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• Quantifying the impact of peer pressure on environmental improvements among local governments in China. • Investigating cities ' reaction to declining air quality rankings through regression discontinuity design. • Demonstrating the efficacy of political incentives in combating pollution and the catalytic effect of rankings on policy action. • Assessing the benefits resulting from air pollution reductions using an exposure response function. This paper estimates the impact of peer governmental pressure on air quality using a regression discontinuity design inherent in China's air quality ranking system. Because air quality rankings are important for political evaluations, local officials who witnessed a decline in air quality ranking are motivated to enforce more stringent environmental standards compared to their counterparts with increased rankings. By exploiting this regulatory discontinuity with monthly air quality ranking data from 2012 to 2020 of 169 cities, we find that cities experiencing a lower air quality ranking in the current month compared to the previous month exhibit a subsequent improvement in air quality during the following month, as evidenced by decreased pollutant concentrations. Furthermore, our analysis reveals that in cities where pollutant rankings decline more sharply, officials are less likely to encounter fewer promotion opportunities. Importantly, we observe that the discontinuity in individual pollutant concentrations is not solely influenced by their respective rankings but is also impacted by the overall A ir Q uality I ndex (AQI) ranking. Linking the reduction in air pollutants concentration with the economic benefits, a back-of-the-envelope calculation indicates the decrease in premature deaths due to cardiovascular and respiratory diseases amounts to approximately 200 thousand, resulting in an associated economic saving of more than 600 billion Chinese yuan. [ABSTRACT FROM AUTHOR]

The deployment of new energy trucks is a crucial national strategy in China to achieve deep decarbonization in road transport. Although fuel cell trucks and electric tucks are regarded as alternatives to conventional fuel trucks due to the advantage of zero usage emissions, their applicability for each truck type has not been determined. By developing a total cost of ownership analysis, this study dynamically determines the most economical alternative fuel type for each truck type and identifies when the large-scale deployment of new energy trucks is economically achievable. Then, by conducting a life cycle analysis with a localized database, this study quantitively evaluates the green gashouse emission intensities and their possible changes of different types of trucks. Finally, the emission reduction potential in the truck fleet by applying fuel cell and alternative fuel during 2020–2050 is comprehensively evaluated. The main results suggest that electric trucks are economically suitable for mini and light-duty trucks by 2031 and 2026, while fuel cell trucks suit medium-duty and heavy-duty trucks by 2027 and 2032. The application of alternative fuels in the truck fleet could achieve 28% carbon emissions in 2030 and up to 80% in 2050. • Analyzes TCO and GHG for Chinese trucks, identifies new energy types for different trucks. • Electric trucks viable for mini and light-duty by 2031 and 2026, fuel cell for medium and heavy-duty by 2027 and 2032. • Electric trucks emit 11.9–61.4% less GHG than diesel in 2020, expected to exceed 90% by 2050. • Hydrogen costs to decrease, making fuel cell trucks economically viable for heavy-duty transportation. • Study recommends policy measures for new energy trucks, including incentives, infrastructure, and regulations. [ABSTRACT FROM AUTHOR]

Forest mammal diversity declined rapidly due to the widespread loss and fragmentation of primary forest habitats, requiring further research on forest mammal diversity. China is a country with diverse forest types, large climate and elevation gradient, high mammal diversity, but massive anthropogenic disturbance on natural landscapes. However, few studies have assessed the associations between forest mammal diversity and these natural and anthropogenic factors. Therefore, this study tried to explore the relationships between forest mammal diversity captured by camera traps with elevation range, contemporary climate, paleoclimate change and human activities in China. We firstly collected mammal species lists from published literatures, calculated different diversity indices, and related these indices with explanatory variables using the multiple linear regression models. The results showed that forest sites with higher elevation range had higher species richness. Higher contemporary precipitation and cropland area promoted phylogenetic diversity and over-dispersed phylogenetic and functional structure. These findings suggest that the mammal diversity in Chinese forest ecosystems is mainly associated with natural environmental variables, supporting the habitat heterogeneity hypothesis, the energy availability hypothesis and tropical conservatism hypothesis. Meanwhile, the associations between forest mammal diversity and cropland area indicate that although these forest ecosystems play important role in conserving forest mammal diversity, further anthropogenic activities should be avoided. [ABSTRACT FROM AUTHOR]

Simple Summary: Yak is the dominant animal species in China's plateau regions. The development of the yak industry is conducive to protecting the ecosystem of the Qinghai–Tibet Plateau and promoting local economic development. However, the slow growth and development of yak have seriously affected the development of the yak industry. Structural variation (SV) has been widely applied in livestock breeding for growth traits. Therefore, it is of great significance to use SV to improve yak growth traits in yak breeding. Meanwhile, the GHR gene plays an important role in the formation and normal development of bones. This study associated the correlation between the yak GHR SV gene and growth traits and confirmed that GHR-SV can be used as a molecular marker for the early reproduction of yaks. This study provides a theoretical basis for the early growth and development of yaks. The growth hormone receptor (GHR) is a member of the cytokine/hematopoietic factor receptor superfamily, which plays an important role in the growth and development, immunity, and metabolism of animals. This study identified a 246 bp deletion variant in the intronic region of the GHR gene, and three genotypes, including type II, type ID, and type DD, were observed. Genotype analysis of structural variation (SV) was performed on 585 individuals from 14 yak breeds, and it was found that 246 bp deletion was present in each breed. The II genotype was dominant in all yak breeds except for SB yak. The association analysis of gene polymorphisms and growth traits in the ASD yak population showed that the 246 bp SV was significantly associated with body length at 6 months (p < 0.05). GHR messenger RNA (mRNA) was expressed in all the tested tissues, with significantly higher levels in the liver, muscle, and fat than in other organs. The results of transcription activity showed that the luciferase activity of the pGL4.10-DD vector was significantly higher than that of the pGL4.10-II vector (p < 0.05). Additionally, the transcription-factor binding prediction results showed that the SV in the runt-related transcription factor 1 (Runx1) transcription-factor binding site may affect the transcriptional activity of the GHR gene, regulating yak growth and development. This study showed that the novel SV of the GHR gene could be used as a candidate molecular marker for the selection of the early growth trait in ASD yak. [ABSTRACT FROM AUTHOR]

Abstract: China''s floating population is one of the largest migrations in the world. In recent years, great efforts have been made to identify their socio-demographic characteristics. However, the extent of their concern about the local environment has had less attention in the research. In the major migration cities of China, large numbers of migrants have a serious environmental impact on the ecological environment. Their environmental concerns could influence local environment policy design and environment protection implementation. The role that the temporary nature of the floating population plays in their environmental perception is now attracting the attention of local administrations. Based on an investigation conducted in the Shawan River Basin of Shenzhen City, China, this paper studies the floating population''s environmental concerns and possible movement choices, as well as some socio-demographic features. The results show that the percentage of migrants intending to settle in Shenzhen is much larger than previous studies indicated. As concerns local pollution problems, most respondents seem unconcerned and show indifferent attitudes. In particular, migrants ignore the heavy water pollution, which is the most serious pollution in the Basin. People who intend to settle down have more positive opinions on the local environment. The results also indicate that the migrants do not have enough knowledge or environmental awareness and they lack a sense of belonging, which should concern local supervisors and administration. Better education and social activities should be conducted to improve the situation. [Copyright &y& Elsevier]

Abstract: This article estimated the carbon emissions embodied in China''s foreign trade in 2007 with an input-output method. The results showed that China was a net exporter of at least 484.18MT carbon emissions in 2007, which accounted for 8.59% of total on a production basis. In total emissions, imported carbon accounted for 21.97% while exported carbon occupied 30.56%. In terms of sectors, Manufacture of Textile was the biggest net exporter, which was followed by Smelting and Pressing of Ferrous Metals, Manufacture of Metal Products, and so on. In terms of trading partners, Hong Kong was the biggest recipient of exported emissions of mainland China, which was followed by the US, Netherlands, UK, Singapore, and so on. Considering that a large amount of goods exported from mainland China to Hong Kong would be re-exported to the US, the emissions ultimately embodied in China-US trade would be greater than the estimation. Given that current production-based mechanism for allocating carbon abatement burden in international climate regime fails to reflect the complexities of international trade, the sacrifices that net carbon exporters are making and the actual environmental impact of consumption activities, BEET must be paid more attention if future policies would to be equitable and able to encourage active participations. Actually, so far, the seeking of a global solution for combating climate change because of its global impact seems to be prone to problems such as international conflict, carbon leakage, and free riding, etc., and current progress in slowing GHG emissions is actually arriving via fragmented and multispeed efforts, we may not just waiting for a global solution for the problem. Instead, actions at multiple levels with active oversight of local, regional, and national stakeholders, should be promoted. [Copyright &y& Elsevier]

Abstract: Severe industrial pollution has largely hindered the sustainable development of China. Taking Shenzhen’s electroplating industry as a case, this article investigates the current status of the industry and proposes a specialized policy framework to push its environmental innovation. There is a relatively complete environmental management system in Shenzhen’s government, but it does not work well when dealing with the electroplating industry, mainly because it lacks regulation aiming at production technology, which is the underlying decisive factor of the environmental performance of the industry. So, we first develop an evaluation criterion, which incorporates a technological index about whether enterprises engage identified obsolete technologies. With this evaluation criterion, enterprises are classified into “advanced” and “obsolete”. Then, we propose specific policy suggestions for different types of enterprises, including command and control mixed with economic tools, voluntary agreements, establishing electroplating parks, and improving current management system. Finally, we assess the impact of the policy proposal and prove it to be conducive to the sustainable development of the industry and conclude it from a more general perspective. [ABSTRACT FROM AUTHOR]

Yak is an ancient breed and Bazhou Yak is also one of China's unique yak breed resources. In the present study, its complete mitochondrial genome was assembled from Illumina sequencing data and we identified the complete mitochondrial genome of the Bazhou yak (Bos grunniens). The complete mitochondrial DNA is a circular molecule with 16,325 bp length consisting of 13 protein-coding genes, 2 rRNA genes, 22 tRNA genes, and a non-coding control region (D-loop). The overall nucleotide composition is A (33.69%), T (27.30%), C (25.79%), and G (13.22%), respectively. The content of C + G is 39.01%. Phylogenetic analysis of the mitochondrial genomes of 15 related species by MEGA7.0 showed that the genetic relationship of Bazhou yak is closer to Datong yak and polled yak. [ABSTRACT FROM AUTHOR]

Jialuo sheep is one of the important production materials of herdsmen in the pastoral areas of northwestern Sichuan in China. We reported the complete mitogenome of Jialuo sheep for the first time. It is 16,617 bp in length, containing 13 protein-coding genes, 2 ribosomal RNA genes, 22 transfer RNA genes, and a control region (D-loop). In the evolutionary relationship, the mitogenome of Jialuo sheep is closer to Texel sheep. This report will help the further studies of sheep species classification and resource protection. [ABSTRACT FROM AUTHOR]

Maiwa yak is a unique local strain of yak breed resource in China. The complete mitochondrial genome was identified in this work. The mitochondrial DNA is a circular molecule with 16,324 bp in length, including 13 protein-coding genes, 2 rRNA genes, 22 tRNA genes, and a non-coding control region(D-loop). The overall nucleotide ratio is A (33.70%), G (13.22%), T (27.26%), C (25.82%) with a C + G content of 39.04%. Phylogenetic analysis of mitochondrial genomes of 17 close species using MEGA7.0 showed that Maiwa yak is most related to Pali yak and polled yak. [ABSTRACT FROM AUTHOR]

Solar energy has expanded rapidly in recent years, and China is the largest market in terms of installed capacity. With the aim of achieving carbon neutrality by 2060, solar power will play an increasingly important role in China. However, like many other countries, the low energy density of solar photovoltaics is one of the major drawbacks of its further development. The emergence of floating photovoltaic systems (FPV) can not only break this threshold but also generate a series of cobenefits from a brand-new energy-land-water nexus perspective. Using a GIS-MCDA model, an evaporation model, combined with a cost-benefit analysis, this paper estimates the development potential of FPV in China, and its energy-land-water cobenefits are further analyzed. Moreover, to reveal the current land constraint for developing solar photovoltaics in China, the potential of traditional terrestrial solar photovoltaics has also been evaluated. The results show that the potential installed capacity of FPV in China can reach 705.2 GW–862.6 GW with an annual 1164.9 TWh to 1423.8 TWh of potential power output, and most potential FPV stations can obtain positive financial returns. The annual water evaporation reduction is approximately 5.8 km3. In the meantime, around 7117.3 km2 of the land could be conserved, which would alleviate the land constraint for terrestrial solar photovoltaic systems, especially in the highly urbanized eastern and southern coastal areas in China. [ABSTRACT FROM AUTHOR]

• The feasibility of lithium-ion battery remanufacturing is evaluated. • Remanufacturing of electric vehicle batteries is environmentally beneficial. • The potential cost saving is about $1.87 kg−1 cell produced. • The purchase price for spent batteries is a crucial factor to the profitability. The environmental threats posed by spent lithium-ion batteries (LIBs) and the future supply risks of battery components for electric vehicles can be simultaneously addressed by remanufacturing spent electric vehicle LIBs. To figure out the feasibility of battery remanufacturing, this paper quantifies the environmental impacts and costs of the remanufacturing of lithium-nickel-manganese-cobalt oxide battery cells and compares the results with the production of batteries from virgin materials. Based on the EverBatt model, a China-specific database of hydrometallurgical remanufacturing process is established. The results indicate that the reductions in energy consumption and greenhouse gas emissions by battery remanufacturing are 8.55% and 6.62%, respectively. From the economic standpoint, the potential cost-saving from battery remanufacturing is approximately $1.87 kg−1 cell produced. Through a sensitivity analysis, LIB remanufacturing is found to be economically viable until the purchase price of spent batteries rises to $2.87 kg−1. Furthermore, the impact of battery type variability is prominent, whereas the influence of recovery efficiency is limited. [ABSTRACT FROM AUTHOR]

Manufacturing is the foundation of China's economy and accounts for a large proportion of China's CO 2 emissions. In this study, the structural path decomposition (SPD) methodology, based on an environmental input-output model, was used to find critical supply chain paths that drive changes in CO 2 life cycle in China's manufacturing industry from 1992 to 2012. The changes in CO 2 emissions were decomposed into three main factors: carbon emissions intensity, input-output structure, and final demand. In this study, the “weighted average decompositions” method of structural decomposition analysis and the non-comparable input-output table were first applied to the SPD method to obtain accurate results. The results indicate that higher-order paths, especially the paths that started from the “Smelting and Rolling of Metals” and the “Production and Supply of Electricity and Steam” sectors, led to an increase in carbon emissions. This was mainly due to the extension of the industrial chain as well as policy priorities. Moreover, CO 2 emissions from the “Chemical Industry”, “Manufacture of Nonmetallic Mineral Products”, and “Smelting and Rolling of Metals” sectors were mainly induced by the increase of final export demands. Based on the results of this study, relevant policy changes have also been recommended. [ABSTRACT FROM AUTHOR]

The photovoltaic poverty alleviation project (PPAP), as an integration of solar photovoltaics and poverty alleviation, has gained great attention since it was proposed in China. So far, four different modes of PPAP have been formed - household level, village level, jointly-village level, and centralized PPAP. A comprehensive understanding of the effectiveness of different PPAP modes is essential to achieve the aim of getting rid of poverty in Chinese rural areas and to provide references for other developing countries. Therefore, this paper, for the first time, evaluates the economic performance of PPAP under the four modes. By employing cost-benefit analysis, this research elaborates on the effectiveness of PPAP from three aspects – cashflow, net present value, and payback period. The results show that the village level and the jointly-village level PPAP are the most effective modes. However, due to the overplus of installed capacity per household, the centralized PPAP, which is in line with the local governments' income, becomes the most popular mode. Besides, bank loans can significantly increase the number of benefited households, and the beneficiary ratio is critical to the effectiveness of corporations' participation. [ABSTRACT FROM AUTHOR]

The adoption of electric vehicles (EVs) has been supported by a variety of policies. However, many of these policies failed to accomplish their objectives from the demand side as expected. Grasping consumers' preferences accurately is of great significance to increase the efficacy of the promotion policies. Using the random coefficient logit model (BLP), this paper quantitatively analyses the preferences of EV consumers in China, with an emphasis on regional disparity and different operational purposes. The results show that the preferences for EVs are significantly heterogeneous among consumers in restricted and non-restricted cities, and in cities at different development stages. The driving range and the density of charging stations are the key influencing factors for consumers to choose EVs, and different purchasing groups have different preferences. The demand for long-range EVs mainly comes from taxis, while private EV buyers prefer high-density charging facilities. Thus, at the current stage, building more charging stations will be more efficient compared to subsidizing high-range EVs. [ABSTRACT FROM AUTHOR]

Solar photovoltaic (PV) systems have developed rapidly in China, and the issues on where to locate the solar PV stations become critical. In some provinces, the markets are already saturated, and even solar energy curtailment has occurred due to oversupply. Thus, depicting an efficient deployment picture of the solar PV stations in China is in urgent need. To explore this issue, a profit-maximizing model is proposed to optimize the allocation of solar PV stations and interprovincial transmission strategies. The profit of solar PV stations in each province/municipality is evaluated from both economic and environmental perspectives. The economic performance is evaluated by net present value and levelized cost of energy, and the environmental benefits refer to the abatement of CO 2 emissions. The results show that the northwestern and northeastern regions are not suitable to further develop solar PV systems in recent years, while the developed regions including the Yangtze River Delta, Tianjin, Beijing, and Guangdong should be encouraged to deploy more solar PV systems, especially the distributed solar photovoltaics for the commercial/industrial sectors. In 2020, the newly-added installed capacity in Zhejiang, Shandong, Beijing, and Henan is supposed to excess 8500 MW. • Optimized deployment of solar PV stations at provincial level in China is depicted. • Northwest and northeast China lack demand for new solar PV stations in recent years. • Developed provinces should be highly encouraged to deploy more solar PV systems. [ABSTRACT FROM AUTHOR]

China is actively supporting the electrification of passenger vehicles as it attempts to reduce carbon dioxide (CO 2) emissions from the transportation sector. Through a hybrid life cycle assessment, this study aims to evaluate the CO 2 emission reduction potential from this large-scale vehicle electrification. A comprehensive database of passenger electric vehicles sold in 2018 is established and future scenario analysis considering multiple technology advancements is integrated. The results indicate that this vehicle electrification fails to achieve emission savings in 2018, as extra emissions from manufacturing newly sold passenger electric vehicles exceed the avoided emissions from on-road vehicles. In 2030, the emission reductions could feasibly increase to 49.64 million tons and achieve up to 62.16 million tons in the optimistic scenario. By correlation analysis using market-based data in 2018 and scenario analysis in 2030, the fuel economy is identified as a crucial factor to deliver emission mitigation. • The vehicle electrification in China fails to save CO 2 emissions in 2018. • Potential CO 2 emission reductions rises up to 60 million tons in 2030. • Relationships among emissions, vehicle performance and sales are analysed. • Fuel economy is a crucial factor to maximize the emission reduction potential. • Plug-in hybrid electric vehicles gain prominent emission reductions by 2030. [ABSTRACT FROM AUTHOR]

Background: Malignant cerebral edema (MCE) is a severe condition characterized by rapid neurological deterioration and a potentially poor prognosis. Scoring systems including the malignant brain edema (MBE) score, Enhanced Detection of Edema in Malignant Anterior Circulation Stroke score (EDEMA), and modified EDEMA score, have been developed to predict MCE in patients with large hemispheric infarction (LHI). We aimed to externally validate and comparethe predictive efficacy of these scores in LHI patients within 48 h of onset and not undergoing reperfusion therapy., Methods: Demographic, clinical and radiological data were retrospectively collected from LHI patients within 48 h of onset and not receiving reperfusion therapy. Patients were divided into MCE and non-MCE group. The calibration, discrimination, and clinical practicability of the three scores were verified using Hosmer-Lemeshow goodness-of-fit test, receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively. Finally, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were applied to determine the discrimination performance of the three scores., Results: A total of 314 patients were included in the study, with 122 cases being MCE patients. The Hosmer-Lemeshow goodness-of-fit test showed excellent fitting ability across the MBE (p = 0.36), EDEMA (p = 0.61), and modified EDEMA scores (p = 0.62) in our patients. The MBE, EDEMA, and modified EDEMA scores had the AUCs of 0.855 (95 % CI 0.818-0.898), 0.782 (95 % CI 0.727-0.837) and 0.878 (95 % CI 0.844-0.919) respectively. The MBE (NRI, 0.33; 95 % CI, 0.11-0.56, p = 0.003 and IDI, 0.11; 95 % CI, 0.03-0.18; p = 0.004) and modified EDEMA scores (NRI, 1.10; 95 % CI, 0.94-1.26; p < 0.001 and IDI, 0.17; 95 % CI, 0.13-0.20, p < 0.001) showed better performance than the EDEMA score. DCA demonstrated that the modified EDEMA score outperformed the other two scores, possessing heightened clinical usefulness., Conclusions: The MBE, EDEMA, and modified EDEMA scores for predicting MCE are also applicable in non-revascularization LHI patients within 48 h of onset. Both the MBE and modified EDEMA scores demonstrated higher predictive validity as predictive tools for MCE in LHI patients than the EDEMA score. Furthermore, the modified EDEMA score could be a suitable prediction tool in Chinese patients for its excellent clinical utility., 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 Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Full-thickness rectal prolapse (FTRP) frequently occurs in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rate of FTRP post-GMT, which is as high as 23.8%, is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem., Methods: The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed., Results: All patients were cured according to the clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3 ± 3.31, which became 3.7 ± 2.43 (P < 0.0001) postoperatively. The perioperative ACRP was 2.0 ± 0.56 kPa, which became 8.5 ± 2.25 kPa (P < 0.0001) postoperatively. The perioperative MASP was 4.5 ± 1.16 kPa, which became 18.6 ± 2.50 kPa (P < 0.0001) postoperatively. However, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure., Conclusion: The benefits of nmGMTSI include low rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.

Introduction: Gallbladder cancer (GBC), the sixth most common gastrointestinal tract cancer, poses a significant disease burden in China. However, no national representative data are available on the clinical characteristics, treatment and prognosis of GBC in the Chinese population., Methods and Analysis: The Chinese Research Group of Gallbladder Cancer (CRGGC) study is a multicentre retrospective registry cohort study. Clinically diagnosed patient with GBC will be identified from 1 January 2008 to December, 2019, by reviewing the electronic medical records from 76 tertiary and secondary hospitals across 28 provinces in China. Patients with pathological and radiological diagnoses of malignancy, including cancer in situ, from the gallbladder and cystic duct are eligible, according to the National Comprehensive Cancer Network 2019 guidelines. Patients will be excluded if GBC is the secondary diagnosis in the discharge summary. The demographic characteristics, medical history, physical examination results, surgery information, pathological data, laboratory examination results and radiology reports will be collected in a standardised case report form. By May 2021, approximately 6000 patient with GBC will be included. The clinical follow-up data will be updated until 5 years after the last admission for GBC of each patient. The study aimed (1) to depict the clinical characteristics, including demographics, pathology, treatment and prognosis of patient with GBC in China; (2) to evaluate the adherence to clinical guidelines of GBC and (3) to improve clinical practice for diagnosing and treating GBC and provide references for policy-makers., Ethics and Dissemination: The protocol of the CRGGC has been approved by the Committee for Ethics of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine (SHEC-C-2019-085). All results of this study will be published in peer-reviewed journals and presented at relevant conferences., Trial Registration Number: NCT04140552, Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To study the effects of music on anxiety and pain in children with cerebral palsy receiving acupuncture daily in a clinical setting., Design: A randomized controlled trial., Setting: Acupuncture Unit at Shenzhen Hospital of Traditional Chinese Medicine in Shenzhen City of China., Participants: Sixty children with cerebral palsy undergoing acupuncture., Intervention: Children listened to their favorite music or a blank disc for 30 min., Measurements: (1) the modified Yale preoperative anxiety scale for children's anxiety (mYPAS); (2) children's hospital of eastern Ontario pain scale (CHEOPS) and Wong-Baker faces pain rating scale (FACES) for pain intensity; (3) vital signs including mean arterial blood pressure (MAP), heart rate (HR) and respiratory rate (RR)., Results: An independent sample t-test showed significantly lower mYPAS scores in the music group 30 min after the intervention compared with the control group (t=4.72, P=0.00). Significant differences between groups were found in mYPAS scores (F=4.270, d.f.=1, P=0.043, Partial eta(2)=0.069) and over treatment duration (F=143.421, d.f.=1.521, P=0.000, Partial eta(2)=0.712). A significant interaction was also found (F=4.298, d.f.=1.521, P=0.025, Partial eta(2)=0.069). LSD's post hoc testing confirmed that the mYPAS scores significantly increased from the baseline to 1 min (P=0.000, 95% CI 14.913, 20.257) and then gradually decreased from 1 to 30min (P=0.000, 95% CI -18.952, -13.714). For pain intensity scores, a highly significant time effect was found in both the CHEOPS (F=87.347, d.f.=2, P=0.000, Partial eta(2)=0.601) and FACES (F=225.871, d.f.=1.822, P=0.000, Partial eta(2)=0.796), and a significant interaction effect was found as well (F=4.369, d.f.=2, P=0.015, Partial eta(2)=0.070; F=5.859, d.f.=1.822, P=0.005, Partial eta(2)=0.092). However, no significant difference between groups was present (F=2.343, d.f.=1, P=0.131, Partial eta(2)=0.039; F=3.738, d.f.=1, P=0.058, Partial eta(2)=0.061). Significant differences between groups were found in MAP and HR (P<0.05) and over time (P<0.05), but no significant effects in RR were apparent (P>0.05). A significant interaction effect was found in HR (P<0.05), but not in MAP or RR (P>0.05)., Conclusions: This study demonstrates that listening to music while receiving acupuncture can relieve anxiety among children with cerebral palsy; however, no effect was observed in terms of pain reduction. Further research is needed to explore the types of music which best impact an individual's treatment. Whether music results in fewer accidents and side effects of acupuncture should be investigated. Music can be considered as adjunctive therapy in clinical situations that may be anxiety-provoking for children.