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Accurate aircraft turnaround time prediction is an important way to coordinate the operation time of airport ground service and improve the efficiency of airport operation. In this paper, by analyzing the aircraft turnaround operation process, a description model based on Time Transition Petri Net is proposed. The model describes the flight turnaround operation process and the logical relationship of the operation. According to the model, a dynamic prediction method of turnaround time based on Bayesian theorem is designed. According to the actual landing time of the flight, the aircraft turnaround time is predicted. The specific method is to obtain the prior probability distribution and joint distribution law of each operation link according to the flight history data, and use Shapiro-Wilke to test the prior probability distribution of each link. Based on the analysis and comparison between the actual turnaround data of a large airport in China and the forecast data proposed in this paper, the root-mean-square error 3.75 minutes and the mean absolute error 3.40 minutes can be calculated. This paper contributes to the improvement of flight punctuality rate and airport clearance level. [ABSTRACT FROM AUTHOR]

Background: Benevolent leadership is common in organizations, including hospitals, and is known to have positive effects on employees. Yet, nursing literature lacks sufficient research on its relationships with nurses' behavior. Methods: In March to April 2022, a cross-sectional study was carried out involving 320 nurses employed across various hospitals in Sichuan Province, China. Benevolent leadership, affective commitment, work engagement, and helping behavior were evaluated using the Benevolent Leadership Scale, Affective Commitment Scale, Work Engagement Scale, and Helping Behavior Questionnaire, respectively. The study employed structural equation model and the bootstrap method to investigate the proposed relationships. Results: The SEM analysis results indicated a positive association between benevolent leadership and several outcomes among nurses. Specifically, benevolent leadership was found to be positively associated with nurses' affective commitment (β = 0.58, p <.001), work engagement (β = 0.02, p <.001), and helping behavior (β = 0.17, p =.001). Additionally, there was a significant indirect effect between benevolent leadership and nurses' work engagement through affective commitment (β = 0.08, p =.007) as well as between benevolent leadership and helping behavior through affective commitment (β = 0.16, p <.001). Conclusions: This study's findings emphasize the crucial role of benevolent leadership in fostering nurses' positive attitudes and behaviors in the workplace. Hospital administrators could promote the benevolent leadership of head nurses to enhance nurses' affective commitment, work engagement, and helping behaviors. [ABSTRACT FROM AUTHOR]

Background: In September 2019, the "4 + 7" centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion. Method: A single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured. Results: After the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a "carry-over". Conclusions: These findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The "patent cliff" for branded drugs has gradually emerged. Besides, a short-term "spillover effect" of the volume of alternative drugs was observed, requiring special attention and vigilance. [ABSTRACT FROM AUTHOR]

This study determined the value of mixed-reality (MR) technology for doctor-patient communication, preoperative planning, intraoperative navigation, and tumor localization in treating patients with breast cancer. Fifty-eight patients with breast space-occupying lesions (16 benign and 42 malignant) who underwent breast lumpectomy at the People's Liberation Army General Hospital of China were included in this study. The patients were randomly divided into the MR group and the computed tomography (CT) group. In the MR group, a 3D reconstruction of whole-breast ultrasound was used to localize the spatial position of the breast lesion and was combined with the 3D reconstruction of breast MRI to determine the lesion boundaries. To improve the preciseness of surgery, a postoperative survey was conducted. The MR group exhibited a higher level of patient knowledge regarding the disease, treatment, and diagnosis (26.207 ± 1.698 points) than the CT group (19.228 ± 4.889 points) (T = 7.033; P < 0.01), and patient satisfaction with surgical results, treatment confidence, and communication methods (4.448 ± 0.572) was also higher than that of the CT group (3.172 4.448 ± 0.572) 0.602) P < 0.05 . In addition, doctors were significantly more satisfied with surgical planning and intraoperative localization when the MR technique was used (T = 8.273; P < 0.01). The use of MR technology in lumpectomy has improved patients' understanding of surgical procedures and surgical results and has achieved positive results. This technique may provide clinical benefits. [ABSTRACT FROM AUTHOR]

Background: There are a large number of infertile couples in China, but its treatment is notoriously expensive and not currently covered by insurance. The utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization has been debated. Objective: To investigate the cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) versus conventional technology in in vitro fertilization (IVF) from the perspective of the healthcare system in China. Methods: Following the exact steps in the IVF protocol, a decision tree model was developed, based on the data from the CESE-PGS trial and using cost scenarios for IVF in China. The scenarios were compared for costs per patient and cost-effectiveness. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Main outcome measures: Costs per live birth, Costs per patient, Incremental cost-effectiveness for miscarriage prevention. Results: The average costs per live birth of PGT-A were estimated as ¥39230.71, which is about 16.8% higher than that of the conventional treatment. Threshold analysis revealed that PGT-A would need to increase the pregnancy rate of 26.24–98.24% or a cost reduction of ¥4649.29 to ¥1350.71 to achieve the same cost-effectiveness. The incremental costs per prevented miscarriage was approximately ¥45600.23. The incremental cost-effectiveness for miscarriage prevention showed that the willingness to pay would be ¥43422.60 for PGT-A to be cost-effective. Conclusion: The present cost-effectiveness analysis demonstrates that embryo selection with PGT‑A is not suitable for routine applications from the perspective of healthcare providers in China, given the cumulative live birth rate and the high costs of PGT‑A. [ABSTRACT FROM AUTHOR]

Since the outbreak of the 2019 Coronavirus disease (COVID-19) at the end of 2019, it has caused great adverse effects on the whole world, and it has been hindering the global economy. It is ergent to establish an infectious disease model for the current COVID-19 epidemic to predict the trend of the epidemic. Based on the SEIR model, the improved SEIR models were established with considering the incubation period, the isolated population, and genetic algorithm (GA) parameter optimization method. The improved SEIR models can predict the trend of the epidemic situation better and obtain the more accurate epidemic-related parameters. Comparing some key parameters, it is capable to evaluate the impact of different epidemic prevention measures and the implementation of different epidemic prevention levels on the COVID-19, which has significant guidance for further epidemic prevention measures. [ABSTRACT FROM AUTHOR]

Objective. Acute respiratory distress syndrome (ARDS) is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process known as cytokine storm. Xuebijing injection (hereinafter referred to as Xuebijing) is a patent drug that was used to treat ARDS or severe pneumonia (SP) in China. However, its efficacy and mechanism of actions remain unclear. In this study, we used meta-analysis and network pharmacology to assess these traits of Xuebijing. Methods. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases for randomized controlled trials (RCTs) that evaluated Xuebijing therapy for ARDS or SP. The outcomes were total mortality, intensive care unit (ICU) stay time, and TNF-α and IL-6 levels. We performed a meta-analysis using RevMan 5.3 software. The putative targets, top 10 proteins, and possible pathway of Xuebinjing on ARDS were analyzed by network pharmacology. TNF-α and IL-6 were further docked with the six main active components of Xuebinjing using AutoDock 4.2.6 and PyMol 1.5.0.3 software. Results. Fifteen RCTs involving 2778 patients (13 ARDS and 2 SP) were included. Compared with the control, Xuebijing treatment significantly reduced the mortality rate (risk ratio, 0.64 (95% credible interval (CrI), 0.54–0.77)), reduced the ICU stay time (mean difference (MD), -4.51 (95% CrI, -4.97–-4.06)), reduced the TNF-α ((MD), -1.23 (95% CrI, -1.38–-1.08)) and IL-6 ((MD), -1.15 (95% CrI, -1.52–-0.78)) levels. The 56 putative targets, top 10 proteins (MAPK1 (mitogen-activated protein kinase 1), MAPK8 (mitogen-activated protein kinase 8), RELA (transcription factor p65), NFKB1 (nuclear factor NF-kappa-B p105 subunit), JUN (transcription factor AP-1), SRC (proto-oncogene tyrosine-protein kinase), TNF (tumor necrosis factor), HRAS (GTPase HRas), IL6 (interleukin-6), and APP (amyloid-beta A4 protein)), and possible pathways (Ret tyrosine kinase, IL2-mediated signaling events, CD4+/CD8+ T cell-related TCR signaling, p75(NTR)-mediated signaling, CXCR4-mediated signaling events, LPA receptor-mediated events, IL12-mediated signaling events, FAS (CD95) signaling pathway, and immune system) of Xuebinjing's action on ARDS were obtained. The molecular docking results showed that all the six components of Xuebinjing docked with TNF-α, and two components docked with IL-6 got the binding energies lower than -5. Conclusion. Our results recommended Xuebijing treatment for patients with ARDS. Xuebijing has therapeutic effects on ARDS patients partly by regulating the immune cell/cytokine pathways and thus inhibiting the cytokine storm. TNF-α is the cytokine both directly and indirectly inhibited by Xuebijing, and IL-6 is the cytokine mainly indirectly inhibited by Xuebijing. [ABSTRACT FROM AUTHOR]

Background: Oil tea is a type of traditional tea beverage used for treating various ailments in minority population in Guangxi, China. Our previous study showed oil tea improved glucose and lipid levels in type 2 diabetic mice. Yet, the underling molecular mechanisms are still not understood. This study aimed at assessing the effect of oil tea on glucose homeostasis and elucidating the molecular mechanisms underlying the oil tea-induced antidiabetic effects. Methods: Twenty seven db/db mice were gavaged with saline, metformin and oil tea for 8 weeks with measurement of biochemical profiles. A real-time2 (RT2) profiler polymerase chain reaction (PCR) array comprising 84 genes involved in glucose metabolism was measured and validated by quantitative PCR (qPCR). The association between the candidate genes and type 2 diabetes were further analyzed in a case-control study in the Chinese minority population. Results: Oil tea treatment facilitated glucose homeostasis by decreasing fasting blood glucose and total cholesterol, and improving glucose tolerance. Suppressing phosphoenolpyruvate carboxykinase 1 (PCK1) expression was observed in the oil tea treatment group and the expression was significantly correlated with fasting blood glucose levels. Target prediction and functional annotation by WEB-based GEne SeT AnaLysis Toolkit (WebGestalt) revealed that PCK1 mainly involved in the glycolysis/gluconeogenesis pathway among the top Kyoto Encyclopedia of Genes and Genomes (KEGG) database pathways. Both rs707555 and rs2071023 in PCK1 were significantly associated with type 2 diabetes in the minority population of Guangxi. Conclusion: Our findings indicated oil tea improved glucose homeostasis via down-regulation of PCK1 and PCK1 may be a genetic marker for the treatment of type 2 diabetes. [ABSTRACT FROM AUTHOR]

The optimal multimorbidity measures for predicting disability trajectories are not universally agreed upon. We developed a multimorbidity index among middle-aged and older community-dwelling Chinese adults and compare its predictive ability of disability trajectories with other multimorbidity measures. This study included 17,649 participants aged ≥50 years from the China Health and Retirement Longitudinal Survey 2011–2018. Two disability trajectory groups were estimated using the total disability score differences calculated between each follow-up visit and baseline. A weighted index was constructed using logistic regression models for disability trajectories based on the training set (70 %). The index and the condition count were used, along with the pattern identified by the latent class analysis to measure multimorbidity at baseline. Logistic regression models were used in the training set to examine associations between each multimorbidity measure and disability trajectories. C-statistics, integrated discrimination improvements, and net reclassification indices were applied to compare the performance of different multimorbidity measures in predicting disability trajectories in the testing set (30 %). In the newly developed multimorbidity index, the weights of the chronic conditions varied from 1.04 to 2.55. The multimorbidity index had a higher predictive performance than the condition count. The condition count performed better than the multimorbidity pattern in predicting disability trajectories. Self-reported chronic conditions. The multimorbidity index may be considered an ideal measurement in predicting disability trajectories among middle-aged and older community-dwelling Chinese adults. The condition count is also suggested due to its simplicity and superior predictive performance. • The present study is the first to construct a new multimorbidity index using disability trajectories as the outcome. • The multimorbidity index performed better than count- and pattern-based measures in predicting disability trajectories. • The multimorbidity index may ideally be considered when measuring multimorbidity to predict disability trajectories. • The condition count is also suggested due to its simplicity and superior predictive performance. [ABSTRACT FROM AUTHOR]

Increasing residents' commute satisfaction and subjective well-being contribute to a healthy, sustainable, and successful society. In this respect, transport mode choice is commonly recognized as one of the key factors associated with commute satisfaction and commuters' subjective well-being. However, few studies have investigated how e-moped, one of the most popular commute transport modes in China, shapes residents' commute satisfaction and subjective well-being, although e-moped ownership in China is extremely great. Thus, we conducted an empirical study on the impact of commuting by e-mopeds, using the survey data from eight residential communities in Shanghai. A path analysis model was established to investigate the relationships between commute characteristics (including commute distance, commute time, commute costs, transport mode choice, transport environment), socio-demographics, commute satisfaction, and subjective well-being. The model results showed that commute satisfaction positively correlated with commuters' subjective well-being. However, the relationship between transport mode choice and commute satisfaction was demonstrated not straightforward but fully mediated by commute time and commute costs which both showed a negative impact on commute satisfaction. In this case, using active modes was revealed to lead to a happier work commute than using private cars, whereas bus riders were at the bottom of the list as expected. Surprisingly, the use of e-mopeds resulted in the second highest total effects on the increase of commute satisfaction and subjective well-being, due to less commute time and lower commute costs. Moreover, the substitution effects of e-mopeds were examined. The results indicated that bus commuters held the most possibility to shift to e-mopeds; while, it was found hard to let e-moped users alter to the other transport modes of commuters. In this context, it was reasonable to further promote the development of e-mopeds in Shanghai, and targeted practical implications were given in this study. • E-moped is a mainstream transport mode of commuting in Shanghai, China. • How e-mopeds shape commuters' subjective well-being (SWB) is analyzed. • Commuting by e-mopeds is found to associate with the most increase in SWB. • E-moped has the largest substitution effects on city bus. • A targeted strategy for the development of e-mopeds in Shanghai is given. [ABSTRACT FROM AUTHOR]

Introduction: The GAP model was widely used as a simple risk "screening" method for patients with idiopathic pulmonary fibrosis (IPF)., Objectives: We sought to validate the GAP model in Chinese patients with IPF to evaluate whether it can accurately predict the risk for mortality., Methods: A total of 212 patients with IPF diagnosed at China-Japan Friendship Hospital from 2015 to 2019 were enrolled. The latest follow-up ended in September 2022. Cumulative mortality of each GAP stage was calculated and compared based on Fine-Gray models for survival, and lung transplantation was treated as a competing risk. The performance of the model was evaluated in terms of both discrimination and calibration., Results: The cumulative mortality in patients with GAP stage III was significantly higher than that in those with GAP stage I or II (Gray's test p < 0.0001). The Harrell c-index for the GAP calculator was 0.736 (95% CI: 0.667-0.864). The discrimination for the GAP staging system were similar with that for the GAP calculator. The GAP model overestimated the mortality rate at 1- and 2-year in patients classified as GAP stage I (6.90% vs. 1.77% for 1-year, 14.20% vs. 6.78% for 2-year)., Conclusions: Our findings indicated that the GAP model overestimated the mortality rate in mild group., (© 2022 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Objectives: This study aimed to examine and compare the associations between different multimorbidity measures and mortality among older Chinese adults., Study Design and Setting: Using the Chinese Longitudinal Healthy Longevity Survey 2002-2018, data on fourteen chronic conditions from 13,144 participants aged ≥65 years were collected. Multimorbidity measures included condition counts, multimorbidity patterns (examined by exploratory factor analysis), and multimorbidity trajectories (examined by a group-based trajectory model). Mortality risk associated with different multimorbidity measures was each analyzed using Cox regression. C-statistic, the Integrated Discrimination Improvement (IDI), and the Net Reclassification Index (NRI) were used to compare the performance of different multimorbidity measures., Results: Participants with multimorbidity, regardless of measurements, had a higher risk of death compared with people without multimorbidity. Compared with the mortality prediction model using age and sex, C-statistics showed added discrimination (over 0.77, all P < .05) for models with multimorbidity measures. Multimorbidity trajectory showed integrated discrimination and net reclassification improvement for mortality prediction compared to condition count (IDI = 0.042, NRI = 0.033) and multimorbidity pattern (IDI = 0.041, NRI = 0.069)., Conclusion: Adding multimorbidity measures significantly improved the performance of a mortality prediction model using age and sex as predictors. Trajectory-based measures of multimorbidity performed better than count- and pattern-based measures for mortality prediction., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate the price, availability, and affordability of essential medicines in primary healthcare institutions in Jiangsu Province., Methods: A mixed longitudinal and cross-sectional survey was conducted in primary healthcare institutions in Jiangsu based on the adjusted World Health Organization and Health Action International methodology. 45 essential medicines were collected from 30 primary healthcare institutions in Nanjing from 2016 to 2020. We also collected information on these medicines in 70 primary healthcare institutions across seven cities of Jiangsu in 2021. The availability, price, and affordability were compared with matched sets. Differences of availability between years and cities were further compared using Wilcoxon rank-sum test., Results: In Nanjing, the variation was significant of availability during the study period. The MPR was generally decreasing between 2016 and 2020, with the median price ratio (MPR) for lowest-priced generics (LPGs) ranging from 1.20 to 2.53 and originator brands (OBs) substantially above international levels. The median availability of generic medicines increased in 2018 and subsequently stabilized at around 55%, and the availability of originator medicines was low. There were no significant regional differences in prices across the sampled cities in Jiangsu, and the median MPR for LPGs was acceptable (1.23), while the median MPR for OBs was 8.54. The mean availability was different across regions ( p < 0.001), being higher in Nanjing (54.67%) and Nantong (56.22%), and lower in northern Jiangsu (about 35%). For LPGs, there was little difference in the proportion of medicines with low availability and high affordability (50.00% for urban residents and 40.48% for rural residents). For OBs, there were more than half of rural residents had low availability and low affordability of medicines (58.82%)., Conclusions: In terms of yearly changes, the prices of essential medicines have considerably decreased, and the availability of LPGs has slightly increased. However, the availability of medicines was found to be poor and there were regional differences in the availability and affordability of medicines among metropolitan and rural areas. Policy interventions targeting external factors associated with health resource allocation are essential and possible strategies include effective and efficient government investment mechanisms on primary healthcare., 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 Wang, He, Ren, Zhang, Cai, Cao and Li.)

Background: Cardiometabolic diseases (CMDs) are associated with depression. However, it is unclear whether coexisting CMDs may increase the risk of depression. We examined associations between cardiometabolic multimorbidity and depressive symptoms among middle-aged and older Chinese., Methods: Participants aged ≥45 years were enrolled from the China Health and Retirement Longitudinal Study 2011-2018 (N = 18,002). Cardiometabolic multimorbidity was defined as the coexistence of ≥2 CMDs, including stroke, heart disease, diabetes, hypertension, and dyslipidemia. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. We used generalized estimating equation models to examine associations between cardiometabolic multimorbidity and depressive symptoms, including the dose effect of disease count and prevalent disease combinations, as well as individual and additive effects of specific CMDs., Results: The prevalence of cardiometabolic multimorbidity was 24.5%. A higher number of CMDs had an additive dose effect on depressive symptoms that persisted consistently in specific CMDs. Stroke only, heart disease only, and diabetes only were each associated with a higher risk of depressive symptoms compared with no CMDs. CMD combinations involving stroke, heart disease, or diabetes were each associated with an increased risk of depressive symptoms compared with the absence of stroke, heart disease, or diabetes., Limitation: Self-reported chronic conditions., Conclusion: Stroke, heart disease, and diabetes showed individual and additive effects on CMD combinations, whereas hypertension and dyslipidemia only showed associations with depressive symptoms in combinations with other CMDs. These results suggest person-centered healthcare of mental health prevention and treatment for middle-aged and older adults with individual or multiple CMDs., (Copyright © 2022. Published by Elsevier B.V.)

The medical literature contains a wealth of valuable medical knowledge. At present, the research on extraction of entity relationship in medical literature has made great progress, but with the exponential increase in the number of medical literature, the annotation of medical text has become a big problem. In order to solve the problem of manual annotation time such as consuming and heavy workload, a remote monitoring annotation method is proposed, but this method will introduce a lot of noise. In this paper, a novel neural network structure based on convolutional neural network is proposed, which can solve a large number of noise problems. The model can use the multi-window convolutional neural network to automatically extract sentence features. After the sentence vectors are obtained, the sentences that are effective to the real relationship are selected through the attention mechanism. In particular, an entity type (ET) embedding method is proposed for relationship classification by adding entity type characteristics. The attention mechanism at sentence level is proposed for relation extraction in allusion to the unavoidable labeling errors in training texts. We conducted an experiment using 968 medical references on diabetes, and the results showed that compared with the baseline model, the present model achieved good results in the medical literature, and F1-score reached 93.15%. Finally, the extracted 11 types of relationships were stored as triples, and these triples were used to create a medical map of complex relationships with 33 347 nodes and 43 686 relationship edges. Experimental results show that the algorithm used in this paper is superior to the optimal reference system for relationship extraction.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal lung disease characterised by a fibrotic histological pattern found in usual interstitial pneumonia. Its causes, pathogenesis, clinical phenotype and molecular mechanisms are poorly defined. Large-scale, multicentre studies are warranted to better understand IPF as a disease in China, its associated risk factors, clinical characteristics, diagnosis, disease progression and treatment., Methods and Analysis: The Idiopathic Pulmonary Fibrosis Registry China Study (PORTRAY) is a prospective, multicentre registry study of patients with IPF in China. Eight hundred patients will be enrolled over a 36-month period and followed for at least 3 years to generate a comprehensive database on baseline characteristics and various follow-up parameters including patient-reported outcomes. Biological specimens will also be collected from patients to develop a library of blood, bronchoalveolar lavage fluid and lung biopsy samples, to support future research. As of 15 December 2019, 204 patients from 19 large medical centres with relatively high IPF diagnosis and treatment rates had been enrolled. Patient characteristics will be presented using descriptive statistics. The Kaplan-Meier method will be used for survival analyses. Repeated measures will be used to compare longitudinal changes in lung function, imaging and laboratory tests. Results following analysis have been projected to be available by July 2025., Ethics and Dissemination: The study protocol was reviewed and approved by the Institutional Review Board from all the study sites currently recruiting patients. Study results will be published in peer-reviewed journals., Trial Registration Number: NCT03666234., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Depressive symptoms are commonly seen among patients with multiple chronic somatic conditions, or somatic multimorbidity (SMM); however, little is known about the relationships between depressive symptoms and different SMM combinations. Our study aimed to delineate the patterns of SMM and their longitudinal associations with depressive symptoms among a nationally representative sample of middle-aged and older Chinese adults., Design: We employed a longitudinal design., Setting and Participants: Older adults (N = 10,084) aged ≥45 years from the China Health and Retirement Longitudinal Study 2011-2015 participated (mean age = 57.7 years at baseline; 53.3% men)., Methods: Sixteen chronic somatic conditions were ascertained at baseline via questionnaires. Depression was assessed with the Center for Epidemiological Studies Depression Scale at baseline and during follow-up. Patterns of SMM were identified via exploratory factor analyses. Generalized estimating equations were used to evaluate the longitudinal associations between patterns of SMM and the presence of depressive symptoms at follow-up., Results: Compared with participants with no somatic condition, those with 1, 2, and 3 or more somatic conditions had a 21%, 66%, and 111% greater risk, respectively, for the presence of depressive symptoms. Increased factor scores for 4 patterns identified, cardio-metabolic pattern [adjusted odds ratio (AOR) 1.12, 95% confidence interval (CI) 1.06, 1.20], respiratory pattern (AOR 1.25, 95% CI 1.17, 1.33), arthritic-digestive-visual pattern (AOR 1.29, 95% CI 1.22, 1.37), and hepatic-renal-skeletal pattern (AOR 1.09, 95% CI 1.02, 1.16), were all associated with a higher risk of having depressive symptoms., Conclusions and Implications: All SMM patterns were independently associated with depression among middle-aged and older Chinese adults, with greater odds for people with comorbid arthritic-digestive-visual conditions and respiratory conditions. Clinical practitioners should treat the middle-aged and older population under a multiple-condition framework combining SMM and mental disorders., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

In wheat production areas of China, soil lead (Pb) pollution is generally accompanied by cadmium (Cd) pollution and it is of considerable significance in repairing the Cd and Pb co-contaminated soils for safe agronomic production. Organosilicon fertilizer (OSiF) is a new type of silicon (Si) fertilizer that can effectively alleviate heavy metal toxicity in plants, but the mechanisms on its heavy metal detoxification are poorly understood. A soil pot experiment was conducted to evaluate and compare the effects of two OSiFs (OSiFA and OSiFB) and an inorganic silicon fertilizer (InOSiF) on wheat heavy metal uptake and biochemical parameters in a Cd and Pb co-contaminated soil. The results demonstrated that OSiFA, OSiFB and InOSiF could alleviate the Cd and Pb toxicity of wheat, as indicated by increasing wheat grain yield by 65%, 45% and 22%, respectively. The Si fertilizers enhanced leaf gas exchange attributes and chlorophyll content, whereas diminished the oxidative damage, as indicated by a lower level of hydrogen peroxide (H 2 O 2 ) and malondialdehyde (MDA) content, and lower activity of superoxide dismutase (SOD) and catalase (CAT) activity, as compared with control. Adding OSiFA, OSiFB and InOSiF increased Si uptake in roots and shoots, thus reducing Cd and Pb accumulation in the wheat shoot, bran and flour, especially, flour Cd contents by 17%, 10% and 31% respectively, flour Pb contents by 74%, 53% and 48% respectively. Also, Si fertilizers application decreased the health risk index (HRI) of both Cd and Pb. The grey correlation degrees of OSiFA, OSiFB and InOSiF are 0.72, 0.77 and 0.61, respectively, indicating that the effects of OSiFs on detoxifying Cd and Pb could be better than that of InOSiF in wheat. Thus, the use of OSiFs might be a feasible approach to reduce Cd and Pb entry into the human body through crops., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered., Trial Registration: ClinicalTrials.gov (NCT02318199)., Competing Interests: The authors have declared that no competing interests exist.

Background: Excessively deep sedation is prevalent in mechanically ventilated patients and often considered suboptimal. We hypothesized that the bispectral index (BIS), a quantified electroencephalogram instrument, would accurately detect deep levels of sedation., Methods: We prospectively enrolled 90 critically ill mechanically ventilated patients who were receiving sedation. The BIS was monitored for 24 hours and compared with the Richmond Agitation Sedation Scale (RASS) evaluated every 4 hours. Deep sedation was defined as a RASS of -3 to -5. Threshold values of baseline BIS (the lowest value before RASS assessment) and stimulated BIS (the highest value after standardized assessment) for detecting deep sedation were determined in a training set (45 patients, 262 RASS assessments). Diagnostic accuracy was then analyzed in a validation set (45 patients, 264 RASS assessments)., Results: Deep sedation was only prescribed in 6 (6.7%) patients, but 76 patients (84.4%) had at least 1 episode of deep sedation. Thresholds for detecting deep sedation of 50 for baseline and 80 for stimulated BIS were identified, with respective areas under the receiver-operating characteristic curve of 0.771 (95% confidence interval, 0.714-0.828) and 0.805 (0.752-0.857). The sensitivity and specificity of baseline BIS were 94.0% and 66.5% and of stimulated BIS were 91.0% and 66.5%. When baseline and stimulated BIS were combined, the sensitivity, specificity, and clinical utility index were 85.0% (76.1%-91.1%), 85.9% (79.5%-90.7%), and 66.9% (57.8%-76.0%), respectively., Conclusions: Combining baseline and stimulated BIS may help detect deep sedation in mechanically ventilated patients.

Indo-Pacific humpback dolphins (Sousa chinensis) are apex predators in the Pearl River Estuary waters (PRE) of China. PCBs, DDTs and other organochlorine pesticides (OCPs) (e.g., HCHs, HCB, mirex and dieldrin) were analysed in blubber samples of 45 dolphins and 10 prey fishes of S. chinensis collected from 2004 to 2013 in the PRE region to investigate the bioaccumulation and potential biomagnification of persistent organic pollutants (POPs). DDTs were the most abundant residue in the dolphins, with an average of 6,2700 ng g(-1) wet weight (ww), followed by PCBs (average: 1,790 ng g(-1) ww) and other OCPs including ∑HCHs, mirex, endrin, ∑chlordanes, HCB, dieldrin, aldrin, heptachlor, and pentachlorobenzene. The concentrations of PCBs and DDTs in male dolphins significantly increased with age and length. In contrast, female dolphins did not show obvious bioaccumulation trends with age and body length, possibly due to the lactational and parturitional transfer of these compounds. Compared with the POP residues in the prey fishes, the concentrations of PCBs, DDTs, and HCHs in the dolphin blubber increased by factors of 99, 212, and 5, respectively, whereas the residue levels of the other OCPs increased 2-185 times, indicating a potentially significant biomagnification in the top predators. The potential biomagnification factors calculated for most POPs were significantly higher than those in the cetacean species from other regions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Recent genome-wide association studies (GWASs) have identified 15q25.1 as a lung cancer susceptibility locus. Here, we sought to explore the direct carcinogenic effects of genetic variants in this region on the risk of developing lung adenocarcinoma (ADC). Five common SNPs (rs8034191, rs16969968, rs1051730, rs938682, and rs8042374) spanning the 15q25.1 locus were assayed in a case-control study examining a cohort of 301 lung ADCs and 318 healthy controls. Stratification analysis by gender, smoking status, and tumor, node, metastasis (TNM) classification, was performed. In addition, sections from ADC tissue and normal tissue adjacent to tumors were stained with an anti-CHRNA3 (cholinergic receptor nicotinic α3) antibody by immunohistochemistry in 81 cases. Our results demonstrate that rs8042374, a variant of the CHRNA3 gene, is associated with an increased risk of ADC with an OR of 1.76 (95% CI: 1.17-2.65, p=0.024). This variant was linked to a greater risk of ADC in female nonsmokers (OR (95% CI): 1.81 (1.05-3.12), p=0.032) and female stage I+II cases (OR (95% CI): 1.92 (1.03-3.57), p=0.039). Although located within the same gene, rs938682 showed protective effects for smokers, stage III+IV cases, and male stage III+IV cases. Additionally, the CHRNA3 protein level in ADC tissue was slightly higher than in the surrounding normal lung tissue, based on immunohistochemical analysis. Our results suggest that the CHRNA3 polymorphism functions as a genetic modifier of the risk of developing lung ADC in the Chinese population, particularly in nonsmoking females.

Ecological civilization is to normalize human development behaviors to harmonize the relationships between social and ecological development and eco-environment protection. In this paper, a comparative analysis was made on the ecological demonstration activities of ecological demonstration areas led by the Ministry of Environmental Protection, exemplar cities of national environmental protection, and ecological provinces, cities, and counties. It was considered that all the ecological demonstration activities had the problems of lacking pertinence of construction goals, disordered construction subjects, inefficient construction processes, and lacking continuous incentive mechanisms of assessment. In the meantime, through the analysis of the connotations of eco-civilization, the relationships between eco-civilization and eco-demonstration constructions were approached, and the eco-civilization construction mode was put forward in terms of construction goal, construction subject, and construction processes and assessment. The construction mode included the construction goal based on regional characteristics; the synergistic cooperation of construction subjects, the expanding ways of public participation, and the establishment of evaluation system for comprehensively measuring the 'actions and results'.

DNA hypomethylation and/or hypermethylation are presumed to be early events in carcinogenesis, and one or more DNA methyltransferases (DNMTs) have been suggested to play roles in carcinogenesis of gastric cancer (GC). However, there have been no systematic studies regarding the association between DNMT gene polymorphisms and GC risk. Here, we examined the associations of 16 single nucleotide polymorphisms (SNPs) from DNMT1 (rs2114724, rs2228611, rs2228612, rs8101866, rs16999593), DNMT2 (rs11695471, rs11254413), DNMT3A (rs1550117, rs11887120, rs13420827, rs13428812, rs6733301), DNMT3B (rs2424908, rs2424913, rs6087990) and DNMT3L (rs113593938) with GC in the Southern Chinese population. We assessed the associations of these 16 SNPs with GC in a case-control study that consisted of 242 GC cases and 294 controls, using the Sequenom MALDI-TOF-MS platform. Association analyses based on the χ(2) test and binary logistic regression were performed to determine the odds ratio (OR) and 95% confidence interval (95%CI) for each SNP. We found that rs16999593 in DNMT1, rs11254413 in DNMT2 and rs13420827 in DNMT3A were significantly associated with GC susceptibility (OR 1.45, 0.15, 0.66, respectively; 95% CI 1.00-2.11, p = 0.047; 0.08-0.27, p < 0.01; 0.45-0.97, p = 0.034, respectively, overdominant model). These results suggested that DNMT1, DNMT2 and DNMT3A may play important roles in GC carcinogenesis. However, further studies are required to elucidate the mechanism.