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Background: This study addresses the scarcity of research on nausea and vomiting in pregnancy (NVP) in China. It aims to explore the current NVP status in the country using validated questionnaires, analyze associated factors, and provide a useful reference for future research. The study also compares results from different assessment tools. Methods: Online questionnaires were utilized to gather data from 535 pregnant women across 24 provinces. Demographic, pregnancy, and NVP-related information were collected. NVP severity was assessed using Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) and the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scales. Ordinal logistic regression identified factors linked to NVP severity. Differences between PUQE and RINVR assessments were compared. Results: NVP prevalence exceeded 90%, with 96.1% assessed by PUQE and 90.8% by RINVR. Incidence decreased from nausea to retching and vomiting. Severe NVP correlated with reduced gestational weight gain, younger age, fewer gestational weeks, and living in North (all P values < 0.05). There was moderate consistency between PUQE and RINVR assessments. The NVP prevalence assessed by the PUQE is higher than that assessed by the RINVR in the same population. However, the proportion of NVP levels above moderate assessed by RINVR is greater than that assessed by PUQE. Conclusions: NVP is highly prevalent among Chinese pregnant women, with nausea being predominant. RINVR assessments may be better able to identify severe NVP, thereby improving the low treatment rates for severe NVP. [ABSTRACT FROM AUTHOR]

Low-fertility rate has been a common problem in many industrialized countries. To reverse the declining trend of new births, Chinese government gradually lifted its restrictions on the number of births per family, allowing for a household to have no more than two children. Little is known about the additional births or population increase contributed by the gradual relaxation of birth restrictions. To fill this gap, this quasi-experimental design study including data from 124 regions used the synthetic control method and controlled interrupted time series analysis to evaluate the differences in birth rates and rates of natural population increase between China and its synthetic control following implementation of the two-child policy from 2011 to 2020. A total of 123 regions were included in the control pool. Data collected during 1990–2010 were used to identify the synthetic China for each study outcome. The mean rate differences of birth rates and rates of natural increase between China and synthetic China after two-child policy implementation were 1.16 per 1000 population and 1.02 per 1000, respectively. These rate differences were distinguished from variation due to chance (one-sided pseudo- P -values: P for birth rates = 0.047, P for rates of natural increase = 0.020). However, there were statistically significant annual reductions in the pre–post trend of birth rates and rates of natural increase compared with those of controls of <0.340 per 1000 population per year [ P  = 0.007, 95% CI = (−0.584, −0.096)] and <0.274 per 1000 per year [ P  = 0.028, 95% CI = (−0.518, −0.031)]. The results suggested that lifting birth restrictions had a short-term effect on the increase in birth rates and rates of natural population increase. However, birth policy with lifting birth restrictions alone may not have sustained impact on population growth in the long run. [ABSTRACT FROM AUTHOR]

Vibrio vulnificus is a pathogenic bacterium that causes disease in marine fish, affecting fish farming and human health worldwide. In May 2021, in the Bohai Bay region, a disease broke out in commercially farmed pearl gentian grouper (♀Epinephelus fuscoguttatus × ♂Epinephelus lanceolatus), causing huge economic losses. The diseased fish had skin lesions, water accumulation in their abdomens, and showed tissue and organ damage. V. vulnificus biotype 2 has been reported in eels and other marine fish, but it is less reported in pearl gentian grouper. In this study, the pathogenic strain isolated from diseased fish was identified as V. vulnificus EPL 0201 biotype 2 on the basis of physiological and biochemical characteristics and the results of 16S rRNA gene and gyrB sequencing, virulence gene detection, and recursive infection experiments. To gain a comprehensive understanding of the pathogenicity and drug resistance of this strain, whole-genome sequencing was performed. Whole-genome analysis showed that the gene map of this strain was complete. The Virulence Factor Database annotation results showed that this strain had the key virulence factor genes vvhA and rtxA, which cause host disease. In addition, this strain had genes conferring resistance against cephalosporins, aminoglycosides, tetracyclines, and sulfonamides. Antimicrobial susceptibility testing confirmed the presence of these resistance genes identified in the genome. The results of this study show that V. vulnificus EPL 0201 biotype 2 is a multi-drug resistant strain with high pathogenicity. [ABSTRACT FROM AUTHOR]

Background: The follow-up study on neuropsychiatric changes after the lifting of coronavirus disease 2019 (COVID-19) quarantine in patients with cognitive impairment and their caregivers is still lacking, and relative information is needed to formulate more comprehensive healthcare prevention measures worldwide. Aims: To provide data on the changes in neuropsychiatric performance after the lifting of COVID-19 quarantine in patients with cognitive disorders and their caregivers. Methods: Two surveys in Chongqing, China were conducted via telephonic interview with 531 patients and their caregivers. The baseline survey was performed from February 11 to 23, 2020, and the follow-up was from October 24 to November 9, 2020. The data of neuropsychiatric symptoms (NPSs), sleep, nutrition, and chronic diseases of patients, as well as the burden of care, anxiety, and depression of caregivers were evaluated. Results: Significant alleviation of NPSs after the lifting of COVID-19 quarantine was observed in patients with mild cognitive impairment (MCI) and dementia (both P < 0.05). Compared with baseline, the prevalence for NPSs of all participants dropped from 57.94 to 38.82%. Among NPS subdomains, apathy displayed the biggest decline at follow-up by 10.72%, followed by nighttime behavior by 8.65%. Mixed effect generalized estimation equation analysis showed significant amelioration in hallucination, depression, apathy, irritability, aberrant motor behavior, and nighttime behavior (all P < 0.05), with the most prominent changes in nighttime behavior and apathy. Among the patients with unsatisfactory control of chronic disease, the medication adherence rate dropped by approximately 30% after the lifting of quarantine. More importantly, around 13% increase of care burden was observed among the caregivers at follow-up, with both depression and anxiety rising by nearly 4%. Conclusion: The prolonged quarantine may exacerbate NPS in patients with memory disorders, while the care burden and mental stability of the caregivers after the pandemic should also be concerned. [ABSTRACT FROM AUTHOR]

Puccinia striiformis f. sp. tritici Eriks., the cause of wheat yellow or stripe rust on wheat, undergoes sexual reproduction on barberry, but it is unclear if barberry plays any role in stripe rust epidemics under natural conditions. P. striiformis f. sp. tritici was isolated from its alternate host barberry (Berberis spp.) and primary host wheat in the vicinity of barberry by inoculation of aeciospores and urediniospores on Mingxian 169 cultivar in Qinghai province of China in 2018. The P. striiformis f. sp. tritici isolates from barberry and wheat were characterized to virulence patterns by inoculation on 24 differentials bearing Yr gene under control conditions and analyzed using 12 polymorphic simple sequence repeat (SSR) markers. The occurrence frequency of P. striiformis f. sp. tritici on barberry was 1.87% by inoculation aecia, collected from barberry on Mingxian 169 of wheat. A close virulence relationship was presented between P. striiformis f. sp. tritici isolates from both barberry and wheat based on virulence simple matching coefficient and principal coordinates analysis (PCoA). Additionally, the same genetic ancestry, based on structure analysis by STRUCTURE program and genetic relationship analyses using discriminant analysis of principal components and PCoA, was shared between P. striiformis f. sp. tritici isolates from barberry and those from wheat. Together, all the results indicated that the role of barberry in providing aeciospores as an inoculum source causing wheat stripe rust epidemic in Qinghai in spring is of considerable importance. [ABSTRACT FROM AUTHOR]

Background: Serological testing for the presence of Hepatitis B Virus (HBV) markers and anti-HBs titers in infants born to HBsAg positive women is critically important for estimation in immunisation programme.Methods: This was a multi-center and cross-sectional study conducted in Zhejiang province, China. Children aged 7 to 24 months born to HBsAg positive women during December 2018 to February 2019, completed additional HBV serological markers screening. We indicated distribution of HBV serological markers and anti-HBs titers in children. Multiple logistic regression model with adjusted odds ratio and 95% confidence interval (ORadj and 95% CI) was used to explore the factors associated with inadequate immune response (anti-HBs titers< 100 mIU/ml) among children.Results: A total of 1849 children were included. Overall 25 children tested HBsAg positive, giving HBsAg positive rate of 1.35%(95%CI: 0.83-1.88%). 92.00% (23/25) HBsAg positive children were delivered by HBeAg positive mothers. The proportion of protective seroconversion (anti-HBs titers≥10mIU/ml) was 99.29% in all children, and 86.48% children were reported with adequate anti-HBs titers (≥100mIU/ml).We found a significant higher proportions of early antenatal health care (< 13 gestational weeks), and term birth in children with adequate response compared with inadequate response (all P < 0.05). Logistic regression showed preterm birth was a negative factor for inadequate anti-HBs titers (ORadj = 1.868,95%CI 1.132-3.085,P = 0.015).Conclusions: Children delivered by HBeAg positive mothers had higher risk of vertical transmission of HBV, despite completion of 3 doses of hepatitis B vaccine and HBIG injection. Inadequate anti-HBs level was significantly associated with preterm birth in HBsAg positive women. [ABSTRACT FROM AUTHOR]

Background: After the elimination of leprosy in 1995, there were 10–30 newly detected leprosy cases every year in Zhejiang Province, and the epidemiological characteristics of the newly detected leprosy cases have changed. While most of the newly detected cases came from other provinces in China, not Zhejiang, it brought a new challenge for leprosy prevention and control in post- elimination era in Zhejiang, China. This study was aimed to understand the temporal-spatial distribution characteristics of newly detected leprosy cases, and provide the scientific rationales for the development of leprosy control strategy. Methods: Data on the demographic of Zhejiang Province from 2011 to 2019 were obtained from the China Information System for Disease Control and Prevention, and the epidemiological data on leprosy cases newly detected in Zhejiang Province from 2011 to 2019 were obtained from the LEPROSY MANAGEMANT INFORMATION SYSTEM IN CHINA (LEPMIS), and temporal-spatial distributions were described. The geographic information system software—ArcGIS 10.4 was used to draw the statistical maps, and Geoda 1.14.0 was used for local spatial autocorrelation analysis (local Getis coefficient method). Ridley-Jopling classification was used to classify the clinical types into I, TT, BT, BB, BL or LL. Two-group classification system developed by the World Health Organization (WHO) was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. Results: A total of 167 leprosy cases were reported in Zhejiang Province during 2011–2019, including 107 cases in males and 60 in females. The mean age at diagnosis was 37.99±14.81 years, and 94.01% of the cases were detected through the examination at skin-clinics. The number of workers, MB cases, G2D cases were 81 (48.50%), 159 (94.01%), 24 (14.37%) respectively, and the rate of early detection increased from 45.16% in 2011 to 90.91% in 2019. Leprosy cases were reported in all the prefectures of Zhejiang except Zhoushan City. The cases in local population accounted for 23.35% (39 cases), and the cases in floating population (especially coming from high epidemic provinces in China) accounted for 76.65% (128 cases). The annual number of newly detected cases showed a decreasing trend, from 31 cases in 2011 to 11 in 2019. Time of the floating population living in Zhejiang Province ranged from several months to more than 10 years. The annual proportion of new cases with G2D declined from 22.58% in 2011 to 9.09% in 2019. The results of local indicators of autocorrelation (LISA) analysis showed that the high-high areas were mainly concentrated in the middle and northeast of Zhejiang Province, while the low-low areas were in the east and southwest. Conclusion: A few scattered cases still can be seen in post-elimination era, and there was a spatial clustering of the newly detected leprosy cases in Zhejiang Province. Most of the cases in Zhejiang Province were from other high epidemic provinces in China, which brought a new challenge for leprosy control and prevention in post- elimination era in Zhejiang, and it is also necessary to strengthen the early detection and standard management of the leprosy cases in floating population in Zhejiang. Author summary: After elimination, most of the leprosy cases were detected passively, and the epidemiological characteristics of the newly detected leprosy cases had been changed. The proportion of floating population from other provinces in China increased year by year. In 2011, Health Commission of Zhejiang Province developed the planning of reducing harm of leprosy (2011–2020) and implemented leprosy symptom monitoring system in order to strengthen the early detection of leprosy cases. 167 newly detected cases during 2011–2019 were analyzed, whose factors were associated with household registration of other provinces, G2D and delay in diagnosis were explored. Annual proportion of household registration of other provinces showed an increasing trend, from 77.42% in 2011 to 81.82% in 2019, while G2D and delay in diagnosis among newly detected cases showed declining trends, from 22.58%, 40 months in 2011 to 9.09%, 11 months in 2019 respectively. In late phase of leprosy control, some kinds of leprosy control program are still necessary. Control and prevention strategy of floating population based on government commitments would be beneficial to improve early detection of leprosy cases. [ABSTRACT FROM AUTHOR]

Purpose: Genome-wide association studies (GWAS) have identified multiple genetic variants associated with leprosy. To investigate the single and combined associations between single-nucleotide polymorphisms (SNPs) and the development of leprosy, we therefore performed generalized multi-analytical (GMDR) analysis in Chinese leprosy household contacts and constructed a risk prediction model. Patients and Methods: This case–control study included 229 leprosy cases and 233 healthy household contacts in Zhejiang province, China. Participants were genotyped for 17 polymorphisms selected from GWAS. The Pearson χ2 test, logistic regression and GMDR analysis were performed to investigate gene–gene interactions and construct a risk prediction model for leprosy. Results: The genotype and the allele distributions of rs142179458, rs2275606, rs663743 and rs73058713 were significantly different between patients and controls. rs2275606, rs6478108, rs663743 and rs73058713 showed an association after adjusting for sex and age in the logistic regression. A five-way interaction model consisting of rs2058660, rs2275606, rs4720118, rs6478108 and rs780668 was chosen as the optimal model for determining leprosy susceptibility. The model classified 237 (51.3%) into the low-risk group and 225 (48.7%) individuals into the high-risk group. The area under the curve (AUC) of this model was 0.757 (95% CI: 0.712– 0.803), and the odds ratio for leprosy between the high- and low-risk groups was 9.733 (95% CI: 6.384– 14.960; P< 0.001). The sensitivity and specificity of the model were observed to be 74.7% and 76.8%, respectively. Conclusion: Our results suggest that rs2058660, rs2275606, rs4720118, rs6478108 and rs780668, five SNPs with a significant sole effect on leprosy, interact to confer a higher risk for the disease in leprosy household contacts (HHCs). [ABSTRACT FROM AUTHOR]

Coal mine goafs can be used to store and purify mine water; therefore, they are important for mitigating the environmental impact of mining on ecologically fragile areas in Western China. Coal gangue in goafs can reduce turbidity, suspended matter, total hardness, and chemical oxygen demand (COD) in mine wastewater. Because gangue in goaf areas is rich in clay minerals, they serve as ion exchange sites. We investigated the adsorption of heavy metal ions by silty mudstones in the Ulan Mulun mine. The adsorption kinetics and isothermal adsorption characteristics of four heavy metal ions, i.e., Pb(II), Cd(II), Cr(III), and Mn(II), were investigated using batch experiments. Under a pH of 6.75 and temperature of 20°C, the adsorption capacity of silty mudstone particles (<74 μm) was 6.3012 g, 1.5701, 1.2571, and 1.3729 mg/g for Pb(II), Cd(II), Cr(III), and Mn(II), respectively. Based on the experimental results, quantitative relationships between the adsorption quantity per unit of rock surface and the equilibrium concentration of heavy metals in solution were developed using Langmuir, Freundlich, and D–R equations. The relationships were used to obtain the equilibrium concentration of the solution. Finally, the ratio of the f value of the water-rock contact area in the goaf to the water volume was calculated and analyzed. The f value was inversely proportional to the average vertical opening of gaps between gangues in the goaf. The adsorption rate functions for Pb(II), Cd(II), Cr(III), and Mn(II) in the goaf were obtained, and the corresponding adsorption capacities were calculated. The adsorption capacities were controlled by the f value and adsorption properties of the gangue. These results can be used in future studies on mine wastewater treatment. [ABSTRACT FROM AUTHOR]

Based on 57 literatures, the quantitative relations among the apparent activation energy, E, apparent pre-exponential factor, k0 and volatile content on dry ash free basis, Vdaf, fuel ratio (FR) data from TGA experiments were obtained for 131 Chinese power coal samples. Regression was made for lg k0, E with Vdaf, FR, the regression results show that ① E, lg k0 decrease linearly with Vdaf, E = 109. 6-0. 365Vdaf lg k0 = 5. 406-0. 04 Vdaf, and lg k0 increases linearly with E, lg k0 = -0. 193+0. 043E. According to Vdaf of Chinese power coals, E and k0 can be calculated. In addition, according to Arrhenius Law, reaction speed constant number during power coal burning processes can be calculated. ② with the increase of FR, E and lg k0 increase with FR generally, E = 90. 891 +3. 097 37FR-0. 138FR², lg k0 = 3.413 2 - 0. 001FR+0. 022 8FR² The two mathematic relationships mentioned above correspond to the relationship of lg k0 increasing linearly with E. [ABSTRACT FROM AUTHOR]

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is one of the most devastating diseases in wheat. Due to the large-scale and widely-distributed planting pattern of wheat, the directional selection pressure of the pathogen is very strong. Therefore, it is urgent to pyramid more stripe rust resistance genes in wheat cultivars to enhance resistance durability and ensure wheat production safety. In this study, two quantitative trait loci (QTL) for adult plant resistance (APR) to stripe rust, QYr.nafu-2BL and QYr.nafu-3BS, were validated and introgressed from wheat line P9897 into three Chinese elite wheat cultivars, Chuanmai 42, Xiangmai 25, and Zhengmai 9023, through marker validation. The three Chinese elite varieties were used as the female parent to cross with wheat line P9897, and they were selfed to the F6 generation. A total of 114 lines were then selected based on field agronomic traits and stripe rust resistance. Four markers (Xcfd73, Xgwm120, Xbarc87 and Xbarc133) linked with the QTL's regions were employed to screen the 114 F6 lines. Subsequently, 27 lines combining two target QTL from P9897 were selected. The combination of agronomic traits and disease resistance results showed that 13 of these selected lines had favorable application prospects. The promising lines selected in this study could enrich the genetic resources of wheat stripe rust resistance genes, as well as provide material support and a theoretical basis for the prevention and control of wheat stripe rust in China. [ABSTRACT FROM AUTHOR]

Backgrounds: The EuroQol Group Five-Dimensional (EQ-5D) instruments have been validated in China for measuring health-related quality of life (HRQoL) and are increasingly being used in health economic studies. However, there is paucity in the literature documenting long-term changes in the EQ-5D results in the Chinese populations. This study aims to identify such changes and their determinants using the EQ-5D-3 L instrument.Methods: Data were obtained from the National Health Services Surveys in China, which included the EQ-5D-3 L since 2008. We compared the differences between the 2008 and 2013 surveys in the percentage of reported problems, visual analogue scale (VAS) scores, and the EQ-5D-3 L utility index derived from the national value sets. Factors associated with population changes in these EQ-5D results were identified using logistic, linear and Tobit regression models, respectively.Results: Compared with 2008, reported problems in self-care (3.3% vs 3.1%), usual activities (4.8% vs 4.6%) and anxiety/depression (6.4% vs 5.3%) decreased, whereas reported problems in mobility (5.1% vs 5.9%) and pain/discomfort (9.3% vs 12.6%) increased significantly (p < 0.05) in 2013. The regression models revealed a rise (β = 1.61, p < 0.001) in VAS scores, but a slight drop (β = - 0.01, p < 0.001) in utility index in 2013 compared with 2008 after controlling for variations in demographic, behavioral, socioeconomic and residential variables. But the effect sizes of the changes over time (estimated by "average change divided by baseline standard deviation") did not reach the threshold of clinical importance after adjustment for variations in other factors. Higher socioeconomic status (in terms of education, income and residential location) was associated with better EQ-5D-3 L results.Conclusion: The changing trend (decrease) of the utility index is contradictory to that (increase) of the VAS scores, although neither is deemed clinically important. It is evident that socioeconomic and regional disparities in HRQoL exist in China. [ABSTRACT FROM AUTHOR]

Background: Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai.Methods: This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray's proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables.Results: Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71-1.03), and corresponding sub-hazard ratio 0.86 (0.71-1.03). There was strong effect modification by age. In those aged 40-60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45-0.94), and sub-hazard ratio also 0.65 (0.45-0.95).Conclusions: Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes. [ABSTRACT FROM AUTHOR]

A new derivation of the three-dimensional (3D) limit equilibrium method for slope stability analyses is presented, which applies linear algebra operations to matrices to achieve a highly efficient algorithm while maintaining the rigorousness of the formulation. It satisfies six equilibrium conditions and includes all of the components of the intercolumnar forces. The generalized 3D Morgenstern-Price's (MP) assumption for the intercolumn forces is recast into incremental forms. The advantage is that the unknowns of the different physical meanings (i.e., factor of safety (FS) and the coefficients in the MP assumption) are determined by balancing the forces and moments independently. Along with the recasting correction coefficients, they are solved with the triple nested algorithm. The numerical instability that is related to the different orders of magnitude for the residuals is avoided. The varication examples show: (i) the insensitivity of the FS to the prescribed functions in the MP assumption, (ii) the reliability of the method to cope with a complicated slope geometry (simplified methods may provide a larger FS for certain cases), and (iii) the superior efficiency of the algorithm (requires several seconds to converge). This study proposes a practical way to track the irregular 3D tension cracking by repeating the analysis and excluding the columns with the negative normal forces at the bottom. This formulation is applied to a valley landfill slope in China. In comparison to the two-dimensional analysis, there are more reasonable/cost-effective measures to increase the system stability through 3D analyses for several conditions (e.g., seismic loading). • A new three-dimensional method is devised by concise linear algebra operations. • It considers 6 equilibrium conditions and all intercolumnar force components. • Triple nested algorithm achieves a high-efficiency and a good convergence. • Factor of safety is insensitive to the intercolumn force distribution function. • A practical way is proposed to track highly irregular tension cracking surface. [ABSTRACT FROM AUTHOR]

The environmental impacts of grid-connected photovoltaic (PV) power generation from crystalline silicon (c-Si) solar modules in China have been investigated using life cycle assessment (LCA). The life cycle inventory was first analyzed. Then the energy consumption and greenhouse gas (GHG) emission during every process were estimated in detail, and finally the life-cycle value was calculated. The results showed that the energy payback time ( T EPBT ) of grid-connected PV power with crystalline silicon solar modules ranges from 1.6 to 2.3 years, while the GHG emissions now range from 60.1 to 87.3 g-CO 2 ,eq/kW h depending on the installation methods. About 84% or even more of the total energy consumption and total GHG emission occupied during the PV manufacturing process. The solar grade silicon (SoG-Si) production is the most energy-consuming and GHG-emitting process, which accounts for more than 35% of the total energy consumption and the total GHG emission. The results presented in this study are expected to provide useful information to enact reasonable policies, development targets, as well as subsidies for PV technology in China. [ABSTRACT FROM AUTHOR]

Highlights: [•] China’s PV industry’s development history and status quo were introduced. [•] The existing problems and challenges were analyzed based on field studies. [•] Policy recommendations and possible implementation incentives were provided. [ABSTRACT FROM AUTHOR]

Background: The importance of the gut microbiota in maintaining bone homeostasis has been increasingly emphasized by recent research. This study aimed to identify whether and how the gut microbiome of postmenopausal women with osteoporosis and osteopenia may differ from that of healthy individuals., Methods: Fecal samples were collected from 27 individuals with osteoporosis (OP), 44 individuals with osteopenia (ON), and 23 normal controls (NC). The composition of the gut microbial community was analyzed by 16S rRNA gene sequencing., Results: No significant difference was found in the microbial composition between the three groups according to alpha and beta diversity. At the phylum level, Proteobacteria and Fusobacteriota were significantly higher and Synergistota was significantly lower in the ON group than in the NC group. At the genus level, Roseburia, Clostridia&#95;UCG.014, Agathobacter, Dialis ter and Lactobacillus differed between the OP and NC groups as well as between the ON and NC groups ( p < 0.05). Linear discriminant effect size (LEfSe) analysis results showed that one phylum community and eighteen genus communities were enriched in the NC, ON and OP groups, respectively. Spearman correlation analysis showed that the abundance of the Dialister genus was positively correlated with BMD and T score at the lumbar spine ( p < 0.05). Functional predictions revealed that pathways relevant to amino acid biosynthesis, vitamin biosynthesis, and nucleotide metabolism were enriched in the NC group. On the other hand, pathways relevant to metabolites degradation and carbohydrate metabolism were mainly enriched in the ON and OP groups respectively., Conclusions: Our findings provide new epidemiologic evidence regarding the relationship between the gut microbiota and postmenopausal bone loss, laying a foundation for further exploration of therapeutic targets for the prevention and treatment of postmenopausal osteoporosis (PMO)., Competing Interests: The authors declare that they have no competing interests., (© 2024 Ji et al.)

Introduction: Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China., Methods: Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method., Results: The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (-3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (-5.24%) was the top negative contributor, followed by commercial (-1.43%) and basic medical insurance (-0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134)., Conclusion: Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Identifying sources of phytopathogen inoculum and determining their contributions to disease outbreaks are essential for predicting disease development and establishing control strategies. Puccinia striiformis f. sp. tritici (Pst), the causal agent of wheat stripe rust, is an airborne fungal pathogen with rapid virulence variation that threatens wheat production through its long-distance migration. Because of wide variation in geographic features, climatic conditions, and wheat production systems, Pst sources and related dispersal routes in China are largely unclear. In the present study, we performed genomic analyses of 154 Pst isolates from all major wheat-growing regions in China to determine Pst population structure and diversity. Through trajectory tracking, historical migration studies, genetic introgression analyses, and field surveys, we investigated Pst sources and their contributions to wheat stripe rust epidemics. We identified Longnan, the Himalayan region, and the Guizhou Plateau, which contain the highest population genetic diversities, as the Pst sources in China. Pst from Longnan disseminates mainly to eastern Liupan Mountain, the Sichuan Basin, and eastern Qinghai; that from the Himalayan region spreads mainly to the Sichuan Basin and eastern Qinghai; and that from the Guizhou Plateau migrates mainly to the Sichuan Basin and the Central Plain. These findings improve our current understanding of wheat stripe rust epidemics in China and emphasize the need for managing stripe rust on a national scale., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers., Methods: The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme., Results: From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$ 1.03 administrative costs and US$ 5.28 online screening costs., Conclusion: Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China., ((c) 2023 The authors; licensee World Health Organization.)

Objective: Studies have shown that screening for pre-diabetes mellitus (pre-DM) is essential to prevent type 2 diabetes mellitus (T2DM). This study evaluates the cost-effectiveness of two screening strategies that apply the Chinese Diabetes Risk Score (CDRS) to screen for pre-DM in China., Methods: A Markov microsimulation model was conducted from a social perspective, and the input parameters were obtained from published literature or publicly available data. Two screening strategies for pre-DM based on CDRS were built and compared with the control group to determine the cost-effective strategy. The screening strategy of the control group was screening for pre-DM by fasting plasma glucose (FPG) test in adults undergoing annual health examination and no screening in adults without an annual health examination (status quo). Two screening strategies were strategy 1: screening for pre-DM using CDRS in all adults (including with or without an annual health examination); and strategy 2: supplemental self-screening for pre-DM using CDRS in adults without an annual health examination, based on the status quo. We focus on the cumulative prevalence of T2DM and the incremental cost-effectiveness ratio which signifies the cost per case of T2DM prevented. We also evaluated the cost-effectiveness from the health system perspective. One-way and probabilistic sensitivity analyses were conducted to verify the robustness of the results., Results: The costs a case of T2DM prevented for strategy 1 compared with the control group and strategy 2 were $299.67 (95% CI 298.88, 300.46) and $385.89 (95% CI 381.58, 390.20), respectively. In addition, compared with the control group, the cost of strategy 2 to prevent a case of T2DM was $272.23 (95% CI 271.50, 272.96)., Conclusions: Screening for pre-DM using CDRS in all adults was the most cost-effective health policy. We suggest that medical institutions replace FPG with CDRS for pre-DM screening; at the same time, self-screening for pre-DM using CDRS is widely promoted among adults without an annual health examination. There were still some disputes about how CDRS is included in the health examination projects, so strategy 2 should be considered as an alternative screening strategy. Findings provide a reference for the application of the CDRS in pre-DM screening and contribute to T2DM prevention., 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 © 2022 Hao, Yao, Lin, Sun, Zhang, Hu, Zhang, Zhao, Pei, Liu and Zhu.)

Background: Previous studies exploring usual alcohol consumption and falls risk were scarce in China. In addition, the dose-response relationship has not been explored so far. This study aims to estimate the association between usual alcohol consumption and risk of falls among middle-aged and older Chinese adults based on data from the China Health and Retirement Longitudinal Study (CHARLS), which is representative of the population of the entire country., Methods: Baseline survey data in 2015 and follow-up data in 2018 in CHARLS were utilized. Alcohol consumption was calculated in grams per day (gr/day) according to self-reported drinking data and categorized accordingly to The Dietary Guidelines for Chinese Residents (DGC) 2016. Fall was obtained from self-reported information. Multivariable logistic regression analyses were performed to estimate the association of usual alcohol consumption with risk of falling. The dose-response relationship was also explored using restricted cubic splines., Results: A total of 12,910 middle-aged and older participants were included from the CHARLS 2015, of which 11,667 were followed up in 2018. We found that former, moderate, and excessive drinkers were at higher fall risk compared to never drinkers (former: OR, 1.24; 95% CI, 1.05-1.46; moderate: OR, 1.22; 95% CI, 1.06-1.41; excessive: OR, 1.36; 95% CI, 1.15-1.61) in the longitudinal analysis. Similarly, individuals with moderate and excessive alcohol consumption were at increased risk of falling in the cross-sectional analysis (moderate: OR, 1.18; 95% CI, 1.02-1.37; excessive: OR, 1.32; 95% CI, 1.11,1.57). No significant increased risk of falls was found for former drinkers (former: OR, 1.13; 95% CI, 0.96-1.34). We observed a significant non-linear relationship., Conclusions: Our study suggests that usual alcohol consumption was associated with a higher risk of falls, highlighting the key role of alcohol intake on the fall risk, which needed consideration in developing intervention and prevention strategies for reducing falls among middle-aged and older Chinese adults., (© 2022. The Author(s).)

Background: Syphilis has spread throughout China, especially in Zhejiang Province which endangers the health and lives of people. However, the spatial and temporal epidemiological studies of syphilis in Zhejiang are not thorough enough. The temporal and spatial variation and the relevant factors of syphilis incidence should be analyzed for more effective prevention and control in Zhejiang, China., Methods: Data on confirmed cases of syphilis in Zhejiang Province from 2005 to 2018 was used and the spatio-temporal distributions were described. The spatial autocorrelation analysis and SaTScan analysis were performed to identify spatio-temporal clusters. A Bayesian spatial Conditional Autoregression (CAR) model was constructed to explore the relationships between syphilis incidence and common social and natural indicators., Results: 474,980 confirmed cases of syphilis were reported between 2005 and 2018 with a large peak in 2010. Farmers and unemployed people accounted for the largest proportion of confirmed cases. And the significant spatial clusters of syphilis were concentrated in the north of Zhejiang Province, especially in more economically developed regions. Seven spatio-temporal clusters were identified and the main three high-risk areas were located in Hangzhou (RR = 1.62, P < 0.05), Zhoushan and Ningbo (RR = 1.99, P < 0.05), and Lishui (RR = 1.68, P < 0.05). The findings showed that the morbidity of syphilis was positively correlated with the Gross Domestic Product (GDP) per capita, the number of health technicians per 10,000 people, the proportion of the elderly and air temperature were negatively correlated with the proportion of the urban population, the proportion of men and precipitation., Conclusions: The spatio-temporal analysis revealed that the prevalence of syphilis was still serious in Zhejiang Province. Syphilis high-risk areas were mainly located in the more developed coastal regions where more targeted intervention measures were required to be implemented. The study highlighted the need to strengthen Sexually Transmitted Diseases (STD) screening and health education for high-risk groups and improve the coverage of syphilis testing to reduce hidden syphilis cases., 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 © 2022 Zhu, Zhu, Gu, Zhan, Gu, Yao and Li.)

As natural backwater structures, landslide dams both threaten downstream human settlement or infrastructure and contain abundant hydro-energy and tourism resources, so research on their development feasibility is of great significance for permanently remedying them and effectively turning disasters into benefits. Through an analysis of the factors influencing landslide dam development and utilization, an index system (consisting of target, rule, and index layers) for evaluating development feasibility was constructed in this paper. Considering uncertainty and randomness in development feasibility evaluation, a cloud model-improved evaluation method was proposed to determine membership and score clouds based on the uncertainty reasoning of cloud model, and a cloud model-improved analytic hierarchy process (AHP-Cloud Model) was introduced to obtain weights. Final evaluation results were obtained using a hierarchical weighted summary. The improved method was applied to evaluate the Hongshiyan and Tangjiashan landslide dams and the results were compared with the maximum membership principle results. The results showed that the cloud model depicted the fuzziness and uncertainty in the evaluation process. The improved method proposed in this paper overcame the loss of fuzziness in the maximum membership principle evaluation results, and was capable of more directly presenting evaluation results. The development feasibility of the Hongshiyan landslide dam was relatively high, while that of the Tangjiashan landslide dam was relatively low. As suggested by these results, the evaluation model proposed in this paper has great significance for preparing a long-term management scheme for landslide dams., Competing Interests: The authors have declared that no competing interests exist.

Stripe rust is a foliar disease in wheat caused by Puccinia striiformis f. tritici . The best way to protect wheat from this disease is by growing resistant cultivars. Tetraploid wheat can serve as a good source of valuable genetic diversity for various traits. Here, we report the mapping of nine stripe rust resistance quantitative trait loci (QTL) effective against P. striiformis f. tritici in China and Israel. We used recombinant inbred lines (RILs) developed from a cross between the durum wheat cultivar Svevo and Triticum dicoccoides accession Zavitan. By genotyping the RIL population of 137 lines using the wheat 90K single-nucleotide polymorphism array, we mapped an adult-plant resistance locus QYrsv.swust-1BL.1 , the most effective QTL, within a 0.75-centimorgan region in T. turgidum subsp. durum 'Svevo' on chromosome arm 1BL, corresponding to the region of 670.7 to 671.5 Mb on the Chinese Spring chromosome arm 1BL. Of the other eight minor-effect stripe rust QTL, seven were from Svevo and mapped on chromosomes 1A, 1B, 2B, 3A, 4A, and 5A, and one was from Zavitan and mapped on chromosome 2A. Several QTL with epistatic effects were identified as well. The markers linked to the resistance QTL can be useful in marker-assisted selection for incorporation of these resistance QTL into both durum and common wheat cultivars.

Background: EQ-5D-3L is one of the most commonly used instruments for assessing health-related quality of life and cost-utility analyses, but it is not yet available in China. This study aims to develop population norms for the EQ-5D-3L in China in order to encourage appropriate use and interpretation of the EQ-5D-3L instrument., Methods: Data were extracted from the 2013 National Health Services Survey on a nationally representative sample of 188 720 participants. The utility index based on the 2018 Chinese preference-based value sets were calculated for the participants with different demographic and socio-economic characteristics. Differences in reported problems and visual analogue scale (VAS) and utility index scores were tested using a logistic, linear and tobit regression model, respectively., Results: The Chinese respondents were less likely to report problems on the EQ-5D dimensions compared with most populations in other countries. Pain/discomfort was the most commonly reported problem (12.6%). This resulted in a high ceiling effect (84.19%) on the utility index and high mean scores for the utility index (0.985 ± 0.056) and VAS (80.91 ± 13.74) in the Chinese population. Those who were younger, better educated, employed, married, had no illness condition, lived in a more developed region and had a higher income obtained higher scores in both VAS and utility index. The VAS and utility index scores were also associated with gender, residency and lifestyles, but not always in a consistent way. Male and rural residents had a higher VAS score but not in the utility index compared with their female and urban counterparts., Conclusions: This study provides national population norms for the EQ-5D-3L based on the 2018 Chinese preference-based value sets. The norms can be used as a reference for health evaluation studies. Cautions need to be taken for presenting and interpreting the utility index results given the high ceiling effect of the EQ-5D-3L instrument., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Multiple factors, including increasing incidence, poor knowledge of stroke and lack of effective, noninvasive and convenient stroke risk prediction tools, make it more difficult for precautions against stroke in China. Effective prediction models for stroke may assist to establish better risk awareness and management, healthier lifestyle, and lower stroke incidence for people.The China Health and Retirement Longitudinal Survey was the development cohort. Logistic regression was applied to model's development, in which the candidate variables with statistically significant coefficient were included in the prediction model. The area under receiver operating characteristic curve (AUC) and 10-times cross-validation were used for internal validation. Cutoff point of high-risk group was measured by Youden index. The China Health and Nutrition Survey was the validation cohort.The development cohort and the validation cohort included 16557 and 5065 participants, and the incidence density was 358.207/100,000 person-year and 350.701/100,000 person-year, respectively. The model for 2-year new-onset stroke risk prediction included age, hypertension, diabetes, heart disease, and smoking. The AUC and cross-validation AUC were 0.707 (95% confidence interval[CI]: 0.664, 0.750) and the 0.710 (95% CI: 0.650, 0.736). The sensitivity, specificity and accuracy of the cutoff point were 0.774, 0.545, and 0.319. The AUC and cross-validation AUC were 0.800 (95% CI: 0.744, 0.856) and 0.811(95% CI:0.714, 0.847), and the sensitivity, specificity and accuracy of cutoff point being 0.857,0.569, and 0.426 in external validation.A simple prediction tool using 5 noninvasive and easily accessible factors can assist in 2-year new-onset stroke risk prediction in Chinese people over 45 years old, which is believed to be applicable in identifying high-risk individuals and health management in China.

On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06-1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30-1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%-5.8%) and 6.1 percentage point (95% CI: 4.3%-7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93-1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54-0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.

Background: More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China., Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed., Results: (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers., Conclusion: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.

Objective: This study aimed to estimate the time of recurrent ischaemic stroke events among the first 3 years of follow-up after hospitalisation discharge., Study Design: A prospective cohort study., Setting: The research was conducted in the Department of Neurology at a tertiary hospital, Chengdu of China, from January 2010 to June 2016., Outcome Measures: We estimated the restricted mean survival time (RMST) of ischaemic stroke recurrence for the first 3 years after discharge. Basic sociodemographic characteristics and major potential risk factors for recurrence were collected using a semistructured questionnaire. Regression analysis of RMST was used to identify risk factors of recurrent stroke., Participants: Patients hospitalised with first-ever ischaemic stroke were eligible for this study. Patients with severe cognitive impairment were excluded., Results: We included 641 surviving patients who were followed up for 3 years. Stroke recurrence occurred in 115 patients, including 16 patients who died of stroke recurrence. The cumulative risk of stroke recurrence rate was 11.51% (9.20%-14.35%) at 1 year, 16.76% (13.96%-20.05%) at 2 years and 20.07% (17.00%-23.61%) at 3 years. Modified Rankin Scale (mRS) score ≥3 thus resulted in the recurrence time loss, which was 0.22 months (p=0.008) at 6 months, 0.61 months (p=0.004) at 1 year, 1.49 months (p=0.007) at 2 years and 2.46 months (p=0.008) at 3 years. It is similar with the effects of drug adherence after stroke. The recurrence time of patients ≥75 years at 3 years was 2.02 months (p=0.220) less than that of those aged <55 years., Conclusion: In China, the time of first recurrence varies among different patients with ischaemic stroke. The mRS and the level of drug adherence after stroke are important risk factors of stroke recurrence., Competing Interests: Competing interests: There are no financial or other interests to declare, and all authors agree to the publication of the manuscript., (© 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.)

Rationale: Twin pregnancy in women with chronic kidney disease (CKD) is very rare but poses a great risk to both mother and children. In developing countries like China, advanced CKD twin pregnancies are often terminated. Here, we report a successful case and reviewed related cases, hope to facilitate further study., Patient Concerns: A 29-year-old woman with a twin pregnancy showed serum creatinine (Scr) 100 μmol/L (CKD2) at conception. During her 12th week, Scr reached 263 μmol/L (CKD4) with urine protein 3+ and hypertension., Diagnoses: Due to her pregnancy, renal biopsy was not considered. Lab tests showed deterioration of renal function and ultrasound detections showed small kidney size., Interventions: The patient was given basic drug therapy to control her blood pressure and supplemental nutrition without hemodialysis., Outcomes: The patient delivered 2 healthy babies weighting 0.9 and 0.7 kg by cesarean section at the 28th week, but has been under maintenance hemodialysis since then., Lessons: Despite low birth weight and preterm delivery, successful twin pregnancies in some patients with CKD could be realized under early multidisciplinary intervention, but this poses great risks for mothers and twins, especially for patients with advanced CKD and those on hemodialysis.

This study aimed to determine the health-related quality of life (HRQoL) of people with self-reported diagnosed hypertension and its determinants in China. Data was obtained from the 5th National Health Services Survey. The HRQoL of the respondents who were 15 years or older was assessed with the EQ-5D-3L utility index and visual analogue scale (VAS), and compared between those with ( n = 30,063) and without ( n = 158,657) self-reported hypertension. Multivariate logistic regression, Tobit regression, and linear regression models were established to identify predictors of HRQoL. A difference of half standard deviation was deemed as minimal clinically important difference (MCID) for the utility index (0.03). The respondents with self-reported hypertension were more likely to report problems in the five dimensions (Adjusted Odds Ratio = 1.43-1.70) of the EQ-5D-3L, resulting in a significant lower utility index (β = -0.04) and VAS scores (β = -3.22) compared with those without self-reported hypertension, and the difference of the utility index exceeded MCID. In the respondents with self-reported hypertension, higher utility index and VAS scores were found in those who were female, younger, married, employed, smoking, drinking, exercising regularly, absent from comorbidity, resided in the eastern developed region, had normal body mass index, higher levels of education, and income. Hypertension management programs were associated with higher utility index (β = 0.01) and VAS scores (β = 1.02). Overall, hypertension is associated with lower HRQoL. Higher socioeconomic status and participation in management programs for chronic conditions are independent predictors of higher HRQoL of hypertensive people. This study provides a national representative estimate on the HRQoL of hypertensive people in China, which can be used for calculating the burden of hypertension.

Objective: To investigate the association between alcohol drinking and all-cause death in patients with ischemic stroke., Methods: Between January, 2010 and July, 2018, consecutive patients with first-episode ischemic stroke admitted in the West China Hospital, Sichuan University were enrolled, and all the patients were followed up every 3 months.Chi-square test was used to compare the differences in the baseline characteristics between the pre-stroke drinkers and the nondrinkers.The Cox regression model was used to analyze the effects of drinking status, drinking years, drinking frequency, average single alcohol intake before stroke and drinking status during the follow-up period on the mortality of patients after discharge., Results: A total of 855 patients with ischemic stroke were enrolled, and deaths occurred in 140 of these patients.Chi-square test showed significant differences in gender ( P &lt; 0.001), weekly physical exercise time ( P =0.035), smoking ( P &lt; 0.001), and heart disease ( P &lt; 0.001) between the pre-stroke drinkers and nondrinkers.Multivariate Cox regression analysis showed that drinking during the follow-up period ( P =0.001), drinking for less than 28 years before stroke ( P =0.035) and a moderate drinking frequency (5 to 20 times per month for males and 4 to 9 times per month for females; P =0.030) were associated with a lowered risk of death after discharge.No significant effects of pre-stroke drinking status or average single alcohol intake were found on death after ischemic stroke., Conclusions: The drinking years and drinking frequency before stroke and drinking status during the follow-up period are related to the all-cause mortality in patients with ischemic stroke.Investigations of the more specific variables of drinking behaviors during the follow-up period are needed to further clarify the association between drinking and death after ischemic stroke.

In recent years, group B streptococcus (GBS) has become an important pathogen that causes infections in many neonatal organs, including the brain, lung, and eye (Ballard et al., 2016). A series of studies performed on GBS infections in western countries have revealed that GBS is one of the primary pathogens implicated in perinatal infection, and GBS infections are a major cause of neonatal morbidity and mortality in the United States (Decheva et al., 2013). In China, GBS is mainly found by screens for adult urogenital tract and perinatal infections, and neonatal GBS infections have been rarely reported. The incidence rate of early-onset neonatal GBS disease is thought to be lower in China than in western countries; however, this data is controversial since it also reflects the clinical interest in GBS (Dabrowska-Szponar and Galinski, 2001).

Improving the quality of peritoneal dialysis (PD) in areas with a rapid increase in PD patient numbers constitutes the most significant PD challenge in China. Here, we share our experience of implementing a quality improvement program in 8 PD centers, with guidance from matched experienced centers., (Copyright © 2014 International Society for Peritoneal Dialysis.)

Background: Maintenance dialysis therapy is the only way to remove excess fluid in patients with anuric end-stage renal disease. The optimal ultrafiltration (UF) volume in patients on peritoneal dialysis (PD) remains controversial., Methods: We retrospectively analysed a cohort of 86 prevalent anuric PD patients followed up for a median of 25.3 months (range, 6 to 54 months). Clinical and PD parameters were recorded yearly. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors of mortality and technique failure in patients with a UF >/=1 L/24 h or <1 L/24 h., Results: When compared to those with a UF <1 L/24 h, patients with a UF >/=1 L/24 h had significantly higher haemoglobin levels (101.9 +/- 20.5 vs 89.3 +/- 20.2 g/L, P < 0.05) and tended to be younger (55.0 +/- 12.5 vs 60.6 +/- 16.1 years, P = 0.10). Also, while Kt/V and CCr were stable over time, UF decreased significantly over the study period (baseline, 1205.5 +/- 327.3 ml/24 h vs after 3 years, 870.6 +/- 439.8 ml/24 h; P < 0.001). Using Kaplan-Meier analysis, patients with baseline UF <1 L/24 h had significantly worse outcome (survival, 27.2 +/- 3.9 vs 42.4 +/- 1.9 months; P < 0.001). In multivariate Cox regression analysis, age, time-dependent UF volume and serum albumin were independent predictors of mortality, while UF independently predicted technique failure., Conclusions: The present study demonstrates a strong predictive value of daily peritoneal UF for both technique and patient survival in prevalent anuric PD patients. Identifying markers of satisfactory fluid status, as well as optimizing therapy to meet UF goals, remains an important clinical target.

Background: The impact of dialysis modality on the rates and types of infectious complications has not been well studied. The aim of the present investigation was to evaluate the rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in peritoneal dialysis (PD) and haemodialysis (HD) patients in the Asia-Pacific region., Methods: The study included the most recent period-prevalent data recorded in the national or regional dialysis registries of the 10 Asia-Pacific countries/areas (Australia, New Zealand, Japan, China, Taiwan, Korea, Thailand, Hong Kong, Malaysia and India), where such data were available. Longitudinal data were also available for all incident Australian and New Zealand patients commencing dialysis between 1 April 1995 and 31 December 2005. Rates of HCV and HBV infections were compared by chi-square, Poisson regression and Kaplan-Meier survival analyses, as appropriate., Results: Data were obtained on 201,590 patients (HD 173,788; PD 27,802). HCV seroprevalences ranged between 0.7% and 18.1% across different countries and were generally higher in HD versus PD populations (7.9% +/- 5.5% versus 3.0% +/- 2.0%, P = 0.01). Seroconversion rates on dialysis were also significantly higher in HD patients (incidence rate ratio PD versus HD 0.33, 95% CI 0.13-0.75). HCV infection was highly predictive of mortality in Japan (relative risk 1.37, 95% CI 1.15-1.62, P = 0.003) and in Australia and New Zealand (adjusted hazards ratio 1.29, 95% CI 1.05-1.58). HBV infection data were limited, but less clearly influenced by dialysis modality., Conclusions: Dialysis modality selection significantly influences the risk of HCV infection experienced by end-stage renal failure patients in the Asia-Pacific region. No such association could be identified for HBV infection.

Introduction: As economic development continues in China, it is important to evaluate recent changes in dialysis status. However, China lacks a national dialysis registry. This elevates the need to use local registry systems like the Shanghai Dialysis Registry to gain an overview of dialysis status in developed cities in China., Methods: Data were collected from the Shanghai Dialysis Registry from the beginning of 2000 to the end of 2005. All dialysis centers (n = 58) in Shanghai are included in the registry system., Results: Point prevalence of dialysis on December 31, 2005, was 5496, compared with 4842 in 2000. In 2005, 3746 patients began dialysis, yielding a treatment rate of 275.4 patients per million population. The percentage of peritoneal dialysis patients was 18% in 2005, compared with 14% in 2000. The main cause for end-stage renal disease was chronic glomerulonephritis. However, the incidence of diabetic nephropathy increased from 9.9% in 2000 to 17.2% in 2005 and counts as the second major cause of end-stage renal disease. The death rate of patients on dialysis decreased from 9.2% in 2000 to 7.5% in 2005. Cerebrovascular disease was still the leading cause of death and decreased significantly from 2.4% in 2000 to 1.5% in 2005. Dialysis adequacy, hepatitis infection control, and anemia treatment improved., Conclusions: The Shanghai dialysis population grew continuously during the period covered by this study (2000 to 2005). Clinical outcomes improved because of prompt treatment for co-morbidities.

Unlabelled: Objective. We compared patient characteristics, dialysis practice patterns and outcomes of peritoneal dialysis (PD) patients between one Chinese centre and one Canadian centre to determine whether observed differences in demographics and practices are associated with patient and technique survival., Methods: This study included all patients who started on PD between 1 January 2000 and 31 December 2004 at the University Health Network, University of Toronto, Canada and Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. They were followed up from the date of PD initiation until death, cessation of PD, transfer to other centres or to the end of the study (31 December 2006)., Results: We studied 496 patients, 256 from the Canadian centre and 240 from the Chinese centre. Canadian patients were older and more likely to have diabetes and cardiovascular comorbidities at the initiation of PD, while the Chinese patients had lower residual renal function (RRF). More Canadian patients were treated with APD, whereas all Chinese patients were on CAPD with a lower PD volume. Crude patient survival rates at 1, 2, 3 and 5 years were similar between the two centres: 90%, 79%, 72% and 61% for Canadian and 90%, 79%, 71% and 64% for Chinese patients, respectively. After adjustment for demographic and clinical variables, there is no significant difference in mortality between Chinese patients and Canadian patients. Age, cardiovascular disease, diabetes, RRF and serum albumin were independent predictors of patient survival. The death-censored technique survival rates were significantly lower among the Canadian patients compared to Chinese patients. Chinese patients showed a lower risk of technique failure (HR 0.491, 95% CI 0.269-0.898, P = 0.021) after adjustment for patient characteristics. Chinese centre, BMI, serum albumin and gender were independent predictors of technique survival. The average peritonitis rate was one episode every 36.1 patient-months in Canadian patients and one episode every 60.6 patient-months in their Chinese counterparts., Conclusion: Patient characteristics, dialysis practice patterns and outcomes vary between Canadian and Chinese patients. The variability in patient outcomes between these two centres indicates that further improvements may be possible in both centres. We have identified several areas for improving outcomes.