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Variational modal decomposition (VMD) has proven to be an effective technique for improving the accuracy of runoff prediction and has been widely used in runoff analysis and prediction. However, the presence of noise and outliers can complicate the runoff decomposition, so obtaining purely stochastic and deterministic components is difficult. Therefore, exploring the chaotic properties of the components obtained from decomposition can provide a new perspective to reveal intrinsic variability patterns and enhance our understanding of the unity of determinism and stochasticity. In this study, a two-stage VMD framework is proposed to decompose the monthly runoff, with the chaotic characteristics analyzed by employing an unthreshold recurrence plot and the largest Lyapunov exponent. Additionally, a chaotic prediction model is developed using phase space reconstruction, Volterra filter, and wavelet neural network methodologies. The model is validated using monthly runoff data from four stations in the Yellow River Basin, China. The results demonstrate that, although the VMD method effectively isolates trend components in monthly runoff, it still exhibits challenges in separating periodic and random elements, leading to the identification of chaotic components characterized by the amalgamation of periodicity and randomness. Notably, the two-stage VMD-phase space reconstruction-Volterra-wavelet neural networks model outperforms the VMD-phase space reconstruction-Volterra-wavelet neural networks model, with a substantial increase in Nash–Sutcliffe efficiency during validation, rising from an average of 0.9271–0.9508 and reaching a maximum of 0.96 across the four stations. Overall, this study demonstrates the potential of VMD for improving the monthly runoff prediction accuracy and elucidates the interplay between determinism and stochasticity in runoff analysis, offering valuable insights for further research in this area. [ABSTRACT FROM AUTHOR]

Background: Magnesium (Mg) is both an essential macro-element and a known catalyst, and it plays a vital role in various physiological activities and mechanisms in relation to chronic kidney disease (CKD). However, epidemiological evidence involving this is limited and not entirely consistent. This study aims to explore the association of serum Mg concentrations with the risk of CKD among general Chinese adults. Methods: A total of 8,277 Chinese adults were included in the wave of 2009 from the China Health and Nutrition Survey (CHNS). The primary outcome was the risk of CKD, which was defined as the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multivariable logistic regression model was used to examine the relationship of serum Mg concentrations with the risk of CKD. Results: Included were 8,277 individuals, with an overall CKD prevalence of 11.8% (n = 977). Compared with the first quartile of serum Mg, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for participants in the second, third, and fourth quartiles of serum Mg were 0.74 (0.58, 0.93), 0.87 (0.69, 1.11) and 1.29 (1.03, 1.61), respectively. Similar results were observed in our several sensitivity analyses. Restricted cubic spline analysis demonstrated a nonlinear (similar "J"-shaped) association between serum Mg concentrations and the risk of CKD (Pnonlinearity <0.001), with a threshold at around a serum Mg value of 2.2 mg/dL. Conclusions: Our results suggested a similar "J"-shaped association between serum Mg concentration and the risk of CKD among Chinese adults. Further large prospective studies are needed to verify these findings. [ABSTRACT FROM AUTHOR]

The associations between several blood inflammatory indicators and risk of vascular plaques remain inconclusive. A total of 4596 native rural residents in Southeast China were enrolled from the Fuqing cohort study. Blood cell counts and their composite indexes including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and 2 novel indicators (systemic immune inflammation index (SII) and systemic immune inflammation response index (SIRI)) were considered as inflammatory indicators. Common carotid and femoral intima-media thickness (IMT) and plaques were assessed using B-mode ultrasound. Unconditional or multinomial logistic regression was used to evaluate potential associations. The prevalence of multiple femoral plaques (defined as IMT ≥1.5 mm) was significantly higher among participants with the highest tertile of total leukocyte count (odds ratio, 1.78), neutrophil count (1.88), monocyte count (2.51), platelet count (1.68), NLR (1.93), PLR (1.57), SII (2.10), and SIRI (2.94). Higher levels of neutrophil count, platelet count, NLR, and SII were also found to have significant linear dose-response relationships with the prevalence of stenosis, especially in femoral arteries. In conclusion, several blood inflammatory biomarkers may contribute to, or are associated with, the presence of IMT ≥1.5 mm or stenosis especially in femoral arteries. [ABSTRACT FROM AUTHOR]

Spaceborne solar-induced chlorophyll fluorescence (SIF) products have emerged over the past decade. However, limited by the spatial-temporal mismatch between satellite-based and ground measurements or the absence of sufficient in situ SIF observations, no direct validation results of satellite-derived SIF products have been provided to date. The Orbiting Carbon Observatoty-2/3 (OCO-2/3) platforms allow us to validate SIF products using in situ SIF observations benefiting from comparable spatial resolution (1.3 km × 2.25 km and 1.6 km × 2.2 km, respectively) to ground measurements. In addition, the automated in situ SIF measurement technique facilitates accuracy validation of spaceborne SIF dataset. In this communication, we describe a direct validation of OCO-2/3 SIF products using tower-based SIF measurements acquired at six sites across China. There were 1–7 and 1–18 successful observations overpassing six in situ sites for OCO-2 and OCO-3, respectively. An overall consistent temporal variation pattern was observed between the OCO-2/3 SIF products and tower-based SIF measurements. The validation accuracies of OCO-2 and OCO-3 SIF products were 0.26 and 0.33 mW m−2 sr−1 nm−1, respectively. To best use satellite-based SIF products in a wide range of applications, we suggest that further accuracy validation using more in situ SIF observations is required, which in turn requires increased availability of public in situ SIF observations. [ABSTRACT FROM AUTHOR]

Background: Although primary health care (PHC) has been proven to be effective in preventing and treating chronic diseases, the visits rate of PHC institutions is still not ideal. Some patients initially express a willingness to visit PHC institutions but end up seeking health services at non-PHC institutions, and the reasons for this behavior remain unclear. Therefore, the objective of this study is to analyze the factors that contribute to behavioral deviations among chronic disease patients who originally intended to visit PHC institutions. Methods: Data were collected from a cross-sectional survey among chronic disease patients with original intention to visit PHC institutions in Fuqing City, China. The analysis framework was guided by Andersen's behavioral model. Logistic regression models were employed to analyze the factors affecting the behavioral deviations among chronic disease patients with a willingness to visit PHC institutions. Results: A total of 1,048 individuals were finally included and about 40% of the participants with the original willingness to seek care from PHC institutions finally chose non-PHC institutions in their subsequent visits. The results of logistic regression analyses indicated that at the predisposition factor level, older participants (aOR60-69 = 0.602, P < 0.01; aOR70-75 = 0.475, P < 0.01) were less likely to have behavioral deviations. At the enabling factor level, compared to those covered by Urban Employee Basic Medical Insurance (UEBMI) and not reimbursed, those covered by Urban–Rural Resident Basic Medical Insurance (URRBMI) (aOR = 0.297, P < 0.01), and those answering that reimbursement from medical institutions was convenient (aOR = 0.501, P < 0.01) or very convenient (aOR = 0.358, P < 0.001) were less likely to have behavioral deviations. At the need factor level, participants who visited PHC institutions due to illness last year (aOR = 0.348, P < 0.001) and with polypharmacy (aOR = 0.546, P < 0.01) were less likely to have behavioral deviations compared to those without the visit of PHC institutions and not taking polypharmacy, respectively. Conclusions: The deviations between the original willingness of PHC institution visits and subsequent behavior among chronic disease patients were associated with a number of predisposing, enabling, and need factors. Developing the health insurance system, strengthening the technical capacity of PHC institutions, and steadily developing a new concept of orderly healthcare-seeking behavior among chronic disease patients, will help promote their access to PHC institutions as well as improve the effectiveness of the tiered medical system for chronic disease care. [ABSTRACT FROM AUTHOR]

Background: Emerging data suggest that the interpretation of the association between obesity and lipids appears to be oversimplified. This study aimed to quantify the complex relationships between anthropometric indices and lipid profile. Methods: This is a cross-sectional study including 9620 participants in Southern China. Anthropometric indices included the indices of general obesity (ie, body mass index (BMI)) and central obesity (ie, waist circumference (WC) and waist-to-hip ratio (WHR)). Lipids included low-density lipoprotein cholesterol (LDLc) and atherogenic lipids (ie, high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and TG/HDLc ratio). LOESS regression and general linear model were the main statistical methods. Results: Almost all associations between anthropometric indices and lipids were lost in obese adults. The loss of association occurred quicker with LDLc than that with atherogenic lipids; the break point for the association loss was at BMI of 24 kg/m2 with LDLc (Slope Below break-point = 1.81, P< 0.001; Slope Above break-point = 0.29, P=0.121), while at 28 kg/m2 with HDLC (Slope Below break-point = − 1.41, P< 0.001; Slope Above break-point = 0.07, P=0.666) or TG (Slope Below break-point = 4.96, P< 0.001; Slope Above break-point = 2.93, P=0.01), and at 30 kg/m2 with TG/HDLc ratio (Slope Below break-point = 0.15, P< 0.001; Slope Above break-point= 0.01, P=0.936), respectively. Similar relationships were found for WC and WHR. Besides, the presence of other metabolic disorders contributed to the loss of anthropometry-lipids relationships, for example, the BMI-LDLc association attenuated to null in both obese adults and non-obese population but with more than one other metabolic disorders. Conclusion: The relationships were lost between anthropometric indices and lipids in obese adults with different break points across different lipids, which appeared to be dependent on metabolic status. [ABSTRACT FROM AUTHOR]

Numerous validation efforts have been conducted over the last decade to assess the accuracy of global leaf area index (LAI) products. However, such efforts continue to face obstacles due to the lack of sufficient high-quality field measurements. In this study, a fine-resolution LAI dataset consisting of 80 reference maps was generated during 2003–2017. The direct destructive method was used to measure the field LAI, and fine-resolution LAI images were derived from Landsat images using semiempirical inversion models. Eighty reference LAI maps, each with an area of 3 km × 3 km and a percentage of cropland larger than 75%, were selected as the fine-resolution validation dataset. The uncertainty associated with the spatial scale effect was also provided. Ultimately, the fine-resolution reference LAI dataset was used to validate the Moderate Resolution Imaging Spectroradiometer (MODIS) LAI product. The results indicate that the fine-resolution reference LAI dataset builds a bridge to link small sampling plots and coarse-resolution pixels, which is extremely important in validating coarse-resolution LAI products. Measurement(s) leaf area index Technology Type(s) destructive sampling method Sample Characteristic - Environment area of cropland Sample Characteristic - Location China Machine-accessible metadata file describing the reported data: https://doi.org/10.6084/m9.figshare.15124524 [ABSTRACT FROM AUTHOR]

The key to studying urban sustainable development depends on quantifying stores, efficiencies of urban metabolisms and capturing urban metabolisms' mechanisms. This paper builds up the metabolic emergy account and quantifies some important concepts of emergy stores. Emphasis is placed on the urban metabolic model based on the slack based model (SBM) method to measure urban metabolic efficiencies. Urban metabolic mechanisms are discussed by using the regression method. By integrating these models, this paper analyzes the urban metabolic development in Beijing from 2001 to 2010. We conclude that the metabolic emergy stores of Beijing increased significantly from 2001 to 2010, with the emergy imported accounting for most of the increase. The metabolic efficiencies in Beijing have improved since the 2008 Olympic Games. The population, economic growth, industrial structures, and environmental governance positively affect the overall urban metabolism, while the land expansion, urbanization and environmentally technical levels hinder the improving of urban metabolic efficiencies. The SBM metabolic method and the regression model based on the emergy analysis provide insights into the urban metabolic efficiencies and the mechanism. They can promote to integrate such concepts into their sustainability analyses and policy decisions. [ABSTRACT FROM AUTHOR]

During the 2012 London Olympics, a spontaneous movement to 'ignite positive energy' emerged in Chinese social media from the massive and fervent support for the Chinese grassroots torch bearers. This grassroots-oriented movement has generated a 'transcendental Chinese patriotism', in which patriotism is intertwined with individualism, transnationalism, and universalism. The ideal and sentiment of this hybrid Chinese patriotism forms a stark contrast to the mainstream 'Chinese nationalism', which has been characterized by scholars as various forms of reactive collectivism derived from state authority, Confucian tradition, and the wounded memories of China's recent history. This online movement has also demonstrated an impressive efficacy in shaping the socio-political landscape of China beyond transforming Chinese nationalism. [ABSTRACT FROM AUTHOR]

This article examines the ways in which some star-crossed lovers reconcile their romantic attachments and social constraints through life-and-death negotiation of the gender ideals among the Lahu of Lancang, Southwest China. While the prevailing Lahu ideal of the husband-wife dyad (in which the married pair functions as a single social entity) fosters gender equality and marital stability and harmony, the dyad ideal also models romantic expressions through the ritualized singing of courtship songs that ordinarily lead to a marriage. The gaps between the dyadic ideology and its practice, which have been drastically magnified since the Chinese state introduced radical social changes in the 1950s, have significantly increased both dysfunctional marriages and extramarital relationships. This article explores the diverse patterns in which some individuals appropriate the courtship singing sessions to both express their socially disapproved romance and to resolve their dilemma caused by personal romantic longings that contradict social obligations. Resolving these dilemmas typically involves compromising romance for socially acceptable intimacy, committing double suicide in order to marry each other in the afterlife, or choosing separate paths (in which one member of the couple commits suicide and the other does not). The author argues that couples who jointly choose either life apart or love together in the afterlife do so with oneness in thought and mind, simultaneously challenging and reinforcing the ideal of the husband-wife dyad. In contrast, those who commit love-suicide alone push the boundaries of the dyadic ideal to the extreme. [ABSTRACT FROM AUTHOR]

In this study, PM2.5 was analyzed for heavy metals at two sites in industrial northeast China to determine their sources and human health risks during heating and non-heating periods. A positive matrix factorization (PMF) model determined sources, and US Environmental Protection Agency (USEPA) and entropy weight methods were used to assess human health risk. PM2.5 heavy metal concentrations were higher in the heating period than in the non-heating period. In the heating period, coal combustion (59.64%) was the primary heavy metal source at Huagong Hospitals, and the contribution rates of industrial emissions and traffic emissions were 21.06% and 19.30%, respectively. Industrial emissions (42.14%) were the primary source at Xinqu Park, and the contribution rates of coal combustion and traffic emissions were 34.03% and 23.83%, respectively. During the non-heating period, coal combustion (45.29%) and industrial emissions 45.29% and 44.59%, respectively, were the primary sources at Huagong Hospital, and the traffic emissions were 10.12%. Industrial emissions (43.64%) were the primary sources at Xinqu Park, where the coal combustion and traffic emissions were 25.35% and 31.00%, respectively. In the heating period, PM2.5 heavy metals at Xinqu Park had noncarcinogenic and carcinogenic risks, and the hazard index of children (5.74) was higher than that of adult males (5.28) and females (4.49). However, adult males and females had the highest lifetime carcinogenic risk (1.38 × 10−3 and 1.17 × 10−3) than children (3.00 × 10−4). The traditional USEPA and entropy weight methods both produced reasonable results. However, when there is a difference between the two methods, the entropy weight method is recommended to assess noncarcinogenic health risks. [ABSTRACT FROM AUTHOR]

Solar-induced chlorophyll fluorescence (SIF) is regarded as a proxy for photosynthesis in terrestrial vegetation. Tower-based long-term observations of SIF are very important for gaining further insight into the ecosystem-specific seasonal dynamics of photosynthetic activity, including gross primary production (GPP). Here, we present the design and operation of the tower-based automated SIF measurement (SIFSpec) system. This system was developed with the aim of obtaining synchronous SIF observations and flux measurements across different terrestrial ecosystems, as well as to validate the increasing number of satellite SIF products using in situ measurements. Details of the system components, instrument installation, calibration, data collection, and processing are introduced. Atmospheric correction is also included in the data processing chain, which is important, but usually ignored for tower-based SIF measurements. Continuous measurements made across two growing cycles over maize at a Daman (DM) flux site (in Gansu province, China) demonstrate the reliable performance of SIF as an indicator for tracking the diurnal variations in photosynthetically active radiation (PAR) and seasonal variations in GPP. For the O2–A band in particular, a high correlation coefficient value of 0.81 is found between the SIF and seasonal variations of GPP. It is thus concluded that, in coordination with continuous eddy covariance (EC) flux measurements, automated and continuous SIF observations can provide a reliable approach for understanding the photosynthetic activity of the terrestrial ecosystem, and are also able to bridge the link between ground-based optical measurements and airborne or satellite remote sensing data. [ABSTRACT FROM AUTHOR]

Background: Workplace may not only increase the risk of heat-related illnesses and injuries but also compromise work efficiency, particularly in a warming climate. This study aimed to utilize machine learning (ML) and deep learning (DL) algorithms to quantify the impact of temperature discomfort on productivity loss among petrochemical workers and to identify key influencing factors., Methods: A cross-sectional face-to-face questionnaire survey was conducted among petrochemical workers between May and September 2023 in Fujian Province, China. Initial feature selection was performed using Lasso regression. The dataset was divided into training (70%), validation (20%), and testing (10%) sets. Six predictive models were evaluated: support vector machine (SVM), random forest (RF), extreme gradient boosting (XGBoost), Gaussian Naive Bayes (GNB), multilayer perceptron (MLP), and logistic regression (LR). The most effective model was further analyzed with SHapley Additive exPlanations (SHAP)., Results: Among the 2393 workers surveyed, 58.4% (1,747) reported productivity loss when working in high temperatures. Lasso regression identified twenty-seven predictive factors such as educational level and smoking. All six models displayed strong prediction accuracy (SVM = 0.775, RF = 0.760, XGBoost = 0.727, GNB = 0.863, MLP = 0.738, LR = 0.680). GNB model showed the best performance, with a cutoff of 0.869, accuracy of 0.863, precision of 0.897, sensitivity of 0.918, specificity of 0.715, and an F1-score of 0.642, indicating its efficacy as a predictive tool. SHAP analysis showed that occupational health training (SHAP value: -3.56), protective measures (-2.61), and less physically demanding jobs (-1.75) were negatively associated with heat-attributed productivity loss, whereas lack of air conditioning (1.92), noise (2.64), vibration (1.15), and dust (0.95) increased the risk of heat-induced productivity loss., Conclusions: Temperature discomfort significantly undermined labor productivity in the petrochemical sector, and this impact may worsen in a warming climate if adaptation and prevention measures are insufficient. To effectively reduce heat-related productivity loss, there is a need to strengthen occupational health training and implement strict controls for occupational hazards, minimizing the potential combined effects of heat with other exposures., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Fujian Medical University, with approval number (2022–111). All participants provided written informed consents before participating in the study. The research was conducted in accordance with the ethical guidelines and principles outlined in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Aims: Although central adiposity is a well-known risk factor for diabetes, the underlying mechanism remains unclear. The aim of this study was to explore the potential mediation role of circulating WBC counts in the association between central adiposity and the risk of diabetes., Materials and Methods: A cross-sectional study was conducted using data from the Fuqing cohort study, which included 6,613 participants aged 35-75 years. Logistic regression analysis and Spearman's rank correlation analysis were used to examine the relationships between waist-to-hip ratio, WBC counts and glycemic status. Both simple and parallel multiple mediation models were used to explore the potential mediation effects of WBCs on the association of waist-to-hip ratio with diabetes., Results: The study revealed a positive relationship between waist-to-hip ratio and risk of prediabetes (OR = 1.53; 95% CI, 1.35 to 1.74) and diabetes (OR = 2.89; 95% CI, 2.45 to 3.40). Moreover, elevated peripheral WBC counts were associated with both central adiposity and worsening glycemic status (P < 0.05). The mediation analysis with single mediators demonstrated that there is a significant indirect effect of central adiposity on prediabetes risk through total WBC count, neutrophil count, lymphocyte count, and monocyte count; the proportions mediated were 9.92%, 6.98%, 6.07%, and 3.84%, respectively. Additionally, total WBC count, neutrophil count, lymphocyte count, monocyte count and basophil count mediated 11.79%, 11.51%, 6.29%, 4.78%, and 1.76%, respectively, of the association between central adiposity and diabetes. In the parallel multiple mediation model using all five types of WBC as mediators simultaneously, a significant indirect effect (OR = 1.09; 95% CI, 1.06 to 1.14) were observed, with a mediated proportion of 12.77%., Conclusions: Central adiposity was independently associated with an elevated risk of diabetes in a Chinese adult population; levels of circulating WBC may contribute to its underlying mechanisms., (© 2024. The Author(s).)

Background: The current absence of a standardized mandibular body osteotomy design poses challenges in surgical planning. Traditional approaches may not suit patients with wider anterior mandibles, potentially resulting in unsatisfactory outcomes. Addressing this issue requires a rational design that combines mandibular angle and body osteotomies for improved clinical practice., Objectives: In this retrospective cohort study we aimed to analyze mandibular computed tomography (CT) data with digital methods. The goal was to establish an integrated osteotomy design for both mandibular angle and body procedures and classify prevalent mandibular types in the Chinese Han population for surgical guidance., Methods: Included were 89 patients who underwent mandibular angle osteotomy without genioplasty between 2016 and 2022 at Peking University Third Hospital. Mimics 21.0 software facilitated CT data reconstruction and osteotomy planning. Postoperative effects were assessed through imaging, complications, and surveys, leading to mandibular type classification., Results: Mandibular angles were categorized by 3 types, based on osteotomy range. Type I involved mandibular body osteotomy only, type II mandibular angle osteotomy only, and type III both mandibular angle and body osteotomies. Distribution within the cohort was 2.25%, 8.99%, and 88.76% for types I, II, and III respectively. Patient satisfaction was high, with minor and major complications at 47.19% and 1.12% by Clavien-Dindo classification., Conclusions: Utilizing Mimics software, we established an integrated osteotomy design and categorized mandibular types. Findings offer valuable guidance for mandibular angle surgery and contribute to understanding of Asian mandibular morphology., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: Variations in the prevalence and systemic inflammatory (SI) status between non-alcoholic fatty liver disease (NAFLD) and newly defined metabolic dysfunction-associated fatty liver disease (MAFLD) have only been reported by few studies. Hence, this study aimed to compile data on the prevalence and the systemic inflammation levels of MAFLD and NAFLD in a general population from Southeast China was summarized to explore the potential effect of the transformation of disease definition., Methods: A total of 6718 general population participants aged 35-75 were enrolled. Logistic regression and restricted cubic spline (RCS) models were used to examine the relationship between 15 SI indicators and NAFLD and MAFLD. The predicted values of MAFLD and NAFLD were analyzed using the receiver operating characteristic (ROC) curve., Results: The prevalence of MAFLD and NAFLD was 34.7% and 32.4%, respectively. Their overlapping rate was 89.7%, while only 8.3% and 1.9% of participants were MAFLD-only and NAFLD-only. Among three FLD groups, the MAFLD-only group had the highest levels of 8 SI indicators, including CRP, WBC, LYMPH, NEUT, MONO, ALB, NLR, and SIRI. The non-FLD group had the lower levels of all 15 SI indicators compared with all FLD subgroups. The odds ratios (ORs) of 10 SI indicators were significant in both multivariable-adjusted logistic regression and RCS analyses of MAFLD or NAFLD, including CRP, WBC, LYMPH, NEUT, MONO, ALB, PLR, LMR, ALI and CA. ROC analysis showed that the AUC values of all SI were lower than 0.7 in both MAFLD and NAFLD., Conclusions: MAFLD could cover more FLD than NAFLD, and the MAFLD-only group had a more severe inflammation status, whereas the NAFLD-only exhibited lower levels. Moreover, there was not a high AUC and a high sensitivity of SI indicators, suggesting that SI indicators are not good indicators to diagnose NAFLD/MAFLD., (© 2023. The Author(s).)

In recent years, the perpendicular plate of the ethmoid (PPE) has emerged as a new autogenous grafting material in rhinoplasty and septoplasty of nasal deviation. However, no studies have outlined the precise size, shape, and morphologic features of the PPE. Therefore, this study aimed to provide detailed information on the anatomical and morphologic characteristics of the PPE to assist surgeons in performing surgeries that are more precise. About 104 Chinese patients who underwent paranasal computed tomography were assessed in this study. By analyzing the features of the PPE reconstructed with 3-dimensional models, the characteristics of the PPE at different stages of development and according to sex were observed. The PPE had a flat shape, and its lower part was relatively thin. It usually developed horizontally with age, which contributed to expansion of the PPE area. The dimensions of the PPE were significantly larger in male patients than in female patients. Through the reconstruction and measurement of Chinese patients' PPE, the authors have established precise information about the PPE's anatomical and morphologic features. The flat shape and proper size, which are similar to those of nasal septum cartilage, make the PPE an ideal alternative to conventional autogenous grafting materials. The findings might be useful to surgeons in helping them perform surgeries that are more precise.

Aims/hypothesis: The association between dietary Mn and type 2 diabetes is unclear. We aimed to elucidate whether dietary Mn is associated with type 2 diabetes, to investigate whether this association is independent of dietary total antioxidant capacity (TAC) and to explore the underlying mechanisms in their association., Methods: Two prospective cohorts of 3350 and 7133 Chinese adults (20-74 years old) were enrolled including, respectively, 244 and 578 individuals newly diagnosed with type 2 diabetes, with mean values of 4.2 and 5.3 years of follow-up. Cox's proportional-hazards regression and linear regression were performed to investigate the association between dietary Mn and type 2 diabetes (diagnosed by OGTT) or HbA lc and to analyse the joint association between dietary Mn and TAC. Restricted cubic spline (RCS) regression was applied to the non-linear association between dietary Mn and incidence of type 2 diabetes. Mediation analysis was applied to explore potential mediators in their association in a subgroup of 500 participants., Results: Dietary Mn intakes were 4.58 ± 1.04 and 4.61 ± 1.08 (mean ± SD) mg/day in the two cohorts. Dietary Mn was inversely associated with type 2 diabetes incidence and HbA lc concentration in both cohorts (p trend  < 0.01 and <0.01 for type 2 diabetes, and p trend  < 0.01 and =0.02 for HbA lc , respectively, in each cohort) independent of TAC, adjusted for age, sex, BMI, tobacco use, alcohol consumption, physical activity, diabetes inheritance, total energy, carbohydrate, total fatty acids, fibre, calcium, Mg, hypertension, hyperlipidaemia, and impaired glucose tolerance or FBG (all at baseline). Their inverse association was stronger in the presence of diets with high, compared with low, TAC. In RCS, intakes of >6.01 and 6.10-6.97 mg/day were associated with a significantly lower type 2 diabetes incidence in the two respective cohorts. Mediation analysis showed that high plasma Mn and low oxidative stress (increased Mn superoxide dismutase and decreased 8-hydroxydeoxyguanosine) contributed to the association between dietary Mn and both type 2 diabetes and HbA lc ., Conclusions/interpretation: Dietary Mn was inversely associated with type 2 diabetes independently of TAC. In addition, this association was stronger in a high- rather than low-TAC diet. Plasma Mn and oxidative stress were mediators in the association between dietary Mn and type 2 diabetes. Future studies on absolute Mn intake should be conducted to study the potential non-linearity and optimal levels of dietary Mn and type 2 diabetes.

The evidence on the association between long-term low-carbohydrate, high-fat and high-protein diets and type 2 diabetes (T2D) is controversial. Until now, data is limited for Chinese populations, especially in considering the influence of extra energy intake. In this paper, we aimed to investigate the association of low-carbohydrate, high-fat and high-protein diets with type 2 diabetes (T2D) risk in populations consuming extra calories and those with normal caloric intake, We also determined whether the association is mediated by insulin resistance (IR) or β-cell dysfunction. A total of 3644 subjects in the Harbin People's Health Study (Cohort 1, 2008-2012) and 7111 subjects in the Harbin Cohort Study on Diet, Nutrition and Chronic Non-Communicable Diseases (Cohort 2, 2010-2015) were analyzed, with a median follow-up of 4.2 and 5.3 years, respectively. Multivariate relative risks (RRs) and their 95% confidence intervals (95% CIs) were calculated to estimate the association between low-carbohydrate, high-fat and high-protein diet and T2D in logistic regression models. The multivariate RRs (95% CIs) were 1.00, 2.24 (1.07, 4.72) and 2.29 (1.07, 4.88) ( P trend = 0.04), and 1.00, 1.45 (0.91, 2.31) and 1.64 (1.03, 2.61) ( P trend = 0.04) across tertiles of low-carbohydrate, high-fat and high-protein diet scores in the population consuming extra calories in Cohort 1 and Cohort 2, respectively. The association was no longer significant after adjustment for livestock and its products, or poultry and its products. The mediation analysis discovered that this association in the population consuming extra calories was insulin resistance mediated, in both Cohort 1 and Cohort 2. However, the association was not significant among participants overall and participants with normal caloric intake. Our results indicated that long-term low-carbohydrate, high-fat and high-protein diets were associated with increased T2D risk among the population consuming extra calories, which may be caused by higher intake of animal-origin fat and protein as well as lower intake of vegetables, fruit and fiber. Additionally, the association was mediated by IR. In the population consuming extra calories, reducing the intake of livestock, poultry and their products and increasing the intake of vegetables, fruit and fiber might protect this population from developing T2D., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Background: Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV coinfected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pretreatment HBV DNA., Methods: Prospective study of 151 Chinese HIV/HBV coinfected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance., Results: Baseline HBV DNA ≥20,000 IU/mL was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P = 0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these 2 groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P > 0.999) in subjects with baseline HBV DNA <20,000 IU/mL; whereas in those with baseline HBV DNA ≥20,000 IU/mL, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P = 0.002). In stratified multivariate regression, TDF use (RR 1.98, P = 0.010) and baseline HBV DNA (per 1 log increase in International Units Per Milliliter, RR 0.74, P < 0.001) were associated with HBV DNA suppression only when baseline HBV DNA ≥20,000 IU/mL., Conclusion: This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV coinfection when baseline HBV DNA <20,000 IU/mL. Studies with long-term follow-up are warranted to determine if this finding persists.

HIV increases the risk of liver disease as do two common coinfections, hepatitis B and C viruses (HBV and HCV). However, whether combination antiretroviral therapy (cART) reverses or exacerbates hepatic fibrosis remains unclear.This was an observational retrospective study. cART-naïve HIV-infected subjects without a history of substance abuse (including alcohol) had liver disease stage determined by aspartate aminotransferase-to-platelet ratio indices (APRIs) and fibrosis-4 (FIB-4) before and 24 and 48 weeks after cART. All the data were retrieved from previously established cohorts. Values before and after cART were compared using Wilcoxon test for paired samples. Regression analyses were used to determine factors associated with moderate-to-severe liver disease.Of the 1105 HIV-infected subjects, 120 were HBV coinfected and 64 were HCV coinfected. About 20% of HIV monoinfected participants had APRI and FIB-4 scores consistent with moderate-to-significant fibrosis compared to ∼36% of HIV-HBV coinfected and 67% to 77% of HIV-HCV coinfected participants. In adjusted analyses compared with HIV monoinfection, HBV coinfection was associated with 1.18-fold higher APRI (P < 0.001) and a 1.12-fold higher FIB-4 (P = 0.007) prior to cART; while HCV coinfection was associated with 1.94-fold higher APRI (P < 0.001) and a 1.43-fold higher FIB-4 (P < 0.001). After 48 weeks of cART, both fibrosis scores decreased in all subjects; however, HCV coinfection was still associated with higher fibrosis scores at week 48 compared to HIV monoinfection.cART was associated with improvement in hepatic fibrosis scores in the majority of HIV-hepatitis coinfected and HIV-monoinfected Chinese participants.

The evidence about the effect of dietary patterns on blood cholesterol from cohort studies was very scarce. The study was to identify the association of dietary patterns with lipid profile, especially cholesterol, in a cohort in north China. Using a 1-year food frequency questionnaire, we assessed the dietary intake of 4515 adults from the Harbin People's Health Study in 2008, aged 20-74 years. Principle component analysis was used to identify dietary patterns. The follow-up was completed in 2012. Fasting blood samples were collected for the determination of blood lipid concentrations. Logistic regression models were used to evaluate the association of dietary patterns with the incidence of hypercholesterolemia, hypertriglyceridemia, and low-HDL cholesterolemia. Five dietary patterns were identified ("staple food", "vegetable, fruit and milk", "potato, soybean and egg", "snack", and "meat"). The relative risk (RR) between the extreme tertiles of the snack dietary pattern scores was 1.72 (95% CI = 1.14, 2.59, P = 0.004) for hypercholesterolemia, 1.39 (1.13, 1.75, P = 0.036) for hypertriglyceridemia, after adjustment for age, sex, education, body mass index, smoking, alcohol consumption, energy intake, exercise and baseline lipid concentrations. There was a significant positive association between the snack dietary pattern scores and fasting serum total cholesterol (SRC (standardized regression coefficient) = 0.262, P = 0.025), LDL-c (SRC = 0.324, P = 0.002) and triglycerides (SRC = 0.253, P = 0.035), after adjustment for the multiple variables above. Moreover, the adjusted RR of hypertriglyceridemia between the extreme tertiles was 0.73 (0.56, 0.94, P = 0.025) for the vegetable, fruit and milk dietary pattern, and 1.86 (1.33, 2.41, P = 0.005) for the meat dietary pattern. The snack dietary pattern was a newly emerged dietary pattern in northern Chinese adults. It appears conceivable that the risk of hypercholesterolemia can be reduced by changing the snack dietary pattern.

Background: The diagnosis of sarcoidosis is still a significant challenge in China because of the need to exclude other diseases including granulomatous infections and malignancies that may be clinically and radiographically similar. The specific aim of the study is to search for serum protein biomarkers of sarcoidosis and to validate their clinical usefulness in differential diagnosis., Methods: Serum samples were collected from patients with sarcoidosis (n = 37), and compared to those from patients with tuberculosis (n = 20), other pulmonary diseases (n = 20), and healthy volunteers (n = 20) for determination of sarcoidosis-specific or -associated protein expression profiles. The first part of this study focused on proteomic analysis of serum from patients with sarcoidosis to identify a pattern of peptides capable of differentiating the studied populations using the ClinProt profiling technology based on mass spectrometry. Enzyme Linked Immunosorbent Assay (ELISA) was then used to verify corresponding elevation of the serum protein concentration of the potential biomarkers in the same patients sets. Receiver operating characteristic curve (ROC) analyses was performed to determine the optimal cutoff value for diagnosis. Immunohistochemistry was carried out to further confirm the protein expression patterns of the biomarkers in lung tissue., Results: An unique protein peak of M/Z 3,210 Daltons (Da) was found to be differentially expressed between the sarcoidosis and control groups and was identified as the N-terminal peptide of 29 amino acids (94-122) of serum amyloid A (SAA). ELISA confirmed that the serum SAA level was significantly higher in the sarcoidosis group than that of the other 3 control groups (p < 0.05). The cutoff for serum SAA concentration determined by ROC analysis was 101.98 ng/ml, with the sensitivity and specificity of 96.3% and 52.5%, respectively. Immunohistochemical staining showed that the SAA depositions in lung tissue of the sarcoidosis patients were also significantly more intense than in non-sarcoid lung tissue (p < 0.05)., Conclusion: This is the first study to investigate serum protein markers in Chinese subjects with sarcoidosis. This study shows that the serum SAA expression profiles were different between the sarcoidosis and non-sarcoidosis groups. SAA may be a potential serum biomarker for ruling-out the diagnosis of sarcoidosis in Chinese subjects.