Design and fabrication of MoO42--intercalated LDH nanosheets coated on Co9S8 nanotubes with enhanced cycling stability for high-performance supercapacitors.

Transition metal sulfides are promising electrode materials for supercapacitors due to their excellent electrochemical performance and high conductivity. Unfortunately, the low rate performance and poor cycling stability limited their progress towards commercial applications. Herein, the core-shell structure of MoO42--intercalated LDHs coated on Co9S8 nanotubes was rationally designed and prepared to improve their electrochemical performance and cycling stability by adjusting the composition of LDHs. Compared to NiMo-LDH@Co9S8 and CoMo-LDH@Co9S8, the optimized NiCoMo-LDH@Co9S8 electrode exhibits excellent areal specific capacitance (11 F cm-2 at 3 mA cm-2) and excellent cycling stability (94.4% after 5000 cycles). In addition, asymmetric supercapacitor devices were assembled with NiCoMo-LDH@Co9S8 and activated carbon (AC), which delivered a high energy density of 0.94 mWh cm-2, at a power density of 1.70 mW cm-2, and good cycling stability (89.4% after 5000 cycles). These results indicate that the introduction of MoO42- can enhance the synergistic effect of multiple metals and the synthesized NiCoMo-LDH@Co9S8 core-shell composite has great potential in the development of high-performance electrode materials for supercapacitors.

Zeolitic Imidazolate Framework-Derived Co3S4@NiFe-LDH Core-Shell Heterostructure as Efficient Bifunctional Electrocatalyst for Water Splitting.

The development of stable and efficient bifunctional electrocatalysts is of utmost importance for overall water splitting. This study introduces Co3S4@NiFe-LDH core-shell heterostructure prepared via an electrodeposition of ultrathin NiFe-LDH nanosheet on zeolitic imidazolium framework-derived Co3S4 nanosheet arrays. The bifunctional Co3S4@NiFe-LDH/NF exhibits impressive catalytic performance and long-term stability for both the OER and HER with low overpotentials of 100 mA cm-2 at 235 mV and 10 mA cm-2 at 95 mV in 1 M KOH, respectively. The assembled cell with Co3S4@NiFe-LDH/NF as both cathode and anode shows voltages of 1.595 and 1.666 V at current densities of 10 and 20 mA cm-2, respectively, as well as ultralong stability over 500 h. DFT calculations expose a robust electron interaction at the heterogeneous interface of the Co3S4@NiFe-LDH/NF core-shell structure. This interaction promotes electron transfer from NiFe-LDH to Co3S4 and reduces the energy barriers for OER intermediates, thereby enhancing electrocatalytic activity. This research contributes novel insights toward the promising materials for electrochemical water splitting through the construction of heterojunction interfaces.

Electron-Redistributed NiCo@NiFe-LDH Core-Shell Heterostructure for Significantly Enhancing Electrochemical Water Splitting.

Layered double hydroxides (LDHs) are some of the most promising precursors for the development of economically stable and efficient electrocatalysts for water splitting. An effective strategy for designing excellent performance electrocatalysts is to assemble core-shell heterostructures with a tunable electronic structure. In this work, three core-shell heterostructure electrocatalysts (NiCo@NiFe-LDH100/150/200) are developed by a simple hydrothermal and subsequent electrodeposition method on Ni foam. Among them, NiCo@NiFe-LDH150/NF exhibits the best oxygen evolution reaction electrocatalytic activity and long-term stability with a low overpotential of 197 mV to deliver a current density of 10 mA cm-2. In addition, an efficient and stable alkaline electrolytic cell with NiCo@NiFe-LDH150/NF both as the cathode and anode achieves a voltage of 1.66 V at a current density of 10 mA cm-2 and realization of ultralong stability at current densities of 20 and 200 mA cm-2 for 200 h. Density functional theory calculations reveal the strong electron interaction at the heterogeneous interface of the NiCo@NiFe-LDH150/NF core-shell structure, which effectively improves the intrinsic electron conductivity and ion diffusion kinetics and makes an important contribution to the electrocatalytic performance of the material. This work provides a new idea for the selection of materials for electrochemical water splitting by the construction of heterojunction interfaces.

Modified dietary fiber from soybean dregs by fermentation alleviated constipation in mice.

Soybean dregs are the main by-product obtained from the processing of soy products and are good sources of dietary fiber (DF). This study showed that the soluble DF content increased from 4.97% to 18.82%, while the insoluble DF content decreased from 59.37% to 44.89% after soybean dreg fermentation using Trichoderma spp., without any significant change in the total DF content (p > 0.05). Physicochemical property and electron microscopy analysis revealed that the rehydration ratio, dissolution rate, expansion force, and oil holding capacity of DF significantly increased (p < 0.05) with finer microstructure. Additionally, we found that fermented DF could further promote intestinal peristalsis in mice. Furthermore, fermented DF was more effective in balancing and adjusting intestinal flora in mice and promoting the production of short-chain fatty acids. Therefore, this study provides evidence indicating a correlation between the physicochemical properties and functional benefits of DF derived from soybean dregs.

Parents' intention to vaccinate their preschool children against COVID-19: Combining the health belief model and the theory of planned behavior.

The vaccination rate of COVID-19 in preschool children is low, and parents' intention to vaccinate their children is also low due to multiple factors. This study aimed to establish an integrated model based on the Health Belief Model (HBM)and Theory of Planned Behavior (TPB), to explore the factors influencing parents' intention to vaccinate their preschool children with the first and second doses of COVID-19 vaccines. A total of 1264 parents of preschool children from 10 kindergartens participated in this study. Hierarchical multiple logistic regression was used to analyze the intention separately. For the integrated model with the first dose of vaccine of COVID-19, introducing the HBM variable in model 1 explained 33.98% of the variance (F = 398.71, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 41.93% (F = 491.94, p < .001) and parents' intention were associated with their perceived barriers, cues to action, and subjective norms. For the integrated model with the second dose of vaccine of COVID-19, introducing the HBM variable in Model 1 explained 23.76% of the variance (F = 68.82, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 26.67% (F = 77.24, p < .001), and parents' intention was associated with cues to action and subjective norms. The combination of the two theories improves the explanatory power of parents' intention to vaccinate their preschool children against COVID-19, and provides a basis for the development of effective interventions for vaccination of COVID-19 for preschool children.

A quaternary heterojunction nanoflower for significantly enhanced electrochemical water splitting.

Designing highly-efficient, cost-effective, and stable electrocatalysts for water splitting is essential to producing green hydrogen. In this work, a nanoflower quaternary heterostructured Ni(NO3)2(OH)4/Ni(OH)2/Ni3S2/NiFe-LDH electrocatalyst is successfully synthesized by two-step hydrothermal reactions. The sulfur in the electrocatalyst induces higher valence state metal atoms as active sites to accelerate the formation of O2. As expected, benefiting from the unique structural features and solid electronic interactions, Ni(NO3)2(OH)4/Ni(OH)2/Ni3S2/NiFe-LDH exhibits remarkable oxygen evolution reaction performance with a low overpotential of 223 mV at a current density of 100 mA cm-2, a slight Tafel slope of 65.4 mV dec-1, and outstanding stability in alkaline media. Attractively, using Ni(NO3)2(OH)4/Ni(OH)2/Ni3S2/NiFe-LDH as both a cathode and an anode, the alkaline electrolyzer delivers a current density of 10 mA cm-2 only at a cell voltage of 1.67 V, accompanied by superior durability. This work provides a facile method for the rational design of high-performance quaternary electrocatalysts.

Precise design and in situ synthesis of hollow Co9S8@CoNi-LDH heterostructure for high-performance supercapacitors.

Layered double hydroxides (LDHs) and metal sulfides (MSs) have been widely used as promising electrode materials for supercapacitors, and the rational architectural design of MS/LDH heterogeneous structures is critical to optimize large energy storage. Herein, a precisely designed hollow Co9S8 nanotubes@CoNi-LDH nanosheet heterostructure on Ni foam, facilely prepared by an ingenious in situ strategy in this Co9S8 nanoarray was first used as the self-sacrificing template and metal source to in situ synthesize Co-ZIF-67 polyhedron to form the Co9S8@ZIF-67 heterostructure, and then Co9S8@ZIF-67 was in situ etched successfully using Ni2+ ions to form the final Co9S8@CoNi-LDH/NF core-shell nanoarray. This in situ synthetic strategy to fabricate the heterostructure is conducive to boosting the structural stability, modifying the electric structure and regulating the interfacial charge transfer. Due to the synergistic effect and tight heterogeneous interface, Co9S8@CoNi-LDH/NF displayed an outstanding capacitance of 9.65 F cm-2 at a current density of 2 mA cm-2 and excellent capacitance retention rate of 91.7% after 5000 cycles. In addition, the ASC device assembled with AC has an extremely high energy density of 1.0 mW h cm-2 at 2 mA cm-2 and maintains 96.9% capacitance retention after 5000 cycles. This work provides a skillful strategy for the precise design and in situ synthesis of MS/LDH heterostructures with fascinating features for electrochemical energy storage applications.

Zeolitic Imidazolate Framework-Derived Zn/Co-S@Ni(OH)2 Nanoarrays with Excellent Energy Storage and Electrocatalytic Performance.

The design and development of high-performance electrochemical electrode materials are crucial for energy storage and conversion systems. This work reports a facile preparation of a self-supported Zn/Co-S@Ni(OH)2 array electrode in which a Zn/Co-S nanosheet is derived from a leaf-like zeolitic imidazolate framework (Zn/Co-ZIF-L). The core-shell structure provides multiple benefits such as enhanced electrical conductivity, an abundance of exposed active sites, and strong electronic interactions between Zn/Co-S and ultra-thin Ni(OH)2 nanosheets, facilitating faster charge transfer. Consequently, Zn/Co-S@Ni(OH)2 demonstrates remarkable electrochemical characteristics as an electrode material for supercapacitors with an area capacitance of 12.9 F cm-2 at a current density of 2 mA cm-2 in 2 M KOH. The assembled asymmetric supercapacitor device achieves a high energy density of 0.95 mW h cm-2, while showing excellent longevity with a retention of 90.9% over 5000 cycles. Additionally, the Zn/Co-S@Ni(OH)2 arrays demonstrate significant oxygen evolution reaction activity with an overpotential of 242 mV at 10 mA cm-2 in 1 M KOH and significant stability for more than 100 h. This work provides a valuable approach for synthesizing bifunctional electrode materials for both energy storage and electrocatalysis applications.

A general strategy to in situ synthesize hollow metal sulfide/MOF heterostructures for high performance supercapacitors.

Metal-organic frameworks (MOFs) have been extensively applied in supercapacitors. Unfortunately, metal active sites in MOFs are commonly blocked and saturated by organic ligands, leading to insufficient positions available for the electrochemical reaction. To address this issue, we develop a novel strategy to design and prepare a series of hollow metal sulfide/MOF heterostructures, which simultaneously alleviate the large volume expansion, avoid slow kinetics of metal sulfides and expose more electrochemically active sites of the MOF. Consequently, the optimized Co9S8/Co-BDC MOF heterostructure presents outstanding electrochemical performance with a high areal specific capacitance of 15.84 F cm-2 at 2 mA cm-2 and a capacitance retention rate of 87.5% after 5000 charge-discharge cycles. The asymmetric supercapacitors based on the heterostructure deliver a high energy density of 0.87 mW h cm-2 and a power density of 19.84 mW cm-2, as well as long cycling stability. This study provides a new strategy for the rational design and in situ synthesis of metal sulfide/MOF heterostructures for electrochemical applications.

Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007-2018.

Background: Although associations of physical activity and smoking with mortality have been well-established, the joint impact of physical activity and smoking on premature mortality among elderly hypertensive population was still unclear. This study aimed to assess association of physical activity, smoking, and their interaction with all-cause and cardiovascular disease (CVD) mortality risk in elderly hypertensive patients. Methods: We included 125,978 Chinese hypertensive patients aged 60-85 years [mean (SD) age, 70.5 (6.9) years] who had records in electronic health information system of Minhang District of Shanghai, China in 2007-2015. Cox regression was used to estimate individual and joint association of smoking and physical activity on all-cause and CVD mortality. Interactions were measured both additively and multiplicatively. Additive interaction was evaluated by relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). Results: Among 125,978 elderly hypertensive patients (median age 70.1), 28,250 deaths from all causes and 13,164 deaths from CVD were observed during the follow-up up to 11 years. There was an additive interaction between smoking and physical inactivity [RERI: all-cause 0.19 (95% CI: 0.04-0.34), CVD 0.28 (0.06-0.50); AP: all-cause 0.09 (0.02-0.16), CVD 0.14 (0.04-0.23); S: all-cause 1.21 (1.04-1.42), CVD 1.36 (1.06-1.75)], while the concurrence of both risk factors was associated with more than 2-fold risk of death [hazard ratio (HR): all-cause 2.10 (1.99-2.21), CVD 2.19 (2.02-2.38)]. Conclusion: Our study suggested that smoking and physical inactivity together may have amplified association on premature death compared to the sum of their individual associations, highlighting the importance of improving behavioral factors in combination and promoting a comprehensive healthy lifestyle in hypertensive elderly.

Dose-response relationship between Chinese visceral adiposity index and type 2 diabetes mellitus among middle-aged and elderly Chinese.

Introduction: China has the largest population of diabetic patients (about 116 million) in the world. As a novel model of the fat index for Chinese people, the Chinese visceral adiposity index (CVAI) was considered a reliable indicator to assess the dysfunction of visceral fat. This study aimed to explore the dose-response relationship between CVAI and type 2 diabetes mellitus (T2DM) in the Chinese population, considering CVAI as a continuous/categorical variable. Method: Baseline and follow-up data were collected from waves 2011 and 2015, respectively, of the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression models were used to explore the relationship between CVAI and T2DM. We built three models to adjust the possible effect of 10 factors (age, gender, education level, location, marital status, smoking status, drinking status, sleep time, systolic blood pressure (SBP), and diastolic blood pressure (DBP)) on the outcome. The restricted cubic splines were used to examine possible non-linear associations and visualize the dose-response relationship between CVAI and T2DM. Results: A total of 5,014 participants were included, with 602 (12.00%) T2DM patients. The last CVAI quartile group (Q4) presented the highest risk of T2DM (OR, 2.17, 95% CI, 1.67-2.83), after adjusting for all covariates. There was a non-linear (U-shaped) relationship between the CVAI and the risk of T2DM (p for non-linear <0.001) in the restricted cubic spline regression model. CVAI was a risk factor of T2DM when it exceeded 92.49; every interquartile range (IQR) increment in the CVAI was associated with a 57% higher risk of developing T2DM (OR = 1.57, 95% CI = 1.36-1.83) after adjusting for potential confounders. The area under the receiver operating characteristic curve (AUC) (95% confidence interval) for CVAI was 0.623, and the optimal cutoff point was 111.2. There was a significant interaction between CVAI and gender by stratified analysis. Conclusion: CVAI was closely associated with the risk of T2DM and might possibly be a potential marker in predicting T2DM development. The outcome suggested that it might be better to maintain CVAI within an appropriate range.

Comparative endoscopic techniques of medial rectus muscle retraction for approaching intraconal tumors: Our experience with five cases.

Objective: To examine the role of transnasal endoscopic approaches in the management of intraconal tumors and demonstrate the use of an eyelid speculum in comparison with different techniques of medial rectus muscle (MRM) retraction. Methods: Retrospective data of five patients with intraconal tumors operated on and followed up by the senior authors between December 2019 and April 2022 was collected. Presenting symptoms, technical details, imaging and histology findings, outcomes, and complications were evaluated. Results: Four primary and one recurrent tumor were identified. The mean patient age was 50 (range, 29-64) years. One tumor was located lateral to the optic nerve, one central and three medial. A complete surgical resection was obtained in four primary cases and a partial resection was achieved in the recurrent case. The MRM was retracted using three different techniques: (1) an infant eyelid speculum creating an operative window between the medial and inferior rectus muscle, (2) external MRM disinsertion transconjunctivally, (3) a four-handed technique performed transseptally by two surgeons. Transient postoperative ophthalmoplegia was recorded in four cases and transient ptosis in one. Three patients completely recovered in 2-3 months while one undergoing MRM disinsertion ended up in restricted strabismus at 15-month follow-up. No other long-term complications have been noted in all five patients with a mean follow-up of 22 (range, 14-32) months. No patients with primary tumors have required additional surgery for tumor recurrence. Conclusion: The indication of endoscopic intraconal surgery may expand to lesions lateral to the optic nerve when the nerve is not in its natural position. The well-known advantages of the endoscopic techniques, namely the lack of external scars, better visualization, less bleeding, and fewer complications, were confirmed. An eye speculum provides a better surgical corridor and eases the pressure exerted on the MRM, which has a promising application prospect.

Bedside gastrointestinal ultrasound combined with acute gastrointestinal injury score to guide enteral nutrition therapy in critically patients.

BACKGROUND: To use gastric ultrasound to evaluate function and to determine the start time of enteral nutrition (EN) in patients with acute gastrointestinal injury (AGI). METHODS: We reviewed records from 105 patients who suffered AGI levels two (AGI II). We recorded several data points, including ultrasonographic transverse area of gastric antrum (CSA), left descending colonic or right ascending colonic diameter (Diam), peristatic frequency (Peri), EN start time, EN dose, prealbumin (PA), and EN complications. The recovery of intestinal function after EN treatment was judged as success. If there was EN treatment complication, this was judged as failure. We analyzed the changes in gastrointestinal function after EN treatment, to determine feeding time. RESULTS: There were 69 patients in the successful group, and 36 in the failure group. There were no significant differences between the two groups in age, intra abdominal pressure (IAP), APACHE II, PA and disease composition (p > 0.05).There were significant differences in terms of EN startup time, CSA, Diam, Peri, and PA, between the EN success and failure groups. We found IAP does not reflect gastrointestinal function;CSA ≤ 9cm2, Diam ≤ 2.9 cm, Peri > 3 bpm, indicated that the three indexes could reflect the recovery of gastrointestinal function. Receiver operating curve analysis showed that combined CSA, Diam, Peri evaluation determined the best time to start EN. CONCLUSIONS: Monitoring gastric antrum transversal area, colonic diameter, colonic peristatic frequency using ultrasound can guide the timing of initiation of enteral nutrition treatment.

Time-varying association between body mass index and all-cause mortality in patients with hypertension.

BACKGROUND: Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. METHODS: This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), class I obesity (25-29.9 kg/m2) and class II obesity (BMI ≥ 30 kg/m2). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. RESULTS: Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39-1.65], and 1.27 (1.15-1.41) for underweight, respectively; 1.08 (0.96-1.21), and 1.16 (1.03-1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81-0.90), and 0.96 (0.91-1.02) for overweight, respectively; 0.80 (0.76-0.84), and 1.04 (0.99-1.10) for class I obesity, respectively). CONCLUSIONS: We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.

Do plaque-related factors affect the diagnostic performance of an artificial intelligence coronary-assisted diagnosis system? Comparison with invasive coronary angiography.

OBJECTIVE: The aim of this study was to investigate the effects of plaque-related factors on the diagnostic performance of an artificial intelligence coronary-assisted diagnosis system (AI-CADS). METHODS: Patients who underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) were retrospectively included in this study. The degree of stenosis in each vessel was collected from CCTA and ICA, and the information on plaque-related factors (plaque length, plaque type, and coronary artery calcium score (CAC)) of the vessels with plaques was collected from CCTA. RESULTS: In total, 1224 vessels in 306 patients (166 men; 65.7 ± 10.1 years) were analyzed. Of these, 391 vessels in 249 patients showed significant stenosis using ICA as the gold standard. Using per-vessel as the unit, the area under the curves of coronary stenosis ≥ 50% for AI-CADS, doctor, and AI-CADS + doctor was 0.764, 0.837, and 0.853, respectively. The accuracies in interpreting the degree of coronary stenosis were 56.0%, 68.1%, and 71.2%, respectively. Seven hundred fifty vessels showed plaques on CCTA; plaque type did not affect the interpretation results by AI-CADS (chi-square test: p = 0.0093; multiple logistic regression: p = 0.4937). However, the interpretation results for plaque length (chi-square test: p < 0.0001; multiple logistic regression: p = 0.0061) and CACs (chi-square test: p < 0.0001; multiple logistic regression: p = 0.0001) were significantly different. CONCLUSION: AI-CADS has an ability to distinguish ≥ 50% coronary stenosis, but additional manual interpretation based on AI-CADS is necessary. The plaque length and CACs will affect the diagnostic performance of AI-CADS. KEY POINTS: • AI-CADS can help radiologists quickly assess CCTA and improve diagnostic confidence. • Additional manual interpretation on the basis of AI-CADS is necessary. • The plaque length and CACs will affect the diagnostic performance of AI-CADS.

Performance of artificial intelligence-based coronary artery calcium scoring in non-gated chest CT.

OBJECTIVES: To evaluate the risk category performance of artificial intelligence-based coronary artery calcium score (AI-CACS) software used in non-gated chest computed tomography (CT) on three types of CT machines, considering the manual method as the standard. METHODS: A total of 901 patients who underwent both chest CT and electrocardiogram (ECG)-gated non-contrast-enhanced cardiac CT with the same equipment within a 3-month period were enrolled in the study. AI-CACS software was based on a deep learning algorithm and was trained on multi-vendor, multi-scanner, and multi-hospital anonymized data from the chest CT database. The AI-CACS was automatically obtained from chest CT data by the AI-CACS software, while the manual CACS was obtained from cardiac CT data by the manual method. The correlation of the AI-CACS and manual CACS, concordance rate and kappa value of the risk categories determined by the two methods were calculated. The chi-square test was used to evaluate the differences in risk categories among the three types of CT machines from different manufacturers. The risk category performance of the AI-CACS for dichotomous risk categories bounded by 0, 100 and 400 was assessed. RESULTS: The correlation of the AI-CACS with the manual CACS was ρ = 0.893 (p < 0.001). The Bland-Altman plot (AI-CACS minus manual CACS) showed a mean difference of -27.2 and 95% limits of agreement of -290.0 to 235.6. The agreement of risk categories for the CACS was kappa (κ) = 0.679 (p < 0.001), and the concordance rate was 80.6%. The risk categories determined by the AI-CACS software on three types of CT machines were not significantly different (p = 0.7543). As dichotomous risk categories bounded by 0, 100 and 400, the accuracy, kappa value, and area under the curve of the AI-CACS were 88.6% vs. 92.9% vs. 97.9%, 0.77 vs. 0.77 vs. 0.83, and 0.885 vs. 0.964 vs. 0.981, respectively. CONCLUSIONS: There was good correlation and agreement between the AI-CACS and manual CACS in terms of the risk category. It is feasible to obtain the CACS using AI software based on non-gated chest CT data in a short time without increasing the radiation dose or economic burden. The AI-CACS software algorithm has good clinical universality and can be applied to CT machines from different manufacturers.

Association between body mass index and risk of cardiovascular disease-specific mortality among adults with hypertension in Shanghai, China.

The aim of our study was to examine the association between body mass index (BMI) and the risk of cardiovascular disease (CVD)-specific mortality among Chinese adults with hypertension by sex. This study included 212,394 adult hypertensive patients aged 20-85 years registered in the records of Minhang District during 2007-2018. Cox proportional hazards regression was performed to evaluate the association between BMI and CVD-specific mortality among Chinese adults with hypertension. There were 14,029 deaths over an average of 8.24 years (range, 0.19-11.96 years). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across BMI categories (< 18.5 kg/m2, 18.5-24.9 kg/m2 [reference group], 25.0-29.9 kg/m2, and ≥ 30 kg/m2) for CVD-specific mortality were 1.37 (1.22-1.53), 1.00 (reference), 0.95 (0.90-1.01), and 1.21 (1.04-1.40) in males, and 1.44 (1.31-1.59), 1.00 (reference), 0.96 (0.91-1.01), and 1.04 (0.92-1.17) in females. A U-shaped relationship was observed between BMI and CVD-specific mortality (overall association P< 0.001; non-linearity P< 0.001). This association was attenuated in old age. This study revealed a U-shaped relationship between BMI and CVD-specific mortality among hypertensive men and women. In older people, overweight and obesity are potential factors that reduce the risk of CVD death.

Tuberculous Otitis Media Complicated by Meningitis-Induced Bilateral Sensorineural Hearing Loss: A Case Report.

Tuberculosis of the middle ear is a rare but treatable disease; however, delays in diagnosis and treatment usually lead to complications. Diagnosis is made difficult by most physicians being unfamiliar with the typical presenting features and special cultural and pathologic studies being required for diagnosis. A case report and literature review are presented, illustrating typical clinical, epidemiologic, and laboratory features, as well as complications and the treatment of tuberculous otitis media.

Effects of physical activity and stress on the relationship between social capital and quality of life among breast cancer survivors.

This study aims to investigate the serial multiple mediation of physical activity and perceived stress in the relationship between individual social capital and quality of life (QOL) in breast cancer survivors (BCSs). This study was conducted among 520 BCSs between March and April 2017 in Shanghai, China. Data were collected using the Individual Social Capital Scale, the Health-Promoting Lifestyle Profile-II, the Perceived Stress Scale-14 and the EORTC QLQ-C30. Ordinary least-squares regression and the bootstrap method was used to test the significance of the serial multiple mediation model. The serial-multiple mediations of physical activity and perceived stress were found significant in the relationship of QOL with all five dimensions of individual social capital. The separate mediations of two single mediating variables were found significant in the relationship of QOL with control over life and feeling about the community. In the relationship of QOL with social participation, social network and social support, the separate mediation of physical activity was significant, while the separate mediation of perceived stress was not significant. A multidisciplinary team approach and a variety of delivery systems are needed to address the social, physical and psychological issues for improving QOL among BCSs.

CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19.

OBJECTIVE: To investigate the value of initial CT quantitative analysis of ground-glass opacity (GGO), consolidation, and total lesion volume and its relationship with clinical features for assessing the severity of coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: A total of 84 patients with COVID-19 were retrospectively reviewed from January 23, 2020 to February 19, 2020. Patients were divided into two groups: severe group (n = 23) and non-severe group (n = 61). Clinical symptoms, laboratory data, and CT findings on admission were analyzed. CT quantitative parameters, including GGO, consolidation, total lesion score, percentage GGO, and percentage consolidation (both relative to total lesion volume) were calculated. Relationships between the CT findings and laboratory data were estimated. Finally, a discrimination model was established to assess the severity of COVID-19. RESULTS: Patients in the severe group had higher baseline neutrophil percentage, increased high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and lower baseline lymphocyte count and lymphocyte percentage (p < 0.001). The severe group also had higher GGO score (p < 0.001), consolidation score (p < 0.001), total lesion score (p < 0.001), and percentage consolidation (p = 0.002), but had a lower percentage GGO (p = 0.008). These CT quantitative parameters were significantly correlated with laboratory inflammatory marker levels, including neutrophil percentage, lymphocyte count, lymphocyte percentage, hs-CRP level, and procalcitonin level (p < 0.05). The total lesion score demonstrated the best performance when the data cut-off was 8.2%. Furthermore, the area under the curve, sensitivity, and specificity were 93.8% (confidence interval [CI]: 86.8-100%), 91.3% (CI: 69.6-100%), and 91.8% (CI: 23.0-98.4%), respectively. CONCLUSION: CT quantitative parameters showed strong correlations with laboratory inflammatory markers, suggesting that CT quantitative analysis might be an effective and important method for assessing the severity of COVID-19, and may provide additional guidance for planning clinical treatment strategies.