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The total content of cadmium and its distribution between leaves and roots were investigated for pak choi (Brassica chinensis L.), which was grown in a contaminated area of Hangzhou city, China. Results showed that cadmium concentrations in 90% of samples exceeded the Chinese tolerance limit for food. Although roots of pak choi had a higher concentration of cadmium than leaves, leaf tissue (the edible part) accumulated over 80% (on average) of the whole plant cadmium burden due to the greater biomass in leaf tissue. Since pak choi is the staple vegetable in the study area and of great relevance to human health, the dietary intake of cadmium and calculated risk indexes to local residents through the food chain were determined. [ABSTRACT FROM AUTHOR]

Many coastal countries are concerned with sustainable energy generation to meet their current and future energy needs. Tidal energy is an attractive resource as in-stream turbines can generate electricity even at moderate flow velocities. However, not all coastal areas are equally well-suited for tidal energy development. The survey of potential locations and their power densities is a crucial step in evaluating the potential cost-benefit of tidal energy. This research surveys the intensity and distribution of offshore tidal energy along whole coastline of China based on a high-resolution numerical simulation with a minimum mesh spacing of 80 m. The Finite Volume Community Ocean Model (FVCOM) has been used to carry out the numerical simulation work. Since FVCOM uses an unstructured mesh, it can accurately identify complex coastlines, such as those along islands, waterways, and estuaries. The simulation period for this numerical survey is 30 days. The accuracy of the simulation results is validated using 8-days in-situ measurements obtained at 17 coastal stations in the region of study. Research results indicate that the total mean tidal energy is 1.19 × 1014 J along the coastline of China. The tidal energy is mainly distributed in the south and southeast of the coastline of China. This study also identifies 45, 23 and 9 top sites, where the averaged tidal energy density is greater than 500, 1000, and 1500 W/m2, respectively, suitable for tidal energy extraction and utilization. Considering the long development cycle of tidal energy and global climate change, this study also investigates the impact of sea-level rise (SLR) on tidal energy distribution in the region of study using a 50-year (0.5 m) and 100-year (1.0 m) SLR scenarios. It is found that the total mean tidal energy increases by 3.0% and 6.5% for 50-year and 100-year SLR scenarios, respectively. It is believed that the findings drawn from this study could be instructive for future utilization of tidal energy along the coastline of China. • A high-resolution numerical survey of suitable sites for tidal energy extraction has been performed along the whole coastline of China. • Effects of sea-level rise on the tidal power distribution along China coast have been well analyzed. • This study identifies 45, 23 and 9 top sites of the tidal power density greater than 500, 1000, and 1500 W/m2, respectively. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the prevalence of hospital-acquired infections (HAIs) and their main influencing factors in a specialized infectious disease hospital in Chongqing from 2017 to 2023, providing reference for the formulation of precise infection control measures., Methods: A retrospective cross-sectional survey method was employed, combining bedside investigations with medical record reviews. Surveys were conducted on all hospitalized patients on a certain day of the last week of October each year from 2017 to 2023. Data collected included patients' basic information, diagnosis, and hospital infection status. Statistical analysis, including retrospective case-control and multivariable logistic regression analysis, was performed to identify the risk factors for hospital infections., Results: The investigation compliance rate for the prevalence of HAIs in the specialized infectious disease hospital in Chongqing from 2017 to 2023 was greater than 96% each year. The prevalence rate of HAIs ranged from 0.89 to 2.52%. Hospital infection departments were mainly concentrated in general internal medicine, tuberculosis, and HIV/AIDS departments, accounting for 31.25, 26.25, and 23.75%, respectively. The most common infection site was the lower respiratory tract (54.22%), followed by bloodstream and urinary tract infections, each accounting for 9.64%. The predominant pathogens of hospital infections were Klebsiella pneumoniae and fungi. The utilization rate of antimicrobial drugs ranged from 20.75 to 33.25%, primarily for monotherapy. The rate of pathogen testing for therapeutic antimicrobial drug use was 82.84%, meeting national requirements. Multivariable logistic regression analysis revealed that the use of antibiotic (OR = 7.46, 95%CI 2.54-21.89, p  < 0.001) and the presence of cardiovascular diseases (OR = 26.69, 95%CI 6.69-106.54, p  < 0.001) increased the risk of HAIs., Conclusion: The prevalence of HAIs in specialized infectious disease hospitals remains stable, primarily concentrated in departments such as general internal medicine, tuberculosis, and HIV/AIDS. The lower respiratory tract is the main infection site, and comorbid cardiovascular diseases and antibiotic use are risk factors for HAIs. Therefore, to reduce the risk of hospital infections, it is necessary to strengthen the daily monitoring of key departments and the care of key patients. Further implementation of precise and effective infection control measures, including rational antibiotic use, regular infection monitoring and pathogen culture is warranted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Deng, Li, Liu, Xie, Huang, Sun, Su and Deng.)

The sustainability of water industry management model is one of the essential means to achieve sustainable utilization of water resources. Based on existing research on the sustainability of water industry, this study explores the factors affecting the sustainable competitiveness of water industry management model. It constructs a more complete sustainable competitiveness evaluation indicator system. Evidences taken from France and China were selected as the references for the study, and the principal component analysis was used to evaluate the overall sustainable competitiveness and main component dimensions. It is found through this study that the overall competitiveness indicator in the sustainable water industry management model and the sub-dimensional competitiveness indicators in resource support, development base, and environmental impact of water industry of France are better than those of China. China is more competitive in social inclusion, technological innovation, and sustainability of water industry. Based on the research results, this study provides insights into solving the existing issues in the sustainable development of China's water industry to support how China can adjust its water industry management model to improve its sustainable competitiveness., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: HIV/AIDS has emerged as a nationwide epidemic and has taken the forefront position as the primary infectious killer of adults in China. The control and prevention of the disease have been hampered by a weak link in the form of heterosexual transmission. However, conventional intervention measures have demonstrated suboptimal efficacy in reducing the incidence of new HIV infections. In light of the current epidemiological characteristics, we have developed and executed an innovative intervention model known as the Joint Prevention and Control Mechanism of the 'CDC-Public Security Bureau-NGO'. The purpose of this research is to assess the impact of this model on the AIDS awareness, HIV infection rates, sexual behavior, and associated factors among female sex workers and elderly clients. Through the provision of robust evidence of the efficacy of this innovative model, we seek to advocate for its implementation in future interventions., Methods: The research design of this study incorporates both a serial cross-sectional study and time-series analysis from 2014 to 2021, including a 4-year traditional intervention (2014-2017) and the 4-year 'CDC-Public Security Bureau-NGO' innovative intervention (2018-2021), was conducted to evaluate the effects of the new intervention. The GM(1, 1) model was performed to predict the proportion of HIV infection without implementing the innovative intervention in 2018-2021; P and C values were used to evaluate the performance of the model. Mann-Kendall test and descriptive methods were used to analyzed the trend of traditional and innovative interventions models on HIV positive detection rate in FSWs and elderly clients., Results: The condom usage rates during the last commercial sexual encounter for FSWs and elderly clients improved from 74.9% and 9.1%, respectively, to 96.9% and 28.1%. (P < 0.05), newly reported cases of HIV have decreased by 15.56% yearly and the HIV positive detection rate among middle-aged and elderly people has dropped by 14.47%. The innovative intervention model has significantly reduced the HIV infection rates., Conclusions: The 'CDC-Public Security Bureau-NGO' innovative intervention has achieved beneficial effects on HIV/AIDS prevention and control and provides a good reference for Guangxi, China., (© 2024. The Author(s).)

Background: Fine particulate matter (PM 2.5 ) pollution and extreme temperature events (ETEs) are main environmental threats to human health. Elevated stroke mortality has been growingly linked to PM 2.5 mass exposure, while its relationship with PM 2.5 constituents was extensively unstudied across the globe. Additionally, no prior assessments have investigated the interactive effects of PM 2.5 constituents and ETEs on stroke mortality., Methods: Province-wide records of 320,372 stroke deaths collected in eastern China during 2016-2019 were analyzed using an individual-level time-stratified case-crossover design. Daily gridded estimates of PM 2.5 mass and its major constituents (i.e., black carbon [BC], organic matter [OM], ammonium [NH 4 + ], sulfate [SO 4 2- ], and nitrate [NO 3 - ]) were assigned to stroke cases on case days and control days at the residential address. We assessed 12 ETEs defined by multiple combinations of air temperature thresholds (2.5-10th percentiles for cold spell, 90-97.5th percentiles for heat wave) and durations (2-4 days). Conditional logistic regression model was applied to investigate associations of short-term exposure to PM 2.5 constituents and ETEs with stroke mortality. Odds ratio and its 95% confidence interval (CI) were assessed for an interquartile range (IQR) increase in each PM 2.5 constituent and on ETEs days compared with non-ETEs days. Additive interactive effects were quantitatively evaluated via relative excess odds due to interaction (REOI), attributable proportion due to interaction (AP), and synergy index (SI)., Results: Elevated overall stroke mortality was significantly related to PM 2.5 constituents, with the largest odds observed for NO 3 - (1.04, 95% CI: 1.03-1.04, IQR = 11.25 μg/m 3 ), followed by OM (1.03, 1.03-1.04, IQR = 7.97 μg/m 3 ), NH 4 + (1.03, 1.02-1.04, IQR = 6.66 μg/m 3 ), BC (1.03, 1.02-1.03, IQR = 1.41 μg/m 3 ), and SO 4 2- (1.03, 1.02-1.03, IQR = 6.67 μg/m 3 ). Overall, higher risks of stroke mortality were identified in analyses using more rigorous thresholds and lengthened durations of ETEs definitions, ranging from 1.19 (1.17-1.21) to 1.55 (1.51-1.60) for heat wave, and 1.03 (1.02-1.05) to 1.11 (1.08-1.15) for cold spell, respectively. We observed consistent evidence for the synergistic effects of heat wave and PM 2.5 constituents on both ischemic and hemorrhagic stroke mortality, where compound exposures to heat wave and secondary inorganic aerosols (i.e., NO 3 - , SO 4 2- , and NH 4 + ) posed greater increases in risk (0.23< REOI <0.81, 0.16< AP <0.39, and 2.63< SI <8.19)., Conclusions: Short-term exposure to both PM 2.5 constituents and ETEs were associated with heightened stroke mortality, and heat wave may interact synergistically with PM 2.5 constituents to trigger stroke deaths., Competing Interests: Declaration of competing interest All authors affirm that they possess no conflicting financial concerns or personal affiliations that might have affected the investigation presented in this manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: This study aims to evaluate the qualifications and identify skill enhancement areas for epidemiological investigators in Centers for Disease Control and Prevention (CDCs) in Guizhou's, informing future training and policy initiatives to strengthen public health responses., Methods: A cross-sectional survey was conducted in August 2022, and an online, self-designed questionnaire on the Epidemiological Dynamic Data Collection platform was administered to evaluate the professional staff in CDCs. The responses were scored and presented using descriptive statistical methods, and the factors influencing the total score were analyzed by one-way ANOVA and linear regression., Results and Discussion: A total of 1321 questionnaires were collected, yielding an average score of 14.86±3.49 and a qualification rate of 29.9%. The scoring rate of ability of individual protection and coordination in epidemic control was high (87.25%). Meanwhile, improvements in further training were needed in areas such as data analysis ability (23.67%), knowledge of site disinfection (40.40%), and epidemiological investigation skills (42.50%). No significant difference was observed between the scores of city and county CDCs, ( t = 1.071, p =0.284). The effects of gender and age could be disregarded, and the experience in epidemiological work and training (including investigation on COVID-19 cases and contacts), educational background, and professional title partially explained the survey outcome (R Square of the linear regression model was 0.351). The survey indicated the need for additional well-trained epidemiologic investigators in Guizhou. Specified training was effective in improving epidemiologic investigation, and enhancement in data analysis ability and knowledge of field disinfection are recommended in professional staff cultivation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Huang, Yao, Huang, Deng, Wu and Yu.)

Background: Tegoprazan is a potassium-competitive acid blocker that inhibits gastric acid and which may be used for eradicating Helicobacter pylori. This study focuses on the pharmacokinetic interaction and safety between tegoprazan and the combination of clarithromycin, amoxicillin and bismuth in healthy Chinese subjects., Methods: An open-label, three-period, single-center, multiple-dosage, single-sequence, phase I trial was conducted in 22 healthy subjects. In period 1, the subjects took tegoprazan 50 mg twice daily for 7 days, and in period 2 they were administered clarithromycin 500 mg, amoxicillin 1000 mg and bismuth potassium citrate 600 mg twice daily for 7 days (days 14-20). Tegoprazan, clarithromycin, amoxicillin and bismuth potassium citrate were then administered in combination for 7 days (days 21-27) in period 3. Blood samples were collected up to 12 h after the last dose of each period. Safety assessments were performed in each period., Results: The geometric mean ratios (GMRs) [90% confidence interval (CI)] of maximum plasma concentration at steady state (C max,ss ) and area under the plasma concentration-time curve over the dosing interval (AUC τ ) at steady state were 195.93% (175.52-218.71%) and 287.54% (263.28-314.04%) for tegoprazan and 423.23% (382.57-468.22%) and 385.61% (354.62-419.30%) for tegoprazan metabolite M1, respectively. The GMRs (90% CI) of C max,ss and AUC τ were 83.69% (77.44-90.45%) and 110.30% (102.74-118.41%) for clarithromycin, 126.25% (114.73-138.93%) and 146.94% (135.33-159.55%) for 14-hydroxyclarithromycin, 75.89% (69.73-82.60%) and 94.34% (87.94-101.20%) for amoxicillin, and 158.43% (125.43-200.11%) and 183.63% (156.42-215.58%) for bismuth, respectively. All reported adverse events were mild. The frequency of adverse events during the coadministration stage was not higher than that during the single- or triple-drug administration stages., Conclusion: The plasma exposure of tegoprazan, M1, 14-hydroxyclarithromycin and bismuth was increased after the coadministration of tegoprazan, clarithromycin, amoxicillin and bismuth. The coadministration exhibited favorable safety and tolerability., Clinical Trials Registration: CTR20230643., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0-4 years old, 5-9 years old, 10-14 years old) and different periods (2013-2017 and 2018-2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035-2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442-11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401-38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355-0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Poststroke depression (PSD) is common but insufficiently addressed by health professionals, and management is not always evidence-based., Objectives: This evidence implementation project aimed to improve adherence to evidence-based practice for screening, prevention, and management of patients with PSD in the neurology ward of the Fifth Affiliated Hospital of Zunyi Medical University, China., Methods: This project was based on the JBI methodological approach and was conducted in three phases, from January to June 2021: a baseline audit, implementation of strategies, and a follow-up audit. We utilized the JBI Practical Application of Clinical Evidence System software and the Getting Research into Practice tools. Fourteen nurses, 162 stroke patients, and their caregivers participated in this study., Results: The results of the baseline audit showed that compliance with evidence-based practice was poor, with 3/6 criteria showing 0% adherence and the other three audit criteria showing 5.7, 10.3, and 49.4% adherence, respectively. Through feedback to nurses regarding the baseline audit results, the project team identified five barriers and adopted a battery of strategies to overcome these barriers. The follow-up audit revealed significantly enhanced outcomes across all the best practice criteria, and the compliance of each criterion reached at least 80%., Conclusion: The implementation program designed to screen, prevent, and manage PSD in a tertiary hospital in China improved nurses' knowledge and compliance with evidence-based management of PSD. Further testing of this program in more hospitals is needed., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the University of Adelaide, JBI.)

An in-house designed transmission X-ray microscopy (TXM) instrument has been developed and commissioned at beamline BL18B of the Shanghai Synchrotron Radiation Facility (SSRF). BL18B is a hard (5-14 keV) X-ray bending-magnet beamline recently built with sub-20 nm spatial resolution in TXM. There are two kinds of resolution mode: one based on using a high-resolution-based scintillator-lens-coupled camera, and the other on using a medium-resolution-based X-ray sCMOS camera. Here, a demonstration of full-field hard X-ray nano-tomography for high-Z material samples (e.g. Au particles, battery particles) and low-Z material samples (e.g. SiO 2 powders) is presented for both resolution modes. Sub-50 nm to 100 nm resolution in three dimensions (3D) has been achieved. These results represent the ability of 3D non-destructive characterization with nano-scale spatial resolution for scientific applications in many research fields., (open access.)

Aggressive behaviors in early childhood may indicate future violence, so effective intervention measures should be taken on time to promote children's physical and psychological health. Based on sampling survey data from Jintang County in Sichuan Province of China, this paper analyzes the mechanism of rural children's aggressive behaviors from the perspective of peer influences and examines the role of parent involvement in it. The results show that the deeper the degree of deviant peer affiliation, the poorer the psychosocial adaptation of rural children, which is more likely to lead to aggressive behaviors. Parent involvement can effectively inhibit the aggressive behaviors of rural children arising from deviant peer affiliation., (© 2022 Society for Research on Adolescence.)

Background: Oesophageal squamous cell carcinoma and adenocarcinoma of the oesophagogastric junction have a dismal prognosis, and early detection is key to reduce mortality. However, early detection depends on upper gastrointestinal endoscopy, which is not feasible to implement at a population level. We aimed to develop and validate a fully automated machine learning-based prediction tool integrating a minimally invasive sponge cytology test and epidemiological risk factors for screening of oesophageal squamous cell carcinoma and adenocarcinoma of the oesophagogastric junction before endoscopy., Methods: For this multicohort prospective study, we enrolled participants aged 40-75 years undergoing upper gastrointestinal endoscopy screening at 39 tertiary or secondary hospitals in China for model training and testing, and included community-based screening participants for further validation. All participants underwent questionnaire surveys, sponge cytology testing, and endoscopy in a sequential manner. We trained machine learning models to predict a composite outcome of high-grade lesions, defined as histology-confirmed high-grade intraepithelial neoplasia and carcinoma of the oesophagus and oesophagogastric junction. The predictive features included 105 cytological and 15 epidemiological features. Model performance was primarily measured with the area under the receiver operating characteristic curve (AUROC) and average precision. The performance measures for cytologists with AI assistance was also assessed., Findings: Between Jan 1, 2021, and June 30, 2022, 17 498 eligible participants were involved in model training and validation. In the testing set, the AUROC of the final model was 0·960 (95% CI 0·937 to 0·977) and the average precision was 0·482 (0·470 to 0·494). The model achieved similar performance to consensus of cytologists with AI assistance (AUROC 0·955 [95% CI 0·933 to 0·975]; p=0·749; difference 0·005, 95% CI, -0·011 to 0·020). If the model-defined moderate-risk and high-risk groups were referred for endoscopy, the sensitivity was 94·5% (95% CI 88·8 to 97·5), specificity was 91·9% (91·2 to 92·5), and the predictive positive value was 18·4% (15·6 to 21·6), and 90·3% of endoscopies could be avoided. Further validation in community-based screening showed that the AUROC of the model was 0·964 (95% CI 0·920 to 0·990), and 92·8% of endoscopies could be avoided after risk stratification., Interpretation: We developed a prediction tool with favourable performance for screening of oesophageal squamous cell carcinoma and adenocarcinoma of the oesophagogastric junction. This approach could prevent the need for endoscopy screening in many low-risk individuals and ensure resource optimisation by prioritising high-risk individuals., Funding: Science and Technology Commission of Shanghai Municipality., Competing Interests: Declaration of interests L-WW has received research support from the Science and Technology Commission of Shanghai Municipality (grant number 21Y31900100). J-CZ and S-YL are employees of the Harbor Scientific Instrument and received salary support. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In this study, rectal samples collected from 60 stray dogs in dog shelters were screened for canine kobuvirus and other enteroviruses by quantitative real-time reverse transcription polymerase chain reaction. Canine kobuvirus was detected in 25% (15/60) of the samples. In the 15 positive samples, the coinfection rates of canine distemper virus, canine coronavirus, canine astrovirus, canine norovirus, and canine rotavirus were 26.67%, 20.00%, 73.33%, 0%, and 20.00%, respectively. Phylogenetic analysis based on partial VP1 sequences identified a novel canine kobuvirus that was a recombinant of canine and feline kobuvirus. Bayesian evolutionary analysis revealed that the rate of evolution of the VP1 gene of canine kobuvirus was 1.36 × 10 -4 substitutions per site per year (95% highest posterior density interval, 6.28 × 10 -7  - 4.30 × 10 -4 substitutions per site per year). Finally, the divergence time of VP1 was around 19.44 years ago (95% highest posterior density interval, 12.96-27.57 years)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

As a new mode of mining development, green mine optimizes the development and utilization of mineral resources with a minimum of the environmental impact, and how to objectively evaluate the construction level of the green mine has become the key to promote green mine construction and it has also been an important path to achieve sustainable development of mineral resources. The evaluation system and methods of green mine construction, however, are not perfect at present as the existing green mine evaluation mostly adopts the index scoring accumulation method, with which the internal relations between the indicators are ignored, and the subjective influence it causes is too large. Based on the framework model of driving forces, pressure, state, impact and response, an indicator system is constructed in this paper to express the internal relationship between indicators more intuitively. Combined with subjective and objective combination weighting method to determine the index weight, TOPSIS and coupling coordination degree models are introduced to quantitatively evaluate the spatio-temporal evolution process of green mine construction and the coupling coordination between subsystems, analyze and obtain the main obstacle factors affecting the green mine construction of enterprises, and provide suggestions and countermeasures for the improvement of green mine construction of enterprises. The applicability of the model is verified by an actual case study of a mine in China. The model enriches the connotation of green mines, making the evaluation process and results fairer and more reliable, thus providing an effective way to promote the sustainable development of mines.

Background: Quantitative assessment of the risk of local transmission from imported dengue cases makes a great challenge to the development of public health in China. The purpose of this study is to observe the risk of mosquito-borne transmission in Xiamen City through ecological and insecticide resistance monitoring. Quantitative evaluation of mosquito insecticide resistance, community population and the number of imported cases affecting the transmission of dengue fever (DF) in Xiamen was carried out based on transmission dynamics model, so as to reveal the correlation between key risk factors and DF transmission., Methods: Based on the dynamics model and combined with the epidemiological characteristics of DF in Xiamen City, a transmission dynamics model was built to simulate the secondary cases caused by imported cases to evaluate the transmission risk of DF, and to explore the influence of mosquito insecticide resistance, community population and imported cases on the epidemic situation of DF in Xiamen City., Results: For the transmission model of DF, when the community population is between 10,000 and 25,000, changing the number of imported DF cases and the mortality rate of mosquitoes will have an impact on the spread of indigenous DF cases, however, changing the birth rate of mosquitoes did not gain more effect on the spread of local DF transmission., Conclusions: Through the quantitative evaluation of the model, this study determined that the mosquito resistance index has an important influence on the local transmission of dengue fever caused by imported cases in Xiamen, and the Brayton index can also affect the local transmission of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Guo, Liu, Liu, Abudunaibi, Luo, Wu, Deng, Yang, Huang, Wu, Lei, Zhao, Li, Li, Liu, Zhan and Chen.)

Based on the evaluation model of the gray correlation-TOPSIS method, this paper examines the index system of grass-roots water conservancy services in Hunan Province, China. This paper aims at the present situation of grassroots water conservancy in Hunan province, which assisted it in developing grassroots water conservancy services. The evaluation indicators include five criteria levels (institutional staffing, personnel quality, management level, public policy and service capacity) and twenty-four indicator levels. In this paper, the weight calculation method combined with an analytic hierarchy process and an entropy weight method, as well as quantitative and qualitative methods, was used to conduct an empirical study on the basic water conservancy service level of Hunan Province in 2020. The results classify grassroots water services in Hunan Province into three levels. By fitting the GDP of cities and prefectures with the comprehensive closeness, we conclude that there is considerable convergence between the grassroots water conservancy service level of Hunan Province and its local economic level. The more developed the economy, the higher the grassroots water conservancy service level. In addition, through obstacle factor analysis, the main constraints of grassroots water conservancy in various cities and prefectures are obtained. Therefore, the grassroots water conservancy service's ability can be comprehensively improved from three aspects: serviceability, capital investment, and talent construction. This indicator system can promote the overall governance capacity of grassroots water conservancy in the future development of cities and prefectures, and it can also provide Hunan with experience and case examples for the implementation of rural revitalization., Competing Interests: The authors declare no conflict of interest.

Objectives: Despite the adoption of a new childhood immunization program in China, the incidence of mumps remains high. This study aimed to describe the epidemiological characteristics of mumps in Jilin Province from 2005 to 2019 and to assess the transmissibility of mumps virus among the whole population and different subgroups by regions and age groups., Methods: The Non-age-specific and age-specific Susceptible-Exposed-Pre-symptomatic-Infectious-Asymptomatic-Recovered (SEPIAR) models were fitted to actual mumps incidence data. The time-varying reproduction number ( R t ) was used to evaluate and compare the transmissibility., Results: From 2005 to 2019, a total of 57,424 cases of mumps were reported in Jilin Province. The incidence of mumps was the highest in people aged 5 to 9 years (77.37 per 100,000). The two SEPIAR models fitted the reported data well ( P < 0.01). The median transmissibility ( R t ) calculated by the two SEPIAR models were 1.096 (range: 1.911 × 10 -5 -2.192) and 1.074 (range: 0.033-2.114) respectively. The age-specific SEPIAR model was more representative of the actual epidemic of mumps in Jilin Province from 2005-2019., Conclusions: For mumps control, it is recommended that mumps-containing vaccines (MuCV) coverage be increased nationwide in the 5-9 years age group, either by a mumps vaccine alone or by a combination of vaccines such as measles-mumps-rubella (MMR) vaccine. The coverage of vaccines in Jilin Province should be continuously expanded to establish solid immunity in the population. China needs to redefine the optimal time interval for MuCV immunization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Wang, Zhao, Guo, Yu, Zhao, Deng, Huang, Liu, Su and Chen.)

Background: The optimum systolic blood pressure after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to compare the safety and efficacy of blood pressure lowering treatment according to more intensive versus less intensive treatment targets in patients with elevated blood pressure after reperfusion with endovascular treatment., Methods: We conducted an open-label, blinded-endpoint, randomised controlled trial at 44 tertiary-level hospitals in China. Eligible patients (aged ≥18 years) had persistently elevated systolic blood pressure (≥140 mm Hg for &gt;10 min) following successful reperfusion with endovascular thrombectomy for acute ischaemic stroke from any intracranial large-vessel occlusion. Patients were randomly assigned (1:1, by a central, web-based program with a minimisation algorithm) to more intensive treatment (systolic blood pressure target &lt;120 mm Hg) or less intensive treatment (target 140-180 mm Hg) to be achieved within 1 h and sustained for 72 h. The primary efficacy outcome was functional recovery, assessed according to the distribution in scores on the modified Rankin scale (range 0 [no symptoms] to 6 [death]) at 90 days. Analyses were done according to the modified intention-to-treat principle. Efficacy analyses were performed with proportional odds logistic regression with adjustment for treatment allocation as a fixed effect, site as a random effect, and baseline prognostic factors, and included all randomly assigned patients who provided consent and had available data for the primary outcome. The safety analysis included all randomly assigned patients. The treatment effects were expressed as odds ratios (ORs). This trial is registered at ClinicalTrials.gov, NCT04140110, and the Chinese Clinical Trial Registry, 1900027785; recruitment has stopped at all participating centres., Findings: Between July 20, 2020, and March 7, 2022, 821 patients were randomly assigned. The trial was stopped after review of the outcome data on June 22, 2022, due to persistent efficacy and safety concerns. 407 participants were assigned to the more intensive treatment group and 409 to the less intensive treatment group, of whom 404 patients in the more intensive treatment group and 406 patients in the less intensive treatment group had primary outcome data available. The likelihood of poor functional outcome was greater in the more intensive treatment group than the less intensive treatment group (common OR 1·37 [95% CI 1·07-1·76]). Compared with the less intensive treatment group, the more intensive treatment group had more early neurological deterioration (common OR 1·53 [95% 1·18-1·97]) and major disability at 90 days (OR 2·07 [95% CI 1·47-2·93]) but there were no significant differences in symptomatic intracerebral haemorrhage. There were no significant differences in serious adverse events or mortality between groups., Interpretation: Intensive control of systolic blood pressure to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy for acute ischaemic stroke due to intracranial large-vessel occlusion., Funding: The Shanghai Hospital Development Center; National Health and Medical Research Council of Australia; Medical Research Futures Fund of Australia; China Stroke Prevention; Shanghai Changhai Hospital, Science and Technology Commission of Shanghai Municipality; Takeda China; Hasten Biopharmaceutic; Genesis Medtech; Penumbra., Competing Interests: Declaration of interests PY reports funding from Shanghai Changhai Hospital and honoraria for lectures from Stryker, Medtronic, Microvention, and Cerenovus. LS reports grants and speaker fees from Takeda China. CM reports grants from the Dutch Heart Foundation, the European Commission, Stryker, and Healthcare Evaluation Netherlands. MG reports grants from NoNo, Medtronic, and Cerenovus; and consulting fees from Medtronic, Microvention, Stryker, and Mentice; and is the inventor and receives royalties for a novel imaging system for the diagnosis of acute ischaemic stroke (GE Healthcare systems licensing agreement; patents US9324143 and US 9486176) and a device for accessing intracranial vessels (Microvention licensing agreement; US 10,456,552). Jianmin Liu reports grants from the China Stroke Prevention Project and the Science and Technology Commission of Shanghai Municipality. CSA reports grants from the National Health and Medical Research Council (NHMRC) and Medical Research Futures Fund (MRFF) of Australia, the UK Medical Research Council, Penumbra, and Takeda China; and is a board member for the World Stroke Organisation and the Editor-in-Chief of Cerebrovascular Disease. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: There is still a relatively serious disease burden of infectious diseases and the warning time for different infectious diseases before implementation of interventions is important. The logistic differential equation models can be used for predicting early warning of infectious diseases. The aim of this study is to compare the disease fitting effects of the logistic differential equation (LDE) model and the generalized logistic differential equation (GLDE) model for the first time using data on multiple infectious diseases in Jilin Province and to calculate the early warning signals for different types of infectious diseases using these two models in Jilin Province to solve the disease early warning schedule for Jilin Province throughout the year., Methods: Collecting the incidence of 22 infectious diseases in Jilin Province, China. The LDE and GLDE models were used to calculate the recommended warning week (RWW), the epidemic acceleration week (EAW) and warning removed week (WRW) for acute infectious diseases with seasonality, respectively., Results: Five diseases were selected for analysis based on screening principles: hemorrhagic fever with renal syndrome (HFRS), shigellosis, mumps, Hand, foot and mouth disease (HFMD), and scarlet fever. The GLDE model fitted the above diseases better (0.80 ≤ R 2  ≤ 0.94, P <  0. 005) than the LDE model. The estimated warning durations (per year) of the LDE model for the above diseases were: weeks 12-23 and 40-50; weeks 20-36; weeks 15-24 and 43-52; weeks 26-34; and weeks 16-25 and 41-50. While the durations of early warning (per year) estimated by the GLDE model were: weeks 7-24 and 36-51; weeks 13-37; weeks 11-26 and 39-54; weeks 23-35; and weeks 12-26 and 40-50., Conclusions: Compared to the LDE model, the GLDE model provides a better fit to the actual disease incidence data. The RWW appeared to be earlier when estimated with the GLDE model than the LDE model. In addition, the WRW estimated with the GLDE model were more lagged and had a longer warning time., (© 2022. The Author(s).)

Background: Endoscopic screening is the widely accepted screening strategy for esophageal squmaous cell carcinoma (ESCC). However, massive endoscopic screening is expensive and not cost-efficient, and novel pre-endoscopy detection used as a preliminary screening method arouses new concerns. We are planning to launch an artificial intelligence (AI) assisted sponge cytology for detecting esophageal squmaous high-grade intraepithelial neoplasia (HGIN) and above lesions. The aim of this trail is to investigate the efficiency of AI-assisted sponge cytology in population-based screening of early esophageal squmaous epithelial lesions., Methods: The study will be prospectively conducted in five regions with a high prevalence of ESCC. AI-assisted sponge cytology and endoscopic examination will be sequentially performed. Based on our previous data, at least 864 patients with esophageal HGIN and above lesions are needed to achieve enough statistical power. And, a calculated 112,500 individuals with high risks of ESCC will be recruited. In the first stage, each 24,000 participants who meet the inclusion criteria will be recruited on a voluntary basis. Setting pathological results as standard reference, diagnostic threshold and according performance of AI-assisted detection will be evaluated. A prediction model will be constructed by co-analyzing cytological results and relevant risk factors. Then, an external validation cohort will be used for validation of the model efficiency. Also, cost-efficiency analysis will be performed. This study protocol was registered on chineseclinicaltrial.gov (ChiCTR1900028524)., Discussion: Our study will determine whether this AI-assisted sponge cytology can be used as an effective pre-endoscopy detection tool for large-scale screening for ESCC in high-risk areas., (© 2022. The Author(s).)

Objectives: This study aims to explore the interaction of different pathogens in Hand, foot and mouth disease (HFMD) by using a mathematical epidemiological model and the reported data in five regions of China., Methods: A cross-regional dataset of reported HFMD cases was built from four provinces (Fujian Province, Jiangsu province, Hunan Province, and Jilin Province) and one municipality (Chongqing Municipality) in China. The subtypes of the pathogens of HFMD, including Coxsackievirus A16 (CV-A16), enteroviruses A71 (EV-A71), and other enteroviruses (Others), were included in the data. A mathematical model was developed to fit the data. The effective reproduction number ( R eff ) was calculated to quantify the transmissibility of the pathogens., Results: In total, 3,336,482 HFMD cases were collected in the five regions. In Fujian Province, the R eff between CV-A16 and EV-A71&CV-A16, and between CV-A16 and CV-A16&Others showed statistically significant differences ( P < 0.05). In Jiangsu Province, there was a significant difference in R eff ( P < 0.05) between the CV-A16 and Total. In Hunan Province, the R eff between CV-A16 and EV-A71&CV-A16, between CV-A16 and Total were significant ( P < 0.05). In Chongqing Municipality, we found significant differences of the R eff ( P < 0.05) between CV-A16 and CV-A16&Others, and between Others and CV-A16&Others. In Jilin Province, significant differences of the R eff ( P < 0.05) were found between EV-A71 and Total, and between Others and Total., Conclusion: The major pathogens of HFMD have changed annually, and the incidence of HFMD caused by others and CV-A16 has surpassed that of EV-A71 in recent years. Cross-regional differences were observed in the interactions between the pathogens., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Rui, Qi, Ye, Niu, Luo, Deng, Zhang, Yu, Liu, Li, Wang, Wei, Zhang, Huang, Zuo, Zhang, Zhang, Yang, Guo, Zhao, Wu, Li, Chen and Chen.)

Background: The epidemiological characteristics and transmissibility of Coronavirus Disease 2019 (COVID-19) may undergo changes due to the mutation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) strains. The purpose of this study is to compare the differences in the outbreaks of the different strains with regards to aspects such as epidemiological characteristics, transmissibility, and difficulties in prevention and control., Methods: COVID-19 data from outbreaks of pre-Delta strains, the Delta variant and Omicron variant, were obtained from the Chinese Center for Disease Control and Prevention (CDC). Case data were collected from China's direct-reporting system, and the data concerning outbreaks were collected by on-site epidemiological investigators and collated by the authors of this paper. Indicators such as the effective reproduction number ( R eff ), time-dependent reproduction number ( R t ), rate of decrease in transmissibility ( RDT ), and duration from the illness onset date to the diagnosed date ( D ID )/reported date ( D IR ) were used to compare differences in transmissibility between pre-Delta strains, Delta variants and Omicron variants. Non-parametric tests (namely the Kruskal-Wallis H and Mean-Whitney U tests) were used to compare differences in epidemiological characteristics and transmissibility between outbreaks of different strains. P < 0.05 indicated that the difference was statistically significant., Results: Mainland China has maintained a "dynamic zero-out strategy" since the first case was reported, and clusters of outbreaks have occurred intermittently. The strains causing outbreaks in mainland China have gone through three stages: the outbreak of pre-Delta strains, the outbreak of the Delta variant, and outbreaks involving the superposition of Delta and Omicron variant strains. Each outbreak of pre-Delta strains went through two stages: a rising stage and a falling stage, Each outbreak of the Delta variant and Omicron variant went through three stages: a rising stage, a platform stage and a falling stage. The maximum R eff value of Omicron variant outbreaks was highest (median: 6.7; ranged from 5.3 to 8.0) and the differences were statistically significant. The RDT value of outbreaks involving pre-Delta strains was smallest (median: 91.4%; [IQR]: 87.30-94.27%), and the differences were statistically significant. The D ID and D IR for all strains was mostly in a range of 0-2 days, with more than 75%. The range of duration for outbreaks of pre-Delta strains was the largest (median: 20 days, ranging from 1 to 61 days), and the differences were statistically significant., Conclusion: With the evolution of the virus, the transmissibility of the variants has increased. The transmissibility of the Omicron variant is higher than that of both the pre-Delta strains and the Delta variant, and is more difficult to suppress. These findings provide us with get a more clear and precise picture of the transmissibility of the different variants in the real world, in accordance with the findings of previous studies. R eff is more suitable than R t for assessing the transmissibility of the disease during an epidemic outbreak., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Niu, Luo, Yang, Abudurusuli, Wang, Zhao, Rui, Li, Deng, Liu, Zhang, Li, Liu, Li, Huang, Yang, Wang, Chen and Li.)

High sediment flux in large rivers provide sufficient dilution to the heavy metals' concentration. However, sediment starvation caused by hydrological engineering in recent decades has been reported worldwide. Thus, a study is necessary on the influences of recent declining sediment flux on heavy metal pollution change in the suspended sediments. In this study, heavy metal concentrations and speciation (Cd, Pb, Zn, Cu, Co, Ni, and Cr) in suspended sediments were investigated downstream the Three Gorges Dam (TGD) during dry and flood seasons. Substantial changes of Pb, Zn, Cd, and Cu along the river channel were found which were constrained by the dilution efficiency of suspended sediment during the dry season. High proportion of labile fraction revealed anthropogenic sources of heavy metal. Moreover, the historical trend of metal content illustrated TGD construction together with anthropogenic influx both contribute to the increasing environmental risk in the Yangtze River basin., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Severe fever with thrombocytopenia syndrome (SFTS), one kind of tick-borne acute infectious disease, is caused by a novel bunyavirus. The relationship between meteorological factors and infectious diseases is a hot topic of current research. Liaoning Province has reported a high incidence of SFTS in recent years. However, the epidemiological characteristics of SFTS and its relationship with meteorological factors in the province remain largely unexplored., Methods: Data on reported SFTS cases were collected from 2011 to 2019. Epidemiological characteristics of SFTS were analyzed. Spearman's correlation test and generalized linear models (GLM) were used to identify the relationship between meteorological factors and the number of SFTS cases., Results: From 2011 to 2019, the incidence showed an overall upward trend in Liaoning Province, with the highest incidence in 2019 (0.35/100,000). The incidence was slightly higher in males (55.9%, 438/783), and there were more SFTS patients in the 60-69 age group (31.29%, 245/783). Dalian City and Dandong City had the largest number of cases of SFTS (87.99%, 689/783). The median duration from the date of illness onset to the date of diagnosis was 8 days [interquartile range (IQR): 4-13 days]. Spearman correlation analysis and GLM showed that the number of SFTS cases was positively correlated with monthly average rainfall (r s  = 0.750, P < 0.001; β = 0.285, P < 0.001), monthly average relative humidity (r s  = 0.683, P < 0.001; β = 0.096, P < 0.001), monthly average temperature (r s  = 0.822, P < 0.001; β = 0.154, P < 0.001), and monthly average ground temperature (r s  = 0.810, P < 0.001; β = 0.134, P < 0.001), while negatively correlated with monthly average air pressure (r s  = -0.728, P < 0.001; β = -0.145, P < 0.001), and monthly average wind speed (r s  = -0.272, P < 0.05; β = -1.048, P < 0.001). By comparing both correlation coefficients and regression coefficients between the number of SFTS cases (dependent variable) and meteorological factors (independent variables), no significant differences were observed when considering immediate cases and cases with lags of 1 to 5 weeks for dependent variables. Based on the forward and backward stepwise GLM regression, the monthly average air pressure, monthly average temperature, monthly average wind speed, and time sequence were selected as relevant influences on the number of SFTS cases., Conclusion: The annual incidence of SFTS increased year on year in Liaoning Province. Incidence of SFTS was affected by several meteorological factors, including monthly average air pressure, monthly average temperature, and monthly average wind speed., (© 2022. The Author(s).)

Background: In September 2021, there was an outbreak of coronavirus disease 2019 (COVID-19) in Xiamen, China. Various non-pharmacological interventions (NPIs) and pharmacological interventions (PIs) have been implemented to prevent and control the spread of the disease. This study aimed to evaluate the effectiveness of various interventions and to identify priorities for the implementation of prevention and control measures., Methods: The data of patients with COVID-19 were collected from 8 to 30 September 2021. A Susceptible-Exposed-Infectious-Recovered (SEIR) dynamics model was developed to fit the data and simulate the effectiveness of interventions (medical treatment, isolation, social distancing, masking, and vaccination) under different scenarios. The effective reproductive number ( R eff ) was used to assess the transmissibility and transmission risk., Results: A total of 236 cases of COVID-19 were reported in Xiamen. The epidemic curve was divided into three phases ( R eff = 6.8, 1.5, and 0). Notably, the cumulative number of cases was reduced by 99.67% due to the preventive and control measures implemented by the local government. In the effective containment stage, the number of cases could be reduced to 115 by intensifying the implementation of interventions. The total number of cases ( TN ) could be reduced by 29.66-95.34% when patients voluntarily visit fever clinics. When only two or three of these measures are implemented, the simulated TN may be greater than the actual number. As four measures were taken simultaneously, the TN may be <100, which is 57.63% less than the actual number. The simultaneous implementation of five interventions could rapidly control the transmission and reduce the number of cases to fewer than 25., Conclusion: With the joint efforts of the government and the public, the outbreak was controlled quickly and effectively. Authorities could promptly cut the transmission chain and control the spread of the disease when patients with fever voluntarily went to the hospital. The ultimate effect of controlling the outbreak through only one intervention was not obvious. The combined community control and mask wearing, along with other interventions, could lead to rapid control of the outbreak and ultimately lower the total number of cases. More importantly, this would mitigate the impact of the outbreak on society and socioeconomics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Guo, Abudunaibi, Ouyang, Wang, Yang, Deng, Huang, Zhao, Su, Su and Chen.)

Objective: To evaluate the efficacy of Wen-Luo-Tong Granules (WLT) local administration in the treatment of patients with peripheral neuropathy (PN) induced by chemotherapy or target therapy., Methods: This study is a randomized, double-blinded, and placebo-controlled trial. Seventy-eight patients with PN induced by chemotherapy or target therapy were enrolled from China-Japan Friendship Hospital between July 2019 and January 2020. They were randomly assigned to WLT (39 cases) and control groups (39 cases) using a block randomization method. The WLT group received WLT (hand and foot bath) plus oral Mecobalamin for 1 week, while the control group received placebo plus oral Mecobalamin. The primary endpoint was PN grade evaluated by the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE). The secondary endpoints included quantitative touch-detection threshold, neuropathy symptoms, Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy (QLQ-CIPN20), and Quality of Life Questionnaire-Core30 (QLQ-C30)., Results: After treatment, the PN grade in the WLT group was significantly lower than that in the control group (1.00 ± 0.29 vs. 1.75 ± 0.68, P<0.01). The total effective rate in the WLT group was significantly higher than that in the control group (82.05% vs. 51.28%, P<0.01). Compared with the control group, the touch-detection thresholds at fingertips, neuropathy symptom score, QLQ-CIPN 20 (sensory scale, motor scale, autonomic scale, and sum score), and QLQ-C30 (physical functioning, role functioning, emotional functioning, and global health) in the WLT group significantly improved after treatment (P<0.01 or P<0.05)., Conclusion: WLT local administration was significantly effective in the treatment of patients with PN induced by chemotherapy or target therapy. (Trial registration No. ChiCTR1900023862)., (© 2022. The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Anti-aquaporin-4 antibody (AQP4-IgG) is a diagnostic marker of neuromyelitis optica spectrum disorder (NMOSD), but the relationship of different AQP4-IgG serostatus with clinical manifestations and recurrence of disease is still uncertain., Objective: We attempted to observe the changes of AQP4-IgG serostatus and the differences of corresponding clinical manifestations between AQP4-IgG-positive (AQP4-IgG + ) and AQP4-IgG-negative (AQP4-IgG - ) patients during 36-month follow-up, and to explore the significance of AQP4-IgG serostatus in the pathogenesis of NMOSD., Methods: The AQP4-IgG serostatus in eighty-four NMOSD patients during 36 months were re-checked regularly every 6 months in stable phase of the disease, and an additional AQP4-IgG test was performed when the disease relapsed. The clinical data were collected, including gender, age, clinical symptoms and signs, location and length of affected spinal cord segments, expanded disability status scale (EDSS), course of disease, annual recurrence rate (ARR), concomitant connective tissue disease (CTD) and other autoimmune antibodies. According to the change of AQP4-IgG serostatus during 36 months, the enrolled patients were divided into the various groups: with AQP4-IgG + at the first diagnosis; with AQP4-IgG - at the first diagnosis; with persistent AQP4-IgG + ; with persistent AQP4-IgG - ; with conversion to AQP4-IgG - . The clinical characteristics of NMOSD patients among different groups were compared., Results: Eighty-four NMOSD patients (12 males and 72 females) were included in this study. For the patients with AQP4-IgG + at the first diagnosis (60 patients, 71.4%), there were 29 patients (48.3%) continuously positive; 31 cases (51.7%) turned positive to negative while 9 cases (29.0%) turned positive again in which 7 cases (77.8%) coincided with recurrence. The re-positive change of AQP4-IgG was significantly correlated with the recurrence of the disease (P < 0.05); for the patients with AQP4-IgG - at the first diagnosis (24 patients, 28.6%), 19 patients (79.2%) remained negative, and 5 patients (20.8%) turned negative to positive in which 1 patient (20.0%) had a relapse. This conversion of AQP4-IgG serostatus had no significant correlation with the recurrence of the disease (P > 0.05). There was no significant difference in clinical manifestations between the AQP4-IgG + and AQP4-IgG - group at the diagnosis, or between the persistent AQP4-IgG + and persistent AQP4-IgG - group during thirty-six months (P > 0.05). The patients with persistent AQP4-IgG + was more likely to accompany with other antibodies than those with conversion to AQP4-IgG - (P < 0.05), while no significant differences were found in the gross clinical characteristics. (P > 0.05)., Conclusions: AQP4-IgG serostatus can fluctuate in the different phase of NMOSD. There is no significant difference in clinical characteristics between AQP4-IgG + and AQP4-IgG - patients. The conversion of AQP4-IgG + to AQP4-IgG - may not be an appropriate target for treatment, but patients who are AQP4-IgG + turn positive again after conversion to negative need to be vigilant for the recurrence of the disease., (Copyright © 2022. Published by Elsevier B.V.)

Background: This study aimed to explore whether the transmission routes of severe fever with thrombocytopenia syndrome (SFTS) will be affected by tick density and meteorological factors, and to explore the factors that affect the transmission of SFTS. We used the transmission dynamics model to calculate the transmission rate coefficients of different transmission routes of SFTS, and used the generalized additive model to uncover how meteorological factors and tick density affect the spread of SFTS., Methods: In this study, the time-varying infection rate coefficients of different transmission routes of SFTS in Jiangsu Province from 2017 to 2020 were calculated based on the previous multi-population multi-route dynamic model (MMDM) of SFTS. The changes in transmission routes were summarized by collecting questionnaires from 537 SFTS cases in 2018-2020 in Jiangsu Province. The incidence rate of SFTS and the infection rate coefficients of different transmission routes were dependent variables, and month, meteorological factors and tick density were independent variables to establish a generalized additive model (GAM). The optimal GAM was selected using the generalized cross-validation score (GCV), and the model was validated by the 2016 data of Zhejiang Province and 2020 data of Jiangsu Province. The validated GAMs were used to predict the incidence and infection rate coefficients of SFTS in Jiangsu province in 2021, and also to predict the effect of extreme weather on SFTS., Results: The number and proportion of infections by different transmission routes for each year and found that tick-to-human and human-to-human infections decreased yearly, but infections through animal and environmental transmission were gradually increasing. MMDM fitted well with the three-year SFTS incidence data (P<0.05). The best intervention to reduce the incidence of SFTS is to reduce the effective exposure of the population to the surroundings. Based on correlation tests, tick density was positively correlated with air temperature, wind speed, and sunshine duration. The best GAM was a model with tick transmissibility to humans as the dependent variable, without considering lagged effects (GCV = 5.9247E-22, R2 = 96%). Reported incidence increased when sunshine duration was higher than 11 h per day and decreased when temperatures were too high (>28°C). Sunshine duration and temperature had the greatest effect on transmission from host animals to humans. The effect of extreme weather conditions on SFTS was short-term, but there was no effect on SFTS after high temperature and sunshine hours., Conclusions: Different factors affect the infection rate coefficients of different transmission routes. Sunshine duration, relative humidity, temperature and tick density are important factors affecting the occurrence of SFTS. Hurricanes reduce the incidence of SFTS in the short term, but have little effect in the long term. The most effective intervention to reduce the incidence of SFTS is to reduce population exposure to high-risk environments., Competing Interests: The authors declare that they have no competing interests.

Background: Hand-Foot-and-Mouth-Disease (HFMD) has been widely spread in Asia, and has result in a high disease burden for children in many countries. However, the dissemination characteristics intergroup and between different age groups are still not clear. In this study, we aim to analyze the differences in the transmissibility of HFMD, in the whole population and among age groups in Shenzhen city, by utilizing mathematical models., Methods: A database that reports HFMD cases in Shenzhen city from January 2010 to December 2017 was collected. In the first stage, a Susceptive-Infected-Recovered ( SIR ) model was built to fit data of Shenzhen city and its districts, and R eff was used to assess transmissibility in each district. In the second stage, a cross-age groups SIR model was constructed to calculate the difference in transmissibility of reported cases among three age groups of EV71 virus: 0-3 years, 3-5 years, and over 5 years which was denoted as age group 1, 2, and 3, respectively., Results: From 2010 to 2017, 345,807 cases of HFMD were reported in Shenzhen city, with peak incidence in spring and autumn in Shenzhen city and most of its districts each year. Analysis of the EV71 incidence data by age group revealed that age Group 1 have the highest incidence (3.13 ×10 -7 -2.31 ×10 -4 ) while age group 3 had the lowest incidence (0-3.54 ×10 -5 ). The differences in weekly incidence of EV71 between age groups were statistically significant ( t 12 = 7.563, P < 0.0001; t 23 = 12.420, P < 0.0001; t 13 = 16.996, P < 0.0001). The R 2 of the SIR model Shenzhen city population-wide HFMD fit for each region was >0.5, and P < 0.001. R eff values were >1 for the vast majority of time and regions, indicating that the HFMD virus has the ability to spread in Shenzhen city over the long-term. Differences in R eff values between regions were judged by using analysis of variance (ANOVA) ( F = 0.541, P = 0.744). S i I i R i -S j I j R j models between age groups had R 2 over 0.7 for all age groups and P <0.001. The R eff values between groups show that the 0-2 years old group had the strongest transmissibility (median: 2.881, range: 0.017-9.897), followed by the over 5 years old group (median: 1.758, range: 1.005-5.279), while the 3-5 years old group (median: 1.300, range: 0.005-1.005) had the weakest transmissibility of the three groups. Intra-group transmissibility was strongest in the 0-2 years age group (median: 1.787, range: 0-9.146), followed by Group 1 to Group 2 (median: 0.287, range: 0-1.988) and finally Group 1 to Group 3 (median: 0.287, range: 0-1.988)., Conclusion: The incidence rate of HFMD is high in Shenzhen city. In the data on the incidence of EV71 in each age group, the highest incidence was in the 0-2 years age group, and the lowest incidence was in the over 5 years age group. The differences in weekly incidence rate of EV71 among age groups were statistically significant. Children with the age of 0-2 years had the highest transmissibility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Rui, Niu, Xie, Wang, Li, Liu, Yu, Huang, Luo, Deng, Liu, Yang, Li and Chen.)

Hand, foot, and mouth disease (HFMD) is a serious disease burden in the Asia-Pacific region, including China. This study calculated the transmissibility of HFMD at county levels in Jiangsu Province, China, analyzed the differences of transmissibility and explored the possible influencing factors of its transmissibility. We built a mathematical model for seasonal characteristics of HFMD, estimated the effective reproduction number (R eff ), and compared the incidence rate and transmissibility in different counties using non-parametric tests, rapid cluster analysis and rank-sum ratio in 97 counties in Jiangsu Province from 2015 to 2020. The average daily incidence rate was between 0 and 4 per 100,000 people in Jiangsu Province from 2015-2020. The Quartile of R eff in Jiangsu Province from 2015 to 2020 was 1.54 (0.49, 2.50). Rugao District and Jianhu District had the highest transmissibility according to the rank-sum ratio. R eff generally decreased in 2017 and increased in 2018 in most counties, and the median level of R eff was the lowest in 2017 (P < 0.05). The transmissibility was different in 97 counties in Jiangsu Province. The reasons for the differences may be related to the climate, demographic characteristics, virus subtypes, vaccination, hygiene and other infectious diseases., (© 2022. The Author(s).)

Background: To date, there is a lack of sufficient evidence on the type of clusters in which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is most likely to spread. Notably, the differences between cluster-level and population-level outbreaks in epidemiological characteristics and transmissibility remain unclear. Identifying the characteristics of these two levels, including epidemiology and transmission dynamics, allows us to develop better surveillance and control strategies following the current removal of suppression measures in China., Methods: We described the epidemiological characteristics of SARS-CoV-2 and calculated its transmissibility by taking a Chinese city as an example. We used descriptive analysis to characterize epidemiological features for coronavirus disease 2019 (COVID-19) incidence database from 1 Jan 2020 to 2 March 2020 in Chaoyang District, Beijing City, China. The susceptible-exposed-infected-asymptomatic-recovered (SEIAR) model was fitted with the dataset, and the effective reproduction number ( R eff ) was calculated as the transmissibility of a single population. Also, the basic reproduction number ( R 0 ) was calculated by definition for three clusters, such as household, factory and community, as the transmissibility of subgroups., Results: The epidemic curve in Chaoyang District was divided into three stages. We included nine clusters (subgroups), which comprised of seven household-level and one factory-level and one community-level cluster, with sizes ranging from 2 to 17 cases. For the nine clusters, the median incubation period was 17.0 days [Interquartile range (IQR): 8.4-24.0 days (d)], and the average interval between date of onset (report date) and diagnosis date was 1.9 d (IQR: 1.7 to 6.4 d). At the population level, the transmissibility of the virus was high in the early stage of the epidemic ( R eff = 4.81). The transmissibility was higher in factory-level clusters ( R 0 = 16) than in community-level clusters ( R 0 = 3), and household-level clusters ( R 0 = 1)., Conclusions: In Chaoyang District, the epidemiological features of SARS-CoV-2 showed multi-stage pattern. Many clusters were reported to occur indoors, mostly from households and factories, and few from the community. The risk of transmission varies by setting, with indoor settings being more severe than outdoor settings. Reported household clusters were the predominant type, but the population size of the different types of clusters limited transmission. The transmissibility of SARS-CoV-2 was different between a single population and its subgroups, with cluster-level transmissibility higher than population-level transmissibility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yu, Cui, Rui, Zhao, Deng, Liu, Li, Wang, Yang, Li, Chen and Wang.)

Background: Total hip arthroplasty (THA) is a common and effective surgical method for advanced hip arthritis. Rehabilitation exercises are important to improve joint function after THA and are usually conducted in a home-based program. Poor patient adherence limits improvements in pain and function, affecting quality of life. The increasing use of THA in the aging Chinese population underscores the need to develop strategies that maximize functional outcomes. The purpose of this pilot study is to develop and assess the feasibility of a self-efficacy-enhancing intervention (SEEI) to improve exercise adherence in patients undergoing THA., Methods: This single-blinded, parallel, randomized control trial will recruit 150 patients after THA and randomly assign them to an intervention or control group using computer-generated block randomization. The control group will receive usual care using evidence-based guidelines. The intervention group will receive the 6-month SEEI comprising personalized exercise guidance and self-efficacy education delivered using one face-to-face education session and four telephone consultations, supplemented by written materials. Participants are encouraged to build confidence in their own abilities, set rehabilitation goals, and self-monitor their physical exercise., Results: Assessments will be conducted at baseline and 1, 3, and 6 months postsurgery. The outcome indicators are exercise adherence, physical function, anxiety and depression, self-efficacy of rehabilitation, joint function, and quality of life., Conclusions: This study will test a theory-based intervention program to improve self-efficacy in rehabilitation, which may significantly impact out-of-hospital rehabilitation. The results will provide evidence to inform the postoperative recovery of patients undergoing THA or similar procedures., Trial Registration: Chinese Clinical Trials Registry, ChiCTR2000029422 , registered on 31 January 2020., (© 2021. The Author(s).)

Background: Reaching optimal vaccination rates is an essential public health strategy to control the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to simulate the optimal vaccination strategy to control the disease by developing an age-specific model based on the current transmission patterns of COVID-19 in Wuhan City, China., Methods: We collected two indicators of COVID-19, including illness onset data and age of confirmed case in Wuhan City, from December 2, 2019, to March 16, 2020. The reported cases were divided into four age groups: group 1, ≤ 14 years old; group 2, 15 to 44 years old; group 3, 44 to 64 years old; and group 4, ≥ 65 years old. An age-specific susceptible-exposed-symptomatic-asymptomatic-recovered/removed model was developed to estimate the transmissibility and simulate the optimal vaccination strategy. The effective reproduction number (R eff ) was used to estimate the transmission interaction in different age groups., Results: A total of 47 722 new cases were reported in Wuhan City from December 2, 2019, to March 16, 2020. Before the travel ban of Wuhan City, the highest transmissibility was observed among age group 2 (R eff  = 4.28), followed by group 2 to 3 (R eff  = 2.61), and group 2 to 4 (R eff  = 1.69). China should vaccinate at least 85% of the total population to interrupt transmission. The priority for controlling transmission should be to vaccinate 5% to 8% of individuals in age group 2 per day (ultimately vaccinated 90% of age group 2), followed by 10% of age group 3 per day (ultimately vaccinated 90% age group 3). However, the optimal vaccination strategy for reducing the disease severity identified individuals ≥ 65 years old as a priority group, followed by those 45-64 years old., Conclusions: Approximately 85% of the total population (nearly 1.2 billion people) should be vaccinated to build an immune barrier in China to safely consider removing border restrictions. Based on these results, we concluded that 90% of adults aged 15-64 years should first be vaccinated to prevent transmission in China., (© 2021. The Author(s).)

Background: Human immunodeficiency virus (HIV) is a single-stranded RNA virus that can weaken the body's cellular and humoral immunity and is a serious disease without specific drug management and vaccine. This study aimed to evaluate the epidemiologic characteristics and transmissibility of HIV. Methods: Data on HIV follow-up were collected in Nanning City, Guangxi Zhuang Autonomous, China. An HIV transmission dynamics model was built to simulate the transmission of HIV and estimate its transmissibility by comparing the effective reproduction number ( R eff ) at different stages: the rapid growth period from January 2001 to March 2005, slow growth period from April 2005 to April 2011, and the plateau from May 2011 to December 2019 of HIV in Nanning City. Results: High-risk areas of HIV prevalence in Nanning City were mainly concentrated in suburbs. Furthermore, high-risk groups were those of older age, with lower income, and lower education levels. The R eff in each stage (rapid growth, slow growth, and plateau) were 2.74, 1.62, and 1.15, respectively, which suggests the transmissibility of HIV in Nanning City has declined and prevention and control measures have achieved significant results. Conclusion: Over the past 20 years, the HIV incidence in Nanning has remained at a relatively high level, but its development trend has been curbed. Transmissibility was reduced from 2.74 to 1.15. Therefore, the prevention and treatment measures in Nanning City have achieved significant improvement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lin, Deng, Rui, Guo, Hu, Chen, Tang, Zhou, Zhao, Lin, Zhu, Yang, Wang, Xu, Liu, Yang, Li, Li, Luo, Liu, Liu, Huang, Yao, Nong, Nong, Wu, Luo, Chen, Frutos, Yang, Li, Cui and Chen.)

The origin and early dispersal of speakers of Transeurasian languages-that is, Japanese, Korean, Tungusic, Mongolic and Turkic-is among the most disputed issues of Eurasian population history 1-3 . A key problem is the relationship between linguistic dispersals, agricultural expansions and population movements 4,5 . Here we address this question by 'triangulating' genetics, archaeology and linguistics in a unified perspective. We report wide-ranging datasets from these disciplines, including a comprehensive Transeurasian agropastoral and basic vocabulary; an archaeological database of 255 Neolithic-Bronze Age sites from Northeast Asia; and a collection of ancient genomes from Korea, the Ryukyu islands and early cereal farmers in Japan, complementing previously published genomes from East Asia. Challenging the traditional 'pastoralist hypothesis' 6-8 , we show that the common ancestry and primary dispersals of Transeurasian languages can be traced back to the first farmers moving across Northeast Asia from the Early Neolithic onwards, but that this shared heritage has been masked by extensive cultural interaction since the Bronze Age. As well as marking considerable progress in the three individual disciplines, by combining their converging evidence we show that the early spread of Transeurasian speakers was driven by agriculture., (© 2021. The Author(s).)

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and can lead to heart failure (HF), stroke, pulmonary embolism (PE), and other complications, seriously affecting people's quality of life and health. Western medicine is limited in the treatment of AF, while Traditional Chinese Medicine (TCM) has unique advantages, such as less side effects, low toxicity, long effect duration, and high compliance. The prescription of HTDJ is a common prescription for the treatment of atrial fibrillation in Longhua Hospital, Shanghai University of Traditional Chinese Medicine. It has been used for many years and has a large number of clinically effective cases. It has a good clinical application prospect, but there is a lack of effective evaluation of its clinical efficacy., Method: This study adopts a randomized double-blind, single-simulated, placebo-controlled research method. Participants were randomly assigned in a 1:1 ratio through a centrally controlled, computer-generated, simple randomization schedule. Participants would take the medicine for 1 month, and the curative effect would be evaluated. Subsequently, the participants would not take TCM and only receive western medicine treatment. They would be followed up for another 8 weeks, and a clinical evaluation would be conducted. The secondary outcomes include echocardiography, Hamilton Anxiety Scale, Hamilton Depression Scale, rate of increase and decrease of anti-arrhythmia western medicine, the MOS 36-item short-form health survey, N-terminal-pro hormone B-type natriuretic peptide level, and integral TCM syndrome score. Adverse events will be monitored throughout the trial. Cases are from outpatient and inpatient with atrial fibrillation in the Cardiology Department of Longhua Hospital. Evaluations will be conducted at baseline and at weeks 4 and 12 after randomization., Discussion: In this study, the efficacy and safety of HTDJ plus western medicine in the treatment of atrial fibrillation (qi deficiency and phlegm opacities) will be evaluated, so as to provide medical evidence of short-term and medium-term clinical efficacy for the treatment of atrial fibrillation with integrated traditional and western medicine and lay a foundation for further clinical development and application., Trial Registration: ClinicalTrials.gov ChiCTR2000030517 . Registered on March 5, 2020, with the Chinese Clinical Trial Registry., (© 2021. The Author(s).)

Yichang is a city in central China in the Hubei Province. This study aimed to estimate the dynamics of the transmissibility of hepatitis C using a mathematical model and predict the transmissibility of hepatitis C in 2030. Data of hepatitis C cases from 13 counties or districts (cities) in Yichang from 2008 to 2016 were collected. A susceptible-infectious-chronic-recovered (SICR) model was developed to fit the data. The transmissibility of hepatitis C at the counties or districts was calculated based on new infections (including infected or chronically infected cases) reported monthly in the city caused by one infectious individual (MNI). The trend of the MNI was fitted and predicted using 11 models, with the coefficient of determination (R 2 ) was being used to test the goodness of fit of these models. A total of 3065 cases of hepatitis C were reported in Yichang from 2008 to 2016. The median MNI of Yichang was 0.0768. According to the fitting results and analysis, the trend of transmissibility of hepatitis C in Yichang City conforms with the logarithmic (R 2  = 0.918, p < 0.001):MNI = 0.265-0.108 log(t) and exponential (R 2  = 0.939, p < 0.001): MNI = 0.344e (-0.278 t ) models. Hence, the transmission of hepatitis C virus at the county level has a downward trend. In conclusion, the transmissibility of hepatitis C in Yichang has a downward trend. With the current preventive and control measures in place, the spread of hepatitis C can be controlled., (© 2021 John Wiley & Sons Ltd.)

Background: During the period of the coronavirus disease 2019 (COVID-19) outbreak, strong intervention measures, such as lockdown, travel restriction, and suspension of work and production, may have curbed the spread of other infectious diseases, including natural focal diseases. In this study, we aimed to study the impact of COVID-19 prevention and control measures on the reported incidence of natural focal diseases (brucellosis, malaria, hemorrhagic fever with renal syndrome [HFRS], dengue, severe fever with thrombocytopenia syndrome [SFTS], rabies, tsutsugamushi and Japanese encephalitis [JE])., Methods: The data on daily COVID-19 confirmed cases and natural focal disease cases were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We described and compared the difference between the incidence in 2020 and the incidence in 2015-2019 in four aspects: trend in reported incidence, age, sex, and urban and rural distribution. An autoregressive integrated moving average (ARIMA) (p, d, q) × (P, D, Q) s model was adopted for natural focal diseases, malaria and severe fever with thrombocytopenia syndrome (SFTS), and an ARIMA (p, d, q) model was adopted for dengue. Nonparametric tests were used to compare the reported and the predicted incidence in 2020, the incidence in 2020 and the previous 4 years, and the difference between the duration from illness onset date to diagnosed date (DID) in 2020 and in the previous 4 years. The determination coefficient (R 2 ) was used to evaluate the goodness of fit of the model simulation., Results: Natural focal diseases in Jiangsu Province showed a long-term seasonal trend. The reported incidence of natural focal diseases, malaria and dengue in 2020 was lower than the predicted incidence, and the difference was statistically significant (P < 0.05). The reported incidence of brucellosis in July, August, October and November 2020, and SFTS in May to November 2020 was higher than that in the same period in the previous 4 years (P < 0.05). The reported incidence of malaria in April to December 2020, HFRS in March, May and December 2020, and dengue in July to November 2020 was lower than that in the same period in the previous 4 years (P < 0.05). In males, the reported incidence of malaria in 2020 was lower than that in the previous 4 years, and the reported incidence of dengue in 2020 was lower than that in 2017-2019. The reported incidence of malaria in the 20-60-year age group was lower than that in the previous 4 years; the reported incidence of dengue in the 40-60-year age group was lower than that in 2016-2018. The reported cases of malaria in both urban and rural areas were lower than in the previous 4 years. The DID of brucellosis and SFTS in 2020 was shorter than that in 2015-2018; the DID of tsutsugamushi in 2020 was shorter than that in the previous 4 years., Conclusions: Interventions for COVID-19 may help control the epidemics of natural focal diseases in Jiangsu Province. The reported incidence of natural focal diseases, especially malaria and dengue, decreased during the outbreak of COVID-19 in 2020. COVID-19 prevention and control measures had the greatest impact on the reported incidence of natural focal diseases in males and people in the 20-60-year age group., (© 2021. The Author(s).)

Rationale: Neprilysin (NEP) is a major endogenous catabolic enzyme of amyloid β (Aβ). Previous studies have suggested that increasing NEP expression in animal models of Alzheimer's disease had an ameliorative effect. However, the underlying signaling pathway that regulates NEP expression remains unclear. The aryl hydrocarbon receptor (AhR) is a ligand-activated cytoplasmic receptor and transcription factor. Recent studies have shown that AhR plays essential roles in the central nervous system (CNS), but its physiological and pathological roles in regulating NEP are not entirely known. Methods: Western blotting, immunofluorescence, quantitative RT-PCR and enzyme activity assay were used to verify the effects of AhR agonists on NEP in a cell model (N2a) and a mouse model (APP/PS1). Luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay were conducted to investigate the roles of AhR in regulating NEP transcription. Object recognition test and the Morris water maze task were performed to assess the cognitive capacity of the mice. Results: Activating AhR by the endogenous ligand L-Kynurenine (L-KN) or FICZ, or by the exogenous ligand diosmin or indole-3-carbinol (I3C) significantly increases NEP expression and enzyme activity in N2a cells and APP/PS1 mice. We also found that AhR is a direct transcription factor of NEP. Diosmin treatment effectively ameliorated the cognitive disorder and memory deficit of APP/PS1 transgenic mice. By knocking down AhR or using a small molecular inhibitor targeting AhR or NEP, we found that diosmin enhanced Aβ degradation through activated AhR and increased NEP expression. Conclusions: These results indicate a novel pathway for regulating NEP expression in neurons and that AhR may be a potential therapeutic target for the treatment of Alzheimer's disease., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background: Hepatitis E, an acute zoonotic disease caused by the hepatitis E virus (HEV), has a relatively high burden in developing countries. The current research model on hepatitis E mainly uses experimental animal models (such as pigs, chickens, and rabbits) to explain the transmission of HEV. Few studies have developed a multi-host and multi-route transmission dynamic model (MHMRTDM) to explore the transmission feature of HEV. Hence, this study aimed to explore its transmission and evaluate the effectiveness of intervention using the dataset of Jiangsu Province., Methods: We developed a dataset comprising all reported HEV cases in Jiangsu Province from 2005 to 2018. The MHMRTDM was developed according to the natural history of HEV cases among humans and pigs and the multi-transmission routes such as person-to-person, pig-to-person, and environment-to-person. We estimated the key parameter of the transmission using the principle of least root mean square to fit the curve of the MHMRTDM to the reported data. We developed models with single or combined countermeasures to assess the effectiveness of interventions, which include vaccination, shortening the infectious period, and cutting transmission routes. The indicator, total attack rate (TAR), was adopted to assess the effectiveness., Results: From 2005 to 2018, 44 923 hepatitis E cases were reported in Jiangsu Province. The model fits the data well (R 2  = 0.655, P < 0.001). The incidence of the disease in Jiangsu Province and its cities peaks are around March; however, transmissibility of the disease peaks in December and January. The model showed that the most effective intervention was interrupting the pig-to-person route during the incidence trough of September, thereby reducing the TAR by 98.11%, followed by vaccination (reducing the TAR by 76.25% when the vaccination coefficient is 100%) and shortening the infectious period (reducing the TAR by 50.05% when the infectious period is shortened to 15 days)., Conclusions: HEV could be controlled by interrupting the pig-to-person route, shortening the infectious period, and vaccination. Among these interventions, the most effective was interrupting the pig-to-person route.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is regionally distributed in Asia, with high fatality. Constructing the transmission model of SFTS could help provide clues for disease control and fill the gap in research on SFTS models., Methods: We built an SFTS transmission dynamics model based on the susceptible-exposed-infectious-asymptomatic-recovered (SEIAR) model and the epidemiological characteristics of SFTS in Jiangsu Province. This model was used to evaluate the effect by cutting off different transmission routes and taking different interventions into account, to offer clues for disease prevention and control., Results: The transmission model fits the reported data well with a minimum R 2 value of 0.29 and a maximum value of 0.80, P < 0.05. Meanwhile, cutting off the environmental transmission route had the greatest effect on the prevention and control of SFTS, while isolation and shortening the course of the disease did not have much effect., Conclusions: The model we have built can be used to simulate the transmission of SFTS to help inform disease control. It is noteworthy that cutting off the environment-to-humans transmission route in the model had the greatest effect on SFTS prevention and control.

Objective: To evaluate the presence of Brugada electrocardiogram (ECG) pattern, clinical characteristics, treatment, and long-term prognosis of Brugada syndrome in southern Chinese population., Methods: This prospective study consisted of a consecutive series of patients with diagnostic coved type I Brugada ECG pattern at baseline between January 2007 and February 2020. Histories of symptoms including ventricular tachycardia (VT)/ventricular fibrillation (VF) episode, syncope, and family history of Brugada Syndrome (BrS) or unexplained sudden cardiac death were collected. Electrophysiological study and implantable cardioverter-defibrillator (ICD) were performed. All patients included in this study were followed up in the outpatient department every 6 months after baseline evaluation. Occurrences of syncope, VF, and sudden death were independently analyzed by two cardiologists., Results: 45 (56.3%) patients were diagnosed with BrS. During a mean follow-up of 7.9 ± 3.6 years, six patients had experienced documented VF/sudden cardiac death (SCD) or recurrent syncope. Two patients experienced episodes of syncope more than once. Two patients experienced onset of electrical storm with a total of 11 episodes of VF. There were 50% of these events occurring in fever status. One of patient with BrS died of SCD., Conclusion: There was a very low prevalence of Brugada syndrome in southern Chinese population. The risk of arrhythmic events was low in asymptomatic patients. ICD was high effective in preventing SCD without adverse device outcome in long-term follow-up. Fever can lead to predispose to malignant arrhythmia, and aggressive treatment of febrile state in Brugada syndrome was recommended., (© 2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

People's knowledge, attitude and practice (KAP) are a part of the public's emergency response capability and play an important role in controlling public health emergencies. This study aims to evaluate Shanghai residents' KAP and the response ability regarding public health emergency events in China. An anonymous questionnaire investigation including demographics, socioeconomic characteristics and KAP was conducted through the online survey system from April 19 to April 30 2020. Of the 1243 people who completed the questionnaire, 1122 respondents (90.3%) had a good, positive attitude, while only 46.8% of participants had good knowledge, 46.2% performed well in the aspect of practice and 19.5% of residents had good response capability. It was found that men (OR:1.57,95% CI: 1.16-2.13), and people with 10 to 12 years or longer than 12 years of education (OR: 2.08,95% CI: 1.14-3.92; OR: 3.56,95% CI: 1.96-6.72) had the best public emergency response capability. Positive attitudes may be significantly associated with good practice (OR: 1.76, 95% CI: 1.18-2.64). Internet and television were the major media for people to acquire knowledge and skills. A lack of knowledge, poor perception and poor emergency response ability were found in Shanghai residents. Target intervention should be developed and implemented to improve the knowledge and skills of people for dealing with public emergency events.

Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by diastolic dysfunction. Despite the increasing incidence of HFpEF, there is no available therapy that reduces the mortality rate of HFpEF. Zhigancao Tang has been used traditionally for the treatment of cardiovascular diseases in China. The use of traditional Chinese medicine (TCM) is associated with improvements in clinical syndromes and quality of life of patients. A randomized clinical trial should be conducted to provide clear evidence regarding the efficacy and safety of Zhigancao Tang granules for the treatment of HFpEF., Methods: A randomized, double-blinded, placebo-controlled clinical trial was proposed. A total of 122 patients with HFpEF will be randomly assigned to receive Zhigancao Tang granules or placebo for 12 weeks. The primary outcome measure is cardiac function. The secondary outcomes include measurement of the integral TCM syndrome score, echocardiography, 6-min walk test, N-terminal-pro hormone B-type natriuretic peptide level, atrial natriuretic peptide level, Minnesota Living with Heart Failure scale, and Lee's scale. The outcome measures will be evaluated at baseline, 4 weeks, and 12 weeks. Adverse events will be evaluated from baseline till the 12-week follow-up period., Discussion: The results of this trial will demonstrate whether Zhigancao Tang granules are effective and safe for treating HFpEF., Trial Registration: ClinicalTrials.gov NCT04317339 . Registered on 23 March 2020.

Background: Novel coronavirus disease 2019 (COVID-19) causes an immense disease burden. Although public health countermeasures effectively controlled the epidemic in China, non-pharmaceutical interventions can neither be maintained indefinitely nor conveniently implemented globally. Vaccination is mainly used to prevent COVID-19, and most current antiviral treatment evaluations focus on clinical efficacy. Therefore, we conducted population-based simulations to assess antiviral treatment effectiveness among different age groups based on its clinical efficacy., Methods: We collected COVID-19 data of Wuhan City from published literature and established a database (from 2 December 2019 to 16 March 2020). We developed an age-specific model to evaluate the effectiveness of antiviral treatment in patients with COVID-19. Efficacy was divided into three types: (1) viral activity reduction, reflected as transmission rate decrease [reduction was set as v (0-0.8) to simulate hypothetical antiviral treatments]; (2) reduction in the duration time from symptom onset to patient recovery/removal, reflected as a 1/γ decrease (reduction was set as 1-3 days to simulate hypothetical or real-life antiviral treatments, and the time of asymptomatic was reduced by the same proportion); (3) fatality rate reduction in severely ill patients (f c ) [reduction (z) was set as 0.3 to simulate real-life antiviral treatments]. The population was divided into four age groups (groups 1, 2, 3 and 4), which included those aged ≤ 14; 15-44; 45-64; and ≥ 65 years, respectively. Evaluation indices were based on outbreak duration, cumulative number of cases, total attack rate (TAR), peak date, number of peak cases, and case fatality rate (f)., Results: Comparing the simulation results of combination and single medication therapy s, all four age groups showed better results with combination medication. When 1/γ = 2 and v = 0.4, age group 2 had the highest TAR reduction rate (98.48%, 56.01-0.85%). When 1/γ = 2, z = 0.3, and v = 0.1, age group 1 had the highest reduction rate of f (83.08%, 0.71-0.12%)., Conclusions: Antiviral treatments are more effective in COVID-19 transmission control than in mortality reduction. Overall, antiviral treatments were more effective in younger age groups, while older age groups showed higher COVID-19 prevalence and mortality. Therefore, physicians should pay more attention to prevention of viral spread and patients deaths when providing antiviral treatments to patients of older age groups.

Pseudomonas syringae pv. actinidiae (Psa) is a phytopathogen that causes canker in kiwifruit. Few conventional control methods are effective against this bacterium. Therefore, alternative approaches, such as phage therapy are warranted. In this study, a lytic bacteriophage (PN09) of Psa was isolated from surface water collected from a river in Hangzhou, China in 2019. Morphologically, PN09 was classified into the Myoviridae family, and could lyse all 29 Psa biovar 3 strains. The optimal temperature and pH ranges for PN09 activity were determined as 25 to 35 ∘C and 6.0 to 9.0, respectively. The complete genome of PN09 was found to be composed of a linear 99,229 bp double-stranded DNA genome with a GC content of 48.16%. The PN09 endolysin (LysPN09) was expressed in vitro and characterized. LysPN09 was predicted to belong to the Muraidase superfamily domain and showed lytic activity against the outer-membrane-permeabilized Psa strains. The lytic activity of LysPN09 was optimal over temperature and pH ranges of 25 to 40 ∘C and 6.0 to 8.0, respectively. When recombinant endolysin LysPN09 was combined with EDTA, Psa strains were effectively damaged. All these characteristics demonstrate that the phage PN09 and its endolysin, LysPN09, are potential candidates for biocontrol of Psa in the kiwifruit industry.

The livestock manure nitrogen load on farmland (LMNLF) is often used to assess the potential environmental pollution risk of livestock manure nitrogen nutrient (LMN) in a target region. First, the LMNLF of Wuhan city is calculated, and the potential environmental pollution risk of LMN is mainly concentrated in Jiangxia District, Xinzhou District, and Huangpi District, but does not exceed the European Union (EU) standards. Heat map results also certificate this conclusion. Therefore, these three districts are the research emphases. Second, considering spatial distribution of farms, an improved LMNLF method is proposed combining the previous LMNLF and density-based spatial clustering of applications with noise (DBSCAN) methods. Several regions with pollution risks including seven regions in Jiangxia District, one in Xinzhou District, and one in Huangpi District are found out using the improved LMNLF method. Third, to evaluate the carrying capacity of the intensive breeding areas more reasonably, 2 km is taken as the farthest transportation distance of manure; there is still one region in Huangpi District which has serious pollution risk on the environment. These above results can help evaluate the pollution degree of livestock manure to the surrounding environment more precisely.

Background: Proton pump inhibitors (PPIs) are frequently prescribed to patients with coronary heart disease (CHD) under antiplatelet therapy to prevent gastrointestinal (GI) bleeding. However, its clinical impact is still under debate, especially in Asian population. This study was undertaken to explore the effects of concurrent use of clopidogrel and PPIs on the clinical outcomes in Chinese patients with CHD in secondary prevention., Methods: A single-center retrospective study was conducted in 638 patients with CHD on consecutive clopidogrel therapy for at least 1 year. After 18-month follow-up, adverse clinical events were collected. Cox regression was used to calculate hazard ratios (HR) and 95% confidence interval (CI) for the effect of PPI use on the outcomes. A total of 638 patients were recruited from 2014 to 2015 in this study, among whom 201 were sustained PPI users, 188 were intermittent PPI users and the remaining 249 were non-PPI users., Results: Compared with sustained PPI users, intermittent use of PPIs was associated with a lower risk of stroke, major adverse cardiac events (MACE) and net adverse clinical event (NACE) (stroke: adjusted HR: 0.109, 95% CI 0.014-0.878, p = 0.037; MACE: adjusted HR: 0.293, 95% CI 0.119-0.722; p = 0.008; NACE: adjusted HR: 0.357, 95% CI 0.162-0.786, p = 0.011). Subgroup analysis further revealed the benefit of intermittent PPI use was significant in male CHD patients over 60 years old, with hypertension or chronic kidney disease, and undergoing percutaneous coronary intervention during hospitalization., Conclusion: The current findings suggest that the intermittent concurrent use of PPIs and clopidogrel is not associated with an increased risk of 18-month adverse clinical outcomes, and intermittent use of PPIs is associated with a lower rate of MACE and NACE.

Background: To examine differences in the maternal characteristics and pregnancy outcomes of Chinese women with various causes of infertility who underwent in vitro fertilization (IVF) with embryonic cryopreservation treatment., Methods: Cases were pregnancies after IVF-ET with embryonic cryopreservation; controls were spontaneously conceived pregnancies. Subgroup analysis was carried out according to etiology of infertility. The IVF treatment group was divided into 5 subgroups according to infertility etiology as follows: ovulation disorder, tubal disease, male infertility, endometriosis, and mixed infertility. Data on demographic characteristics, medical history, laboratory tests, and delivery were reviewed. Logistic regression analysis was performed for pregnancy and perinatal complications and neonatal outcomes. The multivariable model was adjusted for potential confounders., Results: Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies were associated with significant increases in the rates of the following: gestational diabetes mellitus (GDM) (aOR 1.76[95% CI 1.33-2.33]), preeclampsia (2.60[1.61-4.20]), preterm preeclampsia (4.52[2.03-10.06]), postpartum hemorrhage (1.57[1.04-2.36]), intrahepatic cholestasis of pregnancy (3.84[1.06-13.94]), preterm premature rupture of membranes (2.11[1.17-3.81]), preterm birth (1.95[CI 1.26-3.01]), low birthweight (1.90[1.13-3.20]), macrosomia (1.53[1.03-2.27]), and neonatal intensive care unit (NICU) admission (1.69[1.22-2.34]) in the ovulation disorder group; GDM (1.50[1.21-1.86]), placenta previa (2.70[1.59-4.59]), placenta accreta (1.78[1.10-2.89]), postpartum hemorrhage (1.61[1.19-2.18]), macrosomia (1.60[1.21-2.13]) and 5-min Apgar score ≤ 7 (4.09[1.04-16.08]) in the tubal disease group; placenta previa (9.33[4.22-20.62]), small for gestational age (2.29[1.04-5.08]), macrosomia (2.00[1.02-3.95]) and NICU admission (2.35[1.35-4.09]) in the endometriosis group; placenta previa (4.14[2.23-7.68]) and placenta accreta (2.05[1.08-3.87]) in the male infertility group; and GDM (1.85[1.15-2.98]), placenta previa (4.73[1.83-12.21]), placental abruption (3.39[1.20-9.56]), chorioamnionitis (2.93[1.04-8.26]), preterm birth (2.69[1.41-5.15]), and 1-min Apgar score ≤ 7 (4.68[1.62-13.51]) in the mixed infertility group. Among multiple pregnancies, most of the differences that were significant in singleton pregnancies were less extensive or had disappeared., Conclusions: Infertility etiology within the IVF population was found to affect maternal and neonatal outcomes among all births. During the perinatal period, infertility etiology appears to be an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques compared with spontaneous pregnancies. Higher risk was found for ovulation disorders, and lower risk was found for male infertility.