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As a crucial component of the ecological security pattern, ecological source (ES) plays a vital role in providing ecosystem service value (ESV) and conserving biodiversity. Previous studies have mostly considered ES only from either landscape change pattern or ecological function perspectives, and have ignored their integration and spatio-temporal evolutionary modeling. In this study, we proposed a multi-perspective framework for the spatio-temporal characteristics of ES by ESV incorporating landscape aesthetics, carbon sink characteristics, ecological quality, and kernel NDVI (kNDVI). By integrating the revised ESV and the kernel normalized difference vegetation index as a foundation, we employed the spatial priority model to identify ES. This improvement aims to yield a more practical and specific ESV result. Applying this framework to the Three-River Headwaters Region (TRHR), a significant spatio-temporal change in ecological sources has been observed from 2000 to 2020. This performance provided a reference for ecological conservation in the TRHR. The results indicate that this ecological source identification framework has reliable accuracy and efficiency compared with the existing NRs in the TRHR. This method could reveal more precise spatio-temporal distributions of ES, enhancing ecosystem integrity and providing technical modeling support for developing cross-scale spatial planning and management strategies for nature reserve boundaries. The framework proposed in our research could serve as a reference for building ecological networks in other ecologically fragile areas. [ABSTRACT FROM AUTHOR]

Northwest China (WTL) is an essential ecological barrier zone of China, an important node of the "Silk Road Economic Belt," and a crucial bearing area for China's execution of the "One Road and One Belt" and "Going Global" strategies. However, its ecology is exceedingly fragile and particularly vulnerable to climate change and human interference. This study explored the spatiotemporal evolution characteristics of vegetation in WTL using NDVI data and investigated its drive mechanisms by geodetector, partial correlation analysis, and residual trend analysis methods. As well as forecasting the trend for vegetation changes. The findings demonstrated that (1) the change in NDVI manifested an overall improvement trend and the distribution in space of NDVI rose from the center to the periphery. 57.07% of the area had a sparse cover of vegetation (NDVI between 0 and 0.2). In addition, about 49% of regions had deterioration tendencies, which were mainly aggregated in HX, QCXDB, QCXDN, and the eastern of QCXQN and QCXXB. (2) The NDVI's shifting trend was unsustainability, and the region of uncertain future accounted for 57.45% of the total, with apparent unsustainability features. (3) The key parameters influencing NDVI spatial distribution were Pre (precipitation), vegetation type, land use type, and soil type. The interaction between two factors enhanced the influence of any single element, which appeared as bivariate and nonlinear enhancements. (4) Both climate variations and human activities have been recognized as key variables affecting NDVI growth. NDVI variance in 73.02% of areas was influenced by the combined effects of climate variations and human activities. However, human activities were the most influential element in NDVI growth, with the relative contributions of 80.28% (19.72% of which was caused by climate variations). These results can be conducive to deepening insights into the local vegetation status, identifying the mechanisms driving vegetation change, and providing scientific recommendations for WTL's ecosystem restoration measures based on actual situations. [ABSTRACT FROM AUTHOR]

Based on the two most recent assessments of Chinese higher plants in 2013 and 2020, of 34,450 and 39,330 species, respectively, we analysed the threatened status of Chinese higher plants. In 2020, around 4,088 (10.39%) of the assessed species in China are threatened, 2,875 (7.31%) Near Threatened, 27,593 (70.16%) not currently threatened and categorised as Least Concern and 4,752 (12.08%) categorised as Data Deficient. While in 2013, 3,767 (10.93%) of the assessed higher plants in China are threatened, 2,723 (7.90%) Near Threatened, 24,296 (70.53%) Least Concern and 3,612 (10.48%) Data Deficient. Estimates of the Red List Index in the two years show different patterns when using different weighting methods with the equal steps weighting method showing a slight decrease (0.91675–0.91495) and the extinction risk weighting method showing a slight increase (0.98792–0.98797). We inferred that China's threatened plant species were likely / relatively effectively protected. However, attention should also be given to the non-threatened species in the future as an additional strategy for their conservation, to maintain their non-threatened status. [ABSTRACT FROM AUTHOR]

Mustard, which belongs to the family Brassicaceae, is an annual or biennial herb and is considered as one of the most important native vegetables in China. Glucosinolates are important secondary metabolites containing sulfur and nitrogen in plants, which form a network with other metabolic pathways that play important roles in plant growth, development, and interaction with the environment. We studied varied phenotypic and glucosinolate contents of 60 mustard resources collected from various areas of China. The results showed both agronomic traits and glucosinolates varied greatly among mustard resources. We detected nine glucosinolates in mustard resources and the contents of total glucosinolates ranged from 1.2023 to 30.7310 μmol/g. Through the correlation analysis, we preliminarily found a significant negative correlation between leaf color and glucosinolate contents but needed further validation. For mustard resource JC 18-56, we analyzed the glucosinolate contents in different organs of different growth stages. The results indicated a significant difference among organs in both glucosinolates concentration and composition. The contents of glucosinolatess in alabastrums at bolting stage were highest, up to 140.1257 μmol/g dry weight (DW). We found that the main glucosinolates in roots were 4-methoxyglucobrassicin, while in other organs the glucosinolates were sinigrin. The contents of glucosinolatess in different organs of mustard were as follows: alabastrums > seeds > flowers > siliques > leaves > flower stems > stems > roots. This study provides important references for the selection and cultivation of high-quality mustard varieties. [ABSTRACT FROM AUTHOR]

Objectives: Patients with hematological malignancies are prone to invasive fungal disease due to long-term chemotherapy or radiotherapy. Voriconazole is a second-generation triazole broad-spectrum antibiotic used to prevent or treat invasive fungal infections. Many population pharmacokinetic (pop PK) models have been published for voriconazole, and various diagnostic methods are available to validate the performance of these pop PK models. However, most of the published models have not been strictly evaluated externally. The purpose of this study is to evaluate these models externally and assess their predictive capabilities. Methods: The external dataset consists of adults receiving voriconazole treatment at Fujian Medical University Union Hospital. We re-established the published models based on their final estimated values in the literature and used our external dataset for initial screening. Each model was evaluated based on the following outcomes: prediction-based diagnostics, prediction- and variability-corrected visual predictive check (pvcVPC), normalized prediction distribution errors (NPDE), and Bayesian simulation results with one to two prior observations. Results: A total of 237 samples from 166 patients were collected as an external dataset. After screening, six candidate models suitable for the external dataset were finally obtained for comparison. Among the models, none demonstrated excellent predictive performance. Bayesian simulation shows that all models' prediction precision and accuracy were significantly improved when one or two prior concentrations were given. Conclusions: The published pop PK models of voriconazole have significant differences in prediction performance, and none of the models could perfectly predict the concentrations of voriconazole for our data. Therefore, extensive evaluation should precede the adoption of any model in clinical practice. [ABSTRACT FROM AUTHOR]

Busulfan is a bifunctional alkylating agent that is widely used before hematopoietic stem cell transplantation (HSCT), in combination with other chemotherapeutic drugs. As of 2020, there is no population pharmacokinetic (popPK) model for busulfan in Chinese pediatric patients. A systemic external evaluation of 11 published popPK models was conducted in Chinese pediatric patients undergoing HSCT. Forty pediatric patients were enrolled in this study, with a total of 183 blood concentrations. The relative prediction error (PE%), median PE%, median absolute PE%, and percentage of PE% within ±20% and ±30% were calculated in prediction‐based diagnostics. Simulation‐based diagnostics were conducted through a prediction‐ and variability‐corrected visual predictive check and the normalized prediction distribution error. The relative individual prediction error was calculated using Bayesian forecasting with 1 to 3 concentration points. The 1‐compartment open linear popPK model, which was built by Su‐jin Rhee et al (model H), incorporating the patient's body surface area, age, dosing day, and aspartate aminotransferase as significant covariates had preferable predictability than other popPK models. In prediction‐based diagnostics, the median PE%, percentage of PE% within ±20%, and percentage of PE% within ±30% of model H were 8.48%, 45.35%, and 59.56%, respectively. The normalized prediction distribution error of model H showed that it followed the normal distribution. Based on Bayesian forecasting, model H showed good predictive performance. Thus, model H was the most appropriate model that can be used clinically for individualized dosage adjustments in Chinese pediatric HSCT patients. [ABSTRACT FROM AUTHOR]

Climate change can impact the yield and water footprint of crops. Therefore, assessing such impacts carries great significance for regional water and food security. This study validated and verified the variety parameters of winter wheat for the Decision Support System for Agrotechnology Transfer (DSSAT) model, using the long-term (1993–2013) growth and yield data observed from six agricultural experiment stations in the Haihe River Basin (HRB), China. The growth process was simulated under three representative concentration pathways (RCPs), named RCP2.6, RCP4.5, and RCP8.5—climate scenarios driven by the HadGEM2-ES model. The variety parameters of winter wheat showed high accuracy in the simulation of the anthesis and maturity dates, and could be used for long-term prediction of the growth process. The trends of climate change had positive impacts on the water footprint of winter wheat but adverse impacts on the yield. The growing period was shortened by 3.6 days, 4.7 days, and 5.0 days per decade in the RCP2.6, RCP4.5, and RCP8.5 scenarios, respectively, due to the rapid accumulation of heat. The yield would be increased in lower emissions scenarios (17% in RCP2.6), but decreased in high-emissions scenarios due to high temperatures, which may restrict the growth of wheat. The water footprint was decreased by 10%, 11%, and 13% in the RCP2.6, RCP4.5, and RCP8.5 scenarios, respectively, indicating that the water-use efficiency could be improved in the future. The results showed broad application prospects of the DSSAT model in simulating the response of crop growth to climate change. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a serious pulmonary vascular disease. Excessive proliferation of pulmonary artery smooth muscle cells (PASMCs) plays an important role in the course of this disease. Ligustrazine is an alkaloid monomer extracted from the rhizome of the herb Ligusticum chuanxiong. It is often used to treat cardiovascular diseases, but its effect on PAH has rarely been reported. This study aims to explore the protective effect and mechanism of ligustrazine on PAH. In the in vivo experiment, monocrotaline (MCT) was used to induce PAH in rats, and then ligustrazine (40, 80, 160 mg/kg/day) or sildenafil (25 mg/kg/day) was administered. Four weeks later, hemodynamic changes, right ventricular hypertrophy index, lung morphological characteristics, inflammatory factors, phosphoinositide 3-kinase (PI3K), and AKT expression were evaluated. In addition, primary rat PASMCs were extracted by the tissue adhesion method, a proliferation model was established with platelet-derived growth factor-BB (PDGF-BB), and the cells were treated with ligustrazine to investigate its effects on cell proliferation, inflammation, and cell cycle distribution. The results indicate that ligustrazine can markedly alleviate right ventricular systolic pressure, right ventricular hypertrophy, pulmonary vascular remodeling, and inflammation caused by MCT, and that it decreased PI3K and AKT phosphorylation expression. Moreover, ligustrazine can inhibit the proliferation and inflammation of PASMCs and arrest the progression of G0/G1 to S phase through the PI3K/AKT signaling pathway. Therefore, we conclude that ligustrazine may inhibit the proliferation and inflammation of PASMCs by regulating the activation of the PI3K/AKT signaling pathway, thereby attenuating MCT-induced PAH in rats. Collectively, these findings suggest that ligustrazine may be a promising therapeutic for PAH. [ABSTRACT FROM AUTHOR]

• The community livability evaluation is quantitative, practical and fine-grained. • The evaluation criteria span dimensions of environment, traffic and population. • Remote sensing, surface observation and geospatial big data are used. • Most communities are distributed within the central and marginal urban areas. • Communities in urban area tend to have robustly high livability. Effective evaluation of community livability is in urgent need to avoid increased livability at the expense of sustainability. However, studies concerning community livability evaluation were still conceptual, qualitative or conducted at city or regional scales. The availability of abundant, fine-grained, and multi-source data in the big data era laid the foundation for comprehensive livability evaluation at much finer scales. This paper proposed a quantitative and practical method for up-to-date livability evaluation at individual community scale in China. Nine evaluation criteria were identified spanning dimensions of environment, traffic, convenience, and population. These criteria were calculated respectively from remote sensing, surface observation and geospatial big data. The Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) was applied for community livability evaluation, and the uncertainty and sensitivity of evaluation results were assessed. The livability evaluation in the case study area of Haidian District, Beijing, China demonstrated the practicality and effectiveness of the framework. A total number of 1242 communities in Haidian District were evaluated. Communities in urban area were generally associated with higher evaluation scores and lower uncertainties than those in rural area. The careful selection of criteria weights with high sensitivity, i.e., green space coverage within community and driving time to schools, can potentially significantly reduce the uncertainty of the livability evaluation. The community scale livability evaluation is expected to bridge the gap between theoretical concepts and practical implementations of livability evaluation, and enables the development of more effective and locally specific regulations and policies to improve community livability. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the efficacy of bundle intervention on healthcare-associated (HA) methicillin-resistant Staphylococcus Aureus (MRSA) infection in the neonatal intensive care unit (NICU). Methods. In this study, 11,277 infants having undergone treatment at the NICU in Xiamen, China, from January 2014 to February 2017 were recruited. We retrospectively reviewed patients' demographic and clinical information. Patients from 2014 to 2015 were treated as the control group and those from 2016 to 2017 were classified as the experimental group. Bundle intervention measures were performed, including screening for MRSA, isolation precautions, training of hand hygiene, cleaning protocols, and decontamination of isolation ward. The HA-MRSA data and compliance of infection control measures between both groups were analyzed. Results. Through bundle interventions, the compliance with the isolation of MRSA raised from 55.88% to 92.86% and hand hygiene compliance increased from 90.07% to 93.23% (P < 0.05). The HA infection decreased from 1.87% to 1.71% (P > 0.05) and HA detection rate of MRSA declined from 2.63‰ to 1.00‰, respectively (P < 0.05). Conclusion. Multifaceted interventions can effectively prevent MRSA infection and transmission; this includes active surveillance, isolation precautions, increased hand hygiene compliance, environmental cleaning, and decontamination. [ABSTRACT FROM AUTHOR]

Aridity index, as the ration of potential evapotranspiration and precipitation, is an important indicator of regional climate. GIS technology, Morlet wavelet, Mann-Kendall test, and principal component analysis are utilized to investigate the spatial-temporal variation of aridity index and its impacting factors in China on basis of climate data from 599 stations during 1960–2013. Results show the following. (1) Boundaries between humid and semihumid region, and semihumid and semiarid region coincide with 400 mm and 800 mm precipitation contour lines. (2) Average annual aridity index is between 3.4 and 7.5 and shows decrease trend with a tendency of –0.236 per decade at 99% confidence level. (3) The driest and wettest month appear in December and July, respectively, in one year. (4) Periods of longitudinal and latitudinal shift of aridity index 1, 1.5, and 4 contours coordinate are 10 and 25 years, 6 and 26 years, and 5 and 25 years, respectively. (5) Four principal components which affect aridity index are thermodynamic factors, water and radiation factors, geographical and air dynamic factors, and evaluation factor, respectively. [ABSTRACT FROM AUTHOR]

Downward trend of potential evaporation accompanied with upward of air temperature which is denoted as evaporation paradox has been reported in many regions over the past several decades in the world. In this paper, evaporation paradox and key factors attributed to ET0 changes are systematically analyzed based on data from 599 meteorological stations during 1960–2013. Results show that (1) Evaporation paradox exists in all regions in1960–2013 and 1960–1999 except SWRB in 1960–2013 but no evaporation paradox in 2000–2013. (2) Evaporation paradox exists in large areas in spring and summer, the extent and range fall in autumn, and there is no evaporation paradox in winter. (3) The evaporation paradox area accounts for 73.7% of China in 1960–2013 and 91.2% in 1969–1999. (4) Sunshine hours, humidity, wind speed, and maximum temperature appear to be the most important variables which contributed to ET0 change in China. [ABSTRACT FROM AUTHOR]

Assessing the water footprint (WF) of crops is key to understanding the agricultural water consumption and improving water use efficiency. This study assessed the WF of wheat and maize in the Haihe River Basin (HRB) of Northern China over the period1956–2015, including rain-fed, sufficient, and insufficient irrigation conditions by different irrigation intensity to understand the agricultural water use status. The major findings are as follows: (1) The annual average total WF of wheat and maize production is 20.1 (52% green, 29% blue, and 19% grey) and 15.1 (73% green, 3% blue, and 24% grey) billion m3 year−1, respectively. The proportion of grey WF is much larger than the world average; (2) Wheat has larger unit WF (1580 m3 t−1) than maize (1275 m3 t−1). The unit WF of both wheat and maize shows exponentially decreasing trends, indicating that water use efficiency has been improved. The unit WF is heterogeneous in space, which is larger in Tianjin and Huanghua and smaller in the Southern HRB; (3) Rain-fed crops have the largest unit WF, followed by crops under insufficient and sufficient irrigation conditions for both wheat and maize. To improve the sustainability of water resources, the application of fertilizer must be reduced, and irrigation is an effective way to improve water use efficiency in water-abundant areas. [ABSTRACT FROM AUTHOR]

Objectives: To explore the role of core self-evaluation in mediating between depressive symptoms and suicidal ideation in Chinese adolescents.Methods: We used the cluster sampling method to analyze 11,563 students from five primary and secondary schools in China for depressive symptoms, core self-evaluation, and suicidal ideation using the following scoring scales: Core Self-Evaluation Scale (CSES), Center for Epidemiologic Survey Depression Scale (CES-D), the Second Edition of the Beck Depression Inventory (BDI- II), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Adolescent Self-Rating Life Events Checklist (ASLEC).Results: The incidence of depression was 29.7%; anxiety, 34.2%; and suicidal ideation, 28.0%. Core self-evaluation was a protective factor for suicidal ideation [OR 0.947, 95% CI 0.937-0.959, p<0.001]. Conversely, depression as measured by the CSES score was a risk factor for suicidal ideation (OR 1.084, 95% CI 1.073-1.096, p<0.001), as were anxiety as measured by the SCARED score (OR 1.011, 95% CI 1.006-1.016, p<0.001) and adolescent life events according to ASLEC score groups (OR 1.524, 95% CI 1.434-1.621, p<0.001). Core self-evaluation mediated the relationship between depression and suicidal ideation with an effect size of 13.9%.Conclusions: Better core self-evaluation is a protective factor against suicidal ideation and mediates the relationship between depression and suicidal ideation. We may be able to reduce the risk of suicidal ideation and therefore suicide among adolescents by improving their core self-evaluation. [ABSTRACT FROM AUTHOR]

Rapid urbanization process has a negative or positive impact on vegetation growth. Net primary productivity (NPP) is an effective indicator to characterize vegetation growth status. Taking the core development area of the Central Plains urban agglomeration as the study area, we estimated the NPP and its change trend in the past four decades using the Carnegie-Ames-Stanford Approach (CASA) model and statistical analysis based on meteorological and multi-source remote sensing data. Meanwhile, combined with the urbanization impact framework, we further analyzed urbanization's direct and indirect impact on NPP. The results showed that the urban area increased by 2688 km2 during a high-speed urbanization process from 1983 to 2019. As a result of the intense urbanization process, a continuous NPP decrease (direct impact) can be seen, which aggravated along with the acceleration of the urban expansion, and the mean value of direct impact was 130.84 g C·m−2·a−1. Meanwhile, urbanization also had a positive impact on NPP (indirect impact). The indirect impact showed an increasing trend during urbanization with a mean value of 10.91 g C·m−2·a−1. The indirect impact was mainly related to temperature in climatic factors. The indirect impact has a seasonal heterogeneity, and high-temperature environments of urban areas are more effective in promoting vegetation growth in autumn and winter than in summer. Among different cities, high-speed development cities have higher indirect impact values than medium's and low's because of better ecological construction. This study is of great significance for understanding the impact of urbanization on vegetation growth in the Central Plains urban agglomeration area, supporting urban greening plans, and building sustainable and resilient urban agglomerations. • The direct impact of urbanization has led to a decline in NPP. • The indirect impact of urbanization has improved the vegetation growth environment. • The indirect impact is mainly related to temperature and is greater in urban areas. • The indirect impact has increased regional carbon sinks. • The direct and indirect impacts are both greater in high-speed development cities. [ABSTRACT FROM AUTHOR]

Clarifying the spatiotemporal variation of crop irrigation water requirement (IWR) under the background of climate change is an essential basis for water resource management, determining the irrigation quota and adjusting the planting structure. Using 61 years of climate data from 205 stations in Northwest China, this study investigated the spatiotemporal variations of climatic factors and IWR during the growth period of five main grain crops (spring wheat, winter wheat, spring maize, summer maize, and rice) and explored the dominant climatic driving factors of IWR variation. Results showed that (1) the IWR of grain crops showed distinct differences. Rice was the highest water consumption crop (mean of 753.78 mm), and summer maize was the lowest (mean of 452.90 mm). (2) The variation trends and average values of IWR of different grain crops have spatial heterogeneity across Northwest China. For most crops, high values and increasing trends of IWR were mainly located in eastern Xinjiang, western Gansu, and western Inner Mongolia. (3) T max (maximum temperature), T min (minimum temperature), and P eff (effective precipitation) showed an increasing trend during the growth period of each grain crop, while U 10 (wind speed at 10 m height), SD (solar radiation), and RH (relative humidity) presented decreasing trends. (4) SD, T max , and U 10 promoted the increase of grain crops' IWR, while P eff and RH inhibited it. The impacts of climatic factors on the grain crop IWR differed among different regions. P eff was the most influential factor to the IWR of all grain crops in most areas. Therefore, under the premise of a significant increase in T and uncertain precipitation mode in the future, it is urgent to take effective water-saving measures according to the irrigation needs of the region. To cope with the adverse impact of climate change on the sustainable development of agriculture in the northwest dry area, to ensure regional and national food security., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Grain for Green project (GGP), initialized by the Chinese government in 1999, has achieved substantial achievements accompanied by a decrease in surface runoff on the Loess Plateau, but the impacts of large-scale afforestation on regional water resources are uncertain. Hence, the objective of this study was to explore the impact of land use change on generalized water resources and ecological water stress using the blue and green water concepts, taking the Yanhe River Basin as the case study. The Soil and Water Assessment Tool (SWAT) was applied to quantify the green water and blue water, which are defined as generalized water resources. The ecological water requirement of vegetation (forest and grass), agricultural water footprint and virtual water flow are considered regional water requirements. The land use types of 1980 (Scenario I) and 2017 (Scenario II) were entered into the SWAT model while keeping the other parameters constant to isolate the influence of land use changes. The results show that the average annual differences in blue, green and generalized water resources were -72.08 million m3, 24.34 million m3, and -47.74 million m3, respectively, when the simulation results of Scenario II were subtracted from those of Scenario I, which shows that land use change caused by the GGP led to a decrease in blue and generalized water resources and an increase in green water resources. Surface runoff in Scenario I was more than that in Scenario II in all of the years of the study period from 1980-2017, and green water storage in Scenario I was more than that in Scenario II in all of the years of the study period except in 1998; although lateral flow in Scenario I was less than that in Scenario II except in 2000 and 2015, as was groundwater runoff in 1992, 2000 and 2015, and green water flow in 1998. Blue water flow, green water storage and green water flow in Scenario II were less than those in Scenario I in the whole basin, 12.89 percent of the basin and 99.21 percent of the basin, respectively. The total water footprint increased from 1995 to 2010 because the forest water footprint increased significantly in this period, although the agricultural water footprint and grass water footprint decreased. The ecological water stress index values had no obvious temporal change trends in either land use scenario, but the ecological water stress index in Scenario II was greater than that in Scenario I, which illustrates that the GGP led to an increase in ecological water stress from the perspective of generalized water resources., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Trichloroethylene (TCE) -induced hypersensitivity syndrome (TIHS) is a potentially life-threatening disease. Several genetic susceptibility biomarkers have been found to be associated with TIHS, and this systematic prospective study has been conducted to evaluate the utility of these genetic susceptibility biomarkers in preventing the disease., Methods: The newly hired TCE-exposed workers were recruited from March 2009 to October 2010. HLA-B*13:01 genotyping and 3-month follow-up procedure were conducted. All workers were monitored for adverse reaction by telephone interview every week. The workers with early symptoms of TIHS were asked to go to the hospital immediately for further examination, diagnosis and treatment. The medical expense record data of patients with TIHS were collected for cost-effectiveness analysis in 2018., Results: Among 1651 workers, 158 (9.57%) were found to carry the HLA-B*13:01 allele and 16 (0.97%) were diagnosed with TIHS. HLA-B*13:01 allele was significantly associated with an increased TIHS risk (relative risk=28.4, 95% CI 9.2 to 86.8). As a risk predictor of TIHS, HLA-B*13:01 testing had a sensitivity of 75%, a specificity of 91.1% and an area under curve of 0.83 (95% CI 0.705 to 0.955), the positive and negative predictive values were 7.6% and 99.7%, respectively. The incidence of TIHS was significantly decreased in HLA-B*13:01 non-carriers (0.27%) compared with all workers (0.97%, p=0.014). Cost-effectiveness analysis showed that HLA-B*13:01 screening could produce an economic saving of $4604 per TIHS avoided., Conclusions: Prospective HLA-B*13:01 screening may significantly reduce the incidence of TIHS and could be a cost effective option for preventing the disease in TCE-exposed workers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Acinetobacter baumannii (AB) is critical for healthcare-associated infections (HAI) with significant regional differences in the resistance rate, but its risk factors and infection trends has not been well studied. We aimed to explore the risk factors, epidemiological characteristics and resistance of multidrug-resistant Acinetobacter baumannii (MDR-AB) in intensive care unit inpatients., Methods: Data of patients with MDR-AB (195 cases), and with antibiotic-sensitive AB infection (294 cases, control) during January to December, 2015 in three medical centers in Xiamen, China were conducted and analyzed in the present retrospective study., Results: Lower respiratory tract infection with AB accounted for 68.71%. MDR-AB was detected in 39.88% of all cases. Univariate analysis suggested that mechanical ventilation, indwelling catheter, cancer patients, length of hospitalization in intensive care unit (ICU) ≥15 d, Acute Physiology and Chronic Health Evaluation (APACHE) II score, combined using antibiotic before isolation of AB and use of third-lines cephalosporins were associated with the development of MDR-AB healthcare-associated infections. Dose-response relationship analysis suggested that the age and the days of mechanical ventilation were associated with increased infection with MDR-AB. Logistic regression analysis suggested that, mechanical ventilation, combined using antibiotic before isolation of AB, and indwelling catheter, were associated with MDR-AB infection, with odds ratios (OR) and 95% confidence intervals (CI) of 3.93 (1.52-10.14), 4.11 (1.58-10.73), and 4.15 (1.32-12.99), respectively., Conclusions: MDR-AB infection was associated with mechanical ventilation, combined using antibiotic before isolation of AB, and indwelling catheter. Furthermore, the age and the days of mechanical ventilation were associated with increased infection with MDR-AB.

Although there are great changes of dietary in the past few decades in China, few are known about the aluminium exposure in Chinese diet. The aim of this study is to systematically evaluate the dietary aluminium intake level in residents of Shenzhen, China. A total of 853 persons from 244 household were investigated their diet by three days food records. Finally, 149 kinds of foods in 17 food groups were selected to be the most consumed foods. From them, 1399 food samples were collected from market to test aluminium concentration. High aluminium levels were found in jellyfish (median, 527.5 mg/kg), fried twisted cruller (median, 466.0 mg/kg), shell (median, 107.1 mg/kg). The Shenzhen residents' average dietary aluminium exposure was estimated at 1.263 mg/kg bw/week which is lower than the PTWI (provisional tolerable weekly intake). But 0-2 and 3-13 age groups have the highest aluminium intake exceeding the PTWI (3.356 mg/kg bw/week and 3.248 mg/kg bw/week) than other age groups. And the main dietary aluminium exposure sources are fried twisted cruller, leaf vegetables and bean products. Our study suggested that even three decades rapid economy development, children in Shenzhen still have high dietary aluminium exposure risk. How to control high dietary aluminium exposure still is a great public health challenge in Shenzhen, China.

Objective: We aimed to examine the risk factors related to the development of osteoporosis in rheumatoid arthritis (RA) patients and whether there is an association among the changes in bone mineral density (BMD), disease activities (modified DAS28), serum 25-hydroxyvitamin D (25OHD) levels, and disease duration., Methods: There were 110 patients with RA and 110 age- and sex-matched healthy controls who were concurrently studied. All of the patients underwent the following measurements: erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and serum 25OHD. Dual-energy X-ray absorptiometry (DEXA) was also used to measure the BMD of the left femur at the time of recruitment. Patients taking vitamin D supplement or corticosteroids were excluded., Results: The incidences of osteopenia (45.6% vs. 36.4%, P = 0.170) and osteoporosis (33.6% vs. 5.45%, P = 0.000) were higher in the RA patients than in the healthy controls. There was a significant negative correlation between vitamin D levels and DAS28 (r = -0.325, P = 0.001) and a significant positive correlation between vitamin D levels and BMD (r = 0.422, P = 0.000). The multiple regression analysis revealed that 25OHD levels were significantly correlated with disease activity and BMD (F = 11.087, P = 0.000). Stepwise multiple regression analysis showed that serum 25OHD levels were the significant predictors for low BMD and high disease activity (DAS28) in RA patients., Conclusion: The incidences of osteoporosis and osteopenia were higher in RA patients compared to the age- and gender-matched healthy controls. Low serum 25OHD levels correlate with low BMD and high disease activity in RA patients., (© 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)