Earthquake damage potential and critical scour depth of bridges exposed to flood and seismic hazards under lateral seismic loads

Many bridges located in seismic hazard regions suffer from serious foundation exposure caused by riverbed scour. Loss of surrounding soil significantly reduces the lateral strength of pile foundations. When the scour depth exceeds a critical level, the strength of the foundation is insufficient to withstand the imposed seismic demand, which induces the potential for unacceptable damage to the piles during an earthquake. This paper presents an analytical approach to assess the earthquake damage potential of bridges with foundation exposure and identify the critical scour depth that causes the seismic performance of a bridge to differ from the original design. The approach employs the well-accepted response spectrum analysis method to determine the maximum seismic response of a bridge. The damage potential of a bridge is assessed by comparing the imposed seismic demand with the strengths of the column and the foundation. The versatility of the analytical approach is illustrated with a numerical example and verified by the nonlinear finite element analysis. The analytical approach is also demonstrated to successfully determine the critical scour depth. Results highlight that relatively shallow scour depths can cause foundation damage during an earthquake, even for bridges designed to provide satisfactory seismic performance.

Epidemiology of Sepsis-3 in a sub-district of Beijing: secondary analysis of a population-based database

Background: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. Methods: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. Results: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) Conclusions: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China.

Comparison of Space Glucose Control and Routine Glucose Management Protocol for Glycemic Control in Critically Ⅲ Patients： A Prospective, Randomized Clinical Study

Background：The Space Glucose Control （SGC） system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose （BG） level safely.The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients.Methods：It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia （BG 〉 9.0 mmol/L）.Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days.Target BG for both groups was 5.8-8.9 mmol/L.The primary outcome was the percentage time in the target range.Results：The percentage time within BG target range in the SGC group （69 ＆#177; 15%） was significantly higher than in the routine management group （52 ＆#177; 24%;P 〈 0.01）.No measurement was 〈2.2 mmol/L,and there was only one episode of hypoglycemia （2.3-3.3 mmol/L） in each group.The average BG was significantly lower in the SGC group （7.8 ＆#177; 0.7 mmol/L） than in the routine management group （9.1 ＆#177; 1.6 mmol/L,P 〈 0.001）.Target BG level was reached earlier in the SGC group than routine management group （2.5 ＆#177; 2.9 vs.12.1 ＆#177; 15.3 h,P =0.001）.However,the SGC group performed worse for daily insulin requirement （59.8 ＆#177; 39.3 vs.28.4 ＆#177; 36.7 U,P =0.001）and sampling interval （2.0 ＆#177; 0.5 vs.3.7 ＆#177; 0.5 h,P 〈 0.001） than the routine management group did.Multiple linear regression showed that the intervention group remained a significant individual predictor （P 〈 0.001） of the percentage time in target range.Conclusions：The SGC system,with a BG target of 5.8-8.9 mmol/L,resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia.However,the workload was increased.Trial Registration：http：//www.clinicaltrials.gov,NCT 02491346;https：//www.clinicaltrials.gov/ct2/show/NCT02491346？term=NCT0 2491346＆amp;cond=Hyperglycemia＆amp;cntry1=ES%3ACN＆amp;rank=1.

Cholangiocarcinoma presenting with acquired thrombotic thrombocytopenic purpura confirmed by positive autoantibodies of a disintegrin and metalloproteinase with a thrombospondin type 1 motif,member 13

To the Editor:Thrombotic thrombocytopenic purpura(TTP)is a type of life-threatening thrombotic microangiopathy(TMA)clinically characterized by severe thrombocytopenia,microangiopathic hemolytic anemia,and symptoms of regional ischemia/infarction including neurologic dysfunction and renal insufficiency.