Search

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]