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.
Titanium carbide (TiC) nanoparticles with well‐designed exposed crystal planes perform intriguing prospects for functional and engineering applications. In this study, a simple and controllable in ...situ synthesis strategy was proposed for the synthesis of TiC nanoparticles with specific morphology. Reaction behaviors suggested that most of TiC nanoparticles were formed by an instantaneous reaction between Al3Ti and Al4C3 in the Al‐rich melt and the resultant morphology was controlled by the discrepant growing rates of (100) and (111) crystal planes. In addition, a growth morphology control model was presented for the prediction and manipulation of the morphology of TiC nanoparticles by the doping of different alloying elements Me (Me = Cu, Mg, Mn, Zn, and Si). According to the morphological observations and density functional theory analyses including the interface energy, charge density differences, and orbital hybridization: Cu, Mg, and Zn atoms could stabilize the Al/TiC(111) interface, whereas Mn and Si atoms promoted the rapid growing and disappearance of the TiC(111) planes in the Al melt. This work provides a feasible way to intelligently design and manipulate TiC nanoparticles with desirable exposed crystal planes, and exhibits a promising prospect for personalized applications.
The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China.
...In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines.
We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14-76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β - 0.86; 95% CI - 0.98, - 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed.
The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume-outcome relationship.
Compositional changes of successively emplaced magmatites can be used to infer changes in their petrogenetic evolution and geodynamic setting. The central-northern Lhasa terrane hosts extensive Late ...Cretaceous magmatism, however, the mechanism that triggered the magmatism and its relationship to the directly preceding Late Cretaceous tectonic transition in the central Tibetan Plateau is still unresolved. Therefore, we conducted a detailed petrological, geochronological, geochemical, and isotopic study on recently identified Late Cretaceous doleritic and granodioritic rocks in the Xiongmei area, northern Lhasa subterrane. The potassic (K
2
O/Na
2
O ratios >1) dolerites (ca. 80 Ma) display a post-collisional basaltic shoshonitic signature with uniform moderately enriched whole-rock Sr-Nd and zircon-Hf isotopic compositions ((
87
Sr/
86
Sr)
t
= 0.7070 to 0.7095, whole-rock ε
Nd
(t) = - 2.4 to - 1.3, and zircon ε
Hf
(t) = - 5.9 to +1.9), suggesting that they evolved from a similar parental magma and were likely derived by partial melting of an enriched lithospheric mantle metasomatized by hydrous fluids. The granodiorites are geochemically divided into medium-K and high-K calc-alkaline rocks. The medium-K samples (ca. 80 Ma) are generally characterized by low K
2
O/Na
2
O ratios <1, whereas the high-K samples (78-76 Ma) display high K
2
O/Na
2
O ratios >1. The medium-K samples have positive zircon ε
Hf
(t) values from +4.8 to +6.5 and uniform whole-rock ɛ
Nd
(t) values from - 2.4 to - 1.3, which significantly differ from those of the high-K samples that have negative to positive zircon ε
Hf
(t) values from - 1.9 to +2.8 and negative whole-rock ɛ
Nd
(t) values from - 8.4 to - 5.1. The medium-K samples are characterized by high Sr contents and Sr/Y ratios, coupled with low Y and HREE contents, similar to adakitic compositions, and were interpreted to have been derived from deep partial melting of the foundering juvenile garnet-bearing mafic lower crust at relatively low temperatures. Compared to the medium-K samples, the high-K samples have lower Sr/Y and (La/Yb)
N
ratios, coupled with flat HREE patterns and distinct negative Eu, Sr and Ti anomalies and are most likely derived from shallower partial melting of the K-rich juvenile lower crust at relatively high temperatures. Considering the occurrence of variable magmatism in the central-northern Lhasa subterrane during the Late Cretaceous, the change in magma composition and lower crustal melting conditions (cold-deep vs. hot-shallow) suggest that the lithospheric mantle keel was partially detached by small-scale mantle convection in response to the low-angle Neo-Tethys-associated subduction between 85 and 70 Ma.
This study aimed to investigate the potential mechanism of YAP1 in the senescence and degeneration of endplate chondrocytes induced by intermittent cyclic mechanical tension (ICMT).
According to the ...Pfirrmann grade evaluation classification, 30 human endplate cartilage tissues were divided into the lumbar vertebra fracture (LVF) group and lumbar disc herniation (LDH) group. Then, quantitative reverse transcription polymerase chain reaction, western blot, flow cytometry, hematoxylin-eosin staining, and senescence-associated β-galactosidase staining were performed. The difference in extracellular matrix expression between LVF and LDH endplate cartilage was detected. Second, the effect of ICMT on endplate chondrocytes degeneration was observed. Finally, the key regulatory role of YAP1 in ICMT-induced endplate cartilage degeneration was further verified.
In degraded human endplate cartilage and tension-induced degraded endplate chondrocytes, the expression of YAP1, COL-2A, and Sox9 was decreased. Conversely, the expression of p53 and p21 was increased. By regulating YAP1 in vivo and in vitro, we can achieve alleviation of ICMT-induced senescence of endplate chondrocytes and effective treatment of disc degeneration.
ICMT could induce senescence and degeneration of endplate chondrocytes, and ICMT-induced senescence and degeneration of endplate chondrocytes could be alleviated by regulating YAP1 expression.
Abstract
Background
To investigate the epidemiology and in-hospital mortality of veno-venous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in Mainland China throughout 2018.
...Methods
Patients supported by ECMO from 1700 tertiary hospitals in 31 provinces from January 1 to December 31, 2018, were selected from the National Clinical Improvement System database.
Results
The 1700 included hospitals had 2073 cases of ECMO in 2018, including 714 VV and 1359 VA ECMOs. The average patient age was 50 years (IQR 31–63), and 1346 were male. The average hospital stay was 17 days (IQR 7–30), and the average costs per case was $36,334 (IQR 22,547–56,714). The three provinces with the highest number of ECMO cases were Guangdong, Beijing, and Zhejiang; the southeast coastal areas and regions with higher GDP levels had more cases. Overall in-hospital mortality was 29.6%. Mortality was higher among patients who were male, over 70 years old, living in underdeveloped areas, and who were treated during the summer. Mortality in provinces with more ECMO cases was relatively low. The co-existence of congenital malformations, blood system abnormalities, or nervous system abnormalities increased in-hospital mortality.
Conclusions
Mortality and medical expenses of ECMO among patients in China were relatively low, but large regional and seasonal differences were present. Risk factors for higher in-hospital mortality were older age, male sex, in underdeveloped areas, and treatment during the summer. Additionally, congenital malformations and blood system and nervous system abnormalities were associated with in-hospital mortality.
Objective
To collect and evaluate the diagnostic approach of inflammatory bowel disease (IBD) guidelines and provide useful feedback for guideline developers and evidence‐based clinical information ...to help physicians make decisions.
Methods
Diagnostic guidelines for IBD were retrieved by performing systemic and manual searches. Qualified clinical practice guidelines (CPGs) were included and then evaluated by four well‐trained evaluators using the AGREE II instrument. To reduce the bias generated in this process, we used the Measurement Scale of Rate of Agreement (MSRA) tool to interpret the results. Guidelines with good recommendation distributions among the diagnostic field were further reclassified and evaluated.
Results
Fifteen diagnostic CPGs for IBD were identified and evaluated, and 70.3% (11/15) of the CPGs were above the recommended level. We observed heterogeneity among the diagnostic CPGs for IBD and discrepancies among different domains in one specific guideline. Potential improvements were identified in the fields of stakeholder involvement, rigour of development and applicability. By further analysing the heterogeneity of the recommendations and evidence in 5 UC‐CPGs, we found the following issues: no discussion of diagnosing severe complications of UC, disputed significance of serologic and genetic diagnoses of UC, insufficient attention towards medical histories/physical examinations/differential diagnoses and discrepancy in classification criteria.
Conclusion
The included diagnostic CPGs for IBD were generally of good quality, but heterogeneity was identified. Addressing these issues will provide useful feedback for the guideline updating process, and it will also benefit current clinical practice and eventually patient outcome.
...from the perspective of QICU, prevention of DVT and implementation of the SSC guideline bundle are both clustered treatments, fully reflecting doctors’ awareness and attitudes toward critical care ...patients, which is likely why 3-and 6-h Cssc and DVT prophylaxis rate have a good consistency. ...adverse events, such as unplanned extubation rate, reintubation rate within 48 h, and the rate of unplanned ICU admission reflect management ability of ICU. ...the completion of quality control indicators cannot test the differences in Cssc. ...additional study is needed to determine whether differences in mortality from sepsis might emerge with follow-up beyond 1 year.
Retraction: Receptor tyrosine kinase AXL is correlated with poor prognosis and induces temozolomide resistance in glioblastoma, CNS Neuroscience & Therapeutics 2019, ...(https://doi.org/10.1111/cns.13227). The above article published online on 02 October 2019 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief Jun Chen, and John Wiley & Sons Ltd. The retraction has been agreed due to unreliable data and consequently its misleading results and conclusions.
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