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Objective: We aimed to investigate the prevalence of covert hepatic encephalopathy (CHE) in cirrhotic patients in China and its risk factors. Methods: A multicenter prospective observational study was conducted from January 2021 to March 2022 at 16 medical centers across China to investigate the risk factors of CHE and establish a prediction model for CHE episodes. Results: A total of 528 patients were enrolled in the study. Based on both the psychometric hepatic encephalopathy score and Stroop test results, the prevalence of CHE was 50.4% (266/528), and the consistency between these two tests was 68.9%. Multivariate analysis showed that age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.022–1.063, P < 0.001), duration of education (OR 0.891, 95% CI 0.832–0.954, P = 0.001), comorbidities of cardiovascular diseases, hypertension, cerebral apoplexy or diabetes mellitus (OR 2.072, 95% CI 1.370–3.133, P < 0.001), Child–Pugh score (OR 1.142, 95% CI 1.029–1.465, P = 0.025), and blood urea nitrogen concentration (OR 1.126, 95% CI 1.038–1.221, P = 0.004) were associated with CHE episodes. According to the Chronic Liver Disease Questionnaire, CHE patients had lower scores for abdominal symptoms and systemic symptoms (P < 0.001), indicating a poor health‐related quality of life. Based on a stepwise Cox regression hazard model, we established a nomogram for determining the probabilities of CHE episodes, and the area under the receiver operating characteristic curve was 0.733 (95% CI 0.679–0.788) and 0.713 (95% CI 0.628–0.797) in the training and validation cohorts. Conclusions: CHE is a common complication of cirrhosis in China. Large‐scale studies with long‐term follow‐up are needed to determine the natural history of Chinese CHE patients. [ABSTRACT FROM AUTHOR]

Accurate estimation of regional and global patterns of ecosystem respiration (ER) is crucial to improve the understanding of terrestrial carbon cycles and the predictive ability of the global carbon budget. However, large uncertainties still exist in regional and global ER estimation due to the drawbacks of modeling methods. Based on eddy covariance ER data from 132 sites in China from 2002 to 2020, we established Intelligent Random Forest (IRF) models that integrated ecological understanding with machine learning techniques to estimate ER. The results showed that the IRF models performed better than semiempirical models and machine learning algorithms. The observed data revealed that gross primary productivity (GPP), living plant biomass, and soil organic carbon (SOC) were of great importance in controlling the spatiotemporal variability of ER across China. An optimal model governed by annual GPP, living plant biomass, SOC, and air temperature (IRF‐04 model) matched 93% of the spatiotemporal variation in site‐level ER, and was adopted to evaluate the spatiotemporal pattern of ER in China. Using the optimal model, we obtained that the annual value of ER in China ranged from 5.05 to 5.84 Pg C yr−1 between 2000 and 2020, with an average value of 5.53 ± 0.22 Pg C yr−1. In this study, we suggest that future models should integrate process‐based and data‐driven approaches for understanding and evaluating regional and global carbon budgets. Plain Language Summary: With China already committing to achieve carbon neutrality before 2060, an accurate assessment of land carbon sink and its flux rate in China is an increasingly important area in global change ecology. In this essay, a high‐efficiency and accurate simulation method was introduced in this field; This method is particularly useful in the assessment of carbon sink and its flux rate in China by combining with reliable observation flux data. Using this new method, a reliable and reasonable value of carbon flux (ecosystem respiration) was obtained. Meanwhile, that method provides a better understanding of the mechanism governing the spatiotemporal variability of carbon flux. Therefore, this present study has gone some way toward enhancing our understanding of a comprehensive assessment and analysis of land carbon sink in China. Key Points: A model integrating ecological knowledge and machine learning was established to estimate ecosystem respiration (ER) in ChinaThe spatiotemporal patterns of ER are significantly affected by productivity, plant biomass, soil organic carbon, and air temperatureChina's ER was estimated to be 5.53 ± 0.22 petagrams of carbon per year (Pg C yr−1) on average for the years 2000–2020 [ABSTRACT FROM AUTHOR]

Climate warming-induced rangeland degradation in arid and semiarid steppe imposes substantial threats to the livelihoods of people. But this dilemma can be solved by combining all sectors of agriculture, animal husbandry and tourism through their complementarity, i.e. by adopting integrated landscape ecosystem-based approaches. A number of experiences and lessons have been achieved in a specific sector for its successful development, but not in the multiple social, economic, and ecological systems. In this study, we uses the perspective of integrated ecosystem management to strengthen crop-livestock integration and innovative livelihoods, and propose a multifunctional Kailash Landscape to activate the inter-linkage among agriculture, animal husbandry, and heritage pilgrimage/tourism in order to achieve multifunction of the socio-ecological system. A case study of Kailash Sacred Landscape Conservation and Development Initiative in China was quantitatively and qualitatively analyzed by land use and land cover change and its consequence on multiple ecosystem services. Integrated landscape management was found to be effective in building resilience of socio-ecosystems by reducing the vulnerability of traditional agriculture in terms of improving crop production and animal husbandry. A multifunctional landscape is expected to be integrated and build a resilient sector complementarity including farming, pastorism, environmental and socioeconomic function. The analyses show that integrated landscape approaches provide an effective perspective for sustainable socio-economic development in this sacred landscape. The findings highlight the importance of landscape-scale ecosystem-based adaptation to environment change. [ABSTRACT FROM AUTHOR]

Background: Diagnostic criteria for sarcopenia have not been established in Chinese. This study established criteria based on the L3‐skeletal muscle index (L3‐SMI) and assessed its value for outcomes predicting in cirrhotic Chinese patients. Methods: Totally 911 subjects who underwent a CT scan at two centres were enrolled in Cohort 1 (394 male and 417 female subjects, aged 20–80 years). The data of those subjects younger than 60 years (365 male and 296 female subjects) were used to determine the reference intervals of the L3‐SMI and its influencing factors. Cohort 2 consisted of 480 patients (286 male and 184 female patients) from three centres, and their data were used to investigate the prevalence of sarcopenia and evaluate the value of L3‐SMI for predicting the prognosis and complications of cirrhosis. Results: Age and sex had the greatest effects on the L3‐SMI (P < 0.001). The L3‐SMI scores were clearly higher in male patients than in female patients (52.94 ± 8.41 vs. 38.91 ± 5.65 cm2/m2, P < 0.001) and sharply declined in subjects aged ≥ 60 years. Based on the mean −1.28 × SD among adults aged < 60 years, the L3‐SMI cut‐off value for sarcopenia was 44.77 cm2/m2 in male patients and 32.50 cm2/m2 in female patients. Using these values, 22.5% of the cirrhotic patients (28.7% of male patients and 11.9% of female patients) were diagnosed with sarcopenia. Compared with non‐sarcopenia individuals, sarcopenia patients had lower body mass index (21.28 ± 3.01 vs. 24.09 ± 3.39 kg/m2, P < 0.001) and serum albumin levels (31.54 ± 5.93 vs. 32.93 ± 5.95 g/L, P = 0.032), longer prothrombin times (16.39 ± 3.05 vs. 15.71 ± 3.20 s, P = 0.049), higher total bilirubin concentrations (41.33 ± 57.38 vs. 32.52 ± 31.48 μmol/L, P = 0.039), worse liver function (Child–Pugh score, 8.05 ± 2.11 vs. 7.32 ± 2.05, P = 0.001), higher prevalence of cirrhosis‐related complications (81.82% vs. 62.24%, P < 0.001) and mortality (30.68% vs. 11.22%, P < 0.001). Overall survival was significantly lower in the sarcopenia group [risk ratio (RR) = 2.643, 95% confidence interval (CI) 1.646–4.244, P < 0.001], accompanied with an increased cumulative incidence of ascites (RR = 1.827, 95% CI 1.259–2.651, P = 0.002), spontaneous bacterial peritonitis (RR = 3.331, 95% CI 1.404–7.903, P = 0.006), hepatic encephalopathy (RR = 1.962, 95% CI 1.070–3.600, P = 0.029), and upper gastrointestinal varices (RR = 2.138, 95% CI 1.319–3.466, P = 0.002). Subgroup analysis showed sarcopenia shortened the survival of the patients with Model For End‐Stage Liver Disease score > 14 (RR = 4.310, 95% CI 2.091–8.882, P < 0.001) or Child–Pugh C (RR = 3.081, 95% CI 1.516–6.260, P = 0.002). Conclusions: Sarcopenia is a common comorbidity of cirrhosis and can be used to predict cirrhosis‐related complications and the prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Tuberculosis remains a major public health problem globally, especially in undeveloped countries. This study aimed to evaluate and review the long-term epidemic trends of tuberculosis in China. Methods: Data were extracted from the Global Health Data Exchange. Metrics (prevalence, incidence and mortality) and Joinpoint regression were used to identify the epidemic trends. Results: From 1990 to 2017, decreasing trends in prevalence (average annual percent change, AAPC: − 0.5%, 95% CI: − 0.6% to − 0.5%), incidence (− 3.2%, 95% CI: − 3.5% to − 2.9%), and mortality (− 5.7%, 95% CI: − 6.2% to − 5.3%) of tuberculosis were observed. The incidence and mortality of multidrug-resistant tuberculosis (MDR-TB) decreased with AAPC of − 2.3% (− 3.1% to − 1.4%) and − 4.9% (− 5.4% to − 4.5%), respectively, while the prevalence increased with an AAPC of 1.2% (0.3% to 2.0%). The burden of extensively drug-resistant tuberculosis (XDR-TB) increased with an AAPC of 12.5% (11.9% to 13.2%) in prevalence, 7.6% (6.5% to 8.7%) in incidence, and 4.5% (3.6% to 5.4%) in mortality. The disease burden of tuberculosis increased with age and peaked among those aged over 70. Conclusion: The epidemic of tuberculosis decreased in China, while the disease burden was still challenging to control. MDR-TB and XDR-TB should be emphasized along with the epidemic. It will certainly be a difficult task to achieve the post-2015 global targets by 2025 and 2035. [ABSTRACT FROM AUTHOR]

Background and Aim: Considering the large size of the potential population and limitations of common detection methods, covert hepatic encephalopathy (CHE) is difficult to screen for routinely. The present study aims to explore EncephalApp Stroop Test as a smartphone‐based CHE screening tool in China. Methods: A multicenter, single‐visit study was carried out. The cutoff of the Chinese EncephalApp translation was determined by using Chinese standardized psychometric hepatic encephalopathy score (PHES) in cirrhotic patients as the gold standard. Indicators reflecting time required and number of tests on subtask on (naming the color of pound signs) and off (naming the color of the word in discordant coloring) were recorded, with the feedback from investigators and patients. Results: One hundred forty‐four patients were included; 58 (40.28%) patients were diagnosed with CHE by PHES. The cutoff of > 97.34 s for off time and > 186.63 s for on time + off time had the maximum area under the curve values (0.77) in all patients. Furthermore, with the cutoff of 186.63 s, on time + off time has the highest sensitivity (0.86). However, the specificity was unsatisfactory (0.59). Age and alcoholic hepatitis (odds ratio = 1.05 and 3.12, both P < 0.05) were positively correlated with the risk of CHE. The experience with electronic devices and education duration were negatively correlated (odds ratio = 0.21 and 0.92, both P < 0.05). Compared with PHES, EncephalApp represented 38% time saving. Furthermore, it was superior to PHES regarding accessibility, convenience, and acceptability by administrators (all P < 0.05). Conclusions: The EncephalApp Stroop Test is an efficient screening tool for CHE in Chinese cirrhotic patients. [ABSTRACT FROM AUTHOR]

There are numerous lakes on the Tibetan Plateau (TP), but the role of lake temperature in precipitation over the TP remains unclear. Here the Weather Research and Forecasting (WRF) model was used to detect the impact of lakes on summer rainfall. Three test cases were used to evaluate the effect of lakes surface temperature (LSTs) on precipitation variability. The three cases used different methods to determine initial LSTs, including using sea surface temperature data (SST), the WRF inland water module (avg_tsfc), and a lake model. Results show that when precipitation was stimulated over the TP, LSTs cannot be initialized using SST, which led to large discrepancies of precipitation. Compared with the simulations, the simulated precipitation were improved obviously with LSTs using avg_tsfc, indicating that LSTs have an considerable influence on determining precipitation over the TP. Due to a lack of observational data, the lake scheme does not improve on rainfall simulation, but does effectively simulate precipitation pattern over lakes, such as rainfall over the lakes was dominated by convection during the nighttime. Though the simulated precipitation using SST to initialize LSTs caused large discrepancies, it suggested that precipitation increase especially convective precipitation with increase in LSTs, which confirmed that the moisture from lakes cannot be neglected over the TP. Generally, it was necessary to monitor the LSTs for accurate weather and climate prediction over the TP. [ABSTRACT FROM AUTHOR]

Moso bamboos ( Phyllostachys edulis) are important forestry plants in southern China, with substantial roles to play in regional economic and ecological systems. Mixing broad-leaved forests and moso bamboos is a common management practice in China, and it is fundamental to elucidate the interactions between broad-leaved trees and moso bamboos for ensuring the sustainable provision of ecosystem services. We examine how the proportion of broad-leaved forest in a mixed managed zone, topology, and soil profile affects the effective productivity of moso bamboos (i.e., those with significant economic value), using linear regression and generalized additive models. Bamboo's diameter at breast height follows a Weibull distribution. The importance of these variables to bamboo productivity is, respectively, slope (25.9%), the proportion of broad-leaved forest (24.8%), elevation (23.3%), gravel content by volume (16.6%), slope location (8.3%), and soil layer thickness (1.2%). Highest productivity is found on the 25° slope, with a 600-m elevation, and 30% broad-leaved forest. As such, broad-leaved forest in the upper slope can have a strong influence on the effective productivity of moso bamboo, ranking only after slope and before elevation. These factors can be considered in future management practice. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate 10 year's performance of research foundation of Shanghai Research Institute of Stomatology, and to analyze the relationship between input and output. METHODS: An evaluation target system for hospital research foundation projects was designed according to literature research and experts' consultation. Statistical measures such as general descriptive analysis and multiple stepwise regression were used to analyze the influential factors and the relationship among research output, financial and human input via Excel 2003 and SPSS11.0 software package. RESULTS: An evaluation target system was set up and applied to evaluate the output of hospital research foundation. The performance showed the sustained and stable contribution to the comprehensive research output of the hospital. The education level of the researchers was found to be the key influential factor. CONCLUSIONS: Hospital research foundation plays an important role in cultivating research projects and construction echelon personnel. The whole process of management should be strictly implemented on the projects, and incentive measures are preferable to be set up. [ABSTRACT FROM AUTHOR]

Abstract: Shenzhen is one of the special economic zones in China. It has been growing rapidly from rural land to an industrial city since the mid-1980s. With the process of urbanization, flooding has become a threat to the security of the city area. In this study, Buji River basin in Shenzhen Region was selected to investigate the effect of urbanization on surface runoff and peak discharge. Land use data were obtained from LANDSAT images in 1980, 1988, 1994, and 2000, and surface runoff in the same period was simulated by SCS model. Results showed that urbanization played an important factor intensifying the flood process. Increase of urbanized land and decrease of farmland might be the main reasons for increasing runoff. At 10%, 50% and 90% rainfall probability (the rainfall probability of 10% means 10-year return period of moist year, 2-year return period of normal year and 10-year return period of dry year), the increase of runoff coefficient was 12.6%, 20.7% and 33.5% respectively under relatively dry soil moisture condition, however, and the value was 2.5%, 4.3% and 6.9% respectively under relatively wet soil moisture condition. Urbanization led to obvious increase in the maximum flood discharge and decrease in runoff confluence time. At 1%, 2% and 5% rainfall probability, the increase of the maximum flood discharge was 20.2%, 23.0% and 28.9% respectively, under relatively dry soil moisture condition. The corresponding value was 1.3%, 1.6% and 2.6% respectively under relatively wet soil moisture condition. Due to urbanization in the past 20 years, runoff coefficient increased 13.4% and the maximum flood discharge increased 12.9% on average. [Copyright &y& Elsevier]

Using the Surface waterproofing to solve moisture expansion which leads to the acceleration of surface weathering of sandstone relics is a hot topic. This study focuses on surface coating protection because of the special status of cultural relics. The fluorinated ZnO/SiO 2 nano-coating was applied on the sandstone matrix in this work. The loading of the fluorinated ZnO/SiO 2 in the nano-coating, the penetration depth of the nano-coating in the sandstone matrix, and the waterproofing effect of the sandstone surface were investigated within the limitation of the color difference systematically. The freeze-thaw cycles, light exposure, water absorption, and aging tests were carried out to evaluate the environmental durability of the nano-coating in a simulated humid environment of southwestern of China. All the tests meet the criteria for the heritage protection color difference. When the loading of fluorinated ZnO/SiO 2 nano-coating is 0.4%, the water contact angle (WCA) and oil contact angle (OCA) are significantly improved, which are larger than 160° and 140°, respectively. The WCA and OCA have little changed after freeze-thaw cycle for three weeks, and the WCA only decreases only 7% after 300 h UV aging treatment. This significantly enhanced stability is due to the good penetration depth of the fluorinated ZnO/SiO 2 nano-coating on the sandstone matrix. Moreover, the excellent air permeability is achieved as well to ensure substrate breathing. This work would provide a new idea for the long-term protection of sandstone heritage in practical environment. [ABSTRACT FROM AUTHOR]

Analyzing the approaches that climatic factors affect the spatial variation of annual gross primary productivity (GPP yr ) would improve our understanding on its spatial pattern. Based on network eddy covariance measurements and published data in literature, we separated GPP yr into radiation use efficiency (RUE) and annual absorbed photosynthesis active radiation (APAR yr ), where APAR yr can be regarded as the product of the fraction of absorbed annual photosynthesis active radiation (FPAR yr ) and annual PAR (PAR yr ). Given that PAR yr affects the spatial variation of GPP yr directly through itself, we investigated factors affecting the spatial variations of RUE and FPAR yr , to reveal how climatic factors affect the spatial variation of GPP yr . Results suggest that the spatial variation of RUE was directly affected by annual mean air temperature (MAT) and annual mean CO 2 mass concentration ( ρ cyr ). The increasing MAT and ρ cyr directly enhanced RUE. The increasing annual precipitation (MAP) directly prompted FPAR yr . Therefore, MAT and ρ cyr affected the spatial variation of GPP yr through altering RUE while the effect of MAP was achieved through altering FPAR yr . Our study could also provide an alternative way for regional GPP yr assessment. [ABSTRACT FROM AUTHOR]

Accurate quantifying the magnitudes and distributions of carbon budgets is helpful for strategies in mitigating global climate change. Based on spatial patterns of carbon fluxes (gross ecosystem productivity (GEP), ecosystem respiration (ER) and net ecosystem productivity (NEP)) and their drivers, we constructed geographical statistical assessment schemes and quantified the magnitudes of carbon fluxes in China. The optimal assessment scheme was then validated with observed eddy covariance data to analyze the spatial distributions of carbon fluxes. Using climate-based geographical statistical assessment schemes, our estimates of GEP, ER and NEP in China during 2000s were 7.51±0.51, 5.82±0.16 and 1.91±0.15PgCyr−1, corresponding to 4.29%–6.80%, 5.65%–6.06% and 9.10%–12.73% of global annual carbon fluxes, respectively. The spatial distributions of GEP, ER and NEP, generated from the optimal scheme, were similar, following a southeast–northwest decreasing gradient. The maximum values for GEP, ER and NEP were 1790, 1300 and 490gCm−2 yr−1, respectively, which occurred in Central subtropics and Southern subtropics. Climate-based geographical statistical assessment schemes provided an independent dataset for the regional carbon budget assessment, which can be deemed as the potential carbon fluxes. Meanwhile, most areas in China were potential carbon sink especially Eastern China and the largest potential carbon sink appeared in Central subtropics and Southern subtropics. [ABSTRACT FROM AUTHOR]

Mosquito transmitted viruses are responsible for an increasing burden of human disease. Despite this, little is known about the diversity and ecology of viruses within individual mosquito hosts. Here, using a meta-transcriptomic approach, we determined the viromes of 2,438 individual mosquitoes (81 species), spanning ~4,000 km along latitudes and longitudes in China. From these data we identified 393 viral species associated with mosquitoes, including 7 (putative) species of arthropod-borne viruses (that is, arboviruses). We identified potential mosquito species and geographic hotspots of viral diversity and arbovirus occurrence, and demonstrated that the composition of individual mosquito viromes was strongly associated with host phylogeny. Our data revealed a large number of viruses shared among mosquito species or genera, enhancing our understanding of the host specificity of insect-associated viruses. We also detected multiple virus species that were widespread throughout the country, perhaps reflecting long-distance mosquito dispersal. Together, these results greatly expand the known mosquito virome, linked viral diversity at the scale of individual insects to that at a country-wide scale, and offered unique insights into the biogeography and diversity of viruses in insect vectors., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Building a scientific and reasonable ecological network is the key for optimizing the pattern of territorial development and protection, and is of great significance for ensuring regional ecological security and promoting the virtuous cycle of ecosystems. In previous studies, nodal attack method (destruction of ecological source area) was often used in the "robustness" evaluation of ecological networks. Actually, the ecological corridor is more fragile than the source area, and thus the nodal attack method is not reasonable. In this study, taking Jiuquan City as the research area, based on the circuit model to construct the ecological network, we carried out the topology optimization of ecological network by using three strategies (random edge increase, node degree and priority edge increase with low node intermedium number) in complex network theory. We compared and analyzed the "robustness" of ecological network before and after optimization by constructing edge attack strategy, and selected the best network optimization strategy. The results showed that 65 ecological source areas were identified in Jiuquan City, with a total area of 20275.15 km 2 , and that grassland accounted for 89.5% of the source area. We identified 179 ecological corridors with a total length of 6387.16 km, 158 ecological barrier points with a total area of 1385.5 km 2 . The unused land accounted for 92.2% of the total barrier points area. We identified 63 ecological pinch points, mainly concentrated in the source edge and corridor intersection. Among them, the spatial distribution of 11 barrier points and pinch points was consistent, which was the key area to be repaired in ecological network optimization. The three optimization strategies had significantly improved the stability of ecological network in Jiuquan City. The relative size of the maximum connected subgraph and the edge connected rate of the ecological network of the optimization strategy of adding edges according to degree were all the most stable under random attack mode and deliberate attack mode, which was the best optimization scheme for ecological network in Jiuquan City.

Based on the PSR model, we built an evaluation system for resource and environment carrying capacity. We used the entropy weight method, the comprehensive index model and the spatial analysis function of GIS to explore the spatial-temporal dynamic of the resource and environment carrying capacity of the Lanzhou-Xining urban agglomeration, and used the obstacle degree model to identify the obstacle factors. The results showed that resource and environment carrying capacity of the Lanzhou-Xining urban agglomeration from 2005 to 2018 showed a fluctuating upward trend, which was generally at good condition. The coefficient of variation of resource and environment carrying capacity had a fluctuating upward trend, while regional differences were gradually expanding. Spatially, resource and environment carrying capacity presented a "dual-core" structure centered on the main urban areas of Lanzhou and Xining. The high-level areas were mainly concentrated in the Hehuang Valley with Lanzhou and Xining as the center and some surrounding counties, while the low-level areas were distributed in the central and southern regions of the urban agglomeration. Among them, there were spatiotemporal variations of the subsystem index. The pressure index showed a fluctuating and decreasing trend, and spatially showed a decreasing distribution characteristic from Lanzhou and Xining urban areas to the peripheral areas. The state index showed a fluctuating upward trend, and spatially showed the evolution characteristics of high in the east and west wings and low in the middle. The response index showed an upward trend, and spatially showed distribution patterns high in the east and middle, and low in the west and outside. The urbanization rate, per capita industrial wastewater discharge, domestic waste harmless treatment rate, water consumption index, and the proportion of environmental protection investment in GDP are the main obstacles restricting the improvement of resource and environment carrying capacity of Lanhzhou-Xining urban agglomeration.

Objective: To evaluate the reliability and validity of the Chinese version of the eight-item Morisky Medication Adherence Scale (MMAS-8) in Chinese patients with systemic lupus erythematosus (SLE)., Methods: The survey was conducted with a consecutive sampling of 158 Chinese SLE patients attending public hospitals from January to March 2021. We used the translated Chinese version of the MMAS-8 to collect related data. Reliability, item, and factor analyses were used to test the reliability and validity of the MMAS-8 scale in the selected patients. The internal consistency reliability was evaluated using Cronbach's α coefficient. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs) in a subset of 30 participants. Construct validity was evaluated using confirmatory factor analysis and correlations between the Self-efficacy for Appropriate Medication Use Scale (SEAMS) and related measures., Results: The internal consistency reliability of the Chinese version of the MMAS-8 was high (Cronbach's α = 0.817), and the test-retest reliability was excellent (intraclass correlation = 0.947; P < 0.001). There were significant differences in the F test and t test between the two extreme groups before and after the ranking of 27% of the questionnaire scores (P < 0.001). The Kaiser-Meyer-Olkin (KMO) value of construct validity was 0.860. The spherical test value of Bartlettgers was 417.8822. Factor analysis yielded three components that accounted for 69.375% of the total variance. Exploratory factor analysis identified three dimensions of the Chinese version of the MMAS-8. In terms of criterion validity, the correlation of the MMAS-8 score in SEAMS indicated that the convergent validity was good (r = 0.926; P < 0.001)., Conclusions: This study shows that the Chinese version of the Medication Adherence Scale-8 is a reliable and valid tool for assessing medication adherence in Chinese SLE patients. Key Points • Many factors affect medication adherence in SLE patients. • Many questionnaires measure medication adherence levels. • There is a lack of reliable validation of medication adherence questionnaires specifically for SLE patients., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

To explore the hydrogen and oxygen stable isotopes and vapor sources of atmospheric precipitation in the loess region of north Shaanxi, we collected 107 samples of precipitation during 2018 to 2020 in the Dingbian County, Shaanxi Province. After measuring δ 18 O and δ 2 H of precipitation, we analyzed the isotopic characteristics and vapor sources of precipitation in different seasons. There was obvious seasonal variability in δ 18 O and δ 2 H, in that they were more depleted in the wet season (June-September) but more enriched in the dry season (April-May, October-November). In addition, the deuterium excess values were high in the dry season but low in the wet season. The local meteoric water line was regressed as δ 2 H=7.35δ 18 O+4.19 ( R 2 =0.96, P <0.01) with slope and intercept lower than that of the global meteoric water line, indicating an impact of evaporation on isotope fractionation. There was temperature effect in the precipitation isotopes for the whole year and for the dry season, while the precipitation isotopes in the wet season were affected by the combined effects of temperature and rainfall amount. The HYSPLIT model showed that the dry season water vapor mainly came from the Atlantic Ocean and the polar Arctic Ocean, while the wet season vapor mainly came from the Indian Ocean and Pacific subject to the Westerly.

Background: Recent studies have demonstrated the presence of associations between metabolic syndrome and the onset of nonalcoholic fatty liver disease (NAFLD). Metabolic syndrome, in turn, has been found to be linked to high serum uric acid to HDL-cholesterol ratios (UHR). However, the relationship between UHR values and the occurrence of NAFLD in non-obese individuals remains unknown. The present study aimed to examine the possible correlation between UHR values and NAFLD onset among a non-obese Chinese population without dyslipidemia, as well as comparing the predictive value of UHR versus other NAFLD onset predictors., Methods: A total of 9837 non-obese patients, with normal blood lipid levels, were included in a 5-year retrospective cohort study, and the onset of NAFLD in these patients was diagnosed by liver ultrasound., Results: Out of the 9837 patients, 855 were diagnosed with NAFLD during the 5-year follow-up period, for an overall total prevalence of 8.7% at the end of the study period. Across quintiles 1, 2, 3, 4 and 5 of UHR (respectively, ratios of ≤ 120.88, 120.89-154.01, 154.02-189.91, 189.92-240.46, and ≥ 240.47), the prevalence of NAFLD among the patients increased from 2.4%, 5%, 7.9%, 10.3%, and 17.8%, respectively. After adjustments for age, gender, liver and kidney functional markers, as well as metabolic indicators, multivariate Cox proportional hazard regression analysis demonstrated that the hazard ratio (HR) was the highest in quintile 5, at 1.76 (1.12-2.75), and the lowest in quintile 1. The area under the curve (AUC) for UHR (0.690) was higher than that for serum uric acid (UA, 0.666) and HDL-C (0.636), suggesting the predictive ability of UHR for NAFLD onset was better than either alone. This finding was further supported by the presence of an independent association between UHR and NAFLD, even within the normal range of UA and HDL-C; the HR (95% confidence interval, CI) for NAFLD was 1.002 (1.000-1.004). Compared with other significant predictors, AUC for UHR (0.67) was similar to that of low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C, 0.68), non-high-density lipoprotein cholesterol (NHDL-C)/HDL-C (0.68) and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratios (0.7), and was higher than that of LDL-C (0.63), remnant cholesterol (RC,0.59), and albumin (ALB)/alkaline phosphatase (ALP) ratio (0.61). The sensitivity of UHR (71%) was the highest among all indicators. In the subgroup with ALT < 40U/L, the AUC for UHR was 0.70, which was the highest among all predictors; among ALT > 40U/L, UHR was able to predict the occurrence of NAFLD (AUC = 0.61, p = 0.007), which was not the case for RC (P = 0.441), ALB/ALP (P = 0.419), and ALT/AST (P = 0.159)., Conclusions: UHR serve as an inexpensive and reliable predictor of NAFLD onset in non-obese Chinese people with normal blood lipid levels, allowing for identification of individuals at high risk for NAFLD., (© 2022. The Author(s).)

Using the four periods of land use data and socio-economic statistics of Lanzhou City in 1995, 2005, 2015 and 2018, we examined the evolution characteristics and driving forces of urban land use in Lanzhou, with expansion intensity index, Logistic regression, and principal component analysis method. Based on the multi-agent model, the expansion of urban land use in Lanzhou under multiple scenarios in 2025 was simulated using Netlogo software. The results showed that the intensity and scale of urban land expansion in Lanzhou City from 1995 to 2018 showed an increasing trend, with a total of 307 km 2 of cultivated land and water area. The expansion of urban land in Lanzhou City was significantly related to regional GDP, social fixed asset investment, population density, population, policy, and terrain. The multi-agent model on the Netlogo software could simulate the expansion trend of urban land in Lanzhou, which provided a reliable simulation method for the expansion of valley-type cities. From 2020 to 2025, urban land use under the comprehensive development scenario, natural expansion development scenario, ecological and farmland protection development scenario all showed an increasing trend. The scale of expansion would range between 42.6-134.3 km 2 . The expansion mode would mainly be infilled expansion. Our results could provide decision support for the land space planning and ecological environment layout optimization for Lanzhou City.

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions ( P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT ( P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background & Aims: The EncephalApp Stroop test is a high-sensitivity but low-specificity test that has been used to identify patients with covert hepatic encephalopathy (CHE). We aimed to develop a new strategy to detect CHE, combining EncephalApp Stroop test score with scores from subtests of the psychometric hepatic encephalopathy scoring system (PHES)., Methods: We performed a survey of 569 adult volunteers (229 men) in 9 communities in Shanghai, China, administering the EncephalApp Stroop test to determine the range of scores in the general population. Data from the standard PHES, including the number connection test-A, number connection test-B (NCT-B), line tracing test, serial dotting test (SDT), and digit symbol test, were used as the reference standard for diagnosis of CHE. A combination of the EncephalApp Stroop with subtests of the PHES was used to establish a new strategy for CHE diagnosis. We validated our findings using data from 160 patients with cirrhosis from 5 centers China., Results: We determined the range of EncephalApp Stroop test scores for the volunteers of different decades of age, education levels, and sexes. Age, education level, and sex were independently associated with EncephalApp Stroop test scores. A combination of scores from the EncephalApp Stroop test, the NCT-B, and the SDT identified patients with CHE with the highest level of accuracy, when the standard PHES was used as the reference standard. A combination of scores of 187 sec for the EncephalApp Stroop test and below -1 for the NCT-B or below -1 for the SDT identified patients with CHE with an area under the curve (AUC) of 0.86, 81.0% sensitivity, and 91.9% specificity, and 87.5% accuracy. In the validation cohort, these cutoff scores identified patients with CHE with an AUC of 0.88, 97.1% sensitivity, 79.3% specificity, and 86.9% accuracy. The average time to calculate this score was 374±140 sec, compared 424±115 sec for the entire PHES., Conclusion: Scores from the EncephalApp Stroop test, NCT-B, and SDT identify patients with CHE with approximately 87% accuracy, and in a much shorter time than the standard PHES. This score combination could be a valid and convenient method for identifying patients with CHE. chictr.org.cn number, ChiCTR-EDC-17012007, ChiCTR1800019954., (Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Introduction: The present study aimed to investigate the prevalence and influential factors of thrombocytopaenia in systemic lupus erythematosus (SLE) patients among the Chinese population in order to provide evidence for improving the treatment and nursing of SLE patients., Methods: A retrospective analysis of 3140 SLE patients admitted to two large tertiary hospitals was conducted in Anhui, China, from 2011 to 2018. In addition, the influential factors related to SLE with thrombocytopaenia were analysed through univariate and multivariate analysis., Results: A total of 804 SLE patients had thrombocytopaenia (25.6%). The top 5 clinical manifestations of SLE inpatients were proteinuria (51.0%), lupus nephritis (45.9%), new rash (38.4%), haematuria (36.7%) and pyuria (32.2%). The incidence of neurological manifestations, oral mucosal ulceration, pleurisy, pericarditis, hyperglycaemia, leucocytopaenia, urinary casts, haematuria, pyuria and high disease activity in the thrombocytopaenia group were higher than those in the non-thrombocytopaenia group ( p  < 0.05). Multivariate analysis showed age (odds ratio (OR) = 1.009, p  = 0.005), neurological manifestations (OR = 1.373, p  = 0.048), pericarditis (OR = 1.394, p  = 0.048), hyperglycaemia (OR = 1.717, p  < 0.001), leucocytopaenia (OR = 2.551, p  < 0.001), haematuria (OR = 1.582, p  < 0.001), serum C3 level <0.85 g/L (OR = 1.525, p  = 0.001), serum C4 concentration <0.10 g/L (OR = 1.287, p  = 0.020), serum CRP concentration <8 ng/L (OR = 1.314, p  = 0.005), prothrombin time >15.30 seconds (OR = 1.479, p  = 0.032), activated partial thromboplatin time >45 seconds (OR = 1.924, p  < 0.001) and thrombin time >21 seconds (OR = 1.629, p  = 0.015) were associated with thrombocytopaenia., Conclusion: Thrombocytopaenia has a high prevalence in SLE patients and is related to some baseline, clinical and laboratory characteristics, affecting multiple organs and systems.

Zhangye serves as a good case for studying ecological services because of its fragile ecological environment and its ecological importance. Using land use data from 1987, 2000 and 2016 as well as the modified ecosystem service value (ESV) equivalent, the ESV was estimated and its spatial and temporal changes and gradient differentiation characteristics were analyzed by dividing the studied region into a grid of 3 km×3 km in size. The results showed that from 1987 to 2016, the ESV in Zhangye increased by 564 million Yuan, with the mountainous areas in the south and the desert areas in the north being stable. The ESV of central oasis areas with concentrated human acti-vities significantly changed. Forests contributed to most of the ESVs. Water regulation value was the strongest among all the individual ESVs. The ESV showed strong spatial dependence. Based on the spatial pattern of the two aggregated poles, it shaped three "flower arrangement" clusters, including Ganzhou District, Yanzhi Mountain, and Jingtie Mountain. The ESV distribution showed a topographic differentiation as the value decreased from the Qilian Mountains to the plain oasis, and further to the desert areas. The linear correlation of the terrain and the ESV was negative. As the increasing elevation gradient, the ESV showed a "decreased-increased-decreased" trend, while and it had a "decreased-stable-decreased" in the increasing slope gradient. Overall, the ESV presented two turning zones on the terrain gradient, indicating that both the piedmont zone and the oasis desert transition zone acted as transition zones of the ESV. Areas with the strongest ESV were distributed in the low slope and low terrain relief zones, and the development of oases in flat terrain areas were strongly constrained by water resources.

Understanding the dynamics and underlying mechanism of carbon exchange between terrestrial ecosystems and the atmosphere is one of the key issues in global change research. In this study, we quantified the carbon fluxes in different terrestrial ecosystems in China, and analyzed their spatial variation and environmental drivers based on the long-term observation data of ChinaFLUX sites and the published data from other flux sites in China. The results indicate that gross ecosystem productivity (GEP), ecosystem respiration (ER), and net ecosystem productivity (NEP) of terrestrial ecosystems in China showed a significantly latitudinal pattern, declining linearly with the increase of latitude. However, GEP, ER, and NEP did not present a clear longitudinal pattern. The carbon sink functional areas of terrestrial ecosystems in China were mainly located in the subtropical and temperate forests, coastal wetlands in eastern China, the temperate meadow steppe in the northeast China, and the alpine meadow in eastern edge of Qinghai-Tibetan Plateau. The forest ecosystems had stronger carbon sink than grassland ecosystems. The spatial patterns of GEP and ER in China were mainly determined by mean annual precipitation (MAP) and mean annual temperature (MAT), whereas the spatial variation in NEP was largely explained by MAT. The combined effects of MAT and MAP explained 79%, 62%, and 66% of the spatial variations in GEP, ER, and NEP, respectively. The GEP, ER, and NEP in different ecosystems in China exhibited 'positive coupling correlation' in their spatial patterns. Both ER and NEP were significantly correlated with GEP, with 68% of the per-unit GEP contributed to ER and 29% to NEP. MAT and MAP affected the spatial patterns of ER and NEP mainly by their direct effects on the spatial pattern of GEP., (© 2012 Blackwell Publishing Ltd.)

The effectiveness of the attractants 1-octen-3-ol (octenol) and L-lactic acid (Lurex) on the collection of Aedes albopictus, Culex tritaeniorhynchus, Cx. pipiens pallens, and Anopheles sinensis was first evaluated in Mosquito Magnet Pro traps in Yamenkou and Badachu residential areas, Beijing City, and Lishui area, Zhejiang Province, China. The Mosquito Magnet Pro traps baited with octenol collected significantly more Ae. albopictus, Cx. tritaeniorhynchus, and An. sinensis, but fewer Cx. pipiens pallens than collection by the traps alone. There were no significant differences in the numbers of Cx. pipiens pallens, Cx. tritaeniorhynchus, and An. sinensis collected by Mosquito Magnet Pro traps baited with Lurex compared to the traps alone, but the Mosquito Magnet Pro traps baited with Lurex collected significantly more Ae. albopictus than the number collected by the traps alone at 2 areas in Beijing.