All-natural 2D nanofluidics as highly-efficient osmotic energy generators.

Two-dimensional nanofluidics based on naturally abundant clay are good candidates for harvesting osmotic energy between the sea and river from the perspective of commercialization and environmental sustainability. However, clay-based nanofluidics outputting long-term considerable osmotic power remains extremely challenging to achieve due to the lack of surface charge and mechanical strength. Here, a two-dimensional all-natural nanofluidic (2D-NNF) is developed as a robust and highly efficient osmotic energy generator based on an interlocking configuration of stacked montmorillonite nanosheets (from natural clay) and their intercalated cellulose nanofibers (from natural wood). The generated nano-confined interlamellar channels with abundant surface and space negative charges facilitate selective and fast hopping transport of cations in the 2D-NNF. This contributes to an osmotic power output of ~8.61 W m-2 by mixing artificial seawater and river water, higher than other reported state-of-the-art 2D nanofluidics. According to detailed life cycle assessments (LCA), the 2D-NNF demonstrates great advantages in resource consumption (1/14), greenhouse gas emissions (1/9), and production costs (1/13) compared with the mainstream 2D nanofluidics, promising good sustainability for large-scale and highly-efficient osmotic power generation.

Improved Value of Multiplexed Sensitivity Encoding DWI with Reversed Polarity Gradients in Diagnosing Prostate Cancer: A Comparison Study with Single-Shot DWI and MUSE DWI.

RATIONALE AND OBJECTIVES: This study aimed to investigate the value of multiplexed sensitivity encoding with reversed polarity gradients in improving the quality of diffusion-weighted imaging (DWI) images of the prostate and the diagnostic efficacy of prostate cancer. MATERIALS AND METHODS: Seventy-three patients with prostate disease underwent multiplexed sensitivity encoding with reversed polarity gradients (RPG-MUSE), multiplexed sensitivity encoding (MUSE), and single-shot echo-planar imaging (ssEPI) DWI. Three radiologists performed a qualitative image analysis of the three DWI sequences. Qualitative image analysis included artifact minimization, anatomical detail, and sharpness of prostate edges. Two radiologists measured the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), geometric distortion rate, and the apparent diffusion coefficient (ADC) values of the prostate disease tissue. Two radiologists jointly performed Prostate Imaging Reporting and Data System scoring of prostate lesions and compared the diagnostic efficacy of the three DWI sequences for prostate cancer. RESULTS: There was good agreement among radiologists in the evaluation and measurement of the three DWI sequence images (intraclass correlation coefficient >0.75, P < 0.05). The RPG-MUSE DWI images were rated higher than those of MUSE and ssEPI in terms of artifact minimization, anatomical details, and sharpness of prostate edges (P < 0.05). The SNR and CNR of the RPG-MUSE DWI images were higher than those of MUSE and ssEPI (P < 0.05), and the geometric distortion rate was lower than that of the other two sequences (P < 0.05). There were no statistical differences in ADC values between the three DWI sequences (P > 0.05). The diagnostic efficacy of RPG-MUSE and MUSE DWI was higher than that of ssEPI (P < 0.017). CONCLUSION: RPG-MUSE can reduce the artifacts and geometric distortion in DWI images of the prostate, improve the SNR and CNR of the images, improve the clarity of anatomical details and boundaries without affecting the measurement of ADC values, has the potential to improve the diagnostic efficacy of prostate lesions, and facilitates the clear display and accurate assessment of prostate lesions.

Regulation Mechanism for Designing Decarbonization Pathways in the Copper Industry Toward Carbon Neutrality.

The transformation of the global power structure caused by the carbon neutrality goal will promote copper consumption. It is crucial to explore the decarbonization pathways of the copper industry to help fulfill greenhouse gas (GHG) emission reduction targets. This study utilized material flow analysis and life cycle assessment methods to investigate 12 different subscenarios based on international trade, circular economy, technology evolution, and environmental market factors. Policy combination scenario is employed to reveal the mechanism of decarbonization. The results show that refined copper consumption in China is expected to increase by 62.3% in 2060 compared to 2020. The GHG emissions of China's copper industry will reach 9.1 million tonnes (Mt) CO2e in 2060, technology evolution and environmental market are crucial for realizing carbon neutrality goal of this industry, accounting for 26.4 and 47.2% of emissions reductions, respectively, between 2020 and 2060. International trade and circular economy play important roles in the high-quality carbon peaking stage; however, imported copper and domestic secondary copper will constitute the basic supply of copper resources in China in the long run, and the comparative advantages of them will gradually weaken. Policy combination scenario can achieve the incentive synergy effect, with GHG reduced to 0.5 Mt CO2e in 2060. The enhanced application of policies such as material substitution and carbon emission trading will further promote industry to achieve net-zero GHG emission. We suggest regulating the industry's structure based on the international systemic circulation pattern and accelerating the construction of a green circular chain in the short term to achieve sustainable copper supply and high-quality carbon peaking. Promoting a high-quality technology development strategy and enhancing the environmental markets are recommended in the long term to achieve carbon neutrality.

What can we learn from a Chinese social media used by glaucoma patients?

PURPOSE: Our study aims to discuss glaucoma patients' needs and Internet habits using big data analysis and Natural Language Processing (NLP) based on deep learning (DL). METHODS: In this retrospective study, we used web crawler technology to crawl glaucoma-related topic posts from the glaucoma bar of Baidu Tieba, China. According to the contents of topic posts, we classified them into posts with seeking medical advice and without seeking medical advice (social support, expressing emotions, sharing knowledge, and others). Word Cloud and frequency statistics were used to analyze the contents and visualize the keywords of topic posts. Two DL models, Bidirectional Long Short-Term Memory (Bi-LSTM) and Bidirectional Encoder Representations from Transformers (BERT), were trained to identify the posts seeking medical advice. The evaluation matrices included: accuracy, F1 value, and the area under the ROC curve (AUC). RESULTS: A total of 10,892 topic posts were included, among them, most were seeking medical advice (N = 7071, 64.91%), and seeking advice regarding symptoms or examination (N = 4913, 45.11%) dominated the majority. The following were searching for social support (N = 2362, 21.69%), expressing emotions (N = 497, 4.56%), and sharing knowledge (N = 527, 4.84%) in sequence. The word cloud analysis results showed that ocular pressure, visual field, examination, and operation were the most frequent words. The accuracy, F1 score, and AUC were 0.891, 0.891, and 0.931 for the BERT model, 0.82, 0.821, and 0.890 for the Bi-LSTM model. CONCLUSION: Social media can help enhance the patient-doctor relationship by providing patients' concerns and cognition about glaucoma in China. NLP can be a powerful tool to reflect patients' focus on diseases. DL models performed well in classifying Chinese medical-related texts, which could play an important role in public health monitoring.

Caregiver Perceptions of Children's and Adolescents' Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families' daily lives, including the mental health of children and adolescents. OBJECTIVE: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. METHODS: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. RESULTS: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children's interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. CONCLUSIONS: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers' parenting and psychosocial functioning of children and adolescents.

A comparative examination of the health status of earthquake-affected and non-earthquake-affected adolescents in Yushu.

Background: Yushu, Qinghai Province, which is located in the remote Tibetan Plateau in western China, was struck by a disastrous earthquake in 2010. Methods: This study aimed to compare the health status of adolescents who had (Exp-Group) and had not (Non-Group) experienced the Yushu earthquake, 7 years after it occurred; additionally, group-specific predictors of health status were identified. A cross-sectional study was adopted among students from two junior schools in Yushu, whereby two groups were compared. Descriptive statistics, t-tests, Wilcoxon rank-sum tests, Kruskal-Wallis H tests, and stepwise linear regression were used to analyze data. Results: Exp-Group scored higher than Non-Group on Physiological Component Summary (PCS) but not on Mental Component Summary (MCS). Among Exp-Group participants, lower PCS scores were predicted for "house damaged," "injured," "family member injured," and "family member or friend dead." Lower MCS scores were predicted by "family member or friend dead." Among Non-Group participants, PCS scores were predicted by "residence" and "family member or friend dead." Lower MCS scores were predicted by "not living with parents." Conclusion: Lower PCS and MCS scores of Exp-Group adolescents mainly contributed to earthquake-related injuries, while lower PCS and MCS scores of Non-Group are related to poor living conditions and the fact of the left-behind child.

The impact of school life and family involvement on Western China junior high school students' wellbeing at multidimensional levels.

BACKGROUND: The focus of students' health concerns has gradually progressed from the single factor of physical health to comprehensive health factors, and the physical and mental health of students are now generally considered together. This study focuses on exploring the status of junior high school students' physical health and their subjective health assessment with the major societal factors that affect students' lives: School Life and Family involvement. In addition, we explore the main factors influencing students' subjective health. METHODS: A cross-sectional survey was conducted with 190 Tibetan junior high school students in the Maozhuang Township. The intentional sampling was used to choose the research object. The structured questionnaire comprised four parts, namely social and demographic information, family condition, school life, and subjective health quality which was assessed by PROMIS (Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System). RESULT: The average height and weight of boys and girls are statistically different (p-values of 0.026 and 0.044, respectively), but there is no statistically significant difference in BMI (Body Mass Index) between boys and girls (p-value of 0.194). The average values of the five dimensions of depression, anger, anxiety, fatigue, and peer relationships in the PROMIS of the research subjects were 58.9 ± 5.3, 53.3 ± 8.0, 58.1 ± 7.3, 52.8 ± 8.0, 39.3 ± 6.6. In the demographic dimension, the grade was the main factor influencing anger (p < 0.01) and fatigue (p < 0.01), while gender was related to peer relationships (p = 0.02). In the family dimension, the father's educational level was related to peer relationships (p = 0.05), while the family financial situation was related to depression (p = 0.01). In the school life dimension, relationship with classmates was found to affect anger (p = 0.05), while homework was related to anxiety (p = 0.02) and fatigue (p = 0.05). CONCLUSION: the physical health index BMI and subjective health evaluation of students are worse than students of more developed areas in China. Their family environment and school life all have varying degrees of impact on the five subjective health outcomes. There are differences in gender and grade level. The government and society need to pay more attention to the physical and mental health of students in remote and underdeveloped areas and improve their health through a student nutrition plan and the establishment of mental health offices.

Health status of adolescents in the Tibetan plateau area of western China: 6 years after the Yushu earthquake.

BACKGROUND: An earthquake struck Yushu in Qinghai province of China on April 14, 2010, causing 2698 deaths and 12,135 injuries.The present study aimed to assess the health status, and associated determinants, of child survivors in the epicenter of the Yushu earthquake 6 years after the event. METHODS: A cross-sectional survey was performed among students from two junior schools in Yushu County. Descriptive statistics, t-tests, ANOVA, Wilcoxon rank sum tests, Kruskal-Wallis H tests and stepwise linear regression analysis were used for data analysis. RESULTS: The mean scores onmental component summary (MCS)and physical component summary (PCS) were 42.13 (SD 7.32) and 42.04 (SD 8.07), respectively. Lower PCS in the aftermath of an earthquake was associated with being trapped/in danger, injured to self, receiving no escape training while lowerMCS in the aftermath of an earthquake was associated with a lower grade level, not living with parents, fear during the earthquake, death in the family, and not receiving psychological counseling after the earthquake. CONCLUSIONS: In conclusion, the results of the present study help to expand our knowledge regarding the health status of child survivors 6 years after the Yushu earthquake. Our study provides evidence-based suggestions for specific long-term health interventions in such vulnerable populations.

Polylactic Acid Nanofiber Scaffold Decorated with Chitosan Islandlike Topography for Bone Tissue Engineering.

In this work, a bicomponent scaffold with a core-shell and islandlike structure that combines the respective advantages of polylactic acid (PLA) and chitosan (CS) was prepared via electrospinning accompanied by automatic phase separation and crystallization. The objective of this research was to design nanosized topography with highly bioactive CS onto PLA electrospun fiber surface to improve the cell biocompatibility of the PLA fibrous membrane. The morphology, inner structure, surface composition, crystallinity, and thermodynamic analyses of nanofibers with various PLA/CS ratios were carried out, and the turning mechanism of a core-shell or islandlike topography structure was also speculated. The mineralization of hydroxyapatite and culture results of preosteoblast (MC3T3-E1) cells on the modified scaffolds indicate that the outer CS component and rough nanoscale topography on the surface of the nanofibers balanced the hydrophilicity and hydrophobicity of the fibers, enhanced their mineralization ability, and made them more beneficial for the attachment and growth of cells. Moreover, CS and "islandlike" protrusions on the fiber surface increased the alkaline phosphatase activity of the MC3T3-E1 cells seeded on the fibrous membrane and provided a more appropriate interface for cell adhesion and proliferation. These results illustrate that this kind of PLA/CS membrane has the potential in tissue engineering. More importantly, our study provides a new approach to designing PLA scaffolds, with combined topographic and bioactive modification effects at the interface between cells and materials, for biomedicine.

Synthesis of a water-soluble thiourea-formaldehyde (WTF) resin and its application to immobilize the heavy metal in MSWI fly ash.

Because of the high concentrations of heavy metals, municipal solid waste incineration (MSWI) fly ash is classified as a hazardous waste, which need to be treated to avoid damaging the environment. A novel water-soluble thiourea-formaldehyde (WTF) resin was synthesized by two step reactions (hydroxymethylation reaction and condensation reaction) in the laboratory. Synthetic conditions, removal of free formaldehyde in the resin and the ability of immobilization heavy metals in the MSWI fly ash were studied. The possible molecular structure of the resin was also discussed by elemental analysis and FTIR spectra. Experimental results showed that the synthesis conditions of WTF resin were the formaldehyde/thiourea (T/F) mole ratio of 2.5:1, hydroxymethylation at pH 7.0-8.0 and 60 °C for 30min, and condensation of at pH 4.5-5.0 and 80 °C. In addition, the end point of condensation reaction was measured by turbidity point method. The result of elemental analysis and FTIR spectra indicated that thiourea functional group in the WTF resin chelated the heavy metal ions. Melamine can efficiently reduce the free formaldehyde content in the resin from 8.5% to 2%. The leaching test showed that the immobilization rates of Cr, Pb and Cd were 96.5%, 92.0% and 85.8%, respectively. Leaching concentrations of Cr, Pb and Cd in the treated fly ash were decreased to 0.08 mg/L, 2.44 mg/L and 0.23 mg/L, respectively. The MSWI fly ash treated by WTF resin has no harm to the environment.

Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China.

OBJECTIVES: The injuries caused by earthquakes are often complex and of various patterns. Our study included all fracture inpatients from the Yushu earthquake (1323 in total), to learn more about the incidence and distribution of fractures during earthquakes. METHODS: A retrospective study of the clinical characteristics of hospitalized fracture patients after the 2010 Yushu earthquake was conducted from December 20 to 25, 2010.We reviewed medical records of hospitalized patients who had been evacuated from the Yushu earthquake area between April 14 and June 15, 2010, from 57 hospitals, and also reviewed more than 100 documents assembled from daily medical rescue and disease prevention reports submitted by the frontline rescue organizations. RESULTS: In total, 78.0% of fracture patients were admitted to the hospital within 3 days after the earthquake. There were 1323 patients who presented with 1539 fractures. The most common fracture occurred in the lower limbs, followed by spinal, pelvic, and shoulder-upper limb fractures. The end of the thoracic vertebra and the lumbar vertebra were the high-risk sites for vertebral fractures. A total of 38 patients became paraplegic. A 2-level spatial clustering was detected among the 193 patients presenting with 2 fractures. CONCLUSIONS: Analysis profiles of the injuries and clinical features of patients with earthquake-related fractures will positively impact rescue efforts and the treatment of fracture injuries caused by possible future natural disasters. We should assemble orthopedic-related medications and surgical equipment, and allocate them promptly after a major earthquake.

The Technical Efficiency of Earthquake Medical Rapid Response Teams Following Disasters: The Case of the 2010 Yushu Earthquake in China.

PURPOSE: Performance assessments of earthquake medical rapid response teams (EMRRTs), particularly the first responders deployed to the hardest hit areas following major earthquakes, should consider efficient and effective use of resources. This study assesses the daily technical efficiency of EMRRTs in the emergency period immediately following the 2010 Yushu earthquake in China. METHODS: Data on EMRRTs were obtained from official daily reports of the general headquarters for Yushu earthquake relief, the emergency office of the National Ministry of Health, and the Health Department of Qinghai Province, for a sample of data on 15 EMRRTs over 62 days. Data envelopment analysis was used to examine the technical efficiency in a constant returns to scale model, a variable returns to scale model, and the scale efficiency of EMRRTs. Tobit regression was applied to analyze the effects of corresponding influencing factors. RESULTS: The average technical efficiency scores under constant returns to scale, variable returns to scale, and the scale efficiency scores of the 62 units of analysis were 77.95%, 89.00%, and 87.47%, respectively. The staff-to-bed ratio was significantly related to global technical efficiency. The date of rescue was significantly related to pure technical efficiency. The type of institution to which an EMRRT belonged and the staff-to-bed ratio were significantly related to scale efficiency. CONCLUSIONS: This study provides evidence that supports improvements to EMRRT efficiency and serves as a reference for earthquake emergency medical rapid assistance leaders and teams.

ONU migration in dynamic Time and Wavelength Division Multiplexed Passive Optical Network (TWDM-PON).

We propose a novel Optical Network Units (ONU) migration mechanism within the Time and Wavelength Division Multiplexed PON (TWDM-PON) framework by rearranging the working ONUs to a minimum number of wavelengths and turning off the rest to save power. We show through simulation that the number of working wavelengths can be minimized up to a theoretical lower bound, e.g. 23%, under the typical ONU online profiles. We further investigate how the migration interval and delay influence the user Service Level Agreement (SLA). We find that under the example ONU online profiles, 99.99% ONU SLA can be realized with the migration delay of 1000 milli-seconds. However to realize 99.999% ONU SLA, the migration delay must be 100 milli-seconds or lower.

Obesity and the risk of late mortality after aortic valve replacement with small prosthesis.

BACKGROUND: Whether obesity is related to late mortality with implantation of small aortic prosthesis remains to be clarified. This study was aimed to evaluate the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm). METHODS: From January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived the 30 days after surgery. Patients were defined as normal if body mass index (BMI) was < 24 kg/m2, as overweight if BMI 24-27.9 kg/m2, and as obese if BMI ≥ 28 kg/m2. Data of New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI), and left ventricular mass index (LVMI) of the patients collected at the 3rd month (M), 6th M, 1st year (Y), 3rd Y, 5th Y, 8th Y after operation respectively. RESULTS: By multivariable analysis, obesity was an independent factor of late mortality (hazard ratio [HR]: 1.62; P = 0.01). The obesity and overweight group had more poor survival (p < 0.001) and higher proportion of NYHA class III/IV (p < 0.01) compared with the normal group. Lower EOAI and higher LVMI were found in obesity and overweight group, but we saw no significant difference about LVEF among the three groups. CONCLUSIONS: Obesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.

Obesity is associated with higher long-term mortality after aortic valve replacement with small prosthesis.

OBJECTIVE: Although many studies have evaluated the impacts of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prosthesis. This study evaluated the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm). METHODS: From January 1998 to December 2008, 536 patients in our institution who underwent primary AVR (307 patients with smaller prostheses) survived the 30 days after surgery. Patients were categorised as normal weight if body mass index (BMI) was ≤ 25 kg/m(2), as overweight if BMI 25-30 kg/m(2), and as obese if BMI ≥ 30 kg/m(2). Data were collected at the third-month (M), sixth-M, first-year (Y), third-Y, fifth-Y, and eighth-Y after operation. RESULTS: By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio [HR]: 1.59; p=0.006). The obese and overweight groups of patients exhibited lower survival (p<0.001) and a higher proportion in NYHA class III/IV (p<0.01) compared with the normal group. Lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. CONCLUSIONS: Obesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term.

Impact of obesity on long-term survival after aortic valve replacement with a small prosthesis.

OBJECTIVES: Although many studies have evaluated the impact of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prostheses. This study evaluated the effect of obesity on the late survival of patients after aortic valve replacement (AVR) with implantation of a small aortic prosthesis (size ≤ 21 mm). METHODS: From January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived 30 days after surgery. Patients were categorized as normal weight if body mass index (BMI) was <24 kg/m(2), overweight if BMI 24-27.9 kg/m(2) and obese if BMI ≥ 28 kg/m(2). Data of the New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI) and left ventricular mass index of the patients were collected at the third month, sixth month, first year, third year, fifth year and eighth year after operation. RESULTS: By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio: 1.62; P = 0.01). The obese and overweight groups of patients exhibited lower survival (P < 0.001) and a higher proportion in NYHA Class III/IV (P < 0.01) compared with the normal group. A lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. CONCLUSIONS: Obesity is associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Obesity or/and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.

Medical evacuation management and clinical characteristics of 3,255 inpatients after the 2010 Yushu earthquake in China.

BACKGROUND: A catastrophic earthquake struck the Yushu prefecture of China's Qinghai province on April 14, 2010. Supported by the China National Ministry of Health, this study performed a detailed medical analysis of injuries and diseases, based on comprehensive medical data of hospitalized patients to share the experiences and lessons learned from emergency medical aid operations in high-altitude regions. METHODS: To survey the management of medical relief, more than 10 interviews with rescuers were held and more than 100 documents were reviewed. Medical records of 3,255 patients from 57 hospitals were analyzed retrospectively. Patient demographic data, complaints, diagnoses, prognoses, injury types, dispositions, and means of transportation were all reviewed. RESULTS: A total of 3,255 patients were admitted to hospitals. Of these, 1,426 (43.8%) were middle-aged (31-50 years), 2,574 (79.07%) were transported by plane, and the first 3 days were the peak period for air transportation. The records of 2,622 patients with earthquake-related injuries were analyzed, and 1,775 (68.32%) of them were admitted to hospital within the first 3 days. Bone fractures were diagnosed in 1,431 (55.08%) patients and crush syndrome was observed in 23 (0.89%). Illnesses accounted for 657 patients who were admitted to surveyed hospitals. Of these, 143 (20.63%) suffered from respiratory diseases and 259 (39.97%) from acute high-altitude sickness. Of the latter, 224 (86.49%) were rescuers. The overall mortality rate was 0.2% (7 of 3,255). Four patients died from earthquake-related injuries and three from other illnesses. CONCLUSIONS: A devastating earthquake occurring in a remote, high-altitude region presented a variety of challenges for external medical aid. Air transportation for those with severe injuries and diseases played a crucial role in decreasing the mortality and morbidity. It is necessary for hospitals to initiate effective emergency measures while facing the peak admission flow within the initial 72-hour period. Characteristic factors such as high altitude, low-oxygen content, local construction features, and lifestyle may contribute to complex injuries and illnesses. More attention should be paid to medical aid training for rescuers, and effective measures should be developed to deal with destructive natural disasters occurring in special geographical environments. LEVEL OF EVIDENCE: Epidemiological study, level III.

Molecular characterization of a novel adult diarrhoea rotavirus strain J19 isolated in China and its significance for the evolution and origin of group B rotaviruses.

The complete genome of a novel adult diarrhoea rotavirus strain J19 was cloned and sequenced using an improved single-primer sequence-independent method. The complete genome is 17,961 bp and is AU-rich (66.49 %). Northern blot analysis and genomic sequence analysis indicated that segments 1-11 encode 11 viral proteins, respectively. Protein alignments with the corresponding proteins of J19 with B219, and groups A, B and C rotaviruses, produced higher per cent sequence identities to B219. Among groups A, B and C rotaviruses, 10 proteins from group B rotaviruses exhibited slightly higher amino acid sequence identity to the J19 proteins, but proteins of J19 showed low amino acid sequence identity with groups A and C rotaviruses. Construction of unrooted phylogenetic trees using a set of known proteins and representatives of three known rotavirus groups revealed that six structural proteins were positioned close to B219 and the basal nodes of groups A, B and C lineages, although with a preferred association with group B lineages. Phylogenetic analysis of the five non-structural proteins showed a similar trend. The results of the serological analysis, protein sequence analysis and phylogenetic analysis suggested that J19 would be a novel rotavirus strain with great significance to the evolution and origin of group B rotaviruses.