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In China, Dolichandrone spathacea is a rare and endangered semi-mangrove plant species with an extremely small population, naturally distributed only in Zhanjiang City and the east coast of Hainan Island. Despite conservation concerns, the population status of D. spathacea has received little scientific attention. In this study, we evaluated the current status of D. spathacea on Hainan Island, China, in order to propose sustainable conservation strategies for future ecological restoration of its natural population. D. spathacea on Hainan Island can be divided into four populations. All the D. spathacea populations present a state of overall dispersion, local concentration, and occasionally sporadic existence, and they exist in geographical isolation. The young, middle, and old D. spathacea plants account for 20.42%, 66.20%, and 13.38%, respectively, indicating that the D. spathacea population on Hainan Island is declining. Furthermore, instead of temporal structure, we used diameter at breast height (DBH) to establish a static life table, draw a population survival curve, and quantify the future development trend through population dynamic analysis and time-series prediction. These results suggest that the D. spathacea population in the Bamen Gulf (Wenchang) and Qingmei Harbor (Sanya) on Hainan Island is sensitive to external disturbances and possesses two main increases in mortality rate—namely, in its juvenile and mature stages—due to competition and anthropogenic interferences, which might be the most important reasons for its endangered status. Depending on the current conditions of the D. spathacea population, we should conserve and expand mature trees in situ, preserve their germplasm resources, rehabilitate their habitats to promote provenance restoration, and conduct artificial cultivation and spreading planting in order to realize the sustainable conservation and management of D. spathacea. [ABSTRACT FROM AUTHOR]

A study linking the two economic and social phenomena of rural labor force migration and energy transition can help analyze the underlying causes of rural "Energy Poverty". However, how off-farm employment affects household low-carbon energy consumption and its potential mechanisms requires further research. Using 1351 sampled rural households from the "Rural Energy, Population Transfer and Well-being" survey in 2018 and 2021 to explore response mechanisms through which off-farm employment can influence low-carbon energy intensity. Utilizing the multivariate regression, Sobel test, and moderating effect test, the results demonstrate that off-farm employment, including short-term and long-term off-farm employment, significantly increases the intensity of low-carbon energy use among rural households. Specifically, long-term off-farm employment tends to have a greater positive contribution to the low-carbon energy intensity than short-term off-farm employment. Furthermore, off-farm employment can affect household low-carbon energy intensity through the total income, and effect of the surrounding people in the off-farm employment process also increases their consumption intensity. The research reveals that the rural energy revolution under the constraints of "Carbon Neutral" and "Carbon Peak" should relate to the off-farm development of rural households to achieve "Precise Energy Poverty Alleviation". [ABSTRACT FROM AUTHOR]

Kandelia obovata (S., L.) Yong and Sonneratia caseolaris (L.) Engl. are two dominant mangrove species in the subtropical coastlines of the Pearl River Estuary, China. The main aim of this study was to investigate the specific causes of K. obovata mortality versus S. caseolaris vitality on the west coast of Bao'an, Shenzhen, China and to propose sustainable management strategies for mangrove protection and future ecological planting restoration. Results showed that although both mangroves possessed simple and unstable community structures, S. caseolaris had a more tenacious vitality than the native species K. obovata, indicating that the former possesses stronger adaptability under adversity conditions. Moreover, the salinity of the seawater collection point 5 from the K. obovata plot was found to be lower than that of seawater collection point 1–3 from the S. caseolaris sample plots, indicating that no hydrologic connectivity existed in the K. obovata plots. In addition, the location of the drain outlet (seawater collection point 8) might be another potential risk factor for the dead of near K. obovata forests, implying that they were badly affected by poor oxygen and serious inorganic pollution, such as ammonium nitrogen, total phosphorus, and other inorganic substances. Depending on local circumstances, we should consider strengthening infrastructure construction to activate hydrological connectivity, reinforcing the stability of man-made mangrove communities, and controlling the pollution sources for sustainable mangrove protection and management on the western coast of Bao'an, Shenzhen, China. [ABSTRACT FROM AUTHOR]

Objective: The large-scale epidemic of Coronavirus Disease 2019 (COVID-19) has triggered unprecedented physical and psychological stress on health professionals. This study aimed to investigate the prevalence and risk factors of burnout syndrome, and the relationship between burnout and depressive symptoms among frontline medical staff during the COVID-19 epidemic in China. Methods: A total of 606 frontline medical staff were recruited from 133 cities in China using a cross-sectional survey. The Maslach Burnout Inventory (MBI) was used to assess the level of burnout. Depressive symptoms were assessed by the Patient Health Questionnaire Depression (PHQ-9). Results: During the COVID-19 pandemic, 36.5% of the medical staff experienced burnout. Personal and work-related factors were independently associated with burnout, including age (OR = 0.68, 95% CI: 0.52–0.89, p = 0.004), family income (OR = 0.72, 95% CI: 0.53–0.99, p = 0.045), having physical diseases (OR = 2.16, 95% CI: 1.42–3.28, p < 0.001), daily working hours (OR = 1.35, 95% CI: 1.03–1.77, p = 0.033), and profession of nurse (OR = 2.14, 95% CI: 1.12–4.10, p = 0.022). The correlation coefficients between the scores of each burnout subscale and the scores of depressive symptoms were 0.57 for emotional exhaustion, 0.37 for cynicism, and −0.41 for professional efficacy (all p < 0.001). Conclusions: Our findings suggest that the prevalence rate of burnout is extremely high among medical staff during the COVID-19 pandemic, which is associated with other psychological disorders, such as depression. Psychological intervention for medical staff is urgently needed. Young and less experienced medical staff, especially nurses, should receive more attention when providing psychological assistance. [ABSTRACT FROM AUTHOR]

Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel bunyavirus. Since 2007, SFTS disease has been reported in China with high fatality rate up to 30%, which drew high attention from Centre for Disease Control and Prevention and government. SFTSV is endemic in the centra l and eastern China, Korea and Japan. There also have been similar cases reported in Vietnam. The number of SFTSV infection cases has a steady growth in these years. As SFTSV could transmitted from person to person, it will expose the public to infectious risk. In 2018 annual review of the Blueprint list of priority diseases, World Health Organisation has listed SFTSV infection as prioritised diseases for research and development in emergency contexts. However, the pathogenesis of SFTSV remains largely unclear. Currently, there are no specific therapeutics or vaccines to combat infections of SFTSV. This review discusses recent findings of epidemiology, transmission pathway, pathogenesis and treatments of SFTS disease. [ABSTRACT FROM AUTHOR]

Objective. To compare the difference in clinical and radiographic outcomes between anterior transcorporeal and transdiscal percutaneous endoscopic cervical discectomy (ATc-PECD/ATd-PECD) approaches for treating patients with cervical intervertebral disc herniation (CIVDH). Method. We selected 77 patients with single-segment CIVDH and received ATc-PECD or ATd-PECD in the Second Affiliated Hospital of Chongqing Medical University between March 1, 2010, and July 1, 2015. 35 patients suffered from ATc-PECD, and there were 42 patients in the ATd-PECD group. Obtaining the data of 1, 3, 6, 12, and 24 months postoperatively, the VAS for neck and arm pain and the modified MacNab criteria were used to evaluate the clinical outcomes, comparing radiographic outcomes and complications of these two groups. Results. We found that the mean operative time was significantly longer in the ATc-PECD group (P < 0.05). At the 2-year follow-up, the mean VAS score for neck and arm pain was significantly decreased in both two groups. There was no significant difference in the VAS score for arm pain and neck pain between the two groups at the 2-year follow-up (P = 0.783 and P = 0.785 , respectively). For the ATc-PECD group, the difference in the height of IVS or vertebral body was significant between the preoperative and postoperative groups (P < 0.05 , respectively). For the ATd-PECD group, there was only a significant decrease in the height of the IVS (P < 0.05); the decrease in the surgical vertebral body was not significant between the preoperative and postoperative groups (P > 0.05). Conclusion. In the 2-year follow-up, there is no significant difference in the clinical outcomes between the 2 approaches. While the longer time was consumed in the ATc-PECD group, the lower rate of disc collapse and recurrence is notable. Additionally, when the center diameter of tunnel was limited to 6 mm, the bony defect can be healed without the occurrence of the collapse of the superior endplate, and ATc-PECD may be preferable in the endoscopic treatment of CIVDH. [ABSTRACT FROM AUTHOR]

• A feature extraction method from cellular events was proposed. • A work to combine and use them for traffic status detection based on cellular events. • We presented a traffic status detection method using cellular data. • The classification accuracies for proposed model achieves good results. Traffic status detection on arterial roads is challenging because of the complexity of urban traffic and the limited coverage and high deployment cost of traffic detectors. Ubiquitous mobile phones and data generated from the events of these mobile devices provide a promising approach for traffic status detection. This paper proposes a novel approach solely using cellular event data without the cellphone GPS information to detect traffic status on arterial roads. Different from the conventional methods, the proposed approach uses features derived only from cellular data to estimate traffic status, not requiring any cellphone location information. Both handoff (HO) and location update (LU) events generated at each cellular station were extracted from the original data to form a candidate feature set. A feature selection method based on joint mutual information (JMI) was used to select features to cover the maximum information, which can resolve issues such as loss of useful information caused by conventional feature selection techniques. A support vector machine (SVM) algorithm was then employed to model the relationship between the selected features and traffic status (low, medium, and high-traffic). Finally, the proposed method was validated by both a field experiment in Taicang, China with 1-hour-time-interval samples and a simulation experiment on VISSIM with 5-minute-time-interval samples. This study provides a new perspective for traffic status detection which may help design strategies for traffic management and route navigation to improve traveling efficiency, especially for the cities lack of traffic surveillance devices. [ABSTRACT FROM AUTHOR]

Background: IgA nephropathy (IgAN) is the most common glomerular disease worldwide. It has a high incidence in Asians and is more likely to progress to end-stage renal disease (ESRD). For high-risk IgAN, which is clinically characterized by massive proteinuria and renal dysfunction, however, there has been no international consensus on treatment options. Compared with other developed countries, IgAN patients in China are often found to have severe kidney function loss at initial diagnosis. Yi-Qi-Qing-Jie formula (YQF; a compound recipe of Chinese medicinal herbs) has shown potential renal protection in our previous clinical studies. To further confirm the efficacy and safety of YQF in the treatment of high-risk IgAN, we have designed a prospective double-blind randomized placebo-controlled trial.Methods/design: The TCM-WINE study is a single-center, prospective, double-blind randomized placebo-controlled trial. We plan to randomize 60 participants with biopsy-proven IgAN to a YQF combined group (YQF compound combined with prednisolone, and cyclophosphamide if necessary) or an immunosuppression group (placebo-YQF combined with prednisolone, and cyclophosphamide if necessary). The two groups will enter a 48-week in-trial treatment phase and receive post-trial follow-up until study completion (3 years). All patients will receive optimal supportive care. The primary composite outcome is defined as the first occurrence of a 40% decrease in estimated glomerular filtration rate (eGFR) from the baseline lasting for 3 months, initiating continuous renal replacement treatment, or death due to chronic kidney disease (CKD) during the 3-year study phase. The secondary endpoint events are defined as the mean annual eGFR decline rate (eGFR slope, ml/min per 1.73 m2 per year), which is calculated by the eGFR regression curve for each eligible patient, and proteinuria remission (prescribed as proteinuria < 0.5 g/day) at weeks 24, 36, and 48 during the in-trial phase. The remission rate of symptoms and inflammation status will be evaluated at week 48. Safety monitoring and assessment will be undertaken during the study.Discussion: The TCM-WINE study will evaluate the effects and safety of YQF combined therapy compared with immunosuppression monotherapy on the basis of the optimal supportive treatment in high-risk IgAN. The evidence from this study will provide a novel, effective, and safe Chinese characteristic therapy for high-risk IgAN patients.Trial Registration: ClinicalTrials.gov, NCT03418779. Registered on 18 June 2018. [ABSTRACT FROM AUTHOR]

As one of the vital tectonic units of the Wulian Metamorphic Core Complex (MCC), the Wulian detachment fault zone (WDFZ), which developed in the Jiaodong peninsula, separates the lower plate of the ultrahigh pressure (UHP) metamorphic rocks in the Sulu orogenic belt from the upper plate of the early Cretaceous Zhucheng basin and the basin basement. The fault zone generally strikes NNE with a dip in the west along the southern portion of the MCC and strikes NE with a dip in the WNW along the northern portion. The fault zone displays a wavy-tile-shaped extension on the plane, principally composed of the fault breccias and mylonite and transits downward to the mylonitic gneiss As a whole, the detachment fault zone shows a top-to-west or a WNW extension. By calculating the harmonic mean, we obtain a Flynn index K of 0.98–2.0, and the mean value is approximately 1.35 in the fault zone. According to the polar Mohr construction, the extensional crenulation cleavage, the RS/θ, and the quartz C-axial fabric methods, we acquire mean kinematic vorticity values of 0.64–0.97, 0.76–0.93, 0.6–0.92, and 0.63–0.98 with mean values of 0.83, 0.80, 0.78 and 0.86, respectively, for mylonite and promylonite. The strain measurement results and the kinematic vorticity values indicate that the WDFZ is a normal ductile shear zone developed in the extensional setting. The kinematic track shows that the kinematic vorticity value decreases gradually from the NW to the SE as a whole. A simple shear dominates in the middle and upper parts of the shear zone, which is reflected by a higher vorticity value (>0.75, up to 0.98), a low thinning rate and a lower K value. In contrast, toward the footwall, the pure shear is increased significantly, showing a lower vorticity value (<0.70, low to 0.64), a relatively high thinning rate and a higher K value. Combined with the geotectonic background, the development and evolution of the WDFZ should respond to lithospheric thinning and the destruction of the North China Craton (NCC). As a result, the WDFZ can be defined as a thinning normal shear zone developed in the extension tectonic setting and the combined result of the simple shear caused by the crust extension and pure shear led by the rapid uplift of the footwall and magmatic upwelling. [ABSTRACT FROM AUTHOR]

Background: Natural disasters can indirectly induce epidemics of infectious diseases through air and water pollution, accelerated pathogen reproduction, and population migration. This study aimed to explore the epidemiological characteristics of the main infectious diseases in Sichuan, a province with a high frequency of natural disasters. Methods: Data were collected from the local Centers for Disease Control infectious disease reports from Lu, Shifang and Yuexi counties from 2011 to 2015 and from the baseline survey of the Disaster Mitigation Demonstration Area in Western China in 2016. Principal component regression was used to explore the main influencing factors of respiratory infectious diseases (RIDs). Results: The incidence rates of RIDs and intestinal infectious diseases (IIDs) in 2015 were 78.99/100,000, 125.53/100,000, 190.32/100,000 and 51.70/100,000, 206.00/100,000, 69.16/100,000 in Lu, Shifang and Yuexi respectively. The incidence rates of pulmonary tuberculosis (TB) was the highest among RIDs in the three counties. The main IIDs in Lu and Shifang were hand-foot-mouth disease (HFMD) and other infectious diarrhea; however, the main IIDs in Yuexi was bacillary dysentery. The proportions of illiterate and ethnic minorities and per capita disposable income were the top three influencing factors of RIDs. Conclusions: TB was the key point of RIDs prevention among the three counties. The key preventable IIDs in Lu and Shifang were HFMD and other infectious diarrhea, and bacillary dysentery was the major IIDs in Yuexi. The incidence rates of RIDs was associated with the population composition, the economy and personal hygiene habits. [ABSTRACT FROM AUTHOR]

Measles is a highly contagious and severe disease. Despite mass vaccination, it remains a leading cause of death in children in developing regions, killing 114,900 globally in 2014. In 2006, China committed to eliminating measles by 2012; to this end, the country enhanced its mandatory vaccination programs and achieved vaccination rates reported above 95% by 2008. However, in spite of these efforts, during the last 3 years (2013–2015) China documented 27,695, 52,656, and 42,874 confirmed measles cases. How measles manages to spread in China—the world’s largest population—in the mass vaccination era remains poorly understood. To address this conundrum and provide insights for future public health efforts, we analyze the geospatial pattern of measles transmission across China during 2005–2014. We map measles incidence and incidence rates for each of the 344 cities in mainland China, identify the key socioeconomic and demographic features associated with high disease burden, and identify transmission clusters based on the synchrony of outbreak cycles. Using hierarchical cluster analysis, we identify 21 epidemic clusters, of which 12 were cross-regional. The cross-regional clusters included more underdeveloped cities with large numbers of emigrants than would be expected by chance (p = 0.011; bootstrap sampling), indicating that cities in these clusters were likely linked by internal worker migration in response to uneven economic development. In contrast, cities in regional clusters were more likely to have high rates of minorities and high natural growth rates than would be expected by chance (p = 0.074; bootstrap sampling). Our findings suggest that multiple highly connected foci of measles transmission coexist in China and that migrant workers likely facilitate the transmission of measles across regions. This complex connection renders eradication of measles challenging in China despite its high overall vaccination coverage. Future immunization programs should therefore target these transmission foci simultaneously. [ABSTRACT FROM AUTHOR]

Background: Arsenic trioxide (ATO) is approved for treating terminal-stage liver cancer in China. Cryptotanshinone (CT), a STAT3 inhibitor, has exhibited certain anti-tumor potency; however, the use of CT enhanced ATO for treating liver cancer has not been reported. Here we try to elucidate how CT could enhance the efficacy of ATO for treating liver cancer and its correlation to STAT3 in vitro and in vivo. Methods: Cell viability of ATO combined with CT was assessed by ¹MTT assay. Cell apoptosis induced by ATO combined with CT was detected by Annexin V/PI staining and apoptosis-related proteins were detected by western blotting. STAT3-related proteins were analysis by western blotting analysis and Immunofluorescence assays. Efficacy evaluation of ATO combined with CT on xenograft was carried in nude mice and related proteins were analysis by Immunohistochemistry assays. Results: First we evaluated cell vitality, and our data indicated that the ATO combined with CT showed obvious growth inhibition of Bel-7404 cells compared to ATO or CT alone. Next we found that ATO combined with CT induced cell apoptosis in Bel-7404 cells and upregulated the activation of apoptosis-related proteins cleaved- caspase-3, cleaved-caspase-9, and cleaved-poly(ADP-ribose) polymerase in a time-dependent manner. Next, we found that ATO combined with CT not only inhibited the constitutive levels of phosphorylated-JAK2 and phosphorylated-STAT3Tyr705 but did so in a time-dependent manner. We also found that ATO combined with CT reversed the upregulated expression of phosphorylated-STAT3Tyr705 stimulated by interleukin-6 and downregulated STAT3 direct target genes and the anti-apoptotic proteins Bcl-2, XIAP, and survivin but obviously upregulated the promoting apoptosis proteins Bak,.In vivo studies showed that ATO combined with CT decreased tumor growth. Tumors from ATO combined with CT--treated mice showed decreased levels of phosphorylated-STAT3Tyr705 and the anti-apoptotic protein Bcl-2 but an increased level of pro-apoptotic protein Bax. Conclusions: Our study provides strong evidence that CT could enhance the efficacy of ATO in treating liver cancer both in vitro and in vivo. Downregulation of phosphorylated-STAT3 expression may play an important role in inducing apoptosis of Bel-7404 cells. [ABSTRACT FROM AUTHOR]

Since two large specimens of Chinese paddlefish Psephurus gladius were found unexpectedly in December 2002 and January 2003, a series of measures have been undertaken to attempt to save this critical endangered species. As a part of the rescue plan, a total of eight hydroacoustic and capture surveys were conducted in the upper Yangtze River between 2006 and 2013. Preliminary results from the first four surveys (2006-2008) were reported in 2009. The later four surveys were conducted in the same area and consisted of 578 setlines, 8 anchored setlines and 2003 drift net catches. A total of 1982 fish belonging to 38 species were captured. For the hydroacoustic surveys, a BioSonics echo sounder with a vertically down looking 199 kHz split-beam transducer was applied, both for data recording, and for guiding the capture trials by drift nets and setlines. Post processing applying automatic tracking identified 7217 single targets from the eight acoustic surveys. Body size was estimated from TS values of single targets. No P. gladius were captured. The acoustic data, however, revealed at least a few observations that are difficult to interpret as something other than large P. gladius. Although not conclusive, this gives hope that this species may still exist in the river. [ABSTRACT FROM AUTHOR]

Background: Because the prevalence of connective tissue disease (CTD)-associated interstitial lung disease (ILD; CTD-ILD) in China is unknown, we wanted to analyze the clinical characteristics of this disease in Chinese patients.Methods: The medical records of patients who received a diagnosis of ILD and treated in Shanghai Pulmonary Hospital from January 1999 to January 2013 were reviewed. Based on the records, patients who also received a diagnosis of CTD were identified, and their records of follow-up examinations for a minimum of 12 months until the end of December 2013 were reviewed.Results: Of the 2,678 patients who received a diagnosis of ILD, 1,798 (67%) were identified as having CTD-ILD; 299 (11.2%) had idiopathic pulmonary fibrosis (IPF). Complete clinical data were available for 1,044 patients with CTD-ILD and 178 with IPF. We found that 332 of the 1,044 patients with CTD-ILD (32%) did not receive an accurate diagnosis at the initial hospital admission, 195 (18.7%) of the 1,044 patients showed persistent negative test results for autoantibodies, and 262 (25.1%) of the 1,044 patients had negative autoantibodies at the initial hospital admission and then became positive at follow-up examinations. Of the 288 patients who had confirmed CTD-ILD, 41 (14%) showed pulmonary symptoms as the initial clinical manifestation (PSIM) and 247 (86%) showed extrapulmonary symptoms as the initial clinical manifestation (EPSIM). For the 756 patients who had undifferentiated CTD-ILD, the proportion of PSIM and EPSIM was 44% and 56%, respectively. For patients who presented with PSIM, 23 who had confirmed CTD-ILD (56%) and 216 who had unconfirmed CTD-ILD (65%) did not receive an accurate diagnosis at the initial visit but were ultimately diagnosed at subsequent follow-up examinations.Conclusions: Patients with CTD-ILD do not receive an accurate diagnosis at the initial hospital admission possibly because of negative serologic test results for autoantibodies and the absence of obvious extrapulmonary symptoms. Thus, patients with ILD should be examined for extrapulmonary symptoms and tested for autoantibodies at follow-up examinations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the epidemic characteristics of human cutaneous anthrax (CA) in China, detect the spatiotemporal clusters at the county level for preemptive public health interventions, and evaluate the differences in the epidemiological characteristics within and outside clusters. Methods: CA cases reported during 2005–2012 from the national surveillance system were evaluated at the county level using space-time scan statistic. Comparative analysis of the epidemic characteristics within and outside identified clusters was performed using using the χ2 test or Kruskal-Wallis test. Results: The group of 30–39 years had the highest incidence of CA, and the fatality rate increased with age, with persons ≥70 years showing a fatality rate of 4.04%. Seasonality analysis showed that most of CA cases occurred between May/June and September/October of each year. The primary spatiotemporal cluster contained 19 counties from June 2006 to May 2010, and it was mainly located straddling the borders of Sichuan, Gansu, and Qinghai provinces. In these high-risk areas, CA cases were predominantly found among younger, local, males, shepherds, who were living on agriculture and stockbreeding and characterized with high morbidity, low mortality and a shorter period from illness onset to diagnosis. Conclusion: CA was geographically and persistently clustered in the Southwestern China during 2005–2012, with notable differences in the epidemic characteristics within and outside spatiotemporal clusters; this demonstrates the necessity for CA interventions such as enhanced surveillance, health education, mandatory and standard decontamination or disinfection procedures to be geographically targeted to the areas identified in this study. [ABSTRACT FROM AUTHOR]

Background: Increased risks for hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus have been observed since 2005, in Xi'an, China. Despite increased vigilance and preparedness, HFRS outbreaks in 2010, 2011, and 2012 were larger than ever, with a total of 3,938 confirmed HFRS cases and 88 deaths in 2010 and 2011. Methods and Findings: Data on HFRS cases and weather were collected monthly from 2005 to 2012, along with active rodent monitoring. Wavelet analyses were performed to assess the temporal relationship between HFRS incidence, rodent density and climatic factors over the study period. Results showed that HFRS cases correlated to rodent density, rainfall, and temperature with 2, 3 and 4-month lags, respectively. Using a Bayesian time-series Poisson adjusted model, we fitted the HFRS outbreaks among humans for risk assessment in Xi'an. The best models included seasonality, autocorrelation, rodent density 2 months previously, and rainfall 2 to 3 months previously. Our models well reflected the epidemic characteristics by one step ahead prediction, out-of-sample. Conclusions: In addition to a strong seasonal pattern, HFRS incidence was correlated with rodent density and rainfall, indicating that they potentially drive the HFRS outbreaks. Future work should aim to determine the mechanism underlying the seasonal pattern and autocorrelation. However, this model can be useful in risk management to provide early warning of potential outbreaks of this disease. Author Summary: Hemorrhagic fever with renal syndrome (HFRS, caused by hantavirus) is a zoonotic infectious disease reservoired in rodent populations worldwide, but with 90% of the total cases occurring in China. Xi'an is one of the most endemic areas in China, with a total of 7,748 confirmed HFRS cases from 2005 to 2012. HFRS came to the attention of the public when two larger outbreaks occurred in Xi'an in 2010 and 2011, with 1,366 and 1,067 cases being reported, respectively. By using 8 years of surveillance data (2005–2012) on HFRS dynamics, including data on the main rodent host reservoir, human cases, and weather conditions, we show how the epidemic dynamics of HFRS were associated with seasonality, rodent abundance, rainfall, and temperature. We find that the two larger HFRS outbreaks coincided with the abrupt increase of rodent abundance and/or rainfall. We present a statistical model revealing strong effects of seasonality and autocorrelation and additional effects of rodent density and rainfall on HFRS incidence that gives robust prediction; this approach could be a very practical tool in Xi'an. [ABSTRACT FROM AUTHOR]

Background What was the relationship of Fuzheng Huayu recipe (FZHY) inhibiting hepatocyte apoptosis and HSC activation at different stage of liver fibrosis? In order to answer this question, the study was carried out to dynamically observe FZHY's effect on hepatocyte apoptosis and HSC activation and further explored underling mechanism of FZHY against hepatocyte apoptosis. Methods Mice were randomly divided into four groups: normal, model, FZHY, and N-acetylcystein (NAC) groups. Acute hepatic injury and liver fibrosis in mice were induced by CCl4. Three days before the first CCl4 injection, treatment with FZHY powder or NAC respectively was started. In vitro, primary hepatocytes were pretreated with FZHY medicated serum or ZVAD- FMK and then incubated with ActD and TNF-α. Primary HSCs were treated with DNA from apoptotic hepatocytes incubated by Act D/TNF-α or FZHYmedicated serum. Liver sections were analyzed for HE staining and immunohistochemical evaluation of apoptosis. Serum ALT and AST levels and Alb content and TNF-α expression in liver tissue were detected. Hyp content was assayed and collagen deposition was visualized. Expressions of α-SMA and type I collagen were analyzed by immunofluorescence and immunoblotting. Flow cytometry, immunofluorescence, and DNA ladder for hepatocyte apoptosis and immunoblotting for TNF-R1, Bcl-2 and Bax were also analyzed. Results Mice showed characteristic features of massive hepatocytes apoptosis in early stage of liver injury and developed severe hepatic fibrosis in later phase. FZHY treatment significantly alleviated acute liver injury and hepatocyte apoptosis, and inhibited liver fibrosis by decreasing α-SMA expression and hepatic Hyp content. In vitro, primary hepatocytes were induced by TNF-α and Act D. The anti-apoptotic effect of FZHY was generated by reducing TNFR1 expression and balancing the expressions of Bcl-2 and Bax. Meanwhile, the nuclear DNA from apoptotic hepatocytes stimulated HSC activation in a dose dependent manner, and the DNA from apoptotic hepatocytes treated with FZHY or Z-VAD-FMK reduced HSC activation and type I collagen expression. Conclusion These findings suggested that FZHY suppressed hepatocyte apoptosis through regulating mediators in death receptor and mitochondrial pathways, and the effect of FZHY on hepatocyte apoptosis might play an important role in inhibiting liver fibrosis. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by many serotypes of hantaviruses. In China, HFRS has been recognized as a severe public health problem with 90% of the total reported cases in the world. This study describes the spatiotemporal dynamics of HFRS cases in China and identifies the regions, time, and populations at highest risk, which could help the planning and implementation of key preventative measures. Methods: Data on all reported HFRS cases at the county level from January 2005 to December 2012 were collected from Chinese Center for Disease Control and Prevention. Geographic Information System-based spatiotemporal analyses including Local Indicators of Spatial Association and Kulldorff's space-time scan statistic were performed to detect local high-risk space-time clusters of HFRS in China. In addition, cases from high-risk and low-risk counties were compared to identify significant demographic differences. Results: A total of 100,868 cases were reported during 2005–2012 in mainland China. There were significant variations in the spatiotemporal dynamics of HFRS. HFRS cases occurred most frequently in June, November, and December. There was a significant positive spatial autocorrelation of HFRS incidence during the study periods, with Moran's I values ranging from 0.46 to 0.56 (P<0.05). Several distinct HFRS cluster areas were identified, mainly concentrated in northeastern, central, and eastern of China. Compared with cases from low-risk areas, a higher proportion of cases were younger, non-farmer, and floating residents in high-risk counties. Conclusions: This study identified significant space-time clusters of HFRS in China during 2005–2012 indicating that preventative strategies for HFRS should be particularly focused on the northeastern, central, and eastern of China to achieve the most cost-effective outcomes. Author Summary: Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne viral disease caused by many serotypes of hantaviruses. In China, HFRS has been recognized as a severe public health problem and accounts for 90% of the reported cases in the world. We examined the spatiotemporal dynamics of HFRS cases in China during 2005–2012 and compared characteristics between cases from high-risk and low-risk counties. Several distinct HFRS cluster areas were identified, concentrated in northeastern, central, and eastern of China. Compared with cases from low-risk areas, a higher proportion of cases were younger, non-farmer, and floating residents in high-risk counties. These findings suggest preventative strategies for HFRS should be focused on the identified clusters in order to achieve the most cost-effective outcomes. [ABSTRACT FROM AUTHOR]

Background: Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China.Methods: Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup.Results: Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy.Conclusions: The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions. [ABSTRACT FROM AUTHOR]

Cultured mycelium Cordyceps sinensis (CMCS) is a Chinese herbal medicine, which is widely used for a variety of diseases including liver injury in clinic. The current study aims to investigate the protective effects of CMCS against liver fibrosis and to exploit its active antifibrotic substances in vivo and in vitro. For evaluating the antifibrotic effect of CMCS and ergosterol, male C57BL/6 mice were injected intraperitoneally with carbon tetrachloride (CCl4) and treated with CMCS (120mg/kg/d) or ergosterol (50mg/kg/d). Four weeks later, serum liver function, hepatic hydroxyproline (Hyp) content, liver inflammation, collagen deposition, and expression of alpha smooth muscle actin (α-SMA) in liver tissue were evaluated. Besides, toxicological effects of active compounds of CMCS on hepatocytes and hepatic stellate cells (HSCs) were detected and expressions of permeability of the lysosomal membrane, EdU, F-actin, and α-SMA of activated HSCs were analyzed to screen the antifibrotic substance in CMCS in vitro. Our results showed that CMCS could significantly alleviate levels of serum liver functions, attenuate hepatic inflammation, decrease collagen deposition, and relieve levels of α-SMA in liver, respectively. Ergosterol, the active compound in CMCS that was detected by HPLC, played a dose-dependent inhibition role on activated HSCs via upregulating expressions of permeability of the lysosomal membrane and downregulating levels of EdU, F-actin, and α-SMA on activated HSCs in vitro. Moreover, ergosterol revealed the antifibrotic effect alike in vivo. In conclusion, CMCS is effective in alleviating liver fibrosis induced by CCl4 and ergosterol might be the efficacious antifibrotic substance in CMCS in vivo and in vitro. [ABSTRACT FROM AUTHOR]

This article provides an overview of a study on the incidence and distribution of scrub typhus in mainland China from 2006 to 2012. Scrub typhus is a bacterial infection transmitted by chigger mites, primarily found in areas where infected rodents are present. The study found a total of 27,391 confirmed cases of scrub typhus during the study period, with a higher incidence among females in 2011 and 2012. The disease was most prevalent among individuals aged 60-69 and farmers had a higher incidence compared to non-farmers. The study emphasizes the need for targeted public health interventions to control and prevent scrub typhus outbreaks in China. [Extracted from the article]

Objective: The aim of the study is to examine the spatiotemporal pattern of Japanese Encephalitis (JE) in mainland China during 2002–2010. Specific objectives of the study were to quantify the temporal variation in incidence of JE cases, to determine if clustering of JE cases exists, to detect high risk spatiotemporal clusters of JE cases and to provide evidence-based preventive suggestions to relevant stakeholders. Methods: Monthly JE cases at the county level in mainland China during 2002–2010 were obtained from the China Information System for Diseases Control and Prevention (CISDCP). For the purpose of the analysis, JE case counts for nine years were aggregated into four temporal periods (2002; 2003–2005; 2006; and 2007–2010). Local Indicators of Spatial Association and spatial scan statistics were performed to detect and evaluate local high risk space-time clusters. Results: JE incidence showed a decreasing trend from 2002 to 2005 but peaked in 2006, then fluctuated over the study period. Spatial cluster analysis detected high value clusters, mainly located in Southwestern China. Similarly, we identified a primary spatiotemporal cluster of JE in Southwestern China between July and August, with the geographical range of JE transmission increasing over the past years. Conclusion: JE in China is geographically clustered and its spatial extent dynamically changed during the last nine years in mainland China. This indicates that risk factors for JE infection are likely to be spatially heterogeneous. The results may assist national and local health authorities in the development/refinement of a better preventive strategy and increase the effectiveness of public health interventions against JE transmission. Author Summary: Japanese encephalitis (JE) is a mosquito-borne disease, which primarily occurs in rural and suburban areas of Southeast Asia and the Western Pacific region. JE still remains a significant public health problem in mainland China, with approximately 50% of global cases annually. Few studies have explored the spatiotemporal patterns of JE cases in China. Here we reported the results of Local Indicators of Spatial Association and spatial scan statistics of JE cases in mainland China at the county level during the four periods: 2002; 2003–2005; 2006; 2007–2010. The primary spatiotemporal cluster of JE was detected in Southwestern China between July and August, with the geographical range of JE transmission increasing over the past years. The results of LISA and spatial scan statistics were consistent which indicates that these methods are reliable and could have wider applications in the fields of disease surveillance and management in China, particularly in the surveillance and monitoring of other vector-borne diseases. These findings may assist in informing prevention and control strategies and increase the effectiveness of public health interventions against JE transmission. [ABSTRACT FROM AUTHOR]

Researches on the impact of common ions onto sediments are of great importance for the study of the heavy metal adsorption mechanisms. Considering the surface sediments from the relatively clean reach in the Baotou section of the Yellow River as the adsorbent, this work presents the impacts of common ions (Na+, Mg2+, K+, Ca2+, Cl−, SO4 2−, and NH4 +) on heavy metals (Cu2+, Zn2+, Cd2+, and Pb2+) adsorption. The experimental results reveal that the adsorptive capacities of the heavy metals are controlled by different adsorption mechanisms in different ion concentration ranges. With the increase of the ionic strength, the adsorption of the heavy metals increases for the compression of the electric double layer, whereas decreases for the decreasing of the ionic activities of the heavy metals. The competitive adsorption and complexations between the heavy metals and common ions are also important factors controlling the heavy metal adsorption. According to the experimental results and the real concentration of common ions in the Baotou section of the Yellow River, the increase of the concentrations of Na+, Mg2+, K+, and Ca2+ would cause the increase of Zn2+ adsorption and reduce the Zn pollution. The NH4 + from the industrial discharge of the tributaries has a strong impact on the heavy metal adsorption. [ABSTRACT FROM AUTHOR]

Acidithiobacillus ferrooxidans is an important microorganism used in biomining operations for metal recovery. Whole-genomic diversity analysis based on the oligonucleotide microarray was used to analyze the gene content of 12 strains of A. ferrooxidans purified from various mining areas in China. Among the 3100 open reading frames (ORFs) on the slides, 1235 ORFs were absent in at least 1 strain of bacteria and 1385 ORFs were conserved in all strains. The hybridization results showed that these strains were highly diverse from a genomic perspective. The hybridization results of 4 major functional gene categories, namely electron transport, carbon metabolism, extracellular polysaccharides, and detoxification, were analyzed. Based on the hybridization signals obtained, a phylogenetic tree was built to analyze the evolution of the 12 tested strains, which indicated that the geographic distribution was the main factor influencing the strain diversity of these strains. Based on the hybridization signals of genes associated with bioleaching, another phylogenetic tree showed an evolutionary relationship from which the co-relation between the clustering of specific genes and geochemistry could be observed. The results revealed that the main factor was geochemistry, among which the following 6 factors were the most important: pH, Mg, Cu, S, Fe, and Al. [ABSTRACT FROM AUTHOR]

The ventricular septal defect (VSD) is the most common congenital heart defect and no candidate susceptibility gene has been identified. Endocardial cushion and outflow septal morphogenesis, malalignment of which induces VSD, have been suggested to be mediated by the vascular endothelial growth factor (VEGF). Three single-nucleotide polymorphism (SNP) variants in promoter and 5′-UTR region of the VEGF gene, C−2578A (rs699947), G−1154A (rs1570360) and G−634C (rs2010963), were reported to alter its expression. We assessed the association in a Chinese population between these SNPs and VSD using a double approach: case–control and TDT designs. Among the three SNPs, only −634C allele was less frequently present in 222 patients compared to 352 controls (odds ratio: 0.76, 95% CI: 0.59–0.97, X2=5.06, P=0.024, not significant after a Bonferroni correction). This was significantly less transmitted to VSD patients (trios: 142) (odds ratio: 0.39, 95% CI: 0.25–0.62, X2=8.11, df=1, P=0.004, corrected P=0.024). A similar result was observed for haplotype −2578C/−1154G/−634C allele in both studies (in TDT: X2=7.51, df=1, P=0.006, corrected P=0.048). All these associations for the first time demonstrated that –634C allele was in a significant protective association against VSD, suggesting that VEGF dysregulation was involved in the pathological processes of VSD.European Journal of Human Genetics (2007) 15, 1246–1251; doi:10.1038/sj.ejhg.5201890; published online 11 July 2007 [ABSTRACT FROM AUTHOR]

Since few systematic studies have focused on recurrent acute pancreatitis in China, we sought to investigate its clinical features, including etiological factors and relative frequency. Patients were selected from a total 1471 patients with acute pancreatitis in ten cities of China. All had been admitted to a hospital with an attack of acute pancreatitis between January 1992 and December 2002. Data for each patient was recorded on a standardized form. Of the 1471 patients with acute pancreatitis, 157 (10.7%) had recurrent acute pancreatitis. The majority (63%) were male, with a mean age of 41 years (range, 13–82 years). Regarding the etiology, alcohol (20.4%) and cholelithiasis (20.4%) were the most frequent causes, followed by diet (13.4%), hypertriglyceridemia (8.3%), biliary tract infection (5.7%), other (5.1%), and idiopathic factors (26.8%). Alcohol was most frequent in male patients (30.3%), whereas cholelithiasis was most frequent (34.5%) in female patients. The majority of patients (79.6%) presented with their second attack of pancreatitis. Complications of recurrent acute pancreatitis in order of frequency were pancreatic pseudocyst, multiple organ failure, diabetes mellitus type 2, and shock. Recurrent acute pancreatitis remains a frequent disease, with cholelithiasis and alcohol being the most usual etiological factors. Alcohol is the primary etiological factor in male patients. In about 26.8% of cases, the etiology remains unknown. [ABSTRACT FROM AUTHOR]

Lichen-planus-like keratosis is usually diagnosed pathologically; rarely, a definitive diagnosis can be made grossly in the clinic. Only a few cases of lichen-planus-like keratosis have been reported in China. The purpose of this study was to investigate the clinical and pathological features of lichen-planus-like keratosis in China. Fifty cases of lichen-planus-like keratosis patients diagnosed pathologically during a 5-year period in our clinic were analyzed. Clinical features were recorded. Sectioned specimens were subjected to hematoxylin and eosin staining to observe pathological changes. Results showed that there were 34 males and 16 females (ratio 2:1) with an average age of 61.2 years. Most of the lesions were single papules or plaques with rough surfaces. They were distributed on the face, larger than 1 cm, and dark red to brown in color. Only one case (2%) was considered to be lichen-planus-like keratosis clinically. By hematoxylin and eosin staining, solar lentigo and solar elastosis could be found in 68% and 32% of lichen-planus-like keratosis lesions, respectively. Eosinophil (42%) and plasma cell (36%) infiltration was also found frequently. Exoerythrocytes could be detected in 50% of the cases. Lichen-planus-like keratosis is not uncommon in clinical practice in China, the diagnosis of lichen-planus-like keratosis should be made by a combination of clinical manifestations and pathological changes. It is better to classify lichen-planus-like keratosis as a benign skin tumor. More attention should be paid to lichen-planus-like keratosis in China. [ABSTRACT FROM AUTHOR]

Summary Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease discovered in China in 2009. In July 2013, the first human infection with SFTS virus (SFTSV) was detected in Shaanxi Province, Western China. Methods A seroprevalence study among humans was carried out in an SFTS endemic village; specifically, serum samples were collected from 363 farmers in an SFTS endemic village in Shaanxi Province. The presence of SFTSV antibodies in serum was determined using an ELISA. Results SFTSV antibodies were found in a total of 20 people (5.51%), with no significant difference between males and females (6.93% and 4.42%, respectively; Chi-square = 1.29, p = 0.25). Moreover, the SFTSV antibody positive rate was not significantly different across different age groups (Chi-square = 2.23, p = 0.69). Conclusions SFTSV readily infects humans with outdoor exposure. The results of the serological study indicate that the virus circulates widely in Shaanxi Province. SFTSV represents a public health threat in China. [ABSTRACT FROM AUTHOR]

A correction to the article "Geospatial Characteristics of Measles Transmission in China During 2005-2014" by Yan Yang et al. that was published in a 2017 issue is presented.

Dechloranes, including Dechlorane Plus (DP), Mirex (Dechlorane), Dechlorane 602 (Dec 602), Dechlorane 603 (Dec 603), and Dechlorane 604 (Dec 604), were determined using GC-MSD for water, sediment and oyster samples collected at 15 sampling sites near the Bohai and Huanghai Sea shore area of northern China in 2008. DP and Mirex were detected in most water, sediment, and oyster samples, which indicated widespread distribution of these two compounds. The mean concentrations in water, sediment and oyster samples, respectively, were 1.8 ng/L, 2.9 ng/g dry weight (dw) and 4.1 ng/g wet weight (ww) for total DP, and 0.29 ng/L, 0.90 ng/g dw, and 2.0 ng/g ww for Mirex. Dec 602 and Dec 603 were not detected in water but in small portions of the sediment and oyster samples, showing a low level of contamination by these two chemicals in the region. Strong and significant correlations were found between total DP and Mirex concentrations in water, sediment and oyster samples, probably suggesting similar local sources of these two chemicals. Dec 604 was not found in any samples. The biota-sediment accumulation factor (BSAF) of DP, Mirex, and Dec 602 declined along with the increase of their logarithm of octanol -- water partition coefficients (log Kow), possibly indicating that compounds with lower log Kow (like Mirex and Dec 602) accumulated more readily in biota. The mean fractional abundance of syn-D P (fsyn) was 0.34 in water samples, a value lower than that in Chinese commercial mixture (0.41), while the mean fsym for surface sediment (0.44) and oyster (0.45) samples were higher than technical values. Enrichment of syn-DP in oyster was in agreement with previously reported findings in Great Lakes fish. Enrichment of syn-DP in marine surface sediments, however, is contrary to data reported for fresh water sediments. To our knowledge this is the first report of Dec 602, Dec 603, and Dec 604 in a marine environment and also the first report of Dechloranes in marine biota. [ABSTRACT FROM AUTHOR]

The distribution of dechloranes, a group of chlorinated flame retardants, were investigated in air, soil, and sediment around a newly discovered Dechlorane Plus (DP) production facility in China (Anpon). To date, the only known DP manufacturing plant is located in Niagara Falls, NY (OxyChem). Dechloranes including DP, Dechlorane (Mirex), and the recently discovered Dechlorane 602 (Dec 602) were detected in air, soil, and sediment, while Dechlorane 603 and Dechlorane 604 were below detection limit in all matrices. DP air concentrations near the facility ranged from 7737 to 26734 pg m-3, the greatest reported thus far. Soil concentrations in the same area for DP, Dechlorane, and Dec 602 were 1490 ± 3580 ng g-1, 81.6 ± 96.5 ng g-1, and 7.24 ± 13.2 ng g-1 dry weight, respectively. Interestingly, lower concentrations of DP (4.93 ± 4.34 ng g-1), Dechlorane (30.2 ± 19.9 ng g-1), and Dec 602 (2.14 ± 2.23 ng g-1) were found in sediment from a nearby canal. Spatial trends of Dechlorane and Dec 602 in soil were similar to DP, implying that the DP manufacturing plant may also be a source of these other flame retardants. DP soil concentrations surrounding the facility decreased by an order of magnitude within 7.5 km. The syn-DP fractional abundance (fsyn) value (0.40) for the commercial DP product manufactured at Anpon was slightly higher than that (0.20-0.36) produced by OxyChem. The fsyn value in most air samples was largely similar to the Chinese commercial DP mixture, while most soil and sediment abundances were lower, suggesting a stereoselective depletion of syn-DP. [ABSTRACT FROM AUTHOR]

Abstract: The allele and haplotype frequencies of HLA-A, -B and -DRB1 loci in 10,000 healthy unrelated Han individuals living in the Guanzhong region of the Shaanxi Province were analyzed with the methods of SSO, SSP and SBT. Subsequently, these data were compared with results obtained in Han populations living in other regions as well as to other ethnic groups, using genetic distance measurements, neighbor-joining dendrograms and principal component analysis. In total 18 alleles were detected at the HLA-A locus, 46 alleles at the HLA-B locus and 14 alleles at the HLA-DRB1 locus. HLA-A*02 was the most common HLA-A allele (29.70%), followed by A*11 (18.70%), and A*24 (15.75%); whereas at the HLA-B locus, the allele with the highest frequency was HLA-B*13 (10.76 %), followed by B*46 (7.93%), B*51 (7.68%). At the HLA-DRB1 locus, the most common alleles were HLA-DRB1*15 (15.54%), DRB1*09 (13.18%) and DRB1*04 (11.21%). Three-loci haplotype analysis revealed that HLA A*30- B*13- DRB1*07 (4.11%), A*02 -B*46 -DRB1*09 (2.57%) and A*33 -B*58 -DRB1*17 (1.32%) were the most common haplotypes in this population. Four two-loci haplotypes, including HLA-A*30-B*43, A*30-B*53, B*43-DRB1*07 and B*73-DRB1*04 had significant linkage disequilibrium (relative linkage disequilibrium parameter equals to 1). Compared with other populations, our results indicated that the Han populations in different regions had a similar allelic diversity of HLA -A, -B, and -DRB1 loci. The Han population in the Guanzhong region of the Shaanxi Province had a close genetic relationship with the Northern and Southern Han populations. In summary, the similarities and differences of the HLA allelic diversity and haplotype structure between the Han population in the Guanzhong region and related populations, regarding HLA genotype distribution, provide basic information for further studies of the HLA heterogeneity and anthropological studies. [Copyright &y& Elsevier]

Abstract: Objectives: Rheumatic heart disease continues to be a common health problem in the developing countries. Though there is evidence indicating that rheumatic heart disease prevalence in China has decreased since the 1950s, no objective assessment of its present prevalence has been published. The study was designed to investigate the prevalence of chronic rheumatic heart disease in China. Methods: We performed a community population based investigation from October 2001 to February 2002 in nine communities of nine provinces in China by using a multistage, random sample design. Rheumatic heart disease was diagnosed by echocardiographic imaging. Long-axis views of the mitral valve, color flow recordings were used to search for mitral and aortic regurgitations. M-mode and two-dimensional short- and long-axis views of the aortic root and left atrium were recorded for supporting the diagnosis. Results: Of 9124 participants, 8652 completed the questionnaires and 8080 had comprehensive echocardiographic examinations. We found that 15 subjects had definite echocardiographic evidence of rheumatic heart disease. The rough prevalence of rheumatic heart disease was 186/100,000 adults (2 in 1000 adults). Conclusions: Rheumatic heart disease affected approximately 2 million middle-aged to elderly Chinese, thus constituting a significant health burden. We investigated only urban and suburban communities, the result may underestimate the real prevalence of the disease in China. [Copyright &y& Elsevier]

Glucose disturbances are a common comorbidity of major depressive disorder (MDD) patients and have been extensively studied in the past. However, few studies have explored glucose disturbances in first-episode drug-naïve (FEDN) MDD patients. The purpose of this study was to examine the prevalence and risk factors of glucose disturbances in FEDN MDD patients to understand the relationship between MDD and glucose disturbances in the acute early phase and provide important implications for therapeutic interventions. Using a cross-sectional design, we recruited a total of 1718 MDD patients. We collected their socio-demographic information, clinical data, and blood glucose indicators.17-item Hamilton Depression Rating Scale (HAMD), 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess their depression, anxiety, psychotic symptoms, respectively. The prevalence of glucose disturbances in FEDN MDD patients was 13.6%. Depression, anxiety and psychotic symptoms, body mass index (BMI) levels and suicide attempts rates were higher in the group with glucose disorders than in the group without glucose disorders among patients with first-episode drug-naive MDD. Correlation analysis showed that glucose disturbances were associated with HAMD score, HAMA score, BMI, psychotic symptoms and suicide attempts. Furthermore, binary logistic regression showed that HAMD score and suicide attempts were independently associated with glucose disturbances in MDD patients. Our findings suggest that the prevalence of comorbid glucose disturbances is very high in FEDN MDD patients. Moreover, more severe depressive symptoms and higher suicide attempts are correlated with glucose disturbances in MDD FEDN patients in the early stage., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: Real-word data on long-acting luteinizing hormone-releasing hormone (LHRH) agonists in Chinese patients with prostate cancer are limited. This study aimed to determine the real-world effectiveness and safety of the LHRH agonist, goserelin, particularly the long-acting 10.8-mg depot formulation, and the follow-up patterns among Chinese prostate cancer patients., Methods: This was a multicenter, prospective, observational study in hormone treatment-naïve patients with localized or locally advanced prostate cancer who were prescribed goserelin 10.8-mg depot every 12 weeks or 3.6-mg depot every 4 weeks with or without an anti-androgen. The patients had follow-up evaluations for 26 weeks. The primary outcome was the effectiveness of goserelin in reducing serum testosterone and prostate-specific antigen (PSA) levels. The secondary outcomes included testosterone and PSA levels, attainment of chemical castration (serum testosterone <50 ng/dL), and goserelin safety. The exploratory outcome was the monitoring pattern for serum testosterone and PSA. All analyses were descriptive., Results: Between September 2017 and December 2019, a total of 294 eligible patients received ≥ 1 dose of goserelin; 287 patients (97.6%) were treated with goserelin 10.8-mg depot. At week 24 ± 2, the changes from baseline [standard deviation (95% confidence interval)] in serum testosterone ( n = 99) and PSA ( n = 131) were -401.0 ng/dL [308.4 ng/dL (-462.5, -339.5 ng/dL)] and -35.4 ng/mL [104.4 ng/mL (-53.5, -17.4 ng/mL)], respectively. Of 112 evaluable patients, 100 (90.2%) achieved a serum testosterone level < 50 ng/dL. Treatment-emergent adverse events (TEAEs) and severe TEAEs occurred in 37.1% and 10.2% of patients, respectively. The mean testing frequency (standard deviation) was 1.6 (1.5) for testosterone and 2.2 (1.6) for PSA., Conclusions: Goserelin 10.8-mg depot effectively achieved and maintained castration and was well-tolerated in Chinese patients with localized and locally advanced prostate cancer., Competing Interests: This study was funded by AstraZeneca China. The sponsor was involved in study design, data analysis and interpretation, and writing the report. The manuscript was written with editorial support from medical writers. No other potential conflicts of interests are disclosed by authors., (Copyright © 2023 Cancer Biology & Medicine.)

Over the past two decades, China has experienced a significant decline in birth rates, accompanied by a decrease in fertility and changes in major congenital defects. The development of assisted reproductive technology (ART) has brought hope to individuals facing infertility. However, some issues related to reproductive health and congenital defects have arisen. The reasons for the changing profiling of birth defects and the relationship between the decline in fertility and ART need to be further investigated. Lifestyle factors such as nutritional supplementation need to be altered to protect reproductive capacity. Birth defects, such as congenital heart defects and hypospadias, may serve as a signal for understanding the decline in fertility. To improve fertility, the factors contributing to it need to be identified, vital genetic and medical technologies need to be introduced, and environmental interventions, such as nutritional changes, need to be implemented.

The disturbance of reactive nitrogen (N) on ecosystems and biogeochemical cycles is now one of the most severe environmental problems worldwide. Nitrate (NO 3 - ) is usually a dominant reactive N species in river ecosystems. Excessive NO 3 - concentrations in rivers have led to eutrophication and consequent ecological and environmental damages. Quantifying catchment-scale NO 3 - yield and export dynamics is crucial for effective remediation of river NO 3 - pollution. Frequently, natural abundance isotopes of NO 3 - in a river (δ 15 N/δ 18 O-NO 3 - ) are applied to identify sources and potential transformations of NO 3 - at a catchment scale, while microbial molecular techniques and 15 N pairing experiments are employed to reveal the NO 3 - production and removal processes and their underlying mechanisms in microenvironments (e.g., sediments and soils). In this study, we developed a novel protocol that couples these complementary geochemical and molecular techniques to quantify catchment-scale NO 3 - yield and fluvial export dynamics. The protocol links microscopic processes with catchment-scale geochemical characteristics to explicitly describe the NO 3 - cycling processes and their underlying abiotic and biotic mechanisms within a catchment. We applied the protocol to the Dadu and Jiazela catchments on the Qinghai-Tibet Plateau, and demonstrated the effectiveness of the protocol in determining NO 3 - yield and export dynamics in the catchments., Competing Interests: Declaration of competing interest We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Elevated riverine nitrate (NO 3 - ) levels have led to increased eutrophication and other ecological implications. While high riverine NO 3 - levels were generally ascribed to anthropogenic activities, high NO 3 - levels in some pristine or minimally disturbed rivers were reported. The drivers of these unexpectedly high NO 3 - levels remain unclear. This study combined natural abundance isotopes, 15 N-labeling techniques, and molecular techniques to reveal the processes driving the high NO 3 - levels in a sparsely populated forest river. The natural abundance isotopes revealed that the NO 3 - was mainly from soil sources and that NO 3 - removal processes were insignificant. The 15 N-labeling experiments also quantitatively showed that the biological NO 3 - removal processes, i.e., denitrification, dissimilatory NO 3 - reduction to ammonium (DNRA), and anaerobic ammonia oxidation (anammox), in the soils and sediments were weak relative to nitrification in summer. While nitrification was minor in winter, the NO 3 - removal was insignificant relative to the large NO 3 - stock in the catchment. Stepwise multiple regression analyses and structural equation models revealed that in summer, nitrification in the soils was regulated by the amoA-AOB gene abundances and NH 4 + -N contents. Low temperature constrained nitrification in winter. Denitrification was largely controlled by moisture content in both seasons, and anammox and DNRA could be explained by the competition with nitrification and denitrification on their substrate (nitrite-NO 2 - ). We also revealed the strong hydrological control on the transport of soil NO 3 - to the river. This study effectively revealed the mechanisms underlying the high NO 3 - levels in a nearly pristine river, which has implications for the understanding of riverine NO 3 - levels worldwide., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: The impact of intergenerational caregiving on the mental health of providers remains a controversial topic, especially in countries like China where it is prevalent. Given the country's aging population and recent liberalization of the two-child policy, understanding the effects of intergenerational caregiving on the mental health of middle-aged and older adult(s) individuals is crucial. This study aimed to explore the impact of intergenerational caregiving on mental health among middle-aged and older adult(s) individuals., Methods: We analyzed data from the China Health and Aging Tracking Survey (CHARLS) 2013, consisting of 6602 participants finally. Personal information, family structure, financial support, health status, and physical measurements were selected for analysis. Correlation and regression analyses were used for relationships among variables controlling for potential confounding variables. Mental health status was evaluated using the depression self-rating scale., Results: There is a significant positive effect of intergenerational care on the mental health of middle-aged and older adult(s) people. Additionally, we re-profiled intergenerational care variables by considering the number and length of intergenerational caregivers, and found that the effects remained significant. Furthermore, the effects of intergenerational care vary across subgroups based on gender, age, nature of usual residence, marital status, and physical health status. Finally, we identified two mechanisms through which intergenerational caregiving positively affects mental health: intergenerational financial support and intergenerational spiritual support., Discussion: These findings have important implications for policymakers, healthcare professionals, and family members in promoting the mental health of middle-aged and older adult(s) individuals in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yan, Wu, Chen, Xu, Yu and Li.)

Urban rivers are often characterized by high nitrate (NO 3 - ) loadings. High NO 3 - loadings cause water quality and ecological damages, which undermines the sustainable development of cities. To date, the drivers of these high NO 3 - loadings remain unclear. This study, for the first time, integrated natural-abundance isotopes (δ 15  N/δ 18 O-NO 3 - and δD/δ 18 O-H 2 O) and 15 N-pairing techniques to comprehensively reveal the anthropogenic impacts on the NO 3 - pollution in an urban river. Natural-abundance isotopes suggested that in both the wet and dry seasons, the NO 3 - was predominantly from the conservative mixing of different sources, and biological NO 3 - removal was minor. The 15 N-pairing experiments supported the natural-abundance isotope data, quantitatively showing that in-soil nitrification was prevailing, while NO 3 - removal processes (denitrification, anammox, and dissimilatory NO 3 - reduction to ammonium) were weak. A Bayesian isotope-mixing model showed that soil sources (soil organic nitrogen and chemical fertilizer) dominated the NO 3 - in the upper reaches, while in the lower reaches, the impermeable riparian zone short-circuited the access of soils to the river. Here, the wastewater treatment plants became a significant source of NO 3 - . This study quantitatively revealed the drivers of high NO 3 - loadings in an urban river, and generated important clues for effective NO 3 - pollution control and remediation in urban rivers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Rationale & Objective: Increasing evidence has linked ambient fine particulate matter (ie, particulate matter no larger than 2.5 μm [PM 2.5 ]) to chronic kidney disease (CKD), but their association has not been fully elucidated, especially in regions with high levels of PM 2.5 pollution. This study aimed to investigate the long-term association of high PM 2.5 exposure with incident CKD in mainland China., Study Design: Prospective cohort study., Setting & Participants: 72,425 participants (age ≥18 years) without CKD were recruited from 121 counties in Hunan Province, China., Exposure: Annual mean PM 2.5 concentration at the residence of each participant derived from a long-term, full-coverage, high-resolution (1 × 1 km 2 ), high-quality dataset of ground-level air pollutants in China., Outcomes: Incident CKD during the interval between the baseline examination of each participant (2005-2017) and the end of follow-up through 2018., Analytical Approach: Cox proportional hazards models were used to estimate the independent association of PM 2.5 with incident CKD and the joint association of PM 2.5 with temperature or humidity on the development of PM 2.5 -related CKD. Restricted cubic splines were used to model exposure-response relationships., Results: Over a median follow-up of 3.79 (IQR, 2.03-5.48) years, a total of 2,188 participants with incident CKD were identified. PM 2.5 exposure was associated with incident CKD with an adjusted hazard ratio of 1.71 (95% CI, 1.58-1.85) per 10-μg/m 3 greater long-term exposure. Multiplicative interactions between PM 2.5 and humidity or temperature on incident CKD were detected (all P < 0.001 for interaction), whereas an additive interaction was detected only for humidity (relative risk due to interaction, 3.59 [95% CI, 0.97-6.21])., Limitations: Lack of information on participants' activity patterns such as time spent outdoors., Conclusions: Greater long-term ambient PM 2.5 pollution is associated with incident CKD in environments with high PM 2.5 exposure. Ambient humidity has a potentially synergetic effect on the association of PM 2.5 with the development of CKD., Plain-Language Summary: Exposure to a form of air pollution known as fine particulate matter (ie, particulate matter ≤2.5 μm [PM 2.5 ]) has been linked to an increased risk of chronic kidney disease (CKD), but little is known about how PM 2.5 affects CKD in regions with extremely high levels of PM 2.5 pollution. This longitudinal cohort study in China investigates the effect of PM 2.5 on the incidence of CKD and whether temperature or humidity interact with PM 2.5 . Our findings suggest that long-term exposure to high levels of ambient PM 2.5 significantly increased the risk of CKD in mainland China, especially in terms of cumulative average PM 2.5 . The associations of PM 2.5 and incident CKD were greater in high-humidity environments. These findings support the recommendation that reducing PM 2.5 pollution should be a priority to decrease the burden of associated health risks, including CKD., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the association between serum leucine (leu) and diabetic retinopathy (DR) in patients with type 2 diabetes (T2D) and then to analyze the influence of gender on the association., Method: The electronic medical records of 1,149 T2D patients who met inclusion and exclusion criteria were retrieved from the Second Affiliated Hospital of Dalian Medical University and the First Affiliated Hospital of Jinzhou Medical University. Serum leu levels of all subjects were measured by liquid chromatography-mass spectrometry. Logistic regression was used to obtain the odds ratio (OR) and CI of leu-DR risk in multiple models. When using these models, restricted cubic spline (RCS) was used to test the potential non-linear relationship between multiple continuous independent variables, such as leu and DR (classification), and dependent variables. We also used the additive interaction method to evaluate the interaction effect between leu and gender on DR., Results: Leu was a protective factor of DR [0.78 (0.66, 0.92)]. When gender was divided into male and female, the above relationship was statistically significant only in men [0.73 (0.58, 0.94)]. Three indicators of additive interaction-RERI, AP, and S-suggested that there is no interaction between gender and leu on the risk of DR., Conclusions: Male T2D patients with high leu levels may have a lower risk of DR., Competing Interests: Authors BH, M-LL, and X-TC were employed by the company Dalian Runsheng Kangtai Medical Lab Co. Ltd. Author Y-FC was employed by Shanghai Engineering Research Center of Reproductive Health Drug and Devices. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Huang, Liu, Cui, Cao and Gao.)

Genetic factors play a crucial role for the pathophysiology of treatment-resistant depression (TRD). It has been established that Catechol-O-methyltransferase (COMT) and cyclic amp-response element-binding protein (CREB) are associated with antidepressant response. The aim of this study was to explore the association between single nucleotide polymorphisms (SNPs) in COMT and CREB1 genes and TRD in a Chinese population. We recruited 181 patients with major depressive disorder (MDD) and 80 healthy controls, including 81 TRD patients. Depressive symptoms were assessed with the Hamilton Depression Rating Scale-17 (HDRS). Genotyping was performed using mass spectrometry. Genetic analyses were conducted by PLINK Software. The distribution of COMT SNP rs4818 allele and genotypes were significantly different between TRD and controls. Statistical differences in allele frequencies were observed between TRD and non-TRD groups, including rs11904814 and rs6740584 in CREB1 gene, rs4680 and rs4818 in COMT gene. There were differences in the distribution of HDRS total scores among different phenotypes of CREB1 rs11904814, CREB1 rs6740584, COMT rs4680 and rs4818. Gene-gene interaction effect of COMT-CREB1 (rs4680 × rs6740584) revealed significant epistasis in TRD. There findings indicate that COMT and CREB1 polymorphisms influence the risk of TRD and affect the severity of depressive symptoms of MDD., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Abstract: The identification of single-nucleotide polymorphisms (SNPs) in genes putatively related to pathophysiological processes in major depressive disorder (MDD) might improve both diagnosis and personalized treatment strategies eventually leading to more effective interventions. Considering the important role of the glucocorticoid receptor and the related FK506 binding protein 51 (FKBP51) in the pathophysiology of MDD, we aimed to investigate putative associations between variants of FKBP5, the coding gene of FKBP51, with antidepressant treatment resistance and MDD susceptibility.Nine common SNPs of the FKBP5 gene prioritized based on location and, putative or known functions were genotyped in Han Chinese population, including MDD patients with or without antidepressant-treatment resistance and healthy controls. Associations of FKBP5 SNPs with MDD susceptibility and treatment response were examined in the whole group of MDD patients, as well as in subgroups stratified by antidepressant treatment resistance, compared with healthy controls.In total, 181 Han Chinese patients with MDD and 80 healthy controls were recruited. No significant SNP or haplotype associations were observed in the whole patient group. There were nominal significant differences both for the haplotype block with SNPs in strong LD (r2 > 0.8, P = .040) and haplotype block with SNPs in moderate LD (r2 > 0.1, P = .017) between the haplotype distributions of patients with antidepressant treatment resistance (n = 81) and healthy controls, but both significances did not survive multiple testing correction. Furthermore, no specific haplotype could be observed causing a significant difference in any combination between all comparisons.No associations were observed of FKBP5 variants with MDD or antidepressant treatment response. The lack of associations might be due to the relatively small sample size of this study (power ranged from 0.100 to 0.752). A follow-up study will need larger, better phenotyped, and more homogeneous samples to draw a definitive conclusion regarding the involvement of this gene in MDD., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Apurinic/apyrimidinic endonuclease 1/redox-factor 1 (APE1/Ref-1) gene encodes a multifunctional protein involved in the DNA base excision repair (BER) pathway, which initiates repair of apurinic/apyrimidinic (AP) sites in DNA by catalyzing hydrolytic incision of the phosphodiester backbone. APE1/Ref-1 polymorphisms are related to the occurrence of neural tube defects (NTDs), but the association between APE1/Ref-1 polymorphisms and NTDs is not reported in Chinese Han population. The aim of the present study was to evaluate the association of APE1/Ref-1 polymorphism and the risk of NTD occurrence for Han population in a high-risk area of China. APE1/Ref-1 genotypes were determined by iPLEX Gold SNP genotyping. AP sites and folate level of brain tissues were measured. The results showed that three polymorphisms (rs3136817, rs77794916, and rs1760944) of APE1/Ref-1 were statistically associated with NTD subtypes. Allele C of rs3136817, allele T of rs77794916, and allele G of rs1760944 were associated with an increased risk for encephalocele (OR = 2.52, 95% CI [1.25-5.07], P < 0.01; OR = 1.80, 95% CI [1.04-3.12], P = 0.04; and OR = 1.96, 95% CI [1.12-3.45], P = 0.02), compared with those harboring the alleles T, C, and T, respectively. The folate level in NTDs was lower than that in controls. DNA AP sites in the encephalocele were significantly higher than the control (P < 0.01). The three polymorphisms of APE1/Ref-1 were significantly related to NTD occurrence, which indicated that APE1/Ref-1 might be a potential genetic risk factor for encephalocele in a high-risk area of NTDs in China., (© 2021. Society for Reproductive Investigation.)

Monoclonal gammopathy of renal significance (MGRS) is a pathological state which presents with a spectrum of renal lesions. MGRS is characterized by pathogenic monoclonal immunoglobulins or light chains produced by a premalignant plasma cell or B cell clone. In view of inadequate understanding in the past, the low detection rate of MGRS often results in poor outcomes and reduces quality of life of patients. Thus, MGRS stands for a group of clinical refractory renal diseases. To date, no standard treatment strategy for MGRS is available. Current consensus suggests a clone-directed approach that aims to eradicate the offending clone, but its long-term prognosis is not clear. In this article, we discuss the diagnostic methods, highlight treatment advances, and introduce integrated Chinese and Western medicine in the management of MGRS., (© 2021. The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.)

A comprehensive method for the evaluation of Acanthopanax senticosus (AS) was established by the quantitative analysis of multiple components by single marker (QAMS), fingerprint, similarity analysis (SA), hierarchical cluster analysis (HCA), and factor analysis (FA) based on high performance liquid chromatography (HPLC). A total of 27 common peaks were identified in the standard fingerprint of 20 batches of AS from different regions in China, of which 8 peaks were identified as protocatechuic acid, syringin, chlorogenic acid, caffeic acid, eleutheroside E, hyperoside, isofrqxidin, and acacetin, and the concentrations of these eight components were determined simultaneously by QAMS. The results showed that the QAMS method was effective and feasible compared with the external standard method (ESM) (RD < 3.3 %, P ≤ 0.01). Sample 1 (S1) was used as the reference chromatogram, the similarity of other samples was between 0.765 and 0.968. Through HCA, AS could be mainly divided into two production areas, the north Liaoning (including Liaoning) and the south Liaoning areas. Furthermore, FA showed that the quality of AS in the north Liaoning area was better than that in the south Liaoning area. In summary, the method established in this study can comprehensively and systematically evaluate quality differences in AS samples, and may be used to help to improve the quality control of AS., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

To establish an effective nomogram for predicting in-hospital mortality of COVID-19, a retrospective cohort study was conducted in two hospitals in Wuhan, China, with a total of 4,086 hospitalized COVID-19 cases. All patients have reached therapeutic endpoint (death or discharge). First, a total of 3,022 COVID-19 cases in Wuhan Huoshenshan hospital were divided chronologically into two sets, one (1,780 cases, including 47 died) for nomogram modeling and the other (1,242 cases, including 22 died) for internal validation. We then enrolled 1,064 COVID-19 cases (29 died) in Wuhan Taikang-Tongji hospital for external validation. Independent factors included age (HR for per year increment: 1.05), severity at admission (HR for per rank increment: 2.91), dyspnea (HR: 2.18), cardiovascular disease (HR: 3.25), and levels of lactate dehydrogenase (HR: 4.53), total bilirubin (HR: 2.56), blood glucose (HR: 2.56), and urea (HR: 2.14), which were finally selected into the nomogram. The C-index for the internal resampling (0.97, 95% CI: 0.95-0.98), the internal validation (0.96, 95% CI: 0.94-0.98), and the external validation (0.92, 95% CI: 0.86-0.98) demonstrated the fair discrimination ability. The calibration plots showed optimal agreement between nomogram prediction and actual observation. We established and validated a novel prognostic nomogram that could predict in-hospital mortality of COVID-19 patients.

Aims: Radiotherapy has become a basic treatment modality for head and neck cancer. However, radiotherapy results in inevitable side effects, particularly radiation sialadenitis, that significantly impairs quality of life. A previous study indicated that nerve growth factor (NGF) has a radio-protective effect, but the mechanism was not determined in salivary glands. In this study, we explored the functional role and mechanism regarding how NGF protects salivary glands against IR-induced damage., Main Methods: Human salivary gland (HSG) cells and C57BL/6 mice were selected to establish an IR-induced salivary gland damage model in vitro and in vivo. Recombinant NGF protein and NGF siRNA and over-expression plasmids were applied to manipulate NGF expression in vitro. AAV-NGF was retrogradely perfused into the submandibular gland (SMG) through the SMG duct to manipulate NGF expression in vitro. Small-molecule inhibitors and siRNAs were applied to inhibit AKT and JNK. Western blotting, quantitative PCR, flow cytometry and histology assays were performed to analyse the functional role and mechanism of NGF., Key Findings: Our study demonstrated that NGF expression was upregulated following radiotherapy both in human HSG cells and mouse SMG tissues. NGF could reduce IR-induced HSG cell apoptosis, and AAV-mediated gene therapy could restore the salivary flow rate and protect the salivary gland against IR-induced apoptosis in vivo. Mechanistically, NGF protects salivary glands from IR-induced apoptosis by de-phosphorylating JNK kinase rather than promoting AKT phosphorylation., Significance: The current study findings indicated that the modulation of the NGF pathway might prevent IR-induced salivary hypo-function., (Copyright © 2020. Published by Elsevier Inc.)

Background: Psoriasis is a chronic inflammatory skin disease, affecting about 0.6% of the Chinese population. Many patients are not well controlled by conventional treatments, thus there is need for new treatment regimens. In this study, we assessed the efficacy and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis., Methods: This study was a 52-week, multicentre, randomized, double-blind, placebo-controlled, parallel-group, Phase 3 trial. A sub-population of study participants (≥18 years) of Chinese ethnicity were randomized to receive subcutaneous injections of 300 or 150 mg secukinumab, or placebo. The co-primary endpoints were psoriasis area severity index (PASI) 75 and Investigator's Global Assessment (IGA) 0/1 at Week 12., Results: A total of 441 Chinese patients were enrolled in this study. Co-primary outcomes were achieved; 300 and 150 mg secukinumab were superior to placebo as shown in the proportion of patients that achieved PASI 75 (97.7% and 87.2% vs. 3.7%, respectively; P < 0.001), and IGA 0/1 (82.3% and 69.7% vs. 2.7%; P < 0.001) at Week 12. Treatment efficacy was maintained until Week 52. There was no increase in overall adverse events with secukinumab relative to placebo throughout the 52-week period., Conclusion: Secukinumab is highly effective and well tolerated in Chinese patients with moderate to severe plaque psoriasis., Trial Registration: ClinicalTrials.gov, NCT03066609; https://clinicaltrials.gov/ct2/show/record/NCT03066609.