AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function an...AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function and the development of DR.Beta-cell function was assessed by a modified homeostasis model assessment(modified HOMA)which was gained by using C-peptide to replace insulin in the homeostasis model assessment(HOMA)of beta-cell function.We also studied the relationships between modified HOMA index and serum C-peptide response to 100 g tasteless steamed bread to determine the accuracy of modified HOMA.RESULTS:Our study group consisted of 170 type 2diabetic inpatients with DR(age:58.35±13.87y,mean±SD)and 205 type 2 diabetic inpatients with no DR(NDR)(age:65.52±11.59y).DR patients had higher age,longer diabetic duration,higher hypertension grade,higher postprandial plasma glucose,higher fluctuation level of plasma glucose,lower body mass index(BMI),lower postprandial serum insulin and C-peptide,lower fluctuation level of serum insulin and C-peptide(P【0.05).In our logistic regression model,duration of diabetes,hypertension grade,fasting plasma insulin and glycosylated hemoglobin(HbA1C)were significantly associated with the presence of DR after adjustment for confounding factors(P【0.05).CONCLUSION:Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman’s rank-correlationanalysis,logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors(such as age,sex,duration of diabetes,BMI,hypertension grade,HbA1C,plasma insulin).Duration of diabetes,hypertension grade,fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.展开更多
In the meizoseismal areas hit by the China Wenchuan earthquake on May 12, 2008, the disasterprone environment has changed dramatically, making the susceptibility assessment of debris flow more complex and uncertain. A...In the meizoseismal areas hit by the China Wenchuan earthquake on May 12, 2008, the disasterprone environment has changed dramatically, making the susceptibility assessment of debris flow more complex and uncertain. After the earthquake, debris flow hazards occurred frequently and effective susceptibility assessment of debris flow has become extremely important. Shenxi gully in Du Jiangyan city, located in the meizoseismal areas, was selected as the study area. Based on the research of disaster-prone environment and the main factors controlling debris flow, the susceptibility zonations of debris flow were mapped using factor weight method(FW), certainty coefficient method(CF) and geomorphic information entropy method(GI). Through comparative analysis, the study showed that these three methods underestimated susceptible degree of debris flow when used in the meizoseismal areas of Wenchuan earthquake. In order to solve this problem, this paper developed a modified certainty coefficient method(M-CF) to reflect the impact of rich loose materials on the susceptible degree of debris flow. In the modified method, the distribution and area of loose materials were obtained by field investigations and postearthquake remote sensing image, and four data sets, namely, lithology, elevation, slop and aspect, wereused to calculate the CF values. The result of M-CF method is in agreement with field investigations and the accuracy of the method is satisfied. The method has a wide application to the susceptibility assessment of debris flow in the earthquake stricken areas.展开更多
BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality predictio...BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.展开更多
An integrated evaluation system under randomness and fuzziness was developed in this work to systematically assess the risk of groundwater contamination in a little town, Central China. In this system, randomness of t...An integrated evaluation system under randomness and fuzziness was developed in this work to systematically assess the risk of groundwater contamination in a little town, Central China. In this system, randomness of the parameters and the fuzziness of the risk were considered simultaneously, and the exceeding standard probability of contamination and human health risk due to the contamination were integrated. The contamination risk was defined as a combination of "vulnerability" and "hazard". To calculate the value of "vulnerability", pollutant concentration was simulated by MODFLOW with random input variables and a new modified health risk assessment(MRA) model was established to analyze the level of "hazard". The limit concentration based on environmental-guideline and health risk due to manganese were systematically examined to obtain the general risk levels through a fuzzy rule base. The "vulnerability" and "hazard" were divided into five categories of "high", "medium-high", "medium", "low-medium" and "low", respectively. Then, "vulnerability" and "hazard" were firstly combined by integrated evaluation. Compared with the other two scenarios under deterministic methods, the risk obtained in the proposed system is higher. This research illustrated that ignoring of uncertainties in evaluation process might underestimate the risk level.展开更多
Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an ear...Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.展开更多
Current building design codes allow the appearance of structural and nonstructural damage under design basis earthquakes.The research regarding probabilistic seismic loss estimation in domestic building structure is u...Current building design codes allow the appearance of structural and nonstructural damage under design basis earthquakes.The research regarding probabilistic seismic loss estimation in domestic building structure is urgent.The evaluation in this paper is based on a 11-story reinforced concrete office building,incremental dynamic analysis(IDA)is conducted in Perform 3D program using models capable to simulate all possible limit states up to collapse.Next,the probability distribution of post-earthquake casualties,rebuild costs repair costs and business downtime loss are calculated in PACT software for the studied building considering the modified component vulnerability groups and population flow models.The evaluation procedure can also shed light on other types of buildings in China.For non-typical functional building structures,this article proposes to build a finite element model of structural components and to classify the vulnerability groups based on the construction drawings,and to supply and improve the vulnerability library of appendages in FEMA P-58 according to the actual situation.In this way,the application scope of building seismic performance evaluation can be expanded.展开更多
To address the seismic face stability challenges encountered in urban and subsea tunnel construction,an efficient probabilistic analysis framework for shield tunnel faces under seismic conditions is proposed.Based on ...To address the seismic face stability challenges encountered in urban and subsea tunnel construction,an efficient probabilistic analysis framework for shield tunnel faces under seismic conditions is proposed.Based on the upper-bound theory of limit analysis,an improved three-dimensional discrete deterministic mechanism,accounting for the heterogeneous nature of soil media,is formulated to evaluate seismic face stability.The metamodel of failure probabilistic assessments for seismic tunnel faces is constructed by integrating the sparse polynomial chaos expansion method(SPCE)with the modified pseudo-dynamic approach(MPD).The improved deterministic model is validated by comparing with published literature and numerical simulations results,and the SPCE-MPD metamodel is examined with the traditional MCS method.Based on the SPCE-MPD metamodels,the seismic effects on face failure probability and reliability index are presented and the global sensitivity analysis(GSA)is involved to reflect the influence order of seismic action parameters.Finally,the proposed approach is tested to be effective by a engineering case of the Chengdu outer ring tunnel.The results show that higher uncertainty of seismic response on face stability should be noticed in areas with intense earthquakes and variation of seismic wave velocity has the most profound influence on tunnel face stability.展开更多
文摘AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function and the development of DR.Beta-cell function was assessed by a modified homeostasis model assessment(modified HOMA)which was gained by using C-peptide to replace insulin in the homeostasis model assessment(HOMA)of beta-cell function.We also studied the relationships between modified HOMA index and serum C-peptide response to 100 g tasteless steamed bread to determine the accuracy of modified HOMA.RESULTS:Our study group consisted of 170 type 2diabetic inpatients with DR(age:58.35±13.87y,mean±SD)and 205 type 2 diabetic inpatients with no DR(NDR)(age:65.52±11.59y).DR patients had higher age,longer diabetic duration,higher hypertension grade,higher postprandial plasma glucose,higher fluctuation level of plasma glucose,lower body mass index(BMI),lower postprandial serum insulin and C-peptide,lower fluctuation level of serum insulin and C-peptide(P【0.05).In our logistic regression model,duration of diabetes,hypertension grade,fasting plasma insulin and glycosylated hemoglobin(HbA1C)were significantly associated with the presence of DR after adjustment for confounding factors(P【0.05).CONCLUSION:Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman’s rank-correlationanalysis,logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors(such as age,sex,duration of diabetes,BMI,hypertension grade,HbA1C,plasma insulin).Duration of diabetes,hypertension grade,fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.
基金Financial support was provided by Ministry of Water Resources welfare industry funding(Grant No.201301058)Key Laboratory of Mountain Hazards and Earth Surface Processes independent project funding:Dynamic process and buried risk of debris flow in Shenxi gully after Wenchuan earthquakethe international cooperation project of Ministry of Science and Technology(Grant No.2013DFA21720)
文摘In the meizoseismal areas hit by the China Wenchuan earthquake on May 12, 2008, the disasterprone environment has changed dramatically, making the susceptibility assessment of debris flow more complex and uncertain. After the earthquake, debris flow hazards occurred frequently and effective susceptibility assessment of debris flow has become extremely important. Shenxi gully in Du Jiangyan city, located in the meizoseismal areas, was selected as the study area. Based on the research of disaster-prone environment and the main factors controlling debris flow, the susceptibility zonations of debris flow were mapped using factor weight method(FW), certainty coefficient method(CF) and geomorphic information entropy method(GI). Through comparative analysis, the study showed that these three methods underestimated susceptible degree of debris flow when used in the meizoseismal areas of Wenchuan earthquake. In order to solve this problem, this paper developed a modified certainty coefficient method(M-CF) to reflect the impact of rich loose materials on the susceptible degree of debris flow. In the modified method, the distribution and area of loose materials were obtained by field investigations and postearthquake remote sensing image, and four data sets, namely, lithology, elevation, slop and aspect, wereused to calculate the CF values. The result of M-CF method is in agreement with field investigations and the accuracy of the method is satisfied. The method has a wide application to the susceptibility assessment of debris flow in the earthquake stricken areas.
文摘BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.
基金Projects(51039001,51009063) supported by the National Natural Science Foundation of ChinaProject(SX2010-026) supported by State Council Three Gorges Project Construction Committee Executive Office,China+1 种基金Project(2012BS046) supported by Henan University of Technology,ChinaProject(BYHGLC-2010-02) supported by the Guangzhou Water Authority,China
文摘An integrated evaluation system under randomness and fuzziness was developed in this work to systematically assess the risk of groundwater contamination in a little town, Central China. In this system, randomness of the parameters and the fuzziness of the risk were considered simultaneously, and the exceeding standard probability of contamination and human health risk due to the contamination were integrated. The contamination risk was defined as a combination of "vulnerability" and "hazard". To calculate the value of "vulnerability", pollutant concentration was simulated by MODFLOW with random input variables and a new modified health risk assessment(MRA) model was established to analyze the level of "hazard". The limit concentration based on environmental-guideline and health risk due to manganese were systematically examined to obtain the general risk levels through a fuzzy rule base. The "vulnerability" and "hazard" were divided into five categories of "high", "medium-high", "medium", "low-medium" and "low", respectively. Then, "vulnerability" and "hazard" were firstly combined by integrated evaluation. Compared with the other two scenarios under deterministic methods, the risk obtained in the proposed system is higher. This research illustrated that ignoring of uncertainties in evaluation process might underestimate the risk level.
基金supported by Nursing Research Program of Shanghai Nursing Association(No.2016SD-B03)
文摘Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.
基金This research has been supported by the National Natural ScienceFoundation of China (Grant No. 51778135 )the Natural Science Foundation of JiangsuProvince (Grant No. BK20160207)+1 种基金Aeronautical Science Foundation of China (GrantNo. 20130969010)the Fundamental Research Funds for the Central Universities andPostgraduate Research & Practice Innovation Program of Jiangsu Province (Grant No.KYCX18_0113 and KYLX16_0253).
文摘Current building design codes allow the appearance of structural and nonstructural damage under design basis earthquakes.The research regarding probabilistic seismic loss estimation in domestic building structure is urgent.The evaluation in this paper is based on a 11-story reinforced concrete office building,incremental dynamic analysis(IDA)is conducted in Perform 3D program using models capable to simulate all possible limit states up to collapse.Next,the probability distribution of post-earthquake casualties,rebuild costs repair costs and business downtime loss are calculated in PACT software for the studied building considering the modified component vulnerability groups and population flow models.The evaluation procedure can also shed light on other types of buildings in China.For non-typical functional building structures,this article proposes to build a finite element model of structural components and to classify the vulnerability groups based on the construction drawings,and to supply and improve the vulnerability library of appendages in FEMA P-58 according to the actual situation.In this way,the application scope of building seismic performance evaluation can be expanded.
基金Project([2018]3010)supported by the Guizhou Provincial Science and Technology Major Project,China。
文摘To address the seismic face stability challenges encountered in urban and subsea tunnel construction,an efficient probabilistic analysis framework for shield tunnel faces under seismic conditions is proposed.Based on the upper-bound theory of limit analysis,an improved three-dimensional discrete deterministic mechanism,accounting for the heterogeneous nature of soil media,is formulated to evaluate seismic face stability.The metamodel of failure probabilistic assessments for seismic tunnel faces is constructed by integrating the sparse polynomial chaos expansion method(SPCE)with the modified pseudo-dynamic approach(MPD).The improved deterministic model is validated by comparing with published literature and numerical simulations results,and the SPCE-MPD metamodel is examined with the traditional MCS method.Based on the SPCE-MPD metamodels,the seismic effects on face failure probability and reliability index are presented and the global sensitivity analysis(GSA)is involved to reflect the influence order of seismic action parameters.Finally,the proposed approach is tested to be effective by a engineering case of the Chengdu outer ring tunnel.The results show that higher uncertainty of seismic response on face stability should be noticed in areas with intense earthquakes and variation of seismic wave velocity has the most profound influence on tunnel face stability.
