Purpose
A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies.
Methods
Retrospective analysis of multiple ...cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively.
Results
In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis-related mortality rate was 66.7 (95% confidence interval CI 66.4–67.0) deaths per 100,000 population. This produced a national estimate of 1,025,997 sepsis-related deaths. Sepsis-related mortality rates exhibited significant geographic variation. In multilevel analysis, male sex (rate ratio RR 1.582, 95% CI 1.570–1.595), increasing age (RR 1.914 for 5-year group, 95% CI 1.910–1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298–2.335) were independently associated with increased sepsis-related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.515–0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.684–0.955) were negatively associated with sepsis-related mortality. However, population-based hospital doctors were not significantly associated with sepsis-related mortality.
Conclusions
The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained.
Background
High incidence of asymptomatic venous thromboembolism (VTE) has been observed in severe COVID‐19 patients, but the characteristics of symptomatic VTE in general COVID‐19 patients have not ...been described.
Objectives
To comprehensively explore the prevalence and reliable risk prediction for VTE in COVID‐19 patients.
Methods/Results
This retrospective study enrolled all COVID‐19 patients with a subsequent VTE in 16 centers in China from January 1 to March 31, 2020. A total of 2779 patients were confirmed with COVID‐19. In comparison to 23,434 non‐COVID‐19 medical inpatients, the odds ratios (ORs) for developing symptomatic VTE in severe and non‐severe hospitalized COVID‐19 patients were 5.94 (95% confidence interval CI 3.91–10.09) and 2.79 (95% CI 1.43–5.60), respectively. When 104 VTE cases and 208 non‐VTE cases were compared, pulmonary embolism cases had a higher rate for in‐hospital death (OR 6.74, 95% CI 2.18–20.81). VTE developed at a median of 21 days (interquartile range 13.25–31) since onset. Independent factors for VTE were advancing age, cancer, longer interval from symptom onset to admission, lower fibrinogen and higher D‐dimer on admission, and D‐dimer increment (DI) ≥1.5‐fold; of these, DI ≥1.5‐fold had the most significant association (OR 14.18, 95% CI 6.25–32.18, p = 2.23 × 10−10). A novel model consisting of three simple coagulation variables (fibrinogen and D‐dimer levels on admission, and DI ≥1.5‐fold) showed good prediction for symptomatic VTE (area under the curve 0.865, 95% CI 0.822–0.907, sensitivity 0.930, specificity 0.710).
Conclusions
There is an excess risk of VTE in hospitalized COVID‐19 patients. This novel model can aid early identification of patients who are at high risk for VTE.
Self‐powered smart windows are highly attractive for the development of energy‐efficient buildings system, owing to their superior capacities in regulating the energy and information exchange between ...indoor and outdoor environments. Although immense achievement has been made in the self‐powered cholesteric liquid crystal smart window (CLC‐SW) based on triboelectric nanogenerators (TENGs), such a self‐powered manner is limited by some challenges such as the need of the continuous input of external forces, as well as unstable performance owing to inevitable mechanical abrasion of TENGs surface. Here, a fully self‐powered CLC‐SW is developed by leveraging droplet‐based electricity generator (DEG) as a spontaneous and sustained energy reservoir, in which DEG has superior capacities to harvest ceaseless energy from ambient environment and circumvent any additional electrical power input. It is demonstrated that DEG‐driven CLC‐SW exhibits a rapid response and high tunability in the transformation between the transparent state and the hazy state in a wide range of solar spectrum. Moreover, both the transparent and hazy modes can be self‐sustained for a long time, also be reversibly switched by the gentle mechanical pressure loading. The DEG‐driven smart window developed in this work can find applications such as indoor temperature modulation and privacy information protection.
A fully self‐powered cholesteric liquid crystal smart window (CLC‐SW) is developed by the fusion of CLC and droplet‐based electricity generator (DEG), of which the transparency can be switched reversibly between the hazy and transparent state in a facile and energy‐free manner.
Nonalcoholic fatty liver disease (NAFLD) has become the dominant form of chronic liver disease in children and adolescents with the increasing prevalence of obesity worldwide. NAFLD represents a wide ...spectrum of conditions, ranging from fatty liver - which generally follows a benign, non-progressive clinical course - to non-alcoholic steatohepatitis, a subset of NAFLD that may progress to cirrhosis and end-stage liver disease or liver carcinoma. The underlying pathophysiological mechanism of "pediatric" NAFLD remains unclear, although it is strongly associated with obesity and insulin resistance. In this review we provide a general overview on the current understanding of NAFLD in children and adolescents, which underpins practice, enabling early diagnosis and appropriate therapeutic intervention for this life-threatening liver disease.
Solid‐state Li secondary batteries may become high energy density storage devices for the next generation of electric vehicles, depending on the compatibility of electrode materials and suitable ...solid electrolytes. Specifically, it is a great challenge to obtain a stable interface between these solid electrolytes and cathodes. Herein, this issue can be effectively addressed by constructing a poly(acrylonitrile‐co‐butadiene) coated layer onto the surface of LiNi0.6Mn0.2Co0.2O2 cathode materials. The polymer layer plays a vital role in working as a protective shell to retard side reaction and ameliorate the contact of the solid–solid interface during the cycling process. In the resultant solid‐state batteries, both rate capacity (99 mA h g−1 at 3 C) and cycling stability (75% capacity retention after 400 cycles) are improved after coating. This impressive performance highlights the great importance of layer modification in the cathode and inspires the development of solid‐state batteries toward practical applications.
To mitigate the interfacial problems between cathode and solid electrolyte, a soft poly(acrylonitrile‐co‐butadiene) nanolayer is coated onto the cathode materials. The soft layer can not only sustain an admirable physical contact during cycling but also retard uncontrolled side reactions of the interface by shielding the particles from direct contact with the solid electrolyte.
The blood-spinal cord barrier (BSCB), a physical barrier between the blood and spinal cord parenchyma, prevents the toxins, blood cells, and pathogens from entering the spinal cord and maintains a ...tightly controlled chemical balance in the spinal environment, which is necessary for proper neural function. A BSCB disruption, however, plays an important role in primary and secondary injury processes related to spinal cord injury (SCI). After SCI, the structure of the BSCB is broken down, which leads directly to leakage of blood components. At the same time, the permeability of the BSCB is also increased. Repairing the disruption of the BSCB could alleviate the SCI pathology. We review the morphology and pathology of the BSCB and progression of therapeutic methods targeting BSCB in SCI.
China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third ...among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0–14.0) days, ranging from 10.0 (7.0–13.0) in IS to 14.0 (8.0–22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.
China faces the greatest challenge from stroke in the world. According to results from the Global Burden of Disease Study 2019, there were 3.94 million new stroke cases, 28.76 million prevalent cases ...and 2.19 million deaths due to stroke in China in 2019. Furthermore, stroke is also the leading cause of disability-adjusted life-year (DALY) in China, the number of DALYs reached 45.9 million in 2019. Several recent large-scale epidemiological surveys have updated the data on pre-existing conditions contributed to stroke. The age-adjusted prevalence of overweight among Chinese adults aged 18–69 years was 34.4%, and the prevalence of obesity was 16.8% in 2018. 50.9% of Chinese adults ≥18 years of age without history of hypertension had prehypertension in 2018. The weighted prevalence of hypertension in adults was 27.5% in 2018. The weighted prevalence of total diabetes and pre-diabetes diagnosed by the American Diabetes Association criteria were 12.8% and 35.2%, respectively, among Chinese adults ≥18 years of age in 2017. The weighted atrial fibrillation prevalence was 1.8% among Chinese adults ≥45 years of age and equates to being present in an estimated 7.9 million people in China. Data from 1672 tertiary public hospitals in the Hospital Quality Monitoring System (HQMS) showed that 3 411 168 stroke cases were admitted during 2019. Of those, 2 818 875 (82.6%) were ischaemic strokes (ISs), 485 474 (14.2%) were intracerebral haemorrhages (ICHs), 106 819 (3.1%) were subarachnoid haemorrhages (SAHs). The average age was 66 years old, and 59.6% were male. A total of 1379 (<0.1%), 2604 (0.5%), 1250 (1.2%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 231 519 (36.1%)) of the stroke cases were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (891 103 (26.1%)) and new rural cooperative medical schema (543 108 (15.9%)). The leading risk factor was hypertension (57.3% for IS, 69.9% for ICH and 44.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.4% for IS, 34.6% for ICH and 29.7% for SAH). In-hospital death/discharge against medical advice rate was 8.5%, ranging from 6.0% for IS to 20.6% for SAH. The median and IQR of length of stay was 9.0 (6.0–13.0) days, ranging from 10.0 (7.0–13.0) in IS to 14.0 (8.0–22.0) in ICH. Similar data from 2847 secondary public hospitals or private hospitals in the HQMS were also reported. Data from HQMS showed that higher proportions of interprovincial admission to other provinces were seen in Inner Mongolia, Anhui, Tibet and Beijing. Higher proportions of interprovincial admission from other provinces were seen in Beijng, Tianjin, Shanghai and Ningxia. Data from 323 601 strokes from 1337 hospitals in the Chinese Stroke Center Alliance during 2019 demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.78±0.20, 0.69±0.27 and 0.60±0.31, respectively.
Halide perovskites have received tremendous attention due to their fantastic optical and electrical properties. Here, circularly polarized light emission is successfully demonstrated using a simple ...configuration consisting of inorganic perovskite nanocrystals embedded within a predefined handedness cholesteric superstructure stack. The helical structured cholesteric liquid crystal film acts as a selective filter to transform the unpolarized light emission from perovskite nanocrystals into circularly polarized luminescence. The transformation is accompanied by an extraordinary dissymmetry factor (|glum|) up to 1.6, well‐defined handedness, high photoluminescence quantum yield, and full‐color availability. Furthermore, the circularly polarized luminescence is angular dependent and can easily be modulated by shifting the overlap of the reflection band and the emission band. The proposed method is more straightforward and powerful than the previous approaches, offering new opportunities in optoelectronic and photonic devices.
Circularly polarized luminescence is successfully demonstrated from CsPbX3 perovskite nanocrystals enabled by cholestericsuperstructure stacks. Using the cholesteric liquid crystal films with opposite handedness, high dissymmetry factor values of 1.5–1.6 can easily be achieved for the red, green, and blue emission.
•Using graphite fiber as a skeleton for zinc metal anodes in hybrid aqueous batteries.•After 350 cycles at 1C, a relatively low voltage hysteresis (below 50mV) of Zn@GF has been achieved.•The growth ...of dendritic Zn has been significantly retarded.
Zn metal with high theoretical capacity (820mAhg−1), environmental-friendly properties and low cost is very competitive to be as an anode for aqueous batteries. However, uncontrollable growth of dendritic zinc in these batteries during plating/stripping process of zinc ions not only leads to a low Coulombic efficiency but also brings safety hazards, which have obstructed the application of secondary Zn-based batteries. Here we use high conductive carbon fiber-graphite felt (GF) as collector and electrodeposit zinc under constant voltage to fabricate a self-supported Zn@GF negative electrode. The graphite felt provides this anode larger electroactive area to transport electrons faster and loads zinc in a more event way, thus preluding the zinc plating in several specific directions. This composite anode offers an efficient solution to get a dendrite-free cycling behavior of zinc-based batteries and might be promising in advanced aqueous batteries for large-scale energy storage.
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