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Aim: To evaluate the efficacy and safety of URLi (ultra rapid lispro insulin) compared to insulin lispro as bolus insulin with basal insulin using CGM in the individuals with type 2 diabetes(T2D) in China. Methods: This was a double-blind, randomized, parallel, prospective, phase 3 study. Subjects with uncontrolled T2D were recruited and randomized 1:2 into the insulin lispro and URLi groups. Subjects received a consistent basal insulin regimen during the study and self-administered insulin lispro or URLi before each meal throughout the treatment period. Subjects underwent a 3-day continuous glucose monitoring (CGM) at the baseline and endpoint respectively, and then CGM data were analyzed. The primary endpoint was to compare the difference in postprandial glucose (PPG) control using CGM between the two groups. Results: A total of 57 subjects with T2D completed the study. Our CGM data showed that postprandial glucose excursions after breakfast (BPPGE) in the URLi group was lower than that in the insulin lispro group (1.59 ± 1.57 mmol/L vs 2.51 ± 1.73 mmol/L, p = 0.046). 1-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.37 ± 3.28 mmol/L vs 0.24 ± 2.58 mmol/L, p = 0.047). 2-hour PPG was observed to decrease more in the URLi group than that in the insulin lispro group (-1.12 ± 4.00 mmol/L vs 1.22 ± 2.90 mmol/L, p = 0.021). The mean HbA1c level decreased by 1.1% in the URLi group and 0.99% in the insulin lispro group, with no treatment difference (p = 0.642). In the CGM profile, TBR was not significantly different between the two groups (p = 0.743). The weight gain also did not differ between the two groups (p = 0.303). Conclusion: URLi can control breakfast PPG better than insulin lispro in adults with T2D in China, while it is non-inferior in improving HbA1c. The incidence of hypoglycemic and weight gain were similar between the two groups. [ABSTRACT FROM AUTHOR]

Depressive symptoms and aggression often co-occur, and previous studies have found different bidirectional links between depressive symptoms and aggression, suggesting inconsistent developmental cascades. Moreover, it is unclear whether different functions of aggression are differentially associated with depressive symptoms over time. The present study examined the longitudinal associations of reactive and proactive aggression with depressive symptoms in early adolescence. Adolescents (n = 942, 50.7% girls; mean age = 12.54 years, SD = 0.42) were surveyed annually over three years (2019–2021). Random-intercept cross-lagged panel models were used to disentangle between- and within-person effects. The results showed moderate between-person associations of depressive symptoms with the two aggressive functions. And depressive symptoms were more highly associated with reactive aggression than with proactive aggression. However, the state-level bidirectional cross-lagged associations between reactive and proactive aggression and depressive symptoms were not significant. This study highlights the stable trait-like association between depressive symptoms and reactive aggression, and the absence of state-level bidirectional cross-lagged associations challenges previous developmental cascades in adolescents. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to identify whether low lupus disease activity status (LLDAS) and clinical remission (CR) of belimumab plus standard of care (SoC) therapy are achievable goals in childhood-onset SLE (cSLE). Methods This multicentre, one arm pre-post intervention study was conducted at 15 centres in China. The primary end point was to describe the proportion of patients who achieved LLDAS and CR after 3, 6 and 12 months after treatment with belimumab plus SoC therapy. A multiple regression model was used to impute missing data. A Poisson regression model was used to calculate the effect of belimumab treatment on the reduced risk of serious diseases and the incidence of new damage. Result A total of 193 (92.2% female) with active cSLE from 15 centres were included. At 3, 6 and 12 months, the proportion of LLDAS (CR) was 12.4% (1.0%), 25.6% (4.5%) and 70.3% (29.7%), respectively. The mean SELENA-SLEDAI score decreased from 11.0 at baseline to 3.7, 2.9 and 1.7 at 3, 6 and 12 months. At baseline, all patients received steroids at a mean (s. d.) prednisone equivalent dose of 31.0 (18.2) mg/day, which decreased to 19.4 (10.8) mg/day at month 3, 12.6 (7.2) mg/day at month 6 and 6.7 (5.3) mg/day at month 12. The symptoms and immunological indicators were also significantly improved. Conclusion This is the first and largest sample size prospective clinical intervention study of cSLE patients treated with belimumab in China. LLDAS and CR were attainable treat-to-target of belimumab plus SoC therapy in cSLE. [ABSTRACT FROM AUTHOR]

Background: Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management. Methods: A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes. Results: After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up. Conclusion: Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs. Trial registration: The trial was registered on Chinese Clinical Trials Registry on 2019–04-03. (ChiCTR1900022278). [ABSTRACT FROM AUTHOR]

Background: There may be unexplored interactions between family health, personality, and smoking that could help provide new perspectives on tobacco control. Objective: To examine the relationship between the health of one's family and their smoking habits, as well as investigate the potential influence of personality on this relationship. Methods: For this cross-sectional investigation, a national survey conducted in China in 2022 recruited a total of 21,916 individuals. The Family Health Scale was utilized to assess the health of the family. The 10-item Big Five Inventory scale was utilized to assess the Big five personality traits. The relationship between big five personality, family health, and smoking were investigated using binary and linear logistic regression. The indirect effects mediated by Big five personality were analyzed using mediation analysis with Sobel tests, and the indirect effects were composited using the Karlson-Holm-Breen method. Results: The overall prevalence of smoking in the study population was 14.87%, 26.19% for males and 3.54% for females. Urban and rural smoking prevalence was 13.81% and 16.10% respectively. Binary logistic regression analysis revealed a significant negative relationship between smoking and family health (odds ratio 0.964, 95% CI 0.959, 0.970, P < 0.001) with covariates controlled. The Karlson-Holm-Breen composition facilitated the connection between extraversion (47.81%) and nervousness (52.19%). Conclusions: Preventive interventions for smoking behavior should prioritize family health and the Big five personality as significant areas to focus on. According to this study, in addition to implementing various interventions for different personalities, family health should be strengthened to reduce smoking behavior. [ABSTRACT FROM AUTHOR]

The co-allocation of photovoltaic arrays with crops presents a promising strategy to mitigate the conflict between photovoltaics and agricultural land. However, there is a notable lack of quantitative research on the impact of agrivoltaic system on land quality in fragile areas. In this study, peanuts (Arachis hypogaea) and ryegrass (Lolium perenne) were cultivated in photovoltaic array in the dry–hot valley of southwest China, with an off-site native land serving as the control. Sixteen soil physicochemical and biochemical parameters were measured in the gap and under-panel and control area. Results demonstrated that the agrivoltaic system significantly enhanced soil moisture, organic carbon, nitrogen–phosphorus–potassium nutrients, microbial biomass, and urease activity. It also led to varying degrees of increase in soil pH and electrical conductivity, along with reduced soil sucrase and phosphatase activity. In comparison to the control, the agrivoltaic system notably improved soil quality and multifunctionality. Specially, gap cultivation had a more pronounced positive impact on soil quality than under-panel cultivation, and the cultivation of peanuts had a greater effect on soil quality and multifunctionality improvement than ryegrass. This study provides fundamental data to support the improvement of land quality in photovoltaic developed regions, and to alleviate the conflict between photovoltaics and agricultural land. [ABSTRACT FROM AUTHOR]

Long-term plant residue retention can effectively replenish soil quality and fertility. In this study, we collected rhizosphere soil from the residual roots of annual Cenchrus fungigraminus in the Ulan Buh Desert over the past 10 years. The area, depth, and length of these roots decreased over time. The cellulose content of the residual roots was significantly higher in the later 5 years (2018–2022) than the former 5 years (2013–2017), reaching its highest value in 2021. The lignin content of the residual roots did not differ across samples except in 2015 and reached its highest level in 2021. The total sugar of the residual roots in 2022 was 227.88 ± 30.69 mg·g−1, which was significantly higher than that in other years. Compared to the original sandy soil, the soil organic matter and soil microbial biomass carbon (SMBC) contents were 2.17–2.41 times and 31.52–35.58% higher in the later 3 years (2020–2022) and reached the highest values in 2020. The residual roots also significantly enhanced the soil carbon stocks from 2018–2022. Soil dehydrogenase, nitrogenase, and N-acetyl-β-D-glucosidase (S-NAG) were significantly affected from 2019–2022. The rhizosphere soil community richness and diversity of the bacterial and fungal communities significantly decreased with the duration of the residual roots in the sandy soil, and there was a significant difference for 10 years. Streptomyces, Bacillus, and Sphigomonas were the representative bacteria in the residual root rhizosphere soil, while Agaricales and Panaeolus were the enriched fungal genera. The distance-based redundancy analysis and partial least square path model results showed that the duration of residual roots in the sandy soil, S-NAG, and SMBC were the primary environmental characteristics that shaped the microbial community. These insights provide new ideas on how to foster the exploration of the use of annual herbaceous plants for sandy soil improvement in the future. [ABSTRACT FROM AUTHOR]

Aims: The role of maternal genetic factors in the association between high glycated haemoglobin (HbA1c) levels and adverse birth outcomes remains unclear. Materials and Methods: In this study, the maternal HbA1c levels of 5108 normoglycemic pregnant women in China were measured, and A1298C and C677T polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene were genotyped. Results: Elevated HbA1c levels during the second trimester were associated with increased risks of macrosomia, large‐for‐gestational age (LGA), preterm birth (PTB), and reduced gestational age (p < 0.05). Pregnant women with MTHFR A1298C AA or C677T CT + TT genotypes were susceptible to adverse pregnancy outcomes related to HbA1c levels. Among pregnant women with the A1298C AA genotype, each standard deviation (SD) increase in HbA1c levels increased the risk of PTB by 1.32‐times and reduced the gestational age by 0.11 weeks (p < 0.05). For MTHFR C677T CC + TT genotype carriers, higher HbA1c levels were associated with 1.49‐, 1.24‐, and 1.23‐times increased risks of macrosomia, LGA, and PTB, respectively (p < 0.05). A U‐shaped curve for PTB risk in relation to HbA1c levels was observed among the C677T CC + TT participants, with a cut‐off value of 4.58%. Among subjects with the A1298C AA genotype combined with the C677T CT + TT genotype, each SD increase in HbA1c levels was associated with 1.40 and 1.37‐times increased risks of LGA and PTB, respectively. Conclusions: Our findings highlight the importance of glycaemic control during pregnancy and the potential impact of genetic factors on birth outcomes. However, further large‐scale studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Gleditsia sinensis, commonly known as Chinese Zaojiao, has important economic value and medicinal compounds in its fruits and thorns, making it widely cultivated artificially in China. However, the available literature on the impact of waterlogging on the growth of G. sinensis seedlings and the accumulation of metabolite compounds in its thorns is limited. To address this knowledge gap, G. sinensis seedlings were planted in soil supplemented with pindstrup substrate, which enhances the water-holding capacity of the soil. The analyses of morphological traits and nutrient elements in one-year-old G. sinensis seedlings grown naturally under ambient conditions and metabolite accumulation in its thorns were conducted. The results showed that the waterlogged soil significantly diminished the height, fresh weight, and dry weight of seedling roots and stems (P < 0:05). Furthermore, waterlogging hindered the uptake of iron (Fe) and manganese (Mn), as well as the transport of potassium (K). The identified metabolites within the thorns were categorized into 16 distinct groups. Relative to the control soil, fatty acids and derivatives were the most down-regulated metabolites in the waterlogged soil, accounting for 40.58% of the total metabolites, followed by lignans (38.71%), phenolic acids (34.48%), saccharides and alcohols (34.15%), steroids (16.67%), alkaloids (12.24%), flavonoids (9.28%), and glycerophospholipids (7.41%). Conversely, nucleotides and derivatives experienced the greatest up-regulation in the waterlogged soil, accounting for 50.00% of the total metabolites. In conclusion, waterlogging negatively impacted the growth of G. sinensis seedlings and inhibited the accumulation of metabolites. Hence, when considering the accumulation of secondary metabolites such as lignans and phenolic acids, appropriate management of soil moisture levels should be taken into account. [ABSTRACT FROM AUTHOR]

Paddy fields serve as significant reservoirs of soil organic carbon (SOC) and their potential for terrestrial carbon (C) sequestration is closely associated with changes in SOC pools. However, there has been a dearth of comprehensive studies quantifying changes in SOC pools following extended periods of rice cultivation across a broad geographical scale. Using 104 rice paddy sampling sites that have been in continuous cultivation since the 1980s across China, we studied the changes in topsoil (0–20 cm) labile organic C (LOC I), semi‐labile organic C (LOC II), recalcitrant organic C (ROC), and total SOC. We found a substantial increase in both the content (48%) and density (39%) of total SOC within China's paddy fields between the 1980s to the 2010s. Intriguingly, the rate of increase in content and density of ROC exceeded that of LOC (I and II). Using a structural equation model, we revealed that changes in the content and density of total SOC were mainly driven by corresponding shifts in ROC, which are influenced both directly and indirectly by climatic and soil physicochemical factors; in particular temperature, precipitation, phosphorous (P) and clay content. We also showed that the δ13CLOC were greater than δ13CROC, independent of the rice cropping region, and that there was a significant positive correlation between δ13CSOC and δ13Cstraw. The δ13CLOC and δ13CSOC showed significantly negative correlation with soil total Si, suggesting that soil Si plays a part in the allocation of C into different SOC pools, and its turnover or stabilization. Our study underscores that the global C sequestration of the paddy fields mainly stems from the substantial increase in ROC pool. [ABSTRACT FROM AUTHOR]

Carbonate rock chemical weathering carbon sinks reduce the rate of increase of the atmospheric CO2 concentration and global warming. However, uncertainty still exists in the estimation results of carbonate rock chemical weathering carbon sink fluxes (CCSF), and the contributions of climate change and ecological restoration to the CCSF are not clear. To this end, we compiled published site data on ion concentrations in different watersheds in China and used a classical thermodynamic dissolution model to reassess the potential and spatial and temporal patterns of the CCSF in China from 1991 to 2020. We quantified the contributions of temperature (MAT), precipitation (MAP), evapotranspiration (ET), soil water (SM), and the normalized difference vegetation index (NDVI) to the CCSF. The results revealed that (1) China's CCSF was 22.76 t CO2 km−2 yr−1, which was higher than the global average (15.771CO2 km−2 yr−1). The total carbonate rock chemical weathering carbon sink (CCS) was 4772.67×104 t CO2, contributing 14.91% of the global CCS through a carbonate rock area of 252.98×104 km−2. (2) China's CCSF decreased gradually from southeast to northwest, with values of 33.14, 12.93, and 7.27 t CO2 km−2 yr−1 in the southern karst, Qinghai-Tibetan karst, and northern karst regions, respectively. (3) The overall CCSF in China exhibited an increasing trend from 1991 to 2020, with a rate of increase of 0.16 t CO2 km−2 yr−1. (4) The contributions of the MAP, MAT, ET, SM, and NDVI to the CCSF were 63.3%, 3.02%, 27.5%, 3.1%, and 3.05%, respectively. Among them, the increase in precipitation was the main contributor to the increase in the CCSF in China over the last 30 years, while the enhancement of ET offset part of the positive contribution of the increase in precipitation to the CCSF. In conclusion, the results of this study provide a systematic quantification of the magnitude, the patterns, and the influencing factors of CCS over a long time series in China. The results are of great significance and provide a reference for the diagnosis and gap analysis of the national and global carbon neutrality capacities. [ABSTRACT FROM AUTHOR]

Purpose: To decipher the discrepancies between muscle-specific kinase antibody-positive myasthenia gravis (MuSK-MG) and double-seropositive myasthenia gravis (DSP-MG), and to determine prognostic factors for minimal manifestation status (MMS) achievement in MG patients with MuSK autoantibodies (MuSK-Ab). Patients and Methods: A total of 34 MG patients seropositive for MuSK-Ab were enrolled in this study. The demographic and clinical features were compared between MuSK-MG (n = 28) and DSP-MG (n = 6) patients, and factors affecting MMS induction in all patients with MuSK-Ab were identified using Cox regression analysis. Results: Compared to MuSK-MG patients, those with DSP-MG had similar clinical characteristics, except that they had a lower frequency of bulbar muscle involvement at nadir (50% vs 92.9%; P =  0.029) and higher proportions of comorbidities with diabetes mellitus (33.3% vs 0%; P = 0.027) and thymic abnormalities (33.3% vs 0%; P = 0.027). Higher MG Activities of Daily Living (MG-ADL) scores (HR = 0.16, 95% CI: 0.037– 0.7, P = 0.015) and axial muscle involvement at nadir (HR = 0.39, 95% CI: 0.16– 0.94, P = 0.035) were negative prognostic factors for MMS achievement in patients with MuSK-Ab regardless of acetylcholine receptor antibody (AChR-Ab) positivity. Multivariable Cox regression analysis further established higher MG-ADL scores at the nadir (HR = 0.19, 95% CI: 0.04– 0.94; P = 0.042) as an independent risk factor for MMS achievement. Conclusion: DSP-MG was comparable to MuSK-MG and could be considered a single entity in our cohort. In all MG patients with MuSK-Ab, a higher MG-ADL score at nadir may herald a lower chance of MMS achievement, with no observed potential effect of AChR-Ab presence. [ABSTRACT FROM AUTHOR]

In China, both parents and grandparents play an important role in child-rearing. However, it is unclear whether parenting behaviors reported by early adolescents, parents, and grandparents are comparable. Therefore, this study investigated (a) cross-generational validity of reporting (grand)parenting behavior based on perspectives of adolescents, parents, and grandparents; (b) mean differences in parenting across informants; and (c) how (grand)parenting is related to adolescent's problem behaviors. The sample included 1,149 early adolescents, 1,038 mothers, 926 fathers, and 248 grandparents. Confirmatory factor analyses showed scalar measurement invariance for a five-factor parenting model, including parental support, proactive control, punitive control, harsh punitive control, and psychological control, across informants. Pearson correlations indicated evidence for agreement between informant dyads. Paired samples t-tests showed the lowest scores for grandparents on all parenting variables. By comparing covariance matrices, the results suggested that interrelations of parenting dimensions and associations between parenting and problem behaviors differ for different family members.

The literature on tools of attitudes towards ASD was limited. This study is the first to examine the factor structure and psychometric properties of the multidimensional attitudes scale toward persons with disabilities (MAS) in a sample of Chinese college students (N = 1002, 32.10% males). Confirmatory factor analysis supported the G-MAS-R model's 4-factor structure: calm, negative affect, positive cognitions and behavioral avoidance. The results suggest that the Chinese version of the MAS has satisfactory internal consistency. Pearson correlation analysis showed that the MAS scores were significantly correlated with the Social Distance Scale and Autism Stigma and Knowledge Questionnaire scores. Overall, the findings indicate that the MAS is appropriate for assessing attitudes toward people with ASD in a Chinese context.

Using the Structure of Observed Learning Outcomes (SOLO) taxonomy as the analytic framework, this study examined the impact of the reasoning flow scaffold (RFS) on students' written arguments. Two classes with a total of 88 10th grade students in a school participated in this study. One class, set as the experimental group, was taught scientific argumentation with RFS whereas the control class received conventional argumentation teaching. They all experienced three argument assignments of writing scientific arguments and the measurement task before and after the teaching intervention. The results of data analysis showed that after teaching intervention, students in the experimental group performed significantly better than those in the control group on evidence and rebuttal while there were no significant differences on claim or reason between the two groups. Some implications and suggestions are provided in the last part of this paper.

Objective: The fragility index (FI), which is the minimum number of changes in status from "event" to "non-event" resulting in a loss of statistical significance, serves as a significant supplementary indicator for clinical physicians in interpreting clinical trial results and aids in understanding the outcomes of randomized controlled trials (RCTs). In this systematic literature survey, we evaluated the FI for RCTs evaluating Chinese herbal medicine (CHM) for irritable bowel syndrome (IBS), and explored potential associations between study characteristics and the robustness of RCTs. Methods: A comprehensive search was conducted in four databases in Chinese and four databases in English from their inception to January 1, 2023. RCTs encompassed 1:1 ratio into two parallel arms and reported at least one binary outcome that demonstrated statistical significance were included. FI was calculated by the iterative reduction of a target outcome event in the treatment group and concomitant subtraction of a non-target event from that group, until positive significance (defined as P < 0.05 by Fisher's exact test) is lost. The lower the FI (minimum 1) of a trial outcome, the more fragile the positive result of the outcome was. Linear regression models were adopted to explore influence factors of the value of FI. Results: A total of 30 trials from 2 4118 potentially relevant citations were finally included. The median FI of total trials included was 1.5 (interquartile range [IQR], 1–5), and half of the trials (n = 15) had a FI equal to 1. In 12 trials (40%), the total number of participants lost to follow-up surpassed the respective FI. The study also identified that increased FI was significantly associated with no TCM syndrome differentiation for inclusion criteria of the patients, larger total sample size, low risk of bias, and larger numbers of events. Conclusions: The majority of CHM IBS RCTs with positive results were found to be fragile. Ensuring adequate sample size, scientifically rigorous study design, proper control of confounding factors, and a quality control calibration for consistency of TCM diagnostic results among clinicians should be addressed to increase the robustness of the RCTs. We recommend reporting the FI as one of the components of sensitivity analysis in future RCTs to facilitate the assessment of the fragility of trials. [ABSTRACT FROM AUTHOR]

Background: Mothers play a crucial role in influencing their daughters' HPV vaccination decisions. Addressing barriers to receiving HPV vaccination among mothers of girls may achieve two goals in one strike: increasing vaccination coverage among both mothers and their daughters. This study aims to examine the HPV vaccination uptake and its determinants among mothers of girls in China at both the individual and interpersonal levels. Methods: From July to October 2023, a cross-sectional online study was conducted to investigate HPV vaccine refusal for daughters aged 9–17 years among 11,678 mothers in Shenzhen, China. A randomized selection method was employed, targeting 11 primary schools and 13 secondary schools in Shenzhen. The research team invited mothers of girls to participate in an anonymous online survey. Multilevel logistic regression models (level 1: schools; level 2: individual participants) were employed to analyze the data. Results: Among 11,678 mothers, 41.1% self-reported receiving at least one dose of HPV vaccination. Through multilevel logistic regression analysis, eight items measuring illness representations of HPV, which refers to how people think about HPV, were associated with higher HPV vaccination uptake (AOR: 1.02–1.14). These items included identity (identifying symptoms of HPV), timeline (whether HPV is acute/chronic), negative consequences, personal and treatment control (whether HPV is under volitional control), concern, negative emotions, and coherence (overall understanding of HPV). In addition, participants refusing HPV vaccines for the index daughters (AOR: 0.82, 95%CI: 0.76, 0.89) had lower vaccine uptake. Perceived more difficulties in accessing the 9-valent vaccines (AOR: 1.06, 95%CI: 1.04, 1.08) and more satisfaction with vaccine-related promotional materials (AOR: 1.50, 95%CI: 1.46, 1.54) at the individual level were associated with higher vaccine uptake. At the interpersonal factors, higher frequency of exposure to testimonials given by others about HPV vaccination on social media (AOR: 1.19, 95%CI: 1.14, 1.25) and thoughtful consideration of the veracity of the information (AOR: 1.11, 95%CI: 1.07, 1.16) were correlated with higher HPV vaccination uptake. Conclusions: These findings offer essential implications for modifying HPV disease perceptions, addressing difficulties in accessing the 9-valent HPV vaccines, and enhancing health communication needs to improve HPV vaccine uptake among mothers of girls. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to explore the influence of GPs'information, motivation and behavior skills on EM prescribing behavior in urban and suburban districts. Method: A cross-sectional study was conducted from June to November 2022 cross 3 urban districts and 4 suburban districts in Beijing. The structural equation model was used to analyze the factors influencing the essential medicine prescription behavior among general practitioners in urban and suburban districts. Results: A total of 511 valid questionnaires were collected. There was a statistically significant difference in mean scores for personal motivation and behavioral skills between urban GPs and suburban GPs. For urban GPs, the path analysis revealed that the social motivation had a direct effect on the essential medicine prescribing behavior (β = 0.225, p < 0.05). In contrast, for suburban GPs, both social motivation and personal motivation had a direct effect on the essential medicine prescribing behavior, respectively (β = 0.175, p < 0.05; β = 0.193, p < 0.01). Conclusion: Social motivation of urban GPs were positively and significantly associated with essential medicine prescribing behavior. Social motivation and personal motivation of suburban GPs were positively and significantly associated with essential medicine prescribing behavior. Therefore, various corresponding policies and measures should be developed to promote the National Essential Medicines Policy in China. [ABSTRACT FROM AUTHOR]

Background: China braces for coronavirus disease 2019 (COVID-19) surge after adjusting the "zero COVID" strategy. We aimed to evaluate and compare the prevalence of clinical symptoms of the Omicron variant infection among people living with HIV (PLWH) and HIV-free people. Methods: A cross-sectional study was conducted in Wuchang District, Wuhan, Hubei Province, in December 2022 by a self-administered online survey during the Omicron wave. Participants aged ≥ 18 years with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis were recruited. PLWH managed by the local healthcare system were recruited, while HIV-free people were recruited by sending out online surveys through WeChat. We compared the prevalence of clinical symptoms of COVID-19 between PLWH and HIV-free people, and factors associated with symptom occurrence among PLWH were accessed. Results: Total, 687 PLWH and 1222 HIV-free people were enrolled. After adjusting sex, age, body mass index, comorbidities and COVID-19 vaccination status, the prevalences of all symptoms, including higher degree and long duration of fever (aOR 0.51, 95%CI 0·42 − 0·61; aOR 0.52, 95%CI 0·43 − 0·63), were significantly lower among PLWH than among HIV-free people. Among PLWH, CD4+ T lymphocyte count (CD4 count) between 350 ~ 499 cells/µL and detectable HIV viral load (HIV-VL) were associated with significantly decreased risks of fever (aOR 0·63, 95%CI 0·40 − 0·97; aOR 0·56, 95%CI 0·33 − 0·94), headache (aOR 0·61, 95%CI 0·41 − 0·91; aOR 0·55, 95%CI 0·34 − 0·92) and muscle soreness (aOR 0·57, 95%CI 0·39 − 0·84; aOR 0·57, 95%CI 0·39 − 0·84). No apparent association between the symptoms prevalence and three/four doses of inactivated COVID-19 vaccination among PLWH was observed; both males and older age were associated with significantly decreased risks of nasal congestion/runny nose (aOR 0·52, 95%CI 0·32 − 0·82; aOR 0·97, 95%CI 0·96 − 0·99) and headache (aOR 0·58, 95%CI 0·36 − 0·92; aOR 0·96, 95%CI 0·95 − 0·98); older age was associated with significantly decreased risks of higher degree of fever (aOR 0·97, 95%CI 0·95 − 0·98). Conclusions: PLWH have significantly milder symptoms of the Omicron variant infection than HIV-free people. PLWH who are male, older, have low CD4 count, and detectable HIV-VL have reduced occurrence of COVID-19 symptoms. However, continuous monitoring should be conducted among PLWH during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: The EQ Health and Wellbeing (EQ-HWB) is a new questionnaire for measuring quality of life (QoL) from a broad perspective. The items of the EQ-HWB were derived based on a 'qualitative review' of literature, which reported primarily on Western studies. It can be argued that the QoL is a cultural-related concept and therefore people from China have a different understanding of the QoL. This study aimed to explore whether Chinese citizens could understand the EQ-HWB's candidate items and what they thought of those items. In doing so, we wanted to examine the face validity of the candidate items and explore if further cultural adaptation is necessary. Methods: This research was part of the E-QALY project, in which 36 candidate items were selected for the EQ-HWB from a 97-item pool. In China, three interviewers investigated the face validity of these EQ-HWB candidate items in semi-structured qualitative face-to-face interviews. Respondents were invited to report 'problems' with regard to the interpretation of the items and these problems were grouped into themes. We explored to what extent those themes related to specific cultural aspects in China. We also classified the rates of reported problems for each item into three groups: 1) less than 20%, 2) from 20–50%, and 3) over 50%. Results: For 17 items the rate of reported problems was less than 20%, 15 items fell into the second group (with 20 − 50%) and for 4 items the rate of problems reported was more than 50%. The thematic analysis revealed eight themes: ambiguous problems in the interpretation of 16 items; difficult to understand (11); contained a complex negative expression (10); examples used seemed inappropriate (7); misleading connotation in Chinese (2); long and complex (2); complex response options (1); and use of non-colloquial language (1). Discussion: Our research shows that EQ-HWB candidate items require careful examination to make them more comprehensible. Most of the reported problem themes were generic problems related to the items, and only a few face validity issues appeared to relate to specific cultural aspects in China, even though most of the items were based on Western studies. Our findings are reassuring for the instrument's international application, especially in China. [ABSTRACT FROM AUTHOR]

Background: Higher vocational education is an essential part of the higher education system that complements conventional education. In the context of information and communication technology (ICT) development and academic competition, more and more literature has proved the importance of ICT use in educational development (academic achievement and mental health) and the relationship between information literacy and the educational development of higher vocational students. Objectives: Based on one of the most extensive surveys of higher vocational students, the study combined the Opportunity‐Propensity (O‐P) framework and ecological model to explore the direct effects of different types of ICT use on educational development and the indirect effects from psychological and social factors. Methods: The data involved 28,956 students from seven higher vocational colleges. The class fixed effect and causal mediation analysis models verified the results. Results and Conclusion: The results found differential effects of different types of ICT use on academic achievement and mental health. Information literacy ability can improve the academic achievement of higher vocational students, but at the cost of mental health. ICT use not only directly impacts the academic achievement and mental health, but also has an indirect impact through psychological factors represented by self‐efficacy and technostress and social factors represented by social support. Implications: This study promotes integrating and expanding the O‐P framework and ecological model, enriching the relevant research in ICT use and educational development. Meanwhile, it also provides practical suggestions for realizing rational interventions in ICT use and improving the educational development level of higher vocational students. Lay Description: What is already known about this topic: Information and communication technology (ICT) use is closely related to the educational development of higher vocational students.The trend of ICT use in higher vocational education has become increasingly apparent.The effects of ICT use are heterogeneous among groups with different information literacy. What this paper adds: O‐P framework and ecological model provide the perspective of theoretical integration.The impact of different types of ICT use on educational development varies.Information literacy can improve academic achievement at the cost of mental health.Psychological and social factors play a mediating role in educational development. Implications for practice and/or policy: The research is helpful to guide students to allocate their time reasonably for different ICT uses.Mental health counselling should be strengthened while cultivating information literacy ability.Develop appropriate ICT usage strategies for students with different information literacy.It is helpful to develop appropriate interventions from a psychological and social perspective. [ABSTRACT FROM AUTHOR]

Although metacognition plays a pivotal role in theoretical accounts of mind wandering, their longitudinal relationships have not yet been investigated during the important developmental period of early adolescence. This study aimed to examine the developmental trajectories of spontaneous and deliberate mind wandering and the dynamic associations between metacognition and two types of mind wandering in early adolescence. A sample of 4302 Chinese students beginning in Grade 4 (47.4% female; initial Mage = 9.84, SDage = 0.47) completed questionnaires on five occasions over 2.5 years. The results showed that deliberate mind wandering, but not spontaneous mind wandering, gradually increased from Grade 4 to Grade 6. Metacognition was negatively related to spontaneous mind wandering but positively related to deliberate mind wandering. These findings provide empirical evidence for theoretical viewpoints from both individual differences and developmental perspectives. [ABSTRACT FROM AUTHOR]

Structured marine clay is commonly encountered in offshore engineering projects and engineers are concerned about its impact on the engineering properties of marine clay as well as its correlation with index properties. Current research has emphasized the role of soil structure in these aspects of marine clay. In this study, we investigated the influence of depositional environment and oxidation-induced evolution of clay microstructure on the formation of clay structure in structured clay from Zhanjiang area, a coastal city located in South China. The distinct soil structure observed in marine-terrigenous clay deposited under different environments exhibited sensitivity ranging from 1.6 to 8.9 at varying moisture content levels. The wide range of sensitivity observed in structured marine-terrigenous clay was attributed to free iron oxide derived from siderite present in an acidic environment. Compared to other regions, Zhanjiang marine clay demonstrated favorable mechanical properties but poor physical properties due to its unique clay structure characteristics. Based on these findings, we proposed a modified approach for correlating index properties with engineering properties that yielded good predictions. [ABSTRACT FROM AUTHOR]

Background: A new chemiluminescence assay, the Anti-TP-Ⅱ assay, is going to be commercially available in clinical laboratories in China and other countries. This study examined the performance of the new assay for the detection of TP infection and compared it with that of the Anti-TP assay by using large amounts of clinical samples. Methods: The precision, accuracy, anti-interference ability, and the clinical sensitivity and specificity of the Anti-TP-Ⅱ assay were evaluated. In addition, compared with those of the Anti-TP assay, the false positive and false negative rates of the Anti-TP-Ⅱ assay were evaluated for 2,436 clinical routine samples and 711 preselected Anti-TP assay reactive samples. Discrepancy of the samples was investigated with the recomLinec Treponema IgM/IgG kit or the Elecsys syphilis assay. Results: The precision, accuracy, and anti-interference ability of the Anti-TP-Ⅱ assay met the national standard of China, and there was an overall agreement of 96.75% (Kappa = 0.91) between the two assays. The sensitivity and specificity of the Anti-TP-Ⅱ assay were 100% (95% CI: 94.13% to 100%) and 99.92% (95% CI: 99.70% to 99.99%), respectively. Compared with the Anti-TP assay, the Anti-TP-Ⅱ assay significantly reduced the number of borderline samples and the false positive rate. Conclusions: Considering its excellent performance, the Anti-TP-Ⅱ assay is a good screening test for highthroughput laboratories and can replace the previous generation of reagents, the Anti-TP assay, with a superior specificity. [ABSTRACT FROM AUTHOR]

Wetland ecosystem service function provides and maintains the Earth's life system, which supports human and social development. However, in recent years, with the intensification of human social activities, the wetland area in northeast China has been reduced, and wetland ecosystem service function has been damaged. This paper evaluates the ecosystem service function of wetlands in northeast China based on the InVEST model, taking 40 prefecture-level cities as the evaluation unit, calculating the carbon stock, soil retention, and habitat quality of the wetlands in the study area and analyzing the drivers of changes in ecosystem service function using the PLUS model. The following results were obtained: temporally, the wetland carbon stock decreased from 754 Tg in 2000 to 688 Tg in 2020; the wetland soil retention increased from 24,424 Tg in 2000 to 33,160 Tg in 2010, and then decreased to 28,765 Tg in 2020; and the quality of wetland habitats was roughly unchanged. The wetland habitats in the study area were categorized into 5 types, classified as I, II, III, IV, or V, and the spatial changes in the 40 prefecture-level cities in northeast China were analyzed. The driving factors affecting the change in the wetland ecosystem service function were further analyzed, mainly focusing on changes in the wetland area itself. The influence of other land-use types and the influence of related policies were analyzed in three aspects, among which the GDP and spatial density of the population are social factors, and the elevation and slope are natural factors that provide larger contributions to the change in wetland area. The reduction in forest and grassland areas and the increase in cultivated land and construction land areas have a negative effect on the ecosystem service function of wetlands, and the implementation of relevant wetland protection policies promotes the ecosystem service function of wetlands. According to the problems faced by wetlands in different regions, the government formulates strategies that are in line with local development, with a view to implementing wetland ecological development in the northeast region in the new context, which will help to realize intensive land use and stimulate the vitality of the region. [ABSTRACT FROM AUTHOR]

BACKGROUND: In a previous study, more attention has been given to the psychological state of doctors than to that of nurses although the workload, working hours, and patient contact time are generally higher for nurses than doctors. The current status of nurses' perceived stress, work engagement, and perceived professional benefit during the routine management of the Coronavirus disease 2019 (COVID-19) pandemic and how their perceived stress affects the other two variables are topics that merit research attention. OBJECTIVE: In this study, the status of nurses' perceived stress, work engagement, and perceived professional benefit during the routine management of the COVID-19 pandemic was investigated to explore whether their perceived stress level has any effect on the other two variables. METHODS: The convenience sampling method was adopted, and 669 nurses from the First People's Hospital of Jingzhou were selected to participate in this study. Questionnaires on perceived stress, work engagement, and perceived professional benefit were used in the survey, and the data were processed using the SPSS 20.0 program for the descriptive statistics, independent sample t-test, analysis of variance. RESULTS: The total score of the nurses' perceived stress was 18.58±4.37 points. The total scores of their work engagement (43.32±14.01) and perceived professional benefit (140.23±17.75). CONCLUSION: The nurses' total perceived stress score was at an upper-middle level, and their total work engagement and perceived professional benefit scores were relatively high. Overall, perceived stress has a negative effect on nurses' work engagement and perceived professional benefit. That is, the higher the pressure perception of nurses, the lower the degree of work engagement and perceived professional benefit. [ABSTRACT FROM AUTHOR]

Background Understanding the burden of cervical cancer (CC) in young women aged 15–44 years old are essential for formulating effective preventive strategies. Methods Utilizing the Global Burden of Disease 2019 Study, we estimated incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) due to CC among young women from 1990 to 2019. Additionally, we evaluated the temporal trends using estimated annual percentage changes (EAPCs) during this period. We conducted a decomposition analysis to assess the absolute contributions of three components: population growth, population age structure and epidemiologic changes. Results Globally, there were 187 609.22 incident cases of CC worldwide, resulting in 2621 917.39 DALYs in 2019. From1990 to 2019, the age-standardized rates were decline, only the age-standardized YLDs rate (EAPC = 0.02; 95% CI: −0.02 to 0.05) showed a stable trend. The largest increase in age-standardized incidence rate (ASIR) and age-standardized YLDs rate observed in the high-middle social demographic index (SDI) quintiles. Population growth and age structure changes were associated with substantial changes in cases of CC, especially in South Asia and East Asia. Conclusions Globally, the burden of CC in young women continues to increase, as measured by the absolute number. As populations are growing and age structure changes were associated with substantial changes in cases of CC, governments will face increasing demand for treatment, and support services for CC, especially in South Asia and East Asia. [ABSTRACT FROM AUTHOR]

Background: Many studies have investigated the transfer of skills between laparoscopic and robot-assisted surgery (RAS). These studies have considered time, error, and clinical outcomes in the assessment of skill transfer. However, little is known about the specific operations of the surgeon. Clutch control use is an important skill in RAS. Therefore, the present study aimed to propose a novel objective algorithm based on computer vision that can automatically evaluate a surgeon's clutch use. Additionally, the study aimed to evaluate the correlation between clutch metrics and surgical skill on different surgical robot platforms. Methods: The robotic surgery training center of Wuhan University trained 30 laparoscopic surgeons as the study group between 2023 and 2024. Laparoscopic surgeons were trained by combining robotic simulator exercises and RAS animal experiments. During the training, video and hand movement data were collected. Hand movements identified by a skin-color model were combined with labeling information to classify clutch use. The metrics were validated on different robotic platforms (dv-Trainer, EDGE MP1000, Toumai™ MT1000, and DaVinci Xi system) and among surgeons with different surgical skill levels. Results: On the robotic simulator, clutch accuracy in the expert group was significantly higher than in the study group for all tasks. No significant differences were observed in the number of clutches between the expert and study groups. In the RAS experiment, the number of clutches decreased significantly for both study and expert groups. The accuracy was maintained at a high level in the expert group but decreased rapidly in the study group. Conclusions: We proposed a new objective assessment of surgical skills, clutch use metrics, in cross-platform RAS. Additionally, we verified that the metrics significantly correlated with the surgical skill levels of the surgeons. [ABSTRACT FROM AUTHOR]

In this prospective, multicenter, Phase 2 clinical trial (NCT02987244), patients with peripheral T-cell lymphomas (PTCLs) who had responded to first-line chemotherapy with cyclophosphamide, doxorubicin or epirubicin, vincristine or vindesine, etoposide, and prednisone (Chi-CHOEP) were treated by autologous stem cell transplantation (ASCT) or with chidamide maintenance or observation. A total of 85 patients received one of the following interventions: ASCT (n = 15), chidamide maintenance (n = 44), and observation (n = 26). estimated 3 PFS and OS rates were 85.6%, 80.8%, and 49.4% (P = 0.001). The two-year OS rates were 85.6%, 80.8%, and 69.0% (P = 0.075).The ASCT and chidamide maintenance groups had significantly better progression-free survival (PFS) than the observation group (P = 0.001, and P = 0.01, respectively). The overall survival (OS) differed significantly between the chidamide maintenance group and the observation group (P = 0.041). The multivariate and propensity score matching analyses for PFS revealed better outcomes in the subjects in the chidamide maintenance than observation groups (P = 0.02). The ASCT and chidamide maintenance groups had significant survival advantages over the observation group. In the post-remission stage of the untreated PTCL patients, single-agent chidamide maintenance demonstrated superior PFS and better OS than observation. Our findings highlight the potential benefit of chidamide in this patient subset, warranting further investigation through larger prospective trials. Clinical trial registration: clinicaltrial.gov, NCT02987244. Registered 8 December 2016, http://www.clinicaltrials.gov/ct2/show/NCT02987244. [ABSTRACT FROM AUTHOR]

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We examine the impact on bond credit ratings of reduced information processing costs from two investor interactive platforms in China, i.e. 'Easy Interaction' and 'e-Interaction'. These online platforms provide investors with a channel to directly communicate with listed companies and learn much of corporate operations. Replies and explanations from management assist investors in integrating disclosed information and reducing information processing costs. The reduced costs likely impose reputational concerns on credit rating agencies (CRAs), leading to more stringent rating standards and less rating inflation. We find that more interactions result in lower credit ratings of corporate bonds. This effect is more pronounced for bonds rated by global-partnered CRAs and bonds whose issuers have higher information complexity, and less pronounced for bonds whose issuers have official consultation websites. Further analyses show that reduced information processing costs are associated with more information contents in rating downgrades and timelier ratings. Our findings provide evidence for the disciplinary effect of reduced processing costs on CRA behavior. [ABSTRACT FROM AUTHOR]

Purpose: Based on the perspectives of social capital, image motivation and motivation affordances, this paper explores the direct and moderation effects of different kinds of motivations (i.e. relationship-based motivation, community-based motivation and individual-based motivation) on users' continuous knowledge contributions in social question and answer (Q&A) communities. Design/methodology/approach: The authors collect the panel data of 10,193 users from a popular social Q&A community in China. Then, a negative binomial regression model is adopted to analyze the collected data. Findings: The paper demonstrates that social learning, peer recognition and knowledge seeking positively affect users' continuous contribution behaviors. However, the results also show that social exposure has the opposite effect. In addition, self-presentation is found to moderate the influence of social factors on users' continuous use behaviors, while the moderation effect of motivation affordances has no significance. Originality/value: First, this study develops a comprehensive motivation framework that helps gain deeper insights into the underlying mechanism of knowledge contribution in social Q&A communities. Second, this study conducts panel data analysis to capture the impacts of motivations over time, rather than intentions at a fixed time point. Third, the findings can help operators of social Q&A communities to optimize community norms and incentive mechanisms. [ABSTRACT FROM AUTHOR]

The positive effects of rural tourism are widely recognized, yet its influence on local household consumption has been insufficiently explored. Our study fills this gap by investigating the relationship between rural tourism development and household consumption, using the Leisure Agriculture and Rural Tourism Demonstration County (LARTDC) policy as a quasi‐natural experiment framework. Employing a staggered difference‐in‐differences (DID) method, we found that rural tourism development contributes to a 4.91% increase in per capita household consumption. The robustness of our main results is confirmed using advanced techniques such as Bacon decomposition and DIDM estimations. We attributed this positive impact to the rise in nonfarm employment and infrastructure development. Our heterogeneity analysis further reveals the inclusive nature of rural tourism, showing its significant role in improving household consumption patterns, diminishing consumption inequality, and enhancing welfare, especially in disadvantaged rural households. Further analysis confirms that greater LARTDC policy exposure may lead to higher levels of household consumption. Moreover, we revealed that rural tourism increased the freedom of employment, especially for the elderly and women; however, it did not squeeze out leisure time or hurt the quality of life and welfare. Theoretically, this study contributes to the discourse on tourism's role in fostering economic growth and social equity, addressing the patterns of high savings and low consumption in rural China. Practically, our findings suggest that post‐COVID‐19 recovery strategies in developing countries may emphasize rural tourism development, aiming to stimulate household spending and achieve balanced growth. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to propose a method that can calculate the transportation infrastructure network service capacity enhancement given by planned transportation infrastructure projects construction. Managers can sequence projects more rationally to maximize the construction effectiveness of infrastructure investments. Design/methodology/approach: This paper designed a computational network simulation software to generate topological networks based on established rules. Based on the topological networks, the software simulated the movement path of users and calculated the average travel time. This software allows the adjustment of parameters to suit different research objectives. The average travel time is used as an evaluation index to determine the most appropriate construction sequence. Findings: In this paper, the transportation infrastructure network of Sichuan Province in China was used to demonstrate this software. The average travel time of the existing transportation network in Sichuan Province was calculated as 211 min using this software. The high-speed railways from Leshan to Xichang and from Xichang to Yibin had the greatest influence on shortening the average travel time. This paper also measured the changes in the average travel time under two strategies: shortening the maximum and minimum priorities. All the transportation network optimisation plans for Sichuan Province will be somewhere between these two strategies. Originality/value: The contribution of this research are three aspects: First, a complex network analysis method that can take into account the differences of node elements is proposed. Second, it provides an effective tool for decision makers to plan transportation infrastructure construction. Third, the construction sequence of transportation infrastructure development plan can effect the infrastructure investment effectiveness. [ABSTRACT FROM AUTHOR]

Background: Identifying rheumatoid arthritis patients at higher risk of complications after total hip arthroplasty could make perioperative management more effective. Here we examined whether disease activity is associated with risk of such complications. Methods: We retrospectively analyzed data for 337 rheumatoid arthritis patients at our medical center who underwent primary total hip arthroplasty. Rheumatoid arthritis patients were categorized according to the simplified disease activity index (SDAI), the values of which at admission and follow-up were averaged together. Logistic regression was used to examine associations of mean SDAI with rates of dislocation, infection, periprosthetic fracture and aseptic loosening. As controls, 337 osteoarthritis patients who did not have systemic inflammation and who underwent the same procedure were matched across numerous clinicodemographic variables. Results: Among the 337 rheumatoid arthritis patients, 38 (11.3%) had postoperative complications, the rates of which varied significantly from 0 to 17.5% (p = 0.003) among the four subgroups whose disease activity based on mean SDAI was categorized as high, moderate, low or in remission. Each 1-unit increase in mean SDAI was associated with a significant increase in risk of postoperative complications (OR 1.015, 95% CI 1.001–1.029, p = 0.035). Across all rheumatoid arthritis patients, rate of complications did not differ significantly between patients who received disease-modifying anti-rheumatic drugs or other treatments. Rates of dislocation, of infection or of all postoperative complications combined were significantly lower among osteoarthritis controls than among rheumatoid arthritis patients. Conclusion: Greater mean SDAI is associated with higher risk of dislocation, infection and composite postoperative complications after total hip arthroplasty in rheumatoid arthritis patients. These patients show a significantly higher rate of postoperative complications than osteoarthritis patients, likely reflecting the influence of systemic inflammation. Disease activity should be reduced as much as possible in rheumatoid arthritis patients before they undergo total hip arthroplasty. [ABSTRACT FROM AUTHOR]

International student mobility (ISM) to China is an underexplored topic, especially as it relates to mobility emanating from the Global North. Between 2019 and 2020, we interviewed 25 international students originally from Europe, North and South America, and Oceania and, using thematic analysis, analysed their decisions to study in China. The results show that these young people’s international migration patterns were motivated by a strong desire to search for a sense of home, cultural adventure, personal growth, authenticity, and abundant opportunities in China. In this light, we argue that international students’ migration decision‐making is intertwined with their imaginaries of and imaginative frames for China, which various agents formulate at the intersection of global, national, and local contexts. In the process, we reveal a geographical imaginary of ISM that has been overlooked in the existing literature. [ABSTRACT FROM AUTHOR]

Background: The association of BCAAs (isoleucine, leucine, and valine) with cardiovascular and cerebrovascular diseases has been widely recognized by researchers, but there is limited evidence to support the relationship between BCAAs and multiple chronic conditions (MCCs) in older adults. This study aimed to explore the correlation between BCAA levels in the diets of older adults and MCCs. Methods: Based on a health management cohort project in Nanshan District of Shenzhen, 4278 individuals over 65 years old were selected as participants via multi-stage stratified sampling from May 2018 to December 2019. Data were collected using a validated semi-quantitative food frequency questionnaire, as well as anthropometric and chronic disease reports. MCC was defined as the coexistence of two or more chronic diseases, namely, hypertension, dyslipidemia, diabetes, CAD, stroke, CKD, and CLD. Multivariate unconditional logistic regression analysis was used to analyze the relationship between dietary BCAAs and MCCs in older adults, and then, gender stratification analysis was performed. A restricted cubic spline model (a fitted smooth curve) was used to determine the dose–response relationship of isoleucine with MCCs. Results: A total of 4278 older adults aged 65 and above were included in this study, with an average age of 72.73 ± 5.49 years. The cohort included 1861 males (43.50%). Regardless of whether confounding factors were corrected, isoleucine was a risk factor for MCCs (OR = 3.388, 95%CI:1.415,8.109). After gender stratification, the relationships between dietary isoleucine and MCCs (OR = 6.902, 95%CI:1.875,25.402) and between leucine (OR = 0.506,95%CI:0.309,0.830) and MCCs were significant in women, but not in men. No significant association between valine and MCCs was observed. In addition, isoleucine was a risk factor for MCCs when its intake was greater than 4.297 g/d. Conclusion: Isoleucine may play an important role in regulating age-related diseases. BCAAs such as isoleucine can be used as risk markers for MCCs in older adults. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a serious global public health issue. However, there are few reports on trends in antimicrobial susceptibility in Chinese neonates, and most of the existing evidence has been derived from adult studies. We aimed to assess the trends in antimicrobial susceptibility of common pathogens in full-term neonates with invasive bacterial infections (IBIs) in China. Methods: This cross-sectional survey study analyzed the antimicrobial susceptibility in Chinese neonates with IBIs from 17 hospitals, spanning from January 2012 to December 2021. Joinpoint regression model was applied to illustrate the trends and calculate the average annual percentage change (AAPC). Using Mantel-Haenszel linear-by-linear association chi-square test, we further compared the antibiotic minimum inhibitory concentrations (MICs) by pathogens between 2019 and 2021 to provide precise estimates of changes. Results: The proportion of Escherichia coli with extended-spectrum-beta-lactamase-negative strains increased from 0.0 to 88.5% (AAPC = 62.4%, 95% confidence interval (CI): 44.3%, 82.9%), with two breakpoints in 2014 and 2018 (p-trend < 0.001). The susceptibility of group B Streptococcus (GBS) to erythromycin and clindamycin increased by 66.7% and 42.8%, respectively (AAPC = 55.2%, 95% CI: 23.2%, 95.5%, p-trend = 0.002; AAPC = 54.8%, 95% CI: 9.6%, 118.6%, p-trend < 0.001), as did Staphylococcus aureus to penicillin (AAPC = 56.2%; 95% CI: 34.8%, 81.0%, p-trend < 0.001). However, the susceptibility of Enterococcus spp. to ampicillin declined from 100.0 to 25.0% (AAPC = − 11.7%, 95% CI: − 15.2%, − 8.1%, p-trend < 0.001), and no significant improvement was observed in the antibiotic susceptibility of Escherichia coli to ampicillin, gentamicin, and cephalosporin. Additionally, the proportion of GBS/Staphylococcus aureus with relatively low MIC values for relevant antibiotics also increased in 2021 compared to 2019. Conclusions: Antimicrobial susceptibility of the most prevalent pathogens in full-term neonates seemed to have improved or remained stable over the last decade in China, implying the effectiveness of policies and practice of antibiotic stewardship had gradually emerged. [ABSTRACT FROM AUTHOR]

Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked hereditary disorder in southern China. However, the incidence rate of G6PD deficiency and the frequency of the most common G6PD gene variants vary widely. The purpose of this study was to investigate the prevalence, genotype, and phenotypic features of G6PD deficiency in neonates in Fujian province, southeastern China. Methods: This retrospective cohort study enrolled 2,789,002 newborns (1,521,431 males and 1,267,571 females) based on the newborn screening program for G6PD deficiency in Fujian Province between January 2010 and December 2021. Results: Of the 2,789,002 newborns enrolled, 26,437 cases were diagnosed (22,939 males and 3,498 females), and the estimated prevalence of G6PD deficiency in Fujian province was 0.95%. The prevalence was significantly higher among males (1.51%) than in females (0.28%) (p < 0.00001). Among the 3,198 patients with G6PD deficiency, 3,092 cases (2,145 males and 947 females) were detected to have G6PD gene variants. The top six prevalent genotypes identified represented 90.84% (2095/3,198) of the total and included c.1376G > T (44.93%), c.1388G > A (18.42%), c.1024C > T (9.32%), c.95A > G(8.69%), c.392G > T (5.25%), and c.871G > A (4.22%). The frequency of genotypes with c.1388G > A, c.1024C > T, and c.871G > A was higher in males in the Fujian province than in females, while the frequency of genotypes with c.1376G > T was lower. Furthermore, when comparing the enzyme activities of the top six prevalent genotypes, there were significant differences in the enzyme activities among the genotypes of male hemizygotes and female heterozygotes. According to the new classification of G6PD variants proposed by the World Health Organization (WHO), the variants with c.1376G > T, c.95A > G, and c.871G > A were recognized as Class A, while the c.392G > T, c.1388G > A, and c.1024C > T were recognized as Class B. Discussion: To the best of our knowledge, this study is the first to systematically describe the overview of epidemiological characteristics of newborn G6PD deficiency in Fujian province, China, including the screening rate, incidence rate, and variant spectrum. Additionally, we elucidated the relationship between the distribution of enzyme activity with specific mutations and their WHO classification patterns. Our results could provide strategies for screening, diagnosis, and genetic counseling of G6PD deficiency in this area. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the measurement properties and consistency between the Chinese versions of EQ-5D-3L and EQ-5D-Y-3L among Chinese adolescent populations aged 15–17 years. Methods: Chinese adolescents aged 15–17 studying in high school were recruited through online survey. Social-demographic characteristics and self-reported EQ-5D-3L and EQ-5D-Y-3L responses were collected in the survey. The consistency of responses between the two measures was assessed using redistribution property, and the consistency of utility values was assessed by intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation, F-test and effect sizes, respectively. Sensitivity was compared using relative efficiency (RE). Results: 762 respondents (48.8% male; age 15–17 years;) were recruited. The EQ-5D-3L showed a more severe ceiling effect than EQ-5D-Y-3L (78.2% vs. 66.0%). Respondents reported higher proportions of having problems in four dimensions using the EQ-5D-Y-3L than using the EQ-5D-3L. The consistency of corresponding dimensions between the two measures was relatively good, while non-negligible proportions of inconsistency were observed in "pain/discomfort" (11.4%) and "anxiety/depression" (15.7%) dimensions. The ICC of the utility values between the EQ-5D-3L and EQ-5D-Y-3L was 0.852 (p < 0.001). The Spearman's rank correlation (range: 0.385–0.620) indicated an acceptable convergent validity between the correlative dimensions of the EQ-5D-3L and EQ-5D-Y-3L. The EQ-5D-Y-3L had a higher efficiency than the EQ-5D-3L at detecting differences across EQ VAS subgroups (ES = 1.793 for EQ-5D-3L, ES = 1.920 for EQ-5D-Y-3L). Mixed results were observed in sensitivity. Conclusions: Both the EQ-5D-3L and EQ-5D-Y-3L are demonstrated to be valid and generally consistent for measuring HRQoL among adolescents aged 15–17 years in China. Respondents reported higher proportions of having problems using the EQ-5D-Y-3L than using the EQ-5D-3L. More research is warranted to compare the discriminant validity and test-retest reliability between the two measures. [ABSTRACT FROM AUTHOR]

Object: To analyze the trend of the coupling and coordination of the supply and demand of healthcare resources between the elderly population and healthcare resources in China during the period of 2012–2022, to reveal the impact of the growth of the elderly population on the relationship between the supply and demand of healthcare resources, and to put forward suggestions to improve the coupling and coordination between the supply and demand of healthcare resources and the elderly population, in order to cope with the challenges of an aging society. Methods: By obtaining relevant data from authoritative data sources such as China Statistical Yearbook, Health and Health Statistics Yearbook, and the Chinese government website from 2012 to 2022, we constructed a comprehensive measurement index for the three systems of elderly population, healthcare resource supply, and healthcare resource demand; Using the entropy value method to assign weights to the indicators, combined with the coupling coordination degree model, to reveal the changes of the elderly population change and the supply and demand of medical and health resources; using ArcGIS technology, to study the spatial characteristics of the elderly population change and the supply and demand of medical and health resources. Results: From 2012 to 2022, the supply and demand of healthcare resources and the variation of the elderly population in China show a continuous growth trend, and the comprehensive development level of the system gradually climbs from a low level to a high level. The fluctuation of coupling degree and coordination degree rises, although the coordination degree has always been lower than the coupling degree, but the distance between the coordination degree and the coupling degree gradually narrows with the passage of time. The coordination degree between population aging and medical and health resources development shows spatial heterogeneity in China, with the eastern region significantly higher than the western region/. Conclusions: The coupling degree between population aging and healthcare resource supply and demand in China from 2012 to 2022 shows a general upward trend from low coupling to medium-high coupling, but it is worth noting that even though the degree of coupling increases, the degree of coordination is still relatively lagging behind, suggesting that the government and relevant departments need to pay more attention to coordinated allocation and management of healthcare resources. At the same time, the spatial differences in the degree of coordination among provinces suggest that future policymakers should take regional differences into full consideration in policymaking and sustainable development. [ABSTRACT FROM AUTHOR]

Background: Studies has suggested that receiving social support improves the professional identity of health professional students. According to the two-way social support theory, social support includes receiving social support and giving social support. However, the effect of the two-way social support on health professional students' professional identity has not been clarified yet. Methods: To explore the mechanism of how two-way social support affects health professional students' professional identity, an observational, cross-sectional study was conducted among a convenience and cluster sample of 1449 health professional students from two medical schools in western China. Measures included a short version of the two-way social support scale, a health professional students' professional identity questionnaire, an achievement motivation scale, and a meaning in life scale. (Data were analyzed by use of SPSS26.0 software, Amos 28.0 software, and PROCESSv4.0 plug-in.). Results: Receiving social support, giving social support, achievement motivation, meaning in life, and professional identity were positively correlated with each other. Receiving and giving social support not only directly predicted health professional students' professional identity, but also indirectly predicted health professional students' professional identity through the mediating roles of achievement motivation and meaning in life, and the chain mediating roles of achievement motivation and meaning in life, respectively. The effectiveness of predicting health professional students' professional identity varied among different types of two-way social support, which could be depicted as two-way social support > mainly giving social support > mainly receiving social support > low two-way social support. Conclusion: In the medical education, the awareness and ability of health professional students to receive and give social support should be strengthened. More attention should be drawn on the chain mediating effect of achievement motivation and meaning in life between two-way social support and professional identity. The current results shed new light on exploring effective ways of improving health professional students' professional identity, which suggested that more attention should be paid to the positive effects of mainly giving social support and two-way social support rather than only on the effects of receiving social support. [ABSTRACT FROM AUTHOR]

Investigate the effect of long-term COVID-19 on maternal and fetal complications. A retrospective cohort study was conducted. A total of 623 pregnant women who delivered in Kunming First People's Hospital from November 1, 2022 to July 31, 2023 were selected. By employing statistical methods, we compared the associations between maternal and fetal complications in pregnant women with acute COVID-19 during pregnancy, long-term COVID-19, and non-COVID-19 pregnant women. In the final 623 samples, there were 209 pregnant women with acute COVID-19, 72 pregnant women with long-term COVID-19, and 342 pregnant women without COVID-19. The epidemiological and clinical characteristics of all subjects were similar. Pregnant individuals who developed long-term COVID-19 during their pregnancy had an increased risk of experiencing gestational hypertension (OR 3.344, 95% CI 1.544–7.243), gestational diabetes mellitus (OR 2.301, 95% CI 1.290–4.102), and fetal intrauterine growth restriction (OR 2.817, 95% CI 1.385–5.952). Multivariate binary logistic regression analysis showed that this association remained consistent even after adjusting for confounders and performing subgroup analyses. Other maternal and fetal complications, such as premature rupture of membranes, preterm delivery, neonatal asphyxia, and transfer of neonates to NICU, did not exhibit statistically significant associations. After linear regression analysis, the platelet count (β: − 0.127, 95% CI − 0.001–0.000) of pregnant women with long-term COVID-19 was slightly lower than that of non-COVID-19 pregnant women, and the other coagulation parameters were not statistically significant. The incidence of gestational hypertension, gestational diabetes mellitus and fetal intrauterine growth restriction in pregnant women with long-term COVID-19 is significantly increased, but it does not further increase the coagulation status. [ABSTRACT FROM AUTHOR]

In northeast China, the invasive woodwasp., Sirex noctilio, attacks Pinus sylvestris var. mongolica Litv and often shares habitat with native Sirex nitobei. Previous research showed that S. noctilio can utilize the volatiles from its symbiotic fungus (A. areolatum IGS-BD) to locate host trees. Consequently, symbiotic fungi (A. areolatum IGS-D and A. chailletii) carried by S. nitobei may influence the behavioral selection of S. noctilio. This study aimed to investigate the impact of fungal odor sources on S. noctilio’s behavior in laboratory and field experiments. Our observations revealed that female woodwasps exhibited greater attraction toward the fungal volatiles of 14-day-old Amylostereum IGS-D in a “Y”-tube olfactometer and wind tunnel. When woodwasps were released into bolts inoculated separately with three strains in the field, females of S. noctilio exhibited a preference for those bolts pre-inoculated with A. areolatum IGS-BD. Gas chromatography–mass spectrometry (GC–MS) analysis revealed that the volatiles emitted by the two genotypes of A. areolatum were similar yet significantly distinct from those of Ampelopsis chailletii. Hence, we postulate that the existence of native A. areolatum IGS-D could potentially facilitate the colonization of S. noctilio in scenarios with minimal or no A. areolatum IGS-BD present in the host. [ABSTRACT FROM AUTHOR]

Globally, anthropogenic disturbance and climate change caused a rapid decline of submerged macrophytes in lake ecosystems. Potamogeton crispus (P. crispus), a species that germinates in winter, explosively expanded throughout many Chinese lakes, yet the underlying mechanism remained unclear. Here, this study examined the long-term changes in the distribution patterns of P. crispus in Lake Gaoyou by combining remote sensing images and hydrometeorological data from 1984 to 2022 and water quality data from 2009 to 2022. It aims to unravel the relationships between the distribution patterns of P. crispus and hydrometeorological and water quality factors. The results showed that the area of P. crispus in Lake Gaoyou showed a slight increase from 1984 to 2009, a marked increase from 2010 to 2019, followed by a decline after 2020. Spatially, P. crispus was primarily distributed in the western and northern parts of Lake Gaoyou, with less distribution in the central and southeastern parts of the lake. Wind speed (WS), temperature (Temp), water level (WL), ammonia nitrogen (NH3-N), and Secchi depth (SD) were identified as the key factors regulating the variation in the P. crispus area in Lake Gaoyou. We found that the P. crispus area showed an increasing trend with increasing Temp, WL, and SD and decreasing WS and NH3-N. The influence of environmental factors on the area of P. crispus in Lake Gaoyou varied among seasons. The results indicated that hydrometeorology (WS, Temp, and WL) may override water quality (NH3-N and SD) in driving the succession of P. crispus distribution. The findings of this study offer valuable insights into the recent widespread expansion of P. crispus in shallow lakes across Eastern China. [ABSTRACT FROM AUTHOR]

Introduction: Lucerne (Medicago sativa), is a cornerstone of China's livestock industry, however, due to the backward agronomic strategies and technology, lucerne in China faces cultivation challenges that result in lower productivity and quality than global standards. Therefore, we undertook a meta-analysis to evaluate the impact of five distinct fertilization types on lucerne yield and nutritional quality in various locations in China. The fertilizer practices included manure application, combined mineral fertilizer and manure application (FM), biological fertilizer application, unbalanced application of two or more mineral fertilizer types, and balanced mineral fertilizer application. Furthermore, we investigate influential factors of yield and quality of lucerne under fertilization, including climatic variables (mean annual precipitation, mean annual temperature), initial soil properties (soil organic carbon; total nitrogen, pH), and agronomic factors (seeding rate, harvest frequency, and lucerne stand age). Methods: Our study analyzed 53 published papers to discern the most beneficial fertilizer for enhancing lucerne yield and nutritional quality. Results and discussion: The results showed that the fertilizer practices, on average, significantly improved yield by 31.72% and crude protein content by 11.29%, with FM emerging as the most effective, this is because mineral fertilizers provide available nutrients for lucerne, manure provides essential organic matter for microorganisms and improve soil properties. In addition, the fertilizer practices significantly reduced neutral and acid detergent fiber contents by 6.28% and 8.50%, respectively, while increasing ash content and relative feeding value. Furthermore, climatic variables, soil properties, and planting system factors such as sowing date and harvest frequency significantly affected yield and nutritional quality. The practical implications of our results emphasize the need for balanced and strategic fertilizer application to optimize lucerne production and highlight the potential to adjust cultivation practices according to environmental conditions. Balanced and strategic fertilizer application can simultaneously improve soil properties, enhance soil carbon sequestration, and reduce the emission of greenhouse gases from the soil, which is a vital measure for realizing sustainable agricultural development. [ABSTRACT FROM AUTHOR]

Background: Stickler syndrome type I (STL1) is an autosomal dominant disorder characterized by ocular, auditory, orofacial, and skeletal anomalies. The main causes of STL1 are variants in the COL2A1 gene, which encodes a type II collagen precursor protein. The specific focus of this study was on a newborn from China diagnosed with STL1, with the aim of providing novel insights into the effects of a newly identified intronic variant in the COL2A1 gene on pre-mRNA splicing. Methods: Trio whole exome sequencing was used to identify the causative variant in the family. The identified variant was validated using Sanger sequencing. Bioinformatics programs were used to predict the pathogenicity of the candidate variant. Additionally, an in vitro minigene assay was used to investigate the effects of the identified variant on RNA splicing. Results: The proband with STL1 had a novel heterozygous splicing variant in the intron nine acceptor donor site of COL2A1 (c.655-2A>G). This splice junction variant resulted in aberrant COL2A1 mRNA splicing, leading to the skipping of exon 10 and the production of a shorter protein that may lack the last 18 native amino acids. Conclusion: The c.655-2A>G variant in the COL2A1 gene leads to STL1 through abnormal splicing. By expanding the spectrum of variants in the COL2A1 gene, this finding improves the clinical understanding of STL1 and provides guidance for early diagnosis and disease counseling. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that the inflammatory potential of the diet is associated with a variety of chronic noncommunicable diseases characterized by a chronic low-grade inflammatory response. However, the relationships between dietary inflammatory potential and organismal inflammatory status and osteoporosis have been less studied. This study aimed to investigate the relationships among inflammatory diet, inflammatory state and osteoporosis in the Xinjiang multiethnic population. Methods: The participants consisted of 4452 adults aged 35 to 74 years from Xinjiang, China. The dietary inflammatory index (DII) was calculated using dietary data collected with a semiquantitative food frequency questionnaire, and information about osteoporosis was derived from quantitative ultrasound measurements. The relationships of the DII score and inflammatory factors with the risk of osteoporosis were analysed using multivariate logistic regression, and the nonlinear associations between DII and osteoporosis were further analysed using restricted cubic splines. Results: The results showed that proinflammatory diets were associated with a greater risk of osteoporosis (T3 vs. T1: OR = 1.87; 95% CI = 1.44, 2.45) and that there was no nonlinear relationship between the DII and the risk of osteoporosis. Increased concentrations of the inflammatory factors IL-6, IL-10, IL-12p70, IL-17, and IL-23 were associated with a greater risk of osteoporosis. Conclusions: The risk of osteoporosis can be reduced by increasing the consumption of an appropriate anti-inflammatory diet. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version. Methods: A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test–retest reliability were based on structural consistency across three time points. Results: The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4. Conclusions: This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome(MetS) and depression are independently associated with type 2 diabetes (T2DM) risk. However, little is known about the combined effect of MetS and depression on the risk of T2DM. The present study aims to prospectively explore the impact of MetS and depression on T2DM susceptibility among the Chinese general population. Methods: 6489 general population without T2DM adults in Southwest China were recruited from 2010 to 2012. Depression and MetS were prospectively assessed using a 9-item Patient Health Questionnaire(PHQ-9) and Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (CDS2020) during 2016-2020, respectively. Modified Poisson regression models were conducted to estimate relative risk(RR) and 95% confidence intervals (95% CI) for independent and combined associations of MetS and depression with an incidence of T2DM. Results: During a median follow-up of 6.6 years, 678 cases of T2DM were documented. Individuals with MetS were 1.33 times more likely to develop T2DM than those without MetS. The corresponding RR(95%CI) for depression with no depression was 1.45(1.22-1.72). Notably, compared with no MetS or depression, the multivariate-adjusted RR for a combined effect of MetS and depression on the risk of T2DM was 2.11(1.39-3.22). Moreover, an increased risk of T2DM was more apparent in those ≤ 60 years, males, and overweight. Conclusions: Individuals with multimorbidity of MetS and depression are at a higher risk of T2DM compared with those with no MetS or depression. [ABSTRACT FROM AUTHOR]