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Although the planktonic eukaryotic community (PEC) is an important component of freshwater ecosystems and plays an important ecological role, the impact of artificial water ecological modification on PEC has not been fully evaluated. To analyze the impact of lotus planting on the structure of PEC in urban park ponds, in this study, we analyzed the differences in PECs in different regions (artificial fountain region, potted lotus region, and direct lotus planting region) of an urban pond in subtropical China before and after lotus planting in the short term (~10 d) and for more than a month. Our results indicated that more than a month after planting lotuses, there were evident differences in the compositions of PECs in the three regions. Although there was no significant difference in operational taxonomic unit number and Chao1 indices before and after planting lotuses, planting lotuses significantly increased the Shannon index of the PECs. Moreover, different planting modes of lotuses can alter the structure of PECs after more than a month of growth, and planting lotuses can continuously strengthen the interconnection of various organisms in the PECs. These results expand our understanding of the impacts of artificial ecological modifications on the structure of PECs in urban ponds. [ABSTRACT FROM AUTHOR]

In order to explore the absorption capacity of Suaeda heteroptera for heavy metals in coastal wetlands under tidal conditions, a tidal simulation device for Suaeda heteroptera habitat was designed based on the field conditions of Red Beach in China to investigate the absorption capacity of Suaeda heteroptera at different growth stages for heavy metals. The results showed that the on-site data monitoring at the Red Beach of Panjin in China revealed that zinc had the highest detected values in the water, sediment, and Suaeda heteroptera samples, and the absorption of heavy metals followed the order of Zn > Pb > Cu. Under tidal simulation conditions, the maximum absorption values of copper, lead, and zinc by Suaeda heteroptera at different growth stages were in the order of Zn > Pb > Cu, with metal content of 59.72 mg/kg, 46.73 mg/kg, and 15.70 mg/kg, respectively. These findings were consistent with the trend observed in the on-site monitoring data, and the values in the early growth stage were higher than those in the later growth stage. This result reveals the absorption capacity of Suaeda heteroptera for heavy metals and provides a theoretical basis and data support for wetland ecological restoration. [ABSTRACT FROM AUTHOR]

In recent years, a large number of microplastics (MPs) appeared in the aquatic environment, causing serious pollution. In order to study the influence of MP concentrations on freshwater zooplankton, polystyrene microspheres (PS) of 0.5 μm were used in this study as experimental reagents, and Moina macrocopa, which was dominant zooplankton in the Pearl River Basin of China, was selected as the experimental object. The experiment was divided into four treatment groups plus a control group, and it was conducted for 15 days. The treatment groups had MP concentrations of 10, 10², 10³ and 104 pieces/mL. The survival time, reproduction rate, the total offspring, and the time of first pregnancy of Moina macrocopa were counted every day, and the intrinsic growth rate, generation time, and net reproduction rate were calculated. The results showed that the survival time of Moina macrocopa decreased with the increase of the MP concentration, and the MP concentration had more influence on the reproduction rate. Except for the 10 pieces/mL treatment group, no reproduction occurred in other treatment groups, and the reproduction rate gradually decreased with the increase of age. The life table showed that only the control group and the 10 pieces/mL treatment group had an intrinsic growth rate, and the intrinsic growth rate of the treatment group was far lower than that of the control group. Our experimental results provide basic data and a theoretical basis for further understanding the toxic effects of MPs on freshwater zooplankton. [ABSTRACT FROM AUTHOR]

Objective: Surgical management is the mainstay of treatment for tumours in the parapharyngeal space. This study aimed to evaluate the indications, limits and technical nuances of the endoscopic transoral approach. Method: Thirteen patients with parapharyngeal space tumours that were treated between May 2017 and November 2020 were included in this retrospective study. Results: All patients underwent surgery for complete oncological resection except one patient who received treatment for diagnostic purposes. No major complications were reported, with excellent control of the vital structures of the parapharyngeal space. Conclusion: The endoscopic transoral approach to the parapharyngeal space is a promising alternative approach for selected parapharyngeal space tumours with satisfactory outcomes. [ABSTRACT FROM AUTHOR]

The effects of long-term fertilization on soil organic carbon (SOC), total nitrogen (TN), and soybean yield stability were studied in semiarid areas of China for optimizing soil fertilization and obtaining stable and efficient soybean yield. SOC, TN, and soybean yields in different soil layers were measured after performing nine fertilization treatments for 5 consecutive years. The results showed that CK treatment (1,264.2 kg·hm-2) was significantly lower than other treatments. Under the combination of organic and inorganic treatments, the interannual variation of soybean yield under treatment with organic fertilizer combined with nitrogen and phosphate fertilizer was smaller, while the stability and sustainability indices were higher. The organic carbon and TN contents in surface soil (0-20 cm) showed an increasing trend with different fertilization. There was a significant positive linear correlation between SOC and TN contents in topsoil (0-20 cm) (P < 0.01; correlation coefficient = 0.947**). The yield of soybean increased with the increase of SOC and TN contents in topsoil (0-20 cm), with a significant positive correlation between them (P < 0.05). The yield of soybean increased with the increase of SOC and TN contents in surface soil (20-40 cm), although no significant positive correlation between SOC and TN contents was observed. [ABSTRACT FROM AUTHOR]

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To define the role of organic or inorganic fertilizers in the stability and sustainability of soil organic carbon (SOC) and crop yield, we examined changes in SOC and crop yield, as well as their correlation, in nine different fertilization treatments (sheep manure [M], sheep manure and urea [MN], sheep manure and diammonium phosphate [MP], sheep manure, urea, and diammonium phosphate [MNP], urea and diammonium phosphate [NP], urea and potassium sulfate [NK], diammonium phosphate and potassium sulfate [PK], diammonium phosphate, urea, and potassium sulfate [NPK], no fertilizer [CK]) from 2015 to 2018 on the Loess Plateau. The organic carbon content was higher in organic fertilizer (M, MNP, MP, MN) than in inorganic fertilizer treatments (NP, NPK, NK, PK) and the control. Crop yield was higher for organic than for inorganic fertilizers, whereas that of the control was always lower than those in the fertilization treatments. The highest crop yield was obtained in MNP. Crop yield and soil organic matter quality score correlated positively, with correlation coefficients ranging from 0.5994 to 0.7151. Our results provide a theoretical basis for organic and inorganic fertilizer application in dry farming areas on the Loess Plateau and aid the long-term healthy development of soil in cultivated areas. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence of urinary incontinence (UI), including its subtypes stress UI (SUI), urgency UI (UUI) and mixed UI (MUI), and to examine risk factors for de novo SUI and UUI in Chinese women. Design: Nationwide longitudinal study. Setting: Six geographic regions of China. Participants: Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method. Methods: This study was conducted between May 2014 and March 2016, with follow up in 2018. Data on demographics, medical history, lifestyle and physiological and anthropometric information were collected. Main outcome measurements: Incidence, rate ratio (RR). Results: Analyses included 24 985 women (mean age 41.9 years).The follow‐up response rate was 55.5%, median follow‐up time was 3.7 years. The standardised incidences of UI, SUI, UUI and MUI were 21.2, 13.1, 3.0 and 5.1 per 1000 person‐years, respectively. Risk factors for de novo SUI included delivery pattern (vaginal spontaneous delivery RR 2.12, 95% CI 1.62–2.78 and instrumental delivery RR 3.30, 95% CI 1.99–5.45), high body mass index (BMI) (overweight RR 1.52, 95% CI 1.33–1.74 and obesity RR 1.67, 95% CI 1.32–2.11), cigarette smoking (RR 1.54, 95% CI 1.12–2.12), chronic cough (RR 1.44, 95% CI 1.17–1.76), diabetes (RR 1.33, 95% CI 1.10–1.60) and older age (50–59 years RR 1.49, 95% CI 1.16–1.90 and 60–69 years RR 1.61, 95% CI 1.22–2.13).The risk factors significantly associated with de novo UUI were age (RR increased from 1.21, 95% CI 0.74–1.99, at 30–39 years to 6.3, 95% CI 3.85–10.30, at >70 years) and diabetes (RR 1.48, 95% CI 1.05–2.09). Conclusions: The incidence of female UI is 21.2 per 1000 person‐years in China. Delivery (vaginal spontaneous delivery, instrumental delivery), high BMI, cigarette smoking, chronic cough, diabetes and older age were risk factors. The incidence of female urinary incontinence was 21.2 per 1000 person‐years in China. Delivery, BMI, diabetes and old age are risk factors. The incidence of female urinary incontinence was 21.2 per 1000 person‐years in China. Delivery, BMI, diabetes and old age are risk factors. [ABSTRACT FROM AUTHOR]

To explore the spatial and temporal distribution characteristics of phytoplankton functional groups (PFGs) of the Dongta spawning grounds in the Pearl River, China, quarterly surveys of this area were carried out during March, 2016 to December, 2018, and the ecological status was analyzed and evaluated according to PFGs assemblage index (Q index). 26 PFGs were identified, and the dominant PFGs were C, D, J, K, L0, MP, N, P, S1, S2, T, W1, W2, X2, Y in this area. Phytoplankton Q indexes varied from 1.83 to 3.73, with the mean value 2.91, which showed that the ecological status of the Dongta spawning grounds was “medium” and “good”, but parts occasionally were “tolerable”. Temporally, the general ecological status was good in March and June, but it was medium in September and December. Basing on our study, the results showed that: (1) factors including water velocity (V), DO, Chla, phosphate, oxidation reduction potential, total phosphorus, electrical conductivity, total dissolved solid and salinity were significantly correlated with the dominant PFGs; (2) the phytoplankton Q index was significantly correlated with the V. It was suggested that after the construction and operation of Datengxia Water Dam and its upper reaches cascade dams, attention should be paid to regulate the water flow and velocity in the lower reaches of the river by means of ecological operation, so as to ensure the functions of the spawning grounds and protect the fishery conservation zones in the mainstream of the Pearl River. [ABSTRACT FROM AUTHOR]

Objectives: The frail elderly have an increased risk of frailty because of reduced physical activity, cognitive ability and quality of life. This study aims to evaluate the effects of integrated exercise intervention on the attenuation of frailty in elderly nursing home residents. Design: This study was a cluster randomized controlled trial. SETTING AND PARTICIPANTS: 146 elderly frailty people from 8 elderly nursing homes in Harbin, China, were randomly assigned into the intervention group and control group after obtaining their informed consent. Intervention: The intervention group performed integrated exercise interventions for 12 months, while the control group only continued with their daily activities. Measurements: Sociodemographic, health-related data, frailty levels, gait parameters, cognition, and quality of life were evaluated. Results: The mean age of participants was 80.74± 2.89 years, and 70.37% (n=95) were female. The Difference-in-difference regression showed that, compared with the control group, phenotypic frailty score (β3 =−1.40, p < 0.001) and stride time (β3 = −0.38, p < 0.001) decreased significantly in the intervention group, stride velocity (β3 = 0.24, p < 0.001), step length (β3 = 0.08, p <0.001), cadence (β3 = 17.79, p < 0.001), MMSE total score (β3 = 1.90, p < 0.001) and QOL total score (β3 = 11.84, p < 0.001) increased significantly in the intervention group. Conclusion: The integrated exercise intervention can effectively improve the attenuation of frailty, gait parameters, cognitive function, and quality of life in elderly nursing homes. We can use the findings of this study as a reference for the design of activities for the elderly nursing home residents, to provide them with appropriate exercises, improve their physical functions, and improve or delay their frailty level, which is principally important for developing countries in east Asia where rehabilitation resources are generally scarce. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence, risk factors and burden of symptomatic pelvic organ prolapse (POP) in adult Chinese women.Design: A nationwide cross-sectional study.Setting: Six geographic regions of mainland China.Participants: Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method from February 2014 through March 2016.Methods: We conducted a nationwide epidemiological survey. 'Symptomatic POP' was determined by a screening questionnaire and physical examination.Main Outcome Measurements: Prevalence, odds ratio (OR).Results: A total of 55 477 women (response rate, 92.5%; mean age, 45.1 years old) were included. The prevalence of symptomatic POP was 9.6% (95% CI 9.3-9.8%) and it increased with age in each stage (P < 0.05). Symptomatic POP-Q stage II, which mainly involved anterior compartment prolapse, was the most common (7.52%). Minor/moderate burden of symptomatic POP was the most common, with a prevalence of 9.7% (95% CI 9.5-10.0%). The odds for each type of symptomatic POP increased with age (>50 vs 20-29 years old in symptomatic POP-Q stage II or higher, OR increased from 1.34 [95% CI 1.32-1.45] to 7.34 [95% CI 4.34-12.41]) and multiple vaginal deliveries (multiparous [≥3] vs nulliparous in symptomatic POP-Q stage II or higher, OR increased from 1.91 [1.71-2.13] to 2.78 [2.13-3.64]).Conclusions: We found a lower prevalence of symptomatic POP than that found in other surveys. The main type of symptomatic POP was anterior compartment prolapse, indicating that it should be considered first. Older age and multiple vaginal deliveries increased the odds of each type of symptomatic POP.Tweetable Abstract: The prevalence of female symptomatic pelvic organ prolapse (POP) was 9.6% in China. It is related to old age and multiple vaginal deliveries. [ABSTRACT FROM AUTHOR]

Although infection rates may increase after relaxation of the zero COVID strategy, the extensive vaccination campaign in China could potentially curb the spread of COVID-19, which may be associated with a low level of risk perception and post-traumatic stress symptoms (PTSS). However, the relationship between vaccination, risk perception and PTSS has not been studied extensively. This study aims to examine the associations between the number of COVID-19 vaccine doses, consistency in the type of each dose and time since vaccination with PTSS, and the mediating role of risk perception on such relationships in China. Cross-sectional sampling with a self-report questionnaire was used to measure vaccination, PTSS and risk perception. The survey was conducted in Beijing, China, from 13 January to 9 February 2023. Linear regression analyses were conducted to test the relationship between vaccination, risk perception and PTSS. The analysis included 55,803 individuals. In total, 72.86 % of participants received two doses of the COVID-19 vaccine. Regression results indicated that people with two doses of the COVID-19 vaccine had a lower level of PTSS (β = −1.232, 95 % confidence interval [CI]: −1.930, −0.534) than those who had not received any doses of the COVID-19 vaccine. Only the negative relationship between two-dose vaccination and PTSS was mediated by risk perception, while the negative relationship between the time since vaccination and PTSS was suppressed by risk perception. This study showed that receiving the COVID-19 vaccine reduced PTSS by decreasing perceived risk. Vaccination time was negatively associated with PTSS, but this relationship was suppressed by risk perception. [ABSTRACT FROM AUTHOR]

As the number of coastal nuclear facilities rapidly increases and the wastewater from the Fukushima Nuclear Plant has been discharged into the Pacific Ocean, the nuclear environmental safety of China's marginal seas is gaining increased attention along with the heightened potential risk of nuclear accidents. However, insufficient work limits our understanding of the impact of human nuclear activities on the Yellow Sea (YS) and the assessment of their environmental process. This study first reports the 129 I and 127 I records of posthuman nuclear activities in the two YS sediments. Source identification of anthropogenic 129 I reveals that, in addition to the gaseous 129 I release and re-emission of oceanic 129 I discharged from the European Nuclear Fuel Reprocessing Plants (NFRPs), the Chinese nuclear weapons testing fallout along with the global fallout is an additional 129 I input for the continental shelf of the YS. The 129 I/ 127 I atomic ratios in the North YS (NYS) sediment are significantly higher than those in the other adjacent coastal areas, attributed to the significant riverine input of particulate 129 I by the Yellow River. Furthermore, we found a remarkable 129 I latitudinal disparity in the sediments than those in the seawaters in the various China seas, revealing that sediments in China's marginal seas already received a huge anthropogenic 129 I from terrigenous sources via rivers and thus became a significant sink of anthropogenic 129 I. This study broadens an insight into the potential impacts of terrigenous anthropogenic pollution on the Chinese coastal marine radioactive ecosystem.

Purpose: Few studies have focused on anastomotic recurrence (AR) in colon cancer. This study aimed to clarify the association of resection margin distance with AR and compare the prognosis with nonanastomotic local recurrence (NAR)., Methods: This retrospective cohort study included the clinical data of patients who underwent radical colon cancer surgery between January 1, 2009, and December 31, 2019., Results: A total of 1958 colon cancer patients were included in the study. 34 of whom (1.7%) had AR and 105 of whom (5.4%) had NAR. Multivariate analysis revealed that the lower distal resection margin distance, advanced N stage, and number of lymph nodes dissected were risk factors for AR. In the proximal resection margin, the risk of AR was lowest at a distance of 6 cm or greater, with a 3-year rate of 1.3%. In the distal resection margin, the 3-year AR risk increased rapidly if the distance was less than 3 cm. The prognosis of patients in the AR group was similar to that of patients in the NAR group, regardless of synchronous distant metastases. Furthermore, the radical surgery rate for AR was significantly higher than that for NAR, but the prognosis of AR was comparable to that of NAR., Conclusions: The distal resection margin distance, advanced N stage, and less number of lymph nodes dissected are associated with AR of colon cancer. The prognosis of patients with AR was similar to that of patients with NAR., Trial Registration: Clinical Trial Numbers NCT04074538 ( clinicaltrials.gov ), August 26, 2019, registered, retrospectively registered., (© 2024. The Author(s).)

Purpose: To study the clinical and pathological characteristics of oral lichen planus (OLP) in a large sample., Materials and Methods: A comprehensive analysis was conducted on 105 patients with oral lichen planus (OLP), considering various factors including sex, age, disease site, lesion type, lesion area, morphological characteristics, self-reported symptoms, and history of systemic diseases. Histopathological examination was performed for each patient, and the pathology results were analysed according to sex and age group., Results: 70.5% of the OLP patients were female, and OLP was most likely to occur in the cheek, followed by the tongue, lips, gums and palate. The patients with moderate pain according to the VAS score accounted for 60%. Thirty-nine percent of the OLP patients had a systemic disease, and the most common clinical type of OLP was nonerosive. Most of the pathological results showed liquefaction degeneration of basal cells and infiltration of lamina propria lymphocytes. There was no statistically significant difference in pathological manifestations between male and female patients, and there were statistically significant differences in pathological manifestations among different ages patients., Conclusion: This study analysed the sociodemographic data and clinical manifestations of 105 OLP patients to guide follow-up treatment planning and disease monitoring. Moreover, pathological manifestations should be analysed to avoid delayed treatment and to monitor for carcinogenesis. Furthermore, the correlation of pathological manifestations among OLP patients with different sexes and ages is conducive to further research on the specific differential manifestations and possible underlying mechanisms involved.

Objective: To explore the characteristics of adverse drug reactions during the 24-week therapy with delamanid-containing regimen for patients with multidrug-resistant and rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB). Methods: The prospective multicenter study was conducted from June 2020 to June 2023. A total of 608 eligible patients with MDR/RR-PTB were enrolled in 26 tuberculosis medical institutions in China including 364 males and 79 females, aged 39.6(19.0-68.0) years. Patients were treated with chemotherapy regimens containing delamanid. Patients were closely supervised during treatment of medication, and all adverse reactions occurring during treatment were monitored and recorded. The clinical characteristics of adverse reactions were evaluated by descriptive analysis. Chi-square test and multivariate logistic regression were used to analyze the related factors of QTcF interval prolongation (QT corrected with Fridericia's formula). Results: Of the 608 patients enrolled in this study, 325 patients (53.5%) reported 710 adverse events within 24 weeks of treatment. The top 6 most common complications were hematological abnormalities (143 patients, 23.5%), QT prolongation (114 patients, 18.8%), liver toxicity (85 patients, 14.0%), gastrointestinal reaction (41 patients, 6.7%), peripheral neuropathy (25 patients, 4.1%) and mental disorders (21 patients, 3.5%). The prolongation of QT interval mostly occurred in the 12th week after the first dose of medication. Serious adverse reactions occurred in 21 patients (3.5%). There were 7 patients (1.2%) with mental disorders, including 2 patients (0.3%) with severe mental disorders. Conclusions: The safety of dalamanid-based regimen in the staged treatment of MDR/RR-PTB patients was generally good, and the incidence of adverse reactions was similar to that reported in foreign studies. This study found that the incidence of QT interval prolongation in Chinese patients was higher than that reported overseas, suggesting that the monitoring of electrocardiogram should be strengthened when using drugs containing delamanid that may cause QT interval prolongation.

Background: The triglyceride-glucose (TyG) index and its combination with obesity indicators can predict cardiovascular diseases (CVD). However, there is limited research on the relationship between changes in the triglyceride glucose-waist height ratio (TyG-WHtR) and CVD. Our study aims to investigate the relationship between the change in the TyG-WHtR and the risk of CVD., Methods: Participants were from the China Health and Retirement Longitudinal Study (CHARLS). CVD was defined as self-reporting heart disease and stroke. Participants were divided into three groups based on changes in TyG-WHtR using K-means cluster analysis. Multivariable binary logistic regression analysis was used to examine the association between different groups (based on the change of TyG-WHtR) and CVD. A restricted cubic spline (RCS) regression model was used to explore the potential nonlinear association of the cumulative TyG-WHtR and CVD events., Results: During follow-up between 2015 and 2020, 623 (18.8%) of 3312 participants developed CVD. After adjusting for various potential confounders, compared to the participants with consistently low and stable TyG-WHtR, the risk of CVD was significantly higher in participants with moderate and increasing TyG-WHtR (OR 1.28, 95%CI 1.01-1.63) and participants with high TyG-WHtR with a slowly increasing trend (OR 1.58, 95%CI 1.16-2.15). Higher levels of cumulative TyG-WHtR were independently associated with a higher risk of CVD events (per SD, OR 1.27, 95%CI 1.12-1.43)., Conclusions: For middle-aged and older adults, changes in the TyG-WHtR are independently associated with the risk of CVD. Maintaining a favorable TyG index, effective weight management, and a reasonable waist circumference contribute to preventing CVD., (© 2024. The Author(s).)

Objectives: The present study aimed to investigate the relationship between male hormones and metabolic dysfunction-associated fatty liver disease (MAFLD) in males., Methods: Data from the Fangchenggang Area Male Health and Examination Survey (FAMHES) were used to analyze the male hormone levels between MAFLD patients and controls. Univariate and multivariate logistic regression analyses were performed to identify risk factors for MAFLD. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of male hormones for MAFLD., Result: A total of 1578 individuals were included, with 482 individuals (30.54%) of MAFLD, including 293 (18.57%) with mild disease and 189 (11.98%) with moderate-to-severe disease. The MAFLD patients were significantly older than those without MAFLD. The LH, FSH, and SHBG levels in the MAFLD patients were significantly greater than those in the control group. Age, FSH, LH, SHBG, and estradiol were all risk factors for MAFLD. Age, FSH, and LH were risk factors for moderate-to-severe MAFLD. FSH was an independent risk factor for MAFLD and moderate-to-severe MAFLD. FSH showed an excellent diagnostic value, with an AUC of 0.992 alone and 0.996 after adjusting age., Conclusions: Our findings indicate that FSH may be a potential diagnostic and predictive biomarker for MAFLD., (© 2024. The Author(s).)

Objective: To assess the association of -c.108C>T and c.192Q>R polymorphisms of paraoxonase 1 (PON1) gene with preeclampsia (PE) and the influence of genotypes on the metabolic and oxidative stress indexes among Chinese women., Methods: This case-control study has included 334 patients with PE and 1337 healthy pregnant women. The -c.108C>T and c.192Q>R genotypes were determined by PCR and restriction fragment length polymorphism method. Metabolic and oxidative stress parameters were also analyzed., Results: No statistical difference in the genotypic and allelic frequencies for the -c.108C>T and c.192Q>R polymorphisms of the PON1 gene was found between the PE patients and the healthy controls (P > 0.05). Nevertheless, the 192Q-108T haplotype of these polymorphisms was associated with an increased risk of PE (P = 0.007). Total antioxidant capacity (TAC) and atherosderosis index were higher in patients with the -108TT genotype compared with those with a CT genotype (P < 0.05); whilst total oxidant status was lower in patients with a CT genotype compared with those with a CC genotype (P = 0.036). Malondialdehyde level was higher in patients with a 192RR genotype compared with those with a QQ genotype (P = 0.019). TAC level was higher in patients with a RR genotype compared with those with a QR genotype (P = 0.015)., Conclusion: The 192Q-108T haplotype of the PON1 gene is associated with the risk for PE. These polymorphisms may be associated with abnormal lipid metabolism and oxidative stress among Chinese PE patients.

Background: In November 2015, China launched a pilot program for its Drug Marketing Authorization Holder (MAH) system, aiming to integrate production and research and development resources to spur drug innovation. While many scholars have examined the theoretical relationship between the MAH system and pharmaceutical manufacturing innovation, empirical studies have been scarce., Methods: This study uses inter-provincial panel data on China's pharmaceutical manufacturing industry from 2009 to 2019, along with synthetic control methods, to offer a robust analysis of the impact of the MAH paradigm on innovation quality in pilot provinces. We treat the 2015 MAH system implementation in ten provinces as a natural experiment and account for the mediating effects of R&D investments, allowing us to discern the underlying mechanisms., Results: Our findings demonstrate a significant positive effect of China's MAH system on innovation quality in the pharmaceutical manufacturing industry. Specifically, the system is most effective in Jiangsu, Guangdong, and Shandong provinces. We also identify R&D investments as playing a mediating role in facilitating the favorable impact of the MAH system on innovation quality., Conclusion: Our study highlights the crucial importance of the MAH system in promoting innovation quality in China's pharmaceutical manufacturing industry, providing vital empirical support for its adoption and further enhancement. This research also offers practical insights for policymakers and R&D decision-makers in the pharmaceutical sector., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The characteristics of patients with endophthalmitis due to penetrating ocular trauma are still limited. The aim of the study was to fill these gaps among Chinese population. This retrospective study included patients diagnosed as penetrating ocular traumatic endophthalmitis between January 2016 to December 2018. During the past 3-year period, a total of 201 patients with antecedent penetrating eye injuries were evaluated. Of which, 42 (20.9%) patients presented a clinical course compatible with acute infectious endophthalmitis. 39 (92.86%) patients were males, and 15 (35.71%) patients had mechanical injuries from intraocular foreign body (IOFB), the rate of endophthalmitis due to IOFB was 13.43%, higher to the rate among patients without IOFB (7.46%). The duration between injury occurrence and endophthalmitis onset was 1 day in 10 (23,80%) patients; 2 to 7 days in 31 (73.80%) patients, and 7 to 14 days in 1 (2.38%) patient. After 1 year follow-up, best corrected visual acuity (BCVA) better than 20/400 was observed in 15 (35.71%) patients, counting fingers and hand move in 17 (40.48%) patients, light perception in 5 (11.9%) patients and no light perception in 5 (11.9%) patients, respectively. Patients with promising outcomes had better initial BCVA at baseline (P < .001). Endophthalmitis is a severe ocular infectious condition that may lead to irreversible vision loss. A greater attention must be paid to penetrating eye injuries within males, who had poor BCVA at baseline, particularly with obvious IOFB., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To describe the fetal death rate of birth defects (including a broad range of specific defects) and to explore the relationship between fetal deaths from birth defects and a broad range of demographic characteristics. Data was derived from the birth defects surveillance system in Hunan Province, China, 2016-2020. Fetal death refers to the intrauterine death of a fetus at any time during the pregnancy, including medical termination of pregnancy. Fetal death rate is the number of fetal deaths per 100 births (including live births and fetal deaths) in a specified group (unit: %). The fetal death rate of birth defects with 95% confidence intervals (CI) was calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the relationship between each demographic characteristic and fetal deaths from birth defects. This study included 847,755 births, and 23,420 birth defects were identified. A total of 11,955 fetal deaths from birth defects were identified, with a fetal death rate of 51.05% (95% CI 50.13-51.96). 15.78% (1887 cases) of fetal deaths from birth defects were at a gestational age of < 20 weeks, 59.05% (7059 cases) were at a gestational age of 20-27 weeks, and 25.17% (3009 cases) were at a gestational age of ≥ 28 weeks. Fetal death rate of birth defects was higher in females than in males (OR = 1.25, 95% CI 1.18-1.32), in rural than in urban areas (OR = 1.43, 95% CI 1.36-1.50), in maternal age 20-24 years (OR = 1.35, 95% CI 1.25-1.47), and ≥ 35 years (OR = 1.19, 95% CI 1.11-1.29) compared to maternal age of 25-29 years, in diagnosed by chromosomal analysis than ultrasound (OR = 6.24, 95% CI 5.15-7.55), and lower in multiple births than in singletons (OR = 0.41, 95% CI 0.36-0.47). The fetal death rate of birth defects increased with the number of previous pregnancies (χ 2 trend  = 49.28, P < 0.01), and decreased with the number of previous deliveries (χ 2 trend  = 4318.91, P < 0.01). Many fetal deaths were associated with birth defects. We found several demographic characteristics associated with fetal deaths from birth defects, which may be related to the severity of the birth defects, economic and medical conditions, and parental attitudes toward birth defects., (© 2024. The Author(s).)

Lithium (Li) is an important resource that drives sustainable mobility and renewable energy. Its demand is projected to continue to increase in the coming decades. However, the risk of Li pollution has also emerged as a global concern. Here, we investigated the pollution characteristics, sources, exposure levels, and associated health risks of Li in the Jinjiang River basin, the largest area for Li 2 CO 3 production in China. Our results revealed the dominant role of Li extraction activities in the pollution of the river, with over 95% of dissolved Li in downstream river water being emitted from this source. Moreover, the Li concentration in aquatic plants (i.e., water hyacinth) and animals (i.e., fish) significantly increased from upstream to downstream areas, indicating a significant risk to local aquatic ecosystems. More importantly, our study found that local residents were suffering potential chronic noncarcinogenic health risks primarily from consuming contaminated water and vegetables. We also investigated the pollution characteristics of associated elements present in Li ores (e.g., Rb, Cs, Ni, and F - ). By uncovering the remarkable impact of Li extraction activities on the Li content in ecosystems for the first time, our study emphasizes the importance of evaluating Li pollution from Li-related industrial activities, including mining, extraction, and recovery.

A bacterial strain, designated S6 T , was isolated from the sandy soil on a rocky mountain in South China. Cells of S6 T were Gram-stain-negative, aerobic, non-spore-forming, non-motile and non-prosthecae-producing. 16S rRNA gene sequence analysis revealed the highest similarities to 12 uncultured bacteria, followed by Phenylobacterium sp. B6.10-61 (97.14 %). The closest related validly published strains are Caulobacter henricii ATCC 15253 T (96.15 %), Phenylobacterium conjunctum FWC 21 T (96.08 %) and Caulobacter mirabilis FWC 38 T (96.08 %). Phylogenetic analysis based on 16S rRNA gene, genome and proteome sequences demonstrated that S6 T formed a separated lineage in the genus Phenylobacterium . Strain S6 T contained Q-10 (97.5 %) as the major ubiquinone and C 18 : 1  ω7 c and C 16 : 0 as the major fatty acids. The polar lipid profile consisted of phosphatidylglycerol, an unknown phosphoglycolipid and three unknown glycolipids. The assembled genome comprises a chromosome with a length of 5.5 Mb and a plasmid of 96 014 bp. The G+C content was 67.6 mol%. The morphological, physiological, chemotaxonomic and phylogenetic analyses clearly distinguished this strain from its closest phylogenetic neighbours. Thus it is proposed that strain S6 T represents a novel species in the genus Phenylobacterium , for which the name Phenylobacterium montanum sp. nov. is proposed. The type strain is S6 T (=NBRC 115419 T =GCMCC 1.18594 T ).

Objective: To investigate the factors contributing to the blockage of perfusion tubes during hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with appendiceal pseudomyxoma peritonei (PMP) undergoing combined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy treatment, and to construct a nomogram for predicting the risk of tube occlusion., Study Design: Observational study. Place and Duration of the Study: Department of Gastrointestinal Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, China, from June 2017 to December 2023., Methodology: Tube occlusion was defined as the inability to achieve 30 minutes of continuous unobstructed perfusion. Statistical methods such as univariate analysis, multivariate analysis, and Lasso regression were employed for data analysis., Results: The results revealed that 27% of the 383 hyperthermic intraperitoneal chemotherapy perfusion treatments resulted in the tube occlusion events. Multivariate logistic regression analysis identified age, CA-125, CA19-9, and pathological type as the independent risk factors. A nomogram predicting the tube occlusion was constructed and validated for its predictive accuracy and clinical utility., Conclusion: This study successfully developed a nomogram to predict the tube occlusion risk during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy treatment for patients with pseudomyxoma peritonei, providing valuable guidance for clinical practice and aiding in personalised treatment decisions to improve patient prognosis. However, further research is needed to validate the reliability and clinical applicability of the model, as well as to investigate the impact of tube occlusion on treatment outcomes and corresponding management strategies., Key Words: Pseudomyxoma peritonei, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy treatment, Tube occlusion, Nomogram.

Background: The CRC-VTE trial conducted in China revealed a significant occurrence of venous thromboembolism (VTE) in patients following colorectal cancer (CRC) surgery, raising concerns about implementing thromboprophylaxis measures. The present study aimed to identify and analyze inappropriate aspects of current thromboprophylaxis practices., Methods: This study performed an analysis of the CRC-VTE trial, a prospective multicenter study that enrolled 1836 patients who underwent CRC surgery. The primary objective was to identify independent risk factors for VTE after CRC surgery using multivariate logistic regression analysis. Furthermore, among the cases in which VTE occurred, the appropriateness of thromboprophylaxis was assessed based on several factors, including pharmacologic prophylaxis, time to initiate prophylaxis, drug selection, drug dosage, and duration of pharmacologic prophylaxis. Based on the analysis of the current state of thromboprophylaxis and relevant clinical guidelines, a modified Delphi method was used to develop a clinical pathway for VTE prophylaxis after CRC surgery., Results: In this analysis of 1836 patients, 205 (11.2%) were diagnosed with VTE during follow-up. The multifactorial analysis identified several independent risk factors for VTE, including age (≥70 years), female sex, varicose veins in the lower extremities, intraoperative blood transfusion, and the duration of immobilization exceeding 24 h. None of the patients diagnosed with VTE in the CRC trial received adequate thromboprophylaxis. The main reasons for this inappropriate practice were the omission of thromboprophylaxis, delayed initiation, and insufficient duration of thromboprophylaxis. We developed a specialized clinical pathway for thromboprophylaxis after CRC surgery to address these issues., Conclusions: This study offers a comprehensive nationwide evaluation of existing thromboprophylaxis practices in patients after CRC surgery in China. A specialized clinical pathway was developed to address the identified gaps and improve the quality of care. This clinical pathway incorporates explicit, tailored, detailed recommendations for thromboprophylaxis after CRC surgery., (© 2024 Pharmacotherapy Publications, Inc.)

We investigated Alongshan virus infection in reindeer in northeastern China. We found that 4.8% of the animals were viral RNA-positive, 33.3% tested positive for IgG, and 19.1% displayed neutralizing antibodies. These findings suggest reindeer could serve as sentinel animal species for the epidemiologic surveillance of Alongshan virus infection.

Purpose: The consumption of added sugar has increased rapidly in recent years. Limited knowledge exists regarding the association between added sugar intake and muscle strength, although the latter is a predictor of physical disability in older adults. This study aimed to investigate the association between added sugar intake and longitudinal changes in handgrip strength among middle-aged and elderly Chinese adults., Methods: This prospective cohort study included 5298 adults aged 40 years and older (62.6% men) from the TCLSIH (Tianjin Chronic Low-grade Systemic Inflammation and Health) cohort study. Added sugar intake was obtained through a frequency questionnaire containing 100 items of food. Handgrip strength is measured annually using a handheld digital dynamometer. Multivariate linear regression models were used to examine the association between added sugars intake and the annual changes in handgrip strength and weight-adjusted handgrip strength., Results: In the fully adjusted model, the annual change in handgrip strength for one unit increase in total added sugar, solid added sugar, and liquid added sugar intake was -0.0353 kg, (95% confidence intervals (CI) -0.000148, -0.0000164; P = 0.01), -0.0348 kg (95% CI: -0.000227, -0.0000269; P = 0.01) and -0.0189 kg (95% CI -0.000187, 0.0000338; P = 0.17), respectively. Added sugar from bread and biscuits sources were remarkably associated with a decline in handgrip strength (β = -0.0498; 95%CI -0.00281, -0.000787) and (β = -0.0459; 95%CI 0.00158, 0.00733) (P < 0.01)., Conclusions: Our data suggest that the higher the intake of solid added sugars, but not liquid sugars, were associated with the declined handgrip strength in the Chinese middle-aged and elderly population. In addition, the consumption of added sugars from bread and biscuits sources was also associated with a decline in grip strength., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests regarding the publication of this paper., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Cytokines are of utmost importance in both the physiological and pathological immune responses of the human body. This study utilized flow cytometry to measure the levels of plasma interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-17A (IL-17A) and established their reference intervals, aiming to provide data support for the diagnosis and treatment of clinical diseases., Methods: According to the inclusion and exclusion criteria, a total of 728 reference individuals were included in this study from January 2023 to June 2023. The Kolmogorov-Smirnov test was used to analyse the distributions of plasma IL-2, IL-4, IL-5 and IL-17A. The reference intervals of plasma IL-2, IL-4, IL-5 and IL-17A were established by the unilateral percentile method (95th percentile) based on the guidelines of C28-A 3 and WS/T 402-2012., Results: In this study, the levels of plasma IL-2, IL-4, IL-5 and IL-17A were nonnormally distributed. The concentrations of plasma IL-2, IL-4, IL-5 and IL-17A in healthy adults were not significantly different by sex or age (all P > 0.05). Therefore, all the reference individuals were combined into one group, and the reference intervals of plasma IL-2, IL-4, IL-5 and IL-17 were established by flow cytometry (IL-2 ≤ 10.25 pg/mL, IL-4 ≤ 9.87 pg/mL, IL-5 ≤ 3.36 pg/mL and IL-17A ≤ 9.46 pg/mL)., Conclusions: We first established the reference intervals of plasma IL-2, IL-4, IL-5 and IL-17A in healthy adults based on a single-center population in the Jiangsu region in eastern China, which will provide an important reference value for evaluating human immune status and the diagnosis and treatment of clinical diseases., 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 © 2024 The Second People's Hospital of Lianyungang. Published by Elsevier Ltd.. All rights reserved.)

Background: We examined joint trajectories of physical frailty and social frailty as well as their associations with adverse outcomes., Methods: We conducted a prospective cohort study by using five waves of national data from China Health and Retirement Longitudinal Study (CHARLS 2011-2020), involving 4531 participants aged ≥60 years. We identified 4-year trajectories at three examinations from 2011 to 2015 using parallel process latent class growth analysis. Adverse outcomes were obtained from 2015 to 2020 across two subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. We also conducted analyses by gender., Results: Three joint trajectories were identified, including persistent absence of physical and social frailty (58.5 %), no physical frailty but social frailty (28.1 %), and persistent combination of physical and social frailty (13.4 %). Compared with persistent absence of physical and social frailty, no physical frailty but social frailty and persistent combination of physical and social frailty were associated with higher risk of instrumental activities of daily living (IADL) disability (HR = 1.182-2.020, 95 % CI: 1.014-2.416) and all-cause mortality (HR = 1.440-2.486, 95 % CI: 1.211-3.009). The persistent combination of physical and social frailty was also associated with ADL disability (HR = 2.412, 95 % CI: 1.999-2.911) and falls (HR = 1.410, 95 % CI: 1.196-1.662). Gender differences were observed in relationships between joint trajectories and adverse outcomes., Conclusion: Community-dwelling older adults exhibit distinct joint trajectories and those with persistent combination of physical and social frailty experience greatest risk of incident adverse outcomes. Clinical and public health measures targeting physical or social frailty should account for both and be gender-specific., 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 © 2024 Elsevier B.V. All rights reserved.)

Purpose: To characterize and compare clinical and immunological features of para(p)-autoimmune retinopathy (AIR) and non-para(np)-AIR and to assess the clinical significance of the presence of serum anti-retinal antibodies (ARAs)., Methods: We retrospectively reviewed 48 Chinese patients with p-AIR or np-AIR who took comprehensive ophthalmic examinations and lab tests of the presence of serum ARAs., Results: p-AIR patients differed from np-AIR patients in terms of disease progression, ocular inflammation, findings of OCT, FFA, and presence of ARAs. No significant difference was found in the band number of serum ARAs between AIR patients and healthy controls. The prevalence of antibodies to recoverin and ɑ-enolase in the sera of p-AIR was significantly higher than that of the healthy individuals., Conclusion: While having many similar clinical signs, patients with p-AIR or np-AIR nevertheless displayed unique characteristics. Detection of ARAs subtypes, rather than their quantity, may be helpful in evaluating the conditions in the verified instances.

Rice (Oryza sativa L.) feeds more than half of the global population and faces the critical issues related to food security and environmental sustainability. This study analyzed double rice production data from 2010 to 2020 to assess its spatiotemporal dynamic in food production and carbon (C) footprint in Hainan province, China. The results revealed a 29.5% reduction in rice planting area, leading to a significantly decreased rice self-sufficiency rate from 38% to 33% from 2010 to 2020. During this period, the carbon footprint per unit area (CFa) for early, late, and double rice showed a fluctuating upward trend ranging from 8.1 to 8.4, 8.9 to 9.2, and 17.0 to 17.4 t CO 2 -eq ha -1 , respectively. The total greenhouse gas (GHG) emissions of rice production decreased to around 2 million t CO 2 -eq, primarily due to reduced planting area. The C sequestration initially increased before decreasing to 1.2 million t C in 2020 at a temporal scale. Spatially, the northeast and southwest regions exhibited ∼70% of the total GHG emissions and ∼80% of C sequestration. The regional C footprint per unit yield displayed less favorable outcomes, with some areas (e.g., Wenchang and Haikou) experiencing emission hotspots in recent years. Higher yield and smaller CFa for Lingao and Tunchang were observed compared to the average between 2010 and 2020. This study provides insights into the spatiotemporal dynamics of double rice production and GHG emissions in Hainan, offering a scientific reference for regional food security and environmental sustainability., (© 2024 The Author(s). Journal of Environmental Quality © 2024 American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

This study explored whether household and outdoor air pollution is associated with a greater risk for metabolic syndrome (MetS) among women. In all 11,860 women who cooked with clean energy were included in the analysis. Cooking frequency, range hood use during cooking, passive smoking exposure, and solid fuel use for heating were used to represent household air pollution. The 2-year average concentration of PM 2.5 , and face mask usage were used to reflect outdoor air pollution exposure. An index of air pollution exposure was also constructed. Multivariable logistic regression models were used to estimate the association between air pollution and risk for MetS, and a positive correlation was found. Our results indicated that household cooking used clean energy and exposure to a high level of outdoor PM 2.5 without face mask usage may contribute to an increased risk for MetS among women.

Introduction: Creating romantic relationships characterized by high-quality, satisfaction, few conflicts, and reasoning strategies to handle conflicts is an important developmental task for adolescents connected to the relational models they receive from their parents. This study examines how parent-adolescent conflicts, attachment, positive parenting, and communication are related to adolescents' romantic relationship quality, satisfaction, conflicts, and management., Method: We interviewed 311 adolescents at two time points (females = 52%, ages 15 and 17) in eight countries (China, Colombia, Italy, Kenya, the Philippines, Sweden, Thailand, and the United States). Generalized and linear mixed models were run considering the participants' nesting within countries., Results: Adolescents with negative conflicts with their parents reported low romantic relationship quality and satisfaction and high conflicts with their romantic partners. Adolescents experiencing an anxious attachment to their parents reported low romantic relationship quality, while adolescents with positive parenting showed high romantic relationship satisfaction. However, no association between parent-adolescent relationships and conflict management skills involving reasoning with the partner was found. No associations of parent-adolescent communication with romantic relationship dimensions emerged, nor was there any effect of the country on romantic relationship quality or satisfaction., Conclusion: These results stress the relevance of parent-adolescent conflicts and attachment as factors connected to how adolescents experience romantic relationships., (© 2024 Foundation for Professionals in Services to Adolescents.)

Background: Seasonal late-season water deficits negatively affect the yield and quality of sweet potatoes in northern China. However, the amount of late-season irrigation to achieve high yield and consistent quality storage root remains undetermined. We assessed the yield and some qualitative traits of sweet potatoes such as size, shape, skin/flesh colour and nutritional content, as influenced by five irrigation levels (T 0 : unirrigated control; T 1 : 33% ET c ; T 2 : 75% ET c ; T 3 : 100% ET c ; and T 4 : 125% ET c )., Results: Late-season irrigation significantly increased yield and marketable yield. Yields for T 2 and T 3 were significantly higher than other treatments, whereas T 2 had the highest Grade A rating in a 2-year test. The vertical length of storage roots gradually increased with an increase in irrigation level, whereas the maximum width remained unchanged. The proportion of long elliptic and elliptic storage roots also increased, whereas the proportion of ovate, obovate and round storage roots gradually decreased. The skin and flesh colours became more vivid as the level of irrigation increased, with the skin colour becoming redder and the flesh colour becoming more orange-yellow. The levels of carotenoids, vitamin C and soluble sugar were significantly higher in irrigated crops, with the highest vitamin C and soluble sugar levels in T 2 and the highest carotenoid levels in T 3 treatment., Conclusion: Taken together, these results demonstrate the potential of moderate irrigation in the late-season to improve both yield production and quality potential. The results are of great importance for improving the market value of sweet potatoes and increasing grower profits. © 2024 Society of Chemical Industry., (© 2024 Society of Chemical Industry.)

Douchi is a kind of traditional Chinese fermented soybean product with outstanding umami taste. Besides the umami amino acids in Douchi, peptides were also considered as an important contributor for the umami taste of Douchi. Peptides with molecular weight below 0.66 kDa accounted for more than 50 % in all samples except for TongChuan Douchi, and a total of 421 peptides were identified from the ten kinds of Douchi samples by using LC-MS/MS. Combined with sensory evaluation results, 19 peptides containing Glu, Asp or known umami peptide sequences were chosen as potential umami peptides via PLS-DA and RDA analysis. Among them, 17 soluble peptides exhibited obvious umami taste and the threshold of 7 peptides were lower than MSG solution. Especially, the VD was detected with a minimum umami taste threshold at 0.16 mg/mL. The results indicated that the umami peptides might be the important components affecting the umami taste of Douchi., 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 © 2024 Elsevier Ltd. All rights reserved.)

Background: Antibody-drug conjugates have promising clinical activity in the treatment of solid tumours. BL-B01D1 is a first-in-class EGFR-HER3 bispecific antibody-drug conjugate. We aimed to assess the safety and preliminary antitumour activity of BL-B01D1 in patients with locally advanced or metastatic solid tumours., Methods: This first-in-human, open-label, multicentre, dose-escalation and dose-expansion phase 1 trial was conducted in seven hospitals in China, enrolling patients aged 18-75 years (dose escalation; phase 1a) or older than 18 years (dose expansion; phase 1b), with a life expectancy of at least 3 months, an Eastern Cooperative Oncology Group performance status of 0-1, and histologically or cytologically confirmed locally advanced or metastatic solid tumours that had progressed on current standard treatment. In the phase 1a i3+3 design, patients received intravenous BL-B01D1 at three different schedules: 0·27 mg/kg, 1·5 mg/kg, and 3·0 mg/kg weekly; 2·5 mg/kg, 3·0 mg/kg, and 3·5 mg/kg on days 1 and 8 of each cycle every 3 weeks; or 5·0 mg/kg and 6·0 mg/kg on day 1 of each cycle every 3 weeks. The primary objectives of phase 1a were to identify the safety, maximum tolerated dose, and dose-limiting toxicity. In phase 1b, patients were treated in two schedules: 2·5 and 3·0 mg/kg on days 1 and 8 every 3 weeks, or 4·5, 5·0, and 6·0 mg/kg on day 1 every 3 weeks. The primary objectives of phase 1b were to assess the safety and recommended phase 2 dose of BL-B01D1, and objective response rate was a key secondary endpoint. Safety was analysed in all patients with safety records who received at least one dose of BL-B01D1. Antitumour activity was assessed in the activity analysis set which included all patients who received at least one dose of BL-B01D1 every 3 weeks. This trial is registered with China Drug Trials, CTR20212923, and ClinicalTrials.gov, NCT05194982, and recruitment is ongoing., Findings: Between Dec 8, 2021, and March 13, 2023, 195 patients (133 [65%] men and 62 [32%] women; 25 in phase 1a and 170 in phase 1b) were consecutively enrolled, including 113 with non-small-cell lung cancer, 42 with nasopharyngeal carcinomas, 13 with small-cell lung cancer, 25 with head and neck squamous cell carcinoma, one with thymic squamous cell carcinoma, and one with submandibular lymphoepithelioma-like carcinoma. In phase 1a, four dose-limiting toxicities were observed (two at 3·0 mg/kg weekly and two at 3·5 mg/kg on days 1 and 8 every 3 weeks; all were febrile neutropenia), thus the maximum tolerated dose was reached at 3·0 mg/kg on days 1 and 8 every 3 weeks and 6·0 mg/kg on day 1 every 3 weeks. Grade 3 or worse treatment-related adverse events occurred in 139 (71%) of 195 patients; the most common of which were neutropenia (91 [47%]), anaemia (76 [39%]), leukopenia (76 [39%]), and thrombocytopenia (63 [32%]). 52 (27%) patients had a dose reduction and five (3%) patients discontinued treatment due to treatment-related adverse events. One patient was reported as having interstitial lung disease. Treatment-related deaths occurred in three (2%) patients (one due to pneumonia, one due to septic shock, and one due to myelosuppression). In 174 patients evaluated for activity, median follow-up was 6·9 months (IQR 4·5-8·9) and 60 (34%; 95% CI 27-42) patients had an objective response., Interpretation: Our results suggest that BL-B01D1 has preliminary antitumour activity in extensively and heavily treated advanced solid tumours with an acceptable safety profile. Based on the safety and antitumour activity data from both phase 1a and 1b, 2·5 mg/kg on days 1 and 8 every 3 weeks was selected as the recommended phase 2 dose in Chinese patients., Funding: Sichuan Baili Pharmaceutical., Translation: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests LZ reports receiving research support from Jiangsu Hengrui Pharmaceuticals, Eli Lilly and Company, Novartis, Roche, Chia Tai Tianqing Pharmaceutical Group, Junshi Pharmaceuticals, QiLu Pharmaceutical, Pfizer, and Bristol-Myers Squibb. YZhu, HZhu, and SX are employees of Sichuan Baili Pharmaceutical. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Fusarium crown rot (FCR), caused by Fusarium spp., is a devastating disease in wheat growing areas. Previous studies have shown that FCR is caused by co-infection of F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides in Hubei Province, China. In this study, a method was developed to simultaneously detected DNAs of F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides that can efficiently differentiate them. Whole genome sequence comparison of these four Fusarium spp. was performed and a 20 bp sequence was designed as an universal upstream primer. Specific downstream primers of each pathogen was also designed, which resulted in a 206, 482, 680, and 963 bp amplicon for each pathogen, respectively. Multiplex PCR specifically identified F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides but not from other 46 pathogens, and the detection limit of target pathogens is about 100 pg/μl. Moreover, we accurately determined the FCR pathogen species in wheat samples using the optimized multiplex PCR method. These results demonstrate that the multiplex PCR method established in this study can efficiently and rapidly identify F. graminearum , F. pseudograminearum , F. proliferatum , and F. verticillioides , which should provide technical support for timely and targeted prevention and control of FCR., Competing Interests: The authors declare that they have no competing interests., (© 2024 Deng et al.)

China's long-term sustainability faces socioeconomic and environmental uncertainties. We identify five key systemic risk drivers, called disruptors, which could push China into a polycrisis: pandemic disease, ageing and shrinking population, deglobalization, climate change, and biodiversity loss. Using an integrated simulation model, we quantify the effects of these disruptors on the country's long-term sustainability framed by 17 Sustainable Development Goals (SDGs). Here we show that ageing and shrinking population, and climate change would be the two most influential disruptors on China's long-term sustainability. The compound effects of all disruptors could result in up to 2.1 and 7.0 points decline in the China's SDG score by 2030 and 2050, compared to the baseline with no disruptors and no additional sustainability policies. However, an integrated policy portfolio involving investment in education, healthcare, energy transition, water-use efficiency, ecological conservation and restoration could promote resilience against the compound effects and significantly improve China's long-term sustainability., (© 2024. The Author(s).)

Background: Aspirin is widely used for preventing ischaemic events. About 20%-40% of patients have aspirin resistance (ASR), which prevents them from benefiting from aspirin medication. This study aimed to develop and validate a model based on single-nucleotide polymorphism (SNP) to distinguish ASR patients., Methods: We included patients with spontaneous intracerebral haemorrhage and continuing antiplatelet therapy from a multicentre, prospective cohort study as the derivation cohort. Thromboelastography (inhibition of arachidonic acid channel<50%) was used to identify ASR. Genotyping was performed to identify the ASR-related SNP. Based on the result of the logistic analysis, the aspirin resistance in the Chinese population score (ASR-CN score) was established, and its accuracy was evaluated using the area under the curve (AUC). Patients receiving dual antiplatelet therapy for unruptured intracranial aneurysm embolism were prospectively included in the validation cohort. After embolism, 30-day ischaemic events, including ischaemic stroke, new or more frequent transient ischaemic attack, stent thrombosis and cerebrovascular death, were recorded., Results: The derivation cohort included 212 patients (155 male patients and the median age as 59). 87 (41.0%) individuals were identified with ASR. The multivariate logistic analysis demonstrated six SNPs of GP1BA, TBXA2R, PTGS2 and NOS3 as risk factors related to ASR. The ASR-CN score integrating these SNPs performed well to discriminate ASR patients from non-ASR patients (AUC as 0.77). Based on the validation cohort of 372 patients receiving antiplatelet therapy after embolism (including 130 ASR patients), the ASR-CN score continued to distinguish ASR patients with good accuracy (AUC as 0.80). Patients with high a ASR-CN score were more likely to suffer from 30-day ischaemic events after embolism (OR, 1.28; 95% CI, 1.10 to 1.50; p=0.002)., Conclusion: GP1BA, TBXA2R, PTGS2 and NOS3 were SNPs related to ASR. The ASR-CN score is an effective tool to discriminate ASR patients, which may guide antiplatelet therapy., Clinical Trial Registration: Surgical Treatments of Antiplatelet Intracerebral Hemorrhage cohort (unique identifier: ChiCTR1900024406, http://www.chictr.org.cn/edit.aspx?pid=40640&htm=4)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The aim of this study was to classify distinct subgroups of adolescents based on the severity levels of their mobile phone addiction and to investigate how these groups differed in terms of their psychosocial characteristics. We surveyed a total of 2,230 adolescents using three different questionnaires to assess the severity of their mobile phone addiction, stress, anxiety, depression, psychological resilience, and personality. Latent class analysis was employed to identify the subgroups, and we utilized Receiver Operating Characteristic (ROC) curves and multinomial logistic regression for statistical analysis. All data analyses were conducted using SPSS 26.0 and Mplus 8.5., Methods: We classified the subjects into subgroups based on their mobile phone addiction severity, and the results revealed a clear pattern with a three-class model based on the likelihood level of mobile phone addiction ( p  < 0.05). We examined common trends in psychosocial traits such as age, grade at school, parental education level, anxiety levels, and resilience. ROC analysis of sensitivity versus 1-specificity for various mobile phone addiction index (MPAI) scores yielded an area under the curve (AUC) of 0.893 (95% CI, 0.879 to 0.905, p  < 0.001). We also determined diagnostic value indices for potential cutoff points ranging from 8 to 40. The optimal cutoff value for MPAI was found to be >14, which corresponded to the maximum Youden index (Youden index = 0.751)., Results: The latent classification process in this research confirmed the existence of three distinct mobile phone user groups. We also examined the psychosocial characteristics that varied in relation to the severity levels of addiction., Conclusion: This study provides valuable insights into the categorization of adolescents based on the severity of mobile phone addiction and sheds light on the psychosocial characteristics associated with different addiction levels. These findings are expected to enhance our understanding of mobile phone addiction traits and stimulate further research in this area., 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 © 2024 Wu, Jia, Li, Liu, Zhang, Zhang, Jia and Fan.)

Objective: To compare the effectiveness and safety of nab-paclitaxel, cisplatin, and capecitabine (nab-TPC) with gemcitabine and cisplatin as an alternative first line treatment option for recurrent or metastatic nasopharyngeal carcinoma., Design: Phase 3, open label, multicentre, randomised trial., Setting: Four hospitals located in China between September 2019 and August 2022., Participants: Adults (≥18 years) with recurrent or metastatic nasopharyngeal carcinoma., Interventions: Patients were randomised in a 1:1 ratio to treatment with either nab-paclitaxel (200 g/m 2 on day 1), cisplatin (60 mg/m 2 on day 1), and capecitabine (1000 mg/m 2 twice on days 1-14) or gemcitabine (1 g/m 2 on days 1 and 8) and cisplatin (80 mg/m 2 on day 1)., Main Outcome Measures: Progression-free survival was evaluated by the independent review committee as the primary endpoint in the intention-to-treat population., Results: The median follow-up was 15.8 months in the prespecified interim analysis (31 October 2022). As assessed by the independent review committee, the median progression-free survival was 11.3 (95% confidence interval 9.7 to 12.9) months in the nab-TPC cohort compared with 7.7 (6.5 to 9.0) months in the gemcitabine and cisplatin cohort. The hazard ratio was 0.43 (95% confidence interval 0.25 to 0.73; P=0.002). The objective response rate in the nab-TPC cohort was 83% (34/41) versus 63% (25/40) in the gemcitabine and cisplatin cohort (P=0.05), and the duration of response was 10.8 months in the nab-TPC cohort compared with 6.9 months in the gemcitabine and cisplatin cohort (P=0.009). Treatment related grade 3 or 4 adverse events, including leukopenia (4/41 (10%) v 13/40 (33%); P=0.02), neutropenia (6/41 (15%) v 16/40 (40%); P=0.01), and anaemia (1/41 (2%) v 8/40 (20%); P=0.01), were higher in the gemcitabine and cisplatin cohort than in the nab-TPC cohort. No deaths related to treatment occurred in either treatment group. Survival and long term toxicity are still being evaluated with longer follow-up., Conclusion: The nab-TPC regimen showed a superior antitumoural efficacy and favourable safety profile compared with gemcitabine and cisplatin for recurrent or metastatic nasopharyngeal carcinoma. Nab-TPC should be considered the standard first line treatment for recurrent or metastatic nasopharyngeal carcinoma. Longer follow-up is needed to confirm the benefits for overall survival., Trial Registration: Chinese Clinical Trial Registry ChiCTR1900027112., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Guangdong Basic and Applied Basic Research Foundation, National Natural Science Foundation of China, CPSF, and Postdoctoral Fellowship Program of CPSF for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate the health benefits and intervention efficiency of different strategies of initiating antihypertensive therapy for the primary prevention of cardiovascular diseases in a community-based Chinese population from the Chinese electronic health records research in Yinzhou (CHERRY) study., Methods: A decision-analytic Markov model was used to simulate and compare different antihypertensive initiation strategies, including: Strategy 1, initiation of antihypertensive therapy for Chinese adults with systolic blood pressure (SBP) ≥140 mmHg ( 2020 Chinese guideline on the primary prevention of cardiovascular diseases ); Strategy 2, initiation of antihypertensive therapy for Chinese adults with SBP ≥130 mmHg; Strategy 3, initiation of antihypertensive therapy for Chinese adults with SBP≥140 mmHg, or with SBP between 130 and 140 mmHg and at high risk of cardiovascular diseases ( 2017 American College of Cardiology / American Heart Association guideline for the prevention , detection , evaluation , and management of high blood pressure in adults ); Strategy 4, initiation of antihypertensive therapy for Chinese adults with SBP≥160 mmHg, or with SBP between 140 and 160 mmHg and at high risk of cardiovascular diseases ( 2019 United Kingdom National Institute for Health and Care Excellence guideline for the hypertension in adults : Diagnosis and management ). The high 10-year cardiovascular risk was defined as the predicted risk over 10% based on the 2019 World Health Organization cardiovascular disease risk charts. Different strategies were simulated by the Markov model for ten years (cycles), with parameters mainly from the CHERRY study or published literature. After ten cycles of simulation, the numbers of quality-adjusted life years (QALY), cardiovascular events and all-cause deaths were calculated to evaluate the health benefits of each strategy, and the numbers needed to treat (NNT) for each cardiovascular event or all-cause death could be prevented were calculated to assess the intervention efficiency. One-way sensitivity analysis on the uncertainty of incidence rates of cardiovascular disease and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted., Results: A total of 213 987 Chinese adults aged 35-79 years without cardiovascular diseases were included. Compared with strategy 1, the number of cardiovascular events that could be prevented in strategy 2 increased by 666 (95% UI : 334-975), while the NNT per cardiovascular event prevented increased by 10 (95% UI : 7-20). In contrast to strategy 1, the number of cardiovascular events that could be prevented in strategy 3 increased by 388 (95% UI : 194-569), and the NNT per cardiovascular event prevented decreased by 6 (95% UI : 4-12), suggesting that strategy 3 had better health benefits and intervention efficiency. Compared to strategy 1, although the number of cardiovascular events that could be prevented decreased by 193 (95% UI : 98-281) in strategy 4, the NNT per cardiovascular event prevented decreased by 18 (95% UI : 13-37) with better efficiency. The results were consistent in the sensitivity analyses., Conclusion: When initiating antihypertensive therapy in an economically developed area of China, the strategy combined with cardiovascular risk assessment is more efficient than those purely based on the SBP threshold. The cardiovascular risk assessment strategy with different SBP thresholds is suggested to balance health benefits and intervention efficiency in diverse populations.

Previous studies have related single toxic metals (TMs) to hyperuricemia (HUA) among the general population, however, the association of the TM mixture with HUA, especially in older adults, remains poorly understood. We aimed to examine the relationships between individual TMs and their mixture and HUA in Chinese rural older adults. This study consisted of 2075 rural older adults aged 60 years or over. Blood concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cesium (Cs), gallium (Ga), mercury (Hg), lead (Pb), thallium (Tl), and uranium (U) were detected using inductively coupled plasma mass spectrometry. The associations of single TMs with HUA were assessed using logistic regression and restricted cubic spline (RCS) models, and the association of TM mixture with HUA was explored using the elastic net with environmental risk score (ENET-ERS), quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR) models, respectively. Adjusted logistic regression model showed that Cs (OR = 1.65, 95% CI 1.37-1.99) and Pb (OR = 1.46, 95% CI 1.28-1.67) were positively related to HUA, and RCS model exhibited a positive linear association of Cs and Pb with HUA. ENET-ERS and QGC models quantified a positive correlation between the TM mixture and the odds of HUA, with estimated ORs of 1.15 (95% CI 1.11-1.19) and 1.84 (95% CI 1.37-2.47), respectively, and Cs and Pb had the most weight. BKMR model demonstrated a significant linear association between the TM mixture and increased odds of HUA, with the posterior inclusion probabilities (PIPs) of both Cs and Pb being 1.00. Moreover, we observed a positive interaction between Cs and Pb on HUA. The TM mixture is associated with increased odds of HUA in rural older adults, which may mainly be driven by Cs and Pb. Subsequent studies are warranted to confirm these findings and clarify the mechanisms linking multiple TMs with HUA., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Stroke is a common complication of hypertension, but the predictive value of metabolic syndrome parameters' variability on stroke risk in individuals with hypertension remains unclear. Therefore, our objective was to investigate the relationship between metabolic syndrome parameters' variability and the risk of total stroke and its subtypes in hypertensive patients., Methods: This prospective cohort study included 17,789 individuals with hypertension from the Kailuan study since 2006. Metabolic syndrome parameters, including waist circumference (WC), fasting blood glucose (FBG), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG), were collected at three follow-up visits in the 2006, 2008, and 2010 surveys. We assess the variability utilizing the coefficient of variation (CV), standard deviation (SD), average real variation (ARV), and variability independent of the mean (VIM), with CV initially assessed. Participants were categorized based on the number of high-variability metabolic syndrome parameters (0, 1, 2, ≥ 3). Stroke cases were identified by reviewing medical records. The associations between variability in metabolic syndrome parameters and the risk of total stroke and its subtypes were analyzed using Cox proportional hazard regression models., Results: During a median follow-up of 9.32 years, 1223 cases of stroke were recorded. Participants with ≥ 3 high-variability metabolic syndrome parameters had an increased risk of total stroke (HR: 1.29, 95%CI 1.09-1.52), as well as an increased risk of ischemic stroke (HR: 1.31, 95%CI 1.05-1.63) compared to those without high-variability parameters. The study also examined variability in each metabolic syndrome parameter, and significant associations with an increased risk of total stroke were observed for variability in SBP (HR: 1.24, 95%CI 1.05-1.46) and HDL-C (HR: 1.34, 95%CI 1.09-1.64)., Conclusions: Long-term fluctuations in metabolic syndrome parameters significantly increase the risk of total stroke, especially ischemic stroke. Maintaining low variability in metabolic syndrome parameters could benefit health, and hypertensive individuals must be regularly monitored., (© 2024. The Author(s).)

Background: Sassafras tzumu, an elegant deciduous arboreal species, belongs to the esteemed genus Sassafras within the distinguished family Lauraceae. With its immense commercial value, escalating market demands and unforeseen human activities within its natural habitat have emerged as new threats to S. tzumu in recent decades, so it is necessary to study its genetic diversity and influencing factors, to propose correlative conservation strategies., Results: By utilizing genotyping-by-sequence (GBS) technology, we acquired a comprehensive database of single nucleotide polymorphisms (SNPs) from a cohort of 106 individuals sourced from 13 diverse Sassafras tzumu natural populations, scattered across various Chinese mountainous regions. Through our meticulous analysis, we aimed to unravel the intricate genetic diversity and structure within these S. tzumu populations, while simultaneously investigating the various factors that potentially shape genetic distance. Our preliminary findings unveiled a moderate level of genetic differentiation (F ST  = 0.103, p < 0.01), accompanied by a reasonably high genetic diversity among the S. tzumu populations. Encouragingly, our principal component analysis painted a vivid picture of two distinct genetic and geographical regions across China, where gene flow appeared to be somewhat restricted. Furthermore, employing the sophisticated multiple matrix regression with randomization (MMRR) analysis method, we successfully ascertained that environmental distance exerted a more pronounced impact on genetic distance when compared to geographical distance (β E  = 0.46, p < 0.01; β D  = 0.16, p < 0.01). This intriguing discovery underscores the potential significance of environmental factors in shaping the genetic landscape of S. tzumu populations., Conclusions: The genetic variance among populations of S. tzumu in our investigation exhibited a moderate degree of differentiation, alongside a heightened level of genetic diversity. The environmental distance of S. tzumu had a greater impact on its genetic diversity than geographical distance. It is of utmost significance to formulate and implement meticulous management and conservation strategies to safeguard the invaluable genetic resources of S. tzumu., (© 2024. The Author(s).)