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The purpose of this meta-analysis was to evaluate the perioperative morbidity after anterior resection with diverting loop ileostomy (LI) versus colostomy (LC) and its reversal for rectal cancer. The studies on the application of loop ileostomy versus loop colostomy in anterior resection published from January 2000 to January 2020 were searched in the databases of Pubmed, Embase, Cochrane library, and Clinical trials. All randomized controlled trials (RCTs) and cohort studies were included according to inclusion criteria. Eight studies (2 RCTs and 6 cohort studies) totaling 1451 patients (821 LI and 630 LC) were included in the meta-analysis. The morbidity related to stoma formation and closure did not demonstrate significant differences. Significantly more LCs were complicated by stoma prolapseretraction (OR:0.26,95%CI:0.11-0.60,P = 0.001), parastomal hernia (OR = 0.52,95%CI:0.30-0.88, P = 0.01), surgical site infection (SSI) (OR = 0.24,95%CI:0.11-0.49,P 0.0001) and incisional hernias (OR = 0.39,95%CI:0.19-0.83,P = 0.01) than by LIs. Patients with LI demonstrated significantly more complications related to the stoma, such as dehydration (OR = 0.52,95%CI:0.30-0.88, P = 0.01) and ileus (OR = 2.23,95%CI:1.12-4.43, P = 0.02) than patients with LC. While after the subgroup analysis of different publication years, LI could reduce the risk of the morbidity after stoma formation in previous years group (P = 0.04) with a lower heterogeneity (I

Introduction Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT; www.the4AT.com) is a short ( Methods We searched the following electronic databases through Ovid: MEDLINE, Embase, and PsycINFO. Additional databases were searched: CINAHL (EBSCOhost), clinicaltrials.gov and Cochrane Central Register of Controlled Trials from 2011 (4AT publication) until 21 December 2019. Inclusion criteria: older adults (≥65) across any setting of care except critical care; validation study of the 4AT against a delirium reference standard (standard diagnostic criteria or validated tool). Two reviewers independently screened abstracts and papers and performed the data extraction. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. Results 17 studies (n = 3,701 observations) were included. Various settings including acute medicine, surgery, stroke wards and the emergency department were represented. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). The methodological quality of studies was mostly good. Conclusions The 4AT is now supported by a substantial evidence base comparable to other well-studied tools such as the Confusion Assessment Method (CAM). The strong pooled sensitivity and specificity findings for the 4AT in this meta-analysis along with its brevity and lack of need for specific training provide support for its use as an effective assessment tool for delirium.

In this work, an AlGaN/GaN enhancement-mode high electron mobility transistor (HEMT) with two-step gate recess and electroless plating (EP) approaches is reported. Scanning electron microscopy and atomic force microscopy surface analysis are used to analysis the related properties of the EP-gate structure. A positive threshold voltage Vthof 0.68 V is obtained for the enhancement-mode EP-HEMT. In addition, a traditional HEMT based on thermal-evaporation gate is compared for the demonstration of the studied EP-HEMT with the improved performance, such as a higher maximum drain saturation current of 228.9 mA/mm, a higher maximum transconductance of 107.2 mS/mm, a lower gate leakage current of 1.2 × 10–7 mA/mm, and a higher ON/OFF drain current ratio of 4.57 × 105.

This article examines the impact of pay disparity within the top management team (TMT) on real earnings management. Using data from Chinese listed firms for the period 2007 to 2018, we find that pa...

Objective Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT) is a short ( Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. Results Seventeen studies (3,702 observations) were included. Settings were acute medicine, surgery, a care home and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77–0.92) and the pooled specificity was 0.89 (95% CI 0.83–0.93). The methodological quality of studies varied but was moderate to good overall. Conclusions The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. PROSPERO Registration number CRD42019133702.

Objective: Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance. We hypothesized that under a paperless, computer-based feedback system the rates of antibiotic prescriptions among primary care physicians can be reduced. Methods: A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians’ antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians. Results: There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value = 0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value

BACKGROUND Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is an important type of liver failure in Asia. There is a direct relationship between HBV-ACLF and gastrointestinal barrier function. However, the nutritional status of HBV-ACLF patients has been poorly studied. AIM To investigate the nutritional risk and nutritional status of HBV-ACLF patients and evaluated the impact of nutritional support on the gastrointestinal barrier and 28-d mortality. METHODS Nutritional risk screening assessment and gastrointestinal barrier biomarkers of patients with HBV-ACLF (n = 234) and patients in the compensatory period of liver cirrhosis (the control group) (n = 234) were compared during the period between 2016 and 2018. Changes were analyzed after nutritional support in HBV-ACLF patients. Valuable biomarkers have been explored to predict 28-d death. The 28-d survival between HBV-ACLF patients with nutritional support (n = 234) or no nutritional support (2014-2016) (n = 207) was compared. RESULTS The nutritional risk of the HBV-ACLF patients was significantly higher than that of the control group. The nutritional intake of the patients with HBV-ACLF was lower than that of the control group. The decrease in skeletal muscle and fat content and the deficiency of fat intake were more obvious (P < 0.001). The coccus-bacillus ratio, secretory immunoglobulin A, and serum D-lactate were significantly increased in HBV-ACLF patients. The survival group had a lower nutritional risk, lower D-lactate, and cytokine levels (endotoxin, tumor necrosis factor alpha, interleukin-10, and interleukin-1). Interleukin-10 may be a potential predictor of death in HBV-ACLF patients. The 28-d survival of the nutritional support group was better than that of the non-nutritional support group (P = 0.016). CONCLUSION Patients with HBV-ACLF have insufficient nutritional intake and high nutritional risk, and their intestinal barrier function is impaired. Individualized and dynamic nutritional support is associated with a better prognosis of 28-d mortality in HBV-ACLF patients.

The incidence rate and mortality of liver fibrosis caused by various etiologies are high throughout the world. Liver fibrosis, the subsequent cirrhosis and other serious related complications threaten the health of patients and represent a serious medical burden; yet, there is still a lack of approved methods to prevent or reverse liver fibrosis. Therefore, effective hepatic antifibrotic drugs are urgently needed. The activation and proliferation of hepatic stellate cells are still the mechanisms of fibrosis that remain the focus of therapeutic research. In recent years, significant progress has been made in the development and applicability of antifibrosis drugs. In this review, we summarize the effectiveness and safety of available antifibrosis drugs utilizing different targets. In addition, some characteristics of antifibrosis drugs in phase II and III trials are introduced in detail.

The health-maintaining effects of tea on the human body have been widely proven, even with the tea prepared by brewing tea leaves in cold water becoming a new choice other than hot water. In this research, quality and the antioxidant properties of the Pouchong tea infusions prepared with cold water and hot water were determined and explored their relationships under a consumer hedonic test. The results showed that the chemical components of cold tea infusions increased with increasing duration of brewing, and a maximal increment was observed during the first 2 h of brewing. All chemical components under investigation, except caffeine, were found to be higher in the cold tea infusions over 8 h as compared in the hot tea infusions. The antioxidant ability of cold tea infusion increased with increasing duration of brewing and approached the plateau after 12 hours. The chemical components showed a significantly positive correlation with the antioxidant activities (P

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (COVID-19) have a substantial burden on health-care systems around the world. This is a randomized parallel controlled trial for assessment of the immunogenicity and safety of an inactivated SARS-CoV-2 vaccine, aiming to determine an appropriate vaccination interval of the vaccine for high-risk occupational population. Methods In an ongoing randomized, parallel, controlled phase IV trial between January and May 2021 in Taiyuan City, Shanxi Province, China, we randomly assigned the airport ground staff and public security officers aged 18 to 59 years to receive two doses of inactivated SARS-CoV-2 vaccine at 14 days, 21 days, or 28 days. The serum neutralizing antibody to live SARS-CoV-2 was performed at baseline and 28 days after immunization. Long-term data are being collected. The primary immunogenicity endpoints were neutralization antibody seroconversion and geometric mean titer (GMT) at 28 days after the second dose. Analysis of variance (ANOVA), chi-square, and logistic regression analysis were used for data analysis. Results A total of 809 participants underwent randomization and received two doses of injections: 270, 270, 269 in the 0–14, 0–21, and 0–28 vaccination group, respectively. By day 28 after the second injection, SARS-CoV-2 neutralizing antibody of GMT was 98.4 (95% CI: 88.4–108.4) in the 0–14 group, which was significantly lower compared with 134.4 (95% CI: 123.1–145.7) in the 0–21 group (P CI: 131.3–159.6) in the 0–28 group (P Conclusions Both a two-dose of inactivated SARS-CoV-2 vaccine at 0–21 days and 0–28 days regimens significantly improved SARS-CoV-2 neutralizing antibody level compared to the 0–14 days regimen in high-risk occupational population, with seroconversion rates of 100.0%. Trial registration Chinese Clinical Trial Registry, ChiCTR2100041705, ChiCTR2100041706. Registered 1 January 2021, www.chictr.org.cn. Graphical Abstract

Background Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance. Methods A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians’ antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians. Results There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value = 0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value < 0.001). After a further 3 months, the rate of decline in antibiotic prescriptions was also significantly greater in the intervention group compared to the control group (14.2% vs 4.6%, P-value < 0.001). Conclusions A computer network-based feedback intervention can significantly reduce the antibiotic prescription rates of primary care outpatient physicians. Key messages The feedback intervention continuously affected their prescription behavior for up to six months.

Ecological vulnerability zoning research is an important basis for taking targeted regional ecological environment restoration and governance measures. This study analyzes the ecological vulnerability pattern and trend in the National Energy and Chemical Base (NECB) in the typical region of the Loess Plateau using GIS (Geographic Information System) data and the fuzzy analytic hierarchy process (FAHP) approach. Based on the human activity–natural environment factor index system, 13 factors representing human activities, socioeconomics, meteorology, soil and topography are selected to build an ecological vulnerability index (EVI) system in the NECB region, which aims at identifying the regional features of eco-environment and major environmental problems in the Loess Plateau. By calculating ecological vulnerability zoning, a model of ecological vulnerability trend change is constructed to quantitatively study the overall temporal and spatial variation of ecological vulnerability. The results indicate that the medium and heavy levels of ecological vulnerability index were mostly distributed in the areas with developed energy and chemical industries, and the slight and light levels were distributed in the southern area and developed agricultural regions. A comprehensive ecological vulnerability index had a score of 2.3207 in 2015 and 2.441 in 2000, indicating that the ecological security gradually improved. Nevertheless, highly intense human activities accelerated the degradation of regional eco-environment in recent years.

BackgroundDelirium is prevalent and underdetected among cardiac surgery patients on the postoperative ward. This study aimed to validate the 4 A's Test delirium screening tool and evaluate its accuracy both when used by research assistants and when subsequently implemented by nursing staff on the ward.MethodsThis single-center, prospective observational study evaluated the performance of the 4 A's Test administered by research assistants (phase 1) and nursing staff (phase 2). Assessments were undertaken during the patients' first 3 postoperative days on the postcardiac surgery ward along with previous routine nurse-led Confusion Assessment Method assessments. These index tests were compared with a reference standard diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Surveys regarding delirium screening were administered to nurses pre- and postimplementation of the 4 A's Test in phase 2 of the study.ResultsIn phase 1, a total of 137 patients were enrolled, of whom 24.8% experienced delirium on the postoperative cardiac ward. The 4 A's Test had a sensitivity of 85% (95% confidence interval, 73-93) and a specificity of 90% (95% confidence interval, 85-93) compared with the reference standard. The nurse-assessed Confusion Assessment Method had a sensitivity of 23% (95% confidence interval, 13-37) and specificity of 100% (95% confidence interval, 99-100). In phase 2, nurses (n = 51) screened 179 patients for delirium using the 4 A's Test. Compared with the reference rater, the 4 A's Test had a sensitivity of 58% (95% confidence interval, 28-85) and specificity of 94% (95% confidence interval, 85-98). Postimplementation, 64% of nurses thought that the 4 A's Test improved their confidence in delirium detection, and 76% of nurses would consider routine 4 A's Test use.ConclusionsThe 4 A's Test demonstrated moderate sensitivity and high specificity to detect delirium in a real-world setting after cardiac surgery on the postoperative ward. A modified model of use with less frequent administration, along with increased engagement of the postoperative team, is recommended to improve early delirium detection on the cardiac surgery postoperative ward.

A novel optically-induced dielectrophoretic (ODEP) device incorporating a gold nanofilm is proposed for the manipulation of microparticles. The electrokinetic phenomena induced under different optical radial images are investigated both numerically and experimentally. The results show that the gold nanofilm not only extends the operating frequency of the ODEP device, but also prompts a change in the direction of the DEP force from the outward direction to the inward direction at high frequencies. Consequently, particle concentration can be achieved in the high frequency range. Overall, the proposed device provides a bi-directional and velocity/force-controllable approach for the manipulation of microparticles in ODEP applications.

The African Orphan Crops Consortium (AOCC) successfully initiated the ambitious genome sequencing project of 101 African orphan crops/trees with 6 genomes sequenced, 6 near completion, and 20 currently in progress. Addressing stunting, malnutrition, and hidden hunger through nutritious, economic, and resilient agri-food system is one of the major agricultural challenges of this century. As sub-Saharan Africa harbors a large portion of the severely malnourished population, the African Orphan Crops Consortium (AOCC) was established in 2011 with an aim to reduce stunting and malnutrition by providing nutritional security through improving locally adapted nutritious, but neglected, under-researched or orphan African food crops. Foods from these indigenous or naturalized crops and trees are rich in minerals, vitamins, and antioxidant, and are an integral part of the dietary portfolio and cultural, social, and economic milieu of African farmers. Through stakeholder consultations supported by the African Union, 101 African orphan and under-researched crop species were prioritized to mainstream into African agri-food systems. The AOCC, through a network of international-regional-public-private partnerships and collaborations, is generating genomic resources of three types, i.e., reference genome sequence, transcriptome sequence, and re-sequencing 100 accessions/species, using next-generation sequencing (NGS) technology. Furthermore, the University of California Davis African Plant Breeding Academy under the AOCC banner is training 150 lead African scientists to breed high yielding, nutritious, and climate-resilient (biotic and abiotic stress tolerant) crop varieties that meet African farmer and consumer needs. To date, one or more forms of sequence data have been produced for 60 crops. Reference genome sequences for six species have already been published, 6 are almost near completion, and 19 are in progress.

Hepatitis B virus (HBV) infection is a public health challenge, especially in China. In clinical practice, HBV infection is associated with nephropathy. Impaired renal function is frequently observed in compensated Chronic Hepatitis B (CHB) and cirrhosis (LC). Thus, renal function must be monitored to avoid nephrotoxic effects before and during nucleoside analog treatment. Investigating the predictive markers of early renal dysfunction is essential. New GFR-predicting equations, based on Pcr and/or CystC, have been recently recommended in the general population, but their performance in liver disease patients has been rarely studied. In this study, we will discuss how to detect renal dysfunction in patients with HBV infection. A total of 16 LC patients and 23 CHB patients were enrolled in this study, and we collected and compared the clinical data of the two groups. The estimated glomerular filtration rates (eGFRs) were also calculated by several equations. All patients received 99mTc-DTPA dynamic radionuclide imaging examinations to obtain mGFRs as the reference standard. To evaluate the performance of any equation in the CHB and LC groups, paired t test, Pearson’s correlation, Kappa analysis and Bland–Altman plots were utilized. Moreover, all 39 subjects were divided into two groups (according to GFR > 90 mL/min/1.73 m2). We compared the serum and urinary markers of kidney injury between the two groups and selected the indicators of renal injury by univariate analysis. The mGFR was 72.26 ± 20.69 mL/min/1.73 m2 in the LC group, and 87.49 ± 25.91 mL/min/1.73 m2 in the CHB group. The paired t test results of eGFR and mGFR showed no difference between eGFR (estimated by the CHINAcr-cys equation) and mGFR (p > 0.05) in the compensated LC and CHB groups. The difference between mGFR and eGFR estimated by other methods was obvious (p 90 mL/min/1.73 m2) and showed International normalized ratio (INR) (p = 0.009), creatinine (p = 0.006), urine N-acetyl-β-glucosaminidase (NAG) (p = 0.001) and serum cystatin C (CysC) (p = 0.044). The CHINAcr-cys equation may be more suitable for the estimation of GFR in Chinese patients with CHB or compensated cirrhosis. INR, creatinine, NAG, and CysC are proper biomarkers for screening renal dysfunction in Chinese patients with CHB or compensated LC.

Southern Shaanxi is located in one of the water sources of the China's South-to-North Water Diversion Project. Evaluating ecological vulnerability can effectively supervise environmental changes and master evolving driving forces so as to guide the rational use and protection of ecological environment in regional water sources. Based on meteorological data, remote sensing images and statistical data, this study established an evaluation index system for ecological vulnerability in this special area. Taking advantage of visual expression and data mining capacity of geographical information system and remote sensing, a spatial principal component analysis method was introduced to evaluate the geospatial and temporal features of ecological vulnerability. This study established a feasible method to comprehensively assess the level of ecological vulnerability, and quantitatively analyze the driving forces that affected the ecological vulnerability in study area. The results indicated high levels of ecological vulnerability grade in the urban areas and the adjacent counties. With the accelerated urbanization, the ecological vulnerability index of the three major urban areas and their surrounding areas had gradually increasing ecological vulnerability index. The proportion of III vulnerable areas was always the largest area, which also led to an increase in the instability of the ecological environment. Over time, the most important driving force for ecological vulnerability of evaluation units in different regions was socio-economic factors, and environmental topographic factors were also important secondary factors for ecological vulnerability in Southern Shaanxi.

Objectives To explore the immunogenicity and persistence of the 60 µg hepatitis B vaccine in adults infected with human immunodeficiency virus (HIV). Methods We conducted a randomised controlled trial for adults infected with HIV. A total of 182 patients were randomly allocated to receive 20 µg (IM20 group) or 60 µg (IM60 group) of recombinant hepatitis B vaccine at months 0, 1, and 6 to assess the immunogenicity and were followed-up from month 7 to 42 to assess long-term immunogenicity. Results Our data showed that the response rate and geometric mean concentration (GMC) of antibodies to hepatitis B surface antigen (anti-HBs) in the IM60 group at month 7 were higher than those in the IM20 group (P > 0.05). The GMC of anti-HBs among the two groups decreased rapidly during the follow-up period (P > 0.05). Survival analysis showed that 25% of patients with anti-HBs ≥ 10 mIU/mL were 20 months in the IM60 group and 9.3 months in the IM20 group. Conclusion The three-dose 60 µg hepatitis B vaccine showed partially better immunogenicity and persistence than the three-dose 20 µg vaccine. Trial Registration The trial was registered on clinicaltrials.gov, NCT03316807.

Chronic diseases are diseases that last one year or more and require a continuous medical care and monitoring. Based on this point, a dataset from an APP called Flaredown helps patients of chronic disease improve their symptoms and conditions. In this study, an illness severity-level model was proposed to give the patient an alert to his or her health condition into three different levels according to their severity. Personal information, treatment conditions, and dietary conditions were analyzed by a statistical measure, TD-IDF. Seven different machine learning models were used and compared to generate the illness severity-level model. The results revealed that the XGBoost model with a F 1 score of 0.85 and LightGBM model with a F 1 score of 0.84 have the best performance. We also applied feature selection and parameter tuning for these two models to attain better performance, and the final best F 1 scores achieved by the XGBoost model and LightGBM model were both 0.85. Sensitivity analysis has shown that the treatment feature and symptom feature have important effects on the classification of the illness severity-level. Based on this, a fusion model was designed to study the data and the final accuracy of the fusion model was 93.3%. Thus, this study provides an effective illness severity-level model for a reference and guidance for the management of high-risk groups of chronic diseases. Patients may use this illness severity-level model to self-monitor their illness conditions and take proactive steps to avoid deterioration of their illness and take further medical care.

Supplemental Digital Content is available in the text, Introduction: The incidence of hepatocellular carcinoma (HCC) ranks sixth in the world, but its mortality is the third highest due to the lack of early diagnostic markers. Nowadays, the increase of autoantibody levels has been found in many cancers, and many studies have begun to pay attention to the detection of anti-p53 antibodies in HCC. The purpose of this study is to quantitatively and comprehensively analyze the potential diagnostic value of anti-p53 autoantibodies in HCC Methods: English articles up to November 2019 were collected. The overall sensitivity and specificity were calculated. Besides, the positive likelihood ratio, negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic curves of the overall diagnostic accuracy of anti-p53 antibody were calculated by STATA software. Finally, according to the heterogeneity of the results, the subgroup analysis, and the publication bias were performed. Results: A total of 16 eligible studies were incorporated into this meta-analysis, including 1323 patients with HCC and 1896 control. The pooled sensitivity was 0.28(0.17–0.41) and specificity was 0.98 (0.95–0.99). The pooled DOR was 10.44 (6.31–17.29) and the pooled NLR was 0.74 (0.63–0.86). The area under ROC curve of symmetrical ROC was 0.840. Conclusions: The anti-p53 antibody has a high specificity for HCC, but the low sensitivity is not perfect and would limit the clinical application. The anti-p53 antibody would help rule out HCC but not help rule in HCC for early diagnosis. Whether combined as a diagnostic panel with other biomarkers or laboratory tests may prove useful requires further study.

With the continuous development of computer technology, both hardware and software equipment have undergone upgrading. At the same time, in order to meet the aesthetic needs of the public and the application needs of various industries, the computer is directly used in graphic design, which can give graphic design Bring new changes. Designers have gradually developed from the use of paper and pen as a carrier to use a variety of design software as a carrier to make the designed floor plan more in line with the aesthetic needs of modern people. From the design concept to the presentation of works, continuous innovation can be achieved, thereby expanding the scope of graphic design applications. This article is based on the use of Flash AIR programming and development + Photoshop technology to build a flat visual design platform to meet the needs of customers in the graphic design process. It has the aesthetics of graphic layout, shortens creative design time, improves work efficiency, safe and reliable system, and convenient operation.

ObjectiveDetection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT) is a short (MethodsWe searched MEDLINE, EMBASE, PsycINFO, CINAHL,clinicaltrials.govand the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the websitewww.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥ 65y); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.Results17 studies (3702 observations) were included. Settings were acute medicine, surgery, a care home, and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall.ConclusionsThe 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection.PROSPERO Registration number CRD42019133702.Key pointsThe 4AT is a short delirium assessment tool that is widely used internationally in clinical practice.This systematic review and meta-analysis of diagnostic accuracy studies of the 4AT included 3702 observations in 17 studies from nine countries.Studies recruited from a range of settings including the Emergency Department, and medical, stroke, and surgical wards.The 4AT had a pooled sensitivity of 0.88 and pooled specificity of 0.88.The methodological quality of studies varied but was moderate to good overall.

Objective: This study aimed to investigate the potential value of circumferential resection margin (CRM) in colon cancer prognostics.Summary Background Data: CRM has been extensively studied as an important prognostic factor in rectal and esophageal cancer, but not in colon cancer.Methods: Data from 6,681 CRM-positive patients and 25,908 CRM-negative patients diagnosed with colon cancer in 2010–2015 were obtained from the Surveillance, Epidemiology, and End Results database. Statistical analysis methods utilized included the chi-square test, Kaplan-Meier estimates, Cox proportional, and X-tile software analyses.Results: After propensity score matching, CRM positivity was found to be negatively related with survival (P < 0.001). X-tile software identified 0 and 30 mm as optimal cutoff values (P < 0.001) for prognosis, which was applicable only in stage II–IV patients. A 20 and 33% risk decrease were observed in patients with CRM between 0 and 30 mm [95% confidence interval (CI) = 0.76–0.84], and larger than 30 mm (95% CI = 0.62–0.71), respectively. Chemotherapy strongly benefited prognosis with a hazard ratio of 0.36 (95% CI = 0.34–0.38) for overall survival (OS). Patients with a CRM value of 0–30 mm seemed to benefit most from chemotherapy compared with other groups. CRM and number of regional lymph nodes are independent risk factors, and the latter is a good substitute for CRM in AJCC stage I patients.Conclusion: CRM positivity is a strong unfavorable survival indicator for colon cancer patients. A better outcome is expected with CRM values larger than 30 mm. This cutoff value only applied to stage II–IV patients. For stage I patients, number of regional lymph nodes is a good substitute to predict survival. Chemotherapy was another favorable prognostic factor, especially for patients with a CRM value between 0 and 30 mm.

Endometrial cancer is a common gynaecological malignant tumour among women across the world. Circular RNAs (circRNAs) are a novel kind of non‐coding RNAs, and they can play a crucial role in multiple cancers. Nevertheless, the mechanisms of circRNAs in regulating gene expression in endometrial cancer are still unclear. Here, our work sought to focus on the role that circ_0067835 exert in progression and development of endometrial cancer cells. We observed circ_0067835 was markedly elevated in endometrial cancer. Then, changes in endometrial cancer cell (RL95‐2 and HEC‐1B) function were determined after circ_0067835 knockdown. Loss‐of‐functional assays revealed that circ_0067835 down‐regulation significantly repressed RL95‐1 and HEC‐1B cell proliferation, migration and invasion. Bioinformatics analysis, luciferase reporter experiment and RNA pull‐down assay were employed to predict and validate circ_0067835 can bind to miR‐324‐5p. Increase in miR‐324‐5p remarkably depressed the proliferation, migration and invasion of endometrial cancer cells via inhibiting high mobility group A1 (HMGA1). HMGA1 is identified as a vital prognostic biomarker in endometrial cancer. Currently, we reported circ_0067835 was positively correlated with HMGA1 in endometrial cancer. We implied that circ_0067835 was capable of sponging miR‐324‐5p and inducing its downstream target HMGA1 in vitro and in vivo. In conclusion, circ_0067835 can compete with miR‐324‐5p, resulting in HMGA1 up‐regulation, and therefore induce the development of endometrial cancer.

Oxygen deficiency in the plateau environment weakens aerobic metabolism and reduces the energy supply, leading to high-altitude diseases including decreased circulatory function, decreased nutrient and energy supply to tissues and organs, and decreased waste discharge. The involvement of many metabolic pathways is reflected in dramatic changes in levels of endogenous small molecule metabolites. Metabolomics represents a promising technique for mechanistic studies and drug screening, and metabonomics, or quantitative metabolomics, has been increasingly applied to the study of hypoxic diseases and their pathogenesis, as well as to pharmacodynamics at high altitudes. In this article, we review the recent literature on the pathogenesis of altitude hypoxia and the clinical and preclinical metabonomics of drug interventions. Endogenous metabolites and metabolic pathways change significantly under high-altitude hypoxia. Some drug interventions have also been shown to regulate pathway metabolism, and the problems of applying metabonomics to hypoxic diseases at high altitude and the prospects for its future application are summarized.

As the main part of Guanzhong-Tianshui Economic Zone, involving the 44 areas in Weihe River Plain, we have conducted a quantitative analysis of the level of human settlements in this important regi...

Chronic intermittent hypoxia (CIH) during repetitive airflow cessations may cause endothelial dysfunction. Tanshinone IIA (Tan IIA) has been used to treat various circulatory disturbance-related diseases because of its pharmacological actions, including vasodilation. However, the mechanism of the effect of its vasodilation is not well established. The objective of this study was to explore the effect of Tan IIA in endothelium-dependent contracting factors and endothelin receptors in aortic endothelial dysfunction in CIH rats. Aortas of rats were retrieved for use in in vitro experiments (isometric force measurement), histological analysis, immunohistochemistry, and Western blotting. Tan IIA treatment increased the expression of endothelial nitric oxide synthase (eNOS) and formation of nitric oxide (NO), inhibited the production of endothelin-1 (ET-1), down-regulated ETA receptor expression, and up-regulated ETB receptor expression. In conclusion, Tan IIA protects endothelial function by inhibiting strain-induced ET-1 expression, decreasing ETA receptors, increasing ETB receptors, increasing the formation of NO, and up-regulating eNOS in CIH.

Tanshinone IIA (Tan IIA) may exert significant protective effects against heart oxidative stress damage in obstructive sleep apnoea (OSA) syndrome. Chronic intermittent hypoxia (CIH)-triggered left ventricular dysfunction is used in a rat model to mimic CIH in OSA patients. 48 rats were randomly divided into three groups: normal control (NC) group, CIH group and CIH+Tan IIA group with 16 rats in each group. At the end of experiment (day 21), the blood pressure, Plasma ET-1 and NO content, hemodynamic indexes, heart histology, myocardial apoptosis as well as the expression of eNOS, ET-1, ETA receptor and ETB receptor were compared among different groups. Tan IIA was able to inhibit the increase of blood pressure induced by CIH. Meanwhile, rat cardiac function in Tan IIA group was evaluated by hemodynamic indexes, histopathological examination. Higher ventricular eNOS activity was induced by Tan IIA with a reduction in both ET-1 and ETA receptor expression. However, Tan IIA largely inhibited the decrease of ETB receptor expression. This study demonstrated that Tan IIA has the potential to benefit rat heart against CIH via endothelin system.

We aimed to investigate the genetic and demographic differences and interactions between areas where observed genomic variations in Mycobacterium tuberculosis (M. tb) were distributed uniformly in cold and hot spots. The cold and hot spot areas were identified using the reported incidence of TB over the previous 5 years. Whole genome sequencing was performed on 291 M. tb isolates between January and June 2018. Analysis of molecular variance and a multifactor dimensionality reduction (MDR) model was applied to test gene-gene-environment interactions. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed to test the extent to which genetic mutation affects the TB epidemic using a multivariate logistic regression model. The percentage of the Beijing family strain in hot spots was significantly higher than that in cold spots (64.63% vs 50.69%, P = .022), among the elderly, people with a low BMI, and those having a history of contact with a TB patient (all P

This study investigated whether a self-designed assistive listening device (ALD) that incorporates an adaptive dynamic range optimization (ADRO) amplification strategy can surpass a commercially available monaurally worn linear ALD, SM100. Both subjective and objective measurements were implemented. Mandarin Hearing-In-Noise Test (MHINT) scores were the objective measurement, whereas participant satisfaction was the subjective measurement. The comparison was performed in a mixed design (i.e., subjects' hearing status being mild or moderate, quiet versus noisy, and linear versus ADRO scheme). The participants were two groups of hearing-impaired subjects, nine mild and eight moderate, respectively. The results of the ADRO system revealed a significant difference in the MHINT sentence reception threshold (SRT) in noisy environments between monaurally aided and unaided conditions, whereas the linear system did not. The benchmark results showed that the ADRO scheme is effectively beneficial to people who experience mild or moderate hearing loss in noisy environments. The satisfaction rating regarding overall speech quality indicated that the participants were satisfied with the speech quality of both ADRO and linear schemes in quiet environments, and they were more satisfied with ADRO than they with the linear scheme in noisy environments.

Although it has been reported that polysaccharides found in Lycium barbarum possess neuroprotective effects, little is known of their ability to ameliorate hyperglycemia-aggravated ischemia/reperfusion brain injury. In this study, normoglycemic (NG) and hyperglycemic (HG) rats were compared after 30 minutes of middle cerebral artery occlusion (MCAO), followed by 24 or 27 hours of reperfusion, with HG rats pretreated with lyceum barbarum polysaccharides (LBP) or insulin. In each group, the neurological deficit, infarct volume, pathohistology, and expression of proteins, Opa1 and Drp1, were assessed to determine the efficacy of LBP in alleviating hyperglycemia-aggravated ischemia/reperfusion brain injury. Our results show that, compared to the NG group, the HG group had increases in neurological deficits, infarct volume, and evidence of neuronal pyknosis at 24- and/or 72-h of reperfusion (P

With more than 30,000 species, fish are the largest and most ancient vertebrate group. Despite their critical roles in many ecosystems and human society, fish genomics lags behind work on birds and mammals. This severely limits our understanding of evolution and hinders progress on the conservation and sustainable utilization of fish. Here, we announce the Fish10K project, an international collaborative project or initiative? aiming to sequence 10,000 representative fish genomes under a systematic context within ten years, and officially welcome collaborators to join this effort. As a step towards this goal, we herein describe a feasible workflow for the procurement and storage of biospecimens, and sequencing and assembly strategies. To illustrate, we present the genomes of ten fish species from a cohort of 93 species chosen for technology development.

Deep learning has a high degree of popularity in recent years. It is widely used in computer vision, artificial intelligence and other fields. Sites with high safety needs, such as gas stations, have a high demand for monitoring of dangerous behaviors such as smoking. Under normal circumstances, gas stations will employ corresponding personnel to inspect and supervise, but such labor costs are higher, and the monitoring effect is not good. This article is to use an object detection system based on deep learning technology to detect the dangerous behavior of gas stations. This article mainly solves several problems for gas stations to detect dangerous behaviors: first, what technology is used to achieve object detection; secondly, how to increase the speed of detection as much as possible; and thirdly, how to improve the accuracy of detecting dangerous behavior. To solve the above problems, this article will introduce how to implement an object detection system based on deep learning technology. First, a data set containing dangerous goods is established, then the convolutional neural network is trained, and finally the test results of the training results are checked and transplanted. The results prove that the gas station dangerous behavior detection system based on deep learning technology realized can accurately and quickly detect dangerous objects (cigarettes, etc.) in the image.

Bambara groundnut (Vigna subterranea (L) Verdc.) is an underutilized legume native to sub-Saharan Africa, where it is grown at low levels by many farmers as a component of household food and nutritional security. It is generally regarded as drought tolerant and fills the same agroecological niche as peanut (Arachis hypogaea L). Molecular research in this crop really began only in the early 2000s but has gathered pace and the recent publication of the first genome draft as part of the AOCC drive to sequence 101 African crop species marks an important milestone towards the application of genome-enabled breeding. This crop has potential to contribute to the climate-smart agriculture of the future. The current article traces the progress made in recent years and highlights the challenges that still remain.

In this study, an optically induced dielectrophoretic platform (ODEP) was used to project a radial pattern onto a photosensitive layer of a chip to perform optically induced imaging. After a non-uniform electric field was formed, an optically induced dielectrophoresis force was generated to drive the movement of polystyrene particles. First, the simulation software (COMSOL) was used to conduct electric field analysis of radial patterns and the microelectromechanical systems (MEMS) technology was used to produce a gold nanofilm on optical dielectrophoresis chips. Experiments show that the chip with no gold nanofilm (filmless) is intended to drive polystyrene particles with a diameter of $90 \mu \mathrm{m}$ to move. At $20 \mathrm{V}_{pp}$, the particle driving frequency ranges from 500 Hz to 60 kHz, and have only negative dielectrophoresis forces, with the particle moving speed of approximately $6.7 \mu \mathrm{m} /$s. In addition, the 5-nm gold film chip exhibits negative dielectrophoresis force from 600 Hz to 18 kHz, with a particle moving speed of $10 \mu \mathrm{m} /\mathrm{s}$, while the positive dielectrophoresis force is generated from 23 kHz to 70 kHz. The 50 kHz drive works is best condition, accumulating $90 \mu \mathrm{m}$ particles within a radius of 1 mm into the center of the radial pattern in 60 s, with a particle moving speed of $16.7 \mu \mathrm{m} /$s.

In this research, the impact of municipal green industry policies in 15 cities on the economic and environmental performance of local companies was evaluated, and the policy coordination mechanism was studied. As a dual-goal policy mix, the green industrial policy has been used by Chinese municipal governments to solve the dilemma between the economic growth and environmental mitigation. However, the quantitative evaluation of these green industrial policy trials remains limited. To address this issue, the policy evaluation in this research applied sewage discharge data and operation data of 22,670 Chinese textile firms from 1998 to 2013 from Chinese Environmental Statistics Database. Fixed-effect regression analysis and dynamic difference-in-differences (DID) approach were used to assess the dual-faceted impacts of green industrial policies and their subtypes, as well as the continuity of these impacts. The findings suggest that adopting a dual-objective green industrial policy is an effective approach to encourage heavy-polluting firms to develop in a more balanced and sustainable way. From dynamic DID analysis, these green industrial policies have continuity effects on both chemical oxygen demand discharge intensity and annual revenue of firms after implementation and the general impacts can last for at least 4 years. The study also reveals the heterogeneity in the impacts of three different subtypes of green industrial policy. The technology-push policy subtype can quickly reduce environmental discharge without compromising economic development, while demand-pull policy subtype has a slow effect on the improvement of environmental performance. The balanced policy subtype can promote enterprises to achieve both optimal performance of economy and environment, although the efficiency of balanced policy subtype is between two subtypes. Generally, this research provides reliable basis for the implementation of green industrial policies in developing countries and provides certain inspiration for the enriching of green industry policy theory.

Summary Introduction Advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is associated with a poor prognosis. The genetic factors contributing to fibrosis in NAFLD have been described. However, the genetic mechanism and hub genes of advanced fibrosis have not been elucidated to date. In this study, we performed a weighted gene coexpression network analysis (WGCNA) to identify the hub genes related to advanced fibrosis in NAFLD. Materials and methods The datasets GSE89632 and GSE31803 of NAFLD patients were selected from the Gene Expression Omnibus (GEO) database of NCBI and analyzed by WGCNA. The hub genes were selected in the GSE31803 dataset and verified in the GSE31803 dataset. Gene Ontology (GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of the dataset were also performed. Results The gene LUM was identified as the hub gene in the datasets GSE89632 and GSE31803 according to three different algorithms (gene significance and module membership, the pathways of the genes, and protein expressed by the genes). The functional enrichment analysis shows that the identified module is related to the extracellular matrix, regulation of cell proliferation, and the inflammatory response. The metabolic pathway analysis identified metabolic pathways and focal adhesion as the most important pathways. Conclusion By a variety of methods, LUM was identified as the hub gene of advanced fibrosis in patients with NAFLD. Therefore, further research on the LUM gene is warranted.

The aim of this study was to compare the tissue reactions to silk fibroin scaffolds in the abdominal wall, vagina, and pelvic vesico-uterine of rats. Silk fibroin scaffolds were implanted subcutaneously in the abdominal, pelvic vesico-uterine space, and under the vaginal mucosa of 16 rats. The animals were euthanized at 2, 4, 8, and 12 weeks postoperatively. Hematoxylin and eosin staining was performed to evaluate cellular infiltration, the percentage of macrophages and granulocytes inside and around the scaffolds. The amounts of M1/M2 macrophages at the interface of scaffolds and host tissue were evaluated through an immunofluorescence assay. The degree of acute inflammation was similar among the three groups, and lasted no more than 4 weeks. A faster ingrowth of fibroblasts was found in the abdominally implanted silk fibroin scaffolds, while vaginal implanted scaffolds committed a slower tissue ingrowth rate and much more macrophages infiltration than the pelvic and abdominal group. However, a significantly higher amount of M2 cells were seen in the three groups. In general, silk fibroin has nice biocompatibility in the abdominal, vagina, and pelvic tissue, eliciting healthy tissue formation, and might be a potential choice for female pelvic reconstruction. Microsc. Res. Tech. 80:291-297, 2017. © 2016 Wiley Periodicals, Inc.

Piezotronic pressure sensors have drawn a lot of attention since the piezotronic theory was established. In this work, a piezotronic pressure sensor based on ZnO/NiO core/shell nanorods array is fabricated by a simple and low-cost method. From the I – V characteristics, we can know that a reliable barrier layer is formed at the ZnO/NiO interface. When the ZnO/NiO nanorods are compressed by the pressure, the piezopotential in ZnO changes the NiO barrier height and then modulate the carrier distribution and transportation. Furthermore, the piezo-phototronic effect is a three-way coupling effect of semiconductor, piezoelectric-polarization and photon-excitation properties, which may be a feasible approach to enhance the performance of pressure sensors by tuning the generation, separation and recombination of photo-generated electron–hole pairs during optoelectronic processes in piezoelectric-semiconductor materials. Here, the performance of the pressure sensors is optimized and significantly enhanced by coupling of the piezoelectric effect and photo-excitation of ZnO nanorods. Under a UV (365 nm) illumination, the enhancement in switch ratio and sensitivity of the pressure sensor is about 353% and 445%, respectively. The enhancement is attributed to weakening the influence of bulk resistance. Thus, ZnO/NiO interface plays a crucial role in determining the electrical transport property. Particularly, the created electrons by photons moved towards and accumulated at the interface, which results that more electrons can tunnel through the barrier layer than that without UV illumination under loading. These results indicate the capability of the piezo-phototronic effect to effectively enhance/optimize the performances of pressure sensors.

In this work, a UV photodetector based on a ZnO/NiO core/shell nanorods array is fabricated by hydrothermal growth processes and thermal oxidation. Compressive strain is applied to enhance the Ilight and sensitivity of the UV photodetectors. Under a 1 N compressive strain at −3.5 V, the enhancement in Ilight and sensitivity of the UV photodetector is about 74% and 78.7%, respectively. The possible working principle is that the negative piezo-polarization at the ZnO/NiO interface shifts the depletion region to the ZnO side leading to an increase of the photon-absorption volume. This work may provide a potential approach to enhance the performance of the ZnO/NiO UV photodetector.

An ultraviolet photodetector based on p-NiO/n-ZnO heterojunction was fabricated using thermal oxidation and hydrothermal growth processes. The properties of the UV photoresponse under various strains were investigated. The results showed that the magnitude and the sign of the strain (tension/compression) have a great influence on the decay time by coupling piezoelectric and surface oxygen adsorption/desorption effects. These results demonstrate an effective approach for designing and fabricating strain modulated fast reset UV photodetectors.

In this study, we fabricate a nanogenerator device based on a composite structure formed by ZnO nanorods array/BaTiO3 coating layer for harvesting mechanical energy from environment. The whole device is composed of a Si substrate, a ZnO nanorods array, a BaTiO3 coating layer and a top Cu foil electrode. The ZnO nanorods were grown by a hydrothermal synthesis technique and the BaTiO3 thin layer was coated on the surface of the ZnO nanorods by rf magnetron sputtering process. It is a simple and low-cost growth method to make the ZnO nanorods array act as a template to increase the area of the subsequently deposited BaTiO3 layer. The device produced an enhanced average current of 105 nA, which was 7 times larger than the devices with only piezoelectric ZnO nanorods array and 3.5 times larger than the devices with only piezoelectric BaTiO3 thin film, respectively. The possible reasons contributing to the enhancement of the output current were discussed.

In this research work, a p-NiO/n-ZnO heterostructure was fabricated using thermal oxidation and hydrothermal growth processes. The p-NiO films were oxidized at different temperatures. X-ray diffraction, scanning electron microscopy, energy-dispersive X-ray spectroscopy and UV–visible spectral analysis were used to characterize the p-NiO/n-ZnO heterostructure. The results indicated that the NiO films oxidized at higher temperature have wider optical band gap and lower defect density. In particular, by comparing the photoresponse properties of the UV photodetectors oxidized at different temperatures we suggest that the oxidation temperatures have a great influence on the photoresponse time. The defect density of NiO film decreases with increasing oxidation temperature. And the defect density affects the photoresponse characteristics that the decay time decreases with the decreasing of defect density as the NiO oxidation temperature increases. This work could serve as a valuable guideline for designing and improving the p-NiO/n-ZnO UV photodetectors in a low-cost and large-scale way.

Oligosaccharide derivatives were developed to crosslink keratin materials from poultry feathers, swine bristles and ox hairs to valorize these major wastes from meat industry. Global butchery generates more than 8,600,000 tons of keratinous wastes annually. Keratin was considered a promising resource for developing bio-based products as alternatives to petroleum products. Regenerated keratin products, such as films, usually showed insufficient mechanical properties, and required external crosslinking. However, most crosslinkers for proteins are either toxic, expensive, or with low efficiencies under mild conditions. In this research, regenerated keratin films were crosslinked by oxidized sucrose, a safe and potent bio-polyaldehyde. The crosslinker with verified low toxicity improved both tensile strength and elongation of keratin films, surpassing many other safe crosslinkers. Mechanism of the crosslinking reaction was proposed as forming Schiff bases and aminals and verified via 1H NMR and 13C NMR. Relationship between tensile properties and crosslinking degree of keratin films was also quantified.

Background Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. Methods A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and

Index system is a vital tool for evaluating the ecological environment. In this study, we present a version of ecological hierarchy network (EHN) called “ecological-factor conceptual framework” for the organization of index system. This conceptual framework divides the complex ecological environment into four subsystems that all have explicit definitions or ranges, namely climate factors, soil-terrain factors, biology resource factors and human factors. Our framework makes the selection of indices more explicit and based on science, as well as more representative. Using the ecological-factor conceptual framework, we established an evaluation index system for the upper Hanjiang River in Shaanxi province, China. The index system contained fourteen indicators, such as average annual precipitation, elevation, biological abundance index, net primary productivity (NPP), highway net density and industrial wastewater emission. The ecological environment was comprehensively evaluated using spatial principal component analysis (SPCA). In addition, we used the matrix of principal components to quantitatively analyze the driving forces that affected the ecological environment. The results show that Hanzhong Downtown and Chenggu County had poor ecological environment with ecological environment index (EEI) values of −0.1459 and 0.3506, respectively. Areas that were rated as moderate, high and very high accounted for 86.07% of the study area. We found that human factors were the most important factors driving the deterioration of the ecological environment in the study area.