structure was characterized by highly modularized assembly patterns and more positive interactions. The keystone taxa were mainly involved in nutrient cycling and energy metabolism. The null model analysis results showed that the stochastic process, especially dispersal limitation, tended to be more important in controlling the development of bacterial and fungal communities in karst tiankeng. The bacterial community structure was significantly associated with soil properties (SWC, TN, AN, and BD), while the fungal community structure was significantly associated with soil properties (SWC and TP) and plant diversity. These results can expand our knowledge of the karst tiankeng microbiome.

Urban heat vulnerability: A dynamic assessment using multi-source data in coastal metropolis of Southeast China.

Extreme heat caused by global climate change has become a serious threat to the sustainable development of urban areas. Scientific assessment of the impacts of extreme heat on urban areas and in-depth knowledge of the cross-scale mechanisms of heat vulnerability forming in urban systems are expected to support policymakers and stakeholders in developing effective policies to mitigate the economic, social, and health risks. Based on the perspective of the human-environment system, this study constructed a conceptual framework and index system of "exposure-susceptibility-adaptive capacity" for urban heat vulnerability (UHV) and proposed its assessment methods. Taking Xiamen City, a coastal metropolis, as an example, spatial analysis and Geodetector were used to explore the spatial and temporal changes, spatial characteristics, and patterns of UHV under multiple external disturbances from natural to anthropological factors, and to reveal the main factors influencing UHV forming and spatial differentiation. Results showed that the exposure, susceptibility, adaptive capacity, and UHV in Xiamen City had a spatial structure of "coastal-offshore-inland". On the hot day, both the exposure and UHV showed a temporal pattern of "rising and then falling, peaking at 14:00" and a spatial pattern of "monsoonal-like" movement between coast and inland. Coastal zoning with favorable socioeconomic conditions had less magnitude of changes in UHV, where the stability of the urban system was more likely to be maintained. During the hot months, the high UHV areas were mainly distributed in the inland, while coastal areas showed low UHV levels. Further, coastal UHV was mainly dominated by "heat exposure", offshore by "comprehensive factors", and inland in the northern mountainous areas by "lack of adaptive capacity". Multi-scale urban adaptive capacity was confirmed to alter spatial distribution of exposure and reshape the spatial pattern of UHV. This study promotes the application of multi-scale vulnerability framework to disaster impact assessment, enriches the scientific knowledge of the urban system vulnerability, and provides scientific references for local targeted cooling policy development and extreme heat resilience building programs.

Synergistic Function between Phosphorus-Containing Flame Retardant and Multi-Walled Carbon Nanotubes towards Fire Safe Polystyrene Composites with Enhanced Electromagnetic Interference Shielding.

As a universal polymer material, polystyrene (PS) is widely applied in electrical devices and construction. Thus, it is necessary to improve the flame retardancy and electromagnetic shielding properties of PS material. In this work, PS/silicon-wrapped ammonium polyphosphate/Inorganic acid-treated multi-walled carbon nanotubes composites (PS/SiAPP/aMWCNT, abbreviated as PAC) were prepared via methods of filtration-induced assembly and hot-pressing. Morphology and structure characterization demonstrated that SiAPP and aMWCNT had good dispersion in PS and excellent compatibility with the PS matrix. Thermogravimetric analysis revealed that the addition of aMWCNT to PS improved its thermal stability and carbon-forming characteristics. The peak heat release rate, the peak carbon monoxide production rate, and the peak smoke production rate of the PAC10 composite decreased by 53.7%, 41.9%, and 45.5%, respectively, while its electromagnetic shielding effectiveness reached 12 dB. These enhancements were attributed to the reason that SiAPP and aMWCNT synergistically catalyzed the char generation and SiAPP produced free radical scavengers and numbers of incombustible gases, which could decrease the oxygen concentration and retard the combustion reaction. Therefore, the assembled PS/SiAPP/aMWCNT system provides a new pathway to improve the flame retardant and electromagnetic shielding properties of PS.

Association of Red Cell Index and Adverse Hospitalization Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: A Retrospective Cohort Study.

Purpose: Previous studies have shown that the red cell index (RCI) can be considered as a simple and useful method to evaluate respiratory function. However, at present its association with adverse hospitalization outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not fully understood. Our study aimed to examine the relationship between adverse hospitalization outcomes and RCI among AECOPD patients. Patients and Methods: We performed a retrospective analysis of consecutive patients from January 2015 to October 2021. In this study, RCI was the independent variable, measured at baseline, and adverse hospitalization outcome was the dependent variable. According to the RCI median (RCI=2.221), we divided 377 patients into two roughly equal groups (188 and 189, respectively). Next, the association between RCI and adverse hospitalization outcomes was explored using multivariable logistic regression models. To identify any non-linear relationship, a generalized additive model (GAM) was employed. Results: With a total of 377 patients with AECOPD, we divided them into two roughly equal groups to compare the clinical factors and RCI levels. The patients in the higher RCI group showed poorer outcome incidence (18 [9.57%] vs 31 [16.40%]; p = 0.049). After accounting for potential confounders, the results showed that RCI was positively associated with adverse hospitalization outcomes (odds ratio [OR] = 1.15, 95% CI: 1.01-1.32). In addition, a non-linear relationship was detected between RCI and adverse hospitalization outcomes, which had an inflection point of 3.2. There were odds ratios and confidence intervals of 0.8 (0.7-1.0) and 1.3 (1.2-1.4) on the left and right sides of the inflection point, respectively. Conclusion: The RCI and adverse hospitalization outcomes exhibited a non-linear relationship in the AECOPD patients. RCI is strongly positively correlated with adverse hospitalization outcomes when it was greater than 3.2.

Does Tibetan Household Livelihood Capital Enhance Tourism Participation Sustainability? Evidence from China's Jiaju Tibetan Village.

Identifying effective transformations to reduce poverty and approach rural sustainability is at the core of the first sustainable development goal of the United Nations. This article offers scientific support for continued efforts in sustaining rural development and livelihood resilience. Many studies have examined drivers of livelihood transition from farming to non-farm activities, especially participation in tourism against the backdrop of rural tourism development. However, few studies have identified ways to measure the level of tourism participation or have discussed how household-level capital influences decisions regarding tourism participation made by Tibetan ethnic households. This article assesses the role of livelihood capital in the adoption of tourism activities at the household level in Jiaju Tibetan Village, an ethnic region that is experiencing struggling agricultural business and developing tourism sector. Using household survey data, this study presents an ordinal logistic regression model to identify the determinants of the household tourism participation level. The results showed that households' tourism participation was influenced by physical capital (e.g., proximity to major roads, odds ratio = 2.83 at p = 0.024; fixed capitals, odds ratio = 101.19 at p = 0.039), human capital (e.g., availability of family labor, odds ratio = 0.25 at p = 0.004; availability of skilled member, odds ratio = 2.91 at p = 0.002), and social capital (e.g., relatives in governmental sectors, odds ratio = 5.22 at p = 0.044; government payments, odds ratio = 8.78 at p = 0.04), while the influence of financial capital was not significant. The proximity to major roads, availability of skilled members, fixed assets, and direct and indirect support from the government to households were significantly and positively associated with tourism participation level. The effects of household labor availability and annual family income remain unclear. Overall, household livelihood capital plays a critical role in the enhancement of tourism participation in Jiaju Tibetan Village. Our findings have implications for understanding the shift of on-farm occupation to off-farm activities in tourism and for the pursuit of policies contributing to poverty reduction and rural revitalization in China as well as to the Sustainable Development Goals.

Original karst tiankeng with underground virgin forest as an inaccessible refugia originated from a degraded surface flora in Yunnan, China.

Karst tiankengs are rare natural habitats, having a local microclimate different from surrounding regions. A contrast study on plant communities at the inside and outside of the primitive tiankeng was carried out by performing the qualitative analysis of species compositions of arborous and shrub layers. We found that plant communities in the primitive tiankeng belong to the subtropical moist evergreen broad-leaf forest, whereas those outside the tiankeng belong to subtropical semi-moist needle-broadleaved mixed forest. Trapped habitat of primitive karst tiankeng protects the plant communities significantly different from those in external karst ecosystems, so karst tiankeng has the great value in the plant species protection. Although the trapped habitat decreases plant species abundance inside tiankeng to some extent, highly diverse shrub species are present in the inside-tiankeng plant communities, and the primitive karst tiankeng plays an important role in the plant diversity protection. The primitive karst tiankeng is an important refugia for plant not only as a plant species protection library, but a plant diversity protection library. When implementing measures for the reduction of damages to biodiversity due to global climate changes and human activities, more attention should be paid to the primitive karst tiankeng as a small ecological refugia and biodiversity protection library.

Slope aspect affects the soil microbial communities in karst tiankeng negative landforms.

BACKGROUND: Karst tiankeng is a large-scale negative surface terrain, and slope aspects affect the soil conditions, vegetation and microbial flora in the tiankeng. However, the influence of the slope aspect on the soil microbial community in tiankeng has not been elucidated. METHODS: In this study, metagenomic sequencing technology was used to analyze the soil microbial community structure and functional potentials on the shady and sunny slopes of karst tiankeng. RESULTS: The Shannon-Wiener diversity of microbial communities on shady slope (SHS) was significantly higher than that on sunny slope (SUS). Although the composition of dominant phyla on shady slope (SHS) and sunny slope (SUS) was similar, there were significant differences in beta-diversity. The linear discriminate analysis (LDA) results showed that biomarkers mainly belongs to Actinobacteria, Chloroflexi and Proteobacteria. Functional pathways and CAZy (Carbohydrate-Active Enzymes) genes also had a remarkable response to slope aspect change. LEfSe results indicated several biomarker pathways in sunny slope involved in human disease. Moreover, the abundance of CAZy genes was higher in shady slope and had stronger ability in decomposing litter. The microbial communities were mainly correlation with the vegetation characteristics (species richness and coverage) and soil properties (SOC and pH). CONCLUSIONS: These results indicate slope aspect has a pronounced influence on microbial community composition, structure and function at karst tiankeng. In the future, the conservation of karst tiankeng biodiversity should pay more attention to topographical factors.

Metagenomic analysis reveals the different characteristics of microbial communities inside and outside the karst tiankeng.

BACKGROUND: Karst tiankengs serve as a reservoir of biodiversity in the degraded karst landscape areas. However, the microbial diversity of karst tiankengs is poorly understood. Here, we investigated the composition and function of the microbial community in a karst tiankeng. RESULTS: We found that habitat differences inside and outside the karst tiankeng changed the composition and structure of the soil microbial communities, and the dominant phyla were Proteobacteria, Actinobacteria, Chloroflexi and Acidobacteria. The Shannon-Wiener diversity of microbial communities inside and outside the tiankeng was significantly different, and it was higher inside the tiankeng (IT). Venn and LEfSe analysis found that the soil microbial communities inside the tiankeng had 640 more endemic species and 39 more biomarker microbial clades than those identified outside of the tiankeng (OT)..Functional prediction indicated that soil microorganisms in outside the tiankeng had a high potential for carbohydrate metabolism, translation and amino acid metabolism. There were biomarker pathways associated with several of human diseases at both IT and OT sites. Except for auxiliary activities (AA), other CAZy classes had higher abundance at IT sites, which can readily convert litter and fix carbon and nitrogen, thereby supporting the development of underground forests. The differences in microbial communities were mainly related to the soil water content and soil total nitrogen. CONCLUSIONS: Our results provide a metagenomic overview of the karst tiankeng system and provide new insights into habitat conservation and biodiversity restoration in the area.

Heat Adaptive Capacity: What Causes the Differences Between Residents of Xiamen Island and Other Areas?

Extreme heat events caused by climate change have serious adverse effects on residents' health in many coastal metropolises in southeast China. Adaptive capacity (AC) is crucial to reduce heat vulnerability in the human-environment system. However, it is unclear whether changes in individual characteristics and socioeconomic conditions likely amplify or attenuate the impacts of residents' heat adaptive capacity (HAC) changes. Moreover, which public policies can be implemented by the authorities to improve the HAC of vulnerable groups remains unknown. We conducted a questionnaire survey of 630 residents of Xiamen, a typical coastal metropolis, in 2018. The effects of individual and household characteristics, and government actions on the residents' HAC were examined by using ordinal logistic regression analysis. Results show that the majority (48.10%) of Xiamen residents had a "medium" HAC level, followed by a "high" level (37.14%). On Xiamen Island, residents who settled locally for one-three years and spent less than one hour outdoors might report weaker HAC, and their HAC would not improve with increased air conditioning units in household. In other areas of Xiamen, residents with more rooms in their households, no educational experience, and building areas <50 m2 might report better HAC. Further, vulnerable groups, such as local residents and outdoor workers on Xiamen Island, people lacking educational experience and renters in other areas of Xiamen, showed better AC to hot weather than those in previous studies. Low-income groups should be given more attention by local governments and community groups as monthly household income played a positive role in improving Xiamen residents' HAC. Rational green spaces planning and cooling services, such as street sprinkling operations, provided by municipal departments can effectively bring benefits to Xiamen residents. Identification of basic conditions of AC has significant implications for practical promoting targeted measures or policies to reduce health damages and livelihood losses of urban residents during extreme heat events.

An improved daily standardized precipitation index dataset for mainland China from 1961 to 2018.

The standardized precipitation index (SPI), one of the most commonly used drought indicators, is widely used in the research areas of drought analysis and drought prediction in different fields such as meteorology, agriculture, and hydrology. However, its main disadvantage is the relatively coarse time resolution of one month. To improve the time resolution of SPI to identify flash droughts, we have refined the traditional SPI calculation method and developed a new multi-scale daily SPI dataset based on data from 484 meteorological stations in mainland China from 1961 to 2018. SPI data from three different sites (located in Henan, Yunnan, and Fujian Provinces) at the three-month timescale were analyzed by comparing with historically recorded drought events. We found that the new multi-scale daily SPI can effectively capture drought events in different periods and locations and identify the specific start and end times of drought events. In short, our SPI dataset appears reasonable and capable of facilitating drought research in different fields.

Constructing segregated polystyrene composites for excellent fire resistance and electromagnetic wave shielding.

Electroconductive polystyrene (PS) composites with ideal flame-retardant properties are considered as potential electromagnetic interference (EMI) shielding materials. In this work, PS/silicon wrapped ammonium polyphosphate/multi-wall carbon nanotubes (PS/SiAPP/MWCNT) composites with segregated structure were synthesized via the methods of balling mill and hot-pressing. The obtained results revealed that the SiAPP and MWCNT were successfully introduced onto PS spheres and showed uniform distribution on the PS surface. The thermogravimetric analysis showed that PS/SiAPP/MWCNT containing 7 wt% MWCNT exhibited excellent thermal stability. Furthermore, the results of cone calorimeter test indicated that the heat release rate and total heat release of the PS/SiAPP/MWCNT containing a loading of 7 wt% MWCNT were reduced by 60.5% and 33.9%, respectively. In addition, the EMI shielding performance could reach 11 dB. Above results implied that the synergistic effect between the MWCNT and SiAPP effectively enhanced the flame retardant performance of the PS by promoting the generation of dense and continuous char layer to protect the PS from burning. The multiple reflection and adsorption are responsible for improved EMI shielding effectiveness. Therefore, segregated PS/SiAPP/MWCNT hybrid is an up-and-coming candidate for satisfactory EMI shielding materials with exceptional fire retardancy for electronic devices.

Development of a Predictive Model for Mortality in Hospitalized Patients With COVID-19.

INTRODUCTION: Early identification of patients with novel corona virus disease 2019 (COVID-19) who may be at high mortality risk is of great importance. METHODS: In this retrospective study, we included all patients with COVID-19 at Huanggang Central Hospital from January 23 to March 5, 2020. Data on clinical characteristics and outcomes were compared between survivors and nonsurvivors. Univariable and multivariable logistic regression were used to explore risk factors associated with in-hospital death. A nomogram was established based on the risk factors selected by multivariable analysis. RESULTS: A total of 150 patients were enrolled, including 31 nonsurvivors and 119 survivors. The multivariable logistic analysis indicated that increasing the odds of in-hospital death associated with higher Sequential Organ Failure Assessment score (odds ratio [OR], 3.077; 95% confidence interval [CI]: 1.848-5.122; P < 0.001), diabetes (OR, 10.474; 95% CI: 1.554-70.617; P = 0.016), and lactate dehydrogenase greater than 245 U/L (OR, 13.169; 95% CI: 2.934-59.105; P = 0.001) on admission. A nomogram was established based on the results of the multivariable analysis. The AUC of the nomogram was 0.970 (95% CI: 0.947-0.992), showing good accuracy in predicting the risk of in-hospital death. CONCLUSIONS: This finding would facilitate the early identification of patients with COVID-19 who have a high-risk for fatal outcome.

[Effectiveness of arthroscopic 360° capsular release for frozen shoulder].

OBJECTIVE: To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder. METHODS: Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S 1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up. RESULTS: All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T 6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05). CONCLUSION: Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.